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CN109009324A - 带球囊的胆总管探查鞘管 - Google Patents

带球囊的胆总管探查鞘管 Download PDF

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CN109009324A
CN109009324A CN201810838618.3A CN201810838618A CN109009324A CN 109009324 A CN109009324 A CN 109009324A CN 201810838618 A CN201810838618 A CN 201810838618A CN 109009324 A CN109009324 A CN 109009324A
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CN109009324B (zh
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胡海
张�诚
杨玉龙
赵刚
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Shanghai East Hospital
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/22Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/00234Surgical instruments, devices or methods for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/00234Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/22Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/22Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22054Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation with two balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods
    • A61B17/22Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065Functions of balloons

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Abstract

本发明公开了一种带球囊的胆总管探查鞘管,其头部至尾部依次设有互相连接的引流管段Ⅰ、引流管段Ⅱ、引流管段Ⅲ、引流管段Ⅳ和引流管段Ⅴ;引流管段Ⅰ内设有通道Ⅰ,通道Ⅰ位于鞘管头部的一端封闭,引流管段Ⅰ外壁上设有两个相对设置且与通道Ⅰ连通的侧孔;引流管段Ⅱ内设有与通道Ⅰ连通的通道Ⅱ,引流管段Ⅱ外壁依次套接有上球囊和下球囊;引流管段Ⅲ内设有与通道Ⅱ连通的通道Ⅲ,通道Ⅲ内设有一端延伸至通道Ⅱ且分别与上球囊和下球囊连通的通道Ⅳ和通道Ⅴ。充盈上球囊和下球囊后,上球囊和下球囊封闭胆总管切口,可避免感染性胆汁、冲洗液、泥沙样结石及胆泥等进入腹腔。

Description

带球囊的胆总管探查鞘管
技术领域
本发明涉及一种胆总管探查鞘管,具体地说是一种带球囊的胆总管探查鞘管。
背景技术
肝内外胆管结石是我国的常见病和多发病,胆总管探查取石是治疗该疾病的主要手术方式,传统手术方案为开腹胆总管探查,具有创伤大、恢复慢等缺点。随着腹腔镜及胆道镜技术的发展,目前对于肝内外胆管结石的治疗多采取腹腔镜下胆总管探查、胆道镜取石治疗方案,与传统开腹手术相比,具有创伤小、恢复快、并发症少等优点。
目前,从腹腔穿刺器套管中置入胆道镜,进行胆总管探查及取石时,该方式存在诸多缺点:1.整个手术过程中均需建立气腹,而长时间的气腹容易影响膈肌的摆动,影响呼吸及循环,大量二氧化碳的吸收可发生酸中毒及离子紊乱,高压的二氧化碳经静脉回流,甚至发生气体栓塞,危及患者生命;2.胆道镜探查过程中,大量感染性胆汁、碎石、胆泥及胆道镜冲洗液经切口流入腹腔内,容易导致腹腔感染、腹腔脓肿,而碎石及胆泥进入腹腔后,难以清除干净,导致腹腔粘连、肠梗阻、内瘘、腹腔脓肿等并发症;3.胆总管切开后,胆总管压力降低并塌陷,增加了胆道镜进入胆总管的难度;4.戳卡外套管为硬质塑料,其头端管壁容易损伤胆道镜;5.胆道镜反复进出胆总管,容易导致切口出血。
发明内容
根据上述提出的技术问题,而提供一种带球囊的胆总管探查鞘管。本发明采用的技术手段如下:
一种带球囊的胆总管探查鞘管,其头部至尾部依次设有互相连接的引流管段Ⅰ、引流管段Ⅱ、引流管段Ⅲ、引流管段Ⅳ和引流管段Ⅴ;
所述引流管段Ⅰ内设有通道Ⅰ,所述通道Ⅰ位于所述鞘管头部的一端封闭,所述引流管段Ⅰ外壁上设有两个相对设置且与所述通道Ⅰ连通的侧孔;
所述引流管段Ⅱ内设有与所述通道Ⅰ连通的通道Ⅱ,所述引流管段Ⅱ外壁依次套接有上球囊和下球囊;
所述引流管段Ⅲ内设有与所述通道Ⅱ连通的通道Ⅲ,所述通道Ⅲ内设有一端延伸至所述通道Ⅱ且分别与所述上球囊和所述下球囊连通的通道Ⅳ和通道Ⅴ;
所述引流管段Ⅳ内设有与所述通道Ⅲ连通的通道Ⅵ,所述引流管段Ⅳ外壁上设有充气接头Ⅰ、充气接头Ⅱ和与所述通道Ⅵ连通的出水接头;
所述通道Ⅳ的另一端与所述充气接头Ⅰ连通;
所述通道Ⅴ的另一端与所述充气接头Ⅱ连通;
所述引流管段Ⅴ内设有与所述通道Ⅵ连通的通道Ⅶ,所述引流管段Ⅴ外壁具有用于手持的粗糙面;
所述通道Ⅶ内壁设有防反流垫;
所述防反流垫的材质为硅胶;
所述防反流垫上设有用于胆道镜穿过的弹性孔,所述胆道镜穿过所述弹性孔后,所述弹性孔贴合所述胆道镜,构成密封,防反流。
所述侧孔的直径为0.5-0.8cm,胆道镜可通过所述侧孔。
所述上球囊沿所述引流管段Ⅱ轴线方向的长度为3mm;
所述下球囊沿所述引流管段Ⅱ轴线方向的长度均为5mm;
所述上球囊和所述下球囊充盈时,所述上球囊和所述下球囊的最大直径均为1.5cm;
所述上球囊和所述下球囊上下两端分别通过金属环与所述引流管段Ⅱ固定。
所述引流管段Ⅰ、所述引流管段Ⅱ和所述引流管段Ⅲ的材质为硅胶,具有良好的弹性;
所述引流管段Ⅳ的材质为聚乙烯;
所述引流管段Ⅴ的材质为聚乙烯;
所述引流管段Ⅰ、所述引流管段Ⅱ、所述引流管段Ⅲ和所述引流管段Ⅳ的外径为0.9cm;
所述引流管段Ⅰ、所述引流管段Ⅱ、所述引流管段Ⅲ和所述引流管段Ⅳ的壁厚为1mm,具有较好的支撑;
所述引流管段Ⅰ、所述引流管段Ⅱ和所述引流管段Ⅲ的整体长为30~60cm,可经腹壁直达胆总管。
与现有技术相比,本发明具有以下优点:
1.引流管段Ⅰ、引流管段Ⅱ和引流管段Ⅲ为硅胶材质,避免了胆道镜取石过程中戳卡外套管壁对胆道镜的损伤;
2.引流管段Ⅰ设有两个侧孔,胆道镜可经过侧孔进入胆总管下段及上段;
3.充盈上球囊和下球囊后,上球囊和下球囊封闭胆总管切口,可避免感染性胆汁、冲洗液、泥沙样结石及胆泥等进入腹腔;
4.充盈上球囊和下球囊后,上球囊和下球囊封闭胆总管切口产生弹性压力,具有压迫止血的作用,避免取石术中切口出血;
5.鞘管进入胆总管后,即可关闭气腹及腹腔镜视频,避免了长期气腹产生的并发症及腹腔镜系统的损耗;
6.出水接头连接负压吸引管,可将感染性胆汁、冲洗液、泥沙样结石及胆泥等排出体外,降低上述物质进入腹腔所致的并发症。
基于上述理由本发明可在医疗器具等领域广泛推广。
附图说明
为了更清楚地说明本发明实施例或现有技术中的技术方案,下面将对实施例或现有技术描述中所需要使用的附图做以简单地介绍,显而易见地,下面描述中的附图是本发明的一些实施例,对于本领域普通技术人员来讲,在不付出创造性劳动性的前提下,还可以根据这些附图获得其他的附图。
图1是本发明的具体实施方式中带球囊的胆总管探查鞘管的结构示意图。
图2是本发明的具体实施方式中带球囊的胆总管探查鞘管处于工作状态下的示意图(球囊充盈)。
图3是本发明的具体实施方式中带球囊的胆总管探查鞘管处于工作状态下的示意图(插入胆道镜)。
具体实施方式
为使本发明实施例的目的、技术方案和优点更加清楚,下面将结合本发明实施例中的附图,对本发明实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例是本发明一部分实施例,而不是全部的实施例。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。
如图1-图3所示,一种带球囊的胆总管探查鞘管,其头部至尾部依次设有互相连接的引流管段Ⅰ1、引流管段Ⅱ2、引流管段Ⅲ3、引流管段Ⅳ4和引流管段Ⅴ5;
所述引流管段Ⅰ1内设有通道Ⅰ6,所述通道Ⅰ6位于所述鞘管头部的一端封闭,所述引流管段Ⅰ1外壁上设有两个相对设置且与所述通道Ⅰ6连通的侧孔7;
所述引流管段Ⅱ2内设有与所述通道Ⅰ6连通的通道Ⅱ8,所述引流管段Ⅱ2外壁依次套接有上球囊9和下球囊10;
所述引流管段Ⅲ3内设有与所述通道Ⅱ8连通的通道Ⅲ11,所述通道Ⅲ11内设有一端延伸至所述通道Ⅱ8且分别与所述上球囊9和所述下球囊10连通的通道Ⅳ12和通道Ⅴ13;
所述引流管段Ⅳ4内设有与所述通道Ⅲ11连通的通道Ⅵ14,所述引流管段Ⅳ4外壁上设有充气接头Ⅰ15、充气接头Ⅱ16和与所述通道Ⅵ14连通的出水接头17;
所述通道Ⅳ12的另一端与所述充气接头Ⅰ15连通;
所述通道Ⅴ13的另一端与所述充气接头Ⅱ16连通;
所述引流管段Ⅴ5内设有与所述通道Ⅵ14连通的通道Ⅶ18,所述引流管段Ⅴ5外壁具有用于手持的粗糙面;
所述通道Ⅶ18内壁设有防反流垫19;
所述防反流垫19上设有用于胆道镜20穿过的弹性孔21。
所述侧孔7的直径为0.5-0.8cm。
所述上球囊9沿所述引流管段Ⅱ2轴线方向的长度为3mm;
所述下球囊10沿所述引流管段Ⅱ2轴线方向的长度均为5mm;
所述上球囊9和所述下球囊10充盈时,所述上球囊9和所述下球囊10的最大直径均为1.5cm;
所述上球囊9和所述下球囊10上下两端分别通过金属环25与所述引流管段Ⅱ2固定。
所述引流管段Ⅰ1、所述引流管段Ⅱ2和所述引流管段Ⅲ3的材质为硅胶;
所述引流管段Ⅳ4的材质为聚乙烯;
所述引流管段Ⅴ5的材质为聚乙烯;
所述引流管段Ⅰ1、所述引流管段Ⅱ2、所述引流管段Ⅲ3和所述引流管段Ⅳ4的外径为0.9cm;
所述引流管段Ⅰ1、所述引流管段Ⅱ2、所述引流管段Ⅲ3和所述引流管段Ⅳ4的壁厚为1mm;
所述引流管段Ⅰ1、所述引流管段Ⅱ2和所述引流管段Ⅲ3的整体长为30~60cm。
建立气腹并经腹壁24置入戳卡22,取出戳卡22推进杆,出水接头17连接负压吸引管,使得通道Ⅰ6、通道Ⅱ8、通道Ⅲ11、通道Ⅵ14和负压吸引管连通。
经戳卡22外套管置入所述鞘管并逐步接近胆总管23切口,将所述鞘管经切口进入到胆总管23内,经充气接头Ⅰ15注入空气或生理盐水并充盈上球囊9,再经充气接头Ⅱ16注入空气或生理盐水并充盈下球囊10。
调整负压吸引管的负压吸引压力,使负压出水量与胆道镜20进水量及胆汁量相同,避免胆总管23塌陷或胆总管23内液体经切口外溢。
关闭气腹,停止腹腔镜视频系统,经所述鞘管(通道Ⅰ6、通道Ⅱ8、通道Ⅲ11、通道Ⅵ14和通道Ⅶ18)内注入液体石蜡,从弹性孔21置入胆道镜20,从引流管段Ⅰ1的两个侧孔7分别进入肝内外胆管进行探查及取石。
取净肝内外胆管结石后,再次建立气腹并打开腹腔镜系统,释放上球囊9和下球囊10,取出所述鞘管并缝合胆总管23切口。
最后应说明的是:以上各实施例仅用以说明本发明的技术方案,而非对其限制;尽管参照前述各实施例对本发明进行了详细的说明,本领域的普通技术人员应当理解:其依然可以对前述各实施例所记载的技术方案进行修改,或者对其中部分或者全部技术特征进行等同替换;而这些修改或者替换,并不使相应技术方案的本质脱离本发明各实施例技术方案的范围。

Claims (4)

1.一种带球囊的胆总管探查鞘管,其头部至尾部依次设有互相连接的引流管段Ⅰ、引流管段Ⅱ、引流管段Ⅲ、引流管段Ⅳ和引流管段Ⅴ,其特征在于:
所述引流管段Ⅰ内设有通道Ⅰ,所述通道Ⅰ位于所述鞘管头部的一端封闭,所述引流管段Ⅰ外壁上设有两个相对设置且与所述通道Ⅰ连通的侧孔;
所述引流管段Ⅱ内设有与所述通道Ⅰ连通的通道Ⅱ,所述引流管段Ⅱ外壁依次套接有上球囊和下球囊;
所述引流管段Ⅲ内设有与所述通道Ⅱ连通的通道Ⅲ,所述通道Ⅲ内设有一端延伸至所述通道Ⅱ且分别与所述上球囊和所述下球囊连通的通道Ⅳ和通道Ⅴ;
所述引流管段Ⅳ内设有与所述通道Ⅲ连通的通道Ⅵ,所述引流管段Ⅳ外壁上设有充气接头Ⅰ、充气接头Ⅱ和与所述通道Ⅵ连通的出水接头;
所述通道Ⅳ的另一端与所述充气接头Ⅰ连通;
所述通道Ⅴ的另一端与所述充气接头Ⅱ连通;
所述引流管段Ⅴ内设有与所述通道Ⅵ连通的通道Ⅶ,所述引流管段Ⅴ外壁具有用于手持的粗糙面;
所述通道Ⅶ内壁设有防反流垫;
所述防反流垫上设有用于胆道镜穿过的弹性孔。
2.根据权利要求1所述的带环形球囊的胆总管探查鞘管,其特征在于:所述侧孔的直径为0.5-0.8cm。
3.根据权利要求1所述的带环形球囊的胆总管探查鞘管,其特征在于:所述上球囊沿所述引流管段Ⅱ轴线方向的长度为3mm;
所述下球囊沿所述引流管段Ⅱ轴线方向的长度均为5mm;
所述上球囊和所述下球囊充盈时,所述上球囊和所述下球囊的最大直径均为1.5cm;
所述上球囊和所述下球囊上下两端分别通过金属环与所述引流管段Ⅱ固定。
4.根据权利要求1所述的带环形球囊的胆总管探查鞘管,其特征在于:
所述引流管段Ⅰ、所述引流管段Ⅱ和所述引流管段Ⅲ的材质为硅胶;
所述引流管段Ⅳ的材质为聚乙烯;
所述引流管段Ⅴ的材质为聚乙烯;
所述引流管段Ⅰ、所述引流管段Ⅱ、所述引流管段Ⅲ和所述引流管段Ⅳ的外径为0.9cm;
所述引流管段Ⅰ、所述引流管段Ⅱ、所述引流管段Ⅲ和所述引流管段Ⅳ的壁厚为1mm;
所述引流管段Ⅰ、所述引流管段Ⅱ和所述引流管段Ⅲ的整体长为30~60cm。
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