WO2011069427A1 - 一种消化道吻合器吻切装置 - Google Patents

一种消化道吻合器吻切装置 Download PDF

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Publication number
WO2011069427A1
WO2011069427A1 PCT/CN2010/079442 CN2010079442W WO2011069427A1 WO 2011069427 A1 WO2011069427 A1 WO 2011069427A1 CN 2010079442 W CN2010079442 W CN 2010079442W WO 2011069427 A1 WO2011069427 A1 WO 2011069427A1
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Prior art keywords
nail
kiss
digestive tract
elliptical
abutment
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PCT/CN2010/079442
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English (en)
French (fr)
Inventor
彭阳红
周乃康
Original Assignee
Peng Yanghong
Zhou Naikang
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Application filed by Peng Yanghong, Zhou Naikang filed Critical Peng Yanghong
Publication of WO2011069427A1 publication Critical patent/WO2011069427A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32053—Punch like cutting instruments, e.g. using a cylindrical or oval knife
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil

Definitions

  • the invention relates to a digestive tract stapler, in particular to a kiss and cut device of a digestive tract anastomat.
  • Anastomotic fistula and anastomotic stenosis are the two most serious complications of esophageal cancer surgery.
  • the wide application of digestive tract anastomat in esophageal cancer surgery has reduced the occurrence of anastomotic leakage to a certain extent, but did not reduce the probability of anastomotic stenosis.
  • Postoperative anastomotic stenosis is closely related to anastomotic diameter, postoperative local inflammation, and scar contraction.
  • the digestive tract anastomosis adopts end-to-side anastomosis, and the esophageal diameter of the anastomotic canal anastomosis is small: the esophageal diameter is small, which is prone to postoperative anastomotic stenosis.
  • the digestive tract anastomosis uses end-to-side anastomosis in esophageal cancer surgery, which makes the anastomotic and mediastinal tension too important; especially for esophageal cancer, the position is higher.
  • the utility model patent CN2091650U discloses an oblique mouth type anastomosis head of a digestive tract anastomat, which is envisaged that the oblique shaft type knife, the nail seat, the knife seat, the nail seat outer casing and the long axis of the digestive tract stapler are both 15° - 45°, the larger anastomotic area after the kiss is cut, and the occurrence of anastomotic stenosis is reduced.
  • the technical problem to be solved by the utility model is to provide an elliptical gastrointestinal anastomat kiss-cutting device, so that the relevant staff can adopt partial side-to-side anastomosis technique in the implementation of esophageal-anastomosis surgery, and reduce from a certain limit. Risk factors for sputum; At the same time, the elliptical kiss cut surface is used to enlarge the anastomotic inner diameter to prevent postoperative anastomotic stricture.
  • An elliptical digestive tract anastomotic kiss cutting device comprising an anvil base, a central shaft, and a nail chamber assembly.
  • the abutment is composed of a nail base and a nail cap; the abutment of the nail is elliptical, and the center thereof is a connecting rod; the connecting rod is a hollow rod-shaped device, and a circlip is inserted therein, and the inner side of the circlip is provided with a bulge
  • the nail compartment assembly includes a nail chamber, a suture nail, a ring knife, a push nail piece and a nail box assembly shell ⁇ , the kiss cut surface of the nail chamber assembly matches the kiss cut surface of the nail base, and both are oval, ring cutter and push nail
  • the axial cross section of the piece is elliptical; the central axis is composed of a connecting rod and a tie rod; the pulling rod is located at the center of the nail chamber assembly, and the pulling rod is provided with a groove, and when the
  • the abutment surface of the anvil base and the nail chamber assembly are oval, and the ratio of the short axis to the long axis is Sinl5° ⁇ Sin60°.
  • the relative side technique is used to reduce the uneven force of the anastomosis, reduce the tension of the anastomosis and the mediastinum, and reduce the risk factors of sputum from a certain limit;
  • the elliptical design is adopted to increase the anastomosis area and enlarge the anastomosis inner diameter to prevent postoperative anastomotic stricture; 3. Ensure that the dowels are stapled perpendicular to the anastomotic surface, and the binding is true, reducing the probability of occurrence of anastomotic leakage;
  • FIG. 1 is a schematic structural view of a kiss cutting device, including an abutment cap 1, a snap spring 2, a nail base 3, a connecting rod 4, a drawbar 5, a ring cutter 6, a nail chamber and a nail 7, a pusher 8 and a nail Slot 9;
  • Figure 2 is a side view and an A-direction view of the abutment
  • Figure 3 is a side view and a B-direction view of the nail holder cap
  • Figure 4 is a front side view of the circlip, the inner side of the circlip is provided with a protrusion;
  • Figure 5 is a side view and a C-direction view of the abutment body
  • Figure 6 is a front side view and a three-dimensional view of the connecting rod
  • Figure 7 is a side view and a D-direction view of the nail chamber, the annular knife in the nail chamber assembly;
  • Figure 8 is a front side view of the tie rod of the staple cartridge assembly
  • Figure 9 is a side elevational view and an E-direction view of the push plate in the staple compartment assembly. detailed description
  • FIG. 1 An elliptical digestive tract stapler kiss cutting device is shown in Fig. 1, including an anvil seat I, a central shaft, and a nail chamber assembly II.
  • the abutment is composed of a nail cap 1 and a nail body 3; the abutment III of the abutment is elliptical, and the center thereof is a connecting rod 4; the connecting rod 4 is a hollow rod-shaped device as shown in Fig.
  • the inner side of the circlip 2 is provided with a protrusion;
  • the nail compartment assembly comprises a nail compartment and a suture nail 7, a ring cutter 6, a pusher piece 8 and a nail compartment assembly shell ⁇ , a kiss face of the nail compartment assembly and a kiss of the nail seat
  • the facets are matched, all of which are elliptical, and the axial faces of the ring cutter and the pusher nail are elliptical;
  • the central shaft is composed of the connecting rod 4 and the tie rod 5;
  • the pull rod 5 is located at the center of the nail chamber assembly, and the pull rod 5 is provided with a groove for implementation When the esophagus-gastric anastomosis is performed, the groove on the tie rod 5 coincides with the protrusion of the circlip 2, preventing The kiss cutting device rotates during the operation.
  • the stapler of the short-diameter abutment is selected, and the esophageal diameter is the short diameter of the nail;
  • a full-layer purse-string suture is performed along the esophageal wall with a 7ft silk thread at the predetermined resection of the esophageal site to ensure that the suture surface is substantially parallel to the kiss-cut surface, or slightly smaller than the angle of the kiss-cut surface and the longitudinal axis of the esophagus, and is not ligated;

Description

说 明 书
一种消化道吻合器吻切装置 技术领域
本发明涉及一种消化道吻合器， 特别是一种消化道吻合器的吻切装置。
技术背景
吻合口痿及吻合口狭窄是食管癌手术两个最为严重的并发症。消化道吻合器 在食管癌手术中广泛的应用，在一定程度上降低了吻合口痿的发生，但并未减少 吻合口狭窄的概率。术后吻合口狭窄的发生与吻合口直径、术后局部炎症， 以及 瘢痕收缩有密切联系。消化道吻合器采用端一侧吻合，吻合口管径 吻合段食管 管径大小：食管管径小，即容易发生术后吻合口狭窄。吻合口痿发生的原因较多， 其中消化道吻合器在食管癌手术中采用端一侧吻合，致使吻合口背面及纵隔面张 力过大是一个重要因素；尤其是对于食管癌位置较高，而术中胃体积不够大的病 人， 吻合后吻合口张力较大， 发生吻合口痿的危险系数增加。最新研究《食管胃 全周外翻加侧壁延长吻合术防治吻合口狭窄的临床随机对照研究》比较了全周外 翻加侧壁延长吻合组、手工缝合组和器械吻合组等三种手术方式术后吻合口狭窄 的发生概率，结果显示三组患者术后吻合口狭窄发生率分别为 0、9.6%和 19.1 %, 三组间存在显著差异。这也提示扩大吻合口管径能降低吻合口狭窄的发生。实用 新型专利 CN2091650U公布了一种消化道吻合器的斜口管型吻合头， 其设想是斜 口管型刀、 钉座、 刀座、 钉座外套与消化道吻合器长轴均成 15° -45° , 实现吻切 后较大的吻合口面积，减少吻合口狭窄的发生。然而该设想在实践中存在以下问 题： 食管一胃吻合过程中， 采用的是 "订书机" 的原理， 订书机在使用过程中， 吻合方向和受力方向相同， 保证吻合后钉脚垂直订入， 受力均匀； 而实用新型专 利 CN2091650U的斜面与斜面吻合中，由于吻合方向和钽钉受力方向成一定角度， 使得所述钽钉与吻合面成一角度订入，极易造成吻合中钽钉钉脚受力不均，吻合 效果不确切， 容易造成吻合口痿。 发明内容
本实用新型所要解决的技术问题是提供一种椭圆形的消化道吻合器吻切装 置， 使相关工作人员在实施食管-吻合手术中相对性采用了部分侧-侧吻合技术， 从一定限度上降低痿发生的危险因素； 同时采用椭圆形的吻切面，扩大吻合口内 径， 达到预防术后吻合口狭窄的目的。
为达到以上目的， 本实用新型是采取如下技术方案予以实现的：
一种椭圆形的消化道吻合器吻切装置， 包括抵钉座、 中心轴、 钉舱组件。抵 钉座由钉座主体及钉座帽构成； 抵钉座吻切面呈椭圆形， 其中心为连接杆； 连接 杆为空心杆状装置， 其内插设卡簧， 卡簧内侧面设凸起； 钉舱组件包括钉舱、 缝 合钽钉、环形刀、推钉片及钉舱组件外壳 ^， 钉舱组件的吻切面与抵钉座的吻 切面匹配， 均为椭圆形， 环形刀及推钉片的轴向横截面为椭圆形； 中心轴由连接 杆及拉杆共同构成； 拉杆位于钉舱组件的中心， 拉杆上设凹槽， 实施食管 -胃吻 合手术时， 拉杆上的凹槽与卡簧的凸起吻合， 防止手术操作中吻切装置转动。
上述方案中， 抵钉座与钉舱组件吻切面、钉舱及环形刀轴面均呈椭圆形， 其 短轴与长轴之比为 Sinl5°~Sin60°。
本实用新型具有如下优点：
1.相对性采用了部分侧侧吻合技术， 从一定限度上减少吻合口受力不均， 减少吻合口背面及纵隔面张力， 从一定限度上降低痿发生的危险因素；
2.采用椭圆面设计， 增加吻合口面积， 扩大吻合口内径， 达到预防术后吻 合口狭窄的目的； 3. 保证钽钉垂直于吻合面订入， 订合确实， 降低吻合口痿的发生概率；
4.制作工艺成熟， 耗材少， 成本低；
5.可操作性强， 术者易掌握， 使用便捷。 附图说明
图 1为吻切装置的结构示意图， 包括抵钉座帽 1、 卡簧 2、 钉座主体 3、 连 接杆 4、 拉杆 5、 环形刀 6、 钉舱及钽钉 7、 推钉片 8及钉槽 9;
图 2为抵钉座侧面视图及 A向视图；
图 3为抵钉座帽侧面视图及 B向视图；
图 4为卡簧的正侧面视图， 卡簧内侧面设凸起；
图 5为抵钉座主体的侧面视图及 C向视图；
图 6为连接杆的正侧面视图及三维视图；
图 7为钉舱组件中钉舱、 环形刀的侧面视图及 D向视图；
图 8为钉舱组件中拉杆的正侧面视图；
图 9为钉舱组件中推板的侧面视图及 E向视图。 具体实施方式
一种椭圆形的消化道吻合器吻切装置见图 1， 包括抵钉座 I、 中心轴、 钉舱 组件 II。抵钉座由钉座帽 1及钉座主体 3构成； 抵钉座吻切面 III呈椭圆形， 其中心 为连接杆 4; 连接杆 4为空心杆状装置见图 6， 其内插设卡簧 2， 卡簧 2内侧面设凸 起； 钉舱组件包括钉舱及缝合钽钉 7、 环形刀 6、 推钉片 8及钉舱组件外壳 ^， 钉舱组件的吻切面与抵钉座的吻切面匹配，均为椭圆形，环形刀及推钉片的轴面 为椭圆形； 中心轴由连接杆 4及拉杆 5共同构成； 拉杆 5位于钉舱组件的中心， 拉 杆 5上设凹槽， 实施食管-胃吻合手术时， 拉杆 5上的凹槽与卡簧 2的凸起吻合， 防 止手术操作中吻切装置转动。上述方案中， 抵钉座 I与钉舱组件 II吻切面 III、钉 舱及环形刀轴向横截面均呈椭圆形见各图 1-3、 5、 7、 9， 其短轴与长轴之比为 Sinl5°~Sin60
以下结合附图及实施例对本实用新型作进一步的详细说明：
1.游离完毕胃与食管后，根据食管的管径，选择合适短径的抵钉座的吻合器， 食管管径 抵钉座的短径；
2.首先在预定切除食管部位用 7ft丝线沿食管壁做全层荷包缝合，保证缝合面 大致与吻切面平行， 或略小于吻切面与食管纵轴的角度，暂不结扎；
3.切断并去除病变食管，将抵钉座斜行插入食管残端，保证缝合面大致与吻 切面平行， 结扎缝合线线圈并固定于抵钉座中心杆上， 防止抵钉座转动；
4.于胃端选择适当位置置入吻合器主体，将拉杆 5插入连接杆 4中，必要时 旋转吻合器主体， 直至拉杆 5凹槽与中心杆中卡簧凸起吻合， 不能旋转为止（见 10)；
5.旋紧吻合器器身尾端螺丝， 使被吻合的食管和胃紧密靠拢，抵钉座与钉舱 面完全紧密贴合；
6.打开保险闸， 合拢手柄， 实施食管一胃吻合的手术操作；
7.退出吻合器。

Claims

权 利 要 求 书
1. 一种新型的消化道吻合器吻切装置， 包括抵钉座、 中心轴、 钉舱组件； 抵钉座由钉座主体及钉座帽构成； 抵钉座吻切面呈椭圆形， 其中心为连接杆； 连 接杆为空心杆状装置， 其内插设卡簧， 卡簧内侧面设凸起； 钉舱组件包括钉舱、 缝合钽钉、环形刀、推钉片及钉舱组件外壳 ^， 钉舱组件的吻切面与抵钉座的 吻切面匹配， 均为椭圆形， 环形刀及推钉片的轴向横截面为椭圆形； 中心轴由连 接杆及拉杆共同构成； 拉杆位于钉舱组件的中心， 拉杆上设凹槽， 实施食管-胃 吻合手术时， 拉杆上的凹槽与卡簧的凸起吻合， 防止手术操作中吻切装置转动； 其特征在于， 所述的抵钉座及钉舱组件的吻切面呈椭圆形。
2.根据权利要求 1所述的新型的消化道吻合器吻切装置， 其特征在于， 所述 的抵钉座及钉舱组件的吻切面呈椭圆形， 其短轴与长轴之比为 Sinl5°~Sin60°。
3.根据权利要求 1所述的新型的消化道吻合器吻切装置，其特征在于，所述 钉舱面及环形刀均呈椭圆形， 其短轴与长轴之比为 Sinl5°~Sin60°。
4.根据权利要求 1所述的新型的消化道吻合器吻切装置，其特征在于，所述 卡簧内侧面设凸起。
5.根据权利要求 1所述的新型的消化道吻合器吻切装置，其特征在于，所述 的拉杆上设凹槽。
PCT/CN2010/079442 2009-12-10 2010-12-06 一种消化道吻合器吻切装置 WO2011069427A1 (zh)

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CN104220011A (zh) * 2012-02-24 2014-12-17 广州医科大学附属第二医院 一种外科用吻合器及利用该吻合器的吻合方法
CN103405258A (zh) * 2013-08-23 2013-11-27 刘忠臣 椭圆形不等长吻合钉翻盖三明治式管状吻合器
CN103405259A (zh) * 2013-08-23 2013-11-27 刘忠臣 椭圆形不等长吻合钉翻盖管状吻合器
CN107854151B (zh) * 2017-12-13 2024-02-02 山东省医学科学院附属医院 一种磁力吻合器的下拉式装配工具
CN110974330B (zh) * 2019-12-09 2020-10-30 杭州市第一人民医院 一种经口腔置入的折叠式管型吻合器钉砧座

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US4047654A (en) * 1976-06-23 1977-09-13 Alfredo Alvarado Surgical stapler
CN2036406U (zh) * 1988-08-09 1989-04-26 郑锡良 胆肠吻合器
CN2091650U (zh) * 1991-06-08 1992-01-01 韩鸣 消化道吻合器的斜口管型吻合头
US5205459A (en) * 1991-08-23 1993-04-27 Ethicon, Inc. Surgical anastomosis stapling instrument
US20030144675A1 (en) * 2001-12-14 2003-07-31 Enrico Nicolo Surgical anastomotic devices

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4047654A (en) * 1976-06-23 1977-09-13 Alfredo Alvarado Surgical stapler
CN2036406U (zh) * 1988-08-09 1989-04-26 郑锡良 胆肠吻合器
CN2091650U (zh) * 1991-06-08 1992-01-01 韩鸣 消化道吻合器的斜口管型吻合头
US5205459A (en) * 1991-08-23 1993-04-27 Ethicon, Inc. Surgical anastomosis stapling instrument
US20030144675A1 (en) * 2001-12-14 2003-07-31 Enrico Nicolo Surgical anastomotic devices

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