CN108926364B - Device is established in tunnel behind liver that can monitor - Google Patents
Device is established in tunnel behind liver that can monitor Download PDFInfo
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- CN108926364B CN108926364B CN201810691700.8A CN201810691700A CN108926364B CN 108926364 B CN108926364 B CN 108926364B CN 201810691700 A CN201810691700 A CN 201810691700A CN 108926364 B CN108926364 B CN 108926364B
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- 210000004185 liver Anatomy 0.000 title claims description 25
- 238000000034 method Methods 0.000 claims abstract description 55
- 238000001727 in vivo Methods 0.000 claims abstract description 27
- 238000012806 monitoring device Methods 0.000 claims abstract description 22
- 238000000926 separation method Methods 0.000 claims abstract description 17
- 238000012544 monitoring process Methods 0.000 claims abstract description 13
- 238000000338 in vitro Methods 0.000 claims abstract description 10
- 230000002440 hepatic effect Effects 0.000 claims description 38
- 210000001631 vena cava inferior Anatomy 0.000 claims description 29
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims description 29
- 238000011010 flushing procedure Methods 0.000 claims description 28
- 239000007788 liquid Substances 0.000 claims description 24
- 238000001356 surgical procedure Methods 0.000 claims description 18
- 239000007787 solid Substances 0.000 claims description 9
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims description 6
- 238000000605 extraction Methods 0.000 claims description 6
- 238000007920 subcutaneous administration Methods 0.000 claims description 6
- 208000029836 Inguinal Hernia Diseases 0.000 claims description 5
- VYPSYNLAJGMNEJ-UHFFFAOYSA-N Silicium dioxide Chemical compound O=[Si]=O VYPSYNLAJGMNEJ-UHFFFAOYSA-N 0.000 claims description 5
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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
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- 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
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- 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
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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
- A61B2017/0034—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
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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
- A61B2217/005—Auxiliary appliance with suction drainage system
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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 application provides a monitorable post-liver tunnel establishment device which comprises a tunnel establishment operating rod, an in-vivo fixed guiding device and an in-vitro fixed adjusting device, wherein the tunnel establishment operating rod comprises a monitoring device and a tissue dissecting device, the monitoring device is used for monitoring the establishment of a post-liver tunnel in real time, and the tissue dissecting device is used for separating and dissecting a post-liver gap to establish the post-liver tunnel. In the process of establishing the post-liver tunnel, the monitoring device is extended into the post-liver gap to monitor the anatomical separation of the post-liver gap tissues in real time, so that the blindness of operation in the process of establishing the post-liver tunnel is greatly reduced, meanwhile, the in-vivo fixed guiding device and the in-vitro fixed adjusting device are adopted to ensure that the advancing direction of the tunnel establishment operating rod is consistent with the central longitudinal axis of the post-liver tunnel, the deviation direction is avoided, the short hepatic veins are prevented from being damaged, and the success rate of the post-liver tunnel establishment is ensured.
Description
Technical Field
The application relates to the field of medical instruments, in particular to a device for establishing a tunnel behind a liver, which can be monitored.
Background
Hepatocellular carcinoma is one of the most common malignant tumors worldwide, and the incidence and mortality rate are all the leading ones. Currently, the most effective and only possible cure for liver cancer is still hepatectomy. The excision of the right half liver is safely performed in open surgery, and the retrohepatic tunnel taping technique (i.e. the liver taping pulling technique) created by Belghiti is most useful, and domestic Peng Shu teaches introduction and improvement. The retrohepatic tunnel taping technique (i.e., the liver taping technique) is based on the special anatomical features of the retrohepatic gap. The retrohepatic tunnel refers to a potential gap with relatively few blood vessels between the inferior vena cava and hepatic parenchyma at the posterior segment of the liver, the superior orifice is the hepatic vein filling fossa, the inferior orifice is a slit behind the retrohepatic tail leaf and in front of the inferior vena cava, the gap width averages about 1cm, and the superior-inferior diameter is about 7cm.
The key point of the application of the post-liver tunnel taping technology (namely the liver taping and pulling technology) is to establish a post-liver tunnel, and the post-liver tunnel is established at present mainly according to the standard path method which is introduced and set forth by the teachings of Belghiti and Peng Shu in China. By applying the retrohepatic tunnel taping technology (namely the taping lifting technology), the liver can be split under the anterior approach, so that the short hepatic vein and the right hepatic vein are exposed and then separated, and the inferior vena cava is prevented from being damaged; simultaneously, the section of the liver is minimized and thinnest, and the section bleeding can be controlled; in addition, the extrusion of liver tumor is avoided. Currently, in the process of establishing a post-hepatic tunnel, a macrobend hemostat is mainly used for blunt advancement to the cephalic vein fossa along the avascular area in the center of the post-hepatic gap, and is established by a consultant under finger guidance. The method is mainly carried out according to the experience of operators, has certain blindness and has the possibility of damaging hepatic short veins. In order to reduce the damage to the hepatic short vein, many scholars improve the standard path method, but the improvement is to shorten the standard path substantially, and finally, the large-curve hemostatic forceps are required to be used for penetration, so that the method has great blindness, cannot monitor the process of establishing the post-hepatic tunnel in real time, has great risk, and is easy to damage the hepatic short vein, so that the operation fails.
In addition, the establishment of a retrohepatic tunnel under a laparoscope cannot be guided by fingers, and in case of damage to a hepatic short vein, the retrohepatic tunnel is not only easy to bleed because of incapability of being pressed by hands, but also the high-pressure pneumoperitoneum is extremely easy to form a pneumo plug. Therefore, the method for using the large-curve hemostatic forceps to penetrate through the standard path is not suitable for establishing a post-hepatic tunnel under a laparoscope. Some scholars try to establish a retrohepatic tunnel under a laparoscope by using a golden finger or a nasogastric tube, but the method can only observe the tail side initial part of the retrohepatic gap, but can not observe the middle part and the head side part of the retrohepatic gap, and still has a certain blindness in guiding to directly establish the retrohepatic tunnel.
Disclosure of Invention
Aiming at the problems of larger blindness, high risk and the like in the existing post-liver tunnel establishment technology, the application aims to provide a monitoring post-liver tunnel establishment device which can monitor the post-liver tunnel establishment process in real time, greatly reduce the blindness of operation in the post-liver tunnel establishment process, effectively improve the success rate of operation, improve the accuracy of operation and effectively ensure the safety of operation. The application is applicable not only to human bodies but also to other animals, including: experimental animals, such as dogs, etc., having a hepatic posttunnel structure similar to that of humans partially exist.
In order to solve the technical problems of the application, the application adopts the following technical scheme:
the device comprises a tunnel establishment operating rod, an internal fixation guiding device and an external fixation adjusting device, wherein the tunnel establishment operating rod comprises a monitoring device and a tissue dissecting device, the monitoring device is used for monitoring the establishment of a post-liver tunnel in real time, the tissue dissecting device is used for separating and dissecting a post-liver gap to establish the post-liver tunnel, the internal fixation guiding device is connected with the tunnel establishment operating rod through a first constraint device, and the internal fixation guiding device is used for fixing and guiding the tunnel establishment operating rod to enable the tunnel establishment operating rod to be consistent with the central longitudinal axis of the post-liver tunnel in the post-liver tunnel establishment process; the external fixed adjusting device is connected with the internal fixed guiding device through the second constraint device, the external fixed adjusting device is used for adjusting and fixing the internal fixed guiding device, and the external fixed adjusting device controls the tunnel establishment operating rod through adjusting the internal fixed guiding device so that the tunnel establishment operating rod advances along the standard path direction from the tail side to the head side of the post-hepatic tunnel to establish the post-hepatic tunnel. The device for establishing the post-liver tunnel can realize that the monitoring device stretches into the post-liver gap in the process of establishing the post-liver tunnel, monitors the anatomical separation of the post-liver gap tissue in real time, greatly reduces the blindness of operation in the process of establishing the post-liver tunnel, effectively improves the success rate of operation, simultaneously adopts the internal fixing and guiding device and the external fixing and adjusting device to ensure that the advancing direction of the tunnel establishment operating rod is consistent with the central longitudinal axis of the post-liver tunnel, avoids deviating direction, ensures the success rate of establishing the post-liver tunnel, simultaneously avoids damaging hepatic short veins, and ensures the safety of establishing the post-liver tunnel.
The external fixation adjusting device is used for adjusting and fixing the internal fixation guiding device to enable the internal fixation guiding device to be at an optimal position, namely, clinging to the anterior wall of the hepatic inferior vena cava corresponding to the hepatic posterior tunnel initial part and the anterior wall of the caudal hepatic inferior vena cava, and the longitudinal midline of the bottom surface is consistent with the longitudinal midline of the hepatic inferior vena cava corresponding to the hepatic posterior tunnel initial part and the anterior wall of the caudal hepatic inferior vena cava. Thereby ensuring that the tunnel establishment operating rod is consistent with the central longitudinal axis of the post-liver tunnel in the post-liver tunnel establishment process, and advances along the standard path direction from the tail side to the head side of the post-liver tunnel to establish the post-liver tunnel.
The in-vivo fixing and guiding device is used for fixing and guiding the tunnel establishment operating rod, and not enabling the tunnel establishment operating rod to be fixed, but enabling the tunnel establishment operating rod to be fixedly kept at a position consistent with the central longitudinal axis of the post-liver tunnel, and further guiding the tunnel establishment operating rod to be along a given direction, so that the post-liver tunnel is established. The tunnel establishment operating rod can rotate and/or move back and forth in the internal fixed guiding device in the process of establishing the post-liver tunnel, and can also adjust left, right, up and down in a small amplitude. The post-hepatic tunnel is usually a tunnel without hepatic vein, but the hepatic vein appears in the post-hepatic tunnel when the structure is changed, so that the tunnel establishment operating rod can do small-amplitude movements left, right, up and down in the process of establishing the post-hepatic tunnel, bypass the hepatic vein appearing in the post-hepatic tunnel, avoid damaging the hepatic vein and ensure the safety of the post-hepatic tunnel establishment.
The device for establishing the tunnel behind the liver capable of being monitored adopts an internal fixing and guiding device to fix and guide a tunnel establishing operation rod, and further adopts an external fixing and adjusting device to adjust the internal fixing and guiding device, so that the tunnel establishing operation rod is ensured to be consistent with the central longitudinal axis of the tunnel behind the liver, and is prevented from damaging the short hepatic vein along the direction of the standard path of the tunnel behind the liver, the tunnel behind the liver can be accurately established under monitoring, the risk and blindness possibly existing in the process of establishing the tunnel behind the liver by virtue of the experience of operators in the prior art are avoided, and the success rate and the safety of the tunnel establishment behind the liver are greatly improved.
Further, when the tunnel establishment operating rod, the in-vivo fixing and guiding device and the in-vitro fixing and adjusting device are in a non-use state, the tunnel establishment operating rod, the in-vivo fixing and guiding device and the in-vitro fixing and adjusting device exist in a scattered state to be matched; in the use state, the assembly is assembled.
When the tunnel establishment operating rod, the in-vivo fixing and guiding device and the in-vitro fixing and adjusting device are used under a laparoscope, each part is placed into the abdominal cavity one by one, and then the parts are assembled and used in the abdominal cavity.
The tunnel establishment operating rod, the in-vivo fixing and guiding device and the in-vitro fixing and adjusting device can also be fixedly assembled together, and are directly placed into the abdominal cavity for operation in open operation.
Further, the tunnel establishment operating rod is a long rod with a hollow inside, and after the post-liver tunnel is established, the tunnel establishment operating rod is left in the post-liver tunnel and is used for placing the liver winding belt, so that secondary damage to the liver during the placement of the liver winding belt is avoided.
Further, the monitoring device is a choledochoscope, the tissue dissecting device is a hollow rod, the soft part at the front end of the choledochoscope can be placed into the hollow rod and can rotate and/or move back and forth inside, in the process of establishing a post-hepatic tunnel, the choledochoscope and the hollow rod move cooperatively, and the soft part at the front end of the choledochoscope is flush with the hollow rod at the advancing end or exposes the advancing end of the hollow rod.
Further, the distance between the top end of the soft part at the front end of the choledochoscope and the advancing end of the hollow rod is 0.5cm-1.5cm.
Under the monitoring of the choledochoscope, the hollow rod is used for dissecting tissues, the dense part of the tissues is met, the blunt dissected tissues are moved through the bending and stretching movement of the front end part of the choledochoscope soft part, and the hollow rod and the choledochoscope soft part move cooperatively from the tail side to the head side, so that the whole retrohepatic gap is penetrated, and finally, the retrohepatic tunnel is established. After the post-hepatic tunnel is established, the choledochoscope is pulled out, and the hollow rod is left in the post-hepatic tunnel so as to be beneficial to placing the liver-surrounding belt.
Further, the monitoring device is a miniature camera, the tissue dissecting device is a hollow rod, the miniature camera is arranged inside the hollow rod, the miniature camera is connected with a control rod, the control rod is used for controlling the miniature camera to rotate and/or move back and forth inside the hollow rod, in the process of establishing a post-hepatic tunnel, the miniature camera moves cooperatively with the hollow rod under the operation of the control rod, and the top end of the advancing end of the miniature camera is flush with the hollow rod or exposes the advancing end of the hollow rod; preferably, the distance between the top of the miniature camera and the end part of the advancing end of the hollow rod is 0.5cm-1.5cm.
Further, the hollow rod is internally provided with a water flow flushing device for flushing blood type liquid generated in the process of tissue dissection and separation, and the water flow flushing device is arranged in the hollow rod, so that the miniature camera is in a clear state.
Further, the water flow is normal saline.
Further, the hollow rod is internally provided with a liquid extraction device which is used for extracting the bloody liquid generated in the anatomical separation of tissues and the liquid generated in the flushing process by the water flow flushing device.
Under the monitoring of miniature camera, dissect the tissue with the cavity pole, meet the dense department of tissue, through the miniature camera of control lever operation, with miniature camera front end position bend stretch activity blunt anatomy tissue, cavity pole and miniature camera are from tail side to head side cooperative movement to link up whole posthepatism clearance, finally establish the posthepatism tunnel. After the post-liver tunnel is established, the miniature camera is pulled out by the control rod, and the hollow rod is left in the post-liver tunnel so as to be beneficial to placing the liver-winding belt.
Further, the monitoring device and the tissue dissecting device are miniature cameras, the miniature cameras are arranged at the front end of the hollow rod, and the miniature cameras can be detached from the front end of the hollow rod.
Further, the connecting part of the miniature camera and the hollow rod is provided with a gap for setting a water flow flushing device, the water flow flushing device is arranged inside the hollow rod, penetrates through the gap and is used for flushing the bloody liquid generated in the process of anatomical separation of tissues, so that the miniature camera is in a clear state and is convenient to monitor.
Further, the water flow is normal saline.
Further, the hollow rod is internally provided with a liquid extraction device which passes through the gap and is used for extracting the bloody liquid generated in the anatomical separation of tissues and the liquid generated in the flushing process by the water flow flushing device.
After the post-liver tunnel is established, the miniature camera is disassembled, so that the hollow rod is left in the post-liver tunnel, and the liver-surrounding belt is placed conveniently.
Further, the cross section of the hollow rod is circular or elliptical, the length of the hollow rod is 80-120mm, the cross section diameter of the hollow rod is 3-6mm, the hollow rod can be slightly bent to adapt to the backward and forward bending of the side part of the head of the tunnel behind the liver in the sagittal plane direction corresponding to the longitudinal midline of the anterior wall of the inferior vena cava behind the liver, and the material of the hollow rod is one or more selected from silica gel, latex and plastic.
Further, the cross section of the hollow rod is circular.
Further, the first restraint device is a first hole slot, the tunnel establishment operating rod penetrates through the whole first hole slot and can rotate and/or move back and forth in the first hole slot, and in the process of establishing the post-hepatic tunnel, the direction of the first hole slot is consistent with the central longitudinal axis of the post-hepatic tunnel.
Further, the distance between the lowest edge of the first hole groove and the plane of the bottom of the in-vivo fixed guiding device is 1.0-1.5mm, so that a retrohepatic tunnel can be conveniently established.
Further, the front end of the in-vivo fixing and guiding device is flat, and the flat front end is inserted into the start part of the post-hepatic tunnel and used for fixing and guiding the tunnel establishment operating rod to establish the post-hepatic tunnel along a given direction.
Further, the internal fixation guiding device is of a strip-shaped structure with a flat front end, the flat front end is a small cuboid, the main body part is a large cuboid, the bottoms of the small cuboid and the large cuboid are positioned on the same horizontal plane, in the process of establishing a post-hepatic tunnel, the bottoms of the small cuboid and the large cuboid are clung to the front wall of the inferior hepatic vena cava, namely clung to the inferior hepatic vena cava corresponding to the post-hepatic tunnel starting part and the front wall of the inferior hepatic vena cava corresponding to the tail side of the post-hepatic tunnel starting part, the longitudinal central line of the bottom is consistent with the longitudinal central line of the inferior hepatic vena cava corresponding to the post-hepatic tunnel starting part and the longitudinal central line of the inferior hepatic vena cava corresponding to the tail side of the post-hepatic tunnel starting part, the widths of the small cuboid and the large cuboid are the same, and the first hole groove penetrates through the whole internal fixation guiding device along the length direction of the small cuboid and the post-hepatic tunnel starting part, and is used for ensuring that the tunnel establishment operation rod is consistent with the central longitudinal axis of the post-hepatic tunnel.
Further, the bottom surfaces of the small cuboid and the large cuboid, which are clung to the anterior wall of the inferior vena cava, are arc-shaped, so that the internal fixation guiding device is clung to the anterior wall of the inferior vena cava more.
Further, the length of the small cuboid is 5-10mm, the width is 8-15mm, the height is 8-10mm, the length of the large cuboid is 10-30mm, the height is 10-15mm, and the width is the same as that of the small cuboid.
Further, the external fixed adjusting device comprises a fixed rod and a fixed adjusting device, the fixed rod is connected with the internal fixed guiding device through a second constraint device, the fixed adjusting device is fixedly connected with the operating table, the fixed rod is used for fixedly adjusting the internal fixed guiding device, the operating rod fixed guiding device is located at a working position, namely, the operating rod fixed guiding device is tightly attached to the hepatic lower vena cava and the hepatic lower vena cava front wall corresponding to the hepatic rear tunnel starting part, and the tunnel establishment operating rod is consistent with the central longitudinal axis of the hepatic rear tunnel in the process of establishing the hepatic rear tunnel.
Further, the fixing rod is a solid straight rod, the cross section of the solid straight rod is circular, the diameter of the circular shape is 2-5cm, and the length of the solid straight rod is 200-300mm.
Further, the second restraint device is a second hole groove, and the fixing rod is connected with the in-vivo fixing guide device in a mode of penetrating through the second hole groove.
Further, the direction of the second hole groove is perpendicular to the tunnel establishment operating rod.
Further, the material of the post-liver tunnel establishment device is one or more selected from stainless steel, plastic, silica gel, latex, ceramic and alloy.
The application of the device for establishing the monitoring posthepatitic tunnel is used for establishing a parahepatitic tunnel or establishing a subcutaneous tunnel of laparoscopic thyroid surgery, inguinal hernia surgery and breast surgery.
The operation method of the monitorable posthepatitic tunnel establishment device comprises the following steps:
(1) Placing the in-vivo fixation guiding device into the abdominal cavity;
(2) The external fixed adjusting device is connected with the internal fixed adjusting device through a second constraint device;
(3) The internal fixation guiding device is regulated by the external fixation regulating device to an optimal position, namely the internal fixation guiding device is tightly attached to the anterior wall of the retrohepatic inferior vena cava and the caudal infrahepatic inferior vena cava corresponding to the retrohepatic tunnel starting part, the longitudinal central line of the bottom surface is consistent with the longitudinal central line of the anterior wall of the retrohepatic inferior vena cava and the caudal infrahepatic inferior vena cava corresponding to the retrohepatic tunnel starting part, so that the tunnel establishment operating rod is consistent with the central longitudinal axis of the retrohepatic tunnel in the process of establishing the retrohepatic tunnel, and the front end of the internal fixation guiding device is inserted into the retrohepatic tunnel starting part and then locked;
(4) The tunnel establishment operating rod is connected with the in-vivo fixed guiding device through the first constraint device, and the post-hepatic tunnel is established through controlling the tunnel establishment operating rod.
A second object of the present application is to provide a monitorable post-liver tunnel-establishing system, wherein the monitorable post-liver tunnel-establishing system further comprises a laparoscope device and/or a B-mode ultrasonic device, and the monitorable post-liver tunnel-establishing device can establish a post-liver tunnel under the monitoring guidance of the laparoscope device and/or the B-mode ultrasonic device.
The use of the monitorable post-hepatic tunnel creation system for creating a parahepatic tunnel or for creating a subcutaneous tunnel for laparoscopic thyroid surgery, inguinal hernia surgery, breast surgery.
The beneficial effects of the application are as follows:
(1) The device for establishing the post-liver tunnel can realize that the monitoring device stretches into the post-liver gap in the process of establishing the post-liver tunnel, monitors the anatomical separation of the post-liver gap tissues in real time, overcomes blindness and high risk in the prior art of establishing the post-liver tunnel, and can quickly, simply, conveniently and safely establish the post-liver tunnel under the monitoring device.
(2) The application discloses a monitorable post-liver tunnel establishment device, which adopts an internal fixed guiding device to fix and guide a tunnel establishment operating rod, and further adopts an external fixed adjusting device to adjust the internal fixed guiding device, so that the tunnel establishment operating rod is consistent with the central longitudinal axis of the post-liver tunnel, and is along the direction of a standard path of the post-liver tunnel, thereby avoiding damaging the short hepatic vein, accurately establishing the post-liver tunnel under monitoring, avoiding the risk and blindness possibly existing in the post-liver tunnel establishment process by virtue of the experience of operators in the prior art, and greatly improving the success rate and safety of post-liver tunnel establishment.
(3) The device can be used in open surgery and laparoscope, effectively solves the problem that a large-bend hemostatic forceps cannot penetrate through a retrohepatic tunnel under the laparoscope, realizes that the retrohepatic tunnel establishment device capable of being monitored is adopted under the large visual field of the laparoscope (if necessary, B ultrasonic guidance is adopted), observes the retrohepatic gap middle part and the head side part, and effectively improves the success rate of surgery.
(4) The device for establishing the tunnel behind the liver, which is capable of being monitored, has a simple structure, and main components of a tunnel establishment operating rod, an internal fixing guide device and an external fixing and adjusting device are not fixedly assembled together before use, so that the device is assembled when the tunnel behind the liver needs to be established, and each component is placed into the abdominal cavity one by one when the device is used under the laparoscope, and then assembled in the abdominal cavity.
(5) The application can be used for establishing a post-liver tunnel, a parahepatic tunnel, and other subcutaneous tunnels, such as subcutaneous tunnel establishment of laparoscopic thyroid surgery, inguinal hernia surgery and breast surgery.
Drawings
FIG. 1 is a schematic overall view of a monitorable retrohepatic tunnel setup;
FIG. 2 is a schematic view of a tunnel setup lever;
FIG. 3 is a schematic view of an in vivo fixation guidance device;
fig. 4 is a schematic view of an external fixation adjustment device.
In the figure: 1. the tunnel is established the action bars, 2, internal fixed guiding device, 3, external fixed adjusting device, 4, cavity pole, 5, miniature camera head, 6, control lever, 7, rivers washing unit, 8, space, 9, first hole groove, 10, second hole groove, 11, dead lever, 12, fixed adjusting device, 13, little cuboid, 14, big cuboid, 15, first restraint device, 16, second restraint device.
Detailed Description
The application will be further illustrated with reference to specific examples. It should be understood that these examples are illustrative of the present application and are not intended to limit the scope of the present application. Further, it is understood that various changes and modifications may be made by those skilled in the art after reading the teachings of the present application, and such equivalents are intended to fall within the scope of the application as defined in the appended claims.
Example 1
Fig. 1 is a schematic overall view of a monitorable post-hepatic tunnel establishment device, the post-hepatic tunnel establishment device comprises a tunnel establishment operating rod (1), an in-vivo fixing and guiding device (2) and an in-vitro fixing and guiding device (3), the tunnel establishment operating rod (1) comprises a monitoring device and a tissue dissecting device, the monitoring device is used for monitoring establishment of a post-hepatic tunnel in real time, the tissue dissecting device is used for separating and dissecting a post-hepatic gap, the post-hepatic tunnel is established, the in-vivo fixing and guiding device (2) is connected with the tunnel establishment operating rod (1) through a first constraint device (15) and is used for fixing and guiding the tunnel establishment operating rod (1) so that the post-hepatic tunnel is consistent with a post-hepatic tunnel central longitudinal axis in the post-hepatic tunnel establishment process, the post-hepatic tunnel is established along a given direction, the in-vivo fixing and guiding device (2) is connected through a second constraint device (16) and is used for adjusting and fixing the in-vivo fixing and guiding device (2), and the in-vitro fixing and guiding device (3) is used for further controlling the establishment operating rod (1) along a post-hepatic tunnel establishment direction from a tail end side to a standard tunnel establishment direction. The device for establishing the post-liver tunnel can realize that the monitoring device stretches into the post-liver gap in the process of establishing the post-liver tunnel, monitors the anatomical separation of the post-liver gap tissue in real time, and simultaneously ensures that the advancing direction of the tunnel establishment operating rod (1) is consistent with the central longitudinal axis of the post-liver tunnel so as to avoid damaging hepatic short veins.
Fig. 2 is a schematic view of a tunnel establishment lever, which has three forms according to different operating environments:
(1) The monitoring device is a choledochoscope, the tissue dissecting device is a hollow rod (4), a choledochoscope soft part is arranged in the hollow rod (4) and can rotate and/or move back and forth in the hollow rod (4), the choledochoscope and the hollow rod (4) move cooperatively in the process of establishing a post-hepatic tunnel, and the choledochoscope soft part is flush with the hollow rod (4) at the advancing end or exposes the advancing end of the hollow rod (4); preferably, the choledochoscope soft part exposes 0.5cm-1.5cm of the advancing end of the hollow rod (4) at the advancing end.
(2) As shown in (a) of fig. 2, the monitoring device is a miniature camera (5), the tissue dissecting device is a hollow rod (4), the miniature camera (5) is arranged inside the hollow rod (4), the miniature camera (5) is connected with a control rod (6) for controlling the rotation and/or the back-and-forth movement of the miniature camera (5) inside the hollow rod (4), and in the process of establishing a hepatic tunnel, the miniature camera (5) moves cooperatively with the hollow rod (4) under the operation of the control rod (6), and the miniature camera (5) is flush with the hollow rod (4) at the advancing end or exposes the advancing end of the hollow rod (4); preferably, the miniature camera (5) exposes 0.5cm-1.5cm of the advancing end of the hollow rod (4) at the advancing end; preferably, the hollow rod (4) is internally provided with a water flow flushing device (7), and the water flow flushing device (7) is arranged in the hollow rod (4) and is used for flushing bloody liquid generated in the process of tissue dissection and separation, and meanwhile, an instantaneous water column is formed in front of the miniature camera (5) so as to be in a clear state, so that the monitoring is facilitated, as shown in (b) in fig. 2; preferably, the water stream is normal saline; preferably, the hollow rod (4) is also internally provided with liquid extraction means for extracting the bloody liquid generated during anatomical separation of the tissue and the liquid generated during irrigation by the water flow irrigation means (7).
(3) As shown in (c) of fig. 2, the monitoring device and the tissue dissecting device are miniature cameras (5), the miniature cameras (5) are arranged at the front end of the hollow rod (4), and the miniature cameras (5) can be detached from the front end of the hollow rod (4); preferably, a gap (8) is reserved at the connecting part of the miniature camera (5) and the hollow rod (4) for arranging a water flow flushing device (7), the water flow flushing device (7) is arranged inside the hollow rod (4) and penetrates through the gap (8) for flushing the bloody liquid generated in the process of tissue dissection and separation, and meanwhile, a transient water column is formed in front of the miniature camera (5) so as to be in a clear state, so that the miniature camera is convenient to monitor, as shown in (d) in fig. 2; preferably, the water stream is normal saline water; preferably, the hollow rod (4) is also internally provided with a liquid extraction device which passes through the gap (8) and is used for extracting the bloody liquid generated in the anatomical separation of tissues and the liquid generated in the flushing process by the water flow flushing device (7).
The cross section of the hollow rod (4) is circular or elliptical, the length of the hollow rod (4) is 80-120mm, the cross section diameter of the hollow rod (4) is 3-6mm, the hollow rod (4) can be slightly bent, and the material of the hollow rod (4) is one or more selected from silica gel, latex and plastics; preferably, the hollow rod (4) has a circular cross-section.
Fig. 3 is a schematic diagram of an in-vivo fixing and guiding device, the in-vivo fixing and guiding device (2) is in a strip structure, a first constraint device, namely a first hole groove (9), is arranged in the strip structure, the tunnel establishment operating rod (1) penetrates through the whole first hole groove (9) and can rotate and/or move back and forth in the first hole groove (9), the front end of the strip structure is flat, the flat front end of the strip structure is inserted into a post-liver tunnel starting part, and in the process of establishing a post-liver tunnel, the direction of the first hole groove (9) of the in-vivo fixing and guiding device (2) is consistent with the central longitudinal axis of the post-liver tunnel, and is used for fixing and guiding the tunnel establishment operating rod (1) along a given direction to establish the post-liver tunnel; preferably, the distance between the lowest edge of the first hole groove (9) and the bottom plane of the internal fixing and guiding device (2) is 1.0-1.5mm, so that a retrohepatic tunnel can be conveniently established.
The internal fixation guiding device (2) is of a strip-shaped structure, the front end of the strip-shaped structure is flat, the flat front end is a small cuboid (13), the main body part is a large cuboid (14), the bottom surfaces of the small cuboid (13) and the large cuboid (14) are positioned on the same horizontal plane, in the process of establishing a post-hepatic tunnel, the bottom surfaces of the small cuboid (13) and the large cuboid (14) are clung to the post-hepatic inferior vena cava corresponding to the post-hepatic tunnel initial part and the anterior wall of the tail side of the post-hepatic inferior vena cava, the longitudinal central line of the bottom surface is consistent with the longitudinal central line of the post-hepatic inferior vena cava corresponding to the post-hepatic tunnel initial part and the longitudinal central line of the tail side of the post-hepatic inferior vena cava, the widths of the small cuboid (13) and the large cuboid (14) are the same, the first hole groove (9) penetrates through the whole internal fixation guiding device (2) along the length direction of the small cuboid (13) and the large cuboid (14), and the small cuboid (13) is inserted into the post-hepatic tunnel initial part to ensure that the longitudinal axis is consistent with the post-hepatic central axis (1); preferably, the bottom surfaces of the small cuboid (13) and the large cuboid (14) which are clung to the anterior wall of the inferior vena cava are arc-shaped, so that the internal fixation guiding device (2) is clung to the anterior wall of the inferior vena cava more; preferably, the length of the small cuboid (13) is 5-10mm, the width is 8-15mm, the height is 8-10mm, the length of the large cuboid (14) is 10-30mm, the height is 10-15mm, and the width is the same as that of the small cuboid.
Fig. 4 is a schematic view of an external fixation adjustment device. The external fixation adjusting device (3) comprises a fixing rod (11) and a fixation adjusting device (12), the fixing rod (11) is connected with the internal fixation guiding device (2), the fixation adjusting device (12) is fixedly connected with the operating table, the fixing rod (11) is used for fixedly adjusting the internal fixation guiding device (2) to ensure that the tunnel establishment operating rod (1) is consistent with the central longitudinal axis of the retrohepatic tunnel, the fixation adjusting device (12) is used for fixedly adjusting the fixing rod (11) to enable the operating rod fixation guiding device (2) to be in an optimal position, namely, clinging to the retrohepatic inferior vena cava corresponding to the retrohepatic tunnel starting part and the anterior wall of the retrohepatic inferior vena cava corresponding to the retrohepatic tunnel starting part and the longitudinal midline of the anterior wall of the retrohepatic inferior vena corresponding to the retrohepatic tunnel starting part; preferably, the fixing rod (11) is connected with the internal fixing and guiding device (2) in a mode of penetrating through the second hole groove (10) by arranging a second constraint device, namely the second hole groove (10), on the internal fixing and guiding device (2); preferably, the direction of the second hole groove (10) is vertical to the tunnel establishment operating rod (1); preferably, the fixing rod (11) is a solid straight rod, the cross section of the solid straight rod is circular, the diameter of the circular shape is 2-5cm, and the length of the solid straight rod is 200-300mm.
Example 2
Retrohepatic tunnel (animal experiment, human operation) is established under laparoscope by using a monitorable retrohepatic tunnel establishment device:
after anesthesia of the study object, establishing pneumoperitoneum and operation channel: a10 mm arc incision is made under the umbilicus to build pneumoperitoneum, the pneumoperitoneum pressure is 12-14 mmHg, a pneumoperitoneum needle is pulled out, then a 30-degree celioscope lens is placed, a 1.2 cm incision is made under the xiphoid process as a main operation hole, and 0.5cm incisions are respectively made at the midline of the collarbone under the right rib edge and the anterior axillary line as auxiliary operation holes.
Establishing a posthepatic tunnel: probing the abdominal cavity to expose the inferior hepatic vena cava; the anterior peritoneum of the junction of the inferior hepatic vena cava and the caudate leaves is opened appropriately to be folded a little, and the liver is suspended appropriately; the main components of the post-liver tunnel establishing device, namely a tunnel establishing operation rod and an internal fixing guide device, are placed into the abdominal cavity, and the fixing rod extends into a second hole groove on the internal fixing guide device; the internal fixation guiding device is regulated by the external fixation regulating device to an optimal position, namely, the internal fixation guiding device is tightly attached to the anterior wall of the hepatic lower vena cava corresponding to the hepatic rear tunnel initial part and the anterior wall of the hepatic lower vena cava at the tail side of the hepatic lower vena cava, the longitudinal central line of the bottom surface of the internal fixation guiding device is consistent with the longitudinal central line of the hepatic lower vena cava corresponding to the hepatic rear tunnel initial part and the longitudinal central line of the hepatic lower vena cava at the tail side of the hepatic lower vena cava, and the flat front end of the internal fixation guiding device is inserted into the hepatic rear tunnel initial part and then locked; and extending the tunnel establishment operating rod into the first hole groove, and establishing a post-hepatic tunnel by controlling the tunnel establishment operating rod. After the post-hepatic tunnel is established, the hollow rod is left in the post-hepatic tunnel to facilitate placement of the liver-surrounding belt.
Example 3
One method of operation of a monitorable retrohepatic tunnel-setup device is:
(1) Placing the in-vivo fixation guiding device into the abdominal cavity;
(2) Extending the fixing rod into a second hole groove on the internal fixing and guiding device;
(3) The internal fixation guiding device is regulated by the external fixation regulating device to an optimal position, namely the internal fixation guiding device is tightly attached to the anterior wall of the retrohepatic inferior vena cava and the caudal infrahepatic inferior vena cava corresponding to the retrohepatic tunnel starting part, the longitudinal central line of the bottom surface is consistent with the longitudinal central line of the anterior wall of the retrohepatic inferior vena cava and the caudal infrahepatic inferior vena cava corresponding to the retrohepatic tunnel starting part, so that the tunnel establishment operating rod is consistent with the central longitudinal axis of the retrohepatic tunnel in the process of establishing the retrohepatic tunnel, and the flat front end of the internal fixation guiding device is inserted into the retrohepatic tunnel starting part and then locked;
(4) And extending the tunnel establishment operating rod into the first hole groove, and establishing a post-hepatic tunnel by controlling the tunnel establishment operating rod.
Claims (30)
1. A device for establishing a monitorable post-hepatic tunnel, characterized in that: the device for establishing the post-liver tunnel comprises a tunnel establishment operating rod (1), an in-vivo fixed guiding device (2) and an in-vitro fixed adjusting device (3), wherein the tunnel establishment operating rod (1) comprises a monitoring device and a tissue dissecting device, the monitoring device is used for monitoring the establishment of the post-liver tunnel in real time, the tissue dissecting device is used for separating and dissecting a post-liver gap to establish the post-liver tunnel, the in-vivo fixed guiding device (2) is connected with the tunnel establishment operating rod (1) through a first constraint device (15), and the in-vivo fixed guiding device (2) is used for fixing and guiding the tunnel establishment operating rod (1) so that the tunnel establishment operating rod (1) is consistent with the central longitudinal axis of the post-liver tunnel in the post-liver tunnel establishment process; the external fixed adjusting device (3) is connected with the internal fixed guiding device (2) through the second constraint device (16), the external fixed adjusting device (3) is used for adjusting and fixing the internal fixed guiding device (2), the external fixed adjusting device (3) controls the tunnel establishment operating rod (1) through adjusting the internal fixed guiding device (2) so that the tunnel establishment operating rod (1) advances along the standard path direction from the tail side to the head side of the post-liver tunnel to establish the post-liver tunnel.
2. The monitorable post-hepatic tunnel setup according to claim 1 wherein: the tunnel establishment operating rod (1), the in-vivo fixing and guiding device (2) and the in-vitro fixing and adjusting device (3) exist in a scattered state to be matched when not in a use state; in the use state, the assembly is assembled.
3. The monitorable post-hepatic tunnel setup according to claim 1 wherein: the tunnel establishment operating rod (1) is a long rod with a hollow inside.
4. The monitorable post-hepatic tunnel setup according to claim 1 wherein: the monitoring device is a choledochoscope, the tissue dissecting device is a hollow rod (4), the soft part at the front end of the choledochoscope can be placed into the hollow rod (4) and can rotate and/or move back and forth inside, in the process of establishing a post-hepatic tunnel, the choledochoscope and the hollow rod (4) cooperatively move, and the soft part at the front end of the choledochoscope is flush with the hollow rod (4) at the advancing end or exposes the advancing end of the hollow rod (4).
5. The monitorable post-liver tunnel creation apparatus according to claim 4 and wherein: the distance between the top end of the soft part at the front end of the choledochoscope and the advancing end of the hollow rod (4) is 0.5cm-1.5cm.
6. The monitorable post-hepatic tunnel setup according to claim 1 wherein: the monitoring device is a miniature camera (5), the tissue dissecting device is a hollow rod (4), the miniature camera (5) is arranged inside the hollow rod (4), the miniature camera (5) is connected with a control rod (6), the control rod (6) is used for controlling the miniature camera (5) to rotate and/or move back and forth inside the hollow rod (4), the miniature camera (5) moves cooperatively with the hollow rod (4) under the operation of the control rod (6) in the process of establishing a tunnel after the liver, and the top end of the advancing end of the miniature camera (5) is flush with the hollow rod (4) or exposes the advancing end of the hollow rod (4).
7. The monitorable post-liver tunnel establishing device of claim 6, wherein: the distance between the top of the miniature camera head (5) and the end part of the advancing end of the hollow rod (4) is 0.5cm-1.5cm.
8. The monitorable post-liver tunnel establishing device of claim 6, wherein: the novel blood group anatomical separation device is characterized in that a water flow flushing device (7) for flushing blood group liquid generated in the tissue anatomical separation process is arranged inside the hollow rod (4), and the water flow flushing device (7) is arranged inside the hollow rod (4) so that the miniature camera (5) is in a clear state.
9. The monitorable post-liver tunnel creation apparatus according to claim 8 and wherein: the water flow is normal saline water.
10. The monitorable post-liver tunnel creation apparatus according to claim 8 and wherein: the hollow rod (4) is internally provided with a liquid extraction device which is used for extracting bloody liquid generated in tissue dissection and separation and liquid generated in the flushing process by the water flow flushing device (7).
11. The monitorable post-hepatic tunnel setup according to claim 1 wherein: the monitoring device and the tissue dissecting device are miniature cameras (5), the miniature cameras (5) are arranged at the front end of the hollow rod (4), and the miniature cameras (5) can be detached from the front end of the hollow rod (4).
12. The monitorable post-liver tunnel creation apparatus of claim 11 and wherein: the miniature camera (5) and the connecting part of the hollow rod (4) leave a gap (8) for setting up a water flow flushing device (7), the water flow flushing device (7) set up inside the hollow rod (4), pass the gap (8) for flushing the bloody liquid that produces in the anatomical separation process of tissue, make miniature camera (5) be in clear state, be convenient for monitor.
13. The monitorable post-liver tunnel creation apparatus of claim 12 and wherein: the water flow is normal saline water.
14. The monitorable post-liver tunnel creation apparatus of claim 12 and wherein: the hollow rod (4) is internally provided with a liquid extraction device which penetrates through the gap (8) and is used for extracting bloody liquid generated in tissue dissection and separation and liquid generated in a flushing process by the water flow flushing device (7).
15. The monitorable post-liver tunnel establishing device according to any one of claims 4 to 14, wherein: the cross section of the hollow rod (4) is circular or elliptical, the length of the hollow rod (4) is 80-120mm, the cross section diameter of the hollow rod (4) is 3-6mm, the hollow rod (4) can be slightly bent, and the material of the hollow rod (4) is one or more selected from silica gel, latex and plastics.
16. The monitorable post-liver tunnel creation apparatus of claim 15 and wherein: the cross section of the hollow rod (4) is circular.
17. The monitorable post-liver tunnel establishing device according to any one of claims 1 to 14, wherein: the first restraint device (15) is a first hole groove (9), the tunnel establishment operating rod (1) penetrates through the whole first hole groove (9) and can rotate and/or move back and forth in the first hole groove (9), and in the process of establishing the post-hepatic tunnel, the direction of the first hole groove (9) is consistent with the central longitudinal axis of the post-hepatic tunnel.
18. The monitorable post-liver tunnel creation apparatus of claim 17 and wherein: the distance between the lowest edge of the first hole groove (9) and the bottom plane of the internal fixing and guiding device (2) is 1.0-1.5mm.
19. The monitorable post-liver tunnel establishing device according to any one of claims 1 to 14, wherein: the front end of the in-vivo fixing and guiding device (2) is flat, and the flat front end is inserted into the start part of the post-hepatic tunnel and is used for fixing and guiding the tunnel establishment operating rod (1) along a given direction to establish the post-hepatic tunnel.
20. The monitorable post-liver tunnel creation apparatus of claim 19 and wherein: the internal fixation guiding device (2) be the flat strip structure of front end, flat front end be little cuboid (13), main part is big cuboid (14), the bottom surface of little cuboid (13) and big cuboid (14) be in on same horizontal plane, establish the posthepatism tunnel in-process, the bottom surface of little cuboid (13) and big cuboid (14) hug closely inferior vena cava anterior wall, the width of little cuboid (13) and big cuboid (14) the same, first hole groove (9) run through whole internal fixation guiding device (2) along the length direction of little cuboid (13) and big cuboid (14), little cuboid (13) insert posthepatism tunnel starting portion for guarantee tunnel establishment action bars (1) and posthepatism tunnel central longitudinal axis unanimity.
21. The monitorable post-liver tunnel creation apparatus of claim 20 and wherein: the bottom surfaces of the small cuboid (13) and the large cuboid (14) which are clung to the anterior wall of the inferior vena cava are arc-shaped, so that the internal fixation guiding device (2) is clung to the anterior wall of the inferior vena cava more.
22. The monitorable post-liver tunnel establishing device according to claim 20 or 21, wherein: the length of the small cuboid (13) is 5-10mm, the width is 8-15mm, the height is 8-10mm, the length of the large cuboid (14) is 10-30mm, the height is 10-15mm, and the width is the same as that of the small cuboid.
23. The monitorable post-liver tunnel establishing device according to any one of claims 1 to 14, wherein: the external fixing and adjusting device (3) comprises a fixing rod (11) and a fixing and adjusting device (12), the fixing rod (11) is connected with the internal fixing and guiding device (2) through a second constraint device (16), the fixing and adjusting device (12) is fixedly connected with an operating table, the fixing rod (11) is used for fixedly adjusting the internal fixing and guiding device (2), the operating rod fixing and guiding device (2) is located at a working position, and the tunnel establishment operating rod (1) is consistent with the central longitudinal axis of the hepatic post tunnel in the process of establishing the hepatic post tunnel.
24. The monitorable post-liver tunnel creation apparatus of claim 23 and wherein: the fixing rod (11) is a solid straight rod, the cross section of the solid straight rod is circular, the diameter of the circular shape is 2-5cm, and the length of the solid straight rod is 200-300mm.
25. The monitorable post-liver tunnel creation apparatus of claim 23 and wherein: the second restraint device (16) is a second hole groove (10), and the fixed rod (11) is connected with the in-vivo fixing guide device (2) in a mode of penetrating through the second hole groove (10).
26. The monitorable post-liver tunnel creation apparatus of claim 25 and wherein: the direction of the second hole groove (10) is perpendicular to the tunnel establishment operating rod (1).
27. The monitorable post-liver tunnel establishing device according to any one of claims 1 to 14, wherein: the material of the post-liver tunnel establishment device is one or more selected from stainless steel, plastic, silica gel, latex, ceramic and alloy.
28. Use of a monitorable post-hepatic tunnel creation apparatus according to any of claims 1 to 14 and wherein: the post-liver tunnel establishing device is used for establishing a parahepatic tunnel or establishing a subcutaneous tunnel for laparoscopic thyroid surgery, inguinal hernia surgery and breast surgery.
29. A monitorable post-hepatic tunnel establishment system, characterized by: the monitorable post-liver tunnel establishment system comprises the monitorable post-liver tunnel establishment device according to any one of 1 to 28, and further comprises a laparoscope device and/or a B-ultrasonic device, wherein the monitorable post-liver tunnel establishment device can establish a post-liver tunnel under the monitoring guidance of the laparoscope device and/or the B-ultrasonic device.
30. Use of a monitorable post-liver tunnel setup system according to claim 29 and wherein: the monitorable post-liver tunnel establishing system is used for establishing a parahepatic tunnel or establishing a subcutaneous tunnel of laparoscopic thyroid surgery, inguinal hernia surgery and breast surgery.
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| 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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| 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 |
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