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WO2008011754A1 - A surgical stapler - Google Patents

A surgical stapler Download PDF

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Publication number
WO2008011754A1
WO2008011754A1 PCT/CN2006/001759 CN2006001759W WO2008011754A1 WO 2008011754 A1 WO2008011754 A1 WO 2008011754A1 CN 2006001759 W CN2006001759 W CN 2006001759W WO 2008011754 A1 WO2008011754 A1 WO 2008011754A1
Authority
WO
WIPO (PCT)
Prior art keywords
head
firing
anastomosis
surgical stapler
firing head
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/CN2006/001759
Other languages
English (en)
French (fr)
Inventor
Wang-Dong Chen
Jiang Lin
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Touchstone International Medical Science Co Ltd
Original Assignee
Touchstone International Medical Science Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Touchstone International Medical Science Co Ltd filed Critical Touchstone International Medical Science Co Ltd
Priority to PCT/CN2006/001759 priority Critical patent/WO2008011754A1/zh
Publication of WO2008011754A1 publication Critical patent/WO2008011754A1/zh
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. 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
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A61B2017/1157—Staplers for performing anastomosis, e.g. in a single operation applying the staples radially

Definitions

  • the invention relates to a binding device used in surgical anastomosis surgery, in particular to a surgical binding device which adopts radial emission to perform internal anastomosis, and belongs to the technical field of medical instruments.
  • a surgical stapler is a medical device that is often used in the surgical operation of physiological tissues such as the intestines.
  • the difference in performance of the instrument plays a vital role in the overall surgical effect.
  • the firing direction of the nails is basically the same as the axial direction of the tissue, and the following three ways are specifically:
  • the axial internal anastomosis As shown in Figure 1, the two segments la and lb are introverted, forming an anastomotic ring 2 inside the tissue.
  • This is a more traditional method of anastomosis.
  • the advantage is that the body bleeding during the operation can be discharged along with the contents, and the body tissue is easier to heal after the operation.
  • the disadvantages are: the operation needs to open the door near the anastomosis; after the operation, the anastomosis ring stays in the inner cavity of the tissue, which narrows the internal passage of the tissue, which is not conducive to the removal of the postoperative instrument, which is easy to cause surgical complications, and is not conducive to the postoperative body.
  • the tissue recovery function brings obvious side effects to the patient.
  • this method of anastomosis is not conducive to postoperative examination.
  • FIG. 3 shows.
  • This method of anastomosis is an improvement of the traditional axial internal anastomosis method, which partially overcomes the shortcomings of the conventional method, so that the internal passage of the tissue after surgery is not significantly reduced, which facilitates the removal of the device and the recovery of the function of the body after surgery.
  • the disadvantages are: the body tissue of the anastomosis is always in a tight state, which is not conducive to postoperative tissue healing; the surgical instrument manufacturing is more complicated; postoperative examination is still inconvenient.
  • the object of the present invention is to overcome the technical defects of the prior art axial augmentation anastomosis, and to provide a surgical binding instrument for performing anastomosis by radial emission, which has the advantages of multiple matching methods in the prior art, and more Improve the surgical results.
  • the object of the present invention is achieved by the following technical solution - a surgical stapler comprising an anastomosis head, a connecting elbow, a positioning adjustment mechanism, and a firing mechanism, wherein the anastomosis head portion is provided with a firing mechanism and a radial emitting staple
  • the body organization implements an internal anastomotic device.
  • the object of the present invention can also be further achieved by the following technical measures:
  • the anastomosis head is composed of two parts, a firing head and a fuselage head.
  • the two are movably connected by a matching firing head rod located at the axial position of the firing head and a firing head lever located at the axial center position of the main body portion;
  • the outer ring of the firing head rod is provided with a firing head firing rod
  • the outer ring of the firing head rod is provided with a fuser firing rod, the annular cutter used for the anastomosis and the staple cartridge for storing the staple are located inside the firing head;
  • the front end of the fuselage head is a stepped circular tubular inner cavity structure
  • the inner diameter of the outer tube is larger than the diameter of the annular cutter, and the inner wall of the outer tube is provided with a nail forming groove.
  • the nail grooves on the staple cartridge are arranged in a ring shape in a plane perpendicular to the axis of symmetry of the firing head, and the passage of each nail groove extends outward in a radial direction;
  • the position and number of the nail forming grooves are identical to the nail grooves on the staple cartridge.
  • the nail groove on the staple cartridge forms 1 to 4 radial emission rings in a direction parallel to the axis of symmetry of the firing head; the most preferred solution is to form 2 to 3 radial directions.
  • the firing ring and the position of the nail groove of the adjacent launching ring are staggered to ensure that the shape of the anastomotic ring is regular and the sealing effect is good after the operation.
  • a ring anvil may be embedded in the stepped circular tubular inner cavity from the outer to the inner second round tube at the front end of the fuselage head, and the inner diameter of the annular anvil may be The outer diameter and the outer diameter are respectively smaller than and larger than the diameter of the annular cutter, so that the circular cutter can enter the interior of the softer anvil after the tissue is cut during the operation, thereby ensuring the surgical effect.
  • the outer ring tube at the front end of the fuselage head can adopt a diastolic structure with a finely tunable diameter so that the body tissue can be better seated and fitted.
  • the invention provides an internal anastomosis for the body tissue by a radial firing staple Compared with the various staplers in the prior art, the present invention overcomes the defects of the internal matching method and overcomes the defects of the present invention, and solves the long-standing desire of the present invention. solved problem.
  • the body tissues such as the intestines are basically in a state similar to that before surgery, and the internal passages are not significantly reduced, which is convenient for the removal of the postoperative instruments, and also facilitates the postoperative healing of the tissue, thereby greatly improving the surgical effect.
  • Fig. 1 is a schematic view showing the effect of the prior art axial internal anastomosis.
  • Fig. 2 is a schematic view showing the effect of the prior art axial external anastomosis.
  • Fig. 3 is a schematic view showing the effect of the prior art expansion and internal anastomosis.
  • Figure 4 is a schematic view of the effect of the present invention after surgery.
  • FIG. 5 is a schematic structural view of an anastomosis head portion of a surgical stapler according to the present invention.
  • Figures 6-1 to 6-6 are schematic views of the surgical procedure for performing an anastomosis operation using the surgical stapler provided by the present invention.
  • the meanings of the reference numerals are: la, lb tissue; 2 anastomosis ring; 3 nail forming groove; 4 anvil; 5 fuselage head; 6 firing head firing putter; 7 body firing putter; 8 firing head pull rod; 9 shot head; 10 cutter; 11 staples; 12 shots.
  • a firing head firing pusher 6 is provided on the outer ring of the firing head bar 9, and a body firing pusher 7 is provided on the outer ring of the firing head lever 8.
  • the annular cutter 10 used for the anastomosis and the staple cartridge 11 for storing the staples are all located inside the firing head 12.
  • the front end of the fuselage head 5 is a stepped circular tubular inner cavity structure, the outer diameter of the outer ring pipe is larger than the diameter of the annular cutter 10, and the nail forming groove 3 is provided on the inner wall of the outer ring pipe.
  • the staple grooves on the staple cartridge 11 are arranged in a ring shape in a plane perpendicular to the axis of symmetry of the firing head 12, and the passage of each of the staple grooves extends radially outwardly so as to be parallel to the axis of symmetry of the firing head 12.
  • Two radial launching rings are formed on the top, and the positions of the staple slots of adjacent firing rings are staggered.
  • the number of the nail forming grooves 3 and the position of each of the nail forming grooves 3 on the inner wall of the stepped circular tubular inner ring outer tube at the front end of the body head 5 are all the nails on the staple cartridge 11
  • the slots are consistent.
  • a ring-shaped anvil 4 is embedded in the stepped circular tubular inner cavity at the front end of the fuselage head 5 from the outside to the inside of the second circular tube, and the inner and outer diameters of the annular anvil 4 are respectively smaller than Greater than the diameter of the annular cutter 10.
  • the outer ring of the front end of the fuselage head 5 The round tube has a diastolic structure that allows it to be fine-tuned in diameter.
  • the large diameter is used when the tissue is in place, and the tissue is compressed by the contraction after the position is placed, and then an anastomosis operation is performed.
  • Figures 6-1 to 6-6 illustrate the procedure for performing the surgery using the surgical stapler provided by the present invention, and the surgical results are shown in Fig. 4.
  • the specific process of matching is:
  • the firing head 12 and the fuselage are in a separated state, and the tissues la and lb to be anastomosed respectively enclose the firing head 12 and the fuselage head 5, and are subjected to a dash bag processing, as shown in Fig. 6-1;
  • the firing head 12 is connected to the firing head rod 8 inside the fuselage by the firing head rod, as shown in Fig. 6-2;
  • the surgical stapler provided by the present invention preferably conforms to the normal flow direction of the tissue contents, and the upstream tissue should be treated as la at the time of operation, and the purse is wound around the periphery of the firing head 12; the downstream tissue acts as lb, and The outer periphery of the fuselage head 5 is charged with a purse.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (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)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Description

外科用装订仪 技术领域
本发明涉及外科吻合手术所使用的装订仪，特别为一种采用径向 发射实施内吻合的外科用装订仪， 属于医疗器械技术领域。
技术背景
外科用装订仪是对肠道等生理组织进行外科手术时经常使用的 一种医疗器械，该仪器性能的差异对于整个手术效果起着至关重要的 作用。现有技术中， 吻合时钉子的击发方向均与组织的轴向方向基本 一致， 具体又分以下三种方式：
一、 轴向内吻合。如图 1所示， 两段组织 la和 lb内敛， 在组织 内部形成吻合环 2。 这是比较传统的一种吻合方式， 有多种相应的吻 合器械，其优点是：手术过程中产生的机体出血等能够随着内容物一 起排出， 手术后机体组织比较容易愈合。缺点是： 手术时需要在吻合 点附近开贲门； 手术后吻合环滞留在组织内腔当中， 使组织内部通道 变窄， 不利于术后器械取出， 容易导致手术并发症， 也不利于术后机 体组织恢复功能， 给病人带来明显副作用； 第三， 这种吻合方式不利 于术后检査。
二、轴向外吻合。如图 2所示， 两段组织 la和 lb外翻， 在组织 外部形成吻合环 2， 相关的专利有 US6769594、 US6769590。这种吻合 方式的优点是： 手术中无需开贲门， 术后检査方便， 肠径等组织内部 通道不受影响， 术后器械取出方便； 其最大的缺点是： 手术过程中产 生的机体出血将进入体液当中， 无法排出。
三、 扩张内吻合。 中国专利申请 00819331是这种吻合方式中比 较有代表性的一种， 其装订仪的吻合面为波浪式， 吻合后两段组织 la和 lb局部扩张， 形成通径比较大的吻合环 2， 如图 3所示。 这种 吻合方式是对传统的轴向内吻合方式的改进，它部分克服了传统方式 的缺点， 使得手术后组织内部通道无明显变小， 便于术后取出器械及 恢复机体功能。其缺点是： 吻合处机体组织始终处于紧绷状态， 不利 于术后组织愈合； 手术器械制造比较复杂； 术后检查仍然不方便。
发明内容
本发明的目的在于克服现有轴向发射实施吻合手术的技术缺陷， 提供一种通过径向发射实施吻合手术的外科用装订仪，使其兼具现有 技术中多种吻合方式的优点， 更好地提高手术效果。
本发明的目的通过以下技术解决方案来实现- 外科用装订仪， 包括吻合头、连接弯管、 定位调节机构、击发机 构，其中在吻合头部分设置由击发机构击发、径向发射吻合钉而对机 体组织实施内吻合的装置。
本发明的目的还可通过以下技术措施来进一步实现：
上述外科用装订仪中， 吻合头由击发头和机身头部两个部分构 成，两者通过相互匹配的位于击发头轴心位置的击发头杆以及位于机 身主体部分轴心位置的击发头拉杆而活动连接；所述击发头杆的外圈 设有击发头击发推杆、击发头拉杆的外圈设有机身击发推杆， 吻合时 使用的环形切刀以及存放吻合钉的钉仓均位于击发头的内部；机身头 部的前端为阶梯式圆管状内腔结构，其外圈圆管的内径大于所述环形 切刀的直径， 在外圈圆管的内壁上设有钉子成形槽。
进一步地，上述外科用装订仪中，所述钉仓上的钉槽在垂直于击 发头对称轴的平面内呈环状排布，每个钉槽的通道呈径向发射状向外 延伸； 所述钉子成形槽的位置和数量与钉仓上的钉槽相一致。
更进一步地，上述外科用装订仪中，所述钉仓上的钉槽在平行于 击发头对称轴的方向上形成 1〜4个径向发射环； 最优选方案是形成 2〜3个径向发射环， 相邻发射环的钉槽位置错开排布， 以保证手术 后吻合环形状规整、 密封效果好。
再进一步地，上述任意一种外科用装订仪中，可以在机身头部前 端阶梯式圆管状内腔从外向里第二圈圆管的内部镶嵌环状刀砧，该环 状刀砧的内径和外径分别小于和大于环形切刀的直径，使得手术时环 形切刀在切断组织之后进入能够进入质地较软的刀砧内部，从而保证 手术效果。
此外，上述外科用装订仪中，机身头部前端的外圈圆管可以采用 直径能够微调的舒张式结构， 以便机体组织能够更好地就位和吻合。 本发明提供了一种通过径向发射吻合钉对机体组织实施内吻合 的外科用装订仪，与现有技术中各种装订仪相比，本发明在保留内吻 合方式诸多优点的基础之上，很好地克服了它们存在的种种缺陷，解 决了长期以来人们一直渴望解决的问题。手术后肠道等机体组织基本 上处于与术前相似的状态，其内部通道没有明显变小， 既便于术后器 械取出， 也利于组织术后愈合， 大大提高了手术效果。
附图说明
图 1为现有技术轴向内吻合手术后效果示意图。
图 2为现有技术轴向外吻合手术后效果示意图。
图 3为现有技术扩张内吻合手术后效果示意图。
图 4为本发明手术后效果示意图。
图 5为本发明提供的外科用装订仪的吻合头部分结构示意图。 图 6-1〜图 6-6为应用本发明提供的外科用装订仪实施吻合手术 的手术过程示意图。
附图标记的含义为： la、 lb组织； 2吻合环； 3钉子成形槽； 4 刀砧； 5机身头部； 6击发头击发推杆； 7机身击发推杆； 8击发头拉 杆； 9击发头杆; 10切刀; 11钉仓； 12击发头。
具体实施方式
下面结合附图对本发明的技术方案和特点作详细说明 与现有技术类似， 本发明提供的外科用装订仪整体结构上包括： 吻合头、连接弯管、定位调节机构和击发机构， 其中吻合头部分的结 构如图 5所示。 它由击发头 12和机身头部 5两个部分构成， 两者通 过相互匹配的位于击发头 12轴心位置的击发头杆 9以及位于机身主 体部分轴心位置的击发头拉杆 8而活动连接。在击发头杆 9的外圈设 有击发头击发推杆 6， 在击发头拉杆 8的外圈设有机身击发推杆 7。 吻合时使用的环形切刀 10 以及存放吻合钉的钉仓 11均位于击发头 12的内部。 机身头部 5的前端为阶梯式圆管状内腔结构， 其外圈圆 管的内径大于环形切刀 10的直径， 并且在外圈圆管的内壁上设有钉 子成形槽 3。
钉仓 11上的钉槽在垂直于击发头 12对称轴的平面内呈环状排 布， 每个钉槽的通道呈径向发射状向外延伸， 从而在平行于击发头 12对称轴的方向上形成 2个径向发射环， 相邻发射环的钉槽位置错 开排布。
另一方面，钉子成形槽 3的数量以及每个钉子成形槽 3在机身头 部 5前端阶梯式圆管状内腔外圈圆管的内壁上所处的位置，均与钉仓 11上的钉槽相一致。
为保证手术效果，在机身头部 5前端阶梯式圆管状内腔从外向里 第二圈圆管的内部嵌有环状刀砧 4, 该环状刀砧 4的内径和外径分别 小于和大于环形切刀 10的直径。
为保证机体组织能够更好地就位和吻合，机身头部 5前端的外圈 圆管采用舒张式结构， 使其直径能够微调。 组织就位时采用大口径， 就位后收缩口径压紧组织， 然后实施吻合手术。
图 6-1〜图 6-6示意了采用本发明提供的外科用装订仪进行手术 的过程， 手术效果如图 4所示。 吻合的具体过程为：
( 1 )击发头 12和机身处于分开状态，待吻合的组织 la和 lb分 别包住击发头 12和机身头部 5， 进行扎荷包处理， 见图 6 - 1 ;
(2)击发头 12通过击发头杆 9与机身内部的击发头拉杆 8连接， 见图 6-2;
( 3)通过装订仪机身部位的定位调节机构使击发头 12与机身头 部 5靠拢， 直至击发头击发推杆 6与机身击发推杆 7接触，然后调节 机身头部 5前端外圈圆管的口径而压紧组织， 使待吻合的组织就位， 见图 6- 3 ;
(4)击发——通过装订仪的击发机构向前推动机身击发推杆 7、 进而推动击发头击发推杆 6实施击发， 击发时预先存放在钉仓 11内 部各个钉槽当中的吻合钉沿径向向外发散，与机身头部 5相对应的钉 子成形槽 3配合起来对组织 la和 lb进行吻合； 同时， 环形切刀 10 向刀砧 4方向快速平移，直至抵住或者部分进入刀砧 4内部，从而对 多余的组织进行切除， 见图 6- 4;
( 5)通过装订仪机身部位的定位调节机构使击发头 12与机身头 部 5分开， 见图 6 - 5;
(6 ) 吻合过程结束， 取出器械。 被切除的多余组织也随同器械 一同取出， 见图 6-6。
需要说明的是，应用本发明提供的外科用装订仪最好要顺应组织 内容物的正常流动方向， 手术时应当将上游组织作为 la， 在击发头 12外围打荷包； 下游组织作为 lb， 并在机身头部 5的外围打荷包。

Claims

权利要求
1. 外科用装订仪， 包括吻合头、 连接弯管、 定位调节机构、 击 发机构， 其特征在于： 吻合头设有由击发机构击发、径向发射吻合钉 而对机体组织实施内吻合的装置。
2. 根据权利要求 1所述的外科用装订仪， 其特征在于： 吻合头 由击发头 [12]和机身头部 [5]两个部分构成， 两者通过相互匹配的位 于击发头 [12]轴心位置的击发头杆 [9]以及位于机身主体部分轴心位 置的击发头拉杆 [8]而活动连接；所述击发头杆 [9]的外圈设有击发头 击发推杆 [6]、 击发头拉杆 [8]的外圈设有机身击发推杆 [7]， 吻合时 使用的环形切刀 [10]以及存放吻合钉的钉仓 [11]均位于击发头 [12] 的内部； 机身头部 [5]的前端为阶梯式圆管状内腔结构， 其外圈圆管 的内径大于所述环形切刀 [ 10]的直径，在外圈圆管的内壁上设有钉子 成形槽 [3]。
3. 根据权利要求 2所述的外科用装订仪， 其特征在于： 所述钉 仓 [11]上的钉槽在垂直于击发头 [12]对称轴的平面内呈环状排布，每 个钉槽的通道呈径向发射状向外延伸； 所述钉子成形槽 [3]的位置和 数量与钉仓 [11]上的钉槽相一致。
4. 根据权利要求 3所述的外科用装订仪， 其特征在于： 所述钉 仓 [11]上的钉槽在平行于击发头 [12]对称轴的方向上形成 1〜4个径 向发射环。
5. 根据权利要求 4所述的外科用装订仪， 其特征在于： 所述钉 仓 [11]上的钉槽在平行于击发头 [12]对称轴的方向上形成 2〜3个径 向发射环， 相邻发射环的钉槽位置错开排布。
6.根据权利要求 2〜5所述的任意一种外科用装订仪，其特征在 于： 在机身头部〔5]前端阶梯式圆管状内腔从外向里第二圈圆管的内 部嵌有环状刀砧 [4] ,该环状刀砧 [4]的内径和外径分别小于和大于环 形切刀 [10]的直径。
7. 根据权利要求 2所述的外科用装订仪， 其特征在于： 所述机 身头部 [5]前端的外圈圆管采用直径能够微调的舒张式结构。
PCT/CN2006/001759 2006-07-19 2006-07-19 A surgical stapler Ceased WO2008011754A1 (en)

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WO2014161129A1 (zh) * 2013-03-31 2014-10-09 广东实联医疗器械有限公司 外科用吻合器
CN108938032A (zh) * 2018-09-28 2018-12-07 广州德脉医疗器械有限公司 一种放射性钉仓
CN109199497A (zh) * 2018-09-30 2019-01-15 常州同创医疗器械科技有限公司 一种胆肠吻合器
CN110251180A (zh) * 2019-07-09 2019-09-20 北京博辉瑞进生物科技有限公司 一种钉砧组件及采用该钉砧组件的吻合器
CN112137670A (zh) * 2020-11-06 2020-12-29 辽宁省肿瘤医院 一种中式食管吻合器

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CN1106827C (zh) * 1998-10-27 2003-04-30 张祖仁 外科用管型吻合器
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Publication number Priority date Publication date Assignee Title
WO2014161129A1 (zh) * 2013-03-31 2014-10-09 广东实联医疗器械有限公司 外科用吻合器
CN108938032A (zh) * 2018-09-28 2018-12-07 广州德脉医疗器械有限公司 一种放射性钉仓
CN108938032B (zh) * 2018-09-28 2024-08-02 广州德脉医疗器械有限公司 一种放射性钉仓
CN109199497A (zh) * 2018-09-30 2019-01-15 常州同创医疗器械科技有限公司 一种胆肠吻合器
CN110251180A (zh) * 2019-07-09 2019-09-20 北京博辉瑞进生物科技有限公司 一种钉砧组件及采用该钉砧组件的吻合器
CN110251180B (zh) * 2019-07-09 2024-04-30 北京博辉瑞进生物科技有限公司 一种钉砧组件及采用该钉砧组件的吻合器
CN112137670A (zh) * 2020-11-06 2020-12-29 辽宁省肿瘤医院 一种中式食管吻合器

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