CN113081243B - Visual controllable curved nipple incision sword - Google Patents
Visual controllable curved nipple incision sword Download PDFInfo
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- CN113081243B CN113081243B CN202110517258.9A CN202110517258A CN113081243B CN 113081243 B CN113081243 B CN 113081243B CN 202110517258 A CN202110517258 A CN 202110517258A CN 113081243 B CN113081243 B CN 113081243B
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- 210000002445 nipple Anatomy 0.000 title claims abstract description 52
- 230000000007 visual effect Effects 0.000 title claims abstract description 38
- 238000005452 bending Methods 0.000 claims abstract description 84
- 210000003813 thumb Anatomy 0.000 claims abstract description 24
- 238000000034 method Methods 0.000 claims abstract description 12
- 238000005507 spraying Methods 0.000 claims abstract description 4
- 239000011324 bead Substances 0.000 claims description 8
- 230000007246 mechanism Effects 0.000 claims description 8
- 239000011248 coating agent Substances 0.000 claims description 3
- 238000000576 coating method Methods 0.000 claims description 3
- 239000002184 metal Substances 0.000 claims description 3
- 238000002627 tracheal intubation Methods 0.000 abstract description 9
- 230000008569 process Effects 0.000 abstract description 8
- 238000004804 winding Methods 0.000 abstract description 6
- 238000003780 insertion Methods 0.000 abstract description 4
- 230000037431 insertion Effects 0.000 abstract description 4
- 238000007459 endoscopic retrograde cholangiopancreatography Methods 0.000 description 12
- 210000000277 pancreatic duct Anatomy 0.000 description 12
- 238000005516 engineering process Methods 0.000 description 6
- 238000001574 biopsy Methods 0.000 description 5
- 230000002183 duodenal effect Effects 0.000 description 5
- 239000002861 polymer material Substances 0.000 description 5
- 238000011282 treatment Methods 0.000 description 4
- 238000013461 design Methods 0.000 description 3
- 230000001079 digestive effect Effects 0.000 description 3
- 210000001035 gastrointestinal tract Anatomy 0.000 description 3
- 238000002513 implantation Methods 0.000 description 3
- 210000000496 pancreas Anatomy 0.000 description 3
- 230000005855 radiation Effects 0.000 description 3
- 208000017283 Bile Duct disease Diseases 0.000 description 2
- 206010028980 Neoplasm Diseases 0.000 description 2
- 230000009471 action Effects 0.000 description 2
- 230000009286 beneficial effect Effects 0.000 description 2
- 230000007547 defect Effects 0.000 description 2
- 238000003745 diagnosis Methods 0.000 description 2
- 230000005611 electricity Effects 0.000 description 2
- 238000000605 extraction Methods 0.000 description 2
- 230000036541 health Effects 0.000 description 2
- 238000003384 imaging method Methods 0.000 description 2
- 238000013507 mapping Methods 0.000 description 2
- 229920000642 polymer Polymers 0.000 description 2
- 210000005070 sphincter Anatomy 0.000 description 2
- 239000004575 stone Substances 0.000 description 2
- 206010061218 Inflammation Diseases 0.000 description 1
- 206010035148 Plague Diseases 0.000 description 1
- 241000607479 Yersinia pestis Species 0.000 description 1
- 210000000941 bile Anatomy 0.000 description 1
- -1 biopsy forceps Substances 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 210000001953 common bile duct Anatomy 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000012277 endoscopic treatment Methods 0.000 description 1
- 238000001839 endoscopy Methods 0.000 description 1
- 210000000232 gallbladder Anatomy 0.000 description 1
- 230000004054 inflammatory process Effects 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000002324 minimally invasive surgery Methods 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 239000013307 optical fiber Substances 0.000 description 1
- 230000000750 progressive effect Effects 0.000 description 1
- 230000001681 protective effect Effects 0.000 description 1
- 238000007464 sphincterotomy Methods 0.000 description 1
- 230000001225 therapeutic effect Effects 0.000 description 1
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- 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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
-
- 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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- 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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00166—Multiple lumina
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- 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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00482—Digestive system
-
- 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
- A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
-
- 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
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1412—Blade
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- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
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- Otolaryngology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Heart & Thoracic Surgery (AREA)
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- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
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- Surgical Instruments (AREA)
Abstract
The invention relates to the technical field of nipple incision knives, and provides a visual controllable bent nipple incision knife which comprises a flexible bending part, a flexible knife bar, a handle operation part and a knife wire; the flexible bending part is provided with a camera channel, an instrument channel and cutter wire channels in the form of four grooves; the flexible cutter bar is provided with a camera channel, an instrument channel and four cutter wire channels; the handle operation part comprises a handle shell, a first operation part and a second operation part, wherein the handle shell is provided with a camera channel and an instrument channel, the first operation part comprises a thumb wheel, a rotating shaft system and an electrode column, the rotating shaft system comprises a rotating shaft and a winding wheel, and the winding wheel is provided with a double-layer track; four knife wires are fixedly connected to the reel in pairs. The flexible bending part is a hollow skeleton with gradually increased rigidity, and scale marks are arranged through laser code spraying. The invention can visualize the processes of intubation, etc., realize the pointing of any space gesture, increase the flexibility of the bending of the incision knife, realize large-angle bending, precisely control the insertion depth and improve the control precision and efficiency.
Description
Technical Field
The invention relates to the technical field of accessories for digestive endoscopes, namely nipple cutting knives, in particular to a visual controllable bent nipple cutting knife which is used for digestive endoscopy operation, namely Endoscopic Retrograde Cholangiopancreatography (ERCP) and incidental treatment.
Background
Calculus and tumor at the gallbladder and pancreatic duct of digestive tract are high-frequency and fatal. Retrograde cholangiopancreatography by digestive tract endoscope is the main treatment method. Because the position of the biliary pancreatic duct in the digestive tract is deep, the existing ERCP is the most difficult and risky type of digestive endoscope minimally invasive surgery, the super-selection difficulty of the intubation is high, the operation precision is low, and the complications such as inflammation, bleeding, perforation and the like are urgently needed to be solved.
The duodenal papillary sphincterotomy (EST) is an endoscopic treatment means derived based on ERCP, and is a treatment technique for incising the end portions of the duodenal papillary sphincters and common bile duct under an endoscope using a papillary incision. ESTs have become the first step in therapeutic ERCPs at present, with great operational difficulties and extremely high risks. The papillary incision is an instrument necessary for completing ERCP and EST operations, and in a narrow duodenal environment, the papillary incision is required to pass through an occluded papilla and accurately and super-select to a biliary pancreatic duct, so that the incision has higher flexibility, can obtain a desired direction, and can complete the tasks of lithotripsy, stone extraction, tumor biopsy, stent implantation intervention and the like.
At present, a nipple incision knife used clinically only has a single degree of freedom, the direction of the incision knife is controlled by pulling a knife wire, and the bile and pancreas intubation super-selection is realized by relying on the coordinated movement of a duodenoscope and a forceps lifter. In order to increase the flexibility of the incision knife, an adjustable curved incision knife in the prior art realizes flexible pointing by increasing the degree of freedom of the knife head, and the knife head can be simultaneously bent and rotated, so that the problem of dexterity of the single-degree-of-freedom incision knife is solved, but the following limitations still exist:
(1) The bending movement is still achieved by a wire pulling, and the rotational steering of the cutter head is dependent on the rotation of the wire through the entire cutting blade. In the torsion process, the torque is lost in friction between the incision knife body and the endoscope biopsy cavity, the control precision is difficult to guarantee, and the torsion for many times can lead to the torsion deformation and even blockage of the cavity in the incision knife, so that the intervention of a guide wire and other surgical instruments is not facilitated. Such insufficient dexterity results in poor control accuracy, low work efficiency, and high risk.
(2) At present, the nipple cutting knife used in clinic is made of polymer, and the hardness of the material of the bending section is lower than that of the cutter bar, so that the deformation of the bending section can be realized by pulling the cutter wire fixed at the tail end to achieve the aim of selective pointing. In the process of the ERCP retrograde intervention of the biliary pancreatic duct, the incision knife needs to be bent at a larger angle to insert the duct. The elasticity of the polymer material is poor, the original shape is difficult to recover after repeated bending deformation, and when the bending angle is overlarge, the connecting part of the cutter bar and the bending section is easy to fold and collapse, so that the efficiency and the accuracy of the biliary pancreatic duct intervention are seriously affected.
(3) At present, a nipple incision knife used in clinic is not provided with an endoscopic camera, and can only rely on the field of view fed back by a duodenoscope to finish the intubation super-selection of the biliary pancreatic duct. After the incision knife is inserted into the biliary pancreatic duct, the view in the cavity can not be obtained, and the position can be judged only by the DSA (digital subtraction technique), so that a doctor suffers a great deal of radiation hazard.
(4) During the intervention of the incision knife, perforation easily occurs when the incision knife is inserted too deeply and then cut, and the incision of the sphincter is not realized when the incision knife is too shallow. The existing papillotome is limited by polymer materials, and the bending part is lack or only has a small number of attached marks, so that the precision is low, and the accurate assessment of the intervention depth by doctors is not facilitated.
Disclosure of Invention
Aiming at the problems existing in the prior art, the invention provides a visual controllable bent nipple incision knife, which is provided with a camera channel for visualizing the processes of super-selection intubation, biliary pancreatic duct implantation intervention treatment and the like, wherein four knife wires form two pairs of matched drive to realize the pointing of any space gesture, the rigidity progressive hollow skeleton can increase the flexibility of bending the incision knife and realize large-angle bending, the insertion depth of the precisely designed scale mark can be precisely controlled, the control precision and efficiency can be improved, and the visual controllable bent nipple incision knife has reasonable structural design and convenient and reliable adjustment, and is beneficial to simplifying operation and reducing risks.
The technical scheme of the invention is as follows:
A visual controllable curved nipple cutting knife, which is characterized in that: comprises a flexible bending part, a flexible cutter bar, a handle operation part and a cutter wire;
The flexible bending part comprises a distal head, a middle section and a proximal flexible bending section; the flexible bending part is provided with a first camera channel and a first instrument channel which are communicated in the front-back direction in the axial direction, the flexible bending part is provided with four first cutter wire channels in the middle section and the part of the proximal flexible bending section, each first cutter wire channel is outwards provided with a groove form in the part of the proximal flexible bending section, and the four first cutter wire channels are uniformly distributed along the circumferential direction of the proximal flexible bending section;
The flexible cutter bar is axially provided with a front-back through second camera channel, a second instrument channel and four second cutter wire channels, and the four second cutter wire channels are uniformly distributed along the circumferential direction of the flexible cutter bar;
the handle operation part comprises a handle shell, a first operation part and a second operation part which are arranged vertically symmetrically;
The handle shell is internally provided with a cavity, the proximal end of the handle shell is provided with two hollow tubular protruding parts, and the two tubular protruding parts respectively form a third camera channel and a third instrument channel;
The first operation part comprises a thumb wheel, a rotating shaft system and an electrode column, and the rotating shaft system comprises a rotating shaft and a winding wheel; the handle shell is provided with a first coaxial rotating shaft mounting hole and a second coaxial rotating shaft mounting hole, the rotating shaft is in a stepped shaft form and sequentially comprises a first shaft section, a second shaft section with the diameter larger than that of the first shaft section and a third shaft section with the diameter smaller than that of the second shaft section, the first shaft section sequentially penetrates through the first rotating shaft mounting hole and the second rotating shaft mounting hole and then is fixedly connected with the thumb wheel, the shaft shoulder of the second shaft section abuts against the outer side wall of the handle shell, and the third shaft section is fixedly connected with the electrode column; the winding wheel is arranged in the cavity, sleeved and clamped on the rotating shaft, and a double-layer track is arranged on the winding wheel;
The proximal end of the flexible bending part is fixedly connected with the distal end of the flexible cutter bar, the proximal end of the flexible cutter bar is fixedly connected with the distal end of the handle operation part, the first camera channel, the second camera channel, the cavity and the third camera channel are sequentially communicated, the first instrument channel, the second instrument channel, the cavity and the third instrument channel are sequentially communicated, and the first cutter wire channel, the second cutter wire channel and the cavity which correspond to each other in position are sequentially communicated;
The cutter wires are four, the distal end of each cutter wire is fixedly connected to the head part of the distal end, and the proximal end of each cutter wire sequentially passes through the corresponding first cutter wire channel and the corresponding second cutter wire channel, enters the cavity and is fixedly connected to the reel; the proximal end of one cutter wire of the pair of cutter wires with opposite positions is wound and fixed on one rail of the reel of the first operation part, the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the first operation part, the proximal end of the other cutter wire of the pair of cutter wires with opposite positions is wound and fixed on one rail of the reel of the second operation part, and the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the second operation part; the knife wire is an elastic metal wire and is provided with an insulating coating.
Further, the proximal flexible bending section is provided with cutting grooves at two sides of each first cutter wire channel at intervals of axial distance a, and the cutting grooves of two adjacent first cutter wire channels are axially arranged at intervals.
Further, the axial distance a gradually increases from the distal end to the proximal end of the flexible bend.
Further, the proximal flexible bend section is provided with graduation marks on an outer surface.
Furthermore, the scale marks are realized by a laser code spraying technology.
Further, the first operation part further comprises an elastic limiting mechanism, wherein the elastic limiting mechanism comprises a limiting shaft sleeve, a spring and a top bead;
The handle shell is internally provided with a limiting boss in an inward extending mode, and a cylindrical groove with an axis perpendicular to the axis of the rotating shaft is formed in the limiting boss;
The limiting shaft sleeve is sleeved and clamped on the rotating shaft, and a plurality of hemispherical grooves are uniformly formed in the outer surface of the limiting shaft sleeve along the circumferential direction;
the spring is arranged in the cylindrical groove, and the top bead is propped against the spring on one side and is propped against the hemispherical groove on the other side.
Further, an electrode column protecting sleeve is arranged on the outer side of the handle shell, and the electrode column extends into the electrode column protecting sleeve.
Further, the corresponding knife wire is driven to move to the proximal end to form a bow knife by rotating the thumb wheel; the four cutter wires are driven by two pairs of cooperation through cooperatively controlling the thumb wheel of the first operation part and the thumb wheel of the second operation part, so that the flexible bending part is pointed in any space posture.
The beneficial effects of the invention are as follows:
(1) The invention has the advantages that the camera channel is arranged on the handle operation part, the flexible bending part and the flexible cutter bar, and the camera can be configured, so that the invention can provide real-time and accurate visual feedback for the nipple and the biliary pancreas lumen for doctors, overcomes the invisible defect of the existing nipple cutting knife or the existing contrast tube for executing ERCP cannula operation, solves the most prominent problem which plagues the doctors in the prior ERCP operation, namely, the blind cannula has high failure rate and more complications, and greatly improves the accuracy of pancreatic bile duct disease diagnosis in the interventional process. In addition, the intra-cavity vision provided by the camera is hopeful to replace the DSA (digital subtraction imaging) technology used clinically at present, and the threat of radiation of the technology to the health of doctors is thoroughly avoided.
(2) According to the invention, the first operation part and the second operation part are respectively arranged in the handle operation part and used for controlling the pair of cutter wires, the four cutter wires are enabled to form two pairs to cooperatively drive the flexible bending part through cooperative control of the poking wheels of the two operation parts, the direction of any space posture is realized, the flexible direction adjustment can be realized without rotation, the control is more accurate, and the technical problems that the conventional nipple-incision knife depends on the whole rotation direction adjustment to cause friction loss torque in the incision knife body and the endoscope biopsy cavity, so that the control precision is low, and the torsion deformation even the blockage of the cavity in the incision knife is caused by repeated torsion are solved. Each cutter wire configured by the invention can be connected with high-frequency electricity to cut tissues, so that the technical problem that the operation is inconvenient due to the fact that only a single cutter wire is cut by the existing nipple cutting knife is solved. In addition, the movement direction of the tail end of the nipple opening knife is consistent with the mapping of the visual field direction of the configured camera, and a doctor can intuitively control the direction of the nipple opening knife according to the fed-back visual information in the cavity, so that the technical problems of non-intuitive operation and low efficiency caused by the movement mode of unidirectional bending and matching rotation of the traditional nipple opening knife are solved.
(3) The flexible bending part adopts the stiffness incremental hollow skeleton, so that bending positioning movement of the incision knife becomes more flexible, large-angle bending is easier to realize due to the stiffness incremental design, the efficiency and precision of retrograde intervention of the incision knife from the duodenal papilla to the biliary pancreatic duct are improved, and the technical problem that the efficiency and precision of intubation are affected due to collapse and deformation when the bending angle of the bending section is too large in the intubation process of the biliary pancreatic duct due to the fact that the skeleton structure is lacking due to the limitation of polymer materials of the bending section in the conventional papilla incision knife is solved.
(4) Compared with the traditional nipple cutting knife with the bending part made of polymer materials in clinical use, the flexible bending part provided by the invention can accurately judge the insertion depth, and is convenient for doctors to evaluate the subsequent operations such as stent placement.
(5) According to the invention, the handle operation part is provided with the elastic limiting mechanism, so that the rotation angle of the thumb wheel can be limited, and the phenomenon that the shape of the bow cutter is unstable due to automatic rotation of the thumb wheel under the traction action of the cutter wire after the thumb wheel leaves the hand of a person is avoided.
Drawings
Fig. 1 is a schematic view showing the structure of the visual controllable curved nipple cutting knife in a non-working state.
Fig. 2 is a schematic view of the visual controllable curved nipple cutting knife according to the present invention in an operating state.
Fig. 3 is a schematic view showing the structure of the flexible bending part in a non-working state in the visual controllable bending nipple cutting knife according to the present invention.
Fig. 4 is a schematic view showing the structure of the flexible bending part in an operating state in the visual controllable bending nipple cutting knife according to the present invention.
Fig. 5 is a schematic view showing the structure of the flexible bending part in various working states in the visual controllable bending nipple cutting knife according to the present invention.
Fig. 6 is a top view of a flexible bend in a visual controllable curved nipple cutting knife according to the present invention in a first embodiment.
Fig. 7 is an enlarged view of a portion of the flexible bend of the visual controllable curved nipple cutting knife of fig. 6.
FIG. 8 is a cross-sectional view A-A of the proximal flexible bend section of the flexible bend in the visual steerable-bending nipple cutting tool of the invention of FIG. 7.
FIG. 9 is a B-B cross-sectional view of the proximal flexible bend segment of the flexible bend in the visual steerable curved nipple cutting knife of the present invention of FIG. 7.
Fig. 10 is a C-C cross-sectional view of the intermediate section of the flexible bend in the visual steerable loop nipple cutting knife of the present invention of fig. 7.
Fig. 11 is a D-view of the flexible bend in the visual controllable curved nipple cutting knife of the present invention of fig. 7.
Fig. 12 is an E-E cross-sectional view of the flexible bend in the visual controllable curved nipple cutting knife of the present invention of fig. 7.
Fig. 13 is a schematic cross-sectional view of a flexible blade bar in a visual controllable curved nipple cutting blade of the present invention.
Fig. 14 is a schematic perspective view of a handle operation part in the visual controllable curved nipple cutting knife according to the present invention.
Fig. 15 is a front view of the handle manipulation portion of the visual controllable curved nipple cutting knife of fig. 14 according to the present invention.
Fig. 16 is a schematic view showing the structure of a first operation part of a handle operation part in a visual controllable curved nipple cutting knife according to the present invention in the first embodiment.
Fig. 17 is an F-F cross-sectional view of the handle operating portion of the visual controllable curved nipple cutting knife of the present invention in embodiment two.
Fig. 18 is a schematic view of the structure of the elastic stopper mechanism of the handle operation part in the visual controllable curved nipple cutting knife of fig. 17 according to the present invention.
Fig. 19 is a schematic view showing the structure of a reel in the visual controllable bent-nipple slitting knife of the present invention.
Fig. 20 is a top view of the reel of fig. 19.
In the figures, a 1-flexible bend, a 1-1-distal head, a 1-2-intermediate section, a 1-3-proximal flexible bend, a 1-4-first camera channel, a 1-5-first instrument channel, a 1-6-first cutter wire channel, a 1-7-incision, and 1-8-scale markings; 2-flexible cutter bar, 2-1-second camera channel, 2-2-second instrument channel and 2-3-second cutter wire channel; 3-handle operation part, 3-1-handle shell, 3-1-1-first rotation shaft mounting hole, 3-1-2-second rotation shaft mounting hole, 3-1-3-cylindrical groove, 3-1-4-hemispherical groove, 3-1-5-electrode column protective sleeve, 3-2-third camera channel, 3-3-third instrument channel, 3-4-thumb wheel, 3-5-electrode column, 3-6-rotation shaft, 3-7-reel, 3-8-limit shaft sleeve, 3-9-spring, 3-10-top bead; 4-knife wire.
Detailed Description
The invention will be further described with reference to the drawings and detailed description.
The "proximal" is the end closer to the operator and the "distal" is the end farther from the operator.
As shown in fig. 1 and 2, the visual controllable curved nipple cutting knife of the present invention comprises a flexible curved portion 1, a flexible knife bar 2, a handle operating portion 3, and a knife wire 4.
As shown in fig. 3, 6 and 7, the flexible bending portion 1 includes a distal head portion 1-1, an intermediate section 1-2, and a proximal flexible bending section 1-3. The distal end head 1-1 is of a near-cone-shaped structure, and the near-end flexible bending section 1-3 is a hollow insulating tube body with scale marks on the surface:
As shown in fig. 8, 9, 10, 11 and 12, the flexible bending portion 1 is provided with a first camera channel 1-4 and a first instrument channel 1-5 which are communicated front and back in the axial direction, the flexible bending portion 1 is provided with four first cutter wire channels 1-6 at the middle section 1-2 and the proximal flexible bending section 1-3, each first cutter wire channel 1-6 is provided with a groove form at the proximal flexible bending section 1-3 outwards, and the four first cutter wire channels 1-6 are uniformly distributed along the circumferential direction of the proximal flexible bending section 1-3 and are arranged at the outer sides of the first camera channel 1-4 and the first instrument channel 1-5.
In the first embodiment, as shown in fig. 6, 7 and 12, the proximal flexible bending section 1-3 is provided with cutting grooves 1-7 at axial distance a on both sides of each first wire channel 1-6, and the cutting grooves 1-7 of two adjacent first wire channels 1-6 are axially spaced. The variable rigidity and non-variable rigidity bending of the flexible bending part 1 can be realized through different grooving modes, the first embodiment adopts a variable rigidity hollow structure, specifically, the axial distance a is gradually increased from the distal end to the proximal end of the flexible bending part 1, so that the flexible bending part forms a rigidity incremental hollow skeleton, the bending positioning movement of the incision knife can be more flexible, the rigidity incremental design is easier to realize large-angle bending, the efficiency and the precision of the incision knife from the reverse intervention of the duodenal papilla to the biliary pancreatic duct are improved, and the technical problem that the efficiency and the precision of the intubation are influenced due to the fact that the bending section is easy to collapse and deform when the bending angle is overlarge in the intubation process of the ERCP reverse intervention biliary pancreatic duct due to the lack of a skeleton structure caused by the limitation of polymer material of the bending section is solved.
In the first embodiment, as shown in fig. 6 and 7, the proximal flexible bending section 1-3 is provided with scale marks 1-8 on the outer surface. The scale marks 1-8 are realized by a laser code spraying technology, compared with the traditional nipple cutting knife with a polymer bending part used clinically, the insertion depth can be judged more accurately, and a doctor can evaluate the subsequent stent implantation and other operations conveniently. Specifically, in order to improve the control precision, the invention can set scale marks at the positions of the start point, the stop point, the quarter point and the middle point, and can also add a plurality of other identification bits according to the requirements.
As shown in fig. 13, the flexible cutter bar 2 is provided with a second camera channel 2-1, a second instrument channel 2-2 and four second cutter wire channels 2-3 which are communicated in the front-back direction in the axial direction, and the four second cutter wire channels 2-3 are uniformly distributed along the circumferential direction of the flexible cutter bar 2. Wherein the flexible cutter bar 2 is an insulating sheath tube.
As shown in fig. 14 and 15, the handle operation portion 3 includes a handle housing 3-1, and a first operation portion and a second operation portion which are vertically symmetrically arranged. Wherein the second operation part is positioned below the first operation part.
The handle housing 3-1 forms a cavity inside, and the proximal end of the handle housing 3-1 is provided with two hollow tubular protruding parts, and the two tubular protruding parts respectively form a third camera channel 3-2 and a third instrument channel 3-3.
The structure of the handle operation portion 3 will be described below by taking the first operation portion as an example with reference to the drawings:
In the first embodiment, as shown in fig. 16, the first operation part includes a thumb wheel 3-4, a rotation shaft system, and an electrode column 3-5, and the rotation shaft system includes a rotation shaft 3-6 and a reel 3-7. In a second embodiment of the present invention, as shown in fig. 17, the first operation portion further includes an elastic limiting mechanism.
Specifically, a first coaxial rotating shaft mounting hole 3-1-1 and a second coaxial rotating shaft mounting hole 3-1-2 are formed in the handle shell 3-1, the rotating shaft 3-6 is in a stepped shaft mode and sequentially comprises a first shaft section, a second shaft section with the diameter larger than that of the first shaft section and a third shaft section with the diameter smaller than that of the second shaft section, the first shaft section sequentially penetrates through the first rotating shaft mounting hole 3-1-1 and the second rotating shaft mounting hole 3-1-2 and then is fixedly connected with the thumb wheel 3-4, the shaft shoulder of the second shaft section abuts against the outer side wall of the handle shell 3-1, and the third shaft section is fixedly connected with the electrode column 3-5. The reel 3-7 is disposed inside the cavity and is sleeved and clamped on the rotating shaft 3-6, as shown in fig. 19 and 20, a double-layer track is disposed on the reel 3-7, and the double-layer track is two circular tracks parallel to each other.
As shown in fig. 17 and 18, the elastic limiting mechanism comprises a limiting shaft sleeve 3-8, a spring 3-9 and a top bead 3-10; the handle shell 3-1 is internally provided with a limiting boss in an extending mode, and the limiting boss is provided with a cylindrical groove 3-1-3 with the axis perpendicular to the axis of the rotating shaft 3-6; the limiting shaft sleeve 3-8 is sleeved and clamped on the rotating shaft 3-6, and a plurality of hemispherical grooves 3-1-4 are uniformly formed in the outer surface of the limiting shaft sleeve 3-8 along the circumferential direction; the spring 3-9 is arranged in the cylindrical groove 3-1-3, and the top bead 3-10 is propped against the spring 3-9 on one side and is propped against the hemispherical groove 3-1-4 on the other side.
The handle shell 3-1 is provided with an electrode column protecting sleeve 3-1-5 at the outer side, and the electrode column 3-5 stretches into the electrode column protecting sleeve 3-1-5.
The connection and position of each part are as follows:
The proximal end of the flexible bending part 1 is fixedly connected with the distal end of the flexible cutter bar 2, the proximal end of the flexible cutter bar 2 is fixedly connected with the distal end of the handle operation part 3, the first camera channel 1-4, the second camera channel 2-1, the cavity and the third camera channel 3-2 are sequentially communicated, the first instrument channel 1-5, the second instrument channel 2-2, the cavity and the third instrument channel 3-3 are sequentially communicated, and the first cutter wire channel 1-6, the second cutter wire channel 2-3 and the cavity which correspond to each other in position are sequentially communicated. On one hand, the invention can provide real-time accurate visual feedback of papilla and biliary pancreas lumen for doctors by arranging the camera channel configurable cameras on the handle operation part, the flexible bending part and the flexible cutter bar, overcomes the invisible defect of the existing papilla incision knife or contrast tube for executing ERCP cannula operation, solves the most prominent problem which puzzles the doctors in the ERCP operation at present, namely, high blind cannula failure rate and more complications, and greatly improves the accuracy of pancreatic bile duct disease diagnosis in the interventional process. In addition, the intra-cavity vision provided by the camera is hopeful to replace the DSA (digital subtraction imaging) technology used clinically at present, and the threat of radiation of the technology to the health of doctors is thoroughly avoided. On the other hand, by arranging the instrument channel, the invention can be used for configuring various instruments such as guide wires, laser optical fibers, biopsy forceps, stone extraction basket and the like so as to meet the requirements of different operations.
The number of the cutter wires 4 is four, the distal end of each cutter wire 4 is fixedly connected to the distal end head 1-1, and the proximal end of each cutter wire 4 sequentially passes through the corresponding first cutter wire channel 1-6 and the corresponding second cutter wire channel 2-3, then enters the cavity and is fixedly connected to the reel 3-7. Specifically, the proximal end of one cutter wire of the pair of opposite cutter wires is wound and fixed on one rail of the reel of the first operation part, the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the first operation part, the proximal end of the other cutter wire of the pair of opposite cutter wires is wound and fixed on one rail of the reel of the second operation part, and the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the second operation part, and the proximal end of each cutter wire is fixed in a through hole on the reel after being wound. Wherein the cutter wire 4 is an elastic metal wire and is provided with an insulating coating; the part of the cutter wire 4 positioned in the first cutter wire channel 1-6 is coaxial with the arc section of the first cutter wire channel 1-6.
The working principle of the invention is described below with reference to the accompanying drawings:
Fig. 4 is a schematic view showing the structure of the flexible bending part in an operating state in the visual controllable bending nipple cutting knife according to the present invention. In fig. 4, the present invention drives the corresponding knife wire to move proximally to form an arcuate knife by rotating the thumb wheel. Specifically, taking a pair of cutter wires controlled by the first operation part as an example, the thumb wheel 3-4 is rotated to drive the rotating shaft 3-6 to rotate, and the winding wheel 3-7 is further driven to rotate, so that one cutter wire in the pair of cutter wires is tensioned, the other cutter wire is loosened, and the tensioned cutter wire is pulled outwards along the first cutter wire channel 1-6 in the groove form to form an arch cutter, and the opposite cutter wire is still positioned in the groove of the first cutter wire channel 1-6. Meanwhile, the rotating thumb wheel 3-4 drives the rotating shaft 3-6 and the limiting shaft sleeve 3-8 to rotate, the top bead 3-10 is pressed down and clamped into the hemispherical groove 3-1-4 again after rotating for a fixed angle, the rotating angle of the thumb wheel 3-4 is limited, and the phenomenon that the shape of a bow cutter is unstable due to automatic rotation of the thumb wheel under the traction action of a cutter wire after the thumb wheel leaves a human hand is avoided.
Fig. 5 is a schematic structural view of the flexible bending part of the visual controllable bending nipple cutting knife according to the present invention in various working states. According to the invention, the first operation part and the second operation part are respectively arranged in the handle operation part and are used for controlling the pair of knife wires, and the four knife wires are matched in two pairs to drive the flexible bending part by cooperatively controlling the thumb wheel of the first operation part and the thumb wheel of the second operation part, so that the flexible bending part is pointed in any space posture, flexible direction adjustment can be realized without rotation, the control is more accurate, and the technical problems that the current nipple incision knife depends on integral rotation direction adjustment to cause the internal friction loss torque of the incision knife body and the endoscope biopsy cavity, thereby having low control precision and causing the distortion and even blockage of the internal cavity of the incision knife due to repeated torsion are solved.
Each cutter wire configured by the invention can be connected with high-frequency electricity to cut tissues, so that the technical problem that the operation is inconvenient due to the fact that only a single cutter wire is cut by the existing nipple cutting knife is solved.
In addition, the movement direction of the tail end of the nipple opening knife is consistent with the mapping of the visual field direction of the configured camera, and a doctor can intuitively control the direction of the nipple opening knife according to the fed-back visual information in the cavity, so that the technical problems of non-intuitive operation and low efficiency caused by the movement mode of unidirectional bending and matching rotation of the traditional nipple opening knife are solved.
It should be apparent that the above-described embodiments are merely some, but not all, embodiments of the present application. The above examples are only for explaining the present application and do not limit the scope of the present application. Based on the above embodiments, all other embodiments obtained by those skilled in the art without making creative efforts, i.e., all modifications, equivalents, improvements etc., which are within the spirit and principles of the present application, fall within the protection scope of the present application as claimed.
Claims (6)
1. A visual controllable curved nipple cutting knife, which is characterized in that: comprises a flexible bending part (1), a flexible cutter bar (2), a handle operation part (3) and a cutter wire (4);
The flexible bending part (1) comprises a distal end head part (1-1), an intermediate section (1-2) and a proximal flexible bending section (1-3); the flexible bending part (1) is provided with a first camera channel (1-4) and a first instrument channel (1-5) which are communicated front and back in the axial direction, the flexible bending part (1) is provided with four first cutter wire channels (1-6) at the middle section (1-2) and the part of the proximal flexible bending section (1-3), each first cutter wire channel (1-6) is provided with a groove form outwards at the part of the proximal flexible bending section (1-3), and the four first cutter wire channels (1-6) are uniformly distributed along the circumferential direction of the proximal flexible bending section (1-3);
The flexible cutter bar (2) is provided with a second camera channel (2-1), a second instrument channel (2-2) and four second cutter wire channels (2-3) which are communicated in the front-back direction in the axial direction, and the four second cutter wire channels (2-3) are uniformly distributed along the circumferential direction of the flexible cutter bar (2);
the handle operation part (3) comprises a handle shell (3-1), and a first operation part and a second operation part which are arranged vertically symmetrically;
the handle shell (3-1) is internally provided with a cavity, the proximal end of the handle shell (3-1) is provided with two hollow tubular protruding parts, and the two tubular protruding parts respectively form a third camera channel (3-2) and a third instrument channel (3-3);
The first operation part comprises a thumb wheel (3-4), a rotary shaft system and an electrode column (3-5), wherein the rotary shaft system comprises a rotary shaft (3-6) and a reel (3-7); the handle shell (3-1) is provided with a first coaxial rotating shaft mounting hole (3-1-1) and a second rotating shaft mounting hole (3-1-2), the rotating shaft (3-6) is in a stepped shaft form and sequentially comprises a first shaft section, a second shaft section with the diameter larger than that of the first shaft section and a third shaft section with the diameter smaller than that of the second shaft section, the first shaft section sequentially penetrates through the first rotating shaft mounting hole (3-1-1) and the second rotating shaft mounting hole (3-1-2) and then is fixedly connected with the thumb wheel (3-4), a shaft shoulder of the second shaft section abuts against the outer side wall of the handle shell (3-1), and the third shaft section is fixedly connected with the electrode column (3-5); the coiling wheel (3-7) is arranged in the cavity, sleeved and clamped on the rotating shaft (3-6), and a double-layer track is arranged on the coiling wheel (3-7);
The proximal end of the flexible bending part (1) is fixedly connected with the distal end of the flexible cutter bar (2), the proximal end of the flexible cutter bar (2) is fixedly connected with the distal end of the handle operation part (3), the first camera channel (1-4), the second camera channel (2-1), the cavity and the third camera channel (3-2) are sequentially communicated, the first instrument channel (1-5), the second instrument channel (2-2), the cavity and the third instrument channel (3-3) are sequentially communicated, and the first cutter wire channel (1-6), the second cutter wire channel (2-3) corresponding to the positions are sequentially communicated with the cavity;
The cutter wires (4) are four, the distal end of each cutter wire (4) is fixedly connected to the distal end head (1-1), and the proximal end of each cutter wire (4) sequentially passes through the corresponding first cutter wire channel (1-6) and the corresponding second cutter wire channel (2-3) and then enters the cavity and is fixedly connected to the reel (3-7); the proximal end of one cutter wire of the pair of cutter wires with opposite positions is wound and fixed on one rail of the reel of the first operation part, the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the first operation part, the proximal end of the other cutter wire of the pair of cutter wires with opposite positions is wound and fixed on one rail of the reel of the second operation part, and the proximal end of the other cutter wire is reversely wound and fixed on the other rail of the reel of the second operation part; the cutter wire (4) is an elastic metal wire and is provided with an insulating coating;
The proximal flexible bending section (1-3) is provided with cutting grooves (1-7) at intervals in the axial direction on two sides of each first cutter wire channel (1-6), and the cutting grooves (1-7) of two adjacent first cutter wire channels (1-6) are arranged at intervals in the axial direction;
The first operation part further comprises an elastic limiting mechanism, wherein the elastic limiting mechanism comprises a limiting shaft sleeve (3-8), a spring (3-9) and a top bead (3-10);
The handle shell (3-1) is internally provided with a limiting boss in an extending mode, and a cylindrical groove (3-1-3) with the axis perpendicular to the axis of the rotating shaft (3-6) is formed in the limiting boss;
The limiting shaft sleeve (3-8) is sleeved and clamped on the rotating shaft (3-6), and a plurality of hemispherical grooves (3-1-4) are uniformly formed in the outer surface of the limiting shaft sleeve (3-8) along the circumferential direction;
the spring (3-9) is arranged in the cylindrical groove (3-1-3), and the top bead (3-10) is propped against the spring (3-9) at one side and is propped against the hemispherical groove (3-1-4) at the other side.
2. The visually controllable curved nipple cutting knife according to claim 1, characterized in that the axial distance increases gradually from the distal end to the proximal end of the flexible curved portion (1).
3. The visually controllable curved nipple cutting tool according to claim 1, wherein the proximal flexible curved section (1-3) is provided with graduation marks (1-8) on the outer surface.
4. A visually controllable curved nipple cutting knife according to claim 3, characterized in that the scale marks (1-8) are realized by means of a laser code-spraying technique.
5. The visual controllable curved nipple cutting knife according to claim 1, characterized in that the handle housing (3-1) is provided with an electrode column protecting sleeve (3-1-5) on the outside, the electrode column (3-5) extending into the electrode column protecting sleeve (3-1-5).
6. The visual controllable curved nipple cutting blade of any one of claims 1-5, wherein the corresponding blade wire is moved proximally by rotating the thumb wheel to form a bowing blade; through cooperative control the thumb wheel of the first operation part and the thumb wheel of the second operation part, four cutter wires (4) are driven in two pairs in a matched mode to the flexible bending part (1), and the flexible bending part (1) is oriented in any space posture.
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| CN117357234A (en) * | 2022-06-30 | 2024-01-09 | 微创优通医疗科技(嘉兴)有限公司 | Bending-controlled slitting knife |
| CN116236273A (en) * | 2023-02-28 | 2023-06-09 | 北京大学深圳医院 | Plasma electrode rod assembly, plasma electrode and electrode system |
| CN116058930B (en) * | 2023-03-06 | 2023-06-16 | 浙江首鼎医学科技有限公司 | Nipple incision knife based on incision density and incision advantage switching method thereof |
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| JP5074069B2 (en) * | 2007-03-29 | 2012-11-14 | オリンパスメディカルシステムズ株式会社 | Multi-joint bending mechanism and medical device with multi-joint bending mechanism |
| CN102100582A (en) * | 2009-12-16 | 2011-06-22 | 余姚市柳叶刀医疗器械科技有限公司 | Rotatable wrist minimally-invasive electrode |
| CN104434269A (en) * | 2014-11-28 | 2015-03-25 | 姚俊 | Two-guide-wire papillotome |
| CN111772780A (en) * | 2020-07-28 | 2020-10-16 | 上海市东方医院（同济大学附属东方医院） | Multi-directional papillary sphincter incision knife |
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| CN215384573U (en) * | 2021-05-12 | 2022-01-04 | 中国人民解放军总医院第一医学中心 | Visual controllable curved nipple incision knife |
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