CN113499088A - Visual intracavity closing system for varicose vein of lower limb - Google Patents
Visual intracavity closing system for varicose vein of lower limb Download PDFInfo
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- CN113499088A CN113499088A CN202110634772.0A CN202110634772A CN113499088A CN 113499088 A CN113499088 A CN 113499088A CN 202110634772 A CN202110634772 A CN 202110634772A CN 113499088 A CN113499088 A CN 113499088A
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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
- A61B18/22—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 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
- A61B6/504—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of blood vessels, e.g. by angiography
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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
- A61M25/00—Catheters; Hollow probes
- A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
- A61M25/0023—Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
- A61M25/0026—Multi-lumen catheters with stationary elements
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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
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
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Abstract
The invention discloses a visual intracavity closure system for varicose vein of lower limb, which comprises a digital subtraction angiography machine, a blood vessel puncture short sheath, a guide wire, a double-cavity catheter, a laser therapeutic apparatus, a visual laser optical fiber and an operating table, wherein the digital subtraction angiography machine is connected with the blood vessel puncture short sheath; the digital subtraction angiography frame is arranged on one side of the operating table; the visual laser optical fiber is connected with the laser therapeutic apparatus; the double-cavity catheter comprises a catheter body, a guide wire cavity and an optical fiber cavity, wherein the guide wire cavity and the optical fiber cavity are arranged in the catheter body in an axially parallel mode, and the guide wire and the visual laser fiber are respectively matched with the guide wire cavity and the optical fiber cavity. The invention integrates preoperative imaging evaluation, intraoperative visualization operation and postoperative imaging review, simplifies the operation, avoids repeated operation, increases the burden of patients and reduces postoperative recurrence.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a visual intracavity closure system for varicose vein of lower limb.
Background
Varicose veins in the lower extremities are a common venous disease in vascular surgery, and the incidence in the population can be as high as 20%. The incidence of varicose veins of the lower limbs increases with age, which seriously affects the life quality of people and increases the economic burden of society. The lower limb varicose vein patients mostly have the discomfort of lower limb lumbricus-shaped protrusion, soreness and distension, heaviness, weakness and the like, and the discomfort can develop into limb edema, skin eczema, pigmentation, venous ulcer and even thrombophlebitis when the patients are not treated in time, thereby bringing great influence to the work and life of the patients.
At present, diagnosis and preoperative examination of varicose vein of lower limb mainly depend on blood vessel color ultrasound and digital subtraction angiography, and the blood vessel color ultrasound is safe, noninvasive, simple, convenient and quick, and is a preferred auxiliary examination method for diagnosing varicose vein of lower limb at present. Although anterograde venography is considered to be the golden standard for diagnosing varicose veins of lower limbs, it is an invasive examination and is not clinically developed as a routine diagnostic means at present. However, in some cases, such as congenital venous malformation of lower limbs, complicated vein for transportation, deep vein dysfunction, iliac vein occlusion or stenosis, etc., the intuitiveness and accuracy of lower limb vein angiography are superior, and especially cannot be replaced in the first-stage DSA treatment of complications. But only depends on the blood vessel color ultrasound to cause misdiagnosis and missed diagnosis of patients partially combined with conditions of saphenous vein anatomical variation, Cockett syndrome, deep vein thrombosis syndrome, K-T syndrome and the like. In terms of treatment, the conservative treatment effect of varicose vein of lower limb is not good. The traditional high ligation and exuviation have large wound and are easy to relapse.
The intracavity laser treatment has small operation trauma, reliable operation effect and lower recurrence rate of patients, and is a preferred operation mode for saphenous vein insufficiency recommended by the vascular surgery society SVS and the American vein Forum AVF. Nevertheless, intracavity laser therapy still has its limitations. First, it is difficult to determine whether all varicose veins, especially the punch-through veins, have been effectively treated; secondly, the intracavity closure is performed, and whether the main trunk of the great saphenous vein is effectively closed or not is difficult to determine; finally, conventional treatment procedures tend to lead to misdiagnosis of particular patients, such as double saphenous vein, Cockett Syndrome, deep vein postthrombotic Syndrome, K-T Syndrome (K-T Syndrome), and the like.
Disclosure of Invention
The invention aims to provide a visual intracavity closure system for varicose vein of lower limb aiming at the defects of the prior art, which integrates preoperative imaging evaluation, intraoperative visual operation and postoperative imaging review, avoids repeated operation, increases the burden of patients and reduces postoperative recurrence.
The technical scheme for realizing the aim of the invention is as follows:
a visual intracavity closure system for varicose vein of lower limb comprises a digital subtraction angiography machine, a blood vessel puncture short sheath, a guide wire, a double-cavity catheter, a laser therapeutic apparatus, a visual laser fiber and an operating table; the digital subtraction angiography frame is arranged on one side of the operating table; the visual laser optical fiber is connected with the laser therapeutic apparatus; the double-cavity catheter comprises a catheter body, a guide wire cavity and an optical fiber cavity, wherein the guide wire cavity and the optical fiber cavity are arranged in the catheter body in an axially parallel mode, and the guide wire and the visual laser fiber are respectively matched with the guide wire cavity and the optical fiber cavity.
Further, in order to facilitate visualization under fluoroscopy, so as to realize visual treatment by accurate positioning, the visual laser fiber comprises a laser fiber and a spring ring fixedly installed at the head of the laser fiber, and the spring ring is made of a metal material.
Further, in order to improve the laser treatment effect, the optical fiber cavity is provided with an opening along the axial direction, and the visual laser optical fiber can be separated from the optical fiber cavity through the opening; the width of the opening is smaller than the outer diameter of the laser optical fiber, so that the visual laser optical fiber cannot come out of the optical fiber cavity in the passing process.
Furthermore, as the material of the optical fiber is brittle, the tail part of the visual laser optical fiber is provided with the reinforcing part, so that the tail end strength is increased, and the visual laser optical fiber is prevented from being broken in the separation process.
Further, the visible endoluminal closure system for varicose vein of lower limb of the invention further comprises a separation assisting device sleeved on the visible laser optical fiber, wherein the separation assisting device is suitable for assisting the visible laser optical fiber to be separated from the optical fiber cavity through the opening. Because the open-ended width in optic fibre chamber is less than laser fiber's external diameter, need tear optic fibre from the optic fibre chamber with certain strength, though the optic fibre afterbody is equipped with the rib, still has the risk of losing at the in-process that tears, through setting up separation auxiliary device, the visual laser fiber of being convenient for separates with two-chamber pipe, and the visual laser fiber of further protection simultaneously avoids visual laser fiber to lose.
Furthermore, the separation auxiliary device comprises a base, a connecting part and a conduit supporting part which are integrally formed, wherein the conduit supporting part comprises a first extending part, a second extending part and a third extending part which are sequentially connected, the first extending part is connected with the front part of the base, and the second extending part and the third extending part are connected with the rear part of the base through the connecting part; the base is provided with a through hole along the transverse direction. The separation auxiliary device is sleeved on the visual laser optical fiber through the through hole, and the catheter supporting part is arranged to guide the double-cavity catheter to exit in the separation process, so that the operation is smoother.
Further, the catheter body comprises an inner layer and an intermediate layer which are sequentially arranged outside the guide wire cavity from inside to outside and an outer layer which is wrapped outside the intermediate layer and the optical fiber cavity. The pipe body adopts multilayer structure design, designs the material of every layer according to the in-service use demand, improves the wholeness ability of pipe body.
Furthermore, the inner layer is made of PTFE material, has high lubricity and is a solid material with the lowest friction coefficient, so that the guide wire can smoothly pass through the guide wire cavity; the middle layer adopts a stainless steel flat wire braided layer, so that the strength of the catheter body is improved, and the catheter is prevented from being damaged; the outer layer is made of Pebax materials, is the lightest engineering thermoplastic elastomer, has excellent processing performance and good elasticity, is soft in texture, and is suitable for running in a tortuous vein.
Furthermore, for some patients with tortuous veins with high puncture difficulty and partial patients with puncture branch reflux, the invention also comprises a super-selection catheter which is a single-bent catheter with a three-layer structure, the three-layer structure from inside to outside is respectively made of PTFE material, metal weaving and Pebax material, the inner diameter of the super-selection catheter is larger than the outer diameter of the guide wire, and the guide wire is matched with the super-selection catheter, so that the super-selection is easier by matching the guide wire with the super-selection catheter, and the surgical process is accelerated.
Furthermore, the super-selection catheter adopts a single-bend catheter with an adjustable head, has excellent blood vessel passing performance, and is more convenient for an operator to super-select a lesion part.
Furthermore, in order to simplify the operation, the time for placing the catheter sheath is greatly shortened, the pain of a patient is reduced, and the complications of the patient are reduced, the blood vessel puncture short sheath comprises a puncture needle tube and a catheter sheath sleeved on the puncture needle tube, the catheter sheath punctures along with the puncture needle tube, the front end of the catheter sheath is conical, the blood vessel can conveniently enter the blood vessel, the wound is reduced, the rear end of the catheter sheath is provided with a quick connector, the quick connector is conveniently connected with the rear end of the puncture needle tube, and the puncture needle tube is separated from the catheter sheath and exits after the puncture is completed.
Further, the guide wire comprises a core wire made of elastic nickel-titanium alloy material, and in order to avoid scratching the inner wall of the blood vessel, the distal end of the core wire is provided with a conical soft head; the guide wire also comprises a hydrophilic coating coated on the outer surfaces of the core wire and the conical soft head, so that the surface lubricity is increased, the guide wire can conveniently wander in blood vessels, the adhesion is reduced, and the thrombosis in the use process is avoided.
Furthermore, the laser therapeutic apparatus is provided with a foot switch, so that the opening and closing of the laser therapeutic apparatus are conveniently controlled.
By adopting the technical scheme, the invention has the following beneficial effects:
(1) the digital subtraction angiography machine is arranged, the lower limb varicose veins are treated in a one-stop mode under the guidance of the digital subtraction angiography machine in the whole process, the requirement of angiography before operation of each patient is met, misdiagnosis and missed diagnosis of the patient who is combined with the conditions of iliac vein compression syndrome, inferior vena cava syndrome, deep vein thrombosis, incomplete deep vein function and the like are avoided, and the patient with the combined symptoms can be treated in the same period; the blood vessel puncture short sheath, the guide wire and the double-cavity catheter are matched for use, so that the blood vessel can enter the vein of the lower limb and lesion can be quickly selected; the visual treatment is realized by the matching use of the laser therapeutic apparatus and the visual laser fiber. The whole system integrates preoperative imaging evaluation, intraoperative visual operation and postoperative imaging review, avoids repeated operation, increases the burden of patients and reduces postoperative recurrence.
(2) The head of the visual laser fiber is provided with the spring ring made of metal material, so that the visualization under fluoroscopy is facilitated, the visual treatment is realized, and the positioning is more accurate.
(3) The optical fiber cavity is provided with the opening along the axial direction, and the visual laser optical fiber can be separated from the optical fiber cavity through the opening, so that the laser treatment effect is improved; the width of the opening is smaller than the outer diameter of the laser optical fiber, so that the visual laser optical fiber cannot come out of the optical fiber cavity in the passing process to influence the operation.
(4) The tail part of the visual laser fiber is provided with the reinforcing part, so that the strength of the tail end of the fiber is increased, and the visual laser fiber is prevented from being broken in the separation process.
(5) The optical fiber is torn out from the optical fiber cavity with certain strength due to the fact that the width of the opening of the optical fiber cavity is smaller than the outer diameter of the laser optical fiber, although the tail portion of the optical fiber is provided with the reinforcing portion, the optical fiber is still prone to breakage in the tearing process, the visual laser optical fiber is conveniently separated from the double-cavity catheter through the separation auxiliary device, meanwhile, the visual laser optical fiber is further protected, and breakage of the visual laser optical fiber is avoided.
(6) The separation auxiliary device is provided with the through hole to realize that the separation auxiliary device is sleeved on the visual laser optical fiber, and the catheter supporting part is arranged to guide the double-cavity catheter to exit in the separation process, so that the operation is smoother.
(7) The catheter body of the double-lumen catheter adopts a multi-layer structure design, and the material of each layer is designed according to the actual use requirement, so that the overall performance of the catheter body is improved. The inner layer is made of PTFE material, has high lubricity and is a solid material with the lowest friction coefficient, so that the guide wire can smoothly pass through the guide wire cavity; the middle layer adopts a stainless steel flat wire braided layer, so that the strength of the catheter body is improved, and the catheter is prevented from being damaged; the outer layer is made of Pebax materials, is the lightest engineering thermoplastic elastomer, has excellent processing performance and good elasticity, is soft in texture and is suitable for running in a tortuous vein.
(8) The invention also comprises the super-selection catheter, which is difficult to super-select by adopting a double-lumen catheter for patients with certain tortuous veins with high difficulty in crossing and partial patients with crossing branch reflux, is easier to super-select by utilizing a guide wire matched with the super-selection catheter, and is continuously operated by withdrawing the super-selection catheter and then introducing the double-lumen catheter, thereby accelerating the operation process.
(9) The short sheath for blood vessel puncture comprises a puncture needle tube and a catheter sheath sleeved on the puncture needle tube, wherein the catheter sheath punctures along with the puncture needle tube, so that the operation is simplified, the time for placing the catheter sheath is greatly shortened, and the pain and the complication of a patient are reduced; meanwhile, the front end of the catheter sheath is conical, so that the catheter sheath can conveniently enter a blood vessel and reduce wound, the rear end of the catheter sheath is also provided with a quick connector which is conveniently connected with the rear end of the puncture needle tube, and the puncture needle tube and the catheter sheath can be quickly separated and withdrawn after puncture is completed.
Drawings
In order that the present disclosure may be more readily and clearly understood, reference is now made to the following detailed description of the present disclosure taken in conjunction with the accompanying drawings, in which:
FIG. 1 is a schematic view of the structure of example 1 of the present invention;
FIG. 2 is a schematic view of a guidewire of the present invention;
FIG. 3 is a schematic view of the construction of a double lumen catheter of the present invention;
FIG. 4 is a cross-sectional view taken at A-A of FIG. 3;
FIG. 5 is a schematic view of a visualization laser fiber according to the present invention;
FIG. 6 is a schematic view of the separation aid of the present invention;
FIG. 7 is a right side view of the separation aid of the present invention;
FIG. 8 is a schematic view of the assembly of the dual lumen catheter, visualization laser fiber and detachment assistance device of the present invention;
FIG. 9 is a cross-sectional view taken at B-B of FIG. 8;
FIG. 10 is a schematic view of the configuration of a super catheter of the present invention.
The reference numbers in the drawings are:
the system comprises a digital subtraction angiography machine 1, a blood vessel puncture short sheath 2, a catheter sheath 21, a quick connector 22, a guide wire 3, a core wire 31, a tapered soft tip 32, a double-cavity catheter 4, a catheter body 41, an inner layer 411, an intermediate layer 412, an outer layer 413, a guide wire cavity 42, an optical fiber cavity 43, an opening 431, a laser therapeutic apparatus 5, a foot switch 51, a visual laser optical fiber 6, a laser optical fiber 61, a spring ring 62, a reinforcing part 63, an operating table 7, a separation assisting device 8, a base 81, a through hole 811, a connecting part 82, a catheter supporting part 83, a first extending part 831, a second extending part 832, a third extending part 833 and an over-selection catheter 9.
Detailed Description
In order to better understand the technical solution, the technical solution will be described in detail with reference to the drawings and the specific embodiments.
(example 1)
The visualized endoluminal closure system for varicose veins of lower limbs shown in fig. 1 to 5 comprises a digital subtraction angiography machine 1, a vascular puncture short sheath 2, a guide wire 3, a double-lumen catheter 4, a laser treatment instrument 5, a visualized laser optical fiber 6 and an operating table 7. The guide wire 3 and the visual laser fiber 6 are both matched with the double-cavity catheter 4. Digital subtraction angiography machine 1 is used for carrying out the image science observation to pathological change department, and blood vessel puncture short sheath 2 is used for puncturing the blood vessel, and guide wire 3 uses with the cooperation of two-chamber pipe 4, and the super selected pathological change break-over vein, visual laser fiber 6 reach pathological change department and carry out visual treatment to pathological change department under the effect of laser treatment instrument 5 along two-chamber pipe 4.
Specifically, the digital subtraction angiography machine 1 is erected on the left side of the operating table 7, and the nature, degree and range of diseases can be determined by lower limb vein angiography performed by the digital subtraction angiography machine 1; the system can also be used for observing the functional states of the deep vein, the through vein and the superficial vein, providing related information about the location of the variant superficial vein and the incompetent through branch vein, providing basis for further understanding the surgical complications and reasonable treatment, and the image is clearer compared with B-ultrasound.
The short sheath 2 for blood vessel puncture comprises a puncture needle tube (not shown in the figure) and a catheter sheath 21 sleeved on the puncture needle tube, the varicose vein of a patient often has serious tortuosity, a common puncture sheath is difficult to completely enter a blood vessel sometimes, so that a long-section sheath tube is suspended, the stability is not enough, the catheter sheath 21 is made of high-density polyethylene materials, and compared with the existing catheter sheath, the short and thin catheter sheath is designed to be shorter and thinner in appearance, can enter the varicose vein to a greater extent, and is higher in stability. The catheter sheath 21 punctures along with the puncture needle tube, thereby greatly shortening the time for placing the catheter sheath 21 and reducing the pain and the complication of the patient. The front end of the conduit sheath 21 is conical, so that the conduit sheath can conveniently enter blood vessels and reduce wound, the rear end of the conduit sheath is provided with a quick connector 22 which is conveniently connected with the rear end of the puncture needle tube, and simultaneously, the puncture needle tube is conveniently separated from the conduit sheath and exits after puncture is completed.
The guide wire 3 comprises a core wire 31, a conical soft head 32 is arranged at the far end of the core wire 31, the core wire 31 is made of elastic nickel-titanium alloy materials, and the inner wall of a blood vessel can be prevented from being scratched by the guide wire through the conical soft head 32; in order to increase the lubricity of the surface of the guide wire, the outer surfaces of the core wire and the conical soft head are coated with hydrophilic coatings, so that the guide wire 3 can conveniently move in a blood vessel, the adhesion is reduced, and the thrombosis in the use process is avoided.
The double-lumen catheter 4 comprises a catheter body 41, and a guide wire cavity 42 and an optical fiber cavity 43 which are axially arranged in parallel in the catheter body 41, wherein the optical fiber cavity 43 is provided with an opening 431 along the axial direction. The guide wire 3 and the visual laser fiber 6 are respectively matched with the guide wire cavity 42 and the fiber cavity 43, compared with a single-cavity tube in the prior art, the guide wire 3 does not need to be withdrawn from the tube and then the fiber is led in, the operation is simplified, and the operation process is accelerated. The visualization laser fiber 6 can be separated from the fiber cavity 43 through the opening 431, thereby improving the laser treatment effect. The catheter body 41 comprises an inner layer 411 and an intermediate layer 412 which are arranged outside the guide wire cavity 42 from inside to outside in sequence, and an outer layer 413 which is wrapped outside the intermediate layer 412 and the optical fiber cavity 43. The catheter body 41 of the embodiment adopts a multi-layer structure design, and the material of each layer is designed according to actual use requirements, so that the overall performance of the catheter body 41 is improved. The inner layer 411 is made of PTFE material, has high lubricity and is made of solid material with the lowest friction coefficient, so that the guide wire 3 can smoothly pass through the guide wire cavity 42; the middle layer 412 adopts a stainless steel flat wire braided layer, so that the strength of the catheter body 41 is improved, and the catheter is prevented from being damaged; the outer layer 413 is made of Pebax, is the lightest engineering thermoplastic elastomer, has excellent processing performance and good elasticity, is soft in texture and is more beneficial to running in a tortuous vein.
The laser therapeutic apparatus 5 is provided with a foot switch 51 for controlling the on and off of the laser therapeutic apparatus 5. Visual laser optical fiber 6 links to each other with laser therapeutic instrument 5, including laser optical fiber 61 and fixed mounting at the spring coil 62 of laser optical fiber 61 head, spring coil 62 adopts metal material to make, is convenient for develop under the perspective, realizes visual treatment to accurate location pathological change department avoids the optic fibre head end to get into dark vein and causes the operation risk. The spring ring 62 of this embodiment is preferably stainless steel for medical use, corrosion resistant, easy to manufacture and sterilize, and inexpensive to manufacture. The outer diameter of the laser fiber 61 is larger than the width of the opening 431, ensuring that the visualization laser fiber 6 does not come out of the fiber cavity 43 during the traversing. Because the material of optic fibre is more fragile, the width of opening 431 is less than laser fiber 61's external diameter again, need use certain strength to tear visual laser fiber 6 from optic fibre chamber 43 in the separation process, in order to avoid visual laser fiber 6 to break, be equipped with reinforcing part 63 at the afterbody of laser fiber 61 to increase tail end intensity. The reinforcing part 63 is made of a resin material, has good processability, and is convenient to wrap the surface of the optical fiber.
(example 2)
As shown in fig. 1 to 9, the structure of this embodiment is similar to that of embodiment 1, except that a separation assisting device 8 is added to the visualization laser fiber 6 to assist the visualization laser fiber 6 to be separated from the fiber cavity 43 more easily through the opening 431. Although the tail part of the optical fiber is provided with the reinforcing part 63, the risk of breakage still exists in the tearing process, and the visual laser optical fiber 6 is further protected and the breakage of the visual laser optical fiber 6 is avoided by arranging the separation auxiliary device and assisting the separation.
In particular, the outer diameter of the front end of the detachment assisting device 8 is smaller than the inner diameter of the optical fiber cavity 43, ensuring that the front end can be inserted into the optical fiber cavity 43, thereby protecting the visualization laser fiber 6 and guiding its detachment from the optical fiber cavity 43. The separation assisting device 8 comprises a base 81, a connecting part 82 and a conduit supporting part 83 which are integrally formed, wherein the conduit supporting part 83 comprises a first extending part 831, a second extending part 832 and a third extending part 833 which are sequentially connected, the first extending part 831 is connected with the front part of the base 81, and the second extending part 832 and the third extending part 833 are connected with the rear part of the base 81 through the connecting part 82; the base 81 is transversely provided with a through hole 811 with an inner diameter larger than the outer diameter of the visual laser fiber 6, and the base 81 is in an oblate ring shape along the longitudinal direction, so that the base can be more conveniently torn out from the optical fiber cavity 43. Realize that separation auxiliary device 8 cover is established on visual laser fiber 6 through setting up through-hole 811, through setting up pipe supporting part 83, be used for guiding two-chamber pipe 4 to withdraw out at the separation in-process, make the operation more smooth and easy.
The application method of the embodiment comprises the following steps:
firstly, a digital subtraction angiography machine 1 is adopted to conduct lower limb vein anterograde radiography through the side foot dorsal vein of a patient to observe the general appearance of the lower limb vein, know whether the deep vein is unobstructed, judge whether the root of the great saphenous vein, the deep vein and the through vein have reflux, and clearly determine the main concentrated part of the varicose superficial vein branch.
Secondly, injecting lidocaine subcutaneously and locally at the great saphenous vein part in front of the medial malleolus of the affected side, puncturing and placing the blood vessel puncture short sheath 2, carrying out over-selection on lesion penetrating veins by utilizing the guide wire 3 to be matched with the guide wire cavity 42 of the double-cavity catheter 4, guiding the visual laser fiber 6 into the fiber cavity 43 of the double-cavity catheter 4, inserting the head of the separation auxiliary device 8 into the fiber cavity 43 and withdrawing the double-cavity catheter 4 after the puncture is in place, withdrawing the double-cavity catheter 4 from the vein along the catheter supporting part 83 of the separation auxiliary device 8, and separating the visual laser fiber 6 from the fiber cavity 43 by the separation auxiliary device 8 easily in the process; and finally, carrying out laser discharge under the guidance of DSA to close the trunk of the great saphenous vein.
(example 3)
As shown in fig. 1 to 10, the present embodiment is similar in structure to embodiment 2 except that a super selection duct 9 is added. For some patients with tortuous veins with high puncture difficulty and partial patients with puncture branch reflux, the double-lumen catheter 4 is difficult to perform over-selection, and the over-selection is easier to perform by matching the guide wire 3 with the over-selection catheter 9, so that the surgical progress is accelerated.
Specifically, compared with a common single bent pipe in the prior art, the super selection catheter 9 of the present embodiment adopts a single bent catheter with a three-layer structure, the three-layer structure from inside to outside is respectively made of a PTFE material, a metal woven material and a Pebax material, the texture is soft and slender, the super selection catheter is suitable for running in a tortuous vein, the inner diameter of the super selection catheter 9 is larger than the outer diameter of the guide wire 3, and the guide wire 3 is ensured to be matched with the super selection catheter 9. Meanwhile, the head of the single-bending catheter of the embodiment can be adjusted, so that the catheter has excellent blood vessel trafficability, and is more convenient for an operator to over-select lesions.
The application method of this embodiment is similar to that of embodiment 2, when a patient suffering from thoroughfare reflux is encountered, the guide wire 3 is used to cooperate with the super-selection catheter 9 to super-select the lesion, then the super-selection catheter 9 is withdrawn, and then the double-lumen catheter 4 is passed along the guide wire 3 to continue the intracavity laser closing treatment of embodiment 2 or the sclerosing agent injection catheter is passed along the guide wire 3 to perform the treatment of injecting the foam sclerosing agent. The sclerosing agent injection catheter of the embodiment is slender as a whole, is composed of three layers of structures, is made of a PTFE material, a stainless steel flat wire and a Pebax material from inside to outside, and is more suitable for running in a tortuous vein. The front end opening is smaller than that of a common sclerosing agent injection catheter, and the sclerosing agent injection catheter is used for being matched with the guide wire 3 to pass through a varicose vein, so that excessive sclerosing agent is prevented from going out through the head end, and the risk of deep vein embolism caused by the sclerosing agent is reduced. The wall of the catheter is provided with a plurality of fine side holes, so that the sclerosing agent is conveniently and uniformly distributed in the whole vein, the sclerosing agent injection treatment of the whole varicose vein can be completed at one time without moving the catheter, and the operation is more convenient.
According to the invention, by arranging the digital subtraction angiography machine 1, the lower limb varicose veins can be treated in a one-stop way under the guidance of the digital subtraction angiography machine 1 in the whole process, so that the requirement of angiography before operation of each patient is realized, misdiagnosis and missed diagnosis of the patients with combined conditions of iliac vein compression syndrome, inferior vena cava syndrome, deep vein thrombosis, incomplete deep vein function and the like are avoided, and the patients with combined symptoms can be treated at the same time; the blood vessel puncture short sheath 2, the guide wire 3 and the double-cavity catheter 4 are matched for use, so that the blood vessel can enter the vein of the lower limb and lesion can be quickly selected; the visual treatment is realized by the matching use of the laser treatment instrument 5 and the visual laser fiber 6. The whole system integrates preoperative imaging evaluation, intraoperative visual operation and postoperative imaging review, avoids repeated operation, increases the burden of patients and reduces postoperative recurrence. The double-lumen catheter 4 is adopted to replace the traditional single lumen tube, the visual laser fiber can be introduced without the guide wire 3 which is withdrawn, the operation steps are reduced, the operation process is quicker, and meanwhile, the visual laser fiber 6 can be separated from the double-lumen catheter 4, so that the laser discharge treatment is more facilitated.
The above-mentioned embodiments are intended to illustrate the objects, technical solutions and advantages of the present invention in further detail, and it should be understood that the above-mentioned embodiments are only exemplary embodiments of the present invention, and are not intended to limit the present invention, and any modifications, equivalents, improvements and the like made within the spirit and principle of the present invention should be included in the protection scope of the present invention.
Claims (10)
1. A visual endoluminal closure system for varicose veins of lower limbs, characterized in that: comprises a digital subtraction angiography machine (1), a blood vessel puncture short sheath (2), a guide wire (3), a double-cavity catheter (4), a laser therapeutic apparatus (5), a visual laser fiber (6) and an operating table (7); the digital subtraction angiography machine (1) is erected on one side of the operating table (7); the visual laser fiber (6) is connected with the laser therapeutic apparatus (5); double-chamber pipe (4) are including pipe body (41) and locate wire chamber (42) and optic fibre chamber (43) in pipe body (41) along axial direction parallel, seal wire (3) and visual laser fibre (6) respectively with wire chamber (42) and optic fibre chamber (43) looks adaptation.
2. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 1, wherein: the visual laser fiber (6) comprises a laser fiber (61) and a spring ring (62) fixedly mounted at the head of the laser fiber (61), and the spring ring (62) is made of a metal material.
3. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 2, wherein: the optical fiber cavity (43) is provided with an opening (431) along the axial direction, and the width of the opening (431) is smaller than the outer diameter of the laser optical fiber (61).
4. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 3, wherein: the tail part of the visual laser fiber (6) is provided with a reinforcing part (63).
5. The visualization endoluminal closure system for varicose veins of the lower limbs of claim 4, wherein: the optical fiber separation device is characterized by further comprising a separation auxiliary device (8) sleeved on the visual laser optical fiber (6), wherein the separation auxiliary device (8) is suitable for assisting the visual laser optical fiber (6) to be separated from the optical fiber cavity (43) through the opening (431).
6. The visualization endoluminal closure system for varicose veins of the lower limbs of claim 5, wherein: the separation auxiliary device (8) comprises a base (81), a connecting part (82) and a conduit supporting part (83) which are integrally formed, wherein the conduit supporting part (83) comprises a first extending part (831), a second extending part (832) and a third extending part (833) which are sequentially connected, the first extending part (831) is connected with the front part of the base (81), and the second extending part (832) and the third extending part (833) are connected with the rear part of the base (81) through the connecting part (82); the base (81) is transversely provided with a through hole (811).
7. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 1, wherein: the catheter body (41) comprises an inner layer (411) and an intermediate layer (412) which are sequentially arranged outside the guide wire cavity from inside to outside, and an outer layer (413) which is wrapped outside the intermediate layer (412) and the optical fiber cavity (43).
8. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 7 wherein: the inner layer (411) is made of PTFE material; the middle layer (412) adopts a stainless steel flat wire braided layer; the outer layer (413) is made of a Pebax material.
9. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 1, wherein: the catheter with the three-layer structure is characterized by further comprising a super-selection catheter (9), wherein the super-selection catheter (9) adopts a single-bent catheter with a three-layer structure, the inner diameter of the super-selection catheter (9) is larger than the outer diameter of the guide wire (3), and the guide wire (3) is matched with the super-selection catheter (9).
10. The visualization endoluminal closure system for varicose veins of the lower extremities of claim 1, wherein: the short blood vessel puncture sheath (2) comprises a puncture needle tube and a catheter sheath (21) sleeved on the puncture needle tube, the front end of the catheter sheath (21) is conical, and the rear end of the catheter sheath is provided with a quick connector (22).
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