https://www.laparoscopyhospital.com/v5.htm

Kev siv kom rauglaparoscopic trocarsyog lub hauv paus ntawm kev ua tiav qhov kev phais me me, nrog rau cov kauj ruam tseem ceeb xws li puncture, tsim pneumoperitoneum, thiab ntsuas ntsuas thiab tshem tawm. Cov txheej txheem no xav tau cov kws phais kom muaj kev paub txog lub cev nqaij daim tawv, kev txawj ntse, thiab muaj zog yoog raws.

Cov ntsiab cai rau xaiv qhov chaw Puncture

Kev xaiv ntawm qhov chaw puncture yuav tsum yog raws li kev ntsuam xyuas dav dav ntawm cov txheej txheem phais, hom neeg mob lub cev, keeb kwm kev phais ua ntej, thiab qhov chaw ntawm qhov txhab. Cov chaw puncture feem ntau muaj xws li lub tsev me nyuam, lub plab plab (sab laug thiab sab xis), thiab thaj tsam subxiphoid, uas yuav tsum tsis txhob muaj cov hlab ntsha loj, cov kab mob tseem ceeb, thiab lub qhov quav ntawm lub qhov quav kom txo qis kev pheej hmoo los ntshav, raug mob visceral, thiab incisional hernia. Rau cov neeg mob rog rog, cov poj niam cev xeeb tub, lossis cov neeg uas muaj kev phais plab dhau los, kev hloov kho tus kheej rau qhov chaw puncture yog qhov tsim nyog, thiab cov duab ua ntej xws li ultrasound yuav siv tau thaum xav tau rau qhov tseeb hauv zos.

Tsim "Safety Triangle" thiab Kev Tswj Xyuas Pneumoperitoneum

Qhov pib trocar insertion (feem ntau nyob ib ncig ntawm lub umbilicus) yog cov kauj ruam tseem ceeb tshaj plaws, qhov tseem ceeb tshaj plaws rau kev tsim pneumoperitoneum thiab ua tiav qhov kev phais kom zoo. Cov tswv yim muaj xws li Veress koob txoj kev los yog qhib Hasson mus kom ze. Thaum lub trocar raug muab tso, yuav tsum muaj lub pneumoperitoneum ruaj khov rau kev phais. Lub kaw lus valve ntawm lub trocar (xws li lub valve insufflation thiab sealing valve) tswj qhov sib npaug ntawm cov pa roj carbon dioxide siab (feem ntau yog 12-15 mmHg) thaum tiv thaiv cov pa tawm. Intraoperative saib xyuas ntawm intra- plab hnyuv siab yog tsim nyog; Lub siab tsis txaus ua rau muaj qhov tsis zoo ntawm kev phais mob, thaum lub siab ntau dhau tuaj yeem cuam tshuam txoj kev ua pa thiab cov hlab ntshav.

Ntau-channel Layout thiab Instrument Coordination

Cov txheej txheem laparoscopic nyuaj feem ntau xav tau qhov kev tso kawm ntawm ntau lub trocars teem rau hauv "ua haujlwm daim duab peb sab" configuration. Qhov chaw ntawm lub hauv paus, tus pab, thiab kev soj ntsuam (lub koob yees duab) cov chaw nres nkoj yuav tsum ua raws li lub hauv paus ntsiab lus ntawm daim duab peb sab, kom ntseeg tau tias cov cuab yeej thiab lub koob yees duab raug coj mus rau qhov chaw ntawm qhov txhab kom tsis txhob muaj "chopstick effect," yog li tswj kev ua haujlwm yooj yim thiab raug. Qhov ntau thiab tsawg trocar -feem ntau 5 hli, 10 hli, thiab 12 hli- yuav tsum tau xaiv raws li cov kev qhia tshwj xeeb ntawm cov cuab yeej siv rau kev siv.

Kev Tiv Thaiv thiab Tswj Cov Teeb Meem

Puncture- cuam tshuam txog cov teeb meem yog cov teeb meem tshwm sim thaum txoj kev kawm nkhaus. Kev raug mob ntawm cov hlab ntsha tuaj yeem ua rau retroperitoneal lossis plab phab ntsa hematomas, thaum qhov kev raug mob ntawm lub plab tsis tuaj yeem ua rau muaj qhov tshwm sim loj. Cov kev tiv thaiv muaj xws li kev soj ntsuam ua ntej ua ntej, kev siv kev nyab xeeb- cov khoom siv trocars, kev pom kev ncaj qha rau cov trocar txuas ntxiv tom ntej, thiab ceev faj tswj cov puncture quab yuam thiab kev taw qhia. Thaum muaj teeb meem tshwm sim, kev hloov pauv sai rau kev phais qhib yuav tsum tau ua. Tsis tas li ntawd, trocar tshem tawm los yog dislodgement yog ib qho teeb meem intraoperative nquag; tshiab trocar designs featuring anti-slip barbs zoo daws qhov teeb meem no.

Xaus

Daim ntawv thov ntawm laparoscopic trocars tau hloov zuj zus los ntawm cov khoom siv yooj yim nkag mus rau hauv kev ua haujlwm zoo tshaj plaws nrog ntau yam kev nyab xeeb. Kev paub txog lawv txoj kev siv yog ib kauj ruam tseem ceeb rau cov kws phais mob siv zog kom ncav cuag qhov kawg ntawm cov txheej txheem kev tawm tsam tsawg. Nrog rau qhov tshwm sim ntawm cov thev naus laus zis tshiab xws li kev phais neeg hlau thiab ib leeg -incision laparoscopy, tus qauv tsim thiab kev ua haujlwm ntawm trocars yuav tsis ntseeg mus ntxiv.