Gutpela samting bilong pait bilong operesen bilong ol meri -- Bipolar Forceps

Bipolar electrocoagulation i bin kamap long 1940. Difrens namel long bipolar electrocoagulation na unipolar electrocoagulation em olsem em i save rausim 'invalid electrode' we i pas long hip bilong sikman, na i save konektim tupela 'electrode' i go long tupela 'blade' bilong wanpela 'tweezers'. Tupela 'blade' bilong 'tweezers' i gat insulesen. Taim ol i putim, pawa i save ron tasol long 'tissue' namel long tupela 'tip' bilong 'tweezers', olsem na pawa we i nidim i go daun tru. Planti taim, em i nidim 1 / 4 i go inap 1 / 3 bilong 'unipolar electrocoagulation' tasol. Wantaim divelopmen bilong 'electrosurgical' teknoloji, 'bipolar electrocoagulation' em i bikpela samting long 'laparoscopic surgery'. Olsem wokim ol kiau insait long wanpela sanwis bilong kiau ham, ol 'bipolar electrocoagulation forceps' em i wanpela bikpela samting bilong ol 'laparoskopic surgical' instramen. Bipolar electrocoagulation em i wanpela 'electronic RF current generator'. Bipolar i save pas gut wantaim 'tissue'. Karent i save ron namel long ol 'bipolar pole'. Dip kondensesen bilong en i save go aut long 'radial', na i save rausim wara na mekim ol 'blood vessel' namel long tupela arere bilong 'bipolar' i kamap strong, na i save bagarapim ol 'tissue' na i no save kamapim wanpela 'arc' we i stap ples klia. Long wanem, wanpela 'circuit' i kamap namel long 'jaw' bilong ol 'bipolar pliers', olsem na ol i no nidim wanpela 'negative plate'. Ol 'bipolar forceps' i no gat wok bilong katim, moa yet wok bilong 'coagulation'. Spid bilong 'coagulation' i isi, tasol 'hemostatic effect' em i gutpela. Bikos wok bilong en i stap namel long tupela arere bilong 'forceps' tasol, em i no gat bikpela bagarap na strong long ol 'tissues' klostu na liklik 'influence' long ol 'tissues' i stap klostu. Bipolar electrocoagulation em i moa stret long unipolar electrocoagulation. Em i no nidim long yusim 'negative plate'. Wanpela 'circuit' i kamap namel long ol 'bipolar electrodes', 'discharge area' i stret tru, na bagarap long sait i liklik tru long 'unipolar electrocoagulation'. Em i gutpela moa long 'hemostasis' na 'tissue separation'. Taim yu yusim 'bipolar hemostasis', traim long mekim ples bilong operesen i stap drai.

Skop bilong aplikesen: ha ha, stopim toktok na stopim blut.

Ol step bilong operesen

1. Opim pawa saplai, konektim 'foot pedal' na putim aninit long lek bilong opereta.

2. Bihain long pawa i on self-test, setim autput pawa bihainim ol samting we opereta na opereta i laikim.

3. Konektim 'bipolar electrocoagulation line plug'.

4. Bihain long holim 'tissue' o 'bleeding point', step long pedal long stopim blut, na bihain lusim pedal.

5. Bihain long yusim, pastaim pasim 'host switch' na bihain dailim pawa plag.

Yusim ol skil (long pinis)

1. Ol samting bilong lukautim sik 'bipolar'

1. Yu mas makim gutpela 'bipolar clamp' na 'output power' bilong 30-50w. Folem operesen na ol samting bilong 'tissue'.

2. Larim 'tissue tension' i stap fri taim yu yusim; Kipim operesen fil i stap klin; Noken putim bikpela hat na bagarapim ol bikpela 'tissues' na 'structures' i stap klostu; Daunim pasin bilong pas namel long 'tissue eschar' na 'electrocoagulation forceps'.

3. Olgeta taim bilong 'electrocoagulation' em insait long 3-pela seken, we ol i ken mekim planti taim inap long 'electrocoagulation effect' i kamap. 'Intermittent electrocoagulation' em i gutpela moa long 'continuous electrocoagulation' long stopim 'eschar' namel long 'forceps tip' na 'tissue'.

4. Rausim 'eschar' long 'bipolar forceps' long taim stret: klinim 'eschar' wantaim wetpela 'gauze' o wanpela spesel laplap we i no inap bagarapim.

5. Ol i mas putim ol arere bilong 'bipolar clamp' long wanpela mak na ol i no ken bungim narapela narapela long kamapim sotpela 'current circuit'. Lus bilong 'electrocoagulation'.

6. Long taim bilong 'electrocoagulation' klostu long bikpela 'tissue structure', 'electrocoagulation' autput i mas liklik tru na taim i mas sotpela.

7. ***** ol bikpela samting: ol 'bipolar forceps' bihain long yusim i gat tempereja, olsem na yu no ken yusim olsem 'separation forceps', olsem tromoi ol 'intestinal tubes', bai yu no ken kisim bagarap long 'electrothermal'. 'Electrothermal radiation conduction' insait long ol narapela narapela 'tissues' i narapela narapela, na i save kamapim bagarap long pispis / 'intestinal'.

2. Sapos ol 'electrocoagulation vessels' i gutpela o nogat, dispela em i standet bilong 'intraoperative' obsevesen

Impruvmen bilong 'electrocoagulation':

(1) bihain long 'electrocoagulation', kala bilong ol rop bilong blut i senis long pepol ret i go long wait, na bihain i go long braun yelo; Wol bilong paip i holim yet sampela kain 'flexibility'.

⑵ rop bilong blut i go liklik, na 'diameter' bilong 'diameter' bilong 'blood vessel' i go liklik, inap olsem hap bilong 'diameter' bilong en pastaim; Longpela bilong 'electrocoagulation' bilong ol rop bilong blut em 2-4 taims bilong diamita bilong en.

(3) taim ol i pinisim 'electrocoagulation', het bilong 'tweezers' bai no inap pas long wol bilong ol rop bilong blut.

(4) ol jeneral ekstenel fos olsem 'traction', 'attraction' o 'blood pressure' bai no inap long kamapim blut.

Elektrokoagulesen i go antap tumas:

kala bilong ol rop bilong blut i senis long braunpela yelo i go long blakpela, na wol bilong 'tube' i strong na i bruk bruk.

⑵ rop bilong blut i go liklik tru, na 'diameter' bilong en i liklik long 1 / 3 bilong 'original'.

tip bilong Tong i ken pas long wol bilong paip.

(4) em i no inap long karim liklik strong bilong ausait na em i isi long bruk na blut i ron

I no gat inap 'electrocoagulation':

(1) kala bilong ol rop bilong blut i senis long pepol i go long waitpela.

(2) rop bilong blut i no save go liklik tumas, na 'diameter' bilong 'blood vessel' i no save go daun tumas o i go bikpela hariap bihain long em i go daun; O longpela bilong 'vascular electrocoagulation' i no inap.

(3) blut i ron gen bikos long liklik strong bilong ausait.

3. Bipolar electrocoagulation hemostasis

Ol rot mipela i bihainim i ken kamap long 6-pela poin:

(1) makim wanpela bikpela 'forceps tip' (planti taim 5mm) na liklik 'electrocoagulation' autput bilong abrusim bikpela 'electrocoagulation' o pas namel long 'forceps tip' na wol bilong ol rop bilong blut.

(2) 'intermittent electrocoagulation': em i no isi long kamapim bikpela 'electrocoagulation' o pas namel long 'forceps tip' na 'blood vessel wall'. Olgeta wan wan 'electrocoagulation' i save stap inap 3-pela seken na ol i save mekim planti taim inap long em i kamap long gutpela mak bilong 'electrocoagulation'.

(3) 'incremental electrocoagulation': long ol bikpela 'artery', ol i save muvim 'electrocoagulation' isi isi long 'proximal end' i go long 'distal end', na namba bilong ol 'intermittent electrocoagulation' i save go antap isi isi inap long 'electrocoagulation surface' bilong 'distal blood vessel' i kamap blak, na ol i katim 'blood vessel' long hap we i blak.

(4) longpela bilong hap we 'blood vessel cauterization' i mas kamap 2-4 taims bilong diamita bilong en, na ol i mas katim i go longwe tru. Bihain long 'electrocoagulation', ol i ken wetim 'tissue' wantaim nomol salin bilong abrusim bikpela 'electrocoagulation' o bagarap long 'electrothermal'. Bikos long liklik wol na gutpela hat bilong ol rop bilong blut, em i isi long kisim gutpela paia na pasim aninit long 'electrocoagulation'. Long narapela sait, sapos ol i no save gut long ol 'electrocoagulation' kondisen, em i isi long brukim, pas na bruk bilong 'vascular wall'.

4. Tingting long sapos 'output size' bilong 'electrocoagulation' i stret:

Bipolar pawa seting em 30-50 watts. Ol masin bilong kantri na ol masin bilong narapela kantri i narapela narapela. Yumi ken traim

Taim ol i mekim 'electrocoagulation' long wanpela 'artery' we i gat diamita bilong samting olsem 0.5mm bihainim operesen rutin, Sapos taim bilong 'intermittent electrocoagulation' we i mas kamap long pinisim 'electrocoagulation tube' em 1.5-2.5 seken, orait sais bilong 'electrocoagulation' autput em i stret; Sapos taim bilong 'electrocoagulation' i winim 3-pela seken na ol i no winim 'perfection' bilong 'vascular coagulation', orait ol i mas tingim pawa we i no inap.

Toktok pait insait long ol saveman (mi no inap painim wanpela samting long 'bipolar'. Plis fogivim mi long werim lektrik naip hia)

Namba wan, dispela hevi i ken kamap long wanpela atikol we ol i bin pablisim long 'surgical Endosc' i no long taim i go pinis: "long stadim 'inflammatory response' we i save kamap long 'electric knife' long 'laparoscopic surgery' long rot bilong 'randomized controlled trial'", olsem piksa i soim:

Insait long dispela pepa, ol i skelim ol risal bilong intraoperetiv yusim na non yusim bilong 'electrosurgical' naip, na ol i skelim 'inflammatory response' long taim bilong LC long kisim risets konklusen insait long retpela bokis

Inflametori riaksen we i kamap long 'surgical trauma' i go antap tru long ED (electrotome cutting), moa yet IL-6 na TNF-a.

Olsem na... Hai frikwensi lektrik naip i no gutpela long helt?

Gustavo na ol narapela. I no long taim i go pinis mi bin pablisim wanpela atikol insait long wankain jenol (surgical Endosc) na mi bin askim long en, olsem piksa i soim:

Man i raitim dispela buk i tok maski em i wanbel wantaim planti bilong ol tingting bilong bipo, i gat sampela samting yet we yumi mas toktok long en. Long bikpela inkris bilong 'inflammatory response', ol i no stori long bikpela samting bilong sik, olsem, ol samting we inap kamap bihain long inkris bilong ol 'cytokines', insait long dispela pepa.

Olsem na, man i raitim dispela buk i mekim wanpela nupela stadi, we em i yusim liklik 'laparoscopic' operesen bilong LC na yusim ED oltaim, na tu, kukim 'gallbladder artery'. Insait long dispela stadi, moa long 2000 sikmanmeri i bin kisim operesen bihainim ol 'ED use specifications'. I no gat wanpela 'delay' bilong oraitim sik bikos long bagarap long 'bile duct' na ol narapela hevi bilong en. Planti sikman i bin lusim haus sik insait long 24 aua bihain long operesen na i no gat ol spesel komplen bilong ol i pilim nogut.

Gustavo i tok:

Sapos ol i ken givim moa ditel long RCT bilong bihainim pastaim, na tu ol spesel seting bilong yusim ED, moa yet ol eneji paramita na taim bilong yusim nau long wanwan keis, em i ken klia sapos inkris bilong cytokine level i gat wok long ED eneji, sapos nogat, i hat long pruvim as bilong tupela.

Em i gutpela long luksave olsem insait long data bilong man i bin raitim pastaim, 2-pela long 51 sikman (inap 4%) i kisim bagarap long 'bile duct' bihain long LC. Dispela tupela sikman i no bin stap insait long data analisis, tasol dispela samting i mekim mipela i wari long ekspiriens bilong ol dokta long operesen. Taim yumi tingim olsem mak bilong bagarap long 'common bile duct' em (0.3% ~ 0.7%) tasol, mak bilong bagarap em 4% em klostu moa long 10-pela taim.

Dispela i soim olsem insait long dispela RCT, bikpela hap bilong inkris bilong ol 'inflammatory cytokines' i ken kamap bikos long planti 'ed energy'.

Yu gat wanem tingting na wanem kain tingting yu sapotim?

Sapos em i hat yet long luksave, plis ritim i go het long helpim yu long mekim stretpela tingting

Long sotpela tok, Gustavo i bilip olsem tingting bilong bipo long 'electrotome' teknoloji i no stret. Ol nupela nupela teknoloji bilong 'electrosurgical', we i gat 'active electrode detection system', 'tissue response generator' na 'vascular sealing system', i no helpim tasol sefti bilong 'electrosurgery', tasol tu i soim olsem dispela wok i gat strongpela wok. Yumi no ken tok nogut long en, tasol yumi mas mekim ol manmeri i save long en na yusim gut, na wok long kamapim gutpela teknoloji long lukautim gut ol sikmanmeri na kisim gutpela marasin

Progres bilong saiens na Teknoloji (Nupela Jeneresen Intelejens)

Em i bungim pasin bilong holim, 'coagulation' na katim i kamap wanpela, na dispela i mekim em i isi, stret na gutpela long yusim.