For handling the treatment system of fierce dangerous placental presentation clinical acute diseaseTechnical field
The present invention relates to a kind of for handling the treatment system of fierce dangerous placental presentation clinical acute disease.
Background technique
For reply China human mortality aging, promote population balanced development, China has implemented in full a couple in 2016 canGive birth to the policy of two children.Due to the relieving of two tire policies and the rising of previous cesarean section rate, uterine cicatrix again gestation withIncrease.Once placenta implantation at the scar of uterus, that is, forms fierce dangerous placental presentation.Fierce dangerous placental presentation production is sent out oftenRaw uncontrollable big bleeding, easily causes the severe complications such as disseminated intravascular coagulation, shock, not only uterectomy rateHeight, and maternal mortality rate is high, is that obstetrics are anxious, endangers, severe.
There are many research both at home and abroad about fierce dangerous placental presentation treatment.The side of the fierce dangerous placental presentation for the treatment of is pointed out in researchMethod has very much, including the resistance of conventional Cesarean operation, lower uterine segment tourniquet strapping, Intra-arterial infusions, abdominal aorta sacculusBreak.Conventional Cesarean operation is previously to implement Cesarean esction in the case where no any auxiliary equipment helps, often because going out greatly in artTherefore blood and row uterectomy, patient lose organ, lose permanent fecundity.And lower uterine segment tourniquet is tied upMethod can only select after delivery of baby, limited in terms of the amount of bleeding of uterus in reducing art.
In recent years, gradualling mature with intervention operation, domestic and international some strong large hospitals spend high costHybridization operating room, intervention operating room etc. are set up, balloon position is positioned by x-ray, intervention blocks internal iliac artery or abdominal aortaTo reduce intraoperative hemorrhage.However bilateral internal iliac is blocked due to bilateral to be blocked, surgical procedure is more complex, the time is long, in artUsing DSA, it is exposed to pregnant woman and fetus under x-ray radiation for a long time, for there are in the case where metrecotpia artery blood supply, such asArteria ovarica and (or) arteria iliaca externa participate in blood supply, block bilateral internal iliac merely, not can be effectively controlled intraoperative hemorrhage.AlthoughIntervention in recent years blocks abdominal aorta to achieve good result for fierce dangerous caesarean section with placenta previa, still, and in x-ray JieIt leads down, DSA is needed to assist, puncture process is blind threading method, be easy to cause femoral nerve injury, stock arteriovenous fistula.Moreover build hybridizationOperating room/intervention operating room cost is high, and general hospital is difficult to bear, and patient spends also expensive.
Summary of the invention
The present invention is to overcome the technical problems existing in the prior art and provide clinical for handling fierce dangerous placental presentationThe treatment system of acute disease, the treatment system can make the operation of the fierce dangerous placental presentation clinical acute disease of processing in general operating roomCan be completed, and can be exposed under X-ray to avoid medical staff and female tire and the radiation that is subject to.
It is a kind of for handling the treatment system of fierce dangerous placental presentation clinical acute disease, including ultrasonic scanner and occlusion ballCapsule, for the case where detecting treatment site, ultrasonic scanner is also electrically connected with ultrasonic wave display device ultrasonic scanner.
For using ultrasonic scanner to detect internal situation, avoids and detected in the prior art using X-rayWhen, x-ray protection, DSA equipment etc. are not needed, this project can be carried out after general hospital is trained, entire operation is in general surgeryRoom can be carried out and complete, and can substantially reduce medical insurance spending, save medical insurance, reduce patient's economy and psychological burden.WithLocalization by ultrasonic can be more accurate with guiding puncture femoral artery, avoids accidentally wearing, this is not available for x-ray.
Ultrasonic mediation is mediated compared to x-ray, can avoid medical staff and female tire is exposed under X-ray and the radiation that is subject to,Even if being far below the fetal well-being x-ray radiation dosage of 150mGy, the operating time also will receive obvious limitation.And in ultrasonic guidance mistakeCheng Zhong was not both radiated, and also without time restriction, there are no contrast agent is needed, reduced interference of the external factor to surgical.
Preferred technical solution, supplementary features are: occlusion balloon includes metallic framework, and capsule is provided with outside metallic frameworkBody, utricule are elastomer, and metallic framework includes a metal braid, have the shape of default extension, in the default extensionEach of shape proximally and distally includes a groove, each proximally and distally has a connection terminal, is used to be fixedly attached toEvery one end in metal braid, the connection terminal are contained in inside grooves, and metal braid has memory characteristic, so that working asWhen to the first state for not applying constraint proximally and distally, the shape of metallic framework can support utricule sealing blood vessels, when rightWhen proximal end applies the pulling force far from distal end or applies the thrust far from proximal end to distal end, metallic framework is in the second state,The cross section of second state is less than the cross section under first state can be pumped through the intracorporal blood vessel of people.
The metallic framework that utricule is formed by metal braid, can undertake Main Load with the basic configuration of component utricule,So as to block, block up tight blood vessel on the whole.And it by the sectional area size of utricule, is mutually tied with force-bearing situation proximally and distallyIt closes, to easily realize the switching of big small cross-sectional area.
Further preferred technical solution, supplementary features are: proximal end be it is hollow, distally connect with first connecting rod,First connecting rod proximally in pass through.
By will control the first connecting rod of distal end proximally in pass through, proximal end and distal end can be controlled from unilateral side, it is convenientOne hand controls the operation at both ends simultaneously.
Technical solution still further preferably, supplementary features are: reactant packet are additionally provided in utricule, reaction packet chamber is setThe lateral surface in first connecting rod is set, when the reactant in reactant packet is powered, reactant is chemically reacted, to be used for capsuleCubical expansion is opened.
Reactant packet is set, and to generate bulk gas in the reactant short time, to utricule be strutted, so that capsuleBody can be tightly bonded with blood vessel, be come into full contact with, to guarantee blood vessel constriction uniformly and seal.
Further preferred technical solution, supplementary features are: occlusion balloon further includes the first circuit, the first circuitOn be connected with first switch, first resistor is connected in the first circuit, first resistor is arranged in the reactant of reactant packet.
By way of electric ignition, whether realizing the reaction by extraneous control reactant, to realize to reactantIt automatically controls.
Further preferred technical solution, supplementary features are: utricule is equipped with diaphragm, and utricule is arranged in diaphragmSide, diaphragm is for stopping the gas in utricule to escape from utricule.
By the way that diaphragm is arranged, the evolution of the intracorporal gas of capsule is completely cut off, has improved the lasting seals of blood vessel during operationProperty.
Further preferred technical solution, supplementary features are: diaphragm is equipped with second resistance, second resistance connectionIn the second loop, second switch and third switch are provided in second servo loop, second switch includes the first contact and the second touchingPoint, the first contact are fixedly connected with the first drawstring to a little less, and the first drawstring is driven by the first button, and the first button is pressedWhen, the first drawstring is moved away from the direction of distal end, and the first contact is contacted with the second contact, and is closed when third switch is inWhen conjunction state, so that second resistance conduction is broken so that the gas in utricule escapes to burn diaphragm.
Second servo loop is set, and to control second resistance, the exhaust and metal braid that may be implemented in utricule are contractedThe synchronization of small bore.And by the way that third switch is arranged again, the exhaust of control metal braid deformation extent and utricule is realizedSeparation avoids when individually adjusting metal braid section and causes the malfunction of air bags.
Preferred technical solution, supplementary features are: the step of handling fierce dangerous placental presentation clinical acute disease includes:
S1. Preoperative ultrasound detects abdominal aorta；
S2. Preoperative ultrasound accurately measures abdominal aorta internal diameter, position arteria renalis opening away from abdominal aortic bifurcation at, and surveyIts distance is measured, sizeable sacculus is selected with guidance；
Foley's tube is inserted into abdominal aorta through right common femoral artery Puncture approach by S3. ultrasonic guidance femoral artery puncture, andGuidance sacculus enters between arteria renalis opening and abdominal aortic bifurcation, and fixed indwelling is spare；
S4. ultrasound reaffirms balloon position, and sacculus is blocked state at this time；Ultrasonic guidance precise positioning balloon position,To avoid the important organs such as kidney are blocked, make sacculus upper end close to arteria renalis opening；
S5. preoperative pre- blocking is changed with renal artery anastomosis stenosis blood flow and is confirmed whether to block completely；
S6. balloon occlusion opportunity selection is blocked before delivery of baby；Invasive Technology Department doctor is enjoined before cutting mesometriumDilating sacculus blocks blood supply, while ultrasonic monitoring blood flow dynamic.
Abdominal aorta internal diameter can be accurately measured while detecting abdominal aorta by preoperative, suitable ball is selected with guidanceCapsule diameter；Since sacculus and abdominal aorta internal diameter can coincide, when dilating sacculus, can reach accurate blocking, to avoid sacculus excessiveIt is full that injury of abdominal aorta or sacculus underfilling is caused to lead to Abdominal aortic crossclamping not complete, intraoperative hemorrhage etc..
The above-mentioned method blocked repeatedly can block abdominal aorta according to Suture hemostasis situation in art repeatedly, to avoid it is long whenBetween blood vessel blocking blood injury blacked-out areas internal organs；
With in localization by ultrasonic art can with dynamic monitoring blood flow change and be confirmed whether to block completely, and can find early whether there is or notThe complication such as thrombus and artery dissection, this is also not available for x-ray.
Further preferred technical solution, supplementary features are: further include digital image processing apparatus and controller andStart button,
Digital image processing apparatus for receiving ultrasonic scanner image obtained, and is converted into digital picture, andGray value is lower than the region of preset value in identification digital picture, and the length in a first direction in the region is greater than in second party3 times of upward length, are determined as angiosomes；And according to the infall of multiple angiosomes be confirmed as arteria renalis opening andAt abdominal aortic bifurcation；
Utricule is moved at abdominal aortic bifurcation between arteria renalis opening by controller for controlling mechanical hand,It when the position of utricule is identified by digital image processing apparatus, and is confirmed as after correct position, first switch is triggered, so that utriculeExpansion is to block blood vessel；And third switch and second switch are triggered after operation, by the reduced cross-sectional of utricule, by sacculus fromIt is removed in blood vessel；
Start button, for starting the recognizer of digital image processing apparatus and the journey of controller control sacculus movementSequence.
Further preferred technical solution, supplementary features are: further including digital image processing apparatus and controller, surpassSound wave display device is touch screen,
Digital image processing apparatus for receiving ultrasonic scanner image obtained, and is converted into digital picture, andGray value is lower than the region of preset value in identification digital picture, and the length in a first direction in the region is greater than in second party3 times of upward length, are determined as angiosomes；And according to the infall of multiple angiosomes be confirmed as arteria renalis opening andAt abdominal aortic bifurcation；
Utricule is moved at abdominal aortic bifurcation between arteria renalis opening by controller for controlling mechanical hand,It when the position of utricule is identified by digital image processing apparatus, and is confirmed as after correct position, first switch is triggered, so that utriculeExpansion is to block blood vessel；And third switch and second switch are triggered after operation, by the reduced cross-sectional of utricule, by sacculus fromIt is removed in blood vessel；
Multiple choosings for selection operation step or control first switch, second switch, third switch are set on touch screenSelect key.
Detailed description of the invention
Fig. 1 is the structure chart of the embodiment of the present invention 1；
Fig. 2 is schematic diagram of the occlusion balloon of the embodiment of the present invention 1 in balloon inflation；
Fig. 3 is schematic diagram of the occlusion balloon of the embodiment of the present invention 1 when utricule is shunk.
Fig. 4 is the schematic diagram that ultrasonic scanner carries out Preoperative ultrasound detection abdominal aorta.
Fig. 5 is the schematic diagram that ultrasonic scanner carries out Preoperative ultrasound detection.
Fig. 6 is the schematic diagram of ultrasonic guidance femoral artery puncture.
Fig. 7 is the schematic diagram that ultrasonic scanner carries out the positioning of ultrasonic guidance sacculus.
Fig. 8 is that ultrasonic scanner carries out the dynamic schematic diagram of ultrasonic monitoring blood flow.
Fig. 9 is the structural schematic diagram of the embodiment of the present invention 2.
Figure 10 is the structural schematic diagram of the embodiment of the present invention 3.
Specific embodiment
In order to further understand the content, features and effects of the present invention, the following examples are hereby given, and it is described in detailIt is as follows:
Embodiment 1:
Fig. 1 is the structure chart of the embodiment of the present invention 1；Fig. 2 is the occlusion balloon of the embodiment of the present invention 1 in balloon inflationSchematic diagram；Fig. 3 is schematic diagram of the occlusion balloon of the embodiment of the present invention 1 when utricule is shunk；In figure, represented by appended drawing referenceMeaning is as follows:
1, ultrasonic scanner；2, ultrasonic wave display device；3, occlusion balloon；31, metal braid；32, utricule；33,Groove；34, proximal end；35, distal end；36, first connecting rod；37, reactant packet；38, diaphragm；39, second resistance；40, the first drawstring；41, the first button；42, third switchs.
It is a kind of for handling the treatment system of fierce dangerous placental presentation clinical acute disease, including ultrasonic scanner 1 and occlusionSacculus 3, ultrasonic scanner 1 is for the case where detecting treatment site.Ultrasonic scanner 1 is also electric with ultrasonic wave display device 2Connection.
For using ultrasonic scanner 1 to detect internal situation, avoids and detected in the prior art using X-rayWhen, x-ray protection, DSA equipment etc. are not needed, this project can be carried out after general hospital is trained, entire operation is in general surgeryRoom can be carried out and complete, and can substantially reduce medical insurance spending, save medical insurance, reduce patient's economy and psychological burden.WithLocalization by ultrasonic can be more accurate with guiding puncture femoral artery, avoids accidentally wearing, this is not available for x-ray.
Ultrasonic mediation mediates the radiation that can avoid medical staff and female tire exposure X-ray compared to x-ray, even if being far belowThe fetal well-being x-ray radiation dosage of 150mGy, operating time also will receive obvious limitation.And during ultrasonic guidance, both do not hadThere is radiation, also without time restriction, there are no contrast agent is needed, reduces interference of the external factor to surgical.
It is further preferred that occlusion balloon 3 includes metallic framework, utricule 32 is provided with outside metallic framework, utricule 32 is bulletProperty body, metallic framework includes a metal braid 31, has the shape of default extension, in each of the shape of the default extensionProximal end 34 and distal end 35 include a groove 33, and each proximal end 34 and distal end 35 have a connection terminal, are used to be fixedly attached toEvery one end in metal braid 31, the connection terminal are contained in inside groove 33, and metal braid 31 has memory characteristic,So that the shape of metallic framework can support 32 envelope of utricule when not applying the first state of constraint to proximal end 34 and distal end 35Blood vessel is closed, when applying far from distally 35 pulling force to proximal end 34 or applying the thrust far from proximal end 34 to distal end 35, goldBelong to skeleton and be in the second state, the cross section of the second state is less than the cross section under first state can be pumped through peopleIntracorporal blood vessel.
The metallic framework that utricule 32 is formed by metal braid 31, can undertake master with the basic configuration of component utricule 32Load is wanted, so as to block, block up tight blood vessel on the whole.And by the sectional area size of utricule 32, with proximal end 34 and distal end 35Force-bearing situation combine, to easily realize the switching of big small cross-sectional area.
Still further preferably, proximal end 34 is hollow, and distal end 35 is connect with first connecting rod 36, and first connecting rod 36 is proximallyIt is passed through in 34.
By proximally passing through the first connecting rod 36 of control distal end 35 in 34, proximal end 34 and remote can be controlled from unilateral sideEnd 35, facilitates a hand while controlling the operation at both ends.
Still more preferably, reactant packet 37 is additionally provided in utricule 32, the outer of first connecting rod 36 is arranged in reaction packet chamberSide, when the reactant in reactant packet 37 is powered, reactant is chemically reacted, to be used for 32 distending of utricule.OcclusionSacculus 3 further includes the first circuit, and first switch is connected on the first circuit, and first resistor, the first electricity are connected in the first circuitResistance is arranged in the reactant of reactant packet 37.Although the part-structure is not shown on the diagram, those skilled in the artBe completely can be according to existing knowledge and component comes out related circuit.
Reactant packet 37 is set, and to generate bulk gas in the reactant short time, so that utricule 32 is strutted, so thatObtaining utricule 32 can tightly be bonded with blood vessel, come into full contact with, to guarantee blood vessel constriction uniformly and seal.Pass through electric ignitionMode, whether realizing the reaction by extraneous control reactant, to realize the automatic control to reactant.
Further preferred, utricule 32 is equipped with diaphragm 38, and the side of utricule 32 is arranged in diaphragm 38, and diaphragm 38 is used forThe gas in utricule 32 is stopped to escape from utricule 32.By the way that diaphragm 38 is arranged, the evolution of the gas in utricule 32 is completely cut off, has mentionedThe high lasting seals of blood vessel during operation.
Further preferred, diaphragm 38 is equipped with second resistance 39, and second resistance 39 connects in the second loop, and secondSecond switch and third switch 42 are provided in circuit, second switch includes the first contact and the second contact, the first contact and useThe first drawstring 40 in control proximal end 34 is fixedly connected to a little less, and the first drawstring 40 is driven by the first button 41, the first button41 when being pressed, and the first drawstring 40 is moved away from the direction of distal end 35, and the first contact is contacted with the second contact, and ought theThree switches 42 in the closure state, are broken with burning diaphragm 38 so that the gas in utricule 32 escapes so that second resistance 39 is conductiveOut.Second servo loop is set, and to control second resistance 39, the exhaust and metal braid 31 that may be implemented in utricule 32 are contractedThe synchronization of small bore.And by the way that third switch 42 is arranged again, control 31 deformation extent of metal braid and utricule 32 are realizedThe separation of exhaust avoids when individually adjusting 31 section of metal braid and causes the malfunction of air bags.
The concrete principle of above-mentioned sacculus are as follows:
When sacculus is positioned, by pushing first connecting rod 36, distal end 35 is sent into forward to the appropriate location in blood vessel, andThe first button 41 is pressed, so that proximal end 34 is in the state as far as possible far from distal end 35, so that metal knitted product are pulled open, so thatMetal knitted product are in lesser second state in section.After being sent into place, the first button 41 is unclamped, since metal knitted product haveMemory effect, outside expansion that can be spontaneous when not by external force, so that utricule 32 be strutted.Moreover, at this time by firstIt closes the switch, the reactant in reactant packet 37 chemically reacts, and generates gas, such as ammonium nitrate can be allowed in heated conditionLower generation water, oxygen and nitrogen.Or sodium azide is allowed to generate sodium and nitrogen.Utricule 32 is strutted, at this time due to there is diaphragm 38Stop, so gas will not be revealed from utricule 32.
When needing shrinks sacculus, by lower button, proximal end 34 is pulled to connect relative to first not only through the first drawstring 40The right side into figure of bar 36 is mobile, and the first contact is electrically connected with the second contact, while pressing third switch 42, and second timeRoad conducting, the part of resistance heating diaphragm 38, diaphragm 38 rupture, and gas is sprayed from utricule 32, while proximal end 34 and distal end 35It is separate, but also metal braid 31 is elongated, corresponding sectional area also reduces, and takes sacculus from blood vessel to facilitateOut.
Preferably, the step of processing act of violence dangerous placental presentation clinical acute disease includes:
1. as shown in figure 4, Preoperative ultrasound detects abdominal aorta, and measuring related data.Right side arrow is for showing abdomen masterAt aortic bifurcation between arteria renalis opening at a distance from, left color arrow be abdominal aorta internal diameter.
2. positioning arteria renalis opening is away from abdominal aorta point as shown in figure 5, Preoperative ultrasound accurately measures abdominal aorta internal diameterAt fork, and its distance is measured, so as to guide sizeable sacculus model is selected, to reach accurate blocking.Left arrow isAt abdominal aortic bifurcation, right side arrow is arteria renalis opening.
3. as shown in fig. 6, ultrasonic guidance femoral artery puncture, through right common femoral artery Puncture approach.In Fig. 6, arrow meaning isThe position of femoral artery puncture needle.Foley's tube is inserted into abdominal aorta, and sacculus is guided to enter to arteria renalis opening and abdomen masterBetween aortic bifurcation, fixed indwelling is spare, at this time as shown in Figure 7.In Fig. 7, arrow meaning is sacculus, positioned at abdominal aorta pointAt fork between arteria renalis opening
4. ultrasound reaffirms balloon position, sacculus is blocked state at this time.Ultrasonic guidance precise positioning balloon position, withIt avoids blocking the important organs such as kidney.It is very quick not to ischemic under this plane due to blocking plane below horizontal in the arteria renalisThe internal organs of sense, therefore sacculus is guided to enter between arteria renalis opening and abdominal aortic bifurcation, make sacculus upper end close to kidneyAt arterial ostium.
5. preoperative pre- blocking is changed with renal artery anastomosis stenosis blood flow and is confirmed whether to block completely.
6. as shown in figure 8, the selection of balloon occlusion opportunity is blocked before delivery of baby.It enjoins and is situated between before cutting mesometriumEnter section's doctor's dilating sacculus and blocks blood supply, while ultrasonic monitoring blood flow dynamic.In Fig. 8, in more lines area defined notSee blood flow signal.
7. delivery of baby seraglio body injects oxytocin, row manual removal placenta.Row blunt separation when Placenta acrreta.Then 1The multiple separation of placenta face at " 8 " word suture lower uterine segment and uterine neck internal orifice of number absorbable suture.Sacculus observation is closed after suture to be hadNo active bleeding.
8. balloon occlusion can repeatability operation.It if any active hemorrhage, can block again, until the surface of a wound is without bleeding.It repairsLower edge on uterine incision is cut, is sutured.
Abdominal aorta internal diameter can be accurately measured while detecting abdominal aorta by preoperative, suitable ball is selected with guidanceCapsule diameter；Since sacculus and abdominal aorta internal diameter can coincide, when dilating sacculus, can reach accurate blocking, to avoid sacculus excessiveIt is full that injury of abdominal aorta or sacculus underfilling is caused to lead to Abdominal aortic crossclamping not complete, intraoperative hemorrhage etc..
The above-mentioned method blocked repeatedly can block abdominal aorta according to Suture hemostasis situation in art repeatedly, to avoid it is long whenBetween blood vessel blocking blood injury blacked-out areas internal organs；
With in localization by ultrasonic art can with dynamic monitoring blood flow change and be confirmed whether to block completely, and can find early whether there is or notThe complication such as thrombus and artery dissection, this is also not available for x-ray.
Embodiment 2:
The present embodiment and above-described embodiment the difference is that, in the present embodiment, operation is not manually realExisting, but realized by automated manner, specific corresponding system further includes digital image processing apparatus and controller and opensDynamic button,
Digital image processing apparatus for receiving ultrasonic scanner image obtained, and is converted into digital picture, andGray value is lower than the region of preset value in identification digital picture, and the length in a first direction in the region is greater than in second party3 times of upward length, are determined as angiosomes；And according to the infall of multiple angiosomes be confirmed as arteria renalis opening andAt abdominal aortic bifurcation；
Utricule is moved at abdominal aortic bifurcation between arteria renalis opening by controller for controlling mechanical hand,It when the position of utricule is identified by digital image processing apparatus, and is confirmed as after correct position, first switch is triggered, so that utriculeExpansion is to block blood vessel；And third switch and second switch are triggered after operation, by the reduced cross-sectional of utricule, by sacculus fromIt is removed in blood vessel；
Start button, for starting the recognizer of digital image processing apparatus and the journey of controller control sacculus movementSequence.
Embodiment 3:
The present embodiment and above-described embodiment the difference is that, specific corresponding system further include Digital Image Processing dressIt sets and controller, ultrasonic wave display device is touch screen,
Digital image processing apparatus for receiving ultrasonic scanner image obtained, and is converted into digital picture, andGray value is lower than the region of preset value in identification digital picture, and the length in a first direction in the region is greater than in second party3 times of upward length, are determined as angiosomes；And according to the infall of multiple angiosomes be confirmed as arteria renalis opening andAt abdominal aortic bifurcation；
Utricule is moved at abdominal aortic bifurcation between arteria renalis opening by controller for controlling mechanical hand,It when the position of utricule is identified by digital image processing apparatus, and is confirmed as after correct position, first switch is triggered, so that utriculeExpansion is to block blood vessel；And third switch and second switch are triggered after operation, by the reduced cross-sectional of utricule, by sacculus fromIt is removed in blood vessel；
Multiple choosings for selection operation step or control first switch, second switch, third switch are set on touch screenSelect key.
Although the preferred embodiment of the present invention is described above in conjunction with attached drawing, the invention is not limited to upperThe specific embodiment stated, the above mentioned embodiment is only schematical, be not it is restrictive, this field it is commonTechnical staff under the inspiration of the present invention, without breaking away from the scope protected by the purposes and claims of the present invention, may be used alsoBy make it is many in the form of.Within these are all belonged to the scope of protection of the present invention.