Single type uterine cavity electric cutter
Technical Field
The invention relates to an electrotome of a hysteroscope operation treatment system, in particular to a single-body hysteroscope electrotome ring and electrotome needle which can be separated from a hysteroscope.
Background
In the electric cutting mirror, the electric cutting devices such as the electric cutting ring and the electric cutting needle are generally wrapped with the endoscope into a whole, and the cutting electrodes of the electric cutting ring and the electric cutting needle are mutually and vertically fixed with the operating rod. Therefore, the electrotome is thicker, the uterus is required to be enlarged to 8-11mm when in use, and the larger the uterus is, the larger the cervical injury is, and the greater the possibility of cervical insufficiency caused by operation is. Meanwhile, the resectoscope has a fine structure, is high in price and is easy to damage in operation, so that the wide development of hysteroscopic operations in outpatient service faces a plurality of limiting factors.
Because the electric cutting ring, the electric cutting needle and the operating rod in the electric cutting mirror are fixed, the angle cannot be independently adjusted in the electric cutting treatment, so that when polyps, intrauterine adhesion and submucosal myomas exist in the uterine cavity in the hysteroscopy process, the electric cutting operation is complex, the required electric cutting time is increased along with the increase of focuses (such as larger submucosal myomas), the probability of complicated hyponatremia and water poisoning is obviously increased, and the difficulty of developing hysteroscopic surgery in outpatient service is increased.
Chinese patent CN208426206U discloses a folding electrode electric cutting mirror, wherein, the electric cutting apparatus utilizes the spring to connect cutting electrode and metal sleeve, makes the cutting electrode can rotate certain angle to accomplish the cutting through push-pull, improved the operation efficiency of renal cyst topping decompression art. But the electric cutting instrument and the endoscope are still in an integrated structure, the electric cutting scope is large in size, meanwhile, the spring part belongs to a conductor, and is connected with the cutting electrode into a whole, and the electric cutting scope also has a cutting function, so that the electrode electric cutting scope needs a large uterus expanding size when being used for intrauterine surgery, normal tissues beside a focus are easy to be accidentally injured in operation, and the risk of complications is increased.
At present, no single-body type hysteroscope electric cutter matched with an independent hysteroscope is reported at home and abroad.
Disclosure of Invention
The invention aims to provide a single-body type uterine cavity electrotome.
In order to achieve the above purpose, the present invention adopts the following technical scheme:
The electric cutter comprises a fixed rod, a traction wire, a cutting electrode and an operating handle, wherein the fixed rod is provided with a guide sliding sleeve and a supporting body capable of swinging towards any end (for example, front and rear ends) of the fixed rod, the operating handle is arranged at one end (for example, rear end) of the fixed rod, two ends of the traction wire respectively extend along a folding channel formed outside the other end (for example, front end) of the fixed rod by the guide sliding sleeve and are connected to the operating handle and the supporting body, one end of the fixed rod extends outwards and is connected to a tensioning wire of the supporting body, the cutting electrode is arranged on the supporting body, and the cutting electrode is connected with a cable extending along the fixed rod.
Preferably, the guiding sliding sleeve comprises a bending pipe body and a flat pipe body which are connected with each other, the concave side of the bending pipe body is covered on one end (for example, the front end) of the fixed rod, and the flat pipe body extends to the other end (for example, the rear end) of the fixed rod, where the operating handle is arranged.
Preferably, the support body is cambered surface shell, one end of the support body is in pin joint with the fixed rod, the other end of the support body is connected with the annular electrode, one end of the cable is connected with the extraction electrode arranged in the fixed rod or on the outer surface of the fixed rod, the main body of the cable is arranged in the fixed rod, and the other end of the cable extends to the connection position of the annular electrode and the support body.
Preferably, the support body is hollow cylinder, and the one end and the dead lever pin joint of support body, and the other end and the needle electrode of support body link to each other, and the one end and the setting of cable are in the dead lever inside or on the outward appearance draw electrode link to each other, and the main part of cable sets up in the dead lever inside, and the other end of cable extends to on the support body.
Preferably, the operating handle includes a pair of handle bodies hinged to each other, the tension wire being connected to one of the handle bodies which is engaged with a corresponding end (e.g., rear end) of the fixing lever, and the other handle body being connected to the traction wire.
Preferably, the cross-sectional dimension of the fixing lever is gradually reduced in a direction from one end (e.g., rear end) of the fixing lever where the operation handle is provided to the other end (e.g., front end).
Preferably, the swinging angle of the support body is 30-120 degrees.
Preferably, the diameter of the cutting electrode is 0.5-1.5mm.
The beneficial effects of the invention are as follows:
According to the electric cutter, the traction wire can move along the guide sliding sleeve on the fixed rod through the opening and closing operation handle, so that the supporting body connected with the traction wire is controlled, and the cutting electrode (for example, the needle electrode and the annular electrode) is driven to be opened, folded and the opening angle is changed under the pull-back or pull-back constraint of the tensioning wire. The cutting electrode can be folded when the uterus is moved in and out, and the electric cutter can easily move in and out of the uterus without expanding the uterus or reducing the uterus size, and the cutting electrode is not easy to damage. In hysteroscopy treatment, the hysteroscopy and the electrotome can be held respectively and matched with each other to complete operation, so that a doctor can continuously complete operation of excision of focuses (polyps, intrauterine adhesion and submucosal myomas existing in the uterine cavity) with different angles and depth positions (with larger operation range and higher flexibility) in a certain visual field, the treatment process is simple to operate, a better treatment effect is achieved, and the operation process is safer. Meanwhile, the popularization and application of the invention can also reduce the cost of the instrument (the price of the existing integrated electric cutting mirror is far greater than that of the single electric cutting device), the treatment cost and the treatment time, reduce the treatment pain degree and can finish the corresponding operation in the clinic.
Furthermore, when the invention is applied to hysteroscope colposcope technology, different cutting electrode opening angles (for example, 45-120 degrees) are formed by operating the swinging angle of the support body according to the size of a focus, so that not only can electrotomy treatment be carried out on polyps, intrauterine adhesion, submucosal myomas and the like in the uterine cavity, but also effective electrocoagulation hemostasis can be given to bleeding of small blood vessels in the uterine cavity.
Furthermore, the invention can realize the maximization of the cut tissue by adopting the cutting electrode with larger diameter, thereby shortening the operation time and reducing the risks of complications such as water poisoning and the like.
Further, in the invention, the operating handle of the electric cutter is positioned at the thicker rear end of the fixed rod, the fixed rod is gradually thinned towards the front end of the fixed rod, and the front end of the electric cutter is easier to enter (for example, along the hysteroscopy mirror body) and pass through a narrower part (for example, the cervical orifice) in the uterine cavity during treatment, so that the operation efficiency is improved.
Furthermore, the cambered surface shell or hollow cylindrical support body adopted in the invention is matched with flexible angle adjustment, so that the electric cutting of the non-cutting electrode to the tissue is effectively reduced, and the damage and the injury of misoperation to the normal tissue in the electric cutting are avoided.
Drawings
FIG. 1 is a front view of the monolithic cut-away ring of example 1 (30 degrees when the ring electrode is folded);
FIG. 2 is a schematic diagram of the connection between the support and the ring electrode (side view of the fixing rod) in example 1;
FIG. 3 is a schematic diagram of the cable connection in example 1;
Fig. 4 is a front view of the single-body type electric cut ring in example 1 (when the ring-shaped electrode is opened at 90 degrees);
FIG. 5 is a schematic diagram of the connection between the support and the ring electrode (end view of the fixing rod) in example 1;
Fig. 6 is a front view of the single-body type electric cut ring in example 1 (when the ring electrode is opened to 120 degrees), in which (a) the tension wire portion in the fixing rod is not shown and (b) the tension wire portion in the fixing rod is shown;
FIG. 7 is a front view of the single-body electric cutting needle in example 2 (30 degrees when the needle electrode is folded);
fig. 8 is a front view of the single-body electric cutting needle in example 2 (needle electrode is opened to 90 degrees);
FIG. 9 is a schematic diagram showing the connection between the support and the needle electrode in example 2;
FIG. 10 is a second schematic diagram showing the connection between the support and the needle electrode in example 2;
FIG. 11 is a schematic diagram of the cable connection in example 2;
FIG. 12 is a front view of the single-body electric cutting needle in example 2 (needle electrode open at 120 degrees);
In the figure: 1-1 is a first handle body, 1-2 is a second handle body, 1-3 is a handle connecting part, 1-4 is a traction wire, 1-5 is a fixed rod, 1-6 is a tensioning wire, 2 is a guide sliding sleeve, 3 is a supporting body, 3-1 is a movable connecting point, 3-2 is a fixed connecting point, 4 is an annular electrode, 5 is a cable, 6 is an extraction electrode, and 7 is a needle electrode.
Detailed Description
The invention is described in further detail below with reference to the drawings and examples.
The currently used hysterectomy is cylindrical, the diameter is more than 8mm, and the hysterectomy is developed from the hysterectomy of the male prostate, but the urethral system of the male is greatly different from the structures of the vaginal and uterine reproductive systems of the female. In order to well utilize the physiological structure of a female, the invention separates the uterine cavity checking system from the electrotome system and improves the structure of the electrotome system, thereby forming a single-body electrotome system, the cutting electrode of which can effectively avoid rubbing tissues in and out of the uterine cavity, and simultaneously can play a treatment role in a larger range under the cooperation of the checking mirror, thereby better utilizing the physiological structure of the female to treat, reducing the difficulty and cost of treatment and relieving the pain degree of patients.
Example 1
Referring to fig. 1, 3 and 6b, the single-body type electric cutting ring provided in this embodiment includes a handle, a fixing rod 1-5, a plurality of sections of flexible wires (for example, synthetic fibers such as nylon, high molecular polymers such as PE, metal alloy materials such as titanium steel) with a certain strength and capable of being bent freely, and a circuit loop system. The handle comprises a first handle body 1-1 and a second handle body 1-2 which are connected (hinged) through a handle connecting part 1-3, wherein the first handle body 1-1 is clamped and fixed with the rear end of a fixed rod 1-5, the second handle body 1-2 is connected with a section of the flexible wire rod and serves as a traction wire 1-4, the traction wire 1-4 passes through a guide sliding sleeve 2 which is integrally positioned at the upper part of the fixed rod 1-5, the traction wire 1-4 is horizontally led out from the second handle body 1-2 and extends towards the front end of the fixed rod 1-5, and the front end of the traction wire 1-4 passes through a bending section (a bending tube) of the guide sliding sleeve 2 which is tightly attached to the outer side of the front end of the fixed rod 1-5, so that the flexible wire rod can be folded back to a certain distance in the rear end direction of the fixed rod 1-5 through bending (along the bending tube), and is finally connected with a movable supporting body 3 (cambered surface shell shape) which is connected near the front end of the fixed rod 1-5. The other section of flexible wire rod extends out of the inside of the fixed rod 1-5 along the direction towards the front end of the fixed rod 1-5 and is connected with the support body 3, the specific connection position can be selected at the back side of the connection position of the traction wire 1-4 and the support body 3, the section of flexible wire rod penetrates into one end of the fixed rod 1-5, can reach the rear end of the fixed rod 1-5 along the inside of the fixed rod 1-5 and is connected with a spring preset in the inside of the fixed rod 1-5, and accordingly the pull-back tension wire 1-6 is formed. If there is no preset spring, the flexible wire may be wound and unwound by a wire winding mechanism (e.g., a knob that may be fixed) disposed on the fixing rod 1-5 or the first handle body 1-1, thereby forming a pulling tension wire. The circuit loop system comprises an annular electrode 4 arranged on a support body 3 (in the shape of a cambered surface shell), a cable 5 with a main body buried in the fixing rod 1-5 and a positive and a negative extraction electrode 6, wherein the extraction electrode 6 is connected with an external control circuit through a wiring hole on the fixing rod 1-5, one end of the cable 5 is respectively connected with the positive and the negative extraction electrode 6, and the other end of the cable is led out of the fixing rod 1-5 and is connected with two ends of the annular electrode 4.
Referring to fig. 1,2 and 5, the supporting body 3 is formed by processing a cambered surface shell cut from the side surface of the circular truncated cone, the upper part of the cambered surface shell only maintains the parts at two sides, the parts are respectively connected with the fixing rod 1-5 through pins, the radial section of the fixing rod 1-5 gradually widens along the direction from the front end to the rear end, and when the concave side of the cambered surface shell turns to the fixing rod 1-5 by taking the pins as the shaft (the movable connection point 3-1), the annular electrode 4 can be folded. In the folded state, the inner concave surface of the supporting body 3 (in the shape of a cambered surface shell) is tightly attached to the fixing rods 1-5, so that the radial size of the electric cutting ring (particularly the part of the front end which needs to extend into the uterine cavity) is minimized, the electric cutting ring can easily pass through the external cervical orifice and the internal cervical orifice, and the problem that the electric cutting ring is easy to damage when passing through the cervical canal and the internal cervical orifice is solved. The lower part of the cambered surface shell is provided with a mounting hole (fixed connection point 3-2), the end part of the annular electrode 4 can be fastened by a screw, so that the annular electrode 4 with different sizes can be conveniently mounted (a thinner annular electrode is adopted when an electrotome cavity is adhered, a thicker annular electrode is adopted when an electrotome myoma is caused), and the annular electrode 4 can be conveniently replaced after being consumed by cutting. The cable 5 may be threaded out of the fixation rod 1-5 from the articulation point 3-1 (e.g., inside a pin).
Referring to fig. 4 and 6a, as the handle is opened, the second handle body 1-2 pulls the traction wire 1-4, so that the support body 3 (in the shape of a cambered surface shell) drives the ring electrode 4 to rotate towards the front end of the fixed rod 1-5, and simultaneously the pull-back tension wire 1-6 is pulled away, and when the handle is completely opened, the rotation angle (relative to the fixed rod) of the ring electrode 4 is 120 degrees. In the above rotation process, once the handle stops opening, the support body 3 (in the shape of a cambered surface shell) and the annular electrode 4 are fixed by the reverse traction action of the traction wires 1-4 and the pull-back tension wires 1-6, and according to the different treatment targets in the uterine cavity, not only 90 degrees can be adopted, but also other different angles (for example, any angle between 45 degrees and 120 degrees) can be selected for treatment. Along with the folding of the handle, the tension wire 1-6 is pulled back to enable the support body 3 to drive the annular electrode 4 to rotate towards the rear end of the fixed rod 1-5 until the support body 3 is tightly attached to the fixed rod 1-5. The fixing rod 1-5 with gradually changed radial dimension is adopted, so that the pull-back tension wire 1-6 can be obliquely arranged, the extension length of the pull-back tension wire 1-6 is effectively reduced, the folding angle of the extension part is reduced as much as possible, and the interference to operation is reduced.
The application method of the single-body type electric cutting ring comprises the following steps:
As an independent electrotome, hysteroscopy may be used first for examination. When the electrotome treatment is needed, the vaginal speculum is put on, the uterus is properly dilated according to the tightness of the uterus opening, the uterus opening is generally required to be about 6mm, the monomer type electrotome ring is firstly put into the uterine cavity according to the position of the uterus in hysteroscopy, then the monomer type electrotome ring is fixed by one hand, and the hysteroscope is held by the other hand and enters the uterine cavity from one side of the monomer type electrotome ring. The other method is that the vaginoscope is not arranged, under the colposcope technology, the hysteroscope is firstly used for examination, when the electrotome treatment is needed, the hysteroscope is operated by one hand, the single-body electrotome ring is held by one hand, the single-body electrotome ring is firstly sent to the position near the internal orifice of the uterine cavity along the hysteroscope, the hysteroscope is retracted into the cervical canal, the single-body electrotome ring is sent to the uterine cavity under the direct vision of the hysteroscope, and then the hysteroscope is sent to the uterine cavity from one side; if the uterine opening is loose, the single-body electric cutting ring can be directly sent into the uterine cavity along the hysteroscope.
When detecting the focus such as polyp of uterine cavity, adhesion of uterine cavity, submucosal myoma and the like needing electrotomy, the single electrotomy ring is operated under the hysteroscope to treat. The handle is held tightly to open the annular electrode 4, different opening angles of the handle are selected according to the required cutting position and depth, when the electrified treatment is needed, the electrode plate is stepped on by foot, current is led into the annular electrode 4 through the lead-out electrode 6 and the cable 5, the single type electric cutting ring (using the pull-back tensioning wire 1-6) can be pulled back or pushed forward by utilizing the fixing rod 1-5, the angle of the annular electrode 4 can be adjusted by opening or closing the handle, namely, the focus such as polyp, myoma and the like is resected by rotating the annular electrode 4, and the principle of weeding by a hoe is more met, so that the focus is thoroughly cleared up, the better treatment effect is achieved, and the electrified annular electrode 4 can be used for coagulating when necessary in the resection.
Example 2
Referring to fig. 7 and 11, the single-body type electric cutting needle provided in this embodiment includes a handle, a fixing rod 1-5, a plurality of sections of flexible wires (for example, synthetic fibers such as nylon, high molecular polymers such as PE, metal alloy materials such as titanium steel) with a certain strength and free bending, and a circuit loop system. Unlike embodiment 1, the circuit loop system adopts needle electrode 7 as cutting electrode, and the support body 3 for mounting needle electrode 7 is in the form of cylinder seat, which is convenient for mounting needle electrode 7 and connecting with cable 5 led out from fixing rod 1-5. When the handle is folded, the supporting body 3 (in the form of a cylinder seat) and the needle-shaped electrode 7 are closely attached to the fixed rod 1-5, and the supporting body 3 (in the form of a cylinder seat) and the needle-shaped electrode 7 have smaller radial dimensions relative to the fixed rod 1-5, so that the overall radial dimensions of the electrotome (except the handle) are minimized, the electrotome can easily pass through the external cervical orifice and the internal uterine cavity orifice, and the needle-shaped electrode 7 can be prevented from touching and damaging.
Referring to fig. 9 and 10, the support 3 (in the form of a cylinder seat) and the fixing rods 1-5 are in pin connection, and unlike in the embodiment 1, the support 3 (in the form of a cylinder seat) comprises a cylinder with internal threads, the lower part of the cylinder is fixedly connected with the tail end of the needle electrode 7 through threads, and two inverted-L pins are installed on the top of the cylinder (a cable connected with one lead-out electrode, a cable connected with the top of the cylinder and a cable connected with the other lead-out electrode, and a side wall connected with the cylinder). When the cylinder is turned around the pin (articulation point 3-1) to the fixed rod 1-5, the needle electrode 7 can be folded.
Referring to fig. 8 and 12, as the handle is opened or closed, the traction wire 1-4 moves and the angle of the needle electrode 7 relative to the fixed rod 1-5 is adjusted under the constraint of the force of the pull-back tension wire 1-6. Different angles can be selected between 60 and 120 degrees for electrotomy according to the degree of intrauterine adhesion and the protruding size of submucosal myoma to the uterine cavity.
The use method of the single-body type electric cutting needle is basically the same as that of the single-body type electric cutting ring in the embodiment 1, namely, the angle of the needle-shaped electrode 7 is adjusted by opening or closing the handle, the needle-shaped electrode 7 is used for carrying out electric cutting treatment on focuses such as intrauterine adhesion, submucosal myoma and the like in an electrified state, and the principle of electric cutting treatment from shallow depth is more met, so that a better treatment effect is achieved, and the electrified needle-shaped electrode 7 can be used for coagulation when necessary in cutting.
The electric cutter (electric cutting ring or electric cutting needle) in the above embodiment pulls the uterine opening into an oval shape when being matched with the hysteroscope for treatment. A5 mm diameter inspection mirror cross-sectional area is 6.25 pi, and in addition, a 4mm diameter electrotome with cross-sectional area is 4 pi, the cross-sectional area of two instruments together is 10.25 pi, the 6mm diameter uterine opening cross-sectional area is 9 pi, the 7mm diameter uterine opening cross-sectional area is 12.25 pi, for most patients, the uterine opening is about 6mm, thus basically no uterine expansion is needed, and the smaller or even no uterine expansion is needed, so that the damage to the cervical of the patient can be correspondingly reduced. Moreover, the hysteroscope and the electrotome in the above embodiments are operated without the limitations of the speculum and the cylindrical metal package, and have wider visual field and wider movable range.
The invention provides a single electric cutting ring and an electric cutting needle, which are characterized in that:
1) The single-body electric cutting ring and the electric cutting needle are more in line with the physiological structure of the uterine cavity of a human body, and can be independently fed when being matched with a hysteroscope (an inspection mirror) for treatment, and the front ends of the single-body electric cutting ring and the electric cutting needle are smaller when being folded, and the diameter is about 4 mm. Thus, the dilation Gong Checun is reduced, less damaging to the cervix, and fewer complications are caused.
2) The single-body type electric cutting ring and the electric cutting needle have larger movable range for intrauterine treatment, and the electric cutting effect is improved by changing the cutting electrode (such as thicker diameter), so that the operation process is accelerated correspondingly, and the risk of complications is reduced.
3) The angle of the cutting electrode of the single electric cutting ring and the electric cutting needle can be adjusted in a larger range, the problem that the operation of the traditional hysteroscope is limited by the position of the uterus, the size of the inner opening and the speculum is solved, and the tissue to be electric-cut can be increased at any time according to the needs, so that the electric-cutting operation time is obviously shortened, and the operation complications are reduced.
4) The single electric cutting ring and the electric cutting needle basically do not need to expand uterus and have small damage, so that the treatment process can be completed in an outpatient operating room, the treatment cost is reduced, and a good treatment effect can be achieved.