CN109199584A - 一种输尿管软镜鞘的置入方法 - Google Patents

一种输尿管软镜鞘的置入方法 Download PDF

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CN109199584A
CN109199584A CN201811292654.0A CN201811292654A CN109199584A CN 109199584 A CN109199584 A CN 109199584A CN 201811292654 A CN201811292654 A CN 201811292654A CN 109199584 A CN109199584 A CN 109199584A
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汤庆峰
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Chengdu Xindu Peoples Hospital
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    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B1/00Instruments 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
    • A61B1/307Instruments 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 the urinary organs, e.g. urethroscopes, cystoscopes

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Abstract

本发明公开了一种输尿管软镜鞘的置入方法,属于医疗器械技术领域。本方法在置入输尿管软镜鞘之前先置入引导导丝,引导导丝引导输尿管硬镜的置入,输尿管软镜鞘在输尿管硬镜的支撑、指向和可视作用下,并且在引导导丝的导向作用下,方便将输尿管软镜鞘植入输尿管中预先设定的位置,输出现尿管软镜鞘的置入过程不容易意外损伤,提高了输尿管软镜鞘置入的准确率和成功率。此外,输尿管硬镜的支撑性,可以消除男性尿道的尿道长、具有生理弯曲特性对输尿管软镜鞘置入的影响。

Description

一种输尿管软镜鞘的置入方法
技术领域
本发明涉及医疗器械技术领域,具体涉及一种输尿管软镜鞘的置入方法。
背景技术
目前,随着微创技术的发展,输尿管软镜钬激光碎石术广泛运用于治疗输尿管上段结石和肾结石,而输尿管软镜鞘的置入是决定手术成功与否的关键步骤。
目前输尿管软镜鞘置入方法主要为两种方式:
第一种,凭借术者的经验和手感沿导丝自尿道外口盲视下置入,此种方法存在以下问题:1.输尿管软镜鞘长度较长,一般女性病人要求在35cm,男性更长,经尿道置入过程中,遇到阻力导致中部弯曲,力量传导输尿管软镜鞘前后端不一致或不稳定,在没有直视下或X射线透视监视下,无法判断是输尿管软镜鞘进入输尿管口遇到的阻力还是其他原因,如果是扩张输尿管口遇到的阻力,不稳定的力量输出容易导致输尿管口裂伤,如果是其他原因导致的阻力,突破阻力过程中容易导致意外损伤;2.因手术要求输尿管软镜鞘设计上需要具有一定柔韧性,因此在置入过程中经过人体腔道的自然弯曲部时,导致尖端指向并非完全和引导钢丝走形一致,在没有直视下或X射线透视监视下,盲视置入容易导致置鞘失败或者意外损伤(膀胱穿孔、输尿管口损伤等)3.输尿管软镜鞘置入完全凭借术者的经验和手感,学习曲线长。
第二种,在X射线透视下置入,此种方法存在以下问题:1.采用X射线透视置入需要移动性C臂和专用手术间,设备投入大,同时给医务人员和患者带来辐射损伤;2.虽然在X射线引导下置入,但在进入输尿管口前仍然依靠术者手感和经验,缺乏指向性和直观感受,学习曲线较长,同时无法判定输尿管口损伤情况。
因此,目前输尿管软镜鞘置入方法可能出现意外损伤、成功率低或给医务人员和患者带来辐射损伤。
发明内容
本发明的目的在于提供一种输尿管软镜鞘的置入方法,以解决现有输尿管软镜鞘置入方法可能出现意外损伤、成功率低或给医务人员和患者带来辐射损伤的问题。
本发明解决上述技术问题的技术方案如下:
一种输尿管软镜鞘的置入方法,包括以下步骤:
(1)将输尿管硬镜经尿道置入;
(2)将引导导丝穿过输尿管硬镜的管套并进入至输尿管中,然后退出输尿管硬镜,使引导导丝留置于输尿管内;
(3)在引导导丝旁再次经尿道再次置入输尿管硬镜,并将输尿管硬镜的成像探头固定在输尿管口;
(4)将输尿管软镜鞘从留置的引导导丝和输尿管硬镜旁推送至输尿管内,在输尿管硬镜的直视下,将输尿管软镜鞘推送至预先设定的位置并进行固定;
(5)退出输尿管硬镜并退出引导导丝。
本发明将输尿管硬镜置入后,可以将引导导丝从输尿管的管套中置入输尿管中,同时,输尿管硬镜具有可视性,可以观察到引导导丝在输尿管中所处的位置。引导导丝留置在输尿管中后,对于再次置入的输尿管硬镜和首次置入的输尿管软镜鞘具有引导作用,通过输尿管硬镜的可视性,使输尿管软镜的成像探头固定在输尿管口并且将输尿管软镜鞘推送至预先设定位置,在此过程中,输尿管硬镜对于输尿管软镜鞘具有支撑性、指向性以及可视性以及引导导丝对输尿管软镜鞘具有导向性,可以避免输尿管软镜鞘在推送过程中出现意外损伤,同时,输尿管软镜鞘的置入不需要X射线的照射,避免给医务人员和患者带来辐射损伤。
由于男性成人尿道直径平均8mm,女性成人尿道直径平均8mm,但是尿道易于扩张,可达到10-13mm,通常使用输尿管硬镜为6-9.8F,直径约2.0mm-3.27mm,输尿管软镜鞘通常11-15F,直径约3.67-5mm,因此能够满足输尿管硬镜和输尿管软镜同时置入尿道中。
此外,男性尿道具有尿道长、具有生理弯曲的特性,通过输尿管硬镜的支撑性,对男性尿道的支撑几乎为直线,对输尿管软镜鞘施加的力的传递几乎为直线,力量更容易控制,并且避免了由于弯曲不正常而导致的置入失败、出现意外损伤等情况的出现。
进一步地,上述步骤(2)中,在留置引导导丝时同时留置安全导丝,并将引导导丝和安全导丝均留置于输尿管内;
步骤(5)中,退出引导导丝时,将安全导丝留置于输尿管中。
本发明中的安全导丝在引导导丝出现脱落时,还能够作为备用导丝进行导向,提高输尿管软镜鞘置入的成功率。并且安全导丝在输尿管软镜鞘的置入过程中,一直留置在输尿管中,对后续手术中各医疗器械的进入和退出提供导向性。
进一步地,上述置入方法还包括:在步骤(1)之前进行的步骤(a):在输尿管中置入输尿管支架管,将输尿管进行扩张;
在步骤(1)与步骤(2)之间进行的步骤(b):在输尿管硬镜的直视下,取出留置的输尿管支架管。
本发明的输尿管支架管可以对输尿管进行预扩张,可显著提高置鞘成功率。
进一步地,上述所述输尿管支架管在输尿管中留置的时间为1至2周。
进一步地,上述所述输尿管支架管为D-J管。
进一步地,上述步骤(4)中,在推送的输尿管软镜鞘中具有内芯;步骤(5)中,还包括将内芯退出。
本发明中的内芯随输尿管软镜鞘进入输尿管,为输尿管软镜鞘提供支撑,防止较软的输尿管软镜鞘在尿道、膀胱或输尿管中遇阻力出现打结或不按引导导丝的路线变形。
本发明具有以下有益效果:
(1)本发明的输尿管软镜鞘在输尿管硬镜的支撑、指向和可视作用下,并且在引导导丝的导向作用下,方便将输尿管软镜鞘植入输尿管中预先设定的位置,输出现尿管软镜鞘的置入过程不容易意外损伤,提高了输尿管软镜鞘置入的准确率和成功率。
(2)本发明的输尿管硬镜具有支撑性,可以消除男性尿道的尿道长、具有生理弯曲特性对输尿管软镜鞘置入的影响。
(3)本发明的输尿管软镜鞘在输尿管硬镜的直视下进行置入,避免了常规在X射线直视下置入输尿管软镜鞘带来的辐射损伤问题。
具体实施方式
以下对本发明的原理和特征进行描述,所举实例只用于解释本发明,并非用于限定本发明的范围。
实施例
一种输尿管软镜鞘的置入方法,包括以下步骤:
(1)将D-J管置入到输尿管中,留置2周,对输尿管进行预扩张;
(2)将输尿管硬镜从尿道口置入,依次经过尿道和膀胱后,将输尿管硬镜的成像探头朝向输尿管,为取出D-J管提供可视性以及为放置引导导丝和安全导丝提供可视性和导向性;
(3)在输尿管硬镜的直视下,将留置在输尿管中的D-J管从尿道取出;
(4)将引导导丝和安全导丝穿过输尿管硬镜的管套并进入至输尿管中,然后退出输尿管硬镜,使引导导丝和安全导丝均留置于输尿管内,为输尿管硬镜的再次进入和输尿管软镜鞘的首次进入提供导向性;
(5)在引导导丝旁再次经尿道再次置入输尿管硬镜,并将输尿管硬镜的成像探头固定在输尿管口,为输尿管软镜鞘的进入提供可视性;
(6)将带有内芯的输尿管软镜鞘从留置的引导导丝、安全导丝和输尿管硬镜旁推送至输尿管内,在输尿管硬镜的直视下,将输尿管软镜鞘推送至预先设定的位置并进行固定;
(7)退出输尿管硬镜、引导导丝和内芯,将安全导丝留置在输尿管中。
在本发明的其它实施例中,根据患者输尿管的大小及扩张性,D-J管的留置时间还可以为1周至2周中的任意值。
以上所述仅为本发明的较佳实施例,并不用以限制本发明,凡在本发明的精神和原则之内,所作的任何修改、等同替换、改进等,均应包含在本发明的保护范围之内。

Claims (6)

1.一种输尿管软镜鞘的置入方法,其特征在于,包括以下步骤:
(1)将输尿管硬镜经尿道置入;
(2)将引导导丝穿过输尿管硬镜的管套并进入至输尿管中,然后退出输尿管硬镜,使引导导丝留置于输尿管内;
(3)在引导导丝旁再次经尿道再次置入输尿管硬镜,并将输尿管硬镜的成像探头固定在输尿管口;
(4)将输尿管软镜鞘从留置的引导导丝和输尿管硬镜旁推送至输尿管内,在输尿管硬镜的直视下,将输尿管软镜鞘推送至预先设定的位置并进行固定;
(5)退出输尿管硬镜并退出引导导丝。
2.根据权利要求1所述的输尿管软镜鞘的置入方法,其特征在于,步骤(2)中,在留置引导导丝时同时留置安全导丝,并将引导导丝和安全导丝均留置于输尿管内;
步骤(5)中,退出引导导丝时,将安全导丝留置于输尿管中。
3.根据权利要求1或2所述的输尿管软镜鞘的置入方法,其特征在于,所述置入方法还包括:在步骤(1)之前进行的步骤(a):在输尿管中置入输尿管支架管,将输尿管进行扩张;
在步骤(1)与步骤(2)之间进行的步骤(b):在输尿管硬镜的直视下,取出留置的输尿管支架管。
4.根据权利要求3所述的输尿管软镜鞘的置入方法,其特征在于,所述输尿管支架管在输尿管中留置的时间为1至2周。
5.根据权利要求4所述的输尿管软镜鞘的置入方法,其特征在于,所述输尿管支架管为D-J管。
6.根据权利要求5所述的输尿管软镜鞘的置入方法,其特征在于,步骤(4)中,在推送的输尿管软镜鞘中具有内芯;步骤(5)中,还包括将内芯退出。
CN201811292654.0A 2018-10-31 2018-10-31 一种输尿管软镜鞘的置入方法 Pending CN109199584A (zh)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN116269780A (zh) * 2023-02-23 2023-06-23 之江实验室 进给机构和手术机器人

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140275762A1 (en) * 2013-03-14 2014-09-18 The Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas Healthcare System Ureteroscope and Associated Method For The Minimally Invasive Treatment of Urinary Stones
CN204158359U (zh) * 2014-09-16 2015-02-18 蒋祥新 一种附加可拆卸外鞘的硬质输尿管镜
CN105662581A (zh) * 2016-03-22 2016-06-15 蒋祥新 一种可拆卸可伸缩的输尿管软镜鞘
CN107440672A (zh) * 2017-07-14 2017-12-08 广州医科大学附属第医院 一种带实时压力监测功能的电子输尿管软镜及其操作方法

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140275762A1 (en) * 2013-03-14 2014-09-18 The Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas Healthcare System Ureteroscope and Associated Method For The Minimally Invasive Treatment of Urinary Stones
CN204158359U (zh) * 2014-09-16 2015-02-18 蒋祥新 一种附加可拆卸外鞘的硬质输尿管镜
CN105662581A (zh) * 2016-03-22 2016-06-15 蒋祥新 一种可拆卸可伸缩的输尿管软镜鞘
CN107440672A (zh) * 2017-07-14 2017-12-08 广州医科大学附属第医院 一种带实时压力监测功能的电子输尿管软镜及其操作方法

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN116269780A (zh) * 2023-02-23 2023-06-23 之江实验室 进给机构和手术机器人
CN116269780B (zh) * 2023-02-23 2023-10-10 之江实验室 进给机构和手术机器人

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