CN106344094B - The Alimentary tract disease surface of a wound closes telescopic clamp - Google Patents

Abstract

The present invention relates to a kind of Alimentary tract disease surface of a wound to close telescopic clamp, belongs to medical instruments field.Including four bars, hinge hole is respectively set in the both ends of the bar, and the hinge hole of adjacent two bars constitutes parallelogram clip respectively by hinge axis a ~ d connections；One end of two corresponding hinge axis b, d are connect with two operation cables of gastroscope respectively on parallelogram clip, and clamp structure is arranged in the other end of hinge axis b, d；Hinge axis b, d back movement, the clamp structure of hinge axis b, d other end is set to open by controlling two operation cables；Hinge axis b, d is made to move toward one another for two operation cables of control until contact, the clamp structure closure of hinge axis b, d other end realize the closing clamping of the Alimentary tract disease surface of a wound.Effectively expand the surface of a wound diameter that can be completely enclosed；Effectively drawing surface of a wound mouth side and the effect of anus side mucous membrane can be reached in the range of 45 ° ~ 135 °, improve speed in a closed circuit.

Description

The Alimentary tract disease surface of a wound closes telescopic clamp

Technical field

The present invention relates to medical instruments field, more particularly to a kind of Alimentary tract disease surface of a wound closes telescopic clamp.

Background technology

With Chinese society and economic continuous development, living standards of the people are continuously improved, but people's lives pressure simultaneously Power is also increasing, and allegro life style causes the diet of most people irregular, long-term heavy drinking etc., this is directly Cause in recent years China's Infusion in Patients with Digestive increase year by year.The carcinogenic factor of tumor in digestive tract is mainly bad due to patient Caused by life style, such as feed too fast, feed is irregular, and high grease is eaten for a long time, heats food repeatedly, is the food that goes mouldy, coarse Food and irritable food, long-time heavy drinking etc..The cardinal symptom of tumor in digestive tract is abdominal pain, abdominal distension, has a stomach upset With duration indigestion, melena or stool band blood, constipation replace with diarrhea, and stool attenuates；It is interior when swallowing to have foreign body sensation, feed There is a choke plug sense, the long-time fever of unknown cause, anaemia etc.；Weak, mucocutaneous xanthochromia detests greasy, lumbago etc..This A little symptoms are all daily some relatively common symptoms, are easy to be ignored by people, once patient, which is found, suffers from tumor in digestive tract Mostly highly break up, this can cause prodigious strike to patient, while also bring to patient home and society heavy Burden.

Clinically, for digestive endoscopy as clinically common endoscope detecting method, it can pass through different mirror kinds Class carries out oral cavity, oesophagus, stomach, jejunum, ileum and entire colon, rectum such as gastroscope, Sigmoidoscope, enteroscope complete complete Digestive tract examining can be clearly observed digestive tract disease tumour and precancerous lesion by scope, while can also be to most of lesion Position carries out endoscopic minimally-invasive treatment.Simple and quick therapeutic endoscopy is avoided that the huge wound that conventional open operation is brought, Make operation minimally invasiveization to greatest extent, changes existing Diagnosis-treat Model.

In recent years, ESD enables more Alimentary tract diseases in Endoscopic removal as an emerging endoscopic technic, previously Although EMR has good curative effect to the alimentary canal infantile tumour being confined in mucous membrane, it has been difficult to Whole excision Zhi Jing >The lesion of 2cm, the imperfection of excision and the possibility of recurrence greatly increase.ESD Compared with the size and shape that EMR can control resection organization, completely cut off larger Alimentary tract disease, reduce lesion residual and Recurrence rate can also cut off exedens lesion.To the lesion with ESD indications, as without lymphatic metastasis and not ulcer Differentiated gland cancer in stomach lining, Esophageal Mucosa lamina propria squamous cell carcinoma etc. can be carried out ESD treatments, and no longer need to pass System opens abdomen or open chest surgery, traumatic to reduce, and reduces the incidence of surgical operation related complication, improves trouble The quality of life of person embodies the advantage of minimally-invasive treatment.It is iatrogenic gastrointestinal perforation to additionally need draw attention.Doctor source Property (caused by scope, surgical operation) Alimentary Tract Perforation/defect and pathogenic perforation (such as digestive tract ulcer) belong to clinical Acute disease, such as not closing in time, may secondary pleuroperitoneum infection or even threat to life.

With the continuous development of scope and auxiliary instrument, the progress of therapeutic endoscopy technology has been driven, but has also caused many Artificial tube wall stoma.Such as the careless perforation in digestive endoscopy checking process, the perforation after the expansion of digestive system narrow surgical, Air bag expansion maga-esophagus causes bursting perforated, gastrointestinal tract mucosa polyp enucleation perforation and through natural cavity endoscopic surgery Perforation etc. caused by (natural orifice transluminal endoscopic surgery, NOTES).Its In cut with mucous membrane under most commonly seen papillosphincterotomy (endoscopic sphincterotomy, EST), scope Except mucous membrane decollement under art (endoscopic mucosal resetion, EMR) and scope ( Endoscopic submucosal dissection, ESD) therapeutic endoscopy after it is careless perforation be main Alimentary Tract Perforation root It can be divided into according to time of origin acute and chronic；It can be divided into large, medium and small and Latent perforation again according to penetration hole diameter size；May be used also It is divided into upper digestive tract with different according to position and lower digestive tract is perforated；According to the predictable of perforation generation and treatment can be divided into Property and complication perforation.Treatment and prognosis to make perforation reach good effect, and it is different should to be directed to different type selections Mode treat.Clinically, many situations also result in pathogenic Alimentary Tract Perforation and defect, such as Boerhaave synthesis Sign, digestive tract ulcer, innocent and malignant tumour, more also as accidentally gulped down fishbone, sharp animal bone and metallic foreign body penetrating gastrointestinal tract Deng.Surgical closure Alimentary Tract Perforation and defect are traditional therapies clinically.Mouret in 1990 etc. and After Nathanson etc. first reported the neoplasty of laparoscope perforated ulcer, Repair operation gradually replaces tradition under laparoscope Surgical operation.

Scope interventional minimally-invasive treatment is widely applied to clinic, and the development of endoscopic assistance and its attachment is also with rapid changepl. never-ending changes and improvements. The wherein new technology of Endoscopic Treatment Alimentary Tract Perforation and defect is also come into being, and distinct methods determine treatment outcome not Together.Compared to traditional surgery closed surgery, the closure of perforation or defect can not only shorten treatment time under scope, convenient and efficient, And wound is small, and Silent Neuritis is good, reduces the generation of unnecessary accident and various complication in surgical procedure, is patient and hospital It brings glad tidings.

Currently, the technology being clinically most widely used is exactly metal closure by clip.Titanium clip as it is a kind of gradually at Ripe scope minimally-invasive treatment means, are also increasingly paid attention to by scope section and Gastroenterology dept. doctor.But metal clip is in clinical application There are still many problems, for example, hemostatic clamp operation skill grasp not enough, cannot press from both sides close intestinal wall holostrome, clip type selection, Applicable indication of patient etc. needs further to study and inquire into solve.Clinic is capable there is an urgent need to this simplicity to be had The suturing skill of the direct view under endoscope of effect provides reliable technology branch broadly to carry out a variety of new scope minimally-invasive treatments It holds, the minimally invasive Clinics of scope is made more effectively to be played.The idicatio of scope Titanium clip is also from initially simple office Portion's alimentary canal hemostatic treatment, which gradually expands to, is closed Alimentary Tract Perforation, fistula, fixed catheter or probe in gastrointestinal tract and art Preceding label etc., and existing endoscopic assistance is coordinated successfully to carry out more scope minimally-invasive treatment.Simple metals clamp closes hand Art 1993, it was recently reported that applied metal folder is closed the clinical case of acute perforation in gastrovascular cavity under first case scope, opens Lead to the window that alimentary canal intracavitary is closed the research of defect.After this, relevant metal clip in therapeutic endoscopy middle punch and lacks It damages the research repaired and clinical case continuously emerges in all kinds of documents, but safety and the validity of this new technology, one It is straight to there is dispute.Compared with traditional operation method, it is higher that simple metals clamp closes Surgical technique difficulty, but is worth note Meaning be the technology developability and its good validity and safety, gradually by endoscopic full-thickness resection (EFR) Practitioner take a fancy to and use.Under normal circumstances, perforation can preferably be closed with one or several metal clips.But for Perforation cannot be disposably closed completely by the bigger perforation of diameter since metal clip itself has certain diameter across limit, this When multiple metal clips can be used, from perforation both ends be gradually closed perforation to the mode of intermediate closed.It is external most according to relevant report It uses 22 titanium folders and completes Mucosa Defect after being closed.One applied metal crack closes the zoopery knot of stomach wall full-thickness defects Fruit shows that applied metal, which presss from both sides closure techniques, has clear advantage, can not only use compared to traditional operation suture defect of gastric wall The shorter time reaches clinical healing effect, and comparatively safe reliable.

Titanium presss from both sides joint nylon rope sealing technique, clinically postoperative for tumor in digestive tract or polypectomy, leaves relatively deep Sutured under the scope of the postoperative alimentary canal defect of the larger surface of a wound, especially EFR, frequently be nylon rope joint metal titanium folder The technology of the similar purse string suture constituted.Specific operation process is:1. using, there are two the scopes in pincers road, by nylon rope and metal Titanium folder is inserted into therapeutic endoscopy pincers;2. the two is allowed to be in angle appropriate and orientation, on the surface of a wound for needing to be closed, pass through first The nylon rope put well is anchored by a metal clip;3. proximal end nylon rope then is clamped with second Titanium clip, later in digest tube The proximal edge of wall defect is fixed;4. nylon rope is drawn over to one's side, the both sides of the surface of a wound are folded;5. repeating the above steps, with more A nylon rope, until suturing the surface of a wound completely.Wherein it should be noted that some there are the patients of serious pneumothorax, performing the operation Journey or it is postoperative need close observation, when necessary can upper right abdomen puncture be vented, to mitigate the postoperative abdominal distension of patient.

It is a kind of novel closure alimentary canal defect for OTSC (over the scope clip) sealing technique Suture instruments.In use, first by implement on the hyaline cap of scope front end, pulled by preset line, it will similar bear pawl Metal clip " release ", similar common Loop ligature.When specific operation, first from biopsy duct that one heavy caliber pincers submitting is close Perforation is then unfolded pliers and catches the tissue around defect, pulled in hyaline cap, then " discharge " jaw device.Then, It clamps tooth and is engaged tissue, perforation or some surgical resection margins are closed.The perforation of some full-thickness defects can be also closed, had preferable Healing effect.Currently, more and more documents prove, OTSC systems treatment alimentary canal defect perforation it is upper more effective, just Victory, while few intercurrent disease, safety coefficient are high.In the clinical value of closing 10~30 mm defects of alimentary canal On, OTSC systems have obtained clinical practice approval.OTSC systems have succeeded in animal model test, it was demonstrated that it can be effective It is closed gastral holostrome perforation.Also some researches show that, the healing effect perforated for colon closed using OTSC systems with Traditional suture instruments are similar with conventional stapling technique in anus reservation effect, the disadvantage is that price is extremely expensive, operation is relative complex, to operation Scope doctor is with the requirement of higher technology.

Therapeutic endoscopy is with its unique minimally invasive, efficient, convenient, fast advantage, by the favor of doctor and patients, also by Step is clinically widely applied.According to the existing various methods for being closed acute Alimentary Tract Perforation, we have concluded that the following Conclusion:1. the several method of early stage, at low cost, therapentic part or limited diameter, it is suitble to the closure of privileged site or small perforation; 2. the therapeutic effect of current newest OTSC systems is better than other several closure effects, but complicated for operation, price is very high It is expensive, be not suitable for promoting and applying in situation of all-level hospitals.

Invention content

The purpose of the present invention is to provide a kind of Alimentary tract disease surface of a wound to close telescopic clamp, solves of the existing technology The above problem.The present invention reaches good closing sewing effect, it is made to be more suitable on the basis of retaining original safe and effective emphatically The perforation closure and wound repair of large area, and medical expense is reduced, preferably to apply and promote in clinic.This hair The bright application range that will continue to widen scope and be closed Alimentary Tract Perforation and defect technology, provides better therapeutic effect, allows scope Treatment steps a upper new ladder.

The above-mentioned purpose of the present invention is achieved through the following technical solutions：

The Alimentary tract disease surface of a wound closes telescopic clamp, and novel block telescopic clamp of the operating angle at 45 ° ~ 135 ° realizes the surface of a wound Distal end folder closes（Distance enters the distal end portion of enteron aisle scope）.The present invention utilizes two corresponding hinges on parallelogram mechanism Axis is connect with two operation cables of gastroscope respectively, and the opposite fortune of the two hinge between centers is controlled by this two operation cables It is dynamic to realize the closing clamping of the Alimentary tract disease surface of a wound.Its structure includes four bars 1, and hinge hole, phase is respectively set in the both ends of the bar 1 The hinge hole of adjacent two bars by hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5 connections, constitutes parallel four side respectively Clip；Two corresponding hinge axis b3 on the parallelogram clip, hinge axis d 5 one end respectively with gastroscope two Item operate cable 8 connect, the hinge axis b3, hinge axis d 5 the other end be arranged clamp structure 6；By controlling two operations Cable 8 makes hinge axis b3,5 back movements of hinge axis d, hinge axis b3,5 other ends of hinge axis d clamp structure 6 open；Control Two operation cables 8 of system make hinge axis b3, hinge axis d 5 move toward one another until contact, hinge axis b3,5 other ends of hinge axis d Clamp structure 6 be closed, realize the Alimentary tract disease surface of a wound closing clamping.

The hinge axis b3 is connect by fork configuration 7 with one in two operation cables 8, the width of fork configuration 7 Diameter of the degree more than hinge axis b3；Hinge axis d 5 is directly connect with another operation cable.

It is clearance fit between the hinge hole and hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5, ensures Four bars of parallelogram clip are rotating around hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5 rotations, parallel four side The length of every bar of clip is less than 30mm, to meet the requirement that quadrangular mechanism works in enteron aisle, completes the flexible of clip Function.

The beneficial effects of the present invention are：

1. based on classical surface of a wound closing method, in closed process, the surface of a wound diameter that can be completely enclosed effectively is expanded.

2. adjusting the length of closing folder clamp arm by elasticity, establishes surface of a wound mouth anus side plane under colonoscopy and pressed from both sides with telescopic clamp Relationship between closed interval.

3. adjusting operation handle changes telescopic clamp opening angle so that it can reach in the range of 45 ° ~ 135 ° has Effect drawing surface of a wound mouth side and the effect of anus side mucous membrane, improve speed in a closed circuit.

4. closed using this device, it is only necessary to ensure that clip anus side arm resists surface of a wound periphery mucous membrane, extend clip Mouth side arm drawing surface of a wound offside mucous membrane can be closed, without adjusting shank, more conducively practical application.

The present invention constitutes clip, and two with gastroscope respectively using two on parallelogram mechanism corresponding hinge axis Item operates cable connection, can realize effective closing of the huge surface of a wound, ensure larger sealing diameter and suture dynamics, particularly with Diameter can realize exclusive sealing effect in the huge surface of a wound of large intestine of 20-35mm.

Description of the drawings

Attached drawing described herein is used to provide further understanding of the present invention, and is constituted part of this application, this hair Bright illustrative example and its explanation is not constituted improper limitations of the present invention for explaining the present invention.

Fig. 1 is the structural diagram of the present invention；

Fig. 2 is the schematic side view of Fig. 1；

Fig. 3 is that the hinge axis of the present invention passes through fork configuration and operation cable connection diagram；

Fig. 4 is the schematic side view of Fig. 3；

Fig. 5 is the relative motion that two hinge axis are controlled using operation cable of the present invention（Unfolded state）Schematic diagram；

Fig. 6 is the schematic side view of Fig. 5；

Fig. 7 is the relative motion that two hinge axis are controlled using operation cable of the present invention（Clamp position）Schematic diagram；

Fig. 8 is the schematic side view of Fig. 7.

In figure：1, bar；2, hinge axis a；3, hinge axis b；4, hinge axis c；5, hinge axis d；6, clamp structure；7, fork-shaped knot Structure；8, cable is operated.

Specific implementation mode

The detailed content and its specific implementation mode further illustrated the present invention below in conjunction with the accompanying drawings.

Shown in Fig. 1 to Fig. 8, the Alimentary tract disease surface of a wound of the invention closes telescopic clamp, utilizes parallelogram mechanism Upper two corresponding hinge axis connects with two of gastroscope operation cables respectively, and by this two operate cables control this two The closing clamping of the Alimentary tract disease surface of a wound is realized in the relative motion of a hinge between centers comprising four bars 1, the both ends point of the bar 1 Hinge hole is not set, and the hinge hole of adjacent two bars is connected by hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5 respectively It connects, constitutes parallelogram clip；The one of two corresponding hinge axis b3 on the parallelogram clip, hinge axis d 5 End connect with two of gastroscope operation cables 8 respectively, the hinge axis b3, hinge axis d 5 other end setting clamp structure 6； By controlling two operation cables 8 make hinge axis b3,5 back movements of hinge axis d, hinge axis b3,5 other ends of hinge axis d Clamp structure 6 opens；Two operation cables 8 of control make hinge axis b3, hinge axis d 5 move toward one another up to contacting, hinge axis b3, The clamp structure 6 of 5 other ends of hinge axis d is closed, and realizes the closing clamping of the Alimentary tract disease surface of a wound.

The hinge axis b3 is connect by fork configuration 7 with one in two operation cables 8, the width of fork configuration 7 Diameter of the degree more than hinge axis b3；Hinge axis d 5 is directly connect with another operation cable.Fork configuration avoid operation cable with The interference of hinge axis.

It is clearance fit between the hinge hole and hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5, ensures Four bars of parallelogram clip are rotatable rotating around hinge axis a2, hinge axis b3, hinge axis c4, hinge axis d5, and parallel four The length of every bar of side clip completes stretching for clip less than 30mm to meet the requirement that quadrangular mechanism works in enteron aisle Contracting function.

Shown in Fig. 1 to Fig. 8, in use, parallelogram clip open configuration by with operating gastroscope cable connect It connects and is placed in forceps channel, reached near the Alimentary tract disease surface of a wound with gastroscope；Cables are operated by parallel four using two simultaneously Side clip is moved at the lesion surface of a wound；Controlling two operation cables respectively keeps the hinge axis b being attached thereto, hinge axis d opposite It is mobile, until two hinge axis b, hinge axis d contacts, at this time two hinge axis b, the other sides hinge axis d clamp structure just clamp The lesion surface of a wound.

The present invention can effectively expand the surface of a wound diameter that can be completely enclosed.This novel wound closing telescopic clamp is based on flat Row quadrangular mechanism.Two corresponding hinge axis one end are connect with two operation cables of gastroscope respectively in the mechanism, and are cut with scissors Clamp structure is made in the chain rivet other end.Parallelogram clip is placed on pincers in open configuration by being connect with operating gastroscope cable It in sub-pipes, is reached near the Alimentary tract disease surface of a wound with gastroscope, the opposite of cables two hinge between centers of control is operated using two The closing clamping of the Alimentary tract disease surface of a wound is realized in movement.The present invention realizes the flexible of clip, hinge axis using parallelogram mechanism The fork configuration being connect with operation cable avoids the interference that cable and hinge axis are operated when clamping, and effectively expanding can be complete Totally enclosed surface of a wound diameter.

The foregoing is merely the preferred embodiments of the present invention, are not intended to restrict the invention, for the technology of this field For personnel, the invention may be variously modified and varied.All any modification, equivalent substitution, improvement and etc. made for the present invention, It should all be included in the protection scope of the present invention.

Claims (2)

1. a kind of Alimentary tract disease surface of a wound closes telescopic clamp, it is characterised in that：Including four bars（1）, the bar（1）Both ends point Hinge hole is not set, and the hinge hole of adjacent two bars passes through hinge axis a respectively（2）, hinge axis b（3）, hinge axis c（4）, hinge Axis d（5）Connection constitutes parallelogram clip；Hinge axis b on the parallelogram clip（3）, hinge axis d（5）One End operates cable with two of gastroscope respectively（8）Connection, the hinge axis b（3）, hinge axis d（5）The other end setting clamping knot Structure（6）；By controlling two operation cables（8）Make hinge axis b（3）, hinge axis d（5）Back movement, hinge axis b（3）, hinge Axis d（5）The clamp structure of the other end（6）It opens；Two operation cables of control（8）Make hinge axis b（3）, hinge axis d（5）In opposite directions Movement is until contact, hinge axis b（3）, hinge axis d（5）The clamp structure of the other end（6）It is closed, realizes the Alimentary tract disease surface of a wound Closing clamping；

The hinge axis b（3）Pass through fork configuration（7）With two operation cables（8）In one connection, fork configuration（7） Width be more than hinge axis b（3）Diameter；Hinge axis d（5）Directly it is connect with another operation cable.

2. the Alimentary tract disease surface of a wound according to claim 1 closes telescopic clamp, it is characterised in that：The hinge hole and hinge Chain rivet a（2）, hinge axis b（3）, hinge axis c（4）, hinge axis d（5）Between be clearance fit, ensure parallelogram clip Four bars are rotating around hinge axis a（2）, hinge axis b（3）, hinge axis c（4）, hinge axis d（5）Rotation, parallelogram clip are every The length of root bar completes the Telescopic of clip less than 30mm to meet the requirement that quadrangular mechanism works in enteron aisle.