CN213249337U

CN213249337U - Abdominal cavity exhaust device for endoscopic surgery

Info

Publication number: CN213249337U
Application number: CN202021156547.8U
Authority: CN
Inventors: 刘明星; 元芳芳; 刘丽萍; 冯振; 张尚飞; 宋煜彬; 梁蓉
Original assignee: Individual
Current assignee: Individual
Priority date: 2020-06-22
Filing date: 2020-06-22
Publication date: 2021-05-25
Anticipated expiration: 2030-06-22

Abstract

The utility model discloses an abdominal cavity exhaust device for endoscopic surgery, which comprises a needle cylinder (3), wherein a piston (4) and a piston rod (5) are arranged in the needle cylinder (3), and a needle head (6) is arranged at the front end of the needle cylinder (3); the needle cylinder is characterized in that a pressure gauge (7) is integrated in the middle of the needle cylinder (3), an air outlet (8) is formed in the upper portion of the needle cylinder (3) and located above the pressure gauge (7), a hole cap (10) is screwed outside the air outlet (8), physiological saline (11) is pumped into the needle cylinder (3) through a needle head (6), the liquid level of the physiological saline (11) is located below an induction area of the pressure gauge (7), and a needle cylinder handle (9) of the needle cylinder (3) is vertically hung on the hanging frame (1) through a hanging wire (2). When the exhaust device is used in an endoscopic EFTR operation, the pressure in the abdominal cavity can be reduced, repeated inflation and gas suction in the operation process are not needed, the operation time is greatly shortened, and the occurrence of complications in the operation is reduced.

Description

Abdominal cavity exhaust device for endoscopic surgery

Technical Field

The utility model relates to a digestion scope EFTR operation technical field specifically is an endoscope operation abdominal cavity exhaust apparatus.

Background

With the continuous development of the digestive endoscopy technology, in the process of exploring the treatment technology, the scope of the endoscopic treatment is continuously widened, and the treatment effect is also continuously improved. The human digestive canal wall tissue is divided into 4 layers from inside to outside, which are respectively: mucosal layer, submucosal layer, muscularis propria and serosal layer.

In order to completely remove lesions from the wall of the digestive tract, especially deep lesions of the intrinsic muscular layer, a submucosal tumor (SMT) is removed together with the wall of the digestive tract in a whole layer, and the endoscopic removal method is named as endoscopic full-thickness resection (EFTR).

The treatment of submucosal tumor (SMT) originated from inherent muscular layer is the reason of the development of EFTR technology, and the endoscopic treatment has the advantages that the excision is completed from the eye-catching and alarming incision of the surgical open surgery to the tiny wound of the laparoscope and then to the entrance of the endoscope through the natural orifice of the human body, and the operation of no scar is completely performed on the body surface, which is only the most superficial and most intuitive advantage of the endoscope. The most fundamental advantage of endoscopic EFTR surgery is that the resection and reconstruction of the digestive tract are not needed, the structure of the digestive tract is not changed, and the normal physiological structure and function of the digestive tract are retained to the maximum extent. The method is indiscriminate with the will of the patient, and both doctors and patients hope to find a simple, safe and minimally invasive method which can not only determine the type and the nature of the pathological changes, but also achieve the effect of thorough excision treatment. Thus, endoscopic resection is the first choice for most patients.

The specific operation mode is that an endoscopist operates a digestive endoscope to enter the stomach through the oral cavity, the pharyngeal portion and the esophagus, then the endoscope supplies air through a carbon dioxide air pump in the diagnosis and treatment process, so that the pressure in the stomach is greater than the pressure in the abdominal cavity (the pressure in the abdominal cavity of a normal adult is 0-5 mmHg), the stomach wall structure is expanded, a good operation visual field and an operation space are provided, a tumor (SMT) under the gastric mucosa is found, and the resection is performed through the endoscope and an operation instrument; when the gastric wall is perforated or the gastric wall is defective, gas in the stomach enters the abdominal cavity through the gastric wall perforation or the gastric wall defect part, the pressure in the stomach is slightly equal to the pressure in the abdominal cavity after a period of time, the stomach cannot be fully expanded, a good operation visual field and an operation space are lost, the operation is not facilitated to be continued, an endoscopist needs to continuously supply gas through an endoscope carbon dioxide gas pump, the supplied gas also enters the abdominal cavity through the defective gastric wall, the abdominal cavity is in a closed environment, the pressure in the abdominal cavity of a patient is continuously increased, the pressure in the stomach and the pressure in the abdominal cavity are both greater than the former intra-gastric pressure and intra-abdominal pressure, and the abdominal distension of the patient cannot tolerate obviously in the operation; at the moment, an endoscopist needs to suck out a part of gas stored in the stomach through the suction function of the endoscope to relieve abdominal distension of a patient, the pressure in the stomach is slightly less than the pressure in the abdominal cavity in the suction process, and the stomach is in a contraction state and is also not beneficial to the continuation of an operation; in order to achieve a good operation visual field and an operation space and ensure the safety of a patient, air must be repeatedly supplied and sucked through an endoscope, so that the operation time of the operation is undoubtedly increased, the occurrence of complications in the operation is increased, and if bleeding occurs in the process of removing a tumor, the safety of the patient is threatened due to the lack of the good visual field and the operation space.

The effects in the EFTR procedure are: firstly, the pressure in the abdominal cavity is increased, which causes the diaphragm to move upwards, and simultaneously affects the respiratory system and the circulatory system, compresses the heart and the lung of the patient, and further affects the cardio-pulmonary function of the patient; secondly, the gas in the abdominal cavity presses the stomach wall, so that the stomach wall cannot be fully expanded, and the subsequent operation is seriously affected (the optimal operation state is that the pressure in the stomach is continuously higher than the pressure in the abdominal cavity, so that the stomach wall is expanded in an filling manner); thirdly, the pressure in the abdominal cavity is increased continuously, so that the patient can not tolerate abdominal distension and the like and can not be continuously operated in coordination with the continuation of the operation; fourthly, repeatedly inflating and sucking gas in the stomach to increase the time of the operation; fifthly, the pressure in the abdominal cavity is increased, so that the blood pressure of the patient is increased, and the risk of cerebrovascular accident in the operation of the patient is increased; sixth, under the influence of the operation, the endoscopic physician can suture the wound surface of the stomach wall with the titanium clip at the end of the operation, and the residual gas in the abdominal cavity can not be normally discharged out of the body, thereby causing discomfort such as abdominal pain and abdominal distension of the patient after the operation.

Therefore, the most ideal EFTR operation state is that the pressure in the stomach is greater than the pressure in the abdominal cavity, so that the stomach wall is fully unfolded, a good visual field and an operation space are provided, active stomach wall perforation or stomach wall defect is accompanied in the endoscopic resection process, when the stomach wall perforation or the stomach wall defect, the ideal operation state is damaged, the pressure in the stomach is basically equal to the pressure in the abdominal cavity, so that the stomach cavity cannot be fully unfolded, a good operation visual field and an operation space cannot be provided, and the operation is in an embarrassed situation.

Therefore, the utility model aims to solve the technical problem that: the damaged operation state is pulled back to the positive rail again, the ideal operation state before the perforation or defect of the stomach wall is recovered, the pressure in the stomach is continuously made to be larger than the pressure in the abdominal cavity, the stomach wall is made to be inflated and expanded, and the operation is made to continue smoothly.

Disclosure of Invention

Can be accompanied with the perforation of initiative stomach wall or stomach wall defect to the in-process of scope EFTR excision, the utility model aims at providing an endoscopic surgery abdominal cavity exhaust apparatus.

The utility model discloses an adopt following technical scheme to realize:

an abdominal cavity exhaust device for endoscopic surgery comprises a needle cylinder, wherein a piston and a piston rod are arranged in the needle cylinder, and a needle head is arranged at the front end of the needle cylinder; the needle cylinder is characterized in that a pressure gauge is integrated in the middle of the needle cylinder, an air outlet is formed in the upper portion of the needle cylinder and located above the pressure gauge, a hole cap is screwed outside the air outlet in a rotating mode, physiological saline is pumped into the needle cylinder through a needle head, the liquid level of the physiological saline is located below a sensing area of the pressure gauge, and a needle cylinder handle of the needle cylinder is vertically hung on a hanging frame through a hanging line.

When the device is used, the piston is pulled by the needle head in the needle cylinder to extract physiological saline to a water level line below a pressure gauge sensing area in the middle of the needle cylinder, the piston is continuously pulled in the air to extract the air to a gas level line above an air outlet hole in the upper part of the needle cylinder for later use, and the length of the needle head (puncture needle) is greater than the thickness of the abdominal wall. The venting device may be required to be applied if an active gastric wall perforation or a gastric wall defect occurs during endoscopic EFTR surgical resection.

The upper side of the middle point of the connecting line of the disinfection puncture umbilical region and the upper edge of the pubic symphysis is 1 cm to the left or 1-2 cm to the right, no important organ exists at the position, the puncture is safe, the puncture is performed on the abdominal cavity, the needle point enters the abdominal cavity, the continuous gas overflow is observed, and then the needle cylinder is vertically hung on the hanging frame by adjusting the length of the hanging line. The needle cylinder and the needle head are fixed, in the process, gas in the abdominal cavity enters the needle cylinder through the needle head, passes through the physiological saline and then is located between the piston and the liquid level of the physiological saline, the balance is achieved after a certain time (namely the pressure in the abdominal cavity is the same as the pressure of the gas between the piston in the needle cylinder and the liquid level of the physiological saline), and at the moment, the pressure in the abdominal cavity can be seen through the pressure gauge. The physiological saline has the function of separating the abdominal cavity from the atmosphere, and if the pressure in the abdominal cavity is higher than the external atmospheric pressure, the bubbles can be seen from the physiological saline in the syringe in the process of discharging the gas in the abdominal cavity through the syringe, and the process of discharging the gas in the abdominal cavity can also be seen visually. After the air outlet cap was lifted off to the spiral, communicate abdominal cavity and external atmosphere this moment, it is gaseous that to pass through the pjncture needle by the abdominal cavity and flow through normal saline, reduce intra-abdominal pressure, the scope doctor continues to supply gas through scope carbon dioxide air pump this moment, make the pressure in the gastric cavity increase, the pressure in the gastric cavity is greater than the pressure in the abdominal cavity, the pressure in the abdominal cavity is greater than atmospheric pressure, after gaseous the discharging smoothly in the abdominal cavity, the gastric cavity can be sufficient again and expand, reach a dynamic balance, establish the operation state of ideal again, place the cylinder through gallows and suspension wire perpendicular to horizontal plane. If need observe abdominal cavity internal pressure, as long as twist the venthole with the pore cap once more can, reach balanced through a period of time, the manometer can demonstrate abdominal cavity internal pressure this moment, through monitoring abdominal cavity internal pressure at any time, if observe that abdominal cavity internal pressure is too high, then the air feed volume of scope carbon dioxide air pump should be reduced to the scope doctor, avoid abdominal cavity internal pressure too high and produce adverse effect to the internal organs, if observe that abdominal cavity internal pressure is lower, then the air feed volume of scope carbon dioxide air pump can be increased to the scope doctor, make further sufficient expansion of stomach wall, provide good field of vision and operating space, create the most ideal EFTR operation state.

The endoscope physician can suture the wound surface of the stomach wall by using the titanium clip at the end of the operation, then can measure the pressure in the abdominal cavity of the patient through the exhaust device, and then judge whether residual gas exists in the abdominal cavity of the patient.

The utility model has the advantages of as follows:

1. use this exhaust apparatus in scope EFTR operation, can reduce intra-abdominal pressure, make the diaphragm be in normal functional position, guarantee that the patient breathes and circulation system normal operating, it pours into to have ensured important internal organs blood flow in the patient art, operation end scope doctor can sew up the surface of a wound with the titanium clamp to the stomach wall, remaining gas in the abdominal cavity can also continue to drain out externally, twist with the hole cap and plug up the venthole this moment, measure abdominal cavity internal pressure through the manometer, it can stop the drainage gas to resume to normal people abdominal pressure rear side until observing the patient, guarantee the safety of patient postoperative, it is because the hidden danger that the pneumoperitoneum arouses to get rid of patient's postoperative abdominal pain simultaneously.

2. Use this exhaust apparatus in scope EFTR operation, can reduce the intra-abdominal pressure, make the pressure in the stomach chamber be greater than the pressure in the abdominal cavity, make the abundant expansion of stomach wall, can let follow-up operation go on smoothly, when the complication of bleeding takes place in the art simultaneously, can provide good operation field of vision and operating space, guarantee safety in the patient art.

3. The exhaust device is used in an endoscopic EFTR operation, can reduce the pressure in an abdominal cavity, is more favorable for patients who are not anaesthetized in endoscopic operations (such as enteroscopy operations), can reduce uncomfortable feelings of abdominal distension and the like generated by the patients in the operation process, and is better matched with an endoscopic doctor to perform the operation.

4. When the exhaust device is used in an endoscopic EFTR operation, the pressure in the abdominal cavity can be reduced, repeated inflation and gas suction in the operation process are not needed, the operation time is greatly shortened, and the occurrence of complications in the operation is reduced.

5. Use this exhaust apparatus in scope EFTR operation, can reduce intra-abdominal pressure, reduce patient's blood pressure simultaneously, steadily played positive effect to vital sign in maintaining patient's operation.

The utility model relates to a rationally, fine practical application is worth having.

Drawings

Fig. 1 shows a schematic structural view of the present invention in a pressure measuring state.

Fig. 2 shows a schematic structural view of the present invention in an exhaust state.

In the figure: 1-hanger, 2-suspension wire, 3-syringe, 4-piston, 5-piston rod, 6-needle (puncture needle), 7-pressure gauge, 8-air outlet, 9-syringe handle, 10-hole cap, 11-normal saline, 12-water line and 13-air line.

Detailed Description

The following describes in detail specific embodiments of the present invention with reference to the accompanying drawings.

An abdominal cavity exhaust device for endoscopic surgery, as shown in figure 1, comprises a needle cylinder 3, a piston 4 and a piston rod 5 are arranged in the needle cylinder 3, a needle head 6 is arranged at the front end of the needle cylinder 3, and the piston and the needle head in the needle cylinder 3 belong to the prior art and have no difference with the prior injector; the pressure gauge is characterized in that a pressure gauge 7 is integrated in the middle of the needle cylinder 3, an air outlet 8 is formed in the upper portion of the needle cylinder 3 and located above the pressure gauge 7, a hole cap 10 is screwed outside the air outlet 8, a water level line 12 and an air level line 13 are arranged on the needle cylinder 3, the water level line 12 is located below a sensing area of the pressure gauge 7, and the air level line 13 is located above the air outlet 8.

The piston is pulled by the needle 6 in the syringe 3 to extract the liquid level of the physiological saline 11 to the position of a water level line 12 below the sensing area of the pressure gauge 7, and the syringe handle 9 of the syringe 3 is vertically hung on the hanging bracket 1 through the hanging wire 2.

In practice, it is also known to integrate a pressure gauge 7 in the middle of the barrel 3, for example an inflatable pressure pump system manufactured by american company, i.e. a pressure gauge integrated in the end of the syringe barrel. The lengths of the suspension wire 2 and the suspension bracket 1 are both adjustable.

In an endoscope EFTR operation, firstly, the piston 4 is pulled to extract the physiological saline 11 to a position below a water level line 12 of a sensing area of a pressure gauge 7 in the middle of the needle cylinder 3, and the piston is continuously pulled to extract air in the air to a position above an air outlet hole 8 in the upper part of the needle cylinder 3 to be in a standby state. The length of the needle head 6 (puncture needle) is larger than the thickness of the abdominal wall, but the needle head is not easy to be overlong, generally 4cm, and the damage to the visceral organs after puncture is avoided. The venting device may be applied if an active gastric wall perforation or a gastric wall defect occurs during endoscopic EFTR resection.

The upper part of the middle point of the connecting line of the disinfection puncture umbilical part and the upper edge of the pubic symphysis is 1 cm to the left or 1-2 cm to the right, no important organ exists at the position, the puncture is safe, the puncture is performed on the abdominal cavity, the needle point 6 enters the abdominal cavity, and then the needle cylinder 3 is vertically hung on the hanging bracket 1 by adjusting the length of the hanging wire 2. The needle cylinder 3 and the needle 6 are fixed, in the process, gas in the abdominal cavity enters the needle cylinder 3 through the needle 6, passes through the physiological saline 11 and then is located between the piston 4 and the liquid level of the physiological saline 11, continuous gas overflow in the physiological saline 11 is observed, balance is achieved after a certain time (namely the pressure in the abdominal cavity is the same as the pressure of the gas between the piston in the needle cylinder and the liquid level of the physiological saline), and at the moment, the pressure in the abdominal cavity can be seen through the pressure gauge 7 and is in a pressure measuring state (as shown in figure 1). The physiological saline has the function of separating the abdominal cavity from the atmosphere, and if the pressure in the abdominal cavity is higher than the external atmospheric pressure, the bubbles can be seen from the physiological saline in the needle cylinder 3 in the process of discharging the gas in the abdominal cavity through the needle cylinder, and the process of discharging the gas in the abdominal cavity can also be seen visually. After the vent hole cap 10 is unloaded to the spiral, exhaust apparatus communicates the abdominal cavity with external atmosphere (atmospheric pressure 0.10133 MPa) this moment, gaseous passing through pjncture needle 6 by the abdominal cavity flows out through normal saline 11 and venthole 8, reduce intra-abdominal pressure, endoscope doctor continues to send gas through endoscope carbon dioxide air pump this moment, make the pressure in the gastric cavity increase, the pressure in the gastric cavity is greater than the pressure in the abdominal cavity, the pressure in the abdominal cavity is greater than atmospheric pressure, after the intra-abdominal pressure discharges smoothly, the gastric cavity can be sufficient again and expand, reach a dynamic balance, establish the most ideal operation state again, place cylinder 3 through gallows 1 and hang 2 line perpendicular to horizontal plane, be in exhaust state (as shown in fig. 2). If need observe the intra-abdominal pressure, as long as twist the venthole 8 with the pore cap 10 once more can, reach the equilibrium through the certain time, manometer 7 can demonstrate intra-abdominal pressure this moment, through monitoring intra-abdominal pressure at any time, if observe intra-abdominal pressure too high, then the scope doctor should reduce the air supply volume through scope carbon dioxide air pump, avoid the intra-abdominal pressure too high and produce adverse effect to the internal organs, if observe intra-abdominal pressure ratio lower, then the scope doctor can increase the air supply volume of scope carbon dioxide air pump, make the further sufficient expansion of stomach wall, provide good field of vision and operating space, create the most ideal EFTR operation state.

At last, an endoscopist can suture the wound surface of the stomach wall by using a titanium clip, then the pressure in the abdominal cavity of a patient can be measured by the exhaust device, and whether residual gas exists in the abdominal cavity of the patient or not is judged.

The above, only for the practical operation case of the present invention, not to the limitation of the present invention in any form, all the technical content of the present invention is to make any simple modification to the above embodiments, which still belongs to the protection scope of the technical solution of the present invention.

Claims

1. An abdominal cavity exhaust device for endoscopic surgery comprises a needle cylinder (3), wherein a piston (4) and a piston rod (5) are arranged in the needle cylinder (3), and a needle head (6) is arranged at the front end of the needle cylinder (3); the method is characterized in that: the needle cylinder is characterized in that a pressure gauge (7) is integrated in the middle of the needle cylinder (3), an air outlet (8) is formed in the upper portion of the needle cylinder (3) and located above the pressure gauge (7), a hole cap (10) is screwed outside the air outlet (8), physiological saline (11) is pumped into the needle cylinder (3) through a needle head (6), the liquid level of the physiological saline (11) is located below an induction area of the pressure gauge (7), and a needle cylinder handle (9) of the needle cylinder (3) is vertically hung on the hanging frame (1) through a hanging wire (2).

2. An endoscopic abdominal cavity degassing device according to claim 1, wherein: a water level line (12) is arranged below the sensing area of the pressure gauge (7) outside the needle cylinder (3), and a gas level line (13) is arranged above the gas outlet (8) outside the needle cylinder (3).