CN109620316B

CN109620316B - An endoscopic lasso

Info

Publication number: CN109620316B
Application number: CN201811588556.1A
Authority: CN
Inventors: 金杭斌; 张筱凤; 马文聪
Original assignee: Hangzhou First Peoples Hospital
Current assignee: Hangzhou First Peoples Hospital
Priority date: 2018-12-25
Filing date: 2018-12-25
Publication date: 2022-04-29
Anticipated expiration: 2038-12-25
Also published as: CN109620316A

Abstract

The invention discloses an endoscopic lasso traction method, which includes the following steps: S1, fixing one end of the traction ring to the tissue to be retracted by a fixing clip to form the A end; S2, using another fixing clip to fix the end of the traction ring The other end is fixed at the B end away from the A end; S3, the traction ring is retracted, the B end is fixed, and the A end moves closer to the B end under the action of the traction ring; S4, Step S3 is repeated until the tissue is completely opened. The invention can adjust the direction in which the tissue needs to be retracted according to the needs of the operation, and can be more flexibly applicable to different operations and different surgical situations; when the traction is required, the traction ring does not need to be acted and pulled all the time, reducing the need for endoscopy The obstructed field of view will not hinder the surgical operation of medical staff; and the traction ring can be gradually tightened according to the progress of the operation, which can better grasp the traction force, avoid unnecessary traction on normal tissues, and reduce the number of distractions during the operation. Bleeding and other injuries.

Description

Lower casing cable of endoscope

Technical Field

The invention relates to the technical field of medical instruments, in particular to a lower lasso for an endoscope.

Background

The endoscopic submucosal dissection is a new treatment means appearing in recent years, is also a technology with good clinical application prospect, enables more early digestive tract diseases to be completely resected under an endoscope at one time, and avoids the pain of an open operation and the resection of organs.

In endoscopic submucosal dissection, traction is often used to pull the diseased mucosa away to obtain a better visual field when some lesions are touched, so that an endoscope can enter the interior of the lesions to separate tissues more smoothly. To solve similar problems, the flossing method is currently used clinically, but has many drawbacks: the focus can only be drawn towards one side of the oral side of the upper digestive tract or the anal side of the lower digestive tract; when the traction rope is used, the sight line can be shielded to interfere the visual field under the endoscope, so that the operation of the endoscope is more inconvenient; due to the friction between the traction rope and the endoscope, medical staff cannot control and master the traction force well, and the cardia and other parts are easy to be pulled to bleed.

Disclosure of Invention

The invention aims to provide an endoscopic lasso which can open a sufficient visual field for surgery under the condition of not damaging tissues and ensure that the surgery is carried out under the condition of no visual field obstruction.

In order to realize the purpose of the invention, the invention adopts the following technical scheme: an endoscopic lasso comprises a traction ring (31), a lantern ring (33) and two fixing clamps (32), wherein the two fixing clamps (32) comprise one fixing clamp (32) for fixing one end of the traction ring (31) to an A-end tissue needing to be retracted and the other fixing clamp (32) for fixing the other end of the traction ring (31) to a B-end far away from the A-end; the traction ring (31) is furled, the end B is fixed, and the end A is closed to the end B under the action of the traction ring (31), so that the tissue is completely opened.

Preferably, the lantern ring (33) is sleeved on the traction ring (31), and the traction ring (31) is an 8-shaped traction ring (31) comprising two circular rings with adjustable sizes; the A end and the B end are both fixed on the same circular ring of the 8-shaped traction ring (31).

Preferably, the traction ring (31) is slidable relative to the retaining clip (32).

Preferably, the endoscopic lasso is used in endoscopic submucosal dissection.

Preferably, the fixing clip (32) is a titanium clip.

Preferably, the traction ring (31) is a nylon loop (33).

Compared with the prior art, the endoscope lower lasso adopting the technical scheme has the following beneficial effects:

firstly, the direction of tissue retraction can be adjusted according to the needs of the operation, and the device can be more flexibly suitable for different operations and different operation conditions.

Secondly, when traction is needed, traction is carried out without acting and pulling the traction ring all the time, the blocked visual field under the endoscope is reduced, and the operation of medical personnel is not hindered.

Thirdly, in the traction process, the traction ring can be gradually tightened according to the operation progress, the traction force can be better mastered, unnecessary traction on normal tissues is avoided, and injuries such as bleeding in the operation process are reduced.

Drawings

FIG. 1 is a flowchart of the steps of the present invention for making a lasso under an endoscope;

FIG. 2 is a schematic drawing of the under-endoscope lasso applied in an endoscopic submucosal dissection in this embodiment 1;

FIGS. 3(a) - (c) are schematic views illustrating the traction process of the endoscopic lasso applied in endoscopic submucosal dissection in this embodiment 1;

fig. 4(a) - (b) are schematic drawing diagrams illustrating the application of the endoscopic lasso in endoscopic retrograde cholangiopancreatography in this example 2.

Reference numerals: 1. a focus of disease; 11. a mucosal layer; 12. submucosa; 13. the intrinsic muscle layer; 21. marking; 22. separating the liquid; 31. a traction ring; 32. a fixing clip; 33. a collar; 41. descending duodenum; 42. the duodenal papilla.

Detailed Description

Embodiments of the present invention are described in more detail below with reference to the accompanying drawings.

The basic steps of an endoscopic lasso as shown in fig. 1 include:

s1, fixing one end of the traction ring 31 at the tissue to be retracted through the fixing clip 32 to form an A end;

s2, fixing the other end of the traction ring 31 at the end B far away from the end A through another fixing clamp 32;

s3, the traction ring 31 is folded, the end B is fixed, and the end A is closed towards the end B under the action of the traction ring 31;

s4, repeating the step S3 until the tissue is completely opened.

Wherein the pulling ring 31 can slide relative to the fixing clip 32 to draw the distance between the A end and the B end. The traction ring 31 is sleeved with a lantern ring 33, and the annular traction ring 31 is divided into an 8-shaped traction sleeve formed by two circular rings. The two fixing clamps 32 at the A end and the B end are respectively clamped in a circular ring of the 8-shaped traction sleeve, and the circular ring clamped with the fixing clamps 32 is called a tightening ring; another ring is called the force application ring, which facilitates the pulling of the doctor to tighten the tightening ring.

The fixing clip 32 may be fixed by a conventional titanium clip, and the traction ring 31 may be a nylon ring 33. The titanium clip is inserted into the focus 1 position of the patient through biopsy forceps and the like, and after clamping the mucous membrane tissue and the traction ring 31, the titanium clip is kept at the focus 1 position of the patient, so that the visual field in the operation process is not blocked.

Example 1:

in this embodiment, the present endoscopic subconjunctival index is used in endoscopic submucosal dissection, and the specific application of the present invention in endoscopic submucosal dissection is described below with reference to fig. 2 to 3 of the drawings:

the surface of the human intestinal tract is a mucous layer 11, and the mucous layer 11 is a submucosal layer 12 and an inherent muscle layer 13 next time. During the operation, the physician first knows the size and morphology of the lesion 1 and marks 21 the edge of the lesion 1 if necessary. Then, a separation liquid 22 for lifting the lesion 1 is injected into the submucosa 12, and the separation liquid 22 can separate the lesion 1 from the intrinsic muscle layer 13, so that the lesion 1 can be completely resected without damaging the intrinsic muscle layer 13, and as shown in fig. 3(a), the part to be operated is treated as described above. The separation liquid 22 may be physiological saline, glycerol fructose, sodium hyaluronate, etc.

In fig. 3(b), a part of the mucosa around the lesion is incised along the mark 21 or the outer edge of the mark 21, and after the traction ring 31 is introduced into the lesion 1, the traction ring 31 is fixed to the edge of the mucosa just incised by the fixing clip 32. After the fixing clip 32 is clamped at the edge of the mucous membrane, the traction ring 31 can slide in the fixing clip 32 relative to the fixing clip 32. The surgeon pulls the ring 31 slowly to pull the cut mucosa apart during the surgery. In order to achieve a smooth traction, the traction ring 31 needs at least two fixing clips 32 for fixing. As shown in fig. 3, the incised edge of the lesion 1 is a traction a end, and another fixing clip 32 is clamped on the lesion 1 or normal tissue far away from the a end to form a traction B end, and the position of the B end is set according to the traction direction of the mucosa incised in the operation. When only two traction ends are arranged in the traction process, the direction of the connecting line between the traction end A and the traction end B is the traction direction, and a doctor can clamp another fixing clamp 32 at different positions according to the actual traction direction. In fig. 2, the a end is fixed on the lesion tissue to be pulled, the lesion tissue is cut from the a end, and the B end is fixed on the normal tissue; in fig. 3, the end a and the end B are clamped on or near the lesion tissue, the lesion tissue is cut from the end a, and finally the cut lesion tissue is taken out of the body together with the fixing clip 32 and the traction ring 31 fixed on the lesion tissue.

In fig. 3(B) and (c), the ends a and B are already clamped, in fig. 3(c), the mucosa marked 21 is cut continuously, and when traction needs to be performed on the cut mucosa, a force application tool, such as a hook, is used for pulling the traction ring 31 at the force application ring of the traction ring 31, and the tightening ring is closed. The thus cut mucosal tissue is lifted along a certain side by the traction ring 31 and the fixing clip 32. After the tightening ring is tightened to a certain degree, the force application tool is removed, and the doctor can continue to cut the mucous membrane tissue. During the operation, the doctor repeats the above-described incision and traction until the lesion 1 is completely removed.

In the incision process, the same lesion 1 can be dragged by using a combination of a plurality of groups of traction rings 31 and fixing clips 32 to ensure better retraction effect and operation visual field.

Example 2:

in this embodiment, the specific application of the present endoscopic lasso in endoscopic retrograde cholangiopancreatography is described below with reference to fig. 4(a) to (b):

in the course of endoscopic retrograde cholangiopancreatography, a duodenoscope is inserted into the descending duodenum portion 41, a contrast catheter is inserted into the biopsy channel to the papillary opening after finding the duodenal papillary 42, and a contrast medium is injected to perform x-ray radiography to display the cholangiopancreatography. However, in the course of clinical operation, as shown in fig. 4(a), the duodenal papilla 42 is often covered with wrinkles or the like in the intestine, and it is difficult to find the papilla and inject a contrast medium into the papilla opening.

In this embodiment, the A end of the pull ring 31 is fixed to the fold that is hidden by the duodenal papilla 42, and the B end is fixed to the inside of the intestine that is far from the A end. Before injecting the contrast agent, the force is applied to the force application ring, the tightening ring is folded to make the end A approach the end B, and the folds at the duodenal papilla 42 part are pulled up as shown in fig. 4(B), so that the injection of the contrast agent is facilitated.

The foregoing is a preferred embodiment of the present invention, and it will be apparent to those skilled in the art that various changes and modifications may be made without departing from the spirit of the invention, and these should be considered to be within the scope of the invention.

Claims

1. The utility model provides an use lasso under scope in scope mucosa stripping operation which characterized in that: the retractor comprises a traction ring (31), a lantern ring (33) and two fixing clamps (32), wherein the two fixing clamps (32) comprise one fixing clamp (32) for fixing one end of the traction ring (31) to an A-end tissue needing to be retracted and the other fixing clamp (32) for fixing the other end of the traction ring (31) to a B-end far away from the A-end; the traction ring (31) is furled, the B end is fixed, and the A end is closed to the B end under the action of the traction ring (31), so that the tissue is completely opened; the lantern ring (33) is sleeved on the traction ring (31), and the traction ring (31) is arranged to be an 8-shaped traction ring (31) comprising two circular rings with adjustable sizes; the A end and the B end are both fixed on the same circular ring of the 8-shaped traction ring (31).

2. The endoendoscopic lasso of claim 1, further comprising: the traction ring (31) can slide relative to the fixing clamp (32).

3. The endoendoscopic lasso according to any one of claims 1 to 2, characterized in that: the fixing clip (32) is a titanium clip.

4. The endoendoscopic lasso according to any one of claims 1 to 2, characterized in that: the traction ring (31) is a nylon sleeve ring.