Mawu Oyamba
M'zamankhwala amakono azachipatala, zida ndi matekinoloje apamwamba apezeka, zomwe zimagwira ntchito yofunika kwambiri pakupititsa patsogolo magwiridwe antchito komanso kulondola kwachipatala. Mwa izi, gawo la electrosurgical unit, lomwe limadziwika kuti electrotome, limadziwika kuti ndi chida chofunikira kwambiri chomwe chimakhudza kwambiri maopaleshoni ndi zamankhwala.
Electrotome yakhala gawo lofunikira la zipinda zogwirira ntchito ndi zipatala padziko lonse lapansi. Zasintha momwe maopaleshoni amachitidwira, ndikupereka maubwino angapo kuposa maopaleshoni achikhalidwe. Mwachitsanzo, m’mbuyomu madokotala ochita opaleshoni ankakumana ndi mavuto monga kutaya magazi kwambiri akamachitidwa opaleshoni, zomwe zingachititse kuti odwalawo azivutika komanso kuti azichira kwa nthawi yaitali. Kubwera kwa electrotome kwachepetsa kwambiri nkhaniyi.
Kuphatikiza apo, electrotome yakulitsa mwayi wa maopaleshoni ochepa kwambiri. Njira zochepetsera pang'ono nthawi zambiri zimagwirizanitsidwa ndi kupweteka kochepa, kukhala m'chipatala kwaufupi, komanso kuchira msanga kwa odwala. Electrotome imathandiza madokotala kuchita maopaleshoni ovuta kwambiri ndi odulidwa ang'onoang'ono, kuchepetsa kuvulala kwa thupi la wodwalayo. Izi sizimangopindulitsa wodwalayo ponena za kuchira kwa thupi komanso zimakhala ndi zovuta zachuma, chifukwa kukhalapo kwafupipafupi kuchipatala kungayambitse kuchepetsa ndalama zothandizira zaumoyo.
Pamene sayansi ya zamankhwala ikupitilirabe kusinthika, kumvetsetsa mfundo zogwirira ntchito, kugwiritsa ntchito, komanso kuopsa kwa electrotome ndikofunikira kwa akatswiri azachipatala, odwala, komanso omwe ali ndi chidwi ndi zamankhwala. Nkhaniyi ikufuna kufufuza mozama za electrotome muzamankhwala azachipatala, ndikuwunika zaukadaulo wake, kugwiritsa ntchito mosiyanasiyana pazachipatala zosiyanasiyana, malingaliro achitetezo, komanso ziyembekezo zamtsogolo.
Mfundo Yogwirira Ntchito ya Mipeni Yopangira Ma Electrosurgical
Zoyambira Zamagetsi Amagetsi mu Opaleshoni
Mipeni yopangira ma electrosurgical imagwira ntchito mosiyanasiyana ndi ma scalpel achikhalidwe. Ma scalpel achikhalidwe amadalira m'mbali zakuthwa kuti adutse minofu, monga ngati mpeni wakukhitchini ukudula chakudya. Mawotchiwa amatha kusokoneza umphumphu wa minofu, ndipo mitsempha ya magazi imadulidwa, zomwe zimapangitsa kuti magazi azituluka, zomwe nthawi zambiri zimafuna njira zowonjezera za hemostasis, monga suturing kapena kugwiritsa ntchito hemostatic agents.
Mosiyana ndi izi, mipeni ya electrosurgical imagwiritsa ntchito ma frequency alternating current (AC). Mfundo yaikulu ndi yakuti pamene mphamvu yamagetsi ikudutsa m'kati mwa conductive, pamenepa, minofu yachilengedwe, kukana kwa minofu kumayambitsa kutembenuka kwa mphamvu yamagetsi kukhala mphamvu yotentha. Kutentha kumeneku ndiye chinsinsi cha magwiridwe antchito a Electrosurgical Unit.
Electrosurgical unit (ESU) yomwe imapatsa mphamvu Electrosurgical Unit ili ndi jenereta yothamanga kwambiri. Jenereta iyi imapanga magetsi osinthasintha okhala ndi ma frequency a mazana a kilohertz (kHz) mpaka ma megahertz angapo (MHz). Mwachitsanzo, zida zambiri zopangira opaleshoni yamagetsi zimagwira ntchito pafupipafupi 300 kHz mpaka 500 kHz. Kuthamanga kwapamwamba kumeneku kumaperekedwa kumalo opangira opaleshoni kudzera pa electrode yapadera, yomwe ili nsonga ya Electrosurgical Unit.
Pamene ma frequency apamwamba afika pa minofu, kukana kwa minofu ndi kutuluka kwa ma elekitironi kumapangitsa minofu kutenthedwa. Pamene kutentha kumakwera, madzi a m’maselo a minofuyo amayamba kuphwa. Kuphulika kumeneku kumabweretsa kukula kofulumira kwa maselo, kuwapangitsa kuti aphwanyike ndikupangitsa kuti minofu idulidwe. Kwenikweni, Electrosurgical Unit 'yowotcha' kudzera mu minofu, koma mwadongosolo, monga mphamvu ndi mafupipafupi amakono amatha kusinthidwa malinga ndi zofunikira za opaleshoni.
Udindo Wa Ma Frequency Osiyanasiyana
Kuchuluka kwa magetsi osinthasintha mu Electrosurgical Unit kumagwira ntchito yofunika kwambiri pozindikira ntchito zake panthawi ya opaleshoni, monga kudula ndi kukomoka.
Kudula Ntchito :
Pantchito yodula, mafunde apamwamba kwambiri - pafupipafupi mosalekeza - ma wave wave amagwiritsidwa ntchito nthawi zambiri. Pamene mkulu - pafupipafupi panopa ntchito minofu, mofulumira oscillation wa magetsi munda kumapangitsa kuti mlandu particles mkati minofu (monga ayoni mu extracellular ndi intracellular madzimadzi) kusuntha mmbuyo ndi mtsogolo mofulumira. Kuyenda kumeneku kumapangitsa kutentha kwamphamvu, komwe kumatulutsa madzi m'maselo mwachangu. Pamene maselo anaphulika chifukwa mofulumira vaporization madzi, minofu ndi bwino kudula.
Mafunde apamwamba kwambiri - pafupipafupi - mafunde akudulira adapangidwa kuti apangitse kutentha kwakukulu kumapeto kwa Electrosurgical Unit. Kutentha kwakukulu kumeneku kumapangitsa kuti minofu idutse mwachangu komanso mwaukhondo. Chofunika kwambiri ndi kukhala ndi mphamvu zokwanira zoperekedwa mu nthawi yochepa kuti ziwononge maselo a minofu. Mwachitsanzo, popanga maopaleshoni ngati ocheka khungu, Electrosurgical Unit imayikidwa panjira yodulira yokhala ndi ma frequency oyenerera amatha kupanga madulidwe osalala, kuchepetsa kuvulala kwa minofu ndikuchepetsa chiwopsezo cha kung'ambika kapena kusweka m'mbali zomwe zitha kuchitika ndi scalpel yachikhalidwe.
Ntchito ya Coagulation :
Pankhani ya coagulation, ma frequency osiyanasiyana ndi mawonekedwe apano amagwiritsidwa ntchito. Coagulation ndi njira yoletsa kutuluka kwa magazi popangitsa kuti mapuloteni omwe ali m'magazi ndi minofu yozungulira asinthe mawonekedwe ndikupanga kuundana - ngati chinthu. Izi zimatheka pogwiritsa ntchito otsika - pafupipafupi, pulsed - wave current.
The pulsed - wave current imapereka mphamvu mu kuphulika kwafupipafupi. Mphamvu yamagetsi iyi ikadutsa mu minofu, imatenthetsa minofuyo mowongoka kwambiri poyerekeza ndi mafunde osalekeza omwe amagwiritsidwa ntchito podula. Kutentha kwaiye n'kokwanira kuti denature mapuloteni m'magazi ndi minofu, koma sikokwanira chifukwa mofulumira vaporization ngati nkhani ya kudula. Kusokoneza kumeneku kumapangitsa kuti mapuloteniwo azilumikizana, ndikutseka mitsempha yaying'ono yamagazi ndikuletsa kutuluka kwa magazi. Mwachitsanzo, popanga opaleshoni pomwe pamakhala zotuluka magazi pang'ono pamwamba pa chiwalo, dokotalayo amatha kusintha gawo la Electrosurgical Unit kuti likhale lophatikizana. M'munsi - pafupipafupi pulsed - wave current idzagwiritsidwa ntchito kumalo otuluka magazi, zomwe zimapangitsa kuti mitsempha ya magazi itseke ndipo kutuluka kwa magazi kutha.
Mitundu ya Mipeni Yopangira Ma Electrosurgical
Mipeni ya Monopolar Electrosurgical
Mipeni ya monopolar electrosurgical ndi imodzi mwa mitundu yomwe imagwiritsidwa ntchito kwambiri popanga opaleshoni. Mwadongosolo, monopolar Electrosurgical Unit imakhala ndi electrode ya m'manja, yomwe ndi gawo lomwe dokotalayo amawongolera mwachindunji. Electrode iyi imalumikizidwa ndi electrosurgical unit (ESU) kudzera pa chingwe. ESU ndiye gwero lamphamvu lomwe limapanga magetsi apamwamba kwambiri.
Mfundo yogwira ntchito ya monopolar Electrosurgical Unit imachokera pamagetsi athunthu. Ma frequency apamwamba kwambiri amatulutsidwa kuchokera kunsonga kwa electrode ya m'manja. Pamene nsongayo ikukhudzana ndi minofu, panopa imadutsa mu minofu ndikubwerera ku ESU kupyolera mu electrode yosokoneza, yomwe nthawi zambiri imatchedwa pad pad. Pansi iyi nthawi zambiri imayikidwa pagawo lalikulu la thupi la wodwalayo, monga ntchafu kapena kumbuyo. Cholinga cha pad pansi ndi kupereka njira yotsika-yokanika kuti panopa abwerere ku ESU, kuonetsetsa kuti panopa kufalikira kudera lalikulu la thupi la wodwalayo, kuchepetsa chiopsezo chowotcha pobwerera.
Pankhani ya ntchito, mipeni ya monopolar electrosurgical imagwiritsidwa ntchito kwambiri popanga maopaleshoni osiyanasiyana. Nthawi zambiri opaleshoni, amagwiritsidwa ntchito popanga ma incision panjira ngati appendectomies. Pochotsa zakumapeto, dokotala wa opaleshoni amagwiritsa ntchito monopolar Electrosurgical Unit kuti apange chocheka pakhoma lamimba. The mkulu - pafupipafupi panopa amalola kuti magazi ndi - ochepa odulidwa, monga kutentha kwaiye ndi panopa akhoza coagulate ang'onoang'ono mitsempha nthawi imodzi, kuchepetsa kufunika osiyana hemostatic miyeso ang'onoang'ono magazi.
Mu neurosurgery, mipeni ya monopolar electrosurgical imagwiritsidwanso ntchito, ngakhale mosamala kwambiri chifukwa cha kufooka kwa minofu ya neural. Atha kugwiritsidwa ntchito ngati kugawa minyewa yozungulira chotupa chaubongo. Kukhoza kwenikweni kudula kwa mpeni wa monopolar kungathandize dokotalayo kuti alekanitse chotupacho ndi minofu yathanzi yaubongo yozungulira. Komabe, makonzedwe amagetsi amayenera kusinthidwa mosamala kuti apewe kuwonongeka kwa kutentha kwambiri kuzinthu zapafupi za neural.
Pa opaleshoni ya pulasitiki, mipeni ya monopolar electrosurgical imagwiritsidwa ntchito popanga njira zopangira zingwe zapakhungu. Mwachitsanzo, panthawi ya opaleshoni yokonzanso mawere, dokotala wa opaleshoni angagwiritse ntchito monopolar Electrosurgical Unit kuti apange zipsera za khungu kuchokera kumadera ena a thupi, monga mimba. Kutha kudula ndi kunyezimira nthawi yomweyo kumathandizira kuchepetsa magazi panthawi yovuta yopanga zingwe, zomwe ndizofunikira kwambiri pakumanganso bwino.
Mipeni ya Bipolar Electrosurgical
Mipeni ya Bipolar electrosurgical ili ndi mapangidwe ake komanso mawonekedwe ake omwe amawapangitsa kukhala oyenera maopaleshoni ena, makamaka omwe amafunikira kulondola kwambiri. Mwadongosolo, bipolar Electrosurgical Unit ili ndi maelekitirodi awiri pafupi ndi mzake kumapeto. Ma electrode awiriwa nthawi zambiri amakhala mkati mwa chida chimodzi.
Mfundo yogwiritsira ntchito mipeni ya bipolar electrosurgical ndi yosiyana ndi monopolar. Mu dongosolo la bipolar, ma frequency apamwamba amayenda pakati pa ma elekitirodi awiri otalikirana kwambiri kumapeto kwa chidacho. Pamene nsonga ikugwiritsidwa ntchito ku minofu, panopa imadutsa minofu yomwe imakhudzana ndi ma electrode onse. Kuthamanga komweku komweko kumatanthauza kuti kutentha ndi zotsatira za minofu zimangokhala m'dera lapakati pa ma electrode awiri. Chotsatira chake, kutentha komwe kumapangidwa kumakhala kochuluka kwambiri ndipo sikungatheke kufalikira kumagulu ozungulira.
Chimodzi mwazifukwa zazikulu zomwe mipeni ya bipolar electrosurgical imakonda kuchitidwa maopaleshoni abwino ndikutha kuwongolera bwino pakutentha kwa minofu ndi kudula. M'maopaleshoni amaso, mwachitsanzo, pomwe mapangidwe ake ndi osalimba kwambiri, mipeni yopangira opaleshoni yamagetsi imatha kugwiritsidwa ntchito popanga njira monga iris resection. Dokotala wa opaleshoni amatha kugwiritsa ntchito mpeni wa bipolar kuti adule bwino ndikugwirizanitsa minofu ya m'dera la iris popanda kuwononga lens yoyandikana nayo kapena zinthu zina zofunika kwambiri za maso. Kutentha kwapakati kumatsimikizira kuti chiwopsezo cha kuwonongeka kwa kutentha kwa minyewa yozungulira yozungulira imachepetsedwa.
M'maopaleshoni ang'onoang'ono, monga omwe amakhudza kukonza mitsempha yaing'ono yamagazi kapena minyewa, mipeni yopangira ma electrosurgical ndi yofunika kwambiri. Pamene mukuchita microsurgical anastomosis (suturing pamodzi) ya mitsempha yaing'ono yamagazi, mpeni wa bipolar ukhoza kugwiritsidwa ntchito kuti mutseke pang'onopang'ono magazi ang'onoang'ono popanda kusokoneza kukhulupirika kwa makoma a mitsempha ya magazi kapena mitsempha yapafupi. Kutha kuwongolera bwino zomwe zikuchitika komanso kutentha zimalola dokotalayo kuti agwire ntchito m'gawo laling'ono komanso losakhwima, ndikuwonjezera mwayi wopeza bwino. Kuonjezera apo, popeza magetsiwa amakhala pakati pa maelekitirodi awiriwa, palibe chifukwa chokhalira ndi pad yaikulu monga momwe zimakhalira ndi machitidwe a monopolar, omwe amathandizira kukhazikitsa maopaleshoni abwinowa.
Ntchito Zachipatala
General Surgery
Pama opaleshoni ambiri, mipeni ya electrosurgical imagwiritsidwa ntchito kwambiri m'njira zosiyanasiyana, zomwe zimapereka zabwino zingapo.
Appendectomy :
Appendectomy ndi njira yodziwika bwino yopangira opaleshoni yochotsa chowonjezera, chomwe nthawi zambiri chimakhala chotupa kapena kachilombo. Mukamagwiritsa ntchito Electrosurgical Unit mu appendectomy, kuthamanga kwafupipafupi kumapangitsa kuti magazi azikhala ochepa - kung'ambika pang'ono kwa appendix kuchokera kumagulu ozungulira. Mwachitsanzo, pankhani ya laparoscopic appendectomy, monopolar kapena bipolar Electrosurgical Unit ingagwiritsidwe ntchito kudzera m'madoko a trocar. Ntchito yodula ya Electrosurgical Unit imathandizira dokotalayo kuti adule mwachangu komanso mwaukhondo mesoappendix, yomwe ili ndi mitsempha yamagazi yomwe imapereka zowonjezera. Panthawi imodzimodziyo, ntchito ya coagulation imasindikiza mitsempha yaing'ono yamagazi mkati mwa mesoappendix, kuchepetsa chiopsezo chotaya magazi panthawi ya opaleshoni. Izi sizimangopangitsa kuti malo opangira opaleshoni amveke bwino kwa dokotala komanso amafupikitsa nthawi yonse ya opaleshoni. Mosiyana ndi izi, njira zachikhalidwe zogwiritsira ntchito scalpel kudula masoappendix ndiyeno padera kulumikiza mtsempha uliwonse wamagazi ndi nthawi yambiri - ikudya ndipo zingayambitse magazi ambiri.
Cholecystectomy :
Cholecystectomy, kuchotsa opaleshoni ya ndulu, ndi malo ena kumene mipeni ya electrosurgical imagwira ntchito yofunika kwambiri. Mu cholecystectomy yotseguka, Electrosurgical Unit ingagwiritsidwe ntchito kupukuta zigawo za m'mimba, kuphatikizapo khungu, minofu ya subcutaneous, ndi minofu. Pamene imadutsa mu minofu imeneyi, nthawi imodzi imagwirizanitsa mitsempha yaing'ono yamagazi, kuchepetsa kutaya magazi. Pakung'ambika kwa ndulu kuchokera pachiwindi, mphamvu ya Electrosurgical Unit coagulation imathandizira kutseka timitsempha ting'onoting'ono tamagazi ndi timadontho ta ndulu timene timalumikiza ndulu ndi chiwindi, kuchepetsa chiopsezo chotaya magazi pambuyo pa opaleshoni komanso kutuluka kwa bile.
Mu laparoscopic cholecystectomy, yomwe ndi njira yochepetsera pang'ono, Electrosurgical Unit ndiyofunika kwambiri. The bipolar electrosurgical forceps nthawi zambiri amagwiritsidwa ntchito pochotsa mosamala mitsempha ya cystic ndi cystic duct. Mayendedwe apano omwe amapezeka m'zida zopangira ma electrosurgical bipolar amalola kukhazikika bwino ndikudula kwazinthu izi, kuchepetsa chiwopsezo cha kuwonongeka kwa njira yapafupi ya bile ndi zina zofunika kwambiri. Kukhoza kuchita zinthu zophwekazi ndi Electrosurgical Unit kudzera m'mapapo ang'onoang'ono ndi mwayi waukulu, chifukwa kumabweretsa ululu wochepa, kukhala m'chipatala chachifupi, komanso nthawi yochira msanga kwa odwala poyerekeza ndi opaleshoni yotsegula.
Opaleshoni Yachikazi
Mipeni ya Electrosurgical yapeza kugwiritsidwa ntchito kwambiri pakuchita maopaleshoni achikazi, zomwe zimapangitsa kuti pakhale njira zolondola komanso zogwira mtima.
Hysterectomy kwa Uterine Fibroids :
Uterine fibroids ndi zotupa zomwe sizikhala ndi khansa m'chiberekero zomwe zingayambitse zizindikiro monga kutaya magazi kwambiri, kupweteka kwa m'chiuno, ndi kusabereka. Pochita hysterectomy (kuchotsa chiberekero) kuchiza fibroids zazikulu kapena zizindikiro, mipeni ya electrosurgical ingagwiritsidwe ntchito m'njira zingapo. Mu hysterectomy yotseguka, Electrosurgical Unit imagwiritsidwa ntchito kupaka khoma la m'mimba. Pakuphulika kwa chiberekero kuchokera kuzinthu zozungulira, monga chikhodzodzo, rectum, ndi pelvic sidewalls, Electrosurgical Unit's cutting and coagulation ntchito zimagwiritsidwa ntchito. Ikhoza kudulidwa ndendende m'mitsempha ya chiberekero, yomwe imakhala ndi mitsempha ya magazi, pamene nthawi yomweyo imatseka mitsempha kuti zisawonongeke. Izi zimachepetsa kufunika kwa mitsempha yambiri ya mitsempha, kupangitsa kuti opaleshoni ikhale yosavuta.
Mu laparoscopic kapena robotic - hysterectomy yothandizira, yomwe ndi njira zochepetsera pang'ono, zida za electrosurgical, kuphatikizapo monopolar ndi bipolar electrosurgical zipangizo, zimagwiritsidwa ntchito kwambiri. The bipolar electrosurgical forceps angagwiritsidwe ntchito kugawa mosamala ndi kulumikiza mitsempha yamagazi mozungulira chiberekero, kuonetsetsa kuti magazi - ochepa malo ochotsamo bwino chiberekero. Kuchepa kwa njirazi, zomwe zimatheka chifukwa chogwiritsa ntchito mipeni yopangira magetsi, zimapangitsa kuti wodwalayo asavutike kwambiri, amakhala m'chipatala nthawi yayitali, komanso nthawi yochira msanga.
Opaleshoni Yachibelekero :
Pochita maopaleshoni a khomo lachiberekero, monga loop - electrosurgical excision procedure (LEEP) pochiza khomo lachiberekero intraepithelial neoplasia (CIN) kapena khomo lachiberekero, mipeni yopangira electrosurgical ndiyo zida zomwe amakonda. Mu njira ya LEEP, electrode yopyapyala ya waya yolumikizidwa ku gawo la electrosurgical imagwiritsidwa ntchito. Kuthamanga kwapamwamba kwambiri komwe kumadutsa pamtunda kumapangitsa kutentha, komwe kumapangitsa kuti minyewa ya khomo lachiberekero idutse bwino. Njirayi imakhala yothandiza kwambiri pochotsa minofu yodwalayo ndikuchepetsa kuwonongeka kwa minofu yozungulira yathanzi lachiberekero.
Kafukufuku wasonyeza kuti LEEP ili ndi maubwino angapo. Mwachitsanzo, ili ndi chiwopsezo chachikulu pochiza CIN. Nthawi yogwira ntchito ndi yochepa, nthawi zambiri imakhala pafupifupi mphindi 5-10. Kutaya magazi kwa intraoperative kumakhala kochepa, nthawi zambiri kumakhala kosakwana 10 ml. Kuonjezera apo, chiopsezo cha zovuta monga matenda ndi kutuluka magazi ndizochepa. Pambuyo pa ndondomekoyi, wodwalayo amatha kuyambiranso ntchito zachizolowezi mofulumira, ndipo kutsata kwa nthawi yaitali kumasonyeza kuchepa kwa zilonda zam'chiberekero. Ubwino winanso ndikuti minofu yochotsedwayo imatha kutumizidwa kuti ikafufuze zolondola zamatenda, zomwe ndizofunikira kudziwa kukula kwa matendawa ndikuwongolera chithandizo china ngati kuli kofunikira.
Opaleshoni ya Mitsempha
Mu neurosurgery, kugwiritsa ntchito mipeni yopangira ma elekitirodi ndikofunikira kwambiri chifukwa cha kufooka kwa minofu ya minyewa komanso kufunikira kwa maopaleshoni olondola.
Pochotsa zotupa za muubongo, Electrosurgical Unit imalola katswiri wa opaleshoni ya neurosurgeon kuti athyole chotupacho kuchokera muminyewa yathanzi yaubongo. Monopolar Electrosurgical Unit ingagwiritsidwe ntchito ndi zoikamo zotsika kwambiri - kuchepetsa chiwopsezo cha kuwonongeka kwa matenthedwe amtundu wapafupi wa neural. The mkulu - pafupipafupi panopa ntchito ndendende kudula chotupa minofu pamene imodzi coagulating yaing`ono mitsempha mkati chotupa, kuchepetsa magazi. Izi ndizofunikira chifukwa magazi ambiri muubongo amatha kupangitsa kuti magazi azithamanga kwambiri komanso kuwonongeka kwa minofu yozungulira yaubongo.
Mwachitsanzo, pankhani ya meningioma, yomwe ndi mtundu wamba wa chotupa cha muubongo chomwe chimachokera ku meninges (mitsempha yomwe imaphimba ubongo), dokotala wa opaleshoni amagwiritsa ntchito Electrosurgical Unit kuti alekanitse chotupacho kuchokera ku ubongo wapansi. Kutha kuwongolera kudula ndi kuphatikizika bwino ndi Electrosurgical Unit kumathandiza kuti ubongo ugwire bwino ntchito momwe mungathere. The bipolar electrosurgical forceps amagwiritsidwanso ntchito kawirikawiri mu neurosurgery, makamaka pa ntchito zomwe zimafuna kuwongolera bwino kwambiri, monga kulumikiza mitsempha yaying'ono yamagazi pafupi ndi minyewa yofunika kwambiri. Mayendedwe apano omwe amapezeka m'zida za bipolar amatsimikizira kuti kutentha komwe kumapangidwa kumangokhala kudera laling'ono kwambiri, kuchepetsa chiopsezo cha kuwonongeka kwa chiwongola dzanja ku minofu yozungulira yozungulira.
Ubwino pa Zida Zachikhalidwe Zopangira Opaleshoni
Hemostasis ndi Kuchepetsa Kutaya Magazi
Ubwino umodzi wofunikira kwambiri wa mipeni yopangira ma electrosurgery kuposa zida zopangira maopaleshoni achikhalidwe ndi kuthekera kwawo kodabwitsa kwa hemostatic, komwe kumabweretsa kuchepa kwakukulu kwa kutaya magazi panthawi ya opaleshoni. Ma scalpel achikhalidwe, akagwiritsidwa ntchito podula minyewa, amangodula mitsempha yamagazi, kuisiya yotseguka ndikutuluka magazi. Izi nthawi zambiri zimafuna nthawi yowonjezera - kuwononga njira zochepetsera magazi, monga kupukuta mtsempha waung'ono uliwonse kapena kugwiritsa ntchito hemostatic agents.
Mosiyana ndi zimenezi, mipeni ya electrosurgical, kupyolera mu mphamvu yake yotentha, imatha kugwirizanitsa mitsempha yaing'ono yamagazi pamene ikudula. Pamene mkulu - pafupipafupi panopa akudutsa minofu, kutentha kwaiye denatures mapuloteni m'magazi ndi chotengera makoma. Kusintha kumeneku kumapangitsa magazi kuundana ndipo mitsempha yamagazi imatsekeka. Mwachitsanzo, popanga maopaleshoni ambiri monga kupangidwa kwa chikopa, scalpel yachikhalidwe ingafune kuti dokotala ayime nthawi zonse ndikuwongolera kutuluka kwa magazi, komwe kumatha kukhala kochulukira. Ndi Electrosurgical Unit, momwe imapangidwira, mitsempha yaying'ono yapakhungu ndi minofu ya subcutaneous imalumikizidwa nthawi imodzi. Izi sizimangochepetsa kutayika kwa magazi onse panthawi ya opareshoni komanso zimapereka malo omveka bwino opangira opaleshoni. Kafukufuku woyerekeza kugwiritsiridwa ntchito kwa mipeni yopangira ma electroopaleshoni ndi ma scalpels achikhalidwe pa maopaleshoni ena a m’mimba anapeza kuti pafupifupi kutaya magazi kunachepetsedwa ndi pafupifupi 30 - 40% pogwiritsira ntchito mipeni yopangira magetsi. Kuchepetsa kutaya magazi kumeneku n’kofunika kwambiri chifukwa kutaya magazi kwambiri kungayambitse mavuto monga kuchepa kwa magazi m’thupi, kunjenjemera, ndiponso kuchira kwa nthawi yaitali kwa wodwalayo.
Kuphatikizika Kwabwino Kwambiri ndi Kuphatikizika Kwa Tissue
Mipeni yopangira ma electrosurgical imapereka njira yolondola kwambiri yocheka ndi kuphatikizira minofu, zomwe ndikusintha kwakukulu kuposa zida zachikhalidwe zopangira opaleshoni. Ma scalpels achikale amakhala ndi kudula kosawoneka bwino pamlingo wa microscopic. Angayambitse kung'ambika ndi kuwonongeka kwa minofu yozungulira chifukwa cha mphamvu yamakina yomwe imagwiritsidwa ntchito podula. Izi zitha kukhala zovuta makamaka mukamagwira ntchito m'malo omwe minyewa ndi yosalimba kapena pomwe pali zida zofunika kwambiri pafupi.
Mipeni ya Electrosurgical, Komano, imagwiritsa ntchito kutentha komwe kumayendetsedwa podula. Nsonga ya Electrosurgical Unit ikhoza kupangidwa kuti ikhale ndi malo ochepa kwambiri, omwe amalola kudula molondola kwambiri. Mwachitsanzo, mu neurosurgery, pochotsa chotupa chaching'ono chomwe chili pafupi ndi minyewa yofunika kwambiri, dokotalayo amatha kugwiritsa ntchito Electrosurgical Unit yokhala ndi chotupa chabwino kwambiri. Kuthamanga kwapang'onopang'ono kumatha kusinthidwa kukhala mulingo womwe umadula bwino minofu ya chotupa ndikuchepetsa kuwonongeka kwamafuta omwe ali pafupi ndi ubongo wathanzi. Kukhoza kulamulira mphamvu ndi mafupipafupi a Electrosurgical Unit kumathandiza dokotalayo kuti apange ma dissections a minofu molondola kwambiri. M'maopaleshoni ang'onoang'ono, monga omwe amakhudza kukonzanso mitsempha yaying'ono yamagazi kapena minyewa, mipeni yamagetsi ya bipolar imatha kudula ndikulumikiza minyewa pamalo opangira opaleshoni yaying'ono kwambiri, kuchepetsa chiopsezo cha kuwonongeka kwa zinthu zozungulira. Kulondola kumeneku sikumangowonjezera zotsatira za opaleshoniyo komanso kumachepetsanso zovuta zomwe zimachitika pambuyo pa opaleshoni yokhudzana ndi kuwonongeka kwa minofu.
Nthawi Yaifupi Yogwirira Ntchito
Kugwiritsa ntchito mipeni yopangira ma electrosurgical kungayambitse nthawi yayitali yopangira opaleshoni poyerekeza ndi zida zachikhalidwe zochitira opaleshoni, zomwe zimapindulitsa kwa wodwala komanso gulu la opaleshoni. Monga tanena kale, mipeni yopangira ma electrosurgical imatha kudula ndikulumikizana nthawi imodzi. Zimenezi zimathetsa kufunika kwa dokotala wochita maopaleshoni ochita masitepe osiyana podula ndi kuletsa kutuluka kwa magazi, monga momwe zimakhalira ndi scalpels zachikhalidwe.
Mu opaleshoni yovuta ngati hysterectomy, pogwiritsira ntchito scalpel yachikhalidwe, dokotalayo ayenera kudula mosamala minofu ndi mitsempha yozungulira chiberekero ndiyeno payekha ligate kapena cauterize chotengera chilichonse cha magazi kuti asatuluke. Njirayi ikhoza kukhala nthawi yambiri, makamaka pochita ndi mitsempha yambiri yaing'ono. Ndi Electrosurgical Unit, dokotalayo amatha kudula mwachangu minofuyo ndikumangirira mitsempha yamagazi, ndikuwongolera opaleshoniyo. Kafukufuku wasonyeza kuti nthawi zina kugwiritsa ntchito mipeni electrosurgical akhoza kuchepetsa nthawi opaleshoni ndi 20 - 30%. Nthawi zazifupi zogwirira ntchito zimagwirizanitsidwa ndi kuchepetsedwa kwa chiwopsezo cha zovuta zokhudzana ndi nthawi yayitali ya anesthesia. Wodwala akamadwala nthawi yayitali, ndiye kuti pamakhala chiopsezo chachikulu cha kupuma ndi mtima. Kuonjezera apo, kufupikitsa nthawi zogwirira ntchito kumatanthauza kuti gulu la opaleshoni likhoza kuchita zambiri mu nthawi yoperekedwa, zomwe zingathe kuwonjezera mphamvu za chipinda chogwirira ntchito komanso kuchepetsa ndalama zonse zachipatala.
Zowopsa Zomwe Zingatheke ndi Zovuta
Kuvulala Kwamafuta Kumatenda Ozungulira
Ngakhale pali zabwino zambiri, kugwiritsa ntchito mipeni yopangira ma electrosurgical muzachipatala sikuli koopsa. Chimodzi mwazinthu zomwe zimadetsa nkhawa kwambiri ndikuvulala kwamafuta ozungulira.
Pamene Electrosurgical Unit ikugwira ntchito, mphamvu yamagetsi yamagetsi imatulutsa kutentha kuti tidutse ndikuundana minofu. Komabe, kutentha kumeneku nthawi zina kumatha kufalikira kupitirira malo omwe akufuna. Mwachitsanzo, mu maopaleshoni a laparoscopic, monopolar Electrosurgical Unit, ngati sichigwiritsidwa ntchito mosamala, ikhoza kufalitsa kutentha kupyolera mu zida zowonda za laparoscopic ndikuwononga kutentha kwa ziwalo zoyandikana nazo. Izi ndichifukwa choti kutentha komwe kumapangidwa kumapeto kwa electrode kumatha kuyendetsa patsinde la chidacho. Pakafukufuku wa milandu ya laparoscopic cholecystectomy, adapezeka kuti pafupifupi 1 - 2% ya milandu, panali kuvulala pang'ono kwa kutentha kufupi ndi duodenum kapena m'matumbo, zomwe mwina zidachitika chifukwa cha kutentha kwa Electrosurgical Unit panthawi yochotsa ndulu.
Kuopsa kwa kuvulala kwamafuta kumakhudzananso ndi makonzedwe amagetsi a Electrosurgical Unit. Ngati mphamvuyo yayikidwa kwambiri, kutentha komwe kumapangidwa kudzakhala kwakukulu, kuonjezera mwayi wa kutentha kufalikira kumagulu ozungulira. Kuphatikiza apo, nthawi yolumikizana pakati pa Electrosurgical Unit ndi minofu imakhala ndi gawo. Kulumikizana kwa nthawi yayitali ndi minofu kungayambitse kutentha kwakukulu, kumayambitsa kuwonongeka kwakukulu kwa kutentha.
Pofuna kupewa kuwonongeka kwa kutentha kwa minofu yozungulira, njira zingapo zingatengedwe. Choyamba, madokotala ochita opaleshoni ayenera kuphunzitsidwa bwino kugwiritsa ntchito mipeni ya electrosurgical. Ayenera kumvetsetsa bwino za makonzedwe oyenera a mphamvu zamitundu yosiyanasiyana ya minofu ndi njira zopangira opaleshoni. Mwachitsanzo, pogwira ntchito pazigawo zofooka monga chiwindi kapena ubongo, kuchepetsa mphamvu zamagetsi kumafunika kuchepetsa chiopsezo cha kuwonongeka kwa kutentha. Kachiwiri, kutchinjiriza koyenera kwa zida za electrosurgical ndikofunikira. Kutsekereza mitsinje ya zida za laparoscopic kumatha kuletsa kutentha kwa ziwalo zoyandikana nazo. Makina ena apamwamba a electrosurgical amabweranso ndi zinthu zomwe zimawunika kutentha kwa malo opangira opaleshoni. Njira zowunikira kutenthazi zimatha kuchenjeza dokotalayo ngati kutentha kwa minyewa yozungulira iyamba kukwera pamwamba pamlingo wotetezeka, zomwe zimalola dokotalayo kuti asinthe mphamvu kapena kutalika kwa nthawi yogwiritsira ntchito electrosurgical nthawi yomweyo.
Matenda ndi Zowopsa Zamagetsi
Zowopsa zina zomwe zimagwirizanitsidwa ndi kugwiritsa ntchito mipeni ya electrosurgical ndi kuthekera kwa matenda ndi zoopsa zamagetsi.
Matenda :
Panthawi ya opaleshoni, kugwiritsa ntchito mipeni ya electrosurgical kungapangitse malo omwe angawonjezere chiopsezo cha matenda. Kutentha kopangidwa ndi Electrosurgical Unit kungayambitse kuwonongeka kwa minofu, zomwe zingasokoneze njira zodzitetezera m'thupi. Minofu ikawonongeka chifukwa cha kutentha, imatha kugwidwa ndi bakiteriya. Mwachitsanzo, ngati malo opangira opaleshoni sanatsukidwe bwino komanso otetezedwa ndi tizilombo toyambitsa matenda musanagwiritse ntchito Electrosurgical Unit, mabakiteriya aliwonse omwe amapezeka pakhungu kapena ozungulira akhoza kulowetsedwa mu minofu yowonongeka. Kuphatikiza apo, minofu yowotcha yomwe imapangidwa panthawi ya electrosurgical imatha kupereka malo abwino kuti mabakiteriya akule. Kafukufuku wokhudza matenda opangira opaleshoni pambuyo pa njira zogwiritsira ntchito mipeni yopangira ma electrosurgical anapeza kuti kuchuluka kwa matenda kunali kokwera pang'ono poyerekeza ndi maopaleshoni ogwiritsira ntchito njira zachikhalidwe nthawi zina, makamaka pamene matenda oyenera - njira zodzitetezera sizinatsatidwe.
Kuti muchepetse chiopsezo cha matenda, kukonzekera koyambirira kwa khungu ndikofunikira. Malo opangira opaleshoni ayenera kutsukidwa bwino ndi njira zoyenera zowononga tizilombo toyambitsa matenda kuti achepetse chiwerengero cha mabakiteriya pakhungu. Njira zopangira maopaleshoni monga kugwiritsa ntchito zida za electrosurgical osabala komanso kukonza malo osabala ndizofunikiranso. Pambuyo pa opaleshoni, chisamaliro choyenera cha bala, kuphatikizapo kusintha kwa kuvala nthawi zonse ndi kugwiritsa ntchito mankhwala opha tizilombo ngati kuli kofunikira, kungathandize kupewa kukula kwa matenda.
Zowopsa Zamagetsi :
Zowopsa zamagetsi zimadetsanso nkhawa kwambiri mukamagwiritsa ntchito mipeni yamagetsi. Zowopsa izi zitha kuchitika pazifukwa zosiyanasiyana, monga kusagwira bwino kwa zida, kuyika pansi kosayenera, kapena kulakwitsa kwa opareshoni. Ngati electrosurgical unit (ESU) ikusokonekera, imatha kupereka kuchuluka kwamakono, komwe kungayambitse kuyaka kapena kugwedezeka kwamagetsi kwa wodwala kapena gulu la opaleshoni. Mwachitsanzo, mphamvu yamagetsi ya ESU yolakwika imatha kuyambitsa kusinthasintha kwazomwe zimachokera, zomwe zimapangitsa kuti pakhale mafunde apamwamba mosayembekezereka.
Kuyika pansi kosayenera ndi chifukwa china chofala cha zoopsa zamagetsi. Mu monopolar electrosurgical systems, njira yoyenera yokhazikitsira pansi kudzera pa dispersive electrode (grounding pad) ndiyofunikira kuti zitsimikizidwe kuti zamakono zibwereranso bwino ku ESU. Ngati pad pansi sichimangiriridwa bwino ndi thupi la wodwalayo, kapena ngati pali kupuma kwa dera lokhazikika, panopa angapeze njira ina, monga kudzera m'madera ena a thupi la wodwalayo kapena zipangizo zopangira opaleshoni, zomwe zingathe kuchititsa kuyaka kwa magetsi. Nthawi zina, ngati wodwala akukumana ndi zinthu conductive mu opareshoni chipinda, monga zitsulo mbali ya tebulo opaleshoni, ndi grounding si koyenera, wodwalayo akhoza kukhala pachiwopsezo cha mantha magetsi.
Pofuna kuthana ndi zoopsa zamagetsi, kukonza nthawi zonse ndikuwunika zida za electrosurgical ndizofunikira. ESU iyenera kuyang'aniridwa ngati zizindikiro zilizonse zatha, ndipo zida zamagetsi ziyenera kuyesedwa kuti zitsimikizire kuti zikugwira ntchito bwino. Othandizira ayenera kuphunzitsidwa kuti akhazikitse bwino ndikugwiritsa ntchito zida za electrosurgical, kuphatikizapo kulumikiza koyenera kwa pad pansi. Kuonjezera apo, chipinda chogwiritsira ntchito chiyenera kukhala ndi zipangizo zoyenera zotetezera magetsi, monga zosokoneza zowonongeka (GFCIs), zomwe zingathe kudula mphamvu mwamsanga ngati nthaka - yolakwika kapena kuwonongeka kwa magetsi, kuchepetsa chiopsezo cha ngozi zamagetsi.
Zotukuka Zam'tsogolo ndi Zatsopano
Kupititsa patsogolo Zatekinoloje mu Electrosurgical Unit Design
Tsogolo la mipeni yopangira ma electrosurgical lili ndi lonjezo lalikulu potengera kupita patsogolo kwaukadaulo. Mbali imodzi yomwe ikuyang'ana kwambiri ndikukhazikitsa mapangidwe olondola komanso osinthika a electrode. Pakalipano, maelekitirodi a mipeni ya electrosurgical ndi ofunika kwambiri m'mawonekedwe awo, nthawi zambiri amakhala masamba osavuta kapena nsonga. M'tsogolomu, titha kuyembekezera kuwona ma electrode okhala ndi ma geometri ovuta kwambiri. Mwachitsanzo, maelekitirodi amatha kupangidwa ndi tinthu tating'onoting'ono pamawonekedwe awo. Tizilombo tating'onoting'ono timeneti titha kupititsa patsogolo kukhudzana ndi minofu pamlingo wocheperako, ndikupangitsa kuti kudulirako kukhale kolondola komanso kulumikizidwa. Kafukufuku wokhudzana ndi sayansi ya zida ndi uinjiniya wa zida zamankhwala wawonetsa kuti popanga mawonekedwe a nanoscale pamwamba pa elekitirodi, mphamvu yotumizira mphamvu ku minofu imatha kukulitsidwa mpaka 20 - 30%. Izi zitha kuyambitsa maopaleshoni achangu komanso olondola.
Chinthu chinanso chakupita patsogolo kwaukadaulo ndikuwongolera machitidwe owongolera mphamvu mkati mwa mayunitsi a electrosurgical. Mipeni yamtsogolo yopangira ma electrosurgical ikhoza kukhala ndi mphamvu zenizeni zanthawi - zosinthira kutengera mayankho a minofu. Kusokonezeka kwa minofu kumatha kusiyanasiyana malinga ndi mtundu wa minofu (mafuta, minofu, kapena minofu yolumikizana), kukhalapo kwa matenda, komanso kuchuluka kwa hydration. Mayunitsi amakono opangira opaleshoni yamagetsi nthawi zambiri amadalira milingo yamagetsi yokhazikitsidwa kale, yomwe mwina siyingakhale yabwino pamikhalidwe yonse ya minofu. M'tsogolomu, masensa mkati mwa Electrosurgical Unit amatha kuyeza mosalekeza kuwonongeka kwa minofu pamalo opangira opaleshoni. Mphamvu yotulutsa mphamvu ya electrosurgical unit ikangosinthidwa nthawi yeniyeni kuti zitsimikizire kuti mphamvu yoyenerera imaperekedwa ku minofu. Izi sizingangowonjezera mphamvu ya kudula ndi coagulation komanso kuchepetsa chiopsezo cha kuwonongeka kwa kutentha kwa minofu yozungulira. Kafukufuku wasonyeza kuti njira yeniyeni yosinthira mphamvu ya nthawi yotereyi ingathe kuchepetsa zovuta zokhudzana ndi kutentha ndi 50 - 60% muzochitika zina za opaleshoni.
Kuphatikiza ndi Maukadaulo Ena Opangira Opaleshoni
Kuphatikizana kwa mipeni yopangira ma electrosurgical ndi matekinoloje ena opangira opaleshoni ndi malire osangalatsa okhala ndi kuthekera kwakukulu. Malo amodzi odziwika bwino ndi kuphatikiza ndi opaleshoni ya robotic. M'maopaleshoni othandizidwa ndi robotic, dokotalayo amawongolera manja a robotic kuti agwire ntchito za opaleshoniyo. Mwa kuphatikiza mipeni yopangira ma electrosurgical mu makina opangira ma robotiki, kulondola komanso kusanja kwa mikono yamaloboti kumatha kuphatikizidwa ndi kuthekera kodula ndi kuphatikizika kwa mipeni yamagetsi. Mwachitsanzo, mu prostatectomy yovuta ya robotic, mkono wa robotic ukhoza kukonzedwa kuti uyende bwino mu Electrosurgical Unit mozungulira prostate gland. Kuthamanga kwafupipafupi kochokera ku Electrosurgical Unit kumatha kugwiritsidwa ntchito mosamala kuchotsa prostate kuchokera kumagulu oyandikana nawo ndikumangirira mitsempha yamagazi. Kuphatikizana kumeneku kungayambitse kuchepa kwa magazi, kufupikitsa nthawi zogwirira ntchito, komanso kusunga bwino zigawo zozungulira, potsirizira pake kupititsa patsogolo zotsatira za opaleshoni kwa odwala.
Kuphatikizana ndi njira zopangira opaleshoni zocheperako, monga laparoscopy ndi endoscopy, zikuyembekezekanso kuwona chitukuko china. Mu maopaleshoni a laparoscopic, Electrosurgical Unit pakali pano ndi chida chofunikira, koma kupita patsogolo kwamtsogolo kungapangitse kuti ikhale yofunika kwambiri. Mwachitsanzo, kupangidwa kwa mipeni yaying'ono komanso yosinthika yamagetsi yamagetsi yomwe imatha kuyendetsedwa mosavuta kudzera pamadoko ang'onoang'ono a trocar mu laparoscopy. Mipeni iyi ikhoza kupangidwa kuti ikhale ndi luso lotha kulankhula bwino, kulola dokotala kuti afike ndikugwira ntchito kumalo omwe panopa ndi ovuta kuwapeza. M'maopaleshoni a endoscopic, kuphatikiza mipeni yopangira ma elekitirodi kumatha kupangitsa kuti njira zovutirapo zizichitika mosadukizadukiza. Mwachitsanzo, pochiza khansa ya m'mimba yoyambirira, gawo lophatikizika la Electrosurgical Unit litha kugwiritsidwa ntchito pochotsa minofu ya khansa ndikuchepetsa kuwonongeka kwa minofu yathanzi yozungulira, ndikuchotsa kufunikira kwa maopaleshoni otseguka. Izi zingapangitse kuti wodwalayo asamavutike kwambiri, akhale m'chipatala chachifupi, komanso kuchira msanga.
Mapeto
Pomaliza, Electrosurgical Unit yatulukira ngati chida chosinthira pazamankhwala azachipatala, zomwe zimakhudza kwambiri maopaleshoni ndi zamankhwala.
Kuyang'ana m'tsogolo, tsogolo la mipeni ya electrosurgical ladzaza ndi mwayi wosangalatsa. Kupita patsogolo kwaukadaulo pakupanga ma elekitirodi ndi makina owongolera mphamvu kuli ndi lonjezo la maopaleshoni olondola kwambiri komanso ogwira mtima. Kuphatikizika kwa mipeni yopangira ma electrosurgical ndi matekinoloje ena opangira opaleshoni omwe akungobwera kumene, monga opaleshoni ya robotic ndi njira zapamwamba zowononga pang'ono, zitha kukulitsa kuchuluka kwa zomwe zingatheke m'chipinda chopangira opaleshoni.
Pamene gawo lazamankhwala likupitilirabe, Electrosurgical Unit mosakayikira ikhala patsogolo pakupanga opaleshoni. Kufufuza kosalekeza ndi chitukuko m'derali n'kofunika kuti muzindikire mokwanira zomwe zingatheke, kupititsa patsogolo chisamaliro cha odwala, ndikuyendetsa patsogolo njira za opaleshoni m'zaka zikubwerazi.
