Aiki Haɗin kai a Laparoscopic Total Gastrectomy

Aiki Haɗin kai a Laparoscopic Total Gastrectomy

Abstract, Manufar: Don tattauna haɗin gwiwar aiki da ƙwarewar jinya na laparoscopic total gastrectomy.Hanyoyi An sake nazarin bayanan asibiti na marasa lafiya 11 waɗanda aka yi wa laparoscopic jimlar gastrectomy a baya.Sakamako an sallami marasa lafiya goma sha ɗaya waɗanda aka yi wa laparoscopic jimlar gastrectomy ba tare da wata matsala ba.
Kammalawa: Laparoscopic jimlar gastrectomy yana da ƙarancin rauni, saurin shayewa, ƙarancin zafi da saurin dawowa bayan tiyata ga marasa lafiya.Cancantar aikace-aikacen asibiti.
Mahimman kalmomi laparoscopy;duka gastrectomy;haɗin gwiwar aiki;yankan laparoscopic kusa
Tare da zurfafa tunanin tiyata na zamani mafi ƙarancin ɓarna, an ƙara yin amfani da fasahar laparoscopic a aikin asibiti.Yin tiyatar laparoscopic yana da fa'idodin ƙarancin asarar jini na ciki, ƙarancin zafi bayan tiyata, saurin dawo da aikin gastrointestinal, ɗan gajeren zaman asibiti, ƙarancin tabo na ciki, ƙarancin tasiri akan aikin rigakafi na jiki, da ƙarancin rikitarwa [1].A cikin 'yan shekarun nan, tare da ci gaba da inganta fasaha na laparoscopic, yawancin marasa lafiya da ciwon daji na ciki suna yin magani ta hanyar laparoscopic tiyata.Laparoscopic jimlar gastrectomy yana da wuyar aiki kuma yana buƙatar babban matakin fasaha, kuma yana buƙatar haɗin gwiwa tsakanin likitan fiɗa da ma'aikacin jinya a cikin ɗakin tiyata don tabbatar da kammala aikin.An zaɓi marasa lafiya goma sha ɗaya waɗanda aka yi wa laparoscopic jimlar gastrectomy a asibitinmu daga Maris 2014 zuwa Fabrairu 2015 don bincike, kuma an ba da rahoton haɗin gwiwar aikin jinya kamar haka.
1 Kayayyaki da hanyoyin
1.1 Gabaɗaya majiyyata goma sha ɗaya waɗanda aka yi wa laparoscopic jimlar gastrectomy a asibitinmu daga Maris 2014 zuwa Fabrairu 2015 an zaɓi, ciki har da maza 7 da mata 4, masu shekaru 41-75, tare da matsakaicin shekaru 55.7 shekaru.An tabbatar da ciwon daji na ciki ta hanyar gastroscopy da biopsy pathological kafin a yi aiki a duk marasa lafiya, kuma matakin farko na asibiti shine mataki na farko;akwai tarihin tiyatar ciki na sama ko babban tiyatar ciki a baya.
1.2 Hanyar tiyata Dukan marasa lafiya sun yi laparoscopic radical radical gastrectomy.Dukkanin marasa lafiya an yi musu magani tare da maganin sa barci na gabaɗaya da shigar da bututun tracheal.A karkashin pneumoperitoneum, an rarraba omentum da omentum tare da ultrasonic scalpel da Ligasure don rarraba tasoshin jini na perigastric, da kuma ƙwayoyin lymph da ke kewaye da jijiyar ciki na hagu, artery hepatic, da splenic artery an tsaftace su.An raba ciki da duodenum, ciki da zuciya ta hanyar yankan laparoscopic da na'urar rufewa, ta yadda duk ciki ya kasance kyauta.An daga jejunum kusa da hanji, kuma an yi ɗan ƙaramin buɗewa a cikin kowane ɗayan ciki da jejunum, kuma anastomosis na gefen esophagus-jejunum anastomosis an yi shi tare da yankan laparoscopic da na'urar rufewa, kuma an rufe buɗaɗɗen buɗaɗɗa da jejunum. tare da yankan laparoscopic da na'urar rufewa.Hakanan, ƙarshen jejunum kyauta an daidaita shi zuwa jejunum 40cm nesa da ligament na duodenum.An yi wani yanki na 5cm tsakanin ƙananan bakin bakin aikin xiphoid da igiyar cibiya don cire jikin ciki.An sake gyara samfuran jikin ciki da na ƙwayar lymph kuma an aika da su don bincikar cututtuka.An zubar da kogon peritoneal da salin fluorouracil, kuma an sanya bututun magudanar ruwa don rufe kogon ciki [2].An cire trocar ɗin kuma kowane poke an yi sutured.
1.3 Ziyarar riga-kafi Ziyarci majiyyaci a cikin ɗakin kwana 1 kafin a fara aiki don fahimtar yanayin gaba ɗaya na majiyyaci, duba lamarin, da kuma duba sakamakon gwaje-gwajen gwaje-gwaje daban-daban.Shiga cikin tattaunawar farko a cikin sashen idan ya cancanta, kuma ku yi cikakken shirye-shiryen yin aiki a rana ta biyu.Laparoscopic ciwon daji na ciki har yanzu sabuwar hanyar magani ce, kuma yawancin marasa lafiya ba su da masaniya game da shi kuma suna da shakku game da shi har zuwa wani lokaci.Saboda rashin fahimta, za su damu da tasirin warkewa da amincin aikin, sannan za a sami matsalolin tunani irin su juyayi, damuwa, tsoro har ma da rashin son yin aikin.Kafin tiyata, don kawar da juyayi na majiyyaci da kuma samar da haɗin kai tare da magani, ya zama dole a bayyana aminci da ingancin aikin ga majiyyaci, tare da yin amfani da aikin da aka yi nasara a matsayin misali don inganta lafiyar majiyyaci. amincewar jiyya.Bari marasa lafiya su ci gaba da kwanciyar hankali kuma su ƙarfafa amincewa wajen yaƙar cutar.
1.4 Shirye-shiryen kayan aiki da abubuwa: 1 rana kafin aikin, duba tare da likitan likitancin ko akwai wasu buƙatun kayan aikin tiyata na musamman, ko akwai wani canji a cikin matakan aiki na yau da kullum, da kuma yin shirye-shirye masu dacewa a gaba.Shirya kayan aikin tiyata na laparoscopic akai-akai kuma duba matsayin rigakafin, kuma duba ko ultrasonic scalpel, saka idanu, tushen haske, tushen pneumoperitoneum da sauran kayan aiki sun cika kuma suna da sauƙin amfani.Shirya kuma cikakke iri-iri iri-irilaparoscopic yankan closerskumatubular staplers.Kamar duk sauran ayyukan laparoscopic, laparoscopic total gastrectomy shima yana fuskantar matsalar juyawa zuwa laparotomy, don haka ana buƙatar kayan aikin laparotomy akai-akai.Domin kada ya shafi ci gaban aikin saboda rashin isassun shirye-shirye yayin aikin, ko ma jefa rayuwar mara lafiya cikin hadari.
1.5 Haɗin kai tare da majiyyaci yayin aikin kuma kafa hanyar shiga venous bayan duba bayanan ainihi daidai ne.Bayan taimakon mai maganin sa barci don yin maganin sa barci, sanya majiyyaci a matsayin da ya dace kuma a gyara shi, sanya catheter na fitsari, da kuma gyara bututun lalata gastrointestinal yadda ya kamata.Ma'aikatan jinya na na'urar suna wanke hannayensu minti 20 gaba, kuma suna ƙididdige na'urorin, riguna, allura da sauran abubuwa tare da ma'aikatan aikin jinya.Taimaka wa likitan fida don kashe majiyyaci, kuma yi amfani da rigar kariya mara kyau don ware layin ruwan tabarau, layin tushen haske, da layin wuka na ultrasonic [3].Bincika ko allurar pneumoperitoneum da shugaban aspirator ba su da cikas, daidaita wuka na ultrasonic;taimaka wa likita don kafa pneumoperitoneum, wuce binciken laparoscopic trocar don tabbatar da ciwon daji, sadar da kayan aiki da abubuwan da ake bukata don aikin a cikin lokaci, da kuma taimaka wa likita don lalata kogin ciki a lokacin aikin hayaki na ciki yana tabbatar da fili filin tiyata.A lokacin aikin, ya kamata a aiwatar da dabarun aseptic da ba tare da ƙari ba.Shigar da harsashi mai mahimmanci shine ainihin abin dogara lokacin wucewar laparoscopic yankan kusa, kuma za'a iya mika shi ga mai aiki kawai bayan an tabbatar da samfurin.Rufe ciki kuma duba kayan aikin tiyata, gauze, da alluran suture kuma.
2 sakamako
Babu wani daga cikin marasa lafiya na 11 da ya canza zuwa laparotomy, kuma an kammala dukkan ayyukan a karkashin cikakkiyar laparoscopy.An aika da dukkan marasa lafiya don nazarin ilimin cututtuka, kuma sakamakon ya nuna cewa tsarin TNM na baya-bayan nan na ciwon ciwon daji shine mataki na I. Lokacin aiki shine 3.0 ~ 4.5h, matsakaicin lokaci shine 3.8h;asarar jini yayin aiki shine 100 ~ 220ml, matsakaicin asarar jini shine 160ml, kuma babu ƙarin jini.Dukkanin majiyyatan sun samu sauki sosai kuma an sallame su daga asibiti kwanaki 3 zuwa 5 bayan tiyatar.Duk marasa lafiya ba su da wata matsala kamar zubar da jini na anastomotic, kamuwa da cuta na ciki, kamuwa da cuta, da zubar jini na ciki, kuma aikin tiyata ya gamsu.
3 Tattaunawa
Ciwon daji na ciki yana daya daga cikin ciwace-ciwacen da aka fi sani da shi a kasata.Abin da ya faru na iya kasancewa yana da alaƙa da abubuwa kamar abinci, muhalli, ruhi ko kwayoyin halitta.Yana iya faruwa a kowane bangare na ciki, yana matukar yin barazana ga lafiyar jiki da ta hankali da amincin rayuwar marasa lafiya.A halin yanzu, mafi kyawun magani na asibiti Hanyar har yanzu tiyata ce ta tiyata, amma raunin tiyata na gargajiya yana da girma, kuma wasu tsofaffi marasa lafiya ko waɗanda ke cikin yanayin rashin lafiya sun rasa damar yin tiyata saboda rashin haƙuri [4].A cikin 'yan shekarun nan, tare da ci gaba da ci gaba, haɓakawa da aikace-aikacen fasaha na laparoscopic a cikin aikin asibiti, alamun alamun tiyata sun kara fadada.Nazarin gida da na waje sun tabbatar da cewa tiyatar ciki yana da fa'ida fiye da tiyata na gargajiya wajen maganin ciwon daji na ciki.Amma kuma yana gabatar da ƙarin buƙatu don haɗin gwiwa tsakanin likitan fiɗa da ma'aikacin jinya a cikin ɗakin tiyata.A lokaci guda, ma'aikatan jinya a cikin dakin tiyata ya kamata suyi aiki mai kyau a cikin ziyarar farko da kuma sadarwa tare da marasa lafiya don fahimtar yanayin tunanin mai haƙuri da yanayin jiki.Inganta shirye-shiryen kayan aikin tiyata da ɗakin aiki kafin aikin, don haka ana sanya abubuwan cikin tsari, dacewa da dacewa;a lokacin aikin, kula da fitar da fitsari na mai haƙuri, ƙarar jini, alamun mahimmanci da sauran alamomi;Yi tsinkaya tsarin aiki a gaba, isar da kayan aikin tiyata akan lokaci da daidai, ƙware ka'idodin, amfani da sauƙin kiyaye kayan aikin endoscopic daban-daban, da tabbatar da ingantaccen ci gaba na aikin zuwa mafi girman girma.Matsakaicin aikin aseptic, aiki tare da hankali da aiki shine mabuɗin don tabbatar da ingantaccen aiwatar da aikin.
Don taƙaitawa, laparoscopic jimlar gastrectomy yana da ƙarancin rauni, saurin shayewa, ƙarancin zafi da saurin dawowa bayan tiyata ga marasa lafiya.Cancantar aikace-aikacen asibiti.

nassoshi
[1] Wang Tao, Song Feng, Yin Caixia.Haɗin gwiwar jinya a cikin laparoscopic gastrectomy.Jaridar Sinanci na Nursing, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Aikace-aikacen LigaSure a cikin laparoscopic gastrointestinal tiyata.Jaridar Sinanci na Ƙwararrun Ƙwararrun Ƙwararru, 2004, 4 (6): 493-494.
[3] Xu Min, Deng Zhihong.Haɗin kai na tiyata a cikin laparoscopic yana taimakawa gastrectomy distal.Jaridar Horon Ma'aikatan Jinya, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.Rahoton akan lokuta 150 na cikakken laparoscopic D2 radical gastrectomy don ciwon daji na ciki.Jarida ta Sinawa na tiyatar Endoscopic (Electronic Edition), 2012, 5(4): 36-39.

Source: Baidu Library