CN1331441C - 创口牵引器 - Google Patents

创口牵引器 Download PDF

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CN1331441C
CN1331441C CNB2004100768582A CN200410076858A CN1331441C CN 1331441 C CN1331441 C CN 1331441C CN B2004100768582 A CNB2004100768582 A CN B2004100768582A CN 200410076858 A CN200410076858 A CN 200410076858A CN 1331441 C CN1331441 C CN 1331441C
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sleeve
traction apparatus
wound
ring portion
outer portion
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CN1615802A (zh
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弗兰克·博纳迪奥
约翰·巴特勒
德里克·威廉·扬
阿兰·雷德
奥伊比安·吉尔
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Atropos Ltd
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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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
    • 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
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    • A61B17/3421—Cannulas
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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    • A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • A61B2017/0225—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
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    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
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    • 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
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    • A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body

Abstract

一种用于牵开创口(103)边缘的牵引器(101)包括一个连接在圆筒形套筒(106)远端的内侧固定O形圈(105)和一个连接在套筒(106)近端的加强O形圈(109)。套筒(106)被引导在内环部(110)与位于外环部(110)上的相应凹槽(116)之间。外环部(110)上带有紧固结构(120)，套筒(106)的近端可以附着在紧固结构上，以固定套筒(106)。为了牵开创口(103)，套筒(106)被拉动，同时导向圈(110，111)抵靠着创口(103)周围的组织移动。这样可以将O形圈(105)拉紧到创口(103)附近的组织内侧，并将创口(103)牵开。套筒(106)被局部调节，以使牵拉效率最大化。

Description

创口牵引器
本申请是申请日为2000年10月16日、申请号为00814005.7、发明名称为“创口牵引器”的发明专利申请的分案申请。
技术领域
本发明涉及一种牵引器。具体地讲，本发明涉及这样一种牵引器，其用于牵开切口或人体天然开口的边缘，以将器官或身体结构最大限度地暴露出来，以便在外科手术过程中实施检验和/或进入人体，并且同时保护切开组织的暴露侧。
背景技术
现已知有各式各样的牵引器。然而，现有的牵引器通常难以且不便使用，和/或是相对昂贵的。此外，现有的牵引器局限于用在特定的切口尺寸和特定的患者解剖组织上。
本发明的目的是提供一种改进的创口牵引器，其能够至少部分地解决这些问题，此外，还要提供一种在手术过程中保护创口的方法。
发明内容
根据本发明，提供了一种外科创口牵引器，其包括：
一个远端固定件，其用于插入创口中；
一个套筒，其具有一个内侧创口贴合部分和一个外侧部分，套筒具有一个使内侧创口贴合部分缩减了径向尺寸的插入形态和一个牵开形态；
一个外部导向件，其用于引导套筒的外侧部分；
所述外部导向件包括一个环形件，所述环形件包括内环部和外环部，套筒被引导在这二者之间；
所述外部导向件可以相对于套筒移动，以缩短套筒的轴向延展距离，并因此而将套筒的创口贴合部分推向牵开形态，从而将创口横向牵开。
在本发明的一个优选实施例中，套筒包括一个大致圆筒形的套筒。
在一个优选实施例中，外环部包含用于固定套筒的紧固件。在一种结构中，紧固件包括位于外环部上的紧固结构，在牵开创口时，套筒附着在紧固结构上。
优选的结构是，内环部上设有一个凸块，用于安置在外环部上的一个互补凹槽中，而套筒位于它们之间。
在一个实施例中，内环部相对松弛地配合在外环部的凹槽中。
优选的结构是，所述环部之一上的至少一部分可以从一个基本上将套筒夹持在所述环部之间的静止位置移动到一个使套筒的至少一部分能够相对于所述环部移动的释放位置。理想的结构是，在释放位置，套筒上只有一部分能够相对于所述环部移动。
在另一个实施例中，内环部相对紧密地配合在外环部中，以将套简抓持在它们之间。
在本发明的一个方面，外环部包括互连段，它们可以独立移动，从而便于局部释放套筒，以调节施加在创口上的牵拉力。环部或互连段优选可以在夹持静止位置与释放位置之间手工操纵。
在本发明的一个优选实施例中，套筒包含一个近端加强件，用于与外部固定件咬合。理想的结构是，近端加强件是一个近端环。
优选的结构是，远端固定件由弹性材料制成。通常，远端固定件是O形圈。
优选的结构是，至少导向件上的与套筒咬合的外表面是由低摩擦率的材料例如聚四氟乙烯制成的。
在一个特别优选的实施例中，牵引器包含一个用于将其它装置安装到牵引器上的平台。
在一个尤其优选的实施例中，所述环部之一形成了一个用于将其它装置安装到牵引器上的平台。
附图说明
通过下面参照附图而只以示例的方式所作描述，可以更清楚地理解本发明，在附图中：
图1是一种根据本发明的创口牵引器的分解图；
图2是图1中的牵引器组装后的透视图；
图3是图2中的组装牵引器的侧向剖视图；
图4是一个未牵开的创口的透视图；
图5是将图2中的牵引器的一部分插入创口中时的透视图；
图6是图2中的牵引器在插入后的侧向剖视图；
图7是图2中的牵引器在插入后的俯视图；
图8(a)和8(b)是利用图2中的牵引器横向牵开创口时的侧向剖视图；
图9是图2中的牵引器在横向牵开创口后的侧向剖视图；
图10是图2中的牵引器在横向牵开创口后的俯视图；
图11是图2中的牵引器的导向件一部分的俯视图；
图12是图11中的部分的侧视图；
图13是沿着图11中的剖线A-A所作的剖视图；
图14是另一种根据本发明的牵引器的剖视图；
图15是图14中的牵引器在使用时的剖视图；
图16是另一种根据本发明的牵引器的各部分的分解图；
图17是图16中的牵引器组装后的透视图；
图18和19是图17中的牵引器处于不同位置时的剖开透视图；
图20是图17至19中的牵引器的一部分在操作时的示意性俯视图；
图21是处于图20中的形态下的牵引器部分的侧向剖视图；
图22是牵引器部分处于释放位置时的示意性俯视图；
图23是处于图22中的形态下的牵引器部分的侧向剖视图；
图24是用于与根据本发明的创口牵引器一起使用的手部进入装置的透视图；
图25是图2中的牵引器在图24中的手部进入装置就位后的侧向剖视图；
图26是用于与根据本发明的创口牵引器一起使用的帷帘的透视图；
图27是图2中的牵引器在图24中的帷帘就位后的侧向剖视图；
图28(a)是用于与根据本发明的创口牵引器一起使用的形状限定装置处于柔顺状态时的透视图；
图28(b)是图28(a)中的形状限定装置处于固化状态时的透视图；
图29是图2中的牵引器在图28(b)中的固化形状限定装置就位后的侧向剖视图；
图30是图28中的形状限定装置和一个夹持器的分解图；
图31是图28中的形状限定装置和图30中的夹持器的侧视图；
图32是图2中的牵引器在图28中的形状限定装置和图30中的夹持器就位后的侧向剖视图。
具体实施方式
参看图1至13，图中示出了一种根据本发明的创口牵引器101，其在图示的例子中用于牵开创口例如图4所示的腹部创口103的边缘。
牵引器101包括：一个远端固定件，其在本例中采用的是弹性内侧O形圈105的形式，用于插入到创口103中；以及一个连接件，其在本例中采用的是大致圆筒形的弹力套筒106的形式。套筒106具有一个内侧创口贴合部分和一个外侧部分，内侧创口贴合部分连接在O形圈105上。套筒具有一种插入形态，此时内侧创口贴合部分缩减了径向尺寸，以及一种牵开形态，此时创口103被横向牵开。
套筒106上设有一个外部导向件，在本例中外部导向件包括一个内环部110和一个外环部111，套筒106被引导在这两个部分之间。牵引器101包含外部固定件，用于固定套筒106，以保持创
103牵开，在本例中固定件由位于外环部111外表面上的多个紧固结构120提供出来(图2)，紧固结构120径向向外伸出，以形成钩子。
外环部111具有与内环部110相同的环形形状，但直径更大并且带有一个凹槽116。内环部110由相对坚硬的材料制成，并且在凹槽116中与外环部111相匹配，以将套筒106可滑动地限制在二者之间，如图3所示。在本例中，环部110、111是相对松弛配合的，以便于环部110、111相对于套筒106移动，从而缩短套筒106的轴向延展距离，并因此而将创口贴合部分推向牵开形态，以将创口103横向牵开。
环部110、111是由低摩擦率的材料如聚四氟乙烯(PTFE)制成的。PTFE是一种结实的非弹性材料，其具有适宜的抗拉强度和优异的润滑性。
牵引器101还包含一个近端加强件，用于与紧固结构120咬合，在本例中加强件由弹性外侧O形圈109提供出来，它是由相对于O形圈05而言柔软的材料制成的。外侧O形圈109连接在套筒106的近端，O形圈105、109有助于使套筒106在其末端保持张开形状(图2)。
在使用时，O形圈105和套筒106被挤压成插入形态，以便将O形圈105插入创口103中(图5)。O形圈105由聚合材料制成，以便于将O形圈105压紧成小轮廓的细长形状，如图5所示，从而便于使用。在O形圈105被释放后，弹性O形圈105将返回其常态下的O形并搭在创口103的内边缘上，以将牵引器101安全地固定在创口中，如图6所示。从图6和7中可以看到，在将O形圈105插入后，创口103是基本上闭合的，而套筒106处于褶皱压缩形态。
之后，在将环部110、111推压在创口103周围组织上的同时，套筒106被拉动，如图8(a)所示，以缩短套筒106的轴向延展距离，并因此而将创口贴合部分推向牵开形态，从而将创口103的右侧(从图8(a)中看)横向牵拉。外侧O形圈109的右侧被钩挂在紧固结构120上，以保持创口103的右侧牵开(图8(b))。之后，在推压环部110、111的同时，套筒106的左侧被拉动，以将创口103的左侧牵拉，如图8(b)所示。外侧O形圈109的左侧再被钩挂在紧固结构120上，以保持创口103完全牵开，如图9和10所示。
彼此分开的紧固结构120和创口牵引器101的形态一般可以使得套筒106能够容易地局部操作，如图8(a)和图8(b)所示，从而提供出最优化的牵拉力。因此，通过拉动套筒106并将外侧O形圈10局部钩挂在适宜的紧固结构120上，操作不再仅仅局限于单一的竖直轴向，而是可以在多个不同方向上实施。通过这种方式，牵引器可以适合于特定的应用场合。
用于将套筒106可滑动地限制在内环部110上的凹槽116是C形的，其带有一个伸出的上唇缘117，如图13所示。不论拉动方向或施加到套筒106上的拉力如何，上唇缘117均会将内环部110安全地保持在凹槽116中。优选沿着非竖直方向拉动套筒106和实施局部钩挂外侧O形圈109，而伸出的上唇缘117有助于套筒106的非竖直方向拉动。
弹力套筒106衬套在牵开创口103的侧面上，如图9所示，从而同时用作创口牵开和创口保护件。
这种手术用创口牵引器具有简单的结构，它容易使用，并且可以以低成本制造，从而提供出一种一次性的装置。
根据本发明的简单的创口牵引器可以用于大范围的切口尺寸，并且可以获得一系列不同的局部化牵拉力，以适应于切口、患者解剖组织和将要实施的手术过程的需要。
在图1至10所示的牵引器中，套筒106相对紧密地配合在内外环部110、111之间。然而也可以这样构造内外环部110、111，即内环部110相对更松弛地配合在外环部111中。在这种情况下，导向件包括外环部或其它环形形状，而一个第二元件滑动在其内侧。第二元件具有与外环部相同的环形形状和较小的直径，并且带有一个外部容纳凹槽，该凹槽被设计得能够使外环部松配合在第二元件上，而且二者可以容易地彼此相对滑动。所述元件松配合在一起，以使弹力套筒能够装配在它们之间的间隙中并在此滑动。这种结构显示于图14和15中。在如图15所示地拉动套筒106的局部区域时，内环部106移向适宜的一侧，以将套筒106夹紧在相反侧上，并同时允许对套筒上的抓持段进行操作，从而在将套筒固定在该侧之前使抓持侧的局部牵拉力最优化。这个过程可在套筒106的另一侧局部区域上重复进行。
参看图16至23，图中示出了另一种根据本发明的创口牵引器150，其类似于前面参照图1至13所描述的创口牵引器101，并且在图16至23中以相同的附图标记表示类似的部分。
在本例中，导向件包括内环部110和PTFE外环部151，二者被这样构造，即外环部151在沿外环部151圆周方向相隔的多个离散点上咬合内环部110，以将套筒106在每个离散点处夹持在内外环部110、151之间。外环部151包括沿外环部151圆周方向相隔的多个互连段155，它们按压在内环部110上，以夹持套筒106，并且可以独立移动，以便于局部释放套筒106，用以调节牵拉力。切出的T形槽156设在外环部151的段155与主体158之间，把手160在各个段155之间从外环部151的主体158上径向向外伸出。
在使用时，相邻的把手160被人用手抓住，如图20所示，以便沿箭头A的方向施加释放力，从而将局部的段155沿箭头B的方向从夹持着套筒106的静止位置(图20和21)拉向释放位置(图22和23)，在后一位置，套筒106容易被局部拉动和操纵。通过释放内环部110与段155之间的夹持，弹力套筒106容易从一个位置滑向另一个。这种结构带来的特别益处是，便于局部调节牵拉力。
一般而言，根据本发明的创口牵引器150是这样使用的，即将O形圈105插入创口103中，再拉动套筒106，以使内侧O形圈105平坦抵靠在内部组织表面上。内侧O形圈105将牵引器150固定在创口中，并且防止弹力套筒106从创口103中脱出。之后，通过挤压把手160而将导向件释放，再将环部110、151在弹力套筒10上向下滑动，直至接触到外侧组织表面。通过拉动套筒106以缩短内侧O形圈105与环部110、151之间的距离，并因此而使弹力套筒106与创口103的边缘一起横向移动，可以实现牵开。通过松开外环部151的把手160以将套筒10夹持住，弹力套筒106被固定，从而保持创口103牵开。
根据本发明的创口牵引器还提供出了一个平台，其上可以安装各式各样的辅助装置。在一个实例中，平台由内环部110上的内侧凸出部分提供出来，一个带有互补凹槽172的环部171可以以有些类似于卡扣咬合的方式容易地装配到内侧凸出部分上。多种辅助装置上可以设有这种环部171，例如如图24和25所示，辅助装置可以是用于腹腔镜手术中的手部进入装置175。或者，辅助装置可以是帷帘180(图26和27)或者形状限定装置185，后者被调节为例如需要被握住的器官187的形状，再沿着排气管186将空气排出，以限定住理想的器官保持形态(图28和29)。
或者，平台也可以通过一个夹持器200提供出来，如图30至32所示。夹持器200包括一个上钳爪201、一个下钳爪202、一个卡子203和一个臂204。
夹持器200是这样组装的，即将卡子203拧紧在下钳爪202的底座上，在下钳爪202上滑动上钳爪201，以将阳凸出部分208咬合在相应的阴凹槽209中，并将臂204穿过上下钳爪201、202之间的开口207。多个齿205设在臂204上，这些齿205被构造成这样的尺寸，即当臂204位于开口207中时，这些齿能够向上伸入一个位于上钳爪201中的凹槽206中。如图31中更清楚地显示，这些齿205被这样成形，即臂204可以以棘齿式的结构从开口207中拉回，但不能再向前推进。弹簧钢是一种适宜制作夹持器元件201、202、203、204的材料。
多种装置可以附加在臂204的自由端上，例如形状限定装置185，如图30所示。在使用时，卡子203借助于卡配结构而牢固地固定在创口牵引器101上，而形状限定装置185插入创口103中，如图32所示。之后，形状限定装置185在创口103中横向作棘齿运动，以将例如体内器官220拉出。夹持器200的棘齿结构和形状限定装置185的刚度可以确保将体内器官220牢固地保持在理想位置上。
可以理解，根据本发明的创口牵引器的任一实施例均可以用作平台，其上可以安装其它用于各种手术过程的装置。这些装置可以包括：用于覆盖切口部位或开口的覆盖装置；导致手术过程从开放式过程转变成手部辅助的腹腔镜手术过程的手部进入装置；用于插入仪器的仪器入口；用于腹腔镜手术的套针；用于辅助将体内结构从操作区移开的体内器官牵引器；或者用于向手术室灯光不能照到的区域提供照明的照明装置。对于本领域的普通技术人员而言显而易见的是，这些附加装置并不局限于上面简要列出的那些。
创口牵引器可以构造成其它形式的环形。例如，连接在弹力套筒上的远端和近端圈可以是卵形或椭圆形的，而非圆形的。
牵引器可以用于牵开和保护人体天然开口如肛门或阴道，或者可以用于牵开和保护例如在气管切开术中产生的或在肠胃手术之后产生的人工开口的边缘。
本发明并不局限于上面描述的实施例，它们可以在结构和细节上作出改变。

Claims (19)

1.一种外科创口牵引器，包括：
一个远端固定件，其用于插入创口中；
一个套筒，其具有一个内侧创口贴合部分和一个外侧部分，所述套筒具有一个使内侧创口贴合部分缩减了径向尺寸的插入形态和一个牵开形态；
一个外部导向件，其用于引导套筒的外侧部分；
其特征在于，所述外部导向件包括一个环形件，所述环形件包括内环部和外环部，套筒被引导在这二者之间；
所述外部导向件可以相对于套筒移动，以缩短套筒的轴向延展距离，并因此而将套筒的创口贴合部分推向牵开形态，从而将创口横向牵开。
2.如权利要求1所述的牵引器，其特征在于，套筒包括一个圆筒形的套筒。
3.如权利要求1或2所述的牵引器，其特征在于，外环部包含用于固定套筒的外部紧固件。
4.如权利要求3所述的牵引器，其特征在于，外部紧固件包括位于外环部上的紧固结构，在牵开创口时，套筒附着在紧固结构上。
5.如权利要求1或2所述的牵引器，其特征在于，内环部上设有一个凸块，用于安置在外环部上的一个互补凹槽中，而套筒位于它们之间。
6.如权利要求5所述的牵引器，其特征在于，内环部相对松弛地配合在外环部的凹槽中。
7.如权利要求1或2所述的牵引器，其特征在于，所述环部之一上的至少一部分可以从一个将套筒夹持在所述环部之间的静止位置移动到一个使套筒的至少一部分能够相对于所述环部移动的释放位置。
8.如权利要求7所述的牵引器，其特征在于，在释放位置，套筒上只有一部分能够相对于所述环部移动。
9.如权利要求1或2所述的牵引器，其特征在于，内环部相对紧密地配合在外环部中，以将套筒抓持在它们之间。
10.如权利要求1或2所述的牵引器，其特征在于，外环部包括互连段，它们可以独立移动，从而便于局部释放套筒，以调节施加在创口上的牵拉力。
11.如权利要求10所述的牵引器，其特征在于，其环部或互连段可以在夹持静止位置与释放位置之间手工操纵。
12.如权利要求1或2所述的牵引器，其特征在于，套筒包含一个近端加强件，用于与外部固定件咬合。
13.如权利要求12所述的牵引器，其特征在于，近端加强件是一个近端环。
14.如权利要求1或2所述的牵引器，其特征在于，远端固定件由弹性材料制成。
15.如权利要求1或2所述的牵引器，其特征在于，远端固定件是O形圈。
16.如权利要求1或2所述的牵引器，其特征在于，至少导向件上的与套筒咬合的外表面是由低摩擦率的材料制成的。
17.如权利要求16所述的牵引器，其特征在于，至少导向件的外表面是由聚四氟乙烯制成的。
18.如权利要求1或2所述的牵引器，包含一个用于将其它装置安装到牵引器上的平台。
19.如权利要求1或2所述的牵引器，其特征在于，所述环部之一形成了一个用于将其它装置安装到牵引器上的平台。
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