Cov Txheej Txheem Ua Haujlwm, Kev Tswj Xyuas Kev Ruaj Ntseg, Thiab Kev Saib Xyuas Neeg Mob Rau Cov Ncauj Ncauj Ncauj Ncauj Ncauj

Txawm hais tias kev siv thev naus laus zis sai sai, cov nqaij mos biopsy tseem yog tus txheej txheem cuam tshuam ntawm nws qhov tseem ceeb. Txawm tias koob zoo tshaj plaws tsis tuaj yeem lav tus neeg mob kev nyab xeeb yam tsis muaj cov txheej txheem kev cai thiab kev tswj hwm kev pheej hmoo. Yog li ntawd, tsim kom muaj ib qho kev qhia txog kev coj noj coj ua nyob ib puag ncig ntawm rab koob biopsy yog qhov tseem ceeb.

Cov Txheej Txheem Ua Haujlwm: Kev ua qauv ntawm txhua kauj ruam

1. Pre-Kev Npaj Ua Haujlwm:

• Kev Pom Zoo Qhia:​ Cov kws kho mob yuav tsum tau piav qhia meej txog lub hom phiaj ntawm kev kuaj ntshav biopsy, txheej txheem txheej txheem, muaj teeb meem tshwm sim (piv txwv li, los ntshav, kis kab mob, pneumothorax, mob, tsis txaus sampling yuav tsum tau re- txheej txheem), thiab lwm txoj kev xaiv rau tus neeg mob, tau txais kev tso cai sau ntawv.
• Kev ntsuam xyuas duab:​ Kev tshuaj xyuas ua ntej -kev ua haujlwm ua haujlwm (Ultrasound, CT, MRI) yuav tsum tau txiav txim siab txoj hauv kev zoo tshaj plaws: txoj kev luv tshaj plaws, zam cov qauv tseem ceeb xws li cov hlab ntsha loj, cov hlab ntsha, thiab lub plab zom mov, thiab ua kom muaj kev nyab xeeb txaus.
• Kev npaj tus neeg mob:Anticoagulants thiab antiplatelet agents (xws li, aspirin, clopidogrel, warfarin) yuav tsum tau txiav kom ntev txaus. Coagulation profiles yuav tsum tau kuaj yog tias tsim nyog. Cov tshuaj sedation me me tuaj yeem muab rau cov neeg mob ntxhov siab.

2. Intra- txheej txheem ua haujlwm:

• Cov txheej txheem aseptic:Kev nruj sterile draping yog yuav tsum tau. Cov neeg ua haujlwm yuav tsum hnav hnab looj tes tsis muaj menyuam, lub kaus mom, thiab qhov ncauj qhov ntswg. Cov koob tshuaj biopsy yog siv rau ib zaug xwb - siv; pob kev ncaj ncees yuav tsum raug txheeb xyuas ua ntej qhib.
• Tshuaj loog:Hauv zos infiltration tshuaj loog (1% Lidocaine) yuav tsum tau noj kom txaus, ua tib zoo saib xyuas ntawm daim tawv nqaij, cov ntaub so ntswg subcutaneous, thiab visceral capsules (piv txwv li, daim siab capsule, pleura).
• Puncture Technique:
  • Tib -Pass Technique:Rau cov kab mob ntawm daim tawv nqaij, kev tso ncaj qha tuaj yeem ua tau. Rau cov kab mob sib sib zog nqus, covCov txheej txheem coaxial cannulapom zoo. Lub cannula tau nce mus rau ntawm ntug ntawm qhov txhab, qhov stylet raug tshem tawm, thiab rab phom biopsy tau muab tso rau hauv lub hnab. Qhov no txo ​​qis cov ntaub so ntswg puas thiab tiv thaiv qog hlav los ntawm kev rov punctures.
  • Lub sijhawm ua haujlwm:​ Raws li - lub sijhawm ntsuas kev taw qhia, xyuas kom meej tias rab koob yog nyob hauv nruab nrab ntawm qhov mob ntawm lub hom phiaj thiab tus neeg mob ua tsis taus pa - tuav lub xeev (rau lub ntsws biopsies) ua ntej ua rau lub cuab yeej.
  • Kev tuav pov hwm:Tam sim ntawd muab cov ntaub so ntswg uas tau txais mus rau hauv lub thawv ntim nrog 10% nruab nrab buffered formalin. Rau cov kab lis kev cai microbiology lossis electron microscopy, cov qauv yuav tsum muab tso rau hauv cov raj tsis muaj menyuam lossis cov tshuaj glutaraldehyde, feem. Cov ntaub ntawv tus naj npawb ntawm cov hla thiab cov macroscopic zoo li tus qauv (xws li, ntses- nqaij-xws li, greyish-dawb, hemorrhagic).
• Kev Tshaj Tawm tam sim- txheej txheem:Siv lub zog hauv zos rau hemostasis tsawg kawg 5-10 feeb tom qab tshem koob (15 feeb lossis ntev dua rau cov kab mob vascular zoo li lub siab thiab ob lub raum). Saib xyuas tus neeg mob cov cim tseem ceeb.

Kev tswj hwm kev pheej hmoo: Kev cia siab thiab daws teeb meem

• Hemorrhage:Qhov teeb meem feem ntau. Me me hematomas feem ntau daws spontaneously. Mob hnyav hemoperitoneum lossis hemothorax yuav tsum muaj kev cuam tshuam thaum muaj xwm txheej ceev lossis phais. Cov kev tiv thaiv tseem ceeb suav nrog ua ntej- kev ntsuas kev ua haujlwm coagulation, xaiv cov koob ntsuas qhov tsim nyog, thiab ua kom tsis txhob muaj cov hlab ntsha loj.
• Pneumothorax:Ib qho teeb meem nquag ntawm lub ntsws biopsies. Cov pneumothoraces me me tuaj yeem tswj hwm kev saib xyuas; cov loj yuav tsum tau kaw thoracic kua. Cov tswv yim tiv thaiv suav nrog kev siv coaxial cannulas, xaiv txoj hauv kev uas muaj cov kab mob pleural tuab dua, thiab tua sai sai thaum tus neeg mob ua pa- tuav.
• Kab mob:Cov txheej txheem nruj aseptic yog qhov tseem ceeb. Cov tshuaj tiv thaiv kab mob prophylactic yuav raug txiav txim siab rau cov neeg mob immunocompromised lossis cov neeg muaj kev pheej hmoo siab.
• Needle Tract Seeding:Txawm hais tias qhov tshwm sim tsawg heev (<0.1%), the consequences are severe. The use of a coaxial cannula is the most effective protective measure, as the outer sheath shields the tract from contaminated tumor cells. Avoiding repeated punctures of the same lesion is also critical.
• Mob thiab Vasovagal Reflex:Tsim nyog tshuaj loog hauv zos thiab cov txheej txheem maj mam txo qhov mob. Yog tias pallor, bradycardia, thiab hypotension tshwm sim, tam sim ntawd tso tseg cov txheej txheem, tsa cov ceg qis, thiab muab Atropine raws li xav tau.

Kev Kho Mob: Tib neeg kev sov siab tshaj Technology

• Psychological Support:Cov neeg mob feem ntau muaj kev ntshai heev txog "punctures" thiab "biopsies." Cov neeg ua haujlwm kho mob yuav tsum piav qhia txog cov txheej txheem hauv cov neeg ua haujlwm hauv cov ntsiab lus, qhia lawv tias qhov mob tuaj yeem tswj tau, thiab muab kev sib raug zoo thiab kev lees paub.
• Positioning Comfort:Pab tus neeg mob nyob rau hauv kev xav tias ib qho yooj yim tab sis nkag tau mus rau txoj hauj lwm, siv cov ntaub mos muag rau kev txhawb nqa.
• Tshaj tawm- ua haujlwm ua raws- nce:​ Ua raws li xov tooj hauv 24 teev los kuaj xyuas seb cov ntshav los qeeb, pneumothorax, kub taub hau, lossis lwm yam tsos mob. Qhia cov neeg mob txog cov cim ceeb toom uas xav tau kev kho mob tam sim ntawd.
• Kev Sib Txuas Lus:Thaum muaj cov txiaj ntsig pathology muaj, tus kws kho mob yuav tsum ua siab ntev thiab piav qhia qhov kev tshawb pom rau tus neeg mob, muab cov lus pom meej meej rau cov kauj ruam tom ntej. Txawm hais tias qhov tshwm sim yog qhov ua tau zoo, yuav tsum tau tsim kom muaj kev ua raws li - txoj kev npaj.

Nyob rau hauv xaus, ib tug zoo heev cov ntaub so ntswg biopsy koob tsuas yog ib tug cuab tam. Kev pov hwm kev nyab xeeb tiag tiag yog los ntawm kev nruj ua ntej- kev npaj ua haujlwm, kev txawj ua haujlwm hauv- txheej txheem kev ua haujlwm, kev ua haujlwm raws sijhawm- kev tswj hwm, thiab kev saib xyuas lub cev thiab lub hlwb rau tus neeg mob. Kev koom ua ke ntawm thev naus laus zis thiab tib neeg txoj kev ntseeg yog qhov tseeb ntawm kev kho mob niaj hnub no.