Hemostatic: ofotokoza ndi ndemanga

Hemostatic tatifupi ntchito kuti magazi asiye kutuluka mwa iwo akagwidwa ndi psinjika zosakhalitsa chotengera magazi kapena chitsa cha chotengera yodulidwa. Osiyanasiyana makulidwe a Zida ali dazeni ochepa. Kusiyana kumeneku chifukwa kukhalapo ziwiya zamitundu yosiyanasiyana kuchokera 1 mpaka 20 mm, ndipo ntchito njira zosiyanasiyana hemostasis. ziwiya Small yodulidwa pa ntchito, nsinga achepetsa kenako clamping ligated pamwamba (sutured) chitsa ulusi.

Hemostatic, amene ntchito mongoyembekezera kutsina ziwiya asemphana. achepetsa lakonzedwa kuti magazi asiye kutuluka kwa ziwiya kakang'ono ka magazi, akhoza kuvulaza mapeto a chotengeracho. Monga ulamuliro, izo yopangidwa ndi zisulo okhwima. Clamps, amene amatchedwa mtima, opangidwa ndi nsalu zotanuka, chifukwa zinthu izi za zinalengedwera. Mayina a zida izi ndi mokwanira zogwirizana ndi ntchito zawo amafunira. Mwadzidzidzi, iwo angagwiritsidwe ntchito fixation ya zopukutira m'manja zimapezeka.

Komabe, tiyenera kukumbukira kuti hemostatic tatifupi, kamodzi yofunsira fixation ya zopukutira m'manja zimapezeka kapena mipira thonje ndi gauze, sangapezekenso ntchito cholinga chake. Izi ndi chifukwa mapindikidwe mbali ya ntchito ndi imfa ya magwiridwe. M'tsogolo, iwo mukalembe ndi kugwiritsidwa ntchito pa kukonza mipira ndi zopukutira m'manja zimapezeka.

Zimafunika malo

Hemostatic amafunika zotsatirazi:

• Odalirika fixation pa mapeto a chotengeracho sadzaloledwa slippage.
• Ndi ntchito mobwerezabwereza kwa katundu wawo sayenera anataya.
• chida ayenera kukhala zosavuta yolumikizana ndi adzatseguka mchikakamizo cha manja dotolo.
• Lanu limagwirira ayenera kukhala mwabata kukonza nsagwada, kuteteza inadvertent kutsegula. Kuti tichite zimenezi, mwachitsanzo, oyenera retainer mu mawonekedwe a poyimitsa.
  Pamene waponya kuchokera pamwamba pa mita 1 chida sayenera zokha kutsegula pamwamba ntchito, ndipo mobwerezabwereza kutseka ndi kutsegula kwa m'kamwa mwa si chifukwa iwo molunjika.
• Ayenera kutsatira malamulo a ergonomics.
• Lightness, kupatulapo lacerations omwe angagwe tizivutika ndi tatifupi, oletsa m'mbali bala.
• Tiyenera kulola ntchito electrocoagulator.
• duwali kuti ndigwire mwachidule za kuthengo opaleshoni.
• Kulekeza pa chida zizigwirizana ndi awiri ziwiya.

gulu la clamps

Hemostatic ogaŵikana subgroups zingapo:

1. Hemostatic kupereka zosakhalitsa clamping nsupa tatifupi pamaso ligation kapena kuumiriza kugwira electrocoagulation (notched kopanira hemostatic).

2. mtima clamps, mongoyembekezera wotseka magazi ndi kulola kuti abwezeretse kukhulupirika kwa chotengeracho (angiorrhaphy).

3. onongani clamps omwe amalimbikitsa mapangidwe thrombus mu lumen chotengera pambuyo kutsatira kopanira.

kapangidwe

Hemostatic tatifupi ndi zigawo amene ali m'munsiwa:

• Nsagwada (nsagwada).
• Amangomvera ndi mphete.
• Collapsible kapena wogontha m'linga.
• Poyimitsa.

Fomu nsagwada (nsagwada)

1. Triangular elongated, mwachitsanzo, neurosurgical Halstead clamps.
2. Trapezoidal ananena, mwachitsanzo, Billroth achepetsa.
3. Ndi mano trapezoidal Mwachitsanzo, ndi Kocher achepetsa.
4. Chowulungika Mwachitsanzo, Pean forceps.

Tatifupi akhoza kukhala nsagwada molunjika ndi yokhota kumapeto. Notches pa kali nsagwada analola onse yopingasa ndi oblique. forceps Hemostatic, yokhota kumapeto ntchito nthawi zambiri.

Kocher achepetsa

Kocher achepetsa ndi mano kumapeto. Iwo ali dwi pa mapeto a chotengeracho, monga pa kutseka wina wa mbali ya dzino chilolezo pakati pa zina ziwiri.

Matendawa, dokotalayo ayenera panokha onani mkhalidwe wa hemostatic tatifupi (imodzi, molunjika, yokhota kumapeto - zilibe kanthu), chifukwa:

• kuwononga mano zingachititse poyimitsa samorazmykanie chida, amene ndi oopsa kwambiri pa mtanda clamping chotengera lalikulu.
• skewed mbali ntchito sadzalola kuti bwino kuti magazi asiye kutuluka.

Clamps nsagwada amasiyana mawonekedwe, mbiri ya ntchito pamwamba, cholinga ndi kukula kwa zing'wenyeng'wenye.

mitundu ya clamps

Zotsatirazi mitundu ya tatifupi:

1. hemostatic mwachindunji zida ndi kutalika kwa masentimita 15 kapena 20, kapena ali releasable lanu wononga, ndi mphako oblique pa kali ntchito za m'kamwa mwa. Malekezero a m'kamwa mwa Mano mbali imodzi, limodzi ndi ziwiri kumbali inayo. Pa kutseka kulinga wina wa mano angagwe pakati pa zina ziwiri.

2. yopingasa mphako, iwo zofanana notched, koma pamwamba ntchito ali ndi kudula yopingasa. Unapangidwa zosapanga dzimbiri, pamwamba ndi opukutidwa kuwala ndi. Utali kwa masentimita 16 ndi 20, mukhoza kukhala owongoka kapena yokhota kumapeto.

3. Neurosurgical hemostat "udzudzu", opepuka, kutalika 15,5 masentimita, ali zungulira wononga. Thonje mu gawo kotenga mu mawonekedwe a chulucho truncated, padziko awo ntchito ndi woonda yopingasa notching. Mukhozanso yokhota kumapeto kapena molunjika vertically ndi horizontally. Makamaka ntchito hemostasis ziwiya kakang'ono pa njira neurosurgical.

4. Ana a "udzudzu" mu dongosolo ofanana m'mbuyomo, koma ndi zibwano n'kakang'ono. Utali 12,5 masentimita, nawonso molunjika ndi yokhota kumapeto. Anaikira arachnoid ubongo angioplasty munthu opaleshoni Dokotala, chifukwa ntchito mu ziwalo parenchymal.

5. Nato m'mimba, anafuna hemostasis ndi mtima ligation ku mabala akuya. kutalika ndi 26 cm, thonje ndi molunjika kapena yokhota kumapeto mawonekedwe ndi lalifupi kutalika.

Tatifupi za "udzudzu" komanso mayina a Halstead tatifupi. Osiyana chabwino ntchito pamwamba. изогнутый используется для новорожденных. Clip "udzudzu" wopindidwa ntchito akhanda. небольших сосудов в процессе нейрохирургических операций. Zipangizo hemostasis ziwiya kakang'ono pa ntchito neurosurgical.

Achepetsa Billroth analanda ndi akakufinyani Mitsempha. Iye anali kugwira ntchito yosangalatsa nsagwada ndi ang'ambe thupilo ang'ono, ndi pamwamba tapered kunja. nsagwada zosangalatsa okonzeka ndi amacheka, chifukwa mu zochepa minofu anavulala.

Achepetsa Popper ndi yaitali molunjika opaleshoni achepetsa, omwe amagwiritsidwa ntchito opareshoni ndulu.

Monga kopanira ndi ntchito?

Pamaso opaleshoni dokotalayo ayenera panokha onani machitidwe a clamps. Izi ndi zowona makamaka ndi mitsempha yaikulu. Mwachitsanzo, kulowererana phrenic-chapamimba mitsempha, kani, izo imafika ku lamanzere chapamimba mtsempha wamagazi achepetsa amene ali ndi chilema, ndi zinadzala kuthawa mapeto a chotengeracho, tingayambe magazi kwambiri.

Kodi nakradyvat tatifupi?

M'lifupi gawo la mesentery (mitsempha) ndi ziwiya zimene anayesedwa momwemo akhale inversely molingana ndi wochindikala.

Kumbukirani izi:

- chitsa otsala chachikulu akhoza nekrozirovat zomwe zingachititse purulent kutupa;

- yatsoka lalikulu padziko dera deserozirovannoy kungayambitse matenda zomatira;

- ligature, amene superimposed pa mafuta chochuluka, kusokonezedwa nthawi ina iliyonse.

Pa zigawo yovuta kwambiri kwa Mitsemphayi (a mesentery), amene sikudzakuchokera, ligatures ndi tatifupi ayenera zoika dokotala pa ziwalo za mesentery ndi zochotseka amalowerera wothandizira awo.

Excision ya mitsempha kapena wa mesentery pakati clamps wapangidwa pafupi m'dera yotsala. Voliyumu ya chitsa kuli bwino kuchita pang'ono, Likhale chitsimikizo kuti wovulala sizidzachitika ligatures.

Clamps ndi ligatures pa Mitsemphayi ndi akulimbikitsidwa kugwiritsa ntchito pa ngodya pang'ono, monga ichi kumawonjezera voliyumu ya chitsa, ndipo kumathandiza kuti ligatures mphamvu fixation.

Pali malamulo zotsatirazi, zimene zimafunika kutsata:

1. malekezero a ligatures ndi kukoka. Kotero iwo akhoza Vulani mapeto a chotengeracho.

2. Kusunga mopendekeka ndi madigiri 40-50 pakati pa ndege ya lumo masamba kuchepetsedwa Cooper ndi yarns.

3. m'munsi tsamba la lumo n'kofunika kupuma mu msonkhano.

4. mapeto kagawo ka ligature ayenera musalumphe 1-2 mm.

Hemostats mabala zoletsa

Kusiyanitsa chilonda pa khungu, kawirikawiri ntchito notched hemostatic kopanira mzere (1160 mm yaitali).

Zilonda osaya yoyenera kutsatira mwachindunji. Koma zophatikiza ndi gauze kwa mafuta subcutaneous yabwino kwambiri chifukwa hemostats yokhota kumapeto.

Kusunga zida opaleshoni

Zida kusungidwa mu mkangano malo ouma pa kutentha kwa 15-20 ° C. Izo ziyenera kukhala mu chipinda chomwecho ndi awiri iwo zinthu zomwe zingachititse dzimbiri zitsulo (formalin, ayodini, oyeretsa).

Zida lakonzedwa kuti ntchito imeneyi ake ali zolengedwa, ndi kusanja iwo ndi mtundu ndi kopita. Amene anapangidwa mpweya zitsulo, pa zoyendera mosalekeza kapena kusunga kukonzedwa ndale Vaselini kapena paraffin anaphimba. Kuti zimenezi zitheke odzola mafuta isungunuke ndi kutentha kwa 60-70 ° C, ndi kumizidwa mu chipangizo ndiyeno atakulungidwa mu pepala analimbika.

Lubricant zipangizo si nkhani ya zipangizo zotsatirazi: zosapanga dzimbiri, zotayidwa, mkuwa, mkuwa. Kukonzekera zida dzola mafuta: degrease ndi wiritsani mu madzi soda ndi sopo ndi madzi, zouma, chipikisheni kwa dzimbiri, dzimbiri anachotsa kupukuta alipo. Processing Zida ndi Magolovesi ayenera idzachitika, monga potozhirovye kuda kungachititse kuti dzimbiri mapangidwe.

Takambirana mwatsatanetsatane kuchipatala hemostatic kopanira, mitundu yake, malamulo a ntchito ndi kusunga.