Nhoroondo yekushandiswa uye basa remamaikorosikopu ekuvhiya mukuvhiya kwetsinga

 

Munhoroondo yekuvhiyiwa kwetsinga, kushandiswa kwemaikorosikopu ekuvhiyachiratidzo chinoshamisa, kubva panguva yechinyakare yekuvhiyiwa kwetsinga dzeuropi yekuvhiya pasi pemaziso kusvika kunguva yemazuva ano yekuvhiyiwa kwetsinga dzeuropi pasi pemaikorosikopuNdiani uye rini akaita izvozvomaikorosikopu ari kushandainotanga kushandiswa mukuvhiyiwa kwetsinga? Basa rei rave naromaikorosikopu yekuvhiyaZvakaitwa mukuvandudzwa kwekuvhiyiwa kwetsinga? Nekufambira mberi kwesainzi netekinoroji, zvichaitwa hereMaikorosikopu iri kushandaZvinofanira kutsiviwa nemimwe michina yepamusoro-soro here? Uyu mubvunzo unofanirwa kuzivikanwa nachiremba wese wepfungwa uye kushandisa tekinoroji yazvino uye zvishandiso mumunda wekuvhiya kwetsinga, zvichikurudzira kuvandudzwa kwehunyanzvi hwekuvhiya kwetsinga.

1. Nhoroondo yekushandiswa kweMicroscopy muMinda yezvekurapa

Mufizikisi, magirazi emaziso magirazi ane chimiro chimwe chete chine simba rekukudza, uye kukura kwawo kwakaganhurirwa, kunozivikanwa semagirazi ekukudza. Muna 1590, vanhu vaviri vekuDutch vakaisa magirazi maviri egirazi mukati mebharero rakatetepa recylindrical, nokudaro vachigadzira mudziyo wekutanga pasi rose wekuwedzera chimiro: iyomaikorosikopuMushure mezvo, chimiro chemaikorosikopu chakaramba chichivandudzwa, uye kukura kwacho kwakaramba kuchikura. Panguva iyoyo, masayendisiti ainyanya kushandisa izvi.maikorosikopu yakasanganiswakuti vaone maumbirwo madiki emhuka nemiti, akadai semaumbirwo emasero. Kubva pakati pezana remakore rechi19 kusvika pakupera kwezana remakore rechi19, magirazi ekukudza uye maikorosikopu zvakashandiswa zvishoma nezvishoma mumunda wekurapa. Pakutanga, vanachiremba vakashandisa magirazi ekukudza ane chimiro chegirazi rimwe chete raigona kuiswa pabhiriji remhino pakuvhiya. Muna 1876, chiremba wekuGermany Saemisch akaita kuvhiya kwekutanga "kwe microscopic" pasi rose achishandisa girazi rekukudza regirazi rine compound (rudzi rwekuvhiya haruzivikanwe). Muna 1893, kambani yekuGermany Zeiss yakagadziramaikorosikopu yebhino, inonyanya kushandiswa pakuongorora mumarabhoritari ekurapa, pamwe nekutarisa maronda emukamuri repamusoro nerekunze mumunda wezvemaziso. Muna 1921, zvichibva pakutsvagurudza murabhoritari pamusoro pemuviri wenzeve dzemukati memhuka, chiremba wezvemaziso wekuSweden Nylen akashandisa mushonga wakasimba.maikorosikopu yekuvhiya ine monocularAkagadzirwa uye akagadzirwa naiye pachake kuti aite kuvhiyiwa kwenguva refu kwe otitis media pavanhu, uko kwaive kuvhiyiwa kwechokwadi kwe microsurgery. Gore rimwe chete gare gare, chiremba mukuru waNylen Hlolmgren akatanga chirongwa chekurapa chirwere che otitis media.maikorosikopu yekuvhiya yebinocularyakagadzirwa naZeiss muimba yekuvhiyira.

YekutangaMamaikorosikopu ari kushandayaive nematambudziko akawanda, akadai sekugadzikana kwemuchina, kutadza kufamba, kupenya kwemaaxes akasiyana uye kupisa lenzi yekutarisa, nzvimbo yakamanikana yekuwedzera kuvhiyiwa, nezvimwewo. Izvi zvese zvikonzero zvinoganhurira kushandiswa kwakakura kwemaikorosikopu ekuvhiyaMumakore makumi matatu akatevera, nekuda kwekudyidzana kwakanaka pakati pevanachiremba vekuvhiya nevagadziri vemamaikorosikopu, mashandiro emaikorosikopu ekuvhiyayakaramba ichivandudzwa, uyemaikorosikopu ekuvhiya ebhinocular, maikorosikopu akaiswa padenga, magirazi ekuzoom, chiedza checoaxial lighting, maoko akabatana anodzorwa nemagetsi kana mvura, kudzora tsoka, nezvimwewo zvakagadzirwa zvakatevedzana. Muna 1953, kambani yekuGermany yeZeiss yakagadzira nhevedzano yehunyanzvi.maikorosikopu ekuvhiya e otology, inonyanya kukodzera kuvhiyiwa pamaronda akadzika akadai kwenzeve yepakati nepfupa remukati.maikorosikopu ekuvhiyazvichiri kuramba zvichivandudzika, mafungiro evanachiremba vekuvhiya ari kuchinjawo nguva dzose. Semuenzaniso, vanachiremba vekuGermany Zollner naWullstein vakataura kutimaikorosikopu ekuvhiyainofanira kushandiswa pakuvhiya tympanic membrane shaping. Kubva kuma1950, vanachiremba vemaziso vakachinja zvishoma nezvishoma tsika yekushandisa maikorosikopu chete pakuongorora maziso uye vakatangamaikorosikopu e otosurgicalkupinda mukuvhiyiwa kwemaziso. Kubva ipapo,Maikorosikopu iri kushandayakashandiswa zvakanyanya mukurapa otology nemaziso.

2. Kushandiswa kwemaikorosikopu ekuvhiya mukuvhiya kwetsinga

Nekuda kwekusiyana kwe neurosurgery, kushandiswa kwemaikorosikopu ekuvhiya mukuvhiya kwetsingayave kunonoka zvishoma pane mu otology ne ophthalmology, uye vanachiremba ve neurosurgeon vari kudzidza tekinoroji iyi itsva. Panguva iyoyo,kushandiswa kwemaikorosikopu ekuvhiyazvakanyanya kuEurope. Chiremba wemaziso wekuAmerica Perrit ndiye akatanga kuunzwamaikorosikopu ekuvhiyakubva kuEurope kuenda kuUnited States muna 1946, zvichiisa hwaro hwekuti vanachiremba vekuAmerica vashandiseMamaikorosikopu ari kushanda.

Kubva pamaonero ekuremekedza kukosha kwehupenyu hwemunhu, chero tekinoroji itsva, zvishandiso, kana zvishandiso zvinoshandiswa mumuviri wemunhu zvinofanirwa kuitwa bvunzo dzekutanga dzemhuka uye kudzidziswa kwehunyanzvi kune vanobata. Muna 1955, chiremba wekuAmerica anonzi Malis akavhiya uropi hwemhuka achishandisamaikorosikopu yekuvhiya yebinocularKurze, chiremba wepfungwa paYunivhesiti yeSouthern California muUnited States, akapedza gore achidzidza nzira dzekuvhiya dzekushandisa maikorosikopu murabhoritari mushure mekutarisa kuvhiyiwa kwenzeve achishandisa maikorosikopu. Muna Nyamavhuvhu 1957, akabudirira kuita kuvhiyiwa kweacoustic neuroma pamwana ane makore mashanu ekuberekwa achishandisamaikorosikopu yekuvhiya nzeve, kwaive kuvhiyiwa kwekutanga pasi rose kwe microsurgical. Nguva pfupi yakatevera, Kurze akakwanisa kuvhiya mwana nerve sublingual sublingual nerve anastomosis achishandisamaikorosikopu yekuvhiya, uye mwana akapora zvakanaka kwazvo. Uku kwaive kuvhiyiwa kwechipiri kwe microsurgical pasi rose. Mushure mezvo, Kurze akashandisa marori kutakuraMamaikorosikopu ari kushandakunzvimbo dzakasiyana-siyana dze microsurgical neurosurgery, uye vakakurudzira zvakanyanya kushandiswa kwemaikorosikopu ekuvhiyakune vamwe vanachiremba vepfungwa. Mushure mezvo, Kurze akaita kuvhiya kwekubvisa aneurysm muuropi achishandisamaikorosikopu yekuvhiya(zvinosuwisa kuti haana kuburitsa chero zvinyorwa). Nerutsigiro rwemurwere wetrigeminal neuralgia waakarapa, akatanga rabhoritari yekutanga pasi rose ye micro skull base neurosurgery muna 1961. Tinofanira kugara tichiyeuka mupiro waKurze mukuvhiya kwe microsurgery uye kudzidza kubva kuushingi hwake hwekugamuchira matekinoroji matsva nepfungwa. Zvisinei, kusvika pakutanga kwema1990, vamwe vanachiremba ve neurosurgery muChina havana kugamuchiraMaikorosikopu ekuvhiya kwetsingayekuvhiyiwa. Izvi hazvina kukonzera dambudziko neMaikorosikopu yekuvhiya kweuropipachayo, asi dambudziko nekunzwisisa kwepfungwa dzevanachiremba vepfungwa.

Muna 1958, chiremba wepfungwa wekuAmerica Donaghy akatanga rabhoritari yekutanga pasi rose yekutsvagisa nekudzidzisa kuvhiyiwa kwemicrosurgery muBurlington, Vermont. Pakutanga, akasanganawo nekuvhiringidzika nematambudziko emari kubva kuvakuru vake. Muzvidzidzo, aigara achifungidzira kucheka mitsipa yeropa yecortical kuti abvise zvakananga thrombi kubva kuvarwere vane cerebral thrombosis. Saka akashanda pamwe nachiremba wetsinga Jacobson pakutsvaga mhuka nekiriniki. Panguva iyoyo, pasi pemamiriro emaziso asina kupfeka, mitsipa midiki yeropa ine dhayamita ye7-8 mm kana kupfuura ndiyo yaigona kukwenywa. Kuti awane anastomosis yemitsipa yeropa yakapfava, Jacobson akatanga kuedza kushandisa girazi remagirazi. Nguva pfupi yadarika, akayeuka achishandisamaikorosikopu ekuvhiya e otolaryngologyyekuvhiyiwa paaiva chiremba anogara ikoko. Saka, nerubatsiro rwaZeiss muGermany, Jacobson akagadzira maikorosikopu yekuvhiya ine maoperator maviri (Diploscope) ye vascular anastomosis, iyo inobvumira vanachiremba vaviri vekuvhiya kuita kuvhiya panguva imwe chete. Mushure mekuyedza kwakakura kwemhuka, Jacobson akaburitsa chinyorwa pamusoro pe microsurgical anastomosis yembwa ne non carotid arteries (1960), ine 100% patency rate ye vascular anastomosis. Iri ipepa rekurapa rine chekuita ne microsurgical neurosurgery uye vascular surgery. Jacobson akagadzirawo zvishandiso zvakawanda zve microsurgical, zvakaita se micro scissors, micro pitchers, uye micro instrument handles. Muna 1960, Donaghy akabudirira kuita cerebral artery incision thrombectomy pasi pe amaikorosikopu yekuvhiyakumurwere ane cerebral thrombosis. Rhoton wekuUnited States akatanga kudzidza nezve anatomiki yeuropi achishandisa maikorosikopu muna 1967, achitanga ndima itsva ye anatomiki ye microsurgical uye achipa mipiro yakakosha mukuvandudzwa kwe microsurgery. Nekuda kwezvakanaka zvemaikorosikopu ekuvhiyauye kuvandudzwa kwemidziyo yekuvhiya midiki, vanachiremba vakawanda vanofarira kushandisamaikorosikopu ekuvhiyauye akaburitsa nyaya dzakawanda dzine chekuita nemaitiro ekuvhiya ari pasi pe microsurgical.

3. Kushandiswa kwemaikorosikopu ekuvhiya mukuvhiya kwetsinga muChina

Semunhu wekuChina ane hunyanzvi hwenyika ari kunze kwenyika muJapan, Purofesa Du Ziwei akapa chipo chekutanga chemunomaikorosikopu yekuvhiya kwetsingauye zvine chekuita nazvozvishandiso zve microsurgicalkuDhipatimendi reNeurosurgery reSuzhou Medical College Affiliate Hospital (ikozvino yava Dhipatimendi reNeurosurgery reSuzhou University Affiliate First Hospital) muna 1972. Mushure mekudzokera kuChina, akatanga kuita maoparesheni emicrosurgical akadai se intracranial aneurysms uye meningiomas. Mushure mekudzidza nezvekuwanikwa kwemaikorosikopu ekuvhiya netsingauye michina yekuvhiya midiki, Purofesa Zhao Yadu weDhipatimendi reNeurosurgery reBeijing Yiwu Hospital vakashanyira Purofesa Du Ziwei weSuzhou Medical College kuti vaone kushandiswa kwemaikorosikopu ekuvhiyaPurofesa Shi Yuquan wekuShanghai Huashan Hospital vakashanyira dhipatimendi raPurofesa Du Ziwei kuti vaone maitiro ekuvhiyiwa kwemicrosurgical. Nekuda kweizvozvo, vanhu vakawanda vakatanga kuvhura, kudzidza, uye kushandisaMaikorosikopu ekuvhiya kwetsingakwakatangwa munzvimbo huru dzekuvhiya tsinga dzeuropi muChina, zvichiratidza kutanga kwekuvhiya tsinga dzeuropi muChina.

4. Mhedzisiro yeKuvhiyiwa kweMicrosurgery

Nekuda kwekushandiswa kwemaikorosikopu ekuvhiya netsinga, kuvhiyiwa kusingaitwe nemaziso asina kupfeka kunoitika kana paine kuwedzera kweka6-10. Semuenzaniso, kuvhiyiwa kwegomarara repituitary kuburikidza ne ethmoidal sinus kunogona kuona nekubvisa magomarara epituitary zvakachengeteka uku uchichengetedza gland repituitary rakajairika; kuvhiyiwa kusingaitwe nemaziso asina kupfeka kunogona kuva kuvhiyiwa kuri nani, senge magomarara europi uye magomarara emusana. Nyanzvi yezvedzidzo Wang Zhongcheng aive nehuwandu hwekufa hwe10.7% nekuda kwekuvhiyiwa kweaneurysm yeuropi asati ashandisa amaikorosikopu yekuvhiya kwetsingaMushure mekushandisa maikorosikopu muna 1978, huwandu hwerufu hwakaderera kusvika pa3.2%. Huwandu hwerufu rwekuvhiyiwa kweuropi kwe arteriovenous malformation pasina kushandisa amaikorosikopu yekuvhiyayaive 6.2%, uye mushure me1984, nekushandiswa kwemaikorosikopu ekuvhiya kwetsinga, huwandu hwevakafa hwakaderera kusvika pa1.6%.maikorosikopu yekuvhiya kwetsingainobvumira bundu repituitary kuti rirapwe kuburikidza nenzira isinganyanyi kupindira mumhino pasina chikonzero checraniotomy, zvichideredza huwandu hwerufu kubva pakuvhiyiwa kubva pa4.7% kusvika pa0.9%. Kubudirira kwemhedzisiro iyi hakugoneki pasi pekuvhiyiwa kwemaziso kwetsika, sakamaikorosikopu ekuvhiyachiratidzo chekuvhiyiwa kwetsinga dzeuropi kwemazuva ano uye zvave chimwe chezvishandiso zvekuvhiya zvisingatsiviwi uye zvisingatsiviwi mukuvhiyiwa kwetsinga dzeuropi kwemazuva ano.