JPH01250266A - Pubis upper part washing water drain pipe - Google Patents

Abstract

PURPOSE: To provide a wash-water drainage tube for the upper portion of a pubic bone, capable of simplifying a pressure monitoring by composing so that an air opening is provided at the basic end portion of a vertically arranged shaft or at the adjacent region thereof, and a lateral over-flow opening connected to an outlet hose is provided at the lower part thereof by composing so that the wash water is supplied into a bladder from a housing vessel 10. CONSTITUTION: Wash water is flowed toward the direction as shown by an arrow mark from the vessel 10, and into the bladder through the opening of an end portion, and into the shaft 11, and ascended upward within the tube, and finally again flowed downward through an over-flow opening 17 and an outlet hose 18. Thus, water level is kept at the height of the over-flow opening 17. This water level is stably maintained at the height of the over-flow opening 17 even in any case. The more the flowing rate of the water is increased, the more a lot of water is over flowed, and if the flowing rate of the water is reduced, the over-flow rate is reduce. Since the space of the upper portion of the bladder is communicated to the atmosphere through an air opening 16, the water level 19 of the upper portion of the bladder is not changed.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention relates to an N1 exit canal (irrigating water supplied from a resection instrument penetrating the urethra) of the type stated in the preamble of claim 1 (a suprapubic irrigation water drainage tube with a shaft for draining water from the bladder).

[Conventional technology]

When performing a transurethral resection, an endoscopic resection instrument is introduced through the urethra into the bladder area to perform the surgery there, usually with an electrically actuated cutting blade. Such surgery may be necessary on the bladder wall or often in the area of the prostate.

In order to obtain a clear view in front of the instrument even in cases of relatively heavy bleeding, irrigation water is supplied to the field of view through a supply channel provided in the instrument. In the old method,
The washing water is discharged intermittently through the same channel, whereas in the continuous washing methods currently in use, the washing water is discharged through special channels, so that a constant continuous washing is possible.

In the Iglesias method, supply and drainage channels are provided in an instrument that is inserted into the urethra. On the other hand, in the method according to the preamble of claim 1, which is becoming more and more widely used today, a special drainage channel is provided by the above-mentioned suprapubic irrigation water drainage pipe shaft.

For this purpose, the bladder is first pierced externally using a trocar above the pubic bone, and the shaft is inserted into the passage thus created. This is provided essentially as a tube open at both ends and constitutes a wash water outlet. A discharge hose is provided at its outer proximal end.

As with all irrigation methods mentioned above, with the suprapubic method the irrigation water pressure within the bladder must be carefully monitored;
If this pressure is too high, water can enter the blood circulation through the vessels opened during surgery, resulting in the well-known TURC transurethral resection syndrome, which can be serious for the patient. Therefore, the intravesical pressure must be kept below the maximum permissible value of a few decimeters of water, and at the same time care must be taken to ensure good irrigation with a volume of water of about 1 liter per bag.

If the supply pressure is constant, the intravesical pressure will quickly rise to a value that is too high if the outlet is occluded.

A suprapubic irrigation water drain shaft of the above type is described in the West German publication “Urologie B” (Urology B) 19
It is disclosed in Vol. 26, 1986, pages 189 to 192 (Fig. 3).

[Problem to be solved by the invention]

In this known drain, in addition to the central drain,
A second pressure measurement path is provided in the shaft, which couples the distal region to the proximal connection, and which includes a second pressure measurement path for pressure monitoring purposes. A manometer (pressure gauge) can be connected to its base. Although pressure monitoring is facilitated by this method, monitoring and flow rate adjustment must be continuously performed to maintain the pressure below a critical pressure value. This just also has the disadvantage that two passages must be provided in the shaft, making the actual drainage channel relatively narrow (and can easily become blocked). Another disadvantage is that the suction at the outlet is The problem is that if it is too forceful, the bladder can be suctioned out; the bladder will then collapse, but the operator is generally unaware of this, and positioning on the bladder becomes increasingly difficult. Harmful contact with the bladder wall. It also happens.

Therefore, when monitoring bladder pressure, care must be taken not only to avoid exceeding the maximum pressure, but also to maintain a minimum pressure that ensures that the bladder does not collapse.

It is therefore an object of the invention to provide a discharge pipe of the above type, which allows simplified pressure monitoring.

[Means and operations for solving the problem] The above object is achieved by the present invention, which is characterized by the feature of claim 1 (air opening 1 at or near the proximal end of the shirt 1-11 disposed approximately vertically).
6 and below which a lateral overflow opening 17 is provided which connects to the outlet hose 18).

Since the discharge pipe shaft of the present invention has only one passage, it is possible to provide this passage with a large cross-sectional area so that it does not become obstructed in the form of a simple tube.

Near the upper proximal end of the shaft, an overflow opening is connected to an outlet hose at or, for example, near the proximal end, through which wash water rising up the passageway flows out. In its upper part, an air opening leading to the atmosphere is provided, so that as long as the bladder is supplied with water through the supply channel, a water surface is created at the overflow opening on which the atmosphere acts. In this case, the water level is always at the same height, regardless of the amount supplied.

Therefore, care need only be taken to size the overflow opening and the outlet hose to allow the passage of the maximum amount of wash water that is practically possible.

In this way, the water level will always be maintained at the level of the overflow opening, regardless of the amount of washing water. The water level at the top of the bladder determines the pressure within the bladder. therefore,
Bladder pressure remains constant.

The amount of water supplied does not affect the height of the water level, therefore
The amount of water supplied can be adjusted to 11 levels, depending solely on the operator's requirements (clear visibility, flushing of residues from the surgical site). Thus, a shaft structure is provided that automatically maintains constant bladder pressure without the need for control operations.

Thus, a completely automatic pressure control is achieved with a very simple structure, preventing the bladder pressure from reaching high values that make the patient tense, or from becoming too low that the bladder collapses and prevents surgery. The bladder pressure is always kept at a constant desired level, regardless of the amount of water supplied.

The features of claim 2 (that the shaft 11 is configured such that the vertical spacing of the overflow opening 17 with respect to the bladder 1 can be adjusted) are advantageous.

In this way, the vertical distance of the water level above the bladder can be adjusted,
Bladder pressure can be adapted to changing demands. The overflow opening of the shaft may be adjustable in height, for example with a telescoping shaft that is longitudinally adjustable.

The features of claim 3 are also advantageous, in that an attachment disk 14 is provided on the shaft 11, which engages the skin 4 of the part 0 and is movable in the longitudinal direction and can be fixed. In this way, it is possible to use mounting discs that are commonly used for precise positioning, with a simple shaft attached to them so that they can be adjusted longitudinally only with respect to these discs. In this way, the water level can be adjusted by a few centimeters within the desired range.

The features of claim 4 (that the air opening 16 and the overflow opening 17 are provided in a larger diameter container 15 located at or near the proximal end of the shirt eye 1) are also advantageous. be. In this way, the cross-sectional area of the passage can be substantially enlarged in the vicinity of the overflow opening. Even if there are large fluctuations in the amount of wash water or the amount of overflow water in the outlet hose, the water level will fluctuate only slightly.

The features of claim 5 (that the container 15 is made of transparent material) are also advantageous. In the case of a transparent container, its contents can be continuously observed. Therefore, the proportion of blood contained in water can be easily estimated, and the removal of tissue fragments generated during surgery by washing can be observed.

Finally, the features of claim 6 (that the photometer device is provided in the container 15) are also advantageous. In this way,
The wash water in the container can be continuously checked photometrically, for example by colorimetry for the blood content. Thus, the proportion of blood in water can be automatically indicated. This provides the operator with a valuable indication of the patient's blood loss and allows the anesthetist to transfuse at the appropriate time.

〔Example〕

The invention is schematically illustrated in the accompanying drawing, which shows a cross-section of a bladder with an ablation instrument and an irrigation water outlet shaft inserted.

FIG. 1 shows a part of the body of a lying patient as a longitudinal section of the bladder, showing the bladder wall 1, prostate 2, pubic bone 3 and abdominal skin 4. FIG.

An endoscopic resection instrument having a resection shaft 5 is inserted through the urethra (not shown), and a resection loop 6 (a U-shaped radiofrequency heated wire loop for cutting tissue) projects from the distal end of the shaft 5. There is. An eyepiece 7 and a valve joint 8 are provided at the base end of the resection shaft 5, a water supply hose 9 is connected to the joint 8, and a cleaning water storage container 10 is suspended at a high level. Wash water is supplied to this from. Water exits the containment vessel 10 and flows into the bladder generally in the direction of the arrow through the hose 9 and the supply passageway (not shown) in the resection shaft 5. The irrigation provides a constant clear view of the area of the bladder (for example, a bladder wall malignancy) or in particular the area of the prostate 2 (prostatectomy), which allows working with the instruments shown.

Discharge of washing water from the bladder is performed by a shirt opening 1 provided in a suprapubic washing water discharge pipe according to the present invention. A preferred embodiment of this shaft 11 is shown.

As part of the rsm stage, shirt H1 is placed in the position shown within the bladder by means of a trocar in the usual manner. Therefore, the shaft 11 is made by a trocar.
It is placed in a passageway extending from the exterior of the body above the pubic bone 3 through the abdominal skin 4 and intermediate tissues and the bladder wall l into the bladder. In the exemplary embodiment shown, the shaft 11 is configured as a substantially hollow tube with its distal or inner end open towards the bladder.
It opens into the bladder like a sieve with multiple holes. However, the distal end of the shaft can also be configured as an open tube opening.

The shirt eye 1 passes through a clamp ring 12 with a fixing screw 13 fixed to a mounting disc 14 with a larger diameter. The disk 14 is the abdominal skin 4
The shirt H1 is fixed in a substantially vertical position as shown in the figure, and the shaft 11 is prevented from falling sideways. After adjusting the shaft 11 in a predetermined vertical direction with respect to the disk 14, the shaft 11 is fixed with the fixing screw 13.
can be fixed.

At the upper proximal end of the shaft 11 there is provided a container 15 of larger diameter, the walls of which are shown cut away in the preferred embodiment, made of a transparent material (glass, acrylic, etc.). It is configured.

The container 15 opens upwardly to the atmosphere at its top via an air opening 16, which in the illustrated embodiment corresponds to the diameter of the container, and has an overflow opening 17 on the side. Portion 17 has an outlet hose 18
is connected and the hose 18 extends to a bucket located under the operating table, for example. The air opening 16 can be smaller; for example, the illustrated opening 16 can be covered with a lid having small holes to allow air flow.

As previously mentioned, irrigation water is supplied to the bladder from containment vessel IO. The irrigation water flows from the container 10 in the direction of the arrow shown through the distal opening into the bladder, enters the shaft 11 and rises therein and finally passes through the overflow opening 1.
7 and flowing downwards again through the outlet hose 18, a water surface 19 is formed at the level of the overflow opening 17, as shown in FIG. This water level is in all circumstances at the height shown, i.e. at the overflow opening 17.
is maintained stably at a height of If the flow rate of the wash water increases, more water will overflow, and if the flow rate decreases, the amount of water will overflow. Since the space above the bladder communicates with the atmosphere through the air opening 16, the height of the water level 19 above the bladder does not vary.

As a result of the above arrangement, even if the suction action at the outlet hose 18 is too strong, the water level at the water surface 19 remains at its height. That is, harmful suctions such as emptying the bladder are prevented. If such a situation suddenly occurs, for example, the cutting blade and the bladder wall 1 will come into contact.

As mentioned above, the water level of the water surface 19 is maintained at a constant height under all circumstances. The distance from the bladder to the water level determines the water pressure in the bladder very simply, so that it is always kept at a constant value completely automatically without any special attention from the operator.

By suitably setting the length of the shaft 11, the water pressure can be set very easily in the desired range, for example from 5 to 30 cta water column. If it is necessary to change the water pressure, loosen the fixing screw 13 and tighten the shaft 11.
may be slid slightly upward or downward relative to the mounting disk 14.

Since the container 15 is made of a transparent material as described above, its contents can be easily observed. especially,
This allows the amount of blood contained in the overflowing wash water to be determined very easily and clearly. This information is valuable to operators, especially anesthetists who must perform blood transfusions when necessary. This monitoring can also be automated.

Advantageously, a light meter 20.20 is provided which illuminates the light beam 21 through the container 15 and its contents and automatically determines and indicates the blood proportion by means of colorimetry.

The shaft according to the invention can be modified in various ways from the illustrated embodiment without departing from the scope of the invention. Thus, for example, the overflow opening 17 can be provided directly in the shirt opening 1 without providing the container 15.

The vertical distance adjustment of the overflow opening 17 relative to the bladder can be effected in another way, for example by a longitudinally extendable shaft. Finally, air opening 16 and overflow opening 17 need not be provided directly at the proximal end of shaft 11.

For example, the proximal end of the shaft can be bent laterally, with an air opening 16 located at the bend and an overflow opening 17 at the end of the bend, or
Connecting the outlet hose 18 to the base end of the shaft,
It is also possible to arrange a device with an air opening 16 and an overflow opening 17 in the middle of the hose 18.

〔Effect of the invention〕

As described above based on the embodiments, according to the present invention, it is possible to provide a suprapubic irrigation water discharge pipe that can automatically maintain constant intravesical pressure without requiring any control operation.

[Brief explanation of the drawing]

FIG. 1 is a partial cross-sectional view showing how an embodiment of the suprapubic washing water discharge pipe according to the present invention is used. In the figure, l is the bladder wall, 2 is the prostate, 3 is the pubic bone, 4 is the abdominal skin, 5 is the resection shaft, 6 is the resection loop, lO
is a wash water storage container, 11 is a shaft, 12 is a clamp ring, 14 is a mounting disk, 15 is a container, 16 is an air opening, 17 is an overflow opening, 19 is a water surface,
20 is a photometer, and 21 is a light beam.

Claims (1)

[Claims] 1. In a suprapubic irrigation water discharge tube with a shaft for discharging irrigation water supplied from a resection instrument penetrating the urethra from the bladder, the proximal end of the shaft 11 or A suprapubic wash water discharge pipe characterized in that an air opening 16 is provided in the vicinity thereof, and a lateral overflow opening 17 connected to an outlet hose 18 is provided below it. 2. The suprapubic irrigation water discharge pipe according to claim 1, wherein the shaft 11 is configured to adjust the vertical distance of the overflow opening 17 with respect to the bladder 1. 3. An attachment disk 14 that engages the abdominal skin 4, is longitudinally movable and can be fixed is attached to the shaft 11.
The suprapubic washing water discharge pipe according to claim 2, wherein the pipe is provided above the pubic bone. 4. The air opening 16 and the overflow opening 17
is located at or near the proximal end of the shaft 11,
The suprapubic washing water discharge pipe according to any one of claims 1 to 3, characterized in that it is provided in a container (15) having a larger diameter. 5. The suprapubic washing water discharge pipe according to claim 4, wherein the container 15 is made of a transparent material. 6. The suprapubic irrigation water discharge pipe according to claim 4, wherein a photometer device is provided in the container 15.