Mu myaka yashize, iterambere ryibikoresho byo kubaga ryateje imbere cyane iterambere ryokubaga kijyambere.Mu rwego rwo kubaga gastrointestinal, kuvuka no gukwirakwizwa kwa staples zikoreshwa byazanye gastrointestinal anastomose kurwego rushya.Ugereranije na suture gakondo yintoki, Kongera kubaka inzira yigifu hamwe na stapler ikoreshwa birashobora kugabanya cyane igihe cyo gukora, kugabanya cyane kwangirika kwimitsi no kuva amaraso, bityo bikagabanya igihe cyo kuguma mubitaro.Kugeza ubu, abaganga benshi kandi benshi bafite ubushake bwo guhitamo anastomose ya mashini mubikorwa byubuvuzi.Nyamara, ingorane zijyanye no gukoresha imiti ikoreshwa mu kubaga gastrointestinal ibaho rimwe na rimwe.Kubaga ni kimwe mu bintu bitatu by'ingenzi bigira ingaruka kuri gastrointestinal anastomose.Nabo ubwabo bafite gusobanukirwa no guhitamo staplers hamwe na tekinoroji yo gukora.Ifite uruhare runini, kandi intsinzi ya anastomose ifitanye isano nayo.Iyi ngingo izavuga kubitekerezo byanjye kubijyanye no guhitamo no gukoresha mu buryo bushyize mu gaciro imiti ikoreshwa muburyo busanzwe bwo kubaga gastrica na colorectal.
Gutondekanya uburyo bumwe bwo gukoresha uruhu
Hariho ubwoko bwinshi bwibikoresho bikoreshwa.Ukurikije ihame ryakazi, bagabanijwe muburyo bwo gukanda nubwoko bwibanze.Ukurikije imiterere ya stapler ikoreshwa, bagabanijwemo umurongo wo gutema umurongo, gukata uruziga, kuzenguruka arc, gukata buto, kumashini ya buto na clip.Shiraho clip ya anastomose.
Gukoresha stapler stapler mugikorwa cyo kubaga kumugaragaro
(1) Guhitamo no gushyira mubikorwa imiti ikoreshwa mugihe cyo kubaga gastric
1. Gastrectomy ya proximal: Mubikorwa, muri rusange uruziga ruzenguruka (25-26mm) rusanzwe rukoreshwa muri anastomose ya esophagogastric, kandi rukata umurongo rukoreshwa mugutandukanya igifu.Ubushakashatsi bwerekanye ko anastomose ya 25-26mm ikoreshwa muri esofagusi na gastrointestinal anastomose.Igikoresho cyo kubaga kirashobora kugabanya ibibaho nyuma yibikorwa, ariko ibi ntabwo ari byimazeyo.Umuganga abaga agomba kumenya ubwoko bwa stapler ukurikije diameter y'imbere ya esofagus.Nibyiza gushiraho tissue kandi bigabanya kuva amaraso anastomotique.Ntugakwega ku gahato iyo stapler yakuweho, cyane cyane iyo gutemagura bitarangiye, gukuramo imbaraga birashobora kuganisha ku buryo bworoshye anastomotic tissue avulsion.
Bitewe numwanya wimbitse wa esofagusi, umurima ugaragara mugihe cyo kubaga urakennye, imikorere ya anastomose iragoye cyane, iherezo ryaciwe rya esofagusi rirashwanyagurika byoroshye, kandi ikibazo cyo kuva kwa anastomotique nyuma yo kubagwa ni kinini.Intiti zivuga ko gukoresha inshuro imwe kugira ngo urangize ibyubaka igogora Nyuma, anastomose yatewe intoki kandi irashimangirwa;ariko, ibi byagiye bivuguruzanya.Mubyukuri, gushimangira suture bituma anastomose yuzuye kandi irashobora kugabanya ibibyimba bya fistula ya anastomotique nyuma yo kubagwa, ariko mubyukuri, gushimangira cyane suture bitera ingirangingo za anastomose.Benshi, byoroshye gukora anastomotic stenosis nyuma yo kubagwa.Ubunararibonye bwumwanditsi nuko guhitamo bigomba gushingira kuri anastomose intraoperative.Niba umurima ugaragara wa esofagus usobanutse mugihe cya anastomose, esofagus irekuwe rwose kandi hemostasis irahagije.Ingaruka ya anastomose irashimishije.Suture ishimangira suture, mubisanzwe hitamo suture ishobora kwakirwa (moderi 3-0 cyangwa 4-0), kubera ko anastomose ya silk ifite ikibazo kinini cyumubiri wumubiri wamahanga, biroroshye gukora ibisebe, kuribwa no kuva amaraso muri anastomose, niba ukoresheje umugozi wubudodo. , urashobora gukoresha 3- Umurongo 0 cyangwa 1.
Nubwo kugaruka kwa gastrici bibaho rimwe na rimwe nyuma ya anastomose ya esophagogastric, igira ingaruka ku mibereho y’abarwayi, ibimenyetso ntibigaragara ku barwayi benshi, bityo rero iki gikorwa kiracyakoreshwa kenshi mu buvuzi.
Igihe cyo kohereza: Ugushyingo-24-2021
