Zofunikira za opaleshonindizitsulo zapadera zomwe zimagwiritsidwa ntchito popanga opaleshoni kuti zilowe m'malo mwa sutures kutseka mabala a khungu kapena kulumikiza kapena kuchotsa mbali ya matumbo kapena mapapo.Kugwiritsidwa ntchito kwazitsulo pazitsulo kumachepetsa mayankho otupa a m'deralo, m'lifupi mwa bala, ndi nthawi yotseka.Chitukuko chaposachedwapa, kuchokera ku Zaka za m'ma 1990, ndikugwiritsa ntchito ma tatifupi m'malo mwa zinthu zina;izi sizifuna malowedwe oyambira.
Kugwiritsa Ntchito Linear Cutter Stapler
Malangizo ogwiritsira ntchito
Chodulira chodulira chodulirapo chimayika mizere iwiri yazambiri ya titaniyamu wa mizere iwiri, ndikudula ndi kugawa minofu nthawi imodzi pakati pa mizere iwiri ya mizere iwiri. wophwanyidwa ndi kutsekedwa kwa chida.
Za Linear Cutter Stapler
Njirayi idayambitsidwa ndi dokotala wa opaleshoni waku Hungary Hümér Hültl, "bambo wa opaleshoni ya suturing".Hultl's prototype stapler mu 1908 ankalemera 8 mapaundi (3.6 kg) ndipo anatenga maola awiri kuti asonkhanitse ndi katundu. Njirayi inakonzedwanso ku Soviet Union m'ma 1950, kulola kuti zipangizo zoyamba zogwiritsidwa ntchito popanga malonda zigwiritsidwe ntchito popanga matumbo ndi vascular anastomoses. .Ravitch amabweretsa chitsanzo cha stapler atapita ku msonkhano wa opaleshoni ku USSR ndikuwuza wamalonda Leon C. Hirsch, yemwe anayambitsa Opaleshoni ya America mu 1964 kuti apange ma sutures opaleshoni pansi pa chipangizo chake cha Auto Suture brand.Kufikira kumapeto kwa zaka za m'ma 1970, USSC makamaka. ankalamulira msika, koma mu 1977 Johnson & Johnson's Ethicon mtundu analowa msika, ndipo masiku ano mitundu yonse ikugwiritsidwa ntchito mofala pamodzi ndi mpikisano ku Far East.USSC inapezedwa ndi Tyco Healthcare mu 1998 ndipo inasintha dzina lake kukhala Covidien pa June 29, 2007. Chitetezo ndi patency ya mechanical (anastomotic) bowel anastomosis yaphunziridwa mozama.M'maphunziro oterowo, ma anastomose opangidwa ndi sutured nthawi zambiri amafanana kapena sachedwa kutayikira. Izi zitha kukhala chifukwa cha kupita patsogolo kwaposachedwa kwaukadaulo wa suture komanso maopaleshoni owopsa omwe amachulukirachulukira.Zoonadi, ma suture amakono ndi odziwikiratu komanso osatengeka kwambiri ndi matenda kuposa zida zomwe zidagwiritsidwa ntchito zaka za m'ma 1990 zisanafike —matumbo, silika, ndi bafuta. m'mphepete mwa chilonda ndi kutseka mtsempha wamagazi panthawi ya stapling.Kafukufuku waposachedwapa wasonyeza kuti pogwiritsa ntchito njira zamakono zopangira suturing, palibe kusiyana kwakukulu pa zotsatira pakati pa suturing manual ndi mechanical anastomosis (kuphatikizapo tatifupi), koma mechanical anastomosis imachitika mofulumira kwambiri. kuchucha kumachitika kawirikawiri pambuyo pa opaleshoni.Njira zina zotsekera minofu ya m'mapapo zikufufuzidwa.
Mitundu ndi Ntchito
Chitsulo choyamba chamalonda chinali chopangidwa ndi zitsulo zosapanga dzimbiri zokhala ndi titaniyamu zodzaza makatiriji owonjezeredwa.Mitundu yonse iwiriyi nthawi zambiri imakhala ndi ma cartridges otayira.Mizere yokhazikika ikhoza kukhala yowongoka, yopindika kapena yozungulira.Zozungulira zozungulira zimagwiritsidwa ntchito kumapeto kwa anastomosis pambuyo pochotsa matumbo kapena, kutsutsana kwambiri, opaleshoni ya esophagogastric.Zidazi zingagwiritsidwe ntchito potsegula kapena laparoscopic. njira, zokhala ndi zida zosiyanasiyana zomwe zimagwiritsidwa ntchito pa ntchito iliyonse.Zolemba za Laparoscopic ndizotalika, zowonda kwambiri, ndipo zimatha kufotokozedwa kuti zilowetse kuchokera ku madoko ochepa a trocar.Zina za staplers zimakhala ndi mpeni womwe ungathe kudula ndi kukhazikika mu ntchito imodzi.Staplers amagwiritsidwa ntchito kutseka mkati ndi khungu mabala.Zitsamba zapakhungu nthawi zambiri zimagwiritsidwa ntchito ndi stapler yotayika ndikuchotsedwa ndi chochotsa chapadera.Ngakhale zida zozungulira zozungulira mpaka kumapeto kwa matumbo am'mimba zimagwiritsidwa ntchito kwambiri, zozungulira zozungulira za anastomosis ya mitsempha sizinayambe zafananizidwapo ndi anastomosis wamba ngakhale maphunziro ozama Pangani kusiyana kwakukulu ndi njira za (Carrel) suture.Kupatulapo njira zosiyanasiyana zolumikizira chotengera (eversioned) ku chitsa cham'mimba (inverted), chifukwa chachikulu chomwe chingakhale chakuti, makamaka zotengera zing'onozing'ono, ntchito yamanja ndi kulondola komwe kumafunikira kuyika chitsa chokhacho ndikuwongolera chipangizo chilichonse. kukhala zochepa kwambiri Amapanga kusokera komwe kumafunikira pakusoka kwapamanja, kotero kuti palibe ntchito zambiri zogwiritsira ntchito chida chilichonse. Nthawi ndi magulu opangira opaleshoni osiyanasiyana pamikhalidwe yotetezeka popanda nthawi yofunikira yomwe ikukhudza kusungidwa kwa opereka chiwalo, mwachitsanzo, pansi pazikhalidwe zozizira za opereka chiwalo ndi tebulo lakumbuyo pambuyo pochotsa chiwalo chachilengedwe cha wolandirayo. Cholinga chomaliza ndikuchepetsa gawo lowopsa la ischemic. wa opereka chiwalo, amene akhoza zili mu mphindi kapena zochepa, chabe ndi kulumikiza mapeto a chipangizo ndi kuwongolera stapler.Ngakhale kuti zofunika kwambiri opaleshoni amapangidwa titaniyamu, zitsulo zosapanga dzimbiri amagwiritsidwa ntchito kwambiri pa khungu zina ndi tatifupi.Titanium sichigwira ntchito kwambiri ndi chitetezo chamthupi ndipo, chifukwa ndi chitsulo chopanda chitsulo, sichimasokoneza kwambiri makina ojambulira a MRI, ngakhale kuti zinthu zina zojambula zithunzi zimatha kuchitika. synthetic absorbable sutures.
Kuchotsa spikes pakhungu
Pamene zotsalira za khungu zimagwiritsidwa ntchito kusindikiza zilonda zapakhungu, m'pofunika kuchotsa zotsalira pambuyo pa nthawi yoyenera ya machiritso, nthawi zambiri masiku 5 mpaka 10, malingana ndi malo a bala ndi zinthu zina. ya nsapato kapena mbale yopapatiza komanso yopyapyala yoti ilowetsedwe pansi pa nsonga yapakhungu. " mawonekedwe kuti achotse mosavuta.Pakachitika ngozi, zotsalirazi zimatha kuchotsedwa ndi zida zamagetsi. Zochotsa pakhungu zimapangidwa m'mawonekedwe ndi mawonekedwe osiyanasiyana, zina zimatha kutaya ndipo zina zimatha kugwiritsidwanso ntchito.
Nthawi yotumiza: Nov-18-2022
