CN106137292A - A kind of device for left auricle ligation operation and using method thereof - Google Patents
A kind of device for left auricle ligation operation and using method thereof Download PDFInfo
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- CN106137292A CN106137292A CN201510170230.7A CN201510170230A CN106137292A CN 106137292 A CN106137292 A CN 106137292A CN 201510170230 A CN201510170230 A CN 201510170230A CN 106137292 A CN106137292 A CN 106137292A
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- left auricle
- ligation operation
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Abstract
The invention discloses a kind of device for left auricle ligation operation, comprising: for the outer sheath arriving left auricle through vein blood vessel；For atrial septal puncture and the interior sheath pipe being positioned left auricle seal wire；For importing the seal wire of Minimally Invasive Surgery apparatus；For holding in the mouth the screw that left auricle is most advanced and sophisticated；For being tied a knot and stitching devices in the tip of left auricle；The shearing device cut off is carried out at the knotting most advanced and sophisticated at left auricle；Wherein, the bore of described outer sheath is more than the bore of interior sheath pipe.The invention have the benefit that left auricle is easily caused the Partial Resection that thrombosis produces, thoroughly eradicated the pathogenetic hidden danger of apoplexy；Interior sheath pipe is put into a seal wire to reduce the danger that left auricle tip is poked by outer sheath pipe by mistake；Full operation all operates without open chest surgery through vein blood vessel, reduces and performs the operation invasive and shorten post-operative recovery time；The latter problem that current occluder for left auricle is relevant is avoided owing to having excised left auricle.
Description
Technical field
The present invention relates to a kind of device for left auricle ligation operation and using method thereof, belong to medical apparatus and instruments
Technical field.
Background technology
Auricle is the ear folliculus stretched out from atrium, is the part in atrium.On the left atrium top of heart,
Being positioned at aorta and Pulmonic dorsal part, the angular forward right side of one highlights, for left auricle.The rear wall of left atrium
Having four vein openings, there is left atrioventricular orifice lower section.Current not known auricle has any physiological function；But due to
Left auricle inner face has a pectinate muscles and surface relief is uneven, easily makes blood flow produce vortex and flows decrease, at some
(such as rheumatic heart disease, atrial fibrillation) under pathologic condition, in left auricle, it is easily formed thrombosis；When such as there is atrial fibrillation,
Whole atrium completely loses normal contractile function, and it is stagnant that the blood flow in left auricle tends to the stasis of blood, is easily formed thrombosis.
Corresponding organ (such as heart, lungs, liver spleen, kidney, brain etc.) thromboembolism etc. can be caused after thrombus breaks loose tight
Weight consequence.Therefore, currently for this disease of atrial fibrillation-thrombo-embolic, can be come by anticoagulant or Minimally Invasive Surgery
Treatment；In recent years, utilize the method for Minimally Interventional Therapy method closure left auricle have also been obtained and develop on a large scale very much,
This treatment technology is a kind of well selection for there is severe haemorrhage patient and anticoagulant taboo patient.Often
Left atrial appendage occlusion art have two kinds, one be utilize percutaneous left auricle mutual conductance pipe plug close device block the left heart
Ear, common such as Appriva Medical company；Another kind is to utilize Amplazer interatrial septum plugging umbrella to block up
Close left auricle.Common practices is all to place stopper in left auricle by intubation intervention method, prevent due to
Atrial fibrillation and cause left auricle formed thrombosis, this thrombosis goes upward to the apoplexy that brain causes；Or prevent this thrombosis to pass through
Blood circulation of human body system arrives other positions of health, the systemic thromboembolism caused.Put stopper to the left heart
In ear, block left auricle, block the blood flow entering left auricle, can eliminate and cause left auricle due to atrial fibrillation
Thrombosed risk, prevention of stroke.Such apparatus is the most all to be connected by screw thread and carrier at present,
Apparatus itself divides substantially two big classes from structure, stopper formula occluder for left auricle as depicted in figs. 1 and 2,
Plug disc type occluder for left auricle such as Fig. 3.In figs. 1-5,1 is left atrium (LA), and 2 is left auricle (LAA),
3 is left auricle cavity wall, and 4 is stopper formula occluder for left auricle choked flow film, and 5 is stopper formula occluder for left auricle basis
Body, 6 is the pit shape gap formed between stopper formula occluder for left auricle and left auricle, and 7 is left for plug disc type
Atrial appendage occlusion device body, 8 is the choked flow film of plug disc type occluder for left auricle.Stopper formula occluder for left auricle is
Product being made the spherical cylindric or cone shape stopper of a band choked flow film, stopper has certain bullet
Property, can deform in left auricle, in the hope of adapting to the shape of left auricle cavity, reach to clog the mesh of left auricle
, and the choked flow film on stopper can be with blocking blood flow.Plug disc type occluder for left auricle is cylindrical plug and dish
The complex of disk like part, is sewed with fluid-blocking membrane on dish simultaneously；The left heart that cylindrical plug part is placed
In ear cavity, with fixing whole apparatus；Plate-shape is partially covered on the oral area of left auricle, is used for blocking blood
Flow into left auricle.By intubation intervention method place these apparatuses to the heart of human body, artery and vein vascular,
Time in left auricle, owing to the anatomical structure of heart, the artery and vein vascular of human body, especially left auricle is complicated,
Requiring that apparatus accurately arrives predetermined position, the anatomical structure of predetermined position to be well adapted to, mechanics are wanted
Ask and hemodynamics requirement, it is necessary to the structure of apparatus is had a good design.Only human body is being produced
On the premise of Micro trauma, first puncturing at the skin of blood vessel, seal wire, from puncture orifice intravasation, is led
Pipe under the guiding of seal wire, its one end arrive predetermined position, the other end is stayed external, then utilize conduit and
Apparatus is sent to predetermined position by pusher.When carrying out this type of operation, it is desirable to the least flexible conduit,
Conduit and seal wire to be designed to have well development under X-ray simultaneously.Once conduit reaches predetermined portion
Position, removes seal wire, utilizes the passage that pusher is set up by conduit the end of apparatus guiding catheter, works as device
Tool is when the end of conduit all exposes, and apparatus to disconnect with pusher, to realize the release of apparatus.Such as U.S.
Device disclosed in state's patent US6689150, US8080032 and Chinese patent CN102805654 and
Method.
At present, the structure of domestic and international several occluder for left auricle all uses fashion of barbs, and its card is positioned over a left side
Auricle opening part is bending due to the form of left auricle pouch, and barb is fixed on left atrium near-end and easily causes de-
Falling, closure face is filled in left auricle porch simultaneously, it is impossible to forms smooth wall cavity with left atrium, easily occurs
, there is again the risk of thromboembolism in new cavity.Therefore, Chinese patent CN204092085 discloses
A kind percutaneous occluder for left auricle, this stopper is to be made by high resiliency nitinol alloy wire, including by
Nitinol alloy wire is worked out in netted card and anchor, and anchor quantity is two, and one of them is middle anchor, one
For distal anchor, the near-end of card is provided with the first steel bushing, and the first steel bushing closes for the NiTi tightening up mesh grid one end
Spun gold, is provided with female thread for being connected with push rod at the first steel bushing other end, and the far-end of card is provided with second
Steel bushing, one end of the second steel bushing is for tightening up the nitinol alloy wire of card, and the other end is for tightening up middle anchor
Nitinol alloy wire, the inside of card is sewed with several polyester film layer, and distal anchor is connected to one with middle anchor by latch closure
Rise.This utility model preventing from scar, wound is little；Use and make a concerted effort closure card is firmly stuck in left auricle opening
Place, it is to avoid stopper caducous risk；Closure card forms integrated cavity and avoids with left atrial wall
The formation of secondary cavity, reduces the most thrombosed risk.
The use of various occluder for left auricle is because its operation wound is little, success rate is high, thromboembolism incidence rate is low
Once getting most of the attention etc. advantage, but in recent years, occurring in that increasing postoperative complication--hemopericardium is sent out
Raw rate is higher, and about 6.9%, and also residual shunt phenomenon likely occurs, thus affect therapeutic effect,
Strongly limit the application of occluder for left auricle.For these defects, Chinese patent CN103462668 carries
Supply a kind of left auricle ligation device, be made up of outer sheath, interior sheath pipe, push rod, lock tube and ligature,
Wherein ligature is made into " beautiful pendant rope " shape, makes a call to a line knot every one section, is through in lock tube, and at lock
Set one end forms annulus.Use the left auricle ligation device ligaturing left atrial appendage of the present invention, it is not necessary to open breast, ligation
Solid and reliable, and blocking blood flow completely.In clinical practice, this device also comes out some problems,
Closing in as tapered in the far-end of outer sheath, easily by the most advanced and sophisticated stamp of left auricle if puncture power control is bad
Broken；Ligature knotting position on left auricle is wayward, is affected by body fluid and the left heart during knotting
The impact that ear itself is elastic, knotting easily failure；Impact and the impact of heartbeat in chronic blood flowing
Under, the most automatically untie, make left auricle recover original state.
Summary of the invention
It is an object of the invention to provide a kind of device for left atrial appendage occlusion operation and using method thereof, with
Solve the above-mentioned problems in the prior art.
To achieve these goals, technical scheme is as follows:
A kind of device for left auricle ligation operation, comprising:
For arriving the outer sheath of left auricle through vein blood vessel；
Interior sheath pipe for positioning guide wire；
For importing the seal wire of Minimally Invasive Surgery apparatus；
For holding in the mouth the screw that left auricle is most advanced and sophisticated；
For the stitching devices tied a knot in the tip of left auricle；
The shearing device cut off is carried out at the knotting most advanced and sophisticated at left auricle；
Wherein, the bore of described outer sheath is more than the bore of interior sheath pipe.
Preferably, described interior main body tubular for sheath Guan Youcheng and tapered fore-end composition.
Preferably, the front end of described seal wire is J-shaped.
Preferably, the material of described seal wire is medical titanium alloy.
Preferably, described stitching devices is medical suturing instrument.
Preferably, described shearing device is hot shears cutting nipper.
Preferably, the material of described screw for medical stainless steel.
Preferably, the tapering of described interior sheath pipe front end is (3～4): 1.
Preferably, the ratio of the bore of described outer sheath and interior sheath pipe is 5:4～5:3.
Preferably, the spire length of described screw accounts for the 10～20% of screw total length.
Preferably, the front inner wall of described outer sheath is provided with annular catch.
Preferably, described catch can stir to the rear end of outer sheath is unidirectional.
Preferably, the material of described outer sheath is politef.
Preferably, the material of described interior sheath pipe is high density polyethylene (HDPE).
Preferably, the main part of described interior sheath pipe and the length of fore-end are than being (8～10): 1.
Preferably, the fore-end of described interior sheath pipe can retraction in the main part of inside sheath pipe.
Preferably, described hot shears cutting nipper includes binding clip, vice body and operation handle, and described binding clip includes
Sheath and setting and the caliper within described sheath and steel wire, described caliper includes two that intersection is flexibly connected
Tong arm, two described tong arms are respectively flexibly connected with a transmission arm, and two described transmission arms are by respective tail end
Being movably connected on a key axle, described key axle is nested with steel wire, the tail end of described steel wire is fixedly connected with
Steel cable, the tail end inner sleeve of described sheath is connected to pad, is nested with bearing outside the tail end of sheath,
The end of described bearing and a spring connecting tube is fixing to be connected, spring connecting tube described in described steel wire penetrating to
Outer extension.
Preferably, described pad is plastic spacer or metallic gasket.
Preferably, described vice body includes bourdon tube and is socketed in the insulation sleeve outside described bourdon tube,
Described bourdon tube is located in outside steel wire rope.
Preferably, described bourdon tube is anti-fold bourdon tube.
Preferably, described operation handle includes handle main body, is arranged with bearing in described handle main body,
The inner ring of described bearing is nested in outside insulation sleeve.
Preferably, the tail end of described handle main body is additionally provided with electrode structure, and described electrode structure includes
Electrode plug, electrode base and wire, described electrode plug is installed on electrode base, and described wire is by electricity
Pole base and steel wire electrical connection.
Preferably, the outside of described handle main body is also socketed with slip ring, and the afterbody of described slip ring is movable
Be provided with tail ring.
Preferably, described seal wire is by mandrel, the coil case of the periphery covering mandrel and fastening institute
The fastening part, front end of the front end and described coil case front end of stating mandrel is constituted.
Preferably, described mandrel have be positioned at rear end side large diameter part, be positioned at described large diameter part before
Tapered portion that side and external diameter reduce towards front extreme direction and the path of the front that is positioned at described tapered portion
Portion.
Preferably, it is provided with middle fastening part in described tapered portion, is provided with rear end at described large diameter part tight
Gu portion.
Preferably, described seal wire is by mandrel, the coil case of the periphery covering mandrel and fastening institute
The fastening part, front end of the front end and described coil case front end of stating mandrel is constituted.
Preferably, described mandrel have be positioned at rear end side large diameter part, be positioned at described large diameter part before
Tapered portion that side and external diameter reduce towards front extreme direction and the path of the front that is positioned at described tapered portion
Portion.
Preferably, it is provided with middle fastening part in described tapered portion, is provided with rear end at described large diameter part tight
Gu portion.
Preferably, described stitching thread is suture.
Present invention also offers a kind of sheath pipe assembly for left auricle ligation operation device, it includes interior sheath pipe
And outer sheath, described interior sheath pipe is embedded on the inwall of outer sheath.
Preferably, the inwall of described interior sheath pipe is provided with for three slideways for three seal wire location.
Preferably, three described slideways on the inwall of interior sheath pipe in equilateral triangle arrangement.
The using method of a kind of device being used for left auricle ligation operation as described in the present invention, it includes as follows
Step:
A, find venous inlet；
B, puncture through interatrial septum approach by outer sheath, be that the front end of described outer sheath props up left auricle
Inside tip；
C, by seal wire perspective and intracardiac ultrasound cardiogram guiding under, probe into left auricle along outer sheath
Most advanced and sophisticated；
D, by the guiding of seal wire, insert left auricle shearing device, remove seal wire；
E, screw in and hook the tip of left auricle with screw, be pulled at the mouth of pipe of outer sheath backward:
F, bind the tip of left auricle with stitching thread to reinforce it；
G, further the tip of left auricle is drawn rearward into the inside of outer sheath；
H, embedded suture device, sew up the tip of left auricle, the left side after sewing up with shearing device
Auricle is most advanced and sophisticated to be cut off by suture (far-end)；Remove shearing device
I, by cut-off left auricle pull-out, extract outer sheath, terminate once-through operation.
Preferably, in step c, the most advanced and sophisticated distance of the front end and left auricle that control seal wire is
0.2～0.5cm.
A kind of another kind of using method of the device being used for left auricle ligation operation as described in the present invention, its bag
Include following steps:
A, find venous inlet；
B, puncture through interatrial septum approach by outer sheath, make the front end of described outer sheath prop up the point of left auricle
Inside end；
C, by three seal wires perspective and intracardiac ultrasonic guiding under, probe into left auricle respectively along interior sheath pipe
Most advanced and sophisticated；
D, three seal wires are respectively used to load screw, stitching devices and shearing device；
E, the tip screwing in and hooking left auricle with screw are pulled at the mouth of pipe of outer sheath, with stitching backward
Line binds the tip of left auricle, sews up the tip of left auricle；The left heart after sewing up with shearing device
Have sharp ears end portion is excised, and the tip of left auricle is drawn rearward into the inside of outer sheath further；
I, by cut-off left auricle pull-out, extract outer sheath, terminate once-through operation.
The beneficial effects are mainly as follows:
1, by left auricle is easily caused the Partial Resection that thrombosis produces, apoplexy has thoroughly been eradicated pathogenetic hidden
Suffer from；
2, interior sheath Guan Zhongke puts into three seal wires simultaneously, for being placed with the hands of different purposes in every seal wire
Art apparatus, directly carries out next step after the previous step of operation terminates, it is not necessary in each step of operation
Change seal wire after end, save operating time, greatly reduce operation risk.
Accompanying drawing explanation
Fig. 1 is stopper formula occluder for left auricle position view in heart and left auricle anatomical structure；
Fig. 2 is stopper formula occluder for left auricle position view left auricle in terms of left auricle mouth direction；
Fig. 3 is plug disc type occluder for left auricle position view in heart and left auricle anatomical structure；
Fig. 4 is the occluder for left auricle of the present invention position view in heart and left auricle anatomical structure, its
Middle fixed mount is fixed on the position that left auricle is deeper；
Fig. 5 is the occluder for left auricle of the present invention position view in heart and left auricle anatomical structure, its
Middle fixed mount is fixed on the position that left auricle is shallower；
Fig. 6 is the structural representation of the present invention；
Fig. 7 is the structural representation of hot shears cutting nipper in the present invention；
Fig. 8 is the profile of the slip ring of hot shears cutting nipper in the present invention；
Fig. 9 is the schematic cross-section of the slip ring of hot shears cutting nipper in the present invention；
Figure 10 is the decomposing schematic representation of the tong head of hot shears cutting nipper in the present invention；
Figure 11 is the schematic cross-section of the vice body of hot shears cutting nipper in the present invention；
Figure 12 is the generalized section of the operation handle of hot shears cutting nipper in the present invention；
Figure 13 is the structural representation of the electrode structure of hot shears cutting nipper in the present invention；
Figure 14 is the structural representation of outer sheath in the present invention；
Figure 15 is the cross sectional representation of a kind of interior sheath pipe in the present invention；
Figure 16 is the structural representation of seal wire in the present invention；
Figure 17 is the left auricle ligation device of present invention first step schematic diagram when performing the operation；
Figure 18 is the left auricle ligation device of present invention second step schematic diagram when performing the operation；
Figure 19 is the left auricle ligation device of the present invention the 3rd step schematic diagram when performing the operation；
Figure 20 is the left auricle ligation device of the present invention the 4th step schematic diagram when performing the operation；
Figure 21 is the left auricle ligation device of the present invention the 5th step schematic diagram when performing the operation；
Figure 22 is the left auricle ligation device of the present invention the 6th step schematic diagram when performing the operation；
Figure 23 is the left auricle ligation device of the present invention the 7th step schematic diagram when performing the operation；
Figure 24 is the left auricle ligation device of the present invention the 8th step schematic diagram when performing the operation；
Figure 25 is the left auricle ligation device of the present invention the 9th step schematic diagram when performing the operation；
In figure: 1, left atrium (LA)；2, left auricle (LAA)；3, left auricle cavity wall；4, stopper formula is left
Atrial appendage occlusion device choked flow film；5, stopper formula occluder for left auricle body；6, stopper formula occluder for left auricle with
The pit shape gap formed between left auricle；7, plug disc type occluder for left auricle body；8 is left for plug disc type
The choked flow film of atrial appendage occlusion device；21, outer sheath；211, catch；22, interior sheath pipe；22 ', interior sheath pipe；
221 ', slideway；23, seal wire；2311, mandrel large diameter part；2312, mandrel tapered portion；2313, core
Axle minor diameter part；232, coil case；233, front end fixed part；24, screw；25, hot shears cutting nipper；
251, binding clip；252, vice body；253, operation handle；254, slip ring；255, tail ring；256, electrode
Structure；2511, sheath；2512, tong arm；2513, the first key axle；2514, transmission arm；2515,
Two key axles；2516, steel wire；2517, steel wire rope；2518, pad；2519, clutch shaft bearing；25110、
Spring connecting tube；25111, steel wire rope；2521, bourdon tube；2522, insulation sleeve；2531, handle master
Body；2532, the second bearing；2561, electrode base；2562, electrode plug；2563, wire.
Detailed description of the invention
First embodiment
The structure such as Fig. 6～13 and Figure 16 of the device for left atrial appendage occlusion operation that present embodiment is provided
Shown in, including the outer sheath 21 for arriving left auricle through vein blood vessel；For arriving the left heart through vein blood vessel
Sheath pipe 22 in the interior sheath pipe of ear positioning guide wire 23；It is J-type for importing the front end of Minimally Invasive Surgery apparatus
Seal wire 23；For holding in the mouth the screw 24 of the most advanced and sophisticated medical stainless steel material of left auricle；For to the left heart
The tip of ear carries out knotting device and the stitching devices tied a knot, and this stitching devices can select any one to be used for
The stitching devices of Minimally Invasive Surgery, therefore not shown in figure；For carry out cutting off at the knotting at left auricle tip
Shearing device, such as hot shears cutting nipper 25；Wherein, the bore of described outer sheath 21 is more than the bore of interior sheath pipe 22.
The operation device cut is carried out at the knotting most advanced and sophisticated at left auricle；
Wherein, the bore of described outer sheath is more than the bore of interior sheath pipe.
Left auricle tip is being hooked up and is positioning by screw for convenience, and interior sheath pipe 22 is designed to by managing
The main part of type structure and the fore-end composition of pyramidal structure, the length ratio of main part and fore-end
For (8～10): 1, preferably 8:1, and the tapering of fore-end is (3～4): 1, preferably 4:1.
The material selection medical titanium alloy of seal wire 23 or medical magnesium alloy, preferably medical titanium alloy, and seal wire
The Front-end Design of 23 becomes J-shaped, and seal wire can be enable normally to carry out major branch traveling.
Stitching devices selects medical suturing instrument, and shearing device is hot shears cutting nipper, and hot shears cutting nipper 25 includes binding clip
251, vice body 252 and operation handle 253, binding clip 251 includes sheath 2511 and is arranged at sheath 2511
Internal caliper and steel wire, institute's caliper includes two tong arms 2512 that intersection is flexibly connected, two tong arms 2512
Respectively being flexibly connected by the first key axle 2513 with a transmission arm 2514, two transmission arms 2514 are by each
Tail end be movably connected on the second key axle 2515, the second key axle 2515 is nested with steel wire 2516, steel wire
The tail end of 2516 is fixedly connected with steel cable 2517, and the tail end inner sleeve of sheath 2511 is connected to pad
2518, it is nested with clutch shaft bearing 2519, clutch shaft bearing 2519 and a spring outside the tail end of sheath 2511 even
The end of adapter 25110 is fixing to be connected, and steel wire rope 2517 stretches out through spring connecting tube 25110,
Preferably, pad 2518 is plastic spacer or metallic gasket, and vice body 252 includes bourdon tube 2521 and socket
Insulation sleeve 2522 outside bourdon tube 2521, bourdon tube 2521 is located in outside steel wire rope 2517, bullet
Reed pipe 2521 is anti-fold bourdon tube.Operation handle 253 includes handle main body 2531, handle main body 2531
Inside being arranged with the second bearing 2532, the inner ring of the second bearing 2532 is nested in outside insulation sleeve 2522.Handle master
The tail end of body 2531 is additionally provided with electrode structure, and electrode structure includes electrode plug 2562, electrode base 2561
With wire 2563, electrode plug 2562 is installed on electrode base 2561, and wire 2563 is by electrode base
2561 and steel wire electrical connection.The outside of handle main body is also socketed with slip ring, and the afterbody of described slip ring sets actively
There is tail ring, can refer to the circuit structure of existing Minimally Invasive Surgery handle portion.
The material of screw for medical stainless steel, briefly, be i.e. on the steel wire that root is straight, to be connected to one section
The spire length of tapered spring, described spring i.e. spire, and screw accounts for screw overall length
The 10～20% of degree.
Cooperation for making interior sheath pipe 22 and outer sheath 21 is more smooth, special by outer sheath 21 and interior sheath pipe 22
The ratio in aperture is designed to 5:4～5:3.
In order to improve the safety of use, the material of outer sheath 21 selects politef；Interior sheath pipe 22
Material selects high density polyethylene (HDPE).
More accurate for ensureing the ligation part location at left auricle tip, the leading section of interior sheath pipe 22 is set up separately by spy
Count into can the structure of retraction in the main part of inside sheath pipe 22, when screw 24 is by the point of left auricle
After end draws in interior sheath pipe 22, continue to pull back so that the conical section retraction of interior sheath pipe 22, when interior sheath pipe
After the conical section of 22 is fully retracted to barrel portion, screw cannot continue to pull back, by the point of left auricle
End is fixing.
The coil case 232 of periphery that seal wire 23 by mandrel, can cover mandrel and before fastening described mandrel
The fastening part, front end 233 of end and described coil case front end is constituted.Mandrel has the mandrel particle size being positioned at rear end side
The mandrel taper that portion 2311, the front being positioned at mandrel large diameter part 2311 and external diameter reduce towards front extreme direction
Portion 2312 and be positioned at the mandrel minor diameter part 2313 of front of mandrel tapered portion 2312.In mandrel taper
Portion is provided with middle fastening part, is provided with fastening part, rear end at mandrel large diameter part.
Stitching thread is suture.
The using method of the first embodiment comprises the steps:
A, find venous inlet, as shown in figure 17；
B, puncture through interatrial septum approach by outer sheath, be that the front end of described outer sheath is supported to left auricle
Inside tip, as shown in figure 18；
C, by seal wire perspective and intracardiac ultrasound cardiogram guiding under, probe into left auricle along outer sheath
Tip, as shown in figure 19；
D, remove seal wire, change left auricle shearing device, as shown in figure 20；
E, the tip screwing in and hooking left auricle with screw are pulled at the mouth of pipe of outer sheath backward, such as figure
Shown in 21；
F, bind the tip of left auricle with stitching thread, as shown in figure 22；
G, remove shearing device, further the tip of left auricle is drawn rearward into the inside of outer sheath, such as figure
Shown in 23；
H, embedded suture device, sew up the tip of left auricle, the left side after sewing up with shearing device
Auricle tip is cut off by suture, as shown in figure 24；
I, by cut-off left auricle pull-out, extract outer sheath, terminate once-through operation, as shown in figure 25.
Second embodiment
Present embodiment provides a kind of sheath pipe assembly for left auricle ligation operation device, such as Figure 15
Shown in, in it includes interior sheath pipe 22 ', sheath pipe is embedded on the inwall of outer sheath.Set on the inwall of interior sheath pipe 22 '
Have for three slideways 221 ' for three seal wire location.Article three, the inwall at interior sheath pipe 22 ' of slideway 221 '
On in equilateral triangle arrangement.The interior sheath pipe of this structure can penetrate three seal wires simultaneously, in every seal wire respectively
Load different operating theater instruments, after the previous step of operation terminates, directly carry out next step, it is not necessary at hands
Each step of art changes seal wire after terminating, and saves operating time, greatly reduces operation risk.
3rd embodiment
Present embodiment provide a kind of for left auricle ligation operation device, comprising: sheath pipe assembly；
For importing the seal wire that the front end of Minimally Invasive Surgery apparatus is J-type；For holding in the mouth the medical stainless of left auricle tip
The screw of Steel material；For the stitching devices tied a knot in the tip of left auricle；For at left auricle
The shearing device cut off is carried out at most advanced and sophisticated knotting.
The using method of present embodiment is:
A, find venous inlet；
B, puncture through interatrial septum approach by outer sheath, make the front end of described outer sheath prop up the point of left auricle
Inside end；
C, by three seal wires perspective and intracardiac ultrasound cardiogram guiding under, probe into a left side respectively along interior sheath pipe
The tip of auricle；
D, in three seal wires, it is respectively charged into screw, stitching devices and shearing device；
E, the tip screwing in and hooking left auricle with screw are pulled at the mouth of pipe of outer sheath, with stitching backward
Line binds the tip of left auricle, sews up the tip of left auricle；The left heart after sewing up with shearing device
Have sharp ears end portion is excised, and the tip of left auricle is drawn rearward into the inside of outer sheath further；
I, by cut-off left auricle pull-out, extract outer sheath, terminate once-through operation.
The beneficial effects are mainly as follows:
3, by left auricle is easily caused the Partial Resection that thrombosis produces, apoplexy has thoroughly been eradicated pathogenetic hidden
Suffer from；
4, avoid, owing to having excised the big portion of left auricle, the problem that current stopper exists, such as seal
Stifled device dislocation or closure are the tightest etc..
Interior sheath Guan Zhongke puts into three seal wires simultaneously, is provided with different operating theater instruments, at hands in every seal wire
The previous step of art directly carries out next step after terminating, it is not necessary to changes after each step of operation terminates and leads
Silk, saves operating time, greatly reduces operation risk.
In sum, only presently preferred embodiments of the present invention, not it is used for limiting the model that the present invention implements
Enclose, all impartial changes done according to the shape described in scope of the invention as claimed, structure, feature and spirit
With modification, all should be included in scope of the presently claimed invention.
Claims (34)
1. the device for left auricle ligation operation, it is characterised in that including:
For arriving the outer sheath of left auricle through vein blood vessel；
For arriving left auricle the interior sheath pipe of positioning guide wire through vein blood vessel；
For importing the seal wire of Minimally Invasive Surgery apparatus；
For holding in the mouth the screw that left auricle is most advanced and sophisticated；
For the tip of left auricle is carried out knotting device and stitching devices；
The operation device cut is carried out at the knotting most advanced and sophisticated at left auricle；
Wherein, the bore of described outer sheath is more than the bore of interior sheath pipe.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
Interior main body tubular for sheath Guan Youcheng and tapered fore-end composition.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
The front end of seal wire is J-shaped.
4. according to the device for left auricle ligation operation described in claim 1 or 3, it is characterised in that
The material of described seal wire is medical titanium alloy or other applicable medical material.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
Stitching devices is medical suturing instrument.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
Shearing device is machine cuts or other energy cuts, and described shearing device is hot shears cutting nipper.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
The material of screw for medical stainless steel or other applicable medical material.
Device for left auricle ligation operation the most according to claim 1 and 2, it is characterised in that
The tapering of described interior sheath pipe front end is (3～4): 1.
Device for left auricle ligation operation the most according to claim 1, it is characterised in that described
The ratio of the bore of outer sheath and interior sheath pipe is 5:4～5:3.
10. according to the device for left auricle ligation operation described in claim 1 or 7, it is characterised in that
The spire length of described screw accounts for the 10～20% of screw total length.
11. devices for left auricle ligation operation according to claim 10, it is characterised in that
The front inner wall of described outer sheath be provided with annular catch or other be beneficial to cutting design.
12. devices for left auricle ligation operation according to claim 11, it is characterised in that
Described catch can stir to the rear end of outer sheath is unidirectional.
13. devices for left auricle ligation operation according to claim 1, it is characterised in that institute
The material stating outer sheath is politef or other applicable medical material.
14. devices for left auricle ligation operation according to claim 1, it is characterised in that institute
The material stating interior sheath pipe is high density polyethylene (HDPE) or other applicable medical material.
15. devices for left auricle ligation operation according to claim 1 and 2, it is characterised in that
The main part of described interior sheath pipe is (8～10) with the length ratio of fore-end: 1.
16. devices for left auricle ligation operation according to claim 13, it is characterised in that
The fore-end of described interior sheath pipe can retraction in the main part of inside sheath pipe.
17. devices for left auricle ligation operation according to claim 6, it is characterised in that institute
Stating hot shears cutting nipper and include binding clip, vice body and operation handle, described binding clip includes sheath and arranges and described sheath
Internal caliper and steel wire, described caliper includes two tong arms that intersection is flexibly connected, and two described tong arms are each
Being flexibly connected with a transmission arm, two described transmission arms are movably connected on a key axle by respective tail end,
Being nested with steel wire on described key axle, the tail end of described steel wire is fixedly connected with steel cable, described sheath
Tail end inner sleeve is connected to pad, is nested with bearing, described bearing and a spring connecting tube outside the tail end of sheath
End fixing connect, spring connecting tube described in described steel wire penetrating stretches out.
18. devices for left auricle ligation operation according to claim 17, it is characterised in that
Described pad is plastic spacer or metallic gasket.
19. devices for left auricle ligation operation according to claim 17, it is characterised in that
Described vice body includes bourdon tube and is socketed in the insulation sleeve outside described bourdon tube, and described bourdon tube is located in steel
Outside cord.
20. devices for left auricle ligation operation according to claim 17, it is characterised in that
Described bourdon tube is anti-fold bourdon tube.
21. devices for left auricle ligation operation according to claim 17, it is characterised in that
Described operation handle includes handle main body, is arranged with bearing in described handle main body, and the inner ring of described bearing is embedding
It is enclosed within outside insulation sleeve.
22. devices for left auricle ligation operation according to claim 17, it is characterised in that
The tail end of described handle main body is additionally provided with electrode structure, and described electrode structure includes electrode plug, electrode base
And wire, described electrode plug is installed on electrode base, and electrode base and steel wire are electrically connected by described wire.
23. devices for left auricle ligation operation according to claim 17, it is characterised in that
The outside of described handle main body is also socketed with slip ring, and the afterbody of described slip ring is provided with tail ring actively.
24. devices for left auricle ligation operation according to claim 1, it is characterised in that institute
State seal wire and by mandrel, the coil case of the periphery covering mandrel and fasten the front end of described mandrel and described line
The fastening part, front end of circle body front end is constituted.
25. devices for left auricle ligation operation according to claim 24, it is characterised in that
Described mandrel has and is positioned at the large diameter part of rear end side, the front being positioned at described large diameter part and external diameter towards front end
Tapered portion that direction reduces and be positioned at the minor diameter part of front of described tapered portion.
26. according to the device for left auricle ligation operation described in claim 24 or 25, and its feature exists
In, it is provided with middle fastening part in described tapered portion, is provided with fastening part, rear end at described large diameter part.
27. according to the device for left auricle ligation operation described in claim 24 or 25, and its feature exists
In, it is provided with middle fastening part in described tapered portion, is provided with fastening part, rear end at described large diameter part.
28. devices for left auricle ligation operation according to claim 1, it is characterised in that institute
Stating stitching thread is suture.
29. 1 kinds of sheath pipe assemblies for left auricle ligation operation device, it is characterised in that include interior sheath pipe
And outer sheath, described interior sheath pipe is embedded on the inwall of outer sheath.
The 30. sheath pipe assemblies for left auricle ligation operation device according to claim 28, it is special
Levying and be, the inwall of described interior sheath pipe is provided with for three slideways for three seal wire location.
The 31. sheath pipe assemblies for left auricle ligation operation device according to claim 29, it is special
Levy and be, three described slideways on the inwall of interior sheath pipe in equilateral triangle arrangement.
The using method of 32. 1 kinds of devices being used for left auricle ligation operation as claimed in claim 1, its
It is characterised by, comprises the steps:
A, find venous inlet；
B, puncture through interatrial septum approach by outer sheath, the front end of described outer sheath is pushed against the point of left auricle
Inside end；
C, by seal wire perspective and intracardiac ultrasound cardiogram guiding under, probe into the point of left auricle along outer sheath
End；
D, remove seal wire, change left auricle shearing device；
E, the tip screwing in and hooking left auricle with screw are pulled at the mouth of pipe of outer sheath backward:
F, bind the tip of left auricle with stitching thread；
G, remove shearing device, further the tip of left auricle is drawn rearward into the inside of outer sheath；
H, embedded suture device, sew up the tip of left auricle, the left heart after sewing up with shearing device
Have sharp ears end is cut off by suture；
I, by cut-off left auricle pull-out, extract outer sheath, terminate once-through operation.
33. usings method as claimed in claim 31, it is characterised in that in step c, control seal wire
Front end is 0.5～1.0cm with the most advanced and sophisticated distance of left auricle.
The using method of 34. 1 kinds of devices for left auricle ligation operation as described in claim 1 or 28,
It is characterized in that, comprise the steps:
A, find venous inlet；
B, puncture through interatrial septum approach by outer sheath, make the front end of described outer sheath prop up the point of left auricle
Inside end；
C, by three seal wires perspective and intracardiac ultrasound cardiogram guiding under, probe into a left side respectively along interior sheath pipe
The tip of auricle；
D, in three seal wires, it is respectively charged into screw, stitching devices and shearing device；
E, the tip screwing in and hooking left auricle with screw are pulled in the mouth of pipe of outer sheath, backward with stitching
Line binds the tip of left auricle, is pulled to the most backward in the mouth of pipe of outer sheath at the tip of left auricle, then
Sew up bottom left auricle；Left auricle body excision after sewing up with shearing device, will cut further
The left auricle removed is drawn rearward into the inside of outer sheath；
I, by external for cut-off left auricle pull-out, extract outer sheath, terminate once-through operation.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510170230.7A CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510170230.7A CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
Publications (2)
| Publication Number | Publication Date |
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| CN106137292A true CN106137292A (en) | 2016-11-23 |
| CN106137292B CN106137292B (en) | 2019-02-22 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN201510170230.7A Expired - Fee Related CN106137292B (en) | 2015-04-10 | 2015-04-10 | A kind of device for left auricle of heart ligation operation |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110403640A (en) * | 2018-04-26 | 2019-11-05 | 复旦大学附属中山医院 | It is a kind of through subclavian vein having sexual intercourse interval piercing assembly |
Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1342056A (en) * | 1998-11-06 | 2002-03-27 | 阿普利瓦医学股份有限公司 | Method and device for left atrial appendage occlusion |
| US20040034366A1 (en) * | 1999-11-08 | 2004-02-19 | Ev3 Sunnyvale, Inc., A California Corporation | Device for containing embolic material in the LAA having a plurality of tissue retention structures |
| CN1886096A (en) * | 2003-12-26 | 2006-12-27 | 泰尔茂株式会社 | Tissue closure and tissue closing device |
| 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 |
| CN101920055A (en) * | 2009-06-16 | 2010-12-22 | 朝日印帝克股份有限公司 | Guide wire for medical use |
| CN103462668A (en) * | 2013-09-13 | 2013-12-25 | 徐州亚太科技有限公司 | Left auricle ligation device |
| CN103750901A (en) * | 2014-02-14 | 2014-04-30 | 徐美东 | Multifunctional high-frequency incision knife |
| CN204971414U (en) * | 2015-04-10 | 2016-01-20 | 上海市同济医院 | A device for left auricle of heart ligation operation |
-
2015
- 2015-04-10 CN CN201510170230.7A patent/CN106137292B/en not_active Expired - Fee Related
Patent Citations (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1342056A (en) * | 1998-11-06 | 2002-03-27 | 阿普利瓦医学股份有限公司 | Method and device for left atrial appendage occlusion |
| US20040034366A1 (en) * | 1999-11-08 | 2004-02-19 | Ev3 Sunnyvale, Inc., A California Corporation | Device for containing embolic material in the LAA having a plurality of tissue retention structures |
| CN1886096A (en) * | 2003-12-26 | 2006-12-27 | 泰尔茂株式会社 | Tissue closure and tissue closing device |
| 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 |
| CN101920055A (en) * | 2009-06-16 | 2010-12-22 | 朝日印帝克股份有限公司 | Guide wire for medical use |
| CN103462668A (en) * | 2013-09-13 | 2013-12-25 | 徐州亚太科技有限公司 | Left auricle ligation device |
| CN103750901A (en) * | 2014-02-14 | 2014-04-30 | 徐美东 | Multifunctional high-frequency incision knife |
| CN204971414U (en) * | 2015-04-10 | 2016-01-20 | 上海市同济医院 | A device for left auricle of heart ligation operation |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110403640A (en) * | 2018-04-26 | 2019-11-05 | 复旦大学附属中山医院 | It is a kind of through subclavian vein having sexual intercourse interval piercing assembly |
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| CN106137292B (en) | 2019-02-22 |
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