Ke koho a me ka hoʻohana pono ʻana o Stapler i ka hana ʻana i ka ʻōpū

Ke koho a me ka hoʻohana pono ʻana o Stapler i ka hana ʻana i ka ʻōpū
Chen Lin, Bian Shibo

I nā makahiki i hala iho nei, ua hoʻoikaika nui ka holomua o nā mea hana i ka hoʻomohala ʻana i nā ʻokiʻoki hou.Ma ke kahua o ka gastrointestinal surgery, ka puka ʻana a me ka hoʻolaha ʻana o nā stapler i hāpai i ka anastomosis gastrointestinal i kahi pae hou.Hoʻohālikelike ʻia me ka suture manual maʻamau, ka hoʻohana ʻana i nā staplers ʻO ka hana hou ʻana o ka digestive tract i hana ʻia hiki ke hōʻemi nui i ka manawa hana, e hoʻemi nui i ka pōʻino o ka ʻiʻo a me ke koko, a laila e hōʻemi ana i ka lōʻihi o ka hale maʻi. hana lapaau.Eia naʻe, ʻo ka anastomosis i ka ʻoki ʻana i ka ʻōpū Ma ke ʻano kekahi o nā kumu nui ʻekolu e pili ana i ka anastomosis gastrointestinal, he kuleana koʻikoʻi ke kauā ponoʻī i ke koho ʻana i ka stapler a me ka hopu ʻana i ka ʻenehana hana, a pili pū ka holomua o ka anastomosis.Pili pili 2 E kamaʻilio kēia ʻatikala e pili ana i koʻu mau manaʻo ponoʻī e pili ana i ke koho ʻana a me ka hoʻohana pono ʻana i nā stapler i nā kaʻina hana maʻamau no ka ʻoki ʻana i ka ʻōpū a me ka colorectal.
1. Ka hoʻokaʻawale ʻana o nā stapler
Nui nā ʻano stapler, hiki ke hoʻokaʻawale ʻia i ke ʻano press-fit a me staple-type e like me ke kumu hana.E like me ke ʻano o ka stapler, hiki ke hoʻokaʻawale ʻia i loko o ka stapler ʻoki pololei, ka stapler ʻoki pōʻai, ka stapler arc-cut, ka stapler ʻano pihi a me ka stapler ʻano pepa.
2. ʻO ka hoʻohana ʻana i nā stapler i ka laparotomy
(1) Ke koho ʻana a me ka hoʻohana ʻana i nā stapler i ka ʻoki ʻana
1. Hoʻohana maʻamau ka maʻi maʻi maʻi: Circular stapler (CDH25) no ka anastomosis esophagogastric, a hoʻohana ʻia ka stapler ʻoki laina (TLC10) no ka anastomosis ʻōpū.Ua hōʻike nā haʻawina i ka hoʻohana ʻana i ka stapler 25mm no ka esophagus a me ka anastomosis gastrointestinal hiki ke hōʻemi i ka hiki ʻana o nā pilikia postoperative 3 Akā ʻaʻole kēia.Pono ka mea hana e hoʻoholo i ke ʻano o ka stapler e like me ke anawaena o loko o ka esophagus.ʻO ka hana ʻana o ka ʻiʻo e hōʻemi i ke koko anastomotic Mai huki ikaika i ka wā e haʻalele ai ka stapler, ʻoi aku ka paʻa ʻole o ka ʻoki ʻana, hiki ke maʻalahi ka hoʻoulu ʻana i ka ʻiʻo anastomotic.
Ma muli o ke kūlana anatomical hohonu o ka esophagus, ʻilihune ka mākaʻikaʻi intraoperative, paʻakikī ka anastomosis, maʻalahi ka haʻihaʻi ʻana o ka esophagus, a kiʻekiʻe ka nui o ka leakage anastomotic.Eia naʻe, ua hoʻopaʻapaʻa kēia.ʻO ka manaʻo, hiki i ka hoʻoikaika ʻana i ka suture ke hoʻopau i ka anastomosis a hoʻemi i ka hiki ʻana o ka leakage anastomotic postoperative.Maʻalahi e hana i ka anastomotic stenosis ʻO ka ʻike o ka mea kākau e pono ke koho ʻia e like me ke kūlana anastomotic i ka wā o ka hana.Inā maopopo ke kahua ʻike i ka wā o ka anastomosis, ua manuahi ka esophagus, ua piha ka hemostasis, a ua ʻoluʻolu ka hopena anastomotic, ʻaʻole koi ʻia ka hoʻoikaika ʻana i ka suture;inā loaʻa ka anastomotic incompleteness a i ʻole ka anastomotic bleeding i ka wā o ka hana, hiki ke hoʻohana ʻia ke suture layer Seromuscular e hoʻoikaika i ke kuʻi.ʻO ka mea maʻamau, koho ʻia ka suture hiki ke hoʻopaʻa ʻia (type 3-0 a i ʻole 4-0).Ma muli o ke kiʻekiʻe o ka hopena o ke kino ʻē i ka anastomosis silika, ua maʻalahi ka hana ʻana i ka edema ulcer a me ke koko ma ka anastomosis[4] Hiki ke hoʻohana ʻia ke kaula silika, ʻo 3-0 a i ʻole 1-gauge wire.
ʻOiai e loaʻa ana ka reflux gastric i kēlā me kēia manawa ma hope o ka anastomosis esophagogastric, ka mea e pili ana i ka maikaʻi o ke ola o nā maʻi, akā ʻo ka hapa nui o nā mea maʻi ʻaʻohe mau hōʻailona maopopo, no laila ke hoʻohana pinepine ʻia kēia hana i ka hana lapaʻau[5]
2. Distal gastrectomy: Bi-type gastroduodenal end-to-side or end-to-end anastomosis Bi-type II gastrojejunostomy a me Roux-en-Y gastrojejunostomy ua hoʻohana nui ʻia.
Ma ke ʻano Bi I, hoʻohana ʻia ka stapler circular (CDH25) a me ka stapler ʻoki laina (TLC10) no ka anastomosis.Manaʻo kekahi poʻe loea i ka anastomosis hope-to-end o ka gastroduodenum, i mea liʻiliʻi ke ʻano o ka anastomosis [6] Inā nui ka ʻeha o ka anastomosis E piʻi aʻe ka hopena o ka leakage anastomotic postoperative [7] Manaʻo ka mea kākau ʻoiai ʻo ka hana. paʻakikī o ka anastomosis hope-a-hope, inā lōʻihi ka hoʻolako ʻana i ke koko a me ka anastomosis ʻaʻohe tension-free, ua like ka hopena o nā hoʻopiʻi postoperative o nā ʻano anastomotic ʻelua.ʻAʻohe ʻokoʻa nui.
Ma ke ʻano Bi II, hoʻohana maʻamau ka circular stapler (CDH25) no ka anastomosis, a hiki ke hoʻohana ʻia ka stapler ʻoki laina.Ua maʻa ka mea kākau i ka hoʻohana ʻana i ka hope e hoʻopau i ka gastrojejunum anastomosis.Hiki ke hoʻohana ʻia ka endoscopic linear cutting stapler (6TB45) e ʻoki i ka duodenum.ʻO ka stapler he 6 lālani o nā staples, a maikaʻi ka hana hemostasis suture, a ʻaʻole maʻalahi ka hana ʻana i ka duodenal stump fistula a me ke koko ma hope o ka hana.Inā he edematous ka duodenal stump, hiki ke hoʻohana i ka suture manual, a laila hiki ke hoʻohana ʻia ka 6TB45 e hoʻopau i ka ʻaoʻao gastrojejunal No ka anastomosis lateral, pono e uku ʻia i ka palena mesenteric o ka jejunum a me ka paia o ka ʻōpū o ke koena ʻōpū.Mai lawe i ka ʻiʻo mesenteric i loko o ka anastomosis.No nā pilikia ma hope o ke ʻano II anastomosis, hiki ke hoʻohui ʻia ma kēia kumu.Ma hope o ke ʻano III anastomosis, hiki ke loaʻa pinepine ka alkaline reflux gastritis a me anastomotic stomatitis, no laila hoʻohana ka mea kākau i ka anastomosis Bi-I a i ʻole Roux-en-Y.
Hiki iā Gastrojejunum Roux-en-Y anastomosis ke hoʻohana i ʻelua circular stapler (CDH25) e hoʻopau i ka anastomosis ma waena o ka jejunum a me ka gastrojejunum, a i ʻole e hoʻohana i kahi stapler ʻoki laina e hana i ka anastomosis ʻaoʻao o ka jejunum distal a me ke koena ʻōpū ma o ka mua o ke kiko.E hoʻomanaʻo i ka ʻaoʻao o ka puʻu jejunum distal i luna, a ʻo ka ʻaoʻao o ke kumu jejunum proximal pono e piʻi i luna i ka wā o ka anastomosis ʻaoʻao o ka jejunum.Hiki ke pani 'ia ka haehae mesenteric ma ka hope ha'iha'i o ka jejunum me 3-0 silk suture.
3. Total gastrectomy: Esophagojejunostomy, jejunum pani o ka opu, colon pani o ka opu a me ka esophagojejunum Roux-en-Y?Paʻakikī, maikaʻi ʻole ka maikaʻi o ke ola o ka poʻe maʻi Hiki ke hoʻomaikaʻi maikaʻi i ka maikaʻi o ke ola o nā maʻi, akā paʻakikī ka hana ʻoki ʻana Esophagus-jejunum Roux-en-Y anastomosis a hiki ke hoʻomaikaʻi i nā hōʻailona reflux E koho i kahi ala hana hou. paipai ka mea kākau iā Roux-en-Y anastomosis o ka esophagus a me ka jejunum.Hiki ke hoʻohana ʻia ka circular stapler (CDH25) e hoʻopau i ka anastomosis hope-to-side o ka esophagus mua a me ka jejunum, a hiki ke hoʻohana ʻia ka stapler ʻoki laina (e like me 6TB45) e hoʻopau i ka anastomosis ʻaoʻao o ka proximal. a me ka jejunum mamao.Ua pani ʻia ka stump jejunum me 6TB45.
Ua ʻae ʻia ka hoʻohana ʻana o nā staplers circular i ka gastrojejunostomy a me ka esophagojejunostomy, a ʻo ka hapa nui o nā mea lapaʻau makemake e hoʻohana i nā staplers circular i ka ʻoki ākea [8-9] Inaba et al.!Ua hōʻike ʻia he maikaʻi ka hopena o ka gastrojejunal anastomosis me ka hoʻohana ʻana i ka stapler linear ma lalo o ka laparoscopy.Makemake ka mea kākau i ka stapler linear a i ʻole stapler ma lalo o ke ʻoki laparoscopic no ke kūkulu hou ʻana i ka ʻāpana digestive ma ka laparotomy.
no ka mea:
(1) He maʻalahi kēia ʻano mea hana a maʻalahi hoʻi e hana, e pale ana i nā ʻanuʻu hana paʻakikī e like me ka hoʻokomo ʻana i ka anvil suture string purse a me ka stapler circular e hele ana i loko o ka lua o ka ʻōpū;
(2) ʻAʻole i kaupalena ʻia ka anastomosis e ke anawaena lumen;
(3) He emi ke koko i ka wā o ka anastomosis, a ʻaʻole maʻalahi ke hoʻopōʻino i ka waimaka a i ʻole ka anastomosis piha ʻole i ka wā o ka anastomosis;
(4) Hoʻopōkole i ka manawa hana:
(5) Ke hoʻohālikelike ʻia me ka circular stapler, pono ka linear stapler e hoʻololi i ka pahu staple ke hoʻohana pinepine ʻia i ka wā o ka hana, e hōʻemi ana i ke kumukūʻai hana.Ke hoʻohālikelike ʻia me ka circular stapler, inā hiki iā ia ke hōʻemi i ka nui o nā hoʻopiʻi postoperative, ʻaʻole e hana ʻia ka hōʻoia hōʻoia hou.
(2) Ke koho ʻana a me ka hoʻohana ʻana i nā stapler i ka ʻoki ʻana i ka colorectal
1. ʻO ka anastomosis hope-a-ʻaoʻao o ka ileocolon ma hope o ka hemicolectomy akau: hiki ke hoʻohana i kahi stapler pōʻai (CDH29 a i ʻole 33) e hoʻopau i ka anastomosis hope-a-ʻaoʻao o ka ileocolon, a hiki ke pani laina pololei (TL60 a i ʻole TLC75). e hoʻohana pū ʻia e pani i ke kumu o ke kolona transverse.(TLC75) ʻO ka ʻaoʻao ʻaoʻao anastomosis o ka ʻaoʻao ʻaoʻao o ka ʻaoʻao ʻaoʻao o ka ʻaoʻao ʻaoʻao o ka ʻaoʻao ʻaoʻao ma waena o ka ʻaoʻao ʻaoʻao a i ʻole ka ʻaoʻao hemicolectomy colon, pono e hoʻokomo ʻia kahi stapler circular (CDH29 a i ʻole 33) i loko o ka lumen intestinal proximal.
2. ʻO ka anastomosis hope-a-hope o ka colorectum (kanal anal) ma hope o ka sigmoid a i ʻole ka rectal resection: ʻo ka ʻenehana anastomosis pālua ke ʻano maʻamau i hoʻohana ʻia i ka laparotomy a me ka hana hou ʻana o ka laparoscopic o ka ʻāpana digestive [11] ma ʻaneʻi ka hoʻolauna ʻana i ka anastomosis ʻelua Transanal approach no hana hou ʻana o ka digestive tract.
Hoʻokomo ʻia ke kahawai ʻōpū kokoke i loko o kahi anvil circular stapler, a ua pani ʻia ka ʻoki ʻoki mua ʻana o ka ʻōpū me kahi stapler ʻoki pololei a i ʻole arc.Pono e uhi ʻia ka ʻaoʻao mua o ka stapler me ka solution iodine ma mua o ka hoʻouna ʻia ʻana i loko o ke kahawai anal no ka lubrication a me ka disinfection.Pono e neʻe mālie ke kino o ka hāmeʻa ma ke kahawai anal a hiki i ka ʻaoʻao mua o ka hāmeʻa e hoʻopā mālie i ka ʻaoʻao o loko o ke kumu rectal.
'Ōlelo Aʻo: (1) I ka wā e hoʻopaʻa ʻia ai ka stapler, e pale i ka ʻōpū kokoke mai ka wili ʻana, a i ʻole e hoʻopili ʻia nā moku mesangial:
(2) ʻAʻole pono e manuahi ka mesentery ma nā ʻaoʻao ʻelua o ka anastomosis i mea e lawa ai ke koko i ka ʻōpū;
(3) Pono e wehe ʻia ka ʻiʻo adipose ma nā ʻaoʻao ʻelua o ka ʻōpū ʻōpū ma ka anastomosis i mea e pale ai i ka anastomosis piha ʻole i hoʻokumu ʻia e ka nui o nā kiko i hoʻokomo ʻia i ka wā o ka anastomosis, akā ʻoi aku ka maikaʻi ʻaʻole e ʻoi aku ma mua o ka laulā o 2cm, i ʻole e hoʻopilikia i ka hāʻawi koko o ka ʻōpū ʻōpū ma ka anastomosis;
(4) I ka wā anastomosis, pono ia e pale i nā ʻiʻo pili ʻole ʻē aʻe mai ka hoʻokomo ʻia ʻana i loko o ka stapler, ʻoi aku ka nui o ka pā hope o nā wahine maʻi.Pono e hoʻopaʻa ʻia ke kūlana o ka pā ma hope ma mua o ka puhi ʻana o ka stapler, a hiki ke hana ʻia ka ʻimi ʻana ma hope o ka pau ʻana o ka anastomosis;
(5) Ma hope o ka pau ʻana o ka anastomosis, ʻoi aku ka maikaʻi o ka nānā ʻana i ka pau ʻana o ka anastomosis ma ka "inflating test" a i ʻole injecting methylene blue solution ma o ka anus, a nānā i ka anastomosis ma ka hoʻokolokolo kikohoʻe ma hope o ka hana.
I ka wā anastomosis, pono e pale ʻia ka hoʻopili ʻana o nā laina anastomotic circular a me linear stapler anastomotic, i ʻole e ʻilihune ka hāʻawi ʻana o ke koko ma ka anastomosis, a e maʻalahi ka leakage anastomotic ma hope o ka hana.I ka hoʻohana ʻana i ka pahi uila kiʻekiʻe, e pale i ka hōʻino ʻana i ka rectum a me ka pā vaginal.ʻOiai ua hoʻohana nui ʻia, aia nō kekahi mau hemahema.No ka laʻana, ʻo ka laina koʻikoʻi o ka circular stapler a me ka linear stapler he maʻalahi ke overlap i ka wā o ka hana[12].ʻO ia ka hoʻohana nui ʻana o ka pani ʻana o ka ʻoki laina i ka wā o ka hana, e hoʻopiʻi ai i ka laina anastomotic a hoʻonui i ka hopena o ka leakage anastomotic [13].Hoʻopili ʻia ka ʻōpala a me ka rectum distal e nā kaula ʻeke, hiki ke pale i nā hemahema o ka ʻenehana anastomosis pālua.
3. ʻO ka ʻoki ʻana a me ka anastomosis hope-a-ʻaoʻao colorectal (anal canal): Hiki ke hoʻopau ʻia ke kino stapler ma o ke ʻano o ka ʻōpū a i ʻole ka anal.ʻO ke koʻikoʻi o ka hoʻohana ʻana i ka stapler circular (CDH33 a i ʻole 29) a me ka linear stapler Hoʻokumu ia i kahi loop "J"-shaped o ke kolonā, kahi e hoʻonui ai i ka hiki ke mālama feces o ka rectum a hoʻemi i ka hopena o ka leakage anastomotic postoperative.ʻO Brisinda et al.Ua ʻike ʻo [16] he palekana a hiki ke hoʻokō ʻia ka anastomosis hope-a-ʻaoʻao.ʻOi aku ka liʻiliʻi o ka leakage anastomotic, akā ʻoi aku ka liʻiliʻi o ka nui o kēia hoʻāʻo, a pono mau nā hoʻokolohua lapaʻau nui no ka hōʻoia.
Hiki ke hoʻohana ʻia ka colonic pouch-rectal (anal canal) anastomosis, me ka hoʻohana ʻana i kahi stapler ʻoki laina e hana i kahi 6-7cm J-fold ma ka hope o ke kolonā manuahi a kau i kahi stapler circular (CDH29 a i ʻole 33) ma luna e hele ai i ke kui. Ua hōʻike ʻia kahi meta-analysis, i ka hoʻohālikelike ʻia me ka anastomosis end-to-side, ʻaʻohe ʻokoʻa koʻikoʻi i ka helu ʻana i ka nui o ka hoʻopiʻi postoperative, ka make, a me ka hana defecation ma waena o ka ʻeke colonic [15], akā paʻakikī ka hana o ka ʻeke colonic a paʻakikī. costly Na ke kauka lapaau e koho i ke ala e koho ai.
I nā makahiki i hala iho nei, ua kaulana nā stapler ʻoki curved i ka hana lapaʻau.Manaʻo kekahi poʻe ʻepekema i ka wehe ʻana o ka maʻi kanesa rectal haʻahaʻa, ʻoi aku ka maʻalahi o nā stapler curved e komo i loko o ka lua pelvic ma mua o nā staplers linear, a ʻoi aku ka maikaʻi o ka hopena anastomotic[16].Loaʻa i kēlā me kēia ʻano stapler kona mau hiʻohiʻona a me nā hōʻailona.No nā poʻe maʻi me ka pelvic stenosis a me nā maʻi maʻi i loaʻa i kahi kūlana haʻahaʻa a ʻaʻole hiki ke ʻoki ʻia ka ʻāpana o ka ʻōpū me kahi stapler linear, hiki ke noʻonoʻo ʻia kahi stapler ʻoki arc.ʻAʻohe mea o ka stapler āu e koho ai, pono ʻoe e hahai ʻia ʻO ke kumu o TME, pono e akaka ke anatomy i ka wā o ka hana, a pono e hōʻoia ʻia kahi mākaʻikaʻi maikaʻi.
3. ʻO ka hoʻohana ʻana i nā staplers i ka laparoscopic a me da Vinci robotic surgery
1. ʻO ka hana hou ʻana o ka ʻōpū o ka ʻōpū o ka ʻōpū o ka ʻōpū: hoʻokaʻawale ʻia i ke kūkulu hou ʻana i ka ʻāpana hoʻoheheʻe laparoscopic piha, ka ʻoki liʻiliʻi i kōkua i ka hana hou ʻana i ka digestive tract a me ka lima-kōkua i ka laparoscopic digestive tract reconstruction.Hoʻohana ka hana laparoscopic piha i nā staplers ʻoki laina laina a me nā staplers A i ʻole circular stapler piha laparoscopic anastomosis me ka ʻoki liʻiliʻi liʻiliʻi a me ka ʻike maka no nā poʻe maʻi me ka hoʻōla wikiwiki ʻana, akā ma muli o ka wahi hana haiki, nā koi ʻenehana kiʻekiʻe no ke kauka, ke kumu kūʻai kiʻekiʻe. a i kēia manawa ʻaʻohe ʻano hana maʻamau e loaʻa ai ʻO ka hana ʻoki liʻiliʻi i ʻike ʻia i ke kino, ʻo ia ka huki ʻana i ka ʻiʻo i anastomotic mai ka ʻōpū o ka ʻōpū, hoʻopau i ke kūkulu hou ʻana i loko o ka vitro a i ʻole e hoʻokomo i kahi stapler ma lalo o ke kōkua o kahi ʻoki liʻiliʻi no ka anastomosis. .Ua like ke ano o ka hana me ka laparotomy.I kēia manawa, hoʻohana nui ʻia ka laparoscopy kōkua lima.ʻO ke kūkulu hou ʻana i ka ʻōpala ʻo ka hoʻopaʻa ʻana i ka lima i loko o ka ʻōpū o ka ʻōpū ma o kahi ʻoki liʻiliʻi ma ka paia o ka ʻōpū e kōkua ai i ka hana anastomosis.Eia naʻe, pili pinepine ka lima i ka ʻōpū o ka ʻōpū i ke kahua o ka ʻike o ka hana laparoscopic, a ʻilihune ka hopena anastomotic, no laila ʻaʻole i hoʻohana ʻia.
2. Digestive canal reconstruction in da Vinci robotic gastrointestinal surgery: like me kuʻuna laparoscopic oki no ka alimentary canal reconstruction, hiki ke maheleia i ka liʻiliʻi incision kōkua a piha laparoscopic anastomosis.
4. E mālama pono i ka hoʻohana ʻana i ka stapler:
ʻOiai ua lawe mai ka stapler i nā mea ʻoluʻolu like ʻole i nā kauka, aia nō nā pilikia postoperative koʻikoʻi e hoʻopilikia koʻikoʻi i ka hana maʻamau o ka ʻōpū o ka ʻōpū [17] Anastomotic leakage, anastomotic stenosis a me anastomotic bleeding he mau mea maʻamau Postoperative complications I mea e hōʻemi ai i ka hopena o nā pilikia. , manaʻo ka mea kākau e nānā pono i kēia mau mea:
(1) Pono ka mea hoʻohana e mākaukau i ke kumu hana a me ka hoʻohana ʻana i ke ʻano o ka stapler, a e hahai pono i nā ʻanuʻu hana maʻamau;
(2) I ka wā o ka hana, pono e nānā pono i ka pau ʻana o ka anastomotic anastomosis, inā ua piha ke apo, a inā he koko liʻiliʻi ma ka pae anastomotic.Ke ʻike ʻia kahi anastomosis piha ʻole, pono e hoʻoponopono koke ʻia e ka manual suture a i ʻole e ʻoki ʻia ka ʻāpana ʻōpū anastomotic kumu no ka hana hou ʻana o ka ʻōpala digestive.I kēia manawa, mai lawe i ka manawa.Ke hoʻohana nei ka mea kākau i ka anastomosis manual, hoʻohana maʻamau ka mea kākau i ke ʻano hana suture hoʻopaʻa ʻia ʻelua.ʻOiai he maʻalahi ka manawa hana o ke ʻano suture one-layer a pōkole ka manawa hana ʻO ka ikaika kiʻekiʻe, ʻaʻole maʻalahi e hana i ka leakage anastomotic He maʻalahi ke ʻano o ka suture hoʻomau e hana i ka stenosis anastomotic ma hope o ka suture mau, no laila hoʻohana ʻia ka suture i hoʻopau ʻia;
(3) ʻO ke kūponomea hoʻopaʻa paʻaPono e koho ʻia e like me ka nui o ke kino a me ke kūlana physiological o ka mea maʻi.Ma mua o ka hoʻohana ʻana i ka stapler, pono e hōʻoia i ka paʻa ʻole a ʻaʻohe mea i nalowale a i ʻole nā ​​ʻāpana i nalowale;
(4) Pono ke kahuna lapaʻau e aʻo i ka ʻenehana hana kumu nui o ka humuhumu lima, no ka mea, ʻaʻole kūpono kekahi mau kūlana no ka anastomosis mechanical;
(5) E hōʻoia i ka ʻole o ka haʻalulu i ka anastomosis a maikaʻi ke kahe koko.I ka manawa like, pono e hoʻopili piha ʻia nā kīʻaha koko ma ka palena mesenteric o nā moku a puni ka anastomosis, inā ʻaʻole hiki ke maʻalahi ke koko postoperative;
(6) Loaʻa pinepine ka hemahema o ka anastomosis stapler i ka anastomosis o ka esophagus a me ka ʻōpū a i ʻole ka ʻōpū liʻiliʻi a me ka anastomosis rectal haʻahaʻa.ʻO ka hapa nui o lākou ma muli o ka maikaʻi ʻole o ka ʻike maka a me ka haiki i ka wā hana.No laila, pono e hana ʻia ka ʻoki ʻoki ʻana, ka wehe pono ʻana a me ka hemostasis lawa i ka wā o ka hana., paa ka humuhumu.
I kēia manawa, hiki i nā stapler ke hoʻopau kokoke i nā anastomoses gastrointestinal, a ʻo ka meta-analysis hou e hōʻike ana i ka hana hou ʻana o ka digestive tract o ka ʻokiʻoki ʻana, loaʻa i nā anastomosis mechanical nā mea maikaʻi ʻaʻole hiki ke hoʻohālikelike ʻia me ka suture manual [18], akā ʻo ka anastomosis mechanical wale nō. anastomosis ʻōpū ʻAʻole hiki i kekahi o nā ʻano o ka anastomosis ʻōpū ke hoʻololi loa i ka humuhumu lima.Ma ka hahai wale ʻana i nā loina kumu o ka ʻoki ʻana a me ka hoʻomaʻamaʻa ʻana i nā ʻanuʻu hana maʻamau e hiki ai i nā kauka ke loaʻa nā hopena o ka ʻokiʻoki ʻoluʻolu a pōmaikaʻi i nā maʻi.

Puna: Baidu Library