Izinkinga nezinselele ezibhekene nokuhlinzwa kwe-endoscopic yomgogodla wangaphambili

Inkathi ye-endoscopy yokuhlinzwa yaqala ngasekupheleni kwawo-1970 ngokwethulwa kobuchwepheshe be-endoscopy obusiza umabonakude. Ngokuthuthuka okusheshayo kwamasu angavaleli kancane njenge-arthroscopy, i-laparoscopy, i-thoracoscopy, ne-discoscopy, manje isithathe indawo yokuhlinzwa okuvulekile kwendabuko ekwelapheni okuhlinza izifo eziningi. Ngenxa yesakhiwo esiyingqayizivele se-anatomical kanye nezidingo zokuhlinzwa zomgogodla, ukuhlinzwa komgogodla wangaphambili okungenakuhlasela kancane kubhekene nezinkinga eziningi zomtholampilo, ubunzima obukhulu bokuhlinzwa, kanye nezingozi eziphakeme kakhulu zokuhlinzwa kanye nezinkinga, ezivimbela kakhulu futhi zivimbela ukuthuthukiswa nokuqhubeka kokuhlinzwa komgogodla we-endoscopic wangaphambili.

Ukuhlinzwa kwe-endoscopic okusizwa nge-anterior cervical foramen decompression kwaqala ngawo-1990. Izinzuzo zayo azigcini nje ngokuhlukumezeka okuncane kokuhlinzwa, kodwa futhi ukulondolozwa kwe-disc intervertebral yomlomo wesibeletho, ngaleyo ndlela kugcinwe umsebenzi wayo wemoto. Lokhu kuhlinzwa kunomthelela omkhulu ekwelapheni izimpawu ze-unilateral radicular zomgogodla womlomo wesibeletho, kodwa inkinga eyinhloko yale ndlela ukulimala komthambo we-vertebral ngesikhathi sokwelashwa kwe-hook ye-vertebral hook. U-Jho ukholelwa ukuthi indawo yomlomo wesibeletho engu-6-7 ye-intervertebral, isici esingemuva sejoyinti le-vertebra eboshwe, kanye ne-transverse process foramen yizindawo ezivame kakhulu ukubangela ukulimala komthambo womgogodla. Isikhala somlomo wesibeletho se-6-7 intervertebral sitholakala phakathi kwenqubo eguquguqukayo yomlomo wesibeletho 7 kanye nemisipha yentamo ende. Ukuze ugweme ukulimala komthambo we-vertebral, u-Jho uphakamisa ukusika umsipha wentamo ende ezingeni lomlomo wesibeletho 6. Ucezu lwe-muscle luzohlehla luye enqubweni eguquguqukayo yomlomo wesibeletho 7, ngaleyo ndlela iveze umthambo we-vertebral ngaphansi kwemisipha yentamo ende; Ukuze ugweme ukulimala komthambo we-vertebral ekuhlanganyeleni kwe-vertebra ehlanganisiwe, i-drill yokugaya akufanele ingene emgodini wenqubo eguquguqukayo. Ungqimba lwe-bone cortex lungagcinwa ngesikhathi sokugaya endaweni ehlanganisiwe ye-vertebra, bese ithambo lingasuswa nge-spatula. Ngemuva kwe-discectomy yangaphambili ezigulini ezinezimpawu zezimpande ze-nerve unilateral, izimpawu zezimpande eziphikisanayo zingase zenzeke ngenxa yokungazinzi komlomo wesibeletho. Ukwenza nje ukucindezeleka kwezimpande ze-nerve akukwazi ukudambisa ngokuphumelelayo izimpawu zobuhlungu bentamo kulezi ziguli. I-intervertebral fusion nayo iyadingeka ukuze kugcinwe ukuzinza komlomo wesibeletho, kodwa i-fusion ye-endoscopic engavamile encane kanye nokulungiswa komgogodla womlomo wesibeletho wangaphambili kuyinselele yomtholampilo engaxazululiwe.

Ubuchwepheshe besimanje be-thoracoscopy baqala ekuqaleni kwawo-1990, futhi ngokuthuthuka kwabo okuqhubekayo, kancane kancane sekuqedile ukwelashwa okufana ne-lobectomy, thymectomy, izifo ze-pericardial kanye ne-pleural. Njengamanje, ubuchwepheshe be-thoracoscopic busetshenziswe ekwelapheni i-vertebral lesion biopsy, i-abscess drainage kanye ne-spinal lesion clearance, i-intervertebral disc nucleus pulposectomy ye-thoracic disc herniation, i-decompression yangaphambili kanye nokulungiswa kwangaphakathi kwe-thoracic vertebral fractures, kanye nokulungiswa kwe-scoliosis noma ukukhulula. kanye nokulungiswa kokukhubazeka kwe-kyphosis. Ukusebenza nokuphepha kwayo kuye kwaqashelwa kabanzi. Kodwa-ke, uma kuqhathaniswa nokuhlinzwa kwendabuko yesifuba esivulekile, ukuhlinzwa okuncane kwe-thoracoscopic kwangaphakathi komgogodla akugcini nje kuphela kunezinkinga ezifanayo zezinkinga zokuhlinzwa, kodwa futhi kunesikhathi eside sokuhlinzwa, ubunzima obukhulu bokuhlinzwa, kanye nezingozi eziphakeme zokuhlinzwa. U-Dickman et al. wenza ukuhlinzwa kwe-thoracoscopic kwe-15 ezigulini ze-14 ezine-thoracic disc herniation, okuholela ezimweni ze-3 ze-atelectasis, amacala e-2 we-intercostal neuralgia, icala le-1 le-screw loosening elidinga ukususwa, icala le-1 le-disc intervertebral esele edinga ukuhlinzwa kwesibili, kanye necala le-1 lokuvuza kwe-cerebrospinal fluid nezinye izinkinga. McAfee et al. ibike ukuthi isigameko sokopha okusebenzayo ngemva kokuhlinzwa kwekholomu yomgogodla we-thoracoscopic kancane kancane, i-atelectasis i-5%, i-intercostal neuralgia i-6%, futhi kukhona nezinkinga ezinzima ezifana nokulimala kwenzwa yomgogodla, i-chylothorax, ukulimala kwemisipha ye-septal, nokunye ukulimala kwesitho. L ü Guohua et al. kubika ukuthi izinkinga zokuhlinzwa komgogodla we-thoracoscopic anterior zihlanganisa:; Ngenxa yokopha okubangelwa ukulimala kwe-azygous vein, ukuguqulwa ekuvuleni ukuhlinzwa kwesifuba ukuze kukhululwe ngu-2.6%, ukulimala kwamaphaphu ku-5.2%, i-chylothorax ngu-2.6%, i-atelectasis yendawo ingu-5.2%, i-pleurisy exudative ingu-5.2%, isikhathi sokuphuma kwesifuba> amahora angu-36, umthamo we-drainage>200ml ngu-10.5%, ukuba ndikindiki kwembobo yesifuba noma ubuhlungu obungu-2.6%. Kuboniswa ngokucacile ukuthi esigabeni sokuqala sokuhlinzwa okuvulekile kwe-thoracoscopic scoliosis, izehlakalo zezinkinga ziphakeme kunokuhlinzwa kwendabuko. Ngokuqoqwa kobuchwepheshe kanye nesipiliyoni ekusebenzeni, izehlakalo zezinkinga zizoncishiswa kakhulu. Watanabe et al. ihlaziye iziguli ze-52 ezihlinzwa umgogodla we-thoracoscopic kanye ne-laparoscopic, ezinezinkinga eziphezulu ze-42.3%. Izigameko eziphezulu zezinkinga kanye nezingozi zokuhlinzwa zivimbela ukuthuthukiswa kokuhlinzwa kwe-thoracoscopic anterior thoracic. Ngenxa yalesi sizathu, izazi eziningi zincoma futhi zamukele ukuhlinzwa okuncane okusizwa kwe-thoracoscopic kwe-thoracic yangaphakathi, okungenzi nje ukuhlinza kube lula, kodwa futhi kunciphisa kakhulu isikhathi sokuhlinzwa.

Ngasekupheleni kwawo-1980, i-cholecystectomy yokuqala ye-laparoscopic eyenziwa nguDuBois et al. eFrance kwaletha ukuthuthukiswa kwezinguquko kubuchwepheshe be-laparoscopic. Njengamanje, ukuhlinzwa komgogodla we-laparoscopic wangaphambili kusetshenziselwa ikakhulukazi ukususwa kwama-disc e-lumbar intervertebral aphansi kanye nokuhlinzwa kwe-intervertebral fusion (ALIF). Nakuba i-laparoscopic ALIF inganciphisa ngokuphumelelayo ukulimala kwezicubu, ukuhlinzwa kwe-ALIF kwesisu kudinga ukusungulwa kwe-pneumoperitoneum, engabangela ubunzima ekungeneni komoya kanye ne-air embolism lapho i-inflating futhi ilungisa indawo yesisu ngesikhathi sokuhlinzwa kwe-laparoscopic, okuholela ekhanda eliphansi nezinyawo eziphakeme. Ngaphezu kwalokho, izinkinga zokuhlinzwa kwe-anterior lumbar interbody fusion zihlanganisa i-hernia yangaphandle yesisu, ukulimala kwesitho sesisu, ukulimala emithanjeni yegazi emikhulu, i-arterial and venous embolism, ukulimala kwe-iatrogenic spinal nerve, i-retrograde ejaculation, nokuqhuma kwensimbi. Indaba ye-retrograde ejaculation ngemva kokuhlinzwa kwe-lumbar fusion iya ngokuya idonsa ukunaka kwabantu. Lokhu kungenxa yokulimala kwe-nerve plexus evala isisu esingaphansi esiphambi kwe-lumbar spine engezansi ngesikhathi sokuhlinzwa. URegan et al. ibike ukuthi izehlakalo ze-retrograde ejaculation ezimweni ezingu-215 ze-laparoscopic ephansi ye-lumbar interbody BAK fusion yayingu-5.1%. Ngokombiko we-US FDA ohlola ukusetshenziswa kwe-LT-CAGE ekuhlanganisweni kwe-laparoscopic interbody, kufikela ku-16.2% weziguli ezihlinzwayo besilisa ziba nokuphuma kwe-retrograde ejaculation, okunezehlakalo eziphakeme kakhulu zalezi zinkinga uma kuqhathaniswa nokuhlinzwa okuvamile okuvulekile. Newton et al. bakholelwa ukuthi izehlakalo zezinkinga ekuhlinzeni umgogodla we-thoracoscopic wangaphambili zifana nokuhlinzwa kwendabuko yesifuba esivulekile, kodwa umthamo wokudonsa amanzi ngemuva kokuhlinzwa kwe-thoracoscopic uphakeme kakhulu kunokuhlinzwa kwesifuba esivulekile. Njengoba kunikezwe ubunzima obuphezulu bokusebenza kanye nengozi yokuhlinzwa kwe-laparoscopic lumbar interbody fusion, kanye nesigameko esiphezulu sezinkinga zokuhlinzwa, i-laparoscopic isiza ukuhlinzwa okuncane kwe-incision yangaphambili akugcini nje ngokuhlukumezeka okuncane futhi kulula ukusebenza, kodwa futhi kunesikhathi esifushane sokusebenza futhi izehlakalo eziphansi zezinkinga. Kuyisiqondiso sentuthuko yesikhathi esizayo yokuhlinzwa kwe-lumbar kwangaphakathi okungavamisile kancane.

Nakuba ukuthuthuka kwesayensi yezinto eziphilayo kungathuthukisa ukusebenza kahle kokuhlanganisa, kusekhona okunye ukushiyeka, njengokuhamba okulinganiselwe kanye nokwanda kwengcindezi kumasegimenti aseduze. Ngenxa yalezi zizathu, ukushintshwa kwamanje kwe-intervertebral disc kuyinqubekelaphambili ekhuthaza kakhulu. Nakuba ukuklama ama-intervertebral discs okufakelwa alingana ngokuphelele nezici ezihlukahlukene ze-intervertebral discs yemvelo kunzima kakhulu, kunenzuzo ngempela emzimbeni womuntu. Kunganciphisa umthombo wokutheleleka, kunciphise ukungazinzi okubangelwa ama-disc intervertebral degenerative, ukubuyisela ukwabelana kokucindezeleka kwemvelo, nokubuyisela izici zokunyakaza komgogodla. Ngombono, ukushintshwa kwe-disc yokufakelwa kungashintsha ukuhlinzwa kwe-fusion, ukuhlinzeka ngokunyakaza komzimba komgogodla kanye nokulibaziseka ukuwohloka kwezingxenye eziseduze. I-lumbar disc replacement yokuqala yenziwa ngo-1996, eyashintsha i-disc herniation ebuhlungu. Njengamanje, kunezinhlobo ezahlukene zama-intervertebral discs okwenziwa atholakalayo. Izinto zayo zihlanganisa insimbi noma imicu yokunwebeka. Muva nje, kune-disc intervertebral yokufakelwa ene-polyethylene yangaphakathi kanye nongqimba lwangaphandle lwama-peptide, abese embozwa nge-plasma. Nokho, izinga lempumelelo lokuhlanganisa alikaqinisekiswa ngokugcwele. Ngaphezu kwalokho, izincwadi zibonisa ukuthi ukukhethwa kwamacala, ukuma, ubukhulu, kanye nesimo sama-intervertebral discs okwenziwa kubalulekile ekusebenzeni ngempumelelo kokwelapha. Imibiko yangaphambilini igxile kakhulu ekuhlinzeni okuvulekile kwangaphakathi kokushintshwa kwe-intervertebral disc, futhi amasu amanje we-endoscopic angasetshenziselwa ukushintshwa kwe-laparoscopic yokufakelwa. I-Prodisc isanda kuthuthukisa isizukulwane sesibili se-intervertebral disc prostheses, engakwazi ukumelana nayo yonke imingcele yokunyakaza kwe-lumbar ngaphandle kwe-axial motion. Zincane kancane ngosayizi kunama-intervertebral discs avamile, kodwa zingafakwa nge-laparoscopy yangaphambili noma imicu emincane ngokusebenzisa indlela ye-retroperitoneal.

Ngokuqhubeka okuqhubekayo kobuchwepheshe besimanje bokuhlinza umgogodla kanye nokusetshenziswa kwezinto ezintsha ze-biomaterials kanye nezinsimbi ekusebenzeni komtholampilo, ukuhlinzwa komgogodla wangaphambili okwandayo kufakwa esikhundleni sokuhlinzwa ngemuva. Ukuhlinzwa okukhulu komgogodla okwakuvame ukudinga izindlela zangaphambili nangemuva kancane kancane kuqedwa ngokuhlinzwa okungemuva kwesiteji esisodwa. Ngenxa yesakhiwo esiyinkimbinkimbi se-anatomical, ukuhlukumezeka okuphawulekayo kokuhlinzwa, kanye nezigameko eziphezulu zezinkinga zokuhlinzwa endleleni yangaphambili yomgogodla, kanye nemingcele yokuhlinzwa engokwemvelo kanye nezingozi ezihlobene nokuhlinzwa komgogodla we-endoscopic anterior, eminyakeni yamuva, ukuhlinzwa komgogodla we-endoscopic kwangaphakathi kuye kwadingeka. kancane kancane kwathathelwa indawo ukuhlinzwa komgogodla okungemuva noma okungemuva okungavamisile ngaphambili, ngemuva, nangemuva okusizwa i-endoscopy. Ngokuzayo, ukuhlinzwa komgogodla wangaphambili ngaphansi kwe-laparoscopy kuzosetshenziswa kakhulu ekuhlinzeni komgogodla okuhlangene kwangaphambili nangemuva kusizwa i-laparoscopy. Lokhu akugcini nje ngokuthuthukisa izici ezihlasela kancane zendlela yokuhlinzwa ye-endoscopic, kodwa futhi kugwema izithiyo zokuhlinzwa kwesisu okuyinkimbinkimbi, isikhathi eside sokuhlinzwa, kanye nezinga eliphezulu lezinkinga. Ngokuthuthukiswa nokufakwa kwedijithali kobuchwepheshe be-laparoscopic obunezinhlangothi ezintathu, ukusungulwa kwamagumbi okuhlinza ahlakaniphile nayingxubevange, kuzoba nentuthuko enkulu kubuchwepheshe bokuhlinzwa komgogodla obungangeneleli kancane esikhathini esizayo.