Endoscope device for lacrimal duct diagnosis and treatment and use method

Abstract

The present invention relates to an endoscopic device for lacrimal duct diagnosis and treatment and a method of use, comprising a nasal auxiliary mechanism and an endoscopic mechanism. When in use, the nasal auxiliary mechanism guides the endoscopic mechanism to enter from the nasolacrimal duct, the nasal auxiliary mechanism comprises a rotatably connected straight cylinder and a steering cylinder, the steering cylinder is rotated by a handle and a control guide wire, the endoscopic mechanism comprises an auxiliary catheter and a diagnostic and treatment tool detachably connected to the auxiliary catheter, when in use, the endoscopic mechanism extends into the nasal auxiliary mechanism, the nasal auxiliary mechanism is inserted from the nostril, the rotating cylinder is rotated to align the front end of the endoscopic mechanism with the lower end opening of the nasolacrimal duct, the endoscopic mechanism is manually pushed into the nasolacrimal duct, and the lacrimal duct is diagnosed and treated by the diagnostic and treatment tool. The endoscope of the present invention is easy to operate, avoids damage to the lacrimal canaliculi and lacrimal puncta, has more treatment methods that can be used, and has better treatment effects.

Description

Technical Field

[0001] The present invention relates to the technical field of medical devices, and in particular to an endoscope device for lacrimal duct diagnosis and treatment and a method of using the endoscope device. Background Art

[0002] The tear duct includes structures such as the nasolacrimal duct, lacrimal sac, lacrimal canaliculi and lacrimal puncta. Tear duct diseases are common and frequently occurring diseases in ophthalmology, with the most common being stenosis and obstruction of the lower segment of the tear duct, often accompanied by chronic dacryocystitis or even acute attacks. In addition, patients with lower tear duct rupture caused by trauma and in whom the proximal end cannot be found for various reasons and the canaliculus anastomosis is successfully performed will inevitably experience epiphora. Because the site of the disease is around the eyes, which is the most important part of facial appearance, it seriously affects the patient's work and life, and therefore poses a huge threat to the patient's physical and mental health. The main treatment methods currently include tear duct intubation recanalization, tear duct laser recanalization, dacryocystorhinostomy and nasal endoscopic lacrimal cystostomy. Among them, lacrimal duct intubation and recanalization is a method that causes less damage to the lacrimal duct, but it is performed under blind vision, and the situation in the lacrimal duct is not well understood. It depends entirely on the surgeon's experience. Therefore, it is inevitable that the lacrimal duct will be damaged or even a false duct will be formed under blind vision. The current lacrimal duct laser treatment is all entered from the upper lacrimal duct, and there are generally shortcomings such as small laser spot, heavy thermal effect, and blind operation, which will directly affect the treatment effect of laser. Although the success rate of DCR treatment of external and internal routes has been improved, both have changed the physiological structure of the patient's lacrimal duct. There is currently no special method for patients with traumatic lacrimal canaliculus rupture who have failed to anastomose via the external route.

[0003] The advent of lacrimal endoscopes has brought about a qualitative leap in the diagnosis and treatment of lacrimal duct diseases. Under the direct vision of the lacrimal duct endoscope, the morphological structure of the lacrimal duct mucosa can be directly observed, the narrow and blocked parts can be accurately located, and the lesions can be operated on with lasers and micro-electric drills, thereby minimizing the damage to the normal lacrimal duct mucosa and the damage to the lacrimal duct.

[0004] However, the existing lacrimal duct endoscopes all enter from the lacrimal puncta and lacrimal canaliculus. Since the diameters of the lacrimal puncta and lacrimal canaliculus are small, the diameter of the lacrimal duct endoscope is limited, so the optical fiber bundle used is thin, and the laser, image, etc. will be affected. Many treatment technologies cannot be introduced and applied through the endoscope (such as synchronous injection and suction, drilling, scissors, foreign body forceps, etc.); the thermal effect of the laser can cause damage to the surrounding mucosa and cannot be ignored; in addition, the existing lacrimal duct endoscope technology cannot perform lacrimal duct diagnosis and treatment on patients with severe stenosis and obstruction of the lacrimal puncta and lacrimal canaliculus, as well as patients with ruptured lacrimal canaliculus; this seriously affects the treatment effect and application scope of the endoscope. Summary of the invention

[0005] In order to overcome the above technical defects, the present invention provides an endoscope device for lacrimal duct diagnosis and treatment, which enters from the nasolacrimal duct when in use, can introduce various treatment techniques, is simple to operate, and is convenient for treatment. In order to achieve the above purpose, the present invention adopts the following technical solutions:

[0006] An endoscope device for lacrimal duct diagnosis and treatment comprises a nasal cavity auxiliary mechanism and an endoscope mechanism. When in use, the nasal cavity auxiliary mechanism guides the endoscope mechanism to enter the nasolacrimal duct from the lower end opening of the nasolacrimal duct.

[0007] The nasal auxiliary mechanism includes a straight cylinder and a steering cylinder, one end of the straight cylinder and the steering cylinder has a quarter-arc structure, the straight cylinder and the steering cylinder are rotatably connected through the bottom end of the quarter-arc structure, the upper end of the quarter-arc structure of the steering cylinder is connected to one end of a control guide wire, the other end of the control guide wire is connected to a handle, the handle is rotatably connected to the straight cylinder, and the handle can be turned to pull the control guide wire to realize the rotation of the steering cylinder.

[0008] The endoscope mechanism includes an auxiliary catheter and diagnostic and treatment tools. The auxiliary catheter has multiple treatment channels. The side circumferential surface of the auxiliary catheter is provided with a diagnostic and treatment tool inlet connected to the treatment channel. The diagnostic and treatment tool extends into the treatment channel through the diagnostic and treatment tool inlet, extends out from the end face of the auxiliary catheter, and is detachably connected to the auxiliary catheter.

[0009] Furthermore, the outer diameter of the auxiliary catheter is not less than 2.5 mm.

[0010] Furthermore, the auxiliary catheter is made of elastic material.

[0011] Furthermore, the diagnostic and treatment tools are installed in treatment channels, wherein a guiding optical core is inserted into one of the treatment channels for image acquisition, and other treatment channels are selectively loaded with one or more diagnostic and treatment tools including laser optical fibers, liquid aspiration systems, rotary cutting systems, trephine systems, microscissors and foreign body forceps.

[0012] A method for using an endoscope device for lacrimal duct diagnosis and treatment comprises the following steps:

[0013] Step 1: Insert the diagnostic and treatment tool into the auxiliary catheter through the diagnostic and treatment tool inlet until it extends out of the end surface of the auxiliary catheter.

[0014] Step 2: Insert the endoscope mechanism into the nasal auxiliary mechanism, and insert the nasal auxiliary mechanism from the nostril until the nasal auxiliary mechanism and the endoscope mechanism are directly opposite to the nasolacrimal duct opening.

[0015] Step 3: Slowly push the endoscope mechanism along the tube of the nasal auxiliary mechanism, and the endoscope mechanism enters the lacrimal duct from the opening of the nasolacrimal duct.

[0016] Step 4: Slowly advance the endoscope mechanism until it reaches the blind end of the top of the lacrimal sac. During the advancement process, use diagnostic and treatment tools to treat the lacrimal duct based on the observed situation.

[0017] Step 5: After the treatment is completed, remove the endoscope mechanism and nasal auxiliary mechanism.

[0018] Furthermore, in step 2, the specific operating steps are: extend the nasal auxiliary mechanism with the endoscope mechanism from the nostril to under the inferior turbinate, pull the handle, and use the control guide wire to drive the rotation of the rotating cylinder of the endoscope mechanism so that the front end of the steering cylinder is facing the opening of the lower end of the nasolacrimal duct. At this time, the lower opening of the nasolacrimal duct and its surrounding structures can be directly viewed.

[0019] Furthermore, in step 3, when a narrow obstruction is found, laser treatment is performed using a laser optical fiber or a trephine system is used for treatment; the hyperplastic and polarized tissue in the lacrimal duct is sheared using microscissors and then removed using foreign body forceps; the secretions in the lacrimal duct are cleared using an injection and suction system, and targeted removal and targeted application of medicine are performed.

[0020] Furthermore, in step 3, the light core is guided to continue to advance, enter the upper lacrimal canaliculus or the lower lacrimal canaliculus through the common lacrimal duct, and then pass out through the lacrimal punctum, thereby solving the problem of difficulty in finding the proximal end of the traumatic lacrimal canaliculus rupture.

[0021] Beneficial effects of the present invention:

[0022] 1. The endoscope device of the present invention enters from the lower opening of the nasolacrimal duct with a larger diameter, is easy to operate, and does not need to interfere with the upper lacrimal duct. It overcomes the defects of the traditional lacrimal duct endoscope entering through the lacrimal punctum, requiring repeated dilation of the lacrimal punctum, being difficult to operate, and easily causing punctal and lacrimal canalicular lacerations.

[0023] 2. Compared with the traditional lacrimal duct endoscope, the endoscope device of the present invention has a larger outer diameter, which allows the addition of injection and suction systems, trephine systems, rotary cutting systems, microscissors, foreign body forceps, laser optical fibers and other diagnostic and treatment tools, and significantly increases the number of treatment methods that can be used. BRIEF DESCRIPTION OF THE DRAWINGS

[0024] The drawings in the specification, which constitute a part of the present application, are used to provide a further understanding of the present application. The illustrative embodiments of the present application and their descriptions are used to explain the present application and do not constitute a limitation on the present application.

[0025] Figure 1 It is a schematic diagram of the internal structure of the nasal auxiliary mechanism of the present invention;

[0026] Figure 2 is a side view schematic diagram of the nasal auxiliary mechanism of the present invention;

[0027] Figure 3is a schematic diagram of the auxiliary catheter structure of the present invention;

[0028] Figure 4 It is a schematic diagram of the cooperation between the nasal auxiliary mechanism and the endoscope mechanism of the present invention;

[0029] Figure 5 It is a schematic diagram of the nasal auxiliary mechanism and the endoscope mechanism of the present invention in the use state after being extended into the nostril;

[0030] Figure 6 This is a schematic diagram of the use state after step 2 of the present invention is completed;

[0031] Figure 7 This is a schematic diagram of the use status of the present invention during diagnosis and treatment;

[0032] Figure 8 It is a schematic diagram of the use state of the endoscope mechanism of the present invention after reaching the blind end of the lacrimal sac;

[0033] Among them: 1. Nasal auxiliary mechanism, 101. Straight cylinder, 102. Steering cylinder, 103. Control guide wire, 104. Handle, 105. First rotating shaft, 106. Second rotating shaft, 2. Endoscope mechanism, 21. Auxiliary catheter, 211. Diagnosis and treatment channel, 212. Entrance for diagnosis and treatment tools, 3. Nostril, 4. Nasolacrimal duct, 41. Opening, 5. Inferior turbinate, 6. Lacrimal sac, 7. Common lacrimal duct, 8. Upper lacrimal canaliculus, 9. Lower lacrimal canaliculus, 10. Upper lacrimal punctum, 11. Lower lacrimal punctum. DETAILED DESCRIPTION

[0034] It should be noted that the following detailed descriptions are illustrative and are intended to provide further explanation of the present application. Unless otherwise specified, all technical and scientific terms used herein have the same meanings as those commonly understood by those skilled in the art to which the present application belongs.

[0035] It should be noted that the terms used herein are only for describing specific embodiments and are not intended to limit the exemplary embodiments according to the present application. As used herein, unless the context clearly indicates otherwise, the singular form is also intended to include the plural form. In addition, it should be understood that when the terms "comprise" and / or "include" are used in this specification, it indicates the presence of features, steps, operations, devices, components and / or combinations thereof.

[0036] As introduced in the background technology, the existing lacrimal duct endoscope can only enter from the lacrimal punctum, and the lacrimal punctum needs to be repeatedly expanded, which is difficult to operate and can easily cause lacerations of the lacrimal canaliculus and lacrimal punctum, and other diagnostic and treatment tools cannot be introduced. In response to the above problems, the present application proposes a lacrimal duct diagnostic and treatment endoscope and a method of use.

[0037] In a typical implementation of the present application, Figure 1-4As shown, an endoscopic device for lacrimal duct diagnosis and treatment includes a nasal cavity auxiliary mechanism 1 and an endoscope mechanism 2. When in use, the nasal cavity auxiliary mechanism guides the endoscope mechanism to enter the nasolacrimal duct from the opening at the lower end of the nasolacrimal duct.

[0038] The nasal auxiliary mechanism includes a straight cylinder 101 and a steering cylinder 102, one end of the straight cylinder and the steering cylinder has a quarter-arc structure, the bottom end of the quarter-arc structure of the straight cylinder has a rotating shaft, the bottom end of the quarter-arc structure of the steering cylinder is rotatably connected to the first rotating shaft 105, the upper end of the quarter-arc structure of the steering cylinder is connected to one end of the control guide wire 103, the other end of the control guide wire is connected to a handle 104, the handle is rotatably connected to the second rotating shaft 106, the second rotating shaft is fixed on the inner circumferential surface of the straight cylinder, a sliding hole for handle rotation is provided on the straight cylinder, the handle is rotated, the handle can pull the control guide wire, the control guide wire further pulls the steering cylinder, to realize the rotation of the steering cylinder, the quarter-arc structure is adopted, the maximum rotation angle of the rotating cylinder can reach 90°.

[0039] The endoscope mechanism includes an auxiliary catheter 21 and diagnostic and treatment tools. The auxiliary catheter has multiple diagnostic and treatment channels 211. The side circumferential surface of the auxiliary catheter is provided with a diagnostic and treatment tool inlet 212 connected to the diagnostic and treatment channel. The diagnostic and treatment tool extends into the treatment channel through the diagnostic and treatment tool inlet, extends out from the end face of the auxiliary catheter, is detachably connected to the auxiliary catheter, and can freely enter and exit the diagnostic and treatment channel.

[0040] The seven diagnosis and treatment channels are selectively loaded with optical fibers, laser optical fibers, liquid suction systems, rotary cutting systems, trephine systems, microscissors and foreign body forceps according to the diagnosis and treatment needs. The above-mentioned diagnosis and treatment use equipment commonly used in existing clinical practice, which is already a very mature technology and will not be described in detail here. When in use, one of the treatment channels is loaded with an optical fiber for image acquisition, and one of the remaining channels is transferred into a treatment channel. For example, a laser optical fiber is extended into one of the treatment channels for laser treatment, and another treatment channel is loaded with microscissors for shearing hyperplastic and polarized tissues in the lacrimal duct. A treatment channel can only be loaded with one type of diagnosis and treatment tool, which can be loaded according to actual treatment needs.

[0041] The auxiliary catheter is made of elastic material, can withstand a turn of nearly 90°, and is guided by a control guide wire inside the optical fiber.

[0042] The outer diameter of the auxiliary catheter of the present invention is not less than 2.5 mm, which is convenient for installing various diagnostic and treatment tools. In addition, compared with the traditional lacrimal duct endoscope, the effective inner diameter is doubled, thereby significantly improving the image quality and laser spot diameter.

[0043] The present invention also provides a method for using the endoscope device for lacrimal duct diagnosis and treatment, such as Figure 5-8 As shown, the following steps are included:

[0044] Step 1: According to the needs of diagnosis and treatment, selectively install the optical fiber, laser optical fiber, liquid suction system, rotary cutting system, trephine system, microscissors and foreign body forceps into the diagnosis and treatment channel. Specifically: insert the diagnosis and treatment tools into the auxiliary catheter through the entrance of the diagnosis and treatment tools until they extend out of the front end surface of the auxiliary catheter for a distance to form an endoscope mechanism.

[0045] Step 2: Insert the endoscope mechanism 2 into the nasal auxiliary mechanism 1 , and insert the nasal auxiliary mechanism with the endoscope mechanism from the nostril 3 until the nasal auxiliary mechanism and the endoscope mechanism face the opening 41 of the nasolacrimal duct 4 .

[0046] The specific operating steps are: insert the assembled endoscope mechanism from the handle end of the straight tube until the front end of the endoscope mechanism is flush with the front end of the steering tube, extend the nasal auxiliary mechanism with the endoscope mechanism from the nostril until it is extended to below the inferior turbinate 5 about 1.5 cm away from the nostril, pull the handle, and use the control guide wire to control the rotation of the steering tube so that the front ends of the steering tube and the endoscope mechanism are facing the opening of the lower end of the nasolacrimal duct. At this time, the endoscope mechanism can be used to directly view the lower end opening of the nasolacrimal duct and the surrounding structures, and the nasal auxiliary mechanism can be further adjusted to make the front end of the rotating tube closer to the lower end opening of the nasolacrimal duct.

[0047] Step 3: Slowly push the endoscope mechanism along the tube of the nasal auxiliary mechanism, and the endoscope mechanism enters the lacrimal duct from the opening of the nasolacrimal duct.

[0048] The specific operation steps are: the nasal auxiliary mechanism is fixed by a locking device, and the endoscope mechanism is slowly pushed to allow the endoscope mechanism to enter the nasolacrimal duct from the lower end opening of the nasolacrimal duct. During diagnosis and treatment, only the guide optical core or the entire endoscope mechanism can be advanced at the same time as needed.

[0049] Step 4: Slowly push the endoscope mechanism forward until it reaches the blind end of the top of the lacrimal sac 6. During the pushing process, use diagnostic and treatment tools to treat the lacrimal duct according to the observed situation.

[0050] Specifically, when a narrow or blocked part is found, laser treatment is implemented using laser optical fiber or treatment is performed using a trephine system; microscissors are used to cut the hyperplastic and polarized tissue in the lacrimal duct, and then foreign body forceps are used to remove it. The operation is performed under direct vision, and laser and other means can be used to accurately separate and remove the hyperplastic cords, tumors, foreign bodies, etc. in the lacrimal duct, thereby expanding the scope of treatment, and an injection and suction system is used to clear the secretions in the lacrimal duct, and targeted removal and targeted application of medicine are implemented. At the same time, an injection and suction system is added, and a control device is provided to control its liquid pressure so that the operated cavity maintains a moderate positive pressure, which is helpful for hemostasis and can also cause the surrounding mucosa to contract, so that the cavity is in an expanded state, thereby facilitating exposure of the blocked part and avoiding the formation of false channels; at the same time, bleeding, exudate, etc. can be cleared in a timely and effective manner to ensure that the image is always clear.

[0051] After the endoscope reaches the blind end of the lacrimal sac, it can push the guiding optical core to continue moving, enter the upper lacrimal canaliculus 8 or the lower lacrimal canaliculus 9 through the common lacrimal duct 7, and then pass out from the upper lacrimal punctum 10 or the lower lacrimal punctum 11. This operation can completely solve the clinical problem of difficulty in finding the proximal end of traumatic lacrimal canaliculus rupture.

[0052] Step 5: After the treatment is completed, remove the endoscope mechanism and nasal auxiliary mechanism.

[0053] The normal anatomical data of human lacrimal duct are: the diameter of lacrimal puncta is about 0.5mm, the diameter of lacrimal canaliculus is about 0.6mm, the diameter of lacrimal sac is about 7mm, and the diameter of nasolacrimal duct is about 3-4mm, while the outer diameter of existing lacrimal duct endoscopes is generally 1.1mm, that is, to make an endoscope with a diameter of 1.1mm pass through lacrimal puncta and lacrimal canaliculus with a diameter of only 0.5-0.6mm, it is difficult to repeatedly dilate the lacrimal puncta, and even cause laceration of the lacrimal puncta and lacrimal canaliculus. The endoscope and the use method of the present invention make full use of the characteristics of the lacrimal duct, enter through the lower end opening of the nasolacrimal duct with a larger diameter of the lacrimal duct, are easy to operate, and do not need to interfere with the normal upper lacrimal duct.

[0054] Although the above describes the specific implementation mode of the present invention in conjunction with the accompanying drawings, it is not intended to limit the scope of protection of the present invention. Those skilled in the art should understand that various modifications or variations that can be made by those skilled in the art on the basis of the technical solution of the present invention without creative work are still within the scope of protection of the present invention.

Claims

1. An endoscopic device for lacrimal duct diagnosis and treatment, It is characterized in that It includes a nasal cavity auxiliary mechanism and an endoscope mechanism. When in use, the nasal cavity auxiliary mechanism guides the endoscope mechanism to enter the nasolacrimal duct from the lower end opening of the nasolacrimal duct; The nasal cavity auxiliary mechanism includes a straight cylinder and a steering cylinder, one end of the straight cylinder and the steering cylinder has a quarter arc structure, the straight cylinder and the steering cylinder are rotatably connected through the bottom end of the quarter arc structure, the upper end of the quarter arc structure of the steering cylinder is connected to one end of the control guide wire, the other end of the control guide wire is connected to a handle, the handle is rotatably connected to the straight cylinder, and the handle is turned so that the handle can pull the control guide wire to realize the rotation of the steering cylinder; The endoscope mechanism includes an auxiliary catheter and a diagnosis and treatment tool. The auxiliary catheter has a plurality of treatment channels. A diagnosis and treatment tool inlet communicating with the treatment channel is provided on the side circumferential surface of the auxiliary catheter. The diagnosis and treatment tool extends into the treatment channel through the diagnosis and treatment tool inlet, extends from the end surface of the auxiliary catheter, and is detachably connected to the auxiliary catheter. Insert the endoscope mechanism from the handle end of the straight tube until the front end of the endoscope mechanism is flush with the front end of the steering tube, extend the nasal auxiliary mechanism with the endoscope mechanism from the nostril until it is extended to the lower part of the inferior turbinate about 1.5 cm away from the nostril, pull the handle, and use the control guide wire to control the rotation of the steering tube so that the front ends of the steering tube and the endoscope mechanism are directly facing the opening of the lower end of the nasolacrimal duct. The endoscope mechanism can be used to directly view the lower end of the nasolacrimal duct and the surrounding structures, and further adjust the nasal auxiliary mechanism so that the front end of the rotating tube is closer to the lower end of the nasolacrimal duct. Slowly advance the endoscope mechanism along the pipeline of the nasal auxiliary mechanism, and the endoscope mechanism enters the lacrimal duct from the opening of the nasolacrimal duct. After the endoscope mechanism reaches the blind end of the lacrimal sac, it can push the guiding optical core to continue to move, enter the upper lacrimal canaliculus or the lower lacrimal canaliculus through the common lacrimal duct, and then pass through the upper lacrimal punctum or the lower lacrimal punctum. This operation can completely solve the clinical problem of difficulty in finding the proximal end of traumatic lacrimal canaliculus rupture. The auxiliary catheter is made of elastic material, can withstand a turn of nearly 90°, and is guided by a control guide wire inside the optical fiber; The diagnostic and treatment tools are installed in the treatment channels, one of which is inserted into a guide optical core for image acquisition, and the other treatment channels are selectively loaded with one or more diagnostic and treatment tools including laser optical fiber, liquid suction and injection system, rotary cutting system, trephine system, microscissors and foreign body forceps; The outer diameter of the auxiliary conduit is not less than 2.5 mm.

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