WO2018227646A1 - 一种经皮肾镜清除结石系统及方法 - Google Patents

一种经皮肾镜清除结石系统及方法 Download PDF

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WO2018227646A1
WO2018227646A1 PCT/CN2017/089270 CN2017089270W WO2018227646A1 WO 2018227646 A1 WO2018227646 A1 WO 2018227646A1 CN 2017089270 W CN2017089270 W CN 2017089270W WO 2018227646 A1 WO2018227646 A1 WO 2018227646A1
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passage
suction
valve body
channel
perfusion
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PCT/CN2017/089270
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English (en)
French (fr)
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周振宇
曾宪久
姜守望
陈冲
张雷
夏冬
于波
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沈阳沈大内窥镜有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22079—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with suction of debris

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  • the present invention relates to a percutaneous nephrolithotomy stone removal system and method.
  • the urology treatment of kidney stones is mostly applied to percutaneous nephrolithotomy and calculus.
  • the existing method for percutaneous nephrolithotomy and gravel stone removal uses a single sheath, and the perfusion and attraction are intermittent and alternately performed. It is difficult to ensure that the visual field is continuously clear, and it takes time to wait, which has a certain influence on the efficiency of the crushed stone. And the pressure in the renal pelvis during the lithotripsy is too high, and it is easy to retrograde infection, leading to complications such as sepsis and sepsis.
  • the invention includes an outer sheath, an inner sheath, an attracting valve body, a perfusion attracting source, a perfusion channel, a suction channel and an endoscope, wherein the outer sheath is tubular and the distal end is provided with a water outlet hole, and the outer sheath side surface is provided There is an inlet valve, and the inlet valve is connected to the perfusion source through a perfusion channel, the inner sheath is placed in the outer sheath, and a sandwich channel is formed between the outer sheath and the inner sheath, and the mezzanine channel passes through
  • the inlet valve is provided with a liquid
  • the inner sheath is tubular and the distal end is provided with a pressure relief hole
  • the inner sheath forms an internal passage and communicates with the valve body passage in the suction valve body under the suction valve body
  • the side is provided with a stone channel communicating with the valve body passage, and the stone channel is connected to the perfusion source through the suction channel.
  • the endoscope When the stone is crushed, the endoscope is inserted from the proximal end of the valve body passage, the attraction
  • the upper side of the valve body is provided with a pressure relief passage communicating with the passage in the valve body, and the free end of the pressure relief passage is provided with an overpressure protection valve.
  • a method for removing stones by using the system of the present invention comprising the steps of:
  • the endoscope is inserted into the valve body passage in the body of the suction valve, and enters the kidney through the internal passage in the inner sheath to perform the crushing operation, and the stone passes through the internal passage in the inner sheath and the stone passage channel attracting the valve body in sequence with the perfusate.
  • the suction channel is discharged from the body.
  • a stone collecting container is arranged on the suction channel, and the stone is discharged into the stone collecting container;
  • step S3 or S4 when the distal end of the inner sheath is blocked, or the outlet hole at the distal end of the outer sheath is blocked, the perfusate flows from the pressure relief hole at the distal end of the inner sheath to the internal passage in the inner sheath, and is sucked through the suction valve.
  • the stone channel and the suction channel of the body are discharged from the body;
  • the upper side of the suction valve body is provided with a pressure relief passage communicating with the passage in the valve body, and the free end of the pressure relief passage is provided with an overpressure protection valve.
  • the application of the invention can maintain the clear vision of the visual field, improve the operation efficiency, and ensure the pressure in the kidney in the safe pressure range during the percutaneous nephrolithotomy and stone clearing operation, which facilitates the operation of the doctor during the operation and reduces the operation. Difficulty in surgery.
  • Figure 2 is a schematic view of the outer sheath of the present invention.
  • Figure 3 is a schematic view of the inner sheath of the present invention.
  • Figure 4 is a schematic view of the suction valve body in the present invention.
  • Figure 5 is a schematic view showing the circulation of the perfusate in the normal operation of the present invention.
  • Figure 6 is a schematic view showing the circulation of the perfusate when the distal end of the sheath is blocked or the outlet of the distal end of the sheath is blocked.
  • 1 outer sheath
  • 2 inner sheath
  • 3 suction valve body
  • 4 perfusion suction source
  • 5 perfusion channel
  • 6 suction channel
  • 7 endoscope
  • 8 water outlet
  • 9 inlet valve 10 is a pressure relief hole
  • 11 is a stone channel
  • 12 is a pressure relief channel
  • 13 is an overpressure protection valve
  • 14 is a valve body passage
  • 15 is a stone collection container
  • 16 is a perfusate
  • 17 is a mezzanine channel
  • 18 Internal passage.
  • the present invention includes an outer sheath 1, an inner sheath 2, a suction valve body 3, a perfusion suction source 4, a perfusion channel 5, a suction channel 6, and an endoscope 7 (the perfusion suction source 4 is present
  • the proximal end is an end near the operator, and the “distal end” is an end away from the operator)
  • the outer sheath 1 is tubular and far as shown in FIGS. 1 and 2.
  • the water outlet hole 8 is provided at the end, the water inlet valve 9 is arranged on the proximal side of the outer sheath 1, and the water inlet valve 9 is connected to the perfusion suction source 4 through the perfusion channel 5.
  • the inner sheath 2 is placed in the outer sheath 1, and a sandwich channel 17 is formed between the outer sheath 1 and the inner sheath 2, through which the interlayer channel 17 passes.
  • the water valve 9 is supplied with a liquid
  • the inner sheath 2 is tubular and the distal end is provided with a pressure relief hole 10
  • the inner sheath 2 internally forms an internal passage 18 and communicates with the valve body passage 14 in the suction valve body 3, such as
  • a stone passage 11 communicating with the valve body passage 14 is provided on the lower side of the suction valve body 3, and the stone passage 11 is connected to the perfusion suction source 4 through the suction passage 6.
  • the endoscope 7 When the stone is crushed, the endoscope 7 is inserted into the proximal end of the valve body passage 14 , and the upper side of the suction valve body 3 is provided with a pressure relief passage 12 communicating with the valve body passage 14 , and the pressure relief passage 12 The free end is provided with an overpressure protection valve 13.
  • a method for removing stones by using the system of the present invention comprising the steps of:
  • the inlet valve 9 on the side of the outer sheath 1 is connected to the perfusion suction source 4 by using the perfusion channel 5, and the distal end of the outer sheath 1 is placed in the kidney;
  • the perfusion suction source 4 is activated, and the perfusate 16 is sequentially passed through the perfusion channel 5, the inlet valve 9 on the side of the outer sheath 1, the mezzanine channel 17 between the inner sheath 2 and the outer sheath 1, and the outlet hole at the distal end of the outer sheath 1.
  • 8 is perfused into the kidney, and the perfusate 16 in the kidney passes through the internal passage 18 in the inner sheath 2, the drainage channel 11 of the suction valve body 3, and the suction passage 6 to be excreted, thereby establishing continuous circulation of the perfusion fluid 16 in the kidney;
  • the endoscope 7 is inserted into the valve body passage 14 in the suction valve body 3, and enters the kidney through the internal passage 18 in the inner sheath 2 to perform a crushing operation.
  • the stone is sequentially passed through the internal passage in the inner sheath 2 with the perfusate 16 18.
  • the stone passage passage 11 and the suction passage 6 of the suction valve body 3 are discharged from the outside of the body.
  • the suction channel 6 is provided with a stone collection container 15, and the stone is discharged into the stone collection container 15;
  • the perfusate 16 flows from the pressure relief hole 10 at the distal end of the inner sheath 2.
  • the inner passage 18 in the inner sheath 2 is discharged from the body through the stone passage 11 and the suction passage 6 of the suction valve body 3;
  • the upper side of the suction valve body 3 is provided with a pressure relief passage 12 communicating with the valve body passage 14 , and the pressure relief passage 12 is provided with an overpressure protection valve 13 at the free end, when the S3 or S4 step is performed, when the kidney When the internal pressure exceeds the safe pressure interval, the overpressure protection valve 13 will be opened for pressure relief.

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  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
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Abstract

一种经皮肾镜清除结石系统及方法，利用灌注通道（5）将外鞘（1）侧面的进水阀（9）与灌注吸引源（4）连接，并将外鞘（1）的远端置于肾脏中；将内鞘（2）与吸引阀体（3）连接，并利用吸引通道（6）将吸引阀体（3）与灌注吸引源（4）连接；启动灌注吸引源（4），使灌注液依次经过灌注通道（5）、外鞘（1）侧面的进水阀（9）、内鞘（2）与外鞘（1）之间的夹层通道（17）、外鞘（1）远端的出水孔（8）灌注入肾脏中，而肾脏中的灌注液依次经过内鞘（2）内的内部通道（18）、吸引阀体（3）的排石通道（11）、吸引通道（6）排出体外，建立肾脏内灌注液的持续流通；内窥镜（7）由吸引阀体（3）内的阀体内通道（14）插入，并经过内鞘（2）中的内部通道（18）进入肾脏进行碎石操作，结石随灌注液依次经由内鞘（2）中的内部通道（18）、吸引阀体（3）的排石通道（11）、吸引通道（6）排出体外。

Description

一种经皮肾镜清除结石系统及方法 技术领域
本发明涉及一种经皮肾镜清除结石系统及方法。
背景技术
目前泌尿科治疗肾结石多应用经皮肾微造瘘碎石清石术，术中操作器械的同时，需要结合灌注和吸引。然而，现有用于经皮肾微造瘘碎石清石术的方法中使用单鞘，灌注和吸引为间断、交替进行，很难保证视野持续清晰，需要时间等待，对碎石效率有一定影响；且碎石过程肾盂内压力过高，容易逆行感染，导致脓毒血症、败血症等并发症。
因此，一种在经皮肾微造瘘碎石清石术中，能够保持视野的持续清晰、提高手术效率、并保证肾脏内压力在安全压力区间的技术方案，显得十分必要。
发明内容
本发明目的在于，提供一种在经皮肾微造瘘碎石清石术中，能够保持视野的持续清晰、提高手术效率、并保证肾脏内压力在安全压力区间的技术方案。
本发明的目的是通过以下技术方案来实现的：
本发明包括外鞘、内鞘、吸引阀体、灌注吸引源、灌注通道、吸引通道和内窥镜，其中所述外鞘呈管状且远端设有出水孔，所述外鞘近端侧面设有进水阀，且所述进水阀通过灌注通道与灌注吸引源连接，所述内鞘置于外鞘内，且所述外鞘和内鞘之间形成夹层通道，所述夹层通道通过所述进水阀供液，所述内鞘呈管状且远端设有泄压孔，所述内鞘内部形成内部通道并与所述吸引阀体内的阀体内通道连通，在所述吸引阀体下侧设有与所述阀体内通道相通的排石通道，且所述排石通道通过吸引通道与灌注吸引源连接，碎石时，内窥镜由所述阀体内通道近端插入，所述吸引阀体上侧设有与所述阀体内通道相通的泄压通道，所述泄压通道自由端设有过压保护阀。
一种利用本发明所述系统实现清除结石的方法，它包括以下步骤：
S1、利用灌注通道将外鞘侧面的进水阀与灌注吸引源连接，并将外鞘的远端置于肾脏中；
S2、将内鞘与吸引阀体连接，并利用吸引通道将吸引阀体与灌注吸引源连接；
S3、启动灌注吸引源，使灌注液依次经过灌注通道、外鞘侧面的进水阀、内鞘与外鞘之间的夹层通道、外鞘远端的出水孔灌注入肾脏中，而肾脏中的灌注液依次经过内鞘内的内部通道、吸引阀体的排石通道、吸引通道排出体外，建立肾脏内灌注液的持续流通；
S4、内窥镜由吸引阀体内的阀体内通道插入，并经过内鞘中的内部通道进入肾脏进行碎石操作，结石随灌注液依次经由内鞘中的内部通道、吸引阀体的排石通道、吸引通道排出体外。
所述吸引通道上设有结石收集容器，结石排入所述结石收集容器中；
在S3或S4步骤中，内鞘远端被堵塞、或外鞘远端的出水孔被堵塞时，灌注液从内鞘远端的泄压孔流至内鞘中的内部通道，并经吸引阀体的排石通道及吸引通道排出体外；
所述吸引阀体上侧设有与所述阀体内通道相通的泄压通道，所述泄压通道自由端设有过压保护阀，在进行S3或S4步骤时，当肾内压力超过安全压力区间时，所述过压保护阀将开启进行泄压。
本发明的优点与积极效果为：
本发明的应用，经皮肾微造瘘碎石清石术中，能够保持视野的持续清晰、提高手术效率、并保证肾脏内压力在安全压力区间，方便了医生在手术中的操作，降低了手术难度。
附图说明
图1为本发明的技术方案整体示意图；
图2为本发明中的外鞘示意图；
图3为本发明中的内鞘示意图；
图4为本发明中的吸引阀体示意图；
图5为本发明正常运作时灌注液的循环示意图；
图6为本发明当内鞘远端被堵塞、或外鞘远端的出水孔被堵塞时，灌注液的循环示意图。
其中，1为外鞘，2为内鞘，3为吸引阀体，4为灌注吸引源，5为灌注通道，6为吸引通道，7为内窥镜，8为出水孔，9为进水阀，10为泄压孔，11为排石通道，12为泄压通道，13为过压保护阀，14为阀体内通道，15为结石收集容器，16为灌注液，17为夹层通道，18为内部通道。
具体实施方式
以下将以具体实施例结合附图来说明本发明的原理、结构和所欲达到的技术效果，但所选用的实施例仅用于说明解释，并非用以限制本发明的范围。
如图1～6所示，本发明包括外鞘1、内鞘2、吸引阀体3、灌注吸引源4、灌注通道5、吸引通道6和内窥镜7(所述灌注吸引源4为本领域公知技术，另外以下所述“近端”为靠近操作者的一端，“远端”为远离操作者的一端)，其中如图1和图2所示，所述外鞘1呈管状且远端设有出水孔8，所述外鞘1近端侧面设有进水阀9，且所述进水阀9通过灌注通道5与灌注吸引源4连接， 如图1、图3、图4所示，所述内鞘2置于外鞘1内，且所述外鞘1和内鞘2之间形成夹层通道17，所述夹层通道17通过所述进水阀9供液，所述内鞘2呈管状且远端设有泄压孔10，所述内鞘2内部形成内部通道18并与所述吸引阀体3内的阀体内通道14连通，如图1和图4所示，在所述吸引阀体3下侧设有与所述阀体内通道14相通的排石通道11，且所述排石通道11通过吸引通道6与灌注吸引源4连接，碎石时，内窥镜7由所述阀体内通道14近端插入，所述吸引阀体3上侧设有与所述阀体内通道14相通的泄压通道12，所述泄压通道12自由端设有过压保护阀13。
一种利用本发明所述系统实现清除结石的方法，它包括以下步骤：
S1、利用灌注通道5将外鞘1侧面的进水阀9与灌注吸引源4连接，并将外鞘1的远端置于肾脏中；
S2、将内鞘2与吸引阀体3连接，并利用吸引通道6将吸引阀体3与灌注吸引源4连接；
S3、启动灌注吸引源4，使灌注液16依次经过灌注通道5、外鞘1侧面的进水阀9、内鞘2与外鞘1之间的夹层通道17、外鞘1远端的出水孔8灌注入肾脏中，而肾脏中的灌注液16依次经过内鞘2内的内部通道18、吸引阀体3的排石通道11、吸引通道6排出体外，建立肾脏内灌注液16的持续流通；
S4、内窥镜7由吸引阀体3内的阀体内通道14插入，并经过内鞘2中的内部通道18进入肾脏进行碎石操作，结石随灌注液16依次经由内鞘2中的内部通道18、吸引阀体3的排石通道11、吸引通道6排出体外。
如图1所示，所述吸引通道6上设有结石收集容器15，结石排入所述结石收集容器15中；
如图6所示，在S3或S4步骤中，内鞘2远端被堵塞、或外鞘1远端的出水孔8被堵塞时，灌注液16从内鞘2远端的泄压孔10流至内鞘2中的内部通道18，并经吸引阀体3的排石通道11及吸引通道6排出体外；
所述吸引阀体3上侧设有与所述阀体内通道14相通的泄压通道12，所述泄压通道12自由端设有过压保护阀13，在进行S3或S4步骤时，当肾内压力超过安全压力区间时，所述过压保护阀13将开启进行泄压。

Claims (6)

  1. 一种经皮肾镜清除结石系统，其特征在于：包括外鞘(1)、内鞘(2)、吸引阀体(3)、灌注吸引源(4)、灌注通道(5)、吸引通道(6)和内窥镜(7)，所述外鞘(1)呈管状且远端设有出水孔(8)，所述外鞘(1)近端侧面设有进水阀(9)，且所述进水阀(9)通过灌注通道(5)与灌注吸引源(4)连接，所述内鞘(2)置于外鞘(1)内，且所述外鞘(1)和内鞘(2)之间形成夹层通道(17)，所述夹层通道(17)通过所述进水阀(9)供液，所述内鞘(2)呈管状且远端设有泄压孔(10)，所述内鞘(2)内部形成内部通道(18)并与所述吸引阀体(3)内的阀体内通道(14)连通，在所述吸引阀体(3)下侧设有与所述阀体内通道(14)相通的排石通道(11)，且所述排石通道(11)通过吸引通道(6)与灌注吸引源(4)连接，碎石时，内窥镜(7)由所述阀体内通道(14)近端插入。
  2. 根据权利要求1所述的经皮肾镜清除结石系统，其特征是：所述吸引阀体(3)上侧设有与所述阀体内通道(14)相通的泄压通道(12)，所述泄压通道(12)自由端设有过压保护阀(13)。
  3. 一种利用权利要求1所述的经皮肾镜清除结石系统实现清除结石的方法，其特征在于：包括以下步骤：
    S1、利用灌注通道(5)将外鞘(1)侧面的进水阀(9)与灌注吸引源(4)连接，并将外鞘(1)的远端置于肾脏中；
    S2、将内鞘(2)与吸引阀体(3)连接，并利用吸引通道(6)将吸引阀体(3)与灌注吸引源(4)连接；
    S3、启动灌注吸引源(4)，使灌注液(16)依次经过灌注通道(5)、外鞘(1)侧面的进水阀(9)、内鞘(2)与外鞘(1)之间的夹层通道(17)、外鞘(1)远端的出水孔(8)灌注入肾脏中，而肾脏中的灌注液(16)依次经过内鞘(2)内的内部通道(18)、吸引阀体(3)的排石通道(11)、吸引通道(6)排出体外，建立肾脏内灌注液(16)的持续流通；
    S4、内窥镜(7)由吸引阀体(3)内的阀体内通道(14)插入，并经过内鞘(2)中的内部通道(18)进入肾脏进行碎石操作，结石随灌注液(16)依次经由内鞘(2)中的内部通道(18)、吸引阀体(3)的排石通道(11)、吸引通道(6)排出体外。
  4. 根据权利要求3所述的一种实现清除结石的方法，其特征是：所述吸引通道(6)上设有结石收集容器(15)，结石排入所述结石收集容器(15)中。
  5. 根据权利要求3所述的一种实现清除结石的方法，其特征是：在S3及 S4步骤中，当内鞘(2)远端被堵塞、或外鞘(1)远端的出水孔(8)被堵塞时，灌注液(16)从内鞘(2)远端的泄压孔(10)流至内鞘(2)中的内部通道(18)，并经吸引阀体(3)的排石通道(11)及吸引通道(6)排出体外。
  6. 根据权利要求3所述的一种实现清除结石的方法，其特征是：所述吸引阀体(3)上侧设有与所述阀体内通道(14)相通的泄压通道(12)，所述泄压通道(12)自由端设有过压保护阀(13)，在进行S3或S4步骤时，当肾内压力超过安全压力区间时，所述过压保护阀(13)将开启进行泄压。
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CN110464421A (zh) * 2019-08-15 2019-11-19 广州医科大学附属第一医院 灌注吸引器
CN110711013A (zh) * 2019-09-27 2020-01-21 南华大学附属第一医院 一种经皮肾镜结石清除装置及方法
CN112690871B (zh) * 2020-12-22 2022-05-06 温州市人民医院 一种输尿管负压清石软镜鞘
WO2022147988A1 (zh) * 2021-01-06 2022-07-14 江苏伊凯医疗器械有限公司 一次性变径经皮肾导引套件
CN115919409B (zh) * 2022-12-13 2023-09-05 广州医科大学附属第一医院（广州呼吸中心） 一种经皮肾镜碎石取石装置、方法及电子设备
CN116549106B (zh) * 2023-04-17 2024-02-09 上海璞跃医疗器械有限公司 肾盂结石的清除控制方法、系统及灌注吸引平台

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