CN104770361B - Supplied-liver quickly-fixed perfusion device for liver transplant - Google Patents

本发明涉及一种医药领域，特别是涉及器官移植(肝脏)术中供肝获取时准确快速进行灌注装置的连接及灌注，具体是一种肝移植术中供肝快速固定灌注装置。肝移植术中供肝快速固定灌注装置，包括穿刺引导装置和连接灌注管的连接环，所述穿刺引导装置为顶端带有可收缩环的穿刺钢丝，所述可收缩环带有磁性；所述连接环顶端为锥形，所述连接环底部与灌注管连接，连接环底部内部设有单向流动的活瓣，连接环顶部为含铁材料制备，连接环顶部与可收缩环相互适配，并通过磁性相互吸附。本发明操作简单可行，针对性强，主要用于肝移植术中完成供肝获取时快速灌注。本发明为快速、高效的进行肝脏灌注、获取高质量的供肝提供了有效的技术保障。

The invention relates to the field of medicine, in particular to the accurate and rapid connection and perfusion of a perfusion device for obtaining a donor liver during organ transplantation (liver), in particular to a rapid fixed perfusion device for a liver during liver transplantation. The fast fixation and perfusion device for liver donor in liver transplantation includes a puncture guide device and a connecting ring connected to the perfusion tube, the puncture guide device is a puncture steel wire with a retractable ring at the top, and the retractable ring is magnetic; The top of the connecting ring is tapered, the bottom of the connecting ring is connected to the perfusion pipe, the bottom of the connecting ring is provided with a unidirectional flow valve, the top of the connecting ring is made of iron-containing material, and the top of the connecting ring is compatible with the shrinkable ring. and are magnetically attracted to each other. The operation of the invention is simple and feasible, and has strong pertinence, and is mainly used for rapid perfusion when the donor liver is obtained during liver transplantation. The invention provides an effective technical guarantee for fast and efficient liver perfusion and obtaining high-quality donor livers.

肝移植术中供肝快速固定灌注装置Donor Liver Rapid Fixed Perfusion Device in Liver Transplantation

技术领域technical field

本发明涉及一种医药领域，特别是涉及器官移植（肝脏）术中供肝获取时准确快速进行灌注装置的连接及灌注，具体是一种肝移植术中供肝快速固定灌注装置。The invention relates to the field of medicine, in particular to the accurate and rapid connection and perfusion of a perfusion device when obtaining a donor liver during organ transplantation (liver), in particular to a rapid fixed perfusion device for a liver during liver transplantation.

背景技术Background technique

目前肝移植术已经成为治疗终末期肝病的常规治疗手段，今年来随着我国肝移植技术的不断推广和改善，肝移植术后生存率不断提高。术后并发症发生率也在逐年下降。在肝移植术中，供肝的获取中的关键技术之一是肝脏原位灌注。如何准确定位并快速进行置管固定及灌注是获取优质肝源的技术性难题存在。At present, liver transplantation has become a routine treatment for end-stage liver disease. This year, with the continuous promotion and improvement of liver transplantation technology in my country, the survival rate after liver transplantation has been continuously improving. The incidence of postoperative complications is also decreasing year by year. In liver transplantation, one of the key techniques in obtaining the donor liver is perfusion of the liver in situ. How to accurately locate and quickly perform catheter fixation and perfusion is a technical problem in obtaining high-quality liver sources.

传统供肝获取时，开腹后迅速探查肝脏，了解有无肝硬化、肝占位以及严重脂肪肝，术者提起小肠，由助手结扎小肠系膜，剪开骨盆人口上方后腹膜，显露腹主动脉，剪开其分叉上方前壁，向近端插入经改装后的带2～3个侧孔的Foley导尿管，插入深度为气囊至腹主动脉开口平面上方，气囊内注入25 ml生理盐水，灌注0～4℃灌洗液。完成腹主动脉插管后，开始行门脉灌注。助手向下方牵拉十二指肠，手术者劈开胰腺头部，即可在胰腺后方找到肠系膜上静脉的根部，剪开其前壁，插入自制门静脉插管，深度2-3cm，以防止插入过深到门静脉分支，并且结扎脾静脉。加扎固定后，开始灌注。此操作，需要主刀要熟练准确定位插管深度，并在助手协助下迅速进行插管固定。然而，在这个过程中，容易出现插管过深的情况，这时灌流液流向右半肝顶，易导致左、右肝灌注不充分；同时由于肝左外叶紧贴心脏，一般在灌注过程中降温较慢，致使左、右肝缺血时间有差异。此外在插管固定过程中，传统用线结扎，根据术者操作熟练度的不同对整体灌注装置安装时间也有影响。与此同时，传统灌注管道中缺少防止液体反流的装置，液体灌注完全依靠重力因素进入供肝，在整个灌注过程中随时会因为各种因素引起灌注液的反流，导致灌注速度减慢。因此，寻找一种辅助性装置用于快速定位安装灌注装置，可以方便术者操作，在大大减少灌注插管的时间的基础上保证供肝质量，对肝移植患者的预后生活质量的提高也有着较为巨大的意义。When obtaining a traditional liver donor, the liver is quickly explored after laparotomy to find out whether there is cirrhosis, liver space occupying and severe fatty liver. For the artery, cut the anterior wall above its bifurcation, and insert a modified Foley catheter with 2 to 3 side holes to the proximal end. Saline, perfuse with lavage fluid at 0-4°C. After completion of abdominal aortic cannulation, portal perfusion was initiated. The assistant pulls the duodenum downward, and the operator splits the head of the pancreas to find the root of the superior mesenteric vein behind the pancreas, cuts its front wall, and inserts a self-made portal vein cannula with a depth of 2-3 cm to prevent insertion Go too deep into the portal vein branch and ligate the splenic vein. After the garza is fixed, start the perfusion. This operation requires the surgeon to be proficient in accurately positioning the depth of the cannula, and quickly fix the cannula with the assistance of an assistant. However, in this process, the intubation is prone to be too deep. At this time, the perfusate flows to the right hemihepatic roof, which may easily lead to insufficient perfusion of the left and right livers. The cooling rate in the middle is slower, resulting in differences in the ischemic time between the left and right livers. In addition, in the process of cannula fixation, traditional thread ligation also affects the installation time of the overall perfusion device depending on the operator's proficiency. At the same time, there is no device to prevent liquid reflux in the traditional perfusion pipeline, and the liquid perfusion completely relies on gravity to enter the donor liver. During the entire perfusion process, various factors may cause the perfusate to reflux at any time, resulting in a slowdown of the perfusion speed. Therefore, looking for an auxiliary device for quickly positioning and installing the perfusion device can facilitate the operation of the operator, ensure the quality of the donor liver on the basis of greatly reducing the time for perfusion intubation, and improve the prognosis and quality of life of liver transplant patients. greater significance.

发明内容Contents of the invention

本发明创造性提出一种在肝移植术供肝获取中快速固定、灌注的辅助性装置，该装置操作简便可行，针对性强，能够缩短灌注装置安装时间并快速完成肝脏灌注，防止灌注液反流。The present invention creatively proposes an auxiliary device for rapid fixation and perfusion in liver transplantation. The device is simple and feasible to operate, and has strong pertinence. It can shorten the installation time of the perfusion device and quickly complete liver perfusion, preventing the reflux of perfusate. .

肝移植术中供肝快速固定灌注装置，包括穿刺引导装置和连接灌注管的连接环，所述穿刺引导装置为顶端带有可收缩环的穿刺钢丝，所述可收缩环带有磁性；所述连接环顶端为锥形，所述连接环底部与灌注管连接，连接环底部内部设有单向流动的活瓣，连接环顶部为含铁材料制备，连接环顶部与可收缩环相互适配，并通过磁性相互吸附。The fast fixation and perfusion device for liver donor in liver transplantation includes a puncture guide device and a connecting ring connected to the perfusion tube, the puncture guide device is a puncture steel wire with a retractable ring at the top, and the retractable ring is magnetic; The top of the connecting ring is tapered, the bottom of the connecting ring is connected to the perfusion pipe, and a unidirectional flow valve is provided inside the bottom of the connecting ring, the top of the connecting ring is made of iron-containing material, and the top of the connecting ring is compatible with the shrinkable ring. and are magnetically attracted to each other.

优选的，所述连接环顶端的锥形表面设有筛状孔。Preferably, the conical surface at the top of the connecting ring is provided with sieve-shaped holes.

优选的，所述穿刺钢丝外还设有导管。Preferably, a catheter is provided outside the puncture steel wire.

优选的，所述穿刺引导装置顶端的可收缩环通过穿刺钢丝控制使其张开。Preferably, the retractable ring at the top of the puncture guiding device is controlled by a puncture wire to expand.

优选的，所述穿刺钢丝长度为30厘米。Preferably, the length of the puncture steel wire is 30 cm.

优选的，所述连接环内径为0.8厘米，高度为2厘米。Preferably, the connecting ring has an inner diameter of 0.8 cm and a height of 2 cm.

优选的，所述穿刺钢丝由不锈钢、镍/铂、聚氨酯、聚四氟乙烯组成的复合生物材料；所述连接环顶端锥形部分由含铁物质构成的生物学性状稳定的复合生物材料，可与穿刺针顶端可收缩环磁性链接；余结构为ABS塑料。Preferably, the puncture steel wire is a composite biological material composed of stainless steel, nickel/platinum, polyurethane, and polytetrafluoroethylene; the tapered part at the top of the connecting ring is a biologically stable composite biological material composed of iron-containing substances, which can be It is magnetically linked with the retractable ring at the top of the puncture needle; the rest of the structure is ABS plastic.

下面对本发明进一步阐述：The present invention is further elaborated below:

肝移植术中供肝快速固定灌注装置由两部分组成，包括头端隐藏磁性可收缩扩张环的肝脏穿刺引导装置和与之相配套的头端为活瓣式设计的圆形连接环。The donor liver rapid fixation and perfusion device in liver transplantation consists of two parts, including a liver puncture guide device with a hidden magnetic retractable expansion ring at the head end and a matching circular connecting ring with a valve-shaped head end.

1）头端隐藏磁性可收缩扩张环的肝脏穿刺引导装置：其形状总体为一根细长的质地稍软的肝脏穿刺钢丝，长度为30厘米，其材质由不锈钢、镍/铂、聚氨酯、聚四氟乙烯等组成的复合生物材料，主要起穿刺引导进入门脉的作用；其头端带有一个可收缩的环状装置，其材质为综合性能良好、化学性能稳定的铁氧体磁性材料，可由尾端操作后伸展（内径为0.8厘米）、起到扩张血管的作用。1) Liver puncture guiding device with a hidden magnetic retractable expansion ring at the head: its shape is generally a long and thin liver puncture steel wire with a slightly soft texture, the length is 30 cm, and its material is made of stainless steel, nickel/platinum, polyurethane, polyester Composite biomaterials composed of tetrafluoroethylene, etc., mainly play the role of puncture and guide into the portal vein; its head end has a retractable ring-shaped device, and its material is ferrite magnetic material with good comprehensive performance and stable chemical performance. It can be stretched after operation from the tail end (the inner diameter is 0.8 cm), and it can expand blood vessels.

2）连接环：其与肝脏穿刺引导装置相配套。连接环头端呈锥形，材料为含铁物质，与肝脏穿刺扩张环相匹配，两者构成磁性吸附快速吻合装置，起到固定扩张环的作用，其锥形端尖锐，能快速刺破血管壁，起到打通血管作用，其表面为筛状孔设计，方便灌注液快速流入肝脏；连接环内部为单向活瓣设计，使得灌注只能由经由外界流入肝内而不能逆流；尾端为的灌注管连接口，用于连接灌注管道。所述连接环顶端锥形部分由含铁物质构成的生物学性状稳定的复合生物材料，可与穿刺针顶端可收缩环磁性链接；余结构为综合性能好、化学性能稳定的ABS塑料（丙烯腈-丁二烯-苯乙烯），内径为0.8厘米，高度为2厘米。2) Connecting ring: it matches with the liver puncture guide device. The head end of the connecting ring is tapered, and the material is iron-containing material, which matches the liver puncture expansion ring. The two form a magnetic adsorption fast anastomosis device, which plays the role of fixing the expansion ring. The tapered end is sharp and can quickly puncture blood vessels. The wall plays the role of opening up blood vessels. Its surface is designed with sieve holes to facilitate the rapid flow of perfusate into the liver; the inside of the connecting ring is designed with a one-way valve, so that perfusion can only flow into the liver through the outside and cannot flow backward; the tail end is The perfusion tube connection port is used to connect the perfusion pipeline. The tapered part at the top of the connecting ring is a composite biological material with stable biological properties composed of iron-containing substances, which can be magnetically linked with the shrinkable ring at the top of the puncture needle; the remaining structure is ABS plastic (acrylonitrile) with good comprehensive performance and stable chemical performance. -butadiene-styrene), with an inner diameter of 0.8 cm and a height of 2 cm.

本发明与传统供肝获取灌注的方法相比较具有明显的有益效果：Compared with the traditional method of obtaining perfusion from donated liver, the present invention has obvious beneficial effects:

(1)快速定位扩张血管，在开腹探及肝脏后能通过肝脏穿刺引导装置迅速到达门脉下端并进行管道连接。(1) Quickly locate the dilated blood vessels. After laparotomy and liver exploration, the liver puncture guide can quickly reach the lower end of the portal vein and connect the pipeline.

（2）充分利用磁性材料的特征进行连接环与引导装置的连接，快速的刺破血管进行血液灌注，避免了传统上用线套扎的操作人员的人为差异。(2) Make full use of the characteristics of the magnetic material to connect the connecting ring and the guiding device, quickly puncture the blood vessel for blood perfusion, and avoid the artificial difference of the operator who traditionally uses the thread ligation.

（3）采用活瓣灌注模型的设计，灌注液只能由一个方向进行流动，保证了灌注过程中的单向性，提高灌注效率。(3) With the valve perfusion model design, the perfusate can only flow in one direction, which ensures the unidirectionality in the perfusion process and improves the perfusion efficiency.

本发明采用穿刺钢丝，尤其是30厘米的长度，可以避免出现插管过深导致左、右肝灌注不充分的情况；连接环头端呈锥形，材料为含铁物质，与肝脏穿刺扩张环相匹配，两者构成磁性吸附快速吻合装置，起到固定扩张环的作用，其锥形端尖锐，能快速刺破血管壁，起到打通血管作用，其表面为筛状孔设计，方便灌注液快速流入肝脏；连接环内部为单向活瓣设计，使得灌注只能由经由外界流入肝内而不能逆流；尾端为的灌注管连接口，用于连接灌注管道。本发明操作简单可行，针对性强，主要用于肝移植术中完成供肝获取时快速灌注。本发明明显缩短了灌注装置的安装时间，为快速、高效的进行肝脏灌注、获取高质量的供肝提供了有效的技术保障。The present invention adopts the puncture steel wire, especially the length of 30 centimeters, which can avoid the situation that the intubation is too deep to cause insufficient left and right liver perfusion; Matching, the two constitute a magnetic adsorption rapid anastomosis device, which plays the role of fixing the expansion ring. Its tapered end is sharp, which can quickly pierce the blood vessel wall and play the role of opening the blood vessel. Its surface is designed with sieve holes, which is convenient for perfusion. Quickly flow into the liver; the inside of the connecting ring is designed with a one-way valve, so that the perfusion can only flow into the liver through the outside and cannot be reversed; the end of the perfusion tube is the connection port for connecting the perfusion tube. The operation of the invention is simple and feasible, and has strong pertinence, and is mainly used for rapid perfusion when the donor liver is obtained during liver transplantation. The invention obviously shortens the installation time of the perfusion device, and provides effective technical support for fast and efficient liver perfusion and obtaining high-quality donor livers.

附图说明Description of drawings

图1为实施例1穿刺引导装置的结构示意图。Fig. 1 is a schematic structural view of the puncture guiding device of Embodiment 1.

图2为实施例1穿刺引导装置顶端的可收缩环的变化过程示意图。Fig. 2 is a schematic diagram of the changing process of the shrinkable ring at the top of the puncture guiding device in Embodiment 1.

图3为实施例1连接环的结构示意图。FIG. 3 is a schematic structural view of the connecting ring in Embodiment 1.

图4为连接环内部单向活瓣结构示意图。Fig. 4 is a schematic diagram of the structure of the one-way valve inside the connecting ring.

图5是实施例1穿刺引导装置与连接环结合用于肝移植术的示意图。Fig. 5 is a schematic diagram of the combination of the puncture guide device and the connecting ring in the first embodiment for liver transplantation.

具体实施方式detailed description

下面结合具体实施例进一步阐述本发明，应理解，以下实施例仅用于说明本发明而不用于限制本发明的保护范围。The present invention will be further described below in conjunction with specific examples. It should be understood that the following examples are only used to illustrate the present invention and are not intended to limit the protection scope of the present invention.

下列实施例中所用方法如无特别说明，均为常规方法。以下实施例中所需要的材料或试剂，如无特殊说明均为市场购得。The methods used in the following examples are conventional methods unless otherwise specified. The materials or reagents required in the following examples are commercially available unless otherwise specified.

实施例1Example 1

图1-2和图3-4分别为头端隐藏磁性可收缩扩张环的肝脏穿刺引导装置和与之相配套的圆形连接环。如图1-2所示，肝脏穿刺引导装置由引导丝2和导管1组成，其材质为材质由不锈钢、镍/铂、聚氨酯、聚四氟乙烯等组成的复合生物材料，质软，可塑，主要起穿刺引导进入门脉的作用。其引导丝2头端带有一个可收缩环2-1，可收缩环2-1由不连续的片段经特殊工艺连接、方便收缩和舒张，其材质为综合性能良好、化学性能稳定的铁氧体磁性材料，可由引导丝2尾端操作后伸展（伸展后为内径为0.8厘米的圆环）、起到扩张血管的作用。Figures 1-2 and Figures 3-4 respectively show the liver puncture guide device with the magnetic retractable expansion ring hidden at the head end and the matching circular connecting ring. As shown in Figure 1-2, the liver puncture guide device is composed of a guide wire 2 and a catheter 1, and its material is a composite biological material composed of stainless steel, nickel/platinum, polyurethane, polytetrafluoroethylene, etc., which is soft and plastic. It mainly plays the role of puncture guide into the portal vein. The leading end of the guide wire 2 has a shrinkable ring 2-1, and the shrinkable ring 2-1 is connected by a special process by discontinuous segments to facilitate shrinkage and relaxation. Its material is iron oxide with good comprehensive performance and stable chemical properties. The body magnetic material can be stretched after being manipulated by the tail end of the guide wire 2 (after being stretched, it becomes a ring with an inner diameter of 0.8 cm), and plays the role of dilating blood vessels.

如图3-4所示，为头端为锥形、内部为活瓣式设计的圆形连接环3，整个连接环3的材质为综合性能好、化学性能稳定的ABS塑料（丙烯腈-丁二烯-苯乙烯），内径为0.8厘米，高度为2厘米，其头端为锥形结构，锥形表面为筛状设计，材质为是由含铁物质，可在穿透血管后与肝脏穿刺引导装置顶端扩张后的可收缩环2-1依靠磁性相接、固定可收缩环2-1。锋利的锥形头端设计能快速穿透血管，形成灌注通道。尾端为灌注管连接口，用于链接灌注管子；连接环3内部设有单向活瓣（图4），使得灌注液体只能由经由外界流入肝内而不能逆流，从而达到快速灌注的效果。As shown in Figure 3-4, it is a circular connection ring 3 with a tapered head end and a valve-type design inside. The material of the entire connection ring 3 is ABS plastic (acrylonitrile-butadiene) with good comprehensive performance and stable chemical properties. Diene-styrene), with an inner diameter of 0.8 cm and a height of 2 cm. Its head end is a conical structure, and the conical surface is a sieve-shaped design. The material is made of iron-containing substances, which can be punctured with the liver after penetrating blood vessels. The expanded retractable ring 2-1 at the top of the guiding device relies on magnetic connection to fix the retractable ring 2-1. The sharp tapered tip design can quickly penetrate blood vessels to form a perfusion channel. The tail end is the connection port of the perfusion tube, which is used to connect the perfusion tube; there is a one-way valve inside the connecting ring 3 (Figure 4), so that the perfusion liquid can only flow into the liver through the outside and cannot flow backward, so as to achieve the effect of rapid perfusion .

图5为整个装置的操作流程，在供肝获取过程中，开腹迅速探及肝脏情况后，用肝脏穿刺引导装置经由肝脏表面穿入到达门脉下端，通过引导丝2的手柄控制顶端磁性可收缩环2-1扩张并撑起门脉，此时利用磁性相吸迅速的使磁性可收缩环2-1与连接圆环相3接固定，并稍微转动连接环3使其能牢牢扣紧血管内部的磁性可收缩环2-1，这样连接安装完成。此后用灌注管插连接连接环3的尾端，开始灌注。Figure 5 shows the operation flow of the whole device. In the process of obtaining the liver donor, after laparotomy and rapid detection of the condition of the liver, the liver puncture guide device is used to penetrate through the surface of the liver to reach the lower end of the portal vein. The retractable ring 2-1 expands and props up the portal vein. At this time, the magnetic retractable ring 2-1 is quickly connected to the connecting ring 3 by using magnetic attraction, and the connecting ring 3 is slightly rotated so that it can be firmly fastened. The magnetic retractable ring 2-1 inside the blood vessel is connected and installed like this. Thereafter, insert and connect the tail end of the connecting ring 3 with a perfusion tube to start perfusion.

从上述描述中不难发现，本发明与传统供肝获取灌注的方法相比较具有明显的自身优势：(1)快速定位扩张血管，在开腹探及肝脏后能通过肝脏穿刺引导迅速到达门脉下端并进行管道连接。（2）充分利用磁性材料的特征进行连接置管，锥形头端快速的刺破血管进行血液灌注，避免了传统上用线套扎的操作人员的人为差异。（3）采用活瓣灌注模型的设计，灌注液只能由一个方向进行流动，保证了灌注过程中的液体流动单向性，提高灌注效率。本发明明显缩短了灌注装置的安装时间，为快速、高效的进行肝脏灌注、获取高质量的供肝提供了有效的技术保障。From the above description, it is not difficult to find that the present invention has obvious advantages compared with the traditional methods of obtaining perfusion of liver donors: (1) rapid positioning of dilated blood vessels, and can quickly reach the portal vein through liver puncture guidance after laparotomy. Lower end and pipe connections. (2) Make full use of the characteristics of the magnetic material to connect the catheter, and the tapered head quickly punctures the blood vessel for blood perfusion, avoiding the artificial difference of the operator who traditionally uses the thread ligation. (3) With the valve perfusion model design, the perfusion fluid can only flow in one direction, which ensures the one-way flow of the liquid during the perfusion process and improves the perfusion efficiency. The invention obviously shortens the installation time of the perfusion device, and provides effective technical support for fast and efficient liver perfusion and obtaining high-quality donor livers.

最后，还需要注意的是，以上列举的仅是本发明的具体实施例子。显然，本发明不限于以上实施例子，还可以有许多变形。本领域的普通技术人员能从本发明公开的内容直接导出或联想到的所有变形，均应认为是本发明的保护范围。Finally, it should also be noted that the above examples are only specific implementation examples of the present invention. Apparently, the present invention is not limited to the above examples, and many variations are possible. All deformations that can be directly derived or associated by those skilled in the art from the content disclosed in the present invention should be considered as the protection scope of the present invention.