CN112022257A

Movatterモバイル変換

Info

Publication number: CN112022257A
Application number: CN202010954167.7A
Authority: CN
Inventors: 崔心刚; 叶剑青; 刘梅; 黄佳莉; 曲发军; 干思舜; 曹建伟; 储传敏; 潘秀武; 李霖; 王磊; 杨炜; 杨启维; 田毅君
Original assignee: Second Military Medical University SMMU
Current assignee: Second Military Medical University SMMU
Priority date: 2020-09-11
Filing date: 2020-09-11
Publication date: 2020-12-04

Abstract

An anastomat comprises a nail abutting seat rod, wherein a nail abutting seat is arranged at the head of the nail abutting seat rod. The stapler body includes: a stapler rod; the nail bin assembly is arranged at the head part of the anastomat rod; the knob adjuster is arranged at the position of the anastomat rod close to the tail part and is used for adjusting the rotation angle of the anastomat rod so as to be convenient for closing the nail abutting seat; the fixed handle is arranged at the tail part of the anastomat rod and used for holding the anastomat rod; a percussion handle for anastomotic percussion, which is arranged between the rotary regulator and the fixed handle.

Description

Translated fromChinese

一种吻合器a stapler

技术领域technical field

本发明属于微创手术器械，特别涉及一种可用于腹腔镜下膀胱尿道吻合器。The invention belongs to a minimally invasive surgical instrument, in particular to a vesicourethral stapler that can be used for laparoscopy.

背景技术Background technique

前列腺癌(carcinoma of prostate,PCa)是男性泌尿系统常见恶性肿瘤，发病率随年龄增长而增加。2016年，全球范围内前列腺癌居男性癌症发病率的第1位，病死率的第3位，是严重危害男性健康的恶性肿瘤。在中国，近几年来随着饮食和生活习惯的改变，及前列腺特异性抗原(Prostate specific antigen，PSA)筛查的普及，前列腺癌的发病率呈现持续快速增长趋势，2015年发病达60300例，而病死达26600例，已然成为中国男性泌尿生殖系统发病率和死亡率最高的恶性肿瘤。Prostate cancer (PCa) is a common malignant tumor of the male urinary system, and its incidence increases with age. In 2016, prostate cancer ranked first in male cancer incidence and third in fatality rate worldwide, and it is a malignant tumor that seriously endangers men's health. In China, with changes in diet and living habits and the popularization of prostate-specific antigen (PSA) screening in recent years, the incidence of prostate cancer has shown a sustained and rapid growth trend, reaching 60,300 cases in 2015. With 26,600 deaths, it has become the malignant tumor with the highest morbidity and mortality in the male genitourinary system in China.

目前，腹腔镜前列腺癌根治术是治疗早中期前列腺癌的主要方法中，腹腔镜手术相比开放手术而言创伤小、恢复快，术后6小时即可进食，术后第二天就可下地活动，大大减轻患者痛苦。但是腹腔镜手术对术者技术要求较高，特别是前列腺切除后膀胱与尿道的吻合，一直是腹腔镜前列腺癌手术的重点及难点，需要术者有丰富的经验及手术技巧，如吻合欠佳则术后可能出现尿漏及长期尿失禁的风险。At present, laparoscopic radical prostatectomy is the main method for the treatment of early and mid-stage prostate cancer. Compared with open surgery, laparoscopic surgery is less invasive and has faster recovery. You can eat within 6 hours after surgery, and you can go to the ground the next day after surgery. Activities, greatly reduce the pain of patients. However, laparoscopic surgery has high technical requirements for the operator, especially the anastomosis of the bladder and urethra after prostatectomy, which has always been the focus and difficulty of laparoscopic prostate cancer surgery. It requires the operator to have rich experience and surgical skills, such as poor anastomosis. There is a risk of urinary leakage and long-term urinary incontinence after surgery.

发明内容SUMMARY OF THE INVENTION

本发明实施例之一的吻合器，该吻合器包括，A stapler according to one embodiment of the present invention, the stapler includes:

抵钉座杆，在该抵钉座杆头部设有抵钉座；An anvil seat rod, an anvil seat is arranged at the head of the anvil seat rod;

吻合器本体，包括：The stapler body, including:

吻合器杆；stapler rod;

钉仓组件，被设于所述吻合器杆的头部；a staple cartridge assembly, which is arranged on the head of the stapler rod;

旋钮调节器，设于所述吻合器杆接近尾部的位置，用于调节吻合器杆的转动角度，便于对合抵钉座；The knob adjuster is arranged at the position close to the tail of the stapler rod, and is used to adjust the rotation angle of the stapler rod, so as to facilitate the abutment against the nail seat;

固定手柄，设于所述吻合器杆的尾部；a fixed handle, located at the tail of the stapler rod;

击发手柄，用于吻合击发，设于旋转调节器与固定手柄之间。The firing handle, used for anastomotic firing, is located between the rotary adjuster and the fixed handle.

本发明相对于传统的手工缝合，具有以下优势：Compared with traditional manual sewing, the present invention has the following advantages:

1.操作简单方便，节省手术时间。1. The operation is simple and convenient, saving operation time.

2.一次性使用，避免交叉感染。2. One-time use to avoid cross infection.

3.利用钛钉或不锈钢钉(缝合器)缝合严密、松紧适中。3. Use titanium nails or stainless steel nails (staplers) to suture tightly and with moderate elasticity.

4.具有很少的副作用和有效减少手术并发症等。4. Has few side effects and effectively reduces surgical complications.

5.术后漏尿、尿失禁的发生概率大大降低。5. The probability of postoperative urinary leakage and urinary incontinence is greatly reduced.

附图说明Description of drawings

通过参考附图阅读下文的详细描述，本发明示例性实施方式的上述以及其他目的、特征和优点将变得易于理解。在附图中，以示例性而非限制性的方式示出了本发明的若干实施方式，其中：The above and other objects, features and advantages of exemplary embodiments of the present invention will become readily understood by reading the following detailed description with reference to the accompanying drawings. In the accompanying drawings, several embodiments of the present invention are shown by way of example and not limitation, wherein:

图1根据本发明实施例之一的吻合器结构示意图。Fig. 1 is a schematic structural diagram of a stapler according to one embodiment of the present invention.

图2是尿道、前列腺和膀胱位置示意图。Figure 2 is a schematic diagram of the location of the urethra, prostate and bladder.

图3根据本发明实施例之一的尿道膀胱吻合过程示意图。Fig. 3 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图4根据本发明实施例之一的尿道膀胱吻合过程示意图。4 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图5根据本发明实施例之一的尿道膀胱吻合过程示意图。5 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图6根据本发明实施例之一的尿道膀胱吻合过程示意图。6 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图7根据本发明实施例之一的尿道膀胱吻合过程示意图。7 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图8根据本发明实施例之一的尿道膀胱吻合过程示意图。8 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图9根据本发明实施例之一的尿道膀胱吻合过程示意图。9 is a schematic diagram of a urethra-vesical anastomosis process according to one embodiment of the present invention.

图10根据本发明实施例之一的吻合器结构示意图。Fig. 10 is a schematic structural diagram of a stapler according to one embodiment of the present invention.

图11根据本发明实施例之一的吻合器结构示意图。Fig. 11 is a schematic structural diagram of a stapler according to one embodiment of the present invention.

图12根据本发明实施例之一的吻合器结构示意图。Fig. 12 is a schematic structural diagram of a stapler according to one embodiment of the present invention.

1——抵钉座杆1 - Anvil seat post

2——抵钉座2 - Anvil seat

3——钉仓保护盖3 - Nail compartment protection cover

4——钉仓组件4 - Nail cartridge components

5——吻合器杆5 - Stapler rod

6——旋钮调节器6 - Knob adjuster

7——击发手柄7 - Firing handle

8——固定手柄8 - Fixed handle

9——尿道，901——尿道残端，9 - urethra, 901 - urethral stump,

10——前列腺10 - Prostate

11——膀胱，111——膀胱残端，112——膀胱切口，113——膀胱切口缝合线，11 - Bladder, 111 - Bladder stump, 112 - Bladder incision, 113 - Bladder incision suture,

12——旋转调节螺母，12 - Rotate the adjusting nut,

13——抵钉座保护盖。13 - Anvil seat protection cover.

具体实施方式Detailed ways

腹腔镜前列腺癌根治术是治疗早中期前列腺癌的主要方法，但是腹腔镜手术对术者技术要求较高，特别是前列腺切除后膀胱与尿道的吻合，一直是腹腔镜前列腺癌手术的重点及难点，需要术者有丰富的经验及手术技巧，如吻合欠佳则术后可能出现尿漏及长期尿失禁的风险。Laparoscopic radical prostatectomy is the main method for the treatment of early and mid-stage prostate cancer, but laparoscopic surgery has high technical requirements for the operator, especially the anastomosis of bladder and urethra after prostatectomy, which has always been the focus and difficulty of laparoscopic prostate cancer surgery. , requires the operator to have rich experience and surgical skills, such as poor anastomosis may lead to postoperative urinary leakage and long-term risk of urinary incontinence.

本发明实施例提出的腹腔镜下膀胱尿道吻合器，可以很好地解决膀胱尿道吻合这一难题，大大降低手术难度及手术风险。一般分为一次性或多次使用，用于替代传统手工缝合，使用方便，严密、松紧合适，尤其是其缝合快速、操作简便及很少有副作用和手术并发症等优点。The laparoscopic vesicourethral anastomosis device proposed in the embodiment of the present invention can well solve the problem of vesicourethral anastomosis, and greatly reduces the difficulty and risk of operation. Generally divided into one-time or multiple use, used to replace the traditional manual suture, easy to use, tight, appropriate tightness, especially the advantages of fast suture, easy operation and few side effects and surgical complications.

根据一个或者多个实施例，如图1所示，腹腔镜下膀胱尿道吻合器，主要部件有：抵钉座杆、抵钉座、钉仓、击发手柄，旋钮调节器等。切除多余组织，造成圆形端吻合口，这些部件按一定的操作规程使用，保证组织缝合和吻合口的迅速、准确地完成。According to one or more embodiments, as shown in FIG. 1 , the main components of a laparoscopic vesicourethral stapler are: an anvil seat rod, an anvil seat, a staple cartridge, a firing handle, a knob adjuster, and the like. Excessive tissue is removed to create a round-end anastomosis. These components are used according to certain operating procedures to ensure that the tissue suture and anastomosis can be completed quickly and accurately.

该吻合器包括抵钉座杆和吻合器本体。在抵钉座杆头部设有抵钉座。吻合器本体包括吻合器杆，钉仓组件被设于所述吻合器杆的头部；旋钮调节器，设于所述吻合器杆接近尾部的位置，用于调节吻合器杆的转动角度，便于对合抵钉座。固定手柄设于所述吻合器杆的尾部，用于操作时对吻合器杆的握持。击发手柄用于吻合击发，设于旋转调节器与固定手柄之间。所述钉仓组件被钉仓保护盖所覆盖保护。The stapler includes an anvil stem and a stapler body. An anvil seat is provided on the head of the anvil seat rod. The stapler body includes a stapler rod, and the staple cartridge assembly is set on the head of the stapler rod; the knob adjuster is set at the position close to the tail of the stapler rod, and is used to adjust the rotation angle of the stapler rod, so as to facilitate the Butt against the peg seat. The fixed handle is arranged at the tail of the stapler rod, and is used for holding the stapler rod during operation. The firing handle is used for anastomotic firing, and is arranged between the rotary adjuster and the fixed handle. The staple cartridge assembly is covered and protected by a staple cartridge protective cover.

根据一个或者多个实施例，如图10所示，吻合器杆的固定手柄上设有旋转调节螺母，用于调节钉仓组件与抵钉座对合后所夹持组织的松紧度，达到一定的松紧度后，扳动击发手柄打钉并切除多余组织。According to one or more embodiments, as shown in FIG. 10 , the fixed handle of the stapler rod is provided with a rotating adjustment nut, which is used to adjust the tightness of the tissue clamped by the staple cartridge assembly after the staple anvil assembly is engaged with the staple seat to a certain level. After the tightness is adjusted, the firing handle is pulled to drive the nails and remove excess tissue.

同时操作旋转调节螺母可改变夹持组织的厚度，有利于钛钉穿透组织严密吻合，防止吻合不全漏尿。At the same time, rotating the adjusting nut can change the thickness of the clamping tissue, which is conducive to the tight anastomosis of the titanium nail through the tissue and prevents leakage of urine due to incomplete anastomosis.

此外，根据一个或者多个实施例，如图11和图12，抵钉座杆的抵钉座被抵钉座保护盖所覆盖保护，用于进入尿道时保护尿道粘膜，在到达尿道残端后需要打开保护盖。抵钉座杆由尿道外口进入，到达尿道残端，取下抵钉座保护盖；吻合器杆通过腹腔镜Trocar通道进入患者体内，在膀胱前壁作一切口，吻合器杆进入膀胱内，将抵钉座插入吻合器杆的钉仓组件，吻合膀胱及尿道残端。In addition, according to one or more embodiments, as shown in FIGS. 11 and 12 , the anvil seat of the anvil seat rod is covered and protected by an anvil seat protection cover, which is used to protect the urethral mucosa when entering the urethra, and after reaching the urethral stump The protective cover needs to be opened. The anvil seat rod enters from the outer opening of the urethra and reaches the urethral stump, and the protective cover of the anvil seat is removed; the stapler rod enters the patient's body through the laparoscopic Trocar channel, and an incision is made in the anterior wall of the bladder, and the stapler rod enters the bladder. Insert the anvil seat into the staple cartridge assembly of the stapler rod to anastomos the bladder and urethral stump.

如图3所示，前列腺被切除后留下尿道残端和膀胱残端。如图4所示，抵钉座由抵钉座杆推送从尿道外口进入到达尿道残端，并取下抵钉座保护盖。图5，吻合器杆由膀胱切口进入膀胱。图6，抵钉座的锥头插入钉仓组件，完成对尿道残端和膀胱残端的吻合操作。图5和图6中可见膀胱残端缝合线，如残端开口过大，可用3-0缝合线闭合残端，如图5，以利于将膀胱残端组织聚拢，使吻合牢固。尿道残端由于较细小且可回缩聚拢，无需缝合闭合。图7，抵钉座杆退出尿道。如图8和图9，缝合膀胱切口。吻合结束后，最后才取标本和抵钉座保护盖。保护盖可由正中切口处取出，前列腺标本也是从正中切口中取出，两者可一同放入标本袋，取出。As shown in Figure 3, the prostate was removed leaving a urethral stump and a bladder stump. As shown in Figure 4, the anvil seat is pushed by the anvil seat rod from the outer opening of the urethra to the urethral stump, and the protective cover of the anvil seat is removed. Figure 5. The stapler rod enters the bladder through the bladder incision. Fig. 6, the cone head of the anvil seat is inserted into the staple cartridge assembly to complete the anastomosis of the urethral stump and the bladder stump. The bladder stump suture can be seen in Figure 5 and Figure 6. If the opening of the stump is too large, the stump can be closed with a 3-0 suture, as shown in Figure 5, in order to gather the bladder stump tissue and make the anastomosis firm. Because the urethral stump is small and retractable, it does not need suture closure. Figure 7. Anvil seat post exits urethra. As shown in Figure 8 and Figure 9, the bladder incision is sutured. After the anastomosis, the specimen and the anvil seat protection cover are finally taken. The protective cover can be taken out from the median incision, and the prostate specimen is also taken out from the median incision, and the two can be put into the specimen bag together and taken out.

本发明实施例与手工缝合相比，一次性吻合器缝合和吻合具有以下优点:1.操作简便、迅速，大大地缩短手术时间；2.准确、牢固可靠，保持良好血运，组织愈合更加保证，有效防止漏尿，明显降低吻合口漏的发生率；3.使术野狭小，部位较深的手工缝合或腹腔镜下缝合困难的缝合及吻合变得容易；4.一次性使用有效防止感染。Compared with manual suturing, the embodiment of the present invention has the following advantages for suturing and anastomosis with a disposable stapler: 1. The operation is simple and rapid, which greatly shortens the operation time; 2. It is accurate, firm and reliable, maintains good blood supply, and ensures tissue healing. It can effectively prevent urine leakage and significantly reduce the incidence of anastomotic leakage; 3. Make the suture and anastomosis that are difficult for manual suture or laparoscopic suture with a narrow surgical field and deep parts easier; 4. One-time use effectively prevents infection .

值得说明的是，虽然前述内容已经参考若干具体实施方式描述了本发明创造的精神和原理，但是应该理解，本发明并不限于所公开的具体实施方式，对各方面的划分也不意味着这些方面中的特征不能组合，这种划分仅是为了表述的方便。本发明旨在涵盖所附权利要求的精神和范围内所包括的各种修改和等同布置。It is worth noting that although the foregoing content has described the spirit and principle of the present invention with reference to several specific embodiments, it should be understood that the present invention is not limited to the disclosed specific embodiments, and the division of various aspects does not mean that these Features in aspects cannot be combined, this division is for convenience of presentation only. The invention is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.