DE1057729B - Surgical device for connecting two parts of the intestine - Google Patents

Surgical device for connecting two parts of the intestine

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Publication number
DE1057729B
DE1057729B DEL21521A DEL0021521A DE1057729B DE 1057729 B DE1057729 B DE 1057729B DE L21521 A DEL21521 A DE L21521A DE L0021521 A DEL0021521 A DE L0021521A DE 1057729 B DE1057729 B DE 1057729B
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Germany
Prior art keywords
intestinal
cap
pin
parts
knot
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
DEL21521A
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German (de)
Inventor
I Boerema
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Lameris Instr N V
Original Assignee
Lameris Instr N V
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Lameris Instr N V filed Critical Lameris Instr N V
Publication of DE1057729B publication Critical patent/DE1057729B/en
Pending legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus

Description

DEUTSCHESGERMAN

In der Chirurgie kommt es oft vor, daß zwei Darmteile miteinander verbunden werden müssen, nachdem ein dazwischenliegender Teil aus irgendeinem Grunde entfernt worden ist.In surgery it often happens that two parts of the intestine have to be connected to one another, after an intermediate part has been removed for any reason.

Die Bildung der Verbindung bietet keine besonderen Schwierigkeiten, wenn die zu vereinigendien. Enden der Darmteile leicht erreichbar sind. Wenn aber eines der Enden sich an einer Stelle befindet, die sich von dem Chirurgen schwierig erreichen läßt, muß man seine Zuflucht zu einem zusätzlichen chirurgischen Eingriff nehmen, der die Operation erheblich erschwert und durch den sich oft direkte oder indirekte Gefahr für das Leben des Patienten ergibt.The formation of the connection does not present any particular difficulties when the unification takes place. end up the intestinal parts are easily accessible. But if one of the ends is at a point that is from If the surgeon makes it difficult to achieve, one must resort to an additional surgical one Intervention that makes the operation much more difficult and often direct or indirect Results in danger to the life of the patient.

Es ist eine chirurgische Vorrichtung zum Verbinden zweier Darmteile bekannt, die aus zwei zu einem etwa zylindrischen Körper zu vereinigenden Teilen, besteht, die in den Enden zweier miteinander zu verbindender Darmteile angeordnet werden können, wobei der erste Teil mit einem herausragenden Stift versehen ist, der mit einem in dem zweiten Teil angeordneten Halteorgan zusammenwirkt. Bei dieser bekannten Bauart eines Darmknoters kann die Verbindung zwischen den beiden Teilen des Knoters lediglich durch Manipulation des aus dem Körper des Patienten herausragenden Stückes eines der Teile zustandegebracht und aufrechterhalten werden. Die Anwendung dieser Bauart ist also auf Rektum-Kolon-Anastomose beschränkt. Ferner besteht der Nachteil, daß bei einem sitzenden Patienten trotz der Benutzung von Windungen u. dgl. ein Druck in Axialrichtung auf den Knoter ausgeübt wird. Es ist aber erwünscht, daß der Patient nach einer Darmoperation so bald wie möglich eine sitzende Haltung einnimmt. Es kann somit infolge des auftretenden Axialdruckes der äußerst verletzliche Darmteil leicht reißen.There is a surgical device for connecting two intestinal parts known from two to one approximately cylindrical body to be united, consists in the ends of two to be connected to one another Intestinal parts can be arranged, the first part being provided with a protruding pin which cooperates with a holding member arranged in the second part. With this well-known The connection between the two parts of the knot can only be through the design of an intestinal knot Manipulation of the piece of one of the parts protruding from the patient's body brought about and be sustained. The use of this design is therefore limited to rectum-colon anastomosis. Furthermore, there is the disadvantage that in a sitting patient, despite the use of windings and the like, a pressure is exerted on the knotter in the axial direction. But it is desirable that the Sit down as soon as possible after bowel surgery. So it can as a result of the axial pressure that occurs, the extremely vulnerable part of the intestine can easily tear.

Zum Stand der Technik gehört ferner eine Vorrichtung der genannten Art, bei der ein Kupplungsstift in dem einen Teil der Vorrichtung angeordnet ist, der ins Innere des zweiten Teiles reicht und in seiner Länge so bemessen ist, daß er in seiner Arbeitslage im wesentlichen aus der Vorrichtung nicht vorsteht. Zur Verbindung der Teile kann eine Schnappverbindung verwendet werden, wobei elastische Mittel· zur Erzeugung eines definierten Preßdrucks Anwendung rinden können.The prior art also includes a device of the type mentioned, in which a coupling pin in the one part of the device is arranged, which extends into the interior of the second part and in his Length is dimensioned so that it does not protrude from the device in its working position substantially. A snap connection can be used to connect the parts, with elastic means for Generating a defined pressing pressure can apply.

Hier werden die zu verbindenden Darmteile jedoch in radialer Richtung miteinander verbunden, und es ist unmöglich, diesen Darmknoter in dem Fall zu benutzen, daß eines der Darmenden schwer zu erreichen ist.Here, however, the intestinal parts to be connected are connected to one another in the radial direction, and it is impossible to use this intestinal knotter in the event that one of the intestinal ends is difficult to reach is.

Aufgabe der Erfindung ist es, eine Vorrichtung zum Verbinden zweier Darmteile zu schaffen, die die Nachteile der bekannten Darmknoter nicht aufweist. Dies geschieht nach der Erfindung bei einer Vorrich-Chirurgische Vorrichtung
zum Verbinden zweier DarmteileThe object of the invention is to create a device for connecting two intestinal parts which does not have the disadvantages of the known intestinal knotters. According to the invention, this takes place in a device-surgical device
for connecting two parts of the intestine

Anmelder:Applicant:

Lameris Instrumenten N. V.,
Utrecht (Niederlande)Lameris Instruments NV,
Utrecht (Netherlands)

Vertreter: Dr.-Ing. K. Hoffmeister, Patentanwalt,
Hannover, Königstr. 23Representative: Dr.-Ing. K. Hoffmeister, patent attorney,
Hanover, Königstr. 23

Beanspruchte Priorität:
Niederlande vom 29. März 1954Claimed priority:
Netherlands of March 29, 1954

I. Boerema, Amsterdam (Niederlande),
ist als Erfinder genannt wordenI. Boerema, Amsterdam (Netherlands),
has been named as the inventor

tung der genannten Gattung, die aus zwei stauchend miteinander zu kuppelnden Teilen, zwischen welchen· die zu verbindenden Darmenden eingeklemmt werden können, und Kupplungsorganen besteht, die aus einem mit dem einen Teil verbundenen, in dessen Inneres ragenden Stift, der sich in der gekuppelten Lage gleichfalls durch das Innere des zweiten Teils erstreckt, und aus einem mit dem Stift zusammenarbeitenden Halteorgan, durch das der zweite Teil an den ersten Teil gepreßt werden kann, bestehen, dadurch, daß der an dem einen Teil der Vorrichtung befestigte Stift eine solche Länge hat, daß er in. entkuppelter Lage der Vorrichtung über einen in bezug auf die Länge des ersten Teiles großen Abstand an diesem Teil vorsteht und in der gekuppelten· Lage der Vorrichtung nicht an der Vorrichtung vorsteht, daß das Halteorgan hohl, innerhalb des zweiten Teiles der Vorrichtung beweglich und in bezug auf den Stift in einer bestimmten Stellung fixierbar ist und daß eine gleichfalls innerhalb des zweiten Teiles liegende, sich auf dem Halteorgan abstützende Feder vorgesehen ist, die diesen zweiten Teil in Richtung des ersten Teiles preßt.of the genus mentioned, which consists of two parts to be coupled with one another in compression, between which the intestinal ends to be connected can be clamped, and coupling organs consists of one with the one part connected, in its interior protruding pin, which is in the coupled position also extends through the interior of the second part, and of a retaining member cooperating with the pin, through which the second part is attached the first part can be pressed, in that the one part of the device attached pin has such a length that it in. Decoupled position of the device on a in relation on the length of the first part large distance protrudes on this part and in the coupled · position of the Device does not protrude on the device that the holding member is hollow, within the second part of the Device is movable and can be fixed with respect to the pin in a certain position and that one also provided lying within the second part, supported on the holding member spring is that presses this second part in the direction of the first part.

Nach einer Ausfü'hrungsform der Erfindung ist mit dem Stift ein biegsames Führungsorgan kuppelbar, das durch eine Öffnung in dem beim Halteorgan befindlichen Ende des zweiten Teiles eingeführt werde» kann und über welches ein als eine Hülse ausgebildetes Betätigungsorgan, das gleichfalls durch die Öffnung geführt werden kann, derart beweglich ist, daßAccording to one embodiment of the invention, a flexible guide member can be coupled to the pin, which is inserted through an opening in the end of the second part located at the holding member » can and via which an actuator designed as a sleeve, which also through the opening can be performed, is so movable that

90Ϊ 527/1990Ϊ 527/19

Claims (1)

damit das Halteorgan in die Einschnapplage gebracht werden kann. Die erfindungsgemäße Vorrichtung findet zumal bei vollständiger Magenresektion Anwendung, und zwar in den Fällen, in denen der untere Teil des Oesophagus mit entfernt wird. In diesem Falle kommt die oesophagojejunale Naht etwa um eine Handbreite über dem Diaphragma zu liegen, so daß es, wenn man eine Inzision des Diaphragmas vermeiden will, praktisch unmöglich ist, diese Naht in einer zweckmäßigen Weise aus freier Hand zustande zu bringen. Es ist jedoch klar, daß die Anwendung der erfindungsgemäßen Vorrichtung nicht auf diese spezielle Operation beschränkt ist. Die Erfindung wird nachstehend unter Hinweis auf die Zeichnung näher erläutert. Es zeigt Fig. 1 einen teilweisen Schnitt der Vorrichtung mit dem zugehörigen Führungs- und Betätigungsorgan; die Teile sind hier auseinandergenommen, Fig. 2 die Vorrichtung gemäß der Erfindung in geschlossener Lage und Fig. 3 und 4 zwei Stadien einer Operation mit Hilfe der erfindungsgemäßen Vorrichtung. In Fig. 1 ist auf der linken Seite der Figur der eigentliche Darmknoter und auf der rechten Seite dessen Betätigungs- und Führungsorgan abgebildet. Der Darmknoter besteht aus einer Kappe 1, z. B. aus Kunstharz, in der z. B. mit Hilfe zweier Schräubchen 2 ein hohler, z. B. metallener Stift 3 befestigt ist, der aus der Kappe 1 heraiisragt und an seinem am weitesten von der Kappe entfernten Ende zwei umlaufende Einkerbungen 4 aufweist. Die Kappe 1 bildet mit dem Stift 3 den ersten Teil der Vorrichtung. Der zweite Teil der Vorrichtung besteht aus einem im wesentlichen zylindrischen, an beiden Enden offenen Gehäuse 5, z. B. aus Kunstharz, das am einen Ende mit Innengewinde versehen ist, in das sich eine gleichfalls mit Schraubengewinde versehene, z. B. aus Kunstharz bestehende Kappe 6 einschrauben läßt. Diese Kappe 6 entspricht in ihrer Form im wesentliehen der Kappe 1. In dem Gehäuse befindet sich ein bewegliches Halteorgan 7, z. B. aus Kunstharz, das zwei die Achse des Halteorgans senkrecht kreuzende öffnungen zur Aufnahme eines U-förmigen federnden Metallteiles 8 aufweist. Der Abstand zwischen den Schenkeln dieses Teiles 8 ist derart bemessen, daß der Stift 3, wenn er in das Halteorgan gesteckt wird, mit seinen Einkerbungen^ zwischen diese Schenkel schnappt. Schließlich befindet sich in dem Gehäuse 5 noch eine metallene Schraubenfeder 9, die dafür sorgt, daß zwischen den beiden Teilen des Darmknoters ein etwa konstanter Druck beibehalten wird, wenn die beiden Teile miteinander vereinigt sind. Das auf der rechten Seite der Fig. 1 abgebildete Betätigungs- und Führungsorgan für den Darmknoter besteht aus einem biegsamen Kabel 10, das an dem einen Ende mit einem Handgriff 11 versehen ist. An dem anderen Ende ist eine mit Schraubengewinde versehene Hülse 12 angeordnet, die sich in das gleichfalls mit Schraubengewinde versehene, am weitesten von der Kappe 1 entfernte Ende des Stiftes 3 einschrauben läßt. Auf dem. Kabel 10 ist eine an ihm entlang verschiebbare Hülse 13 angeordnet, die an einem Ende mit einem Handgriff 14 versehen ist. Das Kabel 10 bildet das eigentliche Führunigsorgan, die Hülse 13 das Betätigungsorgan. In Fig. 2 sind die beschriebenen Teile montiert, und zwar in der geschlossenen Lage des Darmknoters wiedergegeben. Aus dieser Figur erhellt weiter, in welcher Weise die Verbindung der beiden Teile des Darmknoters zustande gebracht wird. Das Kabel 10 wird nämlich durch die zentrale Bohrung des zweiten Teiles des Darmknoters geführt und in den Stift 3 des ersten Teiles eingeschraubt. Darauf wird die Hülse 13 auf dem Kabel 10 dem zweiten Teil der Vorrichtung zu bewegt. Bei Beendigung der Bewegung drückt die Hülse 13 das Halteorgan 7 der Spannung der Feder 9 entgegen an den Stift 3, wobei schließlich der federnde Teil 8 in die der Kappe 1 am nächsten liegende Einkerbung 4 des Stiftes 3 schnappt und die beiden Teile starr miteinander zu einem im wesentlichen zylindrischen Ganzen verbunden werden. In den Fig. 3 und 4 sind zwei Stadien des Verbindens zweier Darmteile mit Hilfe der Vorrichtung gemäß der Erfindung abgebildet. Die Kappe 1 wird in den einen Darmteil 15, z. B. in den Oesophagus des Patienten eingebracht und der Darmteil um den Stift 3 geschnürt. Darauf wi-rd das Gehäuse 5 mit der Kappe 6 in den anderen Darmteil 16, z. B. in das Jejunum eingebracht, wobei auch wieder der Darmteil um den aus der Kappe 1 herausraigenden Stift 3 geschnürt wird. Darauf wird durch eine öffnung 17 in der Seitenwand des Jejunum das Kabel 10 mit der Hülse 13 eingebracht. Nach Festschraiuben des Kabels 10 in dem unteren Ende des Stiftes 3 wird die Hülse 13 verschoben, bis die Verbindung zwischen den beiden Teilen des Darmknoters zustandegebracht ist. Darauf wird die Hülse 13 mit dem Kabel 10 wieder aus der öffnung 17 entfernt. In dieser öffnung läßt sich dann ein Katheter zum Leerhalten des Jejunumteiles 16 anordnen, um Kreislaufstörungen zu vermeiden. Darauf kann der Patient durch . diese Öffnung ernährt werden, abgleich der Darmknoter hohl ist und die Ernährung auch auf diesem Wege erfolgen kann. Die zwischen den aneinandergedrückten, vorzugsweise gezahnten Rändern der Kappen 1 und 6 befindlichen Teile des Oesophagus und des Jejunum werden allmählich dünner, und die eingeklemmte Darmscheibe löst sich nach etwa ein bis zwei Wochen, wodurch der Darmknoter beweglich wird und eine ideale Endzu-End-Anas'tomose erhalten wird. Bevor der erste Teil des Darmknoters in dem Oesophagus angeordnet wird, wird ein durch die öffnung 18 in der Kappe 1 (s. Fig. 1) geführter Nylonfaden 19 durch den Oesophagus durch einen Nasenkatheter hinaufgezogen und auf die Backe des Patienten geheftet.. Nach etwa 12. Tagen wird der dann locker liegende Darmknoter mit Hilfe dieses Fadens 19 durch den Mund entfernt. Durch die Benutzung der Vorrichtung gemäß der Erfindung erhält man somit eine große Vereinfachung der totalen Magenresektion, die so sicher ist, daß ein sehr starkes Absinken der Mortalität erwartet werden darf. Es ist.jedoch klar, daß die Vorrichtung nicht ausschließlich auf diese Anwendung beschränkt ist. Patentansprüche:so that the holding member can be brought into the snap-in position. The device according to the invention is used especially in the case of complete gastric resection, specifically in those cases in which the lower part of the esophagus is also removed. In this case the esophagojejunal suture comes to lie about a hand's breadth above the diaphragm, so that if one wishes to avoid incision of the diaphragm it is practically impossible to make this suture in an expedient manner by hand. It is clear, however, that the application of the device according to the invention is not limited to this particular operation. The invention is explained in more detail below with reference to the drawing. 1 shows a partial section of the device with the associated guide and actuating member; the parts are disassembled here, FIG. 2 the device according to the invention in the closed position and FIGS. 3 and 4 two stages of an operation with the aid of the device according to the invention. In Fig. 1, the actual intestinal knot is shown on the left side of the figure and its actuating and guide member on the right side. The intestinal knot consists of a cap 1, e.g. B. made of synthetic resin, in the z. B. with the help of two screws 2 a hollow, z. B. metal pin 3 is attached, which protrudes from the cap 1 and has two circumferential notches 4 at its end furthest from the cap. The cap 1 and the pin 3 form the first part of the device. The second part of the device consists of a substantially cylindrical housing 5 open at both ends, e.g. B. made of synthetic resin, which is provided at one end with an internal thread, in which a likewise provided with screw thread, z. B. made of synthetic resin cap 6 can be screwed. This cap 6 corresponds in its shape in wesentliehen the cap 1. In the housing there is a movable holding member 7, z. B. made of synthetic resin, which has two openings perpendicularly crossing the axis of the holding member for receiving a U-shaped resilient metal part 8. The distance between the legs of this part 8 is dimensioned such that the pin 3, when it is inserted into the holding member, snaps with its notches ^ between these legs. Finally, there is also a metal helical spring 9 in the housing 5, which ensures that an approximately constant pressure is maintained between the two parts of the intestinal knot when the two parts are united with one another. The actuating and guiding element for the intestinal knotter shown on the right-hand side of FIG. 1 consists of a flexible cable 10 which is provided with a handle 11 at one end. At the other end there is a screw-threaded sleeve 12 which can be screwed into the end of the pin 3 which is also provided with a screw thread and which is furthest away from the cap 1. On the. Cable 10 has a sleeve 13 which can be displaced along it and which is provided with a handle 14 at one end. The cable 10 forms the actual guide element, the sleeve 13 the actuating element. In Fig. 2, the parts described are mounted, and shown in the closed position of the intestinal knot. From this figure it is also clear in what way the connection between the two parts of the intestinal knot is brought about. The cable 10 is namely passed through the central bore of the second part of the intestinal knot and screwed into the pin 3 of the first part. The sleeve 13 is then moved on the cable 10 to the second part of the device. At the end of the movement, the sleeve 13 presses the holding member 7 against the tension of the spring 9 against the pin 3, the resilient part 8 finally snapping into the notch 4 of the pin 3 closest to the cap 1 and the two parts rigidly joined to one another be connected substantially cylindrical whole. 3 and 4 show two stages of the joining of two intestinal parts with the aid of the device according to the invention. The cap 1 is in the one intestinal part 15, for. B. introduced into the esophagus of the patient and the intestinal part tied around the pin 3. Then wi-rd the housing 5 with the cap 6 in the other intestinal part 16, z. B. introduced into the jejunum, the intestinal part is again laced around the pin 3 protruding from the cap 1. The cable 10 with the sleeve 13 is then introduced through an opening 17 in the side wall of the jejunum. After the cable 10 has been screwed into the lower end of the pin 3, the sleeve 13 is displaced until the connection between the two parts of the intestinal knot is achieved. The sleeve 13 with the cable 10 is then removed from the opening 17 again. A catheter for keeping the jejunum part 16 empty can then be arranged in this opening in order to avoid circulatory disturbances. The patient can get through it. this opening can be nourished, the intestinal knot is hollow and the nourishment can also take place in this way. The parts of the esophagus and jejunum located between the pressed, preferably toothed edges of the caps 1 and 6 gradually become thinner, and the trapped intestinal disc loosens after about one to two weeks, which makes the intestinal knot mobile and an ideal end-to-end anas 'tomose is obtained. Before the first part of the intestinal knot is arranged in the esophagus, a nylon thread 19, which is guided through the opening 18 in the cap 1 (see FIG. 1), is pulled up through the esophagus through a nasal catheter and attached to the patient's cheek On the 12th day, the loosely lying intestinal knot is removed through the mouth with the help of this thread 19. By using the device according to the invention one thus obtains a great simplification of the total gastric resection, which is so safe that a very strong decrease in mortality can be expected. It is clear, however, that the device is not limited exclusively to this application. Patent claims: 1. Chirurgische Vorrichtung zum Verbinden zweier Darmteile, bestehend aus zwei stauchend miteinander zu kuppelnden Teilen, zwischen welchen die zu verbindenden Darmenden eingeklemmt werden können, und Kupplungsorganen., die aus einem mit dem einen Teil verbundenen, in dessen Inneres ragenden Stift, der sich in der gekuppelten Lage gleichfalls durch das Innere des zweiten Teiles erstreckt, und aus einem mit dem Stift zusammenarbeitenden Halteorgan, durch das der zweite Teil an den ersten Teil gepreßt werden1. Surgical device for connecting two intestinal parts, consisting of two compressing Parts to be coupled with one another, between which the intestinal ends to be connected are clamped can be, and coupling organs., which consist of a connected with one part, in its Inside protruding pin, which in the coupled position also extends through the inside of the second Part extends, and from a cooperating with the pin holding member through which the second part to be pressed against the first part
DEL21521A 1954-03-29 1955-03-24 Surgical device for connecting two parts of the intestine Pending DE1057729B (en)

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Application Number Priority Date Filing Date Title
NL1057729X 1954-03-29

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DE1057729B true DE1057729B (en) 1959-05-21

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