RU2336037C2 - Method of end binding of vessel flanges, for example blood, and related devices - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: method of end binding of blood vessel flanges includes binding elements in contact position of corresponding flange formed blood vessels. Adjoining blood vessel flanges are installed with clips equispaced and sequentially with gap in a circle using V-shaped pins looped with lateral ledges and corresponding devices for installation and reinstallation of clips and pins, binding unit, device of blood motion dwell in blood vessel and fixation unit of these devices of blood vessel binding, for example of the patient, the block for flange formation in blood vessel and adjusting bar.

EFFECT: simplified design of corresponding devices; possible end binding of vessels of small diameters; more technological removal of vessel binding elements and more rapid binding process due to simultaneous blood vessel binding processes provided by two operators.

11 cl, 191 dwg

Description

 The invention relates to medicine, more specifically to surgery, and can be used in operations to fasten at the end of the flanges of blood vessels, mainly blood.

The invention can also be used in other fields of surgery, for example, when fastening the urinary vessels.

A known method of fastening at the end of the flanges of blood vessels using couplings, described in the journal "Lancet" / Russia - on-line /. "Stainless steel couplings for blood vessels." Number 11/84 / of March 21, 2001, New Technologies.

Also known are devices for postoperative ligation of anatomical structures / tissue, vessels, etc. / by means of finished endo-loops, which connect the operated structures / see journal "IR No. 2/2006 / p. 10 /.

The disadvantage of the above devices is their comparative complexity, the impossibility of fastening small diameter vessels, for example 1 mm, and the relatively long fastening of blood vessels.

The objective of the present invention is to simplify the design, the possibility of fastening along the end of vessels of small diameters of the order of 1 mm, more technological removal of the elements of the fastening of the vessels and their more rapid fastening due to the simultaneous work of fastening the blood vessels of two operators.

The fastening device at the end face of the blood vessel flanges consists of staples evenly and sequentially with a circumferential gap arranged using V-shaped loops with side tabs of clothespins and corresponding devices for mounting and removing clips and clothespins, fastening the unit, which is located on both sides of it the middle of the coupling, a device for stopping the movement of blood in a blood vessel and a block for fixing these devices for fastening blood vessels on the body, for example, a person, a device holder to stop the blood flow, to form a unit in a blood vessel flange and the mounting bracket.

The fastening unit is made in the form of a system of symmetric flanges of blood vessels sequentially in a straight line on both sides of each flange of the coupling, a device for stopping the movement of blood in a blood vessel and a block for fixing these devices.

Each coupling consists of two semi-cylindrical couplings with half sleeves with a central coaxial hole equal to the diameter of the blood vessel that are capable of turning back on the sleeve axis of the couplings.

In the couplings uniformly around the circumference with a step equal to two lengths, with a gap of the V-shaped clothespin, recesses are formed parallel to the axis of the couplings with a length equal to two staple lengths, in the recesses, clamping devices are mounted pivotally on the axis transverse to the axis of the clutch.

Between the recesses and the clamping devices in one half of the coupling, guide bushings are fixed along the length of the coupling almost in diametrically opposite directions, in each of the outer sides of one of the ends a rod is mounted with a length equal to the length of the device body to stop the movement of blood, and in the bushings of one half of the coupling are installed until the stop at the end of the transition of the seal of the rod in the end part, the elongated rods each with a length equal to two lengths of the coupling body, with a plate transverse protrusion in the middle.

In the end parts of the rods and bushings from the side of the rods, except for the sleeve axis, semicylindrical recesses are formed almost to the axial and transverse to it, in contact with the roller with a flag installed transversely to the axis with the ability to rotate in the ends of the coupling housings in the eccentric and device stop the movement of blood.

The semicylindrical recesses in the cases of the couplings and the devices for stopping the movement of blood and the end parts of the rods in the docked positions coincide, in the formed bosses with a distance between the ends equal to the two wall thicknesses of the vessels, and between the diametrically opposite directions, the recesses and clamping devices are formed on one side a loop installed on the hub axis, with another mounted locking device.

In the end parts of the bushings on the opposite side of the rods, at the ends transverse to the axis, a lamellar protrusion is formed on one side and a recess on the other in parallel planes of semi-cylindrical recesses in the respective rods and bushings, and in the coupling bodies at corresponding ends, corresponding depths equal to each thickness are formed from the ends of the ends the plate protrusion and two thicknesses of the plate transverse protrusions of the elongated shaft on the other side of the coupling body.

The plane of symmetry passing through the middle of the protrusion and the recesses of the sleeve are located on its axial and parallel to the axial semi-cylindrical surface of the recess.

The longitudinal recesses at the end in each coupling are formed along its circumference in sectors with an angle α of each constructed according to the formulas:

и

,

and

,

where α is the angle of the sector in which part of the blood vessel flanges is fixed on one side of the end with a sleeve;

n is the even number of sectors in the coupling;

r is a radius equal to half the diameter of the blood vessel;

t is the wall thickness of the blood vessel;

a is the flange wall thickness of the V-shaped clothespins;

b is the distance from the inner wall of the flanging of the V-shaped clothespins to the axis of the parallel bar of the paper clip;

C is the distance from the line of the sector to the axis of the parallel core of the paper clip;

l is the distance between the axial parallel staples of the paper clip.

The clamping device of each coupling is made in the form of systems evenly spaced around in the sectors of the housing of each coupling through one, each of which consists of two kinematically connected T-shaped when viewed from the side of the engine and the C-shaped when viewed from the side of the plate with the plate transversely and parallel to it sides and an oppositely directed protrusion in the C-shaped plane of the strip and an eccentric coupling mounted in a rectangular window with two-sided transverse eccentric plane coaxial pins.

The T-shaped engine is mounted with the possibility of reciprocating movement in the formed longitudinal rectangular window parallel to the axis of the coupling, one pin of the eccentric is located closer to the axis of the coupling, the other is located in the eccentric hole of the ring locked by means of a pin mounted in a threaded ring fixed in the coupling body.

In the shelf of the T-shaped engine, longitudinal T-shaped grooves are formed transversely to the engine, with which the reciprocal T-shaped protrusions of one rack of the C-shaped bar contact the protrusion of the outer side with the flange of the blood vessel.

A plate insert is mounted under the C-shaped strip, the T-shaped protrusion from one end of which interacts with the mating T-groove of the coupling body, the T-shaped grooves of the engine and the coupling body are made one-dimensional, the other end of the inserts interacts with the inner side of the blood vessel flange.

On the eccentric end part located in the ring, the segments are symmetrically removed from the diametrically opposite sides until the end part is formed under the corresponding “pharynx” of the L-shaped key.

On the opposite side of the recess with the clamping device installed, a Ts-shaped insert without a plate parallel to the uprights and an opposite boss is inserted with an insert with a T-shaped protrusion in the plane of the rack, which is mated to the T-groove of the coupling body, the front end of the jumper contacts the inner side of a blood vessel flange.

The liner length is less than the depth of the recess in the coupling body by the amount of eccentric eccentricity; the end portion of the bar transverse to the jumper in the extreme rear position in the coupling housing is deepened beyond the outer plane of the blood vessel flange by a value of the order of 0.15 ... 0.2 mm.

-образной скобы во вкладыше.In the end parts of the parallel struts of the bar and the liner in the formed holes are mounted in each bent at right angles to the end of the spring U-shaped brackets in the bar and

-shaped brackets in the liner.

Some ends protruding beyond the T-shaped protrusions of the strap and liner are in contact with the mating cylindrical recesses in the corresponding places of the coupling body with T-grooves located in the middle with the possibility of reciprocating movement.

The other ends of each spring are fixed in the end part of another parallel strut of the strap and liner, in the T-shaped protrusions of the rear strut of the strap and in the T-shaped grooves of the coupling body in the middle, rectangular recesses are formed over the entire width of the T-shaped protrusion and groove with a height equal to 1/3 the length of the T-shaped protrusion and groove, with the inclusion of 1/3 of the T-shaped protrusion of the rear rack of the strap or liner in the recess of the housing with subsequent entry into the T-shaped groove of the housing.

-образной пружины.A longitudinal recess is formed between the uprights in the insert, equal in diameter and depth and width in the cross section

-shaped springs.

The locking device of the halves of the couplings of each coupling is made in the form of a system of concentric and transversely mounted trunnions on one half of the coupling, the middle ring on the other half of the coupling, the inner ring with the outer ring-handle threaded connection.

An annular protrusion is formed on the outer cylindrical surface on the inner ring in the end part of the opposite threaded part, and on the inner cylindrical surface in the middle ring in the end part, the ends of the annular protrusions of the middle and inner rings are in contact.

On the outer cylindrical surface of the outer ring of the handle, longitudinal grooves are formed uniformly around the circumference, with which the thumb and forefinger of the operator's hand are in contact.

In the lower part of the outer, middle and inner rings, symmetrical with respect to the axial cuts are formed with a width equal to the diameter and a depth equal to the height of the trunnion, an arrow is pointed at the end of the outer ring-handle, the tip coinciding with the cutout on the rings, and the trunnion is symmetrical to the plane of the split of the coupling halves.

-образной при виде сбоку, двутавровой - при виде сзади и Ц-образной без Г-образной внешней перемычки части с закрепленным посредине с внешней стороны и в параллельной параллельным стержням плоскости кольцом.Each clip is made of hardened steel wire

-shaped when viewed from the side, I-shaped - when viewed from the rear and Ts-shaped without a L-shaped external jumper of the part with the ring fixed in the middle from the outside and parallel to the plane parallel to the rods.

The places of the first bends, starting from the end parts of parallel rods, along the length of five wall thicknesses of the blood vessel are made with a hardness HR _c equal to 37 ... 42, with bends at an angle of about 45 ° without kinks.

In the end conical parts of the parallel staple rods, longitudinal along the forming grooves are formed to the length of the cone, forming, when viewed from the end, a cross with cutting blades on inclined ribs, the ribs of the cross are located at an angle of 45 ° to the plane of the parallel staple rods.

The V-shaped clothespin is made in the form of a loop having flaps that are capable of turning back, with two feathers made in each spring and covering the loop axis with a transverse cylindrical protrusion at an angle of about 150 ° to the plane of the flap in each side opposite to it.

The feathers of the flaps in the assembled clothespin are held in the attached position and each feather of the flap is located one from another at a distance of 3 sizes of the width of the pen, the last of which are located, for example, to the left of the flap edge, and the width of the flap at the location of the loop is 6 sizes of the width of the loop.

The edges of each leaf of the loop in the direction of the spring radially opposite from its axis, forming flanges, are in contact with the outer surface of the corresponding blood vessel.

Two holes are formed on the sides at the location of the fillets in the lower part of each leaf, the distance between which is equal to the distance between the parallel rods, and the diameters are two diameters of the staple rod, and the holes are aligned with each other.

A device for stopping the movement of, for example, blood in a blood vessel is made in the form of a C-shaped without plate parallel to the racks and oppositely directed boss when viewed from the side and the frame with the side plate at the level of its lower side when viewed from the back and two rectangles, one of which is offset in an angle relative to each other when viewed from above from the casing with a sponge formed upward by the cantilever plane of the rectangle of the rectangle and parallel guide bushings fixed from the bottom.

-образной концевой частью, смонтированной в прямоугольном окне концевой части корпуса в зоне расположения пазов, и другой концевой частью с зубьями в 90° каждый с шагом 0,5 мм, контактирующей с ответными зубьями нижней стороны пластины.In the frame, in its lower part at the base, grooves are formed in which the L-shaped is mounted when viewed from the side with the possibility of reciprocating movement of the plate with a rectangular transverse plate-shaped shelf-sponge, spring-loaded plate spring with

-shaped end part mounted in a rectangular window of the end part of the housing in the area of the grooves, and the other end part with teeth of 90 ° each with a pitch of 0.5 mm in contact with the mating teeth of the lower side of the plate.

The horizontal part of the plate is made by a rail coupled to the gear pivotally mounted by pins in the coaxial holes of the side walls of the frame, a washer-handle is fixed on one end part of the pin of the gear, longitudinal grooves are uniformly formed on the cylindrical outer surface of which.

A rod with a transverse semi-cylindrical recess and a flag is mounted in the end part of one of the guide bushings transversely to its axis, the distance between the parallel guide bushings is equal to the distance between the corresponding corresponding rods of one half of the coupling.

An axle with a spherical end part, the diameter of which is approximately 5/3 of the diameter of the journal journal, is cantilever mounted under the fixed body sponge parallel to the guide bushings.

In the casing of the device, a sponge shelf is mounted in the middle and cantilever, similar in size to the size of a sponge shelf-sponge of a plate.

-образного при виде сбоку и П-образного при виде сверху каркаса, имеющего закрепленную Г-образную при виде сбоку и прямоугольную при виде сверху пластину.The device holder for stopping the movement of blood in a blood vessel is made in the form of a wire

-shaped when viewed from the side and U-shaped when viewed from above, a frame having a fixed L-shaped when viewed from the side and a rectangular plate when viewed from above.

The lower rods are parallel to each other and have in the middle part an annular thickening in contact with the end face with the corresponding ends of the guide bushings of the device.

The vertical part of the L-shaped plate is made with a V-shaped point towards the inflection side, the end parts of the parallel holder rods are pointed, the upper horizontal part of the holder interacts with the operator’s thumb, index and middle fingers.

The flange formation unit, for example, in a blood vessel is made in the form of a system of threaded and threadless bushings kinematically connected to the threaded sleeve housing, the middle internal screw of which is mounted in the middle part inside the sleeve body, the external screw thread is outside the rear part, one threadless one is located in front of the outside , another component - inside the internal threaded sleeve with a collet tube installed inside, in which a rod is mounted, in the front end part of which a glass is fixed.

The glass has a conical bottom with a vertex located in the coupling location zone, a zone and longitudinal slots located uniformly around the circumference of the slot, forming a collet in the end cylindrical part with an end face protruding about 1 mm beyond the end of the blood vessel.

The collet part of the tube is in contact with the collet part of the cup, which interacts with the outer cylindrical surface and the inner cylindrical surface of the blood vessel, approximately in the end front part of the rod there is a conical apex towards the inner middle threaded sleeve, a section in the area of the collet of the tube and the cup.

A dowel is fixed in the plane and transverse axis in the rear end part of the sleeve of the body and the rod, and in the collet tube there is a through window with a width equal to the thickness of the dowel and a length equal to its width, increased by the amount of movement of the tube to ensure contact of the blood vessel wall with the inner surface the Central hole of the coupling with the provision of reciprocating movement of the collet tube relative to the rod.

A collar with a torus groove is formed in the rear part of the collet tube, which interacts with the outer cylindrical surface with the inner cylindrical surface of the screw collar formed in the rear part of the external threaded sleeve, the pins mounted transversely to the axis contact the torus groove of the collar of the collet tube, providing for the reverse-turning movement of the external threaded sleeve relative to the collet tube.

A rectangular cutout with a width equal to the thickness of the dowel and a depth equal to its width is formed in the rear end part of the inner threaded sleeve, with the reciprocating movement of the sleeve relative to the dowel.

A reciprocal annular protrusion of the inner threaded sleeve interacts with the formed annular groove of the inner threaded sleeve to provide a rotational movement of the inner threaded sleeve relative to the inner threaded sleeve.

The end of the blood vessel touches the inner wall of the transverse protruding portion of the jumper of each C-shaped strap of the coupling clamping device and the zigzag ends of the internal threadless sleeve are protrusions between the C-shaped straps of the coupling clamping device that can only move reciprocally and are coupled to the threaded middle inner sleeve.

The diametrically opposite rectangular on a cylindrical surface are formed in the middle internal threaded sleeve of the block, forming jumpers, through-windows, and the thumb and forefinger of the operator’s hand interact with the internal threaded sleeve at the location of the opposite windows inside the sleeve-case with the longitudinal gutters formed uniformly circumferentially , for example, a surgeon.

V-shaped symmetrical grooves are formed in the end front front part of the front threaded sleeve evenly around the circumference opposite to the places between the C-shaped planks of the coupling, in which one spherical end part of the two-shouldered mounted on the transverse axis in the eyes of the sleeve fixed in the front threaded part of the sleeve contact housing, lever.

Another L-shaped end part of the lever protrusion interacts with the counter recess formed in the end C-shaped without plate parallel to the sides and the opposite boss of the sleeve of the coupling.

The ends of the protruding through one zigzag cylindrical parts of the inner threadless sleeve are each made up to the middle of the thickness of the end face on the inner side, starting from the inner surface of the inner threadless sleeve along the torus surface coaxially with the inner surface of the inner ring with a blunt point to about 0.05 mm.

-образном при виде сбоку брусе с возможностью возвратно поворачиваться на шарнирно серединами установленных на передней цапфе бруса двух первых в плоскости поперечно брусу, двух других на первой ступени бруса в плоскости, параллельной плоскости бруса.The block for installing and removing clothespins on the docked flanges of blood vessels is made in the form of a system of kinematically articulated mounted two-arm levers on a two-stage

-shaped when viewed from the side of the beam with the ability to pivotally pivotally in the middle of the beam mounted on the front axle of the two first two in the plane transverse to the beam, the other two on the first step of the beam in a plane parallel to the plane of the beam.

At the ends of the ends of the shoulders of the first two levers, each semi-cylindrical trough is mounted towards each other at an angle of about 150 ° in planes transverse to the plane of the beam.

At the ends of the ends of the other shoulders of the front levers, a V-shaped trench is fixed on each in the plane of the transverse plane of the beam, and parallel to each other, at the ends of the ends of the front shoulders of the other two-arm levers located on the first stage, in a plane parallel to the plane of the beam fixed lenticular on each protrusion in the plane of the beam.

Other shoulders of the same two-arm levers interact with the thumb and forefinger of the operator’s hand, the levers pivotally mounted on an axis transversely mounted on the first step of the beam are spring-loaded with a compression spring, which ensures only the separation of the shoulders of the levers.

On the inner wall, approximately in the middle, of the long shoulders of two two shoulders located in the plane of arrangement on the second level of the beam of the levers in the formed eyes, two of the same length of the rod are pivotally mounted with one end parts.

The other end parts of the rod are pivotally mounted to each other by means of a roller mounted in the longitudinal window of the end part of the second beam level.

The lenticular end parts of the shoulders of horizontally arranged levers contact the V-shaped grooves of the end parts of the shoulders of vertically arranged levers, other semi-cylindrical grooves of the end parts of the shoulders of the same levers interact with cylindrical lateral protrusions at an angle of 150 ° to the sash plane of the respective clothespins.

The block for mounting and dismounting the clip when fastening the blood vessels along the flanges is made in the form of a system kinematically connected with the L-shaped when viewed from the side and the frame with the handle when viewed from above, the body is installed with the possibility of quick installation and dismantling of two V-shaped transverse formed in the lower part in the middle part with bosses in mating longitudinal V-shaped grooves of the coupling body, two spring-loaded single-arm pivotally mounted end parts on one side of each in the housing of the levers transverse to the axis of the couplings parallel axes.

In each lever in the middle part above the bosses of the block body in a T-shaped recess parallel to the plane of each lever, a rectangular washer is mounted with only the possibility of reciprocating movement along the lever with a cantilever and transverse towards the boss mounted ring stepped ring interacting with a larger outer cylindrical surface in the reciprocal holes of the engine mounted with the possibility of reciprocating movement of the side guides in the reciprocal guide bosses.

Inside the ring with a rectangular washer, a spring-loaded tube made of two parts is mounted coaxially riveted coaxially on the end upper part from the sides of which are fixed in diametrically opposite directions in the plane of the axial tube of different heights, starting from the upper sides of the plate, forming a wing tube with stops for it in rectangular overlay.

An oval window and a thickening on one outer side with a height equal to the difference in height of the opposite lamina tube plates are formed in the pad holding the square washer with the ring from axial displacement, and an annular collar is formed in the middle of the tube, which contacts the end with the other end of the torsion spring.

One end part of each torsion spring of one-arm levers is made along a broken line with a blunt apex to the outside, the outer part of which interacts with the groove of the end end part of the one-arm lever, the other end part is made at right angles to the first end part and is made U-shaped in transverse to the plane of the spring with an L-shaped end in its plane.

The lower end part of the prefabricated lamb tube is in contact with the annular part of the paper clip during installation and dismantling in the lowermost position, and in the upper - 0.8 mm higher than the lower one.

The distances between the coupling rods parallel to the coaxial bushings, the parallel guiding bushes of the device for stopping blood movement, the parallel rods of the flange formation unit in the blood vessel are the same, while the diameters of these rods and the coaxial rods elongated from the transverse middle of the plate protrusion are also the same.

The unit for fixing the blood vessel fastening devices is made in the form of a kinematically connected L-shaped system when viewed from the end and from the side and rectangular with evenly distributed holes in the wall when viewed from above the strap and longitudinally installed by a T-shaped joint in the lower part of the vertical wall of the strap parallel to its bending sides when viewed from the end of a cylindrical cup with a spherical bottom, the diameter of the cylindrical inner surface of which is equal to the diameter of the spherical end part of the pin of the device body to stop the movement of blood.

Symmetrically, its axial axis forms a longitudinal groove in the glass with a width equal to the diameter of the journal neck with a spherical end part of the device body for stopping blood movement, increased by the length of the arcs on both sides by an angle of rotation of the journal neck of the body by about 15 ° and a depth equal to the length of the glass to the center the sphere of the bottom, increased by half the diameter of the neck of the journal of the housing and the length of the arc of rotation of the journal in the housing with an angle of rotation of approximately 30 °.

On the side and along the glass, symmetrically to the longitudinal groove and opposite to it, a U-shaped bracket is fixed with a vertical jumper and parallel to the axial glass, in which the distance between parallel horizontal walls on the inside is equal to the internal diameter of the glass.

On the side of the bracket is a T-shaped protrusion parallel to the vertical jumper in contact with a mating T-groove formed on the outside of the vertical wall of the bar with reciprocal movement relative to each other.

A through hole is formed in the parallel walls of the bracket transversely to the axial cup, in which a roller with a shoulder is mounted for rotation only on one end side and, for example, a square on the other, on which a roller rotation handle is fixed.

Transverse to the upper wall of the U-shaped bracket with a concentric formed through hole, a sleeve is fixed with a length equal to the length of the roller between its shoulder and the lower side of the roller rotation handle without the height of the U-shaped bracket.

A recess is formed parallel to the vertical wall in the wall of the lower part of the T-shaped protrusion of the glass, and a spring-loaded feather of the T-shaped groove, bent about 3 ° from the wall, is formed in the middle of the T-shaped groove in the lower lower wall of the strip, equal to the width of the recess in the wall of the T-shaped a protrusion in which wedge-shaped bevels on both sides are formed on the edge of the lower wall of the glass from the inside on the edge, with a depth equal to half the wall thickness.

A cylindrical recess is formed transverse to the axial roller along the length of the flange equal to half the inner diameter of the glass, ensuring that the inner cylindrical surface of the glass and the cylindrical recess coincide, the protrusion of the cylindrical surface of the roller beyond the inner cylindrical surface of the glass is approximately 0.15 mm, ensuring that the cylindrical surface of the roller matches the cylindrical surface of the glass.

In the roller, at a length of approximately 3.5 mm from the shoulder, a transverse axial hole is formed in which a pin is fixed, interacting with the possibility of turning the roller with a reciprocal arc of about 90 ° through the groove of the sleeve, increased along the length of the arc by the size of the diameter of the pin.

The mounting plate is made in the form of a dihedral diagonal at approximately 135 ° with the small and large walls of the strip with parallel and coaxial trunnions transversally mounted laterally from the ends of the small wall with spherical end parts in each diameter similar to the diameters equal to the diameters of its neck and the spherical end part of the trunnion block fixing devices for fastening a blood vessel.

A notch is formed on the larger wall of the plank at an angle of 45 ° to one of its ribs with a pitch of approximately 0.5 mm and a width equal to half the thickness of the plank wall, with an arrow-shaped protrusion formed at the angle of 90 ° in the middle of the small plank wall the large wall of the strip with a protrusion beyond the edge of the small wall by 0.7 mm.

Figures 1 and 2 show flange fastening of blood vessels ⌀1 mm in two projections; figure 3 and 4 - the same bond with the removed clothespins and clips in 2 projections; 5 and 6 - flange fastening of blood vessels ⌀2 mm in 2 projections; Figures 7 and 8 show the same fastening with removed clips and clothespins in 2 x projections; figure 9 - left and right couplings of the unit for fastening on the flanges of blood vessels ⌀ 2 mm when viewed from the side in section; figure 10 is a view of I in figure 9; figure 11 is a section along aa in figure 10; in Fig.12 is a section along BB in Fig.9; Fig.13 is a section along BB in Fig.9; on Fig - ring-handle in the context; in Fig.15 is a section along G-D in Fig.14; in Fig.16 and 17 - the inner ring in 2 projections; on Fig and 19 - the pin of the first half of the coupling in 2 projections; in Fig.20 and 21 - the middle ring of the second half of the coupling in 2 projections; in Fig.22 is a section along DD in Fig.12, the coupling in the closed position of the halves; in Fig.23 is a section along DD in Fig.12, the clutch in the open position of the halves, the locking device is open; on Fig - view E in Fig; in Fig.25 is a section along FJ in Fig.9; in Fig.26 is a section along II in Fig.9; in Fig.27 is a section along KK in Fig.9; in Fig.28 is a section along L-L in Fig.13; in Fig.29, 30 and 31 - clip in 3 projections; on Fig - view II in Fig.29; in Fig.33 is a view III in Fig.31; in Fig.34 is a section along MM in Fig.28; on Fig, 36 and 37 - clothespin in 3 projections; in Fig 38 and 39 - link clothespins in 2 projections; in Fig.40 is a view of IV in Fig.38; on Fig, 42 and 43 - a device for stopping the movement of blood in a blood vessel in 3 projections; on Fig and 45 - the holder of the device to stop the movement of blood in a blood vessel with this device in 2 projections; in Fig.46 is a section along H-H in Fig.42; in Fig.47 is a section along O-O in Fig.41; on Fig - leaf spring when viewed from the side; on Fig, 50 and 51 - the body of the device to stop the movement of blood in 3 projections; on Fig and 53 - rail with a sponge in 2 projections; on Fig, 55 and 56 - the holder of the device to stop the movement of blood in 3 projections; in Fig.57 is a view of V in Fig.47; on Fig - block formation of a flange in a blood vessel in longitudinal section; on Fig - section along PP in Fig; on Fig - section along the RR in Fig; Fig.61 is a section along C-C in Fig.58; Fig.62 is a section along the TT in Fig.58; on Fig and 64 - the eccentric engine in 2 projections; on Fig and 66 - bar in 2 projections; on Fig - inserts when viewed from above; Fig.68 is a view of Fig.67; on Fig - section according to fF in Fig; on Fig - view VI in Fig; in FIG. 71 is a view VII in FIG. on Fig and 73 - block body for the formation of a flange in a blood vessel in 2 projections; on Fig - view X in Fig; on Fig - section along TT in Fig.72; on Fig - type C in Fig; on Fig.77 and 78 - sleeve with eyes in 2 projections; on Fig - clutch left with a device to stop the movement of blood and a block for the formation of a flange in a blood vessel when viewed from above; on Fig - section along H-H in Fig.79; on Fig - front end of the inner ring in a section; on Fig and 83 - the rod in 2 projections; on Fig - section along the Sh-Sh in Fig.9; on Fig, 86 and 87 is a block for installing and removing clothespins in 3 projections; on Fig shows a conditionally section along the trunnion of the beam; on Fig, 89 and 90 - two shoulders right lever in 3 projections; on Fig, 92 and 93 - two shoulders of the left lever in 3 projections; on Fig, 95 and 96 - horizontal two-arm lever in 3 projections; on Fig.97, 98 and 99 - block beam in 3 projections; in Fig.100, 101 and 102 - left thrust in 3 projections; on Fig and 104 - the right thrust in 2 projections; on Fig - the axis of the horizontal levers when viewed from the side; on Fig - section along Shch-Shch on Fig; on Fig, 108 and 109 - block for mounting and dismounting a paper clip in 3 projections; in Fig.10 is a section along the EE in Fig.109; in Fig.11 is a section along southeast in Fig.109; in Fig.112, 113 and 114 - the engine in 3 projections; on Fig - section along the II in Fig; in Fig.116 and 117 - a rectangular washer with an annular stepped ring in 2 projections; in Fig.118 is a section along A ₁ -A ₁ in Fig.109; on Fig - section along B ₁ -B ₁ in Fig.11; on Fig and 121 - the left torsion spring in 2 projections; on Fig - section along B ₁ -B ₁ in Fig.109; on Fig is a section along G ₁ -G ₁ in Fig.109; in Fig.124 is a section along D ₁ -D ₁ in Fig.123; on Fig - section along E ₁ -E ₁ in Fig; in Fig.126, 127 and 128 - the block body for mounting and dismounting the paper clip in 3 projections; in Fig.129 is a section along W ₁ -F ₁ in Fig.111; in Fig.130, 131 and 132 - the upper half of the lamb tube in 3 projections; in Fig.133, 134 and 135 - pad in 3 projections; on Fig and 137 - the lower half of the lamb tube in 2 projections; in Fig.138 is a section along Z ₁ -Z ₁ in Fig.129; in Fig.139, 140 and 141 - the engine in 3 projections; in Fig.142 is a view of VIII in Fig.109; on Fig - part of the housing of the block when viewed from above; in Fig.144 is a section along And ₁ -I ₁ in Fig.143; on Fig, 146 and 147 - liner in 3 projections; in Fig.148 is a section along K ₁ -K ₁ in Fig.142; in Fig.149, 150 and 151 - a sleeve with a rod in 3 projections; on Fig, 153 and 154 - sleeve axis with a rod in 3 projections; on Fig, 156 and 157 is an elongated rod in 3 projections; on Fig - a device for stopping the movement of blood and the left clutch - separated when viewed from the side; on Fig - the same, docked in side view; on Fig - a device for stopping the movement of blood with a left sleeve and a block for the formation of a flange in a blood vessel - separated when viewed from the side; on Fig - the same, docked in side view; on Fig - a device for stopping the movement of blood, docked with the left sleeve, and the right sleeve, docked with a device for stopping the movement of blood, disconnected when viewed from the side; Fig.163 is the same docked in side view; in Fig.164 is a view of L ₁ in Fig.163; in Fig.165 is a view IX in Fig.164; in Fig.166 is a section along M ₁ -M ₁ in Fig.165; in Fig.167 is a view of X in Fig.164; in Fig.168 is a section along H ₁ -H ₁ in Fig.167; in Fig.169, 170 and 171 - block fixing devices for fastening blood vessels in 3 projections; in Fig.172 is a section along O ₁ -O ₁ in Fig.169; in Fig. 17 is a section along P ₁ -P ₁ in Fig. 171; on Fig and 175 - roller in 2 projections; in Fig.176 - a pin fixed in the body of the device to stop the movement of blood in dash-dotted lines; on Fig, 178 and 179 - L-shaped bar in 3 projections; on Fig - section along P ₁ -P ₁ in Fig; on Fig - section along With ₁ -C ₁ in Fig; on Fig, 183 and 184 - a cylindrical glass in 3 projections; in Fig.18 is a section along T ₁ -T ₁ in Fig. 183; on Fig and 187 - block fixing devices for fastening a blood vessel with a device to stop the movement of blood and a clutch, docked left, and a block fixing devices for fastening a blood vessel with a device for stopping the movement of a blood vessel and a clutch, docked right diluted relative to each other approximately on 15 in 2 projections; on Fig - blocks fixing devices for fastening blood vessels, devices for stopping blood flow in blood vessels and couplings are sequentially docked in a line as a whole: block for fixing devices for fastening left → device for stopping blood flow left → coupling left → coupling right → a device for stopping the movement of blood right → a unit for fixing devices for fastening the right when viewed from the side and in Figs. 189, 190 and 191 - the mounting bracket in 3 projections.

The device for fastening along the end faces of blood vessel flanges, for example, ⌀2 mm, contains paper clips 1 arranged around a circle with a lateral clearance using V-shaped clothespins 2, a fastening unit 3 consisting of couplings 4 and 5 on either side of its middle, respectively, from the left and right, a device for stopping the movement of blood in blood vessels 6 and 7, respectively, left and right, and fixation blocks of these devices for fastening blood vessels, respectively left and right, on the body, for example, of a person holding a device for I stop the movement of blood 10, a block for the formation of a flange in a blood vessel 11, the setting bar 12 / cm. Fig.186, 187, 188, 1, 2 ... 8 /, as well as blocks 13 for installing and removing clothespins 2, block 14 for mounting and dismounting paper clips 1 when fastening blood vessels 15 ₂ along flanges 16 / cm. Figs. 85, 86, 87, 107, 108 and 109 /.

Fastening unit 3 / cm. FIG. 188 / containing mounting elements of adjacent flanges 16 of blood vessels 15 ₂ / diameter ⌀2 mm /, is made in the form of a system of symmetric flanges 16 of blood vessels in series in a straight line on both sides of each flange of the coupling 4 of the left and 5 right, devices for stopping the movement of blood in the blood vessel 6 left and 7 right and the fixation unit of these devices 8 left and 9 right / see Fig. 188 /.

Each clutch 4 / in the description, devices and blocks are considered only the left components of the fastening unit: clutch 4, a device for stopping blood flow 6 and a block for fixing these devices 8 / consists of two half-cylindrical leaf-halves 18 that are capable of turning back and forth on the sleeve axis 17 , 19 and 20, 21 / cm. 12, 13 and 80 / couplings 4 and 5 with a central coaxial hole equal to the diameter of the blood vessel 15 ₂ equal to 2 mm

In the couplings 4 and 5 uniformly around the circumference with a step equal to two lengths, with a gap of the V-shaped clothespin 2, recesses are formed parallel to the axis of the couplings with a length equal to two lengths of the staple 1, in the recesses, clamping devices are mounted pivotally on the axis transverse to the axis of the clutch 22 / cm. Fig.9 /.

Between the recesses and the clamping devices 22 in one half 18 and 20, respectively, of the couplings 4 and 5 in almost diametrically opposite directions / cm. Fig.13 / along the length of the clutch fixed guide bushings 17 and 23 / see Fig.149 ... 154 /, in each of the outer sides of one of the ends mounted rod 24 in the sleeve 17 and the rod 25 in the sleeve 23 with a length equal to the length of the housing of devices 6 and 7 for stopping the movement of blood in blood vessels.

In the bushings 17 and 23 of one half 18 of the coupling 4 are installed all the way to the end of the transition / see Fig and 167 / termination of the rod in the end elongated rods 26 with each length equal to almost two lengths of the coupling body, with a plate transverse protrusion 27 in the middle.

In the end parts of the rods 24 and 26 and in the end parts of the bushings 23 from the side of the rods / cm Fig. 149 /, in addition to the bushing axis 17, half-cylindrical almost to the axial recess 28 and 29 / cm are formed. Fig and 155 /, in contact with the roller 30 with the flag 31, respectively / see Fig.34, 166 and 168 /, transverse to the axis installed with the ability to turn back respectively in the end parts of the clutch housings in the area of the eccentric 32 and device 6 for stopping the movement of blood.

The semi-cylindrical recesses 29 in the cases of the couplings 4 and 5 and the device 6 for stopping the movement of blood and the end parts of the rods 24 and 26 in the docked positions coincide / cm. 165 and 166 /, in the formed bosses with a distance between the ends of the couplings equal to two wall thicknesses of the vessels 15 ₂ , and between the diametrically opposite directions of the recesses and clamping devices 22, a loop mounted on the hub axis 17 is formed on one side and mounted on the other locking device 33.

In the end parts of the bushings 17 and 23 on the opposite side of the rods at the ends transverse to the axis, a lamellar protrusion 34 is formed on one side and a recess 35 on the other in parallel planes with semicylindrical recesses 28 and 29 in the respective rods 17 and 23 / cm. Fig.149 ... 154 /.

In the housings 4 and 5, corresponding recesses are formed at the reciprocal places from the end face with a depth equal to each thickness of the plate protrusion 34 of the bushings 17 and 23 to two thicknesses of the plate transverse protrusions 27 of the elongated rod 26 on the other side of the coupling body, the plane of symmetry passing through the middle of the protrusion 34, and the recesses 35 of the bushings 17 and 23 are located on its axial and parallel to the axial semicylindrical surface of the recess 28 / cm. Fig.149 ... 154 /.

;The grooves longitudinal from the end in each coupling 4 and 5 are formed along its circumference in sectors / cm. 4, 8, 107, 108 and 122 / with an angle α of each constructed according to the formulas:

;

,

,

where α is the angle of the sector in which part of the blood vessel flanges / cm is fixed on one side of the end with a clutch. 4 and 8 /;

n is the even number of sectors in the coupling / cm figure 2 and 6 /;

r is the radius equal to half the diameter of the blood vessel / cm Fig.7 /;

t is the thickness of the wall of the blood vessel / cm Fig.7 /;

a is the flange wall thickness of the V-shaped clothespins / cm Fig. 39 /;

b is the distance from the inner flanging wall of the V-shaped clothespins to the axis of the parallel staple bar / cm. Fig. 39 /;

C is the distance from the line of the sector to the axis of the parallel core of the paper clip and

l is the distance between the axial parallel staples of the paper clip / cm. Fig. 39 /.

Clamping device 22 / cm. Fig.9 / of each coupling 4 or 5 is made in the form of a system of uniformly spaced around the circumference in the sectors of the housing of each coupling through one, each of which consists of two kinematically connected T-shaped when viewed from the side of the engine 36 / see Fig.62 and 63 / and the C-shaped when viewed from the side of the strap 37 with the plate laterally and parallel to its sides and the opposite direction of the protrusion 38 / see Fig.9, 10, 11 and 64 / in the C-shaped plane of the strap 37 and installed in a rectangular window 39 / see Fig.9 / clutch eccentric 32 with two-sided transverse plane of the eccentric coaxial pins 40 and 41.

The T-shaped engine 36 is mounted with the possibility of reciprocating movement in the formed longitudinal rectangular window 39 parallel to the axis of the coupling, one pin 40 of the eccentric 32 is located closer to the axis of the coupling, the other pin 41 is in an eccentric hole / cm. Fig.9 and 26 / locked by a pin 42 of the ring 43 mounted in the threaded ring 44, mounted in the housing of the coupling.

In the shelf 45 of the T-shaped engine 36, longitudinal T-grooves 46 / cm are formed transversely to the engine. 62 and 63 /, with which the reciprocal T-shaped protrusions 47 of one rack 43 of the C-shaped bar 37 contacting the protrusion 38 with the outer side with the flange 16 of the blood vessel / see are in contact. Fig.9, 25 and 57 /.

Under the C-shaped strip 37, a plate insert 49 is mounted, a T-shaped protrusion 50 from one end of which interacts with the reciprocal T-shaped groove of the coupling housing / cm. Fig. 63 /, T-grooves of the engine and the coupling housing are made one-dimensional, with the other end face of the inserts 49 interacting with the outer side of the flange of the blood vessel.

On the end portion of the pin 41 of the eccentric 32 located in the ring 43, the segments are symmetrically removed from the diametrically opposite sides until the end portion forms under the corresponding “pharynx” of the L-shaped key / cm. 9, 26 and 57 /, on the opposite side of the recess with the clamping device 22 installed, a C-shaped insert 51 with a T-shaped protrusion 52 / cm formed on the external of the parallel racks is inserted parallel to the racks and the oppositely directed boss. Fig.145 and 147 / in the plane of the rack, the reciprocal T-shaped groove of the coupling body, the front end of the jumper is in contact with the outer side of the flange 16 of the blood vessel / see Fig.9, 10 and 11 /.

The length of the liner 51 is less than the depth in the coupling body by the amount of eccentricity of the eccentric 32, the transverse end portion of the strap 37 in the rearward position in the coupling housing is deepened beyond the outer plane of the blood vessel flange by a value of the order of 0.15 ... 0.2 mm.

-образной скобы 54 во вкладыше 51, одни концы, выступающие за Т-образные выступы планки 37 и вкладыша 51, контактируют с ответными цилиндрическими углублениями в соответствующих местах муфты с расположенными посредине Т-образными пазами с возможностью возвратно-поступательного перемещения, другие концы каждой пружины закреплены в концевой части другой параллельной стойке планки 37 и вкладыша 51 /см. фиг.9, 25 и 57/.In the end parts of the parallel struts of the strap 37 and the insert 51 in the formed holes are mounted in each bent at a right angle end of the spring U-shaped brackets 53 in the strap 37

-shaped brace 54 in the liner 51, some ends protruding beyond the T-shaped protrusions of the strap 37 and the liner 51 are in contact with the mating cylindrical recesses in the corresponding places of the coupling with the T-grooves located in the middle with the possibility of reciprocating movement, the other ends of each spring fixed in the end part of another parallel rack of the strap 37 and the liner 51 / cm. Fig.9, 25 and 57 /.

-образной пружины. In the T-shaped protrusions of the rear leg 48 of the bar 37 and in the T-shaped grooves of the coupling body in the middle, rectangular recesses are formed over the entire width of the T-shaped protrusion and groove and a height equal to 1/3 of the length of the T-shaped protrusion 52 and the groove, ensuring entry 1/3 of the T-shaped protrusion of the rear rack of the strap or liner 51 into the recess of the casing with subsequent entry into the T-groove of the casing, and between the racks in the insert 51 a longitudinal recess is formed, with a depth and width in cross section equal to the diameter of the wire

-shaped springs.

Locking device 33 / cm. 12 and 13 / halves 18, 19 and 20, 21 of the couplings of each coupling are made in the form of a system of concentrically and transversally mounted trunnions 56 on one half 18 and 20 of the coupling 4 and 5, the middle ring 57 and on the other half of the coupling 19 and 21 4 and 5, the inner ring 58 with the outer ring-handle 59 threaded connection / see Fig. 12 ... 23 /.

An annular protrusion 60 is formed on the inner ring 58 in the end portion of the opposite threaded portion on the outer cylindrical surface, and in the middle ring 57 in the end portion, an annular ledge 61 on the inner cylindrical surface.

The ends of the annular protrusions of the middle and inner rings 57 and 58 are in contact with each other, longitudinal grooves are formed on the outer cylindrical surface of the outer ring of the handle 59, with which the operator’s thumb and forefinger interact.

In the lower part of the outer, middle and inner rings, respectively 59, 57 and 58, symmetrical with respect to the axial cutout 62 are formed with a width equal to the diameter and a depth equal to the height of the trunnion, an arrow is shown at the end of the outer ring of the handle, the tip coinciding with the cutout on the rings, and trunnion 56 coincides with the plane of the connector halves 18, 19 and 20, 21 couplings 4 and 5 / see 12 and 13 /.

-образной при виде сбоку, двутавровой при виде сзади и Ц-образной без Г-образной внешней перемычки части с закрепленными посредине с внешней стороны и в параллельной параллельным стержням плоскости кольцом 63 /см. фиг.29, 30 и 31/.Each clip 1 is made of hardened steel wire

-shaped when viewed from the side, an I-beam when viewed from the rear and C-shaped without a L-shaped external jumper of the part with a 63 / cm ring fixed in the middle from the outside and parallel to the plane parallel to the rods. Fig.29, 30 and 31 /.

The places of the first bends, starting from the end parts of parallel rods along the length of five wall thicknesses of the blood vessel, are made with a hardness of HRC equal to 37 ... 42, with bends at an angle of 45 ° without kinks.

In the end conical parts of the parallel rods of the paper clip 1, longitudinal along the forming grooves are formed for the length of the cone, forming, when viewed from the end, a cross with cutting blades on inclined ribs, the edges of the cross are located at an angle of 45 ° to the plane of the parallel staple rods / cm. Fig. 33 /.

The V-shaped clothespin 2 is made in the form of a loop, capable of turning back and having sashes, made in each eye and covering the axis 64 of the loop with two feathers 65 with a transverse cylindrical protrusion 66 at an angle of about 150 ° to the plane of the sash in the opposite direction in each /cm. Fig. 35 ... 40 /.

Feathers 65 of the flaps in the assembled clothespin are held in the attached position and each flap feather is located one from another at a distance of 3 sizes of the width of the feather, the edges of each flap of the loop in the opposite direction from its axis are rounded radially, forming a shoulder, and are in contact with the outer surface of the corresponding blood vessel.

Two openings 67 are formed on the sides at the location of the fillets in the lower part of each leaf, the distance l between which is equal to the distance between the parallel staples of the paper clip 1, and the diameters d are equal to the two diameters of the paper clip and the openings are aligned with each other / cm. Fig.29, 30, 32 and 39 /.

The device 6 for stopping the movement of blood in a blood vessel is made in the form of a C-shaped without plate parallel to the parallel racks and the opposite boss 68 when viewed from the side and frame 69 with a lateral plate protrusion 70 at the rear and two rectangles 71 and 72 , one 71 of which is offset in an angle relative to each other when viewed from above from the housing 73 with parallel guide bushings 74 / cm fixed from the bottom. Fig. 41, 42, 43, 49, 50 and 51 /.

-образной концевой частью 78, смонтированной в прямоугольном окне 79 концевой части корпуса /см. фиг.47/ в зоне расположения пазов 75, и другой концевой частью 80 с зубьями /см. фиг.57/ в 90° в каждой с шагом в 0,5 мм, контактирующей с ответными зубьями нижней стороны пластины 76 пружиной 81, а горизонтальная часть пластины которой выполнена рейкой 82 /см. фиг.52 и 53/.In the frame 69, in its lower part, grooves 75 are formed at the base, in which a L-shaped plate 76 is mounted when viewed from the side, with the ability to move back with a rectangular transverse plate-shelf sponge 77, a spring-loaded plate with

-shaped end part 78 mounted in a rectangular window 79 of the end part of the housing / cm. Fig.47 / in the area of the grooves 75, and the other end part 80 with teeth / see Fig. 57 / at 90 ° each in increments of 0.5 mm in contact with the counter teeth of the lower side of the plate 76 by the spring 81, and the horizontal part of the plate is made by a rail 82 / cm. Fig and 53 /.

The rack 82 is coupled to the gear 83 pivotally mounted by the pins 84 and 85 in the coaxial holes of the side walls of the frame 69, the washer handle 86 / cm is pivotally mounted on one end axle 84. Figs. 41, 42, 43 and 46 /, on the cylindrical outer surface of which lobes are formed.

A rod 87 with a transverse semi-cylindrical recess 83 with a flag 89 is mounted in the end part of one of the guide bushings 74 transversely to its axis, the distance between the parallel guide bushings 74 is equal to the distance between the corresponding respective rods 24 and 25 of one half 18 of the coupling 4.

Under the stationary jaw 77 of the housing 73 parallel to the guide bushings 74, a pin 90 with a spherical end portion 91 / cm is cantilevered. 41, 42 and 43 /, the diameter of which is approximately 5/3 of the diameter of the journal journal.

In the device casing 73, a sponge shelf 92 is mounted in the middle and cantilever, similar in size to the sponge shelf 77 of the rack 82 of the plate 76.

-образного при виде сбоку и П-образного при виде сверху каркаса 93, имеющего закрепленную при виде сбоку пластинку 94 /см. фиг.44, 45, 54, 55 и 56/.The holder 10 of the device 6 and 7 for stopping the movement of blood in a blood vessel is made in the form of, for example, wire

-shaped when viewed from the side and U-shaped when viewed from above of the frame 93 having a plate 94 / cm fixed to the side view. Fig.44, 45, 54, 55 and 56 /.

The lower rods are parallel to each other and have an annular thickening 95 in the middle part, which contacts the end faces of the guide bushings 74 of the device 6 and 7, and the vertical part of the L-shaped plate 94 is made with a V-shaped point towards the bend with a notch.

The end parts of the parallel rods of the holder 10 are pointed, the upper horizontal part of the holder interacts with the thumb, index and middle fingers of the operator.

Block 11 of the formation of the flange in the blood vessel is made in the form of a system of kinematically connected with the threaded sleeve housing 96 of the threaded 97 and 98 and the threaded 99 and 100 bushings, the middle inner threaded 97 of which are mounted in the middle part inside the sleeve-housing 96, the outer threaded 98 outside the back parts, one threadless 99 is located outside the front, the other 100 is integral inside the internal threaded sleeve 97 with a collet tube 101 / cm installed inside. Fig. 58 /.

A rod 102 is mounted inside the collet tube 101, in the front end part of which a cup 103 / cm is fixed. Fig. 58 /, having in the bottom part a conical annular with a vertex located in the area of the coupling, a zone and longitudinal located uniformly around the circumference of the slot, forming a collet in the end cylindrical part with an end that protrudes about 1 mm / cm beyond the end of the blood vessel. Fig and 71 /.

The collet part of the tube 101 is in contact with the collet part of the cup 103, which interacts with the outer cylindrical surface with the inner cylindrical surface of the blood vessel, approximately in the end front part of the rod 102 is formed by a conical apex towards the inner middle threaded sleeve 97 portion in the area of the collet of the tube 101 and the cup 103 / cm. Fig. 58 /.

A key 104 is fixed in the plane and transverse axis in the rear end part of the sleeve body 96 and the rod 102, and a through window 105 is fixed in the collet tube 101, a width equal to the thickness of the key 104 and a length equal to its width, increased by the amount of movement of the tube to ensure contact of the wall blood vessel with the inner surface of the Central hole of the coupling with the provision of reciprocating movement of the collet tube 101 relative to the rod 102 / cm Fig. 58 /.

A collar with a torus groove / cm is formed in the rear part of the collet tube 101. 58 and 62 /, interacting with the outer cylindrical surface with the inner cylindrical surface of the counter shoulder formed at the rear of the outer threaded sleeve 98, the pins mounted transversely to the axis are in contact with the torus groove of the collar of the collet tube 101 to provide reciprocal movement of the outer threaded sleeve 98 relative to collet tube 101 / cm. Fig. 58 /.

A rectangular cutout is formed in the rear end portion of the inner threaded sleeve 100, with a width equal to the thickness of the key 104 and a depth equal to its width, providing reciprocating movement of the sleeve 100 relative to the key 104 / cm. Fig. 58 /.

A reciprocal annular protrusion 105 of the inner threaded sleeve 97 interacts with the formed annular groove of the inner threadless composite sleeve 100 to provide a reciprocating movement of the inner threaded sleeve 97 relative to the inner threadless sleeve 100 / cm. Fig. 58 /.

The end of the blood vessel touches the inner side of the transverse protruding part of the jumper of each C-shaped strip 37 of the clamping device 22 of the coupling 4 and 5, capable of only reciprocating movement, and coupled to a threaded middle sleeve 97 / cm. Fig. 58 /.

In the middle inner threaded sleeve 97 of block 11, diametrically opposed rectangular on a cylindrical surface are formed, forming jumpers, through-windows, and a large and index interact with the inner threaded sleeve at the location of the opposite windows inside the sleeve-housing 96 with the longitudinal and uniform grooves formed uniformly around the circumference operator's fingers / cm. Fig. 61 /.

In the end front front part of the front threaded sleeve 99, V-shaped symmetrical grooves 106 are formed uniformly around the circumference opposite to the places between the C-shaped strips 37 of the couplings 4 and 5, with each spherical end part 107 of the two-shouldered mounted on the transverse axis in the eye of the sleeve in contact with each other 109 mounted in the front threaded portion of the sleeve body 96 of the lever 110 / cm. Fig.58, 72, 77 and 78 /. On the side of sleeve 96, parallel rods 108 are secured in lateral thickenings / cm. Fig. 72, 73 and 74 /.

The other L-shaped end part of the lever 110 by the protrusion 111 interacts with the counter recess 112 formed in the end C-shaped without a plate parallel to the sides of the opposite boss 113 of the sleeve 51 of the 4 / cm coupling. Fig. 58 /.

The ends of the protruding through one zigzag cylindrical parts of the inner threadless sleeve 100 are each made up to the middle of the thickness of the end face on the inner side, starting from the inner surface of the inner threadless sleeve 100 along the torus surface, coaxial to the inner surface of the inner ring, with a blunt point to about 0.05 mm.

-образном при виде сбоку брусе 114 с возможностью возвратно поворачиваться на шарнирно серединами установленных на передней цапфе 115 бруса 114 двух первых 116 и 117 в плоскости поперечно бруса 114, двух других 118 и 119 на первой ступени бруса /см. фиг.98/ в плоскости, параллельной плоскости бруса 114 /на фиг.85 условно изображен разрез бруса 114 на цапфе 115/.Block 13 for installing and removing clothespins 2 on the docked flanges 16 of blood vessels 15 _{2 is} made in the form of a system / see 85, 86, and 87 / kinematically pivotally mounted two-arm levers on a two-stage

-shaped when viewed from the side, the beam 114 with the possibility of pivotally turning the pivots of the two first 116 and 117 in the plane transverse to the beam 114, the other two 118 and 119 on the first step of the beam / cm. Fig. 98 / in a plane parallel to the plane of the beam 114 / Fig. 85 conventionally shows a section of the beam 114 on the axle 115 /.

At the ends of the ends of the shoulders of the first two levers 116 and 117, a semi-cylindrical groove 120 is fixed to each other at an angle of about 150 ° in planes transverse to the plane of the beam 114 / cm. Fig, 86 and 87 /.

At the ends of the ends of the front shoulders of two other two-arm levers 118 and 119, located on the first stage in the plane of the beam, a lenticular protrusion 121 is fixed on each, and the other shoulders of the same levers 117 and 118 interact with the operator’s thumb and forefinger / cm. Fig and 87 /.

The levers 118 and 119 are pivotally mounted on an axis 122 transversely mounted on the first stage of the beam 114, spring-loaded with a compression spring 123, which provides only the separation of the shoulders of the levers 118 and 119, on the inner approximately in the middle of the wall of the long shoulders of two two-arm levers 118 and 119, located in a parallel plane the plane of location on the second step of the beam 114, in the formed eyes / see Figs. 87 and 96 / are pivotally mounted with the same end parts, two of the same length of the rod 124 and 125 / see Fig. 87, 100 ... 104 /.

The other end parts of the rod are pivotally mounted to each other by means of a roller 126 mounted in the longitudinal window 127 of the end part of the second step of the beam 114 / cm. Fig.97, 98 and 99 /.

Lenticular end parts 121 of the shoulders of horizontally arranged levers contact V-shaped grooves 120 of the end parts of the shoulders of vertically arranged levers 116 and 117, other semi-cylindrical grooves 120 of the end parts of the shoulders of the same levers / cm. Figs. 85, 86 and 87 / interact with the cylindrical side protrusions 66 at approximately an angle of 150 ° to the plane of the wings of the respective clothespins 2 / cm. Fig. 35 ... 40 /.

The block 14 for mounting and dismounting the clip 1 when fastening the blood vessels 15 ₂ along the flanges 16 is made in the form of a system kinematically connected with the L-shaped when viewed from the side and the frame with a handle when viewed from above, the housing 128, mounted with the possibility of quick mounting and dismounting two formed in the lower part of the V-shaped transverse bosses 129 and 130 in the mating longitudinal V-shaped grooves of the coupling body 4 and 5 / cm. 109, 110, 123, 126 and 127 /, two spring-loaded single-arm pivotally mounted end parts on one side of each in the housing 128 of the levers 131 and 132 on the parallel axes 133 / cm transverse to the axis of the couplings 4 and 5. 107, 108 and 109 /.

In each lever 131 and 132 in the middle part over the bosses 129 and 130 of the housing 138 of the block 14, a rectangular washer 135 / cm is mounted with the possibility of only reciprocating movement along the lever 131 and 132 in the T-shaped recess parallel to the plane of each lever 134. Figs. 116 and 117 / c cantilever and laterally towards the boss 129 and 130 mounted annular stepped ring 136, interacting with a larger cylindrical surface in the hole of the engine 137, mounted with the possibility of reciprocating movement of the side rails 138 / see Fig. 140 / in reciprocal guide bosses 129 and 130 / cm. 110 and 123 /.

Inside the ring 136 with a rectangular washer 135, a spring-loaded tube 142 made of two parts 139 and 140 coaxially riveted 141 is mounted, on the end upper part 139 from the sides of which are fixed in diametrically opposite directions in the plane of the axial tube 142 of different heights, starting from the upper sides of the plates 143 and 144, forming a lamb tube 145 / cm. 130, 131 and 132 /.

An oval window 147 and a bulge 148 / cm are formed in the square washer 135 holding the ring 136 from axial movement of the overlay 146. Fig.133, 134 and 135 / on one outer side with a height h equal to the height difference of the opposing plates 143 and 144 of the wing tube 145 / cm. 130 ... 135 / with stops 149 for plates 143 and 144. On the bottom of the tube 140 / cm. Fig. 136 / approximately in the middle, an annular flange 150 is formed, which faces end-to-end with the other end of the compression spring 151 / cm. 110, 123 and 136 /.

One end part of each torsion spring 152 of the left and 153 of the right single-arm levers 131 and 132 is made along a broken line / cm. 121 / with an obtuse angle with the apex toward the outside, the outer portion from which interacts with the groove of the end end portion of the one-arm lever 131 and 132, the other end portion is made at right angles to the first end portion and is made U-shaped 154 transverse to the plane of the spring with an L-shaped end in its plane 155.

The lower end part 144 of the collecting tube-lamb 145 is in contact with the annular part 63 of the paper clip 1 during installation and dismantling in the lowermost position, and in the upper - 0.8 mm above the lower / cm. Fig. 111 /.

The distances between the parallel rods 24 and 25 of the couplings 4 and 5, the incoming parallel guide rods 74 of the device 6 and 7 for stopping the movement of blood, the parallel rods of the flange formation block 11 in the blood vessel are of the same type, while the diameters of these rods and the coaxial elongated transversely in the middle the lamellar protrusion rods 26 are the same.

Block 8 of fixing devices for fastening a blood vessel is made in the form of a system of kinematically connected L-shaped when viewed from the end and from the side and rectangular with evenly distributed holes in the wall when viewed from above the strap 156 and longitudinally installed by a T-shaped connection in the lower part of the vertical wall 157 of the plate parallel to the bending of its sides when viewed from the end face of a cup 158 cylindrical with a spherical bottom, the diameter of the cylindrical inner surface of which is equal to the diameter of the spherical end part 91 of the journal 90 of the body CA 73 devices 6 and 7 to stop the movement of blood / cm. Fig. 41, 43, 169, 170 and 171 /.

In the glass 158, a longitudinal groove 159 is formed symmetrically axially with a width equal to the diameter of the journal journal with the spherical end portion 91 of the body of the device 6 for stopping the movement of blood / cm. Fig.172 and 173 /, increased by the length of its arcs on both sides by the angle of rotation of the neck of the trunnion 90 of the body by approximately an angle of 15 ° and a depth equal to the length of the cup to the center of the bottom sphere, increased by half the diameter of the neck of the trunnion 90 of the body and the length of the arc pivoting in the housing with an angle of rotation of 30 ° / cm. Fig.171 and 172 /.

On the side and along the glass 158, symmetrically to the longitudinal groove 159 and opposite, is fixed a U-shaped bracket 160 with a vertical jumper 161 and parallel to the axial glass, in which the distance between the parallel horizontal walls on the inside is equal to the inner diameter of the glass / cm. Fig.169 and 173 /.

On the side of the bracket 160, a T-shaped protrusion 161 is formed parallel to the vertical jumper, which is in contact with the mating T-groove 162 formed on the outside of the vertical wall 157 of the plate 156 with reciprocal movement relative to each other / cm. Fig.169 and 173 /.

A through hole is formed in the parallel walls of the bracket 160 transversely to the axial cup, in which a roller 163 with a shoulder on one end side and a square on the other / cm is mounted for rotation only. FIGS. 169 and 170 /, on which a handle 164 for turning the roller 163 is fixed.

Transverse to the upper wall of the U-shaped bracket 160, a sleeve 165 is fixed concentrically to the through hole with a length equal to the length of the roller between its shoulder and the lower side of the roller rotation handle without the height of the U-shaped bracket 160.

A recess is formed in the wall of the lower part of the T-shaped protrusion 161 parallel to the vertical wall, and in the lower lower part of the vertical wall of the plate 156, in the middle of the T-shaped groove, a spring feather 166 of the T-shaped groove bent about 3 ° from the wall is equal to the width of the recess in the wall of the T-shaped protrusion 161, in which wedge-shaped bevels on both sides are formed on the edge of the lower part remote from the bottom of the glass of the bevel with a depth equal to half the wall thickness / cm of FIG. 185 /.

A cylindrical recess is formed transversely of the axial roller 163 along a length from the shoulder equal to half the inner diameter of the cup, ensuring that the inner cylindrical surface of the cup and the cylindrical recess coincide, the protrusion of the cylindrical surface of the roller beyond the inner cylindrical surface of the cup 158 is approximately 0.15 mm, ensuring mating of the cylindrical surface roller 163 with an inner cylindrical surface of the glass 158 / cm Fig. 172 /.

In the roller, at a length of about 3.5 mm from the shoulder, a transverse symmetrical axial hole is formed in which a 167 / cm pin is fixed. Fig.169, 170 and 180 /, interacting with the possibility of rotation of the roller 163 with a reciprocal arc groove in 90 ° of the sleeve 165, increased along the length of the arc by the size of the diameter of the journal.

The mounting plate 12 is made in the form of a dihedral at an angle of approximately 135 ° of a small 169 and a large 170 walls of the strip 12 with parallel and coaxial trunnions 171 with spherical end parts 172 in each diameter, similar to the diameters equal to its diameters, transversally fixed from the sides of the end part of the small wall the neck, and the spherical end of the journal 90 blocks 8 and 9 of the fixation devices for fastening blood vessels / see Fig.186, 187 and 188 /.

A notch is formed on the larger wall 170 of the plank 12 at an angle of 45 ° to one of its ribs with a pitch of approximately 0.5 mm and a depth equal to half the thickness of the plank wall, with a swept protrusion 173 formed at a 90 ° angle in the small wall 169 of the plank the edge away from the large wall of the plank 12 with the protrusion 173 for the edge of the small wall 169 is approximately 0.7 mm / cm. Fig. 189, 190 and 191 /.

The presented drawings depict devices, blocks, and a fastening unit for fastening flanges of blood vessels with a diameter of 2 mm, each fastening with one fastening of vessels at the end is made in a sector with an angle of 60 °.

For other diameters of blood vessels, the number of bond points and the angle of the sector in which the bond is made will be as follows:

for ⌀1 mm vessels - 4 fastening places, each in a sector with an angle of 90 ° / cm. figure 1, 2, 3 and 4 /;

for ⌀2 mm vessels - 6 fastening places, each in a sector with an angle of 60 ° / cm. 5, 6, 7 and 8 /;

for a ⌀3 mm vessel - 8 fastening places, each in a sector with an angle of 45 °;

for a ⌀4 mm vessel - 10 fastening places, each in a sector with an angle of 36 °;

for a ⌀5 mm vessel - 12 fastening places, each in a sector with an angle of 30 °;

for a ⌀6 mm vessel - 14 fastening places, each in a sector with an angle of 26 ° 43 ';

for a ⌀7 mm vessel - 16 fastening places, each in a sector with an angle of 22 ° 30 '.

The length of the fastening unit is 3 / cm. Fig. 188 / is equal to the length of the mounting plate 12 / cm. Fig. 189, 190 and 191 / and is approximately 55 mm.

The height of the flanges of the fastened blood vessels is approximately 0.6 ... 0.8 mm, depending on the diameter of the vessel.

The length of the clothespins 2 is approximately 1.2 ... 1.5 mm depending on the diameter of the vessel, the width of the staples is 0.8 ... 1.1 mm.

For all blood vessel diameters, the dimensions of the paper clip 1 and clothespin 2 are approximately the same size, and the unit 3 and various devices and blocks for fastening the blood vessels in lateral dimensions depend on the diameter of the blood vessel, for ⌀2 mm - 15 mm; for ⌀15 mm - 18 mm [15 + 15-2)] = 18.

The method of fastening along the flanges of blood vessels is performed in the following sequence:

- after stopping blood and blood vessels, for example, by clamps to the left and to the right of the place of rupture or incision, it is necessary to expose the vessels by 30 mm in each direction from the place of rupture or incision;

- on the spherical end parts 172 of the mounting plate 12, mount on each glass 158 of the fixation block of the device left 8 on the left and right 9 on the right and lock it by turning the roller 163 90 ° in the opposite direction from the place of rupture or section of the blood vessel / cm. Fig and 171 /;

- dock one holder 10 with the left device 6 for stopping the movement of blood, the other holder 10 with the right device 7 for stopping the blood in the blood vessel by inserting 95 parallel rods of the holder 10 into the corresponding bushings 74 of the devices 6 and 7 for stopping the movement of blood to the end with annular thickenings and lock by turning the flag 92 to a horizontal position / see Fig. 42, 44 and 45 /;

- install blocks 8 and 9 of fixing devices with a fixed strap 12 plates on the patient’s body from two sides relative to the gap or incision and secure, for example, with an adhesive film;

- remove the mounting plate 12 from the fixing blocks 8 and 9 first by turning the rollers 90 ° to the sides of the places of rupture or section of the blood vessel, then by translational parallel movement of the spherical end parts along the glasses of blocks 8 and 9;

- mount the spherical end portion 91 of the trunnion 90 of the left device 6 into the left glass 158 of the fixation unit 8 to stop the movement of blood by advancing the spherical end part along the cylindrical part of the glass 158 until it stops into its spherical bottom with subsequent rotation 164 to its position parallel to the blood vessel or transversely of the glass and turning left about 15 ° from the position of the blood vessel, as in Fig.186 and 187;

- mount in the right glass 158 of the fixation block 9 the right spherical end part 91 of the pin 90 of the right device 7 to stop the blood flow by moving the spherical end part along the cylindrical part of the glass 158 until it stops in its spherical bottom with subsequent rotation of the flag 164 until it is parallel with the blood vessel position or transverse to the glass and turning to the right about 15 ° from the position of the blood vessel, as in Fig.186 and 187;

- clamp blood vessels with devices 6 and 7 to stop movement in them by bringing the movable sponge 77 of the rail 76 closer to the fixed sponge 92 of the body 73 of the devices 6 and 7 by turning the washer handle 86 with the thumb and forefinger of the operator’s hand until the flow of blood stops blood vessel with simultaneous removal of the clamps from the blood vessels, and first squeeze the blood vessel with sponges to the extent possible / determined by skill /, then remove the clamp, after which it is necessary to squeeze the sponges until the flow stops I blood, if necessary, it is necessary to ensure that the protrusion of the blood vessel beyond the end of the housing of devices 6 and 7 at 11.5 mm / cm. Fig. 158;

- part halves 18 and 19 of clutch 4 and 20 and 21 of clutch 5 are bred to the point where a blood vessel can enter and fit into the formed "pharynx" by turning the handle washer 59 to the position of the arrow transverse to the axis of the clutch;

- insert the guide rods 24 and 25 of the couplings 4 and 5 into the corresponding guide bushings 74 of the housing 73 of the devices 6 and 7 until they stop, followed by turning the flag to a position parallel to the blood vessel / cm. Fig. 167 /;

- blood vessels 15 ₂ are inserted into the formed "pharynx" of the halves 18 and 19 of the coupling 4 and 20 and 21 of the coupling 5, while observing the positions of the couplings 4 and 5, as shown in Figs. 186 and 187;

- reduce the halves 18 and 19 of the clutch 4 and 20 and 21 of the clutch 5 by turning them to each other and then turning the washer-handle 59 to the position of the arrow parallel to the axis of the clutch, while the clutch should be divorced, as shown in Fig.186 and 187, for the convenience of simultaneous work on two ends of blood vessels to two operators simultaneously;

- insert the end part of the rod 102 of the collet tube 101 of the block 11 into each end part of the blood vessel 15 _{2 by} about 2 ... 2.5 mm, after which the blocks 11 are joined to the end of the couplings 4 and 5 to form a flange in the blood vessels by inserting protruding the rods 108 of the block 11 into the respective bushings 17 and 23, without bringing the block 11 body to the end of the corresponding couplings 4 and 5 by about 1.5 mm, followed by rotation of the sleeve 99 so that the end portion 111 of the levers 110 is located at their axial level;

- dock the blocks 11 to the corresponding couplings 4 and 5 with the subsequent rotation of the sleeve 99 so that the end parts 111 of the levers 110 enter / are located / in the recesses 112 in the C-shaped insert 51 / cm. Fig. 58 /;

- set the protrusion 38 of the strap 37 in the extreme position relative to the front end of the plate insert 49 / cm. 58, 67 and 68 / by turning the upper pin 84 of the cam 32 with a key inserted into the end portion of the pin 41 end face with faces;

- bring the threaded sleeve 100 to the end of the block 4 and 5 of the extreme forward position, as shown in Figs. 28, 70 and 71, by turning the internal threaded sleeve 97 / cm. Fig and 61 /, while the toroidal end part / see Fig.58 and 71 / sleeve 100 will wrap / lift / end of the vessel 15 ₂ ;

- form the flanges 16 of the blood vessels by moving the protrusion 38 of the strap 37 to the eccentric 32 by turning the upper journal 41 with a key, while the vertical position of the flange is formed on the width of the protrusion 38 of the strap 37 / cm. 11 /, the zigzag position of the blocks 8 + 6 + 4 + 11 and 9 + 7 + 5 + 11 should be, as in Fig.186 and 187;

- disconnect the blocks 11 from the couplings 4 and 5 by first turning the sleeve 99 to the exit of the L-shaped end parts 111 of the levers 110 from the recesses 112 of the insert 51 / cm. 58 and 9 /, then by rotating the threaded sleeve 97, while the toroidal end parts of the sleeve 100 will move in the opposite direction from the corresponding couplings 4 and 5, and the collet tube 101 will detach from the collet 103 / cm. Fig. 58 /;

- insert the elongated rods 26 into the corresponding sleeve of the sleeve 4 until they stop with the protrusion 27 into the corresponding recesses of the ends of the sleeve 4 / cm. Fig and 167 / with subsequent fixation by turning the flag;

- having displaced the couplings 4 and 5 on the opposite sides of each other by about 5 mm, the clutch 5 is guided by the guide bushings 23 onto the protruding end parts of the rods 26, reducing the couplings from the position shown in Figs. 186 and 187 to the coincidence / alignment position / their axial in one straight line;

- join the couplings 4 and 5 by contacting at the ends of the couplings and the corresponding flanges in contact at the ends of the blood vessels, as shown in Fig. 188, with the couplings fixed by turning the 31 / cm flag. Fig and 166 /;

-образных пружин навстречу друг другу, при этом свободные концы пружин сместятся друг к другу к торцам своих муфт и выйдут из соответствующих отверстий корпусов муфт с последующим смещением от центра, и извлекают Ц-образный вкладыш 51 /см. фиг.9/ из V-образного углубления каждой муфты 4 и 5;- release the V-shaped recesses in the couplings 4 and 5, located in the plane of the axial couplings and between the clamping devices 22 installed in the respective recesses of the C-shaped strips 37 by removing the V-shaped inserts 51 from the V-shaped recesses by compression

-shaped springs towards each other, while the free ends of the springs move to each other to the ends of their couplings and come out of the corresponding openings of the clutch housings with subsequent displacement from the center, and the 51-cm liner is removed. Fig.9 / from the V-shaped recesses of each coupling 4 and 5;

- in the resulting V-shaped recess of the two couplings 4 and 5, a block 13 is installed for installing and removing clothespins 2, as shown in Figs. 85, 86 and 87, with clothespin 2 by compressing the levers 118 and 119 with the fingers of the operator’s hand to the position when the flaps of the clothespin 2 allow entry onto the docked flanges 16 of adjacent blood vessels, followed by touching the end parts of the flaps of the base of the flanges, as shown in FIG.

- compress the contacting flanges of the blood vessels with the flaps of the clothespin 2 by extending the fingers of the operator’s hand from the shoulders of the levers 118 and 119 in the presence of contacting the fingers with the shoulders of these levers due to the compression of the spring 123 / cm. Figs. 85, 86 and 87 /;

- after installing the clothespin 2 on the flanges 16, the block 13 is removed from the V-shaped recess of the couplings 4 and 5 by reducing the levers 118 and 119 with their subsequent removal;

- in subsequent V-shaped recesses of the couplings adjacent to the clamping devices 22, the installation of clothespins is carried out according to the above technology into the cavity to the last through the clamping device 22;

- in the mounted clothespin 2, a clip mounted on the flanges of the blood vessels is mounted in the block 14, as shown in Figs. 107, 108 and 109, having previously pressed torsion springs 152 and 153 with each other, followed by fixing the end parts of the spring in the holes of the struts of the housing 128 of the block 14, wherein the parallel bars of the clip 1 are located opposite the respective holes of the flaps of the clothespin 2, as in FIGS. 109 and 111, the end portion of the lower tube 140 of the wing tube 145 is installed in the ring 63 of the clip 1 when the plate 143 of the wing tube 145 is located on the pad 146, as shown in FIG. 110;

- move the clip with parallel rods to the corresponding openings of the flap of the clothespin 2 to the stop of the clip ring in the flap by reducing the levers 131 and 132 of the block 14 to the extreme position, while the end parts of the parallel clips of the clip after bending out of the openings of the flaps of the clothespin 2 will bend to each other due to the gutters at an angle of 90 °, as shown in FIG. 124, with the subsequent installation of the wing tube 145 with the plate 144 on the higher protrusion 148 of the lining 146;

- remove the block 14 from the V-shaped recesses of the couplings, previously transferring the wing tube 145 with the plate 144 to a lower protrusion / plane / lining 146 by turning the wing tube 145 90 ° in any direction of rotation;

- in the same sequence, the flanges are fastened in neighboring V-shaped recesses through the clamping device;

- remove in each between the installed clips around the circumference of the clamping device 22 the C-shaped strip 37 and the inserts 49 by removing the free end of the spring 54 / cm. Fig.9 / in two couplings 4 and 5 with the subsequent movement of the strap 37 from their axial until the T-shaped protrusion 47 of the strap 37 comes out of the T-groove 45 of the strap 37 and its extraction from the V-shaped recesses of the couplings 4 and 5, inserts 49 is removed by grabbing it by a U-shaped protrusion / cm. Fig / with subsequent movement from the axial T-shaped protrusion 50 along the T-shaped groove of the housing of the couplings 4 and 5;

- in the resulting V-shaped recesses adjacent to the recesses mounted on the clips, install blocks 13 and 14 in turn, as described above and so on until the last recesses around the circumference in the couplings 4 and 5;

- the circumferential fastening by clips of blood vessels along the flanges is completed;

- in devices 6 and 7, the movable jaws 77 are moved apart from the stationary 92 by rotating the washer-grip 86 to form a “pharynx” between them until the blood vessel is freely removed;

- open the halves 18 and 19 of the coupling 4 and 20 and 21 of the coupling 5 for the formation of a "pharynx" between them until the free extraction of the blood vessel;

- turn the rollers 163 of blocks 8 and 9 to the position of the rotation arms 164 of the rollers 163 to a position transverse to the blood vessel, while the spherical end parts 91 of the trunnions 90 of devices 6 and 7 can freely move along the cylindrical glasses 158 of blocks 8 and 9 / cm. Fig. 172;

- remove the fastening unit 3/4 + 5 + 6 + 7 / from blocks 8 and 9 by turning the unit 3 so that it can be separated from the fastened blood vessels with subsequent translational movement of the unit with the spherical end parts of the devices to stop the movement of blood through the glasses 158 blocks 8 and 9;

- remove the fastening films from the plates 156 of blocks 8 and 9 and remove them from the formed recess with blood vessels;

- the operation of fastening the blood vessels is considered completed.

After the coalescence of the vessels along the flanges / the terms are determined by skill /, if necessary, the clips are removed from the corresponding clothespins, followed by the removal of clips in the following sequence:

- install the block 14 with the lower end part 140 of the wing tube 145 in the ring 63 of the clip 1, as shown in Figs. 111 and 119 / shows the clip in the outermost position from the clothespin 2 /;

- by weakening the efforts on the levers 131, 132 with the fingers of the operator’s hand, the force of the springs 152 and 153 removes the paper clip from the clothespin 2; it is possible to simultaneously remove the paper clips in diametrically opposite locations of the clothespins 2;

- install the block 13 on the clothespin so that the V-shaped end part 120 of the levers 116 and 117 would cover the tabs 66 of the clothespin 2, as shown in Fig, holding the end part 115 / see 86 and 87 / pins with tweezers with special end parts, while the pegs 66 of the clothespin rotate about 150 ° relative to the axis of the clothespins, the flaps 65 of the clothespins 2 also rotate by an angle of 150 °, being released from the flanges 16 of the blood vessel 15 ₂ , with the subsequent separation of the clothespins from the flange of the blood vessel, it is possible to simultaneously remove the clothespins in diametrically opposite locations of the clothespins 2, and so the paper clip is removed and the clothespins are removed along the entire diameter of the blood vessel flange.

The proposed method of fastening at the end faces of blood vessel flanges allows their fastening, to ensure fastening of small diameter vessels, including ⌀1 mm, more technological removal of fastening elements of blood vessels and their faster fastening due to the simultaneous work of fastening blood vessels of two operators.

Claims (11)

1. The method of fastening at the end of the flanges of vessels, such as blood vessels, including fastening elements in a contact position, formed on the flanges of adjacent blood vessels, characterized in that the installation of adjacent flanges of blood vessels is made with clips arranged uniformly and sequentially with a gap around the circumference using V- shaped in the form of loops with lateral protrusions of clothespins and corresponding devices for mounting and dismounting clips and clothespins, and a fastening unit consisting on both sides s from the middle of the coupling, a device for stopping the movement of blood in a blood vessel, a unit for fixing these devices for fastening blood vessels on the body, for example, a patient, a holder for a device for stopping the movement of blood, a unit for forming a flange in a blood vessel and a mounting plate for simultaneous operation for fastening the blood vessels of two operators. 2. A fastening assembly comprising mounting elements of adjacent flanges, for example, blood vessels, characterized in that the unit is made in the form of a system of symmetric flanges of blood vessels sequentially in a straight line on both sides of each coupling flange, a device for stopping blood flow in the blood the vessel and the fixing block of these devices, each coupling consists of two semicylindrical couplings that can rotate on the sleeve axis of the couplings in the form of a loop of leaf-halves of couplings with a central with an axial hole equal to the diameter of the blood vessel, in the couplings uniformly around the circumference with a step equal to two lengths, with a gap of the V-shaped clothespin, recesses are formed parallel to the axis of the couplings with a length equal to two staple lengths, in the recesses are mounted clamped pivotally on the axis transverse to the axis of the coupling devices, between recesses and clamping devices in one half of the coupling, guide bushings are fixed almost in diametrically opposite directions along the length of the coupling, in each of the outer ends of one of the ends of the mounts an rod with a length equal to the length of the device’s body to stop the blood flow, and in the bushings of one half of the coupling, elongated rods each with a length equal to two lengths of the coupling body with a plate transverse protrusion in the middle are installed until the stop at the transition end of the seal of the rod in the end, in the end parts of the rods and bushings on the side of the rods, in addition to the bushing axis, half-cylindrical recesses are formed almost to the axial and transverse to it, in contact with the roller with a flag transversally mounted with the possibility of return rotate tightly in the ends of the clutch housings in the area where the eccentric and the device for stopping the blood flow are located, and the half-cylindrical recesses in the clutch housings and the devices for stopping the blood and end parts of the rods in the docked positions coincide in the formed bosses with a distance between the ends of the couplings equal to two thicknesses of the walls of the vessels, and between diametrically opposite directions of the recesses and clamping devices are formed on one side mounted on the sleeve on the axis of the loop, on the other a mounted locking device, while in the end parts of the bushings on the opposite side of the rods at the ends transverse to the axis, a plate protrusion is formed on one side and a recess on the other in parallel planes of the semicylindrical recesses in the respective rods and bushings, and in the coupling bodies in the reciprocal at the ends, corresponding recesses are formed, equal to each thickness of the plate-like protrusion of the sleeve and two thicknesses of the plate-like transverse protrusions of an elongated rod on the other side of the housing m ft, and the plane of symmetry passing in the middle of the protrusion and the recesses of the sleeve are located on its axial and parallel to the axial half-cylindrical surface of the recess, while the unit for installing and removing clothespins on the joined flanges of blood vessels is made in the form of a system of kinematically articulated two two-arm levers, a two-stage side view of the beam with the ability to rotate pivotally with the midpoints of the two first two mounted in the plane transverse to the beam mounted on the front axle of the beam them at the first step of the beam in a plane parallel to the plane of the beam, while on the ends of the ends of the shoulders of the first two levers are fixed on each semicylindrical trench towards each other at an angle of about 150 ° in planes transverse to the plane of the beam at the ends of the ends of the other shoulders of the two front levers mounted on each U-shaped trough in the plane of the transverse plane of the beam and parallel to each other, and at the ends of the end parts of the front shoulders of the other two two-arm levers located on the first step in a plane parallel to the plane of the beam, a lenticular mounted on each protrusion in the plane of the beam, and the other shoulders of the same two-arm levers interact with the thumb and forefinger of the operator’s hand, while the levers are pivotally mounted on an axis transverse to the first step of the beam are spring-loaded with a compression spring, which provides only a breeding of levers, on the inner approximately in the middle wall of the long shoulders of two two-shoulders located in the parallel plane in relation to the plane of arrangement at the second level of the beam of levers, in the formed eyes, two identical ends of the rod are pivotally mounted by one end parts, the other end parts of the rod are pivotally mounted to each other by means of a roller mounted in the longitudinal window of the end part of the second stage of the beam, and the lenticular end parts of the shoulders of horizontally located levers are in contact with the V-shaped grooves of the end parts of the shoulders of vertically arranged levers, other semi-cylindrical grooves of the end parts her shoulders of the same levers interact with cylindrical lateral protrusions approximately at an angle of 150 ° to the plane of the flap of the corresponding clothespins, while the unit for mounting and removing the clip when fastening the blood vessels along the flanges is made in the form of a system kinematically connected with the L-shaped when viewed from the side and frame with a handle, when viewed from above, with a body installed with the possibility of quick installation and dismantling of two bosses formed in the lower part of the V-shaped transverse in the middle part in the reciprocal longitudinal V-shaped grooves coupling sleeve, two spring-loaded single-arm pivotally mounted end parts on one side of each in the housing of the levers on parallel parallel axes transverse to the axis of the couplings, while in each lever in the middle part over the bosses of the block body in the T-shaped recess mounted parallel to the plane of each lever, only move the rectangular washer along the lever with the cantilever and transverse towards the boss mounted ring stepped ring interacting more cylindrical the surface in the reciprocal hole of the engine, mounted with the possibility of reciprocating movement by the side guides in the reciprocal guide bosses, and inside the ring with a rectangular washer, a spring-loaded component of two parts is mounted coaxially riveted on the tube, on the lateral upper part of which are mounted diametrically in opposite directions in the plane of the axial tube of different heights, starting from the upper sides of the plate, forming a wing tube with stops for them in a straight line an oval window and a thickening on the square washer with the ring from axial displacement, oval windows are formed and a thickening on one outer side with a height equal to the difference in height of the opposite lamina tube plates, with an annular bead contacting the other end on the bottom of the tube approximately in the middle the end of the torsion spring, and one end part of each torsion spring of one-arm levers is made along a broken line with an obtuse angle with the apex to the outside, the outer portion of which interacts with the groove of the end end part of the one-arm lever, the other end part is made at right angles to the first end part and is made U-shaped in the transverse to the plane of the spring with a L-shaped end in its plane, while the lower end part of the collecting tube-wing contacts the ring part of the paper clip during its installation and dismantling in the lowermost position, and in the upper - 0.8 mm higher than the lower one, and the distances between the coupling rods parallel to the coaxial bushings included in the parallel guide bushings and devices for stopping the movement of blood, the parallel rods of the flange formation unit in the blood vessel are the same, while the diameters of these rods and the coaxial rods elongated transversely in the middle with a plate protrusion are also the same, and the block fixing devices for fastening blood vessels is made in the form of a system of kinematically connected shaped when viewed from the end and side and rectangular with evenly spaced holes in the wall when viewed from above the strap and longitudinally installed by a T-shaped connection in the bottom of the vertical wall of the plank parallel to the bending of its sides when viewed from the end of a cylindrical cup with a spherical bottom, the cylinder diameter of the inner surface of which is equal to the diameter of the spherical end of the trunnion of the body of the device for stopping blood movement and in which a longitudinal groove equal to the neck diameter is formed symmetrically to its axial with a spherical end part of the body of the device for stopping the movement of blood, increased by the length of the arcs on both sides by an angle of rotation of the neck of the journal of the housing by about 15 ° and a hollow equal to the length of the cup to the center of the spherical bottom, increased by half the diameter of the neck of the trunnion of the body and the length of the arc of rotation of the trunnion in the body with an angle of rotation of about 30 °, while the side and along the cup are symmetrical to the longitudinal groove and opposite it is fixed a U-shaped bracket with a vertically located jumper and parallel to the axial cup, in which the distance between the parallel horizontal walls on the inside is equal to the diameter of the cup, with a T-shaped parallel to the vertical the protrusion in contact with the reciprocal T-groove formed on the outside of the vertical wall of the strap with the provision of reciprocating movement relative to each other, while a parallel hole is formed in the parallel walls of the bracket transversely to the axial cup, in which the roller a flange on one end side and, for example, a square on the other, on which a roller turning handle is fixed, and transversely to the upper wall of the U-shaped bracket, concentrically formed a through hole is fixed to a sleeve with a length equal to the length of the roller between its shoulder the lower side of the handle for turning the roller without the height of the U-shaped bracket, while in the wall of the lower part of the T-shaped protrusion of the glass, a recess is formed parallel to the vertical wall, and in the middle lower wall of the strip, T- a spring-shaped feather of a T-shaped groove bent approximately 3 ° from the wall is formed with a width equal to the width of the recess in the wall of the T-shaped protrusion, in which at the bottom, remote from the bottom of the glass, the parts are formed with an inner on the lower side, on the rib, wedge-shaped bevels on both sides with a depth equal to half the wall thickness, and a cylindrical recess is formed transversely to the axial roller at a length from the shoulder equal to half the inner diameter of the glass, ensuring that the inner cylindrical surface of the glass and the cylindrical recess coincide, the protrusion of the cylindrical surface of the roller beyond the inner cylindrical surface of the cup is approximately 0.15 mm, ensuring that the cylindrical surface of the roller is mated to the inner the surface of the beaker, while an axial bore is formed transversally in the roller at a length of about 3.5 mm from the shoulder, in which a pin is fixed, interacting with the possibility of turning the bead with a reciprocal arc of about 90 ° through the groove of the sleeve, increased along the length of the arc by trunnion diameter size. 3. The assembly according to claim 2, characterized in that the grooves longitudinal from the end in each coupling are formed along its circumference in sectors with an angle α of each constructed according to the formulas

where α is the angle of the sector in which part of the hemispheres of a blood vessel is fixed on one side of the end with a sleeve; n is the even number of sectors in the coupling; r is a radius equal to half the diameter of the blood vessel; t is the wall thickness of the blood vessel; a is the flange wall thickness of the V-shaped clothespins; c is the distance from the sector line to the axis of the parallel core of the paper clips; l is the distance between the axial parallel staples of the paper clip; b is the distance from the inner flanging wall of the V-shaped clothespins to the axis of the parallel clip bar. 4. The assembly according to claim 2, characterized in that the clamping device of each coupling is made in the form of systems uniformly spaced around the circumference in the sectors of each coupling through one, each of which consists of two kinematically connected T-shaped when viewed from the side of the engine and P- figurative when viewed from the side of a plate with a plate transversely and parallel to its sides and an oppositely directed protrusion in the C-shaped plane of the plate and an eccentric clutch installed in a rectangular window with two-sided transverse eccentric planes coaxial pins mi, the T-shaped engine is mounted with the possibility of reciprocating movement in the formed longitudinal rectangular window parallel to the axis of the coupling, one pin of the eccentric is located closer to the axis of the coupling, the other in the eccentric hole of the ring locked by means of a pin mounted in a threaded ring fixed in the coupling housing, and in the shelf of the T-shaped engine, longitudinal T-shaped grooves are formed transversely to the engine, with which the reciprocal T-shaped protrusions of one Ts-shaped strut are in contact a lance, interacting with the protrusion on the outside with the flange of the blood vessel, while a plate insert is mounted under the U-shaped strip, the T-shaped protrusion from one end of which interacts with the reciprocal T-shaped groove of the coupling housing, the T-shaped grooves of the engine and the coupling housing are made one-dimensional , the other end of the inserts interacts from the inside of the flange of the blood vessel, and on the eccentric located in the ring of the end part of the pin, symmetrically removed from the diametrically opposite sides are segments formation of the end part for the corresponding “pharynx” of the L-shaped key, from the opposite side of the recess with the clamping device installed, a U-shaped insert without a plate parallel to the stacks and an oppositely directed boss an insert with a T-shaped protrusion formed on the outside of the parallel racks in the plane of the rack, the response The T-groove of the coupling body, while the front end of the jumper is in contact with the inner side of the flange of the blood vessel, the liner length is less than the depth of the recess in the coupling housing by the eccentricity of the eccentric, and the end part of the bar transverse to the jumper in the rearward position in the coupling body is deepened beyond the outer surface of the blood vessel flange by a value of the order of 0.15 ... 0.20 mm, moreover, in the end parts of the parallel struts of the bar and the insert in the formed holes each end of the spring-loaded U-shaped brackets in plan and the brackets in the liner are mounted in each bent at right angles, while some ends protruding beyond the T-shaped protrusions of the bar and liner are in contact with the reciprocal cylindrical angles killings in the corresponding places of the coupling body with T-grooves located in the middle with the possibility of reciprocating movement, the other ends of each spring are fixed in the end part of another parallel bar of the bar and the liner, and in the T-shaped protrusions of the rear bar of the bar and in the T-grooves In the middle of the coupling body, rectangular recesses are formed over the entire width of the T-shaped protrusion and groove with a height equal to 1/3 of the length of the T-shaped protrusion and groove, ensuring 1/3 of the T-shaped protrusion of the rear pillar ny or insert into the recess of the housing with subsequent entry into the T-shaped groove of the housing, and between the racks and in the insert is formed a longitudinal depression, with a depth and width in cross section equal to the diameter of the wire spring. 5. The assembly according to claim 2, characterized in that the device of the halves of the couplings of each coupling is made in the form of a system of concentric and transversely mounted trunnions on one half of the coupling, the middle ring on the other half of the coupling, the inner ring with an outer ring-handle threaded connection, at the same time, an annular protrusion on the outer cylindrical surface is formed on the inner ring in the end part of the oppositely threaded, and in the middle ring in the end part is formed on the inner cylindrical surface, the ends of the annular protrusions with the middle and inner rings are in contact with each other, moreover, longitudinal grooves are formed on the outer cylindrical surface of the outer ring of the handle, with which the thumb and forefinger of the operator’s hand interact, while symmetrical axial cuts are formed in the lower part of the outer, middle and inner rings with a width equal to the diameter and a depth equal to the height of the trunnion, an arrow is shown at the end of the outer ring-handle, the tip coinciding with the cutout on the rings, and the trunnion, symme ary plane of the connector halves couplings. 6. The assembly according to claim 2, characterized in that each clip is made of hardened steel I-beam when viewed from the rear and C-shaped without a L-shaped external part with a ring fixed in the middle from the outside and parallel to the plane parallel to the rods, with the first bends, starting from the end parts of parallel rods along the length of five wall thicknesses of the blood vessel, are made with a hardness of HR equal to about 37 ... 42, with bends at an angle of about 45 ° without kinks, moreover, in the end conical parts of the parallel Yelnia rods staples are formed along the longitudinal troughs for forming the cone length, forming a cross with an end cutting blade on the inclined edges of the cross ribs are angled 45 ° to the plane of parallel rods staples. 7. The assembly according to claim 2, characterized in that the V-shaped clothespin is made in the form of a loop having flaps that can be rotated back and forth made in each eye and covering the axis of the loop with two feathers with a transverse cylindrical protrusion at an angle of about 150 ° to the plane of the flap in the opposite direction from it in each, while the feathers of the sash in the assembled clothespin are held in a given position and each feather of the sash is located one from the other at a distance of about three sizes of the width of the feather, the extreme of which are located on example, to the left of the leaflet edge, and the leaflet width at the location of the loop is six sizes of the width of the pen, the edges of each leaflet of the loop in the opposite direction from its axis being rounded radially, forming a shoulder, and in contact with the outer surface of the corresponding blood vessel, sides at the location of the rounding in the lower part of each casement, two holes are formed, the distance between which is equal to the distance between the parallel staples of the paper clip, and the diameters to the two diameters of the paper clip and hole oosny together. 8. The assembly according to claim 2, characterized in that the device for stopping the movement of, for example, blood in a blood vessel is made in the form of a C-shaped without plate parallel to the uprights and the opposite boss when viewed from the side and the frame with the side plate at the level of its lower sides when viewed from the back and two rectangles, one of which is offset in an angle relative to each other when viewed from above the case with a rectangular sponge formed cantilever upwards and parallel guides fixed from the bottom bushings, while in the frame in its lower part at the base grooves are formed in which the L-shaped plate is mounted when viewed from the side with the possibility of reciprocating movement of a plate with a rectangular plate shelf-sponge, a spring-loaded plate spring with an end part mounted in a rectangular window end part of the body in the area of the grooves, and the other end part with teeth of 90 ° each in increments of 0.5 mm in contact with the counter teeth of the lower side of the plate, and the horizontal part of the plate is made by a rail, coupled to the gear, pivotally mounted to the pins in the coaxial holes of the side walls of the frame, and a washer-handle is fixed on one end of the pin of the gear, longitudinal grooves are formed on the cylindrical outer surface of which are uniformly circumferential, while in the end of one of the guide bushings transverse to its axis a rod with a transverse semi-cylindrical recess and a flag is mounted, the distance between the parallel guide bushings is equal to the distance between the corresponding corresponding rods coupling halves, and under the fixed body sponge parallel to the guide bushings, a trunnion with a spherical end part, the diameter of which is about 5/3 of the trunnion neck diameter, is cantileverly mounted in the device’s body in the middle and cantileverly mounted sponge-shelf in sizes similar to the dimensions of the rail-sponge plates. 9. The holder of the device for stopping the movement of, for example, blood in a blood vessel is made in the form, for example, of a wire U-shaped when viewed from above, a frame having a fixed L-shaped when viewed from the side and rectangular when viewed from above, the lower rods parallel to between themselves and have in the middle part an annular thickening in contact with the end face with the corresponding ends of the guide bushings of the device, and the vertical part of the L-shaped plate is made with a C-shaped hole in the direction of the inflection cut, and the ends части parts of the parallel holder rods are pointed; the upper horizontal part of the holder interacts with the operator’s thumb and middle finger. 10. The flange formation unit, for example, in a blood vessel is made in the form of a system of threaded and threadless bushings kinematically connected with the threaded sleeve housing, the middle internal screw of which is mounted in the middle part inside the sleeve body, the external screw thread is outside the rear part, one threadless is located from the front from the outside, another component inside the internal threaded sleeve with a collet tube installed inside, in which a rod is mounted, in the front end of which a glass having the bottom part is conical in the form of a ring with an apex located in the zone of the sleeve’s location and a longitudinal one evenly spaced around the circumference of the slot, forming a collet in the end cylindrical part with an end protruding about 1 mm beyond the end of the blood vessel, the collet part of the tube contacts the collet part of the glass, interacting with the outer cylindrical surface with the inner cylindrical surface of the blood vessel, a conical apex is formed in the end front part of the rod toward the inside For the middle threaded sleeve, there is a section in the zone of the collet of the tube and the cup, a dowel is fixed in the plane and transverse to the axis of the sleeve in the plane and transverse to the axis, and a through window with a width equal to the thickness of the dowel and a length equal to its width is increased by an amount the movement of the tube to ensure contact of the stitch of the blood vessel with the inner surface of the hole of the coupling with the provision of reciprocating movement of the collet tube relative to the rod, in the back of the antler tube collar with a torus groove interacting with the outer cylindrical surface with the inner cylindrical surface of the counter collar formed in the rear part of the external threaded sleeve, pins installed transversely to the axis of the pins are in contact with the torus groove of the collar of the collet tube, allowing the outer threaded sleeve to be rotated back relative to the collet tube, while in the rear the end part of the inner threaded sleeve is formed by a rectangular cutout with a width equal to the thickness of the dowel and a depth equal to e e width, providing a reciprocating movement of the sleeve relative to the key, and the reciprocal annular protrusion of the internal threaded sleeve interacts with the formed annular groove of the internal threaded sleeve to provide reciprocating movement of the internal threaded sleeve relative to the internal threadless sleeve, while the end of the blood vessel touches the inner side the transverse protruding portion of the jumper of each C-shaped strip of the clamping device of the coupling and zigzag The ends of the inner threaded sleeve are located by the protrusions between the C-shaped strips of the clamping devices of the coupling capable of only reciprocating movement and are coupled to the threaded middle inner sleeve, and diametrically opposite rectangular along the cylindrical surface are formed in the middle inner threaded sleeve of the block, forming jumpers between them, through windows and with an internal threaded sleeve at the location of the opposite sides inside the sleeve-body with formed longitudinal but the thumb and forefinger of the operator, for example, a surgeon, interact with the grooves around the circumference, while V-shaped symmetrical grooves are formed in the end front front of the front threaded sleeve evenly around the circumference opposite to the places between the C-shaped plates of the coupling, with each spherical contacting each the end part of the two-shouldered sleeve mounted on the sleeve transverse in the eyes, fixed in the front threaded part of the sleeve-housing of the lever, the other L-shaped end part of the lever with a protrusion of the interaction There is a reciprocal recess formed in the end C-shaped plateless parallel to the sides and the opposite boss of the sleeve of the sleeve, with the ends of the protruding through one zigzag cylindrical parts of the inner threadless sleeve made each to the middle of the thickness of the end from the inside, starting from the inner surface of the inner threadless sleeve along torus surface coaxial to the inner surface of the inner ring with blunting of the tip to about 0.05 mm. 11. The installation plate is made in the form of a dihedral, diagonal at approximately 135 °, with the small and large walls of the strip with parallel and coaxial trunnions with spherical end parts in each diameter similar to the diameters of its neck and spherical end, mounted transversely from the sides of the end part of the small wall parts of the trunnion pin of the device for fixing blood vessels, while a notch is formed on the greater wall of the plank at an angle of 45 ° to one of its ribs with a pitch of approximately 0.5 mm and a depth of half fault stitches strap thickness, and strap middle small stitches on the outer side sagittal projection formed at an angle 90 ° away from the edge of the wall strips large protrusion of rib small wall approximately 0.7 mm.

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