Sau n a m 1805, Bo zz in d a thiet ke mo t d u n g cu d u n g de k h a o sat c a c h a n g d o n g t ro n g tu n h i e n ; do la m o t cai o n g k h o e t r d n g d u o c c h i e u s a n g tir ben n goa i b a n g c a c h d u n g a n h s a n g p h a n xa tu m o t c a y ne n.
V a o n a m 1853 D e s o r m a u x da d u n g ten "noi soi" de d at c h o d u n g cu dau tien d u o c d u n g t ro n g lTnh vuc y k h o a ; o n g noi soi ( dau d o) la m o t cai o n g k h o e t r o ng tren do c o m o t cai de n va c o o n g t h o n g hoi. D u n g c u n a y s au do da d u o c urng d u n g m o t c a c h t h a n h c o n g t r o n g m o t so llnh vu c c u a n g a n h noi soi n g a y khi md i ra ddi.
T u y n hi e n, c h f n h va o n a m 1879 t r o ng lTnh vuc di eu tri n i e u h o c , o n g M a x i m i l i e n Nitze da dat c o so c h o n g a n h noi soi hi en dai. D u n g c u soi b a n g q u a n g ( c y s t o s c o p i e ) d u o c k h e p k m b a n g m o t he t h o n g t ha u kfnh va n g u d n s a a g d u o c dat tir m o t c u c c u a o n g t h a m va d u o c d i n va o t r o n g t h o n g q u a m d t tui d u n g n ude .
Khong may, nhung dac diem giai p h i u cua t u c ung lam c ho ngudi ta kho cd the sir dung dung cu nay trong linh vuc san khoa va vi the noi soi san k ho a van bi tut hau.
1. N h U ng t r u o n g h o p noi soi d a u tien h a y vi c c s u d u n g ky t h u a t n a v d obbt bu o c: bbt bu o c:
Neu n h u p a n t a l e o n i d a dat d u o c t h a n h c o n g n h d sir d u n g d u n g c u noi soi ciia De s o r m a u x (de p h a t hi en m o t k ho i u n g u y e n n h a n g a y ra tinh t r a n g c h a y m a u ) thi tac g ia k h a c lai p h a n na n d u n g c u n a y q u a n sat rat h a n c h e.
N h u n g k h o k h a n do la do:
- Su c an thiet phai d an c o tir c u n g de d u a o n g soi v ao m a d u d n g k i n h ldn hon 1cm
- C h a y m a u m a k h d n g the’ t r a n h khoi do o n g soi c h a m phai t h a n h tir c u n g m a binh t h u d n g no d u o c d in h lien.
— M a u tran va o t r ong o n g da m o lam c a n t rd viec q u a n sat q u a o n g - A n h s a n g be n ngoai q u a yeu
Tdi n a m 1898, C la d o mdi ap d u n g ky t hu at d u n g di en de c h i e u s a n g vao d u n g cu c u a m i n h va c o n g b d k y t hua t soi b u o n g tir c u n g .
V a o n a m 1907 C h ar l es D a vi d sau c u n g da ap d u n g n g u y e n tdc Nitz e va o soi b u o n g tir c u n g . D e n c o soi dot dirge dat va o da u t ro ng be n k ia c u a o n g soi va d u g c d o n g c h a t bdng m o t vit, n h d do no k h o n g n h u n g c o the n g a n m a u c h a y vao m a c o n n g a n no tron ldn vao c a c bo p h a n k h a c khi n g u d i ta d u a dau do tiep xuc vdi lop mo. Vi vay, ngudi ta co the qua n sat mot c a c h ro rang.
2. Soi buong tu cung voi buong tu cung du oc lam cang hay noi soi toan canh
Sau khi giai q u y e t dirge va n dS q u a n sat k h o n g bi m a u c an trd, mg i n gh id n ciru bdt dau h u d n g s a ng tim ki e m c a c h q u a n sat toa n c a n h b u o n g tir c u n g . V a o n a m 1925, R u b i n da sir d u n g k h o n g khi, sau do la k h i c a c b o n i c de ta ch t h an h tir c u n g ra, tuy n h ie n ky t huat c u a o n g sau do lai k h o n g d u g c tiep tuc. N a m 1928 G a u s s d a m d dau m ot loat c a c c a soi b u o n g tir c u n g t ro n g d o sir d u n g n u d e n h u p hirong c a c h de c a n g be mat. Vi k h o n g true tiep tiep xuc, van de m a u g a y c a n trd m oi t ru d n g q u a n sat lai x u a t hi en va sir c a n thiet phai lau rira t h u d n g x u y e n lam c h o p h u o n g p h a p n a y k h o n g tiSn lgi nua. H o n n u a c a c tac gia (G au ss , S c hr oe d er , S e g o n d ) lai q u a n t a m tdi n h u n g riii ro c o the c o do c h a t lo n g d u g c b o m vao 6 b u n g va he t h o n g m a c h m a u .
N a m 1962 S i l a n d e r d a c d g dng lam gian b u o n g tir c u n g b dn g c a c h d u a b o n g t r on g suot vao n h u n g k h o n g c o ket qua.
Cac ky t hu a t hi en dai soi b u o n g tir c u n g toan c a n h
T r o n g ky t hu a t n a y n g u d i ta da dat d u g c tien bo t ro n g c a c llnh vu c l am c a n g b u o n g tir c u n g , d u n g cu q u a n g h oc va c h ie u s ang.
Cang b u o n g tie cung:
Sau n a m 1 97 0 c a c tac g ia L i n d e m a n n d D u e va Por to d P h a p d a sir d u n g lai ky t huat n a y va
da cai t hien viec l am c a n g tir c u n g b dng khf C 0 2 . V ie c h o a n c h i n h ky t huat b o m hoi l am c h o n h u n g sir c d do khf C 0 2 tran o at va o m a c h m a u k h o n g the x a y ra. V i e c lam c a n g b u o n g tir c u n g bdn g c h a t lo ng c o do n h d t c a o k h o n g tan t r ong m a u d o M e n k e n de nghi va o n a m 1968 va sau d o do E d s t r o m va D e r n s t r o m c u n g d u a ra n a m 1 97 0 da thu d u g c ket qua .
D u n g cu q u a n g hoc:
D u n g cu q u a n g h o c d a c o b u d c tien q u a n t r o n g bdt d au tOr n a m 1 9 6 0 khi H o p k i n s t h a y the c a c thau kfnh m o n g b a n g t h u y tinh t r o n g c a c o n g soi c o dien b dn g c a c d u a t h u y t inh dai d u g c n g a n c a c h b dn g c a c "thau k f nh k h d n g khf" m o n g . D o c h ie u s a n g c a o va do m d r o n g dat d u g c n h d d u n g cu m d i c h o p h e p g i a m bdt d u d n g kfnh o n g soi va k h o n g c a n n o n g c 6 tir c u n g . C a c thiet
bi q u an g hoc m dm de o d ugc lam bang c ac ma n g soi thuy tinh von d uo c sir d u n g trong nhidu llnh vuc c u a noi soi lai kho ng tien d ung trong soi b u d n g tir c u ng .
Chieu sang:
N a m 1952 V u l m i e r e da d e m de n m o t t h a y doi Ion khi t h a y thd' c h i d c d e n bdn t r o ng c o d o c h i e u s a n g h an c h e do c o n g k e n h va l am n o n g t hiet bi b a n g m o t c h i ec d u a q u a z t c o the t r uy e n a n h s a n g da d u g c loc tir m o t n g u o n s a n g m a n h d be n n g oa i . Tir n a m 1965, p h u o n g p h a p " anh s a n g l a nh " d u g c p h o c a p r o ng rai n h d k y t huat t r uy e n a nh s a n g b a n g m a n g sgi t h u y t in h k h o n g d o n g nha't.
Cdc ky th u a t hien dai soi h u o n g t u c u n g co tiep xu c:
T r o n g thdi g i a n tir 196 0 tdi 1970, n h u n g that v g n g d o p h u o n g p h a p soi b u o n g tir c u n g t oa n c a n h hien dai k h o n g d u g c p h a t trien m a n h m e d a lam c h o p h u o n g p h a p noi soi tiep x uc c o s o p h a t tridn t rd lai. M a y m a n th a y, n gu di ta da bo s u n g c h o k y t hu at soi b u d n g tir c u n g c 6 d i e n b a n g n h u n g trien v on g mdi.
V a o n a m 1965 M a r l e s c h k i n h a n t h a y su that bai nira c hirng c u a soi b u o n g tir c u n g va c h u t r u o n g q u a y lai p h u o n g p h a p tiep xu c g i a n d o n h o n va d a n g tin c a y hon. O n g ta d u a ra m o t thiet bi c h o p h e p p h o n g to h i n h a n h len 12,5 l i n . V a o n a m 1962, V u l m i e r e c u n g vdi s u g i u p d o ciia T r u n g t a m n g h i e n ciru k h o a h o c q u o c gia d a h o a n c h i n h ky t hua t noi soi tiep x u c b a n d a u t r o n g do chi c i n m o t sgi t h u y tinh d u y n h a t d a c o thd vira c h i e u s a n g vira q u a n sat d ug c. C a c da c d i e m c u a thiet bi sir d u n g a n h s a n g t a n g c u d n g d a l a m c h o no t r d t h a n h m o t d u n g cu rat t hi ch h g p vdi viec t h a m d o b u o n g tir c u n g .
Sau c u n g , k y t hua t vi soi b u o n g tir c u n g true tiep ( m i c r o h y s t e r o s c o p i e ) c h o p h e p n g u d i ta c d the q u a n sat tir c u n g d mire do te bao.
Ill- PHAU THUAT NOI SOI BUONG TUT CUNG 1 9 7 0 - 1997
D e n n h u n g n a m 7 0 thi ky t h ua t noi soi b u o n g tir c u n g d u g c c h a p n h a n tuy c h u a d u g c p h o bi en r o n g rai do s u k h o k h a n t r o n g d i e u c h i n h s ao c h o c d h i nh a nh dep, n h a t la ddi vdi c a c n h a l a m s a n g ft k i n h n g h i e m . T u y n h i e n , trien v o n g c o the t h uc h i e n c a c t h a o tac t r o n g b u o n g tir c u n g d e didu tri lam c h o ky t huat n a y d u g c u a c h u o n g hon.
D a u tien c a c d u n g cu p h a u t hu a t n h u k i m va k e o d u g c d u a v a o b u o n g tir c u n g be n n g o a i o n g noi soi de c at p o l y p h a y c at u x o tir c u n g c d c u d n g h o a c d£ lay v o n g t r a n h thai lac c h o v a t a c h dfnh b u o n g tir c u n g . Sau n a y c a c d u n g cu do d u g c d u a va o c u n g m o t o n g vdi o n g noi soi.
R o b e r t Neu wi rt h ( N e w Y o r k ) la n g u d i da u tien sir d u n g dot d i e n t r o n g noi soi de giai q u y e t n h u n g t r u d n g h g p u x o tir c u n g to. N g u d i ta d u n g G n R H l am teo bdt u x o d e p h i u t h ua t dd d a n g h o n q u a noi soi ( D o n n e z va c o n g su
M il to n G o l d r a t h (Detroit) va c o n g sir de xu at sir d u n g l aser t r o ng noi soi tir n a m 1981. N a m 1983 D e c h e r n e y va P o l a n m o ta p h u o n g p h a p n a o c i t bo n i e m m a c tir c u n g b i n g v o n g d ie n ( e n d o m e ) de didu tri x u a t h u y e t a m da o b i t t h u d n g t h a y vi phai m o c i t bo tir c u n g . Bao c a o na y d a g a y ra nhidu t ranh cai t rong gidi y hoc. G a n d ay V a n c a i l l e d u a ra p h u o n g p h a p d ot di en n ie m ma c t i r c u n g b i n g di en c u c dau tron ( 1 9 8 9 ) lam g i a m rat n h i e u tai bien thiing t i r c u n g ( M a r e s h , 1996). D o t di en c u n g d u o c d u n g de t a ch dfnh b u o n g tir c u n g va c i t va ch n g a n b u o n g tir c u n g .
Tai bien t h u n g tir c u n g khi na o s ac h n i e m m a c tir c u n g b i n g v o n g d i e n c d ty le k h o a n g 3 , 5 3 % t r o n g so 105 00 b e n h nh dn va 2 , 5 7 % n£u c d p h d i h o p vdi dien c u c d au tron. D d i vdi l aser va di en c u c da u tron thi ty le tai bi en t h u n g t i r c u n g la 0 , 6 5 5 % va 0 , 6 4 % . Tai bien c h a y m a u va q u a tai d i c h tru yd n c u n g ldn hon n e u d u n g q u e c i t ( M a r e s h 1996). R 5 r a n g la c a n pha i c d p h u o n g p h a p mdi d o n gi an h o n va an to an hon. H i e n n ay n g u d i ta d a sir d u n g l aser c u d n g d o thap, b o n g n u d e n o n g va p r o g e s t a g e n t ro n g b u 6 n g tir c u n g .
K et q u a n g h i e n ctiu dai ha n va gia t h a n h c a c tra ng thiet bi c o n d a n g d u o c tinh t o a n t h e m
CAC THAM DO CAN LAM SANG BUONG TUT CUNG
D o T h i N g o c L a n
I- MGf DAU
Tti vai c h u c n a m nay, c a c phucmg tien t h a m do, c h dn d o a n b e n h ly b u o n g tti c u n g d a c o n h u n g tien bo ret. C ac p h u o n g tien t h a m d o b u 6 n g tti c u n g b a o g om : sieu a m ( q u a t h a n h b u n g , q u a a m da o) , c h u p b u o n g tti c u n g - voi trting, soi b u o n g tti c u n g , s inh thiet n i e m m a c tti c u n g .
C ho d e n n ay, va n c h u a c o s u t h o n g n h a t k h d n g d in h t inh uu viet h o n h dn c u a c a c loai p h u o n g tien t h a m d o n a o t r ong c h £n d o a n c a c b e n h ly b u o n g tti c u n g . V i e c p h a n tich, so s a nh hieu q ua , bien chting, that bai va g ia t h a n h c u a c a c p h u o n g tien t h a m do b u o n g tti c u n g van la va n d6 c a n thiet. D o vay, trinh tu a p d u n g c a c p h u o n g p h a p t h a m d o c a n l am s a n g b u o n g tti c u n g p h u t huoc vao cac p h u o n g tien sdn co, kinh n g h ie m c u a ng uo i sir d u n g va be nh ly nghi n g d m a c a c p h u o n g p h a p t h a m do c a n l am s a n g n a o d u o c coi la co hieu q u a c a o h o n t ro n g c a c tinh h u d n g cu the.