A kind of plasticity dissection of aorta overlay film frame and dissection of aorta support
Technical field
This utility model relates to technical field of medical instruments, is specifically related to a kind of plasticity dissection of aorta overlay film frame and dissection of aorta support.
Background technology
Arotic disease mainly includes aorta true aneurysm and dissecting aneurysm of aorta.
Aorta true aneurysm is not real tumor, but the aorta local caused due to a variety of causes or generally expand, aorta diameter changes more than the pathologic of normal diameter more than 50%.Aortic aneurysm is further divided into aorta true aneurysm and aortic pseudoaneurysm.Aorta true aneurysm is aorta wall and aortic aneurysm wall holostrome all has neuropathic expansion or aortic aneurysm that is prominent and that formed.Aortic pseudoaneurysm is that ductus arteriosus wall is torn or wears out, and blood cut since then flows out and formed hematoma, how caused by wound by the neighbouring tissue encapsulation of aorta.
Dissecting aneurysm of aorta is due to aortic tunica intima local damage, high pressure blood flow pours blood vessel wall, cause film tear (middle level split typically in middle level 1/3 and outer 2/3 interface), make complete aorta wall structure be divided into two, the gap of splitting between the inside and outside wall of interlayer is formed an interlayer cavity.In order to distinguish with aorta lumen, interlayer cavity is referred to as false chamber, and aorta lumen is referred to as true chamber.
Aorta true aneurysm and dissecting aneurysm of aorta are all the most dangerous diseases, and latter 48 hours interior mortality rates of falling ill are more than 50%, and the mortality rate in two weeks after of falling ill is more than 85%, serious threat human health.Along with the arrival of Chinese aging trend, its sickness rate will constantly rise.
Dissection of aorta, according to Stanford typing, can be divided into A type interlayer and Type B interlayer.
A type: intimal tear is positioned at ascending aorta, aortic arch or proximal segment descending aorta, ascending aorta or aortic arch are involved in extension, it is possible to extend to descending aorta notably ventral aorta.
Type B: intimal tear is frequently located in aortic isthmus, extension is only involved descending aorta or extends to ventral aorta, but not involving ascending aorta and aortic arch.
Dissection of aorta, according to DeBakey typing, can be divided into I type interlayer, II type interlayer and type III interlayer.
I type: intimal tear is positioned at ascending aorta, ventral aorta is involved in extension.
II type: intimal tear is positioned at ascending aorta, expansion is only limitted to ascending aorta.
Type III: intimal tear is positioned at aortic isthmus, extension is involved descending aorta (IIIa) or reaches ventral aorta (IIIb).
A type is equivalent to I type and II type, accounts for the 65%-70% of dissection of aorta;Type B is equivalent to type III, accounts for 30%-35%.
This kind of disease of surgical intervention mainly has the Endovascular of traditional open surgery and Wicresoft to get involved isolation operation at present.
The operating difficulty of surgical operation therapy is big, operating difficulties, and operating time is long, big to the wound of patient, and mortality rate is high.Meanwhile, also need to use ancillary technique: the perfusion of Deep Hypothermia Circulatory Arrest, brain, routine in vitro circulation, heating and cooling and cardiovascular anesthesia etc..It addition, surgical field of view interior conduit is numerous and order complicated, anastomotic stoma is many, causes operating time to extend, and ischemic time and cardiopulmonary bypass time extend the most accordingly, thus adds operative mortality and the generation of complication (especially cerebral complication).
In the Micro trauma interventional therapeutic technique utilizing inner cavity insulation principle, generally use overlay film frame isolation blood flow and aortic aneurysm or dissection of aorta.Aorta tectorial membrane stent mainly PET (pet resin) film or ePTFE (politef) film by tinsel and cover it forms in the market, cylindrical stent skeleton made by tinsel, and it covers PET film or ePTFE membrane.By the thinner induction system of caliber, the overlay film frame of compressive state is guided along the seal wire implanted in advance and sends into human body, under the assistance of toning system, accurately discharge after sending to the position of lesion vessels, covering in lesion vessels section, isolation pathological changes also forms new channel of blood flow.
For aneurysm, after losing blood supply, tumor intracavity remained blood gradually forms thrombosis and fleshization forms vascular tissue, and the tumor wall of expansion state, because being shunk by negative pressure, is gradually restored to original form, thus reaches to treat aneurysmal purpose.For dissection of aorta, Lacuna of Aortic Dissection is covered by overlay film frame, and false intracavity gradually thrombosis is tapered into by negative pressure, thus reaches to treat the purpose of dissection of aorta.
Although current Minimally Interventional Therapy technology has the features such as simple to operate, instant effect, but there is also following risk:
Overlay film frame proximal segment plasticity is poor on the market, there is certain elastic Hui Zhili, easily causes the new interlayer cut of overlay film frame near-end and occurs, forms the inverse A type interlayer torn.In the inverse A type interlayer torn, support source property is topmost factor.
Utility model content
This utility model provides a kind of plasticity dissection of aorta overlay film frame, has good compliance and radial direction support strength, has the plasticity of applicable Aortic Dissection simultaneously.
A kind of plasticity dissection of aorta overlay film frame, including the overlay film of tubulose and multiple ring supports of being sewn to the most successively on overlay film, ring support on a portion overlay film is half stitching support, half sews up and has, on support, the non-suture zone that can separate with overlay film, and overlay film corresponding to inflection side, non-suture zone departs from half stitching support fold inward under bending state.
The plasticity dissection of aorta overlay film frame that this utility model provides, the mode utilizing interventional therapy is delivered to the lesion locations of Human Thoracic Aortic Dissection by delivery conduit, overlay film frame is released in true intracavity, reach to block interlayer cut, reduce false cavity pressure, and promote the therapeutic purposes of false intracavity thrombosis.
Described plasticity dissection of aorta overlay film frame is self-expandable stent, in its natural state, for straight tube-like, when being bent by External Force Acting, in inflection side, ring support is mutually drawn close, overlay film corresponding to non-suture zone gathers folding, owing to non-suture zone does not has stitching thread tractive between ring support and overlay film, the folding property that overlay film bending is complied with is greatly enhanced, the support order stacking of non-suture zone, can draw close closer to also superposition each other, folding based on overlay film, and non-suture zone is superposed, after external force is withdrawn, it still is able to the form continuing to keep overlay film frame bent support structure, improve overlay film frame and maintain the compliance of bending shape, realize the plastic of overlay film frame formalness.
When case of bending, when applying external force makes overlay film frame recover straight tube-like, overlay film frame again recovers and keeps straight tube-like.
Axial along overlay film is sewed up some ring supports successively, or is sewed up some ring supports along the regional area that overlay film is axial, can there is the contact structure in addition to overlay film, or be completely independent between each ring support between each ring support.
After overlay film frame is implanted, only bend certain section of axial region, in order to maintain the structural stability in other regions, it is preferable that described half sews up support is distributed in the bending part after plasticity dissection of aorta overlay film frame is implanted.
Described half sews up support refers to that part is not sewed up, and is not necessarily referring to lucky half region and does not sews up.
In order to realize maintaining the bending shape of overlay film frame, it is preferable that described half stitching support is at least two the most adjacent circles.Such as, three circles or four that described overlay film frame is adjacent enclose or five circle or six circles.
As preferably, described half sews up support rises and falls in wavy while circumferentially extending vertically, and described non-suture zone is in the turnover position of wave.
As preferably, adjacent two and half sew up in support, and the turnover position with identical sensing is mutually aligned or mutual dislocation.
Half stitching support is wavy, circumferentially includes some crests the most spaced apart and trough, and adjacent two and half sew up supports, and crest is mutually aligned, and trough is mutually aligned.
As preferably, same half sews up all non-suture zones in support is in the position of respectively transferring that sensing is identical.Described sensing is identical to be referred to, the direction in the direction of wave top of the waves indication, i.e. crest indication or the direction of trough indication.
During in same half stitching support, all non-suture zones are in crest location, or same half stitching support, all non-suture zones are in wave trough position.
In order to ensure that half stitching support will not offset along the position that axially occurs of overlay film, it is preferable that same half sews up on support, points in identical turnover position, and interval, non-suture zone is arranged.
Can be spaced one even more than pointing to identical turnover position, as a example by non-suture zone is arranged on crest, be spaced one or more crest, a non-suture zone be set.
As preferably, adjacent two and half sew up on supports, and non-suture zone misplaces layout in the circumferential.As a example by non-suture zone is arranged on crest, being spaced a crest and arrange a non-suture zone, adjacent two and half sew up in support, and one and half sew up the non-stitching crest of support and stitching crest the axially aligning along overlay film frame of another half stitching support.
As preferably, moving towards along blood vessel, it is crest that implantation subsequently points to the turnover position of heart, and the turnover position of heart is trough dorsad, is connected by connecting rod between crest adjacent in same ring support and trough.
In order to ensure the unobstructed of blood flow, it is preferable that half sews up in support, and non-suture zone is all in crest position.When non-suture zone is in crest location, in the bent state, the overlay film of non-suture zone folds, and folds the flanging formed and complies with the direction of blood flow.
As preferably, same half sews up in support, and each crest uses height peak separation to arrange according to the different of axial location, and described non-suture zone is positioned at high crest.For i.e. sewing up support for same half, the most different crests is the most spaced apart, and each trough axial location can be concordant, it is also possible to the most concordant.
As preferably, same half sews up in support, and each trough uses depth trough interval to arrange according to the different of axial location, and described non-suture zone is positioned at deep trough.For i.e. sewing up support for same half, the trough that the depth is different is the most spaced apart, and the axial location of each crest can be concordant, it is also possible to the most concordant.
As preferably, the axial height of non-suture zone is the 1/4-3/4 of half stitching support axially height.
Described axial height refers to, the axial distance between the highest crest and the deepest trough.As a example by non-suture zone is positioned at crest, for each non-suture zone, non-seam area is that crest is sewed up at support axially height to away from crest 1/4-3/4 half.
In order to adapt to the specific demand of different blood vessel, the plasticity dissection of aorta overlay film frame that this utility model provides can be the tubulose of non-isometrical extension, such as, plasticity dissection of aorta overlay film frame is Taper Pipe shape, or the variable-diameter structure that plasticity dissection of aorta overlay film frame is Taper Pipe shape and straight tube-like composition.
In order to realize the non-isometrical extension tubular structure of plasticity dissection of aorta overlay film frame, in this utility model, each ring support can have different structures.
The near-end of the plasticity dissection of aorta overlay film frame that this utility model provides at least has the annular support that a circle is sewed up entirely, distal portions the most at least has the annular support that a circle is sewed up entirely, and described full stitching refers to that the crest of ring support and trough position are all stitched together with overlay film.
This utility model additionally provides a kind of dissection of aorta support, including the overlay film frame being mutually butted and bare bracket, it is characterised in that described overlay film frame is described dissection of aorta overlay film frame.
Described overlay film frame is used for blocking blood vessel B-mode interlayer near-end cut, reduces false cavity pressure, and promotes false intracavity thrombosis, and bare bracket is positioned over the far-end of overlay film frame, is used for reinventing the true chamber of blood vessel, and ensures that each Visceral artery blood flow is unobstructed.
Described overlay film frame is mutually nested with the butted part of bare bracket, the most at least part of for overlapping region.The axial length of described overlapping region is configured according to needs.
The plasticity dissection of aorta overlay film frame that this utility model provides, when overlay film frame bends, the non-suture zone of the two adjacent ring supports being in inflection side can be stacked, and the overlay film of non-suture zone occurs to fold to internal stent, maintains the bending shape of overlay film frame.
Accompanying drawing explanation
Fig. 1 is embodiment 1 plasticity dissection of aorta overlay film frame schematic diagram;
Fig. 2 a is the schematic diagram of first kind ring support in embodiment 1 plasticity dissection of aorta overlay film frame;
Fig. 2 b is the suture way schematic diagram of first kind ring support in embodiment 1;
Fig. 3 a is the structural representation of Equations of The Second Kind ring support in embodiment 1;
Fig. 3 b is the suture way schematic diagram of Equations of The Second Kind ring support in embodiment 1;
Fig. 4 is the structural representation of the 3rd class ring support in embodiment 1;
Fig. 5 is the 4th class ring support (bare bracket) and the connected mode schematic diagram of overlay film initiating terminal in embodiment 1;
Fig. 6 is embodiment 2 plasticity dissection of aorta overlay film frame schematic diagram;
Fig. 7 a is the suture way displaying figure of Equations of The Second Kind ring support in embodiment 2;
Fig. 7 b is schematic diagram of arranging between the two and half stitching supports that in embodiment 2, Equations of The Second Kind ring support is adjacent;
Fig. 8 is embodiment 3 plasticity dissection of aorta overlay film frame schematic diagram;
Fig. 9 a is the structural representation of Equations of The Second Kind ring support in embodiment 3;
Fig. 9 b is the suture way displaying figure of Equations of The Second Kind ring support in embodiment 3;
Fig. 9 c is schematic diagram of arranging between the two and half stitching supports that in embodiment 3, Equations of The Second Kind ring support is adjacent;
Figure 10 is embodiment 1 support plasticity displaying figure;
Figure 11 is schematic diagram of arranging between the two and half stitching supports that in embodiment 4, Equations of The Second Kind ring support is adjacent.
Detailed description of the invention
With embodiment, this utility model is described in detail below in conjunction with the accompanying drawings.Near-end described in literary composition refers to the one end near cardiac position, and described far-end is the one end away from cardiac position.In the schematic diagram of each embodiment, being arranged above near-end, lower section is far-end.
Embodiment 1
As shown in Figure 1, the present embodiment overlay film frame 100 is made up of the overlay film 150 of tubulose and the multiple independent ring support that is sewn to the most successively on overlay film, near-end to the far-end of overlay film frame 100 be followed successively by ring support 110 (the 4th class ring support), ring support 120 (first kind ring support), ring support 130 (Equations of The Second Kind ring support) and ring support 140 (the 3rd class ring support).
Depending on the particular number of each ring support is according to the axial length of overlay film frame 100.In the present embodiment, ring support 110 is one, and ring support 120 is one, and ring support 130 is four, and ring support 140 is four.
Overlay film 150 uses woven dacron to make, overlay film generally straight-tube shape, and each ring support is sewn on overlay film 150 by suture 160, forms overlay film frame 100.
Each ring support rises and falls in wavy while circumferentially extending vertically, and each ring support is the ring-type of a closing in the circumferential, is connected by connecting rod between same ring support adjacent peaks and trough.Difference based on ring support axial location, the structure of each ring support slightly difference.
Ring support 110 is near the near-end of overlay film frame, and the axial fluctuating quantity of ring support 110 is maximum, and the trough of ring support 110 is stitched together with overlay film 150 by suture 160, and sewing up height is 3mm~5mm.
The axial fluctuating quantity of ring support 120 is less than ring support 110, ring support 110 is identical with the Wave crest and wave trough quantity of ring support 120, ring support 120 is in the near-end of overlay film 150, the crest of ring support 120 is concordant with the axle head of overlay film 150, meanwhile, the crest of ring support 120 and ring support 110 is axially aligned.The crest of ring support 120, trough and connecting rod are all stitched together with overlay film 150 by suture 160.
As it is shown in figure 1, the shape of four ring supports 130 is identical with the shape of ring support 120, ring support 130 is the most equidistantly arranged along overlay film frame, and the crest of each ring support 130 is axially aligned.Ring support 130 is half stitching support, sews up complete state as shown in Figure 3 with overlay film 150.
The axial fluctuating quantity of each ring support 140 is slightly larger than ring support 130, the Wave crest and wave trough quantity of ring support 140 is more than ring support 130, four ring supports 140 are the most equidistantly arranged along overlay film frame, four ring supports 140 are in the remote location of overlay film frame, are fixed together with overlay film 150 stitching by suture 160.
As shown in Figure 2 a, ring support 120 is by multiple Z-shaped wave components, and each Z-shaped ripple includes a crest 122, adjacent trough 123, and the connecting rod 124 being connected between crest 122 and trough 123.
Ring support 120 uses superelastic nickel ferroalloy silk 121 braiding to form, and superelastic nickel ferroalloy silk 121 selectable string diameter (i.e. diameter) scope is 0.3mm~0.55mm.The string diameter selected in the present embodiment is 0.5mm.
The axial height of ring support 120 be the axial distance of the minimum point of peak and the trough of 10mm~18mm, i.e. crest be 10mm~18mm, in the present embodiment, the axial height of ring support 120 is 14mm.
As shown in Figure 2 a, ring support 120 having 1 connection steel bushing 125, two end points of superelastic NiTi alloy silk 121 are connecting inside steel bushing 125, are then fixed on inside steel bushing 125 by the two of titanium-nickel wire end points by mechanical compaction or welding manner.
Ring support 120 uses suture way to be as shown in Figure 2 b connected with overlay film 150, suture 101 moves towards with whole ring support 120 along the waveform of ring support 120, and ring support 120 is sewn on overlay film 150 by the stitching brief summary 141d that suture 101 is distributed by some non-equidistances.The diameter range of choice of suture 101 is 0.05mm~0.25mm.A diameter of 0.1mm of suture 101 in the present embodiment.
As shown in Figure 2 b, stitch points 141a is positioned at crest 122, and stitch points 141a is uniformly arranged by five stitching brief summary 141d and formed, and adjacent two spacing sewed up between brief summary 141d are 0.3-0.8mm.
In stitch points 141b connecting rod 124 between crest 122 and trough 123, stitch points 141b is sewed up brief summary 141d by two and is formed, and sews up brief summary 141d for two and is evenly distributed in connecting rod 124.Stitch points 141c is positioned at trough 123,5 stitching brief summary 141d uniformly arranging forms, and adjacent two spacing sewed up between brief summary 141d are 0.3-0.8mm.
As shown in Figure 3 a, the selection of ring support 130, waveform configuration, processing technology is identical with ring support 120, ring support 130 is by multiple Z-shaped wave components, and each Z-shaped ripple includes a crest 132, adjacent trough 133, and the connecting rod 134 being connected between crest 132 and trough 133.Ring support 130 uses superelastic nickel ferroalloy silk 131 braiding to form, and two end points are fixed by steel bushing 135.Region residing for each ring support 130 constitutes the proximal body section of overlay film frame 100.
As shown in Figure 3 b, ring support 130 is connected by half suture way with overlay film 150, and the crest 132 of ring support 130 does not has stitch points, stitch points 142a to be positioned at connecting rod 134, is sewed up brief summary 142d by two and forms.Stitch points 142b is positioned at trough 133,5 stitching brief summary 142d uniformly arranging forms, and adjacent two spacing sewed up between brief summary 142d are 0.3-0.8mm.
Each stapling unit includes stitch points 142b and two stitch points 142a, and overall in V word structure, the number of stapling unit is identical with the trough number of ring support 130.
As shown in Figure 4, in the present embodiment, ring support 140 is positioned at the far-end section of overlay film frame 100, the material of ring support 140, and processing technology is identical with ring support 120.Ring support 140 is by multiple Z-shaped wave components, and each Z-shaped ripple includes a crest 142, adjacent trough 143, and the connecting rod 144 being connected between crest 142 and trough 143.Ring support 140 uses superelastic nickel ferroalloy silk 141 braiding to form, and two end points are fixed by steel bushing 145.Ring support 140 is identical with the suture way of ring support 120 and overlay film 150 with the suture way of overlay film 150.
On overlay film 150, each ring support 120, ring support 130, the spacing range of ring support 140 are 3mm~5mm, and actual pitch, during ring support is sewed up, suitably adjusts according to the axial overall length of overlay film 150.
The material of ring support 110 in the present embodiment, waveform configuration (except the axial height of waveform), processing technology is identical with ring support 120.
The suture way of ring support 110 and overlay film 150 is as shown in Figure 5, from the lowest point 113a of trough 113 to the proximal staple of the distance of above 3mm~8mm of trough Yu overlay film 150, stitch points 113b is uniformly arranged by 5 stitching brief summaries and is formed, and adjacent two spacing sewed up between brief summaries are 0.3-0.8mm.
As shown in Figure 10, the proximal body section of the overlay film frame 100 that the present embodiment provides has good plasticity, when overlay film frame 100 bends, adjacent ring support 130 is mutually drawn close in inflection side, owing to ring support 130 is not sewed up at the crest of overlay film frame near-end, overlay film 150 at this crest departs from ring support and forms folding part 136b, depart from 136a at the crest after overlay film 150, owing to there is no the obstruction of overlay film 150, each other can draw close closer to, and it is able to maintain that the case of bending of overlay film frame 100, ensure the overlay film frame 100 plasticity in folding process.
Embodiment 2
As shown in Figure 6, the present embodiment overlay film frame 200, by ring support 210, ring support 220, ring support 230, ring support 240, is sewn on overlay film 250 form by suture 260.
Differing only between the present embodiment and embodiment 1, the suture way between ring support 230 from overlay film 250 is different.The selection of ring support 230, waveform configuration, processing technology is identical with ring support 120.
As shown in Figure 7a, between adjacent crest 222a and the crest 222b of each ring support 230, one of them crest 222b has stitch points, another one crest 222a not to have stitch points to the suture way of ring support 230 and overlay film 250.As shown in Figure 7b, from the point of view of whole overlay film frame, the crest 222b having stitch points and the crest 222a not having stitch points is arranged alternately state along overlay film circumference.
Stitch points 270a of crest 222b is sewed up brief summary 270d by 5 and is formed, and sews up brief summary 270d for 5 and is evenly spaced at crest 222b, and adjacent two spacing sewed up between brief summary 270d are 0.3-0.8mm.Stitch points 270b is positioned in each connecting rod 224, and stitch points 270b is sewed up brief summary 270d by two and formed, and sews up brief summary 270d for two and is evenly spaced in each connecting rod 224.Stitch points 270c is positioned at each trough 223 position, and stitch points 270c is sewed up brief summary 270d by 5 and formed, and sews up brief summary 270d for 5 and is evenly spaced at trough 223, and adjacent two spacing sewed up between brief summary 270d are 0.3-0.8mm.
Embodiment 3
As shown in Figure 8, the present embodiment overlay film frame 300, by ring support 310, ring support 320, ring support 330, ring support 340, is sewed up on overlay film 350 by suture 360 and is formed.
The present embodiment differs only in embodiment 2, and each ring support 330 is different from the structure of ring support 230.
As illustrated in fig. 9, the selection of ring support 330, processing technology are identical with ring support 230, differ only in waveform configuration different, there is difference in height between two crest 322a and 322b that each ring support 330 is adjacent.
As shown in figure 9b, there is not stitch points at higher crest 322a, at relatively low crest 322b, there is stitch points 370a in the suture way between ring support 330 and overlay film 350.From whole ring support 330, crest 322a and crest 322b is arranged alternately state along overlay film circumference.
Stitch points 370a existed at crest 322b is sewed up brief summary 370d by 5 and is formed, and sews up brief summary 370d for 5 and is evenly spaced at crest 322a, and adjacent two spacing sewed up between brief summary 370d are 0.3-0.8mm.Stitch points 370b is positioned in each connecting rod 324, and stitch points 370b is sewed up brief summary 370d by 2 and formed, and sews up brief summary 370d for two and is evenly distributed in connecting rod 324.
Stitch points 370c is positioned at each trough 323 position, and stitch points 370c is sewed up brief summary 370d by 5 and formed, and sews up brief summary 370d for 5 and is evenly spaced at trough 323, and adjacent two spacing sewed up between brief summary 370d are 0.3-0.8mm.
Embodiment 4
As shown in figure 11, the present embodiment differs only in embodiment 3, and adjacent two and half sew up the arrangement mode difference of support.
As shown in figure 11, each half sews up in support, difference in height is there is between two adjacent crest 422a and 422b, the extreme lower position of trough 423 circumferentially flushes, adjacent two and half sew up in support, and one of them half crest sewing up support aligns on axial location with another half trough sewing up support.