Kev xaiv thiab kev tsim nyog siv Stapler hauv kev ua haujlwm hauv plab hnyuv

Kev xaiv thiab kev tsim nyog siv Stapler hauv kev ua haujlwm hauv plab hnyuv
Chen Lin, Bian Shibo

Nyob rau hauv xyoo tas los no, kev nce qib ntawm cov cuab yeej phais mob tau txhawb nqa kev loj hlob ntawm kev phais niaj hnub no.Hauv kev phais plab hnyuv, qhov tshwm sim thiab nrov ntawm staplers tau tsa lub plab hnyuv anastomosis mus rau theem tshiab.Piv nrog rau kev siv phau ntawv suture, daim ntawv thov ntawm staplers Lub plab zom mov rov tsim kho tuaj yeem txo lub sijhawm ua haujlwm, txo cov ntaub so ntswg puas thiab los ntshav, yog li txo qhov nruab nrab ntev ntawm kev mus pw hauv tsev kho mob "Tam sim no, ntau thiab ntau tus kws phais neeg nyiam xaiv cov tshuab anastomosis hauv kev kho mob ua haujlwm.Txawm li cas los xij, anastomosis hauv kev phais plab zom mov Raws li ib qho ntawm peb yam tseem ceeb cuam tshuam rau plab hnyuv anastomosis, tus kws phais nws tus kheej plays lub luag haujlwm tseem ceeb hauv kev xaiv cov stapler thiab tuav ntawm cov txheej txheem ua haujlwm, thiab kev ua tiav ntawm anastomosis kuj muaj feem xyuam rau nws.Zoo sib xws 2 Kab lus no yuav tham txog kuv tus kheej qhov kev xav ntawm kev xaiv thiab kev siv cov staplers hauv cov txheej txheem phais feem ntau rau kev phais plab thiab plab hnyuv.
1. Kev faib tawm ntawm staplers
Muaj ntau ntau hom staplers, uas tuaj yeem muab faib ua hom xovxwm thiab staple-hom raws li txoj cai ua haujlwm.Raws li cov duab ntawm stapler, nws tuaj yeem muab faib ua ncaj-txiav stapler, ncig-txiav stapler, arc-txiav stapler, khawm-zoo li stapler thiab paperclip-shaped stapler.
2. Kev siv cov staplers hauv laparotomy
(1) Kev xaiv thiab siv cov staplers hauv kev phais plab
1. Proximal gastrectomy: Circular stapler (CDH25) feem ntau yog siv rau esophagogastric anastomosis, thiab linear cutting stapler (TLC10) yog siv rau gastric anastomosis.Cov kev tshawb fawb tau pom tias kev siv 25mm stapler rau txoj hlab pas thiab plab hnyuv anastomosis tuaj yeem txo qhov tshwm sim tom qab phais mob 3 Tab sis qhov no tsis yog qhov tseeb.Tus neeg teb xov tooj yuav tsum txiav txim siab txog hom stapler raws li lub puab kab uas hla ntawm txoj hlab pas.Cov ntaub so ntswg shaping kom txo tau cov ntshav anastomotic Tsis txhob rub lub zog thaum lub stapler tshem tawm, tshwj xeeb tshaj yog thaum qhov kev txiav tsis tiav, nws yuav yooj yim ua rau cov ntaub so ntswg anastomotic avulsion.
Vim qhov tob anatomical txoj hauj lwm ntawm txoj hlab pas, qhov intraoperative visual field yog pluag, lub anastomosis yog nyuaj, qhov kawg ntawm txoj hlab pas yog ib qho yooj yim los rhuav tshem, thiab qhov tshwm sim ntawm anastomotic to yog siab.Txawm li cas los xij, qhov no tau muaj teeb meem.Raws li txoj cai, suture reinforcement tuaj yeem ua rau anastomosis ua tiav thiab txo qhov tshwm sim tom qab phais anastomotic to.Yooj yim rau kev tsim anastomotic stenosis Tus sau qhov kev paub yog tias kev xaiv yuav tsum tau ua raws li qhov xwm txheej anastomotic thaum lub sijhawm ua haujlwm.Yog tias qhov pom kev pom meej meej thaum lub sij hawm anastomosis, txoj hlab pas yog dawb, hemostasis tiav, thiab cov nyhuv anastomotic yog qhov txaus siab, tsis tas yuav tsum muaj kev txhawb nqa ntxiv;Yog hais tias anastomotic tsis tiav los yog anastomotic los ntshav tau pom thaum lub sijhawm ua haujlwm, Seromuscular txheej suture tuaj yeem siv los txhawb cov suture.Feem ntau, absorbable suture (hom 3-0 lossis 4-0) raug xaiv.Vim tias qhov tshwm sim ntau ntawm lub cev txawv teb chaws cov tshuaj tiv thaiv kab mob hauv cov kab mob anastomosis, nws yog ib qho yooj yim los tsim ulcer edema thiab los ntshav ntawm anastomosis [4] Cov xov xov, xws li 3-0 los yog 1-gauge hlau yuav siv tau.
Txawm hais tias gastric reflux tshwm sim ib ntus tom qab esophagogastric anastomosis, uas cuam tshuam rau lub neej zoo ntawm cov neeg mob, tab sis feem ntau cov neeg mob tsis muaj cov tsos mob pom tseeb, yog li qhov kev ua haujlwm no tseem siv tau rau hauv kev kho mob [5]
2. Distal gastrectomy: Bi-type gastroduodenal kawg-rau-sab lossis kawg-rau-kawg anastomosis Bi-type II gastrojejunostomy thiab Roux-en-Y gastrojejunostomy yog siv.
Hauv hom Bi I, ncig stapler (CDH25) thiab linear txiav stapler (TLC10) yog siv rau anastomosis.Qee cov kws tshawb fawb qhia txog qhov kawg-rau-kawg anastomosis ntawm gastroduodenum, kom qhov nro ntawm anastomosis me me [6] Yog tias qhov nro ntawm anastomosis dhau lawm, qhov kev pheej hmoo ntawm postoperative anastomotic leakage yuav nce [7] Tus sau ntseeg tias txawm hais tias kev ua haujlwm. ntawm qhov kawg-rau-kawg anastomosis yog qhov nyuaj, tsuav yog tias cov ntshav txaus txaus thiab tsis muaj anastomosis muaj kev ruaj ntseg, qhov tshwm sim ntawm cov teeb meem tom qab ntawm ob txoj kev anastomotic yog tib yam.Tsis muaj qhov sib txawv tseem ceeb.
Hauv hom Bi II, lub voj voog stapler (CDH25) feem ntau yog siv rau anastomosis, thiab linear txiav stapler kuj siv tau.Tus kws sau ntawv tau siv los siv tom kawg los ua kom tiav qhov gastrojejunum anastomosis.Lub endoscopic linear txiav stapler (6TB45) tuaj yeem siv los txiav cov duodenum.Lub stapler muaj tag nrho ntawm 6 kab ntawm staples, thiab suture hemostasis muaj nuj nqi zoo, thiab nws tsis yooj yim los tsim duodenal stump fistula thiab los ntshav tom qab ua haujlwm.Yog hais tias lub duodenal stump yog edematous, phau ntawv suture yuav siv tau, thiab ces 6TB45 yuav siv tau los ua kom tiav gastrojejunal sab Rau lateral anastomosis, yuav tsum tau them nyiaj mloog mus rau lub mesenteric ciam teb ntawm lub jejunum thiab lub plab phab ntsa ntawm lub plab seem.Tsis txhob nqa cov ntaub so ntswg mesenteric rau hauv anastomosis.Rau cov teeb meem tom qab hom II anastomosis, sab-rau-sab jejunum anastomosis (Braun anastomosis) tuaj yeem muab ntxiv rau ntawm no.Tom qab hom III anastomosis, alkaline reflux gastritis thiab anastomotic stomatitis feem ntau tshwm sim, yog li tus kws sau ntawv siv Bi-I lossis Roux-en-Y anastomosis.
Gastrojejunum Roux-en-Y anastomosis tuaj yeem siv ob lub voj voog staplers (CDH25) los ua kom tiav cov anastomosis ntawm jejunum thiab gastrojejunum, los yog siv cov kab txiav stapler los ua ib sab-rau-sab anastomosis ntawm lub distal jejunum thiab lub plab seem ntawm lub plab. pem hauv ntej ntawm txoj hnyuv.Nco ntsoov tias cov kev taw qhia ntawm lub distal jejunum stump yog upward, thiab cov kev taw qhia ntawm lub proximal jejunum stump yuav tsum tau upward thaum lub sij hawm sab-rau-sab anastomosis ntawm jejunum.Cov kua muag mesenteric ntawm qhov kawg ntawm jejunum tuaj yeem raug kaw nrog 3-0 silk suture.
3. Tag nrho gastrectomy: Esophagojejunostomy, jejunum hloov lub plab, txoj hnyuv hloov plab thiab esophagojejunum Roux-en-Y?Kev mob hnyav, kev ua neej tsis zoo ntawm cov neeg mob Kev hloov pauv plab tuaj yeem txhim kho lub neej zoo ntawm cov neeg mob, tab sis kev phais mob yog txoj hauv kev Esophagus-jejunum Roux-en-Y anastomosis yog qhov nyuaj thiab tuaj yeem txhim kho cov tsos mob reflux xaiv txoj kev tsim kho tsim nyog, Tus sau pom zoo Roux-en-Y anastomosis ntawm txoj hlab pas thiab jejunum.Lub voj voj voog stapler (CDH25) tuaj yeem siv los ua kom tiav qhov kawg-rau-sab anastomosis ntawm anterior esophagus thiab jejunum, thiab cov kab txiav stapler (xws li 6TB45) tuaj yeem siv los ua kom tiav rau sab-rau-sab anastomosis ntawm proximal. thiab distal jejunum.Lub jejunum stump raug kaw nrog 6TB45.
Daim ntawv thov ntawm cov staplers ncig hauv gastrojejunostomy thiab esophagojejunostomy tau txais dav, thiab cov kws phais feem ntau nyiam siv cov staplers ncig hauv kev phais qhib [8-9] Inaba li al.!Nws tau tshaj tawm tias cov nyhuv ntawm gastrojejunal anastomosis siv linear stapler nyob rau hauv laparoscopy yog qhov zoo.Tus kws sau ntawv nyiam cov kab stapler lossis txawm tias stapler nyob rau hauv kev phais laparoscopic rau lub plab zom mov rov tsim kho hauv laparotomy.
vim:
(1) Cov cuab yeej no yooj yim thiab yooj yim rau kev khiav lag luam, zam kev ua haujlwm tsis yooj yim xws li kev ntxig ntawm lub hnab ntim cov hlua suture anvil thiab lub voj voog stapler dhau los ntawm txoj hnyuv;
(2) Lub anastomosis tsis txwv los ntawm lub lumen txoj kab uas hla;
(3) Muaj cov ntshav tsawg dua thaum lub sij hawm anastomosis, thiab nws tsis yooj yim ua rau cov ntaub so ntswg puas los yog tsis tiav anastomosis thaum lub sij hawm anastomosis;
(4) Txo lub sijhawm ua haujlwm:
(5) Piv nrog rau lub voj voog stapler, lub linear stapler tsuas yog yuav tsum tau hloov cov staple cartridge thaum nws siv ntau zaus thaum lub sijhawm ua haujlwm, uas txo cov nqi khiav lag luam.Piv nrog rau lub voj voog stapler, seb nws puas tuaj yeem txo qhov tshwm sim ntawm cov teeb meem tom qab phais, Kev soj ntsuam ntxiv tseem tsis tau ua tiav.
(2) Kev xaiv thiab siv cov staplers hauv kev phais mob plab
1. End-to-side anastomosis ntawm ileocolon tom qab txoj cai hemicolectomy: lub voj voog stapler (CDH29 lossis 33) tuaj yeem siv los ua kom tiav qhov kawg-rau-sab anastomosis ntawm ileocolon, thiab txoj kab ncaj nraim kaw (TL60 lossis TLC75) tuaj yeem kuj tseem siv tau los kaw lub stump ntawm txoj hnyuv loj.(TLC75) Side-to-side anastomosis ntawm transverse nyuv ntawm lub ileum Nyob rau hauv qhov kawg-rau-sab anastomosis ntawm lub transverse nyuv los yog sab laug hemicolectomy nyuv, ib ncig stapler (CDH29 los yog 33) yuav tsum muab tso rau hauv lub proximal plab hnyuv lumen.
2. End-to-end anastomosis ntawm colorectum (qhov quav kwj dej) tom qab sigmoid los yog rectal resection: ob chav anastomosis txheej txheem yog feem ntau siv txoj kev nyob rau hauv ob qho tib si laparotomy thiab laparoscopic reconstruction ntawm digestive ib ntsuj av [11] ntawm no mas yog qhia ob chav anastomosis Transanal mus kom ze rau. digestive ib ntsuj av reconstruction.
Cov kwj dej ntawm txoj hnyuv tau muab tso rau hauv ib lub voj voog stapler, thiab qhov kev txiav ua ntej ntawm cov qog raug kaw nrog ib qho ncaj los yog arc-shaped txiav stapler.Lub hauv ntej kawg ntawm lub stapler yuav tsum tau coated nrog iodine tov ua ntej xa mus rau hauv lub qhov quav kwj dej rau lubrication thiab tshuaj tua kab mob.Lub cev ntawm lub cuab yeej yuav tsum tau maj mam nce mus rau hauv qhov quav qhov quav kom txog thaum lub hauv ntej kawg ntawm lub cuab yeej maj mam kov lub puab sab ntawm lub qhov quav.
Faj seeb: (1) Thaum lub sij hawm nruj ntawm stapler, tiv thaiv cov hnyuv ze ntawm qhov sib tw, txwv tsis pub cov hlab ntsha mesangial yuav raug compressed:
(2) Lub mesentery ntawm ob qhov kawg ntawm anastomosis yuav tsum tsis pub ntev dhau los ua kom cov ntshav txaus rau cov hnyuv;
(3) Cov ntaub so ntswg adipose ntawm ob qho kawg ntawm lub plab hnyuv ntawm lub plab yuav tsum tau muab tshem tawm kom tsis txhob ua tiav anastomosis tshwm sim los ntawm cov ntaub so ntswg ntau dhau thaum lub sij hawm anastomosis, tab sis nws yog qhov zoo tshaj kom tsis txhob siab tshaj 2cm, txwv tsis pub nws yuav cuam tshuam rau cov ntaub so ntswg adipose. ntshav txaus ntawm txoj hnyuv hauv plab ntawm anastomosis;
(4) Thaum lub sij hawm anastomosis, nws yog ib qho tsim nyog los tiv thaiv lwm cov ntaub so ntswg tsis cuam tshuam los ntawm kev kos rau hauv stapler, tshwj xeeb tshaj yog cov phab ntsa ntawm qhov chaw mos ntawm cov poj niam cov neeg mob.Txoj hauj lwm ntawm phab ntsa ntawm qhov chaw mos tom qab yuav tsum tau lees paub ua ntej lub stapler raug rho tawm haujlwm, thiab kev tshawb nrhiav qhov chaw mos tuaj yeem ua tiav tom qab anastomosis tiav;
(5) Tom qab anastomosis tiav lawm, nws yog qhov zoo tshaj plaws los xyuas seb qhov anastomosis puas ua tiav los ntawm "inflating test" lossis txhaj tshuaj methylene xiav los ntawm lub qhov quav, thiab xyuas cov anastomosis los ntawm kev kuaj digital tom qab ua haujlwm.
Thaum lub sij hawm anastomosis, qhov sib tshooj ntawm cov voj voog thiab cov kab hauv kab stapler anastomotic yuav tsum tau zam, txwv tsis pub cov ntshav ntawm anastomosis yuav tsis zoo, thiab anastomotic to yuav yooj yim tshwm sim tom qab ua haujlwm.Thaum siv cov riam hluav taws xob ntau zaus, kom tsis txhob muaj kev puas tsuaj rau lub qhov quav thiab qhov chaw mos phab ntsa.Txawm hais tias nws tau siv dav, tseem muaj qee qhov tsis xws luag.Piv txwv li, txoj kab staple ntawm lub voj voog stapler thiab cov kab tawm stapler yog ib qho yooj yim los sib tshooj thaum ua haujlwm[12].Nws yog ntau daim ntawv thov ntawm txoj kab txiav kaw thaum lub sijhawm ua haujlwm, uas yuav ua rau kev sib tshooj ntawm txoj kab anastomotic thiab ua rau muaj kev pheej hmoo ntawm anastomotic to[13].Ob lub stump thiab lub qhov quav qhov quav tau sutured los ntawm cov hlua hnab nyiaj, uas tuaj yeem zam qhov tsis zoo ntawm ob txoj kev anastomosis.
3. Resection thiab colorectal (qhov quav) qhov kawg-rau-sab anastomosis: Lub cev stapler tuaj yeem ua tiav los ntawm lub plab lossis qhov quav.Qhov tseem ceeb ntawm kev siv lub voj voog stapler (CDH33 lossis 29) thiab linear stapler Nws tsim "J" zoo li lub voj voog ntawm txoj hnyuv, uas ua rau kom cov quav cia ntawm qhov quav thiab txo qhov kev pheej hmoo ntawm postoperative anastomotic to.Brisinda et al.[16] pom tias qhov kawg-rau-sab anastomosis muaj kev nyab xeeb thiab ua tau.Qhov tshwm sim ntawm anastomotic leakage yog qis dua, tab sis tus qauv loj ntawm qhov kev sim no tsawg dhau, thiab cov kev sim tshuaj loj loj tseem xav tau los kuaj xyuas.
Colonic pouch-rectal (anal canal) anastomosis kuj tseem siv tau, siv ib txoj kab txiav stapler los ua 6-7cm J-fold ntawm cov nyuv dawb kawg thiab muab ib lub voj voog stapler (CDH29 lossis 33) nyob rau sab saum toj los thauj cov ntsia hlau Ib qho kev ntsuam xyuas meta pom tau tias, piv nrog rau qhov kawg-rau-sab anastomosis, tsis muaj qhov sib txawv tseem ceeb hauv kev ua haujlwm tom qab muaj teeb meem, kev tuag, thiab kev ua haujlwm defecation ntawm lub hnab colonic [15], tab sis kev ua haujlwm ntawm lub hnab colonic yog qhov nyuaj thiab kim heev Nws yog nyob ntawm tus kws phais kom txiav txim siab seb yuav xaiv txoj kev twg.
Nyob rau hauv xyoo tas los no, nkhaus txiav staplers tau maj mam nrov hauv kev kho mob.Qee cov kws tshawb fawb ntseeg tias nyob rau hauv qhov kev txiav txim siab ntawm cov qog nqaij hlav qis qis, cov staplers nkhaus yooj yim nkag mus rau hauv lub plab kab noj hniav dua li cov kab staplers, thiab cov nyhuv anastomotic zoo dua [16].Txhua hom stapler muaj nws tus yam ntxwv thiab kev qhia.Rau cov neeg mob uas muaj pelvic stenosis thiab qog nqaij hlav nyob rau hauv ib qho chaw qis thiab nws lub plab hnyuv tsis tuaj yeem txiav txaus nrog cov kab stapler, ib qho arc-txiav stapler yuav raug txiav txim siab.Txawm tias koj xaiv stapler twg, koj yuav tsum tau ua raws li lub hauv paus ntsiab lus ntawm TME, lub cev nqaij daim tawv yuav tsum meej meej thaum lub sijhawm ua haujlwm, thiab kev pom zoo ntawm kev phais yuav tsum tau ua kom ntseeg tau.
3. Kev siv cov staplers hauv laparoscopic thiab da Vinci neeg hlau phais
1. Kev phais plab hnyuv ntawm laparoscopic gastrointestinal phais: muab faib ua tiav laparoscopic digestive tract reconstruction, me me incision assisted digestive tract reconstruction thiab tes-pab laparoscopic digestive tract reconstruction.Ua tiav laparoscopic kev ua haujlwm siv ntau yam kab txiav staplers thiab staplers Los yog ncig stapler ua tiav laparoscopic anastomosis nrog kev phais me me thiab qhov pom tseeb ntawm qhov tsis pom kev rau cov neeg mob rov qab sai, tab sis vim qhov chaw ua haujlwm nqaim, kev ua haujlwm siab rau tus kws phais, tus nqi phais siab, thiab tam sim no tsis muaj tus qauv kev phais kom tau txais Lub chaw kho mob pom zoo me me incision-pab kev ua haujlwm yog rub cov ntaub so ntswg kom anastomotic tawm ntawm lub plab kab noj hniav, ua kom tiav cov kev tsim kho hauv vitro lossis ntxig ib lub stapler nyob rau hauv kev pab ntawm ib qho me me incision rau anastomosis. .Txoj kev ua haujlwm zoo ib yam li laparotomy.Tam sim no, tes-pab laparoscopy yog siv dav.Kev kho lub plab zom mov yog txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau anastomosis.Txawm li cas los xij, txhais tes nyob rau hauv lub plab kab noj hniav feem ntau cuam tshuam rau qhov kev pom ntawm lub laparoscopic kev ua haujlwm, thiab cov nyhuv anastomotic tsis zoo, yog li nws tsis tshua siv.
2. Digestive canal reconstruction in da Vinci robotic gastrointestinal phais: tib yam li ib txwm laparoscopic phais rau alimentary kwj dej reconstruction, nws yuav muab faib ua me me incision pab thiab tag nrho laparoscopic anastomosis.
4. Kev ceev faj rau kev siv cov stapler tsim nyog:
Txawm hais tias tus stapler tau coj ntau yam yooj yim rau cov kws kho mob, tseem muaj cov teeb meem loj tom qab ua haujlwm uas cuam tshuam rau kev ua haujlwm ntawm lub plab zom mov [17] Anastomotic to, anastomotic stenosis thiab anastomotic los ntshav yog qhov tshwm sim tom qab phais mob txhawm rau txo qhov tshwm sim ntawm cov teeb meem. , tus sau ntseeg tias cov ntsiab lus hauv qab no yuav tsum tau them rau:
(1) Tus neeg teb xov tooj yuav tsum paub txog txoj hauv kev ua haujlwm thiab siv txoj hauv kev ntawm stapler, thiab ua raws li cov kauj ruam ua haujlwm ib txwm muaj;
(2) Thaum lub sijhawm ua haujlwm, nws yuav tsum ua tib zoo xyuas seb qhov anastomotic anastomosis puas tiav, seb lub nplhaib puas tiav, thiab seb puas muaj cov ntshav me me ntawm qhov chaw anastomotic.Thaum pom tias tsis tiav anastomosis, nws yuav tsum tau kho los ntawm phau ntawv suture tam sim ntawd los yog thawj anastomotic plab hnyuv ntu yuav tsum tau excised rau lwm reconstruction ntawm lub plab zom mov.Lub sijhawm no, tsis txhob muab sijhawm.Thaum ua phau ntawv anastomosis, tus sau feem ntau siv ob txheej txheej interrupted suture.Txawm hais tias lub sijhawm ua haujlwm ntawm ib txheej txheej suture yog qhov yooj yim thiab lub sijhawm ua haujlwm luv luv Lub zog siab, tsis yooj yim rau kev tsim cov anastomotic leakage Nruam txoj kev yog ib qho yooj yim los tsim anastomotic stenosis tom qab tas li suture, yog li cuam tshuam suture yog siv;
(3) Qhov tsim nyogstapleryuav tsum tau xaiv raws li qhov loj ntawm lub cev thiab lub physiological mob ntawm tus neeg mob.Ua ntej siv lub stapler, nws yuav tsum tau lees paub tias nws zoo li qub thiab tsis muaj cov staples ploj lawm lossis qhov ploj lawm;
(4) Tus kws phais yuav tsum paub qhov tseem ceeb tshaj plaws ntawm kev ua haujlwm ntawm phau ntawv suturing, vim qee qhov xwm txheej yuav tsis haum rau kev siv tshuab anastomosis;
(5) Xyuas kom meej tias tsis muaj qhov nro ntawm anastomosis thiab cov ntshav tau zoo.Nyob rau tib lub sij hawm, cov hlab ntsha ntawm mesenteric ciam teb ntawm cov hlab ntsha nyob ib ncig ntawm lub anastomosis yuav tsum tau tag nrho ligated, txwv tsis pub tom qab los ntshav yuav yooj yim tshwm sim;
(6) Qhov tsis ua tiav ntawm stapler anastomosis feem ntau tshwm sim hauv anastomosis ntawm txoj hlab pas thiab lub plab lossis cov hnyuv me thiab qhov quav anastomosis qis.Feem ntau ntawm lawv yog vim qhov pom kev tsis zoo thiab qhov chaw ua haujlwm nqaim thaum lub sijhawm ua haujlwm.Yog li ntawd, kev tshem tawm kom pom tseeb, raug tshem tawm thiab hemostasis txaus yuav tsum tau ua thaum lub sijhawm ua haujlwm., lub suture yog ruaj.
Tam sim no, staplers tuaj yeem ua tiav yuav luag tag nrho cov plab hnyuv anastomoses, thiab qhov kev tshuaj ntsuam xyuas qhov tseeb tseem qhia tau hais tias nyob rau hauv lub plab zom mov reconstruction ntawm plab hnyuv, txhua yam anastomosis muaj qhov zoo uas tsis tuaj yeem muab piv nrog phau ntawv suture [18], tab sis txhua yam anastomosis tsuas yog ib qho. gastric anastomosis Ib txoj hauv kev ntawm plab hnyuv anastomosis tsis tuaj yeem hloov pauv phau ntawv suturing.Tsuas yog los ntawm kev ua raws li cov hauv paus ntsiab lus ntawm kev phais thiab kev ua tiav cov txheej txheem ua haujlwm tau zoo tuaj yeem cov kws kho mob tau txais txiaj ntsig zoo ntawm kev phais thiab muaj txiaj ntsig zoo rau cov neeg mob.

Tau qhov twg los: Baidu Library