CN211157863U - A triple trocar device for deep tissue puncture - Google Patents
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Abstract
Translated fromChinese
Description
Translated fromChinese技术领域technical field
本申请涉及深部组织的穿刺技术，尤其涉及无超声引导下对深部组织穿刺的三联套管针和方法。The present application relates to deep tissue puncture technology, in particular to a triple trocar and method for deep tissue puncture without ultrasound guidance.
背景技术Background technique
临床工作中经常需要穿刺深部组织，如急性心包填塞时心包穿刺引流，日常锁骨下静脉穿刺置管，多以18G或20G粗穿刺针(外径分别是1.2mm和 0.9mm)直接穿刺，然后利用seldinger技术交换导丝及鞘管。粗穿刺针穿刺进入目标位置如心包腔或锁骨下静脉的血管腔，是成功穿刺的第一步，粗穿刺针管壁的钢针结构有利于穿透表浅质硬组织以及在周围很多骨性结构的情况下固定一条通道。但存在的问题是以粗针直接穿刺深部组织增加了深部组织的直接损伤，尤其是多次穿刺不成功时，且有可能在穿刺心包等操作时，由于粗针对于深部结构的突破感不明显，直接穿透左/右室壁，未及时发现情况下进一步置入导丝及鞘管，造成不可挽回的后果，危及生命。In clinical work, it is often necessary to puncture deep tissues, such as pericardial puncture and drainage during acute pericardial tamponade, daily subclavian vein puncture and catheterization, and direct puncture with 18G or 20G thick puncture needles (outer diameters of 1.2mm and 0.9mm, respectively), and then use The seldinger technique exchanges the guide wire and sheath. The puncture of the coarse puncture needle into the target site, such as the pericardial cavity or the vascular lumen of the subclavian vein, is the first step for successful puncture. A channel is fixed in the case of the structure. However, the problem is that the direct puncture of the deep tissue with the thick needle increases the direct damage of the deep tissue, especially when multiple punctures are unsuccessful, and it is possible that during the operation such as puncturing the pericardium, the sense of breakthrough in the deep structure is not obvious due to the rough needle. , directly penetrate the left/right ventricular wall, and further insert the guide wire and sheath without timely detection, resulting in irreversible consequences and life-threatening.
常规穿刺心包或锁骨下静脉也有时会使用普通的套管针进行穿刺，其内置的钢针抽出回血后再略前进一点，保证穿刺套管进入心包或血管，无阻力推送套管进入心包腔或血管内，退出钢针，然后利用seldinger技术交换导丝及鞘管。存在的问题是当穿刺深部组织时，套管容易受浅部组织挤压变形，甚至尖端位置移动脱离出心包或血管腔，导致穿刺失败，甚至导丝或鞘管误入假腔造成不良后果。所以常规的套管针穿刺更适合表浅组织穿刺，如浅静脉穿刺以及桡动脉穿刺等。Routine puncture of the pericardium or subclavian vein is also sometimes performed with an ordinary trocar. The built-in steel needle is drawn back to the blood and then slightly advanced to ensure that the puncture cannula enters the pericardium or blood vessel, and the cannula is pushed into the pericardial cavity or pericardial cavity without resistance. Intravascular, the needle is withdrawn, and then the guide wire and sheath are exchanged using the seldinger technique. The existing problem is that when puncturing deep tissue, the cannula is easily squeezed and deformed by the superficial tissue, and even the tip position moves out of the pericardium or vascular lumen, resulting in puncture failure, and even the guide wire or sheath is mistakenly inserted into the false lumen, resulting in adverse consequences. Therefore, conventional trocar puncture is more suitable for superficial tissue puncture, such as superficial vein puncture and radial artery puncture.
超声引导下穿刺可全程看到穿刺过程，相当于直视下操作，尤其是技术熟练时，但是临床情况有时非常危急，如急性心包填塞，只能盲穿，以争分夺秒的抢救生命。经锁骨下静脉置管属于临床常规操作，多根据术者经验盲穿，只有个别复杂疑难或高危患者会尝试超声引导穿刺，很难大范围常规应用。Ultrasound-guided puncture can see the whole process of puncture, which is equivalent to the operation under direct vision, especially when the technique is skilled, but the clinical situation is sometimes very critical, such as acute cardiac tamponade, and can only be punctured blindly to save lives in a race against time. Intubation through the subclavian vein is a routine clinical operation, which is mostly blindly punctured based on the experience of the operator. Only a few complicated, difficult or high-risk patients will try ultrasound-guided puncture, which is difficult to be routinely applied on a large scale.
实用新型内容Utility model content
鉴于上述问题，本申请旨在提出一种用于深部组织穿刺的三联套管针装置，其能够方便地穿透浅部组织和穿刺进入深部组织。本申请还旨在提出一种使用本申请的三联套管针装置进行深部组织穿刺的方法。In view of the above problems, the present application aims to propose a triple trocar device for deep tissue puncture, which can easily penetrate the superficial tissue and penetrate into the deep tissue. The present application also aims to provide a method for deep tissue puncture using the triple trocar device of the present application.
本申请的一种用于深部组织穿刺的三联套管针装置，其包括：粗穿刺针、穿刺套管、细穿刺针；A triple trocar device for deep tissue puncture of the present application includes: a thick puncture needle, a puncture cannula, and a thin puncture needle;
粗穿刺针形成为管状，其第一端形成为包括斜面的尖端；The thick puncture needle is formed into a tubular shape, the first end of which is formed as a tip including a bevel;
穿刺套管形成为管状，其第一端形成为包括斜面的尖端，其第二端形成为端座；The puncture cannula is formed into a tubular shape, the first end of which is formed as a tip including a bevel, and the second end of which is formed as an end seat;
细穿刺针形成为管状，其第一端形成为包括斜面的尖端，其第二端形成为端座；The fine puncture needle is formed into a tubular shape, its first end is formed as a tip including a bevel, and its second end is formed as an end seat;
穿刺套管和细穿刺针的长度大于粗穿刺针的长度；The length of the puncture cannula and the thin puncture needle is greater than the length of the thick puncture needle;
穿刺套管插入于粗穿刺针中，穿刺套管与粗穿刺针之间形成为气密的；The puncture cannula is inserted into the thick puncture needle, and the puncture cannula and the thick puncture needle are airtight;
细穿刺针插入于穿刺套管中，细穿刺针与穿刺套管之间形成为气密的；The thin puncture needle is inserted into the puncture cannula, and the thin puncture needle and the puncture cannula are airtight;
穿刺过程中，在浅部组织穿刺时，粗穿刺针、穿刺套管、细穿刺针的尖端对齐；在深部组织穿刺时，穿刺套管和细穿刺针自粗穿刺针的第一端伸出，一起刺入深部组织，然后退出细穿刺针，经由所述穿刺套管，建立深部组织内与受试者的身体外的通道。During the puncture process, when puncturing the superficial tissue, the tips of the thick puncture needle, the puncture cannula, and the thin puncture needle are aligned; when the deep tissue is punctured, the puncture cannula and the thin puncture needle protrude from the first end of the thick puncture needle, The deep tissue is penetrated together, and then the fine needle is withdrawn, through the puncture cannula, establishing a passage between the deep tissue and the outside of the subject's body.
优选地，所述粗穿刺针、穿刺套管、细穿刺针的尖端的斜面对齐，构成一个平整的斜面。Preferably, the inclined surfaces of the tips of the thick puncture needle, the puncture sleeve and the thin puncture needle are aligned to form a flat inclined surface.
优选地，所述细穿刺针的第二端的端座用于连接负压抽吸装置。Preferably, the end seat of the second end of the thin puncture needle is used for connecting the negative pressure suction device.
优选地，所述粗穿刺针外侧形成有刻度；所述穿刺导管的外侧形成有刻度。Preferably, a scale is formed on the outer side of the thick puncture needle; and a scale is formed on the outer side of the puncture catheter.
优选地，所述细穿刺针的端座与所述穿刺套管的端座可拆卸地地结合在一起。Preferably, the end seat of the thin puncture needle is detachably combined with the end seat of the puncture cannula.
优选地，所述穿刺套管的端座的第二侧形成凹穴；所述细穿刺针的端座的第一侧形成凸起；所述凸起卡持所述凹穴中。Preferably, a recess is formed on the second side of the end seat of the puncture cannula; a protrusion is formed on the first side of the end seat of the thin puncture needle; and the protrusion is clamped in the recess.
本申请的一种用于深部组织穿刺的方法，其利用上述的三联套管针装置进行；A method for deep tissue puncture of the present application, which utilizes the above-mentioned triple trocar device;
以粗穿刺针携带穿刺套管和细穿刺针穿刺浅部组织，建议一条穿过浅部组织的通道；Use a thick puncture needle to carry a puncture cannula and a thin puncture needle to puncture the superficial tissue, and a channel through the superficial tissue is recommended;
外接注射器持续负压吸引情况下，进一步推送穿刺套管和细穿刺针；Under the condition of continuous negative pressure suction of the external syringe, further push the puncture cannula and fine puncture needle;
以细穿刺针携带穿刺套管进入目标深部组织，抽出回血时表明穿刺套管已到位；固定细穿刺针，无阻力情况下直接推送穿刺套管，使得穿刺套管进一步进入目标组织内；Use a fine puncture needle to carry the puncture cannula into the target deep tissue, and when the blood is drawn back, the puncture cannula is in place; fix the fine puncture needle, and directly push the puncture cannula without resistance, so that the puncture cannula further enters the target tissue;
利用seldinger技术，用导丝交换细穿刺针，置入鞘管或引流管。Using the seldinger technique, a thin needle is exchanged with a guide wire, and a sheath or drainage tube is placed.
优选地，所述目标深部组织为心包腔或锁骨下静脉。Preferably, the target deep tissue is the pericardial cavity or the subclavian vein.
通过本申请的一种深部组织穿刺装置和应用方法，可以在穿刺深部组织时减少重要组织脏器损伤，增加穿刺时对深部组织的敏感性，提高穿刺成功率，从而改善临床预后，可应用于临床实践，如心包积液穿刺引流和锁骨下静脉穿刺置管，具有很强的临床应用价值。The deep tissue puncturing device and application method of the present application can reduce the damage of important tissue organs when puncturing deep tissue, increase the sensitivity to deep tissue during puncturing, improve the success rate of puncturing, thereby improving clinical prognosis, and can be applied to Clinical practice, such as puncture and drainage of pericardial effusion and cannulation of subclavian vein, has strong clinical application value.
附图说明Description of drawings
图1为本申请的用于深部组织穿刺的三联套管针装置的各组成部件的剖面结构示意图；1 is a schematic cross-sectional structure diagram of each component of the triple trocar device for deep tissue puncture according to the present application;
图2为本申请的用于深部组织穿刺的三联套管针装置用于穿刺浅部组织时的结构示意图；2 is a schematic structural diagram of the triple trocar device for deep tissue puncture of the application when it is used to puncture superficial tissue;
图3为本申请的用于深部组织穿刺的三联套管针装置用于穿刺深部组织时的结构示意图；3 is a schematic structural diagram of the triple trocar device for deep tissue puncture according to the application when it is used to puncture deep tissue;
图4为本申请的用于深部组织穿刺的三联套管针装置的细穿刺针被撤出的结构示意图；4 is a schematic structural diagram of the withdrawal of the fine puncture needle of the triple trocar device for deep tissue puncture according to the present application;
图5为锁骨下静脉解剖图；Figure 5 is an anatomical diagram of the subclavian vein;
图6为心包积液示意图。Figure 6 is a schematic diagram of pericardial effusion.
具体实施方式Detailed ways
下面，结合附图对本申请进行详细说明。Hereinafter, the present application will be described in detail with reference to the accompanying drawings.
本申请的一种用于深部组织穿刺的三联套管针装置，其包括：粗穿刺针10 刺套管20穿刺针30。A triple trocar device for deep tissue puncture of the present application comprises: a thick puncture needle 10 a puncture cannula 20 a
粗穿刺针10形成为管状，其第一端11形成为包括斜面的尖端；穿刺套管 20形成为管状，其第一端21形成为包括斜面的尖端，其第二端形成为端座22；细穿刺针30形成为管状，其第一端31形成为包括斜面的尖端，其第二端形成为端座32。The
穿刺套管20和细穿刺针30的长度大于粗穿刺针10的长度。The length of the
穿刺套管20插入于粗穿刺针10中，穿刺套管20与粗穿刺针10之间形成为气密的；气密可以通过穿刺套管20与粗穿刺针10之间紧密接触形成，例如使得穿刺套管20的外径等于粗穿刺针10的内径，或者在穿刺套管20与粗穿刺针10之间设置密封圈或密封垫。The
细穿刺针30插入于穿刺套管20中，细穿刺针30与穿刺套管20之间形成为气密的；气密可以通过细穿刺针30与穿刺套管20之间紧密接触形成，例如使得穿刺套管20的内径等于细穿刺针30的外径，或者在穿刺套管20与细穿刺针30之间设置密封圈或密封垫。The
穿刺过程中，在浅部组织穿刺时，粗穿刺针10、穿刺套管20、细穿刺针 30的尖端对齐，一起穿过浅部组织；在深部组织穿刺时，穿刺套管20和细穿刺针30自粗穿刺针10的第一端伸出，一起刺入深部组织，然后退出细穿刺针，经由所述穿刺套管，建立深部组织内与受试者的身体外的通道。During the puncture, when puncturing the superficial tissue, the tips of the
粗穿刺针、穿刺套管、细穿刺针的尖端11、21、31的斜面对齐，构成一个平整的斜面，以方便浅部组织的穿刺。The inclined surfaces of the
细穿刺针30的第二端的端座32用于连接负压抽吸装置，例如注射器。端座32上看可以形成连接注射器的乳头的插口33。The
粗穿刺针的第二端也可以形成端座12，以方便操作粗穿刺针10，例如通过握持端座12来推动粗穿刺针携带穿刺套管和细穿刺针穿刺前部组织。The second end of the thick puncture needle can also form an
粗穿刺针10外侧形成有刻度，以方便判断粗穿刺针进入的深度；穿刺导管20的外侧形成有刻度，以方便判断穿刺套管进入的深度。A scale is formed on the outside of the
细穿刺针的端座32与穿刺套管的端22座可拆卸地地结合在一起。穿刺套管20的端座22的第二侧形成凹穴23；细穿刺针30的端座32的第一侧形成凸起；凸起卡持凹穴23中。The
本申请的一种用于深部组织穿刺的方法，其利用上述的三联套管针装置进行；A method for deep tissue puncture of the present application, which utilizes the above-mentioned triple trocar device;
以粗穿刺针携带穿刺套管和细穿刺针穿刺浅部组织，建议一条穿过浅部组织的通道；Use a thick puncture needle to carry a puncture cannula and a thin puncture needle to puncture the superficial tissue, and a channel through the superficial tissue is recommended;
外接注射器持续负压吸引情况下，进一步推送穿刺套管和细穿刺针；Under the condition of continuous negative pressure suction of the external syringe, further push the puncture cannula and fine puncture needle;
以细穿刺针携带穿刺套管进入目标组织，例如心包腔或锁骨下静脉，抽出回血时表明穿刺套管已到位；固定细穿刺针，无阻力情况下直接推送穿刺套管，使得穿刺套管进一步进入目标组织内；Use a fine puncture needle to carry the puncture cannula into the target tissue, such as the pericardial cavity or subclavian vein. When the blood is drawn back, the puncture cannula is in place; fix the fine puncture needle and directly push the puncture cannula without resistance, so that the puncture cannula is further into the target organization;
利用seldinger技术，用导丝交换细穿刺针，置入鞘管或引流管。Using the seldinger technique, a thin needle is exchanged with a guide wire, and a sheath or drainage tube is placed.
实施例1：穿刺锁骨下静脉Example 1: Puncture of the subclavian vein
1.患者平卧位，去枕，常规消毒铺单，以粗穿刺针携带穿刺套管和细穿刺针，保持尖端平齐，于右侧锁骨中外1/3处穿刺锁骨下浅部组织，先用粗穿刺针针尖顶到锁骨，然后在锁骨下的骨缝中建立一条穿过浅部组织的通道，控制进针深度，在预计穿刺锁骨下静脉前固定粗穿刺针。1. The patient is in a supine position, the pillow is removed, and the sheets are routinely sterilized. Carry the puncture cannula and fine puncture needle with a thick puncture needle, keep the tip flush, and puncture the superficial subclavian tissue at the middle and outer 1/3 of the right clavicle. The tip of the coarse puncture needle was applied to the clavicle, and then a channel through the superficial tissue was established in the subclavian suture, the depth of the needle insertion was controlled, and the coarse puncture needle was fixed before the expected puncture of the subclavian vein.
2.外接注射器持续负压吸引情况下，进一步推送穿刺套管和细穿刺针，通过穿刺套管表面的刻度控制进针深度。以细穿刺针携带穿刺套管穿刺进入锁骨下静脉，抽出回血，提示穿刺套管已到位，固定细穿刺针，无阻力情况下直接推送穿刺套管，提示穿刺套管准确进入目标位置，可以适当深入一些避免脱落。2. Under the condition of continuous negative pressure suction of the external syringe, further push the puncture cannula and fine puncture needle, and control the depth of the needle through the scale on the surface of the puncture cannula. The puncture cannula is punctured into the subclavian vein with a fine puncture needle, and the blood is drawn back, indicating that the puncture cannula is in place, fix the fine puncture needle, and push the puncture cannula directly without resistance, indicating that the puncture cannula has entered the target position accurately, and can be properly Go deeper to avoid falling out.
3.然后退出细穿刺针，通过穿刺套管，再利用seldinger技术交换导丝，置入鞘管或引流管。3. Then withdraw the fine puncture needle, pass through the puncture cannula, and then use the seldinger technique to exchange the guide wire and place the sheath or drainage tube.
实施例2：穿刺心包积液Example 2: Puncture of pericardial effusion
1.急性心包填塞的患者或慢性大量心包积液的患者，取平卧位，常规消毒铺单，以粗穿刺针携带穿刺套管和细穿刺针，保持尖端平齐，于剑突下或心尖穿刺胸壁浅部组织，先用粗穿刺针建立一条穿过胸壁浅部组织的通道，控制进针深度，在预计穿刺心包前固定粗穿刺针。1. Patients with acute pericardial tamponade or patients with chronic massive pericardial effusion, take a supine position, routinely sterilize and lay sheets, carry a puncture cannula and a fine puncture needle with a thick puncture needle, keep the tip flush, and place it under the xiphoid process or at the apex of the heart. To puncture the superficial tissue of the chest wall, first use a thick puncture needle to establish a channel through the superficial tissue of the chest wall, control the depth of the needle insertion, and fix the thick puncture needle before the pericardium is expected to be punctured.
2.外接注射器持续负压吸引情况下，进一步推送穿刺套管和细穿刺针，通过穿刺套管表面的刻度控制进针深度。以细穿刺针携带穿刺套管穿刺进入心包，抽出回血，提示穿刺套管已到位，固定细穿刺针，无阻力情况下直接推送穿刺套管，提示穿刺套管准确进入目标位置，可以适当深入一些避免脱落。2. Under the condition of continuous negative pressure suction of the external syringe, further push the puncture cannula and fine puncture needle, and control the depth of the needle through the scale on the surface of the puncture cannula. The puncture cannula is punctured into the pericardium with a fine puncture needle, and the blood is drawn back, indicating that the puncture cannula is in place, fix the fine puncture needle, and push the puncture cannula directly without resistance, indicating that the puncture cannula has accurately entered the target position, and it can be properly penetrated. Avoid falling off.
3.细穿刺针仅需穿过壁层心包，阻力较小，即可抽到回血，进针的力量更好控制。当细穿刺针碰到室壁，由于室壁具有一定厚度，且不间断收缩舒张，进针力度有限的情况下穿透室壁的风险大幅度降低，操作更为安全。3. The fine puncture needle only needs to pass through the parietal pericardium, and the resistance is small, and the blood can be drawn back, and the force of the needle can be better controlled. When the thin puncture needle touches the ventricular wall, because the ventricular wall has a certain thickness and uninterrupted contraction and relaxation, the risk of penetrating the ventricular wall is greatly reduced under the condition of limited needle insertion force, and the operation is safer.
4然后退出细穿刺针，通过穿刺套管，再利用seldinger技术交换导丝，置入鞘管或引流管。4 Then withdraw the fine puncture needle, pass through the puncture cannula, and then use the seldinger technique to exchange the guide wire and place the sheath or drainage tube.
与现有技术相比，本发明具有的优点和效果如下：Compared with the prior art, the present invention has the following advantages and effects:
1.不依靠超声引导，而是利用穿刺针自身的结构特点，用细穿刺针携带穿刺套管去穿刺深部组织，突破感强于粗穿刺针，且进一步无阻力推送穿刺套管验证套管位于目标腔隙，完成穿刺置管至关重要的第一步。穿刺套管完全进入目标腔隙如锁骨下静脉也减少了交换导丝不成功的情况。优化临床操作，具有良好的临床转化价值。1. Instead of relying on ultrasound guidance, but using the structural characteristics of the puncture needle itself, the thin puncture needle is used to carry the puncture cannula to puncture the deep tissue. The target cavity is the first crucial step in completing the cannulation. Complete penetration of the cannula into the target space such as the subclavian vein also reduces unsuccessful wire exchange. Optimizing clinical operations has good clinical translation value.
2.当穿刺心包时，细穿刺针仅需穿过壁层心包，阻力较小，即可抽到回血，进针的力量更好控制。当细穿刺针碰到室壁，由于室壁具有一定厚度，且不间断收缩舒张，进针力度有限的情况下穿透室壁的风险大幅度降低，操作更为安全。2. When puncturing the pericardium, the fine puncture needle only needs to pass through the parietal pericardium, and the resistance is small, and the blood can be drawn back, and the force of the needle can be better controlled. When the thin puncture needle touches the ventricular wall, because the ventricular wall has a certain thickness and uninterrupted contraction and relaxation, the risk of penetrating the ventricular wall is greatly reduced under the condition of limited needle insertion force, and the operation is safer.
3.以粗穿刺针引导穿透浅部组织，如胸壁或锁骨下区域，在四周都是骨性结构的组织中间建一条通道，固定不动，较全程塑料套管更稳定，明显减少穿刺套管移位或脱落的可能，增加穿刺成功率。3. Use a thick puncture needle to guide the penetration of superficial tissues, such as the chest wall or subclavian area, build a channel in the middle of the tissue surrounded by bony structures, and fix it, which is more stable than the whole plastic sleeve and significantly reduces the puncture sleeve. The possibility of tube displacement or detachment increases the success rate of puncture.
4.以细穿刺针携带穿刺套管穿刺深部组织，直接的组织损伤减小，尤其是多次穿刺时，这在穿刺锁骨下静脉时很重要。4. Using a fine puncture needle to carry a puncture cannula to puncture deep tissue, the direct tissue damage is reduced, especially when puncturing multiple times, which is very important when puncturing the subclavian vein.
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| CN110339435A (en)* | 2019-08-20 | 2019-10-18 | 中国人民解放军总医院 | A triple trocar device and method for deep tissue puncture |
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| CN110339435A (en)* | 2019-08-20 | 2019-10-18 | 中国人民解放军总医院 | A triple trocar device and method for deep tissue puncture |
| CN110339435B (en)* | 2019-08-20 | 2024-06-11 | 中国人民解放军总医院 | Triple trocar device and method for deep tissue penetration |
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