Ukusebenzisana Kokusebenza ku-Laparoscopic Total Gastrectomy
I-Abstract, Inhloso: Ukuxoxa ngokubambisana kokusebenza kanye nesipiliyoni sobuhlengikazi se-laparoscopic total gastrectomy.Izindlela Idatha yomtholampilo yeziguli eziyi-11 ezathola i-laparoscopic total gastrectomy yahlaziywa ngokuphindaphindiwe.Imiphumela Iziguli eziyishumi nanye ezathola i-laparoscopic total gastrectomy zakhishwa ngaphandle kwezinkinga ezinkulu.
Isiphetho: I-Laparoscopic total gastrectomy inokuhlukumezeka okuncane, ukuphuma ngokushesha, ubuhlungu obuncane kanye nokululama ngokushesha kwangemva kokuhlinzwa kweziguli.Ifanele ukusetshenziswa komtholampilo.
Amagama ayisihluthulelo laparoscopy;i-gastrectomy ephelele;ukubambisana kokusebenza;ukusika kwe-laparoscopic eduze
Ngokujula kwemiqondo yesimanje yokuhlinza engangeneleli kancane, ubuchwepheshe be-laparoscopic buye basetshenziswa kabanzi ekusebenzeni komtholampilo.Ukuhlinzwa kwe-laparoscopic kunezinzuzo zokulahlekelwa igazi elingaphansi kokuhlinzwa, ubuhlungu obuncane ngemva kokuhlinzwa, ukululama ngokushesha kokusebenza kwamathumbu, ukuhlala isikhathi esifushane esibhedlela, isibazi esincane sesisu, umthelela omncane ekusebenzeni kwamasosha omzimba, kanye nezinkinga ezimbalwa [1].Eminyakeni yamuva nje, ngokuthuthuka okuqhubekayo kobuchwepheshe be-laparoscopic, iziguli eziningi ezinomdlavuza wesisu zelashwa ngokuhlinzwa kwe-laparoscopic.I-Laparoscopic total gastrectomy inzima ukusebenza futhi idinga izinga eliphezulu lobuchwepheshe, futhi idinga ukubambisana okuseduze phakathi kodokotela ohlinzayo nomhlengikazi ekamelweni lokuhlinza ukuze kuqinisekiswe ukuqedwa kokusebenza kahle.Iziguli eziyishumi nanye ezahlinzwa i-laparoscopic total gastrectomy esibhedlela sethu kusukela ngo-March 2014 kuya ku-February 2015 zakhethwa ukuze zihlaziywe, futhi ukubambisana kwabahlengikazi ngokuhlinzwa kubikwa kanje.
1 Izinto kanye nezindlela
1.1 Ulwazi Olujwayelekile Iziguli eziyishumi nanye ezahlinzwa i-laparoscopic isiyonke ye-gastrectomy esibhedlela sethu kusukela ngoNdasa wezi-2014 kuya kuNhlolanja wezi-2015 zakhethwa, okuhlanganisa abesilisa abayisi-7 nabesifazane abangu-4, abaneminyaka engu-41-75 ubudala, abaneminyaka yobudala ephakathi kwama-55.7.Umdlavuza wesisu waqinisekiswa yi-gastroscopy kanye ne-pathological biopsy ngaphambi kokuhlinzwa kuzo zonke iziguli, futhi isigaba somtholampilo sangaphambi kokuhlinzwa kwakuyisiteji I;kwakukhona umlando wokuhlinzwa kwesisu esiphezulu noma ukuhlinzwa okukhulu kwesisu esikhathini esidlule.
1.2 Indlela yokuhlinzwa Zonke iziguli zenziwa i-laparoscopic radical total gastrectomy.Zonke iziguli zalashwa nge-anesthesia jikelele kanye ne-tracheal intubation.Ngaphansi kwe-pneumoperitoneum, i-omentum ne-omentum kwahlakazwa nge-ultrasonic scalpel kanye ne-Ligasure ukuze kukhishwe imithambo yegazi ye-perigastric, futhi ama-lymph nodes azungeze umthambo wesisu wesokunxele, umthambo we-hepatic, nomthambo we-splenic kwahlanzwa.Isisu kanye ne-duodenum, isisu kanye ne-cardia kwahlukaniswa yi-laparoscopic yokusika nokuvala idivayisi, ukuze isisu sonke sikhululeke ngokuphelele.Ijejunamu yaphakanyiswa eduze komphimbo, futhi kwavuleka indawo encane emthonjeni ngamunye kanye nejejunum, futhi i-anastomosis ye-esophagus-jejunum side anastomosis yenziwa nge-laparoscopy yokusika nokuvala, futhi ukuvuleka kwe-esophagus ne-jejunum kwavalwa. nge-laparoscopic yokusika nokuvala idivayisi.Ngokufanayo, isiphetho samahhala se-jejunum sashintshwa saba yi-jejunum 40cm kude ne-suspensory ligament ye-duodenum.Ukusika okungu-5cm kwenziwa phakathi komlomo ongezansi wenqubo ye-xiphoid kanye nenkaba ukuze kukhishwe umzimba wesisu.Umzimba we-gastric kanye ne-lymph node zahlungwa futhi zathunyelwa ukuze zihlolwe i-pathological.Umgodi we-peritoneal wawugezwa nge-fluorouracil saline, futhi kwafakwa ishubhu lokudonsa amanzi ukuze kuvalwe umgodi wesisu [2].I-trocar yasuswa futhi i-poke ngayinye yahlanganiswa.
1.3 Ukuvakasha ngaphambi kokuhlinzwa Vakashela isiguli ewodini ngosuku olungu-1 ngaphambi kokuhlinzwa ukuze uqonde isimo sesiguli esijwayelekile, ubuyekeze icala, futhi uhlole imiphumela yokuhlolwa kwaselabhorethri okuhlukahlukene.Bamba iqhaza engxoxweni yangaphambi kokuhlinzwa emnyangweni uma kunesidingo, futhi wenze amalungiselelo aphelele okusebenza ngosuku lwesibili.Ukukhishwa komdlavuza wesisu nge-laparoscopic kuseyindlela yokwelapha entsha, futhi iziguli eziningi azazi ngokwanele ngakho futhi zinokungabaza ngakho ngokwezinga elithile.Ngenxa yokuntula ukuqonda, bazokhathazeka ngomphumela wokwelapha nokuphepha kokuhlinzwa, bese kuba nezinkinga ezingokwengqondo ezinjengokwesaba, ukukhathazeka, ukwesaba ngisho nokungafuni ukuhlinzwa.Ngaphambi kokuhlinzwa, ukuze kuqedwe ukwethuka kwesiguli nokusebenzisana kangcono nokwelashwa, kuyadingeka ukuchaza ukuphepha nokusebenza kahle kokuhlinzwa esigulini, futhi usebenzise ukuhlinzwa okuyimpumelelo njengesibonelo sokuthuthukisa umuzwa wokuphepha wesiguli kanye nokuphepha kanye nokusebenza kahle kokuhlinzwa. ukuzethemba kokwelashwa.Vumela iziguli zigcine isimo somqondo esikhululekile futhi zakhe ukuzethemba ekulweni nalesi sifo.
1.4 Ukulungiswa kwezinsimbi nezinto: Ngosuku olungu-1 ngaphambi kokuhlinzwa, hlola nodokotela ohlinzayo ukuthi zikhona yini izimfuneko zethuluzi lokuhlinza elikhethekile, ukuthi lukhona yini ushintsho ezinyathelweni zokuhlinza okuvamile, futhi wenze amalungiselelo ahambisanayo kusenesikhathi.Lungiselela njalo amathuluzi okuhlinza i-laparoscopic futhi uhlole isimo sokukhipha amagciwane, futhi uhlole ukuthi i-ultrasonic scalpel, ukuqapha, umthombo wokukhanya, umthombo we-pneumoperitoneum nezinye izinto zokusebenza ziphelele futhi kulula ukuzisebenzisa.Lungiselela futhi uphelele izinhlobo ezahlukene zei-laparoscopic cutting closersfuthiama-staplers ama-tubular.Njengazo zonke ezinye izinhlelo zokusebenza ze-laparoscopic, i-laparoscopic total gastrectomy nayo ibhekene nenkinga yokuguqulwa ku-laparotomy, ngakho amathuluzi we-laparoscopic adinga ukulungiswa njalo.Ukuze ungaphazamisi ukuqhubeka komsebenzi ngenxa yokungalungiseki okwanele ngesikhathi sokuhlinzwa, noma ubeke engozini impilo yesiguli.
1.5 Sebenzisana nesiguli ngesikhathi sokuhlinzwa futhi uthole ukufinyelela kwe-venous ngemva kokuhlola ulwazi lukamazisi ukuthi lulungile.Ngemva kokusiza obulala izinzwa ukuba enze i-anesthesia, beka isiguli endaweni efanele futhi usilungise, faka i-catheter yomchamo, futhi ulungise kahle ishubhu lokunciphisa emathunjini.Abahlengikazi bemishini bageza izandla zabo imizuzu engu-20 kusengaphambili, futhi babale amathuluzi, okokugqoka, izinaliti nezinye izinto kanye nabahlengikazi abazulazulayo.Siza udokotela ohlinzayo ukuthi akhiphe amagciwane esigulini, futhi asebenzise umkhono ovikelayo oyinyumba ukuze ahlukanise ulayini welensi, umugqa womthombo wokukhanya, kanye nomugqa wommese osebenza kahle [3].Hlola ukuthi inaliti ye-pneumoperitoneum nekhanda le-aspirator alivimbeli yini, lungisa ummese we-ultrasonic;ukusiza udokotela ukuthi asungule i-pneumoperitoneum, adlulise ukuhlolwa kwe-trocar laparoscopic ukuze aqinisekise isimila, alethe amathuluzi nezinto ezidingekayo ukuze ahlinzwe ngesikhathi, futhi asize udokotela ukuthi akhiphe umgodi wesisu ngesikhathi sokuhlinzwa Intuthu yangaphakathi iqinisekisa insimu ecacile yokuhlinza.Ngesikhathi sokusebenza, izindlela ze-aseptic ne-tumor-free kufanele zisetshenziswe ngokuqinile.Ukufakwa kwe-cartridge yesisekelo empeleni kunokwethenjelwa lapho kudlula ukusika kwe-laparoscopic eduze, futhi kungadluliselwa ku-opharetha kuphela ngemva kokuqinisekiswa kwemodeli.Vala isisu bese uhlola izinsimbi zokuhlinza, i-gauze, nezinaliti zokuthunga futhi.
2 imiphumela
Akukho nesisodwa seziguli eziyi-11 esiguqukele ku-laparotomy, futhi konke ukuhlinzwa kwaqedwa ngaphansi kwe-laparoscopy ephelele.Zonke iziguli zathunyelwa ukuhlolwa kwe-pathological, futhi imiphumela yabonisa ukuthi isiteji se-TNM sangemva kokuhlinzwa kwamathumba amabi kwakuyisiteji I. Isikhathi sokusebenza sasingu-3.0 ~ 4.5h, isikhathi esijwayelekile sasingu-3.8h;ukulahlekelwa kwegazi ngesikhathi sokuhlinzwa kwaba ngu-100 ~ 220ml, isilinganiso sokulahlekelwa kwegazi sasingu-160ml, futhi kwakungekho ukumpontshelwa igazi.Zonke iziguli zalulama futhi zaphuma esibhedlela ezinsukwini ezi-3 kuya kweziyi-5 ngemva kokuhlinzwa.Zonke iziguli zazingenazo izinkinga ezinjengokuvuza kwe-anastomotic, ukutheleleka kwesisu, ukungenwa yizimbobo, nokopha kwesisu, futhi umphumela wokuhlinzwa wawugculisa.
3 Ingxoxo
Umdlavuza wesisu ungesinye sezimila eziyingozi ezivame kakhulu ezweni lami.Isigameko saso singase sihlobane nezinto ezifana nokudla, indawo ezungezile, umoya noma ufuzo.Ingenzeka kunoma iyiphi ingxenye yesisu, isongela kakhulu impilo engokomzimba nengokwengqondo kanye nokuphila kweziguli.Njengamanje, ukwelashwa okuphumelelayo kakhulu komtholampilo Indlela isahlinzwa ngokuhlinzwa, kodwa ukuhlukumezeka okungokwesiko kokuhlinzwa kukhulu, futhi ezinye iziguli esezikhulile noma lezo ezisesimweni esibi ngokomzimba zilahlekelwa ithuba lokwelashwa ngokuhlinzwa ngenxa yokungabekezelelani [4].Eminyakeni yamuva nje, ngokuthuthuka okuqhubekayo, ukuthuthukiswa kanye nokusetshenziswa kobuchwepheshe be-laparoscopic emsebenzini womtholampilo, izinkomba zokuhlinzwa ziye zandiswa nakakhulu.Ucwaningo lwasekhaya nolwangaphandle luye lwafakazela ukuthi ukuhlinzwa kwesisu kunezinzuzo eziningi kunokuhlinzwa kwendabuko ekwelapheni umdlavuza wesisu osethuthukile.Kodwa futhi ibeka phambili izidingo eziphakeme zokubambisana phakathi kukadokotela ohlinzayo nomhlengikazi egumbini lokuhlinzela.Ngesikhathi esifanayo, abahlengikazi egumbini lokuhlinza kufanele benze umsebenzi omuhle ekuvakasheni kwangaphambi kokuhlinzwa futhi baxhumane neziguli ukuze baqonde isimo sengqondo sesiguli nesimo somzimba.Thuthukisa amalungiselelo ezinto zokuhlinza kanye negumbi lokusebenza ngaphambi kokuhlinzwa, ukuze izinto zibekwe ngendlela ehlelekile, elula futhi efika ngesikhathi;ngesikhathi sokuhlinzwa, qaphela ngokucophelela ukuphuma komchamo wesiguli, ivolumu yokopha, izimpawu ezibalulekile nezinye izinkomba;Ukubikezela inqubo yokuhlinza kusenesikhathi, ulethe amathuluzi okuhlinza ngesikhathi nangendlela enembile, uphathe kahle izimiso, ukusetshenziswa kanye nokugcinwa okulula kwezinsimbi ezihlukahlukene ze-endoscopic, futhi uqinisekise ukuqhubeka kahle komsebenzi ngezinga elikhulu kakhulu.Ukusebenza okuqinile kwe-aseptic, ukubambisana okuqotho nokusebenza okusebenzayo yizihluthulelo zokuqinisekisa ukuqaliswa kokusebenza kahle.
Ukufingqa, i-laparoscopic total gastrectomy inokuhlukumezeka okuncane, ukuphuma ngokushesha, ubuhlungu obuncane kanye nokululama ngokushesha kweziguli.Ifanele ukusetshenziswa komtholampilo.
izinkomba
[1] Wang Tao, Song Feng, Yin Caixia.Ukubambisana kwabahlengikazi ku-gastrectomy ye-laparoscopic.I-Chinese Journal of Nursing, 2004, 10 (39): 760-761.
[2] Li Jin, Zhang Xuefeng, Wang Xize, et al.Ukusetshenziswa kwe-LigaSure ekuhlinzeni kwe-laparoscopic kwamathumbu.Ijenali yesiShayina Yokuhlinza Okuncane Kancane, 2004, 4(6): 493-494.
[3] Xu Min, Deng Zhihong.Ukubambisana kokuhlinzwa ku-laparoscopic esiza i-distal gastrectomy.Ijenali Yokuqeqeshwa Kwabahlengikazi, 2010, 25 (20): 1920.
[4] Du Jianjun, Wang Fei, Zhao Qingchuan, et al.Umbiko mayelana nezimo eziyi-150 ze-laparoscopic D2 radical gastrectomy ephelele yomdlavuza wesisu.Ijenali yesiShayina Yokuhlinzwa Kwe-Endoscopic (I-Electronic Edition), 2012, 5(4): 36-39.
Umthombo: I-Baidu Library
Isikhathi sokuthumela: Jan-21-2023
