Lub trocar ua haujlwm ua "lub rooj vag" ntawm qhov kev phais me me, thiab nws qhov kev ua tiav zoo yog thawj kauj ruam mus rau kev ua haujlwm du, tab sis nws kuj muaj qhov pheej hmoo. Kev paub txog cov txheej txheem txheej txheem txheej txheem, nkag siab tob txog qhov cuam tshuam ntawm lub cev, thiab ua tau zoo hauv kev tiv thaiv thiab kev tswj hwm yog cov kev kawm yuam kev rau txhua tus kws phais laparoscopic. Los ntawm cov txheej txheem kaw classic (dig muag) tso rau qhov kev nyab xeeb qhib Hasson cov txheej txheem thiab qhov muag pom kev, kev siv thev naus laus zis tau tsom mus rau lub hom phiaj tseem ceeb ntawm kev txo cov teeb meem cuam tshuam.

Insertion Techniques: Evolution los ntawm Dig Muag Puncture rau Direct Visualization

Kaw Txoj Kev (Ntxig tom qab Veress Needle Puncture)Qhov no yog cov txheej txheem tsoos tshaj plaws. Ua ntej, Veress koob yog punctured ntawm lub umbilicus los yog ib qhov chaw predetermined los tsim ib tug pneumoperitoneum, cais lub plab phab ntsa los ntawm lub hauv nruab nrog cev los tsim ib tug operative chaw. Lub Veress koob yog tom qab ntawd thim, thiab thawj trocar (thawj cannula) tau muab tso rau ntawm tib qhov chaw. Raws li qhov muag tsis pom kev, cov kauj ruam no ua rau muaj kev pheej hmoo siab tshaj plaws thiab yuav tsum muaj kev soj ntsuam dav dav thiab cov lus pom zoo los ntawm tus kws phais.

Qhib Txoj Kev (Hasson Technique)Txhawm rau kom tsis txhob muaj kev pheej hmoo ntawm qhov muag tsis pom kev, tshwj xeeb tshaj yog rau cov neeg mob uas muaj kev phais plab ua ntej thiab muaj peev xwm intra-abdominal adhesions, txoj kev qhib muaj kev nyab xeeb zoo dua. Ib qho kev txiav me me yog ua ncaj qha rau ntawm qhov chaw xaiv, nrog cov txheej txheem txiav mus rau peritoneum. Lub blunt-tipped cannula xws li Hasson trocar yog muab tso rau hauv lub plab kab noj hniav raws li kev pom ncaj qha, sutured thiab ruaj ntseg, ua raws li kev sib txuas rau pneumoperitoneum insufflator. Thaum qhov muag tsis pom kev raug zam, txoj kev no yuav siv sij hawm ntev me ntsis thiab koom nrog qhov kev txiav loj me me.

Visual PunctureNrog rau kev siv dav dav ntawm optical trocars, ib txoj hauv kev tshiab los ua ke qhov zoo ntawm ob qho tib si kaw thiab qhib cov tswv yim tau dhau los ua qhov tseem ceeb. Tom qab pneumoperitoneum tsim, pob tshab trocar nruab nrog lub endoscope yog maj mam tig thiab nce mus rau hauv kev pom ncaj qha, nkag mus rau hauv lub plab phab ntsa cov ntaub so ntswg txheej los ntawm txheej kom txog rau thaum nkag mus rau hauv peritoneal kab noj hniav. Muab qhov kev nyab xeeb siab tshaj plaws, txoj kev no maj mam dhau los ua thawj qhov kev xaiv hauv ntau lub chaw phais.

Cov Ntsiab Cai Ua Haujlwm Tseem Ceeb thiab Kev Ntsuas Transillumination

Lub kaum sab xis: Lub trocar feem ntau muab tso rau ntawm phab ntsa hauv plab es tsis yog ntawm oblique lub kaum sab xis, txhawm rau tiv thaiv kev raug mob rau cov hlab ntsha loj hauv retroperitoneal xws li cov hlab ntsha iliac.

quab yuam tswj: Insertion yuav tsum tsis tu ncua, qeeb thiab rotational, nrog rau cov ntaub so ntswg nkag mus rau hauv lub twj paj nruag sharpness los yog blunt dissection quab yuam. Kev siv zog ntau dhau yuav tsum tsis txhob siv. Qhov kev xav ntawm "muab-txoj kev" qhia tias nkag mus rau hauv lub plab kab noj hniav.

Transillumination xeem: Tom qab tso cov thawj kev soj ntsuam trocar thiab tso lub laparoscope, tom qab ua hauj lwm trocars yuav tsum tau muab tso rau hauv lub teeb laparoscopic illumination. Lub plab phab ntsa raug tshuaj xyuas sab nraud kom tsis txhob pom cov hlab ntsha nrog rau cov hlab ntsha tsis zoo ntawm cov hlab ntsha, nrog rau kev sib tsoo ua rau thaj tsam avascular, tiv thaiv kab mob plab phab ntsa vascular.

Common Complications thiab Lawv Tiv Thaiv & Tswj

Txawm hais tias kev txhim kho thev naus laus zis tsis tu ncua, cov teeb meem cuam tshuam txog trocar tseem tshwm sim ntawm qhov xwm txheej ntawm 0.2% -6%. Hom loj yog teev hauv qab no:

Kev raug mob hlab ntsha: Qhov teeb meem loj tshaj plaws thiab muaj feem cuam tshuam txog txoj sia

Kev raug mob ntawm cov hlab ntsha loj: Kev puas tsuaj rau lub plab aorta, inferior vena cava lossis iliac hlab ntsha, feem ntau tshwm sim los ntawm kev sib sib zog nqus tob, lub kaum sab xis lossis lub cev tsis muaj zog. Tam sim ntawd hloov mus rau qhib laparotomy rau hemostasis yog xav tau thaum raug mob.

Lub plab phab ntsa raug mob: Feem ntau feem ntau cuam tshuam nrog cov hlab ntsha epigastric tsis zoo, tiv thaiv tau los ntawm kev sim transillumination. Manifested raws li active los ntshav los ntawm qhov chaw puncture tom qab raug mob, kev tswj muaj xws li sab nraud compression, intra-abdominal electrocoagulation los yog suturing. Lub Foley catheter kuj tseem tuaj yeem muab tso rau ntawm qhov chaw nres nkoj trocar, nrog rau lub zais pa nce thiab sab nraud traction rau compression hemostasis.

Visceral raug mob: Kev puas tsuaj rau lub plab, tso zis, lub siab thiab lwm yam kabmob, feem ntau tshwm sim hauv cov neeg mob uas muaj cov kab mob hauv plab. Cov kev raug mob uas tau txheeb xyuas intraoperatively yuav tsum tau kho tam sim; Kev ncua sij hawm tom qab lub plab hnyuv perforation feem ntau tshwm sim nrog peritonitis thiab yuav tsum tau tshawb xyuas qhov xwm txheej ceev laparotomy.

Trocar Site Hernia (TSH): Protrusion ntawm intra-abdominal ntsiab lus los ntawm fascial defects ntawm trocar ports Loj dua los yog sib npaug li 10 mm inch. Tshaj tawm qhov tshwm sim nyob rau hauv domestic gynecological laparoscopy yog kwv yees li 0.013%, tab sis siab dua nyob rau hauv ib qho chaw nres nkoj laparoscopy. Kev tiv thaiv yog qhov tseem ceeb: cov khaubncaws sab nraud povtseg yuav tsum tau sutured thaum kawg ntawm kev phais rau cov chaw nres nkoj 10 hli lossis loj dua. Blunt-dissection trocars kuj txo cov kev pheej hmoo ntawm hernia los ntawm kev ua kom tsis tu ncua thiab me me fascial defects.

Trocar-site qog seeding: Tsis tshua muaj qhov tseem ceeb hauv kev phais rau cov qog qog nqaij hlav xws li qog noj ntshav ntawm zes qe menyuam thiab mob qog noj ntshav hauv lub gallbladder, tejzaum nws muaj feem cuam tshuam nrog cov khoom siv rov qab ua rau muaj kev sib kis, qog cell aerosolization thiab CO₂ pneumoperitoneum teebmeem. Cov hauv paus ntsiab lus tsis muaj qog nqaij hlav yog qhov tseem ceeb: cov khoom siv qog nqaij hlav yuav tsum tsis txhob rov thim rov qab los ntawm trocars; resected specimens, tshwj xeeb tshaj yog cov qog nqaij hlav, yuav tsum tau muab rho tawm hauv cov hnab ntim khoom es tsis yog ncaj qha ntawm cov chaw nres nkoj trocar.

Cov teeb meem roj av: suav nrog subcutaneous emphysema thiab pneumothorax, feem ntau txuas rau kev tsim pneumoperitoneum tsis tsim nyog tsis yog trocar insertion nws tus kheej.

Xaus

Trocar insertion yog ib qho kev xav tau thiab muaj kev pheej hmoo siab hauv kev phais laparoscopic. Kev siv cov thev naus laus zis tshiab xws li optical trocars tau txhim kho kev nyab xeeb zoo dua. Txawm li cas los xij, txawm tias cov cuab yeej siv hluav taws xob hauv lub xeev tsis tuaj yeem hloov pauv cov kev paub txog anatomical, cov txheej txheem ua haujlwm tau zoo thiab kev paub txog kev tiv thaiv tsis zoo. Ua raws li cov txheej txheem kho mob, ua kom paub ntau hom kev sib tsoo, thiab tswj xyuas kev ceev faj kom tsis txhob muaj kev pheej hmoo yog qhov tseem ceeb kom ntseeg tau tias qhov kev phais mob tsawg kawg nkaus ua tiav qhov kev raug mob tsawg thiab kev nyab xeeb.