Dr. Michael Pavletic tshuaj xyuas cov txheej txheem sib txawv thiab cov txheej txheem ntawm kev siv tawv nqaij staplers.
Veterinary kws phais neeg tau saib xyuas kev phais mob stapling, tshwj xeeb tshaj yog 10 xyoo dhau los. Cov laj thawj pom meej rau cov kws kho tsiaj paub txog cov khoom siv phais mob phais: txo qis phais / siv tshuaj loog rau lub sijhawm rau tus neeg mob, qhov yooj yim ntawm daim ntawv thov thiab xwm yeem hauv kev tshwm sim. Qee tus kws kho mob tau maj mam los txais cov kev phais mob, feem ntau vim tias muaj peev xwm txhawj xeeb tus nqi cuam tshuam nrog kev nqis peev rau cov khoom siv thiab khoom siv, tsis muaj kev kawm paub thiab tsis tshua muaj kev phais li cas hauv kev xyaum.
Daim tawv nqaij staplers
Cov tawv nqaij stapler tseem nyob raws li qhov yooj yim ntawm cov khoom siv khov khov mus rau tswv. Feem ntau, cov tawv nqaij tawv yooj yim rau kev thov thiab tshem tawm; lawv muab cov kws phais mob qhov kev ruaj ntseg ntawm qhov yooj yim cuam tshuam ntawm suture qauv thaum txuag lub sijhawm tseem ceeb ntawm lub sijhawm kaw ntev lossis ntau cov tawv nqaij txiav.
Los ntawm kuv qhov kev sim kho mob, muaj ob lub sijhawm qhov tawv nqaij tawv yuav tsis zoo rau kev kaw qhov mob: kaw qhov txhab hauv qhov sib luag, thiab siv rau ntawm daim tawv nyias nyias. Lub cev tsis sib haum xeeb suture qauv zoo dua tuaj yeem tswj qhov txhab kaw ntsej muag ntawm qhov tsis sib haum xeeb nruab nrab, tshwj xeeb tshaj yog nyob rau thaj chaw uas cov lus tsa suab hauv cheeb tsam tuaj yeem txhim kho qhov kev cuam tshuam no. Cov tawv nqaij nyias ib txwm tsis yog muab cov tawv nqaij tuab txaus rau cov rooj zaum kom tsim nyog lossis teeb tsa cov tawv nqaij tawv. Yog li ntawd, cov tawv nqaij tawv nqaij muaj qhov sib zog ua kom sib zog lossis tig, ua rau lawv cov kev tshem tawm tom qab muaj teeb meem. Kuj ceeb tias, cov kua nplaum rau tawv nqaij dhau ntawm cov kab staple, tuaj yeem txo lossis tshem tawm qhov sib nyiam no, thaum muab" ntxiv; hneev taw" ntawm kev ruaj ntseg.
Xyoo tas los no, cov tawv nqaij tawv nqaij tau siv kom muaj txiaj ntsig zoo txhawm rau ua kom nqaij tawv ua rau daim tawv nqaij sib kis nrog tus neeg xa khoom. Daim tawv nqaij sib txuas yog thov rau thaj tsam tus neeg txais, nrog nws cov ciam teb me ntsis sib tshooj qhov txhab rau cov txhab. Daim tawv nqaij mob yog thov thaum kho cov nyom dag kom paub tseeb tias cov ntoo txhuam kom zoo rau lub txaj. Cov tawv nqaij tawv kuj siv los ua kom ruaj ntseg hnav ntawm thaj chaw muaj pob txha los tiv thaiv kev hnav khaub ncaws hauv qab ntawm cov ntaub qhwv cov ntaub qhwv tawv tawv.
Daim tawv nqaij txhuam yog cov hlau tsis muaj ntxig nyob hauv muaj pes tsawg leeg. Yog li ntawd, lawv tuaj yeem siv tau zoo li cov cim xaim hluav taws xob sab hauv thaum thov rau cov nqaij mos subcutaneous thiab cov leeg nqaij hauv qab cov nqaij ntshiv tom qab cov nqaij hlav rov ua dua. Cov ntawv cim xim hlau tau tuaj yeem pab hluav taws xob oncologist hauv kev txiav txim siab cov npoo ntawm thaj chaw phais thiab thaj chaw tsim nyog kom irradiate postoperatively.
Vascular staplers
Vascular clips yog qhov txiaj ntsig uas tsis muaj txiaj ntsig kom ua rau cov ntshav me me sai sai thaum lub sijhawm phais mob. Txhim kho hauv kev tsim qauv ntawm cov neeg tso tseg pov tseg tau ua lawv qhov chaw soj ntsuam siv ntau" cov neeg siv tau phooj ywg zoo." Cov Kendall / USSC Surgiclip chav nyob, piv txwv li, tam sim no muaj ib lub tshuab ntsaws ntsaws ruaj ruaj kom yooj yim tso rau ntawm cov vias ncaj qha vias.
Vascular clips yog qhov tshwj xeeb rau cov txheej txheem uas yuav tsum tau muaj ntau txoj hauv kev, los yog muaj qhov xav tau los ua kom ruaj ntseg cov hlab ntsha hauv cheeb tsam lub cev tsis ua haujlwm. Cov kev qhia ua piv txwv suav nrog: forelimb thiab hindlimb kev txiav tawm, kev txha caj qaum, kev qog ua qog ntshav, thoracic phais thiab qhov muag pom. Feem ntau cov vascular stapling pab kiag li lawm tso ib txoj kab tawm ntawm ib zaug. Lub ligate-divide-staple (LDS) siv ob txoj kab nkhaus nkhaus rau lub nkoj thaum lub ntsej sib txiav rau hauv lub taub ntim uas ua kom faib cov nkoj ib txhij. Raws li qhov tshwm sim, LDS chav nyob yog qhov muaj txiaj ntsig tshwj xeeb hauv kev ua haujlwm splenectomies sai sai thiab muaj txiaj ntsig. Nws raug suav hais tias yog txoj hauv kev zoo dua ntawm kev ua haujlwm splenectomies ntawm Angell
Linear stapling cov khoom siv
Cov staplers kab tso npe thov ob rau plaub kab ntawm cov khoom siv zoo ntawm titanium staples hauv kev teeb tsa staggered. Thoracoabdominal (TA) staplers siv ob kab ntawm staples; qhov kev zam yog TA-30 V-3 daim cartridge uas ntim cov leeg pob txha nrog lub voos peb npaug (rau kev ruaj ntseg ntxiv). Gastrointestinal anastomosis (GIA) staplers siv plaub kab ntawm staples. Kev nrov tshaj plaws GIA cartridges muaj kev txiav hniav uas faib nruab nrab ntawm kab thib ob thiab thib peb kab ntawm staples thaum ua ntawv thov. Yog li ntawd, GIA thiab TA staplers muaj qee yam sib txawv.
TA staplers siv tau zoo heev hauv qee qhov kev ua tiav los ntawm lub ntsws ntsws; lawv yog qhov kev xaiv rau ob txheej txheem no. TA staplers tseem muaj txiaj ntsig zoo rau cov kev kho mob hauv qab no: kev kho mob ib feem ntawm lub plab, kaw lub plab ntawm lub plab, kev phais ib feem lossis ua tiav daim siab, ib feem ntawm tus txha caj qaum, kaw qhov kev nkag mus rau hauv lub cev, phais ntawm atrial appendage hlav, tshem tawm txoj hlab pas diverticula, ovariohysterectomy hauv cov dev loj , kaw ntawm cov pob txha caj qaum loj (piv txwv li nephrectomy, neoplasms).
Ua ke nrog GIA stapler, kev ua haujlwm zoo rau qhov kawg ntawm qhov ua rau mob plab hnyuv tuaj yeem ua rau dev thiab cov neeg mob feline loj dua. Ib yam li ntawd, lawv tseem tuaj yeem ua haujlwm rau cholecystoduodenostomy, cholecystojejunostomy thiab cov txheej txheem Bilroth II.
GIA stapler ib leeg tshwj xeeb tshaj yog ua rau kev rov ua qhov chaw loj ntawm kev cog lus lub plab zom mov. Nyob rau hauv cov mob ntawm gastric necrosis theem ob rau lub plab voos vuv / torsion, GIA stapler yog txoj kev zoo tshaj plaws kom muaj txiaj ntsig tshem tawm cov chaw no sai, thaum txo kev pheej hmoo ntawm kev tso dej paug sib luag. Tom qab tshem tawm, ib qho kev nruam nruam suture qauv thov dua tus kab staple kom tiav cov txheej txheem.
Vaj staplers
Cov staplers ncig ua ke siv ob kab ntawm staples nyob rau hauv txoj kab sib luag ib puag ncig rau qhov kawg-rau-kawg anastomosis ntawm lub plab hnyuv loj thiab me, nrog rau txoj hlab pas. Lawv kuj tau txais txiaj ntsig zoo siv rau anastomosing lub davhlau ya nyob twg esophagus lossis duodenal ntu (Bilroth I) rau lub plab. Lawv tau siv hauv cov txheej txheem colectomy ib nrab ob qho tib si hauv dev thiab miv. Txawm hais tias lawv nyob twj ywm raws li ib qho tseem ceeb stapling ntaus hauv kev kho tsiaj cov nqaij mos phais, lawv tsis tshua muaj kev siv cov khoom siv stapling hauv feem ntau cov tsiaj phais mob. Dua li ntawm qhov no, lawv muaj txiaj ntsig zoo rau cov txheej txheem anastomotic ntau nyuaj ua rau kev phais tsiaj me.
Qhia Kom Nyeem Ntawv
Lwm yam kev txiav txim siab
Cov ntawv me dua ntawm cov ntaub so ntswg staplers muaj rau siv nyob rau hauv kev phais endoscopic. Txawm hais tias thaj chaw ntawm kev phais tsiaj tsiaj me no muaj qee yam nyob hauv lub sijhawm no, nws yog thaj chaw tseem ceeb hauv kev phais neeg. Cov twj paj nruag hloov kho no tuaj yeem siv rau kev phais me me, los yog siv nrog kev sib xyaw ua ke mus rau sab hauv lub plab thiab hauv plab, tshwj xeeb tshaj yog nyob rau cov neeg mob kho tsiaj me.
Cov cuab yeej tsim kho tshiab hauv cov cuab yeej siv dag zog txuas ntxiv pab lawv daim ntawv thov kev phais. Ua haujlwm dhau sijhawm, kws kho tsiaj yuav tau siv staplers rau kev siv cov khoom siv, thaum txiav txim siab siv cov tshiab ntawm cov cuab yeej tshiab no.
Pavletic yog tus thawj coj ntawm Lub Tsev Haujlwm Saib Xyuas Kev phais thiab tus thawj coj ntawm kev pabcuam phais mob ntawm Boston' s Angell Memorial Tsiaj Tsev Kho Mob. Nws yog 1974 kawm tiav ntawm University of Illinois thiab ib xyoo 1981 tus neeg sawv cev ntawm American College ntawm Veterinary Surgeons. Nws yog tus sau txog xyoo 1999 Atlas ntawm Kev Kho Tsiaj Me Me, Kev Hloov Kho Thib Ob, luam tawm los ntawm WB Saunders.