CN115429209A - Ureteroscope sheath assembly and stone removing method thereof - Google Patents

Abstract

The application provides a ureteroscope sheath assembly and a stone removing method thereof, which mainly comprise a sheath tube with a main cavity channel, a sheath core with a sheath core channel and a sheath mirror, wherein the sheath core and the sheath mirror can be combined and penetrated in the main cavity channel; or the sheath mirror can be independently arranged in the main cavity channel in a penetrating way so as to form a sheath core working channel for executing the water return operation in the main cavity channel; or the sheath core can be separately arranged in the main cavity channel in a penetrating way so as to form a sheath mirror working channel in the main cavity channel, one of the sheath mirror working channel or the sheath core channel can be used for executing water injection operation, and the other can be used for executing water return operation. Therefore, the stone removing operation method and the stone removing device have the advantages that different combinations among the sheath tube, the sheath core and the sheath mirror are utilized to be suitable for carrying out the stone removing operation in different stages, the complexity of the stone removing operation can be reduced, and the stone removing effect can be improved.

Description

Ureteroscope sheath assembly and stone clearing method thereof

technical field

The embodiment of the present application relates to the technical field of medical devices, in particular to a ureteroscope sheath assembly and a stone removal method thereof.

Background technique

A ureteroscope is a medical device that can be inserted from the external opening of the urethra to reach the ureter or kidney. The ureteroscope is usually equipped with an illuminating device, an illuminating device and a lithotripsy device, so that the doctor can observe the internal conditions of the ureter or the kidney and perform directional removal of the stones therein during the operation.

Generally speaking, the types of ureteroscopes can be mainly divided into rigid mirrors and soft mirrors. Among them, rigid ureteroscopes are more rigid and difficult to bend. Because the mirror can be partially bent, it can reach the position that hard mirrors cannot reach, which makes up for the shortcomings in the application of hard mirrors.

The endoscopic operation process of traditional flexible ureteroscopic surgery generally includes: firstly, use a rigid ureteroscope to explore the ureter, and indwell a guide wire; then, push the guide sheath to a predetermined position along the guide wire in a blind state, such as the ureteropelvis Below the junction (UPJ); then, remove the inner core and advance the flexible scope along the introducer sheath to the target location to perform stone clearance.

The technical problems existing in the prior art mainly include: because the ureter has a curved section and a narrow section, and the introducer sheath cannot be observed when the introducer sheath is inserted, there is a risk of perforation in the inserting operation of the introducer sheath; in addition, the existing flexible ureteroscope The diameter of the mirror body section at the insertion part is larger than the diameter of the distal bending part, so that the gap between the guide sheath and the flexible ureteroscope is small, and it leads to the problem of insufficient backwater space during lithotripsy. Furthermore, in the existing stone clearing operation, since the perfusion channel and the suction channel are far apart, the circulation cannot be formed in time, which affects the efficiency of stone removal.

Contents of the invention

In view of the above problems, the present application provides a ureteroscopic sheath mirror assembly and a stone-clearing method thereof, which can reduce the complexity of the stone-clearing operation and improve the stone-clearing effect.

The first aspect of the present application provides a ureteroscope assembly, which includes: a sheath tube with a main lumen; a sheath core with a sheath core channel; and a sheath mirror; the sheath core and the sheath mirror can be combined with each other And penetrate in the main cavity; the sheath mirror can be separately penetrated in the main cavity, so as to form a sheath core working channel for performing the water return operation in the main cavity; the sheath core can be independently pierced through the main lumen to form a sheath mirror working channel in the main lumen, so as to perform a water injection operation through one of the sheath mirror working channel and the sheath core channel, and through the The other of the sheath mirror working channel and the sheath core channel performs a water return operation.

Optionally, the sheath includes a sheath distal end having a first guiding surface and a sheath proximal end opposite to the sheath distal end; the sheath core includes a sheath core distal end having a second guiding surface and Relative to the sheath core proximal end of the sheath core distal end, the sheath core distal end can protrude from the sheath tube distal end and produce bending deformation; the sheath mirror includes a sheath mirror distal end with a third guiding surface and the proximal end of the sheath mirror relative to the distal end of the sheath mirror, the distal end of the sheath mirror can protrude from the distal end of the sheath tube and produce bending deformation; wherein, when the sheath core and the sheath mirror are combined to wear When set in the main lumen, the second guiding surface at the distal end of the sheath core is exposed at the distal end of the sheath tube, and the third guiding surface at the distal end of the sheath mirror is exposed at the sheath core The distal end, and the first guide surface, the second guide surface, and the third guide surface can be butted with each other to form an integrated guide surface; wherein, the first guide surface, the second guide surface , The third guide surface includes one of an inclined surface and an arc surface.

Optionally, the sheath further includes a guide movably arranged at the proximal end of the sheath; wherein, the guide can rotate circumferentially relative to the sheath to drive the sheath core and/or Or the sheath mirror rotates synchronously relative to the sheath tube.

Optionally, the guide member and the proximal end of the sheath are threaded or snapped.

Optionally, the guide further includes: a sheath core cover, the cross section of which is not smaller than the cross section of the sheath core, used to block the working channel of the sheath core at the proximal end of the sheath tube, and by means of the The guide member rotates circumferentially relative to the sheath tube to control the synchronous rotation of the sheath mirror relative to the sheath tube; the sheath mirror cover, which has the same cross section as the sheath mirror, is used for The proximal end blocks the working channel of the sheath mirror, so that the synchronous rotation of the sheath core relative to the sheath is controlled by the circumferential rotation of the guide member relative to the sheath.

Optionally, the ureteroscope sheath assembly further includes: a sheath core positioning structure, which is respectively provided on the proximal end of the sheath core and the guide member, and is used to provide axial positioning of the sheath core relative to the sheath , to adjust the length of the exposed tube at the distal end of the sheath core relative to the distal end of the sheath tube; the positioning structure of the sheath mirror is separately arranged on the proximal end of the sheath mirror and the guide member, and is used to provide the sheath mirror Axially positioned relative to the sheath to adjust the length of the exposed tube of the distal end of the sheath scope relative to the distal end of the sheath.

Optionally, the sheath core positioning structure includes a sheath core positioning groove provided on the guide member and a plurality of sheath core positioning protrusions provided at the proximal end of the sheath core; The sheath mirror positioning groove on the guide member and a plurality of sheath mirror positioning protrusions arranged at the proximal end of the sheath mirror.

Optionally, the sheath mirror includes a sheath mirror bending section adjacent to the distal end of the sheath mirror and a sheath mirror penetrating section adjacent to the proximal end of the sheath mirror; wherein, the cross-sectional diameter of the sheath mirror penetrating section is not larger than The cross-sectional diameter of the curved section of the sheath mirror; and wherein, when the sheath core is withdrawn from the main lumen, the curved section of the sheath mirror is exposed at the distal end of the sheath tube, and the penetrating section of the sheath mirror is left In the sheath tube, the cross-sectional area of the sheath-core working channel formed in the sheath tube is maximized.

Optionally, the sheath mirror passing section may be made of a single material or a composite material, and different segments of the sheath mirror passing section may have the same hardness or different hardness.

Optionally, the sheath mirror bending section includes an active bending section and a passive bending section.

Optionally, the sheath mirror further includes a traction member, which is connected to the active bending section and extends to the proximal end of the sheath mirror along the axial direction of the sheath mirror. The bending segment applies traction to cause bending deformation of the active bending segment.

Optionally, the distal end of the sheath core can clamp the distal end of the sheath mirror; wherein, when the sheath mirror moves axially relative to the sheath tube, the sheath core can be driven relative to the sheath tube move synchronously; or, when the distal end of the sheath mirror bends and deforms, the distal end of the sheath core can be driven to bend and deform synchronously.

Optionally, opposite sides of the outer sidewall of the sheath core may abut against the inner sidewall of the main lumen to retain the outer side of the sheath core after the sheath mirror is withdrawn from the main lumen. The wall is in close contact with the inner sidewall of the main lumen such that the cross-section of the sheath mirror working channel is substantially the same as the cross-section of the sheath mirror.

Optionally, the cross-section of the sheath core includes one of a C-shape and an Ω-shape; the cross-section of the sheath mirror includes one of a circle, an ellipse, a gourd shape, and a figure-of-eight shape.

Optionally, the tube side of the sheath tube further includes a channel interface communicating with the main lumen, for providing a water injection device or a drainage device externally connected to the sheath tube.

The second aspect of the present application provides a stone clearing method, which is applied to the ureteroscope sheath assembly described in the first aspect above, which includes: making the sheath core and the sheath mirror combination in the ureteroscope sheath assembly pass through the sheath In the main lumen, and according to the intracavity images captured by the sheath mirror in real time, the combined sheath core, the sheath mirror, and the sheath tube are transported to the ureteropelvic junction; removed from the sheath to form a sheath core working channel in the sheath, and perform lithotripsy for stones in the kidney according to the intracavity images captured by the sheath mirror in real time, and through the sheath core The working channel performs the backwater operation; the sheath core is inserted into the sheath tube, and the sheath core is positioned to the target position of the broken stone in the kidney by means of the sheath mirror, and the The sheath mirror is removed from the sheath tube to form a sheath mirror working channel in the sheath tube; using the sheath core to perform a water injection operation to perform irrigation for the debris at the target location, and using the sheath mirror The working channel performs a backwater operation to expel the debris at the target site; and removes the ureteroscope sheath assembly.

It can be seen from the above technical solutions that the ureteroscopic sheath mirror assembly and its stone clearing method according to the embodiment of the present application can form different working states through any combination of the sheath tube, the sheath core and the sheath mirror, so as to be suitable for performing different stages of surgery. Stone clearing operation, in order to reduce the complexity of ureteral stone clearing operation, so as to facilitate the smooth execution of the operation.

Furthermore, the integrated guide surface formed by the respective end guide surfaces of the sheath tube, the sheath core, and the sheath mirror can not only achieve the technical effect of combining the upper sheath with safety and visibility, but also improve the quality of the sheath tube and the sheath mirror. The gap between them can reduce the resistance during mirroring, and can avoid damage to the ureteral mucosa caused by the ureteroscopic sheath mirror assembly during mirroring.

In addition, since the cross-sectional diameter of the sheath mirror penetrating section in the sheath mirror is not larger than the cross-sectional diameter of the sheath mirror bending section, when the sheath core is withdrawn from the main lumen, the bending section of the sheath mirror is exposed to the distal end of the sheath tube, and Only the piercing section of the sheath-retaining mirror is pierced inside the sheath tube to maximize the cross-sectional area of the sheath-core working channel formed in the sheath tube, so as to improve the water return efficiency of the stone removal operation and reduce the pressure on the kidney.

In addition, there is a sheath core channel through the sheath core. When the sheath mirror is withdrawn from the sheath tube, the sheath core and the working channel of the sheath mirror cooperate with each other to flush and discharge the gravel at the target position. Active water circulation in stone clearing surgery to reduce the probability of complications.

Description of drawings

In order to more clearly illustrate the technical solutions in the embodiments of the present application or the prior art, the following will briefly introduce the drawings that need to be used in the description of the embodiments or the prior art. Obviously, the accompanying drawings in the following description are only These are some embodiments described in the embodiments of the present application, and those skilled in the art can also obtain other drawings based on these drawings.

FIG. 1 is a schematic perspective view of an exploded structure of a ureterothecal scope assembly of the present application.

Fig. 2 is a side view of the disassembled structure of the ureteroscope assembly of the present application.

Fig. 3 is a schematic diagram of an embodiment of a working state of the ureteroscopic sheath mirror assembly of the present application.

FIG. 4 is a partial structural schematic diagram of the working state shown in FIG. 3 .

FIG. 5 is a schematic cross-sectional view of the working state shown in FIG. 3 .

Fig. 6 is a schematic diagram of an embodiment of another working state of the ureteroscope assembly of the present application.

FIG. 7 is a CC cross-sectional schematic view of the working state shown in FIG. 6 .

Fig. 8 is a schematic diagram of another working state of the ureteroscopic sheath mirror assembly of the present application.

FIG. 9 is a CC cross-sectional schematic view of the working state shown in FIG. 8 .

Fig. 10 and Fig. 11 are partial structural schematic diagrams of the guide member of the ureterothecal scope assembly of the present application.

12A and 12B are schematic diagrams of another embodiment of the sheath core of the ureteroscope assembly of the present application.

13A to 13C are schematic cross-sectional views of different embodiments of sheath mirrors of the ureteral sheath mirror assembly of the present application.

14A to 14C are schematic cross-sectional views of different embodiments of the sheath core of the ureteroscope assembly of the present application.

15 to 18 are schematic diagrams of embodiments of different treatment stages of the stone cleaning method of the present application.

Component number

10: ureteroscope sheath assembly;

20: sheath tube;

20a, 20b: segmented pipe body;

202: main cavity;

204: Sheath core working channel;

206: working channel of the sheath mirror;

208: the distal end of the sheath;

210: the first guide surface;

212: the proximal end of the sheath;

214: guide piece;

216: sheath core cover;

218: sheath mirror cover;

220: inner wall;

222: channel interface;

30: sheath core;

30a, 30b: end side;

302: the distal end of the sheath core;

304: the second guide surface;

306: the proximal end of the sheath core;

308: outer wall;

310: sheath core channel;

40: sheath mirror;

402: the distal end of the sheath mirror;

404: the third guide surface;

406: the proximal end of the sheath mirror;

408: sheath mirror bending section;

410: sheath mirror piercing section;

412: active bending segment;

414: passive bending segment;

416: sheath mirror channel;

50: guide surface;

60: sheath core positioning structure;

602: sheath core positioning groove;

604: Sheath core positioning convex part;

62: sheath mirror positioning structure;

622: sheath mirror positioning slot;

624: sheath mirror positioning convex part;

70: Straight metal wire;

80: guide wire;

902: External opening of urethra;

904: ureter;

906: Bladder triangle;

908: ureteropelvic junction (UPJ);

910: Kidney calices.

detailed description

In order to enable those skilled in the art to better understand the technical solutions in the embodiments of the present application, the following will clearly and completely describe the technical solutions in the embodiments of the present application in conjunction with the drawings in the embodiments of the present application. Obviously, the described The embodiments are only some of the embodiments of the present application, but not all of them. All other embodiments obtained by persons of ordinary skill in the art based on the embodiments in the embodiments of the present application shall fall within the protection scope of the embodiments of the present application.

The ureteroscope sheath assembly of the present application is mainly used for directional removal of stones in the ureter or kidney, specifically, it can be used to enter the target position in the kidney via the patient's ureter in a visualized state, so as to establish a surgical channel for performing stone removal surgery, Utilizing the ureteroscope sheath assembly of the present application can not only improve the success rate of one-time mirroring, but also increase the water return ratio of the mirror sheath during the operation, so as to relieve the pressure on the kidneys and improve the efficiency of stone expulsion.

The specific implementation of each embodiment of the present application will be further described below in conjunction with the accompanying drawings of the embodiments of the present application.

Please refer to FIG. 1 , the ureteroscope sheath assembly 10 of the present application mainly includes a sheath tube 20 , a sheath core 30 and a sheath mirror 40 .

In this embodiment, the sheath tube 20 has a main lumen 202 axially passing through the sheath tube 20 .

Optionally, the sheath 20 may include a sheath distal end 208 and a sheath proximal end 212 opposite the sheath distal end 208 .

Optionally, the tube side of the sheath tube 20 may further include a channel interface 222 communicating with the main lumen 202 for providing a water injection device or a drainage device externally connected to the sheath tube 20 .

Optionally, the channel interface 222 can be fixedly connected with the sheath tube 20 by means of glue or heat fusion.

Optionally, the sheath tube 20 can be designed as a one-piece tube body, or can be formed by combining multiple segmented tube bodies (such as the segmented tube bodies 20a, 20b in FIG. 2 ), which is not limited in the present application.

In this embodiment, the sheath core 30 has a sheath core channel 310 axially penetrating the sheath core 30 .

Optionally, the sheath core 30 may include a sheath core distal end 302 and a sheath core proximal end 306 relative to the sheath core distal end 302, and wherein the sheath core distal end 302 may protrude from the sheath tube distal end 208 and produce bending deformation .

In this embodiment, the sheath mirror 40 can include a sheath mirror distal end 402 and a sheath mirror proximal end 406 opposite to the sheath mirror distal end 402, wherein the sheath mirror distal end 402 can protrude from the sheath tube distal end 208 and bend out of shape.

Furthermore, a camera module (not shown) may be provided at the end of the sheath mirror 40 for capturing images of the cavity (such as the ureter).

In addition, a sheath mirror channel 416 can also be formed along the axial direction of the sheath mirror 40, which can be used to pass through a guide wire, so that the ureteroscope sheath assembly 10 can travel along the extension direction of the guide wire and reach a target position in the patient's body (such as , ureteropelvic junction (UPJ)).

It should be noted that the above-mentioned structural design of the sheath mirror 40 is well known to those skilled in the art, and is not the technical focus of this application, so it will not be described in detail herein.

Wherein, the sheath core 30 and the sheath mirror 40 can be combined and threaded in the main lumen 202 or alone in the main lumen 202, so that the ureteroscope sheath assembly 10 can be configured in different working states, so as to be suitable for performing different stages of surgery. Stone clearing operation.

In one embodiment, the sheath core 30 and the sheath mirror 40 can be combined with each other and passed through the sheath tube 20 for the delivery operation (refer to the state shown in FIG. 3 ), wherein the sheath mirror 40 is used during the delivery operation , to capture image data in the patient's cavity (such as the ureter) in real time, so as to realize the visual delivery operation, so that the doctor can observe the curved section and the narrow section in the ureter, thereby helping to accurately push the ureteroscope sheath assembly 10 to the UPJ via the ureter, And the risk of perforation of the ureter can be avoided during the delivery operation.

Optionally, please refer to FIG. 4 , the sheath tube distal end 208 of the sheath tube 20 may have a first guiding surface 210, and the sheath core distal end 302 of the sheath core 30 may have a second guiding surface 304; End 402 may have a third guide surface 404 .

Wherein, when the sheath core 30 and the sheath mirror 40 are combined to pass through the main lumen 202 to perform the delivery operation, the second guide surface 304 of the sheath core distal end 302 can be exposed to the sheath tube distal end 208, and at the same time, the sheath mirror is far away The third guiding surface 404 of the end 402 is also exposed at the distal end 302 of the sheath core, so that the first guiding surface 210 of the sheath tube 20 and the second guiding surface 304 of the sheath core 30 and the third guiding surface 404 of the sheath mirror 40 are mutually butted. state to form a one-piece guide surface 50 .

Optionally, the first guide surface 210 , the second guide surface 304 , and the third guide surface 404 are, for example, inclined surfaces as shown in the drawings, or may be designed as arc surfaces (not shown), which is not limited in the present application.

In summary, the present application uses the sheath core 30 to fill the gap between the sheath tube 20 and the sheath mirror 40, which can reduce resistance during the delivery operation, so that the sheath core 30 and the sheath mirror 40 can be stably positioned on the sheath tube 20 Not easy to slip off. In addition, the guide surface 50 formed by the combination of the sheath tube 20, the sheath core 30, and the sheath mirror 40 can reduce the upward resistance, so as to facilitate the delivery of the ureteroscope sheath assembly 10 to the target position, for example, the ureteroscope sheath assembly 10 through the The ureter is transported to the ureteropelvic junction (UPJ), and the top of the ureteroscope sheath assembly 10 can avoid damage to the ureteral mucosa during the transport process.

Optionally, in the case that the sheath core 30 and the sheath mirror 40 are combined to pass through the main lumen 202 of the sheath tube 20 , the sheath core 30 and the sheath mirror 40 can produce a linked action.

In one embodiment, the sheath core distal end 302 of the sheath core 30 can clamp the sheath mirror distal end 402 of the sheath mirror 40, so that the sheath core 30 (the sheath core distal end 302) can follow the sheath mirror 40 (the sheath mirror distal end) 402) and linkage action.

For example, when the sheath mirror 40 moves axially relative to the sheath tube 20 , it can drive the sheath core 30 to move axially relative to the sheath tube 20 synchronously.

As another example, when the distal end 402 of the sheath mirror and the distal end 302 of the sheath core are both exposed to the distal end 208 of the sheath tube, when the distal end 402 of the sheath mirror is bent and deformed, the distal end 302 of the sheath core can be driven to produce the same or similar bending deformations.

In this embodiment, the sheath mirror bending section 408 of the sheath mirror 40 may include an active bending section 412 and a passive bending section 414 (refer to FIG. 2 ).

Optionally, the sheath mirror 40 further includes a tractor (not shown), which can be connected to the active bending section 412 of the sheath mirror 40 and extends to the sheath mirror proximal end 406 along the axial direction of the sheath mirror 40, A traction force can be applied to the active bending segment 412 via a traction member, so that the active bending segment 412 generates active bending deformation. The above-mentioned structural design belongs to common technical means in this field, and is not the technical focus of this application, so it will not be described in detail.

Furthermore, the passive bending section 414 of the sheath mirror 40 can, for example, abut against the inner wall of the organ, so that the passive bending section 414 can be passively formed by the abutment force exerted by the inner wall of the organ on the passive bending section 414 . Bending deformation.

In one embodiment, the distal end 302 of the sheath core can be bent and deformed using the principle of passive bending, that is, in the state where the distal end 302 of the sheath core clamps the distal end 402 of the sheath mirror, the distal end 302 of the sheath core is provided to bend according to the sheath mirror. The degree of bending deformation of the segment 408 produces a corresponding passive bending deformation.

In another embodiment, the distal end 302 of the sheath core can also adopt an active bending principle to produce bending deformation.

For example, the sheath core distal end 302 of the sheath core 30 can be premolded into a curved state, and by passing a straight metal wire 70 in the sheath core 30, the sheath core distal end 302 presents a straight line state under the action of the straight metal wire 70 , and by withdrawing the straight wire 70 from the sheath core 30, the distal end 302 of the sheath core is bent and deformed (see FIGS. 12A and 12B ).

As mentioned above, since the end of the sheath mirror 40 (the distal end 402 of the sheath mirror) is equipped with a camera module that can capture intracavity images, through the linkage design between the sheath mirror 40 and the sheath core 30, the sheath mirror can be used to The end 402 accurately positions the distal end 302 of the sheath core at the target position to improve stone clearing effect.

Optionally, the cross-section of the sheath core 30 may present a C-shape (that is, more than half a ring) as shown in FIG. 13A or an Ω-shape as shown in FIGS. 13B and 13C. Correspondingly, the cross-section of the sheath mirror 40 may be as follows Circular as shown in Figure 14A, or oval as shown in Figure 14B, or gourd-shaped as shown in Figure 14C, but not limited thereto, the cross section of the sheath mirror 40 can also be 8-shaped (not shown )

Optionally, one (refer to FIG. 13A ) or multiple (refer to FIG. 13B , FIG. 13C ) sheath core channels 310 in the sheath core 30 can be designed.

By virtue of the structural design of the sheath mirror 40 and the sheath mirror 30, the opposite sides of the sheath core 30 (such as the end sides 30a, 30b of the sheath core 30) can detachably clamp the opposite sides of the sheath mirror 40, so that The sheath mirror 40 and the sheath core 30 are integrated to realize the technical effect of the linkage movement of the two.

In one embodiment, the sheath mirror 40 can be separately installed in the main lumen 202 to form a sheath-core working channel 204 for performing backwater operation in the main lumen 202 (as shown in FIGS. 6 and 7 ). ).

In this embodiment, the sheath mirror 40 may include a sheath mirror bending section 408 adjacent to the sheath mirror distal end 402 and a sheath mirror penetrating section 410 adjacent to the sheath mirror proximal end 406 .

Wherein, the cross-sectional diameter of the sheath mirror penetrating section 410 is not larger than the cross-sectional diameter of the sheath mirror bending section 408 . Preferably, the cross-sectional diameter of the sheath mirror penetrating section 410 may be smaller than the cross-sectional diameter of the sheath mirror bending section 408 .

Specifically, when the sheath core 30 is withdrawn from the main lumen 202, the sheath mirror bending section 408 of the sheath mirror 40 can be exposed to the sheath tube distal end 208, and the sheath mirror penetrating section 410 of the sheath mirror 40 can be left in the sheath. In the tube 20 (that is, the state shown in FIG. 6 ), in this state, the cross-sectional area of the sheath core working channel 204 formed in the sheath tube 20 can be maximized (that is, the main lumen 202 is relatively large compared to the sheath mirror. The diameter ratio of 40 is maximized), so as to increase the water return ratio of the water return operation performed by the sheath-core working channel 204, thereby effectively reducing the pressure of the renal pelvis during the operation and improving the safety of the operation.

Optionally, the sheath mirror penetrating section 410 can be made of a single material or composed of composite materials, so that different sections of the sheath mirror penetrating section 410 can have the same hardness or different hardness, for example, the opposite sections of the sheath mirror penetrating section 410 The two ends can show different hardness according to the different mixing ratio of materials, so as to meet different operation requirements.

In one embodiment, the sheath core 30 can be separately threaded through the main lumen 202 to form the sheath mirror working channel 206 in the main lumen 202, so that the sheath mirror working channel 206 and the sheath core channel 310 can One performs the water injection operation, and the other of the sheath mirror working channel 206 and the sheath core channel 310 performs the water return operation. In this state, the sheath mirror working channel 206 and the sheath core channel 310 can form a perfusion-suction circulatory system in the kidney, thereby improving the efficiency of stone removal.

Furthermore, compared with the prior art, since the distance between the sheath lens working channel 206 and the sheath core channel 310 is relatively short, a circulation loop can be formed in time to further improve the effect of gravel discharge.

In addition, during the operation, the sheath core 30 can also be moved axially relative to the sheath tube 20 to adjust the exposed length of the sheath core distal end 30 relative to the sheath tube distal end 208, thereby providing a more flexible sheath core distal end 30. In order to get close to the location of the gravel and perform flushing and discharge, the discharge effect of the gravel can be further improved and the probability of complications can be reduced.

In this embodiment, the cross-section of the main lumen 202 can be circular, and the cross-section of the sheath core 30 can be C-shaped or Ω-shaped, so that the opposite sides of the outer wall 308 of the sheath core 30 (such as the end side 30a, 30b) can abut against the inner side wall 220 of the main lumen 202, so that after the sheath mirror 40 is withdrawn from the main lumen 202, the outer side wall of the sheath core 30 can be kept close to the inner side wall 220 of the main lumen 202, so that The cross-section of the sheath mirror working channel 206 formed in the sheath tube 20 can be substantially the same as the cross-section of the sheath mirror 40 , so as to improve the effect of stone removal.

Optionally, the sheath 20 further includes a guide 214 movably disposed at the proximal end 212 of the sheath.

Wherein, the guide member 214 can rotate circumferentially relative to the sheath tube 20 to drive the sheath core 30 and/or the sheath mirror 40 to rotate synchronously relative to the sheath tube 20 .

Optionally, the guide member 214 and the proximal end 212 of the sheath may be threaded (such as the embodiment shown in FIG. 2 ) or snapped (not shown). However, it is not limited thereto, and other flexible connection methods can also be used, as long as the guide member 214 can rotate circumferentially relative to the sheath tube 20 , which is not limited in the present application.

Specifically, please refer to FIG. 10 and FIG. 11 , the guide member 214 may include a sheath core cover 216 and a sheath mirror cover 218 .

Wherein, the cross section of the sheath core cover 216 is not smaller than the cross section of the sheath core 30 (such as C-shaped, Ω-shaped, etc.), and is used to provide the sheath core cover 216 in the sheath after the sheath core 30 is withdrawn from the main lumen 202. The proximal end 212 blocks the sheath core working channel 204. In this state, the sheath core cover 216 can abut against the proximal end 406 of the sheath mirror. The core cover 216 rotates circumferentially relative to the sheath tube 20 ), and can drive the sheath mirror 40 to rotate synchronously relative to the sheath tube 20 to adjust the circumferential positioning position of the sheath mirror 40 relative to the sheath tube 20 .

Furthermore, the sheath mirror cover 218 can have the same cross-section as the sheath mirror 40 (such as circular, elliptical, gourd-shaped, figure 8, etc.), and is used to provide a sheath mirror 40 after the sheath mirror 40 is withdrawn from the main lumen 202. The mirror cover 218 blocks the sheath mirror working channel 206 at the proximal end 212 of the sheath tube. In this state, the sheath mirror cover 218 can abut against the sheath core gold shield 212. Therefore, when the guide member 214 rotates circumferentially relative to the sheath tube 20 (ie, the sheath mirror cover 218 rotates circumferentially relative to the sheath tube 20 ), and the sheath core 30 can be driven to rotate synchronously relative to the sheath tube 20 to adjust the circumferential positioning position of the sheath core 30 relative to the sheath tube 20 .

Optionally, the ureteroscope sheath assembly 10 further includes a sheath core positioning structure 60, which is separately provided at the proximal end 306 of the sheath core and the guide 214, and is used to provide the axial positioning of the sheath core 30 relative to the sheath tube 20, so as to adjust the sheath core End 302 is long relative to the exposed tube of sheath distal end 208.

In this embodiment, the sheath core positioning structure 60 may include a sheath core positioning groove 602 provided on the guide 214 and a plurality of sheath core positioning protrusions 604 provided at the proximal end 306 of the sheath core (refer to FIG. 10 and FIG. 11 ). .

Specifically, each sheath core positioning protrusion 604 can be distributed on the limit bar fixed on the sheath core proximal end 306, and the limit bar can be passed through the sheath mirror positioning groove 622, and relative to the sheath mirror positioning groove. 622 moves axially so that the sheath core positioning groove 602 and any one of the plurality of sheath core positioning protrusions 604 are mutually positioned, so as to adjust the axial positioning position of the sheath core 30 relative to the sheath tube 20 and achieve adjustment of the sheath core positioning distance. The technical effect of the length of the distal end 208 of the sheath that the end 302 is exposed.

Optionally, the ureteroscope sheath assembly 10 further includes a sheath scope positioning structure 62, which is separately provided on the sheath scope proximal end 406 and the guide member 214, and is used to provide the axial positioning of the sheath scope 40 relative to the sheath tube 20, so as to adjust the distance of the sheath scope. End 402 is long relative to the exposed tube of sheath distal end 208.

In this embodiment, the sheath mirror positioning structure 62 may include a sheath mirror positioning groove 622 provided on the guide member 214 and a plurality of sheath mirror positioning protrusions 624 provided at the proximal end 406 of the sheath mirror (refer to FIG. 10 and FIG. 11 ). .

Specifically, each sheath mirror positioning protrusion 624 can be distributed on the limit bar fixed on the sheath mirror proximal end 406, and the limit bar can be passed through the sheath mirror positioning groove 622, and relative to the sheath mirror positioning groove. 622 moves axially so that the sheath mirror positioning groove 622 and any one of the plurality of sheath mirror positioning protrusions 624 are mutually positioned, so as to adjust the axial positioning position of the sheath mirror 40 relative to the sheath tube 20 and realize the adjustment of the sheath mirror far The technical effect of the length of the distal end 208 of the sheath that the end 402 is exposed.

Furthermore, the present application also provides a stone-clearing method. The following will exemplarily describe the processing steps of the stone-clearing method in this embodiment in conjunction with the accompanying drawings, which mainly include the following:

Step S1502, locating the position of the stone.

Step S1504, assembling the sheath tube 20, the sheath core 30 and the sheath mirror 40 to form a visualization guide sheath (as shown in FIG. 3 ).

In this embodiment, the sheath core 20 and the sheath mirror 30 can be combined to pass through the main lumen 202 of the sheath tube 20 .

Specifically, the combined sheath tube 20 , sheath core 30 , and sheath mirror 40 can form a guide surface 50 (refer to FIG. 4 ), so as to facilitate delivery operations.

Furthermore, using the sheath core 20 to fill the gap between the sheath mirror 30 and the sheath mirror 40 can reduce the upward resistance during the delivery process, and make the sheath core 30 and the sheath mirror 40 stably positioned in the sheath tube 20 without displacement. risk of slipping or slipping.

In step S1506, the assembled sheath tube 20, sheath core 30 and sheath mirror 40 are delivered to the ureteropelvic junction in the patient along the extension direction of the guide wire (refer to FIG. 15 ).

In this embodiment, the guide wire 80 pre-installed in the patient's body can be passed through the sheath mirror channel 416 of the sheath mirror 40 (refer to FIG. 5 ) or through the sheath core channel 310 of the sheath core 30 (not shown). out), so that the assembled sheath tube 20 , sheath core 30 and sheath mirror 40 are sent into the patient's body along the extending direction of the guide wire 80 .

Specifically, during the delivery process, according to the intracavitary images captured in real time by the camera module of the sheath mirror 40 and under the guidance of the guide wire 80, the combined sheath core 30, sheath mirror 40, and sheath can be moved step by step. Tube 20 passes through ureter 904 via external urethral opening 902 to trigone 906 and through the ureteral opening to ureteropelvic junction 908 (see FIGS. 16-17 ).

Thereby, the present application can realize the visualized delivery operation, and can observe the travel route of the ureteroscope sheath assembly 10 in real time according to the intracavity images captured by the sheath mirror 40 in real time, and cooperate with the sheath tube 20, the sheath core 30, and the sheath mirror The guide surface formed by 40 can avoid damage to the ureter 904 mucosa during delivery.

Step S1508 , removing the sheath core 30 from the sheath tube 20 to form a sheath core working channel 204 in the sheath tube 20 .

Specifically, guidewire 80 and sheath core 30 may be removed from sheath 20 .

Step S1510, performing lithotripsy for the stones in the kidney.

Specifically, the sheath mirror 40 can be further advanced into the kidney or calyces 910, and according to the intracavity images captured by the sheath mirror 40 in real time, instruments such as laser fibers can be used to target the renal calices 910 through the sheath mirror channel 416 of the sheath mirror 40. Lithotripsy is performed on the stones in the kidney, and during the lithotripsy process, the water return operation is performed through the sheath-core working channel 204 to reduce the internal pressure of the kidney.

In this embodiment, since the curved section 408 of the sheath mirror 40 with a larger cross-section completely protrudes from the distal end 208 of the sheath tube, only the penetrating section 410 of the sheath mirror with a smaller cross-section remains inside the sheath tube 20, Therefore, the cross-sectional area of the sheath core working channel 204 formed in the sheath tube 20 can be maximized. This design is conducive to improving the return water treatment efficiency of the sheath core working channel 204, reducing the internal pressure of the kidney, and reducing the occurrence of complications. .

Step S1512, judge whether the stone is completely pulverized, if not, go to step S1514, if yes, go to step S1516.

Step S1514, put in the set stone tool to take the unpowdered gravel, and then proceed to step S1516.

In this embodiment, after the lithotripsy is completed, the laser optical fiber can be withdrawn, and according to the size of the stone, a mesh basket can be used to collect the unpowdered stone.

Step S1516, inserting the sheath core and delivering it to the target position.

In this embodiment, the sheath core 30 is reinserted into the sheath tube 20 , and the sheath core 30 is positioned to the target position of the broken stone in the kidney by means of the sheath mirror 40 .

Specifically, the sheath core distal end 302 of the sheath core 30 can clamp the sheath mirror distal end 402 of the sheath mirror 40, so that the sheath core 30 (the sheath core distal end 302) can follow the movement of the sheath mirror 40 (the sheath mirror distal end 402). The operation is linked to the action, and by means of the real-time captured intracavity image of the scope sheath 40, the distal end 402 of the sheath scope is controlled to bend and deform or move back and forth to locate the target position of the gravel, and make the sheath linked with it The core distal end 302 can also be accurately positioned at the target location.

Step S1518, withdraw the sheath mirror.

Specifically, the sheath mirror 40 can be removed from the sheath tube 20 to form a sheath mirror working channel 206 in the sheath tube 20 .

Step S1520, perform a perfusion flushing operation to discharge powdery gravel (refer to FIG. 18 ).

In this embodiment, the water injection operation can be performed by using the sheath core channel 310 in the sheath core 30 to flush the broken stones at the target location, and the water return operation can be performed by using the sheath lens working channel 206 in the sheath tube 20 to discharge the target. location of powdered gravel.

Specifically, a water injection device can be connected to the proximal end 306 of the sheath core to perfuse the sheath core channel 310 with liquid, and water can be discharged through the distal end 302 of the sheath core to wash away the powdery crushed stones in the calices 910 to the kidney. The proximal end 212 is connected to a negative pressure suction device to expel powdery debris washed into the kidney.

As mentioned above, since the cross-section of the main lumen 202 can be circular, the cross-section of the sheath core 30 can be C-shaped or Ω-shaped, so that the opposite sides of the outer wall 308 of the sheath core 30 (such as the end side 30a, 30b) can abut against the inner side wall 220 of the main lumen 202, so that after the sheath mirror 40 is withdrawn from the main lumen 202, the outer side wall of the sheath core 30 can be kept close to the inner side wall of the main lumen 202, so that the sheath The cross-section of the sheath mirror working channel 206 formed in the tube 20 is substantially the same as that of the sheath mirror 40 , so as to ensure that powdery gravel can be smoothly discharged through the sheath mirror working channel 206 .

Furthermore, since the distance between the working channel 206 of the sheath mirror and the channel 310 of the sheath core is relatively short, a circulation loop can be formed in time to further improve the effect of discharging gravel.

Preferably, during the flushing process, when the working channel 206 of the sheath mirror is blocked by debris, the guide 214 can be used to control the circumferential rotation of the sheath core 30 relative to the sheath tube 20 or to control the axis of the sheath core 30 relative to the sheath tube 20 . To move to agitate the trapped stones, thereby increasing the flow rate in the working channel 206 of the sheath mirror.

In another embodiment, the water injection operation can also be performed by using the sheath mirror working channel 206 in the sheath tube 20 to perform flushing for the gravel at the target position, and the water return operation can be performed by using the sheath core channel 310 in the sheath core 30 to Discharges powdery gravel at the target location.

Step S1522, judging whether the stone clearing result is acceptable.

In this embodiment, the sheath mirror 40 can be reinserted into the sheath tube 20 to detect the residual state of stones in the kidney, so as to judge whether the result of stone removal is acceptable, if yes, go to step S1524, if not, go back to step S1520 .

Step S1524, remove the ureteroscope sheath assembly in the patient's body, and end the stone clearing operation.

To sum up, the ureteroscope sheath assembly and stone clearing method of the present application mainly include the following advantages:

It can systematically solve the removal of upper ureteral stones and kidney stones, and place a safety guide wire in a visible state, and use the sheath core to fill the gap between the sheath tube and the sheath mirror, which can reduce the upward resistance of the ureteroscope sheath assembly, and It avoids damage to the ureter, and does not need to frequently replace hard and soft mirror instruments, so as to simplify the complexity of stone clearing operation.

The cross-sectional diameter of the penetrating section of the sheath mirror is not greater than the cross-sectional diameter of the curved section of the sheath mirror, which can maximize the cross-sectional area of the sheath-core working channel formed in the sheath tube, improve the return water efficiency during the operation, and reduce the pressure in the renal pelvis , to improve surgical safety.

After the lithotripsy is completed, use the sheath-core channel of the sheath core to infuse liquid to wash away the powdered gravel in the calices, and use the working channel of the sheath mirror to connect a negative pressure suction device to form a perfusion-suction circulatory system in the kidney , so as to improve the efficiency of stone cleaning.

Using the guide to control the axial movement or circumferential rotation of the sheath core relative to the sheath tube can effectively solve the problem that the working channel of the sheath mirror is blocked by gravel, so as to improve the flow rate.

Finally, it should be noted that: the above embodiments are only used to illustrate the technical solutions of the embodiments of the present application, and are not intended to limit them; although the application has been described in detail with reference to the foregoing embodiments, those of ordinary skill in the art should understand that: It is still possible to modify the technical solutions described in the foregoing embodiments, or perform equivalent replacements for some of the technical features; and these modifications or replacements do not make the essence of the corresponding technical solutions deviate from the spirit and spirit of the technical solutions of the various embodiments of the present application. scope.

Claims (16)

1. A ureteroscope sheath assembly, comprising:

a sheath having a main lumen;

a sheath core having a sheath core channel; and

a sheath mirror;

the sheath core and the sheath mirror can be mutually combined and penetrate through the main cavity;

the sheath mirror can be independently arranged in the main cavity channel in a penetrating way so as to form a sheath core working channel for executing water return operation in the main cavity channel;

the sheath core can be independently arranged in the main cavity channel in a penetrating mode, so that a sheath mirror working channel is formed in the main cavity channel, water injection operation is performed through one of the sheath mirror working channel and the sheath core channel, and water return operation is performed through the other one of the sheath mirror working channel and the sheath core channel.

2. The ureteroscope sheath assembly of claim 1,

the sheath comprises a sheath distal end having a first guide surface and a sheath proximal end opposite the sheath distal end;

the sheath core comprises a sheath core distal end with a second guide surface and a sheath core proximal end opposite to the sheath core distal end, and the sheath core distal end can extend out of the sheath tube distal end and generate bending deformation;

the sheath mirror comprises a sheath mirror distal end with a third guide surface and a sheath mirror proximal end opposite to the sheath mirror distal end, and the sheath mirror distal end can extend from the sheath tube distal end and generate bending deformation;

when the sheath core and the sheath mirror are combined and arranged in the main cavity channel in a penetrating mode, the second guide surface at the distal end of the sheath core is exposed out of the distal end of the sheath tube, the third guide surface at the distal end of the sheath mirror is exposed out of the distal end of the sheath core, and the first guide surface, the second guide surface and the third guide surface can be mutually butted to form an integrated guide surface;

wherein the first guide surface, the second guide surface, and the third guide surface include one of a slope and an arc surface.

3. The ureteroscope sheath assembly of claim 2, wherein the sheath further comprises a guide member movably disposed at the proximal end of the sheath;

wherein the guide is rotatable circumferentially relative to the sheath to drive synchronous rotation of the sheath core and/or the sheath mirror relative to the sheath.

4. The ureteroscope sheath assembly according to claim 3, wherein the guide member is threaded or snap-fit into the sheath proximal end.

5. The ureteroscope sheath assembly of claim 3, wherein the guide further comprises:

a sheath core cover with a cross section not smaller than that of the sheath core, which is used for blocking the sheath core working channel at the proximal end of the sheath tube and controlling the sheath mirror to rotate synchronously relative to the sheath tube by means of circumferential rotation of the guide piece relative to the sheath tube;

a sheath cap having the same cross-section as the sheath for occluding the sheath working channel at the sheath proximal end for controlling the sheath core to rotate synchronously relative to the sheath by circumferential rotation of the guide relative to the sheath.

6. The ureteroscope sheath assembly of claim 3, further comprising:

a sheath core positioning structure, disposed on the proximal end of the sheath core and the guide, for providing axial positioning of the sheath core relative to the sheath, so as to adjust an exposed length of the distal end of the sheath core relative to the distal end of the sheath;

the sheath mirror positioning structure is arranged on the proximal end of the sheath mirror and the guide piece respectively and used for providing axial positioning of the sheath mirror relative to the sheath tube so as to adjust the length of the exposed tube at the distal end of the sheath mirror relative to the distal end of the sheath tube.

7. The ureteroscope sheath assembly according to claim 6,

the sheath core positioning structure comprises a sheath core positioning groove arranged on the guide piece and a plurality of sheath core positioning convex parts arranged at the proximal end of the sheath core;

the sheath mirror positioning structure comprises a sheath mirror positioning groove arranged on the guide piece and a plurality of sheath mirror positioning convex parts arranged at the proximal end of the sheath mirror.

8. The ureteroscope sheath assembly of claim 2, wherein the sheath comprises a sheath bending section adjacent the sheath distal end and a sheath penetrating section adjacent the sheath proximal end;

the diameter of the section of the sheath mirror penetrating section is not more than that of the section of the sheath mirror bending section;

and when the sheath core withdraws from the main cavity, the sheath mirror bending section is exposed out of the distal end of the sheath tube, and the sheath mirror penetrating section is remained in the sheath tube, so that the cross section area of the sheath core working channel formed in the sheath tube is maximized.

9. The ureteroscope sheath assembly of claim 8, wherein the sheath penetrating segment may be composed of a single material or a composite material, and different sections of the sheath penetrating segment may have the same hardness or different hardnesses.

10. The ureteroscope sheath assembly of claim 8, wherein the sheath bend section comprises an active bend section and a passive bend section.

11. The ureteroscope sheath assembly according to claim 10, wherein the sheath further comprises a pulling member connected to the active bending section and extending in the axial direction of the sheath to the proximal end of the sheath, and wherein a pulling force can be applied to the active bending section via the pulling member to cause bending deformation of the active bending section.

12. The ureteroscope sheath assembly of claim 11, wherein the sheath core distal end may grip the sheath distal end;

wherein the sheath core is drivable to move synchronously relative to the sheath when the sheath mirror moves axially relative to the sheath;

alternatively, the sheath core distal end may be driven to simultaneously flex as the sheath scope distal end flexes.

13. The ureteroscope sheath assembly according to claim 12, wherein opposite sides of the outer sidewall of the sheath core may abut the inner sidewall of the primary channel to hold the outer sidewall of the sheath core against the inner sidewall of the primary channel after withdrawal of the sheath from the primary channel such that the cross-section of the sheath-scope working channel is substantially the same as the cross-section of the sheath-scope.

14. The ureteroscope sheath assembly according to claim 13,

the sheath core cross-section comprises one of a C-shape and an omega-shape;

the cross section of the sheath mirror comprises one of a circle, an ellipse, a gourd shape and an 8 shape.

15. The ureteroscope sheath assembly of claim 1, wherein the tube side of the sheath further comprises a channel interface in communication with the primary channel for providing water injection or drainage external to the sheath.

16. A method of removing stone applied to a ureteroscope sheath assembly according to any one of claims 1-15, comprising:

a sheath core and a sheath mirror in the ureteroscope sheath component are combined and arranged in a main channel of a sheath tube in a penetrating manner, and the sheath core, the sheath mirror and the sheath tube which are combined into a whole are conveyed to the ureteroscope junction according to an intracavity image captured by the sheath mirror in real time;

removing the sheath core from the sheath tube to form a sheath core working channel in the sheath tube, performing lithotripsy treatment on the calculus in the kidney according to the intracavity image captured by the sheath mirror in real time, and performing water return operation by means of the sheath core working channel;

inserting the sheath core into the sheath, positioning the sheath core to a target location within the kidney where the debris is located with the sheath scope, and removing the sheath scope from the sheath to form a sheath scope working channel in the sheath;

performing a water injection operation with one of the sheath core or the sheath-scope working channel to perform flushing for the debris of the target location and a water return operation with the other of the sheath core or the sheath-scope working channel to discharge the debris of the target location; and

removing the ureteroscope sheath assembly.

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