CN115568808A

CN115568808A - Dispersion distribution type percutaneous nephroscope

Info

Publication number: CN115568808A
Application number: CN202211093437.5A
Authority: CN
Inventors: 程跃; 胡嘉盛; 方立; 刘冠琳
Original assignee: Ningbo First Hospital
Current assignee: Ningbo First Hospital
Priority date: 2022-09-08
Filing date: 2022-09-08
Publication date: 2023-01-06

Abstract

A discretely distributed percutaneous nephroscope is disclosed that is adapted to pass through the skin of a patient at a predetermined location to reach the kidney for treatment of kidney stones. The dispersive distribution type percutaneous nephroscope comprises: the endoscope comprises an introducer sheath with an introducer channel and an endoscope body arranged in the introducer channel. The endoscope body comprises a mirror body with a front end wall and an image acquisition device arranged on the mirror body. The mirror main body comprises a main pipe body and a discharge channel arranged in the main pipe body, and a discharge port communicated with the discharge channel is arranged in the middle area of the front end wall. The decentralized distributed percutaneous nephroscope relatively increases the space for discharging crushed stones by adjusting the spatial distribution position and structural characteristics of a passage for discharging stones to avoid blockage of crushed stones as much as possible.

Description

Dispersion distribution type percutaneous nephroscope

Technical Field

The application relates to the field of medical equipment, in particular to a dispersive distributed percutaneous nephroscope.

Background

Urinary tract stone diseases (e.g., kidney stones, ureteral stones) are a common urinary system disease. The prevalence rate and the recurrence rate of urinary calculus are both high and tend to rise year by year. In addition, urinary calculus may cause complications such as urinary tract infection, urinary tract infarction, renal failure, etc., and will seriously affect the health of people.

Percutaneous nephrolithotomy is one of the treatment methods for urinary calculus. Percutaneous nephrolithotomy is a minimally invasive procedure in which a lithotomy channel is first established between the skin and the kidney collecting system through a surgical incision (around 0.5 cm) in the skin of a patient, then a percutaneous nephroscope is placed and lithotripsy is performed by a lithotripsy optical fiber (e.g., a pneumatic ballistic lithotripter, a holmium laser, an ultrasonic lithotripper), and then the crushed stones are discharged from the body.

However, the conventional percutaneous nephroscope still has disadvantages in application, for example, crushed stones are easily blocked during the process of being discharged, and are difficult to be discharged out of the body efficiently. Specifically, a conventional percutaneous nephroscope includes a scope sheath and an endoscope disposed within the scope sheath with a gap therebetween. During the operation, the crushed stones are discharged out of the body through the gap between the sheath and the endoscope, and the crushed stone-discharging efficiency and the discharging rate are both limited by the radial size of the gap between the sheath and the endoscope.

It will be appreciated that the sheath has limited radial dimensions in order to more easily pass through a surgical incision in the patient's skin and reach the renal congregation system, and that the endoscope has preset radial dimensions due to the need to make room for some surgical instruments (e.g., lithotripsy fibers, guide wires) or other necessary structures. Therefore, constrained by the radial dimensions of the sheath and endoscope, the gap between the sheath and endoscope is quite limited, and crushed stones tend to clog this gap during expulsion, not only affecting stone removal efficiency, but also potentially leading to excessive intra-renal pressure.

Accordingly, there is a need for an optimized stone removal solution for percutaneous nephroscopy to improve stone removal efficiency.

Disclosure of Invention

An advantage of the present application is to provide a discretely distributed percutaneous nephroscope, in which an exhaust passage for discharging a stone is provided in an inner scope body thereof, and a space for discharging a crushed stone is relatively increased by a spatial arrangement of exhaust ports communicating with the exhaust passage and a structural feature to avoid clogging of the crushed stone as much as possible.

Another advantage of the present application is to provide a discretely distributed percutaneous nephroscope in which stone discharge efficiency is relatively improved since the discretely distributed percutaneous nephroscope relatively increases a space for discharging crushed stones.

It is yet another advantage of the present application to provide a decentralized distributed percutaneous nephroscope that reduces the risk of elevated pressure within the renal pelvis by avoiding, as much as possible, clogging of the discharge ports with crushed stones.

It is yet another advantage of the present application to provide a discretely distributed percutaneous nephroscope wherein the cross-section of the discharge channel and the orthographic projection of the discharge port of the discretely distributed percutaneous nephroscope are circular in shape to facilitate discharge of crushed stones.

To achieve at least one of the above advantages, according to one aspect of the present application, there is provided a decentralized distributed percutaneous nephroscope adapted to reach a kidney through skin of a preset location of a patient for treating a kidney stone, the decentralized distributed percutaneous nephroscope comprising:

an introducer sheath having an introducer channel; and

the inner lens body is arranged in the guide channel;

wherein, the endoscope body includes:

the endoscope comprises a main tube body and an exhaust channel arranged in the main tube body, wherein the front end wall comprises a middle area and an edge area surrounding the middle area, and an exhaust port communicated with the exhaust channel is arranged in the middle area of the front end wall; and

an image capture device disposed on the mirror body, the image capture device being mounted to an edge region of the front end wall, and the discharge opening being within a field of view of the image capture device.

In the dispersive distribution type percutaneous nephroscope according to the application, the scope main body is movably arranged in the guide channel, and the outer diameter of the scope main body is less than or equal to the inner diameter of the guide channel.

In the dispersive distribution-type percutaneous nephroscope according to the present application, the guide channel includes a front guide opening at a front end of the guide sheath, the mirror body further has an outer peripheral wall, and a shape of a cross section of the outer peripheral wall of the mirror body coincides with a shape of a cross section of an inner peripheral wall of the front guide opening.

In the dispersive distribution type percutaneous nephroscope according to the present application, the guide channel further includes a rear guide opening located at a rear end of the guide sheath, an inner peripheral wall of the rear guide opening has an internal thread, and an outer peripheral wall of the mirror body has an external thread corresponding to the internal thread.

In the dispersive distribution-type percutaneous nephroscope according to the present application, a shape of an orthographic projection of the discharge port in an axial direction set by the mirror main body is a circle.

In the dispersive distribution-type percutaneous nephroscope according to the present application, a middle region of the front end wall is perpendicular to a central axis of the scope body.

In the decentralized percutaneous nephroscope according to the present application, the central region of the front end wall extends obliquely forward in a preset extension direction from a first side thereof adjacent to the image capture device to a second side opposite to the first side.

In the dispersive distributed percutaneous nephroscope according to the present application, the middle region includes a steep region extending obliquely forward from a first side thereof adjacent to the image pickup device and a gentle region extending forward from the steep region, and at least a part of the discharge port is located in the steep region.

In the scatter profile type percutaneous nephroscope according to the present application, an angle between the preset extending direction and an axial direction set by the scope body decreases first and then increases from the first side to the second side of the central region.

In the dispersion distribution type percutaneous nephroscope according to the present application, the mirror body further includes a first working channel communicating with the discharge port, the discharge channel communicating between the discharge port and the first working channel.

In the decentralized distributed percutaneous nephroscope according to the present application, the scope body further includes a first working channel disposed in the main tube body, and the front end wall is provided with a first working opening communicated with the first working channel.

In the decentralized distributed percutaneous nephroscope according to the present application, the endoscope body further comprises at least one working component telescopically arranged in the first working channel, and the head of the working component is adapted to extend out of the discharge port, so that the head of the working component is within the field of view of the image acquisition device when extending out of the discharge port.

In the decentralized distributed percutaneous nephroscope according to the present application, the endoscope body further comprises at least one working component telescopically arranged in the first working channel, the head of the working component is adapted to extend out from the first working port, and the head of the working component is within the field of view of the image acquisition device when extending out of the first working port.

In the dispersive distribution type percutaneous nephroscope according to the application, the scope main body further comprises an injection channel arranged on the main tube body, and the scope main body is provided with an injection port communicated with the injection channel.

In the dispersive distribution-type percutaneous nephroscope according to the present application, the injection port is provided at the edge region.

In the dispersion distribution type percutaneous nephroscope according to the present application, the scope body further has a peripheral wall, and the injection port is provided in the peripheral wall.

Further objects and advantages of the present application will become apparent from an understanding of the ensuing description and drawings.

These and other objects, features and advantages of the present application will become more fully apparent from the following detailed description, the accompanying drawings and the claims.

Drawings

The above and other objects, features and advantages of the present application will become more apparent by describing in more detail embodiments of the present application with reference to the attached drawings. The accompanying drawings are included to provide a further understanding of the embodiments of the application and are incorporated in and constitute a part of this specification, illustrate embodiments of the application and together with the description serve to explain the principles of the application. In the drawings, like reference numbers generally represent like parts or steps.

FIG. 1 illustrates a schematic view of a decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 2 illustrates an exploded schematic view of a decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 3A illustrates a partial schematic view of an inner lens body of a decentralized distributed percutaneous nephroscope according to an embodiment of the application.

Fig. 3B illustrates a schematic orthographic view of an endoscope body of a decentralized percutaneous nephroscope according to an embodiment of the application.

FIG. 4 illustrates a partial schematic view of a variant implementation of the endoscope body of the decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 5 illustrates a partial schematic view of another variant implementation of the endoscopic body of a decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 6A illustrates one of the schematic working processes of the decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 6B illustrates a second schematic operation of the decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Fig. 6C illustrates a third schematic process diagram of the operation of the decentralized distributed percutaneous nephroscope according to an embodiment of the present application.

Detailed Description

Hereinafter, example embodiments according to the present application will be described in detail with reference to the accompanying drawings. It should be understood that the described embodiments are only some embodiments of the present application and not all embodiments of the present application, and that the present application is not limited by the example embodiments described herein.

Summary of the application

As described above, percutaneous nephrolithotomy is one of the treatments for urinary tract calculus. However, the conventional percutaneous nephroscope still has disadvantages in application, for example, the crushed stones are easy to be blocked during the discharging process and difficult to be discharged out of the body efficiently. Specifically, a conventional percutaneous nephroscope includes a scope sheath and an endoscope disposed within the scope sheath with a gap therebetween. During the operation, the crushed stones are discharged out of the body through the gap between the sheath and the endoscope, and the crushed stone-discharging efficiency and the discharging rate are both limited by the radial size of the gap between the sheath and the endoscope. Constrained by the radial dimensions of the sheath and the endoscope, the gap between the sheath and the endoscope is quite limited, and crushed stones can easily block the gap during the discharging process, which not only affects the stone discharging efficiency, but also may cause the pressure in the kidney to be too high.

The inventors of the present application consider that in order to avoid the blocking of the crushed stones at the percutaneous nephroscope, one can start with the size of the crushed stones on the one hand and the structure of the percutaneous nephroscope on the other hand. In practical applications, it is found that the size of the crushed stone is difficult to control completely, and the crushing condition of the stone is influenced by various factors, such as the physical properties of the stone, the output energy of the lithotripsy optical fiber, the position stability of the stone, etc. In the process of hitting the kidney stones through the lithotripsy optical fiber, most of the kidney stones are hit off at the same time, the size is large, and the hit-off stones are in a free state and are difficult to be hit off again. Therefore, it is considered to avoid the blocking of the crushed stones at the percutaneous nephroscope starting from the structure of the percutaneous nephroscope.

The inventors of the present application found that the size of the space for discharging the crushed stones is one of the reasons for affecting the discharge rate and discharge efficiency of the stones. In the removal of stones through a conventional percutaneous nephroscope, on the one hand, the stone removal efficiency and removal rate by fragmentation is limited by the radial size of the gap between the sheath and the endoscope. On the other hand, the gap between the inner wall of the sheath and the outer wall of the endoscope is an annular gap, and a full circle of the outer wall of the endoscope protrudes towards the sheath relative to the central axis of the annular gap, so that the broken stones are not easy to pass through. However, when the gap between the sheath and the endoscope is used as a passage for discharging stones, the above problems are difficult to avoid.

Based on this, the inventors of the present application propose to relatively increase the space for discharging the crushed stones by adjusting the spatial distribution position and structural characteristics (e.g., shape, size) of the passage for discharging stones, to avoid clogging of the crushed stones as much as possible.

Further, a dispersive distributed percutaneous nephroscope is proposed, comprising: the endoscope comprises an introducer sheath with an introducer channel and an endoscope body arranged in the introducer channel. The endoscope body comprises a mirror body with a front end wall and an image acquisition device arranged on the mirror body. The mirror main body comprises a main tube body and a discharge channel arranged in the main tube body, the front end wall comprises a middle area and an edge area surrounding the middle area, the middle area of the front end wall is provided with a discharge port communicated with the discharge channel, and the discharge port is positioned in the field range of the image acquisition equipment. The decentralized distributed percutaneous nephroscope relatively increases the space for discharging crushed stones by adjusting the spatial distribution position and structural characteristics of a passage for discharging stones to avoid blockage of crushed stones as much as possible.

Exemplary percutaneous nephroscope

As shown in fig. 1 to 6C, a dispersive distribution-type percutaneous nephroscope 1 according to an embodiment of the present application is illustrated. The dispersive distribution-type percutaneous nephroscope 1 can be applied to an operation procedure for treating the renal calculus S by percutaneous nephrolithotomy. Specifically, the decentralized distributed percutaneous nephroscope 1 is adapted to pass through the skin of a predetermined position of a patient to reach the kidney k for treating a kidney stone S (as shown in fig. 6C), and after a lithotripsy optical fiber breaks up the stone S inside the kidney k, the broken stone S can be discharged outside the body through the decentralized distributed percutaneous nephroscope 1.

For convenience of explanation, in the present embodiment, the end of the decentralized distributed percutaneous nephroscope 1 inserted into the skin of the patient during the operation is referred to as the front end of the decentralized distributed percutaneous nephroscope 1, and the end opposite to the front end of the decentralized distributed percutaneous nephroscope 1 is referred to as the rear end thereof.

In the embodiment of the present application, the dispersive and distributive percutaneous nephroscope 1 includes: an introducer sheath 10 and an endoscope body 20 provided in the introducer sheath 10 are shown in fig. 1 and 2. The introducer sheath 10 has an introducer channel 11 extending through the introducer sheath 10, and the endoscope body 20 is disposed in the introducer channel 11 in the introducer sheath 10. The endoscope body 20 comprises an endoscope body 21 capable of being inserted into the skin of a patient, and the effective working length of the endoscope body 21 is greater than or equal to the length from the skin of a preset position of the patient to a target position of a kidney k. The total length of the mirror body 21 is greater than its effective working length.

The introducer sheath 10 includes an insertion section capable of being inserted into the kidney and an operation section connected to a rear end of the insertion section. The operation section comprises an operation main body, at least one holding piece and at least one standby operation piece, wherein the holding piece and the at least one standby operation piece are arranged on the operation main body. The medical personnel can place fingers on the at least one holding piece so as to be convenient for the medical personnel to hold. Some surgical instruments may be coupled to the at least one redundant operator to facilitate functional manipulation (e.g., perfusion, suction of fluid, or debris) by medical personnel via the surgical instrument coupled to the at least one redundant operator. The insertion end may be detachably mounted to the operation section, or may be fixedly mounted to the operation end, which is not limited in this application.

The scope body 21 includes a main tube 211 and an exhaust passage 212 provided in the main tube 211, and the crushed stones S can be exhausted outside the body through the exhaust passage 212. In particular, suction may be applied by means of a suction device communicating with the discharge channel 212, such that the channel cavity of the discharge channel 212 is under negative pressure, and the crushed stones S entering the discharge channel 212 are discharged outside the body. More specifically, the endoscope body 20 further includes a holding portion 23 disposed on the endoscope main body 21, and the holding portion 23 includes a housing, at least one auxiliary tube disposed in the housing, and at least one interface corresponding to the at least one auxiliary tube. The at least one auxiliary tube comprises a first auxiliary tube connected to the main tube 211, the first auxiliary tube has a first auxiliary channel connected to the discharge channel 212, the at least one port comprises a first port 231 connected to the first auxiliary channel, and the suction device can be connected to the discharge channel 212 through the first port 231 and the first auxiliary channel.

The at least one auxiliary tube may be integrally formed on the main tube 211 through a molding process, or may be combined with the main tube 211 through a welding process, etc., which is not limited in this application.

Preferably, the outer diameter of the mirror body 21 is smaller than or equal to the inner diameter of the guide channel 11, and the mirror body 21 is movably disposed in the guide channel 11. In a specific example of the present application, the mirror body 21 is movably disposed in the guide passage 11 in such a manner as to be telescopically disposed in the guide passage 11. During surgery, the scope body 21 may be removed from the introducer sheath 10 and other surgical instruments may be placed in the introducer sheath 10.

The guide channel 11 is arranged between the insertion section and the operating section. The guide channel 11 comprises a front guide opening 111 at the front end of the guide sheath 10 and a rear guide opening 112 at the rear end of the guide sheath 10, and a channel body 113 extending between the front guide opening 111 and the rear guide opening 112, the mirror body 21 being extendable through the front guide opening 111 and the rear guide opening 112, the mirror body 21 having a front end wall 210 and a peripheral wall 220 extending rearwardly around the outer periphery of the front end wall 210.

In one embodiment of the present application, the inner peripheral wall of the rear guide opening 112 has an internal thread, and the outer peripheral wall 220 of the mirror body 21 has an external thread corresponding to the internal thread, so that the mirror body 21 can be extended out of the front guide opening 111 or retracted into the guide passage 11 by rotating the inner mirror body 20. Because the thread is arranged between the rear guide opening 112 and the endoscope main body 21, a doctor can more stably control the extending length of the inner endoscope body 20, and the tissue and organ of a patient are prevented from being injured due to the overlong extending length of the inner endoscope body 20.

More preferably, when the mirror body 21 protrudes out of the front guide opening 111, there is no gap between the outer peripheral wall 220 of the mirror body 21 and the inner peripheral wall of the front guide opening 111, so as to avoid that the crushed stones S are difficult to be discharged out of the body by being caught in the gap between the outer peripheral wall 220 of the mirror body 21 and the inner peripheral wall of the front guide opening 11111, and this can provide the inner mirror body 20 with a sufficient radial dimension to more flexibly arrange the respective passages and openings, and other necessary structures or devices. Accordingly, in one specific example of the present application, the cross-sectional shape of the outer peripheral wall 220 of the mirror body 21 coincides with the cross-sectional shape of the inner peripheral wall of the front guide opening 111, and the outer diameter of the mirror body 21 is equal to the inner diameter of the front guide opening 111 or slightly smaller than the inner diameter of the front guide opening 111. In one embodiment, the clearance between the outer peripheral wall 220 of the mirror body 21 and the inner peripheral wall of the front guide opening 111 is less than a preset value of 0.5 mm, i.e., the clearance between the outer peripheral wall 220 of the mirror body 21 and the inner peripheral wall of the front guide opening 111 is less than 0.5 mm.

The channel body 113 of the guide channel 11 may be bonded to the mirror body 21, or may have a gap with the mirror body 21. Accordingly, in one particular example of the present application, the inner diameter of the channel body 113 of the guide channel 11 is equal to the outer diameter of the mirror body 21. In another specific example of the present application, the inner diameter of the channel body 113 of the guide channel 11 is smaller than the mirror body, i.e. there is a gap between the channel body 113 of the guide channel 11 and the mirror body 21. The guide sheath 10 has a conduction opening communicating with the channel body 113 in the peripheral wall thereof, and the gap between the channel body 113 of the guide channel 11 and the mirror body 21 allows the perfusion fluid to pass therethrough and exit from the conduction opening.

It should be noted that, in the embodiments of the present application, the inner diameter or the outer diameter refers to an equivalent circular diameter. That is, when the shape of the cross section of the structure is a circle, the diameter of the structure is the diameter of the corresponding circle, and when the shape of the cross section of the structure is a non-circle, the diameter of the structure is the diameter of a circle having the same area as the area of the cross section of the structure. The cross-section of the structure refers to: a common area (or non-empty intersection) of the structure and a face perpendicular to the axial direction in which the structure is set.

During the operation of using the dispersive percutaneous nephroscope 1 to remove stones from kidney stones S, the endoscope body 20 needs to reserve space for some surgical instruments (e.g., lithotripsy optical fiber, guide wire 3) and other necessary structures or devices, for example, in some embodiments of the present application, a channel and an opening for allowing perfusion fluid to pass through, a channel and an opening for allowing lithotripsy optical fiber to pass through, an image acquisition device 22, etc. are provided. In order to ensure the space of the discharge channel 212 for discharging the crushed stones S, other structures or devices are arranged while ensuring the radial dimension of the discharge channel 212, provided that the radial space of the endoscope body 20 is limited.

Accordingly, in the present embodiment, the discharge passage 212 is disposed in the middle of the main tube 211, the front end wall 210 includes a middle region 2101 and an edge region 2102 surrounding the middle region 2101 and adjacent to the outer periphery of the front end wall 210, the middle region 2101 is provided with the discharge port 60 communicated with the discharge passage 212, and other necessary structures or devices with low requirements on the radial dimension can be dispersedly disposed in the edge region 2102, so that the utilization rate of the radial space of the mirror main body 21 can be improved, and the radial space of the mirror main body 21 can be fully utilized.

Also, it is preferable that the cross section of the discharge passage 212 is circular, and the shape of the orthographic projection of the discharge port 60 in the axial direction set by the mirror main body 21 is circular, as shown in fig. 3B. When the discharge passage 212 is a circular passage, each part of the outer passage wall of the circular passage is flared with respect to the central axis thereof, and no excess circumferential wall protrudes inside toward the outer passage wall to restrict the space for discharging the stones S, making it easier for the passage of the crushed stones S, than when the discharge passage 212 is an annular gap.

Here, the axial direction in which the mirror main body 21 is set is: in the forward direction along the central axis of the mirror body 21. Accordingly, the radial direction in which the mirror body 21 is set means a direction perpendicular to the axial direction in which the mirror body 21 is set. The orthographic projection of the discharge port 60 in the axial direction set by the mirror main body 21 means: when light is irradiated to the discharge port 60 in the axial direction set by the mirror body 21, the discharge port 60 is orthographically projected on a plane perpendicular to the central axis of the mirror body 21.

In some embodiments of the present application, the discharge passage 212 has an inner diameter equal to or greater than one-half of the inner diameter of the main tube 211, and the discharge port 60 has an area equal to or greater than one-half of the area of the front end wall 210, so as to prevent the crushed stones S from being blocked at the discharge port 60, thereby ensuring a space for discharging the stones S.

In the embodiment of the present application, the mirror main body 21 further includes a flow injection channel disposed on the main tube 211, and the mirror main body 21 is provided with a flow injection port 70 communicated with the flow injection channel. The infusion channel is adapted to communicate with an infusion device to allow the infusion fluid to pass through and be injected into the kidney k, the infusion fluid exiting the infusion port 70 may impact the crushed stone S, bounce off when encountering the inner wall of the renal pelvis or other body, entrain the crushed stone S when reaching the vicinity of the exit port 60, enter the exit port 60, and be expelled from the body through the exit channel 212 communicating with the exit port 60.

Correspondingly, the at least one auxiliary tube comprises a second auxiliary tube connected to the main tube 211, the second auxiliary tube has a second auxiliary channel connected to the injection channel, the at least one interface comprises a second interface 232 (not shown) connected to the second auxiliary channel, and the perfusion apparatus can be connected to the injection channel through the second interface 232 and the second auxiliary channel.

The injection port 70 may be provided in the front end wall 210 of the mirror body 21 or the outer peripheral wall 220. In a specific example of the present application, the spout 70 is disposed in the edge region 2102 of the front end wall 210, as shown in fig. 5. In another specific example of the present application, the flow port 70 is provided at a front end of the outer peripheral wall 220 adjacent to the discharge port 60 in the axial direction set by the mirror body 21. When the flow ports 70 are provided in the outer peripheral wall 220, the flow ports 70 mainly occupy a space in the axial direction of the mirror body 21, so that a radial space of the mirror body 21 can be saved for the arrangement of the discharge ports 60, and the design of the structural features such as the size, shape, number, and the like of the flow ports 70 and the discharge ports 60 is more flexible.

The shape, size and number of the orifices 70 are not intended to be limiting. For example, the injection ports 70 may be designed to be semi-circular, drop-shaped, circular, etc., the size of the injection ports 70 may be designed according to the actual application requirements, and the number of the injection ports 70 may be 1,2, or other values.

It should be noted that, during the operation procedure of using the dispersive distributed percutaneous nephroscope 1 to remove stones to treat renal stones S, the length of the extended inner scope body 20 should be suitable, and when the inner scope body 20 enters the kidney k to a deep depth, it may enter the renal vein or even the vena cava by mistake, thereby causing a heavy bleeding. Accordingly, as shown in fig. 3A and 3B, the endoscope body 20 further includes an image capturing device 22 disposed on the endoscope body 21, so that the position reached by the decentralized and distributed percutaneous nephroscope 1 can be monitored in real time, and the operation safety can be improved. Also, the image pickup device 22 is mounted to an edge region 2102 of the front end wall 210, and preferably, the front end of the decentralized percutaneous nephroscope 1 is within the field of view of the image pickup device 22.

Specifically, the image capturing device 22 is adapted to be communicably connected to an image output device (e.g., an image display) so that medical personnel can observe the condition of the decentralized distributed percutaneous nephroscope 1 and the kidney k through the image output device. The image capturing device 22 includes at least one camera, preferably having a field of view that covers a substantial portion of the front end wall 210 of the decentralized distributed percutaneous nephroscope 1.

Further, the discharge port 60 is located within the field of view of the image capturing device 22, so that the state of the discharge port 60 can be observed in real time to improve the stone discharge efficiency and the safety of the operation. For example, when the discharge port 60 is observed to be clogged, the calculi S clogged in the discharge port 60 can be removed in time, or the injection of the perfusate and the aspiration of the fluid and the crushed calculi S can be stopped in time to maintain the balance of the internal pressure of the kidney k.

In order to allow the discharge opening 60 to be located within the field of view of the image pickup device 22, the discharge opening 60 may be located in front of the image pickup device 22, where the discharge opening 60 is located in front of the image pickup device 22 means that the center of the discharge opening 60 is located in front of the center of the light receiving surface of the image pickup device 22 that receives light reflected by an object. Accordingly, the middle region 2101 of the front end wall 210 may be located in front of the image capturing device 22. Also, preferably, the discharge port 60 and the image pickup device 22 are close to each other from the rear to the front so that the discharge port 60 is within the field of view of the image pickup device 22, and accordingly, the image pickup device 22 and/or the discharge port 60 may be disposed obliquely with respect to the radial direction set by the mirror body 21.

Further, the discharge port 60 may be provided on a plane parallel to the radial direction set by the mirror body 21, that is, a plane perpendicular to the central axis of the mirror body 21, or may be provided on a plane inclined with respect to the radial direction set by the mirror body 21. That is, the middle region 2101 of the front end wall 210 may be parallel to the radial direction in which the mirror body 21 is set, i.e., perpendicular to the central axis of the mirror body 21, or may be inclined with respect to the radial direction in which the mirror body 21 is set.

In one particular example of the application, the middle region 2101 of the front end wall 210 is perpendicular to the central axis of the mirror body 21, as shown in FIG. 4. The light receiving surface of the image pickup device 22 is located behind the discharge port 60 and is provided to an edge area 2102 of the front end wall 210 obliquely toward a radial direction in which the discharge port 60 is set with respect to the mirror main body 21 so that at least a part of the discharge port 60 is within a field of view of the image pickup device 22.

In another specific example of the present application, the middle region 2101 of the front end wall 210 extends obliquely forward from its first side adjacent to the image-capturing device 22 to a second side opposite to the first side in a preset extension direction, as shown in fig. 3. The image pickup device 22 is located rearward of the middle region 2101, and is provided at an edge region 2102 of the front end wall 210 obliquely toward a radial direction in which the discharge port 60 is set with respect to the mirror main body 21, so that at least a part of the discharge port 60 is within a field of view of the image pickup device 22.

It should be understood that the greater the inclination of the middle region 2101, that is, the closer to the central axis of the mirror body 21, the steeper the middle region 2101 is, the closer the discharge opening 60 is to the image pickup device 22 in the radial direction set by the mirror body 21, the greater the probability that the image pickup device 22 can photograph the discharge opening 60.

In this particular example, the middle region 2101 includes a steep region extending obliquely forward from its first side adjacent to the image capture device 22 and a flat region extending forward from the steep region, at least a portion of the discharge opening 60 is located in the steep region, and the discharge opening 60 may include a steep section corresponding to the steep region and a flat section corresponding to the flat region. Optionally, the discharge openings 60 are all located in the steep area so that the image capture device 22 can capture as much of the entire discharge opening 60 and its vicinity as possible. In one embodiment of this specific example, an angle between the preset extending direction and an axial direction set by the mirror main body 21 is smaller than half of an angle of field of a camera of the image pickup device 22.

Further, in this particular example, the angle between the preset extension direction and the axial direction set by the mirror body 21 decreases and then increases from the first side to the second side of the central region 2101. Accordingly, the angle between the preset direction of extension of the steep region and the axial direction set by the mirror body 21 decreases from the first side of the middle region 2101 to the gentle region, is increasingly steep, and is recessed inwardly so as not to obscure the light reflected towards the image acquisition device 22 by the protrusion of the middle region 2101 of the front end wall 210.

It is worth mentioning that, in this specific example, the front end wall 210 extends obliquely from a first side adjacent to the image capturing device 22 to a second side opposite to the first side, and the inclination of the second side peripheral portion adjacent to the second side (i.e., the angle between the front end wall 210 and the plane perpendicular to the radial direction set by the mirror body 21) is low, so as to prevent the second side peripheral portion located in front of the first side peripheral portion of the front end wall 210 from being too sharp to damage the organ tissue of the patient, which can improve the safety of the operation.

In other specific examples, the center of the light receiving surface of the image capturing device 22 may also be flush with the center of the discharge port 60. Further, it may be designed that either one of the image pickup device 22 and the middle region 2101 of the front end wall 210 is disposed obliquely with respect to the radial direction set by the mirror main body 21, or it may be designed that both the image pickup device 22 and the middle region 2101 of the front end wall 210 are disposed obliquely with respect to the radial direction set by the mirror main body 21.

In the embodiment of the present application, the scope main body 21 further includes a first working channel for allowing a working component (e.g., a lithotripsy optical fiber, a guide wire 3, and other surgical instruments) to pass through, and the first working channel is disposed on the main tube body 211, can be isolated from other channels to avoid mutual interference between the channels, and can also be communicated with other channels, which is not limited in the present application.

Accordingly, in one specific example of the present application, the mirror body 21 further includes a first working channel communicating with the discharge port 60, and the discharge channel 212 communicates between the discharge port 60 and the first working channel. The endoscope body 20 further comprises at least one working component telescopically arranged in the first working channel, the head of the at least one working component is suitable for extending out of the discharge port 60, so that the head of the at least one working component is within the field of view of the image acquisition device 22 when extending out of the discharge port 60, and the at least one working component comprises the lithotripsy optical fiber.

In another specific example of the present application, the mirror body 21 further includes a first working channel disposed on the main tube body 211, and the front end wall 210 is provided with a first working opening 80 communicated with the first working channel, as shown in fig. 5. The endoscope body 20 further comprises at least one working component telescopically disposed in the first working channel, a head of the at least one working component is adapted to extend out of the first working opening 80, and the head of the at least one working component is within a field of view of the image capturing device 22 when extending out of the first working opening 80.

Correspondingly, the at least one auxiliary pipe body includes a third auxiliary pipe body connected to the main pipe body 211, the third auxiliary pipe body has a third auxiliary channel communicated with the first working channel, the at least one interface includes a third interface 233 communicated with the third auxiliary channel, and the working component can enter the first working channel through the third interface 233.

It will be understood by those skilled in the art that the working component may be disposed in other channels, for example, the guide wire 3 may pass through the injection port 70 and the injection channel or the exhaust port 60 and the exhaust channel 212 to guide the decentralized distributed percutaneous nephroscope 1 to enter the kidney k, and the guide wire 3 may be drawn out from the injection channel after guiding the decentralized distributed percutaneous nephroscope 1 to enter the kidney k, so as not to affect the output of the perfusate or the output of the stones S, or affect the passage of other working components. For another example, the lithotripsy fiber may be movably disposed in the discharge passage 212 and extend from the discharge port 60.

The operation of the dispersion distribution type percutaneous nephroscope 1 for treating renal calculus S by percutaneous nephrolithotomy will be described below.

Step 1: a decentralized distributed percutaneous nephroscope 1 is placed into the kidney collecting system. Specifically, first, a lithotomy tunnel is established between the patient's skin and the kidney assembly system. An incision (about 0.5 mm) can be made in the skin of the patient at a predetermined location and the renal k can be punctured by the puncture needle 2 under the guidance of an X-ray machine or a B-ultrasonic machine to establish the lithotomy channel, as shown in fig. 6A. It should be noted that the depth of the puncture is crucial for the operation, and when the depth of the puncture is shallow, the puncture needle 2 may only enter the renal parenchyma and not reach the renal collecting system, not only the purpose of treating the kidney stone S is not achieved, but also the renal hemorrhage may be caused; when the puncture depth is deep, the puncture needle 2 may be mistakenly inserted into the renal vein or even the vena cava, which may cause a large bleeding.

Next, guidewire 3 is placed into the kidney assembly system, as shown in fig. 6B. Specifically, the puncture needle 2 comprises a needle sheath and a needle core movably arranged on the needle sheath, and after the puncture needle 2 punctures the kidney k and enters the kidney collecting system, the needle core can be withdrawn and a guide wire 3 can be inserted into the needle sheath so that the guide wire 3 is arranged in the kidney collecting system along the needle sheath.

Then, the decentralized percutaneous nephroscope 1 is inserted to the target position of the kidney k as shown in fig. 6C. Specifically, the decentralized distributed percutaneous nephroscope 1 is inserted into the kidney assembly system along the guide wire 3, and the guide wire 3 can be withdrawn after the decentralized distributed percutaneous nephroscope 1 enters the target position of the kidney k.

In some embodiments of the present application, the introducer sheath 10 of the decentralized percutaneous nephroscope 1 and the dilation tube disposed in the introducer sheath 10 may be first inserted into the renal congregation system along the guidewire 3, and the guidewire 3 may be passed through the operative channel of the dilation tube such that the introducer sheath 10 and the dilation tube can enter the renal congregation system along the guidewire 3. The insertion end of the dilation tube inserted into the kidney assembly system has a tapered structure from the back to the front, that is, the front end of the insertion end of the dilation tube has a small size, and can easily penetrate through the skin of a patient and enter the kidney assembly system, then the dilation tube in the decentralized distributed percutaneous nephroscope 1 is withdrawn, and the endoscope body 20 of the decentralized percutaneous nephroscope 1 is inserted into the guide sheath 10 until the endoscope body 21 of the endoscope body 20 reaches the target position of the kidney k.

In other embodiments of the present application, the guiding sheath 10 of the decentralized percutaneous nephroscope 1 and the endoscope body 20 disposed in the guiding sheath 10 are directly inserted along the guiding wire 3 to the target position of the kidney k, and the guiding wire 3 can pass through the discharge channel 212 or the injection channel of the endoscope body 20, or the first working channel, so that the guiding sheath 10 and the endoscope body 20 can enter the target position of the kidney k along the guiding wire 3. Preferably, the front end of the mirror body 21 has a tapered structure from back to front, which can easily penetrate through the skin of the patient and enter the kidney assembly system, and an image capturing device 22 adapted to be communicably connected to an image output device is provided on the mirror body 21 to capture images of the mirror body 21 and the tissues around the mirror body 21, so that medical staff can observe the condition of the mirror body 21 and the kidney k through the image output device.

Step 2: the kidney stone S is crushed by a stone crushing device. In particular, a lithotripsy apparatus may enter the first working channel of the decentralized distributed percutaneous nephroscope 1 through its third interface 233, which communicates with the first working channel, and protrude from the first working opening 80 or the discharge opening 60 to hit the kidney stones S. The lithotripsy apparatus may be implemented as a pneumatic ballistic lithotripter, a holmium laser, an ultrasonic lithotripter, etc., and is not limited in this application.

And step 3: the crushed stones S are discharged out of the body through the discharge passage 212 of the dispersive percutaneous nephroscope 1. Specifically, during the fragmentation of a kidney stone S by a lithotripsy apparatus, a perfusate may be administered to the kidney k, and the perfusate may exit a fluid port 70 in communication with the fluid passageway to impact the fragmented stone S. As shown in fig. 6C, the perfusate bounces back when it encounters the inner wall of the renal pelvis or other body, and upon reaching the vicinity of the discharge port 60, entrains the crushed stones S into the discharge port 60 and is discharged from the body through the discharge passage 212 communicating with the discharge port 60. During the process of crushing the kidney stones S by the stone crushing device, the suction device communicated with the discharge channel 212 can also perform suction, so that the channel cavity of the discharge channel 212 is in a negative pressure state, and the crushed stones S entering the discharge channel 212 are discharged out of the body.

In summary, a distributed percutaneous nephroscope 1 according to an embodiment of the present application is explained, in which the distributed percutaneous nephroscope 1 is provided with a discharge passage 212 for discharging the calculi S in the inner scope body 20 thereof, and the space for discharging the crushed calculi S is relatively increased by the spatial arrangement and the structural characteristics of the discharge ports 60 communicating with the discharge passage 212, so as to avoid the crushed calculi S from being clogged as much as possible.

It will be appreciated by persons skilled in the art that the embodiments of the invention described above and shown in the drawings are given by way of example only and are not limiting of the invention. The objects of the present invention have been fully and effectively accomplished. The functional and structural principles of the present invention have been shown and described in the examples, and any variations or modifications of the embodiments of the present invention may be made without departing from the principles.

Claims

1. A decentralized distributed percutaneous nephroscope adapted to pass through the skin of a patient at a predetermined location to reach the kidney for treatment of a kidney stone, comprising:

an introducer sheath having an introducer channel; and

the inner lens body is arranged in the guide channel;

wherein, the endoscope body includes:

an image pickup device provided to the mirror main body, the image pickup device being mounted to an edge area of the front end wall, and the discharge port being within a field of view of the image pickup device.

2. The decentralized and distributed percutaneous nephroscope according to claim 1, wherein the scope body is movably arranged in the guide channel, the outer diameter of the scope body being smaller than or equal to the inner diameter of the guide channel.

3. The decentralized distributed percutaneous nephroscope according to claim 2, wherein the guide channel comprises a front guide opening at the front end of the guide sheath, the mirror body further having an outer peripheral wall whose cross-sectional shape coincides with the cross-sectional shape of the inner peripheral wall of the front guide opening.

4. The decentralized percutaneous nephroscope according to claim 3, wherein the guide channel further comprises a posterior guide opening at the posterior end of the guide sheath, the inner peripheral wall of the posterior guide opening having an internal thread, the outer peripheral wall of the scope body having an external thread corresponding to the internal thread.

5. The decentralized distributed percutaneous nephroscope according to claim 1, wherein the shape of the orthographic projection of the discharge port in the axial direction set by the mirror body is circular.

6. The decentralized distributed percutaneous nephroscope according to claim 5, wherein the central region of the front end wall is perpendicular to the central axis of the scope body.

7. The decentralized distributed percutaneous nephroscope according to claim 5, wherein the central region of the front end wall extends obliquely forward in a preset extension direction from a first side thereof adjacent to the image acquisition device to a second side opposite to the first side.

8. The decentralized distributed percutaneous nephroscope according to claim 7, wherein the middle region comprises an abrupt region extending obliquely forward from its first side adjacent to the image acquisition device and a flat region extending forward from the abrupt region, at least a part of the discharge opening being located in the abrupt region.

9. A decentralized distributed percutaneous nephroscope according to claim 8, wherein the angle between the preset extension direction and the axial direction in which the scope body is set decreases and then increases from the first side to the second side of the central region.

10. The decentralized distributed percutaneous nephroscope according to claim 5, wherein the scope body further comprises a first working channel communicating with the discharge opening, the discharge channel communicating between the discharge opening and the first working channel.

11. The decentralized percutaneous nephroscope according to claim 5, wherein the scope body further comprises a first working channel disposed in the main tube, the front end wall being provided with a first working opening communicating with the first working channel.

12. The decentralized percutaneous nephroscope according to claim 10, wherein the endoscope body further comprises at least one working element telescopically disposed in the first working channel, the head of the working element being adapted to extend from the discharge port such that the head of the working element is within the field of view of the image capture device when extending out of the discharge port.

13. The decentralized distributed percutaneous nephroscope according to claim 11, wherein the endoscope body further comprises at least one working member telescopically arranged in the first working channel, the head of the working member is adapted to protrude from the first working port, and the head of the working member is within the field of view of the image capture device when protruding from the first working port.

14. A decentralized distributed percutaneous nephroscope adapted to pass through the skin of a patient at a predetermined location to reach the kidney for treatment of a kidney stone, comprising:

an introducer sheath having an introducer channel; and

the inner lens body is arranged in the guide channel;

wherein, the endoscope body includes:

the image acquisition equipment is arranged on the edge area of the front end wall, the discharge port is positioned in the field of view of the image acquisition equipment, the mirror body further comprises a flow injection channel arranged on the main pipe body, and the mirror body is provided with a flow injection port communicated with the flow injection channel.

15. The decentralized distributed percutaneous nephroscope according to claim 14, wherein the injection port is provided in the edge region.