CN106137292B - A kind of device for left auricle of heart ligation operation - Google Patents
A kind of device for left auricle of heart ligation operation Download PDFInfo
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- CN106137292B CN106137292B CN201510170230.7A CN201510170230A CN106137292B CN 106137292 B CN106137292 B CN 106137292B CN 201510170230 A CN201510170230 A CN 201510170230A CN 106137292 B CN106137292 B CN 106137292B
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- ligation operation
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Abstract
The invention discloses a kind of devices for left auricle of heart ligation operation comprising: for reaching the outer sheath of left auricle of heart through vein blood vessel；For atrial septal puncture and the interior sheath for being positioned at left auricle of heart seal wire；For importing the seal wire of Minimally Invasive Surgery instrument；For holding in the mouth the screw at left auricle of heart tip；Knotting and stitching devices are carried out for the tip to left auricle of heart；Disconnecting device for being cut off at the knotting at left auricle of heart tip；Wherein, the bore of the outer sheath is greater than the bore of interior sheath.The invention has the benefit that the part for easily leading to thrombus generation in left auricle of heart is cut off, the pathogenetic hidden danger of apoplexy has thoroughly been eradicated；A seal wire is put into interior sheath to reduce the danger that outer interior sheath accidentally pokes left auricle of heart tip；Full operation is operated through vein blood vessel without open chest surgery, is reduced and is performed the operation invasive and shorten post-operative recovery time；Due to having cut off left auricle of heart so as to avoid the relevant latter problem of current occluder for left auricle.
Description
Technical field
The present invention relates to a kind of devices for left auricle of heart ligation operation, belong to the field of medical instrument technology.
Background technique
Auricle is the ear folliculus stretched out from atrium, is a part in atrium.On the atrium sinistrum top of heart, it is located at actively
The back side of arteries and veins and pulmonary artery, the angular forward right side of one is prominent, is left auricle of heart.There are four veins to be open for the rear wall of atrium sinistrum, lower section
There is left atrioventricular orifice.Current not known auricle has any physiological function；But since left auricle of heart inner face has musculi pectinati and surface relief not
It is flat, so that blood flow is generated vortex and flows decrease, under certain pathologic conditions (such as rheumatic heart disease, atrial fibrillation), in left auricle of heart
Easily form thrombus；For example when atrial fibrillation occurs, entire atrium completely loses normal contractile function, and the blood flow in left auricle of heart tends to the stasis of blood
It is stagnant, easily form thrombus.Corresponding organ (such as heart, lungs, liver and spleen, kidney, brain etc.) embolism etc. can be caused tight after thrombus breaks loose
Weight consequence.Therefore, it is directed to this illness of atrial fibrillation-thrombo-embolic at present, can be treated by anticoagulant or Minimally Invasive Surgery；In recent years,
It has also obtained developing on a large scale very much using the method that Minimally Interventional Therapy method blocks left auricle of heart, which seriously goes out for existing
It is a kind of selection well for blood patient and anticoagulant taboo patient.There are two types of common left atrial appendage occlusion arts, and one is utilizations
Percutaneous left auricle of heart mutual conductance pipe plug closes device and blocks left auricle of heart, common such as Appriva Medical company；Another kind is to utilize
The atrial septum Amplazer plugging umbrella is stifled to close left auricle of heart.Common practices is all that plugging device is placed by intubation intervention method to left auricle of heart
In, prevention causes left auricle of heart to form thrombus due to atrial fibrillation, which goes upward to apoplexy caused by brain；Or prevents the thrombus and pass through
Blood circulation of human body system reach other positions of body, caused by systematicness embolism.Plugging device is put into left auricle of heart, is blocked left
Auricle blocks the blood flow for entering left auricle of heart, can eliminate due to atrial fibrillation and cause the thrombosed risk of left auricle of heart, in prevention
Wind.Such instrument is usually all to be connected by screw thread with conveyer at present, and instrument itself divides substantially two major classes from structure
Plug formula occluder for left auricle is as depicted in figs. 1 and 2, fills in disc type occluder for left auricle such as Fig. 3.In figs. 1-5,1 is atrium sinistrum
(LA), 2 be left auricle of heart (LAA), and 3 be left auricle of heart cavity wall, and 4 be plug formula occluder for left auricle choked flow film, and 5 be plug formula left auricle of heart
Plugging device ontology, the 6 pit shape gaps formed between plug formula occluder for left auricle and left auricle of heart, 7 be plug disc type left auricle of heart
Plugging device ontology, 8 be the choked flow film for filling in disc type occluder for left auricle.Plug formula occluder for left auricle is product to be made into a band
The spherical cylindric or coniform plug of choked flow film, plug have certain elasticity, can deform in left auricle of heart, in the hope of
The shape for adapting to left auricle of heart cavity achievees the purpose that clog left auricle of heart, and the choked flow film on plug can be with blocking blood flow.Fill in disc type
Occluder for left auricle is the complex of cylindrical plug and plate-shape part, while fluid-blocking membrane is sewed on disk；Cylindric plug
In the left auricle of heart cavity that subdivision is placed, with the entire instrument of fixation；Plate-shape is partially covered on the oral area of left auricle of heart, for hindering
Disconnected blood flows into left auricle of heart.By intubation intervention method place these instruments to human body heart, artery and vein vascular, left auricle of heart
When middle, since the anatomical structure of the heart of human body, artery and vein vascular, especially left auricle of heart is complicated, it is desirable that instrument accurately reaches in advance
Determine position, while to well adapt to anatomical structure, mechanical requirements and the haemodynamics requirement of predetermined position, it is necessary to instrument
Structure have one well design.Under the premise of only generating Micro trauma to human body, worn at the skin close to blood vessel first
Thorn, seal wire enter blood vessel from puncture orifice, and for conduit under the guiding of seal wire, one end reaches predetermined position, and the other end stays in vitro,
Then instrument is sent to predetermined position using conduit and pusher.When carrying out such operation, it is desirable that very small flexible to lead
Pipe, while conduit and seal wire will be designed to there is good development under X-ray.Once conduit reaches scheduled position, removal is led
Silk, the channel established using pusher by conduit is the end of instrument guiding catheter, when instrument is from the whole dew in the end of conduit
When out, instrument will be disconnected with pusher, to realize the release of instrument.As United States Patent (USP) US6689150, US8080032 and in
Device and method disclosed in state patent CN102805654.
Currently, the structure of several occluder for left auricle is all made of fashion of barbs both at home and abroad, disk is placed in left auricle of heart and opens
Since the form of left auricle of heart pouch is in bending at mouthful, barb is fixed on atrium sinistrum proximal end and easily causes and falls off, while plugging surface is filled out
It fills in left auricle of heart inlet, smooth wall cavity cannot be formed with atrium sinistrum, new cavity easily occur, there is thromboembolism again
Risk.Therefore, Chinese patent CN204092085 discloses the percutaneous occluder for left auricle of kind, which is by high resiliency
Nitinol alloy wire is made, and including being in netted disk and anchor by nitinol alloy wire establishment, anchor quantity is two, one of them
For intermediate anchor, one is distal anchor, and the proximal end of disk is equipped with the first steel bushing, and the first steel bushing is used to tighten the NiTi of mesh grid one end
Alloy wire is equipped with internal screw thread in the first steel bushing other end and is used to connect with push rod, and the distal end of disk is equipped with the second steel bushing, and second
One end of steel bushing is used to tighten the nitinol alloy wire of disk, and the other end is used to tighten the nitinol alloy wire of intermediate anchor, disk it is interior
Portion is sewed with several polyester film layers, and distal anchor is linked together with intermediate anchor by latch closure.The utility model preventing from scar, wound are small；
Left auricle of heart opening is securely stuck in for disk is blocked using resultant force, avoids the caducous risk of plugging device；Block disk and a left side
Atrial wall forms the formation that integrated cavity avoids secondary cavity, reduces thrombosed risk again.
The use of various occluder for left auricle is because of the advantages such as its operation wound is small, success rate is high, thromboembolism incidence is low
Once attracting attention, but in recent years, and more and more postoperative complications occurred -- hemopericardium incidence is higher, about
6.9%, and it is also possible to there is residual shunt phenomenon, to influence therapeutic effect, strongly limit occluder for left auricle
Using.For these defects, Chinese patent CN103462668 provides a kind of left auricle ligation device, by outer sheath, interior sheath
Pipe, push rod, lock tube and ligature composition, wherein ligature is made into " jade pendant rope " shape, makes a call to a knot every one section, is through
In lock tube, and annulus is formed in lock tube one end.It is tied using left auricle ligation device ligaturing left atrial appendage of the invention without opening chest
Prick solid and reliable, and complete blocking blood flow.In clinical practice, which is also exposed some problems, such as outer sheath
Distally tapered closing in, puncture power control it is bad if be easy the tip of left auricle of heart is poked；Ligature is on left auricle of heart
Knotting position is not easy to control, and when knotting is influenced by body fluid and the influence of left auricle of heart elasticity itself, knots and is easy to fail；?
It under the influence of the impact of chronic blood flowing and heartbeat, easily unlocks automatically, left auricle of heart is made to restore original state.
Summary of the invention
The purpose of the present invention is to provide a kind of devices for left atrial appendage occlusion operation, to solve to exist in the prior art
The above problem.
To achieve the goals above, technical scheme is as follows:
A kind of device for left auricle of heart ligation operation comprising:
For reaching the outer sheath of left auricle of heart through vein blood vessel；
Interior sheath for positioning guide wire；
For importing the seal wire of Minimally Invasive Surgery instrument；
For holding in the mouth the screw at left auricle of heart tip；
The stitching devices to knot for the tip to left auricle of heart；
Disconnecting device for being cut off at the knotting at left auricle of heart tip；
Wherein, the bore of the outer sheath is greater than the bore of interior sheath.
Preferably, the interior sheath in tubular main body and tapered front end portion by forming.
Preferably, the front end of the seal wire is in J-shaped.
Preferably, the material of the seal wire is medical titanium alloy.
Preferably, the stitching devices are medical suturing instrument.
Preferably, the disconnecting device is hot shears cutting nipper.
Preferably, the material of the screw is medical stainless steel.
Preferably, the taper of the interior sheath front end is (3~4): 1.
Preferably, the ratio between bore of the outer sheath and interior sheath is 5: 4~5: 3.
Preferably, the spire length of the screw accounts for the 10~20% of screw total length.
Preferably, the front inner wall of the outer sheath is equipped with annular baffle.
Preferably, the baffle can unidirectionally be stirred to the rear end of outer sheath.
Preferably, the material of the outer sheath is polytetrafluoroethylene (PTFE).
Preferably, the material of the interior sheath is high density polyethylene (HDPE).
Preferably, the length ratio of the main part of the interior sheath and front end portion is (8~10): 1.
Preferably, the front end portion of the interior sheath can bounce back in the main part of inside sheath.
Preferably, the hot shears cutting nipper includes binding clip, vice body and operation handle, and the binding clip includes sheath and sets
Set with the caliper and steel wire inside the sheath, the caliper include intersect be flexibly connected two tong arms, two tong arms
It is respectively flexibly connected with a transmission arm, two transmission arms are movably connected on a key axis by respective tail end, the key
Steel wire is nested on axis, the tail end of the steel wire is fixedly connected with steel cable, is socketed with pad on the inside of the tail end of the sheath
The tail end outside of piece, sheath is nested with bearing, and the bearing is fixedly connected with the end of a spring connecting tube, and the wirerope is worn
The spring connecting tube is crossed to extend outwardly.
Preferably, the gasket is plastic spacer or metal gasket.
Preferably, the vice body includes bourdon tube and the insulation sleeve that is socketed on the outside of the bourdon tube, the bullet
Reed pipe is threaded through on the outside of wirerope.
Preferably, the bourdon tube is anti-fold bourdon tube.
Preferably, the operation handle includes handle main body, and bearing, the axis are arranged in the handle main body
The inner ring held is nested in outside insulation sleeve.
Preferably, the tail end of the handle main body is additionally provided with electrode structure, and the electrode structure includes that electrode is inserted
Head, electrode base and conducting wire, the electrode plug are installed on electrode base, and electrode base and steel wire are electrically connected by the conducting wire
It connects.
Preferably, the outside of the handle main body is also socketed with slip ring, and the tail portion of the slip ring is actively equipped with
Tail ring.
Preferably, the seal wire is by mandrel, the coil case for the periphery for covering mandrel and the fastening mandrel
The front end fastening part of front end and the coil case front end is constituted.
Preferably, the mandrel have positioned at rear end side large diameter part, positioned at the large diameter part front end side and
The tapered portion that outer diameter reduces towards preceding extreme direction and the small diameter portion positioned at the front end side of the tapered portion.
Preferably, it is equipped with intermediate fastening part in the tapered portion, is equipped with rear end fastening part in the large diameter part.
Preferably, the seal wire is by mandrel, the coil case for the periphery for covering mandrel and the fastening mandrel
The front end fastening part of front end and the coil case front end is constituted.
Preferably, the mandrel have positioned at rear end side large diameter part, positioned at the large diameter part front end side and
The tapered portion that outer diameter reduces towards preceding extreme direction and the small diameter portion positioned at the front end side of the tapered portion.
Preferably, it is equipped with intermediate fastening part in the tapered portion, is equipped with rear end fastening part in the large diameter part.
Preferably, the suture is suture.
The present invention also provides a kind of sheath tube assemblies for left auricle of heart ligation operation device comprising interior sheath and epitheca
Pipe, the interior sheath are embedded on the inner wall of outer sheath.
Preferably, the inner wall of the interior sheath is equipped with for three slideways for the positioning of three seal wires.
Preferably, three slideways is in equilateral triangle arrangement on the inner wall of interior sheath.
A kind of application method for the device of left auricle of heart ligation operation as described in the present invention comprising following steps:
A, venous inlet is found；
B, it is punctured with outer sheath through atrial septum approach, is that the front end of the outer sheath resists in the tip of left auricle of heart
Side；
C, seal wire is probeed into the tip of left auricle of heart along outer sheath under the guidance of perspective and intracardiac ultrasound electrocardiogram；
D, by the guiding of seal wire, it is inserted into left auricle of heart disconnecting device, removes seal wire；
E, the tip of left auricle of heart is screwed in and hooked with screw, be pulled at the nozzle of outer sheath backward:
F, the tip of left auricle of heart is bound to reinforce it with suture；
G, the tip of left auricle of heart is further drawn rearward into the inside of outer sheath；
H, embedded suture device sutures the tip of left auricle of heart, with disconnecting device by the left auricle of heart tip after suture
It is cut off by suture (distal end)；Remove disconnecting device
I, cut-off left auricle of heart is pulled out, extracts outer sheath, terminate once-through operation.
Preferably, it in step c, controls at a distance from the front end of seal wire and the tip of left auricle of heart as 0.2~0.5cm.
A kind of another application method for the device of left auricle of heart ligation operation as described in the present invention comprising as follows
Step:
A, venous inlet is found；
B, it is punctured with outer sheath through atrial septum approach, resists the front end of the outer sheath in the tip of left auricle of heart
Side；
C, three seal wires are probeed into the tip of left auricle of heart along interior sheath under the guidance of perspective and intracardiac ultrasound respectively；
D, three seal wires are respectively used to be packed into screw, stitching devices and disconnecting device；
E, it is screwed in screw and the tip for hooking left auricle of heart is pulled to backward at the nozzle of outer sheath, bound with suture
The tip of left auricle of heart sutures the tip of left auricle of heart；The left auricle of heart tip portion after suture is cut off with disconnecting device, into
The tip of left auricle of heart is drawn rearward into the inside of outer sheath by one step；
I, cut-off left auricle of heart is pulled out, extracts outer sheath, terminate once-through operation.
The beneficial effects are mainly reflected as follows:
1, the part for easily leading to thrombus generation in left auricle of heart is cut off, has thoroughly eradicated the pathogenetic hidden danger of apoplexy；
2, three seal wires can be put into interior sheath simultaneously, are used to be placed with the surgical instrument of different purposes in every seal wire,
Next step is directly carried out after the previous step of operation, it is not necessary to be replaced seal wire after each step of operation, be saved
Operating time has been saved, operation risk is greatly reduced.
Detailed description of the invention
Fig. 1 is position view of the plug formula occluder for left auricle in heart and left auricle of heart anatomical structure；
Fig. 2 is from position view of the plug formula occluder for left auricle in left auricle of heart in terms of left auricle of heart mouth direction；
Fig. 3 is the position view for filling in disc type occluder for left auricle in heart and left auricle of heart anatomical structure；
Fig. 4 is position view of the occluder for left auricle of the present invention in heart and left auricle of heart anatomical structure, wherein fixing
Frame is fixed on the deeper position of left auricle of heart；
Fig. 5 is position view of the occluder for left auricle of the present invention in heart and left auricle of heart anatomical structure, wherein fixing
Frame is fixed on the shallower position of left auricle of heart；
Fig. 6 is structural schematic diagram of the invention；
Fig. 7 is the structural schematic diagram of hot shears cutting nipper in the present invention；
Fig. 8 is the sectional view of the slip ring of hot shears cutting nipper in the present invention；
Fig. 9 is the schematic cross-section of the slip ring of hot shears cutting nipper in the present invention；
Figure 10 is the decomposition diagram of the tong head of hot shears cutting nipper in the present invention；
Figure 11 is the schematic cross-section of the vice body of hot shears cutting nipper in the present invention；
Figure 12 is the diagrammatic cross-section of the operation handle of hot shears cutting nipper in the present invention；
Figure 13 is the structural schematic diagram of the electrode structure of hot shears cutting nipper in the present invention；
Figure 14 is the structural schematic diagram of outer sheath in the present invention；
Figure 15 is a kind of cross-sectional view of interior sheath in the present invention；
Figure 16 is the structural schematic diagram of seal wire in the present invention；
Figure 17 is first step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 18 is second step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 19 is third step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 20 is the 4th step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 21 is the 5th step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 22 is the 6th step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 23 is the 7th step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 24 is the 8th step schematic diagram when left auricle ligation device of the invention is performed the operation；
Figure 25 is the 9th step schematic diagram when left auricle ligation device of the invention is performed the operation；
In figure: 1, atrium sinistrum (LA)；2, left auricle of heart (LAA)；3, left auricle of heart cavity wall；4, plug formula occluder for left auricle choked flow
Film；5, plug formula occluder for left auricle ontology；6, the pit shape gap formed between plug formula occluder for left auricle and left auricle of heart；
7, disc type occluder for left auricle ontology is filled in；8 be the choked flow film for filling in disc type occluder for left auricle；21, outer sheath；211, baffle；22,
Interior sheath；22 ', interior sheath；221 ', slideway；23, seal wire；2311, mandrel large diameter part；2312, mandrel tapered portion；2313, mandrel
Small diameter portion；232, coil case；233, front end fixed part；24, screw；25, hot shears cutting nipper；251, binding clip；252, vice body；
253, operation handle；254, slip ring；255, tail ring；256, electrode structure；2511, sheath；2512, tong arm；2513, the first key
Axis；2514, transmission arm；2515, the second key axis；2516, steel wire；2517, wirerope；2518, gasket；2519, first bearing；
25110, spring connecting tube；25111, wirerope；2521, bourdon tube；2522, insulation sleeve；2531, handle main body；2532, second
Bearing；2561, electrode base；2562, electrode plug；2563, conducting wire.
Specific embodiment
First embodiment
The structure of the device of left atrial appendage occlusion operation is used for provided by present embodiment as shown in Fig. 6~13 and Figure 16,
Including the outer sheath 21 for reaching left auricle of heart through vein blood vessel；For reaching left auricle of heart and positioning guide wire 23 through vein blood vessel
Sheath 22 in interior sheath；Front end for importing Minimally Invasive Surgery instrument is in the seal wire 23 of J-type；For holding in the mouth the doctor at left auricle of heart tip
With the screw 24 of stainless steel material；For knotting device and stitching devices that the tip to left auricle of heart knots, the seam
It attaches together to set and can select any stitching devices for being used for Minimally Invasive Surgery, therefore be not shown in the figure；For at left auricle of heart tip
The disconnecting device cut off at knotting, such as hot shears cutting nipper 25；Wherein, the bore of the outer sheath 21 is greater than the mouth of interior sheath 22
Diameter.
Operation device for being cut at the knotting at left auricle of heart tip；
Wherein, the bore of the outer sheath is greater than the bore of interior sheath.
In order to facilitate screw in hooking up and positioning to left auricle of heart tip, interior sheath 22 is designed to by cylinder structure
The length ratio of the front end portion of main part and pyramidal structure composition, main part and front end portion is (8~10): 1, preferably 8:
1, and the taper of front end portion is (3~4): 1, preferably 4: 1.
The material selection medical titanium alloy or medical magnesium alloy of seal wire 23, preferably medical titanium alloy, and the front end of seal wire 23
It is designed to J-shaped, seal wire can be enable normally to carry out major branch traveling.
Stitching devices select medical suturing instrument, and disconnecting device is hot shears cutting nipper, and hot shears cutting nipper 25 includes binding clip 251, vice body
252 and operation handle 253, binding clip 251 includes sheath 2511 and the caliper and steel wire that are set to inside sheath 2511, institute's caliper packet
Two tong arms 2512 for intersecting and being flexibly connected are included, two tong arms 2512 respectively pass through 2513 activity of the first key axis with a transmission arm 2514
Connection, two transmission arms 2514 are movably connected on the second key axis 2515 by respective tail end, nested on the second key axis 2515
There is steel wire 2516, the tail end of steel wire 2516 is fixedly connected with steel cable 2517, is socketed with pad on the inside of the tail end of sheath 2511
Piece 2518, is nested with first bearing 2519 on the outside of the tail end of sheath 2511, first bearing 2519 and a spring connecting tube 25110
End is fixedly connected, and wirerope 2517 passes through spring connecting tube 25110 and extends outwardly, it is preferable that gasket 2518 is plastic spacer
Or metal gasket, vice body 252 include bourdon tube 2521 and the insulation sleeve 2522 for being socketed in 2521 outside of bourdon tube, bourdon tube 2521
It is threaded through 2517 outside of wirerope, bourdon tube 2521 is anti-fold bourdon tube.Operation handle 253 includes handle main body 2531, hand
Second bearing 2532 is arranged in handle main body 2531, the inner ring of second bearing 2532 is nested in outside insulation sleeve 2522.Handle main body
2531 tail end is additionally provided with electrode structure, and electrode structure includes electrode plug 2562, electrode base 2561 and conducting wire 2563, electrode
Plug 2562 is installed on electrode base 2561, and electrode base 2561 and steel wire are electrically connected by conducting wire 2563.Outside handle main body
Side is also socketed with slip ring, and the tail portion of the slip ring is actively equipped with tail ring, can refer to the circuit of existing Minimally Invasive Surgery handle portion
Structure.
The material of screw is medical stainless steel, briefly, be connected on the straight steel wire of root one section it is tapered
Spring, the spring, that is, spire, and the spire length of screw accounts for the 10~20% of screw total length.
To keep the cooperation of interior sheath 22 and outer sheath 21 more smooth, spy sets the ratio between outer sheath 21 and the aperture of interior sheath 22
Count into 5: 4~5: 3.
In order to improve the safety used, the material of outer sheath 21 selects polytetrafluoroethylene (PTFE)；The material of interior sheath 22 selects
High density polyethylene (HDPE).
To guarantee that it is more acurrate that the ligation part at left auricle of heart tip positions, special be designed to the front end portion of interior sheath 22 can be with
The structure to bounce back in the main part of inside sheath 22, after the tip of left auricle of heart is pulled in interior sheath 22 by screw 24, after
It is continuous to pull back, so that the conical section of interior sheath 22 bounces back, after the conical section of interior sheath 22 is fully retracted to barrel portion,
Screw can not continue to pull back, and the tip of left auricle of heart is fixed.
Seal wire 23 can be by mandrel, the front end of the coil case 232 for the periphery for covering mandrel and the fastening mandrel and described
The front end fastening part 233 of coil case front end is constituted.Mandrel has the mandrel large diameter part 2311 positioned at rear end side, is located at mandrel particle size
Mandrel tapered portion 2312 that the front end side in portion 2311 and outer diameter reduce towards preceding extreme direction and positioned at mandrel tapered portion 2312
The mandrel small diameter portion 2313 of front end side.It is equipped with intermediate fastening part in mandrel tapered portion, is equipped with rear end fastening part in mandrel large diameter part.
Suture is suture.
The application method of first embodiment includes the following steps:
A, venous inlet is found, as shown in figure 17；
B, it is punctured with outer sheath through atrial septum approach, is that the front end of the outer sheath is supported to the tip of left auricle of heart
Side, as shown in figure 18；
C, seal wire is probeed into the tip of left auricle of heart along outer sheath, such as under the guidance of perspective and intracardiac ultrasound electrocardiogram
Shown in Figure 19；
D, seal wire is removed, changes left auricle of heart disconnecting device, as shown in figure 20；
E, it is screwed in screw and the tip for hooking left auricle of heart is pulled to backward at the nozzle of outer sheath, as shown in figure 21；
F, the tip of left auricle of heart is bound with suture, as shown in figure 22；
G, disconnecting device is removed, the tip of left auricle of heart is further drawn rearward into the inside of outer sheath, as shown in figure 23；
H, embedded suture device sutures the tip of left auricle of heart, with disconnecting device by the left auricle of heart tip after suture
It is cut off by suture, as shown in figure 24；
I, cut-off left auricle of heart is pulled out, extracts outer sheath, terminate once-through operation, as shown in figure 25.
Second embodiment
A kind of sheath tube assembly for left auricle of heart ligation operation device is provided in present embodiment, as shown in figure 15,
It is embedded on the inner wall of outer sheath including sheath in interior sheath 22 '.The inner wall of interior sheath 22 ' is equipped with for determining for three seal wires
Three slideways 221 ' of position.Three slideways 221 ' are in equilateral triangle arrangement on the inner wall of interior sheath 22 '.This structure it is interior
Sheath can penetrate three seal wires simultaneously, be respectively charged into different surgical instruments in every seal wire, terminate in the previous step of operation
Next step is directly carried out afterwards, it is not necessary to be replaced seal wire after each step of operation, be saved operating time, substantially reduce
Operation risk.
Third embodiment
It is provided in present embodiment a kind of for left auricle of heart ligation operation device comprising: sheath tube assembly；For importing
The front end of Minimally Invasive Surgery instrument is in the seal wire of J-type；For holding in the mouth the screw of the medical stainless steel material at left auricle of heart tip；With
In the stitching devices that the tip to left auricle of heart knots；Cutting dress for being cut off at the knotting at left auricle of heart tip
It sets.
The application method of present embodiment are as follows:
A, venous inlet is found；
B, it is punctured with outer sheath through atrial septum approach, resists the front end of the outer sheath in the tip of left auricle of heart
Side；
C, three seal wires are probeed into left auricle of heart along interior sheath under the guidance of perspective and intracardiac ultrasound electrocardiogram respectively
Tip；
D, screw, stitching devices and disconnecting device are respectively charged into three seal wires；
E, it is screwed in screw and the tip for hooking left auricle of heart is pulled to backward at the nozzle of outer sheath, bound with suture
The tip of left auricle of heart sutures the tip of left auricle of heart；The left auricle of heart tip portion after suture is cut off with disconnecting device, into
The tip of left auricle of heart is drawn rearward into the inside of outer sheath by one step；
I, cut-off left auricle of heart is pulled out, extracts outer sheath, terminate once-through operation.
The beneficial effects are mainly reflected as follows:
3, the part for easily leading to thrombus generation in left auricle of heart is cut off, has thoroughly eradicated the pathogenetic hidden danger of apoplexy；
4, due to cut off the big portion of left auricle of heart, so as to avoid current plugging device there are the problem of, such as plugging device dislocation
Or it blocks not tight etc..
Three seal wires can be put into interior sheath simultaneously, different surgical instruments are provided in every seal wire, in the upper of operation
Next step is directly carried out after one step, it is not necessary to seal wire is replaced after each step of operation, when saving operation
Between, greatly reduce operation risk.
In conclusion only presently preferred embodiments of the present invention, is not used to limit the scope of implementation of the present invention, it is all according to
Equivalent changes and modifications carried out by shape described in scope of the invention as claimed, construction, feature and spirit should be included in this
In the scope of the claims of invention.
Claims (27)
1. a kind of device for left auricle of heart ligation operation characterized by comprising
For reaching the outer sheath of left auricle of heart through vein blood vessel；
For reaching the interior sheath of left auricle of heart and positioning guide wire through vein blood vessel；
For importing the seal wire of Minimally Invasive Surgery instrument；
For holding in the mouth the screw at left auricle of heart tip；
The stitching devices to knot for the tip to left auricle of heart；
Disconnecting device for being cut at the knotting at left auricle of heart tip；
Wherein, the bore of the outer sheath is greater than the bore of interior sheath,
The interior sheath is embedded on the inner wall of outer sheath, and the inner wall of the interior sheath is equipped with for being three seal wires positioning
Three slideways, three slideways are in equilateral triangle arrangement on the inner wall of interior sheath.
2. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the interior sheath is by pipe
The main body of shape and tapered front end portion composition.
3. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the front end of the seal wire is in
J-shaped.
4. the device according to claim 1 or 3 for left auricle of heart ligation operation, which is characterized in that the material of the seal wire
Material is medical titanium alloy or medical magnesium alloy.
5. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the stitching devices are doctor
Use stitching unstrument.
6. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the disconnecting device is heat
Cutting nipper.
7. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the material of the screw
Material is medical stainless steel.
8. the device according to claim 1 or 2 for left auricle of heart ligation operation, which is characterized in that before the interior sheath
The taper at end is 3~4.
9. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the bore of the interior sheath
It is 0.6~0.8 times of the bore of outer sheath.
10. the device according to claim 1 or claim 7 for left auricle of heart ligation operation, which is characterized in that the screw
Spire length account for the 10~20% of screw total length.
11. the device according to claim 10 for left auricle of heart ligation operation, which is characterized in that before the outer sheath
Inner wall is held to be equipped with annular baffle.
12. the device according to claim 11 for left auricle of heart ligation operation, which is characterized in that the baffle can be outside
It unidirectionally stirs the rear end of sheath.
13. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the material of the outer sheath
Material is polytetrafluoroethylene (PTFE).
14. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the material of the interior sheath
Material is high density polyethylene (HDPE).
15. the device according to claim 1 or 2 for left auricle of heart ligation operation, which is characterized in that the interior sheath
Main part is 8~10 times of the length of its front end portion.
16. the device according to claim 13 for left auricle of heart ligation operation, which is characterized in that before the interior sheath
End part can bounce back in the main part of inside sheath.
17. the device according to claim 6 for left auricle of heart ligation operation, which is characterized in that the hot shears cutting nipper packet
Binding clip, vice body and operation handle are included, the binding clip includes sheath and setting and the caliper and steel wire inside the sheath, the pincers
Body includes intersecting two tong arms being flexibly connected, and two tong arms are respectively flexibly connected with a transmission arm, two transmission arms
It is movably connected on a key axis by respective tail end, steel wire is nested on the key axis, the tail end of the steel wire is fixed to be connected
It is connected to steel cable, gasket is socketed on the inside of the tail end of the sheath, is nested with bearing, the bearing on the outside of the tail end of sheath
It is fixedly connected with the end of a spring connecting tube, spring connecting tube described in the steel wire penetrating extends outwardly.
18. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the gasket is plastics
Gasket or metal gasket.
19. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the vice body includes bullet
Reed pipe and the insulation sleeve being socketed on the outside of the bourdon tube, the bourdon tube are threaded through on the outside of wirerope.
20. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the bourdon tube is anti-
Folded ammunition reed pipe.
21. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the operation handle packet
Handle main body is included, bearing is arranged in the handle main body, the inner ring of the bearing is nested in outside insulation sleeve.
22. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the handle main body
Tail end is additionally provided with electrode structure, and the electrode structure includes electrode plug, electrode base and conducting wire, and the electrode plug is installed in
On electrode base, electrode base and steel wire are electrically connected by the conducting wire.
23. the device according to claim 17 for left auricle of heart ligation operation, which is characterized in that the handle main body
Outside is also socketed with slip ring, and the tail portion of the slip ring is actively equipped with tail ring.
24. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that the seal wire by mandrel,
Cover the front end fastening part structure of the coil case of the periphery of mandrel and the front end of the fastening mandrel and the coil case front end
At.
25. the device according to claim 24 for left auricle of heart ligation operation, which is characterized in that the mandrel has position
The tapered portion that reduces towards preceding extreme direction in the large diameter part of rear end side, the front end side positioned at the large diameter part and outer diameter, Yi Jiwei
Small diameter portion in the front end side of the tapered portion.
26. the device according to claim 25 for left auricle of heart ligation operation, which is characterized in that set in the tapered portion
There is intermediate fastening part, is equipped with rear end fastening part in the large diameter part.
27. the device according to claim 1 for left auricle of heart ligation operation, which is characterized in that it further include suture, institute
Stating suture is suture.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510170230.7A CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510170230.7A CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
Publications (2)
| Publication Number | Publication Date |
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| CN106137292A CN106137292A (en) | 2016-11-23 |
| CN106137292B true CN106137292B (en) | 2019-02-22 |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201510170230.7A Expired - Fee Related CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
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| CN (1) | CN106137292B (en) |
Families Citing this family (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110403640A (en) * | 2018-04-26 | 2019-11-05 | 复旦大学附属中山医院 | A kind of atrial septal puncture assembly through subclavian vein |
| CN111870304A (en) * | 2020-08-13 | 2020-11-03 | 上海拓舜医疗科技有限公司 | A left atrial appendage tying device |
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| CN1342056A (en) * | 1998-11-06 | 2002-03-27 | 阿普利瓦医学股份有限公司 | Method and device for left atrial appendage occlusion |
| CN1886096A (en) * | 2003-12-26 | 2006-12-27 | 泰尔茂株式会社 | Tissue closure and tissue closing device |
| CN101057789A (en) * | 2006-04-21 | 2007-10-24 | 深圳市先健科技股份有限公司 | Device for ligaturing left atrial appendage and using method thereof |
| CN101920055A (en) * | 2009-06-16 | 2010-12-22 | 朝日印帝克股份有限公司 | Guide wire for medical use |
| CN103462668A (en) * | 2013-09-13 | 2013-12-25 | 徐州亚太科技有限公司 | Left auricle ligation device |
| CN103750901A (en) * | 2014-02-14 | 2014-04-30 | 徐美东 | Multifunctional high-frequency incision knife |
| CN204971414U (en) * | 2015-04-10 | 2016-01-20 | 上海市同济医院 | A device for left auricle of heart ligation operation |
Family Cites Families (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6994092B2 (en) * | 1999-11-08 | 2006-02-07 | Ev3 Sunnyvale, Inc. | Device for containing embolic material in the LAA having a plurality of tissue retention structures |
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2015
- 2015-04-10 CN CN201510170230.7A patent/CN106137292B/en not_active Expired - Fee Related
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1342056A (en) * | 1998-11-06 | 2002-03-27 | 阿普利瓦医学股份有限公司 | Method and device for left atrial appendage occlusion |
| CN1886096A (en) * | 2003-12-26 | 2006-12-27 | 泰尔茂株式会社 | Tissue closure and tissue closing device |
| CN101057789A (en) * | 2006-04-21 | 2007-10-24 | 深圳市先健科技股份有限公司 | Device for ligaturing left atrial appendage and using method thereof |
| CN101920055A (en) * | 2009-06-16 | 2010-12-22 | 朝日印帝克股份有限公司 | Guide wire for medical use |
| CN103462668A (en) * | 2013-09-13 | 2013-12-25 | 徐州亚太科技有限公司 | Left auricle ligation device |
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| CN204971414U (en) * | 2015-04-10 | 2016-01-20 | 上海市同济医院 | A device for left auricle of heart ligation operation |
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| Publication number | Publication date |
|---|---|
| CN106137292A (en) | 2016-11-23 |
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