New Endoscopic stapler|Laparoscopic stapler

Zowonongeka za Laparoscopic Linear Cutter Stapler ndi Zigawo

I. Dzina la malonda, chitsanzo, ndondomeko
Dzina mankhwala: disposable endoscopic liniya kudula stapler ndi zigawo zikuluzikulu
Kufotokozera kwachitsanzo:Kutaya endoscopic liniya kudula stapler: PESS35, PESS45, PESS60, PESM35, PESM45, PESM60, PESL35, PESL45, PESL60, PEPS35, PEPS45, PEPS60, PEPM35, PEPM45, PEPM60, PEPL405, PL655,
Zida zotayidwa za endoscopic linear kudula stapler: PSGST35M, PSGST35W, PSGST35B, PSGST35D, PSGST35G, PSGST35T, PSGST45M, PSGST45W, PSGST45B, PSGST45D, PSGST45W, PSGST45G0, PSGST45G0, PSGST4SGTS, PSGST6SGST6SGST4SGTS SGST35G, PSGST60T, PSGST60B, PSGST60T, PSGST60D, PSGST60B, PSGST35G , PSGST60D, PSGST60B PPEPR60D, PPEPR60G, PPEPR60T.
II.Zochita zamalonda
Stapler iyenera kuyimitsidwa bwino, zolowa m'malo ziyenera kukhala zosavuta, zolimba, komanso zopanda chotchinga, ndipo pazikhala mawu kapena zilankhulo zina zikakhazikika.Mfundo zazikuluzikulu ziyenera kuikidwa mokhazikika mumsonkhano, ndipo zotsalira siziyenera kuwululidwa pamwamba pa cartridge yaikulu pambuyo pogwedezeka.Kutsegula ndi kutseka kwa nsagwada za stapler kuyenera kusinthasintha ndipo pasakhale kupanikizana.Mapangidwe ophatikizana ndi mawonekedwe ozungulira a stapler ayenera kukhala osinthika komanso opanda malire.Kugwirizana pakati pa thupi la stapler ndi zigawo zake ziyenera kukhala zolimba komanso zodalirika.Pambuyo pa stapler kugwedeza mutu wake pamtunda waukulu, imatha kumaliza kuwombera ndikukhazikitsanso.Pali mphamvu yokhotakhota pambuyo poti nsagwada za stapler zatsekedwa, ndipo mphamvu yokhotakhota sayenera kuchepera 4N.Pali mphamvu inayake yotseka pambuyo poti nsagwada za stapler zatsekedwa, ndipo mphamvu yotseka siyenera kukhala yosachepera 30N.Zili ndi ntchito zina za dzanja limodzi.The stapler ayenera kukhala ndi stapling bwino ndi kudula ntchito.Zigawo zosinthika zimatha kugwiritsidwa ntchito podula ndikudula komanso zosachepera 8.Mphepete mwa kudula pambuyo pa stapling iliyonse iyenera kukhala yabwino komanso yopanda ma burrs, ndipo kutalika kwa mapeto a distal a mzere uliwonse wa stapling ayenera kukhala wautali kuposa mzere wodula M'litali uyenera kukhala osachepera 1.5 kutalika kwa msomali, ndi zofunikira pambuyo pa anastomosis iliyonse. ayenera kupangidwa ngati "B".Mzere wokhazikika pambuyo pa anastomosis uyenera kukhala ndi mphamvu yamtundu wina wa suture, ndipo mphamvu ya mzere wa suture siyenera kuchepera 0.1N/mm.The stapler ayenera kukhala ndi kuwombera ndondomeko ndemanga chipangizo chimene chingasonyeze kuwombera kapena udindo.
III.Main dongosolo
Zowonongeka zamtundu wa endoscopic zodulira ndi zigawo zake zimapangidwa ndi thupi ndi zigawo, momwe thupi limapangidwa ndi anvil, mutu wolumikizana, ndodo, ndodo yozungulira, paddle yosinthira, batani losinthira tsamba, zenera lowombera, mayendedwe atsamba Wopangidwa ndi zenera lachizindikiro, batani lotulutsa, chogwirira, chotsekera, chowombera, chowombera, mpeni wodula, ndi mpando wa cartridge wokhazikika, msonkhanowu umapangidwa ndi katiriji yayikulu ndi zoyambira.
IV.Kuchuluka kwa ntchito
Ndi oyenera resection, transection ndi anastomosis m`mapapo, bronchial minofu, m`mimba ndi matumbo potsegula kapena endoscopic opaleshoni.

Onani Chithunzi 1, Chithunzi 2, Gulu 1, ndi Gulu 2 pamitundu ndi miyeso yoyambira ya ma endoscopic liniya kudula staplers ndi zida zodulira.

V. Mawonekedwe azinthu ndi kapangidwe kake

1—Mpando wotsutsana ndi misomali, 2—Mutu wolumikizana, 3—Ndodo;4 - Mphepete mwa kuzungulira;5—Paladi yosinthira; 6—Batani losinthira mayendedwe;7-Kuwombera zenera;8 - zenera lolozera masamba;9-Batani lomasulidwa;10 - chogwirira; 11 - chotsekera;12 - chogwirira chowombera;13—kudula mpeni;14 - mpando wa cartridge wa msomali

Chithunzi 1 Thupi la mzere wodulira stapler wa endoscopy yotayika

1-Staple bin 2-chokhazikika

Chithunzi 2 Linear kudula stapler msonkhano wa disposable endoscope

Table 1 Miyeso yoyambira ya thupi

Table 1 Miyeso yoyambira ya thupi

Zindikirani: Zomwe zili ndi kutalika kofanana ndi 35 zitha kugwiritsidwa ntchito pathupi lokhala ndi kutalika kwa 35, zigawo zomwe zili ndi kutalika kwa 45 zitha kugwiritsidwa ntchito pathupi lokhala ndi kutalika kwa 45, ndi zigawo zofananira. kutalika kofananira kwa 60 kumatha kugwiritsidwa ntchito ngati kutalika kofananira Thupi ndi 60.

Table 2 Basic dimension unit of components: mm

VI.Contraindications
1).edema kwambiri mucosal;
2).Ndizoletsedwa kugwiritsa ntchito chipangizochi pachiwindi kapena ndulu.Chifukwa cha kupanikizika kwa minofu yotereyi, kutsekedwa kwa chipangizocho kungakhale ndi zotsatira zowononga;
3).Sangagwiritsidwe ntchito m'malo omwe hemostasis singawonedwe;
4).Zigawo za imvi sizingagwiritsidwe ntchito ku minofu yokhala ndi makulidwe osakwana 0.75mm pambuyo pa kupsinjika kapena minofu yomwe siingathe kupanikizidwa bwino mpaka makulidwe a 1.0mm;
5).Zigawo zoyera sizingagwiritsidwe ntchito pamagulu omwe ali ndi makulidwe osakwana 0.8mm pambuyo pa kupanikizana kapena minyewa yomwe singathe kupanikizidwa bwino mpaka makulidwe a 1.2mm;
6).Chigawo cha buluu sichiyenera kugwiritsidwa ntchito pa minofu yomwe imakhala yocheperapo 1.3mm pambuyo pa kupanikizana kapena yomwe siingapangidwe bwino mpaka 1.7mm.
7).Zigawo za golidi sizingagwiritsidwe ntchito pamagulu omwe ali ndi makulidwe osakwana 1.6mm pambuyo pa kuponderezedwa kapena minofu yomwe siingapangidwe bwino mpaka makulidwe a 2.0mm;
8).Chigawo chobiriwira sichiyenera kugwiritsidwa ntchito pa minofu yomwe imakhala yocheperapo 1.8mm pambuyo pa kupanikizana kapena yomwe siingathe kupanikizidwa bwino ndi makulidwe a 2.2mm.
9).Chigawo chakuda sichiyenera kugwiritsidwa ntchito pa minofu yomwe imakhala yocheperapo 2.0mm pambuyo pa kupanikizana kapena yomwe siingathe kupanikizidwa bwino ndi makulidwe a 2.4mm.
10).Ndi zoletsedwa ntchito pa minofu pa msempha.

VII.Momwe mungagwiritsire ntchito
Malangizo oyika makatiriji oyambira:
1).Chotsani chida ndi makatiriji oyambira m'mapaketi awo pansi pa opaleshoni ya aseptic;
2).Musanakweze katiriji yoyambira, onetsetsani kuti chidacho chili pamalo otseguka;
3).Onani ngati katiriji yayikulu ili ndi chivundikiro choteteza.Ngati cartridge yaikulu ilibe chivundikiro chotetezera, ndiyoletsedwa kuigwiritsa ntchito;
4).Ikani katiriji yoyambira pansi pampando wa nsagwada, ikani motsetsereka mpaka katiriji yokhazikika igwirizane ndi bayonet, konzani katiriji yayikulu ndikuchotsa chophimba choteteza.Panthawiyi, chidacho chakonzeka kuwotcha;(Zindikirani: Katiriji yokhazikika isanayikidwe, chonde musachotse chivundikiro choteteza katiriji.)
5).Mukatsitsa katiriji yayikulu, kanikizani katiriji kolowera komwe kuli mpando wa misomali kuti mutulutse pampando waukulu wa cartridge;
6).Kuti muyike katiriji yatsopano, bwerezani masitepe 1-4 pamwambapa.

Malangizo a Intraoperative:
1).Tsekani chogwirira chotseka, ndipo phokoso la "kudina" limasonyeza kuti chogwirira chotseka chatsekedwa, ndipo malo occlusal a cartridge ya staple ali mu chikhalidwe chotsekedwa;Zindikirani: Musagwire chogwirira chowombera panthawiyi
2).Mukalowa m'matumbo a thupi kudzera mu cannula kapena incision ya trocar, occlusal pamwamba pa chidacho chiyenera kudutsa mu cannula pamaso pa occlusal pamwamba pa cartridge ya staple;
3).Chidacho chimalowa m'bowo la thupi, dinani batani lotulutsa, tsegulani gawo la occlusal la chidacho, ndikukhazikitsanso chogwirira chotseka.
4).Tembenuzirani chikhomo chozungulira ndi chala chanu kuti chizungulire, ndipo chikhoza kusinthidwa madigiri 360;
5).Sankhani malo oyenera (monga mawonekedwe a thupi, chiwalo kapena chida china) monga malo olumikizirana, kokerani chowongoleracho ndi chala cholozera, gwiritsani ntchito mphamvu yolumikizirana ndi malo olumikizirana kuti musinthe ngodya yoyenera, ndikuwonetsetsa kuti katiriji yaikulu ili mkati mwa gawo la masomphenya.
6).Sinthani mawonekedwe a chida kuti minofu ikhale ya anastomosed/kudulidwa;
Zindikirani: Onetsetsani kuti minofuyo imayikidwa mopanda phokoso pakati pa malo occlusal, palibe zopinga mu malo occlusal, monga ma clip, mabulaketi, mawaya owongolera, ndi zina zotero, ndipo malowa ndi oyenera.Pewani mabala osakwanira, ma staples omwe sanapangidwe bwino, ndi/kapena kulephera kutsegula malo ozungulira a chida.
7).Chidacho chikasankha minofu kuti ikhale anastomosed, kutseka chogwiriracho mpaka kutsekedwa ndikumva / kumva "kudina" phokoso;
8).Chida chowombera.Gwiritsani ntchito njira ya "3+1" kuti mupange ntchito yodulira ndi kusefera;"3": Gwirani chogwirira chowombera mokwanira ndikusuntha kosalala, ndikuchimasula mpaka chigwirizane ndi chotsekera.Pa nthawi yomweyo, onani kuti chiwerengero pa zenera chizindikiro chowombera ndi "1" "Ichi ndi sitiroko, chiwerengero chidzawonjezeka ndi" 1 "ndi sitiroko iliyonse, okwana 3 zikwapu zotsatizana, pambuyo sitiroko yachitatu, tsamba. mawindo owongolera mbali zonse za chogwirira choyera chokhazikika chidzaloza kumapeto kwa chidacho, kuwonetsa kuti mpeni uli munjira yobwerera, gwirani ndikumasula chogwiriziranso, zenera la chizindikiro lidzawonetsa 0, zomwe zikuwonetsa kuti mpeniwo uli munjira yobwerera. wabwerera pomwe adayambira;
9).Dinani batani lotulutsa, tsegulani malo occlusal, ndikukhazikitsanso chogwirira chowombera cha chogwirira chotseka;
Zindikirani: Dinani batani lotulutsa, ngati malo occlusal sakutseguka, choyamba tsimikizirani ngati zenera la chizindikiro likuwonetsa "0" komanso ngati zenera lolozera chala likulozera mbali yakutsogolo ya chida kuti muwonetsetse kuti mpeni uli poyambira. udindo.Kupanda kutero, muyenera kukankhira pansi batani losinthira tsambalo kuti mutembenuzire komwe tsambalo, ndikugwiritsitsa chogwiriracho mpaka chigwirizane ndi chotsekera, ndiyeno dinani batani lotulutsa;
10).Pambuyo kumasula minofu, onani zotsatira za anastomosis;
11).Tsekani chogwirira chotseka ndikutulutsa chidacho.

VIII.Njira zosamalira ndi kukonza zinthu

1. Kusungirako: Sungani m'chipinda chokhala ndi chinyezi chosaposa 80%, chodutsa mpweya wabwino, ndipo mulibe mpweya wowononga.
2. Mayendedwe: Zogulitsa zomwe zapakidwa zimatha kunyamulidwa ndi zida zabwinobwino.Panthawi yoyendetsa, iyenera kuchitidwa mosamala ndikupewa kuwala kwa dzuwa, kugunda kwamphamvu, mvula ndi mphamvu yokoka.
IV.Tsiku lothera ntchito
Mankhwalawa akatsukidwa ndi ethylene oxide, nthawi yotseketsa ndi zaka zitatu, ndipo tsiku lotha ntchito likuwonetsedwa pa chizindikirocho.

X. Mndandanda wa magawo
palibe

XI, Kusamala, Machenjezo
1. Mukamagwiritsa ntchito mankhwalawa, machitidwe a aseptic ayenera kutsatiridwa mosamalitsa;
2. Chonde yang'anani kuyika kwa mankhwalawa mosamala musanagwiritse ntchito, ngati matuza awonongeka, chonde siyani kugwiritsa ntchito;
3. Mankhwalawa amatsukidwa ndi ethylene oxide, ndipo chosawilitsidwa ndi ntchito yachipatala.Chonde onani chizindikiritso cha litayamba m'bokosi lotsekera la mankhwalawa, "buluu" amatanthauza kuti mankhwalawa atsekedwa ndipo angagwiritsidwe ntchito mwachindunji kuchipatala;
4. Mankhwalawa amagwiritsidwa ntchito pa opareshoni imodzi ndipo sangatsekeredwe akagwiritsidwa ntchito;
5. Chonde onani ngati mankhwalawa ali mkati mwa nthawi yovomerezeka musanagwiritse ntchito.Nthawi yovomerezeka yoletsa kubereka ndi zaka zitatu.Zogulitsa zopitirira nthawi yovomerezeka ndizoletsedwa;
6. Gulu lodula la laparoscopic lopangidwa ndi kampani yathu liyenera kugwiritsidwa ntchito molumikizana ndi mtundu wofananira ndi mawonekedwe amtundu wodula wa laparoscopic wopangidwa ndi kampani yathu.Onani Table 1 ndi Table 2 kuti mudziwe zambiri;
7. Maopaleshoni ang'onoang'ono amayenera kuchitidwa ndi anthu omwe aphunzitsidwa mokwanira komanso odziwa njira zochepetsera zochepa.Asanayambe opaleshoni yocheperako, zolemba zachipatala zokhudzana ndi njirayi, zovuta zake ndi zoopsa zake ziyenera kufunsidwa;
8. Kukula kwa zida zowononga pang'ono kuchokera kwa opanga osiyanasiyana kumatha kusiyana.Ngati zida zopangira opaleshoni zocheperako komanso zowonjezera zomwe zimapangidwa ndi opanga osiyanasiyana zimagwiritsidwa ntchito pa opaleshoni imodzi nthawi imodzi, ndikofunikira kuyang'ana ngati zikugwirizana musanachite opaleshoniyo;
9. Chithandizo cha radiation musanachite opaleshoni chingayambitse kusintha kwa minofu.Mwachitsanzo, kusinthaku kungayambitse minofu kukhuthala kuposa zomwe zafotokozedwa pamtengo wosankhidwa.Chithandizo chilichonse cha wodwala chisanachitike opaleshoni chiyenera kuganiziridwa mosamala ndipo chingafunike kusintha kwa njira ya opaleshoni kapena njira;
10. Osamasula batani mpaka chida chitatha kuyaka;
11. Onetsetsani kuti mwayang'ana chitetezo cha cartridge yamtengo wapatali musanawombe;
12. Pambuyo powombera, onetsetsani kuti mwayang'ana hemostasis pamzere wa anastomotic, fufuzani ngati anastomosis yatha komanso ngati pali kutaya;
13. Onetsetsani kuti makulidwe a minofu ali mkati mwazomwe zatchulidwa komanso kuti minofu imagawidwa mofanana mkati mwa stapler.Minofu yambiri kumbali imodzi ingayambitse anastomosis yosauka, ndipo kutuluka kwa anastomotic kumachitika;
14. Pankhani ya minofu yambiri kapena yochuluka, kuyesa kukakamiza choyambitsacho kungayambitse sutures yosakwanira komanso zotheka kuphulika kwa anastomotic kapena kutulutsa.Kuphatikiza apo, kuwonongeka kwa zida kapena kulephera kwa moto kumatha kuchitika;
15. Kuwombera kumodzi kumayenera kumalizidwa.Osawotcha pang'ono chida.Kuwotcha kosakwanira kungapangitse kuti pakhale zitsulo zopangidwa molakwika, mzere wosadulidwa wosakwanira, kutuluka magazi ndi kutuluka kwa suture, ndi / kapena kuvutika kuchotsa chida;
16. Onetsetsani kuti muwotche mpaka kumapeto kuti zitsimikizidwe kuti zowonjezera zimapangidwira bwino ndipo minofu imadulidwa bwino;
17. Finyani chogwirira chowombera kuti muwonetsetse kudula.Osakanikiza chogwiririra mobwerezabwereza, zomwe zingayambitse kuwonongeka kwa malo a anastomosis;
18. Mukayika chipangizocho, onetsetsani kuti chitetezo chili pamalo otsekedwa kuti musamayambitse kuwombera modzidzimutsa, zomwe zimapangitsa kuti tsambalo liwoneke mwangozi ndi kutumizidwa kwapang'onopang'ono kapena kutumizidwa kwathunthu kwazitsulo;
19. Nthawi yochuluka yowombera mankhwalawa ndi nthawi 8;
20. Kugwiritsa ntchito chipangizo ichi ndi anastomotic line reinforcement zipangizo akhoza kuchepetsa chiwerengero cha akatemera;
21. Izi ndizogwiritsidwa ntchito kamodzi kokha.Chipangizocho chikatsegulidwa, kaya chigwiritsidwe ntchito kapena ayi, sichingatsekedwenso.Onetsetsani kuti mwatseka loko yotetezera musanagwire;
22. Zotetezedwa pazifukwa zina za nyukiliya maginito resonance (MR):
·Mayeso osakhala achipatala akuwonetsa kuti ma staples omwe ali ndi grade ya TA2G amatha kugwiritsidwa ntchito kwa MR mokhazikika.Odwala amatha kuwunika mosamala mukangoyikapo zinthu zotsatirazi:
·Magawo a static magnetic field ali pakati pa 1.5T-3.0T okha.
·Mawonekedwe apamwamba kwambiri a maginito ndi 3000 gauss/cm kapena pansi.
·Mawonekedwe akulu kwambiri a MR, kusanthula kwa mphindi 15, kuchuluka kwa mayamwidwe amthupi lonse (SAR) ndi 2 W/kg.
Munthawi ya sikani, kutentha kwakukulu kwa zinthu zoyambira kumayembekezereka kukhala 1.9°C mutasanthula kwa mphindi 15.
Zambiri zazinthu:
Poyesedwa mosavomerezeka pogwiritsa ntchito kujambula kwa gradient echo pulse sequence ndi kachitidwe ka maginito a 3.0T MR, zoyambira zidayambitsa zinthu zakale pafupifupi 5 mm kuchokera pamalo oyikapo.
23. Onani chizindikiro cha tsiku lopanga;