吻合器的发展与分类

1、吻合器的历史及发展,外科手术的共同目标,高效 快速 止血 安全 为患者提供最佳效果 为外科医生提供最佳效果,何为吻合,两种组织结构之间行手术连接 a surgical connection between two structures,霍尔斯特德提出的构建吻合的原理 halsteds principles for creating an anastomosis,无吻合口张力 无吻合口漏 止血效果好 足够的吻合口血供 足够的吻合口内径,吻合的目的,吻合组织 ，建立通路 结扎血管或组织移植体残端 保持止血,吻合方式,缝合/手缝吻合 suture/ hand-sewn approximation 缝

2、钉固定器械/缝钉吻合 stapling device/stapled approximation,机械吻合的理念,双排交错的缝钉理念,b型成钉的缝合理念,缝钉的参数,根据组织厚度决定钉子关闭的高度,缝钉成型,非反应性钛=引起的组织反应较少 non reactive titanium = causes little tissue reaction b形,缝钉线,吻合器发展史,1908年，第一台吻合器械（匈牙利的humer htl） first stapling instrument (humer htl, hungary) 早期产品 early production 不好使用 cumbersom

3、e 结构复杂 complicated 性能不可靠 unreliable,吻合技术的发展,最近发展状况（过去的25年中） recent development (within the last 25 years) 更可靠 more reliable 使用更便捷 easier to use 质量更好 better quality 出现的技术问题较少 fewer technical problems 能在较难处理的位置构建吻合 ability to create anastomoses in difficult places,吻合器类型i-直线型吻合器,这些吻合器至少导入两排双重错开的钛缝钉，一些吻

4、合器同时能切割及分切组织。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器类型ii-直线型切割吻合器,这些吻合器至少导入两排双重错开的钛缝钉，一些吻合器同时能切割及分切组织。 these staplers place at least two double staggered rows of titanium staples and some simultaneous

5、ly cut and divide tissue between them,吻合器类型iii-弧形切割吻合器,这些吻合器至少导入两排双重错开的钛缝钉，一些吻合器同时能切割及分切组织。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器类型iv-管型吻合器,这些吻合器至少导入两排双重错开的钛缝钉，一些吻合器同时能切割及分切组织。 these staplers place a

6、t least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,吻合器类型v-腔镜下直线切割吻合器,这些吻合器至少导入两排双重错开的钛缝钉，一些吻合器同时能切割及分切组织。 these staplers place at least two double staggered rows of titanium staples and some simultaneously cut and divide tissue between them,为什么选择机械吻合,使用便捷 ease of use 稳定 consistency 速度快 speed 一些缝钉可同时在两组双排缝钉之间切割组织 some simultaneously cut between two sets of double rows of stapl