CN111905237A - ERCP (electric resistance thermal capacitance) auxiliary bile duct over-selection device - Google Patents

Abstract

The invention discloses an ERCP auxiliary bile duct super-selection device, which comprises: a catheter, an air injection cavity, a first guide wire cavity and a second guide wire cavity arranged at the proximal end of the catheter; the catheter is provided with: a first guide wire outlet , a balloon, and a second guide wire outlet; wherein, the first guide wire outlet is opened at the distal end of the catheter; the first guide wire extends from the first guide wire outlet after being passed through the first guide wire cavity; the second guide wire The guide wire outlet is opened on the tube wall of the catheter; the second guide wire extends from the second guide wire outlet after being passed through the second guide wire cavity; the balloon is arranged between the first guide wire outlet and the second guide wire outlet and wrapping on the outer surface of the catheter; the air bag is inflated through the air injection cavity and the air injection volume is controlled, so as to control the size of the air bag; the superselection device controls the size of the air bag according to the distance between the second guide wire outlet and the air bag, and the size of the air bag. The second guide wire is squeezed through the balloon to adjust the superselection direction of the second guide wire. The invention can improve the success rate of superselection of difficult bile ducts.

Description

An ERCP-assisted bile duct superselection device

technical field

The invention relates to the technical field of medical devices, in particular to an ERCP auxiliary bile duct superselection device.

Background technique

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is an imaging technique that retrogradely displays the cholangiopancreatography by injecting contrast agent through the duodenal papilla under the endoscope. The gold standard for bile duct disease. On the basis of ERCP, interventional treatments such as duodenal papilla sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD), and endoscopic endoscopic bile drainage (ERBD) can be performed. ERCP is more accurate in diagnosing bile duct and pancreatic diseases than B-ultrasound and CT. It can also diagnose bile duct stones, biliary strictures, obstructive jaundice, suppurative cholangitis, and biliary pancreatitis through minimally invasive surgical techniques. , biliary tract roundworm and other diseases for fast, safe and effective treatment. Compared with surgical treatment, ERCP treatment has less damage to patients, faster recovery, lower cost and fewer complications, especially for those elderly patients and frail patients who cannot tolerate surgery. . To a certain extent, various treatment methods such as bile duct stones, acute suppurative cholangitis, and biliary pancreatitis can replace surgery. Because of its safety, rapidity, and few complications, more and more patients are accepted. .

Clinically, for bile ducts that are difficult to superselection, conventional surgical instruments are often used clinically, and the direction of the guide wire is passively adjusted by changing the position, posture, and angle of the instruments and endoscopes to improve the success rate of bile duct superselection. The shortcomings are as follows: 1. The direction of the guide wire is mainly adjusted passively, so the success rate is low. For example, when the pull-type incision is used, the surgeon usually adjusts the tightness of the knife and changes the position of the broach in the bile duct. To change the direction of the guide wire, to try super selection, has a certain blindness. 2. Repeated attempts prolong the operation time and increase the risk of surgery for patients. 3. Increase the hospitalization cost of patients, because the method is passive, especially for surgeons with low technical level, they often need to try repeatedly with various surgical instruments, which increases the hospitalization cost of patients and increases the economic burden.

SUMMARY OF THE INVENTION

The purpose of the present invention is to provide an ERCP-assisted bile duct super-selection device to improve the super-selection success rate of difficult bile ducts.

In order to achieve the above purpose, an ERCP auxiliary bile duct superselection device provided by the present invention comprises: a catheter, and an air injection cavity, a first guide wire cavity, and a second guide wire cavity provided at the proximal end of the catheter; the first guide wire cavity The wire cavity is used to pass the first guide wire; the second guide wire cavity is used to pass the second guide wire; the catheter is provided with: a first guide wire outlet, a balloon, and a second guide wire outlet; wherein , the first guide wire outlet is opened at the distal end of the catheter; after the first guide wire is passed through the first guide wire cavity, it protrudes from the first guide wire outlet; The second guide wire outlet is opened on the tube wall of the catheter; the second guide wire extends from the second guide wire outlet after being passed through the second guide wire cavity; The air bag is arranged between the first guide wire outlet and the second guide wire outlet, and is wrapped on the outer surface of the catheter; the air bag is inflated through the air injection cavity and the air injection volume is controlled, Thereby, the size of the air bag is controlled; the super-selection device squeezes the second guide wire through the air bag according to the distance between the outlet of the second guide wire and the air bag and controls the size of the air bag to adjust the The superselected orientation of the second guidewire.

Preferably, the super-selection device further comprises: a handle; the air injection cavity, the first guide wire cavity and the second guide wire cavity respectively penetrate through the handle and are fixed on the handle.

Preferably, during superselection, the airbag blocks the bile duct that is easy to superselection, so that the second guide wire enters the target bile duct.

Preferably, the inside of the catheter is provided with a first guide wire guide area communicated with the first guide wire cavity, for guiding the first guide wire to the outlet of the first guide wire. out.

Preferably, the inside of the catheter is provided with a second guide wire guide area that communicates with the second guide wire cavity, for guiding the second guide wire to the second guide wire outlet. out.

Preferably, the inside of the conduit is provided with a gas injection pipe, and the gas injection cavity is communicated with the air bag through the gas injection pipe.

Preferably, the length of the superselection device is 2000mm.

Preferably, according to the distance between the second guide wire outlet and the airbag and the size of the airbag, the superselection devices are classified into different specifications.

Compared with the prior art, the beneficial effects of the present invention are:

The superselection device of the invention is simple in structure and design, easy to use, and can change the current status. When facing the superselection of difficult bile ducts, it turns passive into active, and improves the superselection success rate of superselection of difficult bile ducts; it can shorten the operation time and reduce the number of patients. Hospital costs.

Description of drawings

FIG. 1 is a schematic structural diagram of an ERCP-assisted bile duct superselection device of the present invention.

Figure 2 is a schematic diagram of the left hepatic duct, the right hepatic duct and the common hepatic duct in Bismuth type IIIb cholangiocarcinoma.

Figure 3 is a schematic diagram of cholangiocarcinoma Bismuth type IIIb.

4 is a schematic diagram of using the device of the present invention to assist the superselection of the left hepatic duct in Bismuth type IIIb cholangiocarcinoma.

FIG. 5 is a schematic diagram of using the device of the present invention to assist the superselection of the cystic duct.

Detailed ways

The technical solutions of the present invention will be further described below with reference to the accompanying drawings and embodiments.

The terms "proximal end" and "distal end" in the present invention refer to the end close to the operator as the proximal end and the end away from the operator as the distal end during clinical surgical operation of the instrument.

As shown in FIG. 1 , the ERCP-assisted bile duct superselection device of the present invention includes a catheter 10 , a gas injection lumen 20 , a first guide wire lumen 30 and a second guide wire lumen 40 provided at the proximal end of the catheter 10 . The first guide wire cavity 30 is used to pass the first guide wire, and the second guide wire cavity 40 is used to pass the second guide wire.

The catheter 10 is provided with: a first guide wire outlet 11 , a balloon 12 , and a second guide wire outlet 13 . The first guide wire outlet 11 is opened at the distal end of the catheter 10 ; the first guide wire extends from the first guide wire outlet 11 after being passed through the first guide wire cavity 30 . The second guide wire outlet 13 is opened on the tube wall of the catheter 10 ; after the second guide wire is passed through the second guide wire cavity 40 , it extends from the second guide wire outlet 13 . The balloon 12 is arranged between the first guide wire outlet 11 and the second guide wire outlet 13 , and is wrapped around the outer surface of the catheter 10 . In some embodiments, the balloon 12 and the outer wall of the catheter 10 form a closed cavity. The airbag 12 is inflated through the insufflation chamber 20 and the insufflation volume is controlled.

The super selection device of the present invention adjusts the super selection direction of the second guide wire according to the distance between the second guide wire outlet 13 and the air bag 12 and by controlling the size of the air bag 12 . The first guide wire is used to guide the catheter 10 into the hyperselective bile duct. During superselection, the air bag 12 can block the bile ducts that are prone to superselection after being inflated. The bile duct that is easy to superselection is the bile duct that forms a branch with the target bile duct. Because it is easier to superselection than the target bile duct, the conventional guide wire always superselects the bile duct that is easy to superselection, resulting in the difficulty of superselection of the target bile duct. After the easy-to-superselection bile duct is blocked, the second guide wire can only be super-selected into the target bile duct, and by controlling the gas injection volume of the air bag 12, thereby controlling the size of the air bag 12, the super-selection direction of the second guide wire can be adjusted, so that the target bile duct can be adjusted. superselection is easier. The closer the distance between the second guide wire outlet 13 and the air bag 12 is, the larger the volume of the air bag 12 is, and the larger the turning angle of the second guide wire after the air bag 12 squeezes the second guide wire.

The super-selection device of the present invention can be designed with different specifications according to the distance between the second guide wire outlet 13 and the air bag 12 and the size of the air bag 12 . For clinical use, select a super-selection device with appropriate specifications.

In some embodiments, the superselection device further includes: a handle 50 . The air injection cavity 20 , the first guide wire cavity 30 and the second guide wire cavity 40 respectively penetrate the handle 50 and are fixed on the handle 50 .

A first guide wire guide area communicated with the first guide wire lumen 30 may be provided inside the catheter 10 for guiding the first guide wire to the first guide wire outlet 11 to extend.

A second guide wire guide area communicated with the second guide wire lumen 40 may be provided inside the catheter 10 for guiding the second guide wire to the second guide wire outlet 13 to extend.

An insufflation pipeline can be arranged inside the catheter 10 , and the insufflation cavity 20 communicates with the balloon 12 through the insufflation pipeline.

The gas injection chamber 20 can be connected to a joint and then connected to a two-way connection to control the gas injection volume. The first guide wire lumen 30 and the second guide wire lumen 40 are respectively connected with joints, so that the guide wire can pass through.

In some embodiments, the superselection device is 2000mm long.

The device of the invention is mainly used for assisting the superselection of bile ducts in difficult superselection of ERCP, which can improve the success rate, shorten the operation time and reduce the hospitalization cost of patients.

Example 1

Take the left bile duct superselection in Bismuth type IIIb cholangiocarcinoma as an example. As shown in FIG. 2 , anatomically, the common hepatic duct 60 is formed by the confluence of the left and right hepatic ducts. Literature reports suggest that the right hepatic duct 61 has a straighter angle than the left hepatic duct 62 (that is, the angle formed with the common hepatic duct 60 is larger). Therefore, , the guidewire is more likely to enter the straighter right hepatic duct during superselection of the normal bile duct61. As shown in FIG. 3 , in Bismuth type IIIb cholangiocarcinoma, the tumor 70 invades the hilar bile duct and the left hepatic duct 62 , which further increases the difficulty of superselecting the left hepatic duct 62 . In conventional surgery, the surgeon can only passively adjust the direction of the guide wire by changing the position and angle of the endoscope body, using pull-type scalpel, stone extraction balloon assistance, etc., to improve the probability of the guide wire entering the left hepatic duct 62 . First, these methods are blind to a certain extent; in addition, these methods are often closely related to the experience of the surgeon, and the success rate will be greatly reduced for those with insufficient experience; second, repeated failures and repeated attempts with a variety of instruments , prolong the operation time, increase the operation risk, and also increase the hospitalization cost and economic burden of the patients.

When the device of the present invention is used, the angle formed by the left and right hepatic ducts and the common bile duct is evaluated according to the results of angiography, and a device with an appropriate specification is selected. As shown in FIG. 4 , first, the first guide wire 14 is superselected into the right hepatic duct 61 that is not invaded by the tumor 70 , the balloon 12 is retracted to the entrance of the right hepatic duct 61 , and air is injected to make the balloon 12 block the right hepatic duct 61 that is not stenotic. For the hepatic duct 61, the left hepatic duct 62 is superselected with the second guide wire 15.

Example 2

Take cystic duct superselection as an example. The same situation also occurs in the superselection of the cystic duct. With the gradual improvement of the quality of life, the incidence of gallstones and cholecystitis is getting higher and higher. Surgical removal of the gallbladder may be the best choice for most patients, especially acute gallbladder. At the time of inflammation, although many patients had 100,000 or even millions of them unwilling, they could only reluctantly cut their love. In recent years, the emergence of gallbladder drainage under ERCP has brought good news to the majority of patients, but the superselection of the cystic duct has become a stumbling block before the successful operation. Because of the special angle and structure of the cystic duct, it is very difficult to superselection. In addition, patients with acute cholecystitis are often complicated with cystic duct stone incarceration, which further increases the difficulty of superselection.

As shown in FIG. 5 , the device of the present invention can be selected according to the angiography results. The auxiliary device of the present invention can guide the balloon 12 into the common hepatic duct 60 by the first guide wire 14 . The balloon 12 is inflated to completely block the common hepatic duct 60, and the second guide wire 15 is used to superselect the cystic duct 90. The second guide wire 15 cannot enter the more smooth and unobstructed common hepatic duct 60, and the size of the balloon 12 can also adjust the guide wire 2, greatly improving the success rate of super selection.

To sum up, the superselection device of the present invention can improve the success rate of superselection of difficult bile ducts, shorten the operation time, and reduce the hospitalization cost of patients.

While the content of the present invention has been described in detail by way of the above preferred embodiments, it should be appreciated that the above description should not be construed as limiting the present invention. Various modifications and alternatives to the present invention will be apparent to those skilled in the art upon reading the foregoing. Accordingly, the scope of protection of the present invention should be defined by the appended claims.

Claims (7)

1. An ERCP auxiliary bile duct superselection device is characterized in that, comprising: a catheter (10), and a gas injection cavity (20), a first guide wire cavity (30), a second guide wire cavity (30), and a A guide wire cavity (40); the first guide wire cavity (30) is used to pass the first guide wire (14); the second guide wire cavity (40) is used to pass the second guide wire ( 15); The catheter (10) is provided with: a first guide wire outlet (11), a balloon (12), and a second guide wire outlet (13); wherein, The first guide wire outlet (11) is opened at the distal end of the catheter (10); after the first guide wire (14) is passed through the first guide wire cavity (30), the The first guide wire outlet (11) extends out; The second guide wire outlet (13) is opened on the tube wall of the catheter (10); after the second guide wire (15) is passed through the second guide wire cavity (40), the The second guide wire outlet (13) extends out; The balloon (12) is arranged between the first guide wire outlet (11) and the second guide wire outlet (13), and is wrapped around the outer surface of the catheter (10); the balloon ( 12) injecting gas through the gas injection cavity (20) and controlling the gas injection volume, thereby controlling the size of the airbag (12); The super-selection device squeezes the second guide wire through the air bag (12) according to the distance between the second guide wire outlet (13) and the air bag (12) and controlling the size of the air bag (12). A guide wire (15) to adjust the superselection direction of the second guide wire (15). 2. The ERCP auxiliary bile duct super-selection device according to claim 1, wherein the super-selection device further comprises: a handle (50); the air injection cavity (20), the first guide wire cavity ( 30) The second guide wire cavity (40) respectively penetrates the handle (50) and is fixed on the handle (50). 3. ERCP auxiliary bile duct superselection device according to claim 1, is characterized in that, during superselection, described balloon (12) blocks bile ducts that are easy to superselection, so that described second guide wire (15) enters the purpose bile duct. 4. The ERCP auxiliary bile duct super-selection device according to claim 1, characterized in that, a first guide wire guide area communicated with the first guide wire cavity (30) is provided inside the catheter (10). , used to guide the first guide wire (14) to the first guide wire outlet (11) to extend. 5. The ERCP auxiliary bile duct super-selection device according to claim 1, characterized in that, a second guide wire guide area communicated with the second guide wire cavity (40) is provided inside the catheter (10). , used to guide the second guide wire (15) to the second guide wire outlet (13) to extend. 6. The ERCP auxiliary bile duct superselection device according to claim 1, characterized in that, a gas injection pipeline is provided inside the conduit (10), and the gas injection cavity (20) passes through the gas injection pipeline communicate with the air bag (12). 7. The ERCP auxiliary bile duct superselection device according to claim 1, characterized in that, according to the distance between the second guide wire outlet (13) and the air bag (12) and the air bag ( 12), the super-selection device is divided into different specifications.

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