RU2110222C1 - Device for forming of intestinal end-to-end anastomosis - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: device has pair of compression rings 1 provided with arc-shaped jumpers 2, oriented to opposite sides with their convexities and converging facility in the form of spring 8 made of titanium nickelide. In addition, it has hollow cylinders 3 with lugs 6 mounted for movement over arc-shaped jumpers 2 having parallel guide sections for lugs 5 and protruding beyond compression rings 1 as limiters 7 of shift of compression rings 1. Edges of every cylinder 3 are made as bead 4 divided by four recesses 9 into hooks for purse-string suture fixation. Spring 8 is intended for introduction into cavities of cylinders 3 and coupling to hooks 6 positioned on middle parts of arc- shaped jumpers 3 by means of extreme turns bent out relative to axis of spring 8 and oriented orthogonally with respect to each other. EFFECT: reduced postoperative complications, improved primary permeability of anastomosis, long life and higher reliability of device. 2 dwg

Description

 The invention relates to medicine, in particular to medical instruments, and can be used to create an inter-intestinal anastomosis in any part of the colon and rectum.

 A serious complication of operations on the large intestine and rectum is still the failure of anastomotic sutures. The search for new ways of forming an intestinal anastomosis to reduce postoperative complications is an urgent problem in abdominal surgery.

 A known method of creating a compression anastomosis using a device made of nitinol by A. with. N 1186199, which consists in the convergence of two loops of the intestine, parallel to the puncture of the walls, the introduction of a clip device into the intestinal lumen after its preliminary deformation. But this method allows you to create an inter-intestinal anastomosis only side by side and does not create uniform compression around the entire perimeter of the anastomosis.

 A known method and device for creating an end-terminal anastomosis of the intestine by AS N 1179978. A device for implementing this method contains a pair of compression rings made of magnetic material. The mutual attraction of the rings after their rapprochement ensures the creation of a tight interintestinal anastomosis. But for this method, the likelihood of postoperative complications due to the primary obstruction of the anastomosis caused by tight purse string sutures is high.

 The closest in technical essence to the proposed is the device described in the article Ziganshina R.V. et al. New aspects of solving the problem of creating anastomosis in abdominal surgery, Implants with shape memory, 1991, N 2, p.6 - 7, Fig. 3.

 This device contains two compression rings equipped with arched jumpers installed in a plane perpendicular to the plane of the ring and fixed ends at diametrically opposite points of the ring, both arcs located in the same plane so that their bulges are directed in opposite directions, and the reduction mechanism is made in in the form of a spring made of titanium nickelide, fixed at its ends in the middle of opposing jumpers. In this case, the method consists in excising and removing the pathological focus, applying purse string sutures to the intestinal ends, introducing compression rings into the gut ends of the intestine, partially tightening the seams and bringing the ends closer to their contact, and before matching the joined rings, the purse string sutures are dissolved and removed.

 The disadvantages of this device are the likelihood of failure of the joints of the anastomosis due to the inability to center the compression rings, a very short time of application of the anastomosis, because the recovery time of the nickel-titanium spring is limited.

 To eliminate these drawbacks, hollow cylinders with ears are inserted into the device containing a pair of compression rings equipped with arched jumpers oriented in convex directions in opposite directions and a rapprochement device in the form of a spring made of titanium nickelide, arranged to move along arched jumpers made with parallel guides sections under the ears and with ends protruding beyond the compression rings, while the edges of each cylinder are made in the form of a side divided by four recesses on hooks for fixing the cassette seam, and the spring is made for insertion into the cavity of the cylinders and connection with hooks mounted on the middle parts of the arcuate jumpers by means of extreme turns bent relative to the spring axis, orthogonally oriented relative to each other.

 In FIG. 1 presents the inventive device in General; in FIG. 2 - detailing, where 1 is a compression ring, 2 is an arched bridge, 3 is a hollow cylinder, 4 is a cylinder rim, 5 is a cylinder “eye”, 6 is a hook, 7 is a compression ring displacement limiter, 8 is a spring, 9 is a recess .

 The device consists of two identical halves and a spring 8 connecting them. Each half of the device consists of a compression ring 1 equipped with an arched jumper 2. The ends of the arched jumper 2 extend beyond the compression ring 1 and serve as limiters 7. The limiters 7 serve to limit the displacement of the two halves relative to each other. In the middle part of the arcuate axis 2 there is a hook 6 for fixing the spring 8. Each half of the device has inside a hollow cylinder 3 with "ears" 5 that move along parallel guides of the arcuate axis 2 of the device. On the other hand, the cylinder 3 ends with a collar 4, which acts as hooks for fixing the purse string suture placed on the intestine. The cylinder 3 has four recesses 9 on the side surface from the side of the side 4, corresponding to the position of the arched jumpers and opposite displacement limiters 7 of the compression rings 1.

 All these elements of the device are made of stainless steel.

Round spring 8 made of nickel-titanium alloy grade TH 10 (+10 - +25) consists of 12 turns, half of the 2 extreme turns of the spring are bent relative to the axis of the spring at an angle of 90 ^o and are oriented to each other at an angle of 90 ^o .

 The cross-section of the spring wire is 1.5-1.9 mm, the outer diameter of the spring is 11.5 - 11.9 mm, the inner diameter of the spring is 10 mm, the diameter of the compression ring is 30 - 33 mm (depending on the lumen of the intestinal tube), the diameter of the cylinder is 18 - 21 mm, cylinder length 16 mm, eyelet height 3-4 mm, cylinder side height 2 mm, recess in cylinder 5 mm, hook length 5-7 mm, maximum length of the protruding part of the cylinder from the compression ring when it is extended 12 mm, the maximum length of the distance of the cylinder from the compression ring when it is moved inward is 9 mm, the length of the limiter press rings 3 mm.

 The diameter of the wire from which the device is made is 2.5 - 3 mm, the wall thickness of the cylinder is 0.8 mm.

 With these parameters, the device develops a force on the wall of the colon of 800 - 1200 g.

 The device operates as follows.

 After resection of the affected area of the large intestine, purse string sutures are applied close to the clamps previously placed on the ends of the anastomosed intestinal tubes, one on each side. The clips are removed from the ends of the intestinal tubes. The movable hollow cylinder 3 extends forward of the compression ring 1 (12 mm). The half of the device is firmly clamped by the hook 6, on which the spring 8 will be fixed in the future, and inserted into the intestinal lumen. A purse string suture, previously imposed on the intestine, is fastened on the cylinder 3, the sides 4 of the cylinder 3 do not allow the end of the intestine to slide off the cylinder 3. Then, the cylinder 3 is pushed into the device by a clamp. Its end is 9 mm from the compression ring. At the same time, complete fixation of the intestinal stump is achieved, the lumen of the device is not narrowed, the distance of the squeezed tissue of the intestine from the imposed purse string suture is uniform throughout the anastomosis circumference.

 Similarly, the second end of the anastomosis is created.

 Then, the cooled nickel-titanium spring 8 is stretched by 7-8 cm, inserted into the cylinders 3 of the device and fixed on the hooks 6. Under the influence of the temperature of the intestine, the spring 8 is uniformly compressed, taking its original shape. No forced fixation of the stretched spring is required, which does not change its compression force and avoids its deformation.

 The spring is in the cold for as long as it takes to fix the intestine to each half of the device, which allows the operation to be carried out without much haste.

 On the eve of the operation, the spring is placed for 7-8 hours in an antiseptic solution in the freezer or, if urgently needed, can be treated with a solution of chloroethyl immediately before the operation.

 For an experienced surgeon, it takes up to 3 minutes to apply one half of the device.

 The proposed device is reliable, therefore, postoperative complications are reduced, the primary patency of the anastomosis is improved. In addition, long-term operation of the device and the spring is possible.

Claims (1)

 A device for creating an end-to-end intestinal anastomosis, comprising a pair of compression rings equipped with arched jumpers oriented in convex directions in opposite directions, and a rapprochement device in the form of a spring made of titanium nickelide, characterized in that hollow cylinders with ears located at the ability to move along arched jumpers made with parallel guide sections under the ears and with ends protruding beyond the compression rings in the form of compression displacement limiters rings, while the edges of each cylinder are made in the form of a side, divided by four recesses into hooks for fixing the cassette seam, and the spring is made for insertion into the cavity of the cylinders and connected with hooks mounted on the middle parts of the arcuate bridges by means of extreme turns bent off the axis of the spring and oriented relative to each other.

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