CN209153830U - The binding ligator of the lower processing prostate dorsal vein clump of laparoscope auxiliary - Google Patents

Abstract

The utility model provides a kind of binding ligator of lower processing prostate dorsal vein clump of laparoscope auxiliary, including shaft, equipped with arc column-shape showering handgrip and have the head of tubular structure, be bent the neck of adjutage, the abdomen of arc-shaped support arm and tail portion, tail portion be connecting rod and with refer to circle connection.The binding ligator both can be applied to classical open operation, also can be applied to current most common minimally invasive Laparoscopic operation.Important function is all had for controlling the bleeding of veniplex and reducing sphincter urethrae damage, there is very high clinical value.

Description

The binding ligator of the lower processing prostate dorsal vein clump of laparoscope auxiliary

Technical field

The utility model relates to the technical fields of surgical instrument, in particular to a kind of to handle prostate under laparoscope auxiliary The binding ligator of dorsal vein clump and its application on processing veniplex.

Background technique

Clamping blood vessel and tightening blood vessel is that ongoing two steps of surgical operation can cause bleeding if dealt with improperly. Such as major complications are serious big bleeding in the art of radical prostatectomy or cystectomy art.Prostate is a fiber Flesh sexual gland body, it is flexible, be located at pelvis depths, between neck of urinary bladder and triangular ligament, before be pubic symphysis, behind be rectum. Periprostatic plexus vasculosus is abundant, forms diffused veinlet clump in different alignments in prostate back surface, Referred to as carry on the back Deep venou clump complex.Meanwhile the variation of vein is also very common.It is to go out greatly that deep dorsal vein of penis clump, which is dealt with improperly, The common cause of blood, intraoperative hemorrhage are typically from the damage of back Deep venou clump.

During free prostate gland tip and urethra, if the bleeding of deep dorsal vein of penis clump cannot obtain well Control, it is unclear to often lead to surgical field of view, blindness clamp or sewing hemostasis, coup injury sphincter urethrae and Periurethral group It knits, leads to the postoperative urinary incontinence.Therefore, effective control back Deep venou clump bleeding, is to avoid or mitigate to damage sphincter urethrae etc. The committed step of wound.

For this purpose, medical field has done a large amount of research and practice.Some scholars study discovery: before cutting back Deep venou clump It mainly correctly finds the plane between urethra antetheca and back Deep venou clump, pass through right angle forceps, band knot pricks deep dorsal vein of penis. For this purpose, there is scholar usually to use finger blunt separation.Since the fascia of package back Deep venou clump is often more tough and tensile, keep blunt separation tired Difficulty, it is firmly excessive to be easy to damage sphincter urethrae and Periurethral supporting tissue.When across right angle forceps, if position is to the front, It is easy to pass through between veniplex, puncturing veins appear in Continuous hemorrhage after detachment；If position is to the rear, right angle forceps easy damaged Sphincter urethrae and surrounding supporting tissue.Some scholars do not emphasize the plane between free back Deep venou clump and urethra antetheca, and It is directly to pick up back Deep venou clump with Allis pincers to be tied.In the past once with Allis pincers clamp carry on the back Deep venou clump, but due to Allis pincers are friction clamp, are not suitable for angle and depth after pubis, it is difficult to place.Meanwhile the head end of Allis pincers is small, completely will be difficult The back entire veniplex of Deep venou clump picks up, and can often leak bundle or damage back Deep venou clump.

Even more important phenomenon is to be located at pelvis bosom, operation shadowless lamp light at back Deep venou clump there are one in operation Line is generally difficult to be shining into, the arthroscopic diagnosis especially in small notch, and lower clamp processing and surgical procedure can not be looked at straight by typically resulting in, blind Mesh clamp ties, operation is caused to can not be successfully big bleeding in implementation or art and damage peripheral organs etc..

Therefore, the free of Deep venou clump and safely and effectively ligation cutting are carried on the back, is radical prostatectomy or bladder The important step cut in the art of art entirely and reduce bleeding, smoothly complete operation.Although having done very big improvement on current modus operandi, But the complication of big bleeding and the urinary incontinence is still to carry out the major obstacle of operation.

Utility model content

In order to solve the above-mentioned problems in the prior art, the utility model provides a kind of lower processing of laparoscope auxiliary The binding ligator of prostate dorsal vein clump, including shaft, head, neck, abdomen, tail portion and shaft；Wherein head is arranged There are left handgrip and right handgrip, the handgrip is arc column-shape showering, forms tubular structure when handgrip closes up when left and right；Neck is provided with Curved left adjutage and right adjutage；Abdomen is provided with arc-shaped left support arm and right support arm, when left and right support arm closes When holding together, abdomen is in circle hole shape；Tail portion is provided with left connecting rod and right connecting rod, and connects respectively with left finger circle and right finger circle；Adjutage One end and handgrip column-shape showering in the middle part of connect, the other end is connect with support arm, and support arm is connected with connecting rod.

Further, handgrip, adjutage, support arm, connecting rod and refer to circle composition binding ligator ontology, the first noumenon and Second ontology is assembled into scissor type structure by shaft.

Further, the column-shape showering upper edge of handgrip is equipped with step structure.

Further, silica gel strip is embedded in support arm.

Preferably, the bracket for being also equipped in the shaft of ligator and being used to support laparoscope is bundled.

It further, is detachable connection between shaft and bracket.

Further, refer to and mutually matched lock toothing is set on circle.

The utility model additionally provides the binding ligator and handles application on veniplex in the course of surgery.

The beneficial effects of the utility model are: in general, the binding ligator is will be entire in prostate dorsal surface The surface netted Deep venou Cong Yuqi fascia is tied up together, it can be achieved that entire bundle ties detachment, and operation is almost carried out under direct-view, and Under laparoscope auxiliary, anatomical layer and structure are more clearly seen clearly.Conducive to accurate operation, wound is reduced, and can be in no CO₂Pneumoperitoneum Situation menisectomy, expands operative indication.The binding ligator both can be applied to classical open operation, can also answer For current most common minimally invasive Laparoscopic operation.Clinical application the going out for control dorsal vein clump of the binding ligator Blood and reduction sphincter urethrae damage all have important function, have very high clinical value.Specifically:

1, the binding ligator is to carry on the back Deep venou clump anatomical features according to prostate and design: it, which is located at, is laid in forefront Gland surface mesh structure, tube wall is thin, mutual traffic, rejects Prostatic Surface external fat tissue, it is seen that is covered by thin fascia Deep dorsal vein of penis clump, be triangle.Veniplex binding ligator described in the utility model is will in prostate dorsal surface The entire surface netted Deep venou Cong Yuqi fascia is tied up together, makes rete venosum collection and at a bundle (cylindric), entire bundle ties detachment.

2, after prostate back Deep venou plexus vasculosus is tied up, the dissection of pubis back Deep venou clump, apex of prostate and urethra is closed System will show naturally.Operation is almost carried out under direct-view, and prostate tip and urethra can be easily and safely handled The anatomical structure of surrounding, avoids damage to.

3, the more complete reservation Denonvillier's ligament of energy, since Denonvillier's ligament is for the stabilization of maintenance membranous urethra Property, prevent the postoperative urinary incontinence from playing an important role.Hardly using right angle forceps or Allis pincers processing prostate back Deep venou clump technology It is possible or very difficult.And binding ligator described in the utility model can achieve this purpose.

4, due to using binding ligator described in the utility model and corresponding operation being carried out in Prostatic Surface, without It needs to find urethra antetheca and carries on the back the plane between Deep venou clump, also do not need the sphincter urethrae of dissection free prostate gland tip And its surrounding anatomical structures.To avoid damage to sphincter urethrae equivalent damage.

5, when handling distal side (prostate tip) veniplex, the arc edge that prostate tip is close in front of urethra is placed Veniplex bundlees ligator, is banded in distal side back Deep venou clump after pubis completely in the tubular structure of binding ligator, binding Run through below ligator with 2-0 absorbable suture and is tied.The unique structure design of binding ligator described in the utility model, can be complete Whole, convenient disposal pubis rear vein beard.

6, veniplex binding ligator neck may be designed to various types of curvature, can be according to the practical pelvis situation of patient It is selected.Meanwhile a length of 1.0cm of ligator head end is bundled, internal diameter is the tubular structure of 0.8cm, is suitble to Asian (yellow just Kind of people) back Deep venou clump anatomy length and size, pubis rear vein beard can be tied up wherein completely；It is tight with 2-0 suture needle Inserting needle and needle out can be easier to by pasting smooth pincers wall.

7, it is located at pelvis bosom at this, operation shadowless lamp can not usually be shining into, and cause difficult or not in direct-view menisectomy Energy.A radius, which has also been devised, in the abdomen of binding ligator described in the utility model can be placed in all kinds of abdomens for 2-2.5cm or so The circular hole of hysteroscope can not only import light, and can more clearly see anatomical layer and structure clearly under the amplification under laparoscope, Conducive to accurate operation, wound is reduced, postoperative pain is light, restores the characteristics of minimally invasive laparoscopic surgery such as fast.It simultaneously can be in no CO₂Gas Abdomen situation menisectomy, expands operative indication, and the patient bad for cardio-pulmonary function also can be carried out Minimally Invasive Surgery.

8, laparoscope is placed in the poroid laparoscope rest area of binding ligator abdomen ring (in the area Tuo Jing), not only may be used To guarantee that the light source of laparoscope determines the positive middle part in binding ligator, while laparoscope being made to be always positioned at binding ligator In the poroid area (circle hole shape) Tuo Jing of abdomen ring, avoid the head end of laparoscope when bundling ligator row switching action by handgrip It clamps, and interferes surgical procedure, or even damage laparoscope.

Therefore binding ligator described in the utility model is tied up applied to veniplex, can be effectively controlled pubis rear vein beard Bleeding, satisfactory effect.The safety of operation is not only increased, and structure is simple, it is easy to operate.

Detailed description of the invention

The schematic diagram of Fig. 1 binding ligator.

The schematic diagram of Fig. 2 binding ligator open configuration.

Fig. 3 has the physiological structure figure of veniplex.

Fig. 4 veniplex is tied ligator and uses schematic diagram.

The binding ligator schematic diagram of bracket is installed in Fig. 5-1 support arm, bundlees ligator closure at this time.

The binding ligator schematic diagram of bracket is installed in Fig. 5-2 support arm, ligator is bundled at this time and opens.

Fig. 6-1 is connected with the rotating shaft bracket.

The shaft that Fig. 6-2 is connected with bracket is mounted on binding ligator schematic diagram, bundlees ligator closure at this time.

The shaft that Fig. 6-3 is connected with bracket is mounted on binding ligator schematic diagram, bundlees ligator at this time and opens.

Fig. 7 is enlarged drawing at the A of Fig. 6-3, it is shown that slip area.

Specific embodiment

The binding ligator that prostate dorsal vein clump is handled under laparoscope auxiliary as illustrated in fig. 1 and 2, including successively Head 1, neck 2, abdomen 3 and the tail portion 5 of connection.Wherein head 1 is provided with right handgrip 11 and left handgrip 12, and the handgrip is arc Shape column-shape showering forms head tubular structure when handgrip closes up when left and right.Neck 2 is provided with curved right adjutage 21 and Zuo Yanshen Arm 22.Abdomen 3 is laparoscope rest area.In the design scheme of Fig. 1 and 2, abdomen 3 is provided with arc-shaped 31 He of right support arm Left support arm 32, when left and right, support arm closes up, abdomen is in circle hole shape.Tail portion 5 is provided with right connecting rod 51 and left connecting rod 52, and divides It is not connect with right finger circle 53 and left finger circle 54.It is connect in the middle part of one end of adjutage and handgrip arc column-shape showering, the other end and branch Brace connection, support arm are connected with connecting rod.Handgrip, adjutage, support arm, connecting rod and refer to circle constitute binding ligator sheet Body, the first noumenon (right handgrip, right adjutage, right support arm, right connecting rod and right finger circle) and the second ontology (left handgrip, Zuo Yanshen Arm, left support arm, left connecting rod and left finger enclose) scissors-type is assembled by shaft 4.

As shown in Figures 3 and 4, bundle ligator left and right handgrip can prostate dorsal surface will entire netted Deep venou clump with Its surface fascia is tied up together, and left and right handgrip forms tubular structure when closing up, and makes rete venosum in tubular structure Nei Ji and at one Bundle, veniplex, which is formed, cylindric ties detachment convenient for entire bundle.

Handgrip as shown in Figure 7 is equipped with step structure, the i.e. front-end platform of upper edge in the column-shape showering upper edge of handgrip 13 will be lower than back-end platform 14 in upper edge, to form a knotting slip area 15.The slip area is simultaneously not arranged in handgrip Top, as shown in figure 4, ligature knot when, suture first can be suspended to slip area 15 by operation suture thread 103, followed by into Row slip knots, and operation in this way can make knot get to optimal pelvis distalmost end depths.

There are many models for the curvature of 2 adjutage of neck, can select different model according to the pelvic anatomy form of patient, It is selected during surgery for doctor.

As shown in figure 4, the support arm of binding ligator abdomen forms circle hole shape when closing up, all kinds of laparoscopes 102 can be placed in In the circle hole shape structure.In another improvement project of the support arm as shown in Fig. 6-3, it is inside embedded with elastic device 33, such as Silica gel strip or rubber ring.When support arm closes up, medical silica-gel internal diameter outline is less than the outer diameter of laparoscope, utilizes silica gel strip Elasticity, silica gel strip are squeezed, and so that the bore inner diameter of abdomen is become larger after compressive deformation and laparoscope can be smoothly put into support arm.Together When silica gel strip elasticity squeeze under, laparoscope can be stuck in the circular hole after support arm is filled the span of a man's arms.

Shown in Fig. 1 and 2, as binding ligator the first noumenon and the second ontology open or close up, abdomen is by support arm institute The bore inner diameter of formation can become larger or become smaller, or as the angle of opening is different, bore inner diameter also can be with variation.This may Will lead to the laparoscope being placed in the circular hole to fall, it is therefore desirable to allow binding ligator the first noumenon and the second ontology opening Angle remains unchanged.In surgical procedure, binding ligator can change surgery location, or become opening and closing up in two states Change, original locking state can constantly be broken.Make in surgical procedure, the medical staff of hand steered laparoscope is unable to ensure at hysteroscope In accurate, center, rational position, and operator's smooth operation is interfered, or even laparoscope can be damaged.

In order to ensure that hysteroscope is in accurate, center, rational position during surgery, the binding ligator is devised detachably Laparoscope bracket, so that laparoscope is passed through bracket and it made to be in accurate, rational position always.

It is fixed as shown in Fig. 5-1 to 5-2 in the scheme of laparoscope, the inside of right support arm 31 is hollow groove body 35, bracket 41 one end is fixed on left support arm 32, and the other end is inserted into the hollow groove body of right support arm 31.As shown in fig. 5-1, when When left and right support arm closes up, bracket 41 enters in the hollow groove body 35 of right support arm 31.When support arm opening in left and right is that part is held in the palm Frame 41 skids off groove body along hollow groove body.Due to the cooperation of bracket and hollow groove body, bundle ligator has close ring always Shape laparoscope rest area.With the propulsion of operation, doctor can continuously adjust the position of laparoscope, but since laparoscope is to shelve In laparoscope rest area (in bracket), so that limit it is in binding ligator medium position always, it ensure that laparoscope The accuracy of light source radiating angle.The material of the bracket is rigid, or steel wire or steel bar with certain elasticity.

Another is fixed in the scheme of laparoscope as shown in Fig. 6-1 to 6-3, is bundled and is also installed in the shaft 4 of ligator There is the bracket 41 for being used to support laparoscope.In use, the shaft 4 with bracket is inserted in binding ligator the first noumenon and the In the axis hole 43 of two ontologies, the first noumenon and the second ontology can mutually be opened and closed as scissors.And it is located at the support in shaft Frame is not connected directly with the first noumenon and the second ontology, not will receive position locating for binding ligator the first noumenon and the second ontology The influence set, and remain the intrinsic internal diameter of bracket, therefore laparoscope can be steadily stored in always in the bracket, favorably Successfully carry out in operation smoothness.The length of shaft and the internal diameter of bracket, which can according to need, is arranged the different type of a plurality of sizes Number, operative doctor according to the process selection of actual operation whether mounting bracket, bracket is an apolegamy component, before surgery will bundle The first noumenon and the second ontology and the shaft with bracket for tying up ligator fit together, and are formed scissor.Due to first It is all using shaft as axis rotation when body and the second ontology close up or open each other, and shaft itself not can rotate, this just makes It must bundle in ligator the first noumenon and the second ontology opening or closing course, the bracket being connected in shaft not will receive always It influences, can remain the angle or internal diameter of original position or opening.Bracket may include sizes, according to actual needs It is installed to by shaft on the ontology of binding ligator.

It can be fixedly connected between shaft and bracket and be also possible to detachable connection.Bracket can be the ring of closure or open The ring put.Bracket is made of rigid material.In further design, elastic silica gel or rubber are set in rigid material outer ring Circle is supported with preferably cooperating and stablizing with the laparoscope being put into it using the elasticity of silica gel or rubber ring.

In a specific veniplex binding ligator design scheme, binding ligator is made of stainless steel material, Total length is 27cm, and head is to be about 1.0cm, and internal diameter (D1) is the tubular structure of 0.8cm, and neck portion design is at various types of curved Curvature can be selected according to patient's actual conditions.Abdomen, which devises internal diameter (D2), can be placed in all kinds of abdomens for 2-2.5cm or so The circular hole of hysteroscope can be carried out minimally invasive scope (laparoscope auxiliary) menisectomy or small notch open surgery.Pass through scope or laparoscope Light can not only be imported, and can more clearly see anatomical layer and structure clearly under the amplification under laparoscope, is conducive to precisely behaviour Make, reduce wound, postoperative pain is light, restores the characteristics of minimally invasive laparoscopic surgery such as fast.It simultaneously can be in no CO₂Pneumoperitoneum situation is set about Art expands operative indication, can the patient bad for cardio-pulmonary function also can be carried out Minimally Invasive Surgery.

Clinical application of the binding ligator in radical prostatectomy or underwent radical cystectomy is shown Example.

Preset 18F Foley catheter in urethra, connects sterile urine collection bag empty bladder.Median incision of lower abdomen successively cuts abdomen Wall, abdomen self-retractor appear lacuna after pubis.Reject capsula prostatica external fat tissue, sharp property cuts in pelvic cavity fascia to shame Bone capsular ligament,pelviprostatic lateral margin.Since prostate passivity, sufficiently push away levator ani, appear fascia white on the outside of prostate.At this moment, The visible prostate covered by thin fascia carries on the back Deep venou clump 101, is triangle.Firstly, in nearside (bladder and prostate Migrate portion), ligator, which is bundled, with veniplex close to center fixes.When prostate is larger, in the pelvic cavity of left and right at compartment cut away from From it is roomy when, should fix clamp in the middle part of the prostate.Make nearside back Deep venou clump control in binding ligator, is tied in veniplex It ties up to be run through below ligator with 1-0 absorbable suture and tie.This operation is generally wanted 1-2 times.Then distal side (apex of prostate is carried out Portion) binding ligation fixation.The arc edge for being close to prostate tip in front of urethra places veniplex and bundlees ligator, similarly makes shame Bone rear vein beard is banded in completely in the tubular structure of binding ligator, absorbable with 1-0 below veniplex binding ligator Suture using 15 hanging wire of slip area, is knotted by slip through tying, knot can be beaten in distalmost end.It wouldn't be cut after knotting. After staying one of this line purposes to be turned off pubis rear vein beard, if there is the vein of bleeding, it can use this suture and done again through meeting It pricks.It is appropriate to cut off a part on the outside of ligament if Denonvillier's ligament is wide.This operation will conscientiously carry out 2 times.It is cut with electric knife Veniplex between two bounding wires of disconnected distance up to the white fascia right above prostate, then with gland fascia before scissors arcuately shape and Striated muscle layer in front of urethra, abundant detachment.Up to the junction of prostate tip and urethra.At this point, fully controlled in bleeding In the case of, urethra antetheca and rear wall are cut off as close as possible to prostate tip.Then conventional line radical prostatectomy or inverse Line mode row radical cystectomy.The attention thing of operation includes: 1, in the adipose tissue of Prostatic Surface center, Chang You Superficial vein clump is carried on the back, cutting should be ligatured or directly with ultrasound knife detachment.2, when in prostate tip, veniplex ties up suture, art Person will be easier to from the left side inserting needle of veniplex.3, after veniplex ties up operation, it should before capable of explicitly manifesting very much Relationship between column gland tip form, membranous urethra and dorsal vein clump.4, big bleeding, art nearby occur for cutting dorsal vein clump Person sutures using 2-0 Absorption Line row Z-shaped.5, the case for retaining neurovascular bundle, after first neurovascular bundle should be separated with urethra, Detachment urethra again.

According to radical-ability prostate and cystectomy and normotopia wing after many cases prostate cancer, bladder cancer patients row pubis The statistical result showed of Guang art, it is quiet using veniplex described in the utility model binding ligator control pubis back Deep venou in art Arteries and veins clump, good results.In open operation, the amount of bleeding of processing back Deep venou clump is 30~170ml, average out to 60ml；? When laparoscopy-assisted operation, the amount of bleeding of processing back Deep venou clump is 0~100ml, generally less than 50ml or less.Prostate cancer The urine control at radical cure and new operation on bladder patient's Follow-up After, daytime and night can reach satisfied degree.

Claims (6)

1. the binding ligator of the lower processing prostate dorsal vein clump of laparoscope auxiliary, which is characterized in that including head, neck, Abdomen, tail portion and shaft；Wherein head is provided with left handgrip and right handgrip, and the handgrip is arc column-shape showering, when left and right handgrip Tubular structure is formed when closing up；Neck is provided with curved left adjutage and right adjutage；Abdomen is provided with arc-shaped left branch Brace and right support arm, when left and right, support arm closes up, abdomen is in circle hole shape；Tail portion is provided with left connecting rod and right connecting rod；Extend It is connected in the middle part of one end of arm and the column-shape showering of handgrip, the other end is connect with support arm, and support arm is connected with connecting rod.

2. binding ligator according to claim 1, which is characterized in that the column-shape showering upper edge of handgrip is equipped with ladder-like knot Structure.

3. binding ligator according to claim 1, which is characterized in that be embedded with silica gel strip in support arm.

4. binding ligator according to claim 1, which is characterized in that be also equipped in shaft and be used to support laparoscope Bracket.

5. binding ligator according to claim 4, which is characterized in that be detachable connection between shaft and bracket.

6. binding ligator according to claim 1, which is characterized in that the connecting rod and finger circle connection.