Te hītori tono me te tūranga o ngā karuārai pokanga i roto i te pokanga roro

 

I roto i te hītori o te pokanga roro, ko te whakamahinga ongā karuārai pokangahe tohu hou, e ahu whakamua ana mai i te wā pokanga roro tuku iho o te mahi pokanga i raro i te kanohi tahanga ki te wā pokanga roro hou o te mahi pokanga i raro i tekaruāraiNā wai, ā, nōnahea hokingā karuārai mahitīmata te whakamahi i roto i te pokanga roro? He aha te tūranga kuakaruārai pokangai whai wāhi ki te whanaketanga o te pokanga roro? Mā te whanaketanga o te pūtaiao me te hangarau, kaKaruārai mahime whakakapi ki ētahi taputapu matatau ake? He pātai tēnei me mōhio ngā taote pokanga roro katoa, me te whakamahi i ngā hangarau me ngā taputapu hou ki te mara o te pokanga roro, hei whakatairanga i te whakapai ake i ngā pūkenga pokanga pokanga roro.

1、Te Hītori o ngā Whakamahinga Maikorokoro i te Marae Hauora

I roto i te ahupūngao, ko ngā karāhe mōhiti he karāhe pūkohu me te hanganga kotahi e whai pānga whakanui ana, ā, he iti noa iho te whakanui, e mōhiotia ana ko ngā karāhe whakanui. I te tau 1590, i tāutahia e ngā tāngata Tatimana e rua ngā pereti karāhe pūkohu ki roto i tētahi oko porotaka angiangi, ā, nā reira i hangaia ai te taputapu whakanui hanganga hiato tuatahi o te ao: tekaruārai. I muri mai, i whakapaitia tonutia te hanganga o te karuārai, ā, i piki haere tonu te whakanui. I taua wā, ko tēnei te mea nui i whakamahia e ngā kaipūtaiaokaruārai hiatoki te tirotiro i ngā hanganga ririki o ngā kararehe me ngā tipu, pērā i te hanganga o ngā pūtau. Mai i waenganui ki te mutunga o te rautau 19, kua āta whakamahia ngā karu whakanui me ngā karu iti i roto i te ao rongoā. I te tīmatanga, i whakamahia e ngā taote pokanga ngā karu whakanui momo karu me te hanganga karu kotahi ka taea te whakanoho ki te piriti o te ihu mō te pokanga. I te tau 1876, i whakahaerehia e te tākuta Tiamana a Saemisch te pokanga "iti" tuatahi o te ao mā te whakamahi i te karu whakanui karu matatini (kāore i te mōhiotia te momo pokanga). I te tau 1893, i hangaia e te kamupene Tiamana a Zeiss tekaruārai kanohi, e whakamahia ana mō te tirotiro whakamātautau i roto i ngā taiwhanga hauora, tae atu ki te tirotiro i ngā whara o te kornea me te ruma o mua i roto i te mara o te ophthalmology. I te tau 1921, i runga i te rangahau taiwhanga mō te hanganga o roto o te taringa kararehe, i whakamahia e te tohunga otolaryngology Huitene a Nylen he pūmaukaruārai pokanga kotahii hangaia, i hangaia hoki e ia anō hei mahi i te pokanga otitis media mau tonu ki te tangata, he pokanga moroiti tūturu tēnei. Kotahi tau i muri mai, i whakaurua e te tākuta pai rawa atu a Nylen, a Hlolmgren, hekaruārai pokanga karu-ruai hangaia e Zeiss i roto i te rūma pokanga.

Te wā tōmuaNgā karu hiko whakahaerehe maha ngā ngoikoretanga, pērā i te kore pumau o te miihini, te kore e taea te neke, te whakamārama i ngā toki rerekē me te whakamahana o te arotahi arotahi, te whaiti o te mara whakanui pokanga, me ētahi atu. Koinei katoa ngā take e whakawhāiti ana i te tono whānui ongā karuārai pokangaI ngā tau toru tekau i muri mai, nā te taunekeneke pai i waenga i ngā taote pokanga mengā kaihanga karu hiko, te mahi angā karuārai pokangai whakapai tonutia, ā,ngā karu tirotiro pokanga karu rua, ngā karu hiko e mau ana i te tuanui, ngā karāhe whakanui, te whakamārama pūtake mārama coaxial, ngā ringa honohono e whakahaeretia ana e te pēhanga wai hiko, te whakahaere i te papa waewae, me ētahi atu mea i whakawhanakehia i ia wā. I te tau 1953, i whakaputa te kamupene Tiamana a Zeiss i tētahi raupapa o ngā mea motuhakengā karuārai pokanga mō te otology, he tino pai mō ngā pokanga i ngā whara hohonu pērā i te taringa waenga me te wheua temporal. Ahakoa te mahi angā karuārai pokangakei te whakapai tonu, kei te huri tonu hoki te hinengaro o ngā taote pokanga. Hei tauira, i whakatauhia e ngā tākuta Tiamana a Zollner rāua ko Wullsteinngā karuārai pokangame whakamahi mō te pokanga hanga kiriuhi tympanic. Mai i te tekau tau atu i 1950, kua āta whakarerekētia e ngā tākuta kanohi te mahi o te whakamahi i ngā karuārai anake mō ngā whakamātautau kanohi, ā, kua whakauruhia maingā karuārai mateki te pokanga kanohi. Mai i taua wā,Karuārai mahiKua whakamahia whānuitia i roto i ngā mara o te otology me te ophthalmology.

2、Te whakamahinga o te karuārai pokanga i roto i te pokanga roro

Nā te āhuatanga motuhake o te pokanga roro, ko te whakamahinga ongā karuārai pokanga i roto i te pokanga rorohe paku muri ake i te otology me te ophthalmology, ā, kei te kaha te ako a ngā taote pokanga roro i tēnei hangarau hou. I taua wā, ko tete whakamahinga o ngā karuārai pokangai Ūropi te nuinga. Nā te tākuta kanohi o Amerika, a Perrit, i whakauru tuatahingā karuārai pokangamai i Ūropi ki te Hononga o Amerika i te tau 1946, i whakatakoto i te turanga mō ngā taote pokanga roro o Amerika ki te whakamahiNgā karu hiko whakahaere.

Mai i te tirohanga o te whakaute i te uara o te ora tangata, ko ngā hangarau hou, ngā taputapu hou, ngā taputapu rānei e whakamahia ana mō te tinana tangata me whai whakamātautau tuatahi ki ngā kararehe me te whakangungu hangarau mō ngā kaiwhakahaere. I te tau 1955, i whakahaerehia e te taote pokanga roro o Amerika a Malis te pokanga roro ki ngā kararehe mā te whakamahi i tētahikaruārai pokanga karu-ruaI pau i a Kurze, he taote pokanga roro i te Whare Wānanga o Southern California i te Hononga o Amerika, te tau kotahi ki te ako i ngā tikanga pokanga o te whakamahi i te karuārai i roto i te taiwhanga whai muri i tana tirotiro i te pokanga taringa i raro i te karuārai. I te marama o Ākuhata 1957, i angitu tana mahi i te pokanga neuroma acoustic i runga i tētahi tamaiti 5-tau te pakeke mā te whakamahi i tētahikaruārai taringa, koinei te pokanga moroiti tuatahi o te ao. I muri tata mai, ka angitu a Kurze ki te whakahaere i te anastomosis o te io kanohi ki te tamaiti mā te whakamahi i tekaruārai pokanga, ā, he tino pai te whakaoranga o te tamaiti. Koinei te tuarua o ngā pokanga moroiti i te ao. I muri mai, ka whakamahia e Kurze ngā taraka hei kaweNgā karu hiko whakahaereki ngā wāhi rerekē mō te pokanga roro moroiti, ā, i tino taunaki kia whakamahiangā karuārai pokangaki ētahi atu taote pokanga roro. I muri mai, ka mahi a Kurze i te pokanga tapahi aneurysm roro mā te whakamahi i tekaruārai pokanga(engari, kāore ia i whakaputa tuhinga). Nā te tautoko a tētahi tūroro neuralgia trigeminal i rongoatia e ia, i whakatūria e ia te taiwhanga pokanga roro turanga angaanga moroiti tuatahi o te ao i te tau 1961. Me maumahara tonu tātou ki te takoha a Kurze ki te pokanga moroiti, me te ako mai i tōna maia ki te whakaae ki ngā hangarau me ngā whakaaro hou. Heoi, tae noa ki te tīmatanga o te tekau tau atu i 1990, kāore ētahi taote pokanga roro i Haina i whakaae.Ngā karuārai roromō te pokanga. Kāore tēnei i raru ki teKaruārai rorotonu, engari he raruraru ki te māramatanga whakaaro o ngā taote pokanga roro.

I te tau 1958, i whakatūria e te taote pokanga roro o Amerika, a Donaghy, te taiwhanga rangahau me te whakangungu moroiti tuatahi o te ao i Burlington, Vermont. I ngā wāhanga tuatahi, i tūpono ia ki te whakapoauau me ngā raruraru pūtea mai i ōna rangatira. I roto i te ao mātauranga, i whakaaro tonu ia ki te tapahi i ngā oko toto cortical hei tango tika i ngā thrombi mai i ngā tūroro he thrombosis roro. Nō reira i mahi tahi ia me te taote pokanga toto a Jacobson ki te rangahau kararehe me te haumanu. I taua wā, i raro i ngā āhuatanga o te kanohi tahanga, ko ngā oko toto iti anake he diameter o te 7-8 mirimita, neke atu rānei, ka taea te tuitui. Hei whakatutuki i te anastomosis pito-ki-te-pito o ngā oko toto pai ake, i ngana tuatahi a Jacobson ki te whakamahi i te karāhe whakanui momo karāhe. I muri tata mai, ka mahara ia ki te whakamahi i tekaruārai pokanga otolaryngologymō te pokanga i a ia e noho ana hei rata noho. Nō reira, me te āwhina a Zeiss i Tiamana, i hangaia e Jacobson he karuārai pokanga kaiwhakahaere-rua (Diploscope) mō te anastomosis vascular, e āhei ai ngā taote pokanga e rua ki te mahi i te pokanga i te wā kotahi. Whai muri i ngā whakamātautau kararehe maha, i whakaputa a Jacobson i tētahi tuhinga mō te anastomosis microsurgical o ngā kurī me ngā uaua kore-carotid (1960), me te reiti patency 100% o te anastomosis vascular. He pepa hauora hou tēnei e pā ana ki te pokanga roro microsurgical me te pokanga vascular. I hoahoahia hoki e Jacobson he maha ngā taputapu microsurgical, pērā i te kutikuti micro, ngā pupuri ngira micro, me ngā kakau taputapu micro. I te tau 1960, i angitu a Donaghy ki te mahi i te thrombectomy tapahi uaua roro i raro i tekaruārai pokangamō tētahi tūroro e pāngia ana e te toto toto roro. I tīmata a Rhoton o te Hononga o Amerika ki te ako i te hanganga o te roro i raro i te karuārai i te tau 1967, hei pionia i tētahi mara hou o te hanganga moroiti me te whai wāhi nui ki te whanaketanga o te pokanga moroiti. Nā ngā painga ongā karuārai pokangame te whakapainga ake o ngā taputapu pokanga moroiti, he nui ake te hunga pokanga e pai ana ki te whakamahingā karuārai pokangamō te pokanga. Ā, he maha ngā tuhinga e pā ana ki ngā tikanga pokanga moroiti i whakaputaina.

3、Te whakamahinga o te karuārai pokanga i roto i te pokanga roro i Haina

I a ia e noho ana hei Hainamana whenua whenua i Hapani, i koha a Ahorangi Du Ziwei i te tuatahi o ngā taonga ā-rohekaruārai rorome ngā mea e pā anangā taputapu pokanga moroitiki te Tari Pokanga Niho o te Hōhipera Hononga o te Kāreti Hauora o Suzhou (ināianei ko te Tari Pokanga Niho o te Hōhipera Tuatahi Hononga o te Whare Wānanga o Suzhou) i te tau 1972. I muri i tana hokinga mai ki Haina, i mahi tuatahi ia i ngā pokanga moroiti pēnei i ngā aneurysms intracranial me ngā meningioma. Whai muri i tana ako mō te wātea ongā karuārai rorome ngā taputapu pokanga moroiti, i toro atu a Ahorangi Zhao Yadu o te Tari Pokanga Niho o te Hōhipera Yiwu o Beijing ki a Ahorangi Du Ziwei o te Kāreti Hauora o Suzhou ki te tirotiro i te whakamahinga ongā karuārai pokangaI toro atu a Ahorangi Shi Yuquan o te Hōhipera Huashan o Shanghai ki te tari o Ahorangi Du Ziwei ki te tirotiro i ngā tikanga pokanga moroiti. Nā reira, i puta he ngaru o te whakaurunga, te ako, me te whakamahinga oNgā karuārai roroi tīmata i roto i ngā pokapū pokanga roro nui o Haina, koinei te tīmatanga o te pokanga roro moroiti o Haina.

4. Ngā Pānga o te Pokanga Iti

Nā te whakamahinga ongā karuārai roro, ko ngā pokanga kāore e taea te mahi ki te kanohi tahanga ka taea te mahi i raro i ngā āhuatanga o te whakanui ake i te 6-10 ngā wā. Hei tauira, ko te mahi pokanga pukupuku pituitary mā roto i te sinus ethmoidal ka taea te tautuhi me te tango haumaru i ngā pukupuku pituitary me te tiaki i te repe pituitary noa; Ko te pokanga kāore e taea te mahi ki te kanohi tahanga ka taea te noho hei pokanga pai ake, pērā i ngā pukupuku roro me ngā pukupuku intramedullary o te taurakira. Ko te reiti mate o te tohunga mātauranga a Wang Zhongcheng he 10.7% mō te pokanga aneurysm roro i mua i te whakamahi i tekaruārai roro. Whai muri i te whakamahinga o te karuārai i te tau 1978, i heke te auau mate ki te 3.2%. Ko te auau mate o te pokanga arteriovenous malformation cerebral me te kore e whakamahi i tekaruārai pokangahe 6.2%, ā, i muri i te tau 1984, me te whakamahi i tengā karuārai roro, kua heke te reiti mate ki te 1.6%. Ko te whakamahinga okaruārai roroka taea te rongoā i ngā pukupuku pituitary mā te huarahi transnasal transsphenoidal iti rawa te whakaekenga, me te kore e hiahiatia he craniotomy, ka whakaiti i te reiti mate pokanga mai i te 4.7% ki te 0.9%. Kāore e taea te whakatutuki i ēnei hua i raro i te pokanga kanohi tuku iho, nō reirangā karuārai pokangahe tohu mō te pokanga roro o ēnei rā, ā, kua waiho hei tētahi o ngā taputapu pokanga tino nui, kāore e taea te whakakapi i roto i te pokanga roro o ēnei rā.