Operation Cooperation mu Laparoscopic Total Gastrectomy

Operation Cooperation mu Laparoscopic Total Gastrectomy

Mwachidule, Cholinga: Kukambilana za mgwirizano wa opaleshoni komanso unamwino wa laparoscopic total gastrectomy.Njira Zomwe zachipatala za odwala 11 omwe adachitidwa ndi laparoscopic gastrectomy yonse adawunikidwa mobwerezabwereza.Zotsatira Odwala khumi ndi mmodzi omwe adachitidwa opaleshoni ya laparoscopic yonse adatulutsidwa popanda mavuto aakulu.
Kutsiliza: Laparoscopic total gastrectomy imakhala ndi zowawa zochepa, kutulutsa msanga, kupweteka kochepa komanso kuchira msanga kwa odwala.Zoyenera kugwiritsa ntchito kuchipatala.
mawu ofunika laparoscopy;gastrectomy yonse;mgwirizano wa ntchito;laparoscopy kudula pafupi
Ndi kuzama kwa malingaliro amakono opangira opaleshoni pang'onopang'ono, luso la laparoscopic lakhala likugwiritsidwa ntchito kwambiri pazachipatala.Opaleshoni ya Laparoscopic ili ndi ubwino wochepa magazi, kupweteka kochepa pambuyo pa opaleshoni, kuchira msanga kwa m'mimba, kukhala m'chipatala kwaufupi, kuchepa kwa chilonda cha m'mimba, kuchepa kwa chitetezo cha mthupi, ndi zovuta zochepa [1].M'zaka zaposachedwapa, ndi mosalekeza kusintha luso laparoscopic, odwala ambiri khansa chapamimba amathandizidwa ndi laparoscopic opaleshoni.Laparoscopic total gastrectomy ndi yovuta kugwira ntchito ndipo imafuna luso lapamwamba laukadaulo, ndipo imafuna mgwirizano wapamtima pakati pa dokotala wa opaleshoni ndi namwino m'chipinda chopangira opaleshoni kuti atsimikizire kuti ntchitoyo ikutha bwino.Odwala khumi ndi mmodzi omwe adadwala matenda a laparoscopic okwana gastrectomy m'chipatala chathu kuyambira March 2014 mpaka February 2015 adasankhidwa kuti awunikenso, ndipo mgwirizano wa unamwino wa opaleshoni umanenedwa motere.
1 Zipangizo ndi njira
1.1 Zambiri Odwala khumi ndi mmodzi omwe adachitidwa opaleshoni ya laparoscopic m'chipatala chathu kuyambira March 2014 mpaka February 2015 anasankhidwa, kuphatikizapo amuna 7 ndi akazi 4, a zaka 41-75, omwe ali ndi zaka zapakati pa 55.7.Khansara ya m'mimba inatsimikiziridwa ndi gastroscopy ndi matenda biopsy pamaso opaleshoni onse odwala, ndi preoperative matenda siteji anali siteji I;panali mbiri ya opaleshoni yam'mimba yam'mimba kapena opaleshoni yaikulu ya m'mimba m'mbuyomu.
1.2 Njira ya Opaleshoni Odwala onse anachitidwa laparoscopic radical total gastrectomy.Odwala onse amathandizidwa ndi anesthesia wamba ndi tracheal intubation.Pansi pneumoperitoneum, omentum ndi omentum anali dissected ndi akupanga scalpel ndi Ligasure dissect kunja perigastric mitsempha, ndi zamitsempha kuzungulira kumanzere chapamimba mtsempha, kwa chiwindi mtsempha wamagazi, ndi splenic mtsempha wamagazi anatsukidwa.M'mimba ndi duodenum, m'mimba ndi cardia zidalekanitsidwa ndi chida chodula komanso chotseka cha laparoscopic, kotero kuti m'mimba yonse idakhala yaulere.Jejunamu ananyamulidwa pafupi ndi m’memo, ndipo katseko kakang’ono kanapangidwa mum’mero ndi m’khosi uliwonse, ndipo mbali ya esophagus-jejunum mbali anastomosis inachitidwa ndi chipangizo cha laparoscopic kudula ndi kutseka, ndipo kutsekula kwa m’memo ndi jejuna kunatsekedwa. ndi laparoscopic kudula ndi kutseka chipangizo.Mofananamo, mapeto aulere a jejunum adasinthidwa kukhala jejunum 40cm kutali ndi ligament yoyimitsa ya duodenum.A 5cm incision anapangidwa pakati pa m'munsi pakamwa pa ndondomeko xiphoid ndi umbilical chingwe kuchotsa chapamimba thupi.Matupi a m'mimba ndi ma lymph node adachotsedwa ndikutumizidwa kuti akafufuze.Mphuno ya peritoneal idathiridwa ndi saline ya fluorouracil, ndipo chubu chotulutsa madzi chinayikidwa kuti chitseke pamimba [2].The trocar anachotsedwa ndipo poke aliyense anali sutured.
1.3 Ulendo wopita kuchipatala Pitani kwa wodwala m'chipinda cha 1 tsiku la 1 opaleshoni isanayambe kuti mumvetse momwe wodwalayo alili, kuwunikanso mlanduwo, ndikuwona zotsatira za mayesero osiyanasiyana a labotale.Tengani nawo mbali pazokambirana za preoperative mu dipatimenti ngati kuli kofunikira, ndipo konzekerani mokwanira ntchitoyo tsiku lachiwiri.Kuchotsa khansa ya m'mimba ya Laparoscopic ikadali njira yatsopano yochizira, ndipo odwala ambiri sadziwa mokwanira za izi ndipo amakayikira pamlingo wina.Chifukwa cha kusowa kwa chidziwitso, iwo adzadandaula za zotsatira zochizira ndi chitetezo cha opareshoni, ndiyeno padzakhala mavuto amisala monga mantha, nkhawa, mantha komanso kusafuna kuchitidwa opaleshoni.Opaleshoni isanayambe, kuti athetse mantha a wodwalayo komanso kugwirizana bwino ndi chithandizo, m'pofunika kufotokozera chitetezo ndi mphamvu ya opaleshoni kwa wodwalayo, ndikugwiritsa ntchito opaleshoniyo ngati chitsanzo kuti apititse patsogolo chitetezo cha wodwalayo komanso chitetezo chake. chidaliro chamankhwala.Lolani odwala kukhala omasuka m'maganizo ndikumanga chidaliro polimbana ndi matendawa.
1.4 Kukonzekera kwa zida ndi zinthu: 1 tsiku lisanayambe opaleshoni, fufuzani ndi dokotala ngati pali zofunikira zina zapadera zopangira opaleshoni, ngati pali kusintha kwa machitidwe opangira opaleshoni, ndikukonzekera zofananira pasadakhale.Nthawi zonse konzani zida za opaleshoni ya laparoscopic ndikuyang'ana momwe matendawa alili, ndipo fufuzani ngati akupanga scalpel, polojekiti, gwero la kuwala, gwero la pneumoperitoneum ndi zipangizo zina zonse ndizokwanira komanso zosavuta kugwiritsa ntchito.Konzani ndi angwiro mitundu yosiyanasiyana yalaparoscopic kudula zotsekerandizopangira tubular.Mofanana ndi ntchito zina zonse za laparoscopic, laparoscopic total gastrectomy imakhalanso ndi vuto la kutembenuka kwa laparotomy, kotero zida za laparotomy ziyenera kukonzekera nthawi zonse.Kuti asakhudze kupita patsogolo kwa opaleshoniyo chifukwa chosakwanira kukonzekera panthawi ya opaleshoni, kapena kuyika moyo wa wodwalayo pangozi.
1.5 Gwirizanani ndi wodwalayo panthawi ya opaleshoni ndikukhazikitsa mwayi wopita ku venous mutayang'ana kuti chidziwitso ndi cholondola.Pambuyo pothandiza wogonetsa kuti achite opaleshoni, ikani wodwalayo pamalo oyenera ndikumukonza, ikani catheter ya mkodzo, ndikukonza bwino chubu chochepetsera m'mimba.Anamwino a chipangizochi amasamba m'manja kwa mphindi 20 pasadakhale, ndikuwerengera zida, zovala, singano ndi zinthu zina pamodzi ndi anamwino oyendayenda.Thandizani dokotala wa opaleshoni kuti aphe wodwala matenda, ndipo gwiritsani ntchito dzanja loteteza losabala kuti mulekanitse mzere wa lens, mzere wowunikira, ndi mzere wa mpeni wa ultrasonic [3].Yang'anani ngati singano ya pneumoperitoneum ndi mutu wa aspirator ndizosasokoneza, sinthani mpeni wa akupanga;thandizirani dokotala kuti akhazikitse pneumoperitoneum, kupititsa kafukufuku wa trocar laparoscopic kuti atsimikizire chotupacho, kupereka zida ndi zinthu zofunika kuti opareshoniyo ichitike munthawi yake, ndikuthandizira dokotala kuti achepetse pamimba pamimba pakuchita opaleshoni Utsi wamkati umatsimikizira malo opangira opaleshoni.Panthawi ya opaleshoni, njira za aseptic ndi zotupa zopanda chotupa ziyenera kukhazikitsidwa.Kuyika kwa cartridge yamtengo wapatali kumakhala kodalirika podutsa kudula kwa laparoscopic pafupi, ndipo ikhoza kuperekedwa kwa woyendetsa pokhapokha chitsanzocho chitsimikiziridwa.Tsekani pamimba ndikuyang'ana zida zopangira opaleshoni, gauze, ndi singano za suture kachiwiri.
2 zotsatira
Palibe m'modzi mwa odwala 11 omwe adatembenuzidwa kukhala laparotomy, ndipo ntchito zonse zidamalizidwa pansi pa laparoscopy yonse.Odwala onse anatumizidwa kukayezetsa matenda, ndipo zotsatira zake zinasonyeza kuti postoperative TNM staging ya zotupa zoipa anali siteji I. Nthawi opareshoni anali 3.0 ~ 4.5h, pafupifupi nthawi 3.8h;kutayika kwa magazi panthawi ya opaleshoni kunali 100 ~ 220ml, pafupifupi kutaya magazi kunali 160ml, ndipo kunalibe kuikidwa magazi.Odwala onse adachira bwino ndipo adatulutsidwa m'chipatala patatha masiku atatu mpaka 5 atachitidwa opaleshoni.Odwala onse analibe zovuta monga kutayikira kwa anastomotic, matenda a m'mimba, matenda odulidwa, ndi kutuluka magazi m'mimba, ndipo opaleshoniyo inali yokhutiritsa.
3 Kukambitsirana
Khansara ya m'mimba ndi imodzi mwa zotupa zowopsa kwambiri m'dziko lathu.Zochitika zake zikhoza kukhala zokhudzana ndi zinthu monga zakudya, malo, mzimu kapena majini.Zitha kuchitika mbali iliyonse ya m'mimba, kuopseza kwambiri thanzi la thupi ndi maganizo ndi chitetezo cha moyo wa odwala.Pakalipano, chithandizo chamankhwala chothandiza kwambiri Njirayi ikadali yochotsa opaleshoni, koma kuvulala kwachikale kumakhala kwakukulu, ndipo odwala ena okalamba kapena omwe ali ndi thanzi labwino amataya mwayi wolandira chithandizo cha opaleshoni chifukwa cha kusalolera [4].M'zaka zaposachedwa, ndi chitukuko chosalekeza, kukonza ndi kugwiritsa ntchito luso la laparoscopic pa ntchito yachipatala, zizindikiro za opaleshoni zakulitsidwanso.Maphunziro apakhomo ndi akunja atsimikizira kuti opaleshoni ya m'mimba ili ndi ubwino wambiri kuposa opaleshoni yachikhalidwe pochiza khansa yapamwamba ya m'mimba.Koma imayikanso patsogolo zofunika zapamwamba za mgwirizano pakati pa dokotala wa opaleshoni ndi namwino m'chipinda cha opaleshoni.Panthawi imodzimodziyo, anamwino omwe ali m'chipinda chopangira opaleshoni ayenera kuchita ntchito yabwino paulendo wopita kuchipatala ndikukambirana ndi odwala kuti amvetse momwe wodwalayo alili m'maganizo ndi thupi lake.Kupititsa patsogolo kukonzekera kwa zinthu zopangira opaleshoni ndi chipinda chopangira opaleshoni isanayambe, kuti zinthuzo ziziyikidwa mwadongosolo, zoyenera komanso panthawi yake;pa opareshoni, mosamala kuona wodwalayo mkodzo linanena bungwe, magazi kuchuluka, zizindikiro zofunika ndi zizindikiro zina;Kuneneratu za opareshoni pasadakhale, perekani zida zopangira opaleshoni munthawi yake komanso molondola, dziwani mfundo, kugwiritsa ntchito komanso kukonza kosavuta kwa zida zosiyanasiyana zama endoscopic, ndikuwonetsetsa kuti opaleshoniyo ikuyenda bwino kwambiri.Opaleshoni yolimba ya aseptic, mgwirizano wachangu komanso wogwira ntchito ndiye makiyi owonetsetsa kuti ntchitoyi ichitike bwino.
Mwachidule, laparoscopic total gastrectomy imakhala ndi zowawa zochepa, kutulutsa mwachangu, kupweteka kochepa komanso kuchira msanga kwa odwala.Zoyenera kugwiritsa ntchito kuchipatala.

maumboni
[1] Wang Tao, Song Feng, Yin Caixia.Kugwirizana kwa unamwino mu laparoscopic gastrectomy.Chinese Journal of Nursing, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Kugwiritsa ntchito LigaSure mu opaleshoni ya laparoscopic ya m'mimba.Chinese Journal of Minimally Invasive Surgery, 2004, 4 (6): 493-494.
[3] Xu Min, Deng Zhihong.Kugwirizana kwa opaleshoni mu laparoscopic yothandizira distal gastrectomy.Journal of Nurses Training, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.Lipoti la milandu 150 ya Laparoscopic D2 radical gastrectomy yathunthu ya khansa ya m'mimba.Chinese Journal of Endoscopic Surgery (Electronic Edition), 2012, 5 (4): 36-39.

Gwero: Baidu Library