Intwaro ishushe yo kubaga abagore -- Bipolar Forceps

Bipolar electrocoagulation yasohotse kera cane mu 1940. Itandukaniro riri hagati y’ubuhinga bwa bipolar electrocoagulation n’ubuhinga bwa unipolar electrocoagulation ni uko bukuraho umuyagankuba udakora iyo ukoranye n’itako ry’umurwayi, maze bugahuza izo nzira zibiri n’amababa abiri y’igikoresho co gufata amaraso nk’uko bigenda. Ivyo bipande bibiri vy’ivyo bikoresho vy’ugupima birakingirwa. Iyo ikoreshejwe, iyo nkuru ica gusa mu nyama ziri hagati y’imitwe ibiri y’ivyo bikoresho, ku buryo ububasha busabwa bugabanuka cane. Muri rusangi, ikeneye gusa 1 / 4 gushika kuri 1 / 3 y’umuyagankuba w’umubiri umwe. Kubera ubuhinga bwo kubaga umuntu bukoresheje umuyagankuba, ubuhinga bwo kubaga umuntu bukoresheje umuyagankuba ni ngombwa cane mu kubaga umuntu akoresheje ubuhinga bwa laparoscopie. Cokimwe n’ugukora amagi mu mfungurwa zitwa egg ham sandwich, amapinze y’amashanyarazi abiri ni igice gihambaye c’ibikoresho vyo kubaga bikoresheje ubuhinga bwa laparoscopie. Bipolar electrocoagulation ni igikoresho c’ubuhinga bwa none gitera umuriro RF. Ico gice c’umubiri gikorana neza n’umubiri. Ivyo bica hagati y’ibice bibiri vy’umubiri. Ivyo bihimba vy’umubiri bikomeye cane birakwiragira mu buryo bw’imirongo, bikabura amazi mu mitsi y’amaraso iri hagati y’impera zibiri z’ivyo bihimba bibiri, bikaba bihindura ibara ry’umubiri bifitaniye isano n’ico gice c’umubiri kandi ntibibe nk’uruzitiro rugaragara. Kubera ko hagati y’imisaya y’ivyo bikoresho bibiri bifatanya haba uruzitiro, ntibisabwa ko haba igipande c’inyuma. Bipolar forceps mu bisanzwe nta gikorwa co guca, ahanini igikorwa co gutera amaraso. Umuvuduko wo gutera amaraso uragenda buhoro, ariko ingaruka z’uguhagarika amaraso ni izo kwizigirwa. Kubera ko igikorwa caco gifise aho kigarukira gusa hagati y’impembe zibiri z’ivyo bikoresho, nta co gishobora kwonona kandi kigira ico gikoze ku bihimba bikikije, kandi nta co gikora ku bihimba bikikije. Ivyuma bikoreshwa n’umuyagankuba bifise amabara abiri birakora neza kuruta ivyuma bifata amaraso bifise amabara amwe. Ntibikenewe gukoresha isahani y’ibintu bitari vyo. Hagati y’ibikoresho vy’amashanyarazi bifise amabara abiri, habaho uruzitiro, ahantu h’ugusohoka harabereye cane, kandi ivyonona ku ruhande ni bito cane kuruta ivyuma vy’amashanyarazi bifise amabara amwe. Ni vyiza cane ku guhagarika amaraso no gutandukanya utugingo ngengabuzima. Igihe ukoresha ubuhinga bwo guhagarika amaraso, gerageza gutuma ahantu ubagira haguma humye.

Ico ushobora gukoresha: ha ha, reka kuvuga kandi reka kuva amaraso.

Intambwe z'ugukora

1. Ushireko umuriro, ushireko ikirenge, ugishire munsi y’ibirenge vy’uwugikoresha.

2. Inyuma y’ugushiraho ubushobozi bwo kwigerageza, shiraho ubushobozi bwo gusohoka hakurikijwe ibisabwa n’umukoresha n’umukoresha.

3. Huza umurongo w’amashanyarazi y’ibice bibiri.

4. Uhejeje gufata igihimba canke aho amaraso ava, ushire ku nzira kugira ngo amaraso ahagarike kuva, hanyuma urekure iyo nzira.

5. Uhejeje gukoresha, banza uzime umuriro w’umuyagankuba hanyuma ushireko umuyagankuba.

Koresha ubuhinga (ubwa nyuma ku ciyumviro)

1. Ukwirinda gusanzwe ku ndwara y’umutima

1. Hitamwo igikoresho co gufata amabara abiri gibereye n’ububasha bwo gusohoka bwa 30-50w. Bivanye n’imiterere y’ugukora n’imitsi.

2. Gutuma umubiri udatera umubabaro mu gihe ukoresha; Gumana ahantu h’ugukorera hasukuye; Irinde ubushuhe bwinshi bugira ico bukoze ku bihimba n’imibumbe bihambaye bikikije; Gabanya ukwifatanya hagati y’eschar y’imitsi n’ibikoresho vy’ugutera amaraso mu mubiri.

3. Igihe cose c’ugutera amaraso mu mubiri kiri mu masegonda 3, ivyo bikaba bishobora gusubirwamwo incuro nyinshi gushika ingaruka y’ugutera amaraso mu mubiri ishitse. Ugutera amaraso mu bihe bimwe bimwe birakora neza kuruta ugutera amaraso mu gihe c’ugukomeza mu gukingira eschar hagati y’isonga ry’ivyuma n’umubiri.

4. Kura eschar ku gihe ku bipimo bibiri: guhanagura eschar n’igitambaro gitose canke igitambaro kidasanzwe kidashobora gusenyura.

5. Impembe z’ivyo bipolar clamp zitegerezwa kuguma ku ntambwe kanaka kandi ntizishobora gukorana kugira ngo zibe umurongo muto w’amashanyarazi. Gutakaza ubushobozi bwo gutera amaraso.

6. Mu gihe c’ugutera amaraso hafi y’imiterere y’imitsi ihambaye, umuyagankuba usohoka mu gutera amaraso ugomba kuba muto cane kandi igihe kigomba kuba gito.

7. ***** ingingo nyamukuru: amapine y’ibice bibiri amaze gukoreshwa arafise ubushuhe, rero ntabwo akwiye gukoreshwa nk’amapine yo gutandukanya, nk’ugutera imirongo y’amara, kugira ngo umuntu ntakomerekejwe n’ubushuhe bw’umuyagankuba. Ugutwara imishwarara y’umuyagankuba mu bihimba bitandukanye biratandukanye, kandi birasanzwe gukomeretsa amasobe / amara.

2. Kuba imitsi y’amashanyarazi itunganye canke idatunganye ni co kigereranyo co kwihweza mu gihe c’ugukora .

Kunoza ubuhinga bwo gutera amaraso:

(1) inyuma y’aho amaraso akorewe umuyagankuba, ibara ry’imitsi y’amaraso rihinduka riva ku mutuku w’agahama rikaja ku rwera, hanyuma rikaja ku muhondo w’umuhondo w’umuhondo; Uruhome rw’imiyoboro ruracari n’ubushobozi bumwe bumwe bwo guhinduranya.

umutsi w’amaraso uragabanuka, maze umurongo w’umutsi w’amaraso ukaba muto, nk’igice c’umurongo w’intango; Uburebure bw’imitsi y’amaraso ikorana n’umuyagankuba ni incuro 2-4 z’umurongo wayo.

(3) iyo electrocoagulation irangiriye, umutwe w’ico gikoresho co gufata amaraso ntuzokwifatanya n’uruhome rw’umutsi w’amaraso.

(4) inguvu rusangi zo hanze nk’ugukwegwakwegwa, ugukwegwakwegwa canke umuvuduko w’amaraso ntizizotuma umuntu ava amaraso.

Ugukomera kw’amaraso birenze urugero:

ibara ry’imitsi y’amaraso rihinduka riva ku muhondo w’inzobe rikaja ku mwirabura uturitse, kandi uruhome rw’uruzitiro rurakomeye kandi rurasenyuka.

umutsi w’amaraso uragabanuka cane, kandi umurongo wawo uba uri munsi ya 1 / 3 y’uw’intango.

umutwe wa Tong ushobora kwifatanya n’uruhome rw’umuyoboro.

(4) ntishobora kwihanganira akosho gatoyi k’inkomezi zo hanze kandi biroroshe guca ibice no kuva amaraso .

Ugutera amaraso mu mubiri bidahagije:

(1) ibara ry’imitsi y’amaraso rihinduka rikava ku rangi y’umuyugubwe rikaja ku ryera.

(2) umutsi w’amaraso uragabanuka gake, kandi umurongo w’umutsi w’amaraso ntugabanuka cane canke ngo uce waguka ubwo nyene umaze kugabanuka; Canke uburebure bw’imitsi y’umuyagankuba ntibuhagije.

(3) gusubira kuva amaraso kubera inkomezi nkeyi zivuye hanze.

3. Guhagarika amaraso bikoresheje umuyagankuba

Uburyo twakoresheje burashobora gushirwa mu ncamake mu ngingo zitandatu:

(1) uhitemwo umutwe w’ivyuma wagutse (kenshi ni 5mm) n’umuyagankuba mutoyi kugira ngo wirinde umuyagankuba urengeje urugero canke ngo wifatanye hagati y’umutwe w’ivyuma n’uruhome rw’imitsi y’amaraso.

(2) ugutera kw’amaraso mu bihe bimwe bimwe: ntivyoroshe gutuma umuyagankuba utera cane canke ngo ushire hagati y’isonga ry’igikoresho co gufata amaraso n’uruhome rw’imitsi y’amaraso. Igihe cose umuntu akoresheje umuyagankuba, amara nk’amasegonda 3, agasubirwamwo incuro nyinshi gushika ashitse ku rugero rwiza rw’ugutera amaraso mu mubiri.

(3) incremental electrocoagulation: ku mitsi minini, electrocoagulation iragenda buhorobuhoro iva ku mpera y’inyuma ikaja ku mpera y’inyuma, kandi igitigiri c’ugutera amaraso mu bihe bimwe bimwe kiragenda kirushirizaho gushika aho igice c’umuyagankuba c’umutsi w’amaraso wo kure kigira umwijima, maze umutsi w’amaraso uriko urazimira.

(4) uburebure bw’aho umutsi w’amaraso uturirwa buzoshika incuro 2-4 z’umurongo wawo, kandi buzotemwa uko bishoboka kwose. Inyuma y’ugutera umuyagankuba, iyo nyama irashobora gutoberwa n’umunyu usanzwe kugira ngo ntihagire umuyagankuba utera cane canke ngo yononekare kubera ubushuhe bw’umuyagankuba. Kubera uruhome rworoshe n’ubushuhe bwiza bw’imitsi y’imitsi, biroroshe gushika ku gusha no gufunga bihagije mu gihe umuntu akoresheje ubuhinga bwa electrocoagulation busanzwe. Ku rundi ruhande, iyo ivyerekeye electrocoagulation bitamenyekanye neza, biroroshe gusenyuka, kwifatanya n’ugutabura uruhome rw’imitsi.

4. Urubanza ku vyerekeye nimba ubunini bw’isohoka ry’umuyagankuba bubereye:

Inguvu z’ibice bibiri ni 30-50 watts. Amamashini yo mu gihugu n’ayo mu mahanga aratandukanye. Reka tuvyibonere

Iyo electrocoagulation ikorewe ku mutsi ufise umurongo w’imirongo nka 0,5mm hakurikijwe uburyo bwo gukora, Nimba igihe co gutera amaraso mu bihe bimwe bimwe gikenewe kugira ngo umutsi w’amaraso urangire ari amasegonda 1,5-2,5, ubunini bw’umuyagankuba usohoka burabereye; Iyo igihe co gutera amaraso mu mubiri kirenze amasegonda 3 kandi n’ubutungane bwo gutera amaraso mu mitsi butashitse, ububasha budahagije burafatwa.

Debate mu nzego z’inyigisho (ntaco mbona ku vyerekeye bipolar. Ndabinginze mumbabarire ko nambaye imbugita y’umuyagankuba hano)

Ica mbere, iki kibazo gishobora gusubirwamwo n’ingingo yasohowe mu kinyamakuru surgical Endosc vuba: "kwiga inyishu y’umururumba iterwa n’icumu ry’umuyagankuba mu kubaga umuntu akoresheje ubuhinga bwa laparoscopie biciye mu kigeragezo gigenzurwa mu buryo bw’imburakimazi", nk’uko vyerekanwa ku gishushanyo kiri aha hepfo:

Muri iki gitabu, ivyavuye mu gukoresha imbugita y’ubuhinga bwo kubaga mu gihe c’ugukora no kutakoresha biragereranywa, kandi inyishu y’umururumba mu gihe c’ugukora LC iragereranywa kugira ngo haboneke umwanzuro w’ubushakashatsi mu gasandugu gatukura .

Ivyiyumviro vy’umururumba bitewe n’ugukomeretswa n’ugubagwa vyariyongereye cane muri ED (ugucapura kw’amashanyarazi), ahanini IL-6 na TNF-a.

None... Icumu ry’umuyagankuba ry’incuro nyinshi rigira ingaruka mbi ku buzima?

Gustavo n’abandi. Vuba aha yasohoye ingingo muri ico kinyamakuru nyene (surgical Endosc) maze arayibaza, nk’uko vyerekanwa ku gishushanyo gikurikira:

Umwanditsi yavuze ko naho yemeranya n’imyanzuro myinshi yari yarashikirijwe imbere y’aho, hariho ibintu bikwiye gushikirizwa. Ku bijanye n’ukwiyongera gukomeye kw’inyishu y’umururumba, akamaro k’ubuvuzi, ni ukuvuga ingaruka nyazo inyuma y’ukwiyongera kw’ibinyabuzima bita cytokines, ntizidondaguwe muri iki kinyamakuru.

Ku bw’ivyo, umwanditsi yarakoze inyigisho nshasha, akoresheje ubuhinga bwo kubaga LC n’ugukoresha ED mu buryo busanzwe, harimwo no gutera umuriro mu mutsi w’amaraso. Muri iyo nyigisho, abarwayi barenga 2000 babazwe hakurikijwe cane amategeko agenga ikoreshwa rya ED. Nta gukira kwacerewe kwatewe n’ugukomeretswa kw’imitsi y’amaraso n’ingaruka mbi zihuye n’ivyo. Benshi mu barwayi barasezererwa mu masaha 24 bamaze kubagwa ata n’umwe yidoga bidasanzwe y’ukudatekana.

Gustavo yasavye:

Niba ibindi bisobanuro bishobora gutangwa mu gihe c’ikurikira -up RCT, harimwo n’imiterere yihariye y’ikoreshwa rya ED, cane cane ibipimo vy’inguvu n’igihe co gukoresha ubu muri buri nkuru, birashobora gusobanuka nimba ukwiyongera kw’urugero rwa cytokine bifitaniye isano n’inguvu za ED, ahandi ho isano ry’inkomoko hagati y’ivyo bibiri rigoye kwemeza.

Birabereye kumenya ko mu makuru y’umwanditsi w’imbere, abarwayi 2 kuri 51 (nk’ibice 4 kw’ijana) bagize ububabare bw’umutsi w’amaraso inyuma ya LC. Abo barwayi babiri ntibashizwe mu vyo gusesangura amakuru, ariko iki kintu kiratuma tugira amaganya ku bijanye n’ubumenyi abaganga bafise mu bijanye no kubaga. Turavye ko igitigiri c’abakomeretswa n’umutsi w’amaraso rusangi ari (0,3% ~ 0,7%) gusa, igitigiri c’abakomeretswa c’ibice 4% ni hafi incuro zirenga 10.

Ivyo vyerekana ko muri iyi RCT, igice kinini c’ukwiyongera kw’ibihimba vy’umubiri bitera umururumba bishobora guterwa n’inguvu z’ed zirengeje urugero.

None mwebwe mubona gute kandi ni iciyumviro ikihe mushigikiye?

Nimba bikiri bigoye gutandukanya, ndagusavye ukomeze usome kugira ngo ufashe guca urubanza rubereye kuruta .

Muri make, Gustavo abona ko umwanzuro w’imbere y’aho ku bijanye n’ubuhinga bwa electrotome utari wo. Ubuhinga bushasha bwo kubaga umuntu akoresheje umuyagankuba, harimwo uburyo bwo kumenya ivy’umuyagankuba bukora, ubuhinga bwo gutuma imitsi igira inyishu be n’uburyo bwo gukingira imitsi, ntibutuma gusa ubuhinga bwo kubaga umuyagankuba bugira umutekano mwiza, ariko kandi buragaragaza ko uwo mwuga ufise ubuzima bukomeye. Ntidukwiye kubigira amadayimoni, ahubwo dukwiye kubimenyekanisha no kubikoresha mu buryo bubereye, no kubandanya gutegura ubuhinga kugira ngo abarwayi bagire umutekano kandi turonke ingaruka nziza zo kuvura .

Iterambere ry'ubuhinga n'ubuhinga (Ubwenge bw'uruvyaro rushasha)

Ishiramwo gufata, gutera n’ugukata mu kimwe, bikaba bituma bikoreshwa neza, bikaba bitagiramwo amahinyu kandi bikora neza.