腹腔鏡設(shè)備精密度高、結(jié)構(gòu)復(fù)雜，是集現(xiàn)代電子、光學(xué)和機(jī)械等多方面的綜合性體系，因而日常對(duì)腹腔鏡設(shè)備進(jìn)行杰出的保養(yǎng)顯得尤為重要。杰出的保養(yǎng)不僅是延伸腹腔鏡運(yùn)用壽命、降低修理成本的需求，也是降低術(shù)中毛病發(fā)作率的重要前提。
With high precision and complex structure, laparoscopic equipment is a comprehensive system integrating modern electronics, optics and machinery, so it is particularly important to carry out outstanding maintenance of laparoscopic equipment. Outstanding maintenance is not only the need to extend the service life of laparoscopy and reduce the cost of repair, but also the important premise to reduce the incidence of intraoperative problems.
1.腹腔鏡手術(shù)設(shè)備的組成
1. Composition of laparoscopic operation equipment
腹腔鏡手術(shù)是由數(shù)個(gè)設(shè)備聯(lián)合完成的，只有明晰地認(rèn)識(shí)到每個(gè)設(shè)備的功用與特點(diǎn)，才能及時(shí)的發(fā)現(xiàn)問(wèn)題并解決問(wèn)題。一套完好的腹腔鏡手術(shù)設(shè)備一般由以下5個(gè)部分組成：
Laparoscopic surgery is completed by a number of equipment, only a clear understanding of the function and characteristics of each equipment, in order to find and solve problems in time. A complete set of laparoscopic surgery equipment is generally composed of the following five parts:
①顯現(xiàn)攝像體系，包含顯現(xiàn)器、腹腔鏡鏡頭、鏡管、信號(hào)轉(zhuǎn)換器，其功用是用來(lái)收集并顯現(xiàn)體腔內(nèi)明晰、傳神的圖畫(huà)；
① The display camera system includes a display device, a laparoscopic lens, a mirror tube, and a signal converter. Its function is to collect and display clear and vivid pictures in the body cavity;
②冷光源體系，其功用是為手術(shù)供給照明；
② The function of cold light source system is to provide illumination for operation;
③氣腹機(jī)，其功用是為手術(shù)供給足夠的空間；
③ The function of pneumoperitoneum machine is to provide enough space for operation;
④高頻電刀，包含單極和雙極，其功用是施行切除方針；
④ The utility model relates to a high frequency electric knife, which comprises a single pole and a double pole;
⑤負(fù)壓招引體系，包含招引器管、招引管道、招引瓶，其功用是招引切除物和術(shù)中流出的組織液。
⑤ The negative pressure attracting system includes the attracting device tube, the attracting tube and the attracting bottle. Its function is to attract the excised object and the tissue fluid flowing out during the operation.
2.腹腔鏡設(shè)備術(shù)中常見(jiàn)故障及其排除方案
2. Common troubles in laparoscopic equipment operation and Solutions
2.1顯現(xiàn)攝像體系故障
2.1 display camera system fault
(1)黑屏現(xiàn)象：顯現(xiàn)器、冷光源體系電源接頭、攝像線接頭的掉落，冷光源體系燈泡的接觸不良和損壞等多種原因均會(huì)引起顯現(xiàn)器黑屏現(xiàn)象。因而，術(shù)前應(yīng)對(duì)設(shè)備進(jìn)行細(xì)致的查看，并常備冷光源體系的替換燈泡。
(1) Black screen phenomenon: the phenomenon of black screen can be caused by many reasons, such as the falling of the power connector of the display, cold light source system and the camera wire connector, the poor contact and damage of the bulb of the cold light source system, etc. Therefore, the equipment should be checked carefully before operation, and the replacement bulb of cold light source system should be prepared.
(2)圖畫(huà)不明晰：攝像頭焦距偏離或鏡頭上感染異物可形成圖畫(huà)不明晰，微調(diào)焦距或用碘伏棉簽擦洗鏡頭可解決此類問(wèn)題。
(2) Unclear picture: the camera focal length deviates or the lens is infected with foreign matters, which may cause unclear picture. Such problems can be solved by adjusting the focal length or scrubbing the lens with Iodophor cotton swab.
(3)圖畫(huà)明暗度失調(diào)：在手術(shù)中手術(shù)間的光線不行過(guò)亮，應(yīng)關(guān)閉無(wú)影燈，將冷光源調(diào)至自動(dòng)位置，不然會(huì)引起圖畫(huà)過(guò)亮。而圖畫(huà)過(guò)暗可能由兩種狀況引起：①冷光源導(dǎo)光束與腹腔鏡銜接處松動(dòng)或冷光源銜接處稍有松動(dòng)，只需將接頭稍向前推進(jìn)，光源即可康復(fù)正制”；②照明光纖部分?jǐn)嘟z，只需更換悉數(shù)照明光纖即可解決。
(3) Picture light and shade imbalance: the light in the operating room should not be too bright during the operation. The shadowless lamp should be turned off, and the cold light source should be turned to the automatic position, otherwise the picture will be too bright. However, the picture is too dark, which may be caused by two conditions: ① the connection between the cold light guide beam and the laparoscope is loose or the connection between the cold light source is slightly loose, and the light source can be recovered by pushing forward the connector slightly; ② the lighting fiber is partially broken, which can be solved by replacing all the lighting fibers.
(4)圖畫(huà)顏色失衡：攝像頭白色平衡的錯(cuò)誤設(shè)置會(huì)導(dǎo)致圖畫(huà)顏色失真，因而在運(yùn)用攝像體系前需求自動(dòng)或手動(dòng)設(shè)置白色平衡。
(4) Picture color imbalance: the wrong setting of camera white balance will cause picture color distortion, so it needs to set the white balance automatically or manually before using the camera system.
(5)霧視現(xiàn)象：經(jīng)套管置入腹腔前需求進(jìn)行預(yù)熱，使其溫度超越人體腹腔的溫度以防止發(fā)作霧視，將腹腔鏡置入40℃生理鹽水中預(yù)熱約5min即可。
(5) Foggy phenomenon: it needs to be preheated before inserting the cannula into the abdominal cavity to make its temperature exceed the temperature of the abdominal cavity of the human body to prevent the occurrence of foggy vision. Put the laparoscope into 40 ℃ normal saline to preheat for about 5 minutes.
2.2氣腹機(jī)毛病
2.2 pneumoperitoneum machine fault
(1)氣腹針阻塞：在術(shù)中氣腹針可被脂肪顆粒、血塊或其他組織碎片所阻塞，處理措施為運(yùn)用5ml注射器抽吸生理鹽水進(jìn)行沖刷曉暢即可。有時(shí)氣腹針刺入腹膜也會(huì)形成氣腹針的阻塞，此刻需求將氣腹針取出并從頭刺進(jìn)腹腔。
(1) Obstruction of pneumoperitoneum needle: during the operation, the pneumoperitoneum needle can be blocked by fat particles, blood clots or other tissue fragments. The treatment measures are to use 5ml syringe to pump saline for flushing. Sometimes pneumoperitoneum acupuncture into the peritoneum will also form the obstruction of pneumoperitoneum needle. At this moment, it is necessary to take out the pneumoperitoneum needle and insert it into the abdominal cavity from the beginning.
(2)氣腹機(jī)壓力過(guò)低：適度的CO2氣體壓力對(duì)堅(jiān)持腹壓和發(fā)明有利于手術(shù)操作的視界環(huán)境是非常必要的。但是，一旦發(fā)作漏氣就會(huì)引起氣腹機(jī)壓力過(guò)低，繼而難以堅(jiān)持腹腔內(nèi)的壓力。多種因素可引起氣腹機(jī)壓力過(guò)低，常見(jiàn)的為輸氣管道接頭松動(dòng)和穿刺器密封帽損壞引起的漏氣，錯(cuò)誤的設(shè)置C02壓力參數(shù)不容忽視。因而，在正確的CO22壓力參數(shù)設(shè)置下將輸氣管道接頭擰緊并及時(shí)更換損壞的穿刺器密封帽是完成氣腹機(jī)壓力堅(jiān)持正常水平的基本前提。
(2) Pneumoperitoneum pressure is too low: moderate CO2 gas pressure is very necessary to adhere to the abdominal pressure and invent a vision environment conducive to the operation. However, once air leakage occurs, the pressure of pneumoperitoneum will be too low, and then it is difficult to maintain the pressure in the abdominal cavity. Many factors can cause the pressure of the pneumoperitoneum to be too low. The common causes are the gas leakage caused by the loose joint of the gas transmission pipeline and the damage of the sealing cap of the puncture device. The wrong setting of C02 pressure parameters can not be ignored. Therefore, under the correct pressure parameter setting of CO22, tightening the gas transmission pipeline joint and replacing the damaged sealing cap of the puncture device in time is the basic premise to maintain the normal pressure of the pneumoperitoneum machine.
2.3高頻電刀故障
2.3 high frequency electric knife failure
(1)單極電刀故障：電刀、電凝導(dǎo)線與主機(jī)銜接較松會(huì)引起兩者無(wú)任何輸出，應(yīng)及時(shí)查看兩者接頭并將其與主機(jī)結(jié)實(shí)銜接。當(dāng)電刀主機(jī)負(fù)極板與主機(jī)的端口接觸不良時(shí)，電切和電凝將停止工作，負(fù)極板的指示燈由綠色變成赤色并發(fā)出警報(bào)，此刻需將負(fù)極板線從頭刺進(jìn)主機(jī)端口。在術(shù)中患者過(guò)多的皮屑會(huì)形成電刀回路不暢，需求在術(shù)前將皮膚外表的皮屑鏟除干凈。皮毛較多也會(huì)引起相同效果，需堅(jiān)持皮膚的平坦?jié)櫥?/span>
(1) Single pole electric knife fault: loose connection of electric knife, electric condensing wire and main machine will cause no output of the two. Check the connectors of the two in time and connect them firmly with the main machine. When the negative plate of the electric knife host is in poor contact with the port of the host, the electric cutting and electrocoagulation will stop working. The indicator light of the negative plate changes from green to red and gives an alarm. At this moment, it is necessary to insert the negative plate wire into the port of the host from the beginning. In the operation, too much dandruff of patients will form a poor circuit of electric knife, so it is necessary to remove the dandruff on the surface of skin before operation. A lot of fur will cause the same effect. It is necessary to keep the skin smooth and smooth.
(2)雙極凝電故障：雙極凝電毛病一般是由雙極線與主機(jī)接觸不良而引起，需調(diào)整好兩者的接觸面或更換新的雙極線即可。凝血時(shí)發(fā)生的血痂過(guò)多會(huì)引起雙極凝電毛病，需及時(shí)鏟除干凈。
(2) Bipolar condensing fault: Bipolar condensing fault is generally caused by poor contact between bipolar wire and main engine. It is necessary to adjust the contact surface of the two or replace the new bipolar wire. Excessive scab during coagulation will cause bipolar coagulation fault, which needs to be removed in time.
2.4負(fù)壓招引體系故障
2.4 failure of negative pressure system
(1)體系無(wú)負(fù)壓或吸力較小：中心負(fù)壓的關(guān)閉、招引管道的脫節(jié)以及招引瓶的密封性差可引起體系無(wú)負(fù)壓或吸力較小，一旦發(fā)現(xiàn)需對(duì)其敏捷進(jìn)行排查。
(1) The system has no negative pressure or low suction: the closure of the central negative pressure, the disconnection of the suction pipe and the poor sealing of the suction bottle can cause the system to have no negative pressure or low suction. Once found, it needs to be checked quickly.
(2)體系阻塞：術(shù)后要用高壓氣、水槍對(duì)招引體系進(jìn)行反復(fù)沖刷，不然血塊干燥結(jié)痂或其他異物會(huì)淤積于管腔內(nèi)形成招引體系的阻塞。另外，招引體系長(zhǎng)期不用時(shí)要定時(shí)運(yùn)轉(zhuǎn)一段時(shí)間，以保證機(jī)器的正常運(yùn)轉(zhuǎn)。
(2) System obstruction: after the operation, high-pressure air and water gun should be used to wash the system repeatedly, otherwise the blood clot will dry and scab or other foreign matters will deposit in the lumen to form the obstruction of the system. In addition, when the recruitment system is not used for a long time, it needs to be operated for a period of time to ensure the normal operation of the machine.
3.腹腔鏡設(shè)備的日常保養(yǎng)
3. Routine maintenance of laparoscopic equipment
3.1腹腔鏡設(shè)備的清洗與消毒
3.1 cleaning and disinfection of laparoscopic equipment
(1)腹腔鏡設(shè)備的清洗：術(shù)后應(yīng)立即拆開(kāi)腹腔鏡設(shè)備的可拆開(kāi)部分，并對(duì)其進(jìn)行清洗。先用酶劑浸泡，再用活動(dòng)水沖刷。對(duì)帶管腔的器械，每次運(yùn)用后應(yīng)運(yùn)用通條刷反復(fù)通刷，再用流水或高壓水槍反復(fù)沖刷。對(duì)穿刺器械運(yùn)用棉簽清洗閥門(mén)內(nèi)腔、彈簧、密封圈及穿刺錐的側(cè)孔，吹干后及時(shí)將閥門(mén)還原，以防止閥門(mén)內(nèi)的小部件丟失。清洗抓持器械及剪刀時(shí)應(yīng)打開(kāi)旋轉(zhuǎn)軸輕輕沖洗。若軸節(jié)仍有固執(zhí)碎屑則選用超聲清洗器清洗。攝像頭、腹腔鏡視角用軟布擦干晾干，切忌用粗糙的布巾擦洗避免劃傷鏡頭，嚴(yán)禁運(yùn)用超聲波清洗機(jī)對(duì)內(nèi)鏡進(jìn)行清洗。
(1) Cleaning of laparoscopic equipment: the detachable part of laparoscopic equipment should be removed immediately after operation and cleaned. First soak it with enzyme, then wash it with active water. For instruments with lumen, after each use, the brush shall be used repeatedly, and then the water or high-pressure water gun shall be used for repeated flushing. Use cotton swab to clean the inner cavity, spring, sealing ring and side hole of the puncture cone of the puncture device, and restore the valve in time after drying to prevent the small parts in the valve from losing. Open the rotating shaft and wash gently when cleaning the holding apparatus and scissors. If there are still stubborn debris on the coupling, use ultrasonic cleaner for cleaning. The camera and laparoscopic viewing angle shall be dried with soft cloth. It is forbidden to scrub with rough cloth to avoid scratching the lens. It is forbidden to use ultrasonic cleaning machine to clean the endoscope.
(2)腹腔鏡設(shè)備的消毒：針對(duì)不同的器械可別離選用高溫高壓滅菌法、低溫滅菌法等進(jìn)行消毒。攝像頭、電纜和電極不行運(yùn)用消毒液浸泡法或高溫高壓滅菌法消毒，不然對(duì)器械會(huì)形成嚴(yán)峻的損害，只能選用氣體熏蒸消毒法或等離子低溫滅菌法。
(2) Sterilization of laparoscopic equipment: according to different equipment, high-temperature and high-pressure sterilization method and low-temperature sterilization method can be selected separately. Camera, cable and electrode can not be sterilized by using disinfectant immersion method or high-temperature and high-pressure sterilization method, otherwise severe damage will be caused to the instrument, and only gas fumigation or plasma low-temperature sterilization method can be used.
3.2腹腔鏡設(shè)備的保養(yǎng)
3.2 maintenance of laparoscopic equipment
(1)腹腔鏡設(shè)備的放置：腹腔鏡設(shè)備應(yīng)置于腹腔鏡器械臺(tái)上，每次運(yùn)用前后要對(duì)其外表進(jìn)行清潔并罩上防塵罩。各部件要用專用的器械盒寄存，器械寄存應(yīng)擺放有序。一切尖利的器械要防止碰撞，取放時(shí)應(yīng)做到又輕又穩(wěn)。尤其是光學(xué)體系對(duì)光極為靈敏，儀器設(shè)備的放置應(yīng)選擇陰暗的房間，防止強(qiáng)光直射。
(1) Placement of laparoscopic equipment: the laparoscopic equipment shall be placed on the laparoscopic instrument table. Before and after each use, the surface of the laparoscopic equipment shall be cleaned and covered with dust cover. Each component shall be stored in a special instrument box, and the instruments shall be placed in order. All sharp instruments shall be prevented from collision, and shall be light and stable when taken and placed. In particular, the optical system is very sensitive to light. The instrument and equipment should be placed in a dark room to prevent direct light.
(2)腹腔鏡設(shè)備的定時(shí)查看：堅(jiān)持每周對(duì)腹腔鏡設(shè)備的功用進(jìn)行1次查看，每月對(duì)一切器械進(jìn)行除銹和潤(rùn)滑保養(yǎng)1次。
(2) Regular inspection of laparoscopic equipment: adhere to check the function of laparoscopic equipment once a week, and conduct rust removal and lubrication maintenance for all equipment once a month.
3.3腹腔鏡設(shè)備的保養(yǎng)
3.3 maintenance of laparoscopic equipment
保管腹腔鏡設(shè)備需做到：①腹腔鏡設(shè)備的保管應(yīng)完成專人專管，職責(zé)到人；②腹腔鏡設(shè)備的維護(hù)人員熟練掌握各類腹腔鏡手術(shù)器械，術(shù)前仔細(xì)核對(duì)器械配件是否完好，耗材預(yù)備是否完全；③手術(shù)結(jié)束后應(yīng)仔細(xì)核對(duì)器械及配件。
It is necessary to keep the laparoscopic equipment: ① the storage of the laparoscopic equipment shall be in the charge of a special person, with responsibilities assigned to each person; ② the maintenance personnel of the laparoscopic equipment shall be familiar with all kinds of laparoscopic surgical instruments, and carefully check whether the instruments and accessories are in good condition before operation, and whether the consumables are completely prepared; ③ after the operation, the instruments and accessories shall be carefully checked.
以上就是關(guān)于腹腔鏡的組成及應(yīng)急維修和保養(yǎng)的詳細(xì)介紹，由內(nèi)窺鏡設(shè)備維修整理提供，如果還有其它問(wèn)題，歡迎點(diǎn)擊官網(wǎng)咨詢http://www.rxjhq.cn/！
The above is a detailed introduction to the composition of laparoscope and emergency repair and maintenance. It is provided by the repair and arrangement of endoscope equipment. If you have any other questions, please click the official website for consultation http://www.rxjhq.cn/ !
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