Gukemura ibibazo bya Endoskopi yubuvuzi muri Gynecology nubuvuzi bwimyororokere Gusuzuma no kuvura

1 break Impinduka zimpinduramatwara muri tekinoroji ya hysteroscopi

(1) Sisitemu ikonje ya hysteroscopi

Ihungabana ry'ikoranabuhanga:

Gutegura imashini (nka MyoSure) ® bla Icyuma kizunguruka gifite umuvuduko wa 2500rpm gikuraho neza fibroide kugirango wirinde kwangirika kwamashanyarazi kwangirika kwimbere.

Sisitemu yo kugenzura umuvuduko wamazi: Komeza umuvuduko wa nyababyeyi hagati ya 50-70mmHg (amashanyarazi gakondo> 100mmHg) kugirango ugabanye ibyago byo kurenza urugero rwamazi.

Agaciro ka Clinical:

Igihe cyo gusana endometrium nyuma yo gukuramo fibroid fibroid yagabanutse kuva mubyumweru 12 kugeza ibyumweru 4 nyuma yamashanyarazi.

Igipimo gisanzwe cyo gutwita cy’abarwayi batabyara nyuma yo kubagwa cyiyongereye kugera kuri 58% (ugereranije na 32% gusa mu itsinda ry’amashanyarazi).

(2) Kugendana 3D hysteroscopi

Ibyingenzi bya tekinike:

Igihe nyacyo cyo kwerekana 3D (nka Karl Storz IMAGE 1 S Rubina): kwerekana ubujyakuzimu bw'ihembe rya nyababyeyi n'imiterere y'ifungura rya fallopian.

Ufatanije namakuru ya MRI mbere yo gutangira, ubunyangamugayo bwo kumenya imikorere mibi ya nyababyeyi (nka mediastinum yuzuye) ni 100%.

Ibisabwa:

Itondekanya rya stereoskopique yuzuye ya intrauterine (syndrome ya Asherman).

(3) Fluorescence yerekana hysteroscope

Iterambere ry'ikoranabuhanga:

5-ALA itera ikibyimba protoporphyrine IX fluorescence, hamwe na sensibilité yo kumenya 91% kuri kanseri yo hambere (65% gusa munsi ya microscopi yumucyo wera).

Dukurikije imibare yaturutse mu kigo cy’igihugu cya kanseri y’Ubuyapani, indwara ya hyperplasia idasanzwe ya endometrale idasanzwe ishobora kuboneka.

2 、 Paradigm yongeye kubaka tekinoroji ya laparoskopi

(1) Icyambu kimwe robotic laparoscope (SPRS)

Sisitemu ya Da Vinci:

Imashini imwe ya 25mm ikoreshwa kugirango irangize hysterectomie yose, yongerera urwego rwo kwisiga 80% ugereranije no kubaga ibibyimba.

Igikoresho c'intoki cyemewe kigera kuri dogere 7-yubwigenge, hamwe no kudoda no gufunga neza 0.1mm.

Amakuru y’ubuvuzi:

Igipimo cyo kugumana ingirabuzimafatizo zisanzwe mugihe cya ovarian cystectomy irenze 95% (laparoskopi gakondo ni 70%).

(2) Hafi ya infragre fluorescence igenda (NIR)

Ikarita ya lymphatic ICG:

Igihe nyacyo cyo kwerekana lymph node ya sentinel mugihe cyo kubaga kanseri yinkondo y'umura igabanya gutandukana kwa lymph node bitari ngombwa 43%.

Gahunda y'ibitaro bya kanseri ya kaminuza ya Fudan: Guhuza icyatsi cya indocyanine icyatsi na nanocarubone ebyiri, ikimenyetso cyo gutahura cyongerewe kugera kuri 98%.

(3) Kuzamura ingufu za Ultrasonic

Harmonic ACE + 7 ：

Guhindura ubwenge muburyo bwo kunyeganyega (55.5kHz ± 5%), gukata no gufunga imiyoboro y'amaraso icyarimwe.

Umubare w'amaraso mugihe cyo kubaga nyababyeyi yo gukuramo nyababyeyi uri munsi ya 50ml (electrocautery gakondo> 200ml).

3 solutions Ibisubizo byibasiye imiti yimyororokere

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Gukomatanya tekinike:

0.5mm ultra-nziza ya fibre indorerwamo (nka Olympus HYF-1T) ihujwe no kwagura insinga hydraulic.

Sisitemu yo kugenzura igihe nyacyo (<300mmHg) kugirango wirinde gutemba.

Ingaruka zo kuvura:

Igipimo cyo gusubiramo inzitizi zegeranye ni 92%, naho igipimo gisanzwe cyo gutwita mumezi 6 nyuma yo kubagwa ni 37%.

(2) Intanga ngore ikonjesha + transplantation ya endoscopique

Inzira yo guhungabanya:

Intambwe ya 1: Shakisha intanga ngore binyuze muri laparoskopi ya transvaginal (irinde laparotomie).

Intambwe ya 2: Kubika Vitrification no gukonjesha.

Intambwe ya 3: Guhinduranya autologique muri ovarian fossa nyuma ya chimiotherapie kugirango igarure imikorere ya endocrine.

amakuru

Gahunda y'i Buruseli mu Bubiligi: Igipimo cya Ovulation cya 68% nyuma yo guterwa abarwayi b'ingimbi.

(3) Ikizamini cya endometrale cyakirwa (ERT)

Ikoreshwa rya tekinoroji ya endoskopi:

Kusanya ingirabuzima fatizo munsi ya hysteroscopi hanyuma umenye idirishya ryatewe binyuze muri RNA ikurikirana.

Kunoza igipimo cyo gutwita kwa kliniki y’abarwayi bafite kunanirwa kwatewe kuva 21% kugeza 52%.

4 innovation Guhanga udushya mu gusana hasi

(1) Kwimura Transvaginal Mesh Implantation (TVM)

Ubwihindurize mu ikoranabuhanga:

Icapiro rya 3D ryihariye rya polypropilene mesh hamwe na porosity> 70% bigabanya ibyago byo kwandura.

Imashini yafashaga gushyira ahantu neza kugirango hirindwe kwangirika kwimitsi ya obturator.

Ingaruka zo kuvura:

Igipimo cyimyaka 5 yo kwisubiramo kwingingo ya pelvic organisse (POP) kiri munsi ya 10% (kubaga suture gakondo 40%).

(2) Gutera imitsi ya sakrale endoskopique

InterStim plan Gahunda yibasiye:

Gutobora Sakrale 3-umwobo munsi ya cystoskopi, hamwe nigipimo cyiza kirenga 80% mugihe cyibizamini mbere yo guterwa burundu.

Igipimo cyo kunoza igenzura ryinkari mukuvura inkari zidakira ni 91%.

5 direction Icyerekezo cy'ikoranabuhanga kizaza

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Imbonerahamwe yo Kugereranya Inyungu

Ububabare bwuburyo bwa tekinoroji gakondo / gukora neza ibisubizo bibangamira

Icyuma gikonje hysteroscopi / imvune ya electrosurgical ya endometinal stem selile / igipimo cyo gufatira nyuma yibikorwa cyaragabanutse kiva kuri 28% kigera kuri 5%

Umwobo umwe robotic laparoscopic / kubaga umwobo mwinshi ufite inkovu zigaragara / kugarura ubuzima bwa buri munsi nyuma yamasaha 24 nyuma yo kubagwa

Igipimo cyinshi cyibinyoma cya fluorescence falloposcopy / hysterosalpingography / kwimenyekanisha neza kwinzitizi nyayo kugeza 0.1mm

Ovarian tissue gukonjesha transplantation / post chimiotherapie ovarian kunanirwa imburagihe / igipimo cyimihango yo gukira> 60%

Ibyifuzo byo gushyira mubikorwa

Ibitaro byibanze: bifite sisitemu yo hejuru ya hysteroskopi na sisitemu yicyuma gikonje, ikingira 90% yindwara zo munda.

Ikigo cyimyororokere: Shiraho urubuga ruhuriweho na fallopian tube endoscopy no kwimura urusoro.

Umwihariko wa Oncology: Teza imbere kubyimba neza ukoresheje NIR fluorescence yogukoresha.

Iri koranabuhanga ririmo gusobanura ibipimo byo kubaga abagore batewe no kubaga binyuze mu bintu bitatu byingenzi: intambwe ya milimetero, kwangirika kwa zeru, no kongera imikorere ya physiologiya. Biteganijwe ko mu 2027, 90% by’abaganga b’indwara z’abagore bazagera ku buvuzi "ku manywa".