Under endoscope multifunctional snareTechnical Field
The invention relates to the technical field of endoscopic surgical instruments, and particularly provides a multifunctional snare under an endoscope.
Background
In the field of endoscopic surgery, the treatment of tracheal polyps, colonic polyps, gastric fundus polyps, etc., and particularly in colonic polyps, it is often necessary to perform endoscopic submucosectomy (EMR). The raised polyp is sleeved by using a snare, the endoscope is cut electrically, then the snare is withdrawn, the endoscope is used for negative pressure suction, or the biopsy forceps are replaced again to take out the polyp for recovering the specimen, and the wound surface is sealed by using a disposable titanium clip. However, the operation is often insufficient in clinical treatment, namely, 1, the negative pressure suction process of the endoscope can cause sample loss and can not be used for pathological detection due to intestinal peristalsis, long endoscope pipelines and the like, 2, the samples resected by EMR under the endoscope are easier to fall into the distal end of the duodenum to cause sample recovery failure due to the influence of gravity at special anatomical parts such as the duodenum descending part, and 3, in the whole treatment process, the matched assistant needs to replace the endoscope accessories, so that the time consumption is long and the operation time is long. The prior art CN114569234A discloses a multifunctional snare for endoscopic surgery, which comprises a handle, an outer sheath, an inner sheath, an electrocautery ferrule and a clamp, wherein a first sliding block and a second sliding block which can slide are arranged on the handle, the inner sheath is inserted into the outer sheath, the outer sheath and the inner sheath are both arranged on the handle, the clamp is arranged at the free end part of the inner sheath, the electrocautery ferrule is sleeved outside the inner sheath, the first sliding block is connected with the clamp through a first operation control, the second sliding block is connected with the clamp through a second operation control, the first operation control is positioned in the inner sheath, and the second operation control is positioned between the outer sheath and the inner sheath. The inventors believe that there is a great room for improvement in the prior art.
Disclosure of Invention
The invention aims to timely recover the specimen, avoid displacement and loss of the polyp specimen in the process of changing the operation instrument by an assistant, avoid medical disputes, shorten the total time of operation, the interval time of operation cutting and hemostasis and improve the safety of operation. And secondly, the combined operations of cutting, hemostasis, foreign body extraction and the like are integrated, the use and replacement time of surgical instruments are reduced, the head volume of the snare is controlled, and the influence on the passing of endoscopic forceps is avoided, and the surgical operation device is applicable to anatomical bending parts requiring smaller diameters such as fundus of stomach, hepatic flexure of colon and the like. To this end, the invention provides an under-endoscope multifunctional snare comprising a snare wire, a guide wire mechanism and an endoscope cap, the guide wire mechanism being located inside the endoscope cap, the guide wire mechanism comprising at least two layers of mutually nested guide sleeves, the guide sleeve comprising a second guide sleeve and a first guide sleeve inside the second guide sleeve, the snare wire being fixed with the first guide sleeve, the snare wire being located inside the second guide sleeve, the snare wire being movable relative to the second guide sleeve. The snare wire and the wire are wrapped by the multi-layer nested guide sleeves, the snare wire is ensured to recover to a preset shape after passing through a narrow cavity, abrasion of the surface coating of the snare wire after deformation is avoided, the electric leakage risk is avoided, the second guide sleeve is used for conveying the snare wire to an electric cutting area, the first guide sleeve controls the snare wire to stretch out and shrink, the snare wire can move relative to the second guide sleeve, the snare wire can be retracted after working, the integration of hemostasis and foreign body extraction functions is facilitated, and mutual interference between instruments is avoided. It should be noted that the first guide sleeve and the second guide sleeve are insulating biocompatible plastics.
Preferably, the first guide sleeve sidewall is provided with a first through hole, the snare wire comprising a moving portion, the moving portion passing through the first through hole, the snare wire further comprising a working portion, the working portion extending in the extension direction of the guide sleeve. The moving part is used for controlling the extension of the snare wire and the first guide sleeve from the inside of the second guide sleeve, and the working part is used for controlling the extension length of the snare wire and controlling the tightening force of the snare.
Preferably, a separation mechanism is arranged outside the first guide sleeve, the separation mechanism can change working states along with the relative movement of the first guide sleeve and the second guide sleeve, and the separation mechanism separates the endoscope cap and the snare wire. The separation mechanism is used for separating the endoscope cap and the extending snare wire, so that electric leakage caused by contact between other structures of the invention and the snare wire in the electrified electrotome process of the snare wire is avoided, medical accidents occur, the separation mechanism can avoid the situation that a polyp specimen leaves an electrotome area after being resected and influenced by gravity, intestinal peristalsis and the like, and the separation mechanism and the snare wire are retracted after the polyp specimen stops moving, and the polyp specimen is clamped by adopting other structures.
Preferably, the separation mechanism comprises a hard support and a blocking net, the hard support is connected with the first guide sleeve, the blocking net is fixedly covered on the outer side of the hard support, the inner ring of the blocking net is connected with the first guide sleeve, and the outer ring of the blocking net is provided with an elastomer. The elastic body is arranged on the outer ring of the blocking net, after the blocking net leaves the inside of the second guide sleeve, the elastic body is restored according to the elasticity of the elastic body, the hard support is opened according to the restoration condition of the elastic body, the blocking net forms a blocking body for separating the electric cutting position of the snare wire from other parts of the elastic body, after electric cutting is finished, the excised polyp tissue can move under the action of factors such as gravity and intestinal peristalsis, the blocking body formed by the hard support and the blocking net has a blocking effect on the polyp tissue, after the polyp tissue can be stopped, the snare wire and the separation mechanism can be retracted to avoid the loss of the polyp tissue, as the separation mechanism adopts the elastic body to finish opening, the opening degree of the elastic body can be adjusted according to the space size of the electric cutting area, the separation mechanism is prevented from damaging surrounding tissues after the electric cutting area is opened, and preferably, the blocking net can adopt a transparent plastic film, after the separation mechanism is opened, the blocking net can avoid the operation view, whether the snare is blocked by the blocking net, and the polyp tissue is convenient to observe whether the snare is covered and the polyp tissue is tightened.
Preferably, the hard support comprises at least three hard wires, the hard wires are positioned between the first guide sleeve and the second guide sleeve, the blocking net is fixedly covered on the outer side of the hard wires, and one end of each hard wire is fixedly connected with the first guide sleeve. The hard support is made of hard wires, the diameter of the wire-shaped structure is smaller, the hard support is conveniently arranged between the first guide sleeve and the second guide sleeve, the overall diameter of the polyp cutting device is controlled, preferably, the hard wires can be made of metal materials such as nickel-titanium alloy, deformation of the hard wires through a narrow channel is avoided, and meanwhile the hard wires can have certain strength and a blocking net to form a blocking body to block the cut polyp tissue.
Preferably, the blocking net is in a sector shape, and the hard wires are uniformly distributed on the inner surface of the blocking net at intervals. The central angle of the blocking net sector is between 180 degrees and 330 degrees, and the sector notch of the blocking net is positioned at the top, so that other surgical instruments can pass through the device, and meanwhile, the blocking effect of the blocking net on polyp tissues and the separating effect on the snare wire electrotome area and other structures of the device are kept.
Preferably, the elastic body is matched with the inner diameter of the second guide sleeve when in a contracted state, and the hard wire and the first guide sleeve have an included angle alpha when in an expanded state. The elastic body is positioned in the second guide sleeve before the snare wire stretches out, so that the snare wire can smoothly pass through a narrow channel, meanwhile, the elastic body is positioned in the second guide sleeve, so that the second guide sleeve and the isolation snare wire and the second guide sleeve can be stretched, deformation of the snare wire when the snare wire passes through the narrow channel is avoided, meanwhile, the elastic body exists in the second guide sleeve, after the snare wire is retracted into the second guide sleeve, the elastic body presses the inner wall of the second guide sleeve to have larger friction force, the snare wire only stretches out under the operation of an operator, and accidents such as vibration can be avoided, and the snare wire stretches out of the second guide sleeve.
Preferably, the multifunctional snare under the endoscope further comprises a clamp mechanism, the clamp mechanism is located on the outer side of the second guide sleeve, the clamp mechanism comprises at least two clamps, the clamps comprise a separation clamp and a fixing clamp, the separation clamp is located at the front end of the fixing clamp, a separation mechanism is arranged between the separation clamp and the second guide sleeve, a half-through groove is formed in the front end of the endoscope cap, and the groove width of the half-through groove is matched with the width of the separation clamp. The clamp mechanism and the snare wire are coaxially arranged, the problem that the diameter of an endoscope cap is too large due to multiple functional integration is avoided, the operation of a small-diameter anatomical bending part such as the fundus of a stomach and hepatic flexure of a colon cannot be affected due to the fact that the endoscope is nested, the clamp mechanism is fixed on the outer side of the second guide sleeve, the snare wire does not need to be completely withdrawn from the snare, when the wire is withdrawn into the second guide sleeve, the operation can be performed, the electric cutting position is immediately clamped and stopped by adopting the disengaging clamp, the operation time for replacing an instrument for stopping the electric cutting position is shortened, the operation success rate is improved, after the electric cutting position is disengaged, the disengaging clamp and the second guide sleeve are separated through the separating mechanism, the fixed clamp is adopted for clamping and withdrawing a pre-reserved polyp specimen, compared with the traditional method, the time for replacing the surgical instrument is shortened, and the polyp specimen is prevented from losing.
The invention realizes that the specimens can be recovered in time, the displacement and the loss of polyp specimens are avoided in the process of changing operation instruments by an assistant, medical disputes are avoided, the total operation time, the operation cutting and hemostasis interval time are shortened, the operation safety is improved, the invention has the advantages that the composite operations of cutting, hemostasis, foreign matter extraction and the like are integrated, the use and replacement time of the operation instruments is reduced, the head volume of the snare is controlled, the influence on the passing of endoscope forceps channels and anatomical bending parts which are applicable to the fundus, colon liver curves and the like and need smaller diameters is avoided, the material properties of the snare wires and the wires are wrapped by adopting the multi-layer nested guide sleeves, the preset shape of the snare wires is ensured, the abrasion of the surface coating of the snare wires after the snare wires pass through a narrow channel is avoided, the leakage risk is avoided, the second guide sleeve is used for conveying the snare wires to an electric cutting area, the first guide sleeve controls the extension and contraction of the snare wires, the snare wires can move relative to the second guide sleeve, the integration of hemostasis and foreign matter extraction functions are facilitated, and mutual interference between the instruments is avoided.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below. It will be apparent to those skilled in the art from this disclosure that the drawings described below are merely exemplary and that other embodiments may be derived from the drawings provided without undue effort.
FIG. 1 is a schematic structural view of an endoscopic multifunctional snare;
FIG. 2 is a cross-sectional view of the multifunctional snare under an endoscope;
FIG. 3 is a partial enlarged view of the A position of the multifunctional snare under an endoscope;
Fig. 4 is a partial cross-sectional view of the snare wire of the invention in an extended condition;
FIG. 5 is a partial enlarged view of the B position of the multifunctional snare under the endoscope;
Fig. 6 is a partial cross-sectional view of the snare wire retrieval condition of the invention;
FIG. 7 is a partial enlarged view of the C position of the multifunctional snare under the endoscope;
FIG. 8 is a front view of a divider mechanism of the first embodiment;
Fig. 9 is a front view of the separation mechanism of the embodiment.
The reference numerals illustrate 1 snare wire, 11 moving part, 12 working part, 2 separation mechanism, 21 blocking net, 22 hard wire, 23 elastomer, 3 release clip, 31 separation mechanism, 4 endoscope cap, 5 first guide sleeve, 6 second guide sleeve, 7 fixation clip.
Detailed Description
The following description of the embodiments of the present invention will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present invention, but not all embodiments.
Example 1
As shown in connection with fig. 1 and 2, an under-endoscope multifunctional snare comprises a snare wire 1, a guide wire mechanism and an endoscope cap 4, wherein the guide wire mechanism is positioned inside the endoscope cap 4, the guide wire mechanism comprises at least two layers of guide sleeves nested with each other, each guide sleeve comprises a second guide sleeve 6 and a first guide sleeve 5 inside the second guide sleeve 6, the snare wire 1 is fixed with the first guide sleeve 5, the snare wire 1 is positioned inside the second guide sleeve 6, and the snare wire 1 can move relative to the second guide sleeve 6. The snare wire 1 and the wire are wrapped by adopting a plurality of layers of nested guide sleeves, the preset shape of the snare wire 1 is ensured to be restored after the snare wire passes through a narrow cavity, the abrasion of the surface coating of the snare wire 1 after deformation is avoided, the electric leakage risk is avoided, the second guide sleeve 6 is used for conveying the snare wire 1 to an electric cutting area, the first guide sleeve 5 controls the snare wire 1 to extend and shrink, the snare wire 1 can move relative to the second guide sleeve 6, the integration of the hemostasis and foreign body extraction functions is facilitated, and the mutual interference between instruments is avoided. The first guide sleeve 5 and the second guide sleeve 6 are insulating biocompatible plastics. The multifunctional snare under the endoscope further comprises a clamp mechanism, the clamp mechanism is located outside the second guide sleeve 6, the clamp mechanism comprises at least two clamps, the clamps comprise a disengaging clamp 3 and a fixing clamp 7, the disengaging clamp 3 is located at the front end of the fixing clamp 7, a separating mechanism 31 is arranged between the disengaging clamp 3 and the second guide sleeve 6, a semi-through groove is formed in the front end of the endoscope cap 4, and the groove width of the semi-through groove is matched with the width of the disengaging clamp 3. The clamp mechanism is a continuous hair clamp mechanism, the clamp mechanism and the snare wire 1 are coaxially arranged, the problem that the diameter of the endoscope cap 4 is too large due to multiple functional integration and influences the operation of the endoscope cap on anatomical bending parts which need smaller diameters such as the fundus of the stomach and liver of the colon and the like can not be achieved due to the fact that the endoscope is nested, the clamp mechanism is fixed on the outer side of the second guide sleeve 6, the snare wire 1 does not need to be completely withdrawn from the snare, the operation can be achieved when the wire is withdrawn into the second guide sleeve 6, the electric cutting position is immediately clamped and stopped by adopting the detachment clamp 3, the operation time for replacing an instrument for stopping at the electric cutting position is shortened, the operation success rate is improved, after the electric cutting position is clamped by the detachment clamp 3, the detachment clamp 3 is separated from the second guide sleeve 6 through the separation mechanism 31, and a pre-reserved polyp specimen is clamped by adopting the fixing clamp 7 and then withdrawn.
As shown in fig. 3, the first guide sleeve 5 side wall is provided with a first through hole, the snare wire 1 comprising a moving portion 11, the moving portion 11 passing through the first through hole, the snare wire 1 further comprising a working portion 12, the working portion 12 extending in the direction of extension of the guide sleeve. The first through hole is engaged with the snare wire 1, and the first guide sleeve 5 is pulled simultaneously when the moving portion of the snare wire 1 is moved, the moving portion 11 is used to control the snare wire 1 and the first guide sleeve 5 to protrude from the inside of the second guide sleeve 6, and the working portion 12 is used to control the protruding length of the snare wire 1 for snare polyp and to control the tightening force of the snare.
As shown in fig. 4, a separation mechanism 2 is arranged outside the first guide sleeve 5, the separation mechanism 2 can change working states along with the relative movement of the first guide sleeve 5 and the second guide sleeve 6, and the separation mechanism 2 separates the endoscope cap 4 and the snare wire 1. The separation mechanism 2 is used for separating the endoscope cap 4 and the extending snare wire 1, so that electric leakage caused by contact between other structures of the invention and the snare wire 1 in the electrified electrotome process of the snare wire 1 is avoided, medical accidents occur, the separation mechanism 2 can prevent a polyp specimen from leaving an electrotome area after being resected under the influence of gravity, intestinal peristalsis and the like, and the separation mechanism 2 and the snare wire 1 are retracted after the polyp specimen stops moving, and the polyp specimen is clamped by adopting the other structures.
As shown in fig. 4 and 5, the separation mechanism 2 comprises a hard support and a blocking net 21, the hard support is connected with the first guide sleeve 5, the blocking net 21 is fixedly covered on the outer side of the hard support, the inner ring of the blocking net 21 is connected with the first guide sleeve 5, and an elastic body 23 is arranged on the outer ring of the blocking net 21. The elastic body 23 is arranged on the outer ring of the blocking net 21, after the blocking net 21 leaves the inside of the second guide sleeve 6, the elastic body 23 is restored according to the self elasticity, the hard support is opened according to the restoration condition of the elastic body 23 and forms a blocking body by the blocking net 21, the electric cutting position of the snare wire 1 and the rest parts of the elastic body are separated, after electric cutting is finished, the cut polyp tissue can move under the action of factors such as gravity and intestinal peristalsis, the blocking body formed by the hard support and the blocking net 21 has a blocking effect on the polyp tissue, after the polyp tissue is stopped, the snare wire 1 and the separation mechanism 2 can be retracted, the polyp tissue is prevented from losing, the opening degree of the elastic body 23 can be adjusted according to the space size adaptability of an electric cutting area, the separation mechanism 2 is prevented from damaging surrounding tissues after the electric cutting area is opened, the blocking net 21 can be made of transparent plastic film, the transparent material can prevent the operation view of the blocking net 21 after the opening of the separation mechanism 2, and the situation that the snare wire 1 and the polyp tissue is convenient to observe whether the polyp tissue is stopped or not.
As shown in fig. 8, the hard support comprises at least three hard wires 22, the hard wires 22 are located between the first guide sleeve 5 and the second guide sleeve 6, the blocking net 21 is fixed on the outer side of the hard wires 22 in a coating mode, and one end of each hard wire 22 is fixed with the first guide sleeve 5. The hard wire 22 is made of a metal material such as nickel-titanium alloy, so that the hard wire 22 is prevented from deforming through a narrow channel, and meanwhile, the hard wire 22 can have certain strength and form a blocking body with the blocking net 21 to block the polyp tissue after cutting.
As shown in fig. 6 and 7, the elastic body 23 is matched with the inner diameter of the second guide sleeve 6 when in a contracted state, and the hard wire 22 forms an included angle alpha with the first guide sleeve 5 when the elastic body 23 is in an expanded state. The elastic body 23 is positioned inside the second guide sleeve 6 before the snare wire 1 is stretched out, so that the snare wire 1 can smoothly pass through a narrow channel, meanwhile, the elastic body 23 is positioned inside the second guide sleeve 6, so that the second guide sleeve 6 and the snare wire 1 and the second guide sleeve 6 can be separated, deformation of the snare wire 1 caused by the passing of the snare wire 1 can be avoided, and meanwhile, the elastic body 23 exists inside the second guide sleeve 6, after the snare wire 1 is retracted inside the second guide sleeve 6, the elastic body 23 presses the inner wall of the second guide sleeve 6 to have larger friction force, the snare wire 1 can only stretch out under the operation of an operator, and accidents such as vibration can be avoided, and the snare wire 1 stretches out from the inside of the second guide sleeve 6.
Example two
As shown in fig. 9, unlike the first embodiment, in this embodiment, the barrier net 21 has a fan shape, and the stiff wires 22 are uniformly distributed on the inner surface of the barrier net 21 at intervals of a uniform angle. The central angle of the fan shape of the blocking net 21 is between 180 degrees and 330 degrees, the fan-shaped notch of the blocking net 21 is positioned at the top, other surgical instruments are allowed to pass through the device, the device can be suitable for endoscopic surgery with double endoscopic forceps channels, meanwhile, the blocking effect of the blocking net 21 on polyp tissues and the separation effect on the cutting area of the snare wire 1 and other structures of the device are kept, and the interference of the blocking net 21 and the hard support on the operation field is reduced. The double-endoscope forceps channel increases the head volume of the endoscope cap, is difficult to be applied to or not applied to the operation of the small-diameter anatomical bending part, and has high manufacturing cost.
The invention realizes that the specimens can be recovered in time, the displacement and the loss of polyp specimens are avoided in the process of changing operation instruments by an assistant, medical disputes are avoided, the total operation time, the operation cutting and hemostasis interval time are shortened, the operation safety is improved, the combined operation of cutting, hemostasis, foreign matter extraction and the like is integrated, the use and replacement time of the operation instruments is reduced, the head volume of the snare is controlled, the influence on the passing of endoscopic forceps channels and anatomical bending parts which are applicable to the fundus, colon liver curves and the like and need smaller diameters is avoided, the snare wires 1 and the material properties of the wires are wrapped by adopting the multi-layer nested guide sleeves, the preset shape of the snare wires 1 is ensured, the surface coating of the snare wires 1 is prevented from being worn after the snare wires 1 are deformed, the leakage risk is avoided, the second guide sleeve 6 is used for conveying the snare wires 1 to an electric cutting area, the first guide sleeve 5 controls the extension and contraction of the snare wires 1, the snare wires 1 can move relative to the second guide sleeve 6, the integration and the foreign matter extraction functions are avoided.
The above examples and/or embodiments are merely illustrative of preferred embodiments and/or implementations for implementing the technology of the present invention, and are not intended to limit the implementation of the technology of the present invention in any way, and any person skilled in the art should consider that the technology or embodiments substantially identical to the technology of the present invention may be modified slightly and modified to other equivalent embodiments without departing from the scope of the technical means disclosed in the present disclosure.