CN219516424U - Liver transplantation supplies quick catheterization low temperature perfusion device of liver - Google Patents

Abstract

The utility model relates to the technical field of liver and kidney low-temperature perfusion in organ transplantation operation, in particular to a liver transplantation liver rapid tube-placing low-temperature perfusion device which comprises a vessel blocking clamp, wherein a guide groove is arranged on the outer side of the vessel blocking clamp, a puncture mechanism is arranged on the guide groove and comprises a puncture sheath tube and a perfusion catheter, a puncture needle is arranged at the head end of the puncture sheath tube, an automatic rebound needle core with a penetration preventing function is arranged at the top of the puncture needle, and the needle core is a blunt hollow needle core. The utility model can simplify the abdominal aorta dissection step, is convenient for quickly establishing the low-temperature perfusion passage of the abdominal organs, shortens the operation time and improves the success rate of tube placement; in the process of obtaining the organ, the thermal ischemia is the most important factor causing the functional injury of the transplanted organ and is also the common cause of failure of the transplanting operation, and the device can be convenient for operators to operate, reduce the time of perfusion cannula, reduce the organ injury caused by the thermal ischemia and has great significance for prognosis and life quality improvement of liver and kidney transplanted patients.

Description

Liver transplantation supplies quick catheterization low temperature perfusion device of liver

Technical Field

The utility model relates to the technical field of liver and kidney low-temperature perfusion in an organ transplantation operation, in particular to a liver transplantation and liver rapid tube-placing low-temperature perfusion device.

Background

The injection of organ preservation solution through the abdominal aortic cannula is a commonly used low-temperature perfusion mode for the current donor liver acquisition. The specific operation is as follows: pulling up the small intestine, shearing off the retroperitoneal membrane above the pelvic inlet; blunt free abdominal aorta, skeletonized dissection revealing the abdominal aortic lower segment; ligating the distal end of the artery by the silk thread, presetting the silk thread at the proximal end, and playing a role of suspension; cutting the anterior wall of the artery near the distal ligature, pinching the proximal end of the artery with the left hand of the operator to block blood flow, and then shearing the anterior wall of the artery at an angle of 30 degrees; the left side wall and the right side wall of the incision are respectively clamped and pulled to open the arterial lumen, a modified Foley catheter with 2-3 side holes is inserted into the proximal end, the insertion depth is that the balloon is positioned above the opening plane of the abdominal aorta, and 20ml of physiological saline is injected into the balloon; the silk ligates over the arteriotomy preventing reflux of perfusate. After the abdominal aorta is successfully placed, the organ preservation solution at 0-4 ℃ is injected, and the organ low-temperature perfusion is started.

However, this procedure requires a skeletonization of the lower section of the abdominal aorta to be about 3cm long, and during dissection of both sides and the back wall of the artery, it often affects the vessel exposure due to small arterial branches, especially in obese and retroperitoneal hematoma patients, with unclear tissue structure, further increasing difficulty in dissection exposure, delaying celiac arterial perfusion, and increasing risk of ischemia injury to the donor organ; in addition, in the intubation process, the steps of cutting off the blood vessel, traction and fixation, wire ligation, catheter feeding and the like are complicated, and the operation proficiency of operators and the cooperation of operators can influence the establishment of an infusion path; moreover, the Foley catheter head end used in the traditional method lacks a rigid support, so that reverse folding is easy to occur in the process of intubation in the reverse blood flow direction, the intubation is not in place and the perfusion side hole is blocked, the catheters are often required to be repeatedly adjusted and even replaced, the operation time is obviously prolonged, the cold perfusion effect of organs is seriously influenced, the thermal ischemia injury of the organs is caused, and the death risk of transplanted patients is increased; meanwhile, the lack of a pressure monitoring device in the traditional perfusion pipeline can affect the perfusion effect due to the fact that the pressure is too low, so that hepatic cell necrosis is caused, vascular injury is easily caused due to the fact that the pressure is too high, and the viscera quality is affected.

Disclosure of Invention

In order to solve the technical problems, the utility model provides a low-temperature perfusion device for rapid tube placement of liver transplantation and liver supply, which reduces ischemia injury of donor organs.

In order to achieve the above purpose, the utility model provides a liver transplantation liver supply quick tube placement low-temperature perfusion device, which comprises a vessel blocking clamp, wherein the vessel blocking clamp comprises a handle and a clamp head, a guide groove is arranged on the outer side of the vessel blocking clamp, a puncture mechanism is arranged on the guide groove and comprises a puncture sheath tube and a perfusion catheter, the head end of the puncture sheath tube is provided with a puncture needle, the top of the puncture needle is provided with a needle core capable of automatically rebounding, and the needle core is a blunt needle core.

Preferably, the side surface of the clamp head is provided with an undamaged vertical tooth structure, and the vertical tooth structure adopts an upward arc-shaped tail end.

Preferably, the angle between the handle and the clamp head is 45 degrees, the joint of the handle and the clamp head is 2cm more than the joint, the angle between the guide groove and the vascular occlusion clamp is 15 degrees, and the center line of the guide groove is consistent with the axis of the vascular occlusion clamp after being clamped.

Preferably, the front half part of the puncture sheath tube has a 1/2 round cross section, and the rear half part has a rectangular end which is matched with a guide groove of the vascular occlusion forceps.

Preferably, the front half head end of the puncture sheath is an inclined plane for puncture, the inner side of the inclined plane is provided with a clamping groove, the clamping groove is matched with the conical head end of the perfusion catheter, the tail end of the inclined plane of the puncture sheath is provided with a guide wire, the starting point of the guide wire is fixed on the left side wall of the puncture sheath, and the ending point of the guide wire is connected to a guide wire control rod on the right side of the puncture sheath.

Preferably, the tail part of the needle core is provided with a positioning mark and a safety lock catch.

Preferably, the needle core is a hollow tube with a side hole, and the rear part of the needle core is connected with the pressure indication bin through a pipeline.

Preferably, the head end of the perfusion catheter is conical, a groove is arranged to be matched with the clamping groove in the inclined plane of the puncture sheath, and the upper surface of the conical head end of the perfusion catheter is an inclined plane which is consistent with the inclined plane of the puncture sheath.

Preferably, the rear Fang Lianqiu balloon of the head end of the perfusion catheter is provided with a tube body part of the perfusion catheter at the rear part, and two perfusion side holes are arranged at the rear part of the balloon and communicated with the lumen of the perfusion catheter. The opposite side of the first side hole is provided with a pressure measuring hole, the pressure measuring hole is connected with an external pressure detection device through a catheter, the perfusion pressure is monitored in real time, and the perfusion catheter is provided with length scale marks.

Preferably, the perfusion catheter is provided with a clamping groove for restraining the guide wire at a position 1cm away from the head end, the section of the perfusion catheter is wedge-shaped, and the head side is a vertical section.

Compared with the prior art, the device is beneficial to maintaining the liver supply quality, and has important significance for prognosis and life quality improvement of liver transplantation patients; the specific analysis is as follows:

1. by applying the method, only one-time blind threading along the guide groove is needed, the steps of arterial skeletonizing dissection, clamp incision, traction suspension and the like in the traditional method can be omitted, and the catheter is convenient to put in. The direct clamp is used for replacing repeated wire hanging and ligature operation, so that the dependency on the surgical operation level and the matching degree of an assistant is low, the operation time can be obviously shortened, and the success rate of the tube placement is improved;

2. the method has the function of measuring pressure in real time, dynamically monitors the pressure in the blood vessel, guides and adjusts the perfusion pressure so as to maintain the perfusion pressure close to the normal blood pressure and provide organ perfusion in an approximate physiological state;

3. the front end of the perfusion catheter innovated by the method adopts a hard material and steel wire supporting structure, overcomes the defect that the modified Foley catheter is easy to fold reversely in the traditional technology, and has high success rate of catheter placement and positioning preparation;

4. according to the method, the puncture needle with the anti-penetration protection function is introduced into the application of the abdominal aorta puncture catheter, the success of arterial puncture can be confirmed through the state that blood flows into the pressure indication bin, and the influence of the damage of the inner wall of a blood vessel such as an arterial interlayer, a hardening plaque and the like on the success rate of puncture catheter placement is avoided.

Drawings

FIG. 1 is a schematic diagram of the overall structure of the present utility model;

FIG. 2 is a schematic view of the puncturing mechanism according to the present utility model;

FIG. 3 is a schematic view showing the structure of the puncture needle according to the present utility model.

The meaning of each reference sign in the figure is:

1. a handle; 2. a clamp head; 21. a vertical tooth structure; 3. a guide groove; 4. a puncture mechanism; 41. puncturing the sheath; 42. perfusing the catheter; 421. a guide wire; 422. a balloon; 43. a rectangular end; 5. a puncture needle; 52. a needle core; 521. a side hole; 53. a pressure indication bin.

Detailed Description

The following description of the embodiments of the present utility model will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present utility model, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the utility model without making any inventive effort, are intended to be within the scope of the utility model.

The utility model provides a liver transplantation liver supply quick tube-placing low-temperature perfusion device, as shown in figures 1-3, comprising a vessel blocking clamp, wherein the vessel blocking clamp comprises a handle 1 and a clamp head 2, a guide groove 3 is arranged at the outer side of the vessel blocking clamp, a puncture mechanism 4 is arranged on the guide groove 3, the puncture mechanism 4 comprises a puncture sheath 41 and a perfusion catheter 42, a puncture needle 5 is arranged at the head end of the puncture sheath 41, a rebound needle core 52 is arranged at the top of the puncture needle 5, the needle core 52 pops out after the artery wall is broken through, and the needle core 52 is a blunt needle core and is provided with a positioning mark and a spring device, so that the needle core pops out in an initial state to prevent accidental injury; in the puncturing process, the needle core is pushed into the puncture needle after reaching the artery wall, the sharp puncture needle point is exposed, and the positioning mark is positioned at the functional position. When the sharp needle point penetrates through the artery wall, the resistance disappears, the needle core pops out, the positioning mark is positioned at the popping position, the needle core does not move after the safety lock catch is locked, and the needle point is prevented from contacting the artery rear wall to cause penetration.

In this embodiment, the side surface of the forceps head 2 is provided with an atraumatic vertical tooth structure 21 to protect the vessel wall from intima tear.

Specifically, the handle 1 and the clamp head 2 are in a 45-degree angle, the joint of the handle 1 and the clamp head 2 is a hinge point of 2cm above, the guide groove 3 and the clamp head 2 are in a 15-degree angle, the central line of the guide groove 3 is consistent with the axis of the clamp head 2 after the vascular occlusion clamp is clamped, and the puncture sheath 41 is guided to pierce the central axis of the blood vessel.

Further, the front half section of the puncture sheath 41 is 1/2 circle, the perfusion catheter 42 is accommodated and fixed by adopting metal materials, so that puncture is facilitated to enter an arterial cavity, the rear half section is a rectangular end 43, the puncture sheath is matched with the guide groove 3 of the vascular occlusion forceps, a transparent hard polycarbonate material is adopted for observing the rebound condition of the puncture needle core 52, so that the puncture needle is guided to accurately puncture the front wall of an artery under the condition that skeletonized anatomical arteries are not needed, the inner diameter of the tube of the puncture sheath 41 is 6mm, and the rectangular end 43 of the rear half section of the puncture sheath 41 is matched with the guide groove 3, so that transverse offset is not guaranteed.

Further, the front half head end of the puncture sheath 41 is an inclined plane for puncture, the inner side of the inclined plane is designed as a clamping groove and is matched with the conical head end of the perfusion catheter 42, a guide wire 421 is arranged at the tail end of the inclined plane of the puncture sheath 41 and used for restraining the perfusion catheter 42, the separation of the perfusion catheter 42 and the puncture sheath 41 in the puncture process is avoided, the initial end of the guide wire 421 is fixed on the left side wall of the puncture sheath 41, the other end of the guide wire is penetrated out from the opposite side and then moves upwards, the end point is connected to a guide wire control rod on the right side of the puncture sheath 41, the guide wire 421 is tightened through the guide wire control rod during puncture, the perfusion catheter 42 is firmly restrained in the puncture sheath 41, the guide wire 421 is loosened after the puncture is successful, and the perfusion catheter 42 is conveniently fed into the arterial heart side.

Further, a positioning mark and a safety lock catch are arranged at the tail part of the needle core 52, after the puncture is successful, the needle core 52 pops up, and the safety lock catch is pushed to lock the needle core 52 so that the needle core 52 cannot retract. Under the protection of the blunt needle core, the puncture needle cannot directly contact the rear wall of the blood vessel in the subsequent tube placement process, so that unsuccessful puncture caused by penetrating through the artery is avoided.

Further, the needle core 52 is a hollow tube with a side hole 521, the rear part is connected with the pressure indication bin 53 through a pipeline, the pressure indication bin 53 adopts a transparent design, the puncture needle 5 breaks through the front wall of the blood vessel, the needle core 52 pops out, and arterial blood flows into the pressure indication bin 53 through the side hole 521 of the needle core 52, so that puncture success is indicated.

It should be noted that the head end of the infusion catheter 42 is tapered, made of hard polycarbonate material, has a total length of 1.5cm, is provided with a groove which is matched with the inner groove of the inclined plane of the puncture sheath 41, so as to prevent the catheter from rotating during the puncture process, and the upper surface of the tapered head end of the infusion catheter 42 is an inclined plane which is consistent with the inclined plane of the puncture sheath 41, thereby facilitating the puncture into the blood vessel.

The Fang Lianqiu bag 422 behind the head end of the perfusion catheter 42 is made of polyurethane, after the perfusion catheter 42 reaches a preset plane, the bag 422 is expanded, the perfusion catheter 42 is fixed and blood from the thoracic aorta is blocked, the length of the bag part is 1cm, a steel wire is arranged at the center, the total length of the hard conical catheter head end and the bag part with certain toughness is 2.5cm, and the length exceeds the inner diameter of the artery, so that the defect that the catheter in the prior art is easy to be folded reversely is overcome.

The back of the saccule 422 is a tube body part of the perfusion catheter 42, the tube body part is made of medical polyvinyl chloride polymer materials and stainless steel and is provided with two perfusion side holes which are respectively provided with a length scale mark and a hardness which are ideal relative to a Foley catheter, the perfusion catheter is convenient to intubate, the back of the saccule 422 is provided with two perfusion side holes which are communicated with the lumen of the perfusion catheter 42, the opposite side of the first side hole is provided with a pressure measuring opening, the perfusion catheter 42 is connected with an external pressure detection device through the catheter, and the perfusion pressure is detected in real time.

Further, the perfusion catheter 42 is provided with a clamping groove for restraining the guide wire 421 at a position 1cm away from the head end, the cross section is wedge-shaped, the head side is a vertical cross section, the perfusion catheter 42 can be prevented from retreating after the guide wire 421 is tightened, the tail side is in a slope shape, and the perfusion catheter 42 is convenient to separate from the puncture sheath 41 after the guide wire 421 is loosened and is sent to the arterial heart side.

When the liver transplantation quick tube-placing low-temperature perfusion device is used, firstly, the handle 1 is adopted to control the forceps head 2 to clamp a blood vessel, then the puncture sheath 41 is used for puncturing the blood vessel, after the puncture needle 5 punctures, the needle core 52 at the top rebounds to avoid penetrating the rear wall of the blood vessel, the guide wire 421 is tightened by the guide wire control rod during puncturing, the perfusion catheter 42 is firmly restrained in the puncture sheath 41, the guide wire 421 is loosened after puncturing is successful, the perfusion catheter 42 is conveniently fed into the arterial heart side, after puncturing is successful, the needle core 52 pops out to push the safety lock to lock the needle core 52 so that the needle core 52 cannot retract, the puncture needle 5 breaks through the front wall of the blood vessel, the needle core 52 pops out, arterial blood flows into the pressure indication bin 53 through the side hole 521 of the needle core 52 to prompt successful puncturing, and then after the perfusion catheter 42 reaches a preset plane, the balloon 422 is expanded, the perfusion catheter 42 is fixed and blood perfusion from the thoracic aorta is blocked;

the upper surface of the conical head end of the perfusion catheter 42 is an inclined plane which is consistent with the inclined plane of the puncture sheath 41 so as to facilitate puncture into a blood vessel, and the length of the conical head end is close to the inner diameter of an artery, so that the head end is prevented from being reversely folded in the process of being sent to the heart side, and the depth of the catheter is not reached.

Specific application surgical procedures for the device include:

1. pushing open small intestine, exposing back peritoneum, transversely cutting back peritoneum for 3cm above bifurcation of left and right common iliac arteries, exposing front wall of abdominal aorta, performing left hand operation and assisting in fixing abdominal aorta, and controlling clamp head 2 to be inserted close to arterial side wall by using handle 1 to clamp blood vessel; after the clamping, the handle 1 is handed to an assistant;

2. assembling a puncture kit, inserting the perfusion catheter 42 into the puncture sheath 41, and confirming that the clamping grooves are anastomotic, and holding the puncture kit by a right hand of an operator to prepare for puncture, wherein an index finger presses the perfusion catheter 42, and a ring finger pushes a guide wire control rod to tighten a guide wire;

3. after the puncture is felt to be broken, observing the puncture needle core positioning mark to display that the needle core is in a popup state, and enabling blood to flow into the pressure indication bin to push the buoy to displace, and confirming that the puncture is successful through the color and the pressure of the blood;

4. the safety lock catch of the puncture needle core is pressed by the left hand to enable the puncture needle core to pop out of the locking needle core so as to prevent the puncture of the rear wall of the blood vessel in the process of placing the tube; adjusting the puncture inclination angle to continuously puncture 0.5-1cm, then loosening the constraint guide wire control rod of the middle finger of the right hand, and releasing the perfusion catheter;

5. the assistant slightly rotates to insert the perfusion catheter 42 into the proximal end of the abdominal aorta, fills the dilation balloon after reaching a predetermined plane, perfuses the catheter 42 and blocks blood flow from the thoracic aorta;

6. the artery is clamped by a matched vascular clamp above the puncture point, and a perfusion pipeline is established at the moment, and low-temperature perfusion is started. While the perfusion pressure can be monitored dynamically.

The foregoing has shown and described the basic principles, principal features and advantages of the utility model. It will be understood by those skilled in the art that the present utility model is not limited to the above-described embodiments, and that the above-described embodiments and descriptions are only preferred embodiments of the present utility model, and are not intended to limit the utility model, and that various changes and modifications may be made therein without departing from the spirit and scope of the utility model as claimed. The scope of the utility model is defined by the appended claims and equivalents thereof.

Claims (10)

1. The utility model provides a liver transplantation supplies quick catheterization low temperature perfusion device of liver, includes vascular occlusion pincers, its characterized in that: the vascular occlusion forceps comprise a handle (1) and a forceps head (2), a guide groove (3) is arranged on the outer side of the vascular occlusion forceps, a puncture mechanism (4) is arranged on the guide groove (3), the puncture mechanism (4) comprises a puncture sheath tube (41) and a perfusion catheter (42), a puncture needle (5) is arranged at the head end of the puncture sheath tube (41), a needle core (52) capable of rebounding is arranged at the top of the puncture needle (5), and the needle core (52) is a blunt needle core.

2. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the side surface of the clamp head (2) is provided with an undamaged vertical tooth structure (21), and the vertical tooth structure (21) adopts an upward arc end.

3. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the handle (1) and the clamp head (2) are in an angle of 45 degrees, 2cm above the joint of the handle (1) and the clamp head (2) is a hinge point, the guide groove (3) and the vascular occlusion clamp are in an angle of 15 degrees, and the center line of the guide groove (3) is consistent with the axis of the vascular occlusion clamp after the vascular occlusion clamp is clamped.

4. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the front half part of the puncture sheath tube (41) has a 1/2 round section, and the rear half part has a rectangular end (43) which is matched with the guide groove (3) of the vascular occlusion forceps.

5. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the front half head end of the puncture sheath tube (41) is an inclined plane for puncture, the inner side of the inclined plane is provided with a clamping groove, the inner side of the inclined plane is matched with the conical head end of the perfusion catheter (42), the tail end of the inclined plane of the puncture sheath tube (41) is provided with a guide wire (421), one end of the guide wire (421) is fixed on the left side wall of the puncture sheath tube (41), and the other end of the guide wire is connected to a guide wire control rod on the right side of the puncture sheath tube (41).

6. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the tail of the needle core (52) is provided with a positioning mark and a safety lock catch.

7. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the needle core (52) is a hollow tube with a side hole (521), and the rear part of the needle core is connected with the pressure indication bin (53) through a pipeline.

8. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 1, wherein: the head end part of the perfusion catheter (42) is conical, a groove is arranged to be matched with the inner clamping groove of the inclined plane of the puncture sheath tube (41), and the upper surface of the conical head end of the perfusion catheter (42) is an inclined plane and is consistent with the inclined plane of the puncture sheath tube (41).

9. The liver transplantation liver supply rapid catheterization low temperature perfusion device according to claim 8, wherein: the utility model discloses a perfusion catheter, including main part, balloon (422) and outer pressure detection device, the main part is a Fang Lianqiu bag (422) behind the head end of perfusion catheter (42), the body part for perfusion catheter (42) behind balloon (422), the rear of balloon (422) is provided with two and fills the side opening, communicates with each other with the lumen of perfusion catheter (42), and first side opening contralateral side sets up the pressure measurement hole, is connected with outside pressure detection device through the pipe, detects the perfusion pressure in real time, perfusion catheter (42) have length scale mark.

10. The liver transplantation liver-donor rapid catheterization low temperature perfusion device of claim 9, wherein: the perfusion catheter (42) is provided with a clamping groove for restraining the guide wire (421) at a position 1.5cm away from the head end, the section is wedge-shaped, and the head side is a vertical section.