CN118750103A - A bite-cutting endoscope system with negative pressure suction - Google Patents
A bite-cutting endoscope system with negative pressure suction Download PDFInfo
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Abstract
一种带负压吸引的咬切内窥镜系统,包括:外鞘、咬切装置、摄像装置和负压吸引装置;咬切装置包括依次相连的操作部件、驱动杆和咬切部件,咬切部件和驱动杆能由外鞘的后端部插入并从外鞘前端部伸出,操作部件与外鞘后端部连接固定;咬切部件包括上咬合面和下咬合面,上、下咬合面内侧前端均周边分布有咬切齿,咬切齿能在上、下咬合面相对闭合执行咬切操作后对被咬切对象形成咬切力;操作部件适于触发咬切操作;上下咬合面相对闭合后形成容纳目标物的空间,目标物为被咬切对象在经过咬切操作后所切下的部分;摄像装置设置于外鞘前端部;负压吸引装置适于通过负压吸引的方式使目标物被吸出体外。本发明技术方案能从根本上避免引发闭孔神经反射问题、组织烧灼以及肿瘤组织漂浮种植的风险。
A biting endoscope system with negative pressure suction comprises: an outer sheath, a biting device, a camera device and a negative pressure suction device; the biting device comprises an operating component, a driving rod and a biting component connected in sequence, the biting component and the driving rod can be inserted from the rear end of the outer sheath and extended from the front end of the outer sheath, and the operating component is connected and fixed to the rear end of the outer sheath; the biting component comprises an upper biting surface and a lower biting surface, and biting teeth are distributed around the inner front end of the upper and lower biting surfaces, and the biting teeth can form a biting force on the bitten object after the upper and lower biting surfaces are relatively closed to perform a biting operation; the operating component is suitable for triggering the biting operation; the upper and lower biting surfaces are relatively closed to form a space for accommodating a target object, and the target object is the part of the bitten object cut off after the biting operation; the camera device is arranged at the front end of the outer sheath; the negative pressure suction device is suitable for sucking the target object out of the body by negative pressure suction. The technical solution of the present invention can fundamentally avoid the risk of causing obturator nerve reflex problems, tissue burns and floating implantation of tumor tissue.
Description
技术领域Technical Field
本发明涉及医疗器械领域,特别涉及一种带负压吸引的咬切内窥镜系统。The invention relates to the field of medical instruments, and in particular to a cutting endoscope system with negative pressure suction.
背景技术Background Art
膀胱肿瘤是泌尿系统最常见的肿瘤之一,近年来我国膀胱肿瘤的发病率呈逐年升高趋势,其中非肌层浸润性膀胱癌(NMIBC,Non-Muscle-Invasive Bladder Cancer)约占膀胱肿瘤的70%-80%。由于经尿道膀胱肿瘤电切术(TURBT,Transurethral Resection ofBladder Tumor)具有创伤小、恢复快等优点,是目前非肌层浸润性膀胱癌的主要治疗方式。Bladder tumor is one of the most common tumors in the urinary system. In recent years, the incidence of bladder tumors in my country has been increasing year by year, among which non-muscle-invasive bladder cancer (NMIBC) accounts for about 70%-80% of bladder tumors. Transurethral resection of bladder tumor (TURBT) is currently the main treatment for non-muscle-invasive bladder cancer due to its advantages of less trauma and faster recovery.
TURBT主要利用电切镜完成,通过前端的电切环将肿瘤组织切下并止血电凝,切下的肿瘤组织积聚于膀胱内随后利用水流冲出体内。然而,TURBT也具有易引发闭孔神经反射(ONR,Obturator Nerve Reflex)、组织烧灼、术后出血以及肿瘤组织漂浮种植等不足,尤其是闭孔神经反射更是TURBT的主要并发症之一。临床在进行TURBT时,由于电切环的高频电流刺激邻近闭孔神经造成膀胱穿孔的发生率约为2%。一旦闭孔神经反射发生,轻则影响手术进程,重则造成膀胱穿孔、损伤盆腔大血管甚至需要开放手术,增加膀胱肿瘤种植及复发的危险,导致术者切割时,过于谨慎造成瘤体基底部切割不彻底,易于复发。因此,预防ONR是近年来临床关注的重点,而目前对于如何在TURBT中解决ONR的问题是泌尿外科医师关注的难题之一。TURBT is mainly performed using an electrosurgical resectoscope. The tumor tissue is cut off and hemostatically coagulated by the electrosurgical resection ring at the front end. The cut tumor tissue accumulates in the bladder and is then flushed out of the body by water flow. However, TURBT also has the disadvantages of easily inducing obturator nerve reflex (ONR), tissue burns, postoperative bleeding, and floating implantation of tumor tissue. In particular, the obturator nerve reflex is one of the main complications of TURBT. When performing TURBT clinically, the incidence of bladder perforation caused by the high-frequency current of the electrosurgical resection ring stimulating the adjacent obturator nerve is about 2%. Once the obturator nerve reflex occurs, it will affect the surgical process at the least, and cause bladder perforation, damage to the pelvic large blood vessels, and even require open surgery, increase the risk of bladder tumor implantation and recurrence, and cause the surgeon to be too cautious when cutting, resulting in incomplete cutting of the tumor base, which is easy to recur. Therefore, preventing ONR has been the focus of clinical attention in recent years, and how to solve the problem of ONR in TURBT is currently one of the difficult problems that urologists are concerned about.
研究发现,在腰大肌中下行闭孔神经中含有运动纤维与感觉纤维,贴近下外侧膀胱壁、膀胱颈和前列腺部尿道外侧,电切时膀胱腔充盈,缩短膀胱壁与神经距离,电极产生低频电流可刺激ONR,给临床电切除肿瘤带来一定困难。通过经尿道切除膀胱侧壁的肿瘤,会因为充盈的膀胱将膀胱壁和神经间的距离大幅缩短,就容易使得ONR发生,这也是造成患者的大腿内收肌群出现明显而强烈的收缩的原因所在。膀胱肿瘤发病部位多为膀胱侧壁、后壁及三角区。文献报道46.8%的膀胱肿瘤瘤体位于膀胱侧壁。对于膀胱两侧壁肿瘤,尤其是双侧输尿管口外上方2cm处肿瘤,术中因电切环产生电流刺激闭孔神经,导致ONR会对患者的大腿内收肌群产生极为强烈的收缩性、髋关节的屈曲内收。出现ONR的原因为:(1)电流流经闭孔神经刺激闭孔神经;(2)神经冲动传导到肌肉;(3)肌肉出现收缩影响手术。在上述神经反射过程中无论阻断哪一步都可以防止ONR的出现。Studies have found that the descending obturator nerve in the psoas major muscle contains motor fibers and sensory fibers, which are close to the lower lateral bladder wall, bladder neck and the outer side of the prostatic urethra. When the bladder cavity is filled during electroresection, the distance between the bladder wall and the nerve is shortened. The low-frequency current generated by the electrode can stimulate ONR, which brings certain difficulties to clinical electroresection of tumors. Transurethral resection of tumors on the side wall of the bladder will greatly shorten the distance between the bladder wall and the nerve due to the filled bladder, which will easily cause ONR to occur, which is also the reason for the obvious and strong contraction of the patient's thigh adductor muscles. The sites of bladder tumors are mostly the side wall, posterior wall and trigone of the bladder. Literature reports that 46.8% of bladder tumors are located on the side wall of the bladder. For tumors on both sides of the bladder wall, especially tumors 2 cm above the bilateral ureteral orifices, the electric current generated by the electroresection ring during surgery stimulates the obturator nerve, resulting in ONR, which will produce extremely strong contractility on the patient's thigh adductor muscles and flexion and adduction of the hip joint. The causes of ONR are: (1) the current flows through the obturator nerve and stimulates the obturator nerve; (2) the nerve impulse is transmitted to the muscle; (3) the muscle contracts and affects the operation. Blocking any step in the above nerve reflex process can prevent the occurrence of ONR.
为预防TURBT术中闭孔神经反射,现在临床上多采用改变麻醉方式、降低电切功率、疲劳疗法、短促疗法、减少膀胱灌注量等方法减少或避免ONR的发生。然而,上述方法仍然不能从根本上解决闭孔神经反射的问题,而且也各自存在着各种弊端或局限性。In order to prevent the obturator nerve reflex during TURBT, the clinical practice now mainly adopts methods such as changing the anesthesia method, reducing the power of electrosurgical resection, fatigue therapy, short therapy, and reducing the bladder infusion volume to reduce or avoid the occurrence of ONR. However, the above methods still cannot fundamentally solve the problem of obturator nerve reflex, and each of them has various disadvantages or limitations.
发明内容Summary of the invention
本发明要解决的问题是如何能够从根本上避免引发闭孔神经反射问题、组织烧灼以及肿瘤组织漂浮种植的风险。The problem to be solved by the present invention is how to fundamentally avoid the risk of causing obturator nerve reflex problems, tissue burning and floating implantation of tumor tissue.
为解决上述问题,本发明技术方案提供一种带负压吸引的咬切内窥镜系统,包括:外鞘、咬切装置、摄像装置和负压吸引装置;所述咬切装置包括依次相连的操作部件、驱动杆和咬切部件,所述咬切部件和驱动杆能由所述外鞘的后端部插入并从所述外鞘的前端部伸出,所述操作部件与所述外鞘的后端部连接固定;所述咬切部件包括上咬合面和下咬合面,所述上咬合面和下咬合面内侧前端均周边分布有咬切齿,所述咬切齿能在所述上咬合面和下咬合面相对闭合执行咬切操作后对被咬切对象形成咬切力;所述操作部件适于触发所述咬切操作;所述上咬合面和下咬合面相对闭合后形成容纳目标物的空间,所述目标物为所述被咬切对象在经过所述咬切操作后所切下的部分;所述摄像装置的摄像头设置于所述外鞘的前端部;所述负压吸引装置适于通过负压吸引的方式使所述目标物被吸出体外。In order to solve the above problems, the technical solution of the present invention provides a biting endoscope system with negative pressure suction, comprising: an outer sheath, a biting device, a camera device and a negative pressure suction device; the biting device comprises an operating component, a driving rod and a biting component connected in sequence, the biting component and the driving rod can be inserted from the rear end of the outer sheath and extended from the front end of the outer sheath, and the operating component is connected and fixed to the rear end of the outer sheath; the biting component comprises an upper biting surface and a lower biting surface, and the front end of the inner side of the upper biting surface and the lower biting surface are both peripherally distributed with biting teeth, and the biting teeth can form a biting force on the bitten object after the upper biting surface and the lower biting surface are relatively closed to perform a biting operation; the operating component is suitable for triggering the biting operation; the upper biting surface and the lower biting surface are relatively closed to form a space for accommodating a target object, and the target object is the part of the bitten object cut off after the biting operation; the camera of the camera device is arranged at the front end of the outer sheath; the negative pressure suction device is suitable for sucking the target object out of the body by negative pressure suction.
可选的,所述带负压吸引的咬切内窥镜系统还包括内芯,所述内芯能由所述外鞘的后端部插入并从所述外鞘的前端部伸出。Optionally, the cutting endoscope system with negative pressure suction further comprises an inner core, which can be inserted from the rear end of the outer sheath and extended from the front end of the outer sheath.
可选的,所述下咬合面与所述驱动杆的前端固定连接,所述上咬合面通过枢转件与所述驱动杆的前端活动连接。Optionally, the lower occlusal surface is fixedly connected to the front end of the driving rod, and the upper occlusal surface is movably connected to the front end of the driving rod via a pivot member.
可选的,所述操作部件包括适于操作者进行握持的握持部件以及适于触发所述咬切操作的触发部件。Optionally, the operating component includes a holding component suitable for an operator to hold and a triggering component suitable for triggering the biting operation.
可选的,所述咬切部件呈鲨鱼嘴结构或鳄鱼嘴结构。Optionally, the biting component has a shark mouth structure or a crocodile mouth structure.
可选的,所述带负压吸引的咬切内窥镜系统还包括冲洗装置,所述冲洗装置包括与所述外鞘连接的进水接口以及设置于所述外鞘的前端部的注水孔。Optionally, the cutting endoscope system with negative pressure suction also includes a flushing device, which includes a water inlet interface connected to the outer sheath and a water injection hole arranged at the front end of the outer sheath.
可选的,所述外鞘的前端部还设有光源,所述操作部件的后端部包括连接所述光源的光源接口以及连接所述摄像装置的摄像接口,所述光源接口与所述摄像接口一体集成。Optionally, the front end of the outer sheath is further provided with a light source, and the rear end of the operating component includes a light source interface connected to the light source and a camera interface connected to the camera device, and the light source interface is integrated with the camera interface.
可选的,所述驱动杆的内部中空构造为吸引管腔,所述负压吸引装置包括吸引皮管、吸引泵和吸引接口,所述吸引接口设置于所述操作部件的后端部,所述吸引皮管分别连接所述吸引泵以及所述吸引接口,所述吸引管腔与所述吸引接口连通。Optionally, the internal hollow structure of the driving rod is a suction lumen, and the negative pressure suction device includes a suction tube, a suction pump and a suction interface, the suction interface is arranged at the rear end of the operating component, the suction tube is respectively connected to the suction pump and the suction interface, and the suction lumen is connected to the suction interface.
可选的,所述冲洗装置还包括设置于所述外鞘的出水接口,以所述出水接口作为所述吸引接口。Optionally, the flushing device further comprises a water outlet interface arranged on the outer sheath, and the water outlet interface serves as the suction interface.
可选的,所述带负压吸引的咬切内窥镜系统还包括标本采集装置,所述标本采集装置包括皮管接口、标本杯以及设于所述标本杯内适于收集所述目标物的过滤网,所述皮管接口与所述标本杯的两端、所述吸引皮管均为可拆卸连接。Optionally, the cutting endoscope system with negative pressure suction also includes a specimen collection device, which includes a leather tube interface, a specimen cup, and a filter net arranged in the specimen cup and suitable for collecting the target object. The leather tube interface and both ends of the specimen cup and the suction leather tube are all detachably connected.
可选的,所述带负压吸引的咬切内窥镜系统还包括设置于所述标本杯的两端的可控阀门,所述可控阀门适于使所述标本杯两端处于封闭或畅通状态。Optionally, the cutting endoscope system with negative pressure suction further comprises controllable valves disposed at both ends of the specimen cup, and the controllable valves are suitable for making both ends of the specimen cup in a closed or unobstructed state.
可选的,所述带负压吸引的咬切内窥镜系统还包括与所述咬切部件相连的电极,所述咬切部件还适于在所述上咬合面和下咬合面相对闭合的状态下作为电凝止血部件或电切割部件。Optionally, the occlusal cutting endoscope system with negative pressure suction further comprises an electrode connected to the occlusal cutting component, and the occlusal cutting component is further suitable for serving as an electrocoagulation hemostasis component or an electrocuting component when the upper occlusal surface and the lower occlusal surface are in a relatively closed state.
与现有技术相比,本发明的技术方案至少具有以下优点:Compared with the prior art, the technical solution of the present invention has at least the following advantages:
1、咬切部件采用独特的″鲨鱼嘴″结构或″鳄鱼嘴″结构。采用鲨鱼嘴或鳄鱼嘴结构的咬切部件,通过机械的咬切力来切除或离断肿瘤组织,避免现有技术中的膀胱电切镜因需要施加低频电流而引发闭孔神经反射和组织烧灼的弊端。1. The biting component adopts a unique "shark mouth" structure or "crocodile mouth" structure. The biting component adopts a shark mouth or crocodile mouth structure to remove or sever tumor tissue through mechanical biting force, avoiding the disadvantages of the existing cystoscopic resectoscope that requires the application of low-frequency current, which may cause obturator nerve reflex and tissue burning.
2、机械咬切离断肿瘤组织的方式配合负压吸引来抽吸离断的肿瘤组织。通过负压吸引装置,使″鲨鱼嘴″或″鳄鱼嘴″内(咬切部件的上、下咬合面闭合相对闭合后形成能够容纳所切下的肿瘤组织的空间)咬切的肿瘤组织通过负压吸引及时吸出体外,减少了肿瘤组织在膀胱内积聚的时间,进而减少肿瘤组织在体内漂浮种植的风险,降低了手术风险及术后复发率,也缩短了手术时间以及术后寻找切下来的肿瘤组织的时间。2. Mechanically bite and cut off the tumor tissue in combination with negative pressure suction to suck out the severed tumor tissue. Through the negative pressure suction device, the tumor tissue bitten off in the "shark mouth" or "crocodile mouth" (the upper and lower biting surfaces of the biting parts are closed relative to each other to form a space that can accommodate the cut tumor tissue) is sucked out of the body in time through negative pressure suction, which reduces the time for tumor tissue to accumulate in the bladder, thereby reducing the risk of tumor tissue floating and implanting in the body, reducing surgical risks and postoperative recurrence rates, and also shortening the operation time and the time to find the cut tumor tissue after surgery.
3、闭合后的″鲨鱼嘴结构″咬切部件还可以进行电凝止血和电切割。通过″鲨鱼嘴结构″咬切部件导电,可以实现在离断组织的创面进行电凝操作以及时止血,且使电凝面积得以增大(咬切部件的接触面积比常规的手术电极更大),同时避免需要更换止血器械;同时,在一些机械力量无法很好切断的肿瘤组织,仍然能够通过电切割的方式进行离断,提高效率。3. The "shark mouth structure" biting part can also perform electrocoagulation hemostasis and electrocuting after closing. Through the "shark mouth structure" biting part's conductivity, electrocoagulation can be performed on the wound surface of the severed tissue to stop bleeding in time, and the electrocoagulation area can be increased (the contact area of the biting part is larger than that of conventional surgical electrodes), while avoiding the need to replace hemostatic instruments; at the same time, in some tumor tissues that cannot be cut well by mechanical force, they can still be cut off by electrocuting, improving efficiency.
4、通过在负压吸引的过程中设置标本采集装置,并依靠其中的过滤网阻挡被咬切下的肿瘤组织,从而使其能够保留在标本杯中,且可拆卸的标本杯也能够方便地采集到切下的肿瘤组织并独立送检,从而使标本的采集更为便捷,也加快了将标本送检的速度。4. A specimen collection device is provided during the negative pressure suction process, and the filter net therein is used to block the tumor tissue that is bitten and cut, so that it can be retained in the specimen cup. The detachable specimen cup can also conveniently collect the cut tumor tissue and send it for inspection independently, making specimen collection more convenient and speeding up the speed of sending the specimen for inspection.
5、通过设置标本杯的两端的可控阀门,既不影响负压吸引的实施,又使得拆卸下的标本杯便能处于密封状态,无需另外再给标本杯盖上额外的盖子予以封装,从而能够更便捷地实现将采集的标本送检。5. By setting controllable valves at both ends of the specimen cup, it does not affect the implementation of negative pressure suction, and the disassembled specimen cup can be in a sealed state, without the need to cover the specimen cup with an additional lid for sealing, so that the collected specimens can be sent for inspection more conveniently.
6、将采用机械咬切方式切割肿瘤组织的咬切装置、冲洗装置和吸引切下的肿瘤组织的负压吸引装置集成于一体,能够相互配合完成肿瘤组织离断、清理和凝血,使整个TURBT手术过程更为安全、便捷与高效。6. The mechanical biting device for cutting tumor tissue, the flushing device and the negative pressure suction device for sucking the cut tumor tissue are integrated into one device, which can cooperate with each other to complete the separation, cleaning and coagulation of tumor tissue, making the entire TURBT surgical process safer, more convenient and more efficient.
7、通过将负压吸引装置设置连接于操作部件的后端部,可以避免因将负压吸引装置连接于现有技术中常规的出水接口(相当于将该出水接口作为吸引接口使用)而可能产生的堵塞问题,从而使负压吸引作用更为通畅。7. By connecting the negative pressure suction device to the rear end of the operating component, the blockage problem that may be caused by connecting the negative pressure suction device to the conventional water outlet interface in the prior art (equivalent to using the water outlet interface as a suction interface) can be avoided, thereby making the negative pressure suction effect smoother.
附图说明BRIEF DESCRIPTION OF THE DRAWINGS
图1是现有技术中一种膀胱电切镜的结构示意图;FIG1 is a schematic structural diagram of a cystoscopic resectoscope in the prior art;
图2是本发明一个实施例中的带负压吸引的咬切内窥镜系统的结构示意图;FIG2 is a schematic structural diagram of a cutting endoscope system with negative pressure suction in one embodiment of the present invention;
图3是本发明实施例中的咬切部件的立体示意图;FIG3 is a perspective schematic diagram of a cutting component in an embodiment of the present invention;
图4是本发明实施例中的外鞘的前端部的径向截面示意图;4 is a schematic diagram of a radial cross-section of the front end portion of the outer sheath in an embodiment of the present invention;
图5是本发明实施例中的标本采集装置的拆解示意图;FIG5 is a schematic diagram of a disassembled specimen collection device in an embodiment of the present invention;
图6是本发明实施例中的内芯的结构示意图;FIG6 is a schematic diagram of the structure of the inner core in an embodiment of the present invention;
图7是本发明实施例中的外鞘的结构示意图;FIG7 is a schematic diagram of the structure of the outer sheath in an embodiment of the present invention;
图8是本发明另一个实施例中的带负压吸引的咬切内窥镜系统的结构示意图;FIG8 is a schematic structural diagram of a cutting endoscope system with negative pressure suction in another embodiment of the present invention;
图9是本发明另一个实施例中的外鞘前端部、咬切部件以及吸引管的径向截面示意图。9 is a schematic radial cross-sectional view of the front end portion of the outer sheath, the cutting component and the suction tube in another embodiment of the present invention.
具体实施方式DETAILED DESCRIPTION
下面详细描述本发明的实施例,所述实施例的示例在附图中示出,其中自始至终相同或类似的标号表示相同或类似的元件或具有相同或类似功能的元件。下面通过参考附图描述的实施例是示例性的,旨在用于解释本发明,而不能理解为对本发明的限制。Embodiments of the present invention are described in detail below, examples of which are shown in the accompanying drawings, wherein the same or similar reference numerals throughout represent the same or similar elements or elements having the same or similar functions. The embodiments described below with reference to the accompanying drawings are exemplary and are intended to be used to explain the present invention, and should not be construed as limiting the present invention.
在本发明的描述中,需要理解的是,术语″中心″、″纵向″、″横向″、″长度″、″宽度″、″厚度″、″上″、″下″、″前″、″后″、″左″、″右″、″竖直″、″水平″、″顶″、″底″″内″、″外″、″顺时针″、″逆时针″等指示的方位或位置关系为基于附图所示的方位或位置关系,仅是为了便于描述本发明和简化描述,而不是指示或暗示所指的装置或元件必须具有特定的方位、以特定的方位构造和操作,因此不能理解为对本发明的限制。In the description of the present invention, it needs to be understood that the terms "center", "longitudinal", "lateral", "length", "width", "thickness", "up", "down", "front", "back", "left", "right", "vertical", "horizontal", "top", "bottom", "inside", "outside", "clockwise", "counterclockwise" and the like indicate orientations or positional relationships based on the orientations or positional relationships shown in the accompanying drawings, and are only for the convenience of describing the present invention and simplifying the description, and do not indicate or imply that the referred device or element must have a specific orientation, be constructed and operated in a specific orientation, and therefore should not be understood as limiting the present invention.
此外,术语″第一″、″第二″仅用于描述目的,而不能理解为指示或暗示相对重要性或者隐含指明所指示的技术特征的数量。由此,限定有″第一″、″第二″的特征可以明示或者隐含地包括一个或者更多个该特征。在本发明的描述中,″多个″的含义是两个或两个以上,除非另有明确具体的限定。In addition, the terms "first" and "second" are used for descriptive purposes only and should not be understood as indicating or implying relative importance or implicitly indicating the number of the indicated technical features. Therefore, the features defined as "first" and "second" may explicitly or implicitly include one or more of the features. In the description of the present invention, "plurality" means two or more, unless otherwise clearly and specifically defined.
在本发明中,除非另有明确的规定和限定,术语″安装″、″相连″、″连接″、″固定″等术语应做广义理解,例如,可以是固定连接,也可以是可拆卸连接,或一体地连接;可以是机械连接,也可以是电连接;可以是直接相连,也可以通过中间媒介间接相连,可以是两个元件内部的连通。对于本领域的普通技术人员而言,可以根据具体情况理解上述术语在本发明中的具体含义。In the present invention, unless otherwise clearly specified and limited, the terms "install", "connect", "connect", "fix" and the like should be understood in a broad sense, for example, it can be a fixed connection, a detachable connection, or an integral connection; it can be a mechanical connection or an electrical connection; it can be a direct connection, or it can be an indirect connection through an intermediate medium, or it can be the internal communication of two components. For ordinary technicians in this field, the specific meanings of the above terms in the present invention can be understood according to specific circumstances.
在本发明中,除非另有明确的规定和限定,第一特征在第二特征之″上″或之″下″可以包括第一和第二特征直接接触,也可以包括第一和第二特征不是直接接触而是通过它们之间的另外的特征接触。而且,第一特征在第二特征″之上″、″上方″和″上面″包括第一特征在第二特征正上方和斜上方,或仅仅表示第一特征水平高度高于第二特征。第一特征在第二特征″之下″、″下方″和″下面″包括第一特征在第二特征正上方和斜上方,或仅仅表示第一特征水平高度小于第二特征。In the present invention, unless otherwise clearly stipulated and limited, a first feature being "above" or "below" a second feature may include that the first and second features are in direct contact, or may include that the first and second features are not in direct contact but are in contact through another feature between them. Moreover, a first feature being "above", "above" and "above" a second feature includes that the first feature is directly above and obliquely above the second feature, or simply means that the first feature is higher in level than the second feature. A first feature being "below", "below" and "below" a second feature includes that the first feature is directly above and obliquely above the second feature, or simply means that the first feature is lower in level than the second feature.
现有技术中,实施经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌,通常采用的医疗器械为电切镜。如图1所示,现有技术中的一种电切镜结构包括:内窥镜组件17、鞘套组件(包括外鞘11以及内鞘12)、电极15以及电切镜手柄(包括握柄13和握环16),所述鞘套组件和内窥镜组件17分别安装于管柱18的前后两端,所述电极15的后端与滑块14连接,所述滑块14能够沿管柱12的轴向滑动以带动电极15前后移动。In the prior art, a medical device commonly used for transurethral bladder tumor electroresection for the treatment of non-muscle invasive bladder cancer is an electrosurgical resectoscope. As shown in FIG1 , a structure of an electrosurgical resectoscope in the prior art includes: an endoscope assembly 17, a sheath assembly (including an outer sheath 11 and an inner sheath 12), an electrode 15, and an electrosurgical resectoscope handle (including a grip 13 and a grip ring 16), wherein the sheath assembly and the endoscope assembly 17 are respectively mounted on the front and rear ends of a pipe column 18, and the rear end of the electrode 15 is connected to a slider 14, and the slider 14 can slide along the axial direction of the pipe column 12 to drive the electrode 15 to move forward and backward.
电极15沿内鞘12后端部插入并伸出内鞘12前端部的部分为实施电切割的手术电极10。手术电极通常有汽化滚状电极、铲状电极、电切环、切开环和切肿瘤环五种,分别作不同的电切、汽化和电凝用。其中,汽化滚状电极可使病变组织加热至汽化温度,铲状电极可同时完成电切和凝血,切肿瘤环可专门用于肿瘤电切。The electrode 15 is inserted along the rear end of the inner sheath 12 and extends out of the front end of the inner sheath 12 to form a surgical electrode 10 for performing electrical cutting. There are five types of surgical electrodes, namely, a vaporizing roller electrode, a shovel electrode, an electrical cutting ring, an incision ring and a tumor cutting ring, which are used for different electrical cutting, vaporization and electrocoagulation respectively. Among them, the vaporizing roller electrode can heat the diseased tissue to the vaporization temperature, the shovel electrode can perform electrical cutting and coagulation at the same time, and the tumor cutting ring can be used specifically for tumor electrical cutting.
无论采用哪种手术电极,但凡在肿瘤电切过程中存在低频电流,便有可能引发闭孔神经反射的问题,针对该问题,本申请发明人认为TURBT术中闭孔神经反射的根本原因在于″电切″本身,只要采用″电切″的方式切割肿瘤组织便有可能产生低频电流,现有技术中无论采用何种方式规避或减轻闭孔神经反射,却仍然无法脱离″电切″,也就难以从根本上解决闭孔神经反射。因此,本申请发明人考虑应当跳出本领域技术人员的常规技术思维,若将″电切″变更为″机械切″,由于不需要在切割肿瘤组织的过程中″通电″,″低频电流″也就无从产生,从而能够根本上杜绝闭孔神经反射的产生,同时也不会发生组织烧灼的问题。Regardless of the type of surgical electrode used, as long as there is a low-frequency current during the electroresection of the tumor, it is possible to cause the obturator nerve reflex problem. In response to this problem, the inventors of the present application believe that the fundamental cause of the obturator nerve reflex in TURBT surgery lies in the "electroresection" itself. As long as the tumor tissue is cut by "electroresection", low-frequency current is likely to be generated. No matter what method is used in the prior art to circumvent or reduce the obturator nerve reflex, it is still impossible to get rid of "electroresection", and it is difficult to fundamentally solve the obturator nerve reflex. Therefore, the inventors of the present application consider that they should jump out of the conventional technical thinking of those skilled in the art. If "electroresection" is changed to "mechanical cutting", since there is no need to "energize" during the process of cutting the tumor tissue, "low-frequency current" will not be generated, thereby fundamentally eliminating the obturator nerve reflex, and at the same time, the problem of tissue burning will not occur.
基于上述设计理念,本发明技术方案提供一种带负压吸引的咬切内窥镜系统,通过将采用机械咬切方式切割肿瘤组织的咬切装置、冲洗装置和吸引切下的肿瘤组织的负压吸引装置集成于一体,能够相互配合完成肿瘤组织离断、清理和凝血,从而避免现有技术中的膀胱电切镜因混入低频电流而引发闭孔神经反射和组织烧灼的弊端,而且避免肿瘤组织漂浮种植的风险,缩短了手术时间,降低了手术风险及术后复发率。Based on the above design concept, the technical solution of the present invention provides a biting endoscope system with negative pressure suction. By integrating a biting device that cuts tumor tissue by mechanical biting, a flushing device and a negative pressure suction device that attracts the cut tumor tissue into one, they can cooperate with each other to complete tumor tissue severance, cleaning and coagulation, thereby avoiding the disadvantages of the bladder electrosurgical resectoscope in the prior art that causes obturator nerve reflex and tissue burning due to mixing with low-frequency current, and avoiding the risk of floating tumor tissue implantation, shortening the operation time, and reducing the operation risk and postoperative recurrence rate.
需要指出的是,本发明技术方案提供的带负压吸引的咬切内窥镜系统,尤其适于作为经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的医疗器械,但是本领域技术人员容易理解,该带负压吸引的咬切内窥镜系统不局限于应用在治疗膀胱癌(此时具体作为″带负压吸引的咬切膀胱镜系统″,详见后续实施例),例如也可以用于子宫腔内检查和治疗,此时则具体作为″带负压吸引的咬切宫腔镜系统″。It should be pointed out that the biting endoscope system with negative pressure suction provided by the technical solution of the present invention is particularly suitable as a medical device for transurethral bladder tumor electroresection to treat non-muscle invasive bladder cancer. However, it is easy for those skilled in the art to understand that the biting endoscope system with negative pressure suction is not limited to the treatment of bladder cancer (in this case, it is specifically referred to as a "biting cystoscope system with negative pressure suction", see subsequent embodiments for details), for example, it can also be used for intrauterine cavity inspection and treatment, in this case, it is specifically referred to as a "biting hysteroscope system with negative pressure suction".
为使本发明的上述目的、特征和优点能够更为明显易懂,下面结合附图对本发明的具体实施例作详细的说明。In order to make the above-mentioned objects, features and advantages of the present invention more obvious and easy to understand, specific embodiments of the present invention are described in detail below with reference to the accompanying drawings.
如图2所示,本发明的一个实施例提供一种带负压吸引的咬切内窥镜系统,其包括:外鞘22、咬切装置、摄像装置(图2中仅示出咬切装置的操作部件后端部上的摄像接口262)、冲洗装置(图2中仅示出与外鞘22连接的进水接口272和出水接口273)和负压吸引装置(图2中仅示出其包含的吸引皮管251a、251b,未示出吸引泵);所述咬切装置包括依次相连的操作部件(包括握持部件231和触发部件232)、驱动杆21和咬切部件20,所述咬切部件20和驱动杆21能由所述外鞘22的后端部插入并从所述外鞘22的前端部221伸出,所述操作部件与所述外鞘22的后端部连接固定;所述咬切部件20包括上咬合面201和下咬合面202,所述上咬合面201和下咬合面202内侧前端均周边分布有咬切齿203,所述咬切齿203能在所述上咬合面201和下咬合面202相对闭合执行咬切操作后对被咬切对象形成咬切力;所述操作部件适于触发所述咬切操作,其具体可以包括适于操作者进行握持的握持部件231以及适于触发所述咬切操作的触发部件232;所述上咬合面201和下咬合面202相对闭合后形成容纳目标物的空间,所述目标物为所述被咬切对象在经过所述咬切操作后所切下的部分;结合图4,所述摄像装置的摄像头261以及所述冲洗装置的注水孔271设置于所述外鞘22的前端部221;本实施例中,所述冲洗装置还包括设置于所述外鞘22的出水接口273,所述负压吸引装置连接于所述冲洗装置的出水接口273,适于通过负压吸引的方式使所述目标物被吸出体外,此时相当于将该出水接口273作为负压吸引装置的吸引接口。As shown in FIG2 , one embodiment of the present invention provides a cutting endoscope system with negative pressure suction, which includes: an outer sheath 22, a cutting device, a camera device (only the camera interface 262 on the rear end of the operating component of the cutting device is shown in FIG2 ), a flushing device (only the water inlet interface 272 and the water outlet interface 273 connected to the outer sheath 22 are shown in FIG2 ) and a negative pressure suction device (only the suction leather tubes 251a and 251b included therein are shown in FIG2 , and the suction pump is not shown); the cutting device includes a plurality of The outer sheath 22 is provided with an operating part (including a gripping part 231 and a triggering part 232), a driving rod 21 and a biting part 20. The biting part 20 and the driving rod 21 can be inserted from the rear end of the outer sheath 22 and extended from the front end 221 of the outer sheath 22. The operating part is connected and fixed to the rear end of the outer sheath 22. The biting part 20 includes an upper biting surface 201 and a lower biting surface 202. The inner front ends of the upper biting surface 201 and the lower biting surface 202 are both peripherally distributed with biting teeth 203. The biting teeth 203 can form a biting force on the bitten object after the upper biting surface 201 and the lower biting surface 202 are relatively closed to perform a biting operation; the operating component is suitable for triggering the biting operation, which may specifically include a holding component 231 suitable for an operator to hold and a trigger component 232 suitable for triggering the biting operation; the upper biting surface 201 and the lower biting surface 202 are relatively closed to form a space for accommodating a target object, and the target object is the part of the bitten object cut off after the biting operation; in conjunction with Figure 4, the camera 261 of the camera device and the water injection hole 271 of the flushing device are arranged at the front end 221 of the outer sheath 22; in this embodiment, the flushing device also includes a water outlet interface 273 arranged on the outer sheath 22, and the negative pressure suction device is connected to the water outlet interface 273 of the flushing device, which is suitable for sucking the target object out of the body by negative pressure suction, which is equivalent to using the water outlet interface 273 as the suction interface of the negative pressure suction device.
结合图2和图4,所述外鞘22的前端部221还设有光源241;所述操作部件的后端部还设置有所述摄像装置的摄像接口262以及连接所述光源的光源接口242。在实际实施时,所述外鞘22的前端部221使用绝缘材料,所述光源241与由优质导光纤维制造的光缆连接。在其他实施例中,也可以采用光源与摄像头集成在一起的实现方式,即采用自带光源的摄像头。In conjunction with Fig. 2 and Fig. 4, the front end portion 221 of the outer sheath 22 is also provided with a light source 241; the rear end portion of the operating component is also provided with a camera interface 262 of the camera device and a light source interface 242 connected to the light source. In actual implementation, the front end portion 221 of the outer sheath 22 uses insulating material, and the light source 241 is connected to an optical cable made of high-quality light-conducting fiber. In other embodiments, the light source and the camera can also be integrated together, that is, a camera with its own light source can be used.
在具体实施时,所述冲洗装置还包括设置于外鞘22内供灌洗液进出的通道,灌洗液依次通过进水接口272、设置于外鞘22内的该通道,从注水孔271流出实现对被咬切对象及其周边部位的冲洗操作,冲洗操作完成后可通过负压吸引将灌洗液由出水接口273吸出。In a specific implementation, the flushing device also includes a channel arranged in the outer sheath 22 for the entry and exit of the irrigation liquid. The irrigation liquid passes through the water inlet interface 272 and the channel arranged in the outer sheath 22 in turn, and flows out from the water injection hole 271 to realize the flushing operation of the bitten object and its surrounding parts. After the flushing operation is completed, the irrigation liquid can be sucked out from the water outlet interface 273 by negative pressure suction.
本实施例中,所述带负压吸引的咬切内窥镜系统包含有所述冲洗装置及其包含的进水接口272、注水孔271和出水接口273,而在其他实施例中,所述冲洗装置并非必需,仅仅包含吸引接口即可通过负压吸引的方式将咬切下的肿瘤组织吸出体外,此时所述吸引接口相当于本实施例中的出水接口273。In this embodiment, the cutting endoscope system with negative pressure suction includes the flushing device and the water inlet interface 272, water injection hole 271 and water outlet interface 273 included therein, while in other embodiments, the flushing device is not necessary and only includes a suction interface to suck the cut tumor tissue out of the body by negative pressure suction. In this case, the suction interface is equivalent to the water outlet interface 273 in this embodiment.
需要说明的是,本发明实施例中所指的″前″和″后″为相对概念,以″外鞘22″的″前端部″和″后端部″为例,将外鞘22的两端中靠近被咬切对象的一侧称为″前端部″,将远离被咬切对象(靠近操作者)的一侧称为″后端部″。本发明实施例中其他涉及″前端部″和″后端部″的部件或装置也可参照上述说明理解。It should be noted that the "front" and "rear" referred to in the embodiments of the present invention are relative concepts. Taking the "front end" and "rear end" of the "outer sheath 22" as an example, the side of the two ends of the outer sheath 22 close to the object to be cut is called the "front end", and the side away from the object to be cut (close to the operator) is called the "rear end". Other components or devices related to the "front end" and "rear end" in the embodiments of the present invention can also be understood with reference to the above description.
本发明实施例中所指的被咬切对象,具体为膀胱内病变组织(肿瘤组织),而所述目标物则具体是通过咬切操作切割下的部分肿瘤组织,由于依靠咬切装置执行的咬切操作并不一定是一次便能够完成的,也可能存在多次执行咬切操作的情况,因此目标物的数量也会是多个。The object to be bitten referred to in the embodiment of the present invention is specifically the diseased tissue (tumor tissue) in the bladder, and the target object is specifically the part of the tumor tissue cut off by the biting operation. Since the biting operation performed by the biting device is not necessarily completed in one time, and the biting operation may be performed multiple times, the number of target objects may also be multiple.
结合图2和图3,本实施例中,所述咬切部件20呈鲨鱼嘴结构或鳄鱼嘴结构,上咬合面201和下咬合面202分别相当于″鲨鱼嘴″或″鳄鱼嘴″的上下颚,咬切齿203则相当于″鲨鱼嘴″或″鳄鱼嘴″上下颚上的牙齿,咬切操作则相当于″鲨鱼嘴″或″鳄鱼嘴″用牙齿咬住并切断食物含在嘴中。2 and 3 , in this embodiment, the biting component 20 is in the form of a shark mouth structure or a crocodile mouth structure, the upper biting surface 201 and the lower biting surface 202 are respectively equivalent to the upper and lower jaws of a "shark mouth" or a "crocodile mouth", the biting teeth 203 are equivalent to the teeth on the upper and lower jaws of a "shark mouth" or a "crocodile mouth", and the biting operation is equivalent to the "shark mouth" or "crocodile mouth" biting and cutting the food with its teeth and holding it in the mouth.
实际实施时,为了使咬切操作的实施更为简易,所述下咬合面202与所述驱动杆204的前端可以固定连接,所述上咬合面201则通过枢转件204与所述驱动杆204的前端可以活动连接,此时通过驱动上咬合面201向下咬合面202相对运动实施咬合操作。在其他实施例中,也可以使上咬合面201、下咬合面202均设置为通过另一枢转件(结构上区别于枢转件204)与驱动杆204的前端活动连接,上咬合面201、下咬合面202同时相对运动实施咬合操作。In actual implementation, in order to make the bite operation easier to implement, the lower bite surface 202 can be fixedly connected to the front end of the driving rod 204, and the upper bite surface 201 can be movably connected to the front end of the driving rod 204 through the pivot 204, and the bite operation is implemented by driving the upper bite surface 201 to move relative to the lower bite surface 202. In other embodiments, the upper bite surface 201 and the lower bite surface 202 can also be configured to be movably connected to the front end of the driving rod 204 through another pivot (structurally different from the pivot 204), and the upper bite surface 201 and the lower bite surface 202 can move relative to each other at the same time to implement the bite operation.
所述咬合操作是通过操作者使触发部件232向握持部件231方向运动,触发部件232通过铰链部件与滑块233相连接,滑块233能够沿驱动杆21的轴向滑动以使驱动杆21驱动咬切部件20执行咬切操作(上咬合面201向下咬合面202相对运动而闭合),而操作者释放施加在触发部件232上的力,则所述铰链部件产生的复位力会带动滑块233回到初始位置,使驱动杆21驱动咬切部件20的上咬合面201远离下咬合面202,直至回到初始位置。The biting operation is performed by the operator moving the trigger component 232 toward the holding component 231. The trigger component 232 is connected to the slider 233 through a hinge component. The slider 233 can slide along the axial direction of the drive rod 21 so that the drive rod 21 drives the biting component 20 to perform a biting operation (the upper biting surface 201 moves relative to the lower biting surface 202 and closes). When the operator releases the force applied to the trigger component 232, the reset force generated by the hinge component will drive the slider 233 back to the initial position, so that the drive rod 21 drives the upper biting surface 201 of the biting component 20 away from the lower biting surface 202 until it returns to the initial position.
上述操作部件驱动实现咬切部件的咬切操作,其实质上为被动式操作方式,可以参考现有技术中电切镜驱动诸如夹持部件的夹持操作的实现过程,从技术原理上来说是大致类似的,有所区别的只是驱动对象(本申请技术方案中为咬切装置,现有技术中通常为夹持装置)的差别,因此此处不再详细展开描述。本领域技术人员容易理解的是,在其他实施例中,也可以采用主动式操作方式的操作部件实现咬切操作。The above-mentioned operating component drives the biting operation of the biting component, which is essentially a passive operation mode. The implementation process of the prior art in which the resectoscope drives the clamping operation of the clamping component can be referred to. The technical principle is roughly similar, and the only difference is the driving object (the biting device in the technical solution of this application, and the clamping device in the prior art), so it will not be described in detail here. It is easy for those skilled in the art to understand that in other embodiments, the biting operation can also be achieved by using an operating component with an active operation mode.
本实施例中,所述上咬合面201和下咬合面202执行咬切操作后,两者相对闭合能够形成容纳所切割下的肿瘤组织的空间,其类似于鲨鱼将用嘴咬切下的猎物一部分身体置于嘴中。由于被咬切掉下来的肿瘤组织被所述空间所包容,此时依靠负压吸引装置能够更精准地实现对该肿瘤组织的负压吸引操作,且能够在不接触其余膀胱内壁前提下吸出肿瘤组织,因此也就不会使负压吸引操作对膀胱内壁造成意外损伤。In this embodiment, after the upper occlusal surface 201 and the lower occlusal surface 202 perform the biting operation, the two are relatively closed to form a space for accommodating the cut tumor tissue, which is similar to a shark biting off a part of the prey and placing it in its mouth. Since the cut tumor tissue is contained in the space, the negative pressure suction device can more accurately perform the negative pressure suction operation on the tumor tissue, and the tumor tissue can be sucked out without contacting the rest of the bladder inner wall, so the negative pressure suction operation will not cause accidental damage to the bladder inner wall.
需要说明的是,现有技术中的膀胱电切镜,也会包含端部类似夹持部件的附件装置,然而这些附件装置仅仅能够起到对肿瘤组织或者其他对象的夹持作用,并不具有″机械咬切″的功能,更不可能实现将″电切″方式切割下的肿瘤组织完全包容起来,也就难以与负压吸引装置相结合达到上述技术效果。It should be noted that the cystoscopic resectoscope in the prior art also includes an accessory device similar to a clamping component at the end. However, these accessory devices can only clamp the tumor tissue or other objects, and do not have the function of "mechanical biting". It is even more impossible to completely contain the tumor tissue cut by the "electrical cutting" method, and it is difficult to combine with the negative pressure suction device to achieve the above-mentioned technical effect.
结合图2和图5,本实施例中,所述带负压吸引的咬切内窥镜系统还包括标本采集装置,所述标本采集装置包括入口端和出口端的两个皮管接口281、标本杯282以及设于所述标本杯282内适于收集所述目标物(负压吸引装置所吸入的肿瘤组织)的过滤网283;所述负压吸引装置包括吸引皮管251a、251b和吸引泵(附图中未示出),所述标本采集装置的入口端和出口端的两个皮管接口281通过所述吸引皮管251a、251b分别与所述吸引泵以及所述冲洗装置的出水接口273相连。In combination with Figures 2 and 5, in this embodiment, the cutting endoscope system with negative pressure suction also includes a specimen collection device, which includes two leather tube interfaces 281 at the inlet and outlet ends, a specimen cup 282, and a filter net 283 arranged in the specimen cup 282 and suitable for collecting the target object (tumor tissue sucked in by the negative pressure suction device); the negative pressure suction device includes suction leather tubes 251a, 251b and a suction pump (not shown in the drawings), and the two leather tube interfaces 281 at the inlet and outlet ends of the specimen collection device are respectively connected to the suction pump and the water outlet interface 273 of the flushing device through the suction leather tubes 251a, 251b.
参阅图5,在实际实施时,标本采集装置的入口端和出口端的两个皮管接口281与标本杯283的两端、吸引皮管251a、251b均为可拆卸连接。当标本杯283通过负压吸引的方式采集到标本之后,便可以将两个皮管接口281与标本杯283的两端拆卸分离,然后将预制的盖子将标本杯283的两端重新密封后送检。本实施例中,所述带负压吸引的咬切内窥镜系统还包括设置于所述标本杯283的两端的可控阀门282,所述可控阀门282适于使所述标本杯283两端处于封闭或畅通状态。具体实施时,可以通过旋转的方式控制可控阀门282开启或关闭,若可控阀门282处于开启状态,则可以进行负压吸引操作,若标本杯283采集到标本,则可以将可控阀门282关闭,再使位于标本杯283两端的可控阀门282与两个皮管接口281相分离,拆下带有可控阀门282的标本杯283即可送检。所述可控阀门282的具体结构可以参考现有技术中的成熟方案,此处不再详细描述。Referring to FIG. 5 , in actual implementation, the two leather tube interfaces 281 at the inlet and outlet ends of the specimen collection device are detachably connected to the two ends of the specimen cup 283 and the suction leather tubes 251a and 251b. After the specimen cup 283 collects the specimen by negative pressure suction, the two leather tube interfaces 281 can be detached from the two ends of the specimen cup 283, and then the two ends of the specimen cup 283 are resealed with a prefabricated cover and sent for inspection. In this embodiment, the bite-cutting endoscope system with negative pressure suction also includes controllable valves 282 disposed at the two ends of the specimen cup 283, and the controllable valves 282 are suitable for making the two ends of the specimen cup 283 in a closed or unobstructed state. In specific implementation, the controllable valve 282 can be controlled to open or close by rotating. If the controllable valve 282 is in the open state, a negative pressure suction operation can be performed. If the specimen cup 283 collects a specimen, the controllable valve 282 can be closed, and then the controllable valves 282 at both ends of the specimen cup 283 are separated from the two leather tube interfaces 281. The specimen cup 283 with the controllable valve 282 can be removed for inspection. The specific structure of the controllable valve 282 can refer to the mature solutions in the prior art, and will not be described in detail here.
本发明实施例中,通过在负压吸引的过程中设置标本采集装置,并依靠其中的过滤网阻挡被咬切下的肿瘤组织,从而使其能够保留在标本杯中,可以解决微小标本的收集问题,且可拆卸的标本杯也能够方便地采集到切下的肿瘤组织并独立送检,从而使标本的采集更为便捷,也加快了将标本送检的速度。进一步地,通过设置标本杯的两端的可控阀门,既不影响负压吸引的实施,又使得拆卸下的标本杯便能处于密封状态,无需另外再给标本杯盖上额外的盖子予以封装,从而能够更便捷地实现将采集的标本送检。In the embodiment of the present invention, by setting a specimen collection device during the negative pressure suction process, and relying on the filter screen therein to block the tumor tissue that is bitten and cut, so that it can be retained in the specimen cup, the problem of collecting tiny specimens can be solved, and the detachable specimen cup can also easily collect the cut tumor tissue and send it for inspection independently, so that the specimen collection is more convenient and the speed of sending the specimen for inspection is accelerated. Furthermore, by setting controllable valves at both ends of the specimen cup, it does not affect the implementation of negative pressure suction, and the disassembled specimen cup can be in a sealed state, without the need to cover the specimen cup with an additional lid for sealing, so that the collected specimen can be sent for inspection more conveniently.
本发明实施例中,所述带负压吸引的咬切内窥镜系统还可以包括与所述咬切部件20相连的电极(附图中未示出,可以通过中空的驱动杆21的内部布设导线连接所述咬切部件20),所述驱动杆21外包覆绝缘层,所述咬切部件20还适于在所述上咬合面201和下咬合面202相对闭合的状态下作为电凝止血部件或电切割部件。本实施例中,所述操作部件的后端部还包括与所述电极相连的电极插座291,用于所述咬切部件20在作为电凝止血部件时的供电与控制,所述控制包括电流、电压的大小控制以及触发控制等,所述触发控制可以通过踏板的方式实现,操作者在需要实施所述咬切部件20的电凝止血操作时,只需要在设置好相应参数的情况下踏下所述踏板即可完成相应的触发操作。虽然本发明实施例提供的带负压吸引的咬切内窥镜系统主要通过咬切装置实施对于肿瘤组织的咬切操作,但是其并非唯一方式,因为在实际实施时,除了存在止血的需要,还可能存在仅依靠机械切割力量难以较好完成切断肿瘤组织的情况,因此本实施例中利用处于闭合状态的″鲨鱼嘴结构″咬切部件20还可以实现电凝止血和电切割的功能。通过使″鲨鱼嘴结构″咬切部件导电(高频电流),可以实现在离断组织的创面进行电凝操作以及时止血,且使电凝面积得以增大(咬切部件作为电凝止血部件时的接触面积比常规的手术电极更大),同时避免需要更换止血器械;同时,在一些机械力量无法很好切断的肿瘤组织,仍然能够通过电切割(此时所述咬切部件20作为电切割部件,相应的电流、电压等参数不同于所述咬切部件20作为电凝止血部件时的参数)的方式进行离断,提高效率。因此,本发明实施例中的带负压吸引的咬切内窥镜系统能够同时拥有机械切割和电切割两种针对肿瘤组织的切割方式,其实施方式也更为灵活。In an embodiment of the present invention, the biting endoscope system with negative pressure suction may further include an electrode connected to the biting component 20 (not shown in the accompanying drawings, the biting component 20 may be connected by laying a wire inside the hollow driving rod 21), the driving rod 21 is covered with an insulating layer, and the biting component 20 is also suitable for being used as an electrocoagulation hemostasis component or an electric cutting component when the upper biting surface 201 and the lower biting surface 202 are relatively closed. In this embodiment, the rear end of the operating component also includes an electrode socket 291 connected to the electrode, which is used for power supply and control of the biting component 20 when it is used as an electrocoagulation hemostasis component. The control includes current and voltage magnitude control and trigger control, etc. The trigger control can be achieved by a pedal. When the operator needs to implement the electrocoagulation hemostasis operation of the biting component 20, he only needs to step on the pedal after setting the corresponding parameters to complete the corresponding trigger operation. Although the bite-cutting endoscope system with negative pressure suction provided in the embodiment of the present invention mainly implements the bite-cutting operation of tumor tissue through the bite-cutting device, it is not the only way, because in actual implementation, in addition to the need for hemostasis, there may also be a situation where it is difficult to complete the cutting of tumor tissue by relying solely on mechanical cutting force. Therefore, in this embodiment, the "shark mouth structure" bite-cutting component 20 in a closed state can also realize the functions of electrocoagulation hemostasis and electrocutting. By making the "shark mouth structure" bite-cutting component conductive (high-frequency current), electrocoagulation operation can be performed on the wound surface of the severed tissue to stop bleeding in time, and the electrocoagulation area can be increased (the contact area of the bite-cutting component as an electrocoagulation hemostasis component is larger than that of a conventional surgical electrode), while avoiding the need to replace the hemostasis device; at the same time, in some tumor tissues that cannot be cut well by mechanical force, they can still be cut by electrocutting (at this time, the bite-cutting component 20 is used as an electrocutting component, and the corresponding current, voltage and other parameters are different from the parameters when the bite-cutting component 20 is used as an electrocoagulation hemostasis component), thereby improving efficiency. Therefore, the cutting endoscope system with negative pressure suction in the embodiment of the present invention can simultaneously have two cutting methods for tumor tissue, namely mechanical cutting and electrical cutting, and its implementation method is also more flexible.
本领域技术人员知晓,高频电流在通过人体时对神经并无刺激作用,之所以会产生ONR,是因为在高频电流中混有低频电流。当切割侧壁肿瘤时,电切环产生电流流经闭孔,刺激闭孔神经。由于电凝模式下的电流频率较高,无引发ONR的低频电流,故无ONR发生。因此,本实施例中通过″鲨鱼嘴结构″咬切部件20实现电凝止血的功能,并不会引发ONR的风险,而在依靠″鲨鱼嘴结构″咬切部件20实现电切割功能时,则可以进一步根据肿瘤所处的位置评估ONR发生风险的可能性大小而决定是否启用电切割功能,选择余地更大,仍然能够从整体上降低ONR发生风险。Those skilled in the art know that high-frequency current has no stimulating effect on nerves when passing through the human body. ONR occurs because low-frequency current is mixed in the high-frequency current. When cutting the side wall tumor, the electric cutting ring generates current that flows through the obturator foramen, stimulating the obturator nerve. Since the current frequency in the electrocoagulation mode is relatively high, there is no low-frequency current that triggers ONR, so no ONR occurs. Therefore, in this embodiment, the electrocoagulation hemostasis function is achieved by the "shark mouth structure" biting part 20, and there is no risk of ONR. When the electric cutting function is achieved by relying on the "shark mouth structure" biting part 20, the possibility of the risk of ONR can be further evaluated according to the location of the tumor to decide whether to enable the electric cutting function. There is more room for choice, and the risk of ONR can still be reduced overall.
结合图6和图7,本发明实施例中,所述带负压吸引的咬切内窥镜系统还包括内芯,所述内芯包括柱体部件301及其前端的探测部件302(其形状特征适于进入人体直达膀胱位置),所述内芯能由所述外鞘22的后端部插入并从所述外鞘22的前端部221伸出。本领域技术人员知晓,内芯的作用主要是用于完成穿刺操作进入人体内,后续使包含外鞘22(前端部221含摄像头261、注水孔271和光源241)、驱动杆21以及咬切部件20在内的组件到达可以观测肿瘤组织以及对肿瘤组织进行各项操作(例如切割操作)的位置。在通过内芯完成上述功能之后,可以将其从外鞘22抽出,而后再将咬切装置包含的咬切部件20和驱动杆21由外鞘22的后端部插入并从外鞘22的前端部221伸出,执行观测和治疗的相关操作。由于内窥镜涉及的内芯及其所实现的功能为本领域的常规技术手段,此处不再赘述。In conjunction with Fig. 6 and Fig. 7, in an embodiment of the present invention, the bite endoscope system with negative pressure suction also includes an inner core, the inner core includes a columnar component 301 and a detection component 302 at its front end (its shape feature is suitable for entering the human body directly to the bladder position), and the inner core can be inserted from the rear end of the outer sheath 22 and extended from the front end 221 of the outer sheath 22. Those skilled in the art know that the role of the inner core is mainly to complete the puncture operation into the human body, and then make the components including the outer sheath 22 (the front end 221 includes a camera 261, a water injection hole 271 and a light source 241), the driving rod 21 and the bite component 20 reach a position where the tumor tissue can be observed and various operations (such as cutting operations) can be performed on the tumor tissue. After the inner core completes the above functions, it can be extracted from the outer sheath 22, and then the bite component 20 and the driving rod 21 included in the bite device are inserted from the rear end of the outer sheath 22 and extended from the front end 221 of the outer sheath 22 to perform related operations of observation and treatment. Since the inner core involved in the endoscope and the functions it realizes are conventional technical means in this field, they will not be described in detail here.
在上述实施例中,通过将出水接口273作为负压吸引装置的吸引接口,能够充分利用现有技术中电切镜的相关组件,实现相关的负压吸引功能。然而,本申请发明人意识到,现有技术中常规的出水接口通常仅仅适用于完成冲洗之后的排水,其管路设置较小且存在一定曲折,若是将该出水接口作为吸引接口使用,这就容易导致堵塞问题的产生,毕竟吸引的对象中还包含切下的肿瘤组织,仅仅依靠排水的管路是完全有可能发生堵塞而使吸引不畅。In the above embodiment, by using the water outlet interface 273 as the suction interface of the negative pressure suction device, the relevant components of the resectoscope in the prior art can be fully utilized to achieve the relevant negative pressure suction function. However, the inventor of the present application realizes that the conventional water outlet interface in the prior art is usually only suitable for drainage after flushing, and its pipeline is small and has certain twists and turns. If the water outlet interface is used as the suction interface, it is easy to cause blockage problems. After all, the object to be attracted also includes the cut tumor tissue. It is entirely possible that the pipeline that relies solely on drainage will be blocked and the suction will be blocked.
为此,本发明通过另一个实施例解决上述问题。如图8所示,本发明另一个实施例的带负压吸引的咬切内窥镜系统,其包括前述实施例中的所有组件,有所区别的是,负压吸引装置的连接方式和相关配件不同,此外还将摄像接口与光源接口的一体集成。To this end, the present invention solves the above problem through another embodiment. As shown in FIG8 , another embodiment of the present invention is a cutting endoscope system with negative pressure suction, which includes all the components in the above embodiments, except that the connection method and related accessories of the negative pressure suction device are different, and the camera interface and the light source interface are integrated.
继续参阅图8,具体地,所述驱动杆21的内部中空构造为吸引管腔274,所述负压吸引装置包括吸引皮管(吸引皮管251a、吸引皮管251b)、吸引泵和吸引接口273’,所述吸引接口273’设置于所述操作部件的后端部,所述吸引皮管分别连接所述吸引泵以及所述吸引接口273’,所述吸引管腔274与所述吸引接口273’连通。图8示出的驱动杆按照所处位置的不同可以分为三个驱动杆段,分别是伸出外鞘22的驱动杆段21a、插入并包含于外鞘22的驱动杆段21b以及位于操作部件的握持部件与触发部件之间的驱动杆段21c。驱动杆外包覆绝缘层,内部为中空结构(构造为吸引管腔274),可用于更便捷有效地吸引切下的肿瘤组织以及完成冲洗处理之后的灌洗液。Continuing to refer to FIG8 , specifically, the internal hollow structure of the driving rod 21 is a suction lumen 274, and the negative pressure suction device includes a suction leather tube (suction leather tube 251a, suction leather tube 251b), a suction pump and a suction interface 273’, wherein the suction interface 273’ is arranged at the rear end of the operating component, and the suction leather tube is respectively connected to the suction pump and the suction interface 273’, and the suction lumen 274 is connected to the suction interface 273’. The driving rod shown in FIG8 can be divided into three driving rod segments according to different positions, namely, the driving rod segment 21a extending out of the outer sheath 22, the driving rod segment 21b inserted into and contained in the outer sheath 22, and the driving rod segment 21c located between the gripping component and the triggering component of the operating component. The driving rod is coated with an insulating layer on the outside, and has a hollow structure (constructed as a suction lumen 274) inside, which can be used to more conveniently and effectively attract the excised tumor tissue and the irrigation fluid after the flushing treatment.
结合图8和图9,吸引管腔274的前端部与枢转件204’接近,该枢转件204’虽然其所起的作用与图2所示的枢转件204相同,但是其结构特点仍有所差别,本实施例中需要在枢转件204’中设计出能够适配于吸引管腔274前端部的开口,确保其能够顺利连通由第一咬合面201与第二咬合面202在执行咬切操作之后所构成的空间之中,类似于″鲨鱼嘴或鳄鱼嘴的咽喉″。此外,在吸引管腔274内还布设包覆绝缘材料的导线,该导线端部(未包覆绝缘材料)为电极292a和292b,电极292a连接上咬合面201,292b连接下咬合面202,从而实现上咬合面201与下咬合面202相对闭合状态下的电凝止血功能和电切割功能。In conjunction with Figures 8 and 9, the front end of the suction tube cavity 274 is close to the pivot 204'. Although the pivot 204' plays the same role as the pivot 204 shown in Figure 2, its structural features are still different. In this embodiment, it is necessary to design an opening in the pivot 204' that can adapt to the front end of the suction tube cavity 274 to ensure that it can smoothly connect to the space formed by the first occlusal surface 201 and the second occlusal surface 202 after the biting operation is performed, similar to the "throat of a shark's mouth or a crocodile's mouth." In addition, a wire coated with an insulating material is arranged in the suction tube cavity 274, and the ends of the wire (not coated with insulating material) are electrodes 292a and 292b. The electrode 292a is connected to the upper occlusal surface 201, and 292b is connected to the lower occlusal surface 202, thereby realizing the electrocoagulation hemostasis function and the electrocuting function when the upper occlusal surface 201 and the lower occlusal surface 202 are in a relatively closed state.
需要指出的是,由于本实施例中设置吸引接口273’,因此取消了第一个实施例中的出水接口273。本实施例中,通过将负压吸引装置的吸引接口设置于操作部件的后端部,且在驱动杆21内部构造为吸引管腔274,通过该吸引管腔274输送吸引的对象(切下的肿瘤组织和/或完成冲洗处理之后的灌洗液),可以避免因将现有技术中常规的出水接口作为负压吸引装置的吸引接口使用而可能产生的堵塞问题,从而使负压吸引作用更为通畅;此外,通过取消现有技术中常用的内鞘,也为吸引管腔274能够拥有足够大的吸引输送空间(即:径向截面尺寸足够大)提供了必要支撑,确保负压吸引作用得以顺利实施。It should be pointed out that, since the suction interface 273' is provided in this embodiment, the water outlet interface 273 in the first embodiment is cancelled. In this embodiment, by providing the suction interface of the negative pressure suction device at the rear end of the operating component, and constructing a suction lumen 274 inside the driving rod 21, the suction lumen 274 is used to transport the suction object (the excised tumor tissue and/or the irrigation fluid after the flushing treatment), which can avoid the blockage problem that may be caused by using the conventional water outlet interface in the prior art as the suction interface of the negative pressure suction device, thereby making the negative pressure suction effect smoother; in addition, by canceling the inner sheath commonly used in the prior art, it also provides necessary support for the suction lumen 274 to have a sufficiently large suction and delivery space (that is, the radial cross-sectional size is large enough), ensuring that the negative pressure suction effect can be smoothly implemented.
此外,由于第一个实施例中位于操作部件的后端部的摄像接口的位置已用于设置吸引接口373’,所以本实施例中可以将连接所述摄像装置的摄像接口与连接所述光源的光源接口一体集成,参考图8的摄像和光源一体化接口242’。In addition, since the position of the camera interface located at the rear end of the operating part in the first embodiment has been used to set the suction interface 373', the camera interface connected to the camera device and the light source interface connected to the light source can be integrated into one in this embodiment, refer to the camera and light source integrated interface 242' in Figure 8.
本实施例的其他实施内容可以参考第一个实施例中描述的相关内容,此处不再赘述。For other implementation contents of this embodiment, reference may be made to the relevant contents described in the first embodiment, which will not be repeated here.
本发明实施例提供的带负压吸引的咬切内窥镜系统,将采用机械咬切方式切割肿瘤组织的咬切装置、冲洗装置和吸引切下的肿瘤组织的负压吸引装置、标本采集装置集成于一体,彼此相互配合能够完成肿瘤组织离断、清理、凝血和标本采集送检的一气呵成,既能够使整个TURBT手术过程更为安全、便捷与高效,同时还能够更便捷、更高效地实现标本的采集与送检。The cutting endoscope system with negative pressure suction provided in the embodiment of the present invention integrates a cutting device for cutting tumor tissue by mechanical cutting, a flushing device, a negative pressure suction device for sucking the cut tumor tissue, and a specimen collection device. The devices cooperate with each other to complete the tumor tissue severance, cleaning, coagulation and specimen collection and inspection in one go, which can make the entire TURBT surgical process safer, more convenient and more efficient, and can also realize the collection and inspection of specimens more conveniently and efficiently.
此外,从整体结构来看,现有技术中常规的电切镜的鞘套组件通常都包括外鞘以及内鞘两个组件,而镜头、光源等部件均设置于内鞘之中,而本申请技术方案中取消了内鞘组件,而将摄像头、光源、注水孔等均集成于外鞘之上,整体集成度更高,一定程度上也降低了成本。In addition, from the perspective of the overall structure, the sheath assembly of a conventional electroresectoscope in the prior art usually includes two components, an outer sheath and an inner sheath, and the lens, light source and other components are all arranged in the inner sheath. However, in the technical solution of the present application, the inner sheath assembly is eliminated, and the camera, light source, water injection hole, etc. are integrated on the outer sheath, which has a higher overall integration and reduces the cost to a certain extent.
本发明虽然已以较佳实施例公开如上,但其并不是用来限定本发明,任何本领域技术人员在不脱离本发明的精神和范围内,都可以利用上述揭示的方法和技术内容对本发明技术方案做出可能的变动和修改,因此,凡是未脱离本发明技术方案的内容,依据本发明的技术实质对以上实施例所作的任何简单修改、等同变化及修饰,均属于本发明技术方案的保护范围。Although the present invention has been disclosed as above in the form of a preferred embodiment, it is not intended to limit the present invention. Any person skilled in the art may make possible changes and modifications to the technical solution of the present invention by using the methods and technical contents disclosed above without departing from the spirit and scope of the present invention. Therefore, any simple modifications, equivalent changes and modifications made to the above embodiments based on the technical essence of the present invention without departing from the content of the technical solution of the present invention shall fall within the protection scope of the technical solution of the present invention.
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