CN210044060U - Apical suture instrument - Google Patents

Abstract

The utility model relates to an apical suturing device, which comprises a guide piece, a puncture needle, a pushing piece, an anchoring piece, a suture line and a closing piece; a guide wire hole and puncture needle pushing grooves distributed along the circumferential direction are formed in the guide piece; the puncture needle comprises a needle body and a pushing handle which are connected with each other, the puncture needles are respectively arranged in puncture needle pushing grooves of the guide piece, and the proximal end of the needle body can extend out of the proximal end of the guide piece through pushing; the anchoring elements comprise anchoring rods and connecting wires which are mutually connected, the connecting wires form a connecting ring in the middle of the anchoring rods, and the anchoring elements are respectively arranged in needle holes of the puncture needles; the pushing components are respectively arranged at the distal end of each puncture needle hole and can push the anchoring component out from the proximal end of the puncture needle; the connecting wire of the anchor is connected with the suture knot ring through the connecting ring; the joint of the suture line and each connecting wire is provided with a closing sheet. The utility model discloses can realize sewing up to the purse of apex puncture, the location is accurate, and is easy and simple to handle, and the security is high.

Description

Apical suture instrument

Technical Field

The utility model belongs to the technical field of the instrument is sewed up to heart purse-string, especially relate to a heart point stitching instrument.

Background

With the continuous improvement of the medical technology level, the cardiac surgery is developing from the original surgery of big chest-opening type to the minimally invasive type. The minimally invasive transvascular surgery is the minimally invasive surgery, but because of the problems of blood vessel problems of patients and insufficient fineness of instruments, a novel surgery mode, namely the minimally invasive transventricular surgery, is developed between the chest-expanding surgery and the minimally invasive vascular surgery. Transapical minimally invasive surgery requires an incision of about 4cm of skin and muscle tissue between two ribs to directly expose the apex of the heart. The operation type does not need to saw bones, has small injury to human bodies, has short and direct operation path although the injury is slightly larger than the injury through blood vessels, ensures that the operation can be simpler, and is popularized and used for patients with complex lesions and patients who can not undergo surgical operation and blood vessel path operation at present.

The operation through the cardiac path firstly needs to sew a circle of purse at the cardiac apex position, puncture at the middle position of the purse to enable the instrument to enter the heart for operation, and after the operation is finished, the purse is tightened to close the puncture hole. However, it is difficult to sew the purse-string at the apex of the heart, and this is usually done by experienced cardiac surgeons.

SUMMERY OF THE UTILITY MODEL

The utility model aims to solve the technical problem that a heart point stitching instrument is provided can realize that the heart point pocket is sewed up, and is easy and simple to handle, and the security is high.

The technical scheme adopted by the utility model for solving the technical problems is to provide an apex cordis device, which comprises a guide piece, a plurality of puncture needles, a plurality of pushing pieces, a plurality of anchoring pieces, a suture line and a closing piece;

a guide wire hole and a plurality of puncture needle pushing grooves distributed along the circumferential direction are formed in the guide piece;

the puncture needles comprise needle bodies and pushing handles which are connected with each other, the puncture needles are respectively arranged in puncture needle pushing grooves of the guide piece, and the proximal ends of the needle bodies can extend out of the proximal ends of the guide piece through pushing;

the anchoring elements comprise anchoring rods and connecting wires which are mutually connected, the connecting wires form connecting rings in the middle of the anchoring rods, and the anchoring elements are respectively arranged in needle holes of the puncture needles;

the pushing components are respectively arranged at the distal end of each puncture needle hole and can push the anchoring component out from the proximal end of the puncture needle;

the connecting wires of the anchors are connected with the suture knot rings through connecting rings;

the suture line and the knot of each connecting wire loop junction are equipped with the closure piece, be equipped with the perforation on the closure piece and can pass through the suture line and the connecting wire that the perforation is connected along the knot loop and move.

The wire guide hole is arranged at the position of the central axis of the guide piece.

The puncture needle push groove sequentially comprises a push handle guide groove and a needle body hole from far center to near center, and the shape of the push handle guide groove is matched with that of the puncture needle.

Puncture needle propelling movement groove sets up to 4 ~ 8 along the even interval distribution of guide circumference.

The core-proximal end of the guide piece is of a cavity structure, the core-proximal end of the guide piece is provided with a sucker, and the guide piece is provided with a negative pressure leading port communicated with the core-proximal end cavity.

The proximal end of the needle body is an inclined needle head, the lowest point of the inclined needle head of the needle body is provided with a notch along the axial direction of the needle body, and the connecting ring of the connecting wire extends out of the notch when the anchoring piece is arranged in the needle hole of the puncture needle.

The anchoring rod is an arc-shaped nickel-titanium tube, a through hole is formed in the middle of an outer arc of the nickel-titanium tube, and the connecting wire extends out of the through hole to form a connecting ring structure.

Two ends of the connecting wire respectively extend out of two ports of the nickel-titanium tube and are knotted to form a limiting knot.

The pushing component comprises an ejector rod and a limiting push block, the limiting push block is connected with the far end of the ejector rod, and the ejector rod is matched with the needle hole of the puncture needle and is longer than the needle body.

Advantageous effects

The utility model discloses in, the guide has direction and locate function, and a plurality of pjncture needles that distribute along guide circumference can puncture the myocardium tissue through the propelling movement and get into the ventricle, and the anchor piece that sets up in the pjncture needle pinhole can enter into the ventricle through the propelling movement, pulls through the stylolite and tightens up and makes the anchor piece anchor to the myocardium tissue of ventricle side on and pull the myocardium tissue and draw in each other in to the realization is sewed up the purse of a lotus of apex puncture hole, and the location is accurate, and is easy and simple to handle, and the security is high.

Drawings

Fig. 1 is a schematic perspective view of a guide according to an embodiment of the present invention.

Fig. 2 is a schematic plan view of a guide member according to an embodiment of the present invention.

Fig. 3 is a schematic plan view of the embodiment of the present invention with a suction cup guide.

Fig. 4 is a schematic structural view of a puncture needle according to an embodiment of the present invention.

Fig. 5 is a schematic structural view of an anchor according to an embodiment of the present invention.

Fig. 6 is a schematic view of the needle, anchor and pusher assembly of an embodiment of the present invention.

Fig. 7 is a schematic view of the assembly of the anchor, suture and closure panel prior to piercing in accordance with an embodiment of the present invention.

Fig. 8 is a schematic view of the assembly of the post-puncture anchor, suture and closure panel of an embodiment of the present invention.

Fig. 9 is a diagram illustrating the use state of the pre-sewing of the present invention.

Fig. 10 is a view showing the state of the present invention when the suturing operation is completed.

Detailed Description

The present invention will be further described with reference to the following specific examples. It should be understood that these examples are for illustrative purposes only and are not intended to limit the scope of the present invention. Furthermore, it should be understood that various changes and modifications of the present invention may be made by those skilled in the art after reading the teachings of the present invention, and these equivalents also fall within the scope of the appended claims.

An apex suture apparatus as shown in fig. 1-10 includes aguide 1,piercing needles 2,pushers 3,anchors 4,suture 5 andclosure flaps 6.

As shown in fig. 1 and 2, theguide 1 is cylindrical as a whole, has a handle at the distal end, is made of a rigid material such as stainless steel or a hard polymer material, and has a diameter of about 15 to 40 mm. The central shaft position in theguide part 1 is provided with a guide wire hole 1-1, the diameter is about 1mm, and the guide wire hole is used for penetrating through anoperation guide wire 7 to play a role in positioning the apex of the heart. Theguide piece 1 is provided with 4-8 puncture needle pushing grooves at equal intervals along the circumferential direction, and the number of the puncture needle pushing grooves is preferably 4. The puncture needle pushing groove sequentially comprises a pushing handle guide groove 1-2 and a needle body hole 1-3 along the telecentric to proximal direction, the pushing handle guide groove 1-2 is a special-shaped groove, the length is about 20-50mm, the shape is matched with the shape of the pushing handle 2-2 of thepuncture needle 2, the pushing handle 2-2 of thepuncture needle 2 can move along the groove, and the limiting effect is achieved, namely thepuncture needle 2 can penetrate into the heart by 50mm at most, preferably 30 mm. The diameter of the needle body hole 1-3 is about 1.0-1.5 mm, and the needle body 2-1 of thepuncture needle 2 can be accommodated.

More preferably, as shown in fig. 3, the proximal end of theguide member 1 is a cavity structure and is provided with a suction cup 1-4, and the suction cup 1-4 is made of soft silicone rubber or the like, so as to better adhere to the surface of the heart. Theguide piece 1 is provided with a negative pressure leading port 1-5 communicated with the cavity close to the heart end, the negative pressure leading port 1-5 is connected with an external negative pressure suction apparatus, the sucking disc 1-4 generates the effect of sucking the heart through the negative pressure effect, the effect of stabilizing the cardiac muscle can be achieved in the puncture process of thepuncture needle 2, the influence of the heart beating on the puncture is reduced, and the operation safety is improved.

As shown in fig. 4 and 6, thepuncture needle 2 comprises a needle body 2-1 and a push handle 2-2 connected with the distal end of the needle body 2-1. The pushing handle 2-2 is of a special-shaped structure, so that thepuncture needle 2 is prevented from rotating, and meanwhile, the pushing handle can play a limiting role in the puncture process. The needle body 2-1 has an outer diameter of about 1.0 to 1.4mm and an inner diameter of about 0.8 to 1.2 mm. The proximal end of the needle body 2-1 is a beveled needle, and the needle body 2-1 is axially notched 2-3 at the lowest point of the bevel of the needle, about 0.5mm wide and 15mm long, along the needle body 2-1, to allow the connecting wire 4-2 of theanchor 4 to extend out of theneedle 2 through the notch 2-3. When the puncture needle is used, thepuncture needles 2 are respectively assembled in the puncture needle pushing grooves of theguide part 1, and the proximal end of the needle body 2-1 can be pushed to extend out of the proximal end of theguide part 1, so that the myocardium can be punctured.

As shown in fig. 5, theanchoring element 4 includes an anchoring rod 4-1 and a connecting wire 4-2. The anchoring rod 4-1 is an arc-shaped nickel-titanium tube, is about 8-15 mm long, preferably 10mm, is about 0.8-1.0 mm in diameter, is shaped into a certain radian, and is about 140-160 degrees in angle so as to be attached to myocardial tissues. Two ends of the connecting wire 4-2 respectively extend out of two ports of the nickel-titanium tube and are knotted to form a limiting knot, so that the connecting wire 4-2 cannot be separated from the nickel-titanium tube. The middle part of the outer arc of the nickel-titanium tube is provided with a perforation, the middle part of the connecting wire 4-2 extends out of the perforation to form a connecting ring structure, and the length of the connecting ring is about 5-12mm, preferably 6mm, and the connecting ring can be connected with a loop of asuture 5. In use, as shown in figure 6, theanchoring elements 4 are respectively fitted to the proximal end of the needle hole of eachneedle 2, and the connecting wire 4-2 is allowed to protrude from the notch 2-3 and to move along the notch 2-3.

The pushingcomponent 3 comprises a mandril and a limit push block (not shown in the figure), and the limit push block is connected with the far end of the mandril. The diameter of the ejector rod is 0.7-1.1 mm, the ejector rod is matched with the needle hole of thepuncture needle 2, and the length of the ejector rod is about 30-50 mm greater than the length of the needle body 2-1. The limiting push block is used for holding and pushing the ejector rod, cannot enter thepuncture needle 2 and plays a limiting role. As shown in fig. 6, in use, thepusher members 3 are disposed at the distal end of the needle holes of the puncture needles 2, respectively, and can push theanchor members 4 out of the proximal end of thepuncture needle 2.

As shown in fig. 7 and 8, the connecting wire 4-2 of theanchor 4 is looped by a connecting ring and asuture 5, aclosing piece 6 is provided at the looped connection of thesuture 5 and the connecting wire 4-2, and theclosing piece 6 is provided with a perforation and can move along thesuture 5 and the connecting wire 4-2 connected by the looping through the perforation. The connecting wires 4-2 of theanchors 4 are respectively connected with thesame suture 5 in a looping manner according to the structure, and theclosing sheets 6 are respectively sleeved at the connecting positions. Thesuture 5 is PP thread or PTFE thread commonly used in surgery, theclosing sheet 6 is PET membrane or felt sheet commonly used in surgery, when thesuture 5 is tightened in surgery, theclosing sheet 6 can be tightly attached to the outer surface of the heart, and the hemostatic effect can be achieved.

During operation, firstly, a doctor selects a position by adopting a puncture needle (the puncture needle is not the puncture needle 2 contained in the apex cording device) to perform apex puncture, feeds a guide wire 7 along a puncture needle hole and extracts the puncture needle; then, the heart apex suture instrument is sent along the guide wire 7, and when the periphery of the proximal end of the guide piece 1 is attached to the outer surface of the cardiac muscle, puncture needles 2(4, 6 or 8) are pushed in sequence along the circumferential direction of the guide piece 1 to puncture the cardiac muscle tissue; then pushing the pushing component 3 in the puncture needle 2 in sequence to push the anchoring component 4 in the puncture needle 2 out; after pushing out the anchor 4, the guide 1 and the puncture needle 2 are withdrawn, and the state of the stapler and the myocardium is shown in FIG. 9; and then, the anchoring pieces 4 are pulled and tightened through the suture 5, so that the anchoring pieces 4 are tightly attached to the myocardial tissues, the closing pieces are close to the wound generated by the myocardial closed puncture needle, and meanwhile, the myocardial tissues are mutually folded to achieve the state shown in figure 10, thereby achieving the effect of closing the puncture hole in the cardiac operation. Thesuture 5 is slightly loosened, so that the muscle can be relaxed, and a doctor inserts other product delivery systems to perform operations, such as aortic valve replacement, mitral valve repair and other transapical operations. After the operation is finished, thesuture line 5 of the apex cordis stitching instrument is tightened, knotted and fixed,redundant suture lines 5 are cut off, the operation passage is closed, and then follow-up operations such as closing the chest and the like are carried out, so that the whole operation is finished.

The utility model discloses the one end that "proximal end" appeared in the narration indicates to be close to the myocardial tissue and pierce the myocardial tissue even, "distal end" indicates to keep away from the other end of myocardial tissue, "proximal direction" and "distal direction" directive property respectively with "proximal end" and "distal end" directive property unanimity, and the above-mentioned directionality vocabulary of adopting, be based on the convenience and the description of adopting, it is not right the utility model discloses a restriction.

Claims (9)

1. An apex cordis stitching instrument, characterized in that: comprises a guide piece (1), a plurality of puncture needles (2), a plurality of pushing pieces (3), a plurality of anchoring pieces (4), a suture (5) and a closing sheet (6);

a guide wire hole (1-1) and a plurality of puncture needle pushing grooves distributed along the circumferential direction are formed in the guide piece (1);

the puncture needle (2) comprises a needle body (2-1) and a pushing handle (2-2) which are connected with each other, the puncture needles (2) are respectively arranged in puncture needle pushing grooves of the guide piece (1), and the proximal end of the needle body (2-1) can be pushed to extend out of the proximal end of the guide piece (1);

the anchoring elements (4) comprise anchoring rods (4-1) and connecting wires (4-2) which are connected with each other, the connecting wires (4-2) form a connecting ring in the middle of the anchoring rods (4-1), and the anchoring elements (4) are respectively arranged in needle holes of the puncture needles (2);

the pushing pieces (3) are respectively arranged at the distal end of the needle hole of each puncture needle (2) and can push the anchoring piece (4) out of the proximal end of each puncture needle (2);

the connecting wires (4-2) of the anchors (4) are connected with the knotting ring of the suture (5) through connecting rings;

the suture line (5) and the knot ring connecting part of each connecting wire (4-2) are provided with a closing piece (6), and the closing piece (6) is provided with a perforation and can move along the suture line (5) and the connecting wires (4-2) connected by the knot ring through the perforation.

2. An apical suturing device as defined in claim 1, wherein: the wire guide hole (1-1) is arranged at the position of a central shaft of the guide piece (1).

3. An apical suturing device as defined in claim 1, wherein: the puncture needle pushing groove sequentially comprises a pushing handle guide groove (1-2) and a needle body hole (1-3) along the direction from far center to near center, and the shape of the pushing handle guide groove (1-2) is matched with that of a pushing handle (2-2) of the puncture needle (2).

4. An apical suturing device according to claim 1 or 3, wherein: puncture needle propelling movement groove sets up to 4 ~ 8 along even interval distribution in guide (1) circumference.

5. An apical suturing device according to any one of claims 1 to 3, wherein: the near-core end of the guide piece (1) is of a cavity structure, the near-core end is provided with a sucker (1-4), and the guide piece (1) is provided with a negative pressure leading port (1-5) communicated with the near-core end cavity.

6. An apical suturing device as defined in claim 1, wherein: the proximal end of the needle body (2-1) is an inclined needle head, a notch (2-3) is formed in the needle body (2-1) at the lowest point of the inclined needle head along the axial direction of the needle body (2-1), and the anchoring piece (4) is arranged in a needle hole of the puncture needle (2) and the connecting ring of the connecting wire (4-2) extends out of the notch (2-3).

7. An apical suturing device as defined in claim 1, wherein: the anchoring rod (4-1) is an arc-shaped nickel-titanium tube, a through hole is formed in the middle of the outer arc of the nickel-titanium tube, and the connecting wire (4-2) extends out of the through hole to form a connecting ring structure.

8. An apical suturing device according to claim 7, wherein: two ends of the connecting wire (4-2) respectively extend out of two ports of the nickel-titanium tube and are knotted to form a limiting knot.

9. An apical suturing device as defined in claim 1, wherein: the pushing component (3) comprises an ejector rod and a limiting push block, the limiting push block is connected with the far-end center of the ejector rod, and the ejector rod is matched with the needle hole of the puncture needle (2) and is longer than the needle body (2-1).

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