CLIPS SURGICAL — the medical tools intended for crossclamping of bodies, fabrics and objects during the performance of an operative measure.
3. x. on functional purpose divide into clips, holders and nippers. By means of clips overlapping of a gleam of hollow bodies for the termination of movement of contents in them, crossclampings of blood vessels for a temporary stop of bleeding or a blood-groove in them is carried out. Holders serve for keeping of bodies, fabrics, materials and objects in a certain situation. Nippers take and move (delay, take) bodies, fabrics and material (see. Nippers medical ).
3. x. have, as a rule, two working sponges, between to-rymi the body, fabric, material or a subject is clamped. Depending on a method of the data and short circuit of working parts of the tool they are divided into the following types: spring (terminal, tweezers), hinged, polzunny and screw (fig. 1). Along with it there are combined clips, napr, pivotally-polzunnye or spring and screw. The most important functional characteristic of the tightening tool is the size of pressure rendered by working sponges on the bodies or fabrics placed between them. Per acre the fabric clamped in a clip sometimes needs to regulate the size of this pressure it did not exceed a certain value, in order to avoid injuring. Such rationing is carried out, e.g., in the clips intended for temporary crossclamping of hollow bodies. The tightening tool which is not causing structural change of fabrics call elastic, and causing some reversible changes of fabrics — rigid. There are also crushing tightening tools crushing fabrics.
3. x. are known long ago. Many famous surgeons participated in their creation and improvement (some types 3. x. kept in names their names). Constant improvement 3. x., connected with development of the surgical equipment and emergence of new materials and tekhnol. the methods used at their production led to the fact that modern clips considerably differ by outward from originally offered by authors. 3. x. produce from high-quality stainless steel, their outer surfaces shall be polished, internal (teeth, notches, hare) can be opaque.
Features 3. x. are defined by a number of quantitative indices which can be controlled by means of devices. So, e.g., during the use 3. x. the effort is known, a cut the surgeon shall apply during the work with the tool, and the effort developing on working parts 3. x. It is of great importance for creation 3. x., convenient in work and causing necessary compression. fabrics and objects. Curvature and bends 3. x. are defined depending on conditions of their use. Most often 3. x. — these are clips of hinged type with kremalyery.
Clips are subdivided on styptic and for hollow bodies.
Styptic clips are intended for a temporary stop of bleeding from a gleam of the crossed vessel. They are applied in all fields of surgery. They have the box-shaped lock and the handle of rectangular section. In the general surgery most widely use: a Kocher's forceps — a direct clip with cutting on working sponges and acute teeth on the ends (fig. 2, 1) and without them (fig. 2, 2) 15, 16, 20 and 22 cm long; Billroth's clip curved, (fig. 2,3) 16 cm long and a clip with oval sponges of Pean (fig. 2,4). In neurosurgery use direct clips (fig. 2,5) bent (fig. 2, 6) 14.5 cm long with a slanting notch on narrow sponges and clips like «Mosquito» (fig. 2,7) — the most elastic of styptic clips 7,5 and 15 cm long which are issued direct and curved on the plane and on an edge. In ophthalmology styptic clips 8,5 cm long, elastic with small cloves, and clamping force on the third tooth kremalyer of only 0,7 kgfs are applied. At operative measures in deep cavities use direct and curved clips. They differ in abruptly bent ends of working sponges (fig. 2,8) and sometimes existence on sponges, in addition to a cross notch, flutes directed along a working sponge.
Outer surfaces of working sponges, styptic Clips shall be executed so that a ligature, to-ruyu previously tie on them, easily slid off a clip on a vessel. Therefore sponges of These clips do conical, and purity of their surface shall be not below the 10th class in accordance with GOST. For the purpose of the termination of a blood-groove apply elastic clips as they do not break an integrity of a vascular wall to short-term crossclamping of vessels. Sponges of these clips have the longitudinal flutes interfering slipping of a clip even with insignificant pressure of sponges of a clip upon a vascular wall. The first elastic clips were offered by Hyopfner (E. Hopfner) (fig. 2,9).
Development of techniques of an operative measure, including and in vascular surgery, led to creation various on a design' clips for temporary full or partial crossclamping of vessels. In the USSR 15 types of such clips are issued; they differ with length and a form of a bend (fig. 2,10 — 19). For protection from accidental unfastening these clips are supplied with a special latch; width of their sponges is 3,5 — 4 mm. For partial side crossclamping of vessels without stopping of a blood-groove in them which are used at zashivaniye of pristenochny wounds of vessels and imposing of a vascular anastomosis narrow sponges (width of 1.5 mm) have clips and differ in considerable curvature (fig. 2,12).
Along with hinged 3. x. in surgery of vessels clips of polzunny type (fig. 2,13) with a spring are widely applied and screw (fig. 2,14). Screw clamps apply fenestrated (fig. 2,15) during the imposing of a side anastomosis of large vessels. In cardiovascular surgery so-called needle clips (fig. 2,18) intended for capture and rapprochement of edges of a muscle of heart received use. In obstetrics and gynecology at atonic bleedings apply a unit elastic clamp (fig. 2,16) to crossclamping of a uterine artery. In urology for a stop of bleeding from the capsule of a prostate use an original clip (fig. 2, 17) having on one of working sponges the ledges pins entering openings on the second sponge that allows it is reliable to fix a clip, and Fedorov's clip for a renal leg. In ophthalmology, at operations on centuries, apply fenestrated forceps of type to the termination of bleeding tweezers (see) which sponges approach the help of the screw. Carry to elastic also clips for an ear of heart which are issued 4 numbers (fig. 2, 19). On sponges of these clips there is a small cross cutting.
Clips for hollow bodies are most widely applied in went. - kish. surgeries (clips gastric, intestinal, for a rectum, for a gall bladder and bilious channels, for a renal leg). Both the elastic, and crushing clips are applied. From crushing at resections of a stomach use Payr's (fig. 2, 20) clip with the four-hinged self-locked lock, a cut and the fixing pin on the ends of sponges protecting them from a distortion; length of its 36 cm, width of sponges is 9 mm, scope of handles of 18 cm. A similar design the clip of Mayo is applied to crossclamping of a duodenum. The original stiff stomach forceps was offered by S. I. Spasokukotsky. The stiff stomach forceps about the corrugating sponges and a kremalyery (fig. 2, 21) design of All-Union research and test institute of medical equipment (VNIIMT) is put into practice. By the principle of the corrugating clips the corrugating clip with Holdin's (fig. 2, 22) needles for a resection of a stomach by an electrosurgical method is created. In VNIIMT also corrugating clips for imposing of purse-string seams on a stump of a duodenum, a small bowel, on a dome of a caecum are created at appendectomy (fig. 2, 23). For elastic crossclamping of a stomach and guts use the direct and bent clips (fig. 2, 24, 25). Elastic clips are characterized by soft working sponges with longitudinal cutting and long kremalyery (seven-eight teeth), allowing to regulate thinly compressive force of body. Also hinged clips for a rectum (fig. 2, 26), direct and curved clips 20 cm long for crossclamping of bilious channels are used. At gullet, bronchial tubes, duodenum operations apply clips of polzunny type with in parallel the sponges (fig. 2, 27) reduced by means of the screw. At children at operations for a disease of Girshprunga for crossclamping of a rectum and sigmoid it is developed and a set of screw clamps of five sizes (fig. 2, 28) is issued. One handle is included in the package of set, in to-ruyu the clip of the necessary number is inserted and fixed by the screw.
Clips - holders. The clips representing a hinged clip with rack are applied to an attachment of operational linen to skin at surgeries; working sponges of clips are pointed and easily puncture linen and skin (fig. 2, 29). To a peritoneum apply hinged clips with a clove across Mikulich (fig. 2, 30) to an attachment of operational linen or lamellar clips terminals. For capture and deduction of fabrics, extraction of foreign bodys, introductions of tampons to wounds widely use packers — direct or curved (fig. 2, 31). For capture of a mucous membrane of a stomach and guts use a clip for an intestinal wall (fig. 2, 32) of Ellis, working sponges to-rogo have on some acute cloves. Different fenestrated forceps are applied to capture and keeping of bodies: at a gall bladder operations — a clip for a gall bladder (fig. 2, 33); for deduction of a pancreas at its section and the subsequent sewing together with a gut at pankreatoduodenalny resections — a unit clamp for a pancreas (fig. 2, 34). Fenestrated forceps are used also for extraction of stones from a gall bladder, for capture and deduction of a tumor in a nasopharynx, for deduction of a lung at operation on it, etc. There are also different auxiliary clips for the elastic tubes going from devices for hemotransfusion, the sucking-away devices, etc. In the figure 3 clips for elastic tubes are represented screw and spring; one of them (fig. 3, c) is applied generally at hemotransfusion.
Storage, leaving and sterilization 3. x. usual for all metal surgical instruments.
Bibliography: Kabatov Yu. F. Medical tools and equipment, M., 1977; Krendal P. E. and Kabatov Yu. F. Medical merchandizing, M., 1974.
Yu. F. Kabatov.