CN111329537B - Guiding device and guiding method for deep brain minimally invasive surgery - Google Patents
Guiding device and guiding method for deep brain minimally invasive surgery Download PDFInfo
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- CN111329537B CN111329537B CN202010129339.7A CN202010129339A CN111329537B CN 111329537 B CN111329537 B CN 111329537B CN 202010129339 A CN202010129339 A CN 202010129339A CN 111329537 B CN111329537 B CN 111329537B
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- 210000004556 brain Anatomy 0.000 title claims abstract description 60
- 238000002324 minimally invasive surgery Methods 0.000 title claims abstract description 19
- 238000000034 method Methods 0.000 title abstract description 25
- 210000003128 head Anatomy 0.000 claims description 64
- 210000003625 skull Anatomy 0.000 claims description 9
- 210000000613 ear canal Anatomy 0.000 claims description 6
- 238000013459 approach Methods 0.000 claims description 3
- 210000000133 brain stem Anatomy 0.000 claims description 3
- 210000001638 cerebellum Anatomy 0.000 claims description 3
- 238000004804 winding Methods 0.000 claims 2
- 210000005013 brain tissue Anatomy 0.000 abstract description 18
- 230000006378 damage Effects 0.000 abstract description 11
- 238000013461 design Methods 0.000 abstract description 8
- 210000001061 forehead Anatomy 0.000 description 18
- 238000010146 3D printing Methods 0.000 description 13
- 238000005516 engineering process Methods 0.000 description 9
- 238000003780 insertion Methods 0.000 description 9
- 230000037431 insertion Effects 0.000 description 9
- 238000009434 installation Methods 0.000 description 8
- 230000008901 benefit Effects 0.000 description 6
- 210000004709 eyebrow Anatomy 0.000 description 5
- 206010008111 Cerebral haemorrhage Diseases 0.000 description 4
- 238000005520 cutting process Methods 0.000 description 4
- 230000003902 lesion Effects 0.000 description 4
- 238000004519 manufacturing process Methods 0.000 description 4
- 238000001356 surgical procedure Methods 0.000 description 4
- 238000012545 processing Methods 0.000 description 3
- 230000003014 reinforcing effect Effects 0.000 description 3
- 230000002146 bilateral effect Effects 0.000 description 2
- 210000001652 frontal lobe Anatomy 0.000 description 2
- 229940035535 iodophors Drugs 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 210000004761 scalp Anatomy 0.000 description 2
- 238000012549 training Methods 0.000 description 2
- 206010018852 Haematoma Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 238000004458 analytical method Methods 0.000 description 1
- 210000003484 anatomy Anatomy 0.000 description 1
- 210000004227 basal ganglia Anatomy 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 210000003710 cerebral cortex Anatomy 0.000 description 1
- 230000002490 cerebral effect Effects 0.000 description 1
- 238000007428 craniotomy Methods 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 210000000744 eyelid Anatomy 0.000 description 1
- 238000010030 laminating Methods 0.000 description 1
- 239000002184 metal Substances 0.000 description 1
- 238000003801 milling Methods 0.000 description 1
- 210000000869 occipital lobe Anatomy 0.000 description 1
- 210000001152 parietal lobe Anatomy 0.000 description 1
- 238000007639 printing Methods 0.000 description 1
- 230000002441 reversible effect Effects 0.000 description 1
- 238000000926 separation method Methods 0.000 description 1
- 230000001954 sterilising effect Effects 0.000 description 1
- 238000004659 sterilization and disinfection Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 239000000758 substrate Substances 0.000 description 1
- 210000003478 temporal lobe Anatomy 0.000 description 1
- 210000001103 thalamus Anatomy 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
- 208000037816 tissue injury Diseases 0.000 description 1
- 230000007704 transition Effects 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
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- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
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- Media Introduction/Drainage Providing Device (AREA)
Abstract
The invention relates to a guiding device and a guiding method for deep brain minimally invasive surgery, belongs to the technical field of brain minimally invasive surgery equipment, and solves the problem that the existing device is easy to damage brain tissues of a patient. The guiding device comprises: mask guide plate, guide bracket, guide needle and retracting catheter. The mask guide plate can be adhered and fixed on the skin of the head of a patient, the guide bracket is arranged on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide bracket; the guide needle can enter the brain according to the guiding direction of the guide bracket; the retracting catheter can be advanced along the guide needle into a predetermined position within the brain. The invention prevents the shaking of the retracting catheter in the process of entering the brain, not only can reduce the damage degree of the retracting catheter to brain tissues in the process of inserting, but also can further improve the accuracy of the position of the retracting catheter inserted into the brain. Meanwhile, due to the conical design of the front end of the tube core of the retracting tube, the damage to brain tissues in the process of retracting the tube is further reduced, and the position is more accurate.
Description
Technical Field
The invention relates to the technical field of deep brain minimally invasive surgery equipment, in particular to a guiding device and a guiding method for deep brain minimally invasive surgery.
Background
Minimally invasive procedures performed deep in the brain often require the use of brain retraction devices, which are currently available in two main categories.
One type is known as a disposable tissue expander (e.g., produced by Beijing Tianxin fu). The double-cavity design, the endoscope used for the operation is relatively fixed (the flexible application of the endoscope is limited), the straight tube type (with consistent depth and diameter) design of the catheter (the design from shallow to deep diameter is more convenient for the matching use of two instruments in the operation compared with the design), the cross section is round (the oval design pushes away more brain tissues which do not need to be pushed away in the operation of two instruments), and the tube core is hollow but not led to the front end directly (the front end has no straight-out hole, and the guide needle for positioning and pointing the brain cannot pass).
Another class is known as single use brain retraction guide tubes (e.g., produced by vinorelo). The catheter has the specification of LW120807 as the thinnest length, the oval caliber of the front end of the catheter is 12X8mm, and the catheter with the caliber is used for performing cerebral hemorrhage endoscopic minimally invasive surgery, is too thick (can be thinner), and has too large wound; in addition, the maximum length is only 7cm, and many cerebral hemorrhage operation positions are deeper, and the length can not reach hematoma; the tube core (inner tube) of the catheter is a thin-walled tube with oval cross section, the front end opening is narrowed, but the space in the tube core is large, the front end opening is still oval with large area, if the guide needle for positioning is used for introducing the catheter into the brain through the opening, the amplitude of swing of the catheter is large in the process of entering the brain, the access is inaccurate, and the brain tissue injury is also large. In actual use, when the brain retraction catheter is pushed into the brain, the retraction catheter cannot be fixed, so that the possibility of dislocation and offset of the retraction catheter exists, and the risk of deep brain operation is greatly increased.
Disclosure of Invention
In view of the above analysis, the present invention aims to provide a guiding device and a guiding method for deep brain minimally invasive surgery, which are used for solving the problem that the existing device and method are easy to cause great damage to brain tissues of patients.
The aim of the invention is mainly realized by the following technical scheme:
in the technical scheme of the invention, the guiding device for deep brain minimally invasive surgery comprises: mask guide plate, guide bracket, guide needle and retracting catheter. The mask guide plate can be adhered and fixed on the skin of the head of a patient, the guide bracket is arranged on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide bracket; the guide needle can enter the brain according to the guiding direction of the guide bracket; the retracting catheter can be advanced along the guide needle into a predetermined position within the brain.
In the technical scheme of the invention, the guide bracket comprises: the device comprises a mounting head, a guide arm and a guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting head is arranged at the mounting end of the guide arm, and the guide head is provided with the guide end of the guide arm; the guide head is provided with a cylindrical accommodating cavity, an infinitely long cylindrical space is formed by axially extending the cylindrical accommodating cavity, and the guide support and the infinitely long cylindrical space have no public part.
In the technical scheme of the invention, the guide arm is a bent rod or a straight rod, and the cross section of the guide arm is rectangular.
In the technical scheme of the invention, the guide head is a cylindrical barrel with an opening on the side wall, the cylindrical accommodating cavity is positioned in the cylindrical barrel, the opening on the side wall of the guide head is an axial opening, and the corresponding central angle is 30-120 degrees.
In the technical scheme of the invention, the mask guide plate is a frontal face T-shaped mask guide plate for operation or an auricle-surrounding mask guide plate.
In the technical scheme of the invention, a mounting seat is arranged on a mask guide plate; the mount pad is equipped with the mounting hole, and the installation head of guide bracket can insert in the mounting hole, and the shape and the size of the cross section of mounting hole are the same with the cross section of installation head, and the degree of depth of mounting hole is greater than the length of the installation head of guide bracket.
In the technical scheme of the invention, the retracting catheter comprises: an outer tube and an inner tube; the cross sections of the outer tube and the inner tube are oblong or oval, and are tubular structures with deep parts, thin parts and thick parts;
the inner tube and the outer tube and the guide needle and the guide hole are connected in a seamless sleeving manner.
According to the technical scheme, the shallow part of the outer tube is provided with the limiting stop ring, the inner tube is provided with the limiting snap ring, and the limiting stop ring and the limiting snap ring form a limiting structure; the limiting retainer ring is provided with a retainer ring holding part, and the limiting retainer ring is provided with a retainer ring holding part.
In the technical scheme of the invention, the retaining ring holding part and the clamping ring holding part are arranged along the radial direction of the retracting catheter, and a positioning structure is arranged on the contact surface between the retaining ring holding part and the clamping ring holding part and comprises a positioning hole and a positioning block with the same shape and size;
the retaining ring holding part and the clamping ring holding part are also provided with a clamping buckle structure.
In the technical scheme of the invention, the guiding device is used in the guiding method;
the guiding method comprises the following steps:
s1, manufacturing a mask guide plate through a 3D printing technology;
s2, installing the guide bracket on the mask guide plate;
s3, attaching and fixing the mask guide plate on the corresponding part of the skin of the head of the patient;
s4, inserting the guide needle into the brain of the patient through the guide bracket until the tip of the guide needle is inserted into the focus of the patient;
s5, keeping the space position of the guide needle motionless, and removing the guide bracket and the mask guide plate;
s6, guiding the retraction catheter into the brain of the patient through the guide needle until the tip of the retraction catheter is inserted into the focus of the patient;
and S7, keeping the outer tube still, taking the inner tube of the retracting catheter and the guide needle out of the outer tube together, and realizing the entry and operation of instruments for deep brain minimally invasive surgery through the inner space of the outer tube of the dynamically fixed retracting catheter.
The technical scheme of the invention can at least realize one of the following effects:
1. according to the invention, the retracting guide tube can be fixed on a specific gesture through the mask guide plate with a specific structure and the guide bracket with a specific structure, so that the accuracy and the reliability of the retracting guide tube insertion are ensured;
2. according to the invention, through the seamless matching between the inner tube and the outer tube and between the guide hole and the guide needle, the shaking of the retracting catheter is prevented, so that the damage to brain tissues in the process of feeding the retracting catheter into the brain can be reduced to the greatest extent, meanwhile, the accuracy of the inserting position of the retracting catheter is further improved, the damage to brain tissues caused by separation in the process of feeding the retracting catheter can be reduced, and the benefit of the patient in the aspect of cutting is protected;
3. the mask guide plate and the guide bracket can be printed by adopting a 3D printing technology, and the mask guide plate and the guide bracket are separately designed, so that the guide bracket does not need to be printed in 3D, and can be prefabricated into disposable consumables, thus, the guide bracket does not need to be printed in each operation, the mask guide plate is printed only by adopting the 3D printing technology, the operation preparation time is greatly shortened, and valuable rescuing time is won for emergency operations such as cerebral hemorrhage and the like; the two are separated, the guide bracket can be reliably sterilized in advance, so that surgical instruments entering brain tissues can be reliably sterilized through the guide bracket, but not instant 3D printing instruments (mask guide plates) can be soaked and sterilized only by common iodophors, and the surgical operation is safer;
4. the device has the advantages of simple structure, low processing cost, simple method steps, simple and convenient operation, and no need of special professional training for medical staff.
In the invention, the technical schemes can be mutually combined to realize more preferable combination schemes. Additional features and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objectives and other advantages of the invention may be realized and attained by the embodiments of the invention particularly pointed out in the written description and drawings.
Drawings
The drawings are only for purposes of illustrating particular embodiments and are not to be construed as limiting the invention, like reference numerals being used to refer to like parts throughout the several views.
FIG. 1 is a schematic view of a guide bracket without reinforcing ribs according to an embodiment of the present invention;
FIG. 2 is a schematic view of a guide bracket with reinforcing ribs according to an embodiment of the present invention;
FIG. 3 is a schematic view of a forehead face guide plate according to an embodiment of the invention;
FIG. 4 is a schematic view of a mask guide around the pinna in accordance with an embodiment of the present invention;
FIG. 5 is a schematic view illustrating mounting of a forehead face mask guide plate and a guide bracket according to an embodiment of the invention;
FIG. 6 is a schematic view of the mounting of the auricle-surrounding mask guide and guide bracket according to an embodiment of the present invention;
fig. 7 is a schematic view of a retracting catheter according to an embodiment of the present invention.
Reference numerals:
1-a guide bracket; 2-frontal face with guide plate; 3-a auricle mask guide plate; 4-an inner tube; 5-an outer tube; 6-a guide hole;
Detailed Description
The following detailed description of preferred embodiments of the invention is made in connection with the accompanying drawings, which form a part hereof, and together with the description of the embodiments of the invention, are used to explain the principles of the invention and are not intended to limit the scope of the invention.
In describing embodiments of the present invention, it should be noted that, unless explicitly stated and limited otherwise, the term "coupled" should be interpreted broadly, for example, as being fixedly coupled, as being detachably coupled, as being integrally coupled, as being mechanically coupled, as being electrically coupled, as being directly coupled, as being indirectly coupled via an intermediate medium. The specific meaning of the above terms in the present invention can be understood by those of ordinary skill in the art according to the specific circumstances.
The terms "top," "bottom," "above … …," "below," and "on … …" are used throughout the description to refer to the relative positions of components of the device, such as the relative positions of the top and bottom substrates inside the device. It will be appreciated that the devices are versatile, irrespective of their orientation in space.
Example 1
The embodiment of the invention provides a guiding device for deep brain minimally invasive surgery, which comprises: a guide bracket 1, a mask guide plate, a guide needle and a retracting catheter; the guide bracket 1 is arranged on the mask guide plate; the guide needle can be inserted into a retracting catheter which is detachably and fixedly connected with the guide bracket 1; the mask guide plate is attached and fixed on the skin of the head of a patient, and the guide needle and the retracting catheter can be inserted into the brain of the patient. In practical use, the embodiment of the invention also uses the guide clamp and the positioning needle adapting pipe, and the guide clamp and the positioning needle adapting pipe can be fixed on the guide bracket 1 and are used for relatively fixing the guide needle and the guide bracket 1.
As shown in fig. 1, a guide stent 1 is a guide stent 1 of a retracting catheter for minimally invasive brain surgery, the guide stent 1 including: the device comprises a mounting head, a guide arm and a guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting head is arranged at the mounting end of the guide arm, and the guide head is provided with the guide end of the guide arm; the guide head is provided with a cylindrical accommodating cavity which is used for accommodating the guide clamp and the positioning needle adapting pipe and fixing the position of the guide needle through the guide clamp and the positioning needle adapting pipe; can also be used for placing surgical instruments such as drainage tubes and the like. The axial extension of the cylindrical receiving chamber forms an infinitely long cylindrical space, and the guide bracket 1 has no common part with the infinitely long cylindrical space. The mounting head of the guide bracket 1 is inserted in the mounting hole of the mask guide plate, the axis of the cylindrical accommodating cavity coincides with the axis of the retracting guide tube, the posture and the direction of the guide needle can be fixed through the guide bracket 1, and the tip of the guide needle can be kept to be always positioned at the focus in the brain of a patient. Because the guide bracket 1 gives way to the infinitely long cylindrical space, the scalp deformed in a certain range around the incision is prevented from being covered by the guide plate, thereby ensuring the accurate approach direction of the retracting catheter.
In order to reduce the manufacturing cost of the embodiment of the invention on the premise of not influencing the structural strength, in the embodiment of the invention, the guide arm is a bent rod or a straight rod, and the cross section of the guide arm is rectangular, so that the structural strength of the guide arm can be ensured, the material consumption can be reduced to the greatest extent, the regular cross section is convenient to produce and process, and the manufacturing cost of the embodiment of the invention can be greatly saved.
In the embodiment of the invention, the cross section of the mounting head is rectangular, the mounting head can be inserted into the mounting hole of the mask guide plate, and the rectangular and interface shapes can form circumferential limit fixation for the mounting of the guide bracket 1 and the mask guide plate.
In order to further and firmly determine the space position of the guide bracket, in the embodiment of the invention, a limiting ring is arranged at the joint of the mounting head of the guide bracket and the guide arm and is used for limiting the depth of the mounting head inserted into the mounting hole of the mask guide plate.
Meanwhile, in order to prevent the limit ring from rubbing or colliding with other objects, the limit ring is a prismatic table, the shape and the size of the top surface of the prismatic table are the same as the cross section of the guide arm, and the shape and the size of the bottom surface of the prismatic table are the same as the cross section of the mounting head. The transition of the terrace with edges can prevent that the spacing ring from snagging or colliding with other articles.
In the embodiment of the invention, the guide head is a cylindrical barrel with an opening on the side wall, and when the drainage tube is placed by the split guide clamp in the guide head in operation, the drainage tube inserted into the brain can be separated from the guide head and the guide clamp through the opening on the side wall of the guide head, so that the operation of placing the drainage tube into a focus in the brain is completed. The side wall opening of the guide head is an axial opening, and the corresponding central angle is 30-120 degrees, preferably 60-90 degrees.
The lateral wall fixed connection of leading arm and direction head can prevent that leading arm from causing the space interference to infinitely long cylinder space. In order to facilitate the processing of the embodiment of the invention, the guide arm is fixedly connected with the guide head along the radial direction of the guide head, and the side wall is opened at the periphery Xiang Duichen of the guide arm along the guide head. In addition, in order to facilitate the installation of the guide bracket 1, the axis of the cylindrical receiving chamber is parallel to the axis of the installation head.
In the embodiment of the invention, as shown in fig. 2, a reinforcing rib is arranged at the joint of the guide arm and the guide head.
In view of practical use, the dimensions of the embodiments of the present invention are as follows:
the length x width of the cross section of the guide arm is 8mm x 6mm, and the length of the guide arm along the axial direction of the cylindrical accommodating cavity is 52.7mm;
the distance between the axis of the cylindrical accommodating cavity and the axis of the mounting head is 54mm;
the length of the guide head is 30mm, and the diameter of the cylindrical accommodating cavity is 16.3mm;
the height of the limiting ring is 7.3mm;
the mounting head length is 10mm.
As shown in fig. 3 and 5, the mask guide plate is a frontal face mask guide plate 2 for brain operation positioning or an auricle-surrounding mask guide plate 3 for brain operation positioning.
The frontal face mask guide plate 2 is designed and obtained by adopting a 3D printing technology. The forehead face mask guide plate 2 is designed based on anatomy by taking a bilateral arch of the skull of a patient with harder texture and difficult displacement and a nasal root of the nose bridge as an anatomical basis, and comprises a forehead plate, a nose bridge plate and a mounting seat; the nose bridge plate is arranged in the center of the lower part of the forehead plate, and the nose bridge plate and the forehead plate form a T-shaped curved plate; the mounting seat is arranged on the forehead plate; forehead plate, nose bridge plate and mount pad are an integral structure. The outer edges of the forehead plate are respectively arranged at the outer edges of the eyebrow bows, and can wrap the eyebrow bows and the eyebrows, and partial eyelids can be wrapped as appropriate; the two side boundaries of the bridge plate extend from the two inner grins down to the two side root parts of the wing.
The height of the forehead plate is 2-3cm. The forehead face mask guide plate 2 is printed, and the forehead face mask guide plate 2 for positioning of brain operation can be attached and fixed at the corresponding position of the forehead face of a patient through the attachment of the forehead plate and the eyebrow bow and the attachment of the nose bridge plate and the nose bridge.
The mount pad is equipped with the mounting hole, and the installation head can insert in the mounting hole, and the shape and the size of the cross section of mounting hole are the same with the cross section of installation head, and the degree of depth of mounting hole is greater than the length of installation head.
As shown in fig. 4 and 6, the auricle-surrounding mask guide plate 3 for brain operation positioning is designed based on anatomical basis of auricle with spatial form and position determined and auricle basal skin reverse folding with fixed position connected with the skull, and comprises a skull plate, an auricle-surrounding plate and a mounting seat; the auricle-surrounding plate can be attached to the auricle in a rear three-dimensional form, the skull plate is a convex polygon curved plate, the joint of the auricle-surrounding plate and the skull plate can be attached to the auricle of a patient, and the mounting seat is arranged on the outer side of the auricle-surrounding plate; the auricle-surrounding plate and the mounting seat are of an integrated structure.
For example, the operation guidance of cerebellum hemisphere and brain stem, the guide plate needs to extend to the back of the pillow by 8cm behind the external auditory canal and 2cm above the external auditory canal based on the auricle; the common top rear entrance mainly extends upwards, and needs 2cm behind the external auditory canal and 10cm above the external auditory canal.
Too large a auricle-surrounding mask guide 3 can extend the printing time, too small a auricle-surrounding mask guide 3 is unstable or difficult to contain guide bracket feet, and the engagement of the guide bracket mounting head with the guide plate mounting hole is elaborate in 3D printing software.
The auricle-surrounding mask guide plate 3 is designed and obtained by adopting a 3D printing technology. The auricle-surrounding mask guide plate 3 for positioning brain operation can be fixed at the auricle-surrounding part of a patient through the fitting of the auricle-surrounding plate and the auricle.
The mounting seat is provided with a mounting hole, the mounting head of the guide bracket can be inserted into the mounting hole of the mask guide plate, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is larger than the length of the mounting head.
When the embodiment of the invention is actually used, medical staff selects the forehead mask guide plate 2 or the auricle mask guide plate 3 according to actual requirements. The mask guide plate is fixed on the skin of the head of a patient, the guide bracket 1 is arranged in the mounting seat, and the axis of the cylindrical accommodating cavity of the guide bracket 1 is fixed relative to the head of the patient, so that the guide needle can be smoothly inserted into the focus of the patient. When the mask guide plate is designed through 3D printing, CT image information of the brain of a patient needs to be input into computer software, and the design of the insertion direction, target point and posture of the guide needle is carried out in the software. The area range of the mask guide plate and the position and the posture of the mounting seat on the mask guide plate can be determined by determining the insertion direction, the target point and the posture of the guide needle. It should be noted that, the frontal face mask guide plate 2 for positioning brain operation and the auricle-surrounding mask guide plate 3 for positioning brain operation can cover all the requirements of minimally invasive brain deep surgery positioning: the frontal face mask guide plate 2 can meet the positioning requirements of bilateral frontal lobes and deep brain tissue operation, namely, a frontal approach; the auricle-surrounding mask guide plate 3 can meet the design requirements of all cerebral surgery access ways except frontal lobe and deep part thereof on the same side, namely temporal lobe, parietal lobe, occipital lobe, basal ganglion area, thalamus and cerebellum and brain stem on the same side.
As shown in fig. 7, the retracting catheter is a transparent retracting catheter for surgery, comprising: an outer tube 5 and an inner tube 4; the cross sections of the outer tube 5 and the inner tube 4 are oblong or oval, and are of a tubular structure with deep parts, thin parts and thick parts, so that the retracting catheter can be more easily inserted into the brain of a patient, and the damage to the brain tissue of the patient in the insertion process is reduced; the inner tube 4 is provided with guide holes 6 arranged along the axis of the inner tube 4. In using the embodiment of the present invention, as long as the guide needle is fixed, the retracting catheter may be inserted to a predetermined position by inserting the guide needle into the guide hole 6 so that the deep portion of the retracting catheter is inserted at the lesion of the brain of the patient.
In order to reduce the damage of the retracting catheter to the brain tissue of the patient, in the embodiment of the invention, the inner tube 4 and the outer tube 5 and the guide needle and the guide hole 6 are connected in a seamless sleeving manner, so that the axial gap of the retracting catheter is reduced to the greatest extent, and the brain tissue is prevented from being immersed into the gap when the retracting catheter is inserted into the brain tissue of the patient. In order to reduce the damage to the brain tissue of the patient, the diameter of the guide needle is not more than 2mm.
The shallow portion of outer tube 5 is equipped with spacing baffle ring, and inner tube 4 is equipped with spacing baffle ring, and spacing baffle ring form limit structure, and the diameter of spacing baffle ring is greater than or equal to spacing baffle ring, after accomplishing the intubate of retracting the pipe, inner tube 4 needs to take out, and the size of spacing baffle ring is not less than the size of spacing baffle ring and makes things convenient for taking out of inner tube 4.
In the embodiment of the invention, the limit retainer ring is provided with the retainer ring holding part, and the limit retainer ring is provided with the retainer ring holding part, so that medical staff can hold and fix the retracting catheter conveniently.
In order to ensure the relative fixation between the inner tube 4 and the outer tube 5, the retaining ring holding part and the snap ring holding part are arranged along the radial direction of the retracting catheter, the contact surface between the retaining ring holding part and the snap ring holding part is provided with a positioning structure, the positioning structure comprises a positioning hole and a positioning block with the same shape and size, and the inner tube 4 and the outer tube 5 form the circumferential relative fixation through the clamping of the positioning hole and the positioning block. Also for convenience in taking down the inner tube 4, the size of the grip portion of the snap ring is not smaller than that of the grip portion of the retainer ring.
In the embodiment of the invention, the retaining ring holding part and the clamping ring holding part are also provided with the clamping buckle structure, and the clamping buckle structure can relatively fix the inner pipe 4 and the outer pipe 5 along the axial direction.
Since the inner tube 4 is removed and the outer tube 5 is left in the brain of the patient after the retracting catheter is inserted into the lesion in the brain of the patient and is used as a retractor for minimally invasive surgery, the outer tube 5 is a transparent tube in the embodiment of the invention in order to facilitate the observation of the lesion by an endoscope or a microscope.
In order to facilitate understanding of the insertion depth of the retracting catheter, graduation marks are provided on the outer surface of the outer tube 5 of the retracting catheter to understand the insertion depth of the retracting catheter, and to ensure accurate insertion of the tip of the retracting catheter into the lesion of the patient.
Example 2
The embodiment of the invention provides a guiding method for deep brain minimally invasive surgery, which uses the guiding device for deep brain minimally invasive surgery in the embodiment 1.
The guiding method comprises the following steps:
s1, manufacturing a mask guide plate through a 3D printing technology;
the head CT image data of the patient is input into the 3D printing software. According to the details of the case, determining and designing an operation access, namely the insertion direction, target point and posture of the guide needle; and designing a head mask guide plate in 3D printing software according to the set operation access, namely determining the positions of the mask guide plate 2 or the auricle-surrounding mask guide plate 3 and the mounting seat, and performing 3D printing to obtain the mask guide plate.
S2, installing the guide bracket (1) on the mask guide plate;
the guide clamp and the positioning needle adapting pipe are inserted into the guide head of the guide bracket, the guide bracket is installed on the mask guide plate, and the guide bracket 1 is manufactured in batches in advance in a prefabricated mode or can be manufactured in advance by adopting a 3D printing technology.
S3, attaching and fixing the mask guide plate on the corresponding part of the skin of the head of the patient;
the forehead face tool guide plate 2 for positioning brain operation can be fixed on the forehead face of a patient through the fit of the forehead plate and the eyebrow bow and the fit of the nose beam plate and the nose bridge; or, the auricle-surrounding mask guide plate 3 for brain operation positioning can be fixed at the auricle-surrounding part of the patient through the fitting of the auricle-surrounding plate and the auricle. In actual operation, because the time of using is very short, can adopt the mode of manual laminating fixed to temporarily laminate the mask baffle fixed at patient's skull corresponding position.
S4, inserting the guide needle into the brain of the patient through the guide bracket 1 until the tip of the guide needle is inserted into the focus of the patient;
it should be noted that, since the guide needle is to be inserted into the brain of the patient, the minimally invasive craniotomy needs to be performed on the patient before the guiding method according to the embodiment of the invention is performed, including: cutting and retracting the scalp, milling bone flap of small area, cutting hard film, treating cerebral cortex, etc.
The guide needle is a long metal straight needle with the diameter of 2mm and the two ends of which are rounded.
S5, keeping the space position of the guide needle still, and removing the guide bracket 1 and the mask guide plate;
s6, inserting the retracting catheter into the brain of the patient through the guide needle until the tip of the retracting catheter is inserted into the focus of the patient;
the guiding needle is inserted into the guiding hole 6 of the inner tube 4, the position of the guiding needle is kept still, and the retracting catheter is inserted into the brain of the patient.
S7, keeping the outer tube 5 motionless, taking the guide needle and the inner tube 4 of the retracting catheter out of the outer tube 5 step by step, and realizing the instrument entering and operating part of deep brain minimally invasive surgery through the inner space of the outer tube (5) of the dynamically fixed retracting catheter;
the buckling structure between the inner tube 4 and the outer tube 5 is released, the guide needle and the inner tube 4 of the retracting catheter are removed step by step, and medical staff can apply an endoscope or other instruments to perform minimally invasive surgery in the outer tube 5 of the retracting catheter.
In summary, the embodiment of the invention provides a guiding device and a guiding method for deep brain minimally invasive surgery, and the guiding device and the guiding method can fix a retracting catheter on a specific posture through a mask guide plate with a specific structure and a guiding bracket with a specific structure, so that the accuracy and the reliability of the retracting catheter insertion are ensured; according to the invention, through the seamless matching between the inner tube and the outer tube and between the guide hole and the guide needle, the shaking of the retracting catheter is prevented, so that the damage to brain tissues in the process of feeding the retracting catheter into the brain can be reduced, meanwhile, the accuracy of the inserting position of the retracting catheter is further improved, the damage to the expansion of the brain tissues in the process of feeding the retracting catheter can be reduced, and the benefit of the patient in a cutting way is protected; the mask guide plate is printed by adopting a 3D printing technology, and the mask guide plate and the guide bracket are separately designed, so that the guide bracket can be prefabricated into disposable consumable materials, the guide bracket is not required to be printed in each operation, the mask guide plate is printed only by adopting the 3D printing technology, the operation preparation time (within 30 minutes) is greatly shortened, and valuable rescuing time is obtained for emergency operations such as cerebral hemorrhage and the like; the two are separated, and the prefabricated guide bracket can be reliably sterilized in advance, so that surgical instruments entering brain tissues are subjected to reliable sterilization through the guide bracket, and are not instant 3D printing instruments (mask guide plates) which can only be soaked and sterilized by common iodophors, so that the surgical operation is safer; the device has the advantages of simple structure, low processing cost, simple method steps, simple and convenient operation, and no need of special professional training for medical staff.
The present invention is not limited to the above-mentioned embodiments, and any changes or substitutions that can be easily understood by those skilled in the art within the technical scope of the present invention are intended to be included in the scope of the present invention.
Claims (4)
1. A guiding device for deep brain minimally invasive surgery, the guiding device comprising: the mask guide plate, the guide bracket (1), the guide needle and the retracting catheter; the mask guide plate can be adhered and fixed on the skin of the head of a patient, the guide bracket (1) is arranged on the mask guide plate, and the mask guide plate is detachably and fixedly connected with the guide bracket (1); the guide needle can enter the brain according to the guiding direction of the guide bracket; the retracting catheter can enter a preset position in the brain along the guide needle;
the auricle-winding mask guide plate (3) comprises a skull plate, an auricle-winding plate and a mounting seat; the auricle-surrounding plate can be attached to the auricle in a rear three-dimensional form, the skull plate is a convex polygon curved plate, the joint of the auricle-surrounding plate and the skull plate can be attached to the auricle of a patient, and the mounting seat is arranged on the outer side of the auricle-surrounding plate; the auricle-surrounding plate and the mounting seat are of an integrated structure;
when the operation of the cerebellum and the brainstem is guided, the auricle-surrounding mask guide plate (3) extends to the back direction of the pillow by taking the auricle as a base to reach 8cm behind the external auditory meatus and 2cm above the external auditory meatus;
when a common top rear approach is carried out, the auricle-surrounding mask guide plate (3) extends upwards to the rear 2cm of the external auditory canal on the basis of auricles, and is 10cm above the external auditory canal;
the guide bracket (1) comprises: the device comprises a mounting head, a guide arm and a guide head; the guide arm is of a rigid structure and comprises a mounting end and a guide end, the mounting head is arranged at the mounting end of the guide arm, and the guide head is provided with the guide end of the guide arm; the guide head is provided with a cylindrical accommodating cavity, an infinitely long cylindrical space is formed by axially extending the cylindrical accommodating cavity, and the guide bracket (1) and the infinitely long cylindrical space have no public part;
the guide arm is a bent rod, the guide arm is fixedly connected with the side wall of the guide head, the guide head is a cylindrical barrel with an opening on the side wall, the cylindrical accommodating cavity is positioned in the cylindrical barrel, the opening on the side wall of the guide head is an axial opening, the corresponding central angle is 30-120 degrees, and the opening on the side wall is symmetrical with the guide arm along the axial direction of the guide head;
the cylindrical accommodating cavity is used for accommodating the guide clamp and the positioning needle adapting pipe and fixing the position of the guide needle through the guide clamp and the positioning needle adapting pipe;
the retracting catheter includes: an outer tube (5) and an inner tube (4); the cross sections of the outer tube (5) and the inner tube (4) are elliptical or oblong, and are of deep thin and shallow thick tubular structures; the inner tube (4) is provided with a guide hole (6) arranged along the axis of the inner tube (4), and the inner tube (4) is connected with the outer tube (5) and the guide needle is connected with the guide hole (6) in a seamless sleeving manner.
2. The guide device according to claim 1, wherein the mask guide plate is provided with a mounting seat; the mounting seat is provided with a mounting hole, the mounting head of the guide bracket can be inserted into the mounting hole of the mask guide plate, the shape and the size of the cross section of the mounting hole are the same as those of the cross section of the mounting head, and the depth of the mounting hole is larger than the length of the mounting head.
3. The guiding device according to claim 2, characterized in that the shallow part of the outer tube (5) is provided with a limit stop ring, the inner tube (4) is provided with a limit stop ring, and the limit stop ring form a limit structure; the limiting retainer ring is provided with a retainer ring holding part, and the limiting retainer ring is provided with a retainer ring holding part.
4. The guiding device according to claim 3, wherein the retaining ring holding part and the clamping ring holding part are arranged along the radial direction of the retracting catheter, and a positioning structure is arranged on the contact surface between the retaining ring holding part and the clamping ring holding part, and comprises a positioning hole and a positioning block with the same shape and size;
the retaining ring holding part and the clamping ring holding part are also provided with a clamping buckle structure.
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| CN202010129339.7A CN111329537B (en) | 2020-02-28 | 2020-02-28 | Guiding device and guiding method for deep brain minimally invasive surgery |
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| CN202010129339.7A CN111329537B (en) | 2020-02-28 | 2020-02-28 | Guiding device and guiding method for deep brain minimally invasive surgery |
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| CN111329537A (en) | 2020-06-26 |
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