Patent Application
20210068884
The invention relates to the technical field of medical apparatus and instruments, and in particular to an electrode for a prostate surgery and a using method thereof.
Along with the continuous improvement of living standards and the advent of an aging society, the number of patients with benign prostatic hyperplasia is greatly increased, a prostate resection becomes a main surgery of urology, and a transurethral resection of prostate (TURP) is always recognized as a golden standard of treating the benign prostatic hyperplasia by urologists, herein, the benign prostatic hyperplasia is a disease caused by the effect of human body factors, such as imbalance of sex hormones, causing glandular connective tissues and smooth muscle tissues of a median lobe or an inverted lobe under a posterior urethral mucosa to be gradually proliferated, forming multiple globular nodules, and enabling a urethra, a bladder and a kidney to occur a series of function disorder. However, a traditional electroscission has many problems, such as much intraoperative bleeding, poor surgical field of vision, easy mis-resection and incomplete tissue enucleation, but the above problems are solved very well by the invention of prostate enucleation, it is very, popular to doctors, and is learned in succession. In the most of existing prostate enucleations, invisible hard removal is performed on a gland by using a scope lemma, and the removal is completely based on the experience and feeling of the doctor. It is very difficult to learn, and a sheath tube is easily damaged because of careless use, and even a ceramic head at a front end of the sheath tube is broken or fallen off, so the safety of the prostate enucleation is seriously affected, and even the failure of the prostate enucleation is caused.
In order to solve the problems in an existing technology, the invention aims to provide an electrode for a prostate surgery. The electrode, in a using process of the prostate surgery, has functions of being enucleatable and resectable, and also has a function of enlarging a hemostatic area, and is capable of improving the hemostatic effect and improving the hemostatic efficiency, thereby the efficiency of the prostate surgery may be improved, the operation difficulty and risk of the surgery are reduced, the bleeding and injury of a patient during the prostate surgery are also reduced at the same time, the safety and success rate of the surgery are improved, and the patients are benefited.
In order to achieve the above, purpose, the invention provides the following technical scheme.
An electrode for a prostate surgery, including an electrode body, herein, the electrode body is an arc-shaped sheet structure and may be matched with the surface of a prostate tissue Bayer, and the electrode body is provided with a concave arc surface and a convex arc surface; the electrode body includes a base body, an anterior resecting portion and a posterior resecting portion; the anterior resecting portion is forwards protruded from the base body, and the anterior resecting portion is arc-shaped; and the posterior resecting portion is backwards protruded from the base body, the posterior resecting portion is arc-shaped, in enucleating and resecting processes of the TURF, the convex arc surface may also be used as a component for performing electrocoagulation hemostasis on a place to be resected, namely an electrocoagulation hemostasis part.
Further, the posterior resecting portion is backwards extended from the base body and is opposite to an extending direction of the anterior resecting portion.
Further, a length of the anterior resecting portion forwards protruded from the base body is greater than a length of the posterior resecting portion backwards protruded from the base body.
Further, the length of the anterior resecting portion forwards protruded from the base body is 0.35 mm-0.85 mm.
Further, the length of the posterior resecting portion backwards protruded from the base body is 0.2 mm-1.0 mm.
Further, a height of the electrode body is 1.6 mm-3.1 mm, and a distance between two ends of the electrode body is 3.5 mm-5.5 mm.
Further, a radian of the convex arc surface is 11π/18˜2π/3.
Further, an outer edge of the anterior resecting portion and, an, outer edge of the posterior resecting portion are arc surfaces, and radiuses of the two parties are 0.05 mm-0.3 mm.
Another purpose of the invention is to provide a using method of the above electrode, the using method includes the following steps.
S1: a median lobe of prostate is treated, a hyperplasia tissue of the median lobe of prostate is removed by using the anterior resecting portion of the electrode, and in a peeling process, the electrocoagulation hemostasis is performed on a place to be resected by the convex arc surface;
S2: bilateral lobes of the prostate are treated, hyperplasia tissues of the bilateral lobes of the prostate are removed by using the anterior resecting portion of the electrode, and in a peeling process, the electrocoagulation hemostasis is performed on a place to be resected by the convex arc surface; and
S3: the hyperplasia tissues of the bilateral lobes of the prostate and the hyperplasia tissues of the bilateral lobes of the prostate are acquired by using the posterior resecting portion of the electrode to back-resect.
The beneficial effect of the invention is as follows.
In a process that the electrode provided by the invention is used to perform the prostate surgery, because the electrode body is the arc-shaped sheet structure and may be matched with the surface of the prostate tissue layer, and an arc protruded portion at the front end thereof forms the anterior resecting portion, so the electrode has a function of enucleating the hyperplasia tissue of the prostate like a shovel electrode while it is forwards pushed, it is more labor-saving, easier, and more thorough to remove the tissue; because an arc protruded portion at the rear end of the electrode body forms the posterior resecting portion, the plough-shaped electrode has a function of resecting like a ring electrode while it is backwards pulled, so that the fine trimming and accurate resecting may be performed on the tissue while the electrode is back-resect; in addition, the convex arc surface of the whole electrode body provides the largest area of a coagulation surface in the enucleating and resecting processes, is capable of blood-coagulating in a surgical process, and has a function of hemostasis, thereby a risk of massive bleeding in the surgery is reduced.
In the diagram: Electrode body 10, Concave arc surface 11, Convex arc surface 12, Base body 13, Anterior resecting portion 14, Posterior resecting portion 15, Left end portion 16, Right end portion 17, First electrode connecting portion 20, and Second electrode connecting portion 30.
Technical schemes in the embodiments of the invention are clearly and completely described below in combination with drawings in the embodiments of the invention, apparently, the embodiment described are only a part of the embodiments of the invention, but not all of the embodiments. Based on the embodiments in the invention, all other embodiments acquired by those of ordinary skill in the art without marking creative work shall fall within a scope of protection of the invention.
The embodiment provides an electrode for a prostate surgery, it is a plough-shaped electrode for a TURP, and used for a plasma resectoscope.
Reference to
In the embodiment, during a using process of the prostate surgery, because an arc protruded portion at the front end of the electrode body 10 forms the anterior resecting portion 14, the plough-shaped electrode has a function of enucleating the hyperplasia tissue of the prostate like a shovel electrode while it is forwards pushed, it is more labor-saving, easier, and more thorough to remove the tissue; because an arc protruded portion at the rear end of the electrode body 10 forms the posterior resecting portion 15, the plough-shaped electrode has a function of resecting like a ring electrode (may also be understood as the resecting of the reverse shovel electrode) while it is backwards pulled, so that, the fine trimming and accurate resecting may be performed on the tissue while, the plough-shaped electrode is back-resect; in addition, the convex arc surface 12 of the whole electrode body 10 provides the largest area of a coagulation surface in the enucleating and resecting processes, is capable of blood-coagulating in a surgical process, and has a function of hemostasis, thereby, a risk of massive bleeding in the surgery is reduced.
In the TURP, a tissue of benign prostatic hyperplasia is completely removed through a capsule, so that the surgical wound surface is a complete and smooth prostate capsule, and blood vessels exposed on the capsule are clearly visible, and the electrocoagulation hemostasis may be performed on a place to be resected through the convex arc surface 12, so the contraction and hemostasis of the prostate capsule are more thorough after the surgery, the indwelling catheterization time is shorter, and a patient may even consider not performing bladder irrigation after the surgery.
In the embodiment, reference to
Furthermore, in the embodiment, two ends of the electrode body 10 are a left end portion 16 and a right end portion 17 respectively, preferably, a height of the electrode body 10 is 1.6 mm-3.1 mm, a distance between the left end portion 16 and the right end portion 17 of the electrode body 10 is 3.5 mm-5.5 mm, this size setting is to avoid that a size of the electrode body 10 is too large so that occupied space is large, which is not beneficial to the smooth surgery.
Specifically, the electrode of the embodiment further includes two electrode connecting, portions, reference to
In the embodiment, preferably, the radian of the convex arc surface 12 of the electrode body 10 is 11π/18˜2π/3, reference to
In the embodiment, preferably, reference to
The embodiment is a using method in allusion to the electrode (hereinafter referred to as a plough-shaped electrode) in the above embodiment during a surgical process.
Firstly, the TURP specifically includes the following steps: preoperative preparation work is performed, which specifically includes completing various urinary system examinations before a surgery and the like.
The preoperative treatment work, is performed, preoperative skin preparation is performed, an intestinal tract is prepared, and antibiotics are used for an intraoperative period.
Used surgical equipment and specific parameters, firstly the plough-shaped electrode is assembled into a plasma resectoscope, a plasma resection system, such as Olympus TURis, is used, irrigating solution is used as normal saline, an irrigating height is 60 cm, resection power is 280 W, and electrocoagulation power is 140 W.
A specific surgical method is as follows: firstly, a prostate hyperplasia tissue of a median lobe of prostate is treated, a prostate urethral mucosa is firstly resected at a near end of colliculus seminalis, so a prostate capsule may be seen here, the prostate hyperplasia tissue is peeled off by using an anterior resecting portion 14, electrocoagulation hemostasis is performed while a hemostasis part encounters active bleeding, after the partial tissue is peeled off, the peeled prostate hyperplasia tissue is resected by a posterior resecting portion 15, the peeling is repeated, and the resection is performed to the neck of a bladder, hereafter, prostate hyperplasia tissues of bilateral lobes of the prostate are treated by the same method; thereafter, the posterior resecting portion 15 is used to back-resect to acquire the hyperplasia tissue of the median lobe of the prostate and the hyperplasia tissues of the bilateral lobes of the prostate. In the surgery, attention is paid to the gentle movement, a brute force is not used to cause a perforation of the prostate capsule, the enucleating surgery is terminated while the perforation of the capsule is encountered, and changed to an open surgery or a prostate resection. After the surgery, an, anal finger examination is performed to eliminate the possibility of a rectal injury. At the end of the surgery, the prostate tissues are sucked up by using an irrigator, it is checked again whether there is a prostate tissue in the bladder, whether there is active bleeding on the wound surface, and whether an internal urethral sphincter is injured, a three-cavity catheter is placed to continuously irrigate the bladder after the surgery.
In the embodiment, transurethral vaporization enucleation/prostate resection of the plough-shaped electrode consists of three independent endoscopy procedures, and is used for surgically treating benign prostatic hyperplasia (BPH). Specifically including: 1) a transurethral vaporization enucleation and prostate resection of the plough-shaped electrode, referred to as TVERP, the feature of this technology is that the prostate hyperplasia tissue is almost enucleated and subsequently resected by the plough-shaped electrode; 2) a transurethral vaporization enucleation of the plough-shaped electrode, referred to as TVEP, through such a technology, after the prostate hyperplasia tissue is completely enucleated by the plough-shaped electrode, the hyperplasia tissue may be retrieved by using a tissue crusher, and it saves surgical time while the larger prostate is treated; and 3) an ultrasonic-guided accurate prostate resection, referred to as US-TVERP/TVEP, with this technology, during the TVERP or TVEP surgery, sagittal and lateral structures of the prostate may be displayed by transrectal ultrasound in order to more accurately identify a surgical capsule, an apex and a bladder neck of the prostate, and avoid damage to a urethral sphincter or a bladder wall.
A specific process of the above surgery is as follows.
General anesthesia is performed on a patient, and the patient is placed in a lithotomy position;
firstly, near the plough-shaped electrode, vaporization is performed in a 5 o'clock position of the edge at the near end of the colliculus seminalis, until the surgical capsule is identified by characteristic white circular fibers thereof;
then the surgical capsule in a 7 o'clock position is exposed in the same way;
the vaporization is performed to the bladder neck along the surgical capsule from the 5 o'clock position to the 7 o'clock position;
in a dissection process, the plough-shaped electrode is used for sealing (coagulating) blood vessels and evaporating bonding fibers;
while the separation of the median lobe is performed close to the bladder neck, a left lobe is retrograded along the surgical capsule and enucleated by the plough-shaped electrode in a counterclockwise manner;
then, a right lobe is retrograded along the surgical capsule, and enucleated by the plough-shaped electrode in a clockwise manner; and
then an almost avascular lobe is resected by using the plough-shaped electrode or a resecting ring in a gasification mode, and attention is paid to avoid a perforation of a prostatic vesicle.
The vaporization is performed on the prostate hyperplasia tissue by the plough-shaped in a manner similar to the TVERP, but a detachment process is thoroughly performed through the bladder neck, it is different from the case of incomplete detachment in the TVERP. An enlarged lobe of the prostate is completely enucleated, and then pushed into the bladder. The tissue crusher is used to take out the enucleated prostate tissue during the TVEP.
Before an endoscopy is performed, a dual-wing ultrasonic probe is placed in a rectum, sagittal and cross-sectional images of a surgical area are ultrasonic-displayed, the surgical capsule of the prostate, and the urethral sphincter and the bladder neck around the apex of the prostate may be identified in the ultrasonic images. In addition, in the TVERP or TVEP procedure, a position of a surgical instrument may also be monitored by the ultrasound, such real-time display provides an additional field of view outside an endoscope, it guides the electrode to work along a right plane, directly enter the bladder through the bladder neck, and keep a safe distance from the urethral sphincter. In addition, in a process of retrieving the tissue, it also guides the tip of a silencer away from the bladder wall. Such an ultrasonic guiding technology makes the TVERP and TVEP more accurate, and safer.
Postoperative treatment: indwelling catheterization is used to continuously irrigate the bladder after the surgery, antibiotics and hemostatic drugs are applied, generally, bladder irrigation is stopped after the color of the irrigation is cleared in the second day after surgery, the catheter is pulled out after 3-7 days, the patient is discharged from hospital after urinating conditions and postoperative body temperature are observed to be normal.
Postoperative follow-up visit: after one month after the surgery, a postoperative recovery condition is followed-up, including whether current complication, such as postoperative bleeding and postoperative infection, occurs or not; and the surgical effect may be basically evaluated through 3 months of the follow-up after the surgery, including an international prostate symptom score (IPSS), a quality of life score (QOL), and conditions whether urinary incontinence and urethral stricture and the like occurs or not.
The above embodiments are only used to describe the technical schemes of the invention but not to limit them, the invention is described in detail with reference to the preferable embodiments, those skilled in the art should understand that modifications or equivalent replacements made to the technical schemes of the invention, without departing from purpose and scope of the present technical scheme, shall fall within a scope of the claims of the invention.
| Number | Date | Country | Kind |
|---|---|---|---|
| 201921470813.1 | Sep 2019 | CN | national |
| 202010017949.8 | Jan 2020 | CN | national |
