|Publication number||CN104873305 A|
|Application number||CN 201510290278|
|Publication date||2 Sep 2015|
|Filing date||29 May 2015|
|Priority date||29 May 2015|
|Also published as||CN104873305B|
|Publication number||201510290278.1, CN 104873305 A, CN 104873305A, CN 201510290278, CN-A-104873305, CN104873305 A, CN104873305A, CN201510290278, CN201510290278.1|
|Inventors||刘永民, 崔跃, 孙立忠, 寇亚明, 潘旭东, 王振国, 李君涛, 尚再艳, 朱明 , 姚鹏, 乔环宇|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (5), Referenced by (3), Classifications (2), Legal Events (4)|
|External Links: SIPO, Espacenet|
技术领域 TECHNICAL FIELD
 本发明涉及医疗器械领域，特别是涉及到心血管外科手术治疗所使用的医疗器械技术。  The present invention relates to the field of medical devices, particularly in relation to medical devices for cardiovascular surgery technique used.
背景技术 Background technique
 主动脉疾病是一组严重威胁人类健康的心血管疾病，主要包括主动脉夹层、主动脉瘤等。  aortic disease is a serious threat to human health, cardiovascular disease, including aortic dissection, aortic aneurysm. 其中主动脉夹层是一种灾难性疾病，如不进行及时治疗，预后极其凶险。 Where aortic dissection is a catastrophic disease, if not timely treatment, the prognosis is extremely dangerous. 据资料报道，未经治疗的主动脉夹层早期病死率每小时增加1%，50%以上的患者于I周内死亡。 According to reports, the early mortality of untreated aortic dissection increased 1% per hour, more than 50% of patients died within weeks I. 近年来，随着人口老龄化、高血压/动脉硬化发病率增高以及无创性医学影像技术的进步，对此类疾病的检出率呈逐年递增趋势。 In recent years, with the population aging, hypertension / atherosclerosis and advances increased incidence of non-invasive medical imaging technology, the detection rate of such diseases was increasing year by year trend. 但目前我国医疗水平发展不均衡，只有少数几家医院才能开展主动脉疾病的外科治疗。 But the current level of development of China's medical uneven, only a handful of hospitals in order to carry out the surgical treatment of aortic disease. 尤其是被国际同行公认为治疗累及主动脉弓和降主动脉扩张性病变的标准术式，即孙氏手术(Sun's Procedure),由于操作难度大、手术风险高，增加了其推广应用的难度。 In particular, it is considered public international counterparts treatment involving the aortic arch and descending aorta dilatation disease standard operation, namely Sun surgery (Sun's Procedure), since the operation difficult, high surgical risk, increasing the difficulty of its application.
 孙氏手术由孙立忠教授于2003年创立，主要适用于广泛的胸主动脉或胸腹主动脉病变患者，该类病变累及升主动脉、主动脉弓和胸腹主动脉。  Sun surgery in 2003 was founded by Professor Sun Lizhong, mainly applicable to a wide range of thoracic aortic or thoracoabdominal aortic lesions, such lesions involving the ascending aorta, aortic arch and thoracoabdominal aorta. 孙氏手术开发应用新的主动脉弓替换和支架象鼻手术，在降主动脉植入支架型人工血管，进一步简化了手术过程，在减少术后出血，提高远端假腔闭合率等方面效果更好。 Sun development and application of new surgical aortic arch replacement surgery and stents trunk, in the descending aorta stent-graft, further simplifying the surgical procedure, better at reducing postoperative bleeding, increase the rate of distal false lumen closure, etc. . 目前已临床应用数千例，并在世界各地推广，取得了良好的临床效果，被国际同行公认为治疗累及主动脉弓和降主动脉扩张性病变的标准术式。 Clinical application has been thousands of cases, and around the world to promote, and achieved good clinical results, it is internationally recognized peer treatment involving the aortic arch and descending aorta dilatation disease standard operation.
 采用现有主动脉弓替换术和支架型人工血管，为实现主动脉弓的替换，需对弓上头臂分支血管进行游离、阻断和吻合等。  The conventional aortic arch replacement surgery and stent graft for the realization of the replacement of the aortic arch, the need for a bow on top of the free-arm branched blood vessels, blocking and anastomosis. 主动脉弓的周围有许多重要的组织结构，包括气管、食管、神经、胸导管等，对头臂血管的游离提出了很高的技术要求，尤其在游离弓远端前壁和吻合后壁时可伤及迷走神经、膈神经和喉返神经。 Around the aortic arch has many important organizational structure, including the trachea, esophagus, nerves, and other thoracic duct, brachiocephalic vessels free of a very high technical requirements, especially in the free arch distal anastomosis anterior and posterior wall can hurt vagus nerve, phrenic nerve and recurrent laryngeal nerve. 对于肥胖、升主动脉瘤推挤、主动脉弓部分支解剖异常、慢性主动脉夹层特别是夹层累及头臂血管的患者，增加游离弓上分支血管的难度，亦是目前孙氏手术推广应用的难点之一。 For obesity, ascending aortic aneurysm push, part of the aortic arch support anatomic abnormalities, chronic aortic dissection, especially in patients with head and arm dissection involving the blood vessels, increase the difficulty of the free arch branch vessels, also is the difficulty of the current application of the Sun surgery one.
发明内容 SUMMARY OF THE INVENTION
 本发明提出一种术中分支按需阻断式支架型人工血管系统及使用方法，旨在解决现有主动脉外科手术中分支血管游离、周围组织损伤等问题。  The present invention provides a needed surgery branch block stent-graft system and method of use, is intended to address the existing aortic surgery branch vessel free of surrounding tissue damage and other problems. 所述术中分支按需阻断式支架型人工血管系统带有分支阻断装置，可在主动脉弓替换外科手术中，根据需要控制主动脉血管与主动脉弓上分支血管间的阻断与连通，减少或避免对弓上分支血管的游离、阻断和吻合等，降低手术难度，减少手术创伤。 Demand blocking the surgery branch stent-graft system with branch block means in the aortic arch replacement surgery, according to the need to control the aorta and aortic arch blocking communication between the branch vessels and reduce or Avoid free bow branch vessels, blocking and anastomosis to reduce the difficulty of operation, reduce surgical trauma.
 为了实现此目的，本发明采取的技术方案为如下。  To achieve this object, the present invention adopts the technical scheme as follows.
 一种术中分支按需阻断式支架型人工血管系统，所述术中分支按需阻断式支架型人工血管系统包括主体人工血管、分支覆膜支架、分支阻断装置，所述分支阻断装置位于主体人工血管与分支覆膜支架的连接处附近或分支覆膜支架腔内，所述分支阻断装置与主体人工血管或分支覆膜支架间为可分离连接，用于手术中根据需要控制主动脉血管与主动脉弓上分支血管间的阻断与连通。  A branch of surgery needed to block stent-graft system, the demand-blocking surgery branch stent graft system includes a main body graft, stent graft branches, branch block means the said branch block means located graft body near the branch stent graft endovascular stent graft or branch connection, the branch blocking device with the main branch stent graft or graft between the detachable connection for surgery Control aorta and aortic arch blocking communication between the branch vessels and as required.
 其中所述分支覆膜支架的数量为I至3个，相应地，所述支架型人工血管包括I个或以上分支阻断装置，用于阻断主体人工血管连接的主动脉血管与I个、2个或3个分支覆膜支架连接的主动脉弓上分支血管。  wherein the number of branch stent graft is I to 3, and accordingly, the stent-graft includes an I or more branch block means for blocking the aortic graft connected to the main body I a, the two branch vessels or three branches connected to the stent graft aortic arch.
 特别地，所述分支阻断装置可为柔性阻断薄片，所述柔性阻断薄片通过可控连接方法，预置于主体人工血管与分支覆膜支架连接处的外围。  In particular, the blocking means may be flexible branch block sheet, said flexible sheet by means of a controllable blocking the connection method preset to the periphery of the main branch stent graft and the graft junction.
 另外，所述支架型人工血管还包括缝线和解脱线，相应地，主体人工血管与分支覆膜支架连接处的外围有一个以上缝合孔，所述柔性阻断薄片根据以下可分离方式连接于主体人工血管与分支覆膜支架连接处的外围:  In addition, the stent-graft further includes a suture and a relief line, accordingly, the artificial blood vessel body and the peripheral branch stent graft junction with more than one suture holes, said flexible separable blocking sheet according to the following peripherals connected to the main body of the branch graft stent graft junction:
 缝线一端固定至所述柔性阻断薄片上的点，其余部分以单股对折形式，从支架型人工血管主体部分腔内侧，沿所述一个以上的缝合孔中穿出，解脱线从主体人工血管腔外侦牝沿对折缝线内孔依次穿过，以确保缝线不从所述缝合孔中脱落，实现所述柔性阻断薄片在所述主体人工血管与分支覆膜支架连接处的外围的可控连接。  suture end is fixed to the flexible blocking point on the sheet, and the rest in the form of a single strand folded from the inside portion of the stent-graft body cavity, wear along the one or more suture holes, the relief line From the outer body lumen artificial Detective female folded along the suture through the hole in turn, to ensure the suture from the suture holes do not fall off, the realization of the flexible sheet in the body blocking the branch graft stent graft connection Controlled connection at the periphery.
 所述分支阻断装置可为可填充球囊，所述可填充球囊阻断装置包括可填充球囊和导管，可填充球囊和导管间为固定连接，可填充球囊位于分支覆膜支架腔内，填充状态下紧贴分支覆膜支架的内壁。  The branch blocking device can be filled balloon, the balloon can be filled with blocking device comprises a balloon filled room and catheters, can be filled balloon and catheter fixed connection, the balloon can be filled in a branch endovascular stent graft, close to the inner wall of the branch stent graft under populated state.
 另外，所述导管上具有刻度线，用于确定可填充球囊的置入距离。  In addition, the catheter has a tick, is used to determine the balloon can be filled into the distance.
 具体地，所述分支阻断装置为可耐受100毫米汞柱压力的柔性阻断薄片或可填充球囊阻断装置。  In particular, the blocking means is a branch block can withstand a flexible sheet of 100 mm Hg or filled balloon blocking device.
 所述术中分支按需阻断式支架型人工血管系统还包括释放装置，所述释放装置包括引导头、中杆、手柄、捆绑线、主体人工血管释放回拉杆和分支覆膜支架释放回拉杆，引导头位于支架型人工血管的远心端，手柄位于支架型人工血管的近心端，中杆连接于引导头和手柄之间，释放前的支架型人工血管被压缩在中杆上，并用捆绑线束缚固定，主体释放回拉杆连接至主体人工血管并控制其释放，分支释放回拉杆连接至分支覆膜支架并控制其释放。  The demand-blocking surgery branch stent graft system further comprises a release device, the release means comprises a guide head, rod, handle, bundled cable, the main graft release lever back and branch stent graft Press release lever and guide the distal end of the stent graft is located, the proximal end of the handle is in the stent graft, the guide rod is connected between the head and the handle, the stent graft is compressed before the release rod on, and bound with bundled fixed line, released back to the main lever connected to the body and control the release of the artificial blood vessel branch released back lever connected to the branch stent graft and controls its release.
 一种术中分支按需阻断式支架型人工血管系统的使用方法，所述方法包括以下步骤:  A branch of surgery needed to block the use of stent-graft system, the method comprising the steps of:
 Al、将主体人工血管置入主动脉血管，将分支覆膜支架置入主动脉弓上分支血管，释放开分支覆膜支架、主体人工血管和分支阻断装置；  Al, the body into the artificial blood vessel aorta, the branch stent implantation aortic arch branch vessels, branch stent graft is released, the main branch of artificial blood vessels and blocking device;
 B1、需要恢复主动脉血管与主动脉弓上分支血管之间的连通时，撤出解脱线，拉动缝线从缝合孔中穿出，将分支阻断装置从主体人工血管中撤出。  B1, the need to restore communication aorta and aortic arch branch vessels between, the withdrawal of relief line, pulling the suture from the suture holes piercing, the blocking device is withdrawn from the main branch of artificial blood vessels.
 另一种术中分支按需阻断式支架型人工血管系统的使用方法，所述方法包括以下步骤:  Another branch of surgery needed to block the use of stent-graft system, the method comprising the steps of:
 A2、将主体人工血管置入主动脉血管，将分支覆膜支架置入主动脉弓上分支血管，释放分支覆膜支架、主体人工血管；  A2, the body into the artificial blood vessel aorta, the branch stent implantation aortic arch branch vessels, the release branch stent graft, graft body;
[0021 ] B2、可填充球囊可预置在分支覆膜支架腔内，随支架被共同释放，或者在手术过程中通过主体人工血管内腔送入分支覆膜支架内腔，连接导管从主体人工血管近心端引出；  B2, the balloon can be filled in the branch stent graft may be pre-chamber, is released together with the stent, or through the body during surgery of artificial blood vessel into the lumen of branch stent graft lumen of the catheter from the connector body artificial blood vessels proximal lead;
 C2、通过导管的刻度，调节可填充球囊的位置使之处于目标位置；  C2, through the conduit of scale, adjust the position of the balloon can be filled so that in the target location;
 D2、通过导管向可填充球囊注入填充物，使得可填充球囊紧贴分支覆膜支架的内壁；  D2, injected filler to be filled balloon through the catheter so that the balloon can be filled against the inner wall of the branch stent graft;
 E2、需要恢复主动脉血管与主动脉弓上分支血管之间的连通时，通过导管排空可填充球囊内的填充物，并通过导管将可填充球囊撤出体外。  E2, the need to restore the aorta and aortic arch communication between the branch vessels when emptying through a catheter balloon can be filled with filler inside, and will be filled balloon through the catheter withdrawn in vitro.
 通过采用本发明的术中分支按需阻断式支架型人工血管系统及使用方法，能够获得以下有益技术效果。  By using the technique of the present invention, the branch-demand blocking stent-graft system and method of use, it is possible to obtain the following advantageous technical effects.
 1、由于术中分支按需阻断式支架型人工血管系统中的分支阻断装置设计，在孙氏手术中，可完全避免对主动脉弓上分支血管的游离、吻合等操作，减少对血管及周围组织的损伤，降低手术难度。  1, since the surgery branch demand blocking stent-graft system branch blocking device design, the Sun surgery, can completely avoid the aortic arch branch vessel free, consistent with other operations, reduce blood vessels and surrounding tissue damage, reduce the difficulty of operation.
 2、分支阻断装置和支架型人工血管其他部件可共同被压缩，压缩后体积、形态不影响整体在手术中的置入和释放。  2, branch blocking device and stent graft other components may be compressed together, after the compression volume, shape does not affect the overall placement in surgery and released.
 3、分支阻断装置带有解脱线，其与支架型人工血管间的连接可控，手术中可依据需要通过缝线或拉杆将分支阻断装置撤出体外，术后无任何遗留物。  3, branch blocking device with a relief line, which is connected between the stent graft controlled, surgery can be based on need stitches or the branch blocking rod withdrawal extracorporeal device, patients without any legacy thereof.
 4、通过分支阻断装置，可在支架型人工血管释放打开的同时或短时内，实现主动脉弓上分支血管与主动脉血管间的阻隔，且可承受不大于100毫米汞柱的压力而不发生失效。  4, through the branch block means in stent graft is released simultaneously or within a short time to open, to achieve the aortic arch and aortic vascular barrier between branches, and can withstand the pressure of not more than 100 mm Hg without failure.
附图说明 Brief Description
 图1为本发明具体实施方式中术中分支按需阻断式支架型人工血管系统释放前的结构示意图。  FIG. 1 embodiment, the present invention is particularly needed surgery branch structure diagram before blocking stent-graft system release.
 图2为本发明具体实施方式中术中分支按需阻断式支架型人工血管系统释放后的结构示意图。  FIG. 2 embodiment of the present invention intraoperative demand structure diagram branch block stent-graft system after release.
 图3为本发明具体实施方式中术中分支按需阻断式支架型人工血管系统在使用环境下的结构示意图。  FIG. 3 embodiment of the present invention branch surgery demand structure blocking stent-graft system diagram in the operating environment.
 图4为本发明具体实施方式中柔性阻断薄片分支阻断装置的结构示意图。  Figure 4 embodiment the present invention the flexible branch block schematic structural view of the sheet blocking device.
 图5为本发明具体实施方式中可填充球囊阻断装置的结构示意图。  Figure 5 embodiment the present invention is a schematic view of the structure of the balloon blocking device may be filled.
具体实施方式 detailed description
 下面结合附图，对本发明作详细说明。  below with the drawings, the present invention will be described in detail.
 首先介绍说明书附图中各附图标记所代表的元件或组织名称。  First introduced element or organization name specification drawings mark the drawings represent.
 I主体人工血管，  I graft body,
 2分支覆膜支架，  2 branch stent graft,
 3分支阻断装置，  3 branching blocking means,
 4引导头，  4 guide head,
 5 手柄，  5 handle,
 6主体人工血管释放回拉杆，  6 main graft release lever back,
 7分支覆膜支架释放回拉杆，  7 branch stent graft is released back into the rod,
 8阻断装置撤出拉线，  8 withdraw cable blocking device,
 9主动脉弓部置换人工血管，  9 aortic arch replacement graft,
 10人体降主动脉，  10 human descending aorta,
 11主体人工血管(置入主动脉后)，  11 main artificial blood vessels (aorta after implantation).
 12分支覆膜支架(置入分支血管后)，  12 branch stent graft (branch vessel after implantation),
 13柔性阻断薄片形成的阻断横截面，  13 flexible block to block cross-section of the sheet formation,
 14主动脉弓上分支血管内的血流方向，  14 branches of the aortic arch direction of blood flow within the blood vessels,
 15连接分支阻断装置的撤出拉线，  15 connecting branch withdrawal cable blocking device,
 16 缝线，  16 stitches,
 17连接缝线和柔性阻断薄片的点，  17 is connected to sutures and flexible sheet blocking point,
 18缝合孔，  The suture holes 18,
 19解脱线，  relief line 19,
 20可填充球囊，  20 can be filled with balloons,
 21 导管。  21 catheter.
 以下公开详细的示范实施例。  The following detailed disclosure of an exemplary embodiment. 然而，此处公开的具体结构和功能细节仅仅是出于描述示范实施例的目的。 However, specific structural and functional details disclosed herein are merely for the purpose of description of exemplary embodiments.
 应该理解，本发明不局限于公开的具体示范实施例，而是覆盖落入本公开范围内的所有修改、等同物和替换物。  It should be understood that the invention is not limited to the specific exemplary embodiments disclosed, but fall within the scope of the disclosure cover all modifications, equivalents, and alternatives. 在对全部附图的描述中，相同的附图标记表示相同的元件。 In the description of the drawings, the same reference numerals denote the same elements.
 同时应该理解，如在此所用的术语“和/或”包括一个或多个相关的列出项的任意和所有组合。  should also be understood that as used herein the term in any and all combinations "and / or" includes one or more of the associated listed items. 另外应该理解，当部件或单元被称为“连接”或“耦接”到另一部件或单元时，它可以直接连接或耦接到其他部件或单元，或者也可以存在中间部件或单元。 Additionally it should be understood that when part or unit called "connected" or "coupled" to another component or unit, it can be directly connected or coupled to other parts or units, or may also be present in the middle part or unit. 此外，用来描述部件或单元之间关系的其他词语应该按照相同的方式理解(例如，“之间”对“直接之间”、“相邻”对“直接相邻”等)。 In addition, other terms used to describe the relationship between the components or units must be understood in the same manner (e.g., "between" versus "directly between", "adjacent" versus "directly adjacent", etc.).
 如图1所示，本发明具体实施方式中公开了一种术中分支按需阻断式支架型人工血管系统，所述术中分支按需阻断式支架型人工血管系统包括主体人工血管1、分支覆膜支架2和分支阻断装置3，所述分支阻断装置3位于主体人工血管I与分支覆膜支架2的连接处附近或分支覆膜支架2腔内，所述分支阻断装置3与主体人工血管I或分支覆膜支架2间为可分离连接，用于根据需要阻断主体人工血管I连接的主动脉血管与分支覆膜支架2连接的主动脉弓上分支血管之间的连通。  1, the embodiment of the present invention discloses a technique in demand branch block stent-graft system, the demand-blocking surgery branch stent graft system includes a main body artificial blood vessels 1, 2 and branch stent graft branches blocking device 3, the branch blocking means 3 and the main body graft I near the junction of the branch stent graft or branched stent graft 2 cavity 2, said branch 3 is a detachable blocking device connected to the body I graft or branched stent graft 2, according between the need to block the main branch vessel graft I connected aortic stent graft 2 is connected with the branch of the aortic arch connectivity.
 如图2所示，本发明的分支阻断装置3可实现主体人工血管I连接的主动脉血管与分支覆膜支架2连接的主动脉弓上分支血管之间的物理阻断。  As shown in Figure 2, the branch block of the present invention means 3 can be achieved on the main graft aortic stent graft I connected with the branch of the aortic arch 2 connection between the physical block branch vessels. 为了达到更好的阻断效果，在具体实施方式中，所述分支阻断装置3为可耐受100毫米汞柱压力的阻断装置。 In order to achieve a better blocking effect, in a particular embodiment, said blocking means 3 of branching can withstand a pressure of 100 mm Hg blocking device.
 由于人体胸主动脉弓上分支血管的差异性，本发明的术中分支按需阻断式支架型人工血管系统具有多种规格及与其配套的分支阻断装置3，可阻断直径20mm以内的主动脉弓上分支血管与主动脉血管间的连通。  Since the branch vessels on the human thoracic aortic arch differences, surgery of the present invention demand-blocking branch stent graft system with a variety of specifications and its supporting branches blocking device 3, can be blocked within a diameter of 20mm The communication between the branch vessels and aortic arch of the aorta. 对应于主动脉弓上的左锁骨下动脉、左颈总动脉、无名动脉3个分支血管，所述分支覆膜支架2的数量可以为I至3个，相应地，所述术中分支按需阻断式支架型人工血管系统包括I个及以上分支阻断装置3，用于阻断主体人工血管I连接的主动脉血管与I个、2个或3个分支覆膜支架2连接的主动脉弓上分支血管之间的连通。 Corresponds to the aortic arch of the left subclavian artery, the left common carotid artery, innominate artery three branch vessels, the number of the branch stent graft may be I 2 to 3, and accordingly, the demand intraoperative branch block stent-graft system includes I and over 3 branch block means for blocking the main aortic vascular prosthesis I connected to I one, two or three branches branch vessel stent graft aortic arch connected on 2 communication between.
 所述分支阻断装置3与主体人工血管I或分支覆膜支架2之间的可分离连接可以通过点接触、线接触或面接触来实现。  The branch blocking device 3 is connected between the body and a detachable 2 artificial blood vessel I or branch stent graft through the point contact, line contact or surface contact to achieve. 相应地，所述分支阻断装置3为柔性阻断薄片或可填充球囊阻断装置。 Accordingly, the branch blocking means 3 is a flexible sheet or may be filled blocking balloon occlusion device.
 在一个实施方式中，如图3所示，所述分支阻断装置3为柔性阻断薄片13，相应地，所述柔性阻断薄片13可分离连接于主体人工血管I与分支覆膜支架2连接处的外围。  In one embodiment, shown in Figure 3, the blocking means 3 is a flexible branch block sheet 13, respectively, said flexible sheet block 13 is detachably connected to the body and the branch graft Cover I peripheral stent junction 2.
 所述柔性阻断薄片13可以使用不同的方式连接于主体人工血管I与分支覆膜支架2连接处的外围，在一个更加具体的实施方式中，通过缝线16、连接点17、缝合孔18和解脱线19配合，实现柔性阻断薄片13与主体人工血管I与分支覆膜支架2连接处的外围之间的可分离连接。 Peripheral  The flexible blocking sheet 13 can use different ways to connect to the main graft I and 2 branch stent graft junction, in a more specific embodiment, the suture 16 through the connection point 17, suture holes 18 and the relief line 19 together to achieve separable connecting peripheral flexible sheet 13 and the main body block graft I branch stent graft at the connection between the two.
 如图4所示，其中图4-A为从分支覆膜支架2外侧，沿其轴心向主体人工血管I方向的视图，图4-B为从主体人工血管I腔内向分支覆膜支架2方向的视图。  shown in Figure 4, in which FIG. 4-A from the two outer branch stent graft, to the body along its axis I direction, the artificial blood vessel view, FIG. 4-B from the main body of the artificial blood vessel lumen to the branch I Cover View stents in two directions. 与柔性阻断薄片13相对应，所述支架型人工血管还包括缝线16、连接点17和解脱线19，相应地，主体人工血管I与分支覆膜支架2连接处外围有一个以上缝合孔18，所述柔性阻断薄片13根据以下方式可分离连接于主体人工血管I与分支覆膜支架2连接处的外围: And the flexible sheet 13 corresponds to blocking, the stent-graft further includes a suture 16, the connection point 17 and the relief line 19, accordingly, the peripheral body with the branch graft stent graft 2 I connection with more than one suture holes 18, the flexible sheet 13 in the following manner blocking detachable connection to the main graft I branch stent graft with peripheral junction 2:
 缝线16 —端固定至所述柔性阻断薄片13的连接点17，其余部分以单股对折形式，从主体人工血管I腔内侧，沿所述一个以上的缝合孔18中穿出，将所述柔性阻断薄片13连接于所述主体人工血管I与分支覆膜支架2连接处的外围。  suture 16-- end fixed to a connecting point of the flexible sheet 13 to block 17, and the remaining portion is folded in the form of a single strand, the artificial blood vessel from inside the body cavity I, along piercing the one or more suture holes 18, peripheral blocking the flexible sheet 13 is connected to the body with the branch graft stent graft I 2 connection. 如图4-B所示，缝线16穿过缝合孔18时，在所述外围形成“η”形。 As shown in Figure 4-B, the suture 16 through the suture holes 18, formed in the periphery "η" shape.
 解脱线19从所述缝合孔18及多个类似缝合孔中穿过，即从“ Π ”形中穿过，以确保缝线16不从所述缝合孔18中脱落，并可根据需要在将解脱线19撤出后，再将缝线16从所述缝合孔18中拉出，通过连接点17撤出柔性阻断薄片13。  relief line from the suture holes 19 through 18 and a plurality of similar suture holes, from "Π" shape in through to ensure that the suture 16 is not detached from the suture holes 18, and in accordance with After the relief required the withdrawal line 19, and then the suture 16 pulled out from the suture holes 18, 17 through the connection point to block the withdrawal of the flexible sheet 13.
 因此，主体人工血管I连接的主动脉血管与分支覆膜支架2连接的主动脉弓上分支血管之间的阻断是可控的，亦即分支阻断装置3与主体人工血管I或分支覆膜支架2间的连接是可分离的，可以依据手术需要通过拉线或拉杆将分支阻断装置3撤出体外且无任何遗留物。  Thus, the main branch of artificial vascular aortic stent graft I connected blocking branch vessels on the connection between the aortic arch 2 is controlled, that is blocking device 3 and the main branch graft I or branch connecting two of the stent graft is detachable, it can be based operation through cable or rod withdrawal branch blocking device 3 in vitro and without any remnants.
 当柔性阻断薄片13连接至所述主体人工血管I与分支覆膜支架2连接处的外围时，主动脉弓上分支血管内的血流方向14不能流向主动脉，血液流向如图3所示。  When the flexible peripheral blocking sheet 13 is connected to the main body graft I 2 is connected with the branch stent graft at the upper branches of the aortic arch direction of blood flow within the vessel 14 can not flow to the aorta, the blood flow in Figure 3 shows.
 特别地，所述用于连接柔性阻断薄片13和主体人工血管I的缝线16的材料为生物医用材料，且具有一定强度的医用缝合线，如医用锦纶线、医用涤纶线等均可用作缝线16。  In particular, the block for connection to the flexible sheet 13 and the body I graft suture material 16 is biomedical materials, and medical suture having a certain strength, such as medical nylon cord, polyester cord and other medical It can be used as suture 16.
 另外，为保证柔性阻断薄片13和主体人工血管I共同被压缩在支架型人工血管的释放装置上，且不影响整体在手术中的置入，柔性阻断薄片13应体积较小或可压缩，例如使用与人体植入的生物医用材料等同质材料，压缩后体积不影响支架型人工血管在手术中正常的置入。  In addition, in order to ensure a flexible sheet 13 and the body blocking I co-graft is compressed in the stent graft delivery device, and does not affect the overall placement during surgery, the smaller the flexible sheet 13 to be blocked by volume or compressible, such as the use of human implantable biomedical materials homogeneous material, the compressed volume does not affect the stent-graft implantation in normal operation.
 与柔性阻断薄片13、缝线16、连接点17、缝合孔18和解脱线19相对应，本发明实施方式中还公开了一种术中分支按需阻断式支架型人工血管系统的使用方法，所述方法包括以下步骤:  and the flexible block sheet 13, suture 16, the connection point 17, suture holes 18 and the relief line 19 corresponds to the embodiment of the present invention also discloses a technique in demand branch block stent-graft The method of using the system, the method comprising the steps of:
 Al、将主体人工血管I置入主动脉血管，将分支覆膜支架2置入主动脉弓上分支血管，释放开主体人工血管1、分支覆膜支架2和分支阻断装置3 (柔性阻断薄片13)，如图3所示。  Al, I placed the body aortic graft, the branch stent graft placement on 2 aortic arch branch vessels, the body is released artificial blood vessel 1, 2 and branch stent graft branches blocking device 3 (flexible barrier off sheet 13), as shown in FIG. 这样柔性阻断薄片13完全张开，阻断主动脉弓上分支内血流进入主动脉，缝线16和解脱线19通过主体人工血管I腔内，向前端引出，保持在视野范围内。 Such flexible blocking sheet 13 is fully open, blocking the blood flow within the aortic arch branches into the aorta, the suture lines 19 through 16 and the relief I endovascular graft body, leads to the front, to keep within the field of view.
 B1、需要恢复主动脉血管与主动脉弓上分支血管之间的连通时，撤出解脱线19，拉动缝线16从一个以上的缝合孔18中依次穿出，最后在连接点17带动下，将柔性阻断薄片13从主体人工血管I中撤出，恢复主动脉弓上分支与主动脉之间的连通，柔性阻断薄片13和撤出装置在体内无遗留。 When the  B1, the need to restore communication aorta and aortic arch branch vessels between the withdrawal of relief lines 19, pulling the suture 16 from one or more suture holes 18, followed by the piercing, and finally at junction 17 drive , the flexible sheet 13 to block the withdrawal of artificial blood vessels from the body I, the aortic arch to restore communication between the branches and the aorta, the flexible sheet 13 and the withdrawal of blocking devices in the body no legacy.
 这样，通过柔性阻断薄片13、缝线16、连接点17、缝合孔18和解脱线19的配合，可以根据需要阻断或连通主动脉血管与主动脉弓上分支血管，在手术中避免了对主动脉弓上分支血管进行游离、吻合等操作。  Thus, by blocking the flexible sheet 13, suture 16, the connection point 17, with suture holes 18 and the relief line 19, you can block or communication aorta and aortic arch branch vessels as needed, to avoid surgery a branch of the aortic arch vessels were free, consistent operation.
 在另一个实施方式中，如图5所示，所述分支阻断装置3为可填充球囊阻断装置，所述可填充球囊阻断装置包括可填充球囊20和导管21，可填充球囊20和导管21间为固定连接，可填充球囊20位于分支覆膜支架2腔内，填充状态下紧贴分支覆膜支架2的内壁。  In another embodiment, shown in Figure 5, the blocking device 3 for the branch balloon may be filled blocking means, said blocking means comprises a balloon may be filled can be filled balloon 20 and catheter 21 can be filled balloon 20 and catheter 21 is fixedly connected to the balloon 20 can be filled in a branch stent graft 2 cavity, close to the branch stent graft under filling state of the inner wall 2.
 为了更方便操作，在一个更具体的实施方式中，所述导管21上具有刻度线，用于确定可填充球囊20的置入位置。  In order to facilitate the operation, in a more specific embodiment, said catheter having a mark on the line 21, for determining the position may be filled into the balloon 20.
 与可填充球囊阻断装置相对应，本发明公开了一种术中分支按需阻断式支架型人工血管系统的使用方法，所述方法包括以下步骤:  and can be filled with balloon occlusion device corresponding to the present invention discloses a technique in demand branch block stent-graft system used, the method comprising the steps of:
[0081 ] A2、将主体人工血管I置入主动脉血管，将分支覆膜支架2置入主动脉弓上分支血管，释放开主体人工血管1、分支覆膜支架2。  A2, will I graft into the aorta the main artery, the branch stent graft placement on 2 aortic arch branch vessels, the body is released artificial blood vessel 1, 2 branch stent graft. 可填充球囊20及导管21可预置在分支覆膜支架2腔内被同时释放，或在手术过程中支架释放后置入； 20 and can be filled balloon catheter 21 can be preset in the branch stent graft lumen 2 is released simultaneously, or during surgery after stent implantation;
 B2、将可填充球囊20送入分支覆膜支架2腔内，通过导管21的刻度，调整可填充球囊20在分支覆膜支架2腔内的位置，最终使之处于目标位置；  B2, 20 will be filled balloon into the branch stent graft 2 cavity, through the catheter 21 scale, adjust the position may be filled balloon 20 2 endovascular stent graft in the branches, and eventually make it in the target position ;
 C2、通过导管21向可填充球囊20注入填充物，使得可填充球囊20紧贴分支覆膜支架2的内壁，实现主动脉血管和主动脉弓上分支血管间的阻断；  C2, through the catheter 21 to the balloon 20 may be filled with filler injection, so that the balloon can be filled with 20 against the inner wall of the branch stent graft 2, to achieve inter-branch block angiogenesis on the aorta and aortic arch;
 D2、需要恢复主动脉血管与主动脉弓上分支血管之间的连通时，通过导管21排空可填充球囊20内的填充物，并通过导管21将可填充球囊20撤出体外。 When the  D2, on the need to restore communication aorta and aortic arch branch vessels between the evacuated through conduit 21 can be filled with filler inside the balloon 20, and 21 will be filled by the balloon catheter 20 withdrawn from the body.
 具体而言，可填充球囊阻断装置可预置在压缩状态下的支架型人工血管腔内共同置入，或者在手术过程中支架释放后置入。  Specifically, filled balloon occlusion device can be preset in the endovascular stent graft in a compressed state placed under the joint, or during surgery after stent implantation. 手术过程中，首先将阻断式支架型人工血管的主体人工血管I置入降主动脉血管，分支覆膜支架2置入主动脉弓上分支血管，首先释放分支覆膜支架2，再释放主体人工血管1，此时主动脉弓上分支血管与主动脉间是连通的。 During surgery, first blocked the main stent-graft of artificial blood vessels I placed descending aorta, 2 branch stent graft implantation aortic arch branch vessels, the first release of the branch stent graft 2, then release the main graft 1, this time between the aorta and aortic arch branch vessels are connected. 从支架型人工血管内腔，将可填充球囊20连带导管21迅速送入分支覆膜支架2腔内，通过导管21上的刻度线，判定可填充球囊20的置入距离并确定最优位置。 From the stent graft lumen 20 will be filled balloon catheter 21 joint rapid branch stent graft into the cavity 2, line 21 through conduit scale, the determination may be filled balloon into the distance and determine the optimal 20 position. 通过导管21向可填充球囊20内注入填充物，使可填充球囊20充盈，并紧贴分支覆膜支架2内壁，通过面接触阻断主动脉弓上分支血管与主动脉血管间的连通。 21 through the catheter into the balloon 20 may be filled with filler injection that can be filled with filling the balloon 20, and close to the inner wall of the branch stent graft 2, connecting branch vessel between the aorta and aortic arch through surface contact blocked.
 另外，如果是预置型的术中分支按需阻断式支架型人工血管系统，上述步骤B2中，不需要将可填充球囊20送入分支覆膜支架2腔内。  In addition, if the preset type of surgery is needed to block branch stent-graft system, said step B2, does not need to be filled balloon into the branch 20 2 endovascular stent graft.
 需要恢复主动脉弓上分支血管与主动脉血管间的连通时，首先通过导管21排空可填充球囊20内的填充物，使可填充球囊20与分支覆膜支架2内壁的接触分离，并通过导管21将可填充球囊20整体撤出体外，恢复主动脉弓上分支血管与主动脉血管间的连通，可填充球囊20和导管21在体内无任何遗留。 When the  branch vessels need to restore communication between the aorta and aortic arch, first evacuated through conduit 21 can be filled with a filler 20 inside the balloon, so the balloon can be filled with 20 branch stent graft 2 in contact with the inner wall of separation and through conduit 21 will be filled balloon 20 overall withdrawal from the body, to restore communication between the aorta and branch vessels on the aortic arch, can be filled balloon 20 and catheter 21 in the body without any remaining. 手术中完全避免了对主动脉弓上分支血管的游离、吻合等操作。 Completely avoid surgery for aortic arch branch vessel free, consistent operation. 由于相关手术操作在开放视野下进行，可填充球囊20的置入、位置调整、充盈可在短时内完成。 As the relevant surgical procedures carried out in an open field of vision, can be filled into the balloon, the position adjustment 20, the filling can be completed within a short time.
 可填充球囊20亦可作为其他阻断装置因不可预见原因发生失效时的补救措施，可在短时内实现置入、充盈、阻断，具有良好的替代性。  may be filled balloon blocking device 20 may be used as other remedies because of unforeseen causes of failure can be achieved in a short time into, filling, blocking, good alternative.
 另外，本发明术中分支按需阻断式支架型人工血管系统还包括释放装置，如图1所示，所述释放装置包括引导头4、手柄5、主体人工血管释放回拉杆6和分支覆膜支架释放回拉杆7。  In addition, the technique of the present invention, the branch-demand blocking stent-graft system also includes a release device, shown in Figure 1, the release means comprises a guide head 4, the handle 5, the main graft release lever 6 back and branch stent graft is released back into the lever 7. 引导头4位于支架型人工血管的远心端，用于引导支架型人工血管的位置。 The distal end of the guide head 4 is located in the stent graft, to guide the position of the stent-graft is used. 手柄5位于支架型人工血管的近心端，用于操作人员手持。 Located at the proximal end of the handle 5 stent graft for the operator hand. 主体人工血管释放回拉杆6连接至主体人工血管I并控制其释放，分支覆膜支架释放回拉杆7连接至分支覆膜支架2并控制其释放。 Back to the main graft release lever 6 is connected to the main graft I and controls its release, the branch stent graft is released back into the rod 7 is connected to the branch stent graft 2 and controls its release.
 因此，通过使用本发明的术中分支按需阻断式支架型人工血管系统及使用方法，在孙氏手术中，可完全避免对主动脉弓上分支血管的游离、吻合等操作，减少对血管及周围组织的损伤，降低手术难度。  Thus, by using the technique of the present invention, the branch-demand blocking stent-graft system and method of use, in Sun surgery, can completely avoid the aortic arch branch vessel free, consistent with other operations, reduce blood vessels and surrounding tissue damage, reduce the difficulty of operation. 另外，分支阻断装置和支架型人工血管其他部件可共同被压缩，压缩后体积、形态不影响整体在手术中的置入和释放。 In addition, the branch blocking device and stent graft other components may be compressed together, after the compression volume, shape does not affect the overall placement in surgery and released.
 需要说明的是，上述实施方式仅为本发明较佳的实施方案，不能将其理解为对本发明保护范围的限制，在未脱离本发明构思前提下，对本发明所做的任何微小变化与修饰均属于本发明的保护范围。  It should be noted that the above embodiments are merely preferred embodiments of the present invention, it can not be construed as limiting the scope of the present invention without departing from the idea of the premise of the present invention, any minor variations of the present invention made and modifications belong to the scope of the present invention.
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