Ultrasonic Scalpel vs. Electrosurgical Unit

Mawu Oyamba

M'malo a opaleshoni yamakono, kulondola ndi chitetezo ndizofunikira kwambiri. Zida ziwiri zazikulu zomwe zasintha njira zopangira opaleshoni ndi ultrasonic scalpel ndi electrosurgical unit (ESU). Zida zimenezi zimagwira ntchito yofunika kwambiri pa maopaleshoni osiyanasiyana, kuyambira opaleshoni wamba mpaka opareshoni ya minyewa, zomwe zimathandiza kuti maopaleshoni azitha kuchita maopaleshoni molondola komanso kuchepetsa kuvulala kwa odwala.

The ultrasonic scalpel, yomwe imadziwikanso kuti ultrasonic opaleshoni aspirator kapena CUSA (Cavitron Ultrasonic Surgical Aspirator), yakhala yofunika kwambiri m'zipinda zambiri zogwirira ntchito. Imagwiritsa ntchito kugwedezeka kwamphamvu kwafupipafupi kwa akupanga kuti adule ndi kuphatikizira minofu. Ukadaulowu umalola kuti tizidulira molunjika, makamaka m'malo osalimba komwe kuchepetsa kuwonongeka kwa minofu yozungulira ndikofunikira. Mwachitsanzo, mu neurosurgery, pochita opaleshoni muubongo, akupanga scalpel amatha kuchotsa bwino minofu ya chotupa ndikusunga minofu yathanzi momwe angathere.

Kumbali ina, gawo la electrosurgical unit (ESU), lomwe limatchedwanso high - frequency electrosurgical generator, ndi chipangizo china chomwe chimagwiritsidwa ntchito kwambiri popanga opaleshoni. Zimagwira ntchito podutsa mphamvu yamagetsi kudzera m'minyewa, kutulutsa kutentha komwe kumatha kudula, kumangirira, kapena kutsitsa minofu. Ma ESU ndi osinthika kwambiri ndipo amatha kugwiritsidwa ntchito m'njira zosiyanasiyana, kuyambira maopaleshoni ang'onoang'ono akunja mpaka maopaleshoni otsegula amtima.

Kumvetsetsa kusiyana pakati pa zida ziwirizi ndizofunikira kwa madokotala, magulu a opaleshoni, ndi ophunzira azachipatala mofanana. Podziwa mawonekedwe apadera, ubwino, ndi zofooka za ultrasonic scalpel ndi electrosurgical unit, akatswiri azachipatala amatha kupanga zisankho zambiri za chida chomwe chili choyenera kwambiri pa opaleshoni inayake. Izi sizimangowonjezera mphamvu ya opaleshoniyo komanso zimathandizira zotsatira za odwala. M'magawo otsatirawa, tidzafufuza mozama mfundo zogwirira ntchito, ntchito, ubwino, zovuta, ndi chitetezo cha akupanga scalpel ndi electrosurgical unit, kupereka kuyerekezera kwakukulu pakati pa ziwirizi.

Tanthauzo ndi Mfundo Zoyambira

Akupanga Scalpel

An ultrasonic scalpel ndi chida chapamwamba kwambiri chopangira opaleshoni chomwe chimagwiritsa ntchito mphamvu ya mafunde apamwamba kwambiri, omwe amakhala pakati pa 20 - 60 kHz. Mafunde akupanga awa amapanga kugwedezeka kwamakina mkati mwa nsonga ya opaleshoni. Pamene nsonga yogwedezeka ikhudzana ndi tizilombo toyambitsa matenda, imapangitsa kuti mamolekyu amadzi omwe ali m'maselo agwedezeke mofulumira. Kugwedezeka kwakukulu kumeneku kumabweretsa njira yotchedwa cavitation, pomwe tinthu tating'onoting'ono timapanga ndikugwa mkati mwa minofu. The makina kupsyinjika kwa cavitation ndi mwachindunji mawotchi zochita za kugwedera nsonga amawononga minofu ya maselo zomangira, mogwira kudula mwa minofu.

Panthawi imodzimodziyo, kugwedezeka kwakukulu kwafupipafupi kumapangitsanso kutentha, komwe kumagwiritsidwa ntchito kugwirizanitsa mitsempha yamagazi pafupi ndi odulidwawo. Njira imeneyi imatseketsa mitsempha ya magazi, kuchepetsa kutaya magazi panthawi ya opaleshoni. Mwachitsanzo, pochita maopaleshoni a chithokomiro, ultrasonic scalpel imatha kutulutsa chithokomiro kuchokera kumagulu ozungulira ndikuchepetsa kutuluka kwa magazi. Kutha kudula ndi kuwundana nthawi imodzi kumapangitsa kukhala chida chofunikira pa maopaleshoni pomwe kukhalabe ndi malo opangira opaleshoni komanso kuchepetsa kutaya magazi ndikofunikira.

Electrosurgical Unit

Electrosurgical unit (ESU) imagwira ntchito mosiyanasiyana, kudalira ma frequency apamwamba amagetsi amagetsi. Ma frequency osiyanasiyana a ESUs ali pakati pa 300 kHz ndi 3 MHz. Mphamvu yamagetsi ikadutsa m'minyewa ya wodwala kudzera pa elekitirodi (monga pensulo ya opaleshoni kapena nsonga yapadera yodulira kapena yolumikizira), mphamvu yamagetsi ya minofuyo imatembenuza mphamvu yamagetsi kukhala kutentha.

Pali mitundu yosiyanasiyana yogwiritsira ntchito ma ESU. Munjira yodulira, ma frequency apamwamba kwambiri amapanga kutentha kwapakati pakati pa electrode ndi minofu, yomwe imatulutsa minofu, ndikupanga kudula. Mu njira ya coagulation, mphamvu yocheperako imayikidwa, zomwe zimapangitsa kuti mapuloteni omwe ali m'minyewa asinthe ndikukhazikika, zomwe zimasindikiza mitsempha yaying'ono yamagazi ndikuyimitsa magazi. Mwachitsanzo, mu hysterectomy, ESU ingagwiritsidwe ntchito kudula minyewa ya chiberekero ndikusinthira ku njira ya coagulation kuti atseke mitsempha yamagazi pamalo opangira opaleshoni, kupewa kutaya magazi kwambiri. Ma ESU ndi osinthika kwambiri ndipo amatha kugwiritsidwa ntchito pazachipatala zosiyanasiyana, kuchokera ku dermatology pochotsa zotupa pakhungu mpaka maopaleshoni a mafupa ophatikizira mafupa ofewa.

Mfundo Zogwirira Ntchito

Momwe Ultrasonic Scalpel Imagwirira Ntchito

The ntchito akupanga scalpel zachokera mfundo za akupanga yoweyula kufalitsa ndi makina - matenthedwe zotsatira kwachilengedwenso zimakhala.

1. Mbadwo wa Akupanga Mafunde

Jenereta yopangidwa ndi akupanga mkati mwa chipangizocho ndi yomwe imapanga ma siginecha amagetsi apamwamba kwambiri. Zizindikiro zamagetsi izi nthawi zambiri zimakhala ndi ma frequency a 20 - 60 kHz. Jeneretayo imatembenuza zizindikiro zamagetsi izi kukhala zogwedeza zamakina pogwiritsa ntchito piezoelectric transducer. Zida za piezoelectric zili ndi katundu wapadera wosintha mawonekedwe awo pamene magetsi akugwiritsidwa ntchito kwa iwo. Pankhani ya akupanga scalpel, transducer ya piezoelectric imanjenjemera mwachangu poyankha ma siginecha amagetsi pafupipafupi, kutulutsa mafunde akupanga.

2. Kuwongolera Mphamvu

Mafunde omwe akupanga mafundewa amaperekedwa motsatira njira ya waveguide, yomwe nthawi zambiri imakhala ndodo yachitsulo yayitali, yowonda, mpaka kumapeto kwa opaleshoni. The waveguide lakonzedwa kuti efficiently kusamutsa akupanga mphamvu kwa jenereta ku nsonga ndi kochepa mphamvu imfa. Nsonga ya opaleshoni ndi gawo la chida chomwe chimakhudzana mwachindunji ndi minofu panthawi ya opaleshoni.

3. Kuyanjana kwa minofu - Kudula ndi Kuphatikizana

Pamene kunjenjemera opaleshoni nsonga kulankhula minofu, angapo thupi njira zimachitika. Choyamba, kugwedezeka kwakukulu kwafupipafupi kumapangitsa kuti mamolekyu amadzi omwe ali m'maselo a minofu agwedezeke mwamphamvu. Kugwedezeka uku kumabweretsa chodabwitsa chotchedwa cavitation. Cavitation ndi mapangidwe, kukula, ndi kugwa kosasunthika kwa thovu laling'ono mkati mwa sing'anga yamadzimadzi (panthawiyi, madzi mkati mwa minofu). Kuphulika kwa thovuzi kumapangitsa kuti munthu azivutika kwambiri ndi makina a m'deralo, zomwe zimaphwanya mgwirizano wa maselo mu minofu, ndikudula.

Panthawi imodzimodziyo, kugwedezeka kwamakina kwa nsonga kumapangitsanso kutentha chifukwa cha kukangana pakati pa nsonga yogwedezeka ndi minofu. Kutentha kochokera ku 50 - 100 ° C. Kutentha kumeneku kumagwiritsidwa ntchito kulumikiza mitsempha yamagazi pafupi ndi odulidwawo. The coagulation ndondomeko denatures mapuloteni m'mitsempha ya magazi makoma, kuwachititsa kumamatirana ndi kusindikiza chotengera, motero kuchepetsa kutaya magazi pa opaleshoni. Mwachitsanzo, mu maopaleshoni a laparoscopic ochotsa zotupa zazing'ono m'chiwindi, ultrasonic scalpel imatha kudula ndendende minofu yachiwindi ndikumata mitsempha yaying'ono yamagazi, ndikusunga malo opangira opaleshoni omveka bwino kwa dokotala.

Momwe Electrosurgical Unit Imagwirira Ntchito

Electrosurgical unit (ESU) imagwira ntchito pa mfundo yogwiritsira ntchito magetsi othamanga kwambiri kuti apange kutentha mkati mwa minofu, yomwe imagwiritsidwa ntchito podula ndi kugwirizanitsa.

1. High - Frequency Alternating Current Generation

ESU ili ndi magetsi ndi jenereta yomwe imapanga magetsi osinthasintha mafupipafupi. Mafupipafupi apano awa nthawi zambiri amachokera ku 300 kHz mpaka 3 MHz. Kuthamanga kwapang'onopang'ono kumeneku kumagwiritsidwa ntchito m'malo motsika - pafupipafupi (monga magetsi apanyumba pa 50 - 60 Hz) chifukwa ma frequency apamwamba amatha kuchepetsa chiopsezo cha mtima fibrillation. Pafupipafupi, mphamvu yamagetsi imatha kusokoneza ma siginecha amagetsi omwe ali mu mtima, zomwe zingayambitse moyo - kuwopseza arrhythmias. Komabe, mafunde afupipafupi omwe ali pamwamba pa 300 kHz sangakhale ndi zotsatirapo pa minofu ya mtima chifukwa samalimbikitsa mitsempha ndi minofu mofanana.

2. Kuyanjana kwa Minofu - Kudula ndi Njira Zogwirizanitsa

· Njira Yodulira : Mu njira yodulira, mphamvu yamagetsi yapamwamba kwambiri imadutsa mu electrode yaying'ono, yakuthwa-nsonga (monga pensulo ya opaleshoni). Pamene electrode ikuyandikira minofu, kukana kwakukulu kwa minofu ku magetsi kumapangitsa mphamvu yamagetsi kusandulika kutentha. Kutentha kopangidwa ndipamwamba kwambiri, kumafika kutentha kwa 1000 ° C mu arc pakati pa electrode ndi minofu. Kutentha kwakukulu kumeneku kumapangitsa kuti minofuyo ikhale ndi nthunzi, kumapanga kudula. Pamene electrode imayenda motsatira minofu, kudulidwa kosalekeza kumapangidwa. Mwachitsanzo, mu tonsillectomy, ESU mu njira yodulira imatha kuchotsa matani mwachangu komanso molondola potulutsa minofu.

· Coagulation Mode : Mu mawonekedwe a coagulation, mphamvu yocheperako imayikidwa. Kutentha komwe kumachokera kumakwanira kusokoneza mapuloteni mu minofu, makamaka m'mitsempha yamagazi. Mapuloteni omwe ali m'mitsempha yamagazi akasinthana, amapanga coagulum, yomwe imatseka mitsempha yamagazi ndikusiya magazi. Pali mitundu yosiyanasiyana ya njira zolumikizirana zomwe zimagwiritsidwa ntchito ndi ma ESU, monga monopolar ndi bipolar coagulation. Mu monopolar coagulation, magetsi amadutsa kuchokera ku electrode yogwira ntchito kupyolera mu thupi la wodwalayo kupita ku dispersive electrode (padi yaikulu yomwe imayikidwa pakhungu la wodwalayo). Mu bipolar coagulation, ma elekitirodi omwe amagwira ntchito ndi obwerera amakhala mu mphamvu imodzi - ngati chipangizo. Zamakono zimangoyenda pakati pa nsonga ziwiri za forceps, zomwe zimakhala zothandiza kuti zigwirizane bwino m'dera laling'ono, monga ma microsurgeries kapena pochita ndi minofu yosakhwima. Mwachitsanzo, mu neurosurgery, bipolar coagulation ndi ESU itha kugwiritsidwa ntchito kusindikiza mitsempha yaying'ono pamwamba pa ubongo popanda kuwononga kwambiri minofu yozungulira.

Kusiyana Kwakukulu

Gwero la Mphamvu

Kusiyana kwakukulu pakati pa akupanga scalpel ndi electrosurgical unit kuli mu mphamvu zawo. An akupanga scalpel amagwiritsa akupanga mphamvu, amene ali mu mawonekedwe a mkulu - pafupipafupi makina kugwedera. Kugwedezeka kumeneku kumapangidwa potembenuza mphamvu yamagetsi kukhala mphamvu yamakina kudzera pa piezoelectric transducer. Kuchuluka kwa mafunde akupanga mafunde amachokera ku 20 - 60 kHz. Mphamvu yamakinayi imasamutsidwa mwachindunji ku minofu, kuchititsa kusintha kwa thupi monga cavitation ndi kusokonezeka kwa makina.

Kumbali ina, gawo la electrosurgical limagwira ntchito pamagetsi amagetsi. Amapanga magetsi osinthasintha pafupipafupi, nthawi zambiri amakhala 300 kHz - 3 MHz. Mphamvu yamagetsi imadutsa mu minofu, ndipo chifukwa cha kukana kwa minofu, mphamvu yamagetsi imasandulika kukhala mphamvu ya kutentha. Kutentha kumeneku kumagwiritsidwa ntchito pocheka ndi kugwirizanitsa. Magwero osiyanasiyana a mphamvu amachititsa njira zosiyana zogwirizanirana ndi minofu, zomwe zimakhudza zotsatira za opaleshoni ndi mbiri ya chitetezo cha njirazo. Mwachitsanzo, mawotchi chikhalidwe cha akupanga mphamvu mu akupanga scalpel amalola kuti 'mofatsa' mogwirizana ndi minofu mbali zina, monga sadalira kwambiri kutentha m'badwo ngati electrosurgical unit.

Kuyanjana kwa minofu

The akupanga scalpel interacts ndi minofu mwa osakaniza makina kugwedera ndi matenthedwe zotsatira. Pamene kugwedeza nsonga ya akupanga scalpel kulankhula minofu, mkulu - pafupipafupi makina kugwedera chifukwa madzi mamolekyu mkati minofu maselo kunjenjemera mwamphamvu. Izi zimabweretsa cavitation, pomwe tinthu tating'onoting'ono timapanga ndikugwa mkati mwa minofu, ndikupanga kupsinjika kwamakina komwe kumaswa ma cell a minofu. Kuphatikiza apo, kukangana kwamakina pakati pa nsonga yogwedezeka ndi minofu kumatulutsa kutentha, komwe kumagwiritsidwa ntchito polumikizana ndi mitsempha yaying'ono yamagazi. Minofuyo imasokonezedwa makamaka ndi mphamvu zamakina, ndipo kutentha ndi gawo lachiwiri lomwe limathandiza hemostasis.

Mosiyana ndi izi, gawo la electrosurgical unit limalumikizana ndi minofu makamaka chifukwa cha kutentha. Mphamvu yamagetsi yamagetsi yomwe imadutsa m'minyewa imatulutsa kutentha chifukwa cha kukana kwa minofuyo. Mu njira yodulira, kutentha kumakhala koopsa kwambiri (mpaka 1000 ° C mu arc pakati pa electrode ndi minofu) kuti imatulutsa minofu, ndikupanga kudula. Mu njira ya coagulation, mphamvu yocheperapo imagwiritsidwa ntchito, ndipo kutentha komwe kumapangidwa (nthawi zambiri pafupifupi 60 - 100 ° C) kumatulutsa mapuloteni mu minofu, makamaka m'mitsempha yamagazi, zomwe zimapangitsa kuti zifanane ndi kusindikiza. Kuyanjana kwa ESU ndi minofu kumayendetsedwa ndi kutentha - kumapangitsa kusintha, ndipo mphamvu zamakina ndizochepa poyerekeza ndi akupanga scalpel.

Kuwonongeka kwa Matenthedwe

Kusiyanitsa kwakukulu pakati pa zida ziwirizi ndi kuchuluka kwa kuwonongeka kwa kutentha komwe kumayambitsa kumagulu ozungulira. The akupanga scalpel zambiri umabala ndi otsika kutentha pa ntchito. Kutentha kopangidwa kumagwiritsidwa ntchito makamaka polumikizana ndi mitsempha yaing'ono yamagazi ndipo imakhala pa 50 - 100 ° C. Chotsatira chake, kuwonongeka kwa kutentha kwa minofu yozungulira kumakhala kochepa. Mchitidwe wamakina wa ntchito yake umatanthawuza kuti minofu imadulidwa ndikumangika ndikuwonongeka pang'ono kwa kutentha, komwe kumakhala kopindulitsa kwambiri pochita maopaleshoni pomwe kusunga umphumphu wa minyewa yoyandikana ndikofunikira, monga neurosurgery kapena microsurgeries.

Mosiyana ndi zimenezo, electrosurgical unit ikhoza kuwononga kwambiri kutentha. M'njira yodula, kutentha kwambiri (mpaka 1000 ° C) kumatha kupangitsa kuti minofu iwonongeke komanso kuwotcha, osati pamalo odulidwawo komanso madera oyandikana nawo. Ngakhale mumayendedwe a coagulation, kutentha kumatha kufalikira kudera lalikulu mozungulira minofu yothandizidwa, zomwe zitha kuwononga ma cell athanzi ndi zida. Kuwonongeka kwakukulu kumeneku nthawi zina kungayambitse kuchira kwa nthawi yayitali, chiopsezo chowonjezeka cha minofu necrosis, ndi kuwonongeka kwa ntchito ya ziwalo zapafupi kapena minofu. Mwachitsanzo, pakukula kwakukulu kwa minofu yofewa pogwiritsa ntchito ESU, minofu yathanzi yozungulira imatha kukhudzidwa ndi kutentha, zomwe zingakhudze kuchira kwathunthu kwa wodwalayo.

Mphamvu ya Hemostasis

Onse akupanga scalpel ndi electrosurgical unit ali ndi mphamvu ya hemostatic, koma amasiyana pakuchita bwino kwawo komanso momwe amakwanitsira hemostasis. The akupanga scalpel akhoza coagulate ang'onoang'ono mitsempha pamene kudula minofu. Pamene nsonga yogwedezeka ikudutsa mu minofu, kutentha komwe kumachokera nthawi imodzi kumasindikiza mitsempha yaing'ono yamagazi yomwe ili pafupi, kuchepetsa kutaya magazi panthawi ya opaleshoni. Kukhoza kudula ndi kukhazikika panthawi imodzi kumapangitsa kukhala kothandiza kwambiri kusunga malo opangira opaleshoni omveka bwino, makamaka pochita maopaleshoni omwe kutuluka kwa magazi kosalekeza kungasokoneze malingaliro a dokotala. Komabe, mphamvu yake yolimbana ndi mitsempha yambiri yamagazi imakhala yochepa.

Gawo la electrosurgical limakhalanso ndi zinthu zabwino za hemostatic. Mu njira ya coagulation, imatha kusindikiza mitsempha yamagazi yamitundu yosiyanasiyana. Pogwiritsa ntchito mphamvu yocheperako, kutentha komwe kumatulutsa kumapangitsa kuti mapuloteni omwe ali m'mitsempha yamagazi atseke, zomwe zimapangitsa kuti azilumikizana ndikutseka. Ma ESU nthawi zambiri amagwiritsidwa ntchito poletsa kutuluka kwa magazi panthawi ya maopaleshoni, ndipo amatha kusinthidwa kuti agwirizane ndi kukula kwake kosiyanasiyana. Pamitsempha yokulirapo, kuyika kwamphamvu kwamphamvu kungafunikire kuti zitsimikizire kuti zikuyenda bwino. M'maopaleshoni ena ovuta, monga kutulutsa chiwindi komwe kuli mitsempha yambiri yamitundu yosiyanasiyana, ESU ingagwiritsidwe ntchito pamodzi ndi njira zina za hemostatic kuti akwaniritse hemostasis yogwira mtima.

Kulondola ndi Kugwiritsa Ntchito

The akupanga scalpel amapereka mkulu mwatsatanetsatane, makamaka wosakhwima njira opaleshoni. nsonga yake yaying'ono, yonjenjemera imalola kupendekera kolondola kwambiri ndi kugawa. M'maopaleshoni ang'onoang'ono, monga laparoscopic kapena endoscopic njira, ultrasonic scalpel imatha kuyendetsedwa mosavuta kudzera m'mapapo ang'onoang'ono kapena madontho achilengedwe, kupereka madokotala opaleshoni kuti athe kuchita maopaleshoni ovuta kwambiri molondola. Ndizofunikira makamaka pakuchita opaleshoni kumene minofu yomwe imachotsedwa ili pafupi kwambiri ndi zomangamanga zofunika kwambiri, chifukwa kuwonongeka kwake kochepa kwa kutentha ndi kudulidwa kolondola kumathandiza kuchepetsa chiopsezo cha kuvulala kwa nyumbazi.

Mbali ina ya electrosurgical unit ili ndi ntchito zambiri. Itha kugwiritsidwa ntchito m'maopaleshoni osiyanasiyana, kuyambira njira zazing'ono zapakhungu mpaka maopaleshoni akuluakulu otsegula amtima. Ngakhale kuti sangapereke mlingo womwewo wa kulondola monga akupanga scalpel mu njira zina zosakhwima, kusinthasintha kwake ponena za mitundu yosiyanasiyana ya minofu ndi zochitika za opaleshoni ndizopindulitsa kwambiri. M'maopaleshoni akulu komwe liwiro komanso kuthekera kogwira makulidwe osiyanasiyana a minofu ndi kukula kwa chotengera ndikofunikira, ESU ikhoza kusinthidwa kuti ikwaniritse izi. Mwachitsanzo, pochita maopaleshoni a mafupa, ESU imatha kugwiritsidwa ntchito kudula mwachangu minofu yofewa ndikumangirira malo otuluka magazi pakuchotsa minofu yowonongeka kapena kuyika kwa ma prosthetics.

Ubwino ndi Kuipa kwake

Akupanga Scalpel

· Ubwino :

· Kuchepa kwa Magazi : Chimodzi mwazinthu zofunikira kwambiri za ultrasonic scalpel ndi kuthekera kwake kugwirizanitsa mitsempha yaing'ono yamagazi pamene kudula. Izi zimapangitsa kuti magazi achepe kwambiri panthawi ya opaleshoni. Mwachitsanzo, mu maopaleshoni a laparoscopic ochotsa zotupa zazing'ono m'chiwindi kapena ndulu, akupanga scalpel amatha kukhala ndi magazi ochepa - opangira opaleshoni yaulere, omwe ndi ofunikira kuti dokotala azitha kuwona bwino malo opangira opaleshoniyo ndikuchita opaleshoniyo molondola.

· Minimal Tissue Trauma : Opaleshoni ya ultrasonic scalpel makamaka imadalira kugwedezeka kwamakina, komwe kumabweretsa kuwonongeka kochepa kwa minofu yozungulira yathanzi poyerekeza ndi zida zina zopangira opaleshoni. Kuwonongeka kochepa kwamafuta komwe kumayambitsa kumatanthauza kuti minyewa yoyandikana nayo siyingakhudzidwe, kulimbikitsa machiritso mwachangu komanso kuchepetsa chiopsezo cha zovuta zomwe zimachitika pambuyo pa opaleshoni monga matenda kapena kuwonongeka kwa chiwalo. Izi ndizopindulitsa makamaka pochita maopaleshoni okhudza ziwalo zosalimba monga ubongo, maso, kapena minyewa.

Kuchira Mwachangu kwa Odwala : Chifukwa cha kuchepa kwa magazi komanso kuvulala kochepa kwa minofu, odwala omwe amachitidwa opaleshoni ndi ultrasonic scalpel nthawi zambiri amakhala ndi nthawi yochepa yochira. Atha kukhala ndi ululu wocheperako, matenda obwera pambuyo pa opaleshoni, ndipo amatha kubwerera kuntchito zanthawi zonse mwachangu. Izi sizimangowonjezera moyo wa wodwalayo panthawi yomwe akuchira komanso zimachepetsanso ndalama zonse zothandizira zaumoyo zomwe zimagwirizanitsidwa ndi kukhala m'chipatala nthawi yaitali.

· Zoyipa :

· Mtengo Wapamwamba wa Zida : Akupanga scalpel machitidwe ndi okwera mtengo. Mtengo wa chipangizocho, pamodzi ndi zofunikira zake zosamalira ndi kuwongolera, zitha kukhala zolemetsa kwambiri pazachuma pazipatala zina, makamaka zomwe zili ndi zida zochepa. Mtengo wokwerawu ukhoza kuchepetsa kukhazikitsidwa kwa akupanga ma scalpels, zomwe zimakhudza mwayi wa odwala paukadaulo wapamwamba wa opaleshoni.

· Kufunika kwa Luso Lapamwamba pa Ntchito : Kugwiritsira ntchito ultrasonic scalpel kumafuna luso lapamwamba ndi maphunziro. Madokotala ochita opaleshoni ayenera kukhala odziwa bwino kugwiritsa ntchito chipangizochi kuti awonetsetse kudula bwino ndi kukhazikika pamene akuchepetsa kuwonongeka kwa minofu yozungulira. Kuphunzira kugwiritsa ntchito akupanga scalpel mogwira mtima kungatenge nthawi yambiri ndikuchita, ndipo kugwiritsa ntchito molakwika kungayambitse zotsatira za opaleshoni kapena zolakwika za opaleshoni.

· Kugwiritsa Ntchito Mwapang'onopang'ono kwa Mitsempha Yaikulu Yamagazi : Ngakhale kuti ultrasonic scalpel imagwira ntchito pogwirizanitsa mitsempha yaing'ono yamagazi, mphamvu yake yoletsa kutuluka kwa magazi kuchokera ku mitsempha yambiri yamagazi imakhala yochepa. Pamene mitsempha ikuluikulu ikufunika kudulidwa kapena kulumikizidwa panthawi ya opaleshoni, njira zowonjezera monga kugwirizanitsa chikhalidwe kapena kugwiritsa ntchito electrosurgical unit zingafunike. Izi zikhoza kuonjezera zovuta komanso nthawi ya opaleshoni.

Electrosurgical Unit

· Ubwino :

Kudula Kwambiri - Kuthamanga Kwambiri : Gawo la electrosurgical limatha kudula minofu mwachangu kwambiri. M'maopaleshoni omwe nthawi ndi yofunika kwambiri, monga maopaleshoni adzidzidzi kapena kuchotsa minofu yayikulu, kuthekera kodula mwachangu kwa ESU kungakhale mwayi waukulu. Mwachitsanzo, panthawi ya opaleshoni, ESU imatha kudula mwamsanga minofu ya m'mimba kuti ifike kuchiberekero, kuchepetsa nthawi ya opaleshoni komanso kuchepetsa chiopsezo kwa mayi ndi mwana.

· Hemostasis Yothandiza Pamiyeso Yosiyanasiyana ya Mitsuko : Ma ESU ndiwothandiza kwambiri pakukwaniritsa kukomoka kwa mitsempha yamagazi amitundu yosiyanasiyana. Mu njira ya coagulation, amatha kusindikiza ma capillaries ang'onoang'ono komanso mitsempha yayikulu yamagazi pogwiritsa ntchito mphamvu yoyenera yamagetsi. Kusinthasintha kumeneku kumapangitsa ESU kukhala chida chofunikira pa maopaleshoni pomwe kuwongolera kutuluka kwa magazi kuchokera kumitundu yosiyanasiyana ya mitsempha ndikofunikira, monga maopaleshoni a chiwindi kapena maopaleshoni okhudza zotupa zokhala ndi mitsempha yambiri.

· Kukonzekera Kwachidule Kwazida : Poyerekeza ndi zida zina zapamwamba zopangira opaleshoni, kukhazikitsa koyambira kwa ma electrosurgical unit ndikosavuta. Amakhala makamaka ndi jenereta yamagetsi ndi electrode, yomwe imatha kulumikizidwa mosavuta ndikusintha njira zosiyanasiyana za opaleshoni. Kuphweka kumeneku kumapangitsa kukonzekera mwamsanga m'chipinda chopangira opaleshoni, kuchepetsa nthawi yotayika pakukonzekera zipangizo ndikuthandizira madokotala kuti ayambe opaleshoniyo mwamsanga.

· Zoyipa :

· Kuwonongeka Kwambiri Kutentha Kwambiri : Monga tanenera kale, gawo la electrosurgical unit limapanga kutentha kwakukulu panthawi yogwira ntchito, makamaka pamtundu wodula. Kutentha kwapamwambaku kungayambitse kuwonongeka kwakukulu kwamafuta ozungulira, zomwe zimapangitsa kuti minofu iwonongeke, necrosis, ndi kuwonongeka kwa ziwalo zapafupi. Kuchulukitsidwa kwa mphamvu ndi nthawi yayitali yogwiritsira ntchito, kuwonongeka kwa kutentha kumakhala koopsa kwambiri.

· Kuopsa kwa Tissue Carbonization : Kutentha kwakukulu kopangidwa ndi ESU kungapangitse minofu kukhala carbonize, makamaka pazikhazikiko zamphamvu kwambiri. Minofu yopangidwa ndi mpweya imatha kukhala yovuta kuwotcha kapena kuchiritsa bwino, komanso imatha kukulitsa chiwopsezo cha matenda pambuyo pa opaleshoni. Komanso, kukhalapo kwa kaboni minofu akhoza kusokoneza histological kufufuza kwa resected minofu, amene n'kofunika kudziwa molondola ndi kukonzekera mankhwala.

· Chofunikira cha Luso Lapamwamba : Kugwiritsa ntchito chipangizo cha electrosurgical mosamala komanso moyenera kumafuna luso lapamwamba komanso chidziwitso. Wogwira ntchitoyo ayenera kulamulira mphamvu yotulutsa mphamvu molondola, kusankha njira yoyenera (kudula kapena kugwirizanitsa) kwa mitundu yosiyanasiyana ya minofu ndi zochitika za opaleshoni, ndikupewa kuvulaza mwangozi kutentha kwa wodwalayo. Kugwiritsa ntchito molakwika ESU kungayambitse zovuta zazikulu, monga kutuluka magazi kwambiri, kuwonongeka kwa minofu, kapena kuyaka kwamagetsi.

Mapulogalamu mu Opaleshoni

Common Opaleshoni Minda akupanga Scalpel

1. Opaleshoni ya Laparoscopic

· Mu laparoscopic njira, ndi akupanga scalpel ndi okondedwa kwambiri. Mwachitsanzo, pa laparoscopic cholecystectomy (kuchotsa ndulu). Yaing'ono, yeniyeni nsonga ya akupanga scalpel akhoza anaikapo kudzera yaing'ono laparoscopic madoko. Imatha kutulutsa ndulu kuchokera kumagulu ozungulira ndikuchepetsa kutuluka kwa magazi. Kutha kulumikiza mitsempha yaying'ono yamagazi panthawi yodulira ndikofunikira pakuchita opaleshoni yocheperako, chifukwa imathandizira kuti dokotalayo azitha kuwona bwino, yemwe akugwira ntchito mothandizidwa ndi kamera ndi zida zazitali zazitali.

Mu opaleshoni ya laparoscopic colorectal, akupanga scalpel angagwiritsidwe ntchito kulekanitsa m'matumbo kapena rectum kuchokera kumadera oyandikana nawo. Ikhoza kudulidwa ndendende kudzera mu mesentery (minofu yomwe imamangiriza matumbo ku khoma la m'mimba) ndikusindikiza mitsempha yaing'ono yamagazi mkati mwake. Izi zimachepetsa chiopsezo cha kutaya magazi komanso kuwonongeka kwa ziwalo zapafupi monga chikhodzodzo kapena ureters.

1. Opaleshoni Yachifuwa

· Mu maopaleshoni a m'mapapo, ultrasonic scalpel imagwira ntchito yofunika kwambiri. Pochita pulmonary lobectomy (kuchotsa lobe ya m'mapapo), ultrasonic scalpel ingagwiritsidwe ntchito kuphwanya minofu ya m'mapapo ndi kusindikiza mitsempha yaing'ono yamagazi m'deralo. The zochepa matenthedwe kuwonongeka kwa akupanga scalpel ndi opindulitsa kusunga ntchito ya otsala m`mapapo minofu. Mwachitsanzo, ngati wodwala ali ndi matenda a m'mapapo ndi mapapu otsala ayenera kuchulukitsidwa, kugwiritsa ntchito ultrasonic scalpel kungathandize kukwaniritsa cholinga ichi.

· M'maopaleshoni apakati, kumene malo opangira opaleshoni nthawi zambiri amakhala pafupi ndi zinthu zofunika kwambiri monga mtima, mitsempha yaikulu ya magazi, ndi trachea, ultrasonic scalpel's preright and low thermal kufalikira ndizopindulitsa kwambiri. Itha kugwiritsidwa ntchito pochotsa mosamala zotupa kapena zotupa zina mu mediastinum popanda kuwononga kwambiri zida zozungulira.

1. Opaleshoni ya Mitsempha

· Mu maopaleshoni a chotupa muubongo, akupanga scalpel ndi chida chofunikira. Itha kugwiritsidwa ntchito kuchotsa ndendende minofu ya chotupa ndikuchepetsa kuwonongeka kwa minofu yozungulira yathanzi. Mwachitsanzo, pochotsa ma gliomas (mtundu wa chotupa muubongo), ultrasonic scalpel imatha kusinthidwa kuti ikhale yoyenera kuti iwononge maselo a chotupacho kudzera mu cavitation ndi kugwedezeka kwamakina. Kutentha komwe kumachokera kumagwiritsidwa ntchito kugwirizanitsa mitsempha yaing'ono yamagazi mkati mwa chotupacho, kuchepetsa kutuluka kwa magazi panthawi ya opaleshoni. Izi ndizofunikira chifukwa kuwonongeka kulikonse kwa minofu yathanzi yaubongo kumatha kubweretsa kuperewera kwaubongo.

· Pama opaleshoni a msana, ultrasonic scalpel ingagwiritsidwe ntchito kusokoneza minofu yofewa kuzungulira msana, monga minofu ndi mitsempha, molondola. Pochita discectomy (kuchotsa diski ya herniated), ultrasonic scalpel ingagwiritsidwe ntchito kuchotsa mosamala zinthu za disc popanda kuwononga kwambiri mizu ya mitsempha yozungulira kapena msana.

Common Surgical Fields for Electrosurgical Unit

1. General Surgery

· Pochita maopaleshoni otsegula m'mimba, gawo la electrosurgical unit limagwiritsidwa ntchito kwambiri. Mwachitsanzo, panthawi ya gastrectomy (kuchotsa m'mimba) kapena colectomy (kuchotsa gawo la m'matumbo). ESU imatha kudula mwachangu minyewa yam'mimba ndikusinthidwa kukhala njira yolumikizira kuti isindikize mitsempha yayikulu yamagazi. Mu colectomy, ESU ingagwiritsidwe ntchito kudula m'matumbo ndikugwirizanitsa mitsempha yamagazi m'mphepete mwa resection kuti muteteze magazi.

• Pochita maopaleshoni ochizira chophukacho, ESU itha kugwiritsidwa ntchito kuthyola thumba la chophukacho kuchokera m'minofu yozungulira ndikutsekeka komwe kumatuluka magazi. Itha kugwiritsidwanso ntchito popanga zoboola pakhoma lamimba poyika mauna panthawi yokonza chophukacho.

1. Opaleshoni Yapulasitiki Ndi Yokonzanso

· Munjira ngati liposuction, gawo la electrosurgical unit litha kugwiritsidwa ntchito kulumikiza minyewa yaying'ono yamagazi mu minofu ya adipose. Izi zimathandiza kuchepetsa kutaya magazi panthawi yoyamwa mafuta. Kuphatikiza apo, pochita maopaleshoni akhungu, ESU imatha kugwiritsidwa ntchito kudula khungu ndi minyewa yamkati kuti apange chotchinga kenako ndikusindikiza mitsempha yamagazi kuti zitsimikizire kuti chipwirikiticho chimagwira ntchito.

• Pochita maopaleshoni apulasitiki kumaso, monga rhinoplasty (ntchito ya mphuno) kapena njira zokweza nkhope, ESU ingagwiritsidwe ntchito pocheka ndikuletsa kutuluka kwa magazi. Kutha kusintha makonzedwe a mphamvu kumalola dokotala wa opaleshoni kuti agwiritse ntchito ESU pazigawo zonse ziwiri zosakhwima zozungulira mphuno kapena nkhope komanso kuti agwirizane ndi mitsempha yaing'ono yamagazi m'deralo.

1. Obstetrics ndi Gynecology

· Mu gawo la cesarean, ESU ingagwiritsidwe ntchito kudula mwachangu zigawo za khoma la m'mimba kuti ifike kuchiberekero. Pambuyo pobereka, angagwiritsidwe ntchito kutseka chiberekero ndi kuti coagulate mfundo iliyonse magazi mu chiberekero ndi m'mimba minofu.

· Pamaopaleshoni achikazi monga hysterectomy (kuchotsa chiberekero), ESU ingagwiritsidwe ntchito kudula minyewa ya uterine ndikumanga mitsempha yamagazi. Angagwiritsidwenso ntchito pochita maopaleshoni pochiza uterine fibroids kapena ovarian cysts, komwe angagwiritsidwe ntchito kuchotsa zophuka ndikuwongolera kutuluka kwa magazi panthawi ya njirayi.

Mapeto

Pomaliza, akupanga scalpel ndi electrosurgical unit ndi zida ziwiri zofunika zopangira opaleshoni zomwe zimakhala ndi mawonekedwe osiyana. Kusankha pakati pa ultrasonic scalpel ndi electrosurgical unit zimadalira zofunikira zenizeni za opaleshoniyo, mtundu wa minofu yomwe imakhudzidwa, kukula kwa mitsempha ya magazi, ndi zomwe dokotala wa opaleshoniyo wachita ndi zomwe amakonda. Pomvetsetsa kusiyana pakati pa zida ziwirizi, madokotala ochita opaleshoni amatha kupanga zisankho zodziwika bwino, zomwe zingapangitse zotsatira zabwino za opaleshoni, kuchepetsa kupwetekedwa kwa odwala, komanso kupititsa patsogolo nthawi yochira. Pamene luso la opaleshoni likupitirirabe kusinthika, ndizotheka kuti ultrasonic scalpel ndi electrosurgical unit zidzasinthidwanso, kupereka zopindulitsa kwambiri kwa odwala ndi maopaleshoni mofanana.