WO2022161378A1 - 一种可实现先缝后切的包皮吻合器 - Google Patents

一种可实现先缝后切的包皮吻合器 Download PDF

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Publication number
WO2022161378A1
WO2022161378A1 PCT/CN2022/073920 CN2022073920W WO2022161378A1 WO 2022161378 A1 WO2022161378 A1 WO 2022161378A1 CN 2022073920 W CN2022073920 W CN 2022073920W WO 2022161378 A1 WO2022161378 A1 WO 2022161378A1
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WIPO (PCT)
Prior art keywords
link
housing
ejector
handle
casing
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PCT/CN2022/073920
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English (en)
French (fr)
Inventor
李芳柄
朱德胜
彭守强
郑鹏
郑兴荣
周玲强
李雪影
吴秋菊
Original Assignee
浙江医高医疗科技有限公司
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Application filed by 浙江医高医疗科技有限公司 filed Critical 浙江医高医疗科技有限公司
Publication of WO2022161378A1 publication Critical patent/WO2022161378A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/326—Circumcision apparatus

Definitions

  • the invention belongs to a foreskin stapler, in particular to a foreskin stapler which can realize first sewing and then cutting to effectively prevent foreskin bleeding.
  • Circumcision stapler is one of them. Compared with traditional circumcision, the application of circumcision stapler It has many advantages such as less intraoperative blood loss, shorter operation time, minimizing manual operation errors, reducing postoperative infection, less postoperative pain, and faster functional recovery. However, when the existing circumcision stapler is actually used, bleeding and postoperative bleeding still occur.
  • the annular cutter and the staple are fired synchronously, and suturing and cutting are performed simultaneously. If the annular cutter cuts off the redundant foreskin first, more bleeding will occur.
  • the present invention provides a foreskin stapler that can realize first sewing and then cutting, which includes:
  • a housing defining a receiving cavity, one side of the housing forming an open end for a suture circumcision operation;
  • a thimble piece which is pivotally mounted in the housing, the thimble piece has a thimble cylinder and a thimble tube arranged on the rear side of the thimble cylinder, and the front end of the thimble cylinder is arranged toward the open surface;
  • the cutter piece has an annular cutter and an ejector tube formed on the rear side of the annular cutter, the annular cutter is coaxially mounted in the ejector barrel, and the ejector tube pivots through the ejector tube. Needle setting;
  • the handle is arranged through the described housing, and the handle is respectively connected with the ejector tube and the ejector tube through the first transmission mechanism and the second transmission mechanism to drive the ejector tube and the ejector tube to move towards the open end direction, and
  • the first transmission mechanism and the second transmission mechanism are integrally configured to enable the thimble cylinder to protrude out of the housing relative to the annular cutter in advance, so that the annular cutter starts the circumcision operation after the thimble piece completes the stitching work;
  • the elastic reset piece is arranged between the handle and the housing.
  • the handle has a free end extending out of the housing, a main body section arranged through the housing, and a hinged end for hinged connection with the interior of the housing; the hinged end and the rear side of the ejector tube are oscillated
  • the arm is connected by transmission to push the ejector tube to move horizontally.
  • the handle is located on the front side of the main body section of the housing and has a first gear segment
  • the thimble tube has a second rack segment
  • the first gear segment and the second rack segment pass through the first gear segment.
  • a gear meshes with the second gear for transmission; preferably, the upper circumference of the second gear meshed with the second rack segment is divided into a gear area and a stop area, and the gear area is used for meshing transmission with the second rack segment
  • the stop area is used to stop and cooperate with the second rack segment, so that the thimble tube remains positioned after reaching the predetermined position.
  • the front end of the annular cutter is flush with the front end of the ejector barrel, or the front end of the annular cutter is retracted inward relative to the front end of the ejector barrel.
  • the casing comprises a horizontal casing arranged horizontally and a vertical casing extending downward relative to the horizontal casing, the handle is disposed on the front side of the vertical casing, and the handle has a connection with the vertical casing.
  • the body has a natural state of an included angle and a trigger state of swinging toward the vertical housing.
  • the left end of the horizontal housing forms an open end, and the ejector pin and the cutter are pivotally mounted in the horizontal housing; the right end of the horizontal housing has an opening for the glans seat and the ejector rod to pass through the ejector pin Piece and Cutter Piece settings.
  • the first transmission mechanism and the second transmission mechanism are respectively a first link mechanism and a second link mechanism, and the second link mechanism is integrally arranged on the distal side of the first link mechanism.
  • the first transmission mechanism includes a first link, a second link, and a third link, the first link is rotatably disposed on the hinge end of the handle, and the second link is rotatable.
  • the third connecting rod is rotatably arranged on the upper side of the casing, and the free ends of the first connecting rod, the second connecting rod and the third connecting rod are hingedly connected;
  • the second transmission mechanism It includes a fifth link, a sixth link and a seventh link, the fifth link is rotatably arranged on the hinge end of the handle, the sixth link is rotatably arranged on the ejector pin, the The seventh connecting rod is rotatably arranged on the lower side of the casing, and the free ends of the fifth connecting rod, the sixth connecting rod and the seventh connecting rod are hingedly connected.
  • the second transmission mechanism is a second link mechanism; preferably, the second transmission mechanism includes a fifth link, a sixth link, and a seventh link, and the fifth link is rotatably arranged on the At the hinged end of the handle, the sixth link is rotatably arranged on the thimble piece, the seventh link is rotatably arranged on the lower side of the housing, the fifth link, the sixth link, The free end of the seventh link is hingedly connected.
  • an elastic restoring member is arranged between the handle and the housing.
  • the circumcision stapler provided by the present invention can realize the first sew and then cut, and the inner side of the uncut foreskin can be sutured first, and the suture can be completed after the suture is completed. The excess foreskin is then cut.
  • the stapler provided by the present invention can keep the staples in a state of pressing the foreskin all the time when cutting the foreskin, which can effectively prevent bleeding.
  • FIG. 1 is a schematic structural diagram of the foreskin stapler provided in Embodiment 1 of the present invention.
  • FIG. 2 is a schematic diagram of the rotation angle of the handle of the foreskin stapler provided in Embodiment 1 of the present invention
  • FIG. 3 is a schematic structural diagram of another foreskin stapler provided by the present invention.
  • FIG. 4 is a schematic structural diagram of still another foreskin stapler provided in this embodiment.
  • an embodiment of the present invention provides a foreskin stapler that can realize sewing first and then cutting.
  • the foreskin stapler includes a housing 1, a thimble piece 2, a cutter piece 3, a handle 5, and an elastic reset piece:
  • the housing 1 defines a receiving cavity 100, and one side of the housing 1 forms an open end 10 for sewing circumcision operation, and the open end forms an open port for the staples 7 and the cutter of the ejector and cutter pieces to extend. out to complete the suture circumcision operation on the foreskin;
  • the thimble piece 2 is pivotally mounted in the housing cavity 100 of the housing, and the thimble piece has a thimble tube 21 and a thimble tube 22 arranged on the rear side of the thimble tube 21 , and the front end of the thimble tube 21 faces the open face end 10 . set, and its front end is used to install staples 7;
  • the cutter member 3 has an annular cutter and an ejector tube 32 formed on the rear side of the annular cutter.
  • the annular cutter (not shown) is pivotally mounted in the ejector barrel 21 coaxially, as shown in FIG. 1 .
  • the ejector tube 32 is pivotally arranged through the ejector tube 22;
  • the handle 5 is arranged through the described casing, and the handle 5 is connected with the ejector tube 22 and the ejector tube 32 through the first transmission mechanism and the second transmission mechanism respectively to drive the ejector tube 22 and the ejector tube 32 independently.
  • the annular cutter and the ejector cylinder Moving towards the open end direction, the annular cutter and the ejector cylinder are finally extended from the housing; and the first transmission mechanism and the second transmission mechanism are integrally configured to enable the ejector cylinder 21 to protrude from the housing in advance relative to the annular cutter body so that the circumcision operation is achieved after the suture work is completed.
  • the foreskin stapler provided by the present invention abandons the driving circumcision suturing method of cutting first and then sewing, and adopts a brand-new idea of sewing first and then cutting, which fundamentally prevents the circumcision in the loop.
  • the bleeding caused by the time period between cutting and suturing can effectively prevent bleeding.
  • the elastic reset member is arranged between the handle and the housing, so that the handle can be automatically returned after completing the triggering work; preferably, the elastic reset member is a tension spring, and the two ends of the tension spring are respectively connected to the handle and the On the housing, after the handle completes the triggering work, the tension spring provides reset power to help it return to its position automatically.
  • the first transmission mechanism and the second transmission mechanism specifically adopt the following structural forms: the handle 5 has a free end 51 extending out of the casing, a main body section 52 disposed through the casing, and a The hinged end 53 hinged inside the housing; the hinged end 53 is connected with the rear side of the ejector tube 32 through the swing arm 8 to push the ejector tube 32 to move horizontally; in this embodiment, one end of the swing arm 8 is connected to the The handle is connected, and the other end forms an
  • a sliding shaft 321 is formed on the top knife tube.
  • the sliding shaft can be axially slidable inside the sliding cavity. Further drive the horizontal movement of the ejector tube; specifically, symmetrical sliding cavities 81 are formed on both sides of the swing arm, and correspondingly, sliding shafts 321 are formed symmetrically on both sides of the ejector tube, through which the handle and the swing arm slide with each other. The cooperation of the shaft drives the horizontal forward movement of the ejector tube.
  • the handle 5 has a first gear segment 55 on the front side of the main body segment 52 inside the housing, the ejector pin 22 has a second rack segment 221, the first gear segment 55 and the second rack segment 221 through the meshing transmission between the first gear 9 and the second gear 11; in this way, through the first gear segment 55 meshing with the first gear 9, the first gear 9 and the second gear 11, the second gear 11 and the second gear
  • the rack segment 221 engages to trigger the thimble tube 22 to move horizontally toward the front side;
  • the annular cutter when the annular cutter is pushed, since the annular cutter is directly driven forward by the firing handle, the angle of movement of the annular cutter is equal to the angle turned by the firing handle; due to the functional requirements of this embodiment to sew before cutting. , when the firing handle turns a certain angle, the position of the annular cutter should be in the plane position of the front end of the stapler body or an appropriate distance back, and should not exceed the front end position; in this embodiment, when the firing handle is fired, the annular cutter Should be more than 3mm from the front to completely cut off the foreskin.
  • the upper circumference of the second gear 11 meshing with the second rack segment 221 is divided into a gear area 111 and a stop area 112 , and the gear area 111 is used for engaging with the second rack segment 221 and the stop area 112 .
  • the first gear 9 is engaged for transmission, and at the same time, the stop area 112 is used to stop and cooperate with the second rack segment 221 .
  • the stop area 112 is formed in the circumferential direction of the second gear 11 . In this way, please refer to FIG.
  • the firing handle continues to rotate, the first gear segment 55 drives the first gear 9 to continue to rotate, and the first gear 9 drives the second gear 11 Continue to rotate until the stop area 112 of the second gear 11 is just in contact with the first rack segment 221 of the ejector pin 2, that is, there is no next tooth on the second gear 11 to engage and push, only the outer arc surface of the second gear 11.
  • the tangent maintenance is removed, after that, the second gear 11 will always keep the tangent to the ejector pin 2, and a stable force is continuously applied to the ejector pin 2, so that the ejector pin will not retreat, so that the staple 7 at the front end is continuously squeezed force to reduce bleeding.
  • the casing 1 includes a horizontal casing 101 arranged horizontally and a vertical casing 102 extending downward relative to the horizontal casing.
  • the handle 5 is disposed on the front side of the vertical casing 102 , And the handle 5 has a natural state of having an included angle with the vertical housing and a trigger state of swinging toward the vertical housing;
  • the left end of the horizontal casing 101 constitutes an open end 10, and the ejector pin 2 and the cutter member 3 are horizontally pivoted in the horizontal casing; the right end of the horizontal casing has an opening for the glans seat and the ejector rod to pass through.
  • the present invention provides the following suture method: push the staple 7 and the annular cutter to move forward by firing the handle 5, but due to the different advancing speeds of the two places, the staple 7 will first contact the foreskin tissue, After the staple 7 is in place, the annular cutter will touch the foreskin tissue again for cutting;
  • the present invention provides the following movement modes:
  • the manual firing handle pushes the staple 7 and the annular cutter to move forward, the firing handle pushes the gear set to rotate, the gear set engages and pushes the thimble tube, and the staple 7 is placed at the front end of the thimble tube, which simultaneously pushes the staple 7 forward. Movement; the firing handle pushes the ejector tube to move forward, and the front end of the ejector tube is connected with the annular cutter through type connection, which simultaneously pushes the annular cutter to move forward.
  • the entire cutting and suturing motion of the foreskin stapler is realized by squeezing the handle. Due to the structure of the human hand, the rotatable angle of the firing handle is within 45°.
  • the present invention selects a 35° firing power source.
  • the first gear segment on the handle drives the first gear to rotate
  • the first gear drives the second gear to rotate
  • the second gear drives the thimble tube to rotate through the first gear segment.
  • the linear velocity at the meshing position (the tangent position of the index circle) is the same.
  • the firing handle can be set as the firing angular velocity W, the angular velocity of the pinion gear W is small , and the moving speed of the staple 7 is V needle ;
  • the diameter of the index circle of the handle large gear is 30mm
  • the diameter of the index circle of the pinion is 10mm
  • the angle of movement of the annular cutter is equal to the angle at which the firing handle turns;
  • the angle is 17.189°
  • the position of the annular cutter should be in the plane position of the front end of the stapler body or an appropriate distance back, and should not exceed the front end position.
  • the annular cutter should exceed the front end by 3mm (this size is not limited) to completely cut off the foreskin;
  • the angle ⁇ needs to be rotated.
  • the center of rotation is perpendicular to the centerline of the ejector piece, the side angle is ⁇ 1, and the vertical height is H.
  • H decreases with the increase of tan ⁇ 1, and the minimum is infinitely close to 0 (the actual meaning is not significant at this time).
  • H should be within 9.338mm to achieve cutting.
  • the annular cutter cuts, and the staples 7 are always in a compressed state while the annular cutter is cutting, which can better prevent blood from flowing out.
  • this embodiment is basically the same as Embodiment 1, the difference is that the first transmission mechanism and the second transmission mechanism used in this embodiment are a first link mechanism and a second link mechanism, respectively.
  • the two linkages are integrally disposed on the distal side of the first linkage.
  • the first transmission mechanism includes a first link 200, a second link 201, and a third link 202
  • the first link 200 is rotatably disposed on the handle hinge end 53, so
  • the second link 201 is rotatably arranged on the ejector member 32
  • the third link 202 is rotatably arranged on the upper side of the housing 1, the first link 200, the second link 201, the third link 202
  • the other end of the connecting rod 202 is hingedly connected.
  • the second transmission mechanism includes a fifth link 300, a sixth link 301, and a seventh link 303.
  • the fifth link 300 is rotatably disposed on the handle hinge end 53, and the sixth link
  • the rod 301 is rotatably arranged on the thimble tube 22
  • the seventh link 303 is rotatably arranged on the lower side of the housing 1
  • the other ends of the fifth link 300 , the sixth link 301 and the seventh link 303 are hinged to each other. connect.
  • this embodiment is basically the same as Embodiment 1, the difference is that the second transmission mechanism adopted in this embodiment adopts a second link mechanism,
  • the second transmission mechanism is the same as that of the second embodiment.
  • references to the terms “one embodiment,” “some embodiments,” “exemplary embodiment,” “example,” “specific example,” or “some examples”, etc., are meant to incorporate the embodiments A particular feature, structure, material, or characteristic described by an example or example is included in at least one embodiment or example of the present invention.
  • schematic representations of the above terms do not necessarily refer to the same embodiment or example.
  • the particular features, structures, materials or characteristics described may be combined in any suitable manner in any one or more embodiments or examples.

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Abstract

一种可实现先缝后切的包皮吻合器，包括：壳体(1)，其限定出一个收容腔(100)，壳体(1)一侧形成用于缝合环切操作的开放端(10)；顶针件(2)，其枢装在壳体(1)内，顶针件(2)具有一顶针筒(21)以及一设置在顶针筒(21)后侧的顶针管(22)，顶针筒(21)的前端朝向开放端(10)置；切刀件(3)，其具有一环形切刀以及一形成于环形切刀后侧的顶刀管(32)，环形切刀同轴枢装在顶针筒(21)内，顶刀管(32)枢穿过顶针管(22)设置；手柄(5)，其贯穿壳体(1)设置，手柄(5)分别通过第一传动机构、第二传动机构与顶针管(22)和顶刀管(32)传动连接以驱动顶针管(22)和顶刀管(32)朝向开放端(10)方向移动。

Description

一种可实现先缝后切的包皮吻合器 技术领域
本发明属于包皮吻合器，具体涉及一种可实现先缝后切以有效防止包皮溢血的包皮吻合器。
背景技术
随着医学的发展和产品研发，越来越多的微创医疗器械应用于泌尿、男科临床手术，包皮环切吻合器就是其中的一种，包皮环切吻合器的应用相对于传统环切术具有术中出血少、手术时间较短、可最大限度减少手工操作误差、减少术后感染、术后痛苦少、功能恢复快等诸多优点。但是，现有的包皮环切吻合器在实际使用时，还是会出现渗血及术后出血的情况。
现有的包皮环切吻合器在使用时，环形切刀与缝合钉同步击发，同步进行缝合与切割，如果环形切刀先割断多余包皮，会导致较多的渗血情况。
发明内容
针对以上技术问题，本发明提供一种可实现先缝后切的包皮吻合器，其包括：
壳体，其限定出一个收容腔，所述壳体一侧形成用于缝合环切操作的开放端；
顶针件，其枢装在该壳体内，所述顶针件具有一顶针筒以及一设置在顶针筒后侧的顶针管，所述顶针筒的前端朝向开放面设置；
切刀件，其具有一环形切刀以及一设形成于环形切刀后侧的顶刀管，环形切刀同轴枢装在所述的顶针筒内，顶刀管枢穿过所述的顶针管设置；
手柄，其贯穿该所述的壳体设置，所述手柄分别通过第一传动机构、第二传动机构与顶针管和顶刀管传动连接以驱动顶针管和顶刀管朝向开放端方向移动，且所述第一传动机构和第二传动机构整体被构造为能够促使顶针筒相对于环形切刀预先伸出壳体，以使得顶针件在完成缝合工作后环形切刀开始环切操作；
弹性复位件，其设置在手柄和壳体之间。
作为优选，所述手柄具有一伸出壳体的自由端、一贯穿该壳体设置的主体段以及一用于与壳体内部铰接的铰接端；所述铰接端与顶刀管的后侧通过摆动臂,传动连接以推动顶刀管发生水平移动。
作为优选，所述的手柄位于壳体的主体段的前侧具有第一齿轮段，所述顶针管上具有第二齿条段，所述第一齿轮段和第二齿条段之间通过第一齿轮和第二齿轮啮合传动；优选地，与第二齿条段啮合的第二齿轮上周向被划分为齿轮区和止挡区，所述齿轮区用于与第二齿条段啮合传动且止挡区用于与第二齿条段止挡配合，以使得顶针管在到达预定位置后保持定位。
作为优选，所述环形切刀前端与顶针筒的前端齐平，或所述环形切刀前端相对于顶针筒的前端往内缩进。
作为优选，所述壳体包括水平设置的水平壳体以及相对于水平壳体向下延伸的竖向壳体，所述手柄设置在竖向壳体的前侧，且该手柄具有与竖向壳体具有夹角的自然状态以及朝向所述竖向壳体摆动的触发状态。
作为优选，所述水平壳体左端构成开放端，所述顶针件与切刀件水平枢装在所述的水平壳体内；所述水平壳体的右端具有一开口供龟头座和顶杆贯穿顶针件和切刀件设置。
作为优选，所述第一传动机构和第二传动机构分别为第一连杆机构和第二连杆机构，所述第二连杆机构整体设置在第一连杆机构的远侧。
作为优选，所述第一传动机构包括第一连杆、第二连杆、第三连杆，所述第一连杆可转动地设置于所述的手柄铰接端，所述第二连杆可转动地设置于顶刀件，所述第三连杆可转动地设置在壳体上侧，第一连杆、第二连杆、第三连杆自由端相铰接连接；所述第二传动机构包括第五连杆、第六连杆、第七连杆，所述第五连杆可转动地设置于所述的手柄铰接端，所述第六连杆可转动地设置于顶针件，所述第七连杆可转动地设置在壳体下侧，所述的第五连杆、第六连杆、第七连杆的自由端铰接连接。
作为优选，第二传动机构为第二连杆机构；优选地，所述第二传动机构包括第五连杆、第六连杆、第七连杆，所述第五连杆可转动地设置于所述的手柄铰接端，所述第六连杆可转动地设置于顶针件，所述第七连杆可转动地设置在壳体下侧，所述的第五连杆、第六连杆、第七连杆的自由端铰接连接。
作为优选，所述的手柄和壳体之间设有弹性复位件。
相较于现有的吻合器先切后缝或者同时切缝的治疗过程，本发明提供的包皮环切吻合器可以实现先缝后切，可以先对未切割的包皮内侧进行缝合，待缝合完全之后进行多余包皮的切割。此外，本发明提供的吻合器可以在切割包皮的时候，缝合钉始终处于压紧包皮的状态，可以有效防止渗血。
附图说明
图1为本发明实施例1提供的包皮吻合器的结构示意图；
图2为本发明实施例1提供的包皮吻合器的手柄转动角度示意图；
图3为本发明提供的另一种包皮吻合器的结构示意图；
图4为本实施例提供的再一种包皮吻合器的结构示意图。
具体实施方式
下面详细描述本发明的实施例，所述实施例的示例在附图中示出，其中自始至终相同或类似的标号表示相同或类似的元件或具有相同或类似功能的元件。下面通过参考附图描述的实施例是示例性的，仅用于解释本发明，而不能理解为对本发明的限制。
在本发明的描述中，需要理解的是，术语、“上”、“下”、“竖直”、“水平”、“内”、“外”等指示的方位或位置关系为基于附图所示的方位或位置关系，仅是为了便于描述本发明和简化描述，而不是指示或暗示所指的装置或元件必须具有特定的方位、以特定的方位构造和操作，因此不能理解为对本发明的限制。此外，术语“第一”、“第二”仅用于描述目的，而不能理解为指示或暗示相对重要性或者隐含指明所指示的技术特征的数量。由此，限定有“第一”、“第二”的特征可以明示或者隐含地包括一个或者更多个该特征。
在本发明的描述中，需要说明的是，除非另有明确的规定和限定，术语“安装”、“相连”、“连接”应做广义理解，例如，可以是固定连接，也可以是可拆卸连接，或一体地连 接；可以是直接相连，也可以通过中间媒介间接相连，可以是两个元件内部的连通。对于本领域的普通技术人员而言，可以具体情况理解上述术语在本发明中的具体含义。
实施例1
请参阅图1，本发明实施方式提供一种可实现先缝后切的包皮吻合器，该包皮缝合器包括壳体1、顶针件2、切刀件3、手柄5以及弹性复位件：
壳体1限定出一个收容腔100，所述壳体1一侧形成用于缝合环切操作的开放端10，该开放端形成的敞开口供顶针件和切刀件的缝合钉7和切刀伸出以对包皮完成缝合环切操作；
顶针件2枢装在该壳体的收容腔100内，所述顶针件具有一顶针筒21以及一设置在顶针筒21后侧的顶针管22，所述顶针筒21的前端朝向开放面端10设置，且其前端用于安装缝合钉7；
切刀件3具有一环形切刀以及一设形成于环形切刀后侧的顶刀管32，环形切刀(未示出)同轴枢装在所述的顶针筒21内，如图1所示，顶刀管32枢穿所述的顶针管22设置；
手柄5贯穿该所述的壳体设置，所述手柄5分别通过第一传动机构、第二传动机构与顶针管22和顶刀管32传动连接以驱动顶针管22和顶刀管32各自独立地朝向开放端方向移动，最终实现环形切刀和顶针筒从壳体伸出；且所述第一传动机构和第二传动机构整体被构造为能够促使顶针筒21相对于环形切刀预先伸出壳体以使得在完成缝合工作后实现环切操作。
即本发明提供的包皮吻合器相较于现有的包皮吻合器而言，其舍弃了先切后缝的传动环切缝合方法，采用全新的先缝后切思路，从根本上防止了在环切与缝合之间的时间段内造成的溢血情况，有效防止溢血。
弹性复位件设置在手柄和壳体之间，以使得手柄在完成触发工作后能够自动归位；优选地，所述的弹性复位件为拉簧，所述拉簧的两端分别连接在手柄和壳体上，如此，在手柄在完成触发工作后，拉簧提供复位动力帮助其能够自动归位。
所述的第一传动机构和第二传动机构的结构实现方式有多种，例如可以采用传动的齿轮传动方式、连杆传动方式以及齿轮和连杆结合的方式等，本领域技术人员可以自由选择，只要其能够实现环形切刀在顶针筒完成缝合工作后伸出完成环切工作即可，即确保环形切刀和顶针筒的伸出顺序有序进行即可；示例性地，在本发明一些实施例中，所述第一传动机构和第二传动机构具体采用如下结构形式：所述手柄5具有一伸出壳体的自由端51、一贯穿该壳体设置的主体段52以及一用于与壳体内部铰接的铰接端53；所述铰接端53与顶刀管32的后侧通过摆动臂8传动连接以推动顶刀管32发生水平移动；在本实施中，所述摆动臂8一端与手柄连接，另一端形成轴向延伸的滑动腔81，所述顶刀管上形成滑动轴321，该滑动轴可轴向滑动地设置在滑动腔内部，通过手柄的转动，驱动摆动臂的摆动，进一步驱动顶刀管的水平移动；具体地，所述摆动臂的两侧形成对称的滑动腔81，相对应地顶刀管两侧对称形成滑动轴321，手柄和摆动臂通过该滑动腔与滑动轴的配合驱动顶刀管的水平向前移动。
所述的手柄5位于壳体内部的主体段52的前侧具有第一齿轮段55，所述顶针管22上具有第二齿条段221，所述第一齿轮段55和第二齿条段221之间通过第一齿轮9和第二齿轮11啮合传动；如此，通过该第一齿轮段55与第一齿轮9啮合、第一齿轮9和第二齿轮11啮合、 第二齿轮11和第二齿条段221啮合触发顶针管22朝向前侧水平移动；
如上，由于顶刀管32从顶针管11伸出且摆动臂8形成在第二传动机构(所述第一齿轮段55和第二齿条段221、第一齿轮9和第二齿轮11)的后侧，由于二者前进的速度不一致，所以在顶针筒21伸出壳体缝合时环形切刀还未伸出壳体。
可以理解的是，在推动环形切刀时，由于环形切刀是由击发手柄直接带动前进的，环形切刀运动的角度等于击发手柄转过的角度；由于本实施方式先缝后切的功能需求，当击发手柄转过一定角度时，环形切刀位置应处于吻合器主体前端平面位置或者往后适当距离，不应超过前端位置；在本实施例中，当击发手柄击发完毕时，环形切刀应超过前端3mm才能完全切断包皮。
在一些优选实施方式中，与第二齿条段221啮合的第二齿轮11上周向被划分为齿轮区111和止挡区112，所述齿轮区111用于与第二齿条段221和第一齿轮9啮合传动，同时所述的止挡区112用于与第二齿条段221止挡配合，在本实施例中，所述止挡区112为形成于第二齿轮11周向的圆弧段；如此，请再次参阅图1，当缝合钉7到达吻合器前端平面后，击发手柄继续转动，第一齿轮段55带动第一齿轮9继续转动，第一齿轮9带动第二齿轮11继续转动直至第二齿轮11的止挡区112刚好与顶针件2的第一齿条段221处于相抵，即第二齿轮11上此时并没有下一个齿去啮合推动，只有其外圆弧面去相切保持，此后第二齿轮11会始终保持与顶针件2的相切，持续给到顶针件2稳定的力，使顶针件不会后退，也就使得前端的缝合钉7持续受到挤压的力，可以减少出血情况产生。
如图1所示，所述壳体1包括水平设置的水平壳体101以及相对于水平壳体向下延伸的竖向壳体102，所述手柄5设置在竖向壳体102的前侧，且该手柄5具有与竖向壳体具有夹角的自然状态以及朝向所述竖向壳体摆动的触发状态；
所述水平壳体101左端构成开放端10，所述顶针件2与切刀件3水平枢装在所述的水平壳体内；所述水平壳体的右端具有一开口供龟头座和顶杆贯穿顶针件和切刀件设置；
依据本发明提供的包皮吻合器，本发明提供如下缝合方式：通过击发手柄5推动缝合钉7与环形切刀向前运动，但由于两处前进速度不一样，缝合钉7会先接触包皮组织，待缝合钉7到位后，环形切刀会再接触包皮组织进行切割；
本发明提供如下运动方式：
手动击发手柄推动缝合钉7与环形切刀向前运动，击发手柄推动齿轮组转动，齿轮组啮合推动顶针管，缝合钉7放置在顶针管的前端，也就同时在推动着缝合钉7向前运动；击发手柄推动顶刀管向前运动，顶刀管前端与环形切刀通过型连接，也就同时在推动着环形切刀向前运动。
此外，通过挤压手柄，来实现包皮吻合器的整个切割缝合运动，由于人体手部的结构，击发手柄的可旋转角度为45°以内，本发明选定一个35°来做击发动力源。
击发手柄推动缝合钉7时，手柄上的第一齿轮段带动第一齿轮转动，第一齿轮带动第二个齿轮转动，第二齿轮通过第一齿轮段带动顶针管转动，根据齿轮传动原理，齿轮啮合处(分度圆相切位置)的线速度相等。
此时：可以设击发手柄为击发角速度为W，小齿轮的角速度为W 小，缝合钉7的移动速度为V 针；
根据吻合器的尺寸规格选择，手柄大齿轮的分度圆直径为30mm，小齿轮的分度圆直径为10mm，相同模数啮合；
可得：30/2*W＝10/2*W 小＝V 针
15W＝5W 小＝V 针
请参阅图2，根据本产品的缝合钉7高度需要，缝合钉7的推动距离为4.5mm时达到前端平面位置，设当缝合钉7被推动4.5mm时，所用时间为t，击发手柄转动角度为θ；
Figure PCTCN2022073920-appb-000001
所以
Figure PCTCN2022073920-appb-000002
得出：θ＝17.189°
进一步地，在推动环形切刀时，由于环形切刀是由击发手柄直接带动前进的，环形切刀运动的角度等于击发手柄转过的角度；由于先缝后切的功能需求当击发手柄转过角度为17.189°时，环形切刀位置应处于吻合器主体前端平面位置或者往后适当距离，不应超过前端位置。在本案例中，当击发手柄击发完毕时，环形切刀应超过前端3mm(该尺寸不限定死)才能完全切断包皮；
设击发手柄转过17.189°(此时顶刀件运动的距离为L)后还需要转过角度θ，旋转中心往顶刀件中心线上做垂直时，旁边的角度为θ1，垂直高度为H，
根据三角形公式可得：
Figure PCTCN2022073920-appb-000003
Figure PCTCN2022073920-appb-000004
由②可得：L＝Htanθ1③
将③代入①，可得：
Figure PCTCN2022073920-appb-000005
H tan(θ+θ1)＝3+Htanθ1
3＝H tan(θ+θ1)-Htanθ1
Figure PCTCN2022073920-appb-000006
Figure PCTCN2022073920-appb-000007
Figure PCTCN2022073920-appb-000008
Figure PCTCN2022073920-appb-000009
H随着tanθ1的增大而减小，最小为无限接近0(此时实际意义不大)，当tanθ1＝0时，H达到最大，为
Figure PCTCN2022073920-appb-000010
当在此案例中时，θ＝35°-17.189°＝17.811°，此时H约等于9.338mm。
因此H应在9.338mm以内才能实现切割。
本发明提供的缝合器在缝合钉7到达前端平面后，环形切刀进行切割，此时环形切刀进行切割的同时，缝合钉7始终处于压紧的状态，可以更好地防止血液流出。
实施例2
请参阅图3，本实施例与实施例1基本相同，区别在于本实施例采用的所述第一传动机构和第二传动机构分别为第一连杆机构和第二连杆机构，所述第二连杆机构整体设置在第一连杆机构的远侧。
示例性地，所述第一传动机构包括第一连杆200、第二连杆201、第三连杆202，所述第一连杆200可转动地设置于所述的手柄铰接端53，所述第二连杆201可转动地设置于顶刀件32，所述第三连杆可202转动地设置在壳体1上侧，所述第一连杆200、第二连杆201、第三连杆202的另一端相铰接连接。
所述第二传动机构包括第五连杆300、第六连杆301、第七连杆303，所述第五连杆300可转动地设置于所述的手柄铰接端53，所述第六连杆301可转动地设置于顶针管22，所述第七连杆303可转动地设置在壳体1下侧，第五连杆300、第六连杆301、第七连杆303另一端相铰接连接。
实施例3
示例性地，请参阅图4，本实施例与实施例1基本相同，区别在于本实施例采用的所述第二传动机构采用第二连杆机构，
第二传动机构与实施例2的相同。
在本说明书的描述中，参考术语“一个实施例”、“一些实施例”、“示意性实施例”、 “示例”、“具体示例”、或“一些示例”等的描述意指结合该实施例或示例描述的具体特征、结构、材料或者特点包含于本发明的至少一个实施例或示例中。在本说明书中，对上述术语的示意性表述不一定指的是相同的实施例或示例。而且，描述的具体特征、结构、材料或者特点可以在任何的一个或多个实施例或示例中以合适的方式结合。
尽管已经示出和描述了本发明的实施例，本领域的普通技术人员可以理解：在不脱离本发明的原理和宗旨的情况下可以对这些实施例进行多种变化、修改、替换和变型，本发明的范围由权利要求及其等同物限定。

Claims (10)

  1. 一种可实现先缝后切的包皮吻合器，其特征在于，该包皮吻合器包括：
    壳体(1)，其限定出一个收容腔(100)，所述壳体(1)一侧形成用于缝合环切操作的开放端(10)；
    顶针件(2)，其枢装在该壳体(1)内，所述顶针件(2)具有一顶针筒(21)以及一设置在顶针筒(21)后侧的顶针管(22)，所述顶针筒(21)的前端朝向开放端(10)设置；
    切刀件(3)，其具有一环形切刀以及一设形成于环形切刀后侧的顶刀管(32)，环形切刀同轴枢装在所述的顶针筒(21)内，顶刀管(32)枢穿过所述的顶针管(22)设置；
    手柄(5)，其贯穿该所述的壳体(1)设置，所述手柄(5)分别通过第一传动机构、第二传动机构与顶针管(22)和顶刀管(32)传动连接以驱动顶针管(22)和顶刀管(32)朝向开放端(10)方向移动，且所述第一传动机构和第二传动机构整体被构造为能够促使顶针筒(21)相对于环形切刀预先伸出所述的壳体(1)，以使得顶针件在完成缝合工作后环形切刀开始环切操作。
  2. 根据权利要求1所述的包皮吻合器，其特征在于，所述手柄(5)具有一伸出壳体的自由端(51)、一贯穿该壳体(1)设置的主体段(52)以及一用于与壳体内部铰接的铰接端(53)；所述铰接端(53)与顶刀管(32)的后侧通过摆动臂(8)传动连接以推动顶刀管(32)发生水平移动。
  3. 根据权利要求2所述的包皮吻合器，其特征在于，所述的手柄位于壳体的主体段的前侧具有第一齿轮段(55)，所述顶针管(22)上具有第二齿条段(221)，所述第一齿轮段(55)和第二齿条段(221)之间通过第一齿轮(9)和第二齿轮(11)啮合传动；优选地，与第二齿条段(221)啮合的第二齿轮(11)上周向被划分为齿轮区(111)和止挡区(112)，所述齿轮区(111)用于与第二齿条段(221)啮合传动且止挡区(112)用于与第二齿条段(221)止挡配合，以使得顶针管(22)在到达预定位置后保持定位。
  4. 根据权利要求1所述的包皮吻合器，其特征在于，所述环形切刀前端与顶针筒(21)的前端齐平，或所述环形切刀前端相对于顶针筒(21)的前端往内缩进。
  5. 根据权利要求1所述的包皮吻合器，其特征在于，所述壳体包括水平设置的水平壳体(101)以及相对于水平壳体(101)向下延伸的竖向壳体(102)，所述手柄(5)设置在竖向壳体(102)的前侧，且该手柄(5)具有与竖向壳体具有夹角的自然状态以及朝向所述竖向壳体摆动的触发状态。
  6. 根据权利要求5所述的包皮吻合器，其特征在于，所述水平壳体(101)左端构成开放端(10)，所述顶针件(2)与切刀件(3)水平枢装在所述的水平壳体(101)内；所述水平壳体(101)的右端具有一开口供龟头座和顶杆贯穿顶针件和切刀件设置。
  7. 根据权利要求1所述的包皮吻合器，其特征在于，所述第一传动机构和第二传动机构分别为第一连杆机构和第二连杆机构，所述第二连杆机构整体设置在第一连杆机构的远侧。
  8. 根据权利要求7所述的包皮吻合器，其特征在于，所述第一传动机构包括第一连杆(200)、第二连杆(201)、第三连杆(202)，所述第一连杆可转动地设置于所述的手柄铰接端，所述第二连杆可转动地设置于顶刀件，所述第三连杆可转动地设置在壳体上侧，第一连杆、第二连杆、第三连杆自由端相铰接连接；所述第二传动机构包括第五连杆(300)、第六连杆(301)、第七连杆(303)，所述第五连杆可转动地设置于所述的手柄铰接端，所述第六连杆可转动地设置于顶针件，所述第七连杆可转动地设置在壳体下侧，所述的第五连杆、第六连杆、第七连杆的自由端铰接连接。
  9. 根据权利要求1所述的包皮吻合器，其特征在于，第二传动机构为第二连杆机构；优选地，所述第二传动机构包括第五连杆、第六连杆、第七连杆，所述第五连杆可转动地设置于所述的手柄铰接端，所述第六连杆可转动地设置于顶针件，所述第七连杆可转动地设置在壳体下侧，所述的第五连杆、第六连杆、第七连杆的自由端铰接连接。
  10. 根据权利要求1所述的包皮吻合器，其特征在于，其特征在于，所述的手柄和壳体之间设有弹性复位件。
PCT/CN2022/073920 2021-01-27 2022-01-26 一种可实现先缝后切的包皮吻合器 WO2022161378A1 (zh)

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