CN1398173A - 气密的剖腹接入器具 - Google Patents

气密的剖腹接入器具 Download PDF

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CN1398173A
CN1398173A CN01803875A CN01803875A CN1398173A CN 1398173 A CN1398173 A CN 1398173A CN 01803875 A CN01803875 A CN 01803875A CN 01803875 A CN01803875 A CN 01803875A CN 1398173 A CN1398173 A CN 1398173A
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CN1190170C (zh
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F·C·彼得森
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B2017/3419—Sealing means between cannula and body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
    • A61B2017/3441—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable with distal sealing means

Abstract

一种剖腹接入装置(10)能够从外科手术位置取出组织(T)或其它碎屑。一根具有纵向进出口的导管(12)设置有一个具有远端(28)和近端(22)的柔性内套管(20)。该套管(20)形成一个能够让剖腹外科手术器械(16)通过的内部通道(32)。该套管(20)沿导管(12)一侧(34)有轴向张紧，并提供了一个在导管(12)内其它地方的确定导管(12)和套管(20)之间的可充气腔(36)的松散、松垂部分。设置气体口(38)，它能够使来自体腔的压力下的气体进入靠近其远端的可充气腔(36)内，从而使套管被压扁而密封该通道(32)。

Description

气密的剖腹接入器具
发明领域
本发明涉及用于剖腹外科手术的装置，尤其涉及在保持体腔内气压的同时能够使用剖腹外科手术器具将组织从体腔内取出的装置。
发明背景
剖腹外科手术通常要求在患者的组织上开一个或多个能够使剖腹外科器械插入的小口。通常，将要在其中进行剖腹外科手术的体腔(腹部，膝包膜等)被首先充以气体如二氧化碳，从而提供一个能够在其中操纵外科器械的打开的和充气的区域。一根导管通过限定体腔的组织壁，外科器械通过该导管引入体腔内。
由于体腔受到压缩，体腔内的压缩气体有一种通过导管向外逸出的趋势，因此体腔缩小。为了解决该问题，已经推荐了数种装置来提供导管内的压力密封，但是还不能够使剖腹器械通过导管朝内和朝外穿过体腔。这样的一种密封在Mollenauer等的美国专利US5634937中示出。另一种表示在公开号为GB2275420(Gaunt等人)的英国专利申请中，还有一种在公开号为WO94/22357(Yoon)PCT国际专利申请中示出。上述参考文献中所述的密封装置基本上涉及可充气的环形装置，剖腹器械可以通过这些装置的中心。
尽管通过插管插入体腔内的剖腹器械的那些部分的大小常规上是非常均匀的，从而容易引入导管和从导管中取出，但是在将要被引入体腔内的器械的直径比通常情况大很多或小很多时，或特别当要在体腔内切割组织块和通过导管将组织块取出而不显著损失体腔内压力时，会出现问题。特别在后一种情况下，组织取样不容易配合提供的气密，在这种情况下，实际上不得不费力地将组织取样切割成小片以便能够顺利地将它们取出。如果要用力取出大组织取样，那么就可能损坏密封机构，导致体腔内压力损失，容易可预测到会发生医疗问题。
因此需要提供一种剖腹接入装置，该装置能够维持密封防止气体从体腔内逸出，能够使大的组织取样通过导管取出而不损坏压力密封，还能够适合进出导管的多种器械尺寸和结构。
发明简述
本人已经发现，合适的气体密封可以采用通常为管状的柔性材料膜装在剖腹进入导管内而制成，导管一侧的膜张紧，导管内其余的膜保持松垂和松散。松垂膜部分的外表面与导管壁在导管和套管之间确定了一个可充气的腔，套管内表面确定了一个导通导管的通道。该套管的远端和近端连接靠近其远端和近端的导管。
位于导管一侧的柔性套管的张紧结构、以及导管别处的松散和松垂性和套管端部与导管之间的密封能够使套管的松垂部分容易朝导管壁变形，而不会出现断裂或撕裂，从而允许大物体如进行剖腹外科手术的体腔内的组织标本通过该通道。该装置包括一个气体口，该气体口安置成能够使体腔内压力下的气体进入套管和导管之间的腔内，从而使套管被压扁并密封套管确定的通道。
在其密封结构中，套管成为迅速让剖腹器械通过导管进入体腔内的通道，该套管被压扁并配合器械保持气密。当通过导管取出大的组织标本时，套管同样在组织标本周围被压扁，因此在取出标本时套管内的通道扩大以接受该标本，当标本通过时套管在标本下面面向自身变扁，从而保持气密。
因此，在一个实施例中，本发明提供了一种能够从外科手术部位取出组织或其它碎屑的剖腹接入装置。该装置包括一个具有纵轴的导管。一个具有远端和近端的柔性套管安装在导管内，该套管形成让剖腹外科手术器械通过的内部通道。该套管沿导管一侧轴向拉紧，套管还有一个在导管中其它地方的确定导管和套管之间的可充气腔体的松散和松垂部分。该装置包括一个气体口，它设置成使处于压力下的气体进入靠近套管远端的腔体内，从而使套管被压扁并密封该通道。
附图简述
图1是本发明的装置的透视图；
图2是用于图1的装置中的一个柔性套管的透视图；
图3是图2中套管的透视图，表示该套管的松散、松垂性；
图4是本发明装置的拆开后的横剖视图；
图5是本发明的装置拆开后的侧视图，表示一个气体进入口；
图6是类似图5的图，但是表示一个不同的气体进入口；
图7是一装置拆开后的横剖视图，表示一种改进的气体进入口；
图8是沿图4中线8-8剖开的横剖视图，表示处于张开结构的柔性套管；
图9是类似图8的视图，但是表示柔性套管处于密封结构；
图10是类似图8和9的图，但是表示在剖腹器械轴周围处于密封、被压扁位置的柔性套管；
图11是部分横剖之后的分解图，表示通过该装置取出组织标本的步骤，并且还表示一种供气系统；
图12是类似图11的图，表示取出组织过程的另一个步骤；及
图13是图1中13表示的结构的横剖分解视图。
最佳实施例的简述
首先参见图1，本发明的剖腹接入装置一般用附图标记10表示，它包括一个细长的导管12，该导管要求是刚性的，可以用任何适当的材料如金属或塑料材料制成。导管的外部或远端可以安装一个用于使剖腹工具容易由外科医生从体腔外引入导管的杯形或漏斗形的入口部分14。图1中表示的一种典型的剖腹工具是一个镊子16，该镊子有几个爪18，图中表示这些爪夹住一个有待通过该导管取出的放大的组织标本“T”。如图示，该组织标本接近导管12的尺寸。
该导管12可最好地表示在图4中。该导管是一个管，它通常由刚性塑料如聚乙烯、聚碳酸酯或聚砜制成。所示漏斗形部分14安装在导管顶部(近端)，仅用于把剖腹工具引入该导管。导管内是一个通常设计为管状的柔性套管20，该套管的近端22在该导管的近端口24上被对折。在所述的实施例中，漏斗形部分14有一个紧密配合在套管20对折部分上的较低的、大体为圆柱形的颈部26，从而将套管的近端固定在导管的近端。如果必要可以提供粘合剂或胶粘剂，以便将套管的圆柱形颈部26和对折部分固定在导管的近端。
参照图2，一部分套管的近端22与其长度大致成直角，但是其底部或远端28与其长度成锐角，例如与外鞘的长度成约40度的角度。当外鞘的远端28被抬高，以致与外鞘的长度基本成直角时，如图3所示，外鞘本身变得松散和松垂。
外鞘远端28同样绕导管远端口对折，如图4所示，在那里通过任何适当的装置连接导管，在附图中表示的典型装置是一个环绕周围的塑料带30。粘合剂可以用来代替塑料带，或者与塑料带结合，将外鞘远端沿周边固定于导管的远端。外鞘远端与导管最佳连接的细节表示在图13中。导管远端以直径减少的短段15终止，并接纳外鞘的对折部分。带30被接纳在外鞘的对折部分上，带的外径等于靠近段30的导管的外径。这样，导管和带作为一个装置提供了一个等直径光滑外表面，以使导管通过组织壁被接纳和进入体腔。
外鞘20由非常柔软的材料制成，聚氨酯膜有良好的效果。在该最佳实施例中，该膜是弹性的，尽管也可以使用非弹性膜。不论怎样，该膜都要足够柔软，以便迅速和它将要接触的固体的形状保持一致。外鞘20本身限定了一个在导管内延伸的通道32，面对通道的外鞘内表面是光滑的。可以通过挑选原本十分光滑的外鞘材料或通过用一种提供光滑性的材料处理该外鞘内表面来获得光滑性。例如，该外鞘可以是粘合有碳氟聚合物如聚合物(四氟乙烯)薄膜的聚氨酯，或者该外鞘也可以涂敷亲水材料，该材料在湿润时变得很光滑。如果必要，可以在外鞘内表面提供润滑剂如生物兼容的细粉或润滑液如胶状物来增加其光滑性。
要求外鞘的外径稍微大于导管的内径，这与上述套管的松垂性结合，导致套管在导管内保持如图4所示的松垂结构。尽管可以通过上述方法获得松垂性，但是也可以使用其它方法获得松垂性。例如，该套管可以形成在一个心轴周围，用于提供所要求的松垂结构。作为另一例，该套管在成形之后可以只在一定的区域内伸长，从而提供所要求的结构，在这种情况下该套管必须是可伸长的，但是不一定是弹性的，以致于它能够保持其伸出结构。
最好如图4所示，套管34一侧在其与该导管的连接部之间拉紧。外鞘的该侧是图2中所示的短侧。这里所用的“拉紧”反映的事实是外鞘一侧34并没有松松地垂入导管内部，而是保持位于或相当靠近导管该侧壁的一个位置。导管部分34实际上不必很紧或处于轴向张力下。如果必要，外鞘侧34实际上可以通过如焊接或使用粘合剂而与对面导管的表面相连。
在图4中将注意到，外鞘20的松垂部分与对面导管的壁确定了一个可充气的腔36。设置一个气体口，用来使来自体腔内的气体进入可充气空间36，使外鞘朝内压扁。在图4和5中示出有一个适当的口38，该口穿过靠近导管远端的导管壁厚；即刚好高于带30。可以使用各种气体入口。图6表示一个形成在导管远端40内的大体为U形的缝42，该缝非常靠近带30延伸，从而使其近的部分对来自体腔的气体敞开。在图7中，外鞘的远端部分2 8设置有轴向延伸的数个切口或缝44，这些缝形成数个能够使气体通过和进入腔36的口。如果必要，外鞘远端可以绕其周边切口或开槽，以便形成多个向远处延伸的指46，每个指固定在靠近其远端的导管上。
图8是沿图4中线8-8的横剖视图，表示处于松松地限定通道32的处于张开位置的外鞘20。一旦导管伸展，其远端部位于受压体腔内，处于压力下的气体通过气体口38被接纳以充入腔36内，引起导管内壁彼此被压扁，从而密封通道32。该结构表示在图9中。如果剖腹器械的轴例如图1、11和12所示的镊子延伸通过通道32，那么外鞘内壁如图10所示绕轴被压扁，再次密封通道32。由于外鞘内表面十分光滑，如上所述，在剖腹外科手术期间推动剖腹工具靠近或远离鞘膜或在外鞘内进行其它必要操作时能够维持气密。能够理解，外鞘足够松垂，足以能够在腔36充气时使外鞘朝导管中央完全被压扁，从而密封该通道32。
图11和12表示通过本发明的接入装置取出大的组织标本T过程的几个步骤。在图11中，所示导管12处于正常位置，其中其远端位于体腔内，其近端延伸到体腔以外。为了便于显示，代表体腔壁的一层皮肤和肌肉在图11中一般由S表示。进入导管通过该壁的放置涉及削尖的固体套针(未示出)的使用，该套针的向远处突出的削尖端被插入通道32中。体腔通过适当的针和气体输送管以公知的方式充气，套针携带导管的远端刺穿皮肤和肌肉层S。套针(未示出)接着被取出，如上所述，外鞘如图9中那样被压扁，从而密封通道32。
如果必要，导管可以设置有气体输送系统，如图11中48所示，它包括一个与靠近其近端的连通导管的有阀气体管道50。在该导管中，周边肩部52从导管壁稍微向内延伸，从而确定一条周边气体通道54，肩部限制外鞘朝外面向该位置的导管壁塌陷。来自输送管道的气体因此可以向远处流到可充气的腔体36内，从而通过气体口38进入体腔内。气体管道50还可以用于在通过该导管取出非常大的组织切片时降低可充气腔近端的压力，还可以用于在一个外科手术过程中适合于这么做时降低体腔的压力。
在图11和12中，套管表示为可以沿顺时针方向从图4、8、9和10所示的位置转动90度。在图11中，作为剖腹外科手术过程的一部分，已从体腔内的身体上切下大的组织取样T，并用镊子的几个爪18夹住。该组织取样现在必须由镊子就近通过通道32取出，同时不会显著损失体腔内的压力气体。在图11中，将可以看见由于导管壁和外鞘之间的空间36充气，外鞘的内壁已经向镊子的轴46塌陷。由于镊子就近取出，外鞘的壁按要求屈服，接纳和包进组织取样T，如图12所示，因此当组织取样就近通过通道32前进时，外鞘的壁远远地在组织取样的后面闭合，从而维持气体密封。
尽管已经表示和描述了本发明的几种形式，但是其它形式对本领域的普通技术人员而言也是显而易见的。附图所示和上述的实施例只用于说明，并不打算限制本发明的范围，本发明的范围由所附的权利要求书确定。

Claims (12)

1.能够从外科手术位置取出组织或其它碎屑的剖腹接入装置，其包括一个具有纵轴的导管，一个具有远端和近端并安装在导管内的柔性套管，该套管形成一个可以让剖腹外科手术器械通过的内部通道，该套管安装成沿导管一侧有轴向张紧，并且有一个限定导管和套管之间的可充气腔的松散、松垂部分，该装置包括一个安置用于使压力下的气体进入靠近所述远端的腔的气体口，从而使所述套管被压扁而密封所述通道。
2.如权利要求1所述的装置，其特征在于，设有轴向张紧的套管部分依附于该导管上。
3.如权利要求1所述的装置，其特征在于，外鞘近端绕其周边密封于靠近其近端的导管周边。
4.如权利要求1或3所述的装置，其特征在于，外鞘远端安装于靠近其远端的导管周边。
5.如权利要求4所述的装置，其特征在于，所述口包括一个靠近导管远端的穿过所述导管的孔。
6.如权利要求4所述的装置，其特征在于，所述口包括一个靠近导管远端的穿过所述外鞘的孔。
7.如权利要求1所述的装置，其特征在于，所述外鞘由非弹性材料制成。
8.如权利要求1所述的装置，其特征在于，所述外鞘由一种弹性材料制成。
9.如权利要求1所述的装置，其特征在于，所述外鞘有一个内表面面对该通道，并包括一个由所述内表面携带的光滑涂层。
10.如权利要求9所述的装置，其特征在于，所述光滑涂层是润滑液。
11.如权利要求9所述的装置，其特征在于，所述光滑涂层是润滑粉。
12.如权利要求9所述的装置，其特征在于，所述光滑涂层包括一种碳氟化合物聚合物膜。
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CN102258389A (zh) * 2011-05-18 2011-11-30 中国人民解放军第三军医大学第二附属医院 穿刺活检鞘
CN102258389B (zh) * 2011-05-18 2013-04-03 中国人民解放军第三军医大学第二附属医院 穿刺活检鞘
CN111936091A (zh) * 2017-10-18 2020-11-13 J·莫雷诺 眼科显微外科手术器械
CN111936091B (zh) * 2017-10-18 2023-06-06 新眸股份有限公司 眼科显微外科手术器械
CN112472877A (zh) * 2020-12-18 2021-03-12 南京鼓楼医院 用于医疗导管的润滑油灌注的超滑多孔表面的制备方法
CN112472877B (zh) * 2020-12-18 2022-03-08 南京鼓楼医院 用于医疗导管的润滑油灌注的超滑多孔表面的制备方法

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EP1248572B1 (en) 2005-11-23
ES2254440T3 (es) 2006-06-16
AU774922B2 (en) 2004-07-15
AU2956201A (en) 2001-07-31
JP2003520098A (ja) 2003-07-02
DE60115198D1 (de) 2005-12-29
CN1190170C (zh) 2005-02-23
MXPA02006985A (es) 2004-09-06
CA2397118A1 (en) 2001-07-26
CA2397118C (en) 2009-04-14
WO2001052754A1 (en) 2001-07-26
EP1248572A1 (en) 2002-10-16
JP4485110B2 (ja) 2010-06-16
US6447489B1 (en) 2002-09-10

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