Isingeniso
Emkhakheni wezokwelapha wesimanje, ukuhlinzwa kwe-laparoscopic kuye kwavela njengendlela yokuguqula, okuguqula ngokuphawulekayo indawo yezinqubo zokuhlinzwa. Le ndlela yokuhlasela kancane isizuze ukunconywa okusabalele ngezinzuzo zayo eziningi ngaphezu kokuhlinzwa okuvamile okuvulekile. Ngokwenza izimbobo ezincane esiswini, odokotela abahlinzayo bangafaka i-laparoscope - ishubhu elincanyana, eliguquguqukayo elifakwe ukukhanya nekhamera - kanye nezinsimbi zokuhlinza ezikhethekile. Lokhu kuzivumela ukuthi zenze izinqubo eziyinkimbinkimbi ngokunemba okuthuthukisiwe, ukulimala kwezicubu ezincishisiwe, nokuncipha kokulahlekelwa kwegazi. Iziguli zivame ukuzwa ukuhlala esibhedlela isikhathi esifushane, izikhathi zokululama ngokushesha, kanye nobuhlungu obuncane ngemva kokuhlinzwa, okuholela ekuthuthukisweni kwekhwalithi yempilo iyonke phakathi nenqubo yokululama. Ukuhlinzwa kwe-laparoscopic kuthole izinhlelo zokusebenza emikhakheni eminingi yezokwelapha, kusukela ku-gynecology kanye nokuhlinzwa okuvamile kuya ku-urology kanye nokuhlinzwa kwe-colorectal, okuba yingxenye ebalulekile yokuhlinzwa kokuhlinzwa kwesimanje.
Okuhambisana nentuthuko yezindlela ze-laparoscopic iyunithi ye-electrosurgical (ESU), eseyithuluzi elibalulekile ekamelweni lokuhlinza. Ama-ESU asebenzisa imisinga kagesi eyimvamisa ephezulu ukusika, ukubopha, noma ukuqeda izicubu phakathi nezinqubo zokuhlinzwa. Lobu buchwepheshe benza odokotela abahlinzayo bakwazi ukufeza i-hemostasis (ukulawula ukopha) ngokuphumelelayo futhi benze ukuhlukaniswa kwezicubu ngokunemba okukhulu. Ikhono lokulawula ngokunembile amandla kagesi alethwa esicutshini lenze ama-ESU abe yisisekelo kukho kokubili ukuhlinzwa okuvulekile kanye ne-laparoscopic, okunomthelela empumelelweni nasekuphepheni okuphelele kwezinqubo.
Kodwa-ke, naphezu kwezinzuzo eziphawulekayo kokubili ukuhlinzwa kwe-laparoscopic kanye namayunithi e-electrosurgical, ukukhathazeka okuphawulekayo kuye kwavela mayelana nokusetshenziswa kwama-ESU phakathi nezinqubo ze-laparoscopic: ukukhiqizwa kwamagesi ayingozi. Lapho i-high-frequency yamanje kagesi ye-ESU ixhumana nezicubu, ingabangela ukuhwamuka nokubola kwezinto eziphilayo, okuholela ekukhiqizweni kwengxube eyinkimbinkimbi yamagesi. La magesi awagcini nje ngokuba yingozi esigulini esihlinzwayo kodwa futhi ayingozi enkulu empilweni nasekuphepheni kwabasebenzi bezokwelapha abakhona egunjini lokuhlinza.
Izingozi zezempilo ezingaba khona ezihlobene nala magesi ayingozi zihlukahlukene futhi zifinyelela kude. Esikhathini esifushane, ukuchayeka kulawa magesi kungabangela ukucasuka kwamehlo, ikhala, nendlela yokuphefumula yazo zombili iziguli nabahlinzeki bezempilo. Ngokuhamba kwesikhathi, ukuchayeka ngokuphindaphindiwe kungase kwenyuse ingozi yezinkinga zempilo ezingathi sína, njengezifo zokuphefumula, okuhlanganisa umdlavuza wamaphaphu, nezinye izinkinga zempilo ezihlelekile. Njengoba ukuhlinzwa kwe-laparoscopic kuqhubeka nokukhula ekuthandeni nasekusetshenzisweni kwamayunithi okuhlinzwa ngogesi kusalokhu kusabalele, ukuqonda uhlobo lwala magesi ayingozi, imiphumela yawo engaba khona, kanye nendlela yokunciphisa izingozi zawo kuye kwaba okubaluleke kakhulu emphakathini wezokwelapha. Lesi sihloko sihlose ukuhlola kabanzi lesi sihloko esibucayi, sikhanyisela isayensi ekhiqiza igesi, imithelela yezempilo engaba khona, namasu angasetshenziswa ukuze kuqinisekiswe indawo yokuhlinzwa ephephile.
Izisekelo Zokuhlinza Nge-Laparoscopic kanye Nezingxenye Zokuhlinza Nge-Electrosurgical
Ukuhlinzwa Kwe-Laparoscopic: Isimangaliso Esihlasela Kancane
Ukuhlinzwa kwe-laparoscopic, okwaziwa nangokuthi ukuhlinzwa okungavamisile kancane noma ukuhlinzwa kwe-keyhole, kumelele ukugxumela phambili okubalulekile emkhakheni wamasu okuhlinza. Le nqubo iye yashintsha indlela ukungenelela okuningi okwenziwa ngayo, okuhlinzeka iziguli inqwaba yezinzuzo uma kuqhathaniswa nezindlela zokuhlinzwa ezivulekile zendabuko.
Inqubo iqala ngokwenza ama-incision ambalwa amancane, ngokuvamile angabi ngaphezu kwamamilimitha ambalwa ukuya kumasentimitha ubude, esiswini sesiguli. Ngokukodwa kwalokhu kusika, kufakwa i-laparoscope. Leli thuluzi elizacile lifakwe ikhamera enencazelo ephezulu kanye nomthombo wokukhanya onamandla. Ikhamera idlulisela isikhathi sangempela, izithombe ezikhulisiwe zezitho zangaphakathi kumonitha, inikeze udokotela ohlinzayo umbono ocacile nonemininingwane wendawo yokuhlinza.
Khona-ke odokotela abahlinzayo bafaka izinsimbi ezikhethekile ze-laparoscopic ngokusebenzisa izimbobo ezisele. Lawa mathuluzi aklanyelwe ukuthi abe made, azacile, futhi aguquguquke, okuvumela ukukhohliswa okunembile ngaphakathi komzimba kuyilapho kunciphisa ukulimala kwezicubu ezizungezile. Ngosizo lwala mathuluzi, odokotela abahlinzayo bangenza izinqubo eziningi ezihlukahlukene, kuhlanganise nokukhipha inyongo (cholecystectomy), i-appendectomy, ukulungisa i-hernia, nokuhlinzwa okuningi kwezifo zabesifazane kanye nomchamo.
Enye yezinzuzo ezivelele kakhulu zokuhlinzwa kwe-laparoscopic ukuncipha kokuhlukumezeka komzimba. Ukusikwa okuncane kuphumela ekulahlekelweni kwegazi elincane ngesikhathi sokuhlinzwa uma kuqhathaniswa nokuhlinzwa okuvulekile, lapho kwenziwa khona ukusika okukhulu ukuze kuvezwe indawo yokuhlinza. Lokhu akunciphisi nje kuphela isidingo sokumpontshelwa igazi kodwa futhi kunciphisa ingozi yezinkinga ezihlobene nokopha kakhulu. Ukwengeza, ukusika okuncane kuholela ebuhlungu obuncane ngemuva kokuhlinzwa esigulini. Njengoba kunokuphazamiseka okuncane emisipha nezicubu, iziguli zivame ukudinga imithi yobuhlungu encane futhi zithole inqubo yokutakula ekhululekile.
Isikhathi sokululama ngemva kokuhlinzwa kwe-laparoscopic naso sifushane kakhulu. Iziguli ngokuvamile zingaqala kabusha imisebenzi evamile ngokushesha okukhulu, ngokuvamile phakathi kwezinsuku ezimbalwa kuya evikini, kuye ngobunkimbinkimbi benqubo. Lokhu kuphambene nokuhlinzwa okuvulekile, okungase kudinge amasonto okululama kanye nesikhathi esengeziwe sokululama. Ukuhlala isikhathi esifushane esibhedlela kungenye inzuzo, enganciphisi nje kuphela izindleko zokunakekelwa kwezempilo kodwa futhi evumela iziguli ukuthi zibuyele ekuphileni kwazo kwansuku zonke ngokushesha.
Ukuhlinzwa kwe-Laparoscopic kuthole ukusetshenziswa okubanzi emikhakheni ehlukahlukene yezokwelapha. Ku-gynecology, ijwayele ukusetshenziselwa izinqubo ezifana ne-hysterectomy (ukususwa kwesibeletho), i-cystectomy ye-ovarian, nokwelashwa kwe-endometriosis. Ekuhlinzeni okuvamile, isetshenziselwa ukususa inyongo, kanye nokwelapha izimo ezifana nezilonda ze-peptic kanye nezinhlobo ezithile zomdlavuza. Ama-Urologists asebenzisa amasu e-laparoscopic ngezinqubo ezifana ne-nephrectomy (ukususwa kwezinso) kanye ne-prostatectomy. Ukuguquguquka nokusebenza ngempumelelo kokuhlinzwa kwe-laparoscopic kukwenze kwaba ukukhetha okuthandwayo kokungenelela okuningi kokuhlinzwa noma nini lapho kungenzeka.
Amayunithi E-Electrosurgical: Ukunika amandla Ukunemba Ekuhlinzeni
Amayunithi e-Electrosurgical (ESUs) angamadivayisi ezokwelapha ayinkimbinkimbi adlala indima ebalulekile ezinqubweni zokuhlinza zesimanje, ikakhulukazi ekuhlinzeni kwe-laparoscopic. Lawa madivaysi asebenzisa izimiso zikagesi ukwenza imisebenzi eyahlukene ngesikhathi sokuhlinzwa, ikakhulukazi ukusika izicubu kanye nokuhlangana.
Umgomo oyisisekelo wokusebenza we-ESU ubandakanya ukukhiqizwa kwamagagasi kagesi avela kakhulu. Lawa misinga ngokuvamile isukela ku-300 kHz ukuya ku-5 MHz, ngaphezu kwebanga lefrikhwensi kagesi wasendlini (ngokuvamile i-50 - 60 Hz). Lapho i-ESU icushiwe, i-high-frequency current ihanjiswa endaweni yokuhlinza nge-electrode ekhethekile, engaba sesimweni se-scalpel - njengocezu lwesandla noma uhlobo oluhlukile lwe-probe.
Uma isetshenziselwa ukusika izicubu, i-high-frequency current ibangela ama-molecule amanzi angaphakathi kwethishu adlidlize ngokushesha. Lokhu kudlidliza kudala ukushisa, okwenza izicubu zibe mhwamuko futhi zinqamule kuzo. Inzuzo yale ndlela ukuthi inikeza ukusika okuhlanzekile nokunembile. Ukushisa okukhiqizwayo kuphinde kubangele imithambo yegazi emincane njengoba izicubu zisikwa, kunciphisa ukopha phakathi nenqubo. Lokhu kuphambene nezindlela zokusika zemishini zendabuko, ezingase zidale ukopha kakhulu futhi kudinga izinyathelo ezengeziwe zokufeza ukopha.
Ukuze i-coagulation, i-ESU ilungiswe ukuze ilethe iphethini ehlukile yamanje kagesi. Esikhundleni sokusika phakathi kwezicubu, i-current isetshenziselwa ukushisa izicubu kuze kube seqophelweni lapho amaprotheni angaphakathi kwamaseli ashintshana khona. Lokhu kubangela ukuthi isicubu sijiye, noma sijiye, sivale imithambo yegazi futhi kunqande ukopha. Ama-ESU angasethwa kumazinga ahlukene wamandla namagagasi, okuvumela odokotela abahlinzayo ukuthi balawule ngokunembile inani lokushisa nokujula kokungena kwezicubu, kuye ngezidingo ezithile zokuhlinzwa.
Ekuhlinzweni kwe-laparoscopic, ama-ESU abaluleke kakhulu. Ikhono lokwenza i-tissue dissection enembile futhi uzuze i-hemostasis ephumelelayo ngokusebenzisa izimbotshana ezincane zezinqubo ze-laparoscopic kubalulekile. Ngaphandle kokusetshenziswa kwama-ESU, kungaba inselele kakhulu ukulawula ukopha nokwenza ukusika izicubu ezithambile endaweni elinganiselwe yomgodi wesisu. Ama-ESU anika amandla odokotela abahlinzayo ukuthi basebenze ngokuphumelelayo, behlisa ubude besikhathi sokuhlinzwa. Lokhu akuzuzisi isiguli kuphela mayelana nokunciphisa isikhathi ngaphansi kwe-anesthesia kodwa futhi kunciphisa ingozi yezinkinga ezihlobene nezinqubo zokuhlinzwa ezinde.
Ngaphezu kwalokho, ukunemba okunikezwa ama-ESU ekuhlinzeni i-laparoscopic kuvumela ukususwa okunembe kakhudlwana kwezicubu ezigulayo kuyilapho konga izicubu ezizungezile ezinempilo. Lokhu kubalulekile ezinqubweni lapho ukulondolozwa kokusebenza kwesitho esijwayelekile kubalulekile, njengakunye ukuhlinzwa komdlavuza. Ngakho ukusetshenziswa kwama-ESU kube nomthelela omkhulu empumelelweni nasekuphepheni kokuhlinzwa kwe-laparoscopic, okuwenza abe yithuluzi elijwayelekile nelibalulekile ekuhlinzeni kwesimanjemanje. Kodwa-ke, njengoba kushiwo ngaphambili, ukusetshenziswa kwe-ESU ekuhlinzeni i-laparoscopic kuletha nendaba yokukhiqiza igesi eyingozi, esizoyihlola ngokuningiliziwe ezigabeni ezilandelayo.
UGenesise Wamagesi Ayingozi
I-Thermal Effects kanye ne-Chemical Reactions
Uma iyunithi yokuhlinza ngogesi yenziwa isebenze phakathi nokuhlinzwa kwe-laparoscopic, ikhipha uchungechunge oluyinkimbinkimbi lwemiphumela yokushisa kanye nokusabela kwamakhemikhali ngaphakathi kwezicubu zebhayoloji. I-high-frequency current kagesi edlula esicutshini ikhiqiza ukushisa okukhulu. Lokhu kushisa kuwumphumela wamandla kagesi aguqulwa abe amandla ashisayo njengoba lamanje lihlangabezana nokumelana nezicubu. Izinga lokushisa endaweni ye-electrode - ukuxhumana kwezicubu kungakhuphuka ngokushesha kuye emazingeni aphezulu kakhulu, ngokuvamile adlule ku-100 ° C, futhi kwezinye izimo, afinyelele amakhulu ambalwa degrees Celsius.
Kulawa mazinga okushisa aphakeme, izicubu ziba nokubola okushisayo, okubuye kwaziwe ngokuthi yi-pyrolysis. Amanzi angaphakathi kwezicubu ayahwamuka ngokushesha, okuwuphawu lokuqala olubonakalayo lomphumela wokushisa. Njengoba izinga lokushisa liqhubeka nokwanda, izingxenye eziphilayo zezicubu, njengamaprotheni, ama-lipids, nama-carbohydrate, ziqala ukuwohloka. Amaprotheni, akhiwe ngamaketanga amade ama-amino acid, aqala ukuphenduka abese ebola abe izingcezu zamangqamuzana amancane. I-lipids, ehlanganisa ama-fatty acids kanye ne-glycerol, nayo iyancipha ngokushisa, ikhiqiza imikhiqizo ehlukahlukene yokuwohloka. Ama-carbohydrate, afana ne-glycogen agcinwe kumaseli, ayathinteka ngendlela efanayo, ahlukaniswe abe ushukela olula futhi aphinde abole.
Lezi zinqubo zokubola okushisayo zihambisana nenqwaba yokusabela kwamakhemikhali. Isibonelo, ukuwohloka kwamaprotheni kungaholela ekwakhekeni kwe-nitrogen - equkethe izinhlanganisela. Lapho izinsalela ze-amino-asidi kumaprotheni zishiselwa, amabhondi e-nitrogen - carbon ayaqhekeka, okuholela ekukhishweni kwe-ammonia - njengezinhlanganisela nezinye i-nitrogen - eziqukethe ama-molecule. Ukubola kwe-lipids kungakhiqiza ama-fatty acids aguquguqukayo nama-aldehydes. Lokhu kusabela kwamakhemikhali akuwona nje umphumela we-high-temperature pyrolysis kodwa futhi kuthonywa ukuba khona komoyampilo endaweni yokuhlinzwa kanye nokwakheka okuqondile kwezicubu ezilashwayo. Ukuhlanganiswa kwalezi zinqubo ezishisayo namakhemikhali yilokho ekugcineni okuholela ekukhiqizeni amagesi ayingozi ngesikhathi sokuhlinzwa kwe-laparoscopic kusetshenziswa i-electrosurgical unit.
Amagesi Avamile Ayingozi Akhiqizwayo
1. I-Carbon Monoxide (CO)
1. I-Carbon monoxide iyigesi engenambala, engenaphunga, futhi enobuthi kakhulu evame ukukhiqizwa ngesikhathi kusetshenziswa iyunithi yokuhlinzwa ngogesi ekuhlinzweni kwe-laparoscopic. Ukwakheka kwe-CO kwenzeka ikakhulukazi ngenxa yokushiswa okungaphelele kwezinto eziphilayo ezicutshini. Lapho izinga lokushisa eliphezulu le-pyrolysis lamaprotheni, i-lipids, nama-carbohydrate senzeka endaweni enokutholakala okulinganiselwe komoya-mpilo (okungaba njalo endaweni yokuhlinza evaliwe ngaphakathi kwendawo yesisu), izinhlanganisela eziqukethe ikhabhoni esicutshini azifakwanga ngokuphelele i-carbon dioxide ( ). Esikhundleni salokho, zixubene kuphela ne-oxidized, okuholela ekukhiqizweni kwe-CO.
1. Izingozi zezempilo ezihlobene ne-CO zibalulekile. I-CO inokuhlobana okuphezulu kakhulu kwe-hemoglobin egazini kunomoya-mpilo. Lapho ihogelwa, ibophezela ku-hemoglobin yakhe i-carboxyhemoglobin, yehlisa umthamo wokuthwala umoya-mpilo wegazi. Ngisho nokuchayeka kwezinga eliphansi ku-CO kungabangela ubuhlungu bekhanda, isiyezi, isicanucanu, nokukhathala. Ukuchayeka isikhathi eside noma okusezingeni eliphezulu kungaholela ezimpawini ezinzima kakhulu, okuhlanganisa ukudideka, ukulahlekelwa ukwazi, futhi ezimweni ezimbi kakhulu, ukufa. Egunjini lokuhlinzela, isiguli kanye nabasebenzi bezokwelapha basengozini yokuchayeka ku-CO uma umoya ofanele kanye nezinhlelo zokukhipha igesi zingekho.
1. Izinhlayiya Zentuthu
1. Intuthu ekhiqizwa ngesikhathi sokuhlinzwa ngogesi iqukethe ingxube eyinkimbinkimbi yezinhlayiya eziqinile neziwuketshezi. Lezi zinhlayiya zakhiwe izinto ezihlukahlukene, okuhlanganisa izingcezwana zezicubu ezishile, izinto eziphilayo ezingashiswanga, kanye nezihwamuko ezijiyile ezivela ekuboleni okushisayo kwezicubu. Ubukhulu balezi zinhlayiya bungasukela ku-sub-micrometer kuye kuma-micrometer ambalwa ububanzi.
1. Uma uhogela, lezi zinhlayiya zentuthu zingabangela ukucasuka emgudwini wokuphefumula. Bangakwazi ukufaka imigudu yamakhala, uqhoqhoqho, nasemaphashini, okuholela ekukhwehleleni, ukuthimula, nomphimbo obuhlungu. Ngokuhamba kwesikhathi, ukuchayeka kaningi kulezi zinhlayiya kungandisa ingozi yokuba nezinkinga ezinkulu zokuphefumula, njenge-bronchitis engapheli nomdlavuza wamaphaphu. Ngaphezu kwalokho, izinhlayiya zentuthu zingaphinde zithwale ezinye izinto eziyingozi, njengamagciwane namagciwane akhona esicutshini, okungase kube yingozi ezithathelwanayo kubasebenzi bezokwelapha.
1. I-Volatile Organic Compounds (VOCs)
1. Uhlu olubanzi lwezinhlanganisela eziphilayo eziguquguqukayo lukhiqizwa ngesikhathi sokusetshenziswa kweyunithi ye-electrosurgical. Lezi zihlanganisa i-benzene, i-formaldehyde, i-acrolein, nama-hydrocarbon ahlukahlukene. I-Benzene iyi-carcinogen eyaziwayo. Ukuchayeka isikhathi eside ku-benzene kungalimaza umnkantsha, okuholela ekwehleni kokukhiqizwa kwamangqamuzana abomvu egazi, amangqamuzana egazi amhlophe, namaplatelet, isimo esaziwa ngokuthi i-aplastic anemia. Kungandisa futhi ingozi yokuba ne-leukemia.
1. I-Formaldehyde ingenye i-VOC esebenza kakhulu. Kuyigesi enukayo engabangela ukucasuka emehlweni, ikhala, nomphimbo. Ukuchayeka isikhathi eside ku-formaldehyde kuye kwaxhunyaniswa nengozi eyengeziwe yokuba nezifo zokuphefumula, okuhlanganisa isifuba somoya, nezinhlobo ezithile zomdlavuza, njengomdlavuza we-nasopharyngeal. I-Acrolein, ngakolunye uhlangothi, iyinhlanganisela ecasula kakhulu engabangela ukucindezeleka okukhulu kokuphefumula ngisho nasezindaweni eziphansi. Ingalimaza i-epithelium yokuphefumula futhi ihlotshaniswe nezinkinga zokuphefumula zesikhathi eside. Ukuba khona kwalawa ma-VOC endaweni yegumbi lokuhlinza kubangela usongo olukhulu empilweni yabo bobabili ithimba labahlinzayo nesiguli, okugqamisa isidingo sezinyathelo ezisebenzayo zokunciphisa ukuba khona kwabo.
Umthelela Wezempilo
Izingozi Ezigulini
Ngesikhathi sokuhlinzwa kwe-laparoscopic, iziguli zivezwa ngokuqondile kumagesi ayingozi akhiqizwa iyunithi ye-electrosurgical. Ukuhogela kwala magesi kungaba nemiphumela esheshayo neyesikhathi eside empilweni yawo.
Esikhathini esifushane, izimpawu ezivame kakhulu iziguli zihlobene nokucasuka kokuphefumula. Ukuba khona kwezinhlayiya zentuthu, ama-volatile organic compounds (VOCs), nezinye izinto ezicasulayo endaweni yokuhlinzwa kungabangela ukuba amehlo esiguli, ikhala, nomphimbo kucasuke. Lokhu kungase kuholele ekukhwehleleni, ukuthimula, nomphimbo obuhlungu. Ukucasuka komgudu wokuphefumula nakho kungabangela umuzwa wokuqina esifubeni kanye nokuphefumula. Lezi zimpawu azigcini nje ngokubangela ukungaphatheki kahle ngesikhathi sokuhlinzwa kodwa zingase ziphazamise ukuphefumula kwesiguli, okuyinto ekhathaza kakhulu, ikakhulukazi lapho isiguli singaphansi kwe-anesthesia.
Ngokuhamba kwesikhathi, ukuchayeka okuphindaphindiwe noma okubalulekile kulawa magesi ayingozi kungaholela ezindabeni ezibucayi kakhulu zezempilo. Okunye okukhathaza kakhulu ukuthi kungenzeka umonakalo wamaphaphu. Ukuhogela izinhlayiya zentuthu ecolekile kanye nama-VOC athile, njenge-benzene ne-formaldehyde, kungabangela ukulimala ezicutshini zamaphaphu ezithambile. Izinhlayiya ezincane zingangena zijule ku-alveoli, amasaka omoya amancane emaphashini lapho kwenzeka khona ukushintshana kwegesi. Uma sezingenile ku-alveoli, lezi zinhlayiya zingadala impendulo yokuvuvukala emaphashini. Ukuvuvukala okungamahlalakhona emaphashini kungaholela ekuthuthukisweni kwezimo ezifana nesifo esingamahlalakhona sokuvimbela amaphaphu (COPD), okuhlanganisa ukucinana kwemigudu yokuphefumula engapheli kanye ne-emphysema. I-COPD ibonakala ngokuba nobunzima bokuphefumula okuqhubekayo, ukukhwehlela, nokukhiqizwa kwamafinyila ngokweqile, okwehlisa kakhulu izinga lempilo yesiguli.
Ngaphezu kwalokho, uhlobo lwe-carcinogenic lwamanye amagesi, njenge-benzene, lubeka engcupheni yomdlavuza yesikhathi eside. Nakuba ingozi eqondile yokuba isiguli sibe nomdlavuza ngenxa yokuhlinzwa okukodwa kwe-laparoscopic iphansi ngokuqhathaniswa, umphumela onqwabelene wokuchayeka ngokuhamba kwesikhathi (ikakhulukazi ezigulini ezingase zenze izinqubo zokuhlinzwa eziningi ekuphileni kwazo) awunakunakwa. Ukuba khona kwe-benzene entuthuni yokuhlinzwa kungalimaza i-DNA emangqamuzaneni amaphaphu, okuholela ekuguqulweni okungase kubangele ukuthuthukiswa komdlavuza wamaphaphu.
Izingozi Kubasebenzi Bezempilo
Abasebenzi bezokunakekelwa kwempilo, okuhlanganisa odokotela abahlinzayo, abahlengikazi, nodokotela obulala izinzwa, nabo basengozini ngenxa yokuchayeka njalo nangokuphindaphindiwe kumagesi ayingozi akhiqizwa ngesikhathi sokuhlinzwa kwe-laparoscopic. Indawo yegumbi lokusebenza ivamise ukuvalelwa, futhi uma umoya ofanele kanye nezinhlelo zokukhipha igesi zingekho, ukugcwala kwala magesi ayingozi kungakheka ngokushesha.
Ukuchayeka isikhathi eside kumagesi egunjini lokuhlinzela kwandisa ingozi yokuthi abasebenzi bezempilo babe nezifo zokuphefumula. Ukuhogela njalo kwezinhlayiya zentuthu kanye nama-VOC kungaholela ekuthuthukisweni kwesifuba somoya. Imvelo ecasulayo yamagesi ingabangela imigudu yokuphefumula ukuba ivuvuke futhi izwele ngokweqile, okuholela ezimpawu ezifana nokuhefuzela, ukuphelelwa umoya, nokuqina kwesifuba. Abasebenzi bezokunakekelwa kwempilo bangase babe sengozini enkulu yokuba ne-bronchitis engapheli. Ukuchayeka kaningi ezintweni eziyingozi entuthwini yokuhlinza kungabangela ulwelwesi lwamashubhu e-bronchial ukuba luvuvuke futhi lucasuke, okuholela ekukhwehleleni okungapheli, ukukhiqizwa kwamafinyila, nobunzima bokuphefumula.
Ingozi yomdlavuza nayo iyinkinga enkulu kubasebenzi bezempilo. Ukuba khona kwamagesi e-carcinogenic afana ne-benzene ne-formaldehyde endaweni yegumbi lokuhlinza kusho ukuthi ngokuhamba kwesikhathi, ukuchayeka okwandayo kungandisa amathuba okuba nezinhlobo ezithile zomdlavuza. Ngaphandle komdlavuza wamaphaphu, abasebenzi bezempilo bangase babe sengozini enkulu yokuba nomdlavuza we-highs are breathing, njengomdlavuza we-nasopharyngeal, ngenxa yokuxhumana okuqondile kwama-carcinogens nezicubu zekhala kanye ne-pharyngeal.
Ngaphezu kwalokho, ukuhogela amagesi ayingozi kungaba nemiphumela yesistimu empilweni yabasebenzi bezempilo. Ezinye zezinto ezisentuthuni yokuhlinzwa, njengezinsimbi ezisindayo ezingase zibe khona ngamanani amancane esicupheni esikhishwa i-cauterized, zingamuncwa egazini. Uma sezingenile egazini, lezi zinto zingathinta izitho nezinhlelo ezahlukahlukene emzimbeni, okungase kuholele ezinkingeni zemizwa, ukulimala kwezinso, nezinye izindaba zezempilo zesistimu. Imithelela yesikhathi eside yalokhu kuchayeka isacutshungulwa, kodwa kuyacaca ukuthi ubungozi bezempilo kubasebenzi bezempilo bubalulekile futhi budinga ukunakwa okujulile kanye nezinyathelo zokuvimbela.
Ukutholwa kanye Nokuqapha
Izindlela Zamanje Zokuthola
1. Izinzwa zegesi
1. Izinzwa zegesi zidlala indima ebalulekile ekutholeni amagesi ayingozi akhiqizwa phakathi nokuhlinzwa kwe-laparoscopic. Kunezinhlobo eziningana zezinzwa zegesi ezisetshenziswayo, ngayinye inesimiso sayo esiyingqayizivele sokusebenza kanye nezinzuzo.
1. Izinzwa Zegesi Ye-Electrochemical : Lezi zinzwa zisebenza ngokusekelwe kumgomo wokusabela kwe-electrochemical. Uma igesi eqondiwe, njenge-carbon monoxide (CO), ihlangana nama-electrode enzwa, ukusabela kwe-electrochemical kwenzeka. Isibonelo, kunzwa ye-CO electrochemical, i-CO ifakwe i-oxidized ku-electrode esebenzayo, futhi amandla kagesi aphumayo alingana nokuhlushwa kwe-CO endaweni ezungezile. Lokhu kwamanje kuyalinganiswa futhi kuguqulelwe kusignali efundekayo, okuvumela ukunqunywa okunembile kokugxila kwe-CO. Izinzwa ze-Electrochemical zizwela kakhulu futhi ziyakhetha, okuzenza zikufanelekele ukuthola amagesi athile ayingozi endaweni yokuhlinzwa. Anganikeza idatha yesikhathi sangempela kumaleveli egesi, anikeze amandla impendulo esheshayo ezimeni zokugxilisa okuyingozi.
1. Izinzwa Zegesi Ye-infrared : Izinzwa ze-infrared zisebenza ngomgomo wokuthi amagesi ahlukene adonsa imisebe ye-infrared kumaza amaza athile. Ngokwesibonelo, ukuze ibone i-carbon dioxide ( ) namanye ama-hydrocarbon, inzwa ikhipha ukukhanya kwe-infrared. Lapho ukukhanya kudlula endaweni egcwele igesi egunjini lokuhlinza, amagesi aqondiwe amunca imisebe ye-infrared ngamaza awo ajwayelekile. Inzwa ibe isikala inani lokukhanya elimuncwayo noma elidluliswayo, futhi ngokusekelwe kulesi silinganiso, lingakwazi ukubala ukugcwala kwegesi. Izinzwa ze-infrared azithintani futhi zinesikhathi eside sempilo. Futhi azinzile futhi angasebenza ngaphansi kwezimo ezihlukahlukene zemvelo, okuwenza athembeke ekuqaphelweni okuqhubekayo kwamagesi ayingozi ngesikhathi sokuhlinzwa kwe-laparoscopic.
1. Ukukhishwa Kwentuthu kanye Nezinhlelo Zokuqapha
1. Izinhlelo zokukhipha intuthu ziyingxenye ebalulekile yokuqapha igesi egunjini lokuhlinza. Lawa masistimu aklanyelwe ukususa ngokoqobo intuthu namagesi ayingozi akhiqizwa ngesikhathi kusetshenziswa iyunithi yokuhlinzwa kagesi.
1. Amadivayisi Asebenzayo Okukhipha Intuthu : Lawa madivayisi, afana nezikhipha intuthu ezisuselwe ekumunceni, axhumeke ngqo endaweni yokuhlinzwa. Basebenzisa indlela yokudonsa enamandla ukuze badonse intuthu namagesi njengoba kukhiqizwa. Isibonelo, isikhiphi sentuthu esiphathwa ngesandla singabekwa eduze kwethuluzi lokuhlinza ngogesi ngesikhathi sokuhlinzwa. Njengoba i-ESU ikhipha intuthu, i-evacuator iwumunca ngokushesha, ivimbele amagesi ukuba angahlakazeki endaweni yegumbi lokusebenza. Ezinye izinhlelo ezithuthukisiwe zokukhipha intuthu zihlanganiswe nemishini ye-laparoscopic ngokwayo, ukuqinisekisa ukuthi intuthu isuswa eduze komthombo ngangokunokwenzeka.
1. Izingxenye Zokuqapha ngaphakathi Kwezinhlelo Zokukhipha Intuthu : Ngaphezu kokukhipha, lezi zinhlelo ngokuvamile zakhele - ezingxenyeni zokuqapha. Lezi zingabandakanya izinzwa zegesi ezifana nalezi ezishiwo ngenhla. Isibonelo, isistimu yokukhipha intuthu ingase ibe nenzwa ye-CO ehlanganiswe nendlela yayo yokudonsa. Njengoba isistimu imunca intuthu, inzwa ikala ukugxiliswa kwe-CO entuthuni engenayo. Uma ukugxilisa ingqondo kudlula izinga eliphephile elisethiwe, i-alamu ingacushwa, ixwayise ithimba elihlinzayo ukuthi lithathe isinyathelo esifanele, njengokwandisa amandla okukhipha noma ukulungisa indlela yokuhlinza ukuze kuncishiswe ukukhiqizwa kwegesi.
Ukubaluleka Kokuqapha Okuvamile
1. Ukuvikela Impilo Yesiguli
1. Ukuqapha njalo ukugcwala kwegesi eyingozi phakathi nokuhlinzwa kwe-laparoscopic kubalulekile ukuze kuvikelwe impilo yesiguli. Njengoba isiguli sichayeka ngokuqondile kumagesi endaweni yokuhlinzwa, ngisho nokuchayeka okwesikhashana emazingeni aphezulu amagesi ayingozi kungaba nomthelela omubi ngokushesha. Isibonelo, uma ukuhlushwa kwe-carbon monoxide (CO) endaweni yokuhlinzwa kungaqashwe futhi kufinyelela ezingeni eliyingozi, isiguli singase sibe nokuncipha kwe-oxygen - amandla okuthwala igazi. Lokhu kungaholela ku-hypoxia, engabangela ukulimala kwezitho ezibalulekile njengobuchopho, inhliziyo nezinso. Ngokuqapha njalo ukugcwala kwegesi, ithimba labahlinzayo lingaqinisekisa ukuthi isiguli asichayeka emazingeni amagesi ayingozi angabangela izinkinga zempilo ezimbi kangaka.
1. Izingozi zezempilo zesikhathi eside zeziguli nazo zingancishiswa ngokuqapha njalo. Njengoba kushiwo ngaphambili, ukuchayeka kumagesi athile afana ne-benzene ne-formaldehyde ngokuhamba kwesikhathi kungandisa ingozi yokuba nomdlavuza. Ngokugcina ukugcwala kwegesi endaweni yokuhlinza ngaphakathi kwemingcele ephephile, ukuchayeka okwenyukayo kwesiguli kulezi zidakamizwa ze-carcinogenic kunciphisa, kunciphisa ubungozi bezempilo besikhathi eside obuhambisana nokuhlinzwa kwe-laparoscopic.
1. Ukuqinisekisa Ukuphepha Kwabasebenzi Bezempilo
1. Abasebenzi bezempilo egunjini lokuhlinza basengozini yokuchayeka kaningi kumagesi ayingozi. Ukuqapha njalo kusiza ukuvikela impilo yabo futhi. Ngokuhamba kwesikhathi, ukuchayeka njalo emagesini egunjini lokuhlinza kungaholela ekwakhiweni kwezifo zokuphefumula njengesifuba somoya, i-bronchitis engapheli, ngisho nomdlavuza wamaphaphu. Ngokuqapha ukugcwala kwegesi njalo, izikhungo zokunakekelwa kwempilo zingathatha izinyathelo ezisheshayo zokuthuthukisa ukungena komoya noma ukusebenzisa amasistimu okukhipha igesi asebenza kangcono. Isibonelo, uma ukuqapha kukhombisa ukuthi i-concentration of volatile organic compounds (VOCs) iphezulu njalo, isibhedlela singatshala ezinhlelweni ezingcono - zekhwalithi yomoya - zokuhlunga noma sithuthukise intuthu ekhona - imishini yokukhipha. Lokhu kuqinisekisa ukuthi abasebenzi bezempilo abachayeka emazingeni ayingozi amagesi ayingozi phakathi nomsebenzi wabo, okuvikela impilo nempilo yabo yesikhathi eside.
1. Ukuqinisekiswa Kwekhwalithi Ekuhlinzeni
1. Ukuqapha njalo amagesi ayingozi nakho kuyisici esibalulekile sokuqinisekiswa kwekhwalithi ekusebenzeni kokuhlinzwa. Ivumela izibhedlela namathimba okuhlinza ukuthi ahlole ukusebenza kwezinyathelo zabo zokuphepha zamanje. Uma idatha yokuqapha ibonisa ukuthi ukugxiliswa kwegesi kuhlala ngaphakathi kwebanga eliphephile, kubonisa ukuthi amasistimu akhona okukhipha umoya kanye negesi asebenza ngempumelelo. Ngakolunye uhlangothi, uma idatha iveza ukuthi ukugxilisa ingqondo kuyasondela noma kweqa imikhawulo ephephile, kubonisa isidingo sokuthuthukiswa. Lokhu kungase kuhlanganise ukuhlola ukusebenza kweyunithi yokuhlinzwa ngogesi, ukuhlola noma yikuphi ukuvuza ohlelweni lokukhipha igesi, noma ukuqinisekisa ukuthi umoya wegumbi lokuhlinza wanele. Ngokusebenzisa idatha yokuqapha ukuze enze izinqumo ezinolwazi, amaqembu okuhlinza angaqhubeka nokuthuthukisa ukuphepha kwendawo yegumbi lokuhlinza, athuthukise ikhwalithi iyonke yokunakekelwa kokuhlinzwa.
Amasu Okunciphisa
Izilawuli Zobunjiniyela
1. Ukuthuthukisa i-ESU Design
1. Abakhiqizi bamayunithi okuhlinza ngogesi bangadlala indima ebalulekile ekwehliseni ukukhiqizwa kwamagesi ayingozi. Enye indlela iwukuthuthukisa izindlela zokulethwa kwamandla zama-ESU. Isibonelo, ukuthuthukisa ama-ESU anokulawula okunembe kakhudlwana kwamandla kagesi kunganciphisa ukukhiqizwa kokushisa okukhulu. Ngokulawula kahle inani lamandla alethwa esicutshini, izinga lokushisa esicutshini - isikhombimsebenzisi se-electrode singaphathwa kangcono. Lokhu kunciphisa amathuba okushisa ngokweqile kwezicubu, okubuye kunciphise izinga lokubola okushisayo kanye nokukhiqizwa kwamagesi ayingozi.
1. Esinye isici sokuthuthukiswa komklamo we-ESU ukusetshenziswa kwezinto ezithuthukisiwe ze-electrode. Ezinye izinto ezintsha zingase zibe ne-thermal conductivity engcono kanye nezakhiwo zokumelana, okuvumela ukudluliswa okuphumelelayo kwamandla kagesi ngenkathi kunciphisa ukuwohloka okuhlobene nokushisa kwezicubu. Ukwengeza, ucwaningo lungagxila ekuthuthukiseni ama-electrode aklanyelwe ngokuqondile ukunciphisa ukwakheka kwezicubu ezishile, njengoba izicubu ezishile ziwumthombo omkhulu wezinhlayiya zentuthu eyingozi namagesi.
1. Ukuthuthukisa Izinhlelo Zokuhlinza Zokungenisa umoya
1. Ukungena komoya okwanele kubalulekile ekamelweni lokuhlinza ukuze kukhishwe amagesi ayingozi akhiqizwa ngesikhathi sokuhlinzwa kwe-laparoscopic. Izinhlelo zendabuko zokungenisa umoya zingathuthukiswa zibe sezithuthuke kakhulu. Isibonelo, amasistimu okungenisa umoya ogelezayo angafakwa. Lezi zinhlelo zakha ukugeleza komoya ngendlela engaqondile, ehambisa umoya ongcolile ngaphandle kwegumbi lokusebenza ngendlela ephumelela kakhudlwana. Ngokugcina ukugeleza komoya omusha njalo futhi oqondiswe kahle, izinhlelo zokugeleza kwe-laminar zingavimbela ukuqoqwa kwamagesi ayingozi endaweni yokuhlinzwa.
1. Ngokungeziwe ekungeneni komoya okuvamile, izinhlelo zokukhipha umoya wendawo zingahlanganiswa ekusethweni kokuhlinzwa. Lawa masistimu aklanyelwe ukuthwebula ngokuqondile intuthu namagesi emthonjeni, eduze kwethuluzi lokuhlinza ngogesi. Isibonelo, idivayisi yokukhipha umoya esuselwe endaweni ingabekwa eduze ne-laparoscope noma ucezu lwesandla lwe-ESU. Lokhu kuqinisekisa ukuthi amagesi ayingozi akhishwa ngokushesha nje lapho ekhiqizwa, ngaphambi kokuba abe nethuba lokuhlakazeka endaweni enkulu yegumbi lokusebenza. Ukugcinwa njalo nokuqapha kwalezi zinhlelo zokungena komoya kanye ne-exhaust nakho kubalulekile ukuze kuqinisekiswe ukusebenza kwazo okuphezulu. Izihlungi ezinhlelweni kufanele zishintshwe njalo ukuze kugcinwe ukusebenza kwazo kahle ekukhipheni izinhlayiya eziyingozi namagesi emoyeni.
Izinto Zokuzivikela Zomuntu Siqu (PPE)
1. Ukubaluleka kwe-PPE Yabasebenzi Bezempilo
1. Abasebenzi bezempilo egunjini lokuhlinzela kufanele banikezwe futhi baqeqeshwe ngendlela efanele ukusebenzisa izinto zokuzivikela (i-PPE) ukuze banciphise ukuchayeka kwabo kumagesi ayingozi. Enye yezingcezu ezibaluleke kakhulu ze-PPE umshini wokuphefumula osezingeni eliphezulu. Ama-respirators, afana ne-N95 noma ngaphezulu - level particulate - filtering facepiece respirators, aklanyelwe ukuhlunga izinhlayiya ezinhle, kuhlanganise nalezo ezikhona entuthuni yokuhlinzwa. Lezi ziphefumula zinganciphisa ngempumelelo ukuhogela kwezinhlayiya zentuthu, izinhlanganisela zezinto eziphilayo ezishintshashintshayo, nezinye izinto eziyingozi emoyeni wegumbi lokuhlinza.
1. Izihlangu zobuso nazo ziyingxenye ebalulekile ye-PPE. Zinikeza ungqimba olwengeziwe lwesivikelo ngokuvikela amehlo, ikhala, nomlomo ekuthinteni okuqondile nentuthu yokuhlinzwa nokuchaphaza. Lokhu akusizi nje kuphela ukuvimbela ukuhogela kwamagesi ayingozi kodwa futhi kuvikela namagciwane okungenzeka akhona entuthuni.
1. Ukusetshenziswa Okufanelekile kwe-PPE
1. Ukusetshenziswa ngendlela efanele kwe-PPE kubalulekile ekusebenzeni kwayo. Abasebenzi bezokunakekelwa kwempilo kufanele baqeqeshwe ngendlela efanele yokunikela kanye nokukhipha ama-respirators abo. Ngaphambi kokufaka i-respirator, kubalulekile ukwenza ukulingana - hlola. Lokhu kuhlanganisa ukumboza umshini wokuphefumula ngazo zombili izandla nokuhogela nokuwukhipha ujule. Uma ukuvuza komoya kutholwa emaphethelweni emshini wokuphefumula, kufanele kulungiswe noma kushintshwe ukuze kuqinisekiswe uphawu olufanele.
1. Izihlangu zobuso kufanele zigqokwe ngendlela efanele ukuze zivikeleke ngokugcwele. Kufanele zilungiswe ukuze zilingane kahle ekhanda futhi akufanele zifakwe inkungu ngesikhathi sokuhlinzwa. Uma kunenkungu, izixazululo zokulwa nenkungu zingasetshenziswa. Ukwengeza, i-PPE kufanele ishintshwe njalo. Izinto zokuphefumula kufanele zishintshwe ngokuvumelana nezincomo zomenzi, ikakhulukazi uma ziba manzi noma zilimale. Izivikelo zobuso kufanele zihlanzwe futhi zibulawe amagciwane phakathi kokuhlinzwa ukuze kuvinjelwe ukunqwabelana kokungcola.
Imikhuba Engcono Kakhulu Egunjini Lokusebenza
1. Ukuhlanza Nokunakekela Njalo
1. Ukugcina indawo yegumbi lokusebenza ihlanzekile kubalulekile ekwehliseni ukuchayeka kwegesi eyingozi. Indawo egunjini lokuhlinzela kufanele ihlanzwe njalo ukuze kukhishwe noma yiziphi izinsalela zezinto eziyingozi ezikhona entuthuni yokuhlinzwa. Lokhu kuhlanganisa ukuhlanza amatafula okuhlinza, izinto zokusebenza, kanye nephansi. Ukuhlanza njalo kusiza ukuvimbela ukumiswa kabusha kwezinhlayiya okungenzeka ukuthi zihlezi endaweni, kunciphisa ukuhlangana okuphelele kwezinto eziyingozi emoyeni.
1. Iyunithi ye-electrosurgical ngokwayo kufanele futhi igcinwe kahle. Ukusezwa okuvamile kwe-ESU kungaqinisekisa ukuthi isebenza ngendlela efanele. Lokhu kuhlanganisa ukuhlola noma yikuphi ukuxhumeka okuxekethile, ama-electrode agugile, noma ezinye izinkinga zemishini. I-ESU enakekelwe kahle mancane amathuba okuthi ikhiqize ukushisa okudlulele noma ukungasebenzi kahle, okungaba nomthelela ekukhiqizweni kwamagesi ayingozi.
1. Ukuthuthukiswa Kwesu Lokuhlinza
1. Odokotela abahlinzayo bangadlala indima ebalulekile ekwehliseni ukukhiqizwa kwegesi eyingozi ngokusebenzisa amasu abo okuhlinza ngokugcwele. Isibonelo, ukusebenzisa amandla aphansi asebenza ngempumelelo kuyunithi yokuhlinzwa kwe-electrosurgical kunganciphisa inani lokulimala kwezicubu kanye nokukhiqizwa kwegesi okulandelayo. Ngokulawula ngokucophelela ubude besikhathi sokusebenza kwe-ESU kanye nesikhathi sokuxhumana nezicubu, odokotela abahlinzayo bangakwazi futhi ukunciphisa izinga lokubola okushisayo.
1. Omunye umkhuba obalulekile uwukusebenzisa i-ESU ngamafuphi, ukuqhuma okuphakathi nendawo kunokuyenza isebenze ngokuqhubekayo. Lokhu kuvumela izicubu ukuba ziphole phakathi kokuqhuma, kunciphisa ukushisa okuphelele - ukulimala okuhlobene nezicubu kanye nokukhiqizwa kwamagesi ayingozi. Ukwengeza, uma kungenzeka, ezinye izindlela zokuhlinza ezikhiqiza intuthu encane negesi, njenge-ultrasonic dissection, zingacatshangelwa. Lezi zindlela zokwenza izicubu zikwazi ukuhlinzeka ngokusika nokubumbana kwezicubu okusebenzayo ngenkathi zinciphisa ukukhiqizwa kwemikhiqizo eyingozi, okunomthelela endaweni ephephile yokuhlinzwa kuzo zombili iziguli nabasebenzi bezempilo.
Ucwaningo kanye Nemibono Yekusasa
Izifundo Eziqhubekayo
Njengamanje, kunezifundo eziningana eziqhubekayo ezigxile ekubhekaneni nenkinga yokukhiqizwa kwegesi eyingozi ngesikhathi sokuhlinzwa kwe-laparoscopic kusetshenziswa amayunithi okuhlinzwa kagesi. Indawo eyodwa yocwaningo igxile ekuthuthukisweni kwezinto ezintsha zama-electrosurgical electrode. Ososayensi bahlola ukusetshenziswa kwama-polymer athuthukile nama-nanomaterials anezakhiwo ezihlukile. Isibonelo, amanye ama-nanomaterials anamandla okuthuthukisa ukusebenza kahle kokudluliswa kwamandla ngesikhathi sokuhlinzwa ngogesi ngenkathi kunciphisa inani lokulimala kwezicubu ezibangelwa ukushisa. Lokhu kungase kuholele ekunciphiseni ukukhiqizwa kwamagesi ayingozi. Ocwaningweni lwakamuva, abacwaningi baphenye ngokusetshenziswa kwama-electrode ane-carbon - nanotube - coated. Imiphumela yabonisa ukuthi lawa ma-electrode angafinyelela ukusika kwezicubu ezisebenzayo kanye nokuhlangana ngokukhiqiza ukushisa okuncane uma kuqhathaniswa nama-electrode endabuko, okubonisa ukuncipha okungenzeka kokukhiqizwa kwegesi eyingozi.
Olunye ucwaningo luqondiswe ekuthuthukiseni ukwakheka kwamayunithi okuhlinzwa ngogesi ngokwawo. Onjiniyela basebenzela ukuthuthukisa ama-ESU ngamasistimu okulawula ahlakaniphe kakhulu. Lawa ma-ESU esizukulwane esisha azokwazi ukulungisa ngokuzenzakalelayo amandla kagesi namandla asuselwa ohlotsheni lwethishu nomsebenzi wokuhlinza osuwenzile. Ngokuhlanganisa kahle ukulethwa kwamandla, ingozi yokushisisa ngokweqile izicubu kanye nokukhiqiza amagesi ayingozi ngokweqile ingancishiswa. Isibonelo, amanye ama-prototype afakwe izinzwa ezikwazi ukubona ukuthintana kwezicubu ngesikhathi sangempela. I-ESU ibe isilungisa izilungiselelo zayo ngokufanele ukuze iqinisekise ukusebenza kahle nokukhiqizwa kwegesi okuncane.
Ngaphezu kwalokho, ucwaningo luyenziwa mayelana nokusetshenziswa kweminye imithombo yamandla ekuhlinzeni ngogesi. Abanye abacwaningi bahlola ukusetshenziswa kwama-lasers noma amandla e-ultrasonic njengezinye izindlela zamanje kagesi we-high-frequency. Ama-Lasers, isibonelo, anganikeza ukudedelwa kwezicubu okunembayo ngokusatshalaliswa kokushisa okuncane futhi okungenzeka kube yingozi embalwa ngemikhiqizo. Nakuba kusesezigabeni zokuhlola, lawa mathuluzi okuhlinza asekelwe kumandla ahlukile abonisa isithembiso ekwehliseni inkinga yegesi eyingozi ehambisana namayunithi endabuko okuhlinza ngogesi.
Umbono Wokuhlinza Nge-Laparoscopic Okuphephile
Ikusasa lokuhlinzwa kwe-laparoscopic linesithembiso esikhulu sokunciphisa izingozi ezihlobene nokukhiqizwa kwegesi eyingozi. Ngokusungula izinto ezintsha zobuchwepheshe, singalindela ukubona ukuthuthuka okubalulekile ekuphepheni kwalezi zinqubo.
Enye yentuthuko ebalulekile esikhathini esizayo kungaba ukuthuthukiswa kwezinhlelo zokuhlinza ezididiyelwe ngokugcwele. Lezi zinhlelo zizohlanganisa amayunithi e-electrosurgical athuthukisiwe negesi esebenza kahle kakhulu - amasistimu okukhipha nokuhlanza. Isibonelo, iyunithi yokuhlinza ngogesi ingase ixhunywe ngokuqondile endaweni - of - - yobuciko yokukhipha intuthu esebenzisa ubuchwepheshe bokuhlunga obuthuthukisiwe, njengezihlungi ezisekelwe ku-nanoparticle. Lezi zihlungi zizokwazi ukukhipha ngisho nezinhlayiya ezincane eziyingozi namagesi endaweni yokuhlinzwa, ziqinisekise isimo esiseduze - esingenabungozi kuso kokubili isiguli nethimba labahlinzayo.
Ngaphezu kwalokho, ngokuqhubeka kobuhlakani bokwenziwa (AI) nokufunda komshini, amarobhothi okuhlinzwa angase adlale indima ebaluleke kakhulu ekuhlinzweni kwe-laparoscopic. Lawa marobhothi angase ahlelwe ukuthi enze izinqubo zokuhlinzwa ngokunemba okukhulu, kusetshenziswa inani elincane lamandla elidingekayo ukuze kusetshenziswe izicubu. Ama-algorithms anamandla e-AI angahlaziya izici zezicubu ngesikhathi sangempela futhi alungise indlela yokuhlinza ngokufanele, ehlise nakakhulu ukukhiqizwa kwamagesi ayingozi.
Mayelana nokusebenza kwezokwelapha, iziqondiso zesikhathi esizayo kanye nezinhlelo zokuqeqesha odokotela abahlinzayo zingase futhi zigcizelele kakhulu ekunciphiseni ukukhiqizwa kwegesi. Odokotela abahlinzayo bangase baqeqeshelwe ukusebenzisa izindlela ezintsha zokuhlinza nemishini eklanyelwe ukunciphisa ukukhiqizwa kwamagesi ayingozi. Izifundo eziqhubekayo zemfundo yezokwelapha zingagxila ekutholakaleni kwakamuva kocwaningo kanye nezinqubo ezihamba phambili kule ndawo, ukuqinisekisa ukuthi abahlinzeki bezokunakekelwa kwempilo banolwazi lwakamuva ngezindlela ezisebenza kahle kakhulu zokunciphisa ubungozi obuhlobene nokukhiqizwa kwegesi yokuhlinzwa ngogesi.
Sengiphetha, nakuba udaba lokukhiqizwa kwegesi eyingozi phakathi nokuhlinzwa kwe-laparoscopic kusetshenziswa amayunithi okuhlinzwa kuyinkinga enkulu, ucwaningo oluqhubekayo kanye nentuthuko yesikhathi esizayo yezobuchwepheshe nezokwelapha kunikeza ithemba ngendawo yokuhlinzwa ephephile. Ngokuhlanganisa izixazululo zobunjiniyela obusha, izinto ezithuthukisiwe, kanye namasu okuhlinza athuthukisiwe, singabheka phambili esikhathini esizayo lapho ukuhlinzwa kwe-laparoscopic kungenziwa ngengozi encane empilweni nasekuphepheni kokubili kweziguli nabasebenzi bezokunakekelwa kwempilo.
Isiphetho
Kafushane, ukusetshenziswa kwamayunithi okuhlinzwa ngogesi ngesikhathi sokuhlinzwa kwe-laparoscopic, kuyilapho kunikeza izinzuzo ezibalulekile ngokunemba kokuhlinzwa nokulawulwa kwe-hemostasis, kubangela ukukhiqizwa kwamagesi ayingozi. Lawa magesi, okuhlanganisa i-carbon monoxide, izinhlayiya zentuthu, nezinhlanganisela zezinto eziphilayo ezishintshashintshayo, abeka usongo olukhulu empilweni yeziguli nabasebenzi bezempilo.
Izingozi zezempilo zesikhathi esifushane nezesikhathi eside ezihlobene nalawa magesi ayingozi akufanele zithathwe kancane. Iziguli zingase zithole ukucasuka kokuphefumula ngokushesha ngesikhathi sokuhlinzwa, futhi ngokuhamba kwesikhathi, zibhekane nengozi eyengeziwe yokuthuthukisa izifo ezingapheli zokuphefumula nomdlavuza. Abasebenzi bezokunakekelwa kwempilo, ngenxa yokuchayeka kaningi endaweni yegumbi lokuhlinzela, basengozini yokuba nezinkinga eziningi zempilo yokuphefumula kanye neyohlelo.
Izindlela zamanje zokuhlonza, njengezinzwa zegesi namasistimu okukhipha intuthu kanye nokuqapha, zidlala indima ebalulekile ekuhlonzeni ubukhona kanye nokugxila kwalawa magesi ayingozi. Ukuqapha okuvamile kubalulekile hhayi kuphela ekuvikeleni impilo yeziguli nabasebenzi bezokunakekelwa kwempilo kodwa futhi nokuqinisekisa ikhwalithi iyonke yokuhlinzwa.
Amasu okunciphisa, okuhlanganisa nezilawuli zobunjiniyela njengokuthuthukisa idizayini ye-ESU kanye nokuthuthukisa izinhlelo zokungena komoya zokuhlinzwa, ukusetshenziswa kwezinto zokuzivikela ngabasebenzi bezokunakekelwa kwempilo, kanye nokuqaliswa kwezinqubo ezihamba phambili egumbini lokuhlinza, konke kubalulekile ekwehliseni izingozi ezihlobene nokuchayeka kwegesi eyingozi.
Ucwaningo oluqhubekayo lunesithembiso esikhulu sekusasa lokuhlinzwa kwe-laparoscopic. Ukuthuthukiswa kwezinto ezintsha, imiklamo ye-ESU ethuthukisiwe, kanye nokuhlolwa kweminye imithombo yamandla okuhlinzwa ngogesi kunikeza ithemba lokunciphisa ukukhiqizwa kwegesi eyingozi. Umbono wezinhlelo zokuhlinza ezididiyelwe ngokugcwele kanye nokusetshenziswa kwamarobhothi okuhlinza anikwe amandla yi-AI kungase kuthuthukise ukuphepha kwezinqubo ze-laparoscopic.
Kubaluleke kakhulu ukuthi umphakathi wezokwelapha, okuhlanganisa odokotela abahlinzayo, odokotela ababulala izinzwa, abahlengikazi, nabakhiqizi bemishini yezokwelapha, bakubone ukubaluleka kwalolu daba. Ngokusebenzisana, ukusebenzisa izinyathelo zokuvimbela ezidingekayo, nokuhlala sinolwazi ngocwaningo lwakamuva nentuthuko yezobuchwepheshe, singalwela ukuya esikhathini esizayo lapho ukuhlinzwa kwe-laparoscopic kungenziwa ngaphandle kwengozi encane empilweni nasekuphepheni kwabo bonke abahilelekile. Ukuphepha kweziguli nabasebenzi bezempilo egunjini lokuhlinza kufanele kube yinto ehamba phambili ngaso sonke isikhathi, futhi ukubhekana nenkinga yokukhiqizwa kwegesi eyingozi ekuhlinzeni i-laparoscopic kusetshenziswa amayunithi okuhlinzwa kuyisinyathelo esibalulekile ekufinyeleleni lo mgomo.
