JP2645244B2 - Suturing-free intestinal joint gun - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a sutureless gut articulation gun suitable for deep rectal surgery.

[0002]

2. Description of the Related Art Decomposable type of intestinal junction ring (Bi)
of fragmentable Analysis
Ring, hereinafter abbreviated as BAR. ) Is US Davis
& Geck, American Cyanamid
This is a product developed by Company Danbury, CT 06810, and has been used for intestinal joints that do not require suturing in recent years. Easy to operate, fast, safe and 2
Since it decomposes naturally and is excreted outside the body within ~ 3 weeks, a number of related articles using BAR have been published in medical journals as Rikuzoku. The BAR was first introduced to Taiwan from abroad in 1992 by the present inventor, and has been used in a large number of patients with colorectal or rectal diseases at Renai Clinic in Taipei City, and has achieved many results.

[0002]

The BAR can be used for colorectal surgery in a shallow wide abdominal cavity only by using fingers or simple surgical instruments. However, BAR can be used for rectal diseases in the deep and narrow pelvic cavity, for example. In surgery for rectal cancer, it is almost impossible to perform direct intestinal joint surgery. In recent years, the number of rectal cancer patients has increased rapidly, and has become one of the leading causes of death in Japan and overseas, and rectal surgery has been increasing accordingly. In addition, the life expectancy of the people is prolonged, and elderly patients undergoing surgery are increasing accordingly. Therefore, the need to develop a surgical method that is simpler, more reliable, and saves time is urgently needed, and BAR with superior performance can be sufficiently applied to rectal surgery in the pelvic cavity, and the gospel will be brought to more patients. Is desired.

[0003]

SUMMARY OF THE INVENTION In view of the above-mentioned limitations, the present inventor has concentrated his efforts on a BAR stitching-free joining gun which does not require suturing, and has finally completed the present invention. . It is an object of the present invention to provide a bowel articulation gun that does not require suturing. In the case of rectal surgery, enter from the anus and extend to the top of the rectum, attach the BAR already connected to the large intestine,
It is a joining gun adapted to perform a connection operation of a rectal end. The intestine-joining gun which does not require suturing accommodates a guide cylinder, a joining rod and a push rod in a gun head, and accommodates a combination member of a rotating body and a central shaft in a gun body. During the connection operation of the intestine, the rotating body and the central axis are driven to move the connecting rod and the guide cylinder, and the end of the rectum is guided and moved into the neck of the BAR, and the BAR is surely advanced. Control it tightly and finally remove the joining gun to complete the rectal connection surgery.

[0004]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring first to FIGS. 1 to 6, FIG. 1 is a perspective view of a joining gun according to an embodiment of the present invention, FIG. 2 is a perspective view of a gun head and a BAR of the joining gun, and FIG. FIG. 4 is an exploded perspective view of a gun body of the joining gun, FIG. 4 is an exploded perspective view of the gun body, FIG. 5 is an assembled sectional view of the joining gun, and FIG. 6 is a partially enlarged view of FIG. The suturing unnecessary intestinal joining gun according to the present embodiment schematically includes the guide tube 3, the joining rod 5, and the push rod 58.
And a gun body 6 containing a rotating body 7 and a center shaft 8.
The guide head 2 is fitted to the end on the side of the guide cylinder 8 so as to be easily inserted at the time of surgery. Gun head 1
Can be designed to various types of standards so as to conform to the BAR4 standard. The gun head and the gun body 6 are designed so that they can be quickly and reliably attached and detached. In performing the operation of the rectum 91 shown in FIG. 7, the joining gun is inserted from the anus 9, extends to the upper end of the rectum 91, is attached to the BAR 4 already connected to the large intestine 92 shown in FIG. The rotating rod 7 and the central shaft 8 are driven to join the joint rod 5.
Is moved downward, and the end of the rectum 91 is guided so as to enter the gap of the BAR4. Further, the BAR4 is controlled to be securely tightened, and finally, the jointing gun is removed again to complete the intestinal connection operation.

The gun head 1 includes a guide tube 3 placed downward therein, a push rod 58 extending through the center hole of the guide tube 3 and extending upward, and a guide rod 3 extending over the gun head 1 and joined to the joining rod 5. It comprises a locked guide rod 54 and the like.
A fixed shaft 11 is provided at a lower stage of the gun head 1, and a screw 13 to be screwed into a screw 61 in an opening at an upper end of the body 6 shown in FIG. A plurality of round holes 12 are formed in the outer peripheral edge of the lower end of the gun head 1 (see FIG. 7). These holes communicate with the inside of the gun head 1 and exhaust and drain when the guide cylinder 3 is pushed. Is provided for the expulsion. The guide cylinder 3 is a cylinder whose opening is opened downward, and an annular concave portion 31 is formed at the top end. The lower flange 53 of the joining rod 5 is
Abut on the lower side of the annular concave portion 31, and the other portions are exposed upward. As shown in FIG. 3, a plurality of axial grooves 51 are formed in the joining rod 5 to impart elasticity in a radial direction, and a restraining ring 51 is provided on the head of the joining rod 5.
Is fitted to enhance the elasticity of contraction. The screw 55 at the top end of the guide rod 54 is screwed into the bottom end of the center hole of the joining rod 5, and the push rod 58 is inserted into the center hole of the guide rod 54,
And it is screwed into the center hole of the joining rod 5. Pin 59
Are fixed to the fixed shaft 11 and the pin hole of the push rod 58 in the radial direction via the axial guide groove 56 of the guide rod 54. Therefore, the push rod 58 is fixed so as not to move, but the guide cylinder 3, the joining rod 5, and the guide rod 54 can be moved up and down within a certain range. A compression spring 33 is provided in the lower opening of the guide cylinder 3, and a bottom cover 32 is screwed into the lower end. The upper end of the compression spring 33 abuts against the flange 53, and thus lowers the guide cylinder 3 when the connecting rod 5 and the guide rod 54 move downward.

The hollow tubular guide body 6 is composed of a rotating body 7 provided at the lower end, a central shaft 8 located inside and screwed to the rotating body 7, and the like. A screw 61 is cut into the opening at the upper end of the guide body 6 and is screwed to the screw 13 of the rotating shaft 11 shown in FIG. 3 (the tightening speed is increased by a double screw). A screw 62 is cut at the outer peripheral edge of the opening at the lower end of the gun body 6, and is screwed into the opening at the upper end of the coupling 63. The rotator 7 has an upright multi-stage cylindrical shape, and a fixed cap 71 is rotatably mounted in the middle of the rotator 7. The fixed cap 71 is fastened to the opening at the lower end of the coupling 63. The axial center hole of the rotating body 7 is in the form of a screw hole 74, and is screwed into a screw rod 81 below the center shaft 8. The space between the rotating body 7 and the fixed cap 71 is pivotally fastened by a retaining ring 73. A wing 75 is formed on the lower part of the rotating body 7 so as to protrude outward, and a steel ball 76 is provided on the upper end surface of the fixed cap 71 so as to abut upward by a compression spring 77. It is pushed into a hemispherical hole 64 at the lower end of the coupling 63. Thus, after the fixing cap 71 is tightened, the positioning effect is enhanced by the steel balls 76 and the hemispherical holes 64.

The lower half of the center shaft 8 is in the form of a screw rod 81 and is screwed downward into a screw hole 74 of the rotating body 7. One axial guide groove 87 is provided on the outer periphery of the central shaft 8, and a screw 88 is screwed into the guide body 6 and the bushing 89 in the radial direction. The bushing 89 is located in the guide groove 87 of the center shaft 8 so that the center shaft 8 moves only vertically and cannot rotate. At the upper end of the central shaft 8, there is a central hole 82 opening upward, and a plurality of radial holes are drilled in the hole wall to accommodate a steel ball 84,
4 protrudes into the hole wall, but does not fall into the center hole 82. The cylindrical coupling 83 is fitted on the upper stage of the central shaft 8, and the upper stage of the coupling 83 is a retaining ring 86 of the central shaft 8.
, The coupling 83 is pushed upward by the compression spring 85 to make the steel ball 84 protrude into the hole wall of the center hole 82. The fixed shaft 11 of the gun head 1 is joined to the upper end opening of the gun body 6 and further tightly fastened by an O-ring 14. At the same time, the lower side of the guide rod 54 is inserted into the center hole 82 of the central shaft 8, and the coupling 83 locks the steel ball 84 to the concave neck 57 at the lower end of the guide rod 54. When the rotating body 7 is rotated, the center shaft 8, the guide rod 54, and the joining rod 5 are moved up and down linearly, thereby displacing the guide cylinder 3 up and down, but the push rod 58 remains fixed and immovable. .

Referring to FIGS. 7 to 11, FIG. 7 is a schematic view showing a state in which the joining gun according to the embodiment of the present invention is ready for insertion, and FIG. 8 is a state after the joining gun is inserted. FIG. 9 is a schematic perspective view showing a state in which the distal end of the rectum is fastened to a joining gun, FIG. 10 is a schematic perspective view showing a state in which the joining gun is attached to a BAR, and FIG. It is sectional drawing of the state attached to. When actually performing a surgical operation using the joining gun of the present invention, first, the intestinal portion having a lesion is cut off, and a threading operation of the end of the large intestine 92 is performed. Next, the BAR 4 is connected to the end of the large intestine 92, the connecting rod 5 of the connecting gun is raised to an appropriate position, the guide head 2 is covered, and the rectum 91 is inserted from the patient's anus 9 as shown in FIG. Extend from the top of After the guide head 2 is taken out as shown in FIG. 8 and the open end of the rectum 91 is tightly ligated to the outer periphery of the guide tube 3 of the joining gun as shown in FIG.
The BAR 4 already connected to the large intestine 92 is fitted on the joining rod 5 as shown in FIG. Finally, the rotating body 7 is rotated as shown in FIG.
4 and the connecting rod 5 are moved down.

Next, referring to FIGS. 12 to 14, FIG.
2 is a cross-sectional view in which the joining gun has pushed the opening of the rectum into the central hole of the BAR, and FIG.
FIG. 14 is a cross-sectional view when the joining gun has finished tightening the BAR. FIG.
As shown in FIG.
1. When the guide rod 54 and the joint rod 5 are moved downward, the joint rod 5
Moves the guide tube 3 downward through the compression spring 33 to reach the bottom surface inside the gun head 1 and thus guides the open end of the rectum 91 into the gap between the BARs 4 (FIG. 12).
Thus, the guide cylinder 3 is retracted with respect to the gun head 1 and the open end of the rectum 91. As shown in FIG. 13, the end of the rectum 91 is tightly ligated, and during the process of lowering the connecting rod 5, its head is pushed outward by the push rod 58 and further comes into contact with the BAR 4. As shown in FIG.
Has already reached the bottom surface inside the gun head 1 and cannot move further down. At this time, when the rotating body 7 is continuously rotated and the center shaft 8, the screw rod 81, the guide rod 54, and the connecting rod 5 are continuously moved downward, the end of the large intestine 92 and the end of the rectum 91 become BA.
The open head of the connecting rod 5 joins the BAR4 to ensure it is secured by R4, thus completing the rectal connection operation.

Finally, referring to FIGS. 15 and 16, FIG.
5 is a cross-sectional view when the joining gun performs the detaching operation, FIG.
FIG. 4 is a schematic perspective view when the joining gun has completed the detaching operation. After the joining of the BAR 4 is completed, the rotating body 7 is turned in the opposite direction to move the center shaft 8, the screw rod 81, the guide rod 54, and the joining rod 5 upward, but the push rod 58 remains fixed and does not move. As shown in FIG. 15, the head of the joining rod 5 is restored to the closed state, allowing the BAR 4 to pass downward, and further pulling the entire joining gun downward as shown in FIG. Take out and leave. After the rectal splicing operation is completed and the splicing gun is removed, the rotating end 7 is subsequently turned in the opposite direction, the central shaft 8 is raised, and the coupling 83 is pushed to move, thereby directly Is quickly removed from the screw and directly taken out.
When actually performing a rectal joint operation, the gun head 1 should be selected so as to conform to the BAR4 standard, so that the gun head 1 can be quickly joined to the upper end of the gun body 6 and at the same time, The lower side of the guide rod 54 of the joining rod 5 is inserted into the center shaft 8 of the gun body 6 and is securely locked to the steel ball 84 of the coupling 83, so that the effect of joining can be quickly and reliably achieved.

[Brief description of the drawings]

FIG. 1 is a perspective view of a joining gun according to an embodiment of the present invention.

FIG. 2 is a perspective view of a gun head and a BAR of a joining gun.

FIG. 3 is an exploded perspective view of a gun head of the joining gun.

FIG. 4 is an exploded perspective view of a gun body of the joining gun.

FIG. 5 is an assembled sectional view of a joining gun.

FIG. 6 is a partially enlarged view of FIG. 5;

FIG. 7 is a schematic perspective view of a joining gun in a preparation state for insertion.

FIG. 8 is a schematic perspective view showing a state after the joining gun is inserted.

FIG. 9 is a schematic perspective view of a state where the rectal end is firmly fastened to a joining gun.

FIG. 10 is a schematic perspective view showing a state in which the joining gun is attached to the BAR.

FIG. 11 is a sectional view showing a state in which the joining gun is attached to the BAR.

FIG. 12 is a cross-sectional view in which the joining gun has pushed the rectal opening into the neck of the BAR.

FIG. 13 is a schematic perspective view of the joining gun pushing the rectal opening into the neck of the BAR.

FIG. 14 is a sectional view when the joining gun has been tightened to the BAR.

FIG. 15 is a cross-sectional view when the joining gun performs a detaching operation.

FIG. 16 is a schematic perspective view when the joining gun performs a detaching operation.

[Explanation of symbols]

 1. Gun head 2. Guide head 3. Guide tube 4. 4. Joint ring (BAR) Connecting rod 6. Gun body 7. Rotating body 8. Center axis 9. Anus 11. Fixed shaft 12. Round hole 13. Screw 14. O-ring 31. Annular recess 32. Bottom cover 33. Compression spring 51. Groove 52. Restriction ring 53. Flange 54. Guide rod 55. Screw 56. Axial guide groove 57. Concave neck 58. Push rod 59. Pins 61, 62. Screw 63. Coupling 64. Hemispherical hole 71. Fixing cap 72. Screw 73. Screw hole 75. Wing 76. Steel ball 77. Compression spring 81. Screw rod 82. Center hole 83. Coupling 84. Steel ball 85. Compression spring 86. Restriction ring (retaining ring) 87. Axial guide groove 88. Screw 89. Bushing 91. Rectum 92. colon

Claims (7)

(57) [Claims] 1. A hollow cylindrical gun head (1) having an upward opening and a partially threaded fixed shaft (11) extending downward from a lower end, sliding down into the opening of the gun head, And a guide tube (3) used for placing a joining ring (4) at the upper end thereof, a plurality of upper ends extending out of the center holes of the guide tube (3) and the joining ring (4) to facilitate changing the diameter. A connecting rod (5) provided with an axial groove (51) and having a lower end located in the guide cylinder and pressing a compression spring (33) on a bottom cover of the guide cylinder (3); Penetrates the center hole of the fixed shaft (11) of the gun head (1) to tighten the lower end of the gun head, and the radial pin (59) of the fixed shaft is fitted in the axial guide groove (56).
Guide rod (54), whose axial displacement range is limited, and which stands upright in the center hole of the joint rod (5) and the guide rod (3), and is fixed to the fixed shaft (11) of the gun head (1). Radial pins (5
A push rod (58) fixed at 9) and capable of pushing the joint rod head open to the outside, an upright tubular gun body (6), located in the center hole of the gun body (6). A central shaft (8) with a screw rod (81) at the bottom, a coupling (63) at the upper end, and a central shaft (8) screw located at the lower end of the gun body (6). A rod (81) is screwed into a central screw hole, and is composed of a rotating body (7) that causes an axial displacement of the central axis (8) by rotating, and a fixed shaft (7) at the lower end of the gun head (1). 11) is locked to the opening at the upper end of the gun body (6), so that the lower portion of the guide rod (54) is locked and coupled within the coupling (63) at the upper end of the central shaft (8). By turning (7), the center shaft (8) and the guide rod (54 ) And the connecting rod (5) are moved down in the axial direction, the connecting rod (5) first acts on the compression spring (33) to cause the guide cylinder (3) to retreat in the gun head (1), and further join. The rod (5) retreats relative to the guide tube (3) and pushes the end of the rectum into the neck of the joining ring (4), and then joins the joining ring up and down and separates it from the joining ring. A suturing unnecessary intestinal joint gun, which completes the intestinal connection operation. 2. The intestinal joining gun according to claim 1, wherein a round hole (12) communicating with the inside is formed in an outer peripheral edge of the gun head. 3. An elastic restraining ring (5) is attached to the head of the joining rod.
2. The method according to claim 1, wherein 2) is fitted in a radial direction.
The cancer for intestinal junction according to 4. 4. The method according to claim 1, wherein a concave neck (57) is provided at the lower part of the guide rod, and the steel bolt (84) of the coupling (83) at the upper end of the central shaft (8) is locked. The cancer for intestinal junction according to 4. 5. An axial guide groove (87) is provided on the outer peripheral edge of the central shaft (8) to guide a screw (88) in the system direction of the gun body (6) to be inserted. The intestinal junction gun according to claim 1, wherein a displacement range is regulated. 6. The fixing cap according to claim 1, wherein a fixed cap is rotatably provided on an outer periphery of the rotating body so as to abut on an opening at a lower end of the gun body. Intestinal junction gun. 7. A guide tube (3) fitted around a part of the outer circumference of a guide cone (2) having a hollow conical tube shape which is tapered upward to aid insertion into the rectum. The intestinal junction gun according to claim 1.