CN1352539A - Vascular surgery - Google Patents

Vascular surgery Download PDF

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Publication number
CN1352539A
CN1352539A CN99816494A CN99816494A CN1352539A CN 1352539 A CN1352539 A CN 1352539A CN 99816494 A CN99816494 A CN 99816494A CN 99816494 A CN99816494 A CN 99816494A CN 1352539 A CN1352539 A CN 1352539A
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China
Prior art keywords
member
connector
spike
graft
portion
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CN99816494A
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Chinese (zh)
Inventor
阿米尔·洛沙科夫
伊多·凯尔姆尼克
德菲尔·克伦
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拜帕斯公司
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Priority to IL12906799A priority Critical patent/IL129067D0/en
Priority to PCT/IL1999/000285 priority patent/WO1999062408A1/en
Priority to PCT/IL1999/000284 priority patent/WO1999062415A1/en
Application filed by 拜帕斯公司 filed Critical 拜帕斯公司
Publication of CN1352539A publication Critical patent/CN1352539A/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00637Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for sealing trocar wounds through abdominal wall
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646Type of implements
    • A61B2017/00663Type of implements the implement being a suture
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646Type of implements
    • A61B2017/00668Type of implements the implement being a tack or a staple
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00867Material properties shape memory effect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body

Abstract

本发明涉及一个用于将移植血管连接在目标血管上的吻合连接器,该连接器包括一个适于与移植血管的一部分相连接的细安装环部分(104);和一个适于安装在所述安装环部分上的独立的尖钉部分(124),并且每个尖钉部分包括数个尖钉(126),每个所述尖钉(126)都适于刺穿所述移植血管。 The present invention relates to a connector for the graft vessel at the anastomosis connector on the target vessel, the connector mounting includes a thin ring portion (104) adapted to a portion of the graft vessel connected; and adapted to be mounted on a said separate mounting spike portion (124) of the ring portion, and each spike portion comprising a plurality of spikes (126), each of said spikes (126) are adapted to pierce the graft vessel. 优选该连接器包括至少一个用于使所述尖钉部分(124)和所述安装环部分(104)相互锁定的锁定件。 Preferably the connector includes at least one portion of said spike (124) and the mounting ring portion (104) locking the locking member to each other. 优选该锁定件在两部分之间提供一种弹簧运动。 Preferably the locking member provides a spring movement between the two parts.

Description

血管手术 Vascular surgery

相关专利申请本发明是PCT专利申请PCT/IL99/000284和PCT专利申请PCT/IL99/000285的继续申请,这两个专利都指定美国,它们的公开都被并入本专利,以作为参考。 RELATED APPLICATIONS The present invention is a PCT Patent Application PCT / IL99 / 000284 and PCT Patent Application PCT / continuation application IL99 / 000285, which designated the United States are two patents, the disclosures of which patents are incorporated herein, by reference.

发明领域本发明涉及血管吻合术的实施。 Field of the Invention The present invention relates to vascular anastomosis.

发明背景连接两条血管,即血管吻合,是修复、治疗和整形手术中的一项重要的手术技术。 BACKGROUND OF THE INVENTION connecting two blood vessels, ie vascular anastomosis, a repair, plastic surgery, and treatment is an important surgical technique. 旧的吻合标准是以侧对侧、端对端或端对侧的结构手工缝合两条血管。 The old standard is consistent with structure hand side to side, end to end or side contralateral suturing two blood vessels. 尽管通常对任何手术过程而言我们都希望能够缩短其持续时间,但这对于冠状动脉旁外科手术而言是特别重要的,在这种手术中,病人通常与一个心脏-肺机器相连接,而病人的心脏通常停止跳动。 Although generally for any surgical procedure, we all want to be able to shorten its duration, but for coronary artery bypass surgery is particularly important in this kind of surgery, the patient usually associated with a heart - lung machine is connected, and usually the patient's heart stops beating.

除了对血管进行手工缝合之外,目前还有一些连接血管的其它方法,包括U形钉和吻合环。 In addition to manual suturing blood vessels, there are still some other method of connecting a blood vessel, comprising a U-shaped staple and the anastomotic ring. PCT专利公开号WO97/40754和WO97/28749描述了用于冠状动脉旁外科手术的U形钉,其中一条移植血管在其一端与主动脉相连,而在其另一端与一条闭塞的冠状动脉相连接,连接位置位于闭塞位置的远侧。 PCT Patent Publication No. WO97 / 40754 and WO97 / 28749 describes a U-shaped staples for coronary bypass surgery in which a graft vessel is connected to the aorta at one end thereof, and at its other end is connected to a coronary artery occlusion distal connector located in the closed position. 在这种类型的手术中,通过将移植血管钉在主动脉上对吻合进行密封,同时将主动脉和移植血管一起压靠在一个砧上。 In this type of surgery, to seal the anastomosis aortic graft by nails, and while the aortic graft with a pressed against the anvil. 在一种公布方案中,为了进行钉合,该砧被插入主动脉,然后可能通过将砧拆开的方式将其移走。 In one embodiment the publication, in order to perform stapling, the anvil is inserted into the aorta, and possibly through the anvil detachable manner to remove it. 在另一种公布方案中,移植血管的一端外翻在一个环形砧上,从而使该砧一直处在血管的外侧。 In another embodiment the released one end of the graft vessel everted over an annular anvil such that the anvil has been in the outer vessel.

最近,旁外科手术中已经采用了最小化侵入(通孔)手术。 Recently, beside surgery has been employed in minimally invasive (through-hole) surgery. 在这种手术中,在胸部开一个小孔,从而取代断开肋骨,并且乳房动脉(例如左内乳房动脉(LIMA),右内乳房动脉(RIMA))被用作分流移植血管。 In this procedure, a small hole in the chest, so that the ribs substituted disconnected, and mammary artery (e.g. the left mammary artery (LIMA), right internal mammary artery (RIMA)) is used as a bypass graft. 该缝合或钉合是通过使用如上面所述的工具来实施的。 The suturing or stapling is by using a tool as described above according to the embodiment.

一种侵入程度更小的手术甚至不需要在胸部开口,而是通过采用一种预切割方式将一个或多个导管引入血管。 An invasive surgical smaller degree even need to open the chest, but by use of a pre-cut manner the one or more conduits introduced into the vessel. PCT专利G公开号WO97/27898、WO97/13471和WO97/13463和它们的优先权文件,即美国专利申请60/010,614、60/005,164、08/730,327和08/730,496描述了对动脉闭塞进行预切割处理的方法和设备,这些公开专利申请被并入本专利以作为参考,并且被称为“血管吻合专利申请”。 G PCT Patent Publication No. WO97 / 27898, WO97 / 13471 and WO97 / 13463 and their priority document, namely U.S. Patent Application No. 60 / 010,614,60 / 005,164,08 / 730,327 and 08 / 730,496 describes a pre-cut artery occlusion method and apparatus for processing these published patent applications are incorporated by reference in this patent, and referred to as "vascular anastomosis patent application." 这些专利主要包括两种方法。 These patents mainly include two methods. 在一种方法中,在组织(血管外部)中从闭塞位置的一侧至闭塞位置的另一侧开一个管道,并且一个伸展的或或一个伸展/移植血管可以被置入该管道。 In one method, tissue (external blood vessel) in a position closing the opening from one side to the other side of the conduit a closing position, and a stretchable or an extended or / graft may be placed in the duct. 在另一种方法中,一种便于置入的脉管或移植血管与闭塞的血管相连接,并且在闭塞的血管和分流经过闭塞部分的脉管或移植血管之间建立两个侧对侧的吻合。 In another method, for facilitating placement of vascular grafts with or occluded blood vessel is connected, and the establishment of two side to side passes between the blocking portion of the vessel or vascular graft occlusion and shunt agreement. 该脉管的远端和近端部分可以通过多种方式进行封闭。 Distal and proximal portions of the vessel may be closed in various ways. 脉管和动脉之间的连接可通过将两血管粘接来实现,或者通过采用优选的各种连接器来实现。 The connection between the two vessels and arteries may be achieved vessel adhesive is preferably achieved by using various connectors by, or. 其中一种公开的连接器包括两个弹簧,这两个弹簧通过一个可能未伸展的移植血管的一小段相互分开。 One disclosed connector comprises two springs, the two springs by a short stretch of the graft may not separated from each other. 该弹簧呈倒漏斗形,从而两血管可被挤在一起。 The inverted funnel-shaped spring, so that two vessels can be squeezed together. 当两血管之间存在一定间距时,优选采用各种不同技术和/或装置来阻止周围的组织压迫脉管和动脉之间的连接处。 When there is some distance between the two vessels, preferably using a variety of different techniques and / or devices to prevent the connection between the artery and the vascular compression of the surrounding tissue. 采用各种类型的连接器的目的是通过使接触或通过压迫血管间的组织来维持两血管相互靠近,从而大体确保没有血液从连接器和血管之间的连接处渗出。 Various types of connectors employed by contacting the object or vessel by means of compressed tissue between two blood vessels is maintained close to each other, thereby substantially ensuring no blood oozing from the connection between the connector and the blood vessels.

在一种TIPS过程中,一个伸展件被置入一个通道中,该通道被预先开设在门静脉和肝静脉之间。 In a TIPS process, a stretching member is placed in a channel, the channel is opened between the previously portal vein and hepatic veins. 如在上文的某些实施例中所述,血管间的相对位置是通过两血管周围或之间的相对坚实的组织的存在来维持的。 In certain embodiments, as described above, the relative position of the blood vessel is maintained by the presence of a relatively strong tissue between two blood vessels or peripheral. 这样,就没必要要求连接器的一端和与之相连的各条血管的之间的连接部分本身达到完全防渗漏。 Thus, there is no need requires a connection portion between the end of the connector and the pieces connected thereto a blood vessel to achieve complete itself against leakage.

1998年3月互联网WWW上公开的文献“http://me210abc.standford.edu/94-95/projects/Pfizer/Spring/1.html”描述了一种用于减小旁外科手术的复杂性的方法,该公开的文献被并入本专利以作为参考。 March 1998 disclosed in the literature on the Internet WWW "http://me210abc.standford.edu/94-95/projects/Pfizer/Spring/1.html" describes a method for complexity reduction surgery next the method, disclosed in the patent documents are incorporated by reference. 在这种方法中,一个移植血管穿过皮肤进入主动脉,并且从一个位于旁外科手术位置附近的切口中穿出。 In this method, a graft into the aorta through the skin, and is located near from a position near the surgical incision piercing. 胸部开有一个通孔,用于引入一个工具,从而将移植血管缝合或钉合在主动脉以及将被分流的冠状动脉上。 Chest is opened a through hole for introducing a tool, whereby the suturing or stapling graft in the aorta and the coronary artery to be split.

移植血管与冠状动脉的连接特别困难,这是因为该动脉通常处于不健全状态,并且很薄弱,容易被损伤。 Graft coronary connected particularly difficult, because the artery is generally inadequate state, and very weak, easily damaged.

许多人患有周围血管阻塞症。 Many people suffer from peripheral vascular occlusion. 这些病症的典型治疗方法是施行腹动脉分流术、股动脉分流术或施行一种股-腘动脉分流术。 Typical treatment for these disorders is implemented abdominal artery bypass surgery, the femoral artery bypass surgery or administration of one kind femoral - popliteal artery bypass surgery.

发明概要本发明的若干优选实施例的一方面涉及一种自锁吻合装置,该装置包括一个安装环部分和一个包括数个相互连接的尖钉的尖钉部分,优选这两部分都由一种片状材料或管材加工而成,并优选采用相同的材料。 SUMMARY OF THE INVENTION Several preferred embodiments of an aspect of the present invention relates to a self-locking embodiment of the anastomotic device, the apparatus comprising a ring portion and comprising a plurality of interconnected spikes of the spike portion is mounted, preferably by one kind of the two parts tubing or sheet material processing, and preferably the same material. 在本发明的一个优选实施例中,该尖钉部分锁定在安装环部分上,从而使该吻合装置一旦被安装好就不会自动打开。 In a preferred embodiment of the present invention, the spike mounting portion locked on the ring portion, such that the stapling apparatus once installed will not automatically open. 在本发明的一个优选实施例中,该吻合装置由两个组件构成,一个尖钉部分和一个安装环部分。 In a preferred embodiment of the present invention, the anastomotic device consists of two components, a spike portion and a ring portion mounted. 或者,这两部分可以被合并为一个单体件。 Alternatively, the two parts may be combined into a single piece. 在本发明的一个优选实施例中,该锁定部分具有一定的弹性,从而例如允许两个部分产生轴向相对运动。 In a preferred embodiment of the present invention, the locking portion has a certain elasticity, so that, for example, allowing the two portions to produce relative axial movement therebetween.

本发明的若干优选实施例的一方面涉及一种吻合连接器,该连接器具有一个弹簧元件,用于允许通过该吻合连接器相连的两血管之间产生相对运动。 Several preferred embodiments of an aspect of the present invention relates to an anastomotic connector, the connector having a spring element, for allowing relative movement between the two vessels connected via an anastomosis connection. 在本发明的一个优选实施例中,提供有数个弹簧元件,从而使血管的不同部分具有不同的相对运动量。 In a preferred embodiment of the present invention, there is provided several spring elements, so that different parts of the vessel have different relative amount of motion. 在本发明的一个优选实施例中,所有的弹簧都以一个与其中一条血管相连接的单体安装环为基座。 In a preferred embodiment of the present invention, all the springs are mounted to a base ring to which the vessel is connected to a monomer. 然而,这不并是唯一的结构,不同的弹簧可以不同的血管和/或连接器的不同部分为基座。 However, this is not the only configuration and different portions of the spring may be different in different vessels and / or the base of the connector. 在本发明的一个优选实施例中,弹簧允许与一条血管相咬合的尖钉和与另一条血管相连接的安装环之间产生相对运动。 Embodiment, the spring allows the production of a relative movement between the vessel and the spike pin into engagement with the mounting ring and the other is connected to a blood vessel in a preferred embodiment of the present invention. 作为允许各条血管的主要部分之间产生相对运动的替代或附加方案,这种相对运动可以被限制在该吻合连接的某些小部分处。 As between the main portion of the vessel to allow the pieces to generate an alternative or in addition to relative movement, such relative movement may be limited to a small portion of some of the anastomosis connection. 在一个例子中,通过为每一个尖钉提供一个弹簧,被尖钉钉住的组织的厚度差别就可以由弹簧进行补偿。 Difference in thickness of the tissue in one example, by providing a spring for each spike, the tip of the tack can be compensated by a spring. 作为一种替代或附加方案,弹簧允许血管间的接触区域相互压靠在一起。 As an alternative or in addition, the spring allows the contact area between the vessel against each other together. 该弹簧件可以是一个显式的弹簧元件,例如被加工为尖钉的一部分。 The spring member may be a spring element explicit, for example, it is processed as part of the spike. 或者,该弹簧也可以功能性地被包括在其它结构中,这种结构例如用于将一个双体件吻合装置的两部分锁定在一起的锁定件。 Alternatively, the spring may functionally be included in other structures, for example, such a configuration two twin parts of a locking member of the anastomotic device with a locking member.

本发明的若干优选实施例的一方面涉及在例如冠状动脉等小血管上打孔。 Several preferred embodiments of an aspect of the present invention relates to small blood vessels in the coronary arteries, for example, punching and the like. 在本发明的一个优选实施例中,通过首先抓起血管上(例如冠状动脉)的一小部分然后切下该抓起部分的方法进行打孔。 In a preferred embodiment of the present invention, a method is first grabbed by a small portion of the vessel (e.g., artery) is then cut out of the punctured part of the grab. 该抓起和切削动作可以分别由打孔器上的独立元件来完成,也可以由同一个元件来完成。 The grab and the cutting operation can be done on each separate element by a puncher, it may be performed by a single element. 在本发明的一个优选实施例中,被抓起部分的半径小于冠状动脉厚度的两倍。 In a preferred embodiment of the present invention, the radius of the grabbed portion is less than twice the thickness of the coronary arteries. 作为一种替代或附加方案,冠状动脉被抓起后,抓起件被拉离血管,从而使冠状动脉的抓起部分远离冠状动脉的相对一侧。 As an alternative or in addition, the coronary artery was grabbed, pulled away from the blood vessel picked up member, so that the grabbed portion remote from the opposite side of the coronary arteries of the coronary.

本发明的若干优选实施例的一方面涉及通过沿一个理想孔的圆周在冠状动脉上切出孔的技术。 Several preferred embodiments of an aspect of the present invention relates to a technology hole cut through a hole along a desired circumference on the coronary arteries. 在本发明的一个优选实施例中,提供了一种旋转切割装置,该装置具有一个中心抓持器和一个优选呈尖钉状并且位于其圆周上的切削刃。 In a preferred embodiment of the present invention, there is provided a rotary cutting apparatus, the apparatus having a center and a gripper preferably in the form of a spike pin and positioned on the circumference of the cutting edge. 在本发明的一个优选实施例中,该抓持器是一个真空管。 In a preferred embodiment of the present invention, the gripper is a vacuum tube. 作为一种替代或附加方案,该抓持器是一个机械式抓持器。 As an alternative or in addition, the gripper is a mechanical gripper. 在使用过程中,抓持器抓起血管,从而使尖钉刺穿血管壁。 In use, the vessel gripper grabbed, so that the spike to pierce the vessel wall. 然后尖钉承载部分发生转动,从而切下血管壁的一部分。 Then spike carrying portion from rotating, so that the cut portion of the vessel wall.

本发明的若干优选实施例的一方面涉及一种打孔器的自缩回末端。 Some preferred embodiments of an aspect of the present invention is directed to a self retracting the punch tip. 在本发明的一个优选实施例中,该末端在血管上被打出孔之前缩回。 In a preferred embodiment of the present invention, the tip is retracted before the punch holes in the vessel. 优选打孔动作由该末端的回缩来产生。 Preferably punching operation is generated by the end of the retraction. 或者,该末端一旦缩回,就难以再次前伸,从而提供一个附加的保护措施。 Alternatively, once the tip is retracted, it is difficult to reach once again, thereby providing an additional protective measures.

本发明的若干优选实施例的一方面涉及一种用于在血管上打斜孔的打孔器。 Several preferred embodiments of an aspect of the present invention relates to a hole punch for a hit on the inclined hole in a blood vessel. 在本发明的一个优选实施例中,该打孔器包括两个相互不平行的椭圆形表面。 In a preferred embodiment of the present invention, the hole punch comprising two mutually non-parallel elliptical surface. 优选两表面间成一个例如5°的小角度。 Preferably between two surfaces at a small angle a of e.g. 5 °. 或者,至少其中一个表面不是平面,例如包括一个凸起部分,这是为了更好地与将被打孔的血管相配合。 Alternatively, at least one of the surfaces is not planar, for example, comprise a raised portion, which is to better cooperate with the vessel to be punctured.

本发明的若干优选实施例的一方面涉及一种打孔器,其中打孔动作通过非轴向操纵打孔器来实现。 Several preferred embodiments of an aspect of the present invention relates to a hole punch, wherein the non-puncturing operation is achieved by axial manipulation of the hole punch. 这样就减小了因打孔器锋利尖端的意外前伸而对血管的其它部分或下面的组织造成损伤的危险。 This reduces the risk of damage caused by accidental puncher forwardly sharp tip or other portions of the blood vessel tissue below. 优选该打孔器被用于穿孔手术中。 The puncher is preferably perforated for surgery. 作为一种替代或附加方案,该打孔器具有一个轴向手柄。 As an alternative or in addition, the axial hole punch having a handle. 或者,该打孔器具有一个旋转抓持件。 Alternatively, the hole punch having a rotary catch. 在本发明的一个优选实施例中,打孔动作通过挤压打孔器的手柄来实现。 In a preferred embodiment of the present invention, the punching operation is achieved by pressing the punch handle.

本发明的若干优选实施例的一方面涉及一系列用于吻合连接的工具,其中工具绕在移植血管周围。 Several preferred embodiments of an aspect of the present invention relates to a series of tools for anastomosis connection, wherein the tool wound around the graft vessel. 一旦移植血管被连接上,工具就可以被从移植血管上拆下。 Once the graft vessel is connected, the tool can be removed from the graft vessel. 在本发明的某些实施例中,该工具的侧壁上有一条裂缝,移植血管通过该裂缝被插入和/或被拆出。 In certain embodiments of the present invention, a crack in the wall of the tool, the graft vessel is inserted through the fracture and / or removed out. 作为一种替代或附加方案,该工具可以被打开或被劈开。 As an alternative or in addition, the tool may be opened or split. 优选该工具包括一个小钉,当工具的一部分被拉动经过该小钉上方时,该小钉将把该工具劈开。 Preferably the tool comprises a small nail, when the tool is pulled through a portion above the small nail, the tool will be the small nail splitting. 优选该工具上预先加工有裂缝或者至少被预先打孔,然而这并非必须。 Preferably the pre-processing tool or at least cracks prepunched, but this is not necessary. 作为对小钉的一种替代或附加方案,可以采用一个刀片,该刀片沿轴向将该工具撕开。 As an alternative or in addition to the small nail may be employed a blade which is axially tearing the tool. 优选该刀片和/或小钉静止不动,而工具部分相对它们滑动。 Preferably, the blade and / or small nails stationary, and the tool part relative sliding thereof. 作为一种替代或附加方案,该该刀片或小钉滑动。 As an alternative or in addition, the small nail or the blade slide. 该工具可以选择性地包括一个能够防止预加工裂缝的工具被分离的坚硬部分。 The tool may optionally include a rigid portion of the tool can be prevented from being separated from the pre-processing of the fracture. 然而,该坚硬部分包括一个开口,一旦该预加工裂缝的工具被缩入该开口中,该坚硬部分就会允许该工具被劈开,从而使移植血管能够被从封闭的工具中取出。 However, the rigid portion includes an opening, once the pre-processing tool is retracted into the crack opening, which will allow the tool to the hard part is split, so that the graft can be taken out from the closed tool. 这种工具包中的典型工具是一个吻合连接件、一个移植血管外翻器和一个吻合安装件中的一个或多个。 Typically this tool kit is a consistent connection, a graft everted anastomosis and one or a plurality of mounts. 这些工具可以由一个带有不同附件的单一工具构成。 These tools may be constituted by a single tool with different attachments. 作为一种替代或附加方案,这些工具适于在穿孔手术中使用。 As an alternative or in addition, the perforation tool suitable for use in surgery. 作为一种替代或附加方案,这些工具适于穿过血管或内窥的方法。 As an alternative or in addition, these tools are adapted to pass through the inner vessel or endoscopic methods.

作为一种替代或附加方案,该工具被一个例如刀片的外部工具所切开。 As an alternative or in addition, the tool is a blade of an external tool incised. 作为一种替代或附加方案,一条撕裂绳被用于劈开该工具。 As an alternative or in addition, a ripcord is used to split the tool.

本发明的若干优选实施例的一方面涉及一种在使用过程中配合吻合连接器的方法。 Several preferred embodiments of an aspect of the present invention relates to a method of stapling mating connector during use. 在本发明的一个优选实施例中,该连接器包括至少一个(沿横轴方向)增厚部分,优选这些增厚部分位于尖钉上。 In a preferred embodiment of the present invention, the connector includes at least one (in the horizontal axis direction) thickening the thickened portions, preferably located at the tip of the nail. 该增厚部分被优选用于将连接器拉离血管,从而使用该连接器另一侧的弯钩状尖钉刺破血管。 The thickened portion is preferably used for the connector is pulled away from the blood vessel, thereby using the spike-shaped hook of the connector on the other side of the vascular puncture. 作为一种替代或附加方案,该增厚部分被用于将连接器向前推入血管。 As an alternative or in addition, the thickened portion is used to connect the forwardly pushed into vein. 在本发明的一个优选实施例中,加工有增厚部分的尖钉是弹性的、超弹性的或者当使用该吻合装置时以其它的方式移出连接器平面。 In a preferred embodiment of the present invention, the processing spiked thickened portion is elastic, superelastic or when the stapling devices used in other ways out of the plane of the connector. 这样,通过允许或使尖钉弯出与工具的轴向配合,就可以使吻合装置脱离部署工具。 Thus, by permitting or causing the spike cooperate with the axial bending tool, it can cause the anastomotic device from the deployment tool.

本发明的若干优选实施例的一方面涉及一种将包括吻合装置在内的尖钉安装在一条移植血管上的方法,该方法中没有使用单独的步骤对移植血管进行外翻。 Several preferred embodiments of an aspect of the present invention relates to a method comprising graft vessel on a stapling apparatus including a mounting spike, which is not used in a separate step to be everted graft vessel. 在本发明的一个优选实施例中,该移植血管被刺穿在具有第一种结构的尖钉上,同时使移植血管大体保持中间结构(例如,未外翻)。 In a preferred embodiment of the present invention, the graft vessel is pierced with the tip of the nail a first structure, while the structure of the graft vessel remains substantially intermediate (e.g., non-valgus). 当移植血管被刺穿后,尖钉的结构被改变,例如向外旋转,从而使该尖钉在施行吻合的过程中所处的位置更利于与第二条血管相配合。 When the graft is punctured, spike structure is altered, e.g. outward rotation, so that the spike is located in a position consistent with the purposes of the process more conducive to cooperate with the second vessel. 当移植血管朝向第二条血管前伸出时,优选该移植血管因接触而被外翻。 When the front projecting toward the second vascular graft, preferably the graft vessel is everted by contact. 在本发明的一个优选实施例中,尖钉被弯成钩状,以便于当它们指向移植血管时将接管刺穿,同时当它们旋转离开移植血管时,便于与第二条血管相配合。 In a preferred embodiment of the present invention, the spike is bent in hook shape, so that when they point to pierce the graft vessel will take over, while when they are rotated away from the graft vessel, to facilitate mating with the second vessel.

本发明的若干优选实施例的一方面涉及一种移植血管的外翻方法,其中移植血管端部被向后卷起从而覆盖在邻近移植血管端部的移植血管部分上。 Several preferred embodiments of an aspect of the present invention relates to a method for everting the graft vessel, wherein an end portion of the graft vessel is rolled rearwardly to cover adjacent the graft vessel on the end portion of the graft. 在本发明的一个优选实施例中,移植血管端部被抓持住,并且被向后拉,从而覆盖在移植血管上。 In a preferred embodiment of the present invention, the end portion of the graft vessel is grasps, and is pulled back, thereby covering the graft vessel. 优选该移植血管被围绕在一个管件内,并且移植血管端部被外翻在该管件上。 Preferably, the graft vessel is enclosed within a tubular member, and an end portion of the graft vessel is everted over the tubular member. 优选管件和移植血管之间能够自由相互运动。 Preferably freely reciprocal motion between the tube and the graft. 然而,管件的端部被用作移植血管向后折叠的轴线。 However, the end portion of the tube is used as the graft vessel folded back axis. 优选该处翻过程由机械完成,而不直接由手工完成。 Preferably where the process is completed by the turning machinery, and not done directly by hand.

本发明的若干优选实施例的一方面涉及一种移植血管端部的外翻方法,其中近端朝向移植血管的远端被向前卷起在移植血管上。 Some preferred embodiments of an aspect of the present invention relates to a method for everting an end portion of the vascular graft, wherein the distal end toward the proximal end of the graft vessel is rolled forwards on the graft vessel. 在本发明的一个优选实施例中,该移植血管被安装在一个管件之上或其内部,并且移植血管的近端沿朝向移植血管远端的方向以较小的增量被推动。 In a preferred embodiment of the present invention, the graft vessel is mounted on or within a tubular member, and is pushed in small increments direction graft distal direction toward the proximal end of the graft. 优选移植血管的近端被咬住并且被推动,而不是被抓持住。 The proximal end of the graft preferably is gripped and pushed, rather than gripping live.

本发明的若干优选实施例的一方面涉及一种移植血管的一部分的成型方法,该部分特别指端部,但也可能是移植血管的中间部分。 Several preferred embodiments of an aspect of the present invention relates to a method of forming a portion of a graft, particularly the portion of the fingertip portion, but may also be a middle portion of the graft. 优选这种方法用于通过使移植血管的一端增厚来模拟移植血管外翻,而没有真正地外翻。 This method is preferred for one end of the graft vessel through the everted graft vessel thickening simulated without actually valgus. 在本发明的一个优选实施例中,该移植血管是一条乳房动脉。 In a preferred embodiment of the present invention, which is a mammary artery grafts. 在本发明的一个优选实施例中,移植血管端部在轴向挤压的作用下变厚。 In a preferred embodiment of the present invention, the graft vessel at the end portion thickening effect of axial compression. 优选轴向挤压采用一个移植血管内部的模具,用于设定(增大、减小或维持)移植血管的内径。 Preferably axial compression mold using a graft inside a blood vessel, for setting (increasing, decreasing or maintaining) the inner diameter of the graft. 这种挤压可被用于形成一个垂直于轴线的端部,或者这种挤压可被限制形成其它形状,例如形成与冠状动脉的轮廓相匹配的鞍形,或形成一个倾斜端部。 Such extrusion may be used to form a portion of the end perpendicular to the axis of the extrusion may be limited or such other shapes, for example, a coronary matches the contour of the saddle, or form a portion of the inclined end. 在本发明的一个优选实施例中,移植血管增厚部分被吻合连接器刺穿有助于维持其形状。 In a preferred embodiment of the present invention, the graft vessel is thickened portion piercing anastomosis connection helps maintain its shape. 作为一种替代或附加方案,该增厚部分使部分内膜沿移植血管的端部暴露出来,从而有助于施行一种内膜对内膜的吻合连接和/或一种外膜对外膜的连接和/或与其它血管层相匹配。 As an alternative or in addition, so that part of the thickened portion along the graft intimal end portion is exposed, thereby facilitating the implementation of one kind intima anastomosis connection intima and / or one film outside the outer membrane connections and / or other vascular layers match. 在本发明的一个优选实施例中,该增厚部分被一个吻合连接器的尖钉沿平行于移植血管轴线的路径刺穿。 In a preferred embodiment of the present invention, the path portion is a direction parallel to the axis of a graft anastomosis connector spike piercing the thickening.

本发明的若干优选实施例的一方面涉及一种产生一个相对移植血管轴线具有倾斜角的外翻移植血管端部的技术。 Some preferred embodiments of an aspect of the present invention relates to techniques for generating everted graft vessel end portion has an inclined angle relative to the axis of a vascular graft. 在一个倾斜角上直接进行外翻可能比较困难。 Directly eversion may be difficult in a tilt angle. 在本发明的一个优选实施例中,一个吻合连接器具有预先弯曲的尖钉,从而它们的尖端大体平行于另一条血管的表面。 In a preferred embodiment of the present invention, a connector having a pre-anastomotic bent spike, so that the tip thereof is substantially parallel to a surface of another vessel. 因此,当移植血管被部分外翻并且尖钉向外伸出时,这些尖端可以容易地刺破移植血管的一侧并且帮助完成外翻。 Thus, when the graft vessel is everted outwardly and spike portion, which can be easily puncture tip side grafts and help complete eversion.

本发明的若干优选实施例的一方面涉及一种尖钉尖端,该尖端用于防止尖钉过深地刺入。 Some preferred embodiments of an aspect of the present invention relates to a spike tip which is used to prevent the spike penetrate too deep. 在本发明的一个优选实施例中,该尖钉尖端呈分叉状,例如分为两个或三个尖端(例如类似一个音叉)。 In a preferred embodiment of the present invention, the spike tip bifurcated form, for example into two or three tips (e.g., similar to a tuning fork). 在本发明的一个优选实施例中,当移植血管被尖钉刺穿时,当分叉部位接触到动脉时尖钉停止刺穿。 Embodiment, when the graft vessel is punctured the spike, when the forked portion of the contact spikes pierce arterial stopped in a preferred embodiment of the present invention. 或者,各尖端之间呈较大的角度,从而避免压迫尖端之间的组织。 Alternatively, as a larger angle between the tip so as to avoid compression of tissue between the tips.

本发明的若干优选实施例的一方面涉及一个用于在周围(非冠状动脉)血管,例如腿部或腹部动脉内施行旁外科手术的工具包。 Several preferred embodiments of an aspect of the present invention relates to a surrounding (non-coronary) vessel, e.g. purposes beside the leg portion of the surgical kit or abdominal arteries. 在本发明的一个优选实施例中,这样一个工具包包括一个两端安装有一个吻合连接器的移植血管和一个用于在两个吻合连接位置之间引导移植血管的引导件。 In a preferred embodiment of the present invention, such a kit includes two ends mounted graft anastomosis has a connector and a member for guiding the anastomosis connection between the two positions of the guide graft. 在本发明的一个优选实施例中,该引导件由一根引导线构成。 In a preferred embodiment of the present invention, the guide member is constituted by a guide wire. 或者,该引导件是一个刚性引导件。 Alternatively, the guide member is a rigid guide member. 或者,该引导件是一个可偏斜的引导件。 Alternatively, the guide member is a deflectable guide.

本发明的若干优选实施例的一方面涉及一种从一个约束中释放一个弹性或超弹性装置的方法,其中上部约束的拆下使该装置能够产生变形,并且将自身从限定在下部约束上的凸起部分上拆下。 Several preferred embodiments of an aspect of the present invention relates to an elastic or superelastic a release means from a constraint, wherein the upper bound is removed so that the apparatus can be deformed, and itself from the constraint defined on the lower Remove the convex portion.

本发明的若干优选实施例的一方面涉及一种自外翻的吻合连接器。 Several preferred embodiments of an aspect of the present invention relates to a self-everted anastomosis connector. 在本发明的一个优选实施例中,该连接器被压缩并且其上的前向尖钉被插入一个移植血管中。 In a preferred embodiment of the present invention, the connector is compressed and forward thereon spike pin is inserted into a graft blood vessel. 当尖钉被释放时,它们在一个垂直于血管轴线的平面内转动,使血管外翻。 When a spike is released, in which a blood vessel in a plane perpendicular to the rotation axis, the blood vessel eversion. 或者,为了通过使用前向尖钉刺穿血管而与血管连接,该连接器可以包括其它的皱折件(例如作为一个凸缘的一部分),该皱折件使介于其间的血管端部产生皱折,并且当它们变形时拉动血管的端部,从而例如形成一个外翻边。 Alternatively, the spike to pierce the blood vessel by a blood vessel before use to be connected, the connector may include other elements corrugations (e.g., as a part of the flange), the corrugation member the end portion of the blood vessel interposed therebetween is generated wrinkles, and pulls the end portion of a blood vessel when they are deformed, thereby forming an outer flange for example. 在本发明的某些优选实施例中,血管端部的坏死不被认为很重要。 In certain preferred embodiments of the present invention, the end portion of the vascular necrosis is not considered important.

因此,根据本发明的一个优选实施例,提供了一个用于将移植血管连接在目标血管上的吻合连接器,它包括:一个适于与移植血管的一部分相连接的细安装环部分;和一个适于安装在所述安装环部分上的独立的尖钉部分,该尖钉部分包括数个尖钉,每个所述尖钉都适于刺穿所述移植血管。 Thus, according to one preferred embodiment of the present invention, there is provided a connector for stapling the graft vessel connected to the target vessel, comprising: a ring portion adapted for mounting the fine portion of the graft vessel connected; and a adapted to be mounted in the mounting portion separate spikes on the ring portion, said spike portion comprising a plurality of spikes, each spike adapted to pierce the graft vessel. 优选该连接器包括至少一个用于使所述尖钉部分和所述安装环部分相互锁定的锁定件。 Preferably the connector includes at least a portion for causing the spike and the mounting ring portion of the locking member interlocking. 优选所述锁定件被安装在所述安装环部分上。 Preferably the locking member is mounted on the mounting ring portion. 优选所述锁定件与一个由所述尖钉部分所限定的孔相配合。 Preferably, the locking member cooperating with a hole of said portion defined by the spike.

在本发明的一个优选实施例中,所述锁定件提供了一种弹簧运动,该运动可抵抗所述尖钉部分的至少一部分和安装环部分的至少一部分之间的相对轴向运动,并且该阻力取决于运动的幅度。 In a preferred embodiment of the present invention, the locking member provides a spring movement, which may resist relative axial movement between at least a portion of at least a portion of the spike pin and the mounting portion of the ring portion, and the resistance depends on the magnitude of the motion.

在本发明的一个优选实施例中,所述尖钉部分由一种超弹性材料构成。 In a preferred embodiment of the present invention, the portion composed of one spike superelastic material. 作为一种替代或附加方案,所述尖钉被预先弯成钩状,从而所述钩形适于与目标血管相连接。 As an alternative or in addition, the staples are pre-bent into a hook-shaped tip, so that the hook is connected to the target vessel adapted. 作为一种替代或附加方案,所述安装环部分包括数个靠近所述目标血管的翼缘件。 As an alternative or in addition, the mounting flange portion includes a plurality of member adjacent to the target vessel. 优选所述翼缘件限定数个孔,以便所述尖钉件穿过。 Preferably, the flange member defines a plurality of holes to pass through the spike member. 或者,所述翼缘件在其周长上包括至少一个开口,该开口足够宽,以便于其中所述尖钉能够穿过该开口。 Alternatively, the flange member comprising on its circumference at least one opening which is wide enough to be able to pass through the spike wherein the opening.

在本发明的一个优选实施例中,所述安装环部分限定了一个圆柱空间。 In a preferred embodiment of the present invention, the mounting ring portion defining a cylindrical space. 作为一种替代或附加方案,所述安装环部分适于构成一个垂直吻合器。 As an alternative or in addition, the mounting ring is adapted to constitute a vertical portion stapler. 或者,所述安装环部分适于构成一个倾斜吻合器。 Alternatively, the mounting is adapted to constitute a ring portion tilt stapler.

根据本发明的一个优选实施例,还提供了一个用于将移植血管连接在目标血管上的吻合连接器,它包括:一个用于连接所述移植血管的底座;数个用于刺穿所述移植血管并且与所述目标血管相连接的尖钉;和至少一个弹簧件,该弹簧件与至少一个所述尖钉相连接。 According to a preferred embodiment of the present invention, there is also provided a connector for stapling the graft vessel connected to the target vessel, comprising: a base for connecting the graft vessel; for piercing the plurality graft vessel and the target vessel and the spike is connected; and at least one spring member, the spring member and the at least one spike is connected. 该弹簧件被用作所述尖钉和所述底座之间的连接件。 The spring member is used as a connection between the spike member and the base. 优选所述尖钉和所述底座构成一个单体件。 Preferably, the spike and the base form a single member. 或者,所述尖钉和所述底座构成两个分体件。 Alternatively, the spike and the base constitute two separate parts.

在本发明的一个优选实施例中,所述弹簧由一个扁平卷簧构成。 In a preferred embodiment of the present invention, the spring is constituted by a flat coil spring. 作为一个替代或附加方案,所述弹簧由一个片簧构成。 As an alternative or additional embodiment, the spring is constituted by a leaf spring. 作为一个替代或附加方案,所述至少一个弹簧由至少两个相串联的弹簧构成。 As an alternative or additional embodiment, the at least one spring is constituted by at least two springs in series.

在本发明的一个优选实施例中,每一个所述尖钉具有至少与一个独立的弹簧相连接。 In a preferred embodiment of the present invention, each of the spike has at least connected to a separate spring. 作为一个替代或附加方案,所述连接器被设计用于施行倾斜吻合术。 As an alternative or additional embodiment, the connector is designed for performing anastomosis inclined. 作为一个替代或附加方案,所述连接器由包括至少一个与所述尖钉之一相连接的块状件,用于移动所述尖钉。 As an alternative or additional embodiment, the connector comprises a block member connected to at least one of a spike, for moving the spikes. 优选所述块状件适于拉回所述尖钉。 Preferably, the block member adapted to retract the spike. 作为一个替代或附加方案,所述块状件适于向前推出所述尖钉。 As an alternative or in addition, the block member adapted to forwardly out of said spike pin.

根据本发明的一个优选实施例,还提供了一个用于将一个移植血管递送至一个吻合连接处的设备,该设备包括:至少两个管形件,每一个限定了一个孔,该孔适于插入所述移植血管,从而使该移植血管从所述管形件的第一端穿出; According to a preferred embodiment of the present invention, there is provided a graft for delivery to a device connected at a consistent, the apparatus comprising: at least two tubular members, each defining a bore adapted to inserting the graft vessel, so that the vascular graft from the first end of said tubular piercing member;

至少一个分离件,该分离件安装在至少一个所述管形件上,用于劈开另一个所述管形件,从而所述移植血管能够穿过劈开的长槽被移出,该长槽跨越在所述第一端和所述孔之间。 At least one separation member, the separating member mounted on at least one of said tubular member for splitting said another tubular member, so that the graft can be passed through the elongated slot cleavage is removed, the elongated slot spans between said first end and said aperture. 优选所述至少一个分离件由一个切割所述裂缝的刀片构成。 Preferably, the at least one separation member consists of a cutting blade of the slit configuration. 作为一个替代或附加方案,所述至少一个分离件由一个扩展件构成,该扩展件扩宽所述管件内的现有裂缝,从而形成所述长槽。 As an alternative or in addition, at least one separation member is constituted by an extension member, the extension member prior widening crack in the tube, so as to form the elongated slot.

在本发明的一个优选实施例中,该设备包括一个外管件,该外管件防止所述管件分裂,除非它充分回缩。 In a preferred embodiment of the present invention, the apparatus comprises an outer tube, the outer tube member preventing said split pipe member, unless it is fully retracted. 作为一个替代或附加方案,所述管形件适于将一个吻合装置夹在其中。 As an alternative or additional embodiment, the tubular member adapted to clamp a stapling device therein.

根据本发明的一个优选实施例,还提供了一个用于将一个移植血管递送工具从一个封闭在其中的移植血管上拆下的方法,该方法包括:使用一个劈开所述管件,从而形成一个长槽;和将所述移植血管通过所述长槽取出。 According to a preferred embodiment of the present invention, there is provided a method for delivering a graft vessel wherein the graft vessel on the tool is removed from a closure, the method comprising: using a split the tube, thereby forming a long grooves; and the graft removed through said elongated slot. 优选所述槽成形件由一个劈开所述管件的刀片构成。 Preferably the slot shaped member is constituted by a blade of the split pipe member. 作为一个替代或附加方案,所述槽成形件由一个扩展件构成,该扩展件扩宽所述管件内的现有裂缝。 As an alternative or additional embodiment, the groove forming member consists of an extension member, the extension member prior widening crack in the tube.

在本发明的一个优选实施例中,该方法包括拉回至少一个绕在所述移植血管周围的管件。 In a preferred embodiment of the present invention, the method comprising at least a back wound around the tubular graft member. 优选所述拉回动作能够使所述管件与一个槽成形件相贴靠。 Preferably the return operation can be made with the tube member with a groove shaped abutment member.

在本发明的一个优选实施例中,该方法包括使所述槽成形件相对所述管件移动,从而形成所述长槽。 In a preferred embodiment of the present invention, the method includes moving member relative to the tubular member forming said groove to form the elongated slot.

根据本发明的一个优选实施例,还提供了一个吻合连接器,该吻合连接器包括:一个具有一条轴线的环形件;至少一组位于所述环形件上的尖钉;和至少一个沿横轴方向的增厚部分,该增厚部分位于至少一个所述尖钉内,同时远离所述环形件。 According to a preferred embodiment of the present invention, there is also provided a connector anastomosis, the anastomosis connector comprising: an annular member having an axis; at least one set of the spikes located on the annular member; along the horizontal axis and at least one the direction of the thickened portion, the thickened portion is located within said at least one spike, while away from the annular member. 优选该连接器包括一个第二组尖钉,该组尖钉的指向与所述第一组尖钉的方向相反。 Preferably the connector comprises a second set of spikes, spike in the opposite direction of the set point of the first set of spikes. 作为一个替代或附加方案,所述增厚部分包括一个点,其中所述尖钉在该点处分裂成若干尖端。 As an alternative or in addition, the thickened portion comprises a point wherein the tip of the spike at the point of splitting into a plurality of disposition. 优选所述尖端的长度小于该连接器所适用的目标血管的厚度。 Preferably, the tip of a length less than the thickness of the connector applies the target vessel.

在本发明的一个优选实施例中,所述至少一组尖钉在使用过程中不对所述的环形件施加向内或向外的径向压力。 In a preferred embodiment of the present invention, a pressure is applied radially inwardly or outwardly of said at least one set of spikes are not in use of the annular member.

根据本发明的一个优选实施例,还提供了一种用于保持和释放一个带有一个增厚部分的吻合连接器的方法,该方法包括:将所述连接器保持在两个管件之间,所述增厚部分的轴向运动受到至少一个限定在至少一个所述管件上的凸起部分的限制;和拆下所述管件中位于外面的一个,从而该连接器产生变形,并且该增厚部分不再受到所述至少一个凸起部分的限制。 According to a preferred embodiment of the present invention, there is provided a method for holding and releasing a thickening of a portion of the anastomosis connection with, the method comprising: the connector is held between the two tubes, the thickened portion is restricted axial movement of at least one raised portion defining at least one of said tube; and removing the tube member located outside, so that the connector is deformed, and the thickening It is no longer part of the at least one protrusion restricting portion.

根据本发明的一个优选实施例,还提供了一种在一个移植血管和一个目标血管之间施行吻合术的方法,该方法包括:将一个吻合连接器插入目标血管;释放所述连接器的至少一个前向尖钉;拉回所述连接器,从而使所述前向尖钉与所述目标血管相连接;和完成所述吻合过程。 Releasing at least said connector; anastomotic connector into a target vessel: According to a preferred embodiment of the present invention, a method is also provided between a graft vessel and a target vessel anastomosis purposes, the method comprising a forward spike; back of the connector, so that the spike is connected to the front of the target vessel; and completing the anastomosis procedure. 优选完成所述吻合过程包括,释放所述连接器的至少一个后向尖钉,从而与所述目标血管相连接。 Preferably completing the anastomosis procedure comprises releasing the at least one connector to the spike, thereby connected to the target vessel. 或者,完成所述吻合过程包括,将所述尖钉锁定在除所述尖钉外的所述连接器的一部分上。 Alternatively, the process includes completing the anastomosis, the locking spike of the connector portion other than said outer spike. 或者,完成所述吻合过程包括,释放所述尖钉,从而使之朝向除所述尖钉外的所述连接器的一部分缩回。 Alternatively, a part of completing the anastomosis procedure comprises releasing the spike, thus making the connector toward the spike except retraction.

根据本发明的一个优选实施例,还提供了一种用于在血管上打孔的打孔机构,该机构包括:一个适于刺穿所述血管的锋利尖端;一个在一端带有所述尖端的轴;一个远离所述尖端的第一加宽件;和一个远离所述第一加宽件的第二加宽件,所述第一和第二加宽件在其二者之间限定了一个窄径部分,该窄径部分适于容纳被刺穿的血管壁;和一个连接件,该连接件用于使所述尖端的回缩与所述加宽件的一种相对运动相耦合。 According to a preferred embodiment of the present invention, there is also provided a mechanism for puncturing the blood vessel is punctured, the mechanism comprising: a sharpened tip adapted to pierce the blood vessel; having a tip at one end of the a shaft; a widening away from the tip of the first member; and a widening away from the second member first widens member, said first and second members between which widens defining both a narrow diameter portion, the narrow-diameter portion adapted to receive a pierceable vessel wall; and a connecting member, the connecting member for retracting the one of the tip member relative movement widened coupled. 优选所述尖端缩入所述第一加宽件,从而将所述第一加宽件拉向所述第二加宽件。 Preferably, the tip of the retracted first member widened, thereby widening the first member to the second pulling member is widened. 作为一个替代或附加方案,所述尖端被安装在一个尖端轴上,并且通过拉回该尖端轴使尖端缩回,其中所述尖端轴与所述轴相连接,从而当所述尖端轴被充分回拉之后,所述尖端轴与所述轴相接触,并且将其回拉。 As an alternative or additional embodiment, the tip is mounted on a tip of the shaft, and by pulling back the tip of the shaft is retracted tip, wherein said tip is connected to the shaft axis, such that when the shaft is sufficiently tip after pulling back the tip in contact with the shaft axis, and pull it back.

根据本发明的一个优选实施例,还提供了一种用于外翻移植血管的方法,该方法包括:将所述持在一个内部轴柄和一个外管件之间;和将所述移植血管的一端向后推至所述移植血管之上。 According to a preferred embodiment of the present invention, there is provided a method for everting the graft vessel, the method comprising: the holding between an inner mandrel and an outer tubular member; and the grafts pushed back to the top end of the graft vessel. 优选该方法包括将所述推动操作重复数遍,从而获得理想的外翻量。 Preferably, the method comprises the pushing operation was repeated several times to obtain the desired amount of valgus. 作为一个替代或附加方案,推动所述移植血管的所述端部包括将所述端部外翻到所述外管上。 As an alternative or in addition, the end portion of the graft comprises pushing said end portion everted onto the outer tube.

根据本发明的一个优选实施例,还提供了一种移植血管外翻器,它包括:一个末端,该末端适于将所述移植血管安装在其上;一个移植血管止动件,该止动件用于对所述移植血管端部在所述末端上的前伸运动进行限制;和数个置于所述移植血管止动件和所述末端之间的扩张指形件,所述指形件具有一个扩张状态,其中它们的外径大于所述末端和所述移植血管,所述指形件还具有一个非扩张状态,其中其直径不足以与所述移植血管相配合。 According to a preferred embodiment of the present invention, there is provided a graft vessel is everted, comprising: a tip that is adapted to the graft vessel mounted thereon; a vascular graft stopper, the stopper an end piece for the graft vessel on the protrusive movement limiting end; number-graft expansion interposed between the stopper and the end vessel-finger, the finger a member having an expanded state, wherein the tip thereof and an outer diameter greater than the graft, said fingers further having a non-expanded state, the diameter of which is insufficient to cooperate with said vascular graft.

根据本发明的一个优选实施例,还提供了一种用于将安装一个带有尖钉的吻合连接器安装在一个移植血管上的方法,该尖钉带有向外弯出所述连接器的一个空腔的尖端,该方法包括:使所述至少某些所述尖钉保持扭转结构,从而使所述尖钉的尖端弯入该空腔;用所述尖端刺穿所述移植血管;和改变所述尖端的结构,使之向外弯曲。 According to a preferred embodiment of the present invention, there is provided a method for mounting a spike pin with the anastomotic connector is mounted on a graft vessel, which is bent outwardly with a spike of the connector a tip cavity, the method comprising: causing the at least some of said retaining spike twisted structure, such that the bent tip of the spike into the cavity; piercing the graft vessel with the tip; and change the structure of the tip to make it bent outward. 优选改变该结构包括释放所述尖钉。 The structure preferably comprises changing the spike release.

根据本发明的一个优选实施例,还提供了一种模拟移植血管外翻的方法,该方法包括:将所述移植血管的一端压入一个成形工具,从而在所述端部上形成一个增厚部分;和使用吻合连接器的至少一个尖钉刺穿所述增厚部分。 According to a preferred embodiment of the present invention, there is also provided a method for simulating the everted graft vessel, the method comprising: one end of the graft vessel is pushed into a forming tool, so as to form a thickened portion on said end portion; and a connector using at least one stapling spike piercing the thickened portion. 优选所述移植血管由一个乳房动脉构成。 Preferably, the graft consists of a mammary artery. 作为一个替代或附加方案,所述刺穿包括沿所述移植血管的一条轴线进行刺穿。 As an alternative or additional embodiment, the piercing along an axis comprising a piercing the graft vessel. 或者,所述刺穿包括沿与所移植血管的轴线相倾斜的方向进行刺穿。 Alternatively, the piercing direction and comprising the axis of the graft vessel is inclined piercing. 或者,所述刺穿包括沿垂直所述移植血管轴线的方向进行刺穿。 Alternatively, said piercing including a direction perpendicular to the axis of the graft vessel piercing. 在发明的一个优选实施例中,所述成形工具包括一个内轴柄。 In a preferred embodiment of the invention, the forming tool comprising an inner mandrel. 作为一个替代或附加方案,所述模具在所述移植血管上限定了一个所述增厚部分的扁平端表面。 As an alternative or in addition, the graft vessel on the mold defining a flat end surface of the thickened portion. 或者,所述成形工具在所述移植血管上限定了一个所述增厚部分的倾斜端表面。 Alternatively, the shaping tool defines the inclined end surface a thickened portion on the graft vessel. 或者,所述成形在所述移植血管上限定了一个所述增厚部分的非平面的端表面。 Alternatively, said forming defining a non-planar surface of the thickened end portion of the graft vessel.

根据本发明的一个优选实施例,还提供了一种将一个连接器刺穿在一个移植血管上的方法,该方法包括:增宽该移植血管一端的半径;使所述连接器上的至少一个尖钉沿平行于所述移植血管的方向向前伸出,从而使之刺穿所述增宽区域;和使至少一个所述尖钉的端部弯曲成钩状。 According to a preferred embodiment of the present invention, a method is also provided a connector to pierce a graft on, the method comprising: the radius of the widening end of the graft; the upper connector of said at least one spike in the direction parallel to the graft vessel extends forwardly, thus making the piercing widened region; and at least an end portion of the spike a bent like a hook.

根据本发明的一个优选实施例,还提供了一个用于旁外科手术的工具包,该工具包包括:至少一个两端安装有一个吻合连接器的移植血管,所述移植血管和所述连接器适用于周围血管旁外科手术;和至少一个与所述移植血管的一端相连接的引导线。 According to a preferred embodiment of the present invention, there is provided a kit for the next surgery, the kit comprising: at least two ends attached to a connector graft anastomosis, the graft vessel and the connector suitable for peripheral vascular bypass surgery; and at least one guide wire is connected to one end of the graft blood vessel. 优选所述连接器被嵌入在所述移植血管的所述端中。 Preferably the connector is embedded in the end of the graft blood vessel.

根据本发明的一个优选实施例,还提供了一种倾斜打孔器,该打孔器包括:一个轴;一个以一个第一角度相对所述轴倾斜的第一非圆边缘;一个以一个第二角度相对所述轴倾斜的第二非圆边缘;和用于减小所述两边缘之间的缝隙的装置,这是为了切除位于二者之间血管组织。 According to a preferred embodiment of the present invention, there is also provided an inclined hole punch, the hole punch comprising: a shaft; a first angle with respect to a first non-circular edge of the inclined axis; a first to a two second angle relative to said shaft non-circular edge is inclined; and means a gap between the two edges is reduced, which is positioned to cut the blood vessel tissue therebetween. 优选所述两个角度不同。 Preferably, the two different angles. 或者,所述两个角度相同。 Alternatively, the two identical angles.

根据本发明的一个优选实施例,还提供了一种在穿孔手术过程中,用于在血管上打孔的打孔器,该打孔器包括:一个用于刺穿所述血管的尖端; According to a preferred embodiment of the present invention, there is also provided a hole punch piercing A surgical procedure for puncturing the blood vessel, the hole punch comprising: a tip for puncturing the blood vessel;

一个适用于穿孔手术的并且与所述尖端相连接的硬质手柄,该手柄用于所述尖端的一个空间位置;两个表面,该表面用于容纳环绕在所述孔周围的血管壁;和用于使所述表面合在一起从而打出所述孔的装置。 A perforating operation and applicable to the hard handle and the tip is connected to the handle for a spatial position of the tip; two surfaces, which surround the receiving surface for the vessel wall hole; and means for causing the surface of the bore together to play together. 优选所述尖端是变化的。 Preferably, the tip is changed. 或者,所述尖端可沿轴向开有凹槽。 Alternatively, the tip may be are grooved in the axial direction.

根据本发明的一个优选实施例,还提供了一种对一个吻合连接器进行热处理的方法,该方法包括:将一个切割连接器安装在一个模具中;固定所述模具,从而使所述连接器的前向和后向尖钉都弯成理想形状;和对所述固定的连接器进行热处理,从而将之处理成所述结构。 According to a preferred embodiment of the present invention, there is provided a method of heat-treating an anastomotic connector, the method comprising: a connector mounted in a cutting mold; the mold is fixed so that the connector forward and backward over the spikes are bent shape; and heat-treating the fixed connector, such as the processing of the structure.

对附图的简要说明下面将结合附图对优选实施例进行详细说明,从而本发明将被更清楚地得以理解,其中出现在多个图中的相同结构、元件或部分在它们所出现的所有的图中以相同的数字进行了标识,附图包括:图1A-1D概略表示了根据本发明的一个优选实施例的双体件吻合装置的两个部分的等轴测透视图和剖视图;图2A-2F概略表示了对如图1A-1D所示的根据本发明的一个优选实施例的装置的操作;图3A和3B是如图1A-1D所示的根据本发明的一个优选实施例的吻合装置的两个部分的设计平面图;图4A-4D表示了一种用于缩回如图1A-1D所示的根据本发明的一个优选实施例的吻合装置的一个环部分的方法;图5是根据本发明的一个优选实施例的一个单体吻合装置的设计平面图;图6A和6B是吻合区域的侧面剖视图,表示了一种使用图5所示的装置进行吻合的方法;图7A概要 BRIEF DESCRIPTION OF THE DRAWINGS Examples of the preferred embodiments described in detail, so that the present invention will be more clearly be understood with the accompanying drawings, wherein the plurality of figures appear in the same structures, elements or parts throughout they appear figures have been denoted by the same numerals, in which: figures 1A-1D shows a perspective schematic perspective view of two portions of the catamaran member anastomotic device according to one preferred embodiment of the present invention and a sectional view like; FIG. 2A-2F schematically shows the operation of the FIG. 1A-1D shown a preferred embodiment of the apparatus according to the invention; Figures 3A and 3B are a preferred embodiment of the present invention shown in FIG. 1A-1D of design of a plan view of two portions of the stapling apparatus; Figures 4A-4D shows a method for retracting FIG. 1A-1D method according to one portion of the anastomotic ring device of a preferred embodiment of the present invention shown; FIG. 5 is a single preferred embodiment of the present invention, according to one embodiment of the schematic plan stapling apparatus; FIGS. 6A and 6B are side anastomosis region cross-sectional view showing the apparatus shown in FIG. 5 using a method anastomosis; FIG. 7A Summary 示了一个根据本发明的一个优选实施例的向外张开的尖钉的尖端结构;图7B是一个连接器的侧面剖视图,该连接器包括布置在一条动脉内的根据本发明的一个优选实施例的如图7所示的结构;图8A是根据本发明的一个优选实施例的一个动脉吻合连接器的设计平面图;图8B是图8A所示的连接器的俯视图,其中该连接器处于备用状态;图8C是一个放大视图,表示了连接器的相对两侧的两个尖钉的交汇点;图8D是沿图8B中线AA的剖视图,表示了处于备用状态的吻合设备两侧的尖钉的相对位置;图9A和9B表示了一个模具,该模具适于加工图8A-8D所示的根据本发明的一个优选实施例的吻合设备。 Illustrates an embodiment of a tip structure of an outwardly flared spike according to one preferred embodiment of the present invention; FIG. 7B is a side cross-sectional view of a connector, the connector includes an artery disposed within the embodiment according to one preferred embodiment of the invention configuration example shown in FIG. 7; FIG. 8A is a plan view of a design embodiment artery anastomotic connector, according to one preferred embodiment of the present invention; FIG. 8B is a plan view of the connector shown in Figures 8A, wherein the connector is in the standby state; FIG. 8C is an enlarged view showing the intersection of two opposite sides of the spike connector; FIG. 8D is a sectional view taken along line AA in FIG. 8B, showing both sides of the spike stapling device is in the standby state relative position; FIGS. 9A and 9B show a mold which is adapted to stapling apparatus according to one preferred embodiment of the present invention, the processing shown in FIG. 8A-8D.

图10是一个流程图,该图举例表示了根据本发明的一个优选实施例的打孔旁外科手术的过程;图11是一个夹持架工具的示意图,该夹持架工具在旁外科手术过程中用于夹持根据本发明的一个优选实施例的各种其它工具;图12A-12D表示了根据本发明的一个优选实施例的一个抓切打孔器的使用过程;图13A-13D表示了根据本发明的一个优选实施例的一个旋转尖钉打孔器的使用过程; FIG 10 is a flowchart showing an example of the process of FIG next punch according to one preferred embodiment of the present invention surgery; FIG. 11 is a schematic view of a gripping tool holder, the tool holder gripping next surgical procedure various other embodiments of the tool holder according to one preferred embodiment of the present invention is used; FIG. 12A-12D shows a process of using the punch-cut grip in accordance with one preferred embodiment of the present invention; FIGS. 13A-13D shows a rotary spike the punch in accordance with a preferred embodiment of the present invention during use;

图14A-14E表示了根据本发明的一个优选实施例的一个砧打孔器的使用过程;图15A-15D表示了根据本发明的一个优选实施例的一个插在如图11所示的夹持架工具中的打孔器及其使用方法;图16A和16B分别用透视图和透视剖面图表示了一个根据本发明的一个优选实施例的尖端回缩打孔器;图17是一个根据本发明的另一个优选实施例的尖端回缩打孔器的透视图;图18表示了根据本发明的一个优选实施例的倾斜打孔器的一个组装图和一个拆分图;图19A示意性地表示了根据本发明的另一个优选实施例的另一个倾斜打孔器;图19B表示了图19A所示了打孔器的尖端的两个视图;图20A-20D表示了一种根据本发明的一个优选实施例的连接器的安装方法;图21A-21E表示了一个根据本发明的一个优选实施例的移植血管外翻器;图22是根据本发明的一个优选实施例的另一个移植血管外翻 FIGS 14A-14E show an embodiment of the anvil puncher according to one preferred embodiment of the present invention during use; FIGS. 15A-15D shows a plug 11 as shown in FIG clamp according to one preferred embodiment of the present invention. and methods of using the hole punch tool holder; FIG. 16A and 16B respectively show a tip retraction puncher according to one preferred embodiment of the present invention and a perspective view of a perspective cross-sectional view; FIG. 17 according to the present invention is a tip another preferred embodiment of a perspective view of the punch retracted; FIG. 18 shows an assembled view of the punch is inclined in accordance with a preferred embodiment of the present invention and a splitter; Figure 19A schematically showing according to another embodiment of the tilt puncher another preferred embodiment of the present invention; FIG. 19A FIG. 19B shows two views of the punch tip; FIG. 20A-20D represent a according to the present invention the method of mounting the connector to the preferred embodiment; FIGS. 21A-21E shows an everting the graft vessel according to one embodiment a preferred embodiment of the present invention; FIG. 22 is another embodiment of the everted graft vessel according to a preferred embodiment of the present invention. 的剖面示意图;图23A-23G表示了一种根据本发明的一个优选实施例的通过扭转一个连接器的尖钉刺穿和固定血管的方法;图24A-24E表示了一种根据本发明的一个优选实施例的模拟外翻的方法,特别是对乳房动脉而言;图25A是图11所示的根据本发明的一个优选实施例的夹持架工具的近视特写视图,其中插有一个移植血管夹持件和连接器夹持件的组合件;图25B是图25A的透视图;图26表示了图11所示的夹持架的尖端缩回后的位置,表示了与目标血管相咬合的尖钉;图27表示了图25A所示的组合件中的一个层,重点强调了该层中的一个加工裂缝、一个刀片和突出部分;图28是图11所示的夹持架的一个剖视图,表示了当层被充分拉回时将图27所示的层劈开的小钉或圆锥;图29A-29F表示了另一种根据本发明的一个优选实施例的使用一个基于小钉的劈开机构的连接器递送系 A schematic cross-sectional view; FIGS. 23A-23G shows a method of piercing the vessel and fixed by twisting a spike connector of an embodiment in accordance with one preferred embodiment of the present invention; FIGS. 24A-24E represent a accordance with the invention is sIMULATION everted preferred embodiment, especially in terms of mammary artery; FIG. 25A is a close up view of the tool holder holding a preferred embodiment of the present invention, a graft vessel inserted therein as shown in FIG. 11 and a holder assembly holding the connector member; FIG. 25B is a perspective view of FIG. 25A; FIG. 26 shows the position of the tip of the clamping bracket shown in FIG. 11 is retracted, and the target vessel showing meshed spike; FIG. 27 shows a layer of the assembly shown in FIG. 25A, emphasis processing a crack in the layer, and a projecting blade portion; FIG. 28 is a cross-sectional view of the holding frame 11 shown in FIG. It indicates when the layers are sufficiently pulled back layer 27 shown in FIG small nail or split cone; FIG. 29A-29F illustrates the use of another embodiment in accordance with a preferred embodiment of the present invention is based on a small nail split opening the delivery system connector means 统;图30A-30D与图1A-1D相应,表示了根据本发明的一个优选实施例的适用于倾斜连接的吻合连接器;图31A与图2F相应,表示了根据本发明的一个优选实施例的图30A-30D中所示的工作过程中的连接器;图31B与图2D相应,表示了根据本发明的一个优选实施例的完成后的吻合状态;图32A和32B分别相应于图3A和3B,表示了图30A-30D所示的连接器的一个设计平面图;图33A和33B表示了一种根据本发明的一个优选实施例的用于将一个倾斜连接器安装在移植血管上的方法;图34A-34F表示了根据本发明的一个优选实施例的一个自外翻连接器和一种使用这种连接器的方法;图35表示了根据本发明的一个优选实施例的内部嵌有一个吻合连接器的移植血管;和图36表示了根据本发明的一个优选实施例的一个典型的股-腘动脉旁外科手术。 System; FIGS. 30A-30D and FIGS. 1A-1D correspondingly shows the anastomotic connector is adapted embodiment in accordance with one preferred embodiment of the invention, the inclined connection; FIG. 31A and FIG. 2F corresponding, shows an embodiment in accordance with a preferred embodiment of the invention. working process shown in FIG. 30A-30D of the connector; FIG. 2D corresponding to FIGS. 31B and showing a state after the completion of the anastomosis according to a preferred embodiment of the present invention; FIGS. 32A and 32B correspond to FIGS. 3A and 3B, shows a schematic plan of the connector shown in FIG. 30A-30D; 33A and 33B represent a accordance with a preferred embodiment of the present invention for a method embodiment of the connector is mounted on the inclined grafts; FIGS 34A-34F shows an embodiment in accordance with a preferred embodiment of the present invention from the eversion connector and a method of using such a connector; FIG. 35 shows the internal embedded with a stapling embodiment a preferred embodiment of the present invention. graft connector; and FIG. 36 shows an exemplary embodiment of strands according to one preferred embodiment of the present invention - popliteal artery bypass surgery.

对优选实施例的详细说明对一条冠状血管实施吻合连接可能是在一条动脉和该血管之间施行旁外科手术的第一步或第二步,或者它也可能是一个更长手术过程中的一个单一吻合步骤,例如当需要使用一种侧对端吻合连接方法将一条左内乳房动脉(LIMA)或一条右内乳房动脉(RIMA)连接到一条冠状血管时。 The first step in the detailed description of preferred embodiments of a coronary anastomosis connection might be implemented between the blood vessel and an artery bypass surgery performed or second step, or it may be a longer surgical procedure in a step single anastomosis, for example when it is desired to use a side-end anastomosis connection method to a left internal mammary artery (LIMA), or a right internal mammary artery (RIMA) is connected to a coronary blood vessel. 在某些情况下,这种吻合连接存在一些问题,例如,这些问题源于以下的一个或多个原因:(a)冠状血管,特别指被疾病所损伤的血管具有脆弱的结构,并且难以操纵和拉抻。 In some cases, there are some problems such anastomosis connection, e.g., the problems derived from one or more of the following reasons: (a) coronary vessels, blood vessels are damaged by particular means a disease having the fragile structure, and difficult to handle and Stretching.

(b)在手术结束时,并且对某些实施例而言几乎在整个手术过程中,用于实施吻合手术的工具都处在移植血管和冠状血管之外。 (B) at the end of surgery, and in terms of certain embodiments, substantially the entire surgical procedure, the tool for performing anastomosis and are in addition to coronary vascular graft.

(c)通常我们不希望吻合连接器很长(沿轴向),这是因为我们希望获得尽可能小的内体轮廓。 (C) Normally we do not want to fit connector long (axial), it is because we want to get as small as possible within the body contour.

(d)通常我们希望对血管,特别是冠状血管的操纵程度尽可能小。 (D) Normally we hope to blood vessels, especially the degree of manipulation of the coronary vessels as small as possible. 因此如果能够避免对血管进行夹持,将是很有利的。 So if we can avoid holding the blood vessel, it would be very beneficial. 双体件吻合连接装置图1A-1D示意性地表示了根据本发明的一个优选实施例的双体件吻合装置100的两个部分的等轴测透视图和剖视图。 Diabodies member anastomosis connection device of FIG. 1A-1D schematically shows an isometric perspective view of the twin element according to one preferred embodiment of the present invention, the two stapling apparatus like portion 100 and a cross-sectional view. 图1A和1B表示了一个环部分102,优选由一个管件104构成。 1A and 1B shows a ring portion 102, preferably formed of a tubular member 104. 或者,数个孔110被加工在该管件上。 Alternatively, a plurality of holes 110 are machined on the tube. 作为一种替代或附加方案,该管件可以由一个自然展开的网状或其它结构加工而成。 As an alternative or in addition, the tube may be machined from a natural expanded mesh or other structure. 这样,该装置体内的其它材料的总量就得以减少。 Thus, the total amount of other material to the body of the device is reduced. 或者,管件104可以沿径向扩张或收缩,例如塑性的、弹性的、超弹性的或使用变形记忆特性的扩张或收缩。 Alternatively, the tube 104 can be radially expanded or contracted, such as a plastic, elastic, superelastic deformation or shrinkage or expansion memory properties. 使用网状件的另一个可能的优点是该吻合装置具有更好的弹性,并且可以适应组织几何形状的变化,并且甚至可以长时间变形,例如当血管扩张时。 Another possible advantage is that the mesh-like member of the anastomotic device having a more elastic, and can accommodate changes in tissue geometry, and may even be a long deformation, for example when during vasodilation.

优选围绕管件104的圆周设置数个翼缘件108。 Preferably around the circumference of the tube 104 is provided a plurality of flanges 108. 优选每个翼缘件上都有一个开孔,并且被用于保持一个尖钉件(如下文将述)。 Preferably, each opening has an upper flange member, and is used for holding a spike member (as will be described later). 作为一种替代或附加方案,这些翼缘件被用作血管被外翻在其上和/或以其它方式连接在其上的一个凸缘。 As an alternative or in addition, these vessels are used as the flange member is everted / or a flange thereon, and otherwise attached thereto. 或者,该管件上的翼缘件包括若干倒钩,用于固定外翻的血管。 Alternatively, the flange member on the tubular member includes a plurality of barbs, for fixing the everted blood vessel. 作为一种替代或附加方案,该翼缘件被用于提高管件的强度,从而使管件不会沿径向坍陷变形。 As an alternative or in addition, the flange member is used to improve the strength of the tube so that the tube does not collapse deformed radially.

这样,移植血管被管件104所固定。 Thus, the graft vessel 104 are fixed to the tube member. 在某些情况下,这种固定配合是接触式的,在其它情况下,提供了一种机械连接,例如摩擦、在管件104上使用倒钩、使用粘结剂或通过外翻在该翼缘上来实现。 In some cases, such fixed mating contact type, in other cases, a mechanical connection, such as friction, using barb on the tube member 104, by using an adhesive or the flange eversion up to achieve.

优选数个锁定件106被设置在管件104上,例如位于与翼缘件相对的一侧,从而在吻合装置100的使用过程中,用于将尖钉件锁定在相应位置上。 Preferably a plurality of locking members 106 are provided on the tubular member 104, for example, positioned side opposite the flange member, so that during use stapling apparatus 100, for locking spike at corresponding positions. 在本发明的一个优选实施例中,该锁定件呈伸长形,从而相对锁定而言,它们的长度使之具有一定的弹性。 In a preferred embodiment of the present invention, the form of the elongate locking member, thus locking relative terms, their length so as to have a certain flexibility. 这样,即使在锁定之后,尖钉和管件也能够产生某种弹性相对运动。 Thus, even after the locking, the spike and the tube member can also produce some elastic relative movement. 或者,还可以设置其它类型的允许产生轴向运动的机构,例如使尖钉沿轴向具有弹性(相对于吻合连接过程中的预期作用力而言)。 Alternatively, other types may be provided to allow axial movement of the generating means, for example elastic spike axially (with respect to the biasing force of the intended anastomosis connection process).

优选通过将该锁定件设置或放置在远离管件104的翼缘的位置处来获得一个弹性锁定装置。 The locking member is preferably provided by or placed at a position away flange 104 of the tubular member to obtain a resilient locking means. 然而,在其它实施例中,例如如果锁定件本身包括弹簧或由一种弹性件构成,该锁定件也可以接近翼缘或甚至位于翼缘上。 However, in other embodiments, for example if the lock member itself comprises a spring or is made of an elastic member, the locking member may be positioned close to the flange or even on the flanges. 另外,该锁定件也可以出于其它原因接近翼缘或位于翼缘上,例如在不需要弹性运动的情况下。 Further, the locking member may also be other reasons for approaching the flange or on the flange, for example, without the need for an elastic movement.

图1C和1D表示了一个尖钉部分120,优选该尖钉部分120由一个连接有数个尖钉124的环122所构成。 1C and 1D shows a spike portion 120, portion 120 of the spike is preferably a connection of several ring 122 of the spike 124 is constituted. 在本发明的一个优选实施例中,该环的直径稍大于管件104。 In a preferred embodiment of the present invention, the ring is slightly larger than the diameter of the tube 104. 然而需要指明的是,在本发明的某些优选实施例中,环部分102和尖钉部分120其中之一或全部能够沿径向扩张。 However, it should be specified that, in certain preferred embodiments of the present invention embodiment, wherein one or all of the portion 120 can be radially expandable ring portion 102 and a spike. 在本发明的一个优选实施例中,通过使每一个尖钉124插入并穿过一个翼缘件108,同时使环122在管件104上滑动,从而将尖钉部分120安装在环部分102上。 In a preferred embodiment of the present invention, by having each spike 124 is inserted through a flange member 108, while the ring 122 on the tube member 104 slid so that the spike 120 is mounted on a portion of the ring portion 102. 在某些实施例中,翼缘件108的端口是敞开的,而不是闭合的,如图所示。 In certain embodiments, the port flange 108 is open rather than closed, as shown in FIG.

在本发明的一个优选实施例中,当组装吻合装置100时,尖钉被推动穿过闭合翼缘件中的孔。 In a preferred embodiment of the present invention, when the stapling apparatus 100 is assembled, the closure is pushed through the spike holes in the flange member. 或者,该尖钉可以通过一个开口被滑入。 Alternatively, the spike can be slid through an opening. 在另一个实施例中,该开口位于翼缘件的侧面,并且通过转动尖钉部分120而将其安装在管部分102上,从而使尖钉通过该开口进入翼缘件。 In another embodiment, the opening located at the side flange member, and by rotating the spike portion 120 which is mounted on the pipe portion 102, so that the spike through the opening into the flange member.

优选环122相对较硬。 Ring 122 is preferably relatively stiff. 然而,在一些实施例中,当环122无需保持其形状,而主要用于帮助缩回尖钉124时,该环可发具有较高的弹性。 However, in some embodiments, when the ring 122 need not maintain its shape, but mainly to help retract the spike 124, the ring can be made with high elasticity. 应该指出的是,环122可以是开口的,然而优选它是闭合的。 It should be noted that the ring 122 may be open, but preferably it is closed. 优选当环122缩回至锁定件106之上时,锁定件106(图1A,1B)通过与环122相配合进行锁定。 Preferably, when the locking ring 122 is retracted to above the member 106, the locking member 106 (FIG. 1A, 1B) and by the locking ring 122 for mating.

在一个替代实施例中,环122呈正弦形,其中尖钉与远离翼缘的正弦部分相连接。 In an alternative embodiment, ring 122 sinusoidal shape, wherein the sinusoidal portion remote from the flange of the spike is connected. 这样当环放松时,它将拉回尖钉。 So that when the ring relaxation, which it pulls the spike.

尖钉124可以有多种设计方案。 Spike 124 may have various designs. 然而,在本发明的优选实施例中,尖钉朝其端部向内弯曲,并且具有一个带有一个锋利尖端128的弯曲端126。 However, in a preferred embodiment of the present invention, the spike is bent inwardly toward the ends thereof, and having a sharp tip 128 with a curved end 126. 在某些实施例中,尤其指如下将述的,尖钉124可以包括一段扭曲。 In certain embodiments, as will be described below refers in particular, spike 124 may include some distortions. 优选尖钉的曲线部分具有超弹性,这是因为尖钉被加工为预弯曲的形状,并且至少在一部分使用过程中将保持直线结构。 Curve portion of the spike is preferably superelastic, because the pre-spike is processed into a curved shape, and held in the straight configuration during at least a portion of the use. 然而,弹性、塑性、变形记忆和其它机械类型的弯曲也可以在本发明的优选实施例中采用。 However, elasticity, plasticity, memory, and other mechanical deformation of the bending type may also be employed in the preferred embodiment of the present invention.

图2A-2F用侧视剖视图示意性地表示了对吻合装置100的操作过程。 Figures 2A-2F schematically a side sectional view showing a process of stapling apparatus 100 operation. 图2A所示的吻合装置100被安装在一个移植血管130上,从而尖钉124穿过了移植血管的一个局部外翻部分134(例如外翻角度小于180°)。 FIG 2A stapling apparatus 100 is shown mounted on a graft vessel 130, so that the spike 124 through a local portion everted graft vessel 134 (e.g., valgus angle of less than 180 °). 在该实施例中,尖钉沿曲线进入,从而当环128缩回后,如图2B所示,尖钉被环部分120拉直,优选被翼缘件108拉直。 In this embodiment, the spike enters along the curve, so that when the ring 128 is retracted, as shown in FIG 2B the spike ring portion 120 is straightened, flange member 108 is preferably straightened. 当它们被拉直后,或在拉直过程中,优选一个目标血管132被尖钉的尖端128刺穿。 After they are straightened, or straightening process, preferably a target vessel 132 is pierced tip of the spike 128. 或者如图2F所示,甚至在尖钉未被弯曲之前,尖钉尖端就已刺穿血管132。 2F, or even before the spike is not bent, the tip of the spike to pierce the blood vessel 132 already. 在一些实施例中,尖钉也可以向外张开,例如为了扩大开口和/或为了在血管之间形成其它几何形状的连接。 In some embodiments, the spike may be flared, for example in order to expand the opening and / or for forming a connection between angiogenesis other geometries.

在一些实施例中,两个连接件部分的相对运动可以提高尖钉的强度。 In some embodiments, the relative movement of two portions of the connecting member can increase the strength of the spike. 在一些实施例中,这种运动包括使尖钉相对血管132缩回。 In some embodiments, this movement comprising spike 132 is retracted relative to the blood vessel. 或者,尖钉被保持在相对血管132具有固定间距的位置上,或者甚至向前伸出。 Alternatively, the spike is held in a vessel 132 having a fixed pitch relative position, or even projecting forwardly.

图2C表示了图2A的一个替代方案,其中尖钉未被向内弯曲。 Figure 2C shows an alternative embodiment of FIG. 2A, wherein the spike is not bent inwardly. 在插入尖钉的过程中,目标血管上的一个开口136可能会被扩大,或者例如在一个封闭管的作用下,尖钉可能会向内弯曲。 In the process of inserting the spike, an opening 136 in the target vessel may be enlarged, or example under the action of a closed tube, spike may bend inwardly. 也可以采用其它的方法对尖钉进行弯曲,例如使用扭转力,或者通过对变形记忆性的尖钉进行温度处理。 Other methods may also be employed to bend the spike, for example, torsional force, or by a memory spike deformation temperature treatment. 或者,当尖钉伸出时,弯曲端126足够锋利,从而刺穿目标血管。 Alternatively, when the spikes protruding, curved end 126 sharp enough to pierce the target vessel. 或者,尖端128被压靠在尖钉124上,从而使弯曲端126具有较小的轮廓。 Alternatively, the tip 128 is pressed against the spike 124, so that the bent end 126 has a lower profile.

在本发明的一个优选实施例中,血管132可以通过其腔以及其开口136被例如血液、盐水充满,从而血管132的壁被分开。 In a preferred embodiment of the present invention, the blood vessel through its lumen 132 and the opening 136 is such as blood, saline filled, so that the blood vessel wall 132 are separated.

优选一旦环122被充分缩回,锁定件106就与环和/尖钉相配合,将其锁定在相应位置。 Once ring 122 is preferably sufficiently retracted, the locking member 106 and the ring / spike cooperate to lock it in the appropriate position. 图2D表示了一个最终状态,其中尖钉尖端128接触或锁靠在翼缘件的底部或内部。 FIG 2D shows a final state, wherein the spike tip 128 in contact with the bottom or inner or locked against the flange member. 图2E表示了一个最终状态,其中尖钉尖端128接触或锁靠在翼缘件的侧部。 Figure 2E shows a final state, wherein the spike tip 128 in contact with the side portion or the flange against the lock member. 另外,尖钉尖端也可以不与翼缘件接触或锁靠。 Further, the spike tip or may not be in contact with the lock member against the flange. 应该指明的是,通过控制吻合装置和外翻部分的结构,尖钉尖端128可以刺穿或者不刺穿移植血管130的外翻部分134。 It should be specified that by the control means and the stapling portion of the everted configuration, the spike tip 128 can not be punctured or pierced portion 130 everted graft vessel 134. 在本发明的一个优选实施例中,尽管尖端128可以刺穿平坦的外翻部分134,尖端128并不暴露在外面,从而避免它们刺伤附近的其它组织,并对其造成损伤。 In a preferred embodiment of the present invention, although the tip 128 may pierce the everted flat portion 134, the tip 128 is not exposed to the outside, so as to avoid puncture other tissue they close, and causing damage. 这样,在本发明的一些实施例中,包括文中其它部分所述的实施例,当血管被固定时,血管可以被完全刺透或部分刺穿。 Thus, in some embodiments of the present invention, the embodiments described herein including other portions of the embodiment, when the vessel is secured, the blood vessel may be completely or partially pierced piercing.

图3A是根据本发明的一个优选实施例的环部分102的设计平面图。 3A is a plan view of a design ring portion 102 according to one preferred embodiment of the present invention.

图3B是根据本发明的一个优选实施例的尖钉部分120的设计平面图。 3B is a plan view of the spike design in accordance with a preferred embodiment of the present invention, the portion 120. 如图所示,环122中有数个选择性开口129。 As illustrated, the ring 122 has several openings 129 selectively.

图4A-4D表示了一种用于缩回如图1A-1D所示的根据本发明的一个优选实施例的吻合装置的一个环部分的方法。 Figures 4A-4D showing a method of a ring portion 1A-1D stapling apparatus according to one preferred embodiment of the present invention for retracting shown in FIG. 优选如图示意性所示的插入工具140包括一个带有一个环配合部分144的环缩回器142。 The insertion tool is shown schematically in FIG. 140 preferably comprises a loop mating portion 144 having a ring 142 is retracted. 该环配合部分144可与开口129相配合。 The ring portion 144 may be engaged with the mating opening 129. 作为一种替代或附加方案,环配合部分144在其下侧与环122相配合。 As an alternative or in addition, the ring portion 144 fitted at its lower side cooperating with a ring 122. 可以对环配合部分144进行多种改动,然而在本发明的一个优选实施例中,配合部分144包括数个指形件,该指形件远离血管132缩回时,将一起拉动环122。 Rings may be made to various modifications mating portion 144, however, in a preferred embodiment of the present invention, the mating portion 144 includes a plurality of fingers, when the finger-shaped member 132 is retracted away from the vessel, the pull ring 122 together. 指形件与开口129相配合,一个优点是它们提供了一种伸出环122的方法。 Finger cooperates with the opening 129, the advantage that they provide a method of extending ring 122.

当环缩回器142被缩回时,如图4B所示,环122和尖钉124同时也被缩回。 When the ring 142 is retracted is retracted, as shown in FIG. 4B, the spike 124 and ring 122 are also retracted. 当充分缩回之后,环122被锁定件106所锁定。 When fully retracted, the ring 122 is locked locking member 106. 或者,插入工具140的一个延伸部分148将阻止锁定件106的锁定配合,直至该延伸部分被缩回,从而允许纠正出现的错误。 Alternatively, the insertion tool 140 a extending portion 148 will prevent the locking member 106 of locking engagement, until the extension portion is retracted, thereby allowing errors to correct. 在本发明的一个优选实施例中,当锁定件106与环122锁定配合时,将与配合部分144脱离配合,例如通过沿轴向推开处于配合状态的指形件。 In a preferred embodiment of the present invention, when the locking member 106 and locking ring 122 with the mating portion 144 is disengaged, for example in the open state with the fingers in the axial direction. 或者,配合部分可以压迫锁定件106,从而防止它们的工作。 Alternatively, the mating portion may lock compression member 106, thus preventing them from work. 拆下该装置,可以包括推入锁定件106和/或向前伸出尖钉,从而使尖钉向内弯曲。 Remove the device may comprise a locking member 106 is pushed and / or forwardly projecting spike, so that the spike is bent inwardly. 可能需要夹住血管132,从而使尖钉相对于血管缩回。 Clamped vessel 132 may be required, so that the spike is retracted relative to the vessel.

如图4C所示,在本发明的一个优选实施例中,当缩回器142被继续拉回时,配合部分144被工具140的一个凸出部分(或加厚部分)146顶出配合位置。 4C, in a preferred embodiment of the present invention, when the retractor 142 is continuously drawn back, the mating position 146 with a projecting portion (or thickened portion) of the portion 144 of the tool 140. 这样,缩回环122、锁定该吻合装置和拆下插入工具140可作为一个整体的平滑动作进行。 Thus, ring 122 is retracted, the locking means and the anastomotic insertion tool 140 may be removed as a whole smooth operation. 图4D表示了拆下插入工具140之后已完成的吻合状态。 4D shows a fit state insertion tool 140 is removed after completed. 如图所示,尖钉124通常置入血管侧壁,从而减小暴露在血流中的面积,但也并非一定采用这种方式。 As shown, the spike 124 is typically placed in a blood vessel side wall, thereby reducing the area exposed to blood flow, but not necessarily in this way.

在本发明的一个优选实施例中,工具140并非完全围绕在移植血管的周围,例如只有270°的围绕角。 In a preferred embodiment of the present invention, the tool 140 is not completely surrounding the grafts, for example, only about 270 ° of angle. 这样,工具140的侧壁上就形成了一个成槽,从而一旦吻合过程结束后,该工具就可以穿过该槽被从移植血管上拆下。 Thus, on the side wall of the tool 140 is formed into a groove, so that once the anastomosis process ends, the tool through the slot can be removed from the graft vessel. 锁定在本发明的一个优选实施例中,锁定件106锁靠在环122上的锁定动作稍微具有一些弹性,这是为了能够适应局部解剖结构的变化,特别是为了避免在被吻合装置压迫的血管部分上施加太大的压力。 Locked in a preferred embodiment of the present invention, the locking member 106 is locked against the locking action on the ring 122 having a slightly some elasticity, which is able to adapt to changes in the local anatomy, in particular to avoid the vascular anastomosis apparatus being oppressed exert too much pressure on the part. 在本发明的一个优选实施例中,这种弹性的设置值符合一个理想的压力范围,例如,该压力不会太低以导致血液渗漏,也不会太高以导致组织坏死。 In a preferred embodiment of the present invention, this arrangement meets a desired value of the elastic pressure range, for example, the pressure is not too low to cause leakage of blood, can not be too high to cause tissue necrosis. 作为一种替代或附加方案,这种弹性能够适应不同的血管、不同的病人和/或同一条血管的不同部分的血管厚度的变化。 As an alternative or in addition, which can adapt to different elasticity of blood vessels, and various changes in the patient / or the thickness of different parts of the vessel with a vessel. 这种弹性可通过多种方式获得,例如通过下述一种或多种方式,即通过使锁定件106具有弹性、通过使管件104具有弹性、通过使尖钉124具有轴向弹性和/或通过使尖钉的弯曲区域126具有弹性。 This flexibility can be obtained by various ways, for example by the following one or more ways, i.e., by an elastic locking member 106, by an elastic tube member 104, by making the spike has an axial elastic and / or 124 by so that the spike 126 has an elastic bending region. 在一个典型实施例中,尖钉包括一个弹簧部分,例如其底端的一段S曲线,该弹簧部分的长度可以变化,从而调节尖钉尖端与一个锁定件或环122之间的距离。 Embodiment, the spring portion comprises a spike, for example, the S-curve section of its bottom end in an exemplary embodiment, the length of the spring portion may be varied to adjust the distance between the tip of the spike pin member or a locking ring 122.

在本发明的一个优选实施例中,尖钉124,尤其指弯曲区域126刺入血管132的“侧壁”内,从而使尖钉和血流实际上不存在接触。 In a preferred embodiment of the present invention, the spike 124, especially of the bend region 126 pierce the vessel 132, "side walls", so that the blood spike and practically no contact. 然而,优选应该如上文所述对施加在尖钉上的压力进行调节,从而避免产生坏死。 However, as described above should preferably be adjusted applied pressure nail tip, thus avoiding necrosis. 安装环长度当安装该吻合装置100时,管件104被用作一个安装环。 When the length of the mounting ring 100 when the stapling device is mounted, the tube member 104 is used as a mounting ring. 在某些情况下,该安装环的长度可能是表征该吻合装置的适用性的一个因素。 In some cases, the length of the mounting ring may be a factor in the applicability of the anastomotic device characterization. 在本发明的一个优选实施例中,该安装环选取了尽可能小的长度。 In a preferred embodiment of the present invention, the mounting ring selected length as small as possible. 或者,例如在该吻合装置被安装好之后,可以切掉多余的材料。 Alternatively, for example, after the stapling device is mounted, and you can cut off the excess material.

应指出的是,一个倾斜连接器(如下将述)可以相对血管具有一个大体较低的轮廓。 It should be noted that an inclined connector (as will be described later) relative to the blood vessel may generally have a lower profile.

在本发明的一个替代实施例中,管件104由两个被一个弹簧隔开的环所构成。 In an alternative embodiment of the present invention, the tube 104 is constituted by two springs separated by a ring. 一旦吻合过程结束,该管件就会被释放,同时环相接触。 Once the stapling process is complete, the tube will be released while the ring contact. 或者,安装环的收缩也可以通过使尖钉的一部分配合在两个环之间从而使元件106具有锁定作用。 Shrinkage or mounting ring may be fitted by the spike element such that a portion between the two ring 106 having a locking effect. 此外也可以采用其它沿轴向收缩的结构,例如采用正弦形状。 Further employed may be contracted axially other structures, for example using a sinusoidal shape. 单体件吻合装置图5是根据本发明的一个优选实施例的一个单体吻合装置200的设计平面图。 Single piece anastomotic stapling apparatus of FIG. 5 is a schematic plan apparatus 200 according to a preferred embodiment of the present invention a single embodiment. 该图中采用了与图3A和3B相类似的标号方案,用于表示出这两种吻合装置的相似之处。 The figure uses the similarities to FIGS. 3A and 3B embodiment similar reference numerals, shows a two anastomotic device. 单体吻合装置的一个优点是减少或免除了对两个零件的相对位置进行控制的必要。 One advantage of the anastomotic device is reduced monomers or eliminates the need for controlling the relative position of the two parts. 作为一种替代或附加方案,由于只有一个零件,该吻合装置便于夹持,因此也就减小了落入病人体内的可能性。 As an alternative or in addition thereto, since only a part of the anastomotic device to facilitate gripping and, therefore, reduces the likelihood of falling into the patient. 另外,由于只有一个零件,就可以免去锁定翼缘,同时弹性运动可以由专用弹簧223和225来提供。 Further, since only a part, it can be removed from the locking flange, while the elastic movement may be provided by a special spring 223 and 225. 在所示的典型实施例中,弹簧225被用于尖钉的主缩回运动,而弹簧223则针对精确的缩回量提供一些弹性。 In the exemplary embodiment illustrated, the spring 225 is a main spike retraction movement, and the spring 223 provides some flexibility for precise retraction amount. 在该吻合装置的典型使用过程中,通过压动与尖钉224相连的短柱227,就可使尖钉224向前伸出。 In a typical use of the stapling device, the movable press-studs 224 connected to the spike 227, so that the spike 224 can project forward. 当该短柱被释放时,弹簧将拉回尖钉。 When the studs is released, the spring will retract the spike. 或者,通过使弹簧与尖钉在点229处相连接,可以强制拉回弹簧,其中弹簧在点229处具有一个增厚部分。 Alternatively, the spring is connected to the spike at point 229, you can force the return spring, wherein the spring has a thickened portion at point 229.

在一个替代实施例中,两个弹簧225和223中至少有一个产生塑性变形,而不产生弹性变形。 In an alternative embodiment, two springs 225 and 223 have at least one plastic deformation, without elastically deformed.

尽管在一个单体件装置中不需要锁定,但也可以设置锁定机构。 While not required in a single piece locking device, but may be provided a locking mechanism. 或者,可以设置一个阻挡件,用于防止尖钉被拉回时伸出得太远。 Alternatively, a barrier may be provided, for preventing the projecting too far when the spike is drawn back.

图6A和6B是吻合区域的侧面剖视图,表示了一种使用吻合装置200进行吻合的方法。 6A and 6B are side anastomosis region sectional view showing a method of using the anastomosis stapling apparatus 200 method. 如图所示,该过程与图4A-4F所示的过程十分类似,不同之处在于,吻合装置200只由一个零件构成,并且没有锁定操作。 As shown, the procedure is shown in FIG. 4A-4F is very similar, except that stapling apparatus 200 is constituted by a part, and not the locking operation.

在这些图中,翼缘208如图所示向后和向上折出一个部分209。 In these figures, the flange 208 as shown in FIG rearward portion 209 and an upwardly folded. 这种弯折是选择性的,然而它可以提高吻合连接的强度,避免尖钉的尖端228对附近的身体结构造成损伤和/或通过强制使尖钉所夹持的组织进入翼缘208中的孔,从而允许夹紧血管组织。 This folding is optional, but it can improve the strength of the anastomosis connection, prevent the tip of the body structure in the vicinity of 228 pairs of spike damage and / or into the flange by forcing the spike is clamped tissue 208 hole, thereby allowing the clamping vascular tissue.

在吻合装置100和200中,如上所述,优选根据尖钉的相对位置使之具有一定的弹性。 In the stapling apparatus 100 and 200, as described above, preferably has a certain elasticity so that the relative position of the spike. 在一个典型的实施例中,允许的间隙介于0.1和2mm之间,例如大于0.5mm或1.5mm。 In one exemplary embodiment, a gap allowed between 0.1 and 2mm, for example 0.5mm or greater than 1.5mm. 间隙的量通常取决于吻合连接的参数,包括压力、血管的几何形状和连接中使用的尖钉的数目。 Typically the amount of the gap depends on the parameters of the anastomosis connection, comprising a number of pressure, geometry of the blood vessel and the spike used in the connection. 吻合装置的变化图7A示意性地表示了一个根据本发明的一个优选实施例的分叉的尖钉尖端结构260。 FIG change stapling apparatus 7A schematically shows an embodiment of the bifurcated spike tip structure 260 in accordance with a preferred embodiment of the present invention. 优选这种尖钉结构被用于主动脉型吻合连接器,例如如专利PCT/IL99/00284所述,该专利的公开被并入本专利,以作为参考。 This structure is preferably used to spike the aortic anastomosis connection type, for example as described in patent PCT IL99 / 00284 said, the disclosure of which / are incorporated in the present patent, by reference. 然而,这种类型的尖钉结构也可被用于其它的吻合连接器。 However, this type of spike structure may also be used for other anastomotic connectors. 在本发明的一个优选实施例中,结构260被用于将被刺穿的血管夹持在一起,例如用于防止分开,同时避免施加朝向或远离吻合连接器的压力。 In a preferred embodiment of the present invention, structure 260 is used to pierce the blood vessel to be held together, for example, prevent separation while avoiding a pressure is applied toward or away from the anastomosis connector. 或者,该尖钉也可以施加这种径向压力。 Alternatively, the spike may be applied to such radial pressure.

在一个增厚点253,一个尖钉252分成两个尖端254。 In one thickening point 253, a spike 252 is divided into two tips 254. 优选该尖端足够长,从而能够刺入主动脉(或其它“侧壁”)血管,但是不刺穿它。 Preferably the tip is long enough to be able to pierce the aorta (or other "side wall") vessel, but does not pierce it. 或者,该尖端也可以刺穿血管。 Alternatively, the tip can pierce the blood vessel. 另外,也可以设置不同数目的尖端,例如一个或三个,这些尖端可能不共面。 Further may be provided a different number of tips, such as one or three, these tips may not be coplanar. 增厚点253或分叉处被用作一个阻挡点,用于避免尖钉过深地刺入主动脉。 Thickening or bifurcation point 253 is used as a barrier point for avoiding the spikes penetrate too deeply aorta. 作为一个替代或附加方案,如下将述,该增厚点还被用作一个在安装过程中用于操纵吻合装置的锚定点。 As an alternative or additional embodiment, as will be described later, it is also used as the thickening point anchor point for actuating a stapling apparatus during installation.

在本发明的一个优选实施例中,各尖端具有不同的宽度和/或厚度,从而阻挡尖端的缩回。 In a preferred embodiment of the present invention, each tip having a different width and / or thickness, thereby blocking the retraction of the tip. 另外,尖钉上也可以设置这种几何形状的变化。 Further, the nail tip may be provided such variations geometry.

图7B是一个连接器的侧面剖视图,该连接器包括布置在一条动脉256内的根据本发明的一个优选实施例的结构250。 FIG. 7B is a side cross-sectional view of a connector, the connector comprising a structure arranged in accordance with a preferred embodiment of the present invention in an artery 256,250. 如图所示,将两个主动脉层258和260(第三、中间层)夹持在一起的尖端254未被示出。 As illustrated, the tip 254 of aortic two layers 258 and 260 (third intermediate layer) held together are not shown.

作为一个替代或附加方案,叉形尖钉端部的一个优点是有助于使吻合连接器的相对两侧的尖钉之间相互锁定。 As an alternative or in addition, the advantage of a fork-shaped end portion of the spike is locked with each other on opposite sides of the spike helps anastomotic connector. 为此,可以使用带有一个小孔的针眼形尖端,而不是开口的尖端。 For this purpose, use can be shaped tip having a pinhole aperture, rather than the tip opening. 作为一个替代或附加方案,该尖端(或尖钉本身)带有倒钩,用于防止尖钉的缩回。 As an alternative or in addition, the tip (or spike itself) with barbs, spikes for preventing retraction. 或者,尖钉沿其长度方向加工有倒钩,从而提供一个棘爪机构,其中该尖钉只能沿单方向前进。 Alternatively, the spike along its length barbed processing, thereby providing a detent mechanism, wherein the spike proceeds in one direction only. 这样可以提供一个自锁紧吻合连接,特别是与如上所述的弹簧相连接时,其中这些弹簧允许尖钉和吻合连接器之间产生一定的相对运动。 This provides a consistent self-locking connection, in particular when connecting to the spring as described above, wherein the spring allows the spike and stapling a certain relative movement between the connectors.

优选尖钉的横截面呈带有倒角的矩形。 Spike preferably rectangular in cross section with chamfered. 然而,也可以采用其它的横截面。 However, other cross-sections may be employed. 例如,该横截面可以呈三角形(例如,表面朝向或背离尖钉的弯曲方向)、椭圆形或矩形(例如,厚侧或薄侧朝向弯曲方向)。 For example, the cross section may be triangular (e.g., a curved surface towards or away from the direction of the spike), oval or rectangular (e.g., thick or thin side is bent toward the side direction). 或者,尖钉的横截面不与弯曲方向对齐。 Alternatively, the cross section of the spike is not aligned with the bending direction. 另外,该横截面可以沿尖钉的长度方向发生改变。 Further, the cross-section may change along the longitudinal direction of the spike. 这可以通过例如化学蚀刻、激光切割、低温加工或扭转扭转该尖钉而获得。 This may be achieved, for example, chemical etching, laser cutting, machining, or low torsional twisting of the spike is obtained. 其中一些尖钉横截面结构的优点是在所需方向上提供了最大强度,而在其它方向上保持弹性。 Wherein the spike advantage of some cross-sectional configuration to provide maximum strength in the desired direction, while maintaining elasticity in other directions. 作为一种替代或附加方案,该横截面最好能够嵌入血管中,同时不接触血流。 As an alternative or in addition, the cross-section is preferably capable of inserting a blood vessel without contact with blood. 另外,一些尖钉形状在插入过程中有望至少对血管的某些层造成相对较小的损伤。 Further, some of the spike shape expected during the insertion of a relatively small damage caused by at least some of the layers of the blood vessel. 典型实施例图8A是根据本发明的一个优选实施例的一个主动脉吻合连接器的设计平面图。 Exemplary embodiment of FIG. 8A is a plan view of a preferred design of the present invention, an embodiment of the aorta anastomotic connector embodiment.

图8B是图8A所示的连接器的俯视图,其中该连接器处于备用状态。 FIG 8B is a plan view of the connector shown in FIG. 8A, wherein the connector is in a standby state.

图8C是一个放大视图,表示了连接器的相对两侧的两个尖钉的交汇点。 8C is an enlarged view showing the intersection of two opposite sides of the spike connectors.

图8D是沿图8B中线AA的剖视图,表示了处于备用状态的吻合设备两侧的尖钉的相对位置。 8D is a sectional view along line AA in FIG. 8B, showing the relative positions of both sides of the spike stapling device is in a standby state.

图中提供了典型的实施方案,但这并不被认为对其它实施例中的连接器构成限制。 FIG provided exemplary embodiments, but not to be considered limiting of other embodiments of the connector. 优选该连接器采用镍钛合金,并且使用图9A和9B所示的模具被弯曲加工至图中所示的备用位置。 The mold is preferably a nickel alloy connector, and used as shown in FIG. 9A and 9B is bent to the standby position shown in FIG.

在一种典型加工方法中,如图8A所示,一个管件经过激光切割(或一个平板件经过切割,并且在一个轴柄上被弯曲成型后被焊接成一个管)被加工成连接器。 In a typical processing method, shown in Figure 8A, after laser cutting a tubular member (or a plate member after cutting, and is bent on a mandrel after forming into a welded tube) is processed into the connector. 优选该管连接器被安装在一个轴柄262上,优选该轴柄是一个与连接器紧密配合的可扩张的轴柄。 Preferably the pipe connector is mounted on a mandrel 262, the mandrel is preferably a close fit with the connector of the expandable mandrel. 随后,连接器的尖钉补弯绕在一个环模具264上,并且被一个包括部分266和262的两体件外部模具所围绕。 Subsequently, the connector around the bend in the spike up on a ring mold 264 and is a body member comprises two outer mold portions 266 and 262 surrounded. 然后该成型的连接器被置入一个火炉进行热处理,然后优选用水进行淬火。 Then the connector is molded into a heat-treating furnace, and then quenched with water is preferred. 然后,拆下外部模具,并且例如通过使尖钉向后弯曲将环模具264拆下。 Then, the external mold is removed, for example by bending backwards spike ring mold 264 is removed. 在本发明的一个优选实施例中,只有一个热处理工序被用于加工整个连接器。 In a preferred embodiment of the present invention, only a heat treatment step is used to process the entire connector.

在一个典型冠状动脉吻合装置中,尖钉所采用的金属直径介于0.07和0.1mm之间,与通常用于分流缝合的线的直径相近。 In a typical coronary anastomosis device, the diameter of the metal spike used is between 0.07 and 0.1mm, and the diameter of the wire is generally similar for tapping suture. 管件104可以稍厚,例如0.3mm,然而这并非是必需的。 The tube 104 can be thicker, for example 0.3mm, but this is not essential. 连接器材料在本发明的一个优选实施例中,该连接器由镍钛合金加工而成,然而,也可以采用其它材料,例如不锈钢或聚合物,如塑料或复合材料。 Connector material of the present invention a preferred embodiment, the connector is made of nitinol processed, however, other materials may be used, such as stainless steel or a polymer, such as plastic or composite materials. 也可以采用生物可分解塑料。 Biodegradable plastics can also be used. 在某些情况下,连接器可以由两种或多种不同材料构成,例如,每个部分采用不同的材料,甚至同一个部分采用两种或多种不同材料。 In some cases, the connector may be formed from two or more different materials, for example, each portion of different materials, even with the use of a part of two or more different materials.

或者,连接器至少一部分由同种异体移植或异种移植材料构成。 Alternatively, at least a portion of the connector of allogeneic transplant or xenograft material. 例如,环122可以由肌腱构成。 For example, ring 122 may be formed from a tendon.

优选移植血管是一个同种异体移植物,例如一条乳房动脉或一条周围血管。 Preferably a graft is an allograft, e.g. a mammary artery or a peripheral blood vessel. 或者,也可以采用其它移植材料,包括本技术领域内的合成材料或其它类型的材料。 Alternatively, other graft materials may be employed, including synthetic materials in the art, or other type of material. 在某些情况下,该连接器在体外与移植血管相连接,可能处于一个较远的位置。 In some cases, the connector is connected to the graft vessel in vitro, it may be in a remote location. 吻合连接器的使用图10是一个流程图,该图表示了根据本发明的一个优选实施例的打孔旁外科手术的典型过程300。 FIG anastomotic connector 10 is a flowchart which shows a typical embodiment of the process next surgical punch according to one preferred embodiment of the present invention 300. 可以对该程序进行许多改动,例如,移植血管的引入可以通过一个胸部开孔、通过一条血管或者在胸部区域内获得。 Many modifications may be made to the program, for example, may be introduced by a graft opening the chest, or obtained by a blood vessel in the chest area. 在另一个例子中,尽管这种分流通常至少需要两个连接,这两个连接之一或者全部可以通过内窥镜、穿过血管或使用开口手术进行操作。 In another example, although this typically requires shunting at least two connections, one or all of these may be connected through an endoscope, or through the vessel using an open surgical operation. 另外,至少对于冠状远端的连接而言,其中一个连接可被省去,例如如果乳房动脉被使用。 Further, at least for distal coronary connection, the connection may be omitted where a, for example, if the mammary artery is used. 另一种类型的改动是移植血管被准备用于连接时刻(例如,当连接器被安装上时)。 Another type of modification is a graft vessel is prepared for connection time (e.g., when the connector is mounted on). 对于两个极端例子而言,这种准备既可以在体内进行,也可以在另一个国家进行。 For example, two extreme terms, this preparation may be performed in vivo, can also be carried out in another country. 该过程的时限也是灵活的,取决于采用的材料的类型和所用的技术。 The process time is flexible, depending on the type of material used and the technique used. 过程300被描述为一个通用过程,尽管还需要考虑到各种可能的变化。 Process 300 is described as a general process, despite the need to take into account the possible changes.

首先,该分流过程开始(302)。 First, the dividing process is started (302). 这通常包括在胸部开一个或多个孔和/或在身体上开其它孔。 This typically includes one or more open holes and / or holes in the other body to open the chest. 心脏可以停止或不停止跳动,并且将被分流的血管可以被堵塞或不被堵塞。 Heart can be stopped or not stopped beating, and will be diverted or blocked blood vessels can not be blocked.

准备一个移植血管(304)。 Prepare a graft (304). 该移植血管可以从病人体内采集(例如,一条腿静脉),或由手术箱提供。 The grafts can be collected from the patient, or provided (e.g., leg veins) by a surgical case. 该工作可在整个过程开始之前或之后进行。 The work can be performed before or after the beginning of the whole process. 在一些实施例中,该移植血管是一条半连接或未连接的乳房动脉,该动脉可以通过一个通孔被获得和/或准备。 In some embodiments, the graft vessel is connected to a semi-connected or mammary artery, the artery can be obtained and / or prepared by a through hole.

一个连接器(例如100或200)被安装在移植血管(308)上。 A connector (e.g. 100 or 200) is mounted on a graft vessel (308). 根据用于安装和吻合的方法,该血管可在安装吻合连接器之前、过程中或之后被外翻(306)。 The method for installing and anastomosis, the vascular anastomosis can be installed before the connector is everted (306), during or after.

根据旁外科手术类型的不同,移植血管和病人的血管系统之间需要一个、两个或多个连接。 The next type of surgery between the different vascular graft and patient requires a system, two or more connections. 步骤310-316描述了此类连接。 Steps 310-316 describe such connection.

在步骤(310)中,一个孔被开在目标血管上。 In step (310), a hole is opened in the target vessel. 优选该打孔器补保留在孔中,从而防止血液从孔中流出。 Preferably, the fill hole punch retained in the hole, thereby preventing the outflow of blood from the hole.

然后,带有连接器的移植血管被插入孔(312)。 Then, the graft vessel is inserted with a connector hole (312). 在一些实施例中,该连接器在被插入之前或之后发生局部变形,或被允许变形至一个局部安装位置。 In some embodiments, the occurrence of local deformation of the connector is inserted before or after, or to a partial modification allows the installation location.

然后进行连接(314),优选通过完成该设备的变形来实现,但在某些实施例中,可通过拉或推该装置来实现。 Then the connection (314), is preferably achieved by the deformation of the complete device, in certain embodiments, may be achieved by pulling or pushing the device. 此外,可以选择性地采用一个额外步骤,即对该装置的新结构进行锁定,或者切除该装置中的不必要部分(这些步骤均未示出)。 Further, it is possible to selectively employ an additional step of locking the new structure of the apparatus, or cutting unnecessary portion of the apparatus (These steps are not shown).

然后,工具被拆下(316)。 The tool then dismounted (316). 在某些实施例中,该工具围绕在移植血管周围。 In certain embodiments, the tool surrounding the graft vessel. 该工具可以从移植血管的另一端被拆下。 The tool can be detached from the other end of the graft. 或者,该工具被拆除。 Alternatively, the tool is removed. 或者,该工具被分开。 Alternatively, the tool is separated. 或者,该工具被从血管上切除。 Alternatively, the tool is excised from the vessel. 或者,该工具在使用过程中不完全围绕在移植血管周围。 Alternatively, the tool in use is not completely surround the graft.

进行连接的步骤按照需要的次数被重复。 Connecting step is repeated as many times as required. 在某些情况下,步骤304、306和/或308也被重复。 In some cases, steps 304, 306 and / or 308 are also repeated.

当一个或两个连接完成后,优选实施一个质量保证(QA)318步骤,其中检查连接有无泄露和/或确保连接器被正确安装。 When one or both of the connection, a preferred embodiment of the quality assurance (QA) 318 step, wherein the presence or absence of leaks to check the connection and / or ensure that the connector is properly installed. 一个典型的检查可以是检测是否所有的尖钉都被部署得当并且刺入目标血管中。 A typical inspection may check whether all the spikes are properly deployed and penetrating the target vessel. 例如,这种检查可以通过视觉或放射线照相来进行。 For example, this check can be performed by visual or radiography.

然后该过程即告结束(320),例如封闭通孔。 The process then comes to a close (320), for example, closing the through hole.

下面将对上述过程的各步骤中使用的根据本发明的优选实施例的各种不同工具进行介绍。 Various tools according to a preferred embodiment of the present invention the steps below will be used in the above process are described. 典型工具图11是一个夹持架工具400的示意图,该夹持架工具在旁外科手术过程中用于夹持根据本发明的一个优选实施例的各种其它工具。 11 is a schematic typical tool holder holding a tool 400, various other embodiments of the tool holder according to one preferred embodiment of the present invention, the holding tool rack beside the surgical procedure.

优选工具400包括一个手柄402和一个从该手柄延伸出的轴401。 Tool 400 preferably includes a handle 402 and a shaft extending from the handle 401. 该实施例的一个特殊特征是一个大体沿整个夹持架400延伸的长槽404,该长槽404允许移植血管的自由进出,尽管如下将述,该长槽只存在于该工具的远端就已足够。 A special feature of this embodiment is a clamp bracket 400 substantially along the entire length of the groove 404 extending, elongated slot 404 which allows free access grafts, although as will be described later, exists only in the long groove on the distal end of the tool sufficient. 优选在该工具上加工一个末端408,从而使其能够在吻合连接过程中与一个穿透在血管上的孔的内部相配合。 Preferably a processing terminal 408 on the tool, so that it is capable of penetrating inside a hole in a blood vessel anastomosis mating connection. 优选工具400端部处的一个区域406具有较高的侧面(例如,除了一个移植血管拆卸长槽之外,它具有几乎封闭的圆周),用于帮助保持插入在夹持架400内部的工具的结构,如下文将述。 A region 400 at the end of tool 406 preferably has a high side (e.g., in addition to a detachable trough outside the graft vessel, which has an almost closed circle), to help keep frame 400 is inserted in the internal clamping tool for structure, as will be described below. 另外,区域406被用作一个阻挡件,用于防止工具400无限地插入一条血管。 Further, region 406 is used as a barrier for preventing the tool 400 is inserted into a blood vessel indefinitely. 一个区域410具有比区域406较低的侧面,用于允许这种插入的工具能够分开并且使围在其中的移植血管能够自由运动,如下文将述。 A region 410 having a side surface area lower than 406, for allowing the insertion of such a tool can be separated and the graft vessel enclosed therein is free to move, as will be described below. 也可以采用其它结构。 Other configurations may be employed.

优选末端408被安装在一个延伸部分上,该延伸部分与夹持架400相分离,并且当需要从移植血管上拆下工具时,或在安装吻合连接器的过程中,该延伸部分将从夹持架上缩回。 Tip 408 is preferably mounted on an extension, the extension portion 400 and the clamping frame separated, and when the need to remove the tool from the graft, anastomotic or during installation of the connector, which extends from the clip portion holding rack retracted. 然而,优选末端408在打孔操作(此时该末端被推入穿好的孔)之前就处于工作位置,直至某些或全部其它工具都被拆下,并且直至吻合过程结束。 Preferably, however, the end 408 in a punching operation (at which time the terminal is put into the hole is pushed) is in the working position before, until some or all of the other tools are removed, and the process ends until the anastomosis.

优选夹持架工具400包括基准长槽(未示出),用于合适地对齐插入其中的工具。 Gripping means 400 preferably includes a reference frame elongated slot (not shown), a suitable alignment tool inserted therein.

优选末端408采用塑料,然而也可采用金属。 Terminal 408 preferably plastic, but metal may be used. 优选工具400的其它部分选用本技术领域内公知的硬质塑料。 Other preferred portions of the selection tool 400 known in the art of hard plastic. 工具400可以用完即丢。 That means 400 may run out throw. 或者,它可以被消毒和再使用,例如使用本技术领域内公知的消毒方法。 Alternatively, it can be sterilized and re-used, for example, the art known method of disinfection.

在本发明的一个优选实施例中,插入在夹持架400内的工具如果包围着移植血管,那么当它们被缩回时,将被机械地分开。 In a preferred embodiment of the present invention, inserted into the holding frame 400 surrounding the tool if the graft vessel, so that when they are retracted, to be separated mechanically. 因此,移植血管就可以被从工具中取出。 Thus, the graft vessel can be removed from the tool. 作为一种替代或附加方案,为了进行机械分离,可能需要用刀片切断这些工具,被切断的工具可能是夹持架400或者插入工具的一个构成部分。 As an alternative or in addition, to mechanical separation, these tools may require cutting with a blade, the cutting tool may be an integral part of the clamping tool holder 400 or the insertion. 优选插入工具上预先加工有一条(或两条)裂缝,以便于拆除。 Insertion tool preferably has a pre-processing (or both) cracks easier removal. 或者,大多数工具是开口的,例如呈条状,只在其末端有一个用于围绕住血管的环。 Alternatively, most tools are open, for example in strips, only one ring surrounds a blood vessel at its ends. 该工具在拆除过程可能会被损坏,所以它只能被使用一次。 The tool may be damaged during the removal process, so it can only be used once. 或者,它只产生塑性或弹性变形,从而它可以被弯成原始形状、被消毒和再使用。 Alternatively, only plastically or elastically deformable, so that it can be bent into the original shape, sterilized and reused. 打孔器当在血管上打孔时,将出现一些问题,其中一些或全部将通过发明的优选实施例进行说明:(a)避免双打孔,其中血管的另一侧也被穿透。 When the hole punch in the blood vessel perforation, some problems will occur in which some or all of the preferred embodiments of the invention will be described by: (a) avoid double punch, the other side of the vessel which are also penetrated.

(b)避免因打孔器的运动而对血管造成意外损伤。 (B) to avoid accidental movement of the punch caused damage to the blood vessels.

(c)避免血液通过穿出的孔流失。 (C) the risk of blood loss through hole piercing.

(d)准确地去除切下的部分。 (D) removed accurately cut portion.

在本发明的一个优选实施例中,一个打孔操作通常包括两个步骤:(i)使用工具在目标血管上穿一个孔;和(ii)使用工具取出血管壁的一部分。 In a preferred embodiment of the present invention, a punching operation typically includes two steps: (i) using a tool through a hole in the target vessel; and (ii) use a portion of the tool taken the vessel wall.

在本发明的一个优选实施例中,打孔工具为完成步骤(i)和/或(ii)所进行的运动中不存在轴向运动。 Embodiment, the motion of the piercing tool completion of step (i) and / or (ii) is carried out in the absence of axial movement in a preferred embodiment of the present invention. 这样就最小化了双打孔(a)的危险和/或意外损伤(b)的危险。 This minimizes the risk and danger of puncturing bis (a) and / or accidental damage of (b). 抓切打孔器图12A-12D表示了一个第一种打孔器,即打孔器420。 Grasping the cut hole punch of FIG. 12A-12D shows a first hole punch, i.e., hole puncher 420. 与此处所述的其它工具一样,打孔器420可被设计与夹持架工具400一起使用,也可作为一个单独的工具使用。 As with the other tools described herein, may be designed with a hole punch 420 grip bracket used with the tool 400, it may also be used as a separate tool. 在发明的某些实施例中,当孔被打出之后,工具400将被置于该打孔器的一部分之上(通常通过施加力的方式),该部分保持在打出的孔内,从而防止泄露和/或导入末端408。 In certain embodiments of the invention, when the hole is played, the tool 400 is placed over a portion of the hole punch (typically by way of applying a force), the portion held in the hole played, thereby preventing leakage and / or import terminal 408.

打孔器420包括一个分裂为两个(或多个)向外张开的舌形件424的管件423。 The hole punch 420 includes a split into two (or more) tubular flared tongue 424 423. 或者,整个管件可以被分裂开。 Alternatively, the entire tube can be split apart. 一个套筒426被用于当管件423缩回时,使舌形件合拢在一起。 A sleeve 426 is used when the pipe member 423 is retracted, brought together so that tongue.

在图12A中,通过将舌形件压靠在血管上,使血管422的一部分被舌形件咬住。 In FIG. 12A, the tongue is pressed against the blood vessel, the blood vessel 422 is a part of the tongue bite.

在图12B中,该管件产生少量的缩回,并且舌形件夹起血管422的一部分428。 In FIG. 12B, the tube generates a small amount of retraction, and the tongue portion 428 of the dish 422 vessels. 如图所示,优选舌形件424的内表面上具有一个被安装在一个垂直部分上的切削刃。 As shown, having a cutting edge is mounted on a vertical portion of the inner surface 424 of the tongue preferably.

在图12C中,管件423进一步缩回,从而切下部分428。 In FIG. 12C, the tube 423 is further retracted, the lower portion 428 such that cutting.

图12D表示了经过打孔后的剩余血管422。 FIG 12D shows remaining after puncturing the vessel 422.

这种打孔器的某些实施例的一个优点是,通过恰当地设置由舌形件424所限定的孔,该打孔器能够避免同时咬住血管的两侧。 One advantage of certain embodiments of this puncher is, by appropriately setting the tongue 424 defines a hole puncher can be avoided while the biting sides of the vessel. 或者,对于切削血管的咬合件而言,也可以采用一个单独的切削件(未示出)切去咬住部分428。 Alternatively, a cutting member for engaging the blood vessel, may be used a separate cutting element (not shown) cut-out portion 428 bite. 旋转打孔器图13A-13D表示了根据本发明的一个优选实施例的一个旋转尖钉打孔器430的使用过程。 Figures 13A-13D rotary puncher shows a rotary spike puncher according to one preferred embodiment of the present invention, the use of 430. 优选打孔器430包括一个内抓持件432,和一个外切削件434,优选内抓持件432是一个真空管,同时优选外切削件434包括至少一个尖钉436图13B是外切削件434的一个透视图。 Preferably the hole punch 430 includes a gripping member 432, and an outer cutting member 434, the gripping member 432 is preferably a vacuum tube, while the outer cutting member 434 preferably comprises at least one spike 436 in FIG 13B is an external cutting member 434 a perspective view of FIG.

如图13A所示,抓持件432与血管422相接触,并且将其咬住,例如通过使用真空,或使用一个内抓持器(未示出)。 13A, the gripping member 432 in contact with the blood vessel 422, and its bite, for example, an internal gripper by using a vacuum, or (not shown). 优选一旦血管422被咬往,抓持件432就被轻微缩回,从而避免在打孔过程中对血管422的另一侧造成意外损伤。 Once the vessel is preferably 422 to bitten, the gripping member 432 to be retracted slightly so as to avoid accidental damage to the other side of the vessel 422 in the puncturing process.

在图13C中,切削件434朝向血管422向前伸出,从而使尖钉436刺穿血管。 In FIG. 13C, the cutting member 434 extends forwardly toward the vessel 422, so that the spike 436 to pierce a blood vessel. 通过旋转切削件434,尖钉436在血管422上切出一个圆孔。 434, spike cut a circular hole 436 by the rotation of the cutting member 422 in the vessel. 优选尖钉436呈直线形,并且其长度稍大于血管422的壁厚。 Spike 436 is preferably rectilinear, and has a length slightly greater than the wall thickness of the vessel 422. 或者,尖钉也可以采用其它的长度或几何形状。 Alternatively, the spike may be a length or other geometric shapes. 在一个特殊实施例中,尖钉436呈镰刀形,并且通过旋转运动刺入血管422。 In one particular embodiment, a sickle-shaped spike 436, and 422 pierce the vessel by a rotational movement.

图13D表示了经过打孔后的血管422。 FIG 13D shows a vessel 422 after puncturing. 砧打孔器图14A-14E表示了根据本发明的一个优选实施例的一个砧打孔器440的使用过程。 FIG puncher anvil 14A-14E show an anvil puncher according to one preferred embodiment of the present invention uses the process 440.

如图14A和14B所示,一个锋刃422被用于在血管422上切出一个缝隙444。 Shown in FIGS. 14A and 14B, a blade of 422 is used to cut a slot 444 in the vessel 422.

如图14C所示,砧打孔器446包括一个端部加工有一个砧452的内件446和一个端部加工有切削刃450的外件448。 14C, the anvil 446 includes a hole punch machining inner end portion 452 of anvil member 446 and an end portion of a machining cutting edge 450 with an outer member 448. 作为一种替代或附加方案,切削刃和砧或以交换位置,或者只使用切削刃。 As an alternative or in addition, the cutting edge and the anvil or to the exchange position, or only the cutting edge. 砧452穿过孔444被插入血管422。 Anvil 452 is inserted into the vessel 444 through the hole 422. 然后,如图14D所示,直至血管422在砧452和切削刃450之间被切削后,砧才缩回。 Then, as shown in FIG 14D, the blood vessel 422 until after the anvil 452 and the cutting edges 450 are cut, the anvil is retracted only. 图14E表示了打出的孔。 FIG 14E shows the hole played. 避免血液流失和其它改动为了避免血液流失,优选一个封闭管(未示出,但可以是末端408)被插入打出的孔。 Avoid blood loss, and other modifications in order to avoid blood loss, preferably a closed tube (not shown, but may be the end 408) is inserted into the shot hole. 优选该封闭管具有一个阀门,打孔器可穿过该阀门被插入并且当打孔器被移出时,阀门关闭,从而没有血液流出。 Preferably, the tube having a closure valve, the valve can pass through the hole punch is inserted and when the hole punch is removed, the valve closes, so that no blood flow.

该封闭管可被推入该孔。 The closed pipe can be pushed into the aperture. 作为一种替代或附加方案,该管件可被旋转拧入该孔,例如通过在管外侧加工出螺纹。 As an alternative or in addition, the tube can be rotated into the threaded hole, for example, outside of the tube by threaded processing.

作为一种替代或附加方案,通过用盐水代替血液或者作为对血液的补充而使之充满血管,就可以避免血液的流失。 As an alternative or in addition, by replacing the blood with saline or in addition to the full of the blood vessels, blood loss can be avoided. 这种方法有利地防止了脆弱的血管422产生塌陷,或者有助于清除血液。 This method advantageously prevents collapse of the weak vessel 422 is generated, or to help remove the blood. 另外,也可以使这种盐水流经打孔器本身。 Further, it is also possible that brine flows through the hole punch itself. 充满血管422的另一个优点是可使正被操作(打孔、设备连接)的一侧与血管的另一侧隔离开,从而减小损伤血管另一侧的可能性。 Another advantage is filled vessels 422 and allow side to side as the vessel is being operated (punching device connection) isolate, thereby reducing the likelihood of damage to the other side of the vessel. 整体打孔器图15A-15D表示了根据本发明的一个优选实施例的一个插在夹持架工具400中的打孔器460。 FIGS 15A-15D whole puncher shows a clamping frame is inserted in the hole punch tool 400 460, according to one preferred embodiment of the present invention. 打孔器460包括一个轴462,该轴的远端具有一个用于操纵该打孔器的手柄464,而另一端具有一个用于刺穿血管的锋利末端466。 The hole punch 460 includes a shaft 462, the distal end of the shaft 464 having a handle for manipulating the puncher and the other end having a sharpened end 466 for piercing a blood vessel. 在末端466的一端,该轴形成了一个窄径部分468,被刺穿的血管随着末端466继续推入,或者在末端466上的一个后角(未示出)的作用下被引导入窄径部分468处。 At one end of the end 466 of the shaft forms a narrow diameter portion 468, with the pierced vessel 466 continues to push the terminal, or on the end of a corner post 466 is guided into the narrow (not shown) effect diameter portion 468 at. 窄径部分468的一端有一个砧470。 One end of the narrow diameter portion 468 of the anvil 470 has a. 或者,砧470具有一个外角,用于帮助将切下的血管从打孔移至(夹持架400的)末端408。 Alternatively, anvil 470 has an outer corner, for aiding puncturing a blood vessel excised from the move (holding frame 400) 408 end.

当进行打孔时,如图15B所示,末端466相对砧470被缩回,从而在血管上打出一个孔。 When puncturing, as shown in FIG. 15B, the end 466 of the anvil 470 is retracted relative to play a hole in the vessel.

图15C表示了插在夹持架400中的打孔器460。 15C shows the hole punch 460 is inserted in the holding frame 400.

图15D是打孔器460的近端的放大视图,当进行打孔时,它被插入在夹持架400中。 15D is an enlarged view of the proximal end of the hole punch 460, when puncturing, which is inserted in the holding frame 400. 在本发明的一个优选实施例中,砧470和末端466之间有一个定直径区域467,用于防止被切下的血管部分从打孔器上滑落。 In a preferred embodiment of the present invention, there is a constant diameter region 467 between the tip 466 and the anvil 470, the lower portion of a blood vessel for preventing the slide is cut from the hole punch. 优选砧470具有一定的斜度,以便于将被打孔的血管推到夹持架400的末端408上。 The anvil 470 preferably has a certain inclination, so as to push the blood vessel to be punctured onto the end 408 of the clamping bracket 400.

图16A和16B分别用透视图和透视剖面图表示了一个根据本发明的一个优选实施例的尖端回缩打孔器480。 FIGS 16A and 16B respectively show a perspective view and a perspective sectional view of a hole punch 480 is retracted according to a preferred embodiment of the tip according to the present invention. 打孔器480包括一个锋利的缩回末端486、一个砧490、一个限定在末端486和砧490之间的窄径部分488和一个位于末端486和窄径部分488之间的圆柱部分487。 The hole punch 480 includes a sharpened tip 486 is retracted, an anvil 490, a tip 486 defined between the anvil 490 and the narrow diameter portion 488 at the end 486 and a cylindrical portion 487 and a narrow diameter portion 488 between.

如图16A所示,打孔动作通过缩回末端486而产生,优选使用一个加工在圆柱部分487内的轴或缆绳492拉动末端486。 16A, the punch is retracted by operation terminal 486 is generated, it is preferable to use a machine axis or cable 487 within the cylindrical portion 492 of the end 486 is pulled. 当末端486被进一步拉回时,圆柱部分487被拉回并靠在砧490上,使用一个由圆柱部分487和/或砧490所限定的脊部分496切下介于二者之间的窄径部分488内的血管部分。 When the tip 486 is pulled back further, and the cylindrical portion 487 is pulled back against the anvil 490, narrow-bore interposed therebetween by a case of using a cylindrical portion 487 and / or anvil 490 defines a ridge portion 496 cut portion of the inner part of the vessel 488.

在本发明的一个优选实施例中,夹持架400和/或末端408包括一个密封件,例如一个虹膜或活页密封件,打孔器可穿过该密封件被插入和缩回,同时只要末端408位于打出的孔之内,就可防止血液泄露。 In a preferred embodiment of the present invention, the holding frame 400 and / or tip 408 includes a seal member, such as a leaflet or iris seal, the seal may pass through the hole punch is inserted and retracted, while the long end 408 is located within the bore of the shot, blood leakage can be prevented. 其它回缩末端机构图17是一个根据本发明的另一个优选实施例的尖端回缩打孔器500的透视图。 The other end of the retraction mechanism of FIG. 17 is a perspective view of the hole punch 500 is retracted tip according to another preferred embodiment of the present invention. 在该实施例中,末端506在轴502的作用下的回缩运动没有拉回一个圆柱部分507,从而没有切下靠在砧510的切削刃512上的血管422。 In this embodiment, the tip 506 retracted under the action of the movement of the shaft 502 is not pulled back a cylindrical portion 507, so that no blood vessel is cut against anvil 422 on the cutting edge of 512,510. 末端506和圆柱部分507的运动可以相互分离和独立的。 Movement of the cylindrical end portions 506 and 507 may be separate and independent of each other. 或者,这两个运动也可以受到同一个控制。 Alternatively, the two movements can also be subject to the same control. 或者,使用一个位于轴502远端的钉或其它机构将轴502的运动和圆柱部分507和/或砧510的运动耦合在一起。 Alternatively, the distal end 502 of the shaft using a staple or other mechanism to couple together the shaft 502 moving the movement portion 507 and cylindrical and / or the anvil 510. 倾斜打孔器图18表示了根据本发明的一个优选实施例的倾斜打孔器520的一个组装图和一个拆分图,该打孔器打出的孔可以具有不垂直于血管的空腔。 18 shows the inclined hole punch hole punch in accordance with the inclination of a preferred embodiment of the present invention is an assembly view 520 and a split view of a hole punch hole may have played a cavity is not perpendicular to the blood vessel. 根据打孔件形状的不同,孔的形状可以呈圆形、椭圆形或其它形状,甚至多边形。 Depending on the shape of the punch, the shape of the hole may be circular, oval or other shape, or even polygonal. 打孔器520一般包括一个具有前切削刃的外管件528、一个内件524、一个与内件524的内侧相配合的并且如上所述可缩回的回缩末端522和一个切削件526,该切削件被内件524拉回,并靠紧在前切削刃上。 The hole punch 520 generally includes an outer tubular member having a front cutting edge 528, an inner member 524, and an inside of the inner member 524 as described above and a cooperating retractable retraction end 522 and a cutting member 526, the the inner cutting member 524 is pulled back, and the front against the cutting edge. 从而在血管422上打出一个孔。 Thus hit a hole in the vessel 422. 在其它实施例中,切削刃和砧的位置可被改变。 In other embodiments, the position of the cutting edge and the anvil may be changed. 另外,回缩末端522是可选择的。 Further, the retractor end 522 is optional. 在本发明的一个优选实施例中,由切削件526限定的平面并不平行于前切削刃,尽管也可以使之平行。 In a preferred embodiment of the present invention, the plane defined by the cutting member 526 is not parallel to the front cutting edge, although it may be made parallel. 相反,其间有一个5°至15°的角度差,优选采用5°。 Instead, there is an angle between 5 ° to 15 ° difference, preferable 5 °. 例如,对于一个45°的打孔器而言,前切削刃呈45°(位于内件524的后侧),并且切削件526具有50°的角度。 For example, for a hole punch of 45 °, the front cutting edge was 45 ° (on the rear side of inner member 524), and the cutting member 526 has an angle of 50 °. 切削件526与内件524的分离可以使切削刃和打孔末端获得较低的机械加工成本。 Separating member 526 and the inner cutting member 524 of cutting edge and can obtain a lower end of the punch machining costs. 作为一种替代或者附加方案,通过替换切削件526就可以沿不同角度进行打孔。 As an alternative or in addition, puncturing can be performed in different angles by replacing the cutting member 526. 其它倾斜打孔器图19A示意性地表示了根据本发明的另一个优选实施例的另一个倾斜打孔器530。 Other inclined puncher FIG 19A schematically shows a further embodiment 530 is inclined hole punch according to another preferred embodiment of the present invention. 打孔器530使用了一个坚实的尖端件532,该末端件具有一个前尖端536和后切削面538。 The hole punch 530 using a solid tip 532, the tip end piece having a front cutting face 536 and the rear 538. 一个与之配合(通常选择不平行的)的前切削面534用于对二者之间的血管进行切削。 A mating therewith (usually the non-parallel) of the front cutting surface 534 for cutting the blood vessel therebetween.

图19B表示了尖端件532的两个视图。 19B shows two views of the tip member 532. 此处所示的实施例包括数个加工在尖端内的凹槽542。 Embodiment illustrated herein includes a number of machined grooves 542 in the tip. 这些凹槽并非必要,然而,它们看上去可以减小在打孔过程中转动尖端的必要。 These grooves are not necessary, however, they appear to be necessary to reduce the rotation of the tip in the puncturing process. 另外优选加工一个销孔540,以便于将尖端连接在轴上。 Further processing is preferably a pin hole 540, so as to connect the shaft to the tip. 优选后切削面538包括一个倾斜部分544和一个相对较平的部分546,以助于对血管进行夹持。 After the cutting face 538 preferably includes an inclined portion 544 and a relatively flat portion 546, to facilitate gripping of the blood vessel.

或者,打孔器尖端的转动可通过振动尖端和/或打孔器的其余部分获得。 Alternatively, the hole punch tip can be obtained by rotation of the remainder of the vibrating tip and / or the punch. 或者,这种转动也可以通过手动实现。 Alternatively, this rotation can also be achieved manually. 将连接件安装在一个移植血管上有多种方法可用于将吻合装置安装在一个移植血管上。 The connecting member is mounted on a variety of methods may be used to graft the stapling device is mounted on a graft vessel. 在此处所述的多个实施例中,该装置位于移植血管外侧,并且该移植血管与血管之间具有一个内膜对内膜的连接。 In the various embodiments described herein, the apparatus is located outside the graft vessel and the graft lining having a connection between the vessel and the vessel intima. 或者,在某些其它实施例中,大多数装置位于移植血管和吻合连接的外侧。 Alternatively, in some other embodiments, most devices located outside of the graft and anastomosis connection.

在本发明的一个优选实施例中,该移植血管被外翻在连接器上,从而使从移植血管上伸出的尖钉和连接器的其它部分位于移植血管的外翻部分的下面或远端。 In a preferred below or distal to the present embodiment of the invention, the graft vessel is everted on the connector, so that the graft protrudes from the spike and the connector of the graft vessel everted portion positioned other portions . 该外翻部分可以是局部的(例如大约90°)或全部的(例如大约180°)。 The everted portion may be topical (e.g., approximately 90 °) or all (e.g. approximately 180 °). 然而,也可以采用其它的外翻角度。 However, other valgus angle may be employed. 外翻过程本身通常并不简单,这是由于移植血管既滑又小,并且难于操纵。 Eversion process itself is typically not simple, since both the slide and small grafts, and difficult to handle. 另一个问题在于,尖钉可能呈钩状,并且很难在不导致巨大损伤的情况下穿过移植血管。 Another problem is that the spike may be hooked, and is difficult to pass through the graft vessel without causing great damage in the case.

下面将对不同的外翻的解决方法进行描述。 This respect will be described valgus solutions. 具体而言,这种解决方法主要有三大类:(a)移植血管的手工(或机器辅助)外翻。 Specifically, this solution three major categories: (a) graft hand (or machine-assisted) valgus. 连接器可以外翻之前、过程中或之后刺穿移植血管。 Before connector may eversion, during, or after piercing the graft vessel.

(b)用连接器刺穿移植血管,其中外翻的产生实际是通过操纵该装置和/或通过施行吻合来实现的。 (B) piercing the graft vessel connector, wherein the generating means is actually valgus and / or implemented by manipulating by performing anastomosis.

(c)避免全部施行外翻,可能通过模拟该外翻操作。 (C) prevent eversion all purposes, it may be simulated by the eversion operation. 单体连接器安装件图20A-20D表示了一种根据本发明的一个优选实施例的基于刺穿的外翻方法(b)。 FIG monomer mount connector 20A-20D represent a preferred embodiment according to one embodiment of the present invention pierced eversion process (b) based. 如图所示的20A-20D具体实施例的一个优点在于该外翻装置几乎全部处于移植血管外侧,从而该移植血管的一端可以提前与病人相连接。 20A-20D is an advantage of the particular embodiment shown in FIG embodiment is characterized in that the eversion apparatus is almost entirely outside the graft vessel, so that one end of the graft vessel may be connected to the patient in advance.

在图20A中,一条移植血管551被插入血管夹持架552内部。 In FIG 20A, a graft vessel 551 is inserted into the vessel holder 552 sandwiched inside. 一个带有数个前向尖钉556的连接器554被安装在一个连接器夹持架564上。 A plurality of forward with the connector 556 of the spike 554 is mounted on a connector holding frame 564. 优选提供一个或多个保持件562用于防止连接器554上的尖钉556向后弯曲至松弛位置(例如,在超弹性或弹性装置中)。 Or more preferably a holding member 562 for preventing spikes on the connector 554,556 is bent back to a relaxed position (e.g., in the superelastic or elastic means). 移植血管551的端部与数个唇状件560相配合,其中唇状件560与一个扩张器558相连接。 End of the graft vessel 551 with a plurality of cooperating lip 560, wherein the lip member 560 and 558 is connected to a dilator.

在图20B中,扩张器558被撑开,从而半径增大,并且使唇状件560对移植血管551的开口进行拉伸。 In FIG. 20B, the stent 558 is stretched, so that the radius increases, and the opening 551 of the graft vessel 560 pairs lip stretched. 应该指出的是,优选唇状件560的内径等于或大于尖钉556的外径。 It should be noted that the inner diameter of the lip member 560 is preferably equal to or greater than the outer diameter of the spike 556. 另外,也可以须采用其它能够使唇状件560的内径增大的机构。 Further, employed may be other possible to the inner diameter of the lip member 560 of the mechanism is increased.

在图20C中,连接器554向前伸出,从而使尖钉556刺穿移植血管551的端部。 In FIG. 20C, the connector 554 protrudes forward so that the end portion of the spike 556 to pierce the graft vessel 551.

图20D表示了最终的状态,其中获得了部分外翻。 20D shows the final state, wherein the received partial eversion. 应该指出的是,尖钉556一旦被从末端保持件562上释放,就会发生弯曲。 It should be noted that the spike holder 556, once released from the tip member 562, bending occurs. 或者,唇状件560阻止了尖钉556向后弯入移植血管551。 Alternatively, the lip 560 prevents the spike member 556 into the graft vessel 551 bent rearward. 现在就可以拆下各种扩张器和末端保持件。 Now can be removed and the various dilator tip holder.

在一替代实施例中,尖钉以一定的角度普查插入移植血管壁,从而使移植血管产生部分外翻和/或使移植血管维持由移植血管端部的张开所形成的形状。 In an alternative embodiment, the spike is inserted at an angle census graft vessel wall so that the graft vessel everted generating section and / or shape of the flared end portion of the graft is formed so that the graft vessel is maintained. 双体件移植血管外翻器图21A-21E表示了一个根据本发明的一个优选实施例的移植血管外翻器570。 Diabodies graft member everted Figure 21A-21E shows the everted graft vessel 570 according to one embodiment of a preferred embodiment of the present invention. 移植血管551被插入一个移植血管夹持架564(可能其上已安装有一个吻合连接器)中,并且只有其末端向外伸出。 Graft vessel 551 is inserted into a graft vessel grip bracket 564 (which may already have a connector mounting stapling), and only its tip protrudes outwardly. 夹持架564可被一只手握住,而外翻器570在另一只手中。 Holding frame 564 can be held in one hand, while eversion 570 in the other hand. 或者,二者之一或全部可以被安装在工作台上和/或相互连接。 Alternatively, one or all of which may be mounted on a table and / or both interconnected. 连接器554(未示出)可以被安装在夹持架564上。 The connector 554 (not shown) may be mounted on the holding frame 564.

外翻器570包括一个主体571,该主体又包括一个开关580和一个头部572。 Eversion 570 comprises a body 571, the body 580 further comprises a switch 572 and a head portion.

图21B详细表示了头部572。 Figure 21B shows in detail head 572. 其中有一个优选呈圆形的末端574,用于将移植血管551的端部装于其上。 Which has a preferred circular end 574, a portion of the end of the graft vessel 551 attached thereto. 一个具有数个指形件578的扩张器579被用于张开移植血管端部,如下文将述。 Having a plurality of fingers 578 of the dilator 579 is used to open the end portion of graft vessel, as will be described below. 优选提供数个止动指形件576,用于控制移植血管551在末端574和指形件578上的向前移动。 Preferably provides several stop fingers 576, 551 for controlling the end of the graft vessel 574 and moved forward on the fingers 578. 或者,可以对止动指形件576和末端574的相对位置进行控制,这是为了例如控制外翻量或者为了允许对移植血管进行更稳定地夹持,但这并非必须。 Alternatively, a pair of stopper fingers 576 and control the relative position of the end 574, which is, for example, to control the amount or everted graft vessel to allow more stably held, but this is not necessary.

图21C详细表示了扩张器579。 Figure 21C shows in detail the dilator 579.

图21D是穿过扩张器579的一个侧剖面图,表示了装在其上的移植血管551。 FIG 21D is a side cross-sectional view through the stent 579, the graft vessel 551 represents mounted thereon.

在图21E中,一个销582向前伸出,使扩张器579张开。 In FIG 21E, a forwardly projecting pin 582, dilator 579 open. 通过使移植血管夹持件564连同移植血管551向前移动,从而使之进入指形件578的内部,这样就可使该血管外翻。 By making the graft vessel holder 564 is moved forward together with the graft vessel 551, thus making access to the interior of the finger 578, so that the vessel can eversion. 移植血管551的向前移动还可以包括吻合连接器的前移,从而刺穿该移植血管。 Forward movement of the graft vessel 551 may further include forward anastomotic connector, thereby piercing the graft vessel. 在需要时,可以利用例如移植血管的阻力或止动指形件对向前移动的量进行控制。 When desired, using, for example resistance grafts or latching finger on the amount of forward movement is controlled. 当销582被缩回时,指形件578向内移动,同时外翻过程结束。 When the pin 582 is retracted, the fingers 578 move inwardly, while the end of the eversion process. 或者,销582也向前推动包围住扩张器579的管件。 Alternatively, the pin 582 is pushed forward also surrounds the dilator tube 579. 该管件也被用作一个阻挡件,防止指形件578进一步张开,同时使移植血管陷入指形件和该管件之间。 The tubular member is also used as a barrier, preventing the finger 578 is further opened, while the graft between the fingers and into the tube. 当该管件向前移动时,它将使移植血管向外翻离指形件578。 When the tube moves forward, it will turn out the graft vessel 578 from the finger.

在一个替代实施例中,止动指形件579在其末端包括若干小尖钉,并且也在销582的作用下被张开,从而从内部与移植血管相配合。 In an alternative embodiment, the stop finger 579 at its end comprising a plurality of small spike, and also are opened under the action of pin 582, thereby cooperating with the graft vessel from the inside. 销582的继续前伸将驱动止动指形件582(现在被用作外翻指形件)使移植血管向外翻离指形件578。 Pin 582 will continue to reach the stopper driving finger 582 (now used as the eversion finger) turned outwardly so that the graft vessel 578 from the finger. 这种运动与使用镊子进行手工外翻的过程类似,不同之处在于,该移植血管只有内部被接触。 This motion using forceps manual eversion process is similar, except that the graft vessel is only in contact with the interior. 或者,该移植血管可以同时产生内部和外部接触。 Alternatively, the graft may be produced simultaneously in contact with both internal and external. 另一种双体件移植血管外翻器图22是根据本发明的一个优选实施例的另一个移植血管外翻器590的剖面示意图。 Another alternative is everted graft member graft vessel everted twin FIG. 22 is a preferred embodiment of the present invention, a cross-sectional schematic 590. 在外翻器590中,移植血管与外翻器相配合,作为附加或替代的方案,也可以只与移植血管末端相配合(如图21A-21E中的实施例所示)。 590 eversion, the everted graft vessel mate with, as an additional or alternative embodiment, may be fitted only with graft terminal (21A-21E in the embodiment as shown). 一个优选安装在体592端部上的扩张末端594,优选从内部夹持住移植血管551。 An expandable tip 592 is preferably mounted on an end portion of the body 594, preferably gripped from the interior of the graft vessel 551. 移植血管551可以被安装或不被安装在一个移植血管保持件564内部。 Graft vessel 551 may be mounted or not mounted on a graft vessel 564 holding the inner member. 优选末端594是一个膨胀硅树脂末端,它将在一个压力源596的作用下膨胀。 Preferably terminal 594 is a terminal expansion of the silicon resin, it will expand under the influence of a pressure source 596. 一个典型压力源包括一个杆件,当杆件被压入硅树脂末端594中时,将使该末端产生变形。 A typical pressure source comprises a lever, when the lever is pressed into the silicone tip 594, the tip will deform. 或者,也可以采用其它扩张或夹持机构。 Alternatively, expansion may be used or other clamping mechanism.

提供了数个指形件(或一个整环)598,它带有一个配合边缘591。 Providing a plurality of fingers (or a complete ring) 598, which has a mating edge 591. 当指形件598向前伸出时,配合边缘591向后推动移植血管551的边缘,从而使移植血管外翻。 When the forwardly projecting finger 598, a mating edge 591 is pushed rearward edge 551 of the graft vessel, so that the graft vessel everted. 这种外翻可以仅由指形件的一步前移所致。 This can be caused only by the eversion step forward finger member. 或者,每一个这种前移使移植血管产生一个小的向后外翻量。 Alternatively, each such advancing a graft vessel to produce a small amount of valgus rearwardly. 尖钉末端控制在本发明的某些实施例中,用于刺穿外翻血管的连接器上的尖钉在刺穿过程中处于弯曲状态。 Spike control terminal in some embodiments of the present invention, the spike for piercing the everted vessel in the connector in a bent state during piercing. 然而,在本发明的某些优选实施例中,尖钉在刺穿过程之后才被弯曲。 However, in certain preferred embodiments of the present invention, the spike was only after the bending during piercing.

由于移植血管在被刺穿固定时并非必须采用活性材料或甚至在体内进行(或者至少不与身体结构相接触),所以可以采用变形记忆性材料,例如加热时可弯曲的材料。 Since the graft must not be pierced when the active material, or even be fixed (or at least not in contact with the body structure) in the body, it can be modified memory materials employed, for example, flexible material upon heating. 这种加热的热源可来自例如房间的周围空气或通过在连接器通一个电流。 Such heating source can be from ambient air, for example, a room, or by a current through the connector. 优选仅尖钉的末端具有变形记忆性,从而使尖钉的其它部分足够硬以便能插入移植血管。 End of the spike preferably only memory having a deformable, so that the other portion of the spike is hard enough to be inserted into the graft vessel.

或者,当连接器前移时,在其上设置一个遮挡件,用于使尖钉末端保持直线结构,例如采用一个管件,其中每个尖钉带有一具指形件。 Alternatively, when the connector is moved forward, on which is provided a shutter member for retaining the spike tip straight configuration, for example by a pipe member, wherein each spike has a finger.

作为一个替代或附加方案,尖钉在刺穿过程后可在例如塑性变形的作用下被弯曲。 As an alternative or in addition, after the piercing spike in the process it can be bent, for example, under the effect of plastic deformation. 在刺穿移植血管之后,可对尖钉的弯曲点进行热处理,从而使之“获得”新的形状。 After piercing the graft vessel, can be heat treated to the inflection point of the spike, thus making it "won" the new shape. 基于扭转的刺穿图23A-23G表示了一种根据本发明的一个优选实施例的通过扭转一个连接器的尖钉刺穿和固定血管的方法。 Based twisted piercing FIG 23A-23G shows a method of piercing the vessel and fixed by twisting a spike connector of an embodiment in accordance with one preferred embodiment of the present invention. 图23A表示了一个与图2所示的连接器类似的连接器600,不同之处在于尖钉602(只示出一个)被弯曲后尖端604(只示出一个)指向内部,而不是外部。 23A shows a similar view of the connector with the connector 600 shown in FIG. 2, except that the spike 602 (only one shown) after being bent tip 604 (only one shown) directed inwardly, rather than external. 优选连接器600包括一个尖钉部分601和一个管部分603。 The connector 600 preferably comprises a spike portion 601 and a tube portion 603.

优选提供一个套筒608用于保护被插入的移植血管551(图23B),防止它被尖端604意外刺穿。 A sleeve 608 is preferably provided for protecting the inserted graft 551 (FIG. 23B), preventing it from being accidentally piercing tip 604. 在本发明的一个优选实施例中,尖端604的其它结构处在外部,并且它们在一个扭转保持件606的作用下向内扭转,并维持在该位置。 Embodiment, other structures located outside the tip 604 in a preferred embodiment of the present invention, and they are twisted in a twisted inwardly under the action of the holding member 606, and maintained at this position. 然而,这并非必要。 However, this is not necessary. 例如,尖钉602可在移植血管551被刺穿过产生塑性扭转。 For example, the spike 602 may be plastically twisting stabbed through the graft vessel 551. 应该指出的是,超弹性装置中也可以产生塑性变形,例如通过过度转动。 It should be noted that the device may be a superelastic plastically deformed, for example by over-rotation.

在图23B中,移植血管551被插入移植血管保持件,处在套筒608之下。 In 23B, the graft vessel 551 is inserted into the graft vessel holder 608 is under the sleeve.

在图23C中,套筒608被移走,从而使移植血管551和尖端604相接触。 In FIG. 23C, the sleeve 608 is removed, so that the tip 604 and graft 551 in contact.

在图23D中,移植血管551被尖端604刺穿。 In FIG. 23D, the graft vessel 551 is piercing tip 604. 在一种方法中,移植血管551被向前拉出移植血管保持件和/或被拉伸,例如通过使用如图21所示的装置。 In one method, the graft vessel 551 is drawn out forwardly graft holding member and / or elongated, for example by using the device 21 shown in FIG. 在另一个例子中,可通过对移植血管551内部的一个气球或其它可膨胀件进行充气而使连接器600被缩回,从而阻止其运动和/或控制刺穿过程。 In another example, the graft vessel through the interior of a balloon 551 or other expandable member for inflating the connector 600 is retracted, thereby preventing its movement and / or control during piercing.

图23E表示了一个使尖钉相对移植血管551的外翻部分向前移动的选择性步骤。 FIG. 23E shows that the spike opposite a portion of the everted graft vessel 551 moves forward an optional step. 该步骤也可稍后进行,或者被略去。 This step can also be performed later, or is omitted.

在图23F中,扭转保持件606被拆下(或者尖钉被扭转),从而使尖钉产生扭转并且尖端604指向外部。 In FIG. 23F, the holding member 606 detached torsional (or spike is twisted), so that the spike 604 and the tip torsionally pointing outwards.

图23G表示了在拉回尖钉上的移植血管的选择性步骤完成之后,刺穿过程的结束状态。 FIG 23G shows a pull-back after the tip of the nail graft selective step, the ending state during piercing.

应该指出的是,尖钉为便于刺穿和/或外翻而产生的扭转也可以在U形钉实施例中采用,其中吻合过程通过使用数个独立的U形钉进行实施,每个U形钉可绕其长轴旋转,与图中所示的尖钉602的扭转类似。 It should be noted that, for ease of piercing spike twist and / or valgus may be generated using the embodiment examples the U-shaped staple, wherein the stapling process implemented by using several independent U-shaped staples, each of the U-shaped staples can be rotated about its long axis, similar to reverse the spike 602 shown in FIG. 模拟外翻一般来说,乳房动脉相对较厚,不易外翻。 Generally analog valgus, mammary artery is relatively thick and difficult to eversion. 申请者惊奇地发现,乳房动脉可被操纵产生一个有效的外翻区域,而无需实际对动脉进行外翻,并且同时只需在动脉上施加较小的压力。 Applicants surprisingly discovered, mammary artery can be manipulated to produce an effective eversion region, without actually eversion of the artery, and while only a small pressure is applied to the artery.

图24A-24D表示了一种根据本发明的一个优选实施例的模拟外翻的方法,特别是对乳房动脉而言。 FIGS 24A-24D shows a method for simulating an eversion of a preferred embodiment of the present invention, especially in terms of mammary artery.

图24A表示了一条乳房动脉620的一个壁。 FIG 24A shows a wall 620 of a mammary artery. 应该指出的是,也可以采用其它类型的血管和移植血管材料。 It should be noted that other types of blood vessels and vascular graft materials may be used.

在图24B中,提供了一个内模具622和一个与血管配合的外框架621,用于夹住动脉620。 In 24B, the mold 622 is provided an inner and outer frame 621 fitted with a blood vessel, artery 620 for gripping. 这种夹持方法可选用本技术领域内任何一种公知方法,例如一个磨擦表面或小倒钩。 This holding method can choose any known method in the art, for example, a friction surface or small barbs.

在图24C中,框架621向前伸出,从而使动脉620的端部被压靠在模具622的一个成型部分623上,并且被扩宽。 In FIG. 24C, the frame 621 extends forward so that the end portion of the artery 620 is pressed against a molding part 623 of the mold 622, and is widened. 通过恰当地选择模具622、成型部分623和外框架621的几何形状,就可控制变形的尺寸和类型。 By appropriately selecting the mold 622, the molding part 623 and the geometry of the outer frame 621, you can control the size and type of modification. 或者,框架621和/或模具622上加工有脊,从而在动脉620上产生皱纹。 Alternatively, the frame 621 and / or the upper mold ridges 622 processing, thereby generating wrinkles on the artery 620. 尽管图中示出了一个垂直模具,但也可以采用一个倾斜模具,或者一个使动脉620的端部产生其它形状的模具,例如使之形成鞍形。 While there is shown a vertical mold, but the inclination can also be used a mold, or one end portion of the artery so that the mold 620 produces other shapes, for example so as to form a saddle.

在图24D中,动脉620的一个加厚部分被连接器626上的一个尖钉228所刺穿,例如使用此处所述的方法。 In FIG 24D, a thickened portion of the artery 620 is connected on a spike 626 pierce 228, for example using the methods described herein. 模具622可以包括多个开孔,以免损坏尖钉228。 Mold 622 may include a plurality of openings 228 to avoid damage to the spike pin.

在一个典型实施例中,一条左内乳房动脉(LIMA)被压缩了1cm。 In one exemplary embodiment, a left internal mammary artery (LIMA) is compressed 1cm. 应该指出的是,动脉620的内膜和外膜的端部位置也可以由模具622和框架621进行控制。 It should be noted that the end position of the inner and outer membrane of the arteries 620 may be controlled by the die 622 and the frame 621.

图24E表示了一个替代实施例,其中一个连接器632,例如一个动脉连接器刺穿了动脉620的一个加厚部分630。 FIG 24E shows an alternative embodiment in which a connector 632, for example a piercing connector artery, a thickened part 630 of artery 620. 一个环部分634位于加工部分的外侧。 A ring portion 634 is positioned outside the processing portion. 通过使模具622具有适当的形状,也可以使一部分内膜处于加厚部分630外侧的一个位置640处,从而允许内膜对内膜的连接。 By appropriately shaped die 622, it may be a part of the lining in a position 640 thickened portion 630 outward, thereby allowing connection of endometrium endometrium. 动脉620的切割和加厚部分630的保持可以通过被连接器632的一个前向尖钉638所刺穿来实现。 Thickened arterial cut 620 and the holding portion 630 may be implemented pierced by the spike 638 to a connector 632 is through the front.

在本发明的一个替代实施例中,一条血管或移植血管通过被压迫而形成加厚形状(不只是在其端部)并且在加厚部分上穿过一个或多个尖钉或一个连接器,从而维持变形效应。 In an alternative embodiment of the present invention, a blood vessel or vascular graft is formed by being compression thickened shape (not just its end) and through the one or more spike or a connector on a thickened portion, thereby maintaining deformation. 连接器的插入一旦移植血管被外翻并且被连接器刺穿后,该连接器和移植血管就将被连接在目标血管422的一个孔上。 Once the connector is inserted and everted graft vessel is pierced by the connector, the connector and the graft vessel will be connected to a hole 422 of the target vessel. 一旦连接过程结束,工具必需被从移植血管上拆下。 Once the connection process is completed, the tool has to be removed from the graft vessel.

图25A是夹持架工具400的近视特写剖视图,其中插有一个移植血管夹持件和连接器夹持件640的组合件,示意性地表示了移植血管551,但没有表示一个连接器。 FIG 25A is a close up cross sectional view of a close-up 400 of the gripping tool holder, wherein the holder is inserted a vascular graft and the connector 640 of the holder assembly, schematically showing the graft vessel 551, but does not represent a connector. 图25B是图25A的透视图。 25B is a perspective view of FIG. 25A. 优选夹持件640包括两个层,一个优选将一个连接器(未示出)夹持在其表面上的内层642,和一个协助将该装置插入动脉(或其它目标血管)并且对移植血管551的外翻部分进行保护的外层644。 Preferably the clamping member 640 comprises two layers, a preferred one connector (not shown) on its inner clamping surface 642, and a means to assist the insertion artery (or other target vessel) and on Graft everted portion 551 will be an outer layer 644 of the protection. 作为一种替代或附加方案,外层644使尖钉保持直线结构。 As an alternative or in addition, the outer layer 644 so that the spike remains rectilinear configuration. 优选移植血管551的外翻部分介于层644和末端408之间,大然而,它也可以介于层642和644之间。 Preferably the everted graft vessel 551 is interposed between layer 644 and the portion of the end 408, however large it may be between 642 and 644 layers.

优选层642包括数个凸起部分,用于通过连接器上的加厚部分(图7)夹持住该连接器。 Layer 642 preferably comprises a plurality of raised portions for gripped by a thickened portion of the connector (FIG. 7) on the connector. 例如,图7所示的尖钉的尖端可位于该层的一个区域650内,而连接器的主体位于该层的一个区域640内。 For example, the tip of the spike shown in FIG. 7 may be located within a region of the layer 650, while the body of the connector is located within a region of the layer 640. 一个环状凸出部分646阻止连接器的运动。 A projecting annular portion 646 prevents movement of the connector. 类似的结构也可被用于夹持如图2所示的双体件装置。 Similar structures can also be used catamaran member holding apparatus shown in FIG. 此时,层642可在其末端包括若干槽口,从而允许弯曲的尖钉向内弯曲。 In this case, layer 642 may comprise a plurality of notches at its ends, so as to allow the spikes bent inwardly curved.

优选使用一个刀片654划开层644,下文将详细说明。 Blade 654 is preferred to use a gash layer 644, will be described in detail below.

在操作过程中,末端408被缩回,或者层642和644向前伸出,从而使目标血管与层644外侧上的一个区域652相接触。 In operation, tip 408 is retracted, or the layers 642 and 644 extending forwardly, so that the target vessel 652 into contact with a region 644 on the outer layer.

层644被缩回,从而使连接器的前向尖钉能够弯曲。 Layer 644 is retracted so that the connector can be bent prior to the spike. 然后优选夹持架400(或层642)被缩回,从而使弯曲的尖钉与目标血管422(未示出)相配合。 Then preferably grip bracket 400 (or layer 642) is retracted so that the bent spike 422 and the target vessel (not shown) engaged.

图26表示了尖端408缩回后的位置,表示了与目标血管422相咬合的尖钉124。 26 shows a retracted position of the tip 408, with the target vessel 422 represents meshed spike 124.

层644的进一步缩回,将释放对连接器后向尖钉的径向约束,从而允许尖钉弯出区域650(图25A)并且封闭在血管422上。 Layer 644 is further retracted, releasing the connection to the radial constraint on the spike, thereby allowing the spikes bent out area 650 (FIG. 25A) and in the vessel 422 is closed. 此时,层642也可被从吻合处缩回。 In this case, layer 642 may be retracted from the anastomosis.

在本发明的一个优选实施例中,不同层和管件之间的相对运动由工具手柄中的一个机构进行操作,优选只使用一个控制器,例如调节器653。 Embodiment, the relative movement between the different layers and the tube member to be operated by a mechanism in the tool handle, preferably only one controller in a preferred embodiment of the present invention, for example, the regulator 653. 将连接器加载在递送系统上连接器可被安装在层642和644之间,例如,通过将松弛的移植血管置于层642上,然后使用后向尖钉向后弯曲,从而使它们能够被层644所覆盖。 The connector is loaded on the delivery system connector may be installed between the layers 642 and 644, for example, by graft placed on the relaxed layer 642, and then use the spikes bent backwards, so that they can be layer 644 covered. 这种向后弯曲可以通过使用例如镊子或专用工具来完成。 This backward bending may be accomplished by the use of special tools such as tweezers or.

作为一个替代或附加方案,通过使用例如液氮对该连接器进行冷冻,从而使其易于弯曲。 As an alternative or in addition, by using, for example, the liquid nitrogen freezing connector, making it easy to bend.

或者,该连接器也可以通过以下方式被安装:(a)处于松弛状态的连接器被安装在一个轴柄上。 Alternatively, the connector may also be installed in the following ways: (a) in the relaxed state of the connector is mounted on a mandrel.

(b)一个带有V字形凹痕的管件被套在该轴柄上,从而使凹痕与连接器的后向尖钉之一相咬合。 After the tubular member (b) having a V-shaped indentation quilt on the mandrel so that the indentations of the connector to one of the spikes into engagement.

(c)带有凹痕的管件被转动,使配合的尖钉以大体呈直线的结构被卡在外套管件和轴柄之间。 (C) the tube with dimple is rotated, so that the spike with substantially linear structural jammed between the sleeve member and the outer mandrel.

(d)对所有尖钉分别重复步骤(c)。 (D) repeating steps were all spikes (c).

(e)层644被覆盖在轴柄和带有凹痕的管件之上。 (E) layer 644 is covered over the mandrel and the tube with a dimple.

(f)连接器和轴柄被拉动穿过一个带有凹痕的圆锥。 (F) connector and is pulled through mandrel with a tapered dent. 这些凹痕被对齐,从而使前向尖钉免受圆锥的影响。 These indentations are aligned, so that from the effects of the cone to the front so that the spike. 另一方面,连接器的主体受到圆锥的压迫,从而该主体配合在外层644的内侧,其中该外层向前伸出,从而覆盖住连接器主体。 On the other hand, the conical body of the connector by compression, so that the body fits into the outer layer 644 which projects forwardly of the outer layer, thereby covering the connector body.

(g)拆下轴柄并代之以层642。 (G) removing the mandrel layer 642 and replaced. 或者,该轴柄即是层642。 Alternatively, the mandrel 642 that is the layer. 工具的拆卸当末端408和层644缩回时,优选它们被层642上的刀片654划开。 When the end of the removal tool 408 is retracted and the layer 644, which are preferably cut open the blade 654 on the layer 642. 这样,它们就可通过缩回而被拆下,同时不损伤移植血管551。 Thus, they can be removed by the retracted, without damage to the graft vessel 551. 或者,这些层可以带有预加工裂缝,并且通过使用一个将末端408和/或层644劈开的小钉或圆锥而被拆下。 Alternatively, the layers may be pre-processed with a crack, and by the use of a terminal 408 and / or the layer 644 or cleavage of a small nail cone and detached.

图27显示了一个层642,重点强调了该层中的一个预加工裂缝、一个刀片654和突出部分646。 Figure 27 shows a layer 642, a pre-emphasis processing of cracks in the layer, a blade 654 and a projecting portion 646.

图28是工具400和640的一个剖视图,表示了当层642被充分拉回时将层642劈开的小钉或圆锥656而被拆下。 FIG 28 is a cross-sectional view of the tool 400 and 640, 642 represents a case when the layer 642 is pulled back sufficiently small cleaved and split nails or cone 656 when a layer. 在其它实施例中,小钉656可以更加接近至夹持架400的末端和/或它可以在需要时被移至相应位置。 In other embodiments, the staples 656 can be smaller closer to the end 400 and / or it may need to be moved to the corresponding position when the clamping bracket. 其它的劈开方法图29A-29F表示了另一种根据本发明的一个优选实施例的具有一个外侧703和一个远端711的连接器递送系统700。 Other methods of cleaving FIGS 29A-29F shows the outside having a distal end 703 and a connector 711 of another embodiment of a delivery system according to a preferred embodiment of the present invention 700. 系统700也包括一个主体701和一个手柄702。 The system 700 also includes a body 701 and a handle 702.

图29B表示了一个暗盒705、一个连接器夹持件706和一个与杆形件707相连接的劈裂销708。 FIG 29B shows a cassette 705, a connector holding member 706 and a pin with the rod-shaped splitting member 707 is connected 708. 当杆形件707被拉回时,销708将裂开与之相接触的层,例如夹持件706和暗盒705。 When the rod-shaped member 707 is pulled back, the pin 708 will cleave layer in contact therewith, such as clamping member 706 and the cassette 705. 作为一种替代或附加方案,也可使用一个回缩刀片。 As an alternative or in addition, also possible to use a blade retraction.

图29C表示了一个暗盒705,其中一个连接器709从其端部伸出。 FIG 29C shows a cartridge 705, one of the connectors 709 extending from the end portion. 同时还表示出了一个空腔715和一个将被小钉708劈开的裂缝716。 It also shows a cavity 715 and a small nail 708 is split crack 716.

图29D表示了一个覆盖管件704,该管件被用于对经过打孔后的目标血管上的孔进行密封。 FIG 29D shows a cover tube 704, the tube is used to holes punctured through the target vessel after the sealing. 同样也示出了一个长孔和一个将被小钉708劈开的裂缝。 Also shows an elongated hole 708 to be split and a small nail cracks. 优选外侧703与覆盖管件704紧密配合,从而防止血液从裂缝中渗出。 Preferably the outer tube 703 and the cover member 704 mate to prevent blood leaking from cracks. 作为一种替代或附加方案,裂缝区域可包含促进凝血的材料。 As an alternative or in addition, a crack region can comprise a material to promote clotting. 作为一种替代或附加方案,该裂缝区域可以被覆盖上一层弹性材料,例如橡胶。 As an alternative or in addition, the fracture area may be covered with a layer of an elastic material such as rubber.

图29E表示了装置夹持件706和装置709,同时表示了一条裂缝和夹持件706中的一个长孔以及一个基于凸出部分的连接器配合元件718。 FIG 29E shows a clamp means 706 and 709, while showing a long hole and a crack in the holder 706, and based on a mating connector element 718 of the projecting portion.

图29F是系统100的手柄区域的一个剖视图,表示了一个通过挤压一对手柄702,而使系统中某些部分缩回的机构。 FIG. 29F is a sectional view of the handle region 100 of the system, showing a mechanism 702, the system is retracted by pressing certain portions of a pair of handles. 这种挤压经一个杠杆714被传递至一对滑杆717处。 This extrusion 714 is transmitted via a lever to a pair of slider 717. 当滑杆717充分缩回时,它们将通过一对连接销710拉回夹持件706和暗盒705。 When the slider 717 fully retracted, the connecting pin 710 are retracted and the cassette holder 706 through a 705 pair. 这种回拉使装置709的前向尖钉与目标血管相咬合。 This retraction of the device 709 and the forward tip of the staple engaging with the target vessel. 一旦该目标血管被咬住,就只剩暗盒705继续其缩回运动。 Once the bite is the target vessel, the only cartridge 705 continues its retraction movement. 当暗盒705缩回时,装置709被释放,并且使用其后向尖钉与目标血管相配合。 When the cartridge 705 is retracted, the device 709 is released, and thereafter use the spike cooperate with the target vessel.

当手柄702继续被挤压时,杆形件707被拉回,并且使夹持件706被劈开,从而劈开外层并且允许移植血管被取下。 When the handle 702 continues to be pressed, a rod-shaped member 707 is pulled back, and the clamping member 706 is split to allow the graft vessel and the outer split to be removed. 倾斜吻合连接器相应于图1A-1D的图30A-30D表示了根据本发明的一个优选实施例的适用于倾斜连接的吻合连接器800。 Corresponding to the inclination anastomotic connector 1A-1D of FIG. 30A-30D shows an anastomotic connector 800 according to a preferred embodiment applicable to the present invention is connected to the inclination. 其中的元件标号与图1A-1D相应,不同之处在于,用所有的“800”标号代替了“100”标号。 Wherein the element numbers corresponding to Figures 1A-1D, except that, in all the "800" numbers instead of "100" numbers. 使用一个倾斜连接器可以获得比垂直连接的几何形状更有用的连接形状,例如,为了适应移植血管的送入角度、为了适应附近的结构和/或为了使血液更好地流通。 Shaped geometry using a connecting connector can be connected to obtain more useful than the vertical inclination, for example, to accommodate the graft vessel into an angle, in order to adapt the structure in the vicinity and / or to a better blood circulation. 该连接可以相对目标血管的轴线或者横轴方向倾斜。 The connection may be inclined relative to the target vessel axis or horizontal axis. 典型的倾斜角度介于10°和80°之间,优选介于30°和70°之间,在一个典型实施例中大约取为45°。 A typical inclination angle is between 10 ° and 80 °, preferably between 30 ° and 70 °, in an exemplary embodiment, taken as about 45 °.

与图2F相应的图31A表示了工作过程中的连接器800。 And FIG. 2F corresponding to FIG 31A shows connector 800 in the work process. 与图2D相应的图31B表示了完成后的倾斜吻合状态。 FIG. 2D and FIG. 31B shows the corresponding tilt state after the completion of anastomosis.

分别相应于图3A和3B的图32A和32B表示了图30A-30D所示的连接器800的一个设计平面图。 Correspond to Figures 3A and 3B in FIG. 32A and 32B shows a schematic plan view of the connector shown in 30A-30D 800. 在图32和图3中,实际的装置可能比图中所示的装置短,例如只有5个尖钉。 In FIG. 32 and FIG. 3, the apparatus may be shorter than the actual device shown in the drawings, for example, only five spikes.

尽管通常所示的是圆管连接器,然而在本发明的其它优选实施例中,也可以采用椭圆几何形状或其它形状。 While the tube is shown generally in the connector, in other embodiments however, a preferred embodiment of the present invention, an elliptical shape or other geometric shapes may also be employed.

对倾斜移植血管的外翻操作通常比对规则移植血管的外翻操作要难。 Everted graft tilt operation is typically more difficult than for the regular operation of the graft vessel everted. 一般而言,处于连接器的较宽角一侧的移植血管易于外翻,而处于较窄角一侧的移植血管部分相对较难外翻。 In general, a wide angle side of the graft vessel is everted connector easily, and a narrower angle in a side portion of the graft vessel relatively difficult eversion.

图33A和33B表示了在该外翻装置中有助于解决这种问题的一个改动。 33A and 33B shows a change in the eversion apparatus helps to solve this problem. 移植血管551上的一个装置800在移植血管的窄角侧具有一个弯钩839。 It means a vascular graft having a hook 551 800 839 on the narrow angle side of the graft. 如图33B所示,优选用于夹持连接器800的一个夹持件840也使用一个凸出部分842使弯钩839向内弯曲,从而通过使用上述任何一种方法,它可以更简单地刺穿移植血管551。 As shown in FIG. 33B, for holding the connector 800 is preferably a clamping member 840 also uses a convex portion 842 is bent inwardly so that the hook 839, so that by using any of these methods, it can be more easily stabbed graft vessel 551 through. 优选例如当夹持件840被拉回时,凸出部分842在连接器800的作用下被弯曲变形。 Preferably, for example, when the holder 840 is pulled back, the projecting portion 842 is bent and deformed under the effect of the connector 800. 自外翻连接器图34A-34F表示了根据本发明的一个优选实施例的一个自外翻连接器850和一种使用这种连接器的方法。 Since eversion Figure 34A-34F are connected by the self-valgus connector 850 and a method of using such a connector in accordance with a preferred embodiment of the present invention. 图34A表示了连接器850的一段,其中包括一个体部分852、一个后向尖钉854、一个前向尖钉856和一个操纵块状件858。 FIG 34A shows a section of a connector 850, which comprises a body portion 852, a backward spike 854, a spike forward block 856 and actuating member 858 a.

如图34B所示,连接器850被插入一条血管422中并且被安装在一条移植血管551上,从而前向尖钉856被旋转进入移植血管腔内。 , The connector shown in FIG 34B 850 is inserted into a blood vessel 422 and is mounted on a graft vessel 551, 856 is rotated so that the front into the graft vessel lumen to the spike. 优选使用一个压靠在块状件858上的块夹持件862对这种非自然(在一个超弹性、弹性或变形记忆性连接器中)位置进行保持。 Is preferably used a block member 858 is pressed against the holding block 862 is held such unnatural (at a super-elastic, deformable or elastic memory connector) position. 或者,也可以采用塑性变形方法。 Alternatively, the plastic deformation method can also be employed. 优选尖钉854向内弯曲,从而有助于插入血管422,然而这并非必须。 Spike 854 is preferably bent inwardly to facilitate insertion into a vessel 422, but this is not necessary. 优选在夹持件862的外侧布置一个覆盖管件860。 Preferably disposed outside the holding member 862 is covered with a tubular member 860.

在图34C中,优选覆盖管件860向前伸出,从而使血管422远离该装置,并且留出外翻的空间。 In FIG. 34C, the cover tube 860 preferably projects forward so that the vessel 422 away from the device and leave space valgus. 在空间允许的情况下,这种外翻操作也可以在血管422的更深处进行。 In the case where space permits, this eversion operation may be performed in a vessel 422 deeper.

在图34D中,夹持件862被拉回,将块状件858释放,资助允许尖钉856扭转至其松弛位置,从而使移植血管551外翻。 In FIG. 34D, the clamp member 862 is pulled back, the block member 858 is released, allowing the spike 856 funding twisted to its relaxed position, such that the graft vessel 551 everted.

在图34E中,覆盖管件860被拉回,从而允许血管422与连接器850相接触。 In FIG 34E, the cover tube 860 is pulled back, allowing the vessel 422 into contact with the connector 850. 连接器850的缩回使血管422被尖钉856刺穿。 The connector 850 is retracted so that the blood vessel is punctured the spike 422 856. 然后,覆盖管件860被进一步拉回,同时释放尖钉854使之从另一侧刺住血管422。 Then, the cover tube 860 is further retracted, while releasing the other side so that the spike 854 live vascular puncture 422. 如图所示,覆盖管件860的缩回可以由尖钉854所施行。 As shown, the cover tube 860 can be retracted by the spike 854 is performed. 在一个实施例中,覆盖管件860和夹持件862之间有一个用于容纳尖钉854的小空间。 In one embodiment, the tube is covered with between 860 and 862 a holding member for receiving the spike 854 of the small space. 或者,可以在覆盖管件860中限定轴向长孔,从而通过使覆盖管件860桎连接器850沿轴向旋转允许尖钉854被释放。 Alternatively, the cover defining an axial elongated hole in the tube 860 so as to be released by the covering member 860 Zhi pipe connector 850 allows the axial rotation of the spike 854.

图34F表示了吻合连接过程的完成状态。 FIG 34F shows a state of completion of anastomosis connection process. 外围工具包上述过程和装置主要是针对冠状动脉旁外科手术而言。 Peripheral Kit above process and apparatus for mainly in terms of coronary artery bypass surgery. 然而,旁外科手术也可以在身体的其它部分施行。 However, the next surgery can also be implemented in other parts of the body. 例如,头部、脑部、腹部或肢体,例如施行主-股动脉旁外科手术或其它用于向下肢供血的血管的旁外科手术。 For example, head, brain, limbs or abdomen, for example, the main purposes - beside the femoral artery bypass surgery or other surgery to the lower limbs for the blood vessels. 上述的吻合连接器可根据具体部位进行改动。 Anastomotic connector described above can be altered according to the specific site. 优选在周长上每隔1mm设置一个尖钉。 A spike is preferably provided on the circumference at intervals of 1mm. 因此,一个股动脉装置可能具有7个尖钉。 Thus, a device may have a femoral spikes 7.

在许多专利中,都提供有一个工具包,其中包括一条移植血管。 In many patents, there are provided a kit, including a graft vessel. 优选连接器被预先安装在移植血管的一端或两端(如果该移植血管有其它开口或裂缝,可能是多端)上。 Preferably the connector is installed in advance in one or both ends of the graft (graft if the cracks or other openings, may be more ends) on. 图35表示了一种优选方法,该方法用于将连接器874安装在移植血管872上,从而准备好一个备用的移植血管组合件870。 35 shows a preferred method for mounting the connector 874 on the graft vessel 872, so that a spare ready graft assembly 870. 优选连接器被嵌入在移植血管的壁内,例如在加工过程中或通过移植完成后插入该装置。 The connector is preferably embedded within the wall of the graft vessel, e.g. during processing, or by inserting the device is completed after transplantation. 优选移植血管上至少有一个与连接器重叠的部分能够与将与之连接的血管良好地粘合。 At least a portion of the connector can be overlapped and adhered well to the blood vessel is preferably connected thereto the graft. 移植血管的端部可被选择性进行处理,从而在接触到血液时避免产生凝结。 Graft ends may be selectively processed to avoid condensation upon contact with blood. 而可以对远端的部分进行提高凝结能力的处理。 And may be treated to improve the ability of coagulating the distal end portion. 尽管图中所示的是端部连接器,同样也可以对一个侧部连接器进行类似的嵌入操作。 Although shown is an end portion of the connector, also may be similarly embedded in a side portion of the operation connector.

美国专利5,641,373、5,843,173、5,415,619、4,883,453、4,552,707、4,096,227、5,861,033、5,628,789、4,957,669、4,909,979和3,945,052,描述了可被用于本发明的若干优选实施例中的移植血管及其加工方法,这些专利的分开在此处被并入本专利作为参考。 U.S. Patent No. 3,945,052 and 5,641,373,5,843,173,5,415,619,4,883,453,4,552,707,4,096,227,5,861,033,5,628,789,4,957,669,4,909,979 separately, may be described graft vessel and a processing method used in Examples of the present invention, several preferred embodiment, these patents this patent is incorporated by reference herein.

在一个典型实施例中,用于施行旁外科手术的工具包包括一个移植血管和一个引导线或其它用于引导移植血管处在吻合位置处的引导件。 In one exemplary embodiment, tool, the surgical operation for next packet comprises a graft and a guide wire or other device for guiding the guide member in the graft vessel at the anastomosis position.

图36表示了根据本发明的一个优选实施例的一个典型的股-腘动脉旁外科手术。 FIG 36 shows an exemplary embodiment in accordance with a preferred embodiment of the present invention shares - popliteal bypass surgery. 使用移植血管870进行的旁外科手术将在表面股动脉876上的一点886和腘动脉878上的一点888之间施行。 The use of grafts performed 870 bypass surgery will be implemented in the superficial femoral artery 876 between one o'clock and a little 886 888 878 on the popliteal artery. 优选在点886和888上开两个孔882和884。 Preferably open two holes 882 and 884 at points 886 and 888. 在移植血管870一端的装置874被连接在点886处,例如如上所述。 886 is connected at a point 870 at one end of the graft vessel means 874, for example as described above. 使用一条引导线880拉动移植血管870穿过身体到达开孔884处的区域。 Using a guide wire 880 pulls the graft vessel 870 through the opening 884 of the body region reaches. 在根据本发明的一个优选实施例中,引导线880是刚性的,或者包括一个刚性引导件,这是为了便于在两个开孔之间进行引导。 In accordance with a preferred embodiment of the present invention, the guide wire 880 is rigid, or comprises a rigid guide, for convenience of which is guided between two openings. 优选引导线880通过缝合与移植血管870相连接。 Preferably guidewire 880 is connected via stitching 870 to the graft vessel. 在另一个实施例中,两点间的吻合和引导通过内窥或穿过血管(至少提供移植血管)的方法施行。 Embodiment, the endoscopic stapling and guided by or through the vascular (graft vessel providing at least) a method performed between two points in another embodiment.

我们应该知道,上述方法和装置适合在多种手术中使用,例如内窥手术、穿过血管的通孔手术和开孔手术。 We should be aware that the above-described method and apparatus suitable for use in various surgery, endoscopic surgery, for example, through the vascular surgery and through hole openings surgery. 具体来说,应该指出的是,对于血管和移植血管的操作可以完全在体内进行,例如通过一个通孔外翻一条左内乳房动脉(LIMA)。 In particular, it should be noted that it is possible for the operation performed entirely in vivo and vascular grafts, e.g., by a through hole valgus a left inner mammary artery (LIMA).

我们将知道,上述血管手术的方法可以用多种方式进行改变,其中包括改变各步骤的顺序,哪一步在体内进行和哪一步在体外进行、每一个吻合过程中各步骤的顺序、吻合连接器采用的具体材料和/或端对侧吻合连接中哪一条血管是“侧”侧以及哪一条血管或移植血管是“端”侧。 We will know the operation method of the blood vessel may be varied in a variety of ways, including changing the order of the steps, and which step by step which carried out in vitro in vivo, each sequence of steps in the process of anastomosis, anastomosis connector the use of specific materials and / or the end of side anastomosis connection in which a blood vessel is a "side" and the side of a vessel or vascular graft which is "end" side. 另外,在该机械实施例中,不同元件的位置可以更换,同时不超出本发明的思想,例如在打孔装置中交换砧和切削刃的位置以及在需要相对运动的地方用运动件替换静止件。 Further, in this mechanical embodiment, the position of the different elements can be replaced, without departing from the spirit of the present invention, for example, the position of the cutting edge of the anvil and the exchange in the perforating device as well as relative motion where the need to replace the stationary member with a movable element . 此外,本发明描述了所述方法和装置的多个不同特征。 Further, the present invention describes a plurality of different features of the method and apparatus. 应该清楚的是,不同的特征可以通过不同的方式被组合。 It should be clear that the various features can be combined in different ways. 具体而言,并非一个具体实施例中所述的所有特征都必须被包括在所有类似的本发明的优选实施例中。 Specifically, all of the features, the embodiment is not a particular embodiment must all be included in the preferred embodiment similar to the embodiment of the present invention. 另外,上述特征的组合也被认为处在本发明的某些优选实施例的范围之内。 Further, combinations of the above features are also considered within the scope of certain embodiments of the present invention is preferably in the. 此外,根据本发明的其它优选实施例,此处所述的本发明的某些特征也适用于现有技术中的装置。 Further, according to another preferred embodiment of the present invention, certain features described herein are also applicable to the present invention, the prior art apparatus. 用于表述本发明的具体几何形状不应被认为是对本发明的限制,例如,图中所示的圆形腔在其它实施例中可以被椭圆腔所替代。 Specific geometry used to describe the present invention should not be construed as limiting the present invention, e.g., as shown in FIG circular cavity in the other embodiments may be replaced with an elliptical cavity.

另外,本发明的范围还包括手术工具包,这些工具包包括各种适用于施行单个或少量吻合连接手术的医疗设备。 Further, the scope of the present invention further includes a surgical kit, these kits include various suitable for the purposes of connecting a single or a small number of surgical anastomotic medical device. 本说明书的前序部分只是为了便于引导说明,不应被认为是将任何特定部分中所述的内容都限制在该部分中。 The preamble of this specification is only to facilitate guiding description and should not be considered in any particular portion of the contents are limited to that portion. 在具体情况下提出的措施只是示例性的,具体的措施应视实际情况而定。 Measures proposed in the specific case is merely exemplary, concrete measures should be considered the actual situation. 所附权利要求中出现的“包含”、“包括”或类似的词语都是指“包括但不仅限于此”。 "Comprising", "including" or similar words appear in the appended claims are mean "including but not limited to."

本领域内的普通技术人员应该明白,本发明并不被上述内容所限制。 Of ordinary skill in the art should appreciate that the present invention not be limited to the above. 本发明的范围仅仅受到所附的权利要求的限制。 The scope of the present invention is limited only by the appended claims.

Claims (73)

1.一个用于将移植血管连接在目标血管上的吻合连接器,包括:一个适于与移植血管的一部分相连接的薄的安装环部分;和一个适于安装在所述安装环部分上的独立的尖钉部分,该尖钉部分包括数个尖钉,每个所述尖钉都适于刺穿所述移植血管。 1 for connecting a graft vessel to the anastomotic connector on the target vessel, comprising: a ring portion adapted for mounting the thin portion of the graft vessel connected; and a mounting adapted to be mounted on the ring portion separate portions of spike, said spike portion comprising a plurality of spikes, each spike adapted to pierce the graft vessel.
2.如权利要求1所述的连接器,其特征在于,包括至少一个用于使所述尖钉部分和所述安装环部分相互锁定的锁定件。 2. The connector according to claim 1, characterized in that it comprises at least one of said spike portion for mounting said ring portion and a locking member locked to each other.
3.如权利要求2所述的连接器,其特征在于,其中所述锁定件被形成在所述安装环部分上。 The connector according to claim 2, wherein, wherein said locking member is formed on the mounting ring portion.
4.如权利要求3所述的连接器,其特征在于,其中所述锁定件与一个由所述尖钉部分所限定的孔相配合。 4. The connector according to claim 3, characterized in that, wherein said locking member cooperating with a hole of said portion defined by the spike.
5.如权利要求2-4之一所述的连接器,其特征在于,其中所述锁定件提供了一种弹簧运动,该运动可抵抗所述尖钉部分的至少一部分和安装环部分的至少一部分之间的相对轴向运动,并且该阻力取决于运动的幅度。 At least a portion of at least a portion of the mounting ring 5. The connector according to any one of claims 2-4, characterized in that, wherein said locking member provides a spring movement, which is resistant to the spike pin portion relative axial movement between the part, and this resistance depends on the magnitude of the motion.
6.如权利要求1所述的连接器,其特征在于,其中所述尖钉部分由一种超弹性材料构成。 6. The connector according to claim 1, wherein, wherein the spike portion composed of one superelastic material.
7.如权利要求1所述的连接器,其特征在于,其中所述尖钉被预先弯成钩状,从而所述钩形适于与目标血管相连接。 7. The connector according to claim 1, wherein, wherein the spike is previously bent hook, whereby the hook is adapted to connected to the target vessel.
8.如权利要求1所述的连接器,其特征在于,其中所述安装环部分包括数个靠近所述目标血管的翼缘件。 8. The connector according to claim 1, characterized in that, wherein the mounting portion includes a plurality of flange member close to the target vessel.
9.如权利要求8所述的连接器,其特征在于,其中所述翼缘件限定数个孔,以便所述尖钉件穿过。 9. A connector according to claim 8, characterized in that, wherein said flange member defines a plurality of holes to pass through the spike member.
10.如权利要求9所述的连接器,其特征在于,其中所述翼缘件在其周长上包括至少一个开口,该开口足够宽,以便于其中所述尖钉能够穿过该开口。 10. The connector according to claim 9, wherein, wherein said flange member comprises at least one opening on its circumference, which opening is wide enough to facilitate wherein said spike can pass through the opening.
11.如权利要求1所述的连接器,其特征在于,其中所述安装环部分限定了一个圆柱空间。 11. The connector according to claim 1, characterized in that, wherein the mounting ring portion defining a cylindrical space.
12.如权利要求1所述的连接器,其特征在于,其中所述安装环部分适于构成一个垂直吻合器。 12. The connector according to claim 1, characterized in that, wherein the mounting ring is adapted to constitute a vertical portion stapler.
13.如权利要求1所述的连接器,其特征在于,其中所述安装环部分适于构成一个倾斜吻合器。 13. The connector according to claim 1, characterized in that, wherein the mounting ring is adapted to form an inclined portion stapler.
14.一种用于将移植血管连接在目标血管上的吻合连接器,包括:一个用于连接所述移植血管的底座;数个用于刺穿所述移植血管并且与所述目标血管相连接的尖钉;和至少一个弹簧件,该弹簧件与至少一个所述尖钉相连接。 14. A method for stapling the graft vessel connected to the connector on the target vessel, comprising: a base for connecting said grafts; a plurality of piercing the graft vessel and target vessel connected to the the spike; and at least one spring member, the spring member and the at least one spike is connected. 该弹簧件被用作所述尖钉和所述底座之间的连接件。 The spring member is used as a connection between the spike member and the base.
15.如权利要求14所述的连接器,其特征在于,其中所述尖钉和所述底座构成一个单体件。 15. The connector according to claim 14, wherein, wherein said base and said spikes constituting a single member.
16.如权利要求14所述的连接器,其特征在于,其中所述尖钉和所述底座构成两个分体件。 16. The connector according to claim 14, wherein, wherein said base and said spikes constituting two separate pieces.
17.如权利要求14所述的连接器,其特征在于,其中所述弹簧由一个扁平卷簧构成。 17. The connector according to claim 14, wherein, wherein the spring is constituted by a flat coil spring.
18.如权利要求14所述的连接器,其特征在于,其中所述弹簧由一个片簧构成。 18. The connector according to claim 14, wherein, wherein the spring is constituted by a leaf spring.
19.如权利要求14所述的连接器,其特征在于,其中所述至少一个弹簧由至少两个相串联的弹簧构成。 19. The connector according to claim 14, wherein, wherein the at least one spring is constituted by at least two springs in series.
20.如权利要求14-19之一所述的连接器,其特征在于,其中每一个所述尖钉具有至少与一个独立的弹簧相连接。 20. The connector according to any one of claims 14-19, wherein, wherein each of said spike has at least connected to a separate spring.
21.如权利要求14所述的连接器,其特征在于,其中所述连接器被设计用于施行倾斜吻合。 21. The connector according to claim 14, wherein wherein said connector is designed to fit the purposes of the inclination.
22.如权利要求14所述的连接器,其特征在于,其中所述连接器由包括至少一个与所述尖钉之一相连接的块状件,用于移动所述尖钉。 22. The connector according to claim 14, wherein wherein said connector comprises at least one block of one of said spike member connected for moving the spikes.
23.如权利要求22所述的连接器,其特征在于,其中所述块状件适于拉回所述尖钉。 23. A connector according to claim 22, characterized in that, wherein said block member is adapted to retract the spike.
24.如权利要求22所述的连接器,其特征在于,其中所述块状件适于向前推出所述尖钉。 24. The connector according to claim 22, characterized in that, wherein said block member adapted to forwardly out of said spike pin.
25.一个用于将一个移植血管递送至一个吻合连接件的设备,包括:至少两个管形件,每一个限定了一个孔,该孔适于插入所述移植血管,从而使该移植血管从所述管形件的第一端穿出;至少一个分离件,该分离件安装在至少一个所述管形件上,用于劈开另一个所述管形件,从而所述移植血管能够穿过劈开的长槽被移出,该长槽跨越在所述第一端和所述孔之间。 25. A graft for delivery to an anastomotic device a connector, comprising: at least two tubular members, each defining a bore adapted to be inserted into the graft vessel, so that the graft vessel from the first end of the tubular piercing member; at least one separation member, the separating member mounted on at least one of said tubular member for splitting said another tubular member, so that the graft can be worn cleavage had been removed long groove, the elongated groove and spans the aperture between the first end.
26.如权利要求25所述的设备,其特征在于,其中所述至少一个分离件由一个切割所述裂缝的刀片构成。 26. The apparatus according to claim 25, wherein the at least one separating element consists of a cutting blade of the slit configuration.
27.如权利要求25所述的设备,其特征在于,其中所述至少一个分离件由一个扩展件构成,该扩展件扩宽所述管件内的现有裂缝,从而形成所述长槽。 27. The apparatus according to claim 25, wherein, wherein said at least one separation member is constituted by an extension member, the extension member prior widening crack in the tube, so as to form the elongated slot.
28.如权利要求25所述的设备,其特征在于,包括一个外管件,该外管件防止所述管件分裂,除非它充分回缩。 28. The apparatus according to claim 25, wherein the member comprises an outer tube, the outer tube to prevent splitting of said tubular member, unless it is fully retracted.
29.如权利要求25所述的设备,其特征在于,其中所述管形件适于将一个吻合装置夹在其中。 29. The apparatus according to claim 25, wherein said tubular member wherein an anastomotic device adapted sandwiched.
30.一个用于将一个移植血管递送工具从一个封闭在其中的移植血管上拆下的方法,包括:劈开所述管件,从而形成一个长槽;和将所述移植血管通过所述长槽取出。 30. a graft for delivery tool from a method of removing a closure on a graft vessel which comprises: cleaving the tube, thereby forming a long groove; and said graft through said elongated slot take out.
31.如权利要求30所述的方法,其特征在于,其中所述槽成形件由一个劈开所述管件的刀片构成。 31. The method according to claim 30, wherein, wherein said groove is constituted by a blade member formed of the split pipe member.
32.如权利要求30所述的方法,其特征在于,其中所述槽成形件由一个扩展件构成,该扩展件扩宽所述管件内的现有裂缝。 32. The method according to claim 30, wherein, wherein said member is constituted by a groove shaped extension piece, the extension piece widening existing cracks within the tube member.
33.如权利要求30所述的方法,其特征在于,包括:拉回至少一个绕在所述移植血管周围的管件。 33. The method according to claim 30, wherein, comprising: at least a back wound around the pipe member of the vascular graft.
34.如权利要求33所述的方法,其特征在于,其中所述拉回动作能够使所述管件与一个槽成形件相贴靠。 34. The method according to claim 33, wherein, wherein said return operation can be made with the tube member with a groove shaped abutment member.
35.如权利要求30所述的方法,其特征在于,包括使所述槽成形件相对所述管件移动,从而形成所述长槽。 35. The method according to claim 30, wherein said grooved member comprises a tubular member moves relative to the molding to form the elongated slot.
36.一个吻合连接器,包括:一个具有一条轴线的环形件;至少一组位于所述环形件上的尖钉;和至少一个沿横轴方向的增厚部分,该增厚部分位于至少一个所述尖钉内,同时远离所述环形件。 36. One anastomosis connector, comprising: an annular member having an axis; at least one set of spikes positioned on said annular member; and at least one thickening along the transverse direction, which thickened portion on at least one of the said spikes, while away from the annular member.
37.如权利要求36所述的连接器,其特征在于,包括一个第二组尖钉,该组尖钉的指向与所述第一组尖钉的方向相反。 37. A connector according to claim 36, characterized in that it comprises a second set of spikes pointing in the opposite direction of the spike set to the first set of spikes.
38.如权利要求36所述的连接器,其特征在于,其中所述增厚部分包括一个点,其中所述尖钉在该点处分裂成若干尖端。 38. A connector according to claim 36, wherein, wherein said thickened portion comprises a point wherein the tip of the spike at the point of splitting into a plurality of disposition.
39.如权利要求38所述的连接器,其特征在于,其中所述尖端的长度小于该连接器所适用的目标血管的厚度。 39. A connector according to claim 38, wherein, wherein said tip length is less than the thickness of the connector applies the target vessel.
40.如权利要求36所述的连接器,其特征在于,其中所述至少一组尖钉在使用过程中不对所述的环形件施加向内或向外的径向压力。 40. The connector according to claim 36, characterized in that the pressure is applied radially inwardly or outwardly, wherein said at least one set of spikes are not in use of the annular member.
41.一种用于保持和释放一个带有一个增厚部分的吻合连接器的方法,包括:将所述连接器保持在两个管件之间,所述增厚部分的轴向运动受到至少一个限定在至少一个所述管件上的凸起部分的限制;和拆下所述管件中位于外面的一个,从而该连接器产生变形,并且该增厚部分不再受到所述至少一个凸起部分的限制。 41. A method for holding and releasing a stapling a thickened portion with a connector, comprising: a connector held between the two tubes, the thickened portion by axial movement of at least one definition of the limits of the raised portion on at least one of said tubular member; and removing the tube member located outside, so that the connector is deformed, and the thickened portion is no longer part of the at least one protrusion limit.
42.一种在一个移植血管和一个目标血管之间施行吻合的方法,包括:将一个吻合连接器插入目标血管;释放所述连接器的至少一个前向尖钉;拉回所述连接器,从而使所述前向尖钉与所述目标血管相连接;和完成所述吻合过程。 42. A between a graft vessel and a target vessel anastomosis implemented method, comprising: a connector into a target blood vessel anastomosis; releasing the connector to the at least one front spike; back of the connector, so that the front is connected to the spike with the target vessel; and completing the anastomosis procedure.
43.如权利要求42所述的方法,其特征在于,其中完成所述吻合过程包括,释放所述连接器的至少一个后向尖钉,从而与所述目标血管相连接。 43. The method according to claim 42, characterized in that, to complete the anastomotic procedure which comprises releasing the at least one connector to the spike, thereby connected to the target vessel.
44.如权利要求42所述的方法,其特征在于,其中完成所述吻合过程包括,将所述尖钉锁定在除所述尖钉外的所述连接器的一部分上。 44. The method according to claim 42, characterized in that, to complete the anastomotic procedure which comprises the spike to lock said spike pin in addition to an outer upper portion of the connector.
45.如权利要求42所述的方法,其特征在于,其中完成所述吻合过程包括,释放所述尖钉,从而使之朝向除所述尖钉外的所述连接器的一部分缩回。 45. The method according to claim 42, characterized in that, to complete the anastomotic procedure which comprises releasing the spike, thus making it a part of the connector in addition to the spike toward the retracted.
46.一种用于在血管上打孔的打孔机构,包括:一个适于刺穿所述血管的锋利尖端;一个在一端带有所述尖端的轴;一个远离所述尖端的第一加宽件;和一个远离所述第一加宽件的第二加宽件,所述第一和第二加宽件在其二者之间限定了一个窄径部分,该窄径部分适于容纳被刺穿的血管壁;和一个连接件,该连接件用于使所述尖端的回缩与所述加宽件的一种相对运动相耦合,该相对运动使所述窄径部分收缩。 46. ​​A perforating means for perforating the blood vessel, comprising: a sharpened tip adapted to pierce the blood vessel; with a tip of said shaft at an end; a first heating tip away from the wide member; and a widening away from the second member first widens member, said first and second members between which both widens defining a narrow diameter portion, the narrow-diameter portion adapted to receive pierced the vessel wall; and a connecting member, the connecting member for a recoil of the widening of the tip member relative movement is coupled to the relative movement of said narrow diameter portion contraction.
47.如权利要求46所述的打孔机构,其特征在于,其中所述尖端缩入所述第一加宽件,从而将所述第一加宽件拉向所述第二加宽件。 47. The puncturing mechanism according to claim 46, wherein, wherein said tip member is retracted into the first widened, thereby widening the first member to the second pulling member is widened.
48.如权利要求46所述的打孔机构,其特征在于,其中所述尖端被安装在一个尖端轴上,并且通过拉回该尖端轴使尖端缩回,其中所述尖端轴与所述轴相连接,从而当所述尖端轴被充分回拉之后,所述尖端轴与所述轴相接触,并且将其回拉。 48. A mechanism as claimed in claim 46 wherein the puncturing tip of the shaft and the shaft, characterized in that the tip wherein the tip is mounted on a shaft, and by pulling back the tip of the tip of the shaft is retracted, connected to the shaft such that when said tip is fully pulled back, the tip is in contact with the shaft axis, and pull it back.
49.一种用于外翻移植血管的方法,其特征在于,包括:将所述移植血管抓在一个内部轴柄和一个外管件之间;和将所述移植血管的一端向后推至所述移植血管之上。 49. A method for everting the graft vessel, characterized by comprising: grasping the graft vessel between an inner mandrel and an outer tubular member; and one end of the graft vessel is pushed back to the said graft vessel over.
50.如权利要求49所述的方法,其特征在于,包括将所述推动操作重复数遍,从而获得理想的外翻量。 50. The method according to claim 49, wherein said amount comprises everting operation was repeated several times to obtain the desired boost.
51.如权利要求49所述的方法,其特征在于,其中推动所述移植血管的所述端部包括将所述端部外翻到所述外管上。 51. The method according to claim 49, characterized in that the end of the push wherein graft comprises an end portion of the everted onto the outer tube.
52.一种移植血管外翻器,包括:一个末端,该末端适于将所述移植血管安装在其上;一个移植血管止动件,该止动件用于对所述移植血管端部在所述末端上的前伸运动进行限制;和数个置于所述移植血管止动件和所述末端之间的扩张指形件,所述指形件具有一个扩张状态,其中它们的外径大于所述末端和所述移植血管,所述指形件还具有一个非扩张状态,其中其直径不足以与所述移植血管相配合。 52. A eversion graft, comprising: a tip that is adapted to the graft vessel mounted thereon; a vascular graft stopper, the stopper for the end portion of the vascular graft on the end of the protrusive movement limiting; number-th disposed between said expandable graft member and the end stop finger, said finger member having an expanded condition in which the outer diameter thereof and said tip is greater than the graft, said fingers further having a non-expanded state, the diameter of which is insufficient to cooperate with said vascular graft.
53.一种用于将安装一个带有尖钉的吻合连接器安装在一个移植血管上的方法,该尖钉带有向外弯出所述连接器的一个空腔的尖端,包括:使所述至少某些所述尖钉保持扭转结构,从而使所述尖钉的尖端弯入该空腔;用所述尖端刺穿所述移植血管;和改变所述尖端的结构,使之向外弯曲。 53. A connector for mounting a stapling with a spike mounted on a graft method, the spike bent outwardly with a cavity of the connector tip, comprising: the said at least some of said retaining spike twisted structure, such that the bent tip of the spike into the cavity; piercing the graft vessel with the tip; and changes the structure of the tip to make it bent outwardly .
54.如权利要求53所述的方法,其中改变该结构包括释放所述尖钉。 54. A method according to claim 53, wherein the releasing structure comprises changing the spike.
55.一种模拟移植血管外翻的方法,包括:将所述移植血管的一端压入一个成形工具中,从而在所述端部上形成一个增厚部分;和使用吻合连接器的至少一个尖钉刺穿所述增厚部分。 55. A method of simulation everted graft vessel, comprising: one end of the graft vessel is pushed into a forming tool, so as to form a thickened portion on the end portion; and a connector using at least one stapling tip nail piercing the thickened portion.
56.如权利要求55所述的方法,其特征在于,其中所述移植血管由一个乳房动脉构成。 56. The method according to claim 55, wherein, wherein the graft is made of a mammary artery.
57.如权利要求55所述的方法,其特征在于,其中所述刺穿包括沿所述移植血管的一条轴线进行刺穿。 57. The method according to claim 55, wherein, wherein the piercing comprises piercing the graft vessel along an axis.
58.如权利要求55所述的方法,其特征在于,其中所述刺穿包括沿与所移植血管的轴线相倾斜的方向进行刺穿。 58. The method according to claim 55, wherein, wherein the piercing direction and comprising the axis of the graft vessel is inclined piercing.
59.如权利要求55所述的方法,其特征在于,其中所述刺穿包括沿垂直所述移植血管轴线的方向进行刺穿。 59. The method according to claim 55, wherein, wherein the puncturing comprises a direction perpendicular to the axis of the graft vessel piercing.
60.如权利要求55所述的方法,其特征在于,其中所述成形工具包括一个内轴柄。 60. The method according to claim 55, wherein, wherein the forming tool comprises an inner mandrel.
61.如权利要求55所述的方法,其特征在于,其中所述成形工具在所述移植血管上限定了一个所述增厚部分的扁平端表面。 61. The method according to claim 55, wherein, wherein said forming tool defining a flat end surface of the thickened portion on the graft vessel.
62.如权利要求55所述的方法,其特征在于,其中所述成形工具在所述移植血管上限定了一个所述增厚部分的倾斜端表面。 62. The method according to claim 55, wherein the forming tool wherein the inclined end surface defining a portion of said thickened on the graft vessel.
63.如权利要求55所述的方法,其特征在于,其中所述成形工具在所述移植血管上限定了一个所述增厚部分的非平面的端表面。 63. The method according to claim 55, wherein, wherein said forming tool defining a non-planar surface of the thickened end portion of the graft vessel.
64.一种将一个连接器刺穿在一个移植血管上的方法,包括:增宽该移植血管一端的半径;使所述连接器上的至少一个尖钉沿平行于所述移植血管的方向向前伸出,从而使之刺穿所述增宽区域;和使至少一个所述尖钉的端部弯曲成钩状。 64. A method on a graft vessel, comprising a piercing connector: the radius of the widening end of the graft; a spike at least a direction parallel to the direction of the graft to the connector before extended, thus making the piercing widened region; and at least an end portion of the spike a bent like a hook.
65.一个用于旁外科手术的工具包,包括:至少一个两端安装有一个吻合连接器的移植血管,所述移植血管和所述连接器适用于周围血管旁外科手术;和至少一个与所述移植血管的一端相连接的引导线。 65. bypass surgery for a kit, comprising: at least two ends attached to a connector graft anastomosis, the graft vessel and the connector is suitable for peripheral vascular bypass surgery; and at least one of the One end of said guide wire is connected to the graft vessel.
66.如权利要求65所述的工具包,其特征在于,其中所述连接器被嵌入在所述移植血管的所述端中。 66. The kit according to claim 65, wherein, wherein the connector is embedded in the end of the graft blood vessel.
67.一种倾斜打孔器,包括:一个轴;一个以一个第一角度相对所述轴倾斜的第一非圆边缘;一个以一个第二角度相对所述轴倾斜的第二非圆边缘;和用于减小所述两边缘之间的缝隙的装置,这是为了切除位于二者之间血管组织。 67. A hole punch inclination, comprising: a shaft; a first angle with respect to a non-circular edge of the first inclined axis; a second angle with respect to a second non-circular edge of the inclined axis; and means a gap between the two edges is reduced, which is positioned to cut the blood vessel tissue therebetween.
68.如权利要求67所述的打孔器,其特征在于,其中所述两个角度不同。 68. The hole punch of claim 67, wherein, wherein said two different angles.
69.如权利要求67所述的打孔器,其特征在于,其中所述两个角度相同。 69. The hole punch of claim 67, wherein, wherein the two identical angles.
70.一种在穿孔手术过程中用于在血管上打孔的打孔器,包括:一个用于刺穿所述血管的尖端;一个适用于穿孔手术的并且与所述尖端相连接的硬质手柄,该手柄用于所述尖端的一个空间位置;两个表面,该表面用于容纳环绕在所述孔周围的血管壁;和用于使所述表面合在一起从而打出所述孔的装置。 70. A surgical procedure for piercing a blood vessel on the punched hole punch, comprising: a tip for puncturing the blood vessel; a perforating operation and applied to the hard tip is connected to the a handle for a spatial position of the tip; two surfaces, which surround the receiving surface for the vessel wall aperture; and a means for causing the surface of the hole played together to engagement .
71.如权利要求70所述的打孔器,其特征在于,其中所述尖端是变化的。 71. The hole punch according to claim 70, wherein, wherein the tip is varied.
72.如权利要求70所述的打孔器,其特征在于,其中所述尖端可沿轴向开有凹槽。 72. The hole punch according to claim 70, wherein, wherein the tip may be axially open groove.
73.一种对一个吻合连接器进行热处理的方法,包括:将一个切割连接器安装在一个模具中;固定所述模具,从而使所述连接器的前向和后向尖钉都弯成理想形状;和对所述固定的连接器进行热处理,从而将之处理成所述结构。 73. A method of heat treating an anastomotic connector, comprising: a connector mounted in a cutting mold; the mold is fixed so that the forward and backward spike of the connector are bent over shape; and heat-treating the fixed connector, such as the processing of the structure.
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