CN206473380U - Adjustable arteriovenous puncture needle and indwelling sleeve matched with same - Google Patents
Adjustable arteriovenous puncture needle and indwelling sleeve matched with same Download PDFInfo
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- CN206473380U CN206473380U CN201621164926.5U CN201621164926U CN206473380U CN 206473380 U CN206473380 U CN 206473380U CN 201621164926 U CN201621164926 U CN 201621164926U CN 206473380 U CN206473380 U CN 206473380U
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- 210000004204 blood vessel Anatomy 0.000 claims abstract description 21
- 239000008280 blood Substances 0.000 claims description 4
- 210000004369 blood Anatomy 0.000 claims description 4
- 239000012528 membrane Substances 0.000 claims description 4
- 230000023555 blood coagulation Effects 0.000 claims description 3
- 239000007788 liquid Substances 0.000 claims description 2
- NFGXHKASABOEEW-UHFFFAOYSA-N 1-methylethyl 11-methoxy-3,7,11-trimethyl-2,4-dodecadienoate Chemical compound COC(C)(C)CCCC(C)CC=CC(C)=CC(=O)OC(C)C NFGXHKASABOEEW-UHFFFAOYSA-N 0.000 claims 7
- 238000007710 freezing Methods 0.000 claims 2
- 238000006073 displacement reaction Methods 0.000 claims 1
- 238000003780 insertion Methods 0.000 claims 1
- 230000037431 insertion Effects 0.000 claims 1
- 230000001681 protective effect Effects 0.000 abstract description 10
- 229910001285 shape-memory alloy Inorganic materials 0.000 abstract description 5
- 239000003146 anticoagulant agent Substances 0.000 description 7
- 229940127219 anticoagulant drug Drugs 0.000 description 7
- 230000002429 anti-coagulating effect Effects 0.000 description 5
- 238000001746 injection moulding Methods 0.000 description 5
- 239000000463 material Substances 0.000 description 5
- 239000012778 molding material Substances 0.000 description 4
- 230000010100 anticoagulation Effects 0.000 description 3
- 238000010586 diagram Methods 0.000 description 3
- 238000001802 infusion Methods 0.000 description 2
- 239000002861 polymer material Substances 0.000 description 2
- 229910001200 Ferrotitanium Inorganic materials 0.000 description 1
- 208000007536 Thrombosis Diseases 0.000 description 1
- 230000036772 blood pressure Effects 0.000 description 1
- 230000015271 coagulation Effects 0.000 description 1
- 238000005345 coagulation Methods 0.000 description 1
- 238000012790 confirmation Methods 0.000 description 1
- 230000007812 deficiency Effects 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 238000001990 intravenous administration Methods 0.000 description 1
- 238000002955 isolation Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 238000000034 method Methods 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 238000012544 monitoring process Methods 0.000 description 1
- 231100000252 nontoxic Toxicity 0.000 description 1
- 230000003000 nontoxic effect Effects 0.000 description 1
- 206010033675 panniculitis Diseases 0.000 description 1
- 239000000243 solution Substances 0.000 description 1
- 238000004659 sterilization and disinfection Methods 0.000 description 1
- 210000004304 subcutaneous tissue Anatomy 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
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- Infusion, Injection, And Reservoir Apparatuses (AREA)
Abstract
一种可调节式动静脉穿刺针及与其配套的留置套管和外保护套,包括针体、针芯和导丝,所述针芯的尾端固定在针体上,所述针芯上沿针芯方向设有与针芯长度相匹配、且限制导丝径向移动和轴向旋转的至少一根轨道,所述导丝安装在所述轨道内,所述导丝为形状记忆合金制作而成,初始状态时导丝不伸出轨道,所述导丝上固定有方便带动导丝移动伸出轨道的手柄,所述导丝伸出轨道后呈现自然状态,所述导丝在自然状态下与针芯头端延伸方向设有一夹角,所述夹角使得针芯以固定角度插入血管后,导丝在自然状态下与血管平行,本实用新型结构简单,操作方便,适用范围大,方便可靠,易于推广,实用价值大。
An adjustable arteriovenous puncture needle and its matching indwelling sleeve and outer protective sleeve, including a needle body, a needle core and a guide wire, the tail end of the needle core is fixed on the needle body, and the upper edge of the needle core The direction of the needle core is provided with at least one track that matches the length of the needle core and limits the radial movement and axial rotation of the guide wire. The guide wire is installed in the track, and the guide wire is made of shape memory alloy. In the initial state, the guide wire does not extend out of the track, and the guide wire is fixed with a handle that facilitates the guide wire to move and extend out of the track. After the guide wire extends out of the track, it presents a natural state. There is an included angle with the extending direction of the tip of the needle core. The angle makes the guide wire parallel to the blood vessel in a natural state after the needle core is inserted into the blood vessel at a fixed angle. The utility model has the advantages of simple structure, convenient operation, wide application range and convenience Reliable, easy to promote, and great practical value.
Description
技术领域technical field
本实用新型涉及一种可调节式动静脉穿刺针及与其配套的留置套管和外保护套。The utility model relates to an adjustable arteriovenous puncture needle and an indwelling sleeve and an outer protective sheath matched with it.
背景技术Background technique
在临床工作中,为了对患者实施静脉输液,动脉有创血压监测等诊疗操作,经常需要进行动静脉穿刺置管,但是对于部分皮下组织较厚,血管位置较深的部位,传统的穿刺针在穿刺入血管后,难以调整角度至与血管平行,因此经常在推进留置套管时穿破血管,导致留置套管留置失败,造成需要多次穿刺才能完成留置套管留置,加重了病患的痛苦。In clinical work, arteriovenous puncture and catheterization are often required in order to perform intravenous infusion, arterial invasive blood pressure monitoring and other diagnostic and therapeutic operations on patients. However, for some parts with thicker subcutaneous tissue and deeper blood vessels, traditional puncture needles After the puncture into the blood vessel, it is difficult to adjust the angle to be parallel to the blood vessel, so the blood vessel is often punctured when the indwelling sleeve is pushed, resulting in the failure of the indwelling sleeve, resulting in the need for multiple punctures to complete the indwelling sleeve, which aggravates the pain of the patient .
实用新型内容Utility model content
本实用新型针对现有技术的不足而提供了一种结构简单,操作方便,适用范围大,方便可靠,易于推广,实用价值大的一种可调节式动静脉穿刺针及与其配套的留置套管和外保护套。The utility model provides an adjustable arteriovenous puncture needle with simple structure, convenient operation, wide application range, convenience and reliability, easy popularization and great practical value and its supporting indwelling sleeve for the deficiencies of the prior art and outer case.
本实用新型采用如下技术方案实现:一种可调节式动静脉穿刺针,包括针体、针芯和导丝,所述针芯的尾端固定在针体上,所述针芯上沿针芯方向设有与针芯长度相匹配、且限制导丝径向移动和轴向旋转的至少一根轨道,所述导丝安装在所述轨道内,所述导丝为形状记忆合金制作而成,初始状态时导丝不伸出轨道,所述导丝上固定有方便带动导丝移动伸出轨道的手柄,所述导丝伸出轨道后呈现自然状态,所述导丝在自然状态下与针芯头端延伸方向设有一夹角,所述夹角使得针芯以固定角度插入血管后,导丝在自然状态下与血管平行。The utility model is realized by adopting the following technical solutions: an adjustable arteriovenous puncture needle, including a needle body, a needle core and a guide wire, the tail end of the needle core is fixed on the needle body, and the needle core is The direction is provided with at least one track that matches the length of the needle core and limits the radial movement and axial rotation of the guide wire. The guide wire is installed in the track, and the guide wire is made of shape memory alloy. In the initial state, the guide wire does not extend out of the track, and the guide wire is fixed with a handle that facilitates the guide wire to move and extend out of the track. After the guide wire extends out of the track, it presents a natural state. An included angle is set in the extension direction of the tip end of the core, and the included angle makes the guide wire parallel to the blood vessel in a natural state after the needle core is inserted into the blood vessel at a fixed angle.
所述针体上设有限定手柄轴向旋转、且限定手柄轴向移动距离的滑槽,所述手柄安装在所述滑槽内。The needle body is provided with a chute that limits the axial rotation of the handle and the axial movement distance of the handle, and the handle is installed in the chute.
所述轨道设置在针芯的针芯壁内。The track is arranged in the core wall of the core.
所述导丝在自然状态下与针芯延伸方向的夹角为45°。The included angle between the guide wire and the extending direction of the needle core is 45° in a natural state.
所述针体内设有透明的空腔,所述针芯内腔与针体内空腔连通,所述针芯和针体连接处、在与血液接触面上设有具有抗凝血作用的抗凝层,这样在针芯与针头安装时,抗凝层起到隔离固定针芯与针体连接位置的作用,这样防止针芯与针体连接采用的材料对凝血的影响,所述针体空腔的尾端通过尾塞与外界连通,所述尾塞通过不透液体的透气膜密封。The needle body is provided with a transparent cavity, the inner cavity of the needle core communicates with the cavity in the needle body, and the joint between the needle core and the needle body is provided with an anticoagulant with anticoagulant effect on the contact surface with blood. layer, so that when the needle core and the needle head are installed, the anticoagulation layer plays the role of isolating and fixing the connection position between the needle core and the needle body, so as to prevent the influence of the material used for the connection between the needle core and the needle body on blood coagulation, and the cavity of the needle body The tail end communicates with the outside world through a tail plug, which is sealed by a liquid-tight gas-permeable membrane.
所述透气膜由尾塞盖固定在尾塞内。The breathable membrane is fixed in the tail plug by the tail plug cover.
一种留置套管,包括导管和套管体,所述导管尾端通过由具有抗凝血作用的抗凝塞固定在套管体上,所述导管内腔与套管体中部空腔连通,此处抗凝塞是围绕在导管外部的,导管尾端从抗凝塞中心穿过与套管体中部空腔相通,抗凝塞与抗凝层作用相同,所述导管的内径大于针芯和导丝联合形成的外径,所述套管体的中部空腔内径与针体前端外径相匹配,所述套管体安装在针体前端时,所述针芯和导丝从导管内穿过,并且伸出所述导管的头端,所述导管的头端为尖端。An indwelling sleeve includes a catheter and a sleeve body, the tail end of the catheter is fixed on the sleeve body by an anticoagulant plug having an anticoagulant effect, and the inner cavity of the catheter communicates with the cavity in the middle of the sleeve body, Here, the anticoagulation plug surrounds the outside of the catheter, and the tail end of the catheter passes through the center of the anticoagulation plug and communicates with the cavity in the middle of the sleeve body. The outer diameter formed by the combination of the guide wire, the inner diameter of the middle cavity of the sleeve body matches the outer diameter of the front end of the needle body, when the sleeve body is installed at the front end of the needle body, the needle core and the guide wire pass through the catheter through, and protrude from the tip of the catheter, which is the tip.
所述套管体外侧沿套管体的轴心对称设有至少一对固定片。At least one pair of fixing pieces are arranged symmetrically along the axis of the sleeve body on the outer side of the sleeve body.
一种外保护套,包括外保护套本体,所述外保护套本体的内径与套管体外径相匹配,所述外保护套本体在固定片对应位置设有与固定片大小相匹配的缺口。An outer protective sheath comprises an outer protective sheath body, the inner diameter of the outer protective sheath body matches the outer diameter of a casing, and the outer protective sheath body is provided with a gap matching the size of the fixed piece at the corresponding position of the fixed piece.
由于采用上述结构,本装置巧妙的利用形状记忆合金制作的导丝的形状可以恢复的特殊性,将导丝作为动静脉穿刺过程中留置套管送入血管的导向装置,通过导丝在自然状态下与针芯延伸方向设定的夹角,如:45°的夹角,再通过将针芯以固定角度插入血管,如针芯以血管45°的角度插入,这样当导丝脱离轨道的束缚恢复自然状态后,导丝与针芯的角度刚好弥补了针芯与血管的角度,使得导丝在血管内与血管保持平行,这个时候留置套管在送入血管的时候受到导丝的限位作用,沿导丝的角度送入血管,从而保证留置套管刚好送入血管而不会穿破血管,保证穿刺的成功率,大大减轻了病患的痛苦。Due to the adoption of the above-mentioned structure, this device cleverly utilizes the particularity that the shape of the guide wire made of shape memory alloy can be restored. Next, set the included angle with the extension direction of the needle core, such as: 45°, and then insert the needle core into the blood vessel at a fixed angle, such as inserting the needle core at an angle of 45°, so that when the guide wire breaks away from the shackles of the track After returning to the natural state, the angle between the guide wire and the needle core just compensates for the angle between the needle core and the blood vessel, so that the guide wire remains parallel to the blood vessel in the blood vessel. At this time, the indwelling cannula is limited by the guide wire when it is sent into the blood vessel The function is to send it into the blood vessel along the angle of the guide wire, so as to ensure that the indwelling cannula is just sent into the blood vessel without puncturing the blood vessel, ensuring the success rate of puncture and greatly reducing the pain of the patient.
综上所述,本实用新型结构简单,操作方便,适用范围大,方便可靠,易于推广,实用价值大。In summary, the utility model has the advantages of simple structure, convenient operation, wide application range, convenience and reliability, easy popularization and great practical value.
附图说明Description of drawings
图1为本实用新型与留置套管连接后的结构示意图。Fig. 1 is a schematic structural view of the utility model after it is connected with an indwelling sleeve.
图2为本实用新型的结构示意图。Fig. 2 is a structural schematic diagram of the utility model.
图3为本实用新型导丝伸出针芯的结构示意图。Fig. 3 is a schematic diagram of the structure of the guide wire protruding from the needle core of the present invention.
图4为图2A-A处的剖视图。Fig. 4 is a cross-sectional view at Fig. 2A-A.
图5为本实用新型留置套管的结构示意图。Fig. 5 is a schematic structural view of the indwelling cannula of the present invention.
图6为本实用新型外保护套的结构示意图。Fig. 6 is a structural schematic diagram of the outer protective sheath of the present invention.
具体实施方式detailed description
以下结合附图和具体实施方式对本实用新型做进一步的说明。The utility model will be further described below in conjunction with the accompanying drawings and specific embodiments.
如图1、2、3、4所示,一种可调节式动静脉穿刺针,包括针芯1、导丝2、手柄3、针体4和尾塞5。针芯1由钛钢材料制成,在本例中,针芯1在针芯壁内设置有一个与导丝2大小相匹配的轨道,导丝2安装在轨道内,可在轨道内沿轨道方向移动,导丝2由形状记忆合金制成,导丝2可分为设置在头端的导丝头端以及在导丝尾端的导丝固定部,由于导丝2为形状记忆合金制成,在制作时,使得导丝在自然状态下与针芯延伸方向呈45°的夹角,这样当导丝沿轨道从穿刺针头端伸出时,可以恢复自然状态形状,即与针芯1成角45°,当导丝沿轨道完全退回针芯后,可以呈直线型,隐藏于针芯1内。As shown in FIGS. 1 , 2 , 3 , and 4 , an adjustable arteriovenous puncture needle includes a needle core 1 , a guide wire 2 , a handle 3 , a needle body 4 and a tail plug 5 . The needle core 1 is made of titanium steel. In this example, the needle core 1 is provided with a track matching the size of the guide wire 2 in the needle core wall. The guide wire 2 is installed in the track and can be moved along the track in the track The guide wire 2 is made of a shape memory alloy, and the guide wire 2 can be divided into a guide wire head end arranged at the head end and a guide wire fixing part at the guide wire tail end. Since the guide wire 2 is made of a shape memory alloy, the During manufacture, the guide wire is at an angle of 45° with the extension direction of the needle core in the natural state, so that when the guide wire protrudes from the end of the puncture needle along the track, the natural state shape can be restored, that is, it forms an angle of 45° with the needle core 1 °, when the guide wire is fully returned to the needle core along the track, it can be in a straight line and hidden in the needle core 1.
手柄3由医用塑料制成,手柄3与导丝固定部紧密连接。针体4由医用塑料材料制成,为中空圆柱形状,针芯1通过针芯支架7支撑在针体4内,针芯支架7提供了针芯固定的位置,针芯再通过针体前后的注塑材料固定在针体内。所述针芯和针体连接处、在与血液接触面上设有具有抗凝血作用的抗凝层8,抗凝层8可以由具有抗凝血作用的医用高分子材料制成也可以是肝素化处理材料制成,用于隔离固定针芯尾端的注塑材料和与针芯1尾端连通的针体4空腔。滑槽的范围可限制手柄只能在设定空间内前后滑动。在针体4尾端有至少一个尾塞,尾塞由医用塑料材料制成,为中空圆台形状,头端小,尾端大,可从针体4尾端拆卸下来。尾塞5内有至少一个透气膜,可保证气体透过而液体无法透过,透气膜由尾塞盖固定在尾塞内。尾塞盖由医用塑料材料制成,为中空圆台形状,头端小,尾端大,可从尾塞尾端拆卸下来。The handle 3 is made of medical plastic, and the handle 3 is closely connected with the guide wire fixing part. The needle body 4 is made of medical plastic material and is in the shape of a hollow cylinder. The needle core 1 is supported in the needle body 4 by the needle core support 7. The needle core support 7 provides a fixed position for the needle core, and the needle core passes through the front and back of the needle body. The injection molding material is fixed in the needle body. The connection between the needle core and the needle body is provided with an anticoagulant layer 8 with anticoagulant effect on the contact surface with blood, and the anticoagulant layer 8 can be made of medical polymer materials with anticoagulant effect or can be Made of heparinized material, it is used to isolate the injection molding material that fixes the tail end of the needle core and the cavity of the needle body 4 that communicates with the tail end of the needle core 1 . The range of the chute can limit the handle to slide back and forth within the set space. There is at least one tail plug at the tail end of the needle body 4. The tail plug is made of medical plastic material in the shape of a hollow circular platform with a small head end and a large tail end, which can be disassembled from the needle body 4 tail end. There is at least one air-permeable film in the tail plug 5, which can ensure that the gas can pass through but the liquid cannot pass through. The air-permeable film is fixed in the tail plug by the tail plug cover. The tail plug cover is made of medical plastic material and is in the shape of a hollow circular table with a small head end and a large tail end, which can be disassembled from the tail end of the tail plug.
留置套管包括导管14和套管体15。导管14由医用高分子材料制成,具有柔软,表面光滑,无毒无害,不易形成血栓的特点,通过塑料注塑固定于套管体15内。在导管尾端有至少一个具有抗凝血作用的抗凝塞,此处抗凝塞是围绕在导管外部的,导管尾端从抗凝塞中心穿过与套管体中部空腔相通,用于隔离用于固定导管的注塑材料和套管体内的空腔,防止注塑材料对凝血的影响。套管体15由医用塑料制成,为中空圆台形状,其外侧中下部向两侧分别延伸出至少一个翼型固定片16,便于穿刺时手持以及留置后固定。The indwelling sleeve includes a catheter 14 and a sleeve body 15 . The catheter 14 is made of medical polymer material, has the characteristics of softness, smooth surface, non-toxic and harmless, and is not easy to form thrombus, and is fixed in the sleeve body 15 by plastic injection molding. There is at least one anticoagulant plug with anticoagulant effect at the end of the catheter, where the anticoagulant plug surrounds the outside of the catheter, and the tail end of the catheter passes through the center of the anticoagulant and communicates with the cavity in the middle of the sleeve body for The injection molding material used to fix the catheter is isolated from the cavity in the cannula body to prevent the injection molding material from affecting coagulation. The sleeve body 15 is made of medical plastic and is in the shape of a hollow truncated cone. At least one wing-shaped fixing piece 16 extends from the middle and lower part of the outer side to both sides, which is convenient for holding when puncturing and fixing after indwelling.
外保护套由医用塑料制成,用于保护隔离穿刺针头端。外保护套为子弹头样形状,其尾端中点两侧分别有至少一个螯状缺口,可将留置套管体两侧的翼型固定片16卡入缺口内,起到固定作用。The outer protective sheath is made of medical plastic and is used to protect the isolation puncture needle tip. The outer protective sheath has a bullet-like shape, and there is at least one chelate-shaped notch on both sides of the midpoint of its tail end, and the wing-shaped fixing pieces 16 on both sides of the indwelling sleeve body can be snapped into the notch to play a fixing role.
使用时,按照动静脉穿刺操作规范,完成血管位置确认,局部皮肤消毒后,取下本穿刺针的外保护套,将留置套管套入穿刺针上,将手柄移动至轨道尾端,保证导丝2完全退入针芯1内。穿刺针与皮肤成斜45°进针,穿刺针头端进入血管后,可见穿刺针针体4内的空腔中有血液缓慢填充,此时缓慢向穿刺针针头端推动手柄3,移动5-10mm后,导丝2头端可从针芯1头端伸出,并恢复自然形状,与针芯呈45°角度(刚好与血管走势相同),保持穿刺针位置不变,推动留置套管的翼状突起16,缓慢将留置套管延导丝2送入血管内。完成后先向尾端拉动手柄,将导丝2收回针芯,再退出穿刺针。最后将留置套管尾端与输液管路连接。When in use, follow the arteriovenous puncture operation specification, complete the confirmation of the blood vessel position, and after local skin disinfection, remove the outer protective cover of the puncture needle, put the indwelling cannula on the puncture needle, and move the handle to the end of the track to ensure The wire 2 is completely retreated into the needle core 1. The puncture needle is inserted into the skin at an angle of 45°. After the tip of the puncture needle enters the blood vessel, it can be seen that the cavity in the needle body 4 of the puncture needle is slowly filled with blood. At this time, slowly push the handle 3 toward the needle tip of the puncture needle for 5-10mm Finally, the head end of the guide wire 2 can protrude from the head end of the needle core 1, and recover its natural shape, forming an angle of 45° with the needle core (just the same as the trend of the blood vessel), keeping the position of the puncture needle unchanged, and pushing the wing-shaped indwelling cannula. The protrusion 16 slowly sends the indwelling sleeve along the guide wire 2 into the blood vessel. After completion, pull the handle toward the tail end first, retract the guide wire 2 into the needle core, and then withdraw the puncture needle. Finally, connect the tail end of the indwelling sleeve with the infusion line.
以上所述,仅为本实用新型具体实施案例说明,不能以此限定本实用新型的权利保护范围。凡根据本实用新型申请权利要求书及说明书内容所作的等效变化与修改,皆在本实用新型保护的范围内。The above description is only a description of specific implementation cases of the present utility model, and cannot limit the protection scope of the present utility model. All equivalent changes and modifications made according to the claims of the utility model application and the contents of the description are within the protection scope of the utility model.
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| CN201621164926.5U CN206473380U (en) | 2016-11-01 | 2016-11-01 | Adjustable arteriovenous puncture needle and indwelling sleeve matched with same |
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Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106264687A (en) * | 2016-11-01 | 2017-01-04 | 中南大学湘雅医院 | Adjustable arteriovenous puncture needle and indwelling sleeve and outer protective sleeve matched with same |
| CN108926752A (en) * | 2018-06-29 | 2018-12-04 | 广东先来医疗器械有限公司 | A kind of hose safety transfusion needle |
| CN111759424A (en) * | 2020-07-22 | 2020-10-13 | 张忠民 | trocar |
| CN113712636A (en) * | 2021-07-29 | 2021-11-30 | 中国人民解放军东部战区总医院 | Puncture device for arteriovenous internal fistula construction and use method thereof |
-
2016
- 2016-11-01 CN CN201621164926.5U patent/CN206473380U/en not_active Withdrawn - After Issue
Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106264687A (en) * | 2016-11-01 | 2017-01-04 | 中南大学湘雅医院 | Adjustable arteriovenous puncture needle and indwelling sleeve and outer protective sleeve matched with same |
| CN108926752A (en) * | 2018-06-29 | 2018-12-04 | 广东先来医疗器械有限公司 | A kind of hose safety transfusion needle |
| CN108926752B (en) * | 2018-06-29 | 2024-06-07 | 广东先来医疗科技有限公司 | Hose safety transfusion needle |
| CN111759424A (en) * | 2020-07-22 | 2020-10-13 | 张忠民 | trocar |
| CN113712636A (en) * | 2021-07-29 | 2021-11-30 | 中国人民解放军东部战区总医院 | Puncture device for arteriovenous internal fistula construction and use method thereof |
| CN113712636B (en) * | 2021-07-29 | 2022-08-05 | 中国人民解放军东部战区总医院 | Puncture device for arteriovenous internal fistula construction and use method thereof |
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