JP3743512B2 - Surgical mantle - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to a surgical mantle that is suitably used for hematoma removal and tumor removal in endoscopic surgery in neurosurgery.
[0002]
[Prior art]
Conventionally, for example, hematoma removal by craniotomy has been performed for hypertensive intracerebral hemorrhage or subcortical hemorrhage due to arteriovenous malformation, etc. Hematoma removal by minimally invasive craniotomy that only opens a hole has been performed. For this operation, a cylindrical mantle tube is used as a passage for inserting an endoscope and a suction tube into a hole opened in the skull. A mantle tube that has been devised such as using a transparent sheath to obtain a wide endoscope field of view has been proposed, such as a surgical guide tube device disclosed in Japanese Patent Laid-Open No. 2000-287915, and a quadrant peel-off disclosed in Japanese Patent Laid-Open No. 2000-325356. It is disclosed as a mantle tube for cerebral puncture that is possible.
[0003]
A surgical guide tube device disclosed in Japanese Patent Laid-Open No. 2000-287915 has a plate-shaped stopper that can slide on a cylindrical body on an arbitrary outer circumference in the axial direction of a transparent cylindrical body (sheath) that is inserted into the body through a hole in the skull. The stopper is provided with a locking mechanism made of a bar material having a locking member and an urging means, and the stopper is urged and fixed by the locking mechanism in a direction perpendicular to the axis of the cylinder, When the stopper is aligned with the position of the cylinder corresponding to the depth of the hematoma in the tube and inserted until the stopper hits the skull, the tip of the guide member reaches the hematoma, and the cylinder is accidentally inserted deeply. In addition, since the stopper is slidable on the cylindrical body, the surgical guide tube device has advantages such that the insertion depth can be adjusted and changed.
[0004]
On the other hand, the cerebral puncture mantle tube capable of four-part peel-off disclosed in Japanese Patent Application Laid-Open No. 2000-325356 uses a conventional two-part peel-off sheath as a sheath that can be peeled off into four parts so as to be suitable for this operation. Peel off to any length according to the part, and use the peeled off part as a handle (stopper). Compared to a two-part sheath, the insertion port of the endoscope and suction tube is not deformed and has a shape close to a perfect circle. Therefore, there are advantages such as good usability.
[0005]
[Problems to be solved by the invention]
However, the surgical guide tube device disclosed in Japanese Patent Laid-Open No. 2000-287915 is used to insert the guide tube device into the cavity and maintain the stationary state of the cylinder while the surgeon performs an operation with an endoscope or the like. , The assistant must always hold the stopper carefully on the cranium, which is heavy on the human burden and completely relieves the concern that the holding position will become unstable because it depends only on human holding There is a problem that can not be. In addition, the structure of the stopper is complicated and it is imagined that manufacturing costs including parts etc. are required, and it is important to provide this device at a low cost considering that it is a disposable device (disposable medical device), There is also a problem that this becomes difficult.
[0006]
On the other hand, the cerebral puncture mantle tube capable of four-part peel-off disclosed in Japanese Patent Application Laid-Open No. 2000-325356 also has a problem that the assistant always needs to hold the handle (stopper) during the operation, similarly to the above-described device. The cannula once peeled off cannot be restored and cannot be repositioned in the deep direction during the operation, so it is necessary to specify the position of the lesion very carefully in advance, depending on the situation during the operation. There is a concern that it is not possible to respond. Furthermore, it is necessary to peel off the sheath in order to adjust the length, and there is a problem that the operation becomes troublesome when changing during the operation.
[0007]
Therefore, the surgical mantle according to the present invention allows the operator to perform the operation without minimizing the burden of holding the mantle tube by the assistant after inserting the mantle tube into the cavity. Therefore, an object of the present invention is to provide a surgical mantle tube that can be safely and securely held on the skull even if the procedure is performed in the above manner.
[0008]
In addition, the distal end of the outer tube has a degree of freedom in the front-rear, left-right, and left-and-right directions with the burr hole as a fulcrum while maintaining the reliable holding, and the depth in the sheath axial direction can be easily adjusted according to the target site and situation. An object of the present invention is to provide a mantle for operation that can be changed by operation and has high adaptability to the operation.
[0009]
Furthermore, another object of the present invention is to provide a surgical mantle tube that facilitates parts and configuration and is sufficiently inexpensive as a disposable instrument.
[0010]
[Means for Solving the Problems]
Surgical trocar of the present invention, constituted by a cylindrical sheath, the stopper having a mounting feature of the drape covering the body wound margin or wound edge around an arbitrary position in the outer periphery of the sheath, the stopper A collar serving as a contact part with a human body wound edge or a drape around the wound edge, and a fixing part serving as a mounting part to the sheath, wherein the collar part is inclined radially by a thin and flexible resin having elasticity. It is formed as a flat skirt-like suction disk, and preferably the collar portion is easily penetrated by a medical suture needle.
[0011]
The stopper was configured to be slidable in the axial direction of the sheath and fixed at an arbitrary position.
[0012]
A sliding or fixing means between the stopper and the sheath is a hose band-shaped stopper in which knobs are provided at both ends of an annular band in which a leaf spring material intersects at the end on the outer periphery of a stopper fixing portion made of a flexible resin. A fixing tool is provided, and the sheath is urged from the entire periphery by fastening the band with the knob or relaxing operation to fix the stopper, and the stopper is released, and the urging is released to enable the sliding.
[0013]
The sheath is made of a transparent or translucent resin, and the tip is inclined with respect to the axis, preferably in the form of a brain-bella, and the sheath is provided with an indicator whose inclination can be recognized from outside the body. Provided and configured.
[0014]
[Action]
According to the present means, since the stopper is provided with a mounting function around the wound edge, the outer tube can be simply held at the target position after the sheath is inserted into the body cavity. It is not necessary for the assistant to hold with great care, and it is sufficient if the auxiliary holding is performed as necessary. Then, a mounting function by the color of the stopper has a skirt-like suction cup to form a thin plate-shaped flexible resin, be a mounting operation as easy reliable while realizing the effect it can. Furthermore, since the collar is formed of a flexible resin, the surgical suture needle can be easily penetrated, so that the collar and the scalp or the drape can be fixed with a suture thread. In this case, the fixation is further ensured. Further, the necessity of holding by an assistant can be eliminated.
[0015]
Further, the stopper is made of a soft and elastic resin, and the collar is formed in a skirt shape so that flexibility and some stretchability are obtained, so that the stopper can be used as a basic part for fixing the sheath. While maintaining the position, a margin for moving the distal end of the sheath in the front-rear, left-right, and left-right directions with the burr hole serving as the stopper fixing position as a fulcrum is generated, so that a wider range of lesions can be handled with a single insertion. Furthermore, when the above-described hose band-shaped stopper fixing tool is used as a stopper fixing means that is slidable in the axial direction of the sheath and can be fixed at an arbitrary position, the band expands and loosens when the knob is picked. The stopper is slidable around the sheath, and when the knob is released, the band is tightened and fixed to the sheath, so that the stopper moves in the sheath axis direction (body cavity depth) according to the target site and situation. Setting and changing the position is possible with a very simple operation of picking and moving the knob.
[0016]
Furthermore, because the sheath tip is inclined with respect to the axis and formed in a brain-bella shape, hematoma can be sucked not only from the sheath tip but also from the side, and hematoma that spreads to the side can be sucked easily. The application range in insertion can be further expanded. Further, by providing an indicator that can recognize the inclination direction of the tip at the exterior of the sheath, the orientation of the sheath in the cavity can be always grasped from outside the body.
[0017]
DETAILED DESCRIPTION OF THE INVENTION
An example of an embodiment of the present invention will be described in detail with reference to the drawings.
[0018]
FIG. 1 shows a surgical mantle tube according to the present embodiment. The mantle tube 1 includes a cylindrical sheath 11 made of a transparent resin, and a stopper 12 slidably provided at any position on the outer periphery of the sheath 11. The stopper 12 includes a collar 121 serving as a wound edge contact portion, a fixing portion 122 serving as a mounting portion to the sheath 11, and a stopper fixing tool 13 for fixing the stopper 12 to the sheath 11. Consists of.
In this example, the sheath 11 is formed by using a fluororesin tube as a transparent resin, cutting the sheath distal end portion 111 obliquely and chamfering the end portion, and slanting the distal end portion 111 near the rear end portion of the sheath 11. An index hole 112 is provided at a position on the axial extension line of the cut top portion (most projecting portion) as an index that allows the inclination direction of the sheath distal end portion 111 to be recognized from outside the body.
Color 121 of the stopper 12, a silicone rubber in the present embodiment as a resin having a flexible and resilient to form a flat flared suction cup which is inclined radially walk human wound margin around the adsorption board is It was configured to be used by being attached to a drape covering the wound edge. The fixing portion 122 has a cylindrical shape with a through hole having a diameter slightly larger than the outer diameter for inserting the sheath 11. The fixing portion 122 is integrally formed with the collar 121 with silicone rubber and is attached to the outer periphery of the sheath 11. It is configured as a mounting part.
The stopper fixture 13 of the stopper 12 shown in detail in FIG. 2 (A, top view, B, side view) is provided with knobs 132 at both ends of an annular band 131 that intersects the leaf spring material at the ends. It is formed as a general structure such as a hose band or the like, and is attached to the outer periphery of the fixing portion 122 of the stopper 12, and the knob 132 is picked from both sides to widen the inner diameter of the band 131 against the repulsive force of the spring. The band 131 is tightened to the sheath 11 by releasing the knob 132, and the band 131 tightens the sheath 11 by the restoring force of the spring, and the stopper 12 is securely fixed to the sheath 11. . In addition to this example, the stopper fixing tool may be, for example, a screw.
[0019]
FIG. 3 is a set of instruments for performing a burr endoscopic hematoma removal operation including the surgical mantle tube, wherein A is the outer tube, B is the inner tube, and C is the cleaning tool.
The operation in which the mantle tube of the present invention is suitably used includes the burr endoscopic hematoma removal operation. In this operation, in addition to the mantle tube 1, the endoscope is inserted into the lumen. The inner tube 2 and the outer tube 1 that are inserted into the outer tube 1 and used to reliably insert the outer tube tip 111 into the lesion in the brain while observing the position of the hematoma in the brain, etc. After reaching the lesioned part, the tube is replaced with the inner tube 2 and inserted into the outer tube 1 together with the endoscope, and the cleaning tool 3 for removing and washing the hematoma is used. The outer tube 1 and the inner tube 2 The cleaning tool 3 is used as a set tool.
The inner tube 2 has a transparent inner tube 21 made of acrylic resin, and a through hole through which an endoscope can be inserted at the rear end of the inner tube, and can be attached to the rear end of the outer tube 1. The inner cylinder base 22 is configured so that the distal end portion 211 of the inner cylinder 21 has a hemispherical shape so as not to damage the tissue when inserted into the brain, and obstructs the field of view due to adhesion of blood to the endoscope. In order to avoid this, it is formed by sealing, and a scale 23 is provided on the outer peripheral surface to provide an index of insertion depth. The inner tube 2 is inserted into the lumen of the outer tube 1 with the endoscope inserted, and when the inner tube 2 is set in the outer tube 1, the tip 211 of the inner tube 2 is used. Is configured to project slightly from the distal end portion 111 of the outer tube 1 and is inserted into the brain at the hemispherical distal end 211 of the inner tube 2. Further, since both the outer tube 1 and the inner tube 2 are formed of a transparent resin, observation with an endoscope is possible at any time.
The cleaning tool 3 is provided at the rear end of the cleaning tube 31 made of a stainless steel tube and the cleaning tube 31 and can be attached to the rear end of the outer tube 1, and includes a cleaning tube base 32 having an endoscope insertion port 321 and the cleaning tube. 31 and a washing tube base 32 which communicates the lumen through the washing tube base 32, and a washing tube base 34 to which a syringe or the like provided at the rear end of the washing tube 33 can be connected. It is inserted into the outer tube 1 together with the endoscope, and is used to remove or wash the hematoma while observing with the endoscope.
[0020]
Here, an example of clinical use of the present invention will be briefly described by taking the burr endoscopic hematoma removal operation as an example.
1. The distance to the target site (hematoma) is measured by image diagnosis or ultrasonic diagnosis during surgery, and the stopper 12 is fixed to the sheath 11 according to this.
2. The inner tube 2 is inserted into the lumen of the outer tube 1 and attached.
3. An endoscope is inserted into the lumen of the inner tube 2 and puncture is performed in the brain while viewing a monitor image of the endoscope.
4). When the outer tube tip 111 reaches the target site (hematoma), the inner tube 2 is removed from the outer tube 1.
5. The collar 121 of the stopper 12 is fixed to the skin or drape around the wound edge. (If necessary, sew and secure with a suture thread)
6). The cleaning tool 3 is inserted into the outer tube 1 together with the endoscope to remove the hematoma. (When the endoscope is fogged, or in order to prevent fogging, artificial cerebrospinal fluid or physiological saline is injected into the inner cylinder 21 as necessary.)
7). After removal of the hematoma, the mantle tube 1 is removed while observing residual hematoma etc. with an endoscope.
[0021]
【The invention's effect】
According to the surgical mantle of the present invention, since the stopper is mounted around the wound edge as described above, it is not necessary for the assistant to always hold the stopper carefully during the operation, and to assist as necessary. If the collar is fixed with sutures etc., it will be almost unnecessary for the assistant to hold it, so it is possible for the surgeon to perform the operation alone, and this is a human burden for this operation. Can be greatly reduced. In addition, by this action, it is possible to provide a safer and more reliable surgical outer tube by eliminating concerns such as instability of fixation caused by relying solely on human holding.
[0022]
In addition, as described above, the stopper is formed of a flexible and elastic resin in the shape as described above, so that the sheath tip can be freely moved in the front-rear and left-right directions with the head hole as a fulcrum, and the axial direction ( The puncture depth direction) can be moved with very easy operation as described above, and by tilting the sheath tip, the laterally spread hematoma can be easily aspirated as a whole. Therefore, it is possible to provide a surgical outer tube having a large work space, high degree of freedom in operation, excellent adaptability to the situation, and easy for the operator to use.
[0023]
Furthermore, as compared with the prior art, by making the parts and the configuration easier as described above, it is possible to provide a surgical mantle that can be provided as a disposable instrument at a sufficiently low cost.
[Brief description of the drawings]
FIG. 1 is a block diagram showing a mantle tube according to an embodiment of the present invention. FIG. 2 shows a stopper fixture according to the above embodiment, A is a top view, and B is a side view. 1 shows an instrument set for a burr endoscopic hematoma removal operation including an outer tube of the form, A is a configuration of an outer tube, B is an inner tube, and C is a configuration of a cleaning tube
1. Outer tube 11. Sheath 111. Sheath tip 112. Indicator hole 12. Stopper 121. Color 122. Fixing part 13. Stopper fixture 131. Band 132. Knob 2. Inner tube 21. Inner cylinder 22. 2. Inner cylinder base Cleaning tool 31. Washing tube 32. Cleaning tube base 33. Washing tube 34. Cleaning tube base

Claims (6)

A mantle tube used as a passageway insert various instruments Sai human surgery, constructed from a stopper having a tubular sheath, the wound margin around mounting feature provided at an arbitrary position around outside the sheath, the stopper Comprises a collar formed as a skirt-like suction disk made of a thin plate-like flexible resin, which becomes a contact portion around the wound edge, and a fixing portion which becomes a mounting portion to the sheath For mantle. The surgical outer tube according to claim 1, wherein the stopper is slidable in the axial direction of the sheath and can be fixed at an arbitrary position. For the sliding or fixing means of the stopper with the sheath, a hose band-shaped stopper fixing tool having knobs at both ends of an annular band formed by intersecting leaf spring materials at the ends is provided, and the band is tightened by the knob. The surgical mantle according to claim 1 or 2 , wherein the sheath is urged from the entire periphery by operation to fix the stopper, and the urging is released to allow sliding. Surgical cannula of claim 1 to 3 wherein the sheath is made of transparent or translucent resin. Distal end of the sheath, surgical cannula of claim 1 to 4 are inclined relative to the axis. The surgical mantle according to claim 5 , further comprising an indicator that can recognize an inclination direction of the sheath tip from outside the body.

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