RU2160563C1 - Clamp for making ligatures in deep cavities - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has branches with automatic lock and working ends bent in radial direction. Elastic plate for fixing a thread and a guiding roller are mounted on the external surface of one of the branches. Two elastic flexible plates for fixing a thread are mounted on the opposite branch above its joint. The plates are dislocated one relative to the other. The elastic plate is placed at the end of the branch and make a grooves with it along its surface. The guiding roller is place at the apex of the bend. EFFECT: enhanced effectiveness in ligating blood vessels in deep cavities. 4 dwg

Description

 The invention relates to medical equipment, in particular to surgical instruments and is intended mainly for ligature and ligation of vessels in deep cavities, for example, when performing abdominal-anal resection of the rectum in patients with malignant neoplasms of the rectum. It is technically difficult, and sometimes impossible, to perform manipulations on conducting and ligation of vessels in deep cavities with the available surgical instruments due to the fact that due to the lack of space in the depth it is difficult to draw the thread around the clamp.

 Known surgical clamp [1], consisting of pivotally connected intersecting halves with rings under the fingers and a cremallera on one side and two branches: a straightened shortened and elongated, roundly curved along the edge, with a hole on the end - on the other. When clamping and simultaneous ligation of the cystic duct, an elongated curved jaw with a thread held in the hole is brought under the cystic duct and pinched. Bandage the distal part of the cystic duct, then cross the duct between the thread and the clamp. The clamp can also be used for manipulations in deep cavities and for ligation of blood vessels.

 The disadvantages of the surgical clamp are that when it is applied, additional space is required due to the presence of an elongated jaw. The use of this clamp for ligation of vessels in deep cavities is possible if the distance from the dressing to the cavity wall is greater than the difference in the lengths of the branches. Otherwise, the vessel that needs to be squeezed and ligated, when the clamp is closed, will be below the shortened jaw. For ligation of the vessel using this surgical clamp, it is necessary to remove the thread from the opening of the jaw, put it under the elongated jaw and tie the thread, that is, perform the same actions that must be performed when ligation of the vessel using any clamp placed in a deep cavity. Moreover, the use of this surgical clamp does not facilitate the implementation of the most difficult stage of ligation of the vessel in the deep cavity - the establishment of the thread under the clamp. In addition, the use of this surgical clamp provides for the use of an additional tool with which the ligature will be removed from the hole and brought under the clamp.

 A device [2] is known, which represents two articulated intersecting jaws with handles and a rack on one end of the jaw and working jaws on the other. The ends of the jaws are bent radially in a plane perpendicular to the branches. On the outside of the bend, the sponges are beveled so that a wedge-shaped groove is formed when closed. The end part of one of the branches is equipped with a semicircular protrusion limiter in the form of a hemisphere, the other with a recess for interfacing with it. The thread is laid in a wedge-shaped groove. One end of the thread is led out in front of the joint, the other in the end part of the jaws outside the protrusion limiter. The thread is fixed by closing the cremallera. After bringing the tool with the thread under the bandaged vessel, the central end of the thread, located in front of the hinge joint, is stretched in the direction of its peripheral part, the movement of which is limited by the protrusion-hemisphere of the sponge, and a loop is formed. Then the assistant opens the cremallera and the loop, sliding off the hemisphere, lies on the vessel.

 The disadvantages of the known device are that it cannot be used to dress a crossed vessel, which is clamped, since dropping the thread from the hemispherical protrusion requires opening the cremallera, which, if there is a crossed vessel, will inevitably lead to the vessel slipping out from under the clamp and causing bleeding. In addition, when using this device, conditions are created for damage to the thread, which is fixed by closing the cremallera.

 A device for carrying out ligatures in deep cavities [3], which contains the working part in the form of a fork and a handle. The working part is made in the form of a fork having shoulders different in length. At the end of the shoulders there are ligature stoppers in the form of end clamps for the ligature. The handle is bent at an obtuse angle and connected to the fork with the possibility of rotation and fixation by a hinge. On the handle is a ligature holder in the form of a plate for ligature. The ligature is clamped at the end clamps of the working part. The dissector is brought under the vessel that needs to be bandaged. By turning the working part on the hinge, the device is modeled in accordance with the depth of the wound and its shape in such a way as to provide a convenient supply of the ligature to the dissector. A segment of the ligature, stretched between the shoulders of the forks at the end clamps, is captured by the dissector, freely pulled out of the end clamps and brought under the vessel. Another ligature is likewise failed. They are tied and a vessel is crossed between them.

 A disadvantage of the known device for conducting ligatures in deep wounds is the inability to use it for self-ligation of the vessel. The use of this device implies the mandatory use of an additional tool that will pull the thread from the end clamps of the plug and pass it under the vessel. In the case when it is applied to the clamp on a crossed vessel and removing it from the vessel is possible only after ligation of the latter, the use of this device implies the obligatory presence of a third tool that will pull the thread from the end clamps of the fork and pass it under the clamp pressing the crossed vessel.

Known ligature vascular clamp [4], which consists of articulated jaws with ring-shaped handles and bent down and to the left at an angle of 110 ^o to its plane jaws. The lower lip is longer than the upper and has a hole in the end with a through slot for the ligature. On the entire inner surface of the working part of the upper jaw transverse notches are made. The protruding part of the lower sponge is smooth, without incisions, so as not to injure the walls of the vessel when it is isolated. Ligatures are introduced into the opening of the lower sponge, the branches are opened, the lower sponge along with the ends of the ligatures is brought under the vessel. After isolation, its sponges close and pinch the lumen of the vessel. Through the slot in the upper part of the hole, the ligature is removed and the vessel is ligated.

 The disadvantages of the well-known ligature vascular clamp, selected as a prototype, which coincides in most design features, are that for ligation of the vessel with its use, it is necessary to remove the thread from the hole of the sponge, put it under the lower sponge and tie the thread, that is, perform the same actions that must be performed when ligation of the vessel using any clamp imposed in the deep cavity. Moreover, the use of this surgical clamp does not facilitate the implementation of the most difficult stage of ligation of the vessel in the deep cavity - the establishment of the thread under the clamp. In addition, the use of this surgical clamp provides for the use of an additional tool with which the ligature will be removed from the hole and brought under the clamp. The disadvantages of this ligature vascular clamp include the lack of a mechanism for reliable fixation of the thread in the clamp.

 The invention solves the problem of ligation of vessels in deep cavities, when in conditions of lack of space and poor visibility it is necessary to apply a clamp to the vessel, insert a ligature under this clip and bandage the vessel. In this case, the most difficult moment is the establishment of the thread under the clamp, which compresses the vessel. The complexity of this moment of dressing is due to the need to place the thread under the clamp in a narrow space between the end of its branch and the pinched vessel. Significantly complicates this task and the undesirability of using additional tools for this purpose due to lack of space in deep cavities. The invention solves the problem of ligation of vessels in deep cavities without the use of additional tools, provides reliable placement of the thread under the clamp and fixing the thread in the process of applying the clamp.

 The task is carried out in that the clamp for applying ligatures in deep cavities consists of jaws with a rack with working ends bent along the radius, and on the lower jaw from the outer surface an elastic plate is fixed for fixing the thread and the guide roller, and on the opposite jaw, higher the jaw joint, two elastic-elastic plates for fixing the thread are installed, while the elastic plate is located at the end of the lower jaw and forms a groove with the jaw along the lower and front surfaces of the jaw located at the top of the bend of the lower jaw, and two elastic-elastic plates for fixing the threads are located on the front and rear surfaces of the jaws and are offset from each other.

 These significant distinguishing features of the claimed clamp allow for clamping and ligation of blood vessels in deep cavities during surgical interventions, including in the pelvic cavity during abdominal-anal resection. Fixing the thread on the jaw of the clamp from the outer surface using an elastic plate allows you to hold a loop under the clamp without removing it. Placing the thread in the groove on the lower and front surface of the elastic plate provides unhindered slipping of the thread under the clamp, and the presence of a guide roller eliminates the crossing of the thread. The presence of two elasto-elastic plates for fixing the thread provides tension to the thread when applying a clamp and thus eliminates unauthorized slipping of the thread from the elastic plate located at the end of the jaw.

 The invention is illustrated by drawings, where in FIG. 1 shows a side view of the clamp; in FIG. 2 is a front view of a clip; in FIG. 3 shows a cross section of the working part of the clamp in the region of an elastic plate for securing the thread; in FIG. 4 is a view of a clip with a ligature.

 The inventive clamp consists of two branches 1 and 2 with a rack 3 with radiused ends 4, and an elastic plate 5 is rigidly fixed to the bottom branch 1 from the outer surface to secure the thread, forming a groove with the branch on its lower and front surface 6 and a guide a roller 7 located at the top of the bend of the working part of the jaw, and on the opposite jaw 2, above the joint of the jaw 8, two elastic-elastic plates 9 are installed, located on the front and rear surfaces of this jaw, offset from each other.

 The inventive clamp is used as follows.

 A ligature 10 is carried out in a clamp as shown in FIG. 4. Apply a clamp to the lateral ligaments of the rectum. Ligaments cross. The surgeon passes the clamp to the assistant, who holds him upright. The surgeon removes the threads from under the elastic plates 9 located on its branch 2, which fixed the thread 10. After passing the thread in front of the clamp, the surgeon throws a loop, and with the index finger moves the knot towards the guide roller 7, discards the thread from the roller. After that, the surgeon continues to tighten the knot, and the assistant tilts the clamp posteriorly at an angle of 30 degrees. In this case, the thread, under the influence of the surgeon, slides out from under the elastic plate 5, which fixes the thread, and is tightened under the clamp on the vessel.

 The inventive clamp was used in 58 patients. Crossing of the thread, slipping of the ligature from the clamp, inadequate ligation of blood vessels was not noted. In all cases, intra- and postoperative complications were not noted.

 Literature.

 1. Viltsanyuk A.A., Khimich S.D., Fishchenko A.Ya. Surgical clamp // Clinical Surgery, 1990, N 1, c. 76.

 2. Sergeev G.I., Badin A.M., Stolyarov S.I. Ligation of vessels of the root of the lung // Surgery, 1990, N 5, p. 137-138.

 3. Patent 2030901 of the Russian Federation, MKI A 61 B 17/04. Device for ligature in deep wounds / Abdullaev A.G., Movchun A.A., Domrachev S.A. (Russia). - Declared 12/28/92; Publ. 03/20/95, bull. N 8.

 4. Moskalenko Yu.V. Ligature vascular clamp // Clinical Surgery, 1984, N 9, p. 74-75.

Claims (1)

 A clamp for applying ligatures in deep cavities, including jaws with a rack with working ends bent along the radius, characterized in that an elastic plate for fixing the thread and a guide roller are rigidly fixed to the jaw from the outer surface, and two opposite jaws are installed on the opposite jaw above the joint of this jaw elastic-elastic plates for fixing the threads, which are offset relative to each other, while the elastic plate is located at the end of the jaw and forms a groove with the jaw along its surface, and the guide roller is located married at the apex of the jaw bend.

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