随着现代医学技术的发展,微创外科手术在临床上广泛开展,而腹腔镜外科技术是外科微创化的重要组成部分。清晰的手术视野是腹腔镜手术的关键,因此腔镜镜头的防雾处理关重要。在进行腔镜手术过程中,由于体腔温度和体外温度相差较大,部分水蒸气遇到冷的腔镜镜头后容易凝聚形成一层雾,从而影响术野呈现在显示器上的清晰度,影响手术操作。多年来,临床采用传统镜头预热方法进行防雾处理,但该方法在实际应用中,经常会发生热盐水撒出、烫伤、镜头倒翻等现象,增加了术中污染和镜头损坏的几率。
With the development of modern medical technology, minimally invasive surgery is widely carried out in clinic, and laparoscopic surgery is an important part of minimally invasive surgery. Clear surgical field of vision is the key to the safety of laparoscopic surgery, so the anti fog treatment of endoscopic lens is very important. In the process of endoscopic surgery, due to the large difference between the body cavity temperature and the external temperature, some of the water vapor is easy to condense and form a layer of fog after encountering the cold endoscopic lens, thus affecting the clarity of the surgical field on the display and the operation. For many years, the traditional lens preheating method has been used to prevent fogging in clinic, but in practical application, hot salt water is often spilled, scalded and lens overturned, which increases the probability of intraoperative pollution and lens damage.
镜头总是模糊不清,反复擦拭镜头,将会浪费大量时间,也会带来不因素。这就要求扶镜手要善于快速处理镜头起雾及污染问题,尽可能长久的保持视野的清晰,接下来就由
内窥镜维修公司给大家分享一下方法。
The lens is always blurry. Repeatedly wiping the lens will waste a lot of time and bring unsafe factors. This requires that the hand holding the mirror should be good at dealing with the problem of lens fogging and pollution quickly, and keep the vision clear for as long as possible. Next, the endoscope maintenance company will share the solutions.
镜头起雾和污染的方法主要有:
The main solutions to fog and pollution of lens are as follows:
(1)购置带镜头自加热的腔镜设备,但大部分无此功能;
(1) Purchase the cavity mirror equipment with lens self heating, but most brands do not have this function;
(2)镜头涂抹防雾剂,贵、成本高;
(2) Lens coating antifogging agent, expensive, high cost;
(3)碘伏纱布擦拭,成本较低,视野易发黄;
(3) Iodophor gauze wipe, low cost, easy to yellow vision;
(4)将镜头回缩 Trocar内,利用镜头 Trocar 内注入的相对低温的 CO2 气流使视野变清晰,但易反复;
(4) The lens is retracted into trocar, and the field of vision is clear by the relatively low temperature CO2 air flow injected into trocar, but it is easy to repeat;
(5)保温杯装热水浸泡镜头,水温保持在60 ~ 70℃,开始浸泡镜头时间要稍长,约 1 分钟,好让镜头充分预热,高于腹腔内温度。此后,每次镜头模糊后浸泡时间仅需几秒即可。此法过程较为繁琐。
(5) The lens shall be soaked in hot water in a sterilized heat preservation cup. The water temperature shall be kept at 60-70 ℃, and the lens shall be soaked for a little longer time, about 1 minute, so as to fully preheat the lens, which is higher than the temperature in the abdominal cavity. After that, it only takes a few seconds to soak the lens after each blur. The process of this method is complicated.
另外每次置入镜头前需将的密封垫内的组织或血液清理干净,可以通过旋转镜身来避开 Trocar下端的血液;进出动作要迅速,避免镜身在体外太久而降温。
In addition, the tissue or blood in the gasket should be cleaned before each lens is put into the lens, and the blood at the lower end of trocar can be avoided by rotating the mirror body; the movement in and out should be rapid, so as to prevent the mirror body from cooling for too long in vitro.
当急性大出血污染镜头时,切不可拔出镜头擦拭,这样可能会错失处理的好时机,此时可以借助脏器浆膜面(多选择未被污染的胃、肠浆膜面)快速而轻柔地擦拭镜头。不要选择系膜或网膜表面,可能使镜头沾染油脂而更加模糊;也不要选择肝脏或脾脏这类实质性脏器,防止损伤。当术者出血后,扶镜手应重新擦拭镜头。
When the lens is polluted by acute massive hemorrhage, the lens must not be pulled out for wiping, which may miss the good opportunity of treatment. At this time, the lens can be wiped quickly and gently with the help of the visceral serous surface (mostly the unpolluted gastric and intestinal serous surface). Do not choose the surface of the mesentery or omentum, which may make the lens stained with grease and more fuzzy; do not choose the liver or spleen, which is a kind of substantive organ, to prevent damage. When the surgeon solves the bleeding, the lens should be wiped again by the hand holding the mirror.
为使手术进程自然顺畅,扶镜手应尽可能少的擦拭镜头。这就需要扶镜手时刻做好对镜头的保护。比如在能量平台刀头烧灼组织时应将镜头适当退回规避调为远距,防止组织液或血液飞溅污染镜头,待烧灼完成适时调回原来视距。
In order to make the operation process natural and smooth, the hand holding the mirror should wipe the lens as little as possible. This requires the hand holding the mirror to protect the lens at all times. For example, when the knife head of the energy platform burns tissue, the lens should be properly returned to avoid being adjusted to a long distance to prevent tissue fluid or blood splashing from polluting the lens. When the burning is completed, the original sight distance should be adjusted in time.
扶镜手的任务是为手术者提供清晰稳定的手术图像。且随着手术进程变化,提供远近范围和角度适当的视野。也就是说,扶镜手充当的是术者“双眼”的作用。这就要求扶镜手要对手术过程步骤及术者的手术习惯烂熟于胸,要跟手术者保持足够的默契。
The task of the hand holding the mirror is to provide the surgeons with clear and stable surgical images. With the change of the operation process, it can provide a proper field of vision. In other words, the hand holding the mirror acts as the "eyes" of the performer. This requires that the hand holding the mirror should be familiar with the operation procedure and the operation habit of the operator, and keep enough tacit understanding with the operator.
The above is about the solution to the fog pollution of the endoscope lens. If you want to know more about the endoscope, please consult the official website of the endoscope maintenance company http://www.jiangrenyiliao.cn 。