Mbiri ya ntchito ndi ntchito ya ma microscope opangidwa opaleshoni mu neurosurgery

 

M'mbiri ya opaleshoni ya mitsempha, kugwiritsa ntchitoma microscope opangidwa opaleshonindi chizindikiro chodabwitsa, kuchoka pa nthawi yachikhalidwe ya opaleshoni ya mitsempha yochita opaleshoni ya maso ndi maso kupita ku nthawi yamakono ya opaleshoni ya mitsempha yochita opaleshoni pansi pamaikulosikopuNdani ndipo liti anachitama microscope ogwira ntchitoKodi yayamba kugwiritsidwa ntchito mu opaleshoni ya mitsempha? Kodi yakhala ndi ntchito yotanimaikulosikopu ya opaleshoniKodi chinachitapo kanthu pa chitukuko cha opaleshoni ya mitsempha? Ndi kupita patsogolo kwa sayansi ndi ukadaulo, kodiMaikulosikopu yogwira ntchitoKodi zingatheke kusintha zida zina zapamwamba? Ili ndi funso lomwe dokotala aliyense wa opaleshoni ya mitsempha ayenera kudziwa ndikugwiritsa ntchito ukadaulo ndi zida zamakono pantchito yochita opaleshoni ya mitsempha, zomwe zimalimbikitsa luso la opaleshoni ya mitsempha.

1. Mbiri ya Kugwiritsa Ntchito Microscopy Mu Zachipatala

Mu fizikisi, magalasi a maso ndi magalasi ozungulira okhala ndi kapangidwe kamodzi komwe kamakhala ndi mphamvu yokulitsa, ndipo kukula kwawo kumakhala kochepa, komwe kumadziwika kuti magalasi okulitsa. Mu 1590, anthu awiri aku Dutch adayika mbale ziwiri za magalasi ozungulira mkati mwa mbiya yopyapyala yozungulira, motero adapanga chipangizo choyamba padziko lonse chokulitsa mawonekedwe:maikulosikopuPambuyo pake, kapangidwe ka maikulosikopu kanali kukonzedwanso nthawi zonse, ndipo kukula kwake kunawonjezeka nthawi zonse. Panthawiyo, asayansi ankagwiritsa ntchito kwambiri izimaikulosikopu yopangidwa ndi zinthu zosiyanasiyanakuti aone kapangidwe kakang'ono ka nyama ndi zomera, monga kapangidwe ka maselo. Kuyambira pakati pa zaka za m'ma 1800 mpaka kumapeto kwa zaka za m'ma 1800, magalasi okulitsira ndi ma microscope akhala akugwiritsidwa ntchito pang'onopang'ono m'munda wa zamankhwala. Poyamba, madokotala ochita opaleshoni ankagwiritsa ntchito magalasi okulitsira okhala ndi kapangidwe ka lenzi imodzi yomwe ikanatha kuyikidwa pa mlatho wa mphuno kuti achite opaleshoni. Mu 1876, dokotala waku Germany Saemisch adachita opaleshoni yoyamba padziko lonse lapansi ya "microscopic" pogwiritsa ntchito galasi lokulitsira la magalasi (mtundu wa opaleshoni sudziwika). Mu 1893, kampani yaku Germany ya Zeiss idapangamaikulosikopu ya binocular, yomwe imagwiritsidwa ntchito makamaka poyesa mayeso m'ma laboratories azachipatala, komanso poyang'ana zilonda za cornea ndi chipinda chakutsogolo m'munda wa maso. Mu 1921, potengera kafukufuku wa labotale wokhudza kapangidwe ka khutu lamkati mwa nyama, katswiri wa otolaryngologist waku Sweden Nylen adagwiritsa ntchito njira yokhazikikamaikulosikopu ya opaleshoni ya monocularIye mwini adapanga ndi kupanga opaleshoni ya otitis media kwa anthu, yomwe inali opaleshoni yeniyeni ya microsurgery. Patatha chaka chimodzi, dokotala wamkulu wa Nylen, Hlolmgren, adayambitsa opaleshoni.maikulosikopu ya opaleshoni ya binocularyopangidwa ndi Zeiss mchipinda chochitira opaleshoni.

OyambiriraMa maikulosikopu ogwiritsa ntchitoinali ndi zovuta zambiri, monga kusakhazikika bwino kwa makina, kulephera kuyenda, kuunikira kwa nkhwangwa zosiyanasiyana ndi kutentha kwa lenzi yolunjika, malo ocheperako okulitsa opaleshoni, ndi zina zotero. Zonsezi ndi zifukwa zomwe zimalepheretsa kugwiritsa ntchito bwinoma microscope opangidwa opaleshoniM'zaka makumi atatu zotsatira, chifukwa cha mgwirizano wabwino pakati pa madokotala opaleshoni ndiopanga ma microscope, magwiridwe antchito ama microscope opangidwa opaleshoniidasinthidwa nthawi zonse, ndipoma microscope ochitira opaleshoni ya binocular, maikulosikopu okwera padenga, magalasi owonera zoom, kuwala kwa coaxial light source, manja olumikizana olamulidwa ndi magetsi kapena madzi, kulamulira ma pedal a mapazi, ndi zina zotero zinapangidwa motsatizana. Mu 1953, kampani yaku Germany ya Zeiss inapanga mndandanda wa zida zapadera.ma microscope opangidwa opaleshoni ya otology, makamaka yoyenera opaleshoni ya zilonda zakuthwa monga khutu lapakati ndi fupa la nthawi. Pamene ntchito yama microscope opangidwa opaleshoniPamene madokotala akupitirizabe kusintha, maganizo a madokotala a opaleshoni akusinthanso nthawi zonse. Mwachitsanzo, madokotala aku Germany Zollner ndi Wullstein anatima microscope opangidwa opaleshoniiyenera kugwiritsidwa ntchito pa opaleshoni yopangira mawonekedwe a tympanic membrane. Kuyambira m'ma 1950, madokotala a maso asintha pang'onopang'ono njira yogwiritsira ntchito maikulosikopu yokha poyesa maso ndipo ayambitsama microscope a otosurgicalopaleshoni ya maso. Kuyambira pamenepo,Maikulosikopu yogwira ntchitoamagwiritsidwa ntchito kwambiri mu otology ndi ophthalmology.

2. Kugwiritsa ntchito maikulosikopu ya opaleshoni mu opaleshoni ya mitsempha

Chifukwa cha kudziwika kwa opaleshoni ya ubongo, kugwiritsa ntchitoma microscope opangidwa opaleshoni mu opaleshoni ya ubongondi mochedwa pang'ono kuposa mu otology ndi ophthalmology, ndipo madokotala a mitsempha akuphunzira mwakhama ukadaulo watsopanowu. Panthawiyo,kugwiritsa ntchito ma microscope opangidwa opaleshonimakamaka ku Ulaya. Katswiri wa maso wa ku America Perrit adayambitsidwa koyambama microscope opangidwa opaleshonikuchokera ku Ulaya kupita ku United States mu 1946, zomwe zinakhazikitsa maziko a madokotala a mitsempha aku America kuti agwiritse ntchitoMa maikulosikopu ogwiritsa ntchito.

Poganizira za kulemekeza kufunika kwa moyo wa munthu, ukadaulo uliwonse watsopano, zida, kapena zida zomwe zimagwiritsidwa ntchito pa thupi la munthu ziyenera kuyesedwa koyamba ndi nyama ndi kuphunzitsidwa zaukadaulo kwa ogwira ntchito. Mu 1955, dokotala wa opaleshoni ya mitsempha waku America Malis adachita opaleshoni ya ubongo pa nyama pogwiritsa ntchito njira yamaikulosikopu ya opaleshoni ya binocularKurze, dokotala wa opaleshoni ya mitsempha ku yunivesite ya Southern California ku United States, anakhala chaka chimodzi akuphunzira njira zochitira opaleshoni pogwiritsa ntchito maikulosikopu mu labotale atatha kuyang'ana opaleshoni ya khutu pogwiritsa ntchito maikulosikopu. Mu Ogasiti 1957, adachita bwino opaleshoni ya acoustic neuroma pa mwana wazaka 5 pogwiritsa ntchitomaikulosikopu ya opaleshoni ya khutu, yomwe inali opaleshoni yoyamba padziko lonse lapansi yochitidwa opaleshoni ya microsurgical. Patapita nthawi yochepa, Kurze anachita bwino opaleshoni ya mitsempha ya nkhope pa mwanayo pogwiritsa ntchito njira yamaikulosikopu ya opaleshoni, ndipo mwana anachira bwino kwambiri. Uwu unali opaleshoni yachiwiri yochitidwa ndi microsurgical padziko lonse lapansi. Pambuyo pake, Kurze anagwiritsa ntchito magalimoto akuluakulu kunyamulaMa maikulosikopu ogwiritsa ntchitokupita ku malo osiyanasiyana ochitira opaleshoni ya ubongo ya microsurgical, ndipo adalimbikitsa kwambiri kugwiritsa ntchitoma microscope opangidwa opaleshonikwa madokotala ena a mitsempha. Pambuyo pake, Kurze anachita opaleshoni yodula mitsempha ya ubongo pogwiritsa ntchitomaikulosikopu ya opaleshoni(mwatsoka, sanasindikize nkhani iliyonse). Mothandizidwa ndi wodwala matenda a trigeminal neuralgia yemwe adamuchiza, adakhazikitsa labotale yoyamba padziko lonse lapansi ya micro skull base neurosurgery mu 1961. Tiyenera kukumbukira nthawi zonse zomwe Kurze adapereka pa microsurgery ndikuphunzira kuchokera ku kulimba mtima kwake povomereza ukadaulo ndi malingaliro atsopano. Komabe, mpaka kumayambiriro kwa zaka za m'ma 1990, madokotala ena a neurosurgery ku China sanavomereze.Ma microscope a opaleshoni ya ubongoopaleshoni. Izi sizinali vuto ndiMaikulosi a opaleshoni ya ubongolokha, koma vuto ndi kumvetsetsa kwa maganizo a madokotala a opaleshoni ya mitsempha.

Mu 1958, dokotala wa opaleshoni ya mitsempha waku America, Donaghy, adakhazikitsa labotale yoyamba padziko lonse lapansi yofufuza ndi kuphunzitsa opaleshoni ya microsurgery ku Burlington, Vermont. Poyamba, adakumananso ndi chisokonezo ndi mavuto azachuma kuchokera kwa akuluakulu ake. Mu maphunziro apamwamba, nthawi zonse ankaganiza zodula mitsempha yamagazi yotseguka kuti atulutse mwachindunji magazi kuchokera kwa odwala omwe ali ndi thrombosis ya ubongo. Chifukwa chake adagwirizana ndi dokotala wa opaleshoni ya mitsempha Jacobson pa kafukufuku wa zinyama ndi zamankhwala. Panthawiyo, pansi pa maso opanda kanthu, mitsempha yaying'ono yamagazi yokhala ndi mainchesi 7-8 kapena kuposerapo ndi yomwe inkatha kusokedwa. Kuti akwaniritse anastomosis ya mitsempha yamagazi yopyapyala, Jacobson adayesa koyamba kugwiritsa ntchito galasi lokulitsa magalasi. Patapita nthawi yochepa, adakumbukira kugwiritsa ntchitomaikulosikopu ya opaleshoni ya otolaryngologykuti achite opaleshoni pamene anali dokotala wokhalamo. Chifukwa chake, mothandizidwa ndi Zeiss ku Germany, Jacobson adapanga maikulosikopu yochitira opaleshoni ya opareshoni iwiri (Diploscope) ya anastomosis ya mitsempha yamagazi, yomwe imalola madokotala awiri opaleshoni kuchita opaleshoni nthawi imodzi. Pambuyo poyesa kwambiri nyama, Jacobson adasindikiza nkhani yokhudza anastomosis ya mitsempha yamagazi ya agalu ndi mitsempha yamagazi yopanda carotid (1960), yokhala ndi chiŵerengero cha 100% cha anastomosis ya mitsempha yamagazi. Iyi ndi pepala lachipatala lodziwika bwino lokhudzana ndi opaleshoni ya mitsempha yamagazi ya microsurgical ndi opaleshoni ya mitsempha yamagazi. Jacobson adapanganso zida zambiri za microsurgical, monga lumo laling'ono, zogwirira singano zazing'ono, ndi zogwirira zazing'ono za zida zazing'ono. Mu 1960, Donaghy adachita bwino opaleshoni ya thrombectomy ya mitsempha ya ubongo pansi pa amaikulosikopu ya opaleshonikwa wodwala yemwe ali ndi vuto la thrombosis mu ubongo. Rhoton wochokera ku United States anayamba kuphunzira za kapangidwe ka ubongo pogwiritsa ntchito maikulosikopu mu 1967, ndipo anayamba ntchito yatsopano ya kapangidwe ka ubongo pogwiritsa ntchito maikulosikopu ndipo anapereka thandizo lalikulu pakukula kwa opaleshoni ya maikulosikopu. Chifukwa cha ubwino wama microscope opangidwa opaleshonindi kusintha kwa zida zopangira opaleshoni ya microsurgical, madokotala ambiri opanga opaleshoni amakonda kugwiritsa ntchitoma microscope opangidwa opaleshoniNdipo adafalitsa nkhani zambiri zokhudzana ndi opaleshoni ya microsurgical.

3. Kugwiritsa ntchito maikulosikopu ya opaleshoni mu opaleshoni ya mitsempha ku China

Monga munthu wokonda dziko la China ku Japan, Pulofesa Du Ziwei anapereka chithandizo choyamba chapakhomomaikulosikopu ya opaleshoni ya mitsemphandi zina zokhudzana nazozida zochitira opaleshoni ya microsurgicalku Dipatimenti Yoona za Ubongo ya Suzhou Medical College Affiliate Hospital (yomwe tsopano ndi Dipatimenti Yoona za Ubongo ya Suzhou University Affiliate First Hospital) mu 1972. Atabwerera ku China, adachita opaleshoni ya microsurgical koyamba monga aneurysms ya m'mutu ndi meningiomas. Ataphunzira za kupezeka kwama microscope a opaleshoni ya mitsemphandi zida zochizira matenda a microsurgical, Pulofesa Zhao Yadu wochokera ku Dipatimenti ya Neurosurgery ku Beijing Yiwu Hospital adapita kwa Pulofesa Du Ziwei wochokera ku Suzhou Medical College kuti akaone momwe zinthu zilili.ma microscope opangidwa opaleshoniPulofesa Shi Yuquan wochokera ku Shanghai Huashan Hospital anapita ku dipatimenti ya Pulofesa Du Ziwei kuti akaone momwe opaleshoni imachitikira. Chifukwa cha zimenezi, anthu ambiri anayamba kuphunzira, kuphunzira, komanso kugwiritsa ntchito njira imeneyi.Ma microscope a opaleshoni ya ubongoidayambitsidwa m'malo akuluakulu opangira opaleshoni ya mitsempha ku China, zomwe zidayambitsa opaleshoni ya mitsempha yaying'ono ku China.

4. Zotsatira za Opaleshoni ya Microsurgery

Chifukwa cha kugwiritsa ntchitoma microscope a opaleshoni ya mitsempha, opaleshoni yomwe singachitike ndi maso amaliseche imakhala yotheka ngati pali kukula kwa nthawi 6-10. Mwachitsanzo, kuchita opaleshoni ya chotupa cha pituitary kudzera mu ethmoidal sinus kumatha kuzindikira ndikuchotsa zotupa za pituitary bwino ndikuteteza pituitary gland yachibadwa; opaleshoni yomwe singachitike ndi maso amaliseche ikhoza kukhala opaleshoni yabwino, monga zotupa za muubongo ndi zotupa zamkati mwa msana. Katswiri wamaphunziro Wang Zhongcheng anali ndi chiŵerengero cha imfa cha 10.7% chifukwa cha opaleshoni ya aneurysm ya ubongo asanagwiritse ntchitomaikulosikopu ya opaleshoni ya ubongoPambuyo pogwiritsa ntchito maikulosikopu mu 1978, chiwerengero cha imfa chinachepa kufika pa 3.2%. Chiwerengero cha imfa chifukwa cha opaleshoni ya mitsempha ya ubongo popanda kugwiritsa ntchito chipangizo choyezera magazi.maikulosikopu ya opaleshonichinali 6.2%, ndipo pambuyo pa 1984, pogwiritsa ntchitoma microscope a opaleshoni ya ubongo, chiwerengero cha imfa chinatsika kufika pa 1.6%.maikulosikopu ya opaleshoni ya ubongoamalola kuti zotupa za pituitary zichiritsidwe kudzera mu njira yochepetsera kufalikira kwa mphuno popanda kufunikira opaleshoni ya craniotomy, kuchepetsa chiwerengero cha imfa kuchokera pa 4.7% mpaka 0.9%. Kupeza zotsatira izi n'kosatheka pansi pa opaleshoni yachikhalidwe ya maso, koteroma microscope opangidwa opaleshonindi chizindikiro cha opaleshoni ya ubongo yamakono ndipo akhala chimodzi mwa zida zofunika kwambiri komanso zosasinthika pa opaleshoni ya ubongo yamakono.