KR102317978B1 - Biliary drain device for negative pressure-retrograde installation of percutaneous transhepatic biliary drainage - Google Patents

Abstract

The present invention relates to a bile drainage device for retrograde percutaneous biliary drainage that maintains a negative pressure, and the biliary drainage device for retrograde percutaneous biliary drainage that maintains a negative pressure according to the present invention is a station for maintaining negative pressure during pancreaticoduodenectomy. A bile drainage device for planetary percutaneous biliary drainage (NR-PTBD), comprising: a flexible tube having a suction port mounted on an afferent loop for sucking bile; and a guide member installed at the other end of the tube so that the tube inserted through the biliary cut can penetrate the liver tissue.

Description

{BILIARY DRAIN DEVICE FOR NEGATIVE PRESSURE-RETROGRADE INSTALLATION OF PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE}

The present invention relates to a biliary drainage device for retrograde percutaneous biliary drainage that maintains negative pressure, and more particularly, to a simple and safe retrograde percutaneous biliary drainage system that maintains negative pressure for lowering the pressure of afferent small intestine during pancreaticoduodenal resection. It relates to a biliary drainage device for retrograde percutaneous biliary drainage that maintains an operable negative pressure.

Pancreaticoduodenectomy (pancreatoduodenectomy, Whipple procedure, or Kausch-Whipple procedure) is a basic operation for the surgical treatment of duodenal pyloric tumors. Pancreatic-jejunum anastomosis requires a lot of surgical skill, and the fatality rate due to leakage of this anastomosis is reported to be 25-30%, and the incidence rate is reported to be about 10-20%. In addition, various attempts have been made to prevent leakage of the pancreatic-jejunum anastomosis by numerous domestic and foreign hepatobiliary and pancreatic surgeons, but there is no definitive answer yet.

Attempts to reduce leakage of the pancreatic-jejunum anastomosis can be broadly classified into two categories. The first is a method of strengthening the anastomosis of the anastomotic part. For example, a study comparing the Dunkin anastomosis and the mucosal-mucosal anastomosis was conducted, and a pancreatic-gastric anastomosis was attempted instead of the pancreatic-jejunum anastomosis, but no meaningful results were obtained. The second is to reduce the loading of the afferent small intestine and lower the pressure. Several reports have reported that attempts to reduce the loading of the afferent small intestine through percutaneous biliary drainage performed before or after surgery are meaningful.

Recently, negative pressure-retrograde installation of percutaneous transhepatic biliary drainage (NR-PTBD), which maintains negative pressure, has been developed by the present inventors to reduce leakage of the pancreatic-jejunum anastomosis during pancreaticoduodenectomy. are being tried In retrograde percutaneous biliary drainage to maintain this negative pressure, as shown in FIG. 2) Insert the blunt-ended wire (4) into the opening to expose it to the surface of the liver (1), and as shown in FIG. 1 (c), the suction tube ( After connecting the ends of 5), pull the wire 4 as shown in FIG. Thereafter, a suction tube (5) of about 10 to 15 cm is mounted on the afferent loop so that pancreatic juice, bile, intestinal juice, etc. can be sucked, and a drainage bag (Jackson) connected to the suction tube (5) from the outside of the body -Pratt drains, not shown) is a method of reducing the pressure of the afferent small intestine by providing negative pressure to the suction tube (5) to discharge pancreatic juice, bile, intestinal juice, etc. out of the body.

However, in retrograde percutaneous biliary drainage, which maintains negative pressure during pancreaticoduodenectomy, in the process of pulling the wire 4 penetrating the liver (1) tissue for induction of the suction tube (5), the wire (4) ), the problem of separation of the suction tube (5) from the frequent occurs. If the suction tube (5) is separated from the wire (4) while passing through the liver tissue, use the wire (4) to penetrate the liver (1) tissue again, and insert the suction tube (5) at the end of the wire (4). After reconnection, the liver (1) tissue may be excessively damaged because a series of processes of pulling the wire 4 and discharging the suction tube 5 into the opening of the biliary tract 2 must be repeated.

On the other hand, in order to prevent such a problem, the connection part of the wire 4 and the suction tube 5 is tied with a thread so that the fixed state is maintained firmly, but the connection operation of the wire 4 and the suction tube 5 is intermittent. Since it has to be performed in a cramped space between the upper part, that is, the liver (1) and the diaphragm (3), there is a problem that not only the operation time is long but also high skill is required.

Accordingly, an object of the present invention is to solve the problems of the prior art, and to provide a negative pressure that can be performed conveniently and safely in retrograde percutaneous biliary drainage, which maintains negative pressure for lowering the pressure of the afferent small intestine during pancreaticoduodenal resection. To provide a bile drainage device for retrograde percutaneous bile drainage that maintains the biliary tract.

The above object is, according to the present invention, in the bile drainage device for retrograde percutaneous biliary drainage (NR-PTBD) that maintains negative pressure performed during pancreaticoduodenal resection, in the afferent loop to suck bile a flexible tube having a suction port mounted on one end thereof; and a guide member installed at the other end of the tube so that the tube inserted through the biliary cut can penetrate the liver tissue.

Here, the guide member is preferably made in the form of a rod.

In addition, it is preferable that a plurality of guide grooves for bending or cutting the guide member are formed in the guide member along the longitudinal direction.

In addition, it is preferable that the tip of the guide member is curved or bent.

In addition, it is preferable to further include a needle installed after the guide member is removed from the tube so that the other end of the tube can penetrate the skin after penetrating the liver tissue.

In addition, it is preferable that the needle tip is formed at the front end and the coupling portion fixed to the tube is formed at the rear end.

In addition, the other end of the tube to accommodate the bile discharged through the tube after penetrating the skin, drainage bag installed after the needle is removed from the tube; it is preferable to further include.

In addition, the drainage bag is preferably made in the form of a bulb having elasticity to provide a negative pressure to the suction port.

According to the present invention, there is provided a bile drainage device for retrograde percutaneous biliary drainage that maintains negative pressure, which can easily and safely perform retrograde percutaneous biliary drainage, which maintains negative pressure for lowering the pressure of the afferent small intestine during pancreaticoduodenectomy. do.

In addition, since the guide member that penetrates the liver tissue and exits to the outside can be easily bent or cut, the guide member that passes through the liver and is discharged into the cramped space between the liver and the diaphragm is a retrograde percutaneous method that maintains an easy negative pressure. A bile drainage device for biliary drainage is provided.

In addition, by bending the tip of the guide member penetrating the liver tissue in one direction, there is provided a bile drainage device for retrograde percutaneous bile drainage that maintains a negative pressure that can easily control the direction in which the guide member penetrates the liver. .

1 is a schematic diagram showing retrograde percutaneous biliary drainage to maintain negative pressure performed in the conventional pancreaticoduodenal resection;
2 is a perspective view showing the configuration of a bile drainage device for retrograde percutaneous bile drainage that maintains a negative pressure of the present invention;
3 is a schematic diagram showing a retrograde percutaneous cholestasis that maintains negative pressure during pancreaticoduodenectomy using the biliary drainage device for retrograde percutaneous biliary drainage that maintains negative pressure of the present invention;
Figure 4 is a view showing various embodiments of the guide groove according to the present invention according to the bile drainage mechanism for retrograde percutaneous bile drainage that maintains negative pressure.

Prior to the description, in various embodiments, components having the same configuration are typically described in the first embodiment using the same reference numerals, and in other embodiments, configurations different from those of the first embodiment will be described. do.

Hereinafter, a bile drainage device for retrograde percutaneous bile drainage that maintains negative pressure according to a first embodiment of the present invention will be described in detail with reference to the accompanying drawings.

Of the accompanying drawings, FIG. 2 is a perspective view showing the configuration of a biliary drainage device for retrograde percutaneous biliary drainage that maintains a negative pressure of the present invention, and FIG. It is a schematic diagram showing retrograde percutaneous biliary drainage for maintaining negative pressure performed during pancreaticoduodenectomy, and FIG. 4 is a view showing various embodiments of guide grooves according to the present invention for retrograde percutaneous biliary drainage for maintaining negative pressure. am.

As shown in the figure, the present invention's biliary drainage device for retrograde percutaneous biliary drainage that maintains negative pressure is used for retrograde percutaneous cholestasis that maintains negative pressure during pancreaticoduodenal resection, and the tube (10) , including a guide member 20, a needle 30 and a drainage bag (40).

The tube 10 is composed of a general medical tube 10 made of a flexible material, and one end is mounted on an afferent loop to suck pancreatic juice, bile, intestinal juice, etc., and the other end is aspirated pancreatic juice, It is exposed to the outside of the body to expel bile, intestinal juice, etc. out of the body. In addition, a suction port 11 capable of sucking pancreatic juice, bile, intestinal juice, etc. is formed at one end of the tube 10 , and these suction ports 11 are formed in a cross shape or are formed in multiple numbers on the side of the tube 10 . and the like, may be formed in various forms as needed.

The guide member 20 is made in the form of a thin and long rod fixed to the other end of the tube 10 so that the tube 10 can be disposed through the liver (1) tissue, the liver (1) tissue It may be made of a synthetic resin material such as polyamide so that it can be easily bent or cut by an operator after penetrating the liver (1) tissue while having a degree of rigidity that can penetrate through the liver (1).

Specifically, the guide member 20 has a rear end fixed to the other end of the tube 10 and inserted through the bile duct 2 cut in the pancreaticoduodenal resection process. ) Penetrating the tissue and exposed to the outside of the liver (1), the tip is formed with a bent tip portion 22 bent to one side. That is, when the guide member 20 is axially rotated while the guide member 20 penetrates the liver (1) tissue, the guide member 20 penetrates the liver (1) tissue in the direction indicated by the bent tip portion 22. Thus, the penetrating direction of the guide member 20 can be easily adjusted.

In addition, a plurality of guide grooves 21 for bending or cutting the guide member 20 are formed in the guide member 20 along the longitudinal direction. That is, in order for the tube 10 fixed to the rear end of the guide member 20 to be exposed to the outside of the liver 1 , the entire guide member 20 must come out of the liver 1 . At this time, when the operator bends or cuts the guide member 20 using the guide groove 21, the entire guide member 20 exits into a very narrow space between the liver 1 and the diaphragm 3 It is possible to prevent the guide member 20 from contacting the diaphragm 3 .

The guide groove 21 may be configured in various forms depending on the use environment or purpose. For example, when the guide groove 21 is recessed in a direction crossing the guide member 20 from one side of the guide member 20 as shown in Fig. 4 (a), the guide member 20 is moved in one direction. In the case where the guide grooves 21' are respectively recessed in the direction transverse to the guide member 20 from both sides of the guide member 20, as shown in FIG. 4(b), the guide member 20 ) can be cut or bent in either selected direction, and when the guide groove 21 "is in the form of a plurality of through holes passing through the guide member 20 as shown in FIG. 20) can be easily cut in. This guide groove 21 is a range in which the guide member 20 is not arbitrarily bent by the guide groove 21 in the process of the guide member 20 penetrating the liver (1) tissue. It is preferably formed within.

The needle 30 is fixed to the other end of the tube 10 so that the tube 10 can penetrate the skin 6 from the inside to the outside, and the tip can penetrate the skin 6 A sharp tip 31 is formed, and a coupling portion 32 that can be inserted and fixed to the other end of the tube 10 is formed at the rear end.

Meanwhile, the tip part 31 may be bent in one direction to penetrate the skin 6 tissue in a narrow space. In addition, the coupling part 32 is configured in a form that can be inserted and fixed to the other end of the tube 10 , and a plurality of coupling parts 32 are provided on the outer circumferential surface of the coupling part 32 so that the fixed state with the tube 10 can be firmly maintained. A ring-shaped wedge of may be provided.

The drainage bag 40 has the needle 30 removed from the tube 10 to accommodate the bile discharged through the tube 10 after the other end of the tube 10 penetrates the skin 6 . After being installed, it may be formed in the form of a bulb having elasticity to provide negative pressure to the suction port 11 .

Hereinafter, the operation of the first embodiment of the bile drainage device for retrograde percutaneous bile drainage that maintains the above-described negative pressure will be described.

3A, the tip of the guide member 20 fixed to the end of the tube 10 is inserted into the opening of the biliary tract 2 cut by pancreaticoduodenectomy, and the guide member 20 is inserted in the insertion direction. When pushed into the biliary tract 2, the bent tip 22 of the guide member 20 inserted through the opening of the biliary tract 2 penetrates the liver (1) tissue and is exposed to the outside of the liver (1).

At this time, since the bent tip 22 of the guide member 20 is bent in one direction, the direction in which the guide member 20 penetrates the liver (1) tissue is guided in the direction in which the bent tip 22 is bent. . Therefore, the operator can rotate the guide member 20 in the axial direction so that the guide member 20 penetrates the liver (1) tissue in a desired direction.

Next, in the state in which the bent tip 22 of the guide member 20 penetrates the liver (1) tissue and is exposed to the outside, as shown in FIG. 3 (b), hold the bent tip 22 of the guide member 20 The tube 10 connected to the rear end of the guide member 20 may be pulled through the liver (1) tissue.

According to this embodiment, the guide member 20 can be bent or cut using a plurality of guide grooves 21 formed along the longitudinal direction of the guide member 20, so the guide member exposed to the outside of the liver 1 By bending the 20 using the guide groove 21, the diaphragm 3 is moved by the guide member 20 exposed to the outside of the liver 1 in the cramped space between the liver 1 and the diaphragm 3 damage can be prevented. In addition, in this embodiment, the guide member 20 has been described as being bent by the guide groove 21 as an example, but it will be possible to cut it if necessary.

When the guide member 20 is completely exposed to the outside of the liver 1 as shown in Fig. 3 (c), the tube 10 connected to the rear end of the guide member 20 is in a state that penetrates the liver 1 . In this state, the end of the tube 10 is cut to remove the guide member 20 from the end of the tube 10, and the coupling portion 32 provided at the rear end of the needle 30 as shown in FIG. It is fixed to the end of the tube (10).

When the fixing of the needle 30 to the end of the tube 10 is completed, the skin 6 is penetrated using the tip 31 of the needle 30 as shown in FIG. By pulling the needle 30, the end of the tube 10 may be exposed to the outside of the body, and after the end of the tube 10 is exposed to the outside of the body, the end of the tube 10 is cut and the tube Remove the needle (30) from (10).

Then, as shown in Fig. 3 (f), a drainage bag 40 is installed at the end of the tube 10 from which the needle 30 is removed, and one side of the tube 10 extended through the opening of the biliary tract 2 The end is placed in the afferent loop, which is the pancreatic-jejunum anastomosis, and then the pancreas, the biliary tract (2) and the stomach are sutured to the small intestine through pancreaticoduodenectomy, respectively.

After pancreaticoduodenectomy is completed, if negative pressure is provided through the drainage bag, bile, pancreatic juice, and intestinal juice can be discharged outside the body through the suction port 11 formed at one end of the tube 10, so loading of the afferent small intestine Leakage of the pancreatic-jejunum anastomosis can be effectively prevented by reducing the pressure and reducing the pressure.

According to this embodiment as described above, the tube 10 inserted into the opening of the biliary tract 2 using the guide member 20 is installed in a retrograde manner to the outside of the liver 1, thereby reducing the negative pressure performed in the pancreaticoduodenectomy process. Retrograde percutaneous biliary drainage can be performed conveniently and safely.

In addition, since it is possible to easily bend or cut the guide member 20 that penetrates the liver (1) tissue and exits to the outside, the guide member 20 falls out of the cramped space between the liver (1) and the diaphragm (3). It is possible to prevent an increase in the difficulty of the procedure by coming out.

The scope of the present invention is not limited to the above-described embodiments, but may be implemented in various forms of embodiments within the scope of the appended claims. Without departing from the gist of the present invention claimed in the claims, it is considered within the scope of the description of the claims of the present invention to various extents that can be modified by any person skilled in the art to which the invention pertains.

10: tube, 11: suction port, 20: guide member,
21: guide groove, 22: bent tip, 30: needle,
31: tip, 32: coupling, 40: drainage bag

Claims (8)

In the bile drainage device for retrograde percutaneous biliary drainage (NR-PTBD) that maintains negative pressure during pancreaticoduodenectomy,
a flexible tube having a suction port mounted on an afferent loop for sucking bile formed at one end thereof; and
A guide member capable of exposing the other end of the tube connected to the rear end to the outside of the liver tissue by penetrating the liver tissue after the rear end is connected to the other end of the tube, and the tip is inserted through the biliary cut.
The guide member is made in the form of a rod made of a synthetic resin material that can be bent or cut by an operator after penetrating the liver tissue while having a degree of rigidity that can penetrate the liver tissue, and the guide groove for bending or cutting has a length Many are formed along the direction,
A bile drainage device for retrograde percutaneous bile drainage for maintaining negative pressure, characterized in that a bent tip bent in one direction is formed at the tip of the guide member to control the penetration direction. delete delete delete The method of claim 1,
A biliary drainage device for retrograde percutaneous bile drainage further comprising a needle installed after the guide member is removed from the tube so that the other end of the tube can penetrate the skin after penetrating the liver tissue. 6. The method of claim 5,
The needle is a bile drainage device for retrograde percutaneous bile drainage for maintaining negative pressure, characterized in that the tip is formed at the tip and the coupling part fixed to the tube is formed at the rear end. 6. The method of claim 5,
Bile for retrograde percutaneous biliary drainage to maintain negative pressure further comprising; a drainage bag installed after the needle is removed from the tube to accommodate the bile discharged through the tube after the other end of the tube penetrates the skin drainage apparatus. 8. The method of claim 7,
The drainage bag is a bile drainage device for retrograde percutaneous bile drainage for maintaining negative pressure, characterized in that it is made in the form of a bulb having elasticity to provide negative pressure to the suction port.

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