CN110301994A - A kind of artificial ileocaecal sphineter device - Google Patents
A kind of artificial ileocaecal sphineter device Download PDFInfo
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- CN110301994A CN110301994A CN201910725312.1A CN201910725312A CN110301994A CN 110301994 A CN110301994 A CN 110301994A CN 201910725312 A CN201910725312 A CN 201910725312A CN 110301994 A CN110301994 A CN 110301994A
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- ileocaecal sphineter
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- 238000002347 injection Methods 0.000 claims abstract description 20
- 239000007924 injection Substances 0.000 claims abstract description 20
- 238000012544 monitoring process Methods 0.000 claims abstract description 18
- 238000007789 sealing Methods 0.000 claims abstract description 5
- 210000000481 breast Anatomy 0.000 claims abstract description 4
- 230000000968 intestinal effect Effects 0.000 claims description 20
- 230000002452 interceptive effect Effects 0.000 claims description 8
- 239000000463 material Substances 0.000 claims description 7
- 229910045601 alloy Inorganic materials 0.000 claims description 5
- 239000000956 alloy Substances 0.000 claims description 5
- 230000005540 biological transmission Effects 0.000 claims description 5
- 235000001674 Agaricus brunnescens Nutrition 0.000 claims description 3
- 229910001069 Ti alloy Inorganic materials 0.000 claims description 3
- 210000004400 mucous membrane Anatomy 0.000 claims description 3
- 229920002620 polyvinyl fluoride Polymers 0.000 claims description 3
- 239000000919 ceramic Substances 0.000 claims description 2
- 238000003780 insertion Methods 0.000 claims description 2
- 230000037431 insertion Effects 0.000 claims description 2
- 229910000531 Co alloy Inorganic materials 0.000 claims 1
- 210000000813 small intestine Anatomy 0.000 abstract description 17
- 210000000936 intestine Anatomy 0.000 abstract description 8
- 206010051399 Mechanical ileus Diseases 0.000 abstract description 4
- 230000000151 anti-reflux effect Effects 0.000 abstract description 3
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- 238000010586 diagram Methods 0.000 description 5
- 241000894006 Bacteria Species 0.000 description 4
- 206010012735 Diarrhoea Diseases 0.000 description 4
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- 208000002720 Malnutrition Diseases 0.000 description 3
- 208000012868 Overgrowth Diseases 0.000 description 3
- 239000002775 capsule Substances 0.000 description 3
- 210000001072 colon Anatomy 0.000 description 3
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 3
- 238000006073 displacement reaction Methods 0.000 description 3
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
- A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
Abstract
The present invention relates to a kind of artificial ileocaecal sphineter devices, including enteron aisle overlay film frame, artificial valve and pressure monitoring control assembly；The enteron aisle overlay film frame includes pipe-shaped net rack and the annular air-pocket set on two head end of network；The annular air-pocket is equipped with gas injection port and air injection pipe with sealing structure, sets check valve in air injection pipe；Overlay film is equipped in the outside wall surface of network；The artificial valve is fixed on pipe-shaped net rack bosom position by fixed ring, and flowing between end and outflow end has the valve axis for limiting and longitudinally extending along outflow direction；The artificial valve includes three valve leaflets and is used to support the valve leaflet and limits the frame assembly of multiple joint portions.The device can rebuild well ileocaecal sphineter and more meet physiological status, can play the role of anti-reflux and small intestine contents is delayed to empty.In addition, the device with real-time monitoring intestines cavity pressure and can be adjusted, the generation of mechanical ileus is avoided.
Description
Technical field
The present invention relates to enteron aisles to rebuild field of medical technology, and in particular to a kind of artificial ileocaecal sphineter device.
Background technique
Human body ileocaecal sphineter has sphincter function, and not only there is control chyme to slowly enter large intestine, make chyme in small intestine
Inside there is time enough to stop and sufficiently digested and absorbed；It can prevent colonic contents adverse current from entering small intestine again simultaneously, avoid
The effect of bacterial translocation and small Overgrowth of intestinal bacteria.Clinically, one often is caused because certain diseases need to cut off ileocaecal sphineter
Determine the intestinal physiology dysfunction of degree.After ileocaecal sphineter excision, loses it and delay small intestine discharge and anti-reflux effect, on the one hand hold
It easily causes digestion and absorption function bad, a series of complication occurs, such as intractable diarrhea, malnutrition, weight loss, growth
Hypoevolutism, liposoluble vitamin (vitamin A. D. E, K) and vitamin B12Malabsorption etc.；On the other hand make containing a large amount of thin
The colonic contents of bacterium backflow, and secondary small enteral Flora Disturbance causes cholate that cannot be combined, and further promote intestines intracavity liquid
Secretion increases, and generates a large amount of exudative diarrheas and the consumption of cholate library, finally causes malabsorption and small Overgrowth of intestinal bacteria.
In addition, small Overgrowth of intestinal bacteria will lead to again, gut muco-membranous barrier function is impaired, aggravates generation, the hair of enterogenic infection
Even there is intestines source property hepatic lesion and Intestinalis in exhibition, serious person.
In order to improve ileocaecal sphineter excision rear intestinal physiological dysfunction, early in the nineties in last century, domestic and international many scholars
The trial for just having done multiple analog ileocaecal sphineter function is inverted art, intestinal loop circle anastomosis, intestinal tube chamber constriction including small intestinal segment
Art, small intestine sleeve type anastomosis etc., but overall effect is not very ideal.In addition due to the limitation of scientific and technological level at that time,
It is not possible to carry out real-time monitoring to ileocaecal sphineter pressure and adjust in vitro, therefore tend to the wind for causing mechanical ileus to occur
Danger.In view of a variety of odjective causes, there is not yet there is the report for studying artificial ileocaecal sphineter in nearly more than ten year since 21 century again.And in length
We are more, it is realized that ileocaecal sphineter excision seriously affects the quality of life and disease prognosis of patient in the clinical practice of phase.Especially
For the patient that extensive small bowel resection and right hemicolon are cut off, often absorbed with intractable diarrhea, nutrient digestion
The complication such as obstacle, malnutrition.Therefore, how preferably to rebuild ileocaecal sphineter and it is allowed to have become close to physiological status and control
Treat ileocaecal sphineter excision patient major issue urgently to be resolved.
Summary of the invention
The purpose of the present invention constructs a kind of artificial ileocaecal sphineter device, which can rebuild well ileocaecal sphineter and more meet
Physiological status can play the role of anti-reflux and small intestine contents is delayed to empty.Furthermore, it is possible to real-time monitoring intestines cavity pressure
And be adjusted, avoid the generation of mechanical ileus.
To achieve the above object, present invention provide the technical scheme that
A kind of artificial ileocaecal sphineter device, including enteron aisle overlay film frame, artificial valve and pressure monitoring control assembly；The intestines
Road overlay film frame includes pipe-shaped net rack and the annular air-pocket set on two head end of network；The annular air-pocket is equipped with
Gas injection port and air injection pipe with sealing structure set check valve in air injection pipe；Overlay film is equipped in the outside wall surface of network；It is described
Artificial valve includes flowing into end, outflow end, fixed ring, valve leaflet, joint part and frame assembly；The artificial valve passes through
Fixed ring is fixed on pipe-shaped net rack bosom position, and flowing between end and outflow end has restriction longitudinal along outflow direction
The valve axis of extension；The artificial valve includes three valve leaflets and is used to support the valve leaflet and limits multiple companies
The frame assembly of portion is closed, the commissure, which is divided into, is mounted on fixed ring upper cantilever formula structure, the tip energy of joint part
Enough mobile relative to the fixed ring, the valve leaflet is connected on frame assembly by joint part, the joint part
Valve is mobile independently of the fixed ring when fixed ring being enable to be fixed on pipe-shaped net rack.
Further, the network head end is in mushroom-head shape, and the diameter of the annular air-pocket is greater than network
The outer diameter of head end.
Further, the pressure monitoring control assembly includes the pressure sensitive control positioned at artificial valve intake side end wall
Device and external wireless monitor controller.
Further, the pressure monitoring control assembly includes the first electronic control system and the second electronic control system；
First electronic control system includes first singlechip, the first power supply, pressure sensitive controller, the first wireless receiver,
One wireless transmitter；First power supply is the power supply of the first electronic control system；The pressure sensitive controller is piezoelectric ceramics
Piece, pressure sensor are equipped with wireless signal transmitter, and wireless signal transmitter is by being wirelessly connected with controlling terminal；The pressure
Power induction controller, the first wireless receiver, the first wireless transmitter are connect with first singlechip signal.
Further, second electronic control system includes second singlechip, second source, man-machine interactive operation dress
It sets, display, the second wireless receiver, the second wireless transmitter；The second source is the power supply of the second electronic control system, institute
Man-machine interactive operation device, display, the second wireless receiver, the second wireless transmitter is stated to connect with second singlechip signal.
Further, the external wireless monitor controller includes display, wireless transmission/reception window, box body, man-machine friendship
Interoperate key.
Further, the material of the network is cobalt-base alloys, nickel-base alloy or titanium alloy.
Further, network outside wall surface also covers one layer of overlay film, for preventing human body intestinal canal mucous membrane tissue to be embedded in net
In shape bracket, the material of the overlay film is polyvinyl fluoride.
Further, annular air-pocket is sheathed in the outside wall surface of network head end, or is directly affixed on network head
On the end face at end.
Further, the open default pressure value of pressure sensitive controller control artificial valve is 20mmHg.
Compared with prior art, the beneficial effects of the present invention are:
Artificial ileocaecal sphineter device of the invention can rebuild well ileocaecal sphineter and more meet physiological status, can play anti-
The effect backflowed and small intestine contents is delayed to empty.Further, since the device is equipped with pressure monitoring and adjustment equipment, it can be real-time
Monitoring intestines cavity pressure is simultaneously adjusted, and avoids the generation of mechanical ileus.Resection of small intestine extensive for row or right half
For the patient of colectomy, which has slowed down the speed that small intestine is emptied to colon, avoid or reduces digestion
Absorb disorder, maintain enteral relatively sterile, be more conform with physiological function, can significantly improve due to ileocaecal sphineter cut off it is subsequent
The complication such as intractable diarrhea, malnutrition and the Flora Disturbance of hair.
Detailed description of the invention
Fig. 1: the structural schematic diagram of enteron aisle overlay film frame.
Fig. 2: the structural schematic diagram of artificial valve.
The structural schematic diagram of Fig. 3: the first electronic control system.
The structural schematic diagram of Fig. 4: the second electronic control system.
Fig. 5: the structural schematic diagram of external pressure monitoring control device.
In figure: 1- network, 2- annular air-pocket, 3- overlay film, 4- check valve, 5- air injection pipe, 6- sealing-plug, 7- are fixed
Ring, 8- valve leaflet, 9- joint part, 10- display, 11- wireless transmission/reception window, 12- box body, 13- man-machine interactive operation
Key.
Specific embodiment
The present invention is further explained in the light of specific embodiments.
A kind of artificial ileocaecal sphineter device, including 3 bracket of enteron aisle overlay film, artificial valve and pressure monitoring control assembly；It is described
3 bracket of enteron aisle overlay film includes pipe-shaped net rack 1 and the annular air-pocket 2 set on 1 liang of head end of network；The network
1 head end is in mushroom-head shape, and the diameter of the annular air-pocket 2 is greater than the outer diameter of 1 head end of network；On the annular air-pocket 2
Equipped with the gas injection port with sealing structure and air injection pipe 5, check valve 4 is set in air injection pipe 5；It is equipped in the outside wall surface of network 1
Overlay film 3；The artificial valve includes flowing into end, outflow end, fixed ring 7, valve leaflet 8, joint part 9 and frame assembly；Institute
It states artificial valve and 1 bosom position of pipe-shaped net rack is fixed on by fixed ring 7, flowing into has limit between end and outflow end
The fixed valve axis longitudinally extended along outflow direction；The artificial valve includes multiple valve leaflets 8 and is used to support the valve
Film leaflet 8 and limit multiple joint parts 9 position frame assembly, the joint part 9 be mounted on 7 upper cantilever of fixed ring
The tip of formula structure, joint part 9 can be mobile relative to the fixed ring 7, and the valve leaflet 8 is connected by joint part 9
It connects on frame assembly, valve is independently of described solid when the joint part 9 enables fixed ring 7 to be fixed on pipe-shaped net rack 1
It is mobile to determine ring 7.
The pressure monitoring control assembly includes positioned at the pressure sensitive controller of artificial valve intake side end wall and external
Wireless monitor controller.
The pressure monitoring control assembly includes the first electronic control system of pressure sensitive controller and wirelessly supervises in vitro
Survey the second electronic control system of controller；First electronic control system includes first singlechip, the first power supply, feeling of stress
Answer controller, the first wireless receiver, the first wireless transmitter；First power supply is the power supply of the first electronic control system, institute
Pressure sensitive controller, the first wireless receiver, the first wireless transmitter is stated to connect with first singlechip signal.
Second electronic control system includes second singlechip, second source, man-machine interactive operation device, display
10, the second wireless receiver, the second wireless transmitter；The second source is the power supply of the second electronic control system, described man-machine
Interactive operation device, display 10, the second wireless receiver, the second wireless transmitter are connect with second singlechip signal.
The external wireless monitor controller includes display 10, wireless transmission/reception window 11, box body 12, human-computer interaction
Operation button 13.
The material of the network 1 is cobalt-base alloys, nickel-base alloy or titanium alloy, and the above material all has good life
Object compatibility and elasticity, the intestinal stent as made from these materials have superior function, have good bullet under body temperature environment
Property, it can be deformed with normal intestines peristalsis, enteron aisle is made not only to have kept clear but also without discomfort.1 outside wall surface of network is also covered
If one layer of overlay film 3 made of polyvinyl fluoride, can prevent in human body intestinal canal mucous membrane tissue insertion network 1, convenient for from now on
The taking-up of artificial ileocaecal sphineter.The head end of network 1 is in mushroom-head shape, can increase the expansion of entire intestinal stent head end
Power allows entire intestinal stent to be more stably fixed in enteron aisle.The head end of network 1 is additionally provided with annular air-pocket 2, annular gas
Capsule 2 can be sheathed in the outside wall surface of 1 head end of network, or be directly affixed on the end face of 1 head end of network.Annular gas
The sealing structure of 2 gas tube of capsule is check valve 4, and check valve 4 is connected with air injection pipe 5, and doctor can be convenient and fast by air injection pipe 5
For the inflation of annular air-pocket 2.It, only need to be from the connecting portion of air injection pipe 5 and check valve 4 by air injection pipe 5 after annular air-pocket 2 is full of gas
Cutting.
Before artificial ileocaecal sphineter implantation enteron aisle, annular air-pocket 2 is in unaerated state, after implantation, the annular gas of inflated condition
Outer diameter of the capsule 2 equivalent to increase 1 head end of network, allows the connection for hanging on small intestine and colon that entire intestinal stent is stable
Position avoids being subjected to displacement or falling off because of the wriggling of enteron aisle.The mushroom-head shape phase of annular air-pocket 2 and 1 head end of network
Benefit evident: when the head end of network 1 is not in mushroom-head shape, annular air-pocket 2 is easy to make intestinal stent by enteron aisle compressive strain
Generate the possibility of displacement；When the head end of network 1 is in mushroom-head shape, but when not setting annular air-pocket 2, enteron aisle branch in order to prevent
Frame displacement, must just increase the size of mushroom head, after mushroom head becomes larger, make troubles to the taking-up of intestinal stent from now on.
And annular air-pocket 2 and mushroom-head shape it is common be arranged can allow entire intestinal stent be more stably fixed in enteron aisle and
Convenient for taking out intestinal stent in the future.
The pressure monitoring control assembly includes pressure sensitive controller, the first electronic control system, the first power supply, second
Electronic control system and second source.First electronic control system is as shown in figure 3, by first singlechip and respectively with first
The first wireless receiver and the first wireless transmitter composition of single-chip microcontroller connection.Described second electronic control system such as Fig. 4, Fig. 5
The second wireless receiver, the second wireless transmitter, man-machine friendship shown, connect by second singlechip and respectively with second singlechip
Interoperate key 13 and the composition of display 10.The pressure sensitive controller incudes intestinal stent in real time and flows into end small intestine internal pressure
Power, according to the opening and closing of pressure value control artificial valve in small intestine, when pressure value is higher than preset pressure value in small intestine, artificial valve
Automatic opening, small intestine contents enter colon, and pressure drops to preset value hereinafter, artificial valve closing, is adjusted small in real time in small intestine
Enteral pressure state.The open default pressure value of pressure sensitive controller control artificial valve is 20mmHg (under physiological status
Ileocaecal sphineter area static pressure is about 20mmHg)；The pressure sensitive controller by with external second electronic control system without
Line connection, real-time monitoring flows into pressure in the small intestine of end, and is adjusted when necessary according to patient symptom.
The method for implantation of the artificial ileocaecal sphineter are as follows: the artificial ileocaecal sphineter is implanted into small intestine and knot in surgical laparotomy operation
Intestines junction.After artificial ileocaecal sphineter implantation, inflated by air injection pipe 5 to annular air-pocket 2 using syringe or other air charging systems；It connects
Air injection pipe 5 is cut along air injection pipe 5 and the connecting portion of check valve 4 using instrument.
The above is only presently preferred embodiments of the present invention, is not intended to limit the present invention in any form, any ripe
Professional and technical personnel is known, without departing from the scope of the present invention, according to the technical essence of the invention, to the above reality
Any simple modifications, equivalent substitutions and improvements etc. made by example are applied, it is fallen within the scope of protection of the technical scheme of the present invention
It is interior.
Claims (10)
1. a kind of artificial ileocaecal sphineter device, it is characterised in that: including enteron aisle overlay film frame, artificial valve and pressure monitoring control group
Part；The enteron aisle overlay film frame includes pipe-shaped net rack and the annular air-pocket set on two head end of network；The annular
Air bag is equipped with gas injection port and air injection pipe with sealing structure, sets check valve in air injection pipe；In the outside wall surface of the network
Equipped with overlay film；The artificial valve includes flowing into end, outflow end, fixed ring, valve leaflet, joint part and frame assembly；Institute
It states artificial valve and pipe-shaped net rack bosom position is fixed on by fixed ring, flowing into has restriction between end and outflow end
The valve axis longitudinally extended along outflow direction；The artificial valve includes three valve leaflets and to be used to support the valve small
Leaf and the frame assembly for limiting multiple joint portions；The commissure, which is divided into, is mounted on fixed ring upper cantilever formula structure, even
The tip for closing part can be mobile relative to the fixed ring；The valve leaflet is connected to frame assembly by joint part
On；Valve is mobile independently of the fixed ring when joint part enables fixed ring to be fixed on pipe-shaped net rack.
2. a kind of artificial ileocaecal sphineter device according to claim 1, it is characterised in that: the network head end is in mushroom
Head shapes, the diameter of the annular air-pocket are greater than the outer diameter of network head end.
3. a kind of artificial ileocaecal sphineter device according to claim 1, it is characterised in that: the pressure monitoring control assembly packet
Include the pressure sensitive controller and external wireless monitor controller positioned at artificial valve intake side end wall.
4. a kind of artificial ileocaecal sphineter device according to claim 3, it is characterised in that: the pressure monitoring control assembly packet
Include the first electronic control system and the second electronic control system；First electronic control system includes first singlechip, first
Power supply, pressure sensitive controller, the first wireless receiver, the first wireless transmitter；First power supply is the first electronic control
System power supply；The pressure sensitive controller is piezoelectric ceramics piece, and pressure sensor is equipped with wireless signal transmitter, wireless communication
Number transmitter is by being wirelessly connected with controlling terminal；The pressure sensitive controller, the first wireless receiver, the first wireless transmission
Device is connect with first singlechip signal.
5. a kind of artificial ileocaecal sphineter device according to claim 4, it is characterised in that: the second electronic control system packet
Include second singlechip, second source, man-machine interactive operation device, display, the second wireless receiver, the second wireless transmitter；
The second source is the power supply of the second electronic control system, the man-machine interactive operation device, display, the second wireless receiving
Device, the second wireless transmitter are connect with second singlechip signal.
6. a kind of artificial ileocaecal sphineter device according to claim 5, it is characterised in that: the external wireless monitor controller
Including display, wireless transmission/reception window, box body, man-machine interactive operation key.
7. a kind of artificial ileocaecal sphineter device according to claim 1, it is characterised in that: the material of the network is cobalt
Based alloy, nickel-base alloy or titanium alloy.
8. a kind of artificial ileocaecal sphineter device according to claim 1, it is characterised in that: network outside wall surface covers one layer
Overlay film, for preventing in human body intestinal canal mucous membrane tissue insertion network, the material of the overlay film is polyvinyl fluoride.
9. a kind of artificial ileocaecal sphineter device according to claim 1, it is characterised in that: annular air-pocket is sheathed on network
In the outside wall surface of head end, or directly it is affixed on the end face of network head end.
10. a kind of artificial ileocaecal sphineter device according to claim 3, it is characterised in that: the pressure sensitive controller control
The open default pressure value of artificial valve processed is 20mmHg.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910725312.1A CN110301994B (en) | 2019-08-07 | 2019-08-07 | Manual blind flap device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910725312.1A CN110301994B (en) | 2019-08-07 | 2019-08-07 | Manual blind flap device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CN110301994A true CN110301994A (en) | 2019-10-08 |
| CN110301994B CN110301994B (en) | 2024-01-26 |
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ID=68083321
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201910725312.1A Active CN110301994B (en) | 2019-08-07 | 2019-08-07 | Manual blind flap device |
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| Country | Link |
|---|---|
| CN (1) | CN110301994B (en) |
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| US20110160836A1 (en) * | 2008-06-20 | 2011-06-30 | Vysera Biomedical Limited | Valve device |
| CN104116506A (en) * | 2014-07-09 | 2014-10-29 | 周国华 | Ileocecal valve function test and endoscopic pressure measuring system |
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| US20180177623A1 (en) * | 2016-12-23 | 2018-06-28 | Alexander S. Ganz | Obesity treatment devices, systems, and methods |
| CN210843626U (en) * | 2019-08-07 | 2020-06-26 | 南京鼓楼医院 | Artificial ileocecal valve device |
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| WO2009153768A1 (en) * | 2008-06-20 | 2009-12-23 | Vysεra Biomedical Limited | Esophageal valve |
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