RU145975U1 - ATRAUMATIC CLAMP FOR STOPPING OF POST-PERIODENARY UTERINE BLEEDING - Google Patents

Abstract

1. A clamp for stopping postpartum uterine bleeding, characterized in that it contains two intersecting articulated jaws, each of which is divided by a hinge into a clamping branch and a handle with an element of the locking mechanism at its end section, the clamping branch of one of the branches has at its distal, with respect to the hinge, the end of a pair of identical arcuate jaws of circular cross section located on one cylindrical surface with the formation of a gap between them, and parallel to one another in the plane at speeds parallel to the axis of the hinge connecting the jaws, the clamping branch of the other jaw has at its distal end, with respect to the hinge, a single arcuate jaw identical to the jaws indicated above and staggered with respect to the latter, the parameters of the jaws and their location selected from the conditions of placement, when the clamping branches are closed, a single sponge in the gap between a pair of sponges with ensuring not only compression of tissues, vessels, but also, at the same time, their bending along the curve of a wavy surface, at The single sponge is folding and consists of two arcuate parts joined together by its proximal end sections with respect to the joint zone and mounted on the clamp branch with the possibility of rotation one to the other from the distal end of the clamp branch of the single sponge. 2. Press according to claim 1, characterized in that the abutting end portions of the arcuate parts of the sponge are covered by a U-shaped plate bracket mounted with its crossbar at the distal end of the clamp branch of a single sponge, while

Description

The utility model relates to the field of medicine, namely to surgical obstetrics and gynecology, and relates to the design of the device, which is designed to stop postpartum uterine bleeding, and can also be used for gynecological bleeding. In particular, the inventive device may be a disposable tool.

Known use to enhance contractions of the uterus of the imposition of 3-4 abortzang (overlay terminals according to NS Baksheev). In this case, one branch is located on the inner surface of the cervix, the second on the outer. Sipping the handle of the clamps, the uterus is moved down. The reflex effect on the cervix and the possible compression of the descending branches of the uterine artery contribute to a decrease in postpartum blood loss. With the cessation of bleeding, abortions are alternately removed (see Baksheev NS “Uterine bleeding.” Kiev, “Health” 1966, 1970, 1975).

It is known to use, instead of clamps and abortion, forceps with a semicircular working part of clamps that are placed on the cervix (see L. P. Pirogovsky "Forceps to stop uterine bleeding in the early postpartum period." Medical library on the server MedLinks.ru., Publ. 08/18/2009).

A common drawback for these agents is the traumatic, compressive, compression effect of them on the tissues of the cervix and the uterine vessels and nerves that they compress, due to their general design deficiencies, namely:

a) they are all made of metal, most often steel, which causes traumatic squeezing of tissues and a tendency to independently “slide” instruments from the cervix under the influence of their own gravity;

b) the clamping of tissues, blood vessels when using these tools is carried out between two adjacent flat surfaces with close to rectangular faces, which injures the tissue;

c) their hemostatic effect extends only to the descending, smaller branch of the uterine artery, due to the fact that both branches of these instruments are the same length, and: their outer branch abuts against the apex of the lateral vaginal arch, and their inner branch can reach the maximum only to the inner uterine pharynx, and anatomically precisely over the internal uterine pharynx in most cases the anatomical division of the uterine artery into a descending and ascending branch occurs.

Thus, the entire indication of the device (abortion, forceps, clamps, terminals) compresses only the descending, smaller branch of the uterine artery, going from the uterine artery to the cervix, while the majority of the uterine artery is its ascending branch, feeding the uterine body, the placental site remains out of their reach (namely, from the body of the uterus and postpartum uterine bleeding is carried out, which determines massive blood loss), which accounts for their insignificant effectiveness. In all previously known hemostatic clamps and terminals, the working surface was always absolutely closed, with the contact of the clamping surfaces in a straight line, which was achieved by squeezing the tissues and squeezing the bleeding vessels, though with excessive trauma.

The closest analogue to the claimed utility model is a clamp for stopping postpartum uterine bleeding, containing two intersecting articulated branches, each of which is divided by a hinge into a clamping branch with a clamping sponge at its end and a handle with an element of the locking mechanism at its end section. The clamping jaw of each jaw has on the side facing the jaw of the other jaw a wavy surface, at least along the entire length of the jaw, formed for one of the jaws by alternating the same number of protrusions and grooved cavities and for the other sponge, with protrusions and a grooved groove located between them, while the depressions and protrusions of one of the clamping jaws are staggered relative to the depressions and protrusions of the other clamping jaw, respectively, and the parameters of the depressions and protrusions are selected from the condition provided I when closing jaws not only compression of tissue, blood vessels, but simultaneously their flexural waveform sponges surface (RU patent 102 884 U1).

However, the clamp selected as the closest analogue has a significant drawback. Its inner sponge, being introduced to the level of the internal pharynx of the cervix, after the contraction of the uterus and cervix, as a functional part of the uterus, in the process of stopping the uterine contraction, cannot be removed from the uterus, through the lumen of the cervix, since the cervix has contracted , and the diameter of its lumen became much smaller than it was before the operation. As a result, removing the hemostatic clamp, or rather its inner sponge, after stopping uterine bleeding can be not only dangerously traumatic, but also simply impossible.

The inventive utility model is aimed at solving the problem of increasing the effectiveness of stopping postpartum uterine bleeding and minimizing the traumatic effect on the uterine tissues and blood vessels with increasing operational capabilities and preserving the uterus by temporarily stopping the uterine blood flow without entering the abdominal cavity by transvaginal intracervical (intracanal, intracranial) introducing an instrument with sequential compression of the right and left uterine arteries with their ascending to the body of the uterus and, and with descending branches to the cervix.

The technical result achieved by using the inventive utility model is to ensure guaranteed safe removal of the inner lips of the hemostatic clamp.

To achieve the technical result, a clamp is proposed for stopping postpartum uterine bleeding, which contains two intersecting articulated jaws, each of which is divided by a hinge into a clamping branch and a handle with an element of the locking mechanism at its end section. The clamping branch of one of the branches has at its distal end, with respect to the hinge, a pair of identical arcuate jaws of circular cross section located on one cylindrical surface to form a gap between them, parallel to one another in planes parallel to the axis of the hinge connecting the branches. The clamping branch of the other jaw has at its distal end, with respect to the hinge, a single arcuate sponge identical to the jaws indicated above and staggered to the latter. The parameters of the clamping jaws and their location are selected from the placement condition, when the clamping branches are closed, a single sponge is in the gap between a pair of jaws, while ensuring not only compression of the tissues, vessels, but also, their bending along the curve of the wavy surface, while a single sponge made folding and consists of two arcuate parts joined by its proximal end sections in relation to the joint zone and mounted on the clamp branch with the possibility of rotation one to the other in the direction from the distal clamping branches end with a single sponge.

The proximal end sections of the arcuate parts of the sponge are covered by a U-shaped plate bracket mounted with its crossbar at the distal end of the clamp branch of a single sponge, while the corresponding axis of rotation of the corresponding arcuate part passes through the side walls of the bracket and through each of the end sections of the arcuate parts located inside the bracket.

The essence of the utility model is illustrated by drawings, where:

in FIG. 1 shows a clip for stopping postpartum uterine bleeding (front view);

in FIG. 2 is a diagram of the mutual arrangement of the jaws in the clamp.

in FIG. 3 - single clamping jaw in the deployed position;

in FIG. 4 - a single clamping jaw in the expanded position, a fragment;

in FIG. 5 - single clamping jaw in the folded position;

in FIG. 6 - bracket.

The clamp for stopping postpartum uterine bleeding contains two intersecting branches 1 and 2. At the point of intersection, the branches are interconnected by a hinge 3.

The jaw 1 is divided by a hinge 3 into a clamping branch 4 and a handle 5 with an element 6 of the locking mechanism at its end section. The jaw 2 is divided by a hinge 3 into the clamping branch 7 of the handle 8 with the element 9 of the locking mechanism at its end section. Elements 6 and 9 during interaction form a cremallera 10.

The clamping branch 4 of the jaw 1 has at its distal end, with respect to the hinge 3, the end two identical clamping arcuate (arcuate curved) jaws 11 and 12 of circular cross section, which geometrically represent parts of a circle with a diameter from 10 mm to 70 mm depending on the purpose clinical purpose. The jaws 11 and 12 are located on one cylindrical surface 13 at a distance of half their diameter (which can be from 3 mm to 10 mm) from one another, with the formation of a gap 14 between them, and parallel to one another in planes parallel to the axis of the hinge 3. Jaws 11, 12 are external clamping jaws.

The clamping branch 7 of the jaw 2 has at its distal end, in relation to the hinge 3, one (single) arcuate (arcuate curved) jaw 15, identical to the jaws 11, 12 and staggered with respect to them. Sponge 15 is an internal clamping sponge.

The parameters of the clamping jaws 11, 12 and 15 and their mutual arrangement are selected so that when the clamping branches are closed, the sponge 15 is located in the gap between the jaws 11, 12. When the jaws 11, 12 and 15 are closed, not only compression of tissues, vessels, but and, at the same time, their bend along the curve of a wavy surface,

The jaws 11, 12 and 15 are made of a section of a rod made of stainless medical steel or medical plastic, or of a section of a hollow tube made of stainless medical steel or medical plastic.

A single sponge 15 is divided in the middle (along the axis of symmetry) of its arc into two identical arcuate parts (into two halves) 16 and 17. Parts 16 and 17 are joined together by their hemispherical end sections 18 and 19 facing each other. The end sections 18 and 19 are covered by a U-shaped plate bracket 20. The bar 21 of the bracket 20 is mounted on the end 22 of the clamp branch 7. Axes 25 and 26 pass through the side walls 23 and 24 and through the end sections 18 and 19, namely, the axis 25 passes through the side walls 23 and 24 of the bracket 20 and through the center of the sphere of the hemispherical end section 18, and the axis 26 passes through the side walls 23 and 24 of the bracket 20 and through the center of the sphere of the hemispherical end section 19. Axis 25 and axis 26 are parallel to each other and parallel to the axis of the hinge 3. As a result, the arcuate parts 16 and 17 are installed with oimi end portions 18 and 19 respectively on the axes 25 and 26 and can be pivoted towards each other around these axes. In this case, such a turn can be provided only in one direction, namely, towards the opposite runner 21 of the lumen 27 between the walls 23 and 24 of the bracket 20, because turning to the other side will be prevented by the crossbar 21 of the bracket.

Thus, the essence of the claimed utility model is the use of a clamp with an internal sponge 15, always used strictly in the amount of one and consisting of two parts 16, 17, which always fold in the direction into the lumen of the uterine cavity. This provides a reduction in the arcuate span of the sponge, the translation of its arcuate parts in a folded position, in which the parts 16, 17 are adjacent to each other with their lateral arched sides and form a closed pair, which is a continuation of the clamping branch 7 in the longitudinal direction. This ensures guaranteed non-traumatic extraction of the inner jaw of the clamp, and therefore the clamp itself, even with a significantly reduced cervix with a decrease in the diameter of its cervical, cervical canal by the end of the operation to stop uterine bleeding.

Folding of the inner sponge is ensured by cutting the inner sponge 15 in the middle of its length into two halves with rounded end sections on the cutting line, leaving only the tops of these ends in contact, which eliminates any adhesion or difficulty in folding these equal halves.

The clamp is used as follows:

The cervix is exposed in the vaginal speculum and fixed in the terminal forceps superimposed at 12 o’clock and 6 o’clock, after which the internal folding clamping jaw 15 is inserted into the cervical canal while the outer clamping jaws 11, 12 move along the side of the cervix - as far as possible into the lateral vaginal arch. In this case, the inner folding jaw 15 will always be centered between two arcuate outer clamping jaws 11, 12, falling into the groove gap between them. At the same time, with the introduction of the internal folding clamping jaw 15, it is guaranteed to always be in an unfolded state as well as the external clamping jaws 11, 12, while being projected always opposite the groove gap 14 between the jaws 11, 12. Anti-folding of the jaw 15 on at this stage, the side walls 23, 24 and the crossbeam 21 of the bracket have. At the same time, this bracket does not prevent the free folding of the two halves of the jaw 15 in the forward direction along the longitudinal axis of the jaw on which the jaw 15 sits.

In the process of using a hemostatic clamp located on the cervix, there is a contraction of the muscles of the uterus, including the cervix, which is its functional and anatomical part. This reduction leads to a decrease in the diameter of the cervix, and, therefore, makes it difficult to remove the inner clamping jaw 15, which can cause, when trying to force extraction, rupture of the tissues of the cervix and increase uterine bleeding. The execution of the sponge 15 folding anteriorly, in the direction of the longitudinal axis of the inner jaw 2, due to the possibility of rotation of its halves only anteriorly relative to the axis of the inner jaw 2, allows you to freely remove this sponge in the folded state from the cervical canal without injuring the tissue. The addition of the inner sponge 5 contributes to the impact on the outer surfaces of its halves of the tissues of the contracted cervix when removing the clamp. This folding does not double, but on the contrary, is facilitated by a bracket facing its lumen 27 opposite to the bar 21, also anteriorly in the direction of folding of the jaw 15. Thus, the implementation of the hemostatic clamp with a folding inner clamping jaw 15 ensures guaranteed extraction of the clamp without injuring the uterine tissue .

Claims (2)

1. A clamp for stopping postpartum uterine bleeding, characterized in that it contains two intersecting articulated jaws, each of which is divided by a hinge into a clamping branch and a handle with an element of the locking mechanism at its end section, the clamping branch of one of the branches has, at its distal end, with respect to the hinge, a pair of identical arcuate jaws of circular cross section located on one cylindrical surface to form a gap between them, and parallel to one another in planes parallel to the axis of the hinge connecting the branches, the clamping branch of the other jaw has at its distal end, with respect to the hinge, a single arcuate sponge identical to the jaws indicated above and staggered relative to the latter, the parameters of the clamping jaws and their location are selected from the placement condition, when the clamping branches are closed, a single sponge is in the gap between a pair of jaws, while ensuring not only compression of the tissues, vessels, but also, their bending along the curve of the wavy surface, the single sponge is folding and consists of two arched parts joined together by its proximal end sections with respect to the joint zone and mounted on the clamp branch with the possibility of rotation one to the other from the distal end of the clamp branch of the single sponge. 2. The clamp according to claim 1, characterized in that the abutting end sections of the arcuate parts of the sponge are covered by a U-shaped plate bracket mounted with its crossbar at the distal end of the clamp branch of a single sponge, while through the side walls of the bracket and through each of the end brackets located inside the bracket sections of the arcuate parts passes the corresponding axis of rotation of the corresponding arcuate parts parallel to the axis of the hinge branch.