Esophageal-gastric asymmetric anastomosis device with anti-reflux function

Abstract

The present invention discloses an esophagogastric asymmetric stapler with an anti-reflux function. The improvement lies in that the end face of the staple cartridge is formed by closing two arc-shaped plates bent in the same direction end to end to form an arc-shaped cavity. The staple holes on the arc-shaped plates are arranged around the arc-shaped cavity. The shape of the cutting knife is consistent with the shape of the arc-shaped cavity and is abutted against the edge of the inner side wall of the arc-shaped cavity. The anvil on the bottom surface of the staple holder is formed by excavating a cutting groove on a circular plate with a shape consistent with the arc-shaped cavity of the end face of the staple cartridge. The circular plate around the cutting groove is provided with an anvil groove that matches the position and shape of the staple hole. After anastomosis with the present invention, the redundant esophagogastric tissue on the anterior wall deforms into a tongue-like piece into the stomach, and is sutured manually with the posterior wall to form a valve-like tongue-like piece pair in the gastric cavity, jointly constituting a valve-like structure. When not eating, the anastomotic orifice passage is in a valve-like closed state. When eating, due to the peristaltic pressure of the esophagus and the expansion effect of the food bolus, the anastomotic orifice opens, thus playing a role of "cardia-like" preventing gastroesophageal reflux.

Description

Technical Field

[0001] The present invention relates to the field of medical devices, and more specifically, it relates to a novel esophageal-gastric asymmetric stapler with an anti-reflux function. Background Art

[0002] Medically, a stapler is a device used to replace manual suturing. Its main working principle is to sever and staple tissues, similar to a stapler. For tumors at the cardia of the stomach and the esophagus, after surgically removing the esophageal, cardia, or part of the gastric tissue at the tumor site, the healthy esophagus and stomach are connected using a stapler to restore the continuity of the digestive tract. Currently, circular staplers or linear cutting and suturing staplers are commonly used clinically. After anastomosis, the esophagus and stomach are directly connected, and the anastomotic orifice remains continuously open, losing the "cardia"-like structure and anti-reflux function. Postoperatively, intractable reflux esophagitis occurs, seriously affecting the quality of life of patients. Summary of the Invention

[0003] Aiming at the deficiencies of the existing technology, the purpose of the present invention is to provide an esophageal-gastric asymmetric stapler with an anti-reflux function to solve the above problems. Through arc-shaped asymmetric stapling and circumcision, the anterior wall tissue of the anastomotic orifice undergoes elastic deformation and bulges into the gastric cavity. Then, in cooperation with further folding and suturing and trimming of the seromuscular layers of the esophagus and stomach at the posterior wall of the anastomotic orifice, a valve-like structure is formed at the anastomotic orifice, which is in a closed state when not eating, thus having a certain anti-reflux function.

[0004] To achieve the above purpose, the present invention provides the following technical solutions:

[0005] An esophageal-gastric asymmetric stapler with an anti-reflux function, comprising:

[0006] A gun body;

[0007] An adjusting mechanism, arranged along the length direction of the gun body and penetrating through the gun body, with the rear end rotating handle drivingly connected to the front end guiding shaft;

[0008] An anvil seat, arranged at the distal end of the adjusting mechanism, and the anvil shaft of the anvil seat can be clamped with the guiding shaft, and the operation of the anvil seat in the length direction of the gun body is adjusted through the adjusting mechanism;

[0009] A cutting and stapling mechanism, arranged at the front part of the gun body, including a staple cartridge for storing staples and a pusher plate inside it, as well as a cutter close to the inner side of the staple cartridge;

[0010] A firing mechanism, arranged inside the gun body, pushing and connecting the pusher plate and the cutter, and cooperating with the anvil seat to form staples and perform circumcision;

[0011] The end face of the staple cartridge is formed by two arc-shaped plates bending in the same direction and connecting end to end to form a central arc-shaped cavity; a circle of staple holes is opened on the arc-shaped plates around the arc-shaped cavity;

[0012] The nail anvil plate on the bottom surface of the staple cartridge base is formed by excavating a cutting groove on a circular plate, which has the same shape as the arc-shaped cavity at the end face of the staple cartridge. On the circular plate of the staple cartridge base around the cutting groove, there are staple holding grooves that match the position and shape of the nail outlet holes.

[0013] The shape of the cutting knife is the same as the shape of the arc-shaped cavity at the end face of the staple cartridge, and it abuts against the edge of the inner side wall of the arc-shaped cavity.

[0014] A further improved technical solution of the present invention is that the nail anvil shaft of the staple cartridge base includes an arc-shaped plate and a clamping cylinder. The arc-shaped plate is connected in the cutting groove and has the same radian direction as the cutting groove. A suture hole is opened thereon, and the top end of the clamping cylinder is connected to the bottom end of the arc-shaped plate. The purse-string suture at the bottom end of the esophagus is fixed on the staple cartridge base by using the suture hole on the arc-shaped plate, and the tying interface is closer.

[0015] A further improved technical solution of the present invention is that longitudinal holes are opened on the peripheral wall of the clamping cylinder, elastic pieces are arranged in the longitudinal holes, a clamping groove is arranged on the guide shaft, the guide shaft is inserted through the clamping cylinder, and when the elastic piece deforms, the clamping convex on its inner wall is stuck in the clamping groove to clamp and fix the clamping cylinder and the guide shaft. The connection is stable and easy to disassemble.

[0016] A further improved technical solution of the present invention is that the nail outlet holes on the end face of the staple cartridge are arranged in two rows to form an inner ring and an outer ring, and the two rows of nail outlet holes are arranged in a staggered manner to form a non-gap nail outlet ring. The anastomosis is dense and there will be no gaps.

[0017] A further improved technical solution of the present invention is that a knife anvil is abutted against the peripheral wall of the cutting groove of the nail anvil plate. The cutting knife abuts against the knife anvil to cut tissues, and the cutting opening is neat.

[0018] A further improved technical solution of the present invention is that at least one positioning convex is arranged on the peripheral wall of the guide shaft or the inner wall of the nail anvil shaft, and a positioning groove is correspondingly arranged on the inner wall of the nail anvil shaft or the peripheral wall of the guide shaft that is clamped. This prevents circumferential rotation and deformation when the staple cartridge base and the staple cartridge are clamped and matched.

[0019] A further improved technical solution of the present invention is that the firing mechanism includes a push rod in the gun body and a firing handle hinged to the lower part of the handle seat of the gun body. The front end of the push rod is connected to the staple pushing piece and the cutting knife, and the rear end is connected to the firing handle.

[0020] The beneficial effects of the present invention:

[0021] When surgically reconstructing the digestive tract, the front section of the asymmetric stapler body of the present invention is inserted into the gastric cavity, its guiding shaft is led out from the anterior gastric wall, the anvil is placed inside the lower end of the esophagus, and the esophagus bottom is tightly sutured with a purse-string suture. The arc concave surface of the anastomosis is adjusted to be located on the anterior gastric wall. After the anvil shaft and the guiding shaft are clamped and tightened, anastomosis is performed. ① After anastomosis, due to the elastic deformation of the redundant tissues of the esophagus and the stomach stapled on the anterior wall of the anastomosis, which bulge into the gastric cavity, a tongue-shaped piece extending obliquely downward to the opposite side is formed. At the same time, the posterior wall of the anastomosis deforms and displaces upward and forward, and the two arc-shaped anastomotic edges are in a vertical position relationship and deform and approach each other, making the anastomosis tend to close; ② Further, the seromuscular layer at the proximal cut ends of the esophagus and the stomach at the posterior wall of the anastomosis is manually folded and sutured and trimmed, so that the folded part of the gastric wall forms a valve-like structure at the posterior wall of the anastomosis in the gastric cavity, and pushes its posterior wall to deform reversely in an arc shape and approach the anterior wall of the anastomosis; through the combined action of the two, a valve-like structure in the shape of the "His valve" of the cardia is formed at the reconstructed anastomosis, thus changing the round-hole-shaped unobstructed communication state caused by anastomosis with a conventional circular stapler; in the resting state, the reconstructed valve-like structure is in a closed state, while when the stomach peristalsis contracts and the gastric pressure increases, the gastric contents and the dilated gastric fundus push the "His valve" further against the anterior wall of the esophagus at the anterior wall of the anastomosis, making it close more tightly to prevent the gastric contents from refluxing into the esophagus, thus having a certain anti-reflux effect. When eating, due to the peristaltic pressure of the esophagus and the dilating effect of the food bolus, the arc-shaped "His valve" at the reconstructed anastomosis deforms elastically into a circular shape and opens into the distal gastric cavity without affecting eating. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] Figure 1 is a schematic diagram of the overall external structure of the present invention;

[0023] Figure 2 is a partial front view when the anvil at the front end of the present invention is separated;

[0024] Figure 3 is a partial side view when the anvil at the front end of the present invention is separated;

[0025] Figure 4 is a bottom view of the anvil of the present invention;

[0026] Figure 5 is an end view of the staple cartridge of the present invention;

[0027] Figure 6 is a schematic diagram of the communication state between the esophagus and the stomach anastomosed with a conventional circular stapler;

[0028] Figure 7 is a schematic diagram of the communication state between the esophagus and the stomach after asymmetric anastomosis of the present invention;

[0029] Figure 8Schematic diagram of the communication state between the esophagus and the stomach after further suturing and trimming the esophagus and the stomach to form a second tongue piece (valve-like structure) after the asymmetric anastomosis of the present invention;

[0030] Figure 9 Postoperative effect diagram of esophagogastric anastomosis using a common circular stapler;

[0031] Figure 10 To simulate the structural principle of the present invention, a postoperative effect display diagram of hand-sewn esophagogastric asymmetric anastomosis is shown. Figure a: a closed arc-shaped valve-like structure; Figures b - e: deformation from the arc to a circular cavity; Figure f: the reconstructed gastric fundus and its valve-like structure. Detailed implementation mode

[0032] As Figures 1 to 5 shown, the present invention includes:

[0033] A gun body 1;

[0034] An adjusting mechanism, arranged along the length direction of the gun body and penetrating through the gun body, with the rear end rotating handle 21 drivingly connected to the front end guiding shaft 22;

[0035] A kissing and cutting mechanism, arranged at the front part of the gun body, including a staple cartridge 41 for storing staples and a pusher plate (not shown in the figure) inside it, and a cutter 42; the end face of the staple cartridge 41 is formed by two arc-shaped plates bending in the same direction and closing end to end to form a central arc-shaped cavity 43, and a circle of staple holes 44 is opened on the arc-shaped plate around the arc-shaped cavity; the shape of the cutter 42 is consistent with the shape of the arc-shaped cavity 43 on the end face of the staple cartridge, and it is attached to the edge of the inner side wall of the arc-shaped cavity.

[0036] The staple holes 44 on the end face of the staple cartridge 41 have two rows forming an inner circle and an outer circle, and the two rows of staple holes are arranged in a staggered manner to form a non-gap staple circle.

[0037] The anvil 3 is provided at the distal end of the adjustment mechanism. The anvil plate 32 on the bottom surface of the anvil 3 is formed by excavating a cutting groove 33 with the same shape as the arc-shaped cavity at the end face of the staple cartridge on a circular plate. An anvil groove 34 matching the position and shape of the staple outlet hole 44 is provided on the anvil around the cutting groove. A plastic anvil 35 is provided in close contact with the surrounding walls of the cutting groove 34, which is matched with the shape of the cutting knife 42. A anvil shaft 31 is arranged in the cutting groove 33. The anvil shaft 31 includes an arc-shaped plate 311 and a clamping cylinder 312. The arc-shaped plate 311 is connected in the cutting groove 33 and its radian direction is the same as that of the cutting groove. The top end of the clamping cylinder 312 is connected to the bottom end of the arc-shaped plate 311. Vertical holes are opened on the peripheral wall of the clamping cylinder 312, and a spring piece 314 is arranged in the vertical holes. A clamping groove 221 is arranged on the guide shaft 22 of the adjustment mechanism. The guide shaft 22 passes through the clamping cylinder 312. When the spring piece 314 is deformed, the clamping protrusions on its inner wall are stuck in the clamping groove 221 to clamp and fix the anvil shaft 31 and the guide shaft 22. The operation of the anvil 3 in the length direction of the gun body 1 is adjusted through the adjustment mechanism. At least one positioning protrusion 222 is arranged on the inner wall of the anvil shaft. A positioning groove (not shown in the figure) is arranged on the peripheral wall of the corresponding clamped guide shaft in a matching manner. When the positioning protrusion is engaged with the positioning groove, the anvil shaft and the guide shaft will not rotate and displace. A suture hole 313 is opened on the arc-shaped plate 311. The purse-string suture at the bottom end of the esophagus is closed. The two wire ends respectively pass through the bow-back side of the suture hole 313, bypass the arc-shaped plate in the opposite direction, and are tied tightly on the bow-back part of the arc-shaped plate. The tissue at the bottom end of the esophagus is closely attached to the arc-shaped plate for closing.

[0038] The firing mechanism is arranged on the gun body and includes a push rod (not shown in the figure) in the gun body and a firing handle 51 hinged to the lower part of the handle seat of the gun body. The front end of the push rod is connected to the staple pusher and the cutting knife, and the rear end is connected to the firing handle 51 to push and connect the staple pusher and the cutting knife, and cooperate with the anvil to form staples and perform circumcision.

[0039] At present, after surgically removing the cardia, part of the esophagus and / or gastric tissue at the tumor site, a circular stapler is commonly used for esophagogastric anastomosis. After anastomosis, the passage between the esophagus and the stomach is an open and unobstructed circular straight passage (as shown in Figure 6 ), and severe gastric juice reflux often occurs after the operation, seriously affecting the quality of life of patients. Figure 9 It is the postoperative effect diagram of esophagogastric anastomosis using an ordinary circular stapler.

[0040] The present invention has improved the structure of the stapler. The end face of the staple cartridge of the cutting and anastomosis mechanism is formed by two arc-shaped plates that bend in the same direction and are joined end to end to enclose a central arc-shaped cavity. A row of staple holes is formed on the arc-shaped plate around the arc-shaped cavity. The anvil of the anvil holder on the bottom surface is formed by excavating a cutting groove on a circular plate with the same shape as the arc-shaped cavity of the staple cartridge end face. On the circular plate of the anvil around the cutting groove, there are anvil grooves that match the position and shape of the staple holes. The shape of the cutter is the same as the shape of the arc-shaped cavity of the staple cartridge end face and is attached to the edge of the inner side wall of the arc-shaped cavity. After the esophageal and gastric tissues are stapled and anastomosed in this way, the anastomosis opening is an arc-shaped loop that bends in the same direction and is connected end to end. Immediately after that, the cutter inside the loop makes a circumferential cut. After the circumferential cut, on the side of the anterior wall A of the anastomosis opening that is concave into the incision, redundant arc-shaped tissue is retained in the esophagus and the stomach. The redundant arc-shaped tissue on this side elastically deforms and extends into the stomach, forming a tongue-shaped piece 6 that extends obliquely downward to the posterior wall B (the opposite side) (as shown in Figure 7 ). Then, on the side of the posterior wall B of the anastomosis opening, the esophagus and the proximal cutting end C of the stomach are manually sutured with the seromuscular layer folded, so that the folded part of the gastric wall forms a valve-like structure (another tongue-shaped piece 7) in the gastric cavity and is pushed against the opposite side, causing an elastic deformation that extends and adheres in a reverse arc shape, forming two opposing valve-like structures at the anastomosis opening. When not eating, the passage here is closed (as shown in Figure 8 ), changing the original directly connected round hole-shaped unobstructed communication state, having the anti-reflux function like that of the cardia, and at the same time constructing the gastric fundus D. When eating, due to the peristaltic pressure of the esophagus and the dilatation effect of the food bolus, the local anastomosis opening is opened, and it does not affect the passage of food.

[0041] Figure 10 To simulate the structural principle of the present invention, it is a diagram showing the postoperative effect of the asymmetric anastomosis of the esophagus and the stomach by manual suture. Among them, Figure a is a closed state diagram when not eating, and at this time the anastomosis opening is an arc-shaped suture; Figures b, c, d, and e are the dynamic change processes when the esophagus is inflated and dilated. Figure b is when initially inflated, Figure c is when further inflated, the anastomosis opening is a crescent arc-shaped cavity that gradually becomes larger. In Figure d, when continuously inflated, the posterior wall begins to have an arc-shaped reverse elastic deformation. In Figure e, after full inflation, the anastomosis opening deforms into a circular cavity. The continuous views show that the anastomosis opening has good dilatability and will not show stenosis. Figure f is a view from the stomach to the esophagus direction (inverted mirror), the peripheral wall of the anastomosis opening is closely attached to the peripheral wall of the inserted gastroscope, and the reconstructed valve-like structure at E and the gastric fundus D can also be clearly seen.

[0042] The above is only the preferred embodiment of the present invention. The protection scope of the present invention is not limited to the above embodiments. Any method that designs anastomosis instruments of various different shapes to reconstruct the continuity of the digestive tract under the concept of the present invention, thereby forming an asymmetric structure on both sides of the anastomosis, having a valve-like closing function and a certain anti-reflux function, belongs to the protection scope of the present invention. It should be noted that for those skilled in the art, several improvements and refinements made without departing from the principle of the present invention should also be regarded as within the protection scope of the present invention.

Claims

1. An asymmetric esophagogastric anastomosis device with anti-reflux function, comprising: A gun body (1); An adjusting mechanism, arranged along the length direction of the gun body and penetrating through the gun body, with the rear end rotating handle (21) drivingly connected to the front end guiding shaft (22); An anvil seat (3), arranged at the distal end of the adjusting mechanism, and the anvil shaft (31) of the anvil seat can be clamped with the guiding shaft (22), and the anvil seat (3) is adjusted to move in the length direction of the gun body (1) through the adjusting mechanism; A kissing and cutting mechanism, arranged at the front part of the gun body, including a staple cartridge (41) for storing staples and a pusher plate inside it, and a cutter (42) close to the inner side of the staple cartridge; A firing mechanism, arranged inside the gun body, pushing and connecting the pusher plate and the cutter, and cooperating with the anvil seat to form staples and perform circumcision; It is characterized in that: The end face of the staple cartridge (41) is formed by two arc-shaped plates bent in the same direction and connected end to end to form a central arc-shaped cavity (43); a row of staple holes (44) is formed around the arc-shaped cavity on the arc-shaped plate; The anvil plate (32) on the bottom surface of the anvil seat (3) is formed by excavating a cutting groove (33) with the same shape as the arc-shaped cavity on the end face of the staple cartridge on a circular plate, and anvil grooves (34) matching the position and shape of the staple holes are arranged on the anvil plate around the cutting groove; The shape of the cutter (42) is the same as that of the arc-shaped cavity (43) on the end face of the staple cartridge, and it is attached to the edge of the inner side wall of the arc-shaped cavity.

2. The esophageal-gastric asymmetric anastomosis device with anti-reflux function according to claim 1, characterized in that: The anvil shaft (31) of the anvil seat includes an arc-shaped plate (311) and a clamping cylinder (312), the arc-shaped plate (311) is connected in the cutting groove (33) and the radian direction is the same as that of the cutting groove, and a suture hole (313) is formed on it, and the top end of the clamping cylinder (312) is connected to the bottom end of the arc-shaped plate (311).

3. The esophagogastric asymmetric anastomosis device with anti-reflux function according to claim 2, characterized in that: Longitudinal holes are formed on the peripheral wall of the clamping cylinder (312), elastic pieces (314) are arranged in the longitudinal holes, a clamping groove (221) is arranged on the guiding shaft (22), the guiding shaft (22) is inserted through the clamping cylinder (312), and the clamping convex on the inner wall of the elastic piece (314) is deformed to be stuck in the clamping groove (221) to clamp and fix the clamping cylinder (312) and the guiding shaft (22).

4. The anti-reflux esophagogastric asymmetric anastomosis device according to claim 1, characterized in that: The staple holes (44) on the end face of the staple cartridge (41) are arranged in two rows to form an inner ring and an outer ring, and the two rows of staple holes are arranged in a staggered manner to form a non-gap staple discharging ring.

5. The esophageal-gastric asymmetric anastomosis device with anti-reflux function according to claim 1, characterized in that: A knife anvil (35) is attached to the peripheral wall of the cutting groove of the anvil plate (32).

6. The anti-reflux esophagogastric asymmetric anastomosis device according to claim 1, characterized in that: At least one positioning convex (222) is arranged on the peripheral wall of the guiding shaft or the inner wall of the anvil shaft, and a positioning groove is arranged on the inner wall of the corresponding clamped anvil shaft or the peripheral wall of the guiding shaft in a matching manner.

7. The anti-reflux esophagogastric asymmetric anastomosis device according to claim 1, wherein: The firing mechanism includes a push rod inside the gun body and a firing handle hinged to the lower part of the handle seat of the gun body, the front end of the push rod is connected to the pusher plate and the cutter, and the rear end is connected to the firing handle (51).

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