JP2000060862A - Pallial tube for insertion of thoracoscope with cuff - Google Patents

Pallial tube for insertion of thoracoscope with cuff

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Publication number
JP2000060862A
JP2000060862A JP10233734A JP23373498A JP2000060862A JP 2000060862 A JP2000060862 A JP 2000060862A JP 10233734 A JP10233734 A JP 10233734A JP 23373498 A JP23373498 A JP 23373498A JP 2000060862 A JP2000060862 A JP 2000060862A
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cuff
insertion
thoracoscope
internal
side
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Japanese (ja)
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Toshiaki Morikawa
Minoru Shibata
Shiro Uehama
史朗 上濱
稔 柴田
利昭 森川
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Sumitomo Bakelite Co Ltd
住友ベークライト株式会社
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Priority to JP10233734A priority Critical patent/JP2000060862A/en
Publication of JP2000060862A publication Critical patent/JP2000060862A/en
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Abstract

PROBLEM TO BE SOLVED: To prevent the bleeding from the circumference of an insertion part by forming two shrinkable cuffs as internal cuffs and external cuffs, respectively hermetically providing a pallial tube with these cuffs in its circumferential direction and specifying the length of the internal cuff from the end of a thoracoscope inspection port side to an internal side aperture and the expansion capacity of the external cuff.
SOLUTION: The pallial tube for thoracoscope insertion with the cuffs for insertion of the thoracoscope into an incised port in thoracoscopic surgery comprises a conduit 1 extending from the external side to the internal side, the external cuff 2 and the internal cuff 3. Ribs are formed along an axial direction in the thoracoscope insertion cavity 6 in the conduit 1. The external cuff 2 and the internal cuff 3 are expandable and shrinkable. The diameter of the largest part of the cuffs 2 and 3 at the time of their dilation attains 8 to 50 mm in diameter and the diameter of the largest part thereof is preferably approximately the same as the outside diameter of the conduit 1 at the time of shrinkage. The length from the end on the thoracoscope insertion port side of the internal cuff 3 to the aperture on the internal side is set at ≤30 mm and the dilation capacity of the external cuff 2 at a range of 3 to 10 times the dilation capacity of the internal cuff 3.
COPYRIGHT: (C)2000,JPO

Description

【発明の詳細な説明】 【0001】 【発明の属する技術分野】本発明は主として胸腔鏡下外科手術において、切開口に挿入し胸腔鏡を挿通するためのカフ付胸腔鏡挿入用外套管に関するものである。 BACKGROUND OF THE INVENTION [0001] In the present invention mainly thoracoscopic surgery BACKGROUND OF THE INVENTION, relates thoracoscopic insertion cannula cuffed for inserting a thoracoscope is inserted into incision it is. 【0002】 【従来の技術】近年、胸腔鏡下外科手術が急速な広がりをみせ、その適応も拡大している。 [0002] In recent years, thoracoscopic surgery showed a rapid spread, is also expanding its adaptation. これは当初胸腔鏡下気胸手術のような比較的易しいものからスタートしたが、術者の技術向上、器具の改良などによりやがて肺腫瘍、肺癌の手術など従来開胸手術でしか成しえなかったような手術を胸腔鏡下で行うようになりつつある。 This was started from relatively easy ones, such as the original thoracoscopic pneumothorax surgery, the surgeon improvement of technology, could not have only form in soon lung tumor, such as surgery for lung cancer conventional open-heart surgery due to improvement of the instrument It is becoming to perform under thoracoscopic surgery, such as. 【0003】これは胸腔鏡下外科手術が切開を行わないため、患者の術後退院までの期間が短く、また美容上も優れていることが患者のニーズに合っていたためと考えられる。 [0003] This is because the thoracoscopic surgery is not performed an incision, shorter period of up to postoperative hospital discharge of the patient, and it is also excellent on the beauty is considered to be due to not meet the needs of the patient. 一方で美容上の問題から挿入する外套管の本数を減らしたり、外套管の外径をなるべく小さくするなどの試みもなされている。 Meanwhile or reduce the number of the mantle tube to be inserted from cosmetic problems, an attempt has been made, such as minimize the outer diameter of the mantle tube. これは一方で操作性を悪くし、 This is bad operability On the other hand,
ひいては術者のストレス・誤操作につながるため、あまり進んでいないのが現状である。 Because it leads to turn the operator of stress erroneous operation, at present, does not much headway. 【0004】胸腔鏡下の気胸の手術程度であれば、使用する外套管の数は1〜2本程度で済み、また時間が短いため肋間神経を痛めることも少ないが、肺癌などのより高度な手術を行う場合は、使用する外套管の数も多く、 [0004] If the operation order of pneumothorax thoracoscopic, the number of the mantle tube to be used requires only one to two present and it is also less damage to the intercostal nerve for a short time, more advanced, such as lung cancer when performing surgery, many number of the mantle tube to be used,
また時間が長くかかるため肋間神経を痛め、患者の術後疼痛が長引くという欠点がある。 Also damage the intercostal nerve because it takes a long time, there is a disadvantage that prolonged the patient's post-operative pain. このため術式としては前胸部方向より操作鉗子を挿入し、後胸部方向から胸腔鏡を挿入するのが一般的となりつつある。 Therefore Insert the operation forceps from precordial direction as surgical techniques, to insert a thoracoscope from rear chest direction are becoming common. 【0005】この術式によれば前胸部方向から挿入する鉗子の数が少なくて済むため、肋間神経を痛めることが少なく、ひいては患者の術後疼痛が少なくて済むというメリットがある。 [0005] The operative to fewer number of forceps before inserting the chest direction according formulas, less likely to damage the intercostal nerve, there is an advantage that fewer turn postoperative pain patients. 一方では、胸腔鏡を後胸部方向から挿入するため、筋層を2層通過し、少量ずつではあるが挿入部より出血しやすいという欠点がある。 On the one hand, to insert a thoracoscope from the rear chest direction, the muscularis through two layers, there is a drawback that bleed easily than some but the insertion portion in small portions. 【0006】このためこうした出血を防止するために、 [0006] In order to prevent such bleeding for this,
例えば実願平3−106410号に開示された医療用装着用バルーンカテーテルや、特開平5−161657号公報に開示された腹腔鏡下胆嚢摘出術後処置用バルーン付きトラカール、および特願平10−032948号に開示されたカフ付医療用腹腔鏡挿入用外套管などが流用された。 For example Jitsugantaira 3-106410 and medical mounted balloon catheter disclosed in JP, Hei 5-161657 discloses the disclosed laparoscopic cholecystectomy for the treatment balloon trocar, and Japanese Patent Application No. 10- and medical laparoscope insertion cannula is diverted cuffed disclosed in JP 032948. これは、本来気腹ガスの漏れを防止するため開発された物であるため、胸腔鏡下外科手術で用いるには不向きであった。 This is because it was developed to prevent leakage of the original pneumoperitoneum gas, it is not suitable for use in thoracoscopic surgery. それは胸腔内に挿入されるバルーンが邪魔になり、胸腔内でしめるスペースが大きいためであった。 It balloon in the way to be inserted into the thoracic cavity was due space occupied in the thoracic cavity is greater. 【0007】また一方で、胸腔鏡下外科手術専用のトラカールとして、実用新案登録第3024069号に示される胸腔鏡挿入用補助具なる物も開示されている。 [0007] On the other hand, as a trocar dedicated thoracoscopic surgery, it is also disclosed those comprising thoracoscope insertion aid shown in Utility Model Registration No. 3,024,069. これは胸壁上の挿入部周囲の出血防止が目的であった。 This bleeding prevention of the insertion portion surrounding the chest wall was an object. この発明による補助具ではバルーンおよびストッパーにより胸壁を挟み込み、出血を防止する。 The aid according to the invention sandwiching the thoracic wall by a balloon and the stopper to prevent bleeding. この場合、構成する部材が抗血栓性を有しており出血は良好に抑えられた。 In this case, bleeding members constituting the have antithrombotic was suppressed satisfactorily.
しかし一方で素材がシリコーンゴムであるため、耐圧が不十分で比較的破裂しやすく、破裂した際に胸腔内に損傷を与えることが避けられなかった。 On the other hand because the material is a silicone rubber, the withstand voltage is relatively easily ruptured inadequate, can damage the thoracic cavity unavoidable when ruptured. また抗血栓性を有する材料を使用するため、比較的高価な物となるきらいがあった。 Since the use of materials having anti-thrombotic, there is Kirai to be relatively expensive. 【0008】 【発明が解決しようとする課題】本発明は従来の胸腔鏡下外科手術において使用される外套管の性能向上を目指し、種々の検討の結果なされたもので、挿入部周囲からの出血が防止されるばかりでなく、狭い胸腔内において十分な視野が得られ、耐圧が十分で胸腔内に損傷を与える危険性が少なく、また比較的安価なカフ付胸腔鏡挿入用外套管を提供するものである。 [0008] [0008] The present invention aims to improve the performance of the cannula used in conventional thoracoscopic surgery, which was made the result of various studies, bleeding from the insertion portion around not only but is prevented, a sufficient field of view obtained in a narrow thoracic cavity, the breakdown voltage is less risk of damage to the well in the thoracic cavity, also provides a relatively inexpensive thoracoscopic insertion trocar cuffed it is intended. 【0009】 【課題を解決するための手段】即ち本発明は、少なくとも一つの内腔を有する筒状の外套管であって、長さ方向に沿って収縮可能な2つのカフが、体内側カフ及び体外側カフとしてそれぞれ外套管の円周方向に気密的に設けられており、外套管の体内側カフの胸腔鏡挿入口側端部より体内側開口部までの長さが30mm以下であり、また体外側カフの膨張容量は体内側カフの膨張容量の3〜 [0009] [Means for Solving the Problems] Specifically, the present invention is a cylindrical mantle tube of which has at least one lumen, the collapsible two cuffs along the longitudinal direction, the body side cuff and is hermetically disposed in the circumferential direction of the mantle tube respectively as extracorporeal cuff length to the body side opening than thoracoscopic insertion opening side end portion of the body side cuff of the mantle tube is not more 30mm or less, the expansion capacity of the extracorporeal side cuff 3 of the expansion capacity of the body side cuff
10倍でであり、該外套管の内側に滑り向上のためのリブを設けたことを特徴とするカフ付胸腔鏡挿入用外套管である。 And a 10-fold, a thoracoscope insertion mantle tube cuffed, characterized in that a rib for improving sliding inside the 該Gaito tube. 【0010】 【発明の実施の形態】以下図面を用いて本発明を詳細に説明する。 [0010] The present invention will be described in detail with reference to the DETAILED DESCRIPTION OF THE INVENTION The following drawings. 図1(a)は本発明によるカフ付胸腔鏡挿入用外套管の一実施例を示す概略図で図1(b)はその断面図を示す。 1 (a) is FIG. 1 (b) diagrammatically showing an embodiment of a thoracoscope insertion cannula cuffed according to the invention shows a sectional view thereof. 図2(a)はその胸壁への穿刺使用例を示し、図2(b)は比較のため従来のカフ付医療用腹腔鏡挿入用外套管を胸壁へ穿刺使用した例を示す。 2 (a) shows a puncture use example to the chest wall, FIG. 2 (b) shows an example in which the punctured using the chest wall of the conventional medical laparoscope insertion cannula cuffed for comparison. 図3は手術を行う実施例を示す概略図である。 Figure 3 is a schematic diagram showing an example of performing surgery. 図4は胸腔鏡挿通腔の内側に立てたリブの一実施例を示す概略図である。 Figure 4 is a schematic diagram showing an embodiment of a rib erected on the inside of thoracoscopic insertion lumen. 【0011】本発明によるカフ付胸腔鏡挿入用外套管は、主として体外側より体内側に伸びる導管(1)、体外側カフ(2)および体内側カフ(3)よりなる。 [0011] The cuffed thoracoscopic insertion mantle tube according to the invention is mainly conduit extending inside the body from outside the body (1), consisting of the extracorporeal cuff (2) and the body-side cuff (3). 導管(1)は断面が円形、楕円形、正六角形もしくは正八角形などの対称形を有するものであり、成形性、挿入性の面から円形もしくは楕円形が好ましい。 Conduit (1) has a circular cross-section, oval, are those having a symmetrical, such as a regular hexagon or regular octagon, moldability, preferably circular or oval in view of insertability. 【0012】胸腔鏡挿通腔(6)の軸方向に沿ってリブ(5)を立てることもある。 [0012] along the axial direction of the thoracoscope through cavity (6) sometimes make a rib (5). (図4)これはリブ(5) (Figure 4) which rib (5)
を立てることにより、胸腔鏡(14)と胸腔鏡挿通腔(6)の接触面積を減らし、ひいては胸腔鏡(14)との滑りを良好にする。 To make a result, reduce the area of ​​contact thoracoscopy (14) and thoracoscopic insertion cavity (6), to improve the sliding of the turn thoracoscope (14). これにより万が一胸腔鏡挿通腔(6)が押しつぶされて、内腔が狭くなり胸腔鏡(1 Thus by chance thoracoscopic insertion cavity (6) is crushed, the lumen narrows thoracoscopy (1
4)と密着するような場合でも良好な滑り性を確保する。 Even if 4) and such as to be in close contact to ensure good sliding properties. リブ(5)は接触面積を小さくするために鋭角になっており、高さは0.5〜3mm複数箇所に設けられるが3〜5ヶ所が好ましい。 Ribs (5) is an acute angle in order to reduce the contact area, the height is provided in 0.5~3mm plurality of locations preferably 3-5 locations. リブ(5)の高さが0.5m The height of the rib (5) is 0.5m
mより小さいと胸腔鏡(14)と胸腔鏡挿通腔(6)が全面で接触し易く効果がほとんど無く、3mmより大きいと胸腔鏡挿通腔(6)の大きさに対して挿通可能な胸腔鏡(4)の外径が小さくなるため好適ではない。 m smaller than thoracoscopy (14) and thoracoscopic insertion cavity (6) there is little liable effect contact with the entire surface, can be inserted through thoracoscopic respect 3mm larger than the size of the thoracoscope through cavity (6) (4) outer diameter of not preferred because the smaller. またリブ(5)の数が2ヶ所以下では胸腔鏡(4)の保持が出来ず、6ヶ所以上では胸腔鏡(14)との接触面積が大きくなり、リブの有用性が失われる。 The ribs (5) number below two places can not hold thoracoscopic (4) becomes large contact area with the thoracoscope (14) is 6 or more locations, the usefulness of the ribs is lost. 【0013】導管(1)は天然ゴム、シリコーンゴム、 [0013] The conduit (1) natural rubber, silicone rubber,
塩化ビニル樹脂、ポリウレタン樹脂などの可撓性を有する材料もしくはアルミニウム、ステンレス、チタン、カーボンなどの硬質の材料にて構成される。 Material or aluminum with a vinyl chloride resin, a flexible polyurethane resin, stainless steel, titanium, and at a hard material such as carbon. 導管(1)の外径は胸腔鏡挿通腔(6)の内径を考慮すると3〜15 When the outer diameter of the conduit (1) is to consider the inner diameter of the thoracoscope through cavity (6) 3-15
mmが好ましい。 mm is preferable. これは3mmより下では挿入可能な胸腔鏡が無く、また15mmより上では患者への侵襲が大きくなり、有用性が失われてしまうためである。 This is because the below 3mm without insertable thoracoscopy and invasion increases to a patient above the 15 mm, thus usefulness is lost. 全長は30〜150mmが好ましい。 Total length 30~150mm is preferable. これは全長が30mmより下では短いため肥満の人の場合胸壁に埋もれてしまい、使用できない恐れがあるためであり、また150m This overall length is buried in the chest wall when the obese people for short below the 30 mm, is because there may not be used, also 150m
mより上では長すぎて胸腔鏡の視野が悪くなる恐れがある。 It is above a m there is a risk that the field of view of thoracoscopic deteriorates too long. 胸腔鏡挿通腔(6)の内径は2〜14mmである。 The inner diameter of the thoracoscope through cavity (6) is 2~14Mm.
これは内径が2mmより下では挿入する胸腔鏡が実質的に無く、14mmより上では導管(1)の肉厚が薄くなり、必要な強度が保たれなくなるためである。 This thoracoscopy inner diameter to be inserted below the 2mm substantially without thinner wall thickness of the conduit (1) is above the 14 mm, because no longer necessary strength is maintained. 【0014】カフ(2)(3)は体外側カフ膨張用パイロットバルーン(8)および体内側カフ膨張用パイロットバルーン(9)を通じて気体もしくは液体等を注入することにより膨張・収縮が可能である。 [0014] cuff (2) (3) is capable of expansion and contraction by injecting a gas or liquid, such as through the extracorporeal cuff inflation pilot balloon (8) and the body-side cuff inflation pilot balloon (9). 体外側カフ(2)および体内側カフ(3)の膨張時はその最大部の径がφ8〜φ50mmとなり、収縮時はその最大部の径が導管(1)の外径とほぼ同一になるのが好ましい。 Extracorporeal cuff (2) and inflated the diameter φ8~φ50mm next of its maximum part of the body side cuff (3), the time of shrinkage is the diameter of its largest portion is substantially the same as the outer diameter of the conduit (1) It is preferred. これはφ8mmより下では膨張径が小さいため十分な止血効果が得られず、また50mmより上では大きすぎるため使用時に邪魔になるおそれがあるからである。 This is because it may become a hindrance at the time of use because it is too large above the sufficient hemostatic effect can not be obtained, also 50mm since under less inflated diameter than 8 mm diameter. 【0015】カフ(2)(3)の材質としては、軟質塩化ビニル樹脂、ポリエチレンテレフタレート樹脂、ポリウレタン樹脂などの可撓性を有するものが好ましい。 [0015] As the material of the cuff (2) (3), a soft vinyl chloride resin, polyethylene terephthalate resin, those having flexibility such as a polyurethane resin. カフ(2)(3)はあらかじめ希望された膨張径を有するように成形される。 Cuff (2) (3) is shaped to have an expanded diameter in advance desired. これにより、低圧で比較的大きな膨張径まで膨張可能となる。 This allows expansion to a relatively large expansion diameter at low pressure. カフ(2)(3)の肉厚は0.01mm〜3mmが膨張特性、膨張時内圧の面から好ましい。 The thickness of the cuff (2) (3) is 0.01mm~3mm expansion characteristics, preferred in view of the expansion time of the internal pressure. これは0.01mmより下では薄すぎるため膨張時に破裂するおそれがあり、3mmより上では収縮時に厚みがあり邪魔になるためである。 This may explode when inflated because too thin below the 0.01 mm, is above the 3mm is to become is thick disturbed during contraction. 【0016】また体外側カフ(2)の膨張部の軸方向の巾は5〜50mmが好ましく、体内側カフ(3)の軸方向の巾は5〜15mmが好ましい。 Further axial width of the inflatable portion of the extracorporeal cuff (2) is preferably from 5 to 50 mm, the axial width of the body-side cuff (3) is 5~15mm is preferred. これは体内側カフ(3)の大きさが極力小さい方が胸腔内で邪魔にならないためである。 This is because the person magnitude of the body-side cuff (3) is as small as possible not to interfere with the thoracic cavity. また体内側カフ(3)と体外側カフ(2)の間隔は5〜50mmが好ましい。 The spacing of the body side cuff (3) and the external side cuff (2) is 5~50mm is preferred. また体内側カフ(3)の胸腔鏡挿入口側端部から体内側開口部(8) The body-side opening from the thoracoscope insertion opening side end portion of the body side cuff (3) (8)
までの距離は30mm以下である。 The distance to is 30mm or less. これは極力胸腔内へ入る長さを短くし、引いては胸腔内での視野(13)を十分得るためである。 This shortens the length as much as possible enters into the chest cavity, pulls in order obtain a sufficient field of view (13) at the thoracic cavity. (図2(a))従来の外套管ではこの長さが長かったため、視野(13)が十分得られなかった。 (FIG. 2 (a)) for was longer this length in the conventional trocar, field of view (13) can not be obtained sufficiently. (図2(b)) 【0017】体外側カフ(2)のあらかじめ成形される膨張径は体外側カフ(2)の軸方向の巾の1〜5倍が好ましく、体内側カフ(3)のあらかじめ成形される膨張径は体内側カフ(3)の軸方向の巾の2〜8倍が好ましい。 (FIG. 2 (b)) of the [0017] expansion diameter which is pre-shaped in the extracorporeal cuff (2) is preferably 1 to 5 times the axial width of the extracorporeal cuff (2), the body-side cuff (3) previously expanded diameter that is molded 2-8 times the axial width of the body-side cuff (3) is preferable. これは体外側カフ(2)のあらかじめ成形される膨張径が軸方向の巾の1倍より小さいと、胸壁上への固定が困難になり、5倍より大きいと実質的にあらかじめ成形することが困難になり、また胸壁上で邪魔となるためである。 This in expansion diameter beforehand molded in extracorporeal cuff (2) is less than 1 times the axial width, fixed onto the chest wall becomes difficult, be molded 5 times larger than substantially advance it is difficult, also it is to become an obstacle on the chest wall. 体内側カフ(2)のあらかじめ成形される膨張径が軸方向の巾の2倍よりも小さいと、やはり胸壁上への固定が困難になり、8倍より大きいと胸腔内で占める大きさが大きくなり邪魔となるためである。 When inflated diameter pre molded body side cuff (2) is less than twice the axial width, also fixed onto the chest wall becomes difficult, large size occupied by eight times larger than the thoracic cavity it is to become an obstacle. カフ(2) Cuff (2)
(3)の内圧は2.8〜75psiとなり、比較的低圧で大きな膨張径が得られる。 (3) the internal pressure 2.8~75psi becomes large expansion diameter can be obtained at relatively low pressure. 【0018】体内側カフ(3)と体外側カフ(2)が間隔を有するため、その間に胸壁(12)を挟み込み、両方のカフ(2)(3)を膨張させることにより穿刺部位(11)からの出血を防止する。 [0018] Since the body side cuff (3) and the external side cuff (2) has a gap, sandwiching the chest wall (12) therebetween, both the cuff (2) (3) puncture site by expanding the (11) to prevent bleeding from. 使用前カフ(2) Use before the cuff (2)
(3)は収縮され、その外径が導管(1)の外径とほぼ同一であり、胸壁上の導管(1)の径よりもやや大きめに切開された穿刺部位(11)より本発明によるカフ付胸腔鏡挿入用外套管を胸腔内に導入する。 (3) is deflated, by substantially the same, the present invention than slightly larger dissected puncture site (11) than the diameter of the conduit on the chest wall (1) and the outer diameter of the outer diameter of the conduit (1) a thoracoscope inserted for the mantle tube with a cuff is introduced into the thoracic cavity. 体内側カフ(3)のみが胸腔内に完全に導入されたら、まず体内側カフ膨張用パイロットバルーン(10)より気体または流体を注入し、体内側カフ(3)を膨張させる。 When only the body side cuff (3) has been fully introduced into the thoracic cavity, the gas or fluid is injected from the body side cuff inflation pilot balloon (10) is first to inflate the body side cuff (3). これがアンカーとなり、導管(1)が胸壁(12)から抜けることを防止する。 This becomes an anchor, a conduit (1) is prevented from escaping from the chest wall (12). 続いて体外側カフ膨張用パイロットバルーン(9)より気体または流体を注入し、体外側カフ(2)も膨張させる。 Following the gas or fluid is injected from the extracorporeal cuff inflation pilot balloon (9), the extracorporeal cuff (2) is also inflated. これにより2つのカフ(2) As a result two of the cuff (2)
(3)が胸壁(12)に密着し、穿刺部位(11)からの胸腔内への出血が防止される。 (3) is in close contact with the chest wall (12), bleeding is prevented into the thoracic cavity from the puncture site (11). 【0019】カフ(2)(3)に注入する気体としては空気、二酸化炭素、窒素などの不活性ガスが望ましい。 The cuff (2) (3) As the gas injected into the air, carbon dioxide, inert gas such as nitrogen is preferred.
これは万が一カフ(2)(3)から気体が漏れた場合に爆発等の事故を未然に防ぐためである。 This is to prevent accidents such as explosion when the gas leaks from any chance cuff (2) (3). また液体としては滅菌蒸留水、生理的食塩水などが考えられるが、滅菌蒸留水が好ましい。 The sterile distilled water as the liquid, but like saline is considered, preferably sterile distilled water. これは万が一カフ(2)(3)から漏れた場合に汚染・感染等の危険がなく、長期留置した場合にも溶解物が無いため、固着する恐れがないからである。 This is not the risk of such pollution and infection when leaking from any chance cuff (2) (3), because there is no lysates even when long-term indwelling, because there is no risk of sticking. 空気を注入する方が容易であるが、一方では滅菌蒸留水を注入した方が重さがあるため、安定性の面で好ましいことがある。 Although it is easier to inject the air, on the one hand, because the person who was injected with sterile distilled water weighs, it may be preferred in view of stability. どちらを選択するかは術者の要望により異なる。 Which one to choose is different at the request of the operator. 【0020】次に本発明によるカフ付胸腔鏡挿入用外套管により実際の手術を行う方法について図2および図3 [0020] Next, how to perform the actual surgery by thoracoscopic insertion cannula cuffed according to the invention Figures 2 and 3
を用いて解説し、本発明の効果を明確にする。 It describes using, to clarify the effects of the present invention. まず患者の肋間にメスを入れ、小切開を加える。 First, put the female in the intercostal of the patient, add a small incision. 小切開を加え穿刺部位(11)より本発明によるカフ付胸腔鏡挿入用外套管を挿入し、体内側カフ(3)を膨張させる。 Insert the thoracoscope insertion cannula cuffed according to the invention from the puncture site was added a small incision (11) to inflate the body side cuff (3). 続いて導管(1)を手前に引きながら体外側カフ(2)を膨張させる。 Then inflate the extracorporeal cuff (2) while pulling the conduit (1) forward. これにより導管(1)が固定される。 Via pipelines (1) is fixed. 【0021】続いて胸腔鏡(14)を導管(1)の胸腔鏡挿入口(7)から胸腔鏡挿通腔(6)内に挿入する。 [0021] subsequently inserted into thoracoscope insertion opening (7) thoracoscopic insertion cavity (6) of the thoracoscope (14) conduit (1).
続いて肋間の適切なる位置1〜3ヶ所に小切開を加え、 Then a small incision added to the appropriate Naru position 1-3 places intercostal,
これらの小切開口より鉗子(15)、吸引嘴管、電気メス、超音波メス、レーザーメスなどを胸腔内に導入し、 Forceps than these small incisions (15), yankauer, electric knife, ultrasonic scalpel, and laser scalpel is introduced into the thoracic cavity,
必要な処置を行う。 Make the necessary treatment. (図3)この際に穿刺部位(11) (3) the puncture site in the (11)
は主に肋間であることが多く、筋肉と肋骨により導管(1)が圧迫されるため内腔が狭くなることがしばしば見受けられる。 It is mainly that often intercostal a conduit (1) often that the lumen to be squeezed narrowed seen by muscle and ribs. しかしこのような場合でもリブ(5)が立っているため胸腔鏡(14)の動きはスムーズである。 But movement of thoracoscopic for standing ribs (5) even in such a case (14) is smooth. 【0022】ここにおいては図2(a)、(b)に示すように、胸腔内の高さは最大で100mm程度であり、 [0022] Here FIG. 2 (a), (b), the height of the chest cavity is 100mm approximately at a maximum,
体内側カフ(3)の胸腔鏡挿入口側端部から体内側開口部(8)までの長さ(lとする)が例えば50mmある場合、胸腔鏡の視野角を60度とすると、視野(13) If a length (a l), for example 50mm from thoracoscope insertion opening side end portion to the body side opening (8) in the body-side cuff (3), when the 60 ° viewing angle thoracoscopic viewing ( 13)
は直径58mmの円となり、十分な視野を得ることが出来ず、腫瘍を見落とす可能性がある。 Becomes a circle with a diameter of 58mm, it is not possible to obtain a sufficient field of view, there is a possibility that overlook the tumor. (図2(b))一方で図2(a)で示す本発明によるカフ付胸腔鏡挿入用外套管の場合、lが30mmのため、視野(13)が直径80mmの円となり、十分な視野が得られる。 For (FIG. 2 (b)) whereas in thoracoscopic cuffed insertion mantle tube according to the invention shown in FIG. 2 (a), since l is 30 mm, the field of view (13) becomes a circle with a diameter of 80 mm, sufficient viewing It is obtained. また穿刺部位(11)からの出血も防止されるため、胸腔鏡(14)先端が汚れにくくなり、術者のストレスも軽減される。 Since bleeding is also prevented from puncture site (11), thoracoscopic (14) the tip is not easily soiled, the operator of the stress is also reduced. 抜去時は体内側カフ(3)カフをしぼませることにより、容易に抜去も可能である。 Removal time is by deflating the body side cuff (3) cuff is easily withdrawn possible. 【0024】 【発明の効果】本発明によれば胸腔鏡下外科手術において使用される外套管の挿入部周囲からの出血が防止されるばかりでなく、狭い胸腔内において十分な視野が得られ、耐圧が十分で胸腔内に損傷を与える危険性が少なく、また比較的安価なカフ付胸腔鏡挿入用外套管を提供することが可能となる。 According to the present invention not only bleeding from the insertion portion around the outer tube used in thoracoscopic surgery is prevented, a sufficient field of view obtained in a narrow chest cavity, breakdown voltage less risk of damage to the well in the chest cavity, also it is possible to provide a relatively inexpensive thoracoscopic insertion cannula with cuff.

【図面の簡単な説明】 【図1】本発明によるカフ付胸腔鏡挿入用外套管の一実施例を示す概略図である。 It is a schematic diagram showing an embodiment BRIEF DESCRIPTION OF THE DRAWINGS [Figure 1] The present invention cuffed thoracoscopic insertion cannula by. 【図2】本発明によるカフ付胸腔鏡挿入用外套管の胸壁への装着例を示す概略図である。 It is a schematic diagram showing a mounting example of the chest wall thoracoscopic insertion cannula with cuff according to the invention, FIG. 【図3】本発明によるカフ付胸腔鏡挿入用外套管を用いて手術を行う実施例を示す概略図である。 It is a schematic diagram showing an example of performing an operation using a thoracoscopic insertion cannula with cuff according to the present invention; FIG. 【図4】胸腔鏡挿通腔の内側に立てたリブの一実施例を示す概略図である。 4 is a schematic diagram showing an embodiment of a rib erected on the inside of thoracoscopic insertion lumen. 【符号の説明】 1. DESCRIPTION OF SYMBOLS 1. 導管2. Conduit 2. 体外側カフ3. Outside the body cuff 3. 体内側カフ5. Body side cuff 5. リブ6. Rib 6. 胸腔鏡挿通腔7. Thoracoscope inserted through the cavity 7. 胸腔鏡挿入口8. Thoracoscope insertion slot 8. 体内側開口部9. Body side opening 9. 体外側カフ膨張用パイロットバルーン10. Outside the body cuff inflation pilot balloon 10. 体内側カフ膨張用パイロットバルーン11. Body side cuff inflation pilot balloon 11. 穿刺部位12. The puncture site 12. 胸壁13. Chest wall 13. 視野14. Field of view 14. 胸腔鏡15. Thoracoscope 15. 鉗子 forceps

Claims (1)

  1. 【特許請求の範囲】 【請求項1】 少なくとも一つの内腔を有する筒状の外套管であって、長さ方向に沿って収縮可能な2つのカフが、体内側カフ及び体外側カフとしてそれぞれ外套管の円周方向に気密的に設けられており、外套管の体内側カフの胸腔鏡挿入口側端部より体内側開口部までの長さが30mm以下であり、また体外側カフの膨張容量は体内側カフの膨張容量の3〜10倍であることを特徴とするカフ付胸腔鏡挿入用外套管。 Patent Claims: 1. A cylindrical mantle tube of which has at least one lumen, the collapsible two cuffs along the longitudinal direction, respectively as the body-side cuff and extracorporeal cuff in the circumferential direction of the outer tube is provided hermetically, length to inside side opening than thoracoscopic insertion opening side end portion of the body side cuff of the mantle tube is not more 30mm or less, also the expansion of the extracorporeal cuff thoracoscope insertion mantle tube cuffed, wherein the capacity is 3 to 10 times the expansion volume of the body side cuff. 【請求項2】 外套管の内側に滑り向上のためのリブを設けたことを特徴とする請求項1記載のカフ付胸腔鏡挿入用外套管。 2. A thoracoscope insertion cannula with cuff according to claim 1, characterized in that a rib for improving sliding inside the outer tube.
JP10233734A 1998-08-20 1998-08-20 Pallial tube for insertion of thoracoscope with cuff Pending JP2000060862A (en)

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JP2003526440A (en) * 2000-03-15 2003-09-09 エスディージーアイ・ホールディングス・インコーポレーテッド Sleeve of laparoscopic instruments
JP2007525277A (en) * 2004-02-26 2007-09-06 サンダーズ,アイラ Obstructive sleep apnea and snoring treatments and devices
JP2010005412A (en) * 2002-05-09 2010-01-14 Tyco Healthcare Group Lp Adjustable balloon anchoring trocar
JP2010104527A (en) * 2008-10-29 2010-05-13 Tottori Univ Closed lumen producing aid for endoscope or the like and endoscope apparatus
JP2011512232A (en) * 2008-02-19 2011-04-21 ポータエロ・インコーポレイテッド Surgical instrument for treating chronic obstructive pulmonary disease make Haiana
US8074655B2 (en) 2004-02-26 2011-12-13 Linguaflex, Inc. Methods and devices for treating sleep apnea and snoring
JP2012152554A (en) * 2011-01-24 2012-08-16 Tyco Healthcare Group Lp Inflatable access assembly
KR101624043B1 (en) * 2014-09-30 2016-05-25 인제대학교 산학협력단 Hemostatic gauze in the abdominal cavity insert and carry-out device
JP2017124068A (en) * 2016-01-15 2017-07-20 株式会社八光 Port for thoracoscopic surgery
US9925086B2 (en) 2008-10-16 2018-03-27 Linguaflex, Inc. Methods and devices for treating sleep apnea

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JP2003526440A (en) * 2000-03-15 2003-09-09 エスディージーアイ・ホールディングス・インコーポレーテッド Sleeve of laparoscopic instruments
JP4656795B2 (en) * 2000-03-15 2011-03-23 ウォーソー・オーソペディック・インコーポレーテッド Sleeve of laparoscopic instruments
JP2010005412A (en) * 2002-05-09 2010-01-14 Tyco Healthcare Group Lp Adjustable balloon anchoring trocar
JP2007525277A (en) * 2004-02-26 2007-09-06 サンダーズ,アイラ Obstructive sleep apnea and snoring treatments and devices
US8925551B2 (en) 2004-02-26 2015-01-06 Linguaflex, Inc. Method and device for the treatment of obstructive sleep apnea and snoring
US8408213B2 (en) 2004-02-26 2013-04-02 Linguaflex, Inc. Method and device for the treatment of obstructive sleep apnea and snoring
US8074655B2 (en) 2004-02-26 2011-12-13 Linguaflex, Inc. Methods and devices for treating sleep apnea and snoring
US8220467B2 (en) 2004-02-26 2012-07-17 Linguaflex, Inc. Method and device for the treatment of obstructive sleep apnea and snoring
US10195010B2 (en) 2004-02-26 2019-02-05 Linguaflex, Inc. Methods and devices for treating sleep apnea and snoring
JP2011512232A (en) * 2008-02-19 2011-04-21 ポータエロ・インコーポレイテッド Surgical instrument for treating chronic obstructive pulmonary disease make Haiana
US9925086B2 (en) 2008-10-16 2018-03-27 Linguaflex, Inc. Methods and devices for treating sleep apnea
JP2010104527A (en) * 2008-10-29 2010-05-13 Tottori Univ Closed lumen producing aid for endoscope or the like and endoscope apparatus
JP2012152554A (en) * 2011-01-24 2012-08-16 Tyco Healthcare Group Lp Inflatable access assembly
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