DILATORS — medical tools for expansion of wounds, natural cavities and channels, pushings off of bodies, procrastination (retraction) of soft tissues at survey or surgery, and also for protection of surrounding fabrics from accidental damage. The river, applied to expansion of operational wounds, also call ranorasshiritel.
Plates, shovels and pallets, hooks, podjekhmnik, mirrors, retractors, ranorasshiritel, dilators and Bougie carry to R. Feature of most of R. — a brilliant surface, edges at R.'s introduction to a cavity, reflecting light of lighting lamps, creates its additional lighting. With distribution of fiber light guides (see. Endoscopy ), transferring narrowly directed powerful beam of light to a cavity, R.'s surfaces began to do opaque, not giving the patches of light preventing to work to the operator.
The simplest type of the pushing aside tools are plates, shovels and pallets (the tab., 11, 12, 43). They are applied at survey of a throat, to a pushing off of soft tissues at operations and other manipulations. The shovel (rake) of Buyalsky (the tab., 33) and a plate (shovel) of Farabef for a pushing off of interiors (the tab., 34) was one of the first R. of this type.
Hooks are intended for procrastination and short keeping of fabrics, vessels and nerves at an operative measure. Lamellar hooks (the tab., 25, 26, 27) are applied by hl. obr. at all-surgeries. For heart operations use the flexible bilateral hook which is slightly curved on radius from stainless steel (the tab., 24). The hook depending on topography of an operational wound can give the necessary form. Pair hooks across Farabef are universal. Are widespread two - three - and four-gear hooks (the tab., 29, 30, 31) with stupid teeth for expansion of soft tissues and with acute — for more dense fabrics. Use single-toothed hooks on Bromfilda (the tab., 28) for reposition of fragments of bones. Hooks are widely applied in ophthalmology (the tab., 46, 47), in particular at microsurgeries (see. Ophthalmologic tools ), and also at prosthetics of a drum cavity (see. Otorhinolaryngological tools ), in stomatology (the tab., 48), neurosurgery (the tab., 6), obstetrics and gynecology (the tab., 4), etc.
For rise and assignment of various bodies there are elevators — flat or saddle hooks. The shoulder blade retractor on Tyyudora — to Edwards (the tab., 35) for prevention of its sliding is supplied with cloves. With soft tissues use the elevator with slightly bent oval rake to manipulations (the tab., 36), for the same purposes use the retractor for language (the tab., 49). The brain retractor is supplied with lighting (the tab., 7).
Surgical mirrors are intended to hl. obr. for expansion of wounds and cavities. They are various size depending on the mass of the fabrics and bodies which are subject to assignment or a pushing off. As a rule, their metallic surface is given a mirror-like polish. At abdominal and thoracic operations when the sizes of an operational wound are rather big, apply belly saddle mirrors (the tab., 13). Similar mirrors are intended for assignment of a liver, kidneys, a bladder (the tab., 15, 50, 51, 52). In children's surgery use plane and zhelobovaty hepatic mirrors (the tab., 19, 20) several sizes. They are made of light titanium alloy and have a mat surface since titanium does not give in to polish to a specular gloss. From titanium alloy release also mirrors for assignment of the left hepatic lobe, all liver, etc. Various mirrors are applied in gynecology: a mirror for diagnostic vyskablivaniye with replaceable caps (the tab., 2), on Martini (the tab., 3), to the Dean, Sims (see. Obstetric and gynecologic tools ), etc. At operations in an ophthalmosurgery use tiny eyelid lifters with a motionless or mobile mirror across Vodovozov (the tab., 45). Mirrors for heart (the tab., 16) differ in elasticity; on the working terminations they have a roller that does them and traumatic. At heart and lungs operations apply also elastic pair hooks (the tab., 24), wire mirrors (the tab., 17) and flexible bilateral hooks (the tab., 23).
Universal ranorasshiritel in band surgery (fig. 39) and in gynecology a suprapubic belly mirror with a support (the tab., 1) give the chance to the surgeon and his assistant partially to release hands during operation. Two semi-cylindrical mirrors or a hook have Ranorasshiriteli, as a rule, to-rye are moved apart by means of handles; at achievement of the necessary expansion ratio of a cavity are fixed kremalyery or the screw. The same design rectal speculums (the tab., 21), nasal (the tab., 44), etc.
Kremalyera is available also for other R. and ranorasshiritel, napr, for a tracheotomic dilator, a neurosurgical ranorasshiritel with acute sponges (the tab., 9), two - and a three-leaved ranorasshiritel (the tab., 37) across Mayo — to Simpson — to Colin, etc.
Mouth gags with kremalyery (the tab., 42) according to Roser — Kenigu or screw (the tab., 41) on Geystera apply to expansion of an oral cavity. In order that mirrors did not close access to walls of a cavity, their working parts usually do wire as, e.g., at a rectal speculum with wire sponges (the tab., 22), a nasal mirror (the tab., 44) for cultivation of wings of a nose, nek-ry vaginal speculums, or with windows. At band operations use powerful yard retractors with the special (lantern) mechanism of keeping of their working parts in a standard position. For production of big band operations they are let out also coupled (the tab., 40). Yard retractors use also at kidney operations (the tab., 53), a backbone (the tab., 8), etc. At bladder operations apply a wire ranorasshiritel (the tab., 54) type Goss with the third sponge fastening the screw and also a three-leaved ranorasshiritel with the device to a suction and lighting. At Cesarean section apply a special ranorasshiritel (the tab., 5), in neurosurgery — a universal ranorasshiritel of Egorov — Freydina (the tab., 10) with replaceable sponges, etc. (see. Neurosurgical tools ). With the advent of fiber light guides surgical instruments, including and mirrors, are issued with lighters of so-called cold light. At big band operations use a ranorasshiritel with organouderzhivatel for an abdominal cavity (the tab., 38).
The rubles intended for expansion with to lay down. the purpose of the narrow stenosed courses — throats, a gullet, necks of uterus — are called dilators. They are applied, consistently entering into a cavity on the increasing diameter. Dilators are issued sets, napr, guttural R. set of 8 pieces with a diameter from 6 to 12 mm, R. for palliative prosthetics of a gullet — from 3 pieces (to dia. 3, 6 and 9 mm), Hegar's dilators for expansion of a neck of uterus — 32 pieces (to dia. from 3 to 24 mm). For a research and treatment of urethrostenoses and a neck of a bladder serve Bougie (see).
Sterilization (see) the expanding tools it is recommended to carry out hl. obr. in the sukhovozdushny way at t 160 — 180 °, taking into account material of which R.
Hranyat R. in the dry place (are made see. Surgical tools ).
Table. SOME TYPES of DILATORS AND AREA of the MAIN THEIR USE
Bibliography: Short course of operational surgery with topographical anatomy, under the editorship of V. N. Shevkunenko and AN. Maxi-menkova, page 27, L., 1951; Krendal P. E. and Kabatov Yu. F. Medical merchandizing, page 172, etc., M., 1974.
Yu. F. Kabatov.