Xulashada iyo Isticmaalka Macquulka ah ee Stapler ee Hawlgalka mindhicirrada

Xulashada iyo Isticmaalka Macquulka ah ee Stapler ee Hawlgalka mindhicirrada
Chen Lin, Bian Shibo

Sanadihii la soo dhaafay, horumarinta qalabka qalliinka ayaa si weyn kor ugu qaaday horumarinta qalliinka casriga ah.Dhinaca qaliinka caloosha iyo mindhicirka, soo ifbaxa iyo soo shaac-baxa staplers-ka ayaa kor u qaaday anastomosis-ka mindhicirka ilaa heer cusub.Marka la barbar dhigo tolida buug-gacmeedka dhaqameed, codsiga staplers Dib-u-dhiska habka dheef-shiidka ee la sameeyay wuxuu si weyn u gaabin karaa wakhtiga qalliinka, wuxuu si weyn u yareynayaa dhaawaca unugyada iyo dhiig-baxa, taas oo yareyneysa celceliska dhererka isbitaalka shaqo caafimaad.Si kastaba ha ahaatee, anastomosis ee qaliinka caloosha iyo mindhicirka Mid ka mid ah saddexda arrimood ee waaweyn ee saameeya anastomosis caloosha, dhakhtarka qalliinka laftiisa ayaa door muhiim ah ka ciyaara xulashada stapler iyo qabashada farsamada qaliinka, iyo guusha anastomosis ayaa sidoo kale la xidhiidha.Xidhiidh dhow 2 Maqaalkani wuxuu ka hadli doonaa aragtidayda ku saabsan xulashada iyo isticmaalka macquulka ah ee staplers ee hababka qalliinka caadiga ah ee qaliinka caloosha iyo mindhicirka.
1. Kala soocida staplers
Waxaa jira noocyo badan oo ah staplers, kuwaas oo loo qaybin karo nooca saxafada ku haboon iyo nooca aasaasiga ah sida waafaqsan mabda'a shaqada.Marka loo eego qaabka stapler-ka, waxa loo qaybin karaa stapler-ka toosan, stapler-ka-wareega-wareegga ah, stapler-ka-jeexan, badhan-qaabeeya iyo stapler-qaabeeya.
2. Isticmaalka staplers ee laparotomy
(1) Doorashada iyo codsiga staplers ee qaliinka caloosha
1. Gastrectomy Proximal: Stapler wareeg ah (CDH25) ayaa guud ahaan loo isticmaalaa anastomosis esophagogastric, iyo stapler gooyn toosan (TLC10) ayaa loo isticmaalaa anastomosis gastric.Daraasaduhu waxay muujiyeen in isticmaalka 25mm stapler ee hunguriga iyo dheef-shiid kiimikaadka uu hoos u dhigi karo dhacdooyinka dhibaatooyinka qalliinka kadibHawlwadeenku waa inuu go'aamiyaa nooca stapler iyadoo loo eegayo dhexroorka gudaha hunguriga.Qaabaynta unugyada si loo yareeyo dhiigbaxa anastomotic Ha u jiidin si adag marka stapler-ku ka baxo, gaar ahaan marka la jeexiyo aan dhamaystirnayn, waxay si fudud u keeni kartaa avulsion unug anastomotic ah.
Sababtoo ah booska qoto dheer ee anatomical ee hunguriga, goobta muuqaalka gudaha ayaa liidata, anastomosis waa adag tahay, dhamaadka jaban ee hunguriga waa sahlan tahay in la gooyo, iyo dhacdooyinka dheecaanka anastomotic waa mid sarreeya.Si kastaba ha ahaatee, tani waxay ahayd muran.Aragti ahaan, xoojinta tolku waxay ka dhigi kartaa anastomosis-ka mid aad u dhammaystiran oo yareynaya dhacdooyinka dheecaanka anastomotic ee qalliinka ka dambeeya.Si fudud loo sameeyo anastomotic stenosis Waayo-aragnimada qoraaga ayaa ah in doorashada lagu sameeyo iyadoo loo eegayo xaaladda anastomotic inta lagu jiro qaliinka.Haddii goobta muuqaalku ay caddahay inta lagu jiro anastomosis, hungurigu waa bilaash, hemostasis waa dhammaystiran yahay, saameynta anastomotic waa mid ku qanacsan, xoojinta tolnimada looma baahna;Haddii dhamaystir la'aanta anastomotic ama dhiig-bax anastomotic ah la helo inta lagu jiro qalliinka, tolida lakabka seromuscular ayaa loo isticmaali karaa si loo xoojiyo tolka.Guud ahaan, tolnimada la nuugi karo (nooca 3-0 ama 4-0) ayaa la doortaa.Sababtoo ah dhacdooyinka sare ee falcelinta jidhka shisheeye ee anastomosis xariirta, way fududahay in lagu sameeyo bararka boogaha iyo dhiigbaxa anastomosis [4] dun xariirta ah, ama 3-0 ama 1-filid silig ah ayaa la isticmaali karaa
Inkasta oo dib-u-soo-celinta gastric ay dhacdo waqti ka waqti ka dib anastomosis esophagogastric, taas oo saameeya tayada nolosha bukaanka, laakiin bukaanada intooda badan ma laha calaamado muuqda, sidaas darteed qalliinkan ayaa weli inta badan loo isticmaalaa daaweynta bukaan-socodka[5].
2. Gastrectomy Distal: Labada nooc ee gastroduodenal dhamaadka-ilaa-dhinac ama dhamaadka-ilaa-dhamaadka anastomosis Bi-nooca II gastrojejunostomy iyo Roux-en-Y gastrojejunostomy ayaa inta badan la isticmaalaa.
Nooca Bi I, stapler wareeg ah (CDH25) iyo stapler goynta toosan (TLC10) ayaa loo isticmaalaa anastomosis.Culimada qaarkood waxay soo jeedinayaan anastomosis dhamaadka-ilaa-dhamaadka ee gastroduodenum, si xiisadda anastomosis ay u yaraato[6] Haddii xiisadda anastomosis ay aad u badan tahay Khatarta dheecaanka anastomotic ee qalliinka ka dambeeya ayaa kordhin doonta [7] Qoraagu wuxuu aaminsan yahay in inkasta oo qaliinka anastomosis dhamaadka-ilaa-dhamaadka waa dhib badan, ilaa inta la hubiyay bixinta dhiig ku filan iyo anastomosis aan kacsanayn, dhacdooyinka dhibaatooyinka postoperative ee labada hababka anastomotic waa isku mid.Ma jiro farqi weyn.
Nooca Bi II, stapler-ka wareegtada ah (CDH25) ayaa guud ahaan loo isticmaalaa anastomosis, iyo stapler-ka goynta toosan sidoo kale waa la isticmaali karaa.Qoraaga waxaa loo isticmaalaa in uu isticmaalo kan dambe si uu u dhamaystiro gastrojejunum anastomosis.Qalabka goynta tooska ah ee endoscopic stapler (6TB45) ayaa loo isticmaali karaa si loo gooyo duodenumka.Qalabka stapler-ku waxa uu leeyahay wadar ahaan 6 saf oo fadhiisimo ah, shaqada hemostasis-ka tolku waa ay fiicantahay, mana fududa in la sameeyo fistula duodenal fistula iyo dhiigbax qaliinka ka dib.Haddii jirridka duodenal uu bararsan yahay, tolida gacanta ayaa la isticmaali karaa, ka dibna 6TB45 ayaa loo isticmaali karaa si loo dhamaystiro dhinaca gastrojejunal.Ha keenin unugyada mesenteric anastomosis.Dhibaatooyinka ka dib nooca II anastomosis, dhinac-ilaa-dhinac jejunum anastomosis (Braun anastomosis) ayaa lagu dari karaa iyada oo ku saleysan tan.Ka dib nooca III anastomosis, gastritis reflux alkaline iyo stomatitis anastomotic ayaa inta badan u nugul inay dhacaan, sidaas darteed qoruhu wuxuu isticmaalaa Bi-I ama Roux-en-Y anastomosis.
Gastrojejunum Roux-en-Y anastomosis waxay isticmaali kartaa laba staplers wareeg ah (CDH25) si ay u dhamaystirto anastomosis ee u dhexeeya jejunum iyo gastrojejunum, ama isticmaal stapler goynta toosan si ay u sameeyaan anastomosis dhinac-ilaa-dhinac ee jejunum fog iyo caloosha hadhaaga iyada oo loo marayo xaga hore ee xiidanka.Ogsoonow in jihada jirridda jejunum ee fog ay kor u kacday, iyo jihada jirridda jejunum ee u dhow waa inay sidoo kale kor u ahaataa inta lagu jiro anastomosis-ka-dhinac ee jejunum.Jeexitaanka mesenteric ee dhamaadka jaban ee jejunumka waxaa lagu xidhi karaa 3-0 tolmo xariir ah.
3. Wadarta guud ee gastrectomy: Esophagojejunostomy, beddelka jejunum caloosha, beddelka xiidanka caloosha iyo esophagojejunum Roux-en-Y?Ba'an, tayada nolosha tayada liidata ee bukaanka Beddelka caloosha ayaa si weyn u wanaajin kara tayada nolosha bukaanka, laakiin qalliinka qalliinka waa kakan Esophagus-jejunum Roux-en-Y anastomosis waa dhexdhexaad dhexdhexaad ah waxayna hagaajin kartaa calaamadaha reflux Si aad u doorato habka dib u dhiska ee ku habboon. qoraagu wuxuu ku talinayaa Roux-en-Y anastomosis ee hunguriga iyo jejunum.Qalabka wareegga ah (CDH25) waxaa loo isticmaali karaa in lagu dhammaystiro anastomosis-ka-dhammaadka ee hunguriga hore iyo jejunum, iyo stapler-ka goynta toosan (sida 6TB45) ayaa loo isticmaali karaa in lagu dhammaystiro anastomosis-ka dhinac-ilaa-dhinac ee u dhow. iyo jejunum fog.Jirridka jejunum-ka ayaa lagu xidhay 6TB45.
Codsiga staplers wareeg ah ee gastrojejunostomy iyo esophagojejunostomy si weyn ayaa loo aqbalay, dhakhaatiirta qalliinka badankood waxay doorbidaan inay isticmaalaan staplers wareeg ah qalliinka furan [8-9] Inaba et al.!Waxaa la soo sheegay in saamaynta gastrojejunal anastomosis isticmaalaya stapler toosan hoos laparoscopy waa wanaagsan.Qoraagu wuxuu door bidaa stapler toosan ama xitaa stapler hoostiisa qalliinka laparoscopic ee dib u dhiska habka dheefshiidka ee laparotomy.
sababtoo ah:
(1) Qalabka noocan ahi waa mid ku habboon oo fudud in lagu shaqeeyo, isaga oo ka fogaanaya tallaabooyinka qallafsan ee qallafsan sida gelinta dabada xadhigga shandad iyo stapler wareeg ah oo dhex mara daloolka mindhicirka;
(2) Anastomosis kuma koobna dhexroorka lumen;
(3) Waxaa yaraada dhiigbaxa inta lagu jiro anastomosis, mana fududa in la keeno dhaawaca unugyada jeexjeexa ama anastomosis aan dhamaystirnayn inta lagu jiro anastomosis;
(4) Yaree wakhtiga hawlgalka:
(5) Marka la barbardhigo stapler-ka wareegtada ah, stapler-ka tooska ah wuxuu u baahan yahay oo kaliya inuu beddelo kartoonka muhiimka ah marka la isticmaalo dhowr jeer inta lagu jiro hawlgalka, taas oo yaraynaysa kharashka hawlgalka.Marka la barbar dhigo stapler-ka wareegtada ah, haddii ay yarayn karto dhacdooyinka qallafsanaanta qalliinka ka dib, ansaxinta bukaan-socodka dheeraadka ah ayaa weli la samayn.
(2) Doorashada iyo codsiga staplers ee qaliinka mindhicirka
1. Dhamaadka-ilaa-dhinac anastomosis ee ileocolon ka dib hemicolectomy saxda ah: stapler wareeg ah (CDH29 ama 33) ayaa loo isticmaali karaa si loo dhamaystiro anastomosis-ka-dhammaadka ee ileocolon, iyo xirid toosan (TL60 ama TLC75) sidoo kale waxaa loo isticmaalaa in lagu xiro jirridda xiidanka ka gudba.(TLC75) Anastomosis-ka dhinac-ilaa-dhinaca ah ee xiidanka u gudba ee ileum Dhamaadka-ilaa-dhinaca anastomosis ee u dhexeeya xiidanka transverse ama xiidanka hemicolectomy bidix, stapler wareeg ah (CDH29 ama 33) waa in lagu dhejiyaa lumen xiidmaha u dhow.
2. Dhamaadka-ilaa-dhamaadka anastomosis of colorectum (kanal futada) ka dib sigmoid ama dib u soo celinta malawadka: farsamada labajibbaaran anastomosis waa habka ugu badan ee loo isticmaalo labadaba laparotomy iyo dib-u-dhiska laparoscopic ee habka dheef-shiidka [11] halkan inta badan waxay soo bandhigaysaa anastomosis double dib u dhiska habka dheefshiidka.
Kanaalka xiidmaha ee u dhow waxa lagu dhejiyaa anvil stapler wareeg ah, gooyn fog ee buradana waxaa lagu xidhaa qalab goyn toosan ama qaabaysan.Cidhifka hore ee stapler-ka waa in lagu dahaadhida xalalka iodine ka hor inta aan loo dirin kanaalka futada si saliidayn iyo jeermi-dilid.Jirka aaladda waa in si tartiib tartiib ah loogu hormariyaa kanaalka futada ilaa dhamaadka hore ee aaladda si tartiib ah u taabato dhanka gudaha ee kurtka malawadka.
Fiiro gaar ah: (1) Inta lagu jiro adkaynta stapler-ka, ka ilaali mindhicirka u dhow inuu maroojiyo, haddii kale maraakiibta mesangial waa la isku cadaadi doonaa:
(2) Mesentery ee labada daraf ee anastomosis waa inaysan xor u noqon waqti aad u dheer si loo hubiyo bixinta dhiig ku filan xiidmaha;
(3) Unugyada adipose ee labada daraf ee tuubada mindhicirka ee anastomosis waa in laga saaraa si looga hortago anastomosis aan dhamaystirnayn oo ay keento unug aad u badan oo ku xiran inta lagu jiro anastomosis, laakiin waxaa fiican in aan ka badnayn qiyaasta 2cm, haddii kale waxay saameyn doontaa dhiig bixinta tuubada mindhicirka ee anastomosis;
(4) Inta lagu jiro anastomosis, waxaa lagama maarmaan ah in laga hortago unugyo kale oo aan khusayn in lagu dhejiyo stapler, gaar ahaan gidaarka dambe ee siilka bukaanka dumarka.Mawqifka gidaarka dambe ee siilka waa in la xaqiijiyaa ka hor inta aan la ridin stapler, sahaminta xubinta taranka ayaa la samayn karaa ka dib marka la dhammeeyo anastomosis;
(5) Ka dib marka anastomosis-ka la dhammeeyo, waxaa fiican in la hubiyo in anastomosis-ku uu dhammaystiran yahay "tijaabada faafinta" ama lagu duro methylene xal buluug ah iyada oo loo marayo futada, oo hubi anastomosis by baaritaanka digital ka dib qalliinka.
Inta lagu jiro anastomosis, waa in laga fogaadaa isku dhafka xargaha wareega iyo toosan stapler anastomotic, haddii kale sahayda dhiiga ee anastomosis waxay ahaan doontaa mid liidata, iyo dheecaanka anastomotic ayaa si fudud u dhici doona qaliinka ka dib.Markaad isticmaalayso mindida koronto ee soo noqnoqota, ka fogow waxyeelo soo gaadho malawadka iyo gidaarka siilka.Inkasta oo si weyn loo isticmaalo, haddana waxaa jira cillado qaarkood.Tusaale ahaan, xariiqda halbeegga ah ee stapler-ka wareegta ah iyo stapler-ka toosan waa sahlan tahay in la is dul-maro inta lagu jiro hawlgalka[12].Waa codsiga badan ee xidhitaanka tooska ah ee xidhitaanka inta lagu jiro hawlgalka, taas oo keeni doonta isku dhafka khadka anastomotic oo kordhin doona khatarta dheecaanka anastomotic [13].Jirridka iyo malawadka fog labadaba waxaa lagu tolay xadhig shandad ah, taas oo ka fogaan karta faa'iido darrada farsamada anastomosis labanlaab ah.
3. Malawadka iyo mindhicirka (canal futada) anastomosis dhamaadka-ilaa-dhinac: Jidhka stapler waxa lagu dhamaystiri karaa habka caloosha ama futada.Muhiimadda isticmaalka stapler wareeg ah (CDH33 ama 29) iyo stapler toosan Waxay samaysaa loop qaabaysan "J" ee xiidanka, kaas oo kordhiya awoodda kaydinta saxarada ee malawadka waxayna yaraynaysaa khatarta ah dheecaanka anastomotic postoperative.Brisinda iyo al.[16] waxay ogaatay in anastomosis-ka-dhinac-ilaa-dhinaca uu yahay badbaado iyo suurtagal.Dhacdooyinka dheecaanka anastomotic waa hooseeyaa, laakiin cabbirka muunada ee baaritaankani aad buu u yar yahay, tijaabooyin caafimaad oo baaxad leh ayaa weli loo baahan yahay si loo xaqiijiyo.
Kiishka mindhicirka-malawadka (kanaalka dabada) anastomosis sidoo kale waa la isticmaali karaa, iyada oo la adeegsanayo stapler goyn toosan si loo sameeyo 6-7cm J-laal dhamaadka mindhicirka xorta ah oo la saaro stapler wareeg ah (CDH29 ama 33) xagga sare si loo xidho ciddiyaha Falanqaynta maadada ayaa muujisay in, marka la barbardhigo anastomosis-da-dhinac, ma jirin farqi weyn oo la taaban karo oo u dhexeeya heerka qallafsanaanta qalliinka kadib, dhimashada, iyo saxarada inta u dhaxaysa boorsada xiidanka [15], laakiin hawlgalka boorsada gumeysiga ayaa ahaa mid adag Qaali ah Waxay ku xiran tahay dhakhtarka qalliinka inuu go'aan ka gaaro habka uu dooranayo.
Sanadihii la soo dhaafay, staplers-goynta qalooca ayaa si tartiib tartiib ah caan ugu noqday waxqabadka kiliinikada.Culimada qaarkood waxay aaminsan yihiin in dib-u-soo-celinta kansarka malawadka hoose, staplers qalooca ay fududahay in la galo godka miskaha marka loo eego staplers linear, iyo saamaynta anastomotic waa ka fiican tahay[16].Nooc kasta oo stapler ah ayaa leh astaamo iyo tilmaamo u gaar ah.Bukaanka qaba stenosis miskaha iyo burooyinka ku yaal meel hoose oo mindhicirkooda fog aan lagu gooyn karin ku filan stapler toosan, stapler arc-cuting ayaa laga yaabaa in loo tixgeliyo.Si kasta oo aad doorato stapler, waa in aad raacdaa mabda'a TME, anatomy waa in ay caddahay inta lagu jiro qaliinka, iyo goob qalliin oo wanaagsan waa in la hubiyaa.
3. Isticmaalka staplers ee qalliinka laparoscopic iyo da Vinci robotic
1. Dib u dhiska mindhicirka ee qaliinka mindhicirka mindhicirka laparoscopic: loo qaybiyay dib-u-dhiska dheef-shiid kiimikaadka laparoscopic dhamaystiran, jeexitaan yar oo gacan ka geysanaya dib-u-dhiska habka dheef-shiidka iyo dib-u-dhiska dheef-shiid kiimikaadka laparoscopic.Qalliinka laparoscopic oo dhammaystiran wuxuu isticmaalaa stapler-ka-goynta tooska ah ee kala duwan iyo staplers Ama stapler wareeg ah oo dhammaystiran laparoscopic anastomosis oo leh jeexitaan qalliin yar yar iyo goob cad oo aragti ah oo loogu talagalay bukaannada qaba soo kabashada degdegga ah, laakiin sababtoo ah goobta qalliinka oo cidhiidhi ah, shuruudaha farsamo ee sare ee dhakhtarka qalliinka, kharashka qalliinka sare. oo hadda ma jirto hab qalliin oo caadi ah oo lagu helo Qalliinka yar yar ee la jeexay ee lagu caawiyay kiliinikada ayaa ah in la jiido nudaha si ay u noqdaan anastomotic oo ka soo baxa godka caloosha, dhamaystirka dib u dhiska gudaha vitro ama gelista stapler iyadoo la kaashanayo jeex yar oo loogu talagalay anastomosis .Habka qalliinku wuxuu la mid yahay kan laparotomy.Hadda, laparoscopy-ga gacanta lagu caawiyo ayaa si weyn loo isticmaalaa.Dib-u-dhiska habka dheef-shiid kiimikaadka waa in gacanta loo fidiyaa godka caloosha iyada oo la jeexayo yar oo gidaarka caloosha ah si loo caawiyo hawlgalka anastomosis.Si kastaba ha noqotee, gacanta godka caloosha ayaa inta badan saameyn ku yeelata goobta muuqaalka ee hawlgalka laparoscopic, iyo saameynta anastomotic waa mid liidata, sidaas darteed marar dhif ah ayaa loo isticmaalaa.
2. Dib-u-dhiska kanaalka dheef-shiid kiimikaadka ee da Vinci qalliinka caloosha iyo mindhicirka ee robotic: oo la mid ah qalliinka laparoscopic ee dhaqameed ee dib-u-dhiska kanaalka dheef-shiid kiimikaadka, waxaa loo qaybin karaa jeexitaan yar oo la caawiyay iyo laparoscopic anastomosis oo buuxa.
4. Taxadarrada ku saabsan codsiga macquulka ah ee stapler:
In kasta oo stapler-ku uu u keenay hawlo kala duwan oo loogu talagalay dhakhaatiirta, haddana waxaa jira dhibaatooyin qallafsan oo qalliinka ka dambeeya kuwaas oo si xun u saameeya shaqada caadiga ah ee mareenka caloosha iyo mindhicirka , qoraagu waxa uu qabaa in qodobadan hoos ku qoran la fiirsado.
(1) Hawl-wadeenku waa inuu si fiican u yaqaanaa mabda'a shaqada iyo habka isticmaalka stapler, oo si adag u raaco tallaabooyinka hawlgalka caadiga ah;
(2) Inta lagu jiro qaliinka, waxaa lagama maarmaan ah in si taxadar leh loo hubiyo in anastomotic anastomotic uu dhamaystiran yahay, in giraantu ay dhammaatay, iyo haddii uu jiro dhiig-bax yar oo ku yaal goobta anastomotic.Marka la helo anastomosis aan dhamaystirnayn, waa in lagu hagaajiyaa tolitaanka gacanta isla markiiba ama qaybta asalka ah ee anastomotic waa in la gooyaa dib-u-dhiska kale ee habka dheef-shiidka.Waqtigan, ha qaadan fursadaha.Marka uu samaynayo anastomosis-ga gacanta, qoraagu guud ahaan waxa uu adeegsadaa habka tolnimada ee laba-lakab ah ee kala go'ay.Inkasta oo wakhtiga hawlgalka habka tolida hal lakab uu yahay mid fudud oo wakhtiga qalliinku uu gaaban yahay Xoog Sare, ma fududa in la sameeyo dheecaanka anastomotic Habka tolida joogtada ah waa sahlan tahay in la sameeyo stenosis anastomotic ka dib tolitaan joogto ah, sidaas darteed tolida la gooyay ayaa la isticmaalaa;
(3) Ku habboonstaplerwaa in lagu doortaa iyadoo loo eegayo xajmiga xubinta iyo xaaladda jireed ee bukaanka.Kahor inta aan la isticmaalin stapler, waa in la xaqiijiyaa in uu sax yahay oo aysan jirin qaybo maqan ama qaybo maqan;
(4) Dhakhtarka qalliinka waa in uu si fiican u yaqaan farsamada qalliinka ee aasaasiga ah ee tolida gacanta, sababtoo ah xaaladaha qaarkood waxaa laga yaabaa in aysan ku habboonayn anastomosis farsamada;
(5) Hubi in aysan jirin wax kacsanaan ah oo ku yimaada anastomosis oo dhiiggu uu wanaagsan yahay.Isla mar ahaantaana, xididdada dhiigga ee xudduudaha mesenteric ee maraakiibta ku wareegsan anastomosis waa in si buuxda loo xiraa, haddii kale dhiigbaxa ka dambeeya ayaa si fudud u dhacaya;
(6) Fashilka stapler anastomosis wuxuu inta badan ku dhacaa anastomosis ee hunguriga iyo caloosha ama xiidmaha yar iyo anastomosis hoose ee malawadka.Intooda badan waxaa sabab u ah goobta muuqaalka oo liidata iyo goobta shaqada oo cidhiidhi ah inta lagu jiro hawlgalka.Sidaa darteed, kala-bax cad, dib-u-eegis sax ah iyo dhiig-bax ku filan waa in la sameeyaa inta lagu jiro hawlgalka., tolku waa adag yahay.
Waqtigan xaadirka ah, staplers waxay dhamaystiri karaan ku dhawaad ​​dhammaan anastomoses-ka caloosha iyo mindhicirka, iyo falanqaynta ugu dambeysa waxay sidoo kale muujinaysaa in dib-u-dhiska habka dheef-shiidka ee qaliinka mindhicirka, anastomosis farsamaysan uu leeyahay faa'iidooyin aan la barbar dhigi karin tolida gacanta [18], laakiin anastomosis farsamadu waa kaliya anastomosis gastric Mid ka mid ah hababka anastomosis mindhicirka si buuxda uma beddeli karo tollida gacanta.Kaliya marka la raaco mabaadi'da aasaasiga ah ee qalliinka iyo maaraynta tillaabooyinka qalliinka caadiga ah ayaa dhakhaatiirta caafimaadku waxay heli karaan natiijooyin qalliin oo lagu qanco oo ay ka faa'iidaystaan ​​bukaannada.

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