CN219354086U - Surgical instrument for quantitatively cutting off ventricular septum myocardium of left ventricular outflow tract - Google Patents

Abstract

The utility model discloses a surgical instrument for quantitatively cutting off cardiac muscle at a left ventricular outflow tract hypertrophy room interval, which comprises a fixed clamp and a cardiac muscle planing tool, wherein the fixed clamp comprises two articulating occluding units, the upper occluding surface of the upper occluding unit is a plate body, the plate body and the upper front connecting rod of the upper occluding unit are in a shovel shape, the lower occluding surface of the lower occluding unit is a frame body, the rear end part of the frame body is folded upwards to form a jack for sliding the cardiac muscle planing tool, the frame body and the lower front connecting rod of the lower occluding unit are in a shovel shape, the plate body and the frame body are aligned up and down, the upper occluding surface is pressed on the surface of the right ventricle parallel to the room interval, the opening of the lower occluding surface is aligned with a target point of the cardiac muscle to be cut off under the aortic valve, the left inner side wall and the right inner side wall of the folded part of the rear end part of the frame body are respectively provided with a chute, the cardiac muscle planing tool comprises a blade with a lower cutting groove and a tool handle, the tool handle is detachably connected with the top of the rear end of the blade, and slideway bulges which are respectively arranged on the lower sides of the outer side walls of the arched blade and are inserted with the chute.

Description

Surgical instrument for quantitatively cutting off ventricular septum myocardium of left ventricular outflow tract

Technical Field

The utility model relates to a surgical instrument for quantitatively cutting off the ventricular septum of a left ventricular outflow tract.

Background

Hypertrophic obstructive cardiomyopathy (Hypertrophic Obstructive Cardiomyopaghy, HOCM) is genetically related, and ventricular septum and left ventricular wall myocardial hypertrophy enhance myocardial contractility, and reduce diastole compliance, while left ventricular outflow tract stenosis is caused by ventricular septum myocardial pathologic hyperplasia, or by combining anterior leaflet or subvalvular structural dysplasia, and left ventricular outflow tract obstruction is further aggravated by anterior leaflet of the mitral valve being close to ventricular septum in systole due to the Venturi effect of high-speed blood flow. The medical drug treatment has poor effect on severe patients, and the improved and enlarged Morrow operation can obviously reduce the pressure level difference of the left ventricular outflow tract by cutting off hypertrophic cardiac muscle protruding into the left ventricular outflow tract (figure 1) and assisting in repairing the anterior leaflet of the mitral valve and the subvalvular structure thereof, which is currently the gold standard for treating HOCM.

However, since the operation is performed by cutting off the muscles of the proliferation room space protruding into the left ventricular outflow tract through the aortic root incision and the aortic valve, the operation field is very poorly exposed, the operation is a deep well operation (figure 2), and the periphery of the cut myocardium has a plurality of important tissue structures such as myocardial conduction bundles, aortic valve, papillary muscles and the like, and meanwhile, excessive myocardial cutting can cause perforation of the room space to bring disastrous results, and the operation effect can not be achieved due to the insufficient cutting, so that the myocardial cutting is difficult to accurately control. At present, surgeons can only use common surgical instruments in the operation, ensure the operation effect by virtue of own day and experience accumulation, and the operation is still an unstable operation and is still not a stable reproducible stable operation.

In the prior art, surgeons mainly use common surgical instruments, mainly conventional sharp or hooked knives, forceps and scissors, and rely on the insight and clinical experience of the surgeons to ablate redundant ventricular septum myocardium, but due to the limitation of the surgical field, even experienced surgeons still experience too little ablation of myocardium, resulting in residual pressure differences after surgery, or excessive ablation of myocardium or misplacement, resulting in ventricular septum perforation or conductive bundle injury, or other side injury (fig. 3).

Disclosure of Invention

The utility model aims to provide a surgical instrument for quantitatively cutting off the cardiac muscle at the interval of the left ventricular outflow tract hypertrophic chamber, so that the surgical positioning is easier, the surgical instrument is safer, and the range of the myocardial cutting off is more controllable.

In order to achieve the above purpose, the present utility model adopts the following technical scheme:

the utility model provides a quantitative excision left ventricle outflow tract hypertrophic compartment myocardial surgical instrument, including fixed pincers and myocardial planing tool, this fixed pincers includes two articulated interlock units, the upper interlock face of upper interlock unit is the plate body, the upper front connecting rod of this plate body and upper interlock unit is the shovel form, the lower interlock face of lower interlock unit is the framework, the rear end of this framework rolls up upwards and forms the socket that supplies the myocardial planing tool to slide, the lower front connecting rod of this framework and lower interlock unit is the shovel form, this plate body and this framework are in the upper and lower alignment, this upper interlock face is pressed and is pasted on the right ventricle surface that is parallel to the compartment, the trompil alignment of this lower interlock face holds in the support and is in the target point that is to cut the myocardial and lie in the aortic valve down, the spout is offered respectively to the left and right sides wall at the roll up department of this framework rear end, this myocardial planing tool includes the blade and the sword handle that has the lower groove, this sword handle detachably and the rear end top of blade are connected, be equipped with the arch planing tool with the arch to insert respectively in the below the both sides of the lateral wall of this blade, this myocardial planing tool pushes into with the slide along its slide with the chute that the boss is pushed into with the slide along the chute of its forward of the frame of the myocardial planing tool.

Preferably, the upper engaging unit of the fixing clamp comprises a lower holding ring, a body part A and an upper engaging surface, the lower engaging unit of the fixing clamp comprises an upper holding ring, a body part B and a lower engaging surface, the body part A comprises an upper front connecting rod and a lower rear connecting rod, the rear end of the lower rear connecting rod is provided with a lower holding ring, and the joint of the upper front connecting rod and the lower rear connecting rod is hinged with the joint of the lower front connecting rod and the upper rear connecting rod of the body part B.

Preferably, the blade is an arched blade, and comprises a semicircular blade and straight-edge blades which are respectively and downwards arranged at two sides of the semicircular blade, wherein flat bottom edges are respectively and outwards bent at the free ends of the straight-edge blades, the flat bottom edges are correspondingly positioned below the left frame and the right frame, and the outer walls of the side bottoms of the semicircular blades above the flat bottom edges are convexly provided with the slideway bulges.

Preferably, the inner side wall of the folded part of the rear end part of the frame body is arched and matches with the shape of the arched blade.

Preferably, the upper occlusal surface and the upper front connecting rod are bent at 110-130 degrees, and the rear end part of the frame body is bent upwards at 50-70 degrees.

Preferably, the arcuate blades are three sets of 3cm, 4cm or 5cm in length of resectable myocardium, each set having three resectable myocardium heights of 5mm, 8mm and 11mm, respectively.

The utility model has the beneficial effects that: the surgical instrument is specially designed for the open type surgical operation, and aims to solve the problem of insufficient exposure of the surgical field by a surgeon through the auxiliary positioning of the surgical instrument, and can safely, quantitatively and targetedly accurately cut off the hypertrophic ventricular septum muscle protruding into the left ventricular outflow tract. Due to the assistance of the surgical instrument, the operation can be simplified and standardized, a surgeon can fix the space between the rooms to be resected through the fixing forceps, select different types of arched blades, and selectively and easily resect the thickness of cardiac muscle. On the one hand, the operation quality is ensured, and on the other hand, the operation is easier to popularize, and the operation is beneficial to patients.

Drawings

In order to more clearly illustrate the embodiments of the present utility model, the present embodiments will be described below with reference to the accompanying drawings.

Fig. 1 is a schematic view of the structure of the Morrow procedure of fig. 1.

Fig. 2 is a schematic illustration of a difficult exposure of the Morrow procedure.

Fig. 3 is a schematic view of a conventional Morrow procedure.

Fig. 4 is a schematic structural view of the present utility model.

Fig. 5 is a schematic view showing the pushing of the myocardial planing tool into the lower occlusion unit.

Fig. 6 is a schematic view of the structure of the surgical instrument of the present utility model for use in surgery.

Fig. 7 is a schematic plan view of the myocardial planing tool pushed into the lower occlusal surface of the fixation clamp.

Detailed Description

The following examples are given to illustrate possible embodiments of the present utility model, but are not intended to limit the scope of the utility model.

As shown in fig. 4 to 7, a surgical instrument for quantitatively resecting the ventricular septum of a left ventricle outflow tract according to the present utility model comprises a fixed jaw 1 and a myocardial planer tool 2, wherein the fixed jaw 1 comprises two articulated engaging units, an upper engaging surface 111 of the upper engaging unit is a plate body, an upper front connecting rod of the plate body and the upper engaging unit is in a shovel shape, that is, the upper front connecting rod is in an upward inclined shape relative to the upper engaging surface, and a lower engaging surface 120 of the lower engaging unit is a frame body with a long through hole. The rear end of the frame is folded upwards to form a socket 121 for sliding and cutting off a myocardial planing tool, the lower front connecting rod is parallel to the upward folded section of the frame, the lower front connecting rod is in a shovel shape with the horizontal section of the frame, the plate body and the frame are aligned up and down, the upper occlusal surface is pressed against the surface of the right ventricle parallel to the room space, the opening of the lower occlusal surface is aligned with a target point of the myocardial to be cut off and positioned below the aortic valve, the left inner side wall and the right inner side wall of the folded part of the rear end of the frame are respectively provided with a sliding groove 123, the myocardial planing tool 2 comprises a blade 21 with a lower cutting groove and a cutter handle 22, the cutter handle 22 is detachably inserted into the top of the rear end of the blade, slide bulges 211 which are respectively inserted into the sliding grooves 123 are respectively arranged at the lower parts of the two sides of the outer side walls of the blade 21, and the slide bulges are pushed into the front side plates of the front part of the frame along the sliding grooves so as to realize the cutting off of the myocardial planing tool, namely, the myocardial planing tool is pushed into the blade with the lower cutting groove to cut off the myocardial planing tool, and the myocardial planing tool is forcefully pushed into the left chamber to cut off, and the myocardial planing tool is pulled out of the opening from the myocardial planing tool to the opening when the myocardial planing tool is far away from the opening to the heart valve. By adjusting the position of the fixation clamp, multiple resections can be made to achieve the surgeon's desired goal.

Preferably, the upper engaging unit of the fixing clamp 1 includes a lower holding ring 112, a body a113 and the upper engaging surface 111, where the body a113 is in a bent shape, and includes an integrally formed upper front link 1131 and a lower rear link 1132, where the upper front link and the lower rear link are in a bent shape at a joint, the lower rear link is bent backward and downward relative to the upper front link, the upper engaging surface 111 and the upper front link 1131 are in a shape of a shovel bent at 110-130 degrees, and the rear end of the lower rear link 1132 is provided with the lower holding ring 112. The lower engaging unit 12 of the fixed pliers 1 comprises an upper holding ring 122, a body B123 and a lower engaging surface 121, wherein the body B123 is in a bending shape and comprises a lower front connecting rod 1231 and an upper rear connecting rod 1232 which are integrally formed, the lower front connecting rod and the upper rear connecting rod are bent at a joint, the upper rear connecting rod is bent upwards backwards relative to the lower front connecting rod, the rear end of the upper rear connecting rod is provided with an upper holding ring, and the joint of the upper front connecting rod and the lower rear connecting rod is hinged with the joint of the lower front connecting rod and the upper rear connecting rod so as to realize the opening and closing of the upper engaging unit and the lower engaging unit.

Preferably, the blade 21 is an arched blade, and comprises a semicircular blade 212 and straight edge pieces 213 extending downwards at two sides of the semicircular blade, flat bottom edges 214 are respectively bent outwards and perpendicularly at free ends of the straight edge pieces, the flat bottom edges are correspondingly positioned below the left frame and the right frame, the outer walls of the side bottoms of the semicircular blades above the flat bottom edges are convexly provided with the slideway protrusions 211, and when the myocardial planing tool is pushed in, the straight edge pieces between the slideway protrusions 211 and the flat bottom edges 214 slide along the corresponding inner side walls of the left frame side and the right frame side of the frame body. Preferably, the inner side wall of the folded part of the rear end part of the frame body is arched and matches with the shape of the arched blade.

Preferably, the arcuate blades are three sets of 3cm, 4cm or 5cm in length of heart muscle to be resected, each set having three heart muscle thicknesses of 5mm, 8mm and 11mm, respectively. Preferably, the depth of the sliding groove is 1mm, the width of the left frame edge and the width of the right frame edge of the frame body are 2mm respectively, and the width between the left frame edge and the right frame edge is 1.5cm. Because the surgical instrument assists, the operation can be simplified, standardized, a surgeon can fix the room space to be resected through the fixed forceps, select different blades, selectively and easily resect the thickness of the cardiac muscle, conveniently, accurately and quantitatively resect the target cardiac muscle, greatly reduce the operation difficulty, simultaneously improve the operation quality, reduce the operation complications and facilitate the popularization of the operation.

The utility model is divided into two parts, the first part is a clamp type fixing clamp, the upper occlusal surface of the clamp is arranged on the surface of the right ventricle parallel to the ventricular septum, the lower occlusal surface is a fixing frame body with an opening and a sliding groove, the fixing frame body is inserted into a left ventricular outflow tract when in use, and after a surgeon selects the part of ventricular septum cardiac muscle to be resected, the clamp is fixed, so that the opening of the lower occlusal surface aims at a target point of the resected cardiac muscle under the aortic valve. After accurate positioning, the second part of the surgical instrument, namely the myocardial planing tool, is used for forcefully pushing the slide way bulge into the slide way outside the socket of the lower occlusal surface, so that the myocardial can be resected, and a groove is formed in the outflow channel of the left ventricle of the obstruction from the apex of the heart to the opening direction of the aortic valve. By adjusting the position of the fixation clamp, multiple resections can be made to achieve the surgeon's desired goals. Finally, the surgeon can make supplementary excision with the common surgical instrument, and repair the abnormality of the anterior leaflet of the mitral valve and the subvalvular structure thereof, thereby smoothly completing the operation.

The surgical instrument is specially designed for the open type surgical operation, and aims to solve the problem of insufficient exposure of the surgical field by a surgeon through the auxiliary positioning of the surgical instrument, and can safely, quantitatively and targetedly accurately cut off the hypertrophic ventricular septum muscle protruding into the left ventricular outflow tract.

Claims (5)

1. A surgical instrument for quantitatively resecting left ventricular outflow tract hypertrophic ventricular septum myocardium, comprising: the fixing clamp comprises two articulated occluding units, an upper occluding surface of the upper occluding unit is a plate body, an upper front connecting rod of the plate body and the upper occluding unit is in a shovel shape, a lower occluding surface of the lower occluding unit is a frame body, the rear end part of the frame body is folded upwards to form a jack for sliding the myocardial planing tool, the frame body and the lower front connecting rod of the lower occluding unit are in a shovel shape, the plate body and the frame body are aligned up and down, the upper occluding surface is pressed and attached to the surface of a right ventricle parallel to a ventricular septum, an opening of the lower occluding surface is aligned and attached to a target point of the myocardial to be resected and positioned below an aortic valve, sliding grooves are respectively formed in the left inner wall and the right inner wall of a folded part of the rear end part of the frame body, the myocardial planing tool comprises a blade with a lower cutting groove and a tool handle, sliding grooves matched with the sliding grooves are respectively formed in the lower parts of two sides of the outer side walls of the arched blade, and the myocardial planing tool slides towards the front part of the frame body by pushing the sliding grooves.

2. The surgical instrument for quantitatively resecting left ventricular outflow tract hypertrophic ventricular septum of claim 1, wherein: the upper occlusion unit of the fixed clamp comprises a lower holding ring, a body A and an upper occlusion surface, the lower occlusion unit of the fixed clamp comprises an upper holding ring, a body B and a lower occlusion surface, the body A comprises an upper front connecting rod and a lower rear connecting rod, the rear end of the lower rear connecting rod is provided with the lower holding ring, and the joint of the upper front connecting rod and the lower rear connecting rod is hinged with the joint of the lower front connecting rod and the upper rear connecting rod of the body B.

3. The surgical instrument for quantitatively resecting left ventricular outflow tract hypertrophic ventricular septum of claim 1 or 2, wherein: the blade is an arched blade, and comprises a semicircular blade and straight edge pieces which are respectively and downwards arranged at two sides of the semicircular blade, wherein flat bottom edges are respectively and outwards bent perpendicularly at the free ends of the straight edge pieces, the flat bottom edges are correspondingly positioned below the left frame and the right frame, and the outer walls of the side bottoms of the semicircular blades above the flat bottom edges are convexly provided with the slideway bulges.

4. A surgical instrument for quantitatively resecting left ventricular outflow tract hypertrophic ventricular septum according to claim 3, wherein: the inner side wall of the folded part of the rear end part of the frame body is arched and is matched with the shape of the arched blade.

5. The surgical instrument for quantitatively resecting left ventricular outflow tract hypertrophic ventricular septum of claim 4, wherein: the upper occlusal surface and the upper front connecting rod are bent at 110-130 degrees, and the rear end part of the frame body is bent upwards at 50-70 degrees.