【Contraindications】

1) Kusayenerera m'maganizo kapena thupi pakuchita opaleshoni nthawi zambiri

2) Kutaya magazi kwambiri komanso kusokonezeka kwamagazi.

3) Maselo oyera amagazi osakwana 3 × 109/L

4) Zosagwirizana ndi media media

5) Kuphatikizidwa ndi matenda aakulu a m'mapapo a m'mapapo.

6) Odwala omwe amadziwika kapena akuganiziridwa kuti ndi osagwirizana ndi zinthu zomwe zili mu phukusi la chipangizocho..

7) Kukhalapo kapena kukayikira za matenda okhudzana ndi chipangizo, bacteraemia kapena sepsis.

8) Radiotherapy pamalo omwe amayikidwa.

9) Kujambula kapena jekeseni wa mankhwala embolic.

 

【Manufacturedate】 Onani zolemba zamalonda

 

【Zothera nthawi】 Onani zolemba zamalonda

 

【Njira yogwiritsira ntchito】

1. Konzani chipangizo cha doko choyikidwa ndikuwona ngati tsiku lotha ntchito ladutsa; chotsani phukusi lamkati ndikuwona ngati phukusi likuwonongeka.
2. Ayenera kugwiritsa ntchito njira za aseptic kudula tsegulani phukusi lamkati ndikuchotsa mankhwala kuti akonzekere kugwiritsa ntchito.
3. Kugwiritsiridwa ntchito kwa zipangizo zamadoko zomwe zimayikidwa zimafotokozedwa padera pa chitsanzo chilichonse motere.

 

MtunduⅠ

1. Kutuluka, kutulutsa mpweya, kuyesa kutayikira

Gwiritsirani ntchito syringe (singano pachipangizo chothirira) kuboola cholumikizira choyikapo ndikubaya 5mL-10mL ya saline yapathupi kuti mutulutse mpando wa jakisoni ndi lumen ya catheter ndikupatula. Ngati palibe kapena madzi pang'onopang'ono akupezeka, potozani mapeto operekera mankhwala a catheter (mapeto a distal) ndi dzanja kuti mutsegule doko loperekera mankhwala; ndiye Pindani anatseka mapeto operekera mankhwala a catheter, pitirizani kukankhira saline (kukakamiza osapitirira 200kPa), muwone ngati pali kutuluka kwa mpando wa jekeseni ndi kugwirizana kwa catheter, pambuyo pa zonse zachilendo Pambuyo pa zonse, catheter ingagwiritsidwe ntchito.

1. Cannulation ndi ligation

Malinga ndi kafukufuku wa intraoperative, ikani catheter (mapeto operekera mankhwala) mu chotengera chotengera magazi molingana ndi malo a chotupacho, ndipo gwiritsani ntchito ma sutures osayamwa kuti amangirire catheter m'chombocho. Catheter iyenera kulumikizidwa bwino (madutsa awiri kapena kuposerapo) ndikukhazikika.

1. chemotherapy ndi kusindikiza

Intraoperative chemotherapy mankhwala akhoza kubayidwa kamodzi malinga ndi dongosolo la chithandizo; Ndikoyenera kuti mpando wa jakisoni ndi catheter lumen zitsukidwe ndi 6-8 mL ya saline ya thupi, yotsatiridwa ndi 3 mL ~ 5 mL Kathetayo imasindikizidwa ndi 3mL mpaka 5mL ya saline ya heparin pa 100U/mL mpaka 200U/mL.

1. Kukonzekera kwa jekeseni mpando

Pansi pa cystic cavity imapangidwa pamalo othandizira, omwe ndi 0.5 cm mpaka 1 masentimita kuchokera pakhungu, ndipo mpando wa jekeseni umayikidwa muzitsulo ndikukhazikika, ndipo khungu limatsukidwa pambuyo pa hemostasis yovuta. Ngati catheter ndi yayitali kwambiri, imatha kukulungidwa mozungulira kumapeto kwa proximal ndikukhazikika bwino.

 

MtunduⅡ

1.Kutuluka ndi kutulutsa mpweya

Gwiritsirani ntchito syringe (singano ya chipangizo cholowetsa khomo) kubaya saline mumpando wa jakisoni ndi catheter motsatana kuti mutulutse ndi kuchotsa mpweya mu lumen, ndikuwona ngati madzimadzi a conduction ali osalala.

2. Cannulation ndi ligation

4. Kutayikira mayeso

4. Kulumikiza kukamalizidwa, pindani ndi kutseka catheter kumbuyo kwa chotchinga chotsekera ndikupitiriza kubaya saline mu mpando wa jekeseni ndi syringe (singano ya chipangizo choperekera mankhwala) (kupanikizika kwa 200kPa). (kupanikizika kosapitilila 200kPa), onani ngati pali kutayikira kwa jekeseni ndi catheter

kugwirizana, ndi ntchito pokhapokha ngati zonse zili bwino.

5. Chemotherapy, chubu chosindikizira

Intraoperative chemotherapy mankhwala akhoza kubayidwa kamodzi malinga ndi dongosolo la chithandizo; Ndibwino kuti mutsuke jekeseni ndi catheter lumen ndi 6 ~ 8mL ya saline yokhudzana ndi thupi, ndiyeno mugwiritse ntchito 3mL ~ 5mL ya saline ya thupi.

Kathetayo amasindikizidwa ndi 3mL mpaka 5mL ya saline ya heparin pa 100U/mL mpaka 200U/mL.

6. Jekeseni mpando fixation

Pansi pa cystic cavity idapangidwa pamalo othandizira, 0.5 cm mpaka 1 cm kuchokera pakhungu, ndipo mpando wa jekeseni udayikidwa pabowo ndikukhazikika, ndipo khungu lidadulidwa pambuyo pa hemostasis yovuta.

 

Mtundu Ⅲ

Sirinji (singano yapadera ya chipangizo choyikira doko) idagwiritsidwa ntchito kubaya 10mL ~ 20mL saline wamba mu chipangizo choperekera mankhwala kuti atsitse mpando wa jekeseni ndi pabowo la catheter, ndikuchotsa mpweya m'bowo, ndikuwona ngati madziwo atuluka. anali wodabwitsa.

2. Cannulation ndi ligation

Malinga ndi kufufuza kwa intraoperative, ikani catheter m'mphepete mwa khoma la m'mimba, ndipo mbali yotseguka ya mapeto a catheter iyenera kulowa m'mimba ndikukhala pafupi ndi chotupacho momwe mungathere. Sankhani 2-3 mfundo kuti ligate ndi kukonza catheter.

3. chemotherapy, chubu chosindikizira

Intraoperative chemotherapy mankhwala akhoza kubayidwa kamodzi malinga ndi dongosolo la chithandizo, ndiyeno chubucho chimasindikizidwa ndi 3mL ~ 5mL ya 100U/mL ~ 200U/mL heparin saline.

4. Jekeseni mpando fixation

Pansi pa cystic cavity idapangidwa pamalo othandizira, 0.5 cm mpaka 1 cm kuchokera pakhungu, ndipo mpando wa jekeseni udayikidwa pabowo ndikukhazikika, ndipo khungu lidadulidwa pambuyo pa hemostasis yovuta.

Mankhwala kulowetsedwa ndi chisamaliro

A.Opaleshoni ya aseptic mosamalitsa, kusankha kolondola kwa malo opangira jakisoni musanabayidwe, komanso kupha tizilombo toyambitsa matenda pamalo obaya jakisoni.B. Pobaya, gwiritsani ntchito singano pachipangizo chothirira, syringe ya 10 mL kapena kupitilira apo, chala chakumanzere chakumanja chikugwira pamalo obowola ndipo chala chachikulu chimalimbitsa khungu ndikukonza mpando, dzanja lamanja litagwira syringe. molunjika mu singano, kupewa kugwedezeka kapena kuzungulira, ndikubaya pang'onopang'ono saline 5 mL ~ 10 mL pakakhala kugwa ndipo nsonga ya singano imakhudza pansi pa mpando wa jekeseni, ndikuwona ngati njira yoperekera mankhwala ndi yosalala. (ngati sizosalala, muyenera kuyang'ana kaye ngati singano yatsekedwa). Yang'anani ngati pali kukwera kulikonse kwa khungu lozungulira pokankha.

C. Kankhirani mankhwala a chemotherapeutic pang'onopang'ono mutatsimikizira kuti palibe cholakwika. Panthawi yokankhira, samalani kuti muwone ngati khungu lozungulira likukwera kapena lotuwa, komanso ngati pali ululu wamba. Mankhwalawa akakankhidwa, ayenera kusungidwa kwa 15s ~ 30s.

D. Pambuyo pa jekeseni iliyonse, tikulimbikitsidwa kuti muzitsuka mpando wa jekeseni ndi catheter lumen ndi 6 ~ 8mL ya saline yokhudzana ndi thupi, ndikusindikiza catheter ndi 3mL ~ 5mL ya 100U/mL ~ 200U/mL ya saline ya heparin, ndipo pamene yomaliza. 0.5mL ya saline ya heparin ndi jekeseni, mankhwalawa amayenera kukankhidwa pamene akubwerera, kuti dongosolo loyambitsa mankhwala lidzazidwe ndi heparin saline kuteteza crystallization ya mankhwala ndi magazi coagulation mu catheter. Katheta ayenera kuthiridwa ndi heparin saline kamodzi pa milungu iwiri iliyonse panthawi ya chithandizo chamankhwala.

E. Mukabaya jekeseni, tetezani diso la singano ndi mankhwala ophera tizilombo toyambitsa matenda, phimbani ndi chovala chosabala, ndipo samalani kuti dera lanu likhale laukhondo komanso louma kuti mupewe matenda pamalo obowola.

F. Samalani momwe wodwalayo amachitira pambuyo popereka mankhwala ndikuyang'anitsitsa panthawi ya jekeseni wa mankhwala.

 

【Chenjezo, chenjezo ndi zopatsa chidwi】

1. Izi zimatsukidwa ndi ethylene oxide ndipo zimakhala zomveka kwa zaka zitatu.
2. Chonde werengani buku la malangizo musanagwiritse ntchito kuti mutsimikizire chitetezo cha ntchito.
3. Kugwiritsiridwa ntchito kwa mankhwalawa kuyenera kutsatizana ndi zofunikira za malamulo okhudzana ndi machitidwe ndi malamulo a zachipatala, ndipo kuyika, kugwira ntchito ndi kuchotsa zipangizozi ziyenera kuperekedwa kwa madokotala ovomerezeka okha.Kuyika, kugwira ntchito ndi kuchotsa zipangizozi ndi zoletsedwa kwa madokotala ovomerezeka, ndipo chisamaliro chapambuyo pa chubu chiyenera kuchitidwa ndi ogwira ntchito zachipatala oyenerera.
4. Njira yonseyi iyenera kuchitidwa pansi pa zochitika za aseptic.
5. Yang'anani tsiku lotha ntchito ya mankhwala ndi phukusi lamkati kuti liwonongeke musanayambe ndondomeko.
6. Mukagwiritsidwa ntchito, mankhwalawa angayambitse zoopsa zamoyo. Chonde tsatirani machitidwe ovomerezeka azachipatala ndi malamulo onse okhudzana ndi kasamalidwe ndi chithandizo.
7. Musagwiritse ntchito mphamvu mopitirira muyeso pa intubation ndikuyika mtsempha wamagazi molondola komanso mofulumira kuti mupewe vasospasm. Ngati intubation ndi yovuta, gwiritsani ntchito zala zanu kuti mutembenuzire catheter kuchokera mbali ndi mbali pamene mukulowetsa chubu.
8. Kutalika kwa catheter yoyikidwa m'thupi kuyenera kukhala koyenera, kutalika kwambiri kumakhala kosavuta kupindika mu ngodya, zomwe zimapangitsa kuti mpweya wabwino ukhale wochepa, wamfupi kwambiri ndi pamene zochitika zachiwawa za wodwala zimakhala ndi mwayi wotuluka m'chombo. Ngati catheter ndi yaifupi kwambiri, ikhoza kuchoka m'chotengera pamene wodwalayo akuyenda mwamphamvu.
9. Catheter iyenera kuyikidwa m'chombocho ndi ma ligatures opitilira awiri ndikumangika koyenera kuti awonetsetse kuti jekeseni wamankhwala wosalala komanso kuti catheter isagwe.
10. Ngati chipangizo cha doko choyikidwa ndi mtundu II, kugwirizana pakati pa catheter ndi mpando wa jekeseni kuyenera kukhala kolimba. Ngati jekeseni wa intraoperative sikufunika, jekeseni wamba wa saline woyezetsa ayenera kugwiritsidwa ntchito potsimikizira musanawombe pakhungu.
11. Pamene kulekanitsa subcutaneous dera, pafupi hemostasis ayenera kuchitidwa kupewa mapangidwe hematoma m`deralo, madzi kudzikundikira kapena matenda yachiwiri pambuyo opaleshoni; vesicular suture ayenera kupewa jekeseni mpando.
12. Zomatira zachipatala za α-cyanoacrylate zingayambitse kuwonongeka kwa zinthu zoyambira jekeseni; musagwiritse ntchito zomatira zachipatala za α- cyanoacrylate pochiza opangira opaleshoni mozungulira jekeseni. Musagwiritse ntchito zomatira zachipatala za α-cyanoacrylate pamene mukuchita opaleshoni yozungulira jekeseni.
13. Samalani kwambiri kuti catheter isatayike chifukwa chovulala mwangozi ndi zida zopangira opaleshoni.
14. Poboola, singano iyenera kuyikidwa molunjika, syringe yokhala ndi mphamvu ya 10mL kapena kupitilira apo, mankhwalawa ayenera kubayidwa pang'onopang'ono, ndipo singanoyo iyenera kuchotsedwa ikangopuma pang'ono. Kukakamiza kokankhira sikuyenera kupitirira 200kPa.
15. Gwiritsani ntchito singano zapadera pazida zoperekera mankhwala.
16. Pamene kulowetsedwa kwautali kapena kulowetsedwa kwa mankhwala kumafunika, ndi koyenera kugwiritsa ntchito chipangizo chogwiritsira ntchito kamodzi kokha chokhala ndi payipi yapadera ya singano kapena tee, kuti muchepetse chiwerengero cha punctures ndi kuchepetsa zotsatira za wodwalayo.
17. Chepetsani kuchuluka kwa ma punctures, kuchepetsa kuwonongeka kwa minofu ya wodwalayo ndikudzisindikizira mbali zotanuka. Panthawi yosiya jekeseni, jekeseni ya anticoagulant imafunika kamodzi pa sabata ziwiri zilizonse.
18. Izi ndizogwiritsidwa ntchito kamodzi, zosabala, zopanda pyrogenic, zowonongedwa pambuyo pa kugwiritsidwa ntchito, kugwiritsidwanso ntchito ndikoletsedwa.
19. Ngati phukusi lamkati lawonongeka kapena tsiku lotha ntchito ladutsa, chonde libwezereni kwa wopanga kuti liwonongeke.
20. Chiwerengero cha ma puncture pa chipika chilichonse cha jakisoni sichiyenera kupitirira 2000 (22Ga). 21.
21. Mlingo wocheperako ndi 6ml