JP2021071501A - Technique simulator and method for simulation - Google Patents

Abstract

To provide a technique simulator and a method for simulation that allow a user to have a simulation experience similar to an experience with an actual human technique without requiring a clinical experience and also allow a user to effectively learn a technique by using a catheter.SOLUTION: A technique simulator 10 includes a trunk model 14 and a space formation member 18. The space formation member includes: a first space formation unit 36 for forming a first space Sa corresponding to a part of the abdominal cavity of a human body; and a second space formation unit 38 extending from the first space formation unit, for forming a second space Sb corresponding to the Douglas cavum of the human body. The second space formation unit is formed in the shape of a bag. The method for simulation makes the top of a catheter 200 reach the second space through a cut part formed in an alternative object 100 of a human body abdomen.SELECTED DRAWING: Figure 11

Description

The present invention relates to a procedure simulator and a simulation method.

The peritoneal dialysis method has attracted a great deal of attention because it allows patients to exchange dialysate containers (bags) at home or at work, facilitating rehabilitation. In this peritoneal dialysis method, one end of a catheter (peritoneal dialysis catheter) is placed in the abdominal cavity of a patient and the other end is placed outside the body, and dialysate is injected into the abdominal cavity through the lumen of the catheter. This is a method of exchanging the dialysate by discharging the dialysate in the abdominal cavity through the lumen of the catheter after a lapse of a certain period of time.

In order to perform the peritoneal dialysis method in this way, it is necessary to place a catheter in the abdominal cavity of the patient. Therefore, doctors need to learn peritoneal dialysis catheter placement. Therefore, Patent Document 1 proposes a procedure simulator for learning a procedure using a catheter.

Japanese Patent No. 6133015

The present invention has been made in connection with the above proposal, and it is possible to have a simulated experience similar to an actual procedure by the human body without relying on clinical experience, and efficiently learn a procedure using a catheter. It is an object of the present invention to provide a procedure simulator and a simulation method capable of performing.

One aspect of the present invention is a procedure simulator for training a procedure using a catheter, in which a hollow body model corresponding to the body portion of the human body and a hollow body model provided in the body model are provided in the abdominal cavity of the human body. A space forming member for forming a corresponding space is provided, and the fuselage model is provided with an opening at a position corresponding to the abdomen of the human body and a human body abdominal substitute so as to cover the opening. The space-forming member includes a first space-forming portion that forms a first space corresponding to a part of the abdominal cavity of the human body, and a second space-forming portion that extends from the first space-forming portion and corresponds to a Douglas fossa of the human body. It has a second space forming portion for forming a space, the first space communicates with the second space and is opened to the side where the opening is located, and the second space forming portion has a bag shape. It is a procedure simulator formed in.

Another aspect of the present invention is a procedure comprising a hollow body model corresponding to a body portion of a human body and a space forming member provided in the body model to form a space corresponding to the abdominal cavity of the human body. In a simulation method using a simulator, an opening is formed in the body model at a position corresponding to the abdomen of the human body, and a human body abdominal cavity substitute is provided so as to cover the opening to form the space. The members form a first space forming portion that forms a first space corresponding to a part of the abdominal cavity of the human body, and a second space extending from the first space forming portion and corresponding to the Douglas fossa of the human body. It has a second space forming portion, and the first space communicates with the second space and opens to the side where the opening is located, and the second space forming portion is formed in a bag shape. The simulation method includes an incision step of incising the human abdominal cavity substitute, an insertion step of inserting a catheter into the first space through an incision formed in the human abdominal cavity substitute, and after the insertion step. This is a simulation method including a reaching step of bringing the tip of the catheter to the second space.

According to the present invention, since the second space forming portion is formed in a bag shape, the second space can be approximated to the Douglas fossa of an actual human body. This makes it possible to train a procedure (for example, peritoneal dialysis catheter placement) in which the tip of the catheter reaches the Douglas fossa of the human body using a procedure simulator. Therefore, even if it is not based on clinical experience, it is possible to have a simulated experience that is close to the actual procedure by the human body, and it is possible to efficiently learn the procedure using the catheter.

It is an exploded perspective view of the procedure simulator which concerns on one Embodiment of this invention. It is a top view of the procedure simulator of FIG. It is an exploded perspective view of the support member and the space forming member of FIG. It is a vertical cross-sectional view along the IV-IV line (median plane) of FIG. It is a partially omitted cross-sectional view along the VV line of FIG. It is sectional drawing explanatory drawing for demonstrating the 2nd space forming part of FIG. It is a top view of the state in which the human abdominal cavity substitute and the human organ substitute of the procedure simulator of FIG. 2 are omitted. It is a flowchart which showed an example of the simulation method using the procedure simulator which concerns on one Embodiment of this invention. It is a plane explanatory view which shows the state which the internal cuff and the external cuff of a catheter are marked on the abdominal cavity substitute of the human body. It is a plane explanatory view which shows the state which the tip part of the catheter is inserted into the space of a space forming member. It is a partially omitted vertical sectional view for demonstrating the state which made the tip part of the catheter reach the 2nd space. It is a partially omitted vertical cross-sectional view showing a state in which the internal cuff of the catheter is fixed to the peritoneal portion of the human abdominal substitute. It is a plane explanatory view which shows the state which led the rear end part of the catheter to the skin incision of the 2nd marking part. It is a plane explanatory view which shows the state which fixed the external cuff of a catheter to a peritoneal part. It is a plane explanatory view which shows the state which connected the dialysate bag and the dialysate recovery bag to the rear end part of a catheter via a connecting tube. It is a partially omitted vertical sectional view which shows the state which the dialysate is injected into the space of a space forming member. It is a partially omitted vertical sectional view which shows the state which collects the dialysate in the space of a space forming member.

Hereinafter, a procedure simulator and a simulation method according to the present invention will be described with reference to the accompanying drawings with reference to suitable embodiments.

As shown in FIG. 1, the procedure simulator 10 according to the embodiment of the present invention is for training a procedure using a catheter 200 (see FIG. 11 and the like), and a human abdominal cavity substitute 100 is attached to the procedure simulator 10. It is used in the state of being.

First, the human body abdominal cavity substitute 100 will be described. As shown in FIGS. 10 to 17, since the human abdominal cavity substitute 100 is incised and sutured during the simulation of the procedure using the catheter 200, it is new every time the simulation is performed once to several times. It is replaced with the human abdominal substitute 100. Therefore, in the present embodiment, the procedure simulator 10 does not include the human body abdominal cavity substitute 100. However, the procedure simulator 10 may be configured to include the human body abdominal cavity substitute 100.

In FIG. 1, the human body abdominal substitute 100 has a peritoneal portion 102 corresponding to the peritoneal portion of the human body and a skin 104 corresponding to the skin of the abdomen of the human body. As such a human abdominal substitute 100, for example, the abdomen of a mammal other than a human such as a pig or a cow or a bird animal such as a chicken can be used, and it is particularly preferable to use the abdomen of a pig. This is because the abdomen of pigs is inexpensive, highly available, and its structure and tissue are similar to those of the abdomen of the human body. In this embodiment, an example in which the abdomen of a pig is used as the abdominal cavity substitute 100 for the human body will be described. The human body abdominal substitute 100 may be composed of, for example, a peritoneal portion of a mammal such as a pig or a cow, and artificial skin covering the peritoneal portion.

The procedure simulator 10 includes a body model 14, a support member 16, a space forming member 18, and a human organ substitute 20.

In the procedure simulator 10 and the simulation method according to the present invention, the body model 14 is used in a supine position. That is, the torso model 14 is arranged so that the abdomen 14b is located above the back (back 14c). In the procedure simulator 10 and the simulation method according to the present invention, when the supine body model 14 is viewed from above, the direction along the central axis (midline axis) extending from the neck to the foot of the body model 14 (FIG. 1 and the like). The arrow A direction) is called the "long axis direction". Further, when the body model 14 lying on its back is viewed from above, the horizontal direction orthogonal to the long axis direction (arrow B direction in FIG. 1 and the like) is called the "width direction", and is orthogonal to each of the long axis direction and the width direction. The direction (direction of arrow C in FIG. 1 and the like) is referred to as "thickness direction". The left and right sides of the fuselage model 14 coincide with the left and right sides of the actual human body.

The fuselage model 14 is mounted on the support base 12. The fuselage model 14 may be fixed by a fixing means (not shown) while being mounted on the support base 12. In this case, it is possible to prevent the body model 14 from moving with respect to the support base 12 during the simulation using the procedure simulator 10.

The body model 14 corresponds to the body portion of the human body, and the inside thereof is formed in a hollow shape. The fuselage model 14 can be made of, for example, a relatively hard resin material. The fuselage model 14 may have transparency (semi-transparency). In this case, the user can visually recognize the inside of the fuselage model 14 from the outside of the fuselage model 14. The body model 14 can be appropriately set in size according to the expected body size and physique of the patient.

In FIGS. 1, 2, 4 to 7, the torso model 14 has a chest 14a, an abdomen 14b (upper abdomen 14bu, lower abdomen 14bl, lateral abdomen 14bs), back 14c, lumbar region 14d, buttocks 14e, right thigh. Includes 14f, left thigh 14g, and crotch 14h.

In FIG. 1, the abdomen 14b of the fuselage model 14 has an opening 22. The opening 22 is covered by the human abdominal cavity substitute 100. Specifically, the opening 22 extends from the upper abdomen 14 bu of the torso model 14 to substantially the entire lower abdomen 14 bl. As a result, it is possible to prevent the body model 14 from interfering with the medical device such as a scalpel or a catheter used by the operator when the human body abdominal cavity substitute 100 is incised or the catheter 200 is inserted. The size and shape of the opening 22 can be set as appropriate.

The fuselage model 14 is provided with a plurality of (six in this embodiment) locking members 24. The locking member 24 is formed of, for example, a hard resin in a band shape or a linear shape. Both ends of the locking member 24 are fixed to the fuselage model 14.

In FIG. 2, the human body abdominal substitute 100 fastens the fixing belt 26 passed through the gap between the locking member 24 and the outer surface of the body model 14 and the through hole 106 formed in the human body abdominal substitute 100. It is fixed to the fuselage model 14 by fastening with the tool 28. At this time, by adjusting the position where the fixing belt 26 is fastened, the tension acting on the human body abdominal substitute 100 can be adjusted.

In FIGS. 1 and 2, the locking member 24 is, for example, the right thigh 14f and the left thigh 14g of the torso model 14, the left and right flanks 14bs (or the lumbar 14d) of the torso model 14, and the torso model 14. It is provided on each of the left and right chest 14a (or left and right shoulders). Thereby, the human body abdominal substitute 100 can be fixed to the torso model 14 in a well-balanced manner. However, the number, position, etc. of the locking members 24 can be set as appropriate.

As shown in FIGS. 3 to 5, the support member 16 supports the space forming member 18 at a predetermined position in the body model 14. The support member 16 has a bone model 30 that supports the space forming member 18, and a bone support member 32 that supports the bone model 30 at a predetermined position in the body model 14.

The bone model 30 has a lumbar spine 30a and a pelvis 30b. The pelvis 30b includes the sacrum 30c to which the lumbar vertebrae 30a are connected, the ilium 30d provided on both the left and right sides of the sacrum 30c, the left and right pubis 30e provided on the ilium 30d, and the coccyx 30f provided on the sacrum 30c. Including.

The bone support member 32 is arranged in the body model 14 at a portion corresponding to the lumbar portion 14d and the buttock portion 14e (see FIG. 4). The bone support member 32 is made of, for example, urethane foam. However, the constituent material of the bone support member 32 can be appropriately set. On the surface of the bone support member 32, a recess 34 having a shape corresponding to the shape of the back surface of the bone model 30 (lumbar vertebra 30a and pelvis 30b) is formed. The back surface of the bone support member 32 is formed in a shape corresponding to the inner surface shapes of the lumbar portion 14d and the buttock portion 14e of the body model 14. As a result, the bone model 30 is supported by the bone support member 32 from the back side of the body model 14 toward the opening 22.

As shown in FIG. 5, the bone model 30 is placed in the body model 14 when the left and right iliums 30d come into contact with the inner surface of the body model 14 while being arranged on the bone support member 32 set in the body model 14. Is fixed to. That is, the left and right ilium 30d are physically supported in the torso model 14 on the outer surface of the left and right ilium 30d. This makes it possible to further stabilize the position of the bone model 30 within the body model 14.

The space forming member 18 is provided in the body model 14 and forms a space S corresponding to the abdominal cavity of the human body. The space forming member 18 is an integrally molded product made of a flexible material. As the constituent material of the space forming member 18, for example, flexible silicone is preferably used. In this case, since the user can insert the space forming member 18 into the body model 14 through the opening 22 while bending the space forming member 18, the procedure simulator 10 can be set efficiently. However, the constituent material of the space forming member 18 may be a resin material other than silicone. The space forming member 18 is maintained in a predetermined shape in the body model 14. The space forming member 18 has transparency (semi-transparency).

As shown in FIG. 3, the space forming member 18 has a first space forming portion 36, a second space forming portion 38, and an outer edge sheet portion 40.

The first space forming portion 36 forms the first space Sa corresponding to a part of the abdominal cavity of the human body in the body model 14 (see FIGS. 4 and 5). The first space forming portion 36 includes a first bottom wall portion 42 and a first side wall portion 44 projecting upward from the outer edge portion of the first bottom wall portion 42. With the space forming member 18 set in the body model 14, the first bottom wall portion 42 is supported by the lumbar vertebra 30a and the pelvis 30b of the bone model 30. The first space Sa is open upward (the side where the opening 22 is located).

A first bulging portion 46 that bulges upward in a semicircular shape is provided at the center of the first bottom wall portion 42 in the width direction (direction along the width direction of the fuselage model 14). The first bulging portion 46 bulges toward the opening 22 side (upward). The first bulging portion 46 extends along the major axis direction (longitudinal direction) of the fuselage model 14. The lumbar vertebrae 30a and a part of the sacrum 30c of the bone model 30 are arranged in the space behind the first bulge 46 (in the direction toward the back side in the torso model 14) (see FIGS. 6 and 7). ). The shape of the bulging surface of the first bulging portion 46 may correspond to the shape of the spine of the human body.

As shown in FIGS. 3, 4 and 6, the second space forming portion 38 forms the second space Sb corresponding to the Douglas fossa of the human body in the body model 14 (see FIG. 4). Here, the Douglas fossa is a depression located at the lowermost part of the abdominal cavity (peritoneal cavity) of the human body. The Douglas fossa is a recto-uterine pouch that exists between the uterus and the rectum in women, and a recto-cystic fossa that exists between the bladder and the rectum in men. That is, Douglas fossa is present in both women and men. That is, the procedure simulator 10 is not specialized for one gender.

The second space forming portion 38 extends from the first space forming portion 36 and is formed in a bag shape. The second space Sb communicates with the first space Sa. The second space forming portion 38 is inserted into the space between the pubis 30e and the sacrum 30c of the bone model 30 (see FIG. 4). In the second space forming portion 38, the width dimension of the second space Sb along the width direction is the width dimension of the second space forming portion 38 with respect to the first space forming portion 36 in the plan view (top view) from above of the fuselage model 14. It is formed so as to narrow in the extending direction (see FIG. 6). In the second space forming portion 38, the height dimension of the second space Sb along the thickness direction of the body model 14 becomes narrower in the extending direction of the second space forming portion 38 with respect to the first space forming portion 36. (See FIG. 4).

The second space forming portion 38 includes a second bottom wall portion 48, a second side wall portion 50 projecting upward from the second bottom wall portion 48, and a second side wall portion 50 so as to cover the second bottom wall portion 48. Includes an upper wall portion 52 provided at the protruding end portion. In FIG. 4, the second bottom wall portion 48 is connected to the first bottom wall portion 42. The second bottom wall portion 48 is inclined to the side opposite to the upper wall portion 52 in the extending direction of the second space forming portion 38 with respect to the first space forming portion 36. The second space forming portion 38 exists up to the space (pelvic cavity) formed by the pelvis 30b. In other words, the second bottom wall portion 48 is connected to the first bottom wall portion 42 while being inclined toward the chest 14a of the fuselage model 14 in a direction away from the upper wall portion 52 (on the back 14c side of the fuselage model 14). There is.

As shown in FIG. 6, in the central portion of the second bottom wall portion 48 in the width direction (direction along the width direction of the fuselage model 14), a second bulging portion that bulges upward in a semicircular shape. 54 is provided. The second bulging portion 54 is connected to the first bulging portion 46. The second bulge 54 extends along the longitudinal direction of the fuselage model 14. A part of the sacrum 30c of the bone model 30 and the coccyx 30f are arranged in the space behind the second bulging portion 54. The first bulging portion 46 and the second bulging portion 54 function as positioning portions for the space forming member 18 with respect to the bone model 30.

The second side wall portion 50 is connected to the first side wall portion 44 (see FIGS. 3 and 6). In FIG. 4, the upper wall portion 52 is inclined toward the second bottom wall portion 48 toward the extension direction of the second space forming portion 38 with respect to the first space forming portion 36. A convex portion 56 is provided on the inner surface of the upper wall portion 52. The convex portion 56 is a portion that imitates the wall portion of the bladder or uterus of the human body. The convex portion 56 extends from the root portion of the upper wall portion 52 (the boundary portion with the first space forming portion 36) toward the extending end portion of the second space forming portion 38. The convex portion 56 extends over substantially the entire width of the inner surface of the upper wall portion 52 (see FIG. 7). However, the convex portion 56 may be provided only at the central portion of the inner surface of the upper wall portion 52 in the width direction. The outer surface of the convex portion 56 is curved in an arc shape.

As shown in FIG. 7, the outer edge sheet portion 40 is formed in an annular shape so as to orbit the first space forming portion 36. That is, the outer edge sheet portion 40 is a flat member extending from the opening 22 to the surface side of the body model 14 in a state where the space forming member 18 is set in the body model 14. The outer edge sheet portion 40 comes into contact with the outer surface of the body model 14 in a state where the space forming member 18 is set on the body model 14. The outer edge sheet portion 40 is connected to the protruding end of the first side wall portion 44. Specifically, the outer edge sheet portion 40 comes into contact with the first cover portion 40a that contacts the chest 14a and the abdomen 14b (upper abdomen 14bu and the flank 14bs) of the torso model 14, and the second cover portion 40a that contacts the flank 14bs of the torso model 14. The cover portion 40b, the third cover portion 40c in contact with the right thigh portion 14f of the torso model 14, the fourth cover portion 40d in contact with the left thigh portion 14g of the torso model 14, and the crotch portion 14h of the torso model 14. Includes a fifth cover portion 40e that comes into contact with.

At the boundary between the third cover portion 40c and the fifth cover portion 40e, a bent portion 40f that contacts the right inguinal region of the body model 14 is provided. At the boundary between the fourth cover portion 40d and the fifth cover portion 40e, a bent portion 40g that comes into contact with the left inguinal region of the fuselage model 14 is provided. These bent portions 40f and 40g function as positioning portions of the outer edge sheet portion 40 with respect to the body model 14.

As shown in FIG. 1, the human organ substitute 20 is an intestinal model corresponding to the small intestine of the human body. The human organ substitute 20 is arranged in the first space Sa of the first space forming portion 36 (see FIG. 4). The human organ substitute 20 is a long cylindrical member. However, the human organ substitute 20 may be a long cylindrical member. The human organ substitute 20 is an integrally molded product made of a flexible material. As a constituent material of the human organ substitute 20, for example, silicone is preferably used. However, the constituent material of the human organ substitute 20 may be a resin material other than silicone.

A lubricant may be applied to the outer surface of the human organ substitute 20. As the lubricant, for example, an anionic, nonionic, cationic, or amphoteric surfactant can be used. This makes it possible to further approximate the intestinal tract model to the actual intestinal tract of the human body.

The procedure simulator 10 according to the present embodiment is basically configured as described above, and next, the procedure for setting the procedure simulator 10 will be described.

When setting the procedure simulator 10, the user arranges the fuselage model 14 on the support base 12. Then, the user inserts the bone support member 32 through the opening 22 of the body model 14 and arranges it on the inner surface of the waist portion 14d and the buttocks portion 14e of the body model 14. Subsequently, the user inserts the bone model 30 through the opening 22 of the body model 14 and places it in the recess 34 of the bone support member 32. At this time, the bone model 30 is placed on the bone support member 32 with at least one of the bone model 30 and the body model 14 flexed, and the left and right iliac bones 30d of the bone model 30 are brought into contact with the inner surface of the body model 14. (See FIG. 4). Then, the bone model 30 is pressed against the bone support member 32 by the restoring force of at least one of the bone model 30 and the body model 14. As a result, the bone model 30 is fixed in a predetermined position in the body model 14. In addition, a locking portion (not shown) for holding the left and right iliac bones 30d of the bone model 30 may be provided in the body model 14.

After that, the user inserts the space forming member 18 through the opening 22 of the body model 14 and places it on the bone model 30. At this time, the user inserts the second space forming portion 38 into the space between the pubis 30e and the sacrum 30c of the bone model 30. The user also places the second bulge 54 on the coccyx 30f and sacrum 30c of the bone model 30 and the first bulge 46 on the lumbar spine 30a of the bone model 30. Further, the user arranges the outer edge sheet portion 40 of the space forming member 18 on the outer surface of the body model 14.

Next, the human organ substitute 20 is placed in the first space Sa of the first space forming unit 36. The human body organ substitute 20 may be arranged in the first space Sa before the space forming member 18 is set in the body model 14.

Then, the user arranges the human body abdominal substitute 100 so as to cover the opening 22 of the torso model 14. At this time, the human body abdominal substitute 100 is arranged on the outer edge sheet portion 40 of the space forming member 18. Therefore, it is possible to prevent the body model 14 from being soiled by the human body abdominal substitute 100. The user then uses the fixing belt 26 to secure the human abdominal cavity substitute 100 to the torso model 14. This completes the setting of the procedure simulator 10.

Next, a simulation method using the procedure simulator 10 according to the present embodiment will be described. In this embodiment, an example of a simulation method for training a procedure using a catheter (peritoneal dialysis catheter) 200 will be described with reference to FIGS. 8 to 17. The simulation method shown here is an example, and various changes are made depending on the product specifications of the catheter 200 and the procedure of a medical professional. Further, even when these changes are made, the simulation method using the procedure simulator 10 according to the present embodiment can be applied.

First, as shown in FIG. 9, the positions of the inner cuff 202 and the outer cuff 204 of the catheter 200 are marked on the outer surface of the human body abdominal substitute 100 fixed to the torso model 14 (step S1 in FIG. 8). In the present embodiment, a straight type catheter is used as the catheter 200, but the present invention is not limited to this, and for example, a swan neck type catheter may be used.

After that, the return electrode 201 for the electric knife is brought into contact with the human body abdominal substitute 100. Then, the first marking portion M1 corresponding to the internal cuff 202 is incised with an electric knife (medical instrument) (step S2). That is, the peritoneal portion 102 and the skin 104 of the human abdominal substitute 100 are incised with an electric knife. At this time, four edges constituting the peritoneal incision 70 may be held by mosquito forceps (not shown).

Then, a metal rod-shaped stylet 206 is passed through the lumen of the catheter 200, and the distal end side of the catheter 200 is passed through the skin incision 72 of the first marking portion M1 and the peritoneal incision 70 of the space forming member 18. It is inserted into the internal space S (see step S3, FIGS. 10 and 11).

Subsequently, the user (trainee) holds the ring portion 206a of the stylet 206, and by operating the catheter 200, the tip portion of the catheter 200 corresponds to the second space Sb (corresponding to the Douglas fossa of the human body) of the space forming member 18. (Step S4).

At this time, the user makes the tip of the catheter 200 reach the second space Sb while being careful not to let the catheter 200 come into contact with the human organ substitute 20. At this time, the user may insert the tip of the catheter 200 into the second space Sb while contacting the convex portion 56 of the space forming member 18. Further, since the body model 14 and the space forming member 18 have transparency, the user visually recognizes from the outside whether or not the tip end portion of the catheter 200 has reached the second space Sb of the space forming member 18. It can be easily confirmed.

The user then removes the stylet 206 from the catheter 200 and sutures and secures the internal cuff 202 to the peritoneal portion 102 with an absorbent suture 74. (See step S5, FIG. 12). At this time, the incised peritoneal portion 102 is sutured with an absorbent suture thread 74 (FIG. 13). When the suture of the peritoneal portion 102 is completed, the posterior end side of the catheter 200 protrudes from the upper end of the sutured portion of the peritoneal portion 102 to the outside. In this step S5, as shown in FIGS. 12 and 13, the Penrose drain 76 may be inserted in the vicinity of the internal cuff 202 when the incised peritoneal portion 102 is sutured.

Subsequently, the second marking portion M2 corresponding to the external cuff 204 is incised with an electric knife (step S6). That is, only the skin 104 of the human abdominal cavity substitute 100 is incised with an electric knife.

Then, the rear end side of the catheter 200 is guided to the skin incision 78 of the second marking portion M2 through the space between the peritoneal portion 102 and the skin 104 of the human body abdominal substitute 100 by a trocar (not shown) (see step S7 and FIG. 13).

Next, the collagen cuff 80 is attached near the posterior end side of the outer cuff 204 of the catheter 200, and the posterior end of the catheter 200 is guided to a predetermined position through between the peritoneal portion 102 of the human body abdominal substitute 100 and the skin 104. It is exposed to the outside of the skin 104 (step S8, see FIG. 14). Then, with the external cuff 204 placed in the skin incision 78, the peritoneal portion 102 is sutured and fixed with an absorbent suture thread 82 (step S9).

Subsequently, the skin 104 of the human abdominal substitute 100 is sutured with sutures 84 and 86 so that each of the skin incision 72 and the skin incision 78 is completely closed (see step S10 and FIG. 15). In this state, the rear end of the catheter 200 is exposed to the outside of the human abdominal cavity substitute 100.

Then, a bifurcated connecting tube 88 is connected to the rear end of the catheter 200, and a dialysate bag 90 filled with dialysate L is attached to one end of the bifurcated connecting tube 88. An empty dialysate recovery bag 92 is attached to the other end (see step S11, FIG. 15).

Next, the clamp 94 on the dialysate bag 90 side is opened and the clamp 96 on the dialysate recovery bag 92 side is closed so that the catheter 200 and the dialysate bag 90 are communicated with each other and the catheter 200 and the dialysate recovery bag 92 are connected to each other. The dialysate L in the dialysate bag 90 is injected into the space S of the space forming member 18 via the connecting tube 88 and the catheter 200 in a state where the communication is cut off (see step S12 and FIG. 16).

After the injection of the dialysate L is completed, the clamp 94 on the dialysate bag 90 side is closed and the clamp 96 on the dialysate recovery bag 92 side is opened to block the communication between the catheter 200 and the dialysate bag 90. With the catheter 200 and the dialysate recovery bag 92 communicated with each other, the dialysate L in the space forming member 18 is collected in the dialysate recovery bag 92 via the catheter 200 and the connecting tube 88 (step S13, FIG. 17).

At this time, as shown in FIG. 17, when the amount of dialysate L in the space forming member 18 is reduced, the dialysate L collects in the second space Sb of the space forming member 18 corresponding to the Douglas fossa of the human body, but the catheter Since the tip of the 200 is located in the second space Sb, the dialysate L can be collected in the dialysate recovery bag 92. This simulation ends when the collection of dialysate L is completed.

In this case, the procedure simulator 10 according to the present embodiment and the simulation method using the simulator 10 have the following effects.

The procedure simulator 10 includes a hollow body model 14 corresponding to the body portion of the human body, and a space forming member 18 provided in the body model 14 to form a space S corresponding to the abdominal cavity of the human body. In the body model 14, an opening 22 is formed at a position corresponding to the abdomen 14b of the human body, and a human body abdominal substitute 100 is provided so as to cover the opening 22. The space forming member 18 forms a first space forming portion 36 that forms a first space Sa corresponding to the abdominal cavity of the human body and a second space Sb extending from the first space forming portion 36 and corresponding to the Douglas fossa of the human body. It has a second space forming portion 38 and the like. The first space Sa communicates with the second space Sb and opens to the side where the opening 22 is located, and the second space forming portion 38 is formed in a bag shape.

According to such a configuration, since the second space forming portion 38 is formed in a bag shape, the second space Sb can be approximated to the Douglas fossa of an actual human body. As a result, the procedure simulator 10 can be used to train a procedure (for example, peritoneal dialysis catheter placement) in which the tip of the catheter 200 reaches the Douglas fossa of the human body. Therefore, even if it is not based on clinical experience, it is possible to have a simulated experience that is close to the actual procedure by the human body, and it is possible to efficiently learn the procedure using the catheter 200.

The first space forming portion 36 has a first bottom wall portion 42 located on the back surface side of the fuselage model 14, and a first side wall portion 44 protruding upward from the first bottom wall portion 42. The second space forming portion 38 includes a second bottom wall portion 48 connected to the first bottom wall portion 42, and a second side wall portion 50 protruding upward from the second bottom wall portion 48 and connected to the first side wall portion 44. It has an upper wall portion 52 provided at a protruding end portion of the second side wall portion 50 so as to cover the second bottom wall portion 48.

According to such a configuration, the abdominal cavity (including the Douglas fossa) of the human body can be reproduced by the first space forming portion 36 and the second space forming portion 38.

In the second space forming portion 38, the height dimension of the second space Sb along the thickness direction of the body model 14 becomes narrower in the extending direction of the second space forming portion 38 with respect to the first space forming portion 36. Is formed in.

According to such a configuration, the second space Sb can be approximated to the Douglas fossa of the human body.

On the inner surface of the upper wall portion 52, a convex portion 56 extending along the extending direction of the second space forming portion 38 with respect to the first space forming portion 36 is provided.

According to such a configuration, the height dimension of the second space Sb can be easily changed by the convex portion 56.

The second space forming portion 38 is formed so that the width dimension of the second space Sb along the width direction of the body model 14 becomes narrower in the extending direction of the second space forming portion 38 with respect to the first space forming portion 36. Has been done.

According to such a configuration, the second space Sb can be further approximated to the Douglas fossa of the human body.

The inner surface of the second bottom wall portion 48 is inclined in the direction opposite to the upper wall portion 52 in the extending direction of the second space forming portion 38 with respect to the first space forming portion 36.

According to such a configuration, the second space Sb can be further approximated to the Douglas fossa of the human body.

The space forming member 18 has an outer edge sheet portion 40 that extends from the first space forming portion 36 to the outside of the body model 14 through the opening 22 and is arranged so as to come into contact with the outer surface of the body model 14.

According to such a configuration, the outer edge sheet portion 40 can support the first space forming portion 36 and the second space forming portion 38 at predetermined positions in the body model 14. Further, by arranging the human body abdominal substitute 100 on the outer seat portion, it is possible to prevent the body model 14 from being directly soiled by the human body abdominal substitute 100. Further, by arranging the outer edge sheet portion 40 between the human body abdominal substitute 100 and the body model 14, the fixation stability of the human body abdominal substitute 100 is improved.

The space forming member 18 is an integrally molded product made of a flexible material.

According to such a configuration, the space forming member 18 can be easily manufactured. Further, by bending the space forming member 18, the first space forming portion 36 and the second space forming portion 38 can be smoothly arranged in the body model 14, and the assembly reproducibility of the procedure simulator 10 can be improved. Can be improved.

The procedure simulator 10 includes a support member 16 provided in the body model 14 and supporting the space forming member 18.

According to such a configuration, the first space Sa and the second space Sb can be arranged at predetermined positions in the fuselage model 14. As a result, the position of the second space Sb in the fuselage model 14 can be brought closer to the position of the Douglas fossa in the actual human body. Further, by supporting the first space forming portion 36 and the second space forming portion 38 from the back side of the body model 14, even when the inside of the space forming member 18 is filled with the dialysate L, it is actually The position of the Douglas fossa in the human body can be maintained correctly.

The support member 16 has a bone model 30 including a portion corresponding to the pelvis 30b of the human body, and the bone model 30 supports the first space forming portion 36.

According to such a configuration, the position of the second space Sb in the fuselage model 14 can be made closer to the position of the Douglas fossa in the actual human body. Further, even when the inside of the space forming member 18 is filled with the dialysate L, the position of the Douglas fossa in the actual human body can be maintained correctly.

The support member 16 has a bone support member 32 that supports the bone model 30 at a predetermined position in the body model 14.

According to such a configuration, the position of the bone model 30 in the body model 14 can be brought closer to the position of the bone (pelvis) in the actual human body. Even when the space-forming member 18 is filled with the dialysate L, the position of the Douglas fossa in the actual human body can be maintained correctly and stably. In addition, the bone support member 32 improves the assembly reproducibility of the procedure simulator 10.

The procedure simulator 10 includes a human organ substitute 20 arranged in the first space Sa.

According to such a configuration, when the catheter 200 hits the human organ substitute 20, the sensation of hitting the internal organs of the actual human body can be simulated.

The human organ substitute 20 is formed of a soft material to imitate the small intestine of the human body.

With such a configuration, training that is close to the actual procedure can be performed.

The present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the gist of the present invention.

The above embodiments can be summarized as follows.

The above embodiment is a procedure simulator (10) for training a procedure using a catheter (200), and is provided in a hollow body model (14) corresponding to a body portion of a human body and in the body model. A space forming member (18) for forming a space (S) corresponding to the abdominal cavity of the human body is provided, and an opening (22) is formed in the body model at a position corresponding to the abdomen of the human body. A human body abdominal substitute (100) is provided so as to cover the opening, and the space forming member forms a first space (Sa) corresponding to a part of the abdominal cavity of the human body. The first space has (36) and a second space forming portion (38) extending from the first space forming portion to form a second space (Sb) corresponding to the Douglas fossa of the human body. Discloses a procedure simulator that communicates with the second space and opens to the side where the opening is located, and the second space forming portion is formed in a bag shape.

In the above procedure simulator, the first space forming portion includes a first bottom wall portion (42) located on the back side of the fuselage model and a first side wall portion (44) protruding upward from the first bottom wall portion. ), And the second space forming portion has a second bottom wall portion (48) connected to the first bottom wall portion, and the first side wall portion while projecting upward from the second bottom wall portion. A second side wall portion (50) connected to the second side wall portion and an upper wall portion (52) provided at a protruding end portion of the second side wall portion so as to cover the second bottom wall portion may be provided.

In the above-mentioned procedure simulator, in the second space forming portion, the height dimension of the second space along the thickness direction of the body model is the extending direction of the second space forming portion with respect to the first space forming portion. It may be formed so as to narrow toward.

In the above-mentioned procedure simulator, a convex portion (56) extending along the extending direction of the second space forming portion with respect to the first space forming portion may be provided on the inner surface of the upper wall portion.

In the above-mentioned procedure simulator, in the second space forming portion, the width dimension of the second space along the width direction of the body model faces the extending direction of the second space forming portion with respect to the first space forming portion. It may be formed so as to be narrow.

In the above-mentioned procedure simulator, the inner surface of the second bottom wall portion may be inclined in a direction opposite to the upper wall portion in the extending direction of the second space forming portion with respect to the first space forming portion. ..

In the above-mentioned procedure simulator, the space forming member extends from the first space forming portion to the outside of the body model through the opening and is arranged so as to come into contact with the outer surface of the body model. It may have a seat portion (40).

In the above procedure simulator, the space forming member may be an integrally molded product made of a flexible material.

In the above-mentioned procedure simulator, a support member (16) provided in the body model and supporting the space-forming member may be provided.

In the above procedure simulator, the support member may have a bone model (30) including a portion corresponding to the pelvis of the human body, and the bone model may support the first space forming portion.

In the above procedure simulator, the support member may have a bone support member (32) that supports the bone model at a predetermined position in the body model.

In the above-mentioned procedure simulator, the human body organ substitute (20) arranged in the first space may be provided.

In the above procedure simulator, the human organ substitute may be formed of a soft material to imitate the small intestine of the human body.

The above embodiment uses a procedure simulator including a hollow body model corresponding to the body portion of the human body and a space forming member provided in the body model to form a space corresponding to the abdominal cavity of the human body. In the above simulation method, in the body model, an opening is formed at a position corresponding to the abdomen of the human body, and a human body abdominal cavity substitute is provided so as to cover the opening. A first space forming portion forming a first space corresponding to a part of the abdominal cavity of the human body and a second space extending from the first space forming portion to form a second space corresponding to the Douglas fossa of the human body. The first space communicates with the second space and is opened to the side where the opening is located, and the second space forming portion is formed in a bag shape. In the incision step of incising the human body abdominal cavity substitute, the insertion step of inserting the catheter into the first space through the incision portions (70, 72) formed in the human body abdominal cavity substitute, and the insertion step. Later, a simulation method including a reaching step of bringing the tip of the catheter to the second space is disclosed.

10 ... Procedure simulator 14 ... Body model 16 ... Support member 18 ... Space forming member 20 ... Human organ substitute 22 ... Opening 30 ... Bone model 32 ... Bone support member 36 ... First space forming part 38 ... Second space forming part 38 ... Second space forming part 40 ... Outer edge sheet part 42 ... First bottom wall part 44 ... First side wall part 48 ... Second bottom wall part 50 ... Second side wall part 52 ... Upper wall part 56 ... Convex part 100 ... Human body abdominal substitute 200 ... Cauter S ... Space Sa ... First space Sb ... Second space

Claims (14)

A procedure simulator for training procedures using catheters.
A hollow torso model that corresponds to the torso of the human body,
A space forming member provided in the body model and forming a space corresponding to the abdominal cavity of the human body is provided.
In the body model, an opening is formed at a position corresponding to the abdomen of the human body, and a human body abdominal substitute is provided so as to cover the opening.
The space forming member is
A first space forming portion that forms a first space corresponding to a part of the abdominal cavity of the human body,
It has a second space forming portion extending from the first space forming portion and forming a second space corresponding to the Douglas fossa of the human body.
The first space communicates with the second space and is opened to the side where the opening is located.
The second space forming portion is a bag-shaped procedure simulator. The procedure simulator according to claim 1.
The first space forming portion is
The first bottom wall located on the back side of the fuselage model and
It has a first side wall portion that protrudes upward from the first bottom wall portion, and has.
The second space forming portion is
The second bottom wall portion connected to the first bottom wall portion and
A second side wall portion that protrudes upward from the second bottom wall portion and is connected to the first side wall portion, and a second side wall portion.
A procedure simulator having an upper wall portion provided at a protruding end portion of the second side wall portion so as to cover the second bottom wall portion. The procedure simulator according to claim 2.
In the second space forming portion, the height dimension of the second space along the thickness direction of the body model becomes narrower in the extending direction of the second space forming portion with respect to the first space forming portion. A procedure simulator that is formed in. The procedure simulator according to claim 3.
A procedure simulator in which a convex portion extending along the extending direction of the second space forming portion with respect to the first space forming portion is provided on the inner surface of the upper wall portion. The procedure simulator according to any one of claims 2 to 4.
The second space forming portion is formed so that the width dimension of the second space along the width direction of the body model becomes narrower in the extending direction of the second space forming portion with respect to the first space forming portion. The procedure simulator that has been done. The procedure simulator according to any one of claims 2 to 5.
A procedure simulator in which the inner surface of the second bottom wall portion is inclined in a direction opposite to the upper wall portion toward the extending direction of the second space forming portion with respect to the first space forming portion. The procedure simulator according to any one of claims 1 to 6.
The space forming member has an outer edge sheet portion that extends from the first space forming portion to the outside of the body model through the opening and is arranged so as to come into contact with the outer surface of the body model. Simulator. The procedure simulator according to any one of claims 1 to 7.
The space forming member is an integrally molded product made of a flexible material, which is a procedure simulator. The procedure simulator according to any one of claims 1 to 8.
A procedure simulator including a support member provided in the fuselage model to support the space forming member. The procedure simulator according to claim 9.
The support member has a bone model that includes a portion corresponding to the pelvis of the human body.
The bone model is a procedure simulator that supports the first space forming portion. The procedure simulator according to claim 10.
The support member is a procedure simulator having a bone support member that supports the bone model at a predetermined position in the body model. The procedure simulator according to any one of claims 1 to 11.
A procedure simulator comprising a human organ substitute arranged in the first space. The procedure simulator according to claim 12.
The human organ substitute is a procedure simulator formed by imitating the small intestine of the human body with a soft material. It is a simulation method using a procedure simulator including a hollow body model corresponding to the body part of the human body and a space forming member provided in the body model to form a space corresponding to the abdominal cavity of the human body. hand,
In the body model, an opening is formed at a position corresponding to the abdomen of the human body, and a human body abdominal substitute is provided so as to cover the opening.
The space forming member is
A first space forming portion that forms a first space corresponding to a part of the abdominal cavity of the human body,
It has a second space forming portion extending from the first space forming portion and forming a second space corresponding to the Douglas fossa of the human body.
The first space communicates with the second space and is opened to the side where the opening is located.
The second space forming portion is formed in a bag shape.
The simulation method is
The incision step of incising the human abdominal cavity substitute and
An insertion step of inserting a catheter into the first space through an incision formed in the abdominal cavity substitute of the human body.
A simulation method comprising, after the insertion step, a reaching step of bringing the tip of the catheter to the second space.

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