Isingeniso
Emkhakheni wokuhlinzwa kwesimanje, ukunemba nokuphepha kubaluleke kakhulu. Amathuluzi amabili abalulekile aguqule izinqubo zokuhlinza i-ultrasonic scalpel kanye ne-electrosurgical unit (ESU). Lawa mathuluzi adlala indima ebalulekile emisebenzini ehlukahlukene yokuhlinzwa, kusukela ekuhlinzweni okuvamile kuya ku-neurosurgery, okuvumela odokotela abahlinzayo ukuba benze ukuhlinzwa ngokunemba okukhulu kanye nokunciphisa ukuhlukumezeka kwesiguli.
I-scalpel ye-ultrasonic, eyaziwa nangokuthi i-ultrasonic surgical aspirator noma i-CUSA (Cavitron Ultrasonic Surgical Aspirator), isibe yisisekelo emakamelweni amaningi okuhlinza. Isebenzisa ama-high-frequency vibrations ultrasonic ukusika nokubopha izicubu. Lobu buchwepheshe buvumela ukusika okunembe kakhudlwana, ikakhulukazi ezindaweni ezithambile lapho ukunciphisa umonakalo ezicutshini ezizungezile kubalulekile. Isibonelo, ku-neurosurgery, lapho uhlinza ebuchosheni, i-scalpel ye-ultrasonic ingasusa kahle izicubu zesimila kuyilapho isindisa izicubu zemizwa enempilo ngangokunokwenzeka.
Ngakolunye uhlangothi, i-electrosurgical unit (ESU), ebizwa nangokuthi i-high - frequency electrosurgical generator, ingenye idivayisi esetshenziswa kakhulu ezilungiselelweni zokuhlinzwa. Isebenza ngokudlulisa amandla kagesi esicutshini, ikhiqize ukushisa okunganqamula, kugoqe, noma kunciphise izicubu. Ama-ESU aguquguquka ngokwedlulele futhi angasetshenziswa ezinhlobonhlobo zezinqubo, kusukela ekuhlinzweni okuncane kweziguli ezingalaliswanga kuya ekuhlinzweni okuyinkimbinkimbi kwenhliziyo.
Ukuqonda umehluko phakathi kwalezi zinsimbi ezimbili zokuhlinza kubalulekile kodokotela abahlinzayo, amaqembu okuhlinza, kanye nabafundi bezokwelapha ngokufanayo. Ngokwazi izici eziyingqayizivele, izinzuzo, kanye nokulinganiselwa kwe-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical, ochwepheshe bezokwelapha bangenza izinqumo ezinolwazi mayelana nokuthi yiliphi ithuluzi elifaneleka kakhulu inqubo ethile yokuhlinzwa. Lokhu akugcini nje ngokuthuthukisa ukusebenza kokuhlinzwa kodwa futhi kuthuthukisa imiphumela yesiguli. Ezigabeni ezilandelayo, sizocubungula ngokujulile izimiso zokusebenza, izinhlelo zokusebenza, izinzuzo, ukungalungi, nokucatshangelwa kokuphepha kwakho kokubili kwe-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical, sinikeze ukuqhathanisa okuphelele phakathi kwalokhu kokubili.
Incazelo kanye Nemiqondo Eyisisekelo
I-Ultrasonic Scalpel
I-ultrasonic scalpel iyithuluzi lokuhlinza eliyinkimbinkimbi elihlanganisa amandla amagagasi e-ultrasonic avamile, ngokuvamile ebangeni lika-20 - 60 kHz. Lawa maza e-ultrasonic akhiqiza ukudlidliza kwemishini ngaphakathi kwethiphu yokuhlinzwa. Lapho ithiphu elidlidlizayo lihlangana nezicubu zebhayoloji, libangela ukuthi ama-molecule amanzi angaphakathi kwamaseli adlidlizele ngokushesha. Lokhu kudlidliza okunamandla kuholela enqubweni ebizwa ngokuthi i-cavitation, lapho amabhamuza amancane akheka futhi awele ngaphakathi kwezicubu. Ukucindezelwa komshini okuvela ku-cavitation kanye nesenzo somshini esiqondile sethiphu edlidlizayo kwephula izibopho zamangqamuzana ezicubu, ukusika ngokuphumelelayo kwezicubu.
Ngesikhathi esifanayo, ukudlidliza kwe-high-frequency nakho kukhiqiza ukushisa, okusetshenziselwa ukubopha imithambo yegazi eduze nendawo yokusikwa. Le nqubo yokuhlanganisa ivala imithambo yegazi, inciphise ukopha ngesikhathi sokuhlinzwa. Isibonelo, ekuhlinzweni kwe-thyroid, i-scalpel ye-ultrasonic ingakwazi ukuhlinza indlala yegilo ezicutshini ezizungezile kuyilapho inciphisa ukopha. Ikhono lokusika kanye nokujiya kanyekanye likwenza kube ithuluzi elibalulekile ekuhlinzeni lapho ukugcinwa kwenkundla yokuhlinzwa ecacile nokunciphisa ukulahleka kwegazi kubalulekile.
I-Electrosurgical Unit
Iyunithi ye-electrosurgical (ESU) isebenza ngesimiso esihlukile, sithembele kumandla kagesi ashintshashintshayo. Ibanga lefrikhwensi elijwayelekile lama-ESU liphakathi kuka-300 kHz no-3 MHz. Lapho amandla kagesi edlula esicutshini sesiguli nge-electrode (njengepensela yokuhlinza noma ithiphu elikhethekile lokusika noma elixhumanisa), ukumelana nogesi kwethishu kuguqula amandla kagesi abe ukushisa.
Kunezindlela ezihlukene zokusebenza zama-ESU. Kwimodi yokusika, i-high-frequency yamanje idala i-arc yokushisa ephezulu phakathi kwe-electrode kanye nezicubu, ezishisa izicubu, zidale ukusika. Kumodi ye-coagulation, kusetshenziswa umthamo wamandla ophansi, obangela ukuthi amaprotheni esicutshini ajike futhi ahlangane, avale imithambo yegazi emincane futhi amise ukopha. Ku-hysterectomy, isibonelo, i-ESU ingasetshenziswa ukusika izicubu zesibeletho bese ushintshela kumodi yokuhlanganisa ukuze uvale imithambo yegazi endaweni yokuhlinzwa, ukuvimbela ukulahlekelwa igazi eliningi. Ama-ESU aguquguquka kakhulu futhi angasetshenziswa ezintweni eziningi ezikhethekile zokuhlinza, kusukela ku-dermatology ukuze kususwe izilonda esikhumbeni kuye ekuhlinzweni kwamathambo ukuze kuhlinzwe izicubu ezithambile emathanjeni.
Izimiso Zokusebenza
Isebenza kanjani i-Ultrasonic Scalpel
Ukusebenza kwe-scalpel ye-ultrasonic kusekelwe ezimisweni ze-ultrasonic wave propagation kanye ne-mechanical - imiphumela yokushisa ezicutshini zebhayoloji.
1. Isizukulwane samagagasi e-Ultrasonic
Ijeneretha ye-ultrasonic ngaphakathi kwedivayisi inesibopho sokukhiqiza amasiginali kagesi ayimvamisa ephezulu. Lawa masignali kagesi ngokuvamile anezandiso kububanzi obungu-20 - 60 kHz. Ijeneretha ibe isiguqula lezi zimpawu zikagesi zibe ukudlidliza kwemishini kusetshenziswa i-piezoelectric transducer. Izinto ze-Piezoelectric zinempahla eyingqayizivele yokushintsha ukuma kwazo lapho insimu kagesi isetshenziswa kuzo. Endabeni ye-scalpel ye-ultrasonic, i-piezoelectric transducer idlidliza ngokushesha isabela kumasiginali kagesi ayimvamisa ephezulu, ekhiqiza amaza e-ultrasonic.
2. Ukuqhuba Amandla
Amaza e-ultrasonic abe esedluliselwa eduze kwe-waveguide, evame ukuba yinduku yensimbi ende, ezacile, iye emaphethelweni okuhlinzwa. I-waveguide iklanyelwe ukudlulisa ngempumelelo amandla e-ultrasonic kusuka ku-generator kuya ekugcineni ngokulahleka kwamandla okuncane. Ithiphu yokuhlinzwa iyingxenye yensimbi ehlangana ngqo nethishu ngesikhathi sokuhlinzwa.
3. Ukusebenzisana Kwezicubu - Ukusika kanye Nokuhlanganiswa
Lapho ithiphu lokuhlinza elidlidlizayo lithinta izicubu, kwenzeka izinqubo eziningana zomzimba. Okokuqala, i-high-frequency vibrations yenza ama-molecule amanzi angaphakathi kwamaseli ezicubu adlidlize ngamandla. Lokhu kudlidliza kuholela entweni ebizwa ngokuthi i-cavitation. I-Cavitation ukwakheka, ukukhula, kanye nokuwohloka okunamandla kwamabhamuza amancane ngaphakathi kwendawo ewuketshezi (kulokhu, amanzi ngaphakathi kwezicubu). Ukuqhuma kwala mabhamuza kudala ukucindezeleka okukhulu kwendawo, okunqamula izibopho zamangqamuzana esicutshini, kunqamuke ngokuphumelelayo.
Ngesikhathi esifanayo, ukudlidliza komshini kwethiphu nakho kukhiqiza ukushisa ngenxa yokungqubuzana phakathi kwethiphu elidlidlizayo nethishu. Ukushisa okukhiqizwayo kuphakathi kuka-50 - 100°C. Lokhu kushisa kusetshenziselwa ukubopha imithambo yegazi eduze nendawo yokusikwa. Inqubo ye-coagulation ihlotshaniswa namaprotheni asezindongeni zemithambo yegazi, okubangela ukuba ahlangane futhi avale umkhumbi, ngaleyo ndlela anciphise ukulahlekelwa kwegazi ngesikhathi sokuhlinzwa. Isibonelo, ekuhlinzeni kwe-laparoscopic ukuze kukhishwe izimila ezincane esibindini, i-scalpel ye-ultrasonic ingasika ngokunembile izicubu zesibindi ngenkathi ivala imithambo yegazi emincane, igcine insimu ecacile yokuhlinza udokotela ohlinzayo.
Isebenza kanjani i-Electrosurgical Unit
I-electrosurgical unit (ESU) isebenza ngomgomo wokusebenzisa amandla kagesi ashintshashintshayo aphezulu ukuze akhiqize ukushisa ngaphakathi kwethishu, ebese isetshenziselwa ukusika nokuhlanganisa.
1. Okuphezulu - Isizukulwane Samanje Esishintshana Imvamisa
I-ESU iqukethe amandla kagesi kanye nejeneretha ekhiqiza amandla kagesi ashintshashintshayo. Imvamisa yalokhu yamanje ngokuvamile isukela ku-300 kHz iye ku-3 MHz. Lesi samanje sefrikhwensi ephezulu sisetshenziswa esikhundleni se-low - frequency current (njengamandla kagesi wasendlini ku-50 - 60 Hz) ngoba i-high-frequency current inganciphisa ingcuphe ye-fibrillation yenhliziyo. Emaza aphansi, amandla kagesi angaphazamisa amasignali avamile kagesi enhliziyweni, okungase kubangele ukuphila - ama-arrhythmias asongelayo. Kodwa-ke, amaza omoya aphezulu angaphezu kuka-300 kHz mancane amathuba okuthi abe nomthelela onjalo esicupheni senhliziyo njengoba engavusi izinzwa namaseli emisipha ngendlela efanayo.
2. Ukusebenzisana Kwezicubu - Izindlela Zokusika Nokuhlanganisa
· Imodi Yokusika : Kumodi yokusika, amandla kagesi ayimvamisa ephezulu adlula ku-electrode encane, ebukhali - enamachopho (njengepensela yokuhlinza). Lapho i-electrode isondela esicutshini, ukumelana okuphezulu kwezicubu kumandla kagesi kubangela amandla kagesi aguqulwe abe ukushisa. Ukushisa okukhiqizwa kuphezulu kakhulu, kufinyelela emazingeni okushisa afika ku-1000°C ku-arc phakathi kwe-electrode nethishu. Lokhu kushisa okunamandla kuhwamulisa izicubu, kudale ukusikeka. Njengoba i-electrode ihamba eduze kwezicubu, ukusika okuqhubekayo kwenziwa. Isibonelo, ku-tonsillectomy, i-ESU kumodi yokusika ingasusa ngokushesha futhi ngokunembile amathoni ngokufaka umoya wezicubu.
· I-Coagulation Mode : Kumodi ye-coagulation, kusetshenziswa amandla amanje aphansi. Ukushisa okukhiqizwayo kwanele ukuguqula amaprotheni ezicubu, ikakhulukazi emithanjeni yegazi. Lapho amaprotheni asezindongeni zemithambo yegazi eshintshashintsha, akha i-coagulum, evala imithambo yegazi futhi inqande ukopha. Kunezinhlobo ezahlukene zamasu okuhlangana asetshenziswa nama-ESU, afana ne-monopolar ne-bipolar coagulation. Ku-monopolar coagulation, amandla kagesi adlula e-electrode esebenzayo emzimbeni wesiguli aye ku-electrode ehlakazayo (iphedi elikhulu elibekwe esikhumbeni sesiguli). Ku-bipolar coagulation, womabili ama-electrode asebenzayo nabuyayo aku-forceps eyodwa - njengedivayisi. I-current igeleza kuphela phakathi kwamathiphu amabili we-forceps, ewusizo ekuhlanganiseni okunembile endaweni encane, njengaku-microsurgery noma lapho usebenza nezicubu ezithambile. Isibonelo, ku-neurosurgery, i-bipolar coagulation ene-ESU ingasetshenziswa ukuvala imithambo yegazi emincane ebusweni bobuchopho ngaphandle kokudala umonakalo omkhulu ezicutshini zemizwa ezizungezile.
Umehluko Obalulekile
Umthombo Wamandla
Umehluko obaluleke kakhulu phakathi kwe-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical usemithonjeni yawo yamandla. I-scalpel ye-ultrasonic isebenzisa amandla e-ultrasonic, asesimweni sokudlidliza kwemishini. Lokhu kudlidliza kukhiqizwa ngokuguqula amandla kagesi abe amandla emishini ngokusebenzisa i-piezoelectric transducer. Imvamisa yamagagasi e-ultrasonic ngokuvamile isukela ku-20 - 60 kHz. La mandla omshini abe esedluliselwa ngqo esicutshini, okwenza izinguquko zomzimba ezifana ne-cavitation kanye nokuphazamiseka kwemishini.
Ngakolunye uhlangothi, iyunithi ye-electrosurgical isebenza ngamandla kagesi. Ikhiqiza amandla kagesi ashintshashintshayo aphezulu, ngokuvamile ebangeni lika-300 kHz - 3 MHz. Amandla kagesi adluliswa ngezicubu, futhi ngenxa yokumelana kwezicubu, amandla kagesi aguqulwa abe amandla okushisa. Lokhu kushisa kusetshenziselwa izinjongo zokusika kanye nokuhlanganisa. Imithombo yamandla ehlukene iholela ezindleleni ezihlukene zokusebenzisana nezicubu, ezibuye zithinte imiphumela yokuhlinzwa kanye nephrofayili yokuphepha yezinqubo. Isibonelo, imvelo yemishini yamandla e-ultrasonic ku-scalpel ye-ultrasonic ivumela ukusebenzisana 'okuthambile' ngaphezulu nezicubu kwezinye izici, njengoba inganciki ekukhiqizeni ukushisa okushubile njengeyunithi yokuhlinzwa kagesi.
Ukusebenzisana Kwezicubu
I-scalpel ye-ultrasonic isebenzisana nezicubu ngokusebenzisa inhlanganisela yokudlidliza kwemishini kanye nemiphumela yokushisa. Lapho ithiphu elidlidlizayo le-scalpel ye-ultrasonic lithinta izicubu, ukudlidliza kwemishini okuvama kakhulu kubangela ama-molecule amanzi angaphakathi kwamaseli ezicubu ukuba adlidlize ngamandla. Lokhu kuholela ku-cavitation, lapho ama-bubbles amancane akha futhi awele ngaphakathi kwezicubu, okwenza ukucindezeleka komshini okwephula izibopho zamangqamuzana ezicubu. Ukwengeza, ukungqubuzana komshini phakathi kwethiphu elidlidlizayo kanye nethishu kudala ukushisa, okusetshenziselwa ukubopha imithambo yegazi emincane. Izicubu ziphazanyiswa ngokuyinhloko amandla emishini, futhi ukushisa kungumphumela wesibili osiza ku-hemostasis.
Ngokuphambene, iyunithi ye-electrosurgical isebenzisana nezicubu ikakhulukazi ngemiphumela yokushisa. I-high-frequency current kagesi edlula esicutshini idala ukushisa ngenxa yokumelana kwezicubu kumanje. Kumodi yokusika, ukushisa kunamandla kakhulu (kufika ku-1000 ° C ku-arc phakathi kwe-electrode kanye nezicubu) kangangokuthi kuhwamulisa izicubu, kudala ukusika. Kumodi ye-coagulation, kusetshenziswa umthamo wamandla ophansi, futhi ukushisa okukhiqizwayo (imvamisa cishe ku-60 - 100 ° C) kuveza amaprotheni ezicubu, ikakhulukazi emithanjeni yegazi, okubangela ukuthi abambene futhi avale. Ukusebenzisana kwe-ESU nezicubu kubuswa kakhulu ukushisa - izinguquko ezibangelwa, futhi amandla emishini mancane kakhulu uma kuqhathaniswa ne-scalpel ye-ultrasonic.
Ukulimala Okushisayo
Omunye umehluko obalulekile phakathi kwalezi zinsimbi ezimbili ubukhulu bomonakalo oshisayo eziwubangela ezicutshini ezizungezile. I-scalpel ye-ultrasonic ngokuvamile ikhiqiza ukushisa okuphansi ngesikhathi sokusebenza. Ukushisa okukhiqizwayo kusetshenziselwa ikakhulukazi ukuhlanganisa imithambo yegazi emincane futhi kusezingeni lika-50 - 100°C. Ngenxa yalokho, umonakalo oshisayo wezicubu ezizungezile ulinganiselwe. Imvelo yokusebenza kwayo isho ukuthi isicubu siyasikwa futhi sijiyane ngokulimala okuncane okubamba ukushisa, okuzuzisa kakhulu ekuhlinzeni lapho ukulondoloza ubuqotho bezicubu eziseduze kubalulekile, njengaku-neurosurgery noma ukuhlinzwa okuncane.
Ngakolunye uhlangothi, iyunithi ye-electrosurgical ingabangela umonakalo omkhulu wokushisa. Kumodi yokusika, amazinga okushisa aphakeme kakhulu (afinyelela ku-1000 ° C) angaholela ekuhwameni okuphawulekayo kwezicubu kanye nokusha, hhayi nje endaweni yokusikwa kodwa nasezindaweni eziseduze. Ngisho nakumodi yokuhlangana, ukushisa kungasakazekela endaweni enkulu ezungeze izicubu ezilashiwe, okungase kulimaze amaseli anempilo nezakhiwo. Lo monakalo omkhulu oshisayo ngezinye izikhathi ungaholela ezikhathini zokuphulukisa ezinde, ingozi eyengeziwe ye-tissue necrosis, kanye nokukhubazeka okungenzeka komsebenzi wezitho eziseduze noma izicubu. Isibonelo, ngesilinganiso esikhulu sokukhishwa kwezicubu ezithambile kusetshenziswa i-ESU, izicubu ezinempilo ezizungezile zingase zithintwe ukushisa, okungase kube nomthelela kunqubo yonke yokululama yesiguli.
I-Hemostasis Amandla
Kokubili i-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical inamakhono we-hemostatic, kodwa ayahluka ngokusebenza kwawo kanye nendlela afinyelela ngayo ukopha. I-scalpel ye-ultrasonic ingakwazi ukubopha imithambo yegazi emincane ngenkathi isika izicubu. Njengoba ithiphu elidlidlizayo linqamula esicutshini, ukushisa okukhiqizwa ngesikhathi esisodwa kuvala imithambo yegazi emincane eseduze, kunciphisa ukopha kwegazi phakathi nenqubo yokuhlinzwa. Leli khono lokusika nokujiya kanyekanye lenza liphumelele kakhulu ekugcineni indawo yokuhlinza ecacile, ikakhulukazi ekuhlinzweni lapho ukugeleza kwegazi okuqhubekayo kungase kufihle umbono kadokotela ohlinzayo. Nokho, ukuphumelela kwayo ekubhekaneni nemithambo yegazi emikhulu kunomkhawulo.
Iyunithi ye-electrosurgical nayo inezindawo ezinhle ze-hemostatic. Kumodi ye-coagulation, ingavala imithambo yegazi yobukhulu obuhlukahlukene. Ngokusebenzisa amandla wamanje aphansi, ukushisa okukhiqizwe ku-denatures amaprotheni asezindongeni zemithambo yegazi, okuwenza ahlangane futhi avale. Ama-ESU avame ukusetshenziselwa ukulawula ukopha ngesikhathi sokuhlinzwa, futhi angalungiswa ukuze aphathe osayizi bemikhumbi abahlukene. Emithanjeni yegazi emikhulu, kungase kudingeke ukulungiselelwa okungaphezulu kwamandla ukuze kuqinisekiswe ukuhlangana okufanele. Kokunye ukuhlinzwa okuyinkimbinkimbi, njengokukhishwa kwesibindi lapho kunemithambo yegazi eminingi enosayizi abahlukene, i-ESU ingasetshenziswa ngokuhambisana namanye amasu e-hemostatic ukuze kuzuzwe ukopha okusebenzayo.
Ukunemba Nokusebenziseka
I-scalpel ye-ultrasonic inikeza ukunemba okuphezulu, ikakhulukazi ezinqubweni zokuhlinzwa ezibucayi. Ithiphu yayo encane, edlidlizayo ivumela ukusika nokuhlukanisa okunembe kakhulu. Ekuhlinzeni okungatheni, okufana nezinqubo ze-laparoscopic noma ze-endoscopic, i-scalpel ye-ultrasonic ingaqondiswa kalula ngokusebenzisa izimbobo ezincane noma i-orifices yemvelo, inikeze odokotela abahlinzayo amandla okwenza imisebenzi eyinkimbinkimbi ngezinga eliphezulu lokunemba. Kuwusizo ikakhulukazi ekuhlinzeni lapho izicubu ezizosuswa ziseduze nezakhiwo ezibalulekile, njengoba ukulimala kwayo okulinganiselwe okushisayo kanye nekhono lokusika elinembile kusiza ukunciphisa ingozi yokulimala kulezi zakhiwo.
Iyunithi ye-electrosurgical, ngakolunye uhlangothi, inohlu olubanzi lokusebenza. Ingasetshenziswa ezicini ezihlukahlukene zokuhlinza, kusukela ezinqubweni ezincane zesikhumba kuya ekuhlinzweni okukhulu okuvulekile kwenhliziyo. Nakuba ingase inganikeli izinga elifanayo lokunemba njenge-scalpel ye-ultrasonic kwezinye izinqubo ezibucayi, ukuguquguquka kwayo ngokwezinhlobo ezahlukene zezicubu kanye nezimo zokuhlinzwa kuyinzuzo enkulu. Ekuhlinzweni kwesilinganiso esikhulu lapho isivinini nekhono lokusingatha ukujiya kwezicubu ezihlukene nosayizi bemikhumbi kubalulekile, i-ESU ingalungiswa ukuze ihlangabezane nalezi zidingo. Isibonelo, ekuhlinzweni kwamathambo, i-ESU ingasetshenziswa ukusika ngokushesha izicubu ezithambile futhi ihlanganise amaphuzu okopha ngesikhathi kususwa izicubu ezilimele noma ukufakwa kwezitho zokufakelwa.
Izinzuzo kanye Nemibi
I-Ultrasonic Scalpel
· Izinzuzo :
· Ukopha Okuncishisiwe : Enye yezinzuzo eziphawulekayo ze-scalpel ye-ultrasonic yikhono layo lokuhlanganisa imithambo yegazi emincane ngenkathi isika. Lokhu kuholela ekwehleni okukhulu kokulahleka kwegazi phakathi nenqubo yokuhlinzwa. Isibonelo, ekuhlinzweni kwe-laparoscopic ukuze kukhishwe izimila ezincane esibindini noma enyongweni, i-ultrasonic scalpel ingagcina insimu yokuhlinzwa yamahhala enegazi, okubalulekile ukuthi udokotela ohlinzayo ayibone ngeso lengqondo indawo yokuhlinza futhi enze ukuhlinzwa ngokunembile.
· I-Minimal Tissue Trauma : Ukusebenza kwe-scalpel ye-ultrasonic ngokuyinhloko kuncike ekudlidlizeni komshini, okuholela ekulimaleni okuncane ezicutshini ezinempilo ezizungezile uma kuqhathaniswa namanye amathuluzi okuhlinza. Umonakalo olinganiselwe wokushisa eliwudalayo usho ukuthi izicubu eziseduze mancane amathuba okuba zithinteke, okugqugquzela ukuphulukiswa ngokushesha futhi kunciphise nengozi yezinkinga zangemva kokuhlinzwa ezifana nokutheleleka noma ukukhubazeka komsebenzi wesitho. Lokhu kuzuzisa kakhulu ekuhlinzeni okubandakanya izitho ezithambile njengobuchopho, amehlo, noma izinzwa.
· Ukululama Ngokushesha Kweziguli : Ngenxa yokuncipha kokulahlekelwa kwegazi kanye nokuhlukumezeka okuncane kwezicubu, iziguli ezihlinzwa nge-ultrasonic scalpel ngokuvamile zithola isikhathi esifushane sokululama. Bangase babe nobuhlungu obuncane, izifo ezimbalwa ngemva kokuhlinzwa, futhi bangabuyela emisebenzini evamile ngokushesha okukhulu. Lokhu akuthuthukisi nje kuphela ikhwalithi yempilo yesiguli ngesikhathi sokululama kodwa futhi kunciphisa izindleko zokunakekelwa kwezempilo zizonke ezihlobene nokuhlala isikhathi eside esibhedlela.
· Okubi :
· Izindleko Eziphakeme Zezisetshenziswa : Amasistimu e-scalpel e-Ultrasonic abiza kakhulu. Izindleko zocingo ngokwalo, kanye nezidingo zalo zokunakekelwa nokulinganisa, zingaba umthwalo omkhulu wezezimali kwezinye izikhungo zokunakekelwa kwempilo, ikakhulukazi lezo ezisezilungiselelweni ezilinganiselwe zezinsiza. Lezi zindleko eziphezulu zinganciphisa ukwamukelwa okusabalele kwama-scalpel e-ultrasonic, okuthinta ukufinyelela kweziguli kulobu buchwepheshe bokuhlinza obuphambili.
· Imfuneko Yekhono Eliphezulu Lokusebenza : Ukusebenzisa i-scalpel ye-ultrasonic kudinga izinga eliphezulu lekhono nokuqeqeshwa. Odokotela abahlinzayo kudingeka babe nekhono ekuphatheni idivayisi ukuze baqinisekise ukusika okunembile kanye nokujiya kuyilapho benciphisa ukulimala kwezicubu ezizungezile. Ukufunda ukusebenzisa i-scalpel ye-ultrasonic ngempumelelo kungase kuthathe isikhathi esiningi nokuzijwayeza, futhi ukusetshenziswa okungalungile kungaholela emiphumeleni yokuhlinzwa engafaneleki noma ngisho namaphutha okuhlinzwa.
· Ukusebenza Okulinganiselwe Kwemithambo Emikhulu Yegazi : Nakuba i-scalpel ye-ultrasonic iphumelela ekuhlanganiseni imithambo yegazi emincane, ikhono layo lokulawula ukopha emithanjeni yegazi emikhulu lilinganiselwe. Ezimeni lapho imithambo yegazi emikhulu idinga ukusikwa noma ukuxhunywa phakathi nokuhlinzwa, izindlela ezengeziwe ezifana nokuxhunywa kwendabuko noma ukusetshenziswa kweyunithi yokuhlinzwa kagesi kungase kudingeke. Lokhu kungandisa inkimbinkimbi nesikhathi senqubo yokuhlinzwa.
I-Electrosurgical Unit
· Izinzuzo :
· High - Speed Cutting : Iyunithi yokuhlinzwa kagesi inganqamula izicubu ngokushesha okukhulu. Ekuhlinzweni lapho isikhathi siyisici esibucayi, njengokuhlinzwa okuphuthumayo noma ukukhishwa kwezicubu ezinkulu, ikhono lokusika ngokushesha le-ESU lingaba inzuzo enkulu. Isibonelo, ngesikhathi sokuhlinzwa, i-ESU inganqamula ngokushesha izicubu zesisu ukuze ifinyelele esibelethweni, ukunciphisa isikhathi sokuhlinzwa nokunciphisa ingozi kumama nomntwana.
· I-Hemostasis Ephumelelayo Yokuhlukahluka Kosayizi Bemikhumbi : Ama-ESU asebenza kahle kakhulu ekuzuzeni ukopha kwemithambo yegazi yamasayizi ahlukene. Kumodi yokuhlangana, bangavala ama-capillary amancane kanye nemithambo yegazi emikhulu ngokusebenzisa inani elifanele lamandla kagesi. Lokhu kuguquguquka kwenza i-ESU ibe ithuluzi elibalulekile ekuhlinzeni lapho kubalulekile ukulawula ukopha ezinhlotsheni ezihlukahlukene zemithambo yegazi, njengokuhlinzwa kwesibindi noma ukuhlinzwa okubandakanya izimila ezinemithambo yegazi ephezulu.
· Ukusethwa Kwezisetshenziswa Ezilula : Uma kuqhathaniswa namanye amadivaysi okuhlinza athuthukile, ukusethwa okuyisisekelo kweyunithi yokuhlinzwa kagesi kulula. Iqukethe ikakhulukazi i-generator yamandla kanye ne-electrode, engaxhunywa kalula futhi ilungiswe ngezinqubo ezahlukene zokuhlinzwa. Lokhu kuba lula kuvumela ukulungiswa ngokushesha egunjini lokuhlinzela, kunciphisa isikhathi esichithwa ekusethweni kwemishini futhi kuvumela odokotela abahlinzayo ukuthi baqale ukuhlinza ngokushesha.
· Okubi :
· Ukulimala Okubalulekile Okushisayo : Njengoba kushiwo ngaphambili, iyunithi ye-electrosurgical ikhiqiza inani elikhulu lokushisa ngesikhathi sokusebenza, ikakhulukazi kwimodi yokusika. Lokhu kushisa okuphezulu kwezinga lokushisa kungabangela umonakalo omkhulu wokushisa ezicutshini ezizungezile, okuholela ekushiseni kwezicubu, i-necrosis, kanye nokulimala okungaba khona ezithweni eziseduze noma izakhiwo. Uma ukulungiselelwa kwamandla sikhulu kanye nesikhathi sokufaka isicelo eside, yilapho umonakalo oshisayo ungase ube mkhulu.
· Ingozi Ye-Tissue Carbonization : Ukushisa okunamandla okukhiqizwa i-ESU kungabangela ukuthi izicubu zibe nekhabhoni, ikakhulukazi kuzilungiselelo zamandla aphezulu. Izicubu ezinekhabhoni zingaba nzima ukuthunga noma ukuphulukiswa ngendlela efanele, futhi kungase kwandise nengozi yokutheleleka ngemva kokuhlinzwa. Ngaphezu kwalokho, ukuba khona kwezicubu ze-carbonized kungaphazamisa ukuhlolwa kwe-histological yezicubu ezisusiwe, okubalulekile ekuxilongweni okunembile nokuhlela ukwelashwa.
· Imfuneko Yekhono Eliphezulu Lomqhubi : Ukusebenzisa iyunithi yokuhlinzwa ngogesi ngokuphepha nangempumelelo kudinga izinga eliphezulu lekhono nolwazi. Umsebenzisi udinga ukwazi ukulawula ukukhishwa kwamandla ngokunembile, akhethe imodi efanelekile (ukusika noma ukuhlanganisa) ngezinhlobo zezicubu ezihlukene nezimo zokuhlinzwa, futhi agweme ukubangela ukulimala okushisayo esigulini ngephutha. Ukusetshenziswa okungalungile kwe-ESU kungaholela ezinkingeni ezinkulu, ezinjengokopha ngokweqile, ukulimala kwezicubu, noma ngisho nokushiswa kukagesi.
Izicelo Ekuhlinzweni
Izinkambu Ezijwayelekile Zokuhlinza ze-Ultrasonic Scalpel
1. Ukuhlinzwa Kwe-Laparoscopic
· Ezinqubo ze-laparoscopic, i-scalpel ye-ultrasonic ithandwa kakhulu. Isibonelo, ngesikhathi se-laparoscopic cholecystectomy (ukususwa kwe-gallbladder). Ithiphu encane, enembile ye-scalpel ye-ultrasonic ingafakwa ngokusebenzisa amachweba amancane we-laparoscopic. Ingakwazi ukuhlinza kahle i-gallbladder ezicutshini ezizungezile kuyilapho inciphisa ukopha. Ikhono lokubopha imithambo yegazi emincane ngesikhathi sokusikwa libalulekile kulokhu kuhlinzwa okuncane - okuhlaselayo, njengoba kusiza ukugcina umbono ocacile kadokotela ohlinzayo, ohlinza ngosizo lwekhamera nezinsimbi ezinemiphini emide.
· Ekuhlinzweni kwe-laparoscopic colorectal, i-scalpel ye-ultrasonic ingasetshenziswa ukuhlukanisa ikholoni noma i-rectum nezakhiwo eziseduze. Ingakwazi ukusika kahle i-mesentery (izicubu ezinamathisela amathumbu odongeni lwesisu) futhi ivale imithambo yegazi emincane engaphakathi kwayo. Lokhu kunciphisa ingozi yokulahlekelwa igazi kanye nokulimala okungaba khona ezithweni eziseduze njengesinye noma i-ureters.
1. Ukuhlinzwa Kwesifuba
· Ekuhlinzweni kwamaphaphu, i-scalpel ye-ultrasonic idlala indima ebalulekile. Lapho kwenziwa i- pulmonary lobectomy (ukususwa kwe-lobe yamaphaphu), i-scalpel ye-ultrasonic ingasetshenziswa ukuhlinza izicubu zamaphaphu futhi kuvalwe imithambo yegazi emincane endaweni. Ukulimala okulinganiselwe okushisayo kwe-scalpel ye-ultrasonic kunenzuzo ekulondolozeni umsebenzi wezicubu zamaphaphu ezisele. Isibonelo, ezimeni lapho isiguli sinesifo samaphaphu esingaphansi kanye nokusebenza kwamaphaphu asele kudingeka kwandiswe, ukusetshenziswa kwe-scalpel ye-ultrasonic kungasiza ukufeza lo mgomo.
· Ekuhlinzweni kwe-mediastinal, lapho inkundla yokuhlinza ivame ukuba seduze nezakhiwo ezibalulekile njengenhliziyo, imithambo yegazi emikhulu, noqhoqhoqho, ukunemba kwe-ultrasonic scalpel kanye nokusabalala okuncane kokushisa kunenzuzo enkulu. Ingasetshenziselwa ukususa ngokucophelela izimila noma ezinye izilonda ku-mediastinum ngaphandle kokudala umonakalo omkhulu ezakhiweni ezibucayi ezizungezile.
1. Ukuhlinzwa Kwezinzwa
· Ekuhlinzweni kwesimila ebuchosheni, i-ultrasonic scalpel iyithuluzi elibalulekile. Ingasetshenziselwa ukususa izicubu zesimila ngokunembile ngenkathi inciphisa ukulimala kwezicubu ezizungezile ezinempilo ze-neural. Isibonelo, ekukhishweni kwama-gliomas (uhlobo lwesimila ebuchosheni), i-ultrasonic scalpel ingalungiswa ibe izilungiselelo zamandla ezifanele ukuze kuphulwe amaseli esimila ngokusebenzisa i-cavitation nokudlidliza komshini. Ukushisa okukhiqizwayo kusetshenziselwa ukubopha imithambo yegazi emincane engaphakathi kwesimila, kunciphise ukopha ngesikhathi sokuhlinzwa. Lokhu kubalulekile njengoba noma imuphi umonakalo esicutshini sobuchopho obunempilo ungaholela ekushoda okukhulu kwemizwa.
· Ekuhlinzweni komgogodla, i-scalpel ye-ultrasonic ingasetshenziswa ukuhlukanisa izicubu ezithambile ezizungeze umgogodla, njengemisipha nemigqa, ngokunemba. Uma wenza i-discectomy (ukususwa kwe-disc herniated), i-scalpel ye-ultrasonic ingasetshenziswa ukuze isuse ngokucophelela i-disc material ngaphandle kokudala umonakalo omkhulu ezimpandeni ze-nerve ezizungezile noma intambo yomgogodla.
Izinkambu Ezijwayelekile Zokuhlinza ze-Electrosurgical Unit
1. Ukuhlinzwa Okujwayelekile
· Ekuhlinzweni okuvulekile kwesisu, iyunithi ye-electrosurgical isetshenziswa kakhulu. Isibonelo, ngesikhathi se-gastrectomy (ukususwa kwesisu) noma i-colectomy (ukususwa kwengxenye yekholoni). I-ESU inganqamula ngokushesha izicubu zesisu eziwugqinsi bese ishintshelwa kumodi yokuhlangana ukuze ivale imithambo yegazi emikhulu. Ku-colectomy, i-ESU ingasetshenziselwa ukusika i-colon bese ihlanganisa imithambo yegazi emaphethelweni e-resection ukuvimbela ukopha.
· Ekuhlinzweni kokwelapha i-hernia, i-ESU ingasetshenziswa ukuhlinza isaka le-hernia ezicutshini ezizungezile kanye nokubopha noma yimaphi amaphuzu okopha. Ingase futhi isetshenziselwe ukwenza izimbobo odongeni lwesisu ukuze kubekwe inetha ngesikhathi sezinqubo zokulungisa i-hernia.
1. Ukuhlinzwa Kwepulasitiki Nokwakha Kabusha
· Ezinkambisweni ezifana ne-liposuction, iyunithi yokuhlinzwa kagesi ingasetshenziswa ukubopha imithambo emincane yegazi kuzicubu ze-adipose. Lokhu kusiza ukunciphisa ukopha kwegazi ngesikhathi sokumuncwa amafutha. Ngaphezu kwalokho, ekuhlinzeni kwe-flap yesikhumba, i-ESU ingasetshenziswa ukusika isikhumba nezicubu ezingaphansi ukuze kudaleke i-flap bese kuvala imithambo yegazi ukuqinisekisa ukusebenza kwe-flap.
· Ekuhlinzweni kwepulasitiki yobuso, njenge-rhinoplasty (umsebenzi wekhala) noma izinqubo zokuphakamisa ubuso, i-ESU ingasetshenziselwa ukusika nokulawula ukopha. Amandla okulungisa izilungiselelo zamandla avumela udokotela ohlinzayo ukuthi asebenzise i-ESU kukho kokubili ukusikwa okubucayi ekhaleni noma ebusweni kanye nokuhlanganisa imithambo yegazi emincane endaweni.
1. I-Obstetrics kanye ne-Gynecology
· Lapho ukuhlinzwa, i-ESU ingasetshenziswa ukusika ngokushesha izingqimba zezindonga zesisu ukuze ifinyelele esibelethweni. Ngemva kokubeletha umntwana, ingasetshenziswa ukuvala ukusika kwesibeletho kanye nokubopha noma yimaphi amaphuzu okopha esibelethweni kanye nezicubu zesisu.
· Ekuhlinzweni kwezifo zabesifazane okufana ne-hysterectomy (ukususwa kwesibeletho), i-ESU ingasetshenziselwa ukusika imigqa yesibeletho kanye nokubopha imithambo yegazi. Ingasetshenziswa futhi ekuhlinzeni ukwelapha i-uterine fibroids noma ama-ovarian cysts, lapho ingasetshenziswa khona ukususa ukukhula nokulawula ukopha phakathi nenqubo.
Isiphetho
Sengiphetha, i-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical yizinsimbi ezimbili ezibalulekile zokuhlinza ezinezici ezihlukile. Ukukhetha phakathi kwe-ultrasonic scalpel kanye neyunithi yokuhlinzwa kagesi kuncike ezidingweni ezithile zenqubo yokuhlinzwa, uhlobo lwezicubu ezihilelekile, ubukhulu bemithambo yegazi, nolwazi lukadokotela ohlinzayo nalokho akuthandayo. Ngokuqonda umehluko phakathi kwalezi zinsimbi ezimbili, odokotela abahlinzayo bangenza izinqumo ezinolwazi kakhulu, ezingaholela emiphumeleni engcono yokuhlinzwa, ukunciphisa ukuhlukumezeka kwesiguli, kanye nezikhathi zokululama ezithuthukisiwe. Njengoba ubuchwepheshe bokuhlinza buqhubeka nokuvela, kungenzeka ukuthi kokubili i-scalpel ye-ultrasonic kanye neyunithi ye-electrosurgical kuzophinde kucwengwe, kunikeze izinzuzo ezengeziwe ezigulini nakodokotela abahlinzayo ngokufanayo.
