WO2014101581A1 - 微创手术用工作套管 - Google Patents

微创手术用工作套管 Download PDF

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Publication number
WO2014101581A1
WO2014101581A1 PCT/CN2013/087285 CN2013087285W WO2014101581A1 WO 2014101581 A1 WO2014101581 A1 WO 2014101581A1 CN 2013087285 W CN2013087285 W CN 2013087285W WO 2014101581 A1 WO2014101581 A1 WO 2014101581A1
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WO
WIPO (PCT)
Prior art keywords
channel
working
sheath
casing pipe
instrument
Prior art date
Application number
PCT/CN2013/087285
Other languages
English (en)
French (fr)
Inventor
林超
Original Assignee
上海林超医疗设备科技有限公司
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 上海林超医疗设备科技有限公司 filed Critical 上海林超医疗设备科技有限公司
Priority to EP13868640.7A priority Critical patent/EP2939620A4/en
Publication of WO2014101581A1 publication Critical patent/WO2014101581A1/zh

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • 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
    • A61B17/3209—Incision instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B2017/3454—Details of tips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
    • A61B2017/3466—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals for simultaneous sealing of multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
    • A61B2017/3486—Balloon

Definitions

  • the present invention relates to a minimally invasive surgical instrument, and more particularly to a surgical working cannula for use in minimally invasive surgery, such as laparoscopy.
  • open surgery is usually used at home and abroad, but open surgical resection is traumatic, with more bleeding, and the patient suffers a lot of pain and slow recovery.
  • the minimally invasive surgery has small wounds, less bleeding, less pain, and relatively quick recovery. Therefore, with the development of medical technology, open surgical resection is gradually replaced by minimally invasive surgery.
  • laparoscopic techniques are performed by puncturing or small incision in the patient's abdominal wall, placing a laparoscopic instrument from the puncture work cannula, filling the abdominal cavity or the extraperitoneal cavity with gas, and performing the removal or repair of the organ under the supervision of the television.
  • Laparoscopy Technology is an important milestone in the history of medical development in the 20th century.
  • minimally invasive surgery in order to reduce the abdominal wall damage of the patient and to take into account the postoperative aesthetic effects, for example, puncture a working cannula at the umbilical circumference of the abdominal wall, placing a laparoscope and two instruments, can complete an easier operation, such as the abdominal cavity Endoscopic cholecystectomy, transabdominal nephrectomy, etc.
  • the single-hole puncture cannula can only be surgically incision and then placed in each layer of the abdominal wall tissue.
  • the full soft puncture device supports the incision with poor force, such as the incision 3, 5 cm.
  • the technical problem to be solved by the present invention is to provide a working cannula for minimally invasive surgery that overcomes the aforementioned drawbacks of prior art working cannulas, which can accommodate the needs of minimally invasive surgery of multiple types and methods.
  • Another technical problem to be solved by the present invention is to provide a work casing that is safer, more operational, and flexible.
  • a working cannula with a puncture channel for a single-hole laparoscope including a sheath body, a silicone sleeve, a multi-channel cap and a multi-channel leather pad.
  • the sheath is fitted with the silicone sleeve; the multi-channel cap is connected to the silicone sleeve; and the multi-channel leather pad is located under the multi-channel cap.
  • the sheath body comprises three parts, and the upper end of the sheath body has a circular cross section for connecting with the multi-channel cap.
  • the middle portion of the sheath body has a semi-annular cross section, and the inner side of the lower end sheath tail has a puncture channel to form a puncture blade insertion opening.
  • the middle portion of the semi-annular sheath is rigid, and the silicone sleeve is soft.
  • the middle portion of the semi-annular sheath body is fitted with a silicone sleeve to form a half wall which is rigid, and the half wall is in the middle of a soft working sleeve.
  • the middle portion of the semi-annular sheath is at an angle to the sheath tail.
  • the multi-channel cap is provided with a plurality of instrument access channels and a track for lateral sliding of the instrument channels.
  • Each operation channel can be moved along the track.
  • the shape and number of the operation channel and the slide track can be set according to the operation requirements. For example, multiple operation tracks can be arranged in parallel, and each track can be arranged in a rectangular or semi-annular shape, and each track can accommodate One operating channel or multiple.
  • the shape of the track can be set as needed so that the instrument channel can be flexibly distributed within the multi-channel cap to meet the needs of multi-device operation.
  • the multi-channel cap is further provided with a carbon dioxide intake passage.
  • the lower end of the silicone sleeve contains a balloon to prevent the working sleeve from coming out of the incision.
  • the multi-channel cap includes an anti-reflux gas injection hole or valve for injecting the air bag at the lower end of the silicone sleeve.
  • the multi-channel leather pad is located under the multi-channel cap, the leather pad is a soft elastic body, and the carbon dioxide air inlet channel and the plurality of instrument access channels are connected to the channels in the multi-channel cap.
  • the multi-channel leather pad is pleated and can be stretched or shrunk as the operating channel moves, thereby blocking the air in the middle of the casing and outside the cap.
  • the pleats of the multi-channel leather pad may be, for example, accordion-style pleats having a V or U cross section.
  • the lower end of the operation channel is provided with a duckbill-shaped gas leakage preventing flap.
  • the present invention provides a working cannula for minimally invasive surgery having a smaller aperture, multiple operational channels, a larger operating space, sufficient support, and a puncture channel. Because there is a puncture channel for the puncture knife to pass, it has sufficient incision force, and can directly puncture into the body cavity after injecting carbon dioxide gas, and it is not necessary to cut the layers of the tissue, and it is not easy to damage the internal organs of the body cavity, and the wound is small and relatively safe; With multiple operating channels, it can accommodate multiple operating instruments, and more surgical methods and types can be used to meet the needs of more complex operations. Slide channels are provided on the multi-channel caps for the operating channels.
  • the shape and number of the orbital movement, the operation channel and the sliding track can be set according to the operation requirements, so that the operation between the surgical instruments can be coordinated to avoid mutual interference and mutual obstruction; the middle portion of the rigid sheath and the soft silicone sleeve are embedded. Combined with the middle of the working sleeve, it can support the maximum operating space of the instrument and the flexibility of operation; a multi-channel leather pad is arranged under the multi-channel cap, and the multi-channel leather pad is soft and pleated, with the operation channel
  • the activity stretches or shrinks to prevent air leaks. Operational pass
  • the lower end of the track is provided with a duckbill-shaped leak-proof flap to prevent air leakage.
  • the angle between the tail of the sheath and the middle is easy to install the puncture knife and prevent it from coming out during the operation.
  • the positive effect of the invention is that the carbon dioxide gas can be injected directly into the abdominal cavity, and the damage to the tissue is small and safe; the rigid semi-annular puncture cannula and the soft silicone channel are combined into a working sleeve.
  • the maximum operating space of the instrument supported by the rigid puncturing device and the convenient operation of the soft puncturing device; the middle of the semi-annular sheath body, the operation space of the instrument is large, and the instrument channels are dispersedly arranged, for example, from the cross section, up and down, and Sliding along the track, for example, sliding left and right, preventing the two hands from colliding.
  • the two instruments in and out of the channel are arranged up and down (in the upper and lower directions in the cross section of the figure), and the corresponding two slides are arranged in parallel, the doctor operates with two hands, and the instruments do not interfere with each other.
  • the operation is simple and convenient.
  • the lower end of the silicone sleeve prevents the working sleeve from coming out of the incision.
  • FIG. 1 is a schematic illustration of a working sleeve with a puncture channel in accordance with one embodiment of the present invention.
  • FIG. 1 is a schematic view showing the structure of an annular sheath body according to an embodiment of the present invention
  • FIG. 2 is a schematic view showing the structure of a semi-annular sheath body according to an embodiment of the present invention
  • FIG. 3 is a schematic view of a multi-channel silicone pad structure and a cap-and-sheath connection according to an embodiment of the present invention
  • FIG. 4 is a schematic view of a multi-channel cap and a multi-channel silicone pad structure according to an embodiment of the present invention
  • FIG. 7 is a schematic view of a surgical puncture of a puncture cannula according to an embodiment of the present invention.
  • Figure 8 is a schematic illustration of the removal of the puncture knife after successful puncture in accordance with an embodiment of the present invention.
  • Figure 1 shows a working sleeve in accordance with one embodiment of the present invention. Includes sheath 2, silicone sleeve 6, multi-channel cap 9 and multi-channel pad. Wherein, the sheath 2 is fitted with a silicone sleeve, the multi-channel cap is fitted with a silicone sleeve; the multi-channel pad is located below the multi-channel cap, not shown in Figure 1, and will be discussed below.
  • Figure 2 shows a front view of a sheath 2 comprising a sheath upper end 1, a middle 2 and a sheath tail 3.
  • the upper end 1 of the sheath has a circular cross section.
  • Figure 3 is a side elevational view of the sheath 2, the upper end of the sheath 4 ( 1 ) is annular, the cross section includes three parts, and the middle portion of the sheath 2 is semi-annular in cross section, showing that the sheath 3 has a puncture channel ( 5), that is, the puncture knife insertion port.
  • a puncture channel 5
  • Figure 4 is a front elevational view showing the connection of the multi-channel pad 11 and the multi-channel cap 9 to the instrument channel 8 at the upper portion of the working channel.
  • the instrument channel 8 passes through a multi-channel cap 9 and a multi-channel pad 11, which is rigid and can be made, for example, of hard plastic, which is provided with a plurality of openings for the passage of the instrument channel 8, a multi-channel cap 9 is provided with a multi-channel leather pad 11 below, the multi-channel leather pad 11 is a leak-proof soft pleat body, the pleat cross-section shown in the figure is V-shaped, and the multi-channel leather pad 11 can be made of gas-proof silicone. .
  • the end of the instrument channel 8 is provided with a leak-proof flap 12, which may for example be a duckbill valve.
  • FIG. 5 shows a top view of the multi-channel cap 9 and multi-channel pad 11 in accordance with the present invention.
  • a top view of the multi-channel cap 9 which includes an opening for the carbon dioxide inlet passage 7 and three instrument channel rails 10.
  • the three tracks 10 are parallel to each other and the instrument channel 8 can pass through the track 10 and can slide left and right within the track 10.
  • the picture to the right shows a top view of the multi-channel leather pad with a carbon dioxide inlet and three instrument channels 8 in the multi-channel cap.
  • each instrument channel track 10 has an instrument channel 8 therein, and each instrument channel 8 can be slid in the respective track 10, along the track 10 depending on the operation of the surgical instrument. .
  • three parallel rails 10 are provided, the mutually separate and parallel rails 10 being arranged such that the instrument channels 8 can both move along the track and maintain a reasonable separation distance between the active instrument channels 8, as shown in the image to the right. As shown, the positions of the three instrument channels 8 are dispersed from one another, preventing mutual interference obstruction during operation of the instrument.
  • the number and shape of the tracks 10, the number of channels, and the shape can be set according to actual surgical needs. For example, only two operating channels and two operating tracks can be provided for coordinated work by left and right hands.
  • the operation track may be a parallel strip shape, or may be a parallel or a dispersed semi-ring shape or the like.
  • FIG. 6 is a top plan view of a multi-channel cap in accordance with the present invention.
  • the multi-channel cap 9 is provided with three instrument channel rails 10, each of which is in the shape of a circular intermediate rectangle at both ends, one of which has an instrument passage 8 in each of the rails, and the instrument passage 8 can be in the rail 10 Move up and down (up and down direction in the figure).
  • the multi-channel cap 9 is further provided with a carbon dioxide inlet passage 7 and a gas injection hole 14.
  • the gas injection hole 14 can also be provided as a backflow prevention gas injection valve for feeding the silicone sleeve 6 as shown in FIG.
  • the lower bladder 15 is inflated to prevent the working sleeve from coming out of the slit.
  • the puncture knife and sheath are also shown schematically in the figures.
  • FIG. 7 and 8 are schematic views of a use in accordance with an embodiment of the present invention.
  • a surgical puncture is performed using a multi-channel semi-annular puncture cannula with a puncture channel.
  • the carbon dioxide gas is injected into the abdominal cavity using a pneumoperitoneum, and the puncture knife 13 (Fig. 1) is inserted into the sheath end of the multi-channel semi-annular working sleeve with the puncture channel, and the puncture enters the abdominal wall.
  • Figure 8 shows a diagram in accordance with the present invention After the puncture into the abdominal cavity of the working cannula in Fig. 7, the puncture knife 13 is pulled out, the cannula of the present invention is rotated, rotated into the abdominal cavity, and surgery is started.
  • the instrument channels 8 are arranged in a dispersed manner as viewed in cross section, for example, the up and down misalignment of the cross-sectional angles is shown in FIG. There is a traversing elliptical track on the multi-channel cap, and the instrument channel can slide in the track.
  • the left and right hand instruments do not interfere with each other, preventing the instruments from crossing and reducing the collision of the instruments.
  • the operation is simple and convenient, and the flexibility of two-hand operation is increased. Provide a convenient minimally invasive surgical equipment for doctors to carry out difficult surgery.

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Abstract

一种微创手术用工作套管，包括：鞘体（2）、硅胶套管（6）、多通道帽（9）和多通道皮垫（11）。多通道帽（9）和多通道皮垫（11）可供多个器械通道（8）通过。多通道帽（9）和多通道皮垫（11）上还有供二氧化碳气体通道（7）通过的开口。多通道帽上设有多个轨道（10），供器械通道（8）左右移动。多通道帽（9）上还有注气孔（14）或阀用于给硅胶套管（6）下端的气囊（15）充气。多通道皮垫（11）呈皱褶状，截面可呈V形或u形。鞘体（2）与硅胶套管（6）嵌合形成软硬结合的工作套管中部。鞘体（2）的尾部设有穿刺通道（5），可以供穿刺刀通过，鞘体（2）的尾部与鞘体（2）的中部呈一定角度。该工作套管提供了直接穿刺的可能性、足够的支撑力和较大的操作空间，具有操作灵活性、防漏气和防脱出功能，克服了现有的工作套管对微创手术的种类和方法的限制，可以满足较复杂的微创手术的要求。

Description

说明书 微创手术用工作套管
技术领域
本发明涉及一种微创手术器材， 具体涉及一种在微创手术中， 例如腹腔镜中使用的 手术工作套管。
背景技术
对外科手术， 国内外以前通常采用开放性手术， 但开放性手术切除术创伤大， 出血 多， 病人痛苦大， 恢复慢。而微创手术的伤口小， 出血少， 病人痛苦小， 恢复相对较快， 因此随着医学科技的发展， 开放性手术切除术逐渐被微创手术取代。例如， 腹腔镜技术 通过在病人腹壁穿刺或小切口， 从穿刺工作套管置入腹腔镜器械， 用气体充盈腹腔或腹 膜外腔， 在电视监视下， 完成脏器的切除或修复手术， 腹腔镜技术是 20世纪医学发展 史上的重要里程碑。
近年来出现的微创手术， 为了减少病人腹壁损伤和考虑到术后美观效果， 例如， 在 腹壁脐周穿刺一个工作套管， 放置腹腔镜及两个器械， 可完成较容易的手术， 如腹腔内 胆囊切除、经腹腔途径肾切除等。但单孔穿刺套管只能手术切开腹壁组织各层后再放入， 全软性穿刺器支撑切口力度差， 如切口 3， 5厘米。放入全软性穿刺器切口通道不到 3厘 米操作空间； 硬性穿刺器可以把 3厘米切口支撑到 3， 5厘米， 增加操作空间， 但是硬性 管状使操作极为不便。从单孔穿刺套管进入腹腔的器械因受可操作空间的限制， 医生两 手同时操作时， 器械移动操作易互相干扰、 相互阻碍， 非常不便， 而且因不能放入第三 把器械， 使手术方法及手术种类受到很大限制， 无法完成较复杂的手术。 为了两手操作 方便， 又需尽量增大圆形工作套管的孔径， 孔径的增大对腹部损伤相应增大。
发明内容
本发明要解决的技术问题是提供一种微创手术用的工作套管，其能克服现有工作套 管的上述缺陷， 其能够适应多个种类和方法的微创手术需要。
本发明要解决的另一个技术问题是， 提供一种更安全、更具有操作空间和灵活性的 工作套管。
为达到上述目的， 采用的技术方案是： 一种单孔腹腔镜用带穿刺通道的工作套管， 包括鞘体、 硅胶套管、 多通道帽和多通道皮垫。
其中， 鞘体与硅胶套管嵌合； 多通道帽与硅胶套管连接； 多通道皮垫位于多通道帽 下方。 优选地， 鞘体包括三个部分， 鞘体上端横截面呈环形， 用于与多通道帽连接， 鞘体 中部横截面呈半环形， 下端鞘尾内侧有穿刺通道， 形成穿刺刀片插入口。
优选地， 所述半环形鞘体中部为硬性， 硅胶套管为软性。
优选地， 所述半环形鞘体中部与硅胶套管嵌合成半壁呈硬性， 半壁呈软性的工作套 管中部。
优选地， 半环形鞘体中部与鞘尾之间呈角度。
优选地， 多通道帽置有多个器械进出通道和供器械通道横向滑动的轨道。各操作通 道可以沿轨道移动， 操作通道及滑动轨道的形状和数量可以根据手术需要设置， 例如， 多个操作轨道可以平行设置， 每个轨道可以呈类长方形或半环形设置， 每个轨道可以容 纳一个操作通道或多个。可以根据需要设置轨道的形状， 使得器械通道可以在多通道帽 内灵活分布， 满足多器械操作的需要。
优选地， 多通道帽上还设置有二氧化碳进气通道。
优选地， 硅胶套管下端含有气囊， 以防止工作套管脱出切口。
优选的， 多通道帽包括抗反流注气孔或阀门， 给硅胶套管下端的气囊注气。
优选地， 多通道皮垫位于多通道帽下方， 皮垫为软弹性体， 设有二氧化碳进气通道 和多个器械进出通道与多通道帽中的通道相衔接， 相对应。
优选地， 多通道皮垫呈褶皱状设计， 可以随着操作通道的移动而舒展或皱縮， 从而 隔断套管中段与帽外的空气。
优选地， 多通道皮垫的褶皱可以例如是手风琴式褶皱， 横截面呈 V或 U形。
优选地， 操作通道下端设有有鸭嘴形防漏气皮瓣。
因此，本发明提供的用于微创手术的工作套管，其具有较小的孔径、多个操作通道， 较大的操作空间，足够的支撑力，并带有穿刺通道。由于具有穿刺通道可供穿刺刀通过， 其具有足够的切口力度， 在注入二氧化碳气体后可以直接穿刺进入体腔， 不必要切开组 织各层， 不容易损伤体腔内脏器， 伤口较小且比较安全； 由于具有多个操作通道， 可以 容纳多个操作器械， 可以使用更多的手术方法和种类， 满足较复杂手术的需要； 为操作 通道在多通道帽上设置了滑动轨道， 各操作通道可以沿在轨道移动， 操作通道及滑动轨 道的形状和数量可以根据手术需要设置， 如此手术器械之间的操作协调进行， 避免互相 干扰、 互相阻碍的状况； 硬性的鞘体中部与软性的硅胶套管嵌合组成工作套管中部， 既 可以支撑器械的最大操作空间，又有操作的灵活性；在多通道帽下面设置了多通道皮垫， 多通道皮垫为软性呈褶皱状， 随着操作通道的活动而舒展或皱縮， 以防漏气。 操作通 道下端设有有鸭嘴形防漏气皮瓣， 防止漏气。 鞘体尾部与中部之间呈角度， 既便于安 装穿刺刀， 又可以在手术中防脱出。
本发明的积极效果是：可先注入二氧化碳气体后直接穿刺进入腹腔，对组织损伤小、 安全； 硬性半环形穿刺套管和软性硅胶通道组合成工作套管。既有硬性穿刺器支撑的器 械最大操作空间， 又有软性穿刺器的操作方便性； 半环形鞘体中部， 器械操作空间大， 器械通道分散排列， 例如从横截面看是上下排列， 并可沿轨道滑动， 例如左右滑动， 防 双手相碰撞.两器械进出通道呈上下 （指图中横截面中的上下方向） 错位排列， 且相应 的两滑道平行设置， 医生两手操作， 器械互不干扰， 操作简单方便。 硅胶套管下端气囊 防止工作套管脱出切口。 附图说明
以下以附图说明和具体实施方式对本发明作进一步说明。
图 1为根据本发明的一个实施例的带有穿刺通道的工作套管示意图。
图 1为根据本发明的一个实施例的环形鞘体结构示意图；
图 2为根据本发明的一个实施例的半环形鞘体结构示意图；
图 3为根据本发明的一个实施例的多通道硅胶垫结构示意图及帽鞘连接示意图； 图 4为根据本发明的一个实施例的多通道帽俯视图及多通道硅胶垫结构示意图； 图 5为根据本发明的一个实施例的多通道帽器械通道和轨道结构示意图。
图 7为根据本发明的一个实施例的穿刺套管手术穿刺示意图
图 8为根据本发明的一个实施例的穿刺成功后拔出穿刺刀，旋转拨正穿刺套管示意 图。
图中： 1 鞘体上端； 2 鞘体中部； 3 鞘尾； 4鞘体上端； 5 穿刺刀插入口； 6 硅胶 套管； 7 二氧化碳进气通道； 8 器械通道； 9 多通道帽； 10 通道轨道； 11多通道皮垫； 12 防漏气皮瓣； 13穿刺刀； 14 帽上气囊抗反流注气孔或阀门； 15气囊。
具体实施方式
如图 1所示为根据本发明一个实施例的工作套管。 包括鞘体 2， 硅胶套管 6， 多通 道帽 9和多通道皮垫。 其中， 鞘体 2与硅胶套管嵌合， 多通道帽与硅胶套管嵌合； 多通 道皮垫位于多通道帽下方， 在图 1中未示出， 将在下文讨论。
图 2所示为一个鞘体 2的正面视图， 鞘体包括鞘体上端 1， 中部 2和鞘尾 3。 图中 鞘体上端 1横截面呈环形。 图 3所示为鞘体 2的侧面视图， 鞘体上端 4 ( 1 ) 呈环形， 横截面呈包括三个部分， 鞘体中部 2横截面呈半环形， 示出鞘尾 3带有穿刺通道 （5)， 即穿刺刀插入口。
图 4所示为位于工作通道上部的多通道皮垫 11和多通道帽 9与器械通道 8的连接 的正面示意图。 如图 4所示， 器械通道 8通过多通道帽 9和多通道皮垫 11， 多通道帽 为硬性， 可以例如由硬塑料制成， 其设置有多个开口供器械通道 8通过， 多通道帽 9下 面设有多通道皮垫 11， 多通道皮垫 11为防漏气软性褶皱体， 图中示出的褶皱横截面呈 V形， 多通道皮垫 11可以由防漏气的硅胶制成。 此外器械通道 8的尾端设有防漏气皮 瓣 12， 其可以例如是一个鸭嘴阀。
图 5所示为根据本发明的多通道帽 9与多通道皮垫 11的一个俯视图。如左图所示， 是多通道帽 9的俯视图，多通道帽 9包括供二氧化碳进气通道 7通过的开口和三个器械 通道轨道 10。 三个轨道 10相互之间平行， 器械通道 8可以通过轨道 10并可以在轨道 10 内左右滑动。 右图所示为多通道皮垫的俯视图， 多通道帽中置有二氧化碳进气通道 和三个器械通道 8。 从图中可以看出， 此实施例中， 每个器械通道轨道 10中具有一个 器械通道 8， 每个器械通道 8可以在各自的轨道 10中， 根据手术器械操作的需要， 沿 轨道 10 左右滑动。 根据需要， 设置了三个平行的轨道 10， 相互分开且平行的轨道 10 的设置使器械通道 8既可以沿轨道活动，又可以使活动的器械通道 8之间保持合理的间 隔距离， 如右图所示， 三个器械通道 8的位置彼此分散， 防止了器械操作时相互的干 扰阻碍。 可以根据实际手术需要设置轨道 10数量和形状、 通道数量和形状。 例如可以 仅设两个操作通道及两个操作轨道， 供左右手协调工作。 又如， 操作轨道可以为平行的 长条形， 也可以为平行或分散的半环形等。
图 6为根据本发明的多通道帽俯视图。从图 5可以看出多通道帽 9上面设置有三个 器械通道轨道 10， 每个轨道形状为两端圆形中间长方形， 每个轨道中有一个器械通道 8 通过， 器械通道 8可以在轨道 10中上下移动（图中的上下方向）。此外多通道帽 9上还 设置有二氧化碳进气通道 7和注气孔 14.注气孔 14也可以设置为一个防反流的注气阀 门， 其用于给如图 1中所示的硅胶套管 6下的气囊 15充气， 以防止工作套管脱出切口。 图中还示意性地示出了穿刺刀和鞘。
图 7和图 8所示为根据本发明实施例的一个使用示意图。如图 7中所示， 将本发明 的工作套管用于单孔腹腔镜进行手术时，用带有穿刺通道的多通道半环形穿刺套管进行 手术穿刺。其在使用时， 使用气腹针向腹腔注入二氧化碳气体后， 带穿刺通道的多通道 半环形工作套管鞘尾内插入穿刺刀 13 (图 1 )， 穿刺进入腹壁。 图 8所示为根据本发明 的图 7中的工作套管在穿刺进入腹腔后， 拔出穿刺刀 13， 将本发明的套管拨正， 旋转 进入腹腔， 开始手术。
这样，既保证的手术的安全，减少对腹壁及器官的损伤，可兼顾了术后伤口的美观。 改变了目前单孔穿刺套管只能手术切开组织各层后再放入的缺陷。 且因为鞘体 2硬性， 有支撑作用， 硅胶套管 6有弹性。 所以器械既有较大操作空间， 又有操作灵活性。 器械 通道 8从横截面上看， 呈分散排列， 例如图 4中示出横截面角度的上下错位分布。 并有 多通道帽上的横行椭圆形轨道，器械通道可以在轨道中滑动。因此医生两手同时操作时， 左右手器械互不干扰， 防止器械交叉、 减少器械碰撞。 操作简单方便、 增加了两手操作 的灵活性。 给医生开展高难度手术提供一种方便的微创手术器材。

Claims

权利要求书
1、 一种微创手术用的工作套管， 其特征在于： 包括鞘体， 硅胶套管、 多通道帽和 多通道皮垫。
2、 如权利要求 1所述的工作套管， 其特征在于， 所述鞘体的下端鞘尾内侧有穿刺 通道， 形成穿刺刀片插入口。
3、 如权利要求 1或 2所述的工作套管， 其特征在于， 所述鞘体的中部为硬性， 硅 胶套管为软性， 所述鞘体的中部与硅胶套管组成半壁呈硬性， 半壁呈软性的工作套管中 部。
4、 如权利要求 1或 2所述的工作套管， 其特征在于， 所述鞘体中部的横截面呈半 环形与鞘尾之间呈 α角。
5、 如权利要求 1或 2所述的工作套管， 其特征在于， 所述多通道帽置有二氧化碳 进气通道、 多个器械进出通道和多个通道轨道。
6、 如权利要求 5所述的工作套管， 其特征在于， 所述多个通道轨道之间平行设置， 所述器械通道可以在器械通道轨道中滑动。
7、 如权利要求 1或 2所述的工作套管， 其特征在于， 所述硅胶套管下端含有气囊。
8、 如权利要求 5所述的工作套管， 其特征在于， 所述多通道帽包括抗反流注气孔 或阀门， 给所述硅胶套管下端的气囊注气。
9、 如权利要求 1所述的工作套管， 其特征在于， 所述多通道皮垫为软弹性体， 上 端置有二氧化碳进气通道和多个器械进出通道。
10、如权利要求 1或 8所述的工作套管，其特征在于，所述多通道皮垫呈褶皱设计， 横截面呈 V形或 U形。
11、 如权利要求 5或 9所述的工作套管， 其特征在于， 所述多个器械通道呈分散设 置；
12、 如权利要求 9所述的工作套管， 其特征在于， 所述器械进出通道下端有鸭嘴型 防反流皮瓣。
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