JP7324495B2 - ligator - Google Patents

Description

TECHNICAL FIELD The present invention relates to the technical field of ligators for ligating biological tubes such as blood vessels and intestines, organs, instruments, and the like in surgical operations.

2. Description of the Related Art In various surgical operations, blood vessels, intestinal tracts, ureters, and other biological ducts are sometimes ligated temporarily to block them. For example, in carotid endarterectomy (CEA), when a stenosed artery is incised to remove plaque, the artery may be temporarily ligated for avascularization. In off-pump coronary artery bypass grafting (OPCABG), the coronary artery may be temporarily ligated when the bypass is anastomosed to the coronary artery. In addition to blocking biological tubes, various ligatures are also used for the purpose of temporarily suturing organs, etc., fixing instruments such as catheters, cannulae, and chanté tubes that have been inserted, and securing the surgical field. may be made. For example, in order to fix a catheter or the like inserted into the blood vessel, the blood vessel is sometimes ligated. In addition, in cannulation of a heart-lung machine, in order to fix the blood supply/blood withdrawal cannula, a purse-string suture may be applied around the insertion site and ligated after the cannula is inserted. Furthermore, in stent graft insertion into an aortic aneurysm, the entire vessel is sometimes ligated for sheath fixation. For such various ligatures, a ligator called a tourniquet using a tubular body and a string-shaped body is sometimes used (see Patent Documents 1 to 3).

A general tourniquet is used as follows, for example, when ligating a biological tube. First, a string-like body such as a surgical loop or suture thread is wound around the biological tube. Subsequently, both ends of the string-like body are passed through the distal end of the cylindrical body, and both ends of the string-like body are taken out from the proximal end of the cylindrical body. Furthermore, while pulling both ends of the string in the proximal direction, the distal end of the tubular body is pressed against the living canal, and the string is clamped to the proximal end of the tubular body with forceps, a clip, or the like. fixed to By doing so, the biological tube can be ligated by the wound string-like body and the cylindrical body. The strength of the ligation can be adjusted by releasing the fixation of the string-like body. In addition, a tourniquet can be used, for example, in the following manner to fix the cannula during cannulation. A suture thread is wound in advance around the cannulated site of an organ or the like with a suture needle, and both ends of the string-like body are inserted into the cylindrical body. Then, by inserting the cannula and pulling the suture thread while pressing the tubular body against the insertion site and fixing it to the tubular body, the insertion site is crimped to the cannula and the cannula can be fixed.

Cylindrical bodies used in such ligators often have a total length of several centimeters to several tens of centimeters and a diameter of approximately 5 to 10 mm. In particular, when the cylindrical body is long, it is difficult to insert both ends of the string-shaped body into the cylindrical body and take out the string-shaped body manually or by using tweezers, forceps, or the like. Therefore, an instrument called a snare having a hook portion at its distal end, like the ligators of Patent Documents 1 to 3, is sometimes used in this step. A snare is inserted from the proximal end of the cylindrical body in a state in which the biological tube is wound with the string-like body, and both end sides of the string-like body are hooked together on the hook portion at the distal end, and the snare is attached to the cylindrical body. Both ends of the string-like body can be taken out from the proximal end by pulling out from the proximal end.

U.S. Pat. No. 3,877,434 Japanese Patent No. 4414616 Japanese Patent No. 5788893

The ligator as described above, including the snare, is generally disposable, and if the snare is required, the cost will be high. Moreover, it is not preferable to increase the number of instruments used during surgery. Furthermore, if the operability is improved by improving the shape of the tubular body or the snare, the manufacturing cost tends to increase. Therefore, the problem to be solved by the present invention is to improve the ligature operability using the ligator by improving the string-like body of the ligator so that it can be easily inserted into the tubular body. is.

SUMMARY OF THE INVENTION The present invention was created with the aim of solving these problems in view of the actual situation as described above. a string-like body that includes a tubular body, the tubular body having proximal and distal openings at proximal and distal ends, respectively; The string-like body includes a first end and a second end, which are both ends in the length direction, and a winding between the first end and the second end a winding portion, wherein the winding portion is a portion for winding an object at the time of ligation, winding the winding portion around the object, and is pressed, the first end and the second end of the string-like body inserted through the hollow portion from the distal opening toward the proximal opening and pulled in the proximal direction are fixed to the tubular body In the ligator capable of ligating an object, the first end of the string-like body has a locking portion capable of locking the second end, and the second end is attached to the locking portion. The ligator is characterized in that it is constructed so that it can be inserted through the hollow portion in a state in which the ligator is locked .
The invention of claim 2 is characterized in that a hard portion harder than the winding portion is formed at the first end, and the locking portion is provided at the hard portion of the first end. The ligator according to claim 1 .
In the third aspect of the present invention, the first end of the string-like body is composed of a hard portion on the tip side formed to be harder than the winding portion and a flexible portion on the winding portion side having the flexibility of the winding portion. and, after the first end is wound around the object by the winding portion, the second end is locked by the locking portion, and the leading end of the hard portion 3. The ligator according to claim 1 or 2, wherein the flexible part taken out through the tubular body by is fixed to the tubular body together with the second end through a fixing means. be.

According to the invention of claim 1, since both ends of the string-like body can be inserted into the hollow portion while being guided by the hard portion, each end is difficult to bend during insertion, and ligature excellent in operability. It can be used as a vessel.
Moreover , since the first end and the second end can be integrally inserted into the hollow portion with the first end and the second end locked , the operability can be improved.
According to the inventions of claims 2 and 3 , the second end can be stably locked.

1 is a perspective view of a ligator according to a first embodiment; FIG. (A) to (F) are drawings showing an example of use of the ligator according to the first embodiment. Fig. 10 is a perspective view of a ligator according to a second embodiment; (A) An enlarged view of a hook portion, (B) an enlarged view of a state in which a second end portion is locked to the hook portion. (A) to (E) are drawings showing an example of use of the ligator according to the second embodiment.

A first embodiment, which is a reference example of the present invention, will be described with reference to FIGS. In the drawings, 1 is a ligator used for ligating an object to be ligated. The ligator 1 has a long hollow cylindrical tubular body 2 . The tubular body 2 has a proximal opening 3a and a distal opening 4a at the proximal end 3 and the distal end 4, respectively. The proximal opening 3 a and the distal opening 4 a communicate with each other inside the tubular body 2 , and this communicated hollow interior serves as a hollow portion 5 . The ligator 1 also includes a string 10 that is wrapped around an object. After the string-like body 10 is wound around the object, both ends (first and second ends 11 and 12 to be described later) are inserted into the hollow portion 5 from the distal opening 4a of the tubular body 2. , is taken out from the proximal opening 3a and fixed to the tubular body 2, thereby ligating the object. In the present embodiment, a blood vessel V will be described as an object to be ligated.

The cylindrical body 2 according to this embodiment is made of a synthetic resin material having elasticity and flexibility. Also, the cylindrical body 2 may be colored. For example, it is possible to use red for arteries and blue for veins. Alternatively, the cylindrical body 2 may be transparent or translucent. Furthermore, in order to make the proximal end 3 and the distal end 4 distinguishable at a glance, even if only one of the ends is colored or colored differently from the other parts good. Moreover, the cylindrical body 2 is not necessarily limited to a cylindrical shape, and various shapes such as a flat shape, a square tube shape, and a tapered shape can be adopted. Furthermore, the shape of the inner periphery and the outer periphery of the tubular body 2 may be different. For example, while the outer periphery of the cylindrical body 2 is circular, the inner periphery may be polygonal.

The string-like body 10 has a string-like shape that is at least twice as long as the total length of the tubular body 2, and both ends in the length direction thereof are a first end portion 11 and a second end portion 12, and a winding is performed between them. It is referred to as a turning section 13 . At the time of ligation, at least part of the winding portion 13 is directly wound around the blood vessel V. As shown in FIG. A hard portion 14 harder than the winding portion 13 is formed as a front half portion on each of the first end portion 11 and the second end portion 12 . The hard portion 14 is provided over the entire length of the cylindrical body 2 and substantially the same length as the ends of the ends 11 and 12 . On the other hand, the winding portion 13 has flexibility and is suitable for winding an object. By forming the first end portion 11 and the second end portion 12 of the string-like body 10 into the hard portion 14, the ends are bent in the middle when the string-like body 10 is inserted into the tubular body 2. It is easy to insert and insert straight because there is no need to put it away.

The string-like body 10 is made of a resin material having elasticity and has a flat shape. However, it is not limited to this, and it may be a non-stretchable suture thread, or it may have a circular cross section instead of a flat shape, and it may be suitable for the object to be ligated. Any material, shape, or the like can be used.

Further, the hard part 14 of the string-like body 10 can be colored differently from the other parts, especially the wound part 13 . As a result, the operator can determine which part is the rigid portion 14 at a glance, so that the operability is excellent. Further, the shape of the rigid portion 14 of the string-like body 10 may be a cross-sectional shape different from that of other portions, especially the winding portion 13 . For example, if the hard portion 14 is formed in a flat shape narrower than the winding portion 13, the portion of the hard portion 14 can be distinguished at a glance, and the insertion of the hard portion 14 into the hollow portion 5 becomes difficult. becomes easy.

The string-like body 10 having such a wound portion 13 and a rigid portion 14 can be manufactured by extrusion molding using two-color molding, for example, as follows. First, a first step of discharging a hard material for forming the hard portion 14 and a second step of discharging a flexible material, which is a material for forming the other flexible portion (winding portion 13), are carried out as predetermined. Repeat every hour. At this time, the length of the molded portion in the first step is set to be twice the length of the hard portion 14 . Then, after cooling, a cutting step is performed to cut in the width direction at the central portion in the length direction of the relevant portion, so that the hard portions 14 of the same length are formed at both ends 11 and 12 of the cord-like body 10 . can be done.

However, the manufacturing method is not limited to such a method, and for example, when forming the hard portion 14 by compression or using the string-like body 10 as a knitting yarn, the knitting density of the both ends 11 and 12 is increased. A rigid portion 14 can also be formed.

Next, an example of how to use the ligator 1 according to the first embodiment configured as described above will be described with reference to FIG. First, the wound portion 13 of the string-like body 10 is looped, and then the looped portion L is applied to the target blood vessel V and wound an appropriate number of times (state shown in FIG. 2(A)). Then, both ends 11 and 12 of the string-like body 10 are inserted into the loop portion L of the string-like body 10 from the same direction (state shown in FIG. 2(B)). After that, the blood vessel V is tightened by the loop portion L by pulling both ends 11 and 12 of the string-like body 10 . Then, both ends 11 and 12 of the string-like body 10 are inserted into the hollow portion 5 from the distal opening 4a of the cylindrical body 2 (the state shown in FIG. 2(D)), and taken out from the proximal opening 3a (see FIG. 2 ( E) state). After that, while the blood vessel V is pressed by the distal end portion 4 of the cylindrical body 2 and the string-like body 10 is pulled in the proximal direction, both ends 11 of the string-like body 10 are pulled near the proximal end portion 3 . , 12 are fixed by arbitrary fixing means 18 such as forceps or clips (state of FIG. 2(F)). The ligation of the blood vessel V is thus completed.

In this example of use, since both ends 11 and 12 of the string-like body 10 have the hard portion 14, when the string-like body 10 is inserted into the hollow portion 5, the hard portion 14 guides the string-like body 10 halfway. It is possible to avoid bending and making it difficult to insert, and it is excellent in operability. When fixing both ends 11 and 12 to the tubular body 2 after removing them from the proximal opening 3a, if the long hard part 14 interferes with the subsequent work, the hard part 14 is cut off. You can do it. Further, the fixing portion of the string-like body 10 is not limited to the hard portion 14, and may be any suitable portion. The fixing means 18 may be another device such as the above-described forceps or clip, or may be a cap or the like provided on the tubular body 2 in advance, and conventional devices can be used as appropriate.

In the example of the method of use described above, the object is the blood vessel V, and the string-like body 20 is wound around the outer circumference of the object. It is not limited to winding the entire outer circumference of the. In other words, even when the surface layer of a blood vessel, an organ, or the like is sutured with a suture thread, it can be said that the string-like body is wound around the surface layer.

The string-like body 10 used in the ligator 1 according to the first embodiment described above has a first end portion 11, a second end portion 12, and a winding portion 13 therebetween. and the second end portion 12 both have a hard portion 14 which is harder than the wound portion 13 and which is formed over the same length as the tubular body 2 , and the string-shaped body is attached to the hollow portion 5 of the tubular body 2 . Since the first end portion 11 and the second end portion 12 can be inserted at the same time due to the guidance of the hard portion 14, the respective end portions 11 and 12 are less likely to bend in the middle, resulting in excellent operability.

Moreover, since the hard portion 14 is formed to reach the tip of each of the ends 11 and 12, insertion into the distal opening 4a of the cylindrical body 2 is particularly easy. Further, if the hard part 14 is colored differently from the winding part 13 or has a different cross-sectional shape, the position of the hard part 14 can be grasped at a glance, which improves operability. can do.

Next, a second embodiment of the present invention will be described with reference to FIGS. 3 to 5. FIG. The ligator 21 according to the second embodiment differs from that of the first embodiment in the structure of both ends 31 and 32 of the string-like body 30 . Since other configurations are the same as those of the first embodiment, including modifications, description thereof will be omitted as appropriate.

The first end portion 31 of the string-like body 30 according to the second embodiment has a rigid portion 34 on the front half portion , as in the first embodiment, while the second end portion 32 has a rigid portion. and is formed flexibly like the winding portion 33 . Further, the hard portion 34 of the first end portion 31 is provided with a hook portion 35 formed in a hook shape as a locking portion for locking the second end portion 32 . After the winding portion 33 is wound around the blood vessel V to be ligated, the hook portion 35 is engaged with the second end portion 32, and the first end portion 31 is inserted into the hollow portion 25 of the cylindrical body 22. By doing so, the second end portion 32 can be inserted into the hollow portion 25 integrally with the first end portion 31 having the hard portion 34 .

Incidentally, the locking portion is not limited to the hook portion 35 described above, and various types can be used. For example, an insertion hole may be provided in the hard portion 34, and the second end portion 32 may be inserted through the insertion hole, wound and locked. Alternatively, the locking portion may be provided on the second end portion 32 that does not have the rigid portion 34 .

Next, an example of how to use the ligator 21 according to the second embodiment configured as described above will be described with reference to FIG. First, the winding portion 13 is wound around the blood vessel V by leading the second end portion 32 side of the string-like body 30 (the state of FIG. 5(A)). Next, the second end portion 32 is engaged with the hook portion 35 of the first end portion 31 (state shown in FIG. 5(B)). In this locked state, the first end portion 31 is inserted through the distal opening 24a of the tubular body 2 into the hollow portion 25 (state shown in FIG. 5(C)). Then, the first end portion 31 and the locked second end portion 32 are taken out from the proximal opening 23a (state shown in FIG. 5(D)), and the distal end portion 24 of the cylindrical body 22 presses the blood vessel V. At the same time, with the string-like body 30 pulled in the proximal direction, both ends 31 and 32 of the string-like body 30 are fixed in the vicinity of the proximal end 23 by arbitrary fixing means 38 such as forceps and clips (Fig. 5 (E) state). At this time, the locking of the second end portion 32 to the hook portion 35 may be released. Thus, the ligation of the blood vessel V is completed.

In such a usage example, the second end 32 of the string-like body 30 is engaged with the hook portion 35 that is the engaging portion of the first end 31 , so that when the string-like body 30 is inserted into the hollow portion 25 , the first Although the hard portion 34 is provided only at the end portion 31, the second end portion 32 is also inserted integrally with the first end portion by the guidance of the hard portion 34, so that the string-like body 30 is bent in the middle. Difficulty in inserting can be avoided, and operability is excellent.

In the string-like body 30 used in the ligator 21 according to the second embodiment described above, only the first end portion 31 has the hard portion 34, but the first end portion 31 can lock the second end portion 32. The second end portion 32 can be inserted into the hollow portion 25 in a state where the hook portion 35 is engaged with the second end portion 32, so that the hard portion 34 is guided during the insertion. , the first end portion 31 and the second end portion 32 can be inserted at the same time, so that the end portions 31 and 32 are less likely to bend in the middle, resulting in excellent operability. In particular, since the hook portion 35 is provided on the hard portion 34, the second end portion 32 can be stably locked.

The ligator according to the present invention can be used for various objects that need to be temporarily ligated, such as blood vessels, intestinal tracts, ureters, and other biological tubes, as well as various organs and equipment. More specifically, it can be used in various surgical procedures such as ligation of arteries during CEA and OPCABG, fixation of catheters and cannulas, and fixation of sheaths in stent-graft insertion into aortic aneurysms.

INDUSTRIAL APPLICABILITY The present invention can be used in a ligator used for ligating objects such as biological tubes, organs, and instruments in surgical operations.

1 Ligator 2 Cylindrical Body 3 Proximal End 3a Proximal Opening 4 Distal End 4a Distal Opening 4b Distal End Face 5 Hollow Part 10 String-like Body 11 First End 12 Second End 13 Winding Part 14 Hard portion 35 Hook portion (locking portion)
V blood vessel (object)

Claims (3)

A cylindrical body having a hollow portion and a string-shaped body inserted through the hollow portion,
the tubular body has proximal and distal openings at the proximal and distal ends, respectively;
The proximal opening and the distal opening are in communication via a hollow portion of the cylindrical body,
The string-like body has a first end and a second end, which are both ends in the length direction, and a winding portion between the first end and the second end,
The winding part is a part for winding the object when ligating,
While the wound portion is wound around the object, while the object is pressed by the distal end side of the cylindrical body, it is inserted through the hollow portion from the distal opening toward the proximal opening and proximately moves. A ligator capable of ligating an object by fixing the first end and the second end of the pulled string-like body to the tubular body,
The first end of the string-like body has a locking portion that can lock the second end, and can be inserted through the hollow portion while the second end is locked to the locking portion. A ligator characterized in that it is configured to : The ligature according to claim 1 , characterized in that a hard portion harder than the winding portion is formed on the first end, and the locking portion is provided on the hard portion of the first end. vessel. the first end of the string-like body,
a hard part on the tip side formed harder than the winding part;
a flexible portion on the winding portion side having the flexibility of the winding portion;
as provided with
the first end,
After the object is wound by the winding portion, the flexible portion penetrates through the tubular body and is taken out by the guidance of the hard portion in a state where the second end is locked by the locking portion. 3. The ligator according to claim 1, wherein the ligator is fixed to the cylindrical body through fixing means together with the two ends.

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