CN216703072U - Catheter abdominal wall fixing auxiliary device for incision-method peritoneal dialysis catheter - Google Patents

Abstract

The utility model relates to a catheter abdominal wall fixing auxiliary device for a peritoneal dialysis catheter by a cutting method, which comprises an abdominal cavity liner plate, wherein the abdominal cavity liner plate is provided with a first end and a second end opposite to the first end, the first end of the abdominal cavity liner plate is provided with a front stop block, a rear stop block and a stop lever, one end of the stop lever is connected with the front stop block, the other end of the stop lever is connected with the rear stop block, and a penetrating space is formed between the stop lever and the surface of the first end of the abdominal cavity liner plate. The auxiliary device for fixing the abdominal wall of the catheter for the peritoneal dialysis catheterization by the incision method provides a simple, safe and effective solution for fixing the abdominal wall of the catheter in the peritoneal dialysis catheterization by the incision method, is convenient for operators to operate, does not increase additional wounds, has low cost, is suitable for patients with different body types and catheters with different types, plays an important role in improving the success rate of peritoneal dialysis treatment, and can generate positive social and economic benefits.

Description

Catheter abdominal wall fixing auxiliary device for incision-method peritoneal dialysis catheter

Technical Field

The utility model relates to the technical field of surgical instruments, mainly relates to related instruments for an incision-method peritoneal dialysis catheter placement operation, and particularly relates to a catheter abdominal wall fixing auxiliary device for an incision-method peritoneal dialysis catheter placement.

Background

Peritoneal dialysis is a kidney replacement treatment technology which is mainly popularized in China for improving the treatment rate and survival rate of end-stage renal disease (uremia) patients. The treatment is characterized in that a certain amount of dialysate is injected into the abdominal cavity of a patient through a peritoneal dialysis catheter, the abdominal cavity is left for hours, the human peritoneum is used as a semi-permeable membrane in the period, metabolic wastes, uremia toxins and redundant water in the body are absorbed and removed by depending on solute concentration gradient and osmotic pressure gradient between the dialysate and blood flow in peritoneal capillaries, and the continuous stability of internal environments such as human water, electrolyte, acid-base balance and the like is maintained by regularly draining the dialysate in the abdominal cavity and re-injecting fresh dialysate.

The treatment requires a peritoneal dialysis catheterization procedure, in which a permanent peritoneal dialysis catheter (hereinafter referred to as "catheter") is implanted in the abdominal cavity of a patient as a two-way passage for the dialysate to perfuse and drain from the abdominal cavity. Good catheter function is a prerequisite for effective peritoneal dialysis treatment. The common peritoneal dialysis catheterization methods include incision method and laparoscopy, and the former is most commonly used.

The incisional catheterization is a minimally invasive procedure performed under local anesthesia. During operation, the skin, subcutaneous tissues and the abdominal rectus muscle front sheath are incised layer by layer at a position (a lateral median line) which is 9-13cm above the abdominal pubic symphysis and 2-3cm from the lateral median line, the incision is about 4cm long, and then the abdominal rectus muscle is separated bluntly to expose the peritoneum; incising the peritoneum for about 0.5 cm; the catheter enters the abdominal cavity through a peritoneal incision and points to the sacrococcygeal region. Ideally, the intra-abdominal section of the catheter is closely attached to the abdominal wall, and the distal end of the catheter is located at the lowest point of the abdominal cavity, so that the dialysate can be quickly and sufficiently drained out of the abdominal cavity.

In the traditional incision method, the catheter is sutured in a purse-string manner by virtue of silk threads at the incision of the peritoneum, and is fixed in a single point by virtue of a dacron sleeve in the rectus abdominis, which is tightly attached to the sutured part and is adhered to the rectus abdominis. The catheter intra-abdominal section with the length of the distal end of the dacron sleeve in the rectus abdominis up to 15cm is not further fixed in the abdominal cavity, is in a free state and is easy to shift, namely, the tail end leaves the lowest point of the abdominal cavity and even integrally drifts to the upper abdominal part, so that dialysate cannot be fully drained, and the dialysis effect is seriously influenced; moreover, the displaced catheter may be wrapped by tissues such as the omentum, intestinal loops, etc., causing bi-directional obstruction to dialysate perfusion and drainage. The incidence rate of catheter displacement after the catheter placement by the incision method is reported at home and abroad to be about 15-20%; even if operated by a skilled physician, the incidence rate is still nearly 5%. Once the displacement occurs, a considerable proportion of patients need to be operated again, and even peritoneal dialysis treatment fails, which increases the pain of patients, economic burden and medical resource consumption.

Laparoscopic methods are another peritoneal dialysis catheterization method. The abdominal cavity is directly viewed through a laparoscope under general anesthesia, the abdominal wall is punctured 2-4 cm below the position where the catheter penetrates through the peritoneum, the intra-abdominal section of the catheter is fixed on the abdominal wall through a suture, and the intra-abdominal section of the catheter is tightly attached to the abdominal wall in the whole process through two-point fixation. The method can prevent the catheter from shifting. However, the laparoscopy has high technical threshold and cost, large wound, long postoperative recovery time, and high risk of general anesthesia of uremia patients, and cannot be widely developed.

If reliable two-point fixation can be realized in the tube placement by the incision method, the success rate of the operation and peritoneal dialysis treatment can be greatly improved; however, the operation area of the traditional incision method is narrow, and the action range of the operator is limited; the length of the peritoneal incision is only 0.5cm, a circular operation visual field with the diameter of about 1cm is formed after the peritoneal incision is properly stretched, and an operator cannot peep the abdominal cavity at the position 2-4 cm below the peritoneal incision, so that an obvious technical bottleneck exists in the fixation of the abdominal wall of the catheter. Some surgeons have tried to fix the abdominal wall of a catheter in a catheter placement by incision as follows.

Method 1 (see, Chen WM, Cheng CL., a simple method to prevent peritoneal dialysis catheter tip dislodgment Perit Dial int.2007; 27(5): 554-6): the suture is tied at a position 1cm below the dacron sleeve of the catheter, and the suture is punctured from the inner side of the peritoneum and pulled to the outside of the peritoneum by using a suture needle to be tied, so that the catheter is fixed. The abdominal wall fixing point established by the method is close to the peritoneal incision, so that the operation is easy to realize; however, the distance between the abdominal wall fixing point and the fixing point at the peritoneal incision is too short, the formed straight line is unstable, and the knotted suture on the catheter may slip, so that the fixing effect is not exact, and the risk of catheter displacement is difficult to effectively reduce.

Method 2 (see, Oka H, Yamada S, Kaminura T, et al. application of modified simple Peritoneal Wall Anchoring Technique (PWAT) in peritoneal dialysis Perit Dial int.2017; 37(1): 103-8): the method comprises the following steps of penetrating an abdominal membrane from the outside of the peritoneum by using a suture needle and a silk thread at a position 3-4 cm below a peritoneum incision to manufacture an intra-abdominal line loop, probing the intra-abdominal cavity from the peritoneum incision by using surgical forceps, grabbing the line loop under the peritoneum and pulling out the intra-abdominal cavity, and tightening and ligating the line loop after a catheter passes through the line loop to fix the abdominal wall of the catheter. The distance between two fixed points is large, the fixation of the catheter abdominal inner section is more exact, but the fixed points are far away from a peritoneal incision, and an operator is difficult to observe the condition under the peritoneum at the puncture position of a suture needle through an operation visual field (peritoneal incision) with the diameter of only 1cm, so the method belongs to the 'blind puncture' construction fixed point, and has the following hidden troubles: (1) tissues such as intestinal canal, omentum and blood vessel are always present under the peritoneum, and serious complications such as intestinal perforation and bleeding can be caused once accidental injury occurs during puncture; (2) when a needle is used for puncturing the peritoneum to manufacture an intra-abdominal line loop, if a net membrane under the peritoneum is sewn together with the catheter by mistake, the net membrane wraps the intra-abdominal section, so that the catheter loses function; (3) the loop of thread formed under the peritoneum is not clearly visible and grasping with forceps is very difficult, often resulting in fixation failure.

Method 3 (see, Io H, Maeda K, Sekiguchi Y, et al. peritoneal dialysis catheter fixation to peritoneal wall comparison to conventional placement techniques: clinical experience and follow-up of new peritoneal dialysis catheter implantation techniques Semin Dial.2014; 27(4): E42-7): an incision is made below the conventional peritoneal incision, a catheter is placed through the superior incision, and the catheter and peritoneum are ligated at the inferior incision. The method increases surgical trauma, patients are not easily tolerant under local anesthesia, and statistics shows that catheter displacement still occurs in 24% of patients, and compared with the traditional incision method without abdominal wall fixation, the method has no advantages and increases the risk of peritoneal leakage.

Therefore, the method has great defects in the aspects of safety, effectiveness, operability and the like, and does not solve the problem of realizing the fixation of the abdominal wall of the catheter in the peritoneal dialysis catheterization by the incision method.

The current chinese patents relating to peritoneal dialysis catheter abdominal wall fixation are as follows:

peritoneal dialysis catheter holder and method for fixing peritoneal dialysis catheter (CN 200810232907.5): the utility model punctures peritoneum and rectus abdominis twice from the abdominal cavity at the position 3cm below the peritoneum incision through the combination of the pipe sleeve, the pipe core and the lead needle, leads out two ends of a suture from the abdominal cavity respectively, and forms the fixation of the catheter under the peritoneum. The method needs two times of abdominal wall puncture, and the abdominal rectus muscle is punctured besides the peritoneum, so the method has the disadvantages of large damage and easy injury to the main blood vessels such as the inferior abdominal wall artery and the like to cause the bleeding in the muscular layer.

Peritoneal dialysis catheter abdominal wall internal fixation connector (CN 201210363155.2): the utility model comprises an anastomosis forceps which consists of a sleeve arm and a positioning arm; the cannula arm enters the abdominal cavity through the peritoneal incision, the positioning arm is arranged outside the abdominal wall, and the head ends of the cannula arm and the positioning arm are arranged 4-6cm below the peritoneal incision and clamp the abdominal wall from the inner side and the outer side; penetrating the abdominal wall of the clamping part by using a puncture needle, communicating the needle tube with a cannula in the cannula arm, and placing a guide wire in the needle tube; and pulling out the coil for fixing the catheter from the puncture point through the abdominal cavity and from the peritoneal incision, penetrating the catheter through the coil and placing the catheter into the abdominal cavity, and tightening the coil to complete the fixation of the abdominal wall of the catheter. The apparatus belongs to the same inventor as the previous invention, and the risk of bleeding in the muscular layer also exists; and the incision is required to be positioned on the abdominal median line, and is easy to cause postoperative leakage, abdominal wall hernia and other complications compared with the medial incision (namely the incision adopted by the utility model) consistently recommended by relevant operation guidelines at home and abroad.

An operation needle (CN201922153736.3) for fixing an open peritoneal dialysis catheter placing operation: the utility model changes the circular suture needle for fixing the abdominal wall of the catheter into a straight line shape, thereby omitting the step of self-modifying the suture needle by the operator and being easier to extend into the abdominal cavity for puncture from the inner side of the peritoneum to the outside; but can not overcome the defects of too short distance between the fixing points, poor fixing effect, easy damage to the tissues in the abdominal cavity and the like caused by singly using the suture needle to fix the catheter.

A peritoneal dialysis catheter abdominal wall internal fixation introducer (CN202010255702. X): the utility model has complex structure and obscure working principle, changes more pipe flow process of the peritoneal dialysis catheter by the original incision method and is not convenient for operators to master.

SUMMERY OF THE UTILITY MODEL

The utility model aims to overcome the defects of poor operability, poor fixing effect, increased surgical wound risk, easy occurrence of complications and the like of the method for fixing the abdominal wall of the catheter in the conventional peritoneal dialysis catheterization by incision method, and provides a catheter abdominal wall fixing auxiliary device for peritoneal dialysis catheterization by incision method, which can be used as an auxiliary surgical tool to assist in finishing the fixation of the abdominal wall of the catheter.

In order to achieve the above purpose, the catheter abdominal wall fixation auxiliary device for an incision peritoneal dialysis catheter of the utility model is specifically as follows:

the device include abdominal cavity backing plate, abdominal cavity backing plate first end have and with the relative second end of first end hold, the first end department of abdominal cavity backing plate set up positive stop, backstop and shelves pole, the one end of shelves pole with positive stop be connected, the other end of shelves pole with backstop be connected, just the shelves pole with the surface of the first end of abdominal cavity backing plate between have and run through the space.

Preferably, the front stop is disposed obliquely toward the second end of the intra-abdominal bolster.

Preferably, the angle of inclination of the front block relative to the abdominal cavity liner plate is 30-60 degrees.

Preferably, the rear stop block is vertically arranged relative to the abdominal cavity liner plate.

Preferably, the front stop block and the rear stop block are triangular plates, and the stop rod is connected between the tip of the front stop block and the tip of the rear stop block.

Preferably, the penetrating space has a height of 3-5 mm relative to the intra-abdominal cavity backing plate.

Preferably, the abdominal cavity liner plate is provided with scales.

Preferably, the device comprises a handle connected to the second end of the intra-abdominal bolster.

Preferably, the width of the handle is set to be not less than the width of the pad in the abdominal cavity.

Preferably, the stop lever is provided with at least one breakable line.

The auxiliary device for fixing the abdominal wall of the catheter for the peritoneal dialysis catheterization through the incision method provides a simple, safe and effective solution for fixing the abdominal wall of the catheter in the peritoneal dialysis catheterization through the incision method, is convenient for operators to operate, does not increase additional trauma, is low in cost, is suitable for patients with different body types and catheters with different types, plays an important role in improving the success rate of peritoneal dialysis treatment, and can generate positive social and economic benefits.

Drawings

FIG. 1 is a schematic structural view of a catheter abdominal wall fixation auxiliary device for an incision peritoneal dialysis catheter of the utility model.

Fig. 2 is a side view of the catheter abdominal wall fixation aid for a peritoneal dialysis catheter for incision.

Fig. 3 is a front elevational view of the catheter abdominal wall fixation aid for a peritoneal dialysis catheter for incision.

Detailed Description

In order to more clearly describe the technical contents of the present invention, the following further description is given in conjunction with specific embodiments.

Fig. 1 to 3 show an embodiment of the catheter abdominal wall fixation auxiliary device for an incisional peritoneal dialysis catheter according to the present invention. Wherein, the device include abdominal cavity backing plate 1, the abdominal cavity backing plate be used for deepening the abdominal cavity through the operation incision, abdominal cavity backing plate 1 have first end and with the relative second end of first end hold, the first end department of abdominal cavity backing plate 1 set up positive stop 2, backstop 3 and shelves pole 4, the one end of shelves pole 4 with positive stop 1 be connected, the other end of shelves pole 4 with backstop 3 be connected, just shelves pole 4 with the surface of the first end of abdominal cavity backing plate 1 between have and run through space 6.

According to the auxiliary catheter abdominal wall fixation device provided by the utility model, the front stop block, the rear stop block and the stop rod at the head end of the pad plate in the abdominal cavity form a wedge-shaped hollow structure, so that an operator can complete effective catheter abdominal wall fixation under the condition of not increasing surgical wounds, and the postoperative catheter displacement can be avoided by referring to the fixation effect of a peritoneal dialysis catheter by a laparoscopic method.

Specifically, the operator can cut the skin, subcutaneous tissues and the abdominal rectus muscle front sheath at the position 9-13cm above the pubic symphysis and 2-3cm of the lateral midline of the patient according to the conventional operation of an incision method, and perform blunt separation on the abdominal rectus muscle to expose the peritoneum; cutting the peritoneum at the upper position of the incision by about 0.5cm, properly stretching and lifting the lower edge of the incision of the peritoneum by using a vascular clamp, attaching a front stop block of the pad plate in the abdominal cavity to the peritoneum at the inner side of the lower edge of the incision, and feeding the head end structure of the pad plate in the abdominal cavity into the abdominal cavity; then, adjusting the angle to enable the blocking rod of the pad plate in the abdominal cavity to be tightly attached to the peritoneum and continuously push towards the tail side to reach a position 2-4 cm away from the lower edge of the incision of the peritoneum, lifting the peritoneum upwards to form two inclined planes taking the blocking rod as the top, and isolating tissues such as an intestinal canal, a omentum and the like below the peritoneum by using the pad plate in the abdominal cavity to avoid being punctured by a sewing needle in the subsequent operation; sequentially penetrating the peritoneum of the inclined plane at one side, the penetrating space of the head end of the device and the peritoneum of the inclined plane at the opposite side by using a suture needle with a suture to form a thread loop under the peritoneum; the suture at the two ends of the loop is detained outside the peritoneum, the device is withdrawn from the peritoneum incision, and the loop is dragged out of the peritoneum incision along with the head end structure; separating the loop from the device, and placing the abdominal catheter at an ideal position in the abdominal cavity according to a conventional method after the abdominal catheter passes through the loop; and (4) sewing threads at two ends of the tightening thread loop and knotting the threads at the outer side of the peritoneum, and fixing the intra-abdominal section of the catheter at the inner side of the peritoneum to enable the intra-abdominal section of the catheter to be tightly attached to the abdominal wall in the whole process, so that the fixation of the abdominal wall of the catheter is completed.

The stopper rod of the wedge-shaped hollow structure can lift the peritoneum upwards, so that the peritoneum forms two inclined planes by taking the stopper rod as the top, a sewing needle can penetrate the peritoneum from one inclined plane, penetrate the hollow structure and be led out from the other side peritoneum conveniently, and a thread loop is formed under the peritoneum. The intra-abdominal backing plate can isolate and protect tissues such as intestinal canal, omentum and the like below the peritoneum, so that serious complications such as intestinal perforation, intra-abdominal bleeding and the like caused when a suture needle punctures the peritoneum are avoided; meanwhile, the omentum and the catheter are prevented from being sewn together, and the risk that the omentum wraps the inner section of the catheter abdomen is avoided. Moreover, the head end wedge-shaped hollow structure can reliably grab the peritoneum inserting loop in the abdominal cavity and drag the peritoneum inserting loop to the outside of the abdominal cavity, so that the fixation of the abdominal wall of the catheter is conveniently completed; and the peritoneum inserting needle loop is invisible in the traditional 'blind method puncture' process, so that the peritoneum inserting needle loop is difficult to accurately grab and drag the peritoneum out of the abdominal cavity, and the catheter fixing can not be finished.

As shown in fig. 1-2, the front stop block 2 is disposed obliquely toward the second end of the abdominal cavity inner pad 1. The inclination angle of the front block 2 with respect to the abdominal cavity liner plate 1 may be 30 ° to 60 °, for example, 45 °, 50 °, etc.

As shown in fig. 1 to 2, the back stop 3 is vertically arranged relative to the abdominal cavity inner cushion plate 1, that is, the angle relative to the abdominal cavity inner cushion plate 1 is 90 °.

As shown in fig. 1 to 3, the front block 2 and the rear block 3 are both triangular plates, and the blocking rod 4 is connected between the tip of the front block 2 and the tip of the rear block 3. Preferably, the axial direction of the stop rod 4 is arranged parallel to the axial direction of the intra-abdominal pad 1.

In a preferred embodiment, said bar 4 is provided with at least one breakable line. In the embodiment shown in fig. 1, the bar 4 is provided with two breakable lines. The blocking rod 4 can be disconnected along the breakable line, thereby facilitating the operation of a single operator. After the thread loop is dragged out of the incision of the peritoneum along with the head end structure, the stop lever is broken off, so that the thread loop is separated from the device.

As shown in fig. 2 to 3, the through space 6 has a height h of 3 to 5mm, for example, 4mm, relative to the intra-abdominal cavity base plate 1; the longest length l3 of the through-space 6 may be 1.8cm to 2.2cm, e.g. 2.0 cm.

The utility model provides a preferable embodiment of a catheter abdominal wall fixing auxiliary device, which has the specific size that the length l1 of a front stop block 2 is 8.0-9.0 mm, for example, 8.5 mm; the height h1 of the rear block 3 is 5-7 mm, for example, 6 mm; the length l2 of the stop lever 4 is 0.9cm to 1.1cm, for example, 1.0 cm; the length l4 of the abdominal cavity liner plate 1 is 4-6cm, for example, 5 cm; the width d2 of the abdominal cavity liner plate 1 is 6-10 mm, such as 8 mm; the thickness d of the intra-abdominal bolster 1 is 1.5mm to 2.5mm, for example, 2.0 mm.

As shown in fig. 1, the upper surface of the abdominal cavity liner plate 1 is also provided with scales. The scales can accurately position the catheter abdominal wall fixing position, and can meet the operation requirements of patients with different body types.

As shown in fig. 1 to 3, the device comprises a handle 5, wherein the handle 5 is connected with the second end of the intra-abdominal cavity liner plate 1. The width of the handle 5 is set to be larger than or equal to the width of the abdominal cavity liner plate 1, preferably larger than the width of the abdominal cavity liner plate 1. The width of the grip 5 may be 14-18 mm, for example 16mm, i.e. the widths d1 and d3 are 4 mm.

The catheter abdominal wall fixing auxiliary device can be made of medical plastics, is disposable, and is convenient to sterilize and meets the sterile standard of surgical instruments. The device has reasonable size and angle design of all parts, can enter the abdominal cavity without obstacles under the condition of not enlarging or increasing the peritoneal incision, is suitable for all types of peritoneal dialysis catheters, minimizes the change of the operation mode and is convenient for operators to master.

The auxiliary device for fixing the abdominal wall of the catheter for the peritoneal dialysis catheterization through the incision method provides a simple, safe and effective solution for fixing the abdominal wall of the catheter in the peritoneal dialysis catheterization through the incision method, is convenient for operators to operate, does not increase additional trauma, is low in cost, is suitable for patients with different body types and catheters with different types, plays an important role in improving the success rate of peritoneal dialysis treatment, and can generate positive social and economic benefits.

In this specification, the utility model has been described with reference to specific embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the utility model. The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense.

Claims (10)

1. The utility model provides a fixed auxiliary device of pipe stomach wall for cutting out method peritoneal dialysis puts pipe, a serial communication port, the device include abdominal cavity backing plate, abdominal cavity backing plate have first end and with the relative second end of first end, the first end department of abdominal cavity backing plate set up positive stop, backstop and shelves pole, the one end of shelves pole with positive stop be connected, the other end of shelves pole with backstop be connected, just the shelves pole with the surface of the first end of abdominal cavity backing plate between have and run through the space.

2. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis cannula of claim 1, wherein the front stop is angled toward the second end of the abdominal cavity insert.

3. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis catheter according to claim 2, wherein the angle of inclination of the front block with respect to the intra-abdominal pad is 30 ° to 60 °.

4. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis cannula of claim 1, wherein the backstop is vertically disposed with respect to the abdominal cavity liner plate.

5. The catheter abdominal wall fixation assisting device for an incisional peritoneal dialysis catheter according to claim 1, wherein the front stopper and the back stopper are triangular plates, and the stopper rod is connected between the tip of the front stopper and the tip of the back stopper.

6. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis catheter according to claim 1, wherein the penetrating space has a height of 3-5 mm with respect to the intra-abdominal cavity pad.

7. The catheter abdominal wall fixation assisting device for an incisional peritoneal dialysis catheter as claimed in claim 1, wherein the abdominal cavity liner plate is provided with a scale.

8. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis catheter of claim 1, wherein the device comprises a handle, the handle being connected to the second end of the abdominal cavity insert.

9. The catheter abdominal wall fixation aid for an incisional peritoneal dialysis catheter of claim 8, wherein the width of the handle is set to be not less than the width of the intra-abdominal cavity pad.

10. The catheter abdominal wall fixation aid for a peritoneal dialysis catheter by incision method of claim 1, wherein the stop lever is provided with at least one breakable line.

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