Imbali yokusetyenziswa kunye nendima yeemicroscopes zotyando kwi-neurosurgery

 

Kwimbali yotyando lwemithambo-luvo, ukusetyenziswaiimayikroskopu zotyandoluphawu oluphawulekayo, oluvela kwixesha lemveli lotyando lwe-neurosurgical lokwenza utyando phambi kwamehlo ukuya kwixesha lanamhlanje lotyando lwe-neurosurgical phantsi kwe-aimakroskopuNgubani kwaye nini owenza loo ntoiimakroskopu ezisebenzayoziqala ukusetyenziswa kutyando lwemithambo-luvo? Yeyiphi indima enayoimakroskopu yotyandoidlalwe kuphuhliso lotyando lwemithambo-luvo? Ngokuhambela phambili kwesayensi netekhnoloji, ngabaimakroskopu esebenzayoNgaba kufuneka kutshintshwe izixhobo eziphucukileyo? Lo ngumbuzo ekufuneka wonke ugqirha weengqondo awuqaphele aze asebenzise ubuchwepheshe kunye nezixhobo zamva nje kwicandelo lotyando lwengqondo, nto leyo ekhuthaza ukuphuculwa kwezakhono zotyando lwengqondo.

1. Imbali yokusetyenziswa kweMicroscopy kwiCandelo lezonyango

Kwifiziksi, iilensi zeglasi zamehlo ziilensi ezingqukuva ezinesakhiwo esinye esinomphumo wokukhulisa, kwaye ukukhulisa kwazo kulinganiselwe, okwaziwa ngokuba ziiglasi zokukhulisa. Ngo-1590, abantu ababini baseDatshi bafaka iipleyiti ezimbini zelensi ezingqukuva ngaphakathi kwibharele elincinci elisilinda, ngaloo ndlela beyila isixhobo sokuqala sokukhulisa isakhiwo esidityanisiweyo emhlabeni: iimakroskopuEmva koko, ulwakhiwo lwemayikroskopu lwaluphuculwa rhoqo, kwaye ukwandiswa kwanda rhoqo. Ngelo xesha, izazinzulu zazisebenzisa kakhulu leimakroskopu edityanisiweyoukujonga izakhiwo ezincinci zezilwanyana nezityalo, ezifana nolwakhiwo lweeseli. Ukususela phakathi ukuya ekupheleni kwenkulungwane ye-19, iiglasi zokukhulisa kunye neemakroskopu ziye zasetyenziswa kancinci kancinci kwicandelo lezonyango. Ekuqaleni, oogqirha botyando babesebenzisa iiglasi zokukhulisa ezifana neeglasi zamehlo ezinesakhiwo selensi enye enokubekwa kwibhulorho yempumlo xa kutyandwa. Ngo-1876, ugqirha waseJamani uSaemisch wenza utyando lokuqala "lwe-microscopic" ehlabathini esebenzisa iglasi yokukhulisa iglasi yamehlo edibeneyo (uhlobo lotyando alwaziwa). Ngo-1893, inkampani yaseJamani iZeiss yasungula iimakroskopu yebhanocular, esetyenziswa kakhulu ekujongeni ngovavanyo kwiilabhoratri zonyango, kunye nokujonga izilonda ze-cornea kunye negumbi langaphambili kwicandelo le-ophthalmology. Ngo-1921, ngokusekelwe kuphando lwelabhoratri malunga nokwakheka kwendlebe yangaphakathi yesilwanyana, ingcali ye-otolaryngologist yaseSweden uNylen wasebenzisa i-fixedimakroskopu yotyando ye-monocularwayila waza wayenza ngokwakhe ukuze enze utyando lwe-chronic otitis media ebantwini, olu yayilutyando oluncinci lokwenyani. Emva konyaka, ugqirha oyintloko kaNylen uHlolmgren wazisaimakroskopu yotyando yebinocularyenziwe yiZeiss kwigumbi lokutyanda.

KwangokoIimakroskopu ezisebenzayoyayineengxaki ezininzi, ezinje ngokuzinza okungekho sikweni koomatshini, ukungakwazi ukuhamba, ukukhanya kwee-axes ezahlukeneyo kunye nokufudumeza ilensi ejolise kuyo, indawo encinci yokukhulisa utyando, njl. Zonke ezi zizizathu ezithintela ukusetyenziswa ngokubanzi kweiimayikroskopu zotyandoKwiminyaka engamashumi amathathu eyalandelayo, ngenxa yokusebenzisana okuhle phakathi koogqirha kunyeabavelisi bemakroskopu, ukusebenza kweiimayikroskopu zotyandoyaphuculwa rhoqo, kwayeiimayikroskopu zotyando zebinocular, iimakroskopu ezifakwe eluphahleni, iilensi ze-zoom, ukukhanya komthombo wokukhanya we-coaxial, iingalo ezidibeneyo ezilawulwa ngoxinzelelo lwe-elektroniki okanye lwamanzi, ulawulo lwe-pedal yeenyawo, njalo njalo zaphuhliswa ngokulandelelana. Ngo-1953, inkampani yaseJamani iZeiss yavelisa uthotho lwee-specializediimicroscopes zotyando ze-otology, ifanelekile ngakumbi kutyando lwezilonda ezinzulu ezifana nendlebe ephakathi kunye nethambo lexesha. Ngelixa ukusebenza kweiimayikroskopu zotyandoiyaqhubeka iphucuka, indlela yokucinga yoogqirha botyando nayo itshintsha rhoqo. Umzekelo, oogqirha baseJamani uZollner noWullstein bathiiimayikroskopu zotyandokufuneka isetyenziswe kutyando lokubumba i-membrane ye-tympanic. Ukususela ngeminyaka yoo-1950, iingcali zamehlo ziye zatshintsha kancinci indlela yokusebenzisa iimakroskopu kuphela kwiimvavanyo zamehlo kwaye zazisaiimakroskopu ze-otosurgicalukuya kutyando lwamehlo. Ukususela ngoko,imakroskopu esebenzayozisetyenziswa kakhulu kwicandelo le-otology kunye ne-ophthalmology.

2. Ukusetyenziswa kwe-microscope yotyando kwi-neurosurgery

Ngenxa yobuchule botyando lwe-neurosurgery, ukusetyenziswaiimicroscopes zotyando kwi-neurosurgerykusemva kancinci kune-otology kunye ne-ophthalmology, kwaye oogqirha be-neurosurgery bafunda ngenkuthalo obu buchwepheshe butsha. Ngelo xesha,ukusetyenziswa kweemayikroskopu zotyandoyayiseYurophu ikakhulu. Ingcali yamehlo yaseMelika uPerrit yaziswa okokuqalaiimayikroskopu zotyandoukusuka eYurophu ukuya eMelika ngo-1946, kwabekwa isiseko sokuba oogqirha bemithambo-luvo baseMelika basebenziseIimakroskopu ezisebenzayo.

Ngokwembono yokuhlonipha ixabiso lobomi bomntu, naluphi na ubuchwepheshe obutsha, izixhobo, okanye izixhobo ezisetyenziselwa umzimba womntu kufuneka zenze uvavanyo lokuqala lwezilwanyana kunye noqeqesho lobuchwephesha lwabasebenzi. Ngo-1955, ugqirha wezifo zengqondo waseMelika uMalis wenza utyando lobuchopho kwizilwanyana esebenzisaimakroskopu yotyando yebinocularUKurze, ugqirha wezifo zengqondo kwiYunivesithi yaseSouthern California eMelika, uchithe unyaka efunda iindlela zotyando zokusebenzisa imakroskopu kwilebhu emva kokujonga utyando lwendlebe phantsi kwemakroskopu. Ngo-Agasti 1957, wenza ngempumelelo utyando lwe-acoustic neuroma kumntwana oneminyaka emi-5 ubudala esebenzisa i-imakroskopu yotyando lwendlebe, eyayilutyando lokuqala lwe-microsurgical kwihlabathi liphela. Kungekudala emva koko, uKurze wenza ngempumelelo i-facial nerve anastomosis kumntwana esebenzisa i-imakroskopu yotyando, kwaye umntwana wachacha kakuhle kakhulu. Olu yayilutyando lwesibini lwe-microsurgical emhlabeni. Emva koko, uKurze wasebenzisa iilori ukuthwalaIimakroskopu ezisebenzayokwiindawo ezahlukeneyo zotyando lwe-microsurgical neurosurgery, kwaye ndicebisa kakhulu ukusetyenziswa kweiimayikroskopu zotyandoEmva koko, uKurze wenza utyando lokusika i-cerebral aneurysm esebenzisa i-imakroskopu yotyando(ngelishwa, akazange apapashe naliphi na inqaku). Ngenkxaso yesigulana se-trigeminal neuralgia awasinyangayo, waseka ilebhu yokuqala yehlabathi ye-micro skull base neurosurgery ngo-1961. Sifanele sikhumbule igalelo likaKurze kutyando lwe-microsurgery kwaye sifunde kwinkalipho yakhe yokwamkela ubuchwepheshe obutsha kunye neengcinga. Nangona kunjalo, kude kube sekuqaleni kweminyaka yoo-1990, abanye oogqirha be-neurosurgery eTshayina abazange bamkeleIimicroscopes zotyando lwe-neurosurgeryyotyando. Oku bekungeyongxaki ngeI-microscope yotyando lwe-neurosurgeryngokwayo, kodwa yingxaki ngokuqonda kweengcinga zoogqirha bemithambo-luvo.

Ngo-1958, ugqirha wemithambo-luvo waseMelika uDonaghy waseka ilabhoratri yokuqala yophando noqeqesho lotyando lwe-microsurgery eBurlington, eVermont. Kwinqanaba lokuqala, wadibana nokudideka kunye nobunzima bezemali kubaphathi bakhe. Kwizifundo zemfundo, wayesoloko enombono wokusika imithambo yegazi ye-cortical evulekileyo ukuze akhuphe ngokuthe ngqo i-thrombi kwizigulana ezine-cerebral thrombosis. Ngoko ke wasebenzisana nogqirha wemithambo-luvo uJacobson kuphando lwezilwanyana nolweklinikhi. Ngelo xesha, phantsi kweemeko zeliso lenyama, yayiziimithambo yegazi emincinci kuphela enobubanzi obuziimilimitha ezisi-7-8 okanye ngaphezulu eyayinokuthungwa. Ukuze kufezekiswe i-anastomosis yemithambo yegazi emincinci, uJacobson waqala wazama ukusebenzisa iglasi yokukhulisa iiglasi. Kungekudala emva koko, wakhumbula esebenzisa i-imakroskopu yotyando lwe-otolaryngologyukuze atyandwe xa wayengugqirha ohlala apho. Ngoko ke, ngoncedo lukaZeiss eJamani, uJacobson wayila imakroskopu yotyando olusebenzisa izixhobo ezimbini (I-Diploscope) kwi-vascular anastomosis, evumela oogqirha ababini ukuba benze utyando ngaxeshanye. Emva kovavanyo olubanzi lwezilwanyana, uJacobson wapapasha inqaku malunga ne-microsurgical anastomosis yezinja kunye nemithambo yegazi engekho carotid (1960), ene-100% patency rate ye-vascular anastomosis. Eli liphepha lezonyango eliphambili elinxulumene ne-microsurgical neurosurgery kunye notyando lwemithambo yegazi. UJacobson uphinde wayila izixhobo ezininzi ze-microsurgical, ezifana nezikere ezincinci, izibambi zeenaliti ezincinci, kunye nezibambo zezixhobo ezincinci. Ngo-1960, uDonaghy wenza ngempumelelo i-cerebral artery incision thrombectomy phantsi kwe-imakroskopu yotyandokwisigulane esine-cerebral thrombosis. URhoton wase-United States waqala ukufunda nge-anatomy yobuchopho phantsi kwe-microscope ngo-1967, waqala intsimi entsha ye-anatomy yotyando lwe-microsurgical waza wenza igalelo elikhulu kuphuhliso lwe-microsurgery. Ngenxa yeenzuzo zeiimayikroskopu zotyandokunye nokuphuculwa kwezixhobo zotyando lwe-microsurgical, oogqirha abaninzi bayakuthanda ukusebenzisaiimayikroskopu zotyandoyotyando. Kwaye wapapasha amanqaku amaninzi anxulumene noko malunga neenkqubo zotyando lwe-microsurgical.

3. Ukusetyenziswa kwe-microscope yotyando kwi-neurosurgery eTshayina

Njengomntu waseTshayina othanda ilizwe laseJapan, uNjingalwazi uDu Ziwei wanikela ngesipho sokuqala sasekhayaimakroskopu yotyando lwemithambo-luvokunye nezinye ezinxulumene nazoizixhobo zotyando ezincincikwiSebe leNeurosurgery leSuzhou Medical College Affiliate Hospital (ngoku yiNeurosurgery Department of Suzhou University Affiliated First Hospital) ngo-1972. Emva kokubuyela eTshayina, waqala ukwenza utyando lwe-microsurgical olufana ne-intracranial aneurysms kunye ne-meningiomas. Emva kokufunda ngokufumaneka kwe-iimicroscopes ze-neurosurgicalkunye nezixhobo zotyando lwe-microsurgical, uNjingalwazi Zhao Yadu ovela kwiSebe leNeurosurgery kwiSibhedlele saseBeijing Yiwu utyelele uNjingalwazi uDu Ziwei waseSuzhou Medical College ukuze ajonge ukusetyenziswa kweiimayikroskopu zotyandoUNjingalwazi Shi Yuquan waseShanghai Huashan Hospital utyelele ngokwakhe isebe likaNjingalwazi uDu Ziwei ukuze ajonge iinkqubo zotyando lwe-microsurgical. Ngenxa yoko, kwavela ulwazi oluninzi, ukufunda nokusetyenziswa kweIimicroscopes zotyando lwe-neurosurgeryyaqala ukusebenza kwiindawo ezinkulu zotyando lwemithambo-luvo eTshayina, nto leyo eyaphawula ukuqala kotyando lwemithambo-luvo lwaseTshayina.

4. Impembelelo yotyando lweMicrosurgery

Ngenxa yokusetyenziswa kweiimicroscopes ze-neurosurgical, utyando olungenakwenziwa ngeliso lenyama luyenzeka phantsi kweemeko zokwandiswa izihlandlo ezi-6-10. Umzekelo, ukwenza utyando lwe-pituitary tumor nge-ethmoidal sinus kunokuchonga nokususa ii-tumor ze-pituitary ngokukhuselekileyo ngelixa kukhusela i-pituitary gland eqhelekileyo; Utyando olungenakwenziwa ngeliso lenyama lunokuba lutyando olungcono, olufana nee-brainstem tumors kunye nee-spinal cord intramedullary tumors. Ingcali yezemfundo uWang Zhongcheng wayenezinga lokufa eliyi-10.7% kutyando lwe-cerebral aneurysm ngaphambi kokusebenzisa i-imakroskopu yotyando lwemithambo-luvoEmva kokusebenzisa imakroskopu ngo-1978, izinga lokufa lehla laya kwi-3.2%. Izinga lokufa kotyando lwe-cerebral arteriovenous malformation ngaphandle kokusebenzisa i-imakroskopu yotyandoyayiyi-6.2%, kwaye emva kowe-1984, kusetyenziswaiimicroscopes zotyando lwe-neurosurgery, izinga lokufa lehle laya kwi-1.6%. Ukusetyenziswaimakroskopu yotyando lwemithambo-luvoivumela ukuba iithumba zepituitary zinyangwe ngendlela ye-transphenoidal engaphantsi kakhulu ngaphandle kwesidingo se-craniotomy, kunciphisa izinga lokufa ngotyando ukusuka kwi-4.7% ukuya kwi-0.9%. Ukufezekiswa kwezi ziphumo akunakwenzeka phantsi kotyando lwendabuko lwamehlo, ngoko keiimayikroskopu zotyandoluphawu lotyando lwe-neurosurgery lwanamhlanje kwaye luye lwaba sesinye sezixhobo zotyando eziyimfuneko nezingenakutshintshwa kutyando lwe-neurosurgery lwanamhlanje.