CN111150435A - Auxiliary sheath for bladder tumor monoblock excision - Google Patents

Abstract

The invention relates to an auxiliary sheath for a whole cystoma resection, which comprises a sheath, an auxiliary tool and a driving assembly, wherein the auxiliary tool is used for exposing a tumor base part and can be movably sleeved on the sheath; the drive assembly is used to drive the extension and retraction of the auxiliary tool relative to the sheath and/or to drive the angle of the auxiliary tool relative to the sheath. The surgeon is close to the bladder tumour with supplementary mirror sheath or offsets with the bladder tumour, adjusts the extension and the withdrawal of the relative mirror sheath of appurtenance through drive assembly drive, and/or makes the relative mirror sheath slope certain angle of appurtenance through drive assembly for the local ability shift position of the tumour that contacts with appurtenance makes tissue separation, tumour base portion can expose, thereby prevents that the operation field of vision is sheltered from, is convenient for discern the tissue level, masters tumour excision degree of depth.

Description

Auxiliary sheath for bladder tumor monoblock excision

Technical Field

The invention belongs to the technical field of tumor resection, and particularly relates to an auxiliary sheath for a monoblock bladder tumor resection.

Background

Bladder tumors are one of the most common malignant tumors of the urinary system. According to whether bladder cancer invades the muscle layer, the bladder cancer can be divided into Non-muscle invasive bladder cancer (NMIBC) and Muscle Invasive Bladder Cancer (MIBC), and the treatment principles of the Non-muscle invasive bladder cancer and the muscle invasive bladder cancer are quite different, wherein the Non-muscle invasive bladder cancer accounts for more than 70 percent. Transurethral cystotomy (TURBT) is widely used for the diagnosis and treatment of non-muscle invasive bladder cancer. TURBT is also an important diagnostic tool for bladder tumors, and besides gross tumors are all cut off, the excised tumor tissues and the basement thereof, and the bladder muscle layer are also subjected to pathological examination, and bladder tumors are correctly graded and staged to guide further treatment.

The traditional TURBT has the advantages of simple operation, short operation time and the like, but the traditional TURBT operation comprises the steps of 1, cutting the protuberant bladder part of the tumor in sections; 2. basal part of the tumor (including muscular layer) was excised in blocks; 3. mucosal resection or fulguration around the tumor; 4. tumor basement cold biopsy. The surgical method has certain limitations, and because the surgical method adopts block excision, the surgical method has the following defects: 1. the tumor is cut into pieces, so that the bladder tumor is easy to spread and plant; 2. the tumor basement is cut in blocks, so that the tumor invasion and muscle layer conditions cannot be accurately judged, and the staging of the tumor is not facilitated; 3. tumor blood vessels are cut off repeatedly, bleeding is more, the visual field is unclear, and 4 tissues and every tissue are electrically burned, so that pathological diagnosis is influenced. For this reason, in recent years, the concept of a one-piece resection has become increasingly recognized and accepted as urologists have become increasingly aware of bladder tumors. The massive excision refers to the excision of encystranching of the bed tumor, called ETURBT for short, i.e., the massive excision of the bladder tumor together with the muscular layer tissue of the bladder at the base of the tumor. It has the following advantages: 1. the tumor and the basement are accurately removed, and the removal depth is accurate; 2. the completely resected tumor and the specimen of the basement containing the muscular layer can be subjected to accurate pathological staging, the postoperative diagnosis accuracy is improved, and accurate treatment is facilitated; 3. less bleeding and clear operation visual field; 4. can effectively reduce complications in operation such as obturator nerve reflex, bladder perforation and the like, and shorten hospitalization time and postoperative catheter retention time. For example, a Chinese utility model patent ZL201821705206.4 (No. CN209377734U) discloses a transurethral bladder tumor snare excider, which comprises a coat and an adjusting cap arranged at one end of the coat, wherein a first inner core and a second inner core are respectively arranged at the other end of a bearing ring, an electric cutting ring is arranged between the first inner core and the second inner core, a winding shaft is arranged at the bottom of a spiral plate, the transurethral bladder tumor snare excider can horizontally eject the electric cutting ring out of an inner catheter by the rotation of a plug, the electric cutting ring naturally opens to form a ring shape at the moment, so that the electric cutting ring can be sleeved into a tumor from the top until the electric cutting ring is positioned at the tumor basal part, the bladder tumor basal part is convenient to determine, whether a muscle layer is invaded by the bladder tumor basal part after operation is pathologically judged, and the electric cutting ring is wound on the winding shaft by the contraction of the second inner core, the electric excision ring can be tensioned, so that bladder tumors can be electrically excised under direct vision, the integrity of the tumors is improved, and the potential risk of implantation recurrence is reduced. However, when the method of using the snare exciser is used, particularly when the tumor is large, the base part is covered by the tumor, the operation visual field is blocked, the tissue level is not easy to identify, the tumor excision depth is difficult to master, and the application and popularization of ETURBT such as the snare exciser have certain limitations.

Disclosure of Invention

The first technical problem to be solved by the present invention is to provide an auxiliary sheath for lumpy cystoma resection capable of preventing the operative field from being blocked, in view of the above prior art.

The second technical problem to be solved by the present invention is to provide an auxiliary sheath for lumpectomy of bladder tumor suitable for the operation of surgeon to effectively expose the base of bladder tumor.

The third technical problem to be solved by the present invention is to provide an auxiliary sheath for lumpy cystectomy to effectively expose the base of bladder tumor in view of the above prior art.

The technical scheme adopted by the invention for solving the first technical problem is as follows: this an auxiliary sheath for bladder tumour monoblock excision, including the sheath, its characterized in that: also comprises

The auxiliary tool is used for exposing the tumor base part and can be movably sleeved on the endoscope sheath; and

a drive assembly for driving extension and retraction of the auxiliary tool relative to the sheath and/or driving the angle of the auxiliary tool relative to the sheath.

In order to facilitate the manipulation by the surgeon of the auxiliary tool for effective exposure of the bladder tumour substrate, it is further preferred that the auxiliary tool is extendable and retractable relative to the sheath and/or that the auxiliary tool is driven at an angle relative to the sheath, the angle of the auxiliary tool relative to the sheath being adjustable being integrated into a drive assembly, the drive assembly including a limiting member which prevents adjustment of the angle of the auxiliary tool relative to the sheath in the extended and retracted positions of the auxiliary tool relative to the sheath. Because the surgeon puts the auxiliary tool into the bladder, firstly extends to the position of the bladder tumor and then utilizes the auxiliary tool to expose the tumor base part, in the process, the extending depth of the auxiliary tool relative to the bladder tumor needs to be controlled firstly, and then the angle of the auxiliary tool relative to the bladder tumor needs to be controlled, but the auxiliary tool and the bladder tumor are combined into a whole by the scheme, so that the angle of the auxiliary tool relative to the bladder tumor can be adjusted firstly while the extending depth of the auxiliary tool relative to the bladder tumor is adjusted, and the angle of the auxiliary tool relative to the bladder tumor is adjusted after the extending depth of the auxiliary tool relative to the bladder tumor is adjusted.

In order to achieve the purpose of adjusting the extending depth of the auxiliary tool relative to the bladder tumor without adjusting the angle of the auxiliary tool relative to the bladder tumor, and adjusting the angle of the auxiliary tool relative to the bladder tumor after adjusting the extending depth of the auxiliary tool relative to the bladder tumor, the driving assembly is preferably arranged on the lens sheath and far away from the tail end of the auxiliary tool, and comprises:

the mounting seat is of a tubular structure capable of being sleeved on the endoscope sheath, and is provided with an expanded accommodating groove at least in the central part, and one groove wall of the accommodating groove is provided with a limiting hole along the direction in which the auxiliary tool extends and retracts relative to the endoscope sheath;

the first driven part is arranged in the accommodating groove, is connected with the auxiliary tool and is provided with a first pipe body which can be sleeved on the endoscope sheath, the tail end of the first pipe body is provided with a first rack part, the end part of the first pipe body is provided with a first connecting wall and a second connecting wall which are higher than the first rack part and are oppositely arranged, the first connecting wall is provided with a first connecting hole communicated with the limiting hole, and the second connecting wall is provided with a second connecting hole corresponding to the first connecting hole;

the first handle is arranged in the direction vertical to the extension and retraction of the auxiliary tool relative to the endoscope sheath, the tail end of the first handle is provided with a first driving gear meshed with the first rack part, and the first driving gear penetrates through the accommodating groove and can drive the first driven part to slide relative to the endoscope sheath in the rotating state of the first handle;

the second driven part is provided with a second pipe body sleeved at the end part of the first driven part, the outer surface of the second pipe body is provided with a second rack part, and the second driven part is linked with the auxiliary tool;

the transmission part is positioned between the second driven part and the auxiliary tool and can convert the sliding power of the second driven part into angle adjustment of the auxiliary tool relative to the endoscope sheath; and

the second handle is arranged facing the first handle, the tail end of the second handle is provided with a second driving gear meshed with the second rack part, the tail end of the second handle sequentially penetrates through the limiting hole of the accommodating groove of the mounting seat and the first connecting hole of the first driven part, so that the second driving gear is limited between the second connecting holes of the first connecting wall and the second connecting wall, the limiting hole of the accommodating groove of the mounting seat and the first connecting hole of the first driven part jointly form a limiting part of the second handle, under the condition that the first handle drives the first driven part to slide relative to the sheath, the second driven part and the second handle can only slide together with the first driven part due to the limiting effect of the limiting hole of the accommodating groove and the first connecting hole of the first driven part, and under the condition that the first handle stops driving the first driven part to slide relative to the sheath, the second handle can drive the second driven part to slide, so that the auxiliary tool can be adjusted relative to the sheath.

The structure of the auxiliary tool can be various, preferably, from the perspective of convenient manufacture, the auxiliary tool comprises a sleeve movably sleeved on the endoscope sheath and a plate body movably connected on the sleeve and used for exposing the tumor base part, the tail end of the sleeve is connected with the first driven part, the end part of the sleeve is provided with an articulated seat for hinging the plate body, the sleeve is at least provided with a penetration tube arranged along the direction of the extension and retraction of the endoscope sheath, the transmission part comprises a transmission rod, the first end of the transmission rod is connected on the second driven part, the second end of the transmission rod penetrates through one end of the penetration tube, penetrates through the hollow part of the penetration tube, penetrates out of the other end of the penetration tube and is connected with the plate body through the articulated seat. Thus, the sleeve moves along with the movement of the first driven part, thereby realizing the extension and the retraction of the plate body relative to the endoscope sheath; after the second handle is rotated, the second driving gear drives the second driven part, and the second driven part drives the plate body to rotate relative to the sleeve through the transmission rod, so that the angle of the plate body relative to the endoscope sheath is adjusted.

In order to facilitate the exposure of the tumor base, it is preferable that the plate body has an arc-shaped notch at the bottom center, which is concave upward from bottom to top, and a blunt portion for contacting the tumor is defined between the edge of the plate body and the mouth wall of the arc-shaped notch. The blunt portion has a larger contact area with the tumor than a sharp structure, so that the base portion of the tumor can be exposed conveniently after the plate body acts on the tumor.

To solve the third technical problem, it is preferable that the sheath includes an endoscope tube, and the endoscope for observing the bladder tumor is capable of extending and retracting relative to the endoscope tube, wherein the sleeve includes a sleeve portion partially having an open portion for the sleeve to be directly fitted over the endoscope tube, and a first connecting portion connected to the first driven portion and a second connecting portion connected to the plate body, the second connecting portion having a second notch portion for completely exposing an end of the endoscope tube.

When the endoscope is extended relative to the endoscope tube, the end portion of the endoscope can be completely exposed in the second cutaway portion without being covered by the sleeve portion, so that the endoscope can sufficiently observe the position of the bladder tumor in the bladder, and the auxiliary tool can act on the appropriate position of the bladder tumor by means of the observation of the endoscope, thereby effectively exposing the base portion of the bladder tumor.

In order to facilitate cutting of the bladder tumor, the sheath preferably further includes a cutting tube body located below the endoscope tube body, and the cutting tool for cutting the bladder tumor can extend and retract relative to the cutting tube body, and correspondingly, the sleeve and the threading tube are sequentially located above the endoscope tube body. The sleeve pipe and the threading pipe are arranged above the endoscope pipe body, and the cutting tool is arranged below the endoscope pipe body, so that the cutting tool cannot be blocked by the sleeve pipe and the threading pipe when the bladder tumor needs to be cut, and the bladder tumor is conveniently cut.

When a surgeon performs a whole-block bladder tumor resection operation, the surgeon needs to insert the outer sheath into the bladder of a patient, in order to connect the auxiliary sheath with the outer sheath, preferably, the sheath further comprises a connecting piece which is sleeved on the endoscope tube and connected with the mounting seat, and the connecting piece is closer to the plate body of the auxiliary tool than the mounting seat, wherein the connecting piece comprises a body which is provided with a first working channel for the endoscope tube to pass through together with the sleeve and the threading tube, and a second working channel which is used for an operation part for operating the cutting tool to at least partially pass through and is communicated with the cutting tube. The auxiliary sheath is connected with the outer sheath through the connecting piece and is not easy to move, so that the position of the bladder tumor can be observed by using the endoscope, the auxiliary tool is operated to extend and retract relative to the sheath through the driving component of the auxiliary sheath, and/or the angle of the auxiliary tool relative to the sheath is driven, so that the tumor base part is exposed, and then the tumor is cut through the cutting tool.

The connecting element can have various structures, and preferably, in order to facilitate the detachment and installation between the connecting element and the outer sheath, the outer peripheral wall of the body of the connecting element is provided with a convex ring, the end surface of the convex ring extends towards the plate body of the auxiliary tool to form at least one clamping part, and the clamping part is connected with the outer sheath which is used for establishing a working channel after entering the urethra. The setting of protruding circle makes the joint portion have the clearance between the periphery wall of this part body relative with joint portion, and the epitheca cover is established outside this body and is arranged in this clearance to peg graft epitheca and connecting piece, have the advantage of making things convenient for the dismouting.

Joint portion can have multiple shape, preferably, joint portion is the L type, including following first card pin and the perpendicular to that appurtenance's plate body extends and contracts the direction extension the second card pin of direction of the plate body extension and contraction of appurtenance. Acting on the sheath through the second joint foot, area of contact is great, and joint portion is more firm with the sheath connection to the second joint foot is perpendicular to the extension and the shrink direction of sheath to the effect direction of sheath, thereby frictional force between second joint foot and the sheath is great, thereby prevents that supplementary mirror sheath from rocking in the tumour excision operation.

Compared with the prior art, the invention has the advantages that: the auxiliary sheath is provided with an auxiliary tool used for exposing a tumor base part and movably sleeved on the sheath, a driving assembly used for driving the auxiliary tool to extend and retract relative to the sheath and/or adjusting the angle of the auxiliary tool relative to the sheath, a surgeon enables the auxiliary sheath to be close to or abut against the bladder tumor, the driving assembly drives the auxiliary tool to extend and retract relative to the sheath, and/or the driving assembly enables the auxiliary tool to incline a certain angle relative to the sheath, so that the local part of the tumor contacted with the auxiliary tool can move, the tissue is separated, the tumor base part is exposed, the operation visual field is prevented from being blocked, the tissue level is convenient to identify, and the tumor resection depth is mastered.

Drawings

FIG. 1 is a schematic perspective view of an embodiment of the present invention;

FIG. 2 is a schematic view from another angle of FIG. 1;

FIG. 3 is an exploded view of FIG. 1;

FIG. 4 is a schematic perspective view of a mounting base according to an embodiment of the present invention;

FIG. 5 is a schematic perspective view of a cannula (with the hinge mount and the lead-through tube removed) according to an embodiment of the present invention;

FIG. 6 is a perspective view of the mounting block of FIG. 1 with one of the side walls removed;

FIG. 7 is a perspective view of FIG. 1 with the mounting base removed;

FIG. 8 is a cross-sectional view of an embodiment of the present invention;

FIG. 9 is a schematic view of another state of FIG. 8;

fig. 10 is a schematic view of still another state of fig. 8.

Detailed Description

The invention is described in further detail below with reference to the accompanying examples.

Example 1

As shown in figures 1-10, a preferred embodiment of the auxiliary sheath for the massive resection of bladder tumor is disclosed.

The auxiliary sheath for the bladder tumor monoblock resection comprises a sheath 1, an auxiliary tool 2 for exposing a tumor base part and movably sleeved on the sheath 1, and a driving assembly for driving the auxiliary tool 2 to extend and retract relative to the sheath 1 and driving the angle of the auxiliary tool 2 relative to the sheath 1. In other embodiments, the drive assembly may be used only for driving the extension and retraction of the auxiliary tool 2 with respect to the sheath 1, or the drive assembly may be used only for driving the angular adjustment of the auxiliary tool 2 with respect to the sheath 1.

Wherein, the more preferred scheme of drive assembly is: the extension and retraction of the adjustment assisting tool 2 with respect to the sheath 1 and the angle of the driving assisting tool 2 with respect to the sheath 1 are integrated. Because the surgeon puts the auxiliary tool 1 into the bladder, firstly extends to the position of the bladder tumor and then utilizes the auxiliary tool 2 to expose the tumor base part, in the process, the extension depth of the auxiliary tool 2 relative to the bladder tumor needs to be controlled firstly, and then the angle of the auxiliary tool 2 relative to the bladder tumor needs to be controlled, but the scheme integrates the auxiliary tool and the bladder tumor into one driving assembly, so that the angle of the auxiliary tool 2 relative to the bladder tumor can be adjusted firstly while the extension depth of the auxiliary tool 2 relative to the bladder tumor is adjusted, and the angle of the auxiliary tool 2 relative to the bladder tumor is adjusted after the extension depth of the auxiliary tool 2 relative to the bladder tumor is adjusted, so that the operation of the surgeon is more suitable for effectively exposing the tumor base part of the bladder tumor. The following description specifically discloses a scheme in which the extension and retraction of the adjustment assisting tool 2 with respect to the sheath 1, and the angle of the driving assisting tool 2 with respect to the sheath 1 are integrated into one driving assembly.

In particular, the drive assembly comprises limiting means which prevent the adjustment of the angle of the auxiliary tool 2 relative to the sheath 1 in the extended and retracted state of the auxiliary tool 2 relative to the sheath 1. The driving component is arranged on the endoscope sheath 1 and far away from the tail end of the auxiliary tool 2, and comprises a mounting seat 3, a first driven part 4, a first handle 5, a second driven part 6, a transmission part and a second handle 7. The mounting base 3 is of a tubular structure capable of being fitted over the sheath 1, and has an enlarged accommodating groove 31 in a central portion thereof, and one of groove walls of the accommodating groove 31 (corresponding to a right side wall of the mounting base 3 in a state of actual operation by a surgeon) has a stopper hole 32 in a direction in which the auxiliary tool 2 extends and retracts with respect to the sheath 1. The first driven portion 4 is disposed in the accommodating groove 31, connected to the auxiliary tool 2, and has a first tube 41 capable of being sleeved on the sheath 1, the end of the first tube 41 has a first rack portion 411, the end of the first tube 41 has a first connecting wall 42 and a second connecting wall 43 which are higher than the first rack portion 411 and are disposed oppositely, the first connecting wall 42 has a first connecting hole 421 communicated with the limiting hole 32, and the second connecting wall 43 has a second connecting hole 431 corresponding to the first connecting hole 421. The first handle 5 is disposed in a direction perpendicular to the extension and retraction of the auxiliary tool 2 relative to the sheath 1, and the first driving gear 51 engaged with the first rack 411 is disposed at the end of the first handle 5, and the first driving gear 51 passes through the accommodation groove 31 and can drive the first driven part 4 to slide relative to the sheath 1 in a rotating state of the first handle 5. The second driven part 6 has a second tube body fitted over the end of the first driven part 4, and the second tube body has a second rack part 61 on the outer surface thereof, and the second driven part 6 is linked with the auxiliary tool 2. The transmission member is positioned between the second driven part 6 and the auxiliary tool 2, and can convert the sliding power of the second driven part 6 into angle adjustment of the auxiliary tool 2 relative to the sheath 1. The second handle 7 is disposed facing the first handle 5, and the end of the second handle 7 has a second driving gear 71 engaged with the second rack portion 61, the end of the second handle 7 sequentially passes through the position-limiting hole 32 of the accommodating groove 31 of the mounting base 3 and the first connecting hole 421 of the first driven portion 4, so that the second driving gear 71 is limited between the first connecting wall 42 and the second connecting hole 431 of the second connecting wall 43, wherein the position-limiting hole 32 of the accommodating groove 31 of the mounting base 3 and the first connecting hole 421 of the first driven portion 4 together form a limitation member of the second handle 7, and in a state that the first handle 5 drives the first driven portion 4 to slide relative to the sheath 1, the second driven portion 6 and the second handle 7 can only slide relative to the sheath 1 along with the first driven portion 4 due to the limitation action of the position-limiting hole 32 of the accommodating groove 31 and the first connecting hole 421 of the first driven portion 4, and under the state that first handle 5 stops to drive the relative slip of first driven portion 4 for mirror sheath 1, second handle 7 can drive the slip of second driven portion 6, and then makes appurtenance 2 take place the angle modulation relative to mirror sheath 1.

For manufacturing convenience, the auxiliary tool 2 comprises a sleeve 21 movably sleeved on the sheath 1 and a plate body 22 movably connected on the sleeve 21 and used for exposing the base part of the tumor.

Wherein, the plate body 22 can be made of transparent material, so as not to affect the operation field of the endoscope 200; the bottom center of the plate body 22 has an arc notch 221 which is concave upwards from bottom to top, a blunt portion 222 which is used for contacting the tumor is enclosed between the edge of the plate body 22 and the mouth wall of the arc notch 221, and the contact area of the blunt portion 222 with the tumor is larger than that of a sharp structure, so that the bottom of the tumor can be conveniently exposed after the plate body 22 acts on the tumor. The movable connection between the plate 22 and the sleeve 21 may be a hinge joint in this embodiment, or a ball rotation joint. In this embodiment, the end of the sleeve 21 is provided with a hinge seat 215 for the plate body 22 to hinge, the distal end of the sleeve 21 is connected to the first driven portion 4, and the sleeve 21 has a threading tube 211 provided in the direction in which the scope sheath 1 extends and retracts. The transmission member comprises a transmission rod 8, the transmission rod 8 can be an iron rod, a first end of the transmission rod 8 is connected to the second driven part 6, and a second end of the transmission rod 8 penetrates through one end of the threading pipe 211, penetrates through the hollow part of the threading pipe 211, penetrates out through the other end of the threading pipe 211 and is connected with the plate body 22 through the hinge seat 215. Thus, the sleeve 21 moves with the movement of the first driven portion 4, thereby effecting the extension and retraction of the plate body 22 relative to the sheath 1; when the second handle 7 is rotated, the second driving gear 71 drives the second driven portion 6, and the second driven portion 6 drives the plate 22 to rotate relative to the sleeve 21 through the transmission rod 8, so as to adjust the angle of the plate 22 relative to the sheath 1.

In order to connect the sleeve 21 to the endoscope tube 11 without the sleeve 21 interfering significantly with the view of the endoscope 200, it is preferable that: the sleeve 21 (see fig. 4 to 6) includes a sleeve portion 212, the middle portion of the sleeve portion 212 has an open portion 212a for the sleeve 21 to be directly fitted over the endoscope tube body 11, and a first connecting portion 213 connected to the first driven portion 4 and a second connecting portion 214 connected to the plate body 22, the first connecting portion 213 has a first notch portion 213a for the distal end of the endoscope tube body 11 to be completely exposed, and the second connecting portion 214 has a second notch portion 214a for the end of the endoscope tube body 11 to be completely exposed. Thus, when the endoscope 200 is extended relative to the endoscope tube body 11, the end portion of the endoscope 200 can be completely exposed to the second cutaway portion 214a without being covered by the sleeve portion 212, the endoscope 200 can sufficiently observe the position of the bladder tumor in the bladder, and the auxiliary tool 2 can be applied to the appropriate position of the tumor by means of the observation of the endoscope 200, thereby effectively exposing the base portion of the bladder tumor; moreover, the first notch portion 213a is provided so that the end of the endoscope tube body 11 can be completely exposed in the first notch portion 213a, so that when the auxiliary tool 2 is assembled, the position of the auxiliary tool 2 relative to the endoscope tube body 11 can be observed at any time, and the sleeve 21 of the auxiliary tool 2 can be conveniently and quickly sleeved on the middle portion of the endoscope tube body 11.

In order to be able to use the auxiliary sheath with an outer sheath (not shown), an endoscope 200 and a cutting tool (not shown) used in the existing cystoma monobloc resection operation, wherein the outer sheath is used for establishing a working channel after entering the urethra, the endoscope 200 is used for observing the cystoma to be cut, and the cutting tool is used for cutting the cystoma, the auxiliary sheath comprises an endoscope tube 11, a cutting tube 12 positioned below the endoscope tube 11 and a connecting piece 100 sleeved on the endoscope tube 11 and connected with the mounting base 3. Specifically, the sleeve 21 and the threading tube 211 are sequentially located above the endoscope tube 11, the endoscope 200 for observing the bladder tumor can be extended and retracted relative to the endoscope tube 11, the specific structure of the endoscope 200 can be the prior art, for example, including the ocular lens 300, etc., and the cutting tube 12 is used for the cutting tool for cutting the bladder tumor to pass through and can be extended and retracted relative to the cutting tube 12. The cutting tool can be holmium laser or a single-pole electric knife in the prior art, and the like. The connecting element 100 is arranged closer to the plate 22 of the auxiliary tool 2 than to the mounting base 3, wherein the connecting element 100 comprises a body 101, the body 101 having a first working channel 101a for the endoscope tube body 11 together with the sleeve 21 and the feed-through tube 211 to pass through and a second working channel 101b for the manipulation part 400 for manipulating the cutting tool to partially pass through and communicate with the cutting tube body 12. The auxiliary sheath is connected with the outer sheath through the connecting piece 100, the auxiliary sheath is not easy to move, so that the position of the bladder tumor can be observed by using the endoscope 200, the extension and retraction of the auxiliary tool 2 relative to the sheath 1 and the angle of the driving auxiliary tool relative to the sheath 1 are controlled through the driving component of the auxiliary sheath, the tumor base part is exposed, and then the tumor is cut through the cutting tool. In order to facilitate the detachment and installation of the connector 100 from the outer sheath, the outer circumferential wall of the body 101 of the connector 100 has a convex ring 101c, and two clamping portions 10 extend from the end surface of the convex ring 101c toward the plate 22 of the auxiliary tool 2, and the clamping portions 10 are connected to the outer sheath 2 for establishing a working channel after entering the urethra. The arrangement of the convex ring 101c enables a gap to be formed between the clamping portion 102 and the outer peripheral wall of the part of the body 101 opposite to the clamping portion 102, and the sheath is sleeved outside the body 101 and is located in the gap, so that the sheath is inserted into the connecting piece 100, and the connecting device has the advantage of being convenient to disassemble and assemble. The shape of the clip portion 102 can be different, and the clip portion 102 can be L-shaped or straight. The engaging portion 102 in this embodiment includes a first engaging leg 1021 extending along the extending and contracting direction of the plate 22 of the auxiliary tool 2 and a second engaging leg 1022 perpendicular to the extending and contracting direction of the plate 22 of the auxiliary tool 2, i.e. in an L shape. The second clamping foot 1022 acts on the outer sheath, so that the contact area is large, the clamping part 102 is stably connected with the outer sheath, and the acting direction of the second clamping foot 1022 on the outer sheath is vertical to the extending and contracting directions of the outer sheath, so that the friction force between the second clamping foot 1022 and the outer sheath is large, and the auxiliary endoscope sheath is prevented from shaking in the tumor resection operation.

This example is suitable for removal of large bladder tumors.

The principle of use and operation of the auxiliary sheath for the massive cystectomy of the present embodiment are as follows.

1. When performing a gross cystectomy, the surgeon first inserts an outer sheath (not shown) into the bladder through the patient's urethra to create a working channel.

2. The auxiliary sheath is connected to the outer sheath by the clamping portion 102 of the connecting member 100.

3. Next, the endoscope 200 is inserted into the endoscope tube 11, the cutting tool is connected to the manipulation unit 400, the cutting tool is inserted into the cutting tube 12, and the position of the bladder tumor is observed through the endoscope 200.

4. The depth to which the auxiliary tool 2 is extended relative to the bladder tumour is then adjusted by the drive assembly. Specifically, the first handle 5 is rotated, the first handle 5 drives the first driving gear 51 to rotate, the first driving gear 51 drives the first driven part 4 to slide relative to the sheath 1, and the first driven part 6 drives the auxiliary tool 2 to extend and retract relative to the sheath 1 in the sliding process, so that the auxiliary tool 2 is moved to a target position in the bladder and the plate body 22 of the auxiliary tool 2 is in contact with the tumor. At this time, because the second driving gear 71 is limited between the first connecting wall 42 of the first driven portion 4 and the second connecting hole 431 of the second connecting wall 43, wherein the limiting hole 32 of the accommodating groove 31 of the mounting base 3 and the first connecting hole 421 of the first driven portion 4 together form a limiting component of the second handle 7, under the condition that the first handle 5 drives the first driven portion 4 to slide relative to the sheath 1, the second driven portion 6 and the second handle 7 can only slide together with the first driven portion 4 relative to the sheath 1 due to the limiting effect of the limiting hole 32 of the accommodating groove 31 and the first connecting hole 421 of the first driven portion 4.

For example, in the initial state of fig. 8, after the first handle 5 is rotated counterclockwise, the second driven portion 6 is stationary relative to the first driven portion 4, the first driven portion 4 is retracted (i.e. the first driven portion 4 will move to the right when viewed from fig. 8) and brings the auxiliary tool 2 to retract relative to the sheath 1 (i.e. the auxiliary tool 2 will move to the right when viewed from fig. 8, i.e. to the direction close to the surgeon), so as to obtain the state of fig. 9, and the dotted line in fig. 9 represents the position of the plate 22 of the auxiliary tool 2 in the initial state of fig. 8. Similarly, if the first handle 5 is rotated clockwise as seen in fig. 8, the first driven portion 4 will extend the auxiliary tool 2 relative to the sheath 1 (not shown), i.e. move away from the surgeon.

5. The angle of the auxiliary tool 2 relative to the bladder tumour is then adjusted by the drive assembly. Specifically, when the second handle 7 is rotated, the second handle 7 drives the second driving gear 71 to rotate, the second driving gear 71 drives the second driven portion 6 to slide relative to the first driven portion 4, the second driven portion 6 drives the transmission rod 8 to move in the sliding process, so that the plate body 22 connected to the transmission rod 8 is turned relative to the sleeve 21, and the plate body 22 rotates through a certain angle relative to the sleeve 21.

For example, in the initial state shown in fig. 8, when the second handle 7 is rotated clockwise, the second driven portion 6 slides relative to the first driven portion 4 (i.e., the second driven portion 6 slides leftward relative to the first driven portion 4 as viewed in fig. 8, i.e., moves away from the surgeon), and the plate 22 of the auxiliary tool 2 is driven by the transmission rod 8 to turn upward, so as to obtain the state shown in fig. 10, wherein the dotted line in fig. 10 represents the position of the plate 22 of the auxiliary tool 2 in the initial state shown in fig. 8. Similarly, if the second handle 7 is rotated counterclockwise as viewed in FIG. 8, the second driven portion 4 will be caused to retract (not shown) the auxiliary tool 2 relative to the sheath 1 via the transmission rod 8, i.e. to move closer to the surgeon.

Thus, in the process that the plate body 22 rotates relative to the sleeve 21 by a certain angle, the part of the tumor contacted with the plate body 22 moves along with the plate body, so that the tissue is separated, the basal part of the tumor is exposed, the surgical field of vision is prevented from being blocked, the tissue level is convenient to identify, and the tumor resection depth is mastered.

6. Finally, the operation part 400 acts on the cutting tool to cut off the tumor together with the base including the muscle layer.

Example 2

The structure is basically the same as that of embodiment 1, except that: the bottom center of plate body 22 has the convex part and does not design arc breach 221, and the tumor basilar part can be convenient for put into to the convex part, and the convex part also can play the effect of tissue isolation, is convenient for expose the tumor basilar part.

Claims (10)

1. An auxiliary sheath for the monoblock excision of bladder tumor comprises a sheath (1), and is characterized in that: also comprises

The auxiliary tool (2) is used for exposing the tumor base part and can be movably sleeved on the endoscope sheath (1); and

a drive assembly for driving the extension and retraction of the auxiliary tool (2) relative to the sheath (1) and/or driving the angle of the auxiliary tool (2) relative to the sheath (1).

2. An auxiliary sheath for monoblock resection of a bladder tumor according to claim 1, characterized in that: the drive assembly comprises limiting means which prevent the adjustment of the angle of the auxiliary tool (2) relative to the sheath (1) in the extended and retracted state of the auxiliary tool (2) relative to the sheath (1).

3. An auxiliary sheath for monoblock resection of bladder tumors according to claim 2, characterized in that: the driving component is arranged on the endoscope sheath (1) and far away from the tail end of the auxiliary tool (2), and comprises:

the mounting seat (3) is of a tubular structure capable of being sleeved on the endoscope sheath (1), at least the central part of the mounting seat is provided with an expanded accommodating groove (31), and one groove wall of the accommodating groove (31) is provided with a limiting hole (32) along the direction in which the auxiliary tool (2) extends and retracts relative to the endoscope sheath (1);

the first driven part (4) is arranged in the accommodating groove (31), is connected with the auxiliary tool (2), and is provided with a first pipe body (41) which can be sleeved on the endoscope sheath (1), the tail end of the first pipe body (41) is provided with a first rack part (411), the end part of the first pipe body (41) is provided with a first connecting wall (42) and a second connecting wall (43) which are higher than the first rack part (411) and are oppositely arranged, the first connecting wall (42) is provided with a first connecting hole (421) communicated with the limiting hole (32), and the second connecting wall (43) is provided with a second connecting hole (431) corresponding to the first connecting hole (421);

the first handle (5) is arranged in the direction perpendicular to the extension and retraction of the auxiliary tool (2) relative to the endoscope sheath (1), the tail end of the first handle (5) is provided with a first driving gear (51) meshed with a first rack part (411), and the first driving gear (51) penetrates through the accommodating groove (31) and can drive the first driven part (4) to slide relative to the endoscope sheath (1) under the rotating state of the first handle (5);

a second driven part (6) which is provided with a second pipe body sleeved at the end part of the first driven part (4), the outer surface of the second pipe body is provided with a second rack part (61), and the second driven part (6) is linked with the auxiliary tool (2);

the transmission piece is positioned between the second driven part (6) and the auxiliary tool (2) and can convert the sliding power of the second driven part (6) into angle adjustment of the auxiliary tool (2) relative to the endoscope sheath (1); and

the second handle (7) is arranged facing the first handle (5), the tail end of the second handle (7) is provided with a second driving gear (71) meshed with the second rack part (61), the tail end of the second handle (7) sequentially passes through the limiting hole (32) of the accommodating groove (31) of the mounting seat (3) and the first connecting hole (421) of the first driven part (4), so that the second driving gear (71) is limited between the first connecting wall (42) and the second connecting hole (431) of the second connecting wall (43), the limiting hole (32) of the accommodating groove (31) of the mounting seat (3) and the first connecting hole (421) of the first driven part (4) jointly form a limiting part of the second handle (7), and under the condition that the first handle (5) drives the first driven part (4) to slide relative to the mirror sheath (1), the second driven part (6) and the second handle (7) can only slide together relative to the endoscope sheath (1) along with the first driven part (4) due to the limiting effect of the limiting hole (32) of the accommodating groove (31) and the first connecting hole (421) of the first driven part (4), and the second handle (7) can drive the second driven part (6) to slide under the condition that the first handle (5) stops driving the first driven part (4) to slide relative to the endoscope sheath (1), so that the auxiliary tool (2) can be adjusted relative to the endoscope sheath (1).

4. An auxiliary sheath for monoblock resection of bladder tumors according to claim 3, characterized in that: the auxiliary tool (2) comprises a sleeve (21) which is movably sleeved on the endoscope sheath (1) and a plate body (22) which is movably connected to the sleeve (21) and is used for exposing the basal part of the tumor, the tail end of the sleeve (21) is connected with the first driven part (4), the end part of the sleeve (21) is provided with a hinging seat (215) for hinging the plate body (22), and the sleeve (21) at least has a penetration tube (211) arranged along the extending and retracting direction of the sheath (1), and the transmission piece comprises a transmission rod (8), the first end of the driving rod (8) is connected to the second driven part (6), and the second end of the transmission rod (8) penetrates through one end of the threading pipe (211), penetrates through the hollow part of the threading pipe (211), penetrates out of the other end of the threading pipe (211) and is connected with the plate body (22) through the hinge seat (215).

5. An auxiliary sheath for monoblock resection of bladder tumors according to claim 4, characterized in that: the bottom center of the plate body (22) is provided with an arc-shaped notch (221) which is concave upwards from bottom to top, and a blunt part (222) which is used for contacting with the tumor is enclosed between the edge of the plate body (22) and the mouth wall of the arc-shaped notch (221).

6. An auxiliary sheath for monoblock resection of bladder tumors according to claim 5, characterized in that: the endoscope sheath (1) comprises an endoscope tube body (11), and an endoscope (200) for observing bladder tumor can extend and retract relative to the endoscope tube body (11), wherein the sleeve (21) comprises a sleeve part (212), the sleeve part (212) is locally provided with an open part (212a) for directly sleeving the sleeve (21) on the endoscope tube body (11), a first connecting part (213) connected with the first driven part (4) and a second connecting part (214) connected with the plate body (22), and the second connecting part (214) is provided with a second notch part (214a) for completely exposing the end part of the endoscope tube body (11).

7. An auxiliary sheath for monoblock resection of bladder tumors according to any one of claims 4 to 6, characterized in that: the sheath (1) further comprises a cutting tube body (12) positioned below the endoscope tube body (11), and the cutting tool for cutting bladder tumors can extend and retract relative to the cutting tube body (12), and correspondingly, the sleeve (21) and the penetrating tube (211) are sequentially positioned above the endoscope tube body (11).

8. An auxiliary sheath for monoblock resection of bladder tumors according to claim 7, characterized in that: the endoscope sheath (1) further comprises a connecting piece (100) which is sleeved on the endoscope tube body (11) and connected with the mounting seat (3), the connecting piece (100) is closer to a plate body (22) of the auxiliary tool (2) than the mounting seat (3), the connecting piece (100) comprises a body (101), and the body (101) is provided with a first working channel (101a) for the endoscope tube body (11) together with the sleeve (21) and the penetration guide tube (211) to penetrate through and a second working channel (101b) for controlling a control part (400) of a cutting tool to at least partially penetrate through and be communicated with the cutting tube body (12).

9. An auxiliary sheath for monoblock resection of bladder tumors according to claim 8, characterized in that: the outer peripheral wall of the body (101) of the connecting piece (100) is provided with a convex ring (101c), the end face of the convex ring (101c) extends towards the plate body (22) of the auxiliary tool (2) to form at least one clamping part (102), and the clamping part (102) is connected with an outer sheath which is used for establishing a working channel after entering the urethra.

10. An auxiliary sheath for monoblock resection of a bladder tumor according to claim 9, characterized in that: the clamping portion (102) is L-shaped and comprises a first clamping pin (1021) extending along the extending and contracting direction of the plate body (22) of the auxiliary tool (2) and a second clamping pin (1022) perpendicular to the extending and contracting direction of the plate body (22) of the auxiliary tool (2).

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