CN106264664A - Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy - Google Patents
Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy Download PDFInfo
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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
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M31/00—Devices for introducing or retaining media, e.g. remedies, in cavities of the body
- A61M31/005—Devices for introducing or retaining media, e.g. remedies, in cavities of the body for contrast media
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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
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
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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
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
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Abstract
The invention discloses a kind of thread associating Wicresoft of halieutics two mirror and protect the liver liver inside and outside bile duct stone rubble lithotomy, relate to medical apparatus and instruments, bile duct inwall can be touched for solving existing stone extraction basket, easily there is pain, wound, hemorrhage in operation process, it is impossible to enough integrates biliary tract stone extraction, flushing, radiography and expands.It includes stone extraction basket, choledochoscope, peritoneoscope, described stone extraction basket includes conduit, is positioned at the target seeker of the hollow of conduit left end, the basket being positioned on target seeker, described basket includes at least 2 the first baskets, at least 2 the second baskets, described conduit includes the outer tube arranged from outside to inside, sliding tube, inner tube and is slidably connected part, described in be slidably connected part and include the first terminal, second terminal, for connecting the first terminal and the coupling spindle of the second terminal.Gathering formula basket designs, it is to avoid stone extraction basket touches bile duct inwall, and operation process is without pain, wound, hemorrhage, it is possible to integrates biliary tract stone extraction, flushing, radiography and expands.
Description
Technical field
The present invention relates to medical apparatus and instruments, specifically, be that thread associating Wicresoft of halieutics two mirror protects the liver extrahepatic duct knot
Stone rubble lithotomy.
Background technology
The pathogenic factor of liver inside and outside bile duct stone is relevant with the infection of the antibacterial of biliary tract, parasitic infection and cholestasis.This
Outward, the macromolecular substances such as mucoprotein, acidic mucopolysaccharide, immunoglobulin in bile, inflammatory exudate, the epithelium come off is thin
Metal ion etc. in born of the same parents, antibacterial, parasite, bile, both participates in the formation of calculus.Calculus of intrahepatic duct is according to the course of disease and disease
The difference of reason, its clinical manifestation can be many, from early days be confined to stones in intrahepatic bile duct section without obvious clinical symptoms
Calculus in common hepatic duct, to the later stage throughout extrahepatic duct the system even evening of concurrent biliary cirrhosis, hepatic atrophy, liver abscess etc.
Phase case, therefore clinical manifestation is sufficiently complex: 1. epigastrium pain, may be typical case's biliary colic or persistence distending pain, some patients
Pain is inconspicuous, and shivers with cold and generate heat clearly, intermittence；2. can there is long-term biliary tract medical history or with shiver with cold heating, Huang
The acute cholangitis history of subcutaneous ulcer；3. Ipsilateral hepatic region and pectus have regular pain uncomfortable, are often radiated to the back of the body, shoulder；Side common hepatic duct
When blocking, can be the lightest without jaundice or jaundice；4. acute stage, may occur in which the symptom of acute pyogenic cholangitis, or in various degree
Charcot tri-levies (pain, shiver with cold heating, jaundice), and majority is probably caused by the extrahepatic biliary stone of merging.5. hepatic region tenderness
Obvious with percussion pain, liver is unsymmetry enlargement and has tenderness.
Liver inside and outside bile duct stone is frequently-occurring disease and commonly encountered diseases in China.Operation is the unique method treating this disease.Tradition
Therapeutic Method have: the method for operation mainly has: 1. High Choledocholithotomy takes stone；2. for releasing the BILIARY-INTESTINAL DRAINAGE blocked；
3. for the hepalobectomy of infectious lesions in elimination liver.Special tree-like anatomical structure due to bile duct so that calculus therein
More difficult once taken clean.The method generally taking stone has: first, detects along bile duct direction with metal hard lithotomy forceps and takes stone.
This method needs abundant surgical experience, and the most either dynamics or angle are to being all likely to result in Hemobilia or damage
Wound, relatively thick additionally, due to pincers point, it is typically only capable to enter three grades of bile ducts, is difficult to take clean calculus；And this method may not apply to
In laparoscopic biliary tract operation；Second, it is rinsed after inserting each bile duct with rubber urinary catheter.This method is the warmest compared with the former
With, but owing to there being bigger gap between catheter and bile duct, during flushing, reflux is obvious, so flushing pressure is relatively low, takes stone effect
Not good enough and intra-operative cholangiography can not be carried out.Simultaneously narrow when running into the inflammatory edema that bile duct causes due to calculus repetitious stimulation
Narrow section usually can not be passed through time narrow.This method, when endoscope-assistant surgery, can only carry out biliary tract flushing, and can not effectively take
Go out relatively big or that mobility is less calculus, it is impossible to radiography is to understand the patency of bile duct hypomere；3rd, take stone with choledochoscope.This
It is presently considered to be best Biliary Calculi processing method, is greatly improved the extraction efficiency of liver inside and outside bile duct stone.But this equipment
Costliness, needs the study of long period to grasp, and additionally in art, the operating time is relatively long, is therefore in most cases used at present
The postoperative stone that takes, and art is applied relatively fewer.
Patent documentation 201410334420.3 applying date (2014.07.15) discloses a kind of urinary system calculus cavity inner sleeve
Fetching is put, and it is provided with conduit and seal wire, and the far-end of described seal wire is provided with basket, and described basket is fixed with set stone pocket, described set
Stone pocket is opening by the one side of preformed growth bar shaped pocketed and near-end, and set stone pocket is additionally provided with micropore.The urinary system of the present invention
System calculus cavity inner sleeve fetching is put and can disposably be extracted a large amount of rubble, clot and pus block, not by ureter lumen diameter or operation
The restriction of channel internal diameter, takes stone process and will not omit rubble, can be prevented effectively from rubble and be irrigated back kidney by current, can also keep away simultaneously
Exempt from rubble and ureter wall is caused damage, safe and reliable.
Technique scheme has the following disadvantages, and when running into gallbladder and the concurrent calculus of common bile duct, once operation can not solve
Certainly calculus rubble takes stone, it addition, it is obstructed to take stone passage, stone extraction basket sends into bile duct, can touch bile duct inwall, and operation process is easy
Pain, wound, hemorrhage occur, stone extraction basket can not coordinate laparoscopic surgery very well, it is impossible to enough collects biliary tract stone extraction, flushing, radiography
With expand in one, simultaneously the most easily there is biliary duct injury.Misery and financial burden is added to patient.
Summary of the invention
The present invention seeks to have aimed to provide a kind of operation whole process and visually descend endoscopic technic, painless and noninvasive wound, nothing at video
Hemorrhage, the most thoroughly cure calculus of intrahepatic duct, thread associating Wicresoft of halieutics two mirror keeping normal liver organization protects the liver
Liver inside and outside bile duct stone rubble lithotomy.
For realizing above-mentioned technical purpose, the technical solution used in the present invention is as follows:
Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy, including stone extraction basket, biliary tract
Mirror, peritoneoscope, described stone extraction basket includes conduit, is positioned at the target seeker of the hollow of conduit left end, the basket being positioned on target seeker,
Described basket includes at least 2 the first baskets, at least 2 the second baskets, and described conduit includes outer tube, the cunning arranged from outside to inside
Dynamic pipe, inner tube and be slidably connected part, described in be slidably connected part and include the first terminal, the second terminal, be used for connecting the first terminal and
The coupling spindle of the second terminal；
Said inner tube is hollow, and said inner tube left end connection target seeker, said inner tube right-hand member extends outer tube；
Described sliding tube is hollow, and described sliding tube sidewall is inlaid with coupling spindle, and described coupling spindle left end extends slip
Pipe, described coupling spindle left end is provided with the second terminal and the first terminal, and described second terminal is near coupling spindle left end, and fixing connection
Coupling spindle, described the first terminal is away from coupling spindle left end, and the first terminal inwall is arranged at intervals with inside spline wheel gear, outside coupling spindle
Wall is arranged at intervals with and the external splines gear of inside spline wheel gear coupling, and described sliding tube right-hand member is provided with for controlling coupling spindle slip
Sliding button；
Described first basket left end connection target seeker left end, described first basket right-hand member connection the first terminal, described second
Basket left end connects target seeker left end, and described second basket right-hand member connects the second terminal；
Described outer tube is hollow, and described outer tube wall is provided with the first opening slided for the first basket, for the second net
The second opening that basket slides.
Using the invention of technique scheme, utilize one, halieutics two mirror, one refers to stone extraction basket, and two mirrors refer to choledochoscope
And peritoneoscope, the problem that once operation just can solve.Wicresoft protects the liver and takes stone is on the basis of laparoscopically, uses gallbladder under peritoneoscope
House steward cuts, and is sent in common bile duct by fiber endoscopy scope, is gone directly stones in intrahepatic bile duct by common bile duct, by stones in intrahepatic bile duct sacculus
Expansion stones in intrahepatic bile duct, expands stones in intrahepatic bile duct internal diameter, unobstructed takes stone passage, can the most thoroughly remove calculus of intrahepatic duct, hands
Art is omnidistance visually descends endoscopic technic at video, painless and noninvasive wound, without hemorrhage, the most thoroughly cures calculus of intrahepatic duct, just keeps
Normal liver organization.As calculus is excessive use laser lithotripsy, micro-explosion rubble or additive method that residual stone is fragmented into fritter after
Further take out.
Limiting further, be provided with resetting structure in described sliding tube, described resetting structure is positioned at coupling spindle left end.
Limiting further, described resetting structure includes banking stop, back-moving spring and catch, and described back-moving spring left end connects
Banking stop, its right-hand member connects catch, and described catch diameter is more than coupling spindle diameter.
Limiting further, described catch is provided with the first groove towards coupling spindle side.
Limiting further, said inner tube right-hand member is provided with inlet, and described target seeker is provided with liquid outlet.
Limiting further, described first basket is 2, and described second basket is 2, described first basket and the second basket
Cross-distribution, and form cross.
Limit further, the described first a diameter of 0.4-0.6cm of basket, the described first a length of 62-64cm of basket, described
The second a diameter of 0.6-0.8cm of basket, the described first a length of 66-68cm of basket.
Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy operational approach, including following step
Suddenly,
Step one, gets involved, and cuts the aperture of 1cm, it is ensured that can send into stone extraction basket；
Set up a 1cm patient's umbilicus is descending, xiphoid-process next one 0.5cm, 0.5cm aperture under the costal margin of right side, and under liver
Put two pieces of gauzes, stop duodenum and fully appear common bile duct, and electricity consumption is hooked in common bile duct antetheca and opens diameter about 0.8cm size
Otch.
Step 2, detects, and sets up and takes stone passage, it is ensured that takes stone passage unobstructed；
Gone directly stones in intrahepatic bile duct by common bile duct, by stones in intrahepatic bile duct balloon expandable stones in intrahepatic bile duct, expand stones in intrahepatic bile duct internal diameter,
Unobstructed take stone passage.
Step 3, takes stone, sends into stone extraction basket, utilizes stone extraction basket to realize trawlnet and takes out；
With stone extraction basket, whole for calculus in stones in intrahepatic bile duct trawlnets are taken out, reduce the stimulation to common bile duct inner membrance, effectively protect
In card stones in intrahepatic bile duct, calculus is all taken out.
Step 4, checks, and sends into choledochoscope, utilizes choledochoscope to carry out 360 ° and comprehensive detect, really taking stone channel interior
Guarantor will not omit calculus；
Soft very thin fiber endoscopy is utilized to carry out 360 ° and comprehensive detect taking stone channel interior, it is ensured that not have
Any omission, is truly realized and takes clean calculus, and common bile duct far-end to be detected guarantees that common bile duct far-end does not has residual stone.
Step 5, closes abdomen, sends into peritoneoscope, utilizes peritoneoscope to carry out 360 ° outside stone passage comprehensive detect, really taking
Guarantor will not omit calculus.
Peritoneoscope is utilized to carry out 360 ° outside stone passage comprehensive detect taking, it is ensured that not have any omission, really
Accomplishing to take clean calculus, indwelling T pipe gallbladder to be prevented leaks, and the most once patient is found to have biliary tract through T pipe radiography after surgery
During residual calculus, T pipe can be pulled out after tunnel, insert choledochoscope through sinus tract, take with lithotomy forceps, basket etc. under direct-view
Stone.Laser lithotripsy, micro-explosion rubble or additive method is used to further take out after residual stone is fragmented into fritter as calculus is excessive.
Preferably, step 3, before sending into stone extraction basket, first pass through control sliding button and move to right, utilize coupling spindle by basket
Folding, after sending into stone extraction basket, moves to left by controlling sliding button, allows basket launch；Meanwhile, basket deployed condition, internal spline
Gear and external splines gear separated position, by rotational slide pipe, control the first basket and the second basket near and away from shape
State switches.
Preferably, step 3, send into after stone extraction basket, by the inlet in inner tube, pour into disinfectant solution and complete to take stone and lead to
Road rinses；Same, by the inlet in inner tube, pour into contrast agent and complete to take stone passage radiography.
Use the invention operational approach of technique scheme, utilize one, two mirror, use the stone extraction basket designed alone, real
Now taking stone passage obstructed, stone extraction basket sends into bile duct, will not touch bile duct inwall, the painless and noninvasive wound of operation process, does not goes out
Blood, stone extraction basket can coordinate laparoscopic surgery very well, it is possible to integrates biliary tract stone extraction, flushing, radiography and expands, the easiest
There is biliary duct injury.
The present invention compared to existing technology, alleviates misery and financial burden to patient, and many again on Therapeutic Method
The selection of individuation.
Accompanying drawing explanation
The present invention can be further illustrated by the nonlimiting examples that accompanying drawing is given；
Fig. 1 is that thread associating Wicresoft of halieutics two mirror of the present invention protects the liver liver inside and outside bile duct stone rubble lithotomy axonometric chart；
Fig. 2 is that thread associating Wicresoft of halieutics two mirror of the present invention protects the liver liver inside and outside bile duct stone rubble lithotomy front view；
Fig. 3 is that thread associating Wicresoft of halieutics two mirror of the present invention protects the liver liver inside and outside bile duct stone rubble lithotomy left view；
Fig. 4 is A-A cross section view in Fig. 3；
Fig. 5 is the partial enlarged drawing of A in Fig. 4；
Fig. 6 is Fig. 4 (another kind of view)；
Main element symbol description is as follows:
Stone extraction basket 1, conduit 2, target seeker 3, the first basket 4, the second basket 5, outer tube 6, sliding tube 7, inner tube 8, feed liquor
Mouth 8a, liquid outlet 8b, be slidably connected part 9, the first terminal 10, the second terminal 11, coupling spindle 12, sliding button 13, resetting structure
14, banking stop 15, back-moving spring 16, catch 17.
Detailed description of the invention
In order to make those skilled in the art that the present invention be may be better understood, below in conjunction with the accompanying drawings with embodiment to this
Bright technical scheme further illustrates.
Embodiment one,
Such as Fig. 1, shown in Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, thread associating Wicresoft of halieutics two mirror protects the liver extrahepatic duct knot
Stone rubble lithotomy, including stone extraction basket 1, choledochoscope, peritoneoscope, stone extraction basket 1 includes conduit 2, is positioned in conduit 2 left end
Empty target seeker 3, is positioned at the basket on target seeker 3, and basket includes 4, at least 2 the second baskets 5 of at least 2 the first baskets, leads
Pipe 2 includes the outer tube 6 arranged from outside to inside, sliding tube 7, inner tube 8 and is slidably connected part 9, is slidably connected part 9 and includes the first terminal
10, the second terminal 11, for connecting the first terminal 10 and the coupling spindle 12 of the second terminal 11；
Inner tube 8 is hollow, and inner tube 8 left end connection target seeker 3, inner tube 8 right-hand member extends outer tube 6；
Sliding tube 7 is hollow, and sliding tube 7 sidewall is inlaid with coupling spindle 12, and coupling spindle 12 left end extends sliding tube 7, connection
Spindle 12 left end is provided with the second terminal 11 and the first terminal 10, and the second terminal 11 is near coupling spindle 12 left end, and fixing connection joins
Spindle 12, the first terminal 10 is away from coupling spindle 12 left end, and the first terminal 10 inwall is arranged at intervals with inside spline wheel gear, coupling spindle
12 outer walls are arranged at intervals with and the external splines gear of inside spline wheel gear coupling, and sliding tube 7 right-hand member is provided with for controlling coupling spindle 12
The sliding button 13 slided；
First basket 4 left end connects target seeker 3 left end, and the first basket 4 right-hand member connects the first terminal 10, and the second basket 5 is left
End connects target seeker 3 left end, and the second basket 5 right-hand member connects the second terminal 11；
Outer tube 6 is hollow, and outer tube 6 sidewall is provided with the first opening slided for the first basket 4, sliding for the second basket 5
The second dynamic opening.
Being provided with resetting structure 14 in sliding tube 7, resetting structure 14 is positioned at coupling spindle 12 left end.
Resetting structure 14 includes banking stop 15, back-moving spring 16 and catch 17, and back-moving spring 16 left end connects banking stop 15,
Its right-hand member connects catch 17, and catch 17 diameter is more than coupling spindle 12 diameter.
Catch 17 is provided with the first groove towards coupling spindle side.
Inner tube 8 right-hand member is provided with inlet 8a, and target seeker 3 is provided with liquid outlet 8b.
First basket 4 is 2, and the second basket 5 is 2, the first basket 4 and the second basket 5 cross-distribution, and forms cross
Shape.
The first a diameter of 0.4cm of basket 4, the first a length of 62cm of basket 4, the second a diameter of 0.6cm of basket 5, the second net
The a length of 66cm of basket 5.
Embodiment two,
Such as Fig. 1, shown in Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, thread associating Wicresoft of halieutics two mirror protects the liver extrahepatic duct knot
Stone rubble lithotomy, including stone extraction basket 1, choledochoscope, peritoneoscope, stone extraction basket 1 includes conduit 2, is positioned in conduit 2 left end
Empty target seeker 3, is positioned at the basket on target seeker 3, and basket includes 4, at least 2 the second baskets 5 of at least 2 the first baskets, leads
Pipe 2 includes the outer tube 6 arranged from outside to inside, sliding tube 7, inner tube 8 and is slidably connected part 9, is slidably connected part 9 and includes the first terminal
10, the second terminal 11, for connecting the first terminal 10 and the coupling spindle 12 of the second terminal 11；
Inner tube 8 is hollow, and inner tube 8 left end connection target seeker 3, inner tube 8 right-hand member extends outer tube 6；
Sliding tube 7 is hollow, and sliding tube 7 sidewall is inlaid with coupling spindle 12, and coupling spindle 12 left end extends sliding tube 7, connection
Spindle 12 left end is provided with the second terminal 11 and the first terminal 10, and the second terminal 11 is near coupling spindle 12 left end, and fixing connection joins
Spindle 12, the first terminal 10 is away from coupling spindle 12 left end, and the first terminal 10 inwall is arranged at intervals with inside spline wheel gear, coupling spindle
12 outer walls are arranged at intervals with and the external splines gear of inside spline wheel gear coupling, and sliding tube 7 right-hand member is provided with for controlling coupling spindle 12
The sliding button 13 slided；
First basket 4 left end connects target seeker 3 left end, and the first basket 4 right-hand member connects the first terminal 10, and the second basket 5 is left
End connects target seeker 3 left end, and the second basket 5 right-hand member connects the second terminal 11；
Outer tube 6 is hollow, and outer tube 6 sidewall is provided with the first opening slided for the first basket 4, sliding for the second basket 5
The second dynamic opening.
Being provided with resetting structure 14 in sliding tube 7, resetting structure 14 is positioned at coupling spindle 12 left end.
Resetting structure 14 includes banking stop 15, back-moving spring 16 and catch 17, and back-moving spring 16 left end connects banking stop 15,
Its right-hand member connects catch 17, and catch 17 diameter is more than coupling spindle 12 diameter.
Catch 17 is provided with the first groove towards coupling spindle side.
Inner tube 8 right-hand member is provided with inlet 8a, and target seeker 3 is provided with liquid outlet 8b.
First basket 4 is 2, and the second basket 5 is 2, the first basket 4 and the second basket 5 cross-distribution, and forms cross
Shape.
The first a diameter of 0.6cm of basket 4, the first a length of 64cm of basket 4, the second a diameter of 0.8cm of basket 5, the second net
The a length of 68cm of basket 5.
The difference of above-described embodiment one and embodiment two is, for relative embodiment one, and the first basket in embodiment two
A length of 64cm, the first a length of 68cm of basket, basket overall dimensions is longer than in embodiment one, meets the various clinical need of doctor
Want.
Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy operational approach, including following step
Suddenly,
Step one, gets involved, and cuts the aperture of 1cm, it is ensured that can send into stone extraction basket；
Step 2, detects, and sets up and takes stone passage, it is ensured that takes stone passage unobstructed；
Step 3, takes stone, sends into stone extraction basket, utilizes stone extraction basket to realize trawlnet and takes out；
Step 4, checks, and sends into choledochoscope, utilizes choledochoscope to carry out 360 ° and comprehensive detect, really taking stone channel interior
Guarantor will not omit calculus；
Step 5, closes abdomen, sends into peritoneoscope, utilizes peritoneoscope to carry out 360 ° outside stone passage comprehensive detect, really taking
Guarantor will not omit calculus.
Preferably, step 3, before sending into stone extraction basket, first pass through control sliding button and move to right, utilize coupling spindle by basket
Folding, after sending into stone extraction basket, moves to left by controlling sliding button, allows basket launch；Meanwhile, basket deployed condition, internal spline
Gear and external splines gear separated position, by rotational slide pipe, control the first basket and the second basket near and away from shape
State switches.
Preferably, step 3, send into after stone extraction basket, by the inlet in inner tube, pour into disinfectant solution and complete to take stone and lead to
Road rinses；Same, by the inlet in inner tube, pour into contrast agent and complete to take stone passage radiography.
Stone extraction basket of the present invention is applicable to take out cholelithiasis or the foreign body of inside and outside bile duct.The invention have the characteristics that: first,
The basket structure that can switch, is more convenient for extracting inside and outside calculus of bile duct；Second, the inner tube of hollow, by inlet, facilitate smooth and easy note
Enter disinfectant solution, contrast agent；3rd, sliding tube designs, and has push-and-pull and spinfunction, it is simple to sends into stone extraction basket in micropore, makes
Calculus grasping manipulation is more easily effectively；4th, cross basket, take stone and release very comfortable, facilitate in art and repeatedly pick and place；
5th, utilize coupling spindle by basket folding, stop basket and drag and get rid of the strike to bile duct wall；The of 6th, a diameter of 0.4-0.6cm
One basket, second basket of a diameter of 0.6-0.8cm, Multiple Type customization service, more meet the various clinical needs of doctor.
Operating theater instruments and equipment needed for the present invention: operating theater instruments includes that electric celioscope equipment is a set of, fiber endoscopy one
Set, hard mirror is a set of, light source, camera system, bedside B ultrasonic machine, lithotomy forceps, stone extraction basket (cook) expandable balloon seal wire, adjustable
Water-delivery pump, Bladder stone or pneumatic ballistic lithotriptor etc..
The concrete operation method of the present invention is as follows,
Preoperative planning and preparation:
1. imaging examination
(1) ultrasound diagnosis
For woundless testing, convenient and easy, it is the prefered method of diagnosis of intrahepatic calculosis.Typically at the gallbladder of calculus far-end
Pipe has expansion just can make the diagnosis of calculus of intrahepatic duct, because the calcification of liver duct system also has the shadow table of calculus sample
Existing.
(2) CT MRCP check
Mainly contain the pigmented calculus of calcium bilirubinate because of calculus of intrahepatic duct, the content of calcium is higher, therefore at CT photo energy
Clearly illustrate out.CT can also demonstrate the position of hepatic portal, cholangiectasis and liver hypertrophy, the change of atrophy, systematically sees
Examine every aspect, it will be appreciated that the situation that calculus is distributed at stones in intrahepatic bile duct.Bile in biliary system belongs to the liquid of geo-stationary
Body, MRCP can clearly show the morphosis of biliary system.
(3) x-ray cholangiography
It is the classical way for diagnosis of intrahepatic calculosis, generally individually can make correct diagnosis.X-ray cholangiography should
Meeting diagnosis and the needs of operation, a good cholangiography sheet should be able to fully understand that the anatomy of stones in intrahepatic bile duct system becomes
The different distribution with calculus.
(4) endoscopic retrograde cholangiopancreatography (ERCP) (ERCP), biliary tract primary and secondary mirror, choledochoscope inspection have clear and definite examining to calculus of intrahepatic duct
Break and therapeutic value.
2. other auxiliary examinations
(1) manometry of biliary tract
It will be seen that bile passes through biliary excretion by manometry of biliary tract the most normal.For a certain branch stones in intrahepatic bile duct knot
Stone, the clinical meaning of manometry of biliary tract is little.But to left and right common hepatic duct close to hepatic portal position calculus accompany stenosis of bile duct, it is possible to find bile
Draining bad, cause cholangiectasis, bile retention above pathological changes, pressure of biliary tract increases.Have now electronics biliary tract measuring cell
The accurate pressure measured in bile duct, should select to use according to the state of an illness.
(2) radioisotope scanning
Conventional nucleic 99mTe, after being injected intravenously after reticuloendothelial system absorbs, drains into biliary tract.Can be layered during scanning,
Fixed point, it is thus achieved that 3-D view, display and the relation of proximity structure, provide preferable foundation to diagnosis.But to calculus of intrahepatic duct
Diagnosis undesirable.
(3) selective celiac arteriography observes whether arteries exists displacement, pressurized, interruption and abnormal vascular shadow.
Effective for Differential Diagnosis hepatobiliary cancer, carcinoma of gallbladder, but the diagnosis to calculus of intrahepatic duct is undesirable.And angiography is wanted
Asking certain equipment, complex operation, technical conditions require height, not as the prefered method of calculus of intrahepatic duct.
The various preoperative routine examinations such as blood biochemistry to be done immunity, get rid of the general surgical contraindication performed the operation and protect the liver
Take stone surgical contraindication and anesthesia contraindication, it is contemplated that thread associating Wicresoft of row halieutics two mirror protects the liver liver inside and outside bile duct stone
Rubble lithotomy.
Case one
Patient uses trachea general anesthesia intubation, dorsal position, takes umbilicus lower edge otch and enters puncture casing, enters laparoscopic visualization gallbladder big
Adhesion situation, common bile duct situation under little, position, liver, determine that thread associating Wicresoft of row halieutics two mirror protects the liver extrahepatic duct knot
Stone rubble lithotomy, enters Trocar (10mm), then under right rib at the bottom of nearly gallbladder under upper hunter's line sword with umbilicus line midpoint
A Trocar (5mm) is entered in portion again.Under peritoneoscope, enter band line suture needle, tie round ligament of liver one pin, then near under right rib
Enter hernia pin by Trocar, suture is drawn, mentions liver, in upper abdomen sleeve pipe, fill in 2 pieces of yarn blocks, be respectively placed under liver and gallbladder is total
Push downwards duodenum by pipe open, fully appear common bile duct, be then hooked in common bile duct antetheca by coagulation and cut about 0.8cm size and cut
Mouthful, see and have bile to overflow, pull out right rib setting of casing, enter 16Fr renal fibroblast set sheath pipe and enter common bile duct, pull out inner core, enter soft through sheath pipe
Matter choledochoscope is gone directly stones in intrahepatic bile duct by common bile duct, by stones in intrahepatic bile duct balloon expandable stones in intrahepatic bile duct, expands stones in intrahepatic bile duct internal diameter,
Unobstructed taking stone passage, utilize flushing system, can be gone out through sheath pipe by major part microlith, remaining relatively maximum size can be extracted with basket,
As calculus size 1cm and more than, go out through sheath pipe after available Ho.YAG laser lithotripsy, be sized and (use bedside B if desired without residual stones
Onlap and look into).Exit choledochoscope, extract sheath pipe, reinsert Trocar, utilize suturing skill under peritoneoscope, close bottom gallbladder
Otch, decides whether to place Subhepatic drainage pipe and T Tube Drain depending on concrete condition.Microscopic observation liver gallbladder situation and common bile duct seam
Situation after conjunction, finally releases pneumoperitoneum, closes abdominal incision, and art finishes.
Using the present invention the most thoroughly to remove calculus of intrahepatic duct, operation whole process visually descends endoscopic technic, nothing at video
Bitterly, hurtless measure, without hemorrhage, the most thoroughly cure calculus of intrahepatic duct, keep normal liver organization.
Thread associating Wicresoft of halieutics two mirror provided the present invention above protects the liver liver inside and outside bile duct stone rubble lithotomy
It is described in detail.The explanation of specific embodiment is only intended to help to understand method and the core concept thereof of the present invention.Should
Point out, for those skilled in the art, under the premise without departing from the principles of the invention, it is also possible to this
Bright carrying out some improvement and modification, these improve and modify in the protection domain also falling into the claims in the present invention.
Claims (10)
1. thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy, it is characterised in that: include taking stone
Basket, choledochoscope, peritoneoscope, described stone extraction basket includes conduit, is positioned at the target seeker of the hollow of conduit left end, is positioned at target seeker
On basket, described basket includes at least 2 the first baskets, at least 2 the second baskets, and described conduit includes arranging from outside to inside
Outer tube, sliding tube, inner tube and be slidably connected part, described in be slidably connected part and include the first terminal, the second terminal, for connection
One terminal and the coupling spindle of the second terminal；
Said inner tube is hollow, and said inner tube left end connection target seeker, said inner tube right-hand member extends outer tube；
Described sliding tube is hollow, and described sliding tube sidewall is inlaid with coupling spindle, and described coupling spindle left end extends sliding tube, institute
Stating coupling spindle left end and be provided with the second terminal and the first terminal, described second terminal is near coupling spindle left end, and fixing connection couples
Axle, described the first terminal is away from coupling spindle left end, and the first terminal inwall is arranged at intervals with inside spline wheel gear, between coupling spindle outer wall
Every being provided with and the external splines gear of inside spline wheel gear coupling, described sliding tube right-hand member is provided with for controlling the cunning that coupling spindle slides
Dynamic button；
Described first basket left end connects target seeker left end, and described first basket right-hand member connects the first terminal, described second basket
Left end connects target seeker left end, and described second basket right-hand member connects the second terminal；
Described outer tube is hollow, and described outer tube wall is provided with the first opening slided for the first basket, sliding for the second basket
The second dynamic opening.
Thread associating Wicresoft of halieutics two mirror the most according to claim 1 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: be provided with resetting structure in described sliding tube, described resetting structure is positioned at coupling spindle left end.
Thread associating Wicresoft of halieutics two mirror the most according to claim 2 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: described resetting structure includes banking stop, back-moving spring and catch, described back-moving spring left end connects banking stop,
Its right-hand member connects catch, and described catch diameter is more than coupling spindle diameter.
Thread associating Wicresoft of halieutics two mirror the most according to claim 3 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: described catch is provided with the first groove towards coupling spindle side.
Thread associating Wicresoft of halieutics two mirror the most according to claim 4 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: said inner tube right-hand member is provided with inlet, described target seeker is provided with liquid outlet.
Thread associating Wicresoft of halieutics two mirror the most according to claim 5 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: described first basket is 2, described second basket is 2, and described first basket and the second basket intersect and divide
Cloth, and form cross.
7. protect the liver extrahepatic duct according to thread associating Wicresoft of halieutics two mirror described in claim 1 or 2 or 3 or 4 or 5 or 6
Calculus rubble lithotomy, it is characterised in that: the described first a diameter of 0.4-0.6cm of basket, the described first a length of 62-of basket
64cm, the described second a diameter of 0.6-0.8cm of basket, the described first a length of 66-68cm of basket.
8. thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy operational approach, it is characterised in that:
Comprise the following steps,
Step one, gets involved, and cuts the aperture of 1cm, it is ensured that can send into stone extraction basket；
Step 2, detects, and sets up and takes stone passage, it is ensured that takes stone passage unobstructed；
Step 3, takes stone, sends into stone extraction basket, utilizes stone extraction basket to realize trawlnet and takes out；
Step 4, checks, and sends into choledochoscope, utilizes choledochoscope to carry out 360 ° and comprehensive detect taking stone channel interior, it is ensured that no
Calculus can be omitted；
Step 5, closes abdomen, sends into peritoneoscope, utilizes peritoneoscope to carry out 360 ° outside stone passage comprehensive detect taking, it is ensured that no
Calculus can be omitted.
Thread associating Wicresoft of halieutics two mirror the most according to claim 8 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: step 3, send into before stone extraction basket, first pass through control sliding button and move to right, utilize coupling spindle by basket folding,
After sending into stone extraction basket, move to left by controlling sliding button, allow basket launch；Meanwhile, basket deployed condition, inside spline wheel gear and
External splines gear separated position, by rotational slide pipe, control the first basket and the second basket near and away from state switch.
Thread associating Wicresoft of halieutics two mirror the most according to claim 9 protects the liver liver inside and outside bile duct stone rubble lithotomy,
It is characterized in that: step 3, after sending into stone extraction basket, by the inlet in inner tube, pour into disinfectant solution and complete to take the punching of stone passage
Wash；Same, by the inlet in inner tube, pour into contrast agent and complete to take stone passage radiography.
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| CN201610574783.3A CN106264664A (en) | 2016-07-20 | 2016-07-20 | Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610574783.3A CN106264664A (en) | 2016-07-20 | 2016-07-20 | Thread associating Wicresoft of halieutics two mirror protects the liver liver inside and outside bile duct stone rubble lithotomy |
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| CN112842468A (en) * | 2019-01-23 | 2021-05-28 | 薛峰 | Calculus removing device for hepatobiliary surgery |
| CN109620397A (en) * | 2019-01-31 | 2019-04-16 | 郑州大学第附属医院 | Fine biliary tract cuts device under a kind of laparoscope |
| WO2021120178A1 (en) * | 2019-12-20 | 2021-06-24 | 南微医学科技股份有限公司 | Minimally invasive surgical extraction instrument |
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Application publication date: 20170104 |