WO2015027572A1 - 完全转流型肠造瘘管 - Google Patents
完全转流型肠造瘘管 Download PDFInfo
- Publication number
- WO2015027572A1 WO2015027572A1 PCT/CN2013/087195 CN2013087195W WO2015027572A1 WO 2015027572 A1 WO2015027572 A1 WO 2015027572A1 CN 2013087195 W CN2013087195 W CN 2013087195W WO 2015027572 A1 WO2015027572 A1 WO 2015027572A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- tube
- wall
- balloon
- intestinal
- pipe
- Prior art date
Links
- 208000008081 Intestinal Fistula Diseases 0.000 title abstract description 7
- 230000000968 intestinal effect Effects 0.000 claims abstract description 20
- 230000000694 effects Effects 0.000 claims abstract description 15
- 230000000903 blocking effect Effects 0.000 claims abstract description 9
- 239000012530 fluid Substances 0.000 claims abstract description 7
- 210000003736 gastrointestinal content Anatomy 0.000 claims abstract description 7
- 229920002994 synthetic fiber Polymers 0.000 claims abstract description 4
- 210000003815 abdominal wall Anatomy 0.000 claims description 28
- 239000000853 adhesive Substances 0.000 claims description 5
- 230000001070 adhesive effect Effects 0.000 claims description 5
- 238000003780 insertion Methods 0.000 claims description 3
- 230000037431 insertion Effects 0.000 claims description 3
- 206010016717 Fistula Diseases 0.000 abstract description 19
- 230000003890 fistula Effects 0.000 abstract description 19
- 210000000936 intestine Anatomy 0.000 abstract description 17
- VYPSYNLAJGMNEJ-UHFFFAOYSA-N Silicium dioxide Chemical compound O=[Si]=O VYPSYNLAJGMNEJ-UHFFFAOYSA-N 0.000 abstract description 4
- 239000000741 silica gel Substances 0.000 abstract description 4
- 229910002027 silica gel Inorganic materials 0.000 abstract description 4
- 238000001356 surgical procedure Methods 0.000 abstract description 4
- 238000004891 communication Methods 0.000 abstract description 2
- 210000003405 ileum Anatomy 0.000 description 11
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 10
- 230000003872 anastomosis Effects 0.000 description 7
- 206010050456 Anastomotic leak Diseases 0.000 description 5
- 206010036790 Productive cough Diseases 0.000 description 4
- 238000006243 chemical reaction Methods 0.000 description 4
- 210000003802 sputum Anatomy 0.000 description 4
- 208000024794 sputum Diseases 0.000 description 4
- 201000004624 Dermatitis Diseases 0.000 description 2
- 210000000683 abdominal cavity Anatomy 0.000 description 2
- 230000002550 fecal effect Effects 0.000 description 2
- 238000002347 injection Methods 0.000 description 2
- 239000007924 injection Substances 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 238000000034 method Methods 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 230000008855 peristalsis Effects 0.000 description 2
- 210000000813 small intestine Anatomy 0.000 description 2
- 208000033301 Ileal fistula Diseases 0.000 description 1
- 208000015634 Rectal Neoplasms Diseases 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000000605 extraction Methods 0.000 description 1
- 208000003243 intestinal obstruction Diseases 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 206010038038 rectal cancer Diseases 0.000 description 1
- 201000001275 rectum cancer Diseases 0.000 description 1
- 238000007789 sealing Methods 0.000 description 1
- 239000000243 solution Substances 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 238000012546 transfer Methods 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/44—Devices worn by the patient for reception of urine, faeces, catamenial or other discharge; Portable urination aids; Colostomy devices
- A61F5/4404—Details or parts
- A61F5/4405—Valves or valve arrangements specially adapted therefor ; Fluid inlets or outlets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/44—Devices worn by the patient for reception of urine, faeces, catamenial or other discharge; Portable urination aids; Colostomy devices
- A61F5/445—Colostomy, ileostomy or urethrostomy devices
Definitions
- the present invention relates to a fully diverted enterostomy tube. BACKGROUND OF THE INVENTION There is a risk of anastomotic leakage after low anastomosis of rectal cancer. Once an anastomotic leakage occurs, serious complications will occur, and temporary ileal protective ostomy can protect the anastomotic leakage and reduce The role of complications caused by anastomotic leakage, but currently used back to the book
- Chinese Patent No. 2011103436269 discloses a temporary ileal fistula tube in which the fistula tube is placed in the terminal ileum and is taken out of the abdominal wall through the abdominal wall, and the purpose of blocking the proximal intestinal contents by using a negative pressure is taken out and taken out of the body. After the end of the ostomy, the tube can be directly removed, and the ileal wall will be healed by itself, thus avoiding the operation of the sputum.
- the technical structure is relatively complicated, and the pipeline is relatively long, the pipe diameter is relatively small, the drainage distance is relatively long, and the flow effect is long.
- the invention provides a good circulation effect, automatic closure of the ostomy mouth, and avoiding complete circulation of the second operation. Intestinal fistula.
- a full-flow type intestinal fistula including a synthetic material pipe, characterized in that: a deformable air bag is disposed on the pipe near the front end portion, and the pipe is located at a portion in front of the air bag to form a drainage section; a front portion of the thin pipe is disposed in the pipe and a front end of the thin pipe passes through
- the tube wall of the tube communicates with the inner cavity of the air bag, and the rear end of the thin tube is connected with an inflation port for injecting a fluid into the air bag with a one-way valve; the air bag is filled with fluid through the inflation port and A closed structure for blocking the contents of the intestine is formed between the intestines; the bowing flow segment is provided with a drainage opening for guiding the contents of the intestine through the pipeline; and the inflating interface end is provided with a pair for detecting the airbag A pressure gauge for the pressure of the intestinal wall.
- the drainage section is a slanted opening that facilitates insertion of the cannula.
- the pipe wall of the drainage section is provided with a shuttle shape further having an auxiliary drainage effect, and an annular groove is formed in the pipe wall of the pipe, and the pipe is matched with the annular groove.
- the fixing piece is fixedly connected to the abdominal wall.
- a fixing piece is sleeved on the pipe wall of the pipe, and an opposite side of the fixing piece from the abdominal wall is an adhesive surface, and the adhesive surface is fixedly connected to the abdominal wall.
- the rear end of the duct is provided with an outer sleeve adapted to facilitate the passage of the duct out of the abdominal wall.
- the balloon of the invention has a diameter of 4 cm and a length of 5 cm.
- the silica gel material is synthesized and soft.
- the air bag communicates with the inflation port with a one-way valve at the other end of the pipe through the thin tube, and the pressure on the intestinal tube is generated after the water/gas is filled, and the air bag is easily pressed. Deformation, reduce the pressure on the intestine, and at the same time can block the effect of closing the intestine.
- the sealing effect can be evaluated by pressure test. As the peristalsis increases, the intestine will gradually expand, and the balloon can be deformed with the expansion of the intestine. When the time is off, the balloon pressure can also be controlled by refilling the water to delay the closure time of the balloon.
- the specific surgical operation method of the enteric fistula tube of the present invention is as follows: After the rectal anastomosis is completed, the distal ileum is taken from the ileum with a distance of about 15 cm from the ileum, and the 3-0 absorbable line is used as a concentric circular purse of lcm and 1.5 cm, and the pouch center The electric knife cuts a small mouth as much as possible, and inserts the slanting surface of the ostomy tube into the proximal end of the ileum until the airbag is fully inserted into the ileum, and then tightens the inner and outer purses respectively, and pay attention to the outer purse to completely embed the inner purse.
- water is injected from the one-way valve, pay attention to control the pressure of the balloon on the intestinal wall between 30-40cmHg, and then make a 1cm incision on the abdominal wall, the outer sleeve is inserted into the abdominal cavity from the abdominal wall, and the fistula is passed through the outer cannula.
- the abdominal wall was taken out, and the cannula was removed.
- the muscle wall and abdominal wall of the intestinal wall of the small intestine around the fistula were sutured with an absorbable wire for one week.
- the annular fixation piece of the abdominal wall is fixed to fix the fistula tube, and the bottom surface of the annular fixation piece is sticky, and can be closely adhered to the skin, thereby preventing the retraction of the fistula tube and protecting the skin from being eroded by the fecal water, causing ostomy dermatitis. Fix the extra-slice chassis and then put on the ostomy bag. After the operation, the balloon pressure should be monitored. As the intestines gradually expand, the balloon blocking effect will gradually decrease. If there is a leak in the distal rectal anastomosis, it is necessary to continue to inject water into the balloon, keep the airbag closed, and control the balloon pressure to delay protection. cycle. When you don't need to make a sputum, you can pump the air bag and you can remove the ostomy tube. After the fistula is removed, the intestinal wall is automatically healed and does not need to be returned again to achieve complete conversion.
- the contents of the intestine are blocked by the balloon, and the intestinal contents are taken out from the fistula tube to temporarily protect the distal anastomosis. After the distal anastomosis is healed, the ostomy tube is removed. The ostomy mouth is automatically closed, avoiding secondary surgery.
- the inner diameter of the pipe is 75 mm, and the boring pipe is 4 mm in the prior art, and the effect of the flow is proportional to the area of the cavity to ensure a sufficient flow conversion effect.
- the pipeline is only 15cm long, the drainage distance is short, and the effect is good.
- Figure 1 is a schematic view of the overall structure of the present invention.
- Figure 2 is a schematic view of the A-direction structure of Figure 1.
- Figure 3 is a schematic view showing the structure of the outer sleeve of the present invention.
- Figure 4 is a schematic view showing the structure of a fixing sheet in the present invention.
- Fig. 5 is a view showing the state of use of the present invention.
- Fig. 6a is a schematic view A of the connection of the socket fixing piece on the pipe of the present invention.
- Figure 6b is a schematic view B of the connection of the annular groove and the fixing piece on the pipe of the present invention. detailed description
- a full-flow type intestinal fistula tube comprises a synthetic material pipe 1 having a total length of 15 cm, an inner diameter of 7.5 mm and an outer diameter of 10 mm, and the pipe 1 is provided with a deformable air bag 2 near the front end portion.
- the portion of the duct 1 in front of the airbag forms a drainage section 3; the front portion of the thin tube 6 is bored in the duct 1 and the front end of the thin tube 6 passes through the tube of the duct
- the wall is in communication with the inner cavity of the air bag 2, and the rear end of the thin tube 6 is connected to an inflation port 7 for injecting a fluid into the air bag with a one-way valve; 2 forming a closed structure for blocking the contents of the intestine between the inflated port 7 and the intestinal tube;
- the drainage section 3 is provided with a drainage port 4 for guiding the contents of the intestine through the pipe;
- the 7-end is provided with a pressure gauge for detecting the pressure of the balloon against the intestinal wall.
- the drainage section 3 is a slanted opening that facilitates insertion of the cannula.
- the tube wall of the drainage section 3 is provided with a shuttle-shaped side hole 5 having an assisting drainage effect.
- connection between the pipeline and the abdominal wall is as follows:
- An annular groove is formed in the pipe wall of the pipe, and the pipe is fixedly connected to the abdominal wall through a fixing piece matched with the annular groove.
- the fixing piece is an annular fixing piece, has an inner diameter of 0.9 cm, and is provided with elastic rubber for fixing the fistula tube to the abdominal wall after operation, and the outer side can be connected with the sac bag bottom plate.
- the tube wall of the pipe is sleeved with a fixing piece, the inner diameter of the fixing piece is 0.9cm, which is slightly smaller than the outer diameter of the pipe; the opposite side of the fixing piece and the abdominal wall is an adhesive surface, and the adhesive surface is fixedly connected with the abdominal wall .
- the rear end of the pipe 1 is provided with an outer sleeve adapted to guide the pipe out of the abdominal wall; the outer diameter of the outer casing is lOmm, which facilitates the extraction of the fistula tube from the abdominal wall during the operation.
- the balloon of the invention has a diameter of 4 cm and a length of 5 cm.
- the silica gel material is synthesized and soft.
- the air bag communicates with the inflation port with a one-way valve at the other end of the pipe through the thin tube, and the pressure on the intestinal tube is generated after the water/gas is filled, and the air bag is easily pressed. Deformation, reduce the pressure on the intestine, and at the same time can block the effect of closing the intestine. As the peristalsis increases, the intestine will gradually expand, and the balloon can be deformed as the intestine expands, delaying the blocking time.
- the specific surgical operation method of the intestinal fistula of the present invention is as follows: After the rectal anastomosis is completed, the distal ileum is taken from the ileum with a distance of about 15 cm from the ileum.
- the 3-0 absorbable line is used as a concentric circular purse of lcm and 1.5 cm.
- the pouch center electric knife cuts a small mouth as much as possible, and the ostomy tube is inserted into the slanted surface.
- water is injected from the one-way valve, pay attention to control the pressure of the balloon on the intestinal wall between 30-40cmHg, and then make a 1cm incision on the abdominal wall, the outer sleeve is inserted into the abdominal cavity from the abdominal wall, and the fistula is passed through the outer cannula.
- the abdominal wall was taken out, and the cannula was removed.
- the muscle wall and abdominal wall of the intestinal wall of the small intestine around the fistula were sutured with an absorbable wire for one week.
- the annular fixation piece of the abdominal wall is fixed to fix the fistula tube, and the bottom surface of the annular fixation piece is sticky, and can be closely adhered to the skin, thereby preventing the retraction of the fistula tube and protecting the skin from being eroded by the fecal water, causing ostomy dermatitis. Fix the extra-slice chassis and then put on the ostomy bag. After the operation, the balloon pressure should be monitored. As the intestines gradually expand, the balloon blocking effect will gradually decrease. If there is a leak in the distal rectal anastomosis, it is necessary to continue to inject water into the balloon, keep the airbag closed, and control the balloon pressure to delay protection. cycle. When you don't need to make a sputum, you can pump the air bag and you can remove the ostomy tube. After the fistula is removed, the intestinal wall is automatically healed and does not need to be returned again to achieve complete conversion.
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- Epidemiology (AREA)
- Nursing (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
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Abstract
一种完全转流型肠造瘘管,包括合成材料管道(1),所述的管道(1)上靠近前端部位设置有可变形的气囊(2),所述的管道(1)位于所述的气囊前的部分形成引流段(3);细管(6)的前部穿设在所述的管道内且所述细管(6)的前端穿过所述的管道的管壁与气囊(2)的内腔连通,所述的细管(6)的后端连接带有单向阀门的用于向气囊注流体的充气接口(7);所述的气囊(2)经充气接口(7)充流体后与肠管之间形成用于阻断肠内容物的封闭结构;所述的引流段(3)上设有将肠内容物通过管道引出的引流口(4);所述的充气接口(7)端设置有用于检测气囊(2)对肠壁的压力的测压仪。该完全转流型肠造瘘管通过控制硅胶气囊对肠壁的压力,用硅胶气囊阻断肠内容物,使肠内容物从造瘘管引出,起到临时保护远端吻合口的效果,待远端吻合口愈合后拔除造瘘管,造瘘口自动闭合,避免二次手术。
Description
完全转流型肠造瘘管
技术领域 本发明涉及一种完全转流型肠造痿管。 背景技术 直肠癌行低位吻合术后存在吻合口漏的风险, 一旦发生吻合口漏 将带来严重的并发症,而临时说性的回肠保护性造痿术能够起到保护吻 合口漏发生, 降低吻合口漏带来的并发症的作用, 但是目前常用的回 书
肠双腔造痿需要再次行手术回纳, 而二次回纳同样存在着吻合口漏、 肠梗阻等并发症风险, 如何去避免二次回纳手术, 避免二次回纳所带 来的风险, 一直是肛肠外科医生探索的一个方向。 中国专利号 2011103436269公开了一种临时性回肠造痿管,在手 术中将造痿管放置于末端回肠内并穿过腹壁引出体外,利用负压达到 阻断近端肠内容物并引出体外的目的, 在造痿结束后, 管道可直接拔 除, 回肠壁置管口将自行愈合, 从而避免还痿手术。但是该技术结构 比较复杂, 且管道比较长, 管径相对较小, 引流距离比较长, 转流效
; 。
发明内容 为了克服现有造痿管存在的引流距离长、转流效果差且结构较复 杂的缺点, 本发明提供一种转流效果好、 造痿口自动闭合, 避免二次 手术的完全转流型肠造痿管。 本发明采用的技术方案是: 完全转流型肠造痿管, 包括合成材料管道, 其特征在于: 所述的
管道上靠近前端部位设置有可变形的气囊,所述的管道位于所述的气 囊前的部分形成引流段;细管的前部穿设在所述的管道内且所述细管 的前端穿过所述的管道的管壁与气囊的内腔连通,所述的细管的后端 连接带有单向阀门的用于向气囊注流体的充气接口;所述的气囊经充 气接口充流体后与肠管之间形成用于阻断肠内容物的封闭结构;所述 的弓 I流段上设有将肠内容物通过管道弓 I出的引流口;所述的充气接口 端设置有用于检测气囊对肠壁的压力的测压仪。
进一步, 所述的引流段是便于插管***的斜形开口。
进一步,所述的引流段的管壁上开设有具有协助引流效果的梭形 进一步, 所述的管道的管壁上开设有环形凹槽, 所述的管道通过 与所述的环形凹槽相配合的固定片与腹壁固定连接。
进一步, 所述的管道的管壁上套接有一固定片, 所述的固定片与 腹壁相对的一面为粘性面, 所述的粘性面与所述的腹壁固定连接。
进一步,所述的管道后端设置有与其相适配的便于将管道引出腹 壁的外套管。
本发明气囊直径为 4cm, 长度 5cm, 硅胶材料合成, 柔软, 气囊 通过细管与管道另一端的带有单向阀门的的充气接口相通, 充水 /气 后对肠管产生压力, 气囊易受压变形, 降低对肠管的压力, 同时能起 到阻断封闭肠管的效果, 通过压力检测可以评估封闭效果, 随着肠蠕 动增加, 肠管会逐渐扩张, 气囊亦可随着肠管扩张而变形, 延迟阻断 时间, 也可通过再次注水控制球囊压力, 延迟球囊的封闭时间。
本发明所述肠造痿管的具体手术操作方法如下: 直肠吻合完成后, 取末端回肠距离回盲瓣 15cm左右回肠, 3-0可 吸收线作 lcm、 1.5cm大小左右同心圆荷包, 荷包中心电刀切一尽量 小的口子, 将造痿管斜面插向回肠近端, 直至气囊全部***回肠后分 别收紧内外荷包, 注意外荷包尽量把内荷包完全包埋进去。然后从单 向阀门处注水, 注意控制气囊对肠壁的压力在 30-40cmHg之间, 再 在腹壁上做一 1cm左右切口, 将外套管从腹壁外穿入腹腔, 通过外 套管将造痿管引出腹壁, 拔除外套管, 造痿管周边的小肠肠壁浆肌层 和腹壁用可吸收线绕管缝合固定一周。腹壁外造痿管套环形固定片固 定造痿管, 环形固定片底面有粘性, 可以与皮肤密切黏合, 既防止造 痿管回缩, 又可以保护皮肤不被粪水侵蚀, 引起造口皮炎, 固定片外 再贴造口底盘, 然后再套上造痿袋。 术后注意监测气囊压力, 随着肠 管逐渐扩张, 气囊阻断效果会逐渐下降, 如果远端直肠吻合口有漏的 发生, 需继续向气囊注水, 保持气囊的封闭性, 控制气囊压力以延迟 保护周期。 不需要造痿时, 抽空气囊, 即可拔除造痿管。 造痿管拔除 后造痿肠壁自动愈合, 不需要再次回纳, 以达到完全转流的目的。
本发明的有益效果体现在:
1、 通过控制气囊对肠壁的压力, 用气囊阻断肠内容物, 使肠内 容从造痿管引出, 起到临时保护远端吻合口的效果, 待远端吻合口愈 合后拔除造痿管, 造痿口自动闭合, 避免了二次手术。
2、 本发明中管道内径为 75mm, 现有技术中造痿管 4mm, 转流 效果和管腔面积成正比, 保证充分的转流效果。
3、 管道只有 15cm长, 引流距离短, 效果好。
4、 可对气囊测压, 第一次对气囊壁压力进行量化 (目前文献没 有报道肠道气囊压力检测), 保证随着肠壁扩张后通过再次注水控制 气囊对肠壁压力, 仍能起到充分的阻断效果。
5、 配套外套管、 固定片, 使用方便, 操作简单, 效果好。
6、 直接接腹壁外造痿袋, 不需要负压, 进食无渣半流质后, 转 流效果好。
附图说明 图 1是本发明整体结构示意图。
图 2是图 1中 A向结构示意图。
图 3是本发明中外套管结构示意图。
图 4是本发明中固定片结构示意图。
图 5是本发明使用状态图。
图 6a是本发明管道上套接固定片的连接示意图 A。
图 6b是本发明管道上的环形凹槽与固定片的连接示意图 B。 具体实施方式
参照图 1至图 6b, 完全转流型肠造痿管, 包括总长为 15cm、 内 径 7.5mm, 外径 10mm的合成材料管道 1, 所述的管道 1上靠近前端 部位设置有可变形的气囊 2, 所述的管道 1位于所述的气囊前的部分 形成引流段 3; 细管 6的前部穿设在所述的管道 1内且所述细管 6的 前端穿过所述的管道的管壁与气囊 2的内腔连通,所述的细管 6的后 端连接带有单向阀门的用于向气囊注流体的充气接口 7; 所述的气囊
2经充气接口 7充流体后与肠管之间形成用于阻断肠内容物的封闭结 构; 所述的引流段 3上设有将肠内容物通过管道引出的引流口 4; 所 述的充气接口 7端设置有用于检测气囊对肠壁的压力的测压仪。
进一步, 所述的引流段 3是便于插管***的斜形开口。
进一步,所述的引流段 3的管壁上开设有具有协助引流效果的梭 形侧孔 5。
本发明中管道与腹壁的连接方式有如下两种方式:
1、管道的管壁上开设有环形凹槽, 管道通过与环形凹槽相配合的 固定片与腹壁固定连接。所述的固定片为环形固定片, 内径为 0.9cm, 带有弹性橡胶,用于术后固定造痿管于腹壁,其外侧可接造痿袋底盘。
2、 管道的管壁上套接有固定片, 固定片的内径 0.9cm, 略小于 管道的外径; 固定片与腹壁相对的一面为粘性面, 所述的粘性面与所 述的腹壁固定连接。
进一步,所述的管道 1后端设置有与其相适配的便于将管道引出 腹壁的外套管; 所述的外套管内径 lOmm, 方便术中将造痿管引出腹 壁。
本发明气囊直径为 4cm, 长度 5cm, 硅胶材料合成, 柔软, 气囊 通过细管与管道另一端的带有单向阀门的的充气接口相通, 充水 /气 后对肠管产生压力, 气囊易受压变形, 降低对肠管的压力, 同时能起 到阻断封闭肠管的效果, 随着肠蠕动增加, 肠管会逐渐扩张, 气囊亦 可随着肠管扩张而变形, 延迟阻断时间。
本发明所述肠造痿管的具体手术操作方法如下:
直肠吻合完成后, 取末端回肠距离回盲瓣 15cm左右回肠, 3-0可 吸收线作 lcm、 1.5cm大小左右同心圆荷包, 荷包中心电刀切一尽量 小的口子, 将造痿管斜面插向回肠近端, 直至气囊全部***回肠后分 别收紧内外荷包, 注意外荷包尽量把内荷包完全包埋进去。然后从单 向阀门处注水, 注意控制气囊对肠壁的压力在 30-40cmHg之间, 再 在腹壁上做一 1cm左右切口, 将外套管从腹壁外穿入腹腔, 通过外 套管将造痿管引出腹壁, 拔除外套管, 造痿管周边的小肠肠壁浆肌层 和腹壁用可吸收线绕管缝合固定一周。腹壁外造痿管套环形固定片固 定造痿管, 环形固定片底面有粘性, 可以与皮肤密切黏合, 既防止造 痿管回缩, 又可以保护皮肤不被粪水侵蚀, 引起造口皮炎, 固定片外 再贴造口底盘, 然后再套上造痿袋。 术后注意监测气囊压力, 随着肠 管逐渐扩张, 气囊阻断效果会逐渐下降, 如果远端直肠吻合口有漏的 发生, 需继续向气囊注水, 保持气囊的封闭性, 控制气囊压力以延迟 保护周期。 不需要造痿时, 抽空气囊, 即可拔除造痿管。 造痿管拔除 后造痿肠壁自动愈合, 不需要再次回纳, 以达到完全转流的目的。
本说明书实施例所述的内容仅仅是对发明构思的实现形式的列 举, 本发明的保护范围不应当被视为仅限于实施例所陈述的具体形 式,本发明的保护范围也及于本领域技术人员根据本发明构思所能够 想到的等同技术手段。
Claims
1、 完全转流型肠造痿管, 包括合成材料管道, 其特征在于: 所 述的管道上靠近前端部位设置有可变形的气囊,所述的管道位于所述 的气囊前的部分形成引流段;细管的前部穿设在所述的管道内且所述 细管的前端穿过所述的管道的管壁与气囊的内腔连通,所述的细管的 后端连接带有单向阀门的用于向气囊注流体的充气接口;所述的气囊 经充气接口充流体后与肠管之间形成用于阻断肠内容物的封闭结构; 所述的弓 I流段上设有将肠内容物通过管道弓 I出的引流口;所述的充气 接口端设置有用于检测气囊对肠壁的压力的测压仪。
2、 如权利要求 1所述的完全转流型肠造痿管, 其特征在于: 所 述的引流段是便于插管***的斜形开口。
3、 如权利要求 2所述的完全转流型肠造痿管, 其特征在于: 所 述的引流段的管壁上开设有具有协助弓 I流效果的梭形侧孔。
4、 如权利要求 3所述的完全转流型肠造痿管, 其特征在于: 所 述的管道的管壁上开设有环形凹槽,所述的管道通过与所述的环形凹 槽相配合的固定片与腹壁固定连接。
5、 如权利要求 3所述的完全转流型肠造痿管, 其特征在于: 所 述的管道的管壁上套接有一固定片,所述的固定片与腹壁相对的一面 为粘性面, 所述的粘性面与所述的腹壁固定连接。
6、如权利要求 4或 5所述的完全转流型肠造痿管, 其特征在于: 所述的管道后端设置有与其相适配的便于将管道引出腹壁的外套管。
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CN111298273A (zh) * | 2020-04-16 | 2020-06-19 | 上海市东方医院(同济大学附属东方医院) | 回肠造口扩张器 |
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CN103405297A (zh) | 2013-11-27 |
EP3040060B1 (en) | 2018-08-08 |
WO2015028926A1 (zh) | 2015-03-05 |
US10188542B2 (en) | 2019-01-29 |
EP3040060A1 (en) | 2016-07-06 |
CN104146809A (zh) | 2014-11-19 |
CN104146809B (zh) | 2016-07-06 |
EP3040060A4 (en) | 2017-01-18 |
US20160193072A1 (en) | 2016-07-07 |
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