Nhọrọ na ojiji nke Stapler na-arụ ọrụ nke eriri afọ

Nhọrọ na ojiji nke Stapler na-arụ ọrụ nke eriri afọ
Chen Lin, Bian Shibo

N'afọ ndị na-adịbeghị anya, ọganihu nke ngwá ọrụ ịwa ahụ akwalitela mmepe nke ịwa ahụ nke oge a.N'ihe gbasara ịwa ahụ afọ, mpụta na mgbasa ozi nke stapler emeela ka anastomosis eriri afọ banye ọkwa ọhụrụ.E jiri ya tụnyere suture akwụkwọ ntuziaka ọdịnala, ntinye nke stapler Nrụgharị tract digestive rụrụ nwere ike belata oge ọrụ ahụ nke ukwuu, belata mmebi anụ ahụ na ọbara ọgbụgba, si otú a na-ebelata nkezi ogologo oge ụlọ ọgwụ. ụlọ ọgwụ ọrụ.Otú ọ dị, anastomosis na ịwa ahụ eriri afọ Dị ka otu n'ime isi ihe atọ na-emetụta anastomosis nke eriri afọ, onye dọkịta na-awa ahụ n'onwe ya na-arụ ọrụ dị mkpa n'ịhọrọ stapler na ịghọta usoro ọrụ, na ọganihu nke anastomosis nwekwara njikọ na ya.Mmekọrịta chiri anya 2 Isiokwu a ga-ekwu maka echiche nke m na nhọrọ na iji ezi uche eme ihe nke staplers na usoro ịwa ahụ nkịtị maka ịwa ahụ gastric na colorectal.
1. Nhazi nke staplers
Enwere ọtụtụ ụdị staplers, nke enwere ike kewaa n'ụdị pịa-dabara na ụdị staple dị ka ụkpụrụ ọrụ si dị.Dị ka ọdịdị nke stapler si dị, enwere ike kewaa ya ka ọ bụrụ stapler kwụ ọtọ, nke a na-egbutu okirikiri, stapler arc-cut, stapler nke bọtịnụ na mpempe akwụkwọ.
2. Iji staplers na laparotomy
(1) Nhọrọ na ntinye nke staplers na ịwa ahụ gastric
1. Gastrectomy Proximal: A na-ejikarị stapler okirikiri (CDH25) eme ihe maka anastomosis esophagogastric, na linear cutting stapler (TLC10) na-eji maka anastomosis gastric.Nnyocha e mere egosiwo na iji 25mm stapler maka esophagus na eriri afọ anastomosis nwere ike belata ihe omume nke mgbagwoju anya mgbe ọ gasịrị 3 Ma nke a abụghị ihe zuru oke.Onye na-arụ ọrụ ga-ekpebi ụdị stapler dịka dayameta dị n'ime nke esophagus si dị.Nhazi anụ ahụ iji belata ọbara ọgbụgba anastomotic Adọpụla ike mgbe stapler kwụsịrị, ọkachasị mgbe mbepụ ahụ ezughị oke, ọ nwere ike ibute anụ ahụ anastomotic ngwa ngwa.
N'ihi ọnọdụ omimi dị omimi nke esophagus, ebe a na-ahụ anya nke intraoperative adịghị mma, anastomosis siri ike, njedebe gbajiri agbaji nke esophagus dị mfe ịdọpụ, na mmụba nke anastomotic leakage dị elu.Agbanyeghị, nke a abụla arụmụka.N'ụzọ doro anya, nkwado suture nwere ike ime ka anastomosis zuo oke ma belata ihe omume nke ntapu anastomotic gachara.Ọ dị mfe ịmepụta anastomotic stenosis Ahụmahụ onye edemede bụ na a ga-eme nhọrọ dịka ọnọdụ anastomotic n'oge ọrụ ahụ.Ọ bụrụ na ebe a na-ahụ anya doro anya n'oge anastomosis, esophagus bụ n'efu, hemostasis zuru ezu, na mmetụta anastomotic na-eju afọ, ọ dịghị mkpa ịkwado suture;Ọ bụrụ na achọtaghị anastomotic ezughị ezu ma ọ bụ ọbara ọgbụgba anastomotic n'oge a na-arụ ọrụ, enwere ike iji suture seromuscular Layer mee ka suture sie ike.N'ozuzu, a na-ahọrọ suture nke nwere ike ịmị mkpụrụ (ụdị 3-0 ma ọ bụ 4-0).N'ihi mmụba dị ukwuu nke mmeghachi omume anụ ahụ mba ọzọ na silk anastomosis, ọ dị mfe ịmepụta ọnya edema na ọbara ọgbụgba na anastomosis [4] eriri silk, ma ọ bụ 3-0 ma ọ bụ 1-elele waya nwere ike iji.
Ọ bụ ezie na reflux gastric na-eme site n'oge ruo n'oge mgbe esophagogastric anastomosis gasịrị, nke na-emetụta ndụ ndụ nke ndị ọrịa, ma ọtụtụ ndị ọrịa enweghị ihe mgbaàmà doro anya, ya mere a ka na-ejikarị ọrụ a eme ihe na ụlọ ọgwụ [5].
2. Distal gastrectomy: Bi-ụdị gastroduodenal njedebe na-n'akụkụ ma ọ bụ njedebe-na-ọgwụgwụ anastomosis Bi-ụdị II gastrojejunostomy na Roux-en-Y gastrojejunostomy na-tumadi eji.
Na ụdị Bi I, a na-eji stapler okirikiri (CDH25) na linear cutting stapler (TLC10) eme ihe maka anastomosis.Ụfọdụ ndị ọkà mmụta na-atụ aro anastomosis nke gastroduodenum na njedebe na njedebe, nke mere na esemokwu nke anastomosis dị ntakịrị[6] Ọ bụrụ na esemokwu nke anastomosis dịkwa oke ihe ize ndụ nke nkwụsị nke anastomotic na-esote ga-abawanye [7] Onye edemede ahụ kwenyere na ọ bụ ezie na ọrụ ahụ. nke ọgwụgwụ-na-ọgwụgwụ anastomosis na-agbagwoju anya, ọ bụrụhaala na a na-enweta ọbara zuru oke na anastomosis na-enweghị nchekasị, ihe omume nke mgbagwoju anya nke postoperative nke ụzọ abụọ anastomotic bụ otu.Enweghị nnukwu ọdịiche.
N'ụdị Bi II, a na-ejikarị stapler okirikiri (CDH25) eme ihe maka anastomosis, a pụkwara iji stapler ịkpụ linear.A na-eji onye edemede ahụ eme ihe iji mechaa gastrojejunum anastomosis.Enwere ike iji stapler nke endoscopic linear (6TB45) belata duodenum.The stapler nwere ngụkọta nke ahịrị 6 nke staples, na suture hemostasis ọrụ dị mma, na ọ dịghị mfe ịmepụta duodenal stumps fistula na ọbara ọgbụgba mgbe arụ ọrụ.Ọ bụrụ na mkpịsị ụkwụ duodenal bụ edematous, enwere ike iji suture akwụkwọ ntuziaka mee ihe, mgbe ahụ, enwere ike iji 6TB45 mechie akụkụ gastrojejunal Maka anastomosis n'akụkụ, a ga-akwụ ụgwọ nlebara anya na njedebe mesenteric nke jejunum na mgbidi gastric nke afọ fọdụrụnụ.Ewebatala anụ ahụ mesenteric n'ime anastomosis.Maka nsogbu mgbe ụdị II anastomosis gasịrị, enwere ike ịgbakwunye jejunum anastomosis n'akụkụ n'akụkụ (Braun anastomosis) na ndabere a.Mgbe ụdị III anastomosis gasịrị, alkaline reflux gastritis na anastomotic stomatitis na-adịkarị mfe ime, ya mere onye edemede na-eji Bi-I ma ọ bụ Roux-en-Y anastomosis.
Gastrojejunum Roux-en-Y anastomosis nwere ike iji staplers okirikiri abụọ (CDH25) mezue anastomosis dị n'etiti jejunum na gastrojejunum, ma ọ bụ jiri eriri ịkpụ stapler rụọ ọrụ anastomosis n'akụkụ n'akụkụ nke jejunum distal na afọ fọdụrụ site na n'ihu colon.Rịba ama na ntụzịaka nke ukwu jejunum distal dị elu, na ntụzịaka nke ukwu jejunum dị nso kwesịkwara ịdị elu n'oge anastomosis dị n'akụkụ n'akụkụ nke jejunum.Enwere ike iji suture silk 3-0 mechie anya mmiri mesenteric na njedebe gbajiri agbaji nke jejunum.
3. Mkpokọta gastrectomy: Esophagojejunostomy, jejunum nnọchi nke afọ, ngbanwe nke eriri afọ na esophagojejunum Roux-en-Y?Ọnọdụ ndụ siri ike, adịghị mma nke ndị ọrịa ngbanwe nke afọ nwere ike ime ka ndụ ndị ọrịa dịkwuo mma, mana ịwa ahụ bụ mgbagwoju anya Esophagus-jejunum Roux-en-Y anastomosis siri ike ma nwee ike melite mgbaàmà reflux Iji họrọ usoro nrụgharị kwesịrị ekwesị. odee na-akwado Roux-en-Y anastomosis nke esophagus na jejunum.Enwere ike iji stapler okirikiri (CDH25) mezue anastomosis nke njedebe na akụkụ nke esophagus na jejunum, na linear ịkpụ stapler (dị ka 6TB45) nwere ike iji mezue anastomosis n'akụkụ n'akụkụ nke nso nso. na distal jejunum.Eji 6TB45 mechie stump jejunum.
Ngwa nke staplers okirikiri na gastrojejunostomy na esophagojejunostomy anabatala nke ọma, ọtụtụ ndị dọkịta na-awa na-ahọrọ iji okirikiri staplers na ịwa ahụ mepere emepe [8-9] Inaba et al.!A na-akọ na mmetụta nke gastrojejunal anastomosis na-eji linear stapler n'okpuru laparoscopy dị mma.Onye edemede ahụ na-ahọrọ stapler linear ma ọ bụ ọbụna stapler n'okpuru ịwa ahụ laparoscopic maka nhazigharị tract digestive na laparotomy.
n'ihi na:
(1) Ụdị ngwaọrụ a dị mma ma dị mfe iji rụọ ọrụ, na-ezere usoro ọrụ dị egwu dị ka ntinye nke eriri eriri akpa ego na stapler okirikiri na-agafe oghere eriri afọ;
(2) Anastomosis anaghị ejedebe na dayameta lumen;
(3) Enwere obere ọbara ọgbụgba n'oge anastomosis, ọ dịghịkwa mfe ime ka ọkpụkpụ anụ ahụ mebie ma ọ bụ anastomosis ezughị ezu n'oge anastomosis;
(4) Mbelata oge ọrụ:
(5) N'iji ya tụnyere stapler okirikiri, linear stapler naanị kwesịrị iji dochie staple cartridge mgbe a na-eji ya ọtụtụ ugboro n'oge ọrụ, nke na-ebelata ụgwọ ọrụ.E jiri ya tụnyere stapler okirikiri, ma ọ nwere ike ibelata nsogbu nke mgbagwoju anya mgbe ịwachara ahụ, a ka ga-eme nkwado ọzọ n'ụlọ ọgwụ.
(2) Nhọrọ na ngwa nke staplers na ịwa ahụ colorectal
1. Ọgwụgwụ-na-akụkụ anastomosis nke ileocolon mgbe hemicolectomy ziri ezi: enwere ike iji stapler okirikiri (CDH29 ma ọ bụ 33) mechie anastomosis nke njedebe nke ileocolon, na nkwụsịtụ kwụ ọtọ (TL60 ma ọ bụ TLC75) nwere ike. a ga-ejikwa ya mechie mkpịsị ụkwụ nke eriri afọ transverse.(TLC75) Anastomosis n'akụkụ n'akụkụ nke akụkụ transverse colon nke ileum Na njedebe na-aga n'akụkụ anastomosis n'etiti colon transverse ma ọ bụ hemicolectomy colon nke aka ekpe, a ga-etinye stapler okirikiri (CDH29 ma ọ bụ 33) na lumen eriri afọ dị nso.
2. Ọgwụgwụ-na-ọgwụgwụ anastomosis nke colorectum (anal canal) mgbe sigmoid ma ọ bụ rectal resection: abụọ anastomosis Usoro bụ usoro a na-ejikarị na laparotomy na laparoscopic nwughari nke digestive tract [11] ebe a na-ebutekarị anastomosis okpukpu abụọ Transanal obibia maka. nhazigharị tract digestive.
A na-edobe ọwa eriri afọ dị nso n'okirikiri stapler okirikiri, a na-ejikwa stapler kwụ ọtọ ma ọ bụ nke yiri arc mechie ebe dịpụrụ adịpụ nke etuto ahụ.Ekwesịrị iji ngwọta ayodiin kpuchie n'ihu n'ihu stapler tupu ebuga ya na ọwa mmiri maka mmanu na nsị.Ahụ nke ngwaọrụ ahụ ga-eji nwayọọ nwayọọ na-aga n'ihu na canal canal ruo mgbe akụkụ ihu nke ngwaọrụ ahụ ji nwayọọ metụ akụkụ dị n'ime nke ukwu rectal.
Cheta na: (1) N'oge tightening nke stapler, gbochie eriri afọ proximal ka ọ gbagọọ, ma ọ bụghị ya, a ga-ejikọta arịa mesangial:
(2) Mesentery dị na nsọtụ abụọ nke anastomosis ekwesịghị ịbụ nnwere onwe ogologo oge iji hụ na ọbara zuru oke na eriri afọ;
(3) A ga-ewepụ anụ ahụ adipose na nsọtụ abụọ nke eriri afọ eriri afọ na anastomosis iji gbochie anastomosis na-ezughị ezu nke anụ ahụ dị ukwuu na-etinye n'oge anastomosis, ma ọ kacha mma ka ị ghara ịgafe 2cm, ma ọ bụghị ya, ọ ga-emetụta ya. ọbara nke eriri afọ nke eriri afọ na anastomosis;
(4) N'oge anastomosis, ọ dị mkpa igbochi anụ ahụ ndị ọzọ na-adịghị mkpa ka a na-etinye n'ime stapler, karịsịa n'azụ ikpu mgbidi nke ndị inyom na-arịa ọrịa.Ekwesịrị ịkwado ọnọdụ nke mgbidi ikpu n'azụ tupu agbapụ stapler ahụ, a pụkwara ime nchọpụta nke ime ahụ mgbe emechara anastomosis;
(5) Mgbe emechara anastomosis, ọ kacha mma ịlele ma anastomosis zuru ezu site na "nnwale inflating" ma ọ bụ ịgbanye methylene blue solution site na ike, ma lelee anastomosis site na nyocha dijitalụ mgbe arụchara ọrụ.
N'oge anastomosis, a ga-ezere overlapping nke okirikiri na linear stapler anastomotic ahịrị, ma ọ bụghị ya, ọbara na-enye na anastomosis ga-adị njọ, na anastomotic leakage ga-adị mfe ime mgbe ọrụ.Mgbe ị na-eji mma ọkụ eletrik dị elu, zere mmebi nke ikensi na mgbidi ikpu.Ọ bụ ezie na a na-ejikarị ya eme ihe, a ka nwere ntụpọ ụfọdụ.Dịka ọmụmaatụ, eriri staple nke stapler okirikiri na linear stapler dị mfe ijikọ n'oge ọrụ [12].Ọ bụ otutu ngwa nke mmechi ịkpụ ahịrị ahịrị n'oge a na-arụ ọrụ, nke ga-eme ka nchikota nke ahịrị anastomotic na-abawanye ohere nke ntapu anastomotic[13].E jiri eriri akpa wee suture ma ukwu ukwu na nke dị anya, bụ nke nwere ike zere ọghọm dị na usoro anastomosis okpukpu abụọ.
3. Rectal resection na colorectal (anal canal) ọgwụgwụ-na-akụkụ anastomosis: The stapler ahụ nwere ike mechaa site na abdominal ma ọ bụ gbasara ike ịbịaru nso.Ihe dị mkpa iji stapler okirikiri (CDH33 ma ọ bụ 29) na linear stapler Ọ na-etolite akaghị “J” nke eriri afọ, nke na-abawanye ikike nchekwa nsị nke ikensi ma na-ebelata ohere nke mgbapu anastomotic mgbe arụchara ọrụ gasịrị.Brisinda et al.[16] chọpụtara na anastomosis nke ngwụcha ruo n'akụkụ dị mma yana enwere ike.Mmetụta nke anastomotic leakage dị ala, mana nha nlele nke ule a pere mpe, na nnukwu nnwale ụlọ ọgwụ ka achọrọ maka nkwenye.
A pụkwara iji anastomosis mee ihe na-eme ka ọ bụrụ 6-7cm J-fold na njedebe oghere efu ma tinye stapler okirikiri (CDH29 ma ọ bụ 33) n'elu iji mechie ntu ahụ. Nnyocha meta gosiri na, ma e jiri ya tụnyere anastomosis nke njedebe ruo n'akụkụ, ọ dịghị ihe dị iche iche dị ịrịba ama na ọnụ ọgụgụ mgbagwoju anya mgbe ọ gasịrị, ọnwụ, na ọrụ nsị n'etiti obere akpa colonic [15], mana ọrụ nke obere akpa colon bụ mgbagwoju anya na dị ọnụ ahịa Ọ dịịrị dọkịta na-awa ahụ ikpebi usoro ọ ga-ahọrọ.
N'afọ ndị na-adịbeghị anya, ndị na-akpụ akpụ stapler ejirila nwayọọ nwayọọ na-ewu ewu n'omume ụlọ ọgwụ.Ụfọdụ ndị ọkà mmụta kwenyere na na resection nke obere rectal cancer, curved staplers na-adị mfe ịbanye n'ime pelvic oghere karịa linear staplers, na anastomotic mmetụta ka mma[16].Ụdị stapler ọ bụla nwere njirimara ya na ihe ngosi ya.Maka ndị ọrịa nwere pelvic stenosis na etuto ahụ dị n'ọnọdụ dị ala na nke akụkụ eriri afọ ya enweghị ike ịkpụcha ya nke ọma na stapler linear, a pụrụ ịtụle stapler arc-cuting.N'agbanyeghị ụdị stapler ị na-ahọrọ, ị ga-agbasorịrị ụkpụrụ nke TME, nhazi ahụ kwesịrị ịpụta n'oge a na-arụ ọrụ ahụ, na ebe nlele anya nke ọma kwesịrị ijide n'aka.
3. Iji staplers na laparoscopic na da Vinci robotic ịwa ahụ
1. Nrụgharị nke eriri afọ nke ịwa ahụ nke eriri afọ laparoscopic: kewara n'ime nrụgharị akụkụ nke laparoscopic digestive zuru ezu, obere mbepụ na-enyere aka nrụgharị tract digestive na aka na-enyere aka.Arụ ọrụ laparoscopic zuru oke na-eji stapler dị iche iche nke linear na staplers ma ọ bụ stapler okirikiri zuru oke na laparoscopic anastomosis nwere obere ịwa ahụ na mpaghara ọhụụ doro anya maka ndị ọrịa nwere mgbake ngwa ngwa, mana n'ihi oghere ọrụ dị warara, chọrọ teknụzụ dị elu maka dọkịta na-awa ahụ, ọnụ ahịa ịwa ahụ dị elu, na ugbu a ọ dịghị ọkọlọtọ usoro ịwa ahụ iji nweta The clinically ghọtara obere mbepụ-enyere aka na-arụ ọrụ bụ ịdọrọ anụ ahụ ka ọ bụrụ anastomotic si n'ime oghere afọ, mezue nwughari na vitro ma ọ bụ tinye stapler n'okpuru enyemaka nke obere mbepụ maka anastomosis. .Usoro ọrụ yiri nke laparotomy.Ugbu a, a na-eji laparoscopy na-enyere aka n'ọtụtụ ebe.Nrụgharị tract digestive bụ ịgbatị aka n'ime oghere afọ site na obere mbepụ na mgbidi afọ iji nyere aka na ọrụ anastomosis.Otú ọ dị, aka dị n'ime oghere afọ na-emetụtakarị akụkụ anya nke ọrụ laparoscopic, na mmetụta anastomotic adịghị mma, ya mere a na-ejikarị ya eme ihe.
2. Digestive canal reconstruction in da Vinci robotic eriri afọ ịwa ahụ: dị ka omenala laparoscopic ịwa ahụ maka alimentary canal reconstruction, ọ nwere ike kewara n'ime obere mbepụ aka na zuru laparoscopic anastomosis.
4. Akpachara anya maka itinye uche nke stapler:
Ọ bụ ezie na stapler ewetala ndị na-ahụ maka ụlọ ọgwụ mma dị iche iche, a ka nwere nsogbu siri ike na-aga n'ihu nke na-emetụta ọrụ nkịtị nke tract gastrointestinal [17] Anastomotic leakage, anastomotic stenosis na anastomotic ọbara ọgbụgba bụ ihe na-adịkarị mgbagwoju anya Postoperative iji belata nsogbu nke nsogbu. , onye ode akwụkwọ kwenyere na ekwesịrị itinye uche na isi ihe ndị a:
(1) Onye na-arụ ọrụ ga-abụrịrị onye maara nke ọma na ụkpụrụ ọrụ na usoro ojiji nke stapler, ma soro usoro ọrụ nkịtị;
(2) N'oge a na-arụ ọrụ, ọ dị mkpa iji nlezianya nyochaa ma anastomotic anastomosis ezuola, ma mgbanaka ahụ ezuola, na ma enwere ntakịrị ọbara ọgbụgba na saịtị anastomotic.Ozugbo achọpụtara anastomosis na-ezughị ezu, a ga-edozi ya site na suture akwụkwọ ntuziaka ozugbo ma ọ bụ a ga-ewepụ akụkụ eriri afọ anastomotic mbụ maka mwughachi ọzọ nke tract digestive.N'oge a, etinyela ohere.Mgbe ọ na-eme anastomosis akwụkwọ ntuziaka, odee na-ejikarị usoro suture kwụsịrị okpukpu abụọ.Ọ bụ ezie na oge ọrụ nke usoro suture nke otu-layer dị mfe na oge ọrụ dị mkpụmkpụ Elu ike, ọ dịghị mfe ịmepụta anastomotic leakage Usoro na-aga n'ihu na-adị mfe ịmepụta anastomotic stenosis mgbe suture na-aga n'ihu, ya mere a na-eji suture kwụsịrị;
(3) Nke dabara adabastaplera ga-ahọrọ dịka nha nke akụkụ ahụ na ọnọdụ physiological nke onye ọrịa.Tupu iji stapler, a ghaghị ikwenye na ọ dị irè ma ọ dịghị ihe na-efu efu ma ọ bụ akụkụ ndị na-efu;
(4) Dọkịta na-awa ahụ ga-amụtarịrị usoro ọrụ kachasị mkpa nke iji akwụkwọ ntuziaka, n'ihi na ọnọdụ ụfọdụ nwere ike ọ gaghị adabara maka anastomosis n'ibu;
(5) Gbaa mbọ hụ na enweghị nchekasị na anastomosis na ọbara dị mma.N'otu oge ahụ, arịa ọbara dị na mpaghara mesenteric nke arịa dị gburugburu anastomosis kwesịrị ịdị na-ejikọta ya kpamkpam, ma ọ bụghị ya, ọbara ọgbụgba ga-adị ngwa ngwa;
(6) Ọdịda nke stapler anastomosis na-emekarị na anastomosis nke esophagus na afo ma ọ bụ obere eriri afọ na obere rectal anastomosis.Ọtụtụ n'ime ha bụ n'ihi na-adịghị mma visual ubi na warara ọrụ ohere n'oge ọrụ.Ya mere, a ghaghị ime nkesa doro anya, nkwụsịtụ ziri ezi na hemostasis zuru oke n'oge ọrụ., suture siri ike.
Ka ọ dị ugbu a, staplers nwere ike mezue ihe fọrọ nke nta ka ọ bụrụ anastomoses niile nke eriri afọ, yana meta-analysis kachasị ọhụrụ na-egosikwa na n'ime usoro mgbari nri nwughari nke ịwa ahụ afọ, igwe anastomosis nwere uru nke enweghị ike iji ya tụnyere suture ntuziaka[18], mana anastomosis n'ibu bụ naanị a gastric anastomosis Otu n'ime ụzọ nke eriri afọ anastomosis enweghị ike dochie kpamkpam suturing ntuziaka.Naanị site n'ịgbaso ụkpụrụ ndị bụ isi nke ịwa ahụ na ịmara usoro ịwa ahụ ahaziri ahazi, ndị dọkịta nwere ike nweta nsonaazụ ịwa ahụ na-eju afọ ma baara ndị ọrịa uru.

Isi mmalite: Baidu Library