技术领域technical field
本实用新型涉及医疗器械技术领域，具体地说，涉及用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统。The utility model relates to the technical field of medical instruments, in particular to an instrument system for transurethral non-muscle-invasive bladder tumor surgery.
背景技术Background technique
目前，腔内手术是治疗非肌层浸润性膀胱肿瘤等疾病的重要手段，随着科技的不断发展，腔内手术治疗方法也层出不穷，包括单极电切、等离子电切、钬激光、铥激光术、荧光剂或NBI辅助的电切术等。At present, endovascular surgery is an important method for the treatment of non-muscle invasive bladder tumors and other diseases. With the continuous development of science and technology, endovascular surgery treatment methods are emerging in an endless stream, including monopolar resection, plasma resection, holmium laser, thulium laser Surgery, fluorescein or NBI-assisted resection, etc.
总体而言，经尿道膀胱肿瘤电切手术(TURBt)仍是治疗非肌层浸润性膀胱癌的主要方法，但其仍然存在一定的局限性。尤其对于肿瘤体积较大，单次操作不能完全切除的膀胱肿瘤，或因肿瘤形态不规则、肿瘤多发、肿瘤位置位于操作盲区等原因，手术过程中容易丢失解剖层面，造成肿瘤切除不彻底或组织切除过深、过多，从而导致手术效果不理想、术后并发症和肿瘤复发率偏高等问题。而手术器械操作的精细化将有利于提高病灶切割的灵活性，便于一次性切割，准确够及病灶和掌握切割深度、长度等。但是目前关于操作十分精细的经尿道途径非肌层浸润性膀胱肿瘤腔内手术器械还未见报道。Overall, transurethral resection of bladder tumor (TURBt) is still the main method for the treatment of non-muscle-invasive bladder cancer, but it still has certain limitations. Especially for bladder tumors with large tumor volumes that cannot be completely removed in a single operation, or due to irregular tumor shapes, multiple tumors, and tumor locations located in blind areas of the operation, it is easy to lose the anatomical level during the operation, resulting in incomplete tumor resection or tissue loss. Excessive deep and excessive resection will lead to unsatisfactory surgical results, postoperative complications, and high tumor recurrence rates. The refinement of surgical instrument operation will help improve the flexibility of lesion cutting, facilitate one-time cutting, accurately reach the lesion, and grasp the cutting depth and length. However, there is no report on intracavity surgical instruments for non-muscle-invasive bladder tumors through the transurethral approach with very fine operation.
发明内容Contents of the invention
本实用新型的目的是针对现有技术中的不足，提供一种具有多通道的内窥镜。The purpose of the utility model is to provide a multi-channel endoscope aiming at the deficiencies in the prior art.
本实用新型的再一的目的是，提供一种用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统。Another object of the present utility model is to provide an instrument system for transurethral non-muscle invasive bladder tumor surgery.
为实现上述目的，本实用新型采取的技术方案是：In order to achieve the above object, the technical scheme that the utility model takes is:
一种具有多通道的内窥镜，设有镜体和镜鞘，所述的镜体上设有目镜、导光筒、进水管道和出水管道，所述的镜鞘内设有物镜、导光通道、进水通道和出水通道，所述的镜体还设有第一器械连接口和第二器械连接口，所述的镜鞘内还设有第一工作通道和第二工作通道，所述的第一器械连接口与第一工作通道相连通，所述的第二器械连接口与第二工作通道相连通。An endoscope with multiple channels is provided with a mirror body and a mirror sheath. The mirror body is provided with an eyepiece, a light guide tube, a water inlet pipe and a water outlet pipe. The mirror sheath is provided with an objective lens, a guide light channel, water inlet channel and water outlet channel, the mirror body is also provided with a first instrument connection port and a second instrument connection port, and a first working channel and a second working channel are also provided in the mirror sheath, so The first instrument connection port communicates with the first working channel, and the second instrument connection port communicates with the second working channel.
优选地，所述的镜鞘横截面外缘的上缘呈弧形，下缘呈弯折状。Preferably, the upper edge of the outer edge of the cross-section of the mirror sheath is arc-shaped, and the lower edge is curved.
为实现上述第二个目的，本实用新型采取的技术方案是：For realizing above-mentioned second purpose, the technical scheme that the utility model takes is:
一种用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统，它包括如上任一 所述的具有多通道的内窥镜，和A device system for transurethral non-muscle-invasive bladder tumor surgery, which includes an endoscope with multiple channels as described above, and
a)具有可弯关节的末端可弯曲手术器械：其设有驱动手柄和器械杆，所述的器械杆的远端设有由若干个关节组成的可弯曲关节段；所述的驱动手柄、器械杆、可弯曲关节段内部均中空且相连通；所述的驱动手柄上设有两个推杆，每个推杆均设有转动轴，所述的转动轴一端通过驱动手柄壁上的通孔穿插于驱动手柄的腔内，且转动轴上固定有牵引丝，所述的牵引丝具有两个自由端；其中一个推杆配设的牵引丝的两个自由端固定于可弯曲节段中间区段的一个关节上，另一推杆配设的牵引丝的两个自由端固定于可弯曲节段远端的一个关节上，且牵引丝的自由端贯穿在关节上的牵引丝穿孔内；用于贯穿同一推杆配设的牵引丝两个自由端的牵引丝穿孔位置相对；所述的推杆配设有锁定手柄；a) End-bendable surgical instrument with bendable joints: it is provided with a drive handle and an instrument rod, and the distal end of the instrument rod is provided with a bendable joint segment composed of several joints; the drive handle, instrument The inside of the rod and the bendable joint section are all hollow and connected; the driving handle is provided with two push rods, each of which is provided with a rotating shaft, and one end of the rotating shaft passes through the through hole on the wall of the driving handle It is inserted into the cavity of the driving handle, and a pulling wire is fixed on the rotating shaft. The pulling wire has two free ends; the two free ends of the pulling wire provided by one of the push rods are fixed in the middle area of the bendable segment On a joint of the segment, the two free ends of the pulling wire provided by the other push rod are fixed on a joint at the distal end of the bendable segment, and the free end of the pulling wire runs through the hole of the pulling wire on the joint; Opposite to the perforation positions of the two free ends of the pull wires that run through the same push rod; the push rod is equipped with a locking handle;
和/或and / or
b)具有预弯管结构的末端可弯曲手术器械：其设有把手和操作杆，所述的把手和操作杆内设有预弯管，所述的预弯管装配在推拉手柄的推拉杆上，所述的操作杆可相对于把手移动进而调节预弯管相对于操作杆的伸出长度，所述的操作杆和预弯管的内部贯通形成内置器械通道。b) End-bendable surgical instrument with pre-bent tube structure: it is provided with a handle and an operating rod, the handle and operating rod are provided with a pre-bent tube, and the pre-bent tube is assembled on the push-pull rod of the push-pull handle , the operating rod can move relative to the handle to adjust the protruding length of the pre-bending tube relative to the operating rod, and the inside of the operating rod and the pre-bending tube communicate to form a built-in instrument channel.
所述的可弯曲关节段为蛇骨链状或由金属管经激光雕刻成的镂空结构弯曲管构成；和/或所述的所述的预弯管由金属编织管、镍钛合金薄壁管或高分子塑料制成。The bendable joint segment is snake-bone chain-like or is made of a metal tube with a hollow structure curved tube carved by laser; and/or the said pre-bent tube is made of metal braided tube, nickel-titanium alloy thin-walled tube Or made of polymer plastic.
所述的可弯曲关节段为蛇骨链状，每个关节一端设有位置相对的两个销孔，另一端设有位置相对的两个销座，相邻关节在销孔、销座以及铆钉的配合下而铆定；和/或所述的预弯管有两个，分别为第一预弯管和第二预弯管，所述的第一预弯管嵌套于第二预弯管内部，所述的第一预弯管和第二预弯管分别装配在第一推拉杆和第二推拉杆上。The flexible joint segment is in the shape of a snake-bone chain. One end of each joint is provided with two pin holes opposite to each other, and the other end is provided with two pin seats opposite to each other. and/or there are two pre-bent pipes, namely the first pre-bend pipe and the second pre-bend pipe, and the first pre-bend pipe is nested in the second pre-bend pipe Inside, the first pre-bent pipe and the second pre-bend pipe are respectively assembled on the first push-pull rod and the second push-pull rod.
所述的关节上设有四个牵引丝穿孔，四个牵引丝穿孔两两并列构成两组牵引丝穿孔，两组牵引丝穿孔的位置相对，且两组牵引丝穿孔的连线与两个销孔的连线交叉呈“十”字；和/或所述的第一推拉杆和第二推拉杆槽式嵌合可相对于彼此滑动。The joint is provided with four traction wire perforations, and the four traction wire perforations are arranged side by side to form two groups of traction wire perforations. The connecting lines of the holes intersect to form a "cross"; and/or the first push-pull rod and the second push-pull rod are slot-fitted and can slide relative to each other.
用于贯穿同一推杆配设的牵引丝两个自由端的牵引丝穿孔呈圆周对称分布；和/或所述的推拉杆的近端设有夹爪，所述的夹爪的外部设有锁紧套筒。The perforations of the two free ends of the pulling wire used to pass through the same push rod are distributed symmetrically around the circumference; sleeve.
所述的转动轴上设有环绕一周的限位槽，所述的牵引丝固定在限位槽上；和/或所述的夹爪合并于一体时，从近端至远端的周径逐渐变小，所述的锁紧 套筒的内壁周径从近端至远端也逐渐变小；所述的夹爪和锁紧套筒螺纹连接。The rotating shaft is provided with a circumferential limiting groove, and the pulling wire is fixed on the limiting groove; and/or when the jaws are combined, the circumference from the proximal end to the distal end gradually becomes smaller, the inner wall circumference of the locking sleeve also gradually decreases from the proximal end to the far end; the clamping jaws are threadedly connected with the locking sleeve.
所述的推杆还设有推柄和柄座，所述的推柄呈弧形，一端连接在柄座上，一端沿着驱动手柄外壁周长的轨迹线方向弯曲，两个推杆的推柄弯曲延伸方向相反；和/或所述的把手内壁设有凹槽，所述的凹槽底部固定有弹簧，所述的弹簧上端设有弹珠；所述的推拉杆外壁上设有轴向排列的凹坑。The push rod is also provided with a push handle and a handle seat, the push handle is arc-shaped, one end is connected to the handle seat, and one end is bent along the track line direction of the outer wall circumference of the drive handle, the push rods of the two push rods The handle is bent and extended in the opposite direction; and/or the inner wall of the handle is provided with a groove, the bottom of the groove is fixed with a spring, and the upper end of the spring is provided with a marble; the outer wall of the push-pull rod is provided with an axial Aligned pits.
所述的锁定手柄位于柄座和驱动手柄之间，所述的锁定手柄设有固定片和楔子，所述的锁定手柄通过固定片上的穿孔套接于转动轴上，所述的穿孔大于转动轴的横截面面积，所述的楔子可从柄座和驱动手柄之间的缝隙中向内插入卡紧或向外拔出。The locking handle is located between the handle seat and the driving handle, the locking handle is provided with a fixed piece and a wedge, and the locking handle is sleeved on the rotating shaft through a perforation on the fixing piece, and the perforating hole is larger than the rotating shaft The cross-sectional area of the wedge can be inserted inwardly and locked or outwardly pulled out from the gap between the shank and the driving handle.
本实用新型优点在于：The utility model has the advantages that:
具有可弯关节的末端可弯曲手术器械：End-bendable surgical instruments with bendable joints:
1、设有两个推杆，每个推杆分别配设锁定手柄和牵引丝，两套牵引丝的自由端分别固定于可弯曲关节段的中间区段和远端，使得可弯曲关节段被分段控制，能够呈“S”形双曲率弯曲并且形态可固定，显著提高了器械的灵活性，增加了操作的精细度，在特定的手术腔道下，相比于现有手术器械，可以够及病灶的各个部位，全角度无盲区，便于切除各种形态、位置的肿瘤，操作更简单，手术效果更好；1. There are two push rods, and each push rod is equipped with a locking handle and a pulling wire respectively. The free ends of the two sets of pulling wires are respectively fixed on the middle section and the distal end of the bendable joint segment, so that the bendable joint segment is Segmental control, capable of "S"-shaped double-curvature bending and fixed shape, which significantly improves the flexibility of the instrument and increases the fineness of operation. Under a specific surgical channel, compared with existing surgical instruments, it can Reaching all parts of the lesion, no blind spots at all angles, easy to remove tumors of various shapes and locations, easier operation and better surgical effect;
2、转动轴上设有限位槽，牵引丝固定于限位槽上，可防止牵引丝运动时左右偏移幅度过大，避免相互干扰；2. There is a limit groove on the rotating shaft, and the drawing wire is fixed on the limit groove, which can prevent the left and right deviation of the drawing wire from being too large and avoid mutual interference;
3、可弯曲节段每个关节上四个牵引丝穿孔两两并列，构成两组牵引丝穿孔，且两组牵引丝穿孔的连线与两个销孔的连线交叉呈“十”字，能更加灵活的控制可弯曲节段的弯曲角度，实现弯曲角度的最大化；3. The four traction wire perforations on each joint of the bendable segment are juxtaposed to form two groups of traction wire perforations, and the connection line of the two groups of traction wire perforations and the connection line of the two pin holes cross to form a "ten", The bending angle of the bendable segment can be controlled more flexibly to maximize the bending angle;
4、可弯曲节段最远端的关节的远端设有台柱状的固定头，可精准地控制安装于腔体内的器械(如光纤)的头端活动；4. The distal end of the most distal joint of the bendable segment is provided with a column-shaped fixed head, which can precisely control the movement of the head end of the instrument (such as an optical fiber) installed in the cavity;
5、锁定手柄采用阻尼锁定，结构简单，操作简便。5. The locking handle is damped and locked, with simple structure and easy operation.
具有预弯管结构的末端可弯曲手术器械：End-bendable surgical instruments with pre-bent tube construction:
1、将可自然单向弯曲的材料如金属编织管应用于手术器械领域，通过推拉手柄控制其伸出于操作杆远端的长度，进而可获得不同形状的器械末端，如弧形、“S”形双曲率弯曲等，使得装配于内置器械通道的手术器械可够及病灶的各个部位，操作更加精细，在特定的手术腔道下，相比于现有手术器械，可实现全角度无盲区，便于切除各种形态、位置的肿瘤，操作更简单，手术效果 更好；1. Apply materials that can be naturally bent in one direction, such as metal braided tubes, to the field of surgical instruments, and control the length of the handle extending from the distal end of the operating rod through the push-pull handle, so that different shapes of instrument ends can be obtained, such as curved, "S "Shaped double-curvature bending, etc., so that the surgical instruments assembled in the built-in instrument channel can reach all parts of the lesion, and the operation is more precise. Under a specific surgical channel, compared with the existing surgical instruments, it can realize full-angle without blind spots , it is convenient to remove tumors of various shapes and positions, the operation is simpler, and the operation effect is better;
2、设置两个嵌套的预弯管时，用于操纵预弯管的两个推拉杆为槽式嵌合，可以将二者的移动标定在一条直线上，能更加精准地控制两个预弯管的形状，并且可以保证其中一个推拉杆被锁紧时，另一推拉杆也被间接锁紧；2. When setting two nested pre-bending pipes, the two push-pull rods used to manipulate the pre-bending pipes are fitted in grooves, and the movement of the two can be calibrated on a straight line, which can control the two pre-bending pipes more precisely. The shape of the elbow can ensure that when one of the push-pull rods is locked, the other push-pull rod is also indirectly locked;
3、所述的推拉杆可以被锁紧，便于固定预弯管形状，且推拉杆锁紧设计方便实用；3. The push-pull rod can be locked, which is convenient for fixing the shape of the pre-bent pipe, and the locking design of the push-pull rod is convenient and practical;
4、所述的推拉杆近端设有夹爪，通过锁紧套筒旋转锁紧内置器械通道里的手术器械，操作十分简便。4. The proximal end of the push-pull rod is provided with grippers, which can be rotated and locked by the locking sleeve to lock the surgical instruments in the built-in instrument channel, and the operation is very simple.
具有多通道的内窥镜：Endoscopes with multiple channels:
1、设有多个工作通道，可同时配合两种手术器械使用，增加了手术操作的灵活性，便于更加精细化的操作；1. There are multiple working channels, which can be used with two surgical instruments at the same time, which increases the flexibility of surgical operations and facilitates more refined operations;
2、镜鞘的形状以及镜鞘内部各个通道形状、位置设计合理，可保证较小的镜鞘周径，适用于狭窄的尿道等腔体，且可获得清晰的图像，便于指导手术操作。2. The shape of the mirror sheath and the shape and position of each channel inside the mirror sheath are designed reasonably, which can ensure a small diameter of the mirror sheath, which is suitable for narrow urethra and other cavities, and can obtain clear images, which is convenient for guiding surgical operations.
用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统：Device Systems for Transurethral Non-Muscle Invasive Bladder Tumor Surgery:
将具有可弯关节的末端可弯曲手术器械、具有预弯管结构的末端可弯曲手术器械单独配合具有多通道的内窥镜使用，或者将以上两种手术器械同时配合具有多通道的内窥镜使用，可以获得多种形状的手术器械末端，形成环抱式操作角，便于精细化操作，且手术操作部位可以被实时观察。相对于以往膀胱肿瘤单纯依赖“电切环”进行切除而言，本实用新型具有操作精细、全角度无盲区、切除彻底、便于掌握切除深度、人性化操作等特点，有望大幅提升非肌层浸润性膀胱肿瘤的治愈率，减少手术并发症，降低肿瘤复发率。Use the bendable end surgical instrument with bendable joint, the end bendable surgical instrument with pre-bent tube structure alone with the multi-channel endoscope, or combine the above two surgical instruments with the multi-channel endoscope at the same time Using it, various shapes of surgical instrument ends can be obtained, forming an embracing operation angle, which is convenient for fine operation, and the operation site can be observed in real time. Compared with the previous bladder tumors that simply relied on the "electrosurgical cutting ring" for resection, this utility model has the characteristics of fine operation, no blind spots at all angles, thorough resection, easy to grasp the resection depth, humanized operation, etc., and is expected to greatly improve the non-muscle invasion Improve the cure rate of bladder tumors, reduce surgical complications, and reduce tumor recurrence rates.
附图说明Description of drawings
附图1是具有可弯关节的末端可弯曲手术器械的立体图。Figure 1 is a perspective view of a flexible distal surgical instrument with a flexible joint.
附图2是推杆的内部结构示意图。Accompanying drawing 2 is the internal structure schematic diagram of push rod.
附图3是可弯曲关节段的结构示意图。Accompanying drawing 3 is the structure diagram of flexible joint segment.
附图4是关节的结构示意图。Accompanying drawing 4 is the structural representation of joint.
附图5是具有预弯管结构的末端可弯曲手术器械(I)的立体图。Accompanying drawing 5 is the perspective view of the end bendable surgical instrument (I) with pre-bent tube structure.
附图6是图5的A-A剖视图。Accompanying drawing 6 is A-A sectional view of Fig. 5.
附图7是具有预弯管结构的末端可弯曲手术器械(I)中推拉手柄的固定原理图。Accompanying drawing 7 is the fixation schematic diagram of the push-pull handle in the end bendable surgical instrument (I) with the pre-bent tube structure.
附图8是具有预弯管结构的末端可弯曲手术器械(I)中推拉杆的近端结构示意图。Accompanying drawing 8 is the near-end structural schematic view of the push-pull rod in the end-bendable surgical instrument (I) with a pre-bent tube structure.
附图9是图6中B的局部放大图。Accompanying drawing 9 is the partial enlarged view of B in Fig. 6.
附图10是具有预弯管结构的末端可弯曲手术器械(II)的立体图。Accompanying drawing 10 is the perspective view of the end bendable surgical instrument (II) with the pre-bent tube structure.
附图11是图10的C-C剖视图。Accompanying drawing 11 is the C-C sectional view of Fig. 10.
附图12是具有预弯管结构的末端可弯曲手术器械(II)中第一推拉杆和第二推拉杆结构示意图。Accompanying drawing 12 is the structural diagram of the first push-pull rod and the second push-pull rod in the end-bendable surgical instrument (II) with a pre-bent tube structure.
附图13是具有预弯管结构的末端可弯曲手术器械(II)中第一推拉手柄的固定原理图。Accompanying drawing 13 is the fixing principle diagram of the first push-pull handle in the end-bendable surgical instrument (II) with a pre-bent tube structure.
附图14是本实用新型具有多通道的内窥镜立体图。Accompanying drawing 14 is the perspective view of the multi-channel endoscope of the present invention.
附图15是图14的D-D剖视图。Accompanying drawing 15 is the D-D sectional view of Fig. 14.
附图16是本实用新型用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统的立体图。Accompanying drawing 16 is the three-dimensional view of the device system of the utility model used in transurethral non-muscle invasive bladder tumor surgery.
具体实施方式Detailed ways
下面结合附图对本发明提供的具体实施方式作详细说明。The specific embodiments provided by the present invention will be described in detail below in conjunction with the accompanying drawings.
附图中涉及的附图标记和组成部分如下所示：The reference signs and components involved in the accompanying drawings are as follows:
1.具有可弯关节的末端可弯曲手术器械1. End-bendable surgical instruments with bendable joints
11.驱动手柄，12.器械杆，13.可弯曲关节段，131.关节，1311.销孔，1312.销座，1313.牵引丝穿孔，14.接头，15.推杆，151.推柄，152.柄座，153.转动轴，154.限位槽，16.锁定手柄，161.固定片，162.楔子，163.穿孔，17.牵引丝，171.关节，132.固定头11. Drive handle, 12. Instrument rod, 13. Bendable joint section, 131. Joint, 1311. Pin hole, 1312. Pin seat, 1313. Pull wire perforation, 14. Joint, 15. Push rod, 151. Push handle , 152. handle seat, 153. rotating shaft, 154. limit slot, 16. locking handle, 161. fixed piece, 162. wedge, 163. perforation, 17. traction wire, 171. joint, 132. fixed head
2.具有预弯管结构的末端可弯曲手术器械2. End-bendable surgical instrument with pre-bent tube structure
21.把手，211.凹槽，212.弹簧，213.弹珠，22.推拉手柄，2210.第一推拉手柄，2220.第二推拉手柄，221.指环，2211.第一指环，2212.第二指环，222.推拉杆，2221.第一推拉杆，2222.第二推拉杆，2223.凹坑，2224.夹爪，2225.外螺纹，23.操作杆，24.预弯管，241.第一预弯管，242.第二预弯管，25.锁紧套筒，251.旋柄，252.内螺纹，26.内置器械通道 21. Handle, 211. Groove, 212. Spring, 213. Marble, 22. Push-pull handle, 2210. First push-pull handle, 2220. Second push-pull handle, 221. Ring, 2211. First ring, 2212. No. Two rings, 222. Push-pull rod, 2221. The first push-pull rod, 2222. The second push-pull rod, 2223. Dimple, 2224. Gripper, 2225. External thread, 23. Operating rod, 24. Pre-bent pipe, 241. The first pre-bent tube, 242. The second pre-bent tube, 25. Locking sleeve, 251. Rotating handle, 252. Internal thread, 26. Built-in instrument channel
3.具有多通道的内窥镜3. Endoscope with multiple channels
31.镜体，311.第一器械连接口，312.第二器械连接口，313.目镜，314.导光筒，315.进水管道，316.出水管道，32.镜鞘，321.第一工作通道，322.第二工作通道，323.物镜，324.导光通道，325.进水通道，326.出水通道31. Mirror body, 311. First instrument connection port, 312. Second instrument connection port, 313. Eyepiece, 314. Light guide tube, 315. Water inlet pipe, 316. Water outlet pipe, 32. Mirror sheath, 321. No. One working channel, 322. Second working channel, 323. Objective lens, 324. Light guide channel, 325. Water inlet channel, 326. Water outlet channel
本文中，所述的“近端”指本实用新型在使用状态下即手术状态下距离术者较近的一端，所述“远端”指本实用新型在使用状态下即手术状态下距离术者较远的一端。In this article, the "proximal end" refers to the end of the utility model that is closer to the operator in the state of use, that is, the operation state, and the "far end" refers to the end of the utility model that is closer to the operator in the state of use, that is, the operation state. the far end.
实施例1Example 1
一、具有可弯关节的末端可弯曲手术器械1. End-bendable surgical instruments with bendable joints
请参照图1，图1是具有可弯关节的末端可弯曲手术器械的立体图。所述的具有可弯关节的末端可弯曲手术器械由近端至远端依次设有驱动手柄11、器械杆12和可弯曲关节段13，所述的驱动手柄11、器械杆12、可弯曲关节段13内部均中空且相连通。所述的驱动手柄11的近端设有接头14，驱动手柄11上还设有两个推杆15，两个推杆15的位置相对；所述的推杆15设有推柄151、柄座152和转动轴153(图中未示出)，所述的柄座152为圆柱形，所述的推柄151呈弧形，一端连接在柄座152侧壁上，一端沿着驱动手柄11外壁周长的轨迹线方向弯曲；两个推杆15的推柄151弯曲延伸方向正好相反，一个推柄151位于驱动手柄11的上方，另一个推柄151位于驱动手柄11的下方；每个推杆15均配设一个锁定手柄16。Please refer to FIG. 1 . FIG. 1 is a perspective view of a bendable surgical instrument with a bendable end. The terminal bendable surgical instrument with bendable joints is provided with a drive handle 11, an instrument rod 12 and a bendable joint segment 13 in turn from the proximal end to the distal end, and the drive handle 11, the instrument rod 12, and the bendable joint Sections 13 are all hollow inside and communicate with each other. The near end of described drive handle 11 is provided with joint 14, is also provided with two push rods 15 on the drive handle 11, and the position of two push rods 15 is relative; Described push rod 15 is provided with push handle 151, handle seat 152 and a rotating shaft 153 (not shown in the figure), the handle seat 152 is cylindrical, the push handle 151 is arc-shaped, one end is connected to the side wall of the handle seat 152, and the other end is along the outer wall of the driving handle 11 The track line direction of the circumference is curved; the push handles 151 of the two push rods 15 are bent and extended in the opposite direction, one push handle 151 is located above the drive handle 11, and the other push handle 151 is located below the drive handle 11; each push rod 15 are equipped with a locking handle 16.
请参照图2，图2是推杆的内部结构示意图。所述的转动轴153一端固定于柄座152近驱动手柄的一面，另一端通过驱动手柄11壁上的通孔(图中未示出)穿插于驱动手柄11的腔内，且转动轴153位于驱动手柄11腔内的区段外壁上设有环绕一周的限位槽154。所述的限位槽154内固定有两根牵引丝17。所述的牵引丝17一端固定在限位槽154上，另一端为自由端。所述的锁定手柄16设有固定片161和楔子162，所述的固定片161中设有穿孔163，所述的锁定手柄16通过穿孔163套接于转动轴153上，且锁定手柄16位于柄座152和驱动手柄11之间，所述的穿孔163大于转动轴153的横截面面积，使得楔子162可以从柄座152和驱动手柄11之间的缝隙中向内插入卡紧或向外拔出。Please refer to FIG. 2 , which is a schematic diagram of the internal structure of the push rod. One end of the rotating shaft 153 is fixed on the side of the handle seat 152 near the driving handle, and the other end is inserted into the cavity of the driving handle 11 through a through hole (not shown) on the wall of the driving handle 11, and the rotating shaft 153 is located at A circumscribed limiting groove 154 is provided on the outer wall of the section in the cavity of the driving handle 11 . Two pulling wires 17 are fixed in the limiting groove 154 . One end of the pulling wire 17 is fixed on the limiting groove 154, and the other end is a free end. The locking handle 16 is provided with a fixing piece 161 and a wedge 162, the fixing piece 161 is provided with a perforation 163, the locking handle 16 is sleeved on the rotating shaft 153 through the perforation 163, and the locking handle 16 is located on the handle Between the seat 152 and the driving handle 11, the perforation 163 is larger than the cross-sectional area of the rotating shaft 153, so that the wedge 162 can be inserted and clamped inward from the gap between the handle seat 152 and the driving handle 11 or pulled out outward. .
请参照图3，图3是可弯曲关节段的结构示意图。所述的可弯曲关节段13设有若干个关节131，每个关节131一端的侧壁上设有销孔1311，另一端的侧壁上设有突出的销座1312，相邻关节131在侧壁上的销孔1311与销座1312以及铆钉(图中未示出)的配合下而铆定，使得整个可弯曲关节段13呈蛇骨链状。最远端的关节131的远端设有台柱状的固定头132。Please refer to FIG. 3 , which is a schematic structural diagram of the bendable joint segment. The flexible joint segment 13 is provided with several joints 131, each joint 131 is provided with a pin hole 1311 on the side wall at one end, and a protruding pin seat 1312 is provided on the side wall at the other end, and adjacent joints 131 are arranged on the side. The pin holes 1311 on the wall are riveted together with the pin seat 1312 and rivets (not shown in the figure), so that the entire bendable joint segment 13 is in the shape of a snake-bone chain. The distal end of the most distal joint 131 is provided with a pillar-shaped fixing head 132 .
请参照图4，图4是关节的结构示意图。每个关节131上设有两个销孔1311和两个销座1312，两个销孔1311位置相对，两个销座1312位置相对。所述的 关节131内壁上还设有四个牵引丝穿孔1313，四个牵引丝穿孔1313两两并列构成两组牵引丝穿孔1313，且两组牵引丝穿孔1313的位置相对。两组牵引丝穿孔1313的连线与两个销孔1311的连线交叉呈“十”字。各个关节131上的牵引丝穿孔1313相连通形成四条通道。Please refer to FIG. 4 , which is a schematic structural diagram of the joint. Each joint 131 is provided with two pin holes 1311 and two pin seats 1312 , the two pin holes 1311 are opposite to each other, and the two pin seats 1312 are opposite to each other. The inner wall of the joint 131 is also provided with four traction wire perforations 1313, and the four traction wire perforations 1313 are arranged in pairs to form two groups of traction wire perforations 1313, and the positions of the two groups of traction wire perforations 1313 are opposite. The line connecting the two sets of pulling wire holes 1313 intersects the line connecting the two pin holes 1311 to form a "cross". The traction wire perforations 1313 on each joint 131 are connected to form four channels.
其中一个推杆15配设的两根牵引丝17的两个自由端分别从两个牵引丝穿孔1313中穿过且这两个牵引丝穿孔1313位于对角线位置上，即呈圆周对称分布，相对于圆心对称；另一个推杆15配设的两根牵引丝17的两个自由端分别从另外两个牵引丝穿孔1313中穿过。固定在一个推杆15上的两根牵引丝17的两个自由端远端固定在可弯曲节段中间区段的一个关节131上，固定在另一推杆15上的两根牵引丝17的两个自由端固定在最远端的关节131上。The two free ends of the two pull wires 17 provided on one of the push rods 15 respectively pass through the two pull wire holes 1313 and the two pull wire holes 1313 are located at diagonal positions, that is, they are distributed symmetrically around the circumference. Symmetrical with respect to the center of the circle; the two free ends of the two pulling wires 17 assigned to the other push rod 15 respectively pass through the other two pulling wire holes 1313 . Two free end distal ends of the two pull wires 17 fixed on a push rod 15 are fixed on a joint 131 of the middle section of the bendable section, and the two pull wires 17 fixed on the other push rod 15 The two free ends are fixed on the most distal joint 131 .
需要说明的是，所述的推杆15可以控制牵引丝17两个自由端的相对运动，当旋转推杆15时，一个牵引丝17的自由端向远端运动，另一牵引丝17的自由端则向近端运动，进而驱动与上述两根牵引丝17自由端远端相连的关节131处弯曲。所述的具有可弯关节的末端可弯曲手术器械设有两个推杆15，分别配设一套牵引丝17，两套牵引丝17自由端远端分别固定于可弯曲关节段13的中间区段和远端，使得可弯曲关节段13被分段控制，能够呈“S”形双曲率弯曲，显著提高了所述的具有可弯关节的末端可弯曲手术器械的灵活性，增加了操作的精细度，在特定腔道的限定下，其可以够及病灶的各个部位，全角度无盲区。所述的牵引丝17的设计并不仅限于每个转动轴153上固定两根，只要能保证同一转动轴153上具备两个牵引丝自由端，且转动轴153转动时能带动两个牵引丝自由端相对运动即可，例如也可以是转动轴153上设有一根牵引丝且牵引丝的中间区段缠绕于转动轴153上。所述的限位槽154的作用是限制牵引丝17运动时左右偏移幅度过大，以免不同牵引丝17之间相互干扰。优选地，同一推杆15上的两根牵引丝17的两个自由端分别从呈圆周对称的两个牵引丝穿孔1313穿过，可保证同一套牵引丝17控制的可弯曲节段13形成“S”形双曲率弯曲；将四个牵引丝穿孔1313两两并列构成两组，且两组的位置设计成相对的，可保证形成的双向弯曲处于同一平面上；两组牵引丝穿孔1313的连线与两个销孔1311的连线交叉呈“十”字，能更加灵活的控制可弯曲节段13的弯曲角度，实现弯曲角度的最大化。所述的可弯曲节段13最远端的关节131的远端设有台柱状的固定头132，可限定腔体内安装的器械(如光纤)头端的活动，可更精准地控制其中的器械。所述的可弯曲关节段13不仅限于本实施例 的蛇骨链式结构，还可以由薄壁金属管经激光雕刻成的镂空结构弯曲管构成。所述的锁定手柄16可限定推杆15的转动，从而将可弯曲关节段13固定在特定的弯曲角度和形态。所述的推杆15的推柄151呈弧形且一端沿着驱动手柄外壁周长的轨迹线方向弯曲，两个推杆15的推柄151弯曲延伸方向相反，该设计符合人体工程学原理，方便使用大拇指和食指来操纵两个推杆15。本实施例的锁定手柄16采用的是阻尼锁定，该种设计操作十分简便，但其它锁定方式也可。It should be noted that the push rod 15 can control the relative movement of the two free ends of the pull wire 17. When the push rod 15 is rotated, the free end of one pull wire 17 moves to the distal end, and the free end of the other pull wire 17 Then move toward the proximal end, and then drive the joint 131 connected with the free end distal end of the two pulling wires 17 to bend. The end bendable surgical instrument with bendable joints is provided with two push rods 15, respectively equipped with a set of pull wires 17, and the free ends of the two sets of pull wires 17 are respectively fixed in the middle area of the bendable joint segment 13 segment and the distal end, so that the bendable joint segment 13 is controlled in segments, and can be bent in an "S" shape with double curvature, which significantly improves the flexibility of the end bendable surgical instrument with a bendable joint, and increases the operational flexibility. Fineness, under the limitation of a specific cavity, it can reach all parts of the lesion, and there is no blind area in all angles. The design of the drawing wires 17 is not limited to fixing two on each rotating shaft 153, as long as it can ensure that the same rotating shaft 153 has two free ends of the drawing wires, and the rotating shaft 153 can drive the two drawing wires to move freely. The relative movement of the ends is sufficient, for example, a pulling wire may be provided on the rotating shaft 153 and the middle section of the pulling wire is wound on the rotating shaft 153 . The function of the limiting groove 154 is to limit the excessive left and right deviation of the pulling wire 17 when moving, so as to avoid mutual interference between different pulling wires 17 . Preferably, the two free ends of the two pulling wires 17 on the same push rod 15 respectively pass through two circumferentially symmetrical pulling wire holes 1313, which can ensure that the bendable segments 13 controlled by the same set of pulling wires 17 form " S”-shaped double-curvature bending; two groups of four drawing wire perforations 1313 are arranged side by side, and the positions of the two groups are designed to be opposite, which can ensure that the formed bidirectional bending is on the same plane; the connection of the two groups of drawing wire perforations 1313 The intersection of the line and the connecting line of the two pin holes 1311 is in the shape of a "ten", which can more flexibly control the bending angle of the bendable segment 13 and maximize the bending angle. The distal end of the most distal joint 131 of the bendable segment 13 is provided with a column-shaped fixed head 132, which can limit the movement of the head end of the instrument (such as an optical fiber) installed in the cavity, and can control the instrument therein more precisely. The flexible joint segment 13 is not limited to the snake-bone chain structure in this embodiment, but can also be made of a thin-walled metal tube with a hollow structure curved tube carved by laser. The locking handle 16 can limit the rotation of the push rod 15, so as to fix the bendable joint segment 13 at a specific bending angle and shape. The push handle 151 of the push rod 15 is arc-shaped and one end is bent along the track line direction of the outer wall of the driving handle. The push handles 151 of the two push rods 15 bend and extend in opposite directions. This design conforms to the principle of ergonomics. It is convenient to use the thumb and forefinger to manipulate the two push rods 15 . The locking handle 16 of this embodiment adopts damping locking, which is very easy to operate, but other locking methods are also available.
当所述的具有可弯关节的末端可弯曲手术器械单独使用时，以经尿道途径非肌层浸润性膀胱肿瘤腔内手术为例，于所述的具有可弯关节的末端可弯曲手术器械的腔体内插入光纤或其它器械并锁紧，将器械杆12经内窥镜工作通道插入直至膀胱，然后手持驱动手柄11，大拇指控制上方的推杆15，食指控制下方的推杆15，且保证上方的推杆15配设的牵引丝控制可弯曲节段13的远端，以符合人体工程学原理，利用更加灵活的大拇指来控制可弯曲节段13远端的形态。综合调控两个推杆15以获得理想的可弯曲节段13形态，达到所需病灶切割部位，通过锁定手柄16锁紧推杆15，切割病灶即可。所述的具有可弯关节的末端可弯曲手术器械相比于现有手术器械操作更精细，全角度无盲区，因此切除更彻底、便于掌握切除深度、操作更加人性化，可显著提高手术效果，减轻术者工作量。When the terminal bendable surgical instrument with bendable joints is used alone, taking transurethral non-muscle invasive intracavitary surgery as an example, the terminal bendable surgical instrument with bendable joints Insert an optical fiber or other instrument into the cavity and lock it, insert the instrument rod 12 through the working channel of the endoscope to the bladder, then hold the driving handle 11, control the upper push rod 15 with your thumb, and control the lower push rod 15 with your index finger, and ensure The traction wire provided on the upper push rod 15 controls the distal end of the bendable segment 13 to conform to the principle of ergonomics, and a more flexible thumb is used to control the shape of the distal end of the bendable segment 13 . The two push rods 15 are comprehensively regulated to obtain the ideal shape of the bendable segment 13 to reach the desired lesion cutting site, and the push rod 15 is locked by locking the handle 16 to cut the lesion. Compared with the existing surgical instruments, the terminal bendable surgical instruments with bendable joints are finer in operation and have no blind spots at all angles, so the resection is more thorough, the resection depth is easy to grasp, and the operation is more humanized, which can significantly improve the surgical effect. Reduce the operator's workload.
所述的具有可弯关节的末端可弯曲手术器械还可以用于其他尿路上皮肿瘤的切除手术，如输尿管癌、肾盂癌等疾病，仅需根据应用部位不同制作相应尺寸的手术器械即可。The end bendable surgical instrument with bendable joints can also be used for resection of other urothelial tumors, such as ureteral cancer, renal pelvis cancer and other diseases, and it is only necessary to make surgical instruments of corresponding sizes according to different application sites.
二、具有预弯管结构的末端可弯曲手术器械2. End-bendable surgical instruments with pre-bent tube structure
具有预弯管结构的末端可弯曲手术器械(I)End-bendable surgical instrument with pre-bent tube structure (I)
请参照图5，图5是具有预弯管结构的末端可弯曲手术器械(I)的立体图。所述的具有预弯管结构的末端可弯曲手术器械(I)设有把手21、推拉手柄22、操作杆23、预弯管24和锁紧套筒25。所述的把手21一端与推拉手柄22相连，另一端与操作杆23相连。所述的把手21、推拉手柄22、操作杆23、预弯管24均设有空腔。所述的预弯管24位于把手21和操作杆23的内部。所述的锁紧套筒25套于推拉手柄22的近端，且锁紧套筒25外壁上设有旋柄251。Please refer to FIG. 5 . FIG. 5 is a perspective view of a bendable surgical instrument (I) with a pre-bent tube structure. The end bendable surgical instrument (I) with a pre-bent tube structure is provided with a handle 21, a push-pull handle 22, an operating rod 23, a pre-bent tube 24 and a locking sleeve 25. One end of the handle 21 is connected with the push-pull handle 22 , and the other end is connected with the operating rod 23 . The handle 21, the push-pull handle 22, the operating rod 23, and the pre-bent pipe 24 are all provided with cavities. The pre-bent pipe 24 is located inside the handle 21 and the operating rod 23 . The locking sleeve 25 is sleeved on the proximal end of the push-pull handle 22 , and the outer wall of the locking sleeve 25 is provided with a handle 251 .
请参照图6，图6是图5的A-A剖视图。所述的推拉手柄22设有指环221和推拉杆222；所述的指环221固定于推拉杆222的中间区段；所述的推拉杆 222内部中空，远端嵌合于把手21的腔体内并可在把手21的腔体内滑动。所述的预弯管24装配在推拉杆222远端。所述的推拉手柄221和预弯管24的内部贯通形成内置器械通道26。所述的锁紧套筒25套接于推拉杆222近端的外部。Please refer to FIG. 6 , which is a cross-sectional view along line A-A of FIG. 5 . Described push-pull handle 22 is provided with finger ring 221 and push-pull rod 222; Described finger ring 221 is fixed on the middle section of push-pull rod 222; Can slide in the cavity of the handle 21. The pre-bent tube 24 is assembled on the far end of the push-pull rod 222 . The inside of the push-pull handle 221 and the pre-bent tube 24 are connected to form a built-in instrument channel 26 . The locking sleeve 25 is sleeved on the outside of the proximal end of the push-pull rod 222 .
请参照图7，图7是具有预弯管结构的末端可弯曲手术器械(I)中推拉手柄的固定原理图。所述的把手21近端的内壁上设有凹槽211，所述的凹槽211底部固定有弹簧212，所述的弹簧212的上端设有弹珠213。所述的推拉杆222远端的外壁上设有轴向排列的凹坑2223。向推拉杆222施力使其在把手21的腔体内滑动时，所述的弹珠213被压迫回缩至凹槽211内，当停止施力时，在弹簧212的回弹力下，所述的弹珠213落入其中一个凹坑2223内，使推拉杆222相对于把手21固定。Please refer to FIG. 7. FIG. 7 is a schematic diagram of the fixing principle of the push-pull handle in the end-bendable surgical instrument (I) with a pre-bent tube structure. The inner wall of the proximal end of the handle 21 is provided with a groove 211 , the bottom of the groove 211 is fixed with a spring 212 , and the upper end of the spring 212 is provided with a marble 213 . The outer wall of the distal end of the push-pull rod 222 is provided with dimples 2223 arranged axially. When force is applied to the push-pull rod 222 to make it slide in the cavity of the handle 21, the marble 213 is compressed and retracted into the groove 211. When the force is stopped, under the resilience of the spring 212, the The marble 213 falls into one of the recesses 2223 , so that the push-pull rod 222 is fixed relative to the handle 21 .
请参照图8和图9，图8是具有预弯管结构的末端可弯曲手术器械(I)中推拉杆的近端结构示意图，图9是图6中B的局部放大图。所述的推拉杆222近端设有四个夹爪2224；所述的夹爪2224内壁为弧形，四个夹爪2224于中央预留出内置器械通道26；四个夹爪2224外壁上设有外螺纹2225；四个夹爪2224合并于一体时，从近端至远端的周径逐渐变小。所述的锁紧套筒25套于四个夹爪2224的外部，且锁紧套筒25的内壁周径从近端至远端也逐渐变小，锁紧套筒25的内壁上设有内螺纹252。所述的内螺纹252与外螺纹2225相互配合，使得锁紧套筒25可在推拉杆222近端轴向旋转。Please refer to FIG. 8 and FIG. 9, FIG. 8 is a schematic diagram of the proximal structure of the push-pull rod in the end-bendable surgical instrument (I) with a pre-bent tube structure, and FIG. 9 is a partial enlarged view of B in FIG. 6 . The proximal end of the push-pull rod 222 is provided with four jaws 2224; the inner wall of the jaws 2224 is arc-shaped, and the four jaws 2224 reserve a built-in instrument channel 26 in the center; the outer walls of the four jaws 2224 are provided with There are external threads 2225; when the four jaws 2224 are integrated, the circumference from the proximal end to the distal end gradually becomes smaller. The locking sleeve 25 is sleeved on the outside of the four jaws 2224, and the inner wall circumference of the locking sleeve 25 gradually becomes smaller from the proximal end to the far end, and the inner wall of the locking sleeve 25 is provided with an inner wall. Thread 252. The internal thread 252 cooperates with the external thread 2225 so that the locking sleeve 25 can rotate axially at the proximal end of the push-pull rod 222 .
具有预弯管结构的末端可弯曲手术器械(II)End-bendable surgical instrument with pre-bent tube structure (II)
请参照图10，图10是具有预弯管结构的末端可弯曲手术器械(II)的立体图。所述的具有预弯管结构的末端可弯曲手术器械(II)设有把手21、推拉手柄22、操作杆23、预弯管24和锁紧套筒25。所述的推拉手柄22有两个，分别为近端的第一推拉手柄2210和远端的第二推拉手柄2220。所述的预弯管24也有两个，分别为第一预弯管241和第二预弯管242。所述的把手21一端与第二推拉手柄2220相连，另一端与操作杆23相连。所述的把手21、第一推拉手柄2210、第二推拉手柄2220、操作杆23、第一预弯管241和第二预弯管242均设有空腔。所述的第二预弯管242位于把手21和操作杆23的内部，所述的第一预弯管241贯穿于第二预弯管242的内部。所述的锁紧套筒25套于第一推拉手柄2210的近端，且锁紧套筒25外壁上设有旋柄251。Please refer to FIG. 10 , which is a perspective view of the end-bendable surgical instrument (II) with a pre-bent tube structure. The end-bendable surgical instrument (II) with a pre-bent tube structure is provided with a handle 21 , a push-pull handle 22 , an operating rod 23 , a pre-bent tube 24 and a locking sleeve 25 . There are two push-pull handles 22, namely the first push-pull handle 2210 at the proximal end and the second push-pull handle 2220 at the far end. There are also two pre-bent pipes 24 , namely a first pre-bend pipe 241 and a second pre-bend pipe 242 . One end of the handle 21 is connected to the second push-pull handle 2220 , and the other end is connected to the operating rod 23 . The handle 21 , the first push-pull handle 2210 , the second push-pull handle 2220 , the operating rod 23 , the first pre-bent pipe 241 and the second pre-bend pipe 242 are all provided with cavities. The second pre-bending tube 242 is located inside the handle 21 and the operating rod 23 , and the first pre-bending tube 241 runs through the inside of the second pre-bending tube 242 . The locking sleeve 25 is sleeved on the proximal end of the first push-pull handle 2210 , and the outer wall of the locking sleeve 25 is provided with a handle 251 .
请参照图11，图11是图10的C-C剖视图。所述的第一推拉手柄2210设 有第一指环2211和第一推拉杆2221，所述的第一指环2211固定于第一推拉杆2221的中间区段；所述的第二推拉手柄2220设有第二指环2212和第二推拉杆2222。所述的第二推拉杆2222位于第一推拉杆2221远端的上方。第二推拉杆2222的远端嵌合于把手21的腔体内并可在把手21的腔体内滑动，所述的第一推拉杆2221的远端也嵌合于把手21的腔体内并可在把手21的腔体内滑动。所述的第二预弯管242装配在第二推拉杆2222远端，所述的第一预弯管241装配在第一推拉杆2221远端，且第一预弯管241贯穿于第二预弯管242的内部。所述的第一推拉手柄2210、第二推拉手柄2220、第一预弯管241和第二预弯管242各个部件的内部贯通形成内置器械通道26。所述的锁紧套筒25套接于第一推拉手柄2210近端的外部。Please refer to FIG. 11 , which is a sectional view along line C-C of FIG. 10 . The first push-pull handle 2210 is provided with a first finger ring 2211 and a first push-pull rod 2221, and the first finger ring 2211 is fixed on the middle section of the first push-pull rod 2221; the second push-pull handle 2220 is provided with The second finger ring 2212 and the second push-pull rod 2222 . The second push-pull rod 2222 is located above the distal end of the first push-pull rod 2221 . The distal end of the second push-pull rod 2222 is fitted in the cavity of the handle 21 and can slide in the cavity of the handle 21. The distal end of the first push-pull rod 2221 is also fitted in the cavity of the handle 21 and can slide in the cavity of the handle. 21 slides in the cavity. The second pre-bent tube 242 is assembled at the distal end of the second push-pull rod 2222, the first pre-bent tube 241 is assembled at the distal end of the first push-pull rod 2221, and the first pre-bent tube 241 runs through the second pre-bend tube 2222. Inside the elbow 242 . The insides of the first push-pull handle 2210 , the second push-pull handle 2220 , the first pre-bent tube 241 and the second pre-bend tube 242 are connected to form the built-in instrument channel 26 . The locking sleeve 25 is sleeved on the outside of the proximal end of the first push-pull handle 2210 .
请参照图12，图12是具有预弯管结构的末端可弯曲手术器械(II)中第一推拉杆和第二推拉杆结构示意图。所述的第二推拉杆2222位于第一推拉杆2221远端的上方，二者槽式嵌合可相对于彼此滑动，且第二推拉杆2222和第一推拉杆2221的接触部位合并预留有内置器械通道26。所述的第一推拉杆2221近端设有四个夹爪2224；所述的夹爪2224内壁为弧形；四个夹爪2224外壁上设有外螺纹2225。Please refer to FIG. 12 . FIG. 12 is a structural schematic diagram of the first push-pull rod and the second push-pull rod in the end-bendable surgical instrument (II) with a pre-bent tube structure. The second push-pull rod 2222 is located above the distal end of the first push-pull rod 2221, and the two groove-type fittings can slide relative to each other, and the contact parts of the second push-pull rod 2222 and the first push-pull rod 2221 are merged and reserved. Built-in instrument channel 26. The proximal end of the first push-pull rod 2221 is provided with four jaws 2224; the inner walls of the jaws 2224 are arc-shaped; the outer walls of the four jaws 2224 are provided with external threads 2225.
同具有预弯管结构的末端可弯曲手术器械(I)，四个夹爪2224合并于一体时，从近端至远端其周径逐渐变小。所述的锁紧套筒25套于四个夹爪2224的外部，且锁紧套筒25的内壁周径从近端至远端也逐渐变小，锁紧套筒25的内壁上设有内螺纹252。所述的内螺纹252与外螺纹2225相互配合，使得锁紧套筒25可在第一推拉杆2221近端轴向旋转。Like the end bendable surgical instrument (I) with a pre-bent tube structure, when the four jaws 2224 are integrated, the circumference gradually decreases from the proximal end to the distal end. The locking sleeve 25 is sleeved on the outside of the four jaws 2224, and the inner wall circumference of the locking sleeve 25 gradually becomes smaller from the proximal end to the far end, and the inner wall of the locking sleeve 25 is provided with an inner wall. Thread 252. The internal thread 252 cooperates with the external thread 2225 so that the locking sleeve 25 can rotate axially at the proximal end of the first push-pull rod 2221 .
请参照图13，图13是具有预弯管结构的末端可弯曲手术器械(II)中第一推拉手柄的固定原理图。所述的把手21近端的内壁上设有凹槽211，所述的凹槽211底部固定有弹簧212，所述的弹簧212的上端设有弹珠213。所述的第一推拉杆2221远端的外壁上设有轴向排列的凹坑2223。向第一推拉杆2221施力使其在把手21的腔体内滑动时，所述的弹珠213被压迫回缩至凹槽211内，当停止施力时，在弹簧212的回弹力下，所述的弹珠213落入其中一个凹坑2223内，所述的第一推拉杆2221相对于把手21固定，间接地，所述的第二推拉杆2222也被固定。Please refer to FIG. 13 , which is a schematic diagram of fixing the first push-pull handle in the end-bendable surgical instrument (II) with a pre-bent tube structure. The inner wall of the proximal end of the handle 21 is provided with a groove 211 , the bottom of the groove 211 is fixed with a spring 212 , and the upper end of the spring 212 is provided with a marble 213 . The outer wall of the distal end of the first push-pull rod 2221 is provided with dimples 2223 arranged axially. When force is applied to the first push-pull rod 2221 to make it slide in the cavity of the handle 21, the marble 213 is compressed and retracted into the groove 211. When the force is stopped, under the rebound force of the spring 212, the The marble 213 falls into one of the recesses 2223, the first push-pull rod 2221 is fixed relative to the handle 21, and indirectly, the second push-pull rod 2222 is also fixed.
针对以上具有预弯管结构的末端可弯曲手术器械(I)和具有预弯管结构的末端可弯曲手术器械(II)，需要说明的是，所述的内置器械通道26用于装 配手术器械，如激光光纤、柔性注射针、柔性手术剪刀、柔性抓钳等。所述的预弯管24是由弯曲性能好、强度高的可自然单向弯曲的材料制成，例如金属编织管、镍钛合金薄壁管或高分子塑料等，优选金属编织管，如SS304、SS316材料，其扭矩约为1:1，传递力和弯曲性能好，预弯管24可以是单层或多层编织中空管，可以由圆丝、扁丝、其他异形丝中的一种或几种编织而成。所述的预弯管24装配在推拉手柄22的推拉杆222上，术者通过操控指环221可以调节预弯管24在操作杆23远端伸出的长度，由于预弯管24本身具有弯曲性能，因此其伸出长度不同则弯曲成不同的形状，便于够及病灶的各个部位。所述的具有预弯管结构的末端可弯曲手术器械(II)设有两根相嵌套的预弯管24，相应地设有操控两根预弯管24的推拉手柄22，如此通过调节两根预弯管24的伸出长度，可以获得“S”形双曲率弯曲的器械末端，末端更为灵活，增加了操作的精细度，可实现全角度无盲区，此外，还可以设置更多个嵌套的预弯管24以便获得更为多样的器械末端形状。具有预弯管结构的末端可弯曲手术器械(II)中所述的第一推拉杆2221和第二推拉杆2222为槽式嵌合，其优点是可以将二者的移动标定在一条直线上，能更加精准地控制第一预弯管241和第二预弯管242的形状，并且可以保证其中一个推拉杆被锁紧时，另一推拉杆也被间接锁紧。所述的把手21上的凹槽211、弹簧212、弹珠213与推拉杆222的凹坑2223相配合可锁紧推拉手柄22，从而固定预弯管24的形状，该种锁定方式操作十分简便。所述的推拉杆222近端设计有夹爪2224，夹爪2224与锁紧套筒25配合可将内置器械锁紧，该种锁紧方式操作也十分简便。所述的旋柄251是为了方便旋转锁紧套筒25。所述的操作杆23可以是柔性的。Regarding the above bendable surgical instrument (I) with a pre-bent tube structure and the bendable surgical instrument (II) with a pre-bent tube structure, it should be noted that the built-in instrument channel 26 is used to assemble the surgical instrument , such as laser fiber optics, flexible injection needles, flexible surgical scissors, flexible grasping forceps, etc. The pre-bent tube 24 is made of a material with good bending performance and high strength that can be bent in one direction naturally, such as a metal braided tube, a nickel-titanium alloy thin-walled tube or a polymer plastic, etc., preferably a metal braided tube, such as SS304 , SS316 material, its torque is about 1:1, transmission force and bending performance are good, pre-bending tube 24 can be a single-layer or multi-layer braided hollow tube, can be made of a kind of round wire, flat wire, other special-shaped wire Or several kinds of weaving. The pre-bent tube 24 is assembled on the push-pull rod 222 of the push-pull handle 22, and the operator can adjust the length of the pre-bend tube 24 protruding from the distal end of the operating rod 23 by manipulating the finger ring 221. Because the pre-bend tube 24 itself has bending properties , so it bends into different shapes depending on the extension length, which is convenient to reach various parts of the lesion. The end bendable surgical instrument (II) with the pre-bent tube structure is provided with two pre-bent tubes 24 that are nested, and correspondingly provided with a push-pull handle 22 for manipulating the two pre-bent tubes 24, so that by adjusting the two The protruding length of the pre-bent tube 24 can obtain the "S"-shaped double-curvature curved instrument end, the end is more flexible, the fineness of operation is increased, and no blind spots can be realized at all angles. In addition, more Nested pre-bent tubes 24 for a greater variety of instrument tip shapes. The first push-pull rod 2221 and the second push-pull rod 2222 described in the bendable surgical instrument with a pre-bent tube structure (II) are groove-fitting, which has the advantage that the movement of the two can be calibrated on a straight line, The shapes of the first pre-bent pipe 241 and the second pre-bend pipe 242 can be controlled more precisely, and it can be ensured that when one of the push-pull rods is locked, the other push-pull rod is also indirectly locked. The groove 211, spring 212, and marble 213 on the handle 21 cooperate with the pit 2223 of the push-pull rod 222 to lock the push-pull handle 22, thereby fixing the shape of the pre-bent pipe 24. This locking method is very easy to operate . The proximal end of the push-pull rod 222 is designed with a jaw 2224, which cooperates with the locking sleeve 25 to lock the built-in instrument. This locking method is also very easy to operate. The handle 251 is for the convenience of rotating the locking sleeve 25 . The operating rod 23 may be flexible.
当所述的具有预弯管结构的末端可弯曲手术器械单独使用时，以经尿道途径非肌层浸润性膀胱肿瘤腔内手术为例，于所述的具有预弯管结构的末端可弯曲手术器械的内置器械通道26内插入激光光纤或其它手术器械，通过旋转锁紧套筒25锁紧手术器械，将操作杆23经内窥镜工作通道插入直至膀胱，然后手持把手21，手指操纵指环221，通过推拉以控制预弯管24相对于操作杆23的伸出长度，直至预弯管24具备够及病灶的合适形状，停止推拉，此时弹珠213落入凹坑2223，推拉手柄22被锁紧，进行手术操作即可。所述的具有预弯管结构的末端可弯曲手术器械相比于现有手术器械操作更精细，全角度无盲区，因此切除更彻底、便于掌握切除深度、操作更加人性化，可显著提高手术效果，减轻术者工作量。When the end-bendable surgical instrument with a pre-bent tube structure is used alone, taking transurethral non-muscle-invasive bladder tumor surgery as an example, the end-bendable surgical instrument with a pre-bend tube structure Insert laser optical fiber or other surgical instruments into the built-in instrument channel 26 of the instrument, lock the surgical instrument by rotating the locking sleeve 25, insert the operating rod 23 through the working channel of the endoscope to the bladder, then hold the handle 21 and manipulate the ring 221 with your fingers , by pushing and pulling to control the protruding length of the pre-bent tube 24 relative to the operating rod 23 until the pre-bent tube 24 has a suitable shape reaching the lesion, stop pushing and pulling, at this time the marble 213 falls into the pit 2223, and the push-pull handle 22 is activated Lock it tightly and perform the operation. Compared with the existing surgical instruments, the bendable surgical instrument at the end with the pre-bent tube structure is finer in operation and has no blind spots at all angles, so the resection is more thorough, the resection depth is easy to grasp, and the operation is more humanized, which can significantly improve the surgical effect , to reduce the operator's workload.
所述的具有预弯管结构的末端可弯曲手术器械还可以用于其他尿路上皮肿瘤的切除手术，如输尿管癌、肾盂癌等疾病，仅需根据应用部位不同制作相应尺寸的手术器械即可。The end bendable surgical instrument with pre-bent tube structure can also be used for resection of other urothelial tumors, such as ureteral cancer, renal pelvis cancer and other diseases, only need to make surgical instruments of corresponding sizes according to different application sites .
三、具有多通道的内窥镜3. Endoscope with multi-channel
请参照图14，图14是本实用新型具有多通道的内窥镜立体图。所述的具有多通道的内窥镜设有镜体31和镜鞘32。所述的镜体31上设有第一器械连接口311、第二器械连接口312、目镜313、导光筒314、进水管道315和出水管道316。所述的第一器械连接口311设于镜体31的近端，所述的第二器械连接口312、目镜313、导光筒314、进水管道315和出水管道316设于镜体31的侧壁上，且进水管道315和出水管道316位置相反。所述的镜鞘32设于镜体31的远端。Please refer to FIG. 14 . FIG. 14 is a perspective view of an endoscope with multiple channels in the present invention. The multi-channel endoscope is provided with a mirror body 31 and a mirror sheath 32 . The mirror body 31 is provided with a first instrument connection port 311 , a second instrument connection port 312 , an eyepiece 313 , a light guide tube 314 , a water inlet pipe 315 and a water outlet pipe 316 . The first instrument connection port 311 is located at the proximal end of the mirror body 31, and the second instrument connection port 312, eyepiece 313, light guide tube 314, water inlet pipe 315 and water outlet pipe 316 are located at the end of the mirror body 31. On the side wall, and the position of the water inlet pipe 315 and the water outlet pipe 316 are opposite. The mirror sheath 32 is located at the distal end of the mirror body 31 .
请参照图15，图15是图14的D-D剖视图。所述的镜鞘32横截面外缘呈不规则形状，具体地，上缘为弧形，下缘为弯折状。镜鞘32内设有第一工作通道321、第二工作通道322、物镜323、导光通道324、进水通道325和出水通道326。所述的第一工作通道321、第二工作通道322横截面均为圆形，二者位于同侧，所述的进水通道325相对于第一工作通道321和第二工作通道322位于另一侧，且进水通道325与第一工作通道321和第二工作通道322相接触的侧缘向中心凹陷，且与第一工作通道321和第二工作通道322的侧缘相贴附。所述的导光通道324位于进水通道325内，所述的物镜323位于导光通道324内。所述的镜鞘32除去第一工作通道321、第二工作通道322、物镜323、导光通道324和进水通道325的腔体则为出水通道326。Please refer to FIG. 15 , which is a D-D sectional view of FIG. 14 . The outer edge of the cross-section of the mirror sheath 32 is irregular, specifically, the upper edge is arc-shaped, and the lower edge is curved. The mirror sheath 32 is provided with a first working channel 321 , a second working channel 322 , an objective lens 323 , a light guide channel 324 , a water inlet channel 325 and a water outlet channel 326 . The cross sections of the first working channel 321 and the second working channel 322 are both circular, and they are located on the same side. The water inlet channel 325 is located on the other side relative to the first working channel 321 and the second working channel 322 side, and the side edges of the water inlet channel 325 in contact with the first working channel 321 and the second working channel 322 are recessed toward the center, and are attached to the side edges of the first working channel 321 and the second working channel 322 . The light guide channel 324 is located in the water inlet channel 325 , and the objective lens 323 is located in the light guide channel 324 . The cavity of the mirror sheath 32 excluding the first working channel 321 , the second working channel 322 , the objective lens 323 , the light guide channel 324 and the water inlet channel 325 is the water outlet channel 326 .
需要说明的是，所述的目镜313与物镜323之间设有传像器件组，用于将物镜323采集的图像传递给目镜313；所述的导光筒314和导光通道324之间设有导光器件组，通过导光筒314投入光源，经导光通道324传递至手术部位；以上所述的传像器件组和导光器件组均与现有的内窥镜所用器件组相同。所述的进水管道315和进水通道325相连通，用于向手术部位注入水流；所述的出水管道316和出水通道326相连通，用于将手术部位多余水流引流至体外。所述的第一器械连接口311和第一工作通道321相连通，所述的第二器械连接口312和第二工作通道322相连通，其均为手术器械的工作通道，可同时插入两种手术器械，搭配使用，以获得更加精细化的操作方式，获得更好的手术效果。所述的镜鞘32横截面外缘设计成不规则形状而非圆形，可以减小镜鞘32的周 径以适用于男性(男性尿道尺寸≤26Fr，较为狭窄)；所述的进水通道325与第一工作通道321和第二工作通道322相接触的侧缘向中心凹陷，与二者的侧缘相贴附，该设计的目的也是将各个通道紧密排布，以减小镜鞘32周径。所述的导光通道324位于进水通道325内，所述的物镜323位于导光通道324内，如此也可减小镜鞘32周径，且物镜323周围可获得良好照明，物镜323对应的病灶部位可被新注入的水流直接冲洗到，从而可获得清晰的图像，便于术者掌握手术部位的状况。It should be noted that an image transmission device group is arranged between the eyepiece 313 and the objective lens 323 for transferring the image collected by the objective lens 323 to the eyepiece 313; There is a light guide device group, and the light source is input through the light guide tube 314, and delivered to the operation site through the light guide channel 324; the above-mentioned image transmission device group and light guide device group are the same as those used in existing endoscopes. The water inlet pipe 315 is connected with the water inlet channel 325 for injecting water into the surgical site; the water outlet pipe 316 is connected with the water outlet channel 326 for draining excess water from the surgical site out of the body. The first instrument connection port 311 communicates with the first working channel 321, and the second instrument connection port 312 communicates with the second working channel 322, both of which are working channels of surgical instruments, and can be inserted into two kinds of instruments at the same time. Surgical instruments are used together to obtain a more refined operation method and better surgical results. The outer edge of the cross-section of the mirror sheath 32 is designed to be irregular rather than circular, which can reduce the circumference of the mirror sheath 32 to be suitable for men (male urethra size≤26Fr, relatively narrow); the water inlet channel The side edges of 325 that are in contact with the first working channel 321 and the second working channel 322 are recessed toward the center and attached to the side edges of the two. The purpose of this design is also to arrange the channels closely to reduce the size of the mirror sheath 32 circumference. The light guide channel 324 is located in the water inlet channel 325, and the objective lens 323 is located in the light guide channel 324, so that the circumference of the mirror sheath 32 can also be reduced, and good illumination can be obtained around the objective lens 323, and the object lens 323 corresponds to The lesion site can be directly washed by the newly injected water flow, so that a clear image can be obtained, which is convenient for the operator to grasp the condition of the operation site.
四、用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统4. Device system for transurethral non-muscle invasive bladder tumor surgery
请参照图16，图16是本实用新型用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统的立体图。所述的用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统设有包括具有可弯关节的末端可弯曲手术器械1、具有预弯管结构的末端可弯曲手术器械2和具有多通道的内窥镜3。所述的具有可弯关节的末端可弯曲手术器械1的器械杆12插入在第一器械连接口311和第一工作通道321(图中未示出)内，所述的可弯曲关节段13伸出于镜鞘32之外；所述的具有预弯管结构的末端可弯曲手术器械2的操作杆23插入在第二器械连接口312和第二工作通道322(图中未示出)内，所述的预弯管24伸出于镜鞘32之外。Please refer to FIG. 16 . FIG. 16 is a perspective view of the instrument system of the present invention for transurethral non-muscle invasive bladder tumor surgery. The instrument system for transurethral non-muscle invasive bladder tumor surgery is provided with a flexible end surgical instrument 1 with a bendable joint, a flexible end surgical instrument 2 with a pre-bent tube structure, and a multi-channel Endoscope3. The instrument shaft 12 of the end bendable surgical instrument 1 with a bendable joint is inserted into the first instrument connection port 311 and the first working channel 321 (not shown in the figure), and the bendable joint section 13 extends Out of the mirror sheath 32; the operating rod 23 of the end bendable surgical instrument 2 with a pre-bent tube structure is inserted into the second instrument connection port 312 and the second working channel 322 (not shown in the figure), The pre-bent pipe 24 protrudes out of the mirror sheath 32 .
需要说明的是，通过将具有可弯关节的末端可弯曲手术器械1和具有预弯管结构的末端可弯曲手术器械2配合具有多通道的内窥镜3使用，使得镜鞘32的末端形成环抱式操作角，增加了可操作的范围，且可弯曲关节段13和预弯管24均是可弯曲的且弯曲角度可调，从而操作更精细，可够及病灶的各个部位，全角度无盲区。显而易见的，本实用新型用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统中，具有可弯关节的末端可弯曲手术器械1和具有预弯管结构的末端可弯曲手术器械2可单独使用也可配合使用，所述的具有预弯管结构的末端可弯曲手术器械2可以是单推拉手柄式或双推拉手柄式。It should be noted that by using the bendable surgical instrument 1 with a bendable joint and the bendable surgical instrument 2 with a pre-bent tube structure in conjunction with the endoscope 3 with multiple channels, the end of the endoscope sheath 32 forms an encircling The operating angle increases the operable range, and the bendable joint segment 13 and the pre-bent tube 24 are both bendable and the bending angle is adjustable, so that the operation is finer and can reach all parts of the lesion without blind spots at all angles . Obviously, in the instrument system of the present invention for transurethral non-muscle invasive bladder tumor surgery, the end-bendable surgical instrument 1 with a bendable joint and the end-bendable surgical instrument 2 with a pre-bent tube structure can be used alone It can also be used in conjunction with each other. The end-bendable surgical instrument 2 with a pre-bent tube structure can be a single push-pull handle type or a double push-pull handle type.
本实用新型用于经尿道非肌层浸润性膀胱肿瘤手术的器械系统除了用于经尿道途径非肌层浸润性膀胱肿瘤切除手术，还可用于其他尿路上皮肿瘤的切除手术，如输尿管癌、肾盂癌等疾病，仅需根据应用部位不同制作相应尺寸的手术器械即可。The device system of the utility model for transurethral non-muscle-invasive bladder tumor surgery can also be used for resection of other urothelial tumors, such as ureteral cancer, For diseases such as renal pelvis cancer, it is only necessary to make surgical instruments of corresponding sizes according to different application sites.
以上所述仅是本发明的优选实施方式，应当指出，对于本技术领域的普通技术人员，在不脱离本发明方法的前提下，还可以做出若干改进和补充，这些 改进和补充也应视为本发明的保护范围。The above is only a preferred embodiment of the present invention, it should be pointed out that for those of ordinary skill in the art, without departing from the premise of the method of the present invention, some improvements and supplements can also be made, and these improvements and supplements should also be considered Be the protection scope of the present invention.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201420749394.6UCN204394448U (en) | 2014-12-03 | 2014-12-03 | There is multichannel endoscope and the device system for the non-Myometrial involvement tumor of bladder operation of per urethra |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201420749394.6UCN204394448U (en) | 2014-12-03 | 2014-12-03 | There is multichannel endoscope and the device system for the non-Myometrial involvement tumor of bladder operation of per urethra |
| Publication Number | Publication Date |
|---|---|
| CN204394448Utrue CN204394448U (en) | 2015-06-17 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201420749394.6UExpired - Fee RelatedCN204394448U (en) | 2014-12-03 | 2014-12-03 | There is multichannel endoscope and the device system for the non-Myometrial involvement tumor of bladder operation of per urethra |
| Country | Link |
|---|---|
| CN (1) | CN204394448U (en) |
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| Date | Code | Title | Description |
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| C14 | Grant of patent or utility model | ||
| GR01 | Patent grant | ||
| CF01 | Termination of patent right due to non-payment of annual fee | ||
| CF01 | Termination of patent right due to non-payment of annual fee | Granted publication date:20150617 Termination date:20171203 |