Istapler entsha yeEndoscopic|Laparoscopic stapler

I-Laparoscopy eLahlwayo ye-Linear Cutter Stapler kunye neMixholo

I. Igama lemveliso, imodeli, iinkcukacha
Igama lemveliso: Ukulahlwa kwe-endoscopic linear cut stapler kunye namacandelo
Iinkcazo zemodeli:I-endoscopic linear cut stapler elahlayo: PESS35, PESS45, PESS60, PESM35, PESM45, PESM60, PESL35, PESL45, PESL60, PEPS35, PEPS45, PEPS60, PEPM35, PEPM45, PEPM60, PEPL405, PEPL65, PEPL65, PEPL65, PEPS45;
Disposable endoscopic linear cutting stapler components: PSGST35M, PSGST35W, PSGST35B, PSGST35D, PSGST35G, PSGST35T, PSGST45M, PSGST45W, PSGST45B, PSGST45D, PSGST45G, PSGST45T, PSGST60M, PSGST60W, PSGST60B, PSGST35G, PSGST60T, PSGST60B, PSGST60T, PSGST60D, PSGST60B, PSGST35G , PSGST60D, PSGST60B PPEPR60D, PPEPR60G, PPEPR60T.
II.Ukusebenza kwemveliso
I-stapler kufuneka ibekwe ngokuchanekileyo, amacandelo okutshintshwa kufuneka afaneleke, aqine, kwaye angabi nazithintelo, kwaye kufuneka kubekho izandi okanye ezinye izikhokelo xa amacandelo ekhona.Iinqununu kufuneka zilayishwe ngokuzinzileyo kwindibano, kwaye imilinganiselo akufanele ibonakaliswe kumphezulu we-cartridge yesigxina emva kokugungqa.Ukuvulwa kunye nokuvalwa kwemihlathi ye-stapler kufuneka ibe bhetyebhetye kwaye akufanele kubekho i-jamming.Isakhiwo esidibeneyo kunye nesakhiwo sokujikeleza se-stapler kufuneka siguquguquke kwaye sithintele.Uqhagamshelwano phakathi kwe-stapler body kunye namacandelo kufuneka luqine kwaye luthembeke.Emva kokuba i-stapler ijika intloko yayo kwi-angle ephezulu, inokugqiba ngempumelelo ukudubula kunye nokusetha kwakhona.Kukho i-clamping force ethile emva kokuba imihlathi ye-stapler ivaliwe, kwaye i-clamping force akufanele ibe ngaphantsi kwe-4N.Kukho amandla athile okuvala emva kokuba imihlathi ye-stapler ivaliwe, kwaye amandla okuvala akufanele abe ngaphantsi kwe-30N.Inokusebenza okuthile ngesandla esinye.I-stapler kufuneka ibe ne-stapling elungileyo kunye nokusebenza kokusika.Amacandelo anokutshintshwa angasetyenziselwa ukusika amaninzi kunye ne-stapling kwaye angabi ngaphantsi kwamaxesha e-8.Umgca wokusika emva kwe-stapling nganye kufuneka ucoceke kwaye ukhululekile kwii-burrs, kwaye ubude besiphelo se-distal somgca wesigxina kufuneka sibe side kunomgca wokusika Ubude kufuneka bube ubuncinane amaxesha angama-1.5 ubude be-nail, kunye ne-staples emva kwe-anastomosis nganye. kufuneka ibunjwe njengo "B".Umgca wesigxina emva kwe-anastomosis kufuneka ube namandla athile omgca we-suture, kwaye umgca we-staple suture amandla akufanele ube ngaphantsi kwe-0.1N / mm.I-stapler kufuneka ibe nesixhobo sokubonisa ingxelo yenkqubo yokudubula engabonisa inkqubo yokudubula okanye imeko.
III.Ulwakhiwo oluphambili
I-endoscopic yokusika i-stapler elahlayo kunye namacandelo enziwe ngumzimba kunye namacandelo, apho umzimba une-anvil, intloko edibeneyo, intonga, i-rotary knob, i-paddle yokulungisa, iqhosha lokutshintsha i-blade, i-window yesalathisi sokudubula, isalathisi se-blade Eyenziwe ngefestile yesalathisi, iqhosha lokukhulula, isibambo, isibambo sokuvala, isibambo sokudubula, ummese wokusika, kunye nesihlalo esisisigxina se-cartridge, indibano iqulethwe kwi-cartridge yesigxina kunye ne-staples.
IV.Ubungakanani besicelo
Ifanelekile ukutshatyalaliswa, ukugqithiswa kunye ne-anastomosis yemiphunga, izicubu ze-bronchial, isisu kunye namathumbu kwi-open or endoscopic operation.

Jonga i-Figure 1, i-Figure 2, iThebhile 1, kunye neThebhile 2 kwiindidi kunye nemilinganiselo eyisiseko ye-endoscopic linear cutting staplers kunye namacandelo okusika.

V. Imbonakalo yemveliso kunye nesakhiwo

1—Isitulo esichasene nezikhonkwane, 2—Intloko edibeneyo, 3—Intonga;4—Iqhosha lokujikeleza;5—Iphini lokubheqa;I-7-Ifestile yesalathisi sokudubula;8-Ifestile yesalathisi seBlade;9—Iqhosha lokukhulula;I-10-isiphatho;11-isiphatho sokuvala;I-12-isiphatho sokudubula;I-13—imela yokusika;I-14-isihlalo se-cartridge ye-nail

Umzobo 1 Umzimba we-linear cut stapler ye-endoscopy elahlayo

I-1-Staple bin 2-staple

Umzobo 2 Umgca wokusika indibano ye-stapler ye-endoscope elahlayo

Itheyibhile 1 Imilinganiselo esisiseko yomzimba

Itheyibhile 1 Imilinganiselo esisiseko yomzimba

Qaphela: Amacandelo anobude obuhambelanayo be-35 angasetyenziselwa kuphela umzimba onobude obuhambelanayo be-35, amacandelo anobude obuhambelanayo be-45 angasetyenziselwa kuphela umzimba onobude obuhambelanayo be-45, kunye namacandelo ane ubude obuhambelanayo be-60 bunokusetyenziswa kuphela ubude obuhambelanayo Umzimba ngama-60.

Itheyibhile 2 Iyunithi yomlinganiselo osisiseko wamacandelo: mm

VI.Contraindications
1).i-edema ye-mucosal enzima;
2).Akuvumelekanga ngokungqongqo ukusebenzisa esi sixhobo kwisibindi okanye i-spleen tissue.Ngenxa yeempawu ezixinzelelekileyo zezicubu ezinjalo, ukuvalwa kweso sixhobo kunokuba nefuthe elibi;
3).Ayinakusetyenziswa kwiindawo apho i-hemostasis ingabonwa;
4).Amacandelo ampunga awanakusetyenziselwa izicubu ezinobunzima obungaphantsi kwe-0.75mm emva kokunyanzeliswa okanye kwizicubu ezingenako ukunyanzeliswa ngokufanelekileyo kubunzima be-1.0mm;
5).Amacandelo amhlophe awanakusetyenziselwa izicubu ezinobunzima obungaphantsi kwe-0.8mm emva kokunyanzeliswa okanye izicubu ezingenakunyanzeliswa ngokufanelekileyo kubunzima be-1.2mm;
6).Icandelo elihlaza okwesibhakabhaka akufanele lisetyenziselwe izicubu ezingaphantsi kwe-1.3mm ubukhulu emva kokunyanzeliswa okanye ezingenakunyanzeliswa ngokufanelekileyo kubunzima be-1.7mm.
7).Izixhobo zegolide azikwazi ukusetyenziselwa izicubu ezinobunzima obungaphantsi kwe-1.6mm emva kokunyanzeliswa okanye izicubu ezingenakunyanzeliswa ngokufanelekileyo kubunzima be-2.0mm;
8).Icandelo eliluhlaza akufanele lisetyenziselwe izicubu ezingaphantsi kwe-1.8mm ubukhulu emva kokunyanzeliswa okanye ezingenakunyanzeliswa ngokufanelekileyo kubunzima be-2.2mm.
9).Icandelo elimnyama akufanele lisetyenziselwe izicubu ezingaphantsi kwe-2.0mm ubukhulu emva kokunyanzeliswa okanye ezingenako ukunyanzeliswa ngokufanelekileyo kubunzima be-2.4mm.
10).Akuvunyelwe ngokungqongqo ukusebenzisa kwi-tissue kwi-aorta.

VII.Kusetyenziswa kwanjani
Imiyalelo yofakelo lwekhatriji esisiseko:
1).Khupha isixhobo kunye ne-staple cartridge kwiipakethi zabo phantsi komsebenzi we-aseptic;
2).Ngaphambi kokulayisha i-cartridge yesigxina, qinisekisa ukuba isixhobo sikwimeko evulekileyo;
3).Jonga ukuba i-staple cartridge inesikhuselo sokhuselo.Ukuba i-cartridge ye-staple ayinayo isikhuselo sokukhusela, ayivunyelwe ukuyisebenzisa;
4).Namathisela i-cartridge yesigxina phantsi kwesihlalo se-staple staple cartridge, yifake ngendlela ehambisayo kuze kube yilapho i-cartridge yesigxina ihambelana ne-bayonet, lungisa i-cartridge ye-staple endaweni kwaye ukhuphe isikhuselo sokukhusela.Ngeli xesha, isixhobo sikulungele ukutshisa;(Qaphela: Phambi kokuba i-staple cartridge ifakwe endaweni, nceda ungasisusi isigqubuthelo sokhuselo sekhatriji.)
5).Xa ukhulula i-cartridge ye-staple, tyhala i-cartridge ye-staple ukuya kwicala lesihlalo se-nail ukuze uyikhulule kwi-staple cartridge seat;
6).Ukufakela i-cartridge entsha, phinda amanyathelo 1-4 ngasentla.

Imiyalelo yoqhaqho:
1).Vala isibambo sokuvala, kwaye isandi esithi "cofa" sibonisa ukuba isibambo sokuvala sivaliwe, kwaye i-occlusal surface ye-cartridge ye-staple ikwimeko evaliweyo;Qaphela: Musa ukubamba isiphatho sokudubula ngeli xesha
2).Xa ungena kwindawo yomzimba nge-cannula okanye i-incision ye-trocar, i-occlusal surface yesixhobo kufuneka idlule kwi-cannula ngaphambi kokuba i-occlusal surface ye-cartridge ye-staple ingavulwa;
3).Isixhobo singena kumngxuma womzimba, cofa iqhosha lokukhulula, vula i-occlusal surface yesixhobo, kwaye usete kwakhona isibambo sokuvala.
4).Jikela iqhosha elijikelezayo ngomnwe wakho wesalathisi ukuze ujikeleze, kwaye unokulungiswa kwii-360 degrees;
5).Khetha indawo efanelekileyo (efana nesakhiwo somzimba, ilungu okanye esinye isixhobo) njengomphezulu woqhagamshelwano, tsala i-paddle yokulungisa umva ngomnwe wesalathisi, sebenzisa amandla okuphendula kunye nomphezulu wokudibanisa ukulungelelanisa i-angle yokugoba efanelekileyo, kwaye uqinisekise ukuba Ikhatriji esisiseko ingaphakathi kwibala lombono.
6).Lungisa ukuma kwesixhobo kwi-tissue ukuba i-anastomosed / cut;
Qaphela: Qinisekisa ukuba i-tissue ibekwe emcaba phakathi kweendawo ze-occlusal, akukho zithintelo kwi-occlusal surfaces, njengeziqeshana, izibiyeli, iingcingo zesikhokelo, njl., kwaye indawo ifanelekile.Kuthintele ukusikwa okungaphelelanga, iistaples ezingakhiwanga kakuhle, kunye/okanye ukungaphumeleli ukuvula umphezulu oclusal wesixhobo.
7).Emva kokuba isixhobo sikhethe i-tissue ukuba i-anastomosed, vala isibambo de ivalwe kwaye uve / uzive "cofa" isandi;
8).Isixhobo sokudubula.Sebenzisa "3+1" imowudi ukwenza umsebenzi wokusika kunye nokuthunga ngokupheleleyo;“3″: bamba isibambo sokudubula ngokupheleleyo ngeentshukumo ezigudileyo, kwaye usikhulule de silingane nesiphatho sokuvala.Kwangaxeshanye, qaphela ukuba inani elikwifestile yesalathiso sokudubula “1” “Oku kukubetha, inani liya kwanda ngo”1” ngesibetho ngasinye, imivumbo emi-3 elandelelanayo, emva kokubetha kwesithathu, iblade. isalathiso sefestile yeefestile kumacala omabini esiphatho esisisigxina esimhlophe siya kwalatha kwisiphelo esisondeleyo sesixhobo, esibonisa ukuba imela ikwimowudi yokuBuyisa, ubambe kwaye ukhulule isiphatho sokudubula kwakhona, iwindow yesalathisi iya kubonisa 0, ebonisa ukuba imela ibuyele kwindawo yayo yokuqala;
9).Cinezela iqhosha lokukhulula, vula umphezulu we-occlusal, kwaye usete kwakhona isiphatho sokudubula somqheba wokuvala;
Qaphela: Cinezela iqhosha lokukhulula, ukuba indawo ye-occlusal ayivuli, qinisekisa kuqala ukuba iwindow yesalathisi ibonisa "0" kwaye ingaba iwindow yesalathiso seblade ikhomba kwicala elikude lesixhobo ukuqinisekisa ukuba imela ikwisiqalo. isikhundla.Kungenjalo, kufuneka utyhale iqhosha lokutshintsha kwecala leblade umva icala leblade, kwaye ubambe ngokupheleleyo isiphatho sokudubula de silingane nesiphatho sokuvala, kwaye emva koko ucinezele iqhosha lokukhulula;
10).Emva kokukhulula izicubu, khangela umphumo we-anastomosis;
11).Vala isiphatho sokuvala kwaye ukhuphe isixhobo.

VIII.Ukugcinwa kwemveliso kunye neendlela zokulondoloza

1. Ugcino: Gcina kwigumbi elinobumanzi obungekho ngaphezulu kwama-80%, elingena umoya, kwaye akukho zigesi ezidliwayo.
2. Ukuthutha: Imveliso epakishweyo inokuthuthwa ngezixhobo eziqhelekileyo.Ngexesha lokuthutha, kufuneka liphathwe ngononophelo kwaye ugweme ukukhanya kwelanga, ukungqubana okunobundlobongela, imvula kunye ne-gravity extrusion.
IV.Umhla WOKUPHELELWA
Emva kokuba imveliso ifakwe inzala nge-ethylene oxide, ixesha lokuvala inzala yiminyaka emithathu, kwaye umhla wokuphelelwa yisikhathi uboniswa kwileyibhile.

X. Uluhlu lwamacandelo
akukho nanye

XI, iZilumkiso, izilumkiso
1. Xa usebenzisa le mveliso, iinkcukacha zokusebenza kwe-aseptic kufuneka zilandelwe ngokungqongqo;
2. Nceda uhlolisise ukupakishwa kwale mveliso ngononophelo ngaphambi kokusetyenziswa, ukuba ukupakishwa kwe-blister konakaliswe, nceda uyeke ukuyisebenzisa;
3. Le mveliso ifakwe inzalo nge-ethylene oxide, kwaye imveliso eyenziwe inzalo isetyenziselwa ukusetyenziswa kweklinikhi.Nceda ujonge isalathisi sedisk kwibhokisi yokupakisha yokuvala inzala yale mveliso, “ibhlowu” ithetha ukuba imveliso ivalwe inzala kwaye ingasetyenziswa ngokuthe ngqo eklinikhi;
4. Le mveliso isetyenziselwa umsebenzi omnye kwaye ayikwazi ukuvalwa inzala emva kokusetyenziswa;
5. Nceda ujonge ukuba imveliso ingaphakathi kwexesha elisemthethweni ngaphambi kokusetyenziswa.Ixesha lokuqinisekisa ukuvala inzala yiminyaka emithathu.Iimveliso ezingaphaya kwexesha lokuqinisekisa zithintelwe ngokungqongqo;
6. Indibano yokusika i-laparoscopic eveliswe yinkampani yethu kufuneka isetyenziswe ngokubambisana nohlobo oluhambelanayo kunye neenkcukacha ze-laparoscopy ezilahlwayo zelinear cut stapler eziveliswe yinkampani yethu.Jonga iTheyibhile 1 kunye neTheyibhile 2 ngeenkcukacha;
7. Imisebenzi ehlaselayo kancinane kufuneka yenziwe ngabantu abafumene uqeqesho olwaneleyo kwaye abaqhelene neendlela zokuhlasela ezingephi.Ngaphambi kokwenza naluphi na utyando olungephi, uncwadi lwezonyango olunxulumene nobuchwephesha, iingxaki zalo kunye neengozi kufuneka kujongwe;
8. Ubungakanani besixhobo esingenabuncinci esivela kubavelisi abahlukeneyo bunokwahluka.Ukuba izixhobo zotyando ezihlaselayo ezincinci kunye nezixhobo zazo eziveliswe ngabavelisi abohlukeneyo zisetyenziswa kumsebenzi omnye ngexesha elinye, kuyafuneka ukuba kujongwe ukuba ziyahambelana na phambi kokusebenza;
9. Unyango lwemitha phambi kotyando lunokubangela utshintsho kwizicubu.Ngokomzekelo, olu tshintsho lunokubangela ukuqina kwezicubu ngaphaya koko kuchaziweyo kwi-staple ekhethiweyo.Naluphi na unyango lwesigulane ngaphambi kokuhlinzwa kufuneka luqwalaselwe ngokucophelela kwaye lunokufuna utshintsho kwindlela yotyando okanye indlela;
10 Musa ukulikhulula iqhosha de isixhobo sikulungele ukuvutha;
11. Qiniseka ukuba ujonga ukhuseleko lwekhatriji esisiseko phambi kokuba udubule;
12. Emva kokudubula, qiniseka ukuba uhlolisise i-hemostasis kumgca we-anastomotic, khangela ukuba i-anastomosis iphelile kwaye kukho ukuvuza;
13. Qinisekisa ukuba ubukhulu bezicubu bungaphakathi koluhlu oluchaziweyo kwaye izicubu zisasazwa ngokulinganayo ngaphakathi kwe-stapler.Izicubu ezininzi kwicala elinye zinokubangela i-anastomosis embi, kwaye ukuvuza kwe-anastomotic kunokwenzeka;
14. Kwimeko yokugqithisa okanye izicubu ezinobunzima, ukuzama ukunyanzelisa i-trigger kunokubangela i-sutures engaphelelanga kunye nokuqhekeka kwe-anastomotic okanye ukuvuza.Ukongezelela, umonakalo wesixhobo okanye ukungaphumeleli komlilo kunokwenzeka;
15. Makugqitywe ukudubula omnye.Ungaze usitshise isixhobo eso.Ukudubula okungaphelelanga kunokubangela ukuba i-staples eyenziwe ngokungafanelekanga, umgca wokusika ongaphelelanga, ukuphuma kwegazi kunye nokuvuza kwi-suture, kunye / okanye ubunzima bokukhupha isixhobo;
16. Qinisekisa ukuba uvutha umlilo ukuya ekupheleni ukuqinisekisa ukuba i-staples yenziwe ngokuchanekileyo kwaye i-tissue inqunywe ngokuchanekileyo;
17. Cinezela isibambo sokudubula ukuze uveze i-blade yokusika.Musa ukucinezela isibambo ngokuphindaphindiweyo, okuya kubangela umonakalo kwindawo ye-anastomosis;
18. Xa ufaka isixhobo, qinisekisa ukuba ukhuseleko lukwindawo evaliweyo ukuze ugweme ukusebenza ngokungalindelekanga kwesixhobo sokudubula, okukhokelela ekuvezweni kwe-blade ngengozi kunye nokuhanjiswa kwangaphambi kwexesha okanye ngokupheleleyo kwe-staples;
19. Amaxesha amaninzi okudubula ale mveliso ngamaxesha angama-8;
20. Ukusebenzisa esi sixhobo kunye nezixhobo zokuqinisa umgca we-anastomotic kunokunciphisa inani lokudubula;
21. Le mveliso sisixhobo esisodwa sokusetyenziswa.Nje ukuba isixhobo sivulwe, akukhathaliseki nokuba siyasetyenziswa okanye asisetyenziswa, asinakuphinda sivalwe iintsholongwane.Qinisekisa ukuba usitshixa isitshixo sokhuseleko phambi kokuphatha;
22. Ikhuselekile phantsi kweemeko ezithile ze-nuclear magnetic resonance (MR):
·Uvavanyo olungelulo olwasekliniki lubonisa ukuba iistaples ezimiliselweyo ezinomgangatho we-TA2G we-TA2G zingasetyenziselwa uMR ngokwemiqathango.Izigulana zinokuskenwa ngokukhuselekileyo ngoko nangoko emva kokufakwa ngokusisiseko kwezi meko zilandelayo:
·Uluhlu lwemagnethi emileyo luphakathi kwe-1.5T-3.0T kuphela.
Obona bukhulu bokuthambeka kommandla wemagnethi yi-3000 gauss/cm okanye ngaphantsi.
·Inkqubo enkulu ye-MR exeliweyo, ukuskena imizuzu eyi-15, umlinganiselo wokufunxa umzimba wonke (SAR) yi-2 W/kg.
·Phantsi kweemeko zokuskena, ukunyuka kweqondo lobushushu eliphezulu kulindeleke ukuba kube yi-1.9°C emva kokuskena imizuzu eyi-15.
Ulwazi lwe-Artifact:
Xa kuvavanywa ngokungekho kliniki kusetyenziswa umfanekiso we-gradient echo pulse sequence kunye ne-static magnetic field 3.0T inkqubo ye-MR, iziseko zibangele izinto zakudala malunga ne-5 mm ukusuka kwindawo yofakelo.
23. Jonga ileyibhile yomhla wemveliso;