Chaw nres nkoj Layout Thiab Standardized Operation Of Disposable Trocar Sets in Laparoscopic Surgery

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Kev vam meej ntawmlaparoscopickev phais pib nrog kev tsim kom raug ntawm thawj qhov chaw nres nkoj- thiab qhov no yog qhov tseeb thaum lub teeb trocar pov tseg qhia tau tias nws muaj nqis. Txawm hais tias nws yog cholecystectomy, appendectomy, gastrointestinal resection, los yog gynecological myomectomy, cov kws phais yuav tsum tau tsim 2-5 txoj haujlwm ua haujlwm los ntawm phab ntsa plab hnyuv siv cov khoom siv pov tseg. Ntawm cov no, qhov tseem ceeb tshaj plaws "pib chaw nres nkoj" (feem ntau yog 10 hli lossis 12 hli kev soj ntsuam qhov chaw nres nkoj) feem ntau yog nyob ntawm lub plab lossis sab laug sab laug, nrog rau qhov seem yog 5 hli lossis 12 hli auxiliary chaw nres nkoj.

Qhov kev teeb tsa rau plaub yam -chaw nres nkoj laparoscopic cholecystectomy yog raws li nram no: qhov chaw soj ntsuam nyob rau saum toj los yog hauv qab lub umbilicus (10/12 hli trocar); qhov chaw nres nkoj tseem ceeb yog 2-4 cm hauv qab cov txheej txheem xiphoid, me ntsis mus rau sab xis ntawm midline (5 mm lossis 12 mm); Cov chaw nres nkoj ua haujlwm pabcuam tau muab tso rau hauv qab ntawm tus nqi raug nqi raws li nruab nrab -clavicular kab (5 mm) thiab sab laug sab plab (5 mm). Qhov kev ncua deb ntawm cov chaw nres nkoj yuav tsum yog> 8 cm kom tsis txhob "clashing" ntawm cov cuab yeej extracorporeal, thiab qhov kev ncua deb ntawm qhov chaw soj ntsuam mus rau lub hom phiaj ntawm lub cev yuav tsum xyuas kom meej qhov pom qhov tsim nyog rau 30℃lossis 0℃scopes. Rau cov neeg mob rog rog nrog cov phab ntsa plab plab, ncua -ntev (Ntau dua lossis sib npaug li 100 mm) trocar teeb tuaj yeem xaiv tau; Rau cov menyuam yaus lossis cov neeg mob nyias nyias, cov hom luv luv (75 hli) yog siv.

Lub 操作流程 ( txheej txheem ua haujlwm) muab faib ua ob pawg: kaw (Veress pneumoperitoneum method) thiab qhib (Hasson method). Txoj kev kaw yuav tsum xub tsim ib qho pneumoperitoneum dag nrog Veress koob (intra- lub plab siab mus txog 12-14 mmHg). Tom qab paub meej tias rab koob yog qhov raug, ib qho me me (feem ntau 2-3 hli) yog ua. Lub teeb trocar pov tseg, sib sau ua ke nrog obturator, yog nias ntsug (90 degree) tiv thaiv phab ntsa plab. Tus kws phais siv lub thenar eminence txhawm rau txhawm rau qhov kawg ntawm tus kov, nrog rau qhov ntsuas thiab nruab nrab ntiv tes txhawb nqa qhov kawg ntawm cannula. Lub dab teg tig nrog lub siab me ntsis kom maj mam nce mus rau pem hauv ntej- tus yuam sij yog kom nkag siab qhov "muab / tawg qhov kev xav" (qhov kev poob qis hauv kev tawm tsam thaum lub sijhawm nkag mus rau hauv lub peritoneum), tam sim ntawd nres, tshem tawm obturator, paub meej tias cov roj rov qab los ntawm kev xav lossis tshawb xyuas txoj haujlwm los ntawm kev ntxig lub laparoscope, thiab tom qab ntawd kho.

Qhov thib ob thiab thib peb chaw nres nkoj yuav tsum tau punctured nyob rau hauv lub zeem muag ncaj qha nrog lub Scope, zam lub inferior epigastric artery (uas tuaj yeem soj ntsuam nrog transillumination) thiab thaj chaw ntawm kev phais yav dhau los adhesions. Bladeless lossis optical pov tseg trocar teeb pom kev zoo nyob rau theem no: lawv bluntly cais fascial nqaij fibers ntau dua li txiav lawv, txo los ntshav; lub pob tshab obturator tip, 配合 (kev koom tes nrog) 0℃scope, tso cai tiag tiag - lub sij hawm pom kev ntawm kev sib cais ntawm txhua lub plab phab ntsa txheej, txo qhov kev pheej hmoo ntawm dig muag puncture.

Kev ceev faj txog kev siv: Tsis txhob ua nruj rau rauj lub cuab yeej puncture; rau tawv thiab tuab phab ntsa plab, me ntsis thim thiab ces ntsia hlau rau pem hauv ntej; tom qab puncture, tam sim kaw lub hau kaw ntawm cov chaw nres nkoj uas tsis siv los tiv thaiv cov pa tawm; Thaum kawg ntawm cov txheej txheem, ua ntej deflate lub pneumoperitoneum ua ntej tshem tawm cov txheej txheem los tiv thaiv kom txhob decompression sai los ntawm ua rau visceral herniation rau hauv qhov chaw nres nkoj. Standardized lag luam 配合 (sib txuas nrog) siab- cov khoom siv pov tseg zoo trocar tuaj yeem ua tiav thawj zaug - sim puncture ua tau zoo ntawm ntau dua 95% thiab txo qis kev raug mob ntawm cov hlab ntsha thiab plab hnyuv.

Rau cov kws kho mob hauv chav ua haujlwm, npaj cov txheej txheem sib xyaw ua ke ua ntej raws li cov txheej txheem (piv txwv li, 1 × 12 mm + 3 × 5 mm lossis 2 × 12 mm + 2 × 5 mm), tshawb xyuas qhov kev ntseeg siab ntawm lub ntim thiab hnub tas sij hawm, thiab pab tus kws phais hauv kev lees paub qhov airtightness ntawm txhua qhov txuas ntawm cov txheej txheem ua haujlwm tau zoo. rov qab-rau- rov qab phais.