Nhanganyaya
Munzvimbo yekuvhiya kwemazuva ano, kunyatsoita uye kuchengeteka zvakakosha zvikuru. Zvishandiso zviviri zvakakosha zvakashandura nzira dzekuvhiya ndeye ultrasonic scalpel uye electrosurgical unit (ESU). Zviridzwa izvi zvinotamba mabasa akakosha muhunyanzvi hwakasiyana hwekuvhiya, kubva pakuvhiyiwa kwese kusvika kune neurosurgery, zvichiita kuti vavhiyi vakwanise kuita maoparesheni nemazvo uye nekuderedza kukuvara kwemurwere.
Iyo ultrasonic scalpel, inozivikanwawo seye ultrasonic surgical aspirator kana CUSA (Cavitron Ultrasonic Surgical Aspirator), yava chinhu chikuru mumakamuri akawanda ekushanda. Inoshandisa yakakwirira-frequency ultrasonic vibrations kucheka uye coagulate tishu. Iyi tekinoroji inobvumira kuti kuve kwakanyatso kuchekwa, kunyanya munzvimbo dzakatetepa uko kudzikisira kukuvadzwa kwematishu akatenderedza kwakakosha. Semuenzaniso, mune neurosurgery, kana uchivhiya pahuropi, iyo ultrasonic scalpel inogona kunyatso bvisa bundu tishu ichichengetedza hutano neural tishu zvakanyanya sezvinobvira.
Kune rimwe divi, iyo electrosurgical unit (ESU), inonziwo yakakwira-frequency electrosurgical jenareta, chimwe chishandiso chinoshandiswa zvakanyanya mukuvhiya. Inoshanda nekupfuura magetsi kuburikidza nematishu, ichigadzira kupisa kunogona kucheka, kugadzika, kana kuderedza tishu. MaESU anochinja-chinja uye anogona kushandiswa mumhando dzakasiyana siyana, kubva pakuvhiyiwa kwevarwere kunze kusvika pakuvhiyiwa kwakaoma kwemoyo.
Kunzwisisa mutsauko uripo pakati pezviviri izvi zvekuvhiya kwakakosha kune vanovhiya, zvikwata zvekuvhiya, uye vadzidzi vezvokurapa zvakafanana. Nekuziva iyo yakasarudzika maficha, zvakanakira, uye zvinogumira zve ultrasonic scalpel uye electrosurgical unit, nyanzvi dzekurapa dzinogona kuita sarudzo dzine ruzivo pamusoro pekuti ndechipi chishandiso chakanyatsokodzera kune imwe nzira yekuvhiya. Izvi hazvisi kungowedzera kubudirira kwekuvhiyiwa asiwo kunovandudza migumisiro yevarwere. Muzvikamu zvinotevera, tichaongorora zvakadzama mukati memitemo yekushanda, zvikumbiro, zvakanakira, zvisingabatsiri, uye kufunga nezvekuchengetedza kwezvose zviri zviviri ultrasonic scalpel uye electrosurgical unit, zvichipa kuenzanisa kwakakwana pakati pezviviri.
Tsanangudzo uye Mafungiro Akakosha
Ultrasonic Scalpel
An ultrasonic scalpel chishandiso chakaomarara chekuvhiya chinoshandisa simba repamusoro - frequency ultrasonic waves, kazhinji muhuwandu hwe20 - 60 kHz. Aya mafungu e ultrasonic anogadzira ma mechanical vibrations mukati mekuvhiya tip. Kana muromo wevibrating ukasangana neBiological tissues, inoita kuti mamorekuru emvura ari mukati memasero azunguze nekukasira. Kudengenyeka kwakasimba uku kunotungamirira kumuitiro unonzi cavitation, uko mabhuru madiki anoumba uye anodonha mukati mematishu. Iyo mechanic stress kubva kune cavitation uye yakananga mechanic chiito cheiyo vibrating tip inopwanya iyo tishu mamolecular bond, zvichinyatso kucheka nepakati.
Panguva imwe chete, iyo yakakwira-frequency vibrations zvakare inoburitsa kupisa, iyo inoshandiswa kubatanidza tsinga dzeropa padhuze nekuchekwa. Iyi coagulation process inosunga tsinga dzeropa, zvichideredza kurasikirwa neropa panguva yekuvhiya. Semuenzaniso, mukuvhiyiwa kwehuroyi, iyo ultrasonic scalpel inogona kunyatso patsanura thyroid gland kubva kumatishu akatenderedza ichideredza kubuda ropa. Kugona kucheka uye kubatana panguva imwe chete kunoita kuti ive chishandiso chakakosha mukuvhiya uko kuchengetedza nzvimbo yekuvhiya yakajeka uye kuderedza kurasikirwa kweropa kwakakosha.
Electrosurgical Unit
Iyo electrosurgical unit (ESU) inoshanda pane imwe musimboti, ichivimba nepamusoro - frequency alternating magetsi ikozvino. Iyo yakajairika frequency renji yeESUs iri pakati pe300 kHz ne3 MHz. Kana magetsi achipfuura nemunyama yemurwere kuburikidza ne electrode (senge penzura yekuvhiya kana imwe nyanzvi yekucheka kana coagulating tip), kusamira kwemagetsi kwetishu kunoshandura simba remagetsi kuita kupisa.
Kune nzira dzakasiyana dzekushanda kweESUs. Mune yekucheka modhi, iyo yakakwira - frequency ikozvino inogadzira yakakwira - tembiricha arc pakati pe electrode uye tishu, iyo inopfungaira matishu, ichigadzira kucheka. Mune iyo coagulation modhi, yakaderera - simba ikozvino rinoiswa, zvichiita kuti mapuroteni ari munyama aite denature uye coagulate, inovhara tsinga diki dzeropa uye kumisa kubuda ropa. Mune hysterectomy, semuenzaniso, ESU inogona kushandiswa kucheka nemukati mechibereko uye wozochinja kune coagulation modhi yekusimbisa tsinga dzeropa munzvimbo yekuvhiya, kudzivirira kurasikirwa kweropa rakawandisa. MaESU ane hunyanzvi uye anogona kushandiswa mumhando dzakasiyana siyana dzekuvhiya, kubva kudermatology yekubvisa maronda eganda kusvika pakuvhiyiwa kwemapfupa ekunyorovesa - tishu dissection yakatenderedza mapfupa.
Kushanda Nheyo
Iyo Ultrasonic Scalpel Inoshanda sei
Iko kushanda kweiyo ultrasonic scalpel kwakavakirwa pamisimboti ye ultrasonic wave kuparadzira uye mechanika - thermal mhedzisiro pabiological tishu.
1. Chizvarwa cheUltrasonic Waves
An ultrasonic jenareta mukati memudziyo ane basa rekugadzira yakakwirira - frequency magetsi masaini. Aya masaini emagetsi anowanzo kuve nemafrequency ari pakati pe20 - 60 kHz. Jenareta inobva yashandura aya masaini emagetsi kuita ma mechanical vibrations achishandisa piezoelectric transducer. Piezoelectric zvinhu zvine yakasarudzika pfuma yekuchinja chimiro chazvo kana munda wemagetsi waiswa kwavari. Panyaya ye ultrasonic scalpel, piezoelectric transducer inodedera nekukurumidza mukupindura kune yakakwirira - frequency magetsi masaini, achigadzira mafungu e ultrasonic.
2. Energy Conduction
Iwo masaisai e ultrasonic anobva afambiswa achitevedza waveguide, iyo inowanzova refu, yakatetepa simbi tsvimbo, kune yekuvhiya tip. Iyo waveguide yakagadzirirwa kunyatso kuendesa iyo ultrasonic simba kubva kune jenareta kuenda kumuromo ine kushoma simba kurasikirwa. Iyo yekuvhiya muromo ndiyo chikamu chechiridzwa chinouya chakanangana nematishu panguva yekuvhiya.
3. Kudyidzana kweTissue - Kucheka uye Kubatana
Kana iyo yekuvhiya yekuvhiya inobata matishu, akati wandei maitiro emuviri anoitika. Chekutanga, iyo yepamusoro-frequency vibrations inokonzeresa kuti mamorekuru emvura ari mukati mematishu maseru azungunuke zvine simba. Kudengenyeka uku kunotungamira kune chimwe chiitiko chinonzi cavitation. Cavitation ndiko kuumbwa, kukura, uye kuputsika kudonha kwemabhuru madiki mukati memvura yepakati (munyaya iyi, mvura mukati mematishu). Iko kupinza kwemabhuru aya kunogadzira kushushikana kwemagetsi emunharaunda, izvo zvinotyora ma molecular bond munyama, zvichinyatso kucheka nemairi.
Panguva imwe cheteyo, ma mechanical vibrations of the tip anoburitsawo kupisa nekuda kwekukweshana pakati petip inozunguza nematishu. Kupisa kunogadzirwa kuri pakati pe50 - 100°C. Kupisa uku kunoshandiswa kubatanidza tsinga dzeropa dziri pedyo nekuchekwa. Iyo coagulation process inokanganisa mapuroteni ari mumadziro emidziyo yeropa, zvichiita kuti abatane pamwe chete uye avhare mudziyo, nokudaro kuderedza kurasikirwa kweropa panguva yekuvhiyiwa. Semuenzaniso, mukuvhiyiwa kwelaparoscopic yekubvisa mapundu madiki muchiropa, iyo ultrasonic scalpel inogona kunyatsocheka nepakati pechiropa ichivhara tsinga dzeropa, kuchengetedza nzvimbo yekuvhiya yakajeka kune chiremba anovhiya.
Mashandiro eElectrosurgical Unit
Iyo electrosurgical unit (ESU) inoshanda pamusimboti wekushandisa yakakwira - frequency alternating magetsi ekugadzira kupisa mukati metishu, iyo inobva yashandiswa kucheka uye coagulation.
1. High - Frequency Alternating Current Generation
Iyo ESU ine magetsi uye jenareta inoburitsa yakakwirira-frequency alternating magetsi ikozvino. Kuwanda kweichi ikozvino kunowanzo kubva pa300 kHz kusvika ku3 MHz. Iyi yepamusoro-frequency current inoshandiswa panzvimbo yepasi - frequency current (yakadai semagetsi emumba pa50 - 60 Hz) nekuti yakakwira - frequency current inogona kuderedza njodzi ye cardiac fibrillation. Panguva yakaderera, magetsi emagetsi anogona kukanganisa zviratidzo zvemagetsi zvakajairwa mumoyo, zvinogona kukonzera hupenyu - kutyisidzira arrhythmias. Zvisinei, marefu - frequency currents ari pamusoro pe300 kHz haanyanyi kuva nemhedzisiro yakadaro pamhasuru yemwoyo sezvo asingakurudzire tsinga nemaseru mhasuru nenzira imwechete.
2. Kudyidzana kweTissue - Kucheka uye Coagulation Modes
· Kucheka Mode : Muchigadziro chekucheka, iyo yepamusoro-frequency yemagetsi inopfuudzwa nediki, inopinza-inopinza electrode (yakadai sepenzura yekuvhiya). Kana electrode ichisvika patishu, kupikisa kwepamusoro kwetishu kumagetsi emagetsi kunoita kuti simba remagetsi rishandurwe kuve kupisa. Kupisa kunogadzirwa kwakakwira zvakanyanya, kunosvika tembiricha inosvika 1000 ° C muarc pakati pe electrode uye tishu. Uku kupisa kwakanyanya kunopfungaira matishu, zvichiita kucheka. Sezvo electrode inofamba pamwe chete nenyama, inoenderera mberi incision inoitwa. Semuyenzaniso, mune tonsillectomy, iyo ESU mukucheka modhi inogona kukurumidza uye nemazvo kubvisa matonsi nekuputira matishu.
· Coagulation Mode : Mune coagulation modhi, yakaderera - simba ikozvino rinoiswa. Kupisa kunogadzirwa kunokwana kudzora mapuroteni ari munyama, kunyanya mutsinga dzeropa. Kana mapuroteni ari mutsinga yeropa madziro akachinja, anoita coagulum, inovhara tsinga dzeropa uye inomisa kubuda ropa. Kune marudzi akasiyana ezve coagulation matekiniki anoshandiswa neESUs, senge monopolar uye bipolar coagulation. Mune monopolar coagulation, magetsi emagetsi anopfuura kubva pamagetsi anoshanda kuburikidza nemuviri wemurwere kuenda kune dispersive electrode (padhi hombe yakaiswa paganda remurwere). Mubipolar coagulation, ese ari kushanda uye anodzoka maelectrode ari musimba rimwe chete - senge mudziyo. Ikozvino inongoyerera pakati pematipi maviri e forceps, ayo anobatsira pakunyatso coagulation munzvimbo diki, senge microsurgeries kana pakubata nematishu akapfava. Semuyenzaniso, mune neurosurgery, bipolar coagulation ine ESU inogona kushandiswa kuvhara tsinga dzeropa diki pamusoro pehuropi pasina kukonzera kukuvadza kwakanyanya kune yakatenderedza tsinga.
Misiyano Yakakosha
Kunobva Simba
Musiyano wakanyanya kukosha pakati peiyo ultrasonic scalpel uye electrosurgical unit iri mune yavo simba masosi. An ultrasonic scalpel inoshandisa ultrasonic simba, iri muchimiro chepamusoro - frequency mechanical vibrations. Aya mavibrations anogadzirwa nekushandura simba remagetsi kuita mechanical simba kuburikidza nepiezoelectric transducer. Iyo frequency yemafungu e ultrasonic anowanzo kubva pa20 - 60 kHz. Iri simba remagetsi rinobva raendeswa kune matishu, zvichikonzera shanduko yemuviri senge cavitation uye mechanical disruption.
Kune rumwe rutivi, electrosurgical unit inoshanda pamagetsi emagetsi. Inogadzira yakakwirira - frequency alternating magetsi ikozvino, kazhinji muhuwandu hwe300 kHz - 3 MHz. Mhepo yemagetsi inopfuudzwa nemukati, uye nekuda kwekupikisa kwetishu, simba remagetsi rinoshandurwa kuva simba rekupisa. Kupisa uku kunobva kwashandiswa kucheka uye kuita coagulation. Izvo zvakasiyana-siyana zvemasimba zvinotungamira kune nzira dzakasiyana dzekudyidzana netishu, izvo zvinozokanganisa mhedzisiro yekuvhiya uye chengetedzo nhoroondo yemaitiro. Semuyenzaniso, mechanical nature ye ultrasonic energy in an ultrasonic scalpel inobvumira kupindirana 'kupfava' pamwe netishu mune zvimwe zvinhu, sezvo isingavimbi nekupisa kwakanyanya chizvarwa senge electrosurgical unit.
Kudyidzana kweTissue
Iyo ultrasonic scalpel inopindirana nematishu kuburikidza nemusanganiswa wemakanika vibration uye thermal mhedzisiro. Kana iyo vibrating tip ye ultrasonic scalpel inobata tishu, iyo yakakwirira-frequency mechanical vibrations inokonzeresa kuti mamorekuru emvura ari mukati mematishu maseru azungunuke zvine simba. Izvi zvinotungamira kune cavitation, uko mabhuru madiki anoumba uye anodonha mukati mematishu, achigadzira kushushikana kwemagetsi kunopwanya matishu mamolecular bond. Pamusoro pezvo, iko kukweshera kwemagetsi pakati petip inozunguza uye matishu inogadzira kupisa, iyo inoshandiswa kubatanidza tsinga diki dzeropa. Iyo matishu inonyanya kukanganiswa nemagetsi masimba, uye kupisa ndeyechipiri chiitiko chinobatsira muhemostasis.
Kusiyana neizvi, imwe electrosurgical unit inopindirana nematishu kunyanya kuburikidza nemhedzisiro yekupisa. Iyo yepamusoro-frequency yemagetsi inopfuura nemumatishu inoburitsa kupisa nekuda kwekupokana kwetishu kune yazvino. Mune nzira yekucheka, kupisa kwakanyanyisa (kusvika ku1000 ° C mu arc pakati pe electrode uye tishu) zvokuti inoputira mutsara, ichigadzira kucheka. Mune iyo coagulation mode, yakaderera - simba ikozvino rinoshandiswa, uye kupisa kunogadzirwa (kazhinji kunosvika 60 - 100 ° C) kunobvisa mapuroteni ari munyama, kunyanya mutsinga dzeropa, zvichiita kuti dzibatane uye dzivhare. Kudyidzana kweESU nematishu kunonyanya kutongwa nekupisa - kukonzeresa shanduko, uye masimba emagetsi ari mashoma kana achienzaniswa neye ultrasonic scalpel.
Thermal Kukuvadza
Imwe yemusiyano wakakosha pakati pezviridzwa zviviri ndeye kuwanda kwekukuvara kwekupisa kwavanokonzera kune matishu akapoteredza. Iyo ultrasonic scalpel inowanzo gadzira yakaderera kupisa panguva yekushanda. Kupisa kunogadzirwa kunonyanya kushandiswa kubatira tsinga diki dzeropa uye kuri pakati pe50 - 100°C. Somugumisiro, kukuvadza kwekushisa kune zviputi zvakapoteredza kunogumira. Iyo mechanic yekushanda kwayo inoreva kuti matishu inochekwa uye kubatanidzwa nekushomeka kwekukuvadza kwemafuta, izvo zvinonyanya kubatsira mukuvhiya uko kuchengetedza kutendeseka kwematishu ari padyo kwakakosha, senge neurosurgery kana microsurgeries.
Sezvineiwo, electrosurgical unit inogona kukonzera yakawedzera kukuvadza kwemafuta. Mune yekucheka maitiro, iyo yakanyanya kupisa tembiricha (kusvika 1000 ° C) inogona kutungamira kune yakakosha tishu vaporization uye charring, kwete chete panzvimbo yekucheka asiwo munzvimbo dziri pedyo. Kunyangwe muiyo coagulation modhi, kupisa kunogona kupararira kunzvimbo yakakura yakatenderedza tishu yakarapwa, inogona kukuvadza masero ane hutano uye zvimiro. Uku kukuvadzwa kukuru kwekushisa dzimwe nguva kunogona kutungamirira kunguva refu yekuporesa, kuwedzera njodzi yetishu necrosis, uye kukanganisa kunogona kuitika kwenhengo dzepedyo kana matishu. Semuenzaniso, mune yakakura - yakapfava - matishu resection uchishandisa ESU, yakatenderedza ine hutano tishu inogona kukanganiswa nekupisa, izvo zvinogona kukanganisa kupora kwese kwemurwere.
Hemostasis Kugona
Zvose zviri zviviri ultrasonic scalpel uye electrosurgical unit ine hemostatic capabilities, asi inosiyana mukushanda kwayo uye nzira yavanoita nayo hemostasis. Iyo ultrasonic scalpel inogona kubata tsinga diki dzeropa uchicheka matishu. Sezvo muromo unofamba uchicheka nepakati, kupisa kunogadzirwa panguva imwe chete kunovhara tsinga dzeropa dziri pedyo, zvichideredza kurasikirwa neropa panguva yekuvhiya. Uku kugona kucheka nekugwamba panguva imwe chete kunoita kuti zvinyatsoshanda mukuchengetedza nzvimbo yekuvhiya yakajeka, kunyanya mukuvhiya uko kuenderera kuyerera kweropa kunogona kuvhara maonero echiremba. Zvisinei, kubudirira kwayo mukubata nemidziyo mikuru yeropa inogumira.
Iyo electrosurgical unit inewo yakanaka hemostatic properties. Mune coagulation mode, inogona kuvhara tsinga dzeropa dzehukuru hwakasiyana. Nekushandisa yakaderera - simba ikozvino, kupisa kunogadzirwa denatures mapuroteni ari mutsinga yeropa madziro, zvichiita kuti iwonane uye avhare. ESUs anowanzo shandiswa kudzora kubuda ropa panguva yekuvhiyiwa, uye anogona kugadziridzwa kuti abate masaizi emudziyo akasiyana. Kune tsinga dzakakura dzeropa, yakakwira - yekumisikidza simba inogona kudikanwa kuti ive nechokwadi chekubata kwakaringana. Mune kumwe kuvhiyiwa kwakaoma, sekuvhiya kwechiropa uko kune tsinga dzeropa dzakawanda dzehukuru hwakasiyana, ESU inogona kushandiswa pamwe chete nedzimwe nzira dzehemostatic kuwana hemostasis inoshanda.
Precision uye Kushanda
Iyo ultrasonic scalpel inopa yakanyanya kurongeka, kunyanya mukuvhiya kwakapfava. Iyo diki, inozunguza tipi inobvumira kune chaiyo chaiyo incisions uye dissections. Mukuvhiyiwa kuduku, kwakadai se laparoscopic kana endoscopic maitiro, iyo ultrasonic scalpel inogona kushandiswa nyore nyore kuburikidza nediki diki kana mashizha echisikigo, kupa vanachiremba vane simba rekuita maitiro akaoma nehupamhi hwepamusoro. Inonyanya kukosha pakuvhiyiwa uko mushumo unobviswa uri pedyo pedyo nezvivako zvakakosha, sezvo kukuvadzwa kwayo kusingagumi kwekushisa uye kukwanisa kunyatsocheka kunobatsira kuderedza dambudziko rekukuvara kune izvi zvivakwa.
Iyo electrosurgical unit, kune rumwe rutivi, ine huwandu hwakawanda hwekushandisa. Inogona kushandiswa mumhando dzakasiyana dzekuvhiya, kubva padiki maitiro eganda kusvika kune makuru akavhurika - ekuvhiya mwoyo. Kunyangwe zvingave zvisingapi chiyero chakafanana cheiyo ultrasonic scalpel mune mamwe maitiro akatetepa, kuita kwayo kwakasiyana-siyana maererano nemhando dzakasiyana dzematishu uye mamiriro ekuvhiya chinhu chakakosha mukana. Mukuvhiya kwakakura uko kukurumidza uye kugona kubata kwakasiyana matishu uye saizi yemidziyo yakakosha, iyo ESU inogona kugadziridzwa kuti isangane nezvinodikanwa izvi. Semuyenzaniso, mukuvhiyiwa kwemapfupa, ESU inogona kushandiswa kukurumidza kucheka nepakati pematishu akapfava uye coagulate mapoinzi ekubuda ropa panguva yekubviswa kwenyama yakakuvadzwa kana kuiswa kweprosthetics.
Zvakanakira uye Zvakaipa
Ultrasonic Scalpel
· Zvakanakira :
· Kuderedzwa Kubuda Kweropa : Imwe yezvakakosha zvakanakira iyo ultrasonic scalpel kugona kwayo kubatanidza tsinga diki dzeropa paunenge uchicheka. Izvi zvinotungamirira kukuderera kukuru kwekurasikirwa neropa panguva yekuvhiyiwa. Semuenzaniso, mukuvhiyiwa kwelaparoscopic yekubvisa mapundu madiki muchiropa kana gallbladder, iyo ultrasonic scalpel inogona kuchengetedza ropa rakati - remahara nzvimbo yekuvhiya, izvo zvakakosha kuti chiremba anovhiya aone zvakajeka nzvimbo yekuvhiya uye kuita oparesheni yacho nemazvo.
· Minimal Tissue Trauma : Iyo ultrasonic scalpel's oparesheni inonyanya kutsamira pamakanika vibrations, izvo zvinokonzeresa kukuvadzwa kushoma kune akapoterera ane hutano tishu zvichienzaniswa nemamwe maturusi ekuvhiya. Iko kushomeka kwekukuvara kwemafuta kwainokonzeresa kunoreva kuti matishu ari padhuze haanyanye kukanganiswa, kusimudzira kukurumidza kupora uye kuderedza njodzi yekumashure - operative matambudziko akadai sehutachiona kana nhengo - kusashanda zvakanaka. Izvi zvinonyanya kubatsira mukuvhiya kunosanganisira nhengo dzakatetepa sehuropi, maziso, kana tsinga.
· Kukurumidza Kupora kweVarwere : Nekuda kwekuderera kweropa kurasikirwa uye kushoma kwematishu kukuvadzwa, varwere vanovhiyiwa ne ultrasonic scalpel vanowanzowana nguva ipfupi yekupora. Vanogona kunge vaine marwadzo mashoma, mashoma post - operative kutapukira, uye vanogona kudzoka kune zvakajairika zviitiko nekukurumidza. Izvi hazvingonatsiridze hupenyu hwemurwere panguva yekupora asi zvakare zvinoderedza mutengo wehutano hwese hunoenderana nekugara kwenguva refu muchipatara.
· Zvakaipa :
· High Equipment Cost : Ultrasonic scalpel masisitimu anodhura. Mutengo wemudziyo wacho pachawo, pamwe chete nekugadzirisa kwayo uye kuenzanisa zvinodiwa, zvinogona kuve mutoro wakakura wemari kune zvimwe zvivakwa zvehutano, kunyanya izvo zviwanikwa - zvidiki zvigadziriso. Uyu mutengo wakakwirisa unogona kudzikisira kutorwa kwakawanda kwema ultrasonic scalpels, zvichikanganisa kuwanikwa kwevarwere kune iyi tekinoroji yekuvhiya yepamusoro.
· Hunyanzvi Hwepamusoro Hunodiwa paKushanda : Kushandisa ultrasonic scalpel kunoda hunyanzvi hwepamusoro uye kudzidziswa. Vanachiremba vanovhiya vanofanirwa kuve nehunyanzvi mukubata chigadziro kuti ive nechokwadi chekucheka chaiko uye coagulation uku uchideredza kukuvadzwa kwematishu akatenderedza. Kudzidza kushandisa ultrasonic scalpel zvinobudirira kunogona kutora nguva yakawanda uye kudzidzira, uye kushandiswa kusina kunaka kunogona kutungamirira kune suboptimal mhedzisiro yekuvhiya kana zvikanganiso zvekuvhiya.
· Kubudirira Kushoma KweMitsipa Yakakura Yeropa : Kunyange zvazvo ultrasonic scalpel inoshanda mukubatanidza tsinga duku dzeropa, kukwanisa kwayo kudzora kubuda ropa kubva mumitsipa mikuru yeropa inogumira. Mumamiriro ezvinhu apo tsinga dzakakura dzinoda kuchekwa kana kusungirirwa panguva yekuvhiyiwa, dzimwe nzira dzakadai sechinyakare ligation kana kushandiswa kwe electrosurgical unit inogona kudiwa. Izvi zvinogona kuwedzera kuoma uye nguva yekuvhiya.
Electrosurgical Unit
· Zvakanakira :
· Yakakwira - Yekumhanyisa Kucheka : Iyo electrosurgical unit inogona kucheka nemunyama nekukurumidza. Mukuvhiya uko nguva iri chinhu chakakosha, senge mukuvhiyiwa kwekukurumidzira kana hukuru-hukuru matishu resection, kukurumidza kucheka kugona kweESU kunogona kuve mukana mukuru. Semuenzaniso, panguva yecesarean chikamu, ESU inogona kukurumidza kucheka nepakati pedumbu remukati kusvika kuchibereko, kuderedza nguva yekuvhiya uye kuderedza njodzi kuna amai nemwana.
· Inoshanda Hemostasis yeVarying Vessel Sizes : ESUs inoshanda zvakanyanya mukuwana hemostasis yemidziyo yeropa yehukuru hwakasiyana. Mune coagulation mode, vanogona kuvhara macapillaries madiki pamwe netsinga dzakakura dzeropa nekushandisa huwandu hwakakodzera hwesimba remagetsi. Izvi zvakasiyana-siyana zvinoita kuti ESU ive chishandiso chakakosha mukuvhiya uko kudzora kubuda ropa kubva kumhando dzakasiyana dzetsinga kwakakosha, sekuvhiya chiropa kana kuvhiya kunosanganisira mamota ane vascularized zvakanyanya.
· Yakareruka Equipment Setup : Kana ichienzaniswa nemimwe michina yekuvhiya yepamberi, iyo yekutanga kuseta ye electrosurgical unit iri nyore. Inonyanya kuve nejenareta yemagetsi uye electrode, iyo inogona kubatanidzwa nyore nyore uye kugadziriswa kune zvakasiyana-siyana zvekuvhiya. Kureruka uku kunobvumira kukurumidza kugadzirira muimba yekuvhiya, kuderedza nguva inotambiswa pakugadzirisa michina uye zvichiita kuti vavhiyi vatange kuvhiya nekukasika.
· Zvakaipa :
· Yakakosha Kukuvadza Kwekupisa : Sezvambotaurwa, iyo electrosurgical unit inogadzira huwandu hwakawanda hwekupisa panguva yekushanda, kunyanya mukucheka mode. Uku kupisa kwekushisa kwakanyanya kunogona kukonzera kukuvadza kwemafuta kune matishu akatenderedza, zvichitungamira mukutsva kwetishu, necrosis, uye kukuvara kunogona kuitika kune nhengo dziri pedyo kana zvimiro. Iyo yakakura kugadzika kwemagetsi uye kurebesa nguva yekushandisa, iyo yakanyanya kukuvadza kukuvara kwemafuta kungangoita.
· Njodzi yeTissue Carbonization : Kupisa kwakanyanya kunogadzirwa neESU kunogona kukonzera kuti tishu zviite carbonize, kunyanya pazvirongwa zvesimba. Carbonized tissue inogona kunetsa kusuture kana kupora nemazvo, uye inogona kuwedzera njodzi yepost-operative infection. Mukuwedzera, kuvapo kwecarbonized tissue kunogona kukanganisa kuongorora kwe histological yezvakagadziriswa, izvo zvakakosha pakuongororwa kwakarurama uye kuronga kurapwa.
· High Operator Skill Chinodiwa : Kushandisa electrosurgical unit zvakachengeteka uye zvinobudirira kunoda hunyanzvi hwepamusoro uye ruzivo. Mushandi anofanirwa kukwanisa kudzora kubuda kwesimba nenzira kwayo, sarudza nzira yakakodzera (kucheka kana kubatanidza) yemhando dzakasiyana dzematishu uye mamiriro ekuvhiya, uye kudzivirira netsaona kukuvadza kupisa kumurwere. Kushandiswa zvisirizvo kweESU kunogona kukonzera matambudziko akakomba, sekubuda ropa zvakanyanya, kukuvara kwetishu, kana kutsva kwemagetsi.
Zvikumbiro muKuvhiya
Yakajairwa Kuvhiya Minda ye Ultrasonic Scalpel
1. Laparoscopic Surgery
· Mune laparoscopic maitiro, iyo ultrasonic scalpel inofarirwa zvakanyanya. Somuenzaniso, panguva laparoscopic cholecystectomy (kubviswa gallbladder). Iyo diki, chaiyo muromo weiyo ultrasonic scalpel inogona kuiswa kuburikidza nediki laparoscopic ports. Inogona kunyatso patsanura gallbladder kubva kune akatenderedza tishu ichideredza kubuda ropa. Kugona kugadzika tsinga dzeropa panguva yekucheka kwakakosha mune izvi zvishoma - invasive kuvhiyiwa, sezvo kunobatsira kuchengetedza maonero akajeka kune chiremba anovhiya, ari kushanda nerubatsiro rwekamera uye refu-shafted zviridzwa.
· Mu laparoscopic colorectal kuvhiyiwa, iyo ultrasonic scalpel inogona kushandiswa kupatsanura colon kana rectum kubva kune zviri padyo zvimiro. Inogona kunyatsocheka kuburikidza nemesentery (tishu inosungirira ura kumadziro edumbu) uye kuvhara tsinga diki dzeropa mukati mayo. Izvi zvinoderedza njodzi yekurasikirwa neropa uye kukuvara kunogona kuitika kunhengo dziri pedyo dzakadai sedundira kana ureters.
1. Kuvhiyiwa kweThoracic
· Mukuvhiya kwemapapu, iyo ultrasonic scalpel inoita basa rakakosha. Paunenge uchiita pulmonary lobectomy (kubvisa lobe yemapapu), ultrasonic scalpel inogona kushandiswa kuparadzanisa pulmonary tissue uye kuvhara tsinga duku dzeropa munzvimbo. Izvo zvishoma zvinopisa zvinokuvadza zve ultrasonic scalpel zvinobatsira mukuchengetedza basa remapapu akasara. Semuenzaniso, mumamiriro ezvinhu apo murwere ane chirwere chemapapu uye basa remapapu rasara rinoda kuwedzerwa, kushandiswa kwe ultrasonic scalpel kunogona kubatsira kuzadzisa chinangwa ichi.
· Mukuvhiya kwepakati, uko nzvimbo yekuvhiya inowanzova padyo nenzvimbo dzakakosha semoyo, tsinga dzeropa, uye trachea, iyo ultrasonic scalpel's precision uye kushoma kwekushisa kupararira kunobatsira zvakanyanya. Inogona kushandiswa kunyatsobvisa mamota kana mamwe maronda mu mediastinum pasina kukonzeresa kukuvadza kwakanyanya kune zvakapoteredzwa zvakakosha zvimiro.
1. Neurosurgery
· Mukuvhiya bundu reuropi, iyo ultrasonic scalpel chishandiso chakakosha. Inogona kushandiswa kunyatso bvisa bundu tishu uku uchidzikisa kukuvadzwa kune yakatenderedza hutano neural tishu. Semuenzaniso, mukubviswa kwegliomas (rudzi rwebundu remuuropi), iyo ultrasonic scalpel inogona kugadziridzwa kune yakakodzera magetsi marongero kuti aparadze bundu maseru kuburikidza necavitation uye mechanical vibration. Kupisa kunogadzirwa kunoshandiswa kubatanidza tsinga diki dzeropa mukati mebundu, kuderedza kubuda kweropa panguva yekuvhiya. Izvi zvakakosha sezvo chero kukuvadzwa kuhutano hwehuropi tishu kunogona kutungamira kune kwakakosha tsinga kushomeka.
· Mukuvhiya kwemusana, iyo ultrasonic scalpel inogona kushandiswa kuparadzanisa zvinyoro zvinyoro zvakapoteredza musana, zvakadai semhasuru nemarunda, zvakanyatsonaka. Paunenge uchiita discectomy (kubvisa herniated disc), iyo ultrasonic scalpel inogona kushandiswa kunyatsobvisa disc disc pasina kukonzera kukanganisa kwakanyanya kune yakapoteredza midzi midzi kana musana.
Common Surgical Fields yeElectrosurgical Unit
1. General Surgery
· Mukuvhiyiwa kwemudumbu kwakavhurika, iyo electrosurgical unit inoshandiswa zvakanyanya. Semuenzaniso, panguva yegastrectomy (kubviswa kwedumbu) kana colectomy (kubviswa kwechikamu chekoroni). Iyo ESU inogona kukurumidza kucheka nepakati pedumbu gobvu matishu uye yobva yachinjirwa kune coagulation modhi yekusimbisa tsinga dzakakura dzeropa. Mune colectomy, iyo ESU inogona kushandiswa kucheka nemukati mekoloni uye yobva yabatanidza tsinga dzeropa pamigero yerection kudzivirira kubuda ropa.
Mumaoparesheni ekurapa hernias, ESU inogona kushandiswa kuvhiya hernia sac kubva mumatishu akatenderedza uye kugadzika chero mapoinzi ekubuda ropa. Iyo inogona zvakare kushandiswa kugadzira incision mumadziro emimba yekuisa mesh panguva yekugadzirisa hernia.
1. Kuvhiya Kwepurasitiki uye Kuvakazve
· Mukuita senge liposuction, iyo electrosurgical unit inogona kushandiswa kubatanidza tsinga diki dzeropa muadipose tissue. Izvi zvinobatsira kuderedza kurasikirwa kweropa panguva yekusveta kwemafuta. Pamusoro pezvo, mukuvhiyiwa kweganda, iyo ESU inogona kushandiswa kucheka ganda uye matishu epasi kugadzira iyo flap uyezve kuvhara tsinga dzeropa kuti ive nechokwadi chekushanda kweiyo flap.
· Mukuvhiya kwepurasitiki pachiso, senge rhinoplasty (basa remhuno) kana maitiro ekusimudzira kumeso, ESU inogona kushandiswa kugadzira uye kudzora kubuda ropa. Kugona kugadzirisa magadzirirwo emagetsi kunobvumira chiremba anovhiya kuti ashandise ESU kune ese ari maviri akatetepa akachekwa akatenderedza mhino kana kumeso uye nekubatanidza tsinga diki dzeropa munzvimbo.
1. Obstetrics uye Gynecology
Muchikamu checesarean, ESU inogona kushandiswa kukurumidza kucheka nepakati pedumbu remadziro maseru kusvika kuchibereko. Mushure mekusununguka mwana, inogona kushandiswa kuvhara uterine incision uye kugadzirisa chero nzvimbo dzekubuda ropa muchibereko uye mudumbu.
· Mukuvhiyiwa kwevakadzi senge hysterectomy (kubviswa kwechibereko), ESU inogona kushandiswa kucheka nepakati pemarunda echibereko uye kugadzika tsinga dzeropa. Inogona zvakare kushandiswa mukuvhiya kurapa uterine fibroids kana ovarian cysts, uko inogona kushandiswa kubvisa kukura uye kudzora kubuda ropa panguva yekuitwa.
Mhedziso
Mukupedzisa, iyo ultrasonic scalpel uye electrosurgical unit zvinhu zviviri zvakakosha zvekuvhiya zvine maitiro akasiyana. Sarudzo pakati pe ultrasonic scalpel neelectrosurgical unit inoenderana nezvinodiwa chaizvo pakuvhiya, rudzi rwetishu inobatanidzwa, ukuru hwetsinga dzeropa, uye ruzivo rwachiremba uye zvaanoda. Nokunzwisisa kusiyana kwezviridzwa zviviri izvi, vanachiremba vanogona kuita zvisarudzo zvakawanda, izvo zvinogona kutungamirira kumigumisiro yakanaka yekuvhiya, kuderedza kushungurudzika kwevarwere, nekuvandudza nguva dzekudzorera. Sezvo tekinoroji yekuvhiya ichiramba ichishanduka, zvingangoita kuti zvese zviri zviviri ultrasonic scalpel uye iyo electrosurgical unit ichawedzera kunatswa, ichipa zvakatowanda mabhenefiti kuvarwere nevavhiyi zvakafanana.
