CN110833441A - Novel multi-functional mucosa incision sword - Google Patents

Novel multi-functional mucosa incision sword Download PDF

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Publication number
CN110833441A
CN110833441A CN201910528472.7A CN201910528472A CN110833441A CN 110833441 A CN110833441 A CN 110833441A CN 201910528472 A CN201910528472 A CN 201910528472A CN 110833441 A CN110833441 A CN 110833441A
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CN
China
Prior art keywords
knife
bow
cavity
traction
shaped
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CN201910528472.7A
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Chinese (zh)
Inventor
宋健
Original Assignee
宋健
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Priority to CN201910528472.7A priority Critical patent/CN110833441A/en
Publication of CN110833441A publication Critical patent/CN110833441A/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3209Incision instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/320016Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00269Type of minimally invasive operation endoscopic mucosal resection EMR

Abstract

The invention provides a novel mucosa incision knife integrating two mucosa incision knives and a submucosal injection function. Two mucosal cutting knives include: the traditional T knife and the novel bow knife simultaneously combine the function of injecting water under mucosa. This novel multi-functional mucosa incision sword, including handle portion and sheath pipe portion, sheath pipe portion include outer sheath pipe, 2 kinds of incision sword (T sword and bow sword), T sword pull wire guide chamber, the bow sword pulls wire guide chamber (hold concurrently with injection chamber), first, two heat shrinkage bush and first, two high frequency electrode plug and injection joint. The invention realizes two mucosa incision modes of mucosa peeling operation under an endoscope, in particular to an innovative scalpel mucosa incision mode, which greatly improves the efficiency and the safety of the operation, can simultaneously carry out water injection on tissues under mucosa during the operation, can reduce the incidence rate of perforation of the wall of a digestive tract tube, shortens the operation time, improves the efficiency and the safety of the operation, reduces the difficulty of an ESD technology, and is convenient for popularization and application of the ESD technology.

Description

Novel multi-functional mucosa incision sword
Technical Field
The invention relates to an operation incision knife for mucosa dissection under an endoscope, in particular to a novel multifunctional mucosa incision knife, and belongs to the technical field of medical machinery.
Background
The mucosa dissection under the endoscope is a new treatment means appearing in recent years, is also a technology with good clinical application prospect, enables more early digestive tract cancers to be completely excised at one time under the endoscope, avoids the pain of an open operation and the excision of organs, and is an important surgical instrument of the mucosa dissection under the endoscope. Common cutting knives for stripping off early cancers in the market include needle knives, IT knives, hook knives, triangular knives, Flush knives (provided with a flushing hole in a knife head), woodpecker knives, sea bobo knives and the like.
As an important means in the treatment of digestive tract lesions, in order to prevent perforation caused in the operation process, a doctor often needs to inject physiological saline under the mucosa to a position with a high focus first in the process of performing mucosa dissection operation under an endoscope, a mucosa incision knife needs to be replaced after the injection with an injection needle, the physiological saline injected in the operation process can run off along with the operation time, a large amount of time can be wasted in the process of injecting the physiological saline again, and the risk of perforation in the operation is increased because the loss of the physiological saline in the operation can not be supplemented in time.
The invention patent with the patent application number of CN201410281645.7 discloses a combined electric knife, wherein the knife head part comprises at least two or more knife heads which can move or rotate relatively, and doctors can select proper electric knife types for the tissues of the focus part according to the condition analysis and judgment of the tissues of the focus part and different states of the proper electric knife, so that the operation is safe and quick.
The invention patent with the patent application number of 201510937882.9 discloses a multifunctional knife combining an IT knife, a needle knife and water spraying, which has the functions of the IT knife and the needle knife, and also has the function of water spraying, and the sprayed liquid can wash out blood spots, improve the visual field of an endoscope, and also wash burnt tissues adhered to an electrode.
The invention patent of patent application No. 201810924871.0 discloses a multifunctional knife combining an IT knife and an injection needle, which has the functions of the IT knife and the injection needle, realizes the peeling and water injection of tissues before and during the mucosa peeling operation under an endoscope, can continuously fill lost water in the operation process, and avoids the situations of tissue over-cutting and perforation caused by water loss.
Therefore, during the operation, the doctor can frequently change the surgical instruments to meet different requirements of each operation. However, frequent surgical instrument changes are cumbersome and time consuming, which is not conducive to patient surgery, and the need for a multi-functional combination incision knife saves time in changing the instruments. The invention can realize that doctors can conveniently select different electrotome heads without replacing the electrotome, or realize the water spraying function to improve the visual field of the endoscope, or realize the injection function at the same time, and can save the time for replacing the mucous membrane incision knife after the injection of the injection needle. However, the existing mucosa incision knife is in a point-shaped incision, has small incision width and low incision efficiency. And has the defects of difficult control of the cutting depth and angle, difficult control of the operation technology, easy perforation of the digestive canal wall and the like.
Disclosure of Invention
The purpose of the invention is as follows: lie in providing a novel mucous membrane incision sword of integration tradition mucous membrane incision sword and innovative bow sword function and injection water spray function, this kind of mucous membrane incision sword existing tradition mucous membrane incision sword's punctiform opens and the injection function, the bow sword line form that has still fused the innovation opens the function, this function opens the width greatly, it is efficient to open, and can guarantee that the sword silk is parallel with the tangent plane, be difficult for hindering and flesh layer tissue, can effectively avoid the alimentary canal to perforate and improve operation efficiency in the mucous membrane peeling off operation under the endoscope, and the technique is mastered easily, easily popularization, the problem of proposing in the above background art is solved.
The technical scheme adopted by the invention for solving the technical problems is as follows:
a novel multifunctional mucosa incision knife comprises a handle part, a sheath tube part and a tip part, wherein the handle part comprises a handle, a sliding handle and an end cap, and the handle is connected with the sheath tube part through the end cap; the sheath part comprises 2 cavities (2 cutter wire cavities, an injection cavity is shared with an arch cutter traction wire cavity), and the front end part comprises 2 cross section outlets (a T cutter outlet and an injection port), a side arch cutter traction wire groove and an inlet and an outlet. The method is characterized in that: the sheath part comprises an outer sheath, 2 incision knives (T knife and bow knife), 2 incision knife traction wires and 2 tube cavities. The T-shaped knife is fixedly connected with the traction guide wire, the bow-shaped knife is a whole guide wire, the starting part of the head end of the bow-shaped knife is fixed in the sheath tube at the front end part, a bow-shaped knife guide wire groove is arranged outside the sheath tube, the bow-shaped knife is hidden in the sheath tube groove in the non-traction state, the bow-shaped knife is exposed in the bow shape in the traction state, and an insulation protection film is arranged at the exposed part of the traction guide wire of the bow-shaped knife. The two traction guide wires are respectively connected with the two high-frequency electric plug electrodes of the handle part, and the outer sheath tube is connected with the handle part, the injection joint, the first high-frequency electric plug and the second high-frequency electric plug through a heat shrink sleeve; the end cap is communicated with the 2 wire cutting cavities through a heat-shrinkable sleeve, and the injection joint is communicated with the arch knife traction wire cavity through the heat-shrinkable sleeve. The inner wall of the tube cavity at the front end part is provided with a limiting clamp for limiting the retraction depth of the T-shaped knife, and the tail end of the T-shaped knife is provided with a limiting clamp for limiting the extension length of the T-shaped knife. The injection tube cavity is reduced at the position 7cm away from the front end part, so that the pressure of injected water is increased, the hidden groove design for the bow knife is given out by the space, and the bow knife at the front end part of the sheath tube is pulled and bent.
Preferably, the T-shaped knife and the traction guide wire are sleeved and welded in parallel by laser, and the traction guide wire is a steel wire soft rope, and the outer diameter of the traction guide wire is smaller than that of the T-shaped knife.
Preferably, the extension and retraction of the T-shaped knife are controlled by a high-frequency electrode spiral structure connected with a traction guide wire of the T-shaped knife, the T-shaped knife is pushed to extend out of the sheath, and the T-shaped knife is pulled to retract into the sheath by the left-hand rotation.
Preferably, the outer sheath tube is provided with a marker line for identifying a moving distance on an outer wall of the distal end portion on the side of the recess of the osteotome.
Preferably, the inner diameter of the traction wire cavity of the arcade knife is larger than that of the traction wire cavity of the T-shaped knife, and the outer diameter of the front end part is smaller than that of the main body of the outer sheath tube.
The invention has the beneficial effects that:
the invention relates to a novel multifunctional mucosa incision knife, which integrates the functions of a traditional mucosa incision knife, an innovative bow knife and injection water spraying and realizes the functions of peeling and incising various mucosa and supplementing and injecting water for tissues under an endoscope. Can be used for marking, ring-shaped mucosa incision, submucosal point-shaped dissection and linear dissection in the operation process, and can be continuously filled with lost water. The sickle-shaped bow knife mucosa incision mode is increased, the incision knife operation technical difficulty is reduced, the operation efficiency is improved, the time for replacing surgical instruments is shortened, the operation is more efficient and safer, and the popularization and the application of mucosa incision and stripping technology under an endoscope are facilitated.
Drawings
FIG. 1 is a schematic front view of the present invention;
FIG. 2 is a schematic view of the T-knife of the present invention in an operating state;
FIG. 3 is a schematic view of the injection water spray operating condition of the present invention;
FIG. 4 is a schematic view of the working state of the present invention;
FIG. 5 is a schematic view of the tip structure of the outer sheath of the present invention;
FIG. 6 is a schematic view of the surgical procedure and working conditions of the present invention;
in the figure: 101. the device comprises a T-knife 102, limiting clamping blocks 1 and 103, limiting clamping blocks 2 and 104, a T-knife traction wire 105, an injection outlet 106, an injection outlet pressurizing part 107, an arch knife tip end part anchor point 108, an arch knife 109, an arch knife traction wire 110, a handle 111, a sliding clamping block 112, a sliding handle 113, an arch knife traction wire fixing conduit 114, an arch knife high-frequency electrode 115, an injection connector 116, an end cap 117, a first heat-shrinkable sleeve pipe 118, a T-knife high-frequency electrode 119, a 2 nd heat-shrinkable sleeve pipe 120, a T-knife advancing and retreating spiral structure 121, an outer sheath pipe 122, a T-knife traction wire cavity 123 and an arch knife traction wire cavity which are also used as injection cavities.
Detailed Description
The technical solution of the present invention is further specifically described below by way of specific examples in conjunction with the accompanying drawings. It is to be understood that the practice of the invention is not limited to the following examples, and that any variations and/or modifications may be made thereto without departing from the scope of the invention.
Example (b): a novel mucosal incision knife, as shown in fig. 1 and 5, comprises a handle portion and a sheath tube portion.
The handle portion comprises a handle 110, a sliding handle 112 and an end cap 116, a clamping block 111 is arranged on the sliding handle, the sliding handle is connected with the handle in a sliding mode through the clamping block, and the handle is connected with the sheath tube portion through the end cap.
The sheath part comprises an outer sheath 121, a T-shaped knife 101, a T-shaped knife pull wire 104, an injection outlet 105, an arched knife 108, an arched knife pull wire 109, a first heat-shrinkable sleeve 117, an injection connector, an arched knife high-frequency electrode plug 115, a second heat-shrinkable sleeve and a T-shaped knife high-frequency electrode plug. The guide wire drawn by the bow knife is fixedly connected with the catheter of the handle part, and the catheter is connected with the handle part. The outer sheath tube is connected with the handle part, the injection joint and the high-frequency electrode joint of the bow knife through a first heat-shrinkable sleeve, the handle part and the injection joint are positioned at the same end part of the first heat-shrinkable sleeve, and the T-knife telescopic spiral structure and the high-frequency electrode joint thereof are connected through a second heat-shrinkable sleeve.
As shown in fig. 5, two lumens are provided inside the outer sheath, and the lumens include a cutting lumen (also referred to as an injection lumen) 123 for accommodating a scalpel and a T-knife traction guide wire lumen 122, and the inner diameter of the T-knife traction guide wire lumen is smaller than that of the injection lumen. The end cap is communicated with the arch knife traction wire cavity through a first heat-shrinkable sleeve, and the injection connector is communicated with the injection cavity through the first heat-shrinkable sleeve.
The front end part is provided with a first limiting fixture block 102 and a second limiting fixture block 103 for limiting the telescopic length of the T-shaped knife, and the inner wall of the front end part of the injection cavity is provided with a pressurizing structure 106 for enhancing the injection pressure.
The T-shaped cutter cutting wire is connected with the traction wire 104 which is a steel wire rope and is used for increasing the flexibility of the novel mucous membrane incision cutter in the operation. When the T-knife electrode joint part rotates rightwards, the T-knife extends out of the knife cavity, and the second limiting clamping block controls the extending length of the T-knife. When the T-knife electrode joint part rotates leftwards, the T-knife returns to the knife cavity, and the first limiting clamping block controls the returning length of the T-knife. The T-shaped cutter and the traction wire are fixedly connected through laser welding.
And a first heat-shrinkable sleeve is arranged between the end cap and the second heat-shrinkable sleeve, and two ends of the first heat-shrinkable sleeve are respectively and fixedly connected with the second heat-shrinkable sleeve and the end cap.
The handle is internally provided with a catheter 113, a guide wire extends into the catheter and is fixedly connected with a clamping block, the guide wire passes through the end cap and the catheter and is fixedly connected with the clamping block of the sliding handle, the sliding handle and the handle slide relatively to each other to drive the distal ends of the arcualia and the sheath tube to be arched, and the arcualia is exposed outside the sheath tube.
The novel mucosa incision knife provided by the invention has the following use steps:
1. as shown in fig. 4, the sliding handle is pulled backward to have the tip portion in an arcuate shape while the archwire cutting wire is exposed outside the sheath, and the sliding handle is pushed forward to have the tip portion in a linear shape while the archwire cutting wire is hidden in the groove outside the sheath.
2. The novel mucosa incision knife is inserted into a human body through an endoscope clamp pipe.
3. As shown in figure 2, when the T-knife electrode joint part rotates rightwards, the T-knife extends out of the knife cavity, and when the T-knife electrode joint part rotates leftwards, the T-knife retracts into the knife cavity.
4. The burning marks the lesion size range on the normal mucosa at the margin of the diseased tissue, as shown in panels a and B of fig. 6.
5. As shown in fig. 3, the injection joint can be set by high-pressure water injection to inject water under mucosa at the tip part, and the water injection part is marked at the position of cauterized mucosa defect.
6. As shown in the drawing C of FIG. 6, the T-knife is retracted to cut the thread, the injection is performed with the tip injection port aligned with the cauterization mark, and the high pressure water jet injects the liquid into the submucosa through the defect of the mucosa at the cauterization site. The mucosa is cut into openings, and the submucosal supplementary water can be directly injected.
7. The diseased tissue is progressively stripped off circumferentially in spots along the marked points as shown in D in FIG. 6, and a transverse linear incision is made with an arcuate knife as shown in E in FIG. 6 to strip off the submucosal tissue.
8. And (5) injecting liquid to the submucosa in the stripping process if necessary, and repeating the steps 5 and 6 until the diseased tissue is completely stripped.
9. The diseased tissue is removed with a snare or tuck for pathological analysis.
The above-described embodiments are only preferred embodiments of the present invention, and are not intended to limit the present invention in any way, and other variations and modifications may be made without departing from the spirit of the invention as set forth in the claims.

Claims (7)

1. A novel multifunctional mucosa incision knife comprises a handle part, a sheath tube part and a tip part, wherein the handle part comprises a handle, a sliding handle and an end cap, and the handle is connected with the sheath tube part through the end cap; the sheath part comprises 2 cavities (2 cutter wire cavities, an injection cavity and an arch cutter traction wire cavity are shared), and the front end part comprises 2 cross section outlets (a T cutter outlet and an injection port), a side arch cutter traction wire groove and an inlet and an outlet; the method is characterized in that: the sheath part comprises an outer sheath, 2 cutting knives (T knife and bow knife), 2 cutting knife traction wires and 2 tube cavities; the T-shaped knife is fixedly connected with a traction guide wire of the T-shaped knife, the bow-shaped knife is a whole guide wire, the starting part of the head end of the bow-shaped knife is fixed in a sheath tube at the front end part, a bow-shaped knife guide wire groove is arranged outside the sheath tube, the bow-shaped knife is hidden in the sheath tube groove in the non-traction state, the bow-shaped knife is exposed in a bow shape in the traction state, and an insulation protection film is arranged at the exposed part of the traction guide wire; the two traction guide wires are respectively connected with the two high-frequency electric plugs of the handle part, and the outer sheath tube is connected with the handle part, the injection joint, the first high-frequency electric plug and the second high-frequency electric plug through a heat shrink sleeve; the inner part of the outer sheath tube is provided with two tube cavities, each tube cavity comprises 2 cutting cavities for accommodating 2 types of cutting knives and traction wires, the injection cavities share the arch knife traction wire cavity, the end cap is communicated with the 2 cutting wire cavities through a heat-shrinkable sleeve, and the injection joint is communicated with the arch knife traction wire cavity through the heat-shrinkable sleeve; the inner wall of the tip end pipe cavity is provided with a limiting clamp for limiting the extending length of the T-shaped knife; the injection tube cavity is reduced at the position 7cm away from the front end part, so that the pressure of injected water is increased, and a hidden groove design for the bow knife is given by a space.
2. The novel multifunctional mucosa incision knife according to claim 1, characterized in that: the tail end of the T-shaped cutter is hollow, and a traction guide wire is inserted into a tail end cavity of the T-shaped cutter for parallel laser welding; the diameter of the traction guide wire is smaller than that of the T-shaped cutter, the traction guide wire is made of soft multi-strand metal wires, and the tail end of the traction guide wire is connected with a second high-frequency electrode; the bow knife and the traction guide wire thereof are whole soft steel wires, the head end of the bow knife is anchored on the reinforcing part of the sheath tube at the front end part, the bow knife is exposed out of the outer part of the sheath tube, the working length is 3cm, the bow knife runs in the protection groove of the bow knife outside the sheath tube, the bow knife enters the traction guide wire cavity of the bow knife through the inlet of the bow knife of the sheath tube, and the tail end of the bow knife is connected with the first high-frequency electrode.
3. The novel mucosal incision knife of claim 1, wherein: the injection tube cavity and the arch knife traction guide wire cavity are shared, and the caliber of the injection part at the front end part is smaller than the inner diameter of the traction guide wire cavity.
4. The novel mucosal incision knife of claim 1, wherein: the combined design of the T-shaped cutter and the bow cutter, the bow cutter groove protection design of the sheath tube at the front end part, and the insulation protection film design of the rear half part of the working part of the bow cutter.
5. The novel multifunctional mucosa incision knife according to claim 1, characterized in that: the inner cavity of the T-shaped cutter at the front end part is provided with 2 retreating limiting fixture blocks of the T-shaped cutter, and the side surface of the tail end of the T-shaped cutter is provided with 2 advancing limiting fixture blocks.
6. The novel multifunctional mucosa incision knife according to claim 1, characterized in that: the second high-frequency electrode connecting part is of a hollow bolt-nut structure, the T-shaped knife traction wire is connected to the electrode inserting part in the nut cavity through the inner cavity of the bolt, the T-shaped knife can extend out of the tube cavity of the front end part through clockwise rotation of the nut, and the T-shaped knife can return back into the tube cavity of the front end part through anticlockwise rotation of the nut.
7. The novel multifunctional mucosa incision knife according to claim 1, characterized in that: the inner diameter of the wire guide cavity drawn by the bow cutter is larger than that of the T-shaped cutter drawing wire cavity.
CN201910528472.7A 2019-06-19 2019-06-19 Novel multi-functional mucosa incision sword Pending CN110833441A (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CN201910528472.7A CN110833441A (en) 2019-06-19 2019-06-19 Novel multi-functional mucosa incision sword

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
CN201910528472.7A CN110833441A (en) 2019-06-19 2019-06-19 Novel multi-functional mucosa incision sword

Publications (1)

Publication Number Publication Date
CN110833441A true CN110833441A (en) 2020-02-25

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CN201910528472.7A Pending CN110833441A (en) 2019-06-19 2019-06-19 Novel multi-functional mucosa incision sword

Country Status (1)

Country Link
CN (1) CN110833441A (en)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112790856A (en) * 2021-01-18 2021-05-14 山东第一医科大学附属肿瘤医院(山东省肿瘤防治研究院、山东省肿瘤医院) Disposable mucosa incision knife with injection needle and use method

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112790856A (en) * 2021-01-18 2021-05-14 山东第一医科大学附属肿瘤医院(山东省肿瘤防治研究院、山东省肿瘤医院) Disposable mucosa incision knife with injection needle and use method

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