CN104740747A - Ultrasonic-guided percutaneous interventional therapy guide system for arterial duct and usage method thereof - Google Patents
Ultrasonic-guided percutaneous interventional therapy guide system for arterial duct and usage method thereof Download PDFInfo
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- CN104740747A CN104740747A CN201510161230.0A CN201510161230A CN104740747A CN 104740747 A CN104740747 A CN 104740747A CN 201510161230 A CN201510161230 A CN 201510161230A CN 104740747 A CN104740747 A CN 104740747A
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Abstract
The invention belongs to the field of interventional therapy and relates to an ultrasonic-guided percutaneous interventional therapy guide system for an arterial duct and a usage method thereof. The interventional therapy guide system comprises a catheter and a guide wire; the catheter has a guide wire channel and has a certain curved radian; when the guide wire is not inserted, the catheter is provided with sequentially connected arcs with different bending degrees; the guide wire is woven by winding a head-tapered steel cable with a thin steel wire, and the head of the guide wire is most flexible; the guide wire stretches out of the head of the catheter, and the bending degree of the catheter is changed gradually along with the gradually increasing of the stretched distance; after the guide wire stretches out completely, the catheter almost becomes a straight line. By adopting the interventional therapy guide system, the catheter is utilized effectively and the ultrasonic guidance and detection are realized; the interventional therapy guide system is independent of radioactive rays, does not use a contrast agent and effectively solves harms in the present operation; the arteria cruralis is free of puncturing, so that the surgical operation is simplified and better operating effect is obtained.
Description
Technical field
The invention belongs to interventional therapy field, be specifically related to a kind of for ultrasound guidance through the interventional therapy guidance system of femoral vein shutoff ductus arteriosus and using method thereof.
Background technology
Since there is percutaneous interventional in last century, now occur with a collection of classical art formula that is representative through arterial catheter percutaneous transcatheter closure, percutaneous Closure of Atrial Septal Defect etc., the common feature of these operations is: after peripheral blood vessel puncture, under the guiding of lonizing radiation, seal wire, conduit are inserted heart, through conduit, stopper is placed in lesion locations.
These above-mentioned operations must use radiation exposure patient in art, there is the risk of radiation damage, not only can have an impact to the function of the organs such as the bone marrow of patient, genitals and thyroid, and easily cause iatrogenic injury to medical personnel.Because radiation hazradial bundle is huge, national special legislation specifies that medical personnel must wear protective garment to protect oneself in art.On the other hand, the ductus arteriosus percutaneous transcatheter closure under conventional lonizing radiation guide needs first to puncture femoral artery, carries out ductus arteriosus radiography through arterial side, then the femoral vein that punctures, and carries out shutoff through femoral vein feeding seal wire and delivery sheath.Conventional art not only needs puncture femoral artery and vein, and wound is large, and operating time is long, and needs in art to use contrast agent, has the risk causing the complication such as allergy, renal failure.
The advantage that percutaneous interventional has real-time detection, radiationless, contrast-agent-free is carried out with ultrasonic alternative lonizing radiation, have broad application prospects, but because ultrasonic operation principle is completely different from lonizing radiation operation principle, ultrasonic is the scanning one by one of a tangent plane tangent plane, unlike lonizing radiation be projection detection, so with ultrasonic be unique guide means time, maximum difficulty is ultrasonicly to be not easy accurate judgement conduit position in vivo as lonizing radiation, causes difficulty to the accurate location in operation process.So under ultrasound guidance shutoff ductus arteriosus time, operation common conduit turn for twice direction by Tricuspid valve and valve of pulmonary trunk very difficult.
Therefore, how developing a kind of is interventional therapy guidance system and the equipment of the safety of bootstrap technique with ultrasonic, to reduce medical injure and expense, becomes the technical problem in the urgent need to address of this area.
Summary of the invention
In order to overcome the problems referred to above, the cardioanatomy application power outstanding based on the ultrasonic technique of maturation, doctor and good operational capacity, develop the new technique of ultrasound-guided percutaneous ductus arteriosus percutaneous transcatheter closure and design interventional therapy guidance system and help to carry out this technology.
The invention provides a kind of ultrasound guidance through the interventional therapy guidance system of femoral vein shutoff ductus arteriosus and using method thereof, success rate and the safety of ultrasonic guidance interventional technique can be significantly improved.
This interventional therapy guidance system comprises conduit and seal wire, and conduit has silk guide passage; Described conduit has certain crooked radian, when not inserting described seal wire, described conduit has connect successively and the first arc section CD section, the second arc section DF section, three-arc section FG section and the 4th arc section GI section that radian is different; Described seal wire diameter 0.035 inch, long 150-260cm, is wound around the tapered wirerope of head by finer wire and weaves and form, and wirerope head is tapered the long 1-10cm in region.Because wirerope head is tapered, the hardness of seal wire also reduces gradually, and seal wire head is the most soft; Seal wire is after catheter head stretches out, and along with the increase gradually of outreach, conduit camber changes gradually, and after seal wire stretches out completely, conduit is similar to vertical bar type.
Further, the corresponding arc place radius of a circle 240-260mm of the first arc section CD section, the corresponding arc place radius of a circle 12-16mm of the second arc section DF section; The corresponding arc place radius of a circle 40-48mm of three-arc section FG section; The corresponding arc place radius of a circle 10-18mm of 4th arc section GI section; Distance between first arc section starting point C point and the 4th arc section rate of curving peak H point is 50-65mm.
Preferably, the corresponding arc place radius of a circle 251mm of the first arc section CD section, the corresponding arc place radius of a circle 13.75mm of the second arc section DF section; The corresponding arc place radius of a circle 45.0mm of three-arc section FG section; The corresponding arc place radius of a circle 14.0mm of 4th arc section GI section; Between first arc section starting point C point and the 4th arc section rate of curving peak H point, longitudinally height (distance between C point and H point) is 54.35mm.
Further, the 4th arc section GI section can replace by right angle section.Described right angle section is that the conduit being 10-30mm by length is bent into and has a right angle and form.
When the interventional therapy guidance system provided by the present patent application carries out operative treatment, only need through femoral venous puncture, under ultrasonic guiding, use this interventional therapy guidance system, right ventricle is entered through Tricuspid valve, enter pulmonary artery through valve of pulmonary trunk again, then enter descending aorta through ductus arteriosus, thus set up the track from femoral vein to ductus arteriosus.Induction system shutoff ductus arteriosus is sent into through this track.
Present invention also offers a kind of above-mentioned using method for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, it is characterized in that, specifically comprise the steps:
(1) patient gets dorsal position, adopts with lignocaine local anesthesia; Basal anesthesia can be carried out for ill-matched infant; All patients are all without the need to tracheal intubation;
(2) puncture right lateral thigh vein, and measure the 3rd intercostal on the right side of breastbone and, to the distance of point of puncture, be labeled as operating distance; From E point toward B point orientation measurement on conduit, and position when labelling reaches operating distance;
(3) seal wire is inserted in conduit, send into conduit and seal wire through right lateral thigh vein, continue to advance seal wire, and conduit is stretched, conduit is inserted after arriving operating distance, ultrasonicly can find conduit in right atrium;
(4) withdraw from seal wire, make conduit recover camber, under ultrasound guidance, turn clockwise conduit, and adjust tube insertion depth, makes conduit EH bending section insert in right ventricle through Tricuspid valve; Rotary guide pipe under ultrasonic large artery trunks short axis view guides, makes HI section towards valve of pulmonary trunk direction, inserts seal wire, namely enters main pulmonary artery by valve of pulmonary trunk;
(5) ultrasonic display ductus arteriosus, adjustment seal wire direction, enters descending aorta by ductus arteriosus; Indwelling seal wire, exits conduit;
(6) select stopper and the induction system of corresponding size according to Defect diameter, send into delivery sheath through seal wire, send into length and be no more than operating distance 3-8cm, and arrive descending aorta at ultrasonic lower observation delivery sheath by ductus arteriosus; Exit inner core and the seal wire of delivery sheath, keep delivery sheath epitheca to be positioned at descending aorta, send into stopper along delivery sheath, release stopper aorta rear flank, withdraws delivery sheath, makes stopper aorta side be close to ductus arteriosus aorta side opening; Fixing conveying lever, withdraws delivery sheath, is discharged completely by stopper in sheath pipe; Ultrasonic examination plugging effect, if stopper form and residual shunt situation are better, be rotated counterclockwise conveying wirerope release stopper, exit delivery sheath, conventional compression stops blooding, pressure dressing.
Interventional therapy guidance system provided by the invention, the conduit described in effectively utilizing, achieves ultrasonic guidance and detection, does not rely on lonizing radiation completely, do not use contrast agent, efficiently solve the harm in existing operation; And without the need to the femoral artery that punctures, simplify operation technique, serve better surgical effect.
Accompanying drawing explanation
In order to make content of the present invention be more likely to be clearly understood, below according to a particular embodiment of the invention and by reference to the accompanying drawings, the present invention is further detailed explanation, wherein,
Fig. 1 is conduit of the present invention is special shape and structure schematic diagram when not inserting seal wire;
Fig. 2, Fig. 3 be catheter guide wire of the present invention after catheter head stretches out, along with the increase gradually of outreach, conduit camber changes structural representation gradually;
Fig. 4 be conduit of the present invention after seal wire stretches out completely, conduit is similar to the structural representation of vertical bar type;
In figure, 1 is tail end of conduit (grip part), 2 is conduit flat segments (BC section), 3 is conduit first arc section (CD section), 4 is conduit second arc section (DEF section), 5 is conduit three-arc section (FG section), and 6 is conduit the 4th arc section (GI section), and 7 is seal wire.
Detailed description of the invention
Interventional therapy guidance system for ultrasound guidance of the present invention comprises conduit and seal wire, and conduit has silk guide passage; Being illustrated in figure 1 conduit of the present invention is special shape and structure schematic diagram when not inserting seal wire, conduit total length 90-110cm (length that BI section is stretching), preferred 100cm, adopt integrally formed during making, it has specific camber, more specifically, successively in being integrally formed by connecting by four sections of arc sections with different radian, wherein the first arc section CD section corresponding arc place radius of a circle is 240-260mm, preferred 251mm, the corresponding arc place radius of a circle 12-16mm of second arc section DEF section, is preferably 13.75mm; Three-arc section FG section corresponding arc place radius of a circle is 40-48mm, is preferably 45.0mm; 4th arc section GI section corresponding arc place radius of a circle is 10-18mm, and being preferably the longitudinal height (distance between C point and H point) of 14.0mm, CH section is 50-65mm, is preferably 54.35mm; Seal wire diameter is 0.035 inch, long 150-260mm, is wound around a tapered wirerope braiding of leading head forms by finer wire, the tapered zone length of wirerope leading head is 1-10cm, because wirerope head is tapered, the hardness of seal wire also reduces gradually, and seal wire head is the most soft.In addition, the 4th arc section GI section also can replace by right angle section, and described right angle section is that the conduit being 10-30mm by length is bent into and has a right angle and form.
As shown in Figure 2 and Figure 3, when seal wire is after catheter head stretches out, along with the increase gradually of outreach, conduit camber changes gradually; As shown in Figure 4, after seal wire stretches out completely, conduit is similar to vertical bar line style.
Conduit is made up of polymer composite or suitably firm plastic flexible pipe, such as PTFE flexible pipe or the flexible pipe with PTFE matrix, and it is enough to and biocompatible, and can stand sterilization processing.
When using this interventional therapy guidance system for ultrasound guidance, patient gets dorsal position, can with lignocaine local anesthesia for the patient coordinated, and ill-matched infant can basal anesthesia, and patient is all without the need to tracheal intubation.Puncture right lateral thigh vein, and measure the 3rd intercostal on the right side of breastbone and, to the distance of point of puncture, be labeled as operating distance.From E point toward B point orientation measurement on conduit, and position when labelling reaches operating distance.Seal wire is inserted in conduit, send into conduit and seal wire through right lateral thigh vein, continue to advance seal wire, and conduit is stretched, conduit is inserted after arriving operating distance, ultrasonicly can find conduit in right atrium, withdraw from seal wire, make conduit recover camber, under ultrasound guidance, turn clockwise conduit, and adjust tube insertion depth, and conduit EH bending section is inserted in right ventricle through Tricuspid valve.Rotary guide pipe under ultrasonic large artery trunks short axis view guides, makes HI section towards valve of pulmonary trunk direction, inserts seal wire, namely enters main pulmonary artery by valve of pulmonary trunk.Ultrasonic probe shows ductus arteriosus between second rib on the left of breastbone, and adjustment seal wire direction, enters descending aorta by ductus arteriosus.Indwelling seal wire, exits conduit.Select stopper and the induction system of corresponding size according to Defect diameter, send into delivery sheath through seal wire, send into length and be no more than operating distance 3-8CM, and arrive descending aorta at ultrasonic lower observation delivery sheath by ductus arteriosus.Exit inner core and the seal wire of delivery sheath, keep delivery sheath epitheca to be positioned at descending aorta, send into stopper along delivery sheath, release stopper aorta rear flank, withdraws delivery sheath, makes stopper aorta side be close to ductus arteriosus aorta side opening.Fixing conveying lever, withdraws delivery sheath, is discharged completely by stopper in sheath pipe.Ultrasonic examination plugging effect, if stopper form and the satisfaction of residual shunt situation, be rotated counterclockwise conveying wirerope release stopper, exit delivery sheath, conventional compression stops blooding, pressure dressing.
Obviously, above-described embodiment is only for clearly example being described, and the restriction not to embodiment.For those of ordinary skill in the field, can also make other changes in different forms on the basis of the above description.Here exhaustive without the need to also giving all embodiments.And thus the apparent change of extending out or variation be still among the protection domain of the invention.
Claims (8)
1., for a ultrasound guidance ductus arteriosus percutaneous interventional guidance system, this system comprises conduit and seal wire, and conduit has silk guide passage; It is characterized in that, described conduit has certain camber, when not inserting described seal wire, described conduit has the first arc section CD section, the second arc section DEF section, three-arc section FG section and the 4th arc section GI section that connect successively; Described seal wire diameter is 0.035 inch, long 150-260mm, and be wound around a tapered wirerope braiding of leading head by finer wire and form, the tapered zone length of wirerope leading head is 1-10cm; Described seal wire inserts conduit, and after stretching out from catheter head, along with the increase gradually of outreach, conduit camber changes gradually, and after seal wire stretches out completely, described conduit is in approximate vertical bar shaped.
2. according to claim 1ly it is characterized in that for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, the total length of described conduit is 90-110cm.
3. according to claim 1ly to it is characterized in that for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, the corresponding arc place radius of a circle 240-260mm of the first arc section CD section, the corresponding arc place radius of a circle 12-16mm of the second arc section DEF section; The corresponding arc place radius of a circle 40-48mm of three-arc section FG section; The corresponding arc place radius of a circle 10-18mm of 4th arc section GI section.
4. according to claim 3ly to it is characterized in that for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, the corresponding arc place radius of a circle 251mm of the first arc section CD section, the corresponding arc place radius of a circle 13.75mm of the second arc section DF section; The corresponding arc place radius of a circle 45.0mm of three-arc section FG section; The corresponding arc place radius of a circle 14.0mm of 4th arc section GI section.
5. according to claim 1 for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, it is characterized in that: the distance between the first arc section starting point C point and the 4th arc section rate of curving peak H point is 50-65mm.
6. according to claim 1 for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, it is characterized in that: described 4th arc section GI section right angle section replaces.
7. according to claim 6 for ultrasound guidance ductus arteriosus percutaneous interventional guidance system, it is characterized in that: described right angle section has a right angle for conduit that length is 10-30mm is bent into and is formed.
8. the using method for ultrasound guidance ductus arteriosus percutaneous interventional guidance system as described in as arbitrary in claim 1-7, is characterized in that, specifically comprise the steps:
(1) patient gets dorsal position, adopts with lignocaine local anesthesia; Basal anesthesia can be carried out for ill-matched infant; All patients are all without the need to tracheal intubation;
(2) puncture right lateral thigh vein, and measure the 3rd intercostal on the right side of breastbone and, to the distance of point of puncture, be labeled as operating distance; From E point toward B point orientation measurement on conduit, and position when labelling reaches operating distance;
(3) seal wire is inserted in conduit, send into conduit and seal wire through right lateral thigh vein, continue to advance seal wire, and conduit is stretched, conduit is inserted after arriving operating distance, ultrasonicly can find conduit in right atrium;
(4) withdraw from seal wire, make conduit recover camber, under ultrasound guidance, turn clockwise conduit, and adjust tube insertion depth, makes conduit EH bending section insert in right ventricle through Tricuspid valve; Rotary guide pipe under ultrasonic large artery trunks short axis view guides, makes HI section towards valve of pulmonary trunk direction, inserts seal wire, namely enters main pulmonary artery by valve of pulmonary trunk;
(5) ultrasonic display ductus arteriosus, adjustment seal wire direction, enters descending aorta by ductus arteriosus; Indwelling seal wire, exits conduit;
(6) select stopper and the induction system of corresponding size according to Defect diameter, send into delivery sheath through seal wire, send into length and be no more than operating distance 3-8cm, and arrive descending aorta at ultrasonic lower observation delivery sheath by ductus arteriosus; Exit inner core and the seal wire of delivery sheath, keep delivery sheath epitheca to be positioned at descending aorta, send into stopper along delivery sheath, release stopper aorta rear flank, withdraws delivery sheath, makes stopper aorta side be close to ductus arteriosus aorta side opening; Fixing conveying lever, withdraws delivery sheath, is discharged completely by stopper in sheath pipe; Ultrasonic examination plugging effect, if stopper form and residual shunt situation are better, be rotated counterclockwise conveying wirerope release stopper, exit delivery sheath, conventional compression stops blooding, pressure dressing.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201510161230.0A CN104740747A (en) | 2015-04-03 | 2015-04-03 | Ultrasonic-guided percutaneous interventional therapy guide system for arterial duct and usage method thereof |
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| CN201510161230.0A CN104740747A (en) | 2015-04-03 | 2015-04-03 | Ultrasonic-guided percutaneous interventional therapy guide system for arterial duct and usage method thereof |
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Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106139361A (en) * | 2016-07-29 | 2016-11-23 | 武汉大学 | A kind of blood vessel guiding catheter and fixing means thereof |
| CN106901784A (en) * | 2015-12-22 | 2017-06-30 | 潘湘斌 | A kind of guiding system and its application method for ultrasound guidance research of transcatheter closure of ventricular septal defect |
| CN109224262A (en) * | 2018-10-25 | 2019-01-18 | 大连科万维医疗科技有限公司 | A kind of left ventricle drainage tube |
| TWI679996B (en) * | 2019-02-01 | 2019-12-21 | 佳世達科技股份有限公司 | Ultrasound needle positioning system and ultrasound needle positioning method |
| CN114931696A (en) * | 2022-05-19 | 2022-08-23 | 南京脉创医疗科技有限公司 | Radial artery access nerve intervention catheter |
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| US4747840A (en) * | 1986-09-17 | 1988-05-31 | Ladika Joseph E | Selective pulmonary arteriograph catheter |
| WO2005113057A1 (en) * | 2004-05-17 | 2005-12-01 | C. R. Bard, Inc. | Articulated catheter |
| CN202859876U (en) * | 2009-12-28 | 2013-04-10 | 泰尔茂株式会社 | Guide wire |
| CN104023781A (en) * | 2012-01-31 | 2014-09-03 | 泰尔茂株式会社 | Catheter |
| CN203829453U (en) * | 2014-01-26 | 2014-09-17 | 罗宁 | Transradial artery digital subtraction angiography catheter |
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| US4747840A (en) * | 1986-09-17 | 1988-05-31 | Ladika Joseph E | Selective pulmonary arteriograph catheter |
| WO2005113057A1 (en) * | 2004-05-17 | 2005-12-01 | C. R. Bard, Inc. | Articulated catheter |
| CN202859876U (en) * | 2009-12-28 | 2013-04-10 | 泰尔茂株式会社 | Guide wire |
| CN104023781A (en) * | 2012-01-31 | 2014-09-03 | 泰尔茂株式会社 | Catheter |
| CN203829453U (en) * | 2014-01-26 | 2014-09-17 | 罗宁 | Transradial artery digital subtraction angiography catheter |
Cited By (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106901784A (en) * | 2015-12-22 | 2017-06-30 | 潘湘斌 | A kind of guiding system and its application method for ultrasound guidance research of transcatheter closure of ventricular septal defect |
| CN106139361A (en) * | 2016-07-29 | 2016-11-23 | 武汉大学 | A kind of blood vessel guiding catheter and fixing means thereof |
| CN109224262A (en) * | 2018-10-25 | 2019-01-18 | 大连科万维医疗科技有限公司 | A kind of left ventricle drainage tube |
| TWI679996B (en) * | 2019-02-01 | 2019-12-21 | 佳世達科技股份有限公司 | Ultrasound needle positioning system and ultrasound needle positioning method |
| CN114931696A (en) * | 2022-05-19 | 2022-08-23 | 南京脉创医疗科技有限公司 | Radial artery access nerve intervention catheter |
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