CN111110333A - Percutaneous nephropuncture dilation kit, method of use thereof, and surgical assembly - Google Patents
Percutaneous nephropuncture dilation kit, method of use thereof, and surgical assembly Download PDFInfo
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- CN111110333A CN111110333A CN202010100994.XA CN202010100994A CN111110333A CN 111110333 A CN111110333 A CN 111110333A CN 202010100994 A CN202010100994 A CN 202010100994A CN 111110333 A CN111110333 A CN 111110333A
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- balloon
- sheath
- needle
- dilator
- needle sheath
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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
- A61B17/34—Trocars; Puncturing needles
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3413—Needle locating or guiding means guided by ultrasound
Abstract
The invention provides a percutaneous renal puncture dilation kit, a using method and a surgical assembly, wherein the percutaneous renal puncture dilation kit comprises: a puncture needle, a fascia dilator, a balloon dilator and a working sheath; the puncture needle comprises a needle sheath and a needle core; the inner diameter of the sheath is adapted to be passed through by the stylet and the stylet is detachably passed through the sheath such that: the needle core and the needle sheath can be punctured to a target position together when not being separated, and the needle core can be separated and taken out from the needle sheath after the puncture is finished; the outer diameter of the needle sheath matches the inner diameter of the fascia dilator such that: the fascia dilator can be sleeved on the outer wall of the needle sheath at the target position and moves along the outer wall of the needle sheath; the outer diameter of the needle sheath is also matched to the inner diameter of the balloon dilator such that: the balloon dilator can be sleeved on the outer wall of the needle sheath at the target position and moves to the target position along the outer wall of the needle sheath.
Description
Technical Field
The invention relates to the field of medical instruments, in particular to a percutaneous renal puncture dilation kit, a using method thereof and a surgical assembly.
Background
Percutaneous nephrolithotomy (percutaneous nephrolithotomy) is currently the first treatment option for the treatment of complex stones. For a percutaneous nephroscope operation, the most critical step is the establishment of a percutaneous renal channel, which directly affects whether the operation can be performed successfully. In some prior art techniques, the creation of the channel may be performed under X-ray guidance or may be accomplished by ultrasound guidance. The method for establishing the channel by using ultrasonic guidance has the advantages that the position of the puncture needle can be observed in real time during puncture and no radioactive damage exists, but has the disadvantages that a guide wire and an expansion sheath cannot be monitored during channel expansion, channel bleeding is easy to occur, even the channel is lost and the like.
In the prior art, a balloon dilatation method can be adopted when a channel is established, and the method has the characteristics of rapidness, safety, effectiveness and the like. However, if the balloon dilation method is adopted, in order to clearly see the specific positions of the guide wire and the balloon, the specific positions of the guide wire and the balloon can only be clearly seen by using X-ray guidance.
Disclosure of Invention
The invention provides a percutaneous renal puncture dilation kit, a using method thereof and a surgical assembly, which aim to solve the problems that a channel cannot be established by using a balloon dilator under the condition of not adopting X-ray guidance and/or the positioning accuracy is difficult to guarantee.
According to a first aspect of the present invention there is provided a percutaneous nephropuncture dilation kit comprising: a puncture needle, a fascia dilator, a balloon dilator and a working sheath; the puncture needle comprises a needle sheath and a needle core;
the inner diameter of the sheath is adapted to be passed through by the stylet and the stylet is detachably passed through the sheath such that: the needle core and the needle sheath can be punctured to a target position together when not being separated, and the needle core can be separated and taken out from the needle sheath after the puncture is finished;
the outer diameter of the needle sheath matches the inner diameter of the fascia dilator such that: the fascia dilator can be sleeved on the outer wall of the needle sheath at the target position and moves along the outer wall of the needle sheath;
the outer diameter of the needle sheath is also matched to the inner diameter of the balloon dilator such that: the balloon dilator can be sleeved on the outer wall of the needle sheath at the target position and moves to the target position along the outer wall of the needle sheath;
the inner diameter of the working sheath is matched with the outer diameter of the expanded balloon dilator, so that the working sheath can be arranged on the outer side of the expanded balloon dilator in a surrounding mode after being connected.
Optionally, the balloon dilator comprises a balloon body, a balloon rod and a balloon inner tube; the balloon body and the balloon inner tube are arranged at one end of the balloon rod, the inner cavity of the balloon inner tube is communicated with the inner cavity of the balloon rod, and the tube wall of the balloon inner tube is provided with a communication hole communicated with the inner cavity of the balloon body;
a medium for expanding the balloon body can enter the inner cavity of the balloon body through the inner cavity of the balloon rod, the inner cavity of the balloon inner tube and the communication hole in sequence;
the inner diameter of the working sheath is matched with the outer diameter of the expanded balloon body, and the outer diameter of the needle sheath is matched with the inner diameter of the balloon inner tube and the inner diameter of the balloon rod.
Optionally, the end of the balloon body away from the balloon shaft after inflation is flat, so that: after the balloon body is expanded, one end of the balloon body, which is far away from the balloon rod, is flush with one end of the needle sheath, which is used for puncture.
Optionally, the balloon rod is directly or indirectly connected to a pressure pump for injecting the medium.
Optionally, the balloon rod is provided with a folder.
Optionally, the length of the working sheath is matched to the length of the balloon body.
Optionally, the outer side of the needle sheath is provided with marked lines distributed along the length direction of the needle sheath.
Optionally, the fascia dilator is made of a transparent material.
Optionally, the kit further comprises a guidewire accessible through the needle sheath after the core has been removed.
According to a second aspect of the present invention, there is provided a surgical assembly comprising the percutaneous nephropuncture dilation kit of the first aspect and its alternatives, and a visualization device comprising an ultrasound device or an X-ray device; the developing device is used for developing the needle sheath and/or the needle core when the puncture needle punctures the human body.
According to a third aspect of the present invention there is provided a method of using a percutaneous nephropuncture dilation kit according to the first aspect of the present invention and its alternatives, comprising:
taking out the needle core in the puncture needle at the target position and keeping the needle sheath at the target position;
controlling the fascia dilator to move to a required position along the outer wall of the needle sheath, and then taking out the fascia dilator;
controlling the balloon dilator to move along the outer wall of the needle sheath so that: after the balloon dilator moves, the head end of the balloon dilator is flush with the head end of the needle sheath;
controlling inflation of the balloon dilator;
the working sheath is arranged to be positioned outside the balloon dilator, and the head end of the balloon dilator is flush with the head end of the working sheath;
controlling the balloon dilator to contract;
and taking out the balloon dilator and the needle sheath.
The percutaneous renal puncture dilation kit, the use method thereof and the operation assembly provided by the invention adopt the puncture needle with the needle sheath and the needle core, wherein the introduction of the needle sheath can be realized based on ultrasonic waves and X rays, the outer diameter of the needle sheath is matched with the fascia dilator and the balloon dilator, the position of the needle sheath can be used as a reference object for guiding the fascia dilator and the balloon dilator, the position of the balloon dilator is convenient to determine, and the balloon dilator can be connected to a required position no matter whether X-ray guidance is adopted or not, so that the kit can be conveniently realized through the matching design of the inner diameter and the outer diameter and the separable design of the needle sheath and the needle core: regardless of the visualization method used, it is feasible to create a channel using a balloon dilator.
In addition, the needle sheath of the puncture needle is fixed and not drawn out after entering in the operation process, the needle sheath of the puncture needle can be used as a reference object, and the dilator enters along the puncture needle to establish a channel. Because the reference object is always kept unchanged, the reference object does not need to be repeatedly extracted, and the positioning is more accurate. The kit can provide an achievable means for the more accurate positioning through the matching design of the inner diameter and the outer diameter and the separable design of the needle sheath and the needle core.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, and it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to these drawings without creative efforts.
FIG. 1 is a schematic view showing the construction of a puncture needle according to an embodiment of the present invention;
FIG. 2 is a schematic view of the configuration of the needle sheath and balloon dilator in one embodiment of the present invention;
FIG. 3 is a schematic view of the construction of a needle sheath and fascia dilator in accordance with an embodiment of the invention;
FIG. 4 is a schematic view of a balloon dilator in accordance with an embodiment of the present invention;
FIG. 5 is a schematic view of the construction of a fascia dilator in accordance with an embodiment of the invention;
FIG. 6 is a schematic view of the construction of a working sheath in one embodiment of the present invention;
fig. 7 is a schematic view showing the configuration of the pressure pump in one embodiment of the present invention.
Description of reference numerals:
1-puncture needle;
11-a needle core;
12-needle sheath;
13-a limiting part;
2-a balloon dilator;
21-balloon body;
22-balloon shaft;
23-balloon inner tube;
24-a folder;
25-a connecting seat;
3-fascia dilators;
31-marking;
4-working sheath;
5-pressure pump.
FIG. 8 is a schematic flow chart illustrating a method of using the percutaneous nephropuncture dilation kit in accordance with an embodiment of the present invention.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
The terms "first," "second," "third," "fourth," and the like in the description and in the claims, as well as in the drawings, if any, are used for distinguishing between similar elements and not necessarily for describing a particular sequential or chronological order. It is to be understood that the data so used is interchangeable under appropriate circumstances such that the embodiments of the invention described herein are capable of operation in sequences other than those illustrated or described herein. Furthermore, the terms "comprises," "comprising," and "having," and any variations thereof, are intended to cover a non-exclusive inclusion, such that a process, method, system, article, or apparatus that comprises a list of steps or elements is not necessarily limited to those steps or elements expressly listed, but may include other steps or elements not expressly listed or inherent to such process, method, article, or apparatus.
The technical solution of the present invention will be described in detail below with specific examples. The following several specific embodiments may be combined with each other, and details of the same or similar concepts or processes may not be repeated in some embodiments.
FIG. 1 is a schematic view showing the construction of a puncture needle according to an embodiment of the present invention; FIG. 2 is a schematic view of the configuration of the needle sheath and balloon dilator in one embodiment of the present invention; FIG. 3 is a schematic view of the construction of a needle sheath and fascia dilator in accordance with an embodiment of the invention.
Referring to fig. 1-3, a percutaneous nephropuncture dilation kit includes: puncture needle 1, fascia expander 3, sacculus expander 2 and work sheath 4.
The puncture needle 1 can comprise a needle sheath 12 and a needle core 11.
The relationship between the hub 11 and the sheath 12 can be understood as: the stylet 11 can be passed through the sheath 12 and the head of the stylet 11 can be used for puncture, after which the sheath 12 can be held in place and the stylet 11 removed. It will be appreciated that the sheath 12 is intended to be understood as a form of construction through which the hub 11 can pass, and that the hub 11 is intended to be understood as a form of construction through which the sheath 12 can pass and effect penetration.
Wherein the inner diameter of the sheath 12 is adapted to be penetrated by the stylet 11 and the stylet 11 is detachably threaded through the sheath such that: the core 11 and the sheath 12 can be punctured together to a target site without being separated, and after completion of the puncture, the core can be separated and taken out from the sheath. The target position is understood to be a position which can be identified as successful in puncturing, for example, a position in which urine overflows.
The relationship of the needle sheath 12 to the fascia dilator 3, balloon dilator 2, can be understood as: the needle sheath 12 can provide a guide and positioning reference for the access of the balloon dilator 2 and the fascia dilator 3, and specifically:
the outer diameter of the needle sheath 12 is also matched to the inner diameter of the fascia dilator 3 so that: the fascia dilator 3 can be sleeved on the outer wall of the needle sheath 12 at the target position and moves along the outer wall of the needle sheath 12; at this point, the position of the needle sheath 12 may remain unchanged, thereby providing a stable reference;
the outer diameter of the needle sheath 12 matches the inner diameter of the balloon dilator 2 such that: the balloon dilator 2 can be sleeved on the outer wall of the needle sheath 12 at the target position and move to the target position along the outer wall of the needle sheath 12.
In addition to the above description, the kit may further include: a guidewire that can be accessed through the needle sheath after the stylet is removed.
In the above scheme, a puncture needle having a needle sheath and a needle core is adopted, wherein the introduction of the needle sheath can be realized based on ultrasonic waves, and since the outer diameter of the needle sheath is matched with the fascia dilator and the balloon dilator, the positions of the needle sheath can be used as references for guiding the fascia dilator and the balloon dilator, so that the position of the balloon dilator can be conveniently determined, and the balloon dilator can be accessed to a required position no matter whether X-ray guidance is adopted or not.
In addition, in some prior art, in order to realize the location access of sacculus expander, the business turn over operation of making a round trip of each part is complicated, because the location of pjncture needle is the most accurate in the location process, after changing the reference thing later, easily leads to the location inaccurate, and then, even if X ray guide, still easily produce the situation of location inaccurate. Under the structure of the scheme, the needle sheath can be directly used as a positioning reference object of the dilator, and the accurate reaching of the required position can be guaranteed. In other words, the needle sheath of the puncture needle is fixed and not drawn out after entering, and the dilator can enter along the puncture needle by taking the needle sheath of the puncture needle as a reference object to establish a channel. Because the reference object is always kept unchanged, the reference object does not need to be repeatedly extracted, and the positioning is more accurate. The kit of the present embodiment can provide an achievable means for the above more precise positioning by the matching design of the inner and outer diameters and the separable design of the needle sheath and the needle core.
In addition, the embodiment can be applied to the ultrasound-guided scene, and the X-ray-guided scene is not excluded, so that the balloon dilator can be conveniently accessed to the accurate position in the ultrasound-guided scene, and the positioning accuracy can be guaranteed in the X-ray-guided scene.
When the ultrasonic developing probe is applied to an ultrasonic guiding scene, the surface roughness of the needle sheath and the needle core can be further improved, so that the requirement of ultrasonic developing is met.
The relationship of the working sheath to the balloon dilator 2 can be understood as: the inner diameter of the working sheath is matched with the outer diameter of the expanded balloon dilator 2, so that the working sheath can be arranged on the outer side of the expanded balloon dilator 2 in a surrounding mode.
In one embodiment, referring to fig. 1, the tail end of the stylet 11 may be provided with a limiting portion 13, and the radial dimension of the limiting portion 13 is larger than that of the stylet 12, so as to limit the movement of the stylet 11 along the stylet 12 and ensure safety. Meanwhile, the needle core 11 can be controlled to move forwards until the limiting part 13 is contacted with the needle sheath 12 by controlling the limiting part 13, at the moment, the needle core 11 and the needle sheath 12 can move synchronously, the two can be kept not to be separated, and further, if the needle core 11 moves backwards, the needle core 11 can be separated from the needle sheath 12.
In the specific implementation process, the puncture needle 1 can be an 18G puncture needle, the total length is designed to be 50cm, scale marks can be marked at the 15cm position of the front end of the needle sheath 12 in the puncture needle 1, and two scale marks can be marked at the 22cm position and the 36cm position, wherein the mark lines at the 22cm position and the 36cm position can be matched with a fascia dilator and a balloon dilator, for example, the mark lines can be equal in length.
The tail end of the needle sheath 12 is not provided with a tail end extending part, the whole needle sheath is in a round tube shape, and 2cm of the head end of the puncture needle sheath 12 can be specially polished, so that the needle sheath can provide clearer imaging under ultrasound. As the whole length is longer, the needle sheath 12 is bent in the process of puncture and subsequent operation as much as possible by selecting the material with higher rigidity.
Fig. 4 is a schematic view of the construction of a balloon dilator in an embodiment of the invention.
Referring to fig. 4, the balloon dilator 2 includes a balloon body 21, a balloon shaft 22 and a balloon inner tube 23; the balloon body 21 and the balloon inner tube 23 are arranged at one end of the balloon rod 22, the inner cavity of the balloon inner tube 23 is communicated with the inner cavity of the balloon rod 22, and a communication hole communicated with the inner cavity of the balloon body 21 is formed in the tube wall of the balloon inner tube 21.
The inner diameter of the working sheath 4 is matched with the outer diameter of the expanded balloon body 21, the outer diameter of the needle sheath 12 is matched with the inner diameter of the balloon inner tube 23 and the inner diameter of the balloon rod 22.
The medium for expanding the balloon body can enter the inner cavity of the balloon body 21 through the inner cavity of the balloon rod 22, the inner cavity of the balloon inner tube 23 and the communication hole in sequence. The medium may be, for example, saline, and in other alternative embodiments, the medium does not exclude other liquid or gaseous means.
In one embodiment, referring to fig. 4, the end of the balloon body 21 away from the balloon shaft 22 after inflation is flat, so that: after the balloon body 21 is expanded, the end of the balloon body, which is far away from the balloon rod 22, is flush with the end of the needle sheath 12 which is punctured into the human body. The balloon shaft 22 is directly or indirectly connected to a pressure pump for injecting the medium. The balloon shaft 22 may be provided with a folder. The balloon rod 22 may also be provided with a connecting seat 25.
The material of sacculus utricule 21 or whole sacculus expander 2 can adopt withstand voltage wear-resisting multilayer fiber material, the pressure of demarcation blasting can be 25-30ATM, the length of sacculus utricule 21 can be 15cm, sacculus afterbody to connecting seat 25 length 18cm, connecting seat to ball-sacculus pole afterbody 3cm, the sacculus diameter has 18F, 20F, 22F and 24F can select, and compare in the past mostly be the toper after the sacculus head end is sufficient, be planar design through the tip, the design of flat after the sacculus head end adopts sufficient, wholly is cylindrically, the head end coating guarantees that it can develop under the radiation. The balloon inner tubing 23 may have an inner diameter of 1.2mm and may be provided with a hydrophilic coating to accommodate the outer sheath 12 of the 18 gauge needle. The outer diameter of the balloon shaft 22 was F7, and a corresponding balloon folder could be configured to enable refolding of 4 gauge balloons.
Through the planar design (namely the flat design), the head end of the sacculus and the head end of the puncture needle sheath can be ensured to be flush after the sacculus is placed, so that not only can the kidney essence on the channel path be completely expanded, but also unnecessary damage to the kidney can be avoided when the working sheath is placed too deep.
In addition, the puncture needle sheath can be contained in the inner diameters of the saccule and the fascia dilator, the saccule can be directly pre-dilated and placed after the zebra guide wire is placed, the channel can be smoothly established only by means of dilation according to corresponding scales, and the problem that the dilatation process cannot be considered after ultrasonic puncture is used in the prior art is solved.
FIG. 5 is a schematic view of the construction of a fascia dilator in accordance with an embodiment of the invention.
Referring to fig. 5, since the outside of the sheath 12 is provided with the marked lines 31 distributed along the length direction of the sheath, the fascia dilator 3 may be made of a transparent material, which is different from the previous fascia dilators, and the design of the transparent material is convenient for observing whether the insertion depth of the fascia dilator is the same as the insertion depth of the sheath 12 when the fascia dilator is expanded along the puncture needle sheath, and simultaneously preventing the puncture needle sheath from shifting during the expansion process. Therefore, the scales on the puncture needle sheath can be observed in the expansion process by adopting the transparent material, so that the puncture needle sheath can not shift in the expansion process.
In the specific implementation process, the fascia dilator has the overall length of 22cm (with scales), the outer diameters of 6F, 8F and 10F can be selected, the inner diameters of 1.2mm, and the design with the same width is adopted, so that a needle sheath can be accommodated.
FIG. 6 is a schematic view of the construction of a working sheath in one embodiment of the present invention; fig. 7 is a schematic view showing the configuration of the pressure pump in one embodiment of the present invention.
Referring to fig. 6 and 7, the pressure pump 5 can be a pressure pump with a pressure gauge, on which a calibrated burst pressure is displayed; the overall length of the working sheath 4 can be 15cm, and the working sheath 4 and the inner diameter of the balloon are optimally matched (4 types), wherein, taking fig. 6 as an example, the head end of the working sheath 4 can be designed into an oblique angle so as to be conveniently placed along the inflated balloon.
The length of the working sheath 4 may be matched to the length of the balloon body 21. The working sheath is as long as the balloon body 21, and the head end of the working sheath can be confirmed to enter the target renal calyx when the tail parts of the working sheath and the balloon body are flush after the working sheath is placed in the balloon body, so that the problem of over-depth or over-shallow can be avoided.
The matching referred to above may be the same, for example.
The present embodiment also provides a surgical assembly comprising the percutaneous nephropuncture dilation kit of the above alternatives, and a visualization device comprising an ultrasound device or an X-ray device; the developing device is used for developing the needle sheath and/or the needle core when the puncture needle punctures the human body.
Further, in order to improve the developing effect, for example, the following measures may be taken:
if an X-ray device is adopted, the needle sheath and/or the needle core can be made of metal materials in the specific implementation process, and the development of the metal materials is better;
if an ultrasonic device is adopted, the needle sheath and/or the needle core can be made of metal materials in the specific implementation process, and the development of the metal materials is better; meanwhile, the smoother the surface is, the poorer the ultrasonic development effect is, so that the front end surface of the needle sheath and/or the needle core can be polished into a ring shape, the surface reflectivity is enhanced, the scattering effect of ultrasonic waves is increased, and the development effect is improved.
In summary, in the percutaneous renal puncture dilation kit and surgical assembly provided in this embodiment, a puncture needle having a needle sheath and a needle core is adopted, wherein the introduction of the needle sheath can be achieved based on ultrasonic waves or X-rays, and since the outer diameter of the needle sheath is matched with the fascia dilator and the balloon dilator, and the positions thereof can be used as references for guiding the fascia dilator and the balloon dilator, the positions of the balloon dilator can be conveniently determined, and the balloon dilator can be connected to a desired position regardless of whether X-ray guidance is adopted, thus it can be seen that the kit of the present invention can be conveniently implemented by matching the inner diameter and the outer diameter and by a separable design of the needle sheath and the needle core: regardless of the visualization method used, it is feasible to create a channel using a balloon dilator.
In addition, the needle sheath of the puncture needle is fixed and not drawn out after entering in the operation process, the needle sheath of the puncture needle can be used as a reference object, and the dilator enters along the puncture needle to establish a channel. Because the reference object is always kept unchanged, the reference object does not need to be repeatedly extracted, and the positioning is more accurate. The kit of the present embodiment can provide an achievable means for the above more precise positioning by the matching design of the inner and outer diameters and the separable design of the needle sheath and the needle core.
FIG. 8 is a schematic flow chart illustrating a method of using the percutaneous nephropuncture dilation kit in accordance with an embodiment of the present invention.
Based on the above mentioned kit, please refer to fig. 8, the method for using the percutaneous renal puncture dilation kit provided in this embodiment may include:
s11: taking out the needle core in the puncture needle at the target position and keeping the needle sheath at the target position;
s12: controlling the fascia dilator to move to a required position along the outer wall of the needle sheath, and then taking out the fascia dilator;
s13: controlling the balloon dilator to move along the outer wall of the needle sheath so that: after the balloon dilator moves, the head end of the balloon dilator is flush with the head end of the needle sheath;
s14: controlling inflation of the balloon dilator;
s15: the working sheath is arranged to be positioned outside the balloon dilator, and the head end of the balloon dilator is flush with the head end of the working sheath;
s16: controlling the balloon dilator to contract;
s17: and taking out the balloon dilator and the needle sheath.
In the following description of the specific implementation process, the use process of the kit and the implementation process of the operation may be described in combination, and meanwhile, it should be noted that, the following description of the implementation process of the operation is only for better showing the use mode of the kit and the effect thereof, and the use method related to this embodiment is only for describing and protecting the use process of the kit, that is: the description is mainly directed to the way of using the kit in combination, and does not relate to how to treat the human body, so that the kit should not be regarded as a means of treatment and diagnosis acting on the human body.
In the implementation process, before step S11, the patient may take the cystectomy site during percutaneous nephroscopy, place the F7 ureteral catheter and the F16 ureter and fix the former with the latter by using an adhesive tape. Then, take the prone position and raise the waist.
Then, before step S11, the target renal calyx can be punctured under the guidance of ultrasound, the distance of the puncture needle 1 entering the body is observed during the puncturing process, when the ultrasound shows that the puncture needle 1 enters the target renal calyx, the stylet 11 of the puncture needle is pulled out, when urine overflows, the puncturing is successful, and then the zebra guide wire is placed as a safety guide wire, so as to ensure that the channel is not lost, and simultaneously, the folding resistance of the needle sheath 12 of the puncture needle 1 can be increased, and the excessive bending of the needle sheath can be prevented. Other examples of puncturing may also be performed under X-ray guidance.
At this time, in step S12, the assistant fixes the tail of the needle sheath 12 without withdrawing the needle sheath 12 of the puncture needle 1, and the fascia dilator 3 is used to pre-dilate the channel to F10 (the tail of the dilator stops when advancing to the 22cm position on the puncture needle sheath) according to the distance of the puncture needle entering the body, and the fascia dilator 3 is made of transparent material, so that the scales on the puncture needle sheath 12 can be observed during the dilation process, and the needle sheath 12 is guaranteed not to be displaced.
In step S13, after the pre-expansion, the balloon dilator 2 can be directly inserted into the needle sheath 12 of the puncture needle 1, and the tail of the needle sheath 12 fixed by the assistant during the insertion process prevents the needle sheath 12 from shifting, and meanwhile, whether the scales at the 36cm position on the needle sheath 12 of the puncture needle 1 are aligned with the tail of the connecting seat 25 can be observed, so that the head end of the balloon can be aligned with the head end of the puncture needle sheath, and the over-shallow or over-deep expansion can be prevented.
In step S14, the balloon body 21 is injected with saline using the pressure pump 5, the pressure is gradually increased to 25 atmospheres, and the channel is expanded to F24(F18, F20, or F22) and then maintained for 2-4 min.
In step S15, the working sheath 4 can be rotated along the outside of the balloon, and since the working sheath 4 is the same length as the balloon body 21, the head end of the working sheath 4 can be kept in place as long as the working sheath 4 is flush with the tail of the balloon body 21.
In step S16, the fluid in the balloon body 21 can be pumped out to a negative pressure state by the pressure pump 5, and the balloon dilator 2, the outer sheath 21 of the puncture needle 1 and the zebra guide wire are withdrawn, so as to complete the channel establishment.
Therefore, in the embodiment and the alternative scheme thereof, the subsequent expansion can be smoothly carried out only by the puncture needle in place, the efficiency of channel expansion is greatly improved, the overall difficulty of the operation is reduced, and the method is particularly suitable for patients who have no hydrops due to complete antler-shaped calculi and renal calyx. The embodiment avoids the occurrence of repeated expansion and repeated placement of the working sheath as far as possible, greatly reduces the risk of intraoperative hemorrhage, and is more beneficial to patients with damaged renal function hands, especially patients with isolated renal calculus during percutaneous nephrolithotripsy.
Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit the same; while the invention has been described in detail and with reference to the foregoing embodiments, it will be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some or all of the technical features may be equivalently replaced; and the modifications or the substitutions do not make the essence of the corresponding technical solutions depart from the scope of the technical solutions of the embodiments of the present invention.
Claims (10)
1. A percutaneous nephropuncture dilation kit, comprising: a puncture needle, a fascia dilator, a balloon dilator and a working sheath; the puncture needle comprises a needle sheath and a needle core;
the inner diameter of the sheath is adapted to be passed through by the stylet and the stylet is detachably passed through the sheath such that: the needle core and the needle sheath can be punctured to a target position together when not being separated, and the needle core can be separated and taken out from the needle sheath after the puncture is finished;
the outer diameter of the needle sheath matches the inner diameter of the fascia dilator such that: the fascia dilator can be sleeved on the outer wall of the needle sheath at the target position and moves along the outer wall of the needle sheath;
the outer diameter of the needle sheath is also matched to the inner diameter of the balloon dilator such that: the balloon dilator can be sleeved on the outer wall of the needle sheath at the target position and moves to the target position along the outer wall of the needle sheath;
the inner diameter of the working sheath is matched with the outer diameter of the expanded balloon dilator, so that the working sheath can be arranged on the outer side of the expanded balloon dilator in a surrounding mode after being connected.
2. The kit of claim 1, wherein the balloon dilator comprises a balloon body, a balloon shaft, and a balloon inner tube; the balloon body and the balloon inner tube are arranged at one end of the balloon rod, the inner cavity of the balloon inner tube is communicated with the inner cavity of the balloon rod, and the tube wall of the balloon inner tube is provided with a communication hole communicated with the inner cavity of the balloon body;
a medium for expanding the balloon body can enter the inner cavity of the balloon body through the inner cavity of the balloon rod, the inner cavity of the balloon inner tube and the communication hole in sequence;
the inner diameter of the working sheath is matched with the outer diameter of the expanded balloon body, and the outer diameter of the needle sheath is matched with the inner diameter of the balloon inner tube and the inner diameter of the balloon rod.
3. The kit of claim 2, wherein an end of the balloon body distal to the balloon shaft after inflation is planar such that: after the balloon body is expanded, one end of the balloon body, which is far away from the balloon rod, is flush with one end of the needle sheath, which is used for puncture.
4. The kit of claim 2, wherein the balloon shaft is directly or indirectly connected to a pressure pump for injecting the medium.
5. The kit of claim 2, wherein the balloon shaft is provided with a folder.
6. The kit of any one of claims 1 to 5, wherein the working sheath has a length that matches a length of the balloon body.
7. The kit according to any one of claims 1 to 5, wherein the sheath is provided with markings along its length, and the fascia dilator is made of a transparent material.
8. The kit of any one of claims 1 to 5, further comprising a guidewire accessible through the needle sheath after the core has been removed.
9. A surgical assembly comprising the percutaneous nephropuncture dilation kit of any one of claims 1 to 8, and a visualization device comprising an ultrasound device or an X-ray device; the developing device is used for developing the needle sheath and/or the needle core when the puncture needle punctures the human body.
10. A method of using the percutaneous renal puncture dilation kit of any one of claims 1 to 8, comprising:
taking out the needle core in the puncture needle at the target position and keeping the needle sheath at the target position;
controlling the fascia dilator to move to a required position along the outer wall of the needle sheath, and then taking out the fascia dilator;
controlling the balloon dilator to move along the outer wall of the needle sheath so that: after the balloon dilator moves, the head end of the balloon dilator is flush with the head end of the needle sheath;
controlling inflation of the balloon dilator;
the working sheath is arranged to be positioned outside the balloon dilator, and the head end of the balloon dilator is flush with the head end of the working sheath;
controlling the balloon dilator to contract;
and taking out the balloon dilator and the needle sheath.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010100994.XA CN111110333A (en) | 2020-02-19 | 2020-02-19 | Percutaneous nephropuncture dilation kit, method of use thereof, and surgical assembly |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010100994.XA CN111110333A (en) | 2020-02-19 | 2020-02-19 | Percutaneous nephropuncture dilation kit, method of use thereof, and surgical assembly |
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| CN111110333A true CN111110333A (en) | 2020-05-08 |
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| CN202010100994.XA Pending CN111110333A (en) | 2020-02-19 | 2020-02-19 | Percutaneous nephropuncture dilation kit, method of use thereof, and surgical assembly |
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