Guhitamo no gukoresha neza stapler mu kubaga gastrointestinal (Igice cya 2)

Gastrectomy itandukanye ukoresheje stapler imwe

Mu bwoko bwa Bi I, a ukoresheje gastroduodenal end-to-end anastomose, kugirango impagarara za anastomose zakozwe ni nto.Niba impagarara za anastomose ari nini cyane, ibyago bya fistula ya anastomotique biziyongera nyuma yo kubagwa.Umwanditsi yizera ko nubwo anastomose iherezo-iherezo itoroshye, igihe cyose amaraso atangwa kuri anastomose ahagije kandi anastomose itagira impagarara, nta tandukaniro rikomeye riri hagati y’ibibazo biterwa na nyuma yo kubagwa hagati ya anastomose zombi. buryo.

Muburyo bwa Bi-II, umuzenguruko uzenguruka (25-26mm) muri rusange ukoreshwa kuri anastomose, kandi umurongo wo gukata umurongo ushobora no gukoreshwa.Umwanditsi amenyereye gukoresha iyanyuma kugirango arangize gastrojejunal anastomose.Dodenum irashobora gukoreshwa hamwe na endoskopi yumurongo ugabanya stapler (45mm) Gukata.Ubu bwoko bwa stapler bufite imirongo 6 yingenzi.Suture ifite imikorere myiza ya hemostasis.Ntibyoroshye gukora fistula duodenal stump no kuva amaraso nyuma yo kubagwa.Niba duodenal stump edema igaragara, urashobora guhinduranya suture yintoki, hanyuma ukoreshe endoscopic umurongo ugabanya stapler (45mm) kugirango urangize gastro-jejunum kuruhande-anastomose.Mugihe cya anastomose, menya ko marge ya jejunum-to-mesangial igomba kuba ifatanye cyane nurukuta rwa gastrica rwigifu gisigaye.Ntuzane tissue ya mesenteric muri anastomose, bitabaye ibyo biroroshye kwangiza imiyoboro y'amaraso ya mesenteric.Itera ischemia tissue kuri anastomose na anastomotic.Mu rwego rwo gukumira ingorane nyuma ya Bi Ⅱ anastomose, hashobora gukorwa anastomose hagati ya jejunal (Braun anastomose).Bi Ⅱ anastomose ikurikirwa na anastomose.Alkaline reflux gastrite na anastomotic stomatitis ikunda kubaho, kubwibyo nkoresha cyane cyane Bi Ⅰ cyangwa Roux-en-Y anastomose.