吻合器的發(fā)展與分類

1、吻合器的歷史及發(fā)展,外科手術(shù)的共同目標(biāo),高效 快速 止血 安全 為患者提供最佳效果 為外科醫(yī)生提供最佳效果,何為吻合,兩種組織結(jié)構(gòu)之間行手術(shù)連接 a surgical connection between two structures,霍爾斯特德提出的構(gòu)建吻合的原理 halsteds principles for creating an anastomosis,無吻合口張力 無吻合口漏 止血效果好 足夠的吻合口血供 足夠的吻合口內(nèi)徑,吻合的目的,吻合組織 ，建立通路 結(jié)扎血管或組織移植體殘端 保持止血,吻合方式,縫合/手縫吻合 suture/ hand-sewn approximation 縫

2、釘固定器械/縫釘吻合 stapling device/stapled approximation,機(jī)械吻合的理念,雙排交錯(cuò)的縫釘理念,b型成釘?shù)目p合理念,縫釘?shù)膮?shù),根據(jù)組織厚度決定釘子關(guān)閉的高度,縫釘成型,非反應(yīng)性鈦=引起的組織反應(yīng)較少 non reactive titanium = causes little tissue reaction b形,縫釘線,吻合器發(fā)展史,1908年，第一臺(tái)吻合器械（匈牙利的humer htl） first stapling instrument (humer htl, hungary) 早期產(chǎn)品 early production 不好使用 cumbersom

3、e 結(jié)構(gòu)復(fù)雜 complicated 性能不可靠 unreliable,吻合技術(shù)的發(fā)展,最近發(fā)展?fàn)顩r（過去的25年中） recent development (within the last 25 years) 更可靠 more reliable 使用更便捷 easier to use 質(zhì)量更好 better quality 出現(xiàn)的技術(shù)問題較少 fewer technical problems 能在較難處理的位置構(gòu)建吻合 ability to create anastomoses in difficult places,吻合器類型i-直線型吻合器,這些吻合器至少導(dǎo)入兩排雙重錯(cuò)開的鈦縫釘，一些吻

4、合器同時(shí)能切割及分切組織。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器類型ii-直線型切割吻合器,這些吻合器至少導(dǎo)入兩排雙重錯(cuò)開的鈦縫釘，一些吻合器同時(shí)能切割及分切組織。 these staplers place at least two double staggered rows of titanium staples and some simultaneous

5、ly cut and divide tissue between them,吻合器類型iii-弧形切割吻合器,這些吻合器至少導(dǎo)入兩排雙重錯(cuò)開的鈦縫釘，一些吻合器同時(shí)能切割及分切組織。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器類型iv-管型吻合器,這些吻合器至少導(dǎo)入兩排雙重錯(cuò)開的鈦縫釘，一些吻合器同時(shí)能切割及分切組織。 these staplers place a

6、t least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器類型v-腔鏡下直線切割吻合器,這些吻合器至少導(dǎo)入兩排雙重錯(cuò)開的鈦縫釘，一些吻合器同時(shí)能切割及分切組織。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,為什么選擇機(jī)械吻合,使用便捷 ease of use 穩(wěn)定 consistency 速度快 speed 一些縫釘可同時(shí)在兩組雙排縫釘之間切割組織 some simultaneously cut between two sets of double rows of stapl