CN1293550A - 利用软套使探头在结肠内推进 - Google Patents

利用软套使探头在结肠内推进 Download PDF

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CN1293550A
CN1293550A CN00800104A CN00800104A CN1293550A CN 1293550 A CN1293550 A CN 1293550A CN 00800104 A CN00800104 A CN 00800104A CN 00800104 A CN00800104 A CN 00800104A CN 1293550 A CN1293550 A CN 1293550A
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CN1196435C (zh
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迈克尔·沃罗欣
雅克弗·巴－奥
维克托·勒文
吉奥拉·伯纳特
丹·奥兹
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Sightline Technologies Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00148—Holding or positioning arrangements using anchoring means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00151—Holding or positioning arrangements using everted tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/0051—Flexible endoscopes with controlled bending of insertion part
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
    • 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
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0119—Eversible catheters

Abstract

在腔道(40)内前行的内镜装置具有一个带远端和近端的探头(20)以及一个在近侧与探头相连的软套(26)。使套膨胀,以便在腔道内推进探头。探头通常包括一个捕获腔道内的图象的成像装置(28)。

Description

利用软套使探头在结肠内推进
总体而言，本发明涉及在腔道内推进物体。确切地说，本发明涉及使医疗仪器前行穿过结肠的方法和装置。
在本技术领域中，用内镜来检查体腔是众所周知的。通过用挠性内镜来直接检查肠胃道而带来的诊断和治疗优点使得该方法成为现代医学的标准程序。最常见的一种内镜程序就是结肠镜检查，它被用于多种目的，其中包括诊断癌症、确定肠胃出血源、观察受肠炎病感染的部位、取出息肉和消除肠扭转和肠套叠。
尽管结肠镜检查是有用和高效的，但是医生很难进行这样的操作，而且这样的操作会给病人带来痛感并且有时对病人是很危险的。这些问题源于需要通过从其近端由体外向内地推动长而柔软的结肠镜，使之穿过肠道并要控制其方向。
人们希望能提供一种推进装置，以便在人体内从其远端起向前推动或牵拉内镜。目前，已经为此提出了许多种方法和装置，但还没有一种方法和装置获得了临床上或工业应用上的认可。
授予Meiri等人的美国专利4，207，872(该文献的全文在此作为参考文献被引入)描述了一种使用充满流体的多头软凸起使内镜前行穿过体内通道的方法和装置，其中所述凸起沿装放内镜的罩套外表面分布。交替地增大和减小凸起内的流体压力使得内镜沿体内通道前进。每个凸起直接接触体内通道的内表面并对该比较小的接触表面施加局部的接触压力以便推动内镜前进。
授予Choy等人的美国专利3，895，637(其全文在此作为参考文献被引入)描述了一种能够通过连续地给第一、第二可径向充气的构件充气和放气而穿过管状器官的装置。充气将充气后的构件固定在管状器官的局部区域上，而在该装置的可纵向充气的连通部内的气压使该装置的活动部分纵向穿过管状器官。需要在一段较小的管状器官上存在充气构件的足够接触压力，以便使该装置能够通过该器官。美国专利3，895，637没有提出在受压组织的较大区域内分布接触压力以便产生纵向移动的措施。
授予Leighton等人的美国专利4，321，915(其全文在此作为参考文献被引入)描述了一种利用以下交替步骤而将工具引入体腔的反转管装置，即施加正压以便反转管并使工具前进；以及抽成真空以便将反转管拉离工具，从而操作人员可将工具抽出在前一步骤中前进的距离的一半。这要求使用该装置的操作人员在每个压力循环中用手将工具抽出上述距离以避免造成工具前进得太远而超过了反转管的前端。
授予Boretos的美国专利4，403，985(其全文在此作为参考文献被引入)描述了一种用于插入人体腔道的喷气式装置。将高压流体从体外通入该装置并随后沿一个方向喷出该装置上的一个小孔，以便在相反的方向上推进该装置。因此，美国专利4，403，985的装置通过将材料排入人体腔道中而产生推动力。
本发明某些方面的一个目的是提供一种用于在腔道内推进物体的改进的系统和方法。
本发明某些方面的另一个目的是提供一种用于在病人体腔内使内镜前行以便进行检查、诊断和处理的改进的推进机构。
在本发明的优选实施例中，通过使一个与探头相连的软套膨胀而使该装有内镜仪器的探头前行穿过病人的下部肠胃道。套的一端一般被固定在或靠近病人的肛门。当最好用高压气体使套胀大时，探头被向前推进并且使套逐渐伸出到探头与肛门之间。充气的套部分径向向外膨胀，并且只要处于胀大状态，它就相对肠壁基本上保持固定不动。套相对肠壁的纵向移动通常只出现在探头处及其附近。因此，容易使探头前进并最大限度地减轻了对肠胃道的损伤。为了取出探头，使套放气并用套从肛门中向回拉出探头。
在本发明的一些优选实施例中，套环绕探头并在探头前进时反转。套最好折叠到一个或更多个环绕探头的弹性环上，其中所述环最优选地包括环形弹簧，它们环绕着探头的外表面并且通过磁吸引力被吸附在探头上。使套胀大造成探头前进穿过结肠，这造成套从内侧向外展开。因此，套的外部只在探头附近打开，而外部的其余部分保持固定不动。
在本发明的其它优选实施例中，通常以折叠或卷起的紧凑状态将套存放在探头内或紧挨着探头。最好，折叠或卷起的探头被存放在一个在探头近端部分上的凹槽内。当探头前进时，套逐渐脱离其存放状态并贴着肠壁地膨胀。
在本发明的一些优选实施例中，探头包括一个用于轻轻地移过或绕过肠胃道内的曲线部分和例如血块、小变形部和其它障碍物的障碍的独立的方向控制部件，从而探头可以在病人体内移动并同时尽可能地减少有害接触和摩擦。方向控制部件优选地通过气体或流体压力工作并最好如以色列专利申请125，397中所述的那样工作，该申请被转让给了本专利申请的受让人并且其全文在此作为参考文献地被引入。或者，可以采用本技术领域中已知的其它方向控制方法。
在本发明的一些优选实施例中，探头包括检查、诊断和处理用仪器。优选地，所述仪器包括一个成像装置，并且最好是如现有技术中已知的那样是微型摄像机和光源，它们被用于捕获内镜图象。用于操作仪器并接受其数据的机构包括电线、光导纤维缆线或者与所述仪器相连并延伸至操纵仪器并接收来自仪器的数据的操作人员或病人体外设备的管。所述电线、缆线或管最好穿过套。
在本发明的优选实施例中，通过使套膨胀而使探头前行穿过畅胃道的方案降低或消除了采用传统内镜时所需的在探头近端(在病人体外)施加机械力以便插入探头的必要性。因此，本发明减小或消除了向病人身体的任何部位施加集中的局部压力的必要性，减少或消除了在装置或其部件与病人身体之间的摩擦和擦伤，并避免了把流体或其它材料喷入人体腔道中。
因此，根据本发明的一个优选实施例而提出了一种在腔道内前进的内镜装置，它包括：一个具有远端和近端的探头；一个在近侧与探头相连的软套，使该套膨胀以便在腔道内推进探头。
所述探头最好包括一个捕获腔道内的图象的成像装置。
在一个优选实施例中，套在探头前进时反转，其中套绕过探头的外表面并反转到一个固定环上，所述固定环将套保持在探头的外表面上。探头最好包含磁性材料，而且固定环包括一个或更多个金属环，通过磁吸引力将所述金属环吸附在探头上。
此外，已经反转到环上的套的外部优选地被固定住，以便相对于腔壁基本上保持固定不动。
在另一个优选实施例中，套的一部分在紧凑状态下被保持在探头上并且随着探头的前进而伸出探头的近端。探头优选地在其近端附近具有一个凹槽，所述凹槽容放有处于紧凑状态下的套。所述套还最好被固定在一个靠近该探头的位置上，从而已被胀大的且在该临近位置与探头之间的套的一部分相对于腔壁基本上保持固定不动。
所述腔道优选地包括病人体内的一个通道，并且它最好包括肠胃道的一部分。
根据本发明的一个优选实施例，还提出了一种用于在腔道内推动探头的方法，它包括：将一个软套与探头的近端相连；以及使套膨胀以便使探头穿过该腔道。
在一个优选实施例中，套在探头前进时反转，其中连接套的步骤包括使套绕过探头的外表面并将套折叠到一个固定环上，所述固定环将套保持在探头的外表面上。该方法优选地包括固定一个反转的套的外部以便相对腔壁基本上保持固定不动。
在另一个优选实施例中，连接套的步骤包括：在紧凑状态下将套的一部分保持在探头的近端上，从而当探头前进时，套从近端脱出。
所述腔道最好包括病人的肠胃道。
根据以下结合附图对本发明优选实施例的具体描述，本发明将得到更充分的理解。图中：
图1是根据本发明的一个优选实施例的带折叠套的探头的示意剖视图；
图2是根据本发明的一个优选实施例来表示操作中的图1所示探头及有关设备的局部剖开的示意图；以及
图3是根据本发明的另一个优选实施例的带反转套的探头的示意剖视图。
图1是根据本发明一个优选实施例的内镜探头20的示意剖视图。探头20包括一个探头头部或顶部22，它最好呈圆柱形，在其远端带有一个透明的光学视窗或透镜30。探头装有一个电光组件28，它如本领域中所公知的那样最好包括一个光源和微型摄像机，所述摄像机通过透镜30捕获图象。缆束32包括电线31，它们连接组件28和外部控制台，以便在控制台与组件之间传递信息。
探头还包括一个由帽34构成的基座24，它容纳一个盖件和一个内心轴36，所述心轴在其近端具有凸缘。如图所示，软套26被折叠到帽与心轴之间的空间内并且在基座的近端处从在帽与心轴之间形成的圆形缝隙中送出。如图所示，缆束32最好通过一个在心轴36的中心的空洞。
套26最好包含一种可生物相容的且属于本领域中已知的任何适用类型的柔软塑料，它的壁厚最好在大约0．1毫米和0．5毫米之间并且其在胀大时的总体直径约为10毫米。塑料套26被折叠并紧固在基座24内，以便允许套均匀地从其近端向其远端地展开和送出。套的远端相对探头20被严密地密封住，从而套可以如下面将进一步说明的那样充入高压气体或其它流体。
探头20最好包括一个方向控制部件23，它使探头头部22相对基座24倾斜。方向控制部件被用于帮助使探头绕曲线部分转动并避免在肠胃道中受到阻碍。它也可用于使探头头部22倾斜以便捕获不直接位于探头前的探察区的图象或进行外科手术。如上述以色列专利申请125，397所述，方向控制部件23最好包括一组对置的波纹管25、27，它们通过缆束32内的气体或流体管线33胀大或缩小以便转动该部件。尽管为了简化起见而只在图中画出了两个这样的波纹管，但可以理解实际上可以使用一个、三个、四个或更多的波纹管。或者，方向控制部件23可以包括其它类型的如在内镜领域中已知的转向机构，例如以牵引索为基础的机构。
除了电光组件28外，探头头部22可能还包括吸孔和／或灌注口、各种传感器和／或专用的外科手术仪器如活检镊子。这些构件在本技术领域中通常都是众所周知的并且在图中没有画出来。基本上可以采用任何适当类型的工具或传感器并且将它们装在头部22中，而且通过适当地采用缆线32而使之与外部设备相连。
图2以局部剖开的示意图示出了用于内镜检查病人结肠40的根据本发明一个优选实施例的探头20。套26的近端被在人体外的一个固定铰钉50固定到管子48上，所述管子与膨胀和排空设备46相连。缆线32通过一个气密接头穿过套26和管子48，然后与控制台44相连。
探头20经肛门42被插入结肠40中。接着，例如通过开启与一个受控的高压二氧化碳气体源或其它气体源相连接的阀而启动设备46。最好，使用在0．3atm范围内的气压使套胀大。或者，可以采用例如消毒水的液体使套胀大。使套胀大造成将探头20向前推入结肠40中，由此导致套26展开并送出探头的基座24。套的胀大部分一般径向膨胀并可能接触结肠壁，但是套一般相对结肠壁只有最小的纵向移动或没有纵向移动。因此，尽可能地减少了对肠壁的摩擦和损伤。
随着探头20穿过结肠，根据需要，如上所述地起用方向控制组件23以使探头头部22相对基座24转动一定角度。最好通过控制台44来控制方向控制部件以便绕曲线部分和肠胃道中的障碍物地操纵探头。
当内镜检查完毕时，操作设备46，以便排空套26。消除套内的压力并使套瘪下去。此时，最好通过拉动缆线32或瘪掉的套26或者这两者而从结肠40中抽出探头20。
图3是根据本发明一个优选实施例的另一个探头60的示意剖视图，所述探头具有一个在结肠40内前进的反转套70。除了反转套70的操作以外，探头60的结构和操作大致与上述的探头20相似。
探头60的基座62最好由磁性金属制成和／或含有一永磁体。基座62具有两个槽68，它们容纳相应的磁性金属弹簧64、66，所述弹簧成弹性环的形状。槽66的周长最好小于槽64的周长，从而弹簧64比弹簧66长。弹簧64、66的弹性及其对基座62的磁吸引力用于将套70夹持在弹簧与基座之间。
在使探头60穿过结肠42之前，使套70绕过基座62并且环绕所述套地将弹簧64、66装入槽68中。套70接着向外折叠或反转到弹簧64上。套的外部78被拉过弹簧并被固定在铰钉72上。套的备用部分74被折叠或卷起来并被保持在一个位于病人体外的位置上(这与图1所示的探头20的情况相反，其中套的备用部分被保持在探头的基座内)。
为了在结肠40内使探头60前进，通过膨胀／排空设备46胀大套70。备用部分74展开并且如图3所示其内部76被沿远侧方向拉到探头后面，然后在弹簧64上反转。移动的部分76被包含在外部78中，所述外部接触结肠40的壁并基本上是固定不动的。因此，避免了与结肠40的摩擦或对结肠40的损伤。当要抽出探头60时，使套70排空并离开人体地回拉内部76，由此使反转动作反向。
弹簧64、66最好足够紧密地在槽68中压在套70上，并且套本身具有足够的弹性，以便形成一个基本上气密的密封。因此，经过备用部分74而使套胀大的气体没有大量泄漏到结肠40中。或者，膨胀在内部76与外部78之间的空间以使探头60前进。
尽管以上参照用于使仪器组件穿过下部肠胃道的装置描述了优选实施例，但是应当认识到本发明的新颖的原理可被用于在其它体腔内移动物体，并且也可被用于在非医疗应用的腔或其它区域内移动物体。非医疗用途的一个例子包括在强腐蚀性或高温环境下进行检查，其中不希望让推进装置的移动部件暴露在这样的环境中。可以理解，尽管上述的优选实施例具有生理数据传输线和操纵引线，但是如本领域中公知的那样，推进装置和仪器组件可以通过电池带动并能储存数据和／或由无线通信传递数据。
因此，应当认为，优选实施例在此是作为示例给出的并且本发明的整个范围应该只由权利要求书限定。

Claims (17)

1．一种在腔道内前行的内镜装置，包括：
一个具有远端和近端的探头；以及
一个在近侧与探头相连的软套，使该软套膨胀以便在腔道内推进探头。
2．如权利要求1所述的装置，其特征在于，所述探头包括一个捕获腔道内的图象的成像装置。
3．如权利要求1或2所述的装置，其特征在于，所述套在探头前进时反转。
4．如权利要求3所述的装置，其特征在于，所述套绕过探头的外表面并反转到一个固定环上，所述固定环将套保持在探头的外表面上。
5．如权利要求4所述的装置，其特征在于，所述探头包含磁性材料，并且固定环包括一个或更多个金属环，它们通过磁吸引力被吸附在探头上。
6．如权利要求4所述的装置，其特征在于，已反转到环上的套的外部被固定住以便相对腔壁基本上保持固定不动。
7．如权利要求1或2所述的装置，其特征在于，所述套的一部分被以紧凑的状态保持在探头上并且在探头前进时送出探头的近端。
8．如权利要求7所述的装置，其特征在于，所述探头靠近其近端地具有一个凹槽，在所述凹槽中容纳有处于紧凑状态的套。
9．如权利要求7所述的装置，其特征在于，套被固定在一个靠近探头的位置上，从而套的已经胀大的且位于近端位置与探头之间的一部分相对腔壁基本上保持固定不动。
10．如权利要求1或2所述的装置，其特征在于，腔道包括病人体内的一个通道。
11．如权利要求10所述的装置，其特征在于，该通道包括肠胃道的一部分。
12．一种用于在腔道内推进探头的方法，包括：
将一个软套与探头的近端相连；以及
使套膨胀以使探头前行穿过该腔道。
13．如权利要求12所述的方法，其特征在于，所述套在探头前进时反转。
14．如权利要求13所述的方法，其特征在于，连接套的步骤包括使套绕过探头的外表面并将套折叠到一个固定环上，所述固定环将套保持在探头的外表面上。
15．如权利要求13或14所述的方法，其特征在于，它包括将一个反转的套的外部固定住以便相对腔壁基本上保持固定不动。
16．如权利要求12所述的方法，其特征在于，连接套的步骤包括将套的处于紧凑状态的一部分保持在探头的近端处，从而套在探头前进时送出近端。
17．如权利要求12-14之一所述的方法，其特征在于，所述腔道包括病人的肠胃道。
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