CN86105764A - 特别用于输卵管绝育法的外科手术组合器械 - Google Patents
特别用于输卵管绝育法的外科手术组合器械 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1402—Probes for open surgery
Abstract
一件外科组合器械可用于无损伤钳夹人或动物的组织,施行两极高频电流的凝固,切割凝固区域的组织。除去在凝固区的残留的非凝固组织。这些功能不用更换器械就可达到。通过该器械的切取的组织可供组织学鉴定所用。
Description
本发明是关于外科手术器械方面的,更具体地说是关于无损伤钳夹人体或动物体组织并通过两极高频电流使组织凝固的组合器械。通过腹腔窥镜操作,这种器械专门用于妇女输卵管的结扎,所以在下文中称其为腹腔窥镜输卵管绝育法。
外科手术早就在人类医学中用于绝育目的,例如,用于结扎妇女输卵管和男子的输精管,当前,我们采用两极高频电流凝固组织的方法。
在两极高频流中,两个电极相对着装置在器械功能作用单元区域(两极钳夹装置)高频电流只在功能单元钳夹住的组织上通过。
为了施行通过两极高频电流凝固组织的腹腔窥镜输卵管绝育法和移去组织,有必要在施用气腹和插入光学器械后,先钳住输卵管,例如,用两极钳夹装置夹住并凝固输卵管,然后移开这器械,用切割器械在输卵管凝固部位切出一部分,并且,更换器械,用镊子从下腹腔中移去切下的部分。
另外如果输卵管的一部分需要切除,则必须切若干刀,这样站着与切割器械的导套呈90°角的方面切割是特别困难的,因为切割装置对于导套来说是刚性不可变形的。这将是极为不利的因为它将导致非凝固部位也被切割并引起危险的流血。另外,为了从腹腔中移出被切下的部分,这个器械必须第三次被更换。
因为如今采用的两极钳夹装置的电极仅有5-6毫米的宽度,输卵管被夹紧并被凝固若干次,所以有时输卵管在其全长度上被不必要地毁坏。
另外,因为这些器械没有使电极停止的功能,凝结经常发生在输卵管以外的附属部位,结果,其组织(在这里是输卵管)将在两极钳夹装置之间达到很深的地方。如果克服这些困难成功地移出组织,这些组织也会因凝固而完全被毁坏。只有通过克服许多困难才能从组织学上确定这些组织或者干脆就不可能确定。虽然国际上广泛要求的为了组织学的确定而移去组织,这通常仍是不可行的因为(1)大大提高了外科手术的冒险性,(2)组织学上确定的正确性是可疑的。
我发明了一种用于腹腔镜输卵管绝育法的组合器械,它克服了上述常规通用器械的不利因素,并且,特别地,能满足以下要求:
1.无损伤钳挟组织而不用相对改变器械功能单元的位置。
2.通过两极高频电流使被钳夹的组织部位安全凝固,其中功能单元互不接通,所以碳化作用不会发生。被钳夹的组织在两点上发生凝固,而在这两点间留下一段基本上非凝固的组织。
3.用同一器械切割凝固的或无血的组织,即不用更换器械。
4.用同一器械钳住基本上非凝固的组织部分,在器械从下腹腔移出之后,容易地从器械上取下核组织部分,以用于组织学上的检查。
5.单独并独立地用同一个器械施行无损伤钳夹,两极凝固,和组织取出的工作步骤。
组合器械也可用于剥离粘连物,切取组织标本,并且,最终无损伤钳夹和采取组织以通过有诊断价值的腹窥镜检查获得一个总体观察。另外组合器械还可用于开放外科手术。
这项任务由组合器械来完成,它结合了无损伤钳夹的所有的功能,通过高频电流的组织两极凝固,在凝固或无血组织部位切割组织,取出非凝固部分的切除组织等功能。另外,它还可能独立地完成上述各个工作步骤。
因为按照本发明,组合器械操作起来既简单又安全,所以所需的时间减少了,手术风险也减到最小。首先,它使得在无须更换器械的情况下能完成一个完整的腹腔镜输卵管绝育手术-即:钳夹、凝固和切割断二个输卵管并去除多余组织-成为可能。必须特别地强调,用新组合器械对组织的切除只适用于凝固区域,因此,出血的危险性大大地减小了。
另外,对切除组织可靠的组织学鉴定也成为可能的了,因为用组合器械得到切除的组织基本上是非凝固的。当在输卵管子宫做手术时,对切除组织的可靠的组织学鉴定是特别重要的。输卵管子宫位于韧带附近。有必要鉴定切除的是输卵管子宫上进行的结扎成功。
有必要对切除组织加以鉴定。
按照当前的发明,这种组合器械有着这样的优点:它使日后重新受精成为可能因为输卵管只在一处与器械宽度相对应的长度上凝固并被截断。结果,正如目前通常的情况一样,输卵管在它的整个长度上并未被损毁。
组合器械的切割装置可以对要凝固的输卵管部位起到限制作用,这样就使凝固不会深入到输卵管的附属部分。组合器械的夹子在合拢过程中相互靠近,这样,被钳夹的组织正好是在要凝固的点上,并且被均匀地压在一起,结果,一个最佳的无损伤钳夹或凝固就实现了。另外,在使用中,器械的钳夹和切割部分对导套不会相对地移动,因而可以安全的钳夹组织。由于组合器械的这种构造,除输卵管以外的其他组织如附着的粘股状组织也可以被钳夹,并被两极凝固和无血切断。根据粘股状组织的宽度的不同,它可以再一次被钳夹和凝固,这样组织的切口周围都被凝固,且不会流血。
根据本发明,组合器械可用于(1)腹腔镜检查,(2)剖腹术,(3)后部阴道切开术。
主要的应用是腹腔镜输卵管绝育手术,但它也可用在剥离粘连,采取组织样品和无损伤钳夹并移动组织,以便通过能诊断的腹腔镜得到一个总体观察。
组合器械不用拆开就可进行清洗并用不着维修,它可用于所有常规绝育方法进行的绝育手术。
图1是按照本发明的组合器械的部分的正面视图,其中功能单元被分离。
图2是器械的功能单元的正面视图。
图3是功能单元的平面视图。
图1所示的组合器械包括一个握在手中的手柄。图2和图3所示的功能单元的构造使它的独立部件可以相互移动靠近。这些运动通过杆D、H传递至钳夹装置A和B及切割装置F。
手柄部件有三个手柄元件。手柄元件2和3连接在手柄元件1上并可相对地转动。
导套8接在手柄的手柄元件1上。导套8罩住推拉杆D与H,D与H又分别通过手柄元件2、3而移动。
紧挨着手柄部件,导套8安装在插头7上。插头7与导套8绝缘,它用于提供高频电流。另外,在导套8中,有两个导体N与O,它们将插头7联接于钳夹装置A和B。导管8内壁上垫绝缘层。
在导管8的端部相对手柄部件装设着功能单元,它有三种功能:钳夹、凝固和切割。
功能单元包括钳夹装置A、可转动的钳夹装置B和切割装置F。固定的钳夹装置A作为可转动的钳夹装置B的支撑。为此目的,支点C装在A上,同时A与B还作为高频电流的电极。A与B在支点C处是绝缘的。推拉杆B通过关节点I接在B上。因此,操纵杆D,可使B对于A张开大约60°的角,这样,就使装置可以可靠无误地钳夹组织。
固定钳夹装置A被做成U形并在其中心开孔的两侧有相对较宽的法兰平面。可转动的钳夹装置B也是U形的,并在中心开孔P的两边也有着与A相同宽度的法兰平面。在U形钳夹装置A的里面,有一个可绕A中联接点G转动的切割装置F。
如图3所示,为了与固定钳夹装置A的中心开孔E相配合,切割装置F做成U形刀,并且,如图2中虚线所示,它的内壁做成锥状,如图3所示,切割装置F可以通过可转动钳夹装置B的较宽的中心开孔P。推拉杆H通过关节点J与切割装置F联接。切割装置F相对于钳夹装置A的张角也近似为60°在闭合的位置上,F下降进入钳夹装置A。
可转动的钳夹装置B和固定的钳夹装置A在钳夹组织的过程中均匀地接近。换句话说,组织被可转动的B均匀地夹紧在固定的装置A上,所以所有的被钳夹部位都能均匀地凝固,钳夹装置A有与切割装置相配合的中心开孔E。在这个开孔下面放置一个篮子K用来盛装切除的组织。切割装置F适当设计,使得在切割过程中切除的组织被压入篮子K。篮子K可以盛装若干块组织切片,从而整个绝育手术过程中无须更换器械,也就是说两个输卵管手术可以相继进行。
固定钳夹装置A通过绝缘件L与导管8紧紧联接。绝缘件L也用于对推拉杆D和H进行导向。在导套8内,杆D与H的一部分与绝缘件M相连。钳夹装置B通过手柄2和推拉杆D铰接支承。可转动的手柄2通过轴5与固定的手柄1相连。通过轴6与推拉杆D相连。切割装置F通过手柄件3和推拉杆H来操纵。可转动的手柄件3通过轴9与固定手柄件1相连,通过轴心与推拉杆H相连。手柄件3的转动由螺钉4所控制。
按照本发明,用组合器械施行的腹腔镜输卵管绝育手术的过程如下:
施用气腹并插入光学器械之后,采用常规的10毫米套针的穿刺术,将组合器械插入腹腔(例如Wolf GMBH生产的套针),该项器械的插头7与常规的两极高频电机相接。
在确定输卵管的部位并打开钳夹装置B和切割装置F后,输卵管,支撑于张开的切割装置F上,被逐渐闭合的钳夹装置B夹住并压向固定的钳夹装置A,然后从钳夹装置A和B上导入高频电流,这样输卵管就在钳夹装置A与B之间的U形部位凝固。在完成凝固之后,不用张开B,接着驱动切割装置F,位于凝固区的输卵管部分就被切下并压入篮子K中。这就完成了输卵管的结扎和组织切除。对于一个完整的绝育手术,还需在第二根输卵管上施行一个完全相同的手术,而不用更换器械。当这个器械从腹腔中移开的时候,被切除的组织按照手术的次序被移开并用于组织学的鉴定。这对于道理的讨论特别重要。
Claims (6)
1、一种外科组合器械,其特征包括无损伤钳夹人和动物体组织的装置,所述钳夹装置包括第一和第二钳夹件。第二钳夹件联接于第一钳夹件,并在所述钳夹件张开与闭合的位置上可相对于第一钳夹件绕铰支点转动。当所述钳夹件处于闭合位置时,由所述钳夹件所确定的中心开孔相互排列成直线。所述第一和第二钳夹件彼此绝缘并成为电极导入高频电流凝结所述钳夹件所钳夹的组织。在所述中心开孔处,切割件联接于第一钳夹件并在此处切割位于所述钳夹件成直线排列开孔区域的组织,盛装件是所述第一钳夹件的一部分用以获得被所述的切割件切除的组织。
2、按照权利要求1所述的外科器械,其特征是所述切割件F是一个内壁呈锥形的U形刀。所述切割件是将切除组织压入固定钳夹件A的所述盛装件K中。
3、按照权利要求1所述的外科器械,其特征是所述切割件的尺寸应为所述钳夹件的中心开孔所容许。
4、按照权利要求1所述的外科器械,其特征是盛装件是一个丝制篮子,置于第一钳夹件的中心开孔处。
5、按照权利要求1所述的外科器械,其特征是所述钳夹件和所述切割件可独立地操作。
6、按照权利要求1所述的外科器械,其特征是所述钳夹件处于所述闭合位置时,所述钳夹件相互平行。
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US06/758,165 US4655216A (en) | 1985-07-23 | 1985-07-23 | Combination instrument for laparoscopical tube sterilization |
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CN86105764A true CN86105764A (zh) | 1987-01-21 |
CN1006757B CN1006757B (zh) | 1990-02-14 |
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CN86105764A Expired CN1006757B (zh) | 1985-07-23 | 1986-07-23 | 特别用于输卵管绝育法的外科手术组合器械 |
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US (1) | US4655216A (zh) |
EP (1) | EP0210125B1 (zh) |
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DE (1) | DE3661342D1 (zh) |
IN (1) | IN164476B (zh) |
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- 1986-07-15 EP EP86730109A patent/EP0210125B1/de not_active Expired
- 1986-07-15 DE DE8686730109T patent/DE3661342D1/de not_active Expired
- 1986-07-23 CN CN86105764A patent/CN1006757B/zh not_active Expired
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CN102525639B (zh) * | 2010-10-04 | 2015-11-25 | 柯惠Lp公司 | 血管密封器械 |
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US11000330B2 (en) | 2010-10-04 | 2021-05-11 | Covidien Lp | Surgical forceps |
US11779385B2 (en) | 2010-10-04 | 2023-10-10 | Covidien Lp | Surgical forceps |
Also Published As
Publication number | Publication date |
---|---|
CN1006757B (zh) | 1990-02-14 |
DE3661342D1 (en) | 1989-01-12 |
US4655216A (en) | 1987-04-07 |
EP0210125B1 (de) | 1988-12-07 |
IN164476B (zh) | 1989-03-25 |
EP0210125A1 (de) | 1987-01-28 |
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