CN103002815A - A device for translumenal diversion of bile - Google Patents
A device for translumenal diversion of bile Download PDFInfo
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- CN103002815A CN103002815A CN2010800680382A CN201080068038A CN103002815A CN 103002815 A CN103002815 A CN 103002815A CN 2010800680382 A CN2010800680382 A CN 2010800680382A CN 201080068038 A CN201080068038 A CN 201080068038A CN 103002815 A CN103002815 A CN 103002815A
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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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
- A61B17/08—Wound clamps or clips, i.e. not or only partly penetrating the tissue ; Devices for bringing together the edges of a wound
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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
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
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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
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00818—Treatment of the gastro-intestinal system
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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
- A61B2017/00982—General structural features
- A61B2017/00986—Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1139—Side-to-side connections, e.g. shunt or X-connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
- A61B2017/22054—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation with two balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
- A61B2017/22065—Functions of balloons
- A61B2017/22069—Immobilising; Stabilising
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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
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2002/041—Bile ducts
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Abstract
A device (6) for diverting biliary fluid comprises a catheter (13) and an anastomotic coupler (32) connected to the catheter (13), the anastomotic coupler (32) having an expandable first compression portion (33) and an expandable second compression portion (34) adapted to clamp a first portion (17) of a hollow organ and a target portion (18) of the intestine to each other to cause anastomosis of the first portion (17) and the target portion (18), thereby immobilizing the catheter (13) with respect to the anastomosis.
Description
Technical field
The present invention relates in general to for the apparatus and method that affect patient's digestion with operative Modality, and it is intended to treat metabolism disorder, for example morbid obesity and relevant comorbidities, for example diabetes, heart disease, apoplexy, pneumonopathy and thunder bolt.
Background technology
Attempted in the past the multiple MO non-operative treatment for the treatment of that does not have in fact permanent successful.
Treat MO surgical method, for example for permanent dyspeptic open, the abdominal cavity mirror of food and intracavity gastric bypass, progressively use and obtain than ten-strike.Yet, the great and usually highly traumatic modification that existing method for carrying out gastric bypass relates to surgery operating technology time-consuming and that highly rely on agility and patient's gastrointestinal is dissected.Keep these operations and only be used for the severe obesity patient, because they have multiple significant complication, comprise dead danger.For fear of the operating defective of gastric bypass and in order to affect patient's digestion in mode more specifically and targetedly, the present invention concentrates to have described and is mainly used in affecting and adjusts the intestinal hepatic bile and circulate and the method and apparatus of non-digestive tract self.For this reason, consider following possible method and the mechanism that circulation is worked to the intestinal hepatic bile:
-adjustment intestinal hepatic bile cycle frequency, especially bile circulation acceleration;
-adjust contacting and interaction and the physiological signal that triggers by bile and contacting of intestinal wall by bile and enteral food;
-by being adjusted at attaching space between bile and enteral food or the chyme with the time and by targetedly bile being separated the absorbability of adjusting food with food.
The known Wicresoft bypath system and the method that are used for the interactional position of nutrient of adjustment bile and pancreas secretions and gastrointestinal tract have been described in US Patent No. 2005085787A1.Known system comprises pipeline, and pipeline has bile and pancreas secretions are transferred to the first end of gastrointestinal tract downstream position and are connected to the second end of weary Te Shi ampulla from weary Te Shi ampulla.
Described known conduits is extended and is tending towards tying up and wriggling by intestinal is shifted at enteral, so that the far-end of conduit relocates continually away from surgeon's the set goal position.
In addition, in order to follow the coiling path of intestinal, known intracavity pipeline must have significant length, and it increases flow resistance non-requiredly and reduces bile flows to the target location, distally in gastrointestinal tract flow.Therefore, compare with natural intestinal hepatic bile circulation rate, known pipeline is unsuitable for obtaining the remarkable acceleration of bile circulation.
In view of the defective of known technology, the present invention aims to provide bile is transferred to Wicresoft's apparatus and method the part of intestinal in weary Te Shi nipple distally from the biliary system with gallbladder, and it has avoided unexpected relocate of bile pipeline in the target location.
Summary of the invention
Another object of the present invention is the flow that increases the bile of the transfer of target location in small intestinal.
Realize at least a portion of above-mentioned definite purpose by the method that bile is transferred to the target location the intestinal in weary Te Shi vater's papilla distally from the bile flow path, said method comprising the steps of:
A) form first in hollow organ's First office and make mouth;
B) partly locate to form second in the target of intestinal and make mouth, described target part is in the distally of weary Te Shi nipple;
C) proximal part with conduit is placed in the bile flow path;
D) making conduit pass first makes mouthful and second makes mouth and extend to described target location the intestinal from the bile flow path;
E) distal portions of conduit is placed in the described target location in the intestinal.
Owing to extending to target location the intestinal through cavities conduit pipe from the bile flow path, therefore can walk around at least part of duodenum and can minimize bypass length.In addition, be positioned at the mouth of making that the target of intestinal partly locates by conduit is extended through, the distal end of catheter part can not be tied up and can be from required target location displacement.
The target of intestinal partly can be the part of small intestinal, for example the part of the part of duodenal distal part, jejunum or ileum or large intestine, for example transverse colon or sigmoid colon.
According to aspects of the present invention, said method comprising the steps of:
-form first in the First office of intestinal to make mouth; And
-first of intestinal is coincide to the target part of intestinal.
Intestinal-intestinal coincide and forms the seriality of tube chamber, and it has got rid of the danger that enteral prods passes conduit and makes the gap seepage in the abdominal part space between the mouth.
In addition, because intestinal-intestinal coincide, therefore may make conduit extend through the first target part of making mouth and extending duodenum and directly enter intestinal from bile duct, thereby form very short bypass path.
According to another aspect of the present invention, said method comprising the steps of:
-form first in the First office of gallbladder to make mouth; And
-first of gallbladder is coincide to the target part of intestinal.
Coincide and substitute intestinal-intestinal and coincide by forming gallbladder-intestinal, catheter proximal end partly extends through gallbladder wall, thereby avoids conduit to pass weary Te Shi nipple and insert in the weak ductus choledochus that is highly brittle.
According to another aspect of the present invention, the described method First office that is included in ductus choledochus forms the first step of making mouthful.
This allows proximal part with conduit to be placed in the bile flow path and does not enter weary Te Shi nipple and need not to operate gallbladder.
By being used for that bile is transferred at least a portion that realizes above-mentioned definite purpose at the device of the target location of the intestinal in weary Te Shi vater's papilla distally from the bile flow path, described device comprises:
The duct segments that-conduit, described conduit have proximal part and distal portions and extend between proximal part and distal portions,
-being connected to the stapling apparatus of conduit, described stapling apparatus has expansion type the first compression section and expansion type the second compression section,
Wherein, the first compression section and the second compression section can clamp hollow organ's first and the target part of intestinal each other, so that first and target are partly coincide and so that conduit is identical fixing with respect to described.
This permission is placed conduit and is formed and coincide in single step, and conduit is identical fixing with respect to described, so that conduit can not regained from anastomosis sites.
According to aspects of the present invention, conduit comprises outer tubular wall, stapling apparatus comprise the first inflated type annular balloon of being formed in the outer wall and be formed in the outer wall and with the second inflated type annular balloon of the first capsule spacing distance.
According to another aspect of the present invention, the distance between the first capsule and the second capsule is adjustable.
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 apparatus and method that bile shifts through the chamber that are used for according to the embodiment of the invention;
-Fig. 2 shows the zoomed-in view of Fig. 1;
-Fig. 3 shows and is used in accordance with another embodiment of the present invention the method that bile shifts through the chamber;
-Fig. 4 shows the zoomed-in view of Fig. 3;
-Fig. 5 shows and is used in accordance with another embodiment of the present invention the method and apparatus that bile shifts through the chamber;
-Fig. 6-9 shows and is used for according to an embodiment of the invention method step, device and the instrument that bile shifts through the chamber;
-Figure 10 shows the stapling apparatus applicator for the method for Fig. 6-9;
-Figure 11 shows the stapling apparatus after the applicator that arranges and regain among Figure 10;
-Figure 12 shows the device that bile shifts through the chamber that is used for according to another embodiment of the invention, and wherein said device has the first contracted configuration;
-Figure 13 shows the device of the Figure 12 under the second expanded configuration;
-Figure 14 shows the device that uses Figure 12 and 13 and is used for the method that bile shifts through the chamber;
-Figure 15 shows and is used for according to an embodiment of the invention the device that bile shifts through the chamber, and wherein said device illustrates with the first contracted configuration (solid line) and the second expanded configuration (dotted line);
-Figure 16 shows the device that bile shifts through the chamber that is used for according to another embodiment of the invention, and wherein said device illustrates with the first contracted configuration (solid line) and the second expanded configuration (dotted line);
-Figure 17 shows and is used in accordance with another embodiment of the present invention the method and apparatus that bile shifts through the chamber.
The specific embodiment
Referring to diagram, the wherein similarly similar anatomical structure of digitized representation and assembly in a plurality of diagrams, Fig. 1 is the partial view in patient abdominal cavity, it shows stomach 1, duodenum 2, jejunum 3, ileum 4 and colon 5, and biliary system 7, pancreatic duct 9 and weary Te Shi major duodenal papilla 10 with gallbladder 8, bile and pancreatic juice usually pass weary Te Shi major duodenal papilla and enter duodenum 2.Fig. 1 also shows bile is transferred to the method and apparatus 6 of the target location the intestinal in weary Te Shi nipple 10 distally from the bile flow path that is limited by biliary system 7 and gallbladder 8 through the chamber.
According to overall intention, said method comprising the steps of:
-form first at hollow organ's first 17 places to make mouth 11;
-at intestinal 2,3,4,5 target part 18 places form second and make mouth 12, and described target part 18 is in the distally of weary Te Shi nipple 10;
-proximal part 14 of conduit 13 is placed in the bile flow path;
-make conduit 13 pass first from the bile flow path to make mouthful 11 and second and make mouthfuls 12 and extend to intestinal 2,3 target location in 4,5;
-distal portions 15 of conduit 13 is placed in the target location in the intestinal.
Owing to extending to target location the intestinal through cavities conduit pipe 13 from the bile flow path, therefore can walk around at least part of duodenum and can minimize bypass length.In addition, by conduit 13 being extended through the mouth of making at target part 18 places that are positioned at intestinal, distal end of catheter part 15 can not be tied up and can be from required target location displacement.
The target part 18 of intestinal can be the part of small intestinal, for example, and the part of the distal part of duodenum 2, jejunum 3 or ileum 4 or the part of large intestine 5, for example, transverse colon or sigmoid colon.
According to embodiment (Fig. 1,2,5), form first at first 17 places (especially at duodenum 2 places near weary Te Shi nipple 10) of intestinal and make mouth 11, and the first 17 of intestinal is coincide to the target parts 18 of intestinal.This type of intestinal-intestinal coincide and forms the seriality of tube chamber, and it has got rid of the danger that enteral prods is passed in conduit 13 and makes the gap seepage in the abdominal part space between the mouth 11,12.In this embodiment, conduit 13 can extend through weary Te Shi nipple 10 and first from biliary system 7 and make mouthfuls 11 and extend duodenum 2 and directly enter the target part 18 of intestinal, thereby forms very short bypass path (Fig. 2).
In order to place conduit 13, endoscope inserted in the intestinal so that near the duodenum 2 of Oddi's sphincter visual and identification intestinal be used for first make mouthfuls 11 first 17.Can identify with identical endoscope for making the target part 18 that the intestinal of mouth 12 is made in second of mouthful 11 distally in the distally of weary Te Shi nipple 10 with first.Then, the target part 18 of the first 17 of intestinal and intestinal is closer to each other and form betwixt intestinal-intestinal and coincide.For the sake of clarity, be to be understood that intestinal-intestinal coincide and comprise that making mouthful 11 and second by first makes mouthful 12 tube chambers that form, first make mouthful and be connected make mouthful can the first 17 of intestinal are connected with the target part approaching be connected before or after execution.
Form intestinal-intestinal and coincide and can relate to the anastomotic ring device that uses applicator and the abdominal cavity mirror setting of stapling apparatus, stapling apparatus is to some extent description in the US Patent No. 7,452,363 of owning together, and its full content is incorporated this paper by reference into.
Forming after intestinal-intestinal coincide, example such as ERCP (endoscopic retrograde cholangiopancreatography) similar techniques is passed weary Te Shi nipple 10 with the proximal part 14 of conduit 13 and support 16 and is introduced in the ductus choledochus.ERCP operation relate to the endoscope of flexibility pass the oral cavity, the esophagus stomach function regulating enters near in the duodenum 2 of weary Te Shi nipple 10.Then, the doctor is passed in the instrument channel in the endoscope with conduit 13 and stretches out to enter in the duodenum 2 and observe, and is inserted in the weary Te Shi nipple 10.
After catheter proximal end part 14 is positioned in desired locations in the ductus choledochus, start support 16 or other anchoring device to be connected to bile duct and to make with it grappling of conduit 13.
Then, endoscope regains from extended state, and the distal portions 15 of conduit 13 manifests or the distal portions 15 of conduit 13 is displaced from instrument channel and it is booked by the endoscope type grasper and is passed intestinal-intestinal and coincide and be introduced into the target part 18 of intestinal from instrument channel.
According to embodiment, conduit 13 can be fixed in addition stapling apparatus or intestinal-intestinal and coincide, thereby make conduit 13 fixing with respect to the target part 18 of intestinal.Then, endoscope can be regained in patient body.The gained situation is illustrated among Fig. 1 and 2.
For retrograde infection or the pancreatitis that prevents biliary system 7, conduit 13 can comprise the antimicrobial coatings 19 that for example contains silver.
According to another embodiment (Fig. 9), form the first first 17 that makes mouth 11 and gallbladder 8 at first 17 places of gallbladder 8 and coincide with the target part 18 of intestinal 2,3,4,5.In this embodiment, formation gallbladder-intestinal coincide but not intestinal-intestinal coincide, and the proximal part 14 of conduit 13 extends through gallbladder wall, inserts in the weak ductus choledochus that is highly brittle thereby avoid conduit 13 to pass weary Te Shi nipple.
In this embodiment, introduce the abdominal part space by firmly grasping the apparatus percutaneous, and by apparatus promptly firmly grasp gallbladder 8 and towards with the target part 18 tractive gallbladders 8 of intestinal dorsad, can make gallbladder 8 near the target part 18 of intestinal.Promptly apparatus can comprise the relative jaw that is connected to stiff shaft, and perhaps promptly apparatus can comprise the far-end that is connected to stiff shaft and the inflated type capsule with inflated shapes, and this inflated type capsule can engage gallbladder 8 and push it against the target part 18 of intestinal.For this reason, promptly the far-end of apparatus can be introduced in the gallbladder 8 via skin together with the inflated type capsule, and described capsule can inflate to engage the latter in gallbladder.
After the target part 18 of the first 17 of gallbladder and intestinal approaches, anastomotic ring device by using applicator and the abdominal cavity mirror of stapling apparatus arrange formation intestinal-intestinal and coincide, the US Patent No. 7 that this stapling apparatus is being owned together, 452, describe to some extent in 363, its full content is incorporated this paper by reference into.But stapling apparatus can be complete bio-absorbable or biodegradable, or the only nearside of stapling apparatus (gallbladder side) but compression section is bio-absorbable or biodegradable so that stapling apparatus can be discharged with feces.
Forming after gallbladder-intestinal coincide, the proximal part 14 of conduit 13 and support 16 pass this gallbladder-intestinal coincide (that is, pass second and make mouthful and first make mouth) be introduced in the gallbladder 8, and may on be advanced in the cystic duct.This can advantageously realize by improved ERCP (endoscopic retrograde cholangiopancreatography) similar operation, this similar operation relates to that side sight glass with flexibility passes rectum and colon enters intestinal 2,3,4,5 target part 18, the target part 18 that perhaps makes flexible side sight glass direct oral cavity enter intestinal, then conduit 13 is passed the instrument channel in the endoscope and stretch out observation in the target part 18 that enters intestinal, and catheter proximal end part 14 is passed in the identical insertion of the gallbladder-intestinal gallbladder 8, and the guiding that possibly it made progress enters cystic duct.
After catheter proximal end part 14 is positioned at desired location, start support 16 or other anchoring device so that conduit 13 is anchored in gallbladder 8 or the cystic duct.
Then, the side sight glass is regained from extended state, and the distal portions 15 of conduit 13 manifests or the distal portions 15 of conduit 13 is displaced from instrument channel the target part 18 of intestinal from instrument channel.
If need to shift whole bile, can in the ductus choledochus in catheter proximal end (Fig. 9) distally, stopper 20 be set.
According to embodiment, use abdominal cavity mirror method can realize also that gallbladder-intestinal coincide and through the placement of cavities conduit pipe 13, shown in Fig. 6-11.
Figure 11 shows exemplary anastomotic ring device 22, it has proximal ring 23, center ring 24 and is connected the distally ring 25 that is connected with the distally articulated jib by nearside, and anastomotic ring device 22 has the shape of substantial cylindrical and have rivet shape when starting when not starting.Figure 10 shows the exemplary applicator 21 for anastomotic ring device 22.Applicator 21 comprises elongate tool part 26, is connected to the handle 27 of tools section 26, capture element and the control of interior bonds to the actuation member of a selected ring of stapling apparatus 22, interior bonds to selected second ring of stapling apparatus 22, this control is connected to handle 27 and can be so that actuation member and adapter ring are mobile to capture element and selected second ring, thereby starts the plug-in type articulated jib of loop device 22.This type of stapling apparatus and applicator are above-mentioned US Patent No. 7,452,363 existing descriptions.
As shown in Figure 6, applicator 21 can pass the 3rd and make mouthfuls 29 and insert the part of the intestinal that is arranged in target part 18 distally, and can be advanced to target part 18 towards nearside subsequently.Then, the distally of stapling apparatus 22 ring 25 is passed second of previous formation make mouthfuls 12 and insert, start simultaneously the nearside articulated jib of stapling apparatus 22 with circumferentially extending, can fully not slip over second and make mouthfuls 12 so that install 22.By pushing applicator 21 to gallbladder 8, make the target part 18 of intestinal near the first 17 of gallbladder 8.Then, the distally of stapling apparatus 22 ring 25 passed first of the previous formation that is positioned at gallbladder 8 and make mouthful 11 insertions, and start the distally articulated jib with circumferentially extending, thereby the first 17 of gallbladder 8 is clamped to form betwixt coincide (Fig. 7) against the target part 18 of intestinal.Then, applicator 21 can be made mouthfuls 29 by the 3rd and regain and conduit 13 can pass in gallbladder-intestinal anastomosis the 3rd and makes mouthful 29 and second and make mouthful and first make in mouthful 12, the 11 insertion gallbladders 8, and may insert (Fig. 8) in the cystic duct.
After catheter proximal end part 14 is positioned at desired location, can start support 16 or other anchoring device conduit 13 is anchored on (Fig. 9) in gallbladder 8 or the cystic duct.In addition, conduit 13 can be fixed to stapling apparatus 22 so that distal end of catheter part 15 is fixing with respect to the target part 18 of intestinal.
The bile that the gained bypass allows to be derived from liver is transferred to the target location of intestinal.
According to another embodiment (Fig. 3,17), form first at first 18 places of ductus choledochus and make mouth 11.This allows proximal part 14 with conduit to be placed in the bile flow path and does not enter weary Te Shi nipple 10 and need not to operate gallbladder 8.
In the embodiment of Figure 17, by conduit 13 is placed to so that catheter proximal end part 14 is positioned in the ductus choledochus and distal end of catheter part 15 is positioned in jejunum 3 or the ileum 5 and so that bile is walked around part small intestinal 2,3.
In the embodiments of figure 3, by conduit 13 being placed in the per rectum path so that catheter proximal end part 14 is positioned in the ductus choledochus and distal end of catheter part 15 (for example is positioned in the large intestine 5, in horizontal intestinal) and so that bile is walked around small intestinal 2,3 fully, 4.
In feasible laparoscopic surgery, formation peritoneoscope entrance and peritoneoscope cutting device pass this entrance and insert in abdominal part space to make mouth 11 in bile duct 7 places execution first and to carry out second at colon 5 places and make mouth 12.Then, regain cutting device, conduit 13 passes entrance and inserts in the abdominal part space.The proximal part 14 of conduit 13 passes first in the bile duct 7 along the direction (with bile natural flow opposite direction) of driving in the wrong direction and makes mouthfuls 11 and insert and support 16 or other anchoring device are arranged to catheter proximal end part 14 is anchored in the bile duct 7.Then, the bundling type stitching thread is applied to first around conduit 13 and makes mouthfuls 11 and make mouthfuls 11 to seal first.
The distal portions 15 of conduit 13 passes second and makes mouthfuls 12 and insert in the colons 5, and the bundling type stitching thread is applied to second around conduit 13 and makes mouthfuls 12 and make mouthfuls 12 to seal first.Then, in patient body, regain apparatus, remove the hole in entrance and the stitching stomach wall.
By walking around whole small intestinal, owing to lacking bile, the absorption of lipid will reduce significantly.
By check valve 30 (being illustrated among Figure 17) is set, for example the far-end at conduit 13 arranges the backflow that collapsible low-pressure flapper valve can prevent that feces or chyme from not expecting from the intestinal generation.When intestinal or colonic peristalsis were tending towards pushing chyme or feces in the conduit 13, valve 17 cut out, when bile from conduit toward dirty and when the inside of conduit distally outlet opening bile pressure surpassed external pressure, valve was opened.
To transfer to the danger that peritonitis and retrograde infection occur in the bile duct in order reducing owing to chyme or feces, to consider that conduit 13 is passed liver to be introduced in the bile duct 7 through liver.In this case, make distal end of catheter part 15 pass first and make mouthfuls 11, stretch out bile duct 7 and pass second and make mouthfuls 12 and send into colon 5 towards the target part 18 of the perspective of colon 5.
According to another embodiment, conduit 13 passes liver through liver and inserts bile duct 7, and distal end of catheter part 15 pass weary Te Shi nipple 10 send into duodenum 2 and be passed in the duodenal wall previous form first made mouthfuls 11, stretch out and pass second and make mouthfuls 12 and send into the colon 5 from duodenum 2 towards the target part 18 of the perspective of colon 5.
These embodiment need to make mouth 11 and second first and make mouthful 12 places use bundling type stitching thread so that the latter is sealed to prevent that with respect to conduit 13 enteral prods from leaking in the abdominal part space.
Making mouthful 11 and second the identical of Duodeno-colon of making between the mouth 12 by first rebulids intestinal tube chamber seriality and from the bile duct 7 interior identical target parts 18 that enter colon 5 (Fig. 5) that conduit 13 is extended through weary Te Shi nipple 10 and passes the Duodeno-colon, can avoid this type of chronic trauma of intestinal wall.For this reason, can use described about intestinal-intestinal coincide and gallbladder-intestinal is identical apparatus and method hereinbefore.Alternatively, use in US Patent No. 7,618, the stapling apparatus described in 427 and applicator can be realized the Duodeno-Colonic anastomosis, and the full content of this patent is incorporated this paper by reference into.
Figure 12-16 shows other embodiment that bile is transferred to the device 6 of the target location in the intestinal in weary Te Shi vater's papilla 10 distally from bile flow path 7,8.
In the embodiment of Figure 12 and 13, the duct segments 31 that the device 6 identical couplings 32 that comprise conduit 13 and be connected to conduit 13, conduit have proximal part 14, distal portions 15 and extend between proximal part 14 and distal portions 15.The coupling 32 that coincide comprises the first expansion type compression section 33 and the second expansion type compression section 34, wherein the first expansion type compression section 33 and the second expansion type compression section 34 can clamp hollow organ's first 17 and the target part 18 of intestinal each other, so that the coincideing and make conduit 13 fixing with respect to coincideing of gained of first 17 and target part 18.
This allows to place conduit 13 and forms described coincideing in single step, and with conduit 13 with respect to this identical fixing so that conduit can not regained from anastomosis sites.
Under that shrink and state radial expansion, compression section 33,34 allows passing of conduits 13 first to make mouthful 11 and second and make endoscope type or an abdominal cavity mirror of mouthfuls 12 and place.
According to embodiment, conduit 13 comprises outer tubular wall 35, the coupling 32 that coincide comprise the first inflated type annular balloon that is formed in the outer wall 32 and be formed in the outer wall 32 and with the second inflated type annular balloon of the first capsule spacing distance.
According to embodiment, visual the first labelling 36 (for example, radiopacity zone) is arranged on the vessel cluster place that is positioned between the compression section 33,44, and other labelling 37 can be arranged to the contiguous compression section 33,44 relative with the first labelling 36. Labelling 36,37 helps the location of compression section 33,44 and is conducive to the correct location of conduit 13.
Figure 14 show for example use in conjunction with Fig. 9 hereinbefore one of described method form the exemplary non-limiting purposes that gallbladder-intestinal coincide and conduit 13 extended through coincide the device 6 of tube chamber.
According to another embodiment, the distance between the first compression section 33 and the second compression section 34 is adjustable compression stress with regulating action first 17 and target part 18 in anastomosis sites.For this reason, screw-type is regulated coupling 38 (Figure 15) or ratchet-type and is regulated coupling 39 (Figure 16) and can be arranged in the conduit 13 between the first compression section 33 and the second compression section 34.Ratchet-type is regulated coupling 39 also can comprise the drag wire 40 with first end and the second end, first end is connected to the first ratchet portions of two engages ratchet part, the second end from conduit 13 be apparent in respect on the side of the first ratchet portions and can by promptly and tractive with further near ratchet portions.
Although described the preferred embodiments of the present invention in detail, the applicant is not intended to circumscription with claims in this type of specific embodiment, and is intended to contain all modifications form and alternate configuration in the scope of the invention.
Claims (30)
1. method that is used for bile is transferred to from bile flow path (7,8) target location in the intestinal (3,4,5) in weary Te Shi vater's papilla (10) distally said method comprising the steps of:
-locate to form first in hollow organ's first (17) to make mouthful (11);
-to locate to form second in the target part (18) of described intestinal (2,3,4,5) to make mouthful (12), described target part (18) is in the distally of described weary Te Shi nipple (10);
-proximal part (14) of conduit (13) is placed in the described bile flow path (7,8);
-make described conduit (13) pass described first from described bile flow path (7,8) to make mouthful (11) and described second and make mouth (12) and extend to target location in the described intestinal (2,3,4,5).
2. method according to claim 1 comprises that the proximal part (14) with described conduit (13) is anchored on the interior step of biliary system (7).
3. method according to claim 1 and 2 may further comprise the steps:
-locate to form described first in the first (17) near the duodenum (2) of described weary Te Shi nipple (10) to make mouthful (11); And
-first (17) of described duodenum (2) is coincide to the target part (18) of described intestinal.
4. method according to claim 3 may further comprise the steps:
-endoscope is inserted in the described intestinal so that visual near the duodenum (2) of Oddi's sphincter; And
-use described first first (17) that makes mouthful (11) that is used for of described scope recognition intestinal;
-use described scope recognition intestinal be used for described second make the target part (18) of mouthful (12);
-the first (17) that makes duodenum (2) is closer to each other and form betwixt intestinal-intestinal and coincide with the target of intestinal part (18);
-enter near in the duodenum (2) of described weary Te Shi nipple (10) and make described conduit (13) pass the instrument channel of the endoscope in the described duodenum (2) and enter in the described weary Te Shi nipple (10) by making flexible endoscope pass oral cavity, esophagus stomach function regulating, proximal part (14) and the support (16) of described conduit (13) passed described weary Te Shi nipple (10) insert in the ductus choledochus;
-described support (16) is set so that described conduit (13) is anchored to the gallbladder pipe;
-firmly grasp the distal portions (15) of described conduit (13) and described distal portions (15) is passed described intestinal-intestinal coincide to introduce in the target part (18) of described intestinal by the endoscope type grasper.
5. method according to claim 3 may further comprise the steps: described conduit (13) is fixed to described coincideing, thereby makes described conduit (13) fixing with respect to the target part (18) of described intestinal.
6. method according to claim 1 may further comprise the steps:
-first (17) in described gallbladder (8) locates to form described first and makes mouthful (11); And
-first (17) of described gallbladder (8) is coincide to the target part (18) of described intestinal (2,3,4,5).
7. method according to claim 6 may further comprise the steps:
-will firmly grasp the apparatus percutaneous to introduce in the abdominal part space; And
-by described promptly apparatus firmly grasp described gallbladder (8) and towards with the target part described gallbladder of (18) tractive (8) of described intestinal dorsad.
8. method according to claim 7 may further comprise the steps:
-provide to be connected to the described promptly inflated type capsule of the far-end of apparatus;
-the described promptly far-end of apparatus is introduced in the described gallbladder (8) together with described inflated type capsule; And
-by the capsule in the described gallbladder is inflated to firmly grasp described gallbladder.
9. method according to claim 6 may further comprise the steps:
It is identical that-abdominal cavity mirror setting by anastomotic ring device forms gallbladder-intestinal.
10. method according to claim 6 may further comprise the steps:
-after the described gallbladder-intestinal of formation coincide, by making flexible side sight glass enter the target part (18) of described intestinal and make described conduit (13) pass the instrument channel of the endoscope in the target part (18) of described intestinal and described catheter proximal end part (14) is passed described gallbladder-intestinal coincide and insert in the described gallbladder (8), the proximal part (14) of described conduit (13) and support (16) are passed described gallbladder-intestinal coincide in the described gallbladder of insertion (8);
-start described support (16) so that described conduit (13) is anchored in the described gallbladder (8).
11. method according to claim 6 may further comprise the steps: described conduit (13) is fixed to described coincideing, thereby makes conduit (13) fixing with respect to the target part (18) of described intestinal.
12. method according to claim 6 may further comprise the steps:
-formation abdominal cavity mirror entrance;
-in described intestinal, form near described second make mouthful the 3rd make mouth;
-laparoscopic device (21) is passed described abdominal cavity mirror entrance and the described the 3rd together with loop device (22) make a mouthful target part of introducing intestinal;
-described loop device (22) is placed into described second make in mouthful (12), and will have the described second target part (18) of making mouthful (12) and push have the described first first (17) that makes mouth (11) to, and then, described loop device (22) being placed into described first makes in mouthful (11);
-described loop device (22) is set so that described first (17) is coincide to described target part (18);
-pass the described the 3rd to make mouthful (29) and regain described applicator (21); And
-in described gallbladder-intestinal anastomosis described conduit (13) passed the described the 3rd to make mouthful (29) and described second and make mouthful (12) and first and make mouth (11) and insert in the described gallbladder (8).
13. method according to claim 2 is included in the ductus choledochus place and forms described first and make the step of mouthful (11).
14. method according to claim 13 comprises being placed on described catheter proximal end part (14) in the described ductus choledochus and described distal end of catheter part (15) being placed on step in the small intestinal in described duodenum (2) distally.
15. method according to claim 13 comprises described catheter proximal end part (14) being placed in the described ductus choledochus and described distal end of catheter part (15) being placed on step in the colon (5).
16. method according to claim 15 may further comprise the steps:
-formation abdominal cavity mirror entrance;
-abdominal cavity mirror cutting device is passed described entrance insert in the described abdominal part space, and use described cutting device, locate to carry out described first at described bile duct (7) and make mouthful (11) and locate to carry out described second at described colon (5) and make mouthful (12);
-regain described cutting device;
-described conduit (13) is passed described entrance insert in the described abdominal part space; And
-along the direction of driving in the wrong direction the proximal part (14) of described conduit (13) and support (16) are passed described first to make mouth (11) and insert in the described bile duct (7); And
-by being arranged on, described support (16) comes the described proximal part of grappling (14) in the described bile duct (7);
-make mouthful (11) and seal described first and make mouthful (11) by around described conduit (13) the bundling type stitching thread being applied to described first;
-distal portions (15) of described conduit (13) is passed described second make mouthful (12) and insert in the described colon (5);
-make mouthful (12) and seal described second and make mouthful (12) by around described conduit (13) the bundling type stitching thread being applied to described second.
17. method according to claim 1 is included in the step that the far-end (15) of described conduit (13) locates to arrange check valve (30).
18. method according to claim 13 may further comprise the steps:
-make described conduit (13) pass liver to introduce in the described bile duct (7) through liver;
-have an X-rayed the target part (18) of described colon (5);
-described distal end of catheter part (15) is passed described first make mouthful (11), stretch out bile duct (7) towards the target part (18) of described perspective, and pass described second and make mouthful (12) and deliver in the colon (5).
19. method according to claim 1 may further comprise the steps:
-make described conduit (13) pass liver to introduce in the bile duct (7) through liver;
-have an X-rayed the target part (18) of described colon (5);
-described distal end of catheter part (15) is passed described weary Te Shi nipple (10) deliver in the described duodenum (2), and be passed in first of previous formation in the described duodenal wall and make mouthful (11), stretch out and pass described second and make mouthful (12) and deliver to the described colon (5) from described duodenum (2) towards the target part (18) of described perspective.
20. a device (6) of bile being transferred to the target location in the intestinal (3,4,5) from bile flow path (7,8), described device (6) comprising:
-conduit (13), described conduit have the duct segments (31) of proximal part (14) and distal portions (15) and extension between described proximal part (14) and described distal portions (15),
-being connected to the identical coupling (32) of described conduit (13), described identical coupling (32) has expansion type the first compression section (33) and expansion type the second compression section (34),
Described the first compression section (33) and the second compression section (34) can clamp hollow organ's first (17) and the target part (18) of described intestinal each other, so that described first (17) and described target part (18) are identical, thereby described conduit (13) is fixed with respect to described coincideing.
21. device according to claim 20 (6), wherein said conduit (13) comprises outer tubular wall (35), and described identical coupling (32) comprise the first inflated type annular balloon of being formed in the described outer wall (32) and be formed in the described outer wall (32) and with the second inflated type annular balloon of described the first capsule spacing distance.
22. device according to claim 20 (6), wherein said conduit (13) comprise the visual marker (36,37) that is positioned at the vessel cluster place near described compression section (33,44).
23. device according to claim 22 (6), wherein said labelling (36,37) comprises radio-opaque substance.
24. device according to claim 20 (6), wherein the distance between described the first compression section (33) and described the second compression section (34) can be regulated.
25. device according to claim 24 (6), wherein screw-type is regulated coupling (38) and is disposed in the conduit (13) between described the first compression section (33) and described the second compression section (34).
26. device according to claim 24 (6), wherein ratchet-type is regulated coupling (39) and is disposed in the conduit (13) between described the first compression section (33) and described the second compression section (34).
27. device according to claim 26 (6), wherein said ratchet-type is regulated coupling (39) and is comprised the drag wire (40) with first end and the second end, described first end is connected to the first ratchet portions of two engages ratchet part, described the second end from described conduit (13) be apparent on the side relative with described the first ratchet portions and can by promptly and tractive with near described two engages ratchet parts.
28. each described device (6) in 27 according to claim 20 comprises the anchor supports (16) of the proximal part (14) that is connected to described conduit (13).
29. each described device (6) in 28 according to claim 20, wherein said conduit (13) comprises antimicrobial coatings (19).
30. each described device (6) in 29 according to claim 20 comprises the check valve (30) of the far-end that is arranged in described conduit (13).
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/EP2010/060268 WO2012007044A1 (en) | 2010-07-16 | 2010-07-16 | A device for translumenal diversion of bile |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN103002815A true CN103002815A (en) | 2013-03-27 |
Family
ID=43618309
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN2010800680382A Pending CN103002815A (en) | 2010-07-16 | 2010-07-16 | A device for translumenal diversion of bile |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN103002815A (en) |
| WO (1) | WO2012007044A1 (en) |
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| CN108392240A (en) * | 2018-04-25 | 2018-08-14 | 青岛市肿瘤医院 | A kind of rectal neoplasm operation magnet ring stapler |
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| AU2014218701A1 (en) | 2013-02-21 | 2015-09-10 | Xlumena, Inc. | Devices and methods for forming an anastomosis |
| WO2017044991A1 (en) * | 2015-09-13 | 2017-03-16 | Treus Legacy Partners, Llc | Inflatable translumenal shunts and methods and devices for delivery |
| US10449075B2 (en) | 2015-12-15 | 2019-10-22 | Steven Sounyoung Yu | Biliary diversion catheter |
| WO2017203523A1 (en) * | 2016-05-23 | 2017-11-30 | Mor Research Applications Ltd. | Anastomosis device |
| US12076254B2 (en) * | 2021-11-12 | 2024-09-03 | Myka Labs, Inc. | Expanding devices for endoluminal interventions |
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| WO2012007044A1 (en) | 2012-01-19 |
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