CN103002840A - An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract - Google Patents
An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract Download PDFInfo
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- CN103002840A CN103002840A CN2010800680861A CN201080068086A CN103002840A CN 103002840 A CN103002840 A CN 103002840A CN 2010800680861 A CN2010800680861 A CN 2010800680861A CN 201080068086 A CN201080068086 A CN 201080068086A CN 103002840 A CN103002840 A CN 103002840A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0013—Implantable devices or invasive measures
- A61F5/0076—Implantable devices or invasive measures preventing normal digestion, e.g. Bariatric or gastric sleeves
Abstract
An apparatus (11) for diverting biliopancreatic juices discharged into a patient's intestinal tract, comprising a tubular member (12) having an internal food isolating space (13) and a proximal sealing portion (14), a laterally open bile isolating cavity (19) configured to define together with an adjacent portion of intestinal wall a bile isolating space (19), a food sleeve portion (21 ) extending distally from the flexible tubular member (12), a bile diversion conduit (24) extending from the bile isolating cavity (19) in a distal direction and having a distal open bile conduit end (25).
Description
Technical field
The present invention relates generally to following apparatus and method, described apparatus and method are used for affecting with operative Modality patient's digestion, it is intended to treat metabolism disorder, for example morbid obesity and relevant comorbidities (for example, diabetes), heart disease, apoplexy, lung disease and accidental disease.
Background technology
Attempt many non-operative treatment for morbid obesity, but in fact all do not obtained persistent success.
The surgical method for the treatment of morbid obesity for example for persistency food absorption bad open, abdominal cavity mirror and intracavity gastric bypass operation, has obtained increasingly extensive application and has obtained than ten-strike.Yet the method that is used at present carrying out gastric bypass relates to the consuming time and dependent surgery operating technology of high sensitivity and to the remarkable and common disadvantageous modification of patient's gastrointestinal anatomical structure.
Affect patient's digestion for fear of the shortcoming of gastric bypass operation and in mode more specifically and targetedly, the present invention emphatically research is used for major effect and adjusts intestinal-hepatic bile circulation but not gastral method and apparatus.For this reason, should be susceptible to following possibility method and the mechanism that acts on intestinal-hepatic bile circulation:
-adjustment intestinal-hepatic bile cycle frequency, especially bile circulation acceleration;
-adjust contacting and interaction and the physiological signal that triggered with contacting of intestinal wall by bile by the food of bile and enteral;
-by adjust bile and food or chyme at the attaching space of enteral with time of contact and by making bile and food separate targetedly to adjust the absorbability of food.
Be used for that for example bile and pancreatic juice are transferred to enteral known devices and method and discussed to some extent towards the distally with Digestive system in US 2009/0062717 and US 7,314,489.Be disclosed in US 7,314, the device in 489 comprises support, described support have far-end and engage in the weary Te Shi ampulla zone duodenal near-end and between near-end and far-end to produce the diameter parts that reduces of the endless belt volume that can collect bile.The device that is disclosed among the US 2009/0062717 comprises bearing support and conduit, and described bearing support has lateral opening, and described conduit extends between the near-end that is connected to lateral opening and distal open end, and the near-end of wherein said conduit can form reservoir.
These known devices and the method that are used for shift and assimilation liquid are collected bile, but they do not affect particularly or change bile does not contact with intestinal wall and interactional time and space with food.
Therefore purpose of the present invention for a change bile contact with intestinal wall and interactional natural time and space with food, control diabetes to cause weight saving and/or permission in the mode of Wicresoft especially.
The equipment that is discharged to the gallbladder pancreatic juice of Intestinal Mucosal Injury in Patients Undergoing by being used for transfer is realized this purpose, and described equipment comprises:
A) flexible tubular element, described tubular element has:
-inner food insulating space and
-nearside hermetic unit, described nearside hermetic unit can engage intestinal wall and flow between tubular element and intestinal wall to prevent food,
-proximal open end, described proximal open end can be admitted food stream and food stream is guided in the food insulating space,
-distal open end, described distal open end can discharge food stream from the food insulating space,
The open bile separate cavities of-side direction, the open bile separate cavities of described side direction is formed by the outer surface of tubular element and can limit with the adjacent part of intestinal wall the bile insulating space,
B) food sleeve portion, described food sleeve portion is from the distal open end of the tubular element of flexibility towards distal extension and have open distally food sleeve end, and described food sleeve portion limits the food conveying space in inside,
C) bile transfer conduit, described bile transfer conduit are from the bile separate cavities towards distal extension and have open distally bile catheter end, and described bile transfer conduit limits the bile conveying space with described food conveying space isolation in inside.
This equipment is isolated food or chyme and intestinal wall in the zone in tubular element distally, simultaneously with bile from the bile separate cavities and do not enter oddi's sphincter and transfer to the position (open bile catheter end) that is independent of with the zone of chyme isolation.
Summary of the invention
According to an aspect of the present invention, the distal open end of bile transfer conduit is positioned at the position in the distally of the open sleeve end in distally.
This allows to distribute food so that food contact intestinal wall in the primary importance in the tubular element distally of flexibility, and allow primary importance more the enteral second position in distally distribute bile or gallbladder pancreatic juice, so that bile (for example contacts with intestinal wall, distally jejunum or ileum wall) and chyme stream divided a word with a hyphen at the end of a line along intestinal and the intestinal of contact and bile isolation after, flow with chyme with the food of part digestion and to contact.Therefore, for naturalness, attaching space and the time of food-bile-intestinal are significantly changed, and food absorption and intestinal hepatic bile circulate to obtain to lose weight and/or the control of diabetes thereby affect.
According to another aspect of the present invention, the bile transfer conduit comprises outer cover, and described outer cover limits the annular bile conveying space around the food sleeve portion.
According to another aspect of the present invention, the bile conveying space by the outer surface of food sleeve portion and on every side intestinal wall partly limit so that bile with food stream isolation but the mode that contacts with intestinal wall flow in the intestinal from tubular element towards the distally.
According to another aspect of the present invention, the bile transfer conduit comprises the conduit that is arranged in food sleeve portion outside, is independent of intestinal wall and chyme flows with the bile that allows isolation.
According to another aspect of the present invention, the food sleeve portion directly extends from the nearside hermetic unit, thereby forms duodenal sleeve.
According to another aspect of the present invention, the distal open end of bile conduit passes into the food sleeve portion in the position of distal openings sleeve end nearside, allows thus:
-gallbladder pancreatic juice and food flow into first, and wherein the two is isolated from each other and isolates with wall of the lumen;
-gallbladder pancreatic juice is being arranged in the first distally and is still mixing with the second portion of wall of the lumen isolation with food stream;
-food contacts with intestinal wall with the position of gallbladder pancreatic juice in the second portion distally.
According to another aspect of the present invention, described equipment is included in the biliary drainage catheter that extends between near-end and the far-end, and described near-end has support to connect the biliary drainage catheter in the biliary ductal tree, and described far-end connects the tubular element that is communicated with bile separate cavities fluid.This allows optionally to capture bile in the biliary ductal tree and/or pancreatic juice and it is guided in the bile separate cavities.
Also by being used for shifting the method realization of the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing, described method comprises above-mentioned purpose of the present invention:
A) at the bile insulating space of weary Te Shi ampulla location formation between device and intestinal wall;
B) food stream is separated in the zone of bile insulating space far-end with intestinal wall;
C) bile of isolation is transferred to the position in the distally in the zone that the stream of food wherein separates with intestinal wall from the bile insulating space.
According to an aspect of the present invention, the step that shifts the bile of isolation comprises the steps: the bile transfer conduit is extended to from the bile insulating space along distal direction at intracavity the position in the distally in the zone that food stream wherein separates with intestinal wall.
According to another aspect of the present invention, the step that shifts the bile of isolation comprises the steps: to coincide or coincide by intestinal-endogenous tub of tissue-intestinal by intestinal-intestinal, and the direct tube chamber of formation is communicated with between the distally target position of intestinal wall and intestinal in the bile insulating space.
Description of drawings
By accompanying drawing and explanation thereof, these and other aspect of the present invention and advantage will become obvious, described accompanying drawing and explanation thereof show embodiments of the invention, and are used for explaining principle of the present invention together with the specific embodiment of the whole embodiment that describes and hereinafter provide of the present invention that provides above.
-Fig. 1 shows the method and apparatus that is used for shifting the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing according to the first embodiment of the present invention;
-Fig. 2 shows the details of the equipment among Fig. 1;
-Fig. 2 A shows the details of equipment according to a second embodiment of the present invention;
-Fig. 3 shows the details of the equipment of a third embodiment in accordance with the invention;
-Fig. 4 shows the details of the equipment of a fourth embodiment in accordance with the invention;
-Fig. 5 shows the details of equipment according to a fifth embodiment of the invention;
-Fig. 6-12 shows the apparatus and method that are used for equipment is anchored to according to an embodiment of the invention gastrointestinal tract;
-Figure 13 shows the details of equipment according to a sixth embodiment of the invention;
-Figure 14 shows the details of equipment according to a seventh embodiment of the invention;
-Figure 15 A and 15B show the details according to the equipment of the eighth embodiment of the present invention;
-Figure 16 shows the details of equipment according to another embodiment of the invention;
-Figure 17 shows method and apparatus according to another embodiment of the invention.
The specific embodiment
Referring to accompanying drawing, the wherein similarly similar anatomical structure of digitized representation and parts in a plurality of views, Fig. 1 is the partial view in patient's abdominal cavity, wherein show have esophagus 1, the gastrointestinal tract of stomach 2, duodenum 3, jejunum 4, ileum 5, colon 6, and have liver, comprise the liver and gall of major duodenal papilla 10 (bile and pancreatic juice pass it and normally enters duodenum 3) of biliary ductal tree 7, ductus pancreaticus 9 and the weary Te Shi ampulla of gallbladder 8, and the equipment 11 that is used for shifting the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing.
According to embodiment, equipment 11 comprises the tubular element 12 of preferred flexible, described tubular element 12 has inner food insulating space 13 and nearside hermetic unit 14 at least, and described nearside hermetic unit 14 can engage intestinal wall and flow between tubular element 12 and intestinal wall to prevent intestinal wall.Tubular element 12 also forms proximal open end 16 and distal open end 17, and described proximal open end 16 can be admitted food stream and it is guided in the food insulating space 13, and described distal open end 17 can discharge food stream from food insulating space 13.The outer surface 18 of tubular element 12 is to form the mode molding of the open bile separate cavities 19 of side direction, and the open bile separate cavities 19 of described side direction can limit with the adjacent part of intestinal wall bile insulating space 19.
Equipment 11 also comprises food sleeve portion 21, and described food sleeve portion 21 is from the distal open end 17 of the tubular element 12 of flexibility towards distal extension and have open distally food sleeve end 22.Food sleeve portion 21 limits food conveying space 23 in inside.
In addition, open distally bile catheter end 25 can be extended and have to bile transfer conduit 24 from bile separate cavities 19 along distal direction.The bile transfer conduit limits the bile conveying space 26 with 23 isolation of food conveying space in inside.
Can with this equipment for example per os insert and be formulated in 12 rectum at weary Te Shi nipple area 10 places so that bile separate cavities 19 covers weary Te Shi nipple 10 to admit gallbladder pancreatic juice.According to this location, equipment 11 allows food or chyme are isolated in the zone in tubular element 12 distally with intestinal wall, allows simultaneously bile is transferred to the position that is independent of the zone that isolates with chyme from bile separate cavities 19, and need not to enter oddi's sphincter.
According to embodiment, tubular element 12 can support, and described support can be anchored in the small intestinal, and especially gallbladder pancreatic juice normally enters in the duodenum 3 at weary Te Shi nipple 10 places of intestinal, and can capture gallbladder pancreatic juice and it is guided in the bile transfer conduit 24.
In the exemplary embodiment, bile separate cavities 19 comprises the radially outer annular chamber, and described radially outer annular chamber forms and axially defined by radially outstanding nearside tube chamber hermetic unit 14 and radially outstanding distally tube chamber hermetic unit 15 around bile insulating space 20.
Tube chamber hermetic unit 14,15 can be expanded to from the radially less configuration of initial contraction the radially larger configuration of expansion, the radially less configuration of described initial contraction allows equipment 11 is introduced and is transported to through tube chamber (per os) the selected duodenum part at weary Te Shi nipple 10 places, the radially larger configuration of described expansion allows tube chamber hermetic unit 14,15 closely to engage wall of the lumen and tubular element 12 is anchored to wall of the lumen.
For this reason, tube chamber hermetic unit 14,15 can comprise the inflatable balloon section, and described inflatable balloon section can be by injecting for example for example hardening polymer foam or paste and permanently expand of saline solution or setting expansion agent of expansion fluid.
According to embodiment, distally tube chamber hermetic unit 15 also can limit one or more bile access openings 27, and described bile access opening 27 extends to bile transfer conduit 24 and the two is placed to fluid from bile separate cavities 19 and is communicated with.
According to embodiment, the distal open end 25 of bile transfer conduit 24 is positioned at the position in open sleeve end 22 distally, distally.This allows to distribute food so that food contacts with intestinal wall in the primary importance in tubular element 12 distally of flexibility, and allow primary importance more the enteral second position in distally distribute bile or gallbladder pancreatic juice, so that bile and intestinal wall are (for example, distally jejunum or ileum wall) contact, and chyme stream divided a word with a hyphen at the end of a line along intestinal and the intestinal of contact and bile isolation after, flow with the food of part digestion or chyme and to contact.
According to another embodiment (Fig. 2,3), bile transfer conduit 24 can comprise outer cover 28, and described outer cover 28 is basically coaxial with food sleeve portion 21 and limit annular bile conveying space 26 around food sleeve portion 21.In this embodiment, the position of distally bile catheter end 25 depends on the length of outer cover 28 and can be positioned at the position of the nearside of distally food sleeve end 22, so that:
-in first pipeline 29 in tubular element 12 distally, food stream and bile flow is isolated from each other and isolate with intestinal wall,
-the first pipeline 29 distally and the second pipe 30 from distally bile catheter end 25 towards distal extension, bile contacts with intestinal wall, and food stream is still isolated with bile and intestinal wall, and
-second pipe 30 distally and the 3rd pipeline 31 from distally food sleeve end 22 towards distal extension, food stream contacts (Fig. 3) with remaining still unabsorbed bile mixing and with intestinal wall.
In alternative exemplary embodiment (Fig. 2 A), the position of distally bile catheter end 25 can be positioned at the position of the nearside of distally food sleeve end 22, so that:
-in first pipeline 32 in tubular element 12 distally, food stream and bile flow is isolated from each other and isolate with intestinal wall,
-the first pipeline 32 distally and the second pipe 33 from distally food sleeve end 22 towards distal extension, food stream mixes with bile, and food stream and bile are still isolated with intestinal wall, and
-second pipe 33 distally and the 3rd pipeline 34 from distally bile catheter end 25 towards distal extension, food contacts with intestinal wall with bile.
In alternative embodiment (Fig. 4), bile conveying space 26 by the outer surface 35 of food sleeve portion 21 and on every side intestinal wall partly limit so that bile with food stream isolation but the mode that contacts with intestinal wall flow into the intestinal 36 from tubular element 12 towards the distally.
According to exemplary embodiment (Fig. 5), bile transfer conduit 24 comprises the conduit that is arranged in food sleeve portion 21 outsides, thereby allows the bile of isolation to be independent of intestinal wall and chyme or flow of food.
In this embodiment, the position of distally bile catheter end 25 depends on the length of outer conduit and can be positioned at the position in the distally of distally food sleeve end 22, so that:
-in first pipeline 37 in tubular element 12 distally, food stream and bile flow is isolated from each other and isolate with intestinal wall,
-the first pipeline 37 distally and the second pipe 38 from distally food sleeve end 22 towards distal extension, food stream contact intestinal wall, and bile is still isolated with food and intestinal wall, and
-second pipe 38 distally and the 3rd pipeline 39 from distally bile catheter end 25 towards distal extension, bile contacts (Fig. 5) with remaining still unabsorbed food mixing and with intestinal wall.
(not shown) in alternative exemplary embodiment, the position of distally bile catheter end 25 can be positioned at the position of the nearside of distally food sleeve end 22, so that:
-in first pipeline in tubular element 12 distally, food stream and bile flow is isolated from each other and isolate with intestinal wall,
-in the first pipeline distally and from distally bile catheter end 25 towards the second pipe of distal extension, bile contacts with intestinal wall, and food stream still with bile and intestinal wall isolation, and
-second pipe distally and the 3rd pipeline from distally food sleeve end 22 towards distal extension, food contacts with remaining still unabsorbed bile mixing and with intestinal wall.
According to another embodiment, the food sleeve portion can be from can be in conjunction with the described nearside tube chamber hermetic unit 14 of constructing of the embodiment of Fig. 1 and 2 to proximal extension, but form thus the duodenal sleeve device that per os inserts gastrointestinal tract and is anchored on its certain position, wherein nearside tube chamber hermetic unit is positioned at for example some centimeters of weary Te Shi nipple 10 near-ends (upstream).
According to exemplary embodiment, the distal open end 25 of bile transfer conduit 24 can be in the distally certain positions of open sleeve end 22 near-ends pass in the food sleeve portion 21 so that (when when described apparatus preparing is in patient's the gastrointestinal tract):
-in first pipeline in tubular element 12 distally, gallbladder pancreatic juice and food stream are isolated from each other and isolate with wall of the lumen;
-in the second pipe of the first pipeline far-end, gallbladder pancreatic juice mixes with food stream, but still isolates with wall of the lumen;
-in the 3rd pipeline of second pipe far-end, food contacts with intestinal wall with gallbladder pancreatic juice.
According to another exemplary embodiment (Figure 13), equipment 11 is included in the biliary drainage catheter 40 that extends between near-end 41 and the far-end 43, described near-end 41 has support 42 to connect the biliary drainage catheter 40 in the biliary ductal tree 7, and described far-end 43 is connected in the mode that fluid is communicated with the bile separate cavities 19 of tubular element 12.This allows optionally to capture bile in the biliary ductal tree 7 and/or pancreatic juice and it is guided in the bile separate cavities 19.
Equipment 11 can comprise outer cover 44, and described outer cover 44 is partly extended on tubular element 12 and is connected the mode that limits annular bile insulating space 45 with tubular element and is connected with it externally to overlap 44, so that bile insulating space and intestinal wall are isolated.Outer cover 44 has the lateral branching that passes in the bile insulating space 45 and form above-mentioned biliary drainage catheter 40.According to embodiment, the near-end 41 of biliary drainage catheter 40 can locate and be anchored in the common bile duct in coupled position downstream of common bile duct and ductus pancreaticus 9, so that bile and pancreatic juice are drained in the bile insulating space 45 together.Alternatively, the near-end 41 of biliary drainage catheter 40 can locate and be anchored in the common bile duct of coupled position upstream of common bile duct and ductus pancreaticus 9, so that only with biliary drainage in bile insulating space 45, and pancreatic juice can naturally be discharged in the duodenum 3 and in the gap between the outer surface of wall of the lumen and outer cover 44 and flows into intestinal.
Figure 14 shows another exemplary embodiment, wherein outer cover 44 can limit bile insulating space 20 and independent pancreatic juice insulating space 46, described pancreatic juice insulating space 46 and the isolation of bile insulating space and have pancreatic juice outlet 47 apart from distally bile catheter end 25 1 distances.The portions of proximal of biliary drainage catheter 40 can be bifurcated, to limit biliary drainage end 41 and pancreatic juice drainage end 48, described biliary drainage end 41 can locate and be anchored in the common bile duct of coupled position upstream of common bile duct and ductus pancreaticus 9, and described pancreatic juice drainage end 48 can be positioned in the ductus pancreaticus 9.Biliary drainage catheter 40 also can comprise internal diaphragm 51, described internal diaphragm 51 extends to bile insulating space 45 and pancreatic juice insulating space 46 from bifurcation site, so that with biliary drainage in bile insulating space 45, and with pancreatic juice drainage in pancreatic juice insulating space 46.
According to embodiment, pancreatic juice outlet 47 directly is arranged on the food insulating space 13, so that pancreatic juice roughly mixes at the natural place that they contact with food stream, but isolates (Figure 14) with intestinal wall.
According to another aspect of the present invention, equipment 11 can be included between infundibulate proximal open end 50 and the distal open end 52 the nearside sleeve pipe 49 that extends (for example be shown in Fig. 1 and 2 A in), described infundibulate proximal open end 50 can for example be anchored in the stomach 2 by being connected with the suitable shape of pylorus, and described distal open end 52 is connected to the proximal aperture 16 of tubular element 12.But nearside sleeve pipe 49 anchoring arrangements 11 to be resisting preferably peristaltic forces, and can collect the food that is contained in the stomach 2 and it is guided in the food insulating space 13 in the situation that does not contact intestinal wall.
Alternatively or in addition, for the peristaltic forces of resistant function on equipment 11, can for example by stomach coil 53 described equipment 11 be anchored in the gastrointestinal tract, described stomach coil 53 can be from extended configuration (its per os or per nasal can be transported in the stomach 2) strain for screwing arc or circular in configuration (can fit that shape ground engages stomach 2 in order to provide grappling to the anchor lines 54 of the near-end that is connected to tubular element 12) (Figure 11).
In another exemplary embodiment shown in Figure 12, can for example anchor lines 54 be connected to the folding folds in a garment 55 that before in coat of the stomach, forms by T shape hoop.
In another exemplary embodiment shown in Figure 6, can equipment 11 be anchored to intestinal wall by being with 56 under the mucosa, be with under the described mucosa in the 56 insertion wall of the lumen and fully around its extension, form thus anchor ring in intestinal wall, to produce bottleneck portion, described bottleneck portion can engage the respective annular grappling groove 57 in the one in the tube chamber hermetic unit 14,15 that is formed at tubular element 12 for example.
Fig. 7 shows another exemplary embodiment, but wherein can equipment 11 be anchored in the gastrointestinal tract by rami gastrici frame 58 and attached elastic expansion formula (possibly shape memory) camber member 59, and described camber member 59 can form suitable shape with stomach 2 and be connected.
Fig. 8 shows another exemplary embodiment, wherein can equipment 11 be anchored in the gastrointestinal tract by T shape hoop 60, and described T shape hoop 60 hits from the inside of intestinal to deliver to and forms thus the fixed position the intestinal wall and be connected with the near-end of tubular element 12.
Fig. 9 and 9A show another exemplary embodiment, wherein can equipment 11 be anchored in the gastrointestinal tract by the annular anchoring part 61 with a plurality of grappling barbs 62, described barb 62 can (for example move from resting position, rotation) to the operating position, barb 62 is contained in the circumference of anchor portion 61 the unobstructed intracavity with permission equipment 11 and carries in described resting position, barb 62 is radially outward outstanding in described operating position, pierces through thus wall of the lumen and also thereby with equipment 11 anchors to wall of the lumen.
In another exemplary embodiment shown in Figure 10-10C, can equipment 11 be anchored in the gastrointestinal tract by the tubular anchor certain portions 63 with one or more anchor holes 64, described anchor hole 64 is designed to towards intestinal wall part and can allows these intestinal wall partly are pulled in the hole 64 and with it fix.Can be provided for from tubular anchor certain portions 63 internal suction wall of the lumen parts and with its be pulled in the anchor hole 64 intracavity aspirator 55 and for generation of the apparatus and method of permanent (mushroom-head) swelling to prevent that it from retracting from anchor hole 64 of wall of the lumen part.These apparatus and method for generation of wall of the lumen permanent swelling partly can comprise the tissue part that will inject under extender or the sclerosing agent mucosa or the previous tractive of plasticity bead (poly-(methyl methacrylate) PMMA) introducing be passed anchor hole 64.
With reference to Figure 15 A and 15B, outer cover 65 can be provided with sidewise hole 66, and described sidewise hole 66 can be placed on the space that is discharged to ID bile on the oddi's sphincter to be defined for isolation.Around the edge of sidewise hole 66 and in the edge around the near-end 67 of outer cover 65, reinforcing network 68 can be adhered to sleeve pipe so that the reinforcing of seam area to be provided.In addition, surgery can be applied to the outside of outer cover 65 in the zone of reinforcing network 68 and stitching area with felt rug 69.The edge of proximal edge 67 and sidewise hole 66 can be sewn onto duodenal wall, so that sidewise hole 66 is arranged on around the oddi's sphincter, be connected thereby form the nothing leakage with wall of the lumen, be suitable for thus limiting food stream and bile insulating space, as previously mentioned.In addition, the continuous or discontinuous outside gauze 70 that is become with felt by surgery can be arranged on the seam area of duodenal wall outside to prevent that suture cutting serous coat and tractive from going out wall of the lumen.
According to another exemplary embodiment of the present invention, duckbill outlet valve (not shown in detail) can be arranged in the remote area of food sleeve portion 21 and/or bile transfer conduit 24, to prevent that chyme from backflowing and infection risk.
Figure 16 shows another exemplary embodiment for the equipment of isolation food, bile, stomachial secretion liquid and 12 rectum juices, wherein said equipment comprises three sleeve pipes 72,73,74, described sleeve pipe 72,73,74 insert coaxially each other among and the different distally outlet that has the different nearside entrances that are positioned at diverse location and be positioned at diverse location with at assigned address isolation and mixing juice.
Be independent of described apparatus embodiments, the invention still further relates to the method that is discharged to the gallbladder pancreatic juice of Intestinal Mucosal Injury in Patients Undergoing for transfer, described method comprises:
A) at the bile insulating space of weary Te Shi ampulla location formation between equipment and intestinal wall;
B) food stream is separated in the zone of bile insulating space far-end with intestinal wall;
C) bile of isolation is transferred to the position in the distally in the zone that the stream of food wherein separates with intestinal wall from the bile insulating space.
According to embodiment, the step that shifts the bile of isolation comprises the steps: the bile transfer conduit is extended to from the bile insulating space along distal direction at intracavity the position in the distally in the zone that food stream wherein separates with intestinal wall.
According to another exemplary embodiment (Figure 17), the step that shifts the bile of isolation comprises the steps: to coincide or be communicated with by the direct tube chamber of formation between the intestinal wall of endogenous intracavity bypass 71 (having the near-end of the intestinal wall in the bile insulating space that coincide and the far-end of the distally target position that arrives intestinal of coincideing) in the bile insulating space and the distally target position of intestinal by intestinal-intestinal, so that by bypass 71 isolation and transfer bile, simultaneously by 21 isolation of food sleeve portion and conveying food stream.
Although described the preferred embodiments of the present invention in detail, applicant's purpose is not that the scope with claim is limited to these specific embodiments, but contains all modifications form and the alternative constructions that is within the scope of the present invention.
Claims (22)
1. an equipment (11) that is used for shifting the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing comprises tubular element (12), and described tubular element (12) has:
-inner food insulating space (13) and nearside hermetic unit (14), described nearside hermetic unit (14) can engage intestinal wall and flow between described tubular element (12) and described intestinal wall to prevent food,
-proximal open end (16) and distal open end (17), described proximal open end (16) can be admitted food stream and food stream is guided in the described food insulating space (13), described distal open end (17) can discharge food stream from described food insulating space (13)
The open bile separate cavities of-side direction (19), the open bile separate cavities of described side direction (19) can limit with the adjacent part of intestinal wall bile insulating space (19),
Described equipment (11) also comprises:
-food sleeve portion (21), described food sleeve portion (21) is from the distal open end (17) of the tubular element (12) of flexibility towards distal extension and have the open food sleeve end in distally (22), described food sleeve portion (21) limits food conveying space (23) in inside
-bile transfer conduit (24), described bile transfer conduit (24) is extended from described bile separate cavities (19) along distal direction and is had the open bile catheter end in distally (25), and described bile transfer conduit limits the bile conveying space (26) with described food conveying space (23) isolation in inside.
2. equipment according to claim 1 (11), the distal open end (25) of wherein said bile transfer conduit (24) is positioned at the position in the open sleeve end in described distally (22) distally.
3. equipment according to claim 1 (11), the distal open end (25) of wherein said bile transfer conduit (24) can pass in the described food sleeve portion (21) in the position of the open sleeve end in described distally (22) nearside.
4. equipment according to claim 1 (11), the open sleeve end in wherein said distally (22) can pass in the described bile transfer conduit (24) in the position of distal open end (25) nearside of described bile transfer conduit (24).
5. equipment according to claim 1 (11), wherein said tubular element (12) is for being anchored on the support in the small intestinal, gallbladder pancreatic juice normally enters described intestinal at described small intestinal place, and described support can capture described gallbladder pancreatic juice and it is guided in the described bile transfer conduit (24), wherein said bile separate cavities (19) comprises annular chamber, and described annular chamber forms and axially defined by radially outstanding nearside tube chamber hermetic unit (14) and radially outstanding distally tube chamber hermetic unit (15) around described bile insulating space (20).
6. equipment according to claim 2 (11), wherein said tube chamber hermetic unit (14,15) can be expanded to from the radially less configuration of initial contraction the radially larger configuration of expansion.
7. equipment according to claim 6 (11), wherein said tube chamber hermetic unit (14,15) comprise the inflatable balloon section that can permanently expand by injecting expansion fluid.
8. equipment according to claim 1 (11), wherein said bile transfer conduit (24) comprises the outer cover (28) coaxial with described food sleeve portion (21), thereby limits the annular bile conveying space (26) around described food sleeve portion (21).
9. equipment according to claim 1 (11), wherein said bile transfer conduit (24) comprise and are arranged in the outside conduit of described food sleeve portion (21).
10. according to each described equipment (11) in the aforementioned claim, be included in the biliary drainage catheter (40) that extends between near-end (41) and the far-end (43), described near-end (41) can be arranged in the biliary ductal tree (7), and described far-end (43) is connected in the mode that fluid is communicated with described bile separate cavities (19).
11. equipment according to claim 10 (11), comprise outer cover (44), described outer cover (44) is extended on described tubular element (12) and is connected with it, described connected mode is so that limit endless belt bile insulating space (45) between described outer cover (44) and described tubular element (12), described outer cover (44) has the lateral branching that passes in the described bile insulating space (45) and form described biliary drainage catheter (40).
12. equipment according to claim 11 (11), wherein said outer cover (44) limits described bile insulating space (20) and independent pancreatic juice insulating space (46), described pancreatic juice insulating space (46) has the pancreatic juice outlet (47) apart from described distally bile catheter end (25) one distances
The portions of proximal of wherein said biliary drainage catheter (40) be bifurcated and form biliary drainage end (41) and pancreatic juice drainage end (48), and described biliary drainage catheter (40) comprises the internal diaphragm (51) that extends to described bile insulating space (45) and pancreatic juice insulating space (46) from described bifurcation site.
13. equipment according to claim 12 (11), wherein said pancreatic juice outlet (47) directly is arranged on the described food insulating space (13).
14. equipment according to claim 1 (11), comprise nearside sleeve pipe (49), the infundibulate proximal open end (50) and be connected to the distal open end (52) of proximal aperture (16) of described tubular element (12) between of described nearside sleeve pipe in can being anchored at stomach (2) extended.
15. system according to claim 1 (11) comprises that described anchoring device is selected from for the anchoring device that described tubular element (11) is anchored on gastrointestinal tract:
-stomach coil (53), described stomach coil (53) can be from the screw arcuate configuration of extended configuration strain for being connected with the suitable shape of stomach (2), in order to be provided for being connected to the grappling body of anchor lines (54) of the near-end of described tubular element (12)
-anchor lines (54) and a plurality of T shape hoop, described T shape hoop can be connected to described anchor lines the folding folds in a garment (55) in the coat of the stomach,
Band (56) under-mucosa, band (56) can insert in the wall of the lumen in order to form anchor ring in intestinal wall, can engage the corresponding annular anchoring groove (57) that is formed in the described tubular element (12) under the described mucosa,
-rami gastrici frame (58) but and attached elastic expansion formula camber member (59), be connected but described elastic expansion formula camber member (59) can form suitable shape with stomach (2),
-T shape hoop (60), described T shape hoop (60) can be applied to from the inside of intestinal the intestinal wall and with the near-end of described tubular element (12) and be connected,
-annular anchoring part (61), described annular anchoring part (61) has a plurality of grappling barbs (62), described barb (62) can move to the operating position that wherein said barb (62) is radially outward given prominence to from retraction formula resting position
-tubular anchor certain portions (63) thereby and prevent the device that it is retracted from anchor hole (64) for generation of the permanent mushroom-head swelling of wall of the lumen part, described tubular anchor certain portions (63) has one or more described anchor holes (64), one or more described anchor holes (64) can and can allow partly to be pulled to these intestinal wall in the described hole (64) and to be fixed to the upper towards the intestinal wall part
-have the near-end that can be sewn onto duodenal wall and an outer cover (65) of sidewise hole (66), so that described sidewise hole (66) is placed around oddi's sphincter, described outer cover comprises the reinforcing network (68) at the edge that is adhered to the edge that centers on described sidewise hole (66) and the near-end (67) that centers on described outer cover (65), described reinforcing network provides the seam area of reinforcing, surgery is applied to the outside of described outer cover (65) in the zone of described reinforcing network (68) with felt rug (69).
16. system according to claim 1 (11) comprises the duckbill outlet valve, described duckbill outlet valve is arranged at least one the remote area in described food sleeve portion (21) and the described bile transfer conduit (24).
17. an equipment (11) that is used for shifting the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing comprises tubular element (12), described tubular element (12) has:
-inner food insulating space (13) and nearside hermetic unit (14), described nearside hermetic unit (14) can engage intestinal wall and flow between described tubular element (12) and intestinal wall to prevent food,
-proximal open end (16) and distal open end (17), described proximal open end (16) can be admitted food stream and food stream is guided in the described food insulating space (13), described distal open end (17) can discharge food stream from described food insulating space (13)
The open bile separate cavities of-side direction (19), the open bile separate cavities of described side direction (19) can limit with the adjacent part of intestinal wall bile insulating space (19),
Described equipment (11) also comprises:
-food sleeve portion (21), described food sleeve portion (21) is from the distal open end (17) of the tubular element (12) of flexibility towards distal extension and have the open food sleeve end in distally
(22), described food sleeve portion (21) limits food conveying space (23) in inside,
-with the bile conveying space (26) of described food conveying space (23) isolation, described bile conveying space is limited by the outer surface (35) of described food sleeve portion (21), so that bile can flow in the mode of isolating with food stream but contacting with intestinal wall.
18. equipment (11) that is used for shifting the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing, comprise three sleeve pipes (72,73,74), described sleeve pipe (72,73,74) among inserting coaxially each other and have the different nearside entrances that are positioned at diverse location and be positioned at the different distally outlet of diverse location, with at assigned address isolation and mixing juice.
19. be used for shifting the method for the gallbladder pancreatic juice that is discharged to Intestinal Mucosal Injury in Patients Undergoing, described method comprises:
A) form bile insulating space between equipment and intestinal wall in the location of weary Te Shi ampulla;
B) food stream is separated in the zone in described bile insulating space distally with intestinal wall;
C) bile of isolation is transferred to the position in the regional distally that the stream of food wherein separates with intestinal wall from described bile insulating space.
20. method according to claim 19, the step of the bile of wherein said transfer isolation may further comprise the steps: the position that the bile transfer conduit is extended to the regional distally that food stream wherein separates with intestinal wall at intracavity from described bile insulating space along distal direction.
21. method according to claim 19, the step of the bile of wherein said transfer isolation may further comprise the steps: coincideing by intestinal-intestinal, the direct tube chamber of formation is communicated with between the distally target position of intestinal wall and intestinal in described bile insulating space.
22. method according to claim 19, the step of the bile of wherein said transfer isolation may further comprise the steps: form direct tube chamber between the distally target position by the intestinal wall of endogenous intracavity bypass (71) in described bile insulating space and intestinal and is communicated with, described endogenous intracavity bypass (71) has near-end and the identical far-end that arrives the distally target position of intestinal of the intestinal wall in described bile insulating space that coincide.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EP2010/060278 WO2012007048A1 (en) | 2010-07-16 | 2010-07-16 | An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN103002840A true CN103002840A (en) | 2013-03-27 |
| CN103002840B CN103002840B (en) | 2015-05-20 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201080068086.1A Active CN103002840B (en) | 2010-07-16 | 2010-07-16 | An apparatus and method for diverting biliopancreatic juices discharged into a patient's intestinal tract |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN103002840B (en) |
| WO (1) | WO2012007048A1 (en) |
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| ITRM20110379A1 (en) * | 2011-07-19 | 2013-01-20 | Francesco Greco | IMPLANTABLE SYSTEM FOR OBESITY TREATMENT. |
| EP2561839B1 (en) * | 2011-08-23 | 2014-03-26 | Ethicon Endo-Surgery, Inc. | Device for anchoring an endoluminal sleeve in the GI tract |
| CN113171538B (en) * | 2021-05-06 | 2023-05-02 | 海安市人民医院 | Cut-off equipment for intestinal tract treatment |
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Also Published As
| Publication number | Publication date |
|---|---|
| CN103002840B (en) | 2015-05-20 |
| WO2012007048A1 (en) | 2012-01-19 |
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