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<section data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.jpg" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section><span>关注</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><p><br /></p><p><span>缝合是外科手术中必不可少且非常重要的环节。二十世纪前，外科手术中所有的缝合工作都靠手工缝线完成，遇到小伤口或小血管的结扎还好，一旦遇到食管、肺、胃肠、肝脾胰这类内脏器官的手术，医生就得在缝合上花费几个甚至十几个小时。</span></p><section powered-by="gulangu"><section><section powered-by="gulangu"><p><br /></p></section></section></section><p><span>如今很多手术依然需要医生运用高超的“缝纫”技巧对伤口或器官组织进行缝合。但有时他们也能够借助一种医学“订书机”——吻合器，通过机械化的操作方式让手术缝合更加高效，并让许多困难复杂的手术变得简便，且大幅降低了手术并发症发生率。</span></p><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><br /></section><section><p><img src="image/20201014/948f114d1ebd3829d898fbdfde2a2781_2.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><span><br /></span></section></section></section></section></section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><span><strong><span>01吻合器的诞生</span></strong></span></section><section><br /></section></section></section></section></section></section></section><section><span>1908年，匈牙利医生Hümer Hültl从订书机上获得灵感，成功发明出一种新的止血缝合工具——吻合器。它由各种金属部件组装而成，重达8磅，装配费时达2个小时。看它的中文名字你可能没有什么感觉，可如果搬出它的英文名称Surgical Stapler（外科订书机），是不是就形象很多？ </span></section><section><span><br /></span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/257ff0731816de18aa997aae9dd5c784_3.jpg" /></p></section></section></section></section></section><section><span><br /></span></section><section><span>“外科缝合器之父”——Humer Hultl</span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><span>既然是从订书机上获得的灵感，想必大家立刻就能猜到吻合器的工作原理，回忆一下平时你装订纸张的过程，把纸替换成我们体内的组织，就能大概还原吻合器工作时的样子了。</span></section><section><br /></section></section><section powered-by="gulangu"><section><span>当然，如果和文具订书机完全一样，吻合器就称不上是一件伟大的发明了。为了更好解决手术中的止血问题，吻合器的发明者Hültl医生颇有一些很棒的想法：</span></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section powered-by="gulangu"><section><section><span>他改造了钉砧，让受到挤压后的缝钉能呈B字型，这样既能牢牢扎住主要 血管，又能保证钉合组织和切割边缘的血供和营养；他设计的多排缝钉采用交错排列法，缝钉的轨迹如两条平行的虚线，彼此锁住空隙，确保切割所经的所有血管都被结扎，以避免吻合处有渗出现象。</span></section></section></section></section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/4a5621beefa1ab1e410cb68012efc184_4.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>“B”字型缝钉</span></section></section><section powered-by="gulangu"><section><br /></section></section><section><span>值得一提的是，直到今天这两点还被应用于吻合器的设计中。因此Hultl被誉为“外科缝合器之父”。<br /></span></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section><span>吻合器的出现大大提升了一些手术的效率和成功率，而它本身也经历了不断的升级换代：原本的吻合器只能缝合，之后人们在钉仓中加入刀片，实现了边切边缝的功能；应用于不同器官手术的吻合器，在外形和功能上也发生了不同的演变。</span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><span><strong><span>02现代吻合器</span></strong></span><span></span></section></section></section></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/d36508dc0997262d1f0fc7f5910a0c10_5.jpg" /></p></section></section></section></section></section><section><br /></section><section><span>直线型缝合器基本结构<br /></span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><span>1921年直线型缝合器问世 (Aladar Von Petz, 匈牙利)，简化了吻合器的设计，用镍银合金代替金属丝，并且可以重复填装缝钉，使得吻合器更加轻便。1934年德国的H. Friederich和Neuffer对缝合器作了改进，加装了可更换钉仓；1951年前苏联的实验外科器械研究所对缝合器进行了系统的研究，并在此领域处于领先水平。</span></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section><section powered-by="gulangu"><section><section><strong><span>1958年，吻合器在美国获得关键性改良</span></strong></section><section><span>美国学者Ravitch在前苏联实验外科器械研究所参观后，将缝合器技术引进美国。</span></section><section><span><br /></span></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><span>1967年，美国外科公司Auto Suture的创始人Locn Hirsch以及他的工程师们，从根本上解决了装配缝钉费时的问题，生产出一种可以方便应用于临床手术的吻合器。</span><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/da212d1e913e4bb65febb28ae87aabc5_6.jpg" /></p></section></section></section></section></section><section><span>发展中的吻合器</span></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section><section powered-by="gulangu"><section><section><strong><span>1968年，切割缝合器问世</span></strong><span></span></section></section></section></section></section></section></section></section></section><section><span>美国外科公司推出具有双组双排缝钉及刀片的吻合器，在缝合的同时可以进行组织切割，多用于胃肠组织的离断,或胃肠、肠肠的内翻吻合。</span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section><section powered-by="gulangu"><section><section><strong><span>1978年，管型端端吻合器（EEA）问世</span></strong><span></span></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><span>EEA具有双排环形缝钉及刀片，刀片用于吻合时切断缝钉内侧的组织，使之形成端端吻合口，用于不同直径腔道的环状吻合）。</span></section></section><section powered-by="gulangu"><section><span> </span></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/8ab04f76641f5ed074631d20a5f01abd_7.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>管型端端吻合器的出现</span></section><section><br /></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><strong><span>1979年，一次性吻合器问世</span></strong></section><section><span>1979年美国Ethicon公司，研制和发展了多种缝合器和吻合器，并生产出全球第一把完全一次性、单病人使用的机械吻合器。一次性吻合器减少了器械消毒带来的患者交叉感染的几率，降低了患者术后并发症发生的概率，也使吻合器的大批生产和广泛应用又上了一个台阶。</span></section></section></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section><span>此后，各类用于不同组织的缝合器陆续问世，为外科医生们提供了手术用的有力武器。</span></section><section><br /></section><section><p><img src="image/20201014/859ead4b1aa0b631a7b0d2646d64e27e_8.jpg" /></p></section><section><span>一次性吻合器的问世</span></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section><section powered-by="gulangu"><section><section><strong><span>缝钉成型技术改良创新</span></strong><span></span></section></section></section></section></section></section></section></section><section><span>2004年，Covidien公司发明了DST缝钉成型技术。DST是Directional Stapling Technology的缩写，翻译过来是“导向型缝钉成型技术”。和传统技术相比，DST技术做了两点革新：</span></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><span>1、近似方柱形钉腿：</span></section><section><span>横截面近似矩形的方柱形缝钉与推钉板接触的是一个平面，避免推钉板行进时，钉腿发生偏移或扭曲。</span></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/e704d31f3c082ca092623b7058854ff1_9.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>近似方柱形钉腿</span></section><section><br /></section></section><section powered-by="gulangu"><section><span>2、水滴状钉砧：</span></section><section><span>面积更大的钉砧凹槽可以更有效地引导钉腿完美成形。<br /></span></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/67abf9e6f65c273a6a72560275107b1b_10.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>水滴状钉砧</span></section></section><section powered-by="gulangu"><section><br /></section><section><span>这两点共同作用的结果，就是无论需要吻合的组织是厚是薄，都能稳定压出一个处女座也挑不出错的完美B字缝钉。</span></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section><strong><span>2012年，Tristaple创世智能吻合技术问世</span></strong><span></span></section></section></section></section></section></section><section><span>传统吻合器工作时，会在切割路径两边各击发2至3排等高、等尺寸的缝钉。但实际应用时，由于组织厚度存在差异，等高的缝钉难免“顾此失彼”，钉得紧，可能会影响血供和愈合 ；钉得松，可能产生渗漏，真是左右为难。<br /></span></section><section><br /></section><section><span>为了解决这对矛盾，美敦力推出了Tri-Staple? 技术，简单说来，就是采用了三排不等高的、呈阶梯状的缝钉技术。</span></section><section><br /></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/f136f87dddb1d33f9f4a3097ff06bfa5_11.jpg" /></p></section></section></section></section></section><section><span>Tri-Staple? 技术<br /></span></section><section powered-by="gulangu"><section><br /></section></section><section><span>对缝钉高度的简单调整，带来的却是不简单的效果。击发后的缝钉内紧外松，靠近刀口的钉腿短，缝得较紧，能防止出血；远端钉腿高，缝得较松，能维持组织液和血液的流通，为组织提供营养，加快愈合。</span></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section><span>此外，缝钉的击发时间也有先后，从内侧到外侧三排依次击发，配合阶梯型的钉匣面，夹得又准又不伤害组织。同时，在击发过程中，缝钉始终先于刀片，这样的“先缝后切”也最大程度确保了组织的安全。</span></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/b9512c80f2239c68b4d4de1bae6d3c44_12.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>“先缝后切”技术</span></section><section><br /></section></section><section powered-by="gulangu"><section><span>总之，Tri-Staple技术通过三排不等高和渐进性夹闭的独特设计，实现了吻合严密、适配组织厚度和预防损伤的效果，大大提升了患者的术中安全和术后愈合。<br /></span></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section></section></section></section></section><section><section powered-by="gulangu"><section><section><strong><span>2015年，第一台电动智能切割吻合器诞生</span></strong><span></span></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section><p><img src="image/20201014/1d5fc36e19d97708e520d286a25d2931_13.jpg" /></p></section></section></section></section></section><section powered-by="gulangu"><section><span>电动智能切割吻合器</span></section><section><br /></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><section><span>Covidie公司在2015年推出了iDrive?智动平台，机械吻合需要医生不断操纵手柄分段击发缝钉，如果击发速度不当，或是操作时发生移位，都会对患者的组织造成伤害，安全性得不到保障。而iDrive智动平台不仅能自动调节击发速度，匀速击发，还能在夹取组织厚度过厚时给予反馈，提醒医生改变位置或更换另一种高度的钉腿，有效提高了吻合过程中组织的安全性。更不用提只需简单操控手柄处的按钮就能实现钉仓角度的无极旋转，大大方便了医生操作。</span></section><section><br /></section><section><span>总结一下，经历了一个多世纪的发展，目前吻合器主要可分为线性吻合器、环形吻合器、线性切割吻合器、荷包吻合器、皮肤筋膜吻合器和腹腔镜专用吻合器，电动智能切割吻合器等。未来已经走进你我，让我们以更加开放的姿态，去迎接新技术、新器械时代的早日来临！</span></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>来源：医用塑料</p></section><section><br /></section><section><section data-color="#757576"><section><section><section data-brushtype="text"><strong>相关阅读</strong></section></section></section><section><section><section><br /></section></section></section><section data-width="100%"><section><section><section><section data-width="100%"><section><section><p><img src="image/20201014/2aac877ff9233ba5a66e7a5ff3a4febf_14.gif" /></p></section><section 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发表于 2020-10-14 11:18:15