CN106580408A - Disposable balloon uterine manipulator - Google Patents
Disposable balloon uterine manipulator Download PDFInfo
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- CN106580408A CN106580408A CN201611138285.0A CN201611138285A CN106580408A CN 106580408 A CN106580408 A CN 106580408A CN 201611138285 A CN201611138285 A CN 201611138285A CN 106580408 A CN106580408 A CN 106580408A
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- guide rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A61B17/4241—Instruments for manoeuvring or retracting the uterus, e.g. during laparoscopic surgery
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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
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A61B2017/4216—Operations on uterus, e.g. endometrium
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Abstract
The invention provides a disposable balloon uterine manipulator. The disposable balloon uterine manipulator includes a central guide rod, wherein a dome cup sleeves the central guide rod, and can freely slide in the axial direction of the central guide rod; the dome cup includes a cup body and a cannula communicating with the cup body; the inside of the cup body is opened in an inner narrow and outer wide manner; a wrapping flange is arranged outside the cup body; and a ring ridge and a grating belt is arranged on the wrapping flange, and is conductive to determination of the cutting length of a vagina and reduction of dissemination of tumor. The uterine manipulator is a disposable apparatus, and can avoid iatrogenic cross infection. Besides, the central guide rod with the S-shaped structural design can adapt to the normal physiological flexibility formed by a corpus uteri, a vagina and a pelvis; two sections of scales on the central guide rod can be used for direct or indirection measurement of depth of a uterine cavity; and the top end of the central guide rod is provided with an elastic aqueous capsule which is communicated with an injection pipe in the central guide rod, so that the situation that perforation of uterus can be effectively avoided when the uterus is lifted and stability and accuracy during the process of lifting the uterus can be increased.
Description
Technical field
The invention belongs to technical field of medical instruments, and in particular to disposable sacculus uterus raising device.
Background technology
There is problems with now widely used various traditional uterus raising devices：1. non-disposable apparatus is mostly, is needed repeatedly
Sterilization, easily causes cross infection when sterilization is not tight；2. central guide rod is metal straight rod, is unfavorable for having in vagina and cavity of uterus etc.
Move in having the passage of certain physiological bending degree；3. the top of central guide rod is usually a thin bar, hard and sharp keen, easily causes son
Bore a hole in palace.Also, as the top of central guide rod is excessive in the free activity space of uterus intracavity, may cause when swinging uterus
Stability and accuracy are reduced.4. the size of conventional dome cup represents that generally with large size, medium size, trumpet the range of choice is few, easily
Fornix cup and the size of cervix uteri is caused to mismatch, the exposure of complete or vagina is not excessive to cause arched roof exposure.Arched roof exposure is not full-time can
Patient can be affected for the judgement of cut point, increase the probability that normal organ is damaged around bladder, ureter and rectum etc..And
Vagina exposure may excessively cause to cut off vagina excessively, cause postoperative vaginal to shorten；5. conventional dome cup cannot accurately point out the moon
The length in road, for the length of excision vagina is completely with patient's experience, therefore easily causes error, cause vagina resection long or
It is too short.Vagina resection is long may to affect patients ' life quality, the too short probability that may increase tumor recurrence of vagina resection；6. pass
System fornix cup is generally without any elasticity, and front wide and rear narrow or anteroposterior diameter is the same, is unfavorable for passing in and out vagina, may cause incarceration or damage
Hinder vaginal wall；7. when taking out specimen after surgery, it is impossible to effectively prevent tumor cell from coming off, be likely to result in tumour spread to abdominal cavity or
Plant increases the risk of tumor recurrence in Vaginal Stump；8., after cut-out vaginal wall, generally require to add sterile gloveses etc. with gauze
Method is cramming vagina to prevent pneumoperitoneum to be lost in, but effect is poor；9. also some adopt air bag as the act palace of vaginal obturator
Device, its air bag are typically secured on uterus raising device, and when vagina suture is carried out after uterus is cut off, air bag cannot be recycled, only
Vagina can be crammed by additive method；
Fig. 1 and Fig. 2 are the sagittal plain of female pelvic cavity and Coronal internal anatomy respectively, the figure illustrates body of uterus (101), palace
The anatomical structures such as neck (102), arched roof (103) and vagina (104) include front arched roof (103A) in Intrapelvic position, wherein arched roof
With rear arched roof (103B).The figure has also pointed out bladder (105) around which, ureter (106) and rectum (107) etc. important
Histoorgan and body of uterus (101), the isostructural relative position of vagina (104).Body of uterus (101) is connected with cervix uteri (102), palace
Neck (102) is predominantly located in vagina (104), and the part being connected with vagina around which is arched roof.During row panhysterectomy
Vaginal wall (as indicated by broken line a), when cut-out vagina is needed, such as row radical hysterectomy are cut off i.e. from this
When, then vaginal wall (as shown in dotted line B) need to be cut off from below arched roof at 3cm, now be needed bladder, ureter and rectum etc. first
Organ separates enough distances (as shown in Figure 3) from vaginal wall.
Shown by Fig. 4 be to be expert at panhysterectomy when, when uterus raising device inserts vagina, cervix uteri and body of uterus, bladder
And the effect that the organ such as rectum is open in the presence of fornix cup.Fornix cup is exactly to reduce bladder, urine output in this way
The probability of pipe and rectal injury.Fornix vagina is divided into positioned at the outer arched roof (103A and 103B) of vagina side and positioned at abdominal cavity
The interior arched roof (103C and 103D) of side.Outer arched roof can transvaginal be observed, but interior arched roof is generally hidden in uterus and bladder
And in the gap formed between uterus and rectum, therefore be difficult to be observed from the visual field of peritoneoscope (L), only work as external force
Put on outer arched roof so that interior arched roof heads into abdominal cavity, and when the surrounding tissues such as bladder and rectum are pushed open, can just be observed.
Fig. 5 be shown it is traditional the characteristics of be also domestic most popular cross uterus raising device, its fornix cup be before
Footpath is identical afterwards, or even front footpath is more than rear footpath so that larger into resistance during vagina, incarceration easily occurs and even damages vaginal wall.And
And as patient is for the judgement of cervix uteri size is mostly by range estimation, cause fornix cup used kissed with cervix uteri completely sometimes
Close.When rim of a cup is less than cervix uteri, cervix uteri may be caused to cannot be introduced into cup, so that arched roof fully cannot be exposed, cause bladder, straight
Chang Deng tissue injurys probability increases；When rim of a cup is more than cervix uteri, may cause to be headed into Intraabdominal interior arched roof also comprising one
Divide vaginal wall, so that excessive vagina is cut off while uterus is cut off, cause postoperative patient Vaginal Shortening.When the extensive temper of row
During the excision of palace, due to needing to cut off one section of vaginal wall (typically 3cm), it is therefore desirable to first by bladder, ureter and rectum etc.
Surrounding tissue is separated from vagina, with the sufficiently long vaginal wall that dissociates.Although conventional dome cup can expose vagina, for
The judgement of excision vagina length, completely with patient's experience, is easily caused error.Tumor is easily caused when vagina resection is not enough multiple
Send out, conversely, when vagina resection is excessive, patient's life quality may be affected.Also, as conventional dome cup cannot close cup
Gap between mouth and cervix uteri, therefore for some tumors are particularly cervical cancer, from incision vaginal wall to the whole of taking-up specimen
Process, is possible by open abdominal cavity positioned at intravaginal Cervix neoplasms originally and enters internal, or plant in the moon
On road stump, cause had postoperative recurrent tumor, this is also maximum drawback of traditional uterus raising device in cervical cancer operation.Additionally, cross
The central guide rod of shape uterus raising device is metal thin bar, as shown in figure 5, its tip hard and it is sharp keen, when palace is lifted such as undue force, its
The possible break-through Uterus wall in top, not only causes to lift palace difficulty, and is possible to bring intrauterine tumor into abdominal cavity.And due to
Thin bar is excessive in the activity space of uterus intracavity, is likely to result in body of uterus and rocks, and causes the stability and accuracy in act palace all
Reduce.
The content of the invention
In order to solve above-mentioned technical problem, the present invention provides a kind of disposable uterus raising device, can be used in
Expand panhysterectomy, abdomen under laparoscopy-assisted vaginal uterectomy, total hysterectomy under laparoscopy, peritoneoscope
The logical fluid inspection of fallopian tube dyeing under hysteroscope radical hysterectomy next time, Extensive Hysterectomy art, peritoneoscope,
And during various peritoneoscopes and robotic surgery, coordinate swing uterus, positioning arched roof or vaginal wall, to facilitate excision uterus,
The infringement to normal surrounding tissue is reduced simultaneously.
In order to achieve the above object, the present invention is employed the following technical solutions：
Disposable sacculus uterus raising device, including central guide rod, are arranged with fornix cup on central guide rod, and the fornix cup can
Carry out slidably along on central guide rod axial direction；The set that the fornix cup is included cup and is connected with the cup
Pipe；Cup is in interior narrow outer wide open-like shape；This programme provides several different size of fornix cup, can be selected according to the size of cervix uteri
Corresponding fornix cup is selected, so that both reach best match.
Preferably, wrapping rib is provided with the outside of cup, if it is parallel with arterial highway simultaneously on wrapping rib to be provided with grid belt
The ansa of row；The spacing of adjacent twice ansa is 0.5～1.5cm；Grid belt is formed by many bar gratings are arranged in parallel, adjacent two
Gap is formed between grid.
Specifically：Ansa is divided into the first ansa, the second ansa, the 3rd ansa and the 4th ansa from inside to outside, this 4 road
Ansa corresponds respectively to the length of 4 kinds of cutting vaginas；Grid belt is located in the region between the second ansa, the 3rd ansa.Specifically
Ground：4 road ansas are separated by that 1cm is arranged in parallel successively, correspond respectively to the length of 4 kinds of cutting vaginas, from front to back or by introversion
It is followed successively by outward 0cm, 1cm, 2cm, 3cm.
Specifically：During the peritoneoscope and robotic surgery of some gynecological, need uterus from fornix vagina
(i.e. 0cm), or cut off at 1cm, 2cm, 3cm from below arched roof, these processes correspond to panhysterectomy, abdominal cavity under peritoneoscope respectively
Expand panhysterectomy, peritoneoscope radical hysterectomy next time and Extensive Hysterectomy art under mirror.Now
Not only need for arched roof and vaginal wall to be exposed to patient, it is to avoid the normal structure around damaging, while patient can be pointed out not
Cut point corresponding to same vagina resection length, and a good excision platform is provided, in order to avoid in the process of cutting vagina
In be damaged to its hetero-organization.
The fornix cup in Fig. 8 and Fig. 9 includes cup and coupled sleeve pipe, and the former primarily serves the purpose of support simultaneously
And arched roof and vagina are exposed, the latter primarily serves the purpose of fixed cup and transvaginal takes out fornix cup after surgery.
Cup is in interior narrow outer wide open wine glass-shaped, is wrapping rib on the outside of rim of a cup, and its material can be identical with cup.
Wide in the middle of wrapping rib, two is slightly narrow, makes to be not susceptible to incarceration or damage vaginal wall during fornix cup turnover vagina.On wrapping rib
Most important structure is ansa and grid belt.The Main Function of ansa is to judge that the resection length of vaginal wall provides reference for patient
Point, it is to avoid the error that subjective judgment brings.Ansa 4 altogether, is spaced 1cm arranged in parallel from front to back successively.1st ansa position
In rim of a cup, the 4th ansa is located at wrapping rib trailing edge.Due to wrapping rib directly contact vaginal wall, therefore palace is lifted when forcing in
During device, vaginal wall can be headed into abdominal cavity and form ring uplift by ansa, and patient can select different ring uplifts to make as needed
For cut point.And after vaginal wall is cut, ansa is also used as reference point, is consistent the length of vagina resection.Grid
The Main Function of band is to provide the attachment point of several sutures, by through and through suture vaginal wall and grid belt under peritoneoscope, makes
Vaginal wall is brought into close contact and is fixed on wrapping rib, to prevent tumor cell from deviating from, while facilitating postoperative drawing and taking out son
Palace.This function is mainly used in Extensive Hysterectomy and peritoneoscope radical hysterectomy next time.Work as patient
When free vaginal wall is to 2-3cm, vaginal wall can be sutured on grid belt with band line suture needle before vagina is cut, such as Figure 10
Inserting needle position shown in middle a and b.So repeatedly, vaginal wall is brought into close contact with fornix cup, form closed structure, do not only have
Effect prevents Cervix neoplasms from dropping to outside, reduce intraperitoneal send out and Vaginal Stump plantation generation, and by uterus
After being fixed on fornix cup, contribute to postoperative transvaginal and take out uterus.Additionally, cup and sleeve pipe can using with certain elasticity and
Making, so not only facilitating fornix cup can slide rigid material along the central guide rod of S-shaped, and can give arched roof foot
Enough support forces, help patient to judge the position of arched roof.
Preferably, having at regular intervals between the wrapping rib and cup, the spacing is in interior narrow outer width.The structure
Design, is that suture needle leaves space through after vaginal wall and grid belt, is accomplished sewing process.
Preferably, two sections of scales are provided with the outer surface of central guide rod front end.When fornix cup positioned at two sections of scales it
Between when, the scale corresponding to its rim of a cup is just consistent with the scale corresponding to cannula end.Therefore when central guide rod is placed in son
Palace bottom, and fornix cup, when being placed in vagina bottom, the scale of cannula end is i.e. equivalent to the depth of cavity of uterus.
Preferably, the central guide rod is S-shaped forniciform hollow tubing conductor.The structure design of S-shaped primarily to
The normal physiological bending of body of uterus, vagina and pelvis composition is adapted to, while facilitating patient to grasp to which in optimal position
Control, so that body of uterus is swung by patient's requirement.And the centrally located guide rod of syringe connection is contained within central guide rod
The self-closed type injection orifice of the elastic water pocket and handle end on top.What liquid or air can be formed in elastic water pocket and syringe
Flow freely in pipeline.
Preferably, the sleeve pipe on the fornix cup controls the width between fornix cup and central guide rod by take-up
Loose state or tightening state.As shown in figure 11.
Preferably, the segmented thread pipeline section that the take-up is included nut and is connected with sleeve pipe, on sleeve pipe
External screw thread I is mutually continuous with the external screw thread II on segmented thread pipeline section so that nut can be carried out along external screw thread I and external screw thread II
Movement is freely rotated back and forth, loose state or tightening state between fornix cup and central guide rod is realized.As shown in figure 11.
Preferably, being connected with handle in the end of central guide rod, the two sides of handle are in shiny surface, on the front of handle
If being provided with for increasing the arterial highway lines of the frictional force for grasping the uterus raising device or several are raised；If the back side of handle is provided with
Groove is held in arterial highway, and the shape is adapted to hand-held.When moving handle, whole uterus raising device accordingly can be moved, and then reach libron
The purpose in palace.As shown in Fig. 6,14,15.
Preferably, handle is hollow-core construction, central guide rod therethrough, and connects the self-closed type positioned at handle end
Injection orifice, as shown in figure 14.Self-closed type injection orifice has self-enclosed function, the liquid or sky of the injection of Jing self-closed types injection orifice
Gas will not flow backwards outflow, but can be extracted out with syringe Jing self-closed types injection orifice.
Preferably, the top of central guide rod is provided with elastic water pocket, cavity of uterus can be entered with central guide rod.Elastic water
Capsule has certain elasticity, is expandable to 5-8ml, and the volume is similar to normal-sub uterine cavity capacity.
Preferably, the syringe in hollow tubing conductor connects the elastic water pocket and handle end on central guide rod top
Self-closed type injection orifice.A certain amount of water or air can be injected using common medical syringe Jing self-closed types injection orifice, be made
Elastic water pocket expansion becomes big.As shown in Fig. 6,14.
Specifically：In an initial condition, elastic water pocket is in deflated state, and central guide rod transvaginal is inserted cavity of uterus,
And reach uterus bottom.The normal saline or air of 5-8ml now can be extracted with common medical syringe, handle end oneself is handled
In closed injection orifice injection syringe, make elastic water pocket expansion become big, take whole cavity of uterus.Elastic water after due to expansion
Capsule is brought into close contact with uterus inwall, therefore can reduce rocking for body of uterus, so as to increase stability when swinging uterus and accurately
Property, simultaneously because the top for lifting palace bar is changed into soft sacculus from thin stiff rod, therefore the generation of the perforation of uterus can be reduced.It is postoperative can
With liquid or air in syringe Jing self-closed type injection orifices pumpback elasticity water pocket, elastic water pocket is made to recover deflated state, with
Beneficial to taking-up uterus.
Preferably, the detachable vagina gas for preventing the gas transvaginal of pneumoperitoneum to be lost in is provided with central guide rod
Capsule.
Preferably, the detachable vagina air bag includes the main gasbag of front end and the balloonet of rear end, using tool
The material for having certain elasticity is made.Main gasbag is connected with balloonet by breather, and breather is set on balloonet side
Have for controlling the valve that gas is moved towards；When the direction setting of valve is from balloonet to main gasbag, balloonet is extruded repeatedly,
Gas in balloonet enters main gasbag with regard to Jing breathers so that main gasbag expands；Main gasbag is provided with and can fasten and wrap up
Bound edge on sleeve pipe so that main gasbag can be strutted to inside and outside and is enclosed within the sleeve pipe of fornix cup.Cutting vaginal wall
Before, to prevent Intraabdominal gas transvaginal to be lost in, first main gasbag can be placed on the sleeve pipe of fornix cup, and pushes it into the moon
In road, balloonet is then pressed repeatedly, main gasbag is expanded to a certain degree in intravaginal, then cut vaginal wall, now pneumoperitoneum
Gas just cannot be between uterus raising device and vagina gap spill, be maintained pneumoperitoneum.Transvaginal is needed to take out when art finishes
During uterus, can by the direction setting of valve be main gasbag to balloonet, using the elastical retraction of main gasbag, discharge in main gasbag
Gas, takes out main gasbag.Before suture Vaginal Stump, to prevent the hole in the middle of gas Jing main gasbags from spilling, can lead
The special aseptic thin-film set of air bag outer wrapping, the method not only can make main gasbag form closed structure, for clogging vagina
And form pneumoperitoneum, while avoiding the tumor cell dropped on main gasbag or antibacterial is brought into abdominal cavity.As shown in Figure 12,13.
Compared with prior art, the invention has the beneficial effects as follows：
In the present invention, designed uterus raising device is a kind of disposable using apparatus, can avoid medical cross infection；And
And the central guide rod of S-shaped structure design can adapt to the normal physiological bending degree of body of uterus, vagina and pelvis composition, while convenient
Patient is manipulated to which in optimal position, so that body of uterus is swung by patient's requirement.
Two sections of scales on central guide rod can be used to directly or indirectly measure the depth of cavity of uterus, and numerical value is easily read
Take.
The elastic water pocket being connected with the syringe in central guide rod is provided with the top of central guide rod, be efficiently avoid
When lifting palace situations such as the perforation of uterus, and increased stability and accuracy when lifting palace；
The present invention is by a kind of vaginal speculum with measurement function, and provides multiple different size of fornix cup, can be effective
Realize that fornix cup is matched completely with cervix uteri, it is to avoid complete or vagina does not expose excessive situation generation for arched roof exposure, so as to help art
Person accurately judges the position of arched roof when panhysterectomy is carried out, it is to avoid damage the surrounding normal devices such as bladder, ureter and rectum
Official, and vagina resection it is excessive situations such as appearance.Simultaneously as the fornix cup in the present invention is using the material with certain elasticity
Matter is made, and for middle wide, the slightly narrow structure in two, therefore, it is possible to swimmingly pass in and out vagina, it is to avoid occur incarceration or
Damage vagina tissue.
Further, since radical hysterectomy is generally directed to the diseases such as cervical cancer, therefore is cutting vagina and taking out uterus
During, it is possible to make intravaginal Tumor cell dissemination to be located to abdominal cavity originally or be planted in Vaginal Stump, and then cause
Tumor recurrence.And such case generation can be prevented effectively from using the uterus raising device in the present invention, method is in the long enough that dissociated
Vagina after, with line suture needle by vaginal wall be sutured in lower section grid belt on, make between vaginal wall and fornix cup formed closing
Property structure, then cut off vagina.Sending out for tumor not only can be so avoided, and facilitates art to finish traction and take out uterus.Make
During with traditional uterus raising device, patient fully relies on experience for the judgement of vagina resection length, and the error thus brought is likely to result in
Range of operation is not enough or excision vagina is excessive.In the present invention, the wrapping rib of fornix cup is provided with ansa at 4, and interval 0.5～
1.5cm (preferably 1cm) is arranged in order.Each ansa can form corresponding ring uplift on vagina medial wall, along this protuberance
The length of cutting vaginal wall is just the length that protuberance at this is corresponding, i.e. 0cm, 1cm, 2cm, 3cm.The method effectively prevent
The error that subjective judgment vagina resection length is brought.And, the present invention additionally uses detachable vagina air bag, can fill out as vagina
Thing is filled while being used to the loss of pneumoperitoneum to be prevented when cutting vagina and suture Vaginal Stump.And special aseptic thin-film is used by adding
Set, prevents from bringing antibacterial or tumor cell into abdominal cavity when vagina is clogged.
Description of the drawings
Fig. 1 is the sagittal plain internal anatomy of female pelvic cavity；
Fig. 2 is the Coronal internal anatomy of female pelvic cavity；
Excision position view when Fig. 3 is row panhysterectomy in Fig. 1 and during cut-out vagina；
When Fig. 4 is to be expert at panhysterectomy, when uterus raising device inserts vagina, cervix uteri and body of uterus, bladder and rectum etc.
The effect diagram that organ is open in the presence of fornix cup；
Fig. 5 is a kind of traditional and domestic most popular cross uterus raising device；
Fig. 6 is the basic block diagram of the present invention；
Fig. 7 is the scale in the present invention on centrally located guide rod；
Fig. 8 is the cross-sectional view of fornix cup in the present invention；
Fig. 9 is the dimensional structure diagram of fornix cup in the present invention；
Figure 10 is the use state structural representation of fornix cup in the present invention；
Figure 11 is the structural representation of take-up in the present invention；
Figure 12 is the structural representation of detachable vagina air bag in the present invention；
Figure 13 is the dimensional structure diagram of medial vagina air bag of the present invention.
Figure 14 is the structural representation of handle in the present invention；
Figure 15 is the dimensional structure diagram of handle in the present invention；
Figure 16 is the schematic diagram for placing the vaginal speculum with measurement function；
Figure 17 be by central guide rod insert uterus and by elastic water pocket expand after schematic diagram；
Figure 18 is the schematic diagram that fornix cup is inserted vagina；
Figure 19 is to dissociate vagina to 3cm, and the schematic diagram of 4 circular protrusions is formed on vagina medial wall；
Figure 20 be cut vagina before vaginal wall is sutured in the schematic diagram of grid belt；
Figure 21 is to insert the schematic diagram that vaginal wall is cut after vagina air bag；
Figure 22 is the schematic diagram that transvaginal takes out uterus；
Figure 23 is to insert again vagina air bag and form pneumoperitoneum to suture the schematic diagram of Vaginal Stump；
Figure 24 is the schematic diagram after suturing Vaginal Stump；
Accompanying drawing is marked：Central guide rod (1), scale I (11), scale II (12), fornix cup (2), take-up (20), cup
(21), sleeve pipe (22), wrapping rib (23), the first ansa (230), the second ansa (231), the 3rd ansa (232), the 4th ansa
(233), grid belt (24), nut (25), segmented thread pipeline section (26), external screw thread I (221), external screw thread II (261), spacing
(27), vagina air bag (3), main gasbag (31), balloonet (32), breather (33), valve (34), handle (4), handle casing
(41) groove (44), elastic water pocket (5) are held in, syringe (42), self-closed type injection orifice (43).
Specific embodiment
Below in conjunction with the accompanying drawings the specific embodiment of the present invention is made a detailed explanation.
As shown in Fig. 1～24, the present invention provides a kind of specific embodiment of single use uterus raising device, and the uterus raising device includes
Central guide rod 1, fornix cup 2, vagina air bag 3, handle 4 and elastic water pocket 5.As shown in Figure 6 and Figure 8, it is arranged on central guide rod 1
There is fornix cup 2, and the fornix cup 2 can be carried out slidably along on 1 axial direction of central guide rod；The fornix cup 2 includes
Cup 21, and the sleeve pipe 22 that is connected with the cup 21；Cup 21 is in interior narrow outer wide open-like shape, is provided with the outside of cup 21
Wrapping rib 23.As shown in figs. 8-10, grid belt 24 is provided with wrapping rib 23, the outer surface for wrapping rib 23 is provided with 4
Ansa, is followed successively by the first ansa 230, the second ansa 231, the 3rd ansa 232 and the 4th ansa 233 from inside to outside；When fornix cup 2
When being placed in vagina bottom, this at 4 ansa be corresponding in turn to the vagina of arched roof (i.e. 0cm) and 1cm, 2cm, 3cm, A in such as Figure 19, B,
Shown in C, D.
As shown in fig. 6, central guide rod 1 is S-shaped forniciform hollow tubing conductor.The structure design of S-shaped is primarily to suitable
The normal physiological bending degree of body of uterus, vagina and pelvis composition is answered, while facilitating patient to grasp to which in optimal position
Control, so that body of uterus is swung by patient's requirement.After patient sets operation position, by 1 transvaginal of central guide rod and cervix uteri
Uterus intracavity is inserted, and makes the top of central guide rod 1 be located at uterus bottom.A syringe 42 is contained within central guide rod 1 to connect
The self-closed type injection orifice 43 of the elastic water pocket 5 and handle end on central guide rod top.Available common medical syringe extracts 5-
In the normal saline of 8ml or air injection self-closed type injection orifice 43, then Jing syringes 42 enter elastic water pocket 5, make elastic water
The expansion of capsule 5 becomes big.Due to the self-enclosed effect of self-closed type injection orifice 43, after syringe is extracted, elastic water pocket 5 and syringe
Liquid or air in 42 will not spill, and make elastic water pocket 5 be maintained the state for expanding.As the capacity of normal-sub uterine cavity is
5-8ml, therefore after elastic water pocket 5 expands, whole cavity of uterus can be full of, the stability and accuracy for swinging uterus can be increased.
When it is postoperative need transvaginal take out uterus when, can use 43 pumpback of syringe Jing self-closed types injection orifice elasticity water pocket 5 in liquid
Or air, make elastic water pocket 5 recover deflated state, be beneficial to taking-up uterus.
As shown in fig. 7, the outer surface of central 1 front end of guide rod is provided with scale I 11 and scale II 12.The function of scale I 11
It is similar with the scale on common uterine sound, can be used for the depth of direct measurement cavity of uterus.In addition, when fornix cup is carved positioned at two sections
When between degree, the scale I 11 corresponding to its rim of a cup is just consistent with the scale II 12 corresponding to 22 end of sleeve pipe.Therefore in the middle of
Centre guide rod is placed in uterus bottom, and fornix cup is when being placed in vagina bottom, and the scale corresponding to 22 end of sleeve pipe is cavity of uterus
Depth.By the method can indirect gain cavity of uterus depth.
As shown in figs. 8-10, have at regular intervals 27 between the wrapping rib 23 and cup 21, the spacing 27 is in interior narrow
Outer width.The design of the structure, is easy to patient that vaginal wall is sewn on the lattice coral band 24 of wrapping rib.Cut in popularity of being expert at uterus
During except art, when free vagina is to 3cm.With with line suture needle from positioned at being formed between the second ansa 231 and the 3rd ansa 232
Inserting needle vertically downward between ring uplift, suture needle run through vaginal wall and grid belt 24, into spacing 27, across some bar gratings
Afterwards, intraperitoneal is returned to through vaginal wall, so as to complete the process of single needle suture.Diverse location is selected to repeat this process, can be with
Vaginal wall is sewn on grid belt 24 completely.
During the peritoneoscope and robotic surgery of some gynecological, need uterus from fornix vagina or under which
Cut off at square 1cm, 2cm, 3cm, these processes correspond to respectively panhysterectomy under peritoneoscope, expand panhysterectomy, it is secondary extensively
Property hysterectomy and radical hysterectomy.Now being accomplished by will be the accurate location of arched roof and vaginal wall sudden and violent by certain mode
Reveal to patient, it is to avoid the normal structure around damaging, while providing a good excision platform.The master of fornix cup in the present invention
Acts on be this.
Fornix cup 2 in Fig. 8 and Fig. 9 includes cup 21 and coupled sleeve pipe 22, and the former primarily serves the purpose of support
Arched roof and vagina, the latter are primarily served the purpose of fixed and take out cup 21.Cup 21 is in interior narrow outer wide open wine glass-shaped.Cup
Wrapping rib 23 on the outside of mouthful, its material can be identical with cup 21.Wide in the middle of wrapping rib 23, two is slightly narrow, enters fornix cup 2
Incarceration is not susceptible to when going out vagina or vaginal wall is damaged.It is directly contact vaginal wall due to wrapping rib 23, therefore works as external force
When imposing on fornix cup 2, power will be delivered to wrapping rib 23 by cup 21, and strut arched roof and vaginal wall.Now wrapping keeps off
At on side 4, ansa will form ring uplift at 4 on vagina medial wall, be corresponding in turn to from front to back arched roof (0cm) and
The vaginal wall of 1cm, 2cm and 3cm.Patient can according to ring uplift at operation selection wherein as vaginal wall cutting
Point, it is to avoid naked eyes judge excision vagina length and cause error.By taking panhysterectomy as an example, fornix cup is being placed in into vagina bottom
Portion, and when forcing in uterus raising device, the normal structure such as bladder, ureter and rectum is open in the presence of fornix cup.Now vault
It is grand that abdominal cavity is headed in the presence of the first ansa 230, ring uplift is formed, as shown in A in Figure 19.Now patient may be selected to be somebody's turn to do
Protuberance cuts vaginal wall, and cuts off vaginal wall along the first ansa 230.Similarly, when radical hysterectomy is carried out, when
When free vagina is to 3cm, the ring uplift incision vagina formed by the 4th ansa 233 is may be selected, as shown in D in Figure 19, and edge
The cut-out vaginal wall of the 4th ansa 233.But as radical hysterectomy is generally directed to the diseases such as cervical cancer, to prevent from cutting
After vagina, cervix neoplasmses drop to abdominal cavity or plant in Vaginal Stump, can be with band line suture needle through multiple through and through suture vaginal wall
With grid belt 24 (such as a and b in Figure 10), the vaginal wall of uterus side is fixed and wrapping rib 23 is fitted in.The method is not only
Make between vaginal wall and fornix cup 2, to form closed structure, effectively prevent cervix neoplasmses from dropping to abdominal cavity or planting residual in vagina
End, at the same facilitate it is postoperative uterus is drawn, enable specimen successfully transvaginal take out.The present invention provides several difference
The fornix cup of size, it is preoperative by a kind of vaginal speculum with measurement function, accurate measurement cervix uteri size, and to select accordingly corresponding
Fornix cup, make fornix cup and cervix uteri fit like a glove.In addition, cup 21 and sleeve pipe 22 can be using with certain elasticity and rigidity
Material making, so not only facilitating fornix cup 2 can slide along on S-shaped central guide rod 1, and can give arched roof
The support force enough with vagina, helps patient to judge the position of arched roof and vagina.
As shown in figure 11, the sleeve pipe 22 on the fornix cup 2 controls fornix cup 2 with central guide rod by take-up 20
Loose state or tightening state between 1.The segmentation that the take-up 20 is included nut 25 and is connected with sleeve pipe 22
Screw thread pipeline section 26, the external screw thread I on sleeve pipe 22 are mutually continuous with the external screw thread II on segmented thread pipeline section 26 so that nut 25 can
Carry out freely rotating back and forth movement along external screw thread I and external screw thread II, realize the loose shape between fornix cup 2 and central guide rod 1
State or tightening state.
As shown in Fig. 6, Figure 14 and Figure 15, handle 4 is connected with the end of central guide rod 1, be in light in the two sides of handle 4
Sliding surface, if if the front of handle 4 be provided with for increase grasp patient hold the uterus raising device frictional force arterial highway lines or
Dry raised；If the back side of handle 4 is provided with arterial highway and holds groove 44, the shape is adapted to hand-held.When moving handle 4, entirely
Uterus raising device correspondingly will be moved, and then reach the purpose for swinging uterus.
As shown in Fig. 6, Figure 12 and Figure 13, it is additionally provided with central guide rod 1 removable for prevent pneumoperitoneum transvaginal to be lost in
Unload vagina air bag 3.The detachable vagina air bag 3 includes the main gasbag 31 of front end and the balloonet 32 of rear end, main gasbag 31
It is connected with balloonet 32 by breather 33, breather 33 is provided with for controlling gas trend near 32 side of balloonet
Valve 34；When the direction setting of valve 34 is from balloonet 32 to main gasbag 31, when extruding balloonet 32 with handss repeatedly, secondary gas
Gas Jing breathers 33 in capsule 32 enter main gasbag 31 so that main gasbag 31 expands, and then prevents pneumoperitoneum to be lost in；Main gasbag 31
It is provided with the bound edge 35 that can be fastened and wrap up on casing 22 so that main gasbag 31 can be strutted to inside and outside and be enclosed within vault
On the sleeve pipe 22 of grand cup 2.Before vaginal wall is cut, first main gasbag 31 can be placed on the sleeve pipe 22 of fornix cup 2, and be pushed away
Enter intravaginal.By pressing repeatedly balloonet 32, main gasbag 31 is expanded to a certain degree in intravaginal, then cut vaginal wall,
Just can prevent pneumoperitoneum from disappearing.Transvaginal take out uterus before, need to by the direction setting of valve 34 be main gasbag 31 to balloonet 32,
Using the elastical retraction of main gasbag 31, after discharging the gas in main gasbag 31, main gasbag 31 is further taken out.Uterus to be removed, prepares seam
When closing Vaginal Stump, main gasbag 31 can be made to form closed structure in the special thin-film covering of 31 outer wrapping of main gasbag, be clogged again cloudy
Road is forming pneumoperitoneum.
As shown in Figure 16～23, concrete application process of the single use uterus raising device in uterectomy in the present invention：
1. patient takes lithotomy position, inserts the vaginal speculum with measurable function (K), and according to measured cervix uteri size
Corresponding uterus raising device external member is selected, as shown in figure 16.The top Jing cervical orifices of central guide rod 1 are inserted into cavity of uterus, elasticity is made
Water pocket 5 is located at uterus bottom.5-8ml normal saline is extracted with ordinary syringe, the self-closed type injection orifice 43 of 4 end of handle is handled
Injection, expands elastic water pocket 5, so as to play a part of stable uterus.As shown in figure 17.
2. vaginal speculum is taken out, fornix cup 2 is pushed into intravaginal, until rim of a cup is close to arched roof, then rotated and tighten positioned at sleeve pipe
On nut 25, sleeve pipe 22 is fixed on central guide rod 1.Pushing handle 4 before appropriate, makes fornix vagina to intraperitoneal bulging, and
The wrapping rib 23 on fornix cup is made to be close to vaginal wall, as shown in figure 18.
3. now under the peritoneoscope visual field, it can be seen that vagina medial wall wrapping rib ansa extruding under formed 4
Place's ring uplift, as shown in figure 19.Can be according to the corresponding ring uplift of operation selection as cut point.On wrapping rib
At 4, ansa is separated by 1 centimetre successively, is proximally respectively 0 centimetre, 1 centimetre, 2 centimetres, 3 centimetres to distal end, as shown in Figure 8.Accordingly
Represent the length that vaginal wall is cut off in 4 kinds of hysterectomy modes, i.e. panhysterectomy respectively, expand panhysterectomy, secondary wide
General property hysterectomy, radical hysterectomy.Vagina can be dissociated before cutting as needed to corresponding length.Shown in Figure 20 it is
Radical hysterectomy, therefore 3 centimetres of ring uplift is selected as cut point.Before vagina is cut, need vaginal wall
Surrounding through and through suture in the grid belt of lower section, the i.e. region between 1 centimetre and 2 centimetres of ring uplifts, in such as Figure 20 a and
Shown in b arrows.The pin number of suture is more, and the laminating obturation effect of vaginal wall and fornix cup is better.
4., after suture is finished, the main gasbag 31 of vagina air bag 3 is inserted into vagina, and is placed on the sleeve pipe 22 of fornix cup 2, put
The depth for entering by ensure gas will not transvaginal spill and be defined.The direction of valve 34 is set as from balloonet 32 to main gasbag 31,
Balloonet 32 is subsequently extruded repeatedly, is expanded to main gasbag 31 and be close to completely vaginal wall and central guide rod 1.Along the ring of 3 centimeters
Shape protuberance cuts vaginal wall, cuts off uterus.As shown in figure 21.
5. the direction of valve 34 is set from main gasbag 31 to balloonet 32, to lead using the elastical retraction release of main gasbag 31
Gas in air bag 31, transvaginal take out main gasbag 31.The self-closed type injection orifice 43 times of handle end is handled with ordinary syringe
Liquid in extracting cartridge water pocket 5, tightens elastic water pocket 5.Outwards drawing uterus raising device, is sutured in after fornix cup using vaginal wall and is produced
Raw draw, uterus raising device is taken out together with uterus transvaginal.As shown in figure 22.
6. with special aseptic thin-film set parcel main gasbag 31, and vagina is clogged again.After pneumoperitoneum is formed again, in abdomen
Vaginal Stump is sutured under hysteroscope.As shown in figure 23.
7. Figure 24 is the diagram that Vaginal Stump suture is finished.
In the present invention, designed uterus raising device is a kind of disposable using apparatus, can avoid causing infection；And S-shaped
The central guide rod of structure design can adapt to the normal physiological bending degree of body of uterus, vagina and pelvis composition, while facilitating patient
Which is manipulated in optimal position, so that body of uterus is swung by patient's requirement.
The front end of central guide rod is provided with two sections of scales, can be used directly or indirectly in the depth of measurement cavity of uterus.
The elastic water pocket being connected with the syringe in hollow tubing conductor is provided with the top of central guide rod, is effectively kept away
Situations such as undue force causes the perforation of uterus when having exempted from act palace, and increased the stability and accuracy for lifting palace；
The present invention provides several different size of fornix cup, and by a kind of vaginal speculum with measurement function, can
Realize that fornix cup is matched completely with cervix uteri, it is to avoid vagina exposure is excessive or exposure is not complete, and using with certain elasticity design
Fornix cup, be free to pass in and out vagina, it is to avoid occur incarceration or damage vagina tissue.
By the ansa on fornix cup, the cut point of vagina can be accurately positioned, it is to avoid vagina resection is excessive or long, and is
Cutting vagina provides good platform.Be expert at radical hysterectomy or secondary radical hysterectomy when, can by wrapping
Vaginal wall is sutured in fornix cup by the grid belt on rib, to prevent Tumor cell dissemination to abdominal cavity or plant in Vaginal Stump,
Reduce the risk of recurrence.
After detachable vagina air bag can not only prevent from cutting vagina, pneumoperitoneum is lost in, and special aseptic thin-film on set
After set, vagina can be clogged again to form pneumoperitoneum again, be that suture Vaginal Stump creates conditions.
It is emphasized that：The above is only presently preferred embodiments of the present invention, not make any formal to the present invention
Restriction, every technical spirit any simple modification, equivalent variations and modification that above example is made according to the present invention,
Still fall within the range of technical solution of the present invention.
Claims (10)
1. disposable sacculus uterus raising device, including central guide rod (1), it is characterised in that be arranged with fornix cup on central guide rod (1)
, and the fornix cup (2) can be carried out slidably along on central guide rod (1) axial direction (2)；The fornix cup (2) includes
Cup (21) and the sleeve pipe (22) being connected with the cup (21)；Cup (21) in interior narrow outer wide open-like shape, in cup
(21) wrapping rib (23) is provided with the outside of.
2. according to the disposable sacculus uterus raising device described in claim 1, it is characterised in that be provided with lattice in wrapping rib (23)
Grid band (24) is if ansa side by side parallel with arterial highway；
The spacing of adjacent twice ansa is 0.5～1.5cm；Grid belt (24) is formed by many bar gratings are arranged in parallel, adjacent two
Gap is formed between grid.
3. according to the disposable sacculus uterus raising device described in claim 2, it is characterised in that ansa is divided into from inside to outside
One ansa (230), the second ansa (231), the 3rd ansa (232) and the 4th ansa (233), grid belt (24) is positioned at the second ansa
(231), between the 3rd ansa (232).
4. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that before the central guide rod (1)
The outer surface of section is provided with scale I (11) and scale II (12), when fornix cup (2) is between two sections of scales, its rim of a cup institute
Corresponding scale I (11) is just consistent with the scale II (12) corresponding to cannula end.
5. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that the wrapping rib (23)
Have between cup (21) (27) at regular intervals, the spacing (27) is in interior narrow outer width.
6. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that on the fornix cup (2)
Sleeve pipe (22) controls the loose state between fornix cup (2) and central guide rod (1) or fastening shape by take-up (20)
State；The segmented thread pipeline section (26) that the take-up (20) is connected including nut (25) and with sleeve pipe (22), sleeve pipe (22)
On external screw thread I it is mutually continuous with the external screw thread II on segmented thread pipeline section (26) so that nut (25) can be along I He of external screw thread
External screw thread II carries out freely rotating back and forth movement, realizes the loose state between fornix cup (2) and central guide rod (1) or fastening
State.
7. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that at the end of central guide rod (1)
End is connected with handle (4), is in shiny surface in the two sides of handle (4), and the front of handle (4) is provided with and grasps friction for increasing
If arterial highway lines or several are raised；Handle (4) is provided with self-closed type injection in the handle (4) end in hollow structure
Hole (43).
8. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that before central guide rod (1)
End is provided with elastic water pocket (5).
9. according to the disposable sacculus uterus raising device described in claim 7, it is characterised in that the central guide rod (1) is S-shaped
Forniciform hollow tubing conductor, is provided with syringe (42) in central guide rod (1)；Syringe (42) through handle (4), with handle
(4) the self-closed type injection orifice (43) of end is connected.
10. according to the disposable sacculus uterus raising device described in claim 1,2 or 3, it is characterised in that on central guide rod (1)
It is additionally provided with the detachable vagina air bag (3) for preventing pneumoperitoneum to be lost in；Main gasbag of the detachable vagina air bag (3) including front end
(31) and rear end balloonet (32)；Main gasbag (31) is connected with balloonet (32) by breather (33), breather
(33) it is provided with for controlling the one-way cock (34) that gas is moved towards；Main gasbag (31) is provided with and can fasten and be wrapped in sleeve pipe
(22) bound edge (35) on so that main gasbag (31) can be strutted to inside and outside and be set in fornix cup with fully sealing shape
(2) on sleeve pipe (22).
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|---|---|---|---|
| CN201611138285.0A CN106580408A (en) | 2016-12-12 | 2016-12-12 | Disposable balloon uterine manipulator |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201611138285.0A CN106580408A (en) | 2016-12-12 | 2016-12-12 | Disposable balloon uterine manipulator |
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| Application Number | Title | Priority Date | Filing Date |
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| CN201611138285.0A Pending CN106580408A (en) | 2016-12-12 | 2016-12-12 | Disposable balloon uterine manipulator |
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Cited By (6)
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| CN109875676A (en) * | 2019-03-04 | 2019-06-14 | 武欣 | A kind of uterus canceration vaginal canal resection operation utensil |
| CN110680482A (en) * | 2019-10-21 | 2020-01-14 | 南京森盛医疗设备有限公司 | Womb lifting kit and use method thereof |
| CN111529115A (en) * | 2020-05-19 | 2020-08-14 | 河南中医药大学第一附属医院 | Capsule type coronary artery compression device and manufacturing method of chronic myocardial ischemia animal model |
| CN112206043A (en) * | 2019-07-12 | 2021-01-12 | 广州迪克医疗器械有限公司 | Vagina cutting positioner |
| WO2024005757A1 (en) * | 2022-06-30 | 2024-01-04 | T.C. Ankara Universitesi Rektorlugu | A uterine manipulator |
| WO2024010558A1 (en) * | 2022-07-08 | 2024-01-11 | Gaziantep Universitesi Rektorlugu | Uterine manipulator |
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| WO2024010558A1 (en) * | 2022-07-08 | 2024-01-11 | Gaziantep Universitesi Rektorlugu | Uterine manipulator |
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