Umlando wohlelo lokusebenza kanye nendima yama-microscopes okuhlinzwa ku-neurosurgery

 

Emlandweni we-neurosurgery, ukusetshenziswa kwei-microscopes yokuhlinzwakuwuphawu oluyisisekelo, olusuka enkathini yendabuko yokuhlinzwa kwemizwa yokuhlinza ngaphansi kweso lenyama kuya enkathini yesimanje yokuhlinzwa kwemizwa yokuhlinzwa ngaphansi kokuhlinzwa.ngesibonakhulu. Ubani futhi niniama-microscopes asebenzayouqale ukusetshenziswa ku-neurosurgery? Iyiphi indimaisibonakhulu sokuhlinzwaidlalwe ekuthuthukisweni kwe-neurosurgery? Ngokuthuthuka kwesayensi nobuchwepheshe, intandoIsibonakhulu esisebenzayoithathelwe indawo imishini ethile ethuthuke kakhudlwana? Lona umbuzo okufanele wonke udokotela ohlinzayo awazi futhi asebenzise ubuchwepheshe bamuva namathuluzi emkhakheni we-neurosurgery, okukhuthaza ukuthuthukiswa kwamakhono okuhlinzwa okwenziwa yizinzwa.

1, Umlando Wezicelo Ze-Microscopy Emkhakheni Wezokwelapha

Kufiziksi, amalensi engilazi yemehlo amalensi ayi-convex anesakhiwo esisodwa esinomphumela wokukhulisa, futhi ukukhuliswa kwawo kulinganiselwe, okwaziwa ngokuthi yizibuko ezikhulisayo. Ngo-1590, abantu ababili baseDashi bafaka amapuleti amalensi ayi-convex ngaphakathi komgqomo omncane oyicylindrical, ngaleyo ndlela basungula idivayisi yokuqala eyinhlanganisela yomhlaba yokukhulisa isakhiwo:ngesibonakhulu. Ngemva kwalokho, ukwakheka kwe-microscope kwathuthukiswa ngokuqhubekayo, futhi ukukhuliswa kwanda ngokuqhubekayo. Ngaleso sikhathi, ososayensi babesebenzisa lokhu ngokuyinhlokoisibonakhulu esiyinhlanganiselaukubona izakhiwo ezincane zezilwane nezitshalo, njengokwakheka kwamangqamuzana. Kusukela maphakathi nekhulu le-19, izibuko zokukhulisa nezibonakhulu ziye zasetshenziswa kancane kancane emkhakheni wezokwelapha. Ekuqaleni, odokotela abahlinzayo babesebenzisa izibuko zokukhulisa izibuko ezinesakhiwo se-lens esisodwa esasingabekwa ebhulohweni lekhala ukuze zihlinzwe. Ngo-1876, udokotela waseJalimane u-Saemisch wenza ukuhlinzwa kokuqala "okuncane kakhulu" emhlabeni esebenzisa ingilazi yokukhulisa i-eyeglass (uhlobo lokuhlinzwa alwaziwa). Ngo-1893, inkampani yaseJalimane i-Zeiss yasungula i-i-binocular microscope, ikakhulukazi esetshenziselwa ukuhlola ukuhlolwa kumalabhorethri wezokwelapha, kanye nokubheka izilonda ze-cornea kanye negumbi elingaphambili emkhakheni we-ophthalmology. Ngo-1921, ngokusekelwe ocwaningweni lwaselabhorethri mayelana ne-anatomy yangaphakathi yendlebe yezilwane, isazi se-otolaryngologist saseSweden uNylen wasebenzisa i-fixed.Isibonakhulu sokuhlinzwa kwe-monocularyakhelwe futhi yenziwe nguyena ukwenza ukuhlinzwa okungapheli kwe-otitis media kubantu, okwakuyi-microsurgery yangempela. Ngemva konyaka, udokotela ophakeme kaNylen uHlolmgren wethula aisibonakhulu sokuhlinzwa se-binocularekhiqizwa nguZeiss egumbini lokuhlinza.

EkuseniAma-microscopes asebenzayokube nezithiyo eziningi, njengokungaqini kahle kwemishini, ukungakwazi ukunyakaza, ukukhanya kwezimbazo ezahlukene kanye nokushisisa i-lens yenhloso, indawo ewumngcingo yokukhulisa ukuhlinzwa, njll. Lezi zonke izizathu ezinciphisa ukusetshenziswa okubanzii-microscopes yokuhlinzwa. Eminyakeni engamashumi amathathu elandelayo, ngenxa yokuxhumana okuhle phakathi kodokotela abahlinzayo kanyeabakhiqizi be-microscope, ukusebenza kwei-microscopes yokuhlinzwayathuthukiswa ngokuqhubekayo, futhiama-binocular surgery microscopes, ama-microscopes afakwe ophahleni, amalensi okusondeza, ukukhanya komthombo we-coaxial, izingalo eziveziwe ezilawulwa ngomfutho we-elekthronikhi noma wamanzi, isilawuli sezinyawo ezinyakazayo, nokunye kwathuthukiswa ngokulandelana. Ngo-1953, inkampani yaseJalimane i-Zeiss yakhiqiza uchungechunge lwezipeshelii-microscopes yokuhlinzwa ye-otology, ilungele ikakhulukazi ukuhlinzwa ezilonda ezijulile njengendlebe emaphakathi nethambo lesikhashana. Ngenkathi ukusebenza kwei-microscopes yokuhlinzwaiyaqhubeka ithuthuka, ingqondo yodokotela abahlinzayo nayo ishintsha njalo. Ngokwesibonelo, odokotela baseJalimane uZollner noWullstein bakubeka kanjaloi-microscopes yokuhlinzwakufanele isetshenziselwe ukuhlinzwa kolwelwesi lwe-tympanic. Kusukela ngawo-1950, odokotela bamehlo baye bashintsha kancane kancane umkhuba wokusebenzisa i-microscope kuphela ekuhlolweni kwamehlo futhi bethula.i-microscopes ye-otosurgicalekuhlinzweni kwe-ophthalmic. Kusuka lapho,Isibonakhulu esisebenzayozisetshenziswe kabanzi emkhakheni we-otology kanye ne-ophthalmology.

2. Ukusetshenziswa kwe-microscope yokuhlinzwa ku-neurosurgery

Ngenxa yobukhethekile be-neurosurgery, ukusetshenziswa kwei-microscopes yokuhlinzwa ku-neurosurgerysekwephuzile kancane kune-otology ne-ophthalmology, futhi odokotela abahlinzayo bafunda ngenkuthalo lobu buchwepheshe obusha. Ngaleso sikhathi, i-ukusetshenziswa kwe-microscopes yokuhlinzwaikakhulukazi eYurophu. Udokotela wamehlo waseMelika uPerrit wethulwa okokuqalai-microscopes yokuhlinzwakusukela eYurophu kuya e-United States ngo-1946, kwabeka isisekelo sokuthi odokotela abahlinzayo baseMelika basebenziseAma-microscopes asebenzayo.

Ngokombono wokuhlonipha ukubaluleka kwempilo yomuntu, noma ibuphi ubuchwepheshe obusha, okokusebenza, noma amathuluzi asetshenziselwa umzimba womuntu kufanele enze ukuhlolwa kwezilwane kokuqala kanye nokuqeqeshwa kobuchwepheshe kwabasebenza. Ngo-1955, udokotela ohlinzayo waseMelika uMalis wenza ukuhlinzwa kobuchopho ezilwaneni esebenzisa i-isibonakhulu sokuhlinzwa se-binocular. UKurze, udokotela ohlinza izinzwa e-University of Southern California e-United States, wachitha unyaka efunda izindlela zokuhlinza zokusebenzisa isibonakhulu endaweni yokucwaninga ngemva kokubona ukuhlinzwa kwendlebe ngesibonakhulu. Ngo-August 1957, wenza ngempumelelo ukuhlinzwa kwe-acoustic neuroma enganeni eneminyaka emihlanu ubudala esebenzisa i-acoustic neuroma.Isibonakhulu sokuhlinzwa kwendlebe, okwakuwukuhlinzwa kokuqala komhlaba okubangelwa amagciwane. Ngokushesha ngemva kwalokho, u-Kurze wenza ngempumelelo i-facial nerve sublingual nerve anastomosis enganeni esebenzisa i-isibonakhulu sokuhlinzwa, futhi ukululama kwengane kwaba kuhle kakhulu. Lokhu bekungowesibili ukuhlinzwa kwe-microsurgical emhlabeni. Ngemva kwalokho, uKurze wasebenzisa amaloli ukuthwalaAma-microscopes asebenzayoezindaweni ezihlukahlukene ze-microsurgery neurosurgery, futhi wancoma kakhulu ukusetshenziswai-microscopes yokuhlinzwakwabanye odokotela abahlinzayo. Ngemva kwalokho, u-Kurze wenza ukuhlinzwa kwe-cerebral aneurysm clipping esebenzisa aisibonakhulu sokuhlinzwa(ngeshwa, akazange ashicilele noma yiziphi izihloko). Ngokusekelwa isiguli se-trigeminal neuralgia ayelashwa, wasungula ilabhorethri yokuqala yomhlaba ye-micro skull base neurosurgery ngo-1961. Kufanele sihlale sikhumbula igalelo lika-Kurze ekuhlinzeni okuncane futhi sifunde esibindini sakhe sokwamukela ubuchwepheshe obusha nemibono. Nokho, kwaze kwaba sekuqaleni kwawo-1990, abanye odokotela abahlinza izinzwa eChina abazange bakwamukeleI-Neurosurgery microscopesukuhlinzwa. Lokhu bekungeyona inkinga ngeIsibonakhulu se-Neurosurgeryngokwayo, kodwa inkinga ngokuqonda kwemibono yama-neurosurgeons.

Ngo-1958, udokotela ohlinzayo waseMelika u-Donaghy wasungula ilabhorethri yokuqala yomhlaba yocwaningo lwe-microsurgery nokuqeqeshwa eBurlington, eVermont. Ezigabeni zokuqala, waphinde wabhekana nokudideka nobunzima bezezimali kubaphathi bakhe. Ezifundweni, wayehlale ecabanga ukusika imithambo yegazi ye-cortical evulekile ukuze kukhishwe i-thrombi ezigulini ezine-cerebral thrombosis. Ngakho-ke wabambisana nodokotela ohlinza imithambo uJacobson ocwaningweni lwezilwane nolwemitholampilo. Ngaleso sikhathi, ngaphansi kwezimo zeso lenyama, imithambo yegazi emincane kuphela enobubanzi obungamamilimitha ayi-7-8 noma ngaphezulu ingafakwa. Ukuze kuzuzwe i-anastomosis yokuphela-siya-ekupheleni yemithambo yegazi ecolekileyo, u-Jacobson uqale wazama ukusebenzisa ingilazi yokukhulisa isitayela yengilazi. Ngokushesha ngemva kwalokho, wakhumbula ukusebenzisa i-i-otolaryngology microscope yokuhlinzwaukuze ahlinzwe lapho engudokotela ohlala khona. Ngakho, ngosizo lukaZeiss eJalimane, uJacobson waklama isibonakhulu esihlinzayo esisebenza kabili.I-Diploscope) ye-vascular anastomosis, evumela odokotela ababili abahlinzayo ukuba benze ukuhlinzwa ngesikhathi esisodwa. Ngemuva kokuhlolwa okubanzi kwezilwane, uJacobson ushicilele i-athikili ekhuluma nge-microsurgical anastomosis yezinja kanye nemithambo ye-non-carotid (1960), enezinga le-100% lobunikazi be-vascular anastomosis. Leli yiphepha lezokwelapha elingenasisekelo elihlobene ne-microsurgical neurosurgery kanye nokuhlinzwa kwemithambo. U-Jacobson uphinde waklama amathuluzi amaningi okuhlinza okuncane, njengezikele ezincane, izibambo zezinaliti ezincane, nezibambo zezinsimbi ezincane. Ngo-1960, u-Donaghy wenza ngempumelelo i-cerebral artery incision thrombectomy ngaphansi kokuhlinzwa.isibonakhulu sokuhlinzwaesigulini esine-cerebral thrombosis. U-Rhoton wase-United States waqala ukutadisha i-anatomy yobuchopho ngaphansi kwesibonakhulu ngo-1967, waphayona umkhakha omusha we-microsurgical anatomy futhi waba neqhaza elikhulu ekuthuthukisweni kwe-microsurgery. Ngenxa yezinzuzo zei-microscopes yokuhlinzwakanye nokuthuthukiswa kwezinsimbi zokuhlinza ezincane, odokotela abahlinzayo abaningi bayathanda ukusebenzisai-microscopes yokuhlinzwaukuhlinzwa. Futhi ishicilele izindatshana eziningi ezihlobene ngezinqubo ze-microsurgical.

3, Ukusetshenziswa kwe-microscope yokuhlinzwa ku-neurosurgery e-China

NjengomShayina oshisekela izwe laphesheya eJapane, uProfesa Du Ziwei wanikela nge-domestic yokuqalai-neurosurgical microscopenokuhlobeneizinsimbi ze-microsurgicaleMnyangweni We-Neurosurgery weSibhedlela Esihlanganisiwe Sekolishi Lezokwelapha i-Suzhou (manje osekuyi-Neurosurgery Department of Suzhou University Affiliated First Hospital) ngo-1972. Ngemva kokubuyela e-China, waqala ukwenza ukuhlinza okuncane okufana ne-intracranial aneurysms kanye ne-meningiomas. Ngemva kokufunda mayelana nokutholakala kwei-neurosurgical microscopeskanye nezinsimbi zokuhlinza ezincane, uSolwazi Zhao Yadu ovela eMnyangweni Wokuhlinzwa Kwezinzwa esibhedlela saseBeijing Yiwu uvakashele uSolwazi Du Ziwei waseSuzhou Medical College ukuyobheka ukusetshenziswai-microscopes yokuhlinzwa. USolwazi Shi Yuquan waseSibhedlela sase-Shanghai Huashan uzivakashele yena mathupha umnyango kaSolwazi Du Ziwei ukuyobheka izinqubo zokuhlinza ezincane. Ngenxa yalokho, igagasi lesingeniso, ukufunda, nokusebenzisaI-Neurosurgery microscopeskwaqubuka ezikhungweni ezinkulu ze-neurosurgery e-China, okuphawula ukuqala kwe-micro neurosurgery yase-China.

4, Umphumela Wokuhlinzwa Kwe-Microsurgery

Ngenxa yokusetshenziswa kwei-neurosurgical microscopes, ukuhlinzwa okungeke kwenziwe ngeso lenyama kungenzeka ngaphansi kwezimo zokukhulisa izikhathi ezingu-6-10. Isibonelo, ukwenza ukuhlinzwa kwesimila se-pituitary ngokusebenzisa i-ethmoidal sinus kungakhomba ngokuphepha futhi kususe izimila ze-pituitary ngenkathi kuvikela indlala evamile ye-pituitary; Ukuhlinzwa okungenakwenziwa ngeso lenyama kungase kube ukuhlinzwa okungcono, okufana nezimila zobuchopho kanye namathumba e-intramedullary yomgogodla. Isazi sezemfundo u-Wang Zhongcheng sinezinga lokufa elingu-10.7% ngokuhlinzwa kwe-cerebral aneurysm ngaphambi kokusebenzisa i-cerebral aneurysm.i-neurosurgery microscope. Ngemva kokusebenzisa isibonakhulu ngo-1978, izinga lokufa lehla laya ku-3.2%. Izinga lokufa lokuhlinzwa kokukhubazeka kwe-cerebral arteriovenous ngaphandle kokusebenzisa aisibonakhulu sokuhlinzwalalingu-6.2%, futhi ngemva kuka-1984, ngokusetshenziswa kwe-ai-neurosurgery microscopes, izinga lokufa lehla laya ku-1.6%. Ukusetshenziswa kwei-neurosurgery microscopeivumela izimila ze-pituitary ukuthi zelashwe ngokusebenzisa indlela encane ye-transnasal transsphenoidal ngaphandle kwesidingo se-craniotomy, kunciphisa izinga lokufa kokuhlinzwa lisuka ku-4.7% liye ku-0.9%. Ukuphumelela kwale miphumela akunakwenzeka ngaphansi kokuhlinzwa kwamehlo okungokwesiko, ngakho-kei-microscopes yokuhlinzwaziwuphawu lwe-neurosurgery yesimanje futhi sezingomunye wemishini yokuhlinza ebaluleke kakhulu nengenakubuyiseleka ku-neurosurgery yesimanje.