WO2017101187A1 - 一种可固定的腹腔镜穿刺器 - Google Patents

一种可固定的腹腔镜穿刺器 Download PDF

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Publication number
WO2017101187A1
WO2017101187A1 PCT/CN2016/070713 CN2016070713W WO2017101187A1 WO 2017101187 A1 WO2017101187 A1 WO 2017101187A1 CN 2016070713 W CN2016070713 W CN 2016070713W WO 2017101187 A1 WO2017101187 A1 WO 2017101187A1
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Prior art keywords
tube
sheath
connecting structure
fixed
valve
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PCT/CN2016/070713
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English (en)
French (fr)
Inventor
陈勇
苟欣
何卫阳
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陈勇
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Priority claimed from CN201521063682.7U external-priority patent/CN205286423U/zh
Priority claimed from CN201510953394.7A external-priority patent/CN105380684A/zh
Application filed by 陈勇 filed Critical 陈勇
Publication of WO2017101187A1 publication Critical patent/WO2017101187A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles

Definitions

  • the invention belongs to the field of medical instruments, and in particular relates to a fixable laparoscopic puncturing device.
  • Laparoscopic surgery is currently the most widely used minimally invasive surgical procedure.
  • the laparoscopic puncture device is used to pierce the body wall (chest, abdomen, waist, etc.) through the skin, and the front end of the sheath tube of the puncture device is placed in the body cavity such as the abdominal cavity, the thoracic cavity or the posterior abdominal cavity, and then the channel in the sheath tube is pierced.
  • the surgical instrument is placed to perform a corresponding surgical operation on the tissue and organs in the body cavity.
  • the laparoscopic puncture device is a device that must be used in this operation.
  • the existing laparoscopic puncture sheath has no effective fixation device after penetrating into the body cavity, and the puncture sheath tube often appears to be out of the body and deep into the body during the operation.
  • the penetrator sheath is placed too deep and there is a risk of damage to the organ, which may cause the ocular endoscope field to be blocked and make the operation of the surgical instrument difficult.
  • all kinds of forceps, clips, ultrasonic cutter heads and needle holders cannot be opened; the puncture sheath Frequent prolapse causes the surgeon to have to repeatedly puncture the cannula, which seriously affects the progress and quality of the operation and aggravates the patient's trauma.
  • the body cavity is filled with carbon dioxide gas, so that the body cavity is expanded to facilitate the operation of the surgical instrument. Since there is a large gap between the currently used puncture sheath and the body wall puncture channel, this easily causes gas leakage in the cavity. A large amount of gas leakage can cause the body cavity to collapse and collapse, which seriously interferes with the surgical operation; the spilled gas can enter the subcutaneous loose adipose tissue gap to form a wide subcutaneous emphysema, which increases the patient's pain.
  • the most commonly used puncture sheath sheath fixation method is the skin suture method, that is, the suture is tying the suture by passing the thread through the preset side hole on the wall of the puncture device after suturing the skin at the puncture site.
  • the method of sheath fixation is simple and convenient, and can effectively prevent the sheath from coming out, but it cannot solve the problem that the sheath is placed too deeply and the gas is leaking.
  • different researchers have designed a variety of puncturing device-assisted fixation structures or devices with a fixed function.
  • the CN204428128U patent issued by the Chinese Patent Office on July 1, 2015 the elastic rubber fixing plate designed by the Chinese Patent Office can be sleeved outside the sheath of the puncture device, and the elastic tightening action of the rubber material is used to fix the disc and the sheath tube relatively.
  • the skin at the bottom of the disc and the body wall is fixed by suture.
  • CN203915028U and 2015 5 announced by the Chinese Patent Office on November 5, 2014, similar to this in vitro immobilization method.
  • the relative fixing between the piercer sheath and its external fixing device is realized by bolts.
  • the design of the in vitro fixation method can prevent the penetration of the trocar sheath into the deep and/or detachment effect, but in the actual surgical operation, the lancet sheath is repeatedly subjected to the torsion and push-pull force, and the sheath tube and the outer sheath thereof
  • the fixation device still has a large risk of loosening, and the outer casing fixing device must limit the angle of rotation of the puncture sheath to a certain extent, which interferes with the operation of the surgical instrument, which is particularly significant in relatively deep and narrow body cavities such as the operation of the posterior abdominal device.
  • an air bag is arranged on the outer periphery of the front end of the puncture sheath tube.
  • the air bag in the body cavity is filled with water to fill the air bag in the body cavity. This prevents the puncture sheath from coming out and has a certain anti-leakage effect, but such an in vivo fixation method does not prevent the puncture sheath from being placed too deep.
  • an air bag is arranged at the front end, the middle part and the rear end of the puncture sheath tube body.
  • the front end air bag is located in the body cavity, and the middle air bag is located in the body wall puncture channel. Inside, the rear end airbag is positioned outside the body.
  • the fixation of the three balloons in and out of the body can make the puncture sheath securely displaceable, but the multiple balloon design of the puncture sheath significantly reduces the actual effective length of the sheath, and even makes it impossible to penetrate the body wall.
  • Body cavity, the way of fixation inside and outside the body also limits the angle of rotation of the sheath.
  • the balloon in the body cavity is too small to prevent the sheath from shifting. If it is too large, it can interfere with the surgical field of view.
  • the balloon in the middle of the sheath may also tear the body wall.
  • the present invention provides a fixable laparoscopic trocar having a good fixation effect during use.
  • a fixable laparoscopic puncturing device comprising a sheath tube, a fixing structure and a connecting structure
  • the connecting structure connects the sheath tube and the fixing structure along an axial direction of the sheath tube
  • the fixing structure can be fixed or moved on the sheath tube by the connecting structure
  • the fixing structure comprises a fixed tube, an air bag, an infusion/gas passage, and an infusion/gas valve; the fixing tube is sleeved outside the sheath tube and has a length smaller than the sheath tube; the air bag is disposed on the a front end of the fixed pipe; the one end of the liquid injection/air passage is connected to the air bag, and the other end of the liquid injection/air passage protrudes outside the pipe wall of the fixed pipe, and the port of the liquid injection/air passage is Providing a liquid/air valve, the liquid injection/air valve is provided with a rear end of the fixed pipe, and a valve port of the liquid injection/air valve protrudes outside the pipe wall of the fixed pipe; An air bag and the infusion/gas valve are in communication through the infusion/gas passage.
  • the connecting structure includes a first connecting structure and a second connecting structure.
  • the first connecting structure is disposed on an outer wall of the sheath, and the second connecting structure is disposed on an inner wall of the fixed tube.
  • connection structures namely a circular transverse thread and a continuous spiral thread
  • specific structure is as follows:
  • the connecting structure is an annular horizontal strip
  • the first connecting structure is provided with a groove along an axial direction of the sheath tube, and the length of the groove is larger than the length of the second connecting structure, the groove
  • the vertical cross section is the same as the vertical cross section of the second connecting structure, and the first connecting structure and the second connecting structure in the same vertical plane can form an approximately complete annular horizontal strip.
  • the connecting structure is a continuous spiral thread.
  • the sheath has a working length of 10 cm and an outer diameter of 5-12 mm.
  • the fixed tube has a length of 2-5 cm, a tube wall thickness of 1.5 mm, and an outer diameter of 8-15 mm.
  • the volume of the balloon is 2-20 mL.
  • the distance between the airbag and the injecting/gas valve is 0.5-4.0 cm.
  • the liquid injection/gas valve protrudes from the outer side of the tube wall of the fixed tube by a length of 1-2 cm.
  • the balloon is positioned in the subcutaneous fat layer to fix the sheath.
  • the airbag does not significantly reduce the working length of the sheath and limit its angle of rotation.
  • the airbag does not aggravate the damage of the puncture channel.
  • the designed fixed puncture device has simple structure, few operating steps and convenient use.
  • Figure 1 is a schematic view showing the structure of a fixable puncture device of the present invention
  • FIG. 2 is a schematic structural view of a sheath tube having a ring-shaped transverse stripe according to the present invention
  • Figure 3 is a partial enlarged view of C in Figure 2;
  • FIG. 4 is a schematic structural view of a fixing structure in which the connecting structure of the present invention is an annular horizontal strip;
  • Figure 5 is a cross-sectional view taken along line A-A of Figure 4.
  • Figure 6 is a schematic structural view of a sheath tube of the present invention in which the connecting structure is a continuous spiral thread;
  • Figure 7 is a schematic structural view of the fixing structure of the connecting structure of the present invention which is a continuous spiral thread
  • Figure 8 is a cross-sectional view taken along line B-B of Figure 7;
  • Figure 9 is a schematic view showing the state of use of a fixable puncture device of the present invention.
  • connection structure 31, first connection structure; 311, groove;
  • the present invention provides a fixable laparoscopic trocar comprising a sheath 1, a fixed structure 2 and a connecting structure 3 connecting the sheath 1 and the fixed structure 2, along Sheath 1 In the axial direction, the fixing structure 2 can be fixed or moved on the sheath 1 by the connecting structure;
  • the fixing structure 2 specifically includes a fixed tube 21, an air bag 22, an infusion/gas passage (omitted in the drawing), and an infusion/gas valve 23;
  • the fixing tube 21 is sleeved outside the sheath tube 1 and has a length smaller than The sheath tube 1;
  • the air bag 22 is disposed at a front end of the fixed tube 21;
  • the liquid injection/air valve 23 is provided with a rear end of the fixed tube 21, and the valve of the liquid injection/gas valve 23
  • the mouth protrudes from the outside of the tube wall of the fixed tube 21, wherein the length of the liquid injection/air valve 23 protruding from the outside of the tube wall of the fixed tube 21 is preferably 1.0 cm;
  • the liquid/gas valve 23 is communicated through the liquid injection/air passage, and the liquid injection/air passage is provided on the pipe wall of the fixed pipe 21.
  • the fixed tube 21 is movable in the axial direction of the sheath 1 toward the puncture channel, when the balloon 22 at the front end of the fixed tube 21 is placed in the subcutaneous fat layer II.
  • the movement is stopped, and both the sheath tube 1 and the fixed tube 21 are relatively fixed in position by the connecting structure 3.
  • the balloon 22 is positioned in the subcutaneous fat layer II in the body wall puncture channel, that is, between the relatively dense muscle layer III and the skin layer I of the body wall tissue.
  • the liquid/gas passage can be injected into the air bag 22 to fill it.
  • the air bag 22 is prepared by using a medical silicone rubber or a PVC material, and has a tensile strength large enough to withstand the hydraulic pressure or air pressure in the air bag 22, and the air bag 22 is not easily broken by an external force.
  • the valve port of the liquid injection/air valve 23 protrudes from the outer side of the tube wall of the fixed tube 21, and the liquid injection/air valve 23 is located outside the body when the puncturing device is used, and has the outer tube 21 prevented from being excessively penetrated.
  • the role of the channel The penetrator in use is fixed by the filled air bag 22 and the infusion/valve valve 23 protruding from the outside of the tube wall of the fixed tube 21.
  • the balloon 22 is positioned in the subcutaneous loose adipose tissue to fix the sheath 1 accurately.
  • the dense dermal tissue has the characteristics of large compressive strength and high ductility, and can effectively prevent the balloon 22 from coming out of the skin at the incision incision, thereby preventing the sheath 1 from coming off.
  • the body wall muscle layer III has a large compressive strength but a certain ductility, which can effectively prevent the balloon 22 from shifting forward under the action of conventional operating force, thereby preventing the sheath tube 1 from penetrating into the body cavity IV, but if only the air bag 22 is present
  • the design of the balloon 22 may be embedded in the muscle layer III puncture channel during the transient violent push forward, resulting in muscle tear bleeding, and the sheath 1 is displaced before the movement, so in the present invention, the fixed tube 21
  • the liquid inlet/air valve 23 is disposed at the rear end, and the valve opening of the liquid injection/air valve 23 protrudes outside the tube wall of the fixed tube 21, and the design of the puncturing device is in use.
  • the valve port of the injecting liquid/air valve 23 is located just outside the body wall skin, and can effectively prevent the fixed tube 21 and the air bag 22 from being excessively advanced into the puncture channel, the air bag 22 and the injecting/air valve 23
  • the double blocking action of the valve port effectively prevents the sheath tube 1 from going deep into the body cavity IV, and the sheath 1 is restored to its original ideal position due to the elastic action of the air bag 22 after the current thrust action disappears.
  • the air bag 22 can effectively prevent the leakage of gas in the body cavity IV through the puncture channel and the sheath 1 and the formation of subcutaneous emphysema. Since the balloon 22 is filled in the subcutaneous adipose tissue after being filled, it can press and squeeze the peripheral fat tissue to fill the gap between the muscle layer III puncture channel and the sheath tube 1 while the balloon 22 is closely attached to the surrounding tissue. The gas is effectively prevented from leaking to the fat layer II, and the pressing action of the air bag 22 also makes the surrounding adipose tissue denser, wherein the tissue gap disappears and the gas cannot overflow and spread into the subcutaneous space, thereby preventing the formation of subcutaneous emphysema.
  • the bladder 22 does not significantly reduce the working length of the sheath 1 and limits its angle of rotation. Since the balloon 22 is located in the body wall puncture channel, rather than in the body cavity IV or outside the body, the effective length of the sheath 1 is not reduced. Due to the single elasticity, the balloon 22 is located in the soft and loose subcutaneous fat layer II of the body wall, and has a large moving space on the level between the relatively dense muscle layer III and the skin layer I, so that it does not act on the sheath The rotation of the tube 1 causes interference and does not limit the angle of rotation of the sheath 1.
  • the balloon 22 does not aggravate the puncture channel damage. Due to the positioning in the loose subcutaneous fat layer II, the balloon 22 has a small pressing force on the surrounding adipose tissue when the filling is appropriate, and the force acting area is large and dispersed, and does not tear the adipose tissue. In the actual surgical operation, the sheath tube 1 will oscillate continuously, which makes the pressure of the balloon 22 to a certain range of peripheral adipose tissue sometimes absent, and does not occur due to the long-term continuous compression of the adipose tissue by the balloon 22, resulting in ischemia. Necrotic condition.
  • the skin puncture incision required for placement of the fixation tube 21 is slightly larger than that of the conventional incision, but this does not significantly impair the minimally invasiveness of the laparoscopic procedure.
  • the puncture channel skin incision which is most prone to the displacement of the sheath 1 and the gas leakage is much larger than the diameter of the fixing tube 21 in the present invention, so the fixing tube 21 of the present invention can be easily placed under the skin, and Need to enlarge the skin incision.
  • the connecting structure 3 includes a first connecting structure 31 and a second connecting structure 32 that are coupled to each other, the first connecting structure 31 is disposed on an outer wall of the sheath tube 1, and the second connecting structure 32 is disposed on the outer connecting structure The inner wall of the tube 21 is fixed.
  • the present invention provides two ways of connecting structures 3, one of which is shown in one of Figures 2-5 as a circular cross-hatching.
  • the sheath tube 1 of the existing puncturing device is often provided with a circular horizontal groove
  • the annular rib structure can be modified from the groove 311 structure to be used together with the fixed tube 21, and
  • the fixed tube 21 can be conveniently inserted into the rear end of the sheath 1 and moved to be conveniently used.
  • the connecting structure 3 is an annular horizontal stripe
  • the first connecting structure 31 is provided with a groove 311 along the axial direction of the sheath tube 1 , and the length of the groove 311 is greater than the second connecting structure 32 .
  • the length of the groove 311 is the same as the vertical section of the second connecting structure 32, and the first connecting structure 31 and the second connecting structure 32 can form an almost complete shape in the same vertical plane. Circular stripes.
  • the groove 311 on the first connecting structure 31 and the second connecting structure 32 form an approximately complete annular horizontal groove in the same vertical plane, the groove 311 is equivalent to the second connection.
  • the structure 32 provides a sliding passage, the fixed tube 21 being capable of achieving relative sliding with the sheath 1 in the axial direction along the groove 311; when the groove 311 on the first connecting structure 31
  • the fixed connecting tube 21 is not formed in the same vertical plane as the second connecting structure 32, that is, when the first connecting structure 31 and the second connecting structure 32 are in a fitting state.
  • the length of the groove 311 is greater than the length of the second connecting structure 32, so that the second connecting structure 32 can overlap with the groove 311 on the first connecting structure 31 and slide relative to each other without An offset occurs, and the sheath tube 1 can be rotated about the fixed tube 21 such that the second connecting structure 32 and the first connecting structure 31 are overlapped with each other, so that the sheath tube 1 and the The fixed pipe 21 is fixed in relative position in the axial direction, and the fixing effect is exact.
  • the outer wall of the second connecting structure 32 and the inner wall of the groove 311 are gap-fitted, that is, the first in the same vertical plane.
  • the connecting structure 31 and the second connecting structure 32 may form an approximately complete ring shape instead of a complete ring shape.
  • FIG. 6-8 Another configuration of the connecting structure 3 is shown in one of Figures 6-8 as a continuous helical thread.
  • the first connecting structure 31 and the second connecting structure 32 are continuous spiral threads, and both Cooperating with each other, in use, the sheath tube 1 and the fixed tube 21 are relatively rotated, so that the sheath tube 1 and the fixed tube 21 are both moved and reach a desired position, and the relative rotation is stopped at this time.
  • the relative position of the sheath tube 1 and the fixed tube 21 is fixed.
  • the invention adopts a continuous spiral thread as the connecting structure 3, has a simple structure and is convenient for operation, and can fix or move between the sheath tube 1 and the fixing structure 2 relatively quickly.
  • the fixed tube 21 and the connecting structure 3 designed by the invention have simple structure, few operation steps and convenient use. Because the fixing principle of the prior art puncture sheath tube is different, it is not necessary to arbitrarily set the air bag, the water injection channel and the like on the sheath 1 of the existing puncture device, thereby greatly reducing the preparation difficulty and saving resources.
  • the separate design of the fixed tube 21 and the sheath tube 1 allows the user to flexibly select a free combination according to actual conditions, which is very convenient for clinical application.
  • the present invention provides different dimensions of the sheath tube 1, the fixed tube 21 and the air bag 22, wherein the fixed tube 21 only needs to be designed to match two of the currently widely used puncture sheath tubes 1 Three diameter specifications are available.
  • the sheath 1 has a working length of 10 cm and an outer diameter of 5-12 mm.
  • the outer diameter of the sheath 1 is preferably designed to be 5 mm, 10 mm and 12 mm, but can be designed according to specific needs. Other specifications.
  • the fixed tube 21 has a length of 2-5 cm, a tube wall thickness of 1.5 mm, and an outer diameter of 8-15 mm. Considering that the clinical routine puncture site is thicker than the subcutaneous fat layer II of the human body wall, and the skin thickness is generally not more than 1.0 cm, the thickness of the subcutaneous fat layer II according to the different body wall puncture sites of different patients in the actual use process of the present invention.
  • the size of the fixed tube 21 may be specifically designed such that the length of the fixed tube 21 is 3 cm and 5 cm, respectively, and the outer diameter of the fixed tube 21 is 8 mm, 13 mm, and 15 mm, respectively.
  • the volume of the air bag 22 is 2-20 mL, and the volume of the air bag 22 may be 2-10 mL and 10-20 mL.
  • the distance between the airbag 22 and the injecting/air valve 23 is 0.5-4.0 cm.
  • the length of the liquid injection/air valve 23 protruding from the outside of the tube wall of the fixed tube 21 is 1-2 cm.
  • the lengths of the fixed tubes 21 are respectively designed to be 3 cm and 5 cm, respectively, they are suitable for general body type and obese body type, respectively, specifically when the length of the fixed tube 21 is 3 cm, in the fixed tube 21
  • the airbag 22 provided at the front end of the fixed pipe 21 occupies 1.5 cm of the length of the fixed pipe 21, and the liquid injection/valve valve 23 provided at the rear end of the fixed pipe 21 accounts for
  • the length of the fixed tube 21 is 0.5 cm, the distance between the air bag 22 and the infusion/gas valve 23 is 1 cm, and the volume of the air bag 22 is designed to be 2-10 mL; when the length of the fixed tube 21 is 5 cm, In the axial direction of the fixed pipe 21, the air bag 22 provided at the front end of the fixed pipe 21 occupies 2.5 cm of the length of the fixed pipe 21, and the liquid injection/air valve provided at the rear end of the fixed pipe 21
  • the length of the fixed tube 21 is 0.5 cm, the distance between the air bag 22 and the liquid filling/air valve 23 is 2 cm, and the
  • the liquid injection/air valve 23 is provided with a manual control of the liquid injection/air valve. 23 switch.
  • the use of the puncturing device in the laparoscopic surgical device may include a prior art structure such as a puncture needle as needed in addition to the structure of the puncturing device of the present invention.
  • FIG. 9 it is a schematic diagram of the use state of the puncturing device of the present invention:
  • the fixed tube 21 matched with the sheath tube 1 to be used is selected, and the type of the corresponding fixed tube 21 is selected according to the thickness of the subcutaneous fat layer II of the body wall puncture point, and the fixed tube 21 is placed at the rear end of the sheath tube 1.
  • the skin layer I of the puncture site is cut by a sharp knife to the diameter of the fixed tube 21, and the front end of each puncture sheath tube 1 is inserted into the body cavity IV.
  • the laparoscopic force is placed into the body cavity IV through the sheath tube 1 to see the front end of each sheath tube 1 deep into the body cavity IV, or at the puncture hole (the first puncture site is often 2-3 cm), the finger is probed into the body cavity IV.
  • the sheath 1 is placed too much, if the depth is too much, the sheath 1 is pulled back under the direct vision or finger sensing, so that the front end of the sheath 1 is placed in the optimal length of the body cavity IV of about 1-2 cm, ensuring its Does not interfere with surgical operations.
  • the front end of the fixed tube 21 and the balloon 22 are placed in the subcutaneous fat layer II along the sheath tube 1, and the sheath tube 1 of the inner tube of the tube 21 is slightly rotated, so that the first connecting structure 31 located on the outer wall of the sheath tube 1 is fixed.
  • the second connecting structures 32 of the inner wall of the tube 21 are fitted to each other, thereby fixing the relative position of the sheath tube 1 and the fixed tube 21 in the axial direction.
  • water or gas is injected into the valve port of the liquid injection/air valve 23 located at the rear end of the fixed pipe 21, and the air bag 22 at the front end of the pipe wall of the fixed pipe 21 is filled.
  • the size of the air bag 22 is adjusted according to the thickness of the subcutaneous fat layer II, so that the air bag 22 is adjusted.
  • the skin layer I can be slightly raised, and the sheath 1 is fixed. Since the balloon 22 at the front end of the tube wall of the fixed tube 21 is fixed in the subcutaneous fat layer II in the puncture channel, that is, between the muscle layer III and the skin layer I, the puncture sheath tube 1 is also sufficiently fixed, and is not subjected to the push-pull force.
  • the sheath 1 is detached or penetrates into the body cavity IV. Since the valve opening of the liquid injection/air valve 23 projecting from the rear end wall of the fixed pipe 21 is located just outside the skin layer I of the puncture point, it further prevents the sheath 1 from being excessively deep into the body cavity IV. The gap between the puncture channel and the sheath 1 is filled by the balloon 22 so that the air leak of the body cavity IV is also avoided, and the balloon 22 is pressed against the adjacent tissue, and the bleeding of the puncture channel wound is also reduced.
  • the air bag 22 is located in the soft subcutaneous fat layer II of the puncture channel, and is elastically deformable by itself, and has a large moving space, so that the swing of the sheath 1 is not disturbed, thereby avoiding interference with the operation of the surgical instrument.
  • the puncture sheath 1 needs to be removed, the infusion/valve valve 23 only needs to be opened, and since the air bag 22 is elastically retracted, the gas or water in the air bag 22 is discharged by itself, and the puncture device can be removed.

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Abstract

一种可固定的腹腔镜穿刺器，其包括鞘管（1），固定结构（2）和连接所述鞘管（1）和所述固定结构（2）的连接结构（3），沿所述鞘管（1）的轴向方向，所述固定结构（2）通过所述连接结构（3）可在所述鞘管（1）上固定或移动；所述固定结构（2）包括固定管（21）、气囊（22）、注液/气通道和注液/气阀（23）；所述固定管（21）套设于所述鞘管（1）外，且长度小于所述鞘管（1）；所述气囊（22）设于所述固定管（21）的前端；所述注液/气通道一端连接所述气囊（22），所述注液/气通道的另一端凸出所述固定管（21）的管壁外侧，且所述注液/气通道的端口上设有注液/气阀（23），所述注液/气阀（23）设于所述固定管（21）的后端，且所述注液/气阀（23）的阀口凸出于所述固定管（21）的管壁外侧；所述气囊（22）和所述注液/气阀（23）通过所述注液/气通道连通。

Description

一种可固定的腹腔镜穿刺器 技术领域
本发明属于医疗器械领域，具体涉及一种可固定的腹腔镜穿刺器。
背景技术
腹腔镜手术是目前临床开展应用最为广泛的微创手术方式。手术中使用腹腔镜穿刺器经皮肤刺透人体体壁(胸、腹、腰等部位)，将穿刺器的鞘管前端留置于腹腔、胸腔或后腹腔等体腔内，再通过穿刺鞘管内的通道置入手术器械对上述体腔内的组织器官进行相应手术操作。腹腔镜穿刺器是该手术中必须使用的器械，现有的腹腔镜穿刺器鞘管刺入体腔后无有效固定装置，穿刺鞘管在手术过程中经常出现脱出体外和深入体内的情况。穿刺器鞘管置入过深有损伤脏器风险，可导致腔镜视野受到遮挡并使手术器械操作困难，如各类钳、夹、超声刀头及持针器等无法打开；穿刺器鞘管频繁脱出使术者不得不重复穿刺放置套管，严重影响手术进度与质量并加重患者创伤。此外，腹腔镜手术中需向人体体腔内充入二氧化碳气体，使体腔扩张以便于手术器械操作。由于目前使用的穿刺器鞘管与体壁穿刺通道间可存在较大缝隙，这易导致腔内气体泄漏。气体大量外漏可使体腔失压塌陷，严重干扰手术操作；外溢的气体进入皮下疏松脂肪组织间隙还可形成广泛皮下气肿，增加了患者的痛苦。
目前临床应用最多的穿刺器鞘管固定措施是皮肤缝线法，即通过在穿刺部位皮肤缝线后将线穿过穿刺器管壁上预设的侧孔后将缝线打结从而使穿刺器鞘管固定的方法。这种固定方式简单便捷，可切实防止鞘管脱出，但是无法解决鞘管置入过深和气体外漏的问题。针对腹腔镜手术所用穿刺器缺乏完善固定措施的现状，不同研究者设计了多种具有固定作用的穿刺器辅助固定结构或装置。如中国专利局2015年7月1日公告的CN204428128U号专利，其设计的弹性橡胶固定盘可套于穿刺器鞘管外，使用时利用橡胶材料的弹性收紧作用使盘与鞘管相对固定，而盘底与人体体壁穿刺处皮肤通过缝线而固定。采用类似这种体外固定法的中国专利局2014年11月5日公告的CN203915028U号和2015年5 月27日公告的CN103230303B号等专利设计中则以螺栓实现穿刺器鞘管与其外固定装置间的相对固定。这种体外固定法的设计可以起到一定防止穿刺器鞘管置入过深和/或脱出的效果，但在实际手术操作中穿刺器鞘管反复受扭转和推拉力作用，鞘管与其外套的固定装置仍然有较大的松脱风险，而且外套固定装置必定在一定程度上限制穿刺器鞘管转动角度，干扰了手术器械操作，这在相对深远狭小的体腔如后腹腔器械操作时尤为显著。此外，中国专利局2015年8月26日公告的CN204581447U号专利设计中在穿刺器鞘管前端外周设置一个气囊，使用时通过鞘管壁内预留的管道向位于体腔内的气囊注水使其充盈，从而阻止了穿刺器鞘管脱出并具备一定防漏气作用，但是这样的体内固定方法并不能防止穿刺器鞘管置入过深。中国专利局2014年7月30日公告的CN203736281U号专利设计中则在穿刺器鞘管管体前端、中部、后端均设置有气囊，使用时前端气囊位于体腔内，中部气囊位于体壁穿刺通道内，而后端气囊定位于体外。这样的体内外三个气囊的固定作用可以使穿刺器鞘管切实固定无法位移，但是穿刺器鞘管的多个气囊设计明显减少鞘管实际有效使用长度，甚至使其无法穿透体壁置入体腔，体内外均固定的方式也更加限制了鞘管的转动角度，体腔内气囊过小无法防止鞘管移位，过大则可干扰手术视野，而鞘管中部的气囊还可能撕裂体壁肌肉组织加重出血和损伤。类似的设计还见于中国专利局2013年9月4日公告的CN 203169273U号等专利。因此现有的穿刺器固定装置设计存在不能充分固定穿刺器鞘管，限制了鞘管转动角度，减少了鞘管实际工作长度，不具备防漏气功能或有加重体壁穿刺通道损伤风险等缺陷，均不能满意解决腹腔镜穿刺器鞘管固定问题，有必要继续予以改进。
发明内容
为了解决现有技术存在的上述问题，本发明提供了在使用的过程中具有良好的固定效果的一种可固定的腹腔镜穿刺器。
本发明所采用的技术方案为：
一种可固定的腹腔镜穿刺器，其包括鞘管、固定结构和连接结构，
所述连接结构连接所述鞘管和所述固定结构，沿所述鞘管的轴向方向，所 述固定结构通过所述连接结构能够在所述鞘管上固定或移动；
所述固定结构包括固定管、气囊、注液/气通道和注液/气阀；所述固定管套设于所述鞘管外，且长度小于所述鞘管；所述气囊设于所述固定管的前端；所述注液/气通道一端连接所述气囊，所述注液/气通道的另一端凸出所述固定管的管壁外侧，且所述注液/气通道的端口上设有注液/气阀，所述注液/气阀设有所述固定管的后端，且所述注液/气阀的阀口凸出于所述固定管的管壁外侧；所述气囊和所述注液/气阀通过所述注液/气通道连通。
所述连接结构包括相互配合第一连接结构和第二连接结构，所述第一连接结构设于所述鞘管的外壁上，所述第二连接结构设于所述固定管的内壁上。
具体的本发明提供了两种连接结构，分别为环形横纹和连续的螺旋形螺纹，具体结构如下：
所述连接结构为环形横纹，所述第一连接结构上沿所述鞘管的轴向设有凹槽，所述的凹槽的长度大于所述第二连接结构的长度，所述凹槽的竖截面与所述第二连接结构的竖截面的形状相同，同一竖平面内所述第一连接结构和所述第二连接结构可形成近似完整的环形横纹。
所述连接结构为连续的螺旋形螺纹。
所述鞘管的工作长度为10cm，外直径为5-12mm。
所述固定管的长度为2-5cm，管壁的厚度为1.5mm，外直径为8-15mm。
所述气囊的容积为2-20mL。
所述气囊和所述注液/气阀之间的距离为0.5-4.0cm。
所述注液/气阀凸出于所述固定管的管壁外侧的长度为1-2cm。
本发明的有益效果为：
1、所述气囊定位于皮下脂肪层内使鞘管固定效果确切。
2、可有效防止体腔内气体经穿刺通道与所述鞘管间缝隙泄漏和皮下气肿形成。
3、所述气囊不会明显减少所述鞘管工作长度和限制其转动角度。
4、所述气囊不会加重穿刺通道损伤。
5、设计的可固定穿刺器结构简单，操作步骤少，使用便捷。
附图说明
图1是本发明一种可固定穿刺器的结构示意图；
图2是本发明连接结构为环形横纹的鞘管的结构示意图；
图3是图2中C的局部放大图；
图4是本发明连接结构为环形横纹的固定结构的的结构示意图；
图5是图4沿A-A的剖面示意图；
图6是本发明连接结构为连续的螺旋形螺纹的鞘管的结构示意图；
图7是本发明连接结构为连续的螺旋形螺纹的固定结构的的结构示意图；
图8是图7沿B-B的剖面示意图；
图9是本发明一种可固定穿刺器的使用状态示意图。
图中：1、鞘管；2、固定结构；21、固定管；22、气囊；23、注液/气阀；3、连接结构；31、第一连接结构；311、凹槽；32、第二连接结构；Ⅰ、皮肤层；Ⅱ、皮下脂肪层；Ⅲ、肌肉层；Ⅳ、体腔。
具体实施方式
如图1所示，本发明提供了一种可固定的腹腔镜穿刺器，其包括鞘管1、固定结构2和连接所述鞘管1和所述固定结构2的连接结构3，沿所述鞘管1 的轴向方向，所述固定结构2通过所述连接结构能够在所述鞘管1上固定或移动；
所述固定结构2具体包括固定管21、气囊22、注液/气通道(图中省略)和注液/气阀23；所述固定管21套设于所述鞘管1外，且长度小于所述鞘管1；所述气囊22设于所述固定管21的前端；所述注液/气阀23设有所述固定管21的后端，且所述注液/气阀23的阀口凸出于所述固定管21的管壁外侧，其中所述注液/气阀23凸出于所述固定管21的管壁外侧的长度优选为1.0cm；所述气囊22和所述注液/气阀23通过所述注液/气通道连通，所述注液/气通道设于所述固定管21的管壁上。
穿刺器在使用的过程中，所述固定管21可沿所述鞘管1的轴向方向向穿刺通道内移动，当所述固定管21前端的所述气囊22置入皮下脂肪层Ⅱ内时停止移动，通过所述连接结构3使所述鞘管1和所述固定管21两者位置相对固定。此时所述气囊22定位于人体体壁穿刺通道中的皮下脂肪层Ⅱ内，即位于体壁组织相对致密的肌肉层Ⅲ和皮肤层Ⅰ之间。由所述注液/气阀23的阀口通过所述注液/气通道，可以向所述气囊22内注入液体或气体使其充盈。所述气囊22为医用硅橡胶或PVC材料等制备，其拉伸强度大，完全能承受所述气囊22内液压或气压，且所述气囊22不易在外力作用下破裂。所述注液/气阀23的阀口凸出于所述固定管21的管壁外侧，在穿刺器使用时所述注液/气阀23位于体外，具有阻止所述固定管21过度深入穿刺通道的作用。通过充盈的所述气囊22和凸出于所述固定管21的管壁外侧的所述注液/气阀23，将使用中的穿刺器固定。
采用上述结构，所述气囊22定位于皮下疏松脂肪组织内使鞘管1固定效果确切。根据皮肤力学特性，致密真皮组织具有抗压强度大延展性小特点，可有效阻止气囊22自皮肤穿刺切口处脱出体外，进而起到防止鞘管1脱出作用。体壁肌肉层Ⅲ组织抗压强度大但有一定延展性，在常规操作力量作用下其可以有效阻止气囊22向前移位，从而阻止所述鞘管1深入体腔Ⅳ，但如果仅有气囊22的设计，在瞬间暴力前推作用时气囊22原本可能嵌入肌肉层Ⅲ穿刺通道而导致肌肉撕裂出血，同时鞘管1发生前移位，因此本发明中在所述固定管21的 后端设置有所述注液/气阀23，且所述注液/气阀23的阀口凸出于所述固定管21的管壁外侧，该种设计穿刺器在使用的过程中，所述注液/气阀23的阀口恰好位于体壁皮肤外侧，可以有效阻止所述固定管21及所述气囊22过度前移深入穿刺通道，所述气囊22和所述注液/气阀23的阀口的双重阻挡作用切实防止了鞘管1深入体腔Ⅳ，当前推力作用消失后由于所述气囊22弹性作用使鞘管1恢复原来理想位置。
所述气囊22可有效防止体腔Ⅳ内气体经穿刺通道与所述鞘管1间缝隙泄漏和皮下气肿形成。由于所述气囊22充盈后位于皮下脂肪组织中，其可推移挤压外周脂肪组织填塞肌肉层Ⅲ穿刺通道与所述鞘管1之间的缝隙，同时所述气囊22与周围组织贴合紧密，有效阻止了气体漏至脂肪层Ⅱ，所述气囊22的挤压作用也使周围脂肪组织更为致密，其中组织间隙消失，气体无法外溢蔓延入皮下间隙，故而防止了皮下气肿形成。
所述气囊22不会明显减少所述鞘管1工作长度和限制其转动角度。由于所述气囊22位于体壁穿刺通道内，而不是体腔Ⅳ内或体外，故而不会减少所述鞘管1有效使用长度。由于单个弹性所述气囊22位于体壁柔软且疏松的皮下脂肪层Ⅱ内，在相对致密的肌肉层Ⅲ与皮肤层Ⅰ之间的层面上有较大移动空间，因而其不会对所述鞘管1的转动产生干扰，不会限制鞘管1转动角度。
所述气囊22不会加重穿刺通道损伤。由于定位于疏松的皮下脂肪层Ⅱ内，所述气囊22在适当充盈时对周围脂肪组织挤压力小且力作用面积大而弥散，不会撕裂脂肪组织。实际手术操作中所述鞘管1会不停摆动，这使得所述气囊22对一定范围内的外周脂肪组织的压力时有时无，不会出现由于气囊22长时间持续压迫脂肪组织导致其缺血坏死的情况。由于皮肤组织的强大抗压和弹力特性，即使偶尔出现暴力向外牵拉所述气囊22的情况，也不会发生皮肤与皮下脂肪层Ⅱ的撕裂分离。置入所述固定管21时所需皮肤穿刺切口较常规切口稍大，但这并不明显损害腔镜手术微创性。实际手术中，最易发生鞘管1移位和气体泄漏的穿刺通道皮肤切口远大于本发明中所述固定管21的直径，因此本发明的所述固定管21可轻易置入皮下，并不需要扩大皮肤切口。
所述连接结构3包括相互配合的第一连接结构31和第二连接结构32，所述第一连接结构31设于所述鞘管1的外壁上，所述第二连接结构32设于所述固定管21的内壁上。
本发明提供了两种方式的连接结构3，其中一种连接结构3如图2-5之一所示，为环形横纹。考虑到现有穿刺器的鞘管1上常设有环形横纹，为了能够充分利用现有资源，将环形横纹上改出凹槽311结构即可与所述固定管21配合使用，而且所述固定管21可以便捷套入所述鞘管1后端和移动定位而便于使用。所述连接结构3为环形横纹时，所述第一连接结构31上沿所述鞘管1的轴向设有凹槽311，所述的凹槽311的长度大于所述第二连接结构32的长度，所述凹槽311的竖截面与所述第二连接结构32的竖截面的形状相同，同一竖平面内所述第一连接结构31和所述第二连接结构32可形成近似完整的环形横纹。当所述第一连接结构31上的所述凹槽311与所述第二连接结构32在同一竖平面内形成近似完整的环形横纹时，所述凹槽311相当于为所述第二连接结构32提供滑动的通道，所述固定管21能够沿着所述凹槽311在轴向方向上与所述鞘管1实现相对滑动；当所述第一连接结构31上的所述凹槽311与所述第二连接结构32在同一竖平面内不能形成近似完整的环形横纹，即所述第一连接结构31与所述第二连接结构32为嵌合的状态时，所述固定管21不能在其轴向方向上沿着所述鞘管1滑动，即所述固定管21和所述鞘管1相对固定。所述的凹槽311的长度大于所述第二连接结构32的长度，因此所述第二连接结构32既可与所述第一连接结构31上的所述凹槽311重合而相对滑动而不发生偏移，又可以所述鞘管1为轴旋转所述固定管21，使得所述第二连接结构32和所述第一连接结构31相互重叠嵌合，从而使所述鞘管1和所述固定管21在轴向上相对位置固定，且固定效果确切。由于所述固定管21需沿所述凹槽311快速便捷滑动，因此所述第二连接结构32的外壁与所述凹槽311的内壁之间为间隙配合，即同一竖平面内所述第一连接结构31和所述第二连接结构32可形成近似完整的环形，而不是完整的环形。
所述连接结构3的另一种结构如图6-8之一所示，为连续的螺旋形螺纹。所述第一连接结构31和所述第二连接结构32均为连续的螺旋形螺纹，且两者 可相互嵌合，使用时通过所述鞘管1和所述固定管21相对旋转，使得所述鞘管1和所述固定管21两者位置移动并到达理想位置，此时停止相对旋转，所述鞘管1和所述固定管21相对位置即固定。本发明将连续的螺旋形螺纹作为所述连接结构3，结构简单，便于操作使用，能够较快速的实现所述鞘管1和所述固定结构2之间的固定或移动。
本发明设计的所述固定管21和所述连接结构3，结构简单，操作步骤少，使用便捷。由于与此前专利设计的穿刺器鞘管的固定原理不同，不必在现有穿刺器所述鞘管1上繁琐设置气囊、注水通道等结构，因此极大降低了制备难度和节约了资源。所述固定管21与所述鞘管1的分体设计，使得使用者可根据实际情况灵活选用自由组合，十分方便临床应用。
本发明提供了所述鞘管1、所述固定管21和所述气囊22不同的尺寸规格，其中所述固定管21只需设计成与目前临床广泛应用的穿刺器鞘管1相匹配的两三个直径规格即可。
所述鞘管1的工作长度为10cm，外直径为5-12mm。为了与现有穿刺器的鞘管1规格标准相匹配，充分利用已有资源，所述鞘管1的外直径优选地设计为5mm、10mm和12mm三种规格，但可以根据具体的需要设计成其他规格。
所述固定管21的长度为2-5cm，管壁的厚度为1.5mm，外直径为8-15mm。考虑到临床常规穿刺部位为人体体壁皮下脂肪层Ⅱ较厚处，而皮肤厚度一般不超过1.0cm，因此本发明实际使用的过程中，根据不同患者不同体壁穿刺部位的皮下脂肪层Ⅱ厚度，所述固定管21的尺寸规格可具体设计为：所述固定管21的长度分别为3cm和5cm两种规格，所述固定管21的外直径分别为8mm、13mm和15mm三种规格。
所述气囊22的容积为2-20mL，具体所述气囊22的容积可为2-10mL和10-20mL两种规格。
所述气囊22和所述注液/气阀23之间的距离为0.5-4.0cm。
所述注液/气阀23凸出于所述固定管21的管壁外侧的长度为1-2cm。
所述固定管21的长度分别设计为3cm和5cm两种规格时，分别适用于一般体型和肥胖体型患者，具体为当所述固定管21的长度为3cm的规格时，在所述固定管21轴向方向上，设于所述固定管21前端的所述气囊22占所述固定管21的长度为1.5cm，设于所述固定管21后端的所述注液/气阀23占所述固定管21的长度为0.5cm，气囊22与注液/气阀23间的距离为1cm，气囊22的容积设计为2-10mL；当所述固定管21的长度为5cm的规格时，在所述固定管21轴向方向上，设于所述固定管21前端的所述气囊22占所述固定管21的长度为2.5cm，设于所述固定管21后端的所述注液/气阀23占所述固定管21的长度为0.5cm，气囊22与注液/气阀23间的距离为2cm，气囊22的容积设计为10-20mL。
此外为了能够方便使用者在使用的过程中，及时有效的控制所述气囊22内注入的液体或气体的量，所述注液/气阀23上设置有能够手动控制所述注液/气阀23的开关。
所述的穿刺器在腹腔镜手术用装置中的应用，即腹腔镜手术用装置中除了包括本发明中的穿刺器的结构外，还可根据需要包括有穿刺针等现有技术中的结构。
下面通过将本发明的穿刺器应用于腹腔镜手术用装置中，以及具体的工作流程对本发明做进一步的说明，如图9所示，为本发明穿刺器的使用状态示意图：
使用前，选择与所用鞘管1匹配的固定管21，并根据体壁穿刺点皮下脂肪层Ⅱ的厚度，选择相应固定管21的型号，将固定管21套于鞘管1后端。以尖刀切开穿刺处皮肤层Ⅰ至固定管21直径大小，分别将各穿刺器鞘管1前端穿刺置入人体体腔Ⅳ。将腹腔镜经鞘管1置入体腔Ⅳ，查看各鞘管1前端深入体腔Ⅳ的情况，或在穿刺孔处(第一穿刺处切口常为2-3cm)以手指探入体腔Ⅳ扪查各鞘管1置入情况，如深入过多，则在腔镜直视或手指感知下再回拉鞘管1，使得鞘管1前端置入体腔Ⅳ约为1-2cm的最佳长度，保证其不干扰手术操作。 此后再将固定管21前端及气囊22沿鞘管1推移置入皮下脂肪层Ⅱ内，稍旋转固定管21内套的鞘管1，使位于鞘管1外壁的第一连接结构31与位于固定管21内壁的第二连接结构32相互嵌合，从而使鞘管1与固定管21在轴向方向上相对位置固定。再向位于固定管21后端的注液/气阀23的阀口注入水或气体，将固定管21管壁前端的气囊22充盈，气囊22大小需根据皮下脂肪层Ⅱ的厚度调整，使气囊22充盈后恰好将皮肤层Ⅰ稍微顶起即可，此时鞘管1固定操作即完成。由于固定管21管壁前端的气囊22固定于穿刺通道中的皮下脂肪层Ⅱ内，即肌肉层Ⅲ和皮肤层Ⅰ之间，穿刺器鞘管1因而也得到充分固定，受推拉力作用时不会发生鞘管1脱出或深入体腔Ⅳ的情况。由于固定管21后端管壁上凸出的注液/气阀23的阀口此时刚好位于穿刺点皮肤层Ⅰ外侧，其进一步防止了鞘管1的过度深入体腔Ⅳ。穿刺通道与鞘管1间的缝隙被气囊22填塞使得体腔Ⅳ漏气也得以避免，而且气囊22压迫邻近组织，穿刺通道创面出血也随之减少。气囊22位于穿刺通道柔软的皮下脂肪层Ⅱ内，本身可弹性变形，且有较大移动空间，故不会干扰鞘管1的摆动，从而避免了其对手术器械操作的干扰。需要拔除穿刺器鞘管1时只需将注液/气阀23打开，因气囊22弹性回缩，气囊22内气体或水自行排出，即可拔除穿刺器。
本发明不局限于上述最佳实施方式，任何人在本发明的启示下都可得出其他各种形式的产品，但不论在其形状或结构上作任何变化，凡是具有与本申请相同或相近似的技术方案，均落在本发明的保护范围之内。

Claims (8)

  1. 一种可固定的腹腔镜穿刺器，其特征在于：包括鞘管(1)、固定结构(2)、连接结构(3)；
    所述连接结构(3)连接所述鞘管(1)和所述固定结构(2)，沿所述鞘管(1)的轴向方向，所述固定结构(2)通过所述连接结构(3)能够在所述鞘管(1)上固定或移动；
    所述固定结构(2)包括固定管(21)、气囊(22)、注液/气通道和注液/气阀(23)；所述固定管(21)套设于所述鞘管(1)外，且长度小于所述鞘管(1)；所述气囊(22)设于所述固定管(21)的前端；所述注液/气阀(23)设于所述固定管(21)的后端，且所述注液/气阀(23)的阀口凸出于所述固定管(21)的管壁外侧；所述气囊(22)和所述注液/气阀(23)通过所述注液/气通道连通；所述注液/气通道一端连接所述气囊(22)，所述注液/气通道的另一端凸出所述固定管(21)的管壁外侧，且所述注液/气通道的端口上设有注液/气阀(23)。
  2. 根据权利要求1所述的穿刺器，其特征在于：所述连接结构(3)包括相互配合第一连接结构(31)和第二连接结构(32)，所述第一连接结构(31)设于所述鞘管(1)的外壁上，所述第二连接结构(32)设于所述固定管(21)的内壁上。
  3. 根据权利要求2所述的穿刺器，其特征在于：所述连接结构(3)为环形横纹，所述第一连接结构(31)上沿所述鞘管(1)的轴向设有凹槽(311)，所述的凹槽(311)的长度大于所述第二连接结构(32)的长度，所述凹槽(311)的竖截面与所述第二连接结构(32)的竖截面的形状相同，同一竖平面内所述第一连接结构(31)和所述第二连接结构(32)可形成近似完整的环形横纹。
  4. 根据权利要求2所述的穿刺器，其特征在于：所述连接结构(3)为连续的螺旋形螺纹。
  5. 根据权利要求1-4之一所述的穿刺器，其特征在于：所述固定管(21)的长度为2-5cm。
  6. 根据权利要求1-4之一所述的穿刺器，其特征在于：所述气囊(22)的容积为2-20mL。
  7. 根据权利要求1-4之一所述的穿刺器，其特征在于：所述气囊(22)和所述注液/气阀(23)之间的距离为0.5-4.0cm。
  8. 根据权利要求1-4之一所述的穿刺器，其特征在于：所述注液/气阀(23)的阀口凸出于所述固定管(21)的管壁外侧的长度为1-2cm。
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CN110141324A (zh) * 2019-05-30 2019-08-20 江门市中心医院 一种治疗三叉神经痛的穿刺针
CN112494121A (zh) * 2020-12-25 2021-03-16 凌斌 腔镜用多相稳固适配腹壁穿刺器
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CN115430008A (zh) * 2022-10-11 2022-12-06 上海泰佑医疗器械有限公司 一种便于操作的导管鞘组
CN117137554A (zh) * 2023-10-23 2023-12-01 邦士医疗科技股份有限公司 一种腹腔筋膜缝合穿刺装置

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CN108938056A (zh) * 2018-08-01 2018-12-07 张云峰 一种可伸缩固定式腔镜穿刺器
CN108938056B (zh) * 2018-08-01 2024-04-09 四川省医学科学院·四川省人民医院 一种可伸缩固定式腔镜穿刺器
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CN112494121A (zh) * 2020-12-25 2021-03-16 凌斌 腔镜用多相稳固适配腹壁穿刺器
CN114403992A (zh) * 2021-11-17 2022-04-29 牡丹江医学院附属红旗医院 一种可伸缩自清洁式胸腔镜用穿刺器
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CN115430008B (zh) * 2022-10-11 2023-05-02 上海泰佑医疗器械有限公司 一种便于操作的导管鞘组
CN117137554A (zh) * 2023-10-23 2023-12-01 邦士医疗科技股份有限公司 一种腹腔筋膜缝合穿刺装置
CN117137554B (zh) * 2023-10-23 2024-04-02 邦士医疗科技股份有限公司 一种腹腔筋膜缝合穿刺装置

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