CN217987637U - Stitching instrument - Google Patents

Abstract

The utility model provides a stitching instrument, which comprises a nail bin mechanism, a nail anvil mechanism and a transmission mechanism, wherein penetrating grooves extending along the length direction of an actuating mechanism are arranged on a nail bin cover, a nail bin seat and a nail anvil block, and the penetrating grooves form openings at the far ends of the nail bin cover, the nail bin seat and the nail anvil block; guide grooves extending along the length direction of the actuating mechanism are further arranged on the nail bin cover and the nail anvil block on two sides of the penetrating groove; the stitching nails in the nail bin mechanism are arranged on two sides of the penetrating groove in a row and are positioned between the penetrating groove and the guide groove, and the two nail pushing mechanisms are pushed to move on two sides of the penetrating groove respectively and fire the stitching nails. The utility model discloses set up and penetrated the groove, the identical tissue broken end can be followed the opening and drawn the entering and penetrated the groove, then can turn up the tiling with two broken ends to both sides, and the counterpoint is sewed up again, realizes turning up through the apparatus that the intracavity is sewed up.

Description

Stitching instrument

Technical Field

The utility model relates to the field of medical equipment, a be used for stitching up ware is related to.

Background

Due to the development of modern science and technology, a cutting anastomat replacing the traditional manual suture is produced; the cutting anastomat has the advantages of rapid and reliable anastomosis, few postoperative complications and the like. The working principle of the stapler is similar to that of a stapler, namely, a process of performing anastomotic cutting on tissues and organs by using titanium nails and a blade respectively. The existing cutting anastomat is mainly used for cutting and anastomosing skin, alimentary canal, blood vessel, lung and the like, and can be suitable for laparoscope and open surgery. The restoration and reconstruction of many lumen-like internal structures (such as urinary tract: including urethra, urinary bladder urethra, uretero bladder, ureter; intestinal tract, blood vessel, etc.) currently relies clinically mainly on manual tape-and-wire anastomosis and anastomosis using an intraluminal circular stapler or a plurality of linear cutting staplers.

The current intracavity stitching instrument which is clinically used is mainly suitable for the side stitching of the reconstruction of the alimentary canal, and a plurality of linear cutting stitching instruments or nail bins are required to be used. This type of stitching has at least three drawbacks: (1) The normal anatomical structure of a human body is changed, and the suture joint tissue necrosis, suture fistula and hemorrhage are easy to occur after the operation of the suture joint; (2) After suturing, when the contents in the tube cavity pass through the stoma, a 90-degree steering is formed in the tube cavity, so that the tube cavity is not smooth enough and is easy to cause obstruction; (3) Two or more sutures are required, which greatly increases the cost and difficulty of the operation. In addition, the existing intracavity cutting stitching instrument can not be used for stitching small cavities of biliary tract, fallopian tube, ureter, urethra and the like, or can only perform the function of closed cutting. The problems of the prior art will be described in detail below with reference to the accompanying drawings.

As shown in fig. 1, two sections of a lumen to be sutured are formed in the operation, and the end ends of the lumen are sutured together.

Referring to fig. 2, 3 and 5, a wound A1 is formed in a lumen at the right end, the stapler with the bent end portion in fig. 3 is extended into the lumen, an operating handle of the stapler is located outside the lumen, two broken ends of the lumen are pulled to a position between a circular nail anvil A8 and a circular nail bin A9, a nail pushing seat a11 is pushed to trigger anastomosis nails in a circular nail bin a10, the two broken ends of the lumen are nailed together, and redundant tissues are cut off by an annular blade A9, so that a circle of tissue A2 of the lumen which is subjected to the enstrophe suture is formed in fig. 2. The stapler is then removed from the lumen through the incision A1 and the incision A1 is closed using the stapler of fig. 5. This type of stitching has at least three drawbacks: (1) By adopting the inversion type anastomosis, the inversion suture lumen tissue A2 protruding out of the inner wall of the lumen is formed in the lumen, and a plurality of complications such as stenosis, obstruction and the like are easily caused after the operation. (2) A wound A1 needs to be cut on the lumen and needs to be anastomosed again, and the wound needs to be additionally cut due to the operation, so that the operation difficulty is increased, and unnecessary pain is also caused to a patient. (3) The use of multiple staplers greatly increases the cost of the procedure.

Referring to fig. 4 and 5, a second anastomosis method is to pull the lumen at the right end in fig. 1, place the two broken ends side by side, so that the outer walls of the two lumens are attached together, then use the linear anastomat shown in fig. 5 to anastomose the sides of the lumens attached together, that is, place the two lumen walls attached together between a nail bin A6 and a nail anvil A7, fire the anastomosis nail in the nail bin A6 to anastomose the lumen walls of the two lumens together, then open a stoma A3 at the anastomosed position, and finally anastomose the end portions of the two lumens by using the linear anastomat shown in fig. 5. The fistulization opening A3 is a communication opening of two sections of tube cavities. This type of anastomosis has at least three drawbacks: (1) Because the original trend of one section of the tube cavity needs to be changed, the tube cavity is pulled by external force, and the mode can cause damage to the tube cavity. (2) After anastomosis, the flowing contents in the lumen move through the stoma A3, a 90-degree turn is formed in the lumen, the flow is not smooth enough, and the blockage is easy. (3) Two or more anastomoses are required, greatly increasing the cost and difficulty of the operation.

Fig. 6 shows an outward-turning type suture mode, two broken ends are turned outwards, and a circle of outward-turning suture lumen tissue A5 is formed after the suture mode. However, in the current operation, the method is limited to manual suture, and a anastomat cannot be used. As can be explained by referring to fig. 3, if the broken ends of the two sections of lumens are respectively turned over on the circular anvil A8 and the circular nail bin A10 and then sutured, the stapler can not be taken down from the sutured lumen after suturing. In order to realize the outward turning type anastomosis of the anastomat, the invention patent with the application number of 201510282427X provides an extraluminal anastomosis method, and after a lumen is sutured, a scissors is used for cutting off the annular structures of a nail bin and a base, so that the nail bin and the base are removed. However, this method is only an idea and does not give detailed structural features, which cannot be clinically applied for at least four reasons: (1) The surgical space is very small and it is difficult to cut the ring structure by inserting a further scissors between the tissue and the anastomotic ring after the stapling. (2) When the annular structure is cut off by the scissors, external force needs to be applied, secondary damage can be caused to the lumen tissue if the operation is not proper, and even the lumen is pulled off. (3) The materials that scissors are prone to shearing damage are necessarily not rigid enough to create sufficient anastomotic traction force and are destructive to surgical scissors. (4) The anastomosis mode that the nail anvil ring is pulled to extrude the anastomosis nail towards the near end is adopted, and because the distal end can not be peened in the operation, the organ of the tissue is easy to tear.

Disclosure of Invention

The utility model aims to provide an actuating mechanism for turning up formula stitching instrument makes stitching instrument carry out the turning up formula such as intracavity end-end, end-side, side-side and sew up in the human body through microchannel such as sheath card.

The utility model provides a stitching instrument, which comprises a nail bin mechanism, a nail anvil mechanism, a transmission mechanism, a percussion control mechanism and a shell, wherein the percussion control mechanism is arranged on the shell, and the shell comprises a front half shell and a rear half shell; the nail bin mechanism comprises a nail bin cover and a nail bin seat, a nail pushing mechanism is arranged in a space between the nail bin cover and the nail bin seat, and the nail anvil mechanism comprises a nail anvil block; the transmission mechanism comprises a transmission mechanism elastic sheet;

the nail bin cover, the nail bin seat and the nail anvil block are respectively provided with a penetration groove extending along the length direction of the actuating mechanism, and the penetration groove forms an opening at the far end of the nail bin cover, the nail bin seat and the nail anvil block; on both sides of the penetrating groove, the nail bin cover and the nail anvil block are also provided with guide grooves extending along the length direction of the actuating mechanism; the suturing nails in the nail bin mechanism are arranged on two sides of the penetrating groove in rows and are positioned between the penetrating groove and the guide groove;

the drive mechanism elastic sheet comprises a drive mechanism elastic sheet A and a drive mechanism elastic sheet B, the far ends of the drive mechanism elastic sheet A and the drive mechanism elastic sheet B extend into a space between the nail bin cover and the nail bin seat, the nail pushing mechanism comprises a nail pushing mechanism A and a nail pushing mechanism B, and when the far ends of the drive mechanism elastic sheet A and the drive mechanism elastic sheet B move along the guide grooves on the nail bin cover and the nail bin seat, the nail pushing mechanism A and the nail pushing mechanism B are respectively pushed to move at two sides of the penetrating groove. The shell comprises a front half shell and a rear half shell, and the firing control mechanism is convenient to mount.

The important invention of the utility model lies in breaking through the design structure of the conventional linear suturing device, dividing the nail cabin mechanism and the nail anvil mechanism into two parts, and arranging the penetrating groove in the middle part, thereby the broken ends of two tissues to be sutured can be respectively pulled and penetrated from the penetrating groove of the nail cabin mechanism and the penetrating groove of the nail anvil mechanism, and then the broken ends of the tissues to be sutured are outwards turned, thus realizing end suturing, and after sewing, the broken ends are shifted out from the penetrating groove, so that the linear suturing device can also perform outward turning suturing. The utility model discloses a scheme design is exquisite, only needs to change the linear type stitching instrument of conventionality, can realize turning up and sew up.

Preferably, the guide groove comprises a first guide section at the proximal end, a second guide section at the distal end and a connecting section for connecting the first guide section and the second guide section, wherein the distance between the two first guide sections is smaller than the distance between the two second guide sections. At the near end, the transmission mechanism elastic piece A and the transmission mechanism elastic piece B are closer to each other, after the transmission mechanism elastic piece A and the transmission mechanism elastic piece B move towards the far end, the transmission mechanism elastic piece A and the transmission mechanism elastic piece B are far away from each other by utilizing the deformation capacity of the transmission elastic pieces, and the interference on the sewing nail and the like is avoided by the design mode of the second guide section. Meanwhile, the stitching nail can be arranged at the near end of the penetrating groove, the transmission elastic sheet is close to the near end, and the stitching nail can be fired along the connecting section at the near end.

Preferably, the proximal end of the penetrating groove of the nail bin seat is provided with a suturing nail, so that the two sides of the penetrating groove and the tissues to be sutured at the proximal end can be sutured, the sutured intestinal tissue is moved out of the penetrating groove, and then the intestinal tissue which is initially positioned at the distal end of the penetrating groove is sutured manually to complete the overall suturing.

Preferably, the guide grooves on both sides are arranged in parallel from the far end to the near end. At the moment, the suturing nails are distributed in parallel on two sides of the penetrating groove of the nail bin seat, the broken ends of the tissues to be sutured on two sides can be sutured through the executing mechanism, the sutured tissues are moved out of the penetrating groove, and then the tissues which are originally positioned at two ends of the penetrating groove are sutured through the manual operation to complete the whole suturing.

Preferably, the actuator near end is provided with a separation column for separating the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B. The separating column can ensure that the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B are always separated in parallel at the near end, and ensure that the two transmission mechanism elastic sheets cannot interfere with each other when the separating column is pushed forwards or turned. The separation column is narrow at the near end and wide at the far end, and can adopt a spindle shape or a half spindle shape.

Preferably, the staple cartridge seat is detachably arranged below the staple cartridge cover, so that the staple cartridge seat can be replaced by a new staple cartridge seat after the staples are used up, and the main structure of the actuating mechanism can be reused.

If the width of the nail bin cover and the width of the nail anvil block are relatively wide and the width of the nail bin seat is relatively narrow, the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B are respectively arranged at two sides of the nail bin seat and cannot interfere with the nail bin seat during movement, otherwise, a guide groove extending along the length direction of the actuating mechanism needs to be arranged on the nail bin seat.

Preferably, the distal ends of the transmission mechanism elastic sheet a and the transmission mechanism elastic sheet B are respectively connected with a sliding limiting block a and a sliding limiting block B with i-shaped cross sections, the upper ends and the lower ends of the sliding limiting block a and the sliding limiting block B are respectively inserted into the guide grooves on one side of the nail bin cover and the nail anvil seat, the top ends and the bottom ends of the i-shapes are respectively exposed out of the guide grooves on the nail bin cover and the nail anvil seat, and the i-shaped structure can ensure that the transmission mechanism elastic sheet moves along the guide grooves and avoids being separated from the guide grooves.

Preferably, the near ends of the nail pushing mechanism a and the nail pushing mechanism B are respectively provided with a connecting groove, and the connecting columns of the vertical parts of the sliding limiting block a and the sliding limiting block B can be respectively inserted into the connecting grooves of the nail pushing mechanism a and the nail pushing mechanism B, so that the transmission mechanism elastic sheet a and the transmission mechanism elastic sheet B can be detachably connected with the nail pushing mechanism a and the nail pushing mechanism B.

Preferably, the connecting groove is close to the outer side of the nail pushing mechanism, a balancing weight is arranged on the outer side of the nail pushing mechanism, the equal resistance and the balanced stress on two sides are guaranteed, the nail pushing is smooth, and the nail pushing mechanism cannot be biased.

Preferably, the lower ends of the connecting columns of the vertical parts of the sliding limiting block A and the sliding limiting block B are provided with cutting blades, and redundant tissues at the edges of the everted suture are cut off by the cutting blades.

Preferably, the openings of the staple cartridge cover, the staple cartridge seat and the staple anvil block are flaring openings with wide outer parts and narrow inner parts, and the structure is convenient for penetrating the tissue at the broken end to be sutured into the penetrating groove.

Preferably, the bottom of the nail anvil block is provided with a supporting plate, the supporting plate is also provided with a penetrating groove extending along the length direction of the actuating mechanism, and the near end of the supporting plate is provided with a protective plate.

Preferably, an elastic member is arranged at the joint of the nail anvil mechanism and the near end of the nail bin mechanism, the elastic member urges the nail bin mechanism and the nail anvil mechanism to be in an open state, and when the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B move towards the far ends, the nail bin mechanism and the nail anvil mechanism are urged to be closed.

Preferably, the nail bin cover and the nail anvil seat are inwards sunken, so that the size of the executing mechanism is reduced, and the sheath clamping is facilitated.

The utility model provides a brand-new intracavity turns up actuating mechanism for stitching instrument, the advantage as follows: (1) The structure can realize the intracavity eversion suture through minimally invasive surgery channels such as a sheath clamp and the like, is a powerful supplement to the open eversion suture, has completely different mechanism action principles although the eversion suture, and adapts to the requirements of clinical minimally invasive surgery; (2) The suture of tissues and organs (such as blood vessels, urinary tract and the like) which are required to be sutured by eversion of the suture in the prior minimally invasive surgery has a new choice, thereby greatly simplifying the surgery difficulty and improving the suture success rate; (3) The reconstruction target can be basically realized by one-time stitching, and compared with the condition that a plurality of stitching nails are used when a plurality of stitching nails are needed in the past, the operation steps and the operation cost are saved; (4) The outward turning type suture of end-end, end-side, side-side and the like in the cavity can be realized, and the suture scene is widely applicable; (5) Different from the traditional cutting suturing device, the suture instrument can be directly butted and sutured without changing the anatomical structure and continuity of tissues and organs or destroying the peristalsis function of hollow viscera and the like, is beneficial to the retention and recovery of the functions of the viscera of a patient after operation, and greatly reduces the occurrence of related complications; (6) The suturing nail is externally arranged and is positioned outside the cavity after being sutured, so that complications related to the suturing nail, such as narrow suturing opening, bleeding related to the suturing nail, calculus and thrombosis and the like, are reduced.

Drawings

FIG. 1 is a schematic view of two sections of a lumen to be anastomosed;

FIG. 2 is a schematic view of an inverted anastomosis;

FIG. 3 is a schematic view of an inverted anastomosis stapler;

FIG. 4 is a schematic view of a second lumen anastomosis;

FIG. 5 is a schematic view of a stapler for external anastomosis;

FIG. 6 is a schematic view of eversion anastomosis;

FIG. 7 is a schematic view of a stapler firing control mechanism;

fig. 8 is a schematic view of the actuator of the present invention;

FIG. 9 is a schematic view of the suture instrument of the present invention passing through a minimally invasive pathway;

fig. 10 is an exploded view of the actuator of the present invention;

FIG. 11 is a schematic view of the transmission mechanism and the steering mechanism of the present invention;

FIG. 12 is a schematic view of the nail anvil of the present invention;

FIG. 13 is a schematic view of the nail cartridge mechanism (including the open elastic sheet, the metal groove, the suturing nail, the nail snap, etc.) according to the present invention;

FIG. 14 is a schematic view of the transmission mechanism and the nail pushing mechanism of the present invention;

FIG. 15 is a schematic view of a two-section eversion suture;

FIG. 16 is a schematic view of a parallel guide slot on the anvil.

In the figure; 1-trigger control mechanism, 101-trigger, 102-ratchet bar, 103-propulsion rod, 104-reset button, 105-direction adjusting button, 106-steering propulsion rod, 107-trigger safety, 108-handle, 109-shell;

2-cannula, 201-upper half-tube, 202-lower half-tube;

3-stopper, 301-stopper a, 302-stopper B;

4-steering mechanism, 401-sheet metal rod, 402-hooked protrusion;

5-transmission mechanism, 501-connecting part, 5031-transmission mechanism elastic sheet a, 5032-transmission mechanism elastic sheet B, 5041-sliding limiting block a, 5042-sliding limiting block B, 5046-cutting blade, 5047-connecting column a, 5048-connecting column B;

6-a nail bin mechanism, 601-a connecting joint, 602-a first nail bin guiding section, 603-an anchoring mechanism, 604-an opening elastic sheet, 605-a nail bin cover penetrating groove, 606-a nail bin seat, 607-a second nail bin guiding section, 608-a nail bin scale mark, 609-a nail hole, 610-a nail, 611-a nail press, 612-a proximal end platform, 613-a nail bin cover flaring opening and 614-a nail bin connecting section; 615-flaring of a nail bin base, 616-penetrating of the nail bin base into a groove, 617-covering of the nail bin and 619-separation column;

7-an anvil mechanism, 701-a staple forming pit, 702-a guard plate, 703-an anvil connecting section, 704-a first anvil guide section, 705-an anvil penetrating groove, 706-a second anvil guide section, 707-an anvil flaring, 708-a supporting plate, 709-a supporting plate penetrating groove, 710-a staple anvil and 711-an anvil guide groove;

8-a nail pushing mechanism, 801-a connecting groove, 802-a nail pushing bulge, 803-a nail pushing mechanism A, 804-a nail pushing mechanism B; 9-sheath clamp; 1001-broken end A, 1002-first eversion part, 1003-second eversion part, 1101-broken end B, 1102-third eversion part and 1103-fourth eversion part.

Detailed Description

The technical solution of the present invention will be described in detail with reference to fig. 7-15.

For clarity of description, directional terminology is used in the drawings and the following description with respect to an operator's right hand holding the stapler handle horizontally, i.e., the fixed handle is in the jaw of the right hand and the remaining four fingers except the thumb hold the movable handle. Specifically, the terms "proximal" and "rear" refer to a location near the operator, while the terms "distal" and "front" refer to a location away from the operator. The term "left" refers to the left side of the operator, while the term "right" refers to the right side of the operator; "upper" refers to the direction opposite to gravity and "lower" refers to the direction of gravity. Other directional terminology may be understood from the accompanying drawings and the description below.

As shown in FIGS. 7-14, the suturing device provided by the present invention comprises an actuating mechanism and a firing control mechanism, wherein the firing control mechanism is mounted on a housing 109, and the firing control mechanism comprises a trigger 101, a ratchet bar 102, a push rod 103, a reset button 104, a direction adjusting button 105, a steering push rod 106 and a firing safety 107. A handle 108 for holding is formed on the housing, and the trigger 101 can be operated by holding the handle 108 to realize one-handed operation. A return spring is arranged between the trigger 101 and the shell, the trigger 101 is pulled to push the ratchet bar 102 to move forwards, and after the trigger 101 is released, the return spring enables the trigger 101 to return to prepare for pulling the trigger at the next time. The housing 109 is divided into two halves to facilitate mounting of components of the firing control mechanism on the housing, the two halves of the housing are assembled together after mounting to complete mounting, and the two halves of the housing can be fixed by screws after being assembled and can also be welded into a whole. Fig. 7 shows only the front half-shell and the rear half-shell not. The traditional linear cutting stapler can refer to CN101156793A, US5762256B, and specifically describes the structure of the firing control mechanism, which is not described in detail in this application. The actuating mechanism is usually a disposable loading part, is discarded after being used up, and the firing control mechanism can be reused for many times and can be matched with the actuating mechanism of the traditional linear cutting anastomat. The disposable loading unit may also be a disposable unit that is integrated with the firing control mechanism. The actuating mechanism of the utility model comprises a nail bin mechanism 6, a nail anvil mechanism 7, a transmission mechanism 5 and a steering mechanism 4.

As shown in fig. 11, the steering mechanism 4 includes a sheet metal lever 401, a proximal end of which is provided with a hook-like projection 402. As shown in fig. 11 and 14, the transmission mechanism 5 includes a transmission mechanism elastic sheet a 5031, a transmission mechanism elastic sheet B5032, a sliding stopper a 5041 and a sliding stopper B5042. The transmission mechanism elastic sheet (A, B) can be made of elastic material or non-elastic material as long as a certain deformation can be generated. The transmission mechanism elastic sheet A is connected with the sliding limiting block A, and the transmission mechanism elastic sheet B is connected with the sliding limiting block B. The sliding limiting block A and the sliding limiting block B are I-shaped structures, and the lower parts of connecting columns (a connecting column A5047 and a connecting column B5048) in the middle of the I-shaped structures are provided with cutting blades 5046. The nail pushing mechanism 8 comprises a nail pushing mechanism A803 and a nail pushing mechanism B804, the near ends of the two nail pushing mechanisms are respectively provided with a connecting groove 801, the elastic sheets A, B of the transmission mechanism are respectively matched with the nail pushing mechanism A, B to respectively push one nail pushing mechanism, the connecting columns of the elastic sheets A, B of the transmission mechanism can be respectively inserted into the connecting grooves 801 of the nail pushing mechanism A, B, and the stability of pushing can be enhanced through the matching of the connecting columns and the connecting grooves. It can be seen from figure 14 that the connecting groove is arranged at the side part of the nail pushing mechanism, the stress point is positioned at the position close to the outer side of the nail bin cover, the stress is not particularly uniform, when the nail bin seat penetrates into the groove near end to be provided with a suturing nail, the percussion is possibly difficult, the nail pushing mechanism is smooth in order to push the nail, the deviation of the nail pushing mechanism can not occur, a balancing weight can be arranged at the position close to the nail bin cover at the outer side of the connecting groove of the nail pushing mechanism, or the outer side of the connecting groove moves backwards, so that the depth of the connecting groove is deepened, and the resistance at the two sides of the groove is equal and the stress is balanced. The bottom of the nail pushing mechanism 8 is provided with nail pushing protrusions 802, 2 nail pushing protrusions are shown in the figure, two rows of stitching nails can be fired, if the number of rows of stitching nails is more, more nail pushing protrusions can be arranged, and of course, the thickness of the nail pushing protrusions can be increased to cover the stitching nails in multiple rows. In short, the number of the nail pushing protrusions 802 of the nail pushing mechanism 8 is determined according to the number of rows of the suturing nails, and the suturing nails can be fired. The nail pushing bulge is provided with an inclined plane, the inclined angle is the same as the nail pressing angle, and the direction is opposite. The nail bin seat penetrates through the near end of the groove, and the suturing nails are gathered inwards. The transmission mechanism shell fragment of this embodiment realizes detachable the connection through the cooperation of spliced pole and connecting groove between with pushing away the nail mechanism, also can adopt fixed connection's mode.

As shown in fig. 8 and 10, the steering mechanism 4 and the transmission mechanism 5 are mounted in the casing 2. For easy to assemble, set up first half pipe 201, second half pipe 202, set up drive mechanism shell fragment A, drive mechanism shell fragment B in the groove of second half pipe, with first half pipe and second half pipe amalgamation again, both easy to assemble play the guide effect again. In addition, an anchoring mechanism 603 can be arranged at the far end, and the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B penetrate through the anchoring mechanism 603 to play a guiding role. The transmission mechanism 4 is arranged on the side part of the split upper and lower half pipes and then is integrally placed in the sleeve 2. The proximal end of the lower half pipe is provided with a limiting block 3 which comprises a limiting block A301 and a limiting block B302.

As shown in fig. 7, 8 and 9, one side of the proximal end of the executing mechanism is folded with the firing control mechanism 1 of the linear cutting and suturing device, then inserted into the firing control mechanism 1, and rotated 90 degrees, and the limiting block a 301 and the limiting block B302 are inserted into corresponding holes on the firing control mechanism 1, so as to complete the butt joint of the two; at this time, the distal end of the pushing rod 103 of the firing control mechanism 1 is positioned in the proximal connecting part 501 of the transmission mechanism 5 and engaged with the same, and the hook-shaped protrusion 402 at the proximal end of the steering mechanism 4 is positioned in the groove of the steering pushing rod 106, and the two are fixedly connected.

As shown in fig. 8, 10 and 13, the cartridge mechanism 6 includes a cartridge cover 617 and a cartridge holder 606. Nail holes 609 are formed in the nail cartridge seat 606, the nails 610 are placed in the nail holes 609, the nail press 611 is located above the nails 610, the nail press 611 is pressed downwards, and the nail press 611 fires the nails 610 towards the nail anvil mechanism 7. The staple cartridge cover 617 covers the staple cartridge seat 606, and a space for accommodating the staple pushing mechanism 8 is formed between the staple cartridge cover 617 and the staple cartridge seat 606, so that the staple pushing mechanism 8 can move from the proximal end to the distal end of the actuator. The side of the cartridge cap 617 is provided with cartridge graduation marks 608 for indicating the position of the staple hole and preventing the tissue from being displaced, and when the tissue is turned outwards, the end of the tissue is positioned in the cartridge graduation marks and can be easily found once the tissue is displaced. The utility model discloses set up nail storehouse lid penetrating groove 605 and nail storehouse lid guide way in the centre of nail storehouse lid, nail storehouse lid penetrating groove, nail storehouse lid guide way all extend to the near-end from the distal end along actuating mechanism length direction, and the guide way is penetrating the groove both sides and is distributing. The nail bin cover penetrating groove is provided with an opening at the far end of the nail bin cover, and the opening is a nail bin cover flaring port 613 with a wide outer part and a narrow inner part. The magazine cover guide grooves are provided in two numbers, and the magazine covers are arranged in rows on both sides of the magazine cover insertion groove 605. As shown in the figures, the guide slot of the present invention comprises a first staple cartridge guide section 602, a staple cartridge connecting end 614 and a second staple cartridge guide section 607, wherein the first staple cartridge guide section 602 extends to the proximal platform 612, the distance between the two first staple cartridge guide sections 602 is smaller than the distance between the two second staple cartridge guide sections 607, and the staple cartridge connecting section 614 connects the first staple cartridge guide section 602 and the second staple cartridge guide section 607 to form a transition. The nail bin seat 606 is also provided with a nail bin seat penetrating groove 616 which correspondingly extends along the length direction of the actuating mechanism and corresponds to the nail bin cover penetrating groove 605, and the nail bin seat penetrating groove 616 is provided with an opening at the far end of the nail bin seat, and the opening is a nail bin seat flaring 615 which is wide at the outer part and narrow at the inner part. Two sides of the nail bin seat penetrating groove are respectively provided with one row or a plurality of rows of stitching nails. The stitching nails can be arranged at the end part of the near end of the nail box penetrating groove 616, the stitching nails are gathered inwards, the near end of the penetrating groove is crossed as much as possible, and the stitching nails at the two sides and the end part form a V shape or a U shape.

As shown in fig. 8, 10 and 12, the anvil mechanism 7 includes an anvil 710, the anvil 710 is provided with an anvil inserting slot 705 extending along the length direction of the actuator and corresponding to the cartridge seat inserting slot 616, and the anvil inserting slot 705 forms an opening at the distal end of the anvil 710, which is an anvil flare 707 with a wide outer part and a narrow inner part. An anvil guide groove extending along the length direction of the actuator is provided on both sides of the anvil insertion groove 705. The anvil guide slot in this embodiment includes an anvil first guide segment 704, an anvil second guide segment 706, and an anvil connecting segment 703, wherein a distance between the two anvil first guide segments 704 is smaller than a distance between the two anvil second guide segments 706, and the anvil connecting segment 703 connects the anvil first guide segment 704 and the anvil second guide segment 706 to form a transition. The bottom of the anvil seat 710 is provided with a supporting plate 708, the supporting plate 708 is provided with a supporting plate penetrating groove 709 which extends along the length direction of the actuating mechanism, and the supporting plate penetrating groove 709 is provided with an opening at the far end of the supporting plate 708. The near end of the supporting plate 708 is provided with a guard plate 702, and with reference to fig. 8, after the nail bin mechanism is connected with the nail anvil mechanism, the guard plate 702 plays a role of preventing left and right movement from deviating. Between the anvil guide slot and the anvil penetration slot, the anvil seat 710 is further provided with a staple forming pocket 701 matched with a staple. When the staples are converged proximally inwardly, the staple forming pockets are also configured to converge inwardly, forming a U-shape or V-shape. The nail bin cover and the nail anvil seat can be designed into an inwards concave structure so as to reduce the whole size and avoid that the nail bin cover and the nail anvil seat are too large to penetrate into the sheath clamp.

Referring to fig. 8 and 10, the proximal ends of the nail bin mechanism 6 and the nail anvil mechanism 7 are connected together, the nail bin cover and the nail anvil seat can be connected into a whole, the nail bin seat can be designed into an independent part, is detachably arranged below the nail bin cover and can be detached from the execution mechanism, and thus, the nail bin seat can be replaced only without replacing the whole execution mechanism, so that the execution mechanism can be reused. An opening spring 604 is arranged between the nail bin mechanism and the nail anvil mechanism 7, and under the condition of no external force, the opening spring 604 keeps the nail bin mechanism and the nail anvil mechanism separated, except for the part with the near end connected together. The near end of the whole nail bin mechanism and the nail anvil mechanism is connected with the far end of a sheet metal rod 401 of the steering mechanism 4 through a connecting joint 601, and the sheet metal rod 401 can drive the nail bin mechanism 6 and the nail anvil mechanism 7 to swing. The transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B penetrate through the connecting joint 601 and can move in a space between a nail bin cover and a nail bin seat of the nail bin mechanism 6 under the driving of a pushing rod 103 of the firing control mechanism. The sliding limiting block A5041 and the sliding limiting block B5042 respectively penetrate through the nail bin cover guide groove and the nail anvil guide groove on one side of the nail bin cover guide groove and the nail anvil guide groove to play a role in guiding. The sliding limiting block A5041 and the sliding limiting block B5042 are in I-shaped structures, and the upper end and the lower end of the sliding limiting block A are respectively positioned at the upper part of the nail bin cover and the bottom of the nail anvil block, so that the sliding limiting block A and the sliding limiting block B are prevented from falling off from the guide groove in the moving process. The staple cartridge seat 606 may also need to be provided with guide grooves distributed on both sides of the penetrating groove, which are the same as those on the staple cartridge cover, for the sliding stopper A, B to pass through, and specifically, if the width of the staple anvil block needs to be determined, the sliding stopper does not need to be provided if the sliding stopper is not affected, that is, the sliding stopper can pass through the outer side surface of the staple cartridge seat.

As shown in fig. 16, the anvil guide slots 711 on both sides of the anvil insertion slot 705 are parallel and extend from the distal end to the proximal end of the anvil base to the proximal end platform. When the anvil guide groove is thus provided, accordingly, the magazine cover guide groove on the magazine cover needs to be so provided. The same is true if the magazine base needs to be provided with guide grooves. The figure also shows a separation column 619, the separation column 619 is located at the proximal end of the actuator, is located at the proximal platform, and is in a shape with a narrow proximal end and a wide distal end, such as a spindle shape or a semi-spindle shape, and the transmission elastic piece A and the transmission elastic piece B of the transmission mechanism 5 are separated by the separation column 619 when passing through the separation column 619. The separating column enables the elastic sheet to move along the guide groove more stably, and lateral bending is avoided in the moving process. As shown in fig. 10, a separation column 619 may be provided in the embodiment in which the first and second guide sections and the connection section are provided.

The following describes the application process of the present invention in detail:

as shown in fig. 8 and 9, in a resting state, the nail magazine mechanism 6 and the nail anvil mechanism 7 are in a separated state due to the action of the opening elastic sheet 604, the transmission mechanism elastic sheet a 5031, the transmission mechanism elastic sheet B5032, the sliding limit block a 5041 and the sliding limit block B5042 are positioned at the proximal end of the stapler, at this time, the sliding limit block a 5041 and the sliding limit block B5042 are positioned at the proximal end platform 612 of the nail magazine metal groove 605 and are abutted against the connecting joint 601, the sliding limit block A, B extrudes the nail magazine cover guide groove, and the opening angles of the nail magazine mechanism and the nail anvil mechanism can be prevented from being too large; staple pushing mechanism 8 is located proximal to cartridge mechanism 6, distal to staples 610 and staple snaps 611.

When an operator pulls the trigger 101 to squeeze the ratchet bar 102, the push rod 103 is pushed to move towards the far end, and the push rod 103 respectively links the transmission mechanism shrapnel A5031 and the transmission mechanism shrapnel B5032 to move towards the far end through the connecting part 501; at this point, the slide stop a 5041 and slide stop B5042 move distally along the guide channel until they move entirely out of the proximal platform 612; due to the cooperative locking effect of the I-shaped structures of the sliding stopper A5041 and the sliding stopper B5042, the nail bin mechanism 6 is squeezed to be close to the nail anvil mechanism 7, the opening elastic sheet 604 is compressed until the nail bin mechanism 6 and the nail anvil mechanism 7 are closed, and at the moment, the nail pushing mechanism cannot reach the position of a suturing nail. As shown in FIG. 9, at this time, the operator can insert the head of the suturing device into the patient through a minimally invasive channel such as a sheath clip 9 of the laparoscope to prepare for suturing; FIG. 9 is a view of the actuator after it has been passed through the sheath clamp, with the cartridge mechanism and anvil mechanism closed as they are being passed through the sheath clamp. It should be noted that, in this embodiment, the sliding limit block is used to close the nail bin mechanism and the nail anvil mechanism, in the field, other structures are also provided to close the nail bin mechanism and the nail anvil mechanism in advance, instead of the sliding limit block, which is widely implemented, for example, a tubular structure is provided at the proximal end of the execution mechanism, the execution mechanism is pulled back, the proximal end is pulled into the tubular structure, and the tubular structure extrudes the opening elastic sheet to close the nail bin and the nail anvil.

Taking the end stitching of the intestinal canal in the cavity as an example, the utility model can be used for stitching the intestinal canal but not only, and all hollow organs which can be turned up and stitched can be used for the utility model; can be but not limited to sewing in the cavity, and can also be suitable for the utility model by sewing outside the cavity; the present invention can be applied not only to end-to-end stitching but also to stitching scenes such as end-to-end stitching and side-to-side stitching.

The operator adjusts the two broken end intestinal tracts to an appropriate anatomical position under the assistance of an assistant, and one to two traction lines are respectively sutured on the side, close to the operator, of the two broken end intestinal tracts to be sutured. The reset button 104 of the firing control mechanism of the back-pull stitching instrument is linked with the pushing rod 103 to move towards the near end, the pushing rod 103 is linked with the transmission mechanism elastic sheet A5031, the transmission mechanism elastic sheet B5032, the sliding limiting block A5041 and the sliding limiting block B5042 to move towards the near end through the connecting part 501, when the sliding limiting block A5041 and the sliding limiting block B5042 are shifted to the metal groove near-end platform 612 again, the pressure on the two sides of the nail bin 6 and the nail anvil 7 is quickly partially relieved, the opening elastic sheet 604 resets, and the nail bin mechanism 6 and the nail anvil mechanism 7 are separated again to the initial state.

As shown in fig. 7, 8 and 9, the direction adjusting button 105 on the firing control mechanism 1 of the stapler is rotated to drive the steering pushing rod 103 to drive the steering mechanism 4 to move back and forth, so as to further push the integral structure of the nail bin mechanism 6 and the nail anvil mechanism 7 to swing, and the direction is adjusted, and the transmission mechanism elastic sheet a 5031 and the transmission mechanism elastic sheet B5032 are bent left and right along with the direction change of the nail bin mechanism 6 and the nail anvil mechanism 7. At this time, the cross sections of the two broken ends of the intestinal tract are required to be kept parallel to the nail bin mechanism 6 and the nail anvil mechanism 7 as much as possible, and the direction adjusting button 105 is fixed well. Referring to fig. 15, when the diameter of the whole of the nail bin mechanism 6 and the nail anvil mechanism 7 is consistent with the section diameter of the broken-end intestinal tract, the broken end a 1001 of the broken-end intestinal tract on one side is penetrated through the opening at the distal end of the nail bin penetrating groove (the nail bin cover penetrating groove 605 and the nail bin base penetrating groove 616) and pulled towards the proximal end until reaching the proximal end of the nail bin penetrating groove (the nail bin cover penetrating groove 605 and the nail bin base penetrating groove 616), and care is taken to ensure that the opening of the broken-end intestinal tract is exposed out of the bottom surface of the nail bin base 606 by enough height. And similarly, the broken end B1101 of the intestinal tract at the other broken end is pulled to be penetrated by the nail anvil mechanism 7. The broken end A1001 of the intestinal tract exposed out of the bottom surface of the nail bin seat 606 is turned outwards, a first turning-out part 1002 and a second turning-out part 1003 are formed on the bottom surface of the nail bin seat, the first turning-out part and the second turning-out part cover nail holes on two sides of the bottom surface of the nail bin seat 606 and extend out of a moving path of a sliding limiting block A, B, the broken end B1101 of the intestinal tract exposed out of the surface of the nail anvil 710 is turned outwards, a third turning-out part 1102 and a fourth turning-out part 1103 are formed on the upper surface of the nail bin seat, the third turning-out part and the fourth turning-out part cover a staple forming pit and extend out of a moving path of the sliding limiting block A, B, and particularly the near end and the far end of the section of the intestinal tract are required to be located within a nail bin scale mark 608. The operator pulls the trigger 101, the pressing ratchet 102 pushes the push rod 103 to move to the far end, the push rod 103 is linked with the transmission mechanism elastic sheet A5031 and the transmission mechanism elastic sheet B5032 to move to the far end through the connecting part 501, the nail bin mechanism 6 and the nail anvil mechanism 7 are closed again, the guard plate 702 can ensure that the nail bin mechanism 6 and the nail anvil mechanism 7 are closed in an aligned mode, the operator can observe whether the everted intestinal tract completely covers the nail bin mechanism 6 and the nail anvil mechanism 7 at the moment, and observe whether the closed intestinal tract moves back and forth and exceeds the nail bin scale mark 608. If the intestinal tract is not completely covered by the everted intestinal tract or the two ends of the intestinal tract protrude out of the scale marks 608 of the nail bin, the nail bin mechanism 6, the nail bin mechanism and the nail anvil mechanism need to be opened again at the moment, so that the intestinal tract at the end to be sutured is adjusted to the proper position, and the nail bin mechanism 6 is closed again to wait for suturing.

An operator unlocks a firing safety 107 on the firing control mechanism 1, pulls the trigger 101, extrudes the ratchet bar 102 to push the push rod 103 to move towards the far end, the push rod 103 is linked with the transmission mechanism elastic sheet A5031 and the transmission mechanism elastic sheet B5032, the sliding limiting block A5041 and the sliding limiting block B5042 to move towards the far end through the connecting part 501, and the transmission mechanism elastic sheet A5031 and the transmission mechanism elastic sheet B5032 continue to slide forwards under the action of the first guiding sections (the nail bin first guiding section 602 and the nail anvil first guiding section 704). The nail pushing mechanism 8 is preset near the first guide section, and after the connecting column A5047 of the sliding limiting block A and the connecting column B5048 of the sliding limiting block B are respectively contacted with the nail pushing mechanism A803 and the nail pushing mechanism B804, the connecting columns are respectively inserted into the corresponding connecting grooves 801; the actuator spring plate A5031 and the actuator spring plate B5032 push the nail pushing mechanism A803 and the nail pushing mechanism B804 to move towards the far end, and when the proximal ends of the nail holes 609 and the nail press studs 611 are reached, the nail pushing protrusions 802 on the nail pushing mechanism 8 are aligned with the nail press studs 611 and push the nail press studs 611 and the stitching nails 610 to move longitudinally along the direction of the nail holes 609 towards the direction of the nail anvil 710. Staples 610 penetrate the tissue of the intestine at a rapid rate and are formed in a "B" or encircling fashion as the ends of the pocket are crimped inward as staples 610 contact staple forming pockets 701 in the surface of staple anvil 710. Continuously firing the trigger 101, pushing the nail pushing mechanism 8 to move to the far end, and sequentially suturing the suturing nails 610 to the far end; at this time, the cutting blade 5046 is pushed by the pushing force to advance distally along the peripheral track of the cartridge mechanism 6 and cut off the excess intestinal tissue outside the staples 610. Referring to fig. 8 and 10, in the process of pushing the nails, the nail pushing mechanism moves in the space between the nail bin cover and the nail bin base, when the elastic pieces move in the first guiding section, the elastic pieces A, B are closer, when the elastic pieces enter the connecting section, the two elastic pieces start to move towards two sides, and drive the nail pushing mechanism A, B to move at two sides, specifically, the nail pushing mechanism moves in the space between the penetrating groove and the guiding groove, and the two nail pushing mechanisms are respectively positioned at two sides of the penetrating groove. Taking the view shown in fig. 14 and 15 as an example (in operation, the broken end A, B does not form such a regular cylinder), the staple pushing mechanism B804 is located on the left outer side of the broken end a 1001 (the broken end of the tissue to be sutured is separated from the staple pushing mechanism by the staple cartridge cover and the staple cartridge holder and is not contacted), the staple pushing mechanism a 803 is located on the right outer side of the broken end a 1001, the suturing staples are fired from top to bottom, the everting part two 1003 and the everting part four 1103 are sutured together, and the everting part one 1002 and the everting part three 1102 are sutured together. In the second guide section, the two nail pushing mechanisms move between the guide grooves and the penetrating grooves respectively, and obviously, the width of the nail pushing mechanisms is not more than the distance between the guide grooves and the penetrating grooves, otherwise, interference can be generated.

Withdrawing the elastic sheet of the stitching instrument, withdrawing the stitching instrument from the operation area, closing the nail bin mechanism 6 and the nail anvil mechanism 7 again, and withdrawing the stitching instrument from the body of the patient along the minimally invasive channels such as the sheath clamp and the like. Observing the conditions of suturing nail nailing and cutting of the intestinal canal stump tissue, and manually suturing and mending the needle if the suturing nail is not firm or the nail is jumped; meanwhile, two ends of the section diameter of the intestinal tract are turned over to the intestinal tract at the line position, residual redundant tissues are cut off by scissors, the suture device is used for suturing the vacant position for needle filling and suturing, the whole intestinal cavity is closed, and the continuity of the intestinal tract is recovered. It should be noted that there is no suturing nail at the opening of the nail bin cover and the opening of the nail anvil seat, and after suturing with the suturing instrument, the suturing nail needs to be sutured manually. If staples are not provided at the proximal end of the guide channel, manual stapling is required at that location, accordingly. If the position of the suturing nail is not sewed, especially the suturing nail at the position of the second guide section is not nailed firmly, the quality of the suturing device is problematic, the suturing device cannot be sold outside, and the adjustment is needed. With reference to fig. 8, the present invention lays the two intestinal tract broken ends on the upper surface of the nail anvil seat and the lower surface of the nail bin seat respectively to form an oval shape, and then squeezes the suturing nail to suture the edges of the two sides of the oval long axis, and of course, also can suture the edges of the near end of the long axis (placing the suturing nail at the position) synchronously, because the far end of the long axis is difficult to place the suturing nail, the long axis needs manual needle sewing. Although a small part of the head end needs a manual sewing needle, the utility model discloses still solved the intracavity formula of turning up to a great extent and sewed up the problem, realize the instrumentization operation, have very wide market prospect.

Claims (15)

1. A stitching instrument comprises a nail bin mechanism, a nail anvil mechanism, a transmission mechanism, a firing control mechanism and a shell, wherein the firing control mechanism is arranged on the shell, and the shell comprises a front half shell and a rear half shell; the nail bin mechanism comprises a nail bin cover and a nail bin seat, a nail pushing mechanism is arranged in a space between the nail bin cover and the nail bin seat, and the nail anvil mechanism comprises a nail anvil block; the transmission mechanism comprises a transmission mechanism elastic sheet;

the method is characterized in that: the nail bin cover, the nail bin seat and the nail anvil block are respectively provided with a penetration groove extending along the length direction of the actuating mechanism, and the penetration groove forms an opening at the far end of the nail bin cover, the nail bin seat and the nail anvil block; guide grooves extending along the length direction of the actuating mechanism are further arranged on the nail bin cover and the nail anvil block on two sides of the penetrating groove; the suturing nails in the nail bin mechanism are arranged on two sides of the penetrating groove in rows and are positioned between the penetrating groove and the guide groove;

the drive mechanism elastic sheet comprises a drive mechanism elastic sheet A and a drive mechanism elastic sheet B, the far ends of the drive mechanism elastic sheet A and the drive mechanism elastic sheet B extend into the space between the nail bin cover and the nail bin seat, the nail pushing mechanism comprises a nail pushing mechanism A and a nail pushing mechanism B, and when the far ends of the drive mechanism elastic sheet A and the drive mechanism elastic sheet B move along the guide grooves on the nail bin cover and the nail bin seat, the nail pushing mechanism A and the nail pushing mechanism B are respectively pushed to move on two sides of the penetrating groove.

2. The stapler of claim 1, wherein: the guide groove comprises a first guide section at the near end, a second guide section at the far end and a connecting section for connecting the first guide section and the second guide section, wherein the distance between the two first guide sections is smaller than the distance between the two second guide sections.

3. The stapler of claim 2, wherein: the near end of the penetrating groove of the nail bin seat is provided with a suturing nail.

4. The stapler of claim 1, wherein: the guide grooves on both sides are arranged in parallel from the far end to the near end.

5. The stapler of claim 1, wherein: and the near end of the actuating mechanism is provided with a separation column for separating the transmission mechanism elastic sheet A from the transmission mechanism elastic sheet B.

6. The stapler of claim 1, wherein: the nail bin seat is detachably arranged below the nail bin cover.

7. The stapler of claim 1, wherein: the nail cartridge seat is also provided with a guide groove extending along the length direction of the actuating mechanism.

8. The stapler of any one of claims 1-7, wherein: the far ends of the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B are respectively connected with a sliding limiting block A and a sliding limiting block B with I-shaped sections, the upper ends and the lower ends of the sliding limiting block A and the sliding limiting block B are respectively inserted into the guide grooves on one side of the nail bin cover and the nail anvil seat, and the top ends and the bottom ends of the I-shapes are respectively exposed out of the guide grooves on the nail bin cover and the nail anvil seat.

9. The stapler of claim 8, wherein: the near ends of the nail pushing mechanism A and the nail pushing mechanism B are respectively provided with a connecting groove, connecting columns of vertical parts of the sliding limiting block A and the sliding limiting block B can be respectively inserted into the connecting grooves of the nail pushing mechanism A and the nail pushing mechanism B, and therefore the driving mechanism elastic sheet A and the driving mechanism elastic sheet B can be detachably connected with the nail pushing mechanism A and the nail pushing mechanism B.

10. The stapler of claim 9, wherein: the connecting groove is close to the outer side of the nail pushing mechanism, and a balancing weight is arranged on the outer side of the nail pushing mechanism.

11. The stapler of claim 8, wherein: the lower ends of the connecting columns of the vertical parts of the sliding limiting block A and the sliding limiting block B are provided with cutting blades.

12. The stapler of any one of claims 1-7, wherein: the opening parts of the nail bin cover, the nail bin seat and the nail anvil block are flaring openings with wide outside and narrow inside.

13. The stapler of any one of claims 1-7, wherein: the bottom of the nail anvil block is provided with a supporting plate, the supporting plate is also provided with a penetrating groove extending along the length direction of the actuating mechanism, and the near end of the supporting plate is provided with a protective plate.

14. The stapler of any one of claims 1-7, wherein: the joint of the nail anvil mechanism and the near end of the nail bin mechanism is provided with an elastic piece which drives the nail bin mechanism and the nail anvil mechanism to be in an opening state, when the transmission mechanism elastic sheet A and the transmission mechanism elastic sheet B move towards the far end, the nail bin mechanism and the nail anvil mechanism are urged to be closed.

15. The stapler of any one of claims 1-7, wherein: the nail bin cover and the nail anvil seat are inwards sunken.

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