CN201019791Y - forceps stapler - Google Patents
forceps stapler Download PDFInfo
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- CN201019791Y CN201019791Y CNU2007201437459U CN200720143745U CN201019791Y CN 201019791 Y CN201019791 Y CN 201019791Y CN U2007201437459 U CNU2007201437459 U CN U2007201437459U CN 200720143745 U CN200720143745 U CN 200720143745U CN 201019791 Y CN201019791 Y CN 201019791Y
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Abstract
Description
技术领域technical field
本实用新型涉及用于外科手术的医疗器械,尤其涉及一种镊式缝合器。The utility model relates to a medical instrument for surgical operation, in particular to a tweezers type suturing device.
背景技术Background technique
在外科手术中,经常遇到术区位于腔隙深在而且狭窄的部位,如扁桃体窝、鼻腔、胸腔、颅底等部位和一些内窥镜手术中需要缝合的部位,这些部位往往位于重要器官上或其附近,组织脆弱,不耐牵拉,如何进行这些部位的精确缝合是一个一直困扰外科医生的难题。传统的缝合器械由持针器、缝针、缝线组成,缝针的针眼位于缝针的尾端。缝合过程为:外科医生一手用镊子或止血钳等手术器械牵开组织暴露手术野,另一手持持针器夹持穿有缝线的缝针,自要缝合的组织一侧进针,针头从要缝合的组织另一侧穿出后松开持针器,再用同一持针器夹持已穿出的针尖,将针拉出同时通过针的尾端将线带出,将缝针取下后进行缝线打结,完成一次缝合。这种缝合技术在手术野暴露较好的部位(比如皮肤的缝合)显示不出它的缺点,但在深在而且狭窄的腔隙部位,其缺点则非常明显:1、持针器较大的体积使其难以进入一些较小的腔隙或进入后阻挡了术者的视野;2、针尖从要缝合的组织另一侧穿出后,需要助手帮术者夹持针尖,因为在松开持针器后由于组织的回复往往在术者夹住针尖之前使针尖重新退缩到组织中无法夹持,但助手的帮助又带来两个问题,首先由于术区的狭小难以使助手再置入另一手术器械,其次由于助手与术者用力的不一致常常造成组织的撕裂或缝针丢失;3、由于持针器夹持缝针的角度及缝合时用力的角度范围有限,在深在而且狭小的腔隙术区内并不能缝合所有的伤口,一些应该缝合的部位被迫放弃而改为填塞或压迫。由于微创外科发展的需要,人们改进了各种缝合的器具,如:中国专利局公布的专利号为92232376.3、专利号为200520069505.X等专利文献披露的缝合器均为针眼位于缝针前端,较好的保护了要缝合的组织,但都仅仅完成了穿线的动作,还需要术者另一手或助手的帮助。中国专利局在2006年1月公告的申请号为200410052745.9的专利文献披露了一种外科手术自动缝合器,它解决了出针力的一致性问题,并减少了组织的损伤,但是结构复杂、体积较大、操作程序多,不适合小腔隙的缝合。近年来,由于人工智能、组织工程学等相关学科的发展,人们开始模仿人手制作更加微小的器械(请见Maria Siemionow,KaganOzer,Wlodzimierz Siemionow,Robotic assistance inmicrosurgery,Journal of reconstructive microsurgery,2000,(16)8:643-649,机器人辅助显微外科,修复显微外科杂志,2000,(16)8:643-649)或设计智能控制针(请见Patrick Sears and Pierre Dupont,A Steerable Needle Technology Using Curved Concentric Tubes,International Conference on Intelligent Robots and Systems,October9-15,2006,Beijing,China,一种应用弯曲的同轴管的可控针技术,国际智能机器人系统会议,2006年10月9日-15日,中国北京),但都限于其学科本身的发展,这些研究仅停留在理论水平,目前尚未有可利用的器械产生。In surgical operations, it is often encountered that the operation area is located in a deep and narrow cavity, such as the tonsillar fossa, nasal cavity, chest cavity, skull base, etc., and some parts that need to be sutured in endoscopic surgery. These parts are often located in important organs. On or near the area, the tissue is fragile and not resistant to traction. How to suture these parts accurately has been a problem that has always plagued surgeons. Traditional suturing apparatus is made up of needle holder, sewing needle, suture thread, and the eyelet of sewing needle is positioned at the tail end of sewing needle. The suturing process is as follows: the surgeon uses tweezers or hemostatic forceps and other surgical instruments to retract the tissue to expose the surgical field, and the other hand holds the needle holder to hold the suture needle with suture, and inserts the needle from the side of the tissue to be sutured. Release the needle holder after the other side of the tissue to be sutured passes through, and then use the same needle holder to hold the pierced needle point, pull the needle out and at the same time bring the thread out through the tail end of the needle, and remove the needle Finally, the sutures are knotted to complete a suture. This suture technique does not show its disadvantages in the better exposed parts of the surgical field (such as suturing of the skin), but in the deep and narrow cavity, its disadvantages are very obvious: 1. The needle holder is larger The volume makes it difficult to enter some small cavities or block the operator's field of vision; 2. After the needle tip passes through the other side of the tissue to be sutured, an assistant is required to help the operator hold the needle tip, because the Due to the recovery of the tissue after the needle, the needle tip retracts into the tissue and cannot be clamped before the operator clamps the needle tip. However, the help of the assistant brings two problems. First, it is difficult for the assistant to insert another needle because of the narrow operation area. 1. Surgical instruments, and secondly, the inconsistency between the assistant and the operator often causes the tearing of the tissue or the loss of the suture needle; 3. Due to the limited angle range of the needle holder holding the suture needle and the angle range of force when suturing, it is deep and narrow Not all wounds can be sutured in the lacunar surgery area, and some parts that should be sutured have to be abandoned and replaced by packing or compression. Due to the needs of the development of minimally invasive surgery, people have improved various suturing utensils, such as: the patent No. 92232376.3 and the patent No. 200520069505.X disclosed by the Chinese Patent Office all have needle holes at the front end of the sewing needle. The tissue to be sutured is better protected, but only the threading action is completed, and the operator's other hand or the help of an assistant is needed. The patent literature with the application number 200410052745.9 announced by the Chinese Patent Office in January 2006 discloses a surgical automatic stapler, which solves the problem of consistent needle force and reduces tissue damage, but has a complex structure and a large volume. Larger and more operating procedures, it is not suitable for suturing small cavities. In recent years, due to the development of artificial intelligence, tissue engineering and other related disciplines, people have begun to imitate human hands to make smaller instruments (see Maria Siemionow, KaganOzer, Wlodzimierz Siemionow, Robotic assistance inmicrosurgery, Journal of reconstructive microscopy, 2000, (16) 8:643-649, Robot-Assisted Microsurgery, Journal of Reconstructive Microsurgery, 2000, (16) 8:643-649) or designing intelligently controlled needles (see Patrick Sears and Pierre Dupont, A Steerable Needle Technology Using Curved Concentric Tubes, International Conference on Intelligent Robots and Systems, October9-15, 2006, Beijing, China, a controllable needle technology using a curved coaxial tube, International Conference on Intelligent Robots and Systems, October 9-15, 2006, Beijing, China), but they are all limited to the development of the subject itself. These studies are only at the theoretical level, and there is no available equipment yet.
实用新型内容Utility model content
本实用新型充分考虑国内外目前类似或相关装置中出现的各种缺点,并加以克服。其目的是通过该实用新型实现位于深在而且狭窄的术区的精确的缝合。The utility model fully considers and overcomes various shortcomings in current similar or related devices at home and abroad. Its purpose is to realize the precise suturing in the deep and narrow operation area through the utility model.
为此,本实用新型提供了一种镊式缝合器,其中,所述镊式缝合器包括持针器、拾线器、线盒和弹性柄,所述持针器与拾线器均为细杆状,并通过所述弹性柄呈V形地连接为一个整体,所述持针器与拾线器通过所述弹性柄保持V形张开,所述持针器与拾线器之间为线盒,所述线盒内置线轴。For this reason, the utility model provides a tweezers type suturing device, wherein, the tweezers type suturing device includes a needle holder, a thread picker, a thread box and an elastic handle, and the needle holder and the thread picker are thin Rod-shaped, and connected as a whole in a V shape through the elastic handle, the needle holder and the thread picker are kept open in a V shape through the elastic handle, and there is a gap between the needle holder and the thread picker A wire box, the wire box has a built-in bobbin.
上述镊式缝合器通过两个简单的拉杆传动结构实现了持针和拾线的功能,两个结构均构形细长,终末端体积小,适用于深在狭小的术区内操作,依据该原理可根据需要制作成直状、枪状或膝状等与现行的各种镊子相同的形状,应用不同型号的缝针,以适用于不同的术区。该设计充分考虑了医生既往的操作习惯,其外形与操作均与现行的各种镊子基本相同,医生只需对准要缝合的部位捏合一下即可完成缝合,而且线盒的设计省去了护士穿线的繁琐,可连续缝合,操作简单,效率提高。该设计粗短、强度高的结构也可用于皮肤等部位的缝合,由于不需护士穿线,可使整个手术效率提高,由于该设计结构紧凑,携带方便,可一人操作而且操作简单,所以也适用于医务人员紧张的基层部队医院或卫生队。The above-mentioned tweezers-type suturer realizes the functions of holding the needle and picking up the thread through two simple pull rod transmission structures. The principle can be made into the same shape as the current tweezers such as straight, gun-shaped or knee-shaped according to the needs, and different types of sewing needles are used to be suitable for different operation areas. This design fully considers the doctor's previous operating habits. Its shape and operation are basically the same as the current various tweezers. The doctor only needs to point at the part to be sutured and knead to complete the suture. The threading is cumbersome, continuous suturing is possible, the operation is simple, and the efficiency is improved. The thick, short and high-strength structure of this design can also be used for suturing skin and other parts. Since the nurse does not need threading, the efficiency of the entire operation can be improved. Because the design is compact and easy to carry, it can be operated by one person and the operation is simple, so it is also suitable. For grass-roots military hospitals or health teams where medical personnel are in short supply.
附图说明Description of drawings
下面将参照附图对本实用新型进行描述,其中:The utility model will be described below with reference to the accompanying drawings, wherein:
图1为本实用新型的镊式缝合器的总体示意图;Fig. 1 is the overall schematic diagram of the tweezers type suturing device of the present utility model;
图2为线盒的纵切面图;Figure 2 is a longitudinal section view of the wire box;
图3为线盒内轴杆的剖面图;Figure 3 is a cross-sectional view of the shaft in the wire box;
图4为持针器实施例一的示意图;Fig. 4 is a schematic diagram of the first embodiment of the needle holder;
图5示意性地示出了本实用新型持针器实施例一的前端横截面;Fig. 5 schematically shows the cross-section of the front end of
图6为本实用新型持针器实施例二的示意图;Fig. 6 is a schematic diagram of
图7为直形缝针的示意图;Fig. 7 is the schematic diagram of straight sewing needle;
图8为弧形缝针的示意图。Fig. 8 is a schematic diagram of a curved suture needle.
图9为本实用新型拾线器实施例一的实施原理图。Fig. 9 is an implementation schematic diagram of
图10为本实用新型拾线器实施例二的示意图。Fig. 10 is a schematic diagram of
图11为图10所示拾线器的纵切面示意图。FIG. 11 is a schematic longitudinal section view of the wire picker shown in FIG. 10 .
图12为枪状镊式缝合器的实施示意图。Fig. 12 is a schematic diagram of the implementation of the gun-shaped forceps stapler.
图13为膝状镊式缝合器的实施示意图。Fig. 13 is a schematic diagram of the implementation of the knee forceps stapler.
图14为镊式缝合器的另一种实现方式的示意图。Fig. 14 is a schematic diagram of another implementation of the forceps stapler.
图15为镊式缝合器的外观示意图。Fig. 15 is a schematic view of the appearance of the forceps stapler.
具体实施方式Detailed ways
如图1所示,镊式缝合器由持针器21、拾线器1、弹性柄12和线盒11组成。拾线器1和持针器21通过弹性柄12呈V形相连接为一整体,且弹性柄12使两者保持V形张开,拾线器1的外管6前端封闭,外管6的前端稍后偏下方为一出针孔2,外管6前端内侧偏上方有拾线钩3,拾线钩3的前端游离,后端与外管6的外侧壁形成关节,拾线钩3的弧度部分与拾线拉杆4形成关节,拾线拉杆4另一端与细钢丝绳8结合于点7,细钢丝绳8绕过线盒11的顶端固定于持针器杆15向上延长部分的顶端13,拾线拉杆4中间部位与外管6通过弹簧5连接,拾线钩3可随拾线拉杆4的拉紧或松开而开合,弹簧5将拾线拉杆4拉向拾线器前端方向。线盒11位于拾线器的外管6和持针器杆15顶端之间,线盒11内有轴杆10,线轴9可装在轴杆10上,线盒11下方为出线孔14。持针器21由持针器管17和持针拉杆18构成,持针器杆15位于所述持针器管17与所述弹性柄12之间并与它们互连,持针拉杆18的前端为两个可咬合的端齿22,持针器管17和持针拉杆18的后端弯向外侧,后端有拉紧螺丝16,可以通过拉紧螺丝16的正向或反向旋转,驱动持针拉杆18进或退,从而导致端齿22的松开或咬合。旋紧拉紧螺丝16可使端齿22咬紧,从而固定缝针23,缝针23的针尖处有针眼24,缝线20离开线轴9,通过线盒11的出线孔14,穿过位于持针器管17上的固线圈19,到达持针器前端,穿过位于缝针23前端的针眼24。As shown in FIG. 1 , the tweezers type stapler is composed of a
如图2所示为线盒11的纵切面图,线盒11的顶壁26上有凹进,细钢丝绳8可在其内滑动,其后壁27的中央向前突出有轴杆10,轴杆10的顶端有与之形成关节的自动锁定挡块25,当挡块25拉开时,可将线轴9套入轴杆10,挡块25复位可阻止线轴9脱出。线盒的下壁缺如形成出线孔14,前壁缺如方便拆装线轴。As shown in Figure 2, it is a longitudinal section view of the
如图3所示为轴杆10的剖面图,其内为一弹簧29顶起的滑块28,挡块25与轴杆10顶端形成关节,挡块25后端向外延长为椭圆形,当挡块25向外拉开时,其后端可压迫滑块28向下并导致弹簧29收缩,可将线轴套入轴杆10,当外拉力去除后,弹簧29张开可推动滑块28向上,推动挡块25复位,阻止线轴脱出。As shown in Figure 3, it is a cross-sectional view of the
如图4所示,持针器21实施例一由持针器管17和持针拉杆18组成,持针拉杆18位于持针器管17内,并可在其内拉动。持针拉杆18的前端为两个弹性张开的端齿22,两个端齿22的内面形成固定的孔隙30,孔隙30决定了缝针固定的位置和方向。持针器21后端向外侧弯曲,持针拉杆18靠后端部分有螺纹31。持针器管17后端为一圆形凹槽32,拉紧螺丝16上方为分开的两叶,下方为一圆盘33,与圆形凹槽32相适合。拉紧螺丝16的旋转可使持针拉杆18向后拉或向前推。As shown in FIG. 4 , the first embodiment of the
如图5所示是持针器21实施例一的前端横截面图,显示持针器管17横截面为扁圆形,其内的空管腔隙34的截面为类长方形,这样的结构使两个端齿22在持针器管17内的角度位置固定。As shown in Figure 5, it is a cross-sectional view of the front end of the first embodiment of the
如图6所示持针器21实施例二的示意图,缝针23与持针器管17呈固定连接,这样的结构可使持针器前端更加纤细,以使其适用于缝隙更小部位的缝合,这种结构的缺点在于当缝针变钝时不能更换缝针,而是需要更换持针器。As shown in Figure 6, the schematic diagram of the second embodiment of the
如图7所示缝针23为直形,针眼24在缝针23的前端。As shown in FIG. 7 , the
如图8所示缝针23为弧形,针眼24在缝针23的前端。As shown in FIG. 8 , the
如图9所示为拾线器1实施例一的原理图,当缝针23穿过组织向前穿过出针孔2时,缝线20即随之带出,缝线20由于穿过针眼24而被分为两股,分别位于缝针23的上下两侧,由于整个器械的联动,随着拾线拉杆4向后拉,使拾线钩3向后张开;当缝针23后退时,由于组织的积压,针眼退入组织内之前,缝线20松弛弯曲,同时拾线拉杆4向前推,使拾线钩3向前闭合,穿过缝线20位于缝针23上面的一股与缝针23之间的间隙,缝针23退出出针孔2后,缝线20位于缝针23上面的一股则被拾线钩3钩住。As shown in Fig. 9, it is the principle diagram of the first embodiment of the
如图10所示为拾线器1实施例二的示意图,拾线拉杆4位于外管6内,拾线拉杆4的前端为一三角片35,三角片35尖端指向前,出针孔2位于三角片35的略下方。As shown in Figure 10 is a schematic diagram of the second embodiment of the
如图11所示为拾线器实施例二的纵切面示意图,显示缝针23位于出针孔2内,位于拾线拉杆4和三角片35的略下方,使三角片35正好可以穿过缝针23和缝线位于缝针上面一股之间的间隙。As shown in Figure 11, it is a schematic diagram of the longitudinal section of the second embodiment of the thread picker, showing that the
如图12所示为枪状镊式缝合器的实施示意图,即在图1的基础上,将拾线器的外管6的后端和持针器杆15加工成类S形,持针器21后端为直形,其余结构及原理同图1,使整个缝合器形成枪状,适用于术区更加深在的术区,减少对术者视野的遮挡。As shown in Figure 12, it is a schematic diagram of the implementation of the gun-like tweezers type stapler, that is, on the basis of Figure 1, the rear end of the
如图13所示为膝状镊式缝合器的实施示意图,即在图1的基础上,将拾线器的外管6的后端和持针器杆15加工成膝状,持针器21后端为直形,其余结构及原理同图1,使整个缝合器形成膝状,适用于腔隙术区更加狭窄的术区,减少对术者视野的遮挡。As shown in Figure 13, it is a schematic diagram of the implementation of the knee-shaped forceps type stapler, that is, on the basis of Figure 1, the rear end of the
如图14所示为镊式缝合器的另一种实现方式,拾线器的外管6的后端的内外两壁镂空成出叉口36,与之相对应的持针器杆15的部位向内侧突出有叉子37,拾线器前端结构为图9所示,拾线拉杆4在与细钢丝绳8结合于出叉口36下方的点7,细钢丝绳8后方固定于拾线器后端的点38。As shown in Figure 14, it is another implementation of the tweezers-type suturing device. The inner and outer walls of the rear end of the
如图15所示为镊式缝合器的外观示意图,其外形与现行的普通镊子基本相同。Figure 15 is a schematic diagram of the appearance of the tweezers-type stapler, and its appearance is basically the same as that of the current common tweezers.
下面说明本实用新型的具体工作情况。The concrete work situation of the present utility model is described below.
手术开始前,器械护士选择合适规格的镊式缝合器,将其相应的缝针23后端置于持针器的端齿22的孔隙30中,旋紧持针器后方的拉紧螺丝16使持针拉杆18向后拉,持针器的两个端齿22咬合,使缝针23固定于持针器21上;拉开位于轴杆10顶端的挡块25,使轴杆10穿过线轴9的中央孔,松开挡块25使其自动还原完成线轴安装;牵引线轴9的线头拉出缝线20,通过线盒11的出线孔14,穿过位于持针器管17上的固线圈19,到达持针器前端,自下而上穿过位于缝针23前端的针眼24,即缝线20的游离端的一股在缝针23的上方,完成穿线。缝合器即装配完毕备用。Before the operation begins, the instrument nurse selects a tweezers-type stapler of suitable specifications, places the rear end of the
术中需要缝合时,术者单手持镊式缝合器如持普通镊子,对准要缝合的部位,使持针器21和拾线器1位于要缝合的组织的两边,轻轻捏合使其两者前端靠近,缝针23穿过组织向前穿过出针孔2时,缝线20即随之带出,缝线20由于穿过针眼24而被分为两股,分别位于缝针23的上下两侧,在这个过程的同时,由于持针器向内靠近使持针器杆15的顶端13向外牵拉细钢丝绳8,使拾线拉杆4向后拉,进而使拾线钩3向后张开;当缝针23后退时,由于组织的积压,针眼24退入组织内之前,缝线20松弛弯曲,随着缝针23的后退,持针器杆15的顶端13回复原来的位置,拾线拉杆4在弹簧5的回缩力作用下向前推,使拾线钩3向前闭合,穿过缝线20位于缝针23上面的一股(即游离端的一股)与缝针23之间的间隙,缝针23退出出针孔2后,缝线20位于缝针23上面的一股(即游离端的一股)则被拾线钩3勾住,缝针23退回原位后,缝线即留在组织中。自腔隙中取出缝合器的过程中,由于组织积压和拾线器1的牵拉,使缝线20继续被牵拉出线盒11一段距离,在针眼24的外侧合适距离剪断缝线,缝线游离端也从拾线器脱出,进行打结。剩余的缝线依然穿在针眼中,不需要再次穿线即可进行下一次缝合。When suturing is required during the operation, the operator single-hands the tweezers-type suturing device, such as ordinary tweezers, and aligns it with the part to be sutured, so that the
手术结束后,器械护士反方向旋转拉紧螺丝16,推动持针拉杆18向前,两个端齿22由于弹性作用张开,取下缝针23,拉开挡块25,取下线轴9,清洗器械,消毒备用。After the operation is over, the instrument nurse rotates the tightening
图14所示的镊式缝合器的另一种实现方式的具体工作情况为:缝针23在穿过组织向前穿过出针孔2的过程的同时,由于持针器向内靠近使持针器杆15上的叉子37顶住细钢丝绳8向外推,使拾线拉杆4向后拉,进而使三角片35退回到出针孔2的后方;当缝针23后退时,由于组织的积压,针眼退入组织内之前,缝线20松弛弯曲,同时叉子37向后退,拾线拉杆4在弹簧5的回缩力的作用下向前推,使三角片35穿过缝线20位于缝针23上面的一股(即游离端的一股)与缝针23之间的间隙,缝针23退出出针孔2后,缝线20位于缝针23上面的一股(即游离端的一股)则被三角片35勾住,缝针23退回原位后,缝线即留在组织中。其余过程和步骤同上述。The specific working conditions of another implementation of the tweezers-type stapler shown in Figure 14 are as follows: when the
该种缝合器相应的缝针型号固定,使用不同型号缝针如弧形缝针,应更换相应型号的缝合器,以使出针孔2的位置和方向与所用缝针相适应。The corresponding needle type of this kind of suture device is fixed, and if different types of suture needles are used, such as curved suture needles, the corresponding type of suture device should be replaced so that the position and direction of the
虽然这里已经参考所披露的结构描述了本实用新型,但是本实用新型并不限于所描述的细节,并且本申请旨在覆盖落入改进目的或者所附权利要求书的范围内的所有改变或变型。Although the invention has been described herein with reference to the disclosed structure, the invention is not limited to the details described and the application is intended to cover all changes or modifications which come within the purpose of improvement or within the scope of the appended claims .
Claims (10)
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| CNU2007201437459U CN201019791Y (en) | 2007-04-04 | 2007-04-04 | forceps stapler |
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN100574712C (en) * | 2007-04-04 | 2009-12-30 | 中国医学科学院北京协和医院 | forceps stapler |
| CN103068325A (en) * | 2010-08-10 | 2013-04-24 | 库克医学技术有限责任公司 | Clip devices and methods of delivery and deployment |
| CN109044427A (en) * | 2018-09-11 | 2018-12-21 | 谭雄进 | Defect closer component and its interventional method |
-
2007
- 2007-04-04 CN CNU2007201437459U patent/CN201019791Y/en not_active Expired - Lifetime
Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN100574712C (en) * | 2007-04-04 | 2009-12-30 | 中国医学科学院北京协和医院 | forceps stapler |
| CN103068325A (en) * | 2010-08-10 | 2013-04-24 | 库克医学技术有限责任公司 | Clip devices and methods of delivery and deployment |
| CN103068325B (en) * | 2010-08-10 | 2016-08-03 | 库克医学技术有限责任公司 | Clip devices and methods of delivery and deployment |
| CN109044427A (en) * | 2018-09-11 | 2018-12-21 | 谭雄进 | Defect closer component and its interventional method |
| CN109044427B (en) * | 2018-09-11 | 2023-10-20 | 谭雄进 | Defect closure assembly and method of intervention |
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