Tsim Cov Pneumoperitoneum Thiab Kaw Veress Needle Technique: Ib Kauj Ruam Standardized -los ntawm - Cov kauj ruam qhia

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

Txheej txheem cej luam

Txawm hais tias cov kev qhia rau gasless laparoscopy tau nthuav dav hauv xyoo tas los no,Feem ntau ntawm cov txheej txheem laparoscopic tseem vam khom rau pneumoperitoneum kom ua tiav qhov kev phais txaus.Hauv gas laparoscopy, kev tsim pneumoperitoneum yog qhovthawj thiab lub hauv paus kauj ruamuas txiav txim siab qhov ua tiav ntawm tag nrho cov haujlwm.

Ua ntej pib pneumoperitoneum, tus kws phais yuav tsum ua kom tiav ob kauj ruam uas tseem ceeb:

Ntsuas ntsuas: Txhua zaus txheeb xyuas tias txhua lub lumens ntawm Veress koob yog patent thiab tias lub caij nplooj ntoos hlav -loaded mechanism ua haujlwm zoo.

Kev ntsuas tus kheej: Tshawb xyuas cov phab ntsa hauv plab-tshwj xeeb yog thaj tsam periumbilical-rau cov caws pliav thiab cov hlab ntsha tsis zoo. Muab cov kev tshawb pom ua ntej ua ultrasound txogplab phab ntsa thickness thiab supra-pubic nrugtxhawm rau txiav txim siab Veress koob'sqhov chaw nkag, kev taw qhia, thiab kwv yees qhov tob.

I. Xaiv qhov chaw Puncture

1.1 Vim li cas Umbilicus yog qhov nyiam tshaj plaws?

Qhov chaw puncture rau pneumoperitoneum feem ntau coincides nrog rau qhov chaw ntawm lubthawj trocar. Lub umbilicus, raws li ib qho caws pliav ntawm lub plab phab ntsa, yog qhov chaw thinnest nrog cov hlab ntsha tsawg tshaj plaws. Nws muaj zoo tsis muaj cov rog subcutaneous lossis cov nqaij leeg, thiab nws cov vascular anatomical network yog sparse. Yog li ntawd, qhov kev pheej hmoo ntawm ob qho tib si intraoperative thiab postoperative los ntshav yog tsawg. Tsis tas li ntawd, ib qho umbilical incision kho nrog me ntsis kom tsis pom caws pliav, muabcov txiaj ntsig zoo nkauj zoo nkauj.

Feem ntau ntawm cov txheej txheem laparoscopic, a10 hli incisionyog ua nyob rau hauvumbilical center los yog me ntsis saum toj no / hauv qab nws.Kev nkag siab zoo ntawm cov txheej txheem ntawm lub cev ntawm qib no yog qhov tseem ceeb rau kev tso chaw nyab xeeb ntawm thawj trocar.

1.2 Kho qhov Insertion Angle Raws li BMI

Qhov tuab ntawm cov ntaub so ntswg ntawm qhov ncauj sib txawv heev ntawm cov neeg mob ntawm qhov sib txawv. Lub Veress koob ntxig lub kaum sab xis yuav tsum tau kho raws li:

1.3 Kev hloov kho ntawm qhov chaw rau cov xwm txheej tshwj xeeb

Kab mob umbilicus los yog tob tob yav tas los caws pliav: Lub puncture yuav tsum tau ua ntawm lubinferior umbilical ntug.

Loj pelvic loj: Yog hais tias lub pelvis nyob los ntawm ib tug loj qog, qhov chaw puncture yuav tsum tau hloovsaum lub umbilicus.

Ntxiv accessory ports: Ob sab subcostal thaj tsam, ob sab iliac fossae, lossis McBurney's point - xaiv tau yooj yim raws li cov txheej txheem phais tshwj xeeb.

Keeb kwm ntawm kev phais plab ua ntej: Raws li txoj cai dav dav, qhov chaw puncture yuav tsum yogNtau dua lossis sib npaug li 3 cm deb ntawm qhov caws pliav qubkom tsis txhob muaj feem cuam tshuam rau lub plab.

II. Tsim Cov Ntsiab Cai thiab Puncture Technique ntawm Veress Needle

2.1 Lub Veress Needle: Ib qho Kev Tsim Qauv Classic Tshaj li yim xyoo caum

Txij li thaum nws tsim nyob rau hauv 1938 los ntawm Hungarian kws phais János Veress, kaw Veress koob txheej txheem tau dhau los ua.ib qho ntawm feem ntau siv txoj kev los tsim pneumoperitoneum.Nws ingenious kev ruaj ntseg tsim muaj xws li:

Blunt-tipped, hollow stylet nrog sab sab -ports: Tso cai rau insufflation, irrigation, thiab aspiration los ntawm lub koob hub; sab- cov chaw nres nkoj kuj tseem pab tau ntau- kev taw qhia ua haujlwm.

Caij nplooj ntoos hlav- loaded kev ruaj ntseg mechanism ntawm lub hauv paus: Thaum muaj kev tiv thaiv thaum lub sij hawm lub plab phab ntsa nkag mus, lub stylet retracts mus rau hauv lub ntse txheej cannula. Thaum lub taub hau cannula ua txhaum lub peritoneum thiab nkag mus rau hauv lub plab kab noj hniav, tsis kam ploj mus thiab lub caij nplooj ntoos hlav xa cov blunt stylet rau pem hauv ntej.Cov txheej txheem no ua tau zoo tiv thaiv lub ntsej muag ntawm lub ntsej muag ntse los ntawm kev ua tsis ncaj ncees rau kev raug mob hauv - plab viscera.

2.2 Yuav tsum tau ua ua ntej-Puncture Checks

Ua ntej txhua qhov kev siv, cov tshev hauv qab no yuav tsum tau ua - ua rau lawv yog ib feem tseem ceeb ntawm koj txoj haujlwm:

2.3 Tus txheej txheem puncture

Kauj Ruam 1: Ntxuav thiab tua kab mob Umbilical

Ua tib zoo ntxuav lub umbilical fossa nrog antiseptic gauze kom tshem tawm cov khib nyiab thiab sebum. Qhov no feem ntau - cov kauj ruam uas tsis tau pom dua yog qhov tseem ceeb rau kev tiv thaiv kab mob tom qab phais.

Kauj Ruam 2: Daim tawv nqaij Incision

Siv cov tawv nqaij forceps los tuav ob sab ntawm lub umbilical ntug, thiab ua a~ 1 cm midline incisionntawm umbilicus siv scalpel.

Kauj Ruam 3: Txhim kho phab ntsa plab

Tshem cov tawv nqaij forceps thiab hloov lawv nrogphuam clamps (Backhaus clamps)siv rau ob sab ntawm daim tawv nqaij ntawm qhov ncauj, rub cephalad. Qhov no ua rau kom qhov kev ncua deb ntawm phab ntsa sab hauv plab thiab lub hauv paus omentum thiab plab hnyuv, txo qhov kev pheej hmoo ntawm kev raug mob.

Kauj Ruam 4: Veress Needle Insertion

Tus kws phais tuav lub koob Veress ntawm sab tes xis thiab ua kom nws maj mam nrog kev sib hloov, txav mus rau phab ntsa plab (los yog ntawm lub kaum sab xis teev saum toj no). Thaum cov koob hla dhau ntawm lub qhov quav ntawm lub qhov quav thiab qhov peritoneum, qhov sib txawv"tsis kam" los yog "pop"yog xav.Tsis txhob nce mus tam sim ntawm qhov no.

Lwm txoj kev siv: Qee tus kws phais neeg nyiam tuav lub plab phab ntsa nrog sab laug tes thiab ncaj qha ntxig Veress rab koob nrog sab tes xis siv lub zog sib tw. Ob txoj kev siv tau; Cov neeg pib tshiab tuaj yeem xaiv qhov uas muab cov lus pom zoo tactile.

III. Lub Hom Phiaj Indicators kom paub meej Veress Needle nkag mus rau hauv kab noj hniav

Qhov no yog qhovcov kauj ruam tseem ceeb tshaj qhov tseebntawm tag nrho cov txheej txheem. Txawm tias thaum tsis muaj kev tiv thaiv, kev pom zoo los ntawm cov hauv qab no yog qhov yuav tsum tau ua.

3.1 Cov Txheej Txheem Kev Pom Zoo

3.2 Advanced Verification Methods (Thaum Poob Qhov Tsis Txaus Siab Tsis Pom Zoo)

❶ Aspiration Test

Txuas ib lub syringe uas muaj cov ntsev ib txwm mus rau Veress koob.

Ua ntej, aspirate: Yog tias tsis muaj ntshav los yog lub plab zom mov rov qab, txhaj 5-10 ml ntawm saline.

Txhais lus:

✅ Smooth txhaj nrog tsis muaj peev xwm ua kom aspirate → koob taub yog raug rau hauv kab noj hniav.

❌ Aspiration rov qab cov ntshav los yog lub plab zom mov → Kev raug mob rau lub plab lossis cov hlab ntsha loj; Kev ntsuas tam sim rau kev hloov pauv mus rau kev phais qhib yuav tsum tau ua.

❌ Heavy los yog pulsatile los ntshav →Kev hloov pauv tam sim rau qhib laparotomy yog qhov yuav tsum tau ua.

❷ Drop Test

Txuas lub syringe chim yam tsis muaj lub plunger rau lub koob hub, los yog tso ob peb tee dej ntsev ncaj qha rau ntawm lub hub. Yog cov kua dejnrawm nrawm rau hauv plablos ntawm qhov tsis zoo siab, lub koob taub yog raug muab tso rau.

❸ Early Insufflation Test - Tus Qauv Kub Txhua tus pib yuav tsum Master

Cov kev ntsuam xyuas saum toj no tsuas yog lees paub nkag mus rau hauv "kab noj hniav," tab sistsis tuaj yeem paub meej tias qhov kab noj hniav no yog kab noj hniav peritoneal(nws tuaj yeem yog qhov chaw intermuscular lossis preperitoneal). Qhov kev ntsuam xyuas thaum ntxov insufflation muab qhov kev lees paub zaum kawg:

Txuas lub insufflation tubing thiab teeb tsa kev nyab xeeb siab txwv.

Pib insufflation ntawm aTsawg ntws tus nqi ntawm 1 L / min.

Ua tib zoo saib xyuas qhov sib xyaw ntawm cov ntawv nyeem siab thiab ntws:

IV. Insufflation Parameter Settings thiab Intra-Insufflation Monitoring

4.1 Parameter Chaw ntawm Insufflator

Ua ntej insufflation, cov ntsiab lus tseem ceeb hauv qab no yuav tsum tau preset ntawm lub insufflator:

Daim ntawv tiv thaiv lub cev: Qhov pib qeeb - theem insufflation yog qhov tseem ceeb. Yog hais tias CO₂ dej nyab lub plab kab noj hniav sai heev, ua rau muaj kev nce sai hauv intra- plab hnyuv siab, nws yuav ua rau cov vena cava tsis zoo, txo cov venous rov qab, thiab cuam tshuam rau cov hlab plawv.

4.2 Paub qhov txawv txav thaum lub sij hawm insufflation

Thaum lub sij hawm insufflation, yog lub insufflator nyeem ntawv qhia tau hais tiasintra- plab siab tsis tu ncua tshaj 13 mmHg, qhov no qhia txog qhov muaj peev xwm hauv qab no:

Lub Veress koob sab -chaw nres nkoj yog obstructed los ntawm cov ntaub so ntswg;

Lub taub hau tau hloov txoj hauj lwm (piv txwv li, nias tawm tsam phab ntsa plab lossis kos rau hauv omentum);

Muaj kev cuam tshuam hauv lub insufflation tubing system.

Insufflation yuav tsum tau nres tam sim ntawd, thiab rab koob txoj hauj lwm yuav tsum tau kho los yog re-punctured.

V. Xaus

Cov txheej txheem Veress koob kaw muaj qhov zoo ntawmsimplicity thiab lub sij hawm efficiency, ua nws txoj kev siv dav tshaj plaws los tsim pneumoperitoneum hauv kev phais laparoscopic. Txawm li cas los, nws inherent drawback yog lub peev xwm raudig muag puncture-txog kev raug mob rau cov hlab ntsha los yog viscera.​ Yog li ntawd, cov pib tshiab yuav tsum tsim kom muaj kev paub zoo nrog rau tag nrho cov txheej txheem - los ntawm ua ntej- ntsuas ntsuas ntsuas thiab xaiv qhov chaw ntawm tus kheej, mus rau cov txheej txheem kev ntxig, ntau- qhov ntsuas qhov ntsuas qhov ntsuas, thiab qhov tseeb insufflation parameter tswj - txhawm rau ua kom muaj kev nyab xeeb thiab ntseeg siab hauv kev kho mob.