CN112674836B - Cleaning device special for residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty) operation - Google Patents

Abstract

The invention relates to the technical field of medical instruments, in particular to a special cleaning device for residual bile duct stones, mucus and floccules after an ERCP (percutaneous transluminal coronary angioplasty) operation. The cleaning device is provided with a first cleaning part 9, a second cleaning part 11 and a washing part 10 which are three independent cleaning devices, wherein the first cleaning part 9 can non-invasively take out small blocky calculus or quicksand-shaped broken stone in the bile duct of the patient without damaging the bile duct wall of the patient; the flushing part 10 can flush silt-shaped or flocculent stones, mucus and flocculent substances adhered to the bile duct; the second cleaning part 11 cleans sand, mucus and floccule out of the bile duct, so as to prevent small sand from remaining in the bile duct and continuing to grow, so that the stone relapse is caused, and the health of a patient is influenced.

Description

Cleaning device special for residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty) operation

Technical Field

The invention relates to the technical field of medical instruments, in particular to a special cleaning device for residual bile duct stones, mucus and floccules after an ERCP (percutaneous transluminal coronary angioplasty) operation.

Background

Biliary calculi are common diseases in surgery, and calculi in common bile duct can cause secondary jaundice of biliary obstruction, cholangitis and pancreatitis to endanger life. Calculus of bile duct may also be complicated by biliary cirrhosis, hepatic atrophy, liver abscess, etc. The clinical symptoms of bile duct stones are mainly manifested as epigastric pain. The only treatment method for bile duct stones is surgical treatment, i.e. stones in the bile duct are taken out or broken out in a surgical mode. Common treatment methods are: firstly, exploring and fetching stone along the direction of a bile duct by using metal hard stone fetching forceps; secondly, a rubber catheter is inserted into each bile duct and then is washed; and taking out the stone by using a choledochoscope.

The minimally invasive surgery has the advantages of small wound, light pain, quick recovery, short hospitalization time, less bleeding and the like, and becomes an operation method which is widely popularized in clinic at present due to the characteristics. The use of a choledochoscope to remove stones is one of the most common treatment methods for treating biliary stones. Usually, a fibrocholedochoscope is placed along the incision of the biliary tract, and after finding a calculus, the calculus is removed by using a calculus removal net.

The utility model discloses a bile duct stone taking-out system and a using method (CN202010007836.X), which can wash fine biliary tract broken stones with water, and can also suck out washing liquid and the fine biliary tract broken stones by using a negative pressure suction tube, but larger biliary tract broken stones are blocked by a water permeable mesh membrane at an outer water pipe and need to be clamped out by using a clamp; the technical scheme has complex operation steps, causes certain damage to the bile duct after multiple operations, and can not completely clean mucus on the wall of the bile duct out of the bile duct. The utility model discloses a two mirrors of fishing method one silk combine wicresoft to protect inside and outside bile duct calculus stone rubble of liver to get stone art (201610574783.3) and disclose and draw in formula basket design in, avoid getting the stone basket and touch the bile duct inner wall, the operation process does not have pain, wound, bleeds, can collect the biliary tract and get stone, wash, radiography and expansion in an organic whole. But above-mentioned technical scheme can not clear up out the biliary tract with the mucus of bile duct wall and the rubble and the floccule that adsorb on the mucus completely, and the basket can only clear up great rubble, and tiny rubble can not clear up. The statistical result of clinical data shows that the recurrence rate of the calculus of the choledocholithiasis patients after the ERCP operation is 4-24%. The existing researchers think that the recurrence of the gallstone is related to factors such as common bile duct diameter, common bile duct expansion, combined bile duct or pancreatic inflammation, and think that the normal movement function of the bile duct is limited, the bile flow rate is slow or the drainage is not smooth and the calculus is possibly caused by the deposition of visible components in the bile.

The inventor finds that in clinic, after the patient takes the calculus by the ERCP, balloon pressurization radiography prompts the patient to clean the calculus in the bile duct, but the observation is carried out by embedding the bile duct into Spyglass, a large amount of residual silt-like calculus or floccule can still be observed under direct vision, a specific picture is shown in the attached figure 5 of the specification, and A shows that 4 mm of calculus remains in the common bile duct; b shows that there is a large amount of debris, bile sludge and/or flocs in the common bile duct; c, a small amount of broken stones, bile sludge and floccules are contained in the common bile duct; d, displaying that flocculate exists in the common bile duct; e shows common bile duct cleaning. The residual bile duct stones and bile duct wall inflammation floccules are gradually wrapped by crystalline metabolites such as bile pigment to gradually form stones, and need to be removed by secondary operation, thus causing damage to the body and mind of patients. Based on the background, the inventor applies a calculus removing device (CN201921922709.1) specially used for residual bile duct calculus after ERCP operation on 11/8 in 2019, wherein a spongestone removing part 8 is arranged in the calculus removing device, and crushed stone, mucus and floccule in a bile duct can be removed; however, the inventor applies the device to clinical operation, finds that the device can take out the broken stone which is not adsorbed by mucus in the bile duct, but the broken stone which is adsorbed by mucus on the wall of the bile duct, and the mucus and the floccule on the wall of the bile duct cannot be completely taken out by the sponge due to the viscous force of the mucus, and meanwhile, after the mucus is adsorbed on the surface of thestone taking part 8 prepared by the sponge, the mucus on the surface and the mucus on the wall of the bile duct cannot be completely taken out and cannot be taken out for many times, and certain damage is caused to the wall of the bile duct.

Disclosure of Invention

In order to solve the technical problems, the invention provides a special cleaning device for residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty), which comprises an operating handle, aluer connector 6, anouter tube 7 and atransmission rod 8, wherein theouter tube 7 is hollow, one end of the outer tube is connected with the operating handle, and thetransmission rod 8 is arranged in theouter tube 7 and the operating handle; theluer joint 6 is arranged at one end of the side wall of theouter tube 7 close to the operating handle; the operating handle consists of acore bar 1, asliding block 2 and anauxiliary push rod 3, thecore bar 1 is in a hollow rod shape, one end of the core bar is provided with internal threads, the other end of the core bar is provided with a handle ring, and the side wall of the core bar is provided with an opening; the push-assistedrod 3 is arranged inside thecore rod 1, and theslide block 2 is nested on thecore rod 1 and can slide relative to thecore rod 1; one end of theboosting rod 3 is connected to thesliding block 2, and the other end of theboosting rod 3 is connected with thetransmission rod 8; theouter tube 7 is provided with a connectingpart 4, and theouter tube 7 is connected with thecore rod 1 through the connectingpart 4; awater inlet 14 is formed in thesliding block 2, thewater inlet 14 is hermetically connected with thetransmission rod 8, thetransmission rod 8 is hollow and can pass through by water flow, and the tail end of the transmission rod is closed; the cleaning device further comprises afirst cleaning part 9, asecond cleaning part 11 and aflushing part 10, wherein thefirst cleaning part 9 and thesecond cleaning part 11 are made of expansion materials, thefirst cleaning part 9 is embedded on the surface of the tail end of thetransmission rod 8 and used for cleaning large broken stones in the biliary tract, the diameter of the flushingpart 10 is equal to that of thetransmission rod 8 and is connected with the tail end of thetransmission rod 8 in a penetrating manner, and awater outlet 101 is arranged on the surface of the flushing part and used for flushing the wall of the biliary duct and flushing mucus and floccules on the wall of the biliary duct into the biliary duct; the second cleaningpart 11 is connected to the end of the flushingpart 10 in sequence and used for cleaning smaller broken stones in the bile duct, mucus on the wall of the bile duct and floccules.

Preferably, the expansion/compression ratio of thefirst cleaning part 9 and thesecond cleaning part 11 is 10: 1.

preferably, thefirst cleaning part 9 and thesecond cleaning part 11 are made of sponge.

Preferably, thefirst cleaning part 9 and thesecond cleaning part 11 are cylindrical or conical or in other shapes capable of realizing the technical scheme, when thefirst cleaning part 9 and thesecond cleaning part 11 are cylindrical, the cross section diameter is 1-3cm, the length is 1-2cm, and the side walls of thefirst cleaning part 9 and thesecond cleaning part 11 are integrally contacted with the wall of the bile duct; when the first cleaningpart 9 and thesecond cleaning part 11 are conical, the diameter of the section of one end close to the operating handle is smallest, the section is gradually enlarged to the far side, the diameter of the largest section is 1-3cm, the length of the largest section is 1-2cm, the largest section is in contact with the wall of the bile duct and fills the bile duct, the first cleaningpart 9 and thesecond cleaning part 11 are pulled, and all broken stones, mucus and floccules in the bile duct and the wall of the bile duct are cleaned out of the bile duct by thefirst cleaning part 9 and thesecond cleaning part 11.

Preferably, the length of thecore rod 1 is 2-10cm, each cm is provided with scales, and medical personnel can push and pull thetransmission wire 9 according to the scales, so that the positioning is convenient and accurate.

Preferably, the inner part of theouter tube 7 is provided with two cavities, namely afirst cavity 12 and asecond cavity 13, and thetransmission rod 8 is arranged in thesecond cavity 13, so as to push thesliding block 2 and drive the push-assistedrod 3 and thetransmission rod 8 to slide in thesecond cavity 13.

Preferably, theboosting rod 3 and thetransmission rod 8 are connected in a spiral or embedded mode, and the connectedboosting rod 3 and thetransmission rod 8 are communicated.

Preferably, one end of theouter tube 7 close to the operating handle is provided with a protectingsleeve 5, and the protectingsleeve 5 is sleeved outside theouter tube 7 to prevent theouter tube 7 from falling off from thecore rod 1.

Preferably, the cross section of theouter tube 7 is circular, oval or any other shape that can achieve the technical solution.

The invention has the beneficial effects that: the cleaning device special for residual bile duct stones, mucus and floccules after the ERCP operation is adopted, thefirst cleaning part 9, thesecond cleaning part 11 and theflushing part 10 are three independent cleaning devices, thefirst cleaning part 9 can non-invasively take out small-block stones or quicksand-shaped gravels in a bile duct of a patient, the bile duct wall of the patient cannot be damaged, and the surface of thefirst cleaning part 9 can adsorb partial mucus and floccules; the flushingpart 10 can flush silt-shaped or flocculent stones, mucus and flocculent substances adhered to the wall of the bile duct into the bile duct; the second cleaningpart 11 cleans sand, mucus and floccule out of the bile duct, so as to prevent tiny sand and stones from remaining in the bile duct and continuing to grow, so that the stone recurrence is caused, and the health of the patient is influenced; theboosting rod 3, thetransmission rod 8 and thewashing part 10 are hermetically connected, thewater inlet 14 is connected with a water pump or other pressure devices, water or cleaning fluid enters from thewater inlet 14, enters thewashing part 10 along theboosting rod 3 and thetransmission rod 8, and is sprayed out through thewater outlet 101, so that mucus and floccules adhered to the wall of the liner tube are washed; the invention can simultaneously take out the broken stone, the mucus and the floccule in the bile duct at one time, has novel technical scheme, simple operation mode and obvious effect, and can be clinically popularized and applied.

Drawings

FIG. 1 is a schematic diagram of a cleaning device specially used for cleaning residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty)

1. A core bar; 2. a slider; 3. a push-aid rod; 4. a connecting portion; 5. sheathing a pipe; 6. a luer fitting; 7. an outer tube; 8. a transmission rod; 14. a water inlet;

FIG. 2 is a schematic diagram of the use state of a special cleaning device for residual bile duct stones, mucus and floccules after ERCP operation

1. A core bar; 2. a slider; 3. a push-aid rod; 4. a connecting portion; 5. sheathing a pipe; 6. a luer fitting; 7. an outer tube; 8. a transmission rod; 9. a first cleaning section; 10. a washing section; 101. a water outlet; 11. a second cleaning section; 12. a first chamber; 13. a second chamber; 14. a water inlet;

FIG. 3 is a schematic view of the connection of the flushingpart 10

8. A transmission rod; 9. a first cleaning section; 10. a washing section; 101. a water outlet; 11. a second cleaning section; 12. a first chamber; 13. a second chamber; 14. a water inlet;

FIG. 4 is a cross-sectional view of the drivingrod 8 and thefirst cleaning part 9, the cleaningpart 10 and thesecond cleaning part 11 of theouter tube 7

8. A transmission rod; 9. a first cleaning section; 10. a washing section; 101. a water outlet; 11. a second cleaning section; 12. a first chamber; 13. a second chamber;

FIG. 5 ERCP balloon compression angiography results after calculus removal

Detailed Description

The technical solutions of the present invention are described below with reference to specific examples, but the technical solutions of the present invention are not limited to the following examples, and those skilled in the art can easily modify, replace or change the technical solutions without changing the spirit of the technical solutions of the present invention, and thus the technical solutions of the present invention are within the scope of protection.

The noun explains:

1, ERCP: the endoscopic retrograde cholangiopancreatography is one of the main means for minimally invasive treatment of the biliary pancreatic diseases at present, an endoscope is inserted into the descending part of duodenum through the mouth, and is introduced into a bile duct or a pancreatic duct through a duodenal papilla special instrument, contrast agent is injected under X-ray fluoroscopy for radiography, and a sub-endoscope/ultrasonic probe is introduced for observation to complete diagnosis of biliary and pancreatic diseases, and the general name of the technology of corresponding interventional treatment is implemented on the basis of diagnosis.

The SpyGlass system, also known as the SpyGlass Direct Visualization System (SDVS), consists of a host system and associated consumable accessories. The host system is similar to a commonly used endoscope system and comprises a host, a water injection pump, a camera, a light source, a display and the like. The expendable accessories comprise a conveying catheter, a fiber-optic camera, a biopsy forceps, a liquid electric lithotripsy probe, a photodynamic therapy assembly and the like.

3. Bile duct calculi: calculus of bile duct refers to calculus produced in the intrahepatic bile duct system, so it is also called intrahepatic bile duct calculus. It is often combined with extrahepatic calculus, but there are also simple intrahepatic calculus, also known as genuine intrahepatic calculus. In recent years, there are more and more cases of intrahepatic bile duct stones, and classification of stones is generally referred to as bilirubin stones. Hepatobiliary calculus is mostly yellow-green massive or silt-like, and is mostly calcium bilirubinate. Ascarid eggs can be found in the calculus center, so it is believed that hepatobiliary calculus is caused by biliary obstruction due to biliary ascariasis and bacterial infection.

4. The choledochoscope is a medical optical endoscope designed for the endoscopy and endoscopic surgery of the pancreaticobiliary duct. The choledochoscope is generally composed of an objective lens system, an optical image transmission system, and an eyepiece lens system. It enters the body through natural orifices for imaging and diagnosis. The fiber choledochoscope mainly comprises a fiber choledochoscope body and a cold light source, and the fiber choledochoscope body is connected to the light source by means of a connector to form a set of fiber choledochoscope examination and treatment system with complete functions. In order to meet the needs of various examinations and treatments, various accessories are usually provided, mainly a lithotomy net, a biopsy forceps, a cytobrush, a flushing catheter, a camera, a television video observation system, and the like

5. Sponge: is a porous material, has good water absorption and can be used for cleaning articles. Sponges commonly used by people are made of wood cellulose fibers or foamed plastic polymers.

6. An expansion material: a material that expands in volume by a different reaction;

7. screwing: the surface of the cylinder is provided with a thread like a snail shell, which is called a male spiral, and the thread in the hole of the object is called a female spiral. The male and female screws are matched, and the screw can move along the screw by rotating one of the male and female screws, so that the screw thread is denser, and the larger the screw diameter is, the more labor is saved.

8. Inlaying: the method comprises the following steps of embedding one object into another object to fix the two objects; also referred to as being embedded with an object as a decoration. Inlaying means embedding an object, and inlaying means clamping a small object in a gap of a large object.

Example 1A cleaning device specially used for residual bile duct stones, mucus and floccules after ERCP operation

The invention provides a special cleaning device for residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty), which comprises an operating handle, a luer connector 6, an outer tube 7 and a transmission rod 8, wherein the outer tube 7 is hollow, one end of the outer tube is connected with the operating handle, and the transmission rod 8 is arranged in the outer tube 7 and the operating handle; the luer joint 6 is arranged at one end of the side wall of the outer tube 7 close to the operating handle; the operating handle consists of a core bar 1, a sliding block 2 and an auxiliary push rod 3, the core bar 1 is in a hollow rod shape, one end of the core bar is provided with internal threads, the other end of the core bar is provided with a handle ring, and the side wall of the core bar is provided with an opening; the push-assisted rod 3 is arranged inside the core rod 1, and the slide block 2 is nested on the core rod 1 and can slide relative to the core rod 1; one end of the boosting rod 3 is connected to the sliding block 2, and the other end of the boosting rod 3 is connected with the transmission rod 8; the outer tube 7 is provided with a connecting part 4, and the outer tube 7 is connected with the core rod 1 through the connecting part 4; a water inlet 14 is formed in the sliding block 2, the water inlet 14 is hermetically connected with the transmission rod 8, the transmission rod 8 is hollow and can pass through by water flow, and the tail end of the transmission rod is closed; the cleaning device further comprises a first cleaning part 9, a second cleaning part 11 and a flushing part 10, wherein the first cleaning part 9 and the second cleaning part 11 are made of expansion materials, the first cleaning part 9 is embedded on the surface of the tail end of the transmission rod 8 and used for cleaning large broken stones in the biliary tract, the diameter of the flushing part 10 is equal to that of the transmission rod 8 and is connected with the tail end of the transmission rod 8 in a penetrating manner, and a water outlet 101 is arranged on the surface of the flushing part and used for flushing the wall of the biliary duct and flushing mucus and floccules on the wall of the biliary duct into the biliary duct; the second cleaning part 11 is connected to the end of the flushing part 10 in sequence and used for cleaning smaller broken stones in the bile duct, mucus on the wall of the bile duct and floccules. The length of thecore rod 1 is 10cm, each cm is provided with scales, and medical personnel can push and pull thetransmission wire 9 according to the scales, so that the positioning is convenient and accurate. The inner part of theouter tube 7 is provided with two cavities, namely afirst cavity 12 and asecond cavity 13, thetransmission rod 8 is arranged in thesecond cavity 13, the slidingblock 2 is pushed, and the push-assistedrod 3 and thetransmission rod 8 are driven to slide in thesecond cavity 13. One end of theouter tube 7 close to the operating handle is provided with a protectingtube 5, the protectingtube 5 is sleeved outside theouter tube 7 to prevent theouter tube 7 and thecore rod 1 from falling off, and the cross section of theouter tube 7 is circular.

Example 2 method of Using a device designed to clean residual bile duct stones, mucus, and floe after ERCP surgery

The following operations are performed in a sterile environment or under surgical conditions.

(1) According to the diameter of a surgical site and a bile duct of a patient, afirst cleaning part 9 and asecond cleaning part 11 which are made of sponge blocks and have different types are taken, thefirst cleaning part 9 is nested on atransmission rod 8, thesecond cleaning part 11 is connected to the tail end of a cleaningpart 10, after connection, a slidingblock 2 is pulled, and thefirst cleaning part 9, the cleaningpart 10 and thesecond cleaning part 11 are retracted into asecond cavity 13 for later use;

(2) the medical staff puts the guide wire into the bile duct of the patient with the calculus;

(3) the rear end of a guide wire penetrates along a first cavity 12 of an outer tube 7 and penetrates out through a luer connector 6, the outer tube 7 enters along the guide wire and reaches a part with quicksand-shaped stones, floccules and mucus of a bile duct, the tail end of the outer tube 7 passes through the quicksand-shaped stones, the floccules and the mucus and reaches a farther position, a slide block 2 is pushed, a transmission rod 8 connected with the slide block 2 is pushed out of a second cavity 13, a first cleaning part 9 and a second cleaning part 11 are exposed in the bile duct and rapidly expand to fill the whole bile duct, the quicksand-shaped stones are arranged at one end, close to the transmission rod 8, of the first cleaning part 9, a water inlet 14 is connected with a water pump or a pressurizing device to pump water or cleaning liquid, the water or the cleaning liquid is sprayed out from a water outlet 101 at a certain pressure to wash down the mucus and floccules on the wall of the bile duct and is pulled to the slide block 2, and the first cleaning part 9 cleans small blocky stones or quicksand-shaped stones in the bile duct of a patient, the flushing part 10 flushes the wall of the bile duct cleaned by the first cleaning part 9, mucus, floccule and gravels wrapped in the mucus which are not cleaned by the first cleaning part 9 are flushed, the second cleaning part 11 clears sand, mucus and floccule out of the bile duct, the cleaning is finished, and the cleaning device is slowly taken out.

Claims (8)

1. A cleaning device special for residual bile duct stones, mucus and floccules after ERCP (percutaneous transluminal coronary angioplasty) operation comprises an operating handle, a luer connector (6), an outer tube (7) and a transmission rod (8), wherein the outer tube (7) is hollow, one end of the outer tube is connected with the operating handle, and the transmission rod (8) is arranged in the outer tube (7) and the operating handle; the luer connector (6) is arranged at one end of the side wall of the outer tube (7) close to the operating handle; the operating handle consists of a core bar (1), a sliding block (2) and a boosting rod (3), the core bar (1) is in a hollow rod shape, one end of the core bar is provided with internal threads, the other end of the core bar is provided with a handle ring, and the side wall of the core bar is provided with an opening; the push-aid rod (3) is arranged inside the core rod (1), and the sliding block (2) is nested on the core rod (1) and can slide relative to the core rod (1); one end of the push-aid rod (3) is connected to the sliding block (2), and the other end of the push-aid rod (3) is connected with the transmission rod (8); the outer tube (7) is provided with a connecting part (4), and the outer tube (7) is connected with the core rod (1) through the connecting part (4); the method is characterized in that:

a water inlet (14) is formed in the sliding block (2), the water inlet (14) is hermetically connected with the transmission rod (8), the transmission rod (8) is hollow and can pass through cleaning solution, and the tail end of the transmission rod is closed; the cleaning device further comprises a first cleaning part (9), a second cleaning part (11) and a washing part (10), wherein the first cleaning part (9) and the second cleaning part (11) are made of sponge, the first cleaning part (9) is embedded in the surface of the tail end of the transmission rod (8), the diameter of the washing part (10) is equal to that of the transmission rod (8), the washing part is connected to the tail end of the transmission rod (8) in a penetrating mode, and a water outlet (101) is formed in the surface of the washing part; the second cleaning part (11) is sequentially connected to the tail end of the flushing part (10).

2. Cleaning apparatus according to claim 1, characterized in that the expansion/compression ratio of the first cleaning part (9) and the second cleaning part (11) is 10: 1.

3. a cleaning device according to claim 1, characterized in that the first cleaning part (9) and the second cleaning part (11) are cylindrical or conical, and after expansion, have a maximum cross-sectional diameter of 1-3cm and a length of: 1-2 cm.

4. Cleaning device according to claim 1, characterized in that the core rod (1) is provided with graduations.

5. The cleaning device according to claim 1, characterized in that the outer tube (7) has two cavities inside, namely a first cavity (12) and a second cavity (13), and the transmission rod (8) is arranged in the second cavity (13) to push the slide block (2) and drive the push-aid rod (3) and the transmission rod (8) to slide in the second cavity (13).

6. A cleaning device according to claim 1, characterized in that the push-aid rod (3) and the driving rod (8) are connected by means of a screw or a mosaic.

7. A cleaning device as claimed in claim 6, characterized in that the end of the outer tube (7) close to the operating handle is provided with a protective sleeve (5), and the protective sleeve (5) is sleeved outside the outer tube (7).

8. A cleaning device according to claim 7, characterized in that the cross-section of the outer tube (7) is circular or oval.

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