Ikoreshwa rya stapler izenguruka muri gastrojejunostomy na esophagojejunostomy ryaremewe cyane, kandi abaganga benshi babaga bahitamo gukoresha uruziga ruzunguruka mugubaga kumugaragaro.Inaba et al yatangaje ko gukoresha umurongo wa stapler muri gastrojejunostomy munsi ya endoscopi bifite ingaruka nziza.Umwanditsi akunda staplers igororotse cyangwa se na endoscopic staplers kugirango yubake inzira yigifu mu kubaga kumugaragaro, kuko:
.(2) Anastomose ntabwo igarukira kuri diameter ya lumen;(3) Habaho kuva amaraso make mugihe cya anastomose, kandi ntabwo byoroshye gutera amarira ya tissue cyangwa anastomose ituzuye mugihe cya anastomose;(4) Gabanya igihe cyo gukora;.Kubijyanye n’uko bishobora kugabanya ibibazo by’ingaruka nyuma yo kubagwa ugereranije n’uruziga ruzengurutse, hakomeje gukorwa ubugenzuzi bw’amavuriro.
Guhitamo no gushyira mu bikorwainshuro imwe ikoreshwa muburyo bwo kubaga amabara
1. Iburyo bwa hemicolectomy ileocolon iherezo kuruhande rwa anastomose: stapler izenguruka (29 cyangwa 33mm) irashobora gukoreshwa kugirango irangize ileocolon iherezo kuruhande rwa anastomose, kandi igikoresho cyo gufunga umurongo (L60 cyangwa L75) gishobora gukoreshwa kugirango ufunge icyacitse iherezo ryimyanya ndangagitsina, cyangwa umurongo ugabanya umurongo (L75) urashobora gukoreshwa mugukora ileocolon iherezo-kuruhande rwa anastomose.Uruziga ruzengurutse (29 cyangwa 33) rugomba kwinjizwa mumyanya ndangagitsina yo mu mara mugihe cya anastomose ya end-end-end ya colon transvers cyangwa ibumoso bwa hemicolectomie.
2. Sigmoid colon cyangwa rectum resection Colorectum (umuyoboro wa anal) iherezo-iherezo rya anastomose: Double anastomose nuburyo bukoreshwa cyane mukubaka gastrointestinal, tutitaye kuri laparotomie cyangwa kubaga endoskopi.Uru rupapuro rwerekana cyane cyane tekinike yo gukubitwa kabiri binyuze muburyo bwa anal bwo kongera gastrointestinal.
Amara yegeranye ashyirwa hamwe nuruziga ruzengurutse umusumari, kandi umubiri wumutwe ugomba gufungwa numurongo ugororotse cyangwa gukata arc ahabigenewe mbere yo gukata kumpera yikibyimba.Mbere yo kwinjira mu muyoboro wa anal, impera yimbere yumubiri wa stapler igomba gushyirwaho umuti wa iyode kugirango usige amavuta kandi wanduze.Umubiri ugomba gutera imbere gahoro gahoro kugeza igihe impera yimbere yumubiri ikora buhoro buhoro imbere yikibaho.
Icyitonderwa cyo gukoresha inshuro imwe mugikorwa cyo kubaga amabara
... bizagira ingaruka;.Umwanya wurukuta rwinyuma rugomba kwemezwa mbere yuko stapler ikubitwa, kandi ubushakashatsi bwigitereko burashobora gukorwa nyuma yo kurangiza anastomose;. ubukene, nyuma yuburwayi bwa anastomotic imvugo yamugaye, akenshi byabaye mugukoresha icyuma cyamashanyarazi cyumuvuduko mwinshi kugirango wirinde kwangirika, urukuta rwurukiramende nigituba Double anastomose nubwo ikoreshwa cyane, ariko haracyari inenge zimwe na zimwe, nko mumuzingi no kumurongo wuzuza insinga zometseho, gukoresha gukata umurongo gukata anastomat nyuma yo gukuramo amara, birashobora kuba kumpera yuburyo bwurukiramende rwamatwi "Angle" ugutwi kwinjangwe, cyane cyane uburyo bwo gutangiza umurongo wo gukata umurongo hafi inshuro nyinshi, bishobora gutera umurongo wa anastomose, byongera ibyago bya fistula ya anastomotique.Kubwibyo, mubikorwa byubuvuzi, niba ibintu bibyemereye, tekinike imwe ya anastomose irashobora gukoreshwa, ni ukuvuga suture yisakoshi irashobora gukoreshwa kumpera ya colonike yegeranye ndetse na rectum ya kure, kugirango wirinde ibibi byubuhanga bubiri bwa anastomose.
Urukiramende rwimyororokere (anal) kuruhande rwa anastomose: umubiri wibanze urashobora gutera inda cyangwa anal muburyo bwo kurangiza uruhande rwanyuma anastomose ukoresheje umuzenguruko uzenguruka (mm 33 cyangwa 29 mm) hamwe numurongo wa stapling kuruhande rwa anastomose wagize ururondogoro nicyo kamaro. . Anastomose iherezo-iherezo. Ariko, ingano yicyitegererezo cyubu bushakashatsi ni nto cyane, kandi nubuvuzi bunini bwamavuriro buracyakenewe kugirango tubigenzure.
Anastomose yimifuka ya colonike (anal) irashobora kandi gukoreshwa, aho j-inshuro ya 6 ~ 7cm ikorerwa kumpera yubusa hamwe na stapler igororotse.Isesengura ryakozwe ryerekanye ko ugereranije na anastomose iherezo ku rundi, nta tandukanyirizo rishingiye ku mibare ryagaragaye mu kigero cy’ingutu nyuma yo gutangira gukorerwa, igipimo cy’imfu, imikorere y’umwanda, n'ibindi. Ariko, imikorere y’imifuka yo kubika amara yari igoye kandi ihenze, kandi yihariye guhitamo uburyo bukenewe gukemurwa nabaganga babaga.
Mu myaka yashize, stapler imeze nka arc yamenyekanye cyane mubikorwa byubuvuzi.Bamwe mu bahanga bemeza ko mu kurwanya kanseri yo mu muyoboro muke, stapler imeze nka arc byoroshye kwinjira mu mwobo wa pelvic kuruta umurongo wa stapler, kandi ingaruka za anastomose ni nziza.Umwanditsi atekereza ko, ubwoko bubiri bwibikoresho bifite imiterere yabyo kandi byerekana aho ikibyimba cya pelvic giherereye kiri hasi kandi kigufi cyumurongo ntigishobora kuzuza intera ihagije yabatwara amara ya kure, tekereza gukoresha arc gukata anastomat, ntakibazo uhitamo ubwoko bwa stapling, ugomba gukurikiza ihame rya TME, gutandukana neza, kwemeza umurima mwiza wo kubaga.
Igihe cyo kohereza: Ugushyingo-29-2021
