WO2023178836A1

WO2023178836A1 - Liver puncture outfit

Info

Publication number: WO2023178836A1
Application number: PCT/CN2022/097549
Authority: WO
Inventors: 熊力
Original assignee: 中南大学
Priority date: 2022-03-22
Filing date: 2022-06-08
Publication date: 2023-09-28
Also published as: CN114366254B; CN114366254A

Abstract

Provided is a liver puncture outfit, which relates to an intrahepatic blood flow blocking instrument, and comprises a sleeve (1), the head end thereof being provided with a V-shaped clamping nozzle (11), the tail end thereof being provided with a sleeve ring (12), the outer edge of the sleeve (1) being provided with an air bag (13) disposed along the axial direction of the sleeve (1), the outer edge of the air bag (13) being provided with an expansion sleeve (14) having a smooth outer surface, the air bag (13) being capable of pushing the radius of the expansion sleeve (14) to change, and the sleeve (1) being provided with scales; and a core rod (2), comprising a rod body (21) with an angle instrument, a spine end (22) provided with a feedback element, and a holding part (23), the spine end (22) being arranged at one end of the rod body (21), and the holding part (23) being arranged at the other end of the rod body (21). The core rod (2) can be inserted into the sleeve (1) and be in smooth contact with the inner surface of the sleeve (1), the sleeve ring (12) and the holding part (23) are arranged in a limiting manner, and when the core rod (2) is inserted into the sleeve (1), the spine end (22) is higher than the V-shaped clamping nozzle (11), and the expansion sleeve (14) is used as a movable piece. In the process of puncturing the liver and establishing the channel, the expansion sleeve (14) extrudes the punctured liver by means of expansion to achieve the purpose of hemostasis, and the expansion sleeve (14), before exiting the core rod (2), can pass through the tunnel of the sleeve (1) and be accurately placed, so as to clip the blood vessel in front of the V-shaped clamping nozzle (11), thereby achieving blood flow blocking.

Description

A liver puncture device

Cross-references to related applications

This application claims the rights and interests of Chinese patent application 202210279311.0 submitted on March 22, 2022. The contents of this application are incorporated herein by reference.

Technical field

The present invention relates to minimally invasive surgical equipment, in particular to a liver puncture device.

Background technique

The liver is a solid organ with extremely rich blood flow, and its total blood flow can account for 1/4 of cardiac output. Hepatectomy is a technique to remove part of the liver parenchyma. The most critical problem in this process is to control bleeding. Once bleeding and other problems occur, the patient may die, with extremely serious consequences. Therefore, hepatic blood flow occlusion control technology has become an important auxiliary method for liver resection technology. In 1908, Pringle first invented the first porta hepatis occlusion technology, pioneering the occlusion of extrahepatic blood flow: this technology ligated the hepatoduodenal ligament outside the liver, blocking all blood flow channels into the liver as a whole to achieve control. Bleeding. Since then, researchers have developed various blocking technologies on this basis, promoting the rapid development of liver surgery. Although they are simple and effective, because they are all indiscriminate extrahepatic blockade, if the blockade is excessive or for too long, it can easily cause serious complications such as ischemia-reperfusion injury of the whole liver, postoperative liver failure and death. . Therefore, how to block hepatic blood flow appropriately and effectively while ensuring the lowest degree of damage has always been an important issue discussed and researched by the medical community.

On the other hand, the newly developed anatomical liver resection technology is based on the characteristics of the gradual branching and segmental supply of blood vessels in the liver to remove the liver tissue dominated by a certain level of main blood vessels. This method is based on the anatomical distribution of intrahepatic blood vessels. This unique resection method is highly praised because it can completely remove lesions such as tumors and stones. This technique has higher requirements for hepatic blood flow occlusion, and requires a clear and fluoroscopy-like understanding of the distribution of intrahepatic blood vessels. However, the liver tissue is an opaque solid organ filled with red blood. The operator cannot see through the location of the blood vessels. He can only make empirical inferences based on preoperative examinations, or perform real-time detection through intraoperative ultrasound, CT and other solutions. The former is obviously not accurate enough based on subjective judgment, while the latter is complicated to operate, has expensive supporting equipment, and has low accuracy or is affected by real-time position changes of organ movement, making it difficult to distinguish finely and implement it universally.

We creatively put forward the theory of direct puncture into the organ for hemostasis and the theory of three-dimensional topography of the surgical field, which accurately controls the blood flow from the main blood vessels outside the parenchyma visible to the naked eye to the branch blood vessels in the parenchyma, and also controls the blood flow of the resected organs and tissues. The real-time anatomical position is coordinated, thus laying the foundation for future fully automated surgical resection. Accordingly, we have developed a new theory of intrahepatic blood flow occlusion and a device that accurately determines the location of intrahepatic blood vessels and other tissue structures in real time, allowing the operator to most accurately control the blood flow of the diseased liver segment and perform real-time and accurate treatment. Rapidly locating anatomical structures within parenchymal organs can assist in the high-quality and rapid completion of various surgeries including hemostasis of anatomical liver resection.

Contents of the invention

The present invention provides a liver puncture device, which aims to provide a theory of intrahepatic blood flow blocking and a device for accurately determining the position of intrahepatic blood vessels and other tissue structures in real time.

In order to achieve the above objects, embodiments of the present invention provide a liver puncture device, including:

Sleeve, one end of the sleeve is provided with a V-shaped snap-in mouth, and the other end is provided with a sleeve ring, the sleeve ring is provided on the end face of the sleeve, and the outer edge of the sleeve is provided with an air bag, The air bag is arranged along the axial direction of the sleeve, and the outer edge of the air bag is provided with an expansion sleeve with a smooth outer surface. The air bag can push the expansion sleeve to move in a diameter direction away from the center of the sleeve;

The core rod includes a rod body, a spiked end and a holding part, the spiked end is provided at one end of the rod body, and the holding part is provided at the other end of the rod body;

The core rod can be inserted into the sleeve and the rod body is in smooth contact with the inner surface of the sleeve. A limiting structure is provided between the sleeve ring and the holding portion. The core rod When plugged into the sleeve, the spiked end is higher than the V-shaped snap mouth.

Preferably, the expansion sleeve includes a plurality of expansion units connected end to end. The expansion unit includes an outer wall and a connecting piece. Both the connecting piece and the outer wall are arc-shaped. The center of the outer wall is in line with the sleeve. The centers of the circles coincide with each other, the curvature bending direction of the outer wall is opposite to the curvature bending direction of the connecting piece, and the airbag is arranged between the interval formed by the connecting piece and the sleeve.

Preferably, the airbag is in the shape of a long strip, and multiple airbags are connected to the same main bag. The main bag is annular, and the main bag ring is located at one end of the sleeve close to the sleeve ring. The main bag is provided with an air nozzle connected to an external inflation device.

Preferably, the sleeve is provided with a scale, the scale is arranged along the length direction of the sleeve, and the expansion sleeve is made of transparent material.

Preferably, the outer surface of the outer wall is provided with a transparent expansion layer.

Preferably, the sleeve ring is provided with a limiting hole on the side wall, the holding portion is provided with a cavity, a vortex spring is provided in the cavity, and a limiting rod is provided on the outer ring of the vortex spring, so The limiting rod protrudes from the side wall of the holding part, and the inner ring of the vortex spring is provided with a rotating rod. The rotating rod extends out of the end surface of the holding part. The rotation of the rotating rod drives the vortex spring to shrink. .

Preferably, the holding part is provided with a cover plate, and the cover plate is provided above the rotating rod.

Preferably, the spiked end is made of transparent material, has a hollow structure, and is provided with a feedback element for feedback on puncture conditions and an angle for detecting the inclination angle of the core rod. instrument.

Preferably, the feedback element is one of ultrasonic positioning, metal magnetic positioning, and chip battery signal positioning.

The above solution of the present invention has the following beneficial effects:

In this application, an expansion sleeve is used as a movable member. During the process of establishing a channel, the expansion sleeve squeezes the bleeding point of the liver through expansion, completing the purpose of squeezing and hemostasis while building the channel, and the outer surface of the expansion sleeve is smooth. , there will be no secondary damage to the liver during the puncture process.

Description of the drawings

Figure 1 is a front view of the present invention;

Figure 2 is a cross-sectional view in the A-A direction of Figure 1;

Figure 3 is a three-dimensional schematic view of the sleeve;

Figure 4 is a three-dimensional schematic diagram of the core rod;

Figure 5 is a longitudinal sectional view of the core rod;

FIG. 6 is an enlarged schematic diagram of part B in FIG. 5 .

Explanation of reference signs

1-sleeve, 11-V-shaped snap joint, 12-sleeve ring, 13-air bag, 14-expansion sleeve, 141-outer wall, 142-connector, 15-air nozzle, 16-limit hole, 17- expansion layer;

2-core rod, 21-rod body, 22-spiked end, 23 gripping part, 231-vortex spring, 232-limit rod, 233-rotary rod, 24-cover plate.

Detailed ways

In order to make the technical problems, technical solutions and advantages to be solved by the present invention clearer, a detailed description will be given below with reference to the accompanying drawings and specific embodiments.

As shown in Figures 1-6, an embodiment of the present invention provides a liver puncture device, which includes a sleeve 1 and a core rod 2. The core rod 2 can be inserted into the sleeve 1. Specifically, the sleeve 1 is tubular. , one end of the sleeve 1 is provided with a V-shaped snap-in nozzle 11, the V-shaped snap-in nozzle 11 is provided on the side wall of the sleeve 1, and there are two V-shaped snap-in nozzles 11, two V-shaped snap-in connectors 11 are arranged opposite each other. The V-shaped snap-in nozzle 11 is used to clamp and fix blood vessels. A sleeve ring 12 is provided at the other end of the sleeve 1. The sleeve ring 12 is arranged on the end surface of the sleeve 1. The outer side of the sleeve 1 An air bag 13 is provided on the edge of the sleeve 1. The air bag 13 is arranged along the axial direction of the sleeve 1. An expansion sleeve 14 is provided on the outer edge of the air bag 13. When the air bag 13 is inflated, the air bag 13 pushes the expansion sleeve 14 away from the center of the sleeve 1. Movement plays a role in expanding the expansion sleeve 14, and the expanded expansion sleeve 14 squeezes the passing liver tissue wound to achieve the purpose of hemostasis.

The expansion sleeve 14 includes a plurality of expansion units connected at the end. Each expansion unit includes an outer wall 141 and a connecting piece 142. The outer wall 141 and the connecting piece 142 are both arc-shaped. The plurality of outer walls 141 are arranged in an annular shape. The plurality of outer walls 141 constitute A virtual circle is formed, the center of the circle coincides with the center of the sleeve 1, and the virtual circle and the sleeve 1 form a similar circle. The aforementioned connector 142 is disposed between the outer wall 141 and the sleeve 1 and the arc bending direction of the connector 142 is opposite to the arc bending direction of the outer wall 141. One end of the connector 142 of each expansion unit is in contact with the outer wall 141 of the expansion unit. The other end is connected to the outer wall 141 of another expansion unit.

Further, the airbag 13 is disposed between the gap formed by the connecting piece 142 and the sleeve 1. Preferably, the shape of the airbag 13 matches the arc surface of the connecting piece 142 and the sleeve 1 to prevent the airbag 13 from being able to accurately adjust the elastic force when inflating. Act on connector 142. When the connecting piece 142 is deformed under force, the two ends of the connecting piece 142 push the outer wall 141 to move away from the center of the sleeve 1 under the action of elastic force, thereby realizing the expansion of the expansion sleeve 14 . During the process of establishing a channel in the liver, since the wound is not large, there is no need for the expansion sleeve 14 to expand to a large extent. Therefore, when the expansion sleeve 14 provided by the present application is used, the outer wall 141 is deformed to achieve the purpose of squeezing and hemostasis. In addition, due to the structural characteristics of the expansion unit, the plurality of outer walls 141 are arranged at intervals. Therefore, part of the liver tissue will also be squeezed by the connector 142 when the purpose of extrusion and hemostasis is achieved, which can effectively achieve hemostasis of the liver. Preferably, the edges of the connecting piece 142 and the outer wall 141 are rounded.

Furthermore, in this application, an expansion layer 17 can also be provided on the outer surface of the outer wall 141. The expansion layer 17 is made of expansion material to prevent the deformation of the outer wall 141 from being insufficient to completely achieve hemostasis by extrusion.

The aforementioned air bag 13 is in the shape of a long strip, and multiple air bags 13 are connected to the same main bag. The main bag is annular. The main bag ring is located at one end of the sleeve 1 close to the sleeve ring 12. An air nozzle is provided on the main bag. 15. The air nozzle 15 is used to connect to the external inflation device.

The aforementioned core rod 2 includes a rod body 21, a spiked end 22 and a gripping portion 23. The spiked end 22 and the gripping portion 23 are respectively provided at both ends of the rod body 21. The core rod 2 can be inserted into the sleeve 1. When the sleeve 1 is inserted, the rod body 21 is in smooth contact with the inner surface of the sleeve 1. A limiting structure is provided between the sleeve ring 12 and the holding portion 23 to limit the sleeve. The relative position of barrel 1 and core rod 2. When the core rod 2 is inserted into the sleeve 1, the spiked end 22 is higher than the V-shaped snap joint 11, so that when creating a channel, the spiked end 22 plays the role of opening a hole.

Furthermore, the aforementioned limiting structure includes the limiting hole 16 provided on the sleeve ring 12 , the vortex spring 231 provided in the holding portion 23 , and the limiting rod 232 . Specifically, the sleeve ring 12 is provided with limiting holes 16. The preferred number of limiting holes 16 is four, and the angle between adjacent limiting holes 16 and the center of the circle is a right angle. The holding part 23 is provided with a cavity, and a vortex spring 231 is provided in the cavity. The outer ring of the vortex spring 231 is fixed with the aforementioned limiting rod 232, and the inner ring of the vortex spring 231 is provided with a rotating rod 233, and the limiting rod 232 can be passed through. Pass through the side wall of the holding portion 23 and insert into the limiting hole 16 . When the rotating rod 233 rotates, the vortex spring 231 contracts, generating a tangential force F that is tangent to the outer ring of the vortex spring 231, which can be decomposed into a transverse force F1 and a longitudinal force F2. A reaction force is generated, and the reaction force and the transverse force F1 cancel each other out, so that the limit rod 232 is acted upon by the longitudinal force F2 and can pull the limit rod 232 to move within the limit hole 16 to achieve the limit function.

Furthermore, the end surface of the rotating rod 233 protruding from the holding portion 23 is convenient for the user to operate. A cover plate 24 is provided above the holding portion 23. The cover plate 24 is used to cover the rotating rod 233 to avoid accidentally touching the rotating rod during use. 233 and facilitate the application of force when constructing channels.

The aforementioned spiked end 22 is made of transparent material, has a hollow structure, and is provided with a feedback element (not shown in the figure) and an angle meter (not shown in the figure).

Furthermore, the outer surface of the sleeve 1 is smooth, and a scale is provided on the outer surface. The scale is set along the length direction of the sleeve 1 , and the scale starts from the tip of the V-shaped snap-in mouth 11 .

Preferably, the expansion sleeve 14 and the expansion layer 17 are made of transparent materials, which facilitates the user to observe the scale of the sleeve 1 through the expansion sleeve 14 and the expansion layer.

The principle of this application is as follows:

When constructing the channel, it is first necessary to insert the core rod 2 into the sleeve 1, and determine the positional relationship between the core rod 2 and the sleeve 1 in the axial direction of the sleeve 1 through the limiting structure. At this time, the spike end 22 is higher than The V-shaped snap-in nozzle 11 is used to determine the insertion angle on the liver based on the preoperative test results and after insertion, the application is inserted into the liver. During insertion, the angle depth of the application is adjusted according to the feedback from the scale and the angle meter to avoid Blood vessels on the liver. It mainly uses the ultrasonic probe, supplemented by scales and angles to determine whether the application is inserted into the designated position. After the insertion position is determined, the air nozzle 15 is inflated, the air bag 13 is inflated, and the expansion sleeve 14 squeezes the liver on the path of the sleeve 1 to stop bleeding. At the same time, the expansion layer 17 expands when encountering blood, and also plays a role in squeezing and stopping bleeding. , and then rotate the rotating rod 233 to take out the core rod 2 from the sleeve 1 to complete the construction of the channel. After the operation, the air bag 13 is deflated through the air nozzle 15, the expansion sleeve 14 returns to its original shape under the pressure of the liver, the sleeve 1 is taken out, and the wound is disinfected and sutured.

In order to adapt to the sizes of different livers, the present application can be provided with core tubes and core rods 2 of various lengths, and the other structures remain unchanged.

The above is the preferred embodiment of the present invention. It should be pointed out that for those of ordinary skill in the art, several improvements and modifications can be made without departing from the principles of the present invention. These improvements and modifications can also be made. should be regarded as the protection scope of the present invention.

Claims

A liver puncture device, which is characterized by including:

Sleeve (1), one end of the sleeve (1) is provided with a V-shaped snap joint (11), and the other end is provided with a sleeve ring (12), the sleeve ring (12) is provided on the sleeve On the end face of (1), an airbag (13) is provided on the outer edge of the sleeve (1). The airbag (13) is arranged along the axial direction of the sleeve (1). The airbag (13) The outer edge is provided with an expansion sleeve (14) with a smooth outer surface, and the air bag (13) can push the expansion sleeve (14) to move in the diameter direction away from the center of the sleeve (1);

The core rod (2) includes a rod body (21), a spiked end (22) and a gripping portion (23). The spiked end (22) is provided at one end of the rod body (21). The gripping portion (23) ) is provided at the other end of the rod body (21);

The core rod (2) can be inserted into the sleeve (1) and the rod body (21) is in smooth contact with the inner surface of the sleeve (1). The sleeve ring (12) is in contact with the sleeve (1). A limiting structure is provided between the holding parts (23). When the core rod (2) is inserted into the sleeve (1), the spiked end (22) is higher than the V-shaped snap-in mouth. (11);

The expansion sleeve (14) includes a plurality of expansion units connected end to end. The expansion unit includes an outer wall (141) and a connecting piece (142). The connecting piece (142) and the outer wall (141) both It is arc-shaped, the center of the circle of the outer wall (141) coincides with the center of the sleeve (1), the arc bending direction of the outer wall (141) is opposite to the arc bending direction of the connecting piece (142), the The air bag (13) is arranged between the space formed by the connecting piece (142) and the sleeve (1).
The liver puncture device according to claim 1, characterized in that: the air bag (13) is in the shape of a strip, and a plurality of the air bags (13) are connected to the same main bag, and the main bag is in an annular shape. The main bag ring is provided at one end of the sleeve (1) close to the sleeve ring (12), and the main bag is provided with an air nozzle (15) connected to an external inflation device.
The liver puncture device according to claim 1, characterized in that: the sleeve (1) is provided with a scale, the scale is arranged along the length direction of the sleeve (1), and the expansion sleeve (14) is made of transparent material. become.
The liver puncture device according to claim 3, characterized in that: a transparent expansion layer (17) is provided on the outer surface of the outer wall (141).
The liver puncture device according to claim 1, characterized in that the sleeve ring (12) has a limited hole (16) on the side wall, the holding part (23) is provided with a cavity, and the A vortex spring (231) is provided in the cavity, and a limiting rod (232) is provided on the outer ring of the vortex spring (231). The limiting rod (232) extends out of the side wall of the holding portion (23). , the inner ring of the vortex spring (231) is provided with a rotating rod (233), the rotating rod (233) extends out of the end surface of the holding portion (23), and the rotating rod (233) rotates to drive the vortex spring (231) Shrinkage.
The liver puncture device according to claim 5, characterized in that: the holding part (23) is provided with a cover plate (24), and the cover plate (24) covers the rotating rod (233). above.
The liver puncture device according to claim 1, characterized in that: the spiked end (22) is made of transparent material, the spiked end (22) is a hollow structure, and the inside of the spiked end (22) A feedback element for feedback on puncture conditions and an inclinometer for detecting the inclination angle of the core rod (2) are provided.
The liver puncture device according to claim 7, characterized in that: the feedback element is one of ultrasonic positioning, metal magnetic positioning, and chip battery signal positioning.