CN101715319B - 用于粘膜切除术的吻合器 - Google Patents

用于粘膜切除术的吻合器 Download PDF

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CN101715319B
CN101715319B CN200780052578XA CN200780052578A CN101715319B CN 101715319 B CN101715319 B CN 101715319B CN 200780052578X A CN200780052578X A CN 200780052578XA CN 200780052578 A CN200780052578 A CN 200780052578A CN 101715319 B CN101715319 B CN 101715319B
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anastomat
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CN101715319A (zh
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C·雷布法特
D·戴维
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Covidien AG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
    • 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
    • A61B2017/1142—Purse-string sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft

Abstract

一种用于粘膜切除术的吻合器的头部，包含外高脚杯状体(1)，其内同心且可滑动地设置有内高脚杯状体(2)，环形刀片(3)固定于内高脚杯状体的边缘上。内高脚杯状体(2)具有中心孔(5)，其中杆(6)滑动地插入中心孔，在杆末端(7)上固定有砧子(8；8’)。一条或多条彼此平行并适当间隔的环形凹槽(11)形成于杆(6)的侧面上，与杆的轴线垂直。所述凹槽(11)用来容纳当粘膜缠绕在杆(6)上时包括在荷包缝合内的部分粘膜(9a)。通过将杆(6)缩回内高脚杯状体(2)的杆柄(2a)的中心孔(5)中，要去除的粘膜被带入内高脚杯状体(2)中。砧子(8；8’)和环形刀片(3)通过适合的装置靠近彼此移动，以便当吻合器处于闭合位置时将组织切除。

Description

用于粘膜切除术的吻合器
技术领域
本发明涉及一种用于中空器官中的粘膜切除术的吻合器(stapler)，更具体的是涉及一种配备有中央开槽杆的吻合器，该吻合器能够实现较大量的粘膜组织的精确粘膜切除术。
背景技术
粘膜切除术是一种特别适于治疗痔疾、脱肛和直肠粘膜脱垂的手术。现已知的环形机械吻合器可用于施加缝合钉和旋加如可崩解环的压缩装置。所述吻合器可具有中央轴。粘膜切除术的目的是为了去除尽可能大的部分粘膜，从而确保中空器官的粘膜被显著“提升”。
为了实现这个目的，在美国专利6102271中公开了一种环形吻合器，其头部包含两个同心的高脚杯状体。在所述高脚杯状体的侧面上位于其杆柄附近开有两个通孔。所述通孔使得荷包缝合线由此向外穿出。因此所述缝合线可被拉向上面所述的高脚杯状体外，从而将尽可能大体积的粘膜拉进高脚杯状体内。随后，粘膜通过固定在内高脚杯状体边缘上的环形刀片切除。与此同时，设置于高脚杯状体中央的轴移动砧子来施加缝合钉，所述砧子在外高脚杯状体边缘附近被固定在轴的端部上。然而，在上述专利中所介绍的吻合器存在缺陷：在闭合吻合器的步骤中手工拉动缝合线就不能精准地以均匀可控的方式去除粘膜。
US2006/108393公开了一种外科吻合设备，包括伤口治疗材料分发系统，用于将伤口治疗材料输送到目标手术位置。该分发系统包括形成在砧组件中的孔，定向成朝向外的方向分发伤口治疗材料。在一个实施例中，多个口形成在支撑砧组件的砧子元件的杆中。该杆包括分别形成在这些口的近端和远端的第一和第二环形凹槽。通过这种方式，在使用中，要吻合的一部分组织可在所述口的附近独荷包缝合到杆上，以便在吻合的时候能够输送伤口处理材料。
上述的吻合装置的确提供了用于被吻合的组织的固定区域，因此粘膜可以均匀和受控的方式精准地被去除。然而，不能调节被去除粘膜的量。
US5395030公开了一种用于吻合并紧固身体组织的手术装置，包括外壳和固定在杆的自由端的砧子元件，该杆可沿外壳的中心线滑动。在一个实施例中，设置与杆同轴线的抽吸元件，通过旋转安装在操作部分上的砧旋转旋钮，该抽吸元件能够在外壳内前后移动。环形的抽吸凹槽形成在抽吸元件远端部分的圆周中，因此通过产生真空，能够在抽吸凹槽中抽吸并保持一部分要被去除的组织。然后，该抽吸元件被拉回，朝向外壳移动砧子。因此，该组织被拉入外壳中，双层折叠并夹在外壳和砧子之间，因此缝合钉可被送到折叠部分，同时环形刀具被向前推，以便切除须被去除的部分折叠部分。
US6117148公开了一种肠腔内重建和切除装置，包括用于肠的肠套叠的机构、肠吻合机构和用于切断被切除肠的机构。该装置包括在远端的把手和操作端之间延伸的圆柱形外壳。中心柱沿外壳的中心线延伸，并包括环形凹槽。中心柱例如通过螺纹连接相对于外壳和砧子元件能够移动，并由适当的控制器控制，从而允许肠的不同节段肠套叠。在操作中，肠在环形凹槽处例如通过结扎元件被连接到中心柱。然后，中心柱相对于外壳移动，从而使得肠节段的肠套叠被去除。肠套叠之后，肠可被吻合，要切除的节段可被切断并抽回。
US5395030和US6117148提供的方案都解决了调节要被去除组织的量的问题。然而，它们公开的方案太复杂和昂贵，因为在这两种方案中都需要沿着支撑砧子的杆移动的元件和相关的驱动机构。
发明内容
因此，本发明的目的是提供一种没有上述缺陷的用于粘膜切除术的吻合器。所述目的是通过一种吻合器来实现的，其主要技术特征在第一项权利要求中描述，而其他技术特征在后面的权利要求中描述。
为了实现所述目的，依照本发明的吻合器具有中央杆，该杆具有一个或多个形成在其侧面上与其轴线交叉的环形槽。所述槽是为了在荷包缝合缠绕在所述杆上时容纳部分组织，并防止所述部分组织在中央杆收回到内高脚杯状体的杆柄中时沿中央杆发生意外滑动。为了确保在所述杆收回的过程中中空体壁以可控和均匀的方式被拉进内高脚杯状体中，所述槽应具有适当的尺寸并精确地彼此间隔。
依照本发明的吻合器所具有的另一优点是，仅通过在吻合器杆上形成并校准过的环形槽中选出某一环形槽，即可实现精确去除不同量的粘膜。
附图说明
依照本发明的吻合器的另外优点和特征从接下来参照附图对两个实施方式详细且无限定作用的公开内容中对于本领域技术人员是显而易见的，其中：
-图1是处于打开位置的依照本发明的吻合器第一实施例的头部的部分剖视侧视图；
-图2是图1中吻合器的头部穿过中空圆柱形导入器被导入部分剖开的中空器官内部的纵向剖视图；
-图3是吻合器头部穿过中空圆柱形导入器位于中空器官内部、处于闭合位置的纵向剖视图；
-图4是处于打开位置的依照本发明的吻合器第二实施例的头部的部分剖视侧视图；
-图5是图4的吻合器头部穿过中空圆柱形导入器被导入部分剖开的中空器官内部、处于闭合位置的轴侧投影视图；以及
-图6是图5的吻合器头部的纵向剖视图。
具体实施方式
图1和2示出了吻合器的头部，已知吻合器包含了外高脚杯状体1，外杯状体配有第一中空杆柄1a，其中较小的内高脚杯状体2同心且可滑动地位于外杯状体中。环形刀片3被固定在所述内高脚杯状体2的边缘处。内高脚杯状体2处于缩回位置时，环形刀片3位于外高胸杯状体1内部，并不从外高脚杯状体的边缘4伸出。在环形刀片3的对侧，内高脚杯状体2具有第二中空杆柄2a，其具有中心孔5，而杆6可滑动地插入在所述孔中。在与设置有杆6在其中滑动的中心孔5的部分相对的部分中，杆6具有末端7，砧子8被固定在该末端上。附图中示出的吻合器头部的外高脚杯状体1的中空杆柄1a以已知的方式连接到手柄(未示出)上。所述砧子8和所述环形刀片3逐渐地靠近彼此移动，以便当吻合器头部到达闭合位置时能切除粘膜，而吻合器头部到达闭合位置所指的是杆6逐渐地缩回到第二中空杆柄2a的中心孔5中的时候，缩回过程可通过适合的杆缩回机构(未在附图中示出)实现，所述缩回机构包含在吻合器手柄中，如本领域技术人员所熟知的。环形刀片3通过适合的刀片移动机构(未在附图中示出)向前移动，所述移动机构也包含在吻合器手柄中，如本领域技术人员所熟知的。外高脚杯状体1的边缘4可配有适合的凹进4a，所述凹进被设计成容纳适合的缝合装置，例如金属缝合钉。在图2中示出了吻合器头部处于打开位置并通过中空圆柱形导入器10导入中空器官9中，所述导入器具有凸缘10a和10b。
依照本发明，杆6具有一条或多条环形凹槽11，所述凹槽彼此间隔，形成在杆6的侧面上垂直于所述杆轴线。所述环形凹槽11是用来在粘膜9a缠绕在杆6周围时将中空器官9的部分粘膜9a容纳在其内部，粘膜被包含在荷包缝合(未示出)中。环形凹槽11的数量和它们之间的距离被适当校准以便为杆上的荷包缝合提供多个固定位置，从而总是可以去除尽可能大量的粘膜。
杆6的环形凹槽11的深度包括在0.5mm到3mm之间，优选为大约1mm。杆6的横截面优选为圆形，但也可以是多边形的。
杆6的每条环形凹槽11包括圆柱形面12，该圆柱形面的直径小于杆6侧面的其余部分，并通过圆角面13连接到所述侧面上。圆柱面12和杆6其余侧面之间的圆角面13的半径优选为大约1mm。
为了使用依照本发明的吻合器完成粘膜切除术，首先在要从中空器官9上去除掉的粘膜9a的脱垂部分中完成荷包缝合。然后，处于打开位置的吻合器头部通过将砧子8穿过荷包缝合被引入中空器官9中，其中打开位置是指砧子8与外高脚杯状体1的边缘4分开。进而，荷包缝合在外高胸杯状体1的边缘4和砧子8之间缠绕在杆6上。特别地，荷包缝合对应形成在杆6上的环形凹槽11缠绕在杆6上，使得包括在荷包缝合之内的部分粘膜9a位于环形凹槽内不会沿杆6滑动。为了以可控、均匀和精准的方式去掉大量的粘膜，从以精确校准的相应距离形成于杆6上的环形凹槽11中选取确定的环形凹槽11。
如图3所示，最后吻合器头部通过将杆6缩回内高胸杯状体2的杆柄2a的中心孔5中而闭合，从而将要去除掉的粘膜带入内高脚杯状体2中，并同时使得砧子8将要去掉的粘膜推向外高脚杯状体1的边缘4。
在用适合的杆缩回装置将吻合器头部闭合之后，缝合装置14被施加到中空体9的粘膜上，对应于外高脚杯状体1边缘4。例如，这种缝合装置14可以是金属缝合钉。因此，内高脚杯状体2和与之一体的环形刀片3被适合的移动装置朝向砧子8移动，从而将包含在内高脚杯状体2中的粘膜与缝合装置14被施加到其上的中空器官9的粘膜分离。最后，将吻合器头部从中空器官9中取出。
图4、5和6示出了第二可选实施例，其中吻合器头部适于施加可崩解的压缩装置。在本实施例中，砧子8’支撑压缩装置的部件14’，当吻合器头部闭合时，部件14’与互补部件14”、14’”联结，互补部件14”、14’”对应外高脚杯状体1的边缘4设置，这是本领域技术人员所熟知的。
优选地，在粘膜切除术中中空体9通过中空圆柱形导入器10保持打开状态，如图2、3、5和6中所示。
为了说明在杆6上存在几条环形凹槽11的作用并突出由此产生的每条凹槽11与砧子8、8’之间的距离和粘膜去除量之间的一一对应关系，下面参考依照本发明吻合器的非限定性实例。
吻合器具有直径为24mm的环形刀片3和直径等于5mm的杆6，其中深度为1mm的环形凹槽11形成于杆6上，从而在与凹槽11对应的位置，杆6的直径为3mm。
如果环形凹槽11位于对应于杆6与砧子8、8’的连接点的位置，当荷包缝合缠绕在杆6上对应所述凹槽11的位置时，就有21mm的粘膜可被去除掉，这是环形刀片3与环形凹槽11距离的两倍，所述距离等于环形刀片3的半径12mm减去杆6在对应凹槽11位置处的半径1.5mm。
为了去除更多粘膜，优选地，吻合器设有三条环形凹槽11，它们分别设置在与砧子8、8’距离为10mm、20mm和30mm的位置处。这些凹槽对应的粘膜去除量大约为29mm、45mm和63.5mm。实际上，如图3和6中所示，当杆6缩回高脚杯状体2的杆柄2a中时，由于环形刀片3和环形凹槽11的距离增加，与砧子8、8’隔开的凹槽11能够将更多的粘膜拉进所述高脚杯状体2中，其中粘膜9a通过荷包缝合被固定在环形凹槽11中。显而易见，由于本发明，外科医生使用依照本发明的吻合器可以进行更快速、精准和安全的手术。

Claims (8)

1.一种用于粘膜切除术的吻合器，其头部包含至少一个高脚杯状体(1、2)和砧子(8、8’)，所述高脚杯状体具有中心孔(5)，杆(6)滑动插入所述中心孔，所述砧子固定到所述杆(6)的与所述中心孔(5)相对的末端(7)，其特征在于，在杆(6)的侧面上并垂直于所述杆的轴线设有三个环形凹槽(11)，所述凹槽彼此精准地间隔，在粘膜缠绕在杆(6)周围时，所述凹槽(11)适于容纳部分粘膜(9a)，所述部分粘膜(9a)包含在荷包缝合中，并且所述荷包缝合对应于其中一个所述凹槽(11)缠绕在杆(6)上，所述凹槽(11)位于离砧子(8、8’)不同的距离处，因此不同量的粘膜被精准地去除。
2.如权利要求1所述的吻合器，其特征在于，三个环形凹槽(11)分别设置在距离砧子(8、8’)10mm、20mm和30mm的位置处。
3.如权利要求1或2所述的吻合器，其特征在于，杆(6)的凹槽(11)的深度包括在0.5mm到3mm之间。
4.如权利要求3所述的吻合器，其特征在于，杆(6)的凹槽(11)的深度等于1mm。
5.如权利要求1或2所述的吻合器，其特征在于，杆(6)的横截面是圆形的。
6.如权利要求1或2所述的吻合器，其特征在于，杆(6)的每条凹槽(11)包括圆柱形面(12)，该圆柱形面的直径比杆(6)的其余侧面小，并通过圆角面(13)与杆(6)的侧面相连。
7.如权利要求6所述的吻合器，其特征在于，位于圆柱形面(12)和杆(6)的其余侧面之间的圆角面(13)的半径为1mm。
8.如权利要求1或2所述的吻合器，其特征在于，在外高脚杯状体(1)内部同心且可滑动地设置有较小的内高脚杯状体(2)，环形刀片(3)固定于内高脚杯状体的边缘上，所述内高脚杯状体(2)的杆柄(2a)具有中心孔(5)，杆(6)滑动地插入所述中心孔。
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WO2008107918A1 (en) 2008-09-12
US9883862B2 (en) 2018-02-06
US20180110526A1 (en) 2018-04-26
CN101715319A (zh) 2010-05-26
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US10568631B2 (en) 2020-02-25
AU2007348492B9 (en) 2013-04-18
JP5070300B2 (ja) 2012-11-07
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US20100213239A1 (en) 2010-08-26
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US9119621B2 (en) 2015-09-01
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US20140171985A1 (en) 2014-06-19
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US20150028079A1 (en) 2015-01-29
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US20150366561A1 (en) 2015-12-24

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