Umlando wokusetshenziswa kanye nendima yama-microscope okuhlinzwa ekuhlinzeni kwezinzwa

 

Emlandweni wokuhlinzwa kwezinzwa, ukusetshenziswa kweama-microscope okuhlinzwaluwuphawu oluphawulekayo, oluqhubekela phambili kusukela enkathini yendabuko yokuhlinzwa kwemizwa yokwenza ukuhlinzwa ngaphansi kwamehlo kuya enkathini yesimanje yokuhlinzwa kwemizwa yokwenza ukuhlinzwa ngaphansi kwe-imakroskopuNgubani futhi nini owenza lokhoama-microscope asebenzayoiqala ukusetshenziswa ekuhlinzeni izinzwa? Iyiphi indima eyenzileimakroskopu yokuhlinzwaidlalwe ekuthuthukisweni kokuhlinzwa kwezinzwa? Ngokuthuthuka kwesayensi nobuchwepheshe, ingabeI-microscope esebenzayoIngabe kufanele kuthathelwe indawo imishini ethile ethuthukisiwe? Lona umbuzo okufanele wonke udokotela wezinzwa awuqaphele futhi asebenzise ubuchwepheshe bamuva kanye namathuluzi emkhakheni wokuhlinzwa kwezinzwa, okukhuthaza ukuthuthukiswa kwamakhono okuhlinzwa kwezinzwa.

1. Umlando Wokusetshenziswa Kwe-Microscopy Emkhakheni Wezokwelapha

Ku-physics, amalensi ezibuko zamehlo angamalensi aqondile anesakhiwo esisodwa esinomphumela wokukhulisa, futhi ukukhulisa kwawo kunqunyelwe, okwaziwa ngokuthi izibuko zokukhulisa. Ngo-1590, abantu ababili baseDashi bafaka amapuleti amabili e-lens aqondile ngaphakathi komgqomo omncane oyisilinda, ngaleyo ndlela basungula idivayisi yokuqala emhlabeni yokukhulisa isakhiwo esihlanganisiwe: iimakroskopuNgemva kwalokho, isakhiwo se-microscope sathuthukiswa njalo, futhi ukukhulisa kwanda njalo. Ngaleso sikhathi, ososayensi basebenzisa kakhulu lokhuimakroskopu ehlanganisiweukubheka izakhiwo ezincane zezilwane nezitshalo, njengesakhiwo samaseli. Kusukela maphakathi nekhulu le-19 kuya ekupheleni, izibuko zokukhulisa kanye nama-microscope kuye kwasetshenziswa kancane kancane emkhakheni wezokwelapha. Ekuqaleni, odokotela abahlinzayo basebenzisa izibuko zokukhulisa zesitayela seglasi lamehlo ezinesakhiwo selensi eyodwa esingabekwa ebhulohweni lekhala ukuze kuhlinzwe. Ngo-1876, udokotela waseJalimane uSaemisch wenza ukuhlinzwa kokuqala "kwe-microscopic" emhlabeni esebenzisa ingilazi yokukhulisa yeglasi lamehlo ehlanganisiwe (uhlobo lokuhlinzwa alwaziwa). Ngo-1893, inkampani yaseJalimane iZeiss yasungula i-imayikroskopu ye-binocular, esetshenziswa kakhulu ekuhlolweni kokuhlolwa ezindaweni zokucwaninga zezokwelapha, kanye nasekubonweni kwezilonda ze-cornea kanye ne-anterior chamber emkhakheni we-ophthalmology. Ngo-1921, ngokusekelwe ocwaningweni lwe-laboratory mayelana nokwakheka kwendlebe yangaphakathi kwesilwane, isazi se-otolaryngologist saseSweden uNylen wasebenzisa i-fixedimakroskopu yokuhlinzwa eyodwawaklanywa futhi wakhiqizwa nguyena ukuze enze ukuhlinzwa kwe-otitis media okungapheli kubantu, okwakuwukuhlinzwa okuncane kwangempela. Ngonyaka owodwa kamuva, udokotela omkhulu kaNylen uHlolmgren wethula uhleloimakroskopu yokuhlinzwa ye-binocularekhiqizwe yiZeiss egumbini lokuhlinza.

KwasekuqaleniAma-microscope asebenzayoyayinezinkinga eziningi, njengokungazinzi kahle kwemishini, ukungakwazi ukunyakaza, ukukhanya kwezimbazo ezahlukene kanye nokushisa kwelensi eqondiwe, insimu encane yokukhulisa ukuhlinzwa, njll. Lezi zonke yizizathu ezikhawulela ukusetshenziswa kabanzi kweama-microscope okuhlinzwaEminyakeni engamashumi amathathu eyalandela, ngenxa yokusebenzisana okuhle phakathi kodokotela abahlinzayo kanyeabakhiqizi be-microscope, ukusebenza kweama-microscope okuhlinzwayathuthukiswa njalo, futhiama-microscope okuhlinza e-binocular, ama-microscope afakwe ophahleni, amalensi okusondeza, ukukhanya komthombo wokukhanya we-coaxial, izingalo ezihlanganisiwe ezilawulwa ngogesi noma ngamanzi, ukulawula ama-pedal ezinyawo, njalo njalo kwathuthukiswa ngokulandelana. Ngo-1953, inkampani yaseJalimane i-Zeiss yakhiqiza uchungechunge lwezinhlelo ezikhethekileama-microscope okuhlinzwa e-otology, efanelekile kakhulu ekuhlinzeni izilonda ezijulile njengendlebe ephakathi kanye nethambo lesikhashana. Ngenkathi ukusebenza kweama-microscope okuhlinzwaNjengoba iqhubeka ithuthuka, indlela yokucabanga yodokotela abahlinzayo nayo ishintsha njalo. Isibonelo, odokotela baseJalimane uZollner noWullstein bathiama-microscope okuhlinzwakumele isetshenziswe ekuhlinzeni ukwakheka kwe-membrane ye-tympanic. Kusukela ngawo-1950, odokotela bamehlo baye bashintsha kancane kancane umkhuba wokusebenzisa ama-microscope kuphela ekuhlolweni kwamehlo futhi bafakaama-microscope e-otosurgicalukuya ohlinzweni lwamehlo. Kusukela ngaleso sikhathi,I-microscope esebenzayoKusetshenziswe kabanzi emikhakheni ye-otology kanye ne-ophthalmology.

2. Ukusetshenziswa kwe-microscope yokuhlinzwa ekuhlinzeni izinzwa

Ngenxa yobuchwepheshe bokuhlinzwa kwezinzwa, ukusetshenziswaama-microscope okuhlinzwa ekuhlinzeni kwezinzwasekudlule kancane kune-otology kanye ne-ophthalmology, futhi odokotela abahlinza izinzwa bafunda ngenkuthalo lobu buchwepheshe obusha. Ngaleso sikhathi,ukusetshenziswa kwama-microscope okuhlinzwaikakhulukazi eYurophu. Udokotela wamehlo waseMelika uPerrit wethulwa okokuqalaama-microscope okuhlinzwakusukela eYurophu kuya e-United States ngo-1946, kwabeka isisekelo sodokotela abahlinza izinzwa baseMelika ukuthi basisebenziseAma-microscope asebenzayo.

Ngokombono wokuhlonipha ukubaluleka kokuphila komuntu, noma yibuphi ubuchwepheshe obusha, imishini, noma izinsimbi ezisetshenziselwa umzimba womuntu kufanele zihlolwe izilwane kanye nokuqeqeshwa kobuchwepheshe kwabasebenza. Ngo-1955, udokotela wezinzwa waseMelika uMalis wenza ukuhlinzwa kobuchopho ezilwaneni esebenzisaimakroskopu yokuhlinzwa ye-binocularUKurze, udokotela wezinzwa eNyuvesi yaseSouthern California e-United States, wachitha unyaka efunda amasu okuhlinzwa okusebenzisa imakroskopu elabhorethri ngemuva kokubuka ukuhlinzwa kwendlebe ngaphansi kwemakroskopu. Ngo-Agasti 1957, wenza ngempumelelo ukuhlinzwa kwe-acoustic neuroma enganeni eneminyaka emihlanu esebenzisa i-imakroskopu yokuhlinzwa kwendlebe, okwakuwukuhlinzwa kokuqala emhlabeni kokuhlinzwa okuncane. Ngemva kwalokho, uKurze waphumelela ukwenza i-facial nerve anastomosis enganeni esebenzisa i-imakroskopu yokuhlinzwa, futhi ukululama kwengane kwaba kuhle kakhulu. Lokhu kwakuwukuhlinzwa kwesibili okwenziwa nge-microsurgical emhlabeni. Ngemva kwalokho, uKurze wasebenzisa amaloli ukuthwalaAma-microscope asebenzayoezindaweni ezahlukene zokuhlinzwa kwe-microsurgical neurosurgery, futhi ngincoma kakhulu ukusetshenziswa kweama-microscope okuhlinzwakwabanye odokotela abahlinza izinzwa. Ngemva kwalokho, uKurze wenza ukuhlinzwa kokusika i-cerebral aneurysm esebenzisa i-imakroskopu yokuhlinzwa(ngeshwa, akazange ashicilele noma yiziphi izihloko). Ngokusekelwa yisiguli se-trigeminal neuralgia asiphatha, wasungula ilabhorethri yokuqala emhlabeni ye-micro skull base neurosurgery ngo-1961. Kufanele sikhumbule njalo igalelo likaKurze ekuhlinzeni okuncane futhi sifunde ngesibindi sakhe sokwamukela ubuchwepheshe nemibono emisha. Kodwa-ke, kwaze kwaba sekuqaleni kweminyaka yama-1990, abanye odokotela abahlinzayo be-neurosurgery eShayina abazange bamukele.Ama-microscope okuhlinzwa kwe-neurosurgeryukuhlinzwa. Lokhu kwakungeyona inkinga ngeIsibonakhulu sokuhlinzwa kwezinzwauqobo, kodwa inkinga ngokuqonda kwemibono kodokotela abahlinza izinzwa.

Ngo-1958, udokotela wezinzwa waseMelika uDonaghy wasungula ilabhorethri yokuqala emhlabeni yocwaningo nokuqeqeshwa kokuhlinzwa okuncane eBurlington, eVermont. Ezigabeni zokuqala, waphinde wabhekana nokudideka nezinkinga zezimali ezivela kubaphathi bakhe. Ezemfundo, wayehlala ecabanga ngokusika imithambo yegazi ye-cortical evulekile ukuze akhiphe ngqo i-thrombi ezigulini ezine-cerebral thrombosis. Ngakho wabambisana nodokotela ohlinzayo wemithambo yegazi uJacobson ocwaningweni lwezilwane nolwezokwelapha. Ngaleso sikhathi, ngaphansi kwezimo zamehlo angenalutho, imithambo yegazi emincane kuphela enobubanzi obungamamilimitha angu-7-8 noma ngaphezulu yayingathungwa. Ukuze kufezwe i-anastomosis yokuphela kwemithambo yegazi emincane, uJacobson wazama okokuqala ukusebenzisa ingilazi yokukhulisa yesitayela sezingilazi. Ngokushesha ngemva kwalokho, wakhumbula esebenzisa i-i-otolaryngology yesibonakhulu sokuhlinzaukuze ahlinzwe ngesikhathi esengudokotela ohlala khona. Ngakho-ke, ngosizo lweZeiss eJalimane, uJacobson waklama imakroskopu yokuhlinzwa ephindwe kabili (I-Diploscope) ye-anastomosis yemithambo yegazi, evumela odokotela ababili abahlinzayo ukuthi benze ukuhlinzwa ngasikhathi sinye. Ngemva kokuhlolwa okubanzi kwezilwane, uJacobson washicilela isihloko mayelana ne-microsurgical anastomosis yezinja kanye nemithambo yegazi engeyona i-carotid (1960), enezinga eliyi-100% le-patency ye-vascular anastomosis. Leli yiphepha lezokwelapha eliqavile elihlobene ne-microsurgical neurosurgery kanye nokuhlinzwa kwemithambo yegazi. UJacobson waklama nezinsimbi eziningi ze-microsurgical, njengezikele ezincane, izibambo zezinaliti ezincane, kanye nezibambo zezinsimbi ezincane. Ngo-1960, uDonaghy waphumelela ukwenza i-cerebral artery incision thrombectomy ngaphansi kwe-imakroskopu yokuhlinzwakwesiguli esine-cerebral thrombosis. URhoton wase-United States waqala ukutadisha i-anatomy yobuchopho ngaphansi kwe-microscope ngo-1967, waqala insimu entsha ye-anatomy ye-microsurgical futhi wenza iminikelo ebalulekile ekuthuthukisweni kwe-microsurgery. Ngenxa yezinzuzo ze-ama-microscope okuhlinzwakanye nokuthuthukiswa kwezinsimbi zokuhlinzwa ezincane, odokotela abaningi abahlinzayo bayakuthanda ukusebenzisaama-microscope okuhlinzwayokuhlinzwa. Futhi washicilela izihloko eziningi ezihlobene nezinqubo zokuhlinzwa ezincane.

3. Ukusetshenziswa kwe-microscope yokuhlinzwa ekuhlinzeni izinzwa eShayina

Njengomuntu waseShayina othanda izwe lakwamanye amazwe eJapane, uSolwazi uDu Ziwei wanikela ngempahla yokuqala yasekhayaimakroskopu yokuhlinzwa kwemizwakanye nokuhlobeneamathuluzi okuhlinzwa amancanekuMnyango Wezokuhlinzwa Kwezinzwa weSuzhou Medical College Affiliated Hospital (manje osekuyi-Neurosurgery Department yeSuzhou University Affiliated First Hospital) ngo-1972. Ngemva kokubuyela eShayina, waqala ukwenza ukuhlinzwa kwe-microsurgical njenge-intracranial aneurysms kanye ne-meningiomas. Ngemva kokufunda ngokutholakala kwe-ama-microscope okuhlinzwa kwemizwakanye nezinsimbi zokuhlinzwa ezincane, uSolwazi Zhao Yadu ovela eMnyangweni Wezokuhlinzwa Kwezinzwa eBeijing Yiwu Hospital uvakashele uSolwazi Du Ziwei waseSuzhou Medical College ukuyobona ukusetshenziswa kweama-microscope okuhlinzwaUProfesa Shi Yuquan waseShanghai Huashan Hospital uvakashele umnyango kaProfesa Du Ziwei mathupha ukuyobona izinqubo zokuhlinzwa ezincane. Ngenxa yalokho, kwavela igagasi lokwethula, ukufunda, kanye nokusetshenziswa kweAma-microscope okuhlinzwa kwe-neurosurgerykwaqala ezikhungweni ezinkulu zokuhlinzwa kwemizwa eShayina, okwaphawula ukuqala kokuhlinzwa kwemizwa okuncane eShayina.

4. Umphumela Wokuhlinzwa Okuncane

Ngenxa yokusetshenziswa kweama-microscope okuhlinzwa kwemizwa, ukuhlinzwa okungenakukwenziwa ngeso lenyama kungenzeka ngaphansi kwezimo zokukhulisa izikhathi ezingu-6-10. Isibonelo, ukwenza ukuhlinzwa kwe-pituitary tumor nge-ethmoidal sinus kungabona futhi kususe izimila ze-pituitary ngokuphephile ngenkathi kuvikela indlala ye-pituitary evamile; Ukuhlinzwa okungenakukwenziwa ngeso lenyama kungaba ukuhlinzwa okungcono, njengezimila zobuchopho kanye nezimila zangaphakathi kwe-spinal cord. Isazi sezemfundo uWang Zhongcheng wayenesilinganiso sokufa esingu-10.7% sokuhlinzwa kwe-cerebral aneurysm ngaphambi kokusebenzisa i-imakroskopu yokuhlinzwa kwemizwaNgemva kokusebenzisa imakroskopu ngo-1978, izinga lokufa lehla laya ku-3.2%. Izinga lokufa kokuhlinzwa kwe-cerebral arteriovenous malformation ngaphandle kokusebenzisa i-imakroskopu yokuhlinzwakwakungu-6.2%, futhi ngemva kuka-1984, kusetshenziswaama-microscope okuhlinzwa kwe-neurosurgery, izinga lokufa lehle laya ku-1.6%. Ukusetshenziswa kweimakroskopu yokuhlinzwa kwemizwaivumela izimila ze-pituitary ukuthi zelashwe ngendlela ye-transphenoidal engavamile kakhulu ngaphandle kwesidingo se-craniotomy, kunciphisa izinga lokufa ngokuhlinzwa kusuka ku-4.7% kuya ku-0.9%. Ukutholakala kwale miphumela akunakwenzeka ngaphansi kokuhlinzwa kwamehlo okuvamile, ngakho-keama-microscope okuhlinzwaziwuphawu lokuhlinzwa kwemizwa kwesimanje futhi sezibe ngenye yemishini yokuhlinza ebalulekile nengenakufakwa esikhundleni sayo ekuhlinzeni kwemizwa kwesimanje.