WO2015007233A1 - 一种头端可弯曲的输尿管肾镜 - Google Patents

一种头端可弯曲的输尿管肾镜 Download PDF

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Publication number
WO2015007233A1
WO2015007233A1 PCT/CN2014/082470 CN2014082470W WO2015007233A1 WO 2015007233 A1 WO2015007233 A1 WO 2015007233A1 CN 2014082470 W CN2014082470 W CN 2014082470W WO 2015007233 A1 WO2015007233 A1 WO 2015007233A1
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WIPO (PCT)
Prior art keywords
tube
telescopic
mirror
connecting bridge
sheath
Prior art date
Application number
PCT/CN2014/082470
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English (en)
French (fr)
Inventor
孙颖浩
高小峰
彭泳涵
李凌
俞国良
陈尧松
王磊
华立芳
Original Assignee
Sun Yinghao
Gao Xiaofeng
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sun Yinghao, Gao Xiaofeng filed Critical Sun Yinghao
Publication of WO2015007233A1 publication Critical patent/WO2015007233A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/307—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the urinary organs, e.g. urethroscopes, cystoscopes

Definitions

  • the invention relates to a surgical instrument, in particular to a ureteroscope for clinical examination, diagnosis and treatment of urinary tract and kidney stone diseases.
  • the usual surgical method is to first use the ureter to expand the ureter to expand the sheath, then place the ureteral soft lens, and find the stone to crush the stone with a krypton laser.
  • the existing products are rigid ureteroscope and soft ureteral nephroscope.
  • the application of rigid ureteroscope has been nearly 20 years old. It can effectively treat the stones below the ureter because the head can not bend. There is nothing to do with kidney stones.
  • almost all soft ureteroscopes have been imported, such as Japan OLYMPUS URF-P5 fiber ureteroscope, OLYMPUS URF-V electron ureteroscope, STORZ 11278A fiber ureteroscope.
  • the insertion performance of the soft lens in the ureter is not as good as that of the hard oscope.
  • the ureter needs to be expanded beforehand, which will cause trauma to the ureter, damage the ureteral mucosa or even perforation.
  • the soft lens cannot be quickly promoted. Another reason is that the equipment is expensive and uses life. Short life and high cost of treatment.
  • the existing patent documents such as the Chinese patent: "A soft ureteral nephroscope with hard sheath (CN101019756A)", consisting of a hard tube part and a removable soft mirror part, the soft mirror is placed in the hard sheath, And can extend the hard tube.
  • a medical retractable ureteral nephroscope (CN202313262U)" including a three-way valve, a lock cap, a mirror body, a mirror insert, a first outer tube, a second outer tube, and a third outer tube from bottom to top Connecting, the diameters of the first outer tube, the second outer tube, and the third outer tube are sequentially decreased, and the second outer tube can be retracted into the first outer tube, and the third outer tube can be retracted In the second outer tube, the optical plug is mounted on the outer side wall of the mirror insert, the lens barrel is mounted on the outer side wall of the mirror body, and the inner tube is inserted in the outer tube tube assembly, the outer tube tube A surgical instrument channel is disposed within the assembly, and the fiber light guiding system
  • the invention provides a soft and hard consideration, quick assembly and disassembly, which facilitates disinfection of various components, easy insertion into the ureter, and smooth entry into each renal pelvis, especially the lower jaw, which can well observe the situation in the lower jaw.
  • the ureteral nephroscope with flexible head end can solve the problem that the ureteroscope existing in the prior art is difficult to insert into the ureter, the condition in the lower jaw cannot be well observed, the diagnosis and treatment can be effectively performed, and the components can not be quickly assembled and disassembled. problem.
  • the invention also provides a ureteral nephroscope capable of performing circulating water work, reducing intra-renal perfusion pressure, convenient observation, good crushing effect and high stone crushing efficiency; solving the prior art
  • the technical problem of not being able to circulate water into the water, easily damaging the glomerulus, and the efficiency of the crushing stone is not high.
  • the tubular nephroscope includes an operating body, the operating body is connected with a mirror tube, and the operating body includes a mirror body, a detaching mechanism and a telescopic mechanism which are sequentially connected;
  • the mirror tube includes an insertion portion, a bending portion and a tip end portion which are sequentially connected;
  • the insertion portion is connected to the mirror body, and the sheath tube is connected with a sheath tube.
  • the length of the sheath tube is smaller than the length of the lens tube, and the telescopic mechanism is located at one end of the sheath tube, and the telescopic mechanism is connected to the mirror body through the attachment and detachment mechanism.
  • the sheath is a rigid mirror, and the lens tube is composed of a rigid mirror of the insertion portion and a bendable portion, and a tip end portion at the front end of the curved portion.
  • the degree of coincidence of the sheath tube and the lens tube is controlled by the telescopic mechanism, and the telescopic mechanism can make the end portion of the sheath tube completely flush with the tip end portion of the lens tube, thereby making the lens tube very rigid.
  • the rigid lens is easy to insert into the ureter without the need to expand the ureter.
  • the tip When the ureteroscope is working in the renal pelvis, in order to enter each renal pelvis (upper, middle, and lower jaw), the tip is required to be bent.
  • the bending angle can be controlled by the curved handle, but the bending length is fixed.
  • the ureteroscope of the present invention by adjusting the telescopic mechanism, causes the bending portion to extend beyond the length of the sheath tube, and is divided into a microscopic bendable head to find the state of the ureteral orifice, and the curved portion extends only 10-15 mm from the sheath tube, which allows the lens to be small.
  • the range is precisely searched for easy access to the ureteral entrance. Then, the head end is bendable to look for the squat state, and the bottom squat is observed and crushed, and finally it can be fully bent.
  • the assembly and disassembly mechanism allows the mirror body to be quickly separated from the sheath tube and the telescopic mechanism, thereby facilitating cleaning and disinfection and preventing postoperative infection.
  • the mirror body is sterilized with the lens tube, and the telescopic mechanism and the sheath tube are metal parts, and a stricter sterilization procedure can be performed. According to different needs, the two parts are separately disinfected, and the disinfection effect is good. Increased security of use of the device.
  • the telescopic mechanism is connected to the detachable mechanism through a connecting bridge
  • the telescopic mechanism includes a telescopic body
  • the sheath tube and the connecting bridge are connected by the telescopic body
  • the sheath tube is fixed to the telescopic body
  • the telescopic body and the connecting bridge slide.
  • the connection bridge is fixedly connected to the assembly and disassembly mechanism
  • the lens tube is located in a channel formed by the sheath tube and the connection bridge, and the lens tube is connected to the mirror body.
  • One end of the connecting bridge is fixed on the loading and unloading mechanism, and the other end passes through the telescopic mechanism.
  • the connecting bridge serves as a guide rail, and the telescopic mechanism moves on the connecting bridge.
  • the telescopic mechanism and the sheath tube are fixedly connected, and the two are moving together, and the movement distance of the telescopic mechanism on the connecting bridge is used to determine the moving distance of the sheath tube, thereby controlling the length of the lens tube extending out of the sheath tube to satisfy the lens tube. Different needs when using.
  • one end of the telescopic body is connected with a fixing cap, and the sheath tube is fixedly connected with the fixing cap, and a sliding bushing is arranged between the telescopic main body and the connecting bridge, and the sliding bushing is sleeved on the connecting bridge,
  • a control member is mounted on the telescopic body, a through hole is arranged in the center of the control member, and a telescopic button is arranged above the control member.
  • the telescopic button is located outside the telescopic body, and an elastic body is disposed below the control member; Positioning the groove, the connecting bridge passes through the through hole in the center of the control member, and the lower portion of the control member is engaged in the positioning groove by the pressure of the elastic body.
  • the sliding bushing is made of PTFE material with good elasticity and low friction coefficient, which can effectively reduce the sliding resistance.
  • the mirror tube instrument channel is used as the water inlet channel
  • the gap between the lens tube and the sheath tube is used as the water outlet channel.
  • the sliding bushing between the sheath tube and the connecting bridge can realize the function of sealing the circulating water. Prevent water from leaking out of the telescopic mechanism.
  • the sheath is glued to the inner wall of the fixed cap, the fixed cap is used for fixing the sheath, and the telescopic body is detachably threadedly connected with the fixed cap to facilitate assembly of the sheath, the connecting bridge and the lens tube.
  • the connecting bridge passes through the through hole in the center of the control member.
  • the elastic body under the control member is a leaf spring, the control member is pressed, the leaf spring is compressed, and the telescopic body slides on the connecting bridge to the connecting bridge. When the groove is in the position, the control member is loosened, and the elastic force of the leaf spring snaps the control member into the positioning groove to fix the telescopic body and the connecting bridge.
  • the telescopic main body casing is connected with a main body cover, and the fixing cap is screwed to the telescopic main body.
  • the main body cover and the control member are shielded by the main body cover, and the main body cover and the main body are glued and fixed.
  • the connecting bridge is a cylinder
  • the diameter of the connecting bridge is between the diameter of the lens tube and the diameter of the sheath tube, and is flat above the connecting bridge, and has a scale on the plane, and is disposed below the connecting bridge.
  • a protrusion is provided, and the protrusion abuts on the end surface of the telescopic body.
  • the diameter of the connecting bridge should not be too large, because the outer sheath has a sheath sliding, and the sheath is inserted into the human urethra during surgery, so the sheath is generally limited to Fr20 or less.
  • the upper side of the connecting bridge is flattened to prevent rotation of the telescopic mechanism when moving on the connecting bridge.
  • the telescopic body slides on the connecting bridge, and the scale on the connecting bridge can prompt the operator to reach the position, thereby releasing the control member and fixing the telescopic main body and the connecting bridge.
  • the three positioning grooves represent the state of the complete hard mirror from left to right, and the head end is slightly bendable to find the state of the ureteral orifice, and the head end is bendable to find the squat state.
  • the left side of the connecting bridge is convex, so when moving to the leftmost end, the displacement of the left end is restricted by the protrusion.
  • the telescopic body moves to the right to abut on the loading and unloading mechanism. , thus achieving the positioning on the right.
  • the telescopic body moves to the right to the right, and the curved portion is completely exposed outside the sheath tube to achieve a completely curved state.
  • the attaching and detaching mechanism comprises a connecting head, and one end of the connecting head is fixedly connected with a connecting bridge, and the other end of the connecting head is detachably connected to the mirror body through the locking cap, and is disposed on the end face of the connecting head and the mirror body There are locating pins and seals.
  • the lock cap is fixed to the mirror body by a nut. When installing, adjust the nut so that the clearance of the lock cap on the mirror body is appropriate (the lock cap can rotate freely, but there is no axial movement), and the nut is fixed.
  • the connector including the entire telescoping sheath, then interfaces with the lock cap. Positioning pin with docking pin to determine the connector To, prevent rotation.
  • connection between the connector and the lock cap can be achieved by a mechanical structure such as a thread or a chute for quick connection.
  • the connector When disconnecting, the connector can be retracted by turning the lock cap. After separation, the lock cap, nut, locating pin, seal ring, etc. belong to the mirror body and participate in the mirror disinfection.
  • the telescopic sheath assembly due to the pure metal parts, can perform stricter disinfection procedures.
  • the sealing ring is used to prevent leakage of the water circuit.
  • the end of the mirror body is provided with a liquid inlet and a wire guide, and the wire insertion opening is coaxial with the lens tube, and a curved handle and an optical socket for controlling the bending portion are arranged in the middle of the mirror body, and the connection is made.
  • the mirror tube serves as a water inlet passage, and a water outlet passage is formed between the sheath tube and the mirror tube, and the suction port is located on the connecting head for convenient assembly and disassembly.
  • the sheath is integrated with the mirror body and sealed, which is very beneficial for collecting water and stone samples. At the same time, it can also attract the water outlet and reduce the intra-renal perfusion pressure. According to authoritative research report, ureteroscopy and lithotripsy on the kidney The damage to the ball is largely due to the high perfusion pressure.
  • the present invention is capable of rinsing the field of view and the stone fragments by circulating water, and is capable of achieving suction and reducing the water pressure of the perfusion.
  • the curved portion is formed by a snake bone connection, and a pitch of each segment of the snake bone near the tip end portion is smaller than a pitch of each segment of the snake bone near the insertion portion.
  • a pitch of each segment of the snake bone near the tip end portion is smaller than a pitch of each segment of the snake bone near the insertion portion.
  • the snake bone structure used in the invention has a snake bone pitch at the front end smaller than a snake bone pitch at the rear end, so that the cut angle of the front end is larger than the cut angle of the rear end, and when the snake bone is bent, the front end bend radius can be small, and the back end bend radius is obtained.
  • the large effect allows the apex to reach the upper and lower jaws of the renal pelvis smoothly, and is also easy to find. Stones.
  • the operation body is connected with an eye mask, and the eye cover and the operation body form a "Y" shape, and a side leakage port is provided on a side surface of the operation body.
  • the Y-shaped structure makes the instrument channel more smooth, and the guide wire insertion port and the lens tube are coaxial.
  • This wire-in-line structure is popular among doctors, and the insertion is smooth, and the guide wire is not easily damaged. It is also possible to increase the diameter of the guide wire and increase the power of the krypton laser, which is very advantageous for improving the efficiency of the crushed stone.
  • the equipment shall be tested for leaks before and after each use, and the leak detector shall be inspected at the side leakage.
  • a head end bendable ureteroscope of the present invention has the following advantages:
  • the curved portion When the curved portion is retracted into the sheath, it becomes a rigid mirror, which is not substantially different from the current ureteral hard mirror.
  • the advantage of the rigid mirror is retained, that is, the rigidity is inserted, the ureter is inserted easily, and the ureter is not required to be expanded.
  • the product of the present invention becomes a soft mirror characteristic, and the bending function of the head end is realized, which makes it possible to enter the respective renal pelvis, and brings the greatest advantage of the soft mirror.
  • the degree of bending is adjustable, the "looking" ability is more powerful than the soft mirror.
  • the endoscope of the endoscope can easily reach the renal pelvis, suprarenal palpebral and renal pelvis, and the gravel stone does not leave a dead angle.
  • the bending part can only extend 10-15mm from the sheath tube, which allows the lens to be accurately searched in a small range, and it is convenient to find the ureteral inlet.
  • the rigid ureteral nephroscope in order to improve the rigidity of the mirror rod, is made into a thin front and a thick shape, and is designed as a multi-layer tube in the posterior part to improve rigidity.
  • the mirror body portion of the present invention is basically the same as the ordinary rigid mirror. The difference is that a layer of telescopic sheath tube is added outside the lens tube to further increase the rigidity.
  • the telescopic mechanism of the invention has the characteristics of simple and quick installation, separate sterilization of the telescopic mechanism, good sealing performance, and accurate positioning of the stretching position.
  • the separate sterilization of the sheath in the telescopic mechanism is important because insertion into the body often requires more stringent procedures to eliminate the risk of infection.
  • the telescopic mechanism of the invention can meet the requirements of high temperature and high pressure sterilization, and the high temperature and high pressure disinfection is recognized as the most thorough disinfection method in the world (but the damage to the instrument is large, and most instruments cannot be adapted).
  • the eyepiece portion of the invention is designed as a Y-shaped structure, and the guide wire insertion opening and the mirror tube realize "coaxial", and the guide wire is directly inserted into the structure, which not only inserts smoothly, but also protects the guide wire from being easily damaged, and can also be added.
  • Large guide wire diameter, increasing the power of krypton laser, is very beneficial to improve the efficiency of gravel.
  • Figure 1 is a schematic illustration of a ureteral nephroscope with a head end bendable in accordance with the present invention.
  • Figure 2 is a cross-sectional view of the D-D of Figure 1.
  • Fig. 3 is an enlarged schematic view showing the bent portion of Fig. 1 stretched out.
  • Fig. 4 is an enlarged schematic view showing the bending of the bent portion in Fig. 1.
  • Fig. 5 is a cross-sectional view showing the connecting portion of the sheath tube and the mirror body in Fig. 1.
  • Figure 6 is a cross-sectional view of the telescopic mechanism of Figure 5.
  • Figure 7 is a cross-sectional view showing the detaching mechanism of Figure 5;
  • Figure 8 is a front elevational view of the connecting bridge of Figure 5.
  • Figure 9 is a plan view of Figure 8.
  • Figure 10 is an enlarged cross-sectional view of E-E in Figure 8.
  • Figure 11 is a schematic view of a conventional mirror body entering the lower jaw.
  • Figure 12 is a schematic view of the mirror body of the present invention entering the lower jaw. Best way to implement the invention
  • a ureteral nephroscope with a bendable head end includes an operating body 4, and the operating body 4 is connected with a lens tube 17, and the lens tube 17 is sheathed with a sheath tube 6.
  • the length of the sheath tube 6 is smaller than that of the mirror tube 17. length.
  • the operation body 4 includes a mirror body 27, a detachable mechanism and a telescopic mechanism which are sequentially connected;
  • the lens tube 17 includes an insertion portion 9, a bending portion 7 and a tip end portion 8 which are sequentially connected, and the insertion portion 9 is connected to the mirror body 27, and the tip end portion 8
  • An objective lens is attached.
  • the telescopic mechanism is located at one end of the sheath tube 6, and the telescopic mechanism is coupled to the mirror body 27 by a detachable mechanism.
  • a guide wire opening 1 and a liquid inlet 2 are opened at a rear end of the operation body 4, and a curved handle 3 for controlling the bending of the curved portion 7 is provided in a central portion of the operation body 4, and an optical socket 11 and a measurement are provided on a side surface of the operation body 4.
  • an eyecup 14 is attached to the operation body 4, and a focus knob 13 is attached to the eyecup 14.
  • the wire guide 1 and the liquid inlet 2 are located on the same axis as the operation body 4, and the eyecup 14 and the operation body 4 are arranged in a "Y" shape.
  • a suction port 10 and a bellows 5 are provided at the front end of the operation body 4.
  • an instrument channel 15 and an imaging channel 16 are provided in the lens tube 17, and the remaining space of the lens tube is filled with a light guide 38, which is inserted into the lens tube 17 by the optical socket 11.
  • a water passage 19 is formed outside the mirror tube 17 and the sheath tube 6, and the instrument channel 15 can be filled with water and a laser guide wire.
  • the guide wire port 1 and the liquid inlet 2 are connected to the instrument channel 15 in the lens tube, and the suction port 10 is connected to the water outlet channel 19 formed between the sheath tube 6 and the lens tube 17.
  • the water is introduced into the instrument passage 15, and the water outlet passage 19 formed between the mirror body and the sheath tube is discharged to form a complete circulating water passage, and at the same time, when the water is discharged, it can also be attracted.
  • the mouth 10 is attracted to reduce the intra-renal perfusion pressure.
  • the curved portion 7 is formed by a joint of a serpentine 18-section.
  • the pitch T1 between the snake bones at one end of the snake bone 18 near the tip end portion 8 is smaller than the pitch T2 between the snake bones 18 near one end of the insertion portion, and the chamfer angle ⁇ ⁇ is larger than ⁇ 2 .
  • the bending radius of the front end R1 is small, and the bending radius R2 of the rear end is large.
  • the telescopic mechanism is coupled to the attachment and detachment mechanism via a connecting bridge 25.
  • the telescopic mechanism includes a telescopic body 23, a main body cover 30, a telescopic knob 22, a fixed cap 20, and a sliding bushing 24.
  • the telescopic main body 23 is a cylindrical body.
  • a through hole is formed in the center of the telescopic main body 23.
  • the connecting bridge 25 passes through the through hole, and a sliding bushing 24 is attached to the connecting bridge 25, and the sliding bushing 24 is made of a PTFE material.
  • a telescopic main body 23 is provided with a receiving groove, and a telescopic knob 22 is disposed in the receiving groove, and a leaf spring 31 is attached to the lower end of the telescopic knob 22.
  • the body of the telescopic body 23 is connected to the main body cover 30.
  • One end of the leaf spring 31 abuts against the bellows 22, and the other end abuts against the main body cover 31.
  • the telescopic button 22 is pressed, and the telescopic body 23 can move on the connecting bridge 25.
  • the telescopic body 23 is screwed with a fixing cap 20, and the fixing cap 20 includes an outer layer protecting body and an inner layer connecting body 21, and the inner layer connecting body 21 is provided with an external thread, and the inner wall of the telescopic main body 23 is provided The internal thread, the fixed cap is connected to the telescopic body 23 through the inner layer connecting body 21.
  • a through hole is also formed in the center of the fixing cap, and a sheath tube 6 is inserted into the through hole.
  • the outer wall of the sheath tube 6 is glued to the inner wall of the fixing cap, and the fixing cap 20 is connected to the telescopic body 23, and the telescopic body 23 can be
  • the connecting bridge 25 moves to drive the sheath 6 to move left and right, and controls the overlapping length of the sheath 6 and the lens tube 17, so that the length of the bending portion 7 extending out of the sheath tube 6 can be controlled, and the flexible mirror and the hard mirror can be exchanged. .
  • a sliding bushing 24 is attached to the overlap between the sheath tube 6 and the connecting bridge 25, and the sliding bushing 24 not only functions to effectively reduce the sliding resistance, but also seals the circulating water.
  • the mirror tube 17 extends out of the sheath tube 6 through the connecting bridge 25 and the sheath tube 6.
  • the left end of the connecting bridge 25 is provided with a projection 36 which abuts against the sliding bushing 24 and stops when the telescopic body moves to the leftmost end.
  • the connecting bridge 25 is movably connected to the telescopic main body 23, and the other end of the connecting bridge 25 is fixed to the attaching and detaching mechanism.
  • the detachable mechanism includes a connector 26, and the end of the bridge 25 is inserted into the connector 26 and glued to the connector.
  • One end of the connecting head 26 is fixedly connected with a connecting bridge 25, and the other end of the connecting head 26 is detachably connected to the mirror body 27 through the locking cap 35, and a positioning pin 32 and a seal are arranged on the end face of the connecting head 26 and the mirror body 27. Circle 34.
  • the end face of the connector is mounted with the sealing ring 34, and then positioned by the positioning pin 32, the connector 26 and the mirror body 27 are aligned, and the lock cap 35 is pre-installed in the mirror body 27, and the lock cap 35 is stepped in the mirror body.
  • the upper sleeve nut 33 is fixedly locked to the mirror body 27 by the nut 33, and the gap of the lock cap 35 on the mirror body 27 can be made appropriate, so that the lock cap 35 can be freely rotated, but has no axial direction. Inciting. Then, the lock cap 35 is rotated to fix the connector 26 to the mirror body 27.
  • a suction port 10 is opened in the joint head 26, and the suction port 10 communicates with the water outlet passage 19 formed between the mirror tube and the sheath tube.
  • the connector 26 can be withdrawn as long as the lock cap 35 is rotated.
  • the lock cap 35, the nut 33, the positioning pin 32, the seal ring 34 and the like belong to the mirror body, and participate in the mirror sterilization, and the telescopic mechanism, due to the pure metal parts, can perform a stricter disinfection procedure.
  • the sealing ring is used to prevent leakage of the water circuit.
  • the connecting bridge 25 is a cylinder having a diameter larger than the diameter of the mirror tube 17 and smaller than the diameter of the sheath tube 6.
  • the connecting bridge 25 is a plane 37, and a scale is provided on the plane 37: A, B, C.
  • Three positioning grooves 29 are provided below the connecting bridge, and the positioning groove 29 corresponds to the scale, when sliding to "A""Position indicates complete hard-mirror status, "B” indicates that the head end is slightly bendable to find the state of the ureteral orifice, and "C” indicates that the head end is bendable to find the squat state, and completely retreats to the full-bend state.
  • the length of the bridge and the position of each slot are carefully designed according to the working state of the mirror.
  • the diameter of the connecting bridge should not be too large, because the outer side has a sheath sliding, and the sheath tube is inserted into the human urethra during surgery.
  • the telescopic sheath is generally limited to below Fr20.
  • the tip end, the curved portion, and the insertion portion together form an elongated and rigid insertion tube.
  • the curved handle Before the operation, operate the curved handle to straighten the curved part, insert the ureteroscope into the sheath tube and quickly connect with the operating body (mirror body) to control the position of the telescopic button on the mirror body, which can change the soft and hard state of the front end of the mirror. .
  • the telescopic button is in the upper stop position, the bending portion is all retracted into the sheath tube, and the tip end just exposes the sheath tube, and the telescopic knob is released to fix the relative positions of the two.
  • the device thus forms a standard ureteral rigidoscope that is inserted into the urethra into the bladder and extends the ureter upward.
  • press the telescopic button and keep the telescopic sheath and the body position unchanged. Push the mirror body up slowly, and control the length of the bending portion to extend the sheath tube as needed. Operate the curved handle to adjust the bending angle of the tip end. In order to find stones in various parts.
  • the telescopic knob reaches the lower stop position, the curved portion completely extends out of the sheath tube, and the device forms a rigid ureteral nephroscope with a curved end.
  • the curved part is completely designed according to the ureteroscope. Because the length of the bendable part can be adjusted, the ability of the lens to protrude into the kidney and the lower jaw is stronger than that of the soft mirror.
  • the front end of the image is connected to the objective lens on the front end, and the rear end is connected to the focusing eyepiece on the operation part.
  • the naked eye can observe the image at the eyepiece of the eyepiece, or it can be connected to the CCD interface and viewed from the monitor.
  • the illumination light enters from the optical jack on the operating portion and is sent to the apex by the light guiding fiber to illuminate the field of view.
  • Helium laser guide for gravel Wire inserted from the guide wire, along the instrument channel until the tip is extended, and the stone is aligned with the stone. Circulating water enters from the fill port and flows out of the tip along the instrument channel to flush the lens and the broken stone powder. The return water flows out from the gap between the mirror rod and the telescopic sheath until the suction port is sucked out.
  • the equipment shall be tested for leaks before and after each use, and the leak detector (affiliated equipment) shall be inspected at the leak detector.
  • the tip When the ureteroscope is working in the renal pelvis, in order to enter each renal pelvis (upper, middle, and lower jaw), the tip is required to be bent.
  • the bending angle can be controlled by the curved handle, but the bending length is fixed.
  • Some specific parts of the stone as follows, because it is close to the ureteral orifice, it is difficult to enter.
  • the positioning of the stones in these specific parts even the experienced doctors with soft-lens operation, takes a long time to complete with advanced imported equipment.
  • the present invention is achieved by a method of expanding a sheath.
  • the current soft lens shown in Fig. 11 is difficult to enter the chin, and the mirror of the present invention shown in Fig. 12 is easy to enter.

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Abstract

一种头端可弯曲的输尿管肾镜，包括操作主体（4），操作主体（4）连接有镜管（17），操作主体（4）包括依次连接的镜体（27）、装拆机构和伸缩机构；镜管（17）包括依次连接的插入部（9）、弯曲部（7）和先端部（8）；其中插入部（9）与镜体（27）相连，在镜管（17）外套接有鞘管（6），鞘管（6）的长度小于镜管（17）的长度，伸缩机构位于鞘管（6）的一端，伸缩机构通过装拆机构与镜体（27）相连。该输尿管肾镜能软硬兼顾，快速装拆，从而方便各部件消毒，插入输尿管容易，能够顺利的进入各个肾盏，尤其是下盏，能很好的观察下盏内的情况；解决了现有技术中存在的输尿管镜很难插入输尿管，不能很好的观察下盏内的情况，不能有效进行诊疗，同时各部件不能快速装拆消毒的技术问题。

Description

一种头端可弯曲的输尿管肾镜
技术领域
本发明涉及一种手术器械， 尤其涉及一种临床对尿道及肾结石疾病进行检 査、 诊疗和治疗的输尿管肾镜。 背景技术
人体泌尿系统结石是一种常见病、多发病。按 结石部位不同， 可分为膀胱结石、 输尿管结石和肾结石等。 从发生概率上讲， 肾结石占 70%以上。 清除结石手术可分为： 体外超声波碎石、 腔内弹道碎石、 经皮穿剌肾镜术、 经尿道输尿管肾镜术等。从碎石效果、 医生及病人的认可度、 手术风险和并发症发生率、 创伤和恢复时间等方面来分析， 经尿道输尿管肾镜 术具有一定的优势， 输尿管肾镜碎石手术正在普及推广， 已成为医院上尿路结 石的主要治疗手段。 通常的手术方法是， 先用输尿管硬镜镜体扩张后留置输尿 管扩张鞘， 再置入输尿管软镜， 寻及结石以钬激光击碎结石。 现有的产品为硬 性输尿管肾镜和软性输尿管肾镜， 其中硬性输尿管肾镜的应用已有将近二十年 的历史， 能对输尿管以下部位的结石进行有效治疗， 因头端不能弯曲， 它对肾 结石束手无策。 而近几年兴起的软性输尿管肾镜几乎全都进口， 如日本 OLYMPUS URF-P5型纤维输尿管肾镜、 OLYMPUS URF-V型电子输尿管肾镜、 STORZ 11278A型纤维输尿管肾镜。 软镜在输尿管内的插入性能不如硬镜， 现 行软镜术中， 需要事先对输尿管进行扩张， 这将对输尿管造成创伤， 损伤输尿 管粘膜甚至穿孔。 另外， 软镜无法快速推广另一个原因是， 设备昂贵且使用寿 命短， 治疗成本高。 在现有的专利文件中， 如中国专利： "一种带硬鞘的软性 输尿管肾镜 （CN101019756A ) " ， 由硬管部分和可拆装软镜部分组成， 软镜置 于硬鞘内， 并可伸出硬管。 这种硬鞘与软镜的结合， 安装时会发生插入困难， 必须留有足够大的空间才行，插入刚性不好， 同时无法实现出水的收集和吸引。 "一种医用可伸缩式输尿管肾镜 （CN202313262U ) " ， 包括三远阀、 锁帽、 镜 体、 镜插、 第一外镜管、 第二外镜管、 第三外镜管由下至上依次连接， 所述第 一外镜管、 第二外镜管、 第三外镜管的直径尺寸依次递减， 且第二外镜管可缩 入第一外镜管内， 第三外镜管可缩入第二外镜管内， 所述光插安装在镜插的外 侧壁上， 所述镜筒安装在镜体的外侧壁上， 所述内镜管插装在外镜管组件内， 所述外镜管组件内设有手术器械通道， 所述纤维导光系统填充在手术器械通道 与内镜管之间。 上述结构复杂， 且插入人体部分的滑动间隙内的微生物， 无法 彻底消毒。
发明的公开
本发明提供了一种能软硬兼顾， 快速装拆， 从而方便各部件消毒， 插入输尿 管容易， 能够顺利的进入各个肾盏， 尤其是下盏， 能很好的观察下盏内的情况 的一种头端可弯曲的输尿管肾镜； 解决了现有技术中存在的输尿管镜很难插入 输尿管， 不能很好的观察下盏内的情况， 有效进行诊疗， 同时各部件不能快速 装拆消毒的技术问题。
本发明同时还提供了一种能进行循环水工作，减小肾内灌注压力，方便观察， 碎石效果好， 碎石效率高的头端可弯曲的输尿管肾镜； 解决了现有技术中存在 的不能进行循环进水出水， 容易损伤肾小球， 碎石效率不高的技术问题。
本发明的上述技术问题是通过下述技术方案解决的：一种头端可弯曲的输尿 管肾镜， 包括操作主体， 操作主体连接有镜管， 操作主体包括依次连接的镜体、 装拆机构和伸缩机构； 所述的镜管包括依次连接的插入部、 弯曲部和先端部； 其中插入部与镜体相连， 在镜管外套接有鞘管， 鞘管的长度小于镜管的长度， 伸缩机构位于鞘管的一端，伸缩机构通过装拆机构与镜体相连。鞘管是硬性镜， 镜管是由插入部的硬性镜和可以弯曲的弯曲部， 以及位于弯曲部前端的先端部 构成。
由于鞘管的长度小于镜管，通过伸缩机构控制鞘管与镜管的重合度，伸缩机 构能让鞘管的端部与镜管的先端部完全平齐， 从而使得镜管成为刚性很好的硬 性镜， 方便插入输尿管内， 不需要对输尿管进行扩张。 当调整伸缩机构时， 又 可以使镜体具有软镜的特性， 同时通过调整伸缩机构控制弯曲部的伸缩量的不 同， 使得镜体具有比软镜更好的寻找能力。 输尿管软镜在肾盂内工作时， 为了 进入各个肾盏（上盏、 中盏、 下盏）， 需要对先端头进行弯曲， 弯曲角度可以通 过弯曲手柄控制， 但弯曲长度是固定不变的， 对一些特定部位的结石， 如下盏， 因靠近输尿管口， 反而很难进入。 对这些特定部位的结石的定位， 即使是软镜 操作经验丰富的医生， 用先进的进口设备， 也要费很长时间才能完成。 而本发 明的输尿管镜， 通过调整伸缩机构使得弯曲部伸出鞘管的长度不同， 分为头端 微量可弯的寻找输尿管口状态， 弯曲部仅伸出鞘管 10-15mm， 可让镜头小范围 精确搜寻， 方便找到输尿管入口。 然后是头端一半可弯的寻找下盏状态， 在下 盏内进行观察和碎石， 最后可以成为全弯曲状态。
装拆机构可以让镜体与鞘管和伸缩机构快速分离，从而方便清洗和消毒， 防 止术后感染。 镜体与镜管一起消毒， 而伸缩机构和鞘管为金属零件， 可以执行 更严格的消毒程序。 根据不同的需要对两部分分别进行消毒， 消毒效果好， 提 高了设备的使用安全性。
作为优选， 所述的伸缩机构通过连接桥与装拆机构相连， 所述的伸缩机构 包括伸缩主体， 鞘管和连接桥通过伸缩主体相接， 鞘管与伸缩主体固定， 伸缩 主体与连接桥滑动连接， 连接桥与装拆机构固定连接， 镜管位于鞘管和连接桥 连成的通道内， 镜管与镜体相连。 连接桥的一端固定在装拆机构上， 另一端穿 过伸缩机构， 连接桥作为一个导轨， 伸缩机构在连接桥上运动。 伸缩机构和鞘 管是固定连接的， 两者同歩运动， 通过伸缩机构在连接桥上的移动， 来确定鞘 管的移动距离， 从而来控制镜管伸出鞘管的长度， 来满足镜管在使用时的不同 需要。
作为优选， 所述的伸缩主体的一端连接有固定帽， 鞘管与固定帽固定连接， 在伸缩主体与连接桥之间设有滑动衬套， 滑动衬套套接在连接桥上， 在所述的 伸缩主体上安装有控制件， 所述的控制件中心设有通孔， 控制件的上方设有伸 缩钮， 伸缩钮位于伸缩主体外， 控制件的下方设有弹性体； 在连接桥上设有定 位凹槽， 连接桥穿过控制件中心的通孔， 控制件的下方通过弹性体的压力卡接 在定位凹槽内。 滑动衬套为两个， 一个位于伸缩主体与连接桥之间， 另外一个 位于鞘管与连接桥之间， 滑动衬套采用弹性好， 摩擦系数低的 PTFE材料制成， 可以有效降低滑动阻力。 输尿管肾镜在使用时， 利用镜管器械通道作为进水通 道， 镜管和鞘管之间的空隙作为出水通道， 位于鞘管与连接桥之间的滑动衬套 能实现密封循环水的功能， 防止水由伸缩机构处漏出。 鞘管胶合在固定帽的内 壁， 固定帽用于固定鞘管， 伸缩主体与固定帽可拆卸的螺纹连接， 方便鞘管、 连接桥和镜管的组装。 连接桥穿过控制件的中心的通孔， 控制件下方的弹性体 为片簧， 压下控制件， 片簧压缩， 伸缩主体在连接桥上滑动， 到连接桥上的定 位凹槽上时， 松开控制件， 片簧的弹力将控制件卡入定位凹槽内， 将伸缩主体 与连接桥固定。
作为更优选，所述的伸缩主体外套接有主体盖，所述的固定帽与伸缩主体通 过螺纹连接。 通过主体盖将主体和控制件遮挡， 主体盖和主体胶合固定。
作为优选，所述的连接桥为圆柱体， 连接桥的直径的大小位于镜管直径和鞘 管直径之间， 在连接桥的上方为平面， 在平面上设有刻度， 在连接桥的下方设 有三个定位凹槽， 定位凹槽与刻度对应， 在连接桥与伸缩主体相接的一端设有 凸起， 凸起抵接在伸缩主体的端面上。 连接桥的直径不能太大， 因外侧有鞘管 滑动， 而鞘管在手术中要插入人体尿道， 因此鞘管一般限制在 Fr20以下。 连接 桥的上方削扁， 防止伸缩机构在连接桥上运动时发生旋转。 伸缩主体在连接桥 上滑动， 连接桥上的刻度可以提示操作人员到达什么位置， 从而松开控制件， 让伸缩主体与连接桥固定。 三个定位凹槽由左至右分别代表完全硬镜状态， 头 端微量可弯的寻找输尿管口状态， 头端一半可弯的寻找下盏状态。 连接桥的左 边是有凸起的， 因此运动到最左端时， 是通过凸起来限制左端的位移， 由于连 接桥是固定在装拆机构上的， 伸缩主体向右运动抵接在装拆机构上， 从而实现 右边的定位。 伸缩主体向右运动到底， 弯曲部完全露出鞘管外， 实现完全弯曲 状态。
作为优选， 所述的装拆机构包括连接头， 连接头的一端固定连接有连接桥， 连接头的另一端通过锁帽与镜体可拆卸的连接， 在连接头与镜体相接端面上设 有定位销和密封圈。 锁帽通过螺帽固定在镜体上。 安装时， 调节螺母使锁帽在 镜体上的间隙合适（锁帽可自由转动， 但无轴向窜动）， 并使螺母固定。 然后包 括整个伸缩鞘在内的连接头与锁帽对接。 对接时用定位销定位， 确定连接头方 向， 防止转动。 连接头与锁帽的连接可用螺纹或斜槽等机械结构， 实现快速连 接。 分离时， 只要转动锁帽， 连接头便可退出。 分离后， 锁帽、 螺母、 定位销、 密封圈等属于镜体方， 参与镜子消毒， 而伸缩鞘总成， 因纯粹金属零件构成， 可执行更严格的消毒程序。 密封圈用于防止出水回路泄漏。
作为优选，所述的镜体的尾端设有注液口和导丝口， 导丝插入口与镜管保持 同轴， 在镜体的中部设有控制弯曲部的弯曲手柄和光插口， 在连接头上设有吸 引口； 在镜管内设有成像通道和器械通道， 在镜管和鞘管之间形成出液通道； 注液口和导丝口与器械通道相连， 吸引口与出液通道相连。镜管作为进水通道， 鞘管和镜管之间为出水通道， 吸引口位于连接头上， 方便装拆。 鞘管与镜体接 合整体并密封， 这样对收集出水和结石样品十分有利， 同时， 还可以对出水口 进行吸引， 减小肾内灌注压力， 据权威研究报告， 输尿管软镜碎石术对肾小球 的损伤， 很大程度上是由于灌注压过高引起的。 本发明能通过循环水的方式进 行冲洗视场和结石碎末， 而且能实现吸引， 降低灌注水压。
作为优选，所述的弯曲部是有蛇骨连接构成，靠近先端部的各节蛇骨的节距 小于靠近插入部的各节蛇骨的节距。 传统输尿管软镜在肾盂内工作时， 为了进 入各个肾盏（上盏、 中盏、 下盏）， 需要对先端头进行弯曲， 弯曲角度可以通过 弯曲手柄控制， 但弯曲长度是固定不变的， 对一些特定部位的结石， 如下盏， 因靠近输尿管口， 反而很难进入。 对这些特定部位的结石的定位， 即使是软镜 操作经验丰富的医生， 用先进的进口设备， 也要费很长时间才能完成。 本发明 采用的蛇骨结构， 当前端的蛇骨节距小于后端的蛇骨节距时， 使得前端的切角 大于后端的切角， 蛇骨工作弯曲时， 就能达到前端弯曲半径小， 后端弯曲半径 大的效果， 使得先端部可以顺利的到达肾盂内的上盏和下盏， 同时也方便寻找 结石。
作为优选， 所述的操作主体上连接有眼罩， 眼罩与操作主体形成一个 "Y" 字形， 在操作主体的侧面设有侧漏口。 Y形结构， 让器械通道更为通畅， 导丝 插入口与镜管就实现了同轴， 这种导丝直插式结构， 深受医生欢迎， 不但插入 顺畅， 而且导丝也不容易损坏了， 还可加大导丝直径， 提高钬激光功率， 对提 高碎石效率十分有利。 设备在每次使用前后都要进行测漏实验， 由测漏器在侧 漏口上检査。
因此， 本发明的一种头端可弯曲的输尿管肾镜具备下述优点：
( 1 )、 软硬可变。
当弯曲部缩回鞘管内时，就成为硬性镜，与现时的输尿管硬镜没有实质区别， 保留了硬性镜的优点， 即插入时有刚性， 插入输尿管容易， 不需要对输尿管扩 张。 当弯曲部伸出鞘管时， 本发明产品又变成具有软镜特性， 实现了头端可弯 曲功能， 使镜头进入各个肾盏成为可能， 带来了软镜的最大优势特征。
(2)、 弯曲程度可调， "寻找" 能力比软镜更强大。
具有合适的弯曲角度和弯曲半径， 内窥镜先端能方便到达肾盂、 肾上盏、 肾下盏， 碎石取石不留死角。 同时可实现弯曲部仅伸出鞘管 10-15mm， 可让镜 头小范围精确搜寻， 方便找到输尿管入口。
(3 )、 刚性好， 易插入。
一般的硬性输尿管肾镜， 为了提高镜杆刚性， 多制成前细后粗状， 并在后 面部分设计成多层管进一歩提高刚性。 本发明的镜体部分与普通硬性镜基本类 同， 不同的是， 又在镜管外多加一层伸缩鞘管， 进一歩提高了刚性。
(4)、 循环水工作 手术中为了冲洗视场和结石碎末，连续的循环水是必须的。传统的硬镜和 软镜， 由于结构原因， 无法实现循环水。 实际手术中， 镜体承担进水功能， 而 出水只能依靠外加的鞘体， 由于鞘体与镜体的不密封会造成出水到处流泻。 本 发明产品中， 伸缩鞘与镜体操作部接合成整体并密封， 这样对收集出水和结石 样品十分有利， 同时， 还可对出水口进行吸引， 减小肾内灌注压力。 据权威研 究报告， 输尿管软镜碎石术对肾小球的损伤， 很大程度上是由于灌注压过高引 起。
(5 )、 快速装卸的伸缩鞘机构
本发明的伸缩机构具有安装简单快捷、伸缩机构可单独消毒、密封性好、伸 缩位置定位精确等特点。 伸缩机构中的鞘管可单独消毒有重要意义， 因为插入 人体部分往往要求执行更严格的程序， 以消除感染的危险。本发明的伸缩机构， 所有零件都能满足高温高压的消毒要求， 高温高压消毒是世界公认的消毒最彻 底的快速消毒方法 （但对仪器损伤很大， 多数仪器不能适应）。
(6)、 Y形镜体结构
本发明中的目镜部分， 设计成 Y形结构， 导丝插入口与镜管就实现了 "同 轴"， 这种导丝直插式结构， 不但插入顺畅， 保护导丝不易损坏， 还可加大导丝 直径， 提高钬激光功率， 对提高碎石效率十分有利。
附图说明
图 1是本发明的一种头端可弯曲的输尿管肾镜的示意图。
图 2是图 1内的 D-D的剖视图。
图 3是图 1内的弯曲部舒展开的放大示意图。
图 4是图 1内的弯曲部的弯曲的放大示意图。 图 5是图 1内的鞘管与镜体连接部分的剖视示意图。
图 6是图 5内的伸缩机构的剖视示意图。
图 7是图 5内的装拆机构的剖视示意图。
图 8是图 5内的连接桥的主视图。
图 9是图 8的俯视图。
图 10是图 8内 E-E的放大剖视图。
图 11是传统镜体进入下盏的示意图。
图 12是本发明的镜体进入下盏的示意图。 实现本发明的最佳方法
下面通过实施例，并结合附图，对本发明的技术方案作进一歩具体的说明。 实施例：
如图 1所示， 一种头端可弯曲的输尿管肾镜， 包括操作主体 4， 操作主体 4 连接有镜管 17， 镜管 17外套接有鞘管 6， 鞘管 6的长度小于镜管 17的长度。 其中操作主体 4包括依次连接的镜体 27、 装拆机构和伸缩机构； 镜管 17包括 依次连接的插入部 9、 弯曲部 7和先端部 8， 插入部 9与镜体 27相连， 先端部 8安装有物镜镜头。 伸缩机构位于鞘管 6的一端， 伸缩机构通过装拆机构与镜 体 27相连。 在操作主体 4的后端开设有导丝口 1和注液口 2， 在操作主体 4的 中部设有控制弯曲部 7弯曲的弯曲手柄 3， 在操作主体 4的侧面设有光插口 11 和测漏口 12， 在操作主体 4上连接有一个眼罩 14， 在眼罩 14上安装有调焦钮 13。 导丝口 1和注液口 2与操作主体 4位于同一轴线上， 眼罩 14与操作主体 4 呈 "Y"字形排布。 在操作主体 4的前端设有吸引口 10和伸缩钮 5。 如图 2所示， 在镜管 17内设有器械通道 15和成像通道 16， 镜管其余空间 填充有导光束 38， 导光束 38由光插口 11插入到镜管 17内。 在镜管 17和鞘管 6外形成出水通道 19，器械通道 15内可以进水和狄激光导丝。导丝口 1和注液 口 2与镜管内的器械通道 15相连，吸引口 10与鞘管 6和镜管 17之间形成的出 水通道 19相连。 在手术中为了冲洗视场和结石碎末， 器械通道 15内进水， 镜 体与鞘管之间形成的出水通道 19出水，形成一个完整的循环水通道， 同时在出 水时， 还可以在吸引口 10进行吸引， 减小肾内灌注压力。
如图 3和 4所示， 弯曲部 7是由蛇骨 18—节一节连接构成。 蛇骨 18靠近 先端部 8的一端的蛇骨之间的节距 T1小于靠近插入部一端的蛇骨 18之间的节 距 T2, 而蛇骨切角 β ΐ 大于 β 2。 这样蛇骨工作弯曲时， 就能达到前端弯曲半 径 R1小， 后端弯曲半径 R2大的效果。
如图 5和 6和 7所示，伸缩机构通过连接桥 25与装拆机构相连。伸缩机构 包括伸缩主体 23、 主体盖 30、 伸缩钮 22， 固定帽 20和滑动衬套 24。 伸缩主体 23为圆柱体， 在伸缩主体 23的中心设有通孔， 连接桥 25穿过通孔， 在连接桥 25外套接有滑动衬套 24， 滑动衬套 24采用 PTFE材料制造。在伸缩主体 23上 开设有一个容纳槽， 在容纳槽内装有伸缩钮 22， 伸缩钮 22的下端安装有片簧 31。 伸缩主体 23外套接有主体盖 30， 片簧 31的一端抵接在伸缩钮 22的下方， 另外一端抵接在主体盖 31上， 按压伸缩钮 22， 伸缩主体 23可以在连接桥 25 上运动， 松开伸缩钮 23， 由于片簧 31的弹性作用， 将伸缩钮 22顶起， 伸缩钮 22直接卡接到连接桥 25上的定位凹槽 29内， 从而将伸缩主体 23与连接桥 25 的相对位置固定。 伸缩主体 23通过螺纹连接有固定帽 20， 固定帽 20包括外层 保护体和内层连接体 21， 内层连接体 21上设有外螺纹， 伸缩主体 23内壁设有 内螺纹， 固定帽通过内层连接体 21与伸缩主体 23相连。 在固定帽的中心同样 设有通孔， 在通孔内插接有鞘管 6， 鞘管 6的外壁与固定帽的内壁胶合， 而固 定帽 20又与伸缩主体 23相连， 伸缩主体 23可以在连接桥 25上运动， 从而带 动鞘管 6左右运动，控制了鞘管 6与镜管 17的重合长度，从而可以控制弯曲部 7伸出鞘管 6的长度， 实现软镜和硬镜的互换。 在鞘管 6和连接桥 25之间重合 处安装有滑动衬套 24， 滑动衬套 24不仅可以起到有效降低滑动阻力的作用， 同时可以实现密封循环水。 镜管 17穿过连接桥 25和鞘管 6伸出鞘管 6外。 连 接桥 25的左端设有凸起 36， 凸起 36抵接在滑动衬套 24上， 在伸缩主体运动 到最左端的时候， 进行止位。
连接桥 25的一端与伸缩主体 23活动连接，连接桥 25的另一端固定在装拆 机构上。 装拆机构包括连接头 26， 连接桥 25的端部插接在连接头 26内并与连 接头胶合。 连接头 26的一端固定连接有连接桥 25， 连接头 26的另一端通过锁 帽 35与镜体 27可拆卸的连接， 在连接头 26与镜体 27相接端面上设有定位销 32和密封圈 34。 先将连接头的端面安装密封圈 34， 然后通过定位销 32定位， 将连接头 26和镜体 27对齐， 在镜体 27内预装有锁帽 35， 锁帽 35呈阶梯状， 在镜体 27上套接螺母 33， 通过螺母 33将锁帽 35固定锁紧在镜体 27上， 同时 可以使锁帽 35在镜体 27上的间隙合适，使得锁帽 35可以自由转动，但是无轴 向窜动。 然后再旋转锁帽 35， 将连接头 26与镜体 27固定。 在连接头 26上开 设有吸引口 10，吸引口 10与镜管和鞘管之间形成的出水通道 19连通。分离时， 只要转动锁帽 35， 连接头 26便可退出。分离后， 锁帽 35、螺母 33、定位销 32、 密封圈 34等属于镜体的， 参与镜子消毒， 而伸缩机构， 因纯粹金属零件构成， 可执行更严格的消毒程序。 密封圈用于防止出水回路泄漏。 如图 8和 9 和 10所示， 连接桥 25为圆柱体， 连接桥 25的直径的大于镜 管 17直径而小于鞘管 6直径。 在连接桥 25的上方为平面 37， 在平面 37上设 有刻度： A、 B、 C， 在连接桥的下方设有三个定位凹槽 29， 定位凹槽 29与刻 度对应， 当滑动到 "A"位时， 表示完全硬镜状态， "B "表示头端微量可弯的 寻找输尿管口状态， "C"表示头端一半可弯的寻找下盏状态， 完全退到底表示 全弯曲状态。 连接桥的长度和各卡槽位置是根据镜子的工作状态精心设计的。 连接桥的直径不能太大， 因外侧有鞘管滑动， 而鞘管手术中要插入人体尿道。 伸缩鞘管一般限制在 Fr20以下。
使用时， 先端部、 弯曲部、 插入部共同组成一根细长而刚性的插入管。 手 术前， 操作弯曲手柄使弯曲部伸直， 将输尿管肾镜插入鞘管并快速与操作主体 (镜体） 连接成一体， 控制伸缩钮在镜体上的位置， 可以改变镜子前端的软硬 状态。 当伸缩钮位于上止位， 这时弯曲部全部缩进鞘管内， 而先端头恰好露出 鞘管， 放开伸缩钮， 固定二者相对位置。 这样设备就形成了一支标准的输尿管 硬镜， 在可视下插入尿道进膀胱， 延输尿管向上推进。 当先端头进入肾盂后， 按下伸缩钮并保持伸缩鞘与人体位置不变， 将镜体慢慢往上推， 根据需要控制 弯曲部伸出鞘管的长度， 操作弯曲手柄调节先端部弯曲角度， 以便寻找各部位 的结石。 当伸缩钮达到下止位时， 弯曲部完全伸出鞘管， 这时设备就形成了一 支头端可弯曲的硬性输尿管肾镜。 弯曲部位完全按输尿管软镜设计， 由于伸出 的可弯曲部分长度可以调节，使镜头伸入肾上盏、肾下盏的能力比软镜更强大。 传像像纤前端接先端头上的物镜镜头， 后端接位于操作部上的调焦目镜。 肉眼 可在目镜眼罩处观察图像， 也可以接上 CCD接口， 从监视器上观察。照明光从 操作部上的光插口进入， 由导光光纤送至先端， 照明视场。 碎石用的钬激光导 丝， 从导丝口插入， 沿器械通道直至伸出先端头， 对准结石进行碎石。 循环水 从注液口进入，沿器械通道从先端头流出，用来冲洗镜头和被打碎的结石粉末。 回流水从镜杆与伸缩鞘的间隙中流出， 直至吸引口被吸出。 设备在每次使用前 后都要进行测漏试验， 由测漏器 （附属设备） 在测漏口上检査。
输尿管软镜在肾盂内工作时， 为了进入各个肾盏（上盏、 中盏、 下盏）， 需 要对先端头进行弯曲， 弯曲角度可以通过弯曲手柄控制， 但弯曲长度是固定不 变的， 对一些特定部位的结石， 如下盏， 因靠近输尿管口， 反而很难进入。 对 这些特定部位的结石的定位， 即使是软镜操作经验丰富的医生， 用先进的进口 设备， 也要费很长时间才能完成。 为了克服现行软镜上的不足， 本发明通过伸 缩鞘管的方法得以实现。 图 11所示现行软镜进入下盏困难， 图 12所示本发明 镜进入下盏容易。

Claims

权 利 要 求
1. 一种头端可弯曲的输尿管肾镜， 包括操作主体， 操作主体连接有镜管， 其特 征在于： 操作主体包括依次连接的镜体、 装拆机构和伸缩机构； 所述的镜管包 括依次连接的插入部、 弯曲部和先端部； 其中插入部与镜体相连， 在镜管外套 接有鞘管， 鞘管的长度小于镜管的长度， 伸缩机构位于鞘管的一端， 伸缩机构 通过装拆机构与镜体相连。
2. 根据权利要求 1所述的一种头端可弯曲的输尿管肾镜， 其特征在于： 所述的 伸缩机构通过连接桥与装拆机构相连， 所述的伸缩机构包括伸缩主体， 鞘管和 连接桥通过伸缩主体相接，鞘管与伸缩主体固定，伸缩主体与连接桥滑动连接， 连接桥与装拆机构固定连接， 镜管位于鞘管和连接桥连成的通道内， 镜管与镜 体相连。
3. 根据权利要求 2所述的一种头端可弯曲的输尿管肾镜， 其特征在于： 所述的 伸缩主体的一端连接有固定帽， 鞘管与固定帽固定连接， 在伸缩主体与连接桥 之间设有滑动衬套， 滑动衬套套接在连接桥上， 在所述的伸缩主体上安装有控 制件， 所述的控制件中心设有通孔， 控制件的上方设有伸缩钮， 伸缩钮位于伸 缩主体外， 控制件的下方设有弹性体； 在连接桥上设有定位凹槽， 连接桥穿过 控制件中心的通孔， 控制件的下方通过弹性体的压力卡接在定位凹槽内。
4. 根据权利要求 3所述的一种头端可弯曲的输尿管肾镜， 其特征在于： 所述的 伸缩主体外套接有主体盖， 所述的固定帽与伸缩主体通过螺纹连接。
5. 根据权利要求 2所述的一种头端可弯曲的输尿管肾镜， 其特征在于： 所述的 连接桥为圆柱体， 连接桥的直径的大小位于镜管直径和鞘管直径之间， 在连接 桥的上方为平面， 在平面上设有刻度， 在连接桥的下方设有三个定位凹槽， 定 位凹槽与刻度对应， 在连接桥与伸缩主体相接的一端设有凸起， 凸起抵接在伸 缩主体的端面上。
6. 根据权利要求 1至 5任意一项所述的一种头端可弯曲的输尿管肾镜， 其特征 在于： 所述的装拆机构包括连接头， 连接头的一端固定连接有连接桥， 连接头 的另一端通过锁帽与镜体可拆卸的连接， 在连接头与镜体相接端面上设有定位 销和密封圈。
7. 根据权利要求 1至 5任意一项所述的一种头端可弯曲的输尿管肾镜， 其特征 在于： 所述的操作主体的尾端设有注液口和导丝口， 导丝插入口与镜管保持同 轴， 在操作主体的中部设有控制弯曲部的弯曲手柄和光插口， 在操作主体的前 端设有吸引口； 在镜管内设有成像通道和器械通道， 在镜管和鞘管之间形成出 液通道； 注液口和导丝口与器械通道相连， 吸引口与出液通道相连。
8. 根据权利要求 6所述的一种头端可弯曲的输尿管肾镜， 其特征在于： 所述的 镜体的尾端设有注液口和导丝口， 导丝插入口与镜管保持同轴， 在镜体的中部 设有控制弯曲部的弯曲手柄和光插口， 在连接头上设有吸引口； 在镜管内设有 成像通道和器械通道， 在镜管和鞘管之间形成出液通道； 注液口和导丝口与器 械通道相连， 吸引口与出液通道相连， 光插口与成像通道相连。
9. 根据权利要求 1至 5任意一项所述的一种头端可弯曲的输尿管肾镜， 其特征 在于： 所述的弯曲部是有蛇骨连接构成， 靠近先端部的各节蛇骨的节距小于靠 近插入部的各节蛇骨的节距。
10. 根据权利要求 1至 5任意一项所述的一种头端可弯曲的输尿管肾镜， 其特 征在于： 所述的操作主体上连接有眼罩， 眼罩与操作主体形成一个 "Y"字形， 在操作主体的侧面设有侧漏口。
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