CN108926364A - Device is established in tunnel after a kind of liver monitored - Google Patents
Device is established in tunnel after a kind of liver monitored Download PDFInfo
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- CN108926364A CN108926364A CN201810691700.8A CN201810691700A CN108926364A CN 108926364 A CN108926364 A CN 108926364A CN 201810691700 A CN201810691700 A CN 201810691700A CN 108926364 A CN108926364 A CN 108926364A
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- 230000005641 tunneling Effects 0.000 claims abstract description 23
- 238000012806 monitoring device Methods 0.000 claims abstract description 21
- 238000012544 monitoring process Methods 0.000 claims abstract description 16
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
-
- 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
- A61B2017/0034—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means adapted to be inserted through a working channel of an endoscope
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
-
- 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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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Engineering & Computer Science (AREA)
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- Biophysics (AREA)
- Optics & Photonics (AREA)
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- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
- Endoscopes (AREA)
Abstract
Device is established in tunnel after the present invention provides the liver that one kind can monitor, it includes that operating stick, in vivo fixed guidance device and external secured adjusted device are established in tunnel that device is established in tunnel after the liver monitored, it includes monitoring device and anatomic tissue device that operating stick is established in the tunnel, monitoring device is used for the foundation in tunnel after real-time monitoring liver, anatomic tissue device establishes tunnel after liver for carrying out separation dissection to liver post gap.The present invention is after establishing liver in tunneling process, monitoring device is protruded into inside liver post gap, the anatomical isolation of real-time monitoring liver post gap tissue, considerably reduce the blindness operated in tunneling process after establishing liver, simultaneously using fixed guidance device and external secured adjusted device in vivo guarantee tunnel establish operating stick direction of advance it is consistent with tunnel center longitudinal axis after liver, offset direction is avoided, Oral Ganduqing liquior is avoided damage to, it is ensured that tunnel is created as power after liver.
Description
Technical field
The present invention relates to medical instruments field, device is established in tunnel after more specifically to a kind of liver that can be monitored.
Background technique
Hepatocellular carcinoma is one of most common malignant tumour in world wide, and disease incidence and the death rate occupy malignant tumour
Forefront.Currently, liver cancer it is most effective and uniquely be possible to cure treatment method be still hepatectomy.In open surgery
Middle safety carries out the excision of right half liver, most there is tunnel around band technology (lifting technology around liver) after the liver created with Belghiti
With the domestic refined window professor of Peng introduces and improved.Tunnel is based on liver post gap around band technology (lifting technology around liver) after liver
Special anatomical features.Tunnel refers to that a blood vessel between liver back segment inferior caval vein and liver parenchyma is relatively small number of latent after liver
In property gap, suitable for reading is vena hepatica filling nest, and lower mouth is caudate lobe rear after liver, the crack in front of inferior caval vein, and gap width is flat
About 1cm, upper and lower diameter about 7cm.
Using tunnel after liver around band technology (i.e. around liver lift technology) key be to establish liver after tunnel, current main foundation
Belghiti is created, the domestic refined window professor of Peng introduces the standard diameter path method illustrated and establishes tunnel after liver.Using tunnel after liver around
Band technology (i.e. around liver lift technology), the liver that can rive under anterior approach center are split, thus exposure Oral Ganduqing liquior, right hepatic veins again from
It is disconnected, also avoid damage to inferior caval vein；Keep liver section minimum, most thin simultaneously, and controllable section bleeding；In addition avoid extruding liver swollen
Tumor.At present after establishing liver in tunneling process, mainly with big curved hemostat along the avascular area cephalad in liver post gap center
Vein lacuna passivity promotes, and joins forces foundation under finger guidance.This method is mainly carried out according to the experience of operator, is had
Certain " blindness ", has damage the possibility of Oral Ganduqing liquior.Oral Ganduqing liquior is damaged to reduce, many scholars improve standard pathway side
Method, but improve and substantially only shorten standard pathway, it is last or to be penetrated through using big curved hemostat, with very big " blind
Mesh ", can not tunnel is established after real-time monitoring liver process, there are biggish risks, it is easy to damage Oral Ganduqing liquior, cause
Operative failure.
In addition, tunnel after liver is established under laparoscope to be guided with finger, just in case damage Oral Ganduqing liquior, not only because of nothing
Method oppresses easily big bleeding with hand, and high pressure pneumoperitoneum is easy to form aeroembolism.Therefore the big curved hemostat of above-mentioned application penetrates through standard
The method of pathway is not appropriate for establishing tunnel after liver under laparoscope.Some scholars are attempted under laparoscope, using golden finger or nose
Stomach tube establishes tunnel after liver, but this method is only it is observed that liver post gap caudal initial part, can not observe among liver post gap
Portion and cephalic region, tunnel still has certain " blindness " after liver is directly established in guidance.
Summary of the invention
It is the problems such as risk is high, to be solved by this invention for existing tunneling technique of establishing after liver there are larger blindness
Device is established in tunnel after technical problem is to provide the liver that one kind can monitor, which can be monitored in real time the mistake of tunnel foundation after liver
Journey considerably reduces the blindness operated in tunneling process after establishing liver, effectively increases the success rate of operation, improves simultaneously
The accuracy of operation, the safety of effective guarantee operation.The present invention is applicable not only to human body, is also applied for other animals, packet
It includes: partially there is the experimental animal of tunnel structure after liver similar with the mankind, such as dog.
To solve technical problem of the invention, the present invention is adopted the following technical scheme that:
Device is established in tunnel after a kind of liver monitored, and it includes that operating stick, body are established in tunnel that device is established in tunnel after the liver
Interior fixed guidance device and external secured adjusted device, it includes monitoring device and anatomic tissue dress that operating stick is established in the tunnel
It sets, the monitoring device is used for the foundation in tunnel after real-time monitoring liver, and the anatomic tissue device is used for liver post gap
Separation dissection is carried out, tunnel after liver is established, the internal fixed guidance device is established by the first restraint device and tunnel and grasped
Make bar connection, fixed guidance device is used to fix in vivo, guide tunnel establishes operating stick, and tunnel is made to establish operating stick tunnel after liver
It is consistent with tunnel center longitudinal axis after liver in road establishment process；The external secured adjusted device passes through the second restraint device and body
Interior fixed guidance device connection, for external secured adjusted device for adjusting and fixing guidance device in fixed body, described is external
Secured adjusted device establishes operating stick by adjusting internal fixed guidance device to control tunnel, so that operating stick edge is established in tunnel
After liver tunnel advance from the standard pathway direction of caudal cephalad, establish tunnel after liver.Device is established in tunnel after the liver
It may be implemented after establishing liver in tunneling process, monitoring device protruded into inside liver post gap, real-time monitoring liver post gap tissue
Anatomical isolation, considerably reduce the blindness operated in tunneling process after establishing liver, effectively increase the success rate of operation,
After guaranteeing that direction of advance and the liver of operating stick are established in tunnel using internal fixed guidance device and external secured adjusted device simultaneously
Tunnel center longitudinal axis is consistent, avoids offset direction, it is ensured that tunnel is created as power after liver, while avoiding damage to Oral Ganduqing liquior, really
Safety is established in tunnel after liver protection.
The external secured adjusted device is at optimum bit for adjusting and fixing guidance device in fixed body
It sets, i.e., inferior caval vein and its caudal infrahepatic vena cava antetheca after the corresponding liver of tunnel initial part after abutting liver, in the longitudinal direction of bottom surface
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after line liver corresponding with tunnel initial part after liver.To
It is consistent with tunnel center longitudinal axis after liver in tunnel establishment procedure after liver to ensure that operating stick is established in tunnel, and along tunnel after liver
Advance from the standard pathway direction of caudal cephalad, establishes tunnel after liver.
The internal fixed guidance device is used to fix, guide tunnel establishes " fixation " in operating stick, not makes tunnel
It is fixed that operating stick is established in road, but so that tunnel is established operating stick and is capable of fixing and be maintained at consistent with tunnel center longitudinal axis after liver
Position, and then guide tunnel establishes operating stick along set direction, establishes tunnel after liver.Operating stick is established in the tunnel
After establishing liver in tunneling process, it can fix in vivo inside guidance device do and rotate and/or move forward and backward, it can also be with
It is left and right, above and below to the adjustment done by a small margin.Tunnel is usually Oral Ganduqing liquior to be not present, but when structure has variation has after liver
Oral Ganduqing liquior appears in after liver in tunnel, therefore operating stick is established after establishing liver in tunneling process in the tunnel, Neng Gou
Left and right, the upper and lower movement done by a small margin, gets around the Oral Ganduqing liquior after appearing in liver in tunnel, avoids damage to Oral Ganduqing liquior, really
Safety is established in tunnel after liver protection.
Device is established in tunnel after the liver monitored, fixes and guide " tunnel using " fixing guidance device in vivo "
Operating stick is established in road ", and " fixing guidance device in vivo " is further adjusted using " external secured adjusted device ", thus
It is consistent with tunnel center longitudinal axis after liver to ensure " operating stick is established in tunnel ", and along the direction of tunnel standard routes after liver, avoids
Oral Ganduqing liquior is damaged, tunnel after accurately establishing liver can be monitored down, avoids and comes in the prior art by the experience of operator
Establish after liver risk that may be present and blindness in tunneling process, greatly improve success rate that tunnel after liver is established and
Safety.
Further, the tunnel establishes operating stick, fixes guidance device and external secured adjusted device in vivo non-
When use state, exist with scattered state to be matched；In use state, it is assembled into assembly.
The tunnel is established operating stick, internal fixed guidance device and external secured adjusted device and is used under laparoscope
When, each component is put into intraperitoneal one by one, then carries out assembling use in abdominal cavity.
Operating stick, internal fixed guidance device and external secured adjusted device are established in the tunnel to be consolidated
Surely it fits together, directly puts intraperitoneal be operated into open surgery.
Further, the stock that operating stick is inner hollow is established in the tunnel, after tunnel is established after liver, by tunnel
It establishes operating stick to stay in after liver in tunnel, for placing around liver band, avoids placing secondary damage liver when around liver band.
Further, the monitoring device is choledochoscope, and the anatomic tissue device is hollow stem, the choledochoscope front end
Software part can be placed into inside hollow stem, and can be done in inside and be rotated and/or move forward and backward, the tunnel establishment procedure after liver
In, the choledochoscope and hollow stem cooperative motion, the choledochoscope front end software part flushed with hollow stem in preceding inlet side or
Expose the preceding inlet side of hollow stem.
Further, the top of the choledochoscope front end software part and the preceding inlet side end distance of hollow stem are 0.5cm-
1.5cm。
Under the monitoring of choledochoscope, tissue is dissected with hollow stem, is encountered at dense structure, choledochoscope soft body is passed through
The flexion-extension motion Blunt dissection tissue at sub-headend position, hollow stem and choledochoscope software part from caudal cephalad cooperative motion,
To penetrate through entire liver post gap, tunnel after liver is finally established.After tunnel is established after liver, choledochoscope is extracted, hollow stem is stayed
After liver in tunnel, in favor of placing around liver band.
Further, the monitoring device is miniature webcam, and the anatomic tissue device is hollow stem, described miniature
Camera is arranged inside hollow stem, and the miniature webcam is connected with control-rod, and control-rod is for controlling miniature webcam
It rotation inside hollow stem and/or moves forward and backward, after liver in tunnel establishment procedure, the miniature webcam is in control-rod
Operation is lower and hollow stem cooperative motion, the top of the preceding inlet side of the miniature webcam flush with hollow stem or expose in described
The preceding inlet side of empty bar；Preferably, the miniature video camera overhead and the preceding inlet side threshold value of hollow stem are 0.5cm-1.5cm.
Further, the hollow stem is internally provided with for rinsing the blood group liquid generated in anatomic tissue separation process
The water flow flusher of body, the water flow flusher are arranged inside hollow stem, and miniature webcam is made to be in clear state.
Further, the water flow is physiological saline.
Further, liquid extracting device is additionally provided with inside the hollow stem, the liquid extracting device is used for
Extract the liquid that the bloody fluid generated in anatomic tissue separation and water flow flusher generate during the rinsing process.
Under the monitoring of miniature webcam, tissue is dissected with hollow stem, encounters at dense structure, passes through control-rod
Operate miniature webcam, with the flexion-extension motion Blunt dissection tissue at miniature webcam front end position, hollow stem and miniature webcam
From caudal cephalad cooperative motion, to penetrate through entire liver post gap, tunnel after liver is finally established.After tunnel is established after liver,
Miniature webcam is extracted with control-rod, hollow stem is stayed after liver in tunnel, in favor of placing around liver band.
Further, the monitoring device and anatomic tissue device are miniature webcam, and the miniature webcam is set
It sets in anterior end of hollow bar, the miniature webcam can be dismantled from anterior end of hollow bar.
Further, there are gaps for the coupling part of the miniature webcam and hollow stem, rinse for water flow to be arranged
Device, the water flow flusher are arranged inside hollow stem, across the gap, separated for rinsing anatomic tissue
The bloody fluid generated in journey makes miniature webcam be in clear state, convenient for monitoring.
Further, the water flow is physiological saline.
Further, liquid extracting device is additionally provided with inside the hollow stem, the liquid extracting device passes through
The gap produces during the rinsing process for extracting the bloody fluid generated in anatomic tissue separation and water flow flusher
Raw liquid.
After liver tunnel establish after, miniature webcam is dismantled, stays hollow stem after liver in tunnel, in favor of place around
Liver band.
Further, the section morphology of the hollow stem is round or oval, and the length of the hollow stem is 80-
The diameter of section of 120mm, the hollow stem are 3-6mm, and the hollow stem can generate small size bending, to adapt to tunnel after liver
Cephalic region is bent from back to front existing for the sagittal plane direction corresponding with inferior caval vein antetheca longitudinal midline after liver, it is described in
The material of empty bar is selected from one of silica gel, latex, plastics or a variety of.
Further, the section morphology of the hollow stem is circle.
Further, first restraint device is the first hole slot, and operating stick is established through entire the in the tunnel
One hole slot, and can be done in the first hole slot and rotate and/or move forward and backward, after establishing liver in tunneling process, first hole
Slot direction is consistent with tunnel center longitudinal axis after liver.
Further, the first hole slot most lower edge is 1.0- at a distance from internal fixed guidance device bottom plane
1.5mm facilitates tunnel after establishing liver.
Further, the front end of the internal fixed guidance device is flat, tunnel after the flat front end insertion liver
Road initial part, for fixing, guide tunnel establish operating stick along set direction, establish tunnel after liver.
Further, the internal fixed guidance device is the flat strip structure in front end, the flat front end
For small cuboid, main part is big cuboid, and the bottom surface of the small cuboid and big cuboid is in same level,
After establishing liver in tunneling process, infrahepatic vena cava antetheca is close in the bottom surface of the small cuboid and big cuboid, i.e., tightly
Inferior caval vein and its caudal infrahepatic vena cava antetheca after the corresponding liver of tunnel initial part are pasted after liver, after bottom surface longitudinal midline and liver
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after the corresponding liver of tunnel initial part, and described is small rectangular
Body and big cuboid it is of same size, first hole slot is along the length direction of small cuboid and big cuboid through entire
Fixed guidance device in vivo, the small cuboid is inserted into tunnel initial part after liver, for guaranteeing that operating stick and liver are established in tunnel
Tunnel center longitudinal axis is consistent afterwards.
Further, the bottom surface that small cuboid and big cuboid are close to inferior caval vein antetheca be it is arc-shaped, make solid in vivo
Determine guidance device and is more bonded inferior caval vein antetheca.
Further, a length of 5-10mm of the small cuboid, width 8-15mm are highly 8-10mm, described
The length of big cuboid is 10-30mm, is highly 10-15mm, width is identical as small cuboid.
Further, the external secured adjusted device includes fixed link and secured adjusted device, the fixed link
It is connect by the second restraint device with internal fixed guidance device, the secured adjusted device is fixedly connected with operating bed, institute
Tightly the fixed link stated makes the fixed guidance device of operating stick be in operating position, i.e., for fixing guidance device in secured adjusted body
Inferior caval vein and infrahepatic vena cava antetheca after the corresponding liver of tunnel initial part are pasted after liver, so that tunnel is established operating stick and is establishing liver
It is consistent with tunnel center longitudinal axis after liver afterwards in tunneling process.
Further, the fixed link is solid straight-bar, and the section of the solid straight-bar is circle, described circular straight
Diameter is 2-5cm, and the length of the solid straight-bar is 200-300mm.
Further, second restraint device is the second hole slot, and the fixed link passes through through the second hole slot
Mode is connect with internal fixed guidance device.
Further, it is vertical with tunnel to establish operating stick for the second hole slot direction.
Further, the material that is made that device is established in tunnel after the liver is selected from stainless steel, plastics, silica gel, latex, pottery
One of porcelain, alloy are a variety of.
The purposes of device is established in tunnel after the liver monitored, for establishing tunnel or laparoscope thyroid gland by liver
It performs the operation, indirect inguinal hernia is performed the operation, the foundation of the hypodermic tunnel of breast operation.
The operating method of device is established in tunnel after the liver that can be monitored:
(1) it is intraperitoneal that guidance device merging will be fixed in vivo；
(2) external secured adjusted device is connect by the second restraint device with internal secured adjusted device；
(3) fixed guidance device in vivo is adjusted with external secured adjusted device, is adjusted to optimum position, i.e., after abutting liver then
Tunnel originates after inferior caval vein and its caudal infrahepatic vena cava antetheca after the corresponding liver of road initial part, bottom surface longitudinal midline and liver
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after the corresponding liver in portion, to guarantee that operation is established in tunnel
Bar is consistent with tunnel center longitudinal axis after liver in tunneling process after establishing liver, after the front end insertion liver of internal fixed guidance device
Tunnel initial part, then locks；
(4) operating stick is established in tunnel to connect by the first restraint device with internal fixed guidance device, is built by controlling tunnel
Vertical operating stick establishes tunnel after liver.
System, the liver monitored are established in tunnel after the liver that can be monitored a second object of the present invention is to provide one kind
Device is established in tunnel after the above-mentioned any type of liver monitored of system is established in tunnel afterwards, still further comprises laparoscopic apparatus
And/or B ultrasound, after the liver monitored tunnel establish device can under the monitoring of laparoscopic apparatus and/or B ultrasound guide into
The foundation in tunnel after row liver.
The purposes of system is established in tunnel after the liver monitored, for establishing tunnel or laparoscope thyroid gland hand by liver
Art, indirect inguinal hernia operation, breast operation hypodermic tunnel foundation.
Beneficial effects of the present invention are as follows:
(1) tunnel establishes device and may be implemented to stretch monitoring device after establishing liver in tunneling process after liver of the present invention
Enter inside liver post gap, the anatomical isolation of real-time monitoring liver post gap tissue overcomes tunneling technique after establishing liver in the prior art
Existing blindness, high risk quickly, simplicity, can safely establish tunnel after liver under monitoring device.
(2) device is established in tunnel after the liver of the present invention monitored, is fixed using " fixing guidance device in vivo "
With guidance " operating stick is established in tunnel ", and further adjusted using " external secured adjusted device " " fixed in vivo to guide
Device ", so that it is guaranteed that " operating stick is established in tunnel " is consistent with tunnel center longitudinal axis after liver, and along tunnel standard routes after liver
Direction avoids damage to Oral Ganduqing liquior, can monitor down tunnel after accurately establishing liver, avoids in the prior art by operator
Experience establish after liver risk that may be present and blindness in tunneling process, greatly improve what tunnel after liver was established
Success rate and safety.
(3) present invention can not only use in open surgery, can also use, be efficiently solved in abdomen under laparoscope
Under hysteroscope, the problem of not being available tunnel after big curved hemostat perforation liver, realizes and (adopted when necessary under the big visual field of laparoscope
Guided with B ultrasound), device is established using tunnel after the liver monitored in the present invention, observes liver post gap middle part and cephalic region,
Effectively improve the success rate of operation.
(4) the biggish device of assembled figure can not be integrally placed into intraperitoneal, institute of the present invention under laparoscope
It is simple to establish apparatus structure for tunnel after the liver monitored stated, main component " operating stick is established in tunnel ", " fixed in vivo to guide dress
Set " and " external secured adjusted device " be not fixedly assembled using preceding, at tunnel after needing to establish liver, carry out group
Then dress is assembled in use, each component is put into one by one intraperitoneal under laparoscope in abdominal cavity, easy to operate,
Securely and reliably.
(5) present invention can be not only used for establishing tunnel after liver, can be also used for establishing tunnel by liver, also can be applied to
The foundation of other hypodermic tunnels, such as the hypodermic tunnel of the operation of laparoscope thyroid operation, indirect inguinal hernia, breast operation are established
Deng.
Detailed description of the invention
Fig. 1 is that device overall schematic is established in tunnel after the liver that can be monitored；
Fig. 2 is that operating stick schematic diagram is established in tunnel；
Fig. 3 is internal fixed guidance device schematic diagram；
Fig. 4 is external secured adjusted schematic device.
In figure: 1, operating stick is established in tunnel, and 2, fix guidance device in vivo, 3, external secured adjusted device, 4, hollow stem,
5, miniature webcam, 6, control-rod, 7, water flow flusher, 8, gap, the 9, first hole slot, the 10, second hole slot, 11, fixed link,
12, secured adjusted device, 13, small cuboid, 14, big cuboid, the 15, first restraint device, the 16, second restraint device.
Specific embodiment
Present invention will be further explained below with reference to specific examples.It should be understood that these embodiments are merely to illustrate this hair
It is bright rather than limit the scope of the invention.In addition, it should also be understood that, after the content for having read instruction of the invention, this field skill
Art personnel can make various changes or modifications the present invention, and such equivalent forms equally fall within the application the appended claims institute
The range of restriction.
Embodiment 1
Fig. 1 is that device overall schematic is established in tunnel after the liver that can be monitored, and it includes that tunnel is built that device is established in tunnel after the liver
Vertical operating stick (1) fixes guidance device (2) and external secured adjusted device (3) in vivo, and it includes prison that operating stick (1) is established in tunnel
Device and anatomic tissue device are surveyed, monitoring device is used for the foundation in tunnel after real-time monitoring liver, and anatomic tissue device is used for liver
Post gap carries out separation dissection, establishes tunnel after liver, fixes guidance device (2) in vivo and passes through the first restraint device (15) and tunnel
Establish operating stick (1) connection, for fixing, guide tunnel establish operating stick (1), make its after liver in tunnel establishment procedure with liver
Tunnel center longitudinal axis is consistent afterwards, and along set direction, establishes tunnel after liver, external secured adjusted device (3) passes through second
Restraint device (16) is connect with internal fixed guidance device (2), for adjusting and fixing guidance device (2) in fixed body, in vitro
Secured adjusted device (3) establishes operating stick (1) by adjusting internal fixed guidance device (2) further to control tunnel, makes
It advances along tunnel after liver from the standard pathway direction of caudal cephalad, establishes tunnel after liver.Tunnel is established after above-mentioned liver
Device may be implemented after establishing liver in tunneling process, and monitoring device is protruded into inside liver post gap, real-time monitoring liver post gap
The anatomical isolation of tissue, at the same guarantee tunnel establish operating stick (1) direction of advance it is consistent with tunnel center longitudinal axis after liver, avoid
Damage Oral Ganduqing liquior.
Fig. 2 is that operating stick schematic diagram is established in tunnel, and operating stick is established in tunnel, and by different operating environments, there are three types of forms:
(1) monitoring device described in is choledochoscope, and anatomic tissue device is hollow stem (4), and choledochoscope soft body is split into hollow
Bar (4) is internal, and can do in inside and rotate and/or move forward and backward, after liver in tunnel establishment procedure, choledochoscope and hollow stem
(4) cooperative motion, choledochoscope software part flush with hollow stem (4) or expose described hollow stem (4) the preceding inlet side in preceding inlet side；
Preferably, hollow stem (4) preceding inlet side 0.5cm-1.5cm is exposed in preceding inlet side in choledochoscope software part.
(2) as shown in (a) in Fig. 2, monitoring device is miniature webcam (5), and anatomic tissue device is hollow stem (4),
Miniature webcam (5) setting is internal in hollow stem (4), and miniature webcam (5) is connected with control-rod (6), described for controlling
Miniature webcam (5) is in the internal rotation of hollow stem (4) and/or moves forward and backward, after liver in tunnel establishment procedure, miniature video camera
Head (5) is with hollow stem (4) cooperative motion under the operation of control-rod (6), and miniature webcam (5) is in preceding inlet side and hollow stem (4)
Flush or expose described hollow stem (4) the preceding inlet side；Preferably, miniature webcam (5) exposes hollow stem (4) in preceding inlet side and advances
Hold 0.5cm-1.5cm；Preferably, it is additionally provided with water flow flusher (7) inside hollow stem (4), water flow flusher (7) setting
It is internal in hollow stem (4), for rinsing the bloody fluid generated in anatomic tissue separation process, while in miniature webcam (5)
Front forms an instantaneous water column, is at clear state, convenient for monitoring, as shown in (b) in Fig. 2；Preferably, water flow is
Physiological saline；Preferably, liquid extracting device is additionally provided with inside hollow stem (4), liquid extracting device is for extracting tissue solution
The liquid that bloody fluid of the subdivision from middle generation and water flow flusher (7) generate during the rinsing process.
(3) monitoring device as shown in (c) in Fig. 2 and anatomic tissue device are miniature webcam (5), described miniature to take the photograph
Picture head (5) is arranged in hollow stem (4) front end, and the miniature webcam (5) can be dismantled from hollow stem (4) front end；Preferably, institute
There are gap (8) for the coupling part of the miniature webcam (5) and hollow stem (4) stated, for water flow flusher (7), institute to be arranged
Water flow flusher (7) setting stated is internal in hollow stem (4), across the gap (8), for rinsing anatomic tissue separation
The bloody fluid generated in the process, while an instantaneous water column is formed in front of miniature webcam (5), it is at clear shape
State, convenient for monitoring, as shown in (d) in Fig. 2；Preferably, the water flow is physiological saline；Preferably, the hollow stem
(4) internal to be additionally provided with liquid extracting device, the liquid extracting device, across the gap (8), for extracting tissue
The liquid that the bloody fluid and water flow flusher (7) generated in anatomical isolation generates during the rinsing process.
The section morphology of the hollow stem (4) is round or oval, and the length of the hollow stem (4) is 80-
120mm, the diameter of section of the hollow stem (4) are 3-6mm, and the hollow stem (4) can generate small size bending, it is described in
The material of empty bar (4) is selected from one of silica gel, latex, plastics or a variety of；Preferably, the section shape of the hollow stem (4)
State is circle.
Fig. 3 is internal fixed guidance device schematic diagram, and the internal fixed guidance device (2) is strip structure, described
First restraint device, i.e. the first hole slot (9) be set inside strip structure, and operating stick (1) is established through entire the in the tunnel
One hole slot (9), and can be done in the first hole slot (9) and rotate and/or move forward and backward, the strip structure front end is flat, described
Tunnel initial part after flat front end insertion liver, after establishing liver in tunneling process, the internal fixed guidance device (2)
The first hole slot (9) direction it is consistent with tunnel center longitudinal axis after liver, for fixing, guide tunnel establish operating stick (1) along both
Tunnel after liver is established in fixed direction；Preferably, the first hole slot (9) the most lower edge and in vivo fixed guidance device (2) bottom
The distance of plane is 1.0-1.5mm, facilitates tunnel after establishing liver.
The internal fixed guidance device (2) is strip structure, and the front end of the strip structure is flat, and described is flat
Front end be small cuboid (13), main part be big cuboid (14), the small cuboid (13) and big cuboid (14)
Bottom surface be in same level, after establishing liver in tunneling process, the small cuboid (13) and big cuboid (14)
Bottom surface be close to after liver inferior caval vein and its caudal infrahepatic vena cava antetheca after the corresponding liver of tunnel initial part, in the longitudinal direction of bottom surface
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after line liver corresponding with tunnel initial part after liver, described
Small cuboid (13) and big cuboid (14) it is of same size, first hole slot (9) is along small cuboid (13) and big
The length direction of cuboid (14) fixes guidance device (2) in vivo through entire, tunnel after small cuboid (13) the insertion liver
Road initial part, for guaranteeing that it is consistent with tunnel center longitudinal axis after liver that operating stick (1) is established in tunnel；Preferably, small cuboid (13)
The bottom surface being close to inferior caval vein antetheca with big cuboid (14) be it is arc-shaped, make to fix guidance device (2) in vivo and be more bonded
Inferior caval vein antetheca；Preferably, a length of 5-10mm, the width 8-15mm of the small cuboid (13), is highly 8-10mm,
The length of the big cuboid (14) is 10-30mm, is highly 10-15mm, width is identical as small cuboid.
Fig. 4 is external secured adjusted schematic device.The external secured adjusted device (3) include fixed link (11) and
Secured adjusted device (12), the fixed link (11) are connect with internal fixed guidance device (2), the secured adjusted device
(12) it is fixedly connected with operating bed, the fixed link (11) guarantees tunnel for fixing guidance device (2) in secured adjusted body
Establish that operating stick (1) is consistent with tunnel center longitudinal axis after liver, the secured adjusted device (12) is used for secured adjusted fixed link
(11), operating stick fixed guidance device (2) is made to be in optimum position, i.e., cavity of resorption is quiet after the corresponding liver of tunnel initial part after abutting liver
Arteries and veins and its caudal infrahepatic vena cava antetheca, after bottom surface longitudinal midline liver corresponding with tunnel initial part after liver inferior caval vein and its
Caudal infrahepatic vena cava antetheca longitudinal midline is consistent；Preferably, the fixed link (11) and internal fixed guidance device (2)
The second restraint device, i.e. the second hole slot (10), the fixation is arranged by being fixed on guidance device (2) in vivo in connection type
Mode of the bar through the second hole slot (10) is attached；Preferably, the second hole slot (10) direction and tunnel, which are established, operates
Bar (1) is vertical；Preferably, the fixed link (11) is solid straight-bar, and the section of the solid straight-bar is circle, the circle
Diameter be 2-5cm, the length of the solid straight-bar is 200-300mm.
Embodiment 2
Device, which is established, using tunnel after the liver that can be monitored under laparoscope establishes tunnel (zoopery and body operation) after liver:
After research object anesthesia, establishes pneumoperitoneum and operating walk way: doing 10 mm arc incisions under navel and establish pneumoperitoneum, pneumoperitoneum pressure
12~14mmHg transfers to veress needle, is then placed in 30 ° of lens of laparoscope, making 1.2 centimetres of notch under xiphoid-process is primary operating hole, right
Make 0.5 centimetre of notch at costal margin hypocleidium midline, anterior axillary line respectively as auxiliary handle hole.
It establishes tunnel after liver: detecting abdominal cavity, exposure infrahepatic vena cava；It is appropriate to open infrahepatic vena cava and caudate lobe company
It is a little to connect place front peritoneal reflection, liver is suitably suspended in midair；Device main component is established in tunnel after liver, and " operation is established in tunnel
Bar ", " fixing guidance device in vivo " merging abdominal cavity protrude into fixed link in the second hole slot on fixed guidance device in vivo；With
External secured adjusted device adjusts fixed guidance device in vivo, is adjusted to optimum position, i.e. tunnel initial part after abutting liver
Inferior caval vein and its caudal infrahepatic vena cava antetheca, bottom surface longitudinal midline are corresponding with tunnel initial part after liver after corresponding liver
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after liver, consistent with tunnel center longitudinal axis after liver, by body
Tunnel initial part after the flat front end insertion liver of interior fixed guidance device, then locks；Operating stick is established into tunnel and protrudes into
In one hole slot, operating stick is established by controlling tunnel and establishes tunnel after liver.It establishes after liver behind tunnel, hollow stem is stayed into the tunnel after liver
In road, in favor of placing around liver band.
Embodiment 3
One of operating method of device is established in tunnel after the liver that can be monitored:
(1) it is intraperitoneal that guidance device merging will be fixed in vivo；
(2) fixed link is protruded into the second hole slot on fixed guidance device in vivo；
(3) fixed guidance device in vivo is adjusted with external secured adjusted device, is adjusted to optimum position, i.e., after abutting liver then
Tunnel originates after inferior caval vein and its caudal infrahepatic vena cava antetheca after the corresponding liver of road initial part, bottom surface longitudinal midline and liver
Inferior caval vein and its caudal infrahepatic vena cava antetheca longitudinal midline are consistent after the corresponding liver in portion, to guarantee that operation is established in tunnel
Bar is consistent with tunnel center longitudinal axis after liver in tunneling process after establishing liver, and the flat front end of internal fixed guidance device is inserted
Enter tunnel initial part after liver, then locks；
(4) operating stick is established in tunnel to protrude into the first hole slot, establishes operating stick by controlling tunnel and establishes tunnel after liver.
Claims (10)
1. device is established in tunnel after the liver that one kind can monitor, it is characterised in that: it includes tunnel that device is established in tunnel after the liver
Operating stick (1) is established, guidance device (2) and external secured adjusted device (3), the tunnel is fixed in vivo and establishes operating stick
It (1) include monitoring device and anatomic tissue device, the monitoring device is used for the foundation in tunnel after real-time monitoring liver, described
Anatomic tissue device establishes tunnel after liver, the internal fixed guidance device (2) for carrying out separation dissection to liver post gap
Operating stick (1) is established with tunnel by the first restraint device (15) to connect, and fixes guidance device (2) in vivo for fixing, guiding
Operating stick (1) is established in tunnel, make tunnel establish operating stick (1) after liver in tunnel establishment procedure with tunnel center longitudinal axis one after liver
It causes；The external secured adjusted device (3) is connect by the second restraint device (16) with internal fixed guidance device (2), body
Outer secured adjusted device (3) is for adjusting and fixing guidance device (2) in fixed body, the external secured adjusted device (3)
Establish operating stick (1) by adjusting internal fixed guidance device (2) to control tunnel so that tunnel establish operating stick (1) along
Tunnel advances from the standard pathway direction of caudal cephalad after liver, establishes tunnel after liver.
2. device is established in tunnel after the liver according to claim 1 monitored, it is characterised in that: behaviour is established in the tunnel
Make bar (1), fix guidance device (2) and external secured adjusted device (3) in vivo in non-working condition, with scattered shape to be matched
State exists；In use state, it is assembled into assembly.
3. device is established in tunnel after the liver according to claim 1 monitored, it is characterised in that: behaviour is established in the tunnel
Make the stock that bar (1) is inner hollow.
4. device is established in tunnel after the liver according to claim 1 monitored, it is characterised in that: the monitoring device is gallbladder
Road mirror, the anatomic tissue device are hollow stem (4), and the choledochoscope front end software part can be placed into hollow stem (4) inside,
And can be done in inside and rotate and/or move forward and backward, after liver in tunnel establishment procedure, the choledochoscope and hollow stem (4) collaboration
Movement, the choledochoscope front end software part flush or are exposed with hollow stem (4) hollow stem (4) in preceding inlet side and advance
End；Preferably, the top of the choledochoscope front end software part and hollow stem (4) preceding inlet side end distance are 0.5cm-1.5cm.
5. device is established in tunnel after the liver according to claim 1 monitored, it is characterised in that: the monitoring device is
Miniature webcam (5), the anatomic tissue device are hollow stem (4), and miniature webcam (5) setting is in hollow stem (4)
Portion, the miniature webcam (5) are connected with control-rod (6), and control-rod (6) is for controlling miniature webcam (5) in hollow stem
(4) it internal rotation and/or moves forward and backward, after liver in tunnel establishment procedure, the miniature webcam (5) is in control-rod (6)
Operation under with hollow stem (4) cooperative motion, the top of the miniature webcam (5) preceding inlet side flushed with hollow stem (4) or
Expose the preceding inlet side of the hollow stem (4)；Preferably, at the top of the miniature webcam (5) and hollow stem (4) preceding inlet side end
Portion's distance is 0.5cm-1.5cm；Preferably, the hollow stem (4) is internally provided with for rinsing anatomic tissue separation process
The water flow flusher (7) of the blood group liquid of middle generation, water flow flusher (7) setting is internal in hollow stem (4), makes
Miniature webcam (5) is in clear state；Preferably, the water flow is physiological saline；Preferably, the hollow stem (4)
Inside is additionally provided with liquid extracting device, and the liquid extracting device is used to extract the hemorrhagic liquid generated in anatomic tissue separation
The liquid that body and water flow flusher (7) generate during the rinsing process.
6. device is established in tunnel after the liver according to claim 1 monitored, it is characterised in that: the monitoring device and
Anatomic tissue device is miniature webcam (5), and the miniature webcam (5) is arranged in hollow stem (4) front end, and described is miniature
Camera (5) can be dismantled from hollow stem (4) front end；Preferably, the interconnecting piece of the miniature webcam (5) and hollow stem (4)
Fractionation has gap (8), and for being arranged water flow flusher (7), water flow flusher (7) setting is in hollow stem (4)
Portion makes miniature webcam (5) for rinsing the bloody fluid generated in anatomic tissue separation process across the gap (8)
In clear state, convenient for monitoring；Preferably, the water flow is physiological saline；Preferably, the hollow stem (4) is internal
It is additionally provided with liquid extracting device, the liquid extracting device, across the gap (8), for extracting anatomic tissue point
The liquid that bloody fluid and water flow flusher (7) from middle generation generate during the rinsing process.
7. establishing device according to tunnel after the described in any item livers monitored of claim 4 to 6, it is characterised in that: described
The section morphology of hollow stem (4) is round or oval, and the length of the hollow stem (4) is 80-120mm, the hollow stem
(4) diameter of section is 3-6mm, and the hollow stem (4) can generate small size bending, the material choosing of the hollow stem (4)
From one of silica gel, latex, plastics or a variety of；Preferably, the section morphology of the hollow stem (4) is circle.
8. device is established in tunnel after the liver according to any one of claims 1 to 6 monitored, it is characterised in that: described
First restraint device (15) is the first hole slot (9), and the tunnel establishes operating stick (1) and runs through entire first hole slot (9), and energy
It is done in the first hole slot (9) and rotates and/or move forward and backward, after establishing liver in tunneling process, described the first hole slot (9) direction
It is consistent with tunnel center longitudinal axis after liver；Preferably, the first hole slot (9) the most lower edge and in vivo fixed guidance device (2) bottom
The distance of facial planes is 1.0-1.5mm.
9. device is established in tunnel after the liver according to any one of claims 1 to 6 monitored, it is characterised in that: described
The front end of fixed guidance device (2) is flat in vivo, tunnel initial part after the flat front end insertion liver, for fixing, drawing
It leads tunnel and establishes operating stick (1) along set direction, establish tunnel after liver.
10. device is established in tunnel after the liver according to any one of claims 1 to 6 monitored, it is characterised in that: described
Fixed guidance device (2) are the flat strip structure in front end in vivo, and the flat front end is small cuboid (13), main part
It is divided into big cuboid (14), the bottom surface of the small cuboid (13) and big cuboid (14) is in same level, is being built
After vertical liver in tunneling process, infrahepatic vena cava antetheca is close in the bottom surface of the small cuboid (13) and big cuboid (14),
The small cuboid (13) and big cuboid (14) it is of same size, first hole slot (9) is along small cuboid (13)
Guidance device (2) are fixed in vivo through entire with the length direction of big cuboid (14), the small cuboid (13) is inserted into liver
Tunnel initial part afterwards, for guaranteeing that it is consistent with tunnel center longitudinal axis after liver that operating stick (1) is established in tunnel；Preferably, small cuboid
(13) and the bottom surface be close to inferior caval vein antetheca of big cuboid (14) be it is arc-shaped, make to fix guidance device (2) more in vivo
It is bonded inferior caval vein antetheca；Preferably, a length of 5-10mm, the width 8-15mm of the small cuboid (13), is highly 8-
The length of 10mm, the big cuboid (14) are 10-30mm, are highly 10-15mm, width is identical as small cuboid.
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| US6148825A (en) * | 1998-02-13 | 2000-11-21 | Anderson; Bernard Bradley | Method of using a dedicated internal shunt and stent for the inferior vena cava |
| CN103083111A (en) * | 2013-01-21 | 2013-05-08 | 王铁功 | Total hepatic vascular exclusion auxiliary device and operation method and application thereof |
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| CN204049760U (en) * | 2014-07-08 | 2014-12-31 | 华中科技大学同济医学院附属同济医院 | After liver, pincers are carried in tunnel secretly |
| CN205493891U (en) * | 2016-01-25 | 2016-08-24 | 嘉兴市第一医院 | Tunnel dissector behind liver |
| CN209529195U (en) * | 2017-06-30 | 2019-10-25 | 浙江大学 | Apparatus and system is established in tunnel after a kind of liver monitored |
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2018
- 2018-06-28 CN CN201810691700.8A patent/CN108926364B/en active Active
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6148825A (en) * | 1998-02-13 | 2000-11-21 | Anderson; Bernard Bradley | Method of using a dedicated internal shunt and stent for the inferior vena cava |
| CN103083111A (en) * | 2013-01-21 | 2013-05-08 | 王铁功 | Total hepatic vascular exclusion auxiliary device and operation method and application thereof |
| CN203988200U (en) * | 2014-06-27 | 2014-12-10 | 中国人民解放军第二军医大学 | A kind of pressure liver plate for Hemihepatic blood occlusion |
| CN204049760U (en) * | 2014-07-08 | 2014-12-31 | 华中科技大学同济医学院附属同济医院 | After liver, pincers are carried in tunnel secretly |
| CN205493891U (en) * | 2016-01-25 | 2016-08-24 | 嘉兴市第一医院 | Tunnel dissector behind liver |
| CN209529195U (en) * | 2017-06-30 | 2019-10-25 | 浙江大学 | Apparatus and system is established in tunnel after a kind of liver monitored |
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