CN1695563A - Digestive canal stapler - Google Patents
Digestive canal staplerDownload PDFInfo
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- CN1695563A CN1695563ACN 200510024605CN200510024605ACN1695563ACN 1695563 ACN1695563 ACN 1695563ACN 200510024605CN200510024605CN 200510024605CN 200510024605 ACN200510024605 ACN 200510024605ACN 1695563 ACN1695563 ACN 1695563A
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Translated fromChinese技术领域Technical field
本发明涉及到用于代替外科手术中采用针线徒手吻合操作的消化道管型吻合器，特别是涉及到一次性使用的颈部呈直形的或弯形的消化道管型吻合器。The present invention relates to an alimentary canal tubular stapler used to replace freehand anastomosis with needles and threads in surgical operations, in particular to a disposable alimentary canal tubular stapler with a straight or curved neck.
背景技术 Background technique
各种消化道管型吻合器正在外科手术中被广泛地用于吻合人体消化道组织，可以减少手术时间，提高手术质量。它们通常被用于消化道中食管、胃、十二指肠、小肠、结肠和直肠等端端、端侧及侧侧吻合手术，特别适用于显露和操作困难的胃胸顶部的食管端端吻合和低位直肠癌切除后结肠直肠低位端端吻合等手术，还适用于痔核切除和胃幽门造口等在器官内形成管形通道的手术。Various digestive tract tubular staplers are widely used in surgical operations to anastomose human digestive tract tissues, which can reduce operation time and improve operation quality. They are usually used for end-to-end, end-to-side and side-to-side anastomosis of the esophagus, stomach, duodenum, small intestine, colon, and rectum in the digestive tract, especially for end-to-end anastomosis of the top of the stomach and chest that is difficult to expose and operate. Colorectal low-end end-to-end anastomosis after low rectal cancer resection is also suitable for operations such as hemorrhoidectomy and gastric pylorostomy to form tubular passages in organs.
美国专利4319576、4603693、5193731和5350104中介绍的消化道管型吻合器，包括颈部呈直形的或弯形的吻合器身，安装在吻合器身头部的固定的或可装卸的钉筒，安装在钉筒前端的可装卸的钉砧，安装在吻合器身躯部的可枢轴转动的击发手柄，安装在击发手柄旁的保险机构，安装在吻合器身尾部的调节旋钮，安装在吻合器身躯部的钉砧位置指示机构，安装在吻合器身内部的钉砧拉杆、推钉杆和其它辅助零部件。在钉筒内装有吻合钉、推钉座和环形刀。吻合钉在钉筒圆形前端部的钉仓内沿周向排列。钉砧在与钉筒相对的端面上，与钉筒内的吻合钉位置对应地排列有吻合钉成形槽，与钉筒内的环形刀位置对应处装有刀砧。转动调节旋钮，即可通过螺旋机构移动钉砧拉杆，使钉砧相对钉筒前后移动。打开保险机构，即可夹紧击发手柄向前推动推钉杆，通过钉筒内的推钉座将钉筒内的吻合钉和环形刀推出。吻合钉可采用不锈钢丝、钽丝、钛丝或其它具有类似性能的金属丝制造。The digestive tract tubular staplers introduced in US Patent Nos. 4,319,576, 4,603,693, 5,193,731 and 5,350,104 include a straight or curved stapler body with a neck, and a fixed or detachable nail barrel installed on the head of the stapler body , a detachable nail anvil installed at the front end of the nail barrel, a pivotable firing handle installed on the body of the stapler, a safety mechanism installed next to the firing handle, an adjustment knob installed at the tail of the stapler body, and an anastomotic The anvil position indicating mechanism of the stapler body, the anvil pull rod, pusher rod and other auxiliary parts installed inside the stapler body. Staples, a nail pushing seat and a circular knife are arranged in the nail barrel. Staples are arranged circumferentially in the staple bin at the circular front end of the nail barrel. On the end surface opposite to the nail barrel, the anvil is arranged with staple forming grooves corresponding to the positions of the staples in the nail barrel, and a knife anvil is arranged at a position corresponding to the position of the annular knife in the nail barrel. Turn the adjustment knob, the nail anvil pull rod can be moved through the screw mechanism, so that the nail anvil moves back and forth relative to the nail barrel. When the safety mechanism is opened, the firing handle can be clamped to push the nail pushing rod forward, and the staples and ring knife in the nail barrel can be pushed out through the nail pushing seat in the nail barrel. Staples can be made of stainless steel wire, tantalum wire, titanium wire or other metal wires with similar properties.
在使用消化道管型吻合器时，首先将消化道管型吻合器插入待吻合组织，然后转动调节旋钮使钉砧向前移动，以便将待吻合组织扎紧在钉砧和钉筒之间的钉砧拉杆上。此时再以相反方向转动调节旋钮，同时观察指示机构，使钉砧与钉筒之间达到所需的夹紧厚度。待组织被夹紧后打开保险机构，即可夹紧击发手柄推出钉筒内的吻合钉和环形刀。当吻合钉被从钉筒内推出后，即穿透被夹紧的待吻合组织直抵钉砧上的成形槽，使U形的吻合钉弯曲成B形，达到将组织吻合的手术目的。当环形刀被从钉筒内推出后直抵钉砧内的刀砧上，切除被夹紧的待吻合组织的多余部分。完成吻合操作后，转动调节旋钮使钉砧与钉筒间距增大，松开已吻合组织，以便退出消化道管型吻合器。When using the digestive tract tubular stapler, first insert the digestive tract tubular stapler into the tissue to be stapled, and then turn the adjustment knob to move the anvil forward so that the tissue to be stapled can be tightly bound between the anvil and the nail barrel. on the anvil rod. At this time, turn the adjustment knob in the opposite direction and observe the indicating mechanism at the same time, so that the required clamping thickness can be achieved between the nail anvil and the nail barrel. After the tissue is clamped, the safety mechanism is opened, and the firing handle can be clamped to push out the staples and the ring knife in the nail barrel. When the staple is pushed out from the nail barrel, it penetrates the clamped tissue to be anastomotic and reaches the forming groove on the anvil, so that the U-shaped staple is bent into a B-shape to achieve the purpose of anastomosis of the tissue. When the circular knife is pushed out from the nail barrel, it directly touches the anvil in the nail anvil, and the excess part of the clamped tissue to be anastomotic is excised. After finishing the anastomotic operation, turn the adjustment knob to increase the distance between the anvil and the nail barrel, and loosen the anastomotic tissue so as to withdraw from the digestive tract tubular stapler.
临床使用的消化道管型吻合器有重复性使用的和一次性使用的两种。重复性使用的消化道管型吻合器的功能少，每次使用后需拆卸、清洗、消毒和再装配，既影响器械的性能，又易引起交叉感染。由于塑料工业的发展，大量适合医用的质优价廉的塑料被开发出来，促进了各种一次性使用的外科器械蓬勃发展，并在临床获得广泛使用。由于食管、胃和肠等消化道器官的发病率很高，这些管形器官的手工吻合又很困难，手术质量难以保证，因此一次性使用的消化道管型吻合器是目前临床使用量最大的一种一次性使用的外科器械。虽然临床使用一次性使用的消化道管型吻合器可降低手术中的交叉感染，但生产成本较高。美国专利5271544和6193129中介绍的一次性使用的消化道管型吻合器中有大量的金加工零件和注塑零件，而冲压零件较少。这种式样的消化道管型吻合器的令人不满意处是，由于一次性使用的消化道管型吻合器是大规模生产的医疗器械，其中金加工零件的生产成本大于注塑零件，注塑零件的生产成本大于冲压零件，因此一次性使用的消化道管型吻合器的生产成本还需降低。There are two types of alimentary canal staplers used clinically: reusable and disposable. Reusable digestive tract tubular staplers have few functions, and need to be disassembled, cleaned, disinfected and reassembled after each use, which not only affects the performance of the instrument, but also easily causes cross infection. Due to the development of the plastics industry, a large number of high-quality and low-cost plastics suitable for medical use have been developed, which has promoted the vigorous development of various disposable surgical instruments and has been widely used in clinics. Due to the high incidence of digestive tract organs such as the esophagus, stomach and intestines, manual anastomosis of these tubular organs is difficult, and the quality of the operation is difficult to guarantee. Therefore, the disposable digestive tract stapler is currently the most clinically used A single-use surgical instrument. Although the clinical use of disposable digestive tract staplers can reduce cross-infection during surgery, the production cost is relatively high. There are a large number of gold processing parts and injection molded parts in the disposable digestive tract tube type anastomat introduced in US Patent 5271544 and 6193129, and stamping parts are less. The unsatisfactory part of this style of digestive tract stapler is that since the disposable digestive tract stapler is a mass-produced medical device, the production cost of the gold processing parts is greater than that of the injection molded parts, and the injection molded parts The production cost is greater than that of stamping parts, so the production cost of the disposable digestive canal stapler needs to be reduced.
目前，一次性使用的消化道管型吻合器的大部分零件由塑料制成，塑料零件与塑料零件之间的连接，塑料零件与金属零件之间的连接对一次性使用的消化道管型吻合器的质量和成本有很大的影响。美国专利5271544中所介绍的一次性使用的消化道管型吻合器，其吻合器身躯部由塑料制成的左、右吻合器身合拢后采用超声波焊接而成，其弯颈部采用金属弯管制成，金属弯管的两端分别通过金属套管与塑料制成的钉筒和吻合器身滚压连接。这种式样的一次性使用的弯颈式消化道管型吻合器的令人不满意处是，由于金属弯管与塑料制成的左、右吻合器身的强度相差很大，塑料件在受力状态下有蠕变的趋势，很难达到满意的连接效果。另外，金属弯管内部难以加工成较复杂的形状，现有的消化道管型吻合器的钉砧拉杆和推钉杆在弯颈内部都是叠在一起安装的，使用时会相互摩擦和挤压，既增加钉砧拉杆和推钉杆移动阻力又降低移动精度。美国专利5685474中所介绍的一次性使用的消化道管型吻合器，其吻合器身由塑料制成的左、右吻合器身合拢而成，左、右吻合器身采用金属螺钉和铆钉连接在一起。这种式样的一次性使用的消化道管型吻合器的令人不满意处是，由于金属螺钉和铆钉与塑料制成的左、右吻合器身的强度相差很大，塑料件在受力状态下有蠕变的趋势，很难达到满意的连接效果。上述两种美国专利中所介绍的一次性使用的消化道管型吻合器，由塑料制成的推钉座与金属环形刀采用超声波焊接达到连接的目的，钉筒外壳与钉仓采用粘接达到连接的目的。这两种式样的一次性使用的消化道管型吻合器的令人不满意处是，超声波焊接的连接精度与设备、技能和零件的形状有关、加工时间较长，而粘接剂会流入不需要粘接的部位、还对环境有污染；另外，超声波焊接和粘接的质量与被连接的材料的化学成分、熔点、摩擦系数、硬度、表面特性和结构形状等化学性能和物理性能有关，从而大大减少了材料的选择范围，可能难以找到最合适的材料。因此一次性使用的消化道管型吻合器的塑料零件与塑料零件之间的连接、塑料零件与金属零件之间的连接还需改进。At present, most of the parts of the disposable digestive tract stapler are made of plastic. The quality and cost of the device have a great influence. Disposable digestive tract tubular stapler introduced in U.S. Patent No. 5,271,544, its stapler body is welded by ultrasonic welding after the left and right stapler bodies are made of plastic, and its curved neck is made of metal elbow The two ends of the metal elbow are connected by rolling with the plastic nail barrel and the stapler body through the metal sleeve respectively. The unsatisfactory part of the disposable curved neck type digestive tract tubular anastomat of this style is that the strength difference between the left and right anastomotic body made of metal elbow and plastic is very large, and the plastic parts are subjected to There is a tendency to creep under the force state, and it is difficult to achieve a satisfactory connection effect. In addition, it is difficult to process the inside of the metal elbow into a more complex shape. The anvil pull rod and the pusher rod of the existing digestive tract stapler are stacked and installed inside the bend neck, and they will rub and squeeze each other during use. Pressing, not only increases the movement resistance of the anvil pull rod and the push nail rod but also reduces the movement accuracy. Introduced in U.S. Patent No. 5,685,474, the disposable alimentary tract tubular stapler has a stapler body made of left and right stapler bodies made of plastic, and the left and right stapler bodies are connected by metal screws and rivets. Together. The unsatisfactory part of the disposable alimentary tract tubular stapler of this style is that the strength of the left and right stapler bodies made of metal screws and rivets is very different from that of the plastic, and the plastic parts are under stress. There is a tendency of creeping, and it is difficult to achieve a satisfactory connection effect. The disposable digestive tract tubular stapler introduced in the above two US patents uses ultrasonic welding to achieve the purpose of connecting the push nail seat made of plastic and the metal ring knife, and the shell of the nail cylinder and the nail cartridge are bonded to achieve the purpose of connection. purpose of the connection. The unsatisfactory part of these two styles of disposable digestive tract stapler is that the connection accuracy of ultrasonic welding is related to the shape of equipment, skills and parts, the processing time is longer, and the adhesive will flow into different parts. The parts that need to be bonded also pollute the environment; in addition, the quality of ultrasonic welding and bonding is related to the chemical composition, melting point, friction coefficient, hardness, surface characteristics and structural shape of the materials to be connected. As a result, the range of material choices is greatly reduced, and it may be difficult to find the most suitable material. Therefore, the connection between the plastic part and the plastic part, and the connection between the plastic part and the metal part of the disposable digestive tract tubular stapler need to be improved.
当待吻合组织被夹紧后再夹紧击发手柄推出钉筒内的吻合钉时，外科医生往往需要了解U形的吻合钉是否已被弯曲成B形将组织吻合。美国专利5685474中介绍的消化道管型吻合器，当击发手柄通过推钉杆推出钉筒内的吻合钉时，推钉杆在吻合器身内向前移动；当U形的吻合钉已被弯曲成B形将组织吻合时，推钉杆将吻合器身内的一根金属杆挤断，金属杆断裂时发出的声音提示外科医生：U形的吻合钉已被弯曲成B形将组织吻合。这种式样的消化道管型吻合器的令人不满意处是，挤断金属杆需要消耗外科医生较大的夹紧击发手柄的力，并且金属杆断裂的位置也不很准确。美国专利5271544和6193129中介绍的消化道管型吻合器，当U形的吻合钉被弯曲成B形将组织吻合时，环形刀将钉砧内的刀砧切断，刀砧断裂时发出的声音提示外科医生：U形的吻合钉已被弯曲成B形将组织吻合。这种式样的消化道管型吻合器的令人不满意处是，刀砧断裂时发出的声音大小与刀砧材料的硬度和切断的速度有关，即清晰的断裂声音需要消耗较大的力，并且刀砧断裂的位置与吻合钉被弯曲成B形的位置也不完全对应。因此一次性使用的消化道管型吻合器的吻合完成的声音提示机构还需改进。When the anastomotic tissue is clamped and then the firing handle is clamped to push out the staple in the nail barrel, the surgeon often needs to know whether the U-shaped staple has been bent into a B-shape to anastomose the tissue. In the digestive tract tubular stapler introduced in U.S. Patent No. 5,685,474, when the firing handle pushes out the staples in the nail barrel through the pusher rod, the pusher rod moves forward in the stapler body; when the U-shaped staples have been bent into When the B-shape is used to anastomose the tissues, the pusher rod will break a metal rod inside the stapler body, and the sound when the metal rod breaks reminds the surgeon that the U-shaped staples have been bent into a B-shape to anastomose the tissues. The unsatisfactory part of this type of alimentary canal tube stapler is that breaking the metal rod needs to consume a large force of the surgeon to clamp the firing handle, and the broken position of the metal rod is not very accurate. The alimentary canal tubular staplers introduced in US Patent Nos. 5,271,544 and 6,193,129, when the U-shaped staples are bent into a B-shape to anastomose the tissues, the ring knife cuts off the anvil in the anvil, and the sound prompts when the anvil breaks Surgeon: The U-shaped staples have been bent into a B-shape to hold the tissue together. The unsatisfactory part of this type of digestive tract stapler is that the sound when the anvil breaks is related to the hardness of the anvil material and the cutting speed, that is, a clear breaking sound requires a lot of force. And the position where the anvil breaks does not exactly correspond to the position where the staple is bent into a B shape. Therefore, the sound prompt mechanism for the completion of the anastomosis of the disposable digestive tract tubular stapler needs to be improved.
消化道管型吻合器的通过击发手柄推出吻合钉和环形刀执行组织吻合的击发机构目前已有几种式样。美国专利5271544中介绍的消化道管型吻合器，环形刀切割刀砧的作用处为完整的圆周。这种式样的消化道管型吻合器的令人不满意处是，当击发手柄通过推钉杆推出钉筒内的吻合钉和环形刀执行组织吻合时，大部分的力消耗在环形刀切割刀砧上。美国专利6193129中介绍的消化道管型吻合器，环形刀的刀刃为曲线状，环形刀切割刀砧的开始作用处为环形刀的刀刃的波峰，可减少环形刀切割刀砧的作用力。这种式样的消化道管型吻合器的令人不满意处是，曲线状刀刃的环形刀很难制造。上述两种式样的消化道管型吻合器的另一令人不满意处是，当击发手柄通过推钉杆推出钉筒内的推钉座和环形刀执行组织吻合时，推钉座和环形刀随击发手柄的夹紧和放松而前后移动，一旦外科医生在夹紧击发手柄用力困难时放松一下，则推钉座和环形刀也随着后移，此时U形的吻合钉未被弯曲成B形将组织吻合，环形刀也未将多余的组织切除。如果外科医生再次夹紧击发手柄时，推钉座和环形刀可能不再作用在原来的位置上，造成不完整的吻合钉成形和不完整的组织切除。美国专利5685474中介绍的消化道管型吻合器，当击发手柄通过推钉杆推出钉筒内的推钉座和环形刀执行组织吻合时，推钉座和环形刀随击发手柄的夹紧和放松只向前移动而不向后移动。这种式样的消化道管型吻合器的令人不满意处是，完成吻合操作后推钉座和环形刀凸出钉筒，会损伤周围的组织。因此消化道管型吻合器的击发机构还需改进。The firing mechanism of the digestive tract tubular stapler that pushes out the staples and the ring knife to perform tissue anastomosis through the firing handle currently has several styles. In the digestive tract tubular stapler introduced in US Patent No. 5,271,544, the ring knife cuts the anvil at the complete circumference. The unsatisfactory part of this style of digestive tract tubular stapler is that when the firing handle pushes out the staples in the nail barrel and the ring knife to perform tissue anastomosis through the push rod, most of the force is consumed on the ring knife cutting knife. on the anvil. In the digestive tract tubular stapler introduced in U.S. Patent 6,193,129, the blade of the ring knife is curved, and the starting point of the ring knife cutting the anvil is the crest of the blade of the ring knife, which can reduce the force of the ring knife cutting the anvil. The unsatisfactory part of the alimentary canal tube type anastomat of this style is that the circular knife of curved blade is difficult to manufacture. Another unsatisfactory part of the digestive tract tubular staplers of the above two styles is that when the firing handle pushes out the nail pusher seat and the ring knife in the nail barrel through the pusher rod to perform tissue anastomosis, the nail pusher seat and the ring knife With the clamping and loosening of the firing handle, it moves back and forth. Once the surgeon relaxes when it is difficult to clamp the firing handle, the push nail seat and the ring knife also move back. At this time, the U-shaped staple is not bent into a The B shape fits the tissue together, and the ring knife does not remove excess tissue. If the surgeon clamps the firing handle again, the staple pusher and the circular knife may no longer act on the original position, resulting in incomplete staple formation and incomplete tissue resection. The alimentary canal tubular stapler introduced in US Patent 5685474, when the firing handle pushes out the push nail seat and the ring knife in the nail barrel through the push nail rod to perform tissue anastomosis, the push nail seat and the ring knife are clamped and loosened with the firing handle Only move forward and not backward. The unsatisfactory part of the digestive tract tubular stapler of this style is that after the anastomosis operation is completed, the nail pushing seat and the ring knife protrude from the nail barrel, which will damage the surrounding tissues. Therefore, the firing mechanism of the digestive tract tubular stapler needs to be improved.
完成吻合操作后，由于钉砧的面积大于吻合口的面积，消化道管型吻合器从吻合口退出比较困难，可能会撕裂吻合口。消化道管型吻合器的钉砧侧倾转动机构目前已有几种式样。在美国专利5639008中介绍的消化道管型吻合器，钉砧与钉砧拉杆之间采用枢轴连接，钉砧内有一弹簧盘卡住钉砧拉杆使钉砧不能绕钉砧拉杆侧倾转动；当进行吻合操作时，钉筒中的环形刀内侧的推杆将弹簧盘推开，以便在钉砧内的弹簧推动下使钉砧能绕钉砧拉杆侧倾转动。由于侧倾转动后的钉砧在垂直于钉砧拉杆轴线方向的截面积小于吻合口的截面积，使消化道管型吻合器的钉砧容易从吻合口退出。这种式样的消化道管型吻合器的令人不满意处是，钉筒中的环形刀内侧的推杆在钉筒内占有一定的空间，减少了可容纳待吻合组织残段的空间；另一方面，钉砧内的弹簧盘和弹簧及钉筒内的推杆暴露在待吻合组织的残段处，待吻合组织残段会影响弹簧盘、弹簧和推杆的正确动作。因此消化道管型吻合器的钉砧侧倾转动机构还需改进。After the anastomotic operation is completed, since the area of the anvil is larger than that of the anastomosis, it is difficult for the digestive tract tubular stapler to withdraw from the anastomosis, which may tear the anastomosis. There are currently several models of the anvil tilting rotation mechanism of the digestive tract tubular stapler. In the alimentary canal tubular stapler introduced in US Patent No. 5639008, the anvil and the anvil rod are pivotally connected, and a spring disc inside the anvil clamps the anvil rod so that the anvil cannot rotate around the anvil rod; When performing anastomotic operation, the push rod inside the ring knife in the nail barrel pushes away the spring disk, so that the nail anvil can rotate around the nail anvil pull bar under the push of the spring in the nail anvil. Since the cross-sectional area of the anvil in the direction perpendicular to the axis of the anvil pull rod is smaller than the cross-sectional area of the anastomosis after the sideways rotation, the anvil of the digestive tract tubular stapler can easily withdraw from the anastomosis. The unsatisfactory part of the digestive tract tubular stapler of this style is that the push rod inside the ring knife in the nail barrel occupies a certain space in the nail barrel, which reduces the space that can accommodate the residual tissue to be anastomosed; On the one hand, the spring plate and spring in the nail anvil and the push rod in the nail barrel are exposed to the residual tissue to be anastomotic, and the residual tissue to be anastomotic will affect the correct action of the spring plate, spring and push rod. Therefore, the anvil tilting rotation mechanism of the digestive tract tubular stapler needs to be improved.
消化道管型吻合器的钉砧位置指示机构目前已有几种式样。美国专利5639008中介绍的消化道管型吻合器，采用在调节旋钮尾部的槽内显示钉砧拉杆尾部的方式以指示钉砧拉杆拉动钉砧达到夹紧待吻合组织的位置。这种式样的消化道管型吻合器的令人不满意处是，调节旋钮尾部的槽随调节旋钮的转动而不断改变方向，影响观察。在美国专利5271544和6193129中介绍的消化道管型吻合器，采用钉砧拉杆带动一根摆动指针，仅当钉砧拉杆拉动钉砧达到夹紧待吻合组织的位置时，摆动指针才会在吻合器身躯部上的指示窗口中显露，放大指示夹紧厚度。上述两种式样的消化道管型吻合器的令人不满意处是，当钉砧拉杆拉动钉砧未达到夹紧待吻合组织的位置时，指示机构不起指示作用，外科医生无法知道钉砧拉杆拉动钉砧到达的具体位置，不便于决定执行中间过程的操作方式。因此消化道管型吻合器的指示机构还需改进。The anvil position indicating mechanism of the digestive tract tubular stapler has several styles at present. The digestive tract tubular stapler introduced in US Patent No. 5,639,008 adopts the method of displaying the tail of the anvil pull rod in the groove at the tail of the adjustment knob to instruct the anvil pull rod to pull the anvil to the position where the tissue to be anastomotic is clamped. The unsatisfactory part of this type of alimentary canal tube stapler is that the groove at the end of the adjustment knob changes direction continuously with the rotation of the adjustment knob, which affects observation. The alimentary canal tubular staplers introduced in U.S. Patent Nos. 5,271,544 and 6,193,129 use an anvil pull rod to drive a swinging pointer. The indicator window on the body of the tool is revealed, and the clamping thickness is enlarged to indicate the clamping thickness. The unsatisfactory part of the above-mentioned two styles of alimentary canal tubular stapler is that when the anvil pulling rod pulls the anvil and does not reach the position of clamping the tissue to be anastomoticed, the indicating mechanism does not function as an indicator, and the surgeon cannot know the position of the anvil. The specific position that the pull rod pulls the nail anvil to reach is inconvenient to determine the operation mode for performing the intermediate process. Therefore, the indicating mechanism of the digestive tract tubular stapler needs to be improved.
由上述显然可以看出，现在已经设计了大量不同式样的消化道管型吻合器，并且新的消化道管型吻合器的研制工作仍在继续，以便对每年世界上大量使用的消化道管型吻合器作进一步的改进，使得操作更方便、省力、可靠和正确，制造更便利，成本更低。It can be clearly seen from the above that a large number of digestive tract staplers of different styles have been designed, and the development of new digestive tract staplers is still going on, in order to make a comprehensive analysis of the digestive tract staplers that are used in large quantities in the world every year. The further improvement of the stapler makes the operation more convenient, labor-saving, reliable and correct, and the manufacturing is more convenient and the cost is lower.
发明内容Contents of Invention
本发明的目的在于提出一种消化道管型吻合器，实现塑料零件与塑料零件之间的连接、塑料零件与金属零件之间的连接尽量采用卡扣结构，从而在不受力的状态下，塑料零件的受力很小，更适合塑料零件的使用特性，并且装配方便、装配精度高。The purpose of the present invention is to propose a digestive tract tubular stapler to realize the connection between plastic parts and plastic parts, and the connection between plastic parts and metal parts to adopt buckle structure as much as possible, so that in the state of no force, The force of the plastic parts is small, which is more suitable for the use characteristics of the plastic parts, and the assembly is convenient and the assembly precision is high.
本发明的另一目的在于提出一种消化道管型吻合器，实现尽量减小消化道管型吻合器的环形刀切割刀砧的阻力和击发机构的阻力，从而尽量减小击发力。Another object of the present invention is to provide a digestive tract tubular stapler, which minimizes the resistance of the annular knife cutting anvil and the firing mechanism of the digestive tract tubular stapler, thereby reducing the firing force as much as possible.
本发明的另一目的在于提出一种消化道管型吻合器，实现保险机构除了具有保险作用以外，还具有吻合完成的声音和位置提示作用及夹紧击发手柄过程中的防张开作用，从而使外科医生在夹紧击发手柄用力困难时能放松一下也不会影响操作，还能及时了解吻合已经完成的时间。Another object of the present invention is to propose a digestive tract tube-type stapler, in addition to the insurance function, the safety mechanism also has the function of prompting the sound and position of the completion of the anastomosis and the function of preventing opening during the process of clamping the firing handle, thereby It enables the surgeon to relax when it is difficult to clamp the firing handle without affecting the operation, and can also know in time when the anastomosis has been completed.
本发明的另一目的在于提出一种消化道管型吻合器，实现在消化道管型吻合器的指示窗口上的标尺带有更详细的钉砧位置的指示，从而使外科医生能更清楚了解钉砧的具体位置，便于正确选择相应的操作。Another object of the present invention is to propose a digestive tract tubular stapler, so that the scale on the indication window of the digestive tract tubular stapler has a more detailed indication of the position of the anvil, so that the surgeon can understand more clearly The specific position of the nail anvil is convenient for correct selection of the corresponding operation.
本发明的另一目的在于提出一种消化道管型吻合器，实现采用较少的零部件，不占有钉筒内原有的空间，即可达到当完成吻合操作后钉砧自动绕钉砧拉杆侧倾转动的效果，由于侧倾转动后的钉砧在垂直于钉筒轴线方向的截面积小于吻合口的截面积，从而使外科医生能方便地取出消化道管型吻合器。Another object of the present invention is to propose a tubular stapler for the digestive tract, which uses fewer parts and does not occupy the original space in the nail barrel, so that the anvil can automatically wrap around the anvil rod side after the anastomosis operation is completed. Due to the effect of the tilting rotation, the cross-sectional area of the anvil perpendicular to the axis of the nail cylinder is smaller than the cross-sectional area of the anastomotic stoma after the side tilting rotation, so that the surgeon can easily take out the digestive tract tubular stapler.
本发明的另一目的在于提出一种消化道管型吻合器，实现金加工零件尽量采用注塑零件或冲压零件代替，注塑零件尽量采用冲压零件代替，从而减少工时、降低生产成本。Another object of the present invention is to propose a digestive tract tubular stapler, so that metal processing parts can be replaced by injection molded parts or stamped parts as much as possible, and injection molded parts can be replaced by stamped parts as much as possible, thereby reducing man-hours and production costs.
本发明的任务是通过下述技术方案实现的：消化道管型吻合器包括，颈部呈直形的或弯形的吻合器身，安装在吻合器身头部的钉筒，安装在钉筒前方的钉砧，安装在钉筒内的推钉座和环形刀，安装在钉筒圆形端部并沿周向排列的、可由推钉座推出的吻合钉，排列在钉砧的端面上并与钉筒内的吻合钉位置对应的吻合钉成形槽，安装在钉砧内并与钉筒内的环形刀位置对应的刀砧，可在吻合器身内前后移动的、其头部装有钉砧的钉砧拉杆，可在吻合器身内前后移动的、其头部装有推钉座的推钉杆，安装在吻合器身躯部的可枢轴转动的击发手柄，安装在吻合器身尾部的调节旋钮，安装在击发手柄旁的防止击发手柄被误击发的保险机构，指示钉砧位置和/或吻合完成的指示机构，通过调节旋钮使钉砧拉杆在吻合器身内前后移动以调节钉砧与钉筒之间的距离的钉砧位置调节机构，通过击发手柄推动推钉杆在吻合器身内移动以推动钉筒内的推钉座、吻合钉和环形刀的击发机构，安装在吻合器身内部的其它辅助零部件。The task of the present invention is achieved through the following technical solutions: the digestive tract tubular stapler includes a straight or curved stapler body with a neck, a nail barrel installed on the head of the stapler body, and a nail barrel installed on the nail barrel. The nail anvil in the front, the nail pushing seat and the ring knife installed in the nail barrel, the staples that are installed on the circular end of the nail barrel and arranged in the circumferential direction, and can be pushed out by the nail pushing seat, are arranged on the end surface of the nail anvil and Staple forming grooves corresponding to the positions of the staples in the nail barrel, anvils installed in the anvil and corresponding to the positions of the annular knife in the nail barrel, anvils that can move back and forth in the stapler body, and whose heads are equipped with anvils The anvil pull rod of the stapler body can move back and forth in the stapler body, and its head is equipped with a pusher seat, a pivotable firing handle installed on the stapler body, and an adjustment device installed at the tail Knob, a safety mechanism installed next to the firing handle to prevent the firing handle from being accidentally fired, an indicating mechanism for indicating the position of the anvil and/or the completion of anastomosis, and adjusting the knob to make the anvil pull rod move back and forth in the stapler body to adjust the anvil and the stapler. The anvil position adjustment mechanism for the distance between the barrels, through the firing handle to push the push rod to move in the stapler body to push the nail pusher seat, staples and ring knife in the nail barrel The firing mechanism is installed inside the stapler body Other auxiliary parts.
一次性使用的消化道管型吻合器中有大量的塑料零件。与金属零件相比较，塑料零件可承受的应力较小，在受力状态下有蠕变的趋势。与其他连接方式相比较，采用卡扣结构连接方式受被连接塑料材料的化学性能和物理性能的影响较小，从而增加了塑料材料的选择范围，便于找到最合适的塑料材料。因此，本发明在塑料零件与塑料零件之间的连接、塑料零件与金属零件之间的连接中尽量采用卡扣结构，塑料零件在卡扣连接后受力很小，可确保塑料零件内部的装配精度，更适合塑料零件的使用特性，并且装配也十分方便。仅在内部未装配活动零件或难以采用卡扣结构连接的部分才考虑选择采用其他的连接方式。卡扣结构可以选用悬臂梁锁紧件、平面型锁紧件、止逆型锁紧件、扭转型锁紧件或圆环型锁紧件等各种结构。There are a large number of plastic parts in the disposable digestive tract stapler. Compared with metal parts, plastic parts can withstand less stress and have a tendency to creep under stress. Compared with other connection methods, the buckle structure connection method is less affected by the chemical and physical properties of the plastic materials to be connected, thus increasing the selection range of plastic materials and making it easier to find the most suitable plastic materials. Therefore, the present invention adopts buckle structure as much as possible in the connection between plastic parts and plastic parts, and between plastic parts and metal parts. Precision, more suitable for the use characteristics of plastic parts, and the assembly is also very convenient. Other connection methods should only be considered for parts that are not assembled with moving parts or that are difficult to connect with a snap-fit structure. The buckle structure can be selected from various structures such as cantilever beam locks, plane locks, non-reverse locks, twist-type locks or ring-type locks.
本发明中的吻合器身由塑料制成的左、右吻合器身合拢而成。左、右吻合器身也可以分别分成躯部和颈部两部分。当位于吻合器身内部的零部件安装在吻合器身内后，左、右吻合器身合拢时在卡扣结构的作用下锁紧连接在一起。卡扣结构中有弹性卡扣件和固定卡扣件，弹性卡扣件经弹性变形卡扣住固定卡扣件，使弹性卡扣件和固定卡扣件锁紧连接在一起。卡扣结构中的弹性卡扣件和固定卡扣件可以分别固定在左、右吻合器身上。当左、右吻合器身合拢时，左、右吻合器身上的弹性卡扣件卡扣住固定卡扣件，使左、右吻合器身合拢时在卡扣结构的作用下锁紧连接在一起。另一种方案是，卡扣结构中的固定卡扣件固定在左、右吻合器身的其中之一上。当左、右吻合器身合拢时，卡扣结构中的弹性卡扣件从不带固定卡扣件的吻合器身中插入后，弹性卡扣件的一端压在不带固定卡扣件的吻合器身上、另一端经弹性变形卡扣住带有固定卡扣件的吻合器身内的固定卡扣件上，使左、右吻合器身合拢时在卡扣结构的作用下锁紧连接在一起。还有一种方案是，卡扣结构中有弹性卡扣件、固定卡扣件和止动块。当左、右吻合器身合拢时，使弹性卡扣件经弹性变形卡扣住固定卡扣件后，再将止动块插入弹性卡扣件卡扣住固定卡扣件后形成的空隙中以阻止弹性卡扣件从固定卡扣件上脱开。The stapler body in the present invention is formed by joining the left and right stapler bodies made of plastic. The left and right stapler bodies can also be divided into two parts, the trunk and the neck, respectively. After the components inside the stapler body are installed in the stapler body, the left and right stapler bodies are locked and connected together under the action of the buckle structure when they are closed. The buckle structure has an elastic buckle and a fixed buckle, and the elastic buckle buckles the fixed buckle through elastic deformation, so that the elastic buckle and the fixed buckle are locked and connected together. The elastic buckle and the fixed buckle in the buckle structure can be respectively fixed on the left and right staplers. When the left and right stapler bodies are closed, the elastic buckle parts on the left and right stapler bodies buckle the fixed buckle parts, so that when the left and right stapler bodies are closed, they are locked and connected together under the action of the buckle structure . Another solution is that the fixed buckle in the buckle structure is fixed on one of the left and right stapler bodies. When the left and right stapler bodies are closed, after the elastic buckle in the buckle structure is inserted from the stapler body without the fixed buckle, one end of the elastic buckle is pressed against the anastomat without the fixed buckle. The body and the other end of the device are elastically deformed and fastened to the fixed buckle in the stapler body with the fixed buckle, so that when the left and right stapler bodies are closed, they are locked and connected together under the action of the buckle structure. Another solution is that the buckle structure has elastic buckle parts, fixed buckle parts and stoppers. When the left and right stapler bodies are closed, the elastic buckle is elastically deformed to buckle the fixed buckle, and then the stop block is inserted into the gap formed after the elastic buckle buckles the fixed buckle. prevent the elastic buckle from being disengaged from the fixed buckle.
由金属片制成的推钉杆的前端共被冲压弯折成四根推杆。推钉杆的前端也可以由金属片冲压弯折成四根带圆角的角形推杆。四根推杆从钉筒后端伸入钉筒内与推钉座连接。当推钉杆上的推杆插在推钉座上后，金属的推杆与塑料的推钉座在卡扣结构的作用下锁紧连接在一起。卡扣结构中有弹性卡扣件和固定卡扣件，弹性卡扣件经弹性变形卡扣住固定卡扣件，使弹性卡扣件和固定卡扣件锁紧连接在一起。The front ends of the push rods made of sheet metal are stamped and bent into four push rods. The front end of the push rod can also be punched and bent into four angular push rods with rounded corners by sheet metal. Four push rods extend into the nail barrel from the rear end of the nail barrel to connect with the nail pushing seat. After the push rod on the push rod is inserted on the push seat, the metal push rod and the plastic push seat are locked and connected together under the action of the buckle structure. The buckle structure has an elastic buckle and a fixed buckle, and the elastic buckle buckles the fixed buckle through elastic deformation, so that the elastic buckle and the fixed buckle are locked and connected together.
由塑料制成的左、右吻合器身合拢而成的吻合器身与由塑料制成的钉筒在卡扣结构中的止逆弹性片和凹孔的作用下锁紧连接在一起。吻合器身前端的外壁上有止动槽和卡扣结构中的止逆弹性片。钉筒内壁上有肋条和卡扣结构中的凹孔。当由左、右吻合器身合拢而成的吻合器身的前端插入钉筒内时，钉筒内壁的肋条沿吻合器身外壁上的止动槽移动，直到吻合器身外壁上的止逆弹性片弹入钉筒内壁上的凹孔内，使钉筒在卡扣结构的作用下与吻合器身锁紧连接在一起。同时，钉筒内壁的肋条插入吻合器身外壁上的止动槽内以限止钉筒在吻合器身的外壁上转动。另一种方案是，吻合器身外壁上的止逆弹性片露出钉筒的外壁，按下吻合器身外壁上的止逆弹性片即可使钉筒与吻合器身之间的连接脱开，将钉筒拔下后再根据需要更换一只新的钉筒。The stapler body formed by closing the left and right stapler bodies made of plastic and the nail barrel made of plastic are locked and connected together under the action of the non-return elastic sheet and the concave hole in the buckle structure. The outer wall of the front end of the stapler body has a stop groove and a non-return elastic piece in the buckle structure. There are ribs and recessed holes in the buckle structure on the inner wall of the nail barrel. When the front end of the stapler body formed by closing the left and right stapler bodies is inserted into the nail barrel, the ribs on the inner wall of the nail barrel move along the stop grooves on the outer wall of the stapler body until the anti-reverse elasticity on the outer wall of the stapler body The piece is ejected into the concave hole on the inner wall of the nail barrel, so that the nail barrel is locked and connected with the stapler body under the action of the buckle structure. At the same time, the ribs on the inner wall of the nail barrel are inserted into the stop grooves on the outer wall of the stapler body to limit the rotation of the nail barrel on the outer wall of the stapler body. Another solution is that the non-return elastic sheet on the outer wall of the stapler body exposes the outer wall of the nail barrel, and the connection between the nail barrel and the stapler body can be disengaged by pressing the anti-return elastic sheet on the outer wall of the stapler body. Pull out the nail barrel and replace it with a new nail barrel as needed.
塑料的推钉座与金属的环形刀在卡扣结构中的侧向卡爪和扣槽的作用下锁紧连接在一起。环形刀外周的后端带有卡扣结构中的侧向卡爪。推钉座内周上带有卡扣结构中的扣槽。当环形刀插入推钉座内后，环形刀后端的侧向卡爪弹入推钉座的扣槽内，使环形刀在卡扣结构的作用下与推钉座锁紧连接在一起。The plastic push nail seat and the metal ring knife are locked and connected together under the action of the lateral claws and the buckle groove in the buckle structure. The rear end of the ring knife periphery is provided with lateral claws in the buckle structure. There are buckle grooves in the buckle structure on the inner circumference of the push nail seat. After the ring knife is inserted into the push nail seat, the lateral claws at the rear end of the ring knife spring into the buckle groove of the push nail seat, so that the ring knife is locked and connected with the push nail seat under the action of the buckle structure.
钉筒中有钉筒外壳和钉仓。钉筒外壳与吻合器身连接在一起。钉仓内安装有吻合钉。塑料钉筒外壳与塑料钉仓在卡扣结构中的卡爪和扣槽的作用下锁紧连接在一起。钉筒外壳内周的前端带有环形分布的卡扣结构中的卡爪。钉仓外周与钉筒外壳内周的卡爪位置对应处带有环形分布的卡扣结构中的扣槽。当钉仓插入钉筒外壳上后，钉筒外壳内周的卡爪扣入钉仓外周的扣槽内，使钉仓在卡扣结构的作用下与钉筒外壳锁紧连接在一起。A nail barrel shell and a nail cartridge are arranged in the nail barrel. The shell of the nail barrel is connected with the stapler body. Staples are installed in the staple magazine. The plastic nail barrel shell and the plastic nail magazine are locked and connected together under the action of the claws and the buckle groove in the buckle structure. The front end of the inner circumference of the shell of the nail barrel is provided with claws in a ring-shaped buckle structure. There are buckle grooves in a ring-shaped buckle structure at the position corresponding to the position of the claws on the outer circumference of the nail cartridge and the inner circumference of the nail barrel shell. After the staple cartridge is inserted into the shell of the nail barrel, the claws on the inner periphery of the shell of the nail barrel are buckled into the buckle grooves on the outer periphery of the staple cartridge, so that the staple cartridge is locked and connected with the shell of the nail barrel under the action of the buckle structure.
钉砧拉杆与钉砧在卡扣结构中的卡爪和插杆的作用下锁紧连接在一起。钉砧拉杆的前端有钉砧接杆和锁杆，中部有钉砧拉片，后端有螺杆。钉砧接杆的前端与钉砧连接，钉砧接杆的后端有带有周向凹槽的插杆。钉砧拉片的后端插入螺杆前端的缝隙内后与螺杆的前端连接，钉砧拉片的前端插入锁杆后端的缝隙内后与锁杆连接。插入锁杆后端的缝隙内的钉砧拉片上带有卡爪。锁杆的前端带有可插入钉砧接杆上的插杆的插孔。钉砧拉片上的卡爪伸入锁杆的插孔内。当钉砧接杆上的插杆插入锁杆的插孔内后，钉砧拉片上的卡爪扣入插杆的凹槽内，使钉砧连同钉砧接杆在卡扣结构中的卡爪和插杆的作用下与钉砧拉杆的锁杆锁紧连接在一起。当钉砧接杆上的插杆从锁杆的插孔内拔出时，插杆使钉砧拉片上的卡爪张开，即可使钉砧连同钉砧接杆与钉砧拉杆的锁杆脱离。The nail anvil pull rod and the nail anvil are locked and connected together under the action of the claw and the insertion rod in the buckle structure. The front end of the anvil pull rod has an anvil connecting rod and a lock bar, the middle part has an anvil pull piece, and the rear end has a screw rod. The front end of the anvil connecting rod is connected with the nail anvil, and the rear end of the nail anvil connecting rod has an insertion rod with a circumferential groove. The rear end of the nail anvil pulling piece is inserted in the slit of the screw rod front end and is connected with the front end of the screw rod, and the front end of the nail anvil pulling piece is inserted in the slit of the locking bar rear end and is connected with the locking bar. There are claws on the nail anvil pulling piece inserted into the gap at the rear end of the lock bar. The front end of the locking bar has a socket that can be inserted into the insertion rod on the anvil connecting rod. The claw on the nail anvil pulling piece stretches in the jack of locking bar. When the insertion rod on the anvil connecting rod is inserted into the socket of the locking rod, the claws on the anvil pull piece are buckled into the groove of the insertion rod, so that the nail anvil and the claws of the anvil connecting rod in the buckle structure And under the action of the plunger, it is locked and connected with the lock bar of the nail anvil pull bar. When the inserting rod on the anvil connecting rod is pulled out from the socket of the locking rod, the inserting rod will open the claws on the anvil pulling piece, so that the locking rod of the anvil together with the anvil connecting rod and the anvil pulling rod can be opened. break away.
本发明中的保险机构中有击发手柄、击发弹簧、保险栓和保险弹簧。击发手柄与吻合器身枢轴联接。击发弹簧始终使击发手柄趋向于张开的状态。保险栓与吻合器身枢轴联接，保险栓上有操作端和控制端。控制端用于撑住或脱离击发手柄，操作端用于操作保险栓的转动。保险弹簧始终使保险栓的控制端趋向于撑住击发手柄的状态。击发手柄和保险栓上分别带有棘牙。当进行吻合操作时，转动保险栓使控制端脱离击发手柄，击发手柄被夹紧转动后再松开保险栓，击发手柄上的棘牙与保险栓上的棘牙在击发弹簧和保险弹簧的作用下相互啮合，使击发手柄只能被夹紧转动而不能向相反方向张开。当完成吻合操作时，转动保险栓使保险栓的棘牙与击发手柄的棘牙脱离，击发弹簧使击发手柄回复到张开的状态。此时，松开保险栓使控制端在保险弹簧的作用下回复到撑住击发手柄的位置。另一种方案是，当完成吻合操作时，被夹紧转动的击发手柄上的棘牙移出保险栓上的棘牙后，保险栓在保险弹簧的作用下弹向击发手柄，发出的撞击声和保险栓的位置移动提醒外科医生吻合已完成。此时，再转动保险栓使保险栓与击发手柄脱离，击发弹簧使击发手柄回复到张开的状态，然后松开保险栓使控制端在保险弹簧的作用下回复到撑住击发手柄的位置。保险机构可以带有切换片和切换弹簧。钉砧拉杆可带动切换片在吻合器身内向后移动。切换弹簧始终使切换片趋向于朝吻合器身的前方移动。切换片控制保险栓的转动。当钉砧与钉筒之间偏离可执行吻合操作的夹紧厚度时，切换弹簧始终使切换片卡住保险栓，此时保险栓不能被转动后打开。当钉砧移动到可执行吻合操作的夹紧厚度的位置时，钉砧拉杆带动切换片松开保险栓，使保险栓允许被打开。这样，保险机构除了具有保险作用以外，还具有吻合完成的声音和位置提示作用及夹紧击发手柄过程中的防张开作用，从而使外科医生在夹紧击发手柄用力困难时能放松一下也不会影响操作，还能及时了解吻合已经完成的时间，放心地进行下一步的操作。There are firing handle, firing spring, safety bolt and safety spring in the safety mechanism among the present invention. The firing handle is pivotally connected with the stapler body. The firing spring always tends to open the firing handle. The safety bolt is pivotally connected with the stapler body, and the safety bolt has an operation end and a control end. The control end is used to support or break away from the firing handle, and the operating end is used to operate the rotation of the safety bolt. The safety spring tends to support the state of the firing handle with the control end of the safety bolt all the time. There are ratchets on the firing handle and the safety catch respectively. When the anastomosis operation is performed, turn the safety bolt to separate the control end from the firing handle, and then release the safety bolt after the firing handle is clamped and rotated. The bottom and bottom are engaged with each other, so that the firing handle can only be clamped and rotated but cannot be opened in the opposite direction. When the anastomosis operation is completed, the ratchet teeth of the safety bolt are disengaged from the ratchet teeth of the firing handle by rotating the safety bolt, and the firing spring makes the firing handle return to the opened state. At this time, unclamp the safety bolt to make the control end return to the position supporting the firing handle under the action of the safety spring. Another scheme is that when the anastomosis operation is completed, after the ratchet teeth on the clamped and rotated firing handle move out of the ratchet teeth on the safety bolt, the safety bolt bounces to the firing handle under the action of the safety spring, and the impact sound and Movement of the safety pin alerts the surgeon that the anastomosis is complete. Now, turn the safety bolt again to disengage the safety bolt from the firing handle, and the firing spring makes the firing handle return to the open state, then unclamp the safety bolt so that the control end returns to the position of supporting the firing handle under the action of the safety spring. The insurance mechanism can have a switching piece and a switching spring. The anvil pull rod can drive the switching piece to move backward in the stapler body. The switching spring always makes the switching piece tend to move towards the front of the stapler body. The switching sheet controls the rotation of the safety catch. When the clamping thickness between the nail anvil and the nail barrel deviates from the clamping thickness that can perform the anastomotic operation, the switching spring always makes the switching piece block the safety stopper, and the safety stopper cannot be turned and opened at this moment. When the nail anvil moves to the position where the anastomosis operation can be performed to clamp the thickness, the nail anvil pull rod drives the switching piece to release the safety bolt, so that the safety bolt is allowed to be opened. In this way, in addition to the insurance function, the safety mechanism also has the sound and position prompt function of the completion of the anastomosis and the anti-opening function during the clamping of the firing handle, so that the surgeon can relax when it is difficult to clamp the firing handle. It will affect the operation, and it can also know the time when the anastomosis has been completed in time, so that the next operation can be performed with confidence.
本发明中的安装在钉砧内的刀砧与安装在钉筒内的环形刀位置对应的端面呈波浪形。刀砧端面的波浪形可以是正弦波、半圆波、锯齿波、三角波、矩形波、梯形波等各种波浪形。当环形刀切割刀砧时，先切开刀砧端面的波浪形的波峰。由于波峰仅占整个端面的一小部分，因此切割阻力较小。当刀砧波浪形端面的波峰被切开后，刀砧波浪形端面在环形刀切割的作用下被边切开边撕裂，受到的切割阻力较小。由于击发手柄通过推钉杆推出钉筒内的吻合钉和环形刀执行组织吻合时的大部分力消耗在环形刀切割刀砧上，因此通过减少环形刀切割刀砧的阻力即可明显减小击发力。In the present invention, the anvil installed in the nail anvil and the end face corresponding to the position of the annular knife installed in the nail cylinder are wavy. The wavy shape of the anvil end face can be various wavy shapes such as sine wave, semicircular wave, sawtooth wave, triangular wave, rectangular wave, and trapezoidal wave. When the ring knife cuts the anvil, it first cuts the wavy crest of the end face of the anvil. Since the crest only occupies a small portion of the entire end face, there is less resistance to cutting. After the crest of the wavy end surface of the anvil is cut, the wavy end surface of the anvil is torn while being cut under the action of the circular knife, and the cutting resistance received is small. Since the firing handle pushes out the staples in the nail barrel through the push rod and most of the force of the ring knife is consumed on the ring knife cutting anvil when the tissue anastomosis is performed, the impact can be significantly reduced by reducing the resistance of the ring knife cutting the anvil. work hard.
本发明中的钉砧上有钉砧帽和钉砧片。钉砧片由金属片冲压制成，在钉砧片的端面上排列有与钉筒内的吻合钉位置对应的吻合钉成形槽，在钉砧片带有吻合钉成形槽的背面上用塑料涂复。钉砧帽由塑料制成，使钉砧片用塑料涂复的面可采用超声波塑料焊接方法与钉砧帽焊接在一起。达到金加工零件尽量采用注塑零件或冲压零件代替、注塑零件尽量采用冲压零件代替的效果，从而减少加工时间、降低生产成本。Anvil cap and anvil sheet are arranged on the anvil in the present invention. The anvil sheet is made by punching a metal sheet. On the end face of the anvil sheet, there are staple forming grooves corresponding to the positions of the staples in the nail cylinder. complex. The nail anvil cap is made of plastic, so that the plastic-coated surface of the nail anvil sheet can be welded together with the nail anvil cap by an ultrasonic plastic welding method. To achieve the effect that metal processing parts should be replaced by injection molding parts or stamping parts as much as possible, and injection molding parts should be replaced by stamping parts as much as possible, thereby reducing processing time and reducing production costs.
本发明中的钉砧转动控制机构由钉砧、钉砧拉杆、环形刀、刀砧和侧倾弹簧组成。钉砧与钉砧拉杆枢轴联接。刀砧的外侧面与上述钉砧的内侧面连接在一起，刀砧的内侧面上带有径向延伸的止动块，刀砧的止动块撑住钉砧拉杆使钉砧不可绕钉砧拉杆侧倾转动。侧倾弹簧的一端作用在钉砧拉杆上、另一端作用在钉砧上。环形刀的内侧面靠近刀刃处被加工成粗糙的表面，既可以加工成锯齿状的表面，也可以加工成经滚花的表面，还可以加工成其他方式的粗糙表面。当进行吻合操作时，环形刀切开连接刀砧的内侧面和外侧面之间的端面，使刀砧的内侧面部分与外侧面部分脱离。当完成吻合操作时，环形刀的内侧面上的粗糙表面带动刀砧的内侧面部分脱离钉砧，刀砧的内侧面上的止动块不再撑住钉砧拉杆，钉砧拉杆带动钉砧离开钉筒，使钉砧在侧倾弹簧的作用下绕钉砧拉杆侧倾转动。另一种方案是，钉砧转动控制机构中的钉砧拉杆在前端的侧面上带有向前延伸的止动杆，钉砧拉杆的止动杆靠在钉砧与钉砧拉杆枢轴联接处的侧面上使钉砧只可朝一侧绕钉砧拉杆侧倾转动。刀砧的外侧面与钉砧的内侧面连接在一起，刀砧的内侧面上带有径向延伸的止动块，刀砧的止动块撑住钉砧拉杆的止动杆可转动的一边使钉砧不可绕钉砧拉杆侧倾转动。当进行吻合操作时，环形刀切开连接刀砧的内侧面和外侧面之间的端面，使刀砧的内侧面部分与外侧面部分脱离。当完成吻合操作时，环形刀的内侧面上的粗糙表面带动刀砧的内侧面部分脱离钉砧，刀砧的内侧面上的止动块不再撑住钉砧拉杆的止动杆，钉砧拉杆带动钉砧离开钉筒，使钉砧在侧倾弹簧的作用下绕钉砧拉杆侧倾转动。本发明中的钉砧转动控制机构采用较少的零部件，不占有钉筒内原有的空间，即可达到当完成吻合操作后钉砧自动绕钉砧拉杆侧倾转动的效果。由于侧倾转动后的钉砧在垂直于钉筒轴线方向的截面积小于吻合口的截面积，从而使外科医生在完成吻合操作后能方便地取出消化道管型吻合器。The nail anvil rotation control mechanism among the present invention is made up of nail anvil, nail anvil pull bar, ring knife, knife anvil and side tilting spring. The nail anvil is pivotally connected with the nail anvil pull rod. The outer surface of the knife anvil is connected with the inner surface of the above-mentioned nail anvil, and the inner surface of the knife anvil has a radially extending stop block, and the stop block of the knife anvil supports the nail anvil pull rod so that the nail anvil cannot wrap around the nail anvil. The drawbar rotates sideways. One end of the side tilt spring acts on the nail anvil pull rod, and the other end acts on the nail anvil. The inner side of the ring knife is roughened near the edge, either serrated, knurled, or otherwise roughened. When the anastomosis operation is performed, the ring knife cuts open the end face connecting the inner side and the outer side of the anvil, so that the inner side part of the anvil is separated from the outer side part. When the anastomosis operation is completed, the rough surface on the inner side of the annular knife drives the inner side of the anvil to partly break away from the anvil, and the stop block on the inner side of the anvil no longer supports the anvil pull rod, and the anvil pull rod drives the anvil Leaving the nail barrel, the nail anvil is rotated sideways around the nail anvil pull rod under the effect of the side tilt spring. Another solution is that the anvil pull rod in the anvil rotation control mechanism has a stop rod extending forward on the side of the front end, and the stop rod of the anvil pull rod leans against the pivot joint of the nail anvil and the nail anvil pull rod On the side of the nail anvil, it can only tilt and rotate around the nail anvil pull rod towards one side. The outer surface of the knife anvil is connected with the inner surface of the nail anvil, and the inner surface of the knife anvil has a radially extending stop block, and the stop block of the knife anvil supports the rotatable side of the stop bar of the nail anvil pull rod The nail anvil cannot rotate sideways around the nail anvil pull rod. When the anastomosis operation is performed, the ring knife cuts open the end face connecting the inner side and the outer side of the anvil, so that the inner side part of the anvil is separated from the outer side part. When the anastomosis operation is completed, the rough surface on the inner side of the annular knife drives the inner side of the anvil to partly break away from the anvil, and the stop block on the inner side of the anvil no longer supports the stop bar of the anvil pull rod, and the anvil The pull bar drives the nail anvil to leave the nail barrel, so that the nail anvil is tilted and rotated around the nail anvil pull rod under the action of the roll spring. The anvil rotation control mechanism in the present invention uses fewer parts, does not occupy the original space in the nail barrel, and can achieve the effect that the anvil automatically rotates sideways around the anvil pull rod after the anastomosis operation is completed. Since the cross-sectional area of the anvil in the direction perpendicular to the axis of the nail cylinder is smaller than the cross-sectional area of the anastomotic opening after the sideways rotation, the surgeon can conveniently take out the digestive tract tubular stapler after completing the anastomotic operation.
本发明中的指示机构由调节旋钮、钉砧拉杆、钉砧位置指针和指示窗口组成。钉砧拉杆带动钉砧位置指针上的指示标记在位于吻合器身躯部的指示窗口的下方前后移动。指示窗口上的标尺对不允许执行吻合操作的钉砧与钉筒之间的距离和位置沿钉砧拉杆的轴向按1∶1标出直线段，指示窗口上的标尺对允许执行吻合操作的钉砧与钉筒之间的距离和位置沿与钉砧拉杆的轴向成角度的方向标出斜线段。由于当钉砧位置指针上的指示标记随钉砧拉杆轴向移动时，指示窗口上的标尺沿与钉砧拉杆的轴向成角度的方向标出的斜线段长于沿钉砧拉杆的轴向标出的直线段，因此具有放大作用。当通过调节旋钮使钉砧拉杆在吻合器身内前后移动以调节钉砧与钉筒之间的距离时，钉砧拉杆带动钉砧位置指针上的指示标记在位于吻合器身躯部的指示窗口的下方前后移动，从指示窗口的标尺上指示钉砧与钉筒之间的各种距离和位置。本发明的消化道管型吻合器的指示窗口上的标尺带有更详细的钉砧位置的指示，从而使外科医生能更清楚了解钉砧的具体位置，便于正确选择相应的操作。The indicating mechanism in the present invention is made up of adjusting knob, nail anvil pull rod, nail anvil position pointer and indication window. The anvil pull rod drives the indicator mark on the anvil position pointer to move back and forth under the indicator window located on the stapler body. The scale on the indicating window is for the distance and position between the anvil and the nail barrel that are not allowed to perform the anastomosis operation. Mark the straight line segment in 1:1 along the axial direction of the anvil pull rod, and the scale on the indicating window is for the anastomosis operation to be allowed. The distance and position between the nail anvil and the nail barrel are marked with oblique line segments along the direction angled to the axial direction of the nail anvil pull rod. Because when the indicator mark on the anvil position pointer moves axially with the anvil pull rod, the oblique line segment marked by the scale on the indicating window along the direction angled to the axial direction of the anvil pull rod is longer than the axial mark along the anvil pull rod. out of the straight line segment, so it has a magnifying effect. When adjusting the knob to move the anvil pull rod back and forth in the stapler body to adjust the distance between the anvil and the nail barrel, the anvil pull rod drives the indicator mark on the anvil position pointer below the indicator window located on the stapler body Move back and forth, and indicate various distances and positions between the anvil and the nail barrel from the scale in the indication window. The scale on the indication window of the digestive tract tubular stapler of the present invention has more detailed indications of the position of the anvil, so that the surgeon can understand the specific position of the anvil more clearly, so as to facilitate correct selection of corresponding operations.
具体实施方法及其附图说明 Specific implementation methods and description
下面用举例方式，结合附图陈述本发明的最佳实施例，本发明的范围将在权利要求中指出。应当认识到某些或全部附图都是为了说明本发明的最佳实施例的说明简图，而并未描绘出所示部分的真实尺寸。参考最佳实施例的详细叙述，将会更加清楚地理解达到本发明上述的和其它的目的和优点的实际方式。By way of example, preferred embodiments of the present invention are described below with reference to the accompanying drawings, and the scope of the present invention will be pointed out in the claims. It should be recognized that some or all of the drawings are illustrative diagrams illustrating preferred embodiments of the invention and do not depict the true dimensions of the parts shown. The practical manner in which these and other objects and advantages of the invention are achieved will become more clearly understood by reference to the detailed description of the preferred embodiment.
图1是表示本发明实施例的消化道管型吻合器的正视图；Fig. 1 is the front view that shows the digestive tract tubular stapler of the embodiment of the present invention;
图2是表示图1的消化道管型吻合器未夹紧待吻合组织时吻合器头部的局部剖视图；Fig. 2 is a partial sectional view of the stapler head when the digestive tract tubular stapler in Fig. 1 is not clamping the tissue to be stapled;
图3是表示图1的消化道管型吻合器在夹紧并吻合组织时吻合器头部的局部剖视图；Fig. 3 is a partial sectional view of the stapler head when the digestive tract tubular stapler in Fig. 1 is clamping and anastomosing tissues;
图4是表示图1的消化道管型吻合器在完成吻合组织后吻合器头部的局部剖视图；Fig. 4 is a partial cross-sectional view of the stapler head after the digestive tract tubular stapler in Fig. 1 completes the anastomosis;
图5是表示图1的消化道管型吻合器的刀砧波浪形端面的局部放大立体图(未显示刀砧其他部位的详细结构)；Fig. 5 is a partially enlarged perspective view showing the wavy end face of the anvil of the digestive tract tubular stapler of Fig. 1 (detailed structures of other parts of the anvil are not shown);
图6是表示图1的消化道管型吻合器的环形刀靠近刀刃处的局部放大剖视图；Fig. 6 is a partially enlarged cross-sectional view showing the annular knife of the digestive tract tubular stapler of Fig. 1 near the blade;
图7是表示图3的消化道管型吻合器的1-1截面的剖视图(主要显示推钉杆上的角形推杆)；Fig. 7 is a sectional view showing the section 1-1 of the digestive tract tubular stapler of Fig. 3 (mainly showing the angular push rod on the push screw rod);
图8是表示图1的消化道管型吻合器的2-2截面转正后的剖视图(主要显示吻合器身颈部上的卡扣结构)；Fig. 8 is a cross-sectional view showing the 2-2 section of the digestive tract tubular stapler of Fig. 1 after it has been normalized (mainly showing the buckle structure on the neck of the stapler);
图9是表示图8的消化道管型吻合器的3-3截面的局部剖视图；Fig. 9 is a partial cross-sectional view showing the section 3-3 of the digestive tract tubular stapler of Fig. 8;
图10是表示图1的消化道管型吻合器的4-4截面转正后的剖视图(主要显示吻合器身躯部与颈部交界处上的卡扣结构)；Fig. 10 is a sectional view showing the section 4-4 of the alimentary tract tubular stapler of Fig. 1 after being normalized (mainly showing the buckle structure at the junction of the stapler's body and neck);
图11是表示图1的消化道管型吻合器未执行吻合组织时吻合器躯部移去左吻合器身后的局部视图；Fig. 11 is a partial view showing that the stapler body in Fig. 1 is removed from the left stapler when the stapler is not performing anastomosis;
图12是表示图1的消化道管型吻合器在执行吻合组织时吻合器躯部移去左吻合器身后的局部视图；Fig. 12 is a partial view of the digestive tract tubular stapler in Fig. 1 when the stapler body is removed from the left stapler when performing anastomotic tissue;
图13是表示图1的消化道管型吻合器在完成吻合组织时吻合器躯部未移去左吻合器身的局部视图；Fig. 13 is a partial view showing that the stapler body in Fig. 1 has not been removed from the left stapler body when the anastomotic tissue is completed;
图14是表示图13的消化道管型吻合器的5-5截面的剖视图(主要显示吻合器身躯部上的卡扣结构)；Fig. 14 is a sectional view showing the section 5-5 of the digestive tract tubular stapler of Fig. 13 (mainly showing the buckle structure on the stapler body);
图15是表示图14的消化道管型吻合器的6-6截面的局部剖视图。Fig. 15 is a partial sectional view showing section 6-6 of the digestive tract tubular stapler of Fig. 14 .
下面结合图1至图15对本发明实施例的消化道管型吻合器的各零部件和机构进行描述，说明各零部件及其相互联接和作用、在各操作步骤中各机构的动作过程和作用。The parts and mechanisms of the digestive tract tubular stapler according to the embodiment of the present invention will be described below with reference to Fig. 1 to Fig. 15, explaining the parts and their mutual connection and function, and the action process and function of each mechanism in each operation step .
如图1所示，消化道管型吻合器的吻合器身7由塑料制成的左、右吻合器身8和9合拢而成。钉筒10安装在吻合器身7的头部。钉砧11安装在钉砧拉杆12的头部，位于钉筒10的前方。在吻合器身7的躯部安装有指示窗口13、可枢轴转动的击发手柄14和保险栓15。在吻合器身7的尾部安装有调节旋钮16。As shown in FIG. 1 , the
如图2、图3和图4所示，安装在钉砧拉杆12头部的钉砧11上有钉砧帽17和钉砧片18。钉砧片18由金属片冲压制成，在钉砧片18的端面上排列有与钉筒10内的吻合钉19位置对应的吻合钉成形槽20，在钉砧片18带有吻合钉成形槽20的背面21上用塑料涂复。钉砧帽17由塑料制成，使钉砧片18用塑料涂复的面21可采用超声波塑料焊接方法与钉砧帽17焊接在一起。钉砧11内安装刀砧22。如图5所示，与安装在钉筒10内的环形刀23位置对应的刀砧22的端面24呈波浪形25。如图6所示，环形刀23的内侧面靠近刀刃38处被加工成锯齿状的表面39。钉砧11与钉砧拉杆12枢轴联接。钉砧拉杆12在前端的侧面上带有向前延伸的止动杆26。钉砧拉杆12的止动杆26靠在钉砧11与钉砧拉杆12枢轴联接处27的侧面28上使钉砧11只可朝一侧绕钉砧拉杆12侧倾转动。刀砧22的外侧面29上的圆环锁紧爪30与钉砧11的内侧面31锁紧连接在一起。刀砧22的内侧面32上带有径向延伸的止动块33。刀砧22的止动块33撑住钉砧拉杆12的止动杆26可转动的一边使钉砧11不可绕钉砧拉杆12侧倾转动。侧倾弹簧34的一端作用在钉砧拉杆12上、另一端作用在钉砧11上。当进行吻合操作时，环形刀23切开连接刀砧22的内侧面32和外侧面29之间的端面24，使刀砧22的内侧面部分32与外侧面部分29脱离。当完成吻合操作时，环形刀23的内侧面上的锯齿状的表面39带动刀砧22的内侧面部分32脱离钉砧11，刀砧22的内侧面32上的止动块33不再撑住钉砧拉杆12的止动杆26，钉砧拉杆12带动钉砧11离开钉筒10，使钉砧11在侧倾弹簧34的作用下绕钉砧拉杆12侧倾转动。As shown in Fig. 2, Fig. 3 and Fig. 4,
如图2和图3所示，钉筒10由钉筒外壳35、钉仓36、推钉座37、环形刀23和吻合钉19组成。钉仓36内安装有吻合钉19。吻合钉19在钉仓36圆形端部沿周向排列，可由推钉座37推出。钉筒外壳35内壁上有肋条40和凹孔41。吻合器身7前端的外壁上有止动槽42和止逆弹性片43。当由左、右吻合器身8和9合拢而成的吻合器身7的前端插入钉筒10内时，钉筒外壳35内壁的肋条40沿吻合器身7外壁上的止动槽42移动，直到吻合器身7外壁上的止逆弹性片43弹入钉筒外壳35内壁上的凹孔41内，使钉筒10与吻合器身7锁紧连接在一起。同时，钉筒外壳35内壁的肋条40插入吻合器身7外壁上的止动槽42内以限止钉筒10在吻合器身7的外壁上转动。如图4所示的是与图2和图3不同的一种使钉筒10在卡扣结构的作用下与吻合器身7锁紧连接在一起的实施例，吻合器身7外壁上的止逆弹性片44也可以露出钉筒外壳35的外壁，按下吻合器身7外壁上的止逆弹性片44即可使钉筒10与吻合器身7之间的连接脱开，将钉筒10拔下后再根据需要更换一只新的钉筒10。环形刀23外周的后端带有侧向卡爪45。推钉座37内周上带有扣槽46。当环形刀23插入推钉座37内后，环形刀23后端的侧向卡爪45弹入推钉座37的扣槽46内，使环形刀23与推钉座37锁紧连接在一起。钉筒外壳35内周的前端带有环形分布的卡爪47。钉仓36外周与钉筒外壳35内周的卡爪47位置对应处带有环形分布的扣槽48。当钉仓36插入钉筒外壳35上后，钉筒外壳35内周的卡爪47扣入钉仓36外周的扣槽48内，使钉仓36与钉筒外壳35锁紧连接在一起。As shown in FIG. 2 and FIG. 3 , the
吻合器身7由左、右吻合器身8和9合拢而成。如图8和图9所示，右吻合器身9的颈部49上有固定卡扣件50。如图10所示，右吻合器身9躯部51与颈部49交界处上有固定卡扣件52，左吻合器身8躯部53与颈部54交界处上有弹性卡扣件55。如图14和图15所示，右吻合器身9的躯部51上有固定卡扣件56。当位于吻合器身7内部的零部件安装在吻合器身7内后，左、右吻合器身8和9合拢成吻合器身7。此时，如图10所示，左吻合器身8的躯部53与颈部54交界处上的弹性卡扣件55经弹性变形卡扣住右吻合器身9躯部51与颈部49交界处上的固定卡扣件52，使左、右吻合器身8和9的躯部与颈部交界处合拢时在弹性卡扣件55和固定卡扣件52的作用下锁紧连接在一起；如图8和图9所示，弹性卡扣件57从左吻合器身8的颈部54中插入后，弹性卡扣件57的一端58压在左吻合器身8的颈部54上、另一端59经弹性变形卡扣住右吻合器身9的颈部49内的固定卡扣件50上，再将止动块60插入弹性卡扣件57卡扣住固定卡扣件50后形成的空隙中以阻止弹性卡扣件57从固定卡扣件50上脱开，使左、右吻合器身8和9的颈部在弹性卡扣件57、固定卡扣件50和止动块60的作用下锁紧连接在一起；如图14和图15所示，弹性卡扣件61从左吻合器身8的躯部53中插入后，弹性卡扣件61的一端62压在左吻合器身8的躯部53上、另一端63经弹性变形卡扣住右吻合器身9的躯部51内的固定卡扣件56上，再将止动块64插入弹性卡扣件61卡扣住固定卡扣件56后形成的空隙中以阻止弹性卡扣件61从固定卡扣件56上脱开，使左、右吻合器身8和9的躯部合拢时在弹性卡扣件61、固定卡扣件56和止动块64的作用下锁紧连接在一起。上述弹性卡扣件55、57和61均采用悬臂环套型锁紧件。需要说明的是，使左、右吻合器身8和9合拢时锁紧连接在一起的卡扣结构，可以采用同一种的卡扣结构，也可以采用不同种的卡扣结构。The
如图1所示，安装在吻合器身7内部的推钉杆65由金属片冲压制成，可在吻合器身7内前后移动。如图3和图7所示，推钉杆65的前端被冲压弯折成四根带圆角的角形推杆66。推杆66从钉筒10的后端伸入钉筒10内与推钉座37连接。在推钉座37上有弹性卡扣件67。在推杆66上有固定卡扣件68。当推钉杆65上的推杆66插在推钉座37上后，推钉座37上的弹性卡扣件67经弹性变形卡扣住推杆66上的固定卡扣件68，使推钉座37与推杆66锁紧连接在一起。如图11、图12和图13所示，推钉杆65的后端有可由击发手柄14的拨杆69推动的槽70和靠在击发弹簧81上的凸块72。As shown in FIG. 1 , the
如图2、图3和图7所示，钉砧拉杆12的前端有钉砧接杆73和锁杆76，中部有钉砧拉片77，后端有螺杆78。钉砧接杆73的前端与钉砧11连接，钉砧接杆73的后端有带有周向凹槽74的插杆75。钉砧拉片77的后端插入螺杆78前端的缝隙内后与螺杆78的前端连接(见图11)，钉砧拉片77的前端插入锁杆76后端的缝隙内后与锁杆76连接。插入锁杆76后端的缝隙内的钉砧拉片77上有卡爪79。锁杆76的前端带有可插入钉砧接杆73上的插杆75的插孔80。钉砧拉片77上的卡爪79伸入锁杆76的插孔80内。当钉砧接杆73上的插杆75插入锁杆76的插孔80内后，钉砧拉片77上的卡爪79扣入插杆75的凹槽74内，使钉砧11连同钉砧接杆73与钉砧拉杆12的锁杆76锁紧连接在一起。当钉砧接杆73上的插杆75从锁杆76的插孔80内拔出时，插杆75使钉砧拉片77上的卡爪79张开，即可使钉砧11连同钉砧接杆73与钉砧拉杆12的锁杆76脱离。As shown in Fig. 2, Fig. 3 and Fig. 7, the front end of nail
如图11、图12和图13所示，击发手柄14与吻合器身7枢轴联接。击发弹簧81始终使击发手柄14趋向于张开的状态。保险栓15与吻合器身7枢轴联接，保险栓15上有操作端84和控制端85。控制端85用于撑住或脱离击发手柄14，操作端84用于操作保险栓15的转动。保险弹簧86始终使保险栓15的控制端85趋向于撑住击发手柄14的状态以防止击发手柄14被误击发。切换片87可由钉砧拉杆12带动在吻合器身7内向后移动。切换弹簧88始终使切换片87趋向于朝吻合器身7的前方移动。切换片87控制保险栓15的转动。击发手柄14和保险栓15上分别带有棘牙82和83。当钉砧11与钉筒10之间偏离可执行吻合操作的夹紧厚度时，切换弹簧88始终使切换片87卡住保险栓15，此时保险栓15不能被转动后打开。当钉砧11移动到可执行吻合操作的夹紧厚度的位置时，钉砧拉杆12带动切换片87松开保险栓15，使保险栓15允许被打开。当进行吻合操作时，转动保险栓15使控制端85脱离击发手柄14，击发手柄14被夹紧转动后再松开保险栓15，击发手柄14上的棘牙82与保险栓15上的棘牙83在击发弹簧81和保险弹簧86的作用下相互啮合，使击发手柄14只能被夹紧转动而不能向相反方向张开，使外科医生在夹紧击发手柄14用力困难时能放松一下也不会影响操作。当完成吻合操作时，被夹紧转动的击发手柄14上的棘牙82移出保险栓15上的棘牙83后，保险栓15在保险弹簧86的作用下弹向击发手柄14，发出的撞击声和保险栓15的位置移动提醒外科医生吻合已完成。此时，转动保险栓15使保险栓15与击发手柄14脱离，击发弹簧81使击发手柄14回复到张开的状态。然后松开保险栓15使控制端85在保险弹簧86的作用下回复到撑住击发手柄14的位置。As shown in FIG. 11 , FIG. 12 and FIG. 13 , the firing handle 14 is pivotally connected to the
如图11、图12和图13所示，钉砧拉杆12带动钉砧位置指针89上的指示标记90在位于吻合器身7躯部的指示窗口13的下方前后移动。指示窗口13上的标尺91对不允许执行吻合操作的钉砧11与钉筒10之间的距离和位置沿钉砧拉杆12的轴向按1∶1标出直线段92，指示窗口13上的标尺91对允许执行吻合操作的钉砧11与钉筒10之间的距离和位置沿与钉砧拉杆12的轴向成角度的方向标出斜线段93(见图13)。由于当钉砧位置指针89上的指示标记90随钉砧拉杆12的轴向移动时，指示窗口13上的标尺91沿与钉砧拉杆12的轴向成角度的方向标出的斜线段93长于沿钉砧拉杆12的轴向标出的直线段92，因此具有放大作用。当通过调节旋钮16使钉砧拉杆12在吻合器身7内前后移动以调节钉砧11与钉筒10之间的距离时，钉砧拉杆12带动钉砧位置指针89上的指示标记90在位于吻合器身7躯部的指示窗口13的下方前后移动，从指示窗口13的标尺91上指示钉砧11与钉筒10之间的各种距离和位置，使外科医生能更清楚了解钉砧11的具体位置，便于正确选择相应的操作。As shown in FIGS. 11 , 12 and 13 , the
根据上述详细介绍可知，本发明的消化道管型吻合器具有如下特点：外科医生在使用本发明的消化道管型吻合器时，将消化道管型吻合器插入待吻合的消化道器官94和95、转动调节旋钮16、选择合适的钉砧11和钉筒10的间距，将待吻合组织94和95分别扎紧在钉砧拉杆12上后，即可再反向转动调节旋钮16使待吻合组织94和95夹紧在钉砧11和钉筒10之间直到适合吻合操作的夹紧厚度。当通过调节旋钮16调节钉砧11与钉筒10之间的距离时，钉砧位置指针89上的指示标记90在位于吻合器身7躯部的指示窗口13的下方前后移动，从指示窗口13的标尺91上指示钉砧11与钉筒10之间的各种距离和位置。指示窗口13的标尺91对适合吻合操作的夹紧厚度的钉砧位置指示还具有放大作用。本发明的消化道管型吻合器的指示窗口13上的标尺91带有更详细的钉砧位置的指示，从而使外科医生能更清楚了解钉砧11的具体位置，便于正确选择相应的操作。本发明的消化道管型吻合器仅在钉砧11与钉筒10之间达到可执行吻合操作的夹紧厚度的范围时，保险栓15才允许击发手柄14被击发；如果钉砧11与钉筒10之间的距离偏离可执行吻合操作的夹紧厚度的范围时，保险栓15即阻止击发手柄14被击发，从而能避免击发手柄14被误击发的事故，以确保吻合手术安全进行。一旦外科医生确定各步操作正确无误，即可依次打开保险栓15、夹紧击发手柄14、完成吻合操作。安装在钉砧11内的刀砧22与安装在钉筒10内的环形刀23位置对应的端面24呈波浪形25。当环形刀23切割刀砧22时，先切开刀砧22波浪形端面24的波峰。由于波峰仅占整个端面24的一小部分，因此切割阻力较小。当刀砧22波浪形端面24的波峰被切开后，刀砧22波浪形端面24在环形刀23切割的作用下被边切开边撕裂，受到的切割阻力较小。由于击发手柄14通过推钉杆65推出钉筒10内的吻合钉19和环形刀23执行组织吻合时的大部分力消耗在环形刀23切割刀砧22上，因此通过减少环形刀23切割刀砧22的阻力即可明显减小外科医生夹紧击发手柄14时的击发力。保险栓15除了具有保险作用以外，还具有吻合完成的声音提示作用和夹紧击发手柄14过程中的防张开作用，从而使外科医生在夹紧击发手柄14用力困难时能放松一下也不会影响操作，还能及时了解吻合操作已经完成的时间，放心地进行下一步的操作。完成吻合组织后，转动保险栓15，松开击发手柄14，推钉座37和环形刀23自动缩回钉筒10内以防止损伤周围组织。此时转动调节旋钮16使钉砧11松开被吻合的组织94和95后，由于侧倾转动后的钉砧11在垂直于钉筒10轴线方向的截面积小于吻合口96的截面积，从而使外科医生在完成吻合操作后能方便地取出消化道管型吻合器。本发明的消化道管型吻合器在塑料零件与塑料零件之间的连接、塑料零件与金属零件之间的连接中尽量采用卡扣结构，塑料零件在卡扣连接后受力很小，可确保塑料零件内部的装配精度，更适合塑料零件的使用特性，并且装配也十分方便。在钉砧片18带有吻合钉成形槽20的背面21上用塑料涂复。钉砧帽17由塑料制成，使钉砧片18用塑料涂复的面21可采用超声波塑料焊接方法与钉砧帽17焊接在一起。达到金加工零件尽量采用注塑零件或冲压零件代替、注塑零件尽量采用冲压零件代替的效果，从而减少加工时间、降低生产成本。According to the above detailed introduction, the digestive tract tubular stapler of the present invention has the following characteristics: when the surgeon uses the digestive tract tubular stapler of the present invention, the digestive tract tubular stapler is inserted into the
与现有的消化道管型吻合器相比较，本发明的消化道管型吻合器使用时更方便、更准确、更省力、更安全，装配时更便利，生产成本更低，特别适宜在流水线上大规模地生产高质量低成本的一次性使用的直颈式或弯颈式消化道管型吻合器。Compared with the existing digestive tract tubular stapler, the digestive tract tubular stapler of the present invention is more convenient, more accurate, less labor-saving and safer to use, more convenient to assemble, and lower in production cost, especially suitable for assembly line Large-scale production of high-quality and low-cost disposable straight-neck or curved-neck digestive tract staplers.
于是可以看出，上述所陈述的目标，包括由前面说明所显示的那些目标被有效地达到了。这里所述的仅仅是本发明申请的典型的最佳实施形式，可以对上述结构作某些变化也不违背本发明的精神和范围。本发明不局限或被限止于这里所陈述的具体细节，而应如同权利要求的限定中陈述的那样保留对所属领域中等技术人员来说是显而易见的任何改进或改型。It will thus be seen that the above stated objectives, including those indicated by the foregoing description, are effectively achieved. What is described here is only a typical best implementation form of the application of the present invention, and some changes can be made to the above structures without departing from the spirit and scope of the present invention. The invention is not limited or restricted to the specific details set forth herein, but is reserved for any improvements or modifications apparent to one of ordinary skill in the art as set forth in the definitions of the claims.
Claims (18)
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| Application Number | Priority Date | Filing Date | Title |
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| CNB2005100246055ACN100443059C (en) | 2005-03-24 | 2005-03-24 | Tubular anastomat for digestive tract |
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| CNB2006101671278ADivisionCN100448410C (en) | 2005-03-24 | 2005-03-24 | Digestive canal stapler |
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| CN100443059C CN100443059C (en) | 2008-12-17 |
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| CNB2005100246055AExpired - Fee RelatedCN100443059C (en) | 2005-03-24 | 2005-03-24 | Tubular anastomat for digestive tract |
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| WO2011050658A1 (en)* | 2009-10-26 | 2011-05-05 | 北京中法派尔特医疗设备有限公司 | Line stapler |
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| CN104116538A (en)* | 2014-07-16 | 2014-10-29 | 北京中法派尔特医疗设备有限公司 | Anastomat with sound prompting function |
| CN104257409A (en)* | 2014-10-09 | 2015-01-07 | 飞依诺科技(苏州)有限公司 | Stapling device |
| CN104398280A (en)* | 2014-11-13 | 2015-03-11 | 江苏博朗森思医疗器械有限公司 | Tubular anastomat with non-return function |
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| WO2011050658A1 (en)* | 2009-10-26 | 2011-05-05 | 北京中法派尔特医疗设备有限公司 | Line stapler |
| CN102151157A (en)* | 2011-03-14 | 2011-08-17 | 常州市三联星海医疗器械制造有限公司 | Accurate closed space indicating device for anastomat and stitching instrument and indication method thereof |
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| CN105764568A (en)* | 2013-11-15 | 2016-07-13 | 伊西康内外科有限责任公司 | Ultrasonic anastomosis instrument with piezoelectric sealing head |
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| CN108969045B (en)* | 2014-03-26 | 2021-02-26 | 柯惠有限合伙公司 | Surgical stapling device |
| CN104116538A (en)* | 2014-07-16 | 2014-10-29 | 北京中法派尔特医疗设备有限公司 | Anastomat with sound prompting function |
| CN104116538B (en)* | 2014-07-16 | 2017-10-20 | 北京派尔特医疗科技股份有限公司 | It is a kind of that there is the stapler for showing sound function |
| CN104257409A (en)* | 2014-10-09 | 2015-01-07 | 飞依诺科技(苏州)有限公司 | Stapling device |
| CN104257409B (en)* | 2014-10-09 | 2016-05-25 | 飞依诺科技(苏州)有限公司 | Stapler |
| CN105581818B (en)* | 2014-10-24 | 2018-08-07 | 天津瑞奇外科器械股份有限公司 | The nail-anvil assembly and surgical operating instrument of surgical operating instrument |
| CN105581818A (en)* | 2014-10-24 | 2016-05-18 | 瑞奇外科器械(中国)有限公司 | Nail anvil assembly for surgical operating instrument and surgical operating instrument |
| CN104398280A (en)* | 2014-11-13 | 2015-03-11 | 江苏博朗森思医疗器械有限公司 | Tubular anastomat with non-return function |
| CN108289683A (en)* | 2015-11-13 | 2018-07-17 | 柯惠有限合伙公司 | Circular staplers with audible indicator mechanism |
| WO2017079970A1 (en)* | 2015-11-13 | 2017-05-18 | Covidien Lp | Circular stapler with audible indicator mechanism |
| CN108289683B (en)* | 2015-11-13 | 2021-06-25 | 柯惠有限合伙公司 | Circular stapler with audible indicator mechanism |
| CN112438765A (en)* | 2019-08-29 | 2021-03-05 | 苏州天臣国际医疗科技有限公司 | Closing driving mechanism and medical anastomat comprising same |
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