CN113397695A

CN113397695A - Special magnetic traction operation device for endoscopic mucosal dissection

Info

Publication number: CN113397695A
Application number: CN202110871108.8A
Authority: CN
Inventors: 黄永辉; 王迎春; 常虹; 闫秀娥; 张耀朋; 郑炜
Original assignee: Peking University Third Hospital Peking University Third Clinical Medical College
Current assignee: Peking University Third Hospital Peking University Third Clinical Medical College
Priority date: 2021-07-30
Filing date: 2021-07-30
Publication date: 2021-09-17

Abstract

The invention discloses a special magnetic traction operation device for endoscopic mucosa dissection, which belongs to the technical field of medical instruments and comprises a high-frequency electrotome used for cutting mucosa and a metal clip used for clamping the mucosa, wherein a first magnet and a second magnet which repel each other are respectively arranged at the working end of the high-frequency electrotome and the metal clip, the metal clip is clamped at the incision of the mucosa as an auxiliary device by utilizing the characteristic that the magnetic poles of the first magnet and the second magnet repel each other, the metal clip can be automatically repelled by the magnet on the high-frequency electrotome during the operation process by operating the high-frequency electrotome, the mucosa is lifted up, the traction effect is achieved, the operation visual field is improved, the metal clip does not need to be operated by extra effort, and the metal clip can be gradually lifted up along with the operation of the high-frequency electrotome due to certain repulsive force, so that the traction force is not too large, and the direction of the high-frequency electrotome can be changed, the lifting direction can be flexibly changed, and the requirement of high-precision operation is met.

Description

Special magnetic traction operation device for endoscopic mucosal dissection

Technical Field

The invention relates to the technical field of medical instruments, in particular to a magnetic traction operation device special for endoscopic mucosal dissection.

Background

In recent years, with the rapid advance of digestive endoscopy equipment and related instruments, the unprecedented development of minimally invasive surgery under various endoscopes has also been achieved, and particularly the proposal of the concept of 'super-minimally invasive' realizes a plurality of treatments which can only be realized through surgical operations and interventional operations before. Compared with the traditional surgical operation, the treatment under the endoscope can keep the original organs under the premise of thoroughly cutting off pathological changes, the structural integrity of the organs is kept, the body surface has no wound, the operation is shorter, and the postoperative recovery effect of a patient is better. Endoscopic Submucosal Dissection (ESD) is widely applied to endoscopic treatment of early tumors and precancerous lesions of esophagus, stomach and colon at present, and the classic ESD technology is to inject physiological saline into the mucosa to enable the tumors to bulge and separate from the mucosa, then to use various incision knives to dissect the periphery of the lesion and gradually and completely dissect the whole lesion along the submucosa. Endoscope submucosal dissection art is when the operation, generally need use auxiliary device to carry out the lifting to the pathological change mucous membrane to obtain better operation field of vision, auxiliary device commonly used at present is the transparent cap of transparent plastics tubular structure, arranges the transparent cap in the scope head end during the use, utilizes transparent cap can be with having peeled off pathological change jack-up, plays "support" effect, thereby exposes the pathological change mucous membrane better, so that follow-up submucosal dissection (cutting, congealing and blunt nature separation). However, in the actual use process, medical staff find that after the transparent cap is added, not only is the exposure of the submucosa of the pathological changes unsatisfactory, but also due to the blocking of the transparent cap and the difficulty of approaching the submucosa by instruments such as a cutting knife and the like, such as a large-area lesion of the esophagus, the submucosa can not be separated by only using the top and the part of the transparent cap, the clear operation visual field of the submucosa required by ESD can not be achieved, particularly in the part with folds or the corner and the far end of the mucosal tissue, the visual field can hardly meet the requirement, the risk of perforation or bleeding can be increased by blind stripping and cutting, and meanwhile, serious complications in the later period can be caused.

Therefore, in order to ensure that the operation has a good visual field, a dental floss traction auxiliary mode is proposed in recent years, namely, after a focus is cut at the edge and part of submucosal tissue is stripped, a metal clip is extended outside a human endoscope biopsy pore canal and then exposed, the metal clip is opened, the dental floss is fastened on one arm of the clip, then two arms of the clip are slightly closed, the metal clip is pulled back into the transparent cap and then is inserted to the focus again, the metal clip with the dental floss is tied on the mucosa tissue cut at the anal side section of the focus, and the submucosal cutting surface is exposed by the traction of the dental floss on the metal clip, so that the stripping operation is efficiently carried out. However, the dental floss traction method is high in requirement and small in traction force, excessive traction may cause the dental floss to be pulled off from a specimen, so that the traction of an inherent muscular layer is caused, medical staff is required to control the traction of the traction dental floss additionally during traction, and the traction of the traction dental floss is mutually matched with the high-frequency electric knife, so that the medical staff is required to pay high attention to realize the high-precision matching of the traction dental floss and the high-frequency electric knife, but the medical staff is burdened due to the fact that the attention is concentrated for a long time, and potential safety hazards are easily caused when the operation is performed in a tired state.

Therefore, in order to reduce the workload in medical staff, the patent number is "201620536535.5", the utility model discloses a mucous membrane lifting device that the patent name is "a device that is used for supplementary mucous membrane of pathological change mucous membrane to carry in the endoscopic surgery" provides one kind and need not the medical staff and pay attention to extra effort control, through setting up a plurality of metal clip on the rubber band, then press from both sides metal clip around the mucous membrane of pathological change, through adjusting the rubber band length, can turn up the marginal edge of pathological change to pathological change central authorities, improve the operation field of vision then, but above-mentioned auxiliary device, once the rubber band tightens up the back, just can not be along with the regulation on the position of carrying out of operation, consequently hardly satisfy some position that the operation precision requirement is higher such as the more or mucous membrane tissue turning distal end of fold.

Disclosure of Invention

The invention aims to solve the technical problems and provides a special magnetic traction operation device for endoscopic mucosa dissection, which is characterized in that a metal clamp with a built-in magnet is clamped at a mucosa incision to serve as an auxiliary device, then a high-frequency electrotome with the same built-in magnet is adopted to be matched for use, in the operation process, only the high-frequency electrotome is normally operated to perform operation, the metal clamp can be automatically repelled by the magnet on the high-frequency electrotome, then the mucosa is lifted, the operation visual field is improved, the auxiliary device is not required to be operated with extra effort, and the metal clamp can lift the diseased mucosa gradually along with the operation of the high-frequency electrotome due to certain magnetic repulsion force, so that overlarge traction force can be avoided, and the lifting direction can be flexibly changed along with the direction change of the high-frequency electrotome.

In order to achieve the purpose, the invention provides the following scheme: the invention provides a special magnetic traction operation device for endoscopic mucosa dissection, which comprises a high-frequency electrotome used for cutting mucosa and a metal clamp used for clamping the mucosa, wherein a first magnet and a second magnet which are mutually repulsive are respectively arranged at the working end of the high-frequency electrotome and the metal clamp.

Preferably, the high-frequency electrotome comprises a Dual tool bit and a hollow plastic tube matched with the size of the endoscope biopsy hole, the first magnet is coaxially fixed to an annular magnet in the working end of the hollow plastic tube, an insulating conduit is fixed in the first magnet, the insulating conduit extends to the end head of the working end of the hollow plastic tube, the Dual tool bit is sleeved in the insulating conduit, the head of the Dual tool bit extends out of the end head of the working end of the hollow plastic tube, the tail of the Dual tool bit is connected with a conductive wire connected with a power supply system, and the tail of the hollow plastic tube is provided with a traction handle used for controlling the Dual tool bit to move along the axial direction of the hollow plastic tube.

Preferably, the traction handle comprises a pull handle with a pull ring at the tail part and a traction tube with holding rings at two sides, the traction tube is sleeved on the pull handle, a limiting ring for preventing the traction tube from being separated is coaxially fixed at the head part of the pull handle, and a pull rope fixedly connected with the tail part of the Dual tool bit is arranged at the head part of the pull handle.

Preferably, an annular fixing frame is coaxially fixed at the working end of the hollow plastic pipe, and the insulating conduit is fixed in the ring of the annular fixing frame.

Preferably, the length of the hollow plastic pipe is 160mm, the length of the first magnet is 0.5mm, the length of the annular fixing frame is 0.2mm, the distance between the first magnet and the annular fixing frame is 1mm, and the length of the insulating conduit is 20 mm.

Preferably, the metal clip comprises a clip assembly and a connecting seat detachably connected with the metal clip releaser, the second magnet is fixedly connected between the clip assembly and the connecting seat, and the second magnet is an annular magnet.

Preferably, the clip assembly comprises a clip seat fixedly connected with the second magnet and a clip piece arranged on the clip seat, and the end of the clip piece is bent inwards.

Preferably, the ends of the two clamping pieces are respectively provided with a V-shaped occlusion groove and a triangular occlusion tooth.

Preferably, the maximum opening and closing angle of the clamping piece is 160 degrees.

Preferably, the metal clip is a titanium clip.

Compared with the prior art, the invention has the following technical effects:

1. the magnetic traction operation device comprises a metal clamp with a built-in second magnet, a high-frequency electrotome with a built-in first magnet, the mutual matching is realized through doctor operation, the stripping process is carried out, the metal clamp is closed on a mucous membrane beside a pathological change, the high-frequency electrotome normally performs operation, the magnetic poles of the first magnet and the second magnet repel each other, the metal clamp can go deep along with the high-frequency electrotome, the mucous membrane is lifted to improve the operation visual field, the traction effect of the pathological change part is realized, the metal clamp does not need to be operated with extra effort, the metal clamp cannot be excessively pulled due to certain magnetic repulsion force, the metal clamp goes deep along with the high-frequency electrotome and is gradually lifted, the inherent muscle layer is prevented from being pulled, the tissue damage caused by improper operation is avoided, the direction of the high-frequency electrotome is changed simultaneously, the moving direction of the metal clamp can also be changed, and the lifting direction is flexibly changed.

2. The high frequency electrotome has adopted the incision sword of Dual tool bit, and the Dual tool bit has safe effective, reduces the advantage that the annex used, and the Dual tool bit can freely change length in hollow plastic pipe under the traction handle effect to it is fixed after changing length, thereby adaptable different cutting demands.

3. The working end of the hollow plastic pipe is coaxially fixed with an annular fixing frame, the annular fixing frame fixes the end of the insulating conduit in one step, the stability of the insulating conduit in the hollow plastic pipe is improved, the stability of a Dual tool bit in the insulating conduit is guaranteed, and the requirement of high-precision operation is met.

4. The second magnet is fixedly connected between the clamp assembly and the connecting seat, and the second magnet is repelled by the first magnet and can push the metal clamp from the tail of the metal clamp, so that the tail of the metal clamp can rotate outwards to push away the mucous membrane incision.

5. The end of the clamping piece is provided with a V-shaped occlusion groove and a triangular occlusion tooth which can be occluded with each other, when the ends of the two clamping pieces 20 are combined together, the triangular occlusion tooth 22 is just embedded into the V-shaped occlusion groove 21, so that stable clamping of mucous membrane tissues is facilitated, and displacement after clamping cannot be generated.

Drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings needed to be used in the embodiments will be briefly described below, and it is obvious that the drawings in the following description are only some embodiments of the present invention, and it is obvious for those skilled in the art to obtain other drawings without inventive exercise.

FIG. 1 is a schematic structural view of a high-frequency electric knife and a traction handle;

FIG. 2 is a schematic structural view of a high-frequency electrotome;

FIG. 3 is a partially enlarged view of the high-frequency electrotome;

FIG. 4 is a schematic view of the metal clip and the metal clip releaser;

FIG. 5 is a schematic view of a metal clip;

fig. 6 is a schematic view of clip ends of a metal clip.

Description of reference numerals: 1. a high-frequency electrotome; 2. a metal clip; 3. a first magnet; 4. a second magnet; 5. a Dual tool bit; 6. a hollow plastic tube; 7. an insulated conduit; 8. a conductive wire; 9. a traction handle; 10. a pull ring; 11. pulling a handle; 12. a holding ring; 13. a traction tube; 14. a limiting ring; 15. a cable; 16. an annular fixing frame; 17. a connecting seat; 18. a metal clip releaser; 19. a holder; 20. a clip; 21. a V-shaped occlusion groove; 22. triangular occlusion teeth.

Detailed Description

The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

The embodiment provides a special magnetic traction operation device for endoscopic mucosa dissection, which comprises a high-frequency electrotome 1 for cutting mucosa and a metal clamp 2 for clamping lesion mucosa, wherein a first magnet 3 is arranged at the working end of the high-frequency electrotome 1, a second magnet 4 is arranged on the metal clamp 2, and the outer surface magnetic poles of the first magnet 3 and the second magnet 4 are the same as each other as shown in fig. 1 to 6. When the high-frequency electric scalpel is used, the normal saline is injected under the mucosa where the tumor is located to enable the tumor to bulge and be separated from the normal mucosa, then the high-frequency electric scalpel 1 extends into the position near the mucosa where the tumor is located from an endoscope biopsy hole of the endoscope, and the edge of a focus is incised by the high-frequency electric scalpel 1. Then the high-frequency electrotome 1 is drawn out, the metal clamp releaser 18 with the metal clamps 2 extends to the focus from the endoscope biopsy hole of the endoscope, the metal clamps 2 are released, the metal clamps 2 clamp the focus edge again, and the number of the metal clamps 2 is selected according to actual needs; after the metal clip 2 is released, the metal clip releaser 18 is drawn out, the high-frequency electrotome 1 is extended to the focus again for the stripping operation, the metal clip 2 with the second magnet 4 is far away from the high-frequency electrotome 1 under the repulsion of the first magnet 3 on the high-frequency electrotome 1, the position of the high-frequency electrotome 1 is controlled, the metal clip 2 can lift the focus edge, and then more visual fields are exposed, then the metal clip 2 can further lift the focus mucous membrane along with the extension of the high-frequency electrotome 1 until the endoscopic mucous membrane glass operation is completed, and the focus mucous membrane together with the focus and the metal clip 2 is stripped off. The magnetic force of the first magnet 3 and the second magnet 4 is not too large easily, the metal clip 2 is prevented from being pushed down too far, the traction transition is caused, the intrinsic muscle layer is torn, the muscle layer is damaged, and the magnet with proper magnetic force is selected, so that the purpose that the mucous membrane at the focus is gradually lifted is achieved, meanwhile, the lifting direction of the metal clip 2 can be changed by changing the position of the high-frequency electrotome 1, the purpose of accuracy and controllability is achieved, and the position with high precision, such as the part with wrinkles or the corner distal end of the mucous membrane tissue, can be coped with. The clip releaser 18 is a commercially available medical device, which is connected to the clip 2 in a manner that is currently known and will not be described in detail.

In this embodiment, as shown in fig. 1 to 3, the high-frequency electric knife 1 is a high-frequency electric knife 1 with a Dual knife head 5, the high-frequency electric knife 1 is composed of a hollow plastic tube 6, an insulating catheter 7, a first magnet 3 and a conducting wire 8, and the size of the hollow plastic tube 6 is matched with that of the endoscopic biopsy hole, so that the hollow plastic tube 6 can freely stretch and retract in the endoscopic biopsy hole. The first magnet 3 is an annular magnet, preferably, the outer ring of the first magnet 3 is an N pole, the inner ring of the first magnet is an S pole, the first magnet 3 is coaxially fixed in the working section of the hollow plastic pipe 6, the insulating conduit 7 is coaxially fixed in the ring of the first magnet 3, and the end of the insulating conduit 7 is flush with the end of the working end of the hollow plastic pipe 6. The Dual tool bit 5 is sleeved in the insulating guide pipe 7 and can freely stretch out and draw back in the insulating guide pipe 7, the head of the Dual tool bit 5 extends out of the working end of the hollow plastic pipe 6 so as to carry out operation, the tail of the Dual tool bit 5 is electrically connected with the conducting wire 8, and the conducting wire 8 extends outwards along the insulating guide pipe 7 and extends out of the tail of the hollow plastic pipe 6 to be connected with a power supply system. The tail part of the hollow plastic pipe 6 is provided with a traction handle 9 for controlling the Dual tool bit 5 to move along the axial direction of the hollow plastic pipe 6 and controlling the length of the Dual tool bit 5 extending out of the hollow plastic pipe 6, and the traction handle 9 is a control handle commonly used in medical treatment and can be purchased in the market.

Further, in this embodiment, the traction handle 9 includes a pull handle 11, a pull ring 10 is fixedly connected to a tail portion of the pull handle 11, a traction tube 13 is sleeved in a middle portion of the pull handle 11, grip rings 12 are arranged on two sides of the traction tube 13, a limit ring 14 for preventing the traction tube 13 from being detached from the head portion is arranged at a head portion of the pull handle 11, and a pull cable 15 for fixedly connecting with a tail portion of the Dual bit 5 is arranged at the head portion of the pull handle 11. The protruding length of the Dual tool bit 5 in the hollow plastic tube 6 can be controlled by relatively moving the push pull handle 11 in the traction tube 13. It should be noted that the pull handle 11 is further provided with a fixing auxiliary device for fixing the relative position of the pull handle 11 and the traction tube 13, and the device is a structure which is commonly arranged on the existing traction handle 9 and is not described in detail herein. Meanwhile, in order to ensure that the extension length of the Dual head 5 is accurately controlled, scales can be arranged on the pull handle 11 to determine the telescopic distance of the Dual head 5 so as to meet the requirement of the operation.

In this embodiment, the hollow plastic tube 6 is further provided with an annular fixing frame 16, the annular fixing frame 16 is made of plastic and is coaxially fixed at the end of the hollow plastic tube 6, and the end of the insulating conduit 7 is fixed at the center of the inner ring of the annular fixing frame 16, so that the stability of the insulating conduit 7 is improved, and the Dual tool bit 5 is prevented from shaking during the operation.

In this embodiment, as shown in fig. 1 to 3, the length of the hollow plastic tube 6 is 160mm, the length of the first magnet 3 is 0.5mm, the length of the annular fixing frame 16 is 0.2mm, the distance between the first magnet 3 and the annular fixing frame 16 is 1mm, and the length of the insulating conduit 7 is 20 mm.

In this embodiment, as shown in fig. 4 to 6, the metal clip 2 includes a clip assembly, a connecting seat 17, the metal clip 2 is detachably connected to the metal clip releaser 18 through the connecting seat 17, the connecting mode of the connecting seat 17 and the metal clip releaser 18 is conventional and will not be described in detail, and as shown in fig. 4, the metal clip releaser 18 is controlled by the pulling handle 9. The second magnet 4 is arranged between the clamp assembly and the connecting seat 17 and fixedly connected with the clamp assembly and the connecting seat, and the second magnet 4 is a ring magnet. Preferably, the outer ring of the second magnet 4 is an N pole, the inner ring is an S pole, the length of the second magnet 4 is 5mm, the length of the second magnet 4 is longer than that of the first magnet 3, the area of the second magnet 4 is increased, outward rotation and lifting of the metal clamp 2 are facilitated, and the phenomenon that the tail of the metal clamp 2 is separated from the repelling range of the first magnet 3 due to the fact that the length of the second magnet 4 is insufficient after the tail of the metal clamp 2 is lifted can be avoided.

Further, in the present embodiment, as shown in fig. 4 to 6, the clip assembly includes a clip 20 and a holder 19, the ends of the clip 20 are bent inward to facilitate holding of the mucosal tissue, the clip 20 is disposed on the holder 19, and the specific arrangement is a common arrangement for medical clips, and will not be described in detail here. The clip assembly is fixedly attached to the second magnet 4 by means of a clip mount 19.

Further, in this embodiment, referring to fig. 5 and 6, the end of one of the clamping pieces 20 is a saw-toothed structure, a V-shaped engagement groove 21 is formed between the saw teeth, the end of the other clamping piece 20 is provided with triangular engagement teeth 22, the shape and size of the triangular engagement teeth 22 are just matched with the V-shaped engagement groove 21, and when the ends of the two clamping pieces 20 are combined together, the triangular engagement teeth 22 are just embedded into the V-shaped engagement groove 21, so that the mucous membrane tissue can be clamped stably without displacement after clamping. Referring to fig. 6, the V-shaped engagement groove 21 has a maximum width of 3 mm.

Further, in the present embodiment, the maximum opening and closing angle of the clip 20 is 160 °, so as to meet the requirements of various situations. Generally, the metal clip 2 with the angle of 90 degrees has larger hooking force and is more suitable for clipping the mucosa beside the pathological changes, while the metal clip 2 with the angle of 135 degrees has slightly poorer hooking force and is more suitable for hemostasis. But in practical application, the opening and closing angle of the metal clip 2 can be flexibly adjusted.

In the embodiment, the metal clip 2 is a titanium clip, titanium and titanium alloy have good corrosion resistance, titanium is non-toxic and non-magnetic, and is a good material for medical instruments, and meanwhile, the metal clip 2 is small and can not affect the body after being left in the body, so that the titanium clip can automatically fall off and then is discharged together with excrement after the wound surface is recovered, and the period of about 10-15 days is probably needed according to personal conditions.

The principle and the implementation mode of the invention are explained by applying a specific example, and the description of the embodiment is only used for helping to understand the method and the core idea of the invention; meanwhile, for a person skilled in the art, according to the idea of the present invention, the specific embodiments and the application range may be changed. In view of the above, the present disclosure should not be construed as limiting the invention.

Claims

1. The utility model provides a special magnetism of scope mucosa exfoliation technique pulls surgical device which characterized in that, including being used for cutting the high frequency electrotome of mucosa, being used for the centre gripping the metal of mucosa presss from both sides, the work end of high frequency electrotome with be equipped with first magnet, the second magnet of mutual repulsion on the metal presss from both sides respectively.

2. The special magnetic traction surgical device for endoscopic mucosal dissection is characterized in that the high-frequency electrotome comprises a Dual knife head and a hollow plastic tube matched with an endoscopic biopsy hole in size, the first magnet is an annular magnet coaxially fixed in the working end of the hollow plastic tube, an insulating conduit is fixed in the ring of the first magnet, the insulating conduit extends to the end head of the working end of the hollow plastic tube, the Dual knife head is sleeved in the insulating conduit, the head of the Dual knife head extends out of the end head of the working end of the hollow plastic tube, the tail of the Dual knife head is connected with a conducting wire connected with a power supply system, and a traction handle used for controlling the Dual knife head to move along the axial direction of the hollow plastic tube is arranged at the tail of the hollow plastic tube.

3. The magnetic traction surgical device for endoscopic mucosal dissection as claimed in claim 2, wherein the traction handle comprises a pull handle with a pull ring at the tail and a traction tube with holding rings at both sides, the traction tube is sleeved on the pull handle, a limiting ring for preventing the traction tube from separating is coaxially fixed at the head of the pull handle, and a pull cable fixedly connected with the tail of the Dual tool bit is arranged at the head of the pull handle.

4. The magnetic traction surgical device special for endoscopic mucosal dissection as claimed in claim 2, wherein an annular fixing frame is coaxially fixed at the working end of the hollow plastic tube, and the insulating conduit is fixed in the ring of the annular fixing frame.

5. The magnetic traction surgical device special for endoscopic mucosal dissection as claimed in claim 4, wherein the hollow plastic tube is 160mm long, the first magnet is 0.5mm long, the annular fixing frame is 0.2mm long, the distance between the first magnet and the annular fixing frame is 1mm, and the insulating conduit is 20mm long.

6. The magnetic traction surgical device for endoscopic mucosal dissection as claimed in claim 1, wherein the metal clip comprises a clip component and a connecting seat for detachable connection with the metal clip releaser, the second magnet is fixedly connected between the clip component and the connecting seat, and the second magnet is a ring magnet.

7. The magnetic traction surgical device special for endoscopic mucosal dissection as claimed in claim 6, wherein the clip assembly comprises a holder fixedly connected with the second magnet, and a clip disposed on the holder, wherein the end of the clip is bent inward.

8. The magnetic traction surgical device special for endoscopic mucosal dissection according to claim 7, wherein the ends of the two clamping pieces are respectively provided with a V-shaped occlusion groove and a triangular occlusion tooth.

9. The magnetic traction surgical device special for endoscopic mucosal dissection as claimed in claim 8, wherein the maximum opening and closing angle of the clip is 160 °.

10. The magnetic traction surgical device special for endoscopic mucosal dissection as claimed in claim 6, wherein the metal clip is a titanium clip.