CN117679117A

CN117679117A - Ureteroscope multifunctional sheath

Info

Publication number: CN117679117A
Application number: CN202410105741.XA
Authority: CN
Inventors: 邓晓俊; 张炯辉; 张玉峰
Original assignee: Shaoxing Yuancong Technology Co ltd
Current assignee: Shaoxing Yuancong Technology Co ltd
Priority date: 2024-01-25
Filing date: 2024-01-25
Publication date: 2024-03-12

Abstract

The invention discloses a ureteroscope multifunctional sheath, which comprises an outer sheath and a sheath core, wherein the sheath core comprises a first channel and a second channel, the front end position of the first channel is provided with an instrument through hole, the size of the second channel is matched with the size of a guide wire, the outer sheath comprises an outer sheath main body pipe, an outer sheath water inlet and a negative pressure water suction port, and the outer sheath main body pipe comprises a third channel and a fourth channel; one end of the third channel is a sheath water outlet, and the other end of the third channel is connected with a sheath water inlet; one end of the fourth channel is a sheath core outlet, the other end of the fourth channel is connected with the negative pressure water suction port, and a negative pressure adjusting piece is arranged on the negative pressure water suction port. The invention has the function of negative pressure stone suction, when the stone is sucked by negative pressure, circulating water is formed in the renal pelvis to avoid rupture and bleeding of renal pelvis mucous membrane, the circulating water is used for sucking stone by negative pressure, the stone cleaning rate is improved, a pressure measuring device can be externally connected, the pressure of the renal pelvis is known in real time, and the occurrence of sepsis is prevented.

Description

Ureteroscope multifunctional sheath

Technical Field

The invention relates to a ureteroscope multifunctional sheath.

Background

Ureteroscope lithotripsy (FURL), has its unique advantages: firstly, minimally invasive, FURL does not need to puncture, the operation can be finished through a natural human body channel, and the wound is obviously smaller than PCNL; secondly, the stone breaking effect is clear, the stone is directly broken by laser in the FURL operation, the diameter of the stone breaking can be perfectly controlled to be smaller than 2mm, the problems of stone step and renal colic during stone removal caused by the fact that ESWL is difficult to control the volume and shape of broken stone are solved, and the method is obviously superior to ESWL. But it also has certain limitations. First, the surgical timing is selected.

Because some patients are accompanied with ureteral stenosis, distortion and other preoperative unknown factors, the ureteral soft lens conveying sheath (ureteral access sheaths, UAS) cannot be ensured to be safely placed in the I stage, if the UAS is forcefully placed, the ureteral perforation, the rupture and even the ureteral mucosa peeling and other serious complications are caused, so that most patients clinically adopting the FURL operation currently adopt the I stage to place double J tubes, the II stage FURL operation after the ureter 10-14d is expanded, the ureteral lumen is passively expanded through the double J tubes, and the placement of the UAS is facilitated. Secondly, due to the specificity, fineness, longer factors and the like of the lens body of the FURL, the ocular lens is not designed to be wider than a ureteroscope and a nephroscope in view, and particularly when the kidney is severely accumulated, the success rate of searching for stones is limited. And the ureteroscope has small passage, and the diameter of the passed laser optical fiber is small, so that the lithotripsy efficiency is lower than that of a ureteroscope and a nephroscope, for example, the diameter of the calculus is larger than 2cm, and the lithotripsy time is obviously prolonged. The use of the negative pressure suction sheath in the next two years not only greatly quickens the stone cleaning rate in the operation, but also obviously saves the operation time, has definite clinical effect, and has gradually expanded the indication to the point that the stone diameter is about 3cm, even partially reports the treatment of partial deer-horn-shaped stones.

Currently mainstream ureteroscope delivery sheath (ureteral access sheaths, UAS) has the following functions at the same time: 1. general function: the hollow sheath is convenient for the ureteroscope to pass in and out of the broken stone and take the stone; 2. the tail end of the flexible ureteroscope can be bent (actively or passively), and the passive bending is that the flexible ureteroscope actively bends during operation to drive the front end of the sheath to bend passively, so that the flexible ureteroscope is convenient to move in the renal calyx and is beneficial to searching stones, crushing stones and taking stones.

The currently mainstream ureteral soft lens delivery sheath (ureteral access sheaths UAS) has the following disadvantages:

1. the stone sucking effect is poor, the renal pelvis is in a negative pressure state, and the surface mucous membrane is extremely easy to break and bleed due to the negative pressure, so that the operation visual field is influenced, and the operation safety is influenced. Therefore, how to more effectively adsorb crushed stone without affecting the renal pelvis mucosa presents challenges to clinicians.

2. Renal pelvis pressure cannot be monitored. When the renal pelvis pressure is more than 30cm H2O, bacteria of the renal pelvis easily enter the kidney parenchyma to enter blood, so that urine-derived bacteremia is caused, and when infection is aggravated, sepsis is extremely easy to bleed, and the death rate is up to 54 percent, so that the intraoperative monitoring of the renal pelvis pressure is particularly important, but no UAS capable of monitoring the renal pelvis pressure exists at present.

3. All UAS are currently inserted through a guide wire in a brute force manner, if the ureter is extremely vulnerable to injury once the ureter is narrow, the UAS can not be placed successfully (the success rate of the UAS placement in the first period is about 50 percent at present). How to easily and smoothly place UAS under the condition of not being applicable to brute force is needed to be solved.

4. The optimal placement of the UAS is where its anterior end is located at the ureteral junction of the renal pelvis, but current placement of UAS is by a guide wire blind approach, so it is difficult to ensure that the anterior end of the sheath is just in place. Due to individual differences in humans, the ureters are of varying length, and once the sheath is positioned under the nephropelvis ureter during surgery, the sheath needs to be replaced; once the sheath is within the renal pelvis, the inner core front end of the sheath is extremely prone to puncture the renal parenchyma, leading to the potential for massive hemorrhage. Thus, how to place the sheath is a proper benefit presents challenges to the clinician.

Disclosure of Invention

The invention aims to overcome the defects that in the prior art, a ureteral soft lens sheath has poor stone sucking effect, a renal pelvis is in a negative pressure state, rupture bleeding of a surface mucous membrane is easy to occur due to negative pressure, the operation visual field is influenced, and the operation safety is influenced.

The invention solves the technical problems by the following technical scheme:

the multifunctional ureteroscope sheath comprises an outer sheath and a sheath core, wherein the sheath core comprises a first channel and a second channel, the front end of the first channel is provided with an instrument through hole, the size of the second channel is matched with the size of a guide wire,

the outer sheath comprises an outer sheath main body pipe, an outer sheath water inlet and a negative pressure water suction port, and the outer sheath main body pipe comprises a third channel and a fourth channel;

one end of the third channel is a sheath water outlet, and the other end of the third channel is connected with the sheath water inlet;

the size of the fourth channel is matched with the size of the sheath core, one end of the fourth channel is a sheath core outlet, the other end of the fourth channel is connected with the negative pressure water suction port, and a negative pressure adjusting piece is arranged on the negative pressure water suction port.

Preferably, the external continuous water injector that has the pressure measurement of sheath water inlet, the working process of the multi-functional sheath of ureter soft lens includes:

the sheath is arranged at the junction of the nephropelvis and the ureter by using a sheath core with a guide wire;

and injecting water into the water inlet of the outer sheath by using a water injector, detecting water pressure by using a pressure measuring device, and sucking the water at the negative pressure water sucking port.

Preferably, when the guide wire is inserted into the second channel, a first gap is arranged between the outer surface of the guide wire and the inner surface of the second channel, a guide wire through hole and a sheath core water outlet are further arranged at the front end position of the second channel, the sheath core water outlet is positioned at the rear of the guide wire through hole, the sheath core water outlet is connected with the second channel, and the rear end position of the second channel is connected with a sheath core water inlet.

Preferably, the working process of the ureteroscope multifunctional sheath comprises the following steps:

inserting an outer sheath with a sheath core along a guide wire by utilizing a second channel, inserting an endoscope into the first channel, and continuously injecting physiological saline into a water inlet of the sheath core;

and pushing the outer sheath with the sheath core until the front end of the outer sheath is located at the junction of the renal pelvis and ureter under the condition that water is discharged from the water outlet of the sheath core.

placing a guide wire under the urine conveying hard mirror, and withdrawing the ureter hard mirror after the guide wire is reserved;

inserting an outer sheath with a sheath core along a guide wire by utilizing a second channel, inserting an endoscope into the first channel, continuously injecting normal saline into a water inlet of the sheath core, keeping the guide wire horizontal, looking at a display screen with eyes at the head, slowly pushing the outer sheath with the sheath core along the guide wire under direct vision until the front end of the outer sheath is peeped to be positioned at the junction of a renal pelvis and a ureter, and removing the sheath core with the guide wire and the endoscope;

the negative pressure water suction port is externally connected with a negative pressure device, the water inlet of the outer sheath is externally connected with a continuous water injector with pressure measurement, and the soft lens enters the broken stone of the renal pelvis through a fourth channel;

injecting water into the water inlet of the outer sheath by using a water injector, detecting water pressure by using a pressure measuring device, and sucking the water at the negative pressure water sucking port;

inserting a guide wire along a fourth channel, and withdrawing the sheath while withdrawing the soft mirror until the outer sheath completely withdraws from the body;

after the ureteral stent is placed along the guide wire, the guide wire is pulled out, and the catheter is placed.

Preferably, the front end of the outer sheath is provided with a bendable flexible sheath with a preset length.

the endoscope of the first channel is utilized to drive the bendable flexible sheath to bend so that the outer sheath is arranged at the junction of the nephropelvis and the ureter.

Preferably, the outer sheath further comprises a support sheath, the support sheath is connected with the bendable flexible sheath, and the outer shell is integrally formed;

the support sheath with the inside winding wire that is equipped with of shell of flexible sheath that can buckle, the wire in the support sheath section shell closely laminates the winding, be equipped with the clearance between the wire when the wire in the flexible sheath section shell that can buckle winds.

Preferably, the inner surface of the sheath main body tube is provided with a C-shaped valve, the outer surface of the C-shaped valve and the inner surface of the sheath main body tube form the third channel, and the inner surface of the C-shaped valve and the inner surface of the sheath main body tube form the fourth channel.

Preferably, the sheath core water outlet is connected with the first gap and is connected with the sheath core water inlet through the first gap;

when the guide wire extends out of the guide wire through hole, a second gap is arranged between the outer surface of the guide wire and the inner surface of the guide wire through hole, and the inner diameter of the guide wire through hole is smaller than that of the second channel main body.

On the basis of conforming to the common knowledge in the field, the above preferred conditions can be arbitrarily combined to obtain the preferred examples of the invention.

The invention has the positive progress effects that:

the invention has the function of negative pressure stone suction, when the stone is sucked by negative pressure, circulating water is formed in the renal pelvis to avoid rupture and bleeding of renal pelvis mucous membrane, the circulating water is used for sucking stone by negative pressure, the stone cleaning rate is improved, a pressure measuring device can be externally connected, the pressure of the renal pelvis is known in real time, and the occurrence of sepsis is prevented.

The invention can also improve the success rate of placing the ureteroscope delivery sheath, reduce the trauma caused by installing the ureteroscope delivery sheath, further utilize the multifunctional sheath to peep the ureter in front of the sheath, and place the sheath at a proper position under direct vision, thereby providing accurate treatment.

Specifically, the present invention has:

1. the sheath has the function of negative pressure stone suction.

2. The sheath is of a double-channel design, one channel is a working channel, so that a soft lens can conveniently enter and exit the broken stone and can conveniently fill water, and when the broken stone is sucked under negative pressure, the channel can be filled with water at the moment, so that circulating water is formed in the renal pelvis, the negative pressure of the renal pelvis is not caused, and rupture and bleeding of the mucous membrane of the renal pelvis are not caused; in addition, circulating water is formed in the renal pelvis, which is favorable for absorbing broken stone under negative pressure and improving the stone purifying rate. Meanwhile, through the channel, a pressure measuring device can be externally connected, so that the renal pelvis pressure can be known in real time, and the occurrence of sepsis is prevented.

3. The front end of the sheath also has a bendable function, so that the soft mirror can move in the renal pelvis with the sheath.

4. Has the function of actively expanding ureter: when the sheath is placed along the guide wire, sterile normal saline can be injected through the water injection channel, and the water is sprayed on the ureter wall through the top end outlet of the sheath core, so that the ureter cavity is expanded by using water, UAS is convenient to insert, and the UAS placement success rate is improved.

5. Visual: the sheath core is provided with two channels, one is a guide wire channel and the other is an endoscope channel, and the portable endoscope is inserted into the channel, so that the condition of the ureter in front of the sheath can be peeped, the sheath can be placed at a proper position under direct vision, and accurate treatment is provided.

Drawings

Fig. 1 is a schematic cross-sectional view of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 2 is a schematic structural view of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 3 is a schematic diagram showing the structure of the front cross section of the ureteral soft lens multifunctional sheath according to embodiment 1 of the present invention.

Fig. 4 is a schematic view showing another cross-sectional structure of the ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 5 is a schematic structural view of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 6 is a schematic view showing a rear sectional structure of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 7 is a schematic structural view of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Fig. 8 is a schematic sectional view of a ureteroscope multifunctional sheath according to embodiment 1 of the present invention.

Reference numerals: 101. an outer sheath; 201. a sheath core; 2011. a first channel; 2012. a second channel; 2013. a sheath core water inlet; 20111. an instrument through hole; 20112. a slope; 20113. an endoscope; 2014. a guide wire; 2015. a first gap; 2016. a sheath core water outlet; 1011. a flexible sheath that is bendable; 1012. a support sheath; 1013. a wire; 1014. an outer sheath main body tube; 1015. a sheath water inlet; 1016. a negative pressure water suction port; 1017. a third channel; 1018. a fourth channel; 1019. a sheath water outlet; 1020. a negative pressure regulating member; 1021. a C-shaped valve.

Detailed Description

The invention is further illustrated by means of the following examples, which are not intended to limit the scope of the invention.

Example 1

In the present embodiment, the positional or positional relationship indicated by the terms such as "center", "upper", "lower", "left", "right", "vertical", "horizontal", "inner", "outer", and the like are based on the positional or positional relationship shown in the drawings, are merely for convenience of describing the present invention and simplifying the description, and do not indicate or imply that the apparatus or element referred to must have a specific orientation, be constructed and operated in a specific orientation, and thus should not be construed as limiting the present invention. Furthermore, the terms "first," "second," and "third" are used for descriptive purposes only and are not to be construed as indicating or implying relative importance.

The front end (upper end in the drawing of the specification) in this embodiment refers to the end close to the multifunctional sheath tip of the ureteroscope and far from the handle, and the positional relationship of the components of this embodiment is described by reference in order to facilitate description of the present invention and simplify description, rather than to indicate or imply that the device or component to be referred to must have a specific orientation, be configured in a specific orientation, and thus should not be construed as limiting the present invention.

Referring to fig. 1 to 8, a ureteroscope multifunctional sheath is provided in this embodiment.

The ureteroscope multifunctional sheath comprises an outer sheath 101 and a sheath core 201.

The sheath 101 includes a sheath main body tube 1014, a sheath water inlet 1015, and a negative pressure water suction port 1016, and a third channel 1017 and a fourth channel 1018 are provided in the sheath main body tube 1014 (see fig. 8).

One end of the third channel 1017 is a sheath water outlet 1019, and the other end is connected to the sheath water inlet 1015.

The size of the fourth channel 1018 is matched with the size of the sheath core 201, one end of the fourth channel 1018 is a sheath core outlet, the other end of the fourth channel 1018 is connected with the negative pressure water suction port 1016, and a negative pressure adjusting member 1020 is arranged on the negative pressure water suction port 1016.

The embodiment is of a double-channel design, one channel is a working channel, soft mirrors can conveniently enter and exit the broken stone and take the broken stone, and one of the functions of the other channel is to conveniently inject water.

When the negative pressure is carried out to suck broken stone, the channel can be used for injecting water, so that circulating water is formed in the renal pelvis, the negative pressure of the renal pelvis is not caused, and rupture and bleeding of the mucous membrane of the renal pelvis are not caused; in addition, circulating water is formed in the renal pelvis, which is favorable for absorbing broken stone under negative pressure and improving the stone purifying rate. Meanwhile, through the channel, a pressure measuring device can be externally connected, so that the renal pelvis pressure can be known in real time, and the occurrence of sepsis is prevented.

In the embodiment, water is discharged from the water outlet of the outer sheath after the water is injected into the water inlet of the outer sheath, and the outlet of the sheath core sucks the water and the broken stone when the fourth channel is at negative pressure and discharges the water and the broken stone from the negative pressure water suction port to form a circulation.

The working process of the ureteroscope multifunctional sheath comprises the following steps:

The inner surface of the sheath body tube is provided with a C-shaped valve 1021.

The outer surface of the C-valve 1021 (the upper C-valve surface in fig. 8) forms the third passageway 1017 with the inner surface of the sheath body tube 1014.

The inner surface of the C-valve 1021 (the lower C-valve surface in fig. 8) forms the fourth passageway 1018 with the inner surface of the sheath body tube 1014.

The inner surface of the fourth channel is cylindrical.

The sheath water inlet is connected with an external pressure measuring device.

The ureteroscope multifunctional sheath comprises an outer sheath 101 and a sheath core 201, wherein the sheath core 201 is used for being installed inside the outer sheath 101.

The sheath 201 includes a first passageway 2011, a second passageway 2012, and a sheath inlet 2013.

An instrument through hole 20111 is arranged at the front end position of the first channel 2011, and the first channel is an endoscope channel and is used for being inserted into the endoscope 20113.

The second passage 2012 is sized to match the guide wire 2014.

When the guidewire is inserted into the second channel 2012, a first gap 2015 is provided between the outer surface of the guidewire and the inner surface of the second channel.

The front end of the second channel is also provided with a wire through hole and a sheath core water outlet 2016.

The sheath core water outlet 2016 is located behind the guidewire through hole.

The sheath outlet 2016 is coupled to the second passageway 2012.

The rear end position of the second channel 2012 is connected to the sheath core water inlet 2013.

By utilizing the first gap 2015, sterile normal saline entering from the water inlet of the sheath core flows to the water outlet of the sheath core along the first gap and then is sprayed out, so that the ureter can be expanded, and the multifunctional sheath of the ureter soft lens can smoothly enter.

The expansion force can be controlled by controlling the water pressure of the sterile physiological saline.

Further, the sheath core water outlet is connected with the first gap and is connected with the sheath core water inlet through the first gap.

Further, the working process of the ureteroscope multifunctional sheath comprises the following steps:

Through the second clearance, sterile normal saline can overflow from the front end of the guide wire through hole, plays a certain lubrication role, and further improves the success rate of placement of the ureter soft lens conveying sheath.

The number of the sheath core water outlets is two, and the two sheath core water outlets are oppositely arranged. The opposite arrangement ensures that the sterile physiological saline is sprayed out relatively to play a role of expansion.

In other embodiments, the number of sheath-core water outlets is one.

In other embodiments, the number of the sheath core water outlets is two, and the two sheath core water outlets are not oppositely arranged.

In other embodiments, the number of sheath core water outlets is greater than two, and the sheath core water outlets are uniformly or non-uniformly disposed.

The number of water outlets is 1, or 2 or more, and the water outlets can be symmetrically distributed or asymmetrically distributed, and the water outlets are arranged on the side surface of the sheath core to play a role in expansion, so that the water outlets fall into the protection scope of the embodiment.

The axis of the water outlet of the sheath core inclines from the second channel to the rear of the sheath core. The water outlet of the sheath core can be smoother by setting a certain inclination angle, and the sheath core is smoother during insertion.

The front end of the instrument through hole is provided with a slope 20112. The slope surface can provide a larger visual field and operation space for the soft mirror.

The front end of the outer sheath 101 (i.e., the front end of the outer sheath main body tube) is provided with a bendable flexible sheath 1011 of a predetermined length. The front end of the sheath also has a bendable function, so that the soft mirror can move in the renal pelvis with the sheath.

The outer sheath further includes a support sheath 1012, which is connected to the flexible sheath and integrally formed with the housing. The support sheath is positioned behind the bendable flexible sheath of the outer sheath body tube.

The supporting sheath and the flexible sheath are provided with a wound wire 1013 inside the housing.

The metal wires in the supporting sheath section shell are tightly adhered and wound, and gaps are formed between the metal wires when the metal wires in the bendable flexible sheath section shell are wound.

The length of the bendable flexible sheath is 5 to 15 cm. The length of the flexible sheath is preferably 10 cm in this embodiment.

The embodiment can improve the success rate of placing the ureteral soft lens conveying sheath and reduce the condition of wound caused by installing the ureteral soft lens conveying sheath.

Further, the condition of the ureter in front of the sheath can be peeped by utilizing the multifunctional sheath, and the sheath can be placed at a proper position under direct vision, so that accurate treatment is provided.

Further, the embodiment also provides a control method of the ureteroscope multifunctional sheath, which comprises the following steps:

inputting an image acquired by using an endoscope into a processing terminal;

the processing terminal identifies target features in the image acquisition image;

acquiring the direction of the target feature in the image;

the control quantity of the endoscope is obtained in two directions;

and controlling the endoscope to drive the bendable flexible sheath to bend towards the actual position of the target feature by using the control quantity.

Specifically, the present embodiment has the following excellent technical effects:

1. the sheath has the function of negative pressure stone suction.

While specific embodiments of the invention have been described above, it will be appreciated by those skilled in the art that these are by way of example only, and the scope of the invention is defined by the appended claims. Various changes and modifications to these embodiments may be made by those skilled in the art without departing from the principles and spirit of the invention, but such changes and modifications fall within the scope of the invention.

Claims

1. The multifunctional ureteroscope sheath comprises an outer sheath and a sheath core, wherein the sheath core comprises a first channel and a second channel, the front end of the first channel is provided with an instrument through hole, the size of the second channel is matched with the size of a guide wire,

2. The ureteroscope multifunctional sheath according to claim 1, characterized in that the water inlet of the outer sheath is externally connected with a continuous water injector with pressure measurement, and the working process of the ureteroscope multifunctional sheath comprises the following steps:

3. The flexible ureteroscope multifunctional sheath according to claim 2, characterized in that when the guide wire is inserted into the second channel, a first gap is arranged between the outer surface of the guide wire and the inner surface of the second channel, a guide wire through hole and a sheath core water outlet are further arranged at the front end position of the second channel, the sheath core water outlet is positioned behind the guide wire through hole, the sheath core water outlet is connected with the second channel, and the rear end position of the second channel is connected with a sheath core water inlet.

4. The ureteroscope multifunctional sheath of claim 3, wherein the working process of the ureteroscope multifunctional sheath comprises:

5. The ureteroscope multifunctional sheath according to claim 4, characterized in that the working process of the ureteroscope multifunctional sheath comprises:

6. The ureteroscope multifunctional sheath according to claim 1, characterized in that the front end of the outer sheath is provided with a bendable flexible sheath of a preset length.

7. The ureteroscope multifunctional sheath according to claim 6, characterized in that the working process of the ureteroscope multifunctional sheath comprises:

8. The ureteroscope multifunctional sheath according to claim 6, characterized in that the outer sheath further comprises a support sheath, which is connected with the bendable flexible sheath and the outer casing is integrally formed;

9. The ureteroscope multifunctional sheath according to claim 1, characterized in that the inner surface of the sheath body tube is provided with a C-shaped valve, the outer surface of which forms the third channel with the inner surface of the sheath body tube, and the inner surface of which forms the fourth channel with the inner surface of the sheath body tube.

10. The ureteroscope multifunctional sheath according to claim 3, characterized in that the sheath core water outlet is connected with the first gap and is connected with the sheath core water inlet through the first gap;