Isingeniso
Kwezokwelapha zesimanjemanje, kuye kwavela inqwaba yamathuluzi nobuchwepheshe obuthuthukile, obudlala indima ebalulekile ekuthuthukiseni ukusebenza kahle nokunemba kwezinqubo zezokwelapha. Phakathi kwalokhu, iyunithi yokuhlinzwa kagesi, evame ukwaziwa ngokuthi i-electrotome, igqama njengethuluzi elibalulekile elinomthelela obanzi - ohlukahlukene ekuhlinzeni nasekwelapheni.
I-electrotome isiyingxenye ebalulekile yamagumbi okuhlinza kanye nezikhungo zezokwelapha emhlabeni jikelele. Iguqule indlela ukuhlinzwa okwenziwa ngayo, inikeze izinzuzo ezimbalwa kunezindlela zokuhlinza zendabuko. Ngokwesibonelo, esikhathini esidlule, odokotela abahlinzayo babevame ukubhekana nezinselele ezinjengokulahlekelwa igazi eliningi phakathi nokuhlinzwa, okungaholela ezinkingeni nezikhathi zokululama ezinde ezigulini. Ukufika kwe-electrotome kuye kwayinciphisa kakhulu le nkinga.
Ngaphezu kwalokho, i-electrotome inwebise amathuba okuhlinzwa okungavamisile. Izinqubo ezihlasela kancane ngokuvamile zihlotshaniswa nobuhlungu obuncane, ukuhlala isikhathi esifushane esibhedlela, namazinga okululama ngokushesha ezigulini. I-electrotome yenza odokotela abahlinzayo bakwazi ukuhlinza okuyinkimbinkimbi ngemicu emincane, benciphisa ukuhlukumezeka emzimbeni wesiguli. Lokhu akuzuzisi isiguli kuphela mayelana nokululama ngokomzimba kodwa futhi kunemiphumela yezomnotho, njengoba ukuhlala isikhathi esifushane esibhedlela kungaholela ekwehleni kwezindleko zokunakekelwa kwezempilo.
Njengoba isayensi yezokwelapha iqhubeka nokuvela, ukuqonda izimiso zokusebenza, izinhlelo zokusebenza, kanye nezingozi ezingaba khona ze-electrotome kubalulekile kochwepheshe bezokwelapha, iziguli, kanye nalabo abanentshisekelo emkhakheni wezokwelapha. Le ndatshana ihlose ukuhlola ngokuphelele i-electrotome emithini yomtholampilo, ihlolisisa izici zayo zobuchwepheshe, izinhlelo zokusebenza ezihlukahlukene kuzo zonke izici zezokwelapha ezihlukene, ukucatshangelwa kokuphepha, namathemba esikhathi esizayo.
Isimiso Esisebenzayo Semibese Electrosurgical
Izisekelo Zamandla Kagesi Ekuhlinzeni
Imimese ye-electrosurgical isebenza ngomgomo ohluke kakhulu kuma-scalpels emishini yendabuko. Ama-scalpel endabuko ancike emaphethelweni acijile ukuze asike izicubu, kufana nommese wasekhishini osika ekudleni. Lesi senzo sokusika ngomshini sibangela ukuphazamiseka kobuqotho bezicubu, futhi imithambo yegazi iyanqanyulwa, okuholela ekopheni okuvame ukudinga izinyathelo ezengeziwe ze-hemostasis, njengokuthunga noma ukusetshenziswa kwama-hemostatic agents.
Ngokuphambene, imimese yokuhlinzwa kagesi isebenzisa i-high - frequency alternating current (AC). Umqondo oyisisekelo uwukuthi lapho umbane kagesi udlula endaweni eqhubayo, kulokhu, izicubu zezinto eziphilayo, ukumelana kwezicubu kubangela ukuguqulwa kwamandla kagesi kumandla okushisa. Lo mphumela wokushisa uwukhiye womsebenzi we-Electrosurgical Unit.
Iyunithi ye-electrosurgical (ESU) enika amandla i-Electrosurgical Unit iqukethe ijeneretha yefrikhwensi ephezulu. Le generator ikhiqiza i-alternating current ene-frequency ngokuvamile ebangeni lamakhulu e-kilohertz (kHz) ukuya kuma-megahertz ambalwa (MHz). Isibonelo, izinsiza eziningi ezijwayelekile zokuhlinza ngogesi zisebenza kumafrikhwensi azungeze u-300 kHz ukuya ku-500 kHz. Lokhu kusingathwa kwemvamisa ephezulu kube sekulethwa endaweni yokuhlinza kusetshenziswa i-electrode ekhethekile, okuyisihloko se-Electrosurgical Unit.
Lapho i-high-frequency current ifinyelela esicutshini, ukumelana kwezicubu ekugelezeni kwama-electron kubangela ukuthi izicubu zishise. Njengoba izinga lokushisa likhuphuka, amanzi angaphakathi kwamangqamuzana ezicubu aqala ukuhwamuka. Lokhu kuhwamuka kuholela ekwandeni okusheshayo kwamangqamuzana, okubangela ukuba aqhume futhi kubangele ukusikwa kwezicubu. Empeleni, i-Electrosurgical Unit 'ishisa' ngethishu, kodwa ngendlela elawulwayo, njengoba amandla kanye nemvamisa yamanje kungalungiswa ngokuya ngezidingo zokuhlinzwa.
Iqhaza Lamafrikhwensi Ahlukene
Ukuvama komsinga oshintshanayo Ophikweni Lokuhlinzwa kuka-Electrosurgical kudlala indima ebalulekile ekunqumeni imisebenzi yawo ethile ngesikhathi sokuhlinzwa, okuwukuthi ukusika nokuhlanganisa.
Umsebenzi wokusika :
Ngomsebenzi wokusika, imvamisa ephezulu - imvamisa eqhubekayo - yamanje yamagagasi ivame ukusetshenziswa. Uma i-high-frequency current isetshenziswa esicutshini, ukuzulazula okusheshayo kwenkambu kagesi kubangela izinhlayiya ezishajwayo ngaphakathi kwethishu (njengama-ion kuketshezi oluphuma ngaphandle kweselula kanye nolwe-intracellular) ukuthi zihambe ziye emuva naphambili ngokushesha. Lokhu kunyakaza kudala ukushisa okungqubuzanayo, okuhwamisa ngokushesha amanzi ngaphakathi kwamaseli. Njengoba amangqamuzana eqhuma ngenxa yokuhwamuka kwamanzi ngokushesha, izicubu zisikwa ngokuphumelelayo.
I-high-frequency eqhubekayo - yamanje yamaza yokusika yakhelwe ukukhiqiza ukushisa okuphezulu kakhulu ekugcineni kwe-Electrosurgical Unit. Lokhu kushisa okuminyanisa okuphezulu kwenza ukusika okusheshayo nokuhlanzekile kwezicubu. Okubalulekile wukuba nenani elanele lamandla elethwa ngesikhathi esifushane ukuze kuhwamuke amangqamuzana ezicubu. Isibonelo, ohlelweni olujwayelekile lokuhlinza njengokusikwa kwesikhumba, i-Electrosurgical Unit isethelwe kumodi yokusika enamagagasi afanele aphezulu ingakha ukusika okushelelayo, kunciphise inani lokuhlukumezeka kwezicubu futhi kunciphise ingozi yokudabuka noma imiphetho emagebhugebhu engenzeka nge-scalpel evamile.
Umsebenzi we-Coagulation :
Uma kukhulunywa nge-coagulation, kusetshenziswa imvamisa ehlukile kanye ne-waveform yamanje. I-coagulation inqubo yokumisa ukopha ngokubangela ukuthi amaprotheni asegazini kanye nezicubu ezizungezile ashintshe futhi akhe into efana nehlule. Lokhu kufinyelelwa kusetshenziswa i-low - frequency, pulsed - wave current.
I-pulsed - wave current iletha amandla ngokuqhuma okufushane. Lapho le pulsed current idlula esicutshini, ishisa izicubu ngendlela elawulwa kakhulu uma iqhathaniswa neqhubekayo - igagasi lamanje elisetshenziselwa ukusika. Ukushisa okukhiqizwayo kwanele ukuguqula amaprotheni asegazini kanye nezicubu, kodwa akwanele ukubangela ukuhwamuka okusheshayo njengasendaweni yokusika. Lokhu kuguqulwa kwe-denaturation kubangela ukuthi amaprotheni ahlangane, avale ngokuphumelelayo imithambo yegazi emincane futhi amise ukopha. Isibonelo, ngesikhathi sokuhlinzwa lapho kukhona okopha okuncane ebusweni besitho, udokotela ohlinzayo angashintsha i-Electrosurgical Unit ibe yimodi yokuhlanganisa. I-low - frequency pulsed - wave current izobe isisetshenziswa endaweni yokopha, okubangele ukuthi imithambo yegazi ivaleke futhi kunqamuke ukopha.
Izinhlobo Zemimese Ye-Electrosurgical
Imimese ye-Monopolar Electrosurgical
Imimese ye-Monopolar electrosurgical ingenye yezinhlobo ezivame ukusetshenziswa ezinkambisweni zokuhlinza. Ngokwesakhiwo, i-monopolar Electrosurgical Unit iqukethe i-electrode ephathwa ngesandla, okuyingxenye udokotela ohlinzayo ayilawula ngokuqondile. Le electrode ixhunywe ku-electrosurgical unit (ESU) ngekhebula. I-ESU ingumthombo wamandla okhiqiza amandla kagesi aphezulu - imvamisa.
Isimiso sokusebenza se-monopolar Electrosurgical Unit sisekelwe kumjikelezo kagesi ophelele. I-high-frequency current iphuma ekugcineni kwe-electrode ephathwayo. Lapho ithiphu ihlangana nethishu, okwamanje idlula esicutshini bese ibuyela ku-ESU nge-electrode ehlakazekayo, evame ukubizwa ngokuthi i-grounding pad. Le pad yaphansi ivamise ukubekwa endaweni enkulu yomzimba wesiguli, njengethanga noma umhlane. Inhloso ye-grounding pad ukuhlinzeka ngendlela ephansi yokumelana ukuze i-current ibuyele ku-ESU, iqinisekise ukuthi okwamanje isakazeka endaweni enkulu yomzimba wesiguli, ukunciphisa ingozi yokusha endaweni yokubuya.
Mayelana nezicelo, imimese ye-monopolar electrosurgical isetshenziswa kabanzi ekuhlinzeni okuhlukahlukene. Ekuhlinzeni okuvamile, ngokuvamile basetshenziselwa ukusika phakathi nezinqubo ezifana ne-appendectomies. Lapho ekhipha isithasiselo, udokotela ohlinzayo usebenzisa i-monopolar Electrosurgical Unit ukuze enze imbobo odongeni lwesisu. I-high-frequency current ivumela igazi elilinganiselwe - ukusikeka okuncane, njengoba ukushisa okukhiqizwa amandla amanje kungabopha imithambo yegazi emincane kanye kanye, kunciphise isidingo sezinyathelo ezihlukene ze-hemostatic zokopha okuncane.
Ku-neurosurgery, imimese ye-monopolar electrosurgical nayo iyasetshenziswa, nakuba ngokuqapha okukhulu ngenxa yemvelo entekenteke yezicubu zemizwa. Angasetshenziselwa imisebenzi efana nokuhlinza izicubu ezizungeze isimila sobuchopho. Ikhono elinembile lokusika lommese we-monopolar lingasiza udokotela ohlinzayo ahlukanise ngokucophelela isimila kuzicubu zobuchopho ezizungezile ezinempilo. Kodwa-ke, izilungiselelo zamandla zidinga ukulungiswa ngokucophelela ukuze kugwenywe ukulimala kokushisa okudlulele ezakhiweni eziseduze ze-neural.
Ekuhlinzweni kwepulasitiki, imimese ye-monopolar electrosurgical isetshenziselwa izinqubo ezifana nokudala ama-flap esikhumba. Isibonelo, ngesikhathi sokuhlinzwa kokwakhiwa kabusha kwebele, udokotela ohlinzayo angase asebenzise i-monopolar Electrosurgical Unit ukuze enze ama-flap esikhumba avela kwezinye izingxenye zomzimba, njengesisu. Ikhono lokusika kanye nokujiya ngesikhathi esifanayo lisiza ekwehliseni ukopha ngesikhathi senqubo ebucayi yokudala ama-flap, okubalulekile empumelelweni yokwakhiwa kabusha.
Imimese ye-Bipolar Electrosurgical
Imimese ye-bipolar electrosurgical inomklamo ohlukile kanye nesethi yezimpawu eziyenza ifanelekele izinhlobo ezithile zokuhlinzwa, ikakhulukazi lezo ezidinga izinga eliphezulu lokunemba. Ngokwesakhiwo, i-bipolar Electrosurgical Unit inama-electrode amabili eduze kwelinye ekugcineni. Lawa ma-electrode amabili ngokuvamile agcinwa ngaphakathi kwensimbi eyodwa.
Umgomo wokusebenza kwemimese ye-bipolar electrosurgical uhlukile kune-monopolar. Kusistimu ye-bipolar, i-high - frequency current igeleza kuphela phakathi kwama-electrode amabili asondelene ekugcineni kwethuluzi. Lapho ithiphu isetshenziselwa izicubu, lamanje lidlula izicubu ezixhumene nawo womabili ama-electrode. Lokhu kugeleza kwamanje kwasendaweni kusho ukuthi imiphumela yokushisisa nethishu ivalelwe endaweni ephakathi kwama-electrode amabili. Ngenxa yalokho, ukushisa okukhiqizwayo kugxile kakhulu futhi mancane amathuba okuthi kusakazeke ezicutshini ezizungezile.
Esinye sezizathu ezibalulekile zokuthi imimese ye-bipolar electrosurgical ikhethwe ekuhlinzweni okuhle yikhono layo lokuhlinzeka ngokulawula okunembile kokushisisa nokusika kwezicubu. Ekuhlinzweni kwe-ophthalmic, isibonelo, lapho izakhiwo zintekenteke kakhulu, imimese ye-bipolar electrosurgical ingase isetshenziselwe izinqubo ezifana nokukhishwa kwe-iris. Udokotela ohlinzayo angasebenzisa ummese we-bipolar ukuze asike futhi abophe ngokucophelela izicubu endaweni ye-iris ngaphandle kokudala umonakalo kwilensi eseduze noma ezinye izakhiwo zamehlo ezibalulekile. Ukushisa kwendawo kuqinisekisa ukuthi ingozi yokulimala okushisayo kwezicubu ezizungezile ezibucayi iyancishiswa.
Kuma-microsurgery, njengalawo ahilela ukulungiswa kwemithambo yegazi emincane noma imizwa, imimese ye-bipolar electrosurgical nayo ibalulekile. Lapho kwenziwa i-microsurgical anastomosis (i-suturing together) yemithambo yegazi emincane, ummese we-bipolar ungasetshenziswa ukubopha ngobumnene noma yikuphi okopha okuncane ngaphandle kokuthinta ubuqotho bezindonga zemithambo yegazi noma imizwa eseduze. Ikhono lokulawula ngokunembile ukushisa kwamanje nokushisa livumela udokotela ohlinzayo ukuthi asebenze endaweni encane kakhulu futhi ebucayi yokuhlinzwa, okwandisa amathuba omphumela ophumelelayo. Ukwengeza, njengoba i-current ivalekile phakathi kwama-electrode amabili, asikho isidingo sephedi enkulu yokubeka phansi njengasendabeni yezinhlelo ze-monopolar, okwenza kube lula ukusethwa kwalokhu kuhlinzwa kwezikali ezincane.
Izicelo Zomtholampilo
Ukuhlinzwa Okujwayelekile
Ekuhlinzeni okuvamile, imimese ye-electrosurgical isetshenziswa kabanzi ezinkambisweni ezihlukahlukene, enikeza izinzuzo eziningana ezihlukene.
I-Appendectomy :
I-Appendectomy iyindlela evamile yokuhlinzwa yokukhishwa kwe-appendix, evame ukuvuvuka noma itheleleke. Uma usebenzisa i-Electrosurgical Unit ku-appendectomy, i-high - frequency current ivumela igazi elilinganiselwe - ukuhlukaniswa okuncane kwe-appendix ezicutshini ezizungezile. Isibonelo, esimweni se-appendectomy ye-laparoscopic, i-monopolar noma i-bipolar Electrosurgical Unit ingasetshenziswa ngezimbobo ze-trocar. Umsebenzi wokusika we-Electrosurgical Unit wenza udokotela ohlinzayo akwazi ukunqamula ngokushesha futhi ngokuhlanzekile i-mesoappendix, equkethe imithambo yegazi ehlinzeka nge-appendix. Ngesikhathi esifanayo, umsebenzi we-coagulation uvala imithambo yegazi emincane ngaphakathi kwe-mesoappendix, ukunciphisa ingozi yokopha ngesikhathi sokuhlinzwa. Lokhu akugcini nje ngokwenza inkundla yokuhlinza icace kudokotela ohlinzayo kodwa futhi kufinyeza isikhathi sokusebenza sonke. Ngokuphambene, izindlela zendabuko zokusebenzisa i-scalpel ukusika i-mesoappendix bese uhlanganisa ngokuhlukana umthambo ngamunye wegazi zidla isikhathi esiningi futhi zingaholela ekopheni okwengeziwe.
I-Cholecystectomy :
I-Cholecystectomy, ukususwa ngokuhlinzwa kwenyongo, kungenye indawo lapho imimese yokuhlinzwa kagesi idlala indima ebalulekile. Ku-cholecystectomy evulekile, i-Electrosurgical Unit ingasetshenziselwa ukusika izingqimba zezindonga zesisu, okuhlanganisa isikhumba, izicubu ezingaphansi kwesikhumba, kanye nemisipha. Njengoba inqamula kulezi zicubu, ngesikhathi esifanayo ibopha imithambo yegazi emincane, inciphise ukulahleka kwegazi. Ngesikhathi sokuhlukaniswa kwenyongo embhedeni wesibindi, ikhono le-Electrosurgical Unit coagulation lisiza ukuvala imithambo yegazi emincane kanye namapayipi enyongo axhuma i-gallbladder esibindini, kunciphisa ingozi yokopha kwangemva kokuhlinzwa kanye nokuvuza kwenyongo.
Ku-cholecystectomy ye-laparoscopic, okuyinqubo ehlasela kancane, i-Electrosurgical Unit ibaluleke nakakhulu. I-bipolar electrosurgical forceps ivame ukusetshenziselwa ukuhlinza ngokucophelela i-cystic artery kanye ne-cystic duct. Ukugeleza kwendawo kwamanje kumishini ye-bipolar electrosurgical kuvumela ukuhlangana okunembile nokusikwa kwalezi zakhiwo, kunciphise ubungozi bokulimala komgudu wenyongo ovamile oseduze nezinye izakhiwo ezibalulekile. Ikhono lokwenza lezi ziqondiso ezibucayi nge-Electrosurgical Unit ngokusebenzisa izimbobo ezincane liyinzuzo enkulu, njengoba liholela ebuhlungwini obuncane, ukuhlala isikhathi esifushane esibhedlela, kanye nezikhathi zokululama ngokushesha ezigulini uma kuqhathaniswa nokuhlinzwa okuvulekile.
Ukuhlinzwa Kwabesifazane
Imimese ye-Electrosurgical ithole ukusetshenziswa okubanzi ekuhlinzeni kwabesifazane, okuvumela izinqubo ezinembe kakhudlwana nezisebenza kahle.
I-Hysterectomy ye-Uterine Fibroids :
I-uterine fibroids yizinto ezingenawo umdlavuza esibelethweni ezingase zibangele izimpawu ezifana nokopha kakhulu kokuya esikhathini, ubuhlungu be-pelvic, kanye nokungazali. Lapho wenza i-hysterectomy (ukususwa kwesibeletho) ukuze uphathe ama-fibroids amakhulu noma anezimpawu, imimese yokuhlinzwa ingasetshenziswa ngezindlela eziningana. Ku-hysterectomy evulekile, i-Electrosurgical Unit isetshenziselwa ukuhlinza udonga lwesisu. Ngesikhathi sokuhlukaniswa kwesibeletho kusuka ezicutshini ezizungezile, njengesinye, i-rectum, ne-pelvic sidewalls, imisebenzi yokusika nokuhlanganisa ye-Electrosurgical Unit iyasetshenziswa. Ingakwazi ukusika ngokunembile imigqa yesibeletho, equkethe imithambo yegazi, kuyilapho ngesikhathi esifanayo ivala imithwalo ukuvimbela ukopha. Lokhu kunciphisa isidingo sokuxhunywa okubanzi kwemithambo yegazi, kube lula inqubo yokuhlinzwa.
Ku-laparoscopic noma i-robotic - hysterectomy esizwayo, okuyizindlela ezihlasela kancane, amathuluzi okuhlinzwa kagesi, okuhlanganisa namadivaysi e-electrosurgical monopolar kanye ne-bipolar, asetshenziswa kakhulu nakakhulu. I-bipolar electrosurgical forceps ingasetshenziswa ukuhlinza nokuhlanganisa ngokucophelela imithambo yegazi ezungeze isibeletho, ukuqinisekisa ukuthi kunegazi - indawo encane yokukhishwa okubucayi kwesibeletho. Imvelo ehlasela kancane yalezi zinqubo, eyenziwa yenzeka ngokwengxenye ngokusebenzisa imibese yokuhlinza ngogesi, ibangela ukuhlukumezeka okuncane esigulini, ukuhlala isikhathi esifushane esibhedlela, kanye nezikhathi zokululama ngokushesha.
Ukuhlinzwa Komlomo Wesibeletho :
Ngokuhlinzwa komlomo wesibeletho, okufana ne-loop - electrosurgical excision procedure (LEEP) yokwelashwa kwe-cervical intraepithelial neoplasia (CIN) noma ama-polyps omlomo wesibeletho, imimese yokuhlinzwa ngogesi ingamathuluzi akhethwayo. Enqubweni ye-LEEP, i-electrode ye-loop encane yocingo exhunywe kuyunithi ye-electrosurgical isetshenziswa. I-high-frequency current edlula iluphu idala ukushisa, okuvumela ukucaciswa okunembile kwezicubu zomlomo wesibeletho ezingavamile. Le ndlela iphumelela kakhulu ekususeni izicubu ezigulayo kuyilapho inciphisa ukulimala kwezicubu ezizungezile zomlomo wesibeletho ezinempilo.
Ucwaningo lubonise ukuthi i-LEEP inezinzuzo eziningana. Isibonelo, inezinga eliphezulu lempumelelo ekwelapheni i-CIN. Isikhathi esijwayelekile sokusebenza sifushane, ngokuvamile siphakathi kwemizuzu emi-5 - 10. Ukulahleka kwegazi ku-intraoperative kuncane, ngokuvamile kungaphansi kuka-10 ml. Ukwengeza, ingozi yezinkinga ezifana nokutheleleka nokopha iphansi. Ngemva kwenqubo, isiguli ngokuvamile singakwazi ukuqhubeka nemisebenzi evamile ngokushesha, futhi ukulandelwa kwesikhathi eside kubonisa izinga eliphansi lokuphindaphinda kwezilonda zomlomo wesibeletho. Enye inzuzo ukuthi izicubu ezisikiwe zingathunyelwa ukuhlolwa okunembile kwe-pathological, okubalulekile ekunqumeni izinga lesifo kanye nokuqondisa ukwelashwa okwengeziwe uma kunesidingo.
Ukuhlinzwa Kwezinzwa
Ku-neurosurgery, ukusetshenziswa kwemimese yokuhlinza kubaluleke kakhulu ngenxa yesimo esibucayi sezicubu zemizwa kanye nesidingo sokuhlinzwa okunembayo.
Lapho ikhipha izimila ebuchosheni, i-Electrosurgical Unit ivumela udokotela ohlinzayo ukuthi ahlukanise ngokucophelela isimila esicutshini sobuchopho esinempilo. I-monopolar Electrosurgical Unit ingasetshenziswa ngezilungiselelo zamandla aphansi kakhulu ukuze kuncishiswe ubungozi bokulimala kokushisa kwezakhiwo eziseduze zemizwa. I-high-frequency current isetshenziselwa ukusika ngokunembile izicubu zesimila kuyilapho ngasikhathi sinye ibopha imithambo yegazi emincane engaphakathi kwesimila, kunciphisa ukopha. Lokhu kubalulekile njengoba ukopha ngokweqile ebuchosheni kungaholela ekwenyukeni komfutho we-intracranial kanye nokulimala kwezicubu zobuchopho ezizungezile.
Ngokwesibonelo, endabeni ye-meningioma, okuwuhlobo oluvamile lwesimila sobuchopho esivela ku-meninges (ulwelwesi olumboze ubuchopho), udokotela ohlinzayo usebenzisa i-Electrosurgical Unit ukuze ahlukanise ngokucophelela isimila endaweni engaphansi yobuchopho. Ikhono lokulawula ukusika kanye nokuhlangana ngokunembile ne-Electrosurgical Unit kusiza ukulondoloza ukusebenza kobuchopho okuvamile ngangokunokwenzeka. Ama-forceps e-bipolar electrosurgical nawo asetshenziswa kaningi ku-neurosurgery, ikakhulukazi emisebenzini edinga ukulawula okunembe nakakhulu, njengokuhlanganisa imithambo yegazi emincane eduze kwemigudu ebalulekile yemizwa. Ukugeleza kwamanje kwasendaweni kumadivayisi e-bipolar kuqinisekisa ukuthi ukushisa okukhiqizwa kuvalelwe endaweni encane kakhulu, kunciphisa ubungozi bokulimala okuyisibambiso kumathishu e-neural azungezile azwelayo.
Izinzuzo ngaphezu kwamathuluzi okuhlinza endabuko
I-Hemostasis kanye Nokulahlekelwa Kwegazi Okuncishisiwe
Enye yezinzuzo ezibaluleke kakhulu zemimese yokuhlinza ngogesi ngaphezu kwamathuluzi okuhlinza endabuko yikhono lawo elimangalisayo le-hemostatic, eliholela ekwehleni okukhulu kokulahleka kwegazi phakathi nokuhlinzwa. Ama-scalpels endabuko, lapho esetshenziselwa ukusika izicubu, avele ahlukanise imithambo yegazi, ayishiye ivulekile futhi yopha. Lokhu kuvame ukudinga isikhathi esengeziwe - izinyathelo ezithathayo zokulawula ukopha, njengokuthunga umthambo ngamunye wegazi omncane noma ukusebenzisa i-hemostatic agents.
Ngokuphambene, imimese yokuhlinzwa kagesi, ngomphumela wayo oshisayo, ingabopha imithambo yegazi emincane lapho isika. Lapho i-high-frequency current idlula esicutshini, ukushisa okukhiqizwayo kushintsha amaprotheni asegazini nasezindongeni zomkhumbi. Lokhu kuguqulwa kwe-denaturation kubangela ukuba igazi lihlule futhi imithambo yegazi ivaleke. Isibonelo, ekuhlinzweni okuvamile okufana nokwakhiwa kwe-flap yesikhumba, i-scalpel yendabuko izodinga udokotela ohlinzayo ukuthi amise njalo futhi abheke amaphuzu okopha, angaba maningi. Nge-Electrosurgical Unit, njengoba yenza ukusika, imithambo yegazi emincane esikhunjeni kanye nezicubu ezingaphansi kwesikhumba ziyaqina kanyekanye. Lokhu akunciphisi nje kuphela ukopha kwegazi lilonke phakathi nokuhlinzwa kodwa futhi kunikeza insimu yokuhlinza ecacile kadokotela ohlinzayo. Ucwaningo oluqhathanisa ukusetshenziswa kwemimese yokuhlinza ngogesi nezikali zendabuko ekuhlinzweni okuthile kwesisu kwathola ukuthi ukulahleka kwegazi okumaphakathi kwehliswe cishe ngo-30 - 40% lapho kusetshenziswa imibese yokuhlinza ngogesi. Lokhu kuncipha kokulahleka kwegazi kubalulekile njengoba ukopha kakhulu kungaholela ezinkingeni ezifana ne-anemia, ukushaqeka, kanye nezikhathi zokululama ezinde esigulini.
I-Incision Eqondile kanye Ne-Tissue Dissection
Imimese ye-Electrosurgical ihlinzeka ngezinga eliphezulu lokunemba ekusikeni nasekuhlukaniseni izicubu, okuwukuthuthukiswa okuphawulekayo kunamathuluzi okuhlinza endabuko. Ama-scalpel endabuko anesenzo sokusika esingacacile ezingeni le-microscopic. Zingabangela ukudabuka nokulimala kwezicubu ezizungezile ngenxa yamandla omshini asetshenziswa ngesikhathi sokusika. Lokhu kungaba yinkinga ikakhulukazi lapho kusebenza ezindaweni lapho izicubu zithambile noma lapho kunezakhiwo ezibalulekile eziseduze.
Imimese ye-Electrosurgical, ngakolunye uhlangothi, isebenzisa umphumela oshisayo olawulwayo wokusika. Iphoyinti le-Electrosurgical Unit lingaklanywa ukuthi libe nendawo encane kakhulu, evumela ukusikwa okunembe kakhulu. Ngokwesibonelo, ku-neurosurgery, lapho ekhipha isimila esincane esiseduze nezakhiwo ezibalulekile zemizwa, udokotela ohlinzayo angasebenzisa i-Electrosurgical Unit ene-electrode enamaphuzu amahle. I-high-frequency current ingalungiswa ibe sezingeni elinqamula ngokunembile izicubu zesimila kuyilapho kuncishiswa ukulimala okushisayo kwezicubu zobuchopho eziseduze. Ikhono lokulawula amandla kanye nemvamisa ye-Electrosurgical Unit yenza udokotela ohlinzayo enze ukuhlukaniswa kwezicubu ezibucayi ngokunemba okukhulu. Kuma-microsurgery, njengalawo ahilela ukulungiswa kwemithambo yegazi emincane noma imizwa, imimese ye-bipolar electrosurgical ingasika kahle futhi ihlanganise izicubu endaweni encane kakhulu yokuhlinza, inciphise ingozi yokulimala ezakhiweni ezizungezile. Lokhu kunemba akugcini nje ngokuthuthukisa umphumela wokuhlinzwa kodwa futhi kunciphisa amathuba okuba nezinkinga ngemva kokuhlinzwa okuhambisana nokulimala kwezicubu.
Izikhathi Zokusebenza Ezimfushane
Ukusetshenziswa kwemimese yokuhlinzwa ngogesi kungaholela ezikhathini zokusebenza ezifushane uma kuqhathaniswa namathuluzi okuhlinza endabuko, okuzuzisa isiguli kanye nethimba labahlinzayo. Njengoba kushiwo ngaphambili, imimese yokuhlinzwa kagesi ingasika futhi ihlangane kanyekanye. Lokhu kuqeda isidingo sokuba udokotela ohlinzayo enze izinyathelo ezihlukene zokusika abese elawula ukopha, njengoba kunjalo ngama-scalpel angokwesiko.
Enqubweni yokuhlinzwa eyinkimbinkimbi efana ne-hysterectomy, lapho usebenzisa i-scalpel yendabuko, udokotela ohlinzayo kufanele asike ngokucophelela izicubu nemisipha ezungeze isibeletho bese ehlanganisa noma akhiphe umthambo ngamunye wegazi ukuze avimbele ukopha. Le nqubo ingaba isikhathi esiningi, ikakhulukazi lapho usebenzelana nenani elikhulu lemithambo yegazi emincane. Nge-Electrosurgical Unit, udokotela ohlinzayo anganqamula ngokushesha izicubu ngenkathi ehlanganisa imithambo yegazi, enze inqubo yokuhlinzwa ibe lula. Ucwaningo luye lwabonisa ukuthi kwezinye izimo, ukusetshenziswa kwemimese ye-electrosurgical kunganciphisa isikhathi sokusebenza ngo-20 - 30%. Izikhathi ezimfushane zokusebenza zihlotshaniswa nengozi encishisiwe yezinkinga ezihlobene nokubulala izinzwa ende. Uma isiguli singaphansi kwe-anesthesia isikhathi eside, ingozi enkulu yezinkinga zokuphefumula kanye nenhliziyo nemithambo yegazi. Ukwengeza, izikhathi zokusebenza ezimfushane zisho ukuthi ithimba elihlinzayo lingakwazi ukwenza izinqubo eziningi esikhathini esinikeziwe, okungase kukhuphule ukusebenza kahle kwegumbi lokuhlinza kanye nokunciphisa izindleko zokunakekelwa kwezempilo zizonke.
Izingozi Ezingenzeka kanye Nezinkinga
Ukulimala Okushisayo Kwezicubu Ezizungezile
Naphezu kwezinzuzo zayo eziningi, ukusetshenziswa kwemimese ye-electrosurgical emithi yomtholampilo akuyona ngaphandle kwezingozi. Enye yezinto eziyinhloko ezikhathazayo ukulimala okushisayo kwezicubu ezizungezile.
Lapho i-Electrosurgical Unit isebenza, i-high-frequency current ikhiqiza ukushisa ukuze inqamule futhi ibophe izicubu. Kodwa-ke, lokhu kushisa ngezinye izikhathi kungase kudlulele ngale kwendawo okuhlosiwe. Isibonelo, ekuhlinzeni kwe-laparoscopic, i-monopolar Electrosurgical Unit, uma ingasetshenziswa ngokucophelela, ingadlulisela ukushisa ngezinsimbi ezincane ze-laparoscopic futhi ibangele ukulimala okushisayo ezithweni eziseduze. Lokhu kungenxa yokuthi ukushisa okukhiqizwa ekugcineni kwe-electrode kungaqhuba eduze kwe-shaft yensimbi. Ocwaningweni lwezimo ze-laparoscopy ze-cholecystectomy, kwatholakala ukuthi ezimweni ezingaba ngu-1 - 2%, kube khona ukulimala okuncane okushisayo ku-duodenum noma ikholoni eseduze, okungenzeka kubangelwe ukusakazeka kokushisa okuvela ku-Electrosurgical Unit ngesikhathi sokuhlukaniswa kwenyongo.
Ingozi yokulimala okushisayo ihlobene futhi nezilungiselelo zamandla ze-Electrosurgical Unit. Uma amandla esethwe phezulu kakhulu, inani lokushisa elikhiqizwayo lizoba ngokwedlulele, okwandisa amathuba okushisa okusakazekela ezicutshini ezizungezile. Ukwengeza, isikhathi sokuxhumana phakathi kwe-Electrosurgical Unit kanye nezicubu zidlala indima. Ukuthintana isikhathi eside nezicubu kungaholela ekudluliseni okukhulu kokushisa, okubangela ukulimala okuphawulekayo okushisayo.
Ukuvimbela ukulimala okushisayo kwezicubu ezizungezile, izinyathelo eziningana zingathathwa. Okokuqala, odokotela abahlinzayo badinga ukuqeqeshwa kahle ekusebenziseni imibese yokuhlinza ngogesi. Kufanele babe nokuqonda okucacile kwezilungiselelo zamandla ezifanele zezinhlobo ezahlukene zezicubu kanye nezinqubo zokuhlinzwa. Isibonelo, lapho usebenza ezicutshini ezithambile njengesibindi noma ubuchopho, izilungiselelo zamandla aphansi ngokuvamile zidingeka ukuze kuncishiswe ubungozi bokulimala okushisayo. Okwesibili, ukufakwa kahle kwezinsimbi ze-electrosurgical kubalulekile. Ukuvikela imishayo yezinsimbi ze-laparoscopic kungavimbela ukuqhutshwa kokushisa ezithweni eziseduze. Ezinye izinhlelo ezithuthukisiwe zokuhlinza ngogesi nazo ziza nezici eziqapha izinga lokushisa endaweni yokuhlinzwa. Lezi zinhlelo zokuqapha izinga lokushisa zingaxwayisa udokotela ohlinzayo uma izinga lokushisa ezicutshini ezizungezile liqala ukuphakama ngaphezu kwezinga eliphephile, okuvumela udokotela ohlinzayo ukuthi alungise amandla noma ubude besikhathi sohlelo lokuhlinza ngogesi ngokushesha.
Izingozi Zokutheleleka Nezigesi
Enye iqoqo lezingozi ezihambisana nokusetshenziswa kwemibese yokuhlinzwa ngogesi amandla okutheleleka kanye nezingozi zikagesi.
Ukutheleleka :
Ngesikhathi sokuhlinzwa, ukusebenzisa imimese yokuhlinzwa ngogesi kungakha indawo engase yandise ingozi yokutheleleka. Ukushisa okukhiqizwa I-Electrosurgical Unit kungabangela ukulimala kwezicubu, okungase kuphazamise izindlela zokuzivikela ezivamile zomzimba. Lapho isicubu sonakaliswa ukushisa, singaba lula ekuhlaselweni yibhaktheriya. Isibonelo, uma indawo yokuhlinza ingahlanzwanga kahle futhi ingabulawa amagciwane ngaphambi kokusebenzisa i-Electrosurgical Unit, noma yimaphi amagciwane akhona esikhumbeni noma endaweni ezungezile angangeniswa esicutshini esilimele. Ngaphezu kwalokho, izicubu ezishisiwe ezakhiwe ngesikhathi senqubo ye-electrosurgical zinganikeza indawo ekahle yokukhula kwamagciwane. Ucwaningo oluphathelene nezifo endaweni okuhlinzelwa kuyo ngemva kwezinqubo kusetshenziswa imimese yokuhlinzwa ngogesi lwathola ukuthi izinga lokutheleleka lalingaphezulu kancane uma liqhathaniswa nokuhlinzwa okusetshenziswa izindlela zesintu kwezinye izimo, ikakhulukazi lapho ukutheleleka okufanele - izindlela zokulawula zingalandelwanga ngokuqinile.
Ukunciphisa ingozi yokutheleleka, ukulungiswa okuqinile kwesikhumba ngaphambi kokuhlinzwa kubalulekile. Indawo yokuhlinza kufanele ihlanzwe kahle ngezixazululo ezifanele ze-antiseptic ukuze kuncishiswe inani lamagciwane ebusweni besikhumba. Izinyathelo zokuhlinza ezifana nokusebenzisa amathuluzi okuhlinzwa kagesi oyinyumba kanye nokugcina inkambu eyinyumba nakho kubalulekile. Ngemva kokuhlinzwa, ukunakekelwa okufanele kwesilonda, okuhlanganisa izinguquko ezivamile zokugqoka kanye nokusetshenziswa kwama-antibiotic uma kunesidingo, kungasiza ekuvimbeleni ukuthuthukiswa kwezifo.
Izingozi zikagesi :
Izingozi zikagesi nazo ziyinkinga enkulu uma usebenzisa imimese yokuhlinzwa kagesi. Lezi zingozi zingenzeka ngenxa yezizathu ezahlukahlukene, njengokungasebenzi kahle kwemishini, ukubeka phansi phansi okungafanele, noma iphutha lomsebenzisi. Uma i-electrosurgical unit (ESU) ingasebenzi kahle, ingase ilethe inani eliningi lamanje, elingaholela ekushiseni noma ekushayweni kukagesi esigulini noma ethimbeni labahlinzayo. Isibonelo, ukunikezwa kwamandla kwe-ESU okungalungile kungabangela ukushintshashintsha kwamandla okukhiphayo, okuholela ekukhuphukeni okungalindelekile okuphezulu okungalindelekile.
Ukubekwa phansi okungafanele kungenye imbangela evamile yezingozi zikagesi. Ezinhlelweni ze-monopolar electrosurgical, indlela efanele yokubeka phansi ngokusebenzisa i-electrode ehlakazayo (i-grounding pad) ibalulekile ukuze kuqinisekiswe ukuthi yamanje ibuyela ngokuphephile ku-ESU. Uma i-grounding pad ingaxhunywanga ngendlela efanele emzimbeni wesiguli, noma uma kukhona ikhefu kumjikelezo ophansi, umsinga ungathola enye indlela, njengokudlula kwezinye izingxenye zomzimba wesiguli noma izinto zokuhlinza, okungase kubangele ukusha kukagesi. Kwezinye izimo, uma isiguli sithintana nezinto eziqhutshwayo ekamelweni lokuhlinza, njengezingxenye zensimbi zetafula lokuhlinza, futhi isisekelo singalungile, isiguli singase sibe sengozini yokushaqeka kagesi.
Ukubhekana nezingozi zikagesi, ukugcinwa njalo nokuhlolwa kwemishini ye-electrosurgical kuyadingeka. I-ESU kufanele ihlolwe ukuthi azikho izimpawu zokuguga, futhi izingxenye zikagesi kufanele zihlolwe ukuze kuqinisekiswe ukusebenza kahle. Ama-opharetha kufanele aqeqeshelwe ukusetha ngendlela efanele futhi asebenzise okokusebenza kwe-electrosurgical, okuhlanganisa nokunamathiselwe okufanele kwephedi eliphansi. Ukwengeza, igumbi lokuhlinza kufanele lifakwe izinto ezifanele zokuphepha zikagesi, njengeziphazamisi ze-ground - fault circuit (GFCIs), ezinganqamula ugesi ngokushesha uma kwenzeka kuba nephutha eliphansi noma ukuvuza kukagesi, okunciphisa ingozi yezingozi zikagesi.
Ukuthuthukiswa Kwekusasa kanye Nezintsha
Intuthuko Yezobuchwepheshe Kumklamo Ye-Electrosurgical Weyunithi
Ikusasa lemimese yokuhlinzwa kagesi linesithembiso esikhulu mayelana nentuthuko yezobuchwepheshe. Enye indawo okugxilwe kuyo ukuthuthukiswa kwemiklamo ye-electrode enembe kakhudlwana futhi eguquguqukayo. Njengamanje, ama-electrode emimese yokuhlinzwa ayisisekelo ngokuqhathaniswa nokuma kwawo, ngokuvamile abe ama-blade alula noma amathiphu. Ngokuzayo, singalindela ukubona ama-electrode anamajometri ayinkimbinkimbi. Isibonelo, ama-electrode angaklanywa anezakhiwo ezincane endaweni yawo. Lezi zakhiwo ezincane zingathuthukisa ukuthintana nethishu ezingeni elincane, okuvumela ukusikwa okunembe nakakhulu kanye nokuhlangana. Ucwaningo emkhakheni wesayensi yezinto zokwakha kanye nobunjiniyela bemishini yezokwelapha lubonise ukuthi ngokwakha amaphethini e-nanoscale ebusweni be-electrode, ukusebenza kahle kokudluliswa kwamandla ezicutshini kunganyuka kuze kufike ku-20 - 30%. Lokhu kungase kuholele ezinkambisweni zokuhlinzwa ezisheshayo nezinembe kakhudlwana.
Esinye isici sokuthuthuka kwezobuchwepheshe ukuthuthukiswa kwezinhlelo zokulawula amandla ngaphakathi kwamayunithi e-electrosurgical. Imimese yesikhathi esizayo yokuhlinzwa kagesi ingase ifakwe amandla esikhathi sangempela - izindlela zokulungisa ezisuselwe empendulweni yokuphazamiseka kwezicubu. I-tissue impedance ingahluka kuye ngezici ezifana nohlobo lwethishu (amafutha, imisipha, noma izicubu ezixhumeneyo), ukuba khona kwesifo, kanye nezinga le-hydration. Amayunithi amanje okuhlinzwa ngogesi ngokuvamile ancike kumazinga wamandla asethwe ngaphambilini, okungenzeka angabi alungile kuzo zonke izimo zezicubu. Ngokuzayo, izinzwa ezingaphakathi kwe-Electrosurgical Unit zingaqhubeka zilinganisela ukuthintana kwezicubu endaweni yokuhlinzwa. Amandla aphumayo eyunithi yokuhlinzwa kagesi azobe eselungiswa ngokuzenzakalelayo ngesikhathi sangempela ukuze kuqinisekiswe ukuthi inani elifanele lamandla lilethwa esicutshini. Lokhu ngeke nje kuthuthukise ukusebenza kahle kokusika nokuhlanganisa kodwa futhi kunciphise ingozi yokulimala okushisayo kwezicubu ezizungezile. Ucwaningo luveze ukuthi uhlelo olunjalo lokulungisa amandla esikhathi sangempela lungase lunciphise izehlakalo zezinkinga ezihlobene nokushisa ngo-50 - 60% kwezinye izinqubo zokuhlinzwa.
Ukuhlanganiswa Nobunye Ubuchwepheshe Bokuhlinza
Ukuhlanganiswa kwemimese ye-electrosurgical nobunye ubuchwepheshe bokuhlinza kuwumngcele ojabulisayo onamandla amakhulu. Indawo eyodwa ephawulekayo inhlanganisela nokuhlinzwa kwerobhothi. Ekuhlinzeni okusizwa ngamarobhothi, udokotela ohlinzayo ulawula izingalo zerobhothi ukwenza imisebenzi yokuhlinza. Ngokuhlanganisa imimese yokuhlinzwa kagesi ezinhlelweni zamarobhothi, ukunemba kanye nobuciko bezingalo zerobhothi kungahlanganiswa namandla okusika nokuhlanganisa imimese ye-electrosurgical. Isibonelo, ku-prostatectomy eyinkimbinkimbi - okusizwa ngerobhothi, ingalo yerobhothi ingahlelwa ukuthi izule ngokuqondile ku-Electrosurgical Unit ezungeze i-prostate gland. I-high-frequency current evela ku-Electrosurgical Unit ibe-ke isetshenziselwe ukuhlinza ngokucophelela i-prostate kumathishu azungezile kuyilapho ngesikhathi esifanayo kuhlangana imithambo yegazi. Lokhu kuhlanganiswa kungaholela ekulahlekelweni kwegazi okuncishisiwe, izikhathi zokusebenza ezimfushane, kanye nokulondolozwa okungcono kwezakhiwo ezizungezile, ekugcineni kube ngcono imiphumela yokuhlinzwa yeziguli.
Ukuhlanganiswa nezindlela zokuhlinza ezingavamisile kancane, njenge-laparoscopy ne-endoscopy, nakho kulindeleke ukuthi kubonakale intuthuko eyengeziwe. Ekuhlinzweni kwe-laparoscopic, i-Electrosurgical Unit iyithuluzi elibalulekile okwamanje, kodwa intuthuko yesikhathi esizayo ingayenza ibaluleke nakakhulu. Isibonelo, ukuthuthukiswa kwemimese yokuhlinzwa kagesi emincane futhi eguquguqukayo engaqondiswa kalula ngezimbobo ezincane ze-trocar ku-laparoscopy. Le mimese ingaklanywa ukuthi ibe nekhono elingcono lokukhuluma, okuvumela udokotela ohlinzayo ukuthi afinyelele futhi ahlinze ezindaweni okunzima ukufinyelela kuzo njengamanje. Ekuhlinzweni kwe-endoscopic, ukuhlanganiswa kwemibese yokuhlinzwa kagesi kungenza izinqubo eziyinkimbinkimbi kakhulu zenziwe nge-endoscopically. Isibonelo, ekwelapheni umdlavuza wesisu wangaphambi kwesikhathi, i-Endoscopically - ehlanganisiwe ye-Electrosurgical Unit ingasetshenziswa ukuze kukhishwe izicubu ezinomdlavuza kuyilapho kuncishiswa umonakalo ezicutshini ezinempilo ezizungezile, okungenzeka kuqede isidingo sezinqubo zokuhlinzwa ezivulekile ezihlaselayo. Lokhu kungaholela ekuhlukumezekeni okuncane esigulini, ukuhlala isikhathi esifushane esibhedlela, kanye nezikhathi zokululama ngokushesha.
Isiphetho
Sengiphetha, i-Electrosurgical Unit iye yavela njengethuluzi lenguquko emkhakheni wezokwelapha, okunemiphumela efinyelela kude ekuhlinzeni nasekwelapheni.
Uma ubheka phambili, ikusasa lemimese ye-electrosurgical ligcwele amathuba ajabulisayo. Ukuthuthuka kwezobuchwepheshe ekwakhiweni kwama-electrode kanye nezinhlelo zokulawula amandla kubambe isithembiso sezinqubo zokuhlinza ezinembe nakakhulu nezisebenza ngempumelelo. Ukuhlanganiswa kwemimese yokuhlinza ngogesi nobunye ubuchwepheshe bokuhlinza obuvelayo, obufana nokuhlinzwa kwerobhothi kanye nezindlela ezithuthukisiwe ezihlasela kancane, cishe kuzokwandisa ububanzi balokho okungafinyeleleka egunjini lokuhlinza.
Njengoba umkhakha wezokwelapha uqhubeka nokuvela, i-Electrosurgical Unit ngokungangabazeki izohlala ihamba phambili ekusunguleni izinto ezintsha zokuhlinza. Ucwaningo oluqhubekayo nokuthuthukiswa kule ndawo kubalulekile ukuze ufeze ngokugcwele amandla ayo, uthuthukise ukunakekelwa kwesiguli, futhi uqhubekisele phambili ukuthuthukiswa kwamasu okuhlinza eminyakeni ezayo.
