RU2725970C1 - Block of rings for compression anastomosis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to a block of rings used for superimposition of circular anastomoses in surgical operations on hollow organs of gastrointestinal tract. Block of rings includes locking ring (1), needle ring (3) with projecting needle elements (10) and intermediate ring (2). Said rings (1, 2, 3) are made with possibility of coaxial connection when intermediate ring (2) is placed between shut-off (1) and needle ring (3) and needle elements (10) are engaged with surface of locking ring (1). Intermediate ring (2) is made from resilient material, which provides for its compression at connection of rings. At that, end surface (5) of locking ring (1) intended for contact with connected sections (6, 7) of hollow organ has straight section (8) located closer to center of ring (1) and oriented perpendicular to its axis, as well as inclined section (9) located closer to periphery of ring (1) and having a slope in direction from center to periphery.EFFECT: providing uniform excision of tissues and scar formation along the entire perimeter of compression anastomosis.6 cl, 5 dwg

Description

[01] Technical Field

[02] The invention relates to medicine, namely to a block of rings used for applying circular anastomoses during surgical operations on the hollow organs of the gastrointestinal tract.

[03] Background

[04] The principle of applying anastomoses using compression rings is based on simultaneous stitching and fixation of tissue rings. When anastomosis is created by compression in the area of maximum compression, tissue necrosis occurs, and in the area of moderate compression along the external perimeter of the compression elements, tissue fusion occurs. After rejection of the compressive structures, they exit naturally into the lumen of the organ. When connecting the mating parts of the block of rings with tissue sections sandwiched between them, at the first moment, the squeezing of the liquid components from the vessels and intercellular spaces occurs. The force of compression exceeds blood pressure, so the blood supply to the tissues in the compression area stops. Following this, tissue cells are crushed, and cell fluid is displaced from deformed cellular components. When almost all liquid tissue components are squeezed out, mummification of the tissue sandwiched between the squeezing elements occurs.

[05] A known design of a compression ring block for intestinal anastomoses (patent application of the Russian Federation RU96109502, 12.20.1996), containing two connected rings in the form of an oval with a rigidly fixed internal drive and with working surfaces arranged with the possibility of interaction with each other, which is a central circular groove are divided into external and internal, with a tight contact of the internal and the gap between the external working surfaces. The internal drive is made in the form of a rod made of a material with a shape memory effect, curved in the form of at least two elbows and rigidly connected to the rings at opposite points.

[06] In the known device, the compression effect is created by a wire loop in a narrow region. In this regard, tissue rejection occurs unevenly, and sites of anastomosis failure are likely to appear.

[07] A known block of rings for compression anastomosis (publication of international application WO2015193890, 12/23/2015 - the closest analogue), containing a locking ring, a needle ring, and an intermediate ring located between them in the form of a belt having arched spring elements to create a compression force designs. In addition, the design also provides a locking element that maintains a certain gap between the locking and needle rings for a predetermined period of time. These rings are connected to ensure the engagement of the needle elements of the needle ring over the surface of the locking ring.

[08] A disadvantage of the known design is the use of rigid rings, which do not allow adaptation to the real wall thickness of the connected tissues, as a result of which tissue rejection is uneven and there is a high probability of failure of the formed anastomosis.

[09] Disclosure of the invention

[010] The main technical problem to which the claimed invention is directed is the development of the design of compression rings, which can create optimal conditions for the anastomosis, regardless of the thickness and other features of the connected tissues.

[011] The technical result of the invention is to ensure uniform tissue rejection and scar formation around the entire perimeter of the compression anastomosis.

[012] The specified technical result is achieved in the invention due to the fact that the ring block for compression anastomosis of the hollow organ of the gastrointestinal tract contains a locking ring, a needle ring with protruding needle elements and an intermediate ring. These rings are made with the possibility of coaxial connection when placing an intermediate ring between the locking and needle rings and the engagement of the needle elements on the surface of the locking ring. The intermediate ring is made of an elastic material, providing the possibility of compression when connecting the rings. In this case, the end surface of the locking ring, intended for contact with the connected sections of the hollow organ, has a straight section located closer to the center of the ring and oriented perpendicular to its axis, as well as an inclined section (9) located closer to the periphery of the ring and having a slope in the direction from center to the periphery.

[013] In addition, to achieve a technical result, private embodiments of the invention are provided, according to which:

[014] - the end surface of the locking ring is formed by an inner annular protrusion oriented transverse to the axis of the ring;

[015] - the inclined section is formed by the conical surface of the annular protrusion (4) of the locking ring;

[016] - the inclined section is formed by the curved surface of the annular protrusion of the locking ring;

[017] - the needle elements of the needle ring include locking needle elements configured to pierce the locking ring and the connected sections of the hollow organ with fixation on the locking ring, as well as passage needle elements made to pierce the locking ring and the connected sections of the hollow organ without fixing on the locking ring;

[018] - the intermediate ring has through holes for the passage of the needle elements of the needle ring.

[019] Unlike analogues, the design in question uses an elastic intermediate ring, which, in combination with the described profile shape of the end surface of the locking ring, provides uniform tissue rejection and scar formation even if the wall thickness of the connected parts of the hollow organ is not uniform.

[020] Brief Description of the Drawings

[021] The invention is illustrated by drawings, where:

The figure 1 shows the composition of the block of rings;

The figure 2 shows the design of the locking ring;

The figure 3 shows the construction of the unit assembly when installed on the connected tissue of the tubular organ;

The figure 4 shows the design of the apparatus for applying anastomosis using the claimed unit,

Figure 5 shows an exemplary graph of changes in tissue compression force at different points in the profile of the locking ring.

[022] Structural elements and other objects are indicated in the figures by the following positions:

1 - a locking ring;

2 - an intermediate ring;

3 - needle ring;

4 - inner protrusion of the locking ring;

5 - end surface of the locking ring;

6.7 - connected sections of the tubular organ;

8 - flat section;

9 - inclined section;

10 - needle element;

10a - locking needle element;

10b - passage needle element;

11 - case;

12 - pen;

13 - rotary handle;

14 - rod;

15 - stock;

16 - holes in the intermediate ring.

[023] The implementation of the invention

[024] The claimed block is a set of three compression rings: a locking ring (1), an intermediate ring (2) and a needle ring (3) (see figure 1).

[025] The locking ring (1) (Fig. 2) has a housing with an inner annular protrusion (4) forming an end surface (5) in contact with the connected portions (6.7) of the hollow organ (for example, the intestine). The specified end surface (5) has in the center a straight section (8) perpendicular to the axis of the ring, and closer to the periphery there is an inclined section (9) having a slope directed from the center to the periphery of the ring (1). The inclined portion (9) is preferably formed by the conical surface of the ring. However, it is also possible to perform an inclined section (9) with a curved profile, provided that there is a slope that provides an increase in the gap between the end surface (5) of the ring (1) and the connected sections (6,7) when moving away from the center to the periphery of the ring (1) . The locking ring (1) is made of hard plastic material, for example, polyethylene.

[026] The needle ring (3) has a housing with needle elements (10) protruding perpendicular to the axis, which are located around the perimeter of the ring on its end surface. At the same time, at least part of these elements (10) are retaining (10a). The locking needle elements (10a) are designed both for piercing the locking ring (1) and the fabrics to be connected, and for fixing on the thrust ring (1) during assembly of the block. For this, the pointed tips of the elements (10a) can have lateral protrusions (flanges) that do not allow the tip to exit back from the hole formed in the ring (1). In addition, the ring (3) may have passage needle elements (10b), which are intended only for piercing the locking ring (1) and the connected tissues (6,7). The tips of such elements do not have a flange. The needle ring (3) is made of hard plastic, for example, polyethylene, in which needle elements made of hard metal, for example, stainless steel, are fixed.

[027] The intermediate ring (2) is designed to be placed between the retaining (1) and needle (3) rings. The ring (2) is made of an elastic material, which allows the ring to elastically deform in the assembled state of the block. At the same time, through holes (16) are made in the elastic ring for passing through them needle elements (10) of the needle ring (3). For the manufacture of the intermediate ring (2), for example, a rubber compound can be used.

[028] In the assembled state of the block, the intermediate ring (2) with the jointly connected sections (6.7) of the hollow organ (intestine) is clamped between the retainer (1) and the needle ring (3) so that the needle elements (10a, 10b) pierce the joined tissue (6.7) and locking ring (1). In this case, the locking needle elements (10a) engage with their protrusions for the holes formed in the ring (1).

[029] For applying an anastomosis using the claimed compression ring unit, an apparatus (Fig. 4) is used, comprising a housing (11) with a handle (12) and a rotary handle (13), a tubular rod (14) fixed to the housing (11), and a rod (15) located inside the rod (14).

[030] Before use, the locking ring (1) is installed on the end of the rod (14), and the needle (3) and intermediate (2) rings are fixed on the rod (15). When connecting sections (6.7) of the tubular organ, the apparatus is inserted into its internal cavity. One of these sections (6) is fixed on the rod (14) of the apparatus, and the other on the rings (2) and (3) and the rod (15). When the handle (13) is rotated, the joined sections (6.7) come together, and when the handle (12) is pressed, the needle ring (3) pierces the connected tissues (6.7) and the locking ring (1), passing through the holes (16) into intermediate ring (2). In this case, the intermediate ring (2) is compressed, and the locking needle elements (10a) are fixed on the locking ring (1). Then, the inner part of the connected sections (6.7) of the tubular organ is cut out with a special ring knife, which is part of the apparatus (not shown in the figures).

[031] Thus, the connected sections (6.7) of the hollow organ are sandwiched between the intermediate (2) and locking (1) rings. The holes in the rings (1,2,3) provide the possibility of free extraction of the apparatus and the passage of intestinal contents.

[032] Persistent ischemia occurs in squeezed intestinal wall tissues, leading to necrosis in the zone of maximum compression. Moderately pronounced vascular disorders occur in the zone of moderate compression, which is located on the periphery of the compressed areas. Here there is a fusion and scar formation. Necrotic tissues are rejected together with the compression ring block after a certain period of time and are released naturally.

[033] To eliminate the failure of the anastomosis, it is necessary that the process of tissue rejection and scar formation occur simultaneously along the entire perimeter of the compression anastomosis. Given that the wall thickness of the tubular organs in different patients and in different parts of the intestinal tract may differ, the synchronism of these processes is ensured, on the one hand, by using an elastic connecting ring (2), and on the other hand, by the described profile of the end surface of the locking ring (1) (see figure 2).

[034] Figure 5 shows an exemplary graph of changes in tissue compressive force at different points in the profile of the locking ring. On the graph, F is the compressive force at a specific point on the surface of the locking ring, and L is the distance of the surface point from the center of the ring. The graph shows that on a flat section (8) of the ring (1), the force remains practically unchanged, tissues are guaranteed to be squeezed in this area, blood circulation in the tissues is absent, and conditions for the development of tissue necrosis are created. In the inclined section (9), when moving away from the center, the compressive force decreases and conditions arise for the tissue fusion process. The actual distance L, at which tissue fusion occurs, depends on various factors, for example, on the wall thickness of the tubular organ at a given point. Thus, the block of rings with the specified profile adapts to specific conditions in the field of compression and ensures the reliability of the formation of a compression anastomosis.

[035] After stitching, the connected sections of the intestine remain connected using a block of rings. After healing of the connected tissues by the type of primary tension and rejection of the pinched tissues, the rings of the block come out naturally.

Claims (6)

1. A block of rings for compression anastomosis of a hollow organ of the gastrointestinal tract, containing a locking ring (1), a needle ring (3) with protruding needle elements (10) and an intermediate ring (2), while these rings (1,2,3 ) are made with the possibility of coaxial connection when placing the intermediate ring (2) between the locking ring (1) and the needle ring (3) and meshing the needle elements (10) over the surface of the locking ring (1), characterized in that the intermediate ring (2) is made of elastic material, providing the possibility of compression when connecting the rings, while the end surface (5) of the locking ring (1), intended for contact with the connected sections (6,7) of the hollow organ, has a straight section (8) located closer to the center of the ring (1) and oriented perpendicular to its axis, as well as an inclined section (9) located closer to the periphery of the ring (1) and having a slope in the direction from the center to the periphery. 2. The block according to claim 1, characterized in that the end surface (5) of the locking ring (1) is formed by an inner annular protrusion (4), oriented across the axis of the ring (1). 3. The block according to claim 2, characterized in that the inclined section (9) is formed by the conical surface of the annular protrusion (4) of the locking ring (1). 4. The block according to claim 2, characterized in that the inclined section (9) is formed by the curved surface of the annular protrusion (4) of the locking ring (1). 5. The block according to claim 1, characterized in that the needle elements (10) of the needle ring (3) include locking needle elements (10a) configured to pierce the locking ring (1) and the connected sections (6,7) of the hollow organ with fixation on the locking ring (1), as well as passage needle elements (10b), made with the possibility of piercing the locking ring (1) and the connected sections (6,7) of the hollow organ without fixing on the locking ring (1). 6. The block according to claim 1, characterized in that the intermediate ring (2) has through holes (16) for passing the needle elements (10) of the needle ring (3).

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