CN109124854A - 用于接入安置在体内脉管内的物质的方法和设备 - Google Patents
用于接入安置在体内脉管内的物质的方法和设备 Download PDFInfo
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Abstract
一种用于接入肠内物质的方法包含：形成延伸通过腹腔的腹壁的开口；接入所述腹腔内的肠的肠末端段；以与延伸通过所述腹壁的所述开口对齐的方式定位所述肠的所述肠末端段；将所述肠末端段附接到所述开口周围的皮肤组织以在所述肠的管腔和通过所述腹壁的所述开口之间形成流体连通；将接入装置固定在邻近通过所述腹壁的所述开口处；以及将容器连接到所述接入装置，所述容器配置成与所述肠的所述管腔流体连通以收集所述肠内的物质。
Description
技术领域
本公开大体上涉及一种用于接入体内脉管的外科手术和相关联的设备。更具体地说，本公开涉及一种用于执行从肠移除废弃物质的造口术的外科手术和设备。
背景技术
例如肠等体内脉管的外置被称作人造口。可结合造口手术，通过将肠的等分部分反转和缝合到腹壁的外部来形成人造口，从而提供到肠中的内部接入以收集粪便物。与人造口相关联的并发症可包含渗漏、出血、坏死、狭窄、皮肤感染、脱垂等。因此，需要形成改善的方法来减少通常与造口手术相关联的风险和并发症。
发明内容
因此，本公开是针对一种用于接入肠内的物质的方法，包含：形成延伸通过腹腔的腹壁的开口；接入腹腔内的肠的肠末端段；以与延伸通过腹壁的开口对齐的方式定位肠的肠末端段；将肠末端段附接到开口周围的皮肤组织以在肠的管腔和通过腹壁的开口之间形成流体连通；将接入装置固定在邻近通过腹壁的开口处；以及将容器连接到接入装置，所述容器配置成与肠的管腔流体连通以收集肠内的物质。
在实施例中，方法包含将肠的肠末端段耦合到钉合仪器的砧座，将砧座连接到钉合仪器，以及发动钉合仪器以通过开口周围的皮肤组织且在肠的肠末端段内递送紧固件。
在一些实施例中，固定接入装置包含通过开口且在肠的肠末端段的管腔内定位接入装置的连接器段。
在某些实施例中，方法包含在肠的肠末端段的管腔内围绕接入装置的连接器段形成液密密封部分。在实施例中，形成液密密封部分包含对围绕接入装置的连接器段安置的可充气气囊进行充气以接合肠末端段的内壁。在一些实施例中，形成液密密封部分包含将肠的肠末端段缝合到接入装置的连接器段。在某些实施例中，形成液密密封部分包含在肠的肠末端段的管腔内粘附接入装置的连接器段。
在实施例中，耦合肠的肠末端段包含围绕砧座的砧座头部布置肠末端段。在一些实施例中，发动钉合仪器包含相对于钉合仪器的钉筒接近砧座头部。在某些实施例中，发动钉合仪器包含递送钉的环形阵列，其中钉至少部分地通过砧座的砧座头部变形。在实施例中，附接肠的肠末端段包含围绕肠末端段和砧座头部施加荷包线。
在某些实施例中，发动钉合仪器包含通过皮肤组织下面的面部组织递送针。
在一些实施例中，定位肠末端段包含暴露开口外部的肠末端段的末端边缘，并且其中发动钉合仪器包含通过肠末端段的末端边缘递送紧固件。
在一些实施例中，方法包含将网附接到肠末端段和皮肤组织下方的肌肉组织。
根据本公开的用于形成造口以从肠收集物质的方法和相关联的设备通过将肠段直接附接到围绕延伸通过腹壁的造口的皮肤或皮肤层而不需要反转末端边缘和形成人造口。因此，避免了通常与人造口形成相关联的并发症，包含例如肠道津液的渗漏、感染和其它皮肤并发症。用于所述方法的接入装置在治疗期间支撑肠段，并提供附接到收集物或造口袋的机构，同时不会对腹壁产生不当应变，从而保持了造口的完整性。
通过以下描述将了解其它优点。
附图说明
并入在本说明书中且构成本说明书的部分的附图说明本公开的实施例，并与上文给出的本公开的一般描述和下文给出的详细描述一起用以解释本公开的原理，在附图中：
图1是呈部分横截面形式的受检者的腹部区域的示意性说明；
图2是呈部分横截面形式的腹部区域的示意性说明，其说明与执行根据本公开的说明性实施例的造口手术有关的切除的肠和在腹壁中形成的开口；
图3是用于执行造口手术的圆形吻合仪器的透视图；
图4是围绕圆形吻合仪器的砧座头部定位的肠末端段和在仪器启动之前定位在邻近腹腔中的开口处的紧固件筒的示意性说明；
图5是在发动圆形吻合仪器之后附接到皮肤组织上以形成造口的肠末端段的示意性说明；
图6是说明在皮肤组织中形成以附接肠末端段和形成造口的钉线的透视图；
图7是用于插入造口内的接入装置的说明性实施例的透视图；
图8到9是说明图7的接入装置插入造口内的顺序的透视图；
图10是沿着图9的线10-10截得的截面图；
图11是说明以与造口对齐的方式将接入装置固定到腹壁的透视图；
图12是并有外部可充气气囊的接入装置的一个说明性实施例的透视图；
图13是说明定位在造口内的图12的接入装置的截面图；
图14是说明用于形成造口的替代性方法和相关联的接入装置的透视图；
图15是说明图14的接入装置插入造口内的透视图；以及
图16是沿着图15的线16-16截得的截面图。
具体实施方式
参考附图详细描述本公开的各方面，其中相似参考数字表示在若干视图中的每个中的相同或对应元件。如本文中所使用，术语“远侧”或“前”是指装置中离使用者较远的部分，而术语“近侧”或“后”是指装置中更接近使用者的部分。如本文中所使用，术语“临床医生”是指医生、护士或其它医护人员且可包含辅助人员。在以下描述中，未详细地描述熟知功能或构造以免不必要的细节混淆本公开。
以下论述将集中在执行造口手术的方法和相关联的设备上，具体地说，集中在结合结肠造口手术或回肠造口手术将肠的末端边缘固定到腹部组织。然而，导引设备还可应用于其它造口手术，包含尿道造口手术、胃造口手术和空肠造口手术。
参考图1，受检者身体中的腹部区域“AR”一般包含腹壁“AW”，其具有外部皮肤或表层“s”(例如，表皮、真皮和下皮层)、包含结缔组织的筋膜层“f”，以及内部肌肉层“m”(例如，前直肌鞘)，所述内部肌肉层“m”覆盖用于执行例如消化的各种人体功能的器官、脉管和/或其它组织。举例来说，作为受检者身体中的消化系统“D”的部分，胃“S”和肠“I”支撑在腹腔“AC”中。在自然消化过程中，胃“S”和肠“I”与消化系统“D”的其余部分合作以处理食物并通过肛门“A”排泄粪便物“P”。不利的是，例如由于肠“I”的疾病或损伤，可能会需要通过执行通过腹部区域“AB”的造口来绕过通过肛门“A”的自然消化，以便从受检者身体中的肠“I”安全地排泄粪便物“P”。
现参考图2，根据本公开的一个示例性方法，体内器官或脉管，例如肠“I”，可通过例如利用解剖刀穿过腹壁“AW”的表层“s”、筋膜层“f”和内部肌肉层“m”而形成的切口或开口“o”接入。临床医生通过开口“o”引入一个或多个仪器，并将肠“I”等分成第一肠末端段“I1”和第二肠末端段“I2”。第二肠末端段“I2”可利用任何合适的仪器进行密封闭合，所述仪器例如超声波和/或电外科钳(未示出)。关于此类钳的一个实例的构造和操作的详细描述请参考第8,444,664号美国专利，其全部内容以引用的方式并入本文中。
在肠“I”等分成第一末端段“I1”和第二肠末端段“I2”的情况下，注意力指向在腹壁“AW”内围绕开口“o”连接第一肠段“I1”。在实施例中，第一肠末端段“I1”可利用钉合设备固定到腹壁“AW”，所述钉合设备例如图3中所描绘的圆形紧固件设备10。一般来说，圆形紧固件设备10包含支撑接近旋钮14和发动触发器16的手柄组件12。圆形紧固件设备10进一步包含伸长轴杆18，伸长轴杆18从手柄组件12向远侧延伸到支撑于细长轴杆18的远端部分上的末端执行器组件20。末端执行器组件20包含壳体组件22和砧座24，所述砧座24可响应于手柄组件12的接近旋钮14的旋转而在未接近位置(图3)和接近位置之间移动。壳体组件22包含筒26，所述筒26在限定于筒26中的紧固件保持槽28中支撑紧固件(例如，矩形和/或圆形丝钉——未示出)的环形阵列。砧座24包含限定紧固件形成凹座32的砧座头部30，所述紧固件形成凹座32配置成在从筒26发动紧固件后形成紧固件。关于此类圆形紧固件设备的一个实例的构造和操作的详细描述请参考第8,011,554号美国专利，其全部内容以引用的方式并入本文中。
参考图4，在一个示例性手术中，表层“s”至少沿着邻近开口“o”的位置与筋膜“f”分开。之后，钉合设备10的砧座头部30通过开口“o”引入腹壁“AW”内，并定位在第一肠末端段“I1”内。使用荷包缝合术等将第一肠末端段“I1”固定在砧座头部30周围。筒26定位在表层“s”的外部。接着，旋转接近旋钮14以将末端执行器组件20移动到接近位置(图4)，使得第一肠段“I1”和表层“s”的末端部分夹持在砧座头部30和筒26之间。启动手柄组件12的发动触发器16以从筒26的紧固件保持槽28发动紧固件从而抵靠砧座30的紧固件形成凹座32形成，以将第一肠末端段“I1”紧固到表层“s”。接着，可移除圆形紧固件设备10。
图5到6说明附接到第一肠末端段“I1”上的表层“s”。示意性地描绘紧固件34，紧固件34仅穿过表层“s”，而不是下面的筋膜层“f”或肌肉层“m”，从而连接到腹腔“AC”内的第一肠段“I1”。因此，第一肠段“I1”并不延伸通过腹壁“AW”中的开口“o”，而是固定到表层“s”的内表面上。因此，免去了在表层“s”的外部上或腹腔“AC”外部利用第一肠段“I1”形成人造口，以及与其相关联的伴随的局限性，包含例如肠道津液的渗漏、感染和其它皮肤并发症。图6说明穿过表层“s”以与第一肠段“I1”连接从而形成造口的紧固件34的环形阵列。在一些实施例中，预期筋膜层“f”的筋膜组织可被紧固件34所捕获。
此外，外科网50(例如，疝网)(图5)可固定到肌肉层“m”和第一肠末端段“I1”上，以在腹腔“AC”内稳定第一肠末端段“I1”，从而使形成疝的可能性最小化。关于疝网的一个实例的详细描述请参考第9,005,308号美国专利，其全部内容以引用的方式并入本文中。
现参考图7，接入装置备100可以与开口“o”和第一肠末端段“I1”对齐的方式安装到腹壁“AW”上，以提供用于使废弃物质(例如，粪便物“P”)传递到收集装置的套管，所述收集装置例如结肠造口或回肠造口袋(未示出)。接入装置100包含凸缘段102和连接器段104，所述连接器段104从法兰段102延伸并限定纵向轴线“x”。凸缘段102包含多个间隔开的开口106，在实施例中，可以等距径向间隔开地关系安置开口106。开口106配置成接收紧固件以将接入装置100耦合到表层“s”。连接器段104可为圆柱形的并延伸达某一距离，所述距离足以使连接器段104通过开口且在第一肠末端段“I1”内被接收。凸缘段102和连接器段104限定从其穿过的纵向通道108，以准许粪便物“P”传递到收集装置。
接入装置100可由任何生物相容性材料形成，包含不锈钢、钛或一种或多种聚合物。生物相容性聚合物可为可生物降解的、不非可生物降解的，或可生物降解和不可生物降解的组合。如本文所使用，术语“可生物降解的”被定义成包含生物可吸收和生物可再吸收的材料。
在使用中，参考图8到9，接入装置100的连接器段104通过腹壁“AW”中的开口“o”引入，并且凸缘段102相对于表层“s”的外表面定位。在图8到9中，为清晰起见，移除了筋膜层“f”和内部肌肉层“m”。在实施例中，连接器段104可利用粘固剂、粘合剂等固定在第一肠段“I1”内，粘固剂、粘合剂等可在连接器段104插入到第一肠段“I1”中之前或之后施加。连接器段104可利用第一肠段“I1”的内表面形成密封部分。在接入装置100适当地定位成与第一肠末端段“I1”对齐的情况下，凸缘段102通过施加至少一个紧固件110而固定到表层“s”上，如图10到11所描绘。在实施例中，可利用上文结合图3描述的圆形紧固件设备10以在凸缘段102内递送紧固件110(例如，钉)的环形阵列。用于施加紧固件110的其它仪器公开于共同转让给Criscuolo的第2014/0121684号美国专利公开和共同转让给Abuzaina等人的第2014/0276972号美国专利公开中，每一公开的全部内容以引用的方式并入本文中。在替代方案中，凸缘段102可通过缝合固定到表层“s”上。
紧固件110可通过表层“s”递送，而不穿过下面的筋膜层“f”或肌肉层“m”。因此，紧固件110将表层“s”直接连接到肠末端段“I1”。然而，预期至少一些筋膜组织可被紧固件110所捕获。
在接入装置相对于开口“o”固定的情况下，示意性地描绘为附图标记150(图11)的收集装置可安装到接入装置100的凸缘段102上。收集装置150可为结肠造口袋等等。设想了用于将收集装置150安装到凸缘段102的任何方法。收集装置150接收穿过接入装置100的纵向通道108的肠道津液和/或粪便物。
因此，上述方法执行造口手术，同时不需要像形成常规人造口那样反转和暴露肠。接入装置100在治疗期间支撑第一肠末端段“I1”，并提供附接收集装置150的机构，同时不会在腹壁的开口“o”内产生不当应变，也不会对第一肠段“I”产生不当应变，从而保持了造口的完整性。通过将表层“s”直接连接到第一肠末端段“I1”来实现造口，这在某些情况下可为有利的，例如，在治疗肥胖的受检者时，此时对肌肉层“m”的接入是有限的。
图12到13说明用于外科手术的接入装置的实施例，其可任选地包含安置在连接器段104的外部表面上的可充气气球或套囊112。可充气气球112通过套管116而与流体114的源流体连通(在图12中示意性地示出)。套管116可为在连接器段102内延伸的单独导管，或可为延伸通过连接器段104的壁的通路。可充气气球112配置成从图11中描绘的放气情况转变到图12中描绘的膨胀情况，以接合第一肠段“I1”的内表面，从而在第一肠末端段“I1”内固定连接器段104。可充气气球112还可在第一肠末端段“I1”内围绕连接器段104形成密封部分，以防流体或粪便物通过。
图14到16说明用于在腹壁“AW”内围绕开口“o”连接第一肠末端段“I1”的另一方法和接入装置。根据此方法，像常规人造口形成手术中的那样，通过开口“o”拉出第一肠末端段“I1”，并至少部分地反转它，来形成人造口“t”。紧固件120的环形阵列可施加到人造口“t”的组织以通过与下文论述类似的方式连接第一肠末端段“I1”和表层“s”。在实施例中，紧固件120并不接合或穿过下面的筋膜层“f”和肌肉层“m”。包含凸缘段202和连接器段204的接入装置200相对于人造口“t”定位。凸缘段202大体上类似于图7到12的接入装置的凸缘段102。连接器段204的长度可能比图7到11的接入装置100的对应连接器段104短。在使用中，连接器段204定位在腹壁“AW”中的开口“o”内，其中凸缘段202接合表层“s”的外表面。通过或围绕凸缘段202中的开口208向第一肠末端段“I1”的末端边缘施加钉或紧固件206，并将凸缘段202固定到表层“s”上。紧固件206还可穿过筋膜层“f”下面的筋膜组织。收集装置可耦合到凸缘段202，如上文所论述。
所属领域的技术人员应理解，本文中特定地描述且附图中展示的结构及方法是非限制性示例性实施例，且应将描述、公开及图仅仅认作特定实施例的示例。因此，应理解，本公开不限于所描述的精确实施例，且所属领域的技术人员可在不脱离本公开的范围或精神的情况下实现各种其它改变和修改。另外，可在不脱离本公开的范围的情况下将结合某些实施例所示出或描述的元件和特征与某些其它实施例的元件和特征组合，且此类修改和变化也包含在本公开的范围内。因此，本公开的主题并不受到已特定示出和描述的内容限制。
Claims (14)
1.一种用于接入肠内物质的方法，包括：
形成延伸通过腹腔的腹壁的开口；
接入所述腹腔内的肠的肠末端段；
以与延伸通过所述腹壁的所述开口对齐的方式定位所述肠的所述肠末端段；
将所述肠末端段附接到所述开口周围的皮肤组织，以在所述肠的管腔和通过所述腹壁的所述开口之间形成流体连通；
将接入装置固定在邻近通过所述腹壁的所述开口处；以及
将容器连接到所述接入装置，所述容器配置成与所述肠的所述管腔流体连通以收集所述肠内的物质。
2.根据权利要求1所述的方法，包含
将所述肠的所述肠末端段耦合到钉合仪器的砧座；
将所述砧座连接到钉合仪器；
发动所述钉合仪器以通过所述开口周围的所述皮肤组织并在所述肠的所述肠末端段内递送紧固件。
3.根据权利要求2所述的方法，其中固定所述接入装置包含通过所述开口且在所述肠的所述肠末端段的所述管腔内定位所述接入装置的连接器段。
4.根据权利要求3所述的方法，包含在所述肠的所述肠末端段的所述管腔内围绕所述接入装置的所述连接器段形成液密密封部分。
5.根据权利要求4所述的方法，其中形成所述液密密封部分包含对围绕所述接入装置的所述连接器段安置的可充气气囊进行充气以接合所述肠末端段的内壁。
6.根据权利要求4所述的方法，其中形成所述液密密封部分包含将所述肠的所述肠末端段缝合到所述接入装置的所述连接器段。
7.根据权利要求4所述的方法，其中形成所述液密密封部分包含在所述肠的所述肠末端段的所述管腔内粘附所述接入装置的所述连接器段。
8.根据权利要求2所述的方法，其中附接所述肠的所述肠末端段包含围绕所述砧座的砧座头部布置所述肠末端段。
9.根据权利要求8所述的方法，其中发动所述钉合仪器包含相对于所述钉合仪器的钉筒接近所述砧座头部。
10.根据权利要求9所述的方法，其中发动所述钉合仪器包含递送钉的环形阵列，所述钉至少部分地通过所述砧座的所述砧座头部变形。
11.根据权利要求10所述的方法，其中附接所述肠的所述肠末端段包含围绕所述肠末端段和所述砧座头部施加荷包线。
12.根据权利要求2所述的方法，其中发动所述钉合仪器包含通过所述皮肤组织下面的面部组织递送针。
13.根据权利要求2所述的方法，其中定位所述肠末端段包含暴露所述开口外部的所述肠末端段的末端边缘，并且其中发动所述钉合仪器包含通过所述肠末端段的所述末端边缘递送所述紧固件。
14.根据权利要求2所述的方法，包含将网附接到所述肠末端段和所述皮肤组织下方的肌肉组织。
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2018
- 2018-06-05 US US16/000,376 patent/US11160682B2/en active Active
- 2018-06-15 CN CN201810622034.2A patent/CN109124854A/zh active Pending
- 2018-06-18 JP JP2018115238A patent/JP2019013741A/ja active Pending
- 2018-06-18 EP EP18178344.0A patent/EP3421017A1/en not_active Withdrawn
Also Published As
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| JP2019013741A (ja) | 2019-01-31 |
| US11160682B2 (en) | 2021-11-02 |
| US20180360643A1 (en) | 2018-12-20 |
| EP3421017A1 (en) | 2019-01-02 |
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