JP4237919B2 - Suture device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a suturing device used for ligating and suturing a lesion hole portion generated in a trachea or the like due to bronchial fistula or the like.
[0002]
[Prior art]
In some cases (for example, bronchopleural fistula or bronchial fistula) after tracheostomy, the trachea is punctured for some reason (eg external pressure injury). If this condition continues, the patient may experience severe respiratory failure and must immediately close the hole in the trachea. Usually, a thoracotomy is performed, and the open hole is sewn directly by the operator's hand under the direct view of the operator, but the physical strength is sufficient to perform the thoracotomy twice in a short period of time. There are many patients who do not.
[0003]
Therefore, the present inventors have conducted research and development of a tracheal suture device for closing a hole vacated in a trachea or the like using an endoscope (bronchoscope or the like) without performing a thoracotomy. When such a hole is sutured, it takes time to ligate the thread. If this is made into a device, the structure becomes complicated and large, and it is inappropriate as a tracheal suture device for performing sutures using a bronchoscope. It is.
[0004]
[Problems to be solved by the invention]
An object of the present invention is to solve the above-mentioned conventional problems, and the problem is not to use a thoracotomy, but to use an endoscope (eg, a bronchoscope). A hole that can be easily operated from the outside by an operator, in particular, can ligate the thread in a short time, and does not place a burden on the patient without causing a burden on the patient (referred to as “lesion hole” in this specification). .) Can be ligated and sutured to realize a suture device having a simple structure.
[0005]
[Means for Solving the Problems]
In order to solve the above-mentioned problems, the present invention provides an outer tube, an inner tube inserted into the outer tube, and a pair of first and second pivotally attached to the tip of the inner tube so as to be openable and closable. A suture device for ligating and suturing a lesion hole with a thread having a tip held by a thread attachment holder, wherein the first and second puncture pieces are inserted into the inner tube. The opening / closing rod can be opened and closed by operating the opening / closing rod from the outside, and the first thread attachment holder holding recess for inserting and holding the thread attachment holder is provided inside the tip of the first puncture piece. And a magnet for adsorbing and holding the thread attachment holder when the first and second puncture pieces approach each other. The second thread attachment holder holding recess is formed, and the lesion hole portion can be ligated with a thread. To provide a location.
[0006]
Furthermore, in order to solve the above-mentioned problems, the present invention provides an outer tube, an inner tube inserted into the outer tube, and a pair of first and second pivotally attached to the distal end of the inner tube so as to be openable and closable. A suturing device comprising a second puncture piece and a pusher with a pusher rod, and ligating and suturing a lesion hole part with a thread having a tip held by a thread attachment holder, wherein the inner surface of the inner end of the outer tube Is formed with an internal thread, and the first and second puncture pieces can be opened and closed by operating an open / close rod inserted through the inner tube from the outside. A first thread attachment holder holding recess for inserting and holding the thread attachment holder is formed inside the distal end of the first puncture piece. When the puncture pieces of the puncture pieces approach each other, a magnet with a magnet for attracting and holding the thread attachment holder is provided. 2 is provided with a thread holding holder holding recess, and the pusher is formed with a male screw threadedly engaged with the female screw on its outer surface, and can be operated from the outside by the pusher rod. Provided is a suturing device characterized in that the lesion hole can be ligated with the thread by screwing a male screw and rotating the pusher.
[0007]
The open / close rod can be operated by a puncture piece operation handle attached to the outer end thereof, and the pusher rod can be operated by a pusher operation handle attached to the outer end thereof.
[0008]
The inner tube and the outer tube may be provided with a fixing cap that can fix the inner tube and the outer tube to each other at their outer ends.
[0009]
The thread attachment holder is held in the first thread attachment holder retaining recess by an elastic retaining force, a retaining force by a locking rod, or a magnetic retaining force. The force is also set to be weaker than the attractive force of the magnet in the second second thread attachment holder holding recess with the magnet.
[0010]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of a suturing device according to the present invention will be described below with reference to the drawings based on examples. The suturing device according to the present invention includes, as main parts, an outer tube 18 as shown in FIG. 1, an inner tube 15 inserted into the outer tube 18, and a distal end of the inner tube 15 as if it were a heel. A pair of first and second puncture pieces 1 and 5 attached so as to be openable and closable and a pusher 33 as shown in FIG. 6 are provided.
[0011]
As shown in FIG. 1A, the outer tube 18 has a female screw 19 formed on the inner surface of the inner end (the end on the side inserted into the human body). As will be described later, the female screw 19 is configured to be screwed with the pusher 33. In actual use, after the inner tube 15 is inserted into the outer tube 18, the outer ends of the inner tube 15 and the outer tube 18 (ends on the operator side) are both as shown in FIG. The cap 20 having the thread hole 36 is fitted and fixed to each other. As will be described later with reference to FIG. 8A, the suturing device according to the present invention is used under the use of an endoscope or the like by being inserted through a channel of a bronchoscope.
[0012]
As shown in FIGS. 2 (a), 2 (b), 3 (a), and 3 (b), the pair of first and second puncture pieces 1 and 5 have their pivots fitted in the pivot holes 3 and 6, respectively. Then, it is pivotally attached to the inner tube 15 and the tip can be opened and closed. In the inner tube 15, a slit 15 ′ is formed in the same plane as the first and second puncture pieces 1, 5 so that the first and second puncture pieces 1, 5 are not hindered from opening and closing. ing. First and second cam holes 4 and 7 are formed in the first and second puncture pieces 1 and 5.
[0013]
A cam shaft 16 ′ at the tip of the opening / closing rod 16 is inserted into the cam holes 4 and 7. As shown in FIG. 4, the open / close rod 16 passes through the inner tube 15 inserted into the outer tube 18 and extends from the cap hole 35 of the cap 20 to the outside. 21 is attached. By operating this puncture piece operation handle 21, the open / close rod 16 moves back and forth, and the first and second puncture pieces 1 and 5 are opened and closed by the cam shaft 16 'and the cam holes 4 and 7. Can do.
[0014]
As shown in FIGS. 3A to 3D, the first and second puncture pieces 1 and 5 are formed of a plate material, and the distal end portions 13 and 14 are injections that can puncture a tissue of a human body. It has a needle-like shape. The first and second puncture pieces 1 and 5 are formed with relief portions 9 and 10, and when the lesion hole is sandwiched between the first and second puncture pieces 1 and 5 as will be described later. , You can escape without pinching the surrounding tissue.
[0015]
As shown in FIGS. 3 (c) and 5 (c), a first thread attachment holder holding recess 2 is formed in the inner surface 11 of the first puncture piece 1, and this first thread attachment holder holding recess. A thread groove 17 is formed so as to communicate with the place 2. On the other hand, as shown in FIGS. 3 (d) and 5 (c), the inner surface 12 of the second puncture piece 5 has the same shape as the first thread attachment holder holding recess 2, and the magnet 24 has a bottom portion. A second thread attachment holder holding recess 8 with a magnet disposed on the magnet is formed. The thread attachment holder 22 is formed of a material that is attracted to the permanent magnet 24.
[0016]
5 (a) and 5 (b), the thread attachment holder 22 for inserting and holding the tip of the thread 23 into the thread hole 26 is elastically applied to the inner surface of the first thread attachment holder retaining recess 2. It is inserted so that it touches lightly (ball contact). This prevents the thread mounting holder 22 from being unnecessarily displaced from the first thread mounting holder holding recess 2. Specifically, a protrusion for elastically contacting the portion where the thread attachment holder 22 abuts in the first thread attachment holder holding recess 2 may be provided.
[0017]
Alternatively, both the first thread mounting holder holding recess 2 and the thread mounting holder 22 may be provided with locking hooks that lightly engage with each other. However, as will be described later, in use, when the first and second puncture pieces 1 and 5 are closed, they are attracted by the permanent magnet 24 and attracted into the second thread attachment holder holding recess 8. It is important to make elastic contact with the recess 8 for holding the thread attachment holder with sufficient strength.
[0018]
In addition, it is good also as a structure which provides a magnet in the recessed part 2 for a 1st thread | yarn attachment holder holding | maintenance, and attracts | sucks and holds the thread | yarn attachment holder 22 magnetically. In this case, the magnet provided in the first thread attachment holder retaining recess 2 is weaker than the attractive force of the permanent magnet 24 in the second thread attachment holder retaining recess 8 and is simply retained in the first thread attachment holder. Use a permanent magnet with such a weak magnetic force that the thread mounting holder cannot be removed from the recess 2 forcibly.
[0019]
In short, the thread mounting holder 22 is held in the holder holding recess 2 with an elastic holding force, a holding force by a locking rod, or a magnetic holding force. It is necessary that the suction force of the permanent magnet 24 in the recess 35 for holding the second thread attachment holder with the magnet is weaker.
[0020]
Although the specific action of the pusher 33 will be described later, as shown in FIGS. 7A and 7B, the pusher 33 is inserted into the outer tube 18 and used. As shown in FIGS. 6A to 6C, the pusher 33 has a cylindrical shape. As shown in FIGS. 6A and 7B, the pusher 33 has a cylindrical shape. A male screw 30 that is screwed into the female screw 19 on the inner end side is formed.
[0021]
A Y-shaped piece 27 protrudes from the coupling portion 29 at the tip of the pusher 33. A thread slit 28 is formed at the center of the Y-shaped piece 27, and a thread passage 34 is formed through the pusher 33 so as to communicate with the thread slit 28. An inner end of the pusher rod 31 is attached to the base end face 25 of the pusher 33. A pusher operation handle 32 is attached to the outer end of the pusher rod 31.
[0022]
(Function)
The operation of the suturing device according to the present invention having the above configuration will be described. FIGS. 8A and 8B show a state in which a lesion hole formed in the trachea wall is monitored in the trachea using a bronchoscope. When using the suturing device according to the present invention, the thread attachment holder 22 is lightly and elastically mounted in the first thread attachment holder holding recess 2 of the first puncture piece 1, and the thread 23 passes through the thread passage. Derived from the thread hole 36 of the cap 20 to the outside.
[0023]
Then, the outer tube 18 is inserted from the channel of the bronchoscope, and the inner tube 15 is inserted into the outer tube 18. As shown in FIG. 8 (c), the inner tube 15 is inserted to a position facing the lesion hole portion generated in the trachea, and the puncture piece operation handle 21 is operated from the outside, so that FIG. As shown in FIG. 8 (c), the first and second puncture pieces 1 and 5 are opened, and as shown in FIG. 8 (d), the tracheal wall around the lesion hole is first and second. Are pierced by the tips 13 and 14 of the puncture pieces 1 and 5.
[0024]
Then, as shown in FIG. 9A, the puncture piece operation handle 21 is operated to close the first and second puncture pieces 1 and 5 as if to pinch the lesion hole. Then, the thread attachment holder 22 inserted in the first thread attachment holder holding recess 2 of the first puncture piece 1 is a permanent magnet 24 in the second thread attachment holder holding recess 8. It is sucked and moved and held in the second thread attachment holder holding recess 8. And as shown in FIG.9 (b), the 1st and 2nd puncture pieces 1 and 5 are extracted from a trachea wall in a trachea. Then, the thread 23 is stretched as if enveloping the lesion hole.
[0025]
Here, as shown in FIG. 9C, the inner tube 15 is pulled out from the outer tube 18 to the outside. Then, the thread 23 is led out from the outer tube 18 while enveloping the lesion hole. Then, as shown in FIG. 9 (d), the portion of the yarn 23 coming out of the outer tube 18 is kept in a loosely ligated state. In this state, the further outer end of the ligated state of the yarn 23 is hung on the pusher 33 through the yarn slit 28 and the yarn passage 34 of the pusher 33, as shown in FIGS. 6 (a) and 9 (e).
[0026]
Then, the pusher 33 is inserted into the outer pipe 18 from the outer end opening, and the pusher operating handle 32 is operated to move the pusher 33 into the outer pipe 18 as shown in FIG. As a result, the ligated portion of the thread 23 moves to the inside of the outer tube 18 and finally moves close to the lesion hole. Then, as shown in FIG. 10B, the pusher operation handle 32 is rotated to rotate the pusher 33 while screwing the male screw 30 of the pusher 33 into the female screw 19 of the outer tube. As a result, the ligated portion of the thread 23 becomes more tightened, and the lesion hole is bound by the thread 23 as shown in FIG.
[0027]
The embodiments of the present invention have been described based on the examples. However, the present invention is not limited to the above-described examples, and various examples can be made within the scope of the technical matters described in the claims. Needless to say.
[0028]
【The invention's effect】
Since the suturing device of the present invention is configured as described above, it is possible to sew a lesion hole portion using an endoscope or the like without relying on an open chest surgery, and the structure and operation thereof are simple. Particularly, since the ligation of the thread can be performed in a short time, the lesion hole generated in the trachea or the like can be quickly sutured without placing a physical burden on the patient.
[Brief description of the drawings]
FIG. 1 is a view showing first and second puncture pieces attached to an outer tube, an inner tube, and an inner tube of a suturing device according to an embodiment of the present invention.
FIG. 2 is a diagram showing the configuration and operation of first and second puncture pieces of a suturing device according to an embodiment of the present invention.
FIG. 3 is a diagram showing a detailed configuration of first and second puncture pieces of the suturing device according to the embodiment of the present invention.
FIG. 4 is a view showing an outer tube of the suturing device according to the embodiment of the present invention, an outer end portion of the inner tube, and a puncture piece operation handle.
FIG. 5 is a diagram showing a configuration of a thread attachment holder and first and second puncture pieces of a suturing device according to an embodiment of the present invention.
FIG. 6 is a view showing a configuration of a pusher of a suturing device according to an embodiment of the present invention.
FIG. 7 is a view for explaining the action of the pusher of the suturing device according to the embodiment of the present invention.
FIG. 8 is a view for explaining the operation of the suturing device according to the embodiment of the present invention.
FIG. 9 is a view for explaining the operation of the suturing device according to the embodiment of the present invention.
FIG. 10 is a view for explaining the operation of the suturing device according to the embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 1st puncture piece 2 1st thread attachment holder holding recesses 3 and 6 Pivoting hole 4 1st cam hole 5 2nd puncture piece 7 2nd cam hole 8 2nd thread attachment with a magnet Holder holding recesses 9, 10 First and second puncture piece relief portions 11, 12 Inner surfaces 13, 14 of the first and second puncture pieces Tip portions 15 of the first and second puncture pieces 15 Inner tube 16 Opening / closing rod 17 Thread groove 18 Outer tube 19 Female thread 20 formed on the outer tube Cap 21 Puncture piece operation handle 22 Thread attachment holder 23 Thread 24 Permanent magnet 25 Pusher base end face 26 Thread attachment holder thread hole 27 Y-shaped piece 28 Thread Slit 29 Coupling part 30 Male thread 31 formed on the pusher 31 Pusher rod 32 Pusher handle 33 Pusher 34 Thread passage 35 Cap hole 36 Cap hole

Claims (4)

An outer tube, an inner tube inserted into the outer tube, and a pair of first and second puncture pieces pivotally attached to the tip of the inner tube so as to be openable and closable. A suturing device that holds the tip and ligates and sutures a lesion hole with a thread that is led out from the first puncture piece through the inner tube,
The first and second puncture pieces can be opened and closed by operating the open / close rod inserted into the inner tube from the outside.
A first thread attachment holder holding recess for inserting and holding the thread attachment holder is formed inside the distal end portion of the first puncture piece, and inside the distal end portion of the second puncture piece, A second thread attachment holder holding recess with a magnet for attracting and holding the thread attachment holder when the first and second puncture pieces approach each other is formed,
The thread attachment holder is held in the first thread attachment holder retaining recess by an elastic retaining force, a retaining force by a locking rod, or a magnetic retaining force. The force is also weaker than the attractive force of the magnet in the second thread attachment holder holding recess with the magnet, and when the first and second puncture pieces are closed, the first thread attachment holder holding recess is in the first thread attachment holder holding recess. The held thread attaching holder is attracted by a permanent magnet in the second thread attaching holder holding recess, and is moved and held in the second thread attaching holder holding recess. A suturing device that makes it possible to ligate a lesion hole to be ligated with a thread. An outer tube, an inner tube inserted into the outer tube, a pair of first and second puncture pieces pivotably attached to the tip of the inner tube so as to be openable and closable, and a pusher with a pusher rod A suture device for ligating and suturing a lesion hole portion with a thread whose tip is held by a thread attachment holder,
An internal thread is formed on the inner surface of the inner end of the outer tube,
The first and second puncture pieces can be opened and closed by operating the open / close rod inserted into the inner tube from the outside.
A first thread attachment holder holding recess for inserting and holding the thread attachment holder is formed inside the distal end portion of the first puncture piece, and inside the distal end portion of the second puncture piece, A second thread attachment holder holding recess with a magnet for attracting and holding the thread attachment holder when the first and second puncture pieces approach each other is formed,
The thread attachment holder is held in the first thread attachment holder retaining recess by an elastic retaining force, a retaining force by a locking rod, or a magnetic retaining force. The force is also weaker than the attractive force of the magnet in the second thread attachment holder holding recess with the magnet, and when the first and second puncture pieces are closed, the first thread attachment holder holding recess is in the first thread attachment holder holding recess. The held thread attachment holder is attracted by a permanent magnet in the second thread attachment holder holding recess, and is moved and held in the second thread attachment holder holding recess.
The pusher has an external thread formed on the outer surface thereof that is screwed with the female screw. The pusher can be operated from the outside by the pusher rod, and is led out from the outer tube to the outside in a state of enveloping the lesion hole. The outer end of the ligated portion of the thread is configured to be hung on the pusher through the thread slit and the thread passage of the pusher.
A suturing device characterized in that the lesion hole can be ligated with the thread by rotating the pusher while screwing the male screw into the female screw.   2. The opening / closing rod can be operated by a puncture piece operation handle attached to an outer end thereof, and the pusher rod can be operated by a pusher operation handle attached to an outer end thereof. Or the suturing device of 2.   The suturing device according to claim 1, 2 or 3, further comprising a fixing cap that enables the inner tube and the outer tube to be fixed to each other at their outer ends.

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