CN209611212U - A traction device and a traction ring for the traction device - Google Patents

Abstract

A kind of traction device, including clamping part and tractive unit, tractive unit contain closing hitch structure, closing hitch structure is made of elastic material, clamping part includes holder body and clamp arm, and holder body can pass through the biopsy channel of scope, and clamp arm can clamp closing hitch structure；A kind of stretch ring for traction device, stretch ring are that a closing hitch structure or several closing hitch structures are formed by connecting, and stretch ring is made of elastic material.

Description

A traction device and a traction ring for the traction device

technical field

The utility model relates to a traction device in the field of medical equipment and a traction ring used for the traction device, in particular to a traction device which has good elasticity, does not require external force, and can realize the traction of cutting lesions only by relying on the elastic force of the traction part. , to fully expose the operating field of view; at the same time, it can pull and shrink large wounds, so as to facilitate the further clamping of wounds.

Background technique

EMR (endoscopic mucosal resection, EMR) was first used clinically in Japan for the treatment of early gastric cancer. Before it was introduced in Japan, gastrectomy was the only treatment for early gastric cancer. At present, this treatment method has been widely used. Endoscopic submucosal dissection (ESD) refers to the use of a modified needle knife to directly peel off the mucosa from the submucosa under the endoscope. It has good performance and expands the indications for resection of early digestive tract cancer and other tumors, and gradually becomes a widely accepted minimally invasive surgical treatment.

Both ESD and EMR have realized the resection of lesions with an ordinary single-channel endoscope, and avoided the pain of open surgery and the removal of organs. The disadvantage of EMR is that this technique cannot resect large lesions en bloc, and the fragmented specimens taken out are difficult to carry out detailed pathological analysis, the tumor staging is not clear, and there is a high risk of tumor recurrence. Compared with endoscopic treatment methods such as laparotomy and EMR in the past, ESD has the advantages of 1. less trauma, 2. patients can receive multiple treatments for multiple parts, 3. it enables doctors to obtain complete histopathological specimens for analysis, 4. For tumors with large area and irregular shape or with ulcers and scars, the resection rate is over 96% to reduce the probability of recurrence.

However, compared with EMR, ESD takes longer to operate, has greater risks, and is more difficult to operate. The operation time of EMR is about 20 minutes, while the operation time of most ESD is 60-90 minutes. There are complications such as bleeding, perforation, stenosis and postoperative infection, which is not conducive to large-scale promotion and application. Bleeding is rare during EMR, but during ESD operation, the field of view will be covered with blood if you don’t pay attention, so you need to stop the bleeding and wash the field of view continuously. The main steps of ESD surgery are: marking, submucosal injection, marginal incision, stripping, and wound management. For some lesions that are difficult to treat with ESD, repeated submucosal injections are usually used to provide a limited surgical field of view for subsequent stripping operations, but repeated injections can prolong the operation time and increase the risk of bleeding and perforation. Another simple solution is to try to adjust the patient's body position according to the direction of gravity, so that the peeling surface can obtain the ideal tension and obtain the operating field of view. However, in some operations (involving the upper gastrointestinal tract), the patient's choice of body position is limited, which limits the its use effect. Therefore, how to provide a good "surgical field of view" during the operation has become the key to solving the above problems. Scholars from various countries are trying to find a method that can provide a good field of view for the operation and achieve safe and precise cutting and stripping operations.

Inspired by surgical traction techniques, various endoscope-assisted traction techniques have emerged. According to the source of traction, it can be roughly divided into internal traction and external traction; according to the composition of the traction device, it can be divided into dental floss traction, metal clip wire combined traction technology, metal clip elastic ring combined traction technology, S-O metal clip traction technology, magnetic anchor technology etc.

A recent article on digestive endoscopy pointed out in the discussion section that although dental floss is a better auxiliary ESD, it may cause tissue damage, which needs to be paid attention to when using it. In addition, the direction of dental floss traction is fixed, and the traction end is outside the body. Therefore, the dental floss must be parallel to the endoscope, resulting in limited traction direction.

Metal clip wire combined with traction technology, the wire has no elasticity, and after cutting a part of the lesion, the wire may lose its effect and cannot continue to pull the lesion, and the cutting process cannot go smoothly.

Metal clip elastic ring combined with traction technology, the size of the elastic ring is limited, it is necessary to bind the O-ring to the clip with silk thread, and a special outer sheath is required, which is cumbersome to operate and brings inconvenience to the user.

S-O metal clip traction technology, a kind of internal traction technology is designed based on spring, metal clip and nylon ring. This method is derived from the metal clip elastic ring combined with the traction method. The elastic ring is replaced by a spring in order to obtain greater flexibility to adapt to the ESD resection of large and superficial early colon tumors. However, the spring has no effect after cutting. Tension, and the spring occupies a large space, and cannot enter the endoscopic biopsy channel, but the endoscope needs to be taken out during the operation, clamped in vitro with a metal clip extending out of the endoscopic biopsy channel, and then sent into the body to reach the target position During the process, because it is exposed at the far end of the biopsy channel, it is easy to cause harm to the human body, and the use of this method is limited.

The magnetic anchor traction technology requires special equipment, such as a standard retractable arm, which constantly changes the direction of traction outside the body. The operation is cumbersome, and if the number of magnets is large during the operation, it will hinder the field of view of the operation.

Utility model content

The traction device of the utility model is composed of a clamping part and a traction part. The traction part relies on its own elastic force to provide traction force in the body to pull the lesion and fully expose the field of view of the operation. Since there is no need to provide external force, it is not limited by the anatomical position and the size of the digestive tract lumen, and can pull the mucosa, tissue, and organs. It is especially suitable for the difficult position of ESD operation, so that the doctor can use it in a more intuitive and visible situation. The implementation of mucosal dissection can make the operation safer and simpler, greatly shorten the operation time and reduce the patient's pain, and is suitable for large-area lesion dissection.

Commonly used digestive endoscopes include a biopsy channel, an objective lens, an LED light source, a water inlet channel and a water outlet channel, among which the biopsy channel is used to feed into the clamping part and the traction part.

A traction device, the traction device comprises a clamping part and a traction part, the traction part contains a closed traction structure, and the closed traction structure is made of elastic material; the clamping part comprises a clamping body and a clamp arm, The clamping body can pass through the biopsy channel of the endoscope; the clamping arm can clamp the closed traction structure.

Preferably, the closed traction structure is made of silicone rubber or thermoplastic elastomer.

Preferably, there are one, two or more closed traction structures.

Preferably, the closed traction structure can be circular, triangular, rhombus or square, etc.

An elastic structure can be connected between two or more closed traction structures, preferably, the elastic structure is an elastic linear structure, elastic ring and other structures.

Moving the clamping body can cause elastic deformation of the closed traction structure.

A pulling ring for a pulling device, the pulling ring is formed by connecting a closed pulling structure or several closed pulling structures, the pulling ring is made of elastic material, and the elastic structures are connected between the closed pulling structures .

Preferably, the elastic structure is an elastic linear structure, elastic ring and other structures.

Preferably, the closed traction structure can be circular, triangular, rhombus or square and so on.

In the actual operation process, the electric knife can be marked along the circumference of the lesion, and the liquid can be injected through the electric knife or an external syringe to make the lesion bulge and form a liquid buffer layer under the mucosa, that is, a "water cushion". "It forms an effective isolation between the muscular layer and the diseased tissue, and at the same time effectively prevents heat conduction, making the surgical field of view clearer, blood vessels are squeezed and closed by the water cushion, and the risk of bleeding is significantly reduced. After the pre-separation of the mucosa is completed in the body, withdraw the electric knife, open the first clamping part of the traction device, clamp the clamping arm of the first clamping part to one end of the closed traction structure, and pull the first clamping part and the closed traction The structure is put into the biopsy channel of the endoscope together, and after reaching the far end of the biopsy channel, under observation through the eyepiece of the endoscope, the clamp arm of the first clamping part is opened to clamp one end of the pre-separated tissue and the closed traction structure one end. At this time, the proximal end and the distal end of the clamping body of the first clamping part are separated, so that the distal end of the clamping body of the first clamping part and the closed traction structure remain in the body. Continue to repeat the previous operation, put the second clamping part into the biopsy channel of the endoscope, after reaching the far end of the biopsy channel, observe through the eyepiece of the endoscope, open the clamping arm of the second clamping part, and pass through the The other end of the closed traction structure, with the help of the endoscope, is pulled to the other end of the pre-separated tissue and the edge of the pre-separated tissue is clamped. Then, the proximal end and the distal end of the clamping body of the second clamping part are separated, so that the distal end of the clamping body of the second clamping part and the closed traction structure remain in the body. Due to the elastic force of the closed traction structure, during the surgical cutting process, the cut lesion is turned outward due to the elastic effect of the traction part. As the surgical cutting operation proceeds, the cut lesion is continuously pulled up and gradually separated from the muscle layer until it is completely Pull up to completely complete the separation of the lesion. This method allows the lesion to be turned up while being cut, which broadens the surgical field of vision. Under the direct vision of the endoscope, the blood vessels under the cutting target can be found to avoid bleeding, making the operation more convenient. Safe and shorten operation time. If the lesion is too large, you can increase the clamping part and closed traction structure, so that the cut lesion can be pulled up completely, or choose the traction part with elastic linear structure, so that the elastic deformation range of the whole traction part can be increased, so as to pull more Large-scale lesions.

Beneficial effect:

The traction device of the utility model combines the clamping part and the traction part into one body. The traction part has elasticity and can provide force in the body by its own extension. Since there is no need to provide external force, it is not limited by the anatomical position and the size of the lumen of the digestive tract, and is especially suitable for difficult positions in ESD operations. The material has good elasticity, and the pulling range can be adjusted according to the needs, meeting the needs of cutting lesions of different sizes, broadening the field of view of ESD surgery, improving the speed of ESD surgery, and saving operation time.

During the actual use of this product, if there is loose traction, you can add several more clamping parts to clamp the closed traction structure, pull it in other directions, and then clamp it to form a polygonal structure, which can continue to provide traction. The pulling force broadens the operating field of vision until the tissue is completely separated, making the separation process go smoothly.

Description of drawings

Figure 1A is a cross-sectional view and a front view of two ring-shaped closed traction structures in the traction part

Figure 1B is a schematic diagram of three ring-shaped closed traction structures in the traction part

Figure 1C is a schematic diagram of four ring-shaped closed traction structures in the traction part

Figure 1D is a cross-sectional view and a front view of a triangular closed traction structure

Figure 2 is a schematic diagram of the cooperation between the clamping part and the traction part

Figure 3 is a schematic diagram of sending the clamping part and traction part into the endoscopic biopsy channel

Figure 4 is a schematic diagram of the lesion clamped by the first clamping part and the ring-shaped closed traction structure under the guidance of the endoscope

Figure 5 is a schematic diagram of the lesion being clamped by the second clamping part and the ring-shaped closed traction structure under the guidance of the endoscope

Figure 6 is a schematic diagram of the cooperation between the clamping part and the ring-shaped closed traction structure to separate the lesion

Figure 7 is a schematic diagram of the traction device separating the lesion when the space is narrow

Figure 8 is a schematic diagram of the elastic linear structure connected between the ring-shaped closed traction structures

Figures 9A-9C are schematic diagrams of traction device shrinking the lesion wound when the lesion wound is large

1. Traction part, 11. Closed traction structure, 2. Clamping part, 21. First clamping part, 22. Second clamping part, 23. Clamping main body, 24. Clamping arm, 25. Clamping main body, 26. Jaw arm, 3. Endoscope, 4. Biopsy channel, 5. Lesion, 6. Mucosa layer, 7. Muscle layer, 8. Mucosa layer on the opposite side of the lumen

Detailed ways

In order to make the purpose, technical solution and advantages of the utility model clearer, the utility model will be further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described here are only used to explain the utility model, and are not intended to limit the utility model.

Hereinafter, the end of the endoscope close to the operator is defined as the proximal end, and the end far from the operator is defined as the distal end.

Figures 1A-1D and Figure 8 are schematic diagrams of different types of closed traction structures. FIG. 1A is a schematic diagram of the traction part 1 including two ring-shaped closed traction structures, and the two ring structures are closed and connected to form the traction part 1 of the closed traction structure. 1B and 1C are schematic diagrams of the traction part 1 having three annular closed traction structures and four annular closed traction structures. Figure 1D is a cross-sectional view and a front view of a triangular closed traction structure. As shown in Figure 8, the traction part 1 can also be equipped with an elastic linear structure in the closed traction structure. Both the closed traction structure and the elastic linear structure can produce elastic deformation, so that the lesion 5 is completely separated from the mucosal layer 6. This structure is especially It is suitable for cases where the lesion 5 is relatively large. The closed traction structure 11 can be made of elastic material, preferably, the elastic material is silicone rubber or thermoplastic elastomer, and there can be one, two or more closed traction structures. In actual use, according to the size of the lesion, different types of traction parts can be selected for traction separation, which is suitable for mucous membranes, tissues, organs, etc.

Hereinafter, taking the case where the traction part is only composed of a closed traction structure as an example, the use process of the traction device in the present invention for traction and separation of mucous membranes will be described. During the actual operation, the electric knife can be inserted into the vicinity of the lesion through the biopsy channel of the endoscope, and mark around the lesion. After the mark is completed, inject liquid through the electric knife or an external syringe to make the lesion bulge and form a liquid under the mucosa The buffer layer is the "water cushion". As shown in FIGS. 2-6 , FIG. 2 is a schematic diagram of cooperation between the clamping part 2 and the pulling part 1 . The clamping part 2 includes clamping bodies 23 and 25 and clamping arms 24 and 26 . After the pre-separation of the mucosa in the body is completed, the electric knife is withdrawn, the clamp arm 24 of the clamping part 2 of the traction device is opened, and the clamp arm 24 is clamped to one end of the closed traction structure 11 of the traction part 1 . As shown in Figures 3 and 4, the first clamping part 21 and the closed traction structure 11 are put together into the biopsy channel 4 of the endoscope 3, and after reaching the far end of the biopsy channel 4, under observation through the eyepiece of the endoscope 3, Open the clamping arm 24 of the first clamping part 21 so that it clamps one side of the pre-separated lesion 5 and one end of the closed traction structure 11 at the same time, and then clamp the main body 23 of the first clamping part 21 The distal end and the proximal end are separated, so that the first clamping part 21 clamps the distal end of the main body and the closed traction structure 11 stays in the body, and the clamping main body 23 is taken out. As shown in Figure 5, after inserting the second clamping part 22 into the biopsy channel 4 of the endoscope and reaching the far end of the biopsy channel 4, under the observation of the eyepiece of the endoscope 3, the clamping arms 26 of the second clamping part 22 Open, clamp the other end of the closed traction structure 11, and pull it to the other side of the pre-separated lesion 5 with the help of the endoscope. Then the proximal end and the distal end of the clamping body 25 of the second clamping part 22 are separated, so that the distal end of the clamping main body of the second clamping part 22 and the closed traction structure 11 remain in the body. Due to the elastic force of the closed traction structure 11, during the surgical cutting process, the cut lesion 5 is turned outward due to the elastic force of the traction part 1. As the surgical cutting operation proceeds, the cut lesion 5 is continuously pulled up, and the muscle layer 7 Gradually separate until it is pulled up completely, and the separation of lesion 5 is completely completed. This method allows lesion 5 to be turned up while being cut, which broadens the surgical field of view. Submucosal blood vessels can be found under direct vision of the endoscope to avoid bleeding. The operation is more convenient and safe, and the operation time is shortened. If the lesion 5 is too large, you can increase the clamping part 2 and the closed traction structure, so that the cut lesion 5 is completely pulled up, or as shown in Figure 8, choose the traction part 1 containing the elastic linear structure, so that the entire traction part 1 The range of elastic deformation is increased to pull larger lesions5.

As shown in Figure 4 and Figure 7, when the lesion 5 is relatively large and the space is relatively small, such as in the ESD operation in the intestinal tract, one side of the lesion 5 can be cut first, as shown in Figure 4, first through the first clamping part The clamping arm 24 of 21 clamps the cut focus 5, and at this moment, it is sent into the second clamping part 22 through the endoscope 3, and the clamping arm of the second clamping part 22 is observed by the eyepiece of the endoscope 3. 26 clamped to the mucous membrane layer 8 on the opposite side of the intestinal lumen, and the clamp arm 26 of the second clamping part 22 is closed tightly. Under the elastic force of the closed traction structure 11, the cut lesion 5 is It is continuously pulled up to maintain the surgical field of view and facilitate surgical operations.

As shown in Figures 9A-9C, when the wound surface of the lesion 5 is relatively large, with the help of the endoscope 3, first use the clamp arm 24 of the first clamping part to connect one side of the wound surface of the lesion 5 and the side of the closed traction structure 11. One end is clamped, and then with the help of the endoscope 3, the other side of the wound surface of the lesion 5 and the other end of the closed traction structure 11 are clamped with the clamp arm 26 of the second clamping part. Due to the elastic force of the closed traction structure 11 The two sides of the wound surface of the lesion 5 are pulled inward, so that the wound surface of the lesion 5 is reduced, thereby facilitating further clipping of the wound surface of the lesion 5 .

The above descriptions are only preferred embodiments of the present application, so that those skilled in the art can understand or realize the utility model of the present application. Various modifications and combinations of these embodiments will be apparent to those skilled in the art, and the general principles defined herein can be implemented in other embodiments without departing from the spirit or scope of the application . Therefore, the present application will not be limited to the embodiments shown herein, but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.

Claims (13)

1. A traction device, characterized in that, the traction device comprises a clamping part and a traction part, the traction part contains a closed traction structure, and the closed traction structure is made of elastic material; the clamping part comprises a clip The clamping body and the clamping arm can pass through the biopsy channel of the endoscope; the clamping arm can clamp the closed traction structure. 2. The traction device according to claim 1, wherein the closed traction structure is made of silicone rubber or thermoplastic elastomer. 3. The traction device according to claim 1, characterized in that there are one, two or more closed traction structures. 4. Traction device according to claim 3, characterized in that elastic structures can be connected between two or more closed traction structures. 5. The traction device according to claim 4, wherein the elastic structure is an elastic linear structure. 6. The traction device according to claim 4, wherein the elastic structure is an elastic ring. 7. The traction device according to any one of claims 1-6, wherein the closed traction structure is in the shape of a circle, a triangle, a rhombus, or a square. 8 . The traction device according to claim 1 , wherein moving the clamping body of the clamping portion can cause elastic deformation of the closed traction structure. 9. A pulling ring for a pulling device, characterized in that, the pulling ring is formed by connecting one closed pulling structure or several closed pulling structures, and the pulling ring is made of elastic material. 10. The pulling ring according to claim 9, characterized in that elastic structures are connected between the closed pulling structures. 11. The pulling ring according to claim 10, characterized in that, the elastic structure is an elastic linear structure. 12. The pulling ring according to claim 10, characterized in that, the elastic structure is an elastic ring. 13. The pulling ring according to claim 9, characterized in that, the closed pulling structure is in the shape of a circle, a triangle, a rhombus, or a square.