CN108143457B

CN108143457B - Disposable self-pressurizing intestinal tract anastomat matching tool and use method

Info

Publication number: CN108143457B
Application number: CN201711453863.4A
Authority: CN
Inventors: 陈凛; 崔建新; 郗洪庆; 袁成龙; 杨雅雄; 卫勃; 张珂诚
Original assignee: Lanzhou Seemine Shape Memory Alloy Co ltd; Chinese PLA General Hospital
Current assignee: Lanzhou Seemine Shape Memory Alloy Co ltd; Chinese PLA General Hospital
Priority date: 2017-12-28
Filing date: 2017-12-28
Publication date: 2021-01-12
Anticipated expiration: 2037-12-28
Also published as: CN108143457A

Abstract

The invention provides a matched tool and a using method of a disposable self-pressurization intestinal anastomat, wherein the disposable self-pressurization intestinal anastomat consists of a male locking ring, a female locking ring and a memory alloy clamp connected between the two locking rings, internal threads are arranged in the male locking ring, 4 tapered grooves are uniformly distributed on the inner circumference of the female locking ring, and the matched tool used with the product comprises a supporting claw, a threaded lock and a push handle; the supporting claw is formed by a rod part and a head part in an integrated mode, 4 jacking claws are evenly distributed on the circumference of the head part and used for jacking with 4 taper grooves, a threaded lock is sleeved on the rod part, external threads matched with internal threads of a male locking ring are arranged at the front end of the threaded lock, a semi-circular clamping ring structure for hand holding is arranged on two sides of the rear end of the threaded lock, and the tail end of the rod part is fixedly connected with a push handle. The tool integrates two actions of opening and clamping, the top claw evenly opens the top, the threaded lock is connected and locked, the two actions of opening and clamping are completed in a matched mode, the tool can be withdrawn only by rotating the threaded lock, and the operation is simple and rapid.

Description

Disposable self-pressurizing intestinal tract anastomat matching tool and use method

Technical Field

The invention relates to the technical field of medical instruments, in particular to a matched tool of a disposable self-pressurizing intestinal tract anastomat and a using method.

Background

Intestinal anastomosis is one of the most common operations in abdominal surgery and is the most basic operation that a general surgeon must master. The method by which surgeons staple tissue using surgical instruments has continued for nearly 200 years. The use of staplers in modern surgery is quite widespread as one of the most successful surgical instruments, and all manual suturing in gastrointestinal tract surgery can be performed by staplers, which are considered to be the most important advance in the field of surgical instruments in the second half of the 20 th century. More and more surgeons prefer to use staplers during esophageal-intestinal anastomosis, low-rectal-cancer anus protection and laparoscopic surgery.

At present, intestinal anastomosis is performed by a plurality of operation modes such as manual suture, metal nail instrument suture, seamless anastomosis technology and the like, and with the gradual improvement of the design and the process of the anastomat, the anastomat is widely applied in the field of surgery, and especially plays an increasingly important role in reconstructing the digestive tract by intestinal surgery, so that a plurality of operations which are difficult to manually operate and complicated become easy and simple. The intestinal anastomat technology is correctly used and mastered, so that the efficiency and the quality of operation can be improved, a surgeon can be helped to complete the digestive tract reconstruction operation with high difficulty conveniently, accurately and in high quality, the obstacle of poor visual field exposure of certain parts can be overcome by using the intestinal anastomat, and complications such as narrow anastomotic stoma and the like can be avoided due to standardization of the anastomotic stoma. The application of the anastomat technology can reduce the trauma in the operation, thereby reducing the recovery time of the patient and reducing the expenditure.

Although the use of the stapler in the digestive tract reconstruction surgery can shorten the surgery time and reduce the incidence of complications such as anastomotic leakage, anastomotic bleeding, stenosis and the like, if the stapler is improperly used or the technical details of the use of the stapler are not noticed, a certain proportion of complications can still occur. The occurrence of postoperative complications cannot be well controlled in a plurality of anastomats, for example, a nail type intestinal tract anastomat is easy to cause residual metal nails on the intestinal wall in a body, and infection and the like are easy to occur; the disposable intestinal anastomat with the mechanical BAR buckling mode cannot be conveniently and quickly applied to the anastomosis of a low-position rectum part due to structural characteristics, if potential safety hazards exist after anastomosis, the BAR cannot be opened again at the moment, remedial measures are required to be taken, and operation steps and difficulty are increased. In addition, as modern surgery enters a minimally invasive age, people also put higher requirements on intestinal anastomosis.

Disclosure of Invention

In order to solve the defects of the prior art, the invention provides a disposable tool which is convenient, safe, quick and economic to operate and is matched with the opening and clamping of the disposable self-pressurizing intestinal tract anastomat.

The invention is realized by the following technical scheme: a matched tool of a disposable self-pressurization intestinal anastomat comprises a male locking ring, a female locking ring and a memory alloy clamp connected between the two locking rings, wherein the middle parts of the male locking ring and the female locking ring are shaft holes, internal threads are arranged in the shaft holes of the male locking ring, 4 tapered grooves are uniformly distributed on the inner circumference of the female locking ring, and the matched tool used with the disposable self-pressurization intestinal anastomat comprises a supporting claw, a threaded lock and a push handle; the supporting claw is formed by integrally forming a rod part and a head part, 4 jacking claws are uniformly distributed on the circumference of the head part and used for jacking with 4 taper grooves, the threaded lock is sleeved on the rod part, external threads matched with the internal threads of the male lock ring are arranged at the front end of the threaded lock, semicircular clamping ring structures for holding are arranged on two sides of the rear end of the threaded lock, and the tail end of the rod part of the supporting claw is fixedly connected with the push handle.

Further, still include the sleeve pipe, the sleeve pipe suit is on the pole portion of supporting the claw, and is located and pushes away between handle and the screw thread lock rear end, and the pole portion of supporting the claw is smooth axle, is equipped with the locking piece on this axle, is equipped with the location locking portion of fixing a position the locking usefulness with the locking piece cooperatees on the sleeve pipe.

Furthermore, a first arc-shaped groove used for limiting the axial movement of the sleeve is formed in the side edge of the smooth shaft, and a second arc-shaped groove matched with the arc-shaped groove is formed in the inner concave mode of the side edge of the sleeve.

The locking piece consists of an impermeable cylindrical hole formed in the middle of the smooth shaft, a spring and a steel ball, wherein the spring and the steel ball are installed in the hole, and the steel ball is positioned at the top end of the spring; the front part of the sleeve is provided with a spherical through hole which is small at the top and big at the bottom and is matched with the steel ball to be used as a positioning locking part.

Preferably, the push handle is an olive-shaped force application part, and anti-skidding circular arc-shaped grooves are uniformly distributed on the circumference of the push handle.

Preferably, the tail end of the rod part is of a regular hexagonal prism structure, the front end of the push handle is provided with a groove hole which is spliced with the regular hexagonal prism structure, and the push handle and the groove hole are connected into a whole through biological glue after being spliced.

A use method of the tool matched with the disposable self-pressurization intestinal tract anastomat specifically comprises the following steps:

1) unpacking, putting the disposable self-pressurizing intestinal tract anastomat into sterile normal saline which is prepared in advance and is about 0 ℃, immersing and standing, respectively putting the forefinger and the middle finger on semicircular clamping ring structures at two sides of the tail part of the screw lock, pushing the rear part of the thumb or the palm against an olive-shaped pushing and jacking part of the push handle or the push rod, and putting the rear part of the whole tool into the hand;

2) inserting the top claws of the supporting claws into the shaft holes of the male locking ring and the female locking ring to enable 4 top claws and 4 taper grooves of the female locking ring to be in one-to-one correspondence, screwing in the threaded lock sleeved on the supporting claw shaft, and screwing the external threads on the threaded lock and the internal threads of the male locking ring to enable the two to be locked into a whole;

3) the thumb or the back part of the palm is pushed forwards forcibly, the index finger and the middle finger fix the semicircular snap ring structure, the rod part of the supporting claw moves forwards to provide pushing force, and the connected male and female lock rings are opened, so that the distance between the two lock rings is increased;

4) placing the primary lock ring of the product at the anastomosis end close to the part to be anastomosed of the patient, adjusting the primary lock ring to be uniform and stable in circumference, and tightening the tied purse; after the check is correct, the thread lock is screwed out by rotating the semicircular clamping ring structure, and the supporting claw is retreated to enable the tool to retreat the product integrally.

In order to accurately control the opening amount, when the spring and the steel ball in the cylindrical hole which is not communicated with the middle part of the smooth shaft of the supporting claw in the step 3) of the invention are pushed to the spherical through hole of the sleeve, the steel ball in the cylindrical hole is clamped at the spherical through hole under the action of the spring to form a minor arc spherical surface to achieve positioning and locking, and the opening amount between the male lock ring and the female lock ring of the disposable self-pressurization type intestinal tract anastomat is controlled.

The matched tool of the disposable self-pressurizing intestinal anastomat is suitable for minimally invasive or open surgery of which the colon section needs to be cut and end-to-end anastomosed.

The invention has the beneficial effects that:

this instrument has integrateed and has strutted and two actions of centre gripping, and the top claw evenly props the top, and the threaded connection of screw lock is locked, and the cooperation is accomplishing two actions of strutting and centre gripping, only needs rotatory screw lock can move back the instrument when the instrument is released, and one step struts, and one step is dismantled, and the operation is very simple, and the doctor need not to carry on too much training can master the use skill completely. The invention has simple structure without losing strength, less parts and simple structure and is easy to process; the tool and the product are delivered integrally, and sterilized and packaged uniformly. The operating room need not to look for other instruments again and carry out strutting of product, and unified sterilization packing has reduced the independent sterilization before the use of instrument, the cost is reduced.

The sleeve of this instrument suit is on the pole portion of supporting the claw, and is located and pushes away between handle and the screw thread lock rear end, and the volume of strutting distributes evenly on the circumference when can making to strut the product, and even volume of strutting can guarantee that the identical in-process of doctor's operation keeps sufficient field of vision, fixes a position the locking through sheathed tube location locking portion and the locking piece cooperation of supporting claw pole portion, reduces error or the potential safety hazard brought when tightening up the pocket.

When the tool is used in the operation, the operation is simple, the incision and the suture of the auxiliary hole are not needed, the operation steps in the operation process are reduced, and the operation time is saved.

Drawings

FIG. 1 is an exploded view of the assembly of the tool of the present invention;

FIG. 2 is a schematic view of the tool support jaw of the present invention;

FIG. 3 is a schematic view of the construction of the tool thread lock of the present invention;

FIG. 4 is a schematic view of the construction of the tool casing of the present invention;

FIG. 5 is a schematic view of the construction of the push handle of the tool of the present invention;

FIG. 6 is a schematic illustration of the tool of the present invention in docking with a product;

FIG. 7 is a schematic structural view of a product of the present invention;

FIG. 8 is a cross-sectional view of the article of FIG. 7 of the present invention;

FIG. 9 is a view showing the state of use of the tool of the present invention in distracting a product;

FIG. 10 is a schematic view of a first anastomotic fracture end insertion product anastomotic stoma of the present invention;

FIG. 11 is a schematic view of the present invention illustrating the handling of a broken end of a purse wire;

FIG. 12 is a schematic view of a first anastomotic rupture end cinching purse wire of the present invention;

FIG. 13 is a schematic view of the tool of the present invention being fully ejected from the product;

FIG. 14 is a schematic view of a product placement second staple break;

FIG. 15 is a schematic view of a second anastomotic rupture end tightening and rupturing purse wire according to the present invention;

FIG. 16 is a schematic view of the present invention forming an anastomosis region.

In the figure: 1. producing a product; 11. a female lock ring; 12. a tapered recess; 13. a male locking ring; internal threads; 15. a memory alloy clip; 2. a support claw; 21. a top claw; 22. a rod portion; 23. an impermeable cylindrical hole; 24. a first arc-shaped groove; 25. a regular hexagonal prism with a circular arc groove; 3, a thread lock; 31. a circular through hole; 32. an external thread; a semi-circular snap ring structure; 4, sleeving a pipe; a spherical through hole; 43. a second arc-shaped groove; 45. a cylindrical bore; 5, pushing the handle; 51. a slot; 52. arc-shaped strip-shaped anti-slip grooves; 56. pushing against the force section; 6. a spring; steel balls; 8, breaking the end; 9. a purse wire; anastomosis region 10.

Detailed Description

A kit for a disposable self-pressurizing intestinal stapler, wherein the assembled exploded view of the kit and a product is shown in fig. 1 as follows: the product is a disposable self-pressurizing intestinal tract anastomat as shown in figures 7-8, and is formed by coaxially connecting a male locking ring 13 and a female locking ring 11 which are opposite through a memory alloy clamp 15, wherein the male locking ring 13 and the female locking ring 11 are provided with shaft holes in the same direction, internal threads 14 are processed in the shaft holes of the

male locking ring

13, 4 conical grooves 12 are uniformly distributed on the inner circumference of the shaft hole of the female locking ring 11, the memory alloy clamp is made of memory alloy wires in an omega shape, and two ends of the memory alloy clamp are correspondingly connected with the male locking ring 13 and the female locking ring 11 which are opposite. The tool of fig. 1 is used with this product and comprises a screw lock 3, a support jaw 2, a sleeve 4 and a push handle 5;

the support claw 2: as shown in fig. 2, the supporting claw head is structured in such a way that 4 top claws 21 are uniformly distributed at intervals of 90 degrees on the circumference and are directly connected with the conical grooves 12 at the corresponding parts of the female lock ring 11 in a butting way; the supporting claw rod part 22 is a smooth solid mandrel used for shaft hole connection with the thread lock 3 shown in fig. 1; an impermeable cylindrical slotted hole 23 is formed in the upper opening and the lower opening of the shaft, a spring 6 is arranged in the hole, a steel ball 7 is arranged at the top end of the spring, and the spring and the steel ball are matched to achieve the fixed-point locking function; a first arc-shaped groove 24 is formed along the side surface of the rear half solid shaft until the tail part of the support claw; the tail part is processed into a regular hexagonal prism with an arc groove and is fixedly connected with the push handle 5.

The thread lock 3: as shown in fig. 3, the front end of the screw lock is provided with an external thread 32, which is matched and connected with the internal thread 14 of the male locking ring 13 to fix the tool, and the whole tool can be detached by rotating the thread after use; the center of the screw lock is axially provided with a round through hole 31 for the penetration of the smooth shaft of the supporting claw in the figure 2, and after the penetration, the axial rotation of the screw lock on the screw lock is kept from colliding with the screw connection; the two sides of the tail part of the thread lock 3 are provided with semicircular clamping ring structures 33 which are arc-shaped grooves with the sizes similar to those of the forefinger and the middle finger, and the forefinger and the middle finger can be placed in the arc-shaped grooves so as to control the use of the tool.

The sleeve 4 is: as shown in fig. 4, the sleeve 4 is sleeved on the rod part of the support claw and is located between the push handle 5 and the rear end of the screw lock 3, the front part of the sleeve 4 is provided with symmetrical spherical through holes 42 up and down, the upper surface is small in size, the lower surface is large in size, and the holes are matched with the spring 6 and the steel ball 7 shown in fig. 2, so that when the steel ball 7 mounted on the smooth shaft of the support claw reaches the position, the steel ball 7 is clamped at the spherical through hole 42 under the action of the spring 6 to form a minor arc spherical surface to achieve a locking effect, and the smooth shaft of the support claw does not move forward under the action of thrust to control the opening amount between the male lock ring and.

The push handle 5, which is the rearmost end of the tool, is an olive-shaped push and push force part 56 for a palm or a thumb, is used for reducing discomfort of workers possibly caused by local force application and can achieve decomposition of local pressure by uniform component force; four arc-shaped strip-shaped anti-slip grooves 52 are uniformly distributed on the circumferential surface of the olive-shaped pushing and jacking force part 56 at intervals of 60 degrees, so that the anti-slip and attractive appearance is realized, and the material loss is reduced in the manufacturing process. The front end of the push handle is provided with a regular hexagonal prism groove hole 51 which is used for slot type butt joint with the regular hexagonal prism structure at the tail part of the supporting claw and is connected into a whole by biological glue.

When the tool is assembled, firstly, the screw lock shown in figure 3 is sleeved on the rod part 22 of the supporting claw shown in figure 2, the front end of the screw lock is contacted with the head part of the supporting claw, the spring 6 is placed in the blind cylindrical hole 23 in the middle part of the supporting claw, and the steel ball 7 is pressed into the hole by strong force; then the sleeve shown in fig. 4 is sleeved on the supporting claw rod part 22, and the spherical through hole 42 on the sleeve 4 is aligned with the hole of the non-permeable cylinder 23 on the supporting claw rod part; the first arc-shaped groove processed on the side edge of the supporting claw rod part is correspondingly matched with the second arc-shaped groove processed on the side wall of the sleeve, so that the first arc-shaped groove and the second arc-shaped groove are prevented from rotating axially when moving forwards and backwards axially, and the push handle shown in the figure 5 is arranged at the tail end of the supporting claw rod part. When in operation, the steel ball 7 is pressed down to ensure that the steel ball does not exceed the obstructed cylindrical hole 23 of the rod part of the supporting claw, so that a certain distance exists between the obstructed cylindrical hole 23 and the sleeve spherical through hole 42.

Examples

Sterile normal saline (can be completely immersed into a disposable self-pressurizing intestinal anastomat product) at about 0 ℃ is prepared before operation, after the lesion tissues of the colon segment outside the body are excised, foreign matters after excision of the broken ends to be anastomosed are firstly processed, then the broken ends to be anastomosed at the two ends are subjected to purse-string processing by using purse-string forceps, after the processing is finished, the model selection operation is carried out, the thickness of the intestinal wall of the part to be anastomosed and the length of the part to be anastomosed when the part to be anastomosed is naturally tiled are measured by using a vernier caliper matched with the product once, the size of the two parts is compared with the model selection specification on the product use specification, and the end of the part to be anastomosed is anastomosed by selecting the proper product specification size. After the model selection is finished, the corresponding product can be used, as shown in fig. 8. The specific operation is as follows: unpacking, putting the product part into prepared sterile physiological saline at about 0 ℃, immersing and standing for about 15 seconds; as shown in fig. 6, the top claws inserted into the supporting claws of fig. 2 correspond to 4 tapered slot holes of a product one by one, and then the external threads of the screw lock of fig. 3 are screwed into the internal threads of the product to lock the two into a whole. The forefinger and the middle finger are respectively placed in a semicircular snap ring structure shown at the middle tail part of the thread lock, the rear part of the thumb or the palm of the hand is propped against the olive-shaped pushing and propping force part 56 of the pushing handle shown in figure 5, and the whole tool part is placed in the hand; the thumb or the back of the palm is pushed forward forcefully in the sterile saline, the index finger and the middle finger are fixed, and the support claw rod part is pushed forward along the sleeve 4 on the support claw rod part, so that the product is spread, as shown in fig. 9. When the steel ball 7 which is not communicated with the cylindrical hole 23 in the middle of the rod part of the supporting claw is clamped in the spherical through hole 42 in the front part of the sleeve, the upper limit value of the distraction is reached.

Then, approaching the part to be anastomosed, placing a female lock ring 11 into a section of the propped anastomotic stoma as shown in figure 10, adjusting the position of the first broken end to be anastomosed to be about 5mm, tightening the previously beaten purse as shown in figure 11 after the circumference is adjusted to be uniform and stable, checking whether the problem of incomplete purse-string wrapping or complications such as serosal layer tearing exist, and finally cutting off redundant purse strings; after the tool is checked to be correct, the thread lock in the figure 3 is rotated anticlockwise, the thread lock is screwed out from the inner thread of the product, the top claw of the supporting claw can axially withdraw, the tool integrally withdraws from the product as shown in the figure 13, and the tool can be discarded at the moment; as shown in fig. 14, the male locking ring 13 is put into the second cut-end anastomotic stoma to a proper position, as shown in fig. 15, the previously punched purse is tightened, and after checking that no mistake is made, the excess purse string is cut off. The gauze is soaked by sterile normal saline at about 40 ℃ to carry out hot compress on the anastomotic stoma, the memory alloy is heated, and the memory alloy can be restored to the original shape at a quite high speed without any external force, so that the previously enlarged anastomotic size is contracted to the original size to clamp the broken end, and the anastomotic effect is achieved, as shown in fig. 16.

After the operation is finished, the product can fall off after the anastomotic stoma is healed for the first time, and according to the characteristics of the product material, if the product made of degradable material is selected, the product can be decomposed into small blocks without sharp edges and is discharged out of the body along with the intestinal contents, and no residue exists in the body; if the product made of non-degradable materials is selected, the product can be discharged out of the body in an integral form, and no residue is left in the body.

The present invention is not limited to the above-mentioned preferred embodiments, and any other products in various forms can be obtained by anyone in the light of the present invention, but any changes in the shape or structure thereof, which have the same or similar technical solutions as those of the present application, fall within the protection scope of the present invention.

Claims

1. The utility model provides a supporting instrument of disposable self-pressurization formula intestinal anastomat, disposable self-pressurization formula intestinal anastomat comprises public, female catch and the memory alloy clamp of connecting between two catches, and wherein, the middle part of public, female catch is the shaft hole, is equipped with the internal thread in the public catch shaft hole, and the equipartition has 4 tapering recesses, its characterized in that on the internal circumference of female catch: the tool matched with the disposable self-pressurizing intestinal tract anastomat comprises a supporting claw (2), a thread lock (3) and a push handle (5); the supporting claw (2) is formed by integrally forming a rod part (22) and a head part, 4 jacking claws (21) are uniformly distributed on the circumference of the head part and used for jacking up with 4 taper grooves, the threaded lock (3) is sleeved on the rod part (22), external threads (32) matched with internal threads (14) of a male locking ring (13) are arranged at the front end of the threaded lock (3), semi-circular clamping ring structures (33) for hand holding are arranged on two sides of the rear end of the threaded lock (3), and the tail end of the rod part (22) of the supporting claw is fixedly connected with the push handle (5);

the sleeve (4) is sleeved on the rod part (22) of the supporting claw and is positioned between the push handle (5) and the rear end of the threaded lock (3), the rod part (22) of the supporting claw is a smooth shaft, a locking piece is arranged on the shaft, and a positioning locking part matched with the locking piece for positioning and locking is arranged on the sleeve; the locking piece consists of an impermeable cylindrical hole (23) formed in the middle of the smooth shaft, a spring (6) arranged in the hole and a steel ball (7), and the steel ball (7) is positioned at the top end of the spring (6); the front part of the sleeve (4) is provided with a spherical through hole (42) which is small at the top and big at the bottom and is matched with the steel ball as a positioning locking part.

2. The kit of a disposable self-pressurizing intestinal stapler according to claim 1, wherein: a first arc-shaped groove (24) for limiting the sleeve to move axially is arranged on the side edge of the smooth shaft, and a second arc-shaped groove (43) matched with the arc-shaped groove is concavely arranged along the side edge of the sleeve (4).

3. A kit for a disposable self-pressurizing intestinal stapler according to claim 1 or 2, wherein: the push handle (5) is an olive-shaped force application part, and anti-skidding circular arc-shaped grooves (52) are uniformly distributed on the circumference of the push handle.

4. A kit for a disposable self-pressurizing intestinal stapler according to claim 3, wherein: the tail end of the rod part (22) is of a regular hexagonal prism structure, the front end of the push handle (5) is provided with a slotted hole (51) which is spliced with the regular hexagonal prism structure, and the push handle and the regular hexagonal prism structure are connected into a whole through biological glue after being spliced.