CN102166127B - Renal artery directional blocking device - Google Patents

Abstract

The invention discloses a renal artery directional blocking device comprising a clamping slot, wherein one side in the clamping slot is provided with a saccule which is connected with a gas filled tube, and a gas valve is arranged on the gas filled tube. An opening structure at the front end of the renal artery directional blocking device greatly facilitates the fixing of the blocking device around renal artery without surrounding, and the saccule can be quickly removed after the saccule is deflated, namely the blocking can be stopped in midway to temporarily restore the infusion of kidney, so as to be more beneficial to the protection for renal function. The renal artery directional blocking device is reliable in fixing after the device is fixed around the renal artery, can achieve the effect of truly blocking the renal artery, and can quickly and precisely adjust the blocking pressure on the renal artery at any time according to anatomical variations of different individuals, requirements of an operator and changes in the operation, with really reliable blocking effect. Under the condition of incomplete blocking, a patient can also take a medicine for protecting the kidney, the medicine can be directly involved in the metabolism of the kidney at the side, so as to protect the renal function according to actual situation in the operation to the greatest extent.

Description

Renal artery directional blocking device

technical field

The invention belongs to the technical field of clinical medicine and surgery, and relates to a renal artery directional blocking device, which is especially suitable for laparoscopic surgery.

Background technique

Partial nephrectomy has developed rapidly in recent years and is mainly used in renal cancers smaller than 4 cm, solitary renal tumors, double renal cancers, benign renal tumors, segmental renal vascular malformations, and stones limited to the upper or lower poles of the kidney. The main difficulty of the operation lies in the control of renal wound bleeding and the protection of renal function. The renal artery needs to be blocked during the operation. In addition, if more renal parenchyma needs to be cut during nephrolithotomy, the renal artery also needs to be blocked. Traditional open surgery is very difficult and traumatic. In recent years, the progress of laparoscopic surgery has improved partial nephrectomy, and the trauma to patients has been significantly reduced, but it is more difficult, but it puts forward higher requirements for doctors' surgical operations. Require.

The blood flow of the kidneys is very rich, and a normal adult has 1200ml of blood flowing into both kidneys per minute. For some patients who are suitable for partial nephrectomy, during partial nephrectomy, because the blood flow of the kidney is very rich, in order to reduce bleeding and obtain a clear operation field to shorten the operation time and complete the operation accurately, it is often necessary to block the renal artery. broken. However, because the renal parenchyma is very sensitive to reperfusion injury after warm ischemia, warm ischemia for more than half an hour often causes irreversible damage to the renal function of the affected side, and the degree of damage gradually increases with the extension of the renal artery occlusion time . In order to reduce bleeding, obtain a clear operative field, and shorten the operation time, traditional partial nephrectomy often completely blocks the renal artery. The operation should be completed within 30 minutes after renal artery occlusion. At present, it is more difficult to perform laparoscopic partial nephrectomy. However, if the renal artery is not blocked, the blood loss will increase significantly, and it is often difficult to complete laparoscopic partial nephrectomy. surgery, and even had to undergo radical nephrectomy. However, the blocking of the renal artery by the vascular blocking clip is completely blocked, and the blood flow of this side of the kidney is completely stopped, and it is impossible to conveniently give the drug to this side of the kidney to protect the renal function. The inability to precisely adjust the blocking pressure and stop blocking halfway will inevitably cause irreversible damage to the kidney, which is even worse for patients with solitary kidney or functional solitary kidney tumors, which is not conducive to the long-term survival of patients. The use of vascular blocking clips to block the renal artery will cause certain damage to the blood vessel itself, especially in patients with atherosclerosis, there are often atherosclerotic plaques in the renal arteries, which may be blocked by vascular blocking clips or other methods Cause renal artery atherosclerotic plaque rupture or even fall off. The existing blocking methods are difficult to operate under laparoscopy, time-consuming, easy to slip, and even cause secondary damage. Laparoscopic renal artery occlusion and cold perfusion devices have also been proposed. The surgical operation is extremely impractical. Even if the kidney can be perfused, the operation time will be significantly prolonged and the damage to the renal artery will be increased. Once the renal artery is damaged, bleeding will be difficult. control, and even forced nephrectomy. In addition, the anatomical space between and around the renal artery and renal vein is extremely narrow. For anatomical variations such as premature branching of the renal artery or two renal arteries, it is necessary to separate the two renal arteries or the two branches of the renal artery during the operation. Blocking, it is also possible to block only one artery, and even some operators need to block the renal artery and renal vein at the same time. Using other blocking methods to block the pressure changes is small, and it is difficult to achieve fine adjustment of renal artery blockage , it is more difficult to perform laparoscopic operation, and it cannot meet the requirements of surgical operation to the greatest extent. At present, the construction process of laparoscopic vascular blocking forceps is complicated, which increases the surgical consumables and the surgical operation channel, which increases the trauma to the patient and increases the economic burden of the patient. In order to protect the renal function of the patient, it is the best choice to partially block the renal artery of the patient and precisely adjust the blocking pressure, but so far there is no device that can partially block the renal artery and precisely adjust it.

Contents of the invention

The present invention aims to solve the above problems, and provides a renal artery directional blocking device, which can fix itself around the renal artery through operation, and can ideally partially block the renal artery, reduce ischemia-reperfusion injury, and maximize Protect the renal function of the patient to a certain extent. The invention has simple structure and convenient operation.

Technical solution of the present invention is:

A renal artery directional blocking device, comprising: a draw-in slot, a balloon is arranged on one side of the draw-in slot, an inflatable tube is connected to the balloon, and an air valve is arranged on the inflatable tube.

The beneficial result of the present invention is: the structure of the front opening of the device greatly facilitates the device to be fixed around the renal artery without surrounding, and the airbag can be quickly removed after deflation, that is, the blockage can be stopped halfway, and the perfusion of the kidney can be temporarily restored , more conducive to the protection of renal function. After the device is fixed around the renal artery, it can be fixed reliably, and can achieve the effect of blocking the renal artery, and can quickly block the pressure of the renal artery at any time according to the anatomical variation of different individuals, the requirements of the operator and the changes in the operation. And precisely adjusted, the blocking effect is reliable. In the case of incomplete blocking, the patient can be given drugs to protect the kidney at the same time. The drugs can directly participate in the metabolism of the side of the kidney, and protect the renal function to the greatest extent according to the actual situation during the operation. . The device occupies a small space and can block the branches of the renal artery, or only block the renal artery without affecting the renal vein, or block the renal artery and vein separately, and will not cause damage due to the outward expansion and deformation of its own structure. Damage to the surrounding structures of the target blood vessels, and will not affect the surgical operation because it takes up a lot of space. The use of the blocking device not only reduces intraoperative bleeding, but also ensures a clear operative field, and most importantly, protects the function of the kidney to the greatest extent, greatly facilitating the operation. In addition, the device can be placed around the renal artery through the laparoscopic operation sheath card, and the second half can be placed outside the body through the sheath card or next to the sheath card, without additionally increasing the number of laparoscopic operation sheath cards, which facilitates the operation The operation reduces the trauma to the patient, and the various beneficial results mentioned above will be better realized in laparoscopic surgery. The specific advantages are as follows:

1. Simple structure. The invention directly blocks the renal artery through the compression of the balloon in the slot structure, the manufacturing process is relatively simple, and the renal artery can be quickly blocked after the balloon is inflated.

2. It is convenient to fix. The structure of the front opening is very convenient to fix the device around the renal artery. It only needs to place the free renal artery on the surface of the groove. With the expansion of the balloon, it can effectively achieve the purpose of blocking The purpose of fixing the breaking device is not required, which reduces the possibility of accidental injury caused by additional operation steps, greatly reduces the operation steps and operation time, and shortens the anesthesia time, thereby reducing the risk of prolonging the anesthesia time and saving anesthesia. Economical cost of surgery, less trauma to the patient. The structure of the front opening is very convenient for various situations where the device needs to be removed. For example, when the operation is completed and there is no need to continue blocking, or when renal atherosclerosis needs to stop blocking immediately, you only need to deflate the balloon at this time. Quick removal of the device saves surgical time,.

3. Reliable fixation of the renal artery, the matching structure of the balloon and the groove can reliably fix the renal artery, and the external hard frame of the card groove structure and the groove structure opposite to the balloon can effectively limit the balloon With the inward directional expansion of the balloon, the renal artery is further fixed in the groove to prevent the blocking effect from disappearing after the renal artery slips, causing massive bleeding during the operation.

4. Reliable occlusion of the renal artery, due to the inward directional compression of the balloon, its wider contact surface can compress and flatten the renal artery, reduce blood flow in the lumen, and ensure the operation's requirements for renal artery occlusion .

5. The blocking pressure can be precisely adjusted at any time, and the inflation volume in the balloon can be adjusted precisely at any time. The change of the blocking pressure brought about by the increase or decrease of the inflation volume in the balloon can be monitored in real time on the pressure detection gauge. Due to the different diameters and elasticity of the renal arteries, different operators have huge differences in the requirements for occlusion, and extremely small differences in occlusion pressure may have different effects on the renal function of the side. Blockage of blood flow to preserve kidney function. According to the operating conditions of the operative field, the blocking pressure is precisely adjusted, the blood flow of the kidney is controlled, and the blood supply of the kidney is preserved to the greatest extent on the premise of ensuring a clear operative field. It can not only significantly reduce intraoperative bleeding, but also ensure the basic perfusion of the kidney, and avoid the ischemia-reperfusion injury of the kidney to the greatest extent.

6. Due to the incomplete occlusion of the renal artery by balloon compression, drugs to protect the kidney can be given during the operation to improve the metabolism of the kidney on the side and protect the function of the kidney on the side where the operation is performed.

7. The blocking pressure can be adjusted in a wide range. Since the outside of the slot-like structure in the first half of the device is a hard structure, it is not easy to deform and can withstand a large force of balloon expansion, so that the blocking pressure of the balloon can be adjusted. The adjustment range is very large. Different individuals have different diameters and elasticity of the renal artery, and different operators have huge differences in their requirements for occlusion. The structure of this device can meet the needs of different individuals and operators for different occlusion of the renal artery. pressure requirements.

8. Double protective effect on renal artery. The slot structure in the first half of the device will not be deformed during the operation. Various sharp or energy-bearing operating instruments are often used in the operation. The slot structure protects the balloon and blocks the inward directional expansion of the semi-cylindrical structure of the balloon. It can reduce the probability of damage to the balloon by various operations, thereby avoiding the disappearance of renal artery occlusion caused by balloon rupture, massive bleeding in the operative field, and the direct protection of the card slot on the renal artery can increase the protection of the renal artery; the hemispherical shape After the capsule compresses the renal artery, the renal artery becomes flattened. Some patients have atherosclerosis, and the renal artery is relatively brittle. Renal aneurysm, renal infarction caused by atheroma plate falling off, will cause irreversible damage to the patient's renal function, and the hemispherical capsule and groove structure are not easy to induce the change of renal artery shape after renal artery compression. The atheromatous plate of the inner wall ruptures or falls off, thereby increasing the protective effect on the renal artery.

9. The device occupies a small space and is extremely suitable for the operation requirements of laparoscopic partial nephrectomy, and of course it can also meet the requirements of open operations. Because the anatomical space between and around the renal artery and renal vein is extremely narrow, and anatomical variations such as premature branching of the renal artery or two renal arteries, it is necessary to block both renal arteries or both branches of the renal arteries during the operation. It is also possible that only one artery needs to be blocked, and some operators even need to block the renal artery and renal vein at the same time. Because the balloon only expands inward and the structure of the slot does not deform, the device occupies a small space and can block the renal artery. The branch of the artery, or only blocking the renal artery without affecting the renal vein, or blocking the renal artery and vein separately, will not cause damage to the surrounding structure of the target blood vessel due to the outward expansion and deformation of its own structure, and will not Because it takes up more space and affects the operation.

10. Easy to operate. The first half of the device can be placed around the renal artery through the laparoscopic operation sheath card, and the second half can be placed outside the body through the sheath card or next to the sheath card. There is no need to increase the number of laparoscopic operation sheath cards, which is convenient Surgical operation reduces the trauma to the patient, and the second half of it outside the body can conveniently inflate the balloon and monitor the pressure.

11. The balloon is soft and has no cutting effect on the renal artery, and the wide contact surface with the renal artery increases the protection of the renal artery. In the present invention, the renal artery is blocked by the balloon, which replaces the traditionally used vascular blocking clip, avoids damage to the adventitia and intima of the renal artery by the metal clip, and provides a safer treatment for patients with atherosclerosis. Safeguard.

Description of drawings

Fig. 1 is a schematic structural diagram of an embodiment of the present invention.

Fig. 2 is a schematic diagram of the working process of blocking the renal artery in the present invention.

Fig. 3 is a schematic structural diagram of another embodiment of the present invention.

Fig. 4 is a schematic structural diagram of yet another embodiment of the present invention.

Detailed ways

A renal artery directional blocking device, comprising: a card slot 7, a balloon 1 is arranged on one side of the card slot 7, an inflatable tube 2 is connected to the balloon 1, and an air valve is arranged on the inflatable tube 2 5. In this embodiment, a groove 4 is provided on the other side of the groove of the card groove 7, a pressure monitoring gauge 6 is connected to the balloon 1, a pressure measuring tube 3 is connected to the balloon 1, and the pressure measuring tube 3 One end of the pressure measuring tube 3 is connected with the balloon 1, and the other end of the pressure measuring tube 3 is connected with a pressure monitoring gauge 6.

Below with reference to accompanying drawing, the present invention is described in more detail:

Referring to FIG. 1 , there are a balloon 1 and a groove 4 in the slot structure at the front end of the device. Referring to Fig. 2, place the renal artery in the groove after passing through the opening of the slot of the blocking device, inject a little air into the balloon 1 through the air valve 5, and fix itself around the renal artery to prevent it from slipping. The pressure measuring tube core 3 is connected to the pressure monitoring gauge through the side joint 6, and a switch is arranged on the side branch joint 6, which can deflate to reduce the pressure in the balloon.

Referring to Fig. 1 and Fig. 2, in partial nephrectomy or nephrolithotomy, the free renal artery is placed in the groove through the opening of the blocking device, and injected gradually through the air valve 5. After inflation, the balloon 1 compresses the renal artery in the groove to achieve the purpose of gradually partially blocking the renal artery, and the pressure monitoring gauge 6 simultaneously detects the pressure in the balloon 1. According to the operating conditions of the operative field, the blood perfusion of the kidney is adjusted by adjusting the pressure of the occluding balloon, and the occlusion of the renal artery is minimized while the operative field is clear, and the blood supply of the kidney is preserved. If there is too much bleeding in the surgical field, it will obviously affect the operation. You can continue to inject air slowly through the air valve 5 and increase the blocking pressure until the bleeding on the wound surface is reduced to just meet the operation requirements. If the bleeding is serious, a small amount of air should be deflated slowly to monitor the pressure inside the balloon to ensure the smooth progress of the operation and maintain the blood flow of the kidney to a certain extent. At the same time, patients can still be given drugs to protect renal function. These drugs can enter the kidney through the incompletely blocked renal artery, improve the metabolism of the kidney on this side, reduce the generation of harmful metabolites or remove harmful substances, so as to achieve the greatest degree of kidney protection. Functional requirements If excessive inflation is found, implementation examples In laparoscopic partial nephrectomy, after the kidney and renal artery are freed, the front half of the device is placed into the operation field through the laparoscopic operating sheath with separating forceps, and the The renal artery is placed in the groove of the blocking device, and the balloon 1 is inflated after the gas valve 5 is gradually injected, and the renal artery is pressed in the groove 4 to prevent slippage. After the gas is injected through the valve 5, the balloon 1 gradually compresses the renal artery, and the surface of the blocked kidney begins to turn white. The pressure monitoring table 6 simultaneously displays the pressure of the balloon 1, which is the blocking pressure of the renal artery, and the part of the kidney is removed. For the kidney, according to the requirements of wound bleeding and surgical operation, the blocking pressure is adjusted by adjusting the gas injection volume of the balloon 1 through gas injection and deflation, so as to preserve the blood supply of the kidney to the greatest extent while ensuring a clear surgical field. After partial nephrectomy, the incision of the renal parenchyma was re-sutured. At this time, the gas in the balloon was released gradually and slowly, and the wound bleeding was observed. If there was no obvious bleeding on the wound, the gas in the balloon was emptied, and the device was removed. If there is more bleeding on the wound surface during the process of discharging the gas in the balloon, increase the amount of gas in the balloon again by a small amount, suture the wound thoroughly to stop the bleeding, and then empty the gas in the balloon and remove the device.

In laparoscopic nephrolithotomy, after the kidney and renal artery are freed, the renal artery is placed in the groove of the blocking device. Press into groove 4 to prevent slipping. After the gas is injected through the valve 5, the balloon 1 gradually compresses the renal artery, and the surface of the blocked kidney begins to turn white, and the pressure monitoring gauge 6 simultaneously displays the pressure of the balloon 1, which is the blocking pressure of the renal artery, and the incision begins For the kidney, according to the requirements of wound bleeding and surgical operation, the blocking pressure is adjusted by adjusting the gas injection volume of the balloon 1 through gas injection and deflation, so as to preserve the blood supply of the kidney to the greatest extent while ensuring a clear surgical field. After incision of the kidney, take out the stone and re-suture the incision of the renal parenchyma. At this time, the gas in the balloon is released gradually and slowly, and the bleeding on the wound is observed. If there is no obvious bleeding on the wound, the gas in the balloon is emptied and the original device. If there is more bleeding on the wound surface during the process of discharging the gas in the balloon, increase the amount of gas in the balloon again by a small amount, suture the wound thoroughly to stop the bleeding, and then empty the gas in the balloon and remove the device. Therefore, the device not only reduces intraoperative bleeding, but also protects the patient's renal function to the greatest extent.

Although the invention has been described with respect to a preselected embodiment, the invention is not limited to this embodiment, but may be embodied in various forms.

For example, as shown in Fig. 3 and Fig. 4, in another embodiment of the present invention, there is only one tube core leading to the blocking balloon, the end of the tube core is divided into two tube cores, the side joint is connected to the pressure monitoring gauge, and the end The joint is connected to the air valve, and the air valve is used to inject gas into the blocking balloon or deflate the side branch joint to adjust the blocking pressure. The pressure monitoring gauge can simultaneously detect the pressure in the blocking balloon. As shown in Figure 4, in another embodiment of the present invention, a balloon is used instead of the groove, and the two stylets leading to the two balloons are merged into one in the middle of the slot, and the two balloons expand synchronously to compress the renal artery , the end of the tube core is connected to the tee joint, the side joint is connected to the pressure monitoring gauge, the other joint of the tee is connected to the gas injection valve, and the gas is injected into the blocking balloon through the gas injection valve, and the pressure monitoring gauge can simultaneously detect the blocking ball pressure in the capsule.

Claims (2)

1. renal artery orientation blocking device, it is characterized in that, comprise: draw-in groove (7), a side is provided with sacculus (1) in the groove of draw-in groove (7), opposite side is provided with groove (4) in the groove of draw-in groove (7), be connected with pressure monitoring table (6) at sacculus (1), be connected with gas tube (2) at described sacculus (1), be provided with air valve (5) at described gas tube (2), through described air valve (5) progressively after the gas injection, described sacculus (1) is progressively partly blocked renal artery purpose to reach with the renal artery compressing in described groove, the described sacculus of described pressure monitoring table (6) synchronous detecting (1) internal pressure according to the visual area operational circumstances, is regulated kidney perfusion by regulating the blocking-up balloon pressure, farthest reduce arteriorenal blocking-up under the prerequisite clearly in the assurance visual area, the blood that keeps kidney supplies.

2. renal artery orientation blocking device according to claim 1, it is characterized in that, an end that is connected with pressure-measuring pipe (3) and described pressure-measuring pipe (3) at described sacculus (1) is connected with described sacculus (1), is connected with described pressure monitoring table (6) at the other end of described pressure-measuring pipe (3).

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