Kushanda Kubatana muLaparoscopic Yese Gastrectomy
Abstract, Chinangwa: Kukurukura nezvekushanda kwekushandira pamwe uye ruzivo rwehukoti rwe laparoscopic yakazara gastrectomy.Nzira Iyo data yekiriniki yevarwere ve11 vakawana laparoscopic yakazara gastrectomy yakaongororwa zvakare.Mhedzisiro Varwere gumi nemumwe vakaita laparoscopic yakazara gastrectomy vakaburitswa pasina matambudziko akakomba.
Mhedziso: Laparoscopic yakazara gastrectomy ine kushungurudza kushoma, kukurumidza kupera, kurwadza kushoma uye nekukurumidza postoperative kupora kuvarwere.Yakakodzera kushandiswa kwekliniki.
Akakosha mazwi laparoscopy;zvachose gastrectomy;kushandira pamwe;laparoscopic yekucheka pedyo
Nekudzika kwemaitiro emazuva ano ekuvhiya mashoma anoparadza, tekinoroji yelaparoscopic yave ichishandiswa zvakanyanya mukuita kwekiriniki.Kuvhiyiwa kweLaparoscopic kune zvakanakira kurasika kweropa kushoma, marwadzo mashoma mushure mekuvhiyiwa, kukurumidza kupora kwegastrointestinal basa, kupfupika muchipatara kugara, kushoma kwemudumbu vanga, kuderera kwesimba rekudzivirira kwemuviri, uye mashoma matambudziko [1].Mumakore achangopfuura, nekuenderera mberi kwekuvandudzwa kwelaparoscopic tekinoroji, varwere vakawanda vane kenza yemudumbu vanorapwa nekuvhiyiwa kwelaparoscopic.Laparoscopic yakazara gastrectomy yakaoma kushanda uye inoda hunyanzvi hwepamusoro, uye inoda kudyidzana kwepedyo pakati pechiremba anovhiya nemukoti mukamuri yekuvhiya kuti ave nechokwadi chekupedzwa kwakanaka kwekuvhiya.Varwere gumi nemumwe vakaita laparoscopic yakazara gastrectomy muchipatara chedu kubva munaKurume 2014 kusvika Kukadzi 2015 vakasarudzwa kuti vaongororwe, uye kubatana kwekuvhiya kwekuvhiya kunonzi sezvinotevera.
1 Zvishandiso uye nzira
1.1 General ruzivo Varwere gumi nemumwe vakaita laparoscopic yakazara gastrectomy muchipatara chedu kubva munaKurume 2014 kusvika Kukadzi 2015 vakasarudzwa, kusanganisira varume vanomwe nevakadzi 4, vane makore 41-75, vane avhareji yemakore 55.7.Kenza yemudumbu yakasimbiswa ne gastroscopy uye pathological biopsy isati yavhiyiwa mune varwere vese, uye preoperative kiriniki nhanho yaive nhanho I;pakanga pane nhoroondo yekuvhiyiwa kwepamusoro pedumbu kana kuvhiyiwa kukuru kwedumbu munguva yakapfuura.
1.2 Nzira yekuvhiya Varwere vese vakaita laparoscopic radical total gastrectomy.Varwere vese vaibatwa ne general anesthesia uye tracheal intubation.Pasi pepneumoperitoneum, omentum uye omentum zvakaparadzaniswa ne ultrasonic scalpel uye Ligasure kuti iparadze tsinga dzeropa, uye lymph nodes kumativi ekuruboshwe gastric artery, hepatic artery, uye splenic artery zvakacheneswa.Dumbu uye duodenum, dumbu uye cardia zvakaparadzaniswa ne laparoscopic yekucheka nekuvhara chigadzirwa, kuitira kuti dumbu rose rakanga rakasununguka zvachose.Jejunamu yasimudzwa padhuze negumbo, uye kuvhura kudiki kwakaitwa mune imwe neimwe yegurokuro nejejunum, uye iyo esophagus-jejunum side anastomosis yakaitwa nelaparoscopy yekucheka nekuvhara, uye kuvhura kwegurokuro nejejunum kwakavharwa. ine laparoscopic yekucheka nekuvhara mudziyo.Saizvozvo, iyo yemahara magumo ejejunamu yakagadziriswa kune jejunum 40cm kure neiyo suspensory ligament ye duodenum.A 5cm incision yakaitwa pakati pemuromo wezasi we xiphoid process uye guvhu kubvisa gastric body.Gastric body uye lymph node specimens dzakadzokororwa uye dzakatumirwa kuongororwa pathological.Iyo peritoneal cavity yakagezwa nefluorouracil saline, uye chubhu yemvura yakaiswa kuti ivhare dumbu remudumbu [2].Iyo trocar yakabviswa uye poke imwe neimwe yakashongedzwa.
1.3 Shanyiro yepreoperative Shanyira murwere muwadhi zuva 1 kuvhiyiwa kusati kwaitwa kuti unzwisise mamiriro emurwere, ongorora nyaya yacho, uye tarisa mhedzisiro yekuongororwa kwakasiyana-siyana kwema laboratory.Tora chikamu muhurukuro yepamberi mudhipatimendi kana zvichidikanwa, uye ita gadziriro dzakakwana dzekuvhiya pazuva rechipiri.Laparoscopic gastric cancer resection ichiri nzira nyowani yekurapa, uye varwere vazhinji havazive zvakakwana nezvazvo uye vane kupokana nezvazvo kusvika pamwero wakati.Nekuda kwekusanzwisisa, vanozonetsekana nezve kurapa uye kuchengeteka kwekushanda, uye ipapo pachava nezvinetso zvepfungwa zvakadai sekutya, kuzvidya mwoyo, kutya uye kunyange kusada kuvhiyiwa.Kuvhiya kusati kwaitwa, kuitira kuti ubvise kutya kwemurwere uye kushandira pamwe nekurapa, zvinodikanwa kutsanangura kuchengetedzwa uye kushanda kwekushanda kune murwere, uye kushandisa kuvhiya kwakabudirira semuenzaniso wekusimudzira pfungwa yemurwere uye kuchengetedzwa. kurapwa kuvimba.Rega varwere vachengetedze mamiriro epfungwa akasununguka uye kuvaka chivimbo mukurwisa chirwere.
1.4 Kugadzirira kwezviridzwa uye zvinhu: 1 zuva risati ravhiyiwa, tarisa nachiremba kana pane zvakakosha zvekuvhiya zvinodiwa, kana pane chero shanduko mumatanho ekuvhiya echinyakare, uye ita gadziriro dzinoenderana pachine nguva.Gara uchigadzirira laparoscopic yekuvhiya zviridzwa uye tarisa mamiriro ekuuraya hutachiona, uye tarisa kana iyo ultrasonic scalpel, monitor, light source, pneumoperitoneum sosi uye zvimwe zvishandiso zvakakwana uye zviri nyore kushandisa.Gadzirira uye wakakwana mhando dzakasiyana dzelaparoscopic yekucheka closersuyetubular staplers.Kungofanana nemamwe ose maitiro e laparoscopic, laparoscopic yakazara gastrectomy inotarisanawo nedambudziko rekutendeuka kune laparotomy, saka midziyo ye laparotomy inoda kugadzirirwa nguva dzose.Kuti urege kukanganisa kufambira mberi kwekushanda nekuda kwekugadzirira kusina kukwana panguva yekushanda, kana kutoisa upenyu hwemurwere pangozi.
1.5 Bata pamwe nemurwere panguva yekuvhiya uye simbisa kuwana venous mushure mekutarisa ruzivo rwekuzivikanwa rwakarurama.Mushure mekubatsira murapi kuti aite anesthesia, isa murwere panzvimbo yakakodzera uye uigadzirise, isa catheter yeurinary, uye gadzirisa zvakanaka gastrointestinal decompression tube.Vanamukoti vemudziyo vanogeza maoko avo maminetsi makumi maviri pachine nguva, uye vanoverenga midziyo, mapfekero, tsono nezvimwe zvinhu pamwe chete nemanesi anotenderera.Batsira chiremba anovhiya kuuraya utachiona kumurwere, uye shandisa sleeve yekudzivirira isina utachiona kuparadzanisa mutsara welens, mwenje sosi mutsara, uye ultrasonic banga remutsara [3].Tarisa kuti pneumoperitoneum tsono uye aspirator musoro hazvina kuvharwa, gadzirisa banga re ultrasonic;batsira chiremba kuti atange pneumoperitoneum, kupfuudza trocar laparoscopic exploration kuti asimbise bundu, kuendesa zviridzwa uye zvinhu zvinodiwa pakuvhiya nenguva, uye kubatsira chiremba kuti abvise dumbu remudumbu panguva yekuvhiya Utsi hwemukati hunovimbisa nzvimbo yekuvhiya yakajeka.Munguva yekushanda, aseptic uye-bundu-yemahara maitiro anofanirwa kunyatsoitwa.Kuiswa kweiyo staple cartridge ndeyechokwadi kana ichipfuura iyo laparoscopic yekucheka padhuze, uye inogona kupfuudzwa kune opareta chete mushure mekunge modhi yasimbiswa.Vhara dumbu uye tarisa midziyo yekuvhiya, gauze, uye suture tsono zvakare.
2 zvabuda
Hapana kana mumwe wevarwere gumi nemumwe akatendeuka kuita laparotomy, uye mabasa ese akapedzwa pasi pelaparoscopy yakazara.Vose varwere vakatumirwa kuongororwa kwechirwere, uye zvigumisiro zvakaratidza kuti postoperative TNM staging yemakumbo akaipa yaiva danho I. Nguva yekushanda yaiva 3.0 ~ 4.5h, nguva yepakati yaiva 3.8h;kurasikirwa kweropa panguva yekushanda kwaiva 100 ~ 220ml, chiyero chekurasikirwa kweropa chaiva 160ml, uye pakanga pasina kuwedzerwa ropa.Varwere vese vakapora uye vakaburitswa muchipatara mazuva matatu kusvika mashanu mushure mekuvhiyiwa.Vese varwere vaive vasina matambudziko akadai sekudonha kweanastomotic, hutachiona hwemudumbu, hutachiona hwekucheka, uye kubuda ropa mudumbu, uye kuvhiya kwacho kwaigutsa.
3 Kukurukurirana
Chirwere chegomarara remudumbu nderimwe remamota akaipisisa munyika mangu.Chiitiko chayo chinogona kunge chine chekuita nezvinhu zvakaita sekudya, nharaunda, mweya kana genetics.Inogona kuitika mune chero chikamu chemudumbu, ichityisidzira zvakanyanya hutano hwepanyama uye hwepfungwa uye kuchengetedzwa kwehupenyu hwevarwere.Parizvino, iyo inonyanya kushanda yekiriniki kurapwa Iyo nzira ichiri yekuvhiya kuvhiyiwa, asi yechinyakare yekuvhiya kukuvadzwa kwakakura, uye vamwe varwere vakwegura kana avo vane urombo hwemuviri vanorasikirwa nemukana wekuvhiya kurapwa nekuda kwekusashivirira [4].Mumakore achangopfuura, nekuvandudzwa kunoramba kuripo, kuvandudzwa uye kushandiswa kwelaparoscopic teknolojia mubasa rekiriniki, zviratidzo zvekuvhiyiwa zvakawedzerwa.Zvidzidzo zvemumba nekune dzimwe nyika zvakaratidza kuti kuvhiyiwa kwedumbu kune zvakwakanakira pane kuvhiyiwa kwechinyakare mukurapwa kwegomarara remudumbu.Asi zvakare inoisa pamberi pepamusoro zvinodiwa zvekushandira pamwe pakati pachiremba anovhiya nana mukoti mukamuri yekuvhiya.Panguva imwecheteyo, vanamukoti vari mukamuri yekuvhiya vanofanira kuita basa rakanaka mukushanya kwepamberi uye kutaurirana nevarwere kuti vanzwisise mamiriro epfungwa dzemurwere uye mamiriro emuviri.Kuvandudza gadziriro yezvinhu zvekuvhiya uye imba yekushanda isati yaitwa, kuitira kuti zvinhu zviiswe nenzira yakarongeka, yakakodzera uye yakakodzera nguva;panguva yekuvhiya, nyatsocherechedza weti yemurwere, kubuda ropa, zviratidzo zvinokosha uye zvimwe zviratidzo;Kufanofanotaura maitiro ekuvhiya, endesa zviridzwa zvekuvhiya panguva uye nemazvo, tenzi misimboti, kushandisa uye nyore kugadzirisa kweakasiyana endoscopic zviridzwa, uye simbisa kufambira mberi kwakanaka kwekuvhiya kusvika pamwero mukuru.Kuomarara aseptic mashandiro, kungwarira uye kushandira pamwe kwekushandira pamwe ndiwo makiyi ekuona kuti kushanda zvakanaka kwekushanda.
Kupfupisa, laparoscopic yakazara gastrectomy ine kushungurudza kushoma, kukurumidza kupera, kurwadza kushoma uye nekukurumidza postoperative kupora kuvarwere.Yakakodzera kushandiswa kwekliniki.
mareferensi
[1] Wang Tao, Song Feng, Yin Caixia.Nursing kubatana mu laparoscopic gastrectomy.Chinese Journal of Nursing, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Kushandiswa kweLigaSure mu laparoscopic gastrointestinal kuvhiyiwa.Chinese Journal of Minimally Invasive Surgery, 2004, 4 (6): 493-494.
[3] Xu Min, Deng Zhihong.Kuvhiya kubatana mu laparoscopic yakabatsira distal gastrectomy.Nyaya yeNurses Training, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.Chirevo pamusoro pezviitiko zve150 zveLaparoscopic D2 radical gastrectomy yakakwana yekenza yemudumbu.Chinese Journal of Endoscopic Surgery (Electronic Edition), 2012, 5(4): 36-39.
Kunobva: Baidu Library
Nguva yekutumira: Jan-21-2023
