Tub Rog Kub Kub Rau Gynecological Surgery -- Bipolar Forceps

Bipolar electrocoagulation tau tshwm sim thaum ntxov li xyoo 1940. Qhov sib txawv ntawm bipolar electrocoagulation thiab unipolar electrocoagulation yog tias nws tshem tawm cov electrode tsis raug nyob rau hauv kev sib cuag nrog tus neeg mob lub duav, thiab txuas ob lub electrodes rau ob lub hniav ntawm ib khub ntawm tweezers feem. Ob lub hau ntawm cov tweezers yog insulated. Thaum ua ntawv thov, tam sim no tsuas yog dhau los ntawm cov ntaub so ntswg ntawm ob lub tswv yim ntawm cov tweezers, yog li lub zog yuav tsum tau txo qis heev. Feem ntau, nws tsuas yog xav tau 1/4 rau 1/3 ntawm unipolar electrocoagulation. Nrog txoj kev loj hlob ntawm electrosurgical technology, bipolar electrocoagulation yog qhov tseem ceeb hauv kev phais laparoscopic. Zoo li ua cov qe hauv cov qe nqaij npua, bipolar electrocoagulation forceps yog ib feem tseem ceeb ntawm cov cuab yeej phais laparoscopic. Bipolar electrocoagulation yog lub tshuab hluav taws xob RF tam sim no. Cov bipolar sib cuag zoo nrog cov ntaub so ntswg. Tam sim no hla ntawm cov ncej bipolar. Nws qhov sib sib zog nqus condensation propagates radially, dehydrating thiab solidifying cov hlab ntsha ntawm ob kawg ntawm lub bipolar, denaturing cov ntaub so ntswg thiab tsis tsim ib tug pom tseeb arc. Txij li thaum lub voj voog tsim ntawm lub puab tsaig ntawm cov pliers bipolar, tsis tas yuav tsum muaj lub phaj tsis zoo. Bipolar forceps yeej tsis muaj kev txiav, feem ntau coagulation muaj nuj nqi. Lub coagulation ceev yog qeeb, tab sis cov nyhuv hemostatic yog txhim khu kev qha. Vim tias nws qhov kev ua haujlwm tsuas yog txwv ntawm ob qhov kawg ntawm lub forceps, nws muaj kev puas tsuaj me me thiab cuam tshuam rau cov ntaub so ntswg thiab me ntsis cuam tshuam rau cov ntaub so ntswg. Bipolar electrocoagulation yog qhov tseeb dua li unipolar electrocoagulation. Nws tsis tas yuav siv cov phaj tsis zoo. Lub Circuit Court yog tsim los ntawm bipolar electrodes, qhov chaw paug tawm yog qhov tseeb heev, thiab sab kev puas tsuaj tsawg dua unipolar electrocoagulation. Nws yog qhov tsim nyog rau hemostasis thiab cov ntaub so ntswg sib cais. Thaum siv bipolar hemostasis, sim ua kom lub chaw ua haujlwm qhuav qhuav.

Scope ntawm daim ntawv thov: ha ha, tsis txhob hais lus thiab tsis txhob los ntshav.

Cov kauj ruam ua haujlwm

1. Qhib lub hwj huam mov, txuas lub ko taw pedal thiab muab tso rau hauv qab tus neeg teb xov tooj taw.

2. Tom qab lub hwj chim ntawm tus kheej - kuaj, teeb tsa lub zog tso zis raws li qhov xav tau ntawm tus neeg teb xov tooj thiab tus neeg teb xov tooj.

3. Txuas lub bipolar electrocoagulation kab ntsaws.

4. Tom qab tuav cov ntaub so ntswg lossis los ntshav, tuav lub pedal kom tsis txhob los ntshav, thiab tom qab ntawd tso lub pedal.

5. Tom qab siv, thawj zaug tua tus tswv hloov thiab tom qab ntawd hu rau lub hwj chim ntsaws.

Siv cov txuj ci (thaum kawg rau qhov taw tes)

1. Kev ceev faj txog kev puas siab puas ntsws bipolar

1. Xaiv qhov tsim nyog bipolar clamp thiab tso zis zog ntawm 30-50w. Raws li kev ua haujlwm thiab cov ntaub so ntswg.

2. Khaws cov ntaub so ntswg tsis muaj zog thaum siv; Khaws qhov chaw ua haujlwm kom huv si; Tsis txhob kub siab ua rau cov ntaub so ntswg tseem ceeb nyob ib puag ncig thiab cov qauv; Txo qhov adhesion ntawm cov ntaub so ntswg eschar thiab electrocoagulation forceps.

3. Txhua lub sijhawm electrocoagulation yog nyob rau hauv 3 vib nas this, uas tuaj yeem rov ua dua ntau zaus kom txog thaum cov nyhuv electrocoagulation tiav. Intermittent electrocoagulation yog qhov ua tau zoo dua li txuas ntxiv electrocoagulation hauv kev tiv thaiv eschar ntawm forceps tip thiab cov ntaub so ntswg.

4. Tshem tawm cov eschar rau ntawm lub cev bipolar forceps: so cov eschar nrog cov ntaub ntub dej lossis cov ntaub tshwj xeeb uas tsis yog - puas tsuaj.

5. Lub bipolar clamp xaus yuav tsum khaws cia ntawm ib qho kev ncua deb thiab yuav tsum tsis txhob sib cuag los ua ib qho luv luv tam sim no. Kev poob ntawm electrocoagulation.

6. Thaum lub sij hawm electrocoagulation ze ntawm cov ntaub so ntswg tseem ceeb, cov zis electrocoagulation yuav tsum tsawg li tsawg tau thiab lub sij hawm yuav tsum luv.

7. Cov ntsiab lus tseem ceeb: cov bipolar forceps tom qab siv tau qhov kub thiab txias, yog li lawv yuav tsum tsis txhob siv los ua kev sib cais forceps, xws li ntuav cov hnyuv, kom tsis txhob raug mob electrothermal. Electrothermal radiation conduction nyob rau hauv cov ntaub so ntswg sib txawv, thiab feem ntau urinary / plab hnyuv raug mob.

2. Txawm hais tias cov hlab ntsha electrocoagulation zoo tag nrho los yog tsis yog tus qauv ntawm kev soj ntsuam kev ua haujlwm

Kev txhim kho ntawm electrocoagulation:

(1) tom qab electrocoagulation, xim ntawm cov hlab ntsha hloov ntawm purplish liab mus rau dawb, thiab ces mus rau xim av daj; Cov yeeb nkab phab ntsa tseem tuav tau ib qho yooj yim.

⑵ the blood vessel shrinks, and the diameter of the blood vessel becomes smaller, about half of the original diameter; The length of blood vessel electrocoagulation is 2-4 times its diameter.

(3) Thaum lub electrocoagulation tiav lawm, lub hau tweezers yuav tsis ua raws li cov hlab ntsha phab ntsa.

(4) sab nraud quab yuam xws li traction, attraction lossis ntshav siab yuav tsis ua rau los ntshav.

Tshaj electrocoagulation:

⑴ the color of blood vessels changes from brown yellow to scorched black, and the tube wall is hard and brittle.

⑵ the blood vessel shrinks violently, and the diameter is less than 1 / 3 of the original.

⑶ the Tong tip may adhere to the pipe wall.

(4) Nws tsis tuaj yeem tiv taus qhov cuam tshuam me ntsis ntawm sab nraud quab yuam thiab yooj yim tawg thiab los ntshav

Tsis txaus electrocoagulation:

(1) xim ntawm cov hlab ntsha hloov ntawm ntshav mus rau dawb.

(2) cov hlab ntsha tsis tshua muaj qis, thiab txoj kab uas hla ntawm cov hlab ntsha tsis txo qis lossis nthuav dav tam sim tom qab nws txo qis; Los yog qhov ntev ntawm vascular electrocoagulation tsis txaus.

(3) los ntshav dua vim muaj kev cuam tshuam me ntsis ntawm sab nraud quab yuam.

3. Bipolar electrocoagulation hemostasis

Cov hau kev uas peb tau txais yuav tuaj yeem muab sau ua 6 lub ntsiab lus:

(1) xaiv qhov dav forceps tip (feem ntau yog 5 hli) thiab cov zis electrocoagulation qis kom tsis txhob muaj electrocoagulation ntau dhau los yog adhesion ntawm forceps tip thiab cov hlab ntsha phab ntsa.

(2) intermittent electrocoagulation: Nws tsis yooj yim rau ua kom dhau electrocoagulation lossis adhesion ntawm forceps tip thiab phab ntsa hlab ntsha. Txhua electrocoagulation kav ntev li 3 vib nas this thiab rov qab rau ntau zaus kom txog thaum nws mus txog qhov zoo tshaj plaws ntawm electrocoagulation.

(3) incremental electrocoagulation: rau cov hlab ntsha loj, electrocoagulation maj mam txav los ntawm qhov kawg ntawm qhov kawg mus rau qhov kawg ntawm qhov kawg, thiab tus naj npawb ntawm cov electrocoagulation tsis tu ncua yog maj mam nce mus txog rau thaum electrocoagulation nto ntawm cov hlab ntsha distal yog blackened, thiab cov hlab ntsha raug txiav. ntawm qhov chaw dub.

(4) qhov ntev ntawm cov hlab ntsha cauterization cheeb tsam yuav tsum ncav cuag 2-4 npaug ntawm nws txoj kab uas hla, thiab yuav tsum tau txiav kom deb li deb tau. Tom qab electrocoagulation, cov ntaub so ntswg tuaj yeem wetted nrog ib txwm saline kom tsis txhob muaj hluav taws xob ntau dhau los yog electrothermal puas. Vim lub nyias phab ntsa thiab zoo cua sov permeability ntawm venous hlab ntsha, nws yog ib qho yooj yim mus cuag txaus siab hlawv thiab kaw nyob rau hauv niaj hnub electrocoagulation. Ntawm qhov tod tes, yog tias cov txheej txheem electrocoagulation tsis zoo, nws yooj yim rau tawg, adhesion thiab tsim kua muag ntawm phab ntsa vascular.

4. Kev txiav txim siab seb qhov tso zis loj ntawm electrocoagulation puas tsim nyog:

Kev teeb tsa hluav taws xob bipolar yog 30-50 watts. Cov tshuab hauv tsev thiab txawv teb chaws txawv. Cia peb kawm paub

Thaum electrocoagulation tau ua rau ntawm cov hlab ntsha uas muaj txoj kab uas hla ntawm 0.5 hli raws li kev ua haujlwm niaj hnub, Yog tias lub sijhawm sib txuas ntawm electrocoagulation yuav tsum tau ua tiav ntawm electrocoagulation raj yog 1.5-2.5 vib nas this, qhov loj ntawm electrocoagulation tso zis yog tsim nyog; Yog tias lub sijhawm sib txuas ntawm electrocoagulation ntau dua 3 vib nas this thiab qhov ua tiav ntawm vascular coagulation tsis tau mus txog, lub zog tsis txaus yuav tsum raug txiav txim siab.

Kev sib cav nyob rau hauv lub voj voog kev kawm (Kuv nrhiav tsis tau dab tsi txog bipolar. Thov zam txim rau kuv hnav riam hluav taws xob ntawm no)

Ua ntej, qhov teeb meem no tuaj yeem taug qab mus rau ib tsab xov xwm luam tawm hauv kev phais Endosc tsis ntev los no: "los kawm txog cov lus teb inflammatory tshwm sim los ntawm hluav taws xob riam hauv kev phais laparoscopic los ntawm randomized tswj kev sim", raws li qhia hauv daim duab hauv qab no:

Hauv daim ntawv no, cov txiaj ntsig ntawm kev siv intraoperative thiab tsis siv cov riam electrosurgical yog muab piv, thiab cov lus teb inflammatory thaum lub sij hawm LC yog quantified los kos cov kev tshawb fawb xaus rau hauv lub thawv liab.

Cov tshuaj tiv thaiv kab mob tshwm sim los ntawm kev phais mob tau nce ntau hauv ED (electrotome txiav), feem ntau IL-6 thiab TNF-a.

Yog li ... Cov riam hluav taws xob ntau zaus ua rau muaj kev phom sij rau kev noj qab haus huv?

Gustavo et al. Tsis ntev los no tau luam tawm ib tsab xov xwm hauv tib phau ntawv xov xwm (kev phais Endosc) thiab nug nws, raws li pom hauv daim duab hauv qab no:

Tus kws sau ntawv tau hais tias txawm hais tias nws pom zoo nrog rau feem ntau ntawm cov lus xaus dhau los, tseem muaj cov chaw tsim nyog ntawm kev sib tham. Rau qhov nce ntxiv ntawm cov lus teb inflammatory, qhov tseem ceeb hauv kev kho mob, uas yog, qhov tshwm sim tiag tiag tom qab qhov nce ntawm cytokines, tsis tau piav qhia hauv daim ntawv no.

Yog li ntawd, tus sau tau ua ib txoj kev tshawb fawb tshiab, siv mini laparoscopic phais rau LC thiab niaj hnub siv ED, nrog rau cauterization ntawm gallbladder artery. Hauv txoj kev tshawb no, ntau dua 2000 tus neeg mob tau ua haujlwm nruj raws li ED siv cov lus qhia. Tsis muaj kev kho mob qeeb los ntawm kev raug mob ntawm cov kab mob bile thiab cov kev mob tshwm sim sib xws. Cov neeg mob feem ntau raug tso tawm hauv 24 teev tom qab ua haujlwm yam tsis muaj kev tsis txaus siab tshwj xeeb ntawm qhov tsis xis nyob.

Gustavo tau hais tias:

Yog tias muaj cov ntsiab lus ntxiv tuaj yeem muab tau hauv qhov ua raws yav dhau los- nce RCT, suav nrog cov chaw tshwj xeeb rau kev siv ED, tshwj xeeb tshaj yog lub zog tsis muaj zog thiab lub sijhawm siv tam sim no hauv txhua kis, nws tuaj yeem paub meej tias qhov nce ntawm qib cytokine muaj feem cuam tshuam. rau ED lub zog, txwv tsis pub txoj kev sib raug zoo ntawm ob leeg yog qhov nyuaj los ua pov thawj.

Nws yog ib nqi sau cia hais tias nyob rau hauv lub yav dhau los sau cov ntaub ntawv, 2 ntawm 51 cov neeg mob (kwv yees li 4 feem pua) tsim cov kua tsib raug mob tom qab LC. Ob tus neeg mob no tau raug tshem tawm los ntawm kev txheeb xyuas cov ntaub ntawv, tab sis qhov xwm txheej no ua rau peb txhawj xeeb txog cov kws kho mob kev phais. Txiav txim siab tias qhov tshwm sim ntawm cov kab mob hauv lub cev raug mob tsuas yog (0.3 feem pua ​​0.7 feem pua), qhov raug mob ntawm 4 feem pua ​​yog ze li ntawm 10 npaug.

Qhov no qhia tau hais tias nyob rau hauv no RCT, ib tug loj ib feem ntawm qhov nce ntawm inflammatory cytokines tej zaum yuav tshwm sim los ntawm ntau ed zog.

Koj xav li cas thiab qhov kev pom zoo li cas koj txhawb?

Yog tias nws tseem nyuaj rau qhov txawv, thov nyeem ntxiv los pab koj txiav txim kom raug

Nyob rau hauv luv luv, Gustavo ntseeg hais tias yav dhau los xaus ntawm electrotome technology yog tsis ncaj ncees. Lub tshuab electrosurgical tshiab tam sim no, suav nrog cov khoom siv hluav taws xob tshawb pom, cov ntaub so ntswg teb lub tshuab hluav taws xob thiab vascular sealing system, tsis tsuas yog txhim kho kev nyab xeeb ntawm electrosurgery, tab sis kuj ua pov thawj qhov tseem ceeb ntawm daim teb no. Peb yuav tsum tsis txhob demonize nws, tab sis yuav tsum nrov nws thiab siv nws tsim nyog, thiab txuas ntxiv txhim kho thev naus laus zis kom ntseeg tau tias muaj kev nyab xeeb ntawm cov neeg mob thiab ua tiav cov txiaj ntsig zoo.

Kev nce qib ntawm kev tshawb fawb thiab thev naus laus zis (New Generation Intelligence)

Nws integrates grasping, coagulation thiab txiav rau hauv ib qho, ua rau nws yooj yim dua, raug thiab siv tau zoo.