双极电凝培训课件

双极电凝Bipolar,2,B.BraunMelsungenAG|Page,Strategy2015AesculapMarketShares2013NE,MarketShare,9,0,7,6,12,6,30,6,13,2,48,9,11,9,Mio.,ImportanceofbipolarHFsurgeryinNeurosurgery,bipolarforcepsbelongtothemostimportantinstrumentsinspinalandneurosurgicalORs.双极电凝是神经外科和脊柱外科最重要的手术器械areusedinnearlyeverycranialandspinaloperation.几乎每一台颅脑和脊柱手术中都会使用crucialforthesuccessofthesurgicalintervention.对手术的成功开展具有重要作用areusedfor:临床应用graspingoftissue抓持组织openingoftissue分离组织coagulation(sealingoftissue)凝血,3,B.BraunMelsungenAG|Page,Bipolarequipment,BipolarInstrumente.g.GK770RBipolarCablee.g.GN130HF-Unite.g.GN060/GN160Aneutralelectrode,whichyouneedformonopolarHF-surgery,isnotnecessary!不需要单极电凝系统中的负极板！,4,B.BraunMelsungenAG|Page,CoagulationProcess,thetemperatureraisestoapprox.80Celsius局部温度迅速升高至80摄氏度thecellwatervaporizesandthevesselshrinks细胞内水分迅速蒸发，血管收缩agglutinationcausedbycollagenstopsthebleeding细胞内胶原蛋白凝结，出血停止becauseofthetemperaturethevessels“coagulates”likeanegginhotfriedpan.高温让组织迅速凝结，就像高温平底锅上煎鸡蛋组织达到100会开始碳化可靠的凝血需要：适当的功率+足够的时间,5,B.BraunMelsungenAG|Page,BipolarGeneratorGN060,6,B.BraunMelsungenAG|Page,开/关机,微/宏输出,Switchautomaticmode/footswitchmode,:增加/减少,Memory:Storageof4values,Socketforbipolarcablewithbananaplug(28,6mmPIN),Socketforbipolarcable,Socketforfootswitch,功率输出显示屏,7,GN060主机宏双极：1050W微双极：0.110W4个存储记忆按钮附件：脚踏开关：GK226遥控器：GN064,8,GN060功率阻抗曲线,组织由出血至凝血，是阻抗逐渐增高的过程在阻抗超过50-100时，随阻抗的增大，电凝器的输出功率逐渐降低组织凝血完成，主机即停止输出，因此不粘镊子其它品牌在凝血结束后，不能立即衰减其功率，导致组织与镊子粘连,9,双极电凝镊子YASARGIL系列CASPAR系列SINTRAM系列特殊型号附件：双极电凝联线,GN077,GK200,GN140,GK280,10,直型外观设计黑色绝缘涂层不同的长度不同的镊子头端中等的弹簧张力,特殊型号：微型/标准电凝镊,BipolarForceps,11,B.BraunMelsungenAG|Page,描述,把手,弹簧张力器,(PivotpointonnewGK801only),电极,绝缘层,连接口,Ourclassicalbipolarforceps,12,B.BraunMelsungenAG|Page,Duringeverysurgerybloodflows.TostopbleedingElectrosurgeryisused.Forthis,theforcepsareconnectedtobipolarcurrentwhichgeneratesheatintissuetostopthebleeding.Bipolarforcepsareusedforcoagulation,however,theseinstrumentsaremainlyinuseforpreparationduringoperations.电外科用于每一次手术出血的快速止血。双极电凝镊通过连接产生电流的双极主机从而产生高热快速止血。双极电凝镊主要用于凝结止血，同样可以用于组织的分离和制备Ourthreeclassicalbipolarforcepsdesignsare:蛇牌经典的双极电凝镊如下,CASPARForceps,YASARGILForceps,SINTRAMForceps,13,加强弹性的设计使其同样适用于组织制备和铺展工作端圆滑但镊子内侧相对面被辅以精细加工以增强抓持力抗冲击结实耐用的绝缘涂层双侧多个凹状接触面即使在深部手术中也保证安全精细的握持操作光滑且有自洁功能的接口保证稳定联接多种型号选择，适合颅内不同部位手术,Yasargil系列GK7*,14,Caspar系列GK9*,专门设计用于电凝止血纤细精巧的外形，使细致的工作变得不再疲劳镊子尖端圆滑的表面经过抛光处理有效减少组织粘连平行的导向槽保证镊子头端的准确接触牢固的绝缘联结由高质塑料制成光滑且有自洁功能的接口保证稳定联接适合显微外科手术，精细操作,15,Sintram系列GK6*,含银的特殊合金。其他镊子的头端均为不锈钢。不粘头端设计：热量容易被头端带走，不易粘连纤细外形，不阻挡视野前端长，适合颅外凝血及普通外科使用中等弹簧弹力,SintramForceps,Smallportfolioofmostcommonforceps前端长，适合颅外凝血及普通外科使用Preciousmetaltips纤细外形，不阻挡视野Highconductivity,causedbySintram-alloy含银的特殊合金。其他镊子的头端均为不锈钢。Slowheatingupofforcepstips热量容易被头端带走，不粘头端设计Reducesadherenceoftissue不易粘连Mediumspringtension中等弹簧弹力,16,B.BraunMelsungenAG|Page,SpecialAlloy:Lessheatingupatthetipcausesthenon-stickingeffect.Sintramenablesa“heat-flow”fromthetiptotherestoftheinstrument.Thereforethetipstayslongercool!特别合金材质减少镊子尖端高温，保持不粘效果。,SpecialForcepsforirrigation,Coagulation，Preparation，Retraction，GraspingIrrigation(rinsingofbloodforvisualizationoffineanatomicstructures)喷水冲洗，清洁手术创面滴水电凝，防止镊子工作端过热避免结痂，防止过度电凝形成的组织粘连无需清洁电凝镊子表面，缩短手术时间由银合金制成，长寿命设计人体工程学优化，握持力适合亚洲医师ForusewithGN090JetIrrigationUnit,17,B.BraunMelsungenAG|Page,Clue:Theirrigationhelpstoavoidtissueadhesionduringsurgeryandclearsthefieldbefore,afterandduringcoagulation.,18,T-型头端特别为深部位手术需要设计提供安全的抓取及电凝效果对于脆弱的垂体壁不会造成穿孔及损伤,特殊型号：T形垂体电凝镊,19,特殊型号：Landolt垂体电凝镊,管腔设计（可来回滑动）不受腔路狭小的限制均可进入操作！,20,专用于肿瘤切除手术环形头端不同的内径YASARGIL的外观设计,特殊型号：环形电凝镊,IrrigationUnit(GN090),21,B.BraunMelsungenAG|Page,AdjustableParameters:DropsizeDropfrequencyForusewiththeUnitGN060orGN300Accessories:FootswitchGN092PressureCuffGN093IrrigationTubesGN094ConnectioncableGN090830,Clever:Thesecondfootswitchallowstheforcepstoactasanirrigationcannula,enablingyoutocleanorexposewhenneeded.,22,1Non-StickBipolarGeneratoreasyofuse,high-tech“GN160双极电凝主机“易于使用，高科技”30Non-StickForcepsreusable&disposable“30种Rosegold不粘镊子“反复使用&一次性使用”10standard“Forcepsreusable“10种标准不锈钢镊子“反复使用”4BiProtectForcepspreventcollateraldamage,reusable“4种BiProtect镊子“防止相关损伤，反复使用”5universalCablesreusable“5种通用联线”反复使用“,BipolarWhatsnew?,23,Non-StickGenerator+Non-StickBipolarForceps=BestNon-StickEffect不粘电凝器+不粘双极电凝镊=最理想的不粘效果,Conventionalbipolarforcepstendtosticktothecoagulatedtissue.Thiscarriestheriskofinjuringthetissuewhenremovingtheforceps.Oftenthecoagulatedtissuestartsbleedingagain.传统双极电凝镊更易于粘连凝固的组织。在移除电凝镊时，会增加组织损伤的风险，也导致凝固的组织发生再出血。,TheAesculapbipolarNon-StickSystemmininimizesunwantedtissueadhesionandpreventstissuebildupontheforcepstips.蛇牌不粘双极电凝系统可最大限度减少组织粘连，并防止镊尖的残余组织积聚。,WhyNon-Stick?,24,WhatmakesGN160aNon-StickGenerator?GN160为一款性能卓越的不粘电凝器，具备下列优势：Intelligentautomaticcontrol智能自动控制UnlikeconventionalgeneratorstheAesculapNon-StickGeneratoractivelyreducesthepowertopreventcarbonizationandstickingofthetissuewhenrequired.与传统电凝器不同，蛇牌不粘电凝器在需要时可主动有效降低功率，防止发生组织碳化和粘连。,Non-StickBipolarGenerator,ConventionalbipolarGeneratorGN160(standarddose)GN160(standardmodeactivepowerreduction),(forcedmode),Coagulationwitholdgenerator+Yasargilforceps,B.BraunMelsungenAG|Page,25,CoagulationwithGN160+Yasargilforceps,B.BraunMelsungenAG|Page,26,Non-StickBipolarGenerator,WhatmakesGN160aNon-StickGenerator?GN160为一款性能卓越的不粘电凝器，其具备下列优势：,27,Microsparksareonecauseofsticking.Theycanoccuratavoltageof130Vpandhigher.微火花是导致粘连的一个原因。电压达到130Vp甚至更高时会出现微火花。Thenewbipolargeneratorworksatamax.voltageof110Vp(instandardmode)andthereforecanpreventtheoccurrenceofmicrosparks.新型双极电凝器的最高工作电压为110Vp（在标准模式下），因此不会产生微火花。,activepowerreduction有效降低功率mikrosparkprevention防止产生微火花GN160increasesNon-StickbehaviourevenofNon-Non-Stick“forceps.即使对于“非不粘”电凝镊，GN160亦可提高其不粘性。,28,Non-StickBipolarGenerator,PRECISIONRegulationin0,1stepsalsoMALIS精确度微调精度可达0,1。亦可切换为MALIS模式,EASEOFUSESinglewheeltoadjustpowerSinglepedalfootcontroltoactivatetheunit操作简单采用单旋钮调节功率使用单踏板脚踏开关激活电凝器,HIGHTECHReal-timemonitoringandadaptationofparameterstooptimizeNon-StickbehaviorwithoutaffectingcoagulationspeedPreventssparkingandthereforehot-spots技术先进实时监控、调节电凝参数，从而确保在不影响电凝速度的条件下，即可优化不粘性。消除火花，避免产生热点。,COMPATIBILITY&FLEXIBILITYImprovesNon-StickbehaviourofexistingAesculapforcepsFullycompatibewithexistingJetIrrigationUnit(GN090)Fullycompatiblewithfootcontrol(GN161&GK226)兼容性和灵活性显著改善了现有蛇牌电凝镊的不粘性完全兼容现有喷射冲洗系统（GN090）完全兼容脚踏控制（GN161和GK226）,29,Non-StickBipolarForceps,WhatmakesthemtoNon-Stickinstruments?双极电凝镊优质的不粘性功能体现在：Smoothnessofinstrumenttip(initial)镊尖的光滑性（初始阶段）Smoothnessofinstrumenttip(overtime)镊尖的光滑性（随时间推移）Heatdistributiononinstrumenttip镊尖上的热分布Evacuationofheatawayfrominstrumenttip可从镊尖排热,Comparisonofheatdischarge排热对比,RoseGoldforceps、RoseGold电凝镊,standardforceps标准电凝镊,30,YASARGIL/CASPAR,Smoothnessofinstrumenttip(initial)镊尖的光滑性（初始阶段）Smoothnessofinstrumenttip(overtime)镊尖的光滑性（随时间推移）Heatdistributiononinstrumenttip镊尖上的热分布Evacuationofheatawayfrominstrumenttip可从镊尖排热,YASARGIL/CASPAR,31,SINTRAM,Smoothnessofinstrumenttip(initial)镊尖的光滑性（初始阶段）Smoothnessofinstrumenttip(overtime)镊尖的光滑性（随时间推移）Heatdistributiononinstrumenttip镊尖上的热分布Evacuationofheatawayfrominstrumenttip可从镊尖排热,SINTRAMForceps,NONSTICK,32,Non-StickBipolarForceps,Smoothnessofinstrumenttip(initial)镊尖的光滑性（初始阶段）Smoothnessofinstrumenttip(overtime)镊尖的光滑性（随时间推移Heatdistributiononinstrumenttip镊尖上的热分布Evacuationofheatawayfrominstrumenttip可从镊尖排热,Non-StickBipolarForceps,33,AngledbayonetshapeForenhancedsightandeasierhandling.Itmovesthesurgeonshandoutoftheviewwhileworkingunderthemicroscope.带角刺刀形可增强视野，方便操作。在显微镜下工作时，外科医师的手不会阻挡视线。,Inadditiontheslenderdesignoftheseforcepsprovidesaclearviewofthesurgicaloperativesite.此外，这些电凝镊采用细长结构设计，保证手术部位视野清晰。,SlenderDesign细长型设计,34,Non-StickBipolarForceps,Smoothnessofinstrumenttip(initial)镊尖的光滑性（初始阶段）Smoothnessofinstrumenttip(overtime)镊尖的光滑性（随时间推移）Heatdistributiononinstrumenttip镊尖上的热分布Evacuationofheatawayfrominstrumenttip可从镊尖排热,35,NewstandardStainlessSteelBipolarForceps,ClearviewonthesurgicaloperativesiteOurnewstainlesssteelbipolarforcepswiththesameslenderdesignasournewRoseGoldlinearethebasicversionandareanalternativeatafavorableprice.,36,BiProtectForcepsAntiCollateralDamage防止毗邻组织损伤,Ceramicinsulatedforcepstoavoidcollateraldamage陶瓷绝缘电凝镊可有效避免毗邻组织损伤Finetipsforprecisecoagulation精细镊尖可实现精准电凝Non-insulatedtipforcoagulationinthedepth非绝缘镊尖可进行深度电凝,StandardForceps,BiProtect,37,BiProtectForcepsAntiCollateralDamage,38,ForallAAGstandardforceps:AvoidconfusionSinglecableontrayAlwaysrightcableavailableLessfrustration,UniversalCables(3in1connector),Bildaktualiseiren,CableOverview,B.BraunMelsungenAG|Page,39,40,Agenda,InstrumentoverviewMINSetEC/ICBypassInstrumentsInstrumentsforSkullBaseSurgeryKAIRisonBipolaroverviewBipolar&Non-StickBipolar-Competition,AllForceps,NewestadditionsstrengthenourBipolararmamentarium最新的电凝镊强化了我们的双极地位ElevatesourpositionofbeingablemeetalltheBipolarneedsofaHospital使我们能够满足医院对于双极的所有需求Opportunitytosellnewpatternsoffersabilitytoincreasesalesofexistingpatterns销售新产品的同时也可以促进现有产品的销售,USTurnover-Forceps,CompetitionHF-Unit,B.BraunMelsungenAG|Page,42,+verysophisticatedsystemwithmanygimmicks+mono-andbipolar+includesirrigation-noactivepowerreduction-mono-andbipolar-veryexpensive,+mono-andbipolar+worksonlowdose-noactivepowerreduction-mono-andbipolar-veryexpensive,CompetitiveadvatagesofGN160,B.BraunMelsungenAG|Page,43,+especiallydeveloppedtomeetneedsofneurosurgeons专门为神经外科医生所量身设计+activepowerreductionandpreventionofhotspotsforNon-Stickeffect自动衰减功率输出和防止电火花的设计达到不粘效果+easeofuse简便操作+price性价比高,MarketFeedbackGN160,B.BraunMelsungenAG|Page,44,Coagulationwiththenewgeneratorworkswell.Thesimplehandlingofthegeneratorisverypositive!”“UsingGN160incombinationwithstandardforcepshighlyimprovesthe“non-sticking”effectandincreasesqualityofthecoagulation.“Othergeneratorsalwayshavethesamepower.ThisiswhyittakessometimeforfamiliarizationworkingwithGN160.Nevertheless,Ipreferthisgenerator10timestot