CN1030695A - 外科缝合器 - Google Patents
外科缝合器 Download PDFInfo
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Abstract
外科缝合器包括杆(2),空心圆筒刀(3)、多针装
置(5)等。杆(2)布置在空心体(1)内,并有不动的联
接环(13),空心圆筒刀(3)固定在空心管(4)上,杆(2)
从空心管(4)内部通过。多针装置有带孔(8)的环形
件(6)和带针(9)的环形件(7),针(9)可以刺透环
(13)。环形件(7)靠在推杆(19)上,推杆(19)有内倒
角(20)和支承面(21)。支承面(21)与体(1)里的支承
面(22)相互作用。外科缝合器还包括安装在管(4)上
的开岔筒(23)及其定位器。开岔套筒(23)有与倒角
(20)相互作用的锥形凸肩(24)。
Description
本发明属于外科医疗用器械,确切地说,是外科缝合器。
所知道的外科缝合器是借助于创夹缝术对管状器官,例如消化系统的器官,施行吻合术。它包括基体、圆筒形罩、外科创夹及圆筒形手术刀的移动机构等。圆筒形罩至少有一个外科创夹环。借助于圆筒形手术刀,创夹穿透管状器官,并在基体表面上联接起来,而手术刀割掉身体管状器官的多余部分(GB,A,2133735)。
所知道的器械上采用的创夹,长期地或永久地留在患者体内,创夹形成的缝不严密,从而导致手术并发症。
所知道的另一种外科缝合器用于对消化系统器官施行环状压缩式吻合术。缝合器装有多针装置,该装置是由多孔的第一环形件和固定着许多针的第二环形件所组成,而这些针对应于第一部件上的每个孔,并且,至少有一部分针的自由端有密封锥。这一对环形件同轴布置在空心体内。空心体内还同轴布置着一根杆,杆的一端有一个被圆形螺母固定的不能移动的联接环。当施行吻合术时,针穿透这个联接环,一部分针被密封锥固定在联接环上。
缝合器有一个圆筒形刀,刀的内径等于螺母的最大外径。刀固定在布置于体内的空心管上。在空心管内同轴布置着杆。圆筒形刀由它的传动机构使之移动。传动机构与空心管相互作用,并有一个移动手柄。移动手柄相对于体旋转,并有一个与空心管的槽相互作用的杠杆(PCT/SU,79/00049)。
多针装置的环形件和联接环都用具有下列性质的弹性材料或塑性材料制成;它们应是生物作用不活泼的,无毒的,不致癌的。
为施行“对端”吻合术,把缝合器放入管状器官内部,用荷包口缝术把被手术器官的两端固定在杆上。当缝合器的工作部分合拢,多针装置与联接环接近以后,组织也互相接近并以外部浆液性表面互相接触。然后,压一下移动手柄,移动空心管和圆筒刀,并同时推动多针装置,用第二环形件的针刺穿组织,不移动的联接环被穿住它的带密封锥的针固定起来。当继续推进时,圆筒刀割去组织的多余部分,并割破不移动的联接环,形成吻合术的孔。装着圆形螺母的杆的一端,从孔中取出。多针装置和联接环之间的组织被压住。这样,保证了联接的严密性,经过7-10天就能愈合,压住组织的多针装置和联接环掉入空腔器官,自然地排出体外。
这种已知缝合器的特点是,当圆筒刀切掉被联接组织膜的多余部分并开始割破联接环时,被缝合的活组织在联接环与多针装置接近和缝合的瞬间受到损伤。并且,用密封锥固定在联接环上以后的针,继续往里扎,直至结束用刀切割联接环的时刻为止,产生对组织的过分压迫。
因为用刀切割联接环与针移动通过联接环同时实现,使联接环发生变形,导致缝合力增加,从而增加了被缝合组织的损伤。
本发明的基础是创造一种外科缝合器的任务。这种缝合器最好能有一个传动机构,来改变圆筒刀和多针装置的相互作用,把穿刺被缝合组织的过程和在活组织上切割中心孔的过程从时间上分开。
消化系统器官施行环状压缩式吻合术的外科缝合器解决了这个任务。这种缝合器包括多针装置、杆、空心圆筒刀及其传动机构等。多针装置布置在空心体内,有带很多孔的第一环形件和与之间同轴的第二环形件,第二环形件上固定着很多针,每个针对应于第一环形件上的一个孔,至少其中一部分针的自由端有密封锥。杆布置在空心体内,其一端用螺母固定安装着一个联接环。当施行吻合术时,有密封锥的针刺穿联接环,在联接环里固定起来。空心圆筒刀的内径可以让螺母自由通过。刀固定在空心管上,该管同轴布置在空心体内,而杆同轴布置在空心管内。按照本发明,与空心管相互作用的空心圆筒刀传动机构,包括推杆,开岔套筒及其定位器。推杆的一端靠在多针装置的第二环形件上,另一端有一内倒角和与空心体里的支承面相互作用的支承面,以在施行吻合术时,限制第二环形件的运动。开岔套筒安装在空心管上,并有圆锥形的外凸肩,该凸肩与推杆的内倒角相互作用。开岔套筒定位器布置在开岔套筒内的空心管上。
为了防止推杆的自发移动,缝合器有一个定位装置,它包括带切口的圆柱形部件和一个手柄。圆柱形部件布置在空心体内靠近空心管处,空心管上对应于圆柱形部件有一个圆柱形切口,手柄固定在圆柱形部件上,可以相对于空心体旋转,使圆柱形部件上的切口与空心管上的圆柱形切口互相吻合,以便在缝合器准备缝合时,使空心管移动。
开岔套筒定位器做成与空心体同轴的空心管,并刚性地与空心体联结在一起,是适宜的。
作为开岔套筒定位器的空心管,可以作为缝合器的外罩,其长度可以与杆的长度相比量。
开岔套筒定位器也可以包括一个套垫和一个支承件,套垫与杆同轴并有径向孔,支承件布置在套垫的径向孔里,并有一个与套垫同轴的供杆通过的本身的孔。杆上有一个与支承件相互作用的支承面,以在用空心圆筒刀切割联接环的瞬间,止住推杆并相应止住多针装置。
固定着空心圆筒刀的空心管上,与开岔套筒定位器的套垫相互作用的一段上若有纵向槽,当施行吻合术时,支承件就可以在槽内相对于空心管移动。这证明是适宜的。
固定空心圆筒刀的空心管,可以是缝合器的外罩,其长度可与杆的长度相比量。
此外,空心体相对于固定着空心圆筒刀的空心管如果有弹性,并与开岔套筒定位器的套垫相互作用,当被缝合组织厚度很大时,就可以减轻压坏被缝合组织,这是适宜的。
开岔套筒定位器套垫相对于固定空心圆筒刀的空心管如果有弹性,也是适宜的。
所建议的外科缝合器可以减轻缝合时被缝合的活组织受损伤。
缝合器中具有定位装置,可防止推杆在缝合器准备缝合的过程中自发移动。
采用装刀的空心管或定位器的空心套垫作为外罩,可以简化整个缝合器的结构,使它运用更加方便。
当组织的厚度很大时,有弹性的体可以减轻组织的损伤程度。
有弹性的定位器套垫可预先防止套垫的定位松开。
下面对照下列附图,叙述本发明的应用实例,来阐明本发明。
图1,本发明外科缝合器的局部图(纵断面);
图2,与图1同样的外科缝合器的总图(局部纵断面);
图3,图2的Ⅲ-Ⅲ剖面;
图4,图1的Ⅳ-Ⅳ剖面;
图5,本发明外科缝合器的另一实施方案的总图(纵断面);
图6,图5的Ⅵ-Ⅵ剖面;
图7,本发明开岔套筒的总图;
图8,本发明外科缝合器在切割联接环的过程中(纵断面);
图9,另一方案的外科缝合器在切割联接环的过程中(纵断面)。
对消化系统器官施行环状压缩式吻合术的外科缝合器(图1)有空心体1,在空心体1内同轴布置着杆2和空心圆筒刀3,刀3固定在空心管4上。在体1中,与之同轴安装着可拿下的多针装置5,该装置包括两个同轴的环形件6和7。环形件6有许多孔8,而在环形件7上,对应每个孔8固定着针9。针9中的一部分,但不少于其中三个,其自由端有密封锥10。用布置在一部分针9周围的弹簧11,使环形件6相对于环形7有弹性。
联接环13用螺帽12固定在杆2的一端,可与多针装置联在一起,把被缝合的活组织固定起来。
圆筒刀3的内径可以让螺帽12在切开环13之后,自由地通过刀3的空腔。
空心管4同轴布置在空心体内,杆2布置在空心管内。
刀3的传动机构是用铰链15相对于体1转动的手柄14(图2)。体1是由三个零件16和17组成的,相互可以拆开。
体1的零件17是沿套筒的纵轴切开的套筒的两个部分,在手柄14移动的区段组成不动的体1。手柄14(图2)有杠杆18,它与空心管4相互作用,并使空心管与刀3一起移动。
环形件7(图1)靠在有内倒角20的推杆19上(图1,4),推杆19的支承面21在推杆19上呈凸台形状,它与体1内表面上凸台形状的支承面22相互作用。空心管上固定着开岔套筒23,该套筒有一个与推杆19的内倒角20相互作用的锥形外凸肩24。
开岔套筒22的腔里,同时在空心管4上面,布置有定位器。图1介绍的是空心管25作为定位器的方案。空心管25与空心体1刚性地联结在一起,管25与体1同轴,是整个缝合器的外罩。它的长度与杆2的长度相比量,因此,管25罩住缝合器中段的空心管4和杆2,并且,作为外罩的管25又刚性地和零件16,17相互联结在一起。
图5是开岔套筒定位器的另一个实施方案。定位器包括与体1内部的杆2同轴布置的套垫26和支承件27(图5,6),支承件27布置在套垫26的径向孔28里。支承件27有与它本身和套垫26同轴的孔29,以使杆2穿过。
在杆2上布置支承件27的一段有支承面30,它是一个凸台,但杆2上的键槽的端面或杆2上平座的端面,也都可以作为支承面30。
支承面30与支承件27相互作用,以便在用刀3切割联接环13时止住推杆19和多针装置5。
当用这种以套垫26作为开岔套筒23的定位器的方案时,空心管4是缝合器的外罩(图5),这时,空心管4的长度与杆2的长度相比量。
开岔套筒23(图7)是一个空心圆筒,它的侧壁被穿透的槽31开成用圆筒本身未切掉部分33联成的花瓣32,每个花瓣32的自由端做成锥形凸肩24。花瓣32的数目决定于用针9贯穿联接环13所需的力,即缝合的力。缝合器还包括预先防止推杆19自发移动的定位装置,该装置有一个圆柱形件34(图2或3和4),它布置在体1的两个零件17之间,其轴与杆2的轴垂直。部件34上有一个切口35;它对应于空心管4上安装定位装置区段附近的圆形切口36。手柄37固定在圆柱形件34上,用手柄37使部件34旋转到切口35与36重合的位置,空心管4的定位松开,以便移动。
在空心管4(图5)与套垫26相互作用的区段上,有几个纵向槽38。当施行吻合术时,支承件27在这些槽中相对于管4移动。
弹簧39布置在空心管4的凸肩40与体1的凸肩41之间。它使体1相对于管4处于弹性状态。
弹簧42布置在空心管4的凸肩43与套垫26的端面之间,它使开岔套筒22的定位器套垫26相对于空心管4处于弹性状态。
刀3用螺纹固定在管4上。
杆2穿过与螺母45联接的空心螺杆44,螺母45安装在体1的零件17上并可转动。杆2的自由端有螺纹并安上螺母46。当转动螺母46时,杆2从螺杆44中移动到用端面47顶住螺杆44的端面。这时,由于体1的零件17里的槽48不是圆的,所以螺杆44不再转动。
体1的两个零件17用螺母49彼此固定在一起,管4从螺母49中通过。
定位装置的手柄37由两个弹性杠杆50组成(图3),杠杆放在体1的两个零件17的槽51里。
外科缝合器的工作过程如下:
所建议的外科缝合器适用于对消化道的空腔器官按“对端”、“端对侧”、“对侧”方式施行环状压缩式吻合术。下面举的例子是直肠前部切除时施行的“对端”吻合术。
在完成切除术后,对直肠的残余部分和乙状结肠的端部处以荷包口缝术。通过肛门把缝合器放入直肠,同时,联接环13和多针装置5互相靠近。此后,转动螺母45,将杆2的端部及固定于其上的联接环13推至直肠范围内,并在直肠的残余部分束紧荷包口缝。将乙状结肠的端部往带联接环的杆2的端部稍微移动一下,并在乙状结肠上束紧荷包口缝,切掉荷包口缝线头的多余部分,并转动螺母45,使联接环13和多针装置5互相靠向缝合装置。然后,用定位装置的手柄37将部件34转到切口35与36相重合,即松开空心管4的定位,压一下手柄14,手柄14绕铰链15旋转,这时,杠杆18与空心管4相互作用,并将空心管4与刀3以及固定在空心管4上的开岔套筒22一起移动,而开岔套筒23的定位器-空心管25就布置在它的腔内。
开岔套筒23以外锥面凸角24与推杆19的内倒角20相互作用,并传推杆19与多针装置5的环形件7一起移动,针9通过环形件6的孔8,并穿透组织和联接环13,用带密封锥10的针9固定在环上。然后,与体1刚性联接的定位器25停留在开岔套筒23的空腔内,由于支承面21与体1的支承面22相互作用,推杆19被止住,从而不再给多针装置5的环形件7施加压力。当空心管4续推进时,套筒23进入推杆19的空腔(图8)。推杆19不再移动,而刀3刺破组织,并在联接环13上切出一个孔。
在开岔套筒的定位器的另一实施方案,(图5)中,当空心管4运动时,杆2用支承面30与支承件27相互作用,支承件27布置在套垫26的径向孔中,并在管4的纵向槽38内。当针9刺透联接环,带密封锥10的针9固定在联接环13上之后,套垫26止住不动时,它已不在开岔套筒26的空腔内,从而使开岔套筒23的定位松开。
当空心管4续移动时,套筒23进入推杆19的空腔,推杆19不再移动,而刀3切掉组织的多余部分,并在联接环13上切出孔(图9)。从直肠中抽出缝合器,而多针装置5与联接环13一起停留在直肠的空隙中。在手术后5-7天,多针装置5和联接环13与被它们所夹住的坏死的组织一起自然排出体外。在此之前,压缩区周围的肠壁进行愈合。在多针装置5和联接环13脱落之前,肠内容物可以从圆筒刀切出的孔中通过。
用所研究的外科缝合器曾经在实验室里对狗作了12次手术,并临床在胃、小肠和大肠上作了20个手术。
在动物身上看到形成的吻合很好,无瘢痕性增厚现象。
当给病人作胃手术时,要使用相应直径的环,以便在任何情况下,环都可以用自然方法自由地排出。手术后并发症还没有发生过。由于被缝合的活组织损伤减轻,病人手术后5-7天就痊愈了,比规定时间要早。
本发明可以应用于在消化道器官,主要是在肠、胃、食管上进行手术。
Claims (13)
1、用于对消化道器官施行环状压缩式吻合术的外科缝合器,包括空心体1里的多针装置(5)、杆(2)、空心圆筒刀(3)及其传动机构等,多针装置(5)有带多个孔(8)的第一环形件(6)和与之同轴的第二环形件7,针(9)固定在环形件(7)上,每一个针对应于第一环形件(6)上的一个孔(8),至少有一部分针的自由端带密封锥(10)杆(2)的一端用螺母(12)固定着联接环(13)。施行吻合术时,针(9)和其中有密封锥(10)的部分,透过联接环(13),并在联接环(13)上固定住,空心圆筒刀(3)固定在空心管(4)上,它的内径可以让螺母(2)自由地通过,空心管(4)与空心体(1)同轴布置,杆(2)也同轴安在空心体(1)内,空心圆筒刀(3)的传动机构与空心管(4)相互作用,这种外科缝合器的特点是,它有一个推杆(19),开岔套筒(22)及其定位器(25),多针装置(5)的第二环形件(7)靠在推杆(19)的一端,推杆(19)的另一端有一个内倒角(20)和支承面(21),该支承面与空心体(1)的支承面(22)相互作用,以便在施行吻合术时限制第二环形件(7)的运动,开岔套筒(23)固定在空心管(4)上,它有锥形外凸肩(24),此凸肩与推杆(19)的内倒角(20)相互作用,开岔套筒(23)的定位器(25)在开岔套筒(23)里边,并布置在空心管(4)上。
2、按照权利要求1所述的外科缝合器,其特征在于,为了防止推杆(19)的自发移动,它有一个定位装置和一个手柄(37),定位装置包括带切口(35)的圆柱形件(34),该部件布置在空心体(1)内,空心管(4)的附近,空心管(4)上有一个对应于圆柱形件(34)的圆柱形切口(36),手柄(37)固定在圆柱形件(34)上,并可相对于空心体(1)旋转,以使圆柱形件(34)的切口(35)与空心管(4)的切口(36)相吻合,从而使空心管(4)移动,并使外科缝合器作好缝合准备。
3、按照权利要求1或2所述的外科缝合器,其特征在于,开岔套筒(23)的定位器是一个空心管(25),它刚性地与空心体(1)联结在一起,并与空心体(1)同轴布置。
4、按照权利要求3所述的外科缝合器,其特征在于,空心管(25)既是开岔套筒(23)的定位器,又作为外科缝合器的外罩,其长度可与杆(2)的长度相比量。
5、按照权利要求1或2所述的外科缝合器,其特征在于,开岔套筒(23)的定位器包括与杆(2)同轴的套垫(26)和支承件(27),套垫(26)有一个径向孔(28),支承件(27)布置在套垫(26)的径向孔(28)内,并有一个与套垫(26)同轴的本身的孔(29)以使杆(2)从中通过,杆(2)上有与支承件(27)相互作用的支承面(30),以在圆筒刀(3)切割联接环(13)时,止住推杆(19),并相应止住多针装置(5)。
6、按照权利要求5所述的外科缝合器,其特征在于,空心圆筒刀(3)固定在空心管(4)上,空心管(4)与开岔套筒(23)的定位器套垫(26)相互作用的区段上有纵向槽(38),当施行吻合术时,支承件(27)在槽(38)中相对于空心管(4)移动。
7、按照权利要求5所述的外科缝合器,其特征在于,固定空心圆筒刀(3)的空心管(4)是缝合器的外罩,其长度可与杆(2)的长度相比量。
8、按照权利要求6所述的外科缝合器,其特征在于,固定空心圆筒刀(3)的空心管(4)是缝合器的外罩,其长度可与杆(2)的长度相比量。
9、按照权利要求5所述的外科缝合器,其特征在于,空心体(1)相对于固定空心圆筒刀(3)的空心管(4)有弹性,并与开岔套筒(22)的定位器套垫(26)相互作用,这样,可以减少压坏厚度大的被缝合组织。
10、按照权利要求6所述的外科缝合器,其特征在于,空心体(1)相对于固定空心圆筒刀(3)的空心管(4)有弹性,并与开岔套筒(23)的定位器套垫(26)相互作用,这样,可以减少压坏厚度大的被缝合组织。
11、按照权利要求7所述的外科缝合器,其特征在于,空心体(1)相对于固定空心圆筒刀(3)的空心管(4)有弹性,并与开岔套筒(23)的定位器套垫(26)相互作用,这样,可以减少压坏厚度大的被缝合组织。
12、按照权利要求5所述的外科缝合器,其特征在于,开岔套筒(23)的定位器套垫(26)相对于固定空心圆筒刀(3)的空心管(4)有弹性。
13、按照权利要求9所述的外科缝合器,其特征在于,开岔套筒(23)的定位器套垫(26)相对于固定空心圆筒刀(3)的空心管(4)有弹性。
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SU4268008 | 1987-07-14 | ||
SU874268008A SU1616624A1 (ru) | 1987-07-14 | 1987-07-14 | Хирургический сшивающий аппарат |
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CN88104344.3A Pending CN1030695A (zh) | 1987-07-14 | 1988-07-13 | 外科缝合器 |
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EP (1) | EP0324858A4 (zh) |
JP (1) | JPH02501273A (zh) |
CN (1) | CN1030695A (zh) |
AU (1) | AU603910B2 (zh) |
CA (1) | CA1292402C (zh) |
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SU1114405A1 (ru) * | 1982-02-23 | 1984-09-23 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Хирургический сшивающий аппарат дл наложени компрессионных анастомозов на органы пищеварительного тракта |
-
1987
- 1987-07-14 SU SU874268008A patent/SU1616624A1/ru active
-
1988
- 1988-01-27 EP EP19880905035 patent/EP0324858A4/de not_active Ceased
- 1988-01-27 AU AU19324/88A patent/AU603910B2/en not_active Ceased
- 1988-01-27 JP JP63504752A patent/JPH02501273A/ja active Granted
- 1988-01-28 WO PCT/SU1988/000020 patent/WO1989000406A1/ru not_active Application Discontinuation
- 1988-06-06 CA CA000568716A patent/CA1292402C/en not_active Expired
- 1988-06-27 US US07/332,452 patent/US4957499A/en not_active Expired - Fee Related
- 1988-07-13 CN CN88104344.3A patent/CN1030695A/zh active Pending
-
1989
- 1989-03-13 FI FI891182A patent/FI891182A/fi not_active Application Discontinuation
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN100393285C (zh) * | 2004-09-03 | 2008-06-11 | 马剑文 | 人体消化道管形组织可降解吻合件及其吻合器 |
CN104337558A (zh) * | 2013-07-11 | 2015-02-11 | 柯惠Lp公司 | 用于执行手术吻合术的方法和装置 |
CN104337558B (zh) * | 2013-07-11 | 2019-01-01 | 柯惠Lp公司 | 用于执行手术吻合术的方法和装置 |
CN104546044A (zh) * | 2014-04-18 | 2015-04-29 | 北京中法派尔特医疗设备有限公司 | 一种荷包成型装置 |
CN112869810A (zh) * | 2021-01-13 | 2021-06-01 | 苏州优脉瑞医疗科技有限公司 | 一种可降低钉砧架磨损的吻合器 |
CN112869810B (zh) * | 2021-01-13 | 2022-02-01 | 苏州优脉瑞医疗科技有限公司 | 一种可降低钉砧架磨损的吻合器 |
Also Published As
Publication number | Publication date |
---|---|
WO1989000406A1 (en) | 1989-01-26 |
AU603910B2 (en) | 1990-11-29 |
FI891182A0 (fi) | 1989-03-13 |
AU1932488A (en) | 1989-02-13 |
US4957499A (en) | 1990-09-18 |
SU1616624A1 (ru) | 1990-12-30 |
CA1292402C (en) | 1991-11-26 |
FI891182A (fi) | 1989-03-13 |
JPH0579336B2 (zh) | 1993-11-02 |
JPH02501273A (ja) | 1990-05-10 |
EP0324858A1 (de) | 1989-07-26 |
EP0324858A4 (de) | 1990-05-14 |
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