JP2000083961A - Tubular tissue dilator and pressure measuring instrument for this dilator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a tubular tissue dilator for pressing an adhesive part in the state of expanding the diameter of a blood vessel and elongating the adhesive part at the time of adhesion while using a tissue hemostatic adhesive to an anastomosing part in the stage of vascular anastomosing. SOLUTION: This tissue dilator consists of a rod-shaped body 11, a manipulating section 12 disposed on the base end of this rod-shaped body 11 and a dilating section 13 having a plurality of pressing pieces 14 formed on the front end side of the rod-shaped body 11. There are four pieces of the pressing pieces 14 and the front and rear of these pieces are connected by links (17) 18. The other end parts of these links (17) 18 are pinned to a front side plate 15 and a rear side plate 16. A shaft 22 is connected to the front side plate 15 and the rear end thereof is screwed to the cap 21 of a handle 19. The spacing between a handle 19 and the rear side plate 16 is held constant by a hollow pipe 20. When the handle 19 is rotated by clamping a collar 23, the distance between the plates on the entire rear side changes and the pressing pieces 14 put into and out of the shaft 22 in its radial direction, thereby expanding the blood vessel.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an instrument used for a surgical operation, and more particularly to an instrument used for anastomosis of a blood vessel having a relatively large diameter, such as the aorta of the heart, or a tubular tissue such as an esophagus or an intestine. .

[0002]

2. Description of the Related Art During an operation for a dissecting aortic aneurysm, particularly for an acute aortic aneurysm dissection, a stump of a dissected aortic wall is reinforced, a dissected cavity is closed, and an artificial blood vessel is anastomosed. At this time,
A tissue hemostatic adhesive is applied to and adhered to the dissected cavity, so that blood or the like does not leak from the anastomotic part during anastomosis.

[0003] Although the above-mentioned tissue hemostatic adhesive is excellent in adhesiveness to the dissociated aortic wall, it is important that the adhesive site is uniformly pressed from inside and outside and pressed.

[0004] For such a purpose,
Bulldog forceps for tissue hemostatic adhesive (Glue Application B
A forceps called ulldog Clamp) is used. this is,
It has a shape with curved plates at both ends of the tweezers, and by bending this plate by hand etc., the radius of curvature of the plate can be changed freely according to the radius of tubular tissue such as blood vessels Is what it is. In addition, ordinary forceps are configured to open when no force is applied, close when applying force, and pinch an object, but these forceps are reversed, and when force is not applied, the forceps are closed and between the curved plates. It pinches things and opens when you apply force to open them.

[0005] After the joining end of the blood vessel extending from the heart side and the artificial blood vessel inserted to reinforce the stump is superposed and anastomotic, a tissue hemostatic adhesive is applied to the portion where the blood vessel and the artificial blood vessel overlap. When the vascular tissue is inserted, the vascular tissue of the adhesive portion is sandwiched by the bulldog forceps, and a pressing force is applied, the adhesive penetrates to increase the adhesive strength, and a suitable vascular anastomosis can be performed.

[0006]

However, in the method using the above bulldog forceps, it is not possible to sandwich the entire circumference of the blood vessel with one bulldog forceps at a time and apply an even pressing force to the entire adhesion site. Therefore, two bulldog forceps are used to pull the overlapping portion of the blood vessel from both sides to stretch the adhesive portion and simultaneously apply a pressing force. This operation is, of course, required until the adhesive is hardened, which takes time. In the meantime, the progress of the operation is also hindered. Also, it takes time and effort to adjust the curve of the plate to the diameter of the blood vessel each time it is used.

The present invention has been conceived in view of such a fact, and it is possible to expand the diameter of a tubular tissue such as a blood vessel so as to extend an adhesive portion, and to apply a pressing force uniformly.
It is an object of the present invention to provide a tubular tissue dilator that does not disturb the operation and is easy to use.

[0008]

In order to achieve the above object, a tubular tissue expander according to the present invention comprises a rod-shaped body, an operating portion provided on the base end side of the rod-shaped body, and a distal end side of the rod-shaped body. And an expanding part provided with a plurality of pressing pieces formed on the rod, and the operating piece allows the pressing pieces to freely move in and out of the concentric circle of the rod in the radial direction of the rod. Further, it is preferable that the number of the pressing pieces is three or more and the pressing pieces are arranged at substantially equal intervals on a concentric circle of the rod-shaped body.

Alternatively, the expanding portion includes a rear plate,
A front plate, a rear link rotatably connected at one end to the rear plate, a front link rotatably connected at one end to the front plate, and ends between the front link and the distal end of the rear link. A plurality of pressing pieces rotatably connected to each other are provided, and by changing the distance between the front and rear plates, the pressing pieces can simultaneously enter and exit in the radial direction.

Alternatively, a hollow tube is fixed to the rear plate, the hollow tube and the operating section are connected in a state where relative movement in the axial direction is prevented, and a shaft is passed through the hollow tube. Alternatively, the distal end and the front plate may be fixed to each other, and the base end of the shaft may be coupled to the operation unit in a state where relative movement in the axial direction is possible.

The connection between the hollow tube and the operation section is a rotatable connection, and the connection capable of relatively moving the shaft and the operation section in the axial direction is a connection by a screw. it can. It is desirable that the plural pairs of links have a configuration in which the link on the front plate side is short and the link on the rear plate side is long.

[0012] Further, the apparatus may have a fluid bag surrounding all of the plurality of pressing pieces, a conduit for injecting a pressure fluid into the fluid bag, and a pressure gauge for measuring the pressure of the fluid in the fluid bag. Good. The pipeline for injecting the pressure and the pipeline connected from the fluid bag to the pressure gauge may intersect, and a three-way valve may be provided at the intersection.

A pressure measuring device for a tubular tissue expander according to the present invention comprises:
A fluid bag having a length capable of surrounding the entirety of the plurality of pressing pieces in any one of the tubular tissue expanders, a pipe for injecting a pressure fluid into the fluid bag, and a pipe connected from the fluid bag to the pressure gauge. And the two pipes intersect, and a three-way valve is provided at the intersection.

[0014]

Embodiments of the present invention will be described below in detail with reference to the drawings. 1 to 3 are views showing the entire tubular tissue expander of the present invention. FIGS. 1 and 3 (a) show the state before the blood vessel is expanded, and FIGS. 2 and 3 (b) show the expanded state. I have. The tubular tissue expander shown in these figures is an elongated rod-shaped body 11 as a whole, and an operating section 12
However, it has a form in which an enlarged portion 13 is formed on the distal end side. In FIG. 3, A is an aorta extending from the heart side, and B is an artificial blood vessel.

The expanding portion 13 includes four pressing pieces 14, a front plate 15, a rear plate 16, and a front link 17.
And a rear link 18. FIG. 4 to FIG. 8 are views of each component constituting the expanding portion 13. 4 shows the front plate 15 and FIG. 5 shows the rear plate 1.
6, FIG. 6 shows the pressing piece 14, FIG. 7 shows the front link 17, and FIG. 8 shows the rear link.

FIG. 4A is a side view of the front plate,
(B) is the figure seen from the left of (a). As can be seen from FIG. 4, the front plate 15 has a circular shape whose tip end surface is swelled in a spherical shape and has a screw hole 15a at the center.
Four grooves 15b are formed at intervals of 90 degrees around the center 5a. A pin hole 15 is provided on both sides of each groove 15b.
c is bored, and a pin (not shown) can be inserted.

FIG. 5A is a side view of the rear plate,
(B) is the figure seen from the left of (a). The rear plate 16 shown in this figure is also the same as the front plate. A screw hole 16a is formed in the center of the circle, and four grooves 16b are formed around the screw hole 16a.
There is. Pin holes 16c are provided on both sides of each groove 16b, so that pins can be inserted. In addition, plate 1 before and after
Of the screw holes 15a and 16a drilled at the centers of 5 and 16, 16a has a larger diameter.

FIGS. 6A and 6B are views of the pressing piece 14, wherein FIG. 6A is a front view, FIG. 6B is a bottom view, and FIG. 6C is a side view. Pressing piece 1
4 has notches 14a at both ends, and pin holes 14b are formed on both sides of the notches 14a. The pressing piece 14 has a fan-shaped cross section, and the outer pressing surface is a part of a cylindrical surface. Therefore, since each pressing surface can press the vascular tissue without forming an edge, the tissue is not damaged. Also,
Since the four pressing pieces 14 are arranged on concentric circles, when the blood vessel is expanded with these, the blood vessel can be expanded while maintaining a shape close to a circle.

FIGS. 7A and 7B are views of the front link 17, in which FIG. 7A is a front view, FIG. 7B is a bottom view, and FIG. 7C is a side view. As shown in these figures, the front link 17 is a plate-like body having both ends rounded, and has pin holes 17a at both ends. FIG.
3A is a view of the rear link 18, FIG. 3A is a side view, FIG. 3B is a front view, and FIG. 3C is a bottom view. The rear link 18 shown in these figures has a round bar shape, both ends 18a are plate-shaped, and a pin hole 18b is bored here.

The grooves 15b and 16b of the front plate 15 and the rear plate 16 face each other and are arranged so that one groove 15b corresponds to one groove 16b. Front link 17
Is inserted into the groove 15b, and the pin hole 17 of the link is inserted.
a, and a hole (not shown) is inserted into the hole 15c on the plate side so as to be rotatably connected. One end 18a of the rear link 18 is inserted into the groove 16b, and a pin (not shown) is inserted through the pin hole 18b of the link and the hole 16c of the plate side to be rotatably connected.

Both ends of the pair of links 17 and 18 are inserted into notches 14a and 14a at both ends of the pressing piece 14, respectively. Combine freely. The above operation is repeated for the four pressing pieces 14, and the expanding portion 13 is assembled.

FIG. 9A is a cross-sectional view showing the configuration around the operation unit 12, and FIG. 9B is a view of the shaft 22. The handle 19 has a cylindrical shape with a bottom at one end, and a non-slip knurl or the like is engraved on the outside. A female screw 19a is formed on the inner peripheral surface of the cylinder, and a hole 19b is opened at the center of the bottom. Reference numeral 21 denotes a lid, and a large diameter portion of the lid has the same outer diameter as the handle 19, and a knurl or the like is non-slip. The tip is tapered and the outside is external thread 21a
Is formed, and a female screw 21b formed through the center is provided at the center.

A hollow tube 20 is inserted into a hole 19b of the handle 19. The hollow tube 20 has a shape in which a male screw 20a is engraved at the tip and a collar 20b is formed at the rear end to prevent the screw from coming off. Insert the hollow tube 20 into the hole 19b,
Is brought into contact with the periphery of the hole 19b, and the lid 2 is
Screw in 1. The male screw 21a on the small diameter side of the lid 21 and the female screw 19a on the inner periphery of the handle 19 are screwed together to form a hollow tube 20.
Is closed. When the lid 21 is fastened and fixed to the handle 19, the hollow tube 20 can be kept rotatable with the longitudinal movement of the hollow tube 20 prevented. A collar 23 is further fixed to the handle 19 side of the hollow tube 20.

FIG. 9B shows the shaft 22. The shaft 22 has a hollow or solid round bar shape, and has male threads 22 at both ends.
a and 22b, and can be loosely fitted into the hollow portion of the hollow tube 20. The male screw 22a at the proximal end is long and the male screw 2 at the distal end is long.
2b is short. The shaft 22 is inserted into the hollow tube 20, and the longer male screw 22 a at the rear end is screwed with the female screw 21 b formed at the center of the lid 21. If the shaft 22 is grasped with one hand to prevent its rotation, and the handle 19 is rotated right or left with the other hand, the amount of screwing of the shaft 22 into the lid 21 changes. 21 will be moved back and forth in the axial direction. In the above configuration, the rod 11 is constituted by the hollow tube 20 and the shaft 22, and the operating unit 1 is constituted by the shaft 22, the handle 19, and the lid 21.
2 will be configured.

After the assembly of the rod 11 and the operation unit 12 is completed as described above, the tip of the shaft 22 of the rod 11 is inserted from the screw hole 16a side of the rear plate 16 of the expanding part 13 and It penetrates the side plate, is screwed into the female screw 15a of the front plate 15, and is tightly fixed so that it does not come loose. Next, the male screw 2 at the tip of the hollow tube 20
0a is screwed into the female screw 16a at the center of the rear plate 16, and also fixed so as not to be loosened. In this operation, if it is difficult to screw the shaft 22 into the front plate 15, once the shaft 22 is
You may remove it from 1 and go. With the above, the tubular tissue expander 10
Is completed.

Next, the method of use will be described with reference to FIGS. In advance, grasp the collar 23 of the operation unit 12 and turn the handle 19 to open the gap between the front and rear plates 15 and 16,
The links 17 and 18 of the expanding portion 13 and the pressing piece 14 are shown in FIG.
As shown in (a), they are arranged substantially in a straight line. This state is the maximum separation distance between the front plate 15 and the rear plate 16. At this time, the outer diameters of the four pressing pieces 14 are minimum. In this state, the tubular tissue dilator 10 is inserted from one end side of the artificial blood vessel B, and is inserted so that the tip of the pressing piece 14 comes to a portion where the aorta A and the artificial blood vessel B overlap.

The overlap between the aorta A and the artificial blood vessel B is as follows:
It is assumed that the anastomosis has already been performed before inserting the tubular tissue expander. When the pressing piece 14 reaches the position shown in FIG.
A tissue hemostatic adhesive is poured into the anastomotic overlapping portion. Alternatively, the adhesive may be applied either before or immediately after the anastomosis. Then, the handle 1 of the operation unit 12
9, the shaft 22 moves in a direction protruding to the rear end of the lid 21 as shown in FIG. 1B, and the front plate 15 is drawn to the rear plate 16 and the link 17 is moved.
Is rotated outward, and the pressing piece 14 moves outward to expand the blood vessel outward. As a result, the bonding portion is extended, and at the same time, a pressing force is applied, whereby the permeability of the adhesive is improved, and the bonding force can be increased. At this time, handle 1
If the amount of rotation of 9 is determined in advance, the blood vessel can be expanded with an appropriate tension. As the rotation amount of the handle 19, a rotation speed can be used, but instead of the rotation speed,
The length of the shaft 22 protruding from the rear end of the handle 19 may be determined.

By the way, as shown in FIG. 1, links 17 and 18 are rotatably connected to both ends of the pressing piece 14, and the other ends of the links 17 and 18 are connected to the front and rear plates 15 and 15, respectively. Since the pressing piece 14 has a configuration in which the pressing piece 14 is connected, the pressing piece 14 can take a considerably free posture.

Therefore, in the present invention, the rear link 18 is made longer than the front link 17. Also, an O-ring 25 is fitted on the distal end side of the shaft 22, and the pressing piece 14
In order to secure a gap between the shaft and the shaft 22, even when the pressing piece 14 comes closest to the shaft, the front and rear links 17 and 18 do not become completely straight, and the pressing piece 14 Is slightly swelled outward. With such a configuration, when the handle 19 is rotated to bring the front and rear plates close to each other, the four pressing pieces 14 always start moving toward the outside of the shaft all at once, and the front end has a large diameter and the rear end has a large diameter. It expands in a tapered shape with a small diameter, and the diameter of the blood vessel can be surely expanded.

When an adhesive portion such as a blood vessel is expanded by the tubular tissue expander of the present invention, it is desirable to accurately control the tension applied to the adhesive portion. As this method, as described above, there is a method of controlling the rotation amount of the handle 19, the length of the shaft 22 projecting from the rear end of the handle 19, and the like, but the accuracy is coarse.

FIG. 10 shows a pressure measuring device 30 for a tubular tissue dilator which can more accurately measure the pressure applied to a blood vessel when the plurality of pressing pieces 14 expand the blood vessel than the method described above.
FIG. 4 is a diagram illustrating a pressure measuring device (hereinafter simply referred to as a “pressure measuring device”).

The pressure measuring device 30 is provided at the intersection of the fluid bag 31, the pipe 32 connected to the pressure gauge 35, the pipe 33 for injecting the pressure fluid into the fluid bag 31, and the pipe. And a three-way valve 34.

The fluid bag 31 is a hollow bag made of a soft synthetic resin similar to that used for a sphygmomanometer wound around a finger or the like, and has an inlet 31a at substantially the center. However, the width is around 10 mm, and the hook-and-loop fastener is not used. Line 3
Reference numerals 2 and 33 are made of plastic or rubber, and also use a soft material. The pressure gauge 35 may be either a Bourdon tube type or a mercury column type.

FIG. 11 is a diagram showing a state of use of the pressure measuring device 30 shown in FIG. The four pressing pieces 14 of the tubular tissue dilator are inserted into the suturing portion between the aorta A and the artificial blood vessel B, the suturing portion is surrounded by the fluid bag 31 from the outside, and both ends are sandwiched by the clips 36. In this state, the three-way valve 34 is switched to push air from the conduit 33 into the fluid bag 31 to expand the fluid bag 31. Then, the three-way valve 34 is rotated to switch the fluid bag 3
The air pressure in 1 is made measurable by the pressure gauge 35. At this time, the fluid bag is set to such a degree as to lightly contact the suturing portion from the outside. Next, the handle 1 of the tubular tissue expander
Turn 9 to bring the front and rear plates 15, 16 closer together. The pressing piece 14 moves to the outside of the shaft 22, and pushes and expands the fluid bag 31 to the outside through the suture portion between the aorta A and the artificial blood vessel B. As a result, the air pressure inside the fluid bag 31 increases, and the pressure can be read by the pressure gauge. Then, by this pressure, it is possible to directly know how much pressure is applied to the suturing portion expanded by the pressing piece 14, and it is possible to apply an appropriate pressure or tension to the suturing portion.

In the above embodiment, the suturing of a blood vessel and an artificial blood vessel has been described as an example. However, the present invention can be used for general tubular tissues other than blood vessels, such as intestines and trachea. Of course, the same applies to the case of suturing blood vessels or intestines instead of artificial blood vessels.

In the above embodiment, the number of the pressing pieces 14 is four, but at least two pieces, that is, a plurality of pieces may be used. However, since it is better that the blood vessel is close to a circular shape when the blood vessel is expanded, it is preferable to use three or more blood vessels. Further, the more the number is, the closer to the circle, but the more the number is, the more complicated the configuration becomes. From this, it is considered that a practical range is about 4 to 6 as a number that is close to a circle and does not become complicated.

The radial movement of the pressing piece 14 is performed by the mechanism of the front and rear plates 15, 16 and the links 17, 18, but is not limited to this. Furthermore, although the operation method in the operation unit 12 is screw engagement, the invention is not limited to this. For example, any mechanism such as a configuration using a lever can be used as long as the mechanism can change the distance between the front and rear plates. Good. However, the use of screws simplifies the configuration and allows for inexpensive manufacture.

[0038]

According to the present invention as described above,
A rod-shaped body, an operating portion provided on a base end side of the rod-shaped body, and an expanding portion formed on a distal end side of the rod-shaped body and provided with a plurality of pressing pieces; Is made to be able to move in and out in the radial direction of the rod-shaped body, so that the pressing piece moves to the outside in the radial direction, so that the blood vessel can be easily enlarged and the adhesive can be penetrated, and the adhesive force can be increased.

If the number of the pressing pieces is three or more, the blood vessel can be enlarged while keeping a shape close to a circle, which is more effective.

The widening portion includes a rear plate, a front plate, a rear link having one end rotatably connected to the rear plate, and a front link having one end rotatably connected to the front plate. And a plurality of pressing pieces whose both ends are rotatably coupled between the front link and the rear link, and each pressing piece is simultaneously formed by changing the distance between the front and rear plates. With a configuration in which the vehicle enters and exits in the radial direction, an expanded portion having a simple configuration can be obtained.

A hollow tube is fixed to the rear plate, and the hollow tube and the operating portion are connected in a state where relative movement in the axial direction is prevented. When the front end and the front plate are fixed, and the base end of the shaft is coupled with the operation unit in a state where relative movement in the axial direction is possible,
An operation unit having a simple configuration can be obtained.

If the connection between the hollow tube and the operation section is a rotatable connection, and the connection between the shaft and the operation section capable of relative movement in the axial direction is a connection by a screw, Further, a tubular tissue expander having a simple structure can be obtained.

The tubular tissue expander according to any of the above, a fluid bag surrounding all of the plurality of pressing pieces, a conduit for injecting a pressure fluid into the fluid bag, and a pressure of the fluid in the fluid bag. And a pressure gauge for measuring the pressure, it is possible to easily measure the tension applied to the tubular tissue, and to easily apply an appropriate pressing force to the bonded portion.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a closed state of a tubular tissue expander of the present invention.

FIG. 2 is a perspective view showing an open state of the tubular tissue expander of the present invention.

3A and 3B are views showing a use state of the tubular tissue expander of the present invention, wherein FIG. 3A shows a state before a blood vessel is expanded, and FIG.

FIG. 4 is a view of a front plate.

FIG. 5 is a view of a rear plate.

FIG. 6 is a view of a pressing piece.

FIG. 7 is an enlarged view of a front link.

FIG. 8 is an enlarged view of a rear link.

9A is a cross-sectional view around the operation unit, and FIG. 9B is a view of a shaft.

FIG. 10 is a perspective view of a pressure measuring device for a tubular tissue expander.

FIG. 11 is a diagram showing a use state of the pressure measuring device for a tubular tissue expander.

DESCRIPTION OF SYMBOLS 11 Rod-like body 12 Operating part 13 Expanding part 14 Pressing piece 15 Front plate 16 Rear plate 17 Front link 18 Rear link 19 Handle 20 Hollow tube 22 Shaft 30 Pressure gauge 31 Fluid bag 32, 33 Pipeline

Claims (9)

[Claims] 1. An operation section comprising: a rod-shaped body; an operation section provided on a base end side of the rod-shaped body; and an expanding section formed on a distal end side of the rod-shaped body and provided with a plurality of pressing pieces. A tubular tissue expander characterized in that the pressing piece can freely enter and exit in the radial direction of the rod-shaped body by a portion. 2. The apparatus according to claim 1, wherein the number of the pressing pieces is three or more, and the pressing pieces are arranged at substantially equal intervals on a concentric circle of the rod-shaped body.
A tubular tissue expander as described. 3. The expansion portion has a rear plate, a front plate, a rear link having one end rotatably connected to the rear plate, and one end rotatably connected to the front plate. A front link, having a plurality of pressing pieces rotatably coupled at both ends between the front link and the front link rear end,
The tubular tissue expander according to claim 1 or 2, wherein each of the pressing pieces is simultaneously moved in and out in the radial direction by changing a distance between the front and rear plates. 4. A hollow tube is fixed to the rear plate,
The hollow tube and the operating unit are coupled in a state where relative movement in the axial direction is prevented, a shaft is penetrated through the hollow tube to fix a distal end thereof and the front plate, and a proximal end of the shaft is provided. The tubular tissue expander according to claim 3, wherein the tubular tissue expander is coupled to the operation unit so as to be movable relative to the operation unit in the axial direction. 5. The connection between the hollow tube and the operation unit is a rotatable connection, and the connection that allows relative movement in the axial direction between the shaft and the operation unit is a connection by a screw. The tubular tissue expander according to claim 4, wherein 6. The tubular tissue expander according to claim 3, wherein the plurality of pairs of links have shorter links on the front plate side and longer links on the rear plate side. 7. A liquid bag surrounding all of the plurality of pressing pieces, a conduit for injecting a pressure fluid into the fluid bag, and a pressure gauge for measuring a pressure of the fluid in the fluid bag. The tubular tissue expander according to any one of claims 1 to 6, characterized in that: 8. A line for injecting the pressure and a line connected from the fluid bag to the pressure gauge, and a three-way valve is provided at the intersection. A tubular tissue expander according to claim 1. 9. A fluid bag having a length capable of surrounding all of the plurality of pressing pieces in the tubular tissue expander according to any one of claims 1 to 6, and a conduit for injecting a pressure fluid into the fluid bag. A pressure measuring device for a tubular tissue expander, comprising: a pipe connected from a fluid bag to a pressure gauge, wherein the two pipes cross each other, and a three-way valve is provided at the crossing portion.