CN100512766C - 伤口牵开机 - Google Patents

伤口牵开机 Download PDF

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CN100512766C
CN100512766C CNB998139580A CN99813958A CN100512766C CN 100512766 C CN100512766 C CN 100512766C CN B998139580 A CNB998139580 A CN B998139580A CN 99813958 A CN99813958 A CN 99813958A CN 100512766 C CN100512766 C CN 100512766C
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wound
outer shroud
machine
connection element
retracts
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CN1329474A (zh
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弗兰克·博纳迪奥
沙内·约瑟夫·麦克纳利
罗南·伯纳德·麦克马纳斯
德里克·威廉·扬
艾伦·里德
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Atropos Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside

Abstract

本发明涉及一种伤口牵开机，其包括：内环，用于插入伤口开口；第一外环，用于固定伤口开口的外部；以及连接元件，其在内环和第一外环之间延伸；其中，该连接元件的一端固定到第一外环上，该连接元件可相对于内环进行移动；且该连接元件的另一端可相对于第一外环进行移动，以缩短位于内环和第一外环之间的连接元件轴向长度。根据本发明，伤口能够被牵引和保护。

Description

伤口牵开机
发明背景
本发明涉及一种外科手术设备。具体地说，本发明涉及一种在手术期间用于切口或身体上天然孔口牵引的设备，用于阻止在手术期间切口的边缘感染或肿块的产生。
伤口牵引
在现代外科手术过程中，要求适当的解剖暴露，以允许手术被安全和有效地进行。通过分开天然孔口的孔壁或舒展开手术切口的边缘，获得所述的解剖暴露。通过适当的牵引，一困难的外科手术可以被简化，反之由于缺乏适当的牵引，一相对简单的手术可以变得更困难甚至危险。通过正确的切口布局和良好导向的牵引，暴露被最大化。
可以使用几种方式获得牵引。最通用的外科伤口牵引方法是利用手持牵开机。所述牵开机可以由金属或热塑塑料制成，允许操作者对伤口边缘施加一牵引力。所述牵开机可以是一次性的，也可以被重复使用，具有多种外形和尺寸，以满足不同的外科手术的要求。
另一种众所周知的牵开机是是被安装在挂架上的牵开机设备。这种设备包括一刚性圆形或马蹄铁形的挂架，在所述挂架上，连接多个可拆卸和可移动的桨形牵开机。设备可以被安装在一操作台上，以提供可靠的固定。可以沿所期望的方向实行牵引。通常这种牵开机由不锈钢制成，以便于为了重复使用而进行清洁和消毒。在消毒之前，一些更复杂的牵开机需要被拆开，然后在使用之前，再重新装配。这些设备总是在伤口上少数指定的位置实行牵引。这是该设备的一个缺陷，因为它导致在伤口边缘部分局部缺血。
美国专利US-A-5,524,644(Crook)介绍了一种伤口牵开机和保护器。这种设备包括一由聚合材料组成的端口敞开的套筒，在所述套筒的每一端具有一弹性环。一个环被插入切口，套筒围绕着另一个环被人工卷起，从而向聚合材料施加张力以获得牵引。由于要求手灵巧，特别是当外科医生的手是湿的时候，设备经常难以使用。此外，增加了设备的调整。这限制了横跨整个腹壁厚度的设备效率。
美国专利US-A-5,545,179(Williamson IV)介绍了一种设备，它具有一人造橡胶的密封元件和管形导管。设备阻止伤口边缘被污染。然而，设备专门适用于腹腔镜仪器，由于伤口切口没有被足够地牵引，所述设备不适用于手做的手术。
国际专利申请WO-A-96/36283(Mollenauer)介绍了一用于牵引和密封一切口的套管针，并提供了一密封的用于外科仪器的通道。虽然设备对伤口边缘提供了牵引和保护，由于尺寸的限制，该种设备不适合于手做的手术。由于一个或多个气球的膨胀，该设备进行牵引和保护，当膨胀时，由于这些气球包围内腔，不可能通过设备看见腹腔内的情况。
国际专利申请WO-A-98/48724介绍了一适用于用手操作的腹腔手术设备。设备具有一伤口牵开机/保护器元件和一用于围绕外科医生的手腕进行密封的元件。伤口保护器元件包括一内环和两个彼此垂直重叠的可膨胀的油炸圈饼形状的外环。利用一人造橡胶套筒，将内环和外环相连。两个外环的膨胀导致人造橡胶套筒被牵引。该设备提供了伤口牵引和保护，但是由于外环，设备不能具有较大的垂直方向轮廓。它调整到达切口的距离并延长所用的任何仪器的支点，从而使横向运动的有效到达距离和暂停将被严格地限制。
伤口保护
如果伤口边缘与感染物质接触，例如身体局部或流经伤口敞开部分的流体，敞开的伤口的边缘容易被感染和交叉感染。致癌材料与伤口边缘接触也可能产生严重的问题。众所周知，致癌细胞可能会生长在伤口区域，特别是在套管针的位置。
为了避免这些问题，必须利用铺巾仔细地保护切口边缘，液体不能透过所述铺巾。美国专利US3,397,692(Creager)介绍了一种切口衬垫。所述衬垫包括一聚合材料板。板的中央具有一孔，利用半刚性环，加强了所述孔的边缘。这个环可以被插入切口，允许外科手术通过环而进行，同时被连接在环上的材料在伤口位置保护切口边缘不被玷污。这些设备被3M公司作为“steridrape”买卖，具有适用于不同的伤口大小的规格。然而，这种设备不适合于切口的牵引。
公知的设备或者是复杂结构，不能有效地密封伤口和/或者难以操作。
因此需要一种改善的外科手术设备，能够至少克服这些问题中的一部分问题。
本发明描述
根据本发明提供一种外科手术设备，它包括：
一内安装元件，用于插入伤口开口；
一第一外安装元件，用于固定伤口开口的外部；
在内、外安装元件之间延伸的连接元件；
连接元件可以移动，以缩短连接元件的轴向长度。
在本发明所推荐的一实施例中，外安装元件可以相对于内安装元件移动，以扭曲连接元件，从而形成一横截面减少的内腔，并缩小了连接元件的轴向长度。
最好外安装元件可以相对于内安装元件转动，以扭曲连接元件。
在本发明所推荐的一实施例中，所述连接元件是一由柔韧材料制成的套筒，所述套筒在内、外安装元件之间延伸。
在一方面，设备包括一第二外安装元件，连接元件在第一安装元件、内安装元件和第二外安装元件之间延伸。
此时，最好第一和第二外安装元件可以彼此相对转动，以扭曲连接元件，并将内安装元件拉向外安装元件。外环也可以相对于内安装元件转动。
在本发明所推荐的一实施例中，所述内安装元件是一O型环。最好所述连接元件是一套筒，它从第一外安装元件伸向O型环，从O型环伸向第二外安装元件。
在本发明所推荐的一实施例中，设备包括锁定元件，用于将第一外安装元件相对于第二外安装元件锁定。
在一种配置中，其中外安装元件位于或可位于另一个外安装元件内。
最好所述套筒的内径大于或等于套筒的轴向长度。
在一最佳配备中，所述套筒的内径大于套筒的轴向长度一定数值，所述数值小于腹壁的平均厚度，通常是2～6cm。这有助于获得一牵引力。
最好随套筒长度的缩短，在外安装元件之间，形成一显著的气密性密封。理想的情况是，在第一和第二外安装元件之间延伸的套筒确定了一可膨胀空间。
在本发明所推荐的一实施例中，所述设备包括一用于与一膨胀装置相连的通口。
本发明也提供一种外科手术设备，其包括：
一用于插入伤口开口的内安装元件；
一第一外安装元件；
一第二外安装元件；
一柔韧材料制成的套筒，从第二外安装元件向内安装元件延伸，从内安装元件向第一外安装元件延伸。
最好第一和第二外安装元件中的一个或两个相对于对方可以移动，以调整内腔的直径，通过在第一和第二外安装元件之间扭曲套筒而限定所述内腔。
理想的是，第一和第二外安装元件可彼此相对转动。
在本发明所推荐的一个实施例中，套筒可拆卸地安装在第二外安装元件上，用于调整套筒的长度。
最好第二外安装元件包括一接受器，套筒被安装或可安装到一环上，所述环可拆卸地安装在接受器内。
在本发明所推荐的另一个实施例中，内安装元件被配置，以减少其尺寸，从而利于插入伤口开口。
通常此时所述内安装元件包括一个环，所述环包括一铰链元件，用于减少环的尺寸。
根据权利要求1所述设备，其特征在于，所述连接元件被平移以缩短连接元件的轴向长度。
根据权利要求23所述设备，其特征在于：所述连接元件包括一套筒，所述套筒被一牵引带机构所平移。
根据权利要求24所述设备，其特征在于：所述连接元件包括多个被连接在内安装元件上的带，带被向上拉，以缩短连接元件的轴向长度。
通常所述外安装元件包括一用于夹持一外科手术仪器的夹持器。
外科手术设备可以形成一伤口牵开机、一伤口保护器或一伤口保护牵开机。
附图简介
通过下文结合附图对本发明所推荐的示例所作的详尽的描述，本发明将变得更加容易理解。
图1是一符合本发明的外科手术设备的透视图；
图2是一图1所示设备的剖面图；
图3示出了该设备处于使用位置时的剖面图；
图4示出了该设备处于另一使用位置时的剖面图；
图5示出了处于图4位置的设备的顶视图；
图6和图7分别是透视图和剖面图，显示了形成图1～5所示设备的方法；
图8是一符合本发明另一种外科手术设备的透视图；
图9是图8所示设备的剖面图，显示所示设备处于一使用位置；
图10是图8所示设备的剖面图，显示所示设备处于另一使用位置；
图11和12是剖面图，显示符合本发明的另一种外科手术设备处于不同的使用位置；
图13是一平面视图，显示了图11所示设备；
图14是一符合本发明另一种外科手术设备的剖面图；
图15A和15B是剖面图，显示了处于使用位置的图14所示设备；
图16是一平面视图，显示了图14所示设备；
图17是一符合本发明另一种外科手术设备的剖面图；
图18是一平面视图，显示了图17所示设备；
图19是一符合本发明另一种外科手术设备的剖面图；
图20是一平面视图，显示了图19所示设备；
图21是一符合本发明另一种外科手术设备的剖面图；
图22是一符合本发明另一种外科手术设备的剖面图；
图23是一平面视图，显示了图22所示设备；
图24是一符合本发明另一种外科手术设备的透视图；
图25是一透视图，显示了图24所示设备正在被调整；
图26是一侧视部分剖面图，显示了图24和25所示设备；
图27是一类似于图26的视图，显示了部分被拆卸的设备；
图28是一类似于图26的视图，显示图27中的设备被重新装配；
图29是一示意性透视图，显示了符合本发明的另一种外科手术设备；
图30是一透视图，显示了图29所示设备处于伤口插入结构；
图31和32分别是透视图和平面视图，显示了图29和30所示设备的内环元件；
图33是一剖面图，显示了处于将要装配状态的两个外科手术设备；
图34是剖面图，显示了图33所示设备处于已被装配的状态；
图35是一平面视图，显示了符合本发明的另一种外科手术设备；
图36是一沿图35中A-A线所做的剖面图，设备处于一切口位置；
图37是一平面视图，显示图35和36所示设备处于另一种使用位置；
图38是一沿图37中B-B线所做的剖面图。
详细描述
参照附图，首先是图1～7，其显示了一特别适用于腹腔手术的外科手术设备。设备1被用于在病人腹部的腹壁3上的切口2的外科手术。在此情况下，伤口被本发明的设备1保护和牵引。因此，本发明提供一伤口保护牵开机。
设备1包括一由弹性材料例如人造橡胶组成的O型环形式的内安装元件，适用于插入伤口开口2；一被安置在伤口开口2的外面的外安装元件和一连接元件，此时，所述连接元件采用在内安装元件10和外安装元件之间延伸的套筒11的形式。外安装元件相对于内O型环10是可移动的，在这里是可转动的，以扭曲套筒11，从而形成一横截面减少的居中的内腔12，并缩短套筒11的轴向长度。由于套筒11被扭曲，内O型环10从图3所示插入位置被向上拉到图4所示的使用位置，在此位置，伤口被封闭，一径向牵引力作用于伤口。通过被封闭和牵引的伤口，外科医生将一带密封手套的手/手臂/仪器插入，在腹腔内部进行外科手术。
在此情况下，外安装元件包括一第一环形圈20形式的第一外安装元件和一第二环形圈21形式的第二外安装元件。套筒11由不会引起排斥的柔软的不透气塑料材料制成，其一端与环20相连，另一端与环21相连。如图2所示，套筒11被连接在环20上，经过O型环10然后返回与环21相连。
在使用中，如图3所示，外科医生在腹腔制造一切口，O型环10被弯曲并插入切口。沿图3中箭头A和B所示方向，外环20、21彼此相对转动。这种相对转动扭曲并缩短了套筒11，直到设备处于图4所示的操作位置。在此位置，内O型环10靠着前部腹壁的内侧，环20、21位于伤口的外面，套筒11在轴向长度上被缩短。套筒11的扭曲提供一尺寸减少的中央内腔12，所述尺寸减少取决于扭曲的程度。180°的相对扭曲将导致内腔的封闭。减少的内腔12提供适用于仪器和/或外科医生手臂的通道，同时保持伤口的密封。
任何适合类型的锁定元件可以被提供，用于将环20、21锁定在一起。锁定元件例如可以包括一可释放的锁存系统，例如一棘轮机构或类似装置。
最好在使用中，在环20、21之间形成一气密性密封。此时，套筒11可以在环20、21和内O型环10之间提供一膨胀空间30。一膨胀连接口可以被提供在设备上，用于实现膨胀。当膨胀时，套筒的伤口结合断面11a被径向向外推，以提供一高效的伤口保护器/密封件和伤口牵开机。内套筒断面11b被膨胀，以进一步限制内腔12并提供更高效的与插入内腔的外科医生前臂、设备或仪器的密封接合。
为了有效地密封接合，如图7所示，套筒11的内径(d)最好大于或等于套筒11的轴向长度(L)。套筒的内径最好大于套筒的轴向长度一定数值，所述数值小于腹腔壁的平均厚度。因为这种结构，当扭曲套筒11时，密封和牵引力被施加到伤口开口上。
如图6、7所示，将圆柱形套筒50连接在一对环20、21上而形成外科手术设备1，所述套筒可以由柔韧塑料材料制成。一弹性O型环10被装配在套筒50上。弹性套筒50然后被围绕自身翻转，所以，O型环10被限定在内、外套筒部分套筒断面11a、11b之间，环20、21处于图1、2所示结构中。
本发明的设备向伤口边缘施加一个力，使伤口适当的暴露，同时没有导致伤口边缘局部缺血。设备阻止伤口边缘交叉感染或产生癌细胞或别的恶性肿瘤细胞。另一个优点是，设备价格低廉，在使用一次后可以被处理，因此不必在使用之间进行清洁和消毒。此外，能够简单地将设备安置在伤口内或人体上天然孔口内所期望的位置，容易拆卸，特别是没有否定作为伤口保护器使用而获得的优点。
图8～10显示了符合本发明的另一种外科手术设备60。设备60类似于设备1，使用相同的附图标记代表相同的元件。此时，套筒61是一单壁套筒，仅有一个外安装环62。如图9、图10所示，当外安装环62相对于内环10转动时，在套筒上形成扭曲，套筒被缩短，向上拉内环10，使之靠着前腹壁的内侧，如图9、10所示。
可以理解，通过例如粘附，可使内O型环10被固定在外科手术设备的套筒上。同样可以理解，一或多个安装元件可以被成型为与组织正确地接合。例如，安装元件可以包括组织接合凸起，用于将安装元件锁定在适当的位置。
很明显在有效地牵引和伤口保护期间，最好外、内安装元件之间的连接元件是一由柔韧材料制成的套筒，连接元件可以是不连续的。例如，套筒可以采用细长的带或类似形状。
图11～13显示了符合本发明的另一种外科手术设备70。此时连接元件包括多个带71，所述带被向上拉，以缩短轴向长度，并形成一伤口牵开机。使用适当的锁定元件例如楔72，将带71保持在缩短状态。此时，一可变光圈类型的设备80被设置在伤口开口内，其可以从图11所示静止状态膨胀到图12所示的受压膨胀状态。
图14～16显示了符合本发明的另一种外科手术设备85。此时连接元件由多个带86所确定，利用一带扣设备87，所述带86可以在内安装环83和外安装环84之间移动，从图15B所示初始位置移动到图15A所示伤口牵引位置。内环83被首先插入切口。通过拉紧带86，外环82被降低到皮肤上。为了获得牵引效果，带86被拉紧，导致伤口边缘从伤口中心点向外移动。带86可以被调整，直到获得最优牵引。带86上的张力被带扣87所维持，利用摩擦或使用夹持机构，所述带扣87可保持带86被绷紧。
图17和18显示了另一种类似于设备85的外科手术设备90。此时，内和外安装环82、83的横截面形状是椭圆型的，以利于带86的平稳的运动。这个设备的操作方式与设备85的操作方式相同。
图19和20显示了另一种外科手术设备93，它具有单股带94。这个设备的操作方式与设备85和90的操作方式相同。此时带94不是环绕内环83，而是直接被连接在内环上。
图21显示了另一种具有带96的外科手术设备95，利用一种锁定机构，带96被固定。锁定机构包括一插入孔的楔97，带96通过所述孔，并利用摩擦夹持带96。一棘轮机构也可以被使用，或一些别的可调整锁定机构将带保持在所需位置。
图22和23所示设备98类似于图21所示设备，除了使用不同结构的楔或棘轮99以将带锁定在所需位置。
图24～26显示了符合本发明的另一种外科手术设备。此时，外科手术设备是一伤口保护牵开机200，它的结构与图1～10所示结构相似。设备1包括一第一O型环201形式的内安装元件，一安装在第一接受器203内的第二O型环202形式的第一外安装元件，和一安装在第二接受器206内的第三O型环205形式的第二外安装元件。此时，接受器203、206如图所示那样相互连接，在装配时，一第四O型环207被设置在接受器203、206之间。
由柔韧弹性塑料材料制成的套筒210从第二接受器206延伸到内O型环201，并从内O型环201延伸到第一外接受器203。如图25所示，接受器203、206是可拆卸的，便于在它们之间沿箭头所示方向相对转动，以改变套筒210的扭曲程度。
图27和28显示了符合本发明的另一种外科手术设备220，它是一种类似于图24～26所示设备，使用相同的附图标记代表相同的元件。此时O型环205可以从接受器206上拆卸，以便于调整套筒210的长度。拆卸O型环205后，套筒210被调整到一期望的长度d。用此方式，一单独设备220可以适用于不同腹部厚度。通过扭曲而形成的内腔直径不必被改变，以迎合腹部尺寸。多余的套筒可以被切掉或缠绕O型密封环205。
图29～32显示了符合本发明的另一种外科手术设备230，它类似于图24～28所示的设备，使用相同的附图标记代表相同的元件。一内安装元件231被配置，以减少其尺寸，从而便于插入伤口开口。此时，内安装元件231是一种开口环，被铰接在232，便于如图所示减少环231的直径。当然很明显，铰链可以被整体形成，实际上可以具有多个这样的铰链。
图33和34显示了两个外科手术设备250、260的组合。设备250是一前臂密封，设备260是一被装配在外密封设备250上的伤口保护牵开机。密封设备250提供一外密封的进入口，通过该进入口，外科医生可以插入他的前臂或插入一仪器或类似物品。
图35～38显示了符合本发明的另一种外科手术设备300。设备300是一类似于上述设备的伤口保护牵开机。此时，伤口保护牵开机300包括一由半刚性弹性材料制成的内环301和一由类似材料制成的外环302。一柔韧材料制成的套筒在环301、302之间延伸。牵引带305被装配在套筒303上，牵引带沿箭头所示方向被向外拉，以向上拉套筒303，从而在切口处绷紧，以提供一伤口保护和牵引。
在我们的系列申请ATRO1/C、ATRO12/C、ATRO14/C、ATRO15/C、ATRO16/C、ATRO17/C中，提出适当的变化和变型，上述申请中的内容可以被结合在这里以供参考。
本发明并不局限于上述示例，可以在结构和细节上进行修改。

Claims (27)

1、一种伤口牵开机，包括：
内环，用于插入伤口开口；
第一外环，用于固定伤口开口的外部；以及
连接元件，其在内环和第一外环之间延伸；
其中，该连接元件的一端固定到第一外环上，该连接元件可相对于内环进行移动；且该连接元件的另一端可相对于第一外环进行移动，以缩短位于内环和第一外环之间的连接元件轴向长度。
2、根据权利要求1所述的伤口牵开机，其特征在于，所述连接元件被设置成绕过所述内环。
3、根据权利要求1所述的伤口牵开机，其特征在于，所述连接元件是由柔韧材料制成的套筒。
4、根据权利要求1所述的伤口牵开机，其特征在于，还包括第二外环。
5.如权利要求4所述的伤口牵开机，其特征在于，所述连接元件在另一端处连接到第二外环上。
6、根据权利要求4所述的伤口牵开机，其特征在于，所述内环是一O型环，且连接元件是一套筒，该套筒从第一外环导向O型环，再从O型环导向第二外环。
7、根据权利要求5所述的伤口牵开机，其特征在于，还包括一锁定元件，用于将第一外环相对于第二外环进行锁定。
8、根据权利要求4所述的伤口牵开机，其特征在于，所述第一外环和第二外环中的其中一个外环，位于或可位于另一个外环之内。
9、根据权利要求4所述的伤口牵开机，其特征在于，在连接元件的长度缩短时，在第一外环和第二外环之间形成有充分气密性密封。
10、根据权利要求9所述的伤口牵开机，其特征在于，该连接元件包括一个套筒，该套筒在第一外环和第二外环之间延伸，以确定一可膨胀空间。
11、根据权利要求10所述的伤口牵开机，其特征在于，所述伤口牵开机包括一通口，用于与一膨胀装置相连。
12、根据权利要求4所述的伤口牵开机，其特征在于，该连接元件是一个套筒，且该套筒可拆卸地安装到第二外环上，用于调整该套筒的长度。
13、根据权利要求12所述的伤口牵开机，其特征在于，第二外环包括一接受器，且该套筒被安装或可安装到另一个环上，所述另一个环可拆卸地安装到该接受器上。
14、根据权利要求1所述的伤口牵开机，其特征在于，该内环被设计成减少其尺寸，从而利于插入伤口开口。
15、根据权利要求14所述的伤口牵开机，其特征在于，所述内环包括一铰链元件，用于减少该内环的尺寸。
16、根据权利要求1所述的伤口牵开机，其特征在于，该第一外环可以相对于内环移动，以扭曲连接元件，从而形成一横截面减少的内腔，并缩短位于内环和第一外环之间的连接元件的轴向长度。
17、根据权利要求16所述的伤口牵开机，其特征在于，该第一外环可相对于内环转动，以扭曲连接元件。
18、根据权利要求4所述的伤口牵开机，其特征在于，第一外环和第二外环可以相对于彼此转动，以扭曲连接元件，并朝向外环方向牵引内环。
19、根据权利要求1所述的伤口牵开机，其特征在于，所述连接元件可被平移，以缩短连接元件的轴向长度。
20、根据权利要求19所述的伤口牵开机，其特征在于，所述连接元件包括一套筒。
21.根据权利要求20所述的伤口牵开机，其特征在于，所述套筒可被一牵引带机构所平移。
22、根据权利要求19所述的伤口牵开机，其特征在于，所述连接元件包括多个带，所述多个带被向上拉动，以缩短位于内环和第一外环之间的所述带的轴向长度。
23、根据权利要求1-22中任一所述的伤口牵开机，其特征在于，所述第一外环或第二外环包括用于夹持外科手术仪器的夹持器。
24、根据权利要求1-2、4-22中任一所述的伤口牵开机，其特征在于，该伤口牵开机形成为伤口保护牵开机。
25、根据前面权利要求1-22中任一所述的伤口牵开机，其特征在于，还包括连接装置，用于将该伤口牵开机连接到其他设备上。
26、根据权利要求25所述的伤口牵开机，其特征在于，所述其他设备是另一种外科手术设备。
27、根据权利要求26所述的伤口牵开机，其特征在于，所述其他设备是前臂封隔装置。
CNB998139580A 1998-12-01 1999-12-01 伤口牵开机 Expired - Fee Related CN100512766C (zh)

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CN102397087A (zh) * 2010-08-12 2012-04-04 Tyco医疗健康集团 胸部进入口件
CN102397087B (zh) * 2010-08-12 2015-04-22 柯惠Lp公司 胸部进入口件

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EP1958573A1 (en) 2008-08-20
US20050240082A1 (en) 2005-10-27
EP1146826A1 (en) 2001-10-24
US7081089B2 (en) 2006-07-25
BR9915848A (pt) 2001-08-21
US20030078478A1 (en) 2003-04-24
DE69928128D1 (de) 2005-12-08
AU773994B2 (en) 2004-06-10
WO2000032116A1 (en) 2000-06-08
US6846287B2 (en) 2005-01-25
DE69928128T2 (de) 2006-07-06
EP1958573B1 (en) 2016-07-27
JP2002531160A (ja) 2002-09-24
EP1602333A1 (en) 2005-12-07
IE991009A1 (en) 2000-07-12
US7300399B2 (en) 2007-11-27
ES2251262T3 (es) 2006-04-16
CA2351643A1 (en) 2000-06-08
ATE308277T1 (de) 2005-11-15
AU1405200A (en) 2000-06-19
CN1329474A (zh) 2002-01-02
US20050090716A1 (en) 2005-04-28
US20010037053A1 (en) 2001-11-01
JP4181306B2 (ja) 2008-11-12
ES2305967T3 (es) 2008-11-01
EP1146826B1 (en) 2005-11-02
IL143179A0 (en) 2002-04-21
US20080097162A1 (en) 2008-04-24
ATE397416T1 (de) 2008-06-15
EP1602333B1 (en) 2008-06-04
US20070203398A1 (en) 2007-08-30
DE69938879D1 (de) 2008-07-17
CA2351643C (en) 2010-02-02

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