CN109820560A - Application of spring leaf and products thereof - Google Patents

Abstract

The invention discloses spring leafs to be applied in the operation of organism tubular tissue fracture Seal treatment, belong to medical apparatus technical field, spring leaf is specially wound in the periphery of the organism tubular tissue, the closing clamp of radial dilatation active force is born as tubular tissue；Enclosed construction in cooperation pipe introduced above is able to completely enclose tubular tissue along fracture, without opening up open wound operation in patient abdomen, it only needs to be put into spring leaf by original laparoscope puncture outfit operation aperture, clamp is operated by spring leaf hoop in vagina pipe outer wall, adjacent circumferential expansion compressing is carried out from the position that intravaginal corresponds to spring leaf, clamping plate effect is served as in inner ring face of spring leaf during this, on the one hand, it is different from open resection, it can be so few that leave the surface of a wound to patient as far as possible, on the other hand, there is closing clamp, expansion compressing is carried out just to be able to clamp tubular tissue therebetween, process is simple, efficiency and sealing effect are significantly better than existing manual suture Seal treatment mode.

Description

Application of spring leaf and products thereof

Technical field

The present invention relates to medical apparatus technical fields, more particularly, to spring leaf at organism tubular tissue fracture closing It is applied and the product including the spring leaf in reason operation.

Background technique

Cervical carcinoma is the most common gynecologic malignant tumor, and carcinoma in situ high incidence age is 30~35 years old, and infiltrating carcinoma is 45~55 Year, in recent years its morbidity have the tendency that rejuvenation, position of being number three in the most common cancer of women；According to clinical stages, patient Age, fertility requirement, systemic conditions, medical technique level and appointed condition etc., which comprehensively consider, formulates individualized treatment side appropriate Case uses based on operation and radiotherapy, the comprehensive therapeutic plan supplemented by chemotherapy:

Operative treatment: operation is mainly used for early cervical carcinoma patient；Common art formula has: complete hysterectomy；Secondary son complete extensively Palace resection and pelvic lymphadenectomy；Radical hysterectomy and pelvic lymphadenectomy；Lymph by abdominal aorta Excision or sampling；Young patient ovary can normally retain, and to the young patient for retaining reproductive function is required, belong to special early stage Feasible conization or Radical trachelectomy.

Radiotherapy: 1) middle and advanced stage patient；2) systemic conditions are not suitable for the early stage patient of operation；3) uterine neck bulk lesion Preoperation radiotherapy；4) discovery of operative treatment pathologic finding has the adjuvant treatment of high risk factor.

Chemotherapy: being mainly used for the patient of advanced stage or relapse and metastasis, in recent years also using operation joint Neoadjuvant chemotherapy (vein Or Intraarterial Chemotherapy) reduce tumor focus and the subclinical transfer of control, it is also used for radio therapy sensitization.

Wherein, complete hysterectomy occupies larger proportion in clinical treatment；Due to cancer cell can implanting, just determine Operation will ensure cancer cell indiffusion, not flow out in this；1) open resection is specifically included that this existing therapy: tradition Abdominal incision is strutted by utensil, manual suture vagina tube wall to be cut is made Seal treatment, to prevent cancer metastasis, led to again later Cutter cutting vagina tube wall is crossed, finally removes in uterus from notch, the surface of a wound caused by the art formula is larger, is unfavorable for patient abdomen wound The healing of mouth；

2) ultrasound knife probeed into after intravaginal suture by laparoscope puncture outfit hole is gradually sheared from vaginal canal periphery；This kind of art formula It needs first to be put into uterus raising device to intravaginal, vaginal canal is then bound by uterus raising device bar by suture suture manually, is closed Processing, to prevent cancer metastasis, cuts out osculum from vagina pipe outer wall finally by ultrasound knife, then by osculum along vagina Pipe is circumferentially gradually sheared, and pulls out in uterus from vaginal canal eventually by uterus raising device；This mode, though wounds are smaller, It performs the operation time-consuming and laborious, especially during Seal treatment is done in manual suture constraint, it cannot be guaranteed that constraint is reliable, and cutting mode Very long, efficiency is extremely low.

In addition, gynaecology's minimally invasive cervical carcinoma operation in the recent period and document, gynaecology or even surgery bound pair Minimally Invasive Surgery are caused Discuss warmly: research is published in October 31 " New England Journal of Medicine " in 2018, two grinding from the Anderson MD Cancer center Study carefully as a result, compare early cervical carcinoma [Ia1(LVSI+), Ia2, Ib1] patient, minimally invasive with the final result for opening abdomen radical surgery:

1st research is the prospective multicenter random contrast clinical trial started in 2008.Minimally invasive group cervical cancer patient 4.5 years Disease-free survival rate ratio, which opens abdomen group, reduces 10.6%(86% than 96.5%), and 3 years overall survivals are also substantially less than and open abdomen group (93.8% Than 99.0%)

2nd research is retrospective epidemiological investigation, is analyzed after matching to two kinds of modus operandi patient's tendentiousness.This grinds Study carefully while having combined Harvard University, Columbia University, Northwest University and two large databases --- National Cancer number According to library (NCDB) and National Cancer center (NCI).The results show that minimally invasive group of mortality risk ratio open abdomen group it is high by 65% (HR= 1.65), before Minimally Invasive Surgery is not used (2000 to 2006 years), the survival rate of cervical carcinoma be increased with the time (although nothing 0.3%) statistical difference increases every year；

After 2006 use Minimally Invasive Surgery, until 2010,4 years overall survivals of cervical carcinoma decline 0.8% every year instead.

In addition, the U.S., the center, the Anderson MD including presiding over LACC research, Thelma Hopkins are cured it has been reported that being based on this conclusion Institute and some other center have suspended cervical carcinoma using minimal invasive techniques at present and have carried out Radical Hysterectomy operation.

Cervical carcinoma hysteroscope vs open topic, is discussing always, and continuing fermentation in a series of international conference in this year, Reach a peak value after NEJM delivers this two researchs.

How domestic expert sees

In general, it is divided into open to the outside world and " hysteroscope " two is sent greatly, viewpoint is different:

Open doctor approves the conclusion of article, it is believed that open surgery is in addition in abdominal wound and other than the hospital stays, other and abdominal cavity Videoendoscopic surgery is not distinguished, even better than laparoscope.

It dominates minimally invasive doctor to think, single this two articles delivered with regard to NEJM are as a result, we can not negate minimally invasive hand Value of the art in treatment of human cervical cancer.Simultaneously in relation to research and viewpoint itself, there is following doubtful point:

For the research that article is related to:

There may be problems for enter group quantity and the Quality Control of first research: 631 patients are in 33 in the 1st research The heart, if terminated by 2017 into a group calculating, each center only enters 2 patients of group every year on average, and the patient recurred concentrates out Now 14 centers in 33 centers prompt the influence of center or operative doctor very important.

Simultaneously author it is also proposed that, such (including diameter of tumor < as a result, can not extend in low danger cervical cancer patient 2 cm, no vascular interstitial infiltration or infiltration 10 mm of <, Lymph Node-negative) because current result of study is not enough to relatively low danger Existence final result of the patient under two kinds of modus operandis

2nd research can not find out whether minimally invasive group of range of operation can match with abdomen group is opened, meanwhile, this research lacks Recur the specific data of information and the cause of death.Two researchs do not carry out the short reason analysis of minimally invasive group of life cycle.

For minimal invasive techniques, patient/surgical quality factor may be influenced

Some state's endoscope experts consult with regard to this problem in the recent period, brainstrust, which considers, potential in endoscope-assistant surgery causes tumour to be broadcast Dissipate potential cause:

Wherein tumour exposure is the major reason that may cause Tumor cell dissemination at uterine neck.(but whether these factors are at other Exist in surgical tumor operation, is worth discussion, cannot be bad because of cervical carcinoma data, deny whole hysteroscope technology answering in surgery With)

Patient's qualification, technical ability and different center Quality Controls and major reason simultaneously

1, tumour exposure at uterine neck, causes tumour spread.

It is closed type excision in open surgery.It is closed stump before cutting off uterine neck, tumour is closed.

In endoscope-assistant surgery, most of is directly to cut off vagina under exposure, sends out offer chance to Cervix neoplasms；Mark This is finally deviate from the case where no closed from vagina, even with flushing liquor processing, will also result in potential tumor cell It sends out and plants.

Possible solution:

After cutting off paracolpium, vagina is cut off through yin.

First purse string suture is closed vagina detachment again

The action of domestic expert:

Based on the response of educational circles, gynaecology, the U.S., domestic expert is also taking action.

November 16, by gynecological oncology branch, Chinese Medical Association General Board predecessor, Martin academician convenes domestic main Woman tumor expert, the main influence that LACC result is discussed and brings cervical carcinoma modus operandi form Chinese expert discussion opinion, basic to believe It ceases as follows:

Do not deny the authenticity and preciseness of research, just completely can not negate that Minimally Invasive Surgery is controlled in cervical carcinoma because of two articles Value in treatment.

Actively promoting the benefit and disadvantage that Minimally Invasive Surgery is carefully treated in minimal invasive surgical procedures, it is accordingly required in particular to note: without tumor Principle implementing when cutting off vagina；The variation of CO2 abdominal pressure；Lift the influence of palace cup；The minimal invasive techniques etc. of patient.

Reinforce the supervision and access of hysteroscope simultaneously, payes attention to sufferer and link up.

For this purpose, increasing closing Interruption formula together to Minimally Invasive Surgery is to significantly reduce the effective measures of the metastasis of cancer.

Summary of the invention

An object of the present invention is to provide spring leaf and applies in the operation of organism tubular tissue fracture Seal treatment, this Application takes the lead in introducing spring leaf and is wound in processing to be closed in the operation of organism tubular tissue fracture Seal treatment Concept of the tubular tissue periphery as closing clamp, while it is complete along fracture by tubular tissue to cooperate the enclosed construction in pipe to be able to Closing, without opening up open wound operation in patient abdomen, it is only necessary to be put into spring by original laparoscope puncture outfit operation aperture Spring leaf hoop in vagina pipe outer wall, is carried out adjacent circumferential expansion compressing from the position that intravaginal corresponds to spring leaf by piece, operation clamp , clamping plate effect is served as in inner ring face of spring leaf during this, on the one hand, is different from open resection, can be lacked as far as possible It obtains and leaves the surface of a wound to patient, on the other hand, there is closing clamp, carry out expansion compressing and be just able to tubular tissue being clamped in it Between, process is simple, and efficiency and sealing effect are significantly better than existing manual suture Seal treatment mode.

In order to solve in the operation of prior art organism tubular tissue fracture Seal treatment, modus operandi is lengthy and tedious, wounds Larger technical problem, invention introduces the applications of spring leaf, and spring leaf is specially applied to organism tubular tissue and is broken In mouth Seal treatment operation, spring leaf is wound in the periphery of organism tubular tissue, is used as tubular tissue and bears radial dilatation work Closing clamp firmly；Here in order to constitute reliable " clamping closure " effect, spring leaf is wound in the periphery of tubular tissue, with The equipment of the application radial dilatation active force of tubular tissue inner cavity collectively constitutes " clamping plate ", and tubular tissue is clamped therebetween, is risen To sealing effect, since " clamping plate " described here is circle shape, Gu is named as " clamp ".

Preferably, the application of spring leaf provided by the present application, wherein organism tubular tissue includes vaginal canal, enteron aisle pipe Or foreskin.

Further, the application of spring leaf provided by the present application, wherein Seal treatment operation is in the organism tubulose The press sealed operation of radial dilatation that the interior lumen of tissue carries out.

Further, the application of spring leaf provided by the present application, wherein further include connection structure, the connection structure is set It is placed in spring leaf, the winding for realizing the spring leaf is fixed.

Preferably, the application of spring leaf provided by the present application, wherein connection structure is magnetic connecting structure, the magnetism Connection structure include be set to the positive connector a of the spring leaf and be set to the back side connector b, the connector a and At least one in the connector b has magnetism.

Preferably, the application of spring leaf provided by the present application, wherein connection structure is tooth socket connection structure, the connection knot Structure includes the tooth connection for being set to described spring leaf one end and the link slot for being set to the spring leaf other end.

Preferably, the application of spring leaf provided by the present application, in order to avoid hurting surrounding tissue when being put into spring leaf, and In the later period as in chopping block cutting process, it is ensured that tissue is cut down, wherein the spring leaf is covered with protective layer；It is cutting through Guarantee that cutter head can be cut in protective layer, both can ensure that blade penetrated tissue to be cut in this way in journey.

Preferably, the application of spring leaf provided by the present application, wherein the protective layer is rubber layer and/or layer of silica gel.

Preferably, the application of spring leaf provided by the present application, it also is contemplated that want to pass through laparoscope puncture outfit to spring leaf Inner tube is put into needs spring leaf to have narrow and long design in vivo, meanwhile, after reaching corresponding position, operating space is narrow, can By slightly applying pressure to spring leaf itself, spring leaf can change oneself state, curly, auto reeling is switched to by strip In tube wall periphery to be cut, wherein the spring leaf is snap bracelet.

A second object of the present invention is to provide a kind of fracture closed surgery utensils, including radial dilatation to oppress module, Cooperate the above-mentioned spring leaf of the application, is used for and the spring leaf together constitutes with " clamping plate " of " clamping closure " technical effect.

Spring leaf provided by the invention application and products thereof at organism tubular tissue fracture closing in the prior art Reason mode, which is compared, has the advantage that the application takes the lead in introducing spring in the operation of organism tubular tissue fracture Seal treatment Piece is simultaneously wound in concept of the tubular tissue periphery of processing to be closed as closing clamp, is able to clamp tubular tissue Closing, without opening up open wound operation in patient abdomen, it is only necessary to be put into spring by original laparoscope puncture outfit operation aperture Spring leaf hoop in vagina pipe outer wall, is carried out adjacent circumferential expansion compressing from the position that intravaginal corresponds to spring leaf by piece, operation clamp , clamp effect is served as in inner ring face of spring leaf during this, on the one hand, is different from open resection, can be lacked as far as possible It obtains and leaves the surface of a wound to patient, on the other hand, there is clamp, carry out expansion compressing and be just able to clamp tubular tissue therebetween, work Sequence is simple, and efficiency and sealing effect are significantly better than existing manual suture Seal treatment mode.

Detailed description of the invention

Fig. 1 is chip architecture of the spring schematic diagram of the present invention；

Fig. 2 is variable condition structural schematic diagram of the present invention.

Wherein: 1, spring leaf；2, connector a；3, connector b；4, layer of silica gel.

Specific embodiment

Technical solution of the present invention is elaborated with reference to the accompanying drawing；

In Hysterectomy, needs that vaginal canals are truncated in three centimeters of left-right positions of uterus arched roof extension, be before truncation Prevent the transfer of cancer cell, existing therapeutic modality is divided into two kinds: 1) patient probes into intravaginal measurement above-mentioned three by uterus raising device The vaginal canal suture of three centimeters of positions is tightened manually and carrys out closing cell's transfer in uterus raising device bar, then is passed through in centimetre position Intraperitoneal ultrasound knife is probeed on corresponding vagina outer tube wall from abdomen and punctures an aperture, finally by aperture along vaginal canal Circumferential gradually to shear, such method requires high and operation extremely time-consuming and laborious patient；2) full open model is performed the operation, and is passed through Suture carrys out closing cell's transfer, but the large area suture of postoperative abdominal and the later period of patient restore all to be larger problem.

If realized vagina tube wall by way of " clamping closure " in view of being able to achieve, operation effect will be obviously improved Rate needs " to clamp " processing, it is contemplated that needs at least two clamping plates, which can be realized, is held on vaginal canal wherein, and independent Compressing is extended out in vagina tube wall by the expanding mechanism probeed into from vagina, since vagina tube wall has certain telescopicing performance, is shown " closing " effect cannot be so realized well, at this point, we, which introduce " spring leaf " in the prior art, is used as " closing clamp " Concept, by spring leaf be applied to uterus excising operation, other separation cutting steps be completed after, strip spring leaf is led to It crosses laparoscope puncture outfit to be put into vivo, measures above-mentioned three centimeters of positions using utensil and spring leaf is wound in vaginal canal pair The outer tube wall of above-mentioned three centimeters of positions is answered, specially clamps the two of spring leaf respectively by two clamps under laparoscope auxiliary End, the both ends is fixedly connected by connection structure thereon, expanding mechanism can be operated by vaginal canal in patient at this time It is held between spring leaf and expanding mechanism, forms reliable " clamping closure " effect since then.

Here in order to constitute reliable " clamping closure " effect, spring leaf is wound in the periphery of tubular tissue, with tubulose group The radial dilatation compressing module for knitting inner cavity collectively constitutes " clamping plate ", and tubular tissue is clamped therebetween, sealing effect is played, due to " clamping plate " described here is circle shape, and Gu is named as " closing clamp ".

The present embodiment part introduces the application of spring leaf, and spring leaf is specially applied to organism tubular tissue fracture In Seal treatment operation, spring leaf is wound in the periphery of organism tubular tissue, is used as tubular tissue and bears radial dilatation effect The closing clamp of power；Wherein, organism tubular tissue includes vaginal canal, enteron aisle pipe or foreskin, and Seal treatment operation is in biology The press sealed operation of radial dilatation that the interior lumen of body tubular tissue carries out.

It further, further include connection structure, the connection structure is set to spring leaf, for realizing the spring leaf Winding is fixed.

As further preferred technical solution, connection structure is magnetic connecting structure, and magnetic connecting structure includes setting In the positive connector a of the spring leaf and at least one in the connector b for being set to the back side, connector a and the connector b Has magnetism.

Another scheme of connection structure as the application, wherein connection structure is tooth socket connection structure, the connection Structure includes the tooth connection for being set to described spring leaf one end and the link slot for being set to the spring leaf other end.

Simultaneously in order to avoid hurting surrounding tissue when being put into spring leaf, and in the later period as in chopping block cutting process, really It protects tissue to cut down, wherein the spring leaf is covered with protective layer；Guarantee that cutter head can cut protective layer in cutting process In, it both can ensure that blade penetrated tissue to be cut in this way；Wherein, protective layer is rubber layer and/or layer of silica gel.

Preferred embodiment as the application, it is contemplated that spring leaf is wanted to be put by laparoscope puncture outfit inner tube in vivo, needs Want spring leaf have narrow and long design, meanwhile, reach corresponding position after, operating space is narrow, can by spring leaf from Body slightly applies pressure, and spring leaf can change oneself state, is switched to by strip curly, and auto reeling is in outside tube wall to be cut Week, wherein the spring leaf is snap bracelet.

In addition, present invention also provides a kind of fracture closed surgery utensil, including radial dilatation oppresses module, cooperation is originally The spring leaf of application, is used for and the spring leaf together constitutes with " clamping plate " of " clamping closure " technical effect.

Embodiment 1

Include spring leaf 1 in the present embodiment as the preferred embodiment of the application, is equipped with connection in the side of spring leaf 1 It is specially barb teeth in part a2(the present embodiment), it is correspondingly provided in connector b3(the present embodiment and has in the other side of the spring leaf 1 Body is to open up hole), this effectively limits spring leaf 1 in the disengaging freedom degree of join domain tangential direction, in addition to this, because Be detached from active force there are also radial at tie point for spring leaf 1, thus the present embodiment it is creative by spring leaf 1 and be equipped with hangnail The region of tooth increases sheet magnetic material, and when used spring leaf 1 is ferrimagnet, the region of spring leaf 1 and aperture can not Magnetism must be increased, the opening area of spring leaf 1 can attract with above-mentioned sheet magnetic material to resist radial disengaging active force, limit diameter To freedom degree；When used spring leaf 1 is nonferromugnetic material, the region of spring leaf 1 and aperture also increases sheet magnetic material, The mutual magnetic force of sheet magnetic material at this time on spring leaf 1 attracts to resist radial disengaging active force, limits radial freedom degree.

Application method and principle: first passing through radial dilatation compressing module, in above-mentioned three centimeters of positions to carry out expansion compressing dynamic Make, by cutting off uterus and vaginal canal and its from the ultrasound knife that the nozzle of laparoscope puncture outfit probes into and under the auxiliary of laparoscope Then the connection of hetero-organization probes into two clamps, and is put into above-mentioned spring leaf from nozzle and clamps spring leaf by a clamp One end bypasses vaginal canal, the other end of spring leaf is clamped by another clamp, and by laparoscope, visually radially compressing module is made Spring leaf is previously placed in and heaves vaginal canal region side by the vaginal canal heaved under, controls radial dilatation at this time and oppresses module It shrinks, spring leaf is wound in the corresponding vagina pipe outer wall heaved before, and barb teeth and hole are corresponded into fit on, though this process It is related to being linked and packed, but due to having additional female sheet material, it is close by the also only that barb teeth and hole is close of clamp operation After can automatically pull together under female active force；Radial dilatation compressing module is finally controlled again and extends out movement, by vaginal canal Wall is held between spring leaf and radial dilatation compressing module.

Embodiment 2

On the basis of embodiment 1, the spring leaf 1 in the present embodiment uses snap bracelet, it is a kind of special spring leaf, because It has two kinds of stable states after handling by die mould, and one is exceptionally straight states, and also one is rolled states, and two states are only Low-force, which need to be applied, mutually to be switched, its appearance is since it is considered that narrow in intraperitoneal operating space, to general Logical spring leaf 1 has inconvenience when winding, and after replacing with snap bracelet, auto reeling is may be implemented in snap bracelet after stress, operation It is more convenient.

Embodiment 3

On the basis of embodiment 2, it is equipped with barb teeth in the front of snap bracelet, is equipped at the back side of snap bracelet opposite with barb teeth Therefore the tooth socket answered or aperture (aperture in the present embodiment) have no since snap bracelet has the characteristic independently wound in join domain Radial disengaging active force, the freedom degree of join domain tangential direction can be limited by above-mentioned barb teeth, is formed a fixed connection.

Embodiment 4

On the basis of embodiment 3, in snap bracelet upper layer of silica gel 4, on the one hand facilitate to protect abdominal cavity inner tissue, another party Face, when carrying out circumferentially cutting in lumen, it can be ensured that cutter head penetrating tubular tissue can ensure that tubulose until in layer of silica gel 4 Tissue is cut completely.

Last institute it is noted that the above specific embodiment is only used to illustrate the technical scheme of the present invention and not to limit it, Although the invention is described in detail with reference to an embodiment, those skilled in the art, which answer, to be understood, can be to this hair Bright technical solution is modified and equivalent replacement, without departing from the spirit and scope of the technical solution of the present invention, should all cover In the scope of the claims of the present invention.

Claims (10)

1. the application of spring leaf, it is characterised in that: the spring leaf is applied to organism tubular tissue fracture Seal treatment hand In art, the spring leaf is wound in the periphery of the organism tubular tissue, is used as the tubular tissue and bears radial dilatation work Closing clamp firmly.

2. application according to claim 1, it is characterised in that: the organism tubular tissue includes vaginal canal, enteron aisle pipe Or foreskin.

3. application according to claim 1, it is characterised in that: the Seal treatment operation is in the organism tubulose group The press sealed operation of radial dilatation that the interior lumen knitted carries out.

4. application according to claim 1, it is characterised in that: further include connection structure, the connection structure is set to bullet Reed, the winding for realizing the spring leaf are fixed.

5. application according to claim 4, it is characterised in that: the connection structure is magnetic connecting structure, the magnetism Connection structure include be set to the positive connector a of the spring leaf and be set to the back side connector b, the connector a and At least one in the connector b has magnetism.

6. application according to claim 4, it is characterised in that: the connection structure is tooth socket connection structure, the connection Structure includes the tooth connection for being set to described spring leaf one end and the link slot for being set to the spring leaf other end.

7. application described according to claim 1~any one of 6, it is characterised in that: the spring leaf is covered with protective layer.

8. application according to claim 7, it is characterised in that: the protective layer is rubber layer and/or layer of silica gel.

9. according to claim 1~6, application described in any one of 8, it is characterised in that: the spring leaf is snap bracelet.

10. a kind of fracture closed surgery utensil, it is characterised in that: including spring leaf according to any one of claims 1 to 9, And radial dilatation oppresses module.