T r o n g noi soi p hd u t huat b u o n g tir c u n g , ng ud i ta sir d u n g l aser N d - Y A G . L o ai l as er n a y c a n c o c o n g suat c a o ( 1 0 0 W ) de c o k h a n a n g p h a h u y c a c m a c h m a u va k h a n a n g d a m x u y e n va o ldp c o tir c u n g . Vdi b u d c s o n g 1064 n m ga n vdi h o n g ng oa i , do vay k h d n g the nhin thay d uo c . Vi the c a n tia s a n g b a n g h e l i u m - n e o n co d u d n g kfnh 2 m m chi dan. Hieu q u a sinh h oc khi c h i eu l aser la g a y b a y ho'i tire la lam h o a than m d va lam c h o m d c o lai. M u o n c d tac d u n g ba y hoi h ay lam h o a than m d thi phai sir d u n g ky t huat " ch a m " , trai lai m u o n lam c h o m d c o lai thi sir d u n g ky t huat " k h d n g c h a m " n h d m m u c dfch c a m m a u m d sau m a k h d n g lam p ha h u y md. Phai t r a n h g a y c h a y m d khi md i t h uc hien, m d d u o c c h ie u tia phai t rd n e n trdng. K y t hu at " c h a m " la de’ d u n g cu p h a t tia laser c h a m vao m d ha y tdn t h u o n g m u o n cdt. Ne u tru dc do. m d da bi c h a y thi vd tinh ky t huat da trd t h a n h " k h d n g c h a m " , luc nay phai het sire tha n t r on g vi c d the ga y hoai tir m d d sau.
M o t the he la se r N d - Y A G mdi cd hai b u d c s o n g va hai c a c h ph at tia - laser K T P , c d b u d c s o n g 1064 va 5 3 2 nm, p h a t tia lien tuc h a y c u c x u n g . Vd i b u d c s o n g 5 3 2 c d tac d u n g c a m m a u be ma t, chi an sau va o m d 1 d e n 2 m m , c h o p h e p c a m m a u n h u n g b l m a t c d n h i l u m a c h m a u . N o c u n g c h o p h e p p h a h u y m d n h a n h c h d n g va k i e m sodt d uo c . Vdi kieu pha t tia lien tuc c h o p h e p c a m m a u tren m o t di en k h a r ong, n h u n g vdi kieu p h a t tia c u c x u n g , laser na y t rd t h a n h mo t c o n d a o vdi do c hf nh x a c cao.
DAO MO SIEU AM TRONG N 0 I SOI
V ie c c h e tao d a o m d sieu a m t r ong noi soi la c a n h c u a m d ra k y n g u y e n md i trong p h au thuat. N a n g l u o n g sieu am do d a o d o n g c o hoc sinh ra. S o n g sieu a m co m u c n a n g l u o n g t h a p d u o c ap d u n g t r ong c h a n d o a n . k h d n g g a y pha huy md. Song sieu am cd m u c n a ng lu o ng c a o d u o c d u n g d l cat m d va c a m m a u . D a o m d sieu am c d k ha n a n g c a m m a u c u n g n h u cdt c a c m d b a n g c a c h c h u y l n sieu a m t h a nh n a n g luong . Ta c d u n g cdt m d va c a m m a u d u o c thuc hien d nhiet do thap, k h d n g lam c h a y md, k h d n g sinh khoi n h u khi s u d u n g dao dien, g iup c h o c a c p h au t hua t vien q u a n sat de d a n g h o n . N g u d i b e n h k h d n g phai c hi u c a c n g u y hie’m c u a d o n g di en c h a y t ro n g c o the, k h d n g c an phai c h u a n bi dac biet (ban ddi c u c noi vao m a y n h u t ro n g d a o d i e n ) . Pha u thuat vien k h d n g c an phai d e o kfnh n h u khi su d u n g laser.
Hien nay, tren the gidi c d hai loai d a o m d u n g d u n g n g u y e n ly sieu a m k h a c nha u ve tan so:
- D a o c o tan so 23 kHz : C U SA IM Sys te m V a l l e y l a b , Inc, h a y U l t r a IM U lt r a s o n i c A s pi r a t or , Sharplan L as er , Inc.
- D a o c d tan so 5 5, 5 kHz : H a r m o n i c Scalpel, U l t r a C i s i o n , Inc, S mi thfie ld , RI.
C h u n g tdi da su d u n g d a o m d sieu am S o n oS u rg c u a h a n g O l y m p u s . D a o co tan so s on g sieu a m la 23,5 k H z. N a n g l u o n g d i e n tu n g u d n p h a t d u o c c h u y e n t ha nh da o d o n g s o ng am cd tac d u n g lam r u n g ddu ludi d a o . D a u ludi d a o r u ng m a n h d a lam p h a t sinh ra n hi et c d tac d u n g d o n g thdi g a y c a m m a u va cat md. N g u d i ta tha y rdng vdi tan so t ha p h o n 23, 5 k H z k h d n g c h o p h e p dau da o r u ng du m a n h , bien do k h d n g du ldn (can c d bi en do d a o d o n g tdi 2 0 0( i m ) de c d the c a m m a u va cat md.
Khi sir d u n g da o m d sieu am, n gu di b e nh an t oa n h o n vi k h d n g c d d o n g dien sinh ra. Cat m d va c d m m a u la do sue n o n g sinh ra bdi d a o d o n g sieu a m vdi tdc do cao. Vdi d a o m o S on o Su rg , dau d a o c o the k h u k h u d n d l d u n g n h i i u lan ( hap am h a y n g a m t r o ng d u n g di ch C i d e x ) , chi phi c h o m o t t r u d n g h o p phdu t huat c d the g i a m di n h i l u . H o n n ua , dau d a o m d n a y c d the q u a y d u o c 360°, p h au t hu a t vien c d the t h a o tac d l d a n g hon. T u y md i sir d u n g , n h u n g c h u n g tdi tha y d a o m d sieu a m S o n oS u rg c d n h u g c d i l m la:
- Thdi gi an c a m m a u va cat m d lau hon d ao dien.
- M u o n cat d l d a n g, m d phai c o m o t sue c a n g nh at di nh . - Rat k h o thu c hien c a m m a u tren m o t d i e n nho.
- L a s e r va sieu am la hai t h a n h tuu ky t h ua t n h a n h c h d n g d u g c u n g d u n g vao p h au t huat noi soi, gi up c h o c a c t h a y t h u d c c o t h e m p h u o n g tien t h u a n lgi, th uc hien c a c ky t hua t p ha u thuat.
TAI LIEU THAM KHAO
1. M o n r d o n S, B r u n et a ud J M, B e a c c o C. L e s 4 m e c a n i s m e s d ' i n t e r a c t i o n laser - tissus vivants.
2. B r u n e t a u d J M , M o r d o n S, Be ac o C, C r i n q u e t t e V. L a s e r s et sec uri te . 3. P o u l y J L. Le laser en c o e l i o s c o p i e .
4. F e r e n z y A, B e r g er o n C, R i c h ar t R M . H u m a n p a p i l l o m a v i r u s D N A in C 0 2 l aser g e n e r a t e d p l u m e o f s m o k e a n d r o g e n its c o n s e q u e n c e s to the s u r g e o n . O b s t e t G y n e c o l , 1990; 75: 114-8. 5. F e r e n z y A, B e r g er o n C, R i c h ar t R M . C a r b o n d i o x i d e la se r e n e r g y d is p er s e h u m a n p a p i l l o m a v i r u s d e o x y r i b o n u c l e i c a ci d o n t o t r e a t m e n t fields. A m O b s t e t G y n e c o l , 1990; 163: 1271-4. 6. D o r s e y J H . A p p l i c a t i o n o f l aser in g y n e c o l o g y . O p e r a t i v e g y n e c o l o g y , s eve nt h e d i t i o n , L i p p i n c o t t C o m p a n y , 1992; 4 9 9 - 5 2 3 . 7. A m a r a l J F. U lt r a s o n i c e n e r g y in l a p a r o s c o p i c s u r g e r y . Sur gical t e c h n o l o g y i nt e rn a t i o n a l III.
8. St ri ng er N H . L a p a r a s c o p i c m y o m e c t o m y with the H a r m o n i c Scalpel, a r e w i e w o f 25 c a s es . J or na l o f g y n e c o l o g i c s u r g e r y , M a r y A n n Li b er t , Inc, P u b l i s h e r s .
9. F o s l e r D L. Use o f the u l t r a s o n i c c a l l y a ct i vat ed scalpel a n d r o g e n s h e a r s in e n d o s c o p i c s u r g er y. P r e s e n t e d at this i nt e rn a t i o n a l c o n g r e s s on ne w t e c h n o l o g y a n d a d v a n c e d t e c h n i q u e s in s u r g e r y , L u x e m b o u r g , j u n e
UCH SIJT SOI BUONG TUf CUNG
L e T h i T h a n h V d n
I- UCH SUf
M o vit la d u n g cu c o n h a t d u o c sir d u n g t ro n g ky t h ua t noi soi s a n k h o a . D u o c biet d en tir thoi c o H y lap va d u o c sir d u n g nhidu h o n d u o i t hoi T r u n g c o va n h u n g the ky sau do, vao n u a da u the ky 19 d u n g cu n a y d u o c R e c a m e r h o a n c h i n h . M o vit ( s p e c u l u m ) t r o n g t i eng la tinh c o n c o nghTa la cai g u o n g , vi v a y c o m o t vai sir hieu lam t ro n g c a c s a c h v d v6 v iec sir d u n g d un g cu n a y va g u o n g de soi va o t ro n g a m dao.