CN210727837U - Guide for assisting liver puncture procedures - Google Patents

Abstract

Guide for assisting liver puncture procedures. It belongs to the field of liver puncture instruments. The existing invasive tumor in situ treatment technology lacks instruments to assist the puncture operation, which leads to the problem of inaccurate direction of the puncture needle track. The design method of the guide plate used to assist the liver puncture operation, obtain the CT scan data of the thoracic cavity with the positioning point group on the thoracic cavity skin; carry out the reconstruction of the three-dimensional model of the liver and surrounding blood vessels, organs, bones, and skin; Simulate liver puncture in the 3D model of the puncture needle, and determine the design plan of the needle track; use the determined needle track plan and the positioning point group on the skin to design the guide plate with the puncture needle channel and the positioning point group; 3D printing the designed guide plate model . The finished guide plate for assisting liver puncture operation is obtained. The method of the utility model can improve the safety and accuracy of the operation through the formulation of the preoperative operation plan. The structure of the product is simple and the manufacturing cost is low.

Description

Guide for assisting liver puncture procedures

technical field

The utility model relates to a guide plate used for assisting liver puncture operation.

Background technique

Radiofrequency ablation is a minimally invasive tumor in situ treatment technology. With the help of imaging technologies such as ultrasound or CT, the electrode needles are positioned and guided directly into the tumor. The radiofrequency energy is used to generate high temperature in the local tissue of the lesion, drying and finally coagulation and inactivation of soft tissue and tissue. tumor. During the operation, it is not only necessary to avoid structures such as important blood vessels, bile ducts and other adjacent organs, but also to monitor and plan the needle insertion stroke at any time according to the imaging equipment to determine the angle and needle insertion distance. Due to its relatively low spatial resolution, B-ultrasound is easily interfered by surrounding tissues, and the interference of intestinal gas, obesity and ribs often affects judgment. Or it is a space-occupying area close to surrounding organs (such as esophagus, stomach, intestine, etc.) and blood vessels (such as hepatic artery, hepatic vein, right gastric artery, etc.), and ultrasound-guided percutaneous puncture is difficult and has large positioning errors, making it difficult Accurate positioning in a short time leads to low preoperative positioning efficiency and difficult treatment. Although CT has sufficient resolution to display the anatomical position and shape of the patient's internal organs and blood vessels, due to its long operation time, in the process of guiding puncture and positioning, it is necessary to repeatedly perform CT corrections to ensure the accuracy of puncture. Sex, not only consumes the resources of examination beds, but also greatly increases the radiation exposure time of patients, and the potential side effects are large.

SUMMARY OF THE INVENTION

The purpose of the utility model is to solve the problem of inaccurate puncture needle track direction caused by the lack of instruments for assisting the puncture operation in the existing in situ treatment technology of traumatic tumors, and propose a guide plate for assisting the puncture operation of the liver.

A guide plate for assisting liver puncture operation, the guide plate includes a guide plate body, and the surface of the guide plate body is provided with a set of transverse reinforcing ribs and longitudinal reinforcing ribs vertically intersected to form a reinforcing rib network,

One side of the guide plate body has a set of positioning holes, each positioning hole is provided with a cross-shaped positioning body, and the positioning hole and the center of the cross-shaped positioning body coincide,

The other side of the guide plate body is provided with a puncture operation window, the first needle track insert and the second needle track insert are inlaid in the puncture operation window, and grooves are respectively provided on the butting surfaces of the first needle track insert and the second needle track insert , the cross section of the groove is a semicircle, the grooves on the butting surfaces of the first needle track insert and the second needle track insert are buckled together to form a needle track with a circular cross-section, and the central axis of the needle track intersects with the guide plate body ;

One side of the puncture operation window communicates with one side of the guide plate body.

The beneficial effects of the present utility model are:

The puncture guide plate of the utility model based on 3D printing can assist the doctor to quickly locate and complete the operation operation quickly, especially for the small diameter, the special complex spatial position, and the multiple tumors have special advantages. By formulating a preoperative surgical plan, the safety and accuracy of the operation can be further improved, especially important blood vessels and organs at risk can be avoided. 3D printing has a short processing cycle and low material cost, which not only meets the clinical time requirements, but also greatly reduces the economic burden of patients.

3D reconstruction based on CTA image data: including skin, ribs, lesions, liver blood vessels, stomach, bile duct, etc., according to the reconstructed model to design the best puncture plan, and complete the preoperative simulation of needle insertion, needle insertion angle and distance. Design the corresponding puncture guide according to the confirmed preoperative simulation plan, and use 3D printing technology to complete the production of the puncture guide.

The customized guide plate for assisting liver puncture operation for patients can achieve rapid and accurate positioning during liver puncture, greatly improving surgical efficiency and treatment accuracy. The puncture needle track is designed into a unique modular structure, which is easy to assemble and disassemble Ensure the continuity of the operation process. The entire use and operation process will not bring burden to the treatment, the operation is simple, and it is ready to use.

The positioning bed designed by the utility model is used for assisting the liver puncture operation. There are armrests on both sides of the bedboard of the positioning bed. The armrest, the limit beam and the height adjustment screw cooperate to realize height adjustment, which can be adjusted for patients with different fat and lean body types. The height of the limit beam is adjusted to fix the patient. At the same time, there is a retractable chest fixing bracket above the positioning bed. During the CT scanning process, the retractable chest bracket can withstand the sternum area, which can effectively suppress the chest expansion caused by breathing during the chest scanning process. and shrinkage, thereby improving the positioning accuracy of the mark point marking step in the guide plate design method.

Description of drawings

Fig. 1 is the method flow chart that the utility model relates to;

Fig. 2 is the schematic diagram of puncture simulation involved in step 3 of the present utility model;

Fig. 3 is a schematic diagram of skin thickening operation;

Figures 4 and 5 are schematic diagrams of the structure of the guide plate used for assisting the liver puncture operation according to the present invention;

6 is a schematic structural diagram of a positioning bed used for assisting liver puncture operation according to the present invention;

FIG. 7 is a schematic diagram of error analysis when the utility model analyzes the prior art by the utility model.

Detailed ways

Specific implementation one:

As shown in Figures 3 and 5, the guide plate used for assisting the liver puncture operation in this embodiment includes a guide plate body 1, and the surface of the guide plate body 1 has a set of raised transverse reinforcement ribs 2 and vertical reinforcement ribs 3 perpendicular to each other. The reinforcing rib network formed by the cross,

One side of the guide plate body 1 has a set of positioning holes 4, each positioning hole 4 is provided with a cross-shaped positioning body 5, and the positioning hole 4 coincides with the center of the cross-shaped positioning body 5.

The other side of the guide plate body 1 has a puncture operation window 6. The puncture operation window 6 is fitted with a first needle track insert 7 and a second needle track insert 8, and the first needle track insert 7 and the second needle track insert. 8. The butting surfaces are respectively provided with grooves 9. The cross-section of the grooves 9 is semi-circular. Needle track 10, the central axis of the needle track intersects with the guide plate body;

One side of the puncture operation window communicates with one side of the guide plate body, which facilitates the operation of removing the guide plate body 1 after the needle is placed.

Specific implementation two:

The difference from the first embodiment is that in the guide plate used for assisting the liver puncture operation in this embodiment, the needle track formed after the grooves on the butting surfaces of the first needle track insert and the second needle track insert are buckled together. The angle formed by the intersection of the central axis of the guide plate and the guide plate body is 1-89°.

Specific implementation three:

A method for designing a guide plate for assisting liver puncture operation using the above positioning bed, the method includes the following steps:

Step 1. Fix the patient on the positioning bed with the positioning bed used to assist the liver puncture operation, mark the position of the liver by marking a set of positioning points on the skin of the chest cavity, and display the positioning points in the form of protrusions, and then obtain CT scan data of thoracic region with anchor point group on thoracic skin;

Step 2, using the CT scan data with the positioning point group obtained in step 1 to reconstruct the three-dimensional model of the liver and surrounding blood vessels, organs, bones, and skin;

Step 3: Simulate liver puncture in the three-dimensional model obtained in Step 2, and determine the design scheme of the needle track;

Step 4, using the needle track scheme determined in step 3 and the positioning point group on the skin to design a guide plate with a puncture needle track and positioning point group;

Step 5: 3D printing the designed guide plate model to obtain a finished guide plate for assisting the liver puncture operation.

The core operation technology of the utility model lies in the body surface mark point positioning technology. Through the comprehensive analysis of the above errors, it can be known that the main reason for the deviation of the puncture needle track is the deformation caused by pressing the sebum layer, which affects the puncture angle, and the image data fed back by the ultrasound It can only observe the approximate deviation direction, but cannot guide the fine-tuning of the needle track. The puncture operation is performed at the thinnest sebum layer at the sternum body, that is, the error of sebum sliding when the guide plate is fitted and positioned will be the smallest. Combined with the guide plate’s cylindrical needle track of 0.4mm The fine-tuning gap can ensure the best puncture accuracy.

The positioning bed for assisting liver puncture operation, as shown in FIG. 6 , the positioning bed includes a bed board B1, a neck support frame B3 is set at the head of the bed board B1, and the long sides of the bed board B1 are close to each other. There is a handrail B6 at the head of the bed, a horizontal slideway is arranged on the handrail B6, rolling pulleys B5 are respectively installed at both ends of the limit beam B2, the limit beam B2 is set above the bed board B1, and the two ends of the limit beam B2 correspond to The slideway of the side armrest B6 is rolled and installed, the beam body of the limit beam B2 is screwed with the height adjustment screw B4, the moving direction of the height adjustment screw B4 is perpendicular to the board surface of the bed board B1, and the end of the height adjustment screw B4 away from the bed board B1 is a nut , One end of the height adjustment screw B4 close to the bed board B1 is fixedly provided with a pressure plate, and the pressure plate is used to increase the contact area with the human chest.

The limiting beam B2 is arc-shaped.

The standard positioning bed with CT caliber is used. There are armrests on both sides of the positioning bed. The armrest, the limit beam and the height adjustment screw are combined to realize height adjustment. The height of the limit beam can be adjusted for patients with different fat and thin body types. To fix the patient, at the same time, there is a retractable chest fixing bracket above the positioning bed. During the CT scanning process, the retractable chest bracket can withstand the sternal body area. During the chest scanning process, it can effectively suppress the expansion and contraction of the chest caused by breathing, thereby further ensuring the mark The positioning accuracy of the point.

Error analysis: The main errors of B-ultrasound-guided percutaneous puncture include measurement errors affecting reconstruction, individual differences between patients, and human errors of the operator. The first two errors are generally considered to be absolute errors, while the operator's operation errors are human controllable errors. , that is, the operator's experience and operation skills affect the size of the error. The individual error mainly considers the degree of obesity of the patient, the size of the tumor, and the relationship between the position of the mass and the main vascular organs. That is, individual differences affect the difficulty of the final operation.

Therefore, the guide plate designed by the utility model mainly has a special auxiliary positioning function for small cell multiple liver cancer. The digital operation plan simulation is performed before surgery to determine the optimal puncture path and avoid the main portal blood vessels and important organs, which can effectively control Human operation error, while ignoring the B-ultrasound reconstruction measurement error, so as to accurately puncture the lesion.

Based on the average results of statistical analysis, the trigonometric function data model was used to simulate the puncture of the puncture needle in the IV and V regions, and the tumor diameter was 20 mm. After simulation calculation, the puncture needle deviates from the theoretical puncture track by 3.82 degrees at the initial body surface, and the puncture needle is at the final landing point. It will completely deviate from the center of the tumor, as shown in Figure 7, set: needle insertion distance S, deviation distance L, deviation angle α,

L=sinα*S

The trigonometric function mathematical model is used to simulate and calculate B-ultrasound-guided puncture for small cell hepatocellular carcinoma of 2 cm in the IV and V regions of the liver. The initial puncture deviation angle deviates from the theoretical needle track by 4 degrees, which will cause errors. Abandon radiofrequency ablation and use open surgery. During the puncture process, it is necessary to puncture the center of the tumor as much as possible to ensure complete ablation of the tumor lesion. Once ablation is incomplete, there is a risk of postoperative recurrence. Therefore, accurate puncture aid guide for needle track positioning and navigation can improve puncture accuracy and reduce surgical risks.

Because the patient will breathe involuntarily during the CT scan, the rib cage of the thoracic cavity will expand and contract to a large extent, which will cause a certain positioning error to the spatial relationship between the three mark points. Therefore, CT and surgery are performed. In the process, we use the external fixed bed device, and cooperate with the body surface mark positioning method to form a new positioning technology. The positioning technology mainly uses a standard positioning bed suitable for CT caliber, with armrests on both sides, armrests, limit beams and height adjustment screws. Coordinate to achieve height adjustment, the height of the limit beam can be adjusted for patients with different fat and thin body types to fix the patient. At the same time, there is a retractable chest fixing bracket above the positioning bed. During the CT scanning process, the retractable chest bracket can withstand the sternum area. In the process of chest scanning, it can effectively suppress the expansion and contraction of the chest caused by breathing, thereby further ensuring the positioning accuracy of the mark point.

Specific implementation four:

Different from the third embodiment, in the design method of the guide plate used to assist the liver puncture operation in this embodiment, in the first step, the position of the liver is marked on the skin of the chest cavity by marking a set of positioning points. The process of displaying the anchor point in a raised form, specifically:

Use an oil-based marker to mark the body surface near the liver. The position of the mark is required to meet the anatomical requirements (the position between the 10th and 11th ribs), evenly distributed on the body surface around the liver, and accurately pasted with lead points. At the mark point, a raised feature of the skin is made to facilitate the positioning of the guide plate positioning hole. Push into CT for enhanced CT scan.

Specific implementation five:

The difference from the fourth embodiment is that in the design method of the guide plate used to assist the liver puncture operation in this embodiment, in the second step, the CT scan data with the positioning point group obtained in the first step is used to perform the liver and surrounding The process of reconstructing the three-dimensional models of blood vessels, organs, bones, and skin, specifically:

Use the new project command to import the patient CT data, the data format is .dicom, use the threshold command under the segment menu to adjust the threshold, and obtain the three-dimensional reconstruction of the liver, blood vessels, tumors, rib bones, skin, and surrounding organs. its 3D model.

Specific implementation six:

The difference from the fifth embodiment is that in the design method of the guide plate used to assist the liver puncture operation in this embodiment, in the third step, the liver puncture is simulated in the three-dimensional model obtained in the second step, and the design scheme of the needle track is determined. process, specifically:

Save the 3D models of skin, bones, tumors, blood vessels, etc. in stl format, and import them into the industrial design software geomagic design direct to simulate the design of the puncture needle track. Accurately placed in the tumor center to ensure the shortest needle insertion stroke, the needle track is designed according to the standard diameter of the puncture needle. Here, the diameter of the puncture needle is 2.7mm. Considering the actual machining accuracy, the puncture aperture is designed to be 3.1mm; the wall thickness of the needle channel is designed to be 3mm, the needle track stretches out of the skin, 5cm above the body surface. In summary, the puncture simulation plan is completed. as shown in picture 2.

Specific implementation seven:

The difference from the sixth embodiment is that in the design method of the guide plate used to assist the liver puncture operation in this embodiment, in step four, the needle track with the puncture needle track is designed using the needle track scheme determined in step three and the set of positioning points on the skin. And the process of positioning the guide plate of the point group, specifically:

Step 41. Import the simulated needle track model and the positioning point group on the skin into the geomagic studio2014 software. First, the skin data is offset and thickened outward, with a thickness of 2mm; as shown in Figure 3;

Step 42: Design the positioning hole, design the corresponding positioning hole according to the position of the lead point on the CT image, and design a cross structure on the positioning hole in order to better align the center point of the mark;

Step 43: In order to further strengthen the rigidity of the guide plate and prevent bending and deformation during use, a reinforcing rib structure is designed on the outer surface of the guide plate.

Step 44. In order to cooperate with the ultrasound examination during the operation, the guide plate needs to be removed during the operation. Therefore, the puncture port needs to be designed as an assembling block structure. When using, the blocks are removed separately, and then the guide plate is removed from the puncture needle. Take it out, you can use B-ultrasound to check the puncture position, and at the same time mark the patient's personal case information on the guide plate.

The present invention can also have other various embodiments, without departing from the spirit and essence of the present invention, those skilled in the art can make various corresponding changes and deformations according to the present invention, but these corresponding changes and deformation should belong to the protection scope of the appended claims of the present utility model.

Claims (2)

1. A baffle for assisting liver puncture operations, characterized in that: the guide plate comprises a guide plate body, the surface of the guide plate body is provided with a reinforcing rib net formed by vertically crossing a group of transverse reinforcing ribs and longitudinal reinforcing ribs,

one side of the guide plate body is provided with a group of positioning holes, a cross-shaped positioning body is arranged in each positioning hole, the positioning holes are superposed with the circle center of the cross-shaped positioning body,

the other side of the guide plate body is provided with a puncture operation window, a first needle track insert and a second needle track insert are embedded in the puncture operation window, the butt joint surfaces of the first needle track insert and the second needle track insert are respectively provided with a groove, the cross section of each groove is semicircular, the grooves of the butt joint surfaces of the first needle track insert and the second needle track insert are buckled to form a needle track with a circular cross section, and the central axis of the needle track is intersected with the guide plate body;

one side of the puncture operation window is communicated with one side of the guide plate body.

2. A guide plate for assisting a liver puncturing operation according to claim 1, wherein: the included angle formed by the intersection of the central axis of the needle channel formed by buckling the grooves of the butting surfaces of the first needle channel insert and the second needle channel insert and the guide plate body is 1-89 degrees.

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