WO2024159665A1 - 一种肾镜 - Google Patents

一种肾镜 Download PDF

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Publication number
WO2024159665A1
WO2024159665A1 PCT/CN2023/096802 CN2023096802W WO2024159665A1 WO 2024159665 A1 WO2024159665 A1 WO 2024159665A1 CN 2023096802 W CN2023096802 W CN 2023096802W WO 2024159665 A1 WO2024159665 A1 WO 2024159665A1
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WIPO (PCT)
Prior art keywords
sheath
bending section
inner support
distal end
support member
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Application number
PCT/CN2023/096802
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English (en)
French (fr)
Inventor
唐剑
Original Assignee
湖南省华芯医疗器械有限公司
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Publication of WO2024159665A1 publication Critical patent/WO2024159665A1/zh

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Classifications

    • 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
    • A61B1/005—Flexible endoscopes
    • 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
    • A61B1/04—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 combined with photographic or television appliances
    • 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
    • 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
    • A61B1/313—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 introducing through surgical openings, e.g. laparoscopes
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02E—REDUCTION OF GREENHOUSE GAS [GHG] EMISSIONS, RELATED TO ENERGY GENERATION, TRANSMISSION OR DISTRIBUTION
    • Y02E30/00—Energy generation of nuclear origin
    • Y02E30/30—Nuclear fission reactors

Definitions

  • the utility model relates to the technical field of endoscopes, in particular to a nephroscope.
  • An endoscope is a medical diagnostic instrument, usually comprising a handle and an insertion part.
  • the insertion part can be inserted into the human body to observe the internal tissues of the human body through the camera module encapsulated at its distal end. It can help doctors determine the location of lesions in the patient's body and the tissue structure characteristics of the lesion location.
  • Operating the endoscope handle can adjust the posture of the active bending section of the insertion part, thereby adjusting the direction of the camera module and realizing functions such as fixed-point observation.
  • the antegrade method is to insert a nephroscope into the kidney through the ureter to remove stones. This method treats stones through the natural cavity of the human body and has the advantages of less trauma, faster recovery and definite efficacy.
  • the retrograde method is often used.
  • the retrograde method is to insert a nephroscope into the kidney through a puncture hole in the waist, and use laser, ultrasound and other lithotripsy tools to break up and remove the kidney stones.
  • the nephroscope in the related technology has the problem of slow stone removal speed and poor stone removal effect.
  • the utility model discloses a nephroscope, which is used to solve the technical problems of slow stone removal speed and poor stone removal effect existing in the nephroscope in the related art.
  • a nephroscope which comprises a handle portion and an insertion portion connected to the handle portion; wherein:
  • the insertion part includes a mirror body and a sheath, the sheath is sleeved on the outside of the mirror body and forms a suction channel between the two, the distal end of the mirror body has an active bending section, and the distal end of the sheath has a
  • the passive bending section of the sheath maintains an original state when the passive bending section of the sheath is inserted into the first part of the detection object, and can bend along with the bending of the active bending section when the passive bending section of the sheath is inserted into the second part of the detection object.
  • the insertion portion further comprises an inner support member, and the inner support member is arranged between the active bending section and the passive bending section of the sheath.
  • the inner support member is in a strip-shaped structure, the inner support member is extended along the axial direction of the insertion portion, and a plurality of the inner support members are distributed along the circumference of the insertion portion.
  • the plurality of inner support members are unevenly distributed along the circumference of the insertion portion.
  • the outer end of the inner support member is fixed to the inner wall of the passive bending section of the sheath, and the inner end of the inner support member abuts against the outer wall of the active bending section; or, the outer end of the inner support member abuts against the inner wall of the passive bending section of the sheath, and the inner end of the inner support member is fixed to the outer wall of the active bending section.
  • the inner support member has a guide portion protruding from the distal end wall of the sheath, and the guide portion has a guide surface that is inclined relative to the axis of the insertion portion.
  • the tube sheath comprises a base tube section and a flexible tube section, the rigidity of the base tube section is greater than the rigidity of the flexible tube section, and the flexible tube section constitutes the passive bending section.
  • a suction nozzle and a pressure measuring nozzle which are connected to the suction channel are arranged at the proximal end of the tube sheath.
  • part of the active bending section protrudes from the distal end wall of the sheath, or the distal end of the active bending section is flush with the distal end wall of the sheath.
  • the insertion part is an integrated structure consisting of a scope body and a sheath.
  • the surgical channel formed by the puncture hole in the waist of the test object constitutes the first part of the test object, and the renal pelvis reached by the distal end of the insertion part constitutes the second part of the test object.
  • the sheath in the original state can assist the scope body to enter the renal pelvis through the surgical channel.
  • the sheath in the original state is usually in a straight state, which can ensure that the insertion part is extended into place and prevent the insertion part from bending arbitrarily during the insertion process and contacting with human tissue to cause secondary damage;
  • the passive bending section of the sheath can follow the active bending of the scope.
  • the curved section bends so that the direction of the distal end of the sheath is roughly consistent with the direction of the distal end of the scope, that is, the direction of the suction channel is roughly consistent with the framing direction of the scope.
  • the distal end of the sheath can also follow the active curved section of the scope to penetrate into the deep renal pelvis, and accurately absorb the gravel in the deep renal pelvis under visual conditions, thereby improving the stone removal speed and effect; at the same time, the injection port of the nephroscope and the suction port of the suction channel can always be in adjacent positions, thereby forming a good water circulation at the distal end of the sheath near the stone, which can not only avoid the snowstorm phenomenon and make the observation field clear, but also avoid the risk of infection caused by increasing the perfusion volume.
  • FIG1 is a schematic structural diagram of a nephroscope according to an embodiment of the present application.
  • FIG2 is a partial enlarged schematic diagram of point A in FIG1;
  • FIG3 is a partial enlarged schematic diagram of point B in FIG1;
  • FIG4 is a schematic structural diagram of an insertion portion of an embodiment of the present application.
  • FIG5 is a schematic structural diagram of an inner support member according to an embodiment of the present application.
  • first, second, etc. in the specification and claims of this application are used to distinguish similar objects, and are not used to describe a specific order or sequence. It should be understood that the data used in this way can be interchangeable under appropriate circumstances, so that the embodiments of the present application can be implemented in an order other than those illustrated or described here, and the objects distinguished by "first”, “second”, etc. are generally of one type, and the number of objects is not limited.
  • the first object can be one or more.
  • “and/or” in the specification and claims represents at least one of the connected objects, and the character “/" generally indicates that the objects associated with each other are in an "or” relationship.
  • proximal end and distal end refer to the distance between the structure and the human body in the use environment, so as to facilitate the description of the positional relationship between the components and facilitate understanding; “proximal end” and “distal end” are relative positional relationships, not absolute ones.
  • An embodiment of the present application discloses a nephroscope.
  • the disclosed nephroscope includes a handle portion 100 and an insertion portion 200 .
  • the proximal end of the insertion portion 200 is connected to the handle portion 100 .
  • the insertion portion 200 includes a mirror body 210 and a sheath 220 .
  • the sheath 220 is sleeved on the outside of the mirror body 210 , and a suction channel 230 is formed therebetween.
  • the distal end of the mirror body 210 has an active bending section 211, and the distal end of the sheath 220 has a passive bending section.
  • the passive bending section of the sheath 220 When the passive bending section of the sheath 220 is inserted into the first part of the detection object, the passive bending section of the sheath 220 maintains its original state.
  • the passive bending section of the sheath 220 When the passive bending section of the sheath 220 is inserted into the second part of the detection object, the passive bending section of the sheath 220 can bend along with the bending of the active bending section 211.
  • the first part of the detection object refers to the surgical channel formed by the lumbar puncture hole in the detection object
  • the second part of the detection object refers to the renal pelvis reached by the distal end of the insertion part 200.
  • the direction of the distal end of the endoscope is changeable, the direction of the distal end of the sheath cannot be consistent with the direction of the distal end of the endoscope.
  • the suction channel constructed by the sheath fails to keep consistent with the viewing direction of the endoscope, making it difficult to accurately absorb the gravel, resulting in slow and poor stone removal; on the other hand, the relative position of the injection port at the distal end of the endoscope and the suction port at the distal end of the suction channel changes.
  • a good water circulation cannot be formed at the front end of the endoscope, and the gravel dust generated easily blocks the camera component, resulting in an unclear field of view, commonly known as the snowstorm phenomenon.
  • the passive bending section of the sheath 220 can bend along with the active bending section 211 of the mirror body 210, so that the orientation of the distal end of the sheath 220 is roughly consistent with the orientation of the distal end of the mirror body 210, that is, the orientation of the suction channel 230 is roughly consistent with the viewing direction of the mirror body 210; on the one hand, the passive bending section of the sheath 220 can bend along with the active bending section 211 of the mirror body 210, so that the sheath 220 can also be inserted into the deep part of the renal pelvis, and the gravel in the deep part of the renal pelvis can be accurately sucked under visual conditions, thereby improving the stone removal speed and optimizing the stone removal effect; on the other hand, the injection port of the mirror body 210 and the suction port of the suction channel 230 can always be in adjacent positions, thereby forming a good water circulation at the distal end of the she
  • this method can greatly reduce the number of puncture holes in the human waist, save operation time, reduce operation risks, and also reduce the physical and psychological burdens on patients.
  • the inventors also discovered during the research that if the sheath 220 is directly sleeved on the outside of the mirror body 210, during the bending process of the active bending section 211, the active bending section 211 will abut against the inner wall of the sheath 220, causing the distal part of the suction channel 230 to be closed, which is not conducive to the suction and discharge of gravel.
  • the insertion part 200 further includes an inner support member 240, which is disposed between the active bending section 211 and the passive bending section of the sheath 220.
  • the inner support member 240 can ensure that there is always a gap between the outer wall of the active bending section 211 and the inner wall of the passive bending section of the sheath 220 to avoid the abutment between the two and the occlusion of the suction channel 230.
  • the inner support member 240 is a strip-shaped structural member, and the inner support member 240 is extended along the axial direction of the insertion part 200.
  • the strip-shaped inner support member 240 occupies a smaller space in the suction channel 230, so that the opening of the suction port at the far end of the suction channel 230 is larger, so that some large pieces of gravel can also be sucked into the suction channel 230, ensuring the suction channel 230's ability to attract gravel.
  • the number of internal support members 240 can be four, and the four internal support members 240 are distributed along the circumference of the insertion part 200.
  • the four internal support members 240 can play a better limiting role in the circumference of the active bending section 211, thereby preventing the active bending section 211 from jumping in the passive bending section of the sheath 220.
  • the plurality of inner support members 240 may be evenly distributed along the circumference of the insertion portion 200, or may be unevenly distributed along the circumference of the insertion portion 200, as long as the scope 210 can be prevented from jumping against the inner wall of the sheath 220, and the embodiment of the present application is not limited to this. It should be noted that, in the case where the plurality of inner support members 240 are unevenly distributed along the circumference of the insertion portion 200, compared with the manner in which the plurality of inner support members 240 are evenly distributed along the circumference of the insertion portion 200, the distal end of the suction channel 230 may form an orifice with a larger opening size, so that some larger gravels can be sucked out.
  • the inner support member 240 can be fixed to the outer side of the active bending section 211, or can be fixed to the inner side of the passive bending section of the sheath 220, or the inner end of the inner support member 240 is fixed to the active bending section 211, and the outer end of the inner support member 240 is fixed to the passive bending section of the sheath 220.
  • the present application does not limit the specific fixing form of the inner support member 240.
  • the outer end of the inner support member 240 is fixed to the inner wall of the passive bending section of the sheath 220, for example, it can be fixed by integral molding, gluing, etc., and the inner end of the inner support member 240 abuts against the outer wall of the active bending section 211; under such a setting, the inner end of the inner support member 240 and the outer wall of the mirror body 210 are slidably matched, on the one hand, it is convenient for the assembly of the mirror body 210, and the mirror body 210 can be inserted into the area defined by multiple inner support members 240; on the other hand, during the bending of the active bending section 211, the abutment method allows a certain amount of activity margin between the mirror body 210 and the sheath 220, thereby avoiding damage to the inner support member 240 and improving the reliability and stability of the use of the nephroscope.
  • the outer end of the inner support member 240 abuts against the inner wall of the passive bending section of the sheath 220 , and the inner end of the inner support member 240 is fixed to the outer wall of the active bending section 211 .
  • the sheath 220 includes a base tube section 221 and a flexible tube section 222.
  • the rigidity of the base tube section 221 is greater than that of the flexible tube section 222.
  • the flexible tube section 222 constitutes a passive bending section of the sheath 220. It should be understood that the flexible tube section 222 has a smaller rigidity and is easy to bend with the active bending section 211, relative to the base tube section 221, and does not mean that the flexible tube section 222 can be bent at will.
  • the flexible tube section 222 should have a certain rigidity to ensure that it remains in its original state during the process of being inserted into the human body.
  • the flexible pipe segment 222 can be shaped (maintaining the initial state) by the properties of the material itself, and passively bend when the force exceeds a preset value, for example, by integrally forming the flexible material with the base pipe segment 221; it can also be shaped by a specific mechanical structure, and passively bend when the force exceeds a preset value, for example, by using a structure similar to a spiral tube or a gooseneck tube to form the flexible pipe segment 222.
  • a suction nozzle 223 and a pressure measuring nozzle 224 connected to the suction channel 230 are provided at the proximal end of the sheath 220.
  • the suction nozzle 223 is used to connect to a negative pressure mechanism for sucking the gravel in the renal pelvis
  • the pressure measuring nozzle 224 is used to connect to a pressure measuring device.
  • the pressure measuring device connected to the pressure measuring nozzle 224 can detect the pressure deep in the renal pelvis in real time, which is convenient for medical staff to accurately judge and control the operation time, and avoid the pressure in the renal pelvis increasing for too long to cause urinary induced sepsis.
  • the distal end of the active bending section 211 is flush with the distal end wall of the sheath 220 .
  • the distal end of the active bending section 211 protrudes from the distal end wall of the sheath 220.
  • the active bending section 211 can be prevented from retracting relative to the sheath 220 due to bending, so that the distal end of the mirror body 210 can be close to the surgical site, thereby improving the accuracy of the surgical operation.
  • the inner support member 240 has a guide portion 241 protruding from the distal end wall of the sheath 220, and the distal end of the guide portion 241 has a guide surface 241a inclined axially relative to the insertion portion 200.
  • the guide surface 241a inclined axially relative to the insertion portion 200.

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Abstract

一种肾镜包括手柄部(100)和连接手柄部(100)的插入部(200)；其中插入部(200)包括镜体(210)和管鞘(220)，管鞘(220)套接于镜体(210)的外侧，并在二者之间形成吸引通道(230)；镜体(210)的远端具有主动弯曲段(211)，管鞘(220)的远端具有被动弯曲段，在管鞘(220)的被动弯曲段插入检测对象的第一部分时，管鞘(220)的被动弯曲段保持原始状态，在管鞘(220)的被动弯曲段插入检测对象的第二部分时，管鞘(220)的被动弯曲段可随主动弯曲段(211)的弯曲而弯曲。在腰部建立好手术通道后，处于原始状态的管鞘(220)可辅助镜体(210)进入到人体肾盂处，进入人体后，管鞘(220)的被动弯曲段能够跟随主动弯曲段(211)发生弯曲，使镜体(210)远端的朝向与管鞘(220)远端的朝向大体一致，如此能够实现对碎石进行精准的吸取，同时能够避免在人体进行多次穿刺开孔。

Description

一种肾镜 技术领域
本实用新型涉及内窥镜技术领域，尤其涉及一种肾镜。
背景技术
内窥镜是一种医疗诊断器械，通常包括手柄和插入部，插入部可以伸入至人体内，通过其远端封装的摄像模组对人体的内部组织进行观察，能够帮助医生判断患者体内的病变位置及病变位置的组织结构特征，操作内窥镜手柄能够对插入部的主动弯曲段进行姿态调节，从而调整摄像模组的朝向，实现定点观察等功能。
治疗肾结石通常采用顺行法和逆行法两种手术方法，顺行法是将肾镜通过输尿管置入肾脏内取石，这种方法为通过人体自然腔道治疗结石，具有创伤小、恢复快和疗效确切等优点；而对于不具有顺行法手术条件的病人，则多采用逆行法，逆行法是在腰部穿刺开孔，通过该穿刺开孔把肾镜插入肾脏，利用激光、超声等碎石工具，把肾结石击碎取出。但是，相关技术中的肾镜存在着取石速度慢和取石效果差的情况。
实用新型内容
本实用新型公开一种肾镜，以解决相关技术中的肾镜存在的取石速度慢和取石效果差的技术问题。
为了解决上述问题，本实用新型采用下述技术方案：
本申请提供一种肾镜，肾镜包括手柄部和连接所述手柄部的插入部；其中：
所述插入部包括镜体和管鞘，所述管鞘套接于所述镜体的外侧，并在二者之间形成吸引通道，所述镜体的远端具有主动弯曲段，所述管鞘的远端具有被 动弯曲段，在所述管鞘的被动弯曲段插入检测对象的第一部分时，所述管鞘的被动弯曲段保持原始状态，在所述管鞘的被动弯曲段插入检测对象的第二部分时，所述管鞘的被动弯曲段可随所述主动弯曲段的弯曲而弯曲。
进一步地，所述插入部还包括内撑件，所述内撑件设于所述主动弯曲段与所述管鞘的被动弯曲段之间。
进一步地，所述内撑件呈条状结构，所述内撑件沿所述插入部的轴向延伸设置，且多个所述内撑件沿所述插入部的周向分布。
进一步地，多个内撑件沿所述插入部的周向非均匀分布。
进一步地，所述内撑件的外端固定于所述管鞘的被动弯曲段的内壁，所述内撑件的内端与所述主动弯曲段的外壁相抵接；或者是，所述内撑件的外端与所述管鞘的被动弯曲段的内壁相抵接，所述内撑件的内端固定于所述主动弯曲段的外壁。
进一步地，所述内撑件具有凸出于所述管鞘的远端端壁的导向部，所述导向部具有相对所述插入部的轴线倾斜设置的导向面。
进一步地，所述管鞘包括基管段和挠性管段，所述基管段的刚性大于所述挠性管段的刚性，所述挠性管段构成所述被动弯曲段。
进一步地，所述管鞘的近端设置有与所述吸引通道相连通的吸引嘴和测压嘴。
进一步地，所述主动弯曲段的部分凸出于所述管鞘的远端端壁，或者，所述主动弯曲段的远端与所述管鞘的远端端壁平齐。
本实用新型采用的技术方案能够达到以下有益效果：
第一、在本申请中，插入部为镜体和管鞘组成的一体式结构，在检测对象的腰部穿刺开孔形成的手术通道构成检测对象的第一部分，插入部的远端到达的肾盂处构成检测对象的第二部分，处于原始状态的管鞘可以辅助镜体经手术通道进入到肾盂处，原始状态的管鞘通常处于直的状态，既能确保插入部伸入到位，又能避免插入部在插入过程中随意弯曲而与人体组织相抵接造成二次伤害；
第二、在插入部的远端探入肾盂后，管鞘的被动弯曲段可随镜体的主动弯 曲段的弯曲而弯曲，使管鞘远端的朝向与镜体远端的朝向大体一致，也即是使吸引通道的朝向与镜体的取景方向保持大体一致，这样的话，管鞘的远端同样能跟随镜体的主动弯曲段探入肾盂深处，在可视条件对肾盂深处的碎石进行精准的吸取，提升了取石速度和取石效果；与此同时，肾镜的注液口与吸引通道的吸引口能够始终处于相邻近的位置，从而在管鞘的远端靠近结石处形成了良好的水循环，既能够规避暴风雪现象，使得观察视野清晰，又能避免加大灌注量而产生感染风险。
附图说明
为了更清楚地说明本实用新型实施例或现有技术中的技术方案，下面将对实施例或现有技术描述中所需要使用的附图作简单地介绍，显而易见地，下面描述中的附图仅仅是本实用新型的一些实施例，对于本领域普通技术人员来讲，在不付出创造性劳动的前提下，还可以根据这些附图获得其他的附图。
图1是本申请实施例的肾镜的结构示意图；
图2是图1中A处的局部放大示意图；
图3是图1中B处的局部放大示意图；
图4是本申请实施例的插入部的结构示意图；
图5是本申请实施例的内撑件的结构示意图；
图中：
100-手柄部；200-插入部，210-镜体，211-主动弯曲段，220-管鞘，221-基管段，222-挠性管段，230-吸引通道，240-内撑件。
具体实施方式
为使本实用新型的目的、技术方案和优点更加清楚，下面将对本实用新型的技术方案进行详细的描述。显然，所描述的实施例仅仅是本实用新型一部分实施例，而不是全部的实施例。基于本实用新型中的实施例，本领域普通技术人员在没有做出创造性劳动的前提下所得到的所有其它实施方式，都属于本实用新型所保护的范围。
本申请的说明书和权利要求书中的术语“第一”、“第二”等是用于区别类似的对象，而不用于描述特定的顺序或先后次序。应该理解这样使用的数据在适当情况下可以互换，以便本申请的实施例能够以除了在这里图示或描述的那些以外的顺序实施，且“第一”、“第二”等所区分的对象通常为一类，并不限定对象的个数，例如第一对象可以是一个，也可以是多个。此外，说明书以及权利要求中“和/或”表示所连接对象的至少其中之一，字符“/”，一般表示前后关联对象是一种“或”的关系。
在本实用新型中，“近端”和“远端”是本结构在使用环境下，相对于人体操作的远近位置，以方便对部件之间的位置关系进行描述，同时方便理解；“近端”和“远端”是相对而言的位置关系，而非绝对的。
下面结合附图1～附图5，通过具体的实施例及其应用场景对本申请实施例提供的肾镜进行详细地说明。
请参见图1，本申请实施例公开一种肾镜，所公开的肾镜包括手柄部100和插入部200，插入部200的近端与手柄部100相连。
在本申请实施例中，插入部200包括镜体210和管鞘220，管鞘220套接于镜体210的外侧，并在二者之间形成吸引通道230。
镜体210的远端具有主动弯曲段211，管鞘220的远端具有被动弯曲段，在管鞘220的被动弯曲段插入检测对象的第一部分时，管鞘220的被动弯曲段保持原始状态，在管鞘220的被动弯曲段插入检测对象的第二部分时，管鞘220的被动弯曲段可随主动弯曲段211的弯曲而弯曲。
需要说明的是，在本申请实施例中，检测对象的第一部分，指的是在检测对象的腰部穿刺开孔所形成的手术通道，检测对象的第二部分，指的是插入部200的远端到达的肾盂处。
发明人在研究过程中发现，在逆行法手术过程中，因为穿刺开孔后的人体组织闭合在一起，采用软管难以直接置入到肾盂内，因此需要将硬质的管鞘经穿刺开孔置入到肾盂内建立起手术通道，再将内窥镜经该手术通道伸入到肾盂内，利用激光、超声等碎石工具破碎结石。但是，因为内窥镜远端的朝向是活动变化的，使得管鞘远端的朝向并不能与内窥镜远端的朝向保持一致，此种情 况下，一方面，管鞘构建的吸引通道未能与内窥镜的取景方向保持一致，难以对碎石进行精准的吸取，存在着取石慢和取石效果差的情况；另一方面，内窥镜远端的注液口与吸引通道远端的吸引口之间的位置相对变化，在处理结石时，无法在内窥镜的前端形成较好的水循环，产生的碎石粉尘容易遮挡摄像组件，导致观察视野不够清晰，俗称暴风雪现象。
另外，因为硬质的管鞘无法探入到肾盂深处，导致在对肾盂深处的结石进行破碎、吸取时，需要在人体腰部进行多次针对性的穿刺开孔，对患者的生理和心理都带来较大的负担。
而在本申请实施例中，肾镜的插入部为镜体210和管鞘220组成的一体式结构，在腰部穿刺开孔后，管鞘220可辅助镜体210进入到人体肾盂处，原始状态的管鞘220通常处于直的状态，既能确保插入部200伸入到位，又能避免插入部200在插入过程中随意弯曲而与人体组织相抵接造成二次伤害。
而在插入部200的远端探入肾盂后，管鞘220的被动弯曲段可随镜体210的主动弯曲段211的弯曲而弯曲，使管鞘220远端的朝向与镜体210远端的朝向大体一致，也即是使吸引通道230的朝向与镜体210的取景方向保持大体一致；一方面，管鞘220的被动弯曲段能够跟随镜体210的主动弯曲段211发生弯曲，使管鞘220同样能够探入肾盂深处，在可视条件对肾盂深处的碎石进行精准的吸取，提升了取石速度，优化了取石效果；另一方面，镜体210的注液口与吸引通道230的吸引口能够始终处于相邻近的位置，从而在管鞘220的远端靠近结石处形成了良好的水循环，既能够规避暴风雪现象，使得观察视野清晰，又能避免加大灌注量而产生感染风险。
与此同时，此种方式能够极大程度上减少在人体腰部穿刺开孔的数量，节约了手术时间，降低了手术风险，同时也降低了患者生理负担和心理负担。
发明人在研究过程中还发现，若直接将管鞘220套设于镜体210的外侧，在主动弯曲段211发生弯曲的过程中，主动弯曲段211会与管鞘220的内壁相抵靠，造成吸引通道230的远端部分封闭，不利于碎石的吸引、排出。
基于上述情况，在本申请实施例中，插入部200还包括内撑件240，内撑件240设于主动弯曲段211与管鞘220的被动弯曲段之间，多个内撑件240沿插入 部200的周向分布，内撑件240能够使主动弯曲段211的外壁与管鞘220的被动弯曲段的内壁之间始终具有间隙，避免两者相抵接而造成吸引通道230出现闭塞的情况。
在进一步的技术方案中，内撑件240呈条状结构件，内撑件240沿插入部200的轴向延伸设置，条状结构的内撑件240在吸引通道230的空间占用较小，使吸引通道230远端的吸引口的孔口较大，使一些大块的碎石同样能够被吸入吸引通道230内，确保吸引通道230对碎石的吸引能力。
一种可选的实施方式中，请参见图3，内撑件240的数量可以为四个，四个内撑件240沿插入部200的周向分布，四个内撑件240能够在主动弯曲段211的周向起到较好的限制作用，避免主动弯曲段211在管鞘220的被动弯曲段内蹿动。
在本申请实施例中，多个内撑件240可以沿插入部200的周向均匀分布，也可以沿插入部200的周向非均匀分布，只要能防止镜体210蹿动抵靠在管鞘220的内壁即可，本申请实施例对此并不限定。需要说明的是，在多个内撑件240沿插入部200的周向非均匀分布的情况下，相较于多个内撑件240沿插入部200的周向均匀分布的方式，吸引通道230的远端可以形成开口尺寸更大的孔口，方便一些尺寸较大的碎石被吸引排出。
在本申请实施例中，内撑件240可以固定于主动弯曲段211的外侧，也可以固定于管鞘220的被动弯曲段的内侧，或者是，内撑件240的内端与主动弯曲段211固定，内撑件240的外端与管鞘220的被动弯曲段固定，本申请并不限定内撑件240的具体固定形式。
一种可选的实施方式中，内撑件240的外端固定于管鞘220的被动弯曲段的内壁，例如可以采用一体成型、胶接等方式进行固定，内撑件240的内端与主动弯曲段211的外壁相抵接；如此设置下，内撑件240的内端与镜体210的外壁滑动方配合，一方面方便镜体210的装配，将镜体210穿设在多个内撑件240限定的区域内即可，另一方面，在主动弯曲段211发生弯曲的过程中，相抵接的方式允许镜体210与管鞘220之间存在一定的活动裕量，避免内撑件240被破坏，提高肾镜使用的可靠性和稳定性。
同理地，在另一种可选的实施方式中，所述内撑件240的外端与所述管鞘220的被动弯曲段的内壁相抵接，所述内撑件240的内端固定于所述主动弯曲段211的外壁。
在本申请实施例中，管鞘220包括基管段221和挠性管段222，基管段221的刚性大于挠性管段222的刚性，挠性管段222构成管鞘220的被动弯曲段。应该理解的是，挠性管段222的刚性较小而易于跟随主动弯曲段211弯曲，是相对基管段221而言的，并不代表挠性管段222是可以随意弯曲的，挠性管段222应该具有一定的刚性，以确保在置入人体过程中保持在原始状态。
需要说明的是，在本申请实施例中，挠性管段222既可以通过材料本身的性质实现定形(保持初始状态)，以及受力超过预设值后被动弯曲，例如通过挠性材料与基管段221一体成型；也可以通过特定机械结构实现定形，以及受力超过预设值后被动弯曲，例如采用与螺旋管或鹅颈管类似的结构构成挠性管段222。
在进一步的技术方案中，管鞘220的近端设置有与吸引通道230相连通的吸引嘴223和测压嘴224，吸引嘴223用于连接负压机构，用于对肾盂处的碎石进行吸取，测压嘴224用于连接测压装置，测压嘴224连接的测压装置可以实时检测肾盂深处的压力，方便医护人员准确判断并控制手术时间，避免肾盂内压力增高时间过长引发尿源性脓毒血症。
一种可选的实施方式中，主动弯曲段211的远端与管鞘220的远端端壁平齐。
在另一种可选的实施方式中，主动弯曲段211的远端凸出于管鞘220的远端端壁，如此设置下，能够避免主动弯曲段211因弯曲而发生相对管鞘220回缩的现象，使镜体210的远端能够贴近手术部位，提高手术操作的精确度。
在进一步的技术方案中，请参见图5，内撑件240具有凸出于管鞘220远端端壁的导向部241，导向部241的远端具有相对插入部200的轴向倾斜的导向面241a，在插入部200穿过手术通道的过程中，基于导向面241a的存在，闭合的人体组织容易被分离开来，而不易对检测对象造成二次伤害。
需要说明的是，在本文中，术语“包括”、“包含”或者其任何其他变体意在涵 盖非排他性的包含，从而使得包括一系列要素的过程、方法、物品或者装置不仅包括那些要素，而且还包括没有明确列出的其他要素，或者是还包括为这种过程、方法、物品或者装置所固有的要素。在没有更多限制的情况下，由语句“包括一个……”限定的要素，并不排除在包括该要素的过程、方法、物品或者装置中还存在另外的相同要素。此外，需要指出的是，本申请实施方式中的方法和装置的范围不限按示出或讨论的顺序来执行功能，还可包括根据所涉及的功能按基本同时的方式或按相反的顺序来执行功能，例如，可以按不同于所描述的次序来执行所描述的方法，并且还可以添加、省去、或组合各种步骤。另外，参照某些示例所描述的特征可在其他示例中被组合。
以上所述，仅为本实用新型的具体实施方式，但本实用新型的保护范围并不局限于此，任何熟悉本技术领域的技术人员在本实用新型揭露的技术范围内，可轻易想到变化或替换，都应涵盖在本实用新型的保护范围之内。

Claims (10)

  1. 一种肾镜，其特征在于，包括手柄部(100)和连接所述手柄部(100)的插入部(200)；其中：
    所述插入部(200)包括镜体(210)和管鞘(220)，所述管鞘(220)套接于所述镜体(210)的外侧，并在二者之间形成吸引通道(230)；
    所述镜体(210)的远端具有主动弯曲段(211)，所述管鞘(220)的远端具有被动弯曲段，在所述管鞘(220)的被动弯曲段插入检测对象的第一部分时，所述管鞘(220)的被动弯曲段保持原始状态，在所述管鞘(220)的被动弯曲段插入检测对象的第二部分时，所述管鞘(220)的被动弯曲段可随所述主动弯曲段(211)的弯曲而弯曲。
  2. 根据权利要求1所述的肾镜，其特征在于，所述插入部(200)还包括内撑件(240)，所述内撑件(240)设于所述主动弯曲段(211)与所述管鞘(220)的被动弯曲段之间。
  3. 根据权利要求2所述的肾镜，其特征在于，所述内撑件(240)呈条状结构，所述内撑件(240)沿所述插入部(200)的轴向延伸设置，且多个所述内撑件(240)沿所述插入部(200)的周向分布。
  4. 根据权利要求3所述的肾镜，其特征在于，多个所述内撑件(240)沿所述插入部(200)的周向非均匀分布。
  5. 根据权利要求2所述的肾镜，其特征在于，所述内撑件(240)的外端固定于所述管鞘(220)的被动弯曲段的内壁，所述内撑件(240)的内端与所述主动弯曲段(211)的外壁相抵接；或者，所述内撑件(240)的外端与所述管鞘(220)的被动弯曲段的内壁相抵接，所述内撑件(240)的内端固定于所述主动弯曲段(211)的外壁。
  6. 根据权利要求2～5任一所述的肾镜，其特征在于，所述内撑件(240)具有凸出于所述管鞘(220)的远端端壁的导向部(241)，所述导向部(241)具有相对所述插入部(200)的轴线倾斜设置的导向面(241a)。
  7. 根据权利要求1～5任一所述的肾镜，其特征在于，所述管鞘(220)包括 基管段(221)和挠性管段(222)，所述基管段(221)的刚性大于所述挠性管段(222)的刚性，所述挠性管段(222)构成所述管鞘(220)的被动弯曲段。
  8. 根据权利要求1所述的肾镜，其特征在于，所述管鞘(220)的近端设置有与所述吸引通道(230)相连通的吸引嘴(223)和测压嘴(224)。
  9. 根据权利要求1所述的肾镜，其特征在于，所述主动弯曲段(211)的远端与所述管鞘(220)的远端端壁平齐。
  10. 根据权利要求1所述的肾镜，其特征在于，所述主动弯曲段(211)的部分凸出于所述管鞘(220)的远端端壁。
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CN218792221U (zh) * 2023-01-31 2023-04-07 湖南省华芯医疗器械有限公司 一种肾镜

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