Ubufatanye bwa Laparoscopic Gastrectomy Yuzuye

Ubufatanye bwa Laparoscopic Gastrectomy Yuzuye

Abstract, Intego: Kuganira ku bufatanye bwimikorere nuburambe bwubuforomo bwa laparoskopi yose gastrectomy.Uburyo Amakuru y’amavuriro y’abarwayi 11 batewe na laparoskopi yose gastrectomie yasesenguwe nyuma.Ibisubizo Abarwayi 11 batewe na laparoskopi gastrectomie yose basohotse nta ngorane zikomeye.
Umwanzuro: Laparoscopic gastrectomy yose ifite ihahamuka rito, umunaniro mwinshi, ububabare buke no gukira vuba nyuma yo kubagwa abarwayi.Birakwiye gukoreshwa mubuvuzi.
Amagambo y'ingenzi laparoscopi;gastrectomy;ubufatanye mu bikorwa;gukata laparoskopi hafi
Hamwe no kurushaho kunoza ibitekerezo bya kijyambere byo kubaga bigezweho, tekinoroji ya laparoskopi yakoreshejwe cyane mubikorwa byubuvuzi.Kubaga Laparoscopique bifite ibyiza byo gutakaza amaraso mu mikorere idahwitse, kubabara nyuma yo kubagwa, gukira vuba imikorere ya gastrointestinal, kumara igihe gito mu bitaro, inkovu nke zo munda, kutagira ingaruka nke ku mikorere y’umubiri y’umubiri, ndetse n’ibibazo bike [1].Mu myaka yashize, hamwe nogukomeza kunoza ikoranabuhanga rya laparoskopi, abarwayi benshi barwaye kanseri yo munda bavurwa no kubaga laparoskopi.Laparoscopic yose gastrectomy iragoye gukora kandi bisaba urwego rwohejuru rwa tekiniki, kandi bisaba ubufatanye bwa hafi hagati yo kubaga numuforomo mubyumba byo kubamo kugirango ibikorwa birangire neza.Abarwayi 11 babazwe na gastrectomie ya laparoskopi yose mu bitaro byacu kuva muri Werurwe 2014 kugeza Gashyantare 2015 batoranijwe kugira ngo babisesengure, kandi havugwa ubufatanye bw'abaforomo mu kubaga ku buryo bukurikira.
1 Ibikoresho nuburyo
1.1 Amakuru rusange Abarwayi 11 batewe na gastrectomie ya laparoskopi yose mu bitaro byacu kuva muri Werurwe 2014 kugeza Gashyantare 2015 batoranijwe, barimo abagabo 7 n’abagore 4, bafite imyaka 41-75, bafite impuzandengo y’imyaka 55.7.Kanseri yo mu gifu yemejwe na gastroscopi na biopsy ya patologi mbere yo kubagwa ku barwayi bose, kandi icyiciro cya mbere cyo kuvura cyari icyiciro cya mbere;habaye amateka yo kubaga inda yo hejuru cyangwa kubagwa munda kera.
1.2 Uburyo bwo kubaga abarwayi bose babazwe na laparoskopi radical gastrectomy.Abarwayi bose bavuwe hamwe na anesthesia rusange hamwe na tracheal intubation.Munsi ya pneumoperitoneum, omentum na omentum byaciwe hamwe na ultrasonic scalpel na Ligasure kugirango bivemo imiyoboro y'amaraso ya perigastricique, kandi imisemburo ya lymph ikikije imitsi yibumoso, imiyoboro y'amaraso, na arteri splenic.Igifu na duodenum, igifu na kardiya byatandukanijwe nigikoresho cyo gukata no gufunga laparoskopi, kuburyo igifu cyose cyari cyuzuye ubusa.Jejunum yazamuwe hafi ya esofagusi, maze hafungurwa akantu gato muri buri esofagusi na jejunum, hanyuma anastomose yo ku ruhande rwa esophagus-jejunum ikorwa hakoreshejwe igikoresho cyo gukata no gufunga laparoskopi, no gufungura esofagusi na jejunum. hamwe na laparoskopi yo gukata no gufunga ibikoresho.Mu buryo nk'ubwo, iherezo ryubusa rya jejunum ryashyizwe kuri jejunum 40cm uvuye kumutwe wa duodenum.Igice cya 5cm cyakozwe hagati yiminwa yo hepfo yimikorere ya xiphoide nu mugozi wo gukuramo umubiri wa gastric.Umubiri wa gastrica na lymph node ingero zarasubitswe kandi zoherejwe kwisuzumisha.Umuyoboro wa peritoneyale washyizwemo saline ya fluorouracil, hanyuma hashyirwaho umuyoboro w'amazi kugira ngo ufunge umwobo w'inda [2].Trocar yakuweho kandi buri poke yarashizweho.
1.3 Gusura mbere yo gusura Sura umurwayi muri ward umunsi 1 mbere yo kubagwa kugirango wumve uko umurwayi ameze muri rusange, asuzume ikibazo, kandi urebe ibyavuye mu bizamini bitandukanye bya laboratoire.Kwitabira ibiganiro bibanziriza ishami nibiba ngombwa, kandi witegure byuzuye kubikorwa kumunsi wa kabiri.Indwara ya kanseri yo mu gifu yitwa Laparoscopique iracyari uburyo bushya bwo kuvura, kandi abarwayi benshi ntibabizi bihagije kandi bafite gushidikanya ku rugero runaka.Bitewe no kutumva neza, bazahangayikishwa ningaruka zo gukiza n’umutekano wibikorwa, hanyuma hazabaho ibibazo bya psychologiya nko guhagarika umutima, guhangayika, ubwoba ndetse no kudashaka kubagwa.Mbere yo kubagwa, kugira ngo umurwayi akureho ubwoba kandi arusheho gufatanya n’ubuvuzi, birakenewe gusobanurira umurwayi umutekano n’akamaro ko kubaga, kandi tugakoresha urugero rwiza nk'urugero kugira ngo umurwayi yumve afite umutekano kandi icyizere cyo kuvura.Reka abarwayi bagumane ibitekerezo byoroheje kandi byubake icyizere cyo kurwanya indwara.
1.4 Gutegura ibikoresho nibikoresho: umunsi 1 mbere yo kubagwa, genzura na muganga ubaga niba hari ibikoresho byihariye bisabwa byo kubaga, niba hari impinduka zahindutse mubikorwa bisanzwe, hanyuma ukore imyiteguro iboneye mbere.Gutegura neza ibikoresho byo kubaga laparoskopi no kugenzura uko byanduye, hanyuma urebe niba ultrasonic scalpel, monitor, isoko yumucyo, isoko ya pneumoperitoneum nibindi bikoresho byuzuye kandi byoroshye gukoresha.Tegura kandi utunganye ubwoko butandukanye bwagukata laparoskopinatubular staplers.Kimwe nibindi bikorwa byose bya laparoskopi, gastrectomy ya laparoskopi yose nayo ihura nikibazo cyo guhinduka muri laparotomie, bityo ibikoresho bya laparotomie bigomba gutegurwa buri gihe.Kugirango udahindura imigendekere yimikorere kubera imyiteguro idahagije mugihe cyo kubaga, cyangwa no guhungabanya ubuzima bwumurwayi.
1.5 Gufatanya numurwayi mugihe cyo kubaga no gushyiraho imiyoboro y'amaraso nyuma yo kugenzura amakuru y'irangamuntu aribyo.Nyuma yo gufasha anesthetiste gukora anesthesia, shyira umurwayi mumwanya ukwiye kandi ubikosore, shyira catheter yinkari, kandi ukosore neza umuyoboro wa gastrointestinal decompression.Abaforomo b'ibikoresho bakaraba intoki iminota 20 mbere, bakabara ibikoresho, imyambarire, inshinge nibindi bintu hamwe nabaforomo bagenda.Fasha umuganga ubaga kwanduza umurwayi, kandi ukoreshe urutoki rudasanzwe rwo kurinda umurongo wa lens, umurongo utanga urumuri, n'umurongo w'icyuma ultrasonic [3].Reba niba urushinge rwa pneumoperitoneum n'umutwe wa aspirator bidakumiriwe, hindura icyuma cya ultrasonic;fasha muganga gushiraho pneumoperitoneum, unyuze mubushakashatsi bwa trocar laparoscopic kugirango wemeze ikibyimba, utange ibikoresho nibikoresho bikenerwa kubagwa mugihe, kandi ufashe muganga guhanagura umwobo winda mugihe cyo kubaga Umwotsi wimbere utanga umurima wo kubaga neza.Mugihe cyo kubaga, tekinike ya aseptic na tumeri igomba gushyirwa mubikorwa.Kwishyiriraho staple cartridge mubyukuri byizewe mugihe unyuze hafi ya laparoskopi ukata hafi, kandi irashobora guhabwa uyikoresha nyuma yicyitegererezo.Funga inda hanyuma urebe ibikoresho byo kubaga, gaze, na inshinge zongeye.
Ibisubizo 2
Nta n'umwe mu barwayi 11 wigeze ahinduka muri laparotomie, kandi ibikorwa byose byarangiye muri laparoskopi yuzuye.Abarwayi bose boherejwe kwisuzumisha indwara, ibisubizo byerekanaga ko TNM nyuma yo kubaga ibibyimba bibi ari icyiciro cya mbere. Igihe cyo kubaga cyari 3.0 ~ 4.5h, impuzandengo yari 3.8h;gutakaza amaraso mugihe cyo kubaga byari 100 ~ 220ml, impuzandengo yo gutakaza amaraso yari 160ml, kandi nta guterwa amaraso.Abarwayi bose bakize neza basohoka mu bitaro nyuma yiminsi 3 kugeza kuri 5 nyuma yo kubagwa.Abarwayi bose nta ngorane bagize nko kumeneka kwa anastomotique, kwandura mu nda, kwandura indwara, no kuva amaraso, kandi ingaruka zo kubaga zari zishimishije.
3 Ikiganiro
Kanseri yo mu gifu ni kimwe mu bibyimba bikunze kugaragara mu gihugu cyanjye.Indwara zayo zishobora kuba zifitanye isano nindyo, ibidukikije, umwuka cyangwa genetiki.Irashobora kugaragara mu gice icyo aricyo cyose cyigifu, ibangamira cyane ubuzima bwumubiri nubwenge ndetse nubuzima bw abarwayi.Kugeza ubu, uburyo bwiza bwo kuvura indwara Ubu buryo buracyari uburyo bwo kubaga, ariko ihahamuka gakondo ryo kubaga ni rinini, kandi abarwayi bamwe na bamwe bageze mu za bukuru cyangwa abafite ubuzima bubi bw'umubiri batakaza amahirwe yo kwivuza kubera kutoroherana [4].Mu myaka yashize, hamwe niterambere rihoraho, kunoza no gukoresha ikoranabuhanga rya laparoskopi mubikorwa byubuvuzi, ibimenyetso byo kubaga byaraguwe cyane.Ubushakashatsi bwakozwe mu gihugu no mu mahanga bwerekanye ko kubaga inda bifite ibyiza byinshi kuruta kubaga gakondo mu kuvura kanseri yo mu nda.Ariko kandi irashyira ahagaragara ibisabwa byisumbuyeho mubufatanye hagati yo kubaga nabaforomo mucyumba cyo kubamo.Muri icyo gihe, abaforomo bo mu cyumba cyo kubamo bagomba gukora akazi keza mu gusura mbere yo gutangira no kuvugana n’abarwayi kugira ngo basobanukirwe n’imitekerereze y’umurwayi n’imiterere y’umubiri.Kunoza imyiteguro yibintu byo kubaga hamwe nicyumba cyo gukoreramo mbere yo kubaga, kugirango ibintu bishyirwe muburyo bwiza, byoroshye kandi mugihe;mugihe cyo kubaga, witegereze neza inkari z'umurwayi zisohoka, ubwinshi bwamaraso, ibimenyetso byingenzi nibindi bipimo;Vuga inzira y'ibikorwa hakiri kare, utange ibikoresho byo kubaga ku gihe kandi neza, umenye amahame, gukoresha no gufata neza ibikoresho bitandukanye bya endoskopi, kandi urebe neza ko ibikorwa bigenda neza.Igikorwa gikomeye cya aseptic, ubufatanye bwitondewe kandi bukora nibikorwa nurufunguzo rwo kwemeza neza imikorere.
Muri make, laparoskopi yose gastrectomie ifite ihahamuka rito, umunaniro mwinshi, ububabare buke no gukira vuba nyuma yo kubagwa abarwayi.Birakwiye gukoreshwa mubuvuzi.

Indanganturo
[1] Wang Tao, Indirimbo Feng, Yin Caixia.Ubufatanye bw'abaforomo muri gastrectomy ya laparoscopique.Ikinyamakuru cyo mu Bushinwa cy’abaforomo, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, n'abandi.Gushyira mu bikorwa LigaSure mu kubaga laparoscopic gastrointestinal.Ikinyamakuru cyo mu Bushinwa cyo Kubaga Byoroheje, 2004, 4 (6): 493-494.
[3] Xu Min, Deng Zhihong.Ubufatanye bwo kubaga muri laparoscopique bwafashije gastrectomy ya kure.Ikinyamakuru cyo guhugura abaforomo, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, n'abandi.Raporo ku bantu 150 barwaye laparoskopi D2 yuzuye ya gastrectomy ya kanseri yo mu gifu.Ikinyamakuru cyo mu Bushinwa cyo kubaga Endoskopi (Edition ya elegitoroniki), 2012, 5 (4): 36-39.

Inkomoko: Isomero rya Baidu