https://en.wikipedia.org/wiki/Veress_needle

Qhov tseeb: Tsis muaj ib yam li "ib-angle- ua haujlwm-txhua qhov" Veress koob txhaj tshuaj.

Cov duab kos ntawm qhov ncauj qhov ntswg uas qhia hauv phau ntawv nyeem yog ib txwm zoo huv si thiab ncaj nraim - ib rab koob yog ntxig obliquely, thiab lub plab kab noj hniav dheev qhib. Tab sis qhov tseeb, tib neeg lub cev zoo li no: qee tus neeg muaj cov phab ntsa hauv plab nyias zoo li txheej ntawm daim ntawv ntub dej (lub aorta yuav luag kov lub peritoneum), qee qhov muaj cov roj subcutaneous txog 10 cm tuab (lub umbilicus yog rub tob rau hauv dej hiav txwv rog), thiab qee tus muaj lawv lub plab qhwv nrog cov txheej txheem phais qub dhau los. Kev kho txhua tus nrog tib cov txheej txheem yog muab tus neeg mob txoj kev nyab xeeb rau txoj hmoov zoo.

BMI Stratification: Anatomical Landmarks Hloov nrog lub cev hnyav

➤ Cov neeg mob ib txwm muaj / qis dua (BMI <25)

Kev pheej hmoo tseem ceeb: Cov hlab ntsha loj sib sib zog nqus nyob ze ua ke.

Tsuas yog hauv qab lub umbilicus yog qhov tseeb ntawm qhov chaw ntawm lub plab aorta bifurcation (ntawm kwv yees li qib L4). Hauv cov neeg mob nyias, muaj cov roj retroperitoneal tsawg dua, thiab qhov kev ncua deb ntawm lub aortic bifurcation mus rau sab hauv ntawm lub tsev me nyuam yuav tsuas yog 1-2 cm. Hauv qhov no:

Lub plab phab ntsa yuav tsum tau quab yuam nqa siv lub phuam clamp los tsim kom muaj kev nyab xeeb.

Lub kaum sab xis ntawm rab koob yuav tsum tau teem rau ntawm 45 degrees thiab tilted rau ntawm lub sacrum, tso cai rau txoj kev koob ua raws li "sab hauv arc" ntawm lub dav hlau sagittal, zam cov hlab ntsha sib sib zog nqus hauv nruab nrab.

Nws raug txwv nruj kom ua 90-degree ntsug thrust yam tsis muaj kev nqa - uas yuav yog ib qho luv luv rau lub aorta.

Classic txoj cai: nyias tus neeg mob=nqa siab, kaum sab xis, mus qeeb.

➤ Cov neeg mob hnyav / rog (BMI 25–35+)

Cov kev pheej hmoo tseem ceeb: koob ntev tsis txaus + Cov kab kab sib txawv nyob rau hauv cov rog txheej + Anatomical landmarks "sab" downward.

Kev tshawb fawb qhia tau hais tias raws li BMI nce, txoj hauj lwm ntawm aortic bifurcation txheeb ze rau ntawm lub plab tiag tiag "tsav mus rau" - nyob rau hauv cov poj niam rog rog, lub bifurcation tuaj yeem yog 2-3 cm saum lub dab teg, ua rau cov hlab ntsha muaj kev nyab xeeb qis dua.

Strategy Reversal:

Lub kaum sab xis yog kho kom ze rau 90℃ntsug txoj hauj lwm (kwv yees li 70-90 degree), vim hais tias cov tuab subcutaneous txheej yog ib txwm inclined. Kev txiav kom ntse ntxiv tsuas yog ua rau rab koob "float" hauv cov rog thiab hloov nws txoj kev coj.

Ib qho kev qhia ntev dua ntawm Veress koob (120–150mm) raug xaiv los xyuas kom meej tias nws tuaj yeem nkag mus rau hauv lub plab kab noj hniav tiag tiag es tsis txhob tso tseg rau hauv pre- thaj tsam peritoneal.

Txoj hlab ntaws ntawm qhov ncauj yuav xav tau qhov tob tob tob kom ncav cuag lub ntsej muag fascial.

➤ emaciation heev (emaciation <18)

Qhov no yog ib qho txaus ntshai tshaj plaws subtypes - uas yuav luag tsis muaj roj padding rau cushioning, txoj hnyuv plab tuaj yeem ncaj qha mus rau lub posterior peritoneum.

Nws raug pom zoo kom xav txog Hasson qhib txoj hauv kev los ua lwm txoj hauv kev los yog tsawg kawg los ua qhov kev ntsuam xyuas ultrasound ntawm txoj hnyuv tsis muaj zog ua ntej txiav txim siab.

Kev thim rov qab yuav tsum tau ua kom nruj dua, thiab cov koob txhaj tshuaj yuav tsum yog "kev nce qib" (ib qho me me ntawm kev ntxig → nres → kev xaav → tom qab ntawd ntxig dua).

Yav dhau los Keeb Kwm ntawm Kev phais plab plab: Qhov tsis pom qhov ntxiab ntawm Adhesions

"Kuv tsuas yog yuav ua ib qho me me ntawm lub plab. Puas yog qhov tsis zoo?" - Cov lus no zais ntau yam ntawm cov hnyuv me me perforation.

Txoj cai yog:

Keeb kwm ntawm qis midline incision (qis plab plab cesarean seem, appendectomy, cystectomy) → Qhov tseem ceeb ntawm adhesions hauv qab umbilicus → Muaj kev pheej hmoo ntawm qhov muag tsis pom qhov ncauj Veress puncture.

Keeb kwm ntawm kev phais mob plab sab sauv (ib feem ntawm lub plab, cholecystectomy ntawm sab sauv nruab nrab) → txaus ntshai nyob rau hauv cheeb tsam saum lub umbilicus.

Teb cov tswv yim:

Palmer txoj kev mus kom ze: Nyob ntawm kwv yees li 3 cm hauv qab ntawm qhov nruab nrab ntawm sab laug clavicle, qhov no yog siv los ua lwm qhov chaw puncture, bypassing qhov xav tias midline adhesion cheeb tsam. Lub plab ntawm no yuav tsum tau lees paub tias tsis txhob overly distended (preoperative gastric tube insertion rau decompression).

Lub hauv paus ntsiab lus ntawm kev zam qhov caws pliav yam tsawg kawg 3 cm.

Cov chaw uas tsim nyog yuav tau ua preoperative plab plab ultrasound los yog CT los ntsuam xyuas qhov chaw ntawm lub plab phab ntsa adhesions / hernias.

Phau Ntawv Qhia Txog Cov Neeg Tshwj Xeeb Ceev

Kev phais thawj zaug / ib txwm BMI ✅ Tus qauv raws tu qauv 45℃+ nqa + peb -qhib pov thawj Obese (BMI> 30) ✅ Ua tau tab sis xav tau koob ntev dua ≈ 90℃ntsug + rab koob ntev + xyuas kom tseeb qhov nkag siab heev emaciated ⚠️ Ceeb toom: ceev faj nqa lossis hloov mus rau Hasson ntau yam kev phais Umbilical Palmer's point los yog Hasson Pregnancy (2nd / 3rd trimester) ❌ Tsis txhob umbilical / midline dig muag puncture → ultrasound- coj lub plab mus kom ze los yog Hasson Loj plab phab ntsa hernia ❌ Hasson los yog directional mus kom deb ntawm lub hernia sac

Complication Spectrum: Paub qhov lawv zoo li ua rau koj tshawb pom lawv ua ntej

Txawm hais tias cov txheej txheem yog qhov tseeb, qhov kev pheej hmoo ntawm qhov tseeb ntawm Veress koob tseem yuav tsum tau kos rau hauv lub siab ntawm txhua tus neeg ua haujlwm:

Vascular raug mob (<0.5% but potentially fatal): The most common type is the inferior epigastric artery (deviating off the midline), iliac vessels (needle angle too steep and too deep), and rare cases involve the aorta/IVC (not pulled out + vertical sharp insertion).

plab hnyuv perforation: Nws feem ntau tshwm sim thaum cov kab mob plab hnyuv ntxwm tau pinned rau txoj kev puncture.

Subcutaneous emphysema: Lub koob taub hau rov qab mus rau hauv qhov chaw preperitoneal / subcutaneous tab sis tsis kuaj pom → txuas ntxiv inflating → gas kis hauv fascial txheej → ntsej muag o, mediastinal emphysema, thiab cuam tshuam nrog qhov cua.

Gas embolism (tsis tshua muaj heev ≈ 1/100,000): Yog tias rab koob nkag mus rau hauv venous ceg thiab xa siab -flow CO₂ → dheev poob rau hauv SpO₂, ETCO₂, thiab circulatory collapse → tam ​​sim ntawd nres cov pa roj, txais yuav sab laug txoj hauj lwm, thiab ua daim carduscitation.