CN104220011A - Surgical stapler and stapling method using stapler - Google Patents
Surgical stapler and stapling method using stapler Download PDFInfo
- Publication number
- CN104220011A CN104220011A CN201280066650.5A CN201280066650A CN104220011A CN 104220011 A CN104220011 A CN 104220011A CN 201280066650 A CN201280066650 A CN 201280066650A CN 104220011 A CN104220011 A CN 104220011A
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- CN
- China
- Prior art keywords
- nail
- anvil
- ejector pin
- pin post
- anvil block
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Classifications
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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
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
Abstract
A surgical stapler and a stapling method using the surgical stapler. A head portion (20) comprises a staple barrel (21) connected at an operation portion (30), a staple pushing column (22) disposed in the stable barrel (21) and capable of being pushed by the operation portion (30), a staple cartridge (23) disposed at an end portion of the staple pushing column (22) and used for accommodating staples, and a cutter (24) supported by the staple pushing column (22) and capable of being pushed by the staple pushing column. An end surface of the staple barrel (21) close to the staple cartridge (23), an end surface of the staple pushing column (22) close to the staple cartridge (23), an end surface of the staple cartridge (23) used for accommodating staples, and a blade end surface of the cutter (24) are elliptic rings fitting each other and perpendicular to the axis; a staple anvil (10) comprises an anvil block (14) and a connection shaft lever (11). A joint surface of the anvil block (14) is an elliptic ring fitting the end surface of the staple cartridge (23) used for accommodating staples. The joint surface of the anvil block (14) is provided with staple positions corresponding to staple holes on the staple cartridge (23). The anastomosis is elliptic anastomosis, so that the anastomotic area is increased, the anastomotic stenosis is less likely to occur, the anastomotic tissues are increased, and the possibility of anastomotic leakage is reduced.
Description
A kind of surgical anastomat and the identical method and technology field using the stapler
The invention belongs to medical instruments field, more particularly to a kind of surgical anastomat and the identical method using the stapler.Background technology
Surgical operation is usually needed by two hollow organs and engaging tissue, such as by oesophagus and stomach（Or colon) coincide, intestines Surgical healing, Ureteral anastomosis, fallopian tubal coincide, biliary anastomosis and vascular anastomosis etc..Traditional anastomosis are that, by two hollow organs and engaging tissue, its effect is reliable, but cumbersome, and technical requirements are high with suture.
In recent years, with the development of stapler, two hollow organs or tissue can be coincide together by anastomosis staple, simple to operate, effect is also reliable.But adjacent tissue, during by two hollow organs together with engaging tissue, is nailed together by existing stapler with anastomosis staple, this necessarily cause different degrees of hollow organ and tissue it is narrow；This is narrow to bring local obstruction to show sometimes.It is narrow in order to mitigate, then require to reduce the stitching to adjacent tissue, this necessarily causes the increase of anastomotic leakage incidence.In order to reduce narrow incidence, it is desirable to reduce the adjacent tissue that coincide；In order to reduce the incidence of anastomotic leakage, it is desirable to the identical adjacent tissue of increase.This is conflict.
For this reason, it may be necessary to provide a kind of improved stapler and the identical method using the stapler.The content of the invention
An object of the present invention is exactly that it can be such that adjacent tissue is reliably connected in order to solve problems of the prior art there is provided a kind of surgical anastomat, prevents anastomotic leakage, and can mitigate narrow and thus caused obstruction phenomenon.
The above-mentioned purpose of the present invention is achieved through the following technical solutions：
A kind of surgical anastomat, including operating portion, head and nail anvil, it is characterised in that：
The head includes being connected to the nail barrel of the operating portion, the ejector pin post that is arranged in the nail barrel and can be promoted by the operating portion, is arranged on the end of the ejector pin post and is used for the cutting knife placing the nail bin of anastomosis staple, supported by the ejector pin post and can be promoted by the ejector pin post；
Wherein, the center of the nail barrel, the ejector pin post, the nail bin and the cutting knife is on an axis；The nail bin is provided with the nail for being used for placing anastomosis staple, and the ejector pin post is provided with ejector pin tooth corresponding with the nail on the nail bin, and the ejector pin tooth can push the anastomosis staple under the promotion of the operating portion through the nail；The cutting knife can be promoted by the ejector pin post and cut off the excess tissue after coincideing；
The end face close with the nail bin of the nail barrel, the end face close with the nail bin of the ejector pin post, the nail bin be used for place the end face of anastomosis staple, the blade end face of the cutting knife and be the vesica piscis being mutually adapted and be each perpendicular to the axis；
The nail anvil includes anvil block and connection axostylus axostyle, the composition surface of the anvil block be with the nail bin be used to place nail position corresponding with the nail on the nail bin is provided with the vesica piscis that the end face of anastomosis staple is adapted, the composition surface of the anvil block；
Neng Shen Shrink docking section is provided with the operating portion；The docking section can axially across the nail barrel, the ejector pin post, the nail bin and the cutting knife middle part, dock fixation with the connection axostylus axostyle of the nail anvil.
Preferably, it is connected to the anvil block connecting shaft rod folding of the nail anvil；The folding direction of the connection axostylus axostyle of the nail anvil is the oval long axis direction on the composition surface of the anvil block.
Preferably, magnet is provided with along along the folding direction of the connection axostylus axostyle on the anvil block, to help the connection axostylus axostyle to fold.
Preferably, the connection axostylus axostyle of the nail anvil is fixedly connected on the anvil block.
Preferably, 2-5 is provided with the nail bin and encloses nail for placing the anastomosis staple；Correspondingly, corresponding 2-5 encloses the nail position on the composition surface of the anvil block, the ejector pin post encloses the ejector pin tooth to push the anastomosis staple including corresponding 2-5；Often enclose the nail and be arranged in ellipse with the cross-section adaptation of the nail bin, respectively enclose the nail position and be arranged in the ellipse that the nail with accordingly enclosing is adapted to, respectively enclose the ejector pin tooth and be also arranged in the ellipse that the nail with accordingly enclosing is adapted to, the nail, nail position and the ejector pin tooth are corresponded each other.
Preferably, the nail anvil is part elliptical body shape, the nail barrel includes the vertical tube part being connected with the connecting portion and the part elliptical body portion docked with the nail anvil, and the nail anvil can form the ellipsoid of an entirety with the part elliptical body portion of the nail barrel when docking completely；The shape of the ejector pin post is adapted to the cavity shape of the nail barrel.
The second object of the present invention is to provide a kind of identical method using above-mentioned surgical anastomat, and its is easy to operate, and it can be such that adjacent tissue is reliably connected, and prevents anastomotic leakage, and can mitigate narrow and thus caused obstruction phenomenon.
To reach this purpose, the present invention is adopted the following technical scheme that：
The identical method of surgical anastomat described in a kind of utilization claim 1, it is characterised in that comprise the following steps：
(1) inclined-plane is cut into the port that will carry out identical the first hollow organ or tissue, thus forms angular cut；
(2) the prefabricated pocket suture on angular cut；
(3) nail anvil of the surgical anastomat is inserted from above-mentioned angular cut；
(4) the pocket suture is tightened up, so described nail anvil is just tiltedly placed in the hollow organ or tissue；
(5) identical the second hollow organ or the otch operating portion for inserting the surgical anastomat of tissue and the head being connected thereto are carried out from corresponding, the docking section of the operating portion is passed from the wall of second hollow organ or tissue；
(6) docking section is made to be docked with the connection axostylus axostyle of the nail anvil；
(7) operating portion is operated, the anvil block and the nail bin for making the nail anvil mutually close up so that docked with the face of the placement anastomosis staple of the nail bin on the composition surface of the anvil block；
(8) operating portion is operated, promotes the ejector pin post to travel forward；The ejector pin post then pushes anastomosis staple, the anastomosis staple on the nail bin is pegged tissue, while the cutting knife cuts off unnecessary tissue, forms oval previous anastomotic；
(9) it coincide after finishing, whole surgical anastomat is exited from second hollow organ or tissue, by second hollow organ or the myometrial suture of tissue.
Preferably, it is connected to the anvil block connecting shaft rod folding of the nail anvil；In the step（2) in, the nail anvil is inserted before first hollow organ or tissue, and the connection axostylus axostyle and the anvil block are inserted in folded state, the major axis of the major axis correspondence angular cut of the oval interface of the anvil block；Central axis of the connection axostylus axostyle along the angular cut is inserted.
Preferably, step（9) further comprise：The docking section is first stretched out forward, the nail anvil, which is followed, to travel forward, the anvil block becomes the state being folded in the presence of the magnet with the connection axostylus axostyle；Then the whole surgical anastomat is exited.
The beneficial effects of the present invention are：After the stapler and identical method of the present invention, previous anastomotic is ellipse, can so increase the area of previous anastomotic, and on previous anastomotic Shrink, tightly influence is smaller after coincideing, and reduces and coincide
Cause anastomotic stricture and obstruction phenomenon therewith；Simultaneously as ellipse increases previous anastomotic, the tissue followed closely when coincideing increases, thus it is tighter to make to coincide, and reduces the possibility of anastomotic leakage；And operation is fairly simple, operating time can be reduced, the dangerous possibility occurred is reduced.
Oblique anvil cuts with scissors in company
Joint chair face
Illustrate jack-post magnetic
Fig. 1 is the overall perspective view of one embodiment of this bar hair bright surgical anastomat of iron；
Fig. 2 is the overall schematic of surgical anastomat shown in Fig. 1, and wherein head is explosive view；Fig. 3 is the explosive view of the partial view of surgical anastomat shown in Fig. 1, and which show nail anvil and head;Fig. 4 be surgical anastomat of the present invention nail anvil and head another embodiment explosive view, the connection axostylus axostyle of wherein nail anvil is not folding；
Fig. 5 is the stereogram of nail anvil in Fig. 3, and wherein nail anvil and connection axostylus axostyle is in open mode；Fig. 6 is the stereogram of nail anvil shown in Fig. 5 in a folded configuration；
Fig. 7 is the lateral plan of nail anvil shown in Fig. 5 in the on-state；
Fig. 8 is the stereogram of nail anvil shown in embodiment illustrated in fig. 4；
Fig. 9 is the end elevation view of nail barrel in embodiment illustrated in fig. 1；
Figure 10 is the sectional side elevation of nail barrel in embodiment illustrated in fig. 1；
Figure 11 is the stereogram of ejector pin post in embodiment illustrated in fig. 1；
Figure 12 is that ejector pin post is placed on the end elevation view after nail barrel in embodiment illustrated in fig. 1；
Figure 13 is the stereogram of nail bin in embodiment illustrated in fig. 1；
Figure 14 is the nail barrel with ejector pin post in embodiment illustrated in fig. 1, the assembling mode schematic diagram with nail bin, wherein left side is the end elevation view that ejector pin post is mounted in nail barrel, right side is the bottom view of nail bin；
Figure 15 is the end elevation view of ejector pin post in embodiment illustrated in fig. 1；
Figure 16-1, Figure 16-2, Figure 16-3, Figure 16 _ 4, Figure 16 _ 5 respectively illustrate the present invention using each step in one embodiment of the identical method of surgical anastomat.Embodiment
Below in conjunction with accompanying drawing, the preferred embodiments of the present invention are discussed in detail.
Wherein, reference is as follows：
10--nail anvil 100 --- butt joint
11- 12- 13- 14- interfaces 142 --- nail position
20 --- head
21 --- nail barrel 211 --- barrel 2110 --- longitudinal ribs
212nd, 214 --- supporting plate
213 --- hollow cylinder 2130 --- ribs of hollow cylinder
218 --- vertical tube part
219 --- --- junction surface 2201 --- outer ring ejector pin tooth 2202 --- inner ring ejector pin teeth of ellipsoid portion post 220
221 --- tubular engages bar 2210 --- cannelures
222 --- transition part
223 --- supporting surface 2231 --- bayonet sockets
23 --- nail bin 231 --- nail
Behaviour's seam 232 --- nail bin junction surface 2321 --- outer groove 2322 --- interior groove cooperation circles of hoop
24 --- cutting knife portion mouthful
30 31 --- handle 32 --- fixture blocks 33
35 36 --- knob 37 --- support bases 38
50 60 --- 80 Fig. 1, Fig. 2 of Anastomat hemorrhoidal circumcision mouthful show the overall structure of the surgical anastomat of the embodiment, as can be seen, and the surgical anastomat includes three parts：Operating portion 30, head 20 and nail anvil 10.
First, its operating portion 30 is first introduced below.
As shown in Fig. 2 operating portion 30 includes the shell 33 of similar tubular, the shell 33 has two pieces of exceptionally shell fastenings to form, in one end port of shell banding of cranse 35.Sleeve 38 is set in the inside cavity of the formation of shell 33, pull bar is internally provided with sleeve 38（Not shown in figure）, one end of the pull bar connects the docking section 34 docked with nail anvil, other end connection knob 36;The knob 36 can control pull bar to march forward or draw back in sleeve 38, and then docking section 34 is advanced or is retreated.As shown in Fig. 2 the docking section 34 is specially the cavity on perisporium with buckling device.
In this embodiment, the knob 36 can reach tune thimble pipe with pull bar by way of screwed hole overcoat food, screw rod
Program, and screw thread is divided into the section of long tooth and the section of short tooth, so as to realize that control stick is significantly mobile and moves by a small margin respectively.Certainly, in other embodiments of the invention, operating portion 30 can also use other suitable structures of the prior art, realize the control to the docking section 34 of pull bar especially its end.
As shown in Figure 1 with Figure 2, operating portion 30 still further comprises handle 31, fixture block 32 and controlfin (not shown in figure）.Controlfin is also disposed in sleeve 38, its longitudinal shape is adapted with above-mentioned pull bar, and support base 37 is connected with the end of controlfin, support base 37 can be enclosed on the end outer surface of above-mentioned pull bar, so that controlfin can advance or retreat with pull bar.The end face of support base 37 (is described below with the ejector pin post 22 in head 20）Bottom is adapted；After installing, the bottom of ejector pin post 22 is just fixed on the support base 37.
The other end connection handle 31 of controlfin, by handle control.When handle 31 is pressed, controlfin can travel forward, so that the support base 37 of controlfin drives ejector pin post 22 to travel forward.Fixture block 32 is operated for joystick 31：When fixture block 32 is begun to fight, handle 31 is blocked so that handle 31 can not be pressed；When fixture block 32 is laid, handle 31 can be pressed；So avoid in operating process, the problem of missing by triggering during handle 31.
2nd, head 20 and nail anvil 10 is described below.
1st, the overall structure introduction on head 20.
As shown in Fig. 2 the nail barrel 21 for including being connected to operating portion 30 of head 20, the ejector pin post 22 being arranged in nail barrel 21, the nail bin 23 for being arranged on the end of ejector pin post 22 and anastomosis staple being placed, the cutting knife 24 that is supported by ejector pin post 22 and can be promoted by ejector pin post.As shown in Fig. 2 nail barrel 21, ejector pin post 22, nail bin 23 and cutting knife 24 center in an axis X.
One end face of nail bin 23 is provided with the nail for being used for placing anastomosis staple, and ejector pin post 22 is provided with ejector pin tooth corresponding with the nail on nail bin 23, and ejector pin tooth can push anastomosis staple under the promotion of operating portion 30 through nail;Cutting knife 24 can be promoted by ejector pin post 22 and cut off the excess tissue after coincideing.Nail bin 23, ejector pin post 22 and cut
The concrete structure of knife 24 will be described below.
With reference to Fig. 1, Fig. 2 and Fig. 3, the mounting means of each part on head 20 is：The end of nail barrel 21 is connected to the end of the sleeve 38 of operating portion 30；Ejector pin post 22 is socketed in inside nail barrel 21, and its respective end is engaged in the support base 37 of the controlfin end of operating portion 30;Nail bin 23 is socketed in the top of ejector pin post 22, and the ejector pin tooth of ejector pin post 22 is corresponded with the nail position of nail bin 23；Cutting knife 24 passes through the middle part of nail bin 23, is located on the respective support face of ejector pin post 22, can be promoted with ejector pin post 22.
Especially, as shown in Fig. 2-Figure 15, the end face close with nail bin 23 of nail barrel 21（Left side）, ejector pin post 22 the end face close with nail bin 23（Left side）, nail bin 23 be used for place section, the blade end face of cutting knife 24 of anastomosis staple（Cross section where cutting edge）It is the vesica piscis being mutually adapted and is each perpendicular to above-mentioned axis X.So that under the controlfin effect of operating portion 30, the ejector pin tooth of ejector pin post 22 promotes the anastomosis staple in nail bin 23, can be with the direction vertical with its port during the promotion cutting knife 24 of ejector pin post 22（That is X-axis line direction）Advance, it is ensured that port exerts a force（Ejector pin power, cutting knife shear force）Vertically, do not offset uniformly,.
Above-mentioned beneficial effect further can also contrast United States Patent (USP) US7,422,138 to be discussed：Equally it is the previous anastomotic to form ellipse in this us patent, but it is due to that force direction is not orthogonal to angular cut direction after it is docked, each anastomosis staple follows closely the vertical of position to it during in order to ensure operation, it sets step on nail bin and the respective composition surface of nail anvil, but it will thus be appreciated that can increase the damage to tissue.And the surgical anastomat of the present invention is used, after docking, it can be ensured that the force direction of each anastomosis staple is each perpendicular to the nail position on the composition surface of anvil block, and whole composition surface is plane, without step, thus tissue damage is small.
2nd, the introduction about the construction of nail anvil 10.
Fig. 3, Fig. 5, Fig. 6, Fig. 7 show a kind of folding nail anvil.As illustrated, nail anvil 10 includes anvil block 14 and connection axostylus axostyle 11, connection axostylus axostyle 11 is foldably connected on anvil block 14 by articulated column 12.Corresponding to each part on above-mentioned head, the composition surface 141 of anvil block 14 is for placing the vesica piscis that the end face of anastomosis staple is adapted with nail bin 23；Multiple nail positions 142 are provided with composition surface 141, the nail that anastomosis staple is placed in these nail positions 142 with being used on nail bin 23 is corresponded, equally the ejector pin tooth also with ejector pin post 22 is corresponded.
As shown in the above Fig., the direction of articulated column 12 is perpendicular to oval long axis direction, so that connection axostylus axostyle 11 can be folded on oval long axis direction.The folding direction of connection axostylus axostyle 11 is complied with anvil block 14 (that is, on oval long axis direction）Be additionally provided with magnet 13, so, anvil block 14 just can in the presence of magnet magnetic force to connection axostylus axostyle 11 be folded each other, in as shown in Figure 6.When so being moved in hollow organ or tissue, the width of whole nail anvil is just smaller, inserts and is easier, and can reduce the infringement to hollow organ or tissue.
In addition, nail anvil 10 also includes the butt joint 100 docked with the docking section 34 in aforesaid operations portion 30, butt joint 100 that is, the end for connecting axostylus axostyle 11；During docking, the butt joint 100 insertion cavity type docking section 34 in and be fastened in docking section 34.Also correspondingly set to limit the stopping means for the depth that butt joint 100 is inserted in docking section 34 on connection axostylus axostyle 11（Not shown in figure）, used here as appropriate device of the prior art.Certainly, in other embodiments of the invention, the structure of butt joint 100 and docking section 34 can be exchanged, as long as that is, one is head, another is the cavity with buckling device；Certainly in other embodiments, it would however also be possible to employ equivalent structure of the prior art.
As shown in Fig. 2 during work, docking section 34 can be docked through nail barrel 21, ejector pin post 22, nail bin 23 and the middle part of cutting knife 24, eventually form the engagement shown in Fig. 1 and finish state with butt joint 100.
Fig. 4, Fig. 8 show another alternative structure of nail anvil 10, in the alternate embodiment, and connection axostylus axostyle 11 is fixedly connected on anvil block 14, it is impossible to folded.So in this nail anvil 10 just without articulated column 12, the both parts of magnet 13, miscellaneous part is identical with the nail anvil of the illustrated embodiment of Fig. 5,6,7, does not tire out state herein.Importantly, the interface 141 of its anvil block 14 is adapted to the end face of the placement anastomosis staple of nail bin 23
Vesica piscis.
It is highly preferred that the shape of head 20 and nail anvil 10 can be arranged to so：The anvil block 14 of nail anvil 10 generally part elliptical body shape；Nail barrel 21 then includes the (taper end of nail barrel i.e. in Fig. 2, Fig. 3, Fig. 4 of vertical tube part 218 being connected with connecting portion）With (the butt end of nail barrel i.e. in Fig. 2, Fig. 3, Fig. 4 of part elliptical body portion 219 docked with nail anvil 10）, nail anvil 10 and part elliptical body 219 can form the ellipsoid of an entirety if docking completely；The shape of ejector pin post 22 and the shape adaptation of nail barrel 21.So head 20 and nail anvil 10, which can be met, obtains the requirement that ellipsoid sutures mouth.
Certainly, in other embodiments of the invention, head 20 and the formation of nail anvil 10 also may be used similar to ellipsoidal profile；Or other irregular profiles can also be formed, as long as meeting the requirement of the above-mentioned requirement to end face vesica piscis and end face perpendicular to axis X.It must be stressed that be, no matter what kind of contour structures head 20 and nail anvil 10 use, and in this surgical anastomat, the composition surface of nail anvil 10 can not completely fit with the composition surface of nail bin, centre must leave space, to accommodate the tissue for being stapled nail stitching.
3rd, it is discussed in detail and introduces nail barrel 21, ejector pin post 22, nail bin 23 and cutting knife 24, and the relation between them.
(1) nail barrel 21.
The stereogram of visible nail barrel 21 in Fig. 2, Fig. 3, Fig. 9 show the end view of nail barrel 21, and Figure 10 is the sectional side elevation of nail barrel 21.
As shown in Fig. 2,3,9,10, nail barrel 21 includes barrel 211, and some longitudinal ribs 2110 are along the circumferential direction evenly arranged with the inner side of barrel 211.Inside cavity in the formation of barrel 211, that end from close nail bin（The end being relatively large in diameter）At a certain distance from, the supporting plate 212,214 of two pieces of formation cross forms is set.Hollow cylinder 213 is set in the center of this two pieces of supporting plate 212,214, two pieces of supporting plates 212,214 are actually divided into two segmentations by the hollow cylinder 213 respectively.
The end face of above-mentioned two pieces of supporting plates 212,214（Close to that end of nail bin）Form the supporting surface of ejector pin post 22；Above-mentioned hollow cylinder 213 is used for pull bar in operating portion 30 and passed through.Many circumferentially evenly distributed ribs 2130 are additionally provided with the inwall of hollow cylinder 213, the undue of pull bar can be effectively limited and rock.
In addition, the taper end end 218 of nail barrel 21 is connected to the end of sleeve 38 of operating portion 30, so as to realize that position is fixed.
(2) ejector pin post 22, cutting knife 24.
Fig. 2, Fig. 3, Fig. 4 show the stereogram of ejector pin post 22；Figure 11 show the stereogram of ejector pin post 22.As shown in Fig. 2,3,4,11, ejector pin post 22 includes engagement bar 221, junction surface 220 and the transition part 222 between both.Generally, the shape of ejector pin post 22 is adapted with the inner chamber of nail barrel 21.
Wherein, as shown in figure 11, engagement bar 221 is tubular, and the internal diameter of this tin is adapted to the external diameter of the hollow cylinder 213 of above-mentioned nail barrel 21；And along the engagement longitudinal direction of bar 221 four cannelures 2210 of formation, it is separated by 90 degree per bar groove.During installation, tubular engagement bar 221 is enclosed on the outer wall of hollow cylinder 213 of nail barrel 21, and the supporting plate of nail barrel 21 passes through four cannelures 2210 of ejector pin post 22.Certainly, in other embodiments of the invention, the supporting plate in nail barrel 21 can be three pieces or more, and the cannelure 2110 of corresponding ejector pin post 22 is just 6 pieces or corresponding；Suitable technology of the prior art can certainly be used, as long as installation of the ejector pin post 22 in nail barrel 21 can be realized.
Figure 15 is the end elevation view of ejector pin post 22, from the figure：Junction surface 220 includes outer ring ejector pin tooth 2201, the inner ring ejector pin tooth 2202 between two circles across setting.Shape, the spacing of these ejector pin teeth 2201,2202 are all adapted with the nail 231 to place anastomosis staple on nail bin 23, and corresponded.These ejector pin teeth push anastomosis staple through the nail on nail bin 23 to the direction of anvil block 14 when using, using the principle of similar stapler, peg and are organized between the composition surface 141 of the corresponding end-faces of nail bin 23 and anvil block 14.Certainly, in the embodiment it is two circle anastomosis staples；Can also be more multi-turn in other examples, preferably 2-5 enclose anastomosis staples,
Ejector pin tooth so herein also accordingly encloses for 2-5.
Figure 12 show the end elevation view after ejector pin post 22 is arranged in nail barrel 21, visible with reference to Figure 12 and Figure 15：The rib 2110 that space between each two outer ring ejector pin tooth 2201 corresponds on the inwall of nail barrel 21, so that it is passed through.Inner ring ejector pin tooth 2202 and outer ring ejector pin tooth 2201 respectively correspond to nail bin 23 jointing end face on inner ring, outer ring nail（Referring to Figure 13), during installation, inner ring, outer ring ejector pin tooth 2202,2201 are respectively and correspondingly through inner ring, outer ring nail；So that nail bin 23 is installed in the end of ejector pin post 22.
As shown in Figure 11, Figure 12, Figure 14, Figure 15, in one end of the close nail bin 23 of ejector pin post 22, at a certain distance of end, horizontal supporting plate 223 is set inside ejector pin post 22, to place cutting knife 24;Four bayonet sockets 2231 arranged are formed in the supporting plate 223, is engaged to protrusion corresponding with the bottom of cutting knife 24, realizes clamping, so that cutting knife 24 is fixed in the supporting plate 223.The position of the supporting plate 223 and the radical length of nail bin 23 will meet claimed below：When the end of nail bin 23 is engaged with the end of anvil block 14, when ejector pin post 22 is promoted, while anastomosis staple pegs tissue, cutting knife 24 will can cut off unnecessary tissue.
(3) nail bin 23.
It is the stereogram of nail bin 23 as shown in figure 13, from it, nail bin 23 includes junction surface 232 and accommodates the nail 231 of nail.The structure at its junction surface 232 and the structure at the junction surface 220 of ejector pin post 22 are fitted to each other：Corresponding to the outer of junction surface 220, the interior ejector pin tooth 2201,2202 of ejector pin post 22, junction surface 232 sets outer groove 2321, interior groove 2322, passed through for outer, interior ejector pin tooth 2201,2202, as Figure 14 shows its corresponding relation.Anastomosis staple is then arranged on the port of each groove 2321,2322（That is, nail 231) on.Often circle groove is arranged in the ellipse adaptable with the elliptical ring end face of nail bin 23, and above-mentioned ejector pin tooth, which is also so corresponded to, is arranged in circle circle ellipse；So, anastomosis staple just can be with oval arrangement, and forms oval previous anastomotic.
4th, the identical method of above-mentioned surgical anastomat is utilized.
By the description to method of coincideing, the 26S Proteasome Structure and Function of above-mentioned surgical anastomat also can more understand.Below by taking the coincideing of stomach and esophagus as an example, certain this method can equally be well applied to coincideing for other species hollow organ or tissue and other hollow organ or tissue.
Such as Figure 16-1 to Figure 16-5 show a kind of identical method of utilization surgical anastomat, and the connection axostylus axostyle 11 of wherein nail anvil 10 is fixedly connected on anvil block 14, is not folding type.The method of coincideing comprises the following steps：
(1) stump that will carry out identical esophagus 80 does an angular cut；
(2) the prefabricated pocket suture on angular cut；
(3) nail anvil 10 of surgical anastomat is inserted from above-mentioned angular cut；
(4) pocket suture is tightened up, the connection axostylus axostyle 11 of nail anvil 10 is passed from pocket suture, and such nail anvil 10 is just tiltedly placed among esophagus 80；
(5) operating portion 30 for inserting surgical anastomat from the gastric wall incision on stomach 90 and the head 20 being connected thereto, as shown in Figure 16-1；The docking section 34 of operating portion 30 is set to be passed from coat of the stomach；
(6) docking section 34 is made to be docked with the butt joint 100 of nail anvil 10；As shown in Figure 16-1；
(7) turn knob 36, make the anvil block 14 of nail anvil 10 mutually close up with nail bin 23, dock；As shown in Figure 16-2, Figure 16-3；
(8) and then fixture block 32 is put down, by lower handle 31;Ejector pin post 22 just travels forward in the presence of controlfin, so that the anastomosis staple on nail bin 23 pegs tissue, while cutting knife 24 cuts off unnecessary tissue；As shown in Figure 16-4；
(9) it coincide after finishing, whole surgical anastomat is taken out from stomach, above-mentioned gastric wall incision is stitched
Close；As shown in Figure 16-5.
If the connection axostylus axostyle 11 of nail anvil 10 is foldably connected on anvil block 14, then above-mentioned steps have following change：
A, step（1) in, the anvil block 14 of nail anvil 10, which is folded, inserts in esophagus 80, and the major axis of the major axis correspondence angular cut of nail anvil 14；
B, step（4) in, when tightening up pocket suture；The connection axostylus axostyle 11 of nail anvil 10 is passed from pocket suture；Turn knob 36, when the nail seat for making nail anvil is mutually drawn close with nail bin, the connection axostylus axostyle of nail anvil 10 is gradually stretched；
C steps（9) in, turn knob 36, the nail seat and nail bin for making nail anvil is separated from each other, so that anvil block 14 is folded in the presence of magnet 13 on connection axostylus axostyle 11；Then whole surgical anastomat is taken out from stomach again.
In above-mentioned technical proposal, because otch is cut to ellipse, anvil block is inclined by inserting along the oval otch, and the end face of anvil block is vesica piscis, the end face of nail bin is also vesica piscis, and the previous anastomotic of ellipse can be thus formed when coincideing, because the previous anastomotic of ellipse is larger, so that the position followed closely when coincideing is more, it coincide and more steps up, prevent the generation of anastomotic leakage；Simultaneously because previous anastomotic is larger, anastomotic stricture is not susceptible to.
Described above is only the preferred embodiments of the present invention, can not be limited the scope of the invention certainly with this；Any equivalent substitution or conversion for above-mentioned technical proposal, all within protection scope of the present invention.
Claims (1)
- Claim1st, a kind of surgical anastomat, including operating portion, head and nail anvil, it is characterised in that：The head includes being connected to the nail barrel of the operating portion, the ejector pin post that is arranged in the nail barrel and can be promoted by the operating portion, is arranged on the end of the ejector pin post and is used for the cutting knife placing the nail bin of anastomosis staple, supported by the ejector pin post and can be promoted by the ejector pin post；Wherein, the center of the nail barrel, the ejector pin post, the nail bin and the cutting knife is on an axis；The nail bin is provided with the nail for being used for placing anastomosis staple, and the ejector pin post is provided with ejector pin tooth corresponding with the nail on the nail bin, and the ejector pin tooth can push the anastomosis staple under the promotion of the operating portion through the nail；The cutting knife can be promoted by the ejector pin post and cut off the excess tissue after coincideing；The end face close with the nail bin of the nail barrel, the end face close with the nail bin of the ejector pin post, the nail bin be used for place the end face of anastomosis staple, the blade end face of the cutting knife and be the vesica piscis being mutually adapted and be each perpendicular to the axis；The nail anvil includes anvil block and connection axostylus axostyle, the composition surface of the anvil block be with the nail bin be used to place nail position corresponding with the nail on the nail bin is provided with the vesica piscis that the end face of anastomosis staple is adapted, the composition surface of the anvil block；Neng Shen Shrink docking section is provided with the operating portion；The docking section can axially across the nail barrel, the ejector pin post, the nail bin and the cutting knife middle part, dock fixation with the connection axostylus axostyle of the nail anvil.2nd, a kind of surgical anastomat as claimed in claim 1, it is characterised in that：It is connected to the anvil block connecting shaft rod folding of the nail anvil；The folding direction of the connection axostylus axostyle of the nail anvil is the oval long axis direction on the composition surface of the anvil block.3rd, a kind of surgical anastomat as claimed in claim 2, it is characterised in that：Magnet is provided with along along the folding direction of the connection axostylus axostyle on the anvil block, to help the connection axostylus axostyle to fold.4th, a kind of surgical anastomat as claimed in claim 1, it is characterised in that：The connection axostylus axostyle of the nail anvil is fixedly connected on the anvil block.5th, a kind of surgical anastomat as any one of claim 1-4, it is characterised in that：2-5 is provided with the nail bin and encloses nail for placing the anastomosis staple；Correspondingly, corresponding 2-5 encloses the nail position on the composition surface of the anvil block, the ejector pin post encloses the ejector pin tooth to push the anastomosis staple including corresponding 2-5；Often enclose the nail and be arranged in ellipse with the cross-section adaptation of the nail bin, respectively enclose the nail position and be arranged in the ellipse that the nail with accordingly enclosing is adapted to, respectively enclose the ejector pin tooth and be also arranged in the ellipse that the nail with accordingly enclosing is adapted to, the nail, nail position and the ejector pin tooth are corresponded each other.6th, a kind of surgical anastomat as claimed in claim 1, it is characterised in that：The nail anvil is part elliptical body shape, the nail barrel includes the vertical tube part being connected with the connecting portion and the part elliptical body portion docked with the nail anvil, and the nail anvil can form the ellipsoid of an entirety with the part elliptical body portion of the nail barrel when docking completely；The shape of the ejector pin post is adapted to the cavity shape of the nail barrel.7th, the identical method of the surgical anastomat described in a kind of utilization claim 1, it is characterised in that comprise the following steps： (1) inclined-plane is cut into the port that will carry out identical the first hollow organ or tissue, thus forms angular cut；(2) the prefabricated pocket suture on angular cut；(3) nail anvil of the surgical anastomat is inserted from above-mentioned angular cut；(4) the pocket suture is tightened up, so described nail anvil is just tiltedly placed in the hollow organ or tissue；(5) identical the second hollow organ or the otch operating portion for inserting the surgical anastomat of tissue and the head being connected thereto are carried out from corresponding, the docking section of the operating portion is passed from the wall of second hollow organ or tissue；(6) docking section is made to be docked with the connection axostylus axostyle of the nail anvil；(7) operating portion is operated, the anvil block and the nail bin for making the nail anvil mutually close up so that docked with the face of the placement anastomosis staple of the nail bin on the composition surface of the anvil block；(8) operating portion is operated, promotes the ejector pin post to travel forward；The ejector pin post then pushes anastomosis staple, the anastomosis staple on the nail bin is pegged tissue, while the cutting knife cuts off unnecessary tissue, forms oval previous anastomotic；(9) it coincide after finishing, whole surgical anastomat is exited from second hollow organ or tissue, by second hollow organ or the myometrial suture of tissue.8th, as claimed in claim 7 coincide method, it is characterised in that：It is connected to the anvil block connecting shaft rod folding of the nail anvil；In the step（2) in, the nail anvil is inserted before first hollow organ or tissue, and the connection axostylus axostyle and the anvil block are inserted in folded state, the major axis of the major axis correspondence angular cut of the oval interface of the anvil block；Central axis of the connection axostylus axostyle along the angular cut is inserted.9th, as claimed in claim 8 coincide method, it is characterised in that：Step（9) further comprise：The docking section is first stretched out forward, the nail anvil, which is followed, to travel forward, the anvil block becomes the state being folded in the presence of the magnet with the connection axostylus axostyle；Then the whole surgical anastomat is exited.
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/CN2012/071555 WO2013123666A1 (en) | 2012-02-24 | 2012-02-24 | Surgical stapler and stapling method using stapler |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN104220011A true CN104220011A (en) | 2014-12-17 |
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ID=49004937
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201280066650.5A Pending CN104220011A (en) | 2012-02-24 | 2012-02-24 | Surgical stapler and stapling method using stapler |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN104220011A (en) |
| WO (1) | WO2013123666A1 (en) |
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| WO2016191907A1 (en) * | 2015-05-29 | 2016-12-08 | Covidien Lp | Circular stapler reload |
| CN106580381A (en) * | 2015-10-19 | 2017-04-26 | 俞晓立 | Surgical stapler |
| WO2023159713A1 (en) * | 2022-02-24 | 2023-08-31 | 黄华 | Built-in type complete intracavity electric tubular stapler |
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| US11801054B2 (en) | 2020-09-22 | 2023-10-31 | Covidien Lp | Surgical stapler with oval tool assembly |
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| Publication number | Publication date |
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| WO2013123666A1 (en) | 2013-08-29 |
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Application publication date: 20141217 |