Nhanganyaya
Mumushonga wemazuva ano wekiriniki, maturusi epamusoro uye matekinoroji akabuda, achitamba mabasa akakosha mukusimudzira mashandiro uye nemazvo ezvekurapa. Pakati peizvi, iyo electrosurgical unit, inowanzo zivikanwa se electrotome, inomira pachena sechishandiso chakakosha chine hupamhi hwekuita mukuvhiya uye kurapwa.
Iyo electrotome yave chikamu chakakosha chemakamuri ekushandisa uye zvivakwa zvekurapa pasirese. Yakashandura nzira dzekuvhiya, ichipa mabhenefiti akati wandei pane echinyakare nzira dzekuvhiya. Semuenzaniso, kare vanachiremba vaiwanzosangana nematambudziko akadai sekurasikirwa neropa rakawandisa panguva yekuvhiyiwa, izvo zvaigona kukonzera matambudziko uye nguva refu yekupora kwevarwere. Kuuya kwe electrotome kwakaderedza zvakanyanya nyaya iyi.
Zvakare, iyo electrotome yakawedzera mikana yekuvhiya kushoma. Minimally invasive maitiro anowanzobatanidzwa nekurwadziwa kushoma, kupfupika kwekugara muchipatara, uye nekukurumidza kupora mitengo yevarwere. Electrotome inoita kuti vavhiyi vakwanise kuita maoparesheni akaomarara nemakachekwa madiki, zvichideredza kukuvara kumuviri wemurwere. Izvi hazvingobatsiri murwere chete maererano nekupora kwemuviri asiwo zvine chekuita nehupfumi, sezvo kupfupika kwekugara muchipatara kunogona kukonzeresa kuderedzwa kwemari yehutano.
Sezvo sainzi yekurapa iri kuramba ichishanduka, kunzwisisa misimboti yekushanda, mashandisirwo, uye njodzi dzinogona kuitika dze electrotome kwakakosha kune nyanzvi dzekurapa, varwere, uye avo vanofarira munda wekurapa. Ichi chinyorwa chine chinangwa chekuongorora zvizere iyo electrotome mumushonga wekiriniki, ichiongorora mune yayo tekinoroji maficha, akasiyana mashandisirwo mumhando dzakasiyana dzekurapa, kufunga nezvekuchengetedza, uye tarisiro yeramangwana.
Kushanda Nheyo yeElectrosurgical Knives
Nheyo dzeMagetsi Emagetsi muKuvhiya
Mapanga eElectrosurgical anoshanda pamusimboti wakasiyana zvakanyanya kubva kune echinyakare mechanicha mascalpels. Masikirwo echinyakare anovimba nemicheto yakapinza kuti icheke nepakati pematishu, senge banga remukicheni rinocheka nechikafu. Iyi mechanical cutting action inokonzera kukanganisa kwehutano hwenyama, uye tsinga dzeropa dzinoparadzaniswa, zvichiita kuti kubuda ropa kunowanzoda mamwe matanho ehemostasis, zvakadai se suturing kana kushandiswa kwehemostatic agents.
Kusiyana neizvi, mapanga emagetsi anoshandisa high - frequency alternating current (AC). Pfungwa huru ndeyokuti kana magetsi achipfuura nepakati pe conductive, munyaya iyi, biological tissue, kushorwa kwetishu kunokonzera kutendeuka kwesimba remagetsi kuita simba rinopisa. Iyi yekupisa mhedzisiro ndiyo kiyi yekushanda kweElectrosurgical Unit.
Iyo electrosurgical unit (ESU) inopa simba Electrosurgical Unit ine yakakwirira - frequency jenareta. Jenareta iyi inogadzira inochinjika ikozvino ine frequency inowanzoitika muhuwandu hwemazana ekilohertz (kHz) kune akati wandei megahertz (MHz). Semuyenzaniso, akawanda akajairika maelectrosurgical madivayiri anoshanda pamafrequency akapoteredza 300 kHz kusvika 500 kHz. Iyi yepamusoro-frequency yazvino inozoendeswa kunzvimbo yekuvhiya kuburikidza neakasarudzika electrode, inova muromo weElectrosurgical Unit.
Kana iyo yepamusoro-frequency yasvika patishu, kuramba kwetishu pakuyerera kwemaerekitironi kunoita kuti tishu zviite kupisa. Sezvo tembiricha inokwira, mvura iri mukati memasero enyama inotanga kunyungudika. Iyi vaporization inotungamirira kukurumidza kuwedzera kwemaseru, zvichiita kuti iparadze uye inokonzera kucheka kwenyama. Muchidimbu, Electrosurgical Unit 'inopisa' kuburikidza nenyama, asi nenzira inodzorwa, sezvo simba uye nguva yakawanda yezvino inogona kugadziriswa maererano nezvinodiwa zvekuvhiya.
Basa RemaFrequency Akasiyana
Kuwanda kwealternating ikozvino muElectrosurgical Unit inoita basa rakakosha pakuona mabasa ayo chaiwo panguva yekuvhiyiwa, kureva kucheka uye coagulation.
Cutting Function :
Kune iyo yekucheka basa, yakakwira - frequency inoenderera - wave ikozvino inowanzoshandiswa. Kana yakakwira-frequency current inoshandiswa kumatishu, kukurumidza oscillation yendima yemagetsi kunoita kuti zvidimbu zvakachajiswa mukati metishu (senge ions muextracellular and intracellular fluids) ifambe ichidzoka nekumberi nekukurumidza. Kufamba uku kunogadzira kupisa kunopisa, izvo zvinokurumidza kufambisa mvura mukati memasero. Sezvo maseru akaputika nekuda kwekukurumidza vaporization yemvura, iyo tishu inocheka zvinobudirira.
Iyo yakakwira - frequency inoenderera - wave ikozvino yekucheka yakagadzirirwa kuburitsa yakakwira - density kupisa pamuromo weElectrosurgical Unit. Uku kupisa kwepamusoro-density kunogonesa kukurumidza uye kwakachena kuchekwa nemunyama. Chinokosha ndechekuti uve nehuwandu hwesimba hwakakwana hunounzwa munguva pfupi yekupfutisa maseru ematishu. Semuyenzaniso, mune yakajairwa kuvhiya senge kuchekwa kweganda, iyo Electrosurgical Unit yakaiswa kune yekucheka modhi ine yakakodzera yakakwirira - frequency ikozvino inogona kugadzira yakatsetseka kucheka, kudzikisa huwandu hwekukuvara kwetishu uye kuderedza njodzi yekubvaruka kana yakakanuka mipendero inogona kuitika nechinyakare scalpel.
Coagulation Basa :
Kana zvasvika kune coagulation, imwe frequency uye waveform yezvino inoshandiswa. Coagulation inzira yekumisa kubuda ropa nekukonzera kuti mapuroteni ari muropa uye matishu akatenderedza aite denature uye kugadzira clot - sechinhu. Izvi zvinowanikwa uchishandisa yakaderera - frequency, pulsed - wave ikozvino.
Iyo pulsed - wave current inopa simba munguva pfupi. Kana iyi pulsed ikozvino inopfuura nemunyama, inopisa matishu nenzira inodzorwa ichienzaniswa neinoenderera - wave ikozvino inoshandiswa kucheka. Kupisa kunogadzirwa kunokwana kuti denature mapuroteni ari muropa uye tishu, asi kwete zvakakwana kukonzera kukurumidza vaporization senge nyaya yekucheka. Uku denaturation inoita kuti mapuroteni abatane, achinyatsovhara tsinga diki dzeropa uye kumisa kubuda ropa. Semuenzaniso, panguva yekuvhiya uko kune madiki anobuda ropa pamusoro penhengo, chiremba anovhiya anogona kushandura iyo Electrosurgical Unit kune coagulation mode. Iyo yakaderera - frequency pulsed - wave ikozvino inozoiswa kunzvimbo inobuda ropa, zvichiita kuti tsinga dzeropa dzivhare uye kubuda ropa kumire.
Mhando dzeElectrosurgical Knives
Monopolar Electrosurgical Knives
Monopolar electrosurgical mapanga ndeimwe yemhando dzinowanzoshandiswa mukuvhiya. Zvimiro, monopolar Electrosurgical Unit ine inobatwa neruoko electrode, inova chikamu icho chiremba anovhiya anoshandisa zvakananga. Iyi electrode yakabatana kune electrosurgical unit (ESU) kuburikidza netambo. Iyo ESU ndiyo sosi yemagetsi inogadzira yakakwira - frequency yemagetsi ikozvino.
Nheyo yekushanda ye monopolar Electrosurgical Unit inobva pamagetsi emagetsi akazara. Iyo yakakwirira-frequency ikozvino inoburitswa kubva kumuromo weiyo handheld electrode. Kana muromo ukasangana nenyama, ikozvino inopfuura nepakati penyama uye yodzokera kuESU kuburikidza ne dispersive electrode, inowanzonzi padhi yepasi. Iyi padhi yekugadzika inowanzoiswa panzvimbo yakakura yemuviri wemurwere, senge chidya kana musana. Chinangwa chepasi pedhi ndechekupa nzira yakaderera-yekudzivirira kuti ikozvino idzokere kuESU, kuve nechokwadi chokuti ikozvino inopararira pamusoro penzvimbo yakakura yemuviri wemurwere, kuderedza ngozi yekutsva panzvimbo yekudzoka.
Panyaya yekushandiswa, monopolar electrosurgical mapanga anoshandiswa zvakanyanya mukuvhiya kwakasiyana. Mukuvhiyiwa kwakawanda, ivo vanowanzo shandiswa kuita incisions panguva yekuvhiya senge appendectomies. Paunenge uchibvisa appendix, chiremba anovhiya anoshandisa monopolar Electrosurgical Unit kugadzira incision mumadziro emimba. Iyo yakakwira - frequency ikozvino inobvumira kuti iite ropa - kushoma kuchekwa, sezvo kupisa kunogadzirwa neazvino kunogona kubatanidza tsinga diki dzeropa panguva imwe chete, kuderedza kudiwa kweakaparadzana hemostatic matanho kune madiki anobuda ropa.
Mune neurosurgery, monopolar electrosurgical mapanga anoshandiswawo, kunyangwe nekuchenjerera kukuru nekuda kwekutetepa kwehunhu hweneural tissue. Iwo anogona kushandiswa kumabasa akadai sekucheka matishu akatenderedza bundu rehuropi. Kunyatsocheka kugona kwebanga remonopolar kunogona kubatsira chiremba anovhiya akanyatso kupatsanura bundu kubva kune akatenderedza uropi tishu. Nekudaro, zvigadziriso zvemagetsi zvinoda kunyatso gadziridzwa kuti udzivise kupisa kwakanyanya kukuvadza kune ari pedyo neural zvimiro.
Mukuvhiya kwepurasitiki, monopolar electrosurgical mapanga anoshandiswa kuita senge kugadzirwa kweganda flap. Semuenzaniso, panguva yekuvhiyiwa kwekuvakazve mazamu, chiremba anovhiya anogona kushandisa monopolar Electrosurgical Unit kugadzira kuputika kweganda kubva kune dzimwe nzvimbo dzemuviri, senge dumbu. Iko kugona kucheka uye kubatana panguva imwe chete kunobatsira mukudzikisa kubuda kweropa panguva yakatetepa maitiro ekugadzira flap, iyo yakakosha pakubudirira kwekuvaka patsva.
Bipolar Electrosurgical Knives
Bipolar electrosurgical mapanga ane dhizaini yakasiyana uye seti yehunhu inoita kuti ikwane kune mamwe marudzi ekuvhiya, kunyanya ayo anoda dhigirii yepamusoro yekurongeka. Zvimiro, bipolar Electrosurgical Unit ine maelectrodes maviri ari padyo nemumwe pamuromo. Aya ma electrode maviri anowanzochengetwa mukati mechimwe chiridzwa.
Nheyo yekushanda ye bipolar electrosurgical mapanga yakasiyana neye monopolar. Mubipolar system, iyo yakakwira-frequency current inoyerera chete pakati pema electrode maviri akanyatso paradzana pamuromo wechiridzwa. Kana iyo muromo inoshandiswa kune tishu, ikozvino inopfuura nepakati penyama iyo inosangana nemagetsi maviri. Uku kuyerera kwenzvimbo kwazvino kunoreva kuti kupisa uye mhedzisiro yetishu inongowanikwa munzvimbo iri pakati pema electrode maviri. Nekuda kweizvozvo, kupisa kunogadzirwa kunowedzera zvakanyanya uye haagone kupararira kune akapoteredza tishu.
Chimwe chezvikonzero zvakakosha kuti bipolar electrosurgical mapanga inofarirwa pakuvhiyiwa kwakanaka kugona kwavo kupa chaiyo kutonga pamusoro pekudziya kwematishu uye kucheka. Mukuvhiyiwa kwemaziso, semuenzaniso, uko zvimiro zvakanyanyisa kutetepa, bipolar electrosurgical mapanga anogona kushandiswa maitiro akadai seiris resection. Chiremba anovhiya anogona kushandisa bipolar banga kunyatsocheka uye kubatanidza matishu ari munzvimbo yeiris pasina kukonzeresa kukuvadza kune iri padyo lens kana zvimwe zvakakosha zvimiro zveziso. Iyo yekudziya yenzvimbo inovimbisa kuti njodzi yekupisa kwekukuvara kune yakatenderedza tishu inodzikiswa.
Muma microsurgeries, akadai seaya anosanganisira kugadziriswa kwetsinga diki dzeropa kana tsinga, bipolar electrosurgical mapanga akakoshawo. Paunenge uchiita microsurgical anastomosis (suturing together) yetsinga diki dzeropa, bipolar banga rinogona kushandiswa kugadzika zvinyoro nyoro chero madiki anobuda ropa pasina kukanganisa kuvimbika kwemadziro etsinga yeropa kana tsinga dziri pedyo. Kugona kunyatso kudzora ikozvino uye kupisa kunobvumira chiremba anovhiya kuti ashande munzvimbo diki uye yakapfava yekuvhiya, ichiwedzera mikana yemhedzisiro inobudirira. Pamusoro pezvo, sezvo yazvino ichivharirwa pakati pema electrode maviri, hapadiwe pedhi hombe yekugadzika senge iri nyaya yemamonopolar system, iyo inowedzera kurerutsa kuseta kweaya mavhiya akanaka.
Clinical Applications
General Surgery
Mukuvhiya kwakawanda, mapanga emagetsi emagetsi anoshandiswa zvakanyanya mumhando dzakasiyana siyana, achipa zvakati wandei zvakanakira.
Appendectomy :
Appendectomy inzira yakajairika yekuvhiya yekubvisa appendix, iyo inowanzo piswa kana hutachiona. Paunenge uchishandisa Electrosurgical Unit mune appendectomy, iyo yakakwira-frequency yazvino inobvumira kuti pave neropa - kushoma dissection yeappendix kubva kune yakatenderedza tishu. Semuenzaniso, kana iri laparoscopic appendectomy, iyo monopolar kana bipolar Electrosurgical Unit inogona kushandiswa kuburikidza netrocar ports. Basa rekucheka reElectrosurgical Unit rinoita kuti chiremba anovhiya akurumidze uye achenese mesoappendix, iyo ine mitsipa yeropa inopa appendix. Panguva imwecheteyo, iyo coagulation function inovhara tsinga duku dzeropa mukati memesoappendix, kuderedza dambudziko rekubuda ropa panguva yekushanda. Izvi hazvingoite kuti nzvimbo yekuvhiya ijeke kune chiremba anovhiya asiwo inopfupisa nguva yese yekuvhiya. Kusiyana neizvi, nzira dzechinyakare dzekushandisa scalpel kucheka mesoappendix uye nekuparadzanisa tsinga yega yega yeropa inodya nguva yakawanda uye inogona kukonzera kubuda ropa kwakawanda.
Cholecystectomy :
Cholecystectomy, kuvhiyiwa kubviswa kwe gallbladder, imwe nzvimbo iyo electrosurgical mapanga anoita basa rakakosha. Mune yakavhurika cholecystectomy, iyo Electrosurgical Unit inogona kushandiswa kuchekerera abdominal wall layer, kusanganisira ganda, subcutaneous tishu, uye tsandanyama. Sezvo ichicheka nepakati pezvinyama izvi, panguva imwe chete inobatana tsinga dzeropa, kuderedza kurasikirwa kweropa. Munguva yekutsemura gallbladder kubva pamubhedha wechiropa, kugona kweElectrosurgical Unit's coagulation kunobatsira kuvhara tsinga diki dzeropa uye bile ducts dzinobatanidza gallbladder nechiropa, kuderedza njodzi yekubuda ropa mushure mekuvhiyiwa uye kubuda kwebile.
Mu laparoscopic cholecystectomy, inova maitiro ekuita zvishoma, Electrosurgical Unit inonyanya kukosha. Iyo bipolar electrosurgical forceps inowanzo shandiswa kutsemura cystic artery uye cystic duct. Iko kuyerera kwazvino kuyerera mubipolar electrosurgical zvishandiso inobvumira kurongeka uye kucheka kwezvimiro izvi, kuderedza njodzi yekukuvadzwa kune yakajairika bile duct uye zvimwe zvakakosha zvimiro. Kugona kuita izvi zvinyoro-nyoro mafambisirwo neElectrosurgical Unit kuburikidza nediki diki ibhenefiti yakakosha, sezvo inotungamirira kumarwadzo mashoma, kupfupika kwekugara muchipatara, uye nekukurumidza kupora nguva kune varwere zvichienzaniswa nekuvhiyiwa pachena.
Gynecological Surgery
Mapanga eElectrosurgical akawana kushandiswa kwakawanda mukuvhiya kwevakadzi, zvichigonesa maitiro akajeka uye anoshanda.
Hysterectomy yeUterine Fibroids :
Uterine fibroids hakusi kukura kwegomarara muchibereko izvo zvinogona kukonzera zviratidzo zvakaita sekubuda ropa kwakanyanya, kurwadziwa kwepelvic, uye kushaya mbereko. Paunenge uchiita hysterectomy (kubvisa chibereko) kurapa hombe kana symptomatic fibroids, electrosurgical mapanga anogona kushandiswa nenzira dzakawanda. Mune yakavhurika hysterectomy, iyo Electrosurgical Unit inoshandiswa kuchekesa madziro edumbu. Panguva yekutsemuka kwechibereko kubva kumatishu akatenderedza, senge dundira, rectum, uye pelvic sidewalls, Electrosurgical Unit yekucheka uye coagulation mabasa anoshandiswa. Inogona kunyatsocheka kuburikidza nemakumbo echibereko, ane mitsipa yeropa, panguva imwe chete achivhara midziyo kudzivirira kubuda ropa. Izvi zvinoderedza kudiwa kwekukurumidzira tsinga dzeropa, kurerutsa nzira yekuvhiya.
Mune laparoscopic kana robhoti - inobatsira hysterectomy, idzo nzira dzisinganyanyi kupindira, zviridzwa zvemagetsi, zvinosanganisira monopolar uye bipolar electrosurgical zvishandiso, zvinoshandiswa zvakatonyanya. Iyo bipolar electrosurgical forceps inogona kushandiswa kunyatso patsanura nekukochekera tsinga dzeropa dzakatenderedza chibereko, kuve nechokwadi chekuti ropa - shoma munda wekubvisa zvine hunyoro kwechibereko. Kusanyanya kupindira kwemaitiro aya, akaitwa kuti agoneke muchikamu nekushandiswa kwemagetsi emagetsi, zvinoguma nekusanyanya kunetseka kumurwere, kugara muchipatara kwenguva pfupi, uye nguva yekupora nekukurumidza.
Cervical Surgeries :
Pakuvhiyiwa kwechibereko, senge loop - electrosurgical excision process (LEEP) yekurapa cervical intraepithelial neoplasia (CIN) kana cervical polyps, electrosurgical mapanga ndiwo anofarirwa maturusi. Mukuita LEEP, tambo yakatetepa loop electrode yakanamatira kune electrosurgical unit inoshandiswa. Iyo yakakwira-frequency inopfuura nemuchiuno inogadzira kupisa, izvo zvinobvumira kucheneswa kweiyo abnormal cervical tissue. Iyi nzira inoshanda zvakanyanya mukubvisa huturu hwechirwere ichideredza kukuvadzwa kune yakapoteredza hutano hwecervical tissue.
Zvidzidzo zvakaratidza kuti LEEP ine mabhenefiti akati wandei. Semuenzaniso, ine chiyero chepamusoro chekubudirira mukurapa CIN. Avhareji yenguva yekushanda ipfupi, kazhinji inotenderedza 5 - 10 maminetsi. Kurasikirwa kweropa kwemukati-kati kudiki, kazhinji kusingasviki 10 mL. Uyezve, njodzi yezvinetso zvakadai sehutachiona uye kubuda ropa kwakaderera. Mushure mekuita, murwere anogona kazhinji kutangazve mabasa akajairwa nekukurumidza, uye nguva refu yekutevera inoratidza kuderera kwekudzokorora kwezvironda zvechibereko. Imwe bhenefiti ndeyekuti iyo yakachekwa tishu inogona kutumirwa kune chaiyo pathological kuongororwa, izvo zvakakosha pakuona kukura kwechirwere uye kutungamira kumwe kurapwa kana zvichidikanwa.
Neurosurgery
Mukuita neurosurgery, kushandiswa kwemapanga emagetsi kwakakosha zvakanyanya nekuda kwekutetepa kwechimiro cheneural tissue uye kudiwa kwekuvhiya chaiko.
Kana uchibvisa mamota ehuropi, iyo Electrosurgical Unit inobvumira iyo neurosurgeon kunyatso bvisa bundu kubva kune yakatenderedza uropi tishu. Iyo monopolar Electrosurgical Unit inogona kushandiswa neakadzika kwazvo - masimba ekugadzirisa kudzikisa njodzi yekukuvara kwekupisa kune ari pedyo neural zvimiro. Iyo yepamusoro-frequency yazvino inoshandiswa kunyatso kucheka mukati mebundu tishu panguva imwe chete ichibatanidza tsinga diki dzeropa mukati mebundu, ichidzikisa kubuda ropa. Izvi zvakakosha sezvo kubuda ropa kwakanyanya muuropi kunogona kukonzera kuwedzera intracranial kudzvanywa uye kukuvadzwa kwetishu dzehuropi dzakatenderedza.
Semuyenzaniso, kana iri meningioma, inova rudzi rwakajairika rwebundu remuuropi rinobuda kubva kumeninges (membranes inovhara uropi), electrosurgeon inoshandisa Electrosurgical Unit kunyatsoparadzanisa bundu kubva kuhuropi hwepasi. Iko kugona kudzora kuchekwa uye coagulation chaizvo neElectrosurgical Unit inobatsira kuchengetedza yakajairika uropi kushanda zvakanyanya sezvinobvira. Iwo bipolar electrosurgical forceps anowanzo shandiswa mukuita neurosurgery, kunyanya kumabasa anotoda kudzora chaiko, sekubatanidza tsinga diki dzeropa pedyo nenzvimbo dzakakosha dzemutsinga. Kuyerera kwazvino kuyerera mumidziyo yebipolar inovimbisa kuti kupisa kunogadzirwa kunovharirwa kunzvimbo diki kwazvo, zvichideredza njodzi yekukuvadzwa kwechibvumirano kune yakatenderedza neural tishu.
Zvakanakira pamusoro peTraditional Surgical Tools
Hemostasis uye Yakaderedzwa Ropa Kurasikirwa
Imwe yemabhenefiti akanyanya kukosha emagetsi emagetsi mapanga pane echinyakare maturusi ekuvhiya kugona kwavo kunoshamisa kwehemostatic, izvo zvinotungamira kuderera kwakanyanya kwekurasikirwa neropa panguva yekuvhiya. Traditional scalpels, kana ikashandiswa kucheka nepakati, inongocheka tsinga dzeropa, ichisiya yakavhurika uye ichibuda ropa. Izvi zvinowanzoda imwe nguva - kutora matanho ekudzora kubuda kweropa, senge suturing imwe neimwe tsinga yeropa kana kushandisa hemostatic agents.
Kusiyana neizvi, mapanga emagetsi emagetsi, kuburikidza nekupisa kwawo, anogona kubata tsinga diki dzeropa paanenge achicheka. Kana iyo yakakwira - frequency ikozvino ichipfuura nemunyama, kupisa kunogadzirwa kunobvisa mapuroteni muropa uye madziro emidziyo. Denaturation iyi inoita kuti ropa rigwambe uye tsinga dzeropa dzivhare. Semuyenzaniso, mukuvhiya kwakajairwa senge ganda - kugadzira flap, yechinyakare scalpel inoda kuti chiremba anovhiya agare akamira uye kugadzirisa mapoinzi ekubuda ropa, anogona kuwanda. NeElectrosurgical Unit, sezvainoita iyo incision, tsinga diki dzeropa muganda uye subcutaneous tishu zvinobatana panguva imwe chete. Izvi hazvingoderedzi kurasikirwa kweropa rose panguva yekuvhiya asiwo zvinopa nzvimbo yekuvhiya yakajeka kune chiremba anovhiya. Imwe wongororo yakaenzanisa mashandisirwo emapanga ekuvhiyiwa nemagetsi uye mascalpels echinyakare mune kumwe kuvhiyiwa kwemudumbu yakawana kuti avhareji yekurasikirwa neropa yakaderedzwa neinosvika 30 - 40% pakushandisa mapanga emagetsi. Uku kudzikiswa kwekurasikirwa neropa kwakakosha sezvo kurasikirwa neropa rakawandisa kunogona kukonzera matambudziko akadai seanemia, kuvhunduka, uye nguva refu yekupora kumurwere.
Precise Incision uye Tissue Dissection
Mapanga eElectrosurgical anopa mwero wepamusoro wechaiyo mukuchekeresa uye kupatsanurwa kwetishu, inova shanduko huru pane zvechinyakare maturusi ekuvhiya. Mascalpels echinyakare ane maitiro asina kujeka ekucheka padanho remicroscopic. Vanogona kukonzera kubvarura uye kukuvadza kune matishu akapoteredza nekuda kwesimba remagetsi rinoshandiswa panguva yekucheka. Izvi zvinogona kunyanya kunetsa kana uchishanda munzvimbo dzine matishu akatetepa kana kune zvakakosha zvimiro zviri padyo.
Electrosurgical mapanga, kune rumwe rutivi, anoshandisa controlled thermal effect yekucheka. Iyo muromo weElectrosurgical Unit inogona kugadzirwa kuve nenzvimbo diki kwazvo, inobvumira kucheka chaiko. Semuyenzaniso, mukuvhiyiwa kweurourosurgery, pakubvisa bundu diki riri padyo neakakosha neural zvimiro, chiremba anovhiya anogona kushandisa Electrosurgical Unit ine yakanaka-yakaiswa electrode. Iyo yepamusoro-frequency yazvino inogona kugadziridzwa kusvika padanho rinocheka chaizvo kuburikidza nebundu tishu uku ichideredza kukuvadzwa kwekupisa kune iri padyo neutano huropi tishu. Kugona kudzora simba uye kuwanda kweElectrosurgical Unit kunoita kuti chiremba anovhiya aite akapfava matishu dissections nekunyatso kurongeka. Muma microsurgeries, akadai seaya anosanganisira kugadziriswa kwetsinga diki dzeropa kana tsinga, bipolar electrosurgical mapanga anogona kunyatso cheka uye kubatanidza matishu munzvimbo diki yekuvhiya, kuderedza njodzi yekukuvadzwa kune zvakatenderedza zvimiro. Kurongeka uku hakungonatsiridza mhedzisiro yekuvhiya chete asiwo kunoderedza mukana wepashure - operative matambudziko ane chekuita nekukuvara kwetishu.
Ipfupi Nguva Yekushanda
Kushandiswa kwemagetsi emagetsi mapanga kunogona kutungamirira kunguva pfupi yekushanda kana ichienzaniswa nemidziyo yekuvhiya yechinyakare, iyo inobatsira kune vese murwere uye timu yekuvhiya. Sezvambotaurwa, mapanga e electrosurgical anogona kucheka uye kubatana panguva imwe chete. Ikoku kunobvisa kudikanwa kwokuti chiremba anovhiya aite matanho akaparadzana okucheka uye ipapo kudzora kubuda kweropa, sezvinoitwa nemicheka yechinyakare.
Mukuvhiya kwakaoma senge hysterectomy, kana uchishandisa scalpel yechinyakare, chiremba anovhiya anofanira kunyatsocheka nepakati akasiyana matishu nemarunda akatenderedza chibereko uye ipapo ega ligate kana cauterize yega yega tsinga yeropa kudzivirira kubuda ropa. Iyi nzira inogona kuva nguva-inopedza, kunyanya pakubata nenhamba yakawanda yemidziyo miduku yeropa. NeElectrosurgical Unit, chiremba anovhiya anogona kukurumidza kucheka nemukati mematishu paanenge achibatanidza tsinga dzeropa, achigadzirisa maitiro ekuvhiya. Zvidzidzo zvakaratidza kuti mune dzimwe nguva, kushandiswa kwemagetsi emagetsi emagetsi kunogona kuderedza nguva yekushanda ne20 - 30%. Nguva pfupi yekushanda inobatanidza nengozi yakaderedzwa yezvinetso zvine chokuita neaneshesia yakareba. Iyo yakareba murwere ari pasi peanesthesia, inowedzera njodzi yekufema uye yemwoyo matambudziko. Pamusoro pezvo, nguva pfupi dzekushanda dzinoreva kuti timu yekuvhiya inogona kuita mamwe maitiro munguva yakatarwa, zvichigona kuwedzera kugona kwekamuri yekuvhiya uye kuderedza mutengo wehutano hwese.
Njodzi Dzinogona Kuitika uye Matambudziko
Kukuvadza Kwekupisa kune Maturusi Akatenderedza
Pasinei nezvakawanda zvakanakira, kushandiswa kwemagetsi emagetsi mukurapa kwekiriniki hakuna njodzi. Chimwe chezvinhu zvinonyanya kunetseka ndechekukuvadza kwekushisa kune zvinyama zvakakomberedza.
Kana Electrosurgical Unit iri kushanda, iyo yakakwira-frequency yazvino inoburitsa kupisa kuti icheke nekukochekera matishu. Zvisinei, kupisa uku kunogona dzimwe nguva kupararira kupfuura nzvimbo yakanangwa. Semuenzaniso, mukuvhiyiwa kwelaparoscopic, iyo monopolar Electrosurgical Unit, kana ikasashandiswa zvakanyatsonaka, inogona kutumira kupisa kuburikidza nemidziyo yakaonda yelaparoscopic uye kukonzeresa kukuvadza kwekupisa kune nhengo dziri pedyo. Izvi zvinodaro nekuti kupisa kunogadzirwa pamuromo we electrode kunogona kuitisa pamwe neshaft yechiridzwa. Muchidzidzo chelaparoscopic cholecystectomy kesi, zvakaonekwa kuti munenge 1 - 2% yezviitiko, paive nekukuvara kudiki kwekupisa kune duodenum kana colon iri pedyo, izvo zvingangove zvakakonzerwa nekupararira kwekushisa kubva kuElectrosurgical Unit panguva yekutsemura gallbladder.
Ngozi yekukuvara kwekupisa inobatanawo nemagetsi emagetsi eElectrosurgical Unit. Kana simba racho rakaiswa zvakanyanya, huwandu hwekupisa hunogadzirwa huchave hwakanyanyisa, huchiwedzera mukana wekupisa kunopararira kune matukisi akapoteredza. Pamusoro pezvo, nguva yekubatana pakati peElectrosurgical Unit uye tishu inoita basa. Kubatana kwenguva refu nenyama kunogona kutungamirira kune kuendeswa kukuru kwekupisa, zvichikonzera kukanganisa kwakanyanya kwekushisa.
Kuti udzivise kukuvara kwemafuta kune matukisi akapoteredza, matanho akawanda anogona kutorwa. Chekutanga, vanachiremba vanovhiya vanofanirwa kuve vakadzidziswa zvakanaka mukushandiswa kwemagetsi emagetsi mapanga. Vanofanira kuva nekunzwisisa kwakajeka kwezvigadziro zvemasimba akakodzera emhando dzakasiyana dzematishu uye maitiro ekuvhiya. Semuyenzaniso, kana uchishanda pamatishu akapfava sechiropa kana uropi, magadzirirwo emagetsi akaderera anowanzo kudiwa kudzikisa njodzi yekukuvadzwa kwekupisa. Chechipiri, kuvharwa kwakakodzera kwemidziyo yemagetsi kwakakosha. Kudzivirira mashafts emidziyo yelaparoscopic kunogona kudzivirira kuitisa kupisa kune nhengo dziri pedyo. Mamwe magadzirirwo emagetsi epamusoro anouyawo aine maficha anotarisisa tembiricha munzvimbo yekuvhiya. Aya tembiricha - ekutarisa masisitimu anogona kuzivisa chiremba anovhiya kana tembiricha iri mumatishu akatenderedza ikatanga kukwira pamusoro pedanho rakachengeteka, zvichibvumira chiremba anovhiya kuti agadzirise simba kana nguva yekushandiswa kwemagetsi nekukasira.
Utachiona uye Njodzi dzeMagetsi
Imwe seti yenjodzi inoenderana nekushandiswa kwemagetsi emagetsi mapanga ndiko kugona kwehutachiona uye njodzi dzemagetsi.
Infection :
Panguva yekuvhiyiwa, kushandiswa kwemagetsi emagetsi kunogona kugadzira nzvimbo inogona kuwedzera njodzi yehutachiona. Kupisa kunogadzirwa neElectrosurgical Unit kunogona kukonzera kukuvara kwetishu, izvo zvinogona kukanganisa nzira dzekudzivirira dzemuviri. Kana iyo matishu ikakuvadzwa nekupisa, inogona kuve nyore kubatwa nebhakitiriya. Semuenzaniso, kana nzvimbo yekuvhiya isina kucheneswa zvakanaka uye isina hutachiona usati washandisa Electrosurgical Unit, chero mabhakitiriya aripo paganda kana munzvimbo yakatenderedza anogona kuunzwa munyama yakakuvadzwa. Mukuwedzera, iyo yakatsva tishu yakaumbwa panguva ye electrosurgical process inogona kupa nharaunda yakanaka yekukura kwebhakitiriya. Ongororo yezvirwere zvepanzvimbo yekuvhiya mushure memaitiro ekushandisa mapanga emagetsi akawana kuti chiyero chehutachiona chaive chakakwira zvishoma zvichienzaniswa nekuvhiya pachishandiswa nzira dzechinyakare mune dzimwe nguva, kunyanya kana hutachiona hwakakodzera - matanho ekudzora haana kunyatsoteverwa.
Kuti kuderedze njodzi yehutachiona, yakasimba preoperative kugadzirira kweganda kunokosha. Nzvimbo yekuvhiya inofanira kunyatsocheneswa neakakodzera antiseptic mhinduro kuderedza kuwanda kwebhakitiriya pamusoro peganda. Matanho ekuvhiya akadai sekushandisa sterile electrosurgical instruments uye kuchengetedza munda usina mbereko kwakakoshawo. Mushure mekuvhiyiwa, kutarisirwa kwakakodzera kwemaronda, kusanganisira kuchinja kwekupfeka nguva dzose uye kushandiswa kwemishonga inorwisa mabhakitiriya kana zvichidiwa, zvinogona kubatsira kudzivirira kukura kwezvirwere.
Njodzi dzeMagetsi :
Njodzi dzemagetsi zvakare inonyanya kunetseka kana uchishandisa electrosurgical mapanga. Idzi njodzi dzinogona kuitika nekuda kwezvikonzero zvakasiyana, senge kusashanda zvakanaka kwemidziyo, kudzika pasi kwakashata, kana kukanganisa kwemushandisi. Kana iyo electrosurgical unit (ESU) ikasashanda, inogona kuendesa yakawandisa ikozvino, izvo zvinogona kutungamira mukupisa kana kuvhunduka kwemagetsi kumurwere kana timu yekuvhiya. Semuyenzaniso, yakashata ESU magetsi ekupa anogona kukonzera kuchinjika mukubuda kwazvino, zvichikonzera kusingatarisirwe kwakakwira - kwazvino kusimuka.
Kudzika pasi kwakashata ndechimwe chikonzero chinowanzokonzera njodzi dzemagetsi. Mune monopolar electrosurgical systems, nzira yakakodzera yepasi kuburikidza ne dispersive electrode (grounding pad) inokosha kuti ive nechokwadi chokuti ikozvino inodzoka zvakachengeteka kuESU. Kana iyo pedhi yepasi isina kunyatsobatanidzwa nemuviri wemurwere, kana kana paine kutyora mudenderedzwa repasi, ikozvino inogona kuwana imwe nzira, senge kuburikidza nedzimwe nhengo dzemuviri wemurwere kana midziyo yekuvhiya, inogona kukonzera kupisa kwemagetsi. Mune zvimwe zviitiko, kana murwere achisangana nezvinhu zvinofambisa muimba yekushanda, zvakadai sezvikamu zvesimbi zvetafura yekuvhiya, uye kugadzika kusina kunaka, murwere angave ari pangozi yekudengenyeka kwemagetsi.
Kugadzirisa njodzi dzemagetsi, kugadzirisa nguva dzose uye kuongororwa kwemidziyo ye electrosurgical inodiwa. Iyo ESU inofanirwa kuongororwa chero zviratidzo zvekupfeka uye kubvaruka, uye zvikamu zvemagetsi zvinofanirwa kuongororwa kuti ive nechokwadi chekushanda. Vashandi vanofanirwa kudzidziswa kumisa nemazvo uye kushandisa michina yemagetsi, kusanganisira kusungirirwa kwakakodzera kwepasi pedhi. Uyezve, imba yekushanda inofanira kunge yakashongedzerwa nemagetsi akakodzera ekuchengetedza zvigadzirwa, zvakadai sepasi - fault circuit interrupters (GFCIs), iyo inogona kukurumidza kutema simba kana ivhu - kukanganisa kana kubuda kwemagetsi, kuderedza njodzi yemagetsi.
Kuvandudzwa Kweramangwana uye Zvitsva
Tekinoroji Kufambira mberi muElectrosurgical Unit Dhizaini
Ramangwana remagetsi emagetsi rine vimbiso huru maererano nekufambira mberi kwetekinoroji. Imwe nzvimbo yekutarisa ndeye kuvandudzwa kweakanyanya kunyatso uye anochinjika emagetsi magadzirirwo. Parizvino, maelectrodes emagetsi emagetsi mapanga ane mashoma muchimiro chawo, kazhinji ari mablades akareruka kana matipi. Mune ramangwana, tinogona kutarisira kuona maelectrodes ane mamwe majeometri akaoma. Semuenzaniso, maelectrodes anogona kugadzirwa ane micro-zvimiro pameso avo. Aya madiki-zvimiro anogona kukwidziridza kusangana nematishu padanho remicroscopic, zvichibvumira kucheka kwakanyanya uye kubatanidzwa. Chidzidzo mumunda wesainzi yemidziyo uye engineering yezvokurapa yakaratidza kuti nekugadzira nanoscale mapatani pamusoro peiyo electrode, kugona kwesimba rekufambisa kune tishu kunogona kuwedzera kusvika 20 - 30%. Izvi zvinogona kutungamira mukuvhiya nekukurumidza uye kwakaringana.
Chimwe chikamu chekufambira mberi kwetekinoroji kuvandudzwa kwesimba rekudzora masisitimu mukati memagetsi emagetsi. Ramangwana electrosurgical mapanga anogona kunge akashongedzerwa nechaiyo - nguva simba - kugadzirisa masisitimu akavakirwa pamatishu impedance mhinduro. Tissue impedance inogona kusiyana zvichienderana nezvinhu zvakaita serudzi rwematishu (mafuta, tsandanyama, kana matishu anobatana), kuvapo kwechirwere, uye dhigirii remvura. Azvino maelectrosurgical units anowanzo vimba ne-pre-set simba mazinga, ayo anogona kunge asina kunaka kune ese matissue mamiriro. Mune ramangwana, masensa mukati meElectrosurgical Unit anogona kuramba achiyera iyo impedance yematishu panzvimbo yekuvhiya. Simba rekubuda kweiyo electrosurgical unit raizogadziriswa otomatiki munguva chaiyo kuona kuti huwandu hwakakodzera hwesimba hunounzwa kune tishu. Izvi hazvingangogadziri kushanda kwekucheka uye kugadzika asi zvakare kuderedza njodzi yekukuvara kwekupisa kune matishu akapoteredza. Tsvagiridzo yakaratidza kuti chaiyo-nguva-yenguva-yekugadzirisa sisitimu inogona kuderedza kuitika kwekupisa-kune hukama ne50 - 60% mune mamwe maitiro ekuvhiya.
Kubatanidzwa nemamwe maSurgical Technologies
Iko kubatanidzwa kwemagetsi emagetsi emagetsi nemamwe matekinoroji ekuvhiya ndiwo muganho unonakidza une mukana wakakosha. Imwe nzvimbo yakakurumbira ndeyekusanganiswa nekuvhiyiwa kwerobhoti. Mukuvhiya kwerobhoti - kunobatsira, chiremba anovhiya anodzora maoko emarobhoti kuita mabasa ekuvhiya. Nekubatanidza mapanga emagetsi emagetsi mumarobhoti masisitimu, iko kurongeka uye dexterity yemaoko emurobhoti inogona kusanganiswa nekucheka uye kugona kubatanidza mapanga emagetsi emagetsi. Semuenzaniso, mune yakaoma robhoti - inobatsira prostatectomy, ruoko rwerobhoti runogona kurongerwa kunyatsofamba muElectrosurgical Unit yakatenderedza prostate gland. Iyo yakakwira - frequency ikozvino kubva kuElectrosurgical Unit inogona kushandiswa kunyatso patsanura prostate kubva kune yakatenderedza tishu panguva imwe chete ichibatanidza tsinga dzeropa. Kubatanidzwa uku kunogona kutungamirira mukuderedza kurasikirwa kweropa, nguva shoma yekushanda, uye kuchengetedzwa zviri nani kwezvivakwa zvakapoteredza, pakupedzisira kuvandudza migumisiro yekuvhiya kune varwere.
Kubatanidzwa nemaitiro mashoma ekuvhiya, senge laparoscopy uye endoscopy, inotarisirwawo kuona imwe budiriro. Mukuvhiya kwelaparoscopic, Electrosurgical Unit parizvino chishandiso chakakosha, asi kufambira mberi kweramangwana kunogona kuita kuti ive yakakosha. Semuyenzaniso, kugadzirwa kwemadiki uye anochinjika mapanga emagetsi ekuvhiya anogona kufambiswa zviri nyore kuburikidza neakamanikana trocar ports mu laparoscopy. Aya mapanga anogona kugadzirwa kuti ave nekugona kutaura zviri nani, achibvumira chiremba wekuvhiya kuti asvike uye ashande munzvimbo dziri kunetsa kuwana. Mukuvhiya kwe endoscopic, kubatanidzwa kwemapanga e electrosurgical kunogona kugonesa maitiro akaomarara kuitwa endoscopically. Semuyenzaniso, mukurapa kwekutanga - nhanho yegomarara remudumbu, endoscopically - yakabatanidzwa Electrosurgical Unit inogona kushandiswa kunyatso bvisa matishu egomarara uku ichideredza kukuvadzwa kune hutano hwakatenderedza tishu, zvichibvisa kudiwa kwekuwedzera kuvhurika - maitiro ekuvhiya. Izvi zvaizoita kuti pasanyanya kunetseka kumurwere, kugara muchipatara kwenguva pfupi, uye nguva dzekukurumidza kupora.
Mhedziso
Mukupedzisa, iyo Electrosurgical Unit yakabuda sechishandiso chekuchinja munharaunda yemishonga yekiriniki, ine zvinosvika kure-zvinoreva zvekuvhiya uye zvekurapa maitiro.
Kutarisa mberi, remangwana remagetsi emagetsi emagetsi akazadzwa nemikana inofadza. Tekinoroji kufambira mberi mukugadzira maelectrode uye masimba ekudzora masisitimu ane vimbiso yezvakanyanya uye zvine hunyanzvi maitiro ekuvhiya. Iko kubatanidzwa kwemagetsi emagetsi emagetsi nemamwe matekinoroji ekuvhiya ari kubuda, akadai sekuvhiya marobhoti uye hunyanzvi hwepamusoro-soro, hunogona kuwedzera kuwedzera chiyero chezvinokwanisika mukamuri yekuvhiya.
Sezvo munda wemushonga uchiramba uchishanduka, iyo Electrosurgical Unit pasina mubvunzo icharamba iri pamberi pekuvhiya innovation. Kuenderera mberi nekutsvagisa uye kusimukira munzvimbo iyi kwakakosha kuti unyatso kuzadzisa kugona kwayo, kuvandudza kutarisirwa kwevarwere, uye kufambisa kufambira mberi kwemaitiro ekuvhiya mumakore anotevera.
