阅读说明：本技术 一种经皮胆道镜胆管支架的输送装置及方法 (Conveying device and method for percutaneous choledochoscope bile duct stent ) 是由 锁涛 巩子君 沈盛 刘厚宝 于 2021-09-15 设计创作，主要内容包括：本发明涉及一种经皮胆道镜胆管支架的输送装置,包括推送导管、推送导管内芯；所述推送导管内芯的外径小于胆管支架的内径；所述推送导管内芯的外径小于推送导管的内径；所述胆管支架套在所述推送导管内芯上,并能够在推送导管前端面的推力下进入胆道。本发明在手术中,能直接通过输送装置将胆道支架进行推送,并推送在位,对比以往手术方式,能够提升手术便捷性和安全性,避免以往手术方式产生的并发症。(The invention relates to a conveying device of a percutaneous choledochoscope bile duct stent, which comprises a pushing catheter and a pushing catheter inner core, wherein the pushing catheter is arranged in the pushing catheter inner core; the outer diameter of the inner core of the push catheter is smaller than the inner diameter of the bile duct support; the outer diameter of the inner core of the pushing catheter is smaller than the inner diameter of the pushing catheter; the bile duct support is sleeved on the inner core of the pushing catheter and can enter the biliary tract under the pushing force of the front end face of the pushing catheter. In the operation, the biliary tract stent can be directly pushed by the conveying device and in place, so that the operation convenience and safety can be improved compared with the conventional operation mode, and the complications caused by the conventional operation mode can be avoided.)

1. A percutaneous choledochoscope bile duct stent conveying device is characterized in that:

comprises a push conduit (1) and a push conduit inner core (2);

the outer diameter of the inner core (2) of the push catheter is smaller than the inner diameter of the bile duct support;

the outer diameter of the pushing catheter inner core (2) is smaller than the inner diameter of the pushing catheter (1);

the bile duct support is sleeved on the pushing catheter inner core (2) and can enter the biliary tract under the pushing force of the front end face of the pushing catheter (1).

2. The percutaneous choledochoscope stent delivery device of claim 1, wherein: the outer diameter of the pushing catheter inner core (2) is smaller than the inner diameter of the catheter joint (3); the catheter joint (3) is fixedly connected with the rear end of the pushing catheter (1).

3. The percutaneous choledochoscope stent delivery device of claim 1, wherein: the length of the push catheter inner core (2) is at least twice as long as the length of the choledochoscope body.

4. The percutaneous choledochoscope stent delivery device of claim 1, wherein: the rear end of the pushing catheter inner core (2) is fixedly connected with the handle (4).

5. The percutaneous choledochoscope stent delivery device of claim 1, wherein: the bile duct support is made of plastic.

6. The percutaneous choledochoscope stent delivery device of claim 4, wherein: the total length of the catheter inner core (2) together with the handle (4) is 2100 mm.

7. The percutaneous choledochoscope stent delivery device of claim 6, wherein: the length of the pushing conduit (1) is 900 mm.

8. A method for conveying a percutaneous choledochoscope bile duct stent is characterized by comprising the following steps:

a delivery device using the percutaneous choledochoscope stent of any one of claims 1 to 7, comprising the steps of:

s1, inserting the push catheter inner core (2) into the bile duct through a choledochoscope biopsy pore, and then pulling out the choledochoscope to ensure that the length of the push catheter inner core (2) is at least twice as long as the choledochoscope body;

s2, sleeving the tail end of the inner core (2) of the push catheter into a bile duct bracket, and then sleeving the push catheter (1);

s3, the front end of the push catheter (1) is propped against the tail end of the bile duct bracket, and the bile duct bracket is pushed to advance until the bile duct bracket is placed at a required position in the bile duct.

Technical Field

The invention relates to a device and a method for conveying a biliary tract stent through a percutaneous choledochoscope, which are used for pushing the biliary tract stent.

Background

Cholelithiasis is one of the most common diseases of the digestive tract, and seriously affects public health.

Two common minimally invasive methods for treating bile duct calculi at present comprise 1) common bile duct exploration (LCBDE) combined with a choledochoscope under a laparoscope and T-tube drainage, and 2) ERCP and LC.

The biggest problem of the first operation (LCBDE + T tube drainage) is that a T tube needs to be left in a patient after the operation (1-2 months are different), so that T tube related complications are easily caused, and the life quality of the patient is greatly influenced. These complications manifest themselves as: the T tube may have related complications such as distortion, falling off, inflammation and rash of peripheral skin and the like, and long-term bile drainage affects the digestive function of a patient, so that malnutrition, electrolyte disorder and the like are caused. More seriously, for patients with malnutrition, diabetes, advanced age and the like, the T-tube sinus is formed more slowly, and the phenomenon that the sinus is still not completely healed when the T-tube is pulled out can occur, particularly after minimally invasive treatment, the abdominal adhesion is lighter than that of an open surgery, the time for forming the sinus is prolonged than that of the open surgery, and the biliary peritonitis occurs after the T-tube is pulled out, so that the repair is needed to be performed through the open surgery again, and the minimally invasive surgery is changed into the serious wound, so that the serious consequences are brought to the patients. Studies have shown that the incidence of T-tube related complications is between 4% and 16%.

The second procedure (ERCP + LC procedure), ERCP treatment, while reducing abdominal surgical trauma, also has a related incidence of complications, particularly severe complications that are not negligible. Research shows that the incidence of ERCP treatment of hemorrhage, cholangitis, pancreatitis, perforation, etc. is 0.7-5%. Once serious complications such as bleeding and perforation occur, the consequences are serious and the death rate is high. Meanwhile, the problem of the functional protection of the sphincter of Oddi is always the key to the dispute between the biliary surgeons and the endoscopists, the sphincter of Oddi is a valve of the biliary system, the pressure and power of the whole biliary system are controlled, the function of the sphincter of Oddi is damaged to cause the reflux and infection of the biliary tract, and the occurrence rate is reported to be about 14-41%. Therefore, it is a common consensus of the present community to protect the function of the sphincter of Oddi, and the indications for ERCP + LC treatment of bile duct stones are extremely strict, and only single bile duct stones with a diameter of less than 8mm are considered suitable for ERCP treatment.

In order to solve the above problems, a safe and effective innovative operation mode is urgently needed, which can not only avoid the occurrence of complications related to the T-tube, but also reduce the complications related to ERCP, i.e. common bile duct exploration which combines a biliary support tube and is sutured for the first time in the laparoscopy. Therefore, how to provide a device for delivering a percutaneous choledochoscope bile duct stent to realize delivery and installation of the biliary duct stent in an operation is a technical problem to be solved urgently in the field.

Disclosure of Invention

The invention aims to provide a device and a method for delivering a biliary stent through a percutaneous choledochoscope, which can directly push the biliary stent in place through the delivery device in an operation. Compared with the prior operation mode, the operation convenience and safety can be improved, and the complications generated by the prior operation mode can be avoided.

The key point of the operation is that the biliary tract supporting tube is directly placed in the operation by applying the device of the invention. The specific operation steps are as follows: on the basis of the first stage suture of the existing LCBDE + bile duct, the biliary tract stent input system is applied to enter the biliary tract stent through the incision of the bile duct under the guidance of a choledochoscope before the suture. Therefore, the T-tube related complications can be avoided, and the problems of postoperative biliary obstruction and biliary leakage can be solved preventively; and avoids ERCP related complications caused by placing the stent through the ERCP way.

The invention adopts the following technical scheme:

a conveying device of a percutaneous choledochoscope bile duct stent comprises a pushing catheter 1 and a pushing catheter inner core 2; the outer diameter of the inner core 2 of the push catheter is smaller than the inner diameter of the bile duct support; the outer diameter of the pushing catheter inner core 2 is smaller than the inner diameter of the pushing catheter 1; the bile duct support is sleeved on the inner core 2 of the pushing catheter and can enter the biliary tract under the pushing force of the front end face of the pushing catheter 1.

Preferably, the device also comprises a catheter connector 3, wherein the outer diameter of the pushing catheter inner core 2 is smaller than the inner diameter of the catheter connector 3; the pipe joint 3 is fixedly connected with the rear end of the push pipe 1.

Preferably, the length of the push catheter inner core 2 is at least twice as long as the length of the choledochoscope body.

Preferably, the rear end of the push catheter inner core 2 is fixedly connected with a handle 4.

Preferably, the bile duct support is made of plastic.

Further, the total length of the catheter core 2 together with the handle 4 is 2100 mm.

Further, the length of the push catheter 1 is 900 mm.

A method for delivering a percutaneous choledochoscope bile duct stent comprises the following steps:

s1, inserting the push catheter inner core 2 into the bile duct through a choledochoscope biopsy pore, and then pulling out the choledochoscope to ensure that the length of the push catheter inner core 2 is at least twice as long as the choledochoscope body;

s2, sleeving the tail end of the inner core 2 of the push catheter into a bile duct bracket, and then sleeving the push catheter 1;

s3, the front end of the push catheter 1 is propped against the tail end of the bile duct bracket, and the bile duct bracket is pushed to advance until the bile duct bracket is placed at a required position in the bile duct.

The invention has the beneficial effects that:

1) in the operation, can directly carry out the propelling movement through conveyor with the biliary tract support to the propelling movement is on the throne, compares operation mode in the past, can promote operation convenience and security. After the bile duct is sutured for the first time, due to the existence of the biliary tract stent, biliary tract high pressure caused by Oddi sphincter spasm is avoided, bile drainage is smooth and unobstructed, and accordingly biliary leakage and cholangitis are reduced.

2) The biliary stent is directly placed at the incision position of the bile duct in the operation, the incision of the sphincter of Oddi is not needed like the previous ERCP operation, and the function of the biliary stent can be protected from being influenced.

3) The T-shaped tube is not placed in the operation, so that the occurrence of related complications of the T-shaped tube is directly avoided, and the postoperative life quality of a patient is greatly improved.

Drawings

Fig. 1 is a structural schematic diagram of a delivery device of a percutaneous choledochoscope bile duct stent of the invention.

In the figure, 1 is a pushing catheter, 2 is a pushing catheter inner core, 3 is a catheter joint, and 4 is a handle.

Detailed Description

The invention is further described with reference to the following figures and specific examples.

Referring to fig. 1, a delivery device of a percutaneous choledochoscope bile duct stent comprises a push catheter 1 and a push catheter inner core 2; the outer diameter of the inner core 2 of the push catheter is smaller than the inner diameter of the bile duct support; the outer diameter of the pushing catheter inner core 2 is smaller than the inner diameter of the pushing catheter 1; the bile duct support is sleeved on the inner core 2 of the pushing catheter and can enter the biliary tract under the pushing force of the front end face of the pushing catheter 1.

In this embodiment, referring to fig. 1, further comprising a catheter adapter 3, the outer diameter of the inner core 2 of the push catheter is smaller than the inner diameter of the catheter adapter 3; the pipe joint 3 is fixedly connected with the rear end of the push pipe 1.

In this embodiment, the length of the push catheter core 2 is at least twice as long as the length of the choledochoscope body. Figure 1 does not show a cholangioscope.

In this embodiment, referring to fig. 1, the rear end of the inner core 2 of the push catheter is fixedly connected with a handle 4, and when the push catheter is moved, the handle 4 can be held by one hand and the push catheter 1 can be moved by the other hand.

In this embodiment, the bile duct support is made of plastic.

In this embodiment, referring to FIG. 1, the total length of the inner catheter core 2 together with the handle 4 is 2100mm and the length of the pusher catheter 1 is 900 mm.

The material of the pushing conduit 1 is polytetrafluoroethylene, commonly called Teflon, and the material has extremely low friction coefficient and mechanism stability. The polytetrafluoroethylene tube is made into a single-cavity round tube through high temperature, hot melting and extrusion molding. Cutting the length according to the required size. And then carrying out subsequent processes such as head end processing, joint installation, X-ray opaque developing ring installation and the like.

Pushing the catheter 1: the polytetrafluoroethylene material is prepared by the following specifications: 2.4 mm.

Pushing the inner core 2 of the catheter: the polytetrafluoroethylene is prepared by the following specifications: 1.6 mm.

The pipe joint 3 is made of ABS material and has the specification of 8.5F (universal).

7F	2.4mm
		8.5F	2.8mm
10F	3.3mm

The specific use method of the conveying device comprises the following steps:

1. the push catheter inner core 2 is inserted into the bile duct through a choledochoscope biopsy duct, and then the choledochoscope is pulled out (the length of the push catheter inner core is at least twice as long as the choledochoscope body, so as to be convenient for exchange).

2. The tail end of the inner core 2 of the push catheter is sleeved with a plastic bile duct stent and then sleeved with the push catheter 1.

3. The push catheter 1 is propped against the tail end of the bile duct bracket, and the bile duct bracket is pushed to move forward and is placed into a required position in the bile duct.

The position of the nipple can be guided by the mode of ERCP after operation due to the existence of the bile duct stent, so that the stimulation caused by repeatedly searching for the nipple opening is avoided, and the related complications of ERCP treatment are greatly reduced. Meanwhile, biliary tract radiography can be carried out through the stent, and the stent can be directly removed.

While the preferred embodiments of the present invention have been described, those skilled in the art will appreciate that various changes and modifications can be made therein without departing from the spirit and scope of the invention as defined by the appended claims.