CN108714040B - vaginal stump press - Google Patents
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- CN108714040B CN108714040BCN201810508242.XACN201810508242ACN108714040BCN 108714040 BCN108714040 BCN 108714040BCN 201810508242 ACN201810508242 ACN 201810508242ACN 108714040 BCN108714040 BCN 108714040B
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- A61B17/00—Surgical instruments, devices or methods
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0493—Protective devices for suturing, i.e. for protecting the patient's organs or the operator
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/28—Surgical forceps
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- A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
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- A61B90/17—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins for soft tissue, e.g. breast-holding devices
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Abstract
Translated fromChinese
Description
Translated fromChinese技术领域technical field
本发明属于医疗技术领域，具体涉及一种阴道残端顶压器。The invention belongs to the field of medical technology, and in particular relates to a vaginal stump pressing device.
背景技术Background technique
盆腔脏器脱垂( pelvic organ prolapse ，简称POP) 是妇科常见疾病，老年女性一生中因 POP 行手术治疗的风险是10%，其中29%会在2年内行第2次手术，POP已严重影响患者的生活质量和身心健康。腹腔镜骶骨阴道固定术 (laparoscopic sacrocolpopexy，简称LSC)通过小面积网片加固中盆腔缺陷，同时可兼顾对阴道前、后壁的加固，取得了较好的临床效果；术中首先行腹腔镜下骶前区域的分离，患者取头低臀高位左低右高位暴露右侧结肠旁间隙，辨认右侧输尿管，纵行打开骶岬前腹膜，暴露骶前区域，取第一骶椎(S1)椎体前无血管区作为缝合位点，沿右侧宫骶韧带内侧打开侧腹膜(或将网片穿行侧腹膜下方)至阴道穹隆处，有子宫者先行子宫切除术，腹腔镜下分离膀胱阴道间隙和直肠阴道间隙，对于阴道顶端缺陷的纠正，一般认为分离阴道顶端黏膜距离穹隆长3 cm即可，将聚丙烯网片设计、剪裁成Y型，宽度3 cm，用卵圆钳钳夹折叠后纱布团，经阴道水平并上举卵圆钳钳柄暴露阴道残端顶部将网片间断缝合固定于阴道残端顶部纤维肌层上，注意缝线不能穿透阴道黏膜层，上抬并上举卵圆钳钳柄暴露阴道前壁将网片分排间断缝合固定于阴道前壁纤维肌层上，注意缝线不能穿透阴道黏膜层，下压并上举卵圆钳钳柄暴露阴道后壁将网片分排间断缝合固定于阴道后壁纤维肌层上，注意缝线不能穿透阴道黏膜层，水平并上举卵圆钳钳柄使阴道残端恢复至生理位置，向上牵拉网片至缝合位点，修剪网片至合适长度，用不可吸收缝线将网片另一端间断缝合固定于S1椎体前方的骶骨前纵韧带上，缝合深度应包含前纵韧带全层，并将网片充分展平，一般需2~3针，注意网片悬吊固定后阴道没有过多张力，阴道顶端所处的最远端达-6 cm以上。可吸收线关闭侧腹膜，将网片包埋于腹膜后；以上为现有技术中阴道顶压残端的方法，其存在以下缺陷：（1）、缝针穿透阴道壁不易及时察觉，手术结束时检查如果有缝穿现象须拆除穿透处针线，甚至其余缝线进行重新缝合，增加了手术操作流程，延长手术时间，同一部位反复多次缝合、拆除可增加网片侵蚀、暴露等严重并发症等的机会；（2）、缝针若缝穿阴道壁后将纱布卷和阴道壁缝合在一起，最后取出纱布时容易拉断补片导致前功尽弃，显著增加患者的住院费用，拆除补片重新手术可增加术中术后骶骨前血管丛大出血、术后网片侵蚀、网片暴露等严重并发症的风险，同时因出血等导致再次手术的难度亦明显增加；（3）、纱布卷塑形性相对较差，难以将阴道前后壁顶压至适宜缝合的位置；（4）、纱布卷不具有钳夹功能，顶压过程中无法确保纱布卷正好位于阴道残端正中，从而影响顶压效果，不利于缝合操作过程及网片长度的测量过程；（5）、卵圆钳钳夹纱布卷后钳柄朝向位置固定，且朝向为上下方向，不利于下压钳柄暴露阴道后壁、上抬钳柄暴露阴道前壁等操作，不利于操作者根据术中情况握持器械。Pelvic organ prolapse (pelvic organ prolapse, referred to as POP) is a common gynecological disease. The risk of surgical treatment for POP in elderly women is 10% in life, and 29% of them will undergo a second operation within 2 years. POP has seriously affected Quality of life and physical and mental health of patients. Laparoscopic sacrocolpopexy (LSC for short) uses a small-area mesh to reinforce the middle pelvic defect, and at the same time can take into account the reinforcement of the anterior and posterior vaginal walls, and has achieved good clinical results; For the separation of the presacral region, the patient is taken in a position with the head low buttocks high, left low and right high to expose the right paracolic space, identify the right ureter, open the peritoneum longitudinally before the sacral promontory, expose the presacral region, and take the first sacral vertebra (S1) The avascular area in front of the body is used as the suture site, and the lateral peritoneum is opened along the medial side of the right uterosacral ligament (or the mesh is passed under the lateral peritoneum) to the vaginal vault. If there is a uterus, hysterectomy is performed first, and the vesico-vaginal space is separated laparoscopically. and the rectovaginal space, for the correction of vaginal apex defects, it is generally considered that the separation of the vaginal apex mucosa is 3 cm long from the fornix, and the polypropylene mesh is designed and cut into a Y shape with a width of 3 cm, and folded with oval forceps Lift the gauze ball horizontally through the vagina and lift the handle of the oval forceps to expose the top of the vaginal stump. Fix the mesh on the fibromuscular layer at the top of the vaginal stump with intermittent sutures. Pay attention that the sutures cannot penetrate the vaginal mucous layer. Lift and lift up The handle of the oval forceps exposes the anterior wall of the vagina, and the mesh is sutured and fixed on the fibromuscular layer of the anterior vaginal wall. Pay attention that the sutures cannot penetrate the vaginal mucous layer. Press down and lift the handle of the oval forceps to expose the posterior vaginal wall Fix the mesh on the fibromuscular layer of the posterior vaginal wall with row-by-row intermittent sutures. Pay attention that the sutures cannot penetrate the vaginal mucous layer. Lift the handle of the oval forceps horizontally and upwards to restore the vaginal stump to its physiological position, and pull the mesh upward. To the suture site, trim the mesh to an appropriate length, and fix the other end of the mesh to the sacral anterior longitudinal ligament in front of the S1 vertebral body with non-absorbable sutures. The suture depth should include the entire layer of the anterior longitudinal ligament, and the mesh It usually takes 2-3 stitches to fully flatten the sheet. Note that there is no excessive tension in the vagina after the mesh is suspended and fixed, and the most distal end of the top of the vagina is above -6 cm. Absorbable thread closes the lateral peritoneum, and embeds the mesh in the retroperitoneum; the above is the method of pressing the stump of the vagina in the prior art, which has the following defects: (1) It is not easy to detect in time when the needle penetrates the vaginal wall, and the operation is over If there is suture penetration at the time of inspection, the needle and thread at the penetration site must be removed, or even the rest of the sutures should be re-sutured, which increases the operation process and prolongs the operation time. Repeated sutures and removal of the same part may increase serious complications such as mesh erosion and exposure. (2) If the needle is sewed through the vaginal wall and the gauze roll is sewn together with the vaginal wall, the patch will be easily broken when the gauze is taken out at the end, resulting in wasted efforts, which will significantly increase the hospitalization expenses of the patient. Surgery can increase the risk of serious complications such as intraoperative and postoperative sacral anterior vascular plexus hemorrhage, postoperative mesh erosion, and mesh exposure. At the same time, the difficulty of reoperation due to hemorrhage is also significantly increased; (3), gauze roll shaping The sex is relatively poor, and it is difficult to press the front and rear walls of the vagina to a position suitable for suture; (4), the gauze roll does not have the clamp function, and it cannot ensure that the gauze roll is exactly in the middle of the vaginal stump during the pressing process, thus affecting the pressing effect , which is not conducive to the suture operation process and the measurement process of the length of the mesh; (5), after the oval forceps clamp the gauze roll, the forceps handle is fixed to the position, and the direction is up and down, which is not conducive to pressing down on the forceps handle to expose the posterior vaginal wall, upper Lifting the handle of the forceps to expose the anterior wall of the vagina is not conducive to the operator to hold the instrument according to the intraoperative situation.
发明内容Contents of the invention
本发明为了解决现有技术中的不足之处，提供一种使用方便、结构设计合理、能够防止缝针穿破阴道壁的阴道残端顶压器。In order to solve the deficiencies in the prior art, the present invention provides a vaginal stump presser which is convenient to use, has a reasonable structural design and can prevent needles from piercing through the vaginal wall.
为解决上述技术问题，本发明采用如下技术方案：阴道残端顶压器，包括左钳部件和右钳部件，左钳部件和右钳部件的结构相同且左右对称设置；In order to solve the above-mentioned technical problems, the present invention adopts the following technical solution: the vaginal stump pressing device includes a left jaw part and a right jaw part, and the left jaw part and the right jaw part have the same structure and are arranged symmetrically;
左钳部件包括钳臂，钳臂的上端固定连接有钳板，钳板的外轮廓线为优弧，钳臂的上端左侧连接有位于钳板下方的球囊，钳臂的内部沿长度方向开设有第一安装孔和第二安装孔，钳臂的下部左侧设有注液接口，注液接口通过注液管道与球囊连接，所述的注液管道穿设在第一安装孔内，注液接口处设有封堵帽；钳臂的下部左侧沿长度方向开设有位于注液接口上方的下长孔，钳臂的上部左侧沿长度方向开设有位于球囊下方的上长孔，上长孔和下长孔均与第二安装孔相连通，第二安装孔内滑动穿设有金属推杆，金属推杆的上端通过上短杆连接有推板，上短杆穿设在上长孔内且与上长孔滑动配合，推板位于上长孔外侧且与钳臂相互垂直，金属推杆的下端通过下短杆连接有推柄，下短杆穿设在下长孔内且与下长孔滑动配合，推柄位于上长孔外侧；钳臂的下端设有能够绕钳臂下端旋转调节的指环手柄；The left pincer part includes a pincer arm, the upper end of the pincer arm is fixedly connected with a pincer plate, the outer contour of the pincer plate is a superior arc, and the left side of the upper end of the pincer arm is connected with a balloon under the pincer plate, and the inside of the pincer arm is along the length direction A first installation hole and a second installation hole are opened, and the lower left side of the forceps arm is provided with a liquid injection interface, which is connected to the balloon through a liquid injection pipe, and the liquid injection pipe is passed through the first installation hole , the liquid injection interface is provided with a plugging cap; the lower left side of the forceps arm is provided with a lower long hole located above the liquid injection interface along the length direction, and the upper left side of the forceps arm is provided with an upper long hole located below the balloon along the length direction. hole, the upper long hole and the lower long hole are all connected with the second installation hole, a metal push rod is slid through the second installation hole, the upper end of the metal push rod is connected with a push plate through the upper short rod, and the upper short rod is pierced In the upper long hole and slidingly fit with the upper long hole, the push plate is located outside the upper long hole and perpendicular to the pliers arm, the lower end of the metal push rod is connected to the push handle through the lower short rod, and the lower short rod is penetrated in the lower long hole And it is slidingly matched with the lower long hole, and the push handle is located outside the upper long hole; the lower end of the pliers arm is provided with a ring handle that can be rotated and adjusted around the lower end of the pliers arm;
左钳部件的钳臂中部后侧与右钳部件的钳臂中部前侧相铰接。The rear side of the middle part of the pincer arm of the left jaw part is hinged with the front side of the middle part of the pincer arm of the right jaw part.
钳臂上设有位于下长孔一侧的长度刻度线。The arm of the tongs is provided with a length scale line on one side of the lower long hole.
左钳部件的钳臂下部与右钳部件的钳臂下部之间设有棘爪。A ratchet is arranged between the lower part of the tong arm of the left jaw part and the lower part of the pincer arm of the right jaw part.
左钳部件的钳板右侧面、右钳部件的钳板左侧面均设有若干防滑凸棱。The right side of the nipper of the left jaw part and the left side of the nipper of the right jaw part are provided with some anti-skid ribs.
钳臂的下端设有球碗，指环手柄的顶部通过球头铰接在球碗内，球碗上沿径向方向开设有螺纹孔，螺纹孔内螺纹连接有定位螺栓，定位螺栓的内端与球头外表面顶压接触。The lower end of the pliers arm is provided with a ball bowl, and the top of the ring handle is hinged in the ball bowl through a ball head. The ball bowl is provided with a threaded hole along the radial direction, and the internal thread of the threaded hole is connected with a set bolt. The inner end of the set bolt is connected to the ball. The outer surface of the head presses into contact.
定位螺栓的内端设有橡胶垫。The inner end of the positioning bolt is provided with a rubber pad.
采用上述技术方案，本发明具有以下有益效果：By adopting the above technical scheme, the present invention has the following beneficial effects:
（1）、本装置通过向球囊内注入亚甲蓝溶液，操作者可以观察是否有亚甲蓝溶液外溢判断缝针是否穿透阴道壁，此时停止缝合过程可避免拆除缝线只需重新缝合即可，可缩短手术时间，避免同一部位反复多次缝合、拆除，从而减少阴道网片侵蚀、暴露等严重并发症等的机会；(1) By injecting the methylene blue solution into the balloon, the operator can observe whether the methylene blue solution overflows and judge whether the suture needle penetrates the vaginal wall. Stopping the suture process at this time can avoid removing the suture and only need to re-install it. Suturing is enough, which can shorten the operation time and avoid repeated suturing and removal of the same part, thereby reducing the chance of serious complications such as erosion and exposure of the vaginal mesh;
（2）、球囊结合推板的设计塑形性较好，可使阴道壁塑形至利于缝合的形态，大大降低手术操作难度，缩短手术时间，减少缝穿阴道壁的几率，从而减少阴道网片侵蚀、暴露等严重并发症等的机会；(2) The design of the balloon combined with the push plate has good plasticity, which can shape the vaginal wall to a shape that is conducive to suturing, greatly reducing the difficulty of operation, shortening the operation time, and reducing the chance of suturing through the vaginal wall, thereby reducing the risk of vaginal bleeding. The chance of serious complications such as mesh erosion and exposure;
（3）、新技术具有钳夹功能，顶压过程中可确保顶压器中部正好位于阴道残端正中，从而保证顶压效果，利于缝合操作过程及网片长度的测量过程；(3) The new technology has the clamp function, which can ensure that the middle part of the pressing device is exactly in the middle of the vaginal stump during the pressing process, so as to ensure the pressing effect and facilitate the suture operation process and the measurement process of the mesh length;
（4）、本装置的指环手柄通过球铰链铰接在钳臂的端部，这种可旋转手柄的设计利于下压钳柄暴露阴道后壁、上抬钳柄暴露阴道前壁等操作，利于操作者根据术中情况握持器械，方便省力；(4) The ring handle of this device is hinged at the end of the forceps arm through a ball hinge. The design of this rotatable handle is conducive to pressing down the forceps handle to expose the back wall of the vagina, lifting the forceps handle to expose the front wall of the vagina, etc., which is convenient for operation. The patient holds the instrument according to the intraoperative situation, which is convenient and labor-saving;
（5）、钳臂上设置位于下长孔一侧的长度刻度线，操作者可以通过长度刻度线观察推柄推进的距离；(5) The length scale line on the side of the lower long hole is set on the clamp arm, and the operator can observe the distance of the push handle through the length scale line;
（6）、左钳部件的钳臂下部与右钳部件的钳臂下部之间设有棘爪，棘爪为卵圆钳上的棘爪，棘爪用于对两个钳臂进行定位；(6) There is a pawl between the lower part of the pliers arm of the left pliers part and the lower part of the pliers arm of the right pliers part. The pawl is the pawl on the oval pliers, and the pawl is used to position the two pliers arms;
（7）、定位螺栓的内端设置橡胶垫，橡胶垫用于增大定位螺栓与球头之间的摩擦力，以实现更好更稳定的定位效果。(7) The inner end of the positioning bolt is provided with a rubber pad, which is used to increase the friction between the positioning bolt and the ball head, so as to achieve a better and more stable positioning effect.
综上所述，本发明结构设计合理，使用方便，能够方便对阴道残端进行缝线，防止缝针时穿透阴道壁，安全性高。To sum up, the present invention has a reasonable structural design, is convenient to use, can conveniently suture the vaginal stump, prevents needles from penetrating through the vaginal wall, and has high safety.
附图说明Description of drawings
图1是本发明的结构示意图；Fig. 1 is a structural representation of the present invention;
图2是图1中H处的放大图；Figure 2 is an enlarged view at H in Figure 1;
图3是图1的右视图；Fig. 3 is the right view of Fig. 1;
图4是钳板的结构示意图；Fig. 4 is the structural representation of nipper;
图5是金属推杆与注液管道的安装示意图。Fig. 5 is a schematic diagram of the installation of the metal push rod and the liquid injection pipe.
具体实施方式Detailed ways
如图1-5所示，本发明的阴道残端顶压器，包括左钳部件和右钳部件，左钳部件和右钳部件的结构相同且左右对称设置；As shown in Figures 1-5, the vaginal stump pressing device of the present invention includes a left jaw part and a right jaw part, and the left jaw part and the right jaw part have the same structure and are arranged symmetrically;
左钳部件包括钳臂1，钳臂1的上端固定连接有钳板2，钳板2的外轮廓线为优弧，钳臂1的上端左侧连接有位于钳板2下方的球囊3，钳臂1的内部沿长度方向开设有第一安装孔4和第二安装孔5，钳臂1的下部左侧设有注液接口，注液接口通过注液管道6与球囊3连接，所述的注液管道6穿设在第一安装孔4内，注液接口处设有封堵帽7；钳臂1的下部左侧沿长度方向开设有位于注液接口上方的下长孔8，钳臂1的上部左侧沿长度方向开设有位于球囊3下方的上长孔9，上长孔9和下长孔8均与第二安装孔5相连通，第二安装孔5内滑动穿设有金属推杆10，该金属推杆10具有一定韧性，金属推杆10与第二安装孔5的孔壁具有一定摩擦力，金属推杆10的上端通过上短杆连接有推板11，上短杆穿设在上长孔9内且与上长孔9滑动配合，推板11位于上长孔9外侧且与钳臂1相互垂直，金属推杆10的下端通过下短杆连接有推柄12，下短杆穿设在下长孔8内且与下长孔8滑动配合，推柄12位于上长孔9外侧；钳臂1的下端设有能够绕钳臂1下端旋转调节的指环手柄13；The left pliers part includes a
左钳部件的钳臂1中部后侧与右钳部件的钳臂1中部前侧相铰接。The rear side of the middle part of the
钳臂1上设有位于下长孔8一侧的长度刻度线14。A
左钳部件的钳臂1下部与右钳部件的钳臂1下部之间设有棘爪15。A
左钳部件的钳板2右侧面、右钳部件的钳板2左侧面均设有若干防滑凸棱16。The right side of the
钳臂1的下端设有球碗17，指环手柄13的顶部通过球头18铰接在球碗17内，球碗17上沿径向方向开设有螺纹孔，螺纹孔内螺纹连接有定位螺栓19，定位螺栓19的内端与球头18外表面顶压接触。The lower end of the
定位螺栓19的内端设有橡胶垫。The inner end of the
腹腔镜骶骨阴道固定术中，首先行腹腔镜下骶前区域的分离，患者取头低臀高位左低右高位暴露右侧结肠旁间隙，辨认右侧输尿管，纵行打开骶岬前腹膜，暴露骶前区域，取第一骶椎(S1)椎体前无血管区作为缝合位点，沿右侧宫骶韧带内侧打开侧腹膜(或将网片穿行侧腹膜下方)至阴道穹隆处，有子宫者先行子宫切除术，腹腔镜下分离膀胱阴道间隙和直肠阴道间隙，对于阴道顶端缺陷的纠正，一般认为分离阴道顶端黏膜距离穹隆长3 cm即可，将聚丙烯网片设计、剪裁成Y型，宽度3 cm，阴道拉钩暴露阴道残端，使用本发明的钳板2钳夹阴道残端正中组织，然后打开封堵帽7，连接注液接口，通过注液管道6向两个球囊3内注入亚甲蓝溶液，直至球囊3内充满亚甲蓝溶液停止注入，接着推动两个推柄12，推柄12沿下长孔8向上移动，推柄12通过金属推杆10向上推动推板11，推板11向上移动并推动球囊3，使球囊3将阴道前后壁顶压并塑形，操作者根据术中实际情况调整指环手柄13至方便且省力的位置（一般为水平位），在调整时只需松动定位螺栓19，由于指环手柄13通过球铰链与钳臂1相连接，所以指环手柄13可以绕钳臂1下端转动，直至合适位置后旋拧定位螺栓19，定位螺栓19即可对球头18进行定位，完成指环手柄13的位置调整；经阴道水平并上举钳臂1暴露阴道残端顶部将网片间断缝合固定于阴道残端顶部纤维肌层上，注意缝线不能穿透阴道黏膜层，若缝合过程中发现针眼有蓝色液体流出或阴道壁塌陷，说明缝针已缝穿阴道壁，须及时拆除此针缝线，并更换本装置的球囊3或者本装置，上抬并上举钳柄暴露阴道前壁将网片分排间断缝合固定于阴道前壁纤维肌层上，注意缝线不能穿透阴道黏膜层，下压并上举卵圆钳钳柄暴露阴道后壁将网片分排间断缝合固定于阴道后壁纤维肌层上，注意缝线不能穿透阴道黏膜层；同理，若缝合阴道前后壁与网片过程中发现针眼有蓝色液体流出或阴道壁塌陷，说明缝针已缝穿阴道壁，须及时拆除相应缝线，并更换球囊3或本装置；水平并上举钳柄使阴道残端恢复至生理位置，向上牵拉网片至缝合位点，修剪网片至合适长度，用不可吸收缝线将网片另一端间断缝合固定于S1椎体前方的骶骨前纵韧带上，缝合深度应包含前纵韧带全层，并将网片充分展平，一般需2~3针，注意网片悬吊固定后阴道没有过多张力，阴道顶端所处的最远端达-6 cm以上，可吸收线关闭侧腹膜，将网片包埋于腹膜后。In laparoscopic sacral colpopexy, the presacral area is firstly separated under laparoscopy. The patient is taken in a position with the head low buttocks high, left low and right high, to expose the right paracolic space, identify the right ureter, and longitudinally open the anterior peritoneum of the sacral promontory to expose the In the presacral area, take the anterior avascular area of the first sacral vertebra (S1) as the suture site, and open the lateral peritoneum along the medial side of the right uterosacral ligament (or pass the mesh under the lateral peritoneum) to the vaginal vault, where the uterus Hysterectomy is performed first, and the vesico-vaginal space and rectovaginal space are separated laparoscopically. For the correction of vaginal apex defects, it is generally considered that the separation of the vaginal apex mucosa is 3 cm long from the fornix, and the polypropylene mesh is designed and cut into a Y shape. , a width of 3 cm, the vaginal hook exposes the vaginal stump, use the
本实施例并非对本发明的形状、材料、结构等作任何形式上的限制，凡是依据本发明的技术实质对以上实施例所作的任何简单修改、等同变化与修饰，均属于本发明技术方案的保护范围。This embodiment does not impose any formal restrictions on the shape, material, structure, etc. of the present invention. All simple modifications, equivalent changes and modifications made to the above embodiments according to the technical essence of the present invention belong to the protection of the technical solution of the present invention. scope.
Claims (6)
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