CN111904558A - PTCD puncture channel blocking device and blocking method - Google Patents

Abstract

A PTCD puncture channel blocking device and a blocking method relate to the technical field of surgical instruments. The PTCD puncture channel blocking device includes a sheath tube, a push rod, a blocking block and a guide wire; the sheath tube is provided with a push rod cavity and a blocking block cavity in the axial direction from the front end to the rear end, and the sheath tube is arranged in the axial direction from the front end to the rear end. There is also a guide wire channel; the push rod is movably inserted in the push rod cavity of the sheath tube; the blocking block is installed in the blocking block cavity of the sheath tube, which can be pushed from the top end of the push rod and discharged from the block inlet and outlet ; The guide wire is movably inserted into the guide wire channel of the sheath. The PTCD puncture channel blocking method is based on the PTCD puncture channel blocking device, which is used to block the puncture channel generated by the PTCD puncture operation. The invention has simple structure, scientific and reasonable structure design, low operation difficulty, can quickly, safely and effectively block the PTCD puncture channel, and has great clinical application value.

Description

PTCD puncture channel blocking device and blocking method

technical field

The invention relates to the technical field of surgical instruments, in particular to a PTCD puncture channel blocking device and a blocking method.

Background technique

Percutaneous transhepatic bile duct drainage (PTCD) is a series of techniques for percutaneous transhepatic bile duct drainage of biliary obstruction under the guidance of imaging equipment, and is mainly used for the treatment of biliary obstruction. For calculous blockages, percutaneous hepatocholangioscopy can be used to remove stones. For tumorous obstruction, stents can be implanted percutaneously in the biliary tract.

At present, the treatment of the PTCD puncture channel is only used as a flow tube channel, and there is no good blocking method. The patient's bile continues to leak into the body through the puncture channel, which is not conducive to the patient's postoperative recovery. For patients whose biliary tract is restored to patency through PTCD placement of stents or biliary stone removal, if the puncture channel can be effectively blocked, bile can be prevented from leaking out of the body, which is beneficial to the patient's postoperative recovery.

At present, the following two methods are mainly used to close the above-mentioned puncture channel in clinical practice: 1. In the first stage, a PTCD drainage tube is indwelled in the puncture channel, and the second stage is surgically removed, which brings great pain and inconvenience to the patient. 2. Use gelatin sponge to block the puncture channel on the liver. However, on the one hand, due to the lack of special blocking tools, it is difficult to accurately deliver the gelatin sponge into the puncture channel, and the operation is difficult. There is bile, blood and tissue fluid exudation, and it is easy to disperse the gelatin sponge, which is difficult to play a blocking effect. Push into the puncture channel.

SUMMARY OF THE INVENTION

The purpose of the present invention is to overcome the deficiencies of the prior art, and to provide a PTCD puncture channel blocking device and a blocking method, which solves the problem of the lack of fast, safe and effective means for blocking the PTCD puncture channel in clinical practice.

The technical scheme of the present invention is: a PTCD puncture channel blocking device, comprising a sheath tube, a push rod, a blocking block and a guide wire;

The inside of the sheath tube is provided with a push rod cavity and a blocking block cavity in sequence from the front end to the rear end along the axial direction. The push rod cavity and the blocking block cavity are communicated with each other. The rod inlet and outlet and the blocking block inlet and outlet, the sheath tube is also provided with a guide wire channel along the axial direction, and the guide wire channel forms a guide wire inlet and a guide wire outlet at the front and rear ends of the sheath tube respectively;

The two ends of the push rod are the hand-held end and the push end respectively. The push rod is movably inserted into the push rod cavity of the sheath tube, and its push end is located in the push rod cavity or extends into the block cavity. The rod inlet and outlet extend outside the sheath;

The blocking block is installed in the blocking block cavity of the sheath tube through the blocking block inlet and outlet of the sheath tube, and forms a transition fit with the blocking block cavity of the sheath tube. outside the sheath;

The guide wire is movably inserted into the guide wire channel of the sheath tube, and its front and rear ends respectively protrude from the guide wire inlet and the guide wire outlet.

A further technical solution of the present invention is: the diameter of the front end of the sheath is enlarged to form a head, the head is provided with an end face A at one end close to the front end of the sheath, the head is provided with a transition surface at the end away from the sheath, and the end face A of the head is provided with a transition surface. There is an ear wing holder, the end face A of the head is provided with an ear wing positioning pit that communicates with the push rod cavity, and the head is also provided with a mounting hole that penetrates to the end face A and the transition surface. Threaded hole section and smooth hole section, the threaded hole section runs through to the transition surface, and the smooth hole section runs through to the end face A;

There are ear wings on the side wall of the hand-held end of the push rod, and the ear wings are respectively matched with the ear wing positioning pit and the ear wing card seat. Protruding from the inlet and outlet of the block of the sheath tube, when the ear wing of the push rod is inserted into the ear wing socket of the sheath tube, the pushing end of the push rod is located in the push rod cavity of the sheath tube; the hand-held end of the push rod is also provided with Cantilever, the cantilever is provided with a boss;

It also includes a push rod reset mechanism; the push rod reset mechanism includes a mounting seat, a sleeve, a push block, a connecting rod, a docking seat and a spring; one end of the mounting seat is provided with a wrench clamping part, and the other end is provided with a sleeve connecting part, and the The side wall surface of the seat is provided with an external thread, and the mounting seat is connected to the threaded hole section of the mounting hole of the sheath tube through the external thread. The detachable connection is on the sleeve connection part of the mounting seat, and is located in the light hole section of the mounting hole of the sheath tube. The sleeve is provided with a rod penetration hole at the end away from the mounting seat; ;One end of the connecting rod protrudes into the inner hole of the sleeve through the rod penetration hole of the sleeve, and is fixedly connected with the push block, and the other end protrudes from the light hole section of the installation hole of the sheath tube and is fixedly connected with the docking seat; the docking seat The upper part is provided with a pit that matches with the boss of the push rod; the spring is compressed and arranged in the inner hole of the sleeve, and the two ends of the spring are respectively abutted against the mounting seat and the push block.

A further technical solution of the present invention is: the number of ear wing clips is two, and the two ear wing clips are annularly arranged on the end face A of the sheath tube around the center line of the sheath tube; correspondingly, the number of ear wing clips is For two, the two ear wings are arranged on the side wall of the hand-held end of the push rod evenly distributed around the center line of the push rod.

A further technical solution of the present invention is: the number of installation holes is two, and the two installation holes are annularly distributed around the center line of the sheath tube and are arranged at the head of the sheath tube; correspondingly, the number of the push rod reset mechanism is two , the two push rod reset mechanisms are respectively arranged in the two installation holes.

A further technical solution of the present invention is that the blocking block is cylindrical, and comprises a gelatin sponge and a degradable shell wrapped on the outside of the gelatin sponge, and the side wall of the degradable shell is provided with hollow holes.

A further technical solution of the present invention is: the block cavity is sequentially provided with an expanding section, a reducing section, a transition section and a sizing section from one end where the inlet and outlet of the blocking block are located to the other end, and the diameter of the sizing section is L, and the diameter of the sizing section is L. The diameter of the diameter section is 0.96~0.98L, the maximum diameter of the expanding section is 1.02~1.06L, the angle a formed by the busbar of the expanding section and the center line of the sheath tube is 3~10°, and the busbar of the transition section and the sheath tube The angle β formed by the center line is 3 to 10°; the diameter of the block is L.

The further technical scheme of the present invention is: the length of the sheath tube is 20-30 cm, the length of the blocking block is 1-1.5 cm, and the length of the guide wire is 80-100 cm.

The technical scheme of the present invention is: a PTCD puncture channel blocking method, based on the above-mentioned PTCD puncture channel blocking device, which is used to block the puncture channel generated by the PTCD puncture operation;

The blocking method is as follows:

S01, pass the rear end of the guide wire through the inner hole of the puncture sheath or the inner hole of the PTCD catheter, and send it into the lower end of the bile duct with the assistance of DSA, thereby establishing a working track;

Before the start of this step, the PTCD puncture operation has been completed, and the puncture sheath and PTCD catheter have not been withdrawn from the puncture channel;

S02, remove the puncture sheath and PTCD catheter, put the sheath on the guide wire through the guide wire channel on the sheath, push the sheath along the guide wire, and send the rear end of the sheath into the puncture channel with the assistance of DSA the junction with the bile duct;

Before the start of this step, the block is installed in the block cavity of the sheath tube; the push rod is installed in the push rod cavity of the sheath tube, and the ear wings on both sides of the push rod are stuck in the ear wing clips of the sheath tube 1;

S03, remove the guide wire, withdraw the sheath tube by the length of the block, and then push the contrast agent through the guide wire entrance of the sheath tube, and then confirm that the rear end of the sheath tube is in the puncture channel with the aid of DSA and does not extend into the bile duct Inside;

S04, pull the push rod out of the puncture channel for a certain distance, so that the ear wings on both sides of the push rod are separated from the ear wings of the sheath tube; then rotate the push rod 90°, so that the ear wings on both sides of the push rod are aligned with the sheath The ear wing positioning pit of the tube; then push the push rod to the depth of the puncture channel. As the push rod advances, on the one hand, the spring is compressed, and on the other hand, the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube; until the The block is pushed out from the block inlet and outlet of the sheath tube. After the block is pushed out, it is blocked at the intersection of the puncture channel and the bile duct to avoid bile leakage;

In this step, when the ear wings on both sides of the push rod are in contact with the bottom surface of the ear wing positioning pit of the sheath tube, the push rod is advanced to the limit position, the compression amount of the spring also reaches the maximum, and the pushing end of the push rod is pushed from the sheath tube. The extension length of the inlet and outlet of the blocking block is 1 to 5mm;

S05, cancel the propulsion force exerted on the push rod, and the pushing end of the push rod is quickly retracted into the push rod cavity of the sheath tube under the elastic force of the spring; then the push rod is pulled out of the puncture channel for a certain distance and then rotated 90°, align the ear wings on both sides of the push rod with the ear wing sockets of the sheath tube; then insert the ear wings on both sides of the push rod into the ear wing sockets of the sheath tube to achieve the relative fixation of the push rod and the sheath tube;

S06, withdraw the sheath tube and the push rod, and suture the wound on the body surface.

The further technical scheme of the present invention is: the action object of the blocking method is a PTCD training model; the PTCD training model sets the torso from the chest to the upper abdomen of the human body, the epidermis on the surface of the torso, and the bones, liver, intrahepatic bile ducts and blood vessels inside the torso, Colored fluid is injected into the intrahepatic bile ducts and blood vessels, and the intrahepatic bile ducts and blood vessels are made of repairable materials.

Compared with the prior art, the present invention has the following advantages:

1. The structure is simple, scientific and reasonable, and the operation difficulty is low. It can quickly, safely and effectively block the PTCD puncture channel, and has great clinical application value.

2. There is a reduced diameter section in the block cavity of the sheath tube, and the diameter of the reduced diameter section is slightly smaller than the diameter of the block, which can jam the block and prevent the block from sliding out from the inlet and outlet of the block; the end of the block cavity is provided with Expanding section, the maximum diameter of the expanding section is slightly larger than the diameter of the blocking block, which is convenient for the blocking block to be loaded into the blocking block cavity from the inlet and outlet of the blocking block. Load or eject.

3. There is an ear wing on the side wall of the hand-held end of the push rod, and the ear wing can be inserted into the ear wing positioning hole of the sheath tube or the ear wing socket; when the ear wing of the push rod is inserted into the ear wing socket of the sheath tube, The push rod and the sheath tube are relatively fixed, and the pushing end of the push rod does not extend into the block cavity, which can effectively prevent the operator from accidentally touching the push rod to push out the block; when the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube , the pushing end of the push rod protrudes a certain length from the inlet and outlet of the block, which is equivalent to limiting the maximum pushing depth of the push rod, which can effectively prevent the operator from pushing the block into the bile duct due to excessive pushing.

4. The block (blocking material) is a two-layer structure, including a degradable shell (outer layer) and a gelatin sponge (inner layer). The degradable shell is biodegradable, non-toxic and side effects, and has excellent biocompatibility It is a hard material that can withstand the thrust of the push rod and keep the overall structure of the blockage from breaking and collapsing; the gelatin sponge has a hemostatic effect on the bleeding of the wound surface, which is used for wound hemostasis, and can be exuded through the hollow holes on the degradable shell. Puncture channel contacts.

5. The guide wire is used to guide and define the advancing route of the sheath tube, thereby ensuring that the rear end of the sheath tube can also be accurately inserted into the puncture channel on the liver.

6. The push rod reset mechanism is set between the sheath tube and the push rod. When the push rod pushes the block out, it needs to overcome the elastic force brought by the push rod reset mechanism. The thrust on the push rod, the push rod is quickly retracted into the push rod cavity of the sheath tube under the action of elastic force, effectively avoiding the risk of contusion of the patient's liver tissue due to the exposure of the top end of the push rod outside the sheath tube.

The present invention will be further described below with reference to figures and embodiments.

Description of drawings

Fig. 1 is the structural representation of the present invention;

Fig. 2 is the A-A sectional view of Fig. 1;

Fig. 3 is the B-B sectional view of Fig. 1;

Fig. 4 is the C-C sectional view of Fig. 2;

Fig. 5 is the D-D sectional view of Fig. 2;

Fig. 6 is the E part enlarged view of Fig. 3;

Fig. 7 is the structural representation of sheath tube;

FIG. 8 is an enlarged view of the F part of FIG. 7;

Fig. 9 is the structural representation of blocking block;

10 is a schematic diagram of step 1 of blocking the PTCD puncture channel using the present invention;

11 is a schematic diagram of step 2 of blocking the PTCD puncture channel using the present invention;

12 is a schematic diagram of step 3 of blocking the PTCD puncture channel using the present invention;

Fig. 13 is a schematic diagram of step 4 of blocking the PTCD puncture channel using the present invention.

Legend description: sheath tube 1; push rod cavity 11; push rod inlet and outlet 111; block cavity 12; block inlet and outlet 121; Channel 13; Guide wire inlet 131; Guide wire outlet 132; Head 14; End face A141; ; Boss 23; Blocking block 3; Gelatin sponge 31; Degradable shell 32; Hollow hole 321; Guide wire 4; Mounting seat 51; Connecting rod 54; docking seat 55; pit 551; spring 56; puncture sheath 6; puncture channel 7; bile duct 8.

Detailed ways

Example 1:

As shown in Figures 1-9, the PTCD puncture channel blocking device includes a sheath 1, a push rod 2, a blocking block 3, a guide wire 4 and a push rod reset mechanism.

The inside of the sheath tube 1 is provided with a push rod cavity 11 and a block cavity 12 in sequence from the front end to the rear end along the axial direction. The front and rear ends of the tube 1 are formed with a push rod inlet and outlet 111 and a block inlet and outlet 121. The sheath tube 1 is also provided with a guide wire channel 13 in the axial direction, and the guide wire channel 13 is formed at the front and rear ends of the sheath tube 1 respectively. Wire inlet 131 and guide wire outlet 132. The diameter of the front end of the sheath tube 1 is enlarged to form the head 14, the head 14 is provided with an end surface A141 at the end close to the front end of the sheath tube 1, the head 14 is provided with a transition surface 142 at the end away from the sheath tube 1, and the end surface A141 of the head 14 There is an ear wing holder 143 on it, the end surface A141 of the head 14 is provided with an ear wing positioning pit 144 that communicates with the push rod cavity 11, and the head 14 is also provided with a mounting hole 145 that penetrates to the end surface A141 and the transition surface 142 , the mounting hole 145 includes a threaded hole segment and an optical hole segment that communicate with each other, the threaded hole segment penetrates to the transition surface 142, and the optical hole segment penetrates to the end surface A141.

The two ends of the push rod 2 are respectively the hand-held end and the push end. The push rod 2 is movably inserted in the push rod cavity 11 of the sheath tube 1, and its push rod end is located in the push rod cavity 11 or extends into the block cavity 12. , and its hand-held end protrudes from the inlet and outlet 111 of the push rod and is located outside the sheath tube 1 . The side wall of the hand-held end of the push rod 2 is provided with an ear wing 21, and the ear wing 21 is matched with the ear wing positioning pit 144 and the ear wing clip seat 143 respectively. When the ear wing 21 of the push rod 2 is inserted into the ear wing positioning pit of the sheath tube 1 At 144 hours, the pushing end of the push rod 2 protrudes from the block inlet and outlet 121 of the sheath tube 1, and when the ear wing 21 of the push rod 2 is inserted into the ear wing holder 143 of the sheath tube 1, the pushing end of the push rod 2 It is located in the push rod cavity 11 of the sheath tube 1 . The handle end of the push rod 2 is also provided with a cantilever 22 , and a boss 23 is provided on the cantilever 22 .

The blocking block 3 is installed in the blocking block cavity 12 of the sheath pipe 1 through the blocking block inlet and outlet 121 of the sheath pipe 1, and forms a transition fit with the blocking block cavity 12 of the sheath pipe 1, which can be pushed by the top end of the push rod 2. , and discharged from the block inlet and outlet 121 to the outside of the sheath tube 1 .

The guide wire 4 is movably inserted into the guide wire channel 13 of the sheath tube 1 , and its front and rear ends protrude from the guide wire inlet 131 and the guide wire outlet 132 respectively.

The push rod reset mechanism includes a mounting seat 51 , a sleeve 52 , a push block 53 , a connecting rod 54 , a docking seat 55 and a spring 56 . One end of the mounting seat 51 is provided with a wrench clamping portion 511, the other end is provided with a sleeve connecting portion 512, the side wall surface of the mounting seat 51 is provided with an external thread, and the mounting seat 51 is connected to the mounting hole 145 of the sheath tube 1 through the external thread. In the threaded hole section, the wrench holding portion 511 faces the transition surface 142, and the sleeve connecting portion 512 faces the end face A141. The sleeve 52 is detachably connected to the sleeve connection part 512 of the mounting seat 51 (specifically, a connection structure with matching internal and external threads can be used), and is located in the light hole section of the installation hole 145 of the sheath tube 1. One end away from the mounting seat 51 is provided with a rod penetration hole. The push block 53 is movably installed in the inner hole of the sleeve 52 . One end of the connecting rod 54 protrudes into the inner hole of the sleeve 52 through the rod penetration hole of the sleeve 52, and is fixedly connected with the push block 53, and the other end protrudes from the light hole section of the installation hole 145 of the sheath tube 1, and is connected with the docking seat. 55 is fixedly connected; the docking seat 55 is provided with a pit 551 that matches with the boss 23 of the push rod 2 . The spring 56 is compressed and arranged in the inner hole of the sleeve 52 , and two ends of the spring 56 abut against the mounting seat 51 and the push block 53 respectively.

Preferably, the number of the ear wing clips 143 is two, and the two ear wing clips 143 are uniformly arranged on the end surface A141 of the sheath tube 1 around the center line of the sheath tube 1 . Correspondingly, the number of ear fins 21 is two, and the two ear fins 21 are uniformly distributed on the side wall of the hand-held end of the push rod 2 around the center line of the push rod 2 . The number of the mounting holes 145 is two, and the two mounting holes 145 are uniformly distributed in the head 14 of the sheath tube 1 around the center line of the sheath tube 1 . Correspondingly, the number of push rod reset mechanisms is two, and the two push rod reset mechanisms are respectively disposed in the two installation holes 145 . The above symmetrically arranged structure can improve the operation stability and use reliability of the plugging device.

Preferably, the blocking block 3 is cylindrical, and includes a gelatin sponge 31 and a degradable shell 32 wrapped outside the gelatin sponge 31 , and the side wall of the degradable shell 32 is provided with a hollow hole 321 . The gelatin sponge 31 is soft in texture and can seep out from the hollow hole 321 and contact with the liver tissue to stop bleeding.

Preferably, the blocking cavity 12 of the sheath tube 1 is sequentially provided with an expanding section 122, a reducing section 123, a transition section 124 and a sizing section 125 from one end where the blocking inlet and outlet 121 is located to the other end. The diameter of the sizing section 125 is is L, the diameter of the reducing section 123 is 0.96-0.98L, the maximum diameter of the expanding section 122 is 1.02-1.06L, and the included angle a formed by the busbar of the expanding section 122 and the center line of the sheath tube 1 is 3-10° , the included angle β formed by the bus bar of the transition section 124 and the center line of the sheath tube 1 is 3-10°. The diameter of the block 3 is L.

Preferably, the length of the sheath tube 1 is 20-30 cm, the length of the blocking block 3 is 1-1.5 cm, and the length of the guide wire 4 is 80-100 cm.

Briefly describe the method for blocking the PTCD puncture channel using the present invention:

The operation of blocking the PTCD puncture channel is as follows:

1. Referring to Figure 10, the rear end of the guide wire 4 is passed through the inner hole of the puncture sheath 6 or the inner hole of the PTCD catheter (not shown in the figure), and is sent into the lower end of the bile duct 8 with the assistance of DSA, thereby establishing a working track;

Before the start of this step, the PTCD puncture operation has been completed, and the puncture sheath 6 and the PTCD catheter have not yet exited the puncture channel 7 .

2. Referring to Fig. 11, remove the puncture sheath 6 and the PTCD catheter, put the sheath tube 1 on the guide wire 4 through the guide wire channel 13 on the sheath tube 1, and push the sheath tube 1 along the guide wire 4. The rear end of the sheath tube 1 is sent into the intersection of the puncture channel 7 and the bile duct 8 with the assistance;

Before the start of this step, the block 4 is installed in the block cavity 12 of the sheath tube 1; the push rod 2 is installed in the push rod cavity 11 of the sheath tube 1, and the ear wings 21 on both sides of the push rod 2 are stuck in the in the ear wing socket 143 .

3. Referring to Figure 12, remove the guide wire 4, withdraw the sheath tube 1 by the length of a block 4, and then push the contrast medium through the guide wire inlet 131 of the sheath tube 1, and then confirm the rear end of the sheath tube 1 with the assistance of DSA. Inside the puncture channel 7 and not extending into the bile duct 8 .

4. Referring to Figure 13, the push rod 2 is pulled out a certain distance to the outside of the puncture channel 7, so that the ear wings 21 on both sides of the push rod 2 are separated from the ear wing clips 143 of the sheath tube 1; then the push rod 2 is rotated 90°, The ear wings 21 on both sides of the push rod 2 are aligned with the ear wing positioning pits 144 of the sheath tube 1; then the push rod 2 is advanced to the depth of the puncture channel 7, and along with the advancement of the push rod 2, the spring 56 is compressed on the one hand, On the other hand, the ear wings 21 of the push rod 2 are inserted into the ear wing positioning holes 144 of the sheath tube 1; The junction of the bile ducts 8 to avoid leakage of bile;

In this step, when the ear fins 21 on both sides of the push rod 2 and the pit bottom surface of the ear fin positioning pit 144 of the sheath tube 1 are in contact with each other, the push rod 2 is advanced to reach the limit position, and the compression amount of the spring also reaches the maximum. The pushing end protrudes from the block inlet and outlet 121 of the sheath tube 1 by a length of 1-5 mm.

5. Cancel the propulsion force exerted on the push rod 2, and the pushing end of the push rod 2 is quickly retracted into the push rod cavity 11 of the sheath tube 1 under the elastic force of the spring 56; then push the push rod 2 to the puncture channel 7 Pull out a certain distance from the outside and rotate it by 90°, so that the ear wings 21 on both sides of the push rod 2 are aligned with the ear wing sockets 143 of the sheath tube 1; then insert the ear wings 21 on both sides of the push rod 2 into the ear wings of the sheath tube 1 The clamping seat 143 is used to realize the relative fixation of the push rod 2 and the sheath tube 1 .

6. Withdraw the sheath tube 1 and the push rod 2, and suture the wound on the body surface.

The object of the above-mentioned occlusion method is the PTCD training model or the patient.

When the object of the blocking method is the PTCD training model, it can help students quickly and proficiently master the method of blocking the PTCD puncture channel. The operation timing is when the puncture sheath and PTCD catheter have not exited the puncture channel after the PTCD puncture operation is completed. Down. The described PTCD training model sets the human body from the chest to the upper abdomen, the epidermis on the surface of the torso, as well as the bones, liver, intrahepatic bile ducts and blood vessels inside the torso. Colored liquid is injected into the intrahepatic bile ducts and blood vessels. Made of repairable materials. Simulates the real tissue structure of the human body.

When the action object of the blocking method is the patient, the leakage of bile to the outside of the body through the puncture channel can be avoided, which is beneficial to the postoperative recovery of the patient. The timing of the operation is that after the PTCD puncture operation is completed, the treatment of biliary obstruction is performed, and the puncture sheath and PTCD catheter have not been withdrawn from the puncture channel.

The PTCD puncture channel blocking device provided by the present invention can also be used for blocking the lithotripsy and lithotripsy channel under percutaneous nephroscopy, and the process is similar to the above operation, and will not be repeated here.

Claims (9)

1. PTCD puncture channel blocking device, is characterized in that: comprise sheath tube, push rod, block and guide wire; The inside of the sheath tube is provided with a push rod cavity and a blocking block cavity in sequence from the front end to the rear end along the axial direction. The push rod cavity and the blocking block cavity are communicated with each other. The rod inlet and outlet and the blocking block inlet and outlet, the sheath tube is also provided with a guide wire channel along the axial direction, and the guide wire channel forms a guide wire inlet and a guide wire outlet at the front and rear ends of the sheath tube respectively; The two ends of the push rod are the hand-held end and the push end respectively. The push rod is movably inserted into the push rod cavity of the sheath tube, and its push end is located in the push rod cavity or extends into the block cavity. The rod inlet and outlet extend outside the sheath; The blocking block is installed in the blocking block cavity of the sheath tube through the blocking block inlet and outlet of the sheath tube, and forms a transition fit with the blocking block cavity of the sheath tube. outside the sheath; The guide wire is movably inserted into the guide wire channel of the sheath tube, and its front and rear ends respectively protrude from the guide wire inlet and the guide wire outlet. 2. PTCD puncture passage blocking device as claimed in claim 1 is characterized in that: the diameter of the front end of the sheath is expanded and forms a head, and the head is provided with an end face A at one end close to the front end of the sheath, and the head is away from the sheath One end is provided with a transition surface, the end surface A of the head is provided with an ear wing holder, the end surface A of the head is provided with an ear wing positioning pit that communicates with the push rod cavity, and the head is also provided with a connection to the end surface A and The installation hole of the transition surface, the installation hole includes a threaded hole section and a smooth hole section that communicate with each other, the threaded hole section runs through the transition surface, and the smooth hole section runs through the end face A; There are ear wings on the side wall of the hand-held end of the push rod, and the ear wings are respectively matched with the ear wing positioning pit and the ear wing card seat. Protruding from the inlet and outlet of the block of the sheath tube, when the ear wing of the push rod is inserted into the ear wing socket of the sheath tube, the pushing end of the push rod is located in the push rod cavity of the sheath tube; the hand-held end of the push rod is also provided with Cantilever, the cantilever is provided with a boss; It also includes a push rod reset mechanism; the push rod reset mechanism includes a mounting seat, a sleeve, a push block, a connecting rod, a docking seat and a spring; one end of the mounting seat is provided with a wrench clamping part, and the other end is provided with a sleeve connecting part, and the The side wall surface of the seat is provided with an external thread, and the mounting seat is connected to the threaded hole section of the mounting hole of the sheath tube through the external thread. The detachable connection is on the sleeve connection part of the mounting seat, and is located in the light hole section of the mounting hole of the sheath tube. The sleeve is provided with a rod penetration hole at the end away from the mounting seat; ;One end of the connecting rod protrudes into the inner hole of the sleeve through the rod penetration hole of the sleeve, and is fixedly connected with the push block, and the other end protrudes from the light hole section of the installation hole of the sheath tube and is fixedly connected with the docking seat; the docking seat The upper part is provided with a pit that matches with the boss of the push rod; the spring is compressed and arranged in the inner hole of the sleeve, and the two ends of the spring are respectively abutted against the mounting seat and the push block. 3. PTCD puncture passage blocking device as claimed in claim 2, is characterized in that: the quantity of ear wing clip seat is two, and two ear wing clip seats are annularly evenly distributed on the sheath tube around the center line of the sheath tube. On the end face A; correspondingly, the number of ear fins is two, and the two ear fins are uniformly distributed on the side wall of the hand-held end of the push rod around the center line of the push rod. 4. The PTCD puncture channel blocking device as claimed in claim 3, wherein the number of the mounting holes is two, and the two mounting holes are arranged in the head of the sheath in a ring shape around the center line of the sheath; Yes, the number of push rod reset mechanisms is two, and the two push rod reset mechanisms are respectively arranged in two installation holes. 5. PTCD puncture passage blocking device as claimed in claim 4, is characterized in that: blocking block is cylindrical, and it comprises gelatin sponge and degradable shell wrapped on the outside of gelatin sponge, and the side wall of degradable shell is provided with. Cutout holes. 6. The PTCD puncture passage blocking device as claimed in claim 5, wherein the block cavity is sequentially provided with an expanding section, a reducing section, a transition section and a sizing section from one end where the blocking block inlet and outlet are located to the other end. The diameter of the sizing section is L, the diameter of the reducing section is 0.96~0.98L, the maximum diameter of the expanding section is 1.02~1.06L, and the angle a formed by the busbar of the expanding section and the center line of the sheath is 3 ～10°, the angle β formed by the busbar of the transition section and the center line of the sheath is 3～10°; The diameter of the block is L. 7 . The PTCD puncture channel blocking device according to claim 6 , wherein the length of the sheath is 20-30 cm, the length of the blocking block is 1-1.5 cm, and the length of the guide wire is 80-100 cm. 8 . 8. A PTCD puncture channel blocking method, based on the PTCD puncture channel blocking device according to any one of claims 1-7, which is used for blocking the puncture channel generated by the PTCD puncture operation; The blocking operation is as follows: S01, pass the rear end of the guide wire through the inner hole of the puncture sheath or the inner hole of the PTCD catheter, and send it into the lower end of the bile duct with the assistance of DSA, thereby establishing a working track; Before the start of this step, the PTCD puncture operation has been completed, and the puncture sheath and PTCD catheter have not been withdrawn from the puncture channel; S02, remove the puncture sheath and PTCD catheter, put the sheath on the guide wire through the guide wire channel on the sheath, push the sheath along the guide wire, and send the rear end of the sheath into the puncture channel with the assistance of DSA the junction with the bile duct; Before the start of this step, the block is installed in the block cavity of the sheath tube; the push rod is installed in the push rod cavity of the sheath tube, and the ear wings on both sides of the push rod are stuck in the ear wing clips of the sheath tube 1; S03, remove the guide wire, withdraw the sheath tube by the length of the block, and then push the contrast agent through the guide wire entrance of the sheath tube, and then confirm that the rear end of the sheath tube is in the puncture channel with the aid of DSA and does not extend into the bile duct Inside; S04, pull the push rod out of the puncture channel for a certain distance, so that the ear wings on both sides of the push rod are separated from the ear wings of the sheath tube; then rotate the push rod 90°, so that the ear wings on both sides of the push rod are aligned with the sheath The ear wing positioning pit of the tube; then push the push rod to the depth of the puncture channel. As the push rod advances, on the one hand, the spring is compressed, and on the other hand, the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube; until the The block is pushed out from the block inlet and outlet of the sheath tube. After the block is pushed out, it is blocked at the intersection of the puncture channel and the bile duct to avoid bile leakage; In this step, when the ear wings on both sides of the push rod are in contact with the bottom surface of the ear wing positioning pit of the sheath tube, the push rod is advanced to the limit position, the compression amount of the spring also reaches the maximum, and the pushing end of the push rod is pushed from the sheath tube. The extension length of the inlet and outlet of the blocking block is 1 to 5mm; S05, cancel the propulsion force exerted on the push rod, and the pushing end of the push rod is quickly retracted into the push rod cavity of the sheath tube under the elastic force of the spring; then the push rod is pulled out of the puncture channel for a certain distance and then rotated 90°, align the ear wings on both sides of the push rod with the ear wing sockets of the sheath tube; then insert the ear wings on both sides of the push rod into the ear wing sockets of the sheath tube to achieve the relative fixation of the push rod and the sheath tube; S06, withdraw the sheath tube and the push rod, and suture the wound on the body surface. 9. PTCD puncture channel blocking method as claimed in claim 8, it is characterized in that: the action object of blocking method is PTCD training model; The internal bones, liver, intrahepatic bile ducts and blood vessels are filled with colored fluid, and the intrahepatic bile ducts and blood vessels are made of repairable materials.

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