Disclosure of Invention
The invention provides an endoscopic pancreatic intestinal anastomat, which at least solves the technical problems that in the prior art, a good suturing technology is needed in an anastomosis mode of embedding a pancreatic broken end by a suture, the operation difficulty is high, the strength is high, and the broken end blood supply is poor due to intensive suturing.
The invention provides a endoscopic pancreatic intestinal anastomat, which comprises a pancreatic intestinal anastomat, wherein the pancreatic intestinal anastomat comprises an elongated rod, an anastomosis cap, a through hole and a pancreatic juice hole, the anastomosis cap is fixed on the elongated rod, the elongated rod is of a hollow structure with the through hole, and one end of the elongated rod is provided with the pancreatic juice hole;
The endoscopic pancreatic anastomosis device further comprises a release device, wherein the pancreatic anastomosis device is arranged in the release device, the release device comprises a sleeve, the pancreatic anastomosis device is arranged in the sleeve, and the pancreatic anastomosis device is coaxial with the sleeve.
Optionally, the diameter of the elongated rod is smaller than 5mm, and/or the number of pancreatic juice holes is larger than one, and/or at least one cap threading hole is arranged on the anastomotic cap.
Optionally, the pancreatic intestine anastomat further comprises a back taper structure, at least one back taper structure is arranged on the slender rod, and the back taper structure and the pancreatic juice hole are located on the same side of the anastomosis cap.
Optionally, the anastomotic cap is circular or elliptical;
And/or one surface of the anastomosis cap is of a concave structure, and the concave structure and the pancreatic juice hole are positioned on the same side of the anastomosis cap.
Optionally, the other end of the slender rod is provided with a rod threading hole;
And/or the other end of the slender rod is a rod tail, and the rod tail is provided with a wedge-shaped structure.
Optionally, the anastomotic cap is elastic, and the edge of the anastomotic cap is provided with at least two cusps;
the sleeve has a sleeve groove, the petals are mated with the sleeve groove, and the petals slide over the sleeve groove surface.
Optionally, the petals of the anastomosis cap are turned inwardly or outwardly, the cannula has a constricted cannula end, and the cannula end has a diameter smaller than the diameter of the petals.
Optionally, a cusp hole is formed on the cusp;
And/or the anastomosis cap is made of memory alloy.
Optionally, a firing trigger, a handle, a retraction button, and a firing bar are assembled in the release device, the firing trigger and the retraction button are connected with the firing bar, the firing bar has a firing bar end, the bar tail is disposed in the firing bar end, and the bar tail is connected with the firing bar end in a matching manner.
The endoscopic pancreatic intestinal stapler is a manual endoscopic pancreatic intestinal stapler or an electric endoscopic pancreatic intestinal stapler.
The invention provides a cavity mirror pancreas intestine anastomat aiming at the defects in the prior art, and designs a release instrument capable of rapidly placing the pancreas intestine anastomat into a body through a cavity mirror channel aiming at the requirement that the pancreas intestine anastomat is inconvenient to be placed into the body.
The technical scheme of the invention aims to solve the technical problem of providing a release instrument which can be safely and conveniently placed into an operation position for a pancreatic intestine anastomat. The instrument may pass through an endoscopic access. The device can move back and forth by manually or electrically operating a firing bar inside the device, so as to push the pancreatic intestine anastomat arranged in the device to enter the operation part along the sleeve, and the back device can be withdrawn. According to different materials of the apparatus, the apparatus can be made of polymer materials for disposable use, and can also be made of metal materials for repeated use.
The invention provides a novel pancreatic/gastric anastomosis method and a novel pancreatic/gastric anastomosis device, which can change the traditional method of suturing pancreas and stomach with suture, and the pancreatic/gastric anastomosis device has the functions of rebuilding the passage of pancreatic juice into the digestive tract, preventing the leakage of the pancreatic juice, facilitating the connection and anastomosis of the stomach and the residual pancreatic juice, and is convenient and firm to anastomose without suture.
Drawings
The above, as well as additional purposes, features, and advantages of exemplary embodiments of the present invention will become readily apparent from the following detailed description when read in conjunction with the accompanying drawings. Several embodiments of the present invention are illustrated by way of example, and not by way of limitation, in the figures of the accompanying drawings and in which:
FIG. 1 is a schematic illustration of an alternative pancreatic stump and jejunum or stomach suture provided in the prior art;
FIG. 2 is a schematic view of an alternative pancreatic anastomat with a disk-shaped anastomosis cap according to an embodiment of the present invention;
FIG. 3 is a schematic view of an alternative pancreatic anastomat with a disk-shaped anastomosis cap showing the concave configuration of the anastomosis cap, in accordance with an embodiment of the present invention;
FIG. 4 is a schematic view of an anastomosis state of an alternative pancreatic anastomat with a petal-shaped anastomosis cap according to an embodiment of the present invention;
FIG. 5 is a schematic view of an alternative pancreatic anastomat with a petal-shaped anastomosis cap in an initial state according to an embodiment of the present invention;
FIG. 6-1 is a schematic view of an alternative petal-shaped anastomosis cap, in accordance with an embodiment of the present invention;
FIG. 6-2 is a schematic view of the reverse side of FIG. 6-1 of an alternative petal-shaped anastomosis cap provided in accordance with an embodiment of the present invention;
Fig. 6-3 are schematic views of an alternative petal-shaped anastomosis cap having a cusp aperture, in accordance with embodiments of the present invention;
FIG. 7 is a schematic view showing the working steps of an alternative single use pancreatic anastomat with a petal-shaped anastomosis cap according to an embodiment of the present invention;
FIG. 8 is a schematic view showing the working steps of an alternative single use pancreatic anastomat with disc-shaped anastomosis cap according to an embodiment of the present invention;
FIG. 9 is an assembled schematic view of an alternative endoscope as a release device for a pancreatic anastomosis according to an embodiment of the present invention;
FIG. 10 is a schematic view of an alternative release device (front section cut away) for a pancreatic anastomat according to an embodiment of the present invention;
FIG. 11 is a schematic view of an alternative release device for a pancreatic stapling instrument, according to an embodiment of the present invention;
FIG. 12 is an exploded view of the major components of an alternative release device for a pancreatic anastomat according to the present embodiments;
FIG. 13 is a schematic view of a cooperating structure of a firing bar and a pancreatic stapler of an alternative release device of the pancreatic stapler according to an embodiment of the present invention;
Fig. 14 is a schematic view of a fitting structure of a sleeve of an alternative release device of a pancreatic intestinal stapler and the pancreatic intestinal stapler according to an embodiment of the present invention;
FIG. 15 is a schematic view of an alternative release device for a pancreatic anastomat prior to being fired out of a sleeve in accordance with an embodiment of the present invention;
FIG. 16 is a schematic view of an alternative release device for a pancreatic stapling instrument after the sleeve has been fired;
FIG. 17 is a schematic view of an alternative electric pancreatic anastomat release device according to an embodiment of the present invention;
FIG. 18 is a schematic illustration of an alternative embodiment of the present invention for operation of a endoscopic pancreatic intestinal stapler with the pancreatic intestinal stapler into the pancreas;
FIG. 19 is a schematic view of an alternative endoscopic pancreatic stapler with a disc-shaped stapling cap, according to an embodiment of the present invention;
FIG. 20 is a schematic view of an alternative embodiment of the present invention wherein a pancreatic intestinal stapler with a disc-shaped stapling cap is mounted in a laparoscopic releaser to form a laparoscopic pancreatic intestinal stapler;
fig. 21 is a schematic view of an alternative endoscopic pancreatic intestinal stapler with a disc-shaped stapling cap for stapling the pancreas intestine, according to an embodiment of the present invention.
Reference numerals:
an elongated rod 11, an anastomotic cap 12, a cusp 121, a valve hole 122, a through hole 13, a back taper structure 14, a pancreatic juice hole 15, a rod threading hole 16, a cap threading hole 17, a rod tail 18 and a concave structure 19;
The pancreatic intestinal stapler 1, the release device 2, the sleeve 21, the sleeve end 211, the sleeve groove 212, the firing trigger 22, the handle 23, the retraction button 24, the firing bar 25 and the firing bar end 251.
Detailed Description
The principles and spirit of the present application will be described below with reference to several exemplary embodiments. It should be understood that these embodiments are presented merely to enable those skilled in the art to better understand and practice the application and are not intended to limit the scope of the application in any way. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the disclosure to those skilled in the art.
This embodiment is shown in fig. 1 to 21.
The embodiment of the invention provides a endoscopic pancreatic intestinal anastomat, which comprises a pancreatic intestinal anastomat 1, wherein the pancreatic intestinal anastomat 1 comprises an elongated rod 11, an anastomosis cap 12, a through hole 13 and a pancreatic juice hole 15, the anastomosis cap 12 is fixed on the elongated rod 11, the elongated rod 11 is of a hollow structure with the through hole 13, and one end of the elongated rod 11 is provided with the pancreatic juice hole 15;
the endoscopic pancreatic anastomosis device further comprises a release device 2, wherein the pancreatic anastomosis device 1 is arranged in the release device 2, the release device 2 comprises a sleeve 21, the pancreatic anastomosis device 1 is arranged in the sleeve 21, and the pancreatic anastomosis device 1 is coaxial with the sleeve 21.
Further, the diameter of the elongated rod 11 is smaller than 5mm, and/or the number of pancreatic juice holes 15 is larger than one, and/or at least one cap threading hole 17 is provided on the anastomosis cap 12.
Further, the pancreatic intestine stapler further comprises a back taper structure 14, at least one back taper structure 14 is provided on the elongated rod 11, and the back taper structure 14 and the pancreatic juice hole 15 are located on the same side of the anastomosis cap 12.
Further, the anastomotic cap 12 is circular or elliptical;
and/or one side of the anastomotic cap 12 is provided with a concave structure 19, and the concave structure 19 and the pancreatic juice hole 15 are positioned on the same side of the anastomotic cap 12.
Further, the other end of the elongated rod 11 has a rod threading hole 16;
and/or the other end of the elongated rod 11 is a rod tail 18, the rod tail 18 having a wedge-shaped structure.
Further, the anastomosis cap 12 is elastic, and the edge of the anastomosis cap 12 is provided with at least two cusps 121;
The sleeve 21 has a sleeve groove 212, the cusps 121 are engaged with the sleeve groove 212, and the cusps 121 slide on the surface of the sleeve groove 212.
Further, the petals 121 of the anastomosis cap 12 are turned inwardly or outwardly, the cannula 21 has a constricted cannula end 211, and the diameter of the cannula end 211 is smaller than the diameter of the petals 121.
Further, the cusps 121 are provided with cusp holes 122;
And/or the anastomosis cap 12 is a memory alloy.
Further, the release device 2 is assembled with a firing trigger 22, a handle 23, a retraction button 24, and a firing bar 25, wherein the firing trigger 22 and the retraction button 24 are connected to the firing bar 25, the firing bar 25 has a firing bar end 251, the tail 18 is disposed in the firing bar end 251, and the tail 18 is cooperatively connected to the firing bar end 251.
The endoscopic pancreatic intestinal stapler is a manual endoscopic pancreatic intestinal stapler or an electric endoscopic pancreatic intestinal stapler.
The specific working principle is as follows:
The pancreatic anastomat is provided with an elongated rod part which can be inserted into a pancreatic duct, a barb bulge on the elongated rod can prop up the pancreatic duct so that pancreatic juice can not leak, and a round hole on the elongated rod can enable the pancreatic juice to enter a hollow pipeline. The other end of the pancreatic intestinal anastomat is provided with a circular or oval cap, and when the slender rod enters the intestinal cavity or the gastric cavity and pierces the intestinal cavity to be inserted into the pancreatic duct, the slender rod can fix the intestinal or gastric wall at the pancreatic stump, so that the pancreatic stump is tightly pressed with serosa layers of the intestinal tract and the stomach to promote healing. The cap-shaped structure on the pancreatic intestinal anastomat is provided with one or more threading holes, and the pancreatic stump and the gastrointestinal wall can be fixed with the aid of sutures. The slender rod of the pancreatic intestine anastomat is hollow, so that pancreatic juice of a pancreatic duct can be guided into intestines and stomach without corroding an anastomotic orifice.
The cap-shaped structure on the pancreatic intestinal anastomat is made of alloy elastic material and is provided with more than 2 pointed ends, the pointed ends are in a restrained state when not released into a pancreatic duct, the pointed ends are elastically released after entering the pancreatic duct, and the pointed ends penetrate through the intestinal stomach wall and penetrate into the pancreatic stump to be firmly gripped, so that the intestines and the stomach can be anastomosed with the pancreas without a suture, and simultaneously, the protruding barbs on the slender rod can be reduced or even eliminated to support the pancreatic duct as little as possible.
The pancreatic intestinal anastomat has the same structure, but is made of absorbable materials such as magnesium or polydioxanone (PPDO), can be absorbed by human body after anastomotic stoma healing, can not be remained in the body, and improves the postoperative life quality of patients.
Specifically, as shown in fig. 2 and 3, the pancreatic intestinal anastomat is provided with an elongated rod 11, the diameter size of the elongated rod is smaller than 5mm, the elongated rod 11 is a through hole 13 with a hollow structure, an anastomotic cap 12 is fixed on the elongated rod 11, the anastomotic cap 12 is circular or elliptical, a cap threading hole 17 is formed on the anastomotic cap 12, and one surface of the anastomotic cap 12 is provided with a concave structure 19, so that the intestinal wall is better attached to the pancreatic broken end. The elongated rod 11 has a rod threading hole 16 at one end and a plurality of pancreatic juice holes 15 at the other end, and the rod tail 18 at the other end has a tail wedge structure which facilitates insertion into pancreatic duct. The elongated rod 11 has one or more back taper structures 14 which can be inserted into and secured within the pancreatic duct so that pancreatic juice does not flow out, and the hollow tube of the elongated rod 11 allows pancreatic juice to flow into the intestines and stomach.
As shown in fig. 4 and 5, the pancreatic intestinal anastomat is provided with an elongated rod 11 with a diameter smaller than 5mm, the elongated rod 11 is provided with a through hole 13 with a hollow structure, the elongated rod 11 is fixedly provided with an anastomotic cap 12, as shown in fig. 6-1, 6-2 and 6-3, the anastomotic cap 12 is petal-shaped, the edge of the anastomotic cap 12 is provided with two or more sharp lobes 121, the sharp lobes 121 on the petal-shaped anastomotic cap 12 are provided with sharp lobe holes 122, and the petal-shaped anastomotic cap 12 is fixedly arranged on the elongated rod 11. The anastomosis cap 12 may be a high-elastic sheet metal structure, may be made of a memory alloy, has two states, and in a constrained state is an anastomosis state shown in fig. 4, and may be placed in a release device of a pancreatic anastomosis, for example, a endoscopic anastomosis, and the state of the pancreatic anastomosis before being placed in the endoscopic anastomosis is an initial state as shown in fig. 5.
As shown in fig. 4 and 5, one end of the elongated rod 11 has a rod threading hole 16, the other end has a plurality of pancreatic juice holes 15, and the rod tail 18 at the other end has a tail wedge structure, which facilitates insertion into pancreatic duct. The elongated rod 11 has one or more back taper structures 14 which can be inserted into and secured within the pancreatic duct so that pancreatic juice does not flow out, and the hollow tube of the elongated rod 11 allows pancreatic juice to flow into the intestines and stomach.
In operation, as shown in fig. 7, in operation steps a, B, C and D, the pancreatic anastomat may be used alone, and as shown in fig. 6-3, two or more cusps 121 of the metal elastic anastomosis cap 12 are provided with cusp holes 122, and the symmetrical two cusp holes 122 may be connected by a suture, so that the cusp holes 122 are restrained without restraining the cusp holes 122 by a release device of the pancreatic anastomat, after the pancreatic anastomat reaches the operation position, the suture is cut, the cusps 121 of the two or more metal elastic anastomosis caps 12 are deformed in opposite directions, and the cusps 121 penetrate through the intestinal wall and then pierce the pancreatic stump to be gripped, thereby completing anastomosis.
The two or more petals 121 of the elastomeric anastomosis cap 12, in a constrained state, have a diameter dimension less than 15mm and are accessible through the endoscopic approach to the surgical site.
When the anastomosis cap 12 is circular or elliptical, the operation steps of the pancreatic anastomat are the same, and the operation principle of the pancreatic anastomat shown in fig. 2 and 3 is shown as operation steps a, B, C and D in fig. 8, so that the concave structure 19 of the anastomosis cap 12 enables the intestinal wall to be better adhered to the pancreatic broken end. One or more back taper structures 14 on the elongated rod 11 enable the elongated rod 11 to be fixed in the pancreatic duct after the elongated rod 11 is inserted into the pancreatic duct so that pancreatic juice does not flow out, and a rod threading hole 16 at one end of the elongated rod 11 and a cap threading hole 17 on the anastomosis cap 12 enable a suture to pass through. The rod threading aperture 16 may be used as a pull stapler. The use of sutures through cap threading aperture 17 allows the pancreatic intestinal stapler to secure the intestinal wall to the suture of the pancreatic stump, strengthening the anastomosis.
The release device may be used to restrain the pancreatic anastomat, for example, when the pancreatic anastomat in the restrained state is pushed into the operation position by using a cavity mirror as shown in fig. 9, the cusps 121 of two or more elastic anastomosis caps 12 are deformed in opposite directions, the cusps 121 penetrate through the intestinal wall and then penetrate into the pancreatic stump to be firmly held, and anastomosis is completed, and the principle of the pancreatic anastomat is changed to that shown in fig. 2 and 3.
As shown in fig. 4, 10, 11, 12, 13 and 14, the pancreatic anastomat 1 is built in the sleeve 21 of the release device 2, 1 and 21 are coaxial, the anastomosis cap 12 fixed on the 1 is provided with characteristic sharp lobes 121,121 matched with the sleeve groove 212 of the sleeve 21 and can slide on the surface of the sleeve, and the diameters of the sleeve ends 211,211 with contraction of the sleeve 21 are smaller than the diameter of the sharp lobes 121, so that the pancreatic anastomat 1 is placed in the sleeve 21 and cannot fall off. The release device 2 is provided with a firing trigger 22, a handle 23 and a back button 24, the firing trigger 22 and the back button 24 are connected with a firing bar 25, the firing bar 25 is provided with a firing bar end 251, and the tail 18 of the tail of the pancreatic intestinal anastomat can be placed in the firing bar end 251 to be matched with the firing bar end 251.
In operation, as shown in fig. 4, 13, 14 and 15, the firing trigger 22 is pulled to move the firing bar 25 forward, and the firing bar end 251 pushes the petals 121 to slide the pancreatic stapling instrument 1 forward along the sleeve 21. After the anastomotic cap 12 leaves the sleeve end 211, as shown in fig. 16, the sliding is continued until the pancreatic intestinal anastomat 1 is pushed out, the firing bar end 251 is separated from the cusps 121, and at this time, the back button 24 is pulled back to complete the release of the pancreatic intestinal anastomat 1.
A schematic diagram of the operation of the pancreatectomy anastomat entering the pancreatectomy device through the cavity-speculum pancreatectomy anastomat is shown in fig. 18, wherein the cavity-speculum pancreatectomy anastomat with petal-shaped anastomosis cap can be replaced by the cavity-speculum pancreatectomy anastomat with disc-shaped anastomosis cap, as shown in fig. 19, fig. 20 is a schematic diagram of the installation of the pancreatectomy device with disc-shaped anastomosis cap into the cavity-speculum releaser to form the cavity-speculum pancreatectomy device, and a schematic diagram of the anastomosis suturing of the pancreata by the cavity-speculum pancreatectomy device with disc-shaped anastomosis cap is shown in fig. 21, and steps A, B, C, D respectively illustrate the process of separating the pancreata from anastomosis suturing.
In another embodiment, the sleeve 21 may be a smooth sleeve-less recess 212, with the petals 121 of the pancreatic stapling instrument 1 coaxially engaging the firing bar end 251 on the firing bar 25, so that the pancreatic stapling instrument 1 can be axially pushed out in the sleeve 21.
In another embodiment, the end 251 of the firing bar 25 may be magnetic, and the tail 18 of the pancreatic intestine stapler 1 is made of metal, and can be adsorbed by the end 251 of the firing bar, and can be smoothly released after the release is completed.
In another embodiment, as shown in FIG. 17, the firing trigger of the release device 2 may be replaced with a motor to effect electric firing and retraction.
It should be noted that although several units/modules or sub-units/modules of the apparatus are mentioned in the above detailed description, this division is merely exemplary and not mandatory. Indeed, the features and functionality of two or more units/modules described above may be embodied in one unit/module in accordance with embodiments of the present invention. Conversely, the features and functions of one unit/module described above may be further divided into ones that are embodied by a plurality of units/modules.
While the spirit and principles of the present invention have been described with reference to several particular embodiments, it is to be understood that the invention is not limited to the disclosed embodiments nor does it imply that features of the various aspects are not useful in combination, nor are they useful in any combination, such as for convenience of description. The invention is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.