CN108186109B - Trans-hook transurethral bladder tumor electrotome electrode - Google Patents
Trans-hook transurethral bladder tumor electrotome electrode Download PDFInfo
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- CN108186109B CN108186109B CN201810106318.6A CN201810106318A CN108186109B CN 108186109 B CN108186109 B CN 108186109B CN 201810106318 A CN201810106318 A CN 201810106318A CN 108186109 B CN108186109 B CN 108186109B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M3/00—Medical syringes, e.g. enemata; Irrigators
- A61M3/02—Enemata; Irrigators
- A61M3/0279—Cannula; Nozzles; Tips; their connection means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M31/00—Devices for introducing or retaining media, e.g. remedies, in cavities of the body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00505—Urinary tract
- A61B2018/00517—Urinary bladder or urethra
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00595—Cauterization
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1422—Hook
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/10—Trunk
- A61M2210/1078—Urinary tract
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2210/00—Anatomical parts of the body
- A61M2210/10—Trunk
- A61M2210/1078—Urinary tract
- A61M2210/1085—Bladder
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Abstract
The invention relates to the technical field of medical instruments, in particular to a trans-hook transurethral bladder tumor electrotome electrode which comprises an electrode body and an operating rod, wherein an endoscope is arranged at the top of the operating rod, a front fork is arranged at the top of the operating rod, the front fork is arranged close to the lower part of the endoscope, and the center of a front fork connecting line is positioned at the video signal acquisition position of the endoscope; the front fork is hollow and is provided with a wire which is communicated with a power supply, the top ends of the front fork are respectively connected with two ends of the electrode body, the electrode body is outwards inclined downwards, the top parts of the front fork are gathered to form a hook tip, and the hook tip is upwards bent. The electrotome electrode can enable a clinician to clearly judge the tumor infiltration depth and range in the primary transurethral bladder tumor electrotome operation.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a trans-hook transurethral bladder tumor electrotome electrode.
Background
Clinically, bladder tumor is a common disease of urinary system, and the primary treatment method is surgical treatment combined with postoperative bladder perfusion chemotherapy. The main operation mode is suprapubic bladder tumor resection or transurethral bladder tumor electrotomy (namely TURBT). Because the bladder tumor recurrence rate is high, the bladder tumor is often subjected to re-operation or repeated operation treatment, the open operation is large in wound, the postoperative recovery is slow, the repeatability is poor, and the bladder tumor is gradually eliminated. Therefore, transurethral bladder tumor electrotomy (TURBT) has little trauma, quick postoperative recovery and strong repeatability, and has gradually replaced open surgery.
The current clinical bladder tumor electrotome is basically plasma electrotome, which has ring shape, spade shape, needle shape, button shape and the like, but the most main and most common clinical use is ring electrode. The ring electrode has been popular for many years, and has the characteristics of convenient operation and high excision efficiency, but two obvious defects are not solved by finding an effective and simple method, and the two methods are as follows: 1. the annular electrode is easy to cause obturator reflex in the obturator foramen reflex area of the bladder in the tumor excision process to cause bladder perforation, even cause severe bleeding in operation and can not be used for hemostasis. This problem has been plagued clinicians, and effective and simple avoidance has not been found for many years; 2. the annular electrode is not possible to be very accurately cut because of the shape of the electrode and the cutting mode of the annular electrode determined by the shape, and the burning of the arc-shaped cutting surface is unclear due to the cutting mode of the annular electrode, so that effective judgment on the tumor infiltration depth cannot be achieved in the operation process, and the situation directly influences the judgment of a clinician on tumor stage in the treatment process. This is due to the inability to accurately determine the resulting misunderstanding, repeated treatment, and passivity of clinical treatment decisions. At present, a small number of clinicians use needle electrodes to cut bladder tumors electrically to effectively avoid obturator reflections, but the defects of the clinicians include blocked vision, limited cutting angle, limited control feeling and accuracy of the cutting process and poor grasping of the cutting range.
Worldwide, because of the inability to transect bladder tumors electrotomy and the small number of open bladder segmental resections patients, this fraction of patients requires radical total bladder resections every year. Even after the entire bladder is resected, the own intestinal tract or stomach is used for in situ neo-bladder, and serious complications after operation and sharp reduction of life quality are faced. In some patients, even when the first transurethral bladder tumor electrotomy is performed, the physician cannot clearly judge the infiltration depth of the bladder tumor in the operation, so that the second electrotomy is forced to be performed about 2 weeks of the first operation.
Disclosure of Invention
Aiming at a plurality of problems existing in bladder tumor electrotome equipment, the invention provides a trans-hook transurethral bladder tumor electrotome electrode.
The invention relates to a trans-hook transurethral bladder tumor electrotome electrode which is arranged in a sheath tube and is closely attached to an endoscope, wherein the electrotome electrode comprises an electrode body and an operating rod, and the tail part of the operating rod is connected with an operating handle; the front fork is hollow and is provided with a wire which is communicated with a power supply, the top ends of the front fork are respectively connected with two ends of the electrode body, the electrode body is outwards inclined downwards, the top parts of the front fork are gathered to form a hook tip, and the hook tip is upwards bent.
Aiming at the characteristics of the urethra bladder tumor operation, in practice, the electrode body adopts a three-section structure, the length of the bottom of the electrode body is 3-4mm, and the angle between the electrode body and the operating rod is 110-130 degrees; the length of the middle part of the electrode body is 2-3mm, and the angle between the electrode body and the operating rod is 140-160 degrees; the length of the electrode hook tip is 1-2mm, and the angle between the electrode hook tip and the operating rod is 230-250 degrees. The electrode body with the specification can realize accurate and good control at the moment, can cut bladder tissues in a layering way, can clearly see a vascular-free plane between the tissues, and can truly realize enucleation of bladder tumors. The electrode body is designed to be inclined downwards, so that the conflict between the electrode and the operation visual field is obviously reduced, the operation visual field is liberated to the greatest extent, and the cutting mode is more accurate and safer due to the design of the electrode body hook tip. Meanwhile, compared with the needle electrode, the needle electrode can not cut off tissues by utilizing the current principle, and can not be used for finding a tissue avascular plane and separating the avascular plane by utilizing the needle electrode.
The bottom of the electrode body and the middle of the electrode body are covered with insulating materials. The redundant part of the electrode is insulated, only the 'punctiform' part of the front part of the electrode is left for working, and the safety, the accuracy and the performance of the electrode are improved under the same power. Because the energy is concentrated at one point, the power at the time of operation is reduced without reducing the operation performance. For example, the ring electrode is used for coagulation, because the ring shape determines a relatively wide contact surface during operation. The shape characteristics of the invention determine that the contact surface of the electrode is greatly reduced when the electrode works, so that the electrode has higher working performance under the same energy. Meanwhile, the working energy of the electrode can be obviously reduced, so that the effect of other electrodes in high energy can be achieved. Thus, the cauterization damage to the tissue can be obviously reduced, the edge definition of the resected tissue is obviously increased, and the natural structure of the tissue can be clearly observed.
Still be provided with the cavity passageway in the sheath, the passageway pastes tight endoscope setting, and the passageway export sets up in front fork line central below, the passageway is the reservation work storehouse that uses with the cooperation of electric cutting electrode, set up into high-pressure water passageway, administration passageway or laser fiber ring passageway as required in the work storehouse. The high-pressure water channel is used for cleaning the affected part locally, and compared with sheath water outlet, the water column is more concentrated, and the flushing effect is better; the administration channel is for topical administration; the laser annulus cauterizes or gasifies the tumor with the laser precision fiber.
Compared with the existing plasma electric cutting equipment, in particular to a replaceable motor and a needle electrode, the invention has the following advantages:
1. the closed cell reflection is effectively and thoroughly avoided. Because the shape of the trans-hook electrode prescribes that the "hook" and "pick" actions be upward and outward when resecting a tumor, the directionality of the action is such that deep cuts are avoided, as compared to the annular, needle-like electrode "dig" approach. At the same time, the cutting mode of the electrode is obviously different from other electrodes by using a short-time and low-power cutting method, so that the phenomenon that closed pore reflection is easily caused when continuous current is needed to work like a ring to cut a tumor is avoided.
2. The effective part of the electrode operation is minimized, and the effectiveness of the electrode operation is not reduced, but rather the electrode operation has higher performance in certain aspects of the electrode operation. Because the contact surface of conventional electrodes is relatively wide, such as the working contact surface of a ring electrode is a full semicircular ring, the same energy is distributed in each part of the ring and cannot be precisely controlled to a "point". The invention carries out insulation treatment on unnecessary parts of the electrode, and the working part is only in a 'dot shape'. This not only increases the local working energy, but also improves the accuracy and safety, and does not cut other tissue that does not need to be cut when cutting the target tissue.
3. The infiltration depth of the bladder tumor can be directly observed with naked eyes in the operation, so that the method plays a guiding role in judging clinical stage and the excision rate of primary operation, and plays a decisive role in clinical treatment strategies. Since the T stage of bladder tumor is marked by the infiltration depth of bladder wall, and the T stage determines the malignancy of the tumor to a great extent, and the requirement of modern surgery on the level anatomy is increased, the T stage is very important in this sense. The trans-hook electrode is used for working because of low current, and an arc-shaped section like a ring electrode is avoided, and a cutting mode of using hooks and hooks is added, so that the tissue structure of the cutting surface is quite clear. Even when the bottom of the tumor works, the current cutting is not needed, after the 'avascular plane' is found by accurate cutting, the 'hook' can be used for lifting the tumor tissue upwards to be peeled off from the normal tissue, so that the true 'enucleation of the tumor' is realized, namely, the natural avascular gap of the tissue is utilized to enucleate the tumor.
4. The range and depth of resected tumors are precisely controlled. The tissue with tumor invasion is locally adhered and hardened, the activity is poor, the tumor invasion is judged by pushing and hooking the tumor boundary tissue, and the excision can be accurately performed around the tumor tissue by using the excision action of hooks and hooks.
5. Provides a new mode of electric cutting bladder tumors. Because of the generation of the trans-hook electrode, the electric cutting mode of the bladder tumor is changed, and a new cutting strategy of the bladder tumor can be obtained. For example, under the accurate and good control of the hook-shaped electrode, the bladder tissue can be dissected in a layering way, the avascular plane between the tissues can be clearly seen, and the enucleation of the bladder tumor can be truly realized, and the excision is not performed. The method has the advantage that the depth of bladder tumor infiltration and the affected tissue level can be clearly judged. Thereby allowing the clinician to more rationally recognize the biological nature of the bladder tumor and how to perform a more perfect resection during the resection to reduce the intraoperative metastasis and tumor residual resulting from the surgical procedure.
6. Providing a wider surgical field of view. Because the previous needle electrode was used to "dig" out the tumor, the electrode was directly in front of the field of view, such that the electrode would block a portion of the field of view directly in front. The design of the trans-hook transurethral bladder tumor electrotome electrode designs the electrode into a reverse hook shape, and the working part sinks below the visual field, so that the visual field right in front can be completely liberated.
In summary, the trans-hooked transurethral bladder tumor electrotome electrode has the beneficial effects that: the method can enable a clinician to clearly judge the tumor infiltration depth and range in the primary transurethral bladder tumor electroincision operation, enable a plurality of patients who have to lose organs to reserve the important organ of the bladder, and can also obtain social benefits such as reducing medical risk, reducing medical cost, improving working efficiency and the like.
Drawings
Fig. 1 is a side view of the present invention.
Fig. 2 is a bottom view of the present invention.
FIG. 3 is a schematic view of the structure of the electrode with channels of the present invention
Wherein, the operation rod 1, the electrode body 2, the front fork 3 and the endoscope 4.
Detailed Description
Example 1: the transurethral bladder tumor electrotome is characterized in that the top end of the operating rod 1 is provided with a front fork 3, the front fork 3 is arranged under the endoscope 4 in a clinging way, and the connecting line center of the front fork 3 is positioned at the video signal acquisition position of the endoscope 4; the front fork 3 is hollow and is provided with a wire which is communicated with a power supply, the top ends of the front fork are respectively connected with two ends of the electrode body 2, the electrode body 2 adopts a three-section structure, the length of the bottom of the electrode body 2 is 3-4mm, and the angle between the front fork and the operating rod 1 is 110-130 degrees; the length of the middle part of the electrode body 2 is 2-3mm, and the angle between the electrode body and the operating rod 1 is 140-160 degrees; the electrode body 2 is inclined outwards and downwards, the top is gathered to form a hook tip, the length of the hook tip of the electrode body 2 is 1-2mm, and the angle between the electrode body and the operating rod 1 is 230-250 degrees; the bottom of the electrode body 2 and the middle of the electrode body 2 are covered with insulating materials.
Example 2: the transurethral bladder tumor electrotome is characterized in that the top end of the operating rod 1 is provided with a front fork 3, the front fork 3 is arranged under the endoscope 4 in a clinging way, and the connecting line center of the front fork 3 is positioned at the video signal acquisition position of the endoscope 4; the front fork 3 is hollow and is provided with a wire which is communicated with a power supply, the top ends of the front fork are respectively connected with two ends of the electrode body 2, the electrode body 2 adopts a three-section structure, the length of the bottom of the electrode body 2 is 3-4mm, and the angle between the front fork and the operating rod 1 is 110-130 degrees; the length of the middle part of the electrode body 2 is 2-3mm, and the angle between the electrode body and the operating rod 1 is 140-160 degrees; the electrode body 2 is inclined outwards and downwards, the top is gathered to form a hook tip, the length of the hook tip of the electrode body 2 is 1-2mm, and the angle between the electrode body and the operating rod 1 is 230-250 degrees; the bottom of the electrode body 2 and the middle of the electrode body 2 are covered with insulating materials. A hollow channel is also arranged in the sheath tube, the channel is closely arranged on the endoscope 4, the channel outlet is arranged below the center of the connecting line of the front fork 3, and the channel is connected with a high-pressure water pipe to be used as a high-pressure water channel.
The above examples are only some embodiments of the present invention, and the length, angle and use of the channels of the electrode body 2 should not be limited to the parameters described in the examples, and all the structures of the present invention are adopted, which fall within the protection scope of the present invention.
Claims (3)
1. The transurethral bladder tumor electrotome is characterized in that the top end of the operating rod (1) is provided with a front fork (3), the front fork (3) is arranged under the endoscope (4) in a manner of being clung to the lower part of the endoscope (4), and the connecting line center of the front fork (3) is positioned at the video signal acquisition position of the endoscope (4); the front fork (3) is hollow and is provided with a wire which is communicated with a power supply, the top ends of the front fork are respectively connected with two ends of the electrode body (2), the electrode body (2) is outwards inclined downwards, the top of the electrode body is gathered to form a hook tip, and the hook tip is bent upwards; the electrode body (2) adopts a three-section structure, and the angle between the bottom of the electrode body (2) and the operating rod (1) is 110-130 degrees; the angle between the middle part of the electrode body and the operating rod (1) is 140-160 degrees; the angle between the hook tip of the electrode body (2) and the operating rod (1) is 230-250 degrees.
2. The trans-hook transurethral bladder tumor electrotome electrode according to claim 1, wherein the length of the bottom of the electrode body (2) is 3-4mm, the length of the middle part of the electrode body (2) is 2-3mm, the length of the hook tip of the electrode body (2) is 1-2mm, and the bottom of the electrode body (2) and the middle part of the electrode body (2) are covered with insulating materials.
3. The trans-hooked transurethral bladder tumor electrotome electrode according to claim 1, wherein a hollow channel is further arranged in the sheath tube, the channel is arranged close to the endoscope (4), and a channel outlet is arranged below the connecting line center of the front fork (3).
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| Application Number | Priority Date | Filing Date | Title |
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| CN201810106318.6A CN108186109B (en) | 2018-02-02 | 2018-02-02 | Trans-hook transurethral bladder tumor electrotome electrode |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201810106318.6A CN108186109B (en) | 2018-02-02 | 2018-02-02 | Trans-hook transurethral bladder tumor electrotome electrode |
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| CN108186109A CN108186109A (en) | 2018-06-22 |
| CN108186109B true CN108186109B (en) | 2024-02-20 |
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| CN113749760A (en) * | 2021-09-02 | 2021-12-07 | 江苏邦士医疗科技有限公司 | Plasma electrode for bladder cancer tumor cutting operation |
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