WO2021136557A1 - 前列腺腺体移除设备和移除方法 - Google Patents

前列腺腺体移除设备和移除方法 Download PDF

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Publication number
WO2021136557A1
WO2021136557A1 PCT/CN2021/073288 CN2021073288W WO2021136557A1 WO 2021136557 A1 WO2021136557 A1 WO 2021136557A1 CN 2021073288 W CN2021073288 W CN 2021073288W WO 2021136557 A1 WO2021136557 A1 WO 2021136557A1
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Prior art keywords
gland
catheter
bladder
anchoring
prostate
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PCT/CN2021/073288
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English (en)
French (fr)
Inventor
程继文
莫林键
莫曾南
李天宇
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广西医科大学第一附属医院
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Priority claimed from CN202010879080.8A external-priority patent/CN113116463B/zh
Application filed by 广西医科大学第一附属医院 filed Critical 广西医科大学第一附属医院
Publication of WO2021136557A1 publication Critical patent/WO2021136557A1/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
    • A61B1/307—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body

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  • the invention relates to a prostate gland removal device and a removal method for removing prostate diseased glands.
  • the first method is to use open surgery to incise the bladder above the pubic bone and remove the enucleated hyperplastic glands. This scheme is only suitable for a small number of patients with huge stones in the bladder, and open surgical bladder incision is more traumatic for elderly patients, increasing the patient's pain, and there is a potential risk of incision non-healing.
  • the second way is to cut the hyperplastic glands into pieces in the cavity of the resection microscope, and then suck them out with a suction device.
  • This scheme has a wide range of applications and is easy for patients to accept, and the cost of this scheme is low, especially suitable for primary hospitals with limited funds.
  • part of the tissue needs to be deliberately reserved to relatively fix the glands in the prostatic fossa, which is convenient for harvesting resection.
  • the vision is not clear enough, the operation space is limited, and the fixed position of the gland is not flexible, sometimes it is necessary to repeatedly identify the boundary of the harvest resection to avoid the influence of factors such as excessive resection, so the resection efficiency is not high.
  • it happens that the glands are completely pushed away from the prostate fossa and into the bladder. At this time, because of the lack of a relatively fixed pivot, the prostate specimen floats in the bladder, and the harvesting resection efficiency will be lower.
  • the third method is to enucleate the entire hyperplastic glands, and then use a costly negative pressure system inserted through an endoscope to adsorb and fix the enucleated glands, and crush them with a special tissue crusher.
  • This solution is easy to fix and smash the hyperplastic glands to suck out, and it is fast, but it requires the purchase of special equipment, the cost is high, and it is difficult to be widely promoted, especially for grassroots hospitals with limited funds.
  • the purpose of the present invention is to overcome one or several technical problems in the above-mentioned prior art, and propose a prostate gland removal device that can remove diseased glands more thoroughly at a lower cost.
  • the present invention provides a prostate gland removal equipment, including an endoscope device, a gland fixing device, a gland crushing device, and a cleaning and removing device.
  • the endoscopic device includes a first catheter and a gland enucleation member.
  • the first catheter can extend along the urethra to the vicinity of the prostate.
  • the gland enucleation member can be guided to and enucleate the diseased gland through the first catheter.
  • the gland fixing device includes a second catheter and an anchoring member.
  • the tip of the second catheter is sharp and can enter the abdominal cavity through the opening in the skin and pierce the bladder into the inside of the bladder.
  • the anchoring member includes a tip formed at the front end and an anchoring portion formed near the front end.
  • the anchoring member can be guided to the vicinity of the enucleated gland located in the bladder via the second catheter, the tip of the anchoring member can penetrate the enucleated gland, and the anchoring part can prevent the enucleated gland from falling off the anchoring member.
  • the gland crushing device can be guided to the enucleated gland fixed by the anchoring member via the first conduit or the second conduit and crush the gland fragments.
  • the cleaning and taking-out device can infuse the cleaning fluid into the bladder through the first catheter or through the first catheter and the second catheter and extract the cleaning fluid and gland fragments together.
  • the cleaning and extracting device includes only one tube, which can be guided by the first catheter into the prostatic fossa, through which the cleaning fluid is poured into the bladder and the cleaning fluid and the gland fragments are drawn out together.
  • the cleaning and taking out device includes: a cleaning fluid perfusion tube, which can be guided into the prostatic fossa via a first catheter, and the cleaning fluid is poured into the bladder; the cleaning fluid is drawn out of the tube and cleaned
  • the fluid extraction tube can be guided into the bladder through the second catheter, and the cleaning fluid and gland fragments can be drawn from the bladder together.
  • the endoscope device further includes a light source optical fiber capable of transmitting light from an external light source to the inside of the human body and an imaging optical fiber capable of transmitting an image inside the human body to the outside of the human body.
  • a catheter is guided near the prostate.
  • the gland fixing device further includes a light source fiber capable of transmitting light from an external light source to the inside of the human body and an imaging fiber capable of transmitting an image inside the human body to the outside of the human body.
  • the catheter is guided into the bladder.
  • the gland fixing device further includes a second catheter stent whose position and posture can be adjusted and fixed, and a second catheter guiding member is formed on the second catheter stent for supporting and guiding the second catheter .
  • the gland fixing device may further include a second catheter stopper, which is held on the outside of the second catheter, and is used to prevent the second catheter from moving toward one of the second catheter stent and the guide member. March forward.
  • the second catheter stopper is adjustably held on the outside of the second catheter, for example, it may be screwed to the outside of the second catheter.
  • the gland fixing device further includes an anchoring member bracket, and an anchoring guide member is formed on the anchoring member bracket for supporting and guiding the anchoring member.
  • the gland fixing device may further include an anchoring stopper, which is held on the outside of the anchoring member for preventing the anchoring member from moving forward by acting with one of the anchoring member bracket and the anchoring guide member.
  • the anchor stopper is adjustably held on the outside of the anchor member.
  • the anchor stopper may be screwed to the outside of the anchor member.
  • the present invention also provides a method for removing prostate glands, including the following steps: guiding the first catheter along the urethra to the vicinity of the prostate; guiding the gland enucleation member to the diseased gland through the first catheter and removing the diseased gland Enucleation of the body; the second catheter with a sharp tip is introduced into the abdominal cavity through the opening in the skin, and the bladder is pierced into the inside of the bladder; the anchoring member is guided through the second catheter to the vicinity of the enucleated gland in the bladder
  • the anchoring member includes a tip formed at the front end and an anchoring part formed near the front end, so that the tip of the anchoring member pierces the enucleated gland and uses its anchoring part to prevent the enucleated gland from falling off the anchoring member; the gland The body crushing device is guided through the first conduit or the second conduit to the enucleated gland fixed by the anchoring member, and broken into gland fragments; the cleaning and removal device is passed through the first conduit or the first conduit
  • the entire diseased gland can be enucleated by the endoscopic device introduced into the diseased gland through the urethra, and the fixation and fragmentation of the enucleated gland is not in the gland. It is done at the fossa, but in the bladder. Therefore, the operating space is large and the field of view is good.
  • the anchoring member that enters the bladder through the abdomen can adopt a very simple structure, and the cost is very low, and at the same time, it can very effectively fix the enucleated glands in the bladder.
  • various existing crushing components or energy platforms that have been purchased in hospitals can be used to crush the fixed glands.
  • various existing cleaning and removal devices especially those purchased in hospitals, can be used to remove the gland fragments from the bladder. It can be seen that by using the prostate gland removal device of the present invention, diseased glands can be removed more thoroughly at a lower cost.
  • Fig. 1 is a schematic diagram of the use state of an embodiment of the prostate gland removal device of the present invention
  • FIGS. 2 and 3 are schematic diagrams of two embodiments of the anchoring member in the prostate gland removal device of the present invention.
  • Fig. 4 is a schematic cross-sectional view of a part including a second catheter and an anchoring member in an embodiment of the prostate gland removal device of the present invention.
  • the directional term is determined with reference to the patient during the operation.
  • the "front end” of the equipment, device, or component refers to the end facing the patient or the patient's diseased part, correspondingly, “forward” or “ “Advance” refers to travel toward the patient or the diseased part of the patient; and “rear end” refers to the end that is away from the patient or the diseased part of the patient.
  • “backward” refers to travel away from the patient or the diseased part of the patient.
  • FIG. 1 the figure schematically illustrates the usage state of a specific embodiment of the prostate gland removal device of the present invention during surgery.
  • This prostate gland removal device consists of two parts, one part operates the glands through the urethra, and the other part passes through the abdomen and bladder to operate the enucleated glands in the bladder.
  • the part that passes through the urethra is the endoscopic device.
  • the endoscope device includes an optical fiber system (not shown in the figure).
  • the optical fiber system generally includes a light source optical fiber capable of transmitting light from an external light source to the inside of the human body and an image capable of transmitting the image inside the human body to the outside of the human body. Imaging fiber.
  • the improvement of the present invention has nothing to do with the optical fiber system.
  • the endoscopic device includes a catheter, which is referred to as the first catheter 50 in the present invention.
  • the first catheter 50 is inserted into the urethra 12 through the urethral opening of the penis 10 of the patient, and the light source fiber and the imaging fiber are introduced into the urethra 12 at the same time. Therefore, the surgeon can use an image display device (not shown) to insert the first catheter 50 along the urethra 12 to the vicinity of the prostate 20.
  • the endoscope device further includes a gland enucleation member 52, which is guided to the diseased gland via the first catheter 50 and enucleates the diseased gland.
  • the improvement of the present invention does not involve the specific content of the gland enucleation technology. Therefore, various gland enucleation techniques in the prior art and gland enucleation components with corresponding structures can be applied in the present invention. It should be understood that “enucleation” and “chopping” are different in terms of separating a gland from a glandular fossa. The former is to separate the diseased gland almost completely from the glandular fossa, while the latter is to use energy platforms such as resectoscope, laser, plasma, etc. piece by piece or one layer while the gland is kept in the glandular fossa. Removal layer by layer. The present invention adopts the technique of gland enucleation, therefore, the removal efficiency is high and complete, and the patient generally does not relapse prostate disease.
  • the part that passes through the abdomen and the bladder in the prostate gland removal device of the present invention is a gland fixing device.
  • the gland fixation device includes a second duct 54.
  • the material, manufacturing process and structure of the second catheter 54 are basically the same as those of the first catheter 50; the main difference is that the second catheter 54 needs to pierce the bladder 30 into the inside of the bladder 30, so the front end of the second catheter 54 is sharp.
  • an opening can be made in the patient's abdomen.
  • the small size of the opening is enough, and it is basically the same as the opening formed by traditional minimally invasive surgery. Therefore, the prognosis is very good, and it will not increase the patient's large health risk and economic burden.
  • the prostate gland removal device of the present invention may include a second catheter support 76 whose position and posture can be adjusted and fixed.
  • This kind of stent is widely used in existing surgical procedures, for example, an operating arm composed of multiple joints and connecting rods.
  • the improvement of the present invention has nothing to do with the specific structure of the operating arm or the stent. As long as the second conduit 54 can be supported and guided, it can be applied to the present invention.
  • a flange-shaped handle or manipulation part 74 may be formed at the rear end of the second catheter 54, which is suitable for the surgeon to push the second catheter 54 by hand.
  • a second catheter guide member in the form of a through hole may be formed on the second catheter holder 76 (reference number is not given).
  • a key-slot structure may be formed between the second duct guide member and the second duct 54.
  • the second conduit 54 can be used as a piston or a part of a piston rod of an electric, hydraulic or pneumatic cylinder.
  • the second duct 54 and the second duct guide member may serve as the piston and the piston rod or the piston rod and the piston of the cylinder, respectively. In these cases, the manipulation part 74 may be omitted.
  • a second catheter stopper 75 is also provided, which can limit the stroke of the second catheter 54 after the position and posture of the second catheter support 76 have been fixed to prevent the travel distance from being too large. The stabbing even pierced other parts of the bladder.
  • the limiting function can be realized by, for example, at least one of the following solutions: the second catheter stopper 75 is in contact with the second catheter stent 76 or the second catheter guide member; and the second catheter restricts the position.
  • the elastic buckle mechanism between the second catheter holder 76 and the second catheter guide member; through the optical or electromagnetic coupling between the second catheter stopper 75 and the second catheter support 76 or the second catheter guide member Activate the locking mechanism or stop providing power to the actuator.
  • the second catheter stopper 75 is shown as a disc-shaped structure in the figure, and realizes the stop function by contacting with the bracket 76. It can be understood that the second conduit stopper 75 can be designed into various suitable structures according to specific limiting principles, application occasions, equipment space and other factors. Any technology suitable for limiting the stroke of the second catheter 54 in the prior art can be considered for application in the present invention, such as the limiting technology used in the endoscopic device.
  • the second catheter stopper 75 in FIG. 4 is held on the outside of the second catheter 54.
  • "Holding” may be a fixed, non-adjustable relative relationship, such as being integral with the second conduit 54 or being fixed on the second conduit 54 by welding, fasteners, or the like. In this case, by adjusting the position and posture of the second catheter holder 76, the stroke of the second catheter can be limited.
  • "Holding” can also be an adjustable relative fixed relationship.
  • the second catheter stopper 75 is threadedly connected to the outside of the second catheter 75, or the second catheter stopper 75 can be along The outside of the second conduit 75 slides and forms an elastic snap structure (not shown) at two or more positions between the two. In this case, the stroke of the second catheter can be limited after the position and posture of the second catheter holder 76 have been fixed.
  • the enucleated gland 22 enters the bladder 30 (as shown in FIG. 1).
  • the fixation and fragmentation of the enucleated gland 22 is performed in the bladder 30.
  • the inner space and visual field of the bladder 30 are much larger, and the operation is more convenient; moreover, the bladder wall can be used as a "stopper" for the enucleated gland 22, combined with the anchoring of the present invention
  • the member can easily capture and fix the enucleated gland 22, and the enucleated gland 22 will not float freely in the bladder.
  • the gland fixing device includes an anchoring member 56. See FIG. 2.
  • the anchoring member 56 is an elongated rod structure, including a tip 60 formed at the front end and an anchoring portion 57 formed near the front end, wherein the tip 60 can penetrate and be enucleated.
  • the gland 22, the anchoring part 57 can prevent the enucleated gland 22 from falling off from the anchoring member 56.
  • the anchoring portion 57 in the example of FIG. 2 is formed by cutting a groove on the rod near the tip 60.
  • the groove may include a first face 58 facing away from the tip 60 and a second face 59 close to the tip 60, wherein the angle formed by the first face 58 and the rod surface is greater than the angle formed by the second face 59 and the rod surface, and the anchoring portion 57
  • the enucleated gland 22 will be trapped in the groove formed by the two faces, and will be caught by the second face 59 at the same time.
  • the groove-shaped anchoring parts 57 shown in the figure are discretely distributed on the surface or peripheral surface of the anchoring member 56, but as another example, the first and second surfaces may be complete peripheral surfaces, thus forming a circle To the groove.
  • the two surfaces may protrude beyond the surface of the member, and the first surface facing away from the tip 60 forms a right angle or an acute angle with the surface of the member, thereby forming a barb; and the first surface near the tip 60
  • the two sides form an obtuse angle with the surface of the member, so that the anchoring part can easily enter the gland 22 that has been enucleated.
  • Such barbs can be discretely distributed on the surface of the anchoring member 56 or can form a complete circle.
  • the anchoring device may be formed by an elastic piece on the member rod that protrudes obliquely outward away from the tip.
  • Fig. 3 shows another example of an anchoring member.
  • the surface of the member rod is formed with threads, and these threads can realize the anchoring function.
  • the relationship between the anchoring member 56 and the second catheter 54 is similar to the relationship between various actuators such as gland enucleation members, optical fibers and the first catheter 50 in the endoscopic device.
  • the anchoring member 56 is disposed in the second catheter 54, as the second catheter 54 enters the abdominal cavity through an opening on the abdominal skin, then pierces the bladder into the bladder, and is guided into the bladder through the second catheter 54. Then, the surgeon can find the enucleated gland 22 with the help of the optical fiber system.
  • the anchoring member 56 can be manipulated to press the enucleated gland 22 against the bladder wall to realize the correction of the enucleated gland 22.
  • the anchoring member 56 is manipulated further forward and the tip 60 is used to pierce the enucleated gland 22, and the anchoring portion 57 near the tip 60 realizes the final fixation of the enucleated gland 22.
  • the optical fiber system may be the optical fiber system (first optical fiber system) in the endoscope device.
  • another optical fiber system (second optical fiber system) can be introduced into the bladder through the second catheter 54 so that the brightness of the visual field can be significantly improved, and the operation of the enucleated gland 22 is more convenient.
  • the first optical fiber system and the second optical fiber system can share one image display device.
  • the gland fixing device further includes an anchor member bracket 72 on which an anchor guide member is formed, an anchor stopper 71, and an operating part 70.
  • the second catheter 54 adopts a direct penetration method similar to acupuncture, that is, the second catheter 54 only moves in translation without rotating.
  • the anchoring member 56 is aimed at the gland 22 that has been enucleated, and therefore, there is no restriction on the way of penetration.
  • the anchoring member 56 penetrates the enucleated gland 22 in a way that it penetrates while rotating.
  • the anchoring guide member (no reference numeral is given) is a threaded hole, that is, the anchoring member 56 is screwed to the bracket 72.
  • the operating portion 70 is located at the rear end of the anchor member 56 and may be integrally formed with the anchor member 56 or fixed to the rear end of the anchor member 56 by welding, fasteners, or the like.
  • the anchoring member 56 may be used as the output end of the rotating electric machine or the motor, a gearbox may be provided between the two, and alternatively, the electric machine or the motor may be of a servo type.
  • the structure and working mode of the anchor stopper 71 can be similar to the second catheter stopper 75, and will not be repeated here.
  • the structure and working mode of the anchoring guide member, anchoring stopper 71, and operating part 70 corresponding to the anchoring member 56 can be basically the same as those described above for the second catheter 54.
  • the adjustment of the anchoring member support 72 and the adjustment of the second catheter support 76 should be performed in association.
  • the two brackets are integrated, the relative positions of the two are specifically fixed, or the anchor member bracket 72 can only be adjusted relative to the second catheter bracket 76 within a limited range.
  • the improvement of the present invention has nothing to do with the specific structural design of the stent, as long as the advancement or retreat of the second catheter 54 and the advancement or retreat of the anchor member 56 in the second catheter 54 can be realized.
  • the gland crushing device 73 can be guided into the bladder through the second catheter 56, and then by means of the first tube
  • the optical fiber system introduced by the catheter 50 and/or the second catheter 54 is positioned near the enucleated gland 22 fixed by the anchor member 56 and breaks the gland fragments. Because there is enough space in the bladder, and the enucleated gland 22 cannot be moved, the present invention has no restrictions on the specific working principle and structure of the gland crushing device, that is, it can use the existing ones, especially those in hospitals.
  • the purchased gland crushing device does not have to spend a high cost, especially for the primary hospital, to purchase a dedicated prostate gland crushing device.
  • energy platforms such as resectoscopes, lasers, plasmas, and mechanical cutting devices can all be used as the gland crushing device of the present invention.
  • the cleaning and removing device used in the present invention can adopt the same scheme as the prior art, that is, pour the cleaning liquid into the bladder, and then extract the cleaning liquid together with the gland fragments formed after the enucleated glands are broken.
  • the cleaning and extraction device includes only one tube, which can be guided by the first catheter through the urethra into the prostatic fossa, and then the cleaning fluid is poured into the bladder through the tube, and then the cleaning fluid and gland fragments are drawn out together.
  • the filling and withdrawal of the cleaning solution can be performed separately via two separate pipes.
  • the cleaning and taking out device includes a cleaning fluid perfusion tube and a cleaning fluid extraction tube, wherein the cleaning fluid perfusion tube can be guided into the prostatic fossa through the first catheter, and the cleaning fluid is poured into the bladder, and the cleaning fluid The extraction tube can be guided into the bladder through the second catheter and withdraw the cleaning fluid and gland fragments from the bladder.
  • the second catheter can be used as a guide member of the anchoring member, for example, the two can be screwed together; the gland crushing device can be guided into the bladder via the first catheter.
  • the method for removing a gland using the prostate gland removal device of the present invention will be described below with reference to FIG. 1.
  • the method includes the following steps: guiding the first catheter along the urethra 12 to the vicinity of the prostate 20; and enucleating the gland 52 Guide the diseased gland through the first catheter 50 and enucleate the diseased gland; introduce the second catheter 54 with a sharp tip into the abdominal cavity through the opening in the skin, and make it pierce the bladder into the bladder; insert the anchoring member 56 Guided via the second catheter 54 to the vicinity of the enucleated gland 22 located in the bladder, the anchoring member 56 includes a tip 60 formed at the front end and an anchoring portion 57 formed near the front end, so that the tip 60 of the anchoring member 56 penetrates the
  • the enucleated gland 22 and its anchoring part 57 are used to prevent the enucleated gland 22 from falling off the anchoring member 56; the gland crushing device 73 is guided through the first duct 50 or the second duct 54 to be fixed
  • the steps listed in the method for removing prostate glands of the present invention can be performed in any suitable sequence that conforms to common sense, that is, the description order and the actual execution order of the steps included in the above method Irrelevant.
  • the first catheter and the second catheter can be inserted into the patient's body simultaneously or sequentially, that is, no matter which catheter is inserted first or both catheters are inserted at the same time, it does not affect the realization of the method of the present invention.
  • the present invention needs to additionally provide a second catheter and its accessory device for piercing the abdominal skin and bladder, however, Since the wound caused by the puncture is very small, the impact on the patient is very small; at the same time, this double catheter structure provides great flexibility for the design and layout of various components, and the space in the bladder is much larger than that of the prostate gland.
  • the socket provides great flexibility for the design of the gland anchoring component, making its structure very simple and effective, and the larger space in the bladder provides a larger field of vision, which also creates favorable conditions for providing better brightness. It facilitates the operation of the enucleated glands.
  • the dual-pipe design of the present invention can make full use of existing and purchased equipment without the need to purchase expensive special equipment. Therefore, generally speaking, the prostate gland removal device of the present invention is not only low in cost, convenient to operate, and good in surgical effect.

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Abstract

一种前列腺腺体移除设备，包括内窥镜装置、腺体固定装置、腺体破碎装置(73)和清洗取出装置。内窥镜装置包括第一导管(50)和腺体剜除构件(52)。腺体固定装置包括第二导管(54)和锚固构件(56)。第二导管(54)的前端是尖锐的，能够经过皮肤上的开孔进入腹腔并刺穿膀胱进入膀胱内部。锚固构件(54)包括在前端形成的尖端(60)和在前端附近形成的锚固部分(57)。腺体破碎装置(73)能够经由第一导管(50)或第二导管(54)被引导至由锚固构件(54)固定住的被剜除腺体(22)并将其破碎成腺体碎片。清洗取出装置能够经由第一导管(50)或者经由第一导管(50)和第二导管(54)，将清洗液灌入膀胱内并将清洗液和腺体碎片一起抽出。利用该前列腺腺体移除设备，不仅成本低、操作方便，而且手术效果好。还公开了相应的移除方法。

Description

前列腺腺体移除设备和移除方法 技术领域
本发明涉及一种用于移除前列腺病变腺体的前列腺腺体移除设备和移除方法。
背景技术
前列腺切除手术作为治疗良性前列腺增生的一种安全、有效的术式，被越来越多泌尿外科医生采纳。从膀胱内取出切除下来的增生腺体是该手术的重要环节。
目前主要有三种取出方式。第一种方式是，采用开放手术在耻骨上切开膀胱，取出剜除的增生腺体。这种方案仅适用于少数膀胱合并有巨大结石的患者，而且开放手术膀胱切开对年老患者创伤较大，增加患者痛苦，有潜在切口不愈合风险。
第二种方式是，利用电切镜腔内将增生腺体切成碎片，然后利用冲吸器吸出。这种方案适用范围广且患者容易接受，而且这种方案的成本低，尤其适用于经费有限的基层医院。然而，利用这种方式，在进行前列腺切除手术的过程中，需要刻意保留部分组织以将腺体相对固定于前列腺窝当中，便于收获性电切。在这种情况下，由于视野不够清晰，操作空间受限，腺体固定位置不灵活，有时需要反复辨识收获性电切的界限，避免电切过度等因素的影响，因而切除效率不高。有时还会发生腺体完全推离前列腺窝进入膀胱的情况，此时因为缺乏相对固定的支点，前列腺标本在膀胱中漂浮，收获性电切效率会更低。
第三方式是，将增生腺体整体剜除，然后利用通过经由内窥镜置入的成本高昂的负压系统吸附固定被剜除下来的腺体，并理由专用组织搅碎器搅碎。这种方案易于固定并将增生腺体搅碎吸出，速度快，但需要购置专用设备，成本高，难以广泛推广，特别是对于经费有限的基层医院。
发明内容
本发明的目的是克服上述现有技术中的一种或者几种技术问题，提出一种前列腺腺体移除设备，能够以较低的成本较为彻底地移除病变腺体。
相应地，本发明提供了一种前列腺腺体移除设备，包括内窥镜装置、腺体固定装置、腺体破碎装置和清洗取出装置。内窥镜装置包括第一导管和腺体剜除构件。第一导管能够沿着尿道延伸至前列腺附近。腺体剜除构件能够经由第一导管被引导至病变腺体处并将病变腺体剜除。腺体固定装置包括第二导管和锚固构件。第二导管的前端是尖锐的，能够经过皮肤上的开孔进入腹腔并刺穿膀胱进入膀胱内部。锚固构件包括在前端形成的尖端和在前端附近形成的锚固部分。锚固构件能够经由第二导管被引导至位于膀胱内的被剜除的腺体附近，其尖端能够刺入被剜除的腺体，其锚固部分能够防止被剜除的腺体从锚固构件脱落。腺体破碎装置能够经由第一导管或第二导管被引导至由锚固构件固定住的被剜除腺体并将其破碎腺体碎片。清洗取出装置能够经由第一导管或者经由第一导管和第二导管，将清洗液灌入膀胱内并将清洗液和腺体碎片一起抽出。
在一种具体实施例中，清洗取出装置包括仅一个管件，能够由第一导管被引导至前列腺窝内，通过该一个管件将清洗液灌入膀胱内并将清洗液和腺体碎片一起抽出。
在一种具体实施例中，清洗取出装置包括：清洗液灌注管件，清洗液灌注管件能够能够经由第一导管被引导至前列腺窝内，并将清洗液灌入膀胱内；清洗液抽出管件，清洗液抽出管件能够经由第二导管被引导至膀胱内，并将清洗液和腺体碎片一起从膀胱内抽出。
在一种具体实施例中，内窥镜装置还包括能够将外部光源的光传输至人体内部的光源光纤和能够将人体内部的图像传输到人体外部的成像光纤，光源光纤和成像光纤能够由第一导管引导至前列腺附近。
在一种具体实施例中，腺体固定装置还包括能够将外部光源的光传输至人体内部的光源光纤和能够将人体内部的图像传输到人体外部的成像光纤，光源光纤和成像光纤由第二导管引导至膀胱内。
在一种具体实施例中，腺体固定装置还包括位置和姿态能够调整并固定的第二导管支架，第二导管支架上形成有第二导管引导构件，用于对第二导管进行支撑和引导。进一步，腺体固定装置还可以包括第二导管限位器，第二导管限位器保持在第二导管的外部，用于通过与第二导管支架和引导构件之一作用而防止第二导管向前行进。作为一个例子，第二导管限位器可调节地保持在第二导管的外部，例如，可以螺纹联结于第二导管的外部。
在一种具体实施例中，腺体固定装置还包括锚固构件支架，锚固构件支架上形成有锚固引导构件，用于对锚固构件进行支撑和引导。进一步，腺体固定装置还可以包括锚固限位器，锚固限位器保持在锚固构件的外部，用于通过与锚固构件支架和锚固引导构件之一作用而防止锚固构件向前行进。作为一个例子，锚固限位器可调节地保持在锚固构件的外部。例如，锚固限位器可以螺纹联结于锚固构件的外部。
本发明还提供了一种前列腺腺体移除方法，包括如下步骤：将第一导管沿着尿道引导至前列腺附近；将腺体剜除构件经由第一导管引导至病变腺体处并将病变腺体剜除；将前端尖锐的第二导管经过皮肤上的开孔引入腹腔，并使其刺穿膀胱进入膀胱内部；将锚固构件经由第二导管引导至位于膀胱内的被剜除的腺体附近，锚固构件包括在前端形成的尖端和在前端附近形成的锚固部分，使锚固构件的尖端刺入被剜除的腺体并利用其锚固部分防止被剜除的腺体从锚固构件脱落；将腺体破碎装置经由第一导管或第二导管引导至由锚固构件固定住的被剜除腺体，并将其破碎成腺体碎片；使清洗取出装置经由第一导管或者经由第一导管和第二导管将清洗液灌入膀胱内，并将清洗液和腺体碎片一起抽出。
根据本发明的前列腺腺体移除设备和移除方法，可以通过经由尿道引入病变腺体处的内窥镜设备将病变腺体整体剜除，被剜除的腺体的固定和破碎不是在腺体窝处进行的，而是在膀胱内完成的。因此，操作空间大，视野好。而且，经腹部进入膀胱内的锚固构件，可以采用非常简单的结构，成本非常低廉，同时可以非常有效地固定住膀胱内被剜除的腺体。接着，根据本发明，可以使用各种现有的、特别是医院已经购入的破碎构件或能量平台，对被固定住的腺体进行破碎。最后，可以使用各种现有的、特别是医院已经购入的清洗取出装置，将腺体碎片从膀胱内取出。可见，利用本发明的前列腺腺体移除设备，能够以较低的成本较为彻底地移除病变腺体。
附图说明
本发明的附图以举例的方式对本发明实施例进行图解说明，这些附图仅仅是示意性的，为了清楚地解释本发明的原理，对构件的相互关系进行了夸大的显示，没有按照真实比例。其中：
图1为本发明前列腺腺体移除设备一种实施例的使用状态示意图；
图2和图3分别为本发明前列腺腺体移除设备中锚固构件的两种实施例的示意图；
图4为本发明前列腺腺体移除设备一种实施例中包括第二导管和锚固构件的部分的剖视示意图。
具体实施方式
下面参照附图，描述本发明前列腺腺体移除设备的具体实施方式。
在本发明中，方向性术语是参照手术过程中的患者确定的，例如，设备、装置或构件的“前端”是指朝向患者或者患者病变部位的端部，相应地，“前行”或“前进”是指朝向患者或者患者病变部位行进；而“后端”是指背离患者或者患者病变部位的端部，相应地，“后退”是指背离患者或者患者病变部位行进。
参见附图1，图中示意性地本发明前列腺腺体移除设备的一种具体实施例在手术过程中的使用状态。这种前列腺腺体移除设备由两个部分组成，一个部分经由尿道对腺体进行操作，另一个部分穿过腹部和膀胱，在膀胱内对被剜除的腺体进行操作。
经由尿道的部分是内窥镜装置。作为本领域的公知常识，内窥镜装置包括光纤系统(图中没有示出)，光纤系统一般包括能够将外部光源的光传输至人体内部的光源光纤和能够将人体内部的图像传输到人体外部的成像光纤。本发明的改进之处与光纤系统无关。
作为本领域的公知常识，内窥镜装置包括导管，在本发明中称为第一导管50。第一导管50通过患者阴茎10的尿道口插入尿道12中，同时将光源光纤和成像光纤引入尿道12中。于是，手术的医师可以借助图像显示设备(未示出)，将第一导管50沿着尿道12一直插入到前列腺20的附近。
内窥镜装置还包括腺体剜除构件52，腺体剜除构件52经由第一导管50被引导至病变腺体处并将病变腺体剜除。本发明的改进不涉及腺体剜除技术的具体内容，因此，现有技术中的各种腺体剜除技术以及相应结构的腺体剜除构件，都可以应用在本发明中。应该理解，就从腺体窝分离腺体而言，“剜除”与“切碎”是不同的。前者是将病变腺体几乎完整地从腺体窝中分离出来，而后者是在腺体保持在腺体窝内的情况下用例如电切镜、激光、等离子体等能量平台一片片或一层层地切除。本发明采用了腺体剜除技术，因此， 切除效率高而且彻底，患者一般不会复发前列腺疾病。
继续参见图1。本发明前列腺腺体移除设备中穿过腹部和膀胱的部分是腺体固定装置。腺体固定装置包括第二导管54。第二导管54的材料、制造工艺和结构与第一导管50基本相同；主要的不同是，第二导管54要刺穿膀胱30进入膀胱30的内部，因此第二导管54的前端是尖锐的。为了将第二导管送入体内，可以先在患者腹部处开一个开孔。这种开孔尺寸很小就足够了，与传统微创手术形成的开孔是基本相同的，因此，预后非常好，不会为患者增加大的健康风险和经济负担。
参见图4。为了对第二导管54进行支撑和引导，本发明前列腺腺体移除设备可以包括位置和姿态能够调整并固定的第二导管支架76。这种支架在现有的手术过程中是广泛采用的，例如，包括多个关节和连杆组成的操作臂。本发明的改进与操作臂或者支架的具体结构无关，只要能够实现对第二导管54的支撑和引导，就可以应用在本发明中。
在图4所示的具体例子中，可以在第二导管54的后端形成凸缘形状的把手或操控部分74，适合于手术医师用手推动第二导管54。相应地，可以在第二导管支架76上形成有通孔形式的第二导管引导构件(没有给出附图标记)。本领域技术人员应该能够按照常识性设计方法确定这种通孔的长径比和/或表面粗糙度，并选用任何合适的材料。作为进一步的例子(没有示出)，第二导管引导构件与第二导管54之间可以形成键-槽结构。
作为另一个例子(没有示出)，第二导管54可以作为电动、液力或气动作动缸的活塞或活塞杆的一部分。作为又一个例子，第二导管54和第二导管引导构件可以分别作为作动缸的活塞和活塞杆或者活塞杆和活塞。在这些情况下，操控部分74可以省略。
在图4所示的具体例子中，还设置有第二导管限位器75，可以在第二导管支架76的位置和姿态已经固定之后，限制第二导管54的行程，防止其行进距离过大而刺伤甚至刺穿膀胱的其他部分。限位功能可以例如通过下面例举的几种方案中的至少一种还实现：通过第二导管限位器75与第二导管支架76或第二导管引导构件相接触；通过第二导管限位器75与第二导管支架76或第二导管引导构件之间的弹性卡扣机构；通过第二导管限位器75与第二导管支架76或第二导管引导构件之间的光学或电磁耦合来触动锁紧机构或者停止给作动缸提供动力。第二导管限位器75在图中显示是盘状结构， 通过与支架76接触实现限位功能。可以理解，第二导管限位器75可以根据具体的限位原理和应用场合以及设备空间等因素，设计成各种适合结构。现有技术中任何适合于限制第二导管54的行程的技术都可以考虑应用在本发明中，例如内窥镜装置中使用的限位技术。
图4中的第二导管限位器75保持在第二导管54的外部。“保持”可以是一种固定的、不可调节的相对关系，例如与第二导管54是一体的，或者通过焊接、紧固件等固定在第二导管54上。在这种情况下，通过调整第二导管支架76的位置和姿态，可以限定第二导管的行程。“保持”也可以是一种可调节的相对固定关系，例如如图4所示，第二导管限位器75螺纹联结于第二导管75的外部，或者第二导管限位器75可以沿着第二导管75的外部滑动并在二者之间两个以上位置处形成弹性卡扣结构(未示出)。在这种情况下，可以在第二导管支架76的位置和姿态已经固定之后，对第二导管的行程进行限定。
下面参照图1至图4，描述本发明的锚固构件56。
利用经由尿道12进入体内的腺体剜除构件52，将前列腺腺体从腺体窝剜除后，被剜除的腺体22进入到膀胱30内(如图1所示)。根据本发明，对被剜除的腺体22的固定和破碎是在膀胱30内进行的。与前列腺腺体窝相比，膀胱30内空间和视野都要大得多，操作起来更加方便；而且，膀胱壁可以作为被剜除的腺体22的“限位器”，结合本发明的锚固构件，可以容易地捕获并固定被剜除的腺体22，不会出现被剜除的腺体22在膀胱内随意漂浮的状况。
腺体固定装置包括锚固构件56，参见图2锚固构件56是一种细长杆结构，包括在前端形成的尖端60和在前端附近形成的锚固部分57，其中，尖端60能够刺入被剜除的腺体22，锚固部分57能够防止被剜除的腺体22从锚固构件56脱落。图2例子中的锚固部分57是通过在尖端60附近的杆体上切割出凹槽形成的。凹槽可以包括背离尖端60的第一面58和靠近尖端60的第二面59，其中，第一面58与杆表面形成的角度大于而第二面59与杆表面形成的角度，锚固部分57一旦进入被剜除的腺体22中，被剜除的腺体22就会陷在这两个面形成的凹槽中，同时被第二面59卡住。图中所示的凹槽形锚固部分57是离散地分布在锚固构件56的表面或者周面上，但作为另一个例子，第一、二面可以是完整的周面，因此，形成一圈周向的凹槽。作为 又一个例子(未示出)，这两个面可以是突出于构件表面之外，并且背离尖端60的第一面与构件表面形成直角或锐角，从而形成倒钩；而靠近尖端60的第二面与构件表面形成钝角，使得锚固部分易于进入被剜除的腺体22中。这种倒钩既可以离散地分布在锚固构件56的表面上，也可以形成完整的一圈。作为又一个例子(未示出)，锚固装置可以由构件杆上背离尖端斜向外突出的弹性片形成。图3示出了又一种锚固构件的例子，构件杆的表面形成有螺纹，这些螺纹可以实现锚固功能。
锚固构件56与第二导管54的关系与内窥镜装置中腺体剜除构件、光纤等各种执行机构与第一导管50的关系类似。具体地说，锚固构件56设置在第二导管54内，随着第二导管54经过腹部皮肤上的开孔进入腹腔然后刺穿膀胱进入膀胱内，而经由第二导管54被引导至膀胱内。然后，手术医师可以借助于光纤系统找到被剜除的腺体22，同时或者之后，操控锚固构件56将被剜除的腺体22顶靠在膀胱壁上，实现对被剜除的腺体22的初步固定；然后，操控锚固构件56进一步前行而利用尖端60刺入被剜除的腺体22，在尖端60附近的锚固部分57进而实现了对被剜除的腺体22的最终固定。
光纤系统可以是内窥镜装置中的光纤系统(第一光纤系统)。作为一个例子，还可以经由第二导管54将另外的光纤系统(第二光纤系统)引入到膀胱内，这样可以明显地改善视野的亮度，更加方便对被剜除的腺体22的操作。第一光纤系统和第二光纤系统可以共用一个图像显示设备。
参见图4，与上面针对第二导管54描述类似，腺体固定装置还包括上面形成有锚固引导构件的锚固构件支架72和锚固限位器71以及操作部分70。考虑到刺入时应该对膀胱组织的损失尽可能小，第二导管54采用的是类似针刺的直接刺入方式，即第二导管54仅仅平动而不转动。锚固构件56针对的是被剜除的腺体22，因此，对于刺入方式没有限制。例如，在图4中，锚固构件56刺入被剜除的腺体22中的方式是一边旋转一边刺入。相应地，锚固引导构件(没有给出附图标记)是螺纹孔，即锚固构件56与支架72螺纹联结。操作部分70位于锚固构件56的后端，可以与锚固构件56一体形成或者通过焊接、紧固件等固定在锚固构件56的后端。在另一例子中(未示出)，锚固构件56可以作为旋转电机或马达的输出端，二者之间可以设有变速箱，并且或者，电机或马达可以是伺服类型的。
锚固限位器71的结构和工作方式可以与第二导管限位器75类似，这里 不再赘述。另外，对应于锚固构件56的锚固引导构件、锚固限位器71和操作部分70的结构和工作方式，可以采用与上面所描述针对第二导管54基本相同的方案。
应该理解的是，因为锚固构件56是位于第二导管54中的，所以，锚固构件支架72的调整与第二导管支架76的调整应该关联进行。例如，两个支架是一体的，二者具体固定的相对位置，或者锚固构件支架72仅仅能相对于第二导管支架76在限定范围内调整。本发明的改进与支架的具体结构设计无关，只要能够实现第二导管54的前进或后退以及锚固构件56在第二导管54中的前进或后退即可。
参见图1和图4，当锚固构件56在膀胱20内固定住被剜除的腺体22后，就可以将腺体破碎装置73经由第二导管56引导至膀胱内，然后借助于经第一导管50和/或第二导管54引入的光纤系统，定位在由锚固构件56固定住的被剜除腺体22附近，并将其破碎腺体碎片。因为在膀胱内具有足够的空间，而且被剜除的腺体22无法移动，所以，本发明对于腺体破碎装置的具体工作原理和结构没有限制，即完全可以使用现有的、特别是医院已经购入的腺体破碎装置，而不必花费特别是对于基层医院来说高昂的费用购入专用前列腺腺体搅碎装置。例如，电切镜、激光、等离子体等能量平台、机械式切割装置，都可以用作本发明的腺体破碎装置。
在本发明中采用的清洗取出装置，可以采用与现有技术相同的方案，即将清洗液灌入膀胱中，然后将清洗液连同破碎了被剜除的腺体后形成的腺体碎片一起抽出体外。例如，清洗取出装置包括仅一个管件，该一个管件能够由第一导管经尿道引导至前列腺窝内，然后通过该管件将清洗液灌入膀胱内，之后将清洗液和腺体碎片一起抽出。作为一个例子，清洗液的灌注和抽出可以经由两个单独的管件分开进行。作为又一个例子，清洗取出装置包括清洗液灌注管件和清洗液抽出管件，其中，清洗液灌注管件能够能够经由第一导管被引导至前列腺窝内，并将清洗液灌入膀胱内，而清洗液抽出管件能够经由第二导管被引导至膀胱内，并将清洗液和腺体碎片从膀胱内抽出。
作为本发明的另一种实施例(未示出)，第二导管内仅设有锚固构件。在这种情况下，第二导管可以作为锚固构件的引导构件，例如，二者之间可以是螺纹联接；腺体破碎装置可以经由第一导管被导引到膀胱内。
下面参照图1描述利用上述本发明的前列腺腺体移除设备移除腺体的方 法，该方法包括如下步骤：将第一导管沿着尿道12引导至前列腺20附近；将腺体剜除构件52经由第一导管50引导至病变腺体处并将病变腺体剜除；将前端尖锐的第二导管54经过皮肤上的开孔引入腹腔，并使其刺穿膀胱进入膀胱内部；将锚固构件56经由第二导管54引导至位于膀胱内的被剜除的腺体22附近，锚固构件56包括在前端形成的尖端60和在前端附近形成的锚固部分57，使锚固构件56的尖端60刺入被剜除的腺体22并利用其锚固部分57防止被剜除的腺体22从锚固构件56脱落；将腺体破碎装置73经由第一导管50或第二导管54引导至由锚固构件56固定住的被剜除腺体22，并将其破碎成腺体碎片；使清洗取出装置经由第一导管50或者经由第一导管50和第二导管54将清洗液灌入膀胱内，并将清洗液和腺体碎片一起抽出。
本领域技术人员应该明白，上述本发明的前列腺腺体移除方法中所列各步骤可以按照任何合适的符合常识的顺序执行，也就是说，上述方法所包含步骤的描述顺序与实际的执行顺序无关。例如，第一导管和第二导管插入患者体内可以是同时进行的，也可以是先后进行的，即不管先插入哪个导管还是同时插入两个导管，均与不影响本发明方法的实现。
从上面对本发明的描述可以明白，虽然与现有技术的电切镜技术和内窥镜技术相比，本发明需要通过另外设置刺穿腹部皮肤和膀胱的第二导管及其附属装置，然而，由于刺穿产生的创口非常小，对患者的影响非常小；与此同时，这种双导管结构为各种组成部件的设计布局提供了非常大的灵活性，膀胱内的空间远大于前列腺腺体窝为腺体锚固构件的设计提供了非常大的灵活性，使得其结构非常简单有效，而且膀胱内的较大空间提供了更大的视野，也为提供更好的亮度创造的有利条件，大大方便了对被剜除的腺体的操作。另外，本发明的这种双导管设计可以充分利用现有和已购入的设备，无需购入费用不菲的专用设备。因此，总体上讲，本发明的前列腺腺体移除设备不仅成本低、操作方便，而且手术效果好。

Claims (14)

  1. 一种前列腺腺体移除设备，包括：
    内窥镜装置，其包括：
    第一导管(50)，第一导管(50)能够沿着尿道(12)延伸至前列腺(20)附近，和
    腺体剜除构件(52)，腺体剜除构件(52)能够经由第一导管(50)被引导至病变腺体处并将病变腺体剜除；
    腺体固定装置，其包括：
    第二导管(54)，第二导管(54)的前端是尖锐的，能够经过皮肤上的开孔进入腹腔并刺穿膀胱进入膀胱内部，和
    锚固构件(56)，锚固构件(56)包括在前端形成的尖端(60)和在前端附近形成的锚固部分(57)，锚固构件(56)能够经由第二导管(54)被引导至位于膀胱内的被剜除的腺体(22)附近，其尖端(60)能够刺入被剜除的腺体(22)，其锚固部分(57)能够防止被剜除的腺体(22)从锚固构件(56)脱落；
    腺体破碎装置(73)，腺体破碎装置(73)能够经由第一导管(50)或第二导管(54)被引导至由锚固构件(56)固定住的被剜除腺体(22)，并将其破碎成腺体碎片；以及
    清洗取出装置，清洗取出装置能够经由第一导管(50)或者经由第一导管(50)和第二导管(54)将清洗液灌入膀胱内，并将清洗液和腺体碎片一起抽出。
  2. 根据权利要求1所述的前列腺腺体移除设备，其中，清洗取出装置包括仅一个管件，该一个管件能够由第一导管(50)引导至前列腺窝内，通过该一个管件将清洗液灌入膀胱内，并将清洗液和腺体碎片一起抽出。
  3. 根据权利要求1所述的前列腺腺体移除设备，其中，清洗取出装置包括：
    清洗液灌注管件，清洗液灌注管件能够能够经由第一导管(50)被引导至前列腺窝内，并将清洗液灌入膀胱内，
    清洗液抽出管件，清洗液抽出管件能够经由第二导管(54)被引导至膀胱内，并将清洗液和腺体碎片一起从膀胱内抽出。
  4. 根据权利要求1所述的前列腺腺体移除设备，其中，内窥镜装置还 包括能够将外部光源的光传输至人体内部的光源光纤和能够将人体内部的图像传输到人体外部的成像光纤，光源光纤和成像光纤能够由第一导管(50)引导至前列腺附近。
  5. 根据权利要求1所述的前列腺腺体移除设备，腺体固定装置还包括能够将外部光源的光传输至人体内部的光源光纤和能够将人体内部的图像传输到人体外部的成像光纤，光源光纤和成像光纤由第二导管(54)引导至膀胱内。
  6. 根据权利要求1所述的前列腺腺体移除设备，腺体固定装置还包括位置和姿态能够调整并固定的第二导管支架(76)，第二导管支架(76)上形成有第二导管引导构件，用于对第二导管(54)进行支撑和引导。
  7. 根据权利要求6所述的前列腺腺体移除设备，腺体固定装置还包括第二导管限位器(75)，第二导管限位器(75)保持在第二导管(54)的外部，用于通过与第二导管支架(76)和引导构件之一作用而防止第二导管(54)向前行进。
  8. 根据权利要求7所述的前列腺腺体移除设备，第二导管限位器(75)可调节地保持在第二导管(54)的外部。
  9. 根据权利要求8所述的前列腺腺体移除设备，第二导管限位器(75)螺纹联结于第二导管(54)的外部。
  10. 根据权利要求1所述的前列腺腺体移除设备，腺体固定装置还包括锚固构件支架(72)，锚固构件支架(72)上形成有锚固引导构件，用于对锚固构件(56)进行支撑和引导。
  11. 根据权利要求10所述的前列腺腺体移除设备，腺体固定装置还包括锚固限位器(71)，锚固限位器(71)保持在锚固构件(71)的外部，用于通过与锚固构件支架(72)和锚固引导构件之一作用而防止锚固构件(56)向前行进。
  12. 根据权利要求11所述的前列腺腺体移除设备，其中，锚固限位器(71)可调节地保持在锚固构件(71)的外部。
  13. 根据权利要求11所述的前列腺腺体移除设备，其中，锚固限位器(71)螺纹联结于锚固构件(71)的外部。
  14. 一种前列腺腺体移除方法，包括：
    将第一导管沿着尿道(12)引导至前列腺(20)附近；
    将腺体剜除构件(52)经由第一导管(50)引导至病变腺体处并将病变腺体剜除；
    将前端尖锐的第二导管(54)经过皮肤上的开孔引入腹腔，并使其刺穿膀胱进入膀胱内部；
    将锚固构件(56)经由第二导管(54)引导至位于膀胱内的被剜除的腺体(22)附近，锚固构件(56)包括在前端形成的尖端(60)和在前端附近形成的锚固部分(57)，使锚固构件(56)的尖端(60)刺入被剜除的腺体(22)并利用其锚固部分(57)防止被剜除的腺体(22)从锚固构件(56)脱落；
    将腺体破碎装置(73)经由第一导管(50)或第二导管(54)引导至由锚固构件(56)固定住的被剜除腺体(22)，并将其破碎成腺体碎片；
    使清洗取出装置经由第一导管(50)或者经由第一导管(50)和第二导管(54)将清洗液灌入膀胱内，并将清洗液和腺体碎片一起抽出。
PCT/CN2021/073288 2019-12-31 2021-01-22 前列腺腺体移除设备和移除方法 WO2021136557A1 (zh)

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