CN201533879U - Urethra under-slung sling for surgical treatment of female urinary incontinence - Google Patents

Abstract

The utility model relates to a urethra under-slung sling for surgical treatment of female urinary incontinence. The urethra under-slung sling is used for fixing a middle urethra, a bladder neck and a near-end urethra, wherein the under-slung sling comprises a monofilament or multifilament belt or net made of polypropylene or macroporous material; the length of the under-slung sling corresponds to fascia intrapelvina anchored therewith; the middle area of the under-slung is provided with two smooth edges and horizontal black lines intersected with the under-slung sling; the remaining parts of the sling are designed into similar arrow tips; and the urethra under-slung sling is characterized in that the edges of the sling (1) are provided with inclined tips directing toward the center of the sling, and according to the condition, the tips are in a mode of steps or teeth which are separated (4, 6) or continuous (8, 9) according to different angles.

Description

Be used for suspender under the urethra of female incontinence surgical intervention

Technical field

Described in the title of this descriptive description, this utility model relates to the improvement of introducing patent of invention No.P-200301134, this improvement is about suspender under the urethra that is used for the female incontinence surgical intervention, the stress incontinence of utilizing this suspender to be very easy to and correcting the women effectively, and described improvement is about realizing this improved operation device and the favourable operational approach that can carry out.

Suspender or net are the current marked improvements that is used for the suspender or the net of this purpose under the urethra of the surgical correction that is used for women's stress incontinence that feature and character are described in main patent of invention P-200301134, because because described suspender or net only are placed under the urethra and are anchored in the pelvis or the urethra pelvic fascia causes its length shorter, and also because its feature that is presented by the edge of the profile of described suspender or net: those terminal (edges) will allow described net to pass and can not leave from the position that described net has been placed, via arrow or fork effect, so that can the not become displacement and be attached to contiguous tissue of described suspender or net; And when the belt of the structure that is implemented described suspender or net or net fastening for fear of the stimulation of medial uretha and neck of bladder, those of middle section (edge) are level and smooth, and the black silk thread that crosses described suspender or net and labelling mid point also is used for stretching described net so that described suspender or net keep being placed exactly under the situation that described suspender or net become rolled-up.

And a purpose of the present utility model provides and is used for implanting the off line instrument of this urethra according to the surgical method that must carry out in order to correct stress incontinence, and described surgical method is very simple, easily the operation of execution and wound minimum.

Suspender under this urethra is applied to patient means surgical intervention to stress incontinence, target is to correct the change of pelvic girdle, reaches stability, and is fixing and improve urethra and neck of bladder, leaks so that prevent the urine during the pressurized.The special characteristic that this utility model provides is: a) actual characteristic of suspender or net and the present architecture advances that proposes under the described urethra of describing in main patent of invention; B) be used for the instrument of the implantation of suspender under the described urethra or net; And c) simplification of technology, described technology also make the orientation tool of suspender under the described urethra or net simplify, and can utilize once again, and Financial cost is low, and the invasive minimum.

Background technology

Stress incontinence is understood to be under the situation that detrusor do not have to shrink, and by the loss that is not intended to through the urine of urethra that the increase of the increase of abdominal pressure and the intravesical pressure that therefore causes causes, described pressure increase has overcome the clossing pressure of urethra.

Woolin (J.Urol., 101:545-546,1969) has inquired 4000 childless women and has found that 50.7% among them show the urinary incontinence to pressurized to a certain degree.Stress incontinence is produced by the change of the tendon structure of pelvic girdle, the change of described tendon structure is on the one hand because the vertical position of gynecoid pelvis must support its inner power that produces causes, and because pressure, along with wearing out of tissue, their promote the decline of urethra-bladder associating.

Have two types stress incontinence in the women, a kind of is owing to the urethra hyperkinesia the most commonly, and a kind of is because the sphincteral deficiency in inside of urethra.

Because the excess syndrome that anterior vaginal wall displacement and urethra descend the hyperkinetic stress incontinence of urethra is described as be in pressurized in clinical term during is although UCP is normal.At this moment, because the insertion of the muscle (pubis-coccyx muscle) of the loss of the loss of the support that provides by anterior vaginal wall under pubourethral ligament, the urethra, function and pelvic girdle, be changed in the urethral occlusive mechanism of medial uretha level.

Owing to inner sphincteral insufficient stress incontinence is because urethra engages and insufficient compression causes closing force or urethral occlusive reduce to produce, often with pressurized during neck of bladder permanent opening and be shifted relevant.The stability of cervix uteri-urethra associating is changed, described cervix uteri-urethra is united and is responsible for urethra compression and provides support and support, and it also compresses the urethra of near-end energetically during pressurized, and because the inefficacy of these mechanism, the pressure (for example simple walking or double-legged standing activities) that urine leaks in minimum takes place down.

According to these notions, treatment must be intended to correct these changes.Yet current use is limited to only corrects the hyperkinetic process of urethra, and the invasive of these technology is very strong, and needs strict study in order to carry out them, and it is only carried out by the expert.In this case, correct by laparoscopy through stomach wall, although the entrance is very little, but require very expensive instrument and operating time usually to continue between 80 and 120 minutes, always finish with the general anesthesia agent, and the situation that bladder and vascular lesion have occurred makes and must carry out laparotomy ventrotomy so that solve these complication.Carry out transvaginal and abdominal part make net through vagina up to the other technologies of net being pulled out through the skin of tension-free stomach wall, adopt common, regional area anesthesia or local anesthesia this moment; Use large-sized net of length 50 or 60cm in these situations, net is terminal with some pins, and these needle sets are useful on blindly leads these pins and therefore avoid to urethra with to the hurtful special installation of bladder; Net penetrates from vagina band (under the urethra), passes triangular ligament film, fascia intrapelvina, rings mid point and crosses, and the fascia of the anterior rectus muscle by abdominal part withdraws from up to the Retropubic skin in the middle section of suspender.Here, complication has been described, the for example perforation of urethra perforation, vesical perforation and intestinal perforation and external iliac artery, described complication is sometimes very serious and must carry out cystoscopy so that get rid of vesical perforation, so that the time of operation cost further prolongs, be used to do cystoscopic surgical materials costliness, and surgery operating technology and the careful study of execution cystoscopy requirement.

Because the existence of these pathological changes, fixedly urethra (suprapubic zone) has appearred replacing upwards, but via plate fixing other technologies of urethra under side direction, in other words, prevent the technology of above-mentioned pathological changes, and these technology utilize net to make pin lead to the side of vagina, search for obturatorius (obturator) hole of their perforation, withdraw from up to the skin through the thigh inner face.Nerve or obturator artery pass the hole of obturatorius, and, because pin is led by blind, these structures pathological changes occurs and also have the delayed complication, for example by net in the path of its inner face from the vaginal area to the thigh and the inflammation, fibrosis and the contraction that cause cause their opening or the serious interference of motion.

For because the surgical intervention of the intrinsic sphincteral insufficient urinary incontinence of urethra, such technology has been described: utilization again the fourdrinier wire made of the organic or synthetic absorbing material again of absorbing material or belt with the path suspention of neck of bladder through the vagina and the abdominal part of combination, described fourdrinier wire or belt utilization after the pubis skin of abdomen from 6 to 10cm transverse incision in advance, pass through to abdominal part from vagina (space under the urethra), dissect intensification and arrive the fascia of anterior rectus muscle up to it, the end of net is sewn on the fascia of described anterior rectus muscle, sometimes very tight belt causes acute or chronic urinary retention, perhaps also places the synthetic equipment made from metal material so that regulate the tension force of net.In this, the complication that causes owing to epifascial net that is sewn to described anterior rectus muscle and the device that is placed on the there has been described, the shortcoming of described technology is: except the material of the suspention that is used for neck of bladder very the costliness, as long as net relates to intolerance, inflammation, infection and fistula (fistulisation), so aspect adjustable equipment, intolerance, the infection in the implantation region and the interference of the big seroma of time-consuming removing frequently appear causing.Vesical perforation is frequent relatively when by pin in these processes, makes to carry out cystoscopy, and the execution cystoscopy means owing to cystoscopic system uses to have prolonged spent in the surgical time.

The utility model content

Briefly, suspender and the improvement introduced according to this utility model under the urethra of describing among the main patent of invention P20031134, because the novelty of the practical structures of net and the implanting instrument of configuration and described net, make and can use the new method of imagining as the surgical intervention of women's stress incontinence, described new method is called: free anchoring in the pelvis.

Correcting because under the situation of the hyperkinetic stress incontinence of urethra, suspender is placed under the medial uretha under the described urethra, constitutes the little sagittal otch of about 2cm at the antetheca of vagina.Using Mei Aoshi to cut in paraurethral space cuts and digs through up to the lower edge that arrives pubis.The implanting instrument that is used for suspender under the described urethra by small-bore, have cone point, a slightly circular and comprise that the long angle coupling of eye forms.The described tip of described folder is used for fastening and forms the described net of suspender under the described urethra or the end of belt, the described tip of described folder is by means of after being introduced into after other space of the upward pressure of the gentleness urethra through being cut open and the pubis and adhering to pubis, and the triangular ligament film is crossed up to passing fascia intrapelvina or urethra pelvic fascia; The described double-layered quilt of the end of fixing described net is opened and described net keeps staying in the pelvis or in the eye of urethra pelvis aponeurosis (aponeuroses), described double-layered quilt is regained, on opposition side, repeat same operation and the described net of tension-free placement, net is adhered to urethra undertissue, fixing and stable urethra.

Because under the situation of the insufficient stress incontinence of intrinsic sphincter, the off line or belt of described urethra is placed on the urethra of nearside.For this reason, use by implanting instrument small-bore, that form by the long looper of eye at its end.From the off line terminal approximately 1cm of described urethra, monofilament interweaves, the length of described monofilament allows it to pass outside up to pubis postabdomen skin from vagina, the eye of described pin is passed through at the two ends of described line through the bossing of described pin, be fixed to the tip of described pin up to the end of described net, described line is secured on the clamp device of close control device or handle, so that by together with the urethra of described pin under space, the pubis and introduce afterwards and when adhering to the latter through formerly being cut open, the displacement that can not become of described net.Pressure by means of the gentleness on the pin, the triangular ligament film is by by up to passing described fascia intrapelvina or urethra pelvic fascia, and the end of described net keep by anchoring and stay in the pelvis or the eye of urethra pelvis aponeurosis (aponeuroses) in, and discharge two lines of end of described net that maintenance is fixed to the tip of described pin by opening described clamp device at that time.This causes when described pin continues to be introduced into tip up to described pin in vertical direction by skin of abdomen around the ramose back of described pubis when, described line slides along described eye, only have described two lines up to described watching, and be pulled up to a loose end through these lines of concave surface of described eye and pass through from vaginal area, up to line by from outside the described skin of abdomen of the back of pubis, drawing back; Described afterwards eye is contracted and described orientation tool is removed, and carries out same operation at opposition side, and described then vaginal incision is sewn.

The described line that occurs through the skin on each side in suprapubic zone is when upwards being spurred, the Zhang Du that is used for regulating described net requirement is corrected up to urinary incontinence, no matter this is the number of degrees by measuring cervix uteri-urethra angle or realizes by making patient cough to make by oneself up to her, at intra-operative or by means of cough pressure or pharynx valsalva's maneuver patient is coughed when standing afterwards.A terminal quilt is cut so that do not pollute their inside, path with skin with flushing then, and another end is pulled and whole line is pulled out.

Suspender is realized by polypropylene monofilament belt or net under the described urethra of main patent of invention P200301134, the central area of suspender has two smooth edge to prevent the stimulation of urethra and neck of bladder when being gripped by belt under the described urethra, and the remainder of suspender is designed with sagittate form under the described urethra, when introducing, the remainder of suspender can not withdraw from and firmly stick in fascia intrapelvina and the adjacent tissue with hands under the described urethra, remains on the position that it is placed.

Current device comparison with being used to correct stress incontinence utilizes the advantage of the present technique of suspender under the described urethra with its positioner as follows, and wherein said positioner comprises according to one of improvement of this utility model contribution:

Needn't go deep into towards innermost organ, thereby not have the danger of serious pathological changes.

Because the structure of being passed only is triangular ligament film and fascia intrapelvina, there is not any vesical perforation, thereby needn't carries out cystoscopy.

The path up to arriving skin that described pin adopts is straight, does not therefore have complication, and other technologies are intersected so that withdraw from Retropubic middle body route.

Owing to there is not implanted this district of different composition, the risk that inflammation and infection (cellulitis) or subcutaneous cellular tissue are shunk does not appear.

Tensile advantage at the described net of horizontal adjustment of urethra pelvic fascia is not have urethral obstruction; When patient stood, when the tension force of the described net of horizontal adjustment of the fascia of the rectus of abdominal part, its enlarged also compacting urethra, causes requirement to extract the acute urinary retention of described net out; As time goes on, when patient has increased her abdominal circumference owing to weight increase or owing to abdominal muscles key film is lax, also produced urine retention, and implanted adjusting prosthese will pull on the described line of the described net in dynamic pressure reducing urination road.

Owing to do not have any metal prostheses at abdominal part, so these patients can accept such as the detecting of nuclear magnetic resonance, NMR, and they can accept the surgical operation of abdominal part at any time, and do not need to seek help from anti--incontinence surgical operation.

It is a kind of simply, in short-term, implement easily and the technology of invasive minimum.

The surgical operation material is minimum: short size belt, and the crooked locating clip of eye is arranged and the fine needle of eye is arranged, can reuse, and therefore more economically.

Operation can be implemented with local anesthesia.

Operating time is 10 to 20 minutes, means when using operating room to save more, therefore is considered to the main surgical operation of stop over.

Reduce the holding time of sick bed, also save more.

Owing to do not have sickness rate, so can be applied to the patient of high surgical risk.

Works very well is similar to suspension technique under the current urethra.

According to an aspect of the present utility model, suspender under a kind of urethra that is used for the female incontinence surgical intervention is provided, the fixing medial uretha of suspender under the described urethra, neck of bladder and near-end urethra, described suspender comprises monofilament or multifilament belt or the net that the material of polypropylene or macropore is made, the length of described suspender is corresponding with the fascia intrapelvina of its anchoring, the central area of described suspender has two level and smooth edges and the horizontal black line that intersects with described suspender, the remainder of described belt is designed to similar arrow tip, suspender is characterised in that under the described urethra: described belt has the oblique tip of pointing to belt central authorities at the edge, according to circumstances, described tip is the separation of different angles or the form of successive step or tooth.

According on the other hand of the present utility model, suspender is characterised in that under the described urethra, described belt or net have comprised that described monofilament lines is used to be pulled and regulate the tension force of described net in the interlacing monofilament lines in the two ends of described belt or net, to correct stress incontinence.

According on the other hand of the present utility model, suspender is characterised in that under the described urethra, but suspender comprises the small-bore and crooked pin of being made by reuse metal or disposable plastic under the described urethra, the far-end of described pin has the bending of the 3-4mm of the form that is straight or slight arcuate, have cone point and eye, described pin has ledge or the handle that is used to keep pin at near-end.

According on the other hand of the present utility model, suspender is characterised in that under the described urethra, described arc pin has near described handle with respect to 40 of the axis of described pin spends to the bendings of 60 degree, and some devices that are used to capture or fix described line, the end of fixing described belt of described line or net.

According on the other hand of the present utility model, suspender is characterised in that under the described urethra, describedly is used to capture or the described device of fixing described line has the form of folder or nail.

According on the other hand of the present utility model, suspender is characterised in that under the described urethra, and described device is limited by the proximal part of control device handle or the slit in the distal portions, or limits by establishing foraminous arcuate fulcrum.

Description of drawings

In order to promote that the understanding of feature of the present utility model and the major part of formation description are enclosed a few sheet of planar figure, wherein accompanying drawing is an illustrative rather than restrictive, and accompanying drawing is as follows:

Fig. 1 is the sketch map of the plane graph of suspender under the urethra of the surgical intervention that is used for women's incontinence described in main patent of invention P200301134.

Fig. 1 a to 1j is according to the various embodiments of described suspender of the present utility model or the corresponding views of its part.

Fig. 2 is the sketch map that is used for the plane graph of the instrument of the implantation of suspender under the described urethra, and described suspender is used for owing to the hyperkinetic incontinence situation of urethra, and described instrument has the eye in bending clamp and the tip.

Fig. 2 a and 2b are the positions for the described eye of observing the most advanced and sophisticated of slightly circular and the terminal 1cm of distance, the corresponding partial view of the described instrument of Fig. 2.

Fig. 3 is because under the situation of interior not enough at sphincter in recurrence incontinence, the sketch map of the plane graph of the instrument that is used to implant, described instrument have the looper of eye in the tip.

Fig. 3 a to 3j is surgical technique and tools or its part or its regional corresponding view of Fig. 3, has the device that is used for fixing line and the different embodiments of control device or handle.

The specific embodiment

Quote the labelling that adopts among Fig. 1, we can see that it relates to net or the belt of describing 1 in main patent of invention, net or sack can be made by the non-absorbing material again such as polypropylene, nylon, polyethylene, polyester, fluoropolymer or other synthetic materials, such as the synthetic absorbing material again of polyglycolic acid, polylactic acid, and such as monofilament or multifilament other again absorbing material make.

The edge of central area is slick to prevent to stimulate the tissue around it, is labeled as label 2.The limit of the end of belt 1 is regular, and contemplate and make belt can not move and will keep being attached to the adjacent tissue that it has been placed, can not become displacement and can not being withdrawed from by the position of anchoring from it of belt is because the limit of belt is as thrusting but the arrow or the fork that can not withdraw from.As Fig. 1 a to 1j finding, belt can: have oblique at the edge and point to the tips of belt central authorities, as arrow (labelling 3 among Fig. 1 a); Be the form (Fig. 1 b) that is formed with toothing with isolating tooth 4; With the continuous structure (Fig. 1 c) that waits heel teeth 5 to be formed with tooth; The structure that tooth is arranged (being labeled as 6 among Fig. 1 d) along oblique length central authorities towards belt; As observed 7 the slant cutting edge of being labeled as among Fig. 1 e; As being labeled as 8 oblique fluctuating among Fig. 1 f; Be the form of continuous tooth in the broached-tooth design, shown in Fig. 1 g, be labeled as 9.As seeing among Fig. 1 h, there is interlacing black silk thread in the centre of suspender or net, its not only the mid point of mark lengths (as relate in the main patent of invention with Fig. 1 in observed), be used for also preventing that suspender or net are folding in the close each other mode self of its longitudinal edge shown in figure h arrow, and when two ends so keep launching when pulled, as observed among Fig. 1 i.

For the suitable location of belt or suspender, as visible among Fig. 1 j, monofilament 11 interweaves apart from 7 to the 15mm places, two ends of net 1, and monofilament 11 will serve as traction apparatus so that regulate the tension force of the net be used to correct urinary incontinence.

Now specially with reference to figure 2, we can see what kind of the off line implanting instrument of urethra is, this urethra is off line to be used for because the treatment of the hyperkinetic stress incontinence of urethra, the implanting instrument general reference numeral that the utility model proposes is a label 12, and comprise about 15 to 20cm the reusable metal clip of growing up, or disposable rigid plastics folder, spend to the angular bend of 45 degree with about 30 at its far-end 1/4th (with the zone of 13 expressions), have the eye of diameter 3mm.Anchor clamps have cone point, slightly circular, shown in labelling 15 among Fig. 2 a, and have diameter 3 to 5mm and as among Fig. 2 b with 16 the expression the terminal 1cm of distance the eye.

Shown in Fig. 3 is to be used for because intrinsic sphincter deficiency, recurrence incontinence or because the off line implanting instrument of urethra of the surgical intervention of the female incontinence that causes of urethra hyperkinesia, this instrument general reference numeral is a label 17, and comprise the pin 18 of diameter from 3 to 6mm, pin 18 is metal and can re-uses, or make by the disposable plastic material, have eye 19 at its tip and have sleeve or handle 20 in the opposite end.Near handle 20 fixed system that is used for line is installed.Instrument 17 has 30 to 50cm total length, (see that Fig. 3 a) has in its distally and is labeled as 21 3 to 4cm straight path with the pin 18 that is bent of angles from 20 degree to 60 degree, or has mild curvature 22 at this end, the tip of instrument is taper, slightly circular (labelling 23 among Fig. 3 b) and apart from most advanced and sophisticated from 5 to the 10mm eyes 19 with diameter 3 to 5mm, shown in 24 among Fig. 3 b.

The control device of Fig. 3 a or handle 20 are from beginning to widen with respect to the sweep 25 of about 40 degree of the axis of pin 18 to 60 degree.Control device or handle can be: columniform (not showing in the drawings), length from 8 to 12cm; Ellipse with level and smooth profile is as shown in Fig. 3 c; Be provided with the recess 26 (seeing Fig. 3 d) that is used for finger grip; Or seen in Fig. 3 e, be labeled as 27 triangle and also be provided with recess.

On the level of pin 18 end and sleeve pipe or handle 20 beginnings (seeing Fig. 3 f), be supplied with and be used to capture or the device 28 of static line, described line is the end of suspender under the urethra fixedly, device 28 shapes that are used to regulate the traction force of net and present alligator clip in this case are although it also can have the form (Fig. 3 g) of pin 29; Device 28 limits (seeing Fig. 3 h) by the proximal part of sleeve pipe or handle or the slit 30 of distal portions, has the shape of the fulcrum 31 shown in Fig. 3 i, or comprise hole 32 in the fulcrum 31 of static line, shown in Fig. 3 j.

Claims (8)

1. suspender under the urethra that is used for the female incontinence surgical intervention, the fixing medial uretha of suspender under the described urethra, neck of bladder and near-end urethra, described suspender comprises monofilament or multifilament belt or the net that the material of polypropylene or macropore is made, the length of described suspender is corresponding with the fascia intrapelvina of its anchoring, the central area of described suspender has two level and smooth edges and the horizontal black line that intersects with described suspender, the remainder of described belt is designed to similar arrow tip, suspender is characterised in that under the described urethra: described belt (1) has the oblique tip of pointing to belt central authorities at the edge, according to circumstances, described tip is the separation (4 of different angles, 6) or the continuously step of (8,9) or the form of tooth.

2. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 1, it is characterized in that: intersect so that the described black silk thread (10) of the mid point of described belt of labelling or net (1) with described belt or net (1) in central authorities, to allow (1) horizontal expansion of described belt and to make described belt (1) keep the mode that accurately is placed, keep being anchored to described edge.

3. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 1, it is characterized in that: described belt or net (1) have comprised the interlacing monofilament lines in two ends (11) at described belt or net (1), described monofilament lines (11) is used to be pulled and regulate the tension force of described net (1), to correct stress incontinence.

4. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 1, it is characterized in that: suspender comprises the folder (12) of the localized small-bore type that is used for described belt or net (1) under the described urethra, the described far-end that is clipped in is bent, and has cone point (15) and eye (14) endways.

5. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 1, it is characterized in that: but suspender comprises the small-bore and crooked pin of being made by reuse metal or disposable plastic (17) under the described urethra, the far-end of described pin (17) has the bending of the 3-4mm of the form that is straight (21) or slight arcuate (22), have cone point (23) and eye (19), described pin has ledge or the handle (20 that is used to keep pin at near-end, 26,27).

6. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 5, it is characterized in that: described arc pin has near described handle with respect to 40 of the axis of described pin spends to the bendings of 60 degree, and some devices (20 that are used for capturing or fixing described line (11), 26,27), the end of fixing described belt of described line (11) or net (1).

7. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 6 is characterized in that: describedly be used to capture or the described device (20,26,27) of fixing described line has folder (28) or follows closely the form of (29).

8. suspender under the urethra that is used for the female incontinence surgical intervention according to claim 6, it is characterized in that: described device (20,26,27) proximal part or the slit in the distal portions (30) by control device handle (20) limits, or limited by the arcuate fulcrum that can be provided with hole (32) (31).

Images