CN1956747A - 成像管 - Google Patents

成像管 Download PDF

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CN1956747A
CN1956747A CNA2005800163811A CN200580016381A CN1956747A CN 1956747 A CN1956747 A CN 1956747A CN A2005800163811 A CNA2005800163811 A CN A2005800163811A CN 200580016381 A CN200580016381 A CN 200580016381A CN 1956747 A CN1956747 A CN 1956747A
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conduit
intubate
guider
imaging sensor
inner chamber
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奥伦·加夫列利
欧弗·弗雷德曼
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ET VISION Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
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    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/00073—Insertion part of the endoscope body with externally grooved shaft
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B1/00064—Constructional details of the endoscope body
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/0661—Endoscope light sources
    • A61B1/0676—Endoscope light sources at distal tip of an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/0661—Endoscope light sources
    • A61B1/0684—Endoscope light sources using light emitting diodes [LED]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0113—Mechanical advancing means, e.g. catheter dispensers
    • A—HUMAN NECESSITIES
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • A61M25/0136—Handles therefor
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1011—Multiple balloon catheters
    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04N—PICTORIAL COMMUNICATION, e.g. TELEVISION
    • H04N23/00—Cameras or camera modules comprising electronic image sensors; Control thereof
    • H04N23/56—Cameras or camera modules comprising electronic image sensors; Control thereof provided with illuminating means
    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04N—PICTORIAL COMMUNICATION, e.g. TELEVISION
    • H04N7/00—Television systems
    • H04N7/18—Closed-circuit television [CCTV] systems, i.e. systems in which the video signal is not broadcast
    • H04N7/183—Closed-circuit television [CCTV] systems, i.e. systems in which the video signal is not broadcast for receiving images from a single remote source
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/0029—Multi-lumen catheters with stationary elements characterized by features relating to least one lumen located at the middle part of the catheter, e.g. slots, flaps, valves, cuffs, apertures, notches, grooves or rapid exchange ports
    • A—HUMAN NECESSITIES
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    • A61M25/00—Catheters; Hollow probes
    • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • A61M25/0026—Multi-lumen catheters with stationary elements
    • A61M25/0032—Multi-lumen catheters with stationary elements characterized by at least one unconventionally shaped lumen, e.g. polygons, ellipsoids, wedges or shapes comprising concave and convex parts

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Abstract

本发明涉及一种将气体或液体之类的流体运送到体内或体外的导管。导管具有三角形内腔和任选的附属结构。一个任选部件是采用放置导管的导向器的导向啮合结构。另一个部件是设置在插管壁内的二级内腔。导管尖端的摄像机和照明器件安装在部分柔性的PCB上，并包装在允许所有部件基本上指向前方的插管中。

Description

成像管
技术领域
本发明通常涉及医疗器械，更具体地说，涉及成像管。
背景技术
将插管插入病人身体器官、洞腔和管道内的操作是急救和危急护理医学中的普通操作过程。可以将气管插管插入不能剧烈呼吸或者接受普通麻醉的病人气管内。必须将气管插管快速、准确地放置，并将其尖端定位在病人气管的中部，以避免意外滑动并且为双肺提供合适的密封和通气。同样，鼻-胃插管通常是通过鼻或嘴插入需要人工喂养或需要抽出胃内容物的病人胃里的。在急救治疗中频繁插入身体洞腔内的另一种插管是尿管。这种导管通过尿道螺旋盘入尿膀胱内。这些插管和导管在其整个使用过程中的正确放置是极其重要的。其它导管的实例有腹膜透析/灌洗管、胸腔插管和直肠插管。
许多患有危急病症或接受普通麻醉的病人都需要人工呼吸。40多年来，最常用的提供人工呼吸的方法是，将压缩空气通过气管插管泵入病人肺内。此插管是通过病人的嘴或鼻插入的并经过声带之间而进入气管内。或者是，插管可通过气管切开术的外科切口插入气管内。对于口腔插管术，操作者经常使用由把柄和刀片构成的喉镜。操作者将刀片插入病人嘴内并使其前进，直到刀片尖端位于舌根外的咽部为止。然后利用把柄操作刀片并且将舌部推到一边，直到能够看见会厌和声襞为止。随后瞄准气管插管的尖端并通过声襞之间推动到气管内。这种插入方法用于大多数的插管术中，但却需要技术、培训和经验，并且仅由专业医师和许可的护理人员来实施。
当插管困难时经常使用的另一种方法是，在纤维光学气管镜上进行。首先，将气管镜和光源连接起来，以便为面对其尖端的视野提供必需的亮度。然后通过气管插管插入气管镜轴，并使其尽可能远地移动。随后通过气管镜的目镜或者视频显示器，在目视下将气管镜尖端插入病人气道并使之通过声襞之间进入气管内。气管插管现在能够被推到气管镜轴以下推并通过声襞之间移动进入气管内。现在将气管插管固定并将气管镜除去，以便释放出气管插管内腔。虽然气管镜法比喉镜法更安全，但是所需设备却昂贵、精密、更繁琐，很少在急救现场或急救车上使用。
在使用过程中将气管插管固定并避免其意外移动，这对于避免可怕事故的发生是极其重要的。通过给在管尖附近围绕插管的管套充气，而使插管外壁与气管内壁之间的空间堵塞，从而提供了气密密封。管套通过管壁上的薄通道与气管插管的外端相连。该通道与单向阀相连，通过此阀门注射空气，以便将管套充气到所需的压力和体积。管套还有助于固定插管就位，但是经常在管头周围施加额外的紧固件，以避免插管滑动或移动。
一旦将插管插入，就有必要查验其是否正确定位。插管意外插入食道或者将其在气道内放置得太深、从而其尖端就位于主干支气管上而不是气管内，这可导致悲惨的结果和窒息。许多方法都可用来查验气管插管的放置。经常对胸腔两侧进行听诊来查验空气是否对称地进入两肺。胸腔x-射线是查验插管放置的另一种良好检验方法。x-射线图揭示出气管插管尖端与气管第一分歧(隆突)之间的关系。无论气管插管何时放置或重新定位，都可以并且应该采集x-射线图。此外，利用吸球通过纤维光学气管镜，或者通过发送和接收声信号，可查验插管的放置。利用这些方法来查验气管插管的初始放置。目前没有可连续监测插管的实际放置的有效装置。
正如若干专利和科学论文所披露的，纤维光学目视的优点与简单设计的喉镜相结合。此外，业已描述了一种包括在气管插管插入过程中观看气道的装置的目视针。然而，还没有公知的方法能够将目视装置永久地并入气管插管的前面并且在无需喉镜的情况下将其插入。
插入身体洞腔的插管经常是用柔性、可变形的软材料制成的，以便与插入的管道轮廓一致，并将施加到接触组织上的压力以及与接触组织的摩擦减到最小。然而，软壁管在插入过程中以及其后易弯曲、坍塌和形成扭结。
为了避免坍塌，一些插管是用更硬的材料制成，或者具有更厚的壁，因此具有对组织造成潜在压力伤害的固有缺陷。目前用软材料(例如硅氧烷)制成的其它插管配有用更硬材料制成的内部支架。例如，存在具有用柔性材料制成的埋置螺旋的气管插管。该螺旋避免坍塌，同时保持插管的轴向柔性。内部螺旋实质上使插管制造的复杂性及其成本增大。
将软管插入身体的困难，经常是用内部半刚性插管器或经过插管的管心针克服的。这种内部插管器吞没了插管腔并且在插入过程中避免其输送流体。使插入过程容易实施的另一种方法是，采用使组织膨胀并产生空间的附件，插管能够以最小的阻力通过此空间。这样的附件包括喉镜和Magil钳。
附图说明
图1A是本发明插管的示意性等距图，示出了三角形内腔；
图1B是本发明插管的示意性等距图，示出了具有圆三角和二级内腔的内腔；
图1C是本发明插管的示意性等距图，示出了与外部相连的二级内腔；
图1D是具有斜尖的本发明插管的示意性等距图；
图2A是本发明插管尖端的示意性等距图，示出了导向啮合结构部件；
图2B是本发明插管尖端的示意性等距图，示出了导向啮合结构部件；
图2C是本发明插管尖端的示意性等距图，示出了导向啮合结构部件；
图2D是本发明插管尖端的示意性等距图，示出了导向啮合结构部件；
图2E是本发明的插管和具有夹持翼的导向器的示意性等距图；
图2F是本发明的插管和具有把柄的导向器的示意性等距图；
图3是本发明导管的示意性剖视图，其采用了用防护套保护的充气套；
图4A是采用柔性PCB的光源和成像传感器组件的示意性等距图；
图4B是采用包装在导管内的柔性PCB的光源和成像传感器组件的示意性等距图。
具体实施方式
一般插管结构
为了克服以上提出的问题，我们公开了一种插入人体或动物身体的洞腔内、用诸如硅氧烷、聚乙烯、乳胶、PVC或类似弹性体之类的柔性软材料制成的插管。本发明的插管具有实质上为三角形的内腔和规则的圆形外围。现在所参照的图1A表示出一段插管10，此插管用于将流体(液体或气体)输送到身体的洞腔内或从其中输送出来或者从身体内或身体外的一个部位输送到另一个部位。内腔12具有实质上为三角形的截面。在一个实施例中，三角形的角14是尖的。在另一个实施例中，如所参照的图1B所示，插管10具有三角形内腔，此三角形的角18是圆的，并且曲率半径一般是插管外径的三分之一至八分之一。本发明的另一方面是与本发明插管的三角形主腔共存的二级内腔。该图示出了在壁28内具有不同形状和位置的多个二级内腔22，24，26。在本发明的一个优选实施例中，这些二级内腔占据了管壁的更厚部分。二级内腔22示出了具有圆形截面并且完全埋置在壁28中。二级内腔24示出了具有椭圆形截面并且也完全埋置在壁中。二级内腔以与外部或内部表面相距任意距离的方式设置在管壁中。它们还可暴露到大气中(如图1C所示)。二级内腔22经由狭缝30对外部敞开。同样，二级内腔可通过插管内部的狭窄缝隙而开放。这样的开口能够用来在管壁中插入电缆、电线、纤维、光学纤维或插入工具。通过加热或通过施加保护层或利用胶水可以密封狭缝。通过狭缝将电缆或其它纵向部件插入管壁内，比使这些部件螺旋通过狭窄的二级内腔更容易些。二级内腔的开口一般是密封的，直到使用时才打开。在图1D中，描述了本发明的一个优选实施例，其中插管10的尖端是斜的，因此壁28也是斜的。
导向器
本发明的另一方面是，提供一种用于将柔性管导入人或动物具体的洞腔内的装置。按照本发明的一个方面，导向器有助于放置柔性管。导向器是一般用金属或塑料制成的刚性或半刚性细长工具，其插在内腔或二级内腔中或者插在外部狭缝或内部狭缝中，或者完全在外部，而从内部附着到插管的内表面上或者肤浅地附着到插管的外表面上。外部设置的导向器可沿管轴在一个或多个部位附着到插管上。一般而言，导向器也可部分设置在管内部以及部分设置在管的内腔或狭缝中。为了完成导向，本发明的导向器与管的尖端啮合，以便插管一旦放置，就容易去除。如图2A-F所示，用于完成导向的导向啮合结构部件与插管相连而形成。在图2A中，啮合结构部件42是在尖端附近围绕插管的四周圆环。在图2B中，啮合结构部件42是在尖端附近围绕插管的四周槽。在图2C中，啮合结构部件42是插管中的凹陷。另一种啮合部件是折痕。在图2D中，啮合部件是槽，导向器的尖端插入其中，从而允许被导向器44向前推。在图2E中，啮合部件42可被导向器44推动。具有两个管夹持翼46的导向器位于与啮合点相距一段能够沿管轴固定导向器的距离的地方。在一些实施例中，导向器安装到诸如容易实施扭转的把柄上。一些把柄可弯曲形成用于把持导管的圆形结构，从而有助于导向和/或释放。在图2F中，所示出的把柄48将插管50贴切地把持在缺口52中。为了释放导向器54，把柄向一边扭转并且导向器抽回。
导向器与插管的啮合是暂时的，因此在插入过程完成之后，导向器可从插管上脱离并除掉。通过抽回导向器或者通过扭转并抽回，可完成脱离。由于导向器具有安装翼，因此通过沿管轴抽拉导向器直到安装翼从对插管的保持释放为止，而抽回导向器。如果翼不太紧，那么插管就通过拉到一边而释放出来。在导向器通过二级内腔或者在插管旁边的狭缝中这样的情形中，其经常仅仅部分通过插管。在这样的情形中，管壁上具有将外部与内腔或狭缝连接起来的插孔。
套筒保护
利用充气套或套筒固定导管，这是公知的，诸如这样的器械公开在国际专利申请WO 2004/043527中。管套/套筒通过插入管形结构中而用来锚定导管和/或阻塞通道，从而通过给管套/套筒充气，而由径向推靠结构壁的导管套/套筒完成牢固的内部把持。按照本发明的一个实施例，管套/套筒由外部套筒保护着(如现在所参照的图3所示)。插管60中的纵向剖面表示出管壁62(剖面线部分)、套筒充气管64(在其它实施例中是埋置在管壁内)、和套筒66。防护套68覆盖充气套。防护套对给插管充气的套筒施加机械保护。当导向器与套管一起使用时，有两个主要的可能布置来容纳导向器。按照一个布置，一个细长袋在管的旁边插入，从而除了插入导向器的开口之外其被管套完全覆盖。在另一个布置中，通过与二级内腔相连的管侧面上的孔插入导向器。这种情形中的套筒，可在充气之后覆盖进入孔，从而堵塞入口，避免二级内腔被污染。
照明和成像传感器组件以及包装
本发明的导管特别有益的是具有照明单元，此单元由于诸如操纵导管并监测身体内部之类的原因而特别有用。成像传感器安装在本发明的导管尖端(如现在所参照的图4A-B所示)。图4A表示出，成像传感器和透镜74装配在微型PCB(印刷电路板)76上。在柔性PCB副翼78上安装的是光源，一般是LED(发光二极管)80。成像传感器和照明部件的这种特定组件使光源便于设置在与成像传感器透镜基本相同的水平上。在其它实例中，照明部件也可与成像传感器在不同的水平上、在其之下或之上。在图4B中，所示出的成像传感器组件包装在导管84内，从而成像传感器74和整个组件保持适当的角度，一般将照明部件指向前。馈送线86沿插管84的内腔运行。在本发明的一个优选实施例中，馈送成像传感器的电线与馈送光源的电线不同。单独馈送对于照明部件而言比对于成像传感器而言更容易执行不同的激励体系。例如，为了避免过度加热，光可周期性中断或者暗淡，或者其中一些照明部件关闭，或者使用不同的光谱，而成像传感器不会伴随着改变。
三角形内部周围的益处
在内部三角形插管每个单位长度的质量与内部圆形插管的质量相同的情况下，内部三角形插管具有更高的弯曲强度、抗坍塌性和避免扭结性。内部三角形内腔插管的附加优点是，它能够容纳相当大宽度的二级内腔。本发明插管的基本上为三角形的内腔可应用于插入体内的所有柔性壁插管，这些插管包括(但不限于)气管插管、鼻-胃插管、胸腔插管、腹膜插管、尿管、直肠插管。这种形式的内腔还可应用于为了将流体从一个洞腔传送到另一个洞腔而植入体内的插管，例如用来将脑脊髓液从脑室分流到胸腔或腹腔的插管。

Claims (13)

1、一种导管，用于经从如下组选择的途径从一个部位向另一个部位运送流体，所述组包括体内至体外、体内的第一部位至第二部位、体外至体内的部位，所述导管包括具有三角形内腔的插管。
2、如权利要求1所述的导管，其特征在于，一个成像传感器组件包装在所述插管的尖端内部。
3、如权利要求1所述的导管，其特征在于，至少一个二级内腔与所述内腔并排设置在所述插管壁中。
4、如权利要求3所述的导管，其特征在于，所述二级内腔在所述插管侧面是对外部开放的。
5、一种导管，其中至少一个导向啮合结构部件设置在所述导管的表面上。
6、一种用于放置一个导管尖端的导向器，通过暂时与导管结构啮合而放置导管尖端，其中所述导向器实质上是细长的和刚性的。
7、如权利要求6所述的用于放置导管尖端的导向器，其中所述导向器具有插管夹持翼。
8、如权利要求6所述用于放置导管尖端的导向器，其中所述导向器安装到把柄上。
9、权利要求8所述用于放置导管尖端的导向器，其中所述把柄采用用于夹持所述导向器的装置。
10、一种照明和成像传感器组件，其中包含在由成像传感器和照明器件构成的目录中的至少一个项目，装配在微型PCB上，包含在由成像传感器和照明器件构成的目录中的至少一个项目，装配在所述PCB的柔性PCB副翼上。
11、如权利要求10所述的照明和成像传感器组件，其特征在于，所述PCB和所述PCB副翼包装在导管中。
12、一种照明和成像传感器组件，其中不同的电路分别激励所述至少一个照明部件和所述至少一个成像传感器。
13、一种导管，用于经从如下组选择的途径从一个部位向另一个部位运送流体，所述组包括体内至体外、体内的第一部位至第二部位、体外至体内的部位，其中所述导管采用能够充气的套筒，所述导管具有在外部设置在所述充气套筒之上的防护套筒。
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