CN1771011B - 吻合术用的螺旋装置 - Google Patents

吻合术用的螺旋装置 Download PDF

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CN1771011B
CN1771011B CN038265451A CN03826545A CN1771011B CN 1771011 B CN1771011 B CN 1771011B CN 038265451 A CN038265451 A CN 038265451A CN 03826545 A CN03826545 A CN 03826545A CN 1771011 B CN1771011 B CN 1771011B
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埃尔温·德温特
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Abstract

本发明,螺旋装置,是用于吻合人体内空心管状结构(比如血管、肠和输尿管)的机械装置。因此并不限于(微细)管。其能用于每种进行吻合术的外科手术和制替换管手术中。其允许端部对侧面或者侧面对侧面地进行吻合。螺旋装置非常易于应用到管壁上。螺旋是非常快速的技术,并且节省手术时间而且只需基本的显微外科技能。制造也很容易。另一优点是螺旋装置能安装到受体管上而无需首先在该管上进行开口和/或堵塞。以后,受体管壁能用激光或手术刀来开口。应当理解的是,上述只是示例性的而非限制性的,并且所述领域的技术人员在不偏离本发明范围的前提下能作出变型。

Description

吻合术用的螺旋装置
技术领域
本发明涉及吻合装置,更具体地说,螺旋装置能将一根血管的端部吻合到另一血管的侧面(端部到侧面——参见图1)或者将一根血管的侧面吻合到另一血管的侧面(侧面到侧面——参见图2)。
背景技术
(脑部、心脏、肌肉、器官内的)生命细胞需要恒定供应的营养、氧气、能量(葡萄糖)。已经发现,这些成分存在于在健康的血管系统中运行的血液之中。作为泵送系统,心脏确保血液(营养)循环通过全身。当细胞对氧气或营养的需求与血流到细胞的输送能力之间存在着差异时,就有细胞会损坏甚至死亡。在一些生命器官中,细胞死亡之前的这种剧烈的局部缺血非常短暂。对于脑细胞,死亡在3分钟之后发生。这种缺血的原因主要是血管病(动脉硬化)、小或大血管的狭窄和堵塞、或者心脏问题(冠心病)。动脉硬化最主要的危险因素是:高血压、高血脂(elevated serum lipids)、抽烟、糖尿病、缺乏体育锻炼以及肥胖症(即摄取了超出消耗能量所需的卡路里)。
为了治疗被堵住或堵塞的血管,实践中已经使用了药物疗法和外科手术。药物疗法对于疾病处于开始阶段时很有用,但是在疾病进一步发展时则不然,这导致血管的堵塞并且最终导致(心脏、脑部、肾等的)梗塞。
医生可用的医学诊断工具和新技术设备已经得到巨大的增长:MRI扫描、MRA扫描、CT扫描、CTA扫描。这就使得能对患有血管疾病的患者进行更早的诊断和更成功的治疗。
在血管手术中,首先进行血管内操作,例如:扩张,这能在心脏手术(冠状动脉)和血管手术(颈动脉的缩窄)中扩展堵塞的血管;腹主动脉的扩张改造动脉瘤;以及最近的基底动脉的脑部扩张改造纺锤形动脉瘤。
在血管手术中,其次进行再血管化手术,即吻合术和制替换管术。这些再血管化手术在存在着局部缺血(危险)、(心脏、脑部、四肢等)梗塞(危险)的情况下进行。普通血管手术中、心脏手术(冠状动脉替换管)中以及神经外科手术中的制替换管手术想要绕开巨大的血管畸形(巨大的动脉瘤)。在肿瘤手术中,制替换管手术想要避免在切除肿瘤之后和/或之前脑部局部缺血的危险。移植物可以是动脉移植物(对于心脏手术将是左侧内乳动脉(lima)或右侧内乳动脉(rima),对于神经外科手术将是颞动脉或枕动脉),或者静脉移植(v.s.m.),或者甚至是修复材料。这些高度复杂的手术需要非常有能力的外科手术团队、精密的仪器、先进的显微外科设备、放大镜(magnifying loops)、或者对于神经外科——手术显微镜。在显微血管手术中,超细的缝合材料用来将血管彼此缝合(吻合术)。这种缝合技术非常耗时并且要求非常先进的显微外科手术技能。此外,不能得到非常光滑的接头,针脚在管壁中产生微皱折。已经开发了很多方法来利用机械装置在短时间内进行吻合术而无需缝合。绝大多数这种装置非常复杂并且使用起来非常耗时(例如,在脑部手术中,一次显微血管手术平均需要二十到三十分钟)。在此期间,在上述所有形式的显微血管手术中存在着很高的流血和感染危险。对于患者的健康来说,减少这种时间是最重要的。
发明内容
本发明的目标是发明一种非常容易且非常快速地进行血管吻合术的方法。
本发明的螺旋装置,提供了能在不进行缝合的情况下将一根管的侧面吻合到另一根管(侧面到侧面)或者将一根管的端部吻合到另一根管的侧面(端部到侧面)的装置。于是,就有了非常光滑的接头,管壁上不会有任何皱折。
这种螺旋装置非常易于应用在管壁上,只需几秒钟就能将螺旋装置螺旋入受体管的管壁并且将其螺旋入供体管。这种过程也可以倒过来,首先将该装置螺旋入供体管并且随后将其螺旋到受体管上。
其能用在每个处理血管问题的外科手术中,比如在血管手术、心脏手术以及神经外科手术中进行的吻合术或制替换管术。
受体管壁的打开能在不堵塞受体管或者暂时堵塞受体管的情况下进行。这能容易地与现有的用于以非堵塞的方式打开受体管的激光技术相结合。
附图说明
图1:利用螺旋装置的端部对侧面的吻合术;
图2:利用螺旋装置的侧面对侧面的吻合术;
图3a:单个端部的螺旋装置的侧视图;
图3b:单个端部的螺旋装置的顶视图;
图3c:内部视图:单个端部的螺旋装置的受体管内部;
图3d:螺旋入供体管的单个端部的螺旋装置;
图4a:双端部的螺旋装置/环形的侧视图;
图4b:双端部的螺旋装置/环形的顶视图;
图4c:内部视图:双端部的螺旋装置/环形的受体管内部;
图5a:双端部的螺旋装置/螺旋形的侧视图;
图5b:双端部的螺旋装置/螺旋形的顶视图;
图6a:键环螺旋装置的侧视图;
图6b:键环螺旋装置的顶视图;
图7a:具有可移除的头部的螺旋装置的侧视图;
图7b:具有可移除的头部的螺旋装置的顶视图;
图7c:现场视图:具有可移除的头部的螺旋装置置于管壁内;
图7d:可移除的头部附属到具有可移除的头部的螺旋装置的剩余部分的方式的视图;
图8a:螺纹刀具的侧视图;
图8b:螺纹刀具的顶视图;
图8c:螺纹刀具的尖端的视图,由两个规则的绕线和一个锋利的绕线组成。
具体实施方式
本发明的螺旋装置主要有五种形式。
1.单个端部的螺旋装置。这种装置是具有四至六个保证弹性的绕线的弹簧。前三个绕线非常靠近,即它们之间的间距最小(间距使得螺旋装置能钻入管壁)。在单个端部的螺旋装置的一端上有着非常锋利的端部,用于在管壁上打孔。另一端是钝头的。
锋利的端部是圆形的,即非切割的但是能在管壁上打孔。锋利且圆的点向内向下弯曲10至20度(α)(参见图3a、3b、3c、3d)。可选地,这个锋利、圆形且非切割的点可以向下弯曲90度(α)。在这种情况下,端部类似于螺旋拔塞器,但是端部并不位于最终绕线的中间而是在其周边。
2.双端部的螺旋装置/环形。这种装置是具有四至六个保证弹性的绕线的弹簧。前三个绕线非常靠近,即它们之间的间距最小(间距使得螺旋装置能钻入管壁)。在双端部的螺旋装置/环形的一端呈环的形式,这个环具有两个锋利、圆形且非切割的点,这两个点在相同的方向上指向但是彼此分开180度(参见图4a、4b、4c)。这两个点向内向下弯曲10至20度。可选地,这些锋利、圆形且非切割的点可以向下弯曲90度。在这种情况下,它们类似于螺旋拔塞器,但是端部并不位于最终绕线的中间而是在其周边。双端部的螺旋装置的另一端是钝头的。
3.双端部的螺旋装置/螺旋形。这种装置是具有四至六个保证弹性的绕线的弹簧。前三个绕线非常靠近,即它们之间的间距最小(间距使得螺旋装置能钻入管壁)。双端部的螺旋装置/螺旋形包括两个锋利、圆形且非切割的点,第一个源自于端部,第二个源自于起始点但是弯曲为与另一锋利点对准(参见图5a、5b)。再次,这两个点在相同方向上指向,不过彼此离开180度。它们向内向下弯曲10至20度。可选地,这些锋利、圆形且非切割的点可以向下弯曲90度。在这种情况下,端部类似于螺旋拔塞器,但是端部并不位于最终绕线的中间而是在其周边。
4.键环螺旋装置。这种装置包括二至三个绕线,类似于键环。在一端上有着锋利、圆形且非切割的点,其向内向下弯曲10至20度。可选地,这个点可以向下弯曲90度。在这种情况下,端部类似于螺旋拔塞器,但是端部并不位于最终绕线的中间而是在其周边。另一端是钝头的。在两个端部相遇之处,环中有扭曲(参见图6a、6b)。
5.具有可移除的头部的螺旋装置。这种装置包括两个基本部件,可移除的头部(具有敷料器)和三个绕线的空心螺钉,后者保持在正确的位置(即血管内)。
5.1头部包括两个绕线,并且以螺旋拔塞器的形式结束(参见图7a、7b)。其又是圆形、锋利且非切割的点。头部与敷料器形成一个整体,即具有用于将头部钻入管壁的把手的细长轴。一旦头部处于正确的位置(即管的中间)(参见图7c),其与敷料器一起从停留在管壁内的螺旋装置的剩余部分中移除。
5.2螺旋装置的另一部件包括三个借助于内部的逆时针绕线附属到头部的空心绕线(参见图7d)。每个绕线都比前一个宽,因而扩展了管壁以及其中由头部形成的开口。这个开口以不闭塞的方式形成,即受体管无需暂时性地堵塞。
其它工具。在第五种形式中,即具有可移除的头部的螺旋装置,无需其它工具来打开管壁。
在其它形式中,管壁中的孔可以由传统的手段来形成——基本上:利用外科手术刀的堵塞方式,或者利用激光的非堵塞方式——或者借助于螺纹刀具。这种特殊设计的装置以非堵塞的方式操作。其呈空心柱体的形式,其中顶部具有把手的长轴上下移动(参见图8a、8b)。这个轴终止于由三个绕线构成的螺钉。其中前两个呈螺旋拔塞器的形式,因此锋利的点处于中间。它们将管壁保持在正确的位置,而第三个绕线——形成一个完整的360度圆——实际上切割并移除将要在该处形成孔的管壁部分。第三绕线具有向下指向的锋利边缘,而前两个绕线是水平的,类似于普通螺钉中的(参见图8c)。
直径:根据血管的种类,五个螺旋装置的直径可以从1毫米变化到大于2厘米。
材料:螺旋装置由抗氧化材料、或钛、或超塑性材料(比如镍钛合金)、或合成材料,或者可再吸收材料制成。
材料厚度:根据血管的直径,材料的厚度可以从0.1毫米到任意所需的厚度。
弹性:取决于材料。
利用螺旋装置的操作技术的说明:
A.对于前四种形式的螺旋装置——即:单个端部的螺旋装置、双端部的螺旋装置/环形、双端部的螺旋装置/螺旋形、键环螺旋装置——技术如下:
端部对侧面
在第一步骤,受体管借助于现有血管手术中的技术来暴露。当静脉移植物端部对侧面地使用时,螺旋装置螺旋入移植物(供体管)或者缝合到供体管。
在第二步骤,包含螺旋装置的供体管被螺旋入受体管。
可选地,螺旋装置能先被螺旋入受体管并且随后供体管附属到其上。
螺旋装置被顺时针地转入管并且一圈之后就完成,也就是说,360度之后就处于正确的位置。
在第三步骤中,受体管的壁借助现有技术打开,比如激光或外科手术刀。
2.侧面对侧面
首先,夹紧供体管并将其开口。螺旋装置被螺旋进去并穿过管壁,因而用两个绕线将供体管打孔。这些绕线随后被螺旋入受体管(顺时针360度)。随后借助于现有技术(比如激光或外科手术刀)在受体管壁中钻孔,比如激光或外科手术刀。
B.对于第五种形式,也就是具有可移除的头部的螺旋装置,上述A中所述的技术以同样的方式应用,不过是在移除头部之后进行。
在所有这些形式中,取决于外科医生的选择,螺旋装置能以堵塞或者非堵塞的方式使用。
制造和工业实用性
螺旋装置能在商业上制造并且用于吻合两个不同或同样尺寸的管。其能用于所有主要的血管手术、心脏手术以及神经外科手术中。

Claims (10)

1.用于将一根管的侧面吻合到另一根管的侧面的外科螺旋装置,这些管是人体的空心管状结构,该螺旋装置包括具有数个绕线的螺钉状螺旋形弹簧,所述螺钉状螺旋形弹簧的前三个绕线非常靠近,它们之间的间距最小,使得螺旋装置能钻入管壁,所述螺钉状螺旋形弹簧的前绕线具有锋利且圆形的非切割端部,前绕线和第二绕线能将第一管的管壁保持在前绕线和第二绕线之间,第二绕线和第三绕线能将第二管的管壁保持在第二绕线和第三绕线之间。
2.根据权利要求1的外科螺旋装置,其特征在于螺钉状螺旋形弹簧是双端部的,具有两个锋利、圆形且非切割的点,这两个点指向相同的方向但是彼此分离180度。
3.根据权利要求1或2的外科螺旋装置,其特征在于,所述锋利且圆形的端部相对于其它绕线向内向下弯曲10至20度。
4.根据权利要求1或2的外科螺旋装置,其特征在于,所述锋利且圆形的端部相对于其它绕线向下弯曲90度。
5.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由抗氧化材料制成。
6.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由钛制成。
7.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由超塑性材料制成。
8.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由镍钛合金制成。
9.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由合成材料制成。
10.根据权利要求1的外科螺旋装置,其特征在于螺旋装置由可再吸收材料制成。
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