Varicocele ligatures puncture outfit under a kind of laparoscopeTechnical field
The present invention relates to technical field of medical instruments, varicocele ligation puncture outfit under specifically a kind of laparoscope.
Background technology
Varicocele refers to that swelling occurs in the vein in males scrotum, shows as scrotum falling inflation discomfort, testis or smallAbdomen takes out pain, stands or tired postemphasis, lies down or mitigates during rest, scrotum enlargement and sagging, cutis laxa during standing, it is seen that quietThe expansion of arteries and veins clump, bending, elongation.It can be laid one's hand on during palpation and earthworm shape cirso- group, the phlebangioma of varicose after prostrate reduce or disappeared,It is a kind of not clear andrological diseases of origin cause of formation, any man is possible to suffer from, and severe patient can cause orchiatrophy and infertility etc. to be askedTopic.By the different degrees of expansion of pampiniform plexus in spermatic cord and it is tortuous with the characteristics of.It can be divided into primary and Secondary cases VC by the cause of diseaseTwo kinds.Primary VC may be increased by intravascular pressure, and left side spermatic vein stroke is grown and at right angles imports left renal vein, intestines systemArtery and sustainer compressing left renal vein, influence left internal spermatic vein backflow, as " cracker " phenomenon (NCS), spermatic cord on filmConnective tissue weakness and vein valve dysfunction, incompetence around internal jugular vein, spermatic vein tube wall tissue textural anomaly.
Varicocele invasive surgery under laparoscope, also known as high ligation, mainly using general anesthesia or caudal anaesthesia,The spermatic vein of varicose is ligatured under laparoscope, caused so as to solve caused by varicocele the testis pendant pain that risesSex dysfunction and because of phlebectasia blood stasis, cause orchiatrophy and Spermatogenic failure, caused sterile problem.Operation stepSuddenly include：Patient's horizontal position, after anaesthetizing successfully, routine disinfection skin, drape；The small otch of a 1cm is done in omphalos upper limb, is pierced into nothingVeress needle is damaged, artificial pneumoperitoneum is established, establishes peephole passage disease and insert peephole, then make respectively in left lower quadrant, Right Lower AbdomenTwo, the small otch of 0.5cm, 0.5cm, establishes operating walk way.Observe and seek and the spermatic vein of left side varicose, see flank film and abdomenChamber is shown in that vein is thick without obvious adhesion, opening side peritonaeum and dividing vein surrounding tissue, fully exposure vein, diameter about 2.6mm；About 2.6mm cirso-s both ends are taken after peeling off vein surrounding tissue to upper and lower ends as ligation, are closed with safe section biology folder both ends folderThe internal spermatic vein of varicose, and electric coagulation hemostasis, check that the surface of a wound without bleeding, exhausts local oozing of blood, checks biology folder fixation, artIt is wild without oozing of blood, the same left side in right side, check apparatus gauze it is errorless after, take out laparoscopic instrument, release residual air, suture abdominal incision,Art finishes.Laparoscopic varicocele ligation is obvious compared with open surgery superiority, bilateral lesion, open surgery postoperative recurrence andThe patient for having groin history of operation is more suitable for this operation, and the therapeutic process retains artery and lymphatic vessel of the spermatic vein with row, reallyProtect testis not to be damaged, normal tissue does not cause to damage, and bleeding is few, and wound is small, and belly scar is small, is recommendable artFormula.According to above-mentioned surgical procedure, pneumoperitoneum first need to be established using veress needle, be punctured again by puncture outfit afterwards, so carried outThe time of operation is longer, and during puncturing into abdomen, easily causes the damage of other tissues and internal organ.
Application publication number is that the A of CN 101947120 Chinese patent discloses a kind of spiral puncture instrument with pneumoperitoneum deviceAnd its application method.It is made up of the cannula sheath of the foot section brought handle and the core bar of the foot section brought core rod seat, and described core bar is skyHeart pipe, front end are provided with pin hole, and core bar inner chamber is sequentially provided with the veress needle with resetting means, air guide along core bar front end to core bar endPipe, the syringe needle of veress needle extend outside core bar from pin hole, and airway tube is sheathed on outside veress needle end, and the one of described resetting meansEnd is connected to airway tube and is fixed on cannula sheath inwall, and the other end of resetting means is fixed on veress needle；When with handleCannula sheath combined with the core bar with core rod seat and core bar front end it is fully extended go out cannula sheath when, the core below rubber check valveBar side wall is provided with passage, and upper end open and the core rod seat inwall of airway tube are not bordered on, and the present invention has simple to operate, reductionThe advantages that operation risk；But the spiral puncture instrument with pneumoperitoneum device and its application method of the technical scheme are present：What is set determinesPosition ring only plays the simple effect for stopping puncture outfit insertion abdominal cavity depths, reliably can not be fixed or positioned, Ye JiDevice is produced the displacement of horizontal plane or axial direction in operating process, and then increase operating difficulty；Meanwhile axial direction is occurringWhen being displaced outwardly, needle point is caused to be come off from piercing portions, operative doctor is very careful in order to avoid situation as generationGround is punctured, so workability extreme difference, operation requires higher.
The content of the invention
In order to solve the above technical problems, mutually tied with escapement using fixed mechanism it is an object of the invention to provide one kindThe structure design of conjunction, using the flexible principle of the expansion of elastic bag and the absorption principle of carbon nano pipe array, it can effectively prevent from boringHead is come off from piercing portions, greatly improves operability, while gas port is provided with conehead, can implement the inflation effect of veress needleFruit, there is simple in construction, easy to use, varicocele ligation puncture outfit under safe and reliable laparoscope.
To reach above-mentioned purpose, technical scheme is as follows：
Varicocele ligatures puncture outfit under a kind of laparoscope, including main sheath, the handle positioned at main sheath tail end, interiorIt is placed on main sheath and hollow core bar and the pole socket for being arranged on core bar tail end, is provided with the handle and main sheath is coaxial opensMouthful, handle side wall is provided with the breather pipe with air valve, and the core bar is inserted by opening in main sheath and the front end extension of core barGo out main sheath, the core bar front end is tapered and provided with perforation, and the core bar inwall at the perforation, which is provided with, prevents core barThe escapement of slippage, in addition to be arranged on the piercing mechanism of core bar inner chamber and be movably connected in main sheath pipe outer wall and be used to inhaleThe fixed mechanism of skin surface is attached to, it is in criss-cross body that the fixed mechanism, which includes, is arranged on the silicon substrate of body lower surfaceBottom, the carbon nano pipe array for being arranged on silicon substrate bottom surface and it is arranged on the central area of body and is mutually fitted with cannula sheath outer wallThe connecting portion answered.
Further, the escapement includes support ring and elastic bag, and the support ring is arranged on core bar inwallUpper and annular housing is formed between core bar inwall, the elastic bag is arranged in the annular housing, with annular housingMultiple through holes are provided with corresponding core bar wall, multiple air inlets connected with elastic bag, the air inlet are provided with support ringThe appendix connected with breather pipe is provided with mouthful.
Further, under obstructed gaseity, the elastic bag is shunk in annular housing, described under aeration statusElastic bag expands and passes through the through hole to extend to outside core bar, and the part that the elastic bag is extended to outside core bar forms elasticityStop part.
Further, the elastic bag with transparent elastomeric material by being made.
Further, the upper surface of the body is provided with the scale in right-angled intersection, is set in the wherein adjacent both ends of bodyThere is projection, the groove to match with projection is provided with remaining both ends of body, passes through the raised and groove between adjacent bodiesPhase clamping.
Further, the connecting portion is provided with elastic part by place near to the upper end, provided with section is in arc in the lower surface of connecting portionThe wound accommodating chamber of shape.
Further, the piercing mechanism includes conehead, the connecting rod for being arranged on conehead rear end and extending to outside pole socket, settingIn the press section of connecting rod tail end, the support plate being installed on core bar inwall and the bullet being arranged between conehead rear end and support plateProperty part, be placed on core bar in the conehead and slidably to extend to perforation outer and do not depart from core bar.
Further, the conehead includes tapering tip portion and column part, be provided with the tapering tip portion it is multiple with it is logicalThe gas port of tracheae connection, the first groove and the second groove, the cylinder are provided with close to the tapering tip portion surface of the gas portSeal groove is partially circumferentially provided with wall, sealing ring is provided with the seal groove.
Further, first groove is provided with stress sensor, and second groove is provided with temperature sensor,The bottom of first groove and the second groove is provided with cable-through hole, and the cable-through hole is used for passing through for connection line.
Further, the handle is provided with the display of connection stress sensor and temperature sensor, close to described aobviousShow that device is provided with multiple shrinkage pools for being easy to hold.
Beneficial effects of the present invention：
1st, the structure design being combined using fixed mechanism with escapement, it make use of the flexible principle of expansion of elastic bagAnd the absorption principle of carbon nano pipe array, effectively it can prevent conehead from being come off from piercing portions, and main sheath was not being performed the operationMoved in journey into human body or outside human body, substantially increase operability, while gas port is provided with conehead, to implement pneumoperitoneumThe inflation effect of pin, the puncture for treating of safety can be carried out to spermatic vein position, meet the safe handling work(of puncture and pneumoperitoneumIt can need.
2nd, elastic bag is under obstructed gaseity, shrinks in annular housing, playing the effect that does not influence conehead puncture,Under aeration status, elastic bag expands and passes through the through hole to extend to outside core bar, and its extension constitutes elastic barrier portion,Elastic barrier portion has flexible elastic contacting effect, avoids the damage to piercing portions surrounding tissue.
3rd, the body set is designed using decussate texture, is advantageous to be fixedly supported upon skin surface, carbon nano pipe arrayIt is that object is fixed the absorption affinity for imitating gecko sole, main sheath easily can be fixed on to the skin surface of patient, carbonThe absorption fixed form of nano-tube array will not cause sense of discomfort to patient, and can be with Reusability, and fixation is reliable, effectivelyThe security of operation is improved, being provided with addition on body can interface arrangment between scale and adjacent bodies in right-angled intersectionDesign, can be advantageous to be accurately positioned point of puncture, easy to use, reduce operating difficulty；The elastic part set simultaneously canFixed position is adjusted, the wound accommodating chamber being provided with can be such that wound enters wherein, protect wound not influenceed by contact.
4th, the elastic component set at conehead rear portion can make conehead with ability is timely retracted, can be right in puncture processExerted oneself during operation it is excessive play effective cushioning effect, it is safe to use.
5th, the stress deformation amount sensing signal of conehead can be transferred on display by the stress sensor set in real time, can be justIn the dynamics value of the quantitative control operation of operating personnel, effectively prevent it is firmly excessive other abdominal tissues are stabbed, TEMPDevice can be monitored to the temperature in abdominal cavity in real time, prevent because it is too high or too low for temperature influence operation the degree of accuracy and caused by perform the operationThe delay of time, the operability and security of operation are improved, bleeding is few, and wound is small, and belly scar is small, while has structureThe characteristics of simple and easy to use.
Brief description of the drawings
Fig. 1 is the main structure diagram that varicocele ligatures puncture outfit under a kind of laparoscope of the present invention；
Fig. 2 is the structural representation of the conehead retraction that varicocele ligatures puncture outfit under a kind of laparoscope of the present invention；
Fig. 3 is that varicocele ligatures the structural representation that the conehead of puncture outfit stretches out under a kind of laparoscope of the present invention；
Fig. 4 is the plan structure signal for the fixed mechanism that varicocele ligatures puncture outfit under a kind of laparoscope of the present inventionFigure；
Fig. 5 is the clamping schematic diagram of the fixed mechanism that varicocele ligatures puncture outfit under a kind of laparoscope of the present invention.
Embodiment
For the objects, technical solutions and advantages of the present invention are more clearly understood, below in conjunction with accompanying drawing, the present invention is made intoOne step describes in detail.
It should be noted that unless otherwise indicated, technical term or scientific terminology used in this application should be this hairThe ordinary meaning that bright one of ordinary skill in the art are understood.
In the description of the present application, it is to be understood that the orientation or position relationship of " preceding " instruction of term are based on accompanying drawing 1Shown " left side ", the orientation or position relationship of term " tail " instruction are based on " right side " shown in accompanying drawing 1, are for only for ease of descriptionThe present invention and simplify description, rather than instruction or imply that signified device or element there must be specific orientation, with specificAzimuth configuration and operation, therefore be not considered as limiting the invention.
As Figure 1-5, under a kind of laparoscope varicocele ligature puncture outfit, including main sheath 1, positioned at main sheathThe handle 2 of tail end, it is interior be placed on main sheath and hollow core bar 3 and the pole socket 4 for being arranged on core bar tail end, be provided with the handleThe coaxial opening with main sheath, handle side wall are provided with the breather pipe 22 with air valve 21, and the core bar inserts main sheath by openingPipe is interior and main sheath is extended in the front end of core bar, is herein prior art characteristic, concrete structure does not repeat；The core bar front endTapered and provided with perforation 31, core bar inwall at the perforation is provided with the escapement 5 for preventing that core bar from slipping, and also wrapsInclude the piercing mechanism 6 for being arranged on core bar inner chamber and be movably connected in main sheath pipe outer wall and be used to adsorb the fixation in skin surfaceMechanism 7, the fixed mechanism include in criss-cross body 71, are arranged on the silicon base 72 of body lower surface, are arranged on silicon substrateThe carbon nano pipe array 73 of bottom surface and be arranged on body central area and with cannula sheath outer wall be adapted connecting portion74, defined herein lower surface is close to the side of skin, and upper surface is the side away from skin；Criss-cross body is advantageous to solidSurely be supported on skin surface, carbon nano pipe array is that object is fixed the absorption affinity for imitating gecko sole, can easily byMain sheath is fixed on the skin surface of patient, and the absorption fixed form of carbon nano pipe array will not cause sense of discomfort to patient, andCan be with Reusability, fixation is reliable, effectively increases the security of operation.
As the further improvement to above-mentioned technical proposal, the escapement 5 includes support ring 51 and elastic bag52, the support ring is arranged on the inwall of core bar 3 and annular housing 53 is formed between core bar inwall, and the elastic bag is setIn the annular housing, multiple through holes 54 are provided with core bar wall corresponding with annular housing, are provided with support ring multipleThe air inlet 511 connected with elastic bag, the appendix 55 connected with breather pipe 22 is provided with the air inlet.
Further, under obstructed gaseity, the elastic bag 52 is shunk in annular housing 53, can play not cone of influenceThe effect that head punctures, under aeration status, the elastic bag expands and passes through the through hole to extend to outside core bar 3, the bulletProperty air bag extend to part outside core bar and form elastic barrier portion 52a, elastic barrier portion has flexible elastic contacting effect, keeps awayThe damage to piercing portions surrounding tissue is exempted from.
Preferably, for the elastic bag 52 by being made with transparent elastomeric material, the transparency is advantageous to the sight of endoscopeExamine, do not weaken surgical field of view.
As the further improvement to above-mentioned technical proposal, the upper surface of the body 71 is provided with the scale in right-angled intersection711, projection 712 is provided with the wherein adjacent both ends of body, the groove to match with projection is provided with remaining both ends of body713, pass through between adjacent bodies described raised with groove phase clamping, so as to be advantageous to be accurately positioned to point of puncture, useIt is convenient, reduce the difficulty of operation.
Preferably, body is made of plastic material, can due to that can not possibly be complete horizontal plane around human abdomenThe body of plasticity can be extended and be bent, and it is bonded completely with the skin of fixed position and contacted, ensure carbon nano pipe arrayAdsorption effect.
Further, the connecting portion 74 is provided with elastic part 741 by place near to the upper end, is advantageous to the fixed bit in main sheathPut and be adjusted, the curved wound accommodating chamber 742 of section is provided with the lower surface of connecting portion, sets wound accommodating chamber to make woundMouth enters wherein, protects wound not influenceed by contact.
As the further improvement to above-mentioned technical proposal, the piercing mechanism 6 includes conehead 61, is arranged on conehead rear endAnd the connecting rod 62 extended to outside pole socket 4, the press section 63 for being arranged on connecting rod tail end, the support plate 64 being installed on core bar inwall withAnd be arranged on the elastic component 65 between conehead rear end and support plate, it is preferred that support plate be provided with it is multiple be used for appendix and itsIts connection line passes through；Core bar 3 is placed in the conehead and slidably extends to outside perforation 31 and does not depart from core bar, is being pressedDuring press section, the transmission of conehead through connecting rod is directly punctured, and core bar is retracted under the elastic force effect of elastic component after the completion of punctureInner chamber, to avoid conehead from damaging other tissues.
Preferably, 3-4 blade is uniformly arranged on the taper surface of conehead, the effect of puncture can be improved, receipts after having puncturedRetraction core bar inner chamber will not produce additional injuries to other tissues.
As the further improvement to above-mentioned technical proposal, the conehead 61 includes tapering tip portion and column part, instituteState and multiple gas ports 611 connected with breather pipe 22 are provided with tapering tip portion, opened close to the tapering tip portion surface of the gas portThere are the first groove 612 and the second groove 613, seal groove 614 is provided with the column part circumference wall, is provided with the seal grooveSealing ring 615, be advantageous to prevent intraperitoneal liquid from entering core bar inner chamber.
Preferably, the breather pipe of connection gas port and connection elastic bag is separately controlled, namely close to gasControl valve is set on the breather pipe of valve, and control valve can be supplied respectively to gas port and elastic bag, so as to discharge elastic gasIntraperitoneal gas will not be discharged during intracapsular gas simultaneously.
Further, first groove 612 is provided with stress sensor 8, and second groove 613 passes provided with temperatureSensor 9, is provided with cable-through hole 616 in the bottom of the first groove and the second groove, the cable-through hole be used for connection line by,The handle 2 is provided with the display 10 of connection stress sensor 8 and temperature sensor 9, set stress sensor can in real time byThe stress deformation amount sensing signal of conehead is transferred on display, can the quantitative control operation of personnel easy to operation dynamics value, haveEffect prevent it is firmly excessive other abdominal visceras are stabbed, temperature sensor can be monitored to the temperature in abdominal cavity in real time, preventOnly because it is too high or too low for temperature influence operation the degree of accuracy and caused by operating time delay, the operable of operation can be effectively improvedProperty and security.
Further, multiple shrinkage pools 23 for being easy to hold are provided with close to the display, it is easy to use.
When specifically used, core bar is inserted into main sheath and core bar front end is extended to outside main sheath, pole socket and handleOpening fasten, breather pipe is connected with external gas source, and air valve is closed, and adjusting elasticity part, fixed mechanism is adjustedSection carries out puncture point orientation, while the quantity punctured as needed using the scale auxiliary on body, in advance will to suitable positionFixed mechanism is individually fixed on skin surface, and carbon nano pipe array has good adsorption effect, and main sheath can be avoided to moveDynamic sliding, after above steps is ready to, and then operating press section makes conehead implement to puncture, and through after site of puncture, opens gasValve is inflated respectively to elastic bag and abdominal cavity, and the elastic barrier portion formed after elastic bag prolonged expansion, which can contact, to be puncturedOn the inwall of position, and then play a part of stopping that core bar slips, whole flow process is simple to operate, easy to use, securely and reliably.
Explanation and embodiment above is only exemplary, does not form any restrictions to the scope of the present invention.This areaTechnical staff should be understood that without departing from the spirit and scope of the invention can be to the details and shape of inventive technique schemeFormula is modified or replaced, but these modifications and replacement are each fallen within protection scope of the present invention.