WO2021078035A1 - 腹腔镜手术用隔离盆腔与腹腔的保护膈及与其配套使用的穿刺器 - Google Patents

腹腔镜手术用隔离盆腔与腹腔的保护膈及与其配套使用的穿刺器 Download PDF

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WO2021078035A1
WO2021078035A1 PCT/CN2020/120527 CN2020120527W WO2021078035A1 WO 2021078035 A1 WO2021078035 A1 WO 2021078035A1 CN 2020120527 W CN2020120527 W CN 2020120527W WO 2021078035 A1 WO2021078035 A1 WO 2021078035A1
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sheath
cavity
abdominal cavity
puncture
tube
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PCT/CN2020/120527
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English (en)
French (fr)
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凌斌
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凌斌
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features 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
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00287—Bags for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/0034—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means adapted to be inserted through a working channel of an endoscope

Definitions

  • the invention relates to an auxiliary device for laparoscopic surgery.
  • the pelvic cavity and the abdominal cavity are two connected areas in the human body.
  • Laparoscopic surgery is to puncture the abdominal wall to form multiple tiny puncture holes, and then inflate the abdominal cavity to expand the abdominal cavity, thus forming a space for surgical operations in the pelvic cavity and abdominal cavity
  • a long-handled surgical instrument is inserted through the abdominal wall puncture sheath in the abdominal wall puncture hole to separate or remove the diseased tissues or organs in the abdominal or pelvic cavity.
  • the high air pressure in the abdominal cavity formed by laparoscopic surgery inflates the abdominal cavity, presses the diaphragm upwards, and then squeezes the chest cavity, which significantly increases the burden on the heart and lungs.
  • the pelvis Since the pelvis is located below the abdominal cavity, when performing laparoscopic surgery on pelvic organs such as the uterus, bladder, rectum, etc., in order to prevent the omentum, intestines and other organs in the abdominal cavity from sliding into the pelvic cavity due to their own gravity and obstructing the surgical field of vision
  • the patient At present, the patient’s head low and high foot position is currently used clinically, that is, the horizontal position of the pelvic cavity that the patient is required to maintain for a long time during the operation is higher than the horizontal position of the abdominal cavity. This worsens the situation and further increases the burden on the heart and lungs, especially for elderly patients and patients with cardiopulmonary dysfunction, which will inevitably increase the risk of surgical anesthesia.
  • the tumor tissue debris generated during the current pelvic surgery and the dirty liquid generated by the pelvic washing are very easy to spread downward and flow into the abdominal cavity due to the "upside down" position maintained by the patient during the operation, that is, it can enter the abdominal cavity
  • the inner intestinal space, the area under the diaphragm, and other areas therefore contaminate the abdominal cavity, which is difficult to completely remove, causing inflammation or tumor spread, such as subdiaphragmatic abscess, tumor abdominal implantation and other serious complications.
  • the tumor cells shed from the sheath especially the tumor cells contaminated by the outer wall of the sheath tube next to the sheath tube, are very easy to be left in the tissue of the patient's abdominal wall puncture hole, and the minimally invasive abdominal wall incision often occurs with tumor implantation and metastasis , A serious threat to the lives of patients.
  • the structure of the human body is very mysterious.
  • the diaphragm in the human body completely isolates the thoracic cavity from the abdominal cavity, avoiding the mutual interference between the two.
  • the invention is used in laparoscopic surgery to artificially establish a "diaphragm" layer between the abdominal cavity and the pelvis to completely isolate the pelvic cavity and the abdominal cavity to avoid mutual interference.
  • the technical problem to be solved by the present invention is to avoid the shortcomings of the above-mentioned prior art, and provide a pelvic cavity and abdominal cavity artificially re-isolated into two closed and independent regions, which can guarantee and improve the pelvic cavity under laparoscopy.
  • the safety and convenience of the surgical patient isolate the pelvic cavity from the protective diaphragm of the abdominal cavity.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention includes a control catheter and an isolation bag body, the opening of the isolation bag body is connected with a fluid-fillable annular sac, and the control catheter is connected with the annular sac, At least one fixed sheath is provided on the ring-shaped sac and/or the isolation bag body close to the ring-shaped sac, and the fixed sheath is connected to the inner side of the isolation bag. Said isolation bag is connected to the inside of the bag sheath.
  • control catheter includes a control base, an inner tube installed at the right port of the control base, and an outer tube coaxial with the inner tube, and the left control base ,
  • the ports on both sides of the right are connected, a one-way air valve is provided between the inner tube and the control base, the left end of the outer tube is sealed to the left end of the inner tube, and the outer tube is connected to the inner tube.
  • a fluid channel is formed between the outer tube, a fluid control valve that can be used to fill fluid is provided on the outer tube, a hollow diversion pad is sleeved on the outer wall of the inner tube and buckled on the right end of the outer tube, and the hollow diversion pad passes through the The nut on the right side is fixed, and the annular bladder is connected with the hollow diversion pad and communicates with the fluid channel through the diversion hole on the hollow diversion pad.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention wherein the fixed sheath and the bag sheath have the same structure, and each includes a sheath base and a catheter threadedly connected to the sheath base And a sheath cap threadedly connected to the outer port of the catheter, and a pull wire is connected to the sheath cap.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention wherein the isolation bag body is provided with a sheath tube hole for connecting the sheath tube of the bag body, and the sheath tube hole is located on the outer side of the isolation bag body
  • a tensile washer is thermally welded, and an anti-drop washer is thermally welded on the outer side of the tensile washer.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention wherein the length of the stretcher wire used for inserting the bag sheath tube of the laparoscope is greater than the length of the corresponding and matched puncture device, which can meet the requirement of Extend out of the body after passing through the trocar.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention wherein an annular retractor line is arranged inside the annular bag, and the isolation bag body is made of a waterproof film material.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention wherein there are two pocket sheath tubes, which are an upper pocket sheath tube and a side pocket sheath tube.
  • the present invention also provides a puncture device used in conjunction with the protective diaphragm that isolates the pelvic cavity and the abdominal cavity for laparoscopic surgery.
  • the puncture device includes a puncture base and a puncture catheter.
  • the puncture catheter is threadedly connected, and the puncture base can also be threadedly connected with a diaphragm-protecting bag sheath and a fixed sheath for laparoscopic surgery to isolate the pelvic cavity from the abdominal cavity.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery can divide the pelvic cavity and the abdominal cavity artificially into two closed and independent areas, ensuring and improving the safety and convenience of patients undergoing laparoscopic pelvic surgery, and improving the patients Comfort.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention has the following beneficial effects:
  • the protective isolation bag is inflated. Therefore, high air pressure is formed in the isolation bag and the pelvic cavity. If high air pressure is not formed in the abdominal cavity, it is impossible to generate pressure on the diaphragm, thus avoiding abdominal air pressure. The increased pressure in the chest cavity affects the patient’s cardiopulmonary function.
  • the protective isolation bag isolates the abdominal cavity and the pelvic cavity, so the omentum, intestines and other organs in the abdominal cavity cannot fall into the pelvic cavity due to the patient's position change, so the patient can maintain a comfortable and safe supine position or even semi-recumbent during the operation Under the premise of ensuring that the pelvic surgical field is not blocked and interfered, it not only effectively avoids the dangerous "inverted" position that the patient is forced to adopt, but also avoids the compression of the chest cavity caused by this position and affects the cardiopulmonary function.
  • the protective isolation bag isolates the abdominal cavity and the pelvic cavity, and the patient can maintain a comfortable and safe supine position or even a semi-recumbent position during the operation. Therefore, the pelvic irrigation fluid and the tumor tissue debris present in it are limited to the protective bag. Avoid contamination in the abdominal cavity.
  • the sheath port for surgical instrument access leads into the protective isolation bag in the abdominal cavity.
  • the abdominal wall puncture incision and the surgically removed lesion are completely isolated by the protective isolation bag.
  • the tumor cells contaminating the surgical instrument cannot contaminate the sheath.
  • the outer wall of the sheath tube is completely sealed with a sheath cap to prevent tumor cells from leaking.
  • Figure 2 An enlarged front view of the annular bag when it starts to inflate
  • Figure 3 is a schematic diagram of the isolation bag body, annular sac, bag body sheath and fixed sheath placed in the abdominal cavity;
  • Fig. 4 is an enlarged schematic diagram of B of Fig. 3;
  • FIG. 5 Schematic diagram of the use of the pelvic and abdominal cavity isolation and protection diaphragm for laparoscopic surgery
  • Fig. 6 is an enlarged schematic view of A in Fig. 1;
  • Figure 7 is a schematic diagram of the side bag sheath and the isolation bag body when installed
  • Fig. 8 is an enlarged schematic view of the hollow diversion pad.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention includes a control catheter 1 and an isolation bag 10.
  • the isolation bag body 10 is made of a waterproof film material.
  • the opening of the isolation bag body 10 is connected with a fluid-filled annular bag 3, and the annular bag 3 is provided with an annular retractor line 31.
  • the outer side of the isolation bag body 10 is provided with two bag body sheath tubes which communicate with the inner side of the isolation bag body 10, which are an upper bag body sheath tube 2a and a side bag body sheath tube 2b, respectively.
  • the outer side of the isolation bag body 10 needs to be provided with at least one bag body sheath in order to meet the basic requirements of laparoscopic surgery.
  • the number of bag body sheath tubes can be adjusted according to the actual situation.
  • the bag body sheath in this embodiment There are two tubes as described above.
  • the side pocket sheath 2 b includes a sheath base 20, a catheter 21 and a sheath cap 22 threadedly connected to the outer port of the catheter 21.
  • the catheter 21 is a rigid catheter.
  • the sheath cap 22 is provided with a pulling hole 23 connected with the pulling wire 24.
  • the isolation bag body 10 is respectively provided with two sheath tube holes for connecting the upper bag body sheath tube 2a and the side bag body sheath tube 2b, and a tensile washer is thermally welded to the sheath tube hole on the outer surface of the isolation bag body 10 101.
  • the tensile washer 101 is made of soft waterproof material, which can effectively prevent the isolation bag body from being strained due to excessive force.
  • An anti-drop washer 100 is thermally welded to the outside of the tensile washer 101.
  • the anti-drop washer 100 is made of hard waterproof material. The anti-drop washer 100 makes the connection between the bag sheath and the isolated bag more firm and prevents the bag sheath Fall off from the isolation bag.
  • the side bag sheath 2b When installing the side bag sheath 2b, first insert the sheath base 20 from the isolation bag 10 through the sheath hole, the base baffle of the sheath base 20 is placed in the isolation bag 10, and then the catheter 21 The end with the catheter baffle is threadedly connected with the sheath base 20 protruding outside the isolation bag body 10, and finally the sheath cap 22 is installed on the outer port of the catheter 21.
  • the upper bag sheath 2a is used to insert the laparoscope 91.
  • the structure of the upper bag sheath 2a is different from that of the side bag sheath 2b in that the length of the puller 24 of the upper bag sheath 2a is longer. It is longer than the length of the puncture device 60 (see FIG. 3) that is used in conjunction with the corresponding puncture device 60, which can satisfy the requirement that it passes through the puncture device 60 from the body and extends out of the body.
  • the control catheter 1 includes a control base 11, an inner tube 13 and an outer tube 12.
  • the left and right ports of the control base 11 are connected, the inner tube 13 is installed on the right port of the control base 11, and a one-way air valve 18 and a one-way air valve 18 are provided between the inner tube 13 and the control base 11
  • it is a silicone cross sealing cap, which is used to open or close the passage between the inner tube 13 and the inner hole of the control base 11.
  • the outer tube 12 is coaxial with the inner tube 13, a fluid channel 14 is formed between the inner wall of the outer tube 12 and the outer wall of the inner tube 13, and the left end of the outer tube 12 and the left end of the inner tube 13 are hermetically connected together.
  • the hollow diversion pad 16 is sleeved on the outer wall of the inner tube 13 and buckled on the step surface of the right end of the outer tube 12.
  • the nut 17 is located on the right side of the hollow diversion pad 16 and is threadedly connected with the outer wall of the inner tube 13 to connect the hollow diversion pad 16 fixed.
  • the outer side of the hollow diversion pad 16 is provided with four uniformly distributed through holes as diversion holes 160 along the circumferential direction.
  • the annular bladder 3 is wrapped on the outer surface of the hollow diversion pad 16 and connected together in a sealed manner, and communicates with the fluid channel 14 through the diversion hole 160 on the hollow diversion pad 16.
  • the outer tube 12 of the control catheter 1 is provided with a fluid control valve 15 for charging and discharging fluid to the fluid channel 14.
  • a fixing sheath 2c is provided on the annular balloon 3 opposite to the connection between the annular balloon 3 and the control catheter 1 for fixing the annular balloon 3.
  • the structure of the fixed sheath 2c and the side pocket sheath 2b are exactly the same, but the installation position is different.
  • the annular capsule 3 is provided with a fixed sheath hole penetrating the inner and outer sides of the fixed sheath 2c for connecting with the fixed sheath 2c.
  • the connection between the fixed sheath 2c and the annular capsule 3 is connected with the side bag sheath 2b and the isolation bag 10 The way is exactly the same.
  • the fixed sheath 2c communicates with the inside of the isolation bag body 10.
  • the fixed sheath 2c can also be mounted on the isolation bag body 10 close to the annular capsule 3, and can also serve to fix the annular capsule 3 as well.
  • the method of using the protective diaphragm for separating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention is as follows: when performing laparoscopic surgery, the patient is first anesthetized and disinfected, and then as shown in Figure 3, the upper abdominal wall 61 (located at the umbilical wall) of the abdominal wall 6
  • the trocar 60 is inserted into the upper left abdominal wall 62, the right upper abdominal wall 63, and the right lower abdominal wall 64, respectively.
  • the puncture device 60 includes a puncture catheter 602, a puncture base 601 threadedly connected to the puncture catheter 602, and an inflation valve 603 connected to the puncture base 601.
  • the puncture base 601 can also be threadedly connected with the side pocket sheath 2b, the upper pocket sheath 2a, and the outer port of the catheter 21 for fixing the sheath 2c.
  • the puncture device 60 on the left upper abdominal wall 62 is inflated into the abdominal cavity 7 and the pelvic cavity 8, and a relatively large space is formed in the abdominal cavity 7 and the pelvic cavity 8.
  • the trocar 60 at the upper abdominal wall 61 is placed in the laparoscope 91 for observation, and the trocar 60 at the right upper abdominal wall 63 and the right lower abdominal wall 64 are respectively inserted with long-handled surgical instruments 92 for operation.
  • a puncture hole 65 is opened on the lower left side of the abdominal wall 6, and the upper bag sheath 2a, the side bag sheath 2b, the fixed sheath 2c, the isolation bag 10, the annular capsule 3 and the annular capsule are connected by non-destructive clamps. 3 The ends of the connected control catheters 1 are fed into the abdominal wall 6 in sequence.
  • the pull wire 24 of the upper bag sheath 2a is fed into the trocar 60 at the upper abdominal wall 61, and the laparoscope 91 follows The puller wire 24 is sent out and retreated until the upper end of the puller wire 24 is placed outside the port of the puncture base 601 of the trocar 60, and then the laparoscope 91 is repositioned into the trocar 60 at the upper abdominal wall 61 Used to continue observation.
  • the long-handled surgical instrument 92 in the trocar 60 located at the right lower abdominal wall 64 is used to pull the pull hole 23 or the pull wire 24 on the fixed sheath 2c, and the sheath cap 22 of the fixed sheath 2c is pulled together with
  • the puncture device 60 on the right lower abdominal wall 64 is pulled out of the body together, and the puncture base 601 of the puncture device 60 and the sheath cap 22 of the fixed sheath 2c are respectively unscrewed, and the puncture base 601 is threadedly connected to the fixed sheath 2c On the catheter 21, the fixed sheath 2c is fixed on the abdominal wall 6.
  • the patient temporarily takes the head low and the feet high, and with the aid of the laparoscope 91 and the long-handled surgical instrument 92 on the right upper abdominal wall 63, the intestines, omentum, and other internal organs in the abdominal cavity 7 that have slipped into the pelvic cavity 8 are incorporated into the abdominal cavity
  • the annular balloon 3 is inflated through the fluid control valve 15 of the control catheter 1 (liquid such as water can also be filled), because the two sides of the annular balloon 3 are respectively fixed on the abdominal wall 6 by the control catheter 1 and the fixed sheath 2c. Therefore, the annular outer side of the inflated annular capsule 3 all squeeze the pelvic floor, side pelvic wall, and abdominal wall to the outside, thereby isolating the abdominal cavity 7 and the pelvic cavity 8 into two independent spaces.
  • the pulling hole 23 or the pulling wire 24 of the side bag sheath 2b is pulled, and the sheath cap 22 together with the trocar 60 on the right upper abdominal wall 63 is pulled out of the body, and twisted
  • the puncture base 601 of the lower puncture device 60 and the sheath cap 22 on the side pocket sheath 2b are threaded to connect the puncture base 601 to the catheter 21 of the side pocket sheath 2b, so that the side pocket sheath 2b is fixed to On the abdominal wall 6.
  • the gas in the abdominal cavity 7 is discharged through the puncture device 60 at the left upper abdominal wall 62, and the pelvic cavity 8 is inflated through the inflation valve 603 of the puncture base 601 connected to the fixed sheath 2c, and the isolation bag body 10 expands toward the abdominal cavity 7, and the pelvic cavity The space of 8 is fully exposed.
  • the laparoscope 91 is inserted into the isolation bag 10 through the puncture base 601 at the upper abdominal wall 61 and the upper bag sheath 2a for observation; the long-handled surgical instrument 92 is passed through the upper right abdominal wall
  • the puncture base 601 and the side pocket sheath 2b at 63 are placed in the isolation bag 10; the second long-handled surgical instrument 92 is placed into the isolation through the puncture base 601 and the fixed sheath 2c at the right lower abdominal wall 64
  • the third long-handled surgical instrument 92 is placed in the isolation bag body 10 through the control base 11 and the inner tube 13 of the control catheter 1. Then, relevant surgical operations are performed on the uterus 80 or other pelvic organs in the pelvic cavity 8.
  • the puncture base 601 at the upper abdominal wall 61, the right upper abdominal wall 63 and the right lower abdominal wall 64 are respectively unscrewed, and then the upper pocket sheath 2a, side pocket sheath 2b and fixed
  • the sheath cap 22 of the sheath tube 2c is installed back to the corresponding catheter 21. Then open the fluid control valve 15 of the control catheter 1 to discharge the gas in the annular balloon 3, and withdraw the control catheter 1 and part of the annular balloon 3 out of the abdominal wall, and cut the annular balloon 3 out of the body to expose the retractor wire 31 in it.
  • the take-up wire 31 is pulled outwards to gradually close the pocket opening of the isolation bag body 10 in the pelvic cavity 8 and the abdominal cavity 7, and then the annular sac 3, the isolation bag body 10 and the fixed sheath 2c, the upper bag sheath 2a and the side
  • the bag sheath 2b is drawn out of the body through the puncture hole 65 of the abdominal wall 6.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery of the present invention has the following beneficial effects:
  • the protective isolation bag is inflated. Therefore, high air pressure is formed in the isolation bag and the pelvic cavity. If high air pressure is not formed in the abdominal cavity, it is impossible to generate pressure on the diaphragm, thus avoiding abdominal air pressure. The increased pressure in the chest cavity affects the patient’s cardiopulmonary function.
  • the protective isolation bag isolates the abdominal cavity and the pelvic cavity, so the omentum, intestines and other organs in the abdominal cavity cannot fall into the pelvic cavity due to the patient's position change, so the patient can maintain a comfortable and safe supine position or even semi-recumbent during the operation Under the premise of ensuring that the pelvic surgical field is not blocked and interfered, it not only effectively avoids the dangerous "inverted" position that the patient is forced to adopt, but also avoids the compression of the chest cavity caused by this position and affects the cardiopulmonary function.
  • the protective isolation bag isolates the abdominal cavity and the pelvic cavity, and the patient can maintain a comfortable and safe supine position or even a semi-recumbent position during the operation. Therefore, the pelvic irrigation fluid and the tumor tissue debris present in it are limited to the protective bag. Avoid contamination in the abdominal cavity.
  • the sheath port for surgical instrument access leads into the protective isolation bag in the abdominal cavity.
  • the abdominal wall puncture incision and the surgically removed lesion are completely isolated by the protective isolation bag.
  • the tumor cells contaminating the surgical instrument cannot contaminate the sheath.
  • the outer wall of the sheath tube is completely sealed with a sheath cap to prevent tumor cells from leaking.
  • the protective diaphragm for isolating the pelvic cavity and the abdominal cavity for laparoscopic surgery can divide the pelvic cavity and the abdominal cavity artificially into two closed and independent areas, ensuring and improving the safety and convenience of patients undergoing laparoscopic pelvic surgery, and improving the patients The comfort.

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Abstract

本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，包括控制导管(1)和隔离袋体(10)，隔离袋体(10)的开口上连接有可充流体的环形囊(3)，控制导管(1)与环形囊(3)连接，在环形囊(3)和/或接近环形囊(3)的隔离袋体(10)上设有至少一个固定鞘管(2c)，固定鞘管(2c)与隔离袋体(10)的内侧连通，隔离袋体(10)上还设有至少一个与隔离袋体(10)内侧连通的袋体鞘管。本发明腹腔镜手术用隔离盆腔与腹腔的保护膈可以将盆腔和腹腔人为的隔离划分为两个封闭独立的区域，保障和提高了腹腔镜下盆腔手术患者的安全性和便捷性，提高了患者的舒适度。

Description

腹腔镜手术用隔离盆腔与腹腔的保护膈及与其配套使用的穿刺器 技术领域
本发明涉及一种腹腔镜手术的辅助装置。
背景技术
盆腔和腹腔是人体内相连通的两个区域，腹腔镜手术是在腹壁上穿刺形成多个微小的穿刺孔，再向腹腔内充气后使腹腔膨胀，因此在盆腔和腹腔内形成手术操作的空间，在腹腔镜窥视下，经过腹壁穿刺孔内的腹壁穿刺器鞘管置入长柄手术器械，将腹腔或盆腔内病变的组织或器官分离或切除。
特别需要强调的是，腹腔镜手术向腹腔内充气形成的腹腔内高气压，向上压迫膈肌，进而挤压胸腔，明显增加了心肺负担。
由于盆腔位于腹腔的下方，当进行子宫、膀胱、直肠等盆腔内器官的腹腔镜手术时，为了避免腹腔内的网膜、肠管等腹腔内的器官因自身的重力作用滑落到盆腔而遮挡手术视野，目前临床采用患者头低足高的体位，也就是术中要求患者长时间保持的盆腔水平位置要高出腹腔的水平位置，患者被强制保持类似于呈部分“倒立”的姿势，显然更是雪上加霜，进一步增加了心肺负担，尤其是对于老年患者，心肺功能障碍的患者，都势必增加了手术麻醉风险。
另外，目前患者盆腔手术过程中产生的肿瘤组织碎屑，以及盆腔冲洗产生的污秽液体，由于患者术中保持的“倒立”体位，均非常容易扩散向下方流入到腹腔内，即可以进入到腹腔内的肠间隙，膈肌下方等区域，因此污染腹腔，难以完全清除，造成炎症扩散或肿瘤扩散，如膈下脓肿、肿瘤腹腔种植等严重并发症。
由于腹腔镜手术器械是通过腹壁穿刺器的鞘管进入盆腹腔，手术器械在接触、分离、切割肿瘤组织后，非常容易发生肿瘤组织细胞污染手术器械，当此污染的手术器械从腹壁穿刺器的鞘管反复出入时，也就非常容易发生腹壁穿刺器的鞘管内肿瘤细胞污染，以及位于腹腔内的腹壁穿刺器鞘管口，甚至鞘管口旁鞘管外壁的肿瘤细胞污染，因此当从腹壁拔出腹壁穿刺器时，其鞘管内脱落的肿瘤细胞，尤其鞘管口旁鞘管外壁污染的肿瘤细胞就非常容易遗落在病人腹壁穿刺孔的组织中，时常发生腹壁微创切口肿瘤种植转移，严重威胁患者生命。
人体结构非常奥妙，人体内的膈肌将胸腔和腹腔完全隔离，避免了两者的相互干扰。本发明是用于腹腔镜手术时，在腹腔和盆腔之间人为建立一个“膈肌”层，将盆腔和腹腔完全 隔离，避免相互干扰。
发明内容
本发明要解决的技术问题是为避免上述现有技术所存在的不足之处，提供一种可将盆腔和腹腔人为再隔离划分为两个封闭独立的区域的、能够保障和提高腹腔镜下盆腔手术患者的安全性和便捷性的隔离盆腔与腹腔的保护膈。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，包括控制导管和隔离袋体，所述隔离袋体的开口上连接有可充流体的环形囊，所述控制导管与所述环形囊连接，在环形囊和/或接近环形囊的隔离袋体上设有至少一个固定鞘管，所述固定鞘管与所述隔离袋体的内侧连通，所述隔离袋体上还设有至少一个与所述隔离袋体内侧连通的袋体鞘管。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中所述控制导管包括控制基座、安装于控制基座右端口的内管和与内管同轴的外管，所述控制基座左、右两侧端口相连通，所述内管与控制基座之间设有单向气阀，所述外管的左端与所述内管左端密封连接，所述外管与所述内管之间形成流体通道，所述外管上设有可用于充流体的流体控制阀,空心导流垫套在所述内管外壁上并扣在所述外管的右端，空心导流垫通过位于其右侧的螺母进行固定，所述环形囊与所述空心导流垫连接，并通过空心导流垫上的导流孔与所述流体通道连通。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中所述固定鞘管和所述袋体鞘管结构完全相同，均各自包括鞘管基座、与所述鞘管基座螺纹连接的导管和螺纹连接于导管外侧端口的鞘帽，所述鞘帽上连接有牵拉线。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中所述隔离袋体上设有用于连接所述袋体鞘管的鞘管孔，在位于所述隔离袋体外侧面上的鞘管孔处热焊接有抗拉垫圈，在抗拉垫圈的外侧热焊接有防脱垫圈。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中用于插入腹腔镜的所述袋体鞘管的牵拉线的长度大于与其对应且配套使用的穿刺器的长度，可满足其从体内通过穿刺器后延伸出体外。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中所述环形囊里面设有环形的牵收线，所述隔离袋体由防水薄膜材料制成。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈，其中所述袋体鞘管为两个，分别为上袋体鞘管和侧袋体鞘管。
本发明还提供一种与腹腔镜手术用隔离盆腔与腹腔的保护膈配套使用的穿刺器，包括穿 刺基座和穿刺导管，所述穿刺基座上设有充气阀，所述穿刺基座与所述穿刺导管螺纹连接，所述穿刺基座还可与腹腔镜手术用隔离盆腔与腹腔的保护膈的袋体鞘管和固定鞘管的导管螺纹连接。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈可以将盆腔和腹腔人为的隔离划分为两个封闭独立的区域，保障和提高了腹腔镜下盆腔手术患者的安全性和便捷性，提高了患者的舒适度。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈与已有技术相比，本发明有益效果体现在：
1、腹腔镜下手术时是向防护隔离袋内充气，因此是在隔离袋和盆腔内形成高气压，而腹腔内没有形成高气压，也就不可能对膈肌产生压力，因此而避免了腹腔气压升高造成的胸腔受压而影响患者心肺功能。
2、防护隔离袋将腹腔和盆腔隔离，腹腔内的网膜、肠管等器官也就无法因为患者的体位改变而落入盆腔，因此患者术中可以保持舒适安全的平卧位，甚至于半卧位，在保障盆腔术野不受遮挡干扰的前提下，既有效规避了患者被迫采用的危险的“倒立”体位，也避免了因此体位而造成的胸腔受压而影响心肺功能。
3、防护隔离袋将腹腔和盆腔隔离，以及患者术中可以保持舒适安全的平卧位，甚至于半卧位，因此盆腔冲洗液及其中存在的肿瘤组织碎屑等均限制于保护袋内，避免了腹腔内的污染。
4、手术器械出入的鞘管口在腹腔内通向防护隔离袋内，腹壁穿刺切口与手术切除病灶被防护隔离袋完全隔离，当手术器械反复出入时，污染手术器械的肿瘤细胞无法污染鞘管的外壁，鞘管外口采用鞘帽完全密闭防止肿瘤细胞泄漏，而污染鞘管内壁的肿瘤细胞即使脱落，也只能从鞘管内口脱落到防护隔离袋内，有效避免了传统腹腔镜手术器械在接触污染了肿瘤细胞后，仍需要反复出入于直接暴露于腹腔的腹壁穿刺器管鞘，因此可能造成的腹壁穿刺切口的肿瘤细胞种植转移，有效保障患者安全。
下面结合附图对本发明腹腔镜手术用隔离盆腔与腹腔的保护膈的实施例作进一步说明。
附图说明
图1主视图；
图2环形囊开始充气时的放大主视图；
图3隔离袋体、环形囊、袋体鞘管和固定鞘管置入腹腔的示意图；
图4为图3的B处的放大示意图；
图5腹腔镜手术用盆腔与腹腔隔离保护膈使用状态示意图；
图6为图1的A处的放大示意图；
图7侧袋体鞘管与隔离袋体安装时的示意图；
图8空心导流垫的放大示意图。
具体实施方式
如图1和图2所示，本发明腹腔镜手术用隔离盆腔与腹腔的保护膈包括控制导管1和隔离袋体10。隔离袋体10由防水薄膜材料制成，隔离袋体10的开口上连接有可充流体的环形囊3，环形囊3里面设有环形的牵收线31。隔离袋体10的外侧设有两个与隔离袋体10内侧连通的袋体鞘管，分别为上袋体鞘管2a和侧袋体鞘管2b。隔离袋体10的外侧至少需要设有一个袋体鞘管才能满足腹腔镜手术的基本要求，在现场实际操作中，可根据实际情况调整袋体鞘管的数量，本实施例中的袋体鞘管如上所述为两个。如图6和图7所示，侧袋体鞘管2b包括鞘管基座20、导管21和螺纹连接于导管21外侧端口的鞘帽22。导管21为硬质导管。鞘帽22上设有连接牵拉线24的牵拉孔23。隔离袋体10分别设有两个用于连接上袋体鞘管2a和侧袋体鞘管2b的鞘管孔，在位于隔离袋体10外侧面上的鞘管孔处热焊接有抗拉垫圈101，抗拉垫圈101由软质防水材料制成，可有效预防因受力过大而拉伤隔离袋体。在抗拉垫圈101的外侧热焊接有防脱垫圈100，防脱垫圈100由硬质防水材料制成，防脱垫圈100使得袋体鞘管与隔离袋体的连接更加牢固，防止袋体鞘管从隔离袋体上脱落。安装侧袋体鞘管2b时，先将鞘管基座20从隔离袋体10内穿过鞘管孔，鞘管基座20的基座挡板置于隔离袋体10内，然后将导管21带有导管挡板的一端与伸出隔离袋体10外侧的鞘管基座20螺纹连接，最后将鞘帽22装在导管21的外端口上。上袋体鞘管2a用于插入腹腔镜91，上袋体鞘管2a的结构与侧袋体鞘管2b不同之处在于，上袋体鞘管2a的牵拉线24长度较长，其长度大于与其对应配套使用的穿刺器60(见图3)的长度，可满足其从体内通过穿刺器60后延伸出体外。
如图2所示，控制导管1包括控制基座11、内管13和外管12。控制基座11左、右两侧端口相连通，内管13安装于控制基座11的右端口，且内管13与控制基座11之间设有单向气阀18，单向气阀18优选为硅胶十字密封帽，用于打开或关闭内管13与控制基座11的内孔之间的通道。外管12与内管13同轴，外管12的内壁与内管13的外壁之间形成流体通道14，外管12的左端与内管13的左端密封连接在一起。空心导流垫16套在内管13外壁上并 扣在外管12的右端台阶面上，螺母17位于空心导流垫16的右侧，且与内管13的外壁螺纹连接，将空心导流垫16固定。如图8所示，空心导流垫16外侧沿周向开有四个均布的通孔为导流孔160。环形囊3包裹在空心导流垫16的外侧面且密封连接在一起，并通过空心导流垫16上的导流孔160与流体通道14连通。控制导管1的外管12上设有流体控制阀15，用于对流体通道14进行充放流体。如图1所示，在环形囊3与控制导管1的连接处相对的环形囊3上设有固定鞘管2c，用于固定环形囊3。固定鞘管2c与侧袋体鞘管2b的结构完全相同，只是安装位置不同。环形囊3上设有贯穿其内外侧的用于与固定鞘管2c连接的固定鞘管孔，固定鞘管2c与环形囊3的连接方式与侧袋体鞘管2b和隔离袋体10的连接方式完全相同。固定鞘管2c与隔离袋体10的内侧连通。固定鞘管2c也可以装在接近环形囊3的隔离袋体10上，同样也可以起到固定环形囊3的作用。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈的使用方法如下：在进行腹腔镜手术时，首先对患者进行麻醉消毒，然后如图3所示，在腹壁6的上腹壁处61(位于脐部附近)、左上腹壁处62、右上腹壁处63和右下腹壁处64分别置入穿刺器60。如图4所示，穿刺器60包括穿刺导管602、与穿刺导管602螺纹连接的穿刺基座601及连接于穿刺基座601上的充气阀603。穿刺基座601还可与侧袋体鞘管2b、上袋体鞘管2a和固定鞘管2c的导管21的外端口螺纹连接。通过左上腹壁处62的穿刺器60向腹腔7和盆腔8内充气，腹腔7和盆腔8内形成较大的空间。通过上腹壁处61的穿刺器60置入腹腔镜91进行观察，在右上腹壁处63和右下腹壁处64的穿刺器60中分别置入长柄手术器械92用于操作。
接着，在腹壁6的左下侧开一个穿刺孔65，通过无损夹钳将上袋体鞘管2a、侧袋体鞘管2b、固定鞘管2c、隔离袋体10、环形囊3以及与环形囊3相连的控制导管1的端部依次送入腹壁6内。然后通过右上腹壁处63和右下腹壁处64的长柄手术器械92的协助，将上袋体鞘管2a的牵拉线24送入上腹壁处61的穿刺器60内，腹腔镜91随着牵拉线24向外送出而向后退，直到将牵拉线24的上端置于穿刺器60的穿刺基座601端口外，然后重新将腹腔镜91复位置入上腹壁处61的穿刺器60内用于继续观察。
下一步，通过位于右下腹壁处64的穿刺器60内的长柄手术器械92去牵拉固定鞘管2c上的牵拉孔23或牵拉线24，将固定鞘管2c的鞘帽22连同右下腹壁处64的穿刺器60一起牵引出体外，并将穿刺器60的穿刺基座601和固定鞘管2c的鞘帽22分别拧下，将穿刺基座601螺纹连接在固定鞘管2c的导管21上，使固定鞘管2c固定在腹壁6上。
患者暂时性采取头低足高位，并在腹腔镜91和右上腹壁处63的长柄手术器械92的辅助下，将滑落在盆腔8内的肠管、大网膜等腹腔7内的脏器纳入腹腔7内，然后通过控制导管 1的流体控制阀15对环形囊3进行充气(也可以充入液体例如水)，因为环形囊3的两侧分别通过控制导管1和固定鞘管2c固定在腹壁6上，所以膨胀后的环形囊3的环形外侧均向外侧挤压盆底、侧盆壁以及腹壁，从而将腹腔7和盆腔8隔离为两个相互独立的空间。
然后通过右上腹壁处63的长柄手术器械92，牵引侧袋体鞘管2b的牵拉孔23或牵拉线24，将鞘帽22连同右上腹壁处63的穿刺器60一起牵引出体外，拧下穿刺器60的穿刺基座601和侧袋体鞘管2b上的鞘帽22，将穿刺基座601螺纹连接于侧袋体鞘管2b的导管21上，使侧袋体鞘管2b固定于腹壁6上。
接着，取出位于上腹壁处61的穿刺器60内的腹腔镜91，通过位于穿刺器60外侧的牵拉线24，将上袋体鞘管2a的鞘帽22连同上腹壁处61的穿刺器60一起牵引出体外，并分别拧下穿刺器60的穿刺基座601和上袋体鞘管2a上的鞘帽22，将穿刺基座601螺纹连接于上袋体鞘管2a的导管21上，使上袋体鞘管2a固定于腹壁6上。
通过左上腹壁处62的穿刺器60排出腹腔7内的气体，通过与固定鞘管2c连接的穿刺基座601的充气阀603向盆腔8内充气，隔离袋体10向腹腔7的方向扩展，盆腔8的空间充分展露。
抬高患者的头侧，将体位恢复为安全、舒适的平卧位或半卧位。最后，如图5所示，将腹腔镜91通过上腹壁处61的穿刺基座601和上袋体鞘管2a置入隔离袋体10内，用于观察；将长柄手术器械92通过右上腹壁处63的穿刺基座601和侧袋体鞘管2b置入隔离袋体10内；将第二个长柄手术器械92通过右下腹壁处64的穿刺基座601和固定鞘管2c置入隔离袋体10内；将第三个长柄手术器械92通过控制导管1的控制基座11和内管13置入隔离袋体10内。然后对盆腔8内的器官子宫80或其他盆腔器官进行相关的手术操作。
当手术操作全部完成后，将上腹壁处61、右上腹壁处63和右下腹壁处64的穿刺基座601分别拧下，然后重新将上袋体鞘管2a、侧袋体鞘管2b和固定鞘管2c的鞘帽22安装回与其对应的导管21上。然后打开控制导管1的流体控制阀15，排出环形囊3中的气体，向腹壁外抽出控制导管1和部分环形囊3，在体外剪开环形囊3，露出其中的牵收线31，将牵收线31向外牵拉，逐步将隔离袋体10的袋口在盆腔8和腹腔7内关闭，进而将环形囊3、隔离袋体10及固定鞘管2c、上袋体鞘管2a和侧袋体鞘管2b经过腹壁6的穿刺孔65牵出体外。
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈与已有技术相比，本发明有益效果体现在：
1、腹腔镜下手术时是向防护隔离袋内充气，因此是在隔离袋和盆腔内形成高气压，而腹腔内没有形成高气压，也就不可能对膈肌产生压力，因此而避免了腹腔气压升高造成的胸腔受压而影响患者心肺功能。
2、防护隔离袋将腹腔和盆腔隔离，腹腔内的网膜、肠管等器官也就无法因为患者的体位改变而落入盆腔，因此患者术中可以保持舒适安全的平卧位，甚至于半卧位，在保障盆腔术野不受遮挡干扰的前提下，既有效规避了患者被迫采用的危险的“倒立”体位，也避免了因此体位而造成的胸腔受压而影响心肺功能。
3、防护隔离袋将腹腔和盆腔隔离，以及患者术中可以保持舒适安全的平卧位，甚至于半卧位，因此盆腔冲洗液及其中存在的肿瘤组织碎屑等均限制于保护袋内，避免了腹腔内的污染。
4、手术器械出入的鞘管口在腹腔内通向防护隔离袋内，腹壁穿刺切口与手术切除病灶被防护隔离袋完全隔离，当手术器械反复出入时，污染手术器械的肿瘤细胞无法污染鞘管的外壁，鞘管外口采用鞘帽完全密闭防止肿瘤细胞泄漏，而污染鞘管内壁的肿瘤细胞即使脱落，也只能从鞘管内口脱落到防护隔离袋内，有效避免了传统腹腔镜手术器械在接触污染了肿瘤细胞后，仍需要反复出入于直接暴露于腹腔的腹壁穿刺器管鞘，因此可能造成的腹壁穿刺切口的肿瘤细胞种植转移，有效保障患者安全。
以上的实施例仅仅是对本发明的优选实施方式进行描述，并非对本发明的范围进行限定，在不脱离本发明设计精神的前提下，本领域普通技术人员对本发明的技术方案作出的各种变形和改进，均应落入本发明权利要求书确定的保护范围内。
工业实用性
本发明腹腔镜手术用隔离盆腔与腹腔的保护膈可以将盆腔和腹腔人为的隔离划分为两个封闭独立的区域，保障和提高了腹腔镜下盆腔手术患者的安全性和便捷性，提高了患者的舒适。

Claims (8)

  1. 一种腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：包括控制导管(1)和隔离袋体(10)，所述隔离袋体(10)的开口上连接有可充流体的环形囊(3)，所述控制导管(1)与所述环形囊(3)连接，在环形囊(3)和/或接近环形囊(3)的隔离袋体(10)上设有至少一个固定鞘管(2c)，所述固定鞘管(2c)与所述隔离袋体(10)的内侧连通，所述隔离袋体(10)上还设有至少一个与所述隔离袋体(10)内侧连通的袋体鞘管。
  2. 根据权利要求1所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：所述控制导管(1)包括控制基座(11)、安装于控制基座(11)右端口的内管(13)和与内管(13)同轴的外管(12)，所述控制基座(11)左、右两侧端口相连通，所述内管(13)与控制基座(11)之间设有单向气阀(18)，所述外管(12)的左端与所述内管(13)左端密封连接，所述外管(12)与所述内管(13)之间形成流体通道(14)，所述外管(12)上设有可用于充流体的流体控制阀(15),空心导流垫(16)套在所述内管(13)外壁上并扣在所述外管(12)的右端，空心导流垫(16)通过位于其右侧的螺母(17)进行固定，所述环形囊(3)与所述空心导流垫(16)连接，并通过空心导流垫(16)上的导流孔(160)与所述流体通道(14)连通。
  3. 根据权利要求1-2中任一项所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：所述固定鞘管(2c)和所述袋体鞘管结构完全相同，均各自包括鞘管基座(20)、与所述鞘管基座(20)螺纹连接的导管(21)和螺纹连接于导管(21)外侧端口的鞘帽(22)，所述鞘帽(22)上连接有牵拉线(24)。
  4. 根据权利要求3中所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：所述隔离袋体(10)上设有用于连接所述袋体鞘管的鞘管孔，在位于所述隔离袋体(10)外侧面上的鞘管孔处热焊接有抗拉垫圈(101)，在抗拉垫圈(101)的外侧热焊接有防脱垫圈(100)。
  5. 根据权利要求4所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：用于插入腹腔镜的所述袋体鞘管的牵拉线(24)的长度大于与其对应且配套使用的穿刺器(60)的长度，可满足其从体内通过穿刺器(60)后延伸出体外。
  6. 根据权利要求5所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：所述环形囊(3)里面设有环形的牵收线(31)，所述隔离袋体(10)由防水薄膜材料制成。
  7. 根据权利要求6中所述的腹腔镜手术用隔离盆腔与腹腔的保护膈，其特征在于：所述袋体鞘管为两个，分别为上袋体鞘管(2a)和侧袋体鞘管(2b)。
  8. 一种根据权利要求1-7中任一项所述的腹腔镜手术用隔离盆腔与腹腔的保护膈配套使用的穿刺器，包括穿刺基座(601)和穿刺导管(602)，所述穿刺基座(601)上设有充气阀(603)，其特征在于：所述穿刺基座(601)与所述穿刺导管(602)螺纹连接，所述穿刺基座(601)还可与腹腔镜手术用隔离盆腔与腹腔的保护膈的袋体鞘管和固定鞘管(2c)的导管(21)螺纹连接。
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