Ukukhethwa kanye nokusetshenziswa okunengqondo kwe-Stapler ekusebenzeni kweGastrointestinal

Ukukhethwa kanye nokusetshenziswa okunengqondo kwe-Stapler ekusebenzeni kweGastrointestinal
Chen Lin, Bian Shibo

Eminyakeni yamuva, ukuthuthukiswa kwezinsimbi zokuhlinza kuye kwakhuthaza kakhulu ukuthuthukiswa kokuhlinzwa kwesimanje.Emkhakheni wokuhlinzwa kwe-gastrointestinal, ukuvela nokuthandwa kwe-staplers kuye kwaphakamisa i-anastomosis ye-gastrointestinal esigabeni esisha.Uma kuqhathaniswa ne-suture ye-manual yendabuko, ukusetshenziswa kwe-staplers Ukwakhiwa kabusha komgudu wokugaya ukudla okwenziwe kunganciphisa kakhulu isikhathi sokusebenza, kunciphise kakhulu ukulimala kwezicubu nokopha, ngaleyo ndlela kunciphise ubude obujwayelekile bokulaliswa esibhedlela “Okwamanje, odokotela abahlinzayo abaningi ngokwengeziwe bakhetha ukukhetha i-anastomosis yomshini umsebenzi womtholampilo.Kodwa-ke, i-anastomosis ekuhlinzweni kwamathumbu Njengenye yezinto ezintathu ezinkulu ezithinta i-anastomosis yamathumbu, udokotela ohlinzayo ngokwakhe udlala indima ebalulekile ekukhethweni kwe-stapler nokubamba indlela yokusebenza, futhi impumelelo ye-anastomosis nayo ihlobene nayo.Okuhlobene eduze 2 Lesi sihloko sizokhuluma ngemibono yami mayelana nokukhethwa kanye nokusetshenziswa okunengqondo kwama-staplers ezinkambisweni zokuhlinzwa ezivamile zokuhlinzwa kwesisu kanye ne-colorectal.
1. Ukuhlukaniswa kwama-staplers
Kunezinhlobo eziningi zama-staplers, ezingahlukaniswa zibe uhlobo olulingana nokucindezelwa kanye nohlobo lwesisekelo ngokomgomo wokusebenza.Ngokusho kokuma kwe-stapler, ingahlukaniswa ibe yi-stapler eqondile, i-stapler-cut-circular, i-arc-cut stapler, i-stapler emise okwenkinobho kanye ne-stapler emise okwe-paperclip.
2. Ukusetshenziswa kwama-staplers ku-laparotomy
(1) Ukukhethwa kanye nokusetshenziswa kwama-staplers ekuhlinzweni kwesisu
1. I-Proximal Gastrectomy: I-Circular stapler (CDH25) ngokuvamile isetshenziselwa i-esophagogastric anastomosis, futhi i-linear cutting stapler (TLC10) isetshenziselwa i-anastomosis yesisu.Ucwaningo luye lwabonisa ukuthi ukusetshenziswa kwe-stapler engu-25mm ye-esophagus kanye ne-gastrointestinal anastomosis Kunganciphisa ukuvela kwezinkinga zangemva kokuhlinzwa 3 Kodwa lokhu akukona ngokuphelele.Umsebenzisi kufanele anqume uhlobo lwe-stapler ngokobubanzi bangaphakathi bomphimbo.Ukuma kwezicubu ukuze unciphise ukopha kwe-anastomotic Musa ukudonsa kanzima lapho i-stapler ihoxisa, ikakhulukazi uma ukusika kungaphelele, kungabangela kalula ukuvuvuka kwezicubu ze-anastomotic.
Ngenxa yokujula kwe-anatomical positions of the esophagus, inkambu yokubuka ye-intraoperative ayilungile, i-anastomosis inzima, ukuphela kwe-esophagus ephukile kulula ukuyidabula, futhi izigameko zokuvuza kwe-anastomotic ziphezulu.Nokho, lokhu kuye kwaba nempikiswano.Ngokwethiyori, ukuqinisa i-suture kungenza i-anastomosis iphelele futhi kunciphise ukuvela kokuvuza kwe-anastomotic kwangemva kokuhlinzwa.Kulula ukwakha i-anastomotic stenosis Okuhlangenwe nakho komlobi ukuthi ukukhetha kufanele kwenziwe ngokuvumelana nesimo se-anastomotic ngesikhathi sokuhlinzwa.Uma insimu ebonakalayo icacile ngesikhathi se-anastomosis, i-esophagus ikhululekile, i-hemostasis iphelile, futhi umphumela we-anastomotic uyanelisa, ukuqiniswa kwe-suture akudingeki;uma ukungapheleli kwe-anastomotic noma ukopha kwe-anastomotic kutholakala ngesikhathi sokuhlinzwa, i-Seromuscular layer suture ingasetshenziswa ukuqinisa i-suture.Ngokuvamile, i-suture absorbable (uhlobo 3-0 noma 4-0) ikhethiwe.Ngenxa yezehlakalo eziphezulu zokusabela komzimba wangaphandle ku-silika anastomosis, kulula ukwenza i-ulce edema kanye nokopha ku-anastomosis[4] Intambo kasilika, kungaba i-3-0 noma i-1-gauge wire ingasetshenziswa.
Nakuba i-reflux ye-gastric yenzeka ngezikhathi ezithile ngemva kwe-esophagogastric anastomosis, ethinta izinga lempilo yeziguli, kodwa iziguli eziningi azinazo izimpawu ezisobala, ngakho-ke lokhu kuhlinzwa kusasetshenziswa kaningi emisebenzini yomtholampilo[5]
2. I-Distal Gastrectomy: I-Bi-type gastroduodenal end-to-side noma i-end-to-end anastomosis Bi-type II gastrojejunostomy kanye ne-Roux-en-Y gastrojejunostomy isetshenziswa kakhulu.
Ohlotsheni lwe-Bi I, i-stapler eyindilinga (CDH25) kanye ne-linear cutting stapler (TLC10) isetshenziselwa i-anastomosis.Ezinye izazi zisikisela ukuthi i-anastomosis yokuphela kokuphela kwe-gastroduodenum, ukuze ukungezwani kwe-anastomosis kuncane[6] Uma ukushuba kwe-anastomosis kukukhulu Ingozi yokuvuza kwe-anastomotic ngemuva kokuhlinzwa izokwanda [7] Umbhali ukholelwa ukuthi nakuba ukusebenza I-anastomosis yokuphela kokuphela iyinkimbinkimbi, inqobo nje uma kuqinisekiswa ukunikezwa kwegazi elanele kanye ne-anastomosis engenazingxabano, izehlakalo zezinkinga zangemva kokuhlinzwa zezindlela ezimbili ze-anastomotic ziyafana.Awukho umehluko obalulekile.
Ohlotsheni lwe-Bi II, i-stapler eyindilinga (CDH25) ngokuvamile isetshenziselwa i-anastomosis, futhi i-stapler yokusika eqondile ingasetshenziswa.Umbhali usetshenziselwa ukusebenzisa lesi sakamuva ukuqedela i-gastrojejunum anastomosis.I-endoscopic linear cutting stapler (6TB45) ingasetshenziswa ukusika i-duodenum.I-stapler inengqikithi yemigqa eyisi-6 yezinto eziyisisekelo, futhi umsebenzi we-suture hemostasis muhle, futhi akulula ukwenza i-duodenal stump fistula nokopha ngemva kokuhlinzwa.Uma isiphunzi se-duodenal sine-edema, i-suture ye-manual ingasetshenziswa, bese i-6TB45 ingasetshenziswa ukuqedela uhlangothi lwe-gastrojejunal Ukuze uthole i-lateral anastomosis, ukunakwa kufanele kukhokhwe emngceleni we-mesenteric we-jejunum kanye nodonga lwesisu sesisu esisele.Ungalethi izicubu ze-mesenteric ku-anastomosis.Ezinkingeni ngemva kohlobo lwe-II anastomosis, i-jejunum anastomosis ehlangothini kuya ohlangothini (i-Braun anastomosis) ingangezwa ngalesi sisekelo.Ngemuva kohlobo lwe-III anastomosis, i-alkaline reflux gastritis kanye ne-anastomotic stomatitis kuvame ukuthambekela ukwenzeka, ngakho umbhali usebenzisa i-Bi-I noma i-Roux-en-Y anastomosis.
I-Gastrojejunum Roux-en-Y anastomosis ingasebenzisa ama-staplers amabili ayindilinga (CDH25) ukuze iqedele i-anastomosis phakathi kwe-jejunum ne-gastrojejunum, noma isebenzise umugqa wokusika umugqa ukuze wenze i-anastomosis ehlangene ye-distal jejunum kanye nesisu esisele ngokusebenzisa phambi kwekholoni.Qaphela ukuthi isiqondiso se-distal jejunum stump siphezulu, futhi isiqondiso se-proximal jejunum stump kufanele futhi sibe phezulu ngesikhathi se-anastomosis ehlangene nehlangothini ye-jejunum.Izinyembezi ze-mesenteric ekugcineni kwe-jejunum zingavalwa nge-3-0 silk suture.
3. I-gastrectomy ephelele: I-Esophagojejunostomy, ukushintshwa kwe-jejunum yesisu, ukushintshwa kwekholoni yesisu kanye ne-esophagojejunum Roux-en-Y?Okubi, izinga elibi lempilo yeziguli Ukushintshwa kwesisu kungathuthukisa kakhulu izinga lempilo yeziguli, kodwa ukuhlinzwa kuyinkimbinkimbi I-Esophagus-jejunum Roux-en-Y anastomosis inzima ngokulinganisela futhi ingathuthukisa izimpawu ze-reflux Ukukhetha indlela efanelekile yokwakha kabusha, umbhali uncoma i-Roux-en-Y anastomosis yomphimbo kanye nejejunum.I-stapler eyindilinga (CDH25) ingasetshenziselwa ukuqedela i-anastomosis yokuphela kohlangothi ye-anterior esophagus ne-jejunum, futhi i-stapler yokusika eqondile (efana ne-6TB45) ingasetshenziswa ukuqedela i-anastomosis ehlangothini nehlangothini ye-proximal. kanye ne-distal jejunum.I-jejunum stump ivaliwe nge-6TB45.
Ukusetshenziswa kwama-staplers ayindilinga ku-gastrojejunostomy kanye ne-esophagojejunostomy kuye kwamukelwa kabanzi, futhi odokotela abaningi abahlinzayo bakhetha ukusebenzisa ama-staplers ayindilinga ekuhlinzeni okuvulekile [8-9] Inaba et al.!Kubikwa ukuthi umphumela we-gastrojejunal anastomosis usebenzisa i-linear stapler ngaphansi kwe-laparoscopy muhle.Umbhali ukhetha i-linear stapler noma ngisho ne-stapler ngaphansi kokuhlinzwa kwe-laparoscopic ukuze kwakhiwe kabusha umgudu wokugaya ukudla ku-laparotomy.
ngoba:
(1) Lolu hlobo lwedivayisi lusebenziseka kalula futhi lulula ukulusebenzisa, lugwema izinyathelo zokusebenza ezinzima njengokufakwa kwe-anvil ye-purse string suture anvil kanye ne-stapler eyindilinga edlula emgodini wamathumbu;
(2) I-anastomosis ayinqunyelwe ububanzi be-lumen;
(3) Kukhona ukopha okuncane ngesikhathi se-anastomosis, futhi akulula ukubangela ukulimala kwezinyembezi zezicubu noma i-anastomosis engaphelele ngesikhathi se-anastomosis;
(4) Nciphisa isikhathi sokusebenza:
(5) Uma kuqhathaniswa ne-stapler eyindilinga, i-stapler yomugqa idinga kuphela ukufaka esikhundleni se-cartridge eyisisekelo lapho isetshenziswa izikhathi eziningi phakathi nokusebenza, okunciphisa izindleko zokusebenza.Uma kuqhathaniswa ne-stapler eyindilinga, noma inganciphisa izehlakalo zezinkinga zangemva kokuhlinzwa, Ukuqinisekiswa okwengeziwe komtholampilo kusazokwenziwa.
(2) Ukukhethwa kanye nokusetshenziswa kwama-staplers ekuhlinzeni i-colorectal
1. I-anastomosis yokuphela kwe-ileocolon ngemva kwe-hemicolectomy kwesokudla: i-stapler eyindilinga (CDH29 noma 33) ingasetshenziswa ukuqedela i-anastomosis yokuphela kwe-ileocolon, nokuvalwa komugqa oqondile (TL60 noma i-TLC75) futhi isetshenziselwe ukuvala isiphunzi sekholoni eguquguqukayo.(TLC75) I-anastomosis ehlangothini ukuya kohlangothi yekholoni eguquguqukayo ye-ileum Ku-anastomosis yokuphela kuya kohlangothi phakathi kwekholoni eguquguqukayo noma ikholoni ye-hemicolectomy yesokunxele, i-stapler eyindilinga (CDH29 noma 33) kufanele ibekwe kulume lwamathumbu aseduze.
2. I-anastomosis yokuphela ukuya ekupheleni ye-colorectum (umsele wendunu) ngemva kokususwa kwe-sigmoid noma i-rectal: inqubo ye-anastomosis ephindwe kabili iyindlela evame ukusetshenziswa kukho kokubili i-laparotomy kanye ne-laparoscopic yokwakhiwa kabusha komgudu wokugaya ukudla [11] lapha ikakhulukazi yethula indlela ye-anastomosis ephindwe kabili ye-Transanal ukwakhiwa kabusha komgudu wokugaya ukudla.
I-proximal canal yamathumbu ifakwa ku-stapler anvil eyindilinga, futhi i-distal pre-cut yesimila ivalwa nge-stapler yokusika eqondile noma emise okwe-arc.Ingxenye engaphambili ye-stapler kufanele ihlanganiswe nesisombululo se-iodine ngaphambi kokuba ithunyelwe ku-anal ukuze igcotshwe futhi ibulawe amagciwane.Umzimba wocingo kufanele uthuthuke kancane kancane kumsele wangemuva kuze kube yilapho umkhawulo ongaphambili wocingo uthinta kancane uhlangothi olungaphakathi lwesiphunzi sangemuva.
Qaphela: (1) Ngesikhathi sokuqiniswa kwe-stapler, vimbela amathumbu aseduze ukuba angasonti, ngaphandle kwalokho imikhumbi ye-mesangial izocindezelwa:
(2) I-mesentery emikhawulweni yomibili ye-anastomosis akufanele ikhululeke isikhathi eside ukuze kuqinisekiswe ukutholakala kwegazi elanele emathunjini;
(3) Izicubu ze-adipose kuzo zombili iziphetho zeshubhu yamathumbu ku-anastomosis kufanele zisuswe ukuze kuvinjelwe i-anastomosis engaphelele ebangelwa izicubu eziningi ezishumekiwe ngesikhathi se-anastomosis, kodwa kungcono kakhulu ukungeqi ububanzi be-2cm, ngaphandle kwalokho izothinta ukunikezwa kwegazi kwe-tube emathunjini ku-anastomosis;
(4) Ngesikhathi se-anastomosis, kuyadingeka ukuvimbela ezinye izicubu ezingabalulekile ekufakweni ku-stapler, ikakhulukazi udonga lwangemuva lwangasese lweziguli zesifazane.Isikhundla sodonga lwangasese lwangasese kufanele siqinisekiswe ngaphambi kokuba i-stapler ixoshwe, futhi ukuhlolwa kwangasese kungenziwa ngemva kokuqedwa kwe-anastomosis;
(5) Ngemva kokuba i-anastomosis isiqediwe, kungcono ukuhlola ukuthi i-anastomosis iphelile yini "ngokuhlolwa kwe-inflating" noma ukujova isisombululo se-methylene eluhlaza okwesibhakabhaka nge-anus, futhi uhlole i-anastomosis ngokuhlolwa kwedijithali ngemva kokuhlinzwa.
Ngesikhathi se-anastomosis, ukugqagqana kwemigqa eyindilinga kanye ne-linear stapler anastomotic kufanele kugwenywe, ngaphandle kwalokho ukunikezwa kwegazi ku-anastomosis kuzoba kubi, futhi ukuvuza kwe-anastomotic kuzokwenzeka kalula ngemva kokuhlinzwa.Uma usebenzisa ummese we-high-frequency kagesi, gwema ukulimala ku-rectum nodonga lwesitho sangasese sowesifazane.Nakuba isetshenziswa kabanzi, kusenamaphutha athile.Isibonelo, umugqa oyisisekelo we-stapler eyindilinga kanye ne-stapler yomugqa kulula ukweqa ngesikhathi sokusebenza[12].Kuwukusetshenziswa okuningi kokuvalwa kokusika komugqa phakathi nokusebenza, okuzobangela ukugqagqana komugqa we-anastomotic futhi kwandise ingozi yokuvuza kwe-anastomotic[13].Kokubili isiphunzi kanye ne-distal rectum kwakuxhunywe izintambo zesikhwama semali, ezingagwema ububi benqubo ye-anastomosis ephindwe kabili.
3. Ukukhishwa kwe-rectal kanye ne-colorectal (i-anal canal) i-end-to-side anastomosis: Umzimba we-stapler ungaqedwa ngokusebenzisa indlela yesisu noma ye-anal.Ukubaluleka kokusebenzisa i-stapler eyindilinga (i-CDH33 noma i-29) kanye ne-stapler yomugqa Yakha iluphu yekholoni emise okuka-“J”, ekhulisa umthamo wokugcina indle ye-rectum futhi inciphise ingozi yokuvuza kwe-anastomotic ngemva kokuhlinzwa.Brisinda et al.[16] bathole ukuthi i-anastomosis ye-end-to-side iphephile futhi ingenzeka.Isigameko sokuvuza kwe-anastomotic siphansi, kodwa usayizi wesampula walokhu kuhlolwa mncane kakhulu, futhi izivivinyo zomtholampilo ezinkulu zisadingeka ukuze kuqinisekiswe.
Isikhwama se-colon-rectal (i-anal canal) anastomosis nayo ingasetshenziswa, kusetshenziswa i-stapler yokusika eqondile ukwenza u-6-7cm J-fold ekugcineni kwekholoni yamahhala bese ubeka i-stapler eyindilinga (CDH29 noma 33) phezulu ukuze uqinise uzipho. Ukuhlaziywa kwe-meta kubonise ukuthi, uma kuqhathaniswa ne-anastomosis yokuphela-kuya-side, kwakungekho umehluko ophawulekayo wezibalo ezilinganisweni zezinkinga zangemva kokuhlinzwa, ukufa, kanye nomsebenzi wokuzikhulula phakathi kwesikhwama se-colon [15], kodwa ukusebenza kwesikhwama se-colon kwakuyinkimbinkimbi futhi kuyabiza Kungudokotela ohlinzayo ukuthi akhethe ukuthi iyiphi indlela.
Eminyakeni yamuva nje, ama-staplers okusika ama-curved kancane kancane adumile emisebenzini yomtholampilo.Ezinye izazi zikholelwa ukuthi ekukhishweni kabusha komdlavuza we-rectal ophansi, ama-staplers agobile kulula ukungena ku-pelvic cavity kune-linear staplers, futhi umphumela we-anastomotic ungcono[16].Uhlobo ngalunye lwe-stapler lunezici zalo kanye nezinkomba.Ezigulini ezine-pelvic stenosis kanye nezimila ezitholakala endaweni ephansi futhi i-distal tract intestinal ayikwazi ukunqunywa ngokwanele nge-stapler eqondile, i-arc-cutting stapler ingacatshangelwa.Kungakhathaliseki ukuthi iyiphi i-stapler oyikhethayo, kufanele Umgomo we-TME kufanele ulandelwe, i-anatomy kufanele icace ngesikhathi sokuhlinzwa, futhi insimu yokubuka enhle yokuhlinzwa kufanele iqinisekiswe.
3. Ukusetshenziswa kwama-staplers ekuhlinzeni i-laparoscopic kanye ne-da Vinci robotic
1. Ukwakhiwa kabusha kwamathumbu okuhlinzwa kwe-laparoscopic yamathumbu: ihlukaniswe yaba ukwakhiwa kabusha kwe-laparoscopic yokugaya ukudla okuphelele, ukusika okuncane kusiza ukwakhiwa kabusha kwepheshana lokugaya kanye nokwakhiwa kabusha kwe-laparoscopic yokugaya ukudla okusizwa ngesandla.Ukuhlinzwa okuphelele kwe-laparoscopic kusebenzisa ama-staplers ahlukene okusika okuqondile kanye nama-staplers Noma i-stapler eyindilinga ephelele ye-laparoscopic anastomosis ene-incision encane yokuhlinzwa kanye nombono ocacile weziguli ezilulama ngokushesha, kodwa ngenxa yesikhala sokusebenza esincane, izidingo eziphezulu zobuchwepheshe kudokotela ohlinzayo, izindleko zokuhlinzwa eziphezulu, futhi okwamanje ayikho indlela yokuhlinzwa ejwayelekile yokuthola Ukuhlinzwa okuncane okuqashelwa emtholampilo ukudonsa izicubu ukuze zibe ne-anastomotic ngaphandle komgodi wesisu, ukuqedela ukwakhiwa kabusha kwe-in vitro noma ukufaka i-stapler ngaphansi kosizo lokusika okuncane kwe-anastomosis. .Indlela yokuhlinza iyafana neye-laparotomy.Njengamanje, i-laparoscopy esizwa ngesandla isetshenziswa kabanzi.Ukwakhiwa kabusha komgudu wokugaya ukudla wukwelula isandla singene emgodini wesisu ngokusika okuncane odongeni lwesisu ukuze kusize ekusebenzeni kwe-anastomosis.Kodwa-ke, isandla emgodini wesisu ngokuvamile sithinta insimu yokubuka ukusebenza kwe-laparoscopic, futhi umphumela we-anastomotic awulungile, ngakho-ke awuvamile ukusetshenziswa.
2. Ukwakhiwa kabusha komsele wokugaya ku-da Vinci ukuhlinzwa kwe-robotic gastrointestinal: okufanayo nokuhlinzwa kwe-laparoscopic yendabuko ukuze kwakhiwe kabusha i-alimentary canal, ingahlukaniswa ibe yi-incision encane esizwayo kanye ne-laparoscopy ye-anastomosis egcwele.
4. Izinyathelo zokuqapha zokusetshenziswa okufanele kwe-stapler:
Nakuba i-stapler ilethe ukunethezeka okuhlukahlukene kodokotela, kusenezinkinga ezingathi sína zangemva kokuhlinzwa ezithinta kakhulu umsebenzi ovamile wepheshana lesisu [17] Ukuvuza kwe-Anastomotic, i-anastomotic stenosis kanye nokopha kwe-anastomotic kuyizinkinga ezivamile uma kuqhathaniswa Ngemva kokuhlinzwa Ukuze kuncishiswe izehlakalo zezinkinga. , umbhali ukholelwa ukuthi amaphuzu alandelayo kufanele anakwe:
(1) Umqhubi kufanele abe nekhono esimisweni sokusebenza kanye nendlela yokusebenzisa i-stapler, futhi alandele ngokuqinile izinyathelo ezijwayelekile zokusebenza;
(2) Ngesikhathi sokuhlinzwa, kuyadingeka ukuhlola ngokucophelela ukuthi i-anastomosis ye-anastomosis iphelele yini, ukuthi iringi iphelele yini, nokuthi kukhona ukopha okuncane endaweni ye-anastomotic.Uma i-anastomosis engaphelele itholakele, kufanele ilungiswe nge-manual suture noma ingxenye yokuqala yamathumbu e-anastomotic kufanele ikhishwe ukuze kwakhiwe kabusha umgudu wokugaya ukudla.Ngalesi sikhathi, ungathathi amashansi.Lapho enza i-anastomosis yezandla, umbhali ngokuvamile usebenzisa indlela ye-suture enezingqimba ezimbili.Nakuba isikhathi sokusebenza se-single-layer suture method silula futhi isikhathi sokusebenza sifushane Amandla aphezulu, akulula ukwenza ukuvuza kwe-anastomotic Indlela eqhubekayo ye-suture kulula ukwakha i-anastomotic stenosis ngemva kokuthunga okuqhubekayo, ngakho-ke kusetshenziswa i-suture ephazamisekile;
(3) Okufanelekilestaplerkumele kukhethwe ngokuhambisana nobukhulu besitho kanye nesimo sokuphila kwesiguli.Ngaphambi kokusebenzisa i-stapler, kufanele kuqinisekiswe ukuthi iphelele futhi azikho izinto eziyisisekelo ezingekho noma izingxenye ezingekho;
(4) Udokotela ohlinzayo kufanele abe yingcweti yesu lokuhlinza eliyisisekelo kakhulu lokuthunga ngesandla, ngoba ezinye izimo zingase zingakufanelekeli i-anastomosis ngomshini;
(5) Qinisekisa ukuthi akukho ukungezwani ku-anastomosis kanye nokunikezwa kwegazi kuhle.Ngesikhathi esifanayo, imithwalo yegazi emngceleni we-mesenteric wemikhumbi ezungeze i-anastomosis kufanele ihlanganiswe ngokugcwele, ngaphandle kwalokho ukuphuma kwegazi ngemuva kokuhlinzwa kuzokwenzeka kalula;
(6) Ukwehluleka kwe-stapler anastomosis ngokuvamile kwenzeka ku-anastomosis yomminzo nesisu noma amathumbu amancane kanye ne-anastomosis ephansi ye-rectal.Eziningi zazo zibangelwa insimu yokubuka empofu kanye nesikhala sokusebenza esincane ngesikhathi sokusebenza.Ngakho-ke, ukuhlukaniswa okucacile, ukukhishwa okunembile kanye ne-hemostasis eyanele kufanele kwenziwe ngesikhathi sokusebenza., umthungo uqinile.
Njengamanje, ama-staplers angakwazi ukuqeda cishe wonke ama-anastomoses amathumbu, futhi ukuhlaziywa kwe-meta kwakamuva kukhombisa ukuthi ekwakhiweni kabusha komgudu wokugaya ukudla kokuhlinzwa kwamathumbu, i-mechanical anastomosis inezinzuzo ezingenakuqhathaniswa ne-manual suture [18], kodwa i-anastomosis yomshini iwuhlelo kuphela. i-gastric anastomosis Enye yezindlela ze-anastomosis yamathumbu ayikwazi ukufaka esikhundleni ngokuphelele i-suturing manual.Kuphela ngokulandela izimiso eziyisisekelo zokuhlinzwa kanye nokuba nolwazi ngezinyathelo zokusebenza ezijwayelekile lapho odokotela bengathola imiphumela yokuhlinzwa egculisayo futhi bazuze iziguli.

Umthombo: I-Baidu Library