Hemostatic: tsananguro uye wongororo

Hemostatic clip anoshandiswa kurega ropa kuburikidza navo unobatwa, uye kwenguva compression ane ropa mudziyo kana chigutsa ari adziviswa mudziyo. Kuwanda hukuru zvekushandisa izvi ane gumi shoma. kusiyana ichi nokuda pamberi midziyo yese siyana kubva 1 kusvika 20 neMM, uye kushandisa dzakasiyana-unyanzvi hemostasis. midziyo Small adziviswa panguva oparesheni, kubata kiramba uye clamping ligated pamusoro (sutured) chigutsa shinda.

Hemostatic, iyo inoshandiswa kwenguva nzwara midziyo vane misiyano. The kiramba akagadzirirwa kumisa kubuda kweropa kubva maduku midziyo ropa, zvinogona kukuvadza pakuguma mudziyo. Kazhinji, chinoitwa pamusoro omarara nezvinhu. Okusungisa, izvo zvinonziwo vascular, akagadzirwa kwakavharwa nenyama zvinhu, nokuda zvinhu izvi zvakagadzirwa yavo. Mazita maturusi izvi kunoenderana zvizere zvavo inozoshandisirwa kushandiswa. Panjodzi, vanogona kushandiswa Kuda kutamba ose napkins.

Zvisinei, tinofanira kuyeuka kuti hemostatic clip, kanenge kamwe vakashandisa nokuda Kuda kutamba ose napkins kana donje balls uye gauze, haachagoni kushandiswa kuti chinangwa chahwo. Izvi nokuda deformation ari kushanda rutivi uye kurasikirwa functionality. Mune ramangwana, vanofanira tara uye kushandiswa bedzi kugadzira mabhora uye napkins.

Zvinodiwa Kuti zviteshi

Hemostatic anofanira kusangana zvinotevera zvinodiwa:

• Nhungamiro Kuda kutamba pamusoro kuguma mudziyo havazobvumirwi slippage.
• With kushandiswa pfuma yavo akadzokorora hakufaniri kurasika.
• The turusi anofanira nyore kubatanidza uye achasvinudzwa vakadhakwa maoko chiremba wacho.
• The nokukiya mashandiro anofanira kuva akachengeteka kugadzirisa shaya, kudzivirira vanhuwo buri. Kuti vaite izvi, Somuenzaniso, yakakodzera retainer muchimiro Racks.
  Kana yadonha nekukwirira 1 mita chiridzwa havafaniri nomuzvarirwo kuzarura basa pamusoro, uye akaramba kuvhara uye yokutanga shaya havafaniri nokuvadzidzisa kururamiswa.
• Anofanira kuita maererano nemitemo ergonomics.
• Nenyama, dzakakudzingai lacerations kuti kuitika pasi kurema clip zvavakatemwa pamusoro ronda kumicheto.
• Tinofanira kubvumira kushandiswa electrocoagulator.
• Kukura kwayo kwete kuvhara muchidimbu kuvhiya munda.
• Chinoguma panguva chishandiso anofanira dzinoenderana dhayamita midziyo.

kupatsanura pakati okusungisa

Hemostatic rakakamurwa subgroups akawanda:

1. Hemostatic clip ichipa pfupi clamping pangagara vasati ligation kana kumanikidza vabatisise electrocoagulation (notched hemostatic clips).

2. Vascular okusungisa, chakamboti kumbomira ropa kuyerera uye nokubvumira kuti adzorere kuvimbika mudziyo (angiorrhaphy).

3. Kupwanya okusungisa anosimudzira paumbwe thrombus ari mudziyo lumen pashure kushandisa Vanthan.

patani Features

Hemostatic clip akaumbwa zvikamu izvo pasi apa:

• Shaya (shaya).
• Rinonyorerana marin'i.
• Wakagadzirwa kana matsi Castle.
• Racks.

Form shaya (shaya)

1. Mativi elongated, semuenzaniso, neurosurgical Halstead okusungisa.
2. Trapezoidal akataura, semuenzaniso, Billroth kiramba.
3. With trapezoidal mazino Somuenzaniso, imwe Kocher kiramba.
4. Oval Somuenzaniso, Pean forceps.

Clips vanogona yakananga uye curved shaya. Notches pashaya dzavo hukawanika kubvumirwa zvose transverse uye oblique. Hemostatic forceps, curved rinoshandiswa kazhinji.

Kocher kiramba

Kocher kiramba ane mazino pakuguma. Vari zvakasimba ndee kuguma mudziyo, sezvakanga rava kuvharwa rimwe rayo chikamu zino Clearance pakati mamwe maviri.

Asati avhiyiwa, chiremba anofanira pachake tarisa mamiriro hemostatic clip (toothed, kururamisa, curved - hazvina basa), nekuti:

• kuvadza mazino anogona kukonzera Racks samorazmykanie chokushandisa, izvo ngozi chaizvo munguva muchinjikwa clamping ane mudziyo guru.
• nokushapira kushanda zvikamu haazobvumiri kuti zvinobudirira kumisa kubuda kweropa.

Okusungisa shaya yakasiyana chimiro, nhoroondo yomunhu ari kushanda pamusoro, chinangwa uye kukura zviridzwa.

marudzi okusungisa

Zvinotevera marudzi clip:

1. hemostatic zvakananga giya uye kureba 15 kusvika 20 cm, kana ane releasable nokukiya sikuruu, ane oblique notch pamusoro kushanda hukawanika ari shaya. Kumigumo shaya vane mazino rimwe divi, mumwe uye zviviri panorumwe rutivi. Rava kuvharwa wenhare rimwe mazino akawa pakati mamwe maviri.

2. transverse notch, ivo fanana notched, asi nokushanda pamusoro ane transverse okurwadzisa. Akagadzirwa Stainless simbi, pose iri yakabwinyiswa kuti chivheneke. Length kubvira 16 kusvika 20 cm, unogona kuva ngaatarire kana curved.

3. Neurosurgical hemostat "mosquito", lightweight, urefu 15.5 cm ane nokukiya sikuruu. Sechipanji ari chikamu longitudinal mu chimiro truncated cône, kwavo kushanda pechiso chinhu mutete transverse notching. Available curved kana ngaatarire vertically uye yakatambarara. Ainyanya kushandiswa hemostasis rwengarava duku panguva neurosurgical dzokuvhiya.

4. Vana "mosquito" iri mamiriro akafanana yapfuura, asi ave wakawondereiko kudai mazuva ose shaya. Length 12.5 cm zvakare yakananga uye curved. Rakagadzirirwa angioplasty munhu arachnoid uropi muna chiremba wokuvhiya, nokuti mabasa ari parenchymal nhengo.

5. abdominal zvakadzama, aida hemostasis uye vascular ligation mu maronda akadzika. kureba yavo 26 cm sechipanji vane yakarurama kana curved chimiro uye pfupi kureba.

Clips of "Mosquito" uyewo kutakura mazita Halstead clip. Siyana akanaka anoshanda pemvura. изогнутый используется для новорожденных. Clip "Mosquito" hwakakungwa inoshandiswa vachangoberekwa. небольших сосудов в процессе нейрохирургических операций. Zvokurimisa hemostasis midziyo duku panguva neurosurgical kushandiswa.

Clamp Billroth rinoburitsa uye akakudzvinya nemidziyo ropa. Akanga kushanda inobaya mwoyo shaya uye incision diki, uye tapered pasi kunze. Maturakiti shaya vakapakata cheka, zvichiguma zvishoma tishu akuvara.

Clamp Popper ari refu yakarurama kuvhiya kiramba, iro rinoshandiswa nenzira nduru dundira oparesheni.

Sezvo clips rikashandiswa?

Pamberi oparesheni chiremba vanofanira kuongorora pachake kushanda okusungisa. Izvi ndezvechokwadi kunyanya makuru arteries. Somuenzaniso, pindana phrenic-gastric shwashwa, asi, asiwo kuruboshwe gastric tsinga kiramba riri chakaremara, rizere yokutiza kuguma mudziyo, izvo zvingaita kuti zvakakomba kubuda ropa.

Sei nakradyvat clip?

Upamhi mugove mesentery (shwashwa) nemidziyo kuti wakaedza mairi, zvinofanira kuva inversely Proportional kune Ukobvu.

Yeuka zvinotevera:

- dzasara chomuti hombe saizi anogona nekrozirovat chinogona kukonzera purulent kuzvimba;

- panowanikwa hombe pamusoro nzvimbo deserozirovannoy kungaita kuti namira chirwere;

- ligature, iyo seari pamusoro unorema mafuta, unogona kukanganiswa chero nguva.

Vatowanda dzinonetsa zvikamu nemarunda (the mesentery), vachagara haana kubviswa, ligatures uye clip vanofanira kumanikidza chiremba ari bvisika zvikamu mesentery kutimanikidza mubatsiri wavo.

Excision yacho shwashwa kana mesentery pakati okusungisa unoitwa pedyo nzvimbo yasara. The Vhoriyamu yasara chigutsa zviri nani kuita zvishoma, rive kuvimbisa kuti nokuparara hazvizoitiki ligatures.

Okusungisa uye ligatures pamusoro nemarunda inokurudzirwa kushandisa pane zvishoma yorusvingo, sezvo ichi anowedzera vhoriyamu chaJese, uye izvi zvinoita kuti hwakasimba Kuda kutamba ligatures.

Kune mitemo anotevera, izvo zvinofanira kutevedzerwa:

1. Nokuti kumigumo ligatures kudhonza. Saka vanogona munovhiya pakuguma mudziyo.

2. Rangarira angled pakati 40-50 madhigirii pakati ndege yacho chigero mashizha rakasanganiswa Cooper uye nezvitsvuku.

3. repasi chipasa pakati chigero zvakafanira zororo mukereke.

4. The cut kuguma ligature anofanira haapfuuri 1-2 mm.

Hemostats pamaronda kurambidzwa

Kusiyanisa ronda kubva ganda, kazhinji kushandisa notched hemostatic inoti mutsetse (1160 mm refu).

Maronda kudzika zvakakodzera kushandisa zvakananga. Asi nokuti vakaiisa kuna gauze kune subcutaneous mafuta vari nani kuti curved hemostats.

Kuchengetera pakuvhiya

Tools inochengetwa huru panzvimbo yakaoma ari kudziya 15-20 ° C. Zvinofanira kuva muimba imwe navo zvinhu peya chinogona kukonzera ngura kuti simbi (formalin, ayodhini, dhibi).

Tools rakagadzirirwa ichi kushandiswa akaitwa kunze makabhati, uye kufambira pavo mhando uye rwendo. Avo vakaitwa kuti kabhoni simbi, panguva kuramba chokufambisa kana okuchengetera kupatsanurwa kwazvakarerekera vaseline kana Paraffin akafukidzwa. Kuti uyu magumo peturu mondo unonyauka kuti tembiricha kuti 60-70 ° C, iri achinyatsotaurira mairi zvokushandisa uye ipapo zvakapombwa akaramba papepa.

Mafuta Ezvemutauro havasi inotevera zvinhu: Stainless simbi, aruminiyamu, nendarira, nendarira. Kugadzirira nematurusi kuzora: degrease ubike mumvura pamwe pasoda uye sipo nemvura, yakaomeswa, iongororwe kuti ngura, huripo Ngura kubviswa nokuda makorari. Processing Ezvemutauro chete magiravhusi yaifanira, sezvo potozhirovye zvisaririra kunogona ngura inotungamirwa.

Dzatakurukura zvakadzama zvokurapa hemostatic inoti, ayo mifananidzo, mitemo kushandiswa uye amatura.