CN115869030A - Medical member and method for using medical member - Google Patents

Abstract

The subject of the invention is to easily punch a sheet-shaped medical component by a cutter of a stitching instrument. A medical member (100) of the present invention comprises: a sheet-like main body (11) which is formed with a plurality of through holes (11) and which can follow the movement of a living body organ to be anastomosed; a traction unit (40) that includes a long linear member (41) and can increase the tension in the surface direction (XY) of the body by traction; and a traction fixing part (50) which comprises a cylindrical member for winding the linear member of the traction part and can adjust the tension by winding the linear member on the cylindrical member.

Description

Medical member and method for using medical member

Technical Field

The present invention relates to a medical member and a method of using the medical member.

Background

Operations for joining living organs by surgical operations (e.g., anastomosis operations of digestive tracts) are known in the medical field. In the case of performing the above-described operation, it is known that it is important as a prognostic factor after the operation that a healing delay does not occur in a joint where living organs are joined to each other.

Various methods and medical instruments are used in a surgery for anastomosing a living organ, but for example, a method of suturing a living organ with a biodegradable suture thread and a method using a mechanical anastomosis device for performing anastomosis with a suturing instrument have been proposed. In particular, when performing an anastomosis operation using a mechanical anastomosis device, the joining force between the living organs at the joint can be increased as compared with a method using a suture thread, and the risk of incomplete suturing can be reduced.

However, the degree of progress of healing in the anastomosis portion also depends on the state of the living tissue in the site to be anastomosed of the patient. Therefore, for example, in the case of using the anastomosis device as described in patent document 1, there is a possibility that the risk of incomplete suturing cannot be sufficiently reduced depending on the state of the living tissue of the patient.

In order to cope with the above situation, it has been proposed to use a medical member described in patent document 2 below in an anastomosis procedure for joining living organs.

The medical member described in patent document 2 is formed of a sheet-like member having a through-hole formed therein. When the medical member is left in a state of being sandwiched between living organs to be anastomosed, the biological components are accumulated in the through-hole to promote healing of the anastomotic portion.

Documents of the prior art

Patent document

Patent document 1: japanese Kokai publication No. 2007-505708

Patent document 2: international publication No. 2019/156230

Disclosure of Invention

In a surgical operation using the medical component, not only the portion to be stapled is stapled to the medical component by the staples discharged from the stapler, but also a portion of the medical component that does not need to be stapled may be punched out by a cutter of the stapler. Here, the sheet-like medical member described above has room for improvement with respect to the ease of punching when the cutter of the stapler is pushed and the punching operation is performed.

The present invention has been made to solve the above-described problems, and an object of the present invention is to facilitate punching of a cutter of a stapler with respect to a sheet-shaped medical member.

One embodiment of the present invention is a medical member including a main body portion, a traction portion, and a traction fixing portion. The main body portion is formed with a plurality of through holes and is configured into a sheet shape capable of following the movement of the living body organ to be anastomosed. The traction unit includes a long linear member and is configured to increase tension in the planar direction of the main body unit by traction. The traction fixing portion includes a cylindrical member around which the linear member of the traction portion is wound, and is configured to be capable of adjusting the tension by winding the linear member around the cylindrical member.

In addition, one embodiment of the present invention includes a method of using the medical member. In the above-described method of use, a medical device having the 1 st engaging tool and the 2 nd engaging tool is prepared. The 1 st engaging tool can be disposed on one side of the main body of the medical member, and has a releasing portion capable of releasing the joining member to be joined to the living body organ, and a1 st shaft disposed radially inward of the releasing portion. The 2 nd engaging tool can be disposed on the other side of the body, has a2 nd shaft engageable with the 1 st shaft, and grips the body together with the 1 st engaging tool. In this usage, the 2 nd shaft of the 2 nd engaging tool is inserted into a substantially central portion of the main body. Then, the linear member of the traction portion is wound around the outer periphery of the cylindrical member of the traction fixing portion to adjust the tension, and the living body organs are anastomosed with the main body portion interposed therebetween. The adjustment based on the tension of the linear member is performed after the main body portion is inserted into the 2 nd axis or before the main body portion is inserted into the 2 nd axis.

Effects of the invention

According to the medical member and the method for using the medical member of the aspect of the present invention, punching by the cutter of the stapler with respect to the sheet-shaped medical member is facilitated.

Drawings

Fig. 1 is a schematic view showing a suture instrument used for anastomosis of medical members according to embodiment 1 of the present invention.

FIG. 2 is a view showing a distal end portion of a1 st engaging tool and a2 nd engaging tool constituting the suture instrument of FIG. 1.

Fig. 3 is a diagram showing a medical member according to embodiment 1.

Fig. 4 is a plan view showing the medical member of fig. 3.

Fig. 5 is a view showing a through hole of a main body of a medical member.

Fig. 6 is a flowchart showing a method of using the medical member according to embodiment 1.

Fig. 7 is a flowchart showing an example of use of the medical member (large intestine anastomosis).

FIG. 8 is a view showing a state in which the shaft of the positioning portion of the 1 st engaging tool of the suture instrument is engaged with the shaft of the 2 nd engaging tool.

Fig. 9 is a view showing a state in which the medical member is sandwiched between the living body organ and the first engaging tool 1 and the second engaging tool 2.

FIG. 10 is a view showing how a living organ is anastomosed.

Fig. 11 is a diagram showing a medical member according to modification 1 of embodiment 1.

Fig. 12 is a view showing a traction fixation section of a medical member according to modification 1.

Fig. 13 is a diagram showing a medical member according to modification 2 of embodiment 1.

Fig. 14 is a view showing a traction fixation section of a medical member according to modification 2.

Fig. 15 is a diagram showing a medical member according to modification 3 of embodiment 1.

Fig. 16 is a view showing a traction fixation section of a medical member according to modification 3.

Fig. 17 is a diagram showing a medical member according to modification 4 of embodiment 1.

Fig. 18 is a view showing a traction fixation section of a medical member according to modification 4.

Fig. 19 is a diagram showing a medical member according to modification 5 of embodiment 1.

Fig. 20 is a view showing a traction fixation portion of a medical member according to modification 5.

Fig. 21 is a diagram showing a medical member according to modification 6 of embodiment 1.

Fig. 22 is a view showing a traction fixation section of a medical member according to modification 6.

Fig. 23 is a diagram showing a medical member according to modification 7 of embodiment 1.

Fig. 24 is a view showing a traction fixation section of a medical member according to modification 7.

Fig. 25 is a perspective view showing a traction fixation section of a medical member according to modification 8 of embodiment 1.

Fig. 26 is a plan view showing a traction fixation section of a medical member according to modification 8.

Fig. 27 is a plan view showing a traction fixation portion of a medical member according to modification 9 of embodiment 1.

Fig. 28 is a plan view showing a traction fixation portion of a medical member according to modification 10 of embodiment 1.

Fig. 29 is a diagram showing a modification of the medical member and the traction portion in modification 11 of embodiment 1.

Fig. 30 is a view showing a modification of the traction unit in the medical member according to modification 12 of embodiment 1.

Fig. 31 is a diagram showing a modification of the traction unit in the medical member according to modification 13 of embodiment 1.

Fig. 32 is a view showing a modification of the traction unit in the medical member according to modification 14 of embodiment 1.

Fig. 33 is a diagram showing a modification of the medical member and the traction portion in modification 15 of embodiment 1.

Fig. 34 is a view showing a modification of the medical member and the traction unit in modification 16 of embodiment 1.

Fig. 35 is a view showing a modification of the traction unit in the medical member according to modification 17 of embodiment 1.

Fig. 36 is a view showing a modification of the medical member and the traction portion of modification 18 of embodiment 1.

Fig. 37 is a view showing the pitch of stitching of the linear member to the main body portion in the traction portion of the medical member according to embodiment 1.

Fig. 38 is a view showing the medical member according to modification 19 of embodiment 1, and showing the pitch of the stitching of the linear member of the traction portion with respect to the main body portion.

Fig. 39 is a view showing the pitch of the stitching of the linear member of the traction portion to the main body portion in the medical member according to modification 20 of embodiment 1.

Fig. 40 is a view showing a modification of the linear member of the traction unit in the medical member according to modification 21 of embodiment 1.

Fig. 41 is a view showing a modification of the linear member of the traction unit in the medical member according to modification 22 of embodiment 1.

Fig. 42 is a view showing a fixing frame and medical members according to modification 23 of embodiment 1.

Fig. 43 is a perspective view showing a medical member according to embodiment 2.

Fig. 44 is a view showing a traction fixation section of the medical member of fig. 43.

Description of the reference numerals

10 a main body part,

11 is arranged in the through hole of the base,

21 a support part for supporting the upper and lower parts of the body,

30 a hole part is formed on the upper surface of the upper cover,

40. 40n, 40p, 40q, 40r, 40s, 40t1, 40t2, 40t3, 40U1, 40U2, 40v, 40w, 40x, 40y traction parts,

41. the linear member of 41s is provided with,

50. 50a, 50b, 50c, 50d, 50e, 50f, 50g, 50h, 50k, 50m, 50y draw the fixed part,

50e, 50f draw the fixed portion (including the inclined portion),

a 50g1 cylindrical member (1 st cylindrical member),

a 50g2 cylindrical member (2 nd cylindrical member),

the slit 51 is provided with a plurality of slits,

51y a fixed cylindrical member, and a cylindrical member,

52. 52b of the plurality of concave portions, and a concave portion,

the 52y rotary-type cylindrical member is,

54 are arranged to penetrate through the hole(s),

54y of the engaging portion of the first and second engaging members,

55. a 55 m-shaped projection part, wherein,

55y are engaged with the engaging portions of the engaging portions,

a fixing frame (60) is fixed on the frame,

100. 100a, 100b, 100c, 100d, 100e, 100f, 100g, 100n, 100p, 100q, 100r, 100s, 100t1, 100t2, 100t3, 100v, 100w, 100x, 100y medical member,

200 of the suturing device, the suturing device is provided,

210 the 1 st engaging means of the engaging means,

270 the 2 nd engagement means is provided on the second side,

the axis of the (310) shaft,

a hole part (H) is formed in the hole part,

r is in the radial direction of the rotor,

in the X-axis direction (thickness direction of the main body),

the YZ plane direction.

Detailed Description

Hereinafter, embodiments for carrying out the present invention will be described in detail with reference to the drawings. The embodiments shown here are for embodying the technical idea of the present invention, and do not limit the present invention. In addition, other embodiments, examples, operational techniques, and the like that can be implemented by those skilled in the art without departing from the scope and spirit of the present invention are all included in the scope and spirit of the present invention, and are included in the invention described in the claims and the equivalent scope thereof.

The drawings attached to this specification are for convenience of illustration and understanding, and may be schematically illustrated by changing the actual aspect ratio, shape, and the like from a reduced size to a modified aspect ratio, and are merely exemplary and not intended to limit the explanation of the present invention.

In the following description, ordinal numbers such as "1 st" and "2 nd" are given for explanation, but any order is not specified unless otherwise specified.

In addition, a coordinate system is shown in the drawings below. The X of the orthogonal coordinate system is referred to as an axial direction X along the axial direction or the thickness direction of the main body 10 constituting the medical member 100. Y and Z are planes intersecting the axial direction X and are called plane directions YZ.

The cylindrical coordinate system r is a direction extending in a radial direction or a radial direction from the center of the main body 10 of the medical member 100 along the plane direction YZ, and is referred to as a radial direction r. θ is referred to as a circumferential direction θ along a circumferential direction or an angular direction of the body 10 or the like in a plane direction YZ intersecting the axial direction X of the body 10 or the like.

< embodiment 1 >)

Fig. 1 is a diagram showing a suture instrument 200 used in a medical member 100 according to embodiment 1. FIG. 2 is a view showing the tip of the 1 st engaging tool 210 and the 2 nd engaging tool 270 constituting the suture instrument 200. Fig. 3 and 4 are views showing the entirety of the medical member 100. Fig. 5 is a view showing the through-hole 11 of the medical member 100.

Fig. 6 to 10 are diagrams for explaining a procedure for performing anastomosis of a digestive tract using the medical member 100, taking an example of a large intestine as an example.

The medical member 100 is anastomosed to a living organ by the stapler 200 at the time of anastomosis operation.

The medical member 100 can be applied to a procedure for joining predetermined living organs to each other (for example, an anastomosis procedure of a digestive tract) as shown in fig. 6 to 10. As will be described later, in the description of the present specification, the large intestine anastomosis operation is described as an example of an operation using the medical member 100, but a site to which the healing promoting apparatus of the present invention can be used is not limited to the large intestine.

Before the explanation of the medical member 100, the suture instrument 200 will be explained.

< suture instrument 200 >

The suturing device 200 joins one of the joined sites (1 st joined site) that is a living organ in the living tissue and the other joined site (2 nd joined site) opposite to the 1 st joined site.

The suture instrument 200 includes a1 st engaging tool 210 and a2 nd engaging tool 270 capable of sandwiching the medical member 100 between the 1 st site to be engaged and the 2 nd site to be engaged. Stapler 200 can be referred to as a circular stapler. The structure of each part will be described below.

As shown in fig. 1, 2, and the like, the 1 st engaging tool 210 is disposed on one side of the medical member 100 when the medical member 100 is anastomosed to a living tissue. The 1 st engaging tool 210 is configured to be able to abut against the 1 st engaged site.

The 2 nd engaging tool 270 is disposed on the opposite side of the 1 st engaging tool 210 from the medical member 100 at the time of fitting, and is configured so as to be capable of abutting against the 2 nd site to be engaged. The details will be described later. The 1 st engaging instrument 210 can be referred to as a trocar, and the 2 nd engaging instrument 270 can be referred to as an anvil. The details are as follows.

< 1 st engaging tool >

As shown in fig. 1 and 2, the 1 st engaging tool 210 includes a long member 220, a positioning portion 230, a releasing portion 240, a punching portion 250, and an operating portion 260.

The long member 220 corresponds to the main body of the 1 st engaging device 210. As shown in fig. 2, the long member 220 has a space S at the longitudinal end thereof, in which the axis of the positioning portion 230 can relatively move forward and backward. The cross section of the long member 220 intersecting the axial direction is formed in a hollow circular shape.

Although the long member 220 extends linearly in the longitudinal direction and has the bent portion in the present embodiment, the bent portion may not be provided in the long member as long as the fitting function and the punching function, which will be described later, can be achieved.

The positioning part 230 has a long shaft. The axis of the positioning portion 230 corresponds to the 1 st axis provided radially inward of the discharge portion 240. As shown in fig. 2, the shaft of the positioning part 230 is configured to be movable forward and backward from the space S at the tip in the longitudinal direction of the long member 220. The positioning portion 230 is configured to be insertable into a hole portion formed in the substantially center of the medical member 100 and a lumen of a shaft 310 of a2 nd engaging tool 270 described later.

The emitting portion 240 is configured to be able to emit a plurality of staples (corresponding to engaging members) that engage the 1 st engaged site and the 2 nd engaged site in a substantially annular shape. The discharging unit 240 is formed in a substantially disc shape on the distal end side in the longitudinal direction of the long member 220. The ejection unit 240 is configured by providing a plurality of staple ejection positions along the circumferential direction at the distal end of the long member 220.

The punching portion 250 is arranged radially inward of the releasing portion 240 at the distal end of the long member 220, and is configured to punch the radially inward side of the 1 st portion to be joined and the 2 nd portion to be joined. As shown in fig. 2, the punching portion 250 is configured to have an annular plate member for punching the 1 st and 2 nd portions to be joined radially inward of the ejection portion 240. The shape of the punched portion 250 is configured to be a perfect circle when viewed from the longitudinal direction in plan view, but if a portion where healing promotion is not necessary is punched, the shape of the punched portion 250 may be an ellipse or the like.

The operation portion 260 is configured to be able to operate the positioning portion 230, the discharging portion 240, and the punching portion 250. As shown in fig. 1, the operation unit 260 includes a rotation portion 261 and a handle 262.

The rotation portion 261 is provided at a base end portion (base end side) in the longitudinal direction of the long member 220. The rotating portion 261 is configured to be rotatable with respect to the long member 220 with the longitudinal direction on the proximal end side of the long member 220 as a rotation axis. The rotating portion 261 is configured to be able to relatively approach and separate the 1 st engaging tool 210 and the 2 nd engaging tool 270 by rotating with respect to the long member 220 in a state where the 2 nd engaging tool 270 is engaged with the 1 st engaging tool 210.

The handle 262 is configured to be able to be held by a user together with a base end portion (base end side) of the long member 220. The handle 262 is rotatably connected to the long member 220 via a rotating shaft 263. The handle 262 is relatively close to the long-sized member 220 by being held by the user to rotate about the rotating shaft 263. This makes it possible to discharge the staple from the discharge portion 240 and to project the annular plate member of the punch 250 from the distal end of the long member 220.

< 2 nd engaging tool >

The 2 nd engaging tool 270 is configured to be able to clamp the medical member 100 together with the 1 st engaging tool 210 across the 1 st engaged site and the 2 nd engaged site. As shown in fig. 2, the 2 nd engaging tool 270 has a head, an abutting portion 280, and a shaft 310.

When the 1 st engaging tool 210 and the 2 nd engaging tool 270 are engaged with each other, the head is disposed adjacent to the distal end side of the long member 220 of the 1 st engaging tool 210. In the present embodiment, as shown in fig. 1 and 2, the head portion is formed in a substantially circular plate shape, and the cross-sectional shape is formed in a shape identical or similar to the circular shape of the long member 220.

The abutment portion 280 is configured to be able to abut against the plurality of staples discharged from the discharge portion 240. The contact portion 280 is provided on the 1 st engaging tool 210 side in the axial direction X (plate thickness direction) of the head portion. The contact portion 280 is configured to be able to contact the plurality of staples discharged from the discharge portion 240. The staples discharged from the discharging portion 240 are abutted by the abutting portion 280 to be deformed, thereby engaging the 1 st engaged position and the 2 nd engaged position.

The shaft 310 is configured to be insertable into a hole formed in the substantially center of the medical member 100 described below.

The shaft 310 is provided with a space for accommodating the shaft of the positioning portion 230 of the 1 st engaging tool 210. The shaft 310 is configured to be fitted to the shaft of the positioning portion 230, and thus the 1 st engaging tool 210 and the 2 nd engaging tool 270 can be aligned. The shaft 310 corresponds to a2 nd shaft engageable with the 1 st shaft.

< medical component 100 >

The medical member 100 is arranged between living organs to be anastomosed, is configured to be flat, and has a plurality of through holes 11 formed therein. As shown in fig. 3 and the like, the medical member 100 includes a main body portion 10, a reinforcing portion 20, a hole portion 30, a pulling portion 40, and a pulling fixing portion 50.

< main body part >

The main body 10 is disposed between the living organs to be anastomosed, and is configured into a sheet shape capable of following the movement of the living organs to be anastomosed.

As shown in fig. 3, the body portion 10 is formed in a circular shape as an example, and has a plurality of through-holes 11 formed so as to penetrate in the thickness direction (axial direction X) of the circular shape as shown in fig. 5. The size of the through-hole 11 of the body 10 is preferably 0.1 to 6mm, more preferably 0.3 to 4mm, and further preferably 0.6 to 1.5mm. The body portion 10 may be configured such that the ratio of the dimension D of the through-hole 11 to the pitch P is 0.25 or more but less than 40. The (regular) circle described as the shape of the main body 10 is an example, and may be a polygon such as an ellipse or a quadrangle, a star, or the like.

The thickness of the main body 10 (dimension T shown in fig. 5) is not particularly limited, but is preferably 0.05 to 0.3mm, and more preferably 0.1 to 0.2mm.

The main body 10 can be made of a biodegradable material. The material of the main body 10 is not particularly limited, and examples thereof include biodegradable resins.

Specifically, there may be mentioned (1) a polymer selected from the group consisting of aliphatic polyesters, polyanhydrides, polyorthoesters, polycarbonates, polyphosphazenes, polyphosphoesters, polyvinyl alcohols, polypeptides, polysaccharides, proteins, and cellulose; (2) Copolymers composed of one or more monomers constituting the above (1), and the like.

That is, the biodegradable sheet preferably includes at least one biodegradable resin selected from the group consisting of polymers selected from the group consisting of aliphatic polyesters, polyanhydrides, polyorthoesters, polycarbonates, polyphosphazenes, polyphosphoesters, polyvinyl alcohols, polypeptides, polysaccharides, proteins, and cellulose, and copolymers of one or more monomers constituting the polymers.

The method for producing the main body portion 10 is not particularly limited, but examples thereof include a method for producing fibers made of the biodegradable resin and producing a mesh-shaped sheet using the fibers. The method for producing the fiber made of the biodegradable resin is not particularly limited, and examples thereof include an electrospinning method (e.g., electrospinning method or electrostatic spinning method) and a melt blowing method. The main body 10 may be used by selecting only one of the above methods, or may be selected from two or more kinds of suitable combinations. Further, as another example of the method for manufacturing the main body portion 20, there can be mentioned: a method for producing the biodegradable sheet of the present invention by spinning fibers composed of the biodegradable resin described above according to a conventional method and weaving the obtained fibers into a mesh shape; a method for producing the biodegradable sheet by compressing the fibers; and a method for producing the biodegradable sheet by interlacing without weaving the fibers.

The main body 10 generates a biological reaction by a constituent material such as biodegradable resin constituting the main body 10. The body 10 guides the discovery of biological components such as fibrin by this action. The biological components guided in this way are collected so as to penetrate through the through-hole 11 of the main body 10, thereby promoting healing. Therefore, by disposing the main body portion 10 of the healing promoting device 100 between the living organs to be joined, the healing is promoted by the above-described mechanism.

< reinforcing part >

The reinforcing part 20 is provided for suppressing rattling, displacement, breakage, and the like of the medical component 100 when the medical component 100 is left between the 1 st engaged site and the 2 nd engaged site by the stapler 200, and the like. The reinforcement portion 20 has an inner reinforcement portion and an outer reinforcement portion. The inner reinforcement is formed along the inner circumferential edge in the hollow circular shape of the body portion 10, and the outer reinforcement is formed along the outer circumferential edge in the hollow circular shape of the body portion 10. The outer reinforcement portion of the reinforcement portion 20 is provided on the outer periphery of the main body portion 10, and may be referred to as a support portion 21 having a higher rigidity than the main body portion 10 (see fig. 3).

In the present embodiment, the inner reinforcement portion and the outer reinforcement portion constituting the reinforcement portion 20 are configured in a shape in which the through-hole 11 is not provided in the main body portion 10. However, as long as the main body portion 10 can be easily expanded and the expanded state can be maintained, the specific shape of the reinforcing portion 20 is not limited to the above, and the positions may not be the inner circumferential edge and the outer circumferential edge. The reinforcing portion 20 is preferably made of a bioabsorbable material such as a thermoplastic resin such as PGA (polyglycolic acid), PLA (polylactic acid), PLGA (polylactic-co-glycolic acid), PDS (poly (p-dioxanone), PCL (polycaprolactone) or the like. However, the reinforcing portion 20 may include a material that is not bioabsorbable. The reinforcing portion 20 may be provided over the entire circumference of at least one of the inside and the outside of the main body portion 10, or may be provided partially over the entire circumference. The inner reinforcement portion is formed coaxially with the inner edge portion, but may be located off-center as long as it does not enter the healing region. The reinforcing portion 20 may be joined to the main body portion 10 by an adhesive or thermal welding, or may be stitched with a thread or the like. In addition to the above, the reinforcing portion 20 may be integrally formed by being caught by a convex portion or the like larger than the hole diameter of the through hole 11 of the body portion 10.

< hole part >

The hole 30 is formed apart from the outer peripheral edge of the main body 10 in the plane direction YZ of the main body 10. The hole 30 is configured to be insertable into the shaft 310 of the suture instrument 200. In the present embodiment, the hole 30 has a substantially circular shape when viewed in the axial direction X. However, if the healing of the living tissue can be promoted by the main body portion 10, the specific shape of the hole is not limited to the circular shape. The hole 30 is preferably a material having no bioabsorbability, such as a thermoplastic resin, such as silicone rubber, polystyrene, polyurethane, polyvinyl chloride, or elastomer, or a material having bioabsorbability, such as metal. The cross section of the hole 30 is preferably a perfect circle, but may be formed in an ellipse, a triangle, a square, a concave shape, a convex shape, or the like.

< traction part >

As shown in fig. 4, the pulling portion 40 includes a long linear member 41, and is configured to increase the tension in the plane direction YZ of the main body portion 10 by pulling. The linear member of the traction portion 40 can be disposed outside the cylindrical member of the traction fixing portion 50, which will be described later, in the radial direction r. The traction portion 40 is partially sewn to the main body portion 10 so as to form a perfect circle when viewed from the axial direction X, and both end portions are configured so as not to be fixed to the main body portion 10 in the present embodiment. The linear member of the traction portion 40 is preferably made of a bioabsorbable material such as a thermoplastic resin such as PGA (polyglycolic acid), PLA (polylactic acid), PLGA (polylactic-co-glycolic acid), PDS (poly (p-dioxanone), PCL (polycaprolactone) or the like.

< traction fixing part >

The traction fixing portion 50 includes a cylindrical member such as a cylinder around which the linear member 41 of the traction portion 40 is wound, and is configured to be able to adjust the tension by winding the linear member 41 around the cylindrical member. The cylindrical member of the traction fixing portion 50 can be integrally formed with the main body 10 by an adhesive or the like. The traction fixing portion 50 has a lock mechanism that generates a resistance force that prevents or suppresses a decrease in tension generated by the linear member 41 of the traction portion 40. In the present embodiment, the locking mechanism of the traction fixing portion 50 includes a slit 51 (see fig. 3) formed in a side surface of the cylindrical member. The linear member 41 of the pulling portion 40 is inserted into the slit 51 in a state where the linear member 41 is wound around the pulling fixing portion 50, whereby the above-described resisting force is generated when the linear member 41 of the pulling portion 40 slides at the insertion portion of the slit 51. The traction fixing portion 50 is configured such that the thickness in the circumferential direction θ of the tubular member is different between the portion having the slits 51 and the portion not having the slits 51, and thus, when the tubular member is fastened by winding the linear member 41 of the traction portion 40, cracks can be less likely to occur in the tubular member. The traction fixing portion 50 may be located radially outward of the shaft 310 of the 2 nd engaging tool 270. The tubular member of the traction fixing portion 50 is provided with a hole portion h which is larger than the through-hole 11 and through which the shaft 310 of the 2 nd engagement tool 270 can be inserted, similarly to the hole portion 30 of the main body portion 10. The traction fixing portion 50 can include a thermoplastic resin such as silicone rubber, polystyrene, polyurethane, polyvinyl chloride, elastomer, or the like. The traction fixing portion 50 may be made of a bioabsorbable material, or may include a material having no bioabsorbability. When the hardness of the structure of the medical member 100 is exemplified, the cylindrical member of the traction fixing portion 50, the linear member 41 of the traction portion 40, the support portion 21 of the reinforcing portion 20, and the main body portion 10 can be formed in this order of the hardness. The traction fixing portion 50 can prevent the medical member 100 from falling off from the shaft 310 and can prevent a displacement from the shaft 310 by fitting the medical member to the shaft 310.

< method of treatment >

Next, a treatment method using the medical member 100 will be described. Fig. 6 is a flowchart showing the procedure of the procedure using the medical member 100.

As shown in fig. 6, the treatment method includes: a medical member 100 having a sheet-like main body portion 10 that promotes healing of a living tissue is disposed between a first site to be joined 1 and a second site to be joined 2, which are targets of joining of living organs (S11). The treatment method comprises the following steps: the first 1 engaged site of the body portion 10 of the medical component 100 is engaged with the second 2 engaged site of the body portion in a state where at least a part of the body portion is disposed between the first 1 engaged site and the second 2 engaged site (S12).

The living body organ to be joined by the treatment method and the site to be joined in the living body organ are not particularly limited and can be arbitrarily selected. However, in the following description, a large intestine anastomosis is taken as an example. In the following description, detailed descriptions of known procedures, known medical devices, medical instruments, and the like are omitted as appropriate.

In the following description of the present specification, "a medical member is disposed between living organs (hereinafter referred to as" the above description ") means that the medical member is disposed in a state in which the medical member directly or indirectly contacts the living organs.

In addition, the above description may mean that the medical member is disposed in a state where a space is formed between the living organs. In addition, the above description may mean that the medical member is disposed in both of the above-described states (for example, the medical member is disposed in a state where the medical member is in contact with one living organ and the medical member is not in contact with the other living organ).

In the description of the present specification, the "periphery" does not define a strict range (region), and means a predetermined range (region) as long as the treatment purpose (joining of living organs) can be achieved.

In addition, the procedure of the operation described in each treatment method can be changed as appropriate when the treatment purpose can be achieved. In the description of the present specification, "relatively close" means two or more portions to be brought close to each other and two or more portions to be brought close to each other.

Fig. 7 is a flowchart showing a procedure of an embodiment of the treatment method (large intestine anastomosis). Fig. 8 to 10 are diagrams for explaining the large intestine anastomosis operation.

In the treatment method of the present embodiment, the living organ to be joined is a large intestine that is cut off along with the excision of a cancerous tumor. Specifically, the living body organs to be joined are the mouth side A1 of the cut large intestine and the anus side A2 of the cut large intestine. In the following description, a procedure of joining the mouth periphery (one site to be joined) of the mouth side A1 of the cut large intestine and a part (the other site to be joined) of the intestinal wall of the anus side A2 of the cut large intestine will be described.

As shown in fig. 7, the treatment method according to the present embodiment includes: disposing a medical member 100 between the periphery of the mouth of the large intestine and the intestinal wall of the large intestine (S101): and relatively approaching the periphery of the mouth of the large intestine to the intestinal wall of the large intestine (S102). The treatment method comprises the following steps: sandwiching the main body portion 10 of the medical component 100 between the periphery of the mouth of the large intestine and the intestinal wall of the large intestine (S103); and joining the main body portion 10 of the medical member 100 while being sandwiched between the periphery of the mouth of the large intestine and the intestinal wall of the large intestine (S104). The details are as follows.

First, the operator prepares the suture instrument 200, forms a part called a port such as a hole around the navel, and raises the abdomen of the patient.

Next, the operator forms an incision (not shown) near the navel, takes the affected part on the oral side A1 out of the body from this incision, and inserts the 2 nd engagement tool 270 of the suture instrument 200 into the oral side A1 of the large intestine. The operator inserts the shaft 310 of the second engaging tool 270 into the mouth side A1 of the large intestine, and stitches the mouth of the large intestine with the shaft 310 protruding to form a stitched portion a11. The outer surface of the sewn portion a11 has a shape partially protruding toward the convex side as it is sewn (see fig. 8).

Next, the operator inserts the shaft 310 of the 2 nd engaging tool 270 into the hole 30 located at the substantially central portion of the main body 10 and the hole h of the traction fixation unit 50. Then, the operator winds the linear member 41 of the traction unit 40 around the tubular member of the traction fixing unit 50 to adjust the tension of the mesh of the main body 10 so as to increase. After the adjustment of the tension is completed, the operator inserts both ends of the linear member 41 of the traction portion 40 into the slits 51 of the traction fixing portion 50 to maintain the tension generated by the linear member 41 of the traction portion 40 or suppress the reduction of the tension.

Next, the operator accommodates the living tissue on the mouth side A1 of the large intestine, on which the medical member 100 is disposed, into the abdominal cavity from the incision portion.

Next, the operator places the 1 st engagement tool 210 of the suture instrument 200 on the anus side A2 of the large intestine. As the 1 st engaging tool 210 is disposed (inserted) on the anus side A2 of the large intestine, a through-hole a21 is formed in the anus side A2 of the large intestine. The timing of forming the through-hole a21 is not particularly limited as long as it is before the 1 st engaging tool 210 is disposed.

Next, the operator engages the shaft of the positioning portion 230 and the shaft 310 of the 2 nd engaging tool 270 at a position separated from each other while maintaining the state in which the main body portion 10 is held on the mouth side A1 of the large intestine (S101). Then, the rotating portion 261 is rotated to relatively approach the 1 st engaging tool 210 and the 2 nd engaging tool 270 as shown in fig. 8 and 9 (S102). Thereby, the periphery of the mouth of the large intestine and the intestinal wall of the large intestine are relatively close.

Next, the operator sandwiches the periphery of the mouth portion formed on the mouth side A1 of the large intestine, the main body portion 10 of the medical member 100, and the periphery of the through-hole a21 formed in the intestinal wall on the anus side A2 of the large intestine between the 1 st engaging tool 210 and the 2 nd engaging tool 270 (S103).

The operator rotates the handle 262 of the operation portion 260 of the stapler 200 about the rotation shaft 263 to project the annular plate member of the blanking portion 250. Then, a part of the mouth side A1 of the large intestine, the radially inner side of the body 10, and a part of the anus side A2 of the large intestine interposed between the 1 st engaging tool 210 and the 2 nd engaging tool 270 are cut off, and the periphery of the cut-off portion is joined in a substantially annular shape by staples (not shown) (S104).

Next, as shown in fig. 10, the operator takes out the suture instrument 200 from the anus side A2 of the large intestine to the outside of the living body through the anus. At this time, the region formed on the inner side of the outer diameter d of the punched portion 250 of the 1 st engaging tool 210 is taken out of the living body together with the suture instrument 200. Thus, the portion of the medical member 100 located radially inward of the punched portion 250 in the radial direction r is removed without remaining in the body. In addition, in the case where the main body portion 10 and the reinforcing portion 20 are not configured by a bioabsorbable material, the main body portion 10 and the reinforcing portion 20 are removed from the port described above.

When the main body portion 10 of the medical component 100 is inserted and placed between the living organs to be joined, the through-hole a21 of the main body portion 10 can pass therethrough to promote healing of the living organs to be joined.

According to this treatment method, the risk of incomplete suturing or the like after a joining operation (for example, an anastomosis operation of a digestive tract) can be reduced by a simple method of sandwiching the sheet-like main body portion 10 between the 1 st and 2 nd sites to be joined.

As described above, the medical member 100 of the present embodiment includes the main body 10, the traction unit 40, and the traction fixing unit 50. The main body 10 is formed with a plurality of through holes 11 and is configured into a sheet shape capable of following the movement of a living organ to be anastomosed. The pulling unit 40 includes a long linear member 41, and is configured to increase the tension in the plane direction YZ of the main body 10 by pulling. The traction fixing portion 50 includes a cylindrical member around which the linear member 41 of the traction portion 40 is wound, and is configured to be able to adjust the tension by winding the linear member 41 around the cylindrical member. In the method of using the medical member 100, the suture instrument 200 having the 1 st engaging instrument 210 and the 2 nd engaging instrument 270 is prepared. The 1 st engaging tool 210 can be disposed on one side of the main body portion 10, and has a shaft provided on a discharge portion 240 capable of discharging a staple to be joined to a living body organ and a positioning portion 230 provided radially inward of the discharge portion 240. The 2 nd engaging tool 270 may be disposed on the other side of the main body 10, and may include a shaft 310 that is engageable with the shaft of the positioning portion 230. In the above-described usage, the shaft 310 of the 2 nd engaging tool 270 is inserted into a substantially central portion of the main body 10. Then, the linear member 41 of the traction portion 40 is wound around the outer periphery of the cylindrical member of the traction fixing portion 50, and the body portion 10 is sandwiched between the body organs to be anastomosed, and the tension is adjusted, thereby performing the anastomosis of the body organs. In the present embodiment, the adjustment of the tension generated by the linear member 41 based on the traction portion 40 is performed after the main body portion 10 is inserted into the shaft 310 of the 2 nd engaging tool 270.

When the main body 10 is made of a relatively soft material such as the mesh, there is a fear that fibers of the main body cannot be smoothly punched out by the punching portion 250 during the punching operation, and the fibers and the like constituting the main body may be scattered. If the mesh of the main body is not cut into a part remaining in the living body and a part not remaining in the living body by the punch 250, stress may be applied to the anastomotic part, which may cause breakage and make it impossible to pull out the suture instrument 200. In contrast, in the present embodiment, by winding the linear member 41 of the pulling portion 40 around the cylindrical member of the pulling and fixing portion 50 as described above, the punching of the main body portion 10 by the punching portion 250 of the suture instrument 200 can be easily performed. Therefore, it is possible to prevent or suppress the occurrence of a situation in which the punching of the body 10 cannot be smoothly performed by the punching portion 250 of the suture instrument 200 due to insufficient tension of the body 10. In addition, it is possible to prevent or suppress damage to the body 10 due to the body 10 not being smoothly penetrated by the punch 250. Further, as described above, since the tension generated by the linear member 41 of the traction portion 40 is generated immediately before the user performs the operation, it is not necessary to apply unnecessary stress to the main body portion 10, and conversely, the tension of the main body portion 10 can be prevented or suppressed from being lowered.

The traction fixing portion 50 has a lock mechanism that generates a resistance force that prevents or suppresses a reduction in the tension generated by the traction portion 40. This prevents or suppresses the release of the tension of the main body 10 adjusted by the draft part 40, and prevents or suppresses the occurrence of punching defects by the punching part 250.

In addition, the locking mechanism includes a slit 51 formed in a side surface of the cylindrical member of the traction fixing portion 50. The lock mechanism is configured to generate a resisting force when the linear member 41 slides at the fitting portion of the slit 51 from the state where the linear member 41 is fitted into the slit 51. With such a configuration, it is possible to prevent or suppress a reduction in tension generated by the linear member 41 of the pulling portion 40, and it is possible to prevent or suppress the occurrence of punching defects of the main body portion 10 due to the punching portion 250. Further, by providing the slit 51 in the tubular member of the traction fixing portion 50, it is possible to eliminate the need for an operation of cutting off the excess linear member 41 when the linear member 41 of the traction portion 40 is wound around the tubular member of the traction fixing portion 50. This can facilitate the operation of the operator in the operation such as the large intestine anastomosis operation.

The medical member 100 further includes a support portion 21. The support portion 21 is provided on the outer periphery of the main body portion 10, and is configured to be more rigid than the main body portion 10. With such a configuration, when the main body 10 is pulled inward in the radial direction r by the pulling portion 40, the entire main body 10 can be prevented or suppressed from being displaced inward in the radial direction r without increasing tension.

The traction fixing portion 50 is configured to have a hole h larger than the through hole 11. With such a configuration, the shaft 310 can be easily inserted into the traction fixing portion 50.

The body 10 is applied to an anastomotic portion of a living organ, and can induce the discovery of a biological component, and promote the healing of the anastomotic portion by allowing the induced biological component to penetrate and gather through the through-hole 11. With such a configuration, the joining of the anastomotic portion can be facilitated.

(modification 1 of embodiment 1)

Fig. 11 is a view showing a medical member 100a according to modification 1 of embodiment 1, and fig. 12 is a view showing a traction fixation portion 50a of the medical member 100a according to modification 1. In embodiment 1, the slit 51 is formed on the outer surface of the cylindrical member of the traction fixing portion 50.

However, the traction fixing portion 50a is configured such that a recess 52 recessed inward in the radial direction r is provided on the outer surface of the cylindrical member shown in fig. 12. In the present modification, the recess 52 is formed in an acute shape such as a triangle in a side view as shown in fig. 12, and the slit 51 is provided inside the recess 52. Further, the tubular member of the traction fixing portion 50a may be provided with a hole portion h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted, similarly to the tubular member of the traction fixing portion 50. In the present modification, the suturing device 200 is similar to embodiment 1, and the main body 10, the reinforcing part 20, the hole 30, and the traction part 40 are similar to embodiment 1. Note that the treatment method using the medical member 100a of the present modification is the same as that of embodiment 1, and thus, description thereof is omitted.

As described above, in the present modification, the recess 52 recessed inward in the radial direction r is provided in at least a part of the outer surface of the cylindrical member of the traction fixing portion 50a, and the slit 51 is formed in the recess 52. With such a configuration, the linear member 41 of the traction portion 40 can be easily inserted into the slit 51.

(modification 2 of embodiment 1)

Fig. 13 is a view showing a medical member 100b according to modification 2 of embodiment 1, and fig. 14 is a view showing a traction fixation portion 50b of the medical member 100b according to modification 2. In modification 1 of embodiment 1, the acute-angled concave portion 52 is provided on the outer surface of the cylindrical member of the traction fixing portion 50 a. However, the concave portion provided in the tubular member may be provided with a concave portion 52b having an arc shape when the tubular member is viewed from the side, and a slit 51 may be provided in the concave portion 52b, as shown in fig. 14, in addition to fig. 12.

Further, a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted can be provided in the tubular member of the traction fixing portion 50b, similarly to the tubular member of the traction fixing portion 50. The suture instrument 200, the main body 10, the reinforcing portion 20, the hole 30, and the pulling portion 40 constituting the medical member 100b are the same as those of embodiment 1. The treatment method using the medical member 100b is the same as that of modification 1 of embodiment 1, and thus, the description thereof is omitted.

(modification 3 of embodiment 1)

Fig. 15 is a view showing a medical member 100c according to modification 3 of embodiment 1, and fig. 16 is a view showing a traction fixation portion 50c of the medical member 100c according to modification 3. In modifications 1 and 2 of embodiment 1, the recesses 52 and 52b are provided in the tubular members of the traction fixing portions 50a and 50 b. However, as shown in fig. 16, the traction fixing portion 50c may be provided with a recess 52b on the outer surface of the tubular member, and a slit 51 and an inner protrusion 53 may be provided inside the recess 52b. The inner protruding portion 53 can be provided in the recess 52b in the vicinity of the boundary between the recess 52b and the outer surface of the traction securing portion 50c where the recess 52b is not provided. By providing the inner protrusion 53 in the recess 52b of the traction fixing portion 50b in this way, the linear member 41 of the traction portion 40 can be prevented or suppressed from moving (escaping) from the recess 52b to the outside. This can prevent or suppress a decrease in the tension adjusted by the linear member 41 of the traction portion 40.

Further, a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted can be provided in the tubular member of the traction fixing portion 50c, similarly to the tubular member of the traction fixing portion 50. The main body 10, the reinforcing part 20, the hole 30, and the pulling part 40 of the suture instrument 200 and the medical member 100c are the same as those of embodiment 1. In addition, in the treatment method using the medical member 100c, when the linear member 41 of the traction portion 40 is inserted into the slit 51, the inner protruding portion 53 is prevented or suppressed from coming off from the cutout portion of the linear member. The rest is the same as embodiment 1, and thus, description thereof is omitted.

(modification 4 of embodiment 1)

Fig. 17 is a view showing a medical member 100d according to modification 4 of embodiment 1, and fig. 18 is a view showing a traction fixation portion 50d of the medical member 100d according to modification 4. In modification 3 of embodiment 1, the recessed portion 52b is provided in the tubular member of the traction fixing portion 50c, and one inner protrusion 53 is provided inside the recessed portion 52b. However, the number of the inner protrusions provided in the recess of the traction fixing portion is not limited to one. As shown in fig. 17 and 18, a plurality of inner protrusions 53 may be provided in the recess 52b provided in the traction fixing portion 50 d. In the present modification, the inner protruding portions 53 are provided so as to face each other in the recessed portions 52b.

Further, the tubular member of the traction fixing portion 50d can be provided with a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted, similarly to the tubular member of the traction fixing portion 50. The main body 10, the reinforcing part 20, the hole 30, and the pulling part 40 of the suture instrument 200 and the medical member 100c are the same as those of embodiment 1. The treatment method using the medical member 100d is the same as in modification 3 of embodiment 1. Therefore, the description is omitted.

(modification 5 of embodiment 1)

Fig. 19 is a view showing a medical member 100e according to modification 5 of embodiment 1, and fig. 20 is a view showing a traction fixation portion 50e of the medical member 100e according to modification 5. In embodiment 1, the traction fixing portion 50 has a cylindrical member such as a substantially cylindrical member. However, as shown in fig. 19 and 20, the tubular member of the traction fixing portion 50e may be formed to have an inclined surface (corresponding to an inclined portion) in which the side surface of the tube is formed to have a size that becomes larger toward the end portion in the axial direction X, like a truncated cone. In this case, the slit 51 can be formed on at least one of the bottom surface (base portion) having a short circumferential length and the vicinity of the base portion of the bottom surface of the tubular member. With such a configuration, the linear member of the traction portion 40 can be easily inserted into the slit 51 by moving from a portion having a long circumferential length to a portion having a short circumferential length along the inclined surface.

As described above, in the present modification, the tubular member of the traction fixing portion 50e includes the inclined surface in which at least a portion of the outer surface increases in size toward the end portion in the axial direction X, and the slit 51 is formed at least at one of the root portion of the inclined surface and the vicinity of the root portion. With such a configuration, the linear member 41 of the traction portion 40 can be easily inserted into the slit 51 along the inclined surface. Further, a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted can be provided in the tubular member of the traction fixing portion 50e, similarly to the tubular member of the traction fixing portion 50. The main body 10, the reinforcing part 20, the hole 30, and the pulling part 40 of the suture instrument 200 and the medical member 100e are the same as those of embodiment 1. A treatment method using the medical member 100e is the same as that of embodiment 1, and thus, description thereof is omitted.

(modification 6 of embodiment 1)

Fig. 21 is a view showing a medical member 100f according to modification 6 of embodiment 1, and fig. 22 is a view showing a traction fixation portion 50f of the medical member 100f according to modification 6. In modification 5 of embodiment 1, the cylindrical member of the traction fixing portion 50e has a single inclined surface inclined like a truncated cone. However, as shown in fig. 21 and 22, the traction fixing portion may be configured to have a cylindrical member having two inclined side surfaces. The traction fixing portion 50f shown in fig. 22 is formed so that both inclined surfaces are contracted toward each other toward the center in the axial direction X. In the present modification, the slit 51 is provided at least either at the boundary between the two inclined surfaces having a smaller circumference or in the vicinity of the boundary. With such a configuration, when the linear member 41 of the traction portion 40 is wound around the cylindrical member of the traction fixing portion 50f, the linear member 41 can be wound so as to be close to the slit 51 having a short circumferential length, and thus the linear member 41 can be easily inserted into the slit 51.

Further, a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted can be provided in the tubular member of the traction fixing portion 50f, similarly to the tubular member of the traction fixing portion 50. The main body 10, the reinforcing part 20, the hole 30, and the pulling part 40 of the suture instrument 200 and the medical member 100f are the same as those of embodiment 1. A treatment method using the medical member 100f is the same as that of embodiment 1, and thus, description thereof is omitted.

(modification 7 of embodiment 1)

Fig. 23 is a view showing a medical member 100g according to modification 7 of embodiment 1, and fig. 24 is a view showing a traction fixation portion 50g of the medical member 100g according to modification 7. In embodiment 1, the traction fixing portion 50 has one tubular member. However, as shown in fig. 23 and 24, the cylindrical member constituting the traction securing portion 50g is not limited to one, and may be constituted by two or the like. In fig. 24, the traction fixing portion 50g includes a tubular member 50g1 (corresponding to the 1 st tubular member) and a tubular member 50g2 (corresponding to the 2 nd tubular member) as two tubular members having different circumferential lengths intersecting the axial direction X. The tubular member 50g1 is provided adjacent to the body 10, and the tubular member 50g2 is provided adjacent to the tubular member 50g1, is spaced apart from the body 10 as compared to the tubular member 50g1, and has an outer surface larger than the tubular member 50g 1. The tubular member 50g1 is configured to have a circular shape with a smaller circumference, i.e., a smaller diameter, than the tubular member 50g2. The tubular members 50g1 and 50g2 are formed as circular columns having side surfaces other than inclined surfaces, and the slits 51 are provided in the tubular member 50g1 adjacent to at least one of the boundaries with the tubular member 50g2 and the vicinity of the boundaries. With such a configuration, the linear member 41 of the traction portion 40 can be locked by the cylindrical member 50g2, and can be prevented or suppressed from coming off (escaping) from the cylindrical member.

As described above, in the present modification, the tubular member of the traction fixing portion 50g includes: a cylindrical member 50g1 provided adjacent to the main body 10; and a cylindrical member 50g2 which is provided adjacent to the cylindrical member 50g1 and has an outer surface formed larger than the cylindrical member 50g 1. The slit 51 is provided adjacent to the tubular member 50g2 in the axial direction X of the tubular member 50g 1. With such a configuration, when tension is applied to the linear member 41 of the traction portion 40, the linear member 41 of the traction portion 40 can be made less likely to come off from the slit 51. Further, the cylindrical members 50g1 and 50g2 may be provided with holes h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted. The main body 10, the reinforcing part 20, the hole 30, and the pulling part 40 of the suture instrument 200 and the medical member 100f are the same as those of embodiment 1. A treatment method using the medical member 100g is the same as that of modification 1 of embodiment 1, and thus, description thereof is omitted.

(modification 8 of embodiment 1)

Fig. 25 is a perspective view showing a traction fixation section 50h of a medical member according to modification 8 of embodiment 1, and fig. 26 is a plan view showing the traction fixation section 50 h. In embodiment 1, the slit 51 into which the linear member 41 of the pulling portion 40 can be inserted is provided on the outer surface of the cylindrical member of the pulling fixing portion 50. However, as shown in fig. 25 and 26, the tubular member of the traction fixing portion 50h may be provided with a through hole 54 through which the linear member 41 of the traction portion 40 can be inserted, not only in the outer surface of the tubular member provided with the slit 51, but also in a portion where the slit 51 is not provided in the circumferential direction θ. The through-hole 54 may be provided to connect one portion of the outer surface of the cylindrical member to another portion. The through-hole 54 may be formed so as to connect one portion to another portion linearly or to connect portions other than the linear portion so long as it is difficult to pull out the linear member 41 when the linear member 41 of the pulling portion 40 is inserted. The traction fixing portion 50h can prevent or suppress the occurrence of cracks or the like from the portion of the through-hole 54 by configuring the wall thickness of the portion where the through-hole 54 is provided to be larger than the portion where the through-hole is not provided. In the traction fixing portion 50h, the slits 51 and the through holes 54 can be provided in an arbitrary angular range when the cylindrical member of the traction fixing portion 50h is viewed in the axial direction X, and the through holes 54 can be provided in other angular ranges. The slit 51 and the through hole 54 may be separated in the circumferential direction θ. The linear member 41 of the traction portion 40 can be disposed so as to be inserted into the slit 51 and inserted into the through-hole 54. This prevents or suppresses a decrease in tension generated in the linear member 41 inserted into the slit 51 and the through-hole 54.

As described above, in the present modification, the traction fixing portion 50 includes the through-hole 54 through which the linear member 41 of the traction portion 40 can be inserted as the lock mechanism, and the through-hole 54 is configured to be used by inserting the linear member 41 of the traction portion 40. With such a configuration, the one end portion of the linear member 41 of the traction portion 40 is fixed in a state where the linear member 41 of the traction portion 40 is wound around the cylindrical member of the traction fixing portion 50, and the tension generated by the linear member 41 of the traction portion 40 can be maintained. Further, a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted can be provided in the cylindrical member of the traction fixing portion 50 h. The main body 10, the reinforcing portion 20, the hole 30, and the pulling portion 40 of the suture instrument 200 and the medical member of the present modification are the same as those of embodiment 1. The treatment method using the medical member of the present modification differs from embodiment 1 in that the linear member 41 of the pulling portion 40 is wound around the cylindrical member of the pulling and fixing portion 50h, and the linear member 41 is inserted into the slit 51 and inserted into the through-hole 54 after increasing the tension. The rest is the same as in embodiment 1, and thus, description thereof is omitted.

(modification 9 of embodiment 1)

Fig. 27 is a plan view showing a traction fixation portion 50k of a medical member according to modification 9 of embodiment 1. In embodiment 1, the slit 51 is provided in the side surface of the cylindrical member of the traction fixing portion 50. However, the traction fixing portion can be configured as follows.

In the present modification, as shown in fig. 27, the tubular member of the traction fixing portion 50k has a slit 51k, a through-hole 54k, and a protrusion 55. The slits 51k are provided along the circumferential direction θ in the outer side surface of embodiment 1. The slit 51k is provided substantially above the cylinder shown in fig. 27. The through-hole 54k is disposed at a position different from the slit 51k in the circumferential direction θ of the cylindrical member of the traction fixing portion 50 k. The through hole 54k is provided substantially below the cylindrical shape in fig. 27. The protruding portion 55 is adjacent to the cylindrical member in the axial direction X of the cylindrical member and is formed integrally with the cylindrical member. The protrusion 55 is formed to protrude outward in the radial direction r from a portion where any one of the slit 51k and the through hole 54k is provided in the circumferential direction θ of the cylindrical member. In the present modification, the protruding portion 55 is configured to protrude from the circumferential outer periphery of the cylindrical member in an arc shape outward in the radial direction r. The protrusion 55 can be provided at a position different from any one of the slit 51k and the through hole 54k in the height direction Z of the cylindrical member. In addition, any combination of the slit 51k and the projection 55 and the through-hole 54k and the projection 55 may be provided in one or more than one circumferential direction θ of the cylindrical member.

The main body 10, the reinforcing portion 20, the hole 30, and the pulling portion 40 of the suture instrument 200 and the medical member of the present modification are the same as those of embodiment 1. Further, the traction fixing portion 50k is provided with a hole h as in embodiment 1. The difference between the treatment method using the medical member of the present modification and that of embodiment 1 is the operation of inserting the linear member 41 of the pulling portion 40 into the slit 51k and the through-hole 54k. When inserting the linear member 41 of the traction portion 40 into the slit 51k, the operator inserts the linear member 41 of the traction portion 40 into the slit 51k and the through hole 54k at the same angular position as the protrusion 55 while checking the protrusion 55. The linear member 41 can be inserted into the slit 51k or the through-hole 54k in advance, as appropriate, depending on the length of the linear member 41. The other treatment methods are the same as those in embodiment 1. Therefore, the description is omitted.

As described above, in the medical member of the present modification, the protrusion 55 is provided in the traction fixation portion 50 k. The protruding portion 55 is adjacent to the cylindrical member in the axial direction X of the cylindrical member and is formed integrally with the cylindrical member. The projection 55 is formed to project outward in the radial direction r in a portion where the slit 51k or the through hole 54k is provided in the circumferential direction θ of the cylindrical member. In this way, by providing the protrusion 55 in the traction fixing portion 50k, the user can easily find a position where the reduction of the tension generated by the linear member 41 of the traction portion 40 is prevented or suppressed, like the slit 51 k. Further, by configuring (the aspect ratio of) the side surface of the tubular member including the slits 51k and the through-holes 54k as viewed in the axial direction X as a portion around which the linear member 41 is wound in the same manner as the arrangement of the fibers of the main body portion 10, the tension applied to the main body portion 10 as viewed in the axial direction X can be easily made uniform in the circumferential direction θ.

(modification 10 of embodiment 1)

Fig. 28 is a plan view showing a traction fixation section 50m of a medical member according to modification 10 of embodiment 1. In modification 9 of embodiment 1, the traction fixing portion 50k is provided with the protruding portion 55 protruding from the circumferential shape of the cylindrical member in an arc shape when viewed in the axial direction X. However, the shape of the protruding portion is not limited to the circular arc shape, and as shown in fig. 28, a protruding portion 55m including a relatively sharp corner portion may protrude outward in the radial direction r from the circumferential shape when viewed in the axial direction X.

The specification of the medical member other than the shape of the protruding portion 55m is the same as that of modification 9 of embodiment 1. That is, the protrusion 55m is configured to protrude radially outward from any one of the slit 51m and the through-hole 54m when viewed in the axial direction X, and the position where the protrusion 55m is provided is different from the position in the height direction Z of the slit 51m and the through-hole 54 m. The main body 10, the reinforcing portion 20, the hole 30, and the pulling portion 40 of the suture instrument 200 and the medical member of the present modification are the same as those of embodiment 1, and the treatment method using the medical member of the present modification is the same as that of modification 9 of embodiment 1. Therefore, the description is omitted.

(modification 11 of embodiment 1)

Fig. 29 is a view showing a traction portion 40n of a medical member 100n according to modification 11 of embodiment 1. In embodiment 1, the tension adjusted when the linear member 41 of the traction portion 40 is wound around the traction fixing portion 50 is maintained by inserting the linear member 41 into the slit 51. However, the configuration of maintaining the tension generated by the linear member 41 is not limited to the above.

In addition to the above-described structure for maintaining the tension generated by the linear member 41, as shown in fig. 29, the linear member 41 of the pulling portion 40n may be wound around the pulling and fixing portion 50, and a knotted portion may be formed on the outer surface of the cylindrical member of the pulling and fixing portion 50 by the linear member 41 of the pulling portion 40 n.

The suturing device 200 and the main body 10, the reinforcing part 20, the hole 30, and the traction fixing part 50 of the medical member are similar to those of embodiment 1. In the treatment method using the medical member, the operation of holding the tension generated by the pulling portion 40n is different from that of embodiment 1 as described above, and the excess wire member 41 is cut after the wire member 41 of the pulling portion 40n is wound around the cylindrical member of the pulling and fixing portion 50 to adjust the tension and form the knot portion, and the description is omitted as in embodiment 1 except for this operation. In addition, since the knotted portion is formed by the linear member 41 of the pulling portion 40n as described above in the present modification, the pulling fixing portion may not have the slit 51.

(modification 12 of embodiment 1)

Fig. 30 is a view showing a medical member 100p according to modification 12 of embodiment 1. In embodiment 1, it is described that the pulling portion 40 has the linear member 41, the linear member 41 is wound around the cylindrical member of the pulling fixing portion 50, and then the linear member 41 of the pulling portion 40 is inserted into the slit 51. However, the traction portion can be configured as follows.

The traction portion 40p has another locking mechanism that prevents or suppresses a decrease in tension generated by the traction portion. The pulling portion 40p further includes a holding member 42 as another locking mechanism in addition to the linear member 41. The holding member 42 is configured to hold the tension adjusted when the tension of the main body 10 is adjusted by the linear member 41 of the traction portion 40 p. As shown in fig. 30, the holding member 42 has a cylindrical shape having two holes through which both end portions of the linear member 41 of the pulling portion 40p are inserted, and the inner wall surface of the cylindrical shape can be configured to have a relatively high friction coefficient.

The main body 10, the reinforcing part 20, and the hole 30 of the suture instrument 200 and the medical member 100p are the same as those of embodiment 1. Further, the pulling portion 40p has the holding member 42, so that the slit 51 is not required in the pulling fixing portion, but the slit 51 may be provided. In addition, the procedure for adjusting the tension of the main body 10 only by the traction unit 40p differs from that of embodiment 1 with respect to the treatment method using the medical member 100 p.

After the medical member 100p is attached to the shaft 310 of the 2 nd engaging tool 270, the linear member 41 of the traction portion 40n is wound around the cylindrical member of the traction fixing portion 50, and the tension is increased. Then, the tension generated by the linear member 41 of the pulling portion 40p is held by the holding member 42 by passing both ends of the linear member 41 of the pulling portion 40p through the holes of the holding member 42 and adjusting the length of the protrusion of both ends of the linear member 41 from the holding member 42. The following operations are the same as those in embodiment 1, and thus, description thereof is omitted.

As described above, in the present modification, the traction portion 40p is configured to include another lock mechanism that prevents or suppresses a decrease in tension generated by the traction portion 40p, as in the holding member 42. By providing the traction portion 40p with the function of preventing or suppressing the reduction of the tension in this manner, the punching operation of the body portion 10 by the punching portion 250 can be easily performed.

(modification 13 of embodiment 1)

Fig. 31 is a diagram showing a medical member 100q according to modification 13 of embodiment 1. In embodiment 1, it is explained that tension is generated by winding the linear member 41 around the cylindrical member of the traction fixing portion 50 in a state where both end portions of the linear member 41 of the traction portion 40 are not fixed, and therefore, both end portions are inserted into the slits 51.

However, the linear member 41 of the pulling portion 40q may be configured such that the pulling fixing portion 50 is wound around the tubular member with one end portion fixed to the main body portion 10. The portion of the linear member 41 of the pulling portion 40q that is not fixed may be configured such that the knotted portion is formed by winding the linear member 41 around the cylindrical member of the pulling and fixing portion 50 as in modification 11, or may be wound around the suture portion a11 formed on the shaft 310 of the 2 nd engaging tool 270. The main body 10, the reinforcing part 20, the hole 30, and the traction fixation part 50 of the suture instrument 200 and the medical member 100q are the same as those of embodiment 1. The treatment method using the medical member 100q is similar to that of embodiment 1 except that when the linear member of the pulling portion 40q is wound around the tubular member of the pulling and fixing portion 50, one end portion of the linear member 41 of the pulling portion 40q is fixed to the main body portion 10. Therefore, the description is omitted.

(modification 14 of embodiment 1)

Fig. 32 is a view showing a traction unit 40r of a medical member 100r according to modification 14 of embodiment 1. In modification 12 of embodiment 1, the pulling portion 40p has been described as having the holding member 42 as another lock mechanism. However, the other lock mechanism in the traction portion can be configured as follows.

In the present modification, the pulling portion 40r includes a linear member 41, and a plurality of locking portions 43 are provided on the linear member 41 at intervals. The engagement portion 43 is configured to be able to be hooked to the mesh of the main body portion 10 against the tension generated by the linear member 41 of the traction portion 40 by a ball having a diameter larger than the through hole 11 of the main body portion 10. In this way, the tension generated by the linear member 41 of the traction portion 40r can be adjusted and maintained by hooking the engagement portion 43 of the traction portion 40q to a desired position of the main body portion 10.

The main body 10, the reinforcing part 20, the hole 30, and the traction fixing part 50 of the suture instrument 200 and the medical member 100r are the same as those of embodiment 1. The treatment method using the medical member 100r is the same as that of embodiment 1 except that the operation of adjusting and holding the tension generated by the linear member 41 of the traction portion 40r is performed by the locking portion 43, and thus the description thereof is omitted. Note that although locking portion 43 is shown as an eye-shaped structure in fig. 32 for easy understanding of hooking to main body 10 having through-hole 11, the specification of main body 10 is the same as that of embodiment 1 and the like.

(modification 15 of embodiment 1)

Fig. 33 is a view showing a traction unit 40s and the like of a medical member 100s according to modification 15 of embodiment 1. In modification 12 of embodiment 1, the pulling portion 40p has been described as having the holding member 42 as another lock mechanism.

However, as shown in fig. 33, the pulling portion 40s may be configured to further include an engaging portion 44 and an insertion portion 45 in addition to the linear member 41s as another locking mechanism. The linear member 41s is formed like a band in the present modification, and the insertion portion 45 is provided near one end portion of the linear member 41s in the longitudinal direction. The plurality of locking portions 44 are provided near an end portion of the linear member 41s opposite to the insertion portion 45 in the longitudinal direction. As shown in fig. 33, the pulling portion 40s is wound so as to cover the tubular member of the pulling fixing portion 50 with the linear member 41s inserted through the insertion portion 45. Then, the linear member 41s is appropriately pulled, and the position where the engagement portion 44 is engaged is adjusted to adjust and maintain the tension generated by the linear member 41s of the pulling portion 40 s.

The main body 10, the reinforcing part 20, the hole 30, and the traction fixation part 50 of the suture instrument 200 and the medical member 100s are the same as those of embodiment 1. The treatment method using the medical member 100s is the same as that of embodiment 1 except for the adjustment of the tension generated by the traction unit 40s described above, and thus, the description thereof is omitted.

(modifications 16, 17, and 18 of embodiment 1)

Fig. 34 is a view showing a pulling part 40t1 of a medical member 100t1 according to modification 16 of embodiment 1, and fig. 35 is a view showing a pulling part 40t2 of a medical member 100t2 according to modification 17 of embodiment 1. Fig. 36 is a view showing a traction portion 40t3 of a medical member 100t3 according to modification 18 of embodiment 1.

In embodiment 1, it is described that, when the main body 10 is viewed in the axial direction X, tension is generated in a state where the linear member 41 of the traction portion 40 is stitched in a perfect circle shape with respect to the main body 10. However, the method of stitching the linear member 41 of the traction portion with respect to the main body portion 10 as viewed in the axial direction X is not limited to the perfect circle shape.

In addition to the above, as shown in fig. 34, when the main body 10 is viewed in the axial direction X, the linear member 41 may be stitched to the main body 10 so that the linear member 41 of the pulling portion 40t1 forms a star shape. As shown in fig. 35, the linear member 41 may be stitched to the body 10 so that the linear member 41 of the traction portion 40t2 forms an elliptical shape when the body 10 is viewed in the axial direction X. As shown in fig. 36, the linear member 41 of the traction portion 40t3 may be stitched to the main body 10 so that the linear member 41 forms a polygon such as a rectangle when the main body 10 is viewed in the axial direction X.

When the mesh is formed by knitting a linear member, the stretching of the mesh constituting the main body portion 10 differs depending on whether the knitting mode of the thread is orthogonal or the radial and circumferential threads intersect with each other. By configuring the knitting form of the pulling portion 40 as described above when viewed in plan from the axial direction X, the tension generated by the linear member of the pulling portion can be generated in a state in which the main body portion 10 is as nearly uniform as possible in accordance with the stretching form of the mesh. The suturing device 200 and the main body 10, the reinforcing part 20, the hole 30, and the traction fixing part 50 of the medical member are similar to those of embodiment 1. A treatment method using a medical member is the same as that of embodiment 1, and thus, description thereof is omitted.

(modifications 19 and 20 of embodiment 1)

Fig. 37 is a view showing the pitch of the linear member 41 of the traction portion 40 relative to the stitching of the main body portion 10 of the medical member 100. Fig. 38 is a view showing the pitch of the linear members 41 sewn to the body 10 in the medical member according to modification 19, and fig. 39 is a view showing the pitch of the linear members 41 sewn to the body 10 in the medical member according to modification 20. In embodiment 1, the linear member 41 of the traction portion 40 is sewn to the main body portion 10.

Here, when the stitching of the linear member 41 of the traction portion 40 to the main body portion 10 of embodiment 1 is illustrated as in fig. 37, the stitching of the traction portion 40 to the main body portion 10 may be made relatively narrow in pitch as shown by the traction portion 40U1 in fig. 38 (modification 19). Note that, the pitch of the stitching of the leading portion 40 with respect to the body portion 10 may be configured not as shown in fig. 37 and 38 but as shown in the leading portion 40U2 of fig. 39, a relatively large pitch and a relatively small pitch are mixed (modification 20).

The suturing device 200 and the main body 10, the reinforcing part 20, the hole 30, and the traction fixing part 50 of the medical member are similar to those of embodiment 1. The treatment method using the medical member is the same as that of embodiment 1. Therefore, the description is omitted.

(modifications 21 and 22 of embodiment 1)

Fig. 40 is a view showing a traction unit 40v of a medical member 100v according to modification 21 of embodiment 1. Fig. 41 is a view showing a traction unit 40w of a medical member 100w according to modification 22 of embodiment 1. In embodiment 1, the tension of the main body 10 is adjusted by the traction portion 40 by winding one linear member 41 around the cylindrical member of the traction fixing portion 50.

However, the specific pattern of the traction portion is not limited to one linear member. In addition to the above, as shown in the medical member 100v of fig. 40, the traction portion 40v may be configured to include two linear members 41, and the tension of the main body portion 10 may be adjusted by partially winding the two linear members 41 around the entire circumference of the cylindrical member of the traction fixation portion 50 (modification 21). The number of the linear members 41 of the pulling portion is not limited to two as shown in fig. 40, and may be other than two, such as six, as shown in the pulling portion 40w of the medical member 100w of fig. 41 (modification 22).

The suturing device 200 and the main body 10, the reinforcing part 20, the hole 30, and the traction fixing part 50 of the medical member are similar to those of embodiment 1. In the treatment method using the medical member, the operation method other than the traction portion is the same as that of embodiment 1. In fig. 40, the tension of the main body 10 is adjusted by pulling two linear members 41, and then the ends of the linear members 41 are inserted into slits 51 (not shown) to maintain the tension. In fig. 41, the tension of the body portion 10 in the circumferential direction θ is adjusted by pulling six linear members 41, and after the adjustment is completed, the ends of the plurality of linear members 41 are inserted into slits 51 (not shown) to maintain the tension. The rest is the same as in embodiment 1, and thus, description thereof is omitted.

In modifications 21 and 22 as described above, the pulling portions 40v and 40w are configured to include a plurality of linear members 41 other than one. Since the stretching in the circumferential direction θ may be uneven, the main body 10 is composed of a plurality of linear members 41 constituting the traction portions 40v and 40x, and thus the tension of the main body 10 having a complicated distribution can be finely adjusted.

(modification 23 of embodiment 1)

Fig. 42 is a plan view showing a medical member 100x according to modification 23 of embodiment 1. In embodiment 1, the linear member 41 of the traction portion 40 is sewn to the outer periphery of the main body portion 10. However, the ring-shaped fixing frame 60 may be disposed on the main body 10, and the linear member 41 of the traction portion 40x may be sewn to both the main body 10 and the fixing frame 60 as shown in fig. 42. With such a configuration, the tension generated when the linear member 41 of the traction portion 40x is wound around the traction fixing portion 50 can be dispersed to the entire body portion 10.

The fixing frame 60 is provided inside the main body 10 so as to be adjacent to the main body 10, and is configured to disperse tension applied to the main body 10 by the linear member 41 of the traction portion 40 x. When the linear member 41 of the pulling portion 40x is pulled, the fixing frame 60 is pulled inward in the radial direction r, and contributes to the generation of tension. The fixing frame 60 may be integrally formed with the main body 10 by fusion or the like. The fixing frame 60 can be made of a material having a relatively high hardness. The fixing frame 60 may or may not be a bioabsorbable material. The fixing frame 60 is disposed relatively inside the main body 10, and thus can be punched out by the punched-out portion 250 of the suture instrument 200, so that the main body 10 is not left in the body when the suture instrument 200 leaves the body organ.

The main body 10, the reinforcing part 20, the hole 30, the traction part 40, the traction fixation part 50, and the treatment method of the medical member 100x are the same as those of embodiment 1. Therefore, the description is omitted.

As described above, in the present modification, the medical member 100x is provided with the fixing frame 60 which is provided adjacent to the main body 10 and disperses the tension applied to the main body 10 by the linear member 41 of the traction portion 40 x. With such a configuration, the stress of the body 10 is dispersed, and punching by the punching portion 250 can be easily performed. In addition, the provision of the fixing frame 60 can also contribute to prevention of damage to the main body 10.

(embodiment 2)

Fig. 43 is a perspective view showing the medical component 100y according to embodiment 2, and fig. 44 is a plan view showing the traction fixation portion 50y and the like of the medical component 100y according to embodiment 2. In embodiment 1, the tension generated by the linear member of the pulling portion 40 is held by the slit 51 formed in the cylindrical member of the pulling fixing portion 50. However, the traction fixing portion can be configured as follows.

In the present embodiment, the main body 10, the reinforcing portion 20, and the hole 30 constituting the medical member 100y are the same as those of embodiment 1. Therefore, the description is omitted.

In the present embodiment, the pulling section 40y is configured to be able to change the tension of the main body section 10 when pulling the linear member 41 in a state where the linear member 41 is stitched to the main body section 10, as in embodiment 1.

As shown in fig. 43 and 44, the traction fixing portion 50y includes a fixed tubular member 51y, a rotary tubular member 52y, and a linear member insertion portion 53y. The fixed tubular member 51y is integrally formed with the main body 10 in the vicinity of the center of the main body 10, as in embodiment 1. The fixed cylindrical member 51y has a hole h through which the shaft 310 of the 2 nd engaging tool 270 can be inserted. The fixed cylindrical member 51y has a plurality of engaging portions 54y formed in an uneven shape along the outer side surface so as to be able to fix the position in the circumferential direction θ of the rotary cylindrical member 52y that fixes the one end portion of the linear member 41 of the pulling portion 40 y. The engaging portion 54y is formed in an uneven shape having a plurality of substantially circular arc shapes arranged along the outer side surface of the cylindrical shape.

The rotary tubular member 52y is disposed outside the fixed tubular member 51y in plan view and is configured to be rotatable with respect to the fixed tubular member 51 y. One end of the linear member 41 of the traction portion 40y is fixed to the outer surface of the rotary cylindrical member 52y. The rotary tubular member 52y has an engaged portion 55y formed by a plurality of projections and recesses on the inner surface and engageable with the engaging portion 54y of the fixed tubular member 51 y. Thus, when the user rotates the rotary tubular member 52y with respect to the fixed tubular member 51y, the amount of the thread-like member 41 wound around the rotary tubular member 52y with respect to the rotary tubular member 52y can be changed to adjust the tension of the main body 10 by the traction portion 40 y. By engaging the engaging portion 54y and the engaged portion 55y with each other, the rotary cylindrical member 52y can be prevented from rotating relative to the fixed cylindrical member 51y in a direction in which the linear member 41 of the traction portion 40y is loosened.

The linear member insertion portion 53y is provided for guiding the linear member 41 sewn into the traction portion 40y of the main body 10 to the tubular member. In the present embodiment, the linear member insertion portion 53y is provided so that a cylindrical shape having a hole portion through which the linear member 41 can be inserted is integrated with the main body portion 10, the fixed cylindrical member 51y, and the like. The linear member insertion portion 53y is provided adjacent to the rotary tubular member 52y in the vicinity of the substantial center of the main body 10.

In the treatment method using the medical member 100y of the present embodiment, the operation of adjusting the tension of the main body 10 by the traction unit 40y and the traction fixation unit 50y is different from that of embodiment 1, and the other operations are the same as those of embodiment 1.

The operator takes out the mouth side A1 of the living body organ to the outside of the body, inserts the 2 nd engaging tool 270 into the mouth side A1 to form the sutured portion a11, and then rotates the rotary tubular member 52y around which the linear member 41 of the traction portion 40y is wound with respect to the fixed tubular member 51y to adjust the tension of the main body portion 10. The rotary cylindrical member 52y can maintain the engagement position between the engagement portion 54y and the engaged portion 55y by changing the engagement position between the engagement portion 54y of the fixed cylindrical member 51y and the engaged portion 55y of the rotary cylindrical member 52y, thereby changing the tension generated by the linear member 41 of the traction portion 40 y. After adjusting the tension of the main body 10 to the state desired by the operator, the operator inserts the hole 30 and the hole h of the medical component 100y into the shaft 310 of the 2 nd engagement tool 270. In this way, in the present embodiment, the tension of the main body 10 generated by the linear member 41 of the traction portion 40y is adjusted before the main body 10 is inserted into the shaft 310 of the 2 nd engagement tool 270. Other operations are the same as those in embodiment 1, and thus, description thereof is omitted.

As described above, the tubular member of the traction fixing portion 50y includes: a fixed tubular member 51y integrally formed with the main body 10; and a rotary tubular member 52y disposed outside the fixed tubular member 51y and rotatable with respect to the fixed tubular member 51 y. The fixed cylindrical member 51y has an engaging portion 54y formed in a concave-convex shape along the outer side surface. The rotating cylindrical member 52y is configured such that one end of the linear member 41 of the pulling portion 40y is fixed to the outer surface thereof, and an engaged portion 55y capable of engaging with the engaging portion 54y of the fixed cylindrical member 51y is provided on the inner surface of the rotating cylindrical member 52y.

With such a configuration, the tension generated by the linear member 41 of the traction portion 40y can be maintained.

The present invention is not limited to the above embodiments, and various modifications can be made within the scope of the claims. In modification 8 of embodiment 1, a through-hole 54 is formed in the outer surface of the cylindrical member of the traction fixing portion 50h in addition to the slit 51. However, the traction fixing portion may have the through hole 54 but not the slit 51 as long as the tension adjusted by the linear member of the traction portion 40 can be maintained. The timing of adjusting the tension of the main body 10 generated by the traction unit depends on the hardness of the traction fixation unit. Therefore, the timing of adjusting the tension of the body portion by the traction portion may be performed after the body portion 10 is inserted into the shaft 310 of the 2 nd engagement tool 270 as described in embodiment 1, or may be performed before the body portion 10 is inserted into the shaft 310 as described in embodiment 2.

Although the medical member 100 is provided with the support portion 21 in embodiment 1, the medical member may not be provided with the support portion 21 as another embodiment of the present invention. In addition, as long as the shaft 310 of the suture instrument 200 can be inserted into the medical member, the medical member may not be provided with the hole 30 in the main body portion 10 and the hole h in the traction fixing portion 50 or the like as another embodiment of the present invention.

In embodiment 2, when the linear member 41 stitched to the drawing portion 40 of the main body portion 10 is fixed to the rotary tubular member 52y, it is inserted into the hole of the linear member insertion portion 53y. However, the portion of the linear member 41 of the traction portion 40 to be a connection point is not limited to a hole portion, and a slit may be provided instead of the hole portion.

Claims (15)

1. A medical member, comprising:

a sheet-like main body portion having a plurality of through holes formed therein and capable of following the movement of a living organ to be anastomosed;

a traction unit that includes a long linear member and can increase tension in the plane direction of the main body by traction; and

and a traction fixing portion including a cylindrical member around which the linear member of the traction portion is wound, the tension being adjustable by winding the linear member around the cylindrical member.

2. The medical member according to claim 1,

the traction fixing portion has a lock mechanism that generates a resistance force that prevents or suppresses a reduction in the tension generated by the traction portion.

3. The medical member according to claim 2,

the locking mechanism includes a slit formed in a side surface of the cylindrical member,

the linear member generates the resisting force when sliding with respect to an insertion portion of the slit from a state in which the linear member is inserted into the slit.

4. The medical member according to claim 2,

the locking mechanism includes a through-hole in the cylindrical member through which the linear member of the traction portion can be inserted,

the through hole is used by inserting the linear member.

5. The medical member according to claim 3,

the cylindrical member includes an inclined portion formed in such a manner that the size thereof becomes larger as the outer side surface goes toward the end portion in the axial direction,

the slit is formed at a root portion of the inclined portion.

6. The medical member according to claim 3,

the cylindrical member has a recess portion in which at least a part of an outer surface is recessed toward a radially inner side,

the slit is formed in the recess.

7. The medical member according to claim 3,

the cylindrical member has: a1 st cylindrical member provided adjacent to the main body portion; and a2 nd cylindrical member which is provided adjacent to the 1 st cylindrical member and has an outer surface formed larger than the 1 st cylindrical member,

the slit is provided adjacent to the 2 nd cylindrical member in the axial direction of the 1 st cylindrical member.

8. The medical member according to claim 3,

the traction fixing portion further includes a protruding portion that is adjacent to the tubular member in the axial direction of the tubular member, is formed integrally with the tubular member, and is formed to protrude radially outward in a portion where the slit is provided in the circumferential direction of the tubular member.

9. The medical member according to any one of claims 1 to 8,

the traction portion has another locking mechanism that prevents or inhibits a reduction in the tension generated by the traction portion.

10. The medical member according to any one of claims 1 to 8,

the tension-distributing member is provided with a fixing frame which is provided adjacent to the main body and distributes the tension generated in the main body by the linear member.

11. The medical member according to claim 1,

the cylindrical member has: a fixed cylindrical member integrally formed with the main body; and a rotary tubular member disposed outside the fixed tubular member and rotatable with respect to the fixed tubular member,

the fixed cylindrical member has an engaging portion formed in a concave-convex shape along an outer side surface,

the rotary cylindrical member has an outer side surface to which one end of the linear member is fixed, and has an engaged portion formed on the inner side surface of the rotary cylindrical member and engageable with the engaging portion of the fixed cylindrical member.

12. The medical member according to any one of claims 1 to 11,

the support portion is provided on the outer periphery of the main body portion and has higher rigidity than the main body portion.

13. The medical member according to any one of claims 1 to 12,

the traction fixing portion has a hole portion larger than the through hole.

14. The medical member according to any one of claims 1 to 13,

the main body part is configured to induce the discovery of a biological component by being applied to an anastomotic portion of the living body organ, and to promote the healing of the anastomotic portion by allowing the induced biological component to penetrate and gather from the through-hole.

15. A method of using a medical member, characterized in that,

preparing a suturing device having a1 st engaging tool and a2 nd engaging tool, wherein the 1 st engaging tool can be arranged on one side of the main body part according to any one of claims 1 to 14, and has a releasing part capable of releasing a joining member for joining the living body organ and a1 st axis arranged radially inward of the releasing part, the 2 nd engaging tool can be arranged on the other side of the main body part, and has a2 nd axis capable of engaging with the 1 st axis, and the main body part is clamped together with the 1 st engaging tool,

inserting the 2 nd shaft of the 2 nd engaging tool into a substantially central portion of the main body,

the linear member of the traction portion is wound around the outer periphery of the cylindrical member of the traction fixation portion to adjust the tension, and the living body organ is anastomosed while the main body portion is sandwiched between the living body organs to be anastomosed,

the adjustment based on the tension of the linear member is performed after the main body portion is inserted into the 2 nd shaft or before the main body portion is inserted into the 2 nd shaft.

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