CN217853123U - Outward turning type stitching instrument - Google Patents

Abstract

The utility model provides an outward-turning stitching instrument, which comprises a nail bin mechanism, a nail anvil mechanism, a transmission mechanism and a firing control mechanism, wherein the nail bin cover, the nail bin seat and the nail anvil block are provided with penetrating grooves extending along the length direction of an executing mechanism, and the penetrating grooves form openings at the far ends of the nail bin cover, the nail bin seat and the nail anvil block; guide grooves extending along the length direction of the actuating mechanism are further arranged on the nail bin cover and the nail anvil block on two sides of the penetrating groove; the suturing nails in the nail bin mechanism are arranged on two sides of the penetrating groove in rows and are positioned between the penetrating groove and the guide groove. The utility model discloses set up and penetrated the groove, the identical tissue broken end can be followed the opening and drawn the entering and penetrated the groove, then can turn up the tiling with two broken ends to both sides, and the counterpoint is sewed up again, realizes turning up through the apparatus that the intracavity is sewed up.

Description

Outward turning type stitching instrument

Technical Field

The utility model relates to the field of medical equipment, a ware is sewed up to formula of turning up is related to.

Background

Due to the development of modern science and technology, a cutting anastomat replacing the traditional manual suture is produced; the cutting anastomat has the advantages of rapid and reliable anastomosis, few postoperative complications and the like. The working principle of the stapler is similar to that of a stapler, namely, a process of performing anastomotic cutting on tissues and organs by using titanium nails and a blade respectively. The existing cutting anastomat is mainly used for cutting and anastomosing skin, alimentary canal, blood vessel, lung and the like, and can be suitable for laparoscope and open surgery. The repair and reconstruction of many lumen-like internal structures (such as urinary tract: including urethra, urinary bladder urethra, uretero bladder, ureter; intestine, blood vessel, etc.) currently relies clinically on manual tape-and-wire anastomosis and anastomosis with an intraluminal circular stapler or a plurality of linear cutting staplers.

The current intracavity stitching instrument which is clinically used is mainly suitable for the side stitching of the reconstruction of the alimentary canal, and a plurality of linear cutting stitching instruments or nail bins are required to be used. This type of stitching has at least three drawbacks: (1) The normal anatomical structure of a human body is changed, and the suture joint tissue necrosis, suture fistula and hemorrhage are easy to occur after the operation of the suture joint; (2) After suturing, when the contents in the tube cavity pass through the stoma, a 90-degree steering is formed in the tube cavity, so that the tube cavity is not smooth enough and is easy to cause obstruction; (3) Two or more sutures are required, which greatly increases the cost and difficulty of the operation. In addition, the existing intracavity cutting suturing devices can not be used for suturing small lumens such as biliary tract, fallopian tube, ureter, urethra and the like, or can only perform the function of closed cutting. The problems of the prior art will be described in detail below with reference to the accompanying drawings.

As shown in fig. 1, two sections of a lumen to be sutured are formed in the operation, and the end ends of the lumen are sutured together.

Referring to fig. 2, 3 and 5, a wound A1 is formed in a lumen at the right end, the stapler with the bent end portion in fig. 3 is extended into the lumen, an operating handle of the stapler is located outside the lumen, two broken ends of the lumen are pulled to a position between a circular nail anvil A8 and a circular nail bin A9, a nail pushing seat a11 is pushed to trigger anastomosis nails in a circular nail bin a10, the two broken ends of the lumen are nailed together, and redundant tissues are cut off by an annular blade A9, so that a circle of tissue A2 of the lumen which is subjected to the enstrophe suture is formed in fig. 2. The stapler is then removed from the lumen through the incision A1 and the incision A1 is closed using the stapler of fig. 5. This type of stitching has at least three drawbacks: (1) By adopting the inversion type anastomosis, the inversion suture lumen tissue A2 protruding out of the inner wall of the lumen is formed in the lumen, and a plurality of complications such as stenosis, obstruction and the like are easily caused after the operation. (2) A wound A1 needs to be opened on the lumen and needs to be anastomosed again, which is caused by the need of additional opening for operation, thus increasing the difficulty of the operation and causing unnecessary pain to the patient. (3) The use of multiple staplers greatly increases the cost of the procedure.

Referring to fig. 4 and 5, a second anastomosis method is to pull the lumen at the right end in fig. 1, place the two broken ends side by side, so that the outer walls of the two lumens are attached together, then use the linear anastomat shown in fig. 5 to anastomose the sides of the lumens attached together, that is, place the two lumen walls attached together between a nail bin A6 and a nail anvil A7, fire the anastomosis nail in the nail bin A6 to anastomose the lumen walls of the two lumens together, then open a stoma A3 at the anastomosed position, and finally anastomose the end portions of the two lumens by using the linear anastomat shown in fig. 5. The stoma A3 becomes a communicating port of two sections of tube cavities. This type of anastomosis has at least three drawbacks: (1) Because the original trend of one section of the tube cavity needs to be changed, the tube cavity is pulled by external force, and the mode can cause damage to the tube cavity. (2) After anastomosis, the flowing contents in the lumen move through the stoma A3, a 90-degree turn is formed in the lumen, the flow is not smooth enough, and the blockage is easy. (3) Two or more anastomoses are required, greatly increasing the cost and difficulty of the operation.

Fig. 6 shows an outward-turning type suture mode, two broken ends are turned outwards, and a circle of outward-turning suture lumen tissue A5 is formed after the suture mode. However, in the current operation, the method is limited to manual suture, and a anastomat cannot be used. As can be explained by referring to fig. 3, if the broken ends of the two sections of lumens are respectively everted on the circular anvil A8 and the circular nail bin A10 and then sutured, there is no way to take down the stapler from the sutured lumen after suturing. In order to realize the outward turning type anastomosis of the anastomat, the invention patent with the application number of 201510282427X provides an extraluminal anastomosis method, and after a lumen is sutured, a scissors is used for cutting off the annular structures of a nail bin and a base, so that the nail bin and the base are removed. However, this method is only an idea and does not give detailed structural features, which cannot be clinically applied for at least four reasons: (1) The operating space is very small and it is difficult to cut the ring-shaped structure by inserting a pair of scissors between the tissue and the anastomotic ring after the suture. (2) When the scissors are used for shearing off the annular structure, external force needs to be applied, secondary damage can be caused to the lumen tissue if the scissors are not operated properly, and even the lumen is cut off. (3) The materials that scissors are prone to shearing damage are necessarily not rigid enough to create sufficient anastomotic traction force and are destructive to surgical scissors. (4) The anastomosis mode that the nail anvil ring is pulled to extrude the anastomosis nail towards the near end is adopted, and because the distal end can not be peened in the operation, the organ of the tissue is easy to tear.

The inventor provides an outward turning type suture scheme for tissue cavity external anastomosis in the invention application with the application number of 202110022419.7 and the name of 'an anastomat', the outward turning type suture mode is that two ends needing to be sutured are turned outwards and then sutured outside as the name suggests, the operation mode is only limited to suture with a thread in an operation of an operator at present, no related suture device is available clinically, and no intra-cavity outward turning type suture device is suitable for intra-cavity minimally invasive suture. The relative eversion stitching instrument applied by the applicant in the earlier period cannot enter a human body through a minimally invasive channel such as a sheath clamp due to overlarge volume of an inserting part, and is difficult to be suitable for laparoscopic and other intracavity minimally invasive operations.

Disclosure of Invention

The utility model aims to provide an outward turning type stitching instrument, which can carry out outward turning type stitching such as intracavity end-end, end-side, side-side and the like in a human body through microchannels such as sheath clamps and the like.

The utility model provides an outward turning stitching instrument, which comprises a nail bin mechanism, a nail anvil mechanism, a transmission mechanism and a percussion control mechanism; an elastic piece is arranged at the joint of the nail anvil mechanism and the near end of the nail bin mechanism, and the nail bin mechanism and the nail anvil mechanism are urged to be in an opening state by the elastic piece; the nail bin mechanism comprises a nail bin cover and a nail bin seat, a nail pushing mechanism is arranged in a space between the nail bin cover and the nail bin seat, and the nail anvil mechanism comprises a nail anvil block; the transmission mechanism is arranged in the sleeve and comprises a transmission mechanism elastic sheet A and a transmission mechanism elastic sheet B; the transmission mechanism is connected with a propelling rod of the firing control mechanism;

the nail bin cover, the nail bin seat and the nail anvil block are provided with penetrating grooves extending along the length direction of the actuating mechanism, and openings are formed at the far ends of the nail bin cover, the nail bin seat and the nail anvil block by the penetrating grooves; on both sides of the penetrating groove, the nail bin cover and the nail anvil block are also provided with guide grooves extending along the length direction of the actuating mechanism; the stitching nails in the nail bin mechanism are arranged on two sides of the penetrating groove in rows and are positioned between the penetrating groove and the guide groove;

the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B extend into a space between the nail bin cover and the nail bin seat and are connected with the nail pushing mechanism, the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B move along the guide grooves on the nail bin cover and the nail anvil seat, and the nail bin is low in near end and high in far end, so that the nail bin mechanism and the nail anvil mechanism are closed when the nail bin moves to the far end.

The important invention of the utility model lies in breaking through the design structure of the conventional linear suturing device, dividing the nail bin mechanism and the nail anvil mechanism into two parts, and arranging the penetrating groove in the middle part, thereby being capable of respectively drawing and penetrating the two intestinal broken ends from the penetrating groove of the nail bin mechanism and the penetrating groove of the nail anvil mechanism, then outwards turning over the broken ends of the tissue to be sutured, realizing end suturing, and moving out from the penetrating groove after sewing, so that the linear suturing device can also perform outward turning-over suturing. The utility model discloses a scheme design is exquisite, only needs to change the linear type stitching instrument of conventionality, can realize turning up and sew up.

Preferably, the guide groove comprises a first guide section at the proximal end, a second guide section at the distal end and a connecting section connecting the first guide section and the second guide section, wherein the distance between the two first guide sections is smaller than the distance between the two second guide sections. At the near end, the transmission mechanism elastic piece A and the transmission mechanism elastic piece B are closer to each other, after the transmission mechanism elastic piece A and the transmission mechanism elastic piece B move towards the far end, the transmission mechanism elastic piece A and the transmission mechanism elastic piece B are far away from each other by utilizing the deformation capacity of the transmission elastic pieces, and the interference on the sewing nail and the like is avoided by the design mode of the second guide section.

Preferably, the proximal end of the penetrating groove of the nail bin seat is provided with a suturing nail, so that the two sides of the penetrating groove and the tissues to be sutured at the proximal end can be sutured, the sutured intestinal tissue is moved out of the penetrating groove, and then the intestinal tissue which is initially positioned at the distal end of the penetrating groove is sutured manually to complete the overall suturing.

Preferably, the staples at both sides and the proximal end of the penetrating slot are formed in a U-shape or a V-shape.

Preferably, the distal ends of the transmission mechanism elastic sheet a and the transmission mechanism elastic sheet B are respectively connected with a sliding limiting block a and a sliding limiting block B with i-shaped cross sections, the upper ends and the lower ends of the sliding limiting block a and the sliding limiting block B are respectively inserted into the guide grooves on the nail bin cover and the nail anvil seat, the top ends and the bottom ends of the i-shapes are respectively exposed out of the guide grooves on the nail bin cover and the nail anvil seat, and the i-shaped structure can ensure that the nail bin mechanism and the nail anvil mechanism are stably closed.

Preferably, the near end of the nail pushing mechanism is provided with two connecting grooves, and connecting columns of the vertical parts of the sliding limiting block A and the sliding limiting block B can be inserted into the connecting grooves, so that the driving mechanism elastic sheet A and the driving mechanism elastic sheet B can be detachably connected with the nail pushing mechanism. And moving the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B towards the far end, inserting the connecting column into the connecting groove, moving the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B towards the near end, and separating the connecting column from the connecting groove.

Preferably, the lower ends of the connecting columns of the vertical parts of the sliding limiting block A and the sliding limiting block B are provided with cutting blades, and redundant tissues are cut off by the cutting blades.

If the width of the nail bin cover and the width of the nail anvil block are relatively wide and the width of the nail bin seat is relatively narrow, the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B are respectively arranged at two sides of the nail bin seat and cannot interfere with the nail bin seat during movement, otherwise, a guide groove extending along the length direction of the actuating mechanism needs to be arranged on the nail bin seat.

Preferably, the openings of the nail bin cover, the nail bin seat and the nail anvil block are flaring openings with wide outer parts and narrow inner parts, and the structure is convenient for penetrating the tissue of the broken end to be sutured into the penetrating groove.

Preferably, the bottom of the nail anvil block is provided with a supporting plate, the supporting plate is also provided with a penetrating groove extending along the length direction of the actuating mechanism, and the near end of the supporting plate is provided with a protective plate.

The utility model provides a brand-new intracavity turns up actuating mechanism for stitching instrument, the advantage as follows: (1) The structure can realize the intracavity eversion suture through minimally invasive surgery channels such as a sheath clamp and the like, is a powerful supplement to the open eversion suture, has completely different mechanism action principles although the eversion suture, and adapts to the requirements of clinical minimally invasive surgery; (2) The tissue and organ (such as blood vessel, urinary tract, etc.) which must be sewed by the outward turning of the suture line during the prior minimally invasive operation is sewed with a new choice, thereby greatly simplifying the operation difficulty and improving the sewing success rate; (3) The reconstruction target can be basically realized by one-time stitching, and compared with the condition that a plurality of stitching nails are used when a plurality of stitching nails are needed in the past, the operation steps and the operation cost are saved; (4) The outward turning type suturing of the inner end, the end and the side of the cavity, and the like can be realized, and the suturing scene is widely applicable; (5) Different from the traditional cutting suturing device, the suture instrument can be directly butted and sutured without changing the anatomical structure and continuity of tissues and organs or destroying the peristalsis function of hollow viscera and the like, is beneficial to the retention and recovery of the functions of the viscera of a patient after operation, and greatly reduces the occurrence of related complications; (6) The suturing nail is externally arranged and is positioned outside the cavity after being sutured, so that complications related to the suturing nail, such as narrow suturing opening, bleeding related to the suturing nail, calculus and thrombosis and the like, are reduced.

Drawings

FIG. 1 is a schematic view of two sections of a lumen to be anastomosed;

FIG. 2 is a schematic view of an inverted anastomosis;

FIG. 3 is a schematic view of an inverted anastomosis stapler;

FIG. 4 is a schematic view of a second lumen anastomosis;

FIG. 5 is a schematic view of a stapler for external anastomosis;

FIG. 6 is a schematic diagram of eversion anastomosis;

FIG. 7 is a schematic view of a typical firing control mechanism for a linear cutting stapler;

fig. 8 is a schematic view of an actuator according to the present invention;

FIG. 9 is a schematic view of the suture instrument of the present invention passing through a minimally invasive pathway;

fig. 10 is an exploded view of the actuator of the present invention;

FIG. 11 is a schematic view of the transmission mechanism and the steering mechanism of the present invention;

FIG. 12 is a schematic view of the nail anvil of the present invention;

FIG. 13 is a schematic view of the nail cartridge mechanism (including the open elastic sheet, the metal groove, the suturing nail, the nail snap, etc.) according to the present invention;

fig. 14 is a schematic view of the transmission mechanism and the nail pushing mechanism of the present invention.

In the figure; 1-trigger control mechanism, 101-trigger, 102-ratchet bar, 103-propulsion bar, 104-reset button, 105-direction adjusting button, 106-steering propulsion bar, 107-trigger safety;

2-cannula, 201-upper half-tube, 202-lower half-tube;

3-a stopper, 301-a stopper A, 302-a stopper B;

4-steering mechanism, 401-sheet metal lever, 402-hook-like projection;

5-transmission mechanism, 501-connecting part, 5031-transmission mechanism elastic sheet a, 5032-transmission mechanism elastic sheet B, 5041-sliding limiting block a, 5042-sliding limiting block B, 5045-connecting column, 5046-cutting blade;

6-a nail bin mechanism, 601-a connecting joint, 602-a first nail bin guiding section, 603-an anchoring mechanism, 604-an opening elastic sheet, 605-a nail bin cover penetrating groove, 606-a nail bin seat, 607-a second nail bin guiding section, 608-a nail bin scale mark, 609-a nail hole, 610-a suturing nail, 611-a nail press, 612-a proximal platform, 613-a nail bin cover flaring opening and 614-a nail bin connecting section; 615-flaring of a nail bin seat, 616-penetrating of the nail bin seat into a groove and 617-covering of the nail bin;

7-anvil mechanism, 701-staple forming pit, 702-guard plate, 703-anvil connecting section, 704-first anvil guiding section, 705-anvil through slot, 706-second anvil guiding section, 707-anvil flaring, 708-pallet, 709-pallet through slot, 710-staple anvil;

8-a nail pushing mechanism, 801-a connecting groove and 802-a nail pushing bulge; 9-sheath clamp.

Detailed Description

The technical solution of the present invention is explained in detail below with reference to fig. 7 to 14.

For clarity of description, directional terminology we use in the drawings and the following description is relative to the operator's right hand holding the stapler handle horizontally, i.e., the fixed handle is in the right web and the remaining four fingers except the thumb hold the movable handle. Specifically, the terms "proximal" and "rear" refer to a location near the operator, while the terms "distal" and "forward" refer to a location away from the operator. The term "left" refers to the left side of the operator, while the term "right" refers to the right side of the operator; "upper" refers to the direction opposite to gravity and "lower" refers to the direction of gravity. Other directional terminology may be understood from the accompanying drawings and the description below.

The utility model provides an actuating mechanism needs to be connected the use with traditional linear type cutting stitching instrument percussion control mechanism, as shown in fig. 7, percussion control mechanism includes trigger 101, ratchet 102, impulse lever 103, reset button 104, direction adjustment button 105, turns to impulse lever 106, percussion insurance 107. The traditional linear cutting stapler can refer to CN101156793A, US5762256B, and specifically describes the structure of the firing control mechanism, which is not described in detail in this application. The actuating mechanism is usually a disposable loading part, is discarded after being used up, and the firing control mechanism can be reused for many times and can be matched with the actuating mechanism of the traditional linear cutting anastomat. The disposable loading unit may also be integrated with the firing control mechanism as a single disposable unit.

The utility model provides an actuating mechanism, on the whole, similar with traditional linear type stitching instrument. Comprises a nail bin mechanism 6, a nail anvil mechanism 7, a transmission mechanism 5 and a steering mechanism 4.

As shown in fig. 11, the steering mechanism 4 includes a sheet metal lever 401, a proximal end of which is provided with a hook-like projection 402. As shown in fig. 11 and 14, the transmission mechanism 5 includes a transmission mechanism elastic sheet a5031, a transmission mechanism elastic sheet B5032, a sliding stopper a5041 and a sliding stopper B5042. The transmission mechanism elastic sheet (A, B) can be made of elastic material or non-elastic material as long as a certain deformation can be generated. The transmission mechanism elastic sheet A is connected with the sliding limiting block A, and the transmission mechanism elastic sheet B is connected with the sliding limiting block B. The sliding limiting block A and the sliding limiting block B are of I-shaped structures, and a cutting blade 5046 is arranged on the lower portion of a connecting column 5045 in the middle of each I-shaped structure. Two connecting grooves 801 are formed in the near end of the nail pushing mechanism 8, connecting columns of the transmission mechanism elastic pieces A, B can be inserted into one of the connecting grooves 801 respectively, and a pushing protrusion 802 is arranged at the bottom of the nail pushing mechanism 8.

As shown in fig. 8 and 10, the steering mechanism 4 and the transmission mechanism 5 are mounted in the casing 2. For easy to assemble, set up first half pipe 201, second half pipe 202, set up drive mechanism shell fragment A, drive mechanism shell fragment B in the groove of second half pipe, with first half pipe and second half pipe amalgamation again, both easy to assemble play the guide effect again. In addition, an anchoring mechanism 603 can be arranged at the far end, and the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B penetrate through the anchoring mechanism 603 to play a role in guiding. The transmission mechanism 4 is arranged on the side part of the split upper and lower half pipes and then is integrally placed in the sleeve 2. The proximal end of the lower half pipe is provided with a limiting block 3 which comprises a limiting block A301 and a limiting block B302.

As shown in fig. 7, 8 and 9, one side of the proximal end of the executing mechanism is folded with the firing control mechanism 1 of the linear cutting and suturing device, then inserted into the firing control mechanism 1, and rotated 90 degrees, and the limiting block a 301 and the limiting block B302 are inserted into corresponding holes on the firing control mechanism 1, so as to complete the butt joint of the two; at this time, the distal end of the pushing rod 103 of the firing control mechanism 1 is positioned in the proximal connecting part 501 of the transmission mechanism 5 and engaged with the same, and the hook-shaped protrusion 402 at the proximal end of the steering mechanism 4 is positioned in the groove of the steering pushing rod 106, and the two are fixedly connected.

As shown in fig. 8, 10 and 13, the cartridge mechanism 6 includes a cartridge cover 617 and a cartridge holder 606. Cartridge holder 606 defines staple holes 609, staples 610 are received in staple holes 609, and staples 611 are positioned above staples 610 and press staples 611 downward, and staples 610 are fired by staples 611 toward anvil mechanism 7. The staple cartridge cover 617 covers the staple cartridge seat 606, and a space for the staple pushing mechanism 8 is accommodated between the staple cartridge cover 617 and the staple cartridge seat 606, so that the staple pushing mechanism 8 can move from the proximal end to the distal end of the actuator. The side of the cartridge cap 617 is provided with cartridge graduation marks 608 for indicating the position of the staple holes and preventing tissue displacement. The utility model discloses set up nail storehouse lid penetrating groove 605 and nail storehouse lid guide way in the centre of nail storehouse lid, nail storehouse lid penetrating groove, nail storehouse lid guide way all extend to the near-end from the distal end along actuating mechanism length direction. The nail bin cover penetrating groove is provided with an opening at the far end of the nail bin cover, and the opening is a nail bin cover flaring port 613 with a wide outer part and a narrow inner part. The nail bin cover guide grooves are two, the nail bin covers are arranged on two sides of the nail bin cover penetrating groove 605 in a split mode and comprise a nail bin first guide section 602, a nail bin connecting end 614 and a nail bin second guide section 607, the distance between the two nail bin first guide sections 602 is smaller than the distance between the two nail bin second guide sections 607, and the nail bin connecting section 614 is connected with the nail bin first guide sections 602 and the nail bin second guide sections 607 to form transition. The nail cabin seat 606 is also provided with a nail cabin seat penetrating groove 616 correspondingly extending along the length direction of the actuating mechanism and corresponding to the nail cabin cover penetrating groove 605, and the nail cabin seat penetrating groove 616 is provided with an opening at the far end of the nail cabin seat, and the opening is a nail cabin seat flaring 615 with wide outside and narrow inside. Two sides of the nail bin seat penetrating groove are respectively provided with one row or a plurality of rows of stitching nails. The proximal end of the cartridge holder through slot 616 may also be provided with staples which converge inwardly, which intersect as far as possible at the proximal end of the slot, the staples on both sides and at the ends forming a V-shape or U-shape.

As shown in fig. 8, 10 and 12, the anvil mechanism 7 includes an anvil 710, the anvil 710 is provided with an anvil inserting slot 705 extending along the length direction of the actuator and corresponding to the cartridge seat inserting slot 616, and the anvil inserting slot 705 forms an opening at the distal end of the anvil 710, which is an anvil flare 707 with a wide outer part and a narrow inner part. The two sides of the anvil insertion slot 705 are provided with anvil guide slots extending along the length direction of the actuator, each anvil guide slot comprises an anvil first guide section 704, an anvil second guide section 706 and an anvil connecting section 703, wherein the distance between the two anvil first guide sections 704 is smaller than the distance between the two anvil second guide sections 706, and the anvil connecting section 703 is connected with the anvil first guide section 704 and the anvil second guide section 706 to form a transition. A supporting plate 708 is arranged at the bottom of the anvil seat 710, a supporting plate penetrating groove 709 extending along the length direction of the actuating mechanism is arranged on the supporting plate 708, and an opening is formed in the distal end of the supporting plate 708 by the supporting plate penetrating groove 709. The proximal end of the supporting plate 708 is provided with a guard plate 702, and with reference to fig. 8, after the nail cartridge mechanism is connected with the nail anvil mechanism, the guard plate 702 plays a role in preventing left and right deviation from both sides. Between the anvil guide slot and the anvil penetration slot, the anvil seat 710 is further provided with a staple forming pocket 701 matched with a staple.

Referring to fig. 8 and 10, the staple cartridge mechanism 6 is connected to the proximal end of the anvil mechanism 7, and an opening spring 604 is disposed between the staple cartridge mechanism and the anvil mechanism 7, so that the opening spring 604 keeps the staple cartridge mechanism and the anvil mechanism separated from each other without external force, except for the portion where the proximal ends are connected together. The near end of the nail bin mechanism and the nail anvil mechanism are connected with the far end of a sheet metal rod 401 of the steering mechanism 4 through a connecting joint 6, and the sheet metal rod 401 can drive the nail bin mechanism 6 and the nail anvil mechanism 7 to swing. The transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B penetrate through the connecting joint 601 and can move in a space between a nail bin cover and a nail bin seat of the nail bin mechanism 6 under the driving of a pushing rod 103 of the firing control mechanism. The sliding limiting block A5041 and the sliding limiting block B5042 respectively penetrate through the nail bin cover guide groove and the nail anvil guide groove on one side of the nail bin cover guide groove and the nail anvil guide groove to play a role in guiding. The sliding limiting block A5041 and the sliding limiting block B5042 are in I-shaped structures, and the upper end and the lower end of the sliding limiting block A5041 are respectively positioned at the upper part of the nail bin cover and the bottom of the nail anvil block, so that the sliding limiting block A and the sliding limiting block B5042 are prevented from falling off from the guide groove in the moving process. The staple cartridge seat 606 may also need to be provided with a guide groove as the staple cartridge cover for the sliding stopper A, B to pass through, and it is not necessary to provide a guide groove if the sliding stopper A, B is specifically provided or not, and the width of the staple anvil block is determined, that is, the sliding stopper can pass through the side surface of the staple cartridge seat.

The protruding 802's of the nail that pushes away of nail mechanism 8 quantity is decided according to the row number of sewing the nail, for example, the both sides of wearing the groove respectively set up one row of sewing nail, then nail mechanism 8 sets up two nail that push away protruding can, if set up the multirow, then set up a plurality of nail that push away archs. The nail pushing bulge is provided with an inclined plane, the inclined angle is the same as the nail pressing angle, and the direction is opposite. The suturing nail is gathered inwards when the nail bin base penetrates through the near end of the groove.

The following describes the usage of the present invention in detail.

As shown in fig. 8 and 9, in a resting state, the nail magazine mechanism 6 and the nail anvil mechanism 7 are in a separated state due to the action of the opening elastic sheet 604, the transmission mechanism elastic sheet a5031, the transmission mechanism elastic sheet B5032, the sliding limit block a5041 and the sliding limit block B5042 are positioned at the proximal end of the stapler, at this time, the sliding limit block a5041 and the sliding limit block B5042 are positioned at the proximal end platform 612 of the nail magazine metal groove 605 and are abutted against the connecting joint 601, the sliding limit block A, B extrudes the nail magazine cover guide groove, and the opening angles of the nail magazine mechanism and the nail anvil mechanism are prevented from being too large; a staple pushing and cutting mechanism 8 is located at a proximal end of cartridge mechanism 6, distal to staples 610 and staple pushers 611.

When the operator pulls the trigger 101 to squeeze the ratchet bar 102, the pushing rod 103 is pushed to move to the far end, and the pushing rod 103 is respectively linked with the transmission mechanism shrapnel A5031 and the transmission mechanism shrapnel B5032 to move to the far end through the connecting part 501; at this point, the slide stop a5041 and slide stop B5042 move distally along the guide channel until they move entirely out of the proximal platform 612; due to the cooperative locking effect of the I-shaped structures of the sliding stopper A5041 and the sliding stopper B5042, the nail bin mechanism 6 is squeezed to be close to the anvil mechanism 7, and the opening elastic sheet 604 is compressed until the nail bin mechanism 6 and the anvil mechanism 7 are closed. As shown in FIG. 9, at this time, the operator can insert the head of the suturing device into the patient through a minimally invasive channel such as a laparoscope sheath clamp 9 and prepare for suturing; FIG. 9 is a view of the actuator after it has been passed through the sheath clamp, with the cartridge mechanism and anvil mechanism closed as they are being passed through the sheath clamp.

Taking the end stitching of the intestinal canal in the cavity as an example, the utility model can be used for stitching the intestinal canal but not only, and all hollow organs which can be turned up and stitched can be used for the utility model; can be but not limited to sewing in the cavity, and can also be suitable for the utility model by sewing outside the cavity; the present invention can be applied not only to end-to-end stitching but also to stitching scenes such as end-to-end stitching and side-to-side stitching.

The operator adjusts the two broken end intestines to an appropriate anatomical position with the assistance of the assistant, and sews one to two drawing lines on the side of the operator corresponding to the two broken end intestines to be sewed. The reset button 104 of the firing control mechanism of the back-pull stitching instrument is linked with the push rod 103 to move towards the near end, the push rod 103 is linked with the transmission mechanism elastic sheet A5031, the transmission mechanism elastic sheet B5032, the sliding limiting block A5041 and the sliding limiting block B5042 to move towards the near end through the connecting part 501, when the sliding limiting block A5041 and the sliding limiting block B5042 are shifted to the metal groove near-end platform 612 again, the pressure on the two sides of the nail bin 6 and the nail anvil 7 is quickly partially relieved, the opening elastic sheet 604 resets, and the nail bin mechanism 6 and the nail anvil mechanism 7 are separated again to the initial state.

As shown in fig. 7, 8 and 9, the direction adjusting button 105 on the firing control mechanism 1 of the stapler is rotated to drive the steering pushing rod 103 to drive the steering mechanism 4 to move back and forth, and further to push the connecting joint 601, the nail bin 6 mechanism and the nail anvil mechanism 7 to swing, so as to adjust the direction, and as the directions of the nail bin mechanism 6 and the nail anvil mechanism 7 are changed, the transmission mechanism elastic sheet a5031 and the transmission mechanism elastic sheet B5032 are bent left and right. At this time, the cross sections of the two broken ends of the intestinal tract are required to be kept parallel to the nail bin mechanism and the nail anvil mechanism 6 and 7 as much as possible, and the direction adjusting button 105 is required to be fixed. And pulling the intestinal tract traction line, when the diameters of the whole of the nail bin mechanism 6 and the nail anvil mechanism 7 are consistent with the section diameters of the intestinal tracts at the broken ends, penetrating the intestinal tracts at the broken ends at one side from the openings at the far ends of the nail bin penetrating grooves (the nail bin cover penetrating groove 605 and the nail bin base penetrating groove 616) and pulling the intestinal tracts towards the near ends until the intestinal tracts reach the near ends of the nail bin penetrating grooves (the nail bin cover penetrating groove 605 and the nail bin base penetrating groove 616), and paying attention to ensure that the openings of the intestinal tracts at the broken ends are exposed out of the bottom surface of the nail bin base 606 to be high enough. Similarly, the broken end intestinal canal on the other side is pulled to be penetrated by the nail anvil mechanism 7. Turning the intestinal tract exposed out of the bottom surface of the staple cartridge seat 606 outwards, covering the staple holes on the two sides of the bottom surface of the staple cartridge seat 606 and extending out of the moving path of the sliding stopper A, B, turning the intestinal tract exposed out of the surface of the staple anvil 710 outwards, covering the staple forming pit and extending out of the moving path of the sliding stopper A, B, and particularly paying attention to the fact that the proximal end and the distal end of the intestinal tract section are required to be located within the scale mark 608 of the staple cartridge. The operator pulls the trigger 101, squeezes the ratchet bar 102 to push the push rod 103 to move towards the far end, the push rod 103 is linked with the transmission mechanism elastic sheet A5031, the transmission mechanism elastic sheet B5032, the sliding limiting block A5041 and the sliding limiting block B5042 to move towards the far end through the connecting part 501, the nail bin mechanism 6 and the nail anvil mechanism 7 are locked and closed again, the guard plate 702 can ensure that the nail bin mechanism 6 and the nail anvil mechanism 7 are closed in an aligned mode, the operator can observe whether the everted intestinal tract completely covers the nail bin mechanism 6 and the nail anvil mechanism 7 at the moment, and observe whether the intestinal tract at the closed part moves forwards and backwards and exceeds the nail bin scale line 608. If the intestinal tract is not completely covered by the everted intestinal tract or the two ends of the intestinal tract protrude out of the scale marks 608 of the nail bin, the nail bin mechanism 6 needs to be opened again at the moment, the broken end intestinal tract to be sutured is adjusted to the proper position, and the nail bin mechanism 6 is closed again to be sutured.

An operator unlocks a firing safety 107 on the firing control mechanism 1, pulls a trigger 101, extrudes a ratchet bar 102 to push a push rod 103 to move towards the far end, the push rod 103 is linked with a transmission mechanism elastic sheet A5031, a transmission mechanism elastic sheet B5032, a sliding limiting block A5041 and a sliding limiting block B5042 to move towards the far end through a connecting part 501, and the transmission mechanism elastic sheet A5031 and the transmission mechanism elastic sheet B5032 continuously and respectively slide forwards under the action of first guiding sections (a nail bin first guiding section 602 and a nail anvil first guiding section 704). When the connecting column 5045 of the sliding limiting block is contacted with the nail pushing mechanism 8, the connecting column 5045 and the nail pushing mechanism are meshed through the connecting groove 801; the actuator spring segment A5031 and the actuator spring segment B5032 push the nail pushing mechanism 8 to move distally, and when the proximal ends of the nail holes 609 and the nail press studs 611 are reached, the nail pushing protrusions 802 at the distal end of the nail pushing mechanism 8 are engaged with the nail press studs 611 and push the nail press studs 611 and the stitching nails 610 to longitudinally displace along the direction of the nail holes 609 toward the direction of the nail anvil 710. Staples 610 penetrate the tissue of the intestine at a rapid rate and assume a "B" shape or wrap around as the ends of the pocket are crimped inward as staples 610 contact staple forming pockets 701 on the surface of staple anvil 710. Continuously firing the trigger 101, pushing the nail pushing mechanism 8 to move to the far end, and sequentially sewing the sewing nails 610 to the far end; at this time, the cutting blade 5046 is pushed by the pushing force to advance distally along the peripheral track of the cartridge mechanism 6 and cut off the excess intestinal tissue outside the staples 610.

The suturing device is retreated along the diameter direction of the section of the sutured intestinal tract, the suturing device is retreated from the operation area, the nail bin mechanism 6 and the nail anvil mechanism 7 are closed again, and the suturing device is retreated out of the body of the patient along the minimally invasive channels such as the sheath clamps. Observing the nailing condition of the suturing nail and the cutting condition of the intestinal residual end tissue, and manually suturing and supplementing the needle if the suturing nail is not firm or jumps; meanwhile, two ends of the section diameter of the intestinal tract are turned over to the intestinal tract at the line position, residual redundant tissues are cut off by scissors, the stitching device is used for stitching the stitching vacant position with a needle, the whole intestinal cavity is closed, and the continuity of the intestinal tract is recovered; and (5) finishing the operation. It should be noted that there is no suturing nail at the opening of the nail bin cover and the opening of the nail anvil seat, and after suturing with the suturing instrument, the suturing nail needs to be sutured manually. If no staples are provided at the proximal end of the guide channel, manual stapling is required at that location, accordingly. With reference to fig. 8, the present invention lays the two intestinal tract broken ends on the upper surface of the nail anvil seat and the lower surface of the nail bin seat respectively to form an oval shape, and then squeezes the suturing nail to suture the edges of the two sides of the oval long axis, and of course, also can suture the edges of the near end of the long axis (placing the suturing nail at the position) synchronously, because the far end of the long axis is difficult to place the suturing nail, the long axis needs manual needle sewing. Although a small part of the head end needs a manual sewing needle, the utility model discloses still solved the intracavity formula of turning up to a great extent and sewed up the problem, realize the instrumentization operation, have very wide market prospect.

Various modifications to the present embodiments will be readily apparent to those skilled in the art, and modifications and variations can be made without departing from the spirit and scope of the embodiments without departing from the scope of the invention as defined in the appended claims.

Claims (10)

1. An outward turning type stitching instrument comprises a nail bin mechanism, a nail anvil mechanism, a transmission mechanism and a firing control mechanism; the joint of the near ends of the nail anvil mechanism and the nail bin mechanism is provided with an elastic piece which drives the nail bin mechanism and the nail anvil mechanism to be in an opening state; the nail bin mechanism comprises a nail bin cover and a nail bin seat, a nail pushing mechanism is arranged in a space between the nail bin cover and the nail bin seat, and the nail anvil mechanism comprises a nail anvil block; the transmission mechanism is arranged in the sleeve and comprises a transmission mechanism elastic sheet A and a transmission mechanism elastic sheet B; the transmission mechanism is connected with a propelling rod of the firing control mechanism;

the method is characterized in that: the nail bin cover, the nail bin seat and the nail anvil block are provided with penetrating grooves extending along the length direction of the actuating mechanism, and the penetrating grooves form openings at the far ends of the nail bin cover, the nail bin seat and the nail anvil block; guide grooves extending along the length direction of the actuating mechanism are further arranged on the nail bin cover and the nail anvil block on two sides of the penetrating groove; the suturing nails in the nail bin mechanism are arranged on two sides of the penetrating groove in rows and are positioned between the penetrating groove and the guide groove;

the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B extend into a space between the nail bin cover and the nail bin base and are connected with the nail pushing mechanism, the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B move along the guide grooves on the nail bin cover and the nail anvil base, and when the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B move, the nail bin mechanism and the nail anvil mechanism are closed.

2. The everting stapler of claim 1, wherein: the guide groove comprises a first guide section at the near end, a second guide section at the far end and a connecting section for connecting the first guide section and the second guide section, wherein the distance between the two first guide sections is smaller than the distance between the two second guide sections.

3. The everting stapler of claim 1, wherein: and a suturing nail is arranged at the near end of the penetrating groove of the nail cartridge seat.

4. The everting stapler of claim 3, wherein: the stitching nails positioned at the two sides and the near end of the penetrating groove form a U shape or a V shape.

5. The everting stapler of claim 1, 2, 3, or 4, wherein: the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B are respectively connected with a sliding limiting block A and a sliding limiting block B with I-shaped sections, the upper ends and the lower ends of the sliding limiting block A and the sliding limiting block B are respectively inserted into the guide grooves on the nail bin cover and the nail anvil seat, and the top end and the bottom end of the I shape are respectively exposed out of the guide grooves on the nail bin cover and the nail anvil seat.

6. The everting stapler of claim 5, wherein: the near-end of the nail pushing mechanism is provided with two connecting grooves, connecting columns of vertical parts of the sliding limiting block A and the sliding limiting block B can be inserted into the connecting grooves, and therefore the driving mechanism elastic piece A and the driving mechanism elastic piece B can be connected with the nail pushing mechanism in a separable mode.

7. The everting stapler of claim 5, wherein: the lower extreme of the spliced pole of the vertical portion of slip stopper A, slip stopper B is provided with cutting blade, cutting blade is located the outside of coincide nail.

8. The flip-up stapler of claim 1, 2, 3, or 4, wherein: the nail bin seat is also provided with a guide groove extending along the length direction of the actuating mechanism.

9. The everting stapler of claim 1, 2, 3, or 4, wherein: the opening parts of the nail bin cover, the nail bin seat and the nail anvil block are flaring openings with wide outer parts and narrow inner parts.

10. The everting stapler of claim 1, 2, 3, or 4, wherein: the bottom of the nail anvil block is provided with a supporting plate, the supporting plate is also provided with a penetrating groove extending along the length direction of the executing mechanism, and the near end of the supporting plate is provided with a protective plate.

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