CN111904558B - PTCD puncture channel plugging device and method - Google Patents
PTCD puncture channel plugging device and method Download PDFInfo
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- CN111904558B CN111904558B CN202010940673.0A CN202010940673A CN111904558B CN 111904558 B CN111904558 B CN 111904558B CN 202010940673 A CN202010940673 A CN 202010940673A CN 111904558 B CN111904558 B CN 111904558B
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- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
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- A61B17/34—Trocars; Puncturing needles
- A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
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Abstract
PTCD puncture channel plugging device and plugging method relate to the technical field of surgical instruments. The PTCD puncture channel plugging device comprises a sheath tube, a push rod, a plugging block and a guide wire; a push rod cavity and a block cavity are sequentially arranged in the sheath tube from the front end to the rear end along the axial direction, and a guide wire channel is also arranged in the sheath tube along the axial direction; the push rod is movably inserted in the push rod cavity of the sheath tube; the block is arranged in a block cavity of the sheath tube and can be discharged from the block inlet and the block outlet under the pushing of the pushing end of the push rod; the guide wire is movably inserted in the guide wire channel of the sheath tube. A PTCD puncture channel plugging method is based on a PTCD puncture channel plugging device and is used for plugging a puncture channel generated by PTCD puncture operation. The invention has simple structure, scientific and reasonable structural design and lower operation difficulty, can realize the rapid, safe and effective blockage of the PTCD puncture channel and has higher clinical application value.
Description
Technical Field
The invention relates to the technical field of surgical instruments, in particular to a PTCD puncture channel plugging device and a plugging method.
Background
Percutaneous transluminal hepatosis biliary tract drainage (PTCD) is a series of techniques for dredging biliary tract obstruction by percutaneous transhepatic cholangiesis under the guidance of imaging equipment, and is mainly used for treating biliary tract obstruction. For calculous blockage, calculus can be removed by percutaneous hepatobiliary endoscopy. For the obstruction of tumor, the bracket can be implanted by percutaneous hepatic puncture in biliary tract.
At present, the PTCD puncture channel is only used as a flow tube channel, a good blocking means is not provided, and the bile of a patient continuously leaks out of the body through the puncture channel, so that postoperative recovery of the patient is not facilitated. And the PTCD is put into a bracket or a biliary tract calculus removal device to ensure that the biliary tract of a patient is recovered to be unobstructed, if the PTCD can effectively block a puncture channel, bile can be prevented from leaking out of the body, and the PTCD is favorable for postoperative recovery of the patient.
Currently, the following two methods are mainly adopted for clinically sealing the puncture channel: 1. the PTCD drainage tube is kept in the puncture channel in the first stage, and the PTCD drainage tube is removed in the second stage by operation, which brings great pain and inconvenience to patients. 2. Use puncture channel on gelatin sponge shutoff liver, however, on the one hand, owing to lack dedicated shutoff instrument, be difficult to accurately deliver to puncture channel with gelatin sponge in, the operation degree of difficulty is great, and on the other hand, it has bile, blood and interstitial fluid to ooze to last in the puncture channel, dashes the ulceration with gelatin sponge easily, is difficult to play the shutoff effect, and on the other hand again, the quantity of gelatin sponge is difficult to hold, and the too little then unable complete shutoff puncture channel of quantity, the too much then is difficult to push puncture channel of quantity.
Disclosure of Invention
The invention aims to overcome the defects of the prior art and provides a PTCD puncture channel plugging device and a plugging method, which solve the problem that a means for quickly, safely and effectively plugging a PTCD puncture channel is lacking clinically at present.
The technical scheme of the invention is as follows: the PTCD puncture channel plugging device comprises a sheath tube, a push rod, a plugging block and a guide wire;
a push rod cavity and a blocking block cavity are sequentially arranged in the sheath tube from the front end to the rear end along the axial direction, the push rod cavity is communicated with the blocking block cavity, the push rod cavity and the blocking block cavity form a push rod inlet and a blocking block inlet at the front end and the rear end of the sheath tube respectively, a guide wire channel is further arranged in the sheath tube along the axial direction, and a guide wire inlet and a guide wire outlet are formed in the guide wire channel at the front end and the rear end of the sheath tube respectively;
the two ends of the push rod are respectively a handheld end and a pushing end, the push rod is movably inserted in the push rod cavity of the sheath tube, the pushing end of the push rod is positioned in the push rod cavity or extends into the block cavity, and the handheld end of the push rod extends out of the push rod inlet and outlet and is positioned outside the sheath tube;
the plugging block is arranged in the plugging block cavity of the sheath tube through the plugging block inlet and outlet of the sheath tube and forms transition fit with the plugging block cavity of the sheath tube, and the plugging block can be discharged to the outside of the sheath tube from the plugging block inlet and outlet under the pushing of the pushing end of the pushing rod;
the guide wire is movably inserted in the guide wire channel of the sheath tube, and the front end and the rear end of the guide wire respectively extend out of the guide wire inlet and the guide wire outlet.
The further technical scheme of the invention is as follows: the diameter of the front end of the sheath tube is enlarged to form a head, an end face A is arranged at one end, close to the front end of the sheath tube, of the head, a transition face is arranged at one end, far away from the sheath tube, of the head, an ear wing clamping seat is arranged on the end face A of the head, an ear wing positioning pit communicated with the push rod cavity is arranged on the end face A of the head, a mounting hole penetrating to the end face A and the transition face is further formed in the head, the mounting hole comprises a threaded hole section and an unthreaded hole section which are communicated with each other, the threaded hole section penetrates to the transition face, and the unthreaded hole section;
the side wall of the handheld end of the push rod is provided with an ear wing, the ear wing is respectively matched with the ear wing positioning pit and the ear wing clamping seat, when the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube, the pushing end of the push rod extends out from the block inlet and the block outlet of the sheath tube, and when the ear wing of the push rod is inserted into the ear wing clamping seat of the sheath tube, the pushing end of the push rod is positioned in the push rod cavity of the sheath tube; the handheld end of the push rod is also provided with a cantilever, and a boss is arranged on the cantilever;
it also comprises a push rod reset mechanism; the push rod resetting mechanism comprises a mounting seat, a sleeve, a push block, a connecting rod, a butt joint seat and a spring; one end of the mounting seat is provided with a wrench clamping part, the other end of the mounting seat is provided with a sleeve connecting part, the side wall surface of the mounting seat is provided with external threads, the mounting seat is in threaded connection with the threaded hole section of the mounting hole of the sheath tube through the external threads, the wrench clamping part faces the transition surface, and the sleeve connecting part faces the end surface A; the sleeve is detachably connected to the sleeve connecting part of the mounting seat and is positioned in the unthreaded hole section of the mounting hole of the sheath tube, and a rod penetrating hole is formed in one end, far away from the mounting seat, of the sleeve; the push block is movably arranged in the inner hole of the sleeve; one end of the connecting rod extends into the inner hole of the sleeve through the rod penetrating hole of the sleeve and is fixedly connected with the push block, and the other end of the connecting rod extends out of the unthreaded hole section of the mounting hole of the sheath tube and is fixedly connected with the butt joint seat; the butt joint seat is provided with a concave pit matched with the boss of the push rod; the spring is compressed and arranged in the inner hole of the sleeve, and two ends of the spring are respectively propped against the mounting seat and the push block.
The invention further adopts the technical scheme that: the number of the ear wing clamping seats is two, and the two ear wing clamping seats are annularly and uniformly distributed on the end surface A of the sheath tube around the central line of the sheath tube; correspondingly, the number of the ear wings is two, and the two ear wings are annularly and uniformly distributed on the side wall of the handheld end of the push rod around the central line of the push rod.
The further technical scheme of the invention is as follows: the number of the mounting holes is two, and the two mounting holes are annularly and uniformly distributed at the head of the sheath pipe around the central line of the sheath pipe; correspondingly, the number of the push rod resetting mechanisms is two, and the two push rod resetting mechanisms are respectively arranged in the two mounting holes.
The further technical scheme of the invention is as follows: the blockings are cylindrical and comprise gelatin sponges and degradable shells wrapping the outside of the gelatin sponges, and hollow holes are formed in the side walls of the degradable shells.
The further technical scheme of the invention is as follows: the block cavity is sequentially provided with an expanding section, a reducing section, a transition section and a sizing section from one end of the block cavity where the block inlet and the block outlet are located to the other end, the diameter of the sizing section is L, the diameter of the reducing section is 0.96-0.98L, the maximum diameter of the expanding section is 1.02-1.06L, an included angle a formed by a bus of the expanding section and a central line of the sheath tube is 3-10 degrees, and an included angle beta formed by the bus of the transition section and the central line of the sheath tube is 3-10 degrees; the diameter of the block is L.
The further technical scheme of the invention is as follows: the sheath tube is 20-30 cm in length, the blocking block is 1-1.5 cm in length, and the guide wire is 80-100 cm in length.
The technical scheme of the invention is as follows: a PTCD puncture channel plugging method is based on the PTCD puncture channel plugging device, and is used for plugging a puncture channel generated by PTCD puncture operation;
the plugging method comprises the following steps:
s01, the rear end of the guide wire is conveyed into the lower end of the bile duct with the assistance of DSA through the inner hole of the puncture sheath or the inner hole of the PTCD catheter, so that a working orbit is established;
before the step is started, the PTCD puncture operation is completed, and the puncture sheath and the PTCD catheter do not exit from the puncture channel;
s02, removing the puncture sheath and the PTCD catheter, sleeving the sheath tube on the guide wire through the guide wire channel on the sheath tube, pushing the sheath tube along the guide wire, and sending the rear end of the sheath tube to the junction of the puncture channel and the bile duct under the assistance of DSA;
before the step is started, the block is arranged in a block cavity of the sheath tube; the push rod is arranged in the push rod cavity of the sheath tube, and the ear wings at two sides of the push rod are clamped in the ear wing clamping seats of the sheath tube 1;
s03, removing the guide wire, withdrawing the sheath tube by a length of a block, pushing the contrast agent into the sheath tube through the guide wire inlet of the sheath tube, and confirming that the rear end of the sheath tube is in the puncture channel and does not extend into the bile duct with the assistance of DSA;
s04, pulling the push rod out of the puncture channel for a certain distance to make the ear wings at the two sides of the push rod separate from the ear wing clamping seat of the sheath tube; then the push rod is rotated by 90 degrees, so that the ear wings at the two sides of the push rod are aligned to the ear wing positioning pits of the sheath tube; then the push rod is pushed to the deep part of the puncture channel, and along with the pushing of the push rod, on one hand, the spring is compressed, and on the other hand, the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube; until the block is pushed out from the block inlet and the block outlet of the sheath tube, the block is blocked at the intersection of the puncture channel and the bile duct after being pushed out, so as to avoid bile leakage;
in the step, when the ear wings on the two sides of the push rod are abutted against the bottom surface of the ear wing positioning pit of the sheath tube, the push rod is pushed to reach the limit position, the compression amount of the spring is maximized, and the pushing end of the push rod extends out of the blocking block inlet and outlet of the sheath tube by 1-5 mm;
s05, the pushing force applied on the push rod is cancelled, and the pushing end of the push rod rapidly retracts into the push rod cavity of the sheath under the elastic force action of the spring; then the push rod is pulled out to the outside of the puncture channel for a certain distance and then rotated for 90 degrees, so that the ear wings at the two sides of the push rod are aligned to the ear wing clamping seat of the sheath tube; then inserting the ear wings at the two sides of the push rod into the ear wing clamping seats of the sheath tube so as to realize the relative fixation of the push rod and the sheath tube;
and S06, withdrawing the sheath tube and the push rod, and suturing the body surface wound.
The further technical scheme of the invention is as follows: the action object of the plugging method is a PTCD training model; the PTCD training model is provided with a trunk from the chest to the upper abdomen of a human body, epidermis on the surface of the trunk, bones, a liver, an intrahepatic bile duct and blood vessels inside the trunk, colored liquid is injected into the intrahepatic bile duct and the blood vessels, and the intrahepatic bile duct and the blood vessels are made of repairable materials.
Compared with the prior art, the invention has the following advantages:
1. simple structure, structure scientific and reasonable, the operation degree of difficulty is low, can realize quick, safe, effectively shutoff PTCD puncture passageway, has great clinical application and worth.
2. A reducing section is arranged in the blocking block cavity of the sheath tube, the diameter of the reducing section is slightly smaller than that of the blocking block, the blocking block can be clamped, and the blocking block is prevented from sliding out of the blocking block inlet and outlet; the end part of the blocking block cavity is provided with an expanding section, the maximum diameter of the expanding section is slightly larger than the diameter of the blocking block, so that the blocking block can be conveniently arranged in the blocking block cavity from the blocking block inlet and outlet, and the inclination angles of the expanding section and the transition section are relatively gentle, thereby being beneficial to the complete arrangement or push-out of the blocking block.
3. The side wall of the handheld end of the push rod is provided with an ear wing, and the ear wing can be mutually inserted with an ear wing positioning pit or an ear wing clamping seat of the sheath tube; when the ear wing of the push rod is inserted into the ear wing clamping seat of the sheath tube, the push rod and the sheath tube are relatively fixed, and the pushing end of the push rod does not extend into the block cavity, so that an operator can be effectively prevented from mistakenly touching the push rod to push out the block; when the ear wing of the push rod is inserted into the ear wing positioning hole of the sheath tube, the pushing end of the push rod extends out of the blocking block inlet and outlet for a certain length, which is equivalent to limit the maximum pushing depth of the push rod, and can effectively prevent an operator from pushing the blocking block into the bile duct due to excessive pushing.
4. The block (blocking material) is a two-layer structure and comprises a degradable shell (outer layer) and a gelatin sponge (inner layer), wherein the degradable shell is made of a hard material which is biodegradable, has no toxic or side effect and has excellent biocompatibility, and can bear the thrust of a push rod to keep the whole structure of the block from breaking and collapsing; the gelatin sponge has hemostatic effect on wound surface bleeding, is used for wound hemostasis, and can be exuded through the hollow hole on the degradable shell to contact with the puncture channel.
5. The guide wire is used for guiding and limiting the advancing route of the sheath, so that the rear end of the sheath can be accurately inserted into the puncture channel on the liver.
6. The push rod resetting mechanism is arranged between the sheath tube and the push rod, the push rod pushes the blocking block out and needs to overcome the elastic force caused by the push rod resetting mechanism, after the blocking block is completely pushed out by the push rod, an operator cancels the pushing force applied on the push rod, the push rod retracts into the push rod cavity of the sheath tube rapidly under the action of the elastic force, and the risk that the liver tissue of a patient is contused due to the fact that the pushing end of the push rod is exposed outside the sheath tube is effectively avoided.
The invention is further described below with reference to the figures and examples.
Drawings
FIG. 1 is a schematic structural view of the present invention;
FIG. 2 is a cross-sectional view A-A of FIG. 1;
FIG. 3 is a cross-sectional view B-B of FIG. 1;
FIG. 4 is a cross-sectional view C-C of FIG. 2;
FIG. 5 is a cross-sectional view taken along line D-D of FIG. 2;
FIG. 6 is an enlarged view of section E of FIG. 3;
FIG. 7 is a schematic structural view of a sheath;
FIG. 8 is an enlarged view of section F of FIG. 7;
FIG. 9 is a schematic view of the construction of the block;
FIG. 10 is a schematic view of step 1 of plugging a PTCD puncture channel using the present invention;
FIG. 11 is a schematic view of step 2 of plugging a PTCD puncture channel using the present invention;
FIG. 12 is a schematic view of step 3 of plugging a PTCD puncture channel using the present invention;
fig. 13 is a schematic view of step 4 of using the present invention to occlude a PTCD puncture channel.
Illustration of the drawings: a sheath tube 1; a push rod cavity 11; a push rod inlet and outlet 111; a blockout cavity 12; a block inlet/outlet 121; an expanding section 122; a reduced diameter section 123; a transition section 124; a sizing section 125; a guide wire channel 13; a guidewire portal 131; a guidewire exit port 132; a head 14; end face A141; a transition surface 142; the ear flap holder 143; an ear positioning well 144; mounting holes 145; a push rod 2; the ear wings 21; a cantilever 22; a boss 23; a blocking block 3; gelatin sponge 31; a degradable shell 32; a hollowed-out hole 321; a guide wire 4; a mount base 51; a wrench holding portion 511; a sleeve connecting portion 512; a sleeve 52; a push block 53; a connecting rod 54; a docking station 55; a pit 551; a spring 56; a puncture sheath 6; a puncture channel 7; and a bile duct 8.
Detailed Description
Example 1:
as shown in fig. 1-9, the PTCD puncture channel blocking device comprises a sheath tube 1, a push rod 2, a blocking block 3, a guide wire 4 and a push rod resetting mechanism.
The sheath tube 1 is internally provided with a push rod cavity 11 and a blocking piece cavity 12 in sequence from the front end to the rear end along the axial direction, the push rod cavity 11 is communicated with the blocking piece cavity 12, the push rod cavity 11 and the blocking piece cavity 12 form a push rod inlet and outlet 111 and a blocking piece inlet and outlet 121 respectively at the front end and the rear end of the sheath tube 1, the sheath tube 1 is internally provided with a guide wire channel 13 along the axial direction, and the guide wire channel 13 forms a guide wire inlet 131 and a guide wire outlet 132 at the front end and the rear end of the sheath tube 1 respectively. The diameter of the front end of the sheath tube 1 is enlarged to form a head part 14, one end of the head part 14 close to the front end of the sheath tube 1 is provided with an end surface A141, one end of the head part 14 far away from the sheath tube 1 is provided with a transition surface 142, the end surface A141 of the head part 14 is provided with an ear wing clamping seat 143, the end surface A141 of the head part 14 is provided with an ear wing positioning pit 144 communicated with the push rod cavity 11, the head part 14 is further provided with a mounting hole 145 communicated to the end surface A141 and the transition surface 142, the mounting hole 145 comprises a threaded hole section and an unthreaded hole section which are communicated with each other, the threaded hole section is communicated to the transition surface 142, and the unthreaded hole.
The two ends of the push rod 2 are respectively a handheld end and a pushing end, the push rod 2 is movably inserted into the push rod cavity 11 of the sheath tube 1, the pushing end is positioned in the push rod cavity 11 or extends into the block cavity 12, and the handheld end extends out of the push rod inlet and outlet 111 and is positioned outside the sheath tube 1. The side wall of the handheld end of the push rod 2 is provided with the ear wing 21, the ear wing 21 is matched with the ear wing positioning pit 144 and the ear wing clamping seat 143, when the ear wing 21 of the push rod 2 is inserted into the ear wing positioning pit 144 of the sheath tube 1, the pushing end of the push rod 2 extends out from the block inlet/outlet 121 of the sheath tube 1, and when the ear wing 21 of the push rod 2 is inserted into the ear wing clamping seat 143 of the sheath tube 1, the pushing end of the push rod 2 is positioned in the push rod cavity 11 of the sheath tube 1. The handheld end of the push rod 2 is also provided with a cantilever 22, and the cantilever 22 is provided with a boss 23.
The block 3 is arranged in the block cavity 12 of the sheath tube 1 through the block inlet/outlet 121 of the sheath tube 1 and forms transition fit with the block cavity 12 of the sheath tube 1, and can be discharged to the outside of the sheath tube 1 from the block inlet/outlet 121 under the pushing of the pushing end of the push rod 2.
The guide wire 4 is movably inserted into the guide wire channel 13 of the sheath tube 1, and the front end and the rear end of the guide wire 4 respectively extend out of the guide wire inlet 131 and the guide wire outlet 132.
The push rod resetting mechanism comprises a mounting seat 51, a sleeve 52, a push block 53, a connecting rod 54, a butt joint seat 55 and a spring 56. One end of the mounting seat 51 is provided with a wrench clamping portion 511, the other end of the mounting seat is provided with a sleeve connecting portion 512, the side wall surface of the mounting seat 51 is provided with an external thread, the mounting seat 51 is connected in the threaded hole section of the mounting hole 145 of the sheath tube 1 through the external thread, the wrench clamping portion 511 faces the transition surface 142, and the sleeve connecting portion 512 faces the end surface a 141. The sleeve 52 is detachably connected to the sleeve connecting portion 512 of the mounting base 51 (specifically, a connecting structure with matching internal and external threads may be adopted), and is located in the unthreaded hole section of the mounting hole 145 of the sheath tube 1, and a rod penetrating hole is formed in one end of the sleeve 52 far away from the mounting base 51. The push block 53 is movably mounted in the inner bore of the sleeve 52. One end of the connecting rod 54 extends into the inner hole of the sleeve 52 through the rod penetrating hole of the sleeve 52 and is fixedly connected with the push block 53, and the other end of the connecting rod extends out of the unthreaded hole section of the mounting hole 145 of the sheath tube 1 and is fixedly connected with the butt joint seat 55; the butt joint seat 55 is provided with a concave pit 551 matched with the convex platform 23 of the push rod 2. The spring 56 is disposed in the inner hole of the sleeve 52 in a compressed manner, and two ends of the spring respectively abut against the mounting seat 51 and the push block 53.
Preferably, the number of the ear wing clamping seats 143 is two, and the two ear wing clamping seats 143 are uniformly distributed on the end surface a141 of the sheath tube 1 around the center line of the sheath tube 1. Correspondingly, the number of the ear wings 21 is two, and the two ear wings 21 are annularly and uniformly distributed on the side wall of the handheld end of the push rod 2 around the central line of the push rod 2. The number of the mounting holes 145 is two, and the two mounting holes 145 are uniformly distributed on the head 14 of the sheath 1 around the center line of the sheath 1. Correspondingly, the number of the push rod resetting mechanisms is two, and the two push rod resetting mechanisms are respectively arranged in the two mounting holes 145. The symmetrically arranged structure can improve the operation stability and the use reliability of the plugging device.
Preferably, the block 3 is cylindrical and comprises a gelatin sponge 31 and a degradable shell 32 wrapped outside the gelatin sponge 31, and hollow holes 321 are formed in the side wall of the degradable shell 32. The gelatin sponge 31 is soft, can seep out of the hollow hole 321, and contacts with liver tissue to stop bleeding.
Preferably, the block cavity 12 of the sheath tube 1 is sequentially provided with an expanding section 122, a reducing section 123, a transition section 124 and a sizing section 125 from one end of the block inlet and outlet 121 to the other end, the diameter of the sizing section 125 is L, the diameter of the reducing section 123 is 0.96-0.98L, the maximum diameter of the expanding section 122 is 1.02-1.06L, an included angle a formed by a bus of the expanding section 122 and a central line of the sheath tube 1 is 3-10 degrees, and an included angle beta formed by a bus of the transition section 124 and the central line of the sheath tube 1 is 3-10 degrees. The diameter of the block 3 is L.
Preferably, the length of the sheath tube 1 is 20-30 cm, the length of the blocking block 3 is 1-1.5 cm, and the length of the guide wire 4 is 80-100 cm.
Brief description of the invention the method of plugging a PTCD puncture channel using the present invention:
the operation of plugging the PTCD puncture channel is as follows:
1. referring to fig. 10, the rear end of the guide wire 4 is fed into the lower end of the bile duct 8 with the aid of DSA through the inner bore of the puncture sheath 6 or the inner bore of a PTCD catheter (not shown in the figure), thereby establishing a working trajectory;
before this step is started, the PTCD puncture procedure has been completed and the puncture sheath 6 and PTCD catheter have not yet exited the puncture channel 7.
2. Referring to fig. 11, the puncture sheath 6 and the PTCD catheter are removed, the sheath 1 is sleeved on the guide wire 4 through the guide wire channel 13 on the sheath 1, the sheath 1 is pushed along the guide wire 4, and the rear end of the sheath 1 is delivered to the junction of the puncture channel 7 and the bile duct 8 with the aid of DSA;
before the step is started, the block 4 is arranged in the block cavity 12 of the sheath tube 1; the push rod 2 is arranged in the push rod cavity 11 of the sheath tube 1, and the ear wings 21 at two sides of the push rod 2 are clamped in the ear wing clamping seats 143 of the sheath tube 1.
3. Referring to fig. 12, the guide wire 4 is removed, the sheath 1 is withdrawn by the length of one of the blocks 4, the contrast medium is pushed through the guide wire inlet 131 of the sheath 1, and then it is confirmed with the aid of DSA that the rear end of the sheath 1 is within the puncture channel 7 and does not protrude into the bile duct 8.
4. Referring to fig. 13, the push rod 2 is pulled out to the outside of the puncture channel 7 for a certain distance, so that the ear wings 21 at the two sides of the push rod 2 are separated from the ear wing clamping seat 143 of the sheath tube 1; then the push rod 2 is rotated by 90 degrees, so that the ear wings 21 at the two sides of the push rod 2 are aligned with the ear wing positioning pits 144 of the sheath tube 1; then the push rod 2 is pushed to the deep of the puncture channel 7, and along with the push rod 2, on one hand, the spring 56 is compressed, and on the other hand, the ear wing 21 of the push rod 2 is inserted into the ear wing positioning hole 144 of the sheath tube 1; until the block 3 is pushed out from the block inlet and outlet 121 of the sheath tube 1, the block 3 is blocked at the junction of the puncture channel 7 and the bile duct 8 after being pushed out, so as to avoid the leakage of bile;
in this step, when the ear wings 21 on both sides of the push rod 2 abut against the bottom surface of the ear wing positioning pit 144 of the sheath tube 1, the push rod 2 is pushed to reach the limit position, the compression amount of the spring is maximized, and the pushing end of the push rod 2 extends out of the block inlet/outlet 121 of the sheath tube 1 by a length of 1-5 mm.
5. The pushing force applied on the push rod 2 is cancelled, and the pushing end of the push rod 2 retracts into the push rod cavity 11 of the sheath tube 1 rapidly under the elastic force of the spring 56; then the push rod 2 is pulled out to the outside of the puncture channel 7 for a certain distance and then is rotated for 90 degrees, so that the ear wings 21 at the two sides of the push rod 2 are aligned with the ear wing clamping seat 143 of the sheath tube 1; then the ear wings 21 at both sides of the push rod 2 are inserted into the ear wing clamping seats 143 of the sheath tube 1 to realize the relative fixation of the push rod 2 and the sheath tube 1.
6. Withdrawing the sheath tube 1 and the push rod 2 and suturing the body surface wound.
The plugging method is used for a PTCD training model or a patient.
When the acting object of the blocking method is a PTCD training model, the method can help a student to quickly and skillfully master the method for blocking the PTCD puncture channel, and the operation time is under the condition that the puncture sheath and the PTCD catheter do not exit the puncture channel after the PTCD puncture operation is finished. The PTCD training model is provided with a trunk from the chest to the upper abdomen of a human body, epidermis on the surface of the trunk, bones inside the trunk, a liver, an intrahepatic bile duct and blood vessels, wherein colored liquid is injected into the intrahepatic bile duct and the blood vessels, and the intrahepatic bile duct and the blood vessels are made of repairable materials. The real tissue structure of the human body is simulated.
When the action object of the plugging method is a patient, bile can be prevented from leaking out of the body through the puncture channel, and postoperative recovery of the patient is facilitated. The operation time is that after the PTCD puncture operation is finished, the treatment of biliary obstruction is performed, and the puncture sheath and the PTCD catheter do not exit from the puncture channel.
The PTCD puncture channel plugging device provided by the invention can also be used for plugging a lithotripsy channel under a percutaneous nephroscope, and the process is similar to the operation and is not repeated.
Claims (7)
- PTCD puncture channel plugging device, characterized by: comprises a sheath tube, a push rod, a block, a guide wire and a push rod resetting mechanism;a push rod cavity and a blocking block cavity are sequentially arranged in the sheath tube from the front end to the rear end along the axial direction, the push rod cavity is communicated with the blocking block cavity, the push rod cavity and the blocking block cavity form a push rod inlet and a blocking block inlet at the front end and the rear end of the sheath tube respectively, a guide wire channel is further arranged in the sheath tube along the axial direction, and a guide wire inlet and a guide wire outlet are formed in the guide wire channel at the front end and the rear end of the sheath tube respectively;the two ends of the push rod are respectively a handheld end and a pushing end, the push rod is movably inserted in the push rod cavity of the sheath tube, the pushing end of the push rod is positioned in the push rod cavity or extends into the block cavity, and the handheld end of the push rod extends out of the push rod inlet and outlet and is positioned outside the sheath tube;the plugging block is arranged in the plugging block cavity of the sheath tube through the plugging block inlet and outlet of the sheath tube and forms transition fit with the plugging block cavity of the sheath tube, and the plugging block can be discharged to the outside of the sheath tube from the plugging block inlet and outlet under the pushing of the pushing end of the pushing rod;the guide wire is movably inserted in the guide wire channel of the sheath tube, and the front end and the rear end of the guide wire respectively extend out of the guide wire inlet and the guide wire outlet;the diameter of the front end of the sheath tube is enlarged to form a head, an end face A is arranged at one end, close to the front end of the sheath tube, of the head, a transition face is arranged at one end, far away from the sheath tube, of the head, an ear wing clamping seat is arranged on the end face A of the head, an ear wing positioning pit communicated with the push rod cavity is arranged on the end face A of the head, a mounting hole penetrating to the end face A and the transition face is further formed in the head, the mounting hole comprises a threaded hole section and an unthreaded hole section which are communicated with each other, the threaded hole section penetrates to the transition face, and the unthreaded hole section;the side wall of the handheld end of the push rod is provided with an ear wing, the ear wing is respectively matched with the ear wing positioning pit and the ear wing clamping seat, when the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube, the pushing end of the push rod extends out from the block inlet and the block outlet of the sheath tube, and when the ear wing of the push rod is inserted into the ear wing clamping seat of the sheath tube, the pushing end of the push rod is positioned in the push rod cavity of the sheath tube; the handheld end of the push rod is also provided with a cantilever, and a boss is arranged on the cantilever;the push rod resetting mechanism comprises a mounting seat, a sleeve, a push block, a connecting rod, a butt joint seat and a spring; one end of the mounting seat is provided with a wrench clamping part, the other end of the mounting seat is provided with a sleeve connecting part, the side wall surface of the mounting seat is provided with external threads, the mounting seat is in threaded connection with the threaded hole section of the mounting hole of the sheath tube through the external threads, the wrench clamping part faces the transition surface, and the sleeve connecting part faces the end surface A; the sleeve is detachably connected to the sleeve connecting part of the mounting seat and is positioned in the unthreaded hole section of the mounting hole of the sheath tube, and a rod penetrating hole is formed in one end, far away from the mounting seat, of the sleeve; the push block is movably arranged in the inner hole of the sleeve; one end of the connecting rod extends into the inner hole of the sleeve through the rod penetrating hole of the sleeve and is fixedly connected with the push block, and the other end of the connecting rod extends out of the unthreaded hole section of the mounting hole of the sheath tube and is fixedly connected with the butt joint seat; the butt joint seat is provided with a concave pit matched with the boss of the push rod; the spring is compressed and arranged in the inner hole of the sleeve, and two ends of the spring are respectively propped against the mounting seat and the push block.
- 2. The PTCD puncture closure device of claim 1 wherein: the number of the ear wing clamping seats is two, and the two ear wing clamping seats are annularly and uniformly distributed on the end surface A of the sheath tube around the central line of the sheath tube; correspondingly, the number of the ear wings is two, and the two ear wings are annularly and uniformly distributed on the side wall of the handheld end of the push rod around the central line of the push rod.
- 3. The PTCD puncture closure device of claim 2 wherein: the number of the mounting holes is two, and the two mounting holes are annularly and uniformly distributed at the head of the sheath pipe around the central line of the sheath pipe; correspondingly, the number of the push rod resetting mechanisms is two, and the two push rod resetting mechanisms are respectively arranged in the two mounting holes.
- 4. The PTCD puncture closure device of claim 3 wherein: the blockings are cylindrical and comprise gelatin sponges and degradable shells wrapping the outside of the gelatin sponges, and hollow holes are formed in the side walls of the degradable shells.
- 5. The PTCD puncture closure device of claim 4 wherein: the block cavity is sequentially provided with an expanding section, a reducing section, a transition section and a sizing section from one end of the block cavity where the block inlet and the block outlet are located to the other end, the diameter of the sizing section is L, the diameter of the reducing section is 0.96-0.98L, the maximum diameter of the expanding section is 1.02-1.06L, an included angle a formed by a bus of the expanding section and a central line of the sheath tube is 3-10 degrees, and an included angle beta formed by the bus of the transition section and the central line of the sheath tube is 3-10 degrees;the diameter of the block is L.
- 6. The PTCD puncture closure device of claim 5 wherein: the sheath tube is 20-30 cm in length, the blocking block is 1-1.5 cm in length, and the guide wire is 80-100 cm in length.
- 7. A PTCD puncture channel blocking method, which is based on the PTCD puncture channel blocking device of any one of claims 1 to 6 and is used for blocking a puncture channel generated by PTCD puncture operation; the action object of the plugging method is a PTCD training model; the PTCD training model is provided with a trunk from the chest to the upper abdomen of a human body, epidermis on the surface of the trunk, bones, a liver, an intrahepatic bile duct and blood vessels inside the trunk, wherein colored liquid is injected into the intrahepatic bile duct and the blood vessels, and the intrahepatic bile duct and the blood vessels are both made of repairable materials;the plugging operation is as follows:s01, the rear end of the guide wire is conveyed into the lower end of the bile duct with the assistance of DSA through the inner hole of the puncture sheath or the inner hole of the PTCD catheter, so that a working orbit is established;before the step is started, the PTCD puncture operation is completed, and the puncture sheath and the PTCD catheter do not exit from the puncture channel;s02, removing the puncture sheath and the PTCD catheter, sleeving the sheath tube on the guide wire through the guide wire channel on the sheath tube, pushing the sheath tube along the guide wire, and sending the rear end of the sheath tube to the junction of the puncture channel and the bile duct under the assistance of DSA;before the step is started, the block is arranged in a block cavity of the sheath tube; the push rod is arranged in the push rod cavity of the sheath tube, and the ear wings at two sides of the push rod are clamped in the ear wing clamping seats of the sheath tube;s03, removing the guide wire, withdrawing the sheath tube by a length of a block, pushing the contrast agent into the sheath tube through the guide wire inlet of the sheath tube, and confirming that the rear end of the sheath tube is in the puncture channel and does not extend into the bile duct with the assistance of DSA;s04, pulling the push rod out of the puncture channel for a certain distance to make the ear wings at the two sides of the push rod separate from the ear wing clamping seat of the sheath tube; then the push rod is rotated by 90 degrees, so that the ear wings at the two sides of the push rod are aligned to the ear wing positioning pits of the sheath tube; then the push rod is pushed to the deep part of the puncture channel, and along with the pushing of the push rod, on one hand, the spring is compressed, and on the other hand, the ear wing of the push rod is inserted into the ear wing positioning pit of the sheath tube; until the block is pushed out from the block inlet and the block outlet of the sheath tube, the block is blocked at the intersection of the puncture channel and the bile duct after being pushed out, so as to avoid bile leakage;in the step, when the ear wings on the two sides of the push rod are abutted against the bottom surface of the ear wing positioning pit of the sheath tube, the push rod is pushed to reach the limit position, the compression amount of the spring is maximized, and the pushing end of the push rod extends out of the blocking block inlet and outlet of the sheath tube by 1-5 mm;s05, the pushing force applied on the push rod is cancelled, and the pushing end of the push rod rapidly retracts into the push rod cavity of the sheath under the elastic force action of the spring; then the push rod is pulled out to the outside of the puncture channel for a certain distance and then rotated for 90 degrees, so that the ear wings at the two sides of the push rod are aligned to the ear wing clamping seat of the sheath tube; then inserting the ear wings at the two sides of the push rod into the ear wing clamping seats of the sheath tube so as to realize the relative fixation of the push rod and the sheath tube;and S06, withdrawing the sheath tube and the push rod, and suturing the body surface wound.
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| CN202235535U (en) * | 2011-10-08 | 2012-05-30 | 于友涛 | Liver puncture needle channel stopper |
| CN104586460A (en) * | 2015-02-14 | 2015-05-06 | 四川大学 | Blood vessel puncturing and blocking system |
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| CN208808558U (en) * | 2018-03-02 | 2019-05-03 | 柳州市工人医院 | One kind can block arteriovenous sliding vagina vasorum |
| CN109938810A (en) * | 2019-03-27 | 2019-06-28 | 深圳市擎源医疗器械有限公司 | Puncture needle component and balloon catheter kit |
| CN107997802B (en) * | 2018-01-11 | 2020-06-30 | 四川大学华西医院 | Accurate hemostasis device in bone clearance |
Family Cites Families (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6599299B2 (en) * | 2001-06-26 | 2003-07-29 | Leonard S. Schultz | Device and method for body lumen occlusion |
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2020
- 2020-09-09 CN CN202010940673.0A patent/CN111904558B/en active Active
Patent Citations (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN202235535U (en) * | 2011-10-08 | 2012-05-30 | 于友涛 | Liver puncture needle channel stopper |
| CN104586460A (en) * | 2015-02-14 | 2015-05-06 | 四川大学 | Blood vessel puncturing and blocking system |
| CN105455880A (en) * | 2016-01-20 | 2016-04-06 | 朱俊余 | Haemorrhoids loop ligature device |
| CN107997802B (en) * | 2018-01-11 | 2020-06-30 | 四川大学华西医院 | Accurate hemostasis device in bone clearance |
| CN208808558U (en) * | 2018-03-02 | 2019-05-03 | 柳州市工人医院 | One kind can block arteriovenous sliding vagina vasorum |
| CN109938810A (en) * | 2019-03-27 | 2019-06-28 | 深圳市擎源医疗器械有限公司 | Puncture needle component and balloon catheter kit |
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