WO2020133712A1

WO2020133712A1 - Device for controlling uterine movement and closing vagina through abdomen for laparoscopic radical cervical for cancer surgery

Info

Publication number: WO2020133712A1
Application number: PCT/CN2019/077777
Authority: WO
Inventors: 李桂林; 金欣
Original assignee: 徐州市妇幼保健院
Priority date: 2018-12-28
Filing date: 2019-03-12
Publication date: 2020-07-02
Also published as: CN109589162A; ZA202000378B

Abstract

A device for controlling uterine movement and closing the vagina through the abdomen for laparoscopic radical surgery for cervical cancer, comprising a laparoscopic puncture device (2) and a uterine body back-and-forth movement assembly (1); the laparoscopic puncture device (2) comprises a puncture sheath (6), wherein the puncture sheath (6) penetrates human tissue (5) and extends into the abdomen, and the puncture sheath (6) may be bendably adjusted; the uterine body back-and-forth movement assembly (1) comprises an operation rod body (7), and the operation rod body (7) passes through the puncture sheath (6) and enters the abdomen; an end of the operation rod body (7) that is located within the abdomen is provided with a uterine body fixing portion (10), the uterine body fixing portion (10) fixing the uterine body (3), while an end of the operation rod body (7) that is located at the exterior of the abdomen is provided with an adjustment portion (11), the adjustment portion (11) adjusting the tightness of the uterine body fixing portion (10). The device for controlling uterine movement and closing the vagina may effectively lift the uterine body (3) and move the uterine body (3) back-and-forth and fully expose the left and right sides of the uterus so that laparoscopic radical surgery for cervical cancer may be performed smoothly without the use of a traditional uterine manipulator.

Description

Laparoscopic radical surgery for cervical cancer via abdominal uterine movement control and vaginal closure device

Technical field

The invention belongs to the field of gynecological minimally invasive surgery, and in particular relates to a device for controlling the movement of the abdomen and the vagina and closing the vagina through the laparoscopic radical operation for cervical cancer.

Background technique

Laparoscopic surgery is increasingly used in my country for the treatment of cervical cancer, and extensive laparoscopic resection of uterine cancer is rapidly developing. However, two newly published studies in the New England Journal of Medicine in October 2018 showed that compared with open surgery, minimally invasive surgery has no advantage in the treatment of cervical cancer, and even has a higher recurrence rate. The conclusion of this study makes it difficult for some laparoscopic treatment doctors. The author also has doubts. Although the scientificity and rigor of their conclusions cannot be doubted, the report only explained the results of laparoscopic and open cervical cancer surgery, but did not explain why such a result is the reason why it is currently unacceptable. Today, endoscopic surgery can completely achieve the same range of operations as laparotomy. An important reason for this result is that a special instrument-uterine lifting device is used in endoscopic surgery.

The cervix was inserted into the uterus through the cervical canal before the operation. During the operation, it was pressed on the cervical cancer focus, and the cervical cancer focus was continuously squeezed and rubbed, causing the cervical cancer cells to enter the microvascular and lymphatic vessels, causing tiny spread and metastasis . After comparing the reported cases, it was found that the distant metastasis in the laparoscopic group was significantly higher than that in the open group. This kind of tiny cell metastasis is difficult to find after the operation. When the obvious distant metastasis is formed, the recurrence rate and mortality rate of endoscopic surgery are higher than those of open surgery. Because this kind of equipment is not needed for laparotomy, it avoids the iatrogenic spread during the operation. Although some laparoscopic doctors said that this spread of laparoscopic surgery may occur, it is necessary to rinse the pelvic cavity with chemotherapy drugs after the operation. However, this method cannot remedy the spread of microscopic cancer, which can be described as a repair.

If endoscopic surgery causes such adverse consequences due to the use of the uterine lifting device, we can take some improvement measures to perform extensive hysterectomy without using the uterine lifting device. However, the uterus can also be lifted, and the left and right sides of the uterus can be fully exposed, allowing extensive surgery to proceed smoothly. It is hoped that such improvements can continue to retain all the advantages of extensive laparoscopic cervical cancer surgery and eliminate the potential adverse risks of laparoscopic cervical cancer treatment, so as to achieve the same good therapeutic effect as extensive laparoscopic surgery. It is very likely that the uterine lifting device will cause adverse consequences of extensive endoscopic cervical cancer resection. The advantages of extensive laparoscopic cervical cancer surgery are obvious, but there are still some disadvantages. Therefore, surgical instruments should be improved, instead of lifting the uterus, and using other instruments instead of lifting the uterus to lift the uterus and close the proximal vagina.

technical problem

In order to overcome the prior art, the uterine device was inserted into the uterus through the cervical canal before the operation. During the operation, it had been pressed on the cervical cancer focus, and the cervical cancer focus was continuously squeezed and rubbed, causing the cervical cancer cells to enter the microvascular and lymphatic vessels. The problem of causing tiny spreading and metastasis problems can achieve extensive hysterectomy without using a cervix, but it can also lift the uterus and expose the left and right sides of the uterus to make the extensive operation smooth. get on.

Technical solution

Laparoscopic radical surgery for cervical cancer includes an abdominal uterine movement control and vaginal closure device, including a laparoscopic puncture device and a uterine body swinging component. The laparoscopic puncture device includes a puncture sheath tube that punctures human tissue and extends into the In the abdominal cavity, the puncture sheath tube can be flexibly adjusted and set, the uterine body swinging assembly includes a joystick body, the joystick body passes through the puncture sheath tube into the abdominal cavity, and one end of the joystick body located in the abdominal cavity is provided with a uterine body A fixing part, the uterine body fixing part fixes the uterus, and an end of the joystick body outside the abdominal cavity is provided with an adjusting part, and the adjusting part adjusts the tightness of the uterine body fixing part.

Further, the joystick body has a long rod structure, and the joystick body is provided with a perforation along the length, and a functional thread is movably inserted in the perforation, and both ends of the functional thread extend to the outside of the perforation, The end of the functional thread located outside the abdominal cavity forms an adjustment portion, and the end of the functional thread located inside the abdominal cavity is connected with a medical suture needle.

Further, the joystick body is a long rod body structure, and the joystick body is provided with a perforation along the length, and a functional thread is movably penetrated in the perforation, and one end of the functional thread passes through one end of the joystick body, and Wrapped in a lasso-like structure and connected to the joystick body, the lasso-like structure forms a uterine body fixing part, and the other end of the functional thread passes out from the other end of the joystick body to form an adjustment part; the function of the adjustment part is pushed and pulled The wire harness adjusts the closed loop size of the lasso structure.

Further, the functional thread is a rigid elastic wire harness.

Further, the noose structure is nested on the uterus, and the noose structure is located at the upper third of the vagina.

Further, the end of the lever body on the side of the adjustment portion of the joystick body is coaxially provided with a wire harness adjustment hole, and an adjustment wire post is provided in the wire harness adjustment hole. In the thread hole through which the functional thread passes, the adjustment thread column adjusts the tightness of the functional thread in the thread hole.

Further, the adjustment wire column is adjusted for axial displacement relative to the joystick body, and the end of the adjustment wire column toward the bottom of the hole of the wire harness adjustment hole is tapered, forming a tapered structure, and the hole of the wire harness adjustment hole The bottom is provided corresponding to the tapered structure. The tapered structure is uniformly provided with a plurality of wire grooves along the circumferential direction, the wire grooves penetrate through the wire holes, and the wire grooves extend toward the tip side of the tapered structure. The shape-shaped structure is divided into several crimping lobes by several wire grooves; by the axial displacement of the adjusting wire column, several of the crimping lobes contract to clamp or loosen the functional wire.

Further, the laparoscopic puncture device includes a puncture sheath tube, and the puncture sheath tube includes a puncture part, a bending part and a stabilizing part connected in sequence, the stabilizing part is connected to the conversion disk of the puncture device, and the puncture part punctures In human tissue, both ends of the curved portion are respectively connected to the puncturing portion and the stabilizing portion, and the puncturing portion is bent relative to the stabilizing portion by the curved portion.

Further, the puncturing portion and the stabilizing portion are both rigid tube structures, and the bending portion is a flexible tube structure.

Further, the curved portion has a double-wall corrugated tube structure, and the curved portion includes a corrugated outer tube in the outer layer and a straight tubular inner core tube in the inner layer, and the inner core tube and the outer tube are fused to form a type .

Beneficial effect

In the present invention, the joystick body passes through the abdominal cavity trocar and enters the abdominal cavity, the uterine body is fixed by the uterine body fixing portion, and the tightness and size of the lasso structure are adjusted by the adjusting portion. The surgeon lifts the outer end of the abdominal cavity by operating the other end of the joystick body Swing the uterus and expose the left and right sides of the uterus to allow the laparoscopic radical surgery for cervical cancer to proceed smoothly without the use of a traditional uterine lifting device. Slide to the middle and upper part of the vagina and tighten it, so that the tumor is enclosed in the tissue to be removed to meet the requirements of tumor-free treatment; and through the abdominal puncture device into the uterine body swinging component, replacing the penetrating device from the vagina and cervical canal The operation method of lifting the uterus can effectively prevent the uterine device from constantly pressing on the cervical cancer foci during surgery, and constantly squeezing and rubbing the cervical cancer foci, causing the cervical cancer cells to enter the microvascular and lymphatic vessels, causing tiny spread And the drawbacks of transfer.

BRIEF DESCRIPTION

Figure 1 is a schematic view of the state of the overall structure of the present invention acting on the uterus;

FIG. 2 is a schematic structural view of the wobble swinging assembly of the present invention;

3 is a partial structural schematic view of the end portion A of the joystick body of the present invention;

4 is a schematic diagram of the three-dimensional structure of the adjusting wire column of the present invention;

Figure 5 is a schematic diagram of the structure of the laparoscopic puncture device of the present invention;

FIG. 6 is a schematic structural diagram of the puncture sheath of the present invention in a completed state;

7 is a schematic structural view of the bending portion of the puncture sheath tube of the present invention;

FIG. 8 is a schematic structural diagram of a wobble swing assembly of a second embodiment of the present invention;

FIG. 9 is a schematic view of the state in which the overall structure of the second embodiment of the present invention acts on the uterus;

10 is a schematic diagram of the position of the fixing portion relative to the uterus in the first and second embodiments of the present invention;

11 is a schematic diagram of a half-section structure of a laparoscopic puncture device according to another embodiment of the present invention;

12 is a schematic diagram of the overall structure of a laparoscopic puncture device according to another embodiment of the invention;

FIG. 13 is a schematic diagram of a puncture sheath in a bent state according to another embodiment of the present invention.

Best Mode of the Invention

As shown in FIG. 1 and FIG. 2, a laparoscopic cervical cancer radical resection device for abdominal uterine movement control and vaginal closure includes a laparoscopic puncture device 2 and a uterine body swinging assembly 1, and the laparoscopic puncture device 2 includes a puncture sheath Tube 6, the puncture sheath tube 6 punctures the human tissue 5 and extends into the abdominal cavity, the laparoscopic puncture device 2 is a common puncture device, and the puncture sheath tube 6 is a flexible tube structure, which can be bent through The puncture sheath can enable medical operation instruments with a certain curvature to smoothly enter the abdominal cavity for operation. The uterine oscillating assembly 1 includes a lever body 7 that passes from the puncture sheath 6 into the abdominal cavity , The end of the joystick body 7 located in the abdominal cavity is provided with a uterine body fixing portion 10, the uterine body fixing portion 10 is fixed to the uterine body 3, the end of the joystick body 7 located outside the abdominal cavity is provided with an adjusting portion 11, the adjustment The portion 11 adjusts the tightness of the uterine body fixing portion 10; the end of the operating lever body 7 located outside the abdominal cavity causes the uterine body in the abdominal cavity to swing circumferentially. 10, including the uterine body 3, the cervix 3b, and the cervical lesion 3a; pass through the abdominal trocar 2 through the joystick body 7 and enter the abdominal cavity, fix the uterine body 3 through the uterine body fixing portion 10, and adjust the fixed portion 10 through the adjusting portion Elasticity, the surgeon lifts and swings the uterus 3 by operating the other end of the joystick body 7 outside the abdominal cavity, and fully exposes the left and right sides of the uterus, allowing the laparoscopic radical cervical cancer surgery without the use of traditional cervix The operation can be carried out smoothly, and the bottom-up operation does not affect the operation range and angle of the top-down instrument, that is, the operation of the operation of the lower end of the uterus 3 and the vaginal stump 5a for other abdominal incisions is extended into the abdominal cavity. Operation, for the bottom-up operation, the joystick body 7 fixes the upper part of the uterus and swings. For the top-down operation mode, the extension of the joystick body into the abdominal cavity will not interfere with the operation of other instruments; and through the abdominal cavity puncture The device extends into the uterine body swinging component, replacing the operation method of lifting the uterus from the vagina and cervical canal into the uterine lifting device, which can effectively avoid the uterine lifting device constantly pressing on the cervical cancer focus 3a during operation and squeezing continuously , Rubbing cervical cancer focus, causing cervical cancer cells to enter the microvessels and lymphatic vessels, causing the drawback of tiny diffusion and metastasis.

As shown in FIG. 8, FIG. 9 and FIG. 10, the joystick body 7 has a long rod structure, and the joystick body 7 is provided with a perforation 8 along the length, and the perforation 8 is movably provided with a function line 9, and the two ends of the functional thread 9 extend to the outside of the perforation 8 respectively, the end of the functional thread 9 located outside the abdominal cavity forms an adjustment portion 11, and the end of the functional thread 9 located inside the abdominal cavity is connected with a medical suture针40. The medical suture needle 40 is a sled needle or a straight needle. The medical suture needle 40 and the functional thread 9 have an integrated structure, and the functional thread 2 is a nylon thread.

The uterine lifting device of the present application can be used together with a laparoscopic puncture device, first puncture the laparoscopic puncturing device with a puncturing sheath core into the abdominal cavity, then take out the puncture sheath core of the laparoscopic puncturing device, and then operate the uterine lifting device by manipulation The free end of the rod body 7 extends into the puncture hole of the laparoscopic puncture device until the medical suture needle located on the functional thread 9 reaches the vicinity of the uterus, and the medical suture needle 40 is clamped with pliers to sew a needle on the uterus and make the functional thread 9 Around the uterus, the forceps will pull the medical suture needle 40 connected with the functional thread 9 out of the patient's body, and knot the functional thread with the medical suture needle 40 side to form a movable The ferrule, which forms the fixed portion 10 that can fit over the uterus, at this time cut the medical suture needle 40 from the functional thread, grip the handle 12 of the uterine swinging assembly, and swing the handle away from the uterus The pull ring of the functional wire 9 is pulled in the direction of the direction, that is, the mediation portion 11 of the free end of the functional wire 9, and as the function 9 is pulled, the movable ferrule at the free end of the joystick body 7 of the uterine oscillating component is continuously reduced until the ferrule The size just fits into the uterus. At this time, tighten the adjustment wire column 14 to clamp the functional wire 9 to avoid loosening of the functional wire. In the subsequent laparoscopic surgery, only by adjusting the angle and length of the uterine lifting device can achieve the purpose of swinging the uterus around to adjust the uterus, so that the surgical field around the uterus is fully exposed to meet the requirements of the operation.

The uterine lifting device of the present application cooperates with a laparoscopic puncture device to send a functional thread with a medical suture needle into the abdominal cavity, and sutures the functional thread 9 on the uterus through the medical suture needle 40, and uses the functional thread 9 to come back and forth Swing the uterus to adjust the position of the uterus and expose the surgical field around the uterus, avoiding the constant squeezing and rubbing of the cervical cancer focus caused by the transvaginal intrauterine lifting device, causing cervical cancer cells to enter the microvessels and lymph Tube, causing technical problems in the spread and metastasis of tiny cervical cancer cells. In addition, after the external uterine lifting device cuts the ligature line after completing all the uterine lifting work, it can also use the remaining thread to pass from the back of the uterus and vagina to the middle and upper part of the ligated vagina, and then knot in front of it to tighten the coil. Close the cut end of the vagina to completely isolate the tumor lesion. Cut the vaginal wall 1 cm below the ligature coil and cut off the uterus. This avoids the implantation and transfer caused by the decontamination of the tumor cells caused by the incision of the vagina in the abdominal cavity, and completely meets the purpose and requirements of the tumor-free technology. This application enables patients to perform safer and more effective laparoscopic cervical cancer radical surgery.

As shown in FIG. 3 and FIG. 4, the end of the lever body 7 on the side of the adjustment portion of the joystick body 7 is coaxially recessed with a harness adjustment hole 15, and an adjustment wire post 14 is provided in the harness adjustment hole 15. Together, they form a wire harness adjusting device for adjusting the tightness of the function wire. The adjusting wire column 14 is axially provided with a wire hole 16 through which the function wire 9 passes. The adjusting wire column 14 adjusts the inside of the wire hole 16 The elasticity of the function line. After the lasso structure 4 is tightly wrapped around the uterus, the functional thread can be tightened and fixed by adjusting the thread column 14 to prevent it from loosening; when adjusting the size of the lasso structure 4, the function can be loosened by adjusting the thread column 14 Line for easy adjustment.

The adjustment wire column 14 is adjusted for axial displacement relative to the joystick body 7. The outer ring of the adjustment wire column includes a thread structure 19, which is set corresponding to the internal thread on the inner wall of the wire harness adjustment hole, and the adjustment is convenient; the adjustment wire column 14 faces the wire harness The end of the adjustment hole 15 on the bottom side of the hole is tapered to form a tapered structure 13. The hole bottom of the harness adjustment hole 15 is corresponding to the tapered structure 13 and also has a tapered structure with the tip side facing the joystick body In the middle of the tapered structure 13, a plurality of wire grooves 17 are evenly provided along the circumferential direction, the wire grooves 17 penetrate the wire holes 16, and the wire grooves 17 extend toward the tip side of the tapered structure 13, the wire grooves The width of is smaller than the diameter of the functional wire, the tapered structure 13 is divided into several crimping lobes 18 by several wire grooves; by the axial displacement of the regulating wire column 14, several of the crimping lobes 18 contract or clamp Functional line 9. When the adjusting wire column 14 is displaced toward the hole bottom side of the wire harness adjusting hole 15, a plurality of crimping lobes 18 are tightened by the conical structure of the hole bottom of the wire harness adjusting hole 15, thereby compressing the functional wire and preventing it from loosening. When adjusting the reverse displacement of the wire column, release the function wire 9. The entire adjustment process is very simple and convenient.

As shown in FIG. 11, FIG. 12, and FIG. 13, a flexible elastic trocar sleeve of a laparoscopic puncture device 2 of the present invention includes a main sleeve 3-2 and a main sleeve 3-2 One end of the tube is connected with a puncture tubular body 3-3. The main body of the puncture tubular body 3-3 is a flexible elastic tube 3-32 made of an elastic material. The flexible elastic tube 3-32 and the main sleeve One end of the 3-2 connection is a fixed root 3-31, the other end of the flexible elastic tube 3-32 is a puncture tip 3-33, and the other end of the main sleeve 3-2 is a closed end 3-21 The puncture hole I3-5 is made in the center of the closed end. The puncture hole I3-5 and the puncture tubular body 3-3 are on the same axis, which is convenient for the puncture sheath core to pass through.

As shown in FIGS. 11 to 13, the flexible elastic trocar sleeve further includes a sealing protective cover 3-1, which makes the trocar sleeve more airtight. A flexible connecting body 3-4 is connected between the sealing protective cover 3-1 and the side wall of the main sleeve 3-2. The flexible connecting body 3-4 can be made of plastic, rubber and other materials. The sealing protective cover 3-1 One end of the opening allows the sealing protective cover 3-1 to be nested on the main sleeve 3-2, the other end of the sealing protective cover 3-1 is the outer closed end 3-11, and the center of the outer closed end has a puncture hole II3 -6, when the sealing protective cover 3-1 is nested on the main sleeve 3-2, the puncture hole II 3-6 is on the same axis as the puncture hole I3-5 and the puncture tubular body 3-3. The inner wall of the sealing protective cover 3-1 and the outer wall of the main sleeve 3-2 are fastened by a snap mechanism, the snap mechanism includes a snap slot 3-8 and a snap slot 3-8 Convex buckle 3-9; the groove 3-8 is made on the outer wall of the main sleeve 3-2, then the convex buckle 3-9 is made on the inner wall of the sealing protective cover 3-1; or The said clip groove 3-8 is made on the inner wall of the sealing protective cover 3-1, and the convex snap 3-9 is made on the outer wall of the main sleeve 3-2. The snap mechanism is used to prevent the sealing protective cover from being loosened when the puncture sheath core is pulled out.

The puncture hole II 3-6 has a sealing film 3-7 with a puncture cut, such as a cross-shaped or rice-shaped cut.

The sealing protective cover 3-1 is made of a soft elastic material, the diameter of the puncture hole II 3-6 is smaller than the outer diameter of the puncture sheath core, the puncture hole II 3-6 is formed with the puncture sheath core passing therethrough The interference fit seal, for example, the outer diameter of the puncture sheath core is 4 mm, and the diameter of the puncture hole II 3-6 is 3 mm.

The puncture hole I3-5 has a sealing film 3-7 with a puncture incision, such as a cross-shaped or rice-shaped incision.

The closed end of the main sleeve 3-2 is made of soft elastic material, the diameter of the puncture hole I3-5 is smaller than the outer diameter of the puncture sheath core, the puncture hole I3-5 and the puncture sheath core passing therethrough Form an interference fit seal.

The outer surface of the puncture tubular body 3-3 is smooth. The fixed root 3-31, the flexible elastic tube 3-32 and the puncturing tip 3-33 of the puncturing tubular body 3-3 are integrally formed of a hard elastic material. The puncture tubular body 3-3 is made of silicone material.

The flexible elastic trocar cannula has a flexible elastic tube body, which is convenient for instruments with angles and radians to enter, easy to adjust, and is particularly suitable for laparoscopic surgery. The flexible elastic tube body of the flexible elastic trocar sleeve has a simple structure and low manufacturing cost. As a disposable medical instrument, it can save a lot of costs. The flexible elastic trocar sleeve uses a flexible connector to connect the protective sleeve to the main sleeve. The structure is simple, easy to use, and has a high value for popularization and application.

Embodiments of the invention

First embodiment: As shown in FIG. 1, FIG. 2 and FIG. 10, the joystick body 7 is a long rod structure, and its end close to the uterine body fixing portion 10 is a curved rod body with a certain curvature, which is The part is a straight rod body to facilitate the swinging of the uterine body 3 in the abdominal cavity. The joystick body 7 is provided with a perforation 8 along the length, and the perforation 8 is movably provided with a functional thread 9 which is A rigid elastic wire harness, such as nylon thread, fishing line, etc., has a certain elasticity and hardness, so that the wire harness can be pushed and pulled from the free end of the functional thread, so that the lasso structure 4 can be expanded or contracted. One end of the joystick body 7 passes out and is wound around a lasso-like structure and then connected to the joystick body 7. The lasso-like structure 4 forms a uterine body fixing portion 10, and the lasso-like structure 4 is inserted into the uterine body 3 after extending into the abdominal cavity On the other hand, the other end of the function wire 9 passes through the other end of the joystick body 7 to form an adjustment portion 11, and the free end of the function wire is also wound into a looped clue to facilitate the operator to pull the function wire, And prevent the harness from slipping; adjust the closed loop size of the lasso structure through the functional harness of the push-pull adjustment section. The lasso structure is sleeved on the uterine body, and the lasso structure is located at the upper third of the vagina to facilitate the operator to deflect the joystick body 7 so that the uterine body can swing, exposing the vision on both sides of the uterine body, It is convenient for physicians to observe and operate.

The device is mainly used for laparoscopic radical surgery for early cervical cancer. During the operation, the joystick body and the associated lasso structure are placed into the pelvis through the lower abdomen puncture hole. The movable coil in front can wrap the uterus, tighten the coil, and pass the joystick body 7 The handle 12 on the end can swing the uterus forward, backward, left, right, and expose the surgical field of view, which facilitates the operation. It can effectively prevent the uterine lifting device from constantly pressing on the cervical cancer focus during the operation, and constantly squeezing and rubbing the cervical cancer focus, causing the cervical cancer cells to enter the microvessels and lymphatic vessels, causing tiny diffusion and metastasis. The coil of the anterior vaginal fornix is slid to the upper third of the middle of the vagina to further close the vaginal cut end, so that the tumor is closed above the cut end, and the vagina is cut off at an appropriate position under the coil to minimize the potential adverse effects of laparoscopic treatment of cervical cancer risk. During the operation, the ligation ring can be slid down to the upper and upper part of the vagina before the vagina is circumcised and tightened, so that the tumor body is enclosed in the tissue to be removed to meet the requirements of tumor-free treatment. After the cervix and tumor are completely closed, the coil is tightened, and the vagina is cut 1 cm below it, which can prevent and control the spread and recurrence of the tumor. At the same time, the device can also be used as an auxiliary means for exposing the surgical field during laparoscopic surgery for other gynecological benign diseases, such as huge hysterectomy.

Second embodiment: As shown in FIG. 8, FIG. 9 and FIG. 10, the joystick body 7 is a long rod body structure, and the joystick body 7 is provided with a through hole 8 along the length, and the through hole 8 is movable A functional wire 9 is pierced, and both ends of the functional wire 9 extend to the outside of the perforation 8 respectively, the functional wire 9 is located at an end outside the abdominal cavity to form an adjustment portion 11, and the functional wire 9 is located at an end inside the abdominal cavity The medical suture needle 40 is connected. The medical suture needle 40 is a sled needle or a straight needle. The medical suture needle 40 and the functional thread 9 have an integrated structure, and the functional thread 2 is a nylon thread.

The main cause of cervical cancer death is uncontrolled tumors. Strict tumor-free technology can minimize or prevent the spread of cancer cells and implantation and metastasis, which is of great significance for improving the survival rate and cure rate of patients with malignant tumors. In my country, the five-year survival rate of many tumors is low, and one of the reasons is that the professional rules of cancer have not been strictly implemented. During the operation, failure to pay attention to the tumor-free technique led to the spread of cancer cells, resulting in local recurrence, implantation, and metastasis after surgery. The device can effectively replace the uterine lifting device to meet the requirements of tumor-free operation during surgery, to prevent and control the implantation, spread and recurrence of tumors, and improve the survival rate of tumor patients.

As shown in FIG. 5 and FIG. 6, the laparoscopic puncture device 2 includes a puncture sheath tube 6, and the puncture sheath tube 6 includes a puncture portion 23, a bending portion 22 and a stabilizing portion 24 connected in sequence, the stabilizing portion 24 is connected to the switching plate 25 of the puncture device, the puncturing portion 23 punctures the human tissue 5, the two ends of the bending portion 22 are connected to the puncturing portion 23 and the stabilizing portion 24, and the puncturing portion 23 is opposed by the bending portion 22 It bends in the circumferential direction of the stabilizing portion 24. When the operating instrument with curvature is inserted into the puncture sheath 1, the puncture sheath 1 can be relatively bent, so that the operating instrument can smoothly enter the abdominal cavity, so as to perform a wide range of operations in the abdominal cavity. The puncturing portion 23 and the stabilizing portion 24 are both rigid tube structures, and the bending portion 22 is a flexible tube structure. When the puncture device extends into the abdominal cavity, the bending portion and the puncturing portion are both located in the abdominal cavity. The stabilizing portion 4 is located on the human tissue. After the puncture, the puncture sheath core is removed. When the operating instrument is extended, the stabilizing portion 4 can reduce the interference of the operating instrument on the human tissue at the incision position and prevent the incision from being expanded.

As shown in FIG. 7, the bending portion 2 is a metal thin-walled tube or a corrugated tube, so as to ensure that all of them can be bent to a certain degree. Preferably, the bent portion 2 is a double-walled corrugated pipe structure made of polyvinyl chloride. The bent portion 22 includes an outer corrugated outer tube 31 in the outer layer and a straight tubular inner core tube 30 in the inner layer. The inner core tube 30 and the outer tube 31 are fused to form a type. The double-layer structure can increase the bending strength of the bellows bending part, so that the bellows is not too soft, ensure that the bending part has a certain supporting strength, and connect the piercing part 3 and the stabilizing part 4 stably, and also make the piercing part 3 Controllable bending to avoid

Damage to other organs.

As shown in FIG. 11, FIG. 12 and FIG. 13, the present invention also provides a flexible elastic trocar cannula that replaces the laparoscopic trocar 2, including a main cannula 3-2, a main cannula One end of 3-2 is connected with a puncture tubular body 3-3. The main body of the puncture tubular body 3-3 is a bendable elastic tube body 3-32 made of elastic material. The bendable elastic tube body 3-32 is One end connected to the main sleeve 3-2 is a fixed root 3-31, the other end of the flexible elastic tube 3-32 is a puncture tip 3-33, and the other end of the main sleeve 3-2 is a closed end 3-21, a puncture hole I3-5 is made in the center of the closed end, and the puncture hole I3-5 is on the same axis as the puncture tubular body 3-3, which is convenient for the puncture sheath core to pass through.

Industrial applicability

The flexible elastic trocar sleeve of the invention has a flexible elastic tube body, which is convenient for instruments with angles and radians to enter, and is convenient to adjust, and is particularly suitable for laparoscopic surgery. The flexible elastic tube body of the flexible elastic trocar sleeve has a simple structure and low manufacturing cost. As a disposable medical instrument, it can save a lot of costs, and has a simple structure, is easy to use, and has a high value for popularization and application.

After the joystick body passes through the abdominal cavity puncture device and enters the abdominal cavity, the uterine body is fixed by the uterine body fixing part, that is, the functional thread is inserted into the abdominal cavity, and the uterine body is wrapped around the uterine body and then knotted to form a movable loop structure. The adjustment column adjusts the extension length of the wire harness to make the fixing part loose or tight, lift and swing the uterus outside the abdominal cavity by operating the other end of the joystick body, and fully expose the left and right sides of the uterus, which can effectively avoid the current In some technologies, the disadvantages caused by the use of a cervix in the cervical cancer foci have been oppressed, and it has strong practicality. A

Claims

Laparoscopic radical surgery for cervical cancer via abdominal uterine movement control and vaginal closure device, characterized by comprising: a laparoscopic puncture device (2) and a uterine body swinging component (1), the laparoscopic puncture device (2) includes a puncture sheath (6), the puncture sheath (6) punctures human tissue and extends into the abdominal cavity, the puncture sheath (6) can be flexibly adjusted, and the uterine body swing assembly (1) includes a joystick body (7) , The joystick body (7) passes through the puncture sheath (6) into the abdominal cavity, and one end of the joystick body (7) located in the abdominal cavity is provided with a uterine body fixing portion (10), the uterine body fixing portion (10) 10) Fixing the uterine body (3), an end of the joystick body (7) located outside the abdominal cavity is provided with an adjusting portion (11), and the adjusting portion (11) adjusts the tightness of the uterine body fixing portion (10).
The laparoscopic cervical cancer radical operation according to claim 1, wherein the abdominal uterine movement control and vaginal closure device is characterized in that the joystick body (7) is a long rod body structure, and the joystick body (7) penetrates along the length A perforation (8) is provided, and a functional thread (9) is movably inserted in the perforation (8), and both ends of the functional thread (9) extend to the outside of the perforation (8) respectively, and the functional thread (8) 9) An end located outside the abdominal cavity forms an adjustment portion (11), and an end of the functional thread (9) located inside the abdominal cavity is connected with a medical suture needle (40).
The laparoscopic cervical cancer radical operation according to claim 1, wherein the abdominal uterine movement control and vaginal closure device is characterized in that the joystick body (7) is a long rod body structure, and the joystick body (7) penetrates along the length A perforation (8) is provided, and a functional thread (9) is movably inserted in the perforation (8), and one end of the functional thread (9) passes through one end of the joystick body (7) and is arranged around a lasso After the shape-like structure is connected to the joystick body (7), the lasso-like structure forms a uterine body fixing part (10), and the other end of the functional wire (9) passes out from the other end of the joystick body (7) to form an adjustment part (11) Adjust the closed loop size of the lasso structure through the functional harness of the push-pull adjustment section.
The laparoscopic radical surgery for cervical cancer according to claim 2 or 3, wherein the abdominal uterine movement control and vaginal closure device is characterized in that the functional thread (9) is a rigid elastic harness.
The laparoscopic radical surgery for cervical cancer according to claim 3, which controls the movement of the uterus through the abdomen and the vaginal closure device, characterized in that the lasso structure is sleeved on the uterus and the lasso structure is located in the middle and upper segment of the vagina 1 /3 place.
The laparoscopic radical cervical cancer radical resection control and vaginal closure device according to claim 2 or 3, characterized in that: the end of the rod body on the side of the adjustment portion of the joystick body (7) is coaxially recessed The wire harness adjusting hole (15) is provided with an adjusting wire post (14) in the wire harness adjusting hole (15), and the adjusting wire post (14) is axially penetrated with a wire through which the functional wire (9) passes Hole (16), the adjusting wire column (14) adjusts the tightness of the functional wire in the wire hole (16).
The laparoscopic radical surgery for cervical cancer according to claim 6, wherein the abdominal uterine movement control and vaginal closure device is characterized in that: the adjustment wire column (14) is adjusted for axial displacement relative to the joystick body (7), the adjustment The end of the wire post (14) facing the bottom of the wire harness adjusting hole (15) is tapered, forming a tapered structure (13), and the hole bottom of the wire harness adjusting hole (15) and the tapered structure (13) Correspondingly, the tapered structure (13) is uniformly provided with a plurality of wire grooves (17) along the circumferential direction, the wire grooves (17) pass through the wire hole (16), and the wire grooves (17) are tapered One side of the tip of the structure (13) extends, the tapered structure (13) is divided into several crimping lobes (18) by several wire grooves; by the axial displacement of the adjusting wire post (14), several of the crimping wires The flap (18) shrinks and clamps or loosens the function wire (9).
The laparoscopic cervical cancer radical surgery according to claim 1, wherein the abdominal uterine movement control and vaginal closure device is characterized in that the laparoscopic puncture device (2) includes a puncture sheath tube (6), the puncture sheath tube ( 6) It includes a puncturing part (23), a bending part (22) and a stabilizing part (24) connected in sequence, the stabilizing part (24) is connected and arranged with the conversion disc (25) of the puncture device, and the puncturing part (23) Puncturing human tissue, two ends of the bending portion (22) are respectively connected to the puncturing portion (23) and the stabilizing portion (24), and the puncturing portion (23) is bent relative to the stabilizing portion (24) by the bending portion (22) .
The laparoscopic radical surgery for cervical cancer according to claim 8, wherein the device for movement control and vaginal closure of the abdomen and uterus is characterized in that the puncture portion (23) and the stabilizing portion (24) are both rigid tube structures, The bending portion (22) is a flexible tube structure.
The laparoscopic radical surgery for cervical cancer according to claim 9, wherein the abdominal uterine movement control and vaginal closure device is characterized in that the curved portion (22) is a double-walled bellows structure, and the curved portion (22) includes external The corrugated outer tube (31) of the layer and the inner tube (30) of the inner tube in the shape of a straight tube are fused to form the inner tube (30) and the outer tube (31).