CN1225229C - 一种用来关闭身体孔洞的闭合导管 - Google Patents

一种用来关闭身体孔洞的闭合导管 Download PDF

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CN1225229C
CN1225229C CNB988125013A CN98812501A CN1225229C CN 1225229 C CN1225229 C CN 1225229C CN B988125013 A CNB988125013 A CN B988125013A CN 98812501 A CN98812501 A CN 98812501A CN 1225229 C CN1225229 C CN 1225229C
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阿里·阿夫尼
维京托·莱文
鲍里斯·施图尔
达恩·奥兹
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Abstract

一种视频摄像内窥镜(20)包含一个具有一个远端和一个近端的大体刚性的长形插入单元(22)以及一个固定在插入单元远端处的视频摄像头(30)。一个套筒(26)套在插入单元上并覆盖了插入单元，该套筒有一个覆盖着视频摄像头的远端部分，该远端部分的至少一部分(36)基本上是透明的。

Description

视频摄像直肠镜
技术领域
本发明一般地涉及医疗探头，具体地涉及内窥镜。
背景技术
对于大肠直肠和乙状结肠的可视检查和诊断，在该技术领域中已知有各种类型的内窥镜。由于刚性的直肠镜和乙状结肠镜具有耐久、易用和比较价廉等优点，所以它们的使用最为普遍。
为了用刚性直肠镜(或乙状结肠镜)进行检查，医生首先通过肛门插入窥视镜。为了易于插入，窥视镜中塞有一个从其远端伸出的带有钝圆远端部的塞头。当窥视镜到位后，医生将取走塞头并用一个插头封住窥视镜的近端。在插头内安装了一个专用望远镜，使医生能观察窥视镜远端处的直肠和乙状结肠的内部，该观察可以是直接看，或者也可以利用连接在望远镜近端的摄像机。为了照明被观察区域，外部控制柜中有一个光源通过光纤被连接到窥视镜的近端。典型地，该插头还含有一个或几个工作通道，用于通过窥视镜注液、注气或插入手术器械。
这种类型的各种直肠镜和乙状结肠镜可以通过商业渠道购得。例如，德国Tuttlingen市的Karl Storz GmbH(公司名)能供应型号为24911S的直肠镜，它可以借助于一个棒状透镜望远镜(其型例如为24946B)来直接观察或通过一个Karl Storz内窥视频摄像机观察直肠。这种直肠镜及其附件是用不锈钢制作的，可以在各次使用之间进行杀菌和消毒。
还可以购得带有一次性窥视镜和塞头的直肠镜和乙状结肠镜，例如纽约州Skaneateles市Welch Allyn Inc.(公司名)生产的KleenSpec(商标名)一次性乙状结肠镜。其窥视镜和塞头是用塑料制作的。窥视镜通过卡夹或螺纹固定到一个多用途手柄上，该手柄上可以安装光源、望远镜、摄像机和器械。
柔性的乙状结肠镜和结肠镜也是本技术领域所已知的。大多数这种结肠镜含有一个光纤束，用来把结肠镜远端处大肠内部的图像传送到固定于近端处的一个目镜或摄像机上。有些柔性结肠镜在其远端有一个带有物镜的CCD(电荷耦合器件)探测器，例如日本东京AsahiOptical Company(公司名)制造的Pentax ES-3801PVE视频摄像乙状结肠镜。不过，与刚性直肠镜和乙状结肠镜相比，柔性镜比较昂贵、易损和难以清洗。
发明内容
本发明某些特色的一个目的是提供一种改良的内窥镜，特别是一种改良的直肠镜。
本发明某些特色的一个目的是提供一种能改善直肠内解剖学特征的可视度的视频摄像直肠镜。
本发明某些特色的另一个目的是提供一种医务人员使用容易和方便的直肠镜。
本发明某些特色的又一个目的是提供一种含有易于更换的一次性使用部分的直肠镜，从而最大限度地减少或免除了各次使用之间杀菌和消毒的必要性。
本发明某些特色的再一个目的是提供易于把内窥镜，特别是直肠镜或乙状结肠镜，插入到体腔内的方法和设备。
本发明某些特色的再一个目的是提供一种改良的内窥镜导向机构。
根据本发明的一方面，提供了一种视频摄像内窥镜，它包括：
一个大体刚性的长形插入单元，它含有一个远端和一个近端；
一个固定于插入单元远端处的视频摄像头；以及
一个可去除地套在插入单元上并覆盖了插入单元的套筒，它有一个覆盖着视频摄像头的远端部分，该远端部分的至少一部分是基本透明的，
其中套筒的远端部分包括一个窄小顶端，该顶端能使内窥镜易于通过肛门插入，及
其中的窄小顶端包括两个或更多个叶片，当通过肛门插入时这些叶片是闭合的，当插入后这些叶片是打开的，以暴露出套筒的远端部分的透明部分。
较佳地，为了打开叶片，套筒被相对于插入单元向近端方向拉移。
较佳地，该套筒含有一个沿纵向穿过它的工作通道，及
其中该套筒在其工作通道内含有一个单向阀门，用于防止流经其中的流体的返流。
通过下面结合附图对本发明一些优选实施例的详细说明，将可更充分地理解本发明，在附图中：
附图说明
图1是根据本发明一个优选实施例的直肠镜的原理性部分剖面图；
图2是图1直肠镜的远端部分的详细剖面图；
图3A和3B分别是根据本发明另一优选实施例的被一个处于闭合状态和打开状态的套筒所覆盖的直肠镜的原理性剖面图；
图4A是根据本发明另一个优选实施例的直肠镜的远端部分的原理性剖面图；
图4B是由图4A直肠镜所获取的视频图像的示意图；
图5A是根据本发明一个优选实施例的直肠镜的远端部分的原理性剖面图；
图5B是根据本发明另一个优选实施例的特别适合于与图5A直肠镜结合使用的直肠插入器的原理性剖面图；以及
图6是根据本发明又一个优选实施例的直肠镜的原理性剖面图。
具体实施方式
现在参见图1，这是根据本发明一个优选实施例的视频摄像直肠镜20的原理性部分剖面图。直肠镜20包括一个可插入到患者直肠内的插入部分22和一个供检查医生把握的手柄24。插入部分22含有一个固定在手柄24上的插入单元28和一个覆盖着插入单元的一次性套筒26。单元28在其远端处含有一个视频摄像头30，该摄像头通过导线32与手柄24连接。套筒26最好由例如聚碳酸化合物等生物兼容塑料材料做成，并且以本技术领域所知的快速连接方式与手柄24连接。套筒26在使用之后将被取下并丢弃。
图2详细说明含有摄像头30的插入部分22的远端的原理性剖面图。摄像头包含一个探测器阵列芯片46，它最好包括例如Sony(索尼公司)的ICX087AKB CCD芯片这样的彩色CCD阵列50，其上还配置了一个合适的光学滤色器48。有一个或几个灯42照明着摄像头视场中的大肠区域。该区域的图像通过套筒26上的光学窗口36被一个物镜44聚焦到阵列50上，从而被接收到。
由芯片46产生的信号由导线32传送给手柄24，再通过一个电缆38(图1)从手柄传送给一个视频柜，在其中信号将得到处理并被用来驱动一个视频显示器。视频柜和显示器(图中未示出)都采用本技术领域熟知的标准视频电子技术。或者，也可以使手柄24含有电源，例如一节或几节电池，以及处理电路和一个视频发射机，并通过无线连结把经过处理的芯片46的信号传送给视频柜。
灯42最好包括一些白光LED，例如瑞士Basel(市Sloan AG(公司名)所生产的T1 White L3-W31N LED。这些灯由视频柜通过导线32和电缆38所传送的电流供电。或者，这些灯也可以由手柄24中的上述电池供电。不论哪种情况，采用灯42可以免去在本技术领域所知的内窥镜中因采用高功率光纤光源来照明观察区域而造成的复杂性和高成本。
图2中示出的窗口36显得比较小，这是为了简化套筒26的制作和降低其成本。套筒26在窗口周围还有一个透明面积，以让灯42发出的光能到达观察区域，但这个面积不需要具有光学级质量。事实上，如果愿意，整个套筒26都可以用透明塑料制成。
应该指出，透镜44和阵列50的光轴相对于单元28的纵轴倾斜了一个角度。窗口36和套筒26的远端也有类似的倾斜角。与本技术领域已知的刚性直肠和乙状结肠镜直接正对着大肠的情形相比，这个倾斜角使得摄像头30能观察比较靠近插入部分22远端的大肠壁区域。由于这种布局，插入部分22的远端可以做得比较窄小而尖细，使得能在不需要单独的塞头的情形下较容易通过患者的肛门插入，同时减少患者的痛苦。球状突起34最好形成在套筒26的远端顶部，其形状最好使得在插入肛门时给患者带来的不舒适感最小化。
套筒26最好至少有一个工作通道38，该通道在套筒远端形成一个开口52。通道38可以用来把例如医用镊子等手术器械插入到大肠内，并在摄像头30的监视下进行手术处理。由于手术器械将对摄像头视场内的大肠壁进行处理，所以上述摄像头的倾斜取向将特别有利于监视这种处理。
附加地或者替代地，通道38也可以用于对大肠的吸取、注液和/或注气，如本技术领域已知的，为此只需把该通道连接到一个合适的泵或气源上。这一连接最好通过手柄24实现，并且吸取、注液或注气最好由手柄上的用户控制器40控制。通常，在检查时希望对大肠充气，以迫使大肠壁离开窗口36，让摄像头30能清晰地看到大肠壁。为此，套筒26最好在其通道38中含有一个单向阀门54，例如本技术领域所知的叶瓣式阀门。当加压气体通过通道对大肠充气后，阀门54将封闭以防止气体返流并保持大肠内的压力。
图3A和3B是说明根据本发明另一个优选实施例的含有一个一次性套筒62的直肠镜60的原理性剖面图。直肠镜60含有一个在其远端有一个视频摄像头30的大体刚性的插入单元28，这一点与图1和2中的直肠镜是基本相同的，但是在直肠镜60中，摄像头的光轴大体上是与单元28的纵轴相一致的。
套筒62包括一个外层64和一个内层66。内层最好由例如聚碳酸化合物等大体刚性的塑料材料做成，并能适配地套在插入单元28上。内层66有一个透明的远端部分，如前所述，其中最好有一个光学窗口68。外层64最好由例如聚乙烯等柔软有弹性的塑料做成，其上有两个或多个叶片70，最好是三个叶片。
如图3A所示，当把直肠镜60插入肛门时，各叶片70将合在一起，封闭住直肠镜的远端并保护着窗口68。这些叶片最好构成一个钝滑的尖顶结构，以便易于插入。
如图3B所示，当插入之后，各叶片70将被打开，以暴露出窗口68，从而使摄像头30能接收大肠内部的图像。这些叶片的打开最好是这样实现的：相对于内层66，向近端方向即直肠外的方向(图3A和3B中的向右方向)拉动外层64。每个叶片70最好都有一个向内的突起72，它保持着与内层的接触，从而拉动时将强迫叶片打开，如图3B所示。在完成了直肠镜处理之后，套筒62可以恢复成图3A的形状，以便通过肛门取出。
图4A是说明根据本发明另一个优选实施例的直肠镜76的远端部分的原理性剖面图。直肠镜76与图1和2所示的直肠镜20大体相似，它包括其远端处带有摄像头30的插入单元28。直肠镜76被一个套筒78覆盖，该套筒78除了有一个伸入到摄像头30视场内的一个球状突起80之外，其余与套筒26相似。在突起80上固定有一个反射镜82，其位置和取向使得通常为直肠壁的生理结构84的图像能被该反射镜反射并通过窗口36被摄像头30获取。在图4A所示的例子中，手术器械88被通过套筒78中的工作通道38插入，用来采集结构84上地点86处的生物样品。
图4B是说明用图4A结构的直肠镜76所获取的视频图像90的示意图。该图像的上面部分示出了摄像头30通过窗口36直接看到的器械88和结构84。由于摄像头的视角，器械的图像发生与距离有关的按透视法缩短。因此仅根据这样的图像是难以判断器械与结构之间的距离的。图像90下面部分的一个插入图92示出了通过反射镜82看到的器械88和结构84。在此情况下，观看器械的角度使得能清楚地看到器械的位置和它至结构84的距离，从而能以较大的精度予以控制。
图5A是根据本发明另一个优选实施例的直肠镜106的远端部分的原理性剖面图。直肠镜106除了其插入单元28含有至少一个柔软有弹性的部分108之外，其余基本上与图1和2所示的直肠镜20类同。弹性部分108中最好含有一个弹簧元件，例如插入一个弹簧钢，在正常情况下该弹簧钢使弹性部分保持直线形，但当其上被施加了横向力时将允许其弯曲。更好地，直肠镜106的套筒26含有例如聚乙烯或硅胶等柔软有弹性的材料，以便在弹性部分108弯曲时套筒也能相应地弯曲和伸长。
直肠镜106的弯曲能力使得在插入直肠到达乙状结肠时能比完全刚性的直肠镜或乙状结肠镜的插入更容易一些，并且对患者造成的痛苦和不舒适感也要小一些。已有技术的刚性直肠镜不可以像直肠镜106那样含有一个柔性部分，这是因为柔性部分的弯曲将破坏内窥观察所用望远镜的光轴。虽然已知技术的乙状结肠镜也可以弯曲并且插入时给患者造成的不舒适性比刚性镜小，但是这种柔性镜需要复杂而昂贵的导向机构。本发明通过把摄像头30设置在直肠镜106的远端处，提供了一种不需要导向机构的柔性结构。
图5B示出根据本发明一个优选实施例的直肠插入器102的原理性剖面图，该直肠插入器可用于对患者大肠96的内窥检查和处理。插入器102特别有用于把直肠镜106导引到大肠内，但也可以与已有技术的普通柔性内窥镜配合使用。插入器102最好由例如聚碳酸化合物等大体刚性但稍有柔性的塑料材料做成，这样可使插入容易一些。插入器内部有一条弯曲的通道104穿过，该通道的内径大小足以让例如直肠镜106等内窥镜插入通过。
插入器102被插入到直肠98内，一直到达大肠96的乙状弯曲100处。然后转动插入器使通道104的开口对着大肠的乙状结肠部分101，如图5B所示。然后使直肠镜106穿过插入器，这时它将着通道的弯曲而弯曲。把带有摄像头30的直肠镜远端推入乙状结肠101，使得可以对大肠96中的下述部分进行检查和处理，若不采用本发明，这样的部分只有使用普通的柔性内窥镜才能达到。插入器102还防止了乙状弯曲100区域受到直肠镜(或通过插入器插入的普通柔性内窥镜)的压力，否则这种压力可能会造成痛苦甚至大肠穿孔。
图6是根据本发明另一个优选实施例的含有一个导向机构111的直肠镜110的原理性剖面图。与前述一些优选实施例相同，直肠镜110也含有插入单元28和摄像头30，它们被一个在远端处带有光学窗口36的一次性套筒112覆盖着。直肠镜110的插入单元28或者像参考图5A所说明的那样含有一个柔性部分，或者如图6所示那样基本上在整个长度上都被做成是柔性的。
导向机构111包括两个位在套筒112内的柔性、长形气囊118和120，它们分别设置在插入单元28的两个径向相对的侧壁上。气囊118和12分别具有可膨胀的壁部分114和116，这两个部分最好如图6所示那样是手风琴折迭状的壁。两个气囊分别通过阀门124与一个压力源126相连，其中的压力源例如是一个气瓶或气泵，阀门和压力源可以含在直肠镜110的手柄122中或者设在一个分开的控制箱中。通过操纵阀门124，气囊118和120将分别被加压到压力P1和P2。在图6所示的例子中，P1＞P2，使气囊118的壁部分114膨胀，气囊120的壁部分116收缩，从而使插入单元28弯曲。
这样，通过对套筒112内的两个气囊118和120充气或放气，机构111为直肠镜110的可控弯曲和导向提供了一种简单、低成本的一次性使用装置。为了实现对直肠镜弯曲形状和方向的更大的控制，还可以沿着直肠镜的长度方向和/或径向设置更多的气囊。应该指出，不论是一次性的或是可重复使用的，这种压力驱动的导向机构也能应用于其他类型的内窥镜。
还应该指出，上述各个实施例只是作为例子给出的，本发明的完整范畴仅由权利要求书限定。

Claims (3)

1、一种视频摄像内窥镜，它包括：
一个大体刚性的长形插入单元，它含有一个远端和一个近端；
一个固定于插入单元远端处的视频摄像头；以及
一个可去除地套在插入单元上并覆盖了插入单元的套筒，它有一个覆盖着视频摄像头的远端部分，该远端部分的至少一部分是基本透明的，
其中套筒的远端部分包括一个窄小顶端，该顶端能使内窥镜易于通过肛门插入，及
其中的窄小顶端包括两个或更多个叶片，当通过肛门插入时这些叶片是闭合的，当插入后这些叶片是打开的，以暴露出套筒的远端部分的透明部分。
2、、根据权利要求1的内窥镜，其中为了打开叶片，套筒被相对于插入单元向近端方向拉移。
3、根据权利要求1的内窥镜，其中，该套筒含有一个沿纵向穿过它的工作通道，及
其中该套筒在其工作通道内含有一个单向阀门，用于防止流经其中的流体的返流。
CNB988125013A 1997-11-04 1998-11-02 一种用来关闭身体孔洞的闭合导管 Expired - Fee Related CN1225229C (zh)

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US6855107B2 (en) 2005-02-15
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