Ukukhethwa kunye nokusetyenziswa okunengqiqo kwe-Stapler ekusebenzeni kweGastrointestinal

Ukukhethwa kunye nokusetyenziswa okunengqiqo kwe-Stapler ekusebenzeni kweGastrointestinal
UChen Lin, uBian Shibo

Kwiminyaka yakutshanje, ukuhambela phambili kwezixhobo zotyando kuye kwakhuthaza kakhulu ukwenziwa kotyando lwale mihla.Kwintsimi yotyando lwesisu, ukuvela kunye nokuthandwa kwe-staplers kuye kwaphakamisa i-anastomosis yesisu kwinqanaba elitsha.Xa kuthelekiswa ne-suture manual yendabuko, ukusetyenziswa kwe-staplers Ukwakhiwa ngokutsha kwendlela yokugaya eyenziwa kunokunciphisa kakhulu ixesha lokusebenza, ukunciphisa kakhulu umonakalo wezicubu kunye nokopha, ngaloo ndlela kuncitshiswe ubude obuqhelekileyo bokulaliswa esibhedlele "Okwangoku, oogqirha abaninzi nangakumbi bakhetha ukukhetha i-anastomosis ye-mechanical in umsebenzi weklinikhi.Nangona kunjalo, i-anastomosis kutyando lwesisu Njengomnye wezinto ezintathu eziphambili ezichaphazela i-anastomosis yesisu, ugqirha ngokwawo udlala indima ebalulekileyo ekukhetheni i-stapler kunye nokubamba ubuchule bokusebenza, kunye nempumelelo ye-anastomosis nayo inxulumene nayo.Ngokusondeleleneyo 2 Eli nqaku liza kuthetha ngezimvo zam malunga nokukhetha kunye nokusetyenziswa okunengqiqo kwe-staplers kwiinkqubo zotyando eziqhelekileyo zotyando lwesisu kunye nomhlaza.
1. Ukuhlelwa kweestaplers
Kukho iintlobo ezininzi ze-staplers, ezinokuthi zohlulwe zibe yi-press-fit type kunye ne-staple-type ngokomgaqo wokusebenza.Ngokwemilo ye-stapler, inokwahlulwa ibe yi-stapler-cut-cut stapler, i-circular-cut stapler, i-arc-cut stapler, i-button-shaped stapler kunye ne-paperclip-shaped stapler.
2. Ukusetyenziswa kwe-staplers kwi-laparotomy
(1) Ukukhethwa kunye nokusetyenziswa kwe-staplers kwi-gastric surgery
1. I-Gastrectomy esondeleyo: I-Circular stapler (CDH25) isetyenziselwa ngokubanzi i-esophagogastric anastomosis, kunye ne-linear cutting stapler (TLC10) isetyenziselwa i-gastric anastomosis.Uphononongo lubonise ukuba ukusetyenziswa kwe-25mm stapler kwi-esophagus kunye ne-gastrointestinal anastomosis kunokunciphisa ukuvela kweengxaki ze-postoperative 3 Kodwa oku akunjalo ngokupheleleyo.Umsebenzisi kufuneka amisele uhlobo lwe-stapler ngokobubanzi bangaphakathi bommizo.Ukubunjwa kwezicubu ukunciphisa ukopha kwe-anastomotic Musa ukutsala nzima xa i-stapler ihoxisa, ngakumbi xa i-incision ingagqibekanga, inokubangela ukuba i-anastomotic avulsion ibe lula.
Ngenxa yokuma kwe-anatomical enzulu yommizo, indawo yokubona ye-intraoperative imbi, i-anastomosis inzima, isiphelo esaphukileyo somqala kulula ukusikrazula, kwaye izehlo zokuvuza kwe-anastomotic ziphezulu.Noko ke, oku kuye kwabangela impikiswano.Ngokwethiyori, ukuqiniswa kwe-suture kunokwenza i-anastomosis igqibelele kwaye inciphise ukuvela kokuvuza kwe-anastomotic emva kokusebenza.Kulula ukwenza i-anastomotic stenosis Amava ombhali kukuba ukhetho kufuneka lwenziwe ngokwemeko ye-anastomotic ngexesha lokusebenza.Ukuba ibala elibonakalayo licacile ngexesha le-anastomosis, i-esophagus ikhululekile, i-hemostasis iphelile, kwaye umphumo we-anastomotic uyanelisayo, ukuqiniswa kwe-suture akufuneki;ukuba i-anastomotic incomplete okanye ukopha kwe-anastomotic kufunyenwe ngexesha lokusebenza, i-Seromuscular layer suture ingasetyenziselwa ukuqinisa i-suture.Ngokuqhelekileyo, i-suture e-absorbeble (uhlobo lwe-3-0 okanye i-4-0) ikhethiwe.Ngenxa yeziganeko eziphezulu zokusabela komzimba wangaphandle kwi-silika anastomosis, kulula ukwenza i-ulcer edema kunye nokopha kwi-anastomosis[4] intambo yesilika, nokuba yi-3-0 okanye i-1-gauge yocingo lunokusetyenziswa.
Nangona i-reflux yesisu isenzeka kumaxesha ngamaxesha emva kwe-esophagogastric anastomosis, echaphazela umgangatho wobomi bezigulane, kodwa izigulane ezininzi azinazo iimpawu ezicacileyo, ngoko olu tyando lusasetyenziswa rhoqo kwiklinikhi[5]
2. I-Distal gastrectomy: I-Bi-type gastroduodenal end-to-side okanye end-to-end anastomosis Bi-type II gastrojejunostomy kunye ne-Roux-en-Y gastrojejunostomy zisetyenziswa kakhulu.
Kuhlobo lwe-Bi I, i-circular stapler (CDH25) kunye ne-linear cutting stapler (TLC10) isetyenziselwa i-anastomosis.Abanye abaphengululi bacebisa i-anastomosis yokuphela ukuya ekupheleni kwe-gastroduodenum, ukuze uxinzelelo lwe-anastomosis luncinci[6] Ukuba uxinzelelo lwe-anastomosis lukhulu Umngcipheko wokuvuza kwe-anastomotic emva kokuhlinzwa uya kwanda [7] Umbhali ukholelwa ukuba nangona umsebenzi I-anastomosis yokuphela kokuphela iyinkimbinkimbi, nje kuphela ukunikezelwa kwegazi okwaneleyo kunye ne-anastomosis engenazo uxinzelelo, iziganeko zeengxaki ze-postoperative zeendlela ezimbini ze-anastomotic ziyafana.Akukho mahluko ubalulekileyo.
Kuhlobo lwe-Bi II, i-stapler yesetyhula (CDH25) isetyenziselwa i-anastomosis, kunye ne-linear cutting stapler nayo ingasetyenziswa.Umbhali usetyenziselwa ukusebenzisa le yokugqibela ukugqiba i-gastrojejunum anastomosis.I-endoscopic linear cutting stapler (6TB45) ingasetyenziselwa ukusika i-duodenum.I-stapler ine-6 ​​iyonke imiqolo ye-staples, kwaye umsebenzi we-suture hemostasis ulungile, kwaye akukho lula ukwenza i-duodenal stump fistula kunye nokopha emva kokuhlinzwa.Ukuba i-duodenal stump i-edematous, i-suture ye-manual ingasetyenziselwa, kwaye ke i-6TB45 ingasetyenziselwa ukugqiba icala le-gastrojejunal Kwi-anastomosis ye-lateral, ingqalelo kufuneka ihlawulwe kumda we-mesenteric we-jejunum kunye nodonga lwesisu sesisu esiseleyo.Musa ukuzisa izicubu ze-mesenteric kwi-anastomosis.Kwiingxaki emva kohlobo lwe-II anastomosis, i-jejunum anastomosis ecaleni kwecala (i-Braun anastomosis) inokongezwa kule siseko.Emva kohlobo lwe-III i-anastomosis, i-alkaline reflux gastritis kunye ne-anastomotic stomatitis zivame ukwenzeka, ngoko umbhali usebenzisa i-Bi-I okanye i-Roux-en-Y anastomosis.
I-Gastrojejunum Roux-en-Y anastomosis inokusebenzisa i-staplers ezimbini ezijikelezayo (CDH25) ukugqiba i-anastomosis phakathi kwejejunum kunye ne-gastrojejunum, okanye isebenzise i-linear cut stapler ukwenza i-anastomosis yecala ukuya kwicala le-distal jejunum kunye nesisu esiseleyo ngokusebenzisa phambi kwekholoni.Qaphela ukuba isalathiso se-distal jejunum stump siphezulu, kwaye isalathiso se-proximal jejunum stump kufuneka sibe phezulu ngexesha le-side-to-side anastomosis ye-jejunum.Ukukrazula kwe-mesenteric ekupheleni kwejejunum kunokuvalwa kunye ne-3-0 ye-silk suture.
3. Iyonke i-gastrectomy: I-Esophagojejunostomy, ukutshintshwa kwejejunum yesisu, ukutshintshwa kwekholoni yesisu kunye ne-esophagojejunum Roux-en-Y?Ubunzima, umgangatho ophantsi wobomi bezigulane Ukutshintshwa kwesisu kunokuphucula kakhulu umgangatho wobomi bezigulane, kodwa utyando luyinkimbinkimbi ye-Esophagus-jejunum Roux-en-Y anastomosis inzima ngokulinganayo kwaye inokuphucula iimpawu ze-reflux Ukukhetha indlela efanelekileyo yokwakha kwakhona, umbhali ucebisa Roux-en-Y anastomosis yommizo kunye jejunum.I-stapler ye-circular (CDH25) ingasetyenziselwa ukugqiba i-anastomosis ye-end-to-side ye-esophagus yangaphambili kunye ne-jejunum, kunye ne-stapler yokusika umgca (njenge-6TB45) ingasetyenziselwa ukugqiba i-anastomosis yecala ukuya kwicala le-proximal. kunye ne-distal jejunum.Isiphunzi sejejunum savalwa nge6TB45.
Ukusetyenziswa kwe-staplers yesetyhula kwi-gastrojejunostomy kunye ne-esophagojejunostomy yamkelwe ngokubanzi, kwaye abaninzi oogqirha bakhetha ukusebenzisa i-staplers ejikelezayo kutyando oluvulekileyo [8-9] Inaba et al.!Kubikwa ukuba umphumo we-gastrojejunal anastomosis usebenzisa i-linear stapler phantsi kwe-laparoscopy ilungile.Umbhali ukhetha i-linear stapler okanye i-stapler phantsi kotyando lwe-laparoscopic yokwakhiwa ngokutsha kwendlela yokugaya kwi-laparotomy.
ngokuba:
(1) Olu hlobo lwesixhobo lufanelekile kwaye lulula ukusebenza, luthintela amanyathelo okusebenza anzima afana nokufakela i-anvil ye-purse string suture anvil kunye ne-stapler ejikelezayo edlula kumqolo wamathumbu;
(2) I-anastomosis ayikhawulelwanga yi-lumen diameter;
(3) Kukho ukopha okuncinci ngexesha le-anastomosis, kwaye akulula ukwenza umonakalo we-tissue weenyembezi okanye i-anastomosis engaphelelanga ngexesha le-anastomosis;
(4) Lifutshane ixesha lokusebenza:
(5) Xa kuthelekiswa ne-stapler yesetyhula, i-stapler yomgca idinga kuphela ukutshintsha i-cartridge yesigxina xa isetyenziswe ngamaxesha amaninzi ngexesha lokusebenza, okunciphisa iindleko zokusebenza.Xa kuthelekiswa ne-stapler yesetyhula, nokuba inokunciphisa iziganeko zeengxaki ze-postoperative, Ukuqinisekiswa kweklinikhi okuqhubekayo kuseza kwenziwa.
(2) Ukukhethwa kunye nokusetyenziswa kwe-staplers kwi-colorectal surgery
1. Ukuphela kwe-anastomosis ye-ileocolon emva kwe-hemicolectomy yasekunene: i-stapler ejikelezayo (i-CDH29 okanye i-33) ingasetyenziselwa ukugqiba i-anastomosis yokuphela kwe-ileocolon, kunye nokuvalwa komgca ochanekileyo (TL60 okanye i-TLC75) ingakwazi zikwasetyenziselwa ukuvala isiphunzi sekholoni enqamlezayo.(TLC75) I-anastomosis yecala ukuya kwicala le-colon eguquguqukayo ye-ileum Kwi-anastomosis yokuphela ukuya kwicala phakathi kwekholoni ye-transverse okanye ikholoni ye-hemicolectomy ekhohlo, i-stapler ye-circular (CDH29 okanye i-33) kufuneka ifakwe kwi-lumen yamathumbu ejikelezayo.
2. Ukuphela kokuphela kwe-anastomosis ye-colorectum (i-anal canal) emva kwe-sigmoid okanye i-rectal resection: i-double anastomosis technique yeyona ndlela isetyenziswa kakhulu kuzo zombini i-laparotomy kunye ne-laparoscopic reconstruction of digestive tract [11] apha ikakhulu yazisa i-double anastomosis Transanal approach for ukwakhiwa ngokutsha kwendlela yokugaya.
I-intestinal intestinal canal ifakwe kwi-anvil ye-stapler ejikelezayo, kwaye i-distal pre-cut ye-tumor ivalwe nge-stapler yokusika eqondileyo okanye e-arc.Isiphelo esingaphambili se-stapler kufuneka sigqunywe ngesisombululo se-iodine ngaphambi kokuba sithunyelwe kwi-anal canal ukuze kuthanjiswe kunye nokubulala iintsholongwane.Umzimba wesixhobo kufuneka uhambele phambili kancinane kumjelo wangaphambili de umphambili wesixhobo uchukumise ngobunono icala elingaphakathi lesiphunzi se-rectal.
Qaphela: (1) Ngexesha lokuqiniswa kwe-stapler, thintela amathumbu ajikelezayo ukuba angajiki, ngaphandle koko iinqanawa ze-mesangial ziya kunyanzeliswa:
(2) I-mesentery kwiziphelo zombini ze-anastomosis akufanele ikhululeke ixesha elide ukuqinisekisa ukunikezelwa kwegazi okwaneleyo emathunjini;
(3) Izicubu ze-adipose kuzo zombini iziphelo zombhobho wamathumbu kwi-anastomosis kufuneka zisuswe ukukhusela i-anastomosis engaphelelanga ebangelwa yizicubu ezininzi ezifakwe ngexesha le-anastomosis, kodwa kungcono ukuba ungadluli uluhlu lwe-2cm, ngaphandle koko kuya kuchaphazela ukunikezelwa kwegazi kumbhobho wamathumbu kwi-anastomosis;
(4) Ngexesha le-anastomosis, kuyimfuneko ukukhusela ezinye izicubu ezingabalulekanga ukuba zifakwe kwi-stapler, ngokukodwa udonga lwangasemva lwezigulane zabasetyhini.Isikhundla sodonga lwangasese lwangasemva kufuneka luqinisekiswe ngaphambi kokuba i-stapler igxothwe, kwaye ukuhlolwa kwangasese kunokwenziwa emva kokuba i-anastomosis igqityiwe;
(5) Emva kokuba i-anastomosis igqityiwe, kukulungele ukujonga ukuba i-anastomosis igqitywe "ngovavanyo lwe-inflating" okanye ukujova isisombululo se-methylene eluhlaza okwesibhakabhaka nge-anus, kwaye ukhangele i-anastomosis ngoviwo lwedijithali emva kokusebenza.
Ngexesha le-anastomosis, ukugqithwa kweesetyhula kunye nemigca ye-stapler ye-anastomotic kufuneka kugwenywe, ngaphandle koko ukunikezelwa kwegazi kwi-anastomosis kuya kuba nzima, kwaye ukuvuza kwe-anastomotic kuya kwenzeka ngokulula emva kokusebenza.Xa usebenzisa imela yombane ejikelezayo, kunqande umonakalo kwi-rectum kunye nodonga lobufazi.Nangona isetyenziswa ngokubanzi, kusekho iziphene.Ngokomzekelo, umgca wesigxina se-stapler yesetyhula kunye ne-stapler yomgca kulula ukugqithela ngexesha lokusebenza[12].Kukusetyenziswa okuphindaphindiweyo kokuvalwa komgca wokusika ngexesha lokusebenza, okuya kubangela ukugqithwa komgca we-anastomotic kunye nokwandisa umngcipheko wokuvuza kwe-anastomotic[13].Zombini isiphunzi kunye ne-distal rectum zaxhonywa ngemitya yesipaji, enokuthi ithintele ubugwenxa bobuchule be-anastomosis ephindwe kabini.
3. Ukukhutshwa kwe-rectal kunye ne-colorectal (i-anal canal) ekupheleni kwe-anastomosis: Umzimba we-stapler unokugqitywa nge-abdominal or anal approach.Ukubaluleka kokusebenzisa i-circular stapler (CDH33 okanye i-29) kunye ne-linear stapler Yenza i-loop ye-"J" efana ne-colon, eyandisa amandla okugcina i-feces ye-rectum kunye nokunciphisa umngcipheko wokuvuza kwe-anastomotic emva kokusebenza.Brisinda et al.[16] yafumanisa ukuba isiphelo se-anastomosis sikhuselekile kwaye sinokwenzeka.Izehlo zokuvuza kwe-anastomotic zisezantsi, kodwa ubungakanani besampulu yolu vavanyo mncinci kakhulu, kwaye ulingo olukhulu lwezonyango lusafuneka ukuze kuqinisekiswe.
I-Colonic pouch-rectal (i-anal canal) i-anastomosis nayo ingasetyenziselwa, usebenzisa i-stapler yokusika i-linear ukwenza i-6-7cm J-fold kwi-colon yamahhala ekupheleni kunye nokubeka i-stapler ejikelezayo (CDH29 okanye i-33) phezulu ukuze ibambelele isikhonkwane. Uhlalutyo lwe-meta lubonise ukuba, xa kuthelekiswa ne-anastomosis yokuphela ukuya kwicala, akukho mahluko abalulekileyo kwi-postoperative rate, ukufa, kunye nomsebenzi wokuhlamba phakathi kwe-colonic pouch [15], kodwa ukusebenza kwesingxobo sekholoni kwakunzima kwaye iindleko Kuxhomekeke kugqirha wotyando ukuba athathe isigqibo sokuba yeyiphi na indlela.
Kwiminyaka yakutshanje, ii-staplers zokusika ezigobileyo ziye zaduma ngokuthe ngcembe kuqheliselo lweklinikhi.Abanye abaphengululi bakholelwa ukuba kuhlaza olusezantsi lomhlaza we-rectal, i-staplers egobileyo kulula ukungena kwi-pelvic cavity kune-linear staplers, kwaye umphumo we-anastomotic ungcono[16].Uhlobo ngalunye lwe-stapler luneempawu zalo kunye nezibonakaliso.Kwizigulane ezine-pelvic stenosis kunye ne-tumors ezibekwe kwindawo ephantsi kwaye i-distal intestinal tract ayinakunqunyulwa ngokwaneleyo nge-linear stapler, i-arc-cutting stapler inokuqwalaselwa.Kungakhathaliseki ukuba yeyiphi i-stapler oyikhethayo, kufuneka Umgaqo we-TME kufuneka ulandelwe, i-anatomy kufuneka icace ngexesha lokusebenza, kwaye inkalo efanelekileyo yokuhlinzwa kufuneka iqinisekiswe.
3. Ukusetyenziswa kwe-staplers kwi-laparoscopic kunye ne-da Vinci robotic surgery
1. Ukwakhiwa ngokutsha kwesisu sotyando lwe-laparoscopic yesisu: yahlulahlulwe yaba yi-laparoscopic epheleleyo yokwakhiwa ngokutsha kwe-digestive tract, i-incision encinci incedise ukwakhiwa ngokutsha kwe-digestive tract kunye nokwakhiwa kwakhona kwe-laparoscopic digestive tract tract.Umsebenzi opheleleyo we-laparoscopic usebenzisa i-staplers yokusika ehlukeneyo kunye ne-staplers Okanye i-stapler yesetyhula epheleleyo ye-laparoscopic anastomosis kunye ne-incision encinci yotyando kunye nombono ocacileyo wezigulana ezinokuchacha ngokukhawuleza, kodwa ngenxa yendawo yokusebenza emxinwa, iimfuno eziphezulu zobugcisa kugqirha wotyando, iindleko eziphezulu zotyando, kwaye okwangoku akukho ndlela yotyando eqhelekileyo yokufumana Umsebenzi omncinci owamkelwa ekliniki kukutsala izicubu ukuba zibe yi-anastomotic ngaphandle komngxuma wesisu, ukugqiba ukwakhiwa ngokutsha kwe-in vitro okanye ufake i-stapler phantsi koncedo lwe-anastomosis encinci. .Indlela yokusebenza iyafana naleyo yelaparotomy.Okwangoku, i-laparoscopy encediswa ngesandla isetyenziswa ngokubanzi.Ukwakhiwa kwakhona kwendlela yokugaya kukwandisa isandla kwisigxina sesisu ngokusikeka okuncinci kudonga lwesisu ukuncedisa ekusebenzeni kwe-anastomosis.Nangona kunjalo, isandla kwisigxina sesisu sihlala sichaphazela intsimi yokujonga umsebenzi we-laparoscopic, kwaye umphumo we-anastomotic umpofu, ngoko awufane usetyenziswe.
2. Ukwakhiwa kwakhona komjelo wokugaya ukutya kwi-da Vinci yotyando lwerobhothi yesisu: kufana notyando lwelaparoscopy yesintu yokwakhiwa ngokutsha komjelo we-alimentary, inokohlulwa ibe yincinci encediswayo kunye ne-laparoscopy epheleleyo ye-anastomosis.
4. Izilumkiso zokusetyenziswa okufanelekileyo kwe-stapler:
Nangona i-stapler izise iindlela ezahlukeneyo zoncedo kwiiklinikhi, kusekho iingxaki ezinzulu zasemva kotyando ezichaphazela ngokunzulu umsebenzi oqhelekileyo wephecana lesisu [17] Ukuvuza kwe-Anastomotic, i-anastomotic stenosis kunye nokopha kwe-anastomotic zixhaphakile kwiingxaki zasemva kotyando Ukuze kuncitshiswe izehlo zeengxaki. , umbhali ukholelwa ukuba ezi ngongoma zilandelayo kufuneka zinikwe ingqalelo:
(1) Umqhubi kufuneka abe nobuchule kumgaqo wokusebenza kunye nendlela yokusebenzisa i-stapler, kwaye alandele ngokungqongqo amanyathelo okusebenza okuqhelekileyo;
(2) Ngexesha lokusebenza, kuyimfuneko ukujonga ngononophelo ukuba i-anastomosis ye-anastomosis iphelile, ukuba i-ring iphelile, kwaye ingaba kukho ukopha okuncinci kwindawo ye-anastomotic.Emva kokuba i-anastomosis engaphelelanga ifunyenwe, kufuneka ilungiswe nge-suture manual ngokukhawuleza okanye i-original intestinal segment ye-anastomotic kufuneka ikhutshwe ngenye indlela yokwakhiwa kwakhona kwendlela yokugaya.Ngeli xesha, musa ukuthatha amathuba.Xa usenza i-anastomosis ye-manual, umbhali ngokubanzi usebenzisa i-double-layer interrupted suture method.Nangona ixesha lokusebenza kwendlela ye-suture ye-single-layer ilula kwaye ixesha lokusebenza lifutshane Amandla aphezulu, akulula ukwenza ukuvuza kwe-anastomotic Indlela eqhubekayo ye-suture kulula ukwenza i-anastomotic stenosis emva kwe-suture eqhubekayo, ngoko ke i-suture ephazamisekileyo isetyenziswa;
(3) Efanelekileyostaplerkufuneka ikhethwe ngokobukhulu belungu kunye nemeko ye-physiological yesigulane.Ngaphambi kokusebenzisa i-stapler, kufuneka kuqinisekiswe ukuba ayichanekanga kwaye akukho zixhobo ezilahlekileyo okanye iindawo ezingekhoyo;
(4) Ugqirha wotyando kufuneka abe ngoyena buchule busisiseko bokusebenza kwe-suturing yezandla, kuba ezinye iimeko zisenokungafaneleki kwi-anastomosis ngoomatshini;
(5) Qinisekisa ukuba akukho xinzelelo kwi-anastomosis kunye nokunikezelwa kwegazi kulungile.Ngelo xesha, imithwalo yegazi kumda we-mesenteric yemikhumbi ejikeleze i-anastomosis kufuneka ifakwe ngokupheleleyo, ngaphandle koko ukuphuma kwegazi emva kokusebenza kuya kwenzeka lula;
(6) Ukungaphumeleli kwe-stapler anastomosis kaninzi kwenzeka kwi-anastomosis ye-esophagus kunye nesisu okanye amathumbu amancinci kunye ne-rectal anastomosis ephantsi.Uninzi lwazo lubangelwa yintsimi yokujonga kakubi kunye nesithuba esincinci sokusebenza ngexesha lokusebenza.Ngoko ke, i-dissection ecacileyo, i-resection echanekileyo kunye ne-hemostasis eyaneleyo kufuneka yenziwe ngexesha lokusebenza., i-suture iqinile.
Okwangoku, i-staplers inokugqiba phantse zonke ii-anastomoses zesisu, kwaye uhlalutyo lwamva nje lwe-meta lubonisa ukuba kwindlela yokugaya ukutya kwakhona utyando lwesisu, i-mechanical anastomosis ineenzuzo ezingenakufaniswa ne-suture manual[18], kodwa i-anastomosis yomatshini yinto kuphela. i-gastric anastomosis Enye yeendlela ze-intestinal anastomosis ayinakuthatha indawo ngokupheleleyo i-suturing manual.Kuphela ngokulandela imigaqo esisiseko yotyando kunye nokuqonda amanyathelo okusebenza asemgangathweni apho oogqirha banokufumana iziphumo zotyando ezanelisayo kwaye bazuze izigulane.

Umthombo: Ithala leencwadi laseBaidu