CN215129689U - Endocardium injection device and endocardium injection system - Google Patents
Endocardium injection device and endocardium injection system Download PDFInfo
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- CN215129689U CN215129689U CN202023344472.9U CN202023344472U CN215129689U CN 215129689 U CN215129689 U CN 215129689U CN 202023344472 U CN202023344472 U CN 202023344472U CN 215129689 U CN215129689 U CN 215129689U
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Abstract
The utility model provides an endocardium injection apparatus and endocardium injection system. The endocardial injection device comprises a sleeve and an injection assembly, wherein a stopping part is arranged at the far end of the sleeve. In the sleeve was located in the injection subassembly slides, the injection subassembly included needle file, needle tubing and spiral nail, and the drive tube is connected to the near-end of needle file, and spiral nail and needle tubing are connected to the distal end, and in the spiral nail was arranged in to the axial along the needle tubing, the needle tubing was made by metal material, and backstop portion can be dismantled with the near-end of spiral nail and be connected, and the drive tube drives the injection subassembly rotation to make spiral nail be connected or separate with backstop portion. The utility model discloses an endocardium injection apparatus and endocardium injection system, when the screw nail is connected with backstop portion, the screw nail receives the spacing unable continuation of backstop portion and advances, can not deepen ventricular wall once more and rotatory hank into ventricular wall tissue, avoids the screw nail to cause unnecessary secondary damage to myocardial tissue, makes the final degree of depth or the injection point position of stinging into the ventricular wall of injection subassembly obtain accurate control, realizes injecting controllable and reduce the operation effect of damage.
Description
Technical Field
The utility model belongs to the technical field of medical instrument, particularly, relate to an endocardium injection device and endocardium injection system.
Background
Myocardial infarction refers to the killing of myocardial cells due to a sudden and severe decrease or interruption in the blood supply to a portion of the heart and deprivation of its oxygen supply. Myocardial infarction may progress to heart failure. Currently, the most effective treatment for patients with end-stage heart failure is heart transplantation. However, in view of the long-term shortage of donor hearts, other approaches are needed to improve the life span of heart failure patients. Moreover, transplantation is not the most suitable treatment option for patients with mild disease. Other treatments include delivery of drugs to the site of action via the bloodstream, or injection of hydrogels, cells, etc. grafts into ischemic myocardium to improve cardiac function. Clinical research shows that the endocardium injection method can make medicine and graft easy to enter target area directly without need of long-distance travel, and is more favorable for acting of chemotactic factor.
In the prior art, the endocardium injection usually adopts the spiral pinning mode to reach the purpose of anchoring in order to reach the endocardium earlier, and rethread syringe needle injects the medicine to the endocardium, and this kind of mode not only can increase the operating procedure of operation, and after the spiral nail anchored to the myocardium, because can't restrict the spiral nail and continue to advance, along with the heart beat, the spiral nail easily removes again in the myocardium tissue to further rotatory hank tissue, can not accurate control puncture depth all the time, cause unnecessary secondary damage simultaneously to the myocardium tissue easily.
SUMMERY OF THE UTILITY MODEL
The utility model discloses a main aim at, overcome above-mentioned prior art, adopt the endocardium injection device of screw nail anchoring can not the accurate control depth of penetration to easily cause the defect of great injury to the myocardial tissue, provide an endocardium injection device, include:
the sleeve is provided with a stopping part at the far end; and the number of the first and second groups,
the injection subassembly slides and locates in the sleeve, the injection subassembly includes needle file, needle tubing and spiral nail, the drive tube is connected to the near-end of needle file, and the distal end is connected spiral nail and needle tubing, the needle tubing is arranged in along the axial in the spiral nail, the needle tubing is made by metal material, backstop portion with the connection can be dismantled to the near-end of spiral nail, the drive tube drives the injection subassembly is rotatory, so that the spiral nail with backstop portion connects or separates.
The utility model also provides an endocardium injection system, including operating handle, conveyer pipe and the endocardium injection device as aforementioned structure, the driving tube wears to locate in the conveyer pipe, telescopic near-end fixed connection in the distal end of conveyer pipe, the operating handle drive the driving tube drives injection subassembly axial helical motion, so that injection subassembly stretch out or withdraw in the sleeve.
The endocardium injection device and the endocardium injection system of the utility model operate the driving tube to drive the injection component to rotate after the sleeve reaches the operation position, so that the injection component moves axially along the sleeve to make the screw nail gradually extend to the far end to prick into the ventricular wall, and the root of the screw nail is gradually close to the stopping part; when the root of the screw nail is connected with the stopping part, the screw nail cannot continue to advance under the limit of the stopping part, and the screw nail completes the pricking action to realize anchoring; after anchoring, the injection assembly starts to inject contrast liquid, medicine or a graft, and in the injection process, the spiral nail cannot enter the ventricular wall again due to the influence of injection action and cannot be twisted into the tissue of the ventricular wall, so that unnecessary secondary damage to the myocardial tissue caused by the spiral nail is effectively avoided.
Drawings
Fig. 1 is an overall view of an endocardial injection system in accordance with an exemplary embodiment of the present invention.
Fig. 2 is a longitudinal cross-sectional view of an exemplary endocardial injection device of the present invention in a retracted state.
Fig. 3 is a longitudinal cross-sectional view of an exemplary endocardial injection device of the present invention in an extended state.
Fig. 4 is a schematic diagram of an exemplary endocardial injection device of the present invention penetrating the wall of a heart chamber.
Fig. 5 is an exploded view of an exemplary endocardial injection device of the present invention.
Fig. 6 is a perspective view of a sleeve and a stopper according to a first example of the present invention.
Fig. 7 is a front cross-sectional view of a sleeve and a stop of an example of the present invention.
Fig. 8 is a perspective view of a sleeve and a stopper portion according to a second example of the present invention.
Fig. 9 is a perspective view of a sleeve and a stopper according to a third example of the present invention.
Fig. 10 is a perspective view of a sleeve and a stopper portion according to a fourth example of the present invention.
Fig. 11 is a front view of a screw according to a first example of the present invention.
Fig. 12 is a perspective view of a screw according to a second example of the present invention.
Fig. 13 is a perspective view of a screw according to a third example of the present invention.
Fig. 14 is a perspective view of a screw according to a fourth example of the present invention.
Fig. 15 is a perspective view of a needle holder according to an example of the present invention.
Fig. 16 is a front view of a needle hub in accordance with an example of the present invention.
Fig. 17 is a left side view of a needle holder according to an example of the present invention.
Figure 18 is a cross-sectional view of a-a section of a needle hub in accordance with an example of the present invention.
Fig. 19 is a parameter view of the a-a section of a needle holder according to an example of the present invention.
Fig. 20 is a perspective view of a needle cannula according to an example of the present invention.
Figure 21 is a parameter oblique view of a syringe according to an example of the present invention.
Figure 22 is a rear view parameter chart of a syringe according to an example of the present invention.
Figure 23 is a left side view of a syringe according to an example of the present invention.
Fig. 24 is a schematic view of a needle cannula of an example of the present invention penetrating a ventricular wall.
Figure 25 is a longitudinal cross-sectional view of an injection assembly according to a first example of the present invention.
Fig. 26 is a longitudinal cross-sectional view of an injection assembly according to a second example of the present invention.
Fig. 27 to 33 are schematic views illustrating the procedure of the endocardial injection system of the present invention for endocardial injection, wherein:
fig. 27 is a schematic view of an introducer sheath being routed into the heart through the aortic arch.
Fig. 28 is a schematic view of an endocardial injection device reaching a desired site along an introducer sheath.
Fig. 29 is a schematic view of the distal end face of the endocardial injection device adjusted to be substantially perpendicular to the ventricular wall.
Fig. 30 is a schematic view of an endocardium injection device using contrast medium to determine adherence.
Fig. 31 is a schematic illustration of the screw anchoring of the endocardial injection device to the myocardium and controlling the injection depth via the stop.
Fig. 32 is a schematic view of an endocardial injection device injecting hydrogel into the ventricular wall after judging the right spot using a contrast medium.
FIG. 33 is a schematic view of the needle cannula being retracted into the hub after completion of an injection by the endocardial injection device.
Detailed Description
In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. It is to be understood that the embodiments described are only some of the embodiments of the present invention, and not all of them. Based on the embodiments of the present invention, all other embodiments obtained by a person of ordinary skill in the art without creative efforts belong to the protection scope of the present invention.
It should be understood that the terms "front", "back", "upper", "lower", "left", "right", "longitudinal", "lateral", "vertical", "horizontal", "top", "bottom", "inner", "outer", "head", "tail", and the like, are used for describing the orientation or positional relationship of the drawings, and are constructed and operated in a specific orientation, and are used only for convenience of describing the present invention, but not for indicating that the referred device or element must have a specific orientation, and thus, should not be construed as limiting the present invention.
It is also noted that, unless expressly stated or limited otherwise, the terms "mounted," "connected," "secured," "disposed," and the like are intended to be inclusive and mean, for example, that they may be fixedly connected, detachably connected, or integrally formed; either directly or indirectly through intervening media, either internally or in any other relationship. When an element is referred to as being "on" or "under" another element, it can be "directly" or "indirectly" on the other element or intervening elements may also be present. The specific meaning of the above terms in the present invention can be understood according to specific situations by those skilled in the art.
In the description of the present invention, it should be noted that the proximal end refers to the end of the instrument or component close to the operator, and the distal end refers to the end of the instrument or component far from the operator; axial refers to a direction parallel to the center line connecting the distal end and the proximal end of the instrument or component, radial refers to a direction perpendicular to the axial direction, and circumferential refers to a direction around the axial direction.
In order to overcome the defects that the endocardium injection device anchored by the spiral nail in the prior art can not accurately control the puncture depth and can cause larger damage to myocardial tissues. The utility model discloses an endocardium injection device 100 for to the myocardium injection medicine or graft, promote pathological change in the heart, the myocardial cell of damage to regenerate and the function is restoreed, thereby heart diseases such as the myocardial infarction that the necrosis of treatment myocardial cell, fibrosis lead to, chronic heart failure. Examples of the present invention are specifically described below with reference to the accompanying drawings.
Referring to fig. 1-5, an endocardial injection device 100 includes a sleeve 110 and an injection assembly 130. The distal end of the sleeve 110 is provided with a stopper 120. Injection assembly 130 is slidingly arranged in sleeve 110, injection assembly 130 comprises needle seat 131, needle tube 132 and screw 133, the proximal end of needle seat 131 is connected with drive tube 220, the distal end is connected with screw 133 and needle tube 132, needle tube 132 is axially arranged in screw 133, stopping portion 120 is detachably connected with the proximal end of screw 133, drive tube 220 drives injection assembly 130 to rotate, so that screw 133 is connected with or separated from stopping portion 120.
Referring to fig. 4, in particular, injection assembly 130 is used to penetrate a ventricular wall 561, through which a drug or implant, etc. is passed into the ventricular wall 561. The ventricular wall 561 includes the endocardium, myocardium and epicardium from the inside out, and the injection assembly 130 is passed through a passageway into the interior of the ventricle for injecting drugs or implants into the myocardium from the inside out.
It will be appreciated that when sleeve 110 reaches the surgical site, drive tube 220 is operated to rotate injection assembly 130 such that injection assembly 130 moves axially along sleeve 110, causing screw 133 to progressively extend distally to penetrate ventricular wall 561, while the root of screw 133 progressively approaches stop 120. When the root of the screw 133 is connected to the stopper 120, the screw 133 is limited by the stopper 120 and cannot move further, and the screw 133 completes the penetration action to achieve the anchoring. After anchoring, the injection assembly 130 starts to inject contrast solution, medicine or implant, and during the injection process, the screw 133 cannot go deep into the ventricular wall 561 again due to the influence of the injection action, and cannot be twisted into the ventricular wall tissue, thereby effectively avoiding unnecessary secondary damage to the myocardial tissue caused by the screw 133.
Referring to fig. 5 to 14, the distal end of the sleeve 110 is provided with a stopper 120. The stopper 120 is used for cooperating with the screw nail 133 to control the injection depth; on the other hand, when screw 133 is completely anchored in the myocardial tissue, stopper 120 may fix screw 133 extending out of sleeve 110, limiting further distal movement of injection assembly 130 and screw 133 in the axial direction to further rotate and entangle the tissue, avoiding secondary damage to the myocardial tissue.
Specifically, the sleeve 110 includes a main body section 111, a sleeve transition section 112, and a delivery connection section 113, which are connected in series. The length of the main body section 111 is sufficient to accommodate the needle tube 132 and the needle seat 131, and a safety space with a certain length can be reserved.
Preferably, at least one through hole 114 is formed on the circumferential side wall of the main body section 111 for allowing the contrast fluid to pass therethrough, so that whether the whole device 100 is attached to the endocardial free wall can be quickly judged according to the actual outflow condition of the contrast fluid from the through hole, and the cross-sectional area of the through hole 114 is generally used as a performance index. Alternatively, the shape of the through hole 114 may be circular, square or irregular, and taking a circular shape as an example, the hole diameter is usually 0.5 to 1.0mm, and other shapes may be converted into equal cross-sectional areas. In this embodiment, circular holes are preferred, the number of holes is 2, and the diameter of the holes is 0.85 mm. It is understood that in other embodiments, the number of the through holes may also be 3, 4, 5 or other positive integers greater than 1.
Alternatively, to ensure smooth withdrawal of the instrument, the transition section 112 of the sleeve is a tapered surface, and the smaller the angle γ of the tapered surface means the longer the tapered surface, and the longer the tapered surface is, which is not favorable for reducing the size of the product and the difficulty of assembly, so the angle γ is usually 30 ° to 60 °, and preferably γ is 45 °. The outer diameter of the delivery connecting section 113 is smaller than the inner diameter of the main body section 111, and the delivery connecting section 113 can be fixed to the delivery pipe 200 by gluing. In particular, a connection hole 115 may be provided on the transfer link 113 to facilitate the glue connection.
Alternatively, the main body section 111 and the conveying connecting section 113 are both cylindrical with a uniform wall thickness. The sleeve 110 may be made of metal or non-metal, such as 304 stainless steel, 316 stainless steel, nitinol, PC, etc. 316 stainless steel is preferred as the material for the sleeve 110 in this embodiment.
Preferably, referring to fig. 6 and 7, the stopper 120 includes a spiral segment 121 disposed on the inner wall of the distal end of the sleeve 110. Referring to fig. 11, the screw 133 includes a spiral part 1331, and the spiral section 121 is fitted to a feeding track of the spiral part 1331. The thread segment 121 has a pitch equal to and in the same direction as the thread of the screw 133, preferably right-handed in this embodiment. The spiral section 121 limits the feeding of the spiral part 1331, and the spiral nail 133 is screwed in or screwed out along the axial direction under the action of the driving tube 220, so that the spiral nail 133 is stably screwed into the ventricular wall 561. When the screw 133 is anchored in the myocardial tissue, the root of the screw 133 contacts the root of the threaded section 121, and the screw 133 is fixed by the threaded section 121 and cannot rotate any more, i.e. the screw 133 and the injection needle 132 cannot move forward any more, so as to limit the anchoring depth and further control the injection depth to avoid piercing the ventricular wall 561. The spiral section 121 plays a guiding role in the advancing process of the spiral part 1331 and plays a limiting role after the spiral nail 133 rotates to the position.
Preferably, referring to fig. 8 to 10, the stopper 120 includes a boss 122 telescopically disposed in the distal cavity of the sleeve 110, the screw 133 includes a spiral part 1331, the boss 122 is connected to the spiral part 1331 when extending out of the inner cavity of the sleeve 110, and the boss 122 is separated from the spiral part 1331 when retracting into the inner cavity of the sleeve 110. In the anchoring process, the boss 122 is contracted in the inner cavity of the sleeve 110, so that the normal screwing-in or screwing-out of the screw 133 is not influenced, after the screw 133 is anchored, the boss 122 extends out of the inner cavity of the sleeve 110 to be contacted with the root part of the screw 133, the screw 133 is fixed by the boss 122, and the screw 133 cannot be screwed in any further, thereby achieving the technical effect equal to that of the thread section. Specifically, the boss 122 is a polygonal limiting column, such as a triangular limiting column, a rectangular limiting column, or a circular limiting column.
Preferably, referring to fig. 11-14, the distal end of the screw 133 is provided with a pointed portion 1332, and the pointed portion 1332 extends distally along the central axis of the needle 132 and beyond the spiral portion 1331. The pointed portion 1332 of the screw 133 serves to pierce the myocardial tissue surface, thereby allowing the screw 1331 to be more easily screwed into the myocardial tissue. To ensure that the tip 1332 first contacts the tissue when anchoring with the screw 133 rather than the helical section 121, the tip of the tip 1332 is designed to extend distally along the central axis of the needle cannula 131 and beyond the helical section 1331.
Further, the cross section of the screw 133 may be circular, rectangular or irregular, and in view of reducing damage to the myocardial tissue as much as possible, the present embodiment is preferable that the cross section of the screw 133 is circular.
It will be appreciated that the screw 133 has a regular outer diameter dimension D1And an inner diameter dimension d1. In one aspect, the screw 133 has an outer diameter D1The larger, the larger the instrument gauge; on the other hand, the screw 133 has an outer diameter D at the same anchoring depth1The larger the anchoring force. Therefore, in general, D is preferred in this embodiment1＝D3(D3 is the outer diameter of guide section 1314 of hub 131). And an inner diameter d1The smaller the diameter, the stronger the screw 133, but the greater the anchoring resistance and the damage to the myocardial tissue, and the inner diameter d is set to ensure sufficient strength of the screw 1331Should be as large as possible based on the outer diameter dimension D1And the depth of injection H (see FIG. 19), inside diameter d, of injection needle 1321Between 2 and 3mm, d is preferred in this embodiment1＝2.5mm。
Preferably, referring to fig. 15 to 19, the needle hub 131 includes a needle tube connecting section 1311, a screw connecting section 1312 and a driving connecting section 1313 from far to near, the needle tube connecting section 1311 is fixedly connected to the proximal end of the needle tube 132, the screw connecting section 1312 is fixedly connected to the proximal end of the screw 133, and the driving connecting section 1313 is fixedly connected to the driving tube 220 at its proximal end, that is, the needle hub 131 can be rotated by the rotation of the driving tube 220, so as to drive the needle tube 132 and the screw 133 to rotate together. The connection mode can meet the requirements that the needle tube 132, the spiral nail 133 and the driving tube 220 are fixed respectively and do not interfere with each other, and the requirements of accurate operation and convenient use are met.
Alternatively, the syringe connecting section 1311 is a cylinder with a uniform wall thickness and an internal bore for receiving the syringe 132, and thus the internal diameter d of the syringe connecting section 13112The dimension is equal to the outside diameter of needle cannula 132 plus twice the single-sided assembly clearance. Outside diameter D of needle cannula connection section 13112And length L2In connection with the connection method, the connection needs to have not only sufficient connection strength but also sealability, and thus, a form of welding all around is used.
Preferably, needle file 131 also includes direction section 1314, and direction section 1314 butt sleeve 110's inner wall is used for leaning on with sleeve 110 and realizes spacingly for needle file 131 is in sleeve 110 internal steady rotation, prevents that needle file 131 from taking place to rock at the in-process that advances.
Further, the guiding section 1314 includes several guiding parts 13141 arranged on the periphery of the needle hub 131, the guiding parts 13141 extend along the axial direction of the needle tube 132, and notches 13142 are formed between the adjacent guiding parts 13141. The guide 13141 is used to abut against the inner wall of the hub 110 to limit the position, and to keep the needle 132 moving in the axial direction in the hub 110, thereby reducing the radial run-out of the needle 132. The notch 13142 is used for passing contrast fluid so that the contrast fluid can fill the inner cavity of the sleeve 110, and the notch 13142 is in fluid communication with the through hole 114, so that whether the distal end face of the sleeve 110 is completely attached to the endocardial free wall can be judged through the condition that the contrast fluid actually flows out of the through hole. Specifically, pilot segment 1314 has an outer diameter D3Length L of3The cylindrical needle cannula is provided with four axially symmetrical notches 13122, the shape of the notches 13122 can be common circular, square or irregular, and the size of the notches 13122 can meet the contrast medium passing performance on the premise that a large enough guide width is ensured.
Preferably, a transition section 1315 is further provided between the guide portion 13141 and the driving connection section 1313, and the cross-sectional area of the transition section 1315 gradually increases from the proximal end to the distal end to be consistent with the cross-sectional area of the guide portion 13141. The transition section 1315 connects the guide section 13141 and the driving connection section 1313, so that the contrast fluid can flow through the space between the transition section 1315 and the sleeve 110, the impact of the contrast fluid on the proximal end of the guide section 13141 is reduced, the contrast fluid is prevented from being turbulent, and the control of the flow rate of the contrast fluid is facilitated.
Preferably, the internal structure of hub 131 is generally divided into four sections, a needle mounting cavity 1316, a retaining step 1317, a tapered cavity 1318, and an injection connection cavity 1319. Needle mounting cavity 1316 is adapted to receive needle cannula 132. Positioning step 1317 is used to position needle cannula 132, and thus inner diameter d of positioning step 13173Should be greater than or equal to the inside diameter d of needle cannula 1321In this embodiment, d is preferred3＝d1. Tapered chamber 1318 functions to transition fluid medium from larger injection connection chamber 1319 to smaller needle mounting chamber 13In 16, the smaller the angle δ is, the better theoretically, but the smaller δ means the longer the tapered cavity 1318 is, and the longer the tapered cavity 1318 is, the less difficult the assembly is, so δ is usually between 30 ° and 60 °, and δ is preferably 45 ° in this embodiment. The injection connection chamber 1319 is used for communication with an injection liquid. In this embodiment, the needle holder 131 is connected to the needle tube 132 by welding. The hub 131 may be made of a metal material, such as 304 stainless steel, 316 stainless steel or nitinol, and 316 stainless steel is preferred in this embodiment.
Preferably, referring to FIGS. 20-22, the distal end of the needle cannula 132 defines a tip 1320, the tip 1320 of the needle cannula 132 including a first bevel 1321 and two second bevels 1322 symmetrically disposed on opposite sides of the first bevel 1321, the two second bevels 1322 extending distally to define a piercing tip 1323. The needle cannula 132 includes a needle body 1324 having a length in addition to the tip 1320, the end face of the needle body 1324 being a plane perpendicular to a central axis of the needle body 1324 representing an axial direction of the needle cannula 132. During the puncturing process of the needle tube 132, the two second inclined planes 1322 enter the ventricular wall 561 first, and as the puncturing depth increases, the first inclined plane 1321 then enters the ventricular wall 561, and since the first inclined plane 1321 enables the proximal ends of the two second inclined planes 1322 to be smoothly transited, the needle body 1324 of the needle tube 132 can smoothly puncture the ventricular wall 561 along the tip 1320, and meanwhile, the damage caused is small.
Further, the angle between the puncturing tip 1323 and the central axis of the needle body 1324 is θ, and the smaller the angle α of the first ramp 1321, the shorter the length L of the tip 13204The longer the θ ranges from 11 to 30 °. The included angle between the first inclined surface 1321 and the central axis of the needle body 1324 is α, and the α range is 11 ° to 20 °. The angle and size of the second inclined surfaces 1322 directly influence the magnitude of the puncturing force, the included angle between each second inclined surface 1322 and the central axis of the needle body 1324 is beta, the range of beta is 11-45 degrees, and the included angle satisfies the condition of alpha<Theta. The basis for this is: the angle θ of the puncturing tip 1323 and the angle β of the two second inclined surfaces 1322 mainly affect the magnitude of the puncturing force of the needle tube 132, and the smaller the angle θ of the puncturing tip 1323 is, and the larger the angle β of the second inclined surfaces 1322 is, the smaller the puncturing force of the needle tube 132 is, but the weaker the strength of the needle holder 131 is.
Preferably, referring to fig. 24, the depth of penetration of needle 132 into ventricular wall 561 is the penetration depth H, and the effective depth of injection H-L4. To prevent the needle 132 from piercing the ventricular wall 561, the piercing depth H is in the range of 3.5-4.5 mm, preferably 4.0mm in this embodiment. Considering the angle α of the first ramp 1321, the angle β of the second ramp 1322 to the length L of the tip 13204In the case where H is known to be 4mm, in order to ensure a sufficient effective depth H, α is 20 °, θ is 30 °, and β is 45 ° in this embodiment, which is preferable.
Alternatively, the inner diameter d may be the same for different syringes 1324The larger the conveying resistance, the lower, but with an increasing outer diameter D4This results in an increased puncture area and, in addition to increased damage to the tissue, an increased risk of back leakage of the injected fluid medium along the gap between the puncture surface and the outer surface of the needle cannula 132, typically with an external needle cannula diameter D4 of the invasive injection system of between 0.4 and 0.7mm, preferably with a D4-0.5 mm and D4-0.35 mm, taking into account the lower delivery resistance and the lower risk of back leakage, and the needle cannula has a certain breaking strength.
Optionally, the needle tube 132 has a certain radiation detectability in addition to sufficient strength to help the operator identify the position of the needle tube 132 and improve the safety of the operation, so the material of the needle tube 132 may be 304 stainless steel, 316 stainless steel or nitinol, etc., in this embodiment, 316 stainless steel is preferred, and the needle holder 131 may be made of the same material as the needle tube 132.
Preferably, referring to fig. 24 and 25, the depth of penetration of needle 132 into ventricular wall 561 is the penetration depth H, and the pitch of travel of screw 133 is the same as the penetration depth. The screw 133 is mainly used to provide an anchoring force, and the larger the pitch T is, the smaller the anchoring force is, but when the pitch T is too small, not only the anchoring force is not increased, but also the damage is additionally increased. It can be understood that when the pitch is infinite, the spiral curvature tends to zero, i.e. becomes a straight needle, and the anchoring force is reduced; however, when the pitch is too small, the number of the rods of the spiral part 1331 per unit length becomes large, the thickness of the tissue accommodated in the gap between the rods becomes too thin, the tissue strength is low, and the number of times of puncturing in the tissue per unit thickness increases, the damage increases, and the anchoring force is inversely reduced, so that it is preferable that the pitch T is equal to the puncturing depth H in consideration of the above.
Preferably, referring to fig. 5, the endocardial injection device 100 further includes at least one injection conduit 210, the injection conduit 210 being in communication with the needle 132. Injection tube 210 is used to connect hub 131 and allow medication to enter needle cannula 132. Specifically, the injection tube 210 is required to have sealing property, flexibility and certain pushing and bending resistance, and may be a PEEK tube, a PI tube or a tube made of other high polymer materials (such as HDPE), and a PI tube is preferred in this embodiment.
In other different embodiments, in order to further improve the space utilization of the injection connecting cavity 1319 of the needle holder 131, and to judge in advance whether the injection site is located away from the blood vessel inside the myocardium, so as to prevent the injected medicine from flowing away with the blood vessel into the body circulation and even causing embolism, the injection tube 210 is provided as a dual lumen communicating with each port on the operation handle 300, that is, the injection tube 210 includes two lumens arranged coaxially or side by side. The newly added channel can be used for injecting a contrast medium through the needle tube 132 to determine in advance whether the injection site avoids a blood vessel inside the myocardium, when the observation is performed under a Digital Subtraction Angiography (DSA) image, if the contrast medium is scattered or flows away along a certain direction, the needle tube 132 may be punctured into a groove of the comb-shaped muscle or a blood vessel, and at this time, the condition for injecting a substance such as a drug is not satisfied, and only when the contrast medium forms a mass and jumps along the heart 500 under the DSA image, the injection site avoids the blood vessel inside the myocardium, and at this time, the injection tube 210 can inject the required drug, thereby avoiding unnecessary injury to the human body.
Optionally, the injection conduit 210 comprises a first conduit 211 and a second conduit 212, the first conduit 211 and the second conduit 212 being disposed along a coaxial dual lumen or axially side-by-side. Referring to fig. 26, in the present embodiment, the injection tube 210 is disposed in a coaxial dual-cavity, the injection tube 210 includes a first tube 211 (for flowing contrast medium) and a second tube 212 (for flowing medicine, etc.), the first tube 211 and the second tube 212 are disposed in a coaxial dual-cavity, and the delivery tube 200 accommodates both the first tube 211 and the second tube 212. A smaller second tube 212 is inserted into the first tube 211, and at least one fluid hole 13131, which may be a circular hole, a square hole or a special-shaped hole, is formed on the circumference of the driving connection 1313 to communicate the first tube 211 with the needle holder 131, so as to facilitate the circulation of the contrast medium for injection. The distal end of drive connector 1313 is connected to hub 131 and is not capable of covering fluid bore 13131 when connected to second conduit 212.
Alternatively, the injection conduit 210 is arranged axially side by side (not shown), and includes a first channel 211 and a second channel 212, the first channel 211 and the second channel 212 are arranged axially side by side, the first channel 211 can be used as a contrast fluid conduit, and the second channel 212 can be used as a drug or the like injection conduit. The delivery pipe 200 can simultaneously accommodate the first channel 211 and the second channel 212, the channels arranged side by side in the axial direction can realize double-channel injection, the added first channel 211 can be used for injecting contrast liquid to judge whether the injection site avoids blood vessels inside cardiac muscle in advance, and injected medicines are prevented from flowing away along the blood vessels to enter the body circulation and even cause embolism.
It will be appreciated that the injection line 210 may be a stack of two separate lines as described above, or may be a multi-lumen tube integrated in parallel to facilitate the connection of different syringes for separate injections of multiple components of a drug.
Referring to fig. 1, the present invention further discloses an endocardium injection system, which includes an operating handle 300, a delivery tube 200 and the endocardium injection device 100 with the aforementioned structure, wherein the driving tube 220 is inserted into the delivery tube 200, the proximal end of the sleeve 110 is fixedly connected to the distal end of the delivery tube 200, and the operating handle 300 drives the driving tube 220 to drive the injection assembly 130 to axially and spirally move, so that the injection assembly 130 extends out of or retracts into the sleeve 110.
Specifically, a delivery tube 200 is connected to the sleeve 110 for accommodating a driving tube 220, and a gap between the driving tube 220 and the delivery tube 200 serves as a passage through which the contrast medium flows. In order to connect the sleeve 110 and the contrast medium, the delivery tube 200 is required to have certain flexibility and pushing and bending resistance, and may be a metal cutting hose, a woven mesh tube or a tube made of other high polymer materials (such as HDPE), and a metal woven mesh tube is preferred in this embodiment.
Preferably, the proximal end of the operating handle 300 includes an injection portion 310, the injection portion 310 communicating with the injection conduit 210, and the injection conduit 210 communicating with the needle tube 132. The injection unit 310 is used to connect to an injector for injecting a medicine or a contrast medium into the endocardium through the needle tube 132 along the injection tube 210. Specifically, the injection part 310 is configured to match with the injection head of the injector, so that the liquid in the injector can enter the injection pipeline 210, and the liquid is prevented from being left outside the operating handle 300.
Preferably, the operating handle 300 further comprises a driving portion 320, the driving portion 320 is connected to the proximal end of the driving tube 220, and the driving tube 220 and the injection assembly 130 are driven to rotate along the axial direction of the sleeve 110 by the rotation of the driving portion 320. Specifically, drive portion 320 may be provided as a rotationally operable knob structure that translates its rotation into a combined axial and helical movement of injection assembly 130 via a threaded connection.
Preferably, the operating handle 300 is further provided with a connecting portion 330 for connecting to the proximal end of the delivery tube 200, the delivery tube 200 remaining stationary relative to the operating handle 300 during operation.
Preferably, the operating handle 300 is further provided with a liquid guiding port 340, the liquid guiding port 340 is communicated with the delivery pipe 200, and the liquid guiding port 340 is provided with a valve body 341 for controlling the on-off of the liquid guiding port. The liquid guide port 340 is used for guiding the contrast liquid filling the inner cavity of the sleeve 110, and the valve body 341 can be used for conveniently controlling the on-off of the contrast liquid. Specifically, the liquid guide port 340 may be disposed on the connection portion 330. When the delivery tube 200 filled with contrast medium is used to determine whether the distal end of the sleeve 110 is close to the free wall, the valve 341 of the drainage port 340 of the operating handle 300 is first opened, and the contrast medium enters from the valve 341 and then flows through the gap between the injection tube 210 and the delivery tube 200. Because the guide section 1314 of the hub 131 is provided with four axially symmetric notches 13142 to allow passage of contrast fluid, the circulating contrast fluid fills the space throughout the sleeve 110. Then, whether the distal end of the sleeve 110 is close to the free wall is determined by the DSA image. If contrast fluid is ejected from the distal end of the sleeve 110, it indicates that the device is not against the free wall; if contrast fluid is ejected from the through-holes 114 in the sleeve 110 and not from the distal end of the sleeve 110, the instrument is said to be against the free wall.
The use of the endocardial injection device and the endocardial injection system of the present invention is briefly described below. First, the structure of the heart 500 will be briefly described for clarity in illustrating the operation of the example of the present invention. Referring to fig. 27, the heart 500 includes a right atrium 510, a right ventricle 530, a left atrium 540, and a left ventricle 560. the tricuspid valve 520 of the right ventricle 530 is used to ensure blood circulation from the right atrium 510 to the right ventricle 530. The mitral valve 550 of the left ventricle 560 is configured to allow blood to flow from the left ventricle 560 to the aorta when the left ventricle 560 contracts, preventing blood from flowing back into the left atrium 540. The aortic arch 570 is emitted from the left ventricle 560. in the present invention, the endocardial injection device 100 enters the left ventricle 560 via the aortic arch 570 and then injects the endocardium.
The following describes in detail the procedure of controlling the injection depth and determining the correct spot on the endocardium by the example of injecting hydrogel 600 into the myocardium by the example of the endocardial injection system:
s1: a standard transfemoral puncture is performed, with the introducer sheath 400 being inserted into the body from the femoral artery, through the aortic arch 570 and into the left ventricle 560, see fig. 27;
s2: the delivery tube 200 sleeved with the adjustable bent sheath enters the body along the inner cavity of the guide sheath 400 to reach the left ventricle 560, see fig. 28;
s3: adjusting the distal end face of the endocardial injection device 100 to be substantially perpendicular to the free wall of the left ventricle with the aid of the introducer sheath 400 and the adjustable bending sheath, see fig. 29;
s4: the endocardial injection device 100 is slowly pushed forward as a whole, and whether the free wall is attached is judged according to the motion state of the delivery pipe 200 of the connecting sleeve 110 under the guidance of angiography examination and ultrasonic images, see fig. 30;
s5: when the endocardial injection device 100 has been attached to the free wall, the valve body 341 on the connecting portion 330 at the proximal end of the operating handle 300 is opened, and contrast fluid is circulated through the delivery tube 200 around the drive tube 220, and since the four axially symmetrical notches 13142 provided in the guide section 1314 of the hub 131 allow the contrast fluid to pass through, the circulated contrast fluid will fill the entire space of the sleeve 110. Judging whether the distal end face of the sleeve 110 is tightly attached to the free wall or not through the DSA image, and if the contrast liquid is sprayed out from the distal end face of the sleeve 110, indicating that the instrument is not tightly attached to the free wall; if the contrast liquid is sprayed out from the through hole 114 of the sleeve 110 but not from the distal end face of the sleeve 110, the instrument is close to the free wall, and the next operation can be executed, otherwise, the steps S2 and S3 are repeated until the instrument is close to the free wall;
s6: when the instrument is confirmed to be tightly attached to the free wall, the driving part 320 on the operation handle 300 is driven to make the screw nail 133 and the needle tube 132 pierce into the free wall, when the root of the screw nail 133 touches the stopping part 120, the screw nail 133 and the needle tube 132 cannot advance further, and the purposes of limiting the injection depth and preventing the screw nail 133 from further rotating and being stranded into the free wall tissue are achieved, see fig. 31;
s7: then, injecting a proper amount of contrast solution into the injection tube 210 by the injection part 310 of the operating handle 300, observing under the DSA image, if the contrast solution is scattered or flows away along a certain direction, it indicates that the needle tube 132 may be punctured into the groove of the comb-shaped muscle or into the blood vessel, and at this time, the condition for injecting the hydrogel 600 is not satisfied, and the needle tube 132 needs to be retracted and the previous operation is repeated until the injection condition is satisfied; when the contrast medium is formed into a bolus and jumps with the heart 500 under the DSA image, a certain amount of hydrogel can be injected into the injection tube 210 at one end of the injection part 310, see fig. 32;
s8: after the injection is complete, needle cannula 132 is retracted into hub 110, see FIG. 33. Repeating the above operations, searching for a second injection point, and so on, and withdrawing the apparatus in sequence after the injection reaches the point number meeting the clinical requirement, thereby completing the whole injection.
Claims (18)
1. An endocardial injection device, comprising:
the sleeve is provided with a stopping part at the far end; and the number of the first and second groups,
the injection subassembly slides and locates in the sleeve, the injection subassembly includes needle file, needle tubing and spiral nail, the drive tube is connected to the near-end of needle file, and the distal end is connected spiral nail and needle tubing, the needle tubing is arranged in along the axial in the spiral nail, the needle tubing is made by metal material, backstop portion with the connection can be dismantled to the near-end of spiral nail, the drive tube drives the injection subassembly is rotatory, so that the spiral nail with backstop portion connects or separates.
2. The endocardial injection device of claim 1, wherein the stop comprises a helical segment disposed on the inner wall of the distal end of the sleeve, and the screw comprises a helical portion, the helical segment being adapted to the feed trajectory of the helical portion.
3. The endocardial injection device of claim 1, wherein the stop comprises a boss telescopically disposed on the inner wall of the distal end of the sleeve, and the screw comprises a spiral portion, the boss being connected to the spiral portion when extended out of the inner wall of the sleeve, and the boss being separated from the spiral portion when retracted into the inner wall of the sleeve.
4. The endocardial injection device of claim 2 or 3, wherein the distal end of the screw is provided with a pointed portion, and the pointed portion extends distally along the central axis of the needle cannula and beyond the spiral portion.
5. The endocardium injection device according to claim 1, wherein the needle seat comprises a needle tube connecting section, a screw connecting section and a driving connecting section from far to near, the needle tube connecting section is fixedly connected with the near end of the needle tube, the screw connecting section is fixedly connected with the near end of the screw, and the near end of the driving connecting section is fixedly connected with the driving tube.
6. The endocardial injection device of claim 5, wherein the hub further comprises a guide section that abuts against an inner wall of the sleeve.
7. The endocardial injection device of claim 6, wherein the guiding section comprises a plurality of guiding portions arranged on the periphery of the needle seat, the guiding portions extend along the axial direction of the needle tube, a notch is formed between adjacent guiding portions, and the inner wall of the sleeve is provided with at least one through hole, and the notch is communicated with the through hole in a fluid mode.
8. The endocardial injection device of claim 7, wherein a transition segment is provided between the guide portion and the drive connection segment, and the cross-sectional area of the transition segment gradually increases from proximal to distal to coincide with the cross-sectional area of the guide portion.
9. The endocardial injection device of claim 1, wherein the distal end of the needle cannula has a tip, and the tip of the needle cannula comprises a first bevel and two second bevels symmetrically disposed on both sides of the first bevel, and the two second bevels extend distally to form a puncture tip.
10. The endocardial injection device of claim 9, wherein the angle between the puncture tip and the axial direction of the needle cannula is in the range of 11 ° to 30 °.
11. The endocardial injection device of claim 9, wherein the included angle between the first inclined plane and the axial direction of the needle tube ranges from 11 ° to 20 °, and the included angle between each second inclined plane and the axial direction of the needle tube ranges from 11 ° to 45 °.
12. The endocardial injection device of claim 1, wherein the helical screw is advanced at the same pitch as the depth of penetration of the needle cannula into the ventricular wall.
13. The endocardial injection device of claim 1, further comprising at least one injection conduit in communication with the needle cannula.
14. The endocardial injection device of claim 13, wherein the injection conduit comprises a first conduit and a second conduit, the first and second conduits being disposed along a coaxial dual lumen or axially side-by-side.
15. An endocardial injection system, comprising an operating handle, a delivery tube and the endocardial injection device according to any one of claims 1-14, wherein the driving tube is arranged in the delivery tube, the proximal end of the sleeve is fixedly connected to the distal end of the delivery tube, and the operating handle drives the driving tube to drive the injection assembly to axially and spirally move, so that the injection assembly extends out of or retracts into the sleeve.
16. The endocardial injection system of claim 15, wherein the proximal end of the operating handle includes an injection portion, the injection portion being in communication with an injection conduit, the injection conduit being in communication with the needle cannula.
17. The endocardial injection system of claim 15, wherein the operating handle comprises a drive portion connected to a proximal end of the drive tube, wherein rotation of the drive portion causes the drive tube and the injection assembly to rotate in an axial direction of the sleeve.
18. The endocardial injection system of claim 15, wherein the operating handle is provided with a fluid guide port, the fluid guide port is communicated with the delivery pipe, and a valve body for controlling the fluid guide port is arranged on the fluid guide port.
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| CN114366250A (en) * | 2021-12-31 | 2022-04-19 | 杭州德柯医疗科技有限公司 | Sleeve, injection device, injection system, ablation device and ablation system |
| CN114681018A (en) * | 2020-12-30 | 2022-07-01 | 杭州德晋医疗科技有限公司 | Endocardium injection device and endocardium injection system |
| WO2023125569A1 (en) * | 2021-12-30 | 2023-07-06 | 杭州德柯医疗科技有限公司 | Catheter assembly, treatment system and method for transcatheter treatment system |
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| CN114681018A (en) * | 2020-12-30 | 2022-07-01 | 杭州德晋医疗科技有限公司 | Endocardium injection device and endocardium injection system |
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| CN114259627A (en) * | 2021-12-30 | 2022-04-01 | 杭州德柯医疗科技有限公司 | Interventional injection device and interventional injection system |
| WO2023125569A1 (en) * | 2021-12-30 | 2023-07-06 | 杭州德柯医疗科技有限公司 | Catheter assembly, treatment system and method for transcatheter treatment system |
| WO2023125570A1 (en) * | 2021-12-30 | 2023-07-06 | 杭州德柯医疗科技有限公司 | Interventional injection device and interventional injection system |
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| CN114366250A (en) * | 2021-12-31 | 2022-04-19 | 杭州德柯医疗科技有限公司 | Sleeve, injection device, injection system, ablation device and ablation system |
| WO2023125571A1 (en) * | 2021-12-31 | 2023-07-06 | 杭州德柯医疗科技有限公司 | Sleeve, injection device, injection system, ablation device and ablation system |
| CN114366250B (en) * | 2021-12-31 | 2023-09-05 | 杭州德柯医疗科技有限公司 | Sleeve, injection device, injection system, ablation device and ablation system |
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