Enzler M A
Chirurgische Klinik, Spital Limmattal, Switzerland.
Eur J Vasc Surg. 1991 Dec;5(6):681-4. doi: 10.1016/s0950-821x(05)80906-5.
When autologous veins or vascular prostheses are implanted for bypass operations or haemodialysis, the use of an appropriate tunnelling device is extremely helpful. In order to avoid perigraft haemorrhage and allow undelayed graft incorporation, the tunneller should match the diameter of the implant. Interchangeable shafts of various lengths and blunt tips of various diameters are prerequisites for a versatile instrument. Most instruments on the market have an important drawback: the handle is welded to one end of the shaft thus preventing "bi-directional" use. We have therefore developed a modified tunneller that can be used equally well in either direction. The connection between shaft and handle affords torsional rigidity and thus allows precise guidance during insertion. The handle can be attached to both ends of the shaft. Thus, for example, in a femoro-popliteal bypass, the distal anastomosis can be constructed first, followed by the introduction of the tunneller from the knee to the groin. As a next step the tip and handle are interchanged and the graft is passed from the knee to the groin. When a haemodialysis shunt with a PTFE-loop is inserted, the bidirectional use of the tunneller makes it possible to insert the graft with a smooth curve into the smallest possible cavity. Thus, the new instrument set called the "Bi-directional Tunneller" is more versatile and easier to use than other tunnellers presently available.
当植入自体静脉或血管假体进行搭桥手术或血液透析时，使用合适的隧道装置非常有帮助。为避免移植血管周围出血并使移植血管能及时融合，隧道器的直径应与植入物相匹配。具备不同长度的可互换轴杆以及不同直径的钝头是多功能器械的必备条件。市面上的大多数器械都有一个重大缺陷：手柄焊接在轴杆的一端，因此无法“双向”使用。因此，我们研发了一种改良型隧道器，它在两个方向上都能同样出色地使用。轴杆与手柄之间的连接提供了扭转刚度，从而在插入过程中能实现精确引导。手柄可以连接在轴杆的两端。例如，在股腘动脉搭桥手术中，可以先构建远端吻合口，然后将隧道器从膝盖插入腹股沟。接下来，将尖端和手柄互换，使移植物从膝盖穿至腹股沟。当插入带有聚四氟乙烯环的血液透析分流管时，隧道器的双向使用使得能够以平滑曲线将移植物插入尽可能小的腔隙中。因此，这种名为“双向隧道器”的新型器械套装比目前市面上的其他隧道器用途更广且更易于使用。
