CN103462668A - Left auricle ligation device - Google Patents
Left auricle ligation device Download PDFInfo
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- CN103462668A CN103462668A CN2013104171885A CN201310417188A CN103462668A CN 103462668 A CN103462668 A CN 103462668A CN 2013104171885 A CN2013104171885 A CN 2013104171885A CN 201310417188 A CN201310417188 A CN 201310417188A CN 103462668 A CN103462668 A CN 103462668A
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Abstract
The invention provides a left auricle ligation device which comprises an outer sheath tube, an inner sheath tube, a push rod, a lock sleeve and a ligature. The ligature is in the shape of a 'jade pendant', a line knot is tied every section, the ligature penetrates the lock sleeve, and a circular ring is formed at one end of the lock sleeve. The left auricle ligation device is used for firmly and reliably ligating a left auricle without opening a chest, and blood flow is completely blocked.
Description
Technical field
The invention belongs to medical instruments field, relate in particular to a kind of left auricle apparatus for ligating.
Background technology
It is one of Etiological caused apoplexy that the thrombosis that atrial fibrillation (atrial fibrillation) causes comes off.The incidence rate of non-valve characteristic of disease patients with atrial fibrillation cerebral embolism is 5 times of normal person, and in valve characteristic of disease chronic atrial fibrillation patient, the cerebral embolism sickness rate is 17 times of normal person.The treatment of oral anticoagulation thing is the important component part of atrial fibrillation therapy.Guideline recommendation, should the Long-term Oral Anticoagulation of Warfarin for the patient of non-isolatism atrial fibrillation.But, because warfarin need to be monitored INR (INR), the treatment window is narrow, patient compliance is poor, and its clinical practice is restricted.Left auricle is the predilection site of heart source property thrombosis, and 60% rheumatic heart disease patients with atrial fibrillation heart source property thrombosis is from left auricle, but not surpasses 90% in the valvular patients with atrial fibrillation.Deducibility thus, carry out shutoff to left auricle and will greatly reduce the patients with atrial fibrillation risk of stroke.May the warfarin taboo be arranged or be reluctant that the patient of Long-term Oral Anticoagulation of Warfarin provides new selection for those by surgical operation or the inaccessible left auricle of interventional method.
1, warfarin method
Registration that Stafford etc. carry out shows, although the curative effect that Anticoagulation of Warfarin prevention atrial fibrillation apoplexy occurs certainly, the clinical practice rate of warfarin is low, only has 1/3 to have the patients with atrial fibrillation of anticoagulant indication to accept the warfarin of effective dose.The analysis reason is as follows: it is narrow that (1) treats window safely and effectively, and the hemorrhage complication incidence rate is about 1.0%-1.3%, the age > patient of 75 years old reaches 1.8%; SPORTIF research H1 only shows that 60% the oral warfarin dosage of patient is in treatment window scope; (2) have multiple medication contraindication: as merge serious hepatic and renal function injure, anemia (Hb<1009/L), refractory hypertension, blood pressure 180/100mm Hg(1 mm Hg=0.133 3 kPa), once cerebral hemorrhage or cranial injury etc. were arranged.(3) patient compliance is poor: 38% patient is arranged because needing long term monitoring INR drug withdrawal voluntarily; Another some patient need be forced to interrupt warfarin treatment because of reasons such as wound, operations, and drug withdrawal intermittently the generation of apoplexy up to 50%.
2, surgery Closure
Cardiac operation is excised simultaneously or to seal left auricle simple, excision or sealing left auricle when therefore many doctors advocate to need the operation on heart treatment for this type of patient.Odell in 1966 etc. have reported the technology through thoracoscope sealing left auricle prevention atrial fibrillation thromboembolism, because this technology greatly reduces wound and the risk of operation, make through thoracoscope sealing left auricle and obtain extensive concern.If can further improve the effect of left auricle sealing in this technology, through thoracoscope sealing left auricle prevention atrial fibrillation thromboembolism, good development prospect is arranged.But, for the current state of the art, only excision or the operating wound face of sealing left auricle are too large, and the danger of complication is arranged, and therefore should not implement surgical operation.
3, transcatheter occlusion
The interventional method wound is little, is one of the focus of popular feeling disease of ZANG-organs research that is situated between in recent years, and the left atrial appendage occlusion device of reporting at present has three kinds: PLAATOTM(Ev3 company), WATCHMAN(Atritech company) and Amplazer interatrial septum stopper.The PLAATOTM apparatus system is comprised of release catheter and stopper two parts.Stopper be take the self-expanding Nitinol as skeleton (diameter 15-32mm), the distensible polytetrafluoroethylene of surface coverage (ePTFE) film.Several anchors are arranged on the stopper skeleton, contribute at the fixing stopper of left auricle opening part, whole intervene operation process is carried out under TEE instructs.The stopper of WATCHMAN device is that polyethylene filter membrane and the nickel-titanium alloy framework thick by 160um forms, and at the equatorial plane of stopper, has a plurality of anchors to be beneficial to fix.The implantation interatrial septum approach that also wears long carries out.The Amplatzer device belongs to the atrial septal defect umbrella, and this method operation is easier, without ultrasonic guidance and general anesthesia.Although adopt the percutaneous transcatheter closure wound little, to perform the operation relatively simple, also there is multiple shortcoming in percutaneous transcatheter closure, such as current plugging device immature, be prone to the complication such as apparatus thromboembolism, cardiac tamponade, and the residual shunt phenomenon likely occurs, thereby affect therapeutic effect.
Summary of the invention
The invention provides a kind of left auricle apparatus for ligating, it adopts ligature type to avoid the shortcoming of percutaneous transcatheter closure, and adopts Wicresoft's mode, without opening breast.Technical scheme of the present invention is as follows:
A kind of left auricle apparatus for ligating, be comprised of epitheca pipe 5, interior sheath pipe 6, push rod 9, lock tube 2 and ligature 1, and the near-end 7 of epitheca pipe 5 is equipped with the external screw thread female Luer, and far-end 4 forms and closely cooperates with interior sheath pipe 6; The near-end 8 of interior sheath pipe 6 connects the female thread female Luer, and interior sheath pipe 6 is loaded on epitheca pipe 5 inside, and blank area forms spiral and connects, and interior sheath pipe 6 is slightly longer than epitheca pipe 5, and the far-end 3 of interior sheath pipe 6 exposes to the epitheca pipe; Push rod 9 is through interior sheath pipe 6, its far-end is welded with screw 23, near-end has operating handle 10, it is characterized in that, lock tube 2 is a cylinder, a cylindrical end diameter slightly large with other parts formation step 13, there is inner bolt hole 14 a slightly large end center, there are two through holes 12,16 on the both sides that parallel with inner bolt hole 14, the tangent position of one of them through hole has a wire casing 15, the diameter that the width of wire casing 15 is a bit larger tham ligature 1 still is less than the diameter of toe-in 19, and the length of wire casing 15 surpasses the position of step 13; Ligature 1 is made into " beautiful pendant rope " shape, make a call to a toe-in 19 every one section, the diameter of toe-in 19 is slightly smaller than the diameter of through hole 12,16, distance between toe-in and toe-in is two times of toe-in diameters, the diameter of first toe-in 20 is greater than the diameter of through hole 12, the never slotted through hole 12 of the end of a thread passes, after the other end forms annulus 21, then through slotted through hole 16.
Preferably, lock tube 2 is a metal cylinder, and the opening part of two through holes of lock tube 2 has chamfering 11,17, and wire casing 15 has chamfering 18 with the through hole intersection.
Preferably, the epitheca pipe adopts polytetrafluoroethylene PTFE to make, and interior sheath pipe adopts high density polyethylene to make, and the female Luer material is ABS; Push rod is wound around the seal wire that becomes spring-like by stainless steel material SUS304; Lock tube adopts medical stainless steel 316L to make; Ligature adopts surgical sutures commonly used.
Preferably, the far-end 4 of epitheca pipe 5 has tapering to close up, and its tapering closes up and forms and closely cooperate with interior sheath pipe 6; The far-end 3 of interior sheath pipe 6 is tip configurations, and this tip configurations exposes to epitheca pipe 5.
Beneficial effect:
Adopt left auricle apparatus for ligating of the present invention, can obtain following beneficial effect:
1. wound is little: owing to adopting through the thoracoscope ligation, without opening breast, preventing from scar.
2. risk is little: the percutaneous transcatheter occlusion is prone to the complication such as apparatus thromboembolism, cardiac tamponade, and ligation of the present invention is reliable for effect, there is no other complication.
3. fixed: according to the left auricle anatomical structure, left auricle and left atrium junction form cervical region, and the employing ligature type can be solid and reliable.
4. effect is remarkable: adopt ligature type, blood flow is blocked fully, do not have residual shunt phenomenon in percutaneous transcatheter closure.
The accompanying drawing explanation
Fig. 1 is left auricle apparatus for ligating schematic diagram of the present invention;
The perspective view at the visual angle that Fig. 2 is lock tube;
Fig. 3 is the perspective view that becomes another visual angle of 90 degree with visual angle Fig. 2 lock tube;
The bottom view that Fig. 4 is lock tube;
Fig. 5 is the ligature schematic diagram;
The installation diagram that Fig. 6 is ligature and lock tube;
The schematic diagram that Fig. 7 is push rod;
Fig. 8 is that apparatus for ligating tightens up view;
The state diagram that Fig. 9 is ligaturing left atrial appendage.
In the drawings: 1 ligature; 2 lock tubes; 3 interior sheath pipe far-ends; 4 epitheca pipe far-ends; 5 epitheca pipes; 6 interior sheath pipes; 7 epitheca pipe near-ends; 8 interior sheath pipe near-ends; 9 push rod; 10 operating handles; 11 chamferings; 12 through holes; 13 steps; 14 inner bolt holes; 15 wire casings; 16 through holes; 17 chamferings; 18 chamferings; 19 toe-ins; 20 first toe-ins; 21 annulus; 22 ligation the end of a thread; 23 screws.
The specific embodiment
Further describe the present invention below in conjunction with accompanying drawing.Should be appreciated that, accompanying drawing and description are only the mode description of a preferred embodiment thereof with example, and should not be construed as, protection scope of the present invention are construed as limiting, and protection scope of the present invention is limited by claims only.
1. structure explanation
Referring to Fig. 1, left auricle apparatus for ligating of the present invention is comprised of epitheca pipe 5, interior sheath pipe 6, push rod 9, lock tube 2 and ligature 1.The near-end 7 of epitheca pipe is equipped with the external screw thread female Luer, and far-end 4 conduits have tapering to close up, and its tapering closes up and forms and closely cooperate with interior sheath pipe; Interior sheath pipe near-end 8 connects the female thread female Luer, and far-end 3 is tip configurations, and interior sheath pipe 6 is loaded on epitheca pipe 5 inside, and blank area forms spiral and connects, and interior sheath pipe 6 is slightly longer than epitheca pipe 5, and the tip configurations of interior sheath pipe 6 exposes to epitheca pipe 5; Push rod 9 is through interior sheath pipe, and its far-end is welded with precision screw 23, and near-end has operating handle 10, as seen in Figure 7; Lock tube 2 is a metal cylinder, a cylindrical end diameter slightly large with other parts formation step 13, there is inner bolt hole 14 a slightly large end center, there are two through holes 12,16 on the both sides parallel with inner bolt hole 14, the opening part of two through holes has chamfering 11,17, and the tangent position of one of them through hole has a wire casing 15, and wire casing 15 has chamfering 18 with through hole 16 intersections, the wire casing width is a bit larger tham the diameter of ligature, and wire casing length surpasses the step position; Ligature 1 is surgical sutures commonly used, be made into " beautiful pendant rope " shape, make a call to a toe-in 19 every one section, the toe-in diameter is slightly smaller than through-hole diameter and is greater than the wire casing diameter, distance between knot and knot is two times of toe-in diameters, and first toe-in 20 is greater than through-hole diameter, and the never slotted through hole 12 of the end of a thread passes, after the other end forms annulus 21, then through slotted through hole 16.During use, interior sheath pipe 6 is loaded in epitheca pipe 5, female Luer screws, and push rod 9 is through interior sheath pipe 6, and the precision screw 23 of push rod 9 far-ends is connected with inner bolt hole 14 spirals of lock tube, and ligation the end of a thread 22 exposes outside in the female Luer of near-end through interior sheath pipe 6.
2. material explanation
The epitheca pipe adopts polytetrafluoroethylene (PTFE) to make, and interior sheath pipe adopts high density polyethylene (HDPE) (HDPE) to make, and the female Luer material is ABS; Push rod is wound in the seal wire of spring-like by stainless steel material SUS304; Lock tube adopts medical stainless steel 316L to make through micro machining; Ligature adopts surgery polyester stitching thread commonly used.
3. description of the process
The far-end of epitheca pipe is through thermoplastic tapering closing in shape, and the near-end thermoplastic becomes horn-like and is connected with the female Luer mechanical type; Interior sheath pipe far-end becomes tip configurations through thermoplastic, and near-end is connected with female Luer is gluing; Push rod is the spring-like seal wire, and far-end is welded with precision screw, and near-end is equipped with handle; Lock tube is processed into through precision optical machinery with stainless steel bars; The ligature acquisition of can tiing a knot by hand.
4. operation principle
The present invention adopts the threading mode of special construction with " the beautiful pendant rope " ligature of lock tube, under the guiding of thoracoscope, the garden that ligature is formed is located on left auricle, adjust by push rod the cervical region that ligature makes it be connected with left atrium in left auricle, tractive exposes an end of ligature, larger toe-in is because diameter is greater than the through hole internal diameter, be stuck in the through hole outside, other toe-in diameter is less than the through hole internal diameter, along with tightening up ligature, and the through hole front end has chamfering, be easy to enter in through hole, toe-in is by through hole and after exposing, because the wire casing incision has chamfering, ligature just enters in wire casing, because the wire casing width is less than the toe-in diameter, and the wire casing end has step, toe-in is stuck in groove can not delay pine, thereby tighten and pricked object, push rod can be assisted and be arrested left auricle, and play in tightening up the process of ligature and adjust position, the effect of force balance, after tightening up ligature, the reverse rotation push rod exits external, exit again interior epitheca pipe, cut unnecessary ligature.
5. the using method of this device
The 1st step, at first be loaded on interior sheath pipe in the epitheca pipe, and female Luer screws;
The 2nd step, be made into surgical sutures " beautiful pendant rope " ligature, and ligature is installed on lock tube;
The 3rd step, by ligature, through interior sheath pipe, the end of a thread exposes to the female Luer outside, drawing expose the end of a thread by push rod through interior sheath pipe, push rod far-end precision screw is connected with lock tube inner bolt hole spiral, the degree of tightness appropriateness, spinning in and out are several times;
The 4th step, lung cancer imports the sheath pipe, under the thoracoscope guiding, the annulus of ligature is placed on left auricle, and the position of adjusting ligature makes it in root;
The 5th step, the balance push rod, reel ligature, toe-in enters through hole one by one, until after tightening up, toe-in is stuck in wire casing and has step to block, and can't delay pine, thereby ligation left auricle;
The 6th step, be rotated counterclockwise push rod, and lock tube separates with push rod, exits push rod and interior epitheca pipe, cuts off unnecessary ligature, completes the operating process of whole device.
The above is described in detail embodiments of the present invention by reference to the accompanying drawings, but the invention is not restricted to above-mentioned embodiment, in the ken possessed at affiliated technical field those of ordinary skill, can also under the prerequisite that does not break away from aim of the present invention, make a variety of changes.
Claims (4)
1. a left auricle apparatus for ligating, by epitheca pipe (5), interior sheath pipe (6), push rod (9), lock tube (2) and ligature (1), formed, the near-end (7) of epitheca pipe (5) is equipped with the external screw thread female Luer, and far-end (4) forms and closely cooperates with interior sheath pipe (6), the near-end (8) of interior sheath pipe (6) connects the female thread female Luer, and interior sheath pipe (6) is loaded on epitheca pipe (5) inside, and blank area forms spiral and connects, and interior sheath pipe (6) is slightly longer than epitheca pipe (5), and the far-end (3) of interior sheath pipe (6) exposes to the epitheca pipe, push rod (9) is through interior sheath pipe (6), its far-end is welded with screw (23), near-end has operating handle (10), it is characterized in that, lock tube (2) is a cylinder, a cylindrical end diameter slightly large with other parts formation step (13), there is inner bolt hole (14) a slightly large end center, there are two through holes (12 on the both sides that parallel with inner bolt hole (14), 16), the tangent position of one of them through hole has a wire casing (15), the diameter that the width of wire casing (15) is a bit larger tham ligature (1) still is less than the diameter of toe-in (19), the length of wire casing (15) surpasses the position of step (13), ligature (1) is made into " beautiful pendant rope " shape, make a call to a toe-in (19) every one section, the diameter of toe-in (19) is slightly smaller than the diameter of through hole (12,16), distance between toe-in and toe-in is two times of toe-in diameters, the diameter of first toe-in (20) is greater than the diameter of through hole (12), the never slotted through hole of the end of a thread (12) passes, after the other end forms annulus (21), then through slotted through hole (16).
2. left auricle apparatus for ligating as claimed in claim 1, is characterized in that, lock tube (2) is a metal cylinder, and the opening part of two through holes of lock tube (2) has chamfering (11,17), and wire casing (15) has chamfering (18) with the through hole intersection.
3. left auricle apparatus for ligating as claimed in claim 1 or 2, is characterized in that, the epitheca pipe adopts polytetrafluoroethylene (PTFE) to make, and interior sheath pipe adopts high density polyethylene (HDPE) (HDPE) to make, and the female Luer material is ABS; Push rod is wound around the seal wire that becomes spring-like by stainless steel material SUS304; Lock tube adopts medical stainless steel 316L to make; Ligature adopts surgical sutures commonly used.
4. left auricle apparatus for ligating as claimed in claim 1, is characterized in that the far-end (4) of epitheca pipe (5) has tapering to close up, and its tapering closes up and forms and closely cooperate with interior sheath pipe (6); The far-end (3) of interior sheath pipe (6) is tip configurations, and this tip configurations exposes to epitheca pipe (5).
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CN201310417188.5A CN103462668B (en) | 2013-09-13 | 2013-09-13 | A kind of left auricle ligation device |
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CN201310417188.5A CN103462668B (en) | 2013-09-13 | 2013-09-13 | A kind of left auricle ligation device |
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Cited By (8)
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CN103932792A (en) * | 2014-03-28 | 2014-07-23 | 郝博 | Lasso for holding and positioning rectal |
CN104939887A (en) * | 2014-03-28 | 2015-09-30 | 上海微创电生理医疗科技有限公司 | Pericardium endoscope, lasso device and heart left aurcle closing system |
CN106028957A (en) * | 2014-02-28 | 2016-10-12 | 奥林巴斯株式会社 | Surgical tool for atrial appendage ligation and atrial appendage ligation system |
CN106132314A (en) * | 2014-03-31 | 2016-11-16 | 奥林巴斯株式会社 | Auricle ligation treatment instrument |
CN106137292A (en) * | 2015-04-10 | 2016-11-23 | 上海市同济医院 | A kind of device for left auricle ligation operation and using method thereof |
CN106491134A (en) * | 2016-10-18 | 2017-03-15 | 宁波市第医院 | Left auricle of heart measuring method in left atrial appendage occlusion art |
CN111631775A (en) * | 2020-06-10 | 2020-09-08 | 昆山市锦溪人民医院(昆山市老年医院) | Left auricle ligation closing device |
WO2021014745A1 (en) * | 2019-07-22 | 2021-01-28 | フォースエンジニアリング株式会社 | Ligator |
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WO2008147678A1 (en) * | 2007-05-21 | 2008-12-04 | Epitek, Inc. | Left atrial appendage closure |
US20120136389A1 (en) * | 2003-05-07 | 2012-05-31 | Anpa Medical, Inc. | Suture lock |
CN103118605A (en) * | 2010-06-26 | 2013-05-22 | 瓦索斯蒂奇股份有限公司 | Method and apparatus for transapical access and closure |
CN203539402U (en) * | 2013-09-13 | 2014-04-16 | 徐州亚太科技有限公司 | Left atrial appendage ligation device |
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US20120136389A1 (en) * | 2003-05-07 | 2012-05-31 | Anpa Medical, Inc. | Suture lock |
CN101057789A (en) * | 2006-04-21 | 2007-10-24 | 深圳市先健科技股份有限公司 | Device for ligaturing left atrial appendage and using method thereof |
WO2008147678A1 (en) * | 2007-05-21 | 2008-12-04 | Epitek, Inc. | Left atrial appendage closure |
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CN203539402U (en) * | 2013-09-13 | 2014-04-16 | 徐州亚太科技有限公司 | Left atrial appendage ligation device |
Cited By (12)
Publication number | Priority date | Publication date | Assignee | Title |
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CN106028957A (en) * | 2014-02-28 | 2016-10-12 | 奥林巴斯株式会社 | Surgical tool for atrial appendage ligation and atrial appendage ligation system |
CN103932792A (en) * | 2014-03-28 | 2014-07-23 | 郝博 | Lasso for holding and positioning rectal |
CN104939887A (en) * | 2014-03-28 | 2015-09-30 | 上海微创电生理医疗科技有限公司 | Pericardium endoscope, lasso device and heart left aurcle closing system |
CN106132314A (en) * | 2014-03-31 | 2016-11-16 | 奥林巴斯株式会社 | Auricle ligation treatment instrument |
CN106137292A (en) * | 2015-04-10 | 2016-11-23 | 上海市同济医院 | A kind of device for left auricle ligation operation and using method thereof |
CN106137292B (en) * | 2015-04-10 | 2019-02-22 | 上海市同济医院 | A kind of device for left auricle of heart ligation operation |
CN106491134A (en) * | 2016-10-18 | 2017-03-15 | 宁波市第医院 | Left auricle of heart measuring method in left atrial appendage occlusion art |
WO2021014745A1 (en) * | 2019-07-22 | 2021-01-28 | フォースエンジニアリング株式会社 | Ligator |
JP2021016616A (en) * | 2019-07-22 | 2021-02-15 | フォースエンジニアリング株式会社 | Ligator |
CN112584782A (en) * | 2019-07-22 | 2021-03-30 | 福力工程株式会社 | Ligation device |
US11389166B2 (en) | 2019-07-22 | 2022-07-19 | Force Engineering Co., Ltd. | Ligation device |
CN111631775A (en) * | 2020-06-10 | 2020-09-08 | 昆山市锦溪人民医院(昆山市老年医院) | Left auricle ligation closing device |
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