Tarihin aikace-aikace da rawar da na'urorin hangen nesa na tiyata ke takawa a fannin tiyatar jijiyoyi

 

A tarihin aikin tiyatar neurosurgery, an yi amfani da shi wajen magance matsalolinna'urorin hangen nesa na tiyatawata alama ce mai ban mamaki, wacce ta ci gaba daga zamanin gargajiya na yin tiyata a ƙarƙashin ido tsirara zuwa zamanin zamani na yin tiyata a ƙarƙashinna'urar duban hoto (microscope)Wanene kuma yaushe ya yi hakanna'urorin microscope masu aikiAn fara amfani da shi a fannin tiyatar jijiyoyi? Wane rawa ya taka?na'urar hangen nesa ta tiyataShin za a yi wasa a cikin ci gaban aikin tiyatar jijiyoyi? Tare da ci gaban kimiyya da fasaha, shin hakan zai faru?Na'urar hangen nesa mai aikiza a maye gurbinsu da wasu kayan aiki masu ci gaba? Wannan tambaya ce da ya kamata kowane likitan tiyata ya sani kuma ya yi amfani da sabbin fasahohi da kayan aiki a fannin tiyatar jijiyoyin, wanda ke inganta haɓaka ƙwarewar tiyatar jijiyoyin.

1, Tarihin Aikace-aikacen Na'urar Duban Kwamfuta a Fagen Likitanci

A fannin kimiyyar lissafi, gilashin ido ruwan tabarau ne mai siffar convex tare da tsari ɗaya wanda ke da tasirin ƙara girma, kuma girmansu yana da iyaka, wanda aka sani da gilashin ƙara girma. A shekara ta 1590, mutane biyu 'yan ƙasar Holland sun sanya faranti biyu masu siffar convex a cikin wani siririn ganga mai siffar silinda, don haka suka ƙirƙiro na'urar ƙara girma ta farko a duniya:na'urar duban hoto (microscope)Bayan haka, tsarin na'urar hangen nesa ta ci gaba da ingantawa, kuma girmanta yana ƙaruwa akai-akai. A wancan lokacin, masana kimiyya galibi suna amfani da wannanna'urar haɗaɗɗen madubin hoto (compound microscope)don lura da ƙananan tsarin dabbobi da tsirrai, kamar tsarin ƙwayoyin halitta. Tun daga tsakiyar ƙarni na 19 zuwa ƙarshen ƙarni na 19, an yi amfani da gilashin ƙara girma da na'urorin hangen nesa a hankali a fannin likitanci. Da farko, likitocin fiɗa sun yi amfani da gilashin ƙara girma irin na gilashin ido tare da tsarin ruwan tabarau ɗaya wanda za a iya sanyawa a kan gadar hanci don tiyata. A shekarar 1876, likita ɗan ƙasar Jamus Saemisch ya yi tiyatar "ƙananan" ta farko a duniya ta amfani da gilashin ƙara girma na gilashin ido (ba a san nau'in tiyatar ba). A shekarar 1893, kamfanin Jamus Zeiss ya ƙirƙirona'urar hangen nesa ta madubi (binocular microscope), galibi ana amfani da shi don duba gwaje-gwaje a dakunan gwaje-gwaje na likitanci, da kuma don lura da raunukan corneal da na gaba a fannin ilimin ido. A shekarar 1921, bisa ga binciken dakin gwaje-gwaje kan ilmin halittar kunnen dabbobi na ciki, likitan kunne na Sweden Nylen ya yi amfani da wani maganin da aka gyara.na'urar hangen nesa ta monocularAn ƙera shi kuma aka ƙera shi da kansa don yin tiyatar otitis media ta yau da kullun ga mutane, wanda ainihin aikin tiyatar ƙananan ƙwayoyin cuta ne. Shekara ɗaya bayan haka, babban likitan Nylen Hlolmgren ya gabatar da wanina'urar hangen nesa ta binocular surgeryZeiss ne ya ƙera shi a ɗakin tiyata.

FarkonNa'urorin hangen nesa masu aikiyana da matsaloli da yawa, kamar rashin kwanciyar hankali na injiniya, rashin iya motsawa, hasken gatari daban-daban da dumama ruwan tabarau na zahiri, filin ƙara girman tiyata, da sauransu. Waɗannan duk dalilai ne da ke iyakance amfani da su.na'urorin hangen nesa na tiyataA cikin shekaru talatin masu zuwa, saboda kyakkyawar hulɗa tsakanin likitocin tiyata damasu kera na'urorin microscope, aikinna'urorin hangen nesa na tiyataan ci gaba da inganta shi, kumana'urorin duban tabarau na tiyata, na'urorin microscopes da aka ɗora a rufin, ruwan tabarau na zuƙowa, hasken tushen haske mai coaxial, hannun da aka sarrafa matsin lamba na lantarki ko ruwa, sarrafa feda ta ƙafa, da sauransu an ci gaba da haɓaka su a jere. A cikin 1953, kamfanin Jamus Zeiss ya samar da jerin na'urori na musamman.na'urar hangen nesa ta tiyata don otology, musamman ya dace da tiyatar raunuka masu zurfi kamar kunnen tsakiya da ƙashi na lokaci.na'urorin hangen nesa na tiyatayana ci gaba da ingantawa, tunanin likitocin tiyata yana canzawa koyaushe. Misali, likitocin Jamus Zollner da Wullstein sun tsara cewana'urorin hangen nesa na tiyatadole ne a yi amfani da shi don tiyatar gyaran membrane na tympanic. Tun daga shekarun 1950, likitocin ido sun canza tsarin amfani da na'urorin microscope kawai don gwajin ido kuma sun gabatar da shina'urorin microscope na otosurgicala cikin tiyatar ido. Tun daga lokacin,Na'urar hangen nesa mai aikiAn yi amfani da shi sosai a fannin ilimin ido da kuma ilimin ido.

2. Amfani da na'urar hangen nesa ta hanyar amfani ...

Saboda takamaiman aikin tiyatar neurosurgery, ana amfani da shi ta hanyar amfani dana'urorin microscopes na tiyata a cikin tiyatar neurosurgeryya ɗan yi jinkiri fiye da na ilimin ido da ido, kuma likitocin tiyatar jijiyoyi suna koyan wannan sabuwar fasaha sosai. A wancan lokacin,amfani da na'urorin hangen nesa na tiyatagalibi yana Turai. Likitan ido na Amurka Perrit ya fara gabatar da shina'urorin hangen nesa na tiyatadaga Turai zuwa Amurka a shekarar 1946, inda aka kafa harsashin amfani da likitocin jijiyoyin kwakwalwa na AmurkaNa'urorin hangen nesa masu aiki.

Daga mahangar girmama darajar rayuwar ɗan adam, duk wata sabuwar fasaha, kayan aiki, ko kayan aikin da ake amfani da su ga jikin ɗan adam ya kamata a yi gwaje-gwajen dabbobi na farko da kuma horar da su ta fasaha ga masu aiki. A shekarar 1955, likitan kwakwalwa na Amurka Malis ya yi wa dabbobi tiyatar kwakwalwa ta amfani da wanina'urar hangen nesa ta binocular surgeryKurze, likitan tiyatar jijiyoyi a Jami'ar Kudancin California da ke Amurka, ya shafe shekara guda yana koyon dabarun tiyatar amfani da na'urar hangen nesa a dakin gwaje-gwaje bayan ya lura da tiyatar kunne ta amfani da na'urar hangen nesa. A watan Agusta na shekarar 1957, ya yi nasarar yin tiyatar jijiyoyi ta acoustic neuroma ga wani yaro ɗan shekara 5 ta amfani da na'urar hangen nesa ta acoustic neuroma.na'urar duba kunne ta microscope, wanda shine tiyatar tiyata ta farko a duniya ta hanyar amfani da microsurgical. Ba da daɗewa ba bayan haka, Kurze ya yi nasarar yin tiyatar hana jijiya ta hanyar amfani da na'urar auna jijiya ta fuskar ɗan adam ta hanyar amfani dana'urar hangen nesa ta tiyata, kuma murmurewar yaron ta yi kyau kwarai da gaske. Wannan ita ce tiyatar tiyata ta biyu a duniya. Bayan haka, Kurze ya yi amfani da manyan motoci don ɗaukar jariri.Na'urorin hangen nesa masu aikizuwa wurare daban-daban don aikin tiyatar jijiyoyin ƙwaƙwalwa na microsurgical, kuma sun ba da shawarar yin amfani da shi sosaina'urorin hangen nesa na tiyataga sauran likitocin tiyatar jijiyoyi. Bayan haka, Kurze ya yi tiyatar yanke bugun zuciya ta hanyar amfani da wanina'urar hangen nesa ta tiyata(abin takaici, bai buga wani labari ba). Tare da goyon bayan wani majiyyaci mai fama da cutar trigeminal neuralgia da ya yi wa magani, ya kafa dakin gwaje-gwaje na farko a duniya na tiyatar jijiyoyin kwakwalwa a shekarar 1961. Ya kamata mu tuna da gudunmawar Kurze ga tiyatar ƙananan ƙwayoyin cuta kuma mu koya daga jarumtarsa ​​ta karɓar sabbin fasahohi da ra'ayoyi. Duk da haka, har zuwa farkon shekarun 1990, wasu likitocin jijiyoyin kwakwalwa a China ba su yarda ba.na'urorin hangen nesa na jijiyoyidon tiyata. Wannan ba matsala ba ce daNa'urar hangen nesa ta jijiyoyi (neurotherapy microscope)kanta, amma matsala ce da fahimtar akidar likitocin jijiyoyin kwakwalwa.

A shekarar 1958, likitan tiyatar kwakwalwa na Amurka Donaghy ya kafa dakin gwaje-gwaje na farko a duniya na bincike da horar da ƙananan tiyata a Burlington, Vermont. A farkon matakai, ya kuma fuskanci rudani da matsalolin kuɗi daga manyansa. A fannin ilimi, koyaushe yana tunanin yanke jijiyoyin jini na cortical don cire thrombi kai tsaye daga marasa lafiya da ke fama da thrombosis na kwakwalwa. Don haka ya yi aiki tare da likitan tiyata Jacobson kan binciken dabbobi da na asibiti. A wancan lokacin, a ƙarƙashin yanayin ido tsirara, ƙananan jijiyoyin jini ne kawai waɗanda diamitansu ya kai milimita 7-8 ko fiye za a iya dinka su. Domin cimma nasarar rage jijiyar jini mai kyau daga ƙarshe zuwa ƙarshe, Jacobson ya fara ƙoƙarin amfani da gilashin ƙara girman gilashi. Ba da daɗewa ba, ya tuna da amfani dana'urar duban dan tayi ta otolaryngologydon tiyata lokacin da yake likita a wurin. Don haka, tare da taimakon Zeiss a Jamus, Jacobson ya ƙera na'urar hangen nesa ta tiyata mai aiki biyu (Diploscope) don maganin hana jijiyoyin jini, wanda ke ba wa likitocin tiyata biyu damar yin tiyatar a lokaci guda. Bayan gwaje-gwajen dabbobi masu yawa, Jacobson ya buga wani kasida kan maganin hana jijiyoyin jini na ƙananan ƙwayoyin cuta (microsurgical anastomosis) na karnuka da jijiyoyin da ba na carotid ba (1960), tare da ƙimar hana jijiyoyin jini na kashi 100%. Wannan takarda ce ta likita mai ban mamaki da ta shafi aikin tiyatar jijiyoyin jini na ƙananan ƙwayoyin cuta da tiyatar jijiyoyin jini. Jacobson ya kuma ƙera kayan aikin tiyata da yawa, kamar ƙananan almakashi, masu riƙe allurar ƙananan ƙwayoyin cuta, da handle na ƙananan ƙwayoyin cuta. A shekarar 1960, Donaghy ya yi nasarar yin tiyatar yanke jijiyoyin kwakwalwa ta hanyar yanke jijiyoyin kwakwalwa a ƙarƙashin wanina'urar hangen nesa ta tiyataga majiyyaci da ke fama da toshewar jijiyoyin kwakwalwa. Rhoton daga Amurka ya fara nazarin tsarin kwakwalwa ta hanyar amfani da na'urar hangen nesa a shekarar 1967, inda ya fara wani sabon fanni na tsarin jijiyoyin jini da kuma bayar da gagarumar gudummawa ga ci gaban tsarin tiyatar kwakwalwa. Saboda fa'idodinna'urorin hangen nesa na tiyatada kuma inganta kayan aikin tiyata na microsurgical, ƙarin likitocin tiyata suna son amfani da suna'urorin hangen nesa na tiyatadon tiyata. Kuma sun buga labarai da yawa masu alaƙa kan hanyoyin tiyatar microsurgical.

3. Amfani da na'urar hangen nesa ta tiyata a fannin tiyatar jijiyoyi a kasar Sin

A matsayinsa na ɗan ƙasar Sin mai kishin ƙasa a ƙasashen waje a Japan, Farfesa Du Ziwei ya bayar da gudummawar farko ta gida ga ƙasar.na'urar hangen nesa ta kwakwalwa (neurotherapy microscope)da kuma alaƙakayan aikin tiyata na microsurgicalzuwa Sashen Kula da Jijiyoyin Jijiyoyi na Asibitin Kwalejin Likitanci ta Suzhou (wanda yanzu shine Sashen Kula da Jijiyoyin Jijiyoyi na Asibitin Farko na Jami'ar Suzhou) a shekarar 1972. Bayan ya dawo kasar Sin, ya fara yin tiyatar tiyata ta microsurgical kamar su aneurysms na cikin kwakwalwa da kuma meningiomas. Bayan ya koyi yadda ake samun suna'urorin hangen nesa na jijiyoyida kuma kayan aikin tiyata na ƙananan ƙwayoyin cuta, Farfesa Zhao Yadu daga Sashen Kula da Jijiyoyi na Asibitin Yiwu na Beijing ya ziyarci Farfesa Du Ziwei daga Kwalejin Kiwon Lafiya ta Suzhou don lura da amfani da kayan aikin tiyata na ƙananan ƙwayoyin cuta.na'urorin hangen nesa na tiyataFarfesa Shi Yuquan daga Asibitin Huashan na Shanghai ya ziyarci sashen Farfesa Du Ziwei da kansa don lura da hanyoyin tiyatar ƙananan ƙwayoyin cuta. Sakamakon haka, an sami ci gaba ta hanyar gabatarwa, koyo, da amfani da su.na'urorin hangen nesa na jijiyoyian fara aikin tiyatar jijiyoyi a manyan cibiyoyin tiyatar jijiyoyi a China, wanda hakan ya nuna farkon aikin tiyatar jijiyoyi na ƙananan ƙwayoyin cuta na China.

4, Tasirin Tiyatar Microsurgery

Sakamakon amfani dana'urorin hangen nesa na jijiyoyi, tiyatar da ba za a iya yi da ido tsirara za ta zama mai yiwuwa a ƙarƙashin yanayin girmanta sau 6-10. Misali, yin tiyatar ciwon pituitary ta hanyar sinus na ethmoidal zai iya gano da kuma cire ciwon pituitary lafiya yayin da yake kare glandar pituitary ta al'ada; Tiyatar da ba za a iya yi da ido tsirara na iya zama mafi kyawun tiyata, kamar ciwace-ciwacen kwakwalwa da ciwace-ciwacen intramedullary na kashin baya. Masanin ilimi Wang Zhongcheng yana da adadin mace-mace na kashi 10.7% don tiyatar aneurysm ta kwakwalwa kafin amfani dana'urar hangen nesa ta kwakwalwa (neurotherapy microscope)Bayan amfani da na'urar hangen nesa a shekarar 1978, adadin mace-macen ya ragu zuwa kashi 3.2%. Yawan mace-macen da ake samu a tiyatar kwakwalwa ta malformation ba tare da amfani da na'urar hangen nesa bana'urar hangen nesa ta tiyataya kasance kashi 6.2%, kuma bayan 1984, tare da amfani da wanina'urorin hangen nesa na jijiyoyin jini, yawan mace-mace ya ragu zuwa kashi 1.6%.na'urar hangen nesa ta kwakwalwa (neurotherapy microscope)Yana ba da damar magance ciwon daji na pituitary ta hanyar amfani da hanyar transsphenoidal mai ɗan mamayewa ba tare da buƙatar craniotomy ba, wanda ke rage yawan mace-macen tiyata daga 4.7% zuwa 0.9%. Samun nasarar waɗannan sakamakon ba zai yiwu ba a ƙarƙashin tiyatar ido ta gargajiya, don hakana'urorin hangen nesa na tiyataalama ce ta aikin tiyatar jijiyoyi ta zamani kuma sun zama ɗaya daga cikin kayan aikin tiyata marasa mahimmanci kuma marasa maye gurbinsu a cikin aikin tiyatar jijiyoyi ta zamani.