Keeb kwm ntawm kev siv thiab lub luag haujlwm ntawm cov tshuab kuaj mob phais hauv kev phais hlwb

 

Hauv keeb kwm ntawm kev phais hlwb, daim ntawv thov ntawmcov tshuab kuaj mob phaisyog ib lub cim tseem ceeb, nce qib los ntawm lub caij nyoog neurosurgical ib txwm muaj ntawm kev phais mob hauv qab lub qhov muag liab qab mus rau lub caij nyoog neurosurgical niaj hnub no ntawm kev phais mob hauv qablub tshuab tsom iavLeej twg thiab thaum twg tau uacov tshuab microscope ua haujlwmpib siv rau hauv kev phais hlwb? Lub luag haujlwm dab tsi muajlub tshuab kuaj mob phaisua si hauv kev txhim kho kev phais hlwb? Nrog rau kev nce qib ntawm kev tshawb fawb thiab thev naus laus zis, puas yuavLub tshuab kuaj mob ua haujlwmpuas yuav hloov los ntawm cov khoom siv siab dua? Qhov no yog ib lo lus nug uas txhua tus kws phais hlwb yuav tsum paub txog thiab siv cov thev naus laus zis tshiab thiab cov cuab yeej siv rau hauv kev phais hlwb, txhawb kev txhim kho cov txuj ci phais hlwb.

1, Keeb Kwm ntawm Kev Siv Microscopy hauv Kev Kho Mob

Hauv kev kawm txog physics, cov tsom iav yog cov tsom iav convex nrog ib lub qauv uas muaj qhov ua kom loj dua, thiab lawv qhov kev loj hlob yog txwv, hu ua tsom iav magnifying. Xyoo 1590, ob tug neeg Dutch tau teeb tsa ob lub phaj tsom iav convex hauv lub thoob cylindrical nyias nyias, yog li tsim lub ntiaj teb thawj lub tshuab tsom iav sib xyaw ua ke: lublub tshuab tsom iavTom qab ntawd, cov qauv ntawm lub tshuab kuaj mob tau txhim kho tas li, thiab qhov loj dua tau nce ntxiv tas li. Lub sijhawm ntawd, cov kws tshawb fawb feem ntau siv qhov nolub tshuab tsom iav sib xyawlos soj ntsuam cov qauv me me ntawm cov tsiaj txhu thiab cov nroj tsuag, xws li cov qauv ntawm cov cell. Txij li thaum nruab nrab mus txog rau thaum xaus ntawm lub xyoo pua 19th, cov tsom iav loj thiab cov tshuab microscopes tau maj mam siv rau hauv kev kho mob. Thaum xub thawj, cov kws phais neeg siv cov tsom iav loj uas muaj ib lub lens uas tuaj yeem muab tso rau ntawm tus choj ntawm lub qhov ntswg rau kev phais. Xyoo 1876, tus kws kho mob German Saemisch tau ua thawj zaug phais "microscopic" hauv ntiaj teb siv cov iav tsom iav sib xyaw (hom kev phais tsis paub). Xyoo 1893, lub tuam txhab German Zeiss tau tsim lublub tshuab tsom iav binocular, feem ntau yog siv rau kev soj ntsuam sim hauv cov chaw kuaj mob, nrog rau kev soj ntsuam cov qhov txhab ntawm lub qhov muag thiab lub qhov muag pem hauv ntej hauv kev kho qhov muag. Xyoo 1921, raws li kev tshawb fawb hauv chaw kuaj mob txog cov tsiaj txhu sab hauv pob ntseg, tus kws kho mob Swedish otolaryngologist Nylen tau siv ib qho khoom siv kho kom ruaj khovlub tshuab kuaj mob monoculartsim thiab tsim los ntawm nws tus kheej los ua kev phais mob otitis media rau tib neeg, uas yog kev phais me me tiag tiag. Ib xyoos tom qab, Nylen tus kws kho mob zoo tshaj plaws Hlolmgren tau qhia txoglub tshuab kuaj mob binoculartsim los ntawm Zeiss hauv chav phais.

Thaum ntxovCov tshuab microscope ua haujlwmmuaj ntau qhov tsis zoo, xws li kev ruaj khov kho tsis zoo, tsis muaj peev xwm txav mus los, lub teeb pom kev ntawm ntau lub axes thiab cua sov ntawm lub lens lub hom phiaj, qhov chaw phais loj dua, thiab lwm yam. Cov no yog txhua yam laj thawj uas txwv tsis pub siv dav duacov tshuab kuaj mob phaisHauv peb caug xyoo tom ntej no, vim muaj kev sib raug zoo ntawm cov kws phais thiabcov chaw tsim khoom siv lub tshuab microscope, kev ua tau zoo ntawmcov tshuab kuaj mob phaistau txhim kho tas li, thiabcov tshuab kuaj mob binocular, cov tshuab microscopes uas tau teeb tsa rau ntawm lub ru tsev, cov iav tsom iav zoom, lub teeb ci coaxial, cov caj npab uas tswj tau los ntawm hluav taws xob lossis dej siab, kev tswj ko taw pedal, thiab lwm yam tau tsim kho tas mus li. Xyoo 1953, lub tuam txhab German Zeiss tau tsim cov khoom siv tshwj xeebCov tshuab microscopes phais rau otology, tshwj xeeb tshaj yog rau kev phais mob ntawm cov qhov txhab tob xws li pob ntseg nruab nrab thiab pob txha ntawm lub cev. Thaum lub sijhawm ua haujlwm ntawmcov tshuab kuaj mob phaistxuas ntxiv mus zoo dua, lub siab ntawm cov kws phais kuj hloov pauv tas li. Piv txwv li, cov kws kho mob German Zollner thiab Wullstein tau hais tiascov tshuab kuaj mob phaisyuav tsum tau siv rau kev phais ua kom daim nyias nyias ntawm lub qhov muag. Txij li xyoo 1950, cov kws kho qhov muag tau maj mam hloov pauv kev coj ua ntawm kev siv cov tshuab microscopes rau kev kuaj qhov muag thiab tau qhia txogcov tshuab kuaj pob ntsegmus rau hauv kev phais qhov muag. Txij thaum ntawd los,Lub tshuab kuaj mob ua haujlwmCov tshuaj tau siv dav hauv kev kho mob otology thiab ophthalmology.

2, Daim ntawv thov ntawm lub tshuab kuaj mob phais hauv kev phais hlwb

Vim yog qhov tshwj xeeb ntawm kev phais hlwb, daim ntawv thov ntawmcov tshuab microscopes phais hauv kev phais hlwbyog lig dua li me ntsis hauv kev kho qhov muag thiab kev kho qhov muag, thiab cov kws kho mob hlwb tab tom kawm cov thev naus laus zis tshiab no. Lub sijhawm ntawd,kev siv cov tshuab kuaj mob phaisfeem ntau yog nyob hauv Tebchaws Europe. Kws kho qhov muag Asmeskas Perrit thawj zaug qhiacov tshuab kuaj mob phaislos ntawm Tebchaws Europe mus rau Tebchaws Meskas xyoo 1946, tso lub hauv paus rau cov kws phais hlwb Asmeskas sivCov tshuab microscope ua haujlwm.

Los ntawm lub zeem muag ntawm kev hwm tus nqi ntawm tib neeg lub neej, txhua yam thev naus laus zis tshiab, khoom siv, lossis cov cuab yeej siv rau tib neeg lub cev yuav tsum tau dhau los ntawm kev sim ua ntej ntawm tsiaj thiab kev cob qhia rau cov neeg ua haujlwm. Xyoo 1955, kws phais hlwb Asmeskas Malis tau ua phais hlwb rau tsiaj siv alub tshuab kuaj mob binocularKurze, ib tug kws phais hlwb ntawm University of Southern California hauv Tebchaws Meskas, tau siv ib xyoos kawm txog kev phais siv lub tshuab microscope hauv chav kuaj mob tom qab saib kev phais pob ntseg hauv qab lub tshuab microscope. Thaum Lub Yim Hli Ntuj xyoo 1957, nws tau ua tiav kev phais acoustic neuroma rau ib tug menyuam yaus 5 xyoos siv ib qholub tshuab kuaj pob ntseg, uas yog thawj zaug phais mob me me hauv ntiaj teb. Tsis ntev tom qab ntawd, Kurze tau ua tiav qhov kev phais mob ntawm lub ntsej muag ntawm tus menyuam siv lublub tshuab kuaj mob phais, thiab tus menyuam txoj kev rov zoo los zoo heev. Qhov no yog qhov kev phais mob me me thib ob hauv ntiaj teb. Tom qab ntawd, Kurze siv cov tsheb thauj khoom los nqaCov tshuab microscope ua haujlwmmus rau ntau qhov chaw rau kev phais mob hlwb me me, thiab pom zoo kom sivcov tshuab kuaj mob phaisrau lwm tus kws phais hlwb. Tom qab ntawd, Kurze tau ua phais mob cerebral aneurysm clipping siv alub tshuab kuaj mob phais(hmoov tsis zoo, nws tsis tau luam tawm ib tsab xov xwm twg). Nrog kev txhawb nqa ntawm tus neeg mob trigeminal neuralgia uas nws tau kho, nws tau tsim lub chaw kuaj mob hlwb micro skull base thawj zaug hauv ntiaj teb xyoo 1961. Peb yuav tsum nco ntsoov Kurze txoj kev koom tes rau microsurgery thiab kawm los ntawm nws lub siab tawv los txais cov thev naus laus zis tshiab thiab cov tswv yim. Txawm li cas los xij, txog thaum ntxov xyoo 1990, qee tus kws phais hlwb hauv Suav teb tsis tau txaisCov tshuab kuaj mob hlwbrau kev phais. Qhov no tsis yog teeb meem nrog rauLub tshuab kuaj mob hlwbnws tus kheej, tab sis teeb meem nrog cov kws kho mob hlwb txoj kev nkag siab txog kev xav.

Xyoo 1958, kws phais hlwb Asmeskas Donaghy tau tsim lub chaw tshawb fawb thiab kev cob qhia microsurgery thawj zaug hauv ntiaj teb hauv Burlington, Vermont. Thaum ntxov, nws kuj tau ntsib kev tsis meej pem thiab teeb meem nyiaj txiag los ntawm nws cov thawj coj. Hauv kev kawm ntawv, nws ib txwm xav txog kev txiav cov hlab ntsha cortical qhib kom rho tawm cov thrombi ncaj qha los ntawm cov neeg mob uas muaj cerebral thrombosis. Yog li nws tau koom tes nrog kws phais vascular Jacobson ntawm kev tshawb fawb tsiaj thiab kev kho mob. Lub sijhawm ntawd, nyob rau hauv cov xwm txheej ntawm lub qhov muag liab qab, tsuas yog cov hlab ntsha me me nrog lub cheeb ntawm 7-8 millimeters lossis ntau dua tuaj yeem xaws. Yuav kom ua tiav qhov kawg-rau-kawg anastomosis ntawm cov hlab ntsha me me, Jacobson thawj zaug sim siv lub iav tsom iav. Tsis ntev tom qab ntawd, nws nco qab siv ib qhokev kuaj mob otolaryngology microscoperau kev phais thaum nws yog ib tug kws kho mob nyob hauv. Yog li, nrog kev pab los ntawm Zeiss hauv lub teb chaws Yelemees, Jacobson tau tsim lub tshuab kuaj mob ob lub tshuab (Diploscope) rau kev phais vascular anastomosis, uas tso cai rau ob tus kws phais mob ua qhov phais tib lub sijhawm. Tom qab kev sim ntau yam hauv tsiaj, Jacobson tau luam tawm ib tsab xov xwm txog kev phais me me ntawm dev thiab cov hlab ntsha tsis yog carotid (1960), nrog rau 100% patency ntawm vascular anastomosis. Qhov no yog ib daim ntawv kho mob tshiab uas cuam tshuam nrog kev phais hlwb microsurgical thiab kev phais vascular. Jacobson kuj tau tsim ntau yam cuab yeej phais me me, xws li micro scissors, micro needle holders, thiab micro instrument handles. Xyoo 1960, Donaghy tau ua tiav qhov kev phais mob cerebral artery incision thrombectomy hauv qab ib qholub tshuab kuaj mob phaisrau ib tug neeg mob uas muaj mob cerebral thrombosis. Rhoton los ntawm Tebchaws Meskas tau pib kawm txog lub hlwb anatomy hauv qab lub tshuab microscope xyoo 1967, ua tus thawj coj hauv kev tshawb fawb tshiab txog microsurgical anatomy thiab ua rau muaj kev pab tseem ceeb rau kev txhim kho microsurgery. Vim yog qhov zoo ntawmcov tshuab kuaj mob phaisthiab kev txhim kho ntawm cov cuab yeej microsurgical, ntau thiab ntau tus kws phais neeg nyiam sivcov tshuab kuaj mob phaisrau kev phais. Thiab tau luam tawm ntau tsab xov xwm ntsig txog cov txheej txheem phais me me.

3, Daim ntawv thov ntawm lub tshuab kuaj mob phais hauv kev phais hlwb hauv Suav teb

Ua ib tug neeg Suav teb txawv teb chaws uas hlub lub teb chaws Nyiv Pooj, Xib Fwb Du Ziwei tau pub thawj lub teb chaws hauv tebchaws.lub tshuab kuaj mob hlwbthiab muaj feem cuam tshuamcov cuab yeej phais me merau Lub Chaw Kho Mob Neurosurgery ntawm Suzhou Medical College Affiliated Hospital (tam sim no yog Lub Chaw Kho Mob Neurosurgery ntawm Suzhou University Affiliated First Hospital) xyoo 1972. Tom qab rov qab mus rau Suav teb, nws thawj zaug ua kev phais mob me me xws li aneurysms intracranial thiab meningiomas. Tom qab kawm txog qhov muaj ntawmcov tshuab kuaj mob hlwbthiab cov cuab yeej microsurgical, Xibfwb Zhao Yadu los ntawm Lub Tsev Kho Mob Neurosurgery ntawm Beijing Yiwu tau mus ntsib Xibfwb Du Ziwei los ntawm Suzhou Medical College los saib xyuas kev sivcov tshuab kuaj mob phaisXibfwb Shi Yuquan ntawm Tsev Kho Mob Shanghai Huashan tau mus xyuas Xibfwb Du Ziwei lub chaw haujlwm los saib xyuas cov txheej txheem phais me me. Yog li ntawd, muaj kev qhia, kev kawm, thiab kev siv cov txheej txheem no.Cov tshuab kuaj mob hlwbtau pib ua haujlwm hauv cov chaw phais hlwb loj hauv Suav teb, uas yog qhov pib ntawm kev phais hlwb me me hauv Suav teb.

4, Cov Nyhuv ntawm Kev Phais Mob Microsurgery

Vim yog siv covcov tshuab kuaj mob hlwb, kev phais uas tsis tuaj yeem ua nrog lub qhov muag liab qab ua tau raws li cov xwm txheej ntawm kev loj hlob ntawm 6-10 zaug. Piv txwv li, kev phais mob qog pituitary los ntawm ethmoidal sinus tuaj yeem txheeb xyuas thiab tshem tawm cov qog pituitary thaum tiv thaiv cov qog pituitary ib txwm muaj; Kev phais uas tsis tuaj yeem ua nrog lub qhov muag liab qab tuaj yeem ua rau kev phais zoo dua, xws li cov qog hlwb thiab cov qog intramedullary qaum. Tus kws tshawb fawb Wang Zhongcheng muaj tus nqi tuag ntawm 10.7% rau kev phais mob cerebral aneurysm ua ntej siv alub tshuab kuaj mob hlwbTom qab siv lub tshuab tsom iav xyoo 1978, tus nqi tuag tau txo qis mus rau 3.2%. Tus nqi tuag ntawm kev phais mob cerebral arteriovenous malformation yam tsis siv alub tshuab kuaj mob phaisyog 6.2%, thiab tom qab xyoo 1984, nrog rau kev siv acov tshuab kuaj mob hlwb, tus nqi tuag tau txo qis mus rau 1.6%. Kev siv ntawmlub tshuab kuaj mob hlwbtso cai rau cov qog pituitary kom kho tau los ntawm kev siv txoj hauv kev transnasal transsphenoidal uas tsis tas yuav tsum tau phais mob taub hau, txo qhov kev tuag ntawm kev phais los ntawm 4.7% mus rau 0.9%. Kev ua tiav cov txiaj ntsig no tsis yooj yim sua nyob rau hauv kev phais qhov muag ib txwm muaj, yog licov tshuab kuaj mob phaisyog ib lub cim ntawm kev phais hlwb niaj hnub no thiab tau dhau los ua ib qho ntawm cov khoom siv phais mob uas tsis tuaj yeem hloov pauv tau hauv kev phais hlwb niaj hnub no.