CN110652616B - 用于微创手术三尖瓣修复的插管 - Google Patents

用于微创手术三尖瓣修复的插管 Download PDF

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CN110652616B
CN110652616B CN201811362256.1A CN201811362256A CN110652616B CN 110652616 B CN110652616 B CN 110652616B CN 201811362256 A CN201811362256 A CN 201811362256A CN 110652616 B CN110652616 B CN 110652616B
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苏瓦斯基·皮奥特
高尼卡·塞扎里
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    • A61B17/34—Trocars; Puncturing needles
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    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/0043—Catheters; Hollow probes characterised by structural features
    • A—HUMAN NECESSITIES
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02—Holding devices, e.g. on the body
    • A61M25/04—Holding devices, e.g. on the body in the body, e.g. expansible
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2017/00238—Type of minimally invasive operation
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0068—Static characteristics of the catheter tip, e.g. shape, atraumatic tip, curved tip or tip structure
    • A61M25/007—Side holes, e.g. their profiles or arrangements; Provisions to keep side holes unblocked

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Abstract

一种用于微创手术修复三尖瓣的插管，由管(5)形成，所述管(5)在其近端设置有头部(2)，所述头部(2)包括锥形刚性环(3)，所述锥形刚性环(3)在另一侧连接柔性环(4)。所述柔性环(4)在折叠状态下为碟状，在所述头部(2)的顶部具有通向所述插管(1)内部的轴向孔(8)。在所述头部(2)的整个长度上以及在所述管(5)靠近所述头部(2)连接处的部分上，在内部具有薄的引导套筒(6)，其在所述刚性环(3)的部分上永久性连接到其壁的表面上，而在其剩余长度上，其相对于所述管(5)的壁是可滑动的。所述引导套筒(6)配备有至少两个拉杆(9)，所述拉杆(9)的一端彼此相对地连接到所述引导套筒(6)的壁上，并且所述拉杆(9)的自由端沿着所述插管(1)的壁延伸超出其远端。

Description

用于微创手术三尖瓣修复的插管
技术领域
本发明涉及一种用于微创外科手术三尖瓣修复的插管。
背景技术
插管术是将插管(专用管)置入动脉血管通常是主动脉或股动脉中以及置入静脉血管中，用于在从患者到提供体外循环的装置之间接收和输送血液的过程。对于三尖瓣手术，有必要对上腔静脉(SVC)和下腔静脉(IVC)进行选择性插管，使得血液不流经右心房，从而允许打开右心房并到达正在进行手术的三尖瓣。在三尖瓣修复的标准程序中，在血液到达右心房之前切断进出SVC和IVC的血流。这个过程对于将右心房与三尖瓣隔离是必要的，同时保护其他器官和组织免于死亡。对于插管术而言，关键在于隔离(关闭)方法，即夹紧插管周围的主静脉以使血液仅在插管内流动而不通过血管腔流动。通常，对于标准手术(胸骨切开术)，通过所谓的束缚贴合器(snugger)从外部夹紧。然而，在微创手术的情况下，这可能是非常困难甚至是不可能的，因为微创手术包括通过在胸腔侧壁上的几厘米切口进入心脏和瓣膜而不影响骨骼，并且在内窥镜的控制下利用专用长工具更换瓣膜。这种手术涉及连接体外循环的不同方法与不同的插管位置(腹股沟中的静脉和股动脉)，因此需要使用完全不同的插管。
市场上有用于微创手术的静脉插管。在插管的远端部添加球囊或特殊套环，以允许主静脉从内侧稍微闭合，产生与从外部夹住静脉相同的效果，由此允许进行微创手术。
通常，微创三尖瓣手术使用两个插管，一个用于下腔静脉，其插入股动脉，另一个用于上腔静脉，其通过颈静脉插入。然而，已经尝试开发一种同时从两个静脉排出血液的插管设计。
因此，根据专利US 6,086,557已知一种静脉插管，其用于在心脏手术期间排出患者的血液并且在插管的主部末端具有两个分支。在每个分支的中间附近，设置有阻塞球囊，球囊填充后从内部密封血管，从而防止血液在其外侧沿着插管流动。
根据美国专利US 5,800,375，已知一种套管和在心脏手术期间进行血管插管术的方法。插管配有两个阻塞气囊以从内部密封主静脉。
根据专利申请CN102475556，已知一种用于主静脉的插管，其具有由软质硅树脂制成的伞形环。
发明内容
本发明的实质在于，一种插管，所述插管由管形成，所述管在其远端设置有头部，所述头部包括锥形刚性环，所述锥形刚性环在另一侧通过柔性环连接所述管，所述柔性环在折叠状态下为碟状，其中在所述头部的顶部具有通向所述插管内部的轴向孔。在所述头部的整个长度上以及在所述管靠近所述头部连接处的部分上，在内部具有薄的引导套筒，在所述刚性环的部分上永久性连接到其壁的表面上，而在其剩余长度上，其相对于所述插管的壁可滑动。所述引导套筒配备有至少两个拉杆，所述拉杆的一端彼此相对地连接到所述引导套筒的壁上，并且所述拉杆的自由端沿着所述插管的壁延伸超出其近端。
优选地，在所述头部的顶部上的入口孔的直径占所述插管的外径的50％至90％。
优选地，在所述插管的10％-20％长度的中心部分上，在壁中具有围绕其圆周均匀间隔开的横向孔。
根据本发明的实施方案的最大优点在于：在微创心脏手术的条件下，其允许从下腔静脉和上腔静脉选择性地排出血液，这是三尖瓣手术所必需的。根据本发明的插管仅通过股静脉导入，而不需要插入其它血管(例如颈静脉)，也不需要从上腔静脉中的插管外部进行密封，此种密封是一个耗时的过程，而且在某些解剖学和临床条件下，例如在再次手术的情况下，非常危险并且不可能进行。
插管应用相对简单并且无疑减少了手术时间，这对于心脏病患者状况和术后恢复速度非常重要。头部设计允许有效通过静脉，同时允许严密切断到右心房的血流。头部的可变外径使得可以将其尺寸调节至静脉内径尺寸。根据本发明的插管相对于球囊形式密封的插管的优越性在于无需进行填充球囊这种耗时且困难的动作，并且二者的密封效果相同。
根据本发明的插管的简单设计对于其制造成本也是重要的，因而对于终端价格也是如此。
附图说明
本发明的目的示出为附图中的实施方案：
图1是插管的侧视图；
图2是插管的纵向截面图；
图3是插管的轴侧立体图；
图4是插管的半截面图；
图5是插管的侧视图；
图6是插管的截面图；
图7是插管的轴侧立体图；
图8是插管的半截面图。
具体实施方式
插管1由管5构成，管5在远端配有头部2，头部2包括锥形刚性环3并且在另一侧通过柔性环4与管5连接，柔性环4在折叠状态下为碟状。在头部2的顶部，具有通向插管1内部的轴向孔8，其直径占插管外径的80％。在头部2的整个长度上以及在靠近头部2的连接处的管5的一部分上，从内侧具有一个薄的引导套筒6，其中在刚性环3的部分上，引导套筒6永久地连接到刚性环3的壁表面上。在引导套筒6的剩余长度上，引导套筒6相对于管5的壁是可滑动的。引导套筒6配有两个拉杆9，所述拉杆9的一端彼此相对地连接到引导套筒6的壁上，并且它们的自由端沿着插管1的壁延伸超出其近端，并且终止于符合人体工程学的手柄。在插管1的10％至20％长度的中心部分上，在壁中具有围绕其圆周均匀间隔开的横向孔7。
将头部2展开的插管1导入股静脉，接着在到达心脏后，穿过右前庭，并将插管1的头部2置入上腔静脉中。然后，拉动拉杆9使得刚性环3压靠柔性环4，使其壁向外凸出。位于插管1近端的连接器连接到提供体外循环的装置。手术后，利用拉杆9将柔性环4的壁拉直，然后将插管1从静脉中取出。

Claims (3)

1.一种用于微创手术修复三尖瓣的插管，所述插管(1)由柔性管(5)形成，所述柔性管(5)在其远端具有连接器，其特征在于，所述柔性管(5)在其近端设置有头部(2)，所述头部(2)包括锥形刚性环(3)，所述锥形刚性环(3)在另一侧连接柔性环(4)，所述柔性环(4)在折叠状态下为碟状，在所述头部(2)的顶部具有通向所述插管(1)内部的轴向孔(8)，其中在包括锥形刚性环(3)和柔性环(4)的所述头部(2)的整个长度上以及在所述柔性管(5)与所述头部(2)的柔性环(4)连接处的部分上，在其内部具有薄的引导套筒(6)，其中在所述锥形刚性环(3)的部分上永久性连接到所述引导套筒(6)的壁的表面上，而在引导套筒(6)的剩余长度上，引导套筒(6)相对于所述柔性管(5)的壁是可滑动的，所述引导套筒(6)配备有至少两个拉杆(9)，所述拉杆(9)的一端彼此相对地连接到所述引导套筒(6)的壁上，并且所述拉杆(9)的自由端沿着所述插管(1)的壁延伸超出其远端。
2.根据权利要求1所述的插管，其特征在于，在所述头部(2)的顶部上的轴向孔(8)的直径占所述插管(1)的外径的50％至90％。
3.根据权利要求1所述的插管，其特征在于，在所述插管(1)的10％-20％长度的中心部分上，在所述插管(1)的壁中具有围绕其圆周均匀间隔开的横向孔(7)。
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KR102237703B1 (ko) 2021-04-09
US11577015B2 (en) 2023-02-14
CA3023870A1 (en) 2019-12-28
IL263043A (en) 2019-03-31
IL263043B (en) 2022-04-01
JP2020000828A (ja) 2020-01-09
CN110652616A (zh) 2020-01-07
JP6773749B2 (ja) 2020-10-21
US20200000996A1 (en) 2020-01-02
KR20200001958A (ko) 2020-01-07
EP3586900A1 (en) 2020-01-01

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