8/14/2019 Can Ban PTNS

1/5

NGOI KHOA LM SNG- 2007

CN BN PHU THUT NI SOI

1-c im chung ca phu thut ni soi (PTTN):

Cuc phu thut c tin hnh bng cc dung c thao tc, thng qua cc cng thao tcc gi l phu thut ni soi.

Cng thao tc: kch thc khng qu 12 mm, c t qua cc ng rch nh trnthnh bng hay thnh ngc.

Phu trng thao tc trong phu thut ni soi:

o Xoang bng: c to ra bng bm hi xoang bng.o Lng ngc: nhc khung sn v phi xp khi vo xoang lng ngc nn to

c phu trng t nhin.

Kh bm hi (CO2) c c im:

o Khng gy chy no C ho tan tt trong cth

2-Dng c v trang thit b:

Cc thit b quang hc: Dng c thao tc:ng soi bng, 10mm, 100 v 300. Kp khng sang chn (grasper)Camera Dng c bc tch (dissector)

Ngun sng KoVideo monitor ng htVideo recorder Kp (clip)

Cc thit b tip cn: Dng c khu ni bng my (stappler)Bnh cha CO2 Ti ng mu bnh phmMy bm hi v kim sot p lc Kim khuCc trocar Km cp kim

Dung c thao tc ring cho PTNS lng ngc:Kp tam gicRing forcep

3-Phu thut ni soi xoang bng:

3.1-Thay i sinh l:

Lin quan n CO2:

o Bnh thng: CO2 h p thu vo mu, c m bi cc h thng m sau cthi ra ngoi qua ng h hp. pH huyt tng v th khng thay i.

o Khi thng kh km hiu qu: CO2 b li, dn n toan chuyn ho.Lin quan n bm hi xoang bng:

o H tun hon: Tng p lc tnh mch nhphi, tng p lc ng mch phi bt Th tch tng mu tht: khng thay i hay gim nh Tng p lc ng mch trung bnh v tng khng lc ngoi bin Nhp tim tng nh, nhng sau duy tr n nh

143

8/14/2019 Can Ban PTNS

2/5

8/14/2019 Can Ban PTNS

3/5

8/14/2019 Can Ban PTNS

4/5

NGOI KHOA LM SNG- 2007

o Vic t cc trocar tip theo phi c tin hnh di s quan st trc tip trn mnhnh monitor

o V tr t trocar: khoang gian sn, ngay btrn xng sn trnh tn thng bmch lin sn

o iu quan trng nht khi tin hnh phu thut l vic nhn bit sang thng nmchm trong nhu m phio Trc khi kt thc cuc phu thut:

1. t ng dn lu xoang mng phi, qua cc lt trocar2. Cnh ng dn lu3. Khu kn cc l trocar4. Bm thng ph qun cho phi ntt5. Kp ng dn lu6. Ni ng dn lu vo h thng bnh kn (siphonage)7. Mkp

Chp kim tra phi 24 gisau phu thut. Ch rt ng dn lu khi phi ntt v khngc kh x qua ng dn lu.

4.3-u im

o Thm m, c bit lm BN rt hi lngo t auo Thi gian nm vin ngno t bin chng hu phu4.4-Bin chng

o Chy muo D kho Lon nhp timo Xp phio Vim phio

Ph thuc my tho M mng phio Nhim trng vt thngo Tn thng gy ra do trocaro Nhi mu ctim4.5-Cc chnh cho PTNS lng ngc:

o Nt n c/ khi u phi (kch thc

8/14/2019 Can Ban PTNS

5/5

NGOI KHOA LM SNG- 2007

o Trn kh mng phio Dy dnh mng phio M mng phio Trn dch mng timo Hch trung thto Tng tit m hi tay (ct thn kinh giao cm ngc)o Trn mu mng phi/mu ng mng phio Nang trung thto Co tht tm v

147