RU141615U1 - HOLLOW BODY CLAMP - Google Patents

Abstract

Hollow organ clamp, consisting of sponges for fixing the walls of hollow organs, with pyramidal tabs-retainers, branches, a motion unit in the form of a dead lock and a lock for fixing branches in the form of a rack, characterized in that on the lips in their proximal and distal parts of the working surface at a distance of 85 mm there are platforms protruding above them at 1.25 mm over a length of 2 mm, while one area has a triangular-protruding surface along the axis of the sponge, and the other has a triangular-concave, in the closed state between the working surfaces of the lips a gap of 2.5 mm, and the working surfaces of the jaws have recesses-protrusions clamps on one of the jaws in its edge applied to millimeter scale, sponges jaws are arranged relative to an angle of 110 °.

Description

The device relates to medicine, namely to surgical gastroenterology and can be used to excise and suture the stomach in case of damage to its wall, excise benign tumors or treat complicated ulcer disease, in proctology, urology, and vascular surgery.

Known application for excision and suturing of the walls of the organs of different versions of clamps-pulp. Clips with fixation of large areas of tissue may have insufficient fixation, and with an increase in the degree of compression, they cause tissue necrosis and the occurrence of complications in the suture area.

The clamp H46A pharyngeal constrictor was used as a prototype (Paches A.I. Tumors of the head and neck. M: Medicine, 2001), however, it provides a very strong fixation along the line of working jaws and also causes a violation of tissue viability. To ensure a sufficient degree of fixation and to prevent violation of tissue viability in the clamp in the proximal and distal parts of the working surface of the jaws at a distance of 85 mm, there are 2 mm long platforms protruding above them at 1.25 mm, one platform has a surface that is triangular-protruding along the axis of the sponge, and the other is a triangular-concave surface. When the clamp is closed, the jaws are in contact with these pads, and there is a gap of 2.5 mm between the surfaces of the jaws that fix the tissues. For ease of operation in deep cavities, the jaws are located relative to the branch at an angle of 110 °.

The technical result is the possibility of strong fixation of the walls of a hollow organ without violating the viability of the tissues in the clamp.

The technical result is ensured by the fact that along each sponge at a distance of 1 mm from one of its edges, every 8 mm there are ten pyramidal protrusions-retainers 1 mm high, the latches of the opposite jaws are offset relative to each other by 4 mm. In the proximal and distal parts of the working surface at a distance of 85 mm there are platforms protruding above them at 1.25 mm 2 mm long, while one platform has a triangular-protruding along the axis of the sponge surface, and the other has a triangular-concave, in the closed state between the working surfaces of the jaws have a gap of 2.5 mm, and on the working surfaces of the jaws there are no recesses for the locking tabs, a millimeter scale is applied on one of the jaws along its edge. Sponges are located relative to the jaws at an angle of 110 °.

The device, after applying it to the protruded wall of the stomach, firmly fixes the wall of the organ due to the protruding pyramidal fixators, but does not cause it to crush and there is no development of subsequent degenerative-necrotic changes, since there is a gap of 2.5 mm between the working surfaces of the sponges.

USEFUL MODEL EXPLAINED BY FIGURES (Figs. 1-3)

In figure 1. Isometric view of the device.

In figure 2. General view of the device, top view.

In figure 3. General view of the device, side view.

The device consists of two sponges for tissue fixation (1) with ten pyramidal fixation tabs 1 mm high located along each sponge 1 mm from one edge every 8 mm. The latches of the opposite jaws are offset relative to each other by 4 mm. In the proximal and distal parts of the working surface at a distance of 85 mm there are platforms protruding above them at 1.25 mm 2 mm long, while one platform has a triangular-protruding along the axis of the sponge surface, and the other has a triangular-concave, in the closed state between the working surfaces of the jaws have a gap of 2.5 mm, and on the working surfaces of the jaws there are no recesses for the locking tabs, a millimeter scale is applied on one of the jaws along its edge. Sponges are located relative to the jaws at an angle of 110 °. The clamp has a motion unit (3) in the form of a dead lock and a jaw fixation lock (4) in the form of a cremallera (see 1-4).

THE DEVICE WORKS AS FOLLOWS

The device is applied by sponges to the affected hollow organ after mobilization of its site in the required volume. When closing the device and the locking lock, the fixing jaws with the pyramidal protrusions-clamps firmly hold the fragment of the hollow organ, but do not cause crushing and violation of tissue viability in the clamp. Depending on the type of organ (stomach, bladder, rectum, aorta) and the type of operation performed (resection of a section of the wall of the stomach, bladder, resection of the colon, prosthetics of the aorta), excision, suturing and prosthetics are carried out according to different methods (suture under the clamp , entwined around the clamp and others), but in all cases the trauma to the fixed organ is less in comparison with the usual crushing clamps and pulp used.

CLINICAL APPLICATION EXAMPLE

To perform operations on the hollow organs of the abdominal cavity, we use a new clamping option.

The hollow organ clamp consists of two sponges for tissue fixation with each sponge located 1 mm from one of its edges, every 8 mm, with ten pyramidal protrusions-clamps 1 mm high, the clamps of the opposite sponges are shifted relative to each other by 4 mm, in the proximal and distal parts of their working surface at a distance of 85 mm there are platforms protruding above them at 1.25 mm 2 mm long, while one platform has a triangle-protruding surface along the axis of the sponge, and the other is triangular-concave, closed position of the nip between the working surfaces of the jaws there is a gap of 2.5 mm, on one of the jaws in its edge applied to millimeter scale. The sponges are located relative to the branches at an angle of 110 °, the movement of the branches and jaws is provided by the movement unit in the form of a dead lock, and the lock is the lock of the fixing of branches in the form of a cremallera.

EXAMPLES OF CLINICAL APPLICATION OF CLAMP FOR HOLLOW BODIES.

Patient N., 23 years old. Case history 1310084. He was hospitalized in the surgical department of the Kursk City Clinical Hospital (GKB SMP) on September 29, 2011 according to urgent indications with a diagnosis of duodenal ulcer complicated by perforation. Common peritonitis. Examinations and preoperative preparation were carried out taking into account medical standards. After 2 hours, the patient was operated on, the upper middle laparotomy was performed. A perforated ulcer of the anterior wall of the duodenal bulb was found. Ulcerative infiltrate 3.0 × 4.0 cm. Perforated hole 0.5 cm. In the abdominal cavity 500 ml of turbid contents with fibrinous deposits in the right hypochondrium and along the right side channel. The abdominal cavity is sanitized, the duodenal bulb is isolated from adhesions, the ulcer is stitched with a Z-shaped suture, and holders are placed on the upper and lower intestinal walls. In the transverse direction to the lumen of the intestine, outside the ulcer infiltrate, a clamp for hollow organs is applied. The ulcerative infiltrate is excised by a clamp with a scalpel, the wall of the duodenum is sutured with a continuous embroidered seam of vicryl. The line of the stitching suture is peritonized with separate nodular serous-muscular sutures. The abdominal cavity is drained in the right hypochondrium and in the right iliac region. The postoperative period was uneventful. Sutures were removed on the 10th day, on the 14th day of the postoperative period, an X-ray examination of the stomach and duodenum was performed. The X-ray picture showed the presence of an expanding duodenoplasty effect after excision of the anterior intestinal wall with ulcerative infiltrate, while a somewhat slower rhythm of peristalsis and evacuation of barium suspension was noted. On the sixteenth day, the patient was discharged in satisfactory condition to continue treatment in a gastroenterological sanatorium.

Patient Z., 56 years old. The medical history 17371. He was hospitalized in the surgical department GKB SMP of the city of Kursk 12/26/2011 with a diagnosis of perforated duodenal ulcer, peritonitis widespread. After examination and preoperative preparation 12/26/2011 operated on emergency evidence. Intraoperative diagnosis: peptic ulcer, chronic LDPC ulcer complicated by perforation, subcompensated output stenosis of the stomach, widespread serous-fibrinous peritonitis. Performed laparotomy, resection of two-thirds of the stomach according to Billroth-I, rehabilitation and drainage of the abdominal cavity in the right hypochondrium and right iliac cavity. During surgery, the lesser curvature of the stomach was sutured over 12 cm by applying a clamp for hollow organs. The postoperative period was uneventful. Sutures were removed on the 10th day of the postoperative period. On the 14th day, an X-ray examination of the function of the gastrointestinal tract was performed. Pathology from the stump of the stomach and gastroduodenoanastomosis was not detected. Motor and evacuation function is somewhat slow, portioned. In satisfactory condition, was discharged for spa treatment in a sanatorium of gastroenterological profile.

Patient D., 87 years old. Case history 17156. Hospitalized in the surgical department of the City Clinical Hospital Nursing Center of Kursk on 12/21/2011 for emergency indications with a diagnosis of obstructive colonic obstruction. The patient was examined, preoperative preparation was carried out, and on December 22, 2011 the patient was operated on. Diagnosis: cancer of the recto-sigmoid colon, T ₄ N ₂ M ₀ . Obstructive colonic obstruction. Hartmann type surgery, abdominal drainage performed. For suturing the stump of the rectum, a clip for hollow organs was used. A morphological study of the drug revealed a moderately differentiated colon adenocarcinoma with foci of low degree of differentiation and germination of the entire thickness of the intestinal wall, infiltrative growth in the mesenteric tissue in the mesenteric lymph nodes, malignant tumor-like growth of low-grade intestinal adenocarcinoma. There were no complications from the abdominal organs in the early postoperative period. Discharged on the 22nd day after surgery in satisfactory condition under the supervision of an oncologist.

Patient K., 69 years old. Case history 15522. He was hospitalized in the surgical department of the City Clinical Hospital Nursing Unit in Kursk on 11/18/2011 with a diagnosis of closed blunt trauma to the abdomen, pelvic peritonitis. After examination and preoperative preparation, an inter-median laparotomy was performed. In the pelvis about 100 ml of turbid effusion with fibrin, paravesical fiber infiltration. A revision of the bladder revealed a rupture of the front wall of the bladder 1 cm long, with prebubble flow of urine up to 100 ml. The edges of the wound are phlegmonically changed. The edges of the wound are taken on the holders on the mobilized, unchanged wall of the bladder; a clamp for hollow organs is applied; the edges of the wound of the bladder are excised. The walls of the bladder are stitched with two oncoming half-sutured sutures, catgut and bandaged. The clip is removed. There is a hermetic bladder wall. Sewing stitches are immersed in a continuous catgut suture on the wall of the bladder. Remediation of the pelvic cavity and the prevesical space. Paravesical fiber is drained by glove-tubular drainage. Extraperitonization of the bladder. Drainage of the pelvic cavity by glove-tubular drainage through the right iliac region. Drainage of subcutaneous fat postoperative wounds. Permanent catheter into the bladder. In the postoperative period he received antibiotics, uroseptics, carried out infusion therapy, symptomatic therapy taking into account the existing cardiovascular pathology. Sutures were removed on the 15th day, partial suppuration of the postoperative wound at the site of drainage was noted. On the 24th day of the postoperative period, cystography was performed in two projections. There are no streaks of contrast medium in the paravesical tissue. Discharged in satisfactory condition under the supervision of a urologist on the 26th day.

The hollow organ clamp was used to excise chronic gastric and duodenal ulcers complicated by perforation in 32 patients and acute gastric bleeding in 6 patients, colon surgery was performed in 18 patients, 5 patients were excised and sutured, and surgery was performed on 5 abdominal aorta performed in 7 patients.

Thus, the use of a device with a new design of sponges with an increase in the fixing properties of sponges and a decrease in the effect of crushing, a convenient configuration for working in deep cavities simplified the operation to excise sections of the stomach, bladder, operations on the colon, and aortic prosthetics. The presence of a millimeter scale on the sponge of the instrument made it possible to more accurately determine the size of injuries, pathological objects and more accurately select the diameter of vascular prostheses. Due to the improvement of the quality of reparation by these organs, the number of complications decreased, there were no cases of suppuration and insolvency of sutures.

The curved configuration of the instrument provides the convenience of working on organs deep in the wound and provides a sufficient view of the tissues in the wound in the static position of the instrument. The millimeter scale on the sponge of the tool increases the objectivity of assessing the size of various objects in the wound.

Claims (1)

Hollow organ clamp, consisting of sponges for fixing the walls of hollow organs, with pyramidal projections-retainers, branches, a motion unit in the form of a dead lock and a lock for fixing branches in the form of a rack, characterized in that on the lips in their proximal and distal parts of the working surface at a distance of 85 mm there are platforms protruding above them at 1.25 mm over a length of 2 mm, while one area has a triangular-protruding surface along the axis of the sponge, and the other has a triangular-concave, in the closed state between the working surfaces of the lips a gap of 2.5 mm, and the working surfaces of the jaws have recesses-protrusions clamps on one of the jaws in its edge applied to millimeter scale, sponges jaws are arranged relative to an angle of 110 °.

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