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

Taw qhia

Nyob rau hauv peb tsab xov xwm dhau los, peb tau tham txog plaub txoj kev siv tshuaj tua kab mob me me uas txhua tus kws phais yuav tsum paub. Tam sim no, plaub txoj hauv kev los tsim pneumoperitoneum hauv kev kho mob yog:classic kaw Veress koob txheej txheem, qhib (Hasson) txheej txheem, ncaj qha trocar insertion, thiab optical trocar insertion. Hnub no, peb yuav tsom mus rau thawj thiab feem ntau siv txoj kev - tusVkoob ereskaw txheej txheem.

Txawm hais tias kev tsim pneumoperitoneum tuaj yeem tshwm sim ncaj, nws yog ib qho txuj ci tseem ceeb uas txhua tus kws phais laparoscopic - tshwj xeeb tshaj yog cov pib tshiab - yuav tsum paub meej. Cov kauj ruam no tsis yog qhov pib ntawm tag nrho cov txheej txheem tab sis kuj yog qhov tseem ceeb ntawm kev txiav txim siab ntawm kev ua haujlwm tom ntej.

I. Xaiv qhov chaw Puncture thiab Incision

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, txoj hlab ntaws ntawm qhov ncauj kho nrog me ntsis kom tsis pom qhov caws pliav, muab cov 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 lub kaum sab xis raws li lub cev Habitus

Lub thickness ntawm lub umbilical cov ntaub so ntswg sib txawv heev nyob rau hauv cov neeg mob ntawm txawv qhov ceeb thawj. 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 hlav, 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. Cov Ntsiab Cai thiab Txheej Txheem ntawm Veress Needle Closed Technique

2.1 Design Essence of the Veress Needle

Txij li thaum nws tsim nyob rau hauv 1938 los ntawm Hungarian kws phais János Veress, Veress koob kaw cov txheej txheem tau dhau los ua ib qho ntawm feem ntau siv txoj hauv 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.

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 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:

Paub meej tias stylet lumen yog patent thiab tsis muaj kev cuam tshuam.

Kuaj tias lub caij nplooj ntoos hlav-loaded kev ruaj ntseg mechanism txuas ntxiv thiab thim rov qab.

Tshawb xyuas cov lus qhia cannula rau ib qho kev khoov lossis blunting.

Cov kev kuaj xyuas no tiv thaiv kev txiav txim siab tsis raug ntawm kev siv dag zog thiab txo qhov kev pheej hmoo ntawm iatrogenic raug mob thaum lub sij hawm puncture.

2.3 Cov txheej txheem puncture txheem

Kauj Ruam 1: Kev tu lub Umbilical thiab Disinfection

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 kaus mom 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. Kev lees paub ua tiav nkag mus rau hauv kab noj hniav peritoneal

Qhov no yog qhovcov kauj ruam tseem ceeb tshaj plawsntawm 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 tip yog raug nyob rau hauv lub peritoneal 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:

3.3 Cov xwm txheej tshwj xeeb yuav tsum tau ceev faj

Yog hais tias ob qho tib si pneumoperitoneum siab thiab roj ntws nyob twj ywm nyob rau hauv qis qis nrog tsawg heev mob plab, thiab tom qab tsis suav nrog cov kab mob,Inadvertent insertion ntawm Veress koob mus rau hauv lub hollow viscus (xws li lub plab los yog plob tsis so tswj) los yog ib tug loj hlab ntsha yuav tsum tau xav tias heev.. Qhov no yog ib qho teeb meem tsis tshua muaj tab sis txaus ntshai heev uas yuav tsum tau txais kev lees paub tam sim thiab kev cuam tshuam.

IV. 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, suav nrog txhua qhov tshwm sim txawv txav thiab lawv cov tswv yim tswj kom raug, txhawm rau ua kom muaj kev nyab xeeb thiab kev ntseeg siab hauv kev kho mob.