Kugwiritsa ntchito kwaarc kudula stapler
Khansara yotsika ya rectum ikutanthauza chotupa chotsika m'mphepete mwake ndikutalikirana ndi m'mphepete mwa kumatako 7cm pansi kapena kukhala mu rectum 1/3 ndime.Kafukufuku wamatenda atsimikizira kuti kulowetsedwa kwa khansa yam'mimba pakhoma la distal ndikochepa ndipo zosakwana 3% ndizokulirapo kuposa 2cm.Chifukwa chake, kutulutsa khansa yam'mimba yokhala ndi gawo la matumbo akulu kuposa 2cm ndikokwanira, motero kukulitsa zisonyezo zakuchepa kwapang'onopang'ono kwa khansa yapakhosi ndikupereka maziko opangira opaleshoni yoteteza anus ku khansa yotsika.Pa nthawi yomweyi, chiwerengero chachikulu cha machitidwe a zachipatala ndi maphunziro oyesera a m'chiuno awonetsa kuti malinga ngati ngalande yamphongo, mphuno yamphongo ndi levator anus zimasungidwa bwino, anus akhoza kusungidwa kuti apitirize kugwira ntchito bwino.Kafukufuku wamatenda kuti amvetsetse mozama zamakhalidwe a khansa yamtundu wa colorectal surgeon amateteza matekinoloje amatako amakhala aluso kwambiri ndipo ma stapling osiyanasiyana amawonekera makamaka kugwiritsa ntchito kuphatikizira kawiri ndikuwongolera kuti apange maopaleshoni ochulukirachulukira kukhala osatheka luso laukadaulo. zovuta kuti zigwirizane ndi odwala omwe akuchulukirachulukira a khansa ya m'matumbo a anus.
Ndi ntchito yaikulu yaukadaulo wapawiri stapler, apeza kuti odwala ena ndi chiuno yopapatiza ndi kunenepa kwambiri, yapita liniya kutseka chipangizo ali ndi zofooka zambiri, zomwe zimapangitsa odwala ena kutaya mwayi kusungidwa kumatako.Arc kudula anastomat chifukwa cha nsonga yake yapadera yokhota kuti ipangidwe mogwirizana ndi thupi laumunthu la kapangidwe ka chiuno chosavuta kutambasulira mpaka pamalo a chiuno cham'chiuno mozama ndikudula ndikulumikiza kulumikiza kumalizidwa kumachepetsanso kuipitsidwa kuti kupewe kutsekeka kwa mzere kumayenera kuchitika. mu yopapatiza danga la mavuto ndi chifukwa rectum odulidwa vice kuvulala mwina;Chomera chodulira chooneka ngati arc chimathandizira masitepe opangira distal rectum resection ndikufupikitsa nthawi ya opaleshoni, zomwe zimapangitsa kuti anastomosis iwiri ikhale yosavuta komanso yotheka.Zanenedwa kuti zochitika za postoperative anastomotic fistula nthawi zambiri zimakhala pakati pa 2.5-5.0% pa njira ziwiri za anastomotic pogwiritsa ntchito ma staplers.Pagulu ili, zochitika za postoperative anastomotic fistula zinali 4.3% mwa odwala 46 omwe ali ndi khansa yotsika ya rectum omwe anachitidwa opaleshoni yoteteza anus ndi arc-kudula stapler popanda anastomotic magazi kapena stenosis, kusonyeza kuti kugwiritsa ntchito arc-kudula stapler kumathandiza kuti akwaniritse bwino. a Ultra-low rectal cancer anterior resection popanda kuwonjezera kuchuluka kwa zovuta za anastomotic.Komabe, deta yowonjezereka ikufunika kuti zitsimikizire ubwino wake pochepetsa chiwerengero cha anastomotic fistula poyerekeza ndi stapler yozungulira.
Mofanana ndi linear stapler, zovuta za kusungidwa kwa khansa ya rectal anus pogwiritsira ntchito arc cutting stapler makamaka zimaphatikizapo kutuluka kwa anastomotic, magazi a anastomotic, anastomotic stenosis, positive incision margin, rectovaginal fistula, postoperative mkodzo kusunga ndi kulephera kugonana.Panalibe anastomotic magazi, anastomotic stenosis ndi rectovaginal fistula, koma 2 milandu anastomotic fistula.Kuphatikizidwa ndi zolemba kuti tifotokoze zomwe zakumana nazo pakugwiritsa ntchito izi arc kudula anastomat chifukwa chachikulu cha anastomotic fistula ndi malo ozama kwambiri, ntchito yovuta, ikuluikulu yam'deralo yosowa magazi kapena kupsinjika, kutulutsa kwapang'onopang'ono komanso pambuyo pa opaleshoni sikuyipitsa kwaulere komanso zinthu zakumaloko komanso anthu osauka. chikhalidwe, kunenepa kwambiri, m'chiuno patsekeke ndi yopapatiza yaing'ono, preoperative anticancer mankhwala, zokhudza zonse zinthu monga shuga mellitus.
Pofuna kupewa kupezeka kwa anastomotic fistula, chidwi chiyenera kuperekedwa kuzinthu zotsatirazi mukamagwiritsa ntchito arc kudula ndi suturing chipangizo choteteza khansa yamphongo.
Mfundo zofunika chisamaliro cha arc kudula suture chipangizo
(1) kugwiritsa ntchito mwaluso zida za anastomotic pochita bwino.(2) Colon proximal idasinthidwa moyenera potengera chithandizo chamankhwala popanda kupsinjika kwa anastomotic.Kukayikiridwa kuti pali vuto, proximal colon iyenera kulekanitsidwa kapena colonic splenic flexure iyenera kumasulidwa.(3) Magazi abwino a anastomosis.Mitundu yaulere ya mesangium patali ndi kutali sikuyenera kukhala yayikulu kwambiri kuti isachotse mafuta m'chipupa chamatumbo.(4) Kusankhidwa kwa malo a anastomotic: malo a anastomotic ayenera kuchotsedwa m'munsi mwa rectum ya dorsal pakatikati pamphepete mwazitsulo, ndipo khoma la m'mimba liyenera kukhala ndi mbali yotseka ya rectum.Chifukwa mtundu waulere wa dorsal rectum nthawi zambiri umakhala wokulirapo kuposa momwe magazi amaperekera magazi ndi anastomosis osauka pano amatha kuchepetsa malo omasuka a dorsal;Pa nthawi yomweyo, ngati mlatho chingwe aumbike pakati pa kudula m'mphepete mwa chubu stapler ndi kutseka m'mphepete mwa rectum, n'zosavuta chifukwa matumbo khoma la mlatho chingwe ischemia necrosis ndi fistula.(5) Mukangomaliza kutulutsa anastomosis, fufuzani ngati mphete zakumtunda ndi zapansi zochotsa zatha.Ngati pali chilema, malo ofanana akhoza kulimbikitsidwa suture.Panthawi imodzimodziyo, kufufuza kwa chala kumatako kunkachitika pambuyo pa anastomosis kuti awone ngati misomali ya anastomotic inali yozungulira.
Pomaliza, monga kusintha kwaukadaulo wapawiri stapler, wapadera arc kudula stapler akhoza anaikapo m`munsi m`chiuno patsekeke.Ntchito yake mu anterior resection ya otsika rectal khansa ndi otetezeka ndi ogwira, makamaka odwala ndi otsika chotupa malo ndi ntchito yovuta.
Nthawi yotumiza: Jan-14-2022