Niaj hnub phais kev kho mob ntawm kev kho kom tshem tawm qhov yuav tsum tau ua cov kev siv loj, uas yog ua tiav tsaug rau lub cuab yeej tshwj xeeb - kev endoscope, thiab hu ua cov kev pab cuam endoscopic. Laparoscopy yog ib hom mob hom mob endoscopy. Cia peb xav li cas, nws yog dab tsi - yog ib qho laparoscopy, nyob rau hauv dab tsi mob yuav siv.
Laparoscopy - nws yog dab tsi?
Cov kev khiav hauj lwm nyob rau hauv lub nruab nrog cev, ua los ntawm txoj kev qhib, yuav tsum muaj ntau tshaj ib lub phais kom ncav cuag kev mob siab ntsws. Endoscopic operations yog ua txawv: rau kev nkag mus rau lub cev nws yuav tsum ua kom cov punctures me me los yog ua kom tsis muaj mob ntawm cov nqaij, qhia txog qhov kawg ntawm qhov kawg ntawm lub cev. Kev kho mob endoscope yog ib lub raj ntev, thaum kawg ntawm lub teeb uas txuas nrog thiab ib lub koob yees duab uas qhia txog cov duab ntawm lub monitor. Ntxiv rau nws, cov khoom siv tsim nyog rau kev khiav hauj lwm raug coj mus rau cov khoom los ntawm nyias cov hlab.
Endoscopic phais muab ntau hom kev lag luam hauv txhua hom tshuaj. Laparoscopy yog ib qho txheej txheem uas muaj feem xyuam rau mob plab thiab mob ntsws plab. Qhov kawg hauv lub qhov txhab no hu ua laparoscope. Muaj ntau ntau yam ntawm laparoscopy: kev kho mob, kuaj xyuas thiab tswj. Kho kom tsis nto - minimally invasive manipulation, uas tuaj yeem raug txhag tau (kev tswj hwm tshuaj) lossis phais mob. Diagnostic thiab tswj cov tswv yim yog siv los pom cov xwm txheej ntawm lub nruab nrog cev.
Diagnostic laparoscopy
Kev siv lub laparoscope rau kev kuaj mob yog qhov kawg theem ntawm kev kuaj xyuas cov kab mob pathological thiab lawv ua rau cov xwm txheej kev tshawb fawb pom tsis meej ua li ntawd. Feem ntau, qhov no yuav tsum tshwm sim thaum tsim txoj kev sib txawv. Feem ntau txoj kev tshawb no raug taw nrog:
- kab mob hauv plab hauv plab kab noj hniav, thaj chaw hauv plab;
- persistent mob syndromes ntawm qhov qhia tshwj xeeb;
- infertility nrog paub tsis meej ua rau;
- suspicion of ectopic cev xeeb tub ;
- mob cov kab mob ntawm cov kab mob hauv plab nrog cov tsos mob tsis meej.
Feem ntau, kev kuaj mob laparoscopy nrog infertility pub rau ib puas feem pua tso siab tau ua tus mob, raws li tus kws kho mob saib xyuas qhov qis tshaj plaws. Qee zaus kev tshawb nrhiav manipulation yog nrog kev kho phais ntawm qhov qhia tawm (tshem tawm ntawm cov hlav, adhesions, excision ntawm endometown endometrium thiab lwm yam).
Phais Laparoscopy
Laparoscopic operations yog ua tiav, raws li yog nyob hauv lub tshuab kuaj kab mob, thiab muab ntau dua visibility, vim cov khoom siv los tsim ib qho plaub caug plaub ntxiv, thiab ua tsaug rau cov optics, lub cev ua haujlwm yog kuaj ntawm cov ces kaum sib txawv. Laparoscopy, zoo li cov txheej txheem siv, yuav ua tau raws li txoj kev npaj tseg (piv txwv li, nrog tshem tawm ntawm kab mob ) los yog yuav muaj xwm ceev (laparoscopy of appendicitis).
Nws yuav tsum tau muab sau tseg tias laparoscopy yog ib qho kev cuam tshuam uas ua rau cov ntshav tsawg thiab tsis muaj zog. Ua tsaug rau cov thooj me tshaj, kev ua haujlwm tom qab qis qis yuav luag tsis pom, uas yog qhov tseem ceeb rau cov pojniam hluas. Tsis zoo li cov kev ua haujlwm hauv kev lag luam, laparoscopy tsis tas yuav mus pw tom tsev kho mob ntev ntev thiab ua rau lub txaj so.
Laparoscopy - indications
Lub lag luam ntawm laparoscopy tau ua nyob rau hauv ntau zaus:
- o ntawm lub gallbladder, lub xub ntiag ntawm concrements nyob rau hauv nws;
- hlav zes qe menyuam;
- o ntawm txoj cai appendix;
- inguinal hernia;
- umbilical hernia;
- hernia ntawm qhov esophageal qhib ntawm lub diaphragm;
- cyst ntawm daim siab;
- obstruction ntawm cov hlab ntaws ;
- uterine myoma;
- endometriosis ;
- omission ntawm lub tsev menyuam, qhov chaw mos;
- adrenal caj pas hlav;
- txheej txheem nplaum;
- urinary tuskheej;
- thawj theem ntawm kev mob khees xaws;
- pancreatic necrosis;
- rog.
Laparoscopy - tiv thaiv kev nqa tawm
Laparoscopy contraindications muaj cov nram qab no:
- purulent peritonitis;
- mob plab tsis zoo los yog mob ntsws;
- mob puas tsuaj ntawm kab mob cerebral;
- loj deviations nyob rau hauv cov kev ua ntawm lub plawv nres los sis ua pa;
- plab hnyuv txhuam;
- pauv nyuam qhuav qhib haujlwm;
- gestation lig;
- hemorrhagic poob siab;
- qhov tseem ceeb ntawm cov pob txha loj;
- ntsws ntsws ntsws nrog mob ntsws ntau heev;
- kev tsis haum rau tshuaj loog.
Laparoscopy - Yuav npaj li cas rau kev phais?
Yog tias tus neeg mob tau qhia txog laparoscopy, yuav ua li cas npaj rau nws, piav qhia tus kws kho mob. Ua ntej txoj haujlwm, ntau yam kev kuaj xyuas pom kev (ntshav thiab zis tsom, kev kuaj ntshav, xoo hluav taws xob, ultrasound, thiab lwm yam) feem ntau ua, tus neeg mob yog nug txog cov kab mob kis, haujlwm, kev tsis haum tshuaj. Kev npaj rau kev cuam tshuam muaj xws li cov hauv qab no:
- ob peb hnub ua ntej laparoscopy - ua raws li cov khoom noj tsis pub hnav, uas tsis suav cov khoom noj khoom haus, roasted, khoom qab zib, carbonated thiab dej cawv;
- tsis kam noj haus thiab haus 12 teev ua ntej kev phais;
- ntxuav ntawm txoj hnyuv los ntawm txoj hlab qhov quav (ua ntej yuav mus pw lossis hnub sawv ntxov ua ntej kev ua haujlwm);
- rau hnub teem - noj ib da dej thiab thaj tsam ntawm depilation, uas yuav tsum ua haujlwm.
Laparoscopy tau ua li cas?
Laparoscopy, cov txheej txheem ntawm kev ua tau zoo uas yog qhov nyuaj, yog ua los ntawm cov kws kho mob uas muaj txuj ci siab heev uas tau kawm tshwj xeeb. Qhov no yog vim, inter alia, rau qhov tseeb tias nyob rau hauv kev tshuaj ntsuam tag nrho cov taw muaj cov lus qhia rov qab, thiab tseem tsim ib qho kev cuam tshuam ntawm qhov tob ntawm thaj chaw kho mob. Tus laparoscopist yuav tsum tau ua kom tiav cov txheej txheem kab noj hniav, vim tias qee zaum ib tus tau hloov mus rau qhov txheej txheem no thaum muaj teeb meem tshwm sim los yog cov txheej txheem.
Ua ntej ua haujlwm, tus neeg mob yog tus soj ntsuam los ntawm ib tus kws kho mob, uas xaiv hom tshuaj loog. Ntau zaus ua rau cov tshuaj loog tso los yog ua ke kom tsaug zog. Tom qab, pneumoperitoneum tau ua tiav - puv cov kabmob plab nrog cov roj nkag los ntawm kev txhaj koob tshuaj tivthaiv ntawm kev tswjhwm thiab kev khiav haujlwm tshaj tawm. Qhov no yog qhov yuav tsum tau nce lub plab phab ntsa, kom koj thiaj li khiav lag luam, tsis txhob kov lwm yam kabmob.
Cov kauj ruam tom ntej yog kev qhia txog thawj cov khoom thauj khoom (tube) los ntawm lub plab phab ntsa, qhov chaw ntawm qhov chaw nqes raug xaiv nyob ntawm seb qhov chaw ntawm lub cev ua haujlwm. Los ntawm no lub raj muaj laparoscope yog txhaj, nyob rau hauv kev tswj ntawm qhov kev ntxiv trocars coj-rau seev cev. Tom qab kuaj tag nrho ntawm cov hauv nruab nrog cev, kev kho mob kev tswj kev noj qab haus huv yog nqa tawm, tom qab uas ntxuav ntawm kev khiav hauj lwm dab tsi, tso cov pa nkev, zom ntawm qhov kev hau kev thiab ua kom raug.
Laparoscopic cholecystectomy
Lub lag luam kom tshem tawm cov roj hmab, ua los ntawm kev nkag mus rau laparoscopic, yog siv rau cholelithiasis thiab polyps, pom tias yuav tau qhib qhov kev pab ("tus qauv kub"). Nyob ntawm qhov nyuaj ntawm qhov teeb meem, laparoscopy ntawm lub gallbladder yog ua los ntawm peb, plaub los yog tsib punctures nyob rau hauv lub plab phab ntsa. Qee zaum, yuav tsum muaj kev hloov mus rau kev qhib ua haujlwm:
- kev ruaj khov ntawm lub cev ntawm thaj chaw ua haujlwm;
- muaj zog nplaum adhesive;
- kev loj hlob ntawm cov teeb meem.
Laparoscopic appendectomy
Nrog ib qho kev mob ntawm daim ntawv qhia appendix, laparoscopy, cov txheej txheem uas tau ua tiav zoo, ua tiav raws li cov nram qab no:
- tus mob appendicitis hauv thawj hnub tom qab pib qhov mob;
- tus mob appendicitis ntev;
- mob mob ntawm cov hnyuv dhau nrog rau kev kawm siab lossis kev mob ntshav qab zib mellitus;
- tus neeg mob lub siab xav tshem tawm cov ntawv qhia los ntawm txoj kev ua siab zoo.
Rau txhua tus txiv neej, nws yuav tsum tau ua kom peb qhov chaw nyob hauv phab ntsa mob plab, cov ntsiab lus uas raug xaiv nyob ntawm seb cov khoom siv anatomical. Qhov kev lag luam no yuav ua tau raws li hauv qab anesthesia. Qhov yuav tsum tau mus rau ib qho qhib lag luam tshwm nyob rau hauv xws li mob:
- nrhiav tau ntawm peritonitis;
- atypical qhov chaw ntawm cov ntawv appendix;
- abscess, perforation;
- ntau yam teeb meem.
Laparoscopy hauv gynecology
Xav txog daim ntawv thov nyob rau ntawm thaj chaw ntawm gynecology laparoscopy, nws yog ib qho tseem ceeb teev hais tias qhov no yog ib qho kev qhia uas feem ntau khaws cov kabmob ntawm tsev me nyuam: uterus nrog myomas, zes qe menyuam hauv cov hlwv, cov hlab hauv plab hauv ectopic cev xeeb tub. Feem ntau, tsuas yog peb qho punctures xwb, yog li ntawd cov khoom zoo nkauj zoo nkauj tuaj yeem ua tiav.
Muaj qee yam kev qhia, laparoscopy thiab hysteroscopy raug ua ib txhij. Hysteroscopy - manipulation, uas tuaj yeem kuaj xyuas lossis ua haujlwm zoo, ua kom kuaj tau lub uterine kab noj hniav, siv cov khoom siv biopsy, kho cov kab mob hauv lub cev (piv txwv, tshem cov polyps). Cov cuab yeej siv rau kev siv - ib qho tshuaj hlais - yog tso los ntawm lub ncauj tsev menyuam. Kev sib xyaw ua ke ntawm laparoscopy thiab hsteroscopy ua rau kom muaj peev xwm tsim kom muaj cov kev mob ntsws thiab tshem tawm tsis tas yuav siv cov tshuaj loog.
Cov teeb meem ntawm laparoscopy
Cov teeb meem tshwm sim tom qab laparoscopy:
- kev puas tsuaj los ntawm cov hlab ntsha ntawm cov hlab ntsha hauv hlab ntsha;
- perforation ntawm sab hauv nruab nrog cev;
- hypothermia;
- tsim ntawm thrombi;
- tsis tseem ceeb hauv lub plawv thiab kev mob ntsws;
- los ntshav;
- tsim ntawm adhesions .
Rov qab kho tom qab laparoscopy
Dua li ntawm qhov tseeb hais tias laparoscopy yog ib qhov txheej txheem minimally invasive, thiab cov neeg tuaj yeem raug tso tawm tom qab ob peb hnub, qee qhov kev pom zoo xav tau kom tsis txhob muaj teeb meem ntev. Yog li, tom qab laparoscopy nws tsim nyog:
- Cia li pw tsaug zog (ntawm ob peb xuab moos mus rau ob peb hnub).
- Txav kev qoj ib ce rau 6 lub hlis.
- Ua raws li kev noj haus kom yog los ntawm tus kws kho mob.
- Saib xyuas kev sib deev rau 2-3 lub lis piam.
- Cev xeeb tub yuav tsum tsis txhob npaj ua ntej tshaj 6-8 lub hlis tom qab.