WO2021088013A1

WO2021088013A1 - Stone removal device dedicated to ercp post-operative residual bile duct stones

Info

Publication number: WO2021088013A1
Application number: PCT/CN2019/116797
Authority: WO
Inventors: 孟文勃; 王煜栋
Original assignee: 兰州大学第一医院
Priority date: 2019-11-08
Filing date: 2019-11-08
Publication date: 2021-05-14

Abstract

Provided is a stone removal device dedicated to ERCP post-operative residual bile duct stones, comprising a core rod (1), a slider (2), a booster rod (3), a luer connector (6), an outer tube (7) and a transmission wire (9); the core rod (1) is in the shape of a hollow rod, and is connected with the outer tube (7) through threads, the booster rod (3) is arranged inside the core rod (1), and the slider (2) is nested on the core rod (1), the booster rod (3) is connected to the slider (2), two cavities (12, 13) are provided inside the outer tube (7) and the luer connector (6) is arranged at one end, close to an operating handle, of the outer tube (7) for a guide wire to pass through; and the stone removal device further comprises a sponge block (8), wherein the sponge block (8) is detachably connected to the tail end of the transmission wire (9) through a connecting portion (4). The stone removal device can non-invasively remove the quicksand-like stones in a patient's bile duct without causing damage to the patient's bile duct wall.

Description

A stone removal device dedicated to residual bile duct stones after ERCP

Technical field

The invention relates to the technical field of medical equipment, and in particular to a stone removal device dedicated to residual bile duct stones after ERCP.

Background technique

Bile duct stones are a common disease in surgery. Stones in the common bile duct can cause biliary obstruction and secondary jaundice, cholangitis and even pancreatitis, which can be life-threatening. Bile duct stones may also be complicated by biliary cirrhosis, liver atrophy, liver abscess and other diseases. The clinical symptoms of bile duct stones are mainly pain in the upper abdomen. The only treatment for bile duct stones is surgical treatment, that is, the stones in the bile duct are removed or broken by surgery. Commonly used treatment methods are: ①Use metal hard stone removing forceps to explore and remove the stones along the direction of the bile duct; ②Use a rubber urinary catheter to insert each bile duct and rinse; ③Use a choledochoscope to remove the stone.

Minimally invasive surgery has the advantages of small wounds, light pain, quick recovery, short hospital stay, and less bleeding. Due to the above characteristics, it has become a surgical method that is currently vigorously promoted in clinical practice. Choledochoscopy is the most commonly used treatment for biliary stones. A fiberoptic choledochoscope is usually placed along the incision of the biliary tract. After the stone is found, the stone removal net is used to remove the stone.

The invention patent "fishing method, two mirrors and one thread combined with minimally invasive liver-protecting intra- and extrahepatic bile duct stone lithotripsy" (201610574783.3) discloses a technical solution that can solve the problem that the existing stone-removing basket will touch the inner wall of the bile duct. The technical solution is as follows: The stone removal device includes a stone removal basket, a choledochoscope, and a laparoscope. The stone removal basket includes a catheter, a hollow seeker located at the left end of the catheter, and a basket located on the seeker. The basket includes at least two The first basket, at least two second baskets, the conduit includes an outer tube, a sliding tube, an inner tube and a sliding coupling arranged from the outside to the inside, and the sliding coupling includes a first terminal, a second terminal, A coupling shaft for connecting the first terminal and the second terminal. The retractable mesh basket design prevents the stone removal mesh basket from touching the inner wall of the bile duct. There is no pain, trauma, or bleeding during the operation, and it can integrate bile duct stone removal, washing, angiography and expansion. However, this method has the following shortcomings and defects. The statistical results of clinical data show that the recurrence rate of stones after ERCP in patients with common bile duct stones is 4%-24%. Existing researchers believe that the recurrence of gallstones is related to the diameter of the common bile duct, dilatation of the common bile duct, dilatation of the cystic duct, and inflammation of the bile duct or pancreas. Forming elements cause stones.

Different from the above-mentioned research results, the inventor found in the clinic that after the ERCP took the stones, the balloon compression angiography showed that the bile duct stones were cleared, but the bile duct was inserted into the SpyGlass method to observe, and it can still be observed under direct vision. A large number of residual silt-like stones or flocs, the specific pictures are shown in Figure 5 of the manual, A shows 4 mm stones remaining in the common bile duct; B shows a large amount of gravel, bile silt and/or flocs in the common bile duct; C It shows a small amount of gravel, bile silt and flocs in the common bile duct; D shows flocs in the common bile duct; E shows cleanness in the common bile duct. Residual bile duct stones will gradually develop and become larger, and eventually may even require a second operation to remove them, causing harm to the patient's body and mind. Based on the above background, we have invented a device dedicated to removing residual stones after ERCP, especially suitable for silt-like stones or flocs.

Summary of the invention

In order to solve the above technical problems, the present invention provides a stone removal device, a stone removal device dedicated to residual bile duct stones after ERCP, which includes an operating handle, a Luer connector 6, an outer tube 7 and a transmission wire 9. Empty, one end is connected with the operating handle, the transmission wire 9 is placed in the outer tube 7 and the operating handle; the luer connector 6 is set on the side wall of the outer tube 7 near the end of the operating handle;

The stone taking device also includes a stone taking part 8 which is detachably connected to the end of the transmission wire 9 through the connecting part 4; the stone taking part 8 is made of elastic material.

Preferably, the stone taking part 8 is made of sponge, foam material and foam.

Preferably, the stone taking part 8 is cylindrical, conical or other shapes that can realize the technical solution. When the stone taking part 8 is cylindrical, the cross-sectional diameter is 1-2 cm, and the side wall of the stone taking part 8 is integral with the bile duct. Wall contact; when the stone removal part 8 is in a conical shape, the diameter of the cross section at the connection with the transmission wire 9 is the smallest and gradually expands to the distance. The diameter of the largest cross section is 1-2cm. It contacts the bile duct wall and fills the bile duct, pulling the stone removal part 8. All gravels and flocs in the bile duct and bile duct wall are cleaned out of the bile duct by the stone removal part 8.

Preferably, the operating handle is composed of a core rod 1, a sliding block 2 and a booster rod 3. The core rod 1 is in the shape of a hollow rod with an internal thread at one end, a handle ring at the other end, and a side wall. There is an opening; the booster rod 3 is arranged inside the core rod 1, the slider 2 is nested on the core rod 1, and can slide relative to the core rod 1; one end of the booster rod 3 is connected to the slider 2, and the booster rod 3 The other end is connected with the transmission wire 9; the outer tube 7 is provided with an external thread, and the outer tube 7 and the core rod 1 are connected by the thread.

Preferably, the length of the core rod 1 is 2-10 cm, and each cm is provided with a scale. The medical staff can push and pull the transmission wire 9 according to the scale to facilitate accurate positioning.

Preferably, the outer tube 7 is provided with two cavities, the first cavity 12 and the second cavity 13, respectively. The transmission wire 9 is arranged in the second cavity 13 to push the slider 2 to drive the booster rod 3 and the second cavity 13 respectively. The transmission wire 9 slides in the second cavity 13.

Preferably, the transmission wire 9 and the connecting portion 4 are connected in a spiral or inlaid manner.

Preferably, a protective sleeve 5 is provided at one end of the outer tube 7 close to the operating handle, and the protective sleeve 5 is sleeved outside the outer tube 7.

Preferably, the cross section of the outer tube 7 is circular, elliptical or any other shape capable of realizing the technical solution.

The beneficial effect of the present invention is that the device for removing residual bile duct stones after ERCP operation disclosed in the present invention can be used to non-invasively remove small block stones or quicksand-like gravels in the patient's bile duct without causing damage to the patient's bile duct wall. At the same time, the stone removal device can completely remove the sandy or flocculent stones adhering to the bile duct, preventing small sands and stones from remaining in the bile duct to continue to grow, leading to the recurrence of the stones and affecting the health of the patient. The technical scheme is simple, the operation method is simple, and the stone removal effect is remarkable, and it can be promoted and applied in clinical practice.

Description of the drawings

Figure 1 A schematic diagram of a stone removal device dedicated to residual bile duct stones after ERCP

1. Core rod; 2. Slide block; 3. Booster rod; 5. Jacket tube; 6. Luer connector; 7. Outer tube; 8. Stone removal part; 9. Transmission wire; 12. First cavity; 13. , The second cavity

Figure 2 Schematic diagram of the use state of a stone removal device dedicated to residual bile duct stones after ERCP

Figure 3 A cross-sectional view of the stone taking part 8 and the transmission wire 9 in the second cavity 13

[Corrected 15.03.2020 according to Rule 91]
Figure 4 Sectional view of outer tube 7 Figure 5 SpyGlass observation of stones or flocs in the bile duct

Detailed ways

The technical solutions of the present invention will be described below in conjunction with specific embodiments. However, the protection scope of the technical solutions of the present invention is not limited to the following embodiments. Any person skilled in the art can perform technical solutions on the premise of not changing the purpose of the technical solutions of the present invention. Simple modification, replacement or deformation all belong to the protection scope of the technical solution of the present invention.

Glossary:

1. ERCP: Endoscopic retrograde cholangiopancreatography is one of the main methods for minimally invasive treatment of biliary and pancreatic diseases. The endoscope is inserted into the descending part of the duodenum through the mouth, and a special instrument is introduced into the bile duct through the duodenal papilla. Or the pancreatic duct is injected with a contrast agent under X-ray fluoroscopy, and the sub-endoscope/ultrasound probe is introduced to complete the diagnosis of biliary and pancreatic diseases, and the general term for the corresponding interventional treatment technology based on the diagnosis.

2. SpyGlass system is also called SpyGlass direct visualization system (SpyGlass direct visualization system, SDVS), which consists of a host system and related consumable accessories. The host system is similar to our commonly used endoscope system, including the host, water injection pump, camera, light source, display and other components. Consumable accessories include delivery catheters, fiber optic cameras, biopsy forceps, electro-hydraulic lithotripsy probes, and photodynamic therapy components.

3. Bile duct stones: Bile duct stones refer to stones produced in the intrahepatic bile duct system, so it is also called intrahepatic bile duct stones. Often coexist with extrahepatic bile duct stones, but there are also simple intrahepatic bile duct stones, also known as true intrahepatic stones. In recent years, there have been more and more cases of intrahepatic bile duct stones, and most of the stones are classified as bilirubin stones. Hepatic bile duct stones are mostly yellow-green massive or "silt-like" stones, and most of them are calcium bilirubin. Ascaris eggs can often be found in stone centers, so some people think that hepatolithiasis is caused by bile duct obstruction caused by biliary roundworms and bacterial infection.

4. Choledochoscopy is a medical optical endoscope designed for endoscopy and endoscopic surgery of the pancreaticobiliary duct. Choledochoscope usually consists of objective lens system, optical image transmission system, and eyepiece system. It enters the human body through natural pores and is used for imaging and diagnosis. The fiber choledochoscope is mainly composed of a fiber choledochoscope body and a cold light source. The body of the fiber choledochoscope is connected to the light source by means of a connector to form a full-featured fiber choledochoscopy and treatment system. In order to meet the needs of various examinations and treatments, it is usually equipped with a variety of accessories, mainly including stone removal nets, biopsy forceps, cell brushes, flushing catheters, cameras, television video observation systems, etc.

5. Sponge: It is a porous material with good water absorption and can be used to clean things. Commonly used sponges are made of wood cellulose fibers or foamed plastic polymers.

6. Elastic materials: thermoplastic elastomers and various special saturated rubbers that cannot be vulcanized with sulfur;

7. Spiral: The thread on the surface of the cylinder is called a male spiral, and the thread in the hole of the object is called a female spiral. The yin and yang two sets of spirals are matched, and one of them can be rotated to make the two move along the spiral. The denser the thread, the larger the spiral diameter, the less labor.

8. Inlay: refers to embedding an object in another object to fix the two; also refers to embedding with objects as decoration. Inlay means to embed objects, and inlay means to clamp small objects in the gaps of large objects.

Example 1 A stone removal device dedicated to residual bile duct stones after ERCP

A stone-removing device dedicated to residual bile duct stones after ERCP, including an operating handle, a Luer connector 6, an outer tube 7 and a transmission wire 9. The outer tube 7 is hollow and one end is connected to the operation handle, and the transmission wire 9 is set. In the outer tube 7 and the operating handle; the Luer connector 6 is arranged on the side wall of the outer tube 7 close to the end of the operating handle; the stone taking device also includes a stone taking part 8 which passes through the connecting part 4 It is detachably connected to the end of the transmission wire 9; the stone taking part 8 is made of elastic material. The stone taking part 8 is made of sponge. The stone taking part 8 is cylindrical, with a maximum cross-sectional diameter of 1-2 cm, so that the expanded diameter of the stone taking part 8 is greater than or equal to the diameter of the bile duct, and crushed stones or flocs are taken out as much as possible. The operating handle is composed of a core rod 1, a slider 2 and a booster rod 3. The core rod 1 is a hollow rod with an internal thread at one end, a handle ring at the other end, and an opening on the side wall; The booster rod 3 is arranged inside the core rod 1, and the slider 2 is nested on the core rod 1, and can slide relative to the core rod 1. One end of the booster rod 3 is connected to the slider 2, and the other end of the booster rod 3 is connected Transmission wire 9; The outer tube 7 is provided with external threads, and the outer tube 7 and the core rod 1 are connected by threads. The length of the core rod 1 is 2-10 cm, and each cm is provided with a scale. The medical staff can push and pull the transmission wire 9 according to the scale, which is convenient and accurate for positioning. The outer tube 7 is provided with two cavities, the first cavity 12 and the second cavity 13, respectively. The transmission wire 9 is arranged in the second cavity 13, and the slider 2 is pushed to drive the booster rod 3 and the transmission wire 9 Slide in the second cavity 13. The transmission wire 9 and the connecting portion 4 are connected in the form of a spiral. A protective sleeve 5 is provided at one end of the outer tube 7 close to the operating handle, and the protective sleeve 5 is sleeved on the outside of the outer tube 7. The cross section of the outer tube 7 is circular.

Example 2 A method of using a stone removal device dedicated to residual bile duct stones after ERCP

(1) Take a new stone taking part 8 made of a sponge block, connect it to the end of the transmission wire 9 through the connecting part 4, and shrink it in the second cavity 13 for use;

(2) The medical staff put the guide wire into the bile duct of the stone patient;

(3) Pass the guide wire along the first lumen 12 of the outer tube 7 and pass through the Luer connector 6, then the outer tube 7 enters along the guide wire and reaches the distal end of the bile duct with quicksand stones, pushing the slider 2. Push the transmission wire 9 connected with the slider 2 out of the second cavity 13, then the stone removal part 8 is exposed in the bile duct, and rapidly expands and becomes larger, filling the entire bile duct, and the quicksand-like stones are in the stone removal part 8 and the connecting part 4, pull the slider 2, the stone is cleared out of the bile duct by the stone removal part 8, and the stone removal device is slowly taken out.

Claims

A stone-removing device dedicated to residual bile duct stones after ERCP, including an operating handle, a Luer connector 6, an outer tube 7 and a transmission wire 9. The outer tube 7 is hollow and one end is connected to the operation handle, and the transmission wire 9 is set. In the outer tube 7 and the operating handle; the Luer connector 6 is arranged at one end of the side wall of the outer tube 7 close to the operating handle; it is characterized in that:

The stone taking device also includes a stone taking part 8 which is detachably connected to the end of the transmission wire 9 through the connecting part 4; the stone taking part 8 is made of elastic material.
The stone taking device according to claim 1, wherein the stone taking part 8 is made of foamed material.
The stone taking device according to claim 2, wherein the stone taking part 8 is made of sponge.
The stone taking device according to any one of claims 1 to 3, wherein the stone taking part 8 is cylindrical or conical, with a maximum cross-sectional diameter of 1-2 cm.
The stone extraction device according to claim 1, wherein the operating handle is composed of a core rod 1, a slider 2, and a booster rod 3. The core rod 1 is in the shape of a hollow rod, and one end is provided with an internal thread , The other end is provided with a handle ring, and the side wall is provided with an opening; the booster rod 3 is arranged inside the core rod 1, the slider 2 is nested on the core rod 1, and can slide relative to the core rod 1; the booster rod 3 is connected at one end On the slider 2, the other end of the booster rod 3 is connected with the transmission wire 9; the outer tube 7 is provided with an external thread, and the outer tube 7 and the core rod 1 are connected by the thread.
The stone taking device according to claim 5, wherein the core rod 1 is provided with a scale.
The stone taking device according to claim 1, wherein the outer tube 7 is provided with two cavities, namely the first cavity 12 and the second cavity 13, and the transmission wire 9 is arranged in the second cavity 13. Pushing the sliding block 2 drives the push rod 3 and the transmission wire 9 to slide in the second cavity 13.
The stone retrieval device according to claim 1, wherein the transmission wire 9 and the connecting portion 4 are connected in a spiral or inlaid form.
The stone taking device according to claim 7, wherein the outer tube 7 is provided with a protective sleeve 5 at one end close to the operating handle, and the protective sleeve 5 is sleeved on the outside of the outer tube 7.
The stone taking device according to claim 7, characterized in that the cross section of the outer tube 7 is circular, elliptical or any other shape capable of realizing the technical solution.