DE3216178A1 - Mechanical lithotriptor with controllable tensile force - Google Patents

Abstract

Device for the mechanical crushing, without any danger to the patient, of large bile duct calculi after previous endoscopic papillotomy. The device comprises a small Dormia basket (monofilament spring steel wire), the tension wire of which is guided in a highly flexible spiral wire jacket. The jacket permits transmission of the tensile force from the outside to the Dormia basket. The Dormia basket and the spiral wire jacket can be visibly inserted in the bile duct through the instrument channel of a commercially available duodenoscope (Olympus, JF-1T). The tensile force exerted on the calculus trapped in the Dormia basket can be read off a load-sensing device. This prevents unnoticed overloading of the lithotriptor (detachment of the Dormia basket).

Description

Description:

Mechanical lithotriptor with controllable traction The invention relates to a medical-technical device for the mechanical destruction of large Chqledochus concrements (lithotripsy) with controllable tensile force.

The invention leaves the patient with a more expensive, saves serious surgery and a long hospital stay.

It is known that lithotripsy or litholysis has been taking place for some time for the comminution of large Gailengangskonkremente made with the following methods be: 1. Lithotripsies: a) electrohydraulic method (Walz).

b) mechanical lithotripsy without controllable tensile force (Seuberth).

2. Chemolitholyses: nasobiliary probes (rinsing with stone-loosening Substances).

The disadvantage of these known methods is that.

to 1 a) that with the electrohydraulic method stone particles splinter and penetrate the common bile duct wall or this due to their strong acceleration can even perforate.

to 1 b) that in mechanical lithotripsy with a four-armed Cup, e.g. B. with a large bilirubin limestone, due to excessive uncontrollable Pulling force can tear up to three arms. However, one would be much less favorable Tear off between the basket and wire rope with a trapped stone. The latter would be the Necessitate an operation.

to 2. a long-term treatment with uncertain success.

References: Dtsch. med. Wschr. 1982, Volume 107, No. 14, 555.

The invention is based on the object of large gallstones to mechanically smash the completed papillotomy by controllable tensile force, so that the individual fragments with a traditional Dormia baskets can be removed or come off by itself This task becomes a generic one Device by the characterizing features of claim 1 and the listed Subclaims solved.

Explanations of the spiral jacket: By reducing the outer diameter achieved by the spiral jacket with the same internal diameter in the insertion part you have a high flexibility as well, which protects the entire bending mechanism contributes to the endoscope and at the same time the risk of perforation 'when catching a calculus greatly diminishes.

Explanation of the pull wire: Through the transition of the pull wire from one monofilament spring steel wire in a wire rope (in the insertion part) with the same tensile strength becomes unhindered even if the albaranna at the endoscope is strongly angled Extending the lithotripsy basket when catching a bile duct concrement achieved.

To push on the monofilament pull wire when extending the lithotripsy basket This wire section is to be avoided in the area of the push rod by a thin steel jacket.

Explanation of the handle: The end of the pull wire is on a round shaft, which runs transversely to the direction of pull, rolled up and thus fixed. This fixation prevents the puller wire from being crushed, which is the case with the Fixation with a fixing screw is not guaranteed.

With the invention can be controlled by a tensile force during mechanical stone fragmentation has all the complications and disadvantages known to date already known lithotripsy techniques can be reduced to a minimum.

An embodiment of the invention is shown in the drawing and is described in more detail below.

They show: FIG. 1 the pulling device with a dynamometer.

This consists of a guide tube a with a holding device a1 for the cap k, a connection for the dynamometer f and an elongated hole ~ 1 ~ is equipped.

Slide tube b is inserted into guide tube a, on which the Holding device bl for the handle h is located. The sliding tube b is in the guide tube a through a screw b2, which is screwed into the guide tube, in the elongated hole 1 guided. This prevents the sliding tube b from rotating in the guide tube a.

A thread is cut into the inside of the guide tube b the knurled screw d is screwed in. The barrel cylinder c, which is also inside the Cleitrohres b is firmly connected to the knurled screw d. This hits a pin during the pulling process, through which the pull or pressure is transferred to the dynamometer f.

Fig. 2 shows the lithotriptor, consisting of a spiral steel jacket s, the outer diameter of which is approx. 22 cm at the distal end constant inner diameter reduced (: introductory part sl The spiral steel jacket s is fixed in the cap ~ k.

The basket t, which is inside the spiral steel egg s and is made of four monofilament spring steel wires and comes with a handle h by a pull wire z made of monofilament spring steel wire, which is inserted in the insertion part 51 merges into a wire rope zl1 (nylon sheathed) with the same tensile strength. To push the monofilament pull wire z when extending the lithotripsy basket t to avoid in the area of the sliding frame st, this wire section is through a thin steel mar.tel z3 splinted. This meets at an Er # position g in the handle an ur, d thus prevents the puller wire z from being pushed back when the Cup.

The handle h, at the end of which is a transverse to the pulling direction, by means of screw x lockable shaft w is attached and on which the pull wire can be fixed by rolling up (Fig.h2), is held by a push rod st in the sleeve e out. In addition, in this sleeve e there is a tube-r with fine calibration plugged in.

The sleeve e is screwed to the closure cap k. Thus form Sleeve e, cap k and steel jacket s and s1 are a solid unit in itself.

Explanation of the invention based on the drawing according to structure and effect wise: After an endoscopic papillotomy, a commercially available duodenoscope (Olympus JF-1T) the introductory part S1 of the lithotriptor (Fig. 1) guided under view in the bile duct. You now drag the handle h with the push rod st into the sleeve e, the cup t in the bile duct is out ejected from the steel jacket and unfolds. Is the stone in the basket t caught, the handle h with the push rod st is again out of the sleeve e drawn. This has the effect that the cup t is pulled back in and with it the stone holds on.

Now the lithotriptor is behind the cap k and in front of the Bracket h # in the brackets a1 and b1 provided for this purpose on the pulling device. By turning the knurled screw d to the right (start of the actual lithotrlpsy process) remove the two brackets. al ur.d b1 in front of each other. Immediately increases the tensile force in the thotriptcr or the pressure of the basket on the gallstone. Under Continuous clockwise rotation of the knurled screw d increases the tensile force that is applied to the Force gauge f can be read, increased until the gallstone breaks into several small ones Particle disintegrates. The lithotriptor and the duddenoscope can now be removed. The process of mechanical L # thotripsy with controllable tensile force is thus completed.

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Claims (1)

Claims: ti. Mechanical lithotriptor with controllable Pulling force to break up gallstones after endoscopic papillotomy not from the bile duct because of its size with a conventional Dormia basket can be removed, characterized in that a four-armed collecting basket (Dormia basket) on the captured gallstone, controlled from the outside, so strong Train or pressure exerts that this breaks up into several smaller particles. This pull or pressure is transmitted to a force gauge on the pulling device and is thus controllable. 2. The mechanical lithotriptor of claim 1, further characterized in that the outer diameter of the spiral steel jacket, in the inside of which the collecting basket runs, at the distal end over a length of approx. 22 cm reduced with the same inner diameter (= particularly flexible entry part). The basket is attached to the handle by a spring steel wire, which merges into a wire rope (with nylon sheath) in the duct part. This spring steel wire (pull wire) is on the end of the handle rolled up a shaft running transversely to the pulling direction and thus fixed to it.