【Contraindications】

1) Psychological ma ọ bụ ahụ adịghị mma maka ịwa ahụ na ọnọdụ izugbe

2) Ọbara ọbara siri ike na ọrịa coagulation.

3) Ọnụ ọgụgụ mkpụrụ ndụ ọbara ọcha na-erughị 3×109/L

4) Ihe nfụkasị na mgbasa ozi dị iche

5) Ejikọtara ya na ọrịa na-adịghị ala ala na-adịghị ala ala.

6) Ndị ọrịa nwere ihe nfụkasị ahụ amaara ma ọ bụ nke a na-enyo enyo na ihe ndị dị na ngwugwu ngwaọrụ.

7) Ọnụnọ ma ọ bụ enyo enyo nke ọrịa metụtara ngwaọrụ, bacteremia ma ọ bụ sepsis.

8) Radiotherapy na saịtị nke echere ntinye.

9) Onyonyo ma ọ bụ ịgba ọgwụ embolic.

 

【Ụbọchị emepụtara】 Hụ akara ngwaahịa

 

【Ebibi 】 Hụ akara ngwaahịa

 

【Usoro ngwa】

1. Kwadebe ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye ma lelee ma ọ bụrụ na ụbọchị njedebe gafere; wepụ ngwugwu ime ma lelee ma ngwugwu ahụ mebiri emebi.
2. Kwesịrị iji usoro aseptic belata imeghe ngwugwu dị n'ime wee wepụ ngwaahịa ahụ maka nkwadebe maka ojiji.
3. A na-akọwa iji ngwaọrụ ọdụ ụgbọ mmiri dị iche iche maka ụdị ọ bụla dị ka ndị a.

 

Ụdị Ⅰ

1. Ntugharị, ikuku ikuku, nnwale ntapu

Jiri sirinji ( agịga maka ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye) ka ịpịa ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye wee gbanye 5mL-10mL nke saline physiological iji wụsa oche ịgba ntụtụ na catheter lumen wee wepu ya. Ọ bụrụ na achọtaghị mmiri ma ọ bụ nwayọ nwayọ, tụgharịa njedebe nnyefe ọgwụ nke catheter (njedebe distal) site n'aka iji mepee ọdụ ụgbọ mmiri ọgwụ; Mgbe ahụ, Fold mechiri njedebe nnyefe ọgwụ nke catheter, na-aga n'ihu na-agbanye saline (nrụgide na-erughị 200kPa), lelee ma enwere ike ịpụ site na oche injection na njikọ catheter, mgbe ọ bụla nkịtị Mgbe ihe niile dị mma, enwere ike iji catheter mee ihe.

1. Cannulation na ligation

Dika nyocha nke intraoperative siri kwuo, tinye catheter (njedebe nnyefe ọgwụ) n'ime arịa ọbara kwekọrọ na ọnọdụ etuto ahụ si dị, ma jiri suture na-adịghị amị mkpụrụ iji jikọta catheter nke ọma na arịa ahụ. A ga-ejikọta catheter nke ọma (paịk abụọ ma ọ bụ karịa) ma dozie ya.

1. chemotherapy na akara

Enwere ike ịgbanye ọgwụ chemotherapy intraoperative otu ugboro dịka atụmatụ ọgwụgwọ siri dị; a na-atụ aro na oche injection na catheter lumen ga-eji 6-8 mL nke saline physiological saline, na-esote 3 ml ~ 5 mL A na-emechi catheter na 3mL ruo 5mL nke saline heparin na 100U / mL na 200U / ml.

1. Ndozi oche injection

A na-emepụta oghere cystic subcutaneous na ebe nkwado, nke dị 0,5 cm na 1 cm site na akpụkpọ anụ ahụ, a na-etinye oche injection n'ime oghere ma dozie ya, na akpụkpọ ahụ na-ekpuchi ya mgbe hemostasis siri ike. Ọ bụrụ na catheter dị ogologo nke ukwuu, enwere ike ijikọ ya n'okirikiri na njedebe dị nso ma dozie ya nke ọma.

 

Ụdị Ⅱ

1.Flushing na ikuku

Jiri sirinji ( agịga maka ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye) tinye saline n'ime oche ịgba ntụtụ na catheter n'otu n'otu iji kpochapu ma wepụ ikuku dị na lumen, wee hụ ma mmiri na-eduzi ọ dị ire.

2. Cannulation na ligation

4. Nnwale ntapu

4. Mgbe emechara njikọ ahụ, gbakọọ ma mechie catheter na azụ nke mkpuchi mkpuchi ma nọgide na-etinye saline n'ime oche injection na sirinji (agịga maka ngwaọrụ nnyefe ọgwụ) (nrụgide karịrị 200kPa). (nrụgide na-erughị 200kPa), lelee ma enwere mpụta site na ngọngọ injection na catheter

njikọ, na-eji naanị mgbe ihe niile bụ nkịtị.

5. Chemotherapy, tube sealing

Enwere ike ịgbanye ọgwụ chemotherapy intraoperative otu ugboro dịka atụmatụ ọgwụgwọ siri dị; A na-atụ aro ka ị were 6 ~ 8mL saline physiological wụsa isi ntụtụ na catheter lumen ọzọ, wee jiri 3mL ~ 5mL nke saline physiological.

A na-eji 3mL ruo 5mL nke saline heparin mechie catheter na 100U/ml ruo 200U/mL.

6. Ndozi oche injection

A na-emepụta oghere cystic subcutaneous n'ebe nkwado, 0.5 cm ruo 1 cm site na akpụkpọ anụ ahụ, a na-etinye oche injection n'ime oghere ma dozie ya, a na-asacha akpụkpọ ahụ mgbe ọ gbasasịrị hemostasis.

 

Ụdị Ⅲ

A na-eji sirinji ( agịga pụrụ iche maka ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye) na-agbanye 10mL ~ 20mL nkịtị saline n'ime ngwaọrụ nnyefe ọgwụ iji kpochapụ oche injection na oghere nke catheter, ma wepụ ikuku dị n'ime oghere ahụ, ma hụ ma mmiri ahụ. bụ unobtrusive.

2. Cannulation na ligation

Dị ka nyocha nke intraoperative si kwuo, tinye catheter n'akụkụ mgbidi afọ, na akụkụ nke oghere nke nnyefe ọgwụ na njedebe nke catheter kwesịrị ịbanye n'ime oghere afọ ma nọrọ nso na ihe mgbaru ọsọ tumor dị ka o kwere mee. Họrọ isi 2-3 iji ligate ma dozie catheter.

3. chemotherapy, akara tube

Enwere ike ịgbanye ọgwụ chemotherapy intraoperative otu ugboro dịka atụmatụ ọgwụgwọ siri dị, wee mechie tube ahụ na 3mL ~ 5mL nke 100U/ml ~ 200U/mL heparin saline.

4. Ndozi oche injection

A na-emepụta oghere cystic subcutaneous n'ebe nkwado, 0.5 cm ruo 1 cm site na akpụkpọ anụ ahụ, a na-etinye oche injection n'ime oghere ma dozie ya, a na-asacha akpụkpọ ahụ mgbe ọ gbasasịrị hemostasis.

Infusion ọgwụ na nlekọta

A.Arụ ọrụ aseptic nke ọma, nhọrọ ziri ezi nke ebe oche ịgba ntụtụ tupu ịgba ọgwụ mgbochi ahụ, yana mkpochapụ nke saịtị ịgba ahụ.B. Mgbe ị na-agbaba, jiri agịga maka ngwaọrụ ọdụ ụgbọ mmiri nwere ike ịkụnye, sirinji nke 10 ml ma ọ bụ karịa, na mkpịsị aka aka ekpe na-emetụ ebe mgbaba na mkpịsị aka na-agbatị akpụkpọ ahụ mgbe ị na-edozi oche injection, na aka nri na-ejide sirinji. kwụ ọtọ n'ime agịga ahụ, na-ezere ịma jijiji ma ọ bụ na-atụgharị, ma jiri nwayọọ nwayọọ na-agbanye saline 5 mL ~ 10 mL mgbe enwere mmetụta nke ịdaba na ọnụ agịga ahụ mechaa metụ ala nke oche injection, wee lelee ma usoro nnyefe ọgwụ adịghị mma. (ọ bụrụ na ọ dịghị mma, ị ga-ebu ụzọ lelee ma agịga ahụ akpọchiela). Lelee ma ọ dị elu akpụkpọ ahụ gbara ya gburugburu mgbe ị na-akwagharị.

C. Jiri nwayọọ nwayọọ na-agbanye ọgwụ chemotherapeutic mgbe ị kwadoro na ọ dịghị njehie. N'oge usoro ịkwanye, ṅaa ntị iji hụ ma akpụkpọ ahụ gbara ya gburugburu ọ dị elu ma ọ bụ na-acha uhie uhie, yana ma enwere mgbu mpaghara. Mgbe agbanyechara ọgwụ ahụ, a ga-edobe ya maka 15s ~ 30s.

D. Mgbe ọ bụla injections, a na-atụ aro ka ikpochapụ oche injection na catheter lumen na 6 ~ 8mL nke saline physiological, wee mechie catheter na 3mL ~ 5mL nke 100U / ml ~ 200U / ml nke saline heparin, na mgbe ikpeazụ. A na-agbanye 0.5mL nke saline heparin, a ghaghị ịkwanye ọgwụ ahụ mgbe ọ na-ala azụ, nke mere na usoro ntinye ọgwụ ahụ jupụtara na saline heparin iji gbochie crystallization ọgwụ na coagulation ọbara na catheter. Ekwesịrị iji saline heparin na-asachapụ catheter otu ugboro kwa izu abụọ n'oge etiti oge ọgwụgwọ chemotherapy.

E. Mgbe ogbugba ahụ gasịrị, were ọgwụ na-efe efe na-asachapụ anya agịga ahụ, were akwa akwa kpuchie ya, ma kpachara anya ka ebe ahụ dị ọcha ma kpọọ nkụ iji gbochie ọrịa n'ebe a na-agbapu ya.

F. Lezienụ anya na mmeghachi omume onye ọrịa mgbe nchịkwa ọgwụ gasịrị ma lelee anya n'oge ịgba ọgwụ.

 

【Akpachara anya, ịdọ aka na ntị na ọdịnaya na-atụ aro】

1. Ngwaahịa a bụ ethylene oxide na-agba ọgwụ mgbochi ma dị irè maka afọ atọ.
2. Biko gụọ ntuziaka ntuziaka tupu eji ya iji hụ na nchekwa nke ojiji.
3. Ojiji nke ngwaahịa a ga-agbasorịrị ihe achọrọ nke koodu omume na ụkpụrụ dị mkpa nke ngalaba ahụike, yana ntinye, ịrụ ọrụ na iwepụ ngwaọrụ ndị a ga-ejedebe na ndị dọkịta nwere ikike. Ntinye, ọrụ na iwepụ ngwaọrụ ndị a bụ. machibidoro ndị dibịa gbaara agbazi, yana nlekọta post-tube kwesịrị ịrụ ọrụ site n'aka ndị ọrụ ahụike ruru eru.
4. A ghaghị ime usoro ahụ dum n'okpuru ọnọdụ aseptic.
5. Lelee ụbọchị njedebe nke ngwaahịa na nkwakọ ngwaahịa dị n'ime maka mmebi tupu usoro ahụ.
6. Mgbe ejiri ya, ngwaahịa ahụ nwere ike ibute ihe egwu dị ndụ. Biko soro usoro ahụike anabatara yana iwu na ụkpụrụ niile dị mkpa maka njikwa na ọgwụgwọ.
7. Ejila ike dị ukwuu n'oge intubation na fanye akwara n'ụzọ ziri ezi na ngwa ngwa iji zere vasospasm. Ọ bụrụ na intubation siri ike, jiri mkpịsị aka gị tụgharịa catheter site n'akụkụ ruo n'akụkụ mgbe ị na-etinye tube.
8. Ogologo nke catheter etinyere n'ime ahụ kwesịrị ekwesị kwesịrị ekwesị, ogologo oge dị mfe ịbanye n'ime akụkụ, na-akpata ikuku ikuku na-adịghị mma, dị mkpụmkpụ bụ mgbe onye ọrịa na-eme ihe ike nwere ike ịpụ n'ụgbọ ahụ. Ọ bụrụ na catheter dị mkpụmkpụ, ọ nwere ike ịpụ n'ụgbọ ahụ mgbe onye ọrịa na-agbali ike.
9. Ekwesịrị itinye catheter n'ime arịa ahụ nwere ihe karịrị ligatures abụọ na njigide kwesịrị ekwesị iji hụ na ịgba ọgwụ mgbochi ahụ dị mma yana igbochi catheter ka ọ pụọ.
10. Ọ bụrụ na ngwaọrụ ọdụ ụgbọ mmiri a na-akụnye bụ ụdị II, njikọ dị n'etiti catheter na oche injection ga-abụrịrị nke siri ike. Ọ bụrụ na achọghị ịgba ọgwụ intraoperative, a ga-eji ntụtụ nnwale saline nkịtị mee ihe maka nkwenye tupu ịdochaa akpụkpọ ahụ.
11. Mgbe ị na-ekewa mpaghara subcutaneous, a ga-eme hemostasis dị nso iji zere ịmepụta hematoma mpaghara, nchịkọta mmiri ma ọ bụ ọrịa nke abụọ mgbe ịwachara ahụ; suture vesicular kwesịrị izere oche injection.
12. Adhesives ọgwụ α-cyanoacrylate nwere ike imebi ihe isi ihe ntụtụ; ejila α-cyanoacrylate adhesives ọgwụ mgbe ị na-agwọ mbepụ ịwa ahụ n'akụkụ ebe ịgba ọgwụ. Ejila α-cyanoacrylate adhesives ọgwụ mgbe ị na-emeso mbepụ ịwa ahụ n'akụkụ ntọala ịgba ọgwụ.
13. Jiri nlezianya dị ukwuu ka ịzenarị ntapu nke catheter n'ihi mmerụ ahụ mberede site na ngwa ịwa ahụ.
14. Mgbe a na-akụ ọkpọ, a ga-etinye agịga ahụ kwụ ọtọ, a ga-eji sirinji nwere ikike nke 10mL ma ọ bụ karịa, a ga-eji nwayọọ nwayọọ gbanye ọgwụ ahụ, ma wepụ agịga ahụ mgbe obere oge kwụsịtụrụ. Nrụgide nrụgide ekwesịghị gafere 200kPa.
15. Jiri naanị agịga pụrụ iche maka ngwaọrụ nnyefe ọgwụ nwere ike ịkụnye.
16. Mgbe achọrọ ogologo infusion ma ọ bụ dochie ọgwụ, ọ dị mma iji ngwaọrụ nnyefe ọgwụ na-arụ otu-eji nwere eriri infusion pụrụ iche ma ọ bụ tee, iji belata ọnụ ọgụgụ nke punctures ma belata mmetụta na onye ọrịa.
17. Belata ọnụ ọgụgụ nke punctures, belata mmebi nke uru ahụ nke onye ọrịa na akụkụ na-agbanwe onwe ya. N'ime oge nkwụsị nke ịgba ọgwụ mgbochi ọrịa, a na-achọ injection anticoagulant otu ugboro kwa izu abụọ.
18. Ngwaahịa a bụ ngwaahịa eji eme otu ihe, nke na-adịghị emerụ ahụ, nke anaghị pyrogenic, mebie ya mgbe ejiri ya, amachibidoro iji ya eme ihe.
19. Ọ bụrụ na ngwungwu ime mebiri emebi ma ọ bụ ụbọchị ngafe ngwaahịa a gafere, biko weghachi ya na onye nrụpụta maka mkpofu.
20. Ọnụọgụ ntụmadị maka ngọngọ ịgba ọgwụ ọ bụla ekwesịghị ịfe 2000 (22Ga). 21.
21. Opekempe kacha nta ntupu bụ 6ml