WO2020199307A1 - 微创手术的中空式矢量支撑多功能保护装置 - Google Patents

微创手术的中空式矢量支撑多功能保护装置 Download PDF

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Publication number
WO2020199307A1
WO2020199307A1 PCT/CN2019/086570 CN2019086570W WO2020199307A1 WO 2020199307 A1 WO2020199307 A1 WO 2020199307A1 CN 2019086570 W CN2019086570 W CN 2019086570W WO 2020199307 A1 WO2020199307 A1 WO 2020199307A1
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WO
WIPO (PCT)
Prior art keywords
head
flap
protection device
hollow
inner cylinder
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PCT/CN2019/086570
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English (en)
French (fr)
Inventor
原福松
吕培军
Original Assignee
北京大学口腔医学院
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Application filed by 北京大学口腔医学院 filed Critical 北京大学口腔医学院
Priority to US16/968,972 priority Critical patent/US11576745B2/en
Publication of WO2020199307A1 publication Critical patent/WO2020199307A1/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
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00544—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated pneumatically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00862—Material properties elastic or resilient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/007—Auxiliary appliance with irrigation system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Definitions

  • the invention relates to the field of medical equipment, and in particular to a hollow vector support multifunctional protection device for minimally invasive surgery.
  • laparoscopic surgery is becoming more and more popular, such as laparoscopy, thoracoscopy, esophagoscopy, bronchoscopy, gastroscopy, colonoscopy, cystoscopy, hysteroscopy, etc., laying a foundation for the realization of minimally invasive coelenteroscope surgery Foundation.
  • intestinal obstruction diseases or extremely narrow lesions it brings difficulties to the implementation of laparoscopic surgery.
  • many scholars at home and abroad have carried out a variety of intraoperative proximal lumen and bowel decompression and lavage methods, such as various intraoperative lumen and bowel lavage methods, temporary proximal colostomy, and intraoperative transanal insertion.
  • Canal decompression, postoperative placement of anal canal decompression, etc. The development of the above methods provides conditions for the implementation of laparoscopic surgery, which has been clinically promoted. However, there are still disadvantages such as long operation time, pollution of the abdominal cavity, and loss of intestinal electrolytes disturbing the body environment. It is reported that various metal stents are used as intestinal support to treat intestinal obstruction at home and abroad. That is, a net-shaped stent is placed in the narrow part of the intestine to expand the intestine, so that the narrow or blocked part can be restored unobstructed, which is created for surgery. condition.
  • Intestinal stents are suitable for patients with duodenal, small intestine, colon, rectal stenosis and obstruction and anastomotic stenosis due to late abdominal malignant tumor invasion, compression or other malignant lesions, but its effect is relatively simple.
  • support laryngoscopes are often used clinically to understand the abnormalities of the laryngeal structure in detail, to clarify the location and scope of the disease, and to biopsy the diseased tissue if necessary, but the examination cannot obtain the functional indicators of the larynx, and the larynx is supported.
  • the mirror is usually a rigid structure and must be used under general anesthesia for the patient, which limits its scope of application and has a single function, which only provides access for surgery.
  • the invention provides a hollow vector support multifunctional protection device for minimally invasive surgery, so as to at least solve the problem that the existing endoscopic surgery support tool is only used to provide access for surgery and has a single function.
  • the embodiment of the present invention provides a hollow vector support multifunctional protection device, including: a protection head, a protection head pitch mechanism, an inner cylinder, an axial movement mechanism of the inner cylinder, and a housing, wherein:
  • the protective head includes a petal ring, a plurality of first rotating shafts, a plurality of petals uniformly arranged on the petal ring through the first rotating shaft, and a torsion spring arranged on the first rotating shaft; the torsion spring Providing a force for the flap to open along the first rotating shaft, and the first rotating shaft is provided with a limiting structure that limits the maximum opening degree of the flap to open;
  • One end of the petal ring of the protective head is connected to the head end of the inner cylinder through a second rotating shaft, and the other end of the petal ring is connected to the protective head pitch mechanism through a third rotating shaft;
  • the inner cylinder is arranged in the housing, and the protection head extends from the head end of the housing; the tail end of the inner cylinder and the tail end of the housing are connected by the inner cylinder axial movement mechanism .
  • the flap includes a hollow layer, an interface and a hole; wherein,
  • the interface is arranged at the bottom end of the flap; the hole is arranged at the top end of the flap; the interface and the hole are communicated through the hollow layer; the interface is connected to the transfusion and exhaust liquid pipeline and/ Or lighting device connection.
  • the inner surface and/or the outer surface of the flap is provided with a fixing structure, and the flap fixes the transfusion and exhaust liquid pipeline and/or the lighting device on the flap through the fixing structure.
  • the transmission mechanism of the protective head pitch mechanism includes one of the following: a link transmission mechanism, a wire rope transmission mechanism, a belt transmission mechanism, a gear transmission mechanism, a chain transmission mechanism, and a key transmission mechanism.
  • the protective head tilt mechanism is driven by one of the following methods: manual drive, motor drive, hydraulic drive, pneumatic drive.
  • the transmission mechanism of the inner cylinder axial movement mechanism includes one of the following: a spiral transmission mechanism, a rack and pinion transmission mechanism, a belt transmission mechanism, a rope transmission mechanism, and a rod transmission mechanism.
  • the outer surface of the flap is a curved surface; the outer surface of the flap is in contact with the head end of the housing to limit the movement of the protective head when the inner cylinder axial movement mechanism drives the protective head.
  • the opening degree of the flap opening is a curved surface; the outer surface of the flap is in contact with the head end of the housing to limit the movement of the protective head when the inner cylinder axial movement mechanism drives the protective head.
  • an elastic membrane is covered between the protection head and the housing, and/or between the plurality of flaps.
  • a thin steel wire spiral ring is arranged between the protection head and the housing, and the elastic film covers the outer surface of the thin steel wire spiral ring.
  • the flaps on the protection head are adjusted by the axial movement mechanism of the inner cylinder to protect the operation area.
  • the size of the operation area can be adjusted freely; the protection head can also By protecting the head tilt mechanism to rotate to the outside to increase the surgical field of vision.
  • infusion and exhaust fluid passages and/or lighting devices are also provided on the flaps to achieve integration of lighting, flushing, drug delivery, cleaning, disinfection, hemostasis, and providing surgical tools such as laser scalpels.
  • the multiple functions of the supporting channel are integrated; the trauma of the operation area is reduced by covering the elastic membrane between the protective head and the shell and/or between the multiple flaps.
  • Figure 1 is an overall structure diagram of a hollow vector support multifunctional protection device according to an embodiment of the present invention
  • Figure 2a is a structural diagram of an axial movement mechanism according to an embodiment of the present invention.
  • 2b is an exploded view of the structure of the axial movement mechanism according to the embodiment of the present invention.
  • Figure 2c is a schematic diagram of a knob according to an embodiment of the present invention.
  • Figure 2d is a cross-sectional view of a housing according to an embodiment of the present invention.
  • Figure 3a is an initial state diagram of a protective head according to an embodiment of the present invention.
  • Fig. 3b is a schematic diagram of a flap deployment process of a protective head according to an embodiment of the present invention.
  • 3c is a schematic diagram of the maximum opening degree of the flap of the protective head according to an embodiment of the present invention.
  • 4a is a schematic diagram of a state in which the protective head is raised to the highest position according to an embodiment of the present invention
  • Fig. 4b is a schematic diagram of an ⁇ axis according to an embodiment of the present invention.
  • 4c is a schematic diagram of the protection head rotating around the ⁇ axis according to an embodiment of the present invention.
  • Figure 5a is a schematic diagram of a hollow flap according to an embodiment of the present invention.
  • Figure 5b is a schematic diagram of a non-hollow flap according to an embodiment of the present invention.
  • Fig. 6 is a schematic diagram of a foldable and retractable elastic film according to an embodiment of the present invention.
  • This embodiment provides a hollow vector support multifunctional protective device for minimally invasive surgery.
  • the protective device can be applied to a variety of medical fields, including oral cavity, nasal cavity, thoracic cavity, and abdominal cavity; large intestine, small intestine, and twelve. Surgery on the fingers, rectum, airway, ear canal, etc.
  • Fig. 1 is a schematic diagram of the overall structure of a hollow vector support multifunctional protection device for minimally invasive surgery according to an embodiment of the present invention.
  • the protection device can go deep into the narrow cavity, and the vector support sleeve protection head (hereinafter referred to as the protection head) 4 and the inner cylinder 5 are moved along the axial direction of the housing 3 through the inner cylinder axial movement mechanism 1.
  • the axial movement mechanism 2 allows the protective head to rotate around the ⁇ -axis, and at the same time, multiple flaps of the protective head automatically open to prop up the surrounding tissues of the cavity and support an operating space for the surgical operation.
  • the hollow vector support multifunctional protection device has a hollow inner tube and a protection head that can guide surgical tools to the lesion tissue, and the valve of the protection head is equipped with a liquid infusion pipeline to provide negative pressure and drug delivery channels, and assist Surgical operation, which makes cavity operation more convenient.
  • the protective device provided by this embodiment greatly increases the safety and convenience of the cavity operation.
  • the hollow inner cylinder 5 allows optical surgical fibers, medical surgical instruments (such as tweezers, operating arms, scalpels, etc.), and sensors (such as imaging probes) to pass through to the surgical area without damaging surrounding tissues, improving surgical adaptability and safety Sex and convenience.
  • medical surgical instruments such as tweezers, operating arms, scalpels, etc.
  • sensors such as imaging probes
  • Fig. 2a the protective head of the channel surgery protector moves along the axial direction of the housing.
  • Fig. 2b is an exploded view
  • Fig. 2c is a schematic diagram of a knob
  • Fig. 2d is a sectional view of the housing.
  • the inner ring of the first bearing 7 and the second bearing 8 of the inner cylinder axial movement mechanism is matched with the knob surface 1-C
  • the outer ring is matched with the housing surface 3-C
  • the threaded retaining ring 9 is matched with the knob surface 1-D
  • the bearing The retaining ring 6 is fixedly connected to the housing by screws 6-1 (or 3-1), and then combined with the rotation shoulder 1-A and the housing shoulder 3-B to fix the first bearing, the second bearing and the knob and the housing.
  • the knob can rotate relative to the housing.
  • the first convex point 5-A of the inner cylinder is matched with the spiral slide groove 1-B of the knob, and the second convex point 5-B of the inner cylinder is matched with the linear slide groove 3-A of the outer casing.
  • the inner cylinder when the knob rotates relative to the housing, the inner cylinder will move along the linear sliding groove 3-A, that is, the housing axis, and at the same time drive the protection head to move along the housing axis.
  • the screw pair has a self-locking function, that is, when the thread lift angle is less than or equal to the friction angle of the screw pair or the equivalent friction angle, the screw pair realizes self-locking.
  • the inner cylinder can only be driven to move linearly by the knob, and the inner cylinder cannot drive the knob to rotate.
  • the optional in addition to the manual example of this patent, the optional can be automated through motor drive, hydraulic drive, and pneumatic drive magnetic drive.
  • the inner tube and the outer shell in this embodiment are separated, which can be disassembled and installed conveniently, which enables preoperative disinfection and simple postoperative cleaning, and can also be made disposable to avoid cross-infection.
  • FIG 3a it is a diagram of the initial state of the petals of the protective head.
  • the various petals of the protective head are closed, and the torsion spring 10 (preferably a leaf spring) connecting the petals and the ring 12 is in an energy storage state.
  • the leaf spring 10 drives each flap to open and is tangent to the edge of the housing.
  • the opening degree of the flap of the protective head increases as the inner cylinder moves upward, as shown in Figure 3b Show.
  • the flap opening of the protective head is the largest.
  • the leaf spring 10 still has a certain amount of energy storage.
  • the knob is rotated in the opposite direction to drive the inner cylinder to move downward, the flap is passively closed, and the leaf spring 10 stores energy.
  • the optional expansion of the flaps of the protective head can also be realized by means of torsion spring, rope drive, gear drive, cam drive, etc.
  • the flap closure of the protective head is passively realized by the energy storage leaf spring 10 and the shell restraint; in other embodiments, the flaps can also be designed as an active and controllable closing structure, that is, the closure of each flap can be controlled Compared with the active closing, the passive closing structure shown in the above embodiment is simpler and more convenient for assembly and disassembly.
  • FIG. 4a it is a schematic diagram of the state when the protective head of the channel surgery protective device rises to the highest position and the opening degree is maximum.
  • the axial movement mechanism of the inner cylinder adopted in this embodiment is a double four-bar mechanism.
  • the double four-bar mechanism includes: a rocker slider mechanism composed of a shell, a rocker 2, a first connecting rod 13, and a slider 14, and a slider composed of a slider 14, a second connecting rod 15, a rocker 12, and an inner cylinder.
  • Rocker mechanism is a rocker slider mechanism composed of a shell, a rocker 2, a first connecting rod 13, and a slider 14, and a slider composed of a slider 14, a second connecting rod 15, a rocker 12, and an inner cylinder.
  • Rocker mechanism Rocker mechanism.
  • the shell and the rocker form a first hinge pair A
  • the rocker and the first link form a second hinge pair B
  • the first link and the slider form a third hinge pair C
  • the slider and the inner cylinder form a sliding pair D
  • the block and the second connecting rod form a fourth hinge pair E
  • the second connecting rod and the flap ring form a fifth hinge pair F
  • the flap ring and the inner cylinder form a sixth hinge pair G.
  • the joystick in addition to manually shaking the joystick, it can also be driven by automation technology, such as motor drive, hydraulic drive, pneumatic drive, etc. to drive the joystick to rotate.
  • automation technology such as motor drive, hydraulic drive, pneumatic drive, etc.
  • it can also be achieved through wire rope transmission, belt transmission, gear transmission, chain transmission, and key transmission.
  • FIG 5a it is a schematic diagram of the flaps of the protective head.
  • the flaps have a double-layer hollow structure, which are the outer hollow layer 4-G and the inner hollow layer 4-H, respectively.
  • the pipe interface 4-A and the inner interface 4-B are connected, and the outer interface and the inner interface are connected with the exhaust fluid pipeline, so that in addition to the function of propping the surrounding tissue, the flap can also inhale and blow (as shown in Figure 4-D and The hole shown in 4-E), or to deliver drugs for the surgical operation, the external interface and the internal interface can also be connected to the lighting circuit to provide lighting for the cavity operation space (as shown in Figure 4-C and 4-F), which is convenient for the operation operating.
  • the flap can also be a non-hollow structure.
  • the line of the gas supply and exhaust liquid pipeline 20 and the lighting device is clamped through a fixed structure 19 (such as a clip)
  • a fixed structure 19 such as a clip
  • the protective head is a multi-petal structure, and the number, shape, length and diameter can be individually designed according to the needs of different surgical sites, and can be divided into different models.
  • the gas conveying liquid pipeline is detachably connected to the protective head through the interface, and the discharging and discharging liquid pipeline is convenient to install and disassemble, which simplifies the disinfection and cleaning process, and is disposable and can avoid cross-infection.
  • a foldable and retractable elastic membrane is covered between the protective head and the shell of the protective device and between the flaps of the protective head.
  • the elastic membrane 11 rises/drops and the flaps
  • the sheet ring rotates to expand or fold, and the elastic membrane 18 expands or folds as the cavity surgery protector protects the head flaps to expand/close, thereby achieving the effect of isolating the cavity surgery protector from surrounding tissues.
  • the elastic membrane material can be a polymer or biological material such as rubber or plastic.
  • a thin steel wire spiral is arranged inside the elastic membrane 11 to prevent the elastic membrane 11 from collapsing; the elastic membrane is preferably a transparent elastic membrane, which can observe the operation condition of the operation area and facilitate safe operation control.
  • the hollow vector support multifunctional protection device for minimally invasive surgery may have at least three active degrees of freedom and one passive degree of freedom.
  • the three active degrees of freedom include: the protection device rolls, that is, the protection device rotates axially around the inner cylinder as a whole; the inner cylinder rises and falls in the axial direction; the head end of the protection device is pitched.
  • a passive degree of freedom includes: the flaps of the protective head are opened and closed by the torsion spring and the axial lifting of the inner cylinder.
  • the protective head, the protective head pitching mechanism, and the inner cylinder axial movement mechanism provided in this embodiment are all preferred structures; these structures can be replaced by other structures that can perform the same functions in the field or related fields.
  • the structure can also achieve the purpose of the present invention, and these structures will not be listed one by one in this embodiment.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Surgical Instruments (AREA)

Abstract

一种微创手术的中空式矢量支撑多功能保护装置，可以应用于口腔、咽喉部、消化道、呼吸道、胸腔、腹腔等腔道微创手术。保护装置的保护头（4）上的瓣片通过内筒轴向移动机构（1）调节开口度来保护手术区域，手术区域大小可自由调节；保护头（4）还能通过保护头俯仰机构向外侧转动增加手术视野，从而实现保护头（4）和瓣片的矢量调节，即保护头（4）和瓣片可按需进行方向、力量和大小的调节。中空式矢量支撑多功能保护装置还通过在瓣片上设置输排气液通路（20）和照明装置，以实现集照明、冲洗、给药、清理、消毒、止血及为激光手术刀等手术工具提供支撑通路多种功能为一体；通过在保护头（4）和外壳（3）之间和/或多个瓣片之间覆盖弹性膜（11，18）等方式减少手术区域的创伤。

Description

微创手术的中空式矢量支撑多功能保护装置 技术领域
本发明涉及医疗设备领域，具体而言，涉及一种微创手术的中空式矢量支撑多功能保护装置。
背景技术
据文献报道，近年来，腔肠道疾病的发病率逐年增高，特别是恶性病变，会侵犯、压迫腔肠道甚至使狭窄部分梗阻，会引起食物消化吸收及排便困难，严重影响了人们的生命及生活质量。全世界每年肠道恶性病变新发病例约100万，其中7％～29％的患者首发症状表现为急性完全或不完全性肠梗阻。由于肠道特别是结直肠梗阻，术前不能行肠道准备，临床处理较困难，术后容易发生吻合口漏及严重感染等并发症，这是肠梗阻外科处理的最根本难题。
随着医疗技术的不断进步，腔镜手术越来越普及，如腹腔镜、胸腔镜、食管镜、支气管镜、胃镜、肠镜、膀胱镜、宫腔镜等，为实现腔肠微创手术奠定了基础。但对于肠梗阻的疾病或极其狭窄的病变部位，给腔镜手术的实施带来了困难。为此，国内外众多学者开展多种术中近端腔肠道减压和灌洗方法，如术中各种腔肠道灌洗法、暂时性近端结肠造口术、术中经肛门插管减压、术后放置肛管减压等。上述方法的开展为腔镜手术的实施提供了条件，得到了临床推广，但仍有手术时间较长，污染腹腔，肠道电解质丢失扰乱机体内环境等弊病。国内外还采用各种金属支架作为肠腔内支撑治疗肠道梗阻的报道，即在肠道狭窄的部位放置一个网状支架将肠道撑开，使狭窄或阻塞部位重新恢复通畅，为手术创造条件。肠道支架适用于因腹部晚期恶性肿瘤侵犯、压迫或其他恶性病变导致十二指肠、小肠、结肠、直肠狭窄梗阻和吻合口狭窄的病人等，但其作用比较单一。对于咽喉部的手术，目前临床上常采用支撑喉镜详细了解喉部结构的异常，明确病变的部位及范围，必要时对病变组织进行活检，但检查不能获得喉的功 能性指标，而且支撑喉镜通常是刚性结构，必须在患者全麻的情况下使用，限制了它的应用范围，而且作用也较单一，仅为手术提供通路。
发明内容
本发明提供了一种微创手术的中空式矢量支撑多功能保护装置，以至少解决现有的腔镜手术支撑工具仅用于为手术提供通路而功能单一的问题。
本发明实施例提供了一种中空式矢量支撑多功能保护装置，包括：保护头、保护头俯仰机构、内筒、内筒轴向移动机构和外壳，其中，
所述保护头包括瓣圈、多个第一转轴、通过所述第一转轴均匀设置在所述瓣圈上的多个瓣片和设置在所述第一转轴上的扭簧；所述扭簧提供所述瓣片沿所述第一转轴打开的力，所述第一转轴设置有限制所述瓣片打开的最大开口度的限位结构；
所述保护头的所述瓣圈的一端通过第二转轴与所述内筒的头端连接，所述瓣圈的另一端通过第三转轴与所述保护头俯仰机构连接；
所述内筒设置在所述外壳内，且所述保护头从所述外壳的头端伸出；所述内筒的尾端与所述外壳的尾端通过所述内筒轴向移动机构连接。
可选地，所述瓣片包括中空层、接口和孔；其中，
所述接口设置在所述瓣片的底端；所述孔设置在所述瓣片的顶端；所述接口和所述孔通过所述中空层连通；所述接口与输排气液管道和/或照明装置连接。
可选地，所述瓣片的内表面和/或外表面设置有固定结构，所述瓣片通过所述固定结构将输排气液管道和/或照明装置固定在所述瓣片上。
可选地，所述保护头俯仰机构的传动机构包括以下之一：连杆传动机构、钢丝绳传动机构、带传动机构、齿轮传动机构、链传动机构、键传动机构。
可选地，所述保护头俯仰机构通过以下之一的方式驱动：手动驱动、 电机驱动、液压机驱动、气压机驱动。
可选地，所述内筒轴向移动机构的传动机构包括以下之一：螺旋传动机构、齿轮齿条传动机构、带传动机构、绳传动机构、杆件传动机构。
可选地，所述瓣片的外表面为曲面；所述瓣片的外表面与所述外壳的头端接触，以在所述内筒轴向移动机构带动所述保护头升降过程中限制所述瓣片打开的开口度。
可选地，在所述保护头和所述外壳之间，和/或，所述多个瓣片之间覆盖有弹性膜。
可选地，所述保护头和所述外壳之间设置有细钢丝螺旋圈，所述弹性膜覆盖在所述细钢丝螺旋圈的外表面。
通过本发明实施例提供的中空式矢量支撑多功能保护装置，其保护头上的瓣片通过内筒轴向移动机构调节开口度来保护手术区域，切手术区域大小可自由调节；保护头还能通过保护头俯仰机构向外侧转动从而增加手术视野。在本发明的优选实施例中，还通过在瓣片上设置输排气液通路和/或照明装置，以实现集照明、冲洗、给药、清理、消毒、止血及为激光手术刀等手术工具提供支撑通路多种功能为一体；通过在保护头和外壳之间和/或多个瓣片之间覆盖弹性膜等方式减少手术区域的创伤。
附图说明
此处所说明的附图用来提供对本发明的进一步理解，构成本申请的一部分，本发明的示意性实施例及其说明用于解释本发明，并不构成对本发明的不当限定。在附图中：
图1是根据本发明实施例的中空式矢量支撑多功能保护装置的整体结构图；
图2a是根据本发明实施例的轴向移动机构的结构图；
图2b是根据本发明实施例的轴向移动机构的结构分解图；
图2c是根据本发明实施例的旋钮示意图；
图2d是根据本发明实施例的外壳的剖视图；
图3a是根据本发明实施例的保护头初始状态图；
图3b是根据本发明实施例的保护头的瓣片展开过程的示意图；
图3c是根据本发明实施例的保护头的瓣片最大开口度状态的示意图；
图4a是根据本发明实施例的保护头上升到最高位置状态示意图；
图4b是根据本发明实施例的α轴示意图；
图4c是根据本发明实施例的保护头绕α轴转动示意图；
图5a是根据本发明实施例的中空式瓣片的示意图；
图5b是根据本发明实施例的非中空式瓣片的示意图；
图6是根据本发明实施例的可折叠内收式弹性膜的示意图。
具体实施方式
下面将详细描述本发明的各个方面的特征和示例性实施例，为了使本发明的目的、技术方案及优点更加清楚明白，以下结合附图及实施例，对本发明进行进一步详细描述。应理解，此处所描述的具体实施例仅用于解释本发明，并不用于限定本发明。对于本领域技术人员来说，本发明可以在不需要这些具体细节中的一些细节的情况下实施。下面对实施例的描述仅仅是为了通过示出本发明的示例来提供对本发明更好的理解。
需要说明的是，在本文中，术语“包括”、“包含”或者其任何其他变体意在涵盖非排他性的包含，从而使得包括一系列要素的过程、方法、物品或者设备不仅包括那些要素，而且还包括没有明确列出的其他要素，或者是还包括为这种过程、方法、物品或者设备所固有的要素。在没有更多限制的情况下，由语句“包括……”限定的要素，并不排除在包括所述要素的过程、方法、物品或者设备中还存在另外的相同要素。
本实施例提供了一种微创手术的中空式矢量支撑多功能保护装置，该保护装置可应用于多种医学领域腔肠道手术，包括口腔、鼻腔、胸腔、腹腔；大肠、小肠、十二指肠、直肠、气道、耳道等手术。
图1是根据本发明实施例的微创手术的中空式矢量支撑多功能保护装置的整体结构示意图。如图1所示，该保护装置可以深入狭小腔道，通过内筒轴向移动机构1让矢量支撑套筒保护头(下面简称保护头)4和内筒5沿外壳3轴向方向移动，通过轴向移动机构2让保护头绕α轴转动，同时保护头的多个瓣片自动打开，将腔道四周组织撑开，为手术操作支撑起一块操作空间。中空式矢量支撑多功能保护装置具有的中空式内筒和保护头可以引导手术工具到达病灶组织，并且保护头的瓣片上设有输排气液管道，用于提供负压及输送药物通道，辅助手术操作，从而让腔道手术更便捷。本实施例提供的保护装置很大程度上增加了腔道手术操作的安全性和便捷性。虽然在本实施例中示例的相关操作是手动(即操作人员操作完成)，而在实际应用中，也可以结合自动化技术实现自动可控操作。
中空式内筒5可以让光纤手术光纤、医疗手术器械(比如镊子、操作臂、手术刀等)、传感器(比如成像探头)穿过到达手术区域，而不损伤周围组织，提高手术适应性、安全性和便捷性。
如图2a所示，为腔道手术保护装置保护头沿外壳轴向移动机构，图2b为其分解图，图2c为旋钮示意图，图2d为外壳剖视图。内筒轴向移动机构的第一轴承7和第二轴承8的内圈与旋钮面1-C配合，外圈与外壳面3-C配合，螺纹挡圈9与旋钮面1-D配合，轴承挡圈6通过螺钉6-1(或3-1)与外壳固连，再结合旋转轴肩1-A和外壳轴肩3-B就能固定第一轴承、第二轴承与旋钮、外壳的相对轴向位置，并且旋钮可以与外壳相对转动。内筒第一凸点5-A与旋钮螺旋滑槽1-B配合，内筒第二凸点5-B与外壳直线滑槽3-A配合。
通过上述设计，当旋钮相对外壳转动时，内筒就会沿着直线滑槽3-A，即外壳轴向移动，同时带动保护头沿外壳轴向移动。在本实例中，螺旋副具有自锁功能，即当螺纹升角小于等于螺旋副的摩擦角或当量摩擦角后螺旋副实现自锁。螺旋副自锁后，只能通过旋钮带动内筒直线运动，而内筒不能带动旋钮旋转。在实际应用中，除了螺旋式传动外，齿轮齿条传动、带传动、绳传动、杆件传动也可以实现该运动。在动力选择上，除了本专利示例的手动外，可选的可以通过电机驱动、液压驱动、气压驱动磁力驱动方式实现自动化。
另外，在本实施例中的内筒和外壳为分离式，可以拆卸，安装方便，使术前消毒，术后清洗简单，也可以做成一次性的，避免交叉感染。
如图3a所示，为保护头的瓣片初始状态图，此时保护头各个瓣片合闭，连接瓣片和瓣圈12的扭簧10(优选为片簧)处于蓄能状态。当内筒和保护头沿外壳轴向位置移动时，片簧10带动各个瓣片打开，并与外壳边沿相切，保护头的瓣片开口度随着内筒向上移动而增加，如图3b所示。当每个瓣片到达限定位置时，如图3c A所示，保护头的瓣片开口度最大，此时，为了克服腔道周围组织的张力或压力，片簧10仍有一定的蓄能。当需要将瓣片闭合时，反方向旋转旋钮，带动内筒向下运动，瓣片被动闭合，同时片簧10储能。在实际应用中，可选的保护头的瓣片展开也可以通过扭簧、绳索传动、齿轮传动、凸轮传动等方式实现。
在上述结构中，保护头的瓣片闭合通过储能片簧10和外壳约束被动实现；在另一些实施例中，瓣片也可以设计为主动可控闭合的结构，即可以控制各个瓣的闭合；相对于主动闭合，上述实施例示出的被动闭合结构更简单，装卸更方便。
如图4a所示，为腔道手术保护装置保护头上升到最高位置，开口度最大时状态示意图。在本实施例中采用的内筒轴向移动机构为双四杆机构。通过摇动摇杆，经过双四杆机构带动瓣片圈12绕轴α(如图4b所示)转动。该双四杆机构包括：外壳、摇杆2、第一连杆13、滑块14组成的摇杆滑块机构，滑块14、第二连杆15、摇杆12、内筒组成的滑块摇杆机构。外壳和摇杆形成第一铰链副A，摇杆和第一连杆形成第二铰链副B，第一连杆和滑块形成第三铰链副C，滑块和内筒形成滑动副D，滑块和第二连杆形成第四铰链副E，第二连杆和瓣片圈形成第五铰链副F，瓣片圈和内筒形成第六铰链副G。当旋钮将内筒和保护头推送到最高位置后，转动摇杆，通过双四杆机构传动，带动保护头瓣片绕α轴转动，中间过程和最大转角状态示意图如图4c所示。在实际应用中，除了手动摇动摇杆外，还可以通过自动化技术，比如电机驱动、液压机驱动、气压机驱动等方式带动摇杆转动。除通过双四杆机构让保护头绕α轴转动外，还可以通过钢丝绳传动、带传动、齿轮传动、链传动、键传动等方式实现。
如图5a所示，为保护头的瓣片的示意图，在本实例中，瓣片为双层中 空结构，分别为外中空层4-G和内中空层4-H，两中空层分别与外管道接口4-A和内接口4-B相通，外接口和内接口与输排气液管道相连，使得瓣片除了撑开四周组织作用外，还能吸气吹气(如图4-D和4-E所示的孔)，或者为手术操作输送药物，外接口和内接口也能连接照明线路，为腔道操作空间提供照明(如图4-C和4-F所示)，方便手术操作。其中，在内筒和外壳之间具有一定的间隙，输排气液管道和照明线路均通过内筒和外壳间的空隙连接到外界，从而避免了管道和线路对人体组织的影响，防止剐蹭损伤周围人体组织，造成二次伤害。
在实际应用中，除了本实例的瓣片为双层中空结构外，瓣片还可以为非中空结构，而是将输排气液管道20和照明装置的线路通过固定结构19(例如卡子)卡在瓣片的内外表面上，或者在内外表面制作管道和线路槽4-P，将通气、输药管和线路压在槽中，如图5b所示。保护头为多瓣结构，数量、形状、长度和直径可以根据不同手术部位的需求个性化设计，可以分成不同的型号。
在上述保护头结构中，输排气液管道通过接口与保护头可拆卸地连接，输排气液管道安装拆卸方便，简化消毒清洗过程，且为一次性使用，能够避免交叉感染。
在保护装置的保护头和外壳中间、保护头的瓣片之间均覆盖有可折叠内收式弹性膜，如图6中11、18所示，弹性膜11随着内筒上升/下降和瓣片圈旋转而展开或折叠，弹性膜18随着腔道手术保护装置保护头瓣片展开/闭合而展开或折叠，从而达到腔道手术保护装置与四周组织的隔离的作用。在实际应用中，弹性膜材料可以是橡胶、塑料等高分子或生物材料。弹性膜11内部设置有细钢丝螺旋圈，防止弹性膜11塌陷；弹性膜优选为透明弹性膜，可以观察术区手术情况，方便手术安全控制。
本发明实施例提供的微创手术的中空式矢量支撑多功能保护装置可以至少具有三个主动自由度和一个被动自由度。其中，三个主动自由度包括：保护装置滚转，即保护装置整体绕内筒轴向转动；内筒沿轴向升降；保护装置头端俯仰。一个被动自由度包括：保护头的瓣片借助扭簧和内筒的轴向升降而开闭。
需要说明的是，在本实施例中提供的保护头、保护头俯仰机构和内筒轴向移动机构均为优选的结构；这些结构可以替换为本领域或者相关领域中能够起到相同功能的其他结构也能够实现本发明的目的，这些结构在本实施例中不再一一例举。
以上所述仅为本发明的优选实施例而已，并不用于限制本发明，对于本领域的技术人员来说，本发明可以有各种更改和变化。凡在本发明的精神和原则之内，所作的任何修改、等同替换、改进等，均应包含在本发明的保护范围之内。

Claims (9)

  1. 一种中空式矢量支撑多功能保护装置，其特征在于，包括：保护头、保护头俯仰机构、内筒、内筒轴向移动机构和外壳，其中，
    所述保护头包括瓣圈、多个第一转轴、通过所述第一转轴均匀设置在所述瓣圈上的多个瓣片和设置在所述第一转轴上的扭簧；所述扭簧提供所述瓣片沿所述第一转轴打开的力，所述第一转轴设置有限制所述瓣片打开的最大开口度的限位结构；
    所述保护头的所述瓣圈的一端通过第二转轴与所述内筒的头端连接，所述瓣圈的另一端通过第三转轴与所述保护头俯仰机构连接；
    所述内筒设置在所述外壳内，且所述保护头从所述外壳的头端伸出；所述内筒的尾端与所述外壳的尾端通过所述内筒轴向移动机构连接。
  2. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，所述瓣片包括中空层、接口和孔；其中，
    所述接口设置在所述瓣片的底端；所述孔设置在所述瓣片的顶端；所述接口和所述孔通过所述中空层连通；所述接口与输排气液管道和/或照明装置连接。
  3. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，所述瓣片的内表面和/或外表面设置有固定结构，所述瓣片通过所述固定结构将输排气液管道和/或照明装置固定在所述瓣片上。
  4. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，所述保护头俯仰机构的传动机构包括以下之一：连杆传动机构、钢丝绳传动机构、带传动机构、齿轮传动机构、链传动机构、键传动机构。
  5. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，所述保护头俯仰机构通过以下之一的方式驱动：手动驱动、电机驱动、液压机驱动、气压机驱动。
  6. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于， 所述内筒轴向移动机构的传动机构包括以下之一：螺旋传动机构、齿轮齿条传动机构、带传动机构、绳传动机构、杆件传动机构。
  7. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，所述瓣片的外表面为曲面；所述瓣片的外表面与所述外壳的头端接触，以在所述内筒轴向移动机构带动所述保护头升降过程中限制所述瓣片打开的开口度。
  8. 根据权利要求1所述的中空式矢量支撑多功能保护装置，其特征在于，在所述保护头和所述外壳之间，和/或，所述多个瓣片之间覆盖有弹性膜。
  9. 根据权利要求8所述的中空式矢量支撑多功能保护装置，其特征在于，所述保护头和所述外壳之间设置有细钢丝螺旋圈，所述弹性膜覆盖在所述细钢丝螺旋圈的外表面。
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