CN114271907A - Pericardial puller, pericardial puller device, pericardial interventional system and operation method - Google Patents

Abstract

The application discloses a pericardium puller, a pericardium puller device, a pericardium interventional system and an operation method, wherein the pericardium puller comprises two pipe fittings movably sleeved, each pipe fitting is provided with a relative far end and a relative near end, and the pipe wall of the far end of each pipe fitting is provided with at least one anchoring thorn; when the two pipe fittings move relatively, the anchoring thorn of each pipe fitting is mutually matched to clamp the pericardium. Compared with the prior art, the scheme has the advantages that the pericardium is clamped by the anchoring of each pipe fitting, when the far ends of the two pipe fittings are far away from the pericardium to move, the pericardium is stably pulled, and the damage to peripheral tissues such as the myocardium is avoided.

Description

Pericardial puller, pericardial puller device, pericardial interventional system and operation method

Technical Field

The application relates to the technical field of medical equipment, in particular to a pericardium lifting device, a pericardium lifting device, a pericardium interventional system and an operation method.

Background

The heart comprises a ventricle, a heart muscle and a heart sac, wherein the ventricle is enclosed by the heart muscle, the heart sac is wrapped outside the heart muscle, and the heart muscle sequentially comprises a fiber layer, a wall layer and an internal organ layer from outside to inside, wherein the internal organ layer is also called as epicardium, a heart sac is arranged between the epicardium layer and the wall layer, and the heart sac usually contains 20-25ml of physiological fluid.

The current epicardial stem cell injection technology comprises open chest to perform direct-view operation, and the direct-view operation has the defects of large wound and slow recovery, so that the stem cell injection by entering the pericardium through minimally invasive operation becomes a preferred treatment means.

The medical apparatus adopted by the minimally invasive surgery is a pericardium puncture outfit, after the pericardium is cut by a tissue engagement needle on the pericardium puncture outfit, the medical apparatus enters the pericardium cavity along the pericardium puncture outfit, so that medical staff can carry out the medical surgery of injecting stem cells in the pericardium cavity.

Of course, the medical operation after the pericardium is incised by the pericardium puncture outfit is not limited to the injection of stem cells, and also includes medical operations such as puncture drainage, myocardial excision, ablation, biological patch placement, left atrial appendage ligation, and cardiac pacemaker placement.

The inventor finds that the pericardium puncture device in the prior art is unreliable in pulling the pericardium during the use process.

Disclosure of Invention

In order to solve the technical problem, the application discloses a pericardial retractor, which comprises two pipes movably sleeved, wherein each pipe is provided with a far end and a near end, and the pipe wall of the far end of each pipe is provided with at least one anchoring thorn;

when the two pipe fittings move relatively, the anchoring thorn of each pipe fitting is mutually matched to clamp the pericardium.

The pericardium is clamped by the anchoring thorns of the pipe fittings, and when the far ends of the two pipe fittings move away from the pericardium, the pericardium is stably pulled, and the damage to peripheral tissues such as the myocardium is avoided.

Several alternatives are provided below, but not as an additional limitation to the above general solution, but merely as a further addition or preference, each alternative being combinable individually for the above general solution or among several alternatives without technical or logical contradictions.

Optionally, for any one of the pipes:

the number of the anchor stabs is multiple;

and a containing cavity with a far end arranged in an open manner and used for the pericardium to enter is formed between every two adjacent anchor stabs along the circumferential direction of the pipe fitting.

The pericardium is gathered in the preset area through the containing cavity, and the anchoring stabs are convenient to clamp the preset area. The increase of the number of the anchor stabs can improve the lifting effect of the center bag and ensure the stability of operation.

Optionally, a receiving area for receiving at least a part of the pericardium is arranged in the receiving cavity, and a side wall of an open portion of the receiving cavity is obliquely arranged to form a guide slope for the pericardium to enter the receiving area in the receiving cavity.

The guide inclined plane has the function of guiding while avoiding, and the movement of the pericardium in the accommodating cavity is cooperatively realized; meanwhile, the guide inclined plane reserves space for the pericardium to enter the open part of the containing cavity and the containing area.

Optionally, the anchor stabs and the pipe fitting are located on the same circumferential surface.

The anchor thorn can not take place the sudden change in the radial of pipe fitting to make the pipe fitting can provide level and smooth outer wall, avoid the anchor thorn to need extra increase working space at relative motion's in-process, conveniently intervene the implementation of process.

Optionally, the anchoring thorn is arranged obliquely relative to the axis of the pipe;

the extending trend of the anchor stabs of the two pipe fittings is reverse.

The pericardium can be guided to enter the containing cavity by the anchor stabs, and the anchor stabs can generate acting force far away from cardiac muscle to the pericardium acting on the anchor stabs, so that the pericardium is gathered, and each anchor stabs can be conveniently operated on the next step.

Optionally, the fitting manner between the two pipe fittings is a rotation fit and a sliding fit along the axial direction of the pipe fitting.

The position between the anchoring thorns of the two pipe fittings can be changed in multiple directions so as to increase the universality of the pericardial lifter.

Optionally, the distal ends of both tubes have viewing windows for viewing by the endoscope.

The state between each anchor and the pericardium was observed through the window.

Optionally, the two pipe fittings are respectively an outer pipe and an inner pipe penetrating through the outer pipe;

the two pipe fittings have an initial state that the distal end of the inner pipe is exposed outside the outer pipe and a working state that the outer pipe is axially pushed so that the anchoring thorn of the outer pipe and the anchoring thorn of the inner pipe are matched with each other.

The pericardium can enter the containing cavity of the inner tube conveniently. Meanwhile, the anchor thorn of the outer tube is prevented from attaching to the pericardium to generate the effect.

Optionally, in a working state, an accumulation area is formed between the anchor stabs of the outer tube and the anchor stabs of the inner tube.

The arrangement of the gathering area can realize the firmness of clamping the pericardium by the anchoring thorn on the pipe fitting.

Optionally, the limit position of the anchoring far end of the outer pipe does not pass over the anchoring far end of the inner pipe, and the anchoring on each pipe fitting is kept unchanged in the radial posture of the pipe fitting.

The movement path of the anchor on the outer tube does not influence tissues outside the distal end side of the inner tube.

Optionally, the pericardial retractor further comprises a driving handle, the driving handle comprising:

a support body connected to the inner tube;

and the screw driving mechanism is connected with the outer pipe and used for driving the outer pipe.

The inner pipe and the outer pipe can be operated through the driving handle respectively, so that an operator can conveniently control the lifting device.

Optionally, the screw drive mechanism comprises:

the transmission piece is slidably and rotatably arranged on the supporting body and is connected with the outer pipe;

and the rotating handle is rotatably arranged on the periphery of the transmission piece and used for driving the transmission piece.

Operating personnel only need through rotatory handle, can drive the outer tube motion through the driving medium, and this setting can be followed structural operating problem who avoids operating personnel, reduces the study cost.

Optionally, the screw driving mechanism further comprises a pin shaft, and the rotating handle drives the transmission member through the pin shaft.

The arrangement of the pin shaft can simplify the structure of the spiral driving mechanism so as to reduce the assembly difficulty of the spiral driving mechanism.

Optionally, the drive handle has an axial direction in space;

the transmission piece is arranged in the support body, and the support body is provided with a spiral groove which is axially arranged around the driving handle;

the rotary handle is rotatably arranged on the periphery of the support body and is provided with a limiting groove axially extending along the driving handle;

one end of the pin shaft is connected with the transmission part, and the other end of the pin shaft penetrates through the spiral groove and is arranged in the limiting groove.

The rotating handle drives the pin shaft to rotate along the spiral groove and move axially along the limiting groove. The spiral groove enables the pin shaft to axially move along the driving handle while rotating around the driving handle, so that the outer pipe can rotate and synchronously move along the axial direction of the pipe fitting. The limiting groove can limit the axial movement stroke and the circumferential rotation angle of the transmission piece along the driving handle.

Optionally, the driving handle further comprises a sleeve movably connected with the support body, the sleeve is sleeved outside the outer tube and has a first state wrapping the anchor thorn and a second state exposing the anchor thorn.

The sleeve wraps the anchor under the condition that the core bag puller is not used, and the effect of protecting the anchor is achieved. The sleeve exposes the anchoring thorn in the using state of the pericardium puller, so that the sleeve is prevented from interfering the anchoring thorn, and the pericardium is conveniently clamped by the anchoring thorn.

Optionally, the driving handle further includes a front end plug and an elastic member, the front end plug is mounted on the support and forms a movable groove with the support, the proximal end of the sleeve passes through the front end plug and enters the movable groove, and has an outward flange matched with the front end plug, and the elastic member is pressed between the transmission member and the sleeve to drive the sleeve to maintain the first state;

or, the driving handle further comprises a front end plug, an elastic part and a partition plate, the front end plug is installed on the support body and forms a movable groove with the support body in a surrounding mode, the near end of the sleeve penetrates through the front end plug to enter the movable groove and is provided with an outward flange matched with the front end plug, the partition plate is pressed against the inner wall of the movable groove, and the elastic part is pressed between the partition plate and the sleeve to drive the sleeve to keep the first state.

Under the condition of no external force, the elastic piece can keep the sleeve in the first state all the time so as to further protect the anchoring thorn. The front end plug is convenient for installing the sleeve and the elastic piece in the movable groove, and the arrangement of the flanging can limit the sleeve to be separated from the movable groove.

The present application also provides a pericardial lifter device, comprising:

a pericardial puller as described herein;

an action component to receive and guide the pericardial lifter.

The present application also provides a pericardial access system comprising:

a pericardial puller device as described herein;

a pericardial puncture outfit matched with the pericardial lifting appliance device.

The application also provides an operation method of the pericardial lifter, which comprises the following steps:

s100, pushing the first pipe fitting along a preset path to enable the anchor thorn at the far end of the first pipe fitting to approach a target area;

s200, rotating the first pipe fitting to enable the anchor thorn at the far end of the first pipe fitting to be in place;

s300, pushing a second pipe fitting along the axial direction of the first pipe fitting to enable the anchoring thorn at the far end of the second pipe fitting to be close to a target area;

s400, rotating the second pipe fitting to enable the anchor stabs at the far end of the second pipe fitting to be in place, wherein the anchor stabs in place on the pipe fittings are mutually matched to form a clamping posture;

and S500, synchronously pulling the two pipes to a desired amplitude.

The anchoring of each pipe fitting realizes the clamping of the target area, so that the two pipe fittings realize the stable traction of the target area.

Optionally, the operation method of the pericardial lifter further includes:

s600, relatively rotating the two pipe fittings to release the clamping postures of the anchor stabs on the two pipe fittings;

and S700, retracting the two pipes along the preset path.

After the operation of the lifting part of the target area is completed, the anchoring thorn on the two pipe fittings releases the clamping gesture, and the two pipe fittings are recovered.

Optionally, in step S100, the second tubular is moved synchronously with the first tubular while the first tubular is pushed along the predetermined path, and the anchoring thorn of the second tubular is on the proximal side of the anchoring thorn of the first tubular.

The anchor at the distal end of the first tubular member is brought into simultaneous proximity with the anchor at the distal end of the second tubular member to a target area.

Optionally, step S300 is performed simultaneously with step S400.

The path of the anchoring barb at the distal end of the second tubular element is advantageously inclined in the axial direction of the tubular element for gripping the target area.

Optionally, in step S400, when the anchors in the pipes are engaged with each other in the clamping position, the anchors of the pipes are not staggered.

When the anchor thorn of each pipe fitting clamps the target area, the part clamped by the target area is prevented from being cut off.

The pericardium puller, the pericardium puller device, the pericardium interventional system and the operating method can stably achieve the traction of the pericardium and avoid the damage to peripheral tissues such as the myocardium.

Drawings

Fig. 1 is a schematic structural diagram of a pericardial access system according to an embodiment of the present disclosure;

fig. 2 is a schematic structural diagram of a pericardial access system according to an embodiment of the present disclosure;

FIG. 3 is a schematic structural view of the center bag lifter of FIG. 1;

FIG. 4 is a schematic view of the construction of the pipes of FIG. 3;

FIG. 5 is a schematic view of a portion of the inner tube of FIG. 4;

FIG. 6 is a partial structural view of the tube of FIG. 4;

FIG. 7 is a schematic view of the two pipes of FIG. 3 in an initial state;

FIG. 8 is a schematic view of the two pipes of FIG. 3 in an operating state;

FIG. 9 is a cross-sectional view of the center package puller of FIG. 3;

FIG. 10 is a schematic view of the center bag lifter of FIG. 3 without the rotating handle;

FIG. 11 is an exploded view of the center bag lifter of FIG. 3;

FIG. 12 is a schematic structural diagram of the actuating assembly of FIG. 1;

FIG. 13 is a partial schematic view of the actuator assembly of FIG. 12;

FIG. 14 is a partial schematic view of the actuator assembly of FIG. 13;

FIG. 15 is a schematic structural diagram of an actuator according to an embodiment of the present disclosure;

FIG. 16 is an exploded view of the actuator of FIG. 15;

FIG. 17 is a schematic structural view of the pericardial puncture device of FIG. 1;

FIG. 18 is a schematic view of the guide tube and piercing member of FIG. 17;

FIG. 19 is a schematic view of the guide tube and piercing member of FIG. 18 in an exploded configuration;

FIG. 20 is a cross-sectional view of the guide tube of FIG. 18;

fig. 21 is a system block diagram of an operation method of a pericardial retractor according to an embodiment of the present disclosure.

The reference numerals in the figures are illustrated as follows:

100. a pericardial access system; 101. a distal end; 102. a proximal end;

10. a pericardial puller; 11. a pipe fitting; 111. an outer tube; 112. an inner tube; 113. a window; 12. anchoring and stabbing; 1211. a first anchor thorn; 1212. a second anchor thorn; 121. a receiving cavity; 122. a housing area; 123. a guide slope; 124. cutting edges; 125. an open site; 126. an accumulation zone; 13. a drive handle; 131. a support body; 1311. a helical groove; 1312. mounting grooves; 1313. a partition plate; 132. a screw drive mechanism; 1321. a transmission member; 1322. rotating the handle; 1323. a limiting groove; 1324. a pin shaft; 1325. mounting holes; 134. a sleeve; 1341. a first portion; 1342. a second portion; 1343. flanging; 135. an elastic member; 136. a diameter reducing portion; 137. an operating handle; 138. a rear end plug; 139. a front end plug; 14. a guide member;

20. a pericardial puncture device; 21. a piercing member; 211. a drive section; 212. a piercing section; 213. a sharp portion; 22. a drive structure; 221. a limiting member; 222. a notch; 223. a strip-shaped hole; 23. a guide tube; 231. a channel; 232. a joint;

30. an actuating device; 31. an action component; 32. a fixed tube; 321. a spiral portion; 322. a groove; 33. an operating sleeve; 331. a flange; 34. an operation channel; 341. an inlet; 342. an outlet; 343. a first stage; 344. a second stage; 3441. a first unit region; 3442. a second unit region; 345. a third stage; 3451. a third unit region; 3452. a fourth unit region; 3453. a butt joint port; 35. a constraint structure; 351. a first step; 352. a second step; 353. a third step; 36. expanding the sheath; 361. a limiting part.

Detailed Description

The technical solutions in the embodiments of the present application will be clearly and completely described below with reference to the drawings in the embodiments of the present application, and it is obvious that the described embodiments are only a part of the embodiments of the present application, 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 application.

It will be understood that when an element is referred to as being "connected" to another element, it can be directly connected to the other element or intervening elements may also be present. When a component is referred to as being "disposed on" another component, it can be directly on the other component or intervening components may also be present.

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this application belongs. The terminology used in the description of the present application herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the application. As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items.

In this application, the terms "first", "second", etc. are used for descriptive purposes only and are not to be construed as indicating or implying relative importance or implying any particular order or number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include one or more of that feature. In the description of the present application, "plurality" means at least two, e.g., two, three, etc., unless specifically limited otherwise.

As shown in fig. 1 to 6, the present application provides a pericardial retractor 10, including two tubes 11 movably sleeved, each tube 11 having a distal end and a proximal end, and a tube wall at the distal end of each tube 11 having at least one anchoring thorn 12; when the two pipes 11 move relatively, the anchoring thorns 12 of the pipes 11 are mutually matched to clamp the pericardium.

In this embodiment and the following embodiments, the "distal end 101" refers to the end close to the lesion, i.e., the end far from the operator, and the "proximal end 102" refers to the opposite, unless otherwise specified.

When the far ends of the two pipe fittings 11 move relative to the pericardium, the pericardium enters between the two anchoring thorns 12 adjacent to each other along the circumferential direction of the pipe fittings 11, when the two pipe fittings 11 move relative to each other, the pericardium is clamped through the anchoring thorns 12 of the pipe fittings 11, and when the far ends of the two pipe fittings 11 move away from the pericardium, the pericardium is stably pulled, so that the damage to peripheral tissues such as the myocardium is avoided.

The two pipes 11 move relatively: the movement of any one of the pipe members 11 can be realized only, and the movement of the two pipe members 11 can also be realized together. In this embodiment, the two pipe members 11 are engaged in a manner of rotation and sliding along the axial direction of the pipe members.

The two pipe members 11 are respectively an outer pipe 111 and an inner pipe 112 inserted into the outer pipe 111, and the outer side wall of the inner pipe 112 is attached to or in clearance fit with the inner side wall of the outer pipe 111, wherein the anchoring on the inner pipe 112 is a first anchoring 1211, and the anchoring on the outer pipe 111 is a second anchoring 1212. The interior of inner tube 112 provides space for more lines and provides a structural basis for complex procedures, particularly procedures that require multiple surgical instruments (e.g., puncture knives, puncture needles, endoscopes, etc.) to enter inner tube 112 for operation. The anchoring spike 12 is arranged at the wall of the tube 11 and also prevents the anchoring spike 12 from interfering with the passage of surgical instruments through the inner tube 112.

The shape and the specific structure of the anchor thorn 12 are not strictly limited, and certain mechanical properties can be met, particularly the mechanical property requirement of the anchor thorn 12 on the lifting operation of the pericardium is met. In order to reduce the difficulty of the process of the anchoring spike 12 and the pipe 11 and to increase the structural strength between the anchoring spike 12 and the pipe 11, reference is made to an embodiment in which the anchoring spike 12 and the pipe 11 are integrally disposed.

In this embodiment, the anchoring spike 12 is located on the same circumference as the tubular member 11.

In the flattened state of the tube 11, the tube 11 and the anchoring thorn 12 are in the same plane, ignoring the thickness of the tube 11 and the anchoring thorn 12.

In the present embodiment, the number of the anchor stabs 12 is plural for any one of the pipes 11; along the circumference of the pipe fitting, a receiving cavity 121 which is open at the far end and is used for the pericardium to enter is formed between two adjacent anchoring thorns 12.

The anchoring points of the tubes 11 acting on the pericardium are arranged around the circumference of the tubes 11, and the central area surrounded by the anchoring points is opposite to the cavity part of the inner tube 112, so that the pericardium can be punctured by a puncturing knife or a puncturing needle or other tools.

Functionally, the containing cavity 121 can stir, even hook, and lift the pericardium, and on the change of the specific shape of the containing cavity 121, the containing cavity has various options, even can be in a hook shape, and can be understood from the function. In this embodiment, a receiving area 122 for receiving at least a portion of the pericardium is disposed in the receiving cavity 121, and a side wall of the opening 125 of the receiving cavity 121 is obliquely disposed to form a guide slope 123 to allow the pericardium to enter the receiving area 122 in the receiving cavity 121.

The guide ramps 123 are disposed obliquely to the axis of the pipe elements.

The housing area 122 extends in the axial direction of the pipe, and the length of the housing area 122 in the axial direction of the pipe is larger than the length in the circumferential direction of the pipe. The receiving area 122 can retain the pericardium entering the receiving cavity 121 within the receiving cavity 121 and achieve a certain gathering or stacking to facilitate the clamping of each anchor 12.

In the present embodiment, the housing area 122 and the opening portion 125 of the housing chamber 121 are in staggered communication in the circumferential direction of the pipe. The accommodating area 122 and the open part which are communicated in a staggered mode in the circumferential direction can prevent the pericardium entering the accommodating area 122 from automatically separating out of the accommodating cavity 121, and the constraint capacity of the accommodating cavity 121 on the pericardium is improved.

In the present embodiment, as shown in fig. 4 to 6, the anchor 12 is disposed obliquely with respect to the axis of the pipe member 11; the extending trend of the anchor stabs 12 of the two pipe fittings 11 is in a reverse direction.

The extending direction vectors of the anchor stabs 12 of the two pipe fittings 11 in the circumferential direction of the pipe body are arranged in opposite directions. For example, the anchoring barbs 12 on one of the pipes 11 extend counterclockwise in the circumferential direction of the pipe body, and the anchoring barbs 12 on the other pipe 11 extend clockwise in the circumferential direction of the pipe body.

When the anchoring thorn 12 is arranged obliquely relative to the axis of the pipe 11, the anchoring thorn 12 can generate acting force far away from cardiac muscle to the pericardium acted by the anchoring thorn, so that the pericardium is gathered, and each anchoring thorn 12 is convenient to realize the next operation.

The inner tube 112 is rotated to make the pericardium enter the receiving cavity 121 of the inner tube 112, the pericardium is gathered in the receiving cavity 121 of the inner tube 112, and the pericardium is wound at the distal end of the inner tube 112; the outer tube 111 is then rotated relative to the inner tube 112, and the second anchor 1212 on the outer tube 111 engages the first anchor 1211 on the inner tube 112 to achieve the pericardial clamping.

The ultimate purpose of the anchoring spike 12 is to achieve a lifting of the pericardium and thus to interact with the pericardium, at the specific site of action, and with reference to one embodiment, the distal end of the anchoring spike 12 is provided with a cutting edge 124 capable of puncturing the pericardium.

The cutting edge 124 is used to achieve the puncture of the pericardium by the anchoring spike 12 for lifting. For example, the cutting edge 124 punctures a portion of the pericardium to achieve stable lifting. The cutting edge 124 serves to enhance the interaction between the anchor spike 12 and the pericardium and is not limited to puncturing or puncturing the pericardium. Preferably, the cutting edge 124 is arranged on the inner tube 112, i.e. the first anchoring barbs 1211 on the inner tube 112 are adapted to pierce the fibre layers and the wall layers, and the second anchoring barbs 1212 on the outer tube 111 are adapted to engage the first anchoring barbs 1211 on the inner tube 112 to grip the fibre layers and the wall layers.

In the present embodiment, as shown in fig. 5 and 6, the distal ends of the two tubes 11 have a viewing window 113 for observation by the endoscope.

When the pericardium is wound around the distal end of the inner tube 112, the pericardium covers the viewing window 113, and the endoscope can observe the pericardium through the viewing window 113, so as to determine whether the pericardium is clamped. When each anchor 12 clamps the pericardium, at least part of the structures of the windows 113 on the two pipes 11 are overlapped.

In order to increase the field of view of the endoscope, in the present embodiment, the number of viewing windows 113 in each tube 11 is plural along the circumferential direction of the tube 11.

In this embodiment, the two tubes 11 have an initial state in which the distal end of the inner tube 112 is exposed outside the outer tube 111, and in the initial state, the first anchoring protrusion 1211 of the inner tube 112 is located below the second anchoring protrusion 1212 of the outer tube 111. As shown in fig. 7 to 8, the two tubes 11 have an operating state in which the outer tube 111 is axially pushed to make the second anchor stabs 1212 of the outer tube 111 and the first anchor stabs 1211 of the inner tube 112 cooperate with each other, in the operating state, the first anchor stabs 1211 of the inner tube 112 are located inside the second anchor stabs 1212 of the outer tube 111, and a clamping gap is formed between the first anchor stabs 1211 of the inner tube 112 and the second anchor stabs 1212 of the outer tube 111, and the existence of the clamping gap prevents the two tubes 11 from cutting off the pericardium therebetween in the operating state.

When the two pipes 11 contact the pericardium in the initial state, the pericardium can enter the receiving cavity 121 of the inner pipe 112 conveniently. Meanwhile, when the two pipes 11 contact the pericardium in the initial state, the pericardium is prevented from being clamped between the second anchoring burr 1212 of the outer pipe 111 and the first anchoring burr 1211 of the inner pipe 112 that does not penetrate the fiber layer and the wall layer.

In this embodiment, in the working state, an aggregation region 126 is formed between the second anchoring barb 1212 of the outer tube 111 and the first anchoring barb 1211 of the inner tube 112, and the aggregation region 126 is gradually reduced from the proximal end to the distal end. Wherein the distal end of the gathering region 126 may be open or closed.

In this embodiment, the distal end limit of the second anchoring barb 1212 of the outer tube 111 does not pass beyond the distal end of the first anchoring barb 1211 of the inner tube 112, and the anchoring barb 12 on each tube 11 remains unchanged in the radial position of the tube 11.

The moving path of the second anchor prong 1212 on the outer tube 111 never goes beyond the distal end of the first anchor prong 1211 of the inner tube 112, i.e., the moving path of the second anchor prong 1212 on the outer tube 111 does not affect the tissue outside the distal end of the inner tube 112. When the two pipes 11 are in the switching state, the inner tube 112 remains stationary, and the distal end of the outer tube 111 advances axially and rotates synchronously.

In this embodiment, as shown in fig. 1 to 3 and 9, the pericardial lifter 10 further includes a driving handle 13, and the driving handle 13 includes:

a support 131 connected to the inner tube 112;

and a screw driving mechanism 132 connected to the outer tube 111 and driving the outer tube 111.

The supporting body 131 is mainly used to support and fixedly mount the components such as the inner tube 112, the screw driving mechanism 132, etc., so the shape and specific configuration of the supporting body 131 are not limited strictly, for example, a frame structure or a solid body component can be adopted, and the general principle is that at least enough mechanical strength is provided and the above components are firmly connected. The support 131 itself may be an integral structure or a detachable separate structure, and may be connected by bolts, pins, or the like for easy detachment.

The screw driving mechanism 132 drives the outer tube 111 to rotate and axially move the outer tube 111, and various transmission modes in the prior art can be adopted according to the installation positions and the movement forms of the screw driving mechanism 132 and the outer tube 111, and the movement direction and speed are changed to adapt to the working characteristics of the outer tube 111. The screw drive 132 ensures at least the necessary mechanical strength and a good, precise fit to ensure the outer tube 111 trajectory, speed and response time.

In the present embodiment, the driving handle 13 has an axial direction spatially parallel to or substantially parallel to the axial direction of each pipe. The drive handle 13 is arranged cylindrically or substantially cylindrically, and each tube 11 passes through the geometric center of the drive handle 13.

In a specific arrangement of the screw driving mechanism 132, referring to one embodiment, as shown in fig. 9 to 11, the screw driving mechanism 132 includes:

a transmission member 1321 slidably and rotatably installed at the supporting body 131, the transmission member 1321 being connected with the outer tube 111;

a rotating handle 1322 rotatably installed at an outer circumference of the transmission member 1321 and driving the transmission member 1321;

the pin 1324, the rotating handle 1322, drives the transmission member 1321 through the pin 1324.

The transmission element 1321 is arranged in the supporting body 131, and the supporting body 131 is provided with a spiral groove 1311 which is axially arranged around the driving handle;

the rotating handle 1322 is rotatably installed on the outer periphery of the supporting body 131, and the rotating handle 1322 has a limit groove 1323 extending axially along the driving handle;

one end of the pin 1324 is connected to the transmission member 1321, and the other end passes through the spiral groove 1311 and is disposed in the limiting groove 1323.

Wherein, along the axial direction of the driving handle, the pin 1324 is abutted with two opposite side walls of the spiral groove 1311; the pin 1324 abuts against two opposite side walls of the limiting groove 1323 along the circumferential direction of the driving handle 13. In this embodiment, the outside of the rotating handle 1322 has an anti-slip thread.

The supporting body 131 has a mounting groove 1312 matching with the transmission member 1321, the transmission member 1321 has a mounting hole 1325, the proximal end of the outer tube 111 extends into the mounting hole 1325 and is fixed in the mounting hole 1325 by gluing or the like, and the proximal end of the inner tube 112 passes through the mounting hole 1325 and is fixedly connected with the supporting body 131. The transmission member 1321 is substantially cylindrical, and the transmission member 1321 is substantially attached to the inner wall of the mounting groove 1312.

In this embodiment, drive handle 13 has a reduced diameter portion 136, and rotating knob 1322 is tubular in configuration and fits over reduced diameter portion 136 with its outer surface flush with the outer surface of drive handle 13.

The reduced diameter portion 136 is an annular recess formed in the drive handle 13 in the circumferential direction thereof, and both sides of the annular recess abut against both ends of the rotating knob 1322. To facilitate assembly of the rotating handle 1322 to the reduced diameter portion 136, referring to one embodiment, as shown in fig. 9-11, the drive handle 13 further includes an operating handle 137, the operating handle 137 being mounted to the support body 131 to form one of the side walls of the annular recess and defining the reduced diameter portion 136 with the support body 131. In order to save material of the lever 137, in another embodiment, the lever 137 is hollow.

The operating handle 137 is mounted on the supporting body 131, and referring to one embodiment, the driving handle 13 further includes a rear end plug 138, and the rear end plug 138 is screwed with the supporting body 131 and cooperates with the supporting body 131 to fix the operating handle 137.

Specifically, the operation lever 137 is substantially cylindrical, the operation lever 137 is fitted around a partial structure of the support body 131, and one axial end of the operation lever 137 abuts against the support body 131 and the other axial end abuts against the rear end plug 138.

In order to prevent the operation handle 137 from rotating relative to the support body 131, one of the operation handle 137 and the support body 131 is provided with a rib, and the other is provided with a rotation stopping groove matched with the rib.

In this embodiment, as shown in fig. 9 to 11, the driving handle 13 further includes a sleeve 134 movably connected to the supporting body 131, the sleeve 134 is sleeved outside the outer tube 111 and has a first state of wrapping the anchor 12 and a second state of exposing the anchor 12.

In the initial state of the two pipe elements 11, the sleeve 134 covers the anchoring thorn 12, and the effect of protecting the anchoring thorn 12 is achieved. In the working state of the two tubes 11, the sleeve 134 exposes the anchoring thorn 12, so as to prevent the sleeve 134 from interfering with the anchoring thorn 12, and facilitate the first anchoring thorn 1211 of the inner tube 112 and the second anchoring thorn 1212 of the outer tube 111 to clamp the pericardium.

In this embodiment, the driving handle 13 further includes a front end plug 139 and an elastic member 135, the front end plug 139 is mounted on the supporting body 131 and surrounds a movable slot with the supporting body 131, the proximal end of the sleeve 134 enters the movable slot through the front end plug 139 and has a flange matched with the front end plug 139, and the elastic member 135 is pressed between the transmission member 1321 and the sleeve 134 to drive the sleeve 134 to maintain the first state.

The distal end of the support 131 is open and a front plug 139 is secured (e.g., by threaded engagement) to the open end of the support 131 to define a movable channel. The movable groove is separated from the installation groove 1312 by a partition 1313, and one end of the elastic member 135 abuts against the partition 1313 and the other end abuts against the sleeve 134. Front plug 139 has a through hole through which sleeve 134 passes. When the sleeve 134 is in the first state, the outward flange 1343 is attached to one side of the movable slot of the front end plug 139.

Sleeve 134 includes a first portion 1341 at the distal end and a second portion 1342 at the proximal end, wherein first portion 1341 substantially abuts outer tube 111, and second portion 1342 has a certain installation gap with outer tube 111 for accommodating elastic member 135, and second portion 1342 can slide along the through hole of front end plug 139. In this embodiment, the elastic member 135 is a spring.

Of course, in other embodiments, the driving handle 13 further includes a partition 1313, the partition 1313 presses against the inner wall of the movable slot, and the elastic member 135 presses between the partition 1313 and the sleeve 134 to separate the elastic member 135 from the transmission member 1321.

Based on the pericardial lifter 10 in each of the above embodiments, as shown in fig. 21, the present application also provides an operation method of the pericardial lifter 10, which may be performed in vivo on the pericardium or in vitro, for example, on a simulation subject, and the pericardium is taken as an example for convenience of description below.

The operation method of the embodiment comprises the following steps:

s100, the first tubular member is advanced along a predetermined path (e.g., an interventional path, if desired, under the guidance of other devices) such that the first anchor 1211 at the distal end of the first tubular member is proximal to the target area.

S200, rotating the first pipe fitting to enable the first anchor 1211 to be in place, wherein the first anchor 1211 acts on a target area in the rotating process to achieve a pre-anchoring effect.

S300, pushing a second pipe fitting along the axial direction of the first pipe fitting to enable a second anchor 1212 at the far end of the second pipe fitting to approach a target area; in order to avoid interference with the pre-anchoring of the first anchor 1211, the second anchor 1212 is always situated on the proximal side of the first anchor 1211 before this step, in which the second anchor 1212 is moved distally, i.e. gradually closer to the first anchor 1211, preferably without the second anchor 1212 ever passing over the first anchor 1211 during the entire process.

S400, rotating the second pipe fitting to enable the second anchor stabs 1212 to be in place, namely, the second anchor stabs 1211 and the first anchor stabs are matched with each other to form a clamping posture, when the second pipe fitting is rotated, the direction of the first pipe fitting is opposite to the direction of the first pipe fitting rotated in the step S200, the clamping posture is more convenient to form, the first anchor stabs 1211 and the second anchor stabs 1212 which are matched with each other are preferably not staggered with each other at the moment, shearing is avoided, and relative to the pre-anchoring before, slipping between each anchor stabs and a target area can be further avoided under the clamping posture.

S500, maintaining the clamping posture and synchronously lifting the two pipes 11 to a desired amplitude. The target region can be pulled when the two tubes 11 are pulled up, and the following operation is performed by taking puncture as an example, and a puncture biopsy can be performed on the pulled pericardium portion by using the puncture.

Subsequently, the operating method of the pericardial lifter 10 may further include:

s600, relatively rotating the two pipe fittings to release the clamping posture of the anchoring stabs on the two pipe fittings, namely releasing the clamped pericardium.

S700, retracting the two pipe fittings along the preset path to complete the recovery of the two pipe fittings, wherein the retracting of the two pipe fittings can be operated synchronously or at intervals.

In order to guide the movement tendency of the pericardial retractor in use and reduce the difficulty of operation, as shown in fig. 1 to 2, an embodiment of the present application further provides a pericardial retractor device including the pericardial retractor 10 and the actuating assembly 3 of the above embodiments, and as shown in fig. 12 to 14, the actuating assembly 31 includes:

a fixed tube 32 having opposite distal and proximal ends;

an operation sleeve 33 connected with the proximal end of the fixed tube 32, wherein an operation channel 34 is arranged on the side wall of the operation sleeve 33, and the operation channel 34 is used for receiving and guiding the pericardial retractor 10;

and a constraint structure 35 arranged at a predetermined position of the operation channel 34 for keeping the pericardial lifter 10 at the current position.

The fixing tube 32 can be anchored to tissue (for example, extrathoracic skin and muscle), the fixing tube 32 fixes the whole actuating unit 31, the pericardial retractor 10 passes through the operating sheath 33 and the fixing tube 32 to reach the pericardial position, when the pericardial retractor 10 performs the actions of puncturing the pericardium and lifting the pericardium, the moving track of the pericardial retractor 10 is adjusted through the operating channel 34 on the operating sheath 33, so that the operation on the pericardium can be stably realized, and the damage to the surrounding tissue such as the myocardium can be avoided.

The constraint structure 35 can realize that the position between the pericardial stretcher 10 and the operation sleeve 33 is relatively fixed, and an operator can also adjust the hand posture, so that the hand operation difficulty of the operator is reduced, and meanwhile, the pericardial stretcher 10 and the operation sleeve 33 can be prevented from being fixed by the extra hand required by the operator.

When the actuating assembly 31 is engaged with the pericardial retractor 10, the distal ends of the two tubes 11 are inserted into the fixing tube 32, the anchoring barbs 12 on the two tubes 11 can be exposed out of the distal end of the fixing tube 32, and the two tubes 11 can also be hidden in the distal end of the fixing tube 32. Drive handle 13 is partially configured to be disposed within operating sleeve 33 and to guide drive handle 13 through operating sleeve 33.

The fixed tube 32 and the operating sleeve 33 have an axis in space, and the axis of the fixed tube 32 and the axis of the operating sleeve 33 are arranged substantially in parallel. In the present embodiment, the axis of the fixed tube 32 coincides with the axis of the operating sleeve 33.

The operating sleeve 33 is substantially cylindrical, one axial end of the operating sleeve 33 is a closed end, the other axial end of the operating sleeve 33 is an open end, the open end of the operating sleeve 33 is used for the pericardial retractor 10 to enter, the closed end of the operating sleeve 33 is connected with the proximal end of the fixed tube 32, and the joint of the operating sleeve 33 and the fixed tube 32 is communicated.

The constraint structure 35 is primarily intended to define the relative position between the pericardial lifter 10 and the actuating sheath, and thus the shape and specific configuration of the constraint structure 35 are not critical. The constraint structure 35 may be an additional component or a part of the operating sheath 33, such as a bolt or a slot, and the general principle is that at least sufficient mechanical strength is required to ensure the firmness of the fixation between the pericardial lifter 10 and the operating sheath.

In order to reduce the difficulty of machining the constraint structure 35 and to increase the structural strength between the constraint structure 35 and the operating sleeve 33, reference is made to one embodiment in which the constraint structure 35 is formed by a side wall of the operating channel 34.

In the specific configuration of the operation channel 34, referring to one embodiment, as shown in fig. 12 to 14, both ends of the operation channel 34 are provided with an inlet 341 and an outlet 342 at the proximal end of the operation sleeve 33;

the operation passage 34 includes:

a first section 343 extending in at least a direction vector along the axial direction of the operating sleeve 33, the proximal end of the first section 343 communicating with the inlet 341;

a second section 344 extending at least along the circumferential direction of the operating sleeve 33 and having a first end and a second end opposite to each other, the first end of the second section 344 communicating with the distal end of the first section 343;

the third segment 345 extends at least along the axial direction of the operating sleeve 33, and the distal end of the third segment 345 is connected to the second end of the second segment 344, and the proximal end is connected to the outlet 342.

The inlet 341 and outlet 342 are configured to guide the guide 14 of the pericardial puller 10 into/out of the operating channel 34.

In the specific arrangement of the operating channel 34, the first section 343 extends in the axial direction of the operating sleeve 33, the second section 344 extends in the circumferential direction of the operating sleeve 33, and the third section 345 extends in the axial direction of the operating sleeve 33.

When the operating sleeve 33 and the pericardial lifting device 10 are used in cooperation, the operating sleeve specifically includes:

first stage, the guide member 14 of the pericardial retractor 10 enters the first section 343 from the inlet 341 and moves along the first section 343, and when reaching the distal end of the first section 343, the anchoring spur 12 is exposed out of the distal end of the fixing tube 32, and the first anchoring spur 1211 on the inner tube 112 contacts the pericardium;

in the second stage, the guide member 14 of the pericardial puller 10 enters the second section 344 from the first section 343, and then the guide member 14 of the pericardial puller 10 moves along the second section 344, during the movement, the first anchoring spur 1211 on the inner tube 112 firstly penetrates into the fiber layer and the wall layer, and along with the rotation of the inner tube 112, the first anchoring spur 1211 drives the pericardium to be wound outside the inner tube 112 through the fiber layer and the wall layer;

in the third stage, when the guide member 14 of the pericardium puller 10 enters the second end of the second section 344, the rotating handle 1322 rotates in the forward direction and drives the pin 1324 to rotate along the spiral groove 1311, the pin 1324 drives the outer tube 111 to rotate through the transmission member 1321, and the outer tube 111 rotates in the forward direction and also advances in the axial direction due to the guiding of the spiral groove 1311 until the second anchor 1212 of the outer tube 111 and the first anchor 1211 on the inner tube 112 cooperate to clamp the pericardium;

in the fourth stage, the guide member 14 of the pericardial puller 10 enters the third section 345 from the second end of the second section 344, and then the guide member 14 of the pericardial puller 10 moves along the third unit area 3451 of the third section 345, and the outer tube 111 and the inner tube 112 are synchronously retracted proximally, so that the distal end of the pericardial puller 10 starts to pull the pericardium through the second anchoring spur 1212 of the outer tube 111 and the first anchoring spur 1211 on the inner tube 112;

the extent of pulling is also limited by the operating sheath 33, and as pulling proceeds, the pericardium is punctured after the guide member 14 reaches the proximal end of the third unit area 3451.

In the fifth stage, after the guide member 14 of the pericardium puller 10 enters the proximal end of the third unit area 3451, the rotating handle 1322 reversely rotates and drives the pin 1324 to rotate along the spiral groove 1311, and the pin 1324 drives the outer tube 111 to reversely rotate through the transmission member 1321 and simultaneously axially recedes until the second anchoring spur 1212 of the outer tube 111 and the first anchoring spur 1211 on the inner tube 112 release from clamping the pericardium;

in the sixth stage, the guide 14 of the pericardial puller 10 enters the fourth unit area 3452 of the third section 345 from the third unit area 3451 of the third section 345, then the guide 14 of the pericardial puller 10 moves along the fourth unit area 3452 of the third section 345, and finally, the guide 14 of the pericardial puller 10 exits the operating sleeve 33 from the outlet 342, and the recovery is completed.

The first section 343 of the working channel 34 can define the length of the anchor spur 12 on the tube 11 extending out of the fixation tube 32, the second section 344 of the working channel 34 can define the number of turns of pericardium wrapped around the tube 11, and the third cell region 3451 of the third section 345 of the working channel 34 can define the distance that the pericardium is pulled by the pericardial puller 10.

In the present embodiment, as shown in fig. 13, in the circumferential direction of the operating sleeve 33, the second section 344 includes a first unit area 3441 and a second unit area 3442, the first unit area 3441 communicates with the first section 343, and the second unit area 3442 communicates with the third section 345;

the first unit area 3441 is connected to the second unit area 3442 via a first step 351.

The pericardial lifter 10 enters the first unit area 3441 from the first section 343, and the first unit area 3441 is a preparation position before the pericardial lifter 10 rotates, and at this time, the operator can release the pericardial lifter 10 and adjust the hand posture. In the present embodiment, the constraining structure 35 includes a first step 351.

In the present embodiment, as shown in fig. 14, the junction of the second section 344 and the third section 345 communicates through a pair of interfaces 3453;

a portion of the second section 344 is configured to pass over the interface 3453 and is provided with a second step 352 that maintains the position of the guide 14 of the pericardial lifter 10.

When the pericardial lifter 10 is rotated to the second end of the second section 344, the second step 352 prevents the inner tube 112 from axially rotating relative to the operating sheath 33 by keeping the guide 14 of the pericardial lifter 10 at the current position, at this time, the first anchor 1211 of the inner tube 112 is located outside the fixing tube 32, the outer tube 111 rotates relative to the inner tube 112 and axially moves along the inner tube 112 to put the two tubes 11 into the working state, and after the two tubes 11 are put into the working state (the pericardium is clamped between the second anchor 1212 of the outer tube 111 and the first anchor 1211 of the inner tube 112), the pericardium can be lifted to increase the separation distance between the fiber layer, the wall layer and the epicardium. In this embodiment, the constraining structure 35 includes a second step 352.

In the present embodiment, as shown in fig. 14, the third segment 345 is formed by turning the third section 3451 and the fourth section 3452 along the axial direction of the operating sleeve 33, and a third step 353 is disposed at the turning point.

The third step 353 can also keep the position of the pericardial retractor 10 at the current position, and at this time, the outer tube 111 rotates relative to the inner tube 112 and moves axially along the inner tube 112 to bring the two tube members 11 into the initial state, and after the two tube members 11 are brought into the initial state, the inner tube 112 can be rotated axially to separate the first anchoring spur 1211 on the inner tube 112 from the pericardium. In this embodiment, the confinement structure 35 includes a third step 353.

In one embodiment, the pericardial puller 10 is configured to mate with the working channel 34. referring to fig. 1 and 2, the pericardial puller 10 has a guide 14 that mates with the working channel 34.

There is no strict limitation on the shape and configuration of the guide 14. For example: to accommodate the operating channel 34, the guide 14 is a slider corresponding to the operating channel 34.

In this embodiment, the guide 14 is disposed outside of the pericardial lifter 10. For example, the guide 14 is located outside the support body 131.

In this embodiment, the actuating assembly 31 further includes a force applying member acting between the operating sheath 33 and the pericardial lifter 10, and the force applying member provides a force to the pericardial lifter 10 along the axial direction of the operating sheath 33 and separated from the operating sheath 33.

Under the action of the force application member, the guide 14 abuts against the side wall on the proximal end side of the operation passage 34 when no external force acts between the bag lifter 10 and the action assembly 31.

The force application member may be part of the operating sheath 33 or the pericardial lifter 10, but may be a separate member. The force application component is mainly used for driving the pericardial lifter 10 to move axially along the operating sleeve 33, and a cylinder or an elastic component 135 can be selected in the prior art for realizing the basic function. In this embodiment, the force application component is the elastic member 135 in the above embodiments.

In the present embodiment, as shown in fig. 12, the outer side wall of the fixed tube 32 is provided with a spiral portion 321.

The spiral portion 321 can increase the frictional force between the fixing tube 32 and the human tissue to enable the fixing tube 32 to be fixed to the human tissue. The screw portion 321 is an external thread that extends spirally in the axial direction of the fixed pipe 32.

In this embodiment, as shown in fig. 12, the tube wall at the distal end of the fixing tube 32 has a plurality of grooves 322 with a distal end open, and the plurality of grooves 322 are sequentially arranged at intervals in the circumferential direction of the tube body.

The groove 322 is arranged to receive the pericardium.

As shown in fig. 15 to 16, the present application further provides an actuating device 30, which includes the actuating assembly 31 according to the above technical solution and an expanding sheath 36 movably disposed in the fixed tube 32, wherein a distal end of the expanding sheath 36 is exposed at a distal end of the fixed tube 32, and a proximal end thereof has a limit portion 361 abutting against a proximal end of the operating sheath 33.

The dilating sheath 36 is capable of closing the distal opening of the fixation tube 32, and the fixation tube 32 is inserted into the body tissue along with the distal end of the dilating sheath 36 to enable the fixation tube 32 to establish a passage at the thoracic cavity. Wherein the proximal end of the dilating sheath 36 is radially dilated to form the stop 361.

In this embodiment, the distal end of the dilating sheath 36 is arcuately tapered.

In this embodiment, the proximal end of the operating sleeve 33 is folded outwardly to form a flange 331. The flange 331 can increase the effect of the deformation resistance of the operating sleeve 33.

As shown in fig. 1 to 2 and 17, the present application further provides a pericardial access system 100, which includes a pericardial retractor device and a pericardial puncture device 20 matched with the pericardial retractor device, where the pericardial retractor device adopts the pericardial retractor device in the above technical solution, the pericardial puncture device 20 includes a puncture element 21, the puncture element 21 is movably installed in the innermost pipe 11 (inner pipe 112) and has a puncture state moving towards the distal end, and the puncture element 21 in the puncture state is used for puncturing the pericardium interacting with each anchor.

In one embodiment of the puncturing element 21, as shown in fig. 17 to 19, with reference to one embodiment, the puncturing element 21 comprises a driving section 211 extending from the distal end to the proximal end of the inner tube 112 and a puncturing section 212 disposed at the distal end of the driving section 211, wherein the driving section 211 is movably engaged with the inner tube 112 and is used for driving the puncturing section 212 into the puncturing state.

Different designs of the piercing member 21 can meet different treatment requirements. In this embodiment, the distal ends of piercing section 212 converge to form a sharp 213 for cutting the pericardium, as shown in fig. 16. The sharp part 213 can realize the puncture of the pericardium, and meanwhile, the puncture section 212 and the driving section 211 can be internally provided with communicated channels to arrange other pipelines, so that the subsequent operation can be conveniently carried out after the puncture.

The driving section 211 is movably arranged in the inner tube 112, a corresponding driving structure 22 can be arranged, the driving section 211 is driven by the driving structure 22, and after the pericardium is lifted and pulled by the pipe fitting 11, the pericardium can be stably punctured by the puncturing section 212, so that a further treatment process can be carried out.

The driving structure 22 mainly drives the driving section 211 to make a linear reciprocating motion along the axial direction of the pipe fitting, and in order to realize the basic function, a motor, a cylinder, a hydraulic cylinder or even a manual driving part can be selected in the prior art, and when the motion mode directly output by the driving structure 22 is inconsistent with the motion mode of the driving section 211, the motion mode can be rotated and transmitted by using a proper transmission part.

In the implementation manner of the driving structure 22, referring to fig. 17, in an embodiment, the driving structure 22 includes a limiting member 221, and the limiting member 221 is movably connected to the pericardial retractor 10 or the pericardial puncture device 20 and is fixedly connected to the driving section 211, so as to be able to control the depth of the pericardium puncture by the puncture piece 21.

The limiting member 221 is sleeved on the outer side of the pericardial retractor 10 and has a notch 222 avoiding the rotating handle 1322. The limiting member 221 is substantially cylindrical, one axial end of the limiting member 221 is a closed end, the other axial end of the limiting member 221 is an open end, the closed end is provided with a hole site, the outer side wall of the puncturing member 21 is fixed in the hole site, the outer side of the limiting member 221 is provided with a joint, and an external pipeline is communicated with the inside of the puncturing member 21 through the joint.

After the operating sheath 33 and the pericardial lifter 10 are used in a fourth stage, that is, after the guide 14 of the pericardial lifter 10 reaches the proximal end of the third unit area 3451, the limiting member 221 is sleeved outside the pericardial lifter 10 from the open side, and the limiting member 221 is pushed axially, so that the limiting member 221 drives the puncturing member 21 to move along the inside of the fixing tube 32 to puncture. In order to limit the penetration section 212 to the extreme position, the outer periphery of the open side abuts against the flange 331 on the operating sleeve 33, providing a safety shield.

Referring to one embodiment, as shown in fig. 17 to 20, the pericardial puncture device 20 further includes a guide tube 23 having a plurality of channels 231, and a plurality of connectors 232 mounted at a proximal end of the guide tube 23 and respectively communicated with the corresponding channels 231, wherein the puncture element 21 is movably inserted into one of the channels 231, and the other channels 231 can be inserted into other devices (such as an endoscope, etc.).

The front end plug 139 is provided with a through hole for the guide tube 23 to pass through, and the joint of each joint 232 and the guide tube 23 is provided with a limit boss matched with the front end plug 139. The extending path of one of the joints 232 is consistent with the axis of the guide pipe 23, the extending paths of the other joints 232 are arranged in an arc shape, and the side wall of the limiting member 221 is provided with a strip-shaped hole 223 matched with the joint 232 of which the extending path is in the arc shape.

The technical features of the above embodiments can be arbitrarily combined, and for the sake of brevity, all possible combinations of the technical features in the above embodiments are not described, but should be considered as the scope of the present specification as long as there is no contradiction between the combinations of the technical features. When technical features in different embodiments are represented in the same drawing, it can be seen that the drawing also discloses a combination of the embodiments concerned.

The above examples only express several embodiments of the present application, and the description thereof is more specific and detailed, but not construed as limiting the claims. It should be noted that, for a person skilled in the art, several variations and modifications can be made without departing from the concept of the present application, which falls within the scope of protection of the present application.

Claims (23)

1. The pericardial retractor is characterized by comprising two pipe fittings which are movably sleeved, wherein each pipe fitting is provided with a relative far end and a relative near end, and the pipe wall of the far end of each pipe fitting is provided with at least one anchoring thorn;

when the two pipe fittings move relatively, the anchoring thorn of each pipe fitting is mutually matched to clamp the pericardium.

2. The pericardial puller of claim 1, wherein for any one of the tubes:

the number of the anchor stabs is multiple;

and a containing cavity with a far end arranged in an open manner and used for the pericardium to enter is formed between every two adjacent anchor stabs along the circumferential direction of the pipe fitting.

3. The pericardial lifter according to claim 2, wherein a receiving area for receiving at least a portion of the pericardium is disposed in the receiving cavity, and the side wall of the open portion of the receiving cavity is inclined to form a guiding slope for the pericardium to enter the receiving area in the receiving cavity.

4. The pericardial puller according to claim 1, wherein the anchor stings are on the same circumference as the tube.

5. The pericardial puller of claim 1, wherein the barb is disposed obliquely to an axis of the tube;

the extending trend of the anchor stabs of the two pipe fittings is reverse.

6. The pericardial lifter according to claim 1, wherein the fitting manner between the two tubes is a rotation fit and a sliding fit along the axial direction of the tubes.

7. The pericardial puller of claim 1, wherein the distal ends of both tubes have viewing windows for viewing by an endoscope.

8. The pericardial lifter according to any one of claims 5-7, wherein the two tubes are an outer tube and an inner tube passing through the outer tube;

the two pipe fittings have an initial state that the distal end of the inner pipe is exposed outside the outer pipe and a working state that the outer pipe is axially pushed so that the anchoring thorn of the outer pipe and the anchoring thorn of the inner pipe are matched with each other.

9. The pericardial lifter of claim 8, wherein in an operative state, a gathering area is formed between the anchoring barbs of the outer tube and the anchoring barbs of the inner tube.

10. The pericardial lifter of claim 8, wherein the outer tube has an anchoring distal end limit that does not pass over the anchoring distal end of the inner tube, and the anchoring on each tube remains unchanged in tube radial attitude.

11. The pericardial puller of claim 8, further comprising a drive handle comprising:

a support body connected to the inner tube;

and the screw driving mechanism is connected with the outer pipe and used for driving the outer pipe.

12. The pericardial puller of claim 11, wherein the screw drive mechanism includes:

the transmission piece is slidably and rotatably arranged on the supporting body and is connected with the outer pipe;

and the rotating handle is rotatably arranged on the periphery of the transmission piece and used for driving the transmission piece.

13. The pericardial puller of claim 12, wherein the screw drive mechanism further includes a pin through which the rotating handle drives the transmission.

14. The pericardial puller of claim 13, wherein the drive handle has an axial direction in space;

the transmission piece is arranged in the support body, and the support body is provided with a spiral groove which is axially arranged around the driving handle;

the rotary handle is rotatably arranged on the periphery of the support body and is provided with a limiting groove axially extending along the driving handle;

one end of the pin shaft is connected with the transmission part, and the other end of the pin shaft penetrates through the spiral groove and is arranged in the limiting groove.

15. The pericardial puller of claim 12, wherein the actuating handle further comprises a sleeve movably coupled to the support body, the sleeve being disposed outside the outer tube and having a first state in which the anchor is wrapped and a second state in which the anchor is exposed.

16. The pericardial lifter according to claim 15, wherein the driving handle further comprises a front end plug and an elastic member, the front end plug is mounted on the supporting body and forms a movable groove with the supporting body, the proximal end of the sleeve passes through the front end plug and enters the movable groove, the sleeve has a flanging matched with the front end plug, and the elastic member is pressed between the driving member and the sleeve to drive the sleeve to maintain the first state;

or, the driving handle further comprises a front end plug, an elastic part and a partition plate, the front end plug is installed on the support body and forms a movable groove with the support body in a surrounding mode, the near end of the sleeve penetrates through the front end plug to enter the movable groove and is provided with an outward flange matched with the front end plug, the partition plate is pressed against the inner wall of the movable groove, and the elastic part is pressed between the partition plate and the sleeve to drive the sleeve to keep the first state.

17. A pericardial puller device, comprising:

using the pericardial puller of any of claims 1-16;

an action component to receive and guide the pericardial lifter.

18. A pericardial access system, comprising:

using the pericardial lifter device of claim 17;

a pericardial puncture outfit matched with the pericardial lifting appliance device.

19. The method of operating the pericardial lifter of any of claims 1-16, comprising:

s100, pushing the first pipe fitting along a preset path to enable the anchor thorn at the far end of the first pipe fitting to approach a target area;

s200, rotating the first pipe fitting to enable the anchor thorn at the far end of the first pipe fitting to be in place;

s300, pushing a second pipe fitting along the axial direction of the first pipe fitting to enable the anchoring thorn at the far end of the second pipe fitting to be close to a target area;

s400, rotating the second pipe fitting to enable the anchor stabs at the far end of the second pipe fitting to be in place, wherein the anchor stabs in place on the pipe fittings are mutually matched to form a clamping posture;

and S500, synchronously pulling the two pipes to a desired amplitude.

20. The method of operating the pericardial puller of claim 19, further comprising:

s600, relatively rotating the two pipe fittings to release the clamping postures of the anchor stabs on the two pipe fittings;

and S700, retracting the two pipes along the preset path.

21. The method of operating the pericardial lifter of claim 19, wherein in step S100, while a first tube is pushed along a preset path, the second tube moves in synchronization with the first tube, and the barb of the second tube is on a proximal side of the barb of the first tube.

22. The method of operating a pericardial lifter according to claim 19, wherein step S300 is performed simultaneously with step S400.

23. The method of operating a pericardial lifter according to claim 19, wherein in step S400, the anchoring barbs of the tubes are not staggered when they are engaged with each other in a gripping position.

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