JP2000175921A - Multiple ligation method and implement for it - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a multiple ligation method and device for it, which can execute prescribed multiple ligating in environment where a winding thread part can properly and easily detached and is not directly touched by a person by simplifying a method for winding a ligating thread to a bobbin part and maintaining a wound winding thread part at the bobbin part to avoid rewinding easily. SOLUTION: This method winds the ligating thread in an order opposite of a ligation order to plural bobbin parts 7 (8, 9) provided with thread inserting grooves 11 (12, 13), seals the opening end of each bobbin part by successively detachable sealing body 30, puts the free end of the ligating thread through a matter to be ligated and then through the grooves 11 (12, 13) in the order of a first ligation, a second ligation... to detach the body 30 each time and successively forms multiple ligations 1, (2, 3...).

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a multiple ligating method and a multiple ligating device capable of performing multiple ligations in accordance with a predetermined multiple ligating method in an environment where humans do not directly touch the ligature. The present invention relates to a convenient and convenient multiple ligating method and multiple ligating device.

[0002]

2. Description of the Related Art In the field of surgery, tying a thread is tyin.
g, the ligature is called a ligature. In the present specification, the entire tying is generally called a ligature, and the number of knots is 2
More than one ligature is referred to as a multiple ligature. The multiple ligating methods are numerous and variously called, but the main ones are male knots, female knots and surgical knots, and the most commonly used ones are surgical knots and male knots. As shown in FIG. 10, the surgical knot is formed by repeatedly winding the first knot 1 twice to reduce the looseness due to friction, and turning the second knot 2 in the winding direction to the first knot.
It is wound once, contrary to the knot 1, and is applied to a place where tension is applied to the yarn at a point where it is hard to be shifted. Surgical knots include surgical knots, surgical knots, surgio
It is called n's knot.

As shown in FIG. 11, a male knot is a single knot in which the first and second knots 1 and 2 are both wound once, and the winding directions of the first knot 1 and the second knot 2 are reversed. It is commonly used for haemostatic ligation and the like as the simplest and most difficult to remove. Male knots are also common knots, main knots, true knots, booth knots, sailor knots, head knots, reef knots, squs
It is called e-knot, true knot, or the like. The female knot, like the male knot, is a single knot in which the first and second knots 1 and 2 are both wound once, and the winding direction is the same for the first and second knots. Became
Generally, it is a loose and uncertain ligature. Female knots are also female knots, false knots, reverse knots, vertical knots, granny
It is called knot or the like. FIG. 12 shows a triple knot in which a third knot 3 is added to a male knot composed of the first and second knots 1 and 2 in order to further prevent loosening. Triple knots are also known as triple ligations, reinforced knots,
It is called a triple knot or the like.

[0004] Conventionally, a surgical ligating instrument used for endoscopic surgery or the like is disclosed in Japanese Patent Application Laid-Open No. HEI 11 (1994).
The invention described in Japanese Patent Application Laid-Open No. 0-201767 is known. In the conventional invention, one end of a ligature is provided so that ligating such as surgical knotting by a predetermined multiple ligating method can be quickly and easily performed on a suture site while watching a monitor in endoscopic surgery or the like. Side is wound around the outer periphery of the bobbin portion of the instrument body in accordance with a required multiple ligating method such as surgical knotting, and held, and the other end side with or without a ligature needle is pulled through the instrument body. The slack of the ligature formed at a portion which is guided by the guide portion from the distal end portion of the instrument body toward the rear end portion through the inside of the bobbin portion, and exits from the bobbin portion and enters the stringing guide portion at the distal end portion of the device body. Through the ligature, pulling the other end of the ligature pulled out to the rear of the instrument body via the thread guide while holding the one end of the ligature of the wound thread portion And the wound thread is pulled toward the tip of the Out from the tip of, is to ligate the ones to be ligated in the required ligation methods such as surgical knot.

[0005]

The first problem with the surgical ligating instrument having the above structure is that the method of winding the ligature around the thread winding portion is complicated and difficult. The free end side is fixed, and the fixed end side is wound around the outer periphery of the bobbin portion of the instrument body in the order of knots in accordance with a required ligation method such as surgical knotting and fixed, and the free end side is opened again. Second, one end side of the ligature is wound around the outer periphery of the bobbin of the instrument body in accordance with a required ligating method such as surgical knotting. Thirdly, it is difficult to maintain the wound thread part. Thirdly, in a state where the wound thread part cannot be easily unraveled, the other end side with or without the ligature needle should be freely loosened and ligated. Sewing or winding the object around it, and then wrapping the inside of the winding thread through the thread guide of the instrument body When pulling out the instrument body toward the rear end, etc., and pulling the other end side, the wound thread part is pulled lightly toward the tip of the thread wound part, slides, disengages from the tip of the instrument body, and ligates. A fourth object of the present invention is to ensure that a desired object can be ligated by a required ligating method such as surgical knotting.
Is that the multiple ligation method including the first, second, and third nodules can be sequentially and reliably ligated. Fifth, within a narrow range that is easy to see on a monitor under an endoscope. Sixth, there is a point that the wound thread portion and the like are present in a concentrated manner. Sixth, it is possible to easily handle and securely ligate. In the column of the problem to be solved by the conventional technology and the invention described above, a ligation method and a surgical instrument using a monitor or the like under an endoscope are referred to, but this is merely an example, However, the technical field to which the invention of the multiple ligating method and the multiple ligating device according to the present invention belongs is not limited to surgical ligating, but is widely used in an environment where humans cannot directly touch. It goes without saying that the technical scope of the present invention extends to the multiple ligating method and the multiple ligating device that can perform the multiple ligating according to the above.

[0006]

Therefore, according to the present invention, as described in claim 1, the free end side of the ligature to which the base end portion is fixed is fixed to the predetermined end where a plurality of knots overlap. According to the multiple ligating method described above, winding can be performed in the reverse order of the knotting order around a plurality of bobbins provided with a thread insertion groove having a side opening from one side toward the tip, and the open ends of each bobbin can be sequentially removed. The free end of the ligature is passed through the object to be ligated, then through the thread insertion groove of the first knot, and then the seal is removed to open the thread insertion groove and the thread winding portion, Then, the thread of the part is removed by pulling the thread of the part to form the first knot, and then the thread is similarly passed through the thread insertion groove of the second knot, the sealing body is removed, the thread insertion groove and the thread part are opened, and the thread of the thread part is removed. Remove and pull 2
An object of the present invention is to provide a multiple ligating method in which nodules are formed and nodules are sequentially formed.

By wrapping the free end side of the ligature having the fixed base end around the bobbin in the reverse order of knotting, the free end is fixed and the base end side is wrapped around the bobbin in knot order in the knot order. It is possible to eliminate the need for a fixing means and a method for fixing the free end side previously fixed as compared with the conventional method of fixing the part, and to smooth the knotting order when opening the free end side from the bobbin and ligating. Can be opened to the public. In addition, by closing the open ends of the respective bobbins with a blocking body and sequentially removing them, it is possible to reliably maintain the binding yarn wound around the respective bobbins at the time of the blockage. When pulling the thread passed through to loosen or knotting the knot without loosening, there is no fear that the thread wound around the thread part will come off, and the closures will be sequentially connected from the open end of each thread part in the order of knots. By detaching, each nodule can be sequentially and reliably connected without slack.

According to the present invention, in the multiple ligating method according to the first aspect, a ligature having a fixed base end is wound around each of the bobbins in the order of the third, second, and first knots. , In the order of the second and third knots, the sealing body is removed to open the thread insertion groove and the bobbin portion, the thread of the bobbin portion is removed and pulled, and the knots are tripled in the order of the first, second and third knots. It is intended to provide a multiple ligating method formed by knotting. With the above configuration, the free end side of the ligature to which the base end is fixed is smoothly wound around the bobbin in the order of the third, second, and first knots in the reverse order of the knot, and the first, second, and third knots In this order, each nodule can be tied in a triple knot without loosening.

According to the present invention, in the multiple ligating method according to claim 1 or 2, the free end of the ligature is inserted into the thread insertion groove from the base end of the thread winding portion toward the open end and pulled. The present invention provides a multiple ligating method characterized in that a thread of a portion is removed in an open end direction to form each knot. By inserting the free end of the ligature into the thread insertion groove in the direction from the base end of the bobbin to the open end, the direction in which the thread is inserted and the direction in which the thread is released from the bobbin coincide with each other. The part of the thread can be smoothly removed in the direction of the open end.

According to the present invention, in the multiple ligating method according to the first, second or third aspect, the open end of the thread winding portion and the thread insertion groove have a communication groove capable of communicating with the thread insertion groove. When communicating, the thread insertion groove is closed with a sealing body through which the free end of the ligature can be inserted, and the open end of the other bobbin and the thread insertion groove are closed with a sealing body without the communication groove, and the free end of the ligature is connected. The sealing body is removed from the thread insertion groove of the thread winding part where the communication groove communicates with the thread insertion groove, the sealing body is removed, the thread insertion groove and the thread winding part are opened, the thread of the thread winding part is removed, and a pull knot is formed. Is provided. Since the free end of the ligature can be inserted through the thread insertion groove when the communication groove of the sealing body communicates with the thread insertion groove of the thread winding portion, for example, the communication groove communicates with the thread insertion groove of the thread winding portion of the first knot. At this time, if the open end of the bobbin portion after the second knot and the thread insertion groove are closed by a sealing body having no other communication hole, the free end of the ligature should be inserted into the thread insertion groove after the second knot. Therefore, the ligature can be inserted through the thread insertion groove of the first knot of the first knot in which the communication groove communicates with the thread insertion groove of the knitting portion, and the knotting order can be prevented from being mistaken.

Further, according to the present invention, a plurality of thread winding portions having thread insertion grooves whose side portions are open from one side to the front end are provided, and a base end portion is fixed to the plurality of thread winding portions. A closed body for wrapping the free end of a ligature in a reverse order of knot order according to a predetermined multiple ligating method in which a plurality of knots are overlapped, closing a thread insertion groove at an open end of each thread winding portion, and releasing the closure in knot order. And to provide a multiple ligating device. A plurality of bobbins, the free end of a ligature having a fixed base end is provided by being wound in the reverse order of knot order according to a predetermined multiple ligating method in which a plurality of knots are overlapped,
The free end of the wound ligature can be passed through the ligature as it is, and can be used by smoothly opening it from the wound part in the knot order. By closing the insertion groove and the open end, the wound state of the thread wound around the thread winding portion can be maintained, so that the thread passed through the ligature can be pulled to loosen or tie the knot without slack. In addition, there is no fear that the thread wound around the bobbin may come off, and the closures are sequentially removed from the open ends of the bobbin sections in the order of the knots, so that the knots can be securely and sequentially connected without looseness. You can do it.

According to the present invention, there is provided a multiple ligating device according to the fifth aspect, wherein the bobbin having a plurality of bobbin portions at predetermined angular intervals around a support shaft, and the support shaft facing the bobbin portion. A sealing body having a sealing surface at the center for abutting against the bobbin and sealing and a sealing release surface adjacent to the sealing surface and unsealing away from the bobbin to release the sealing; An object of the present invention is to provide a multiple ligating device, characterized in that a communication groove communicating with a thread insertion groove of a bobbin portion and allowing a free end of a ligature to be inserted is provided on a sealing surface adjacent to a surface for releasing sealing of a body. It is. Around the support shaft, the sealing surface abuts on the equally-wound bobbin portion of the bobbin to close the bobbin, and rotates relative to each other. While the bobbin can be opened, the communication groove is provided on the sealing surface to communicate with the thread insertion groove of the bobbin and to allow the free end of the ligature to be inserted. If the free end of the ligature is inserted into the thread insertion groove of the connected bobbin, it means that it has been inserted into the correct knot,
The knot can be reliably formed by opening the inserted bobbin by rotating relatively and pulling the yarn.

According to the present invention, there is provided the multiple ligating device according to the sixth aspect, wherein a support shaft for rotating operation is provided on the bobbin, and the support shaft is penetrated through the closing member, and the bobbin is attached to the closing member. It is an object of the present invention to provide a multiple ligating device which is provided so as to be capable of relative rotation operation. The support provided through the closure allows the spool to rotate relative to the closure so as to be rotatable relative to the closure. By operating the closure and the support, multiple ligations can be performed smoothly. Further, the present invention relates to claim 6
Alternatively, the present invention provides a multiple ligating device according to the seventh aspect, wherein the wound body is provided so as to be separable from the spindle and the closing member. Since the bobbin can be divided from the spindle and the sealing body, the ligature can be easily wound around the bobbin portion of the bobbin, and the bobbin wound with the ligature can be separated from the spindle or the sealing body. It can be manufactured as an independent part, packaged and transported, and marketed.

Further, the present invention relates to claim 5, 6, 7 or 8.
5. The multiple ligating device according to claim 1, wherein a base end side of the ligature is firmly fixed to the wound body, and a free end side of the ligating device is hooked openably. Things. By firmly fixing the base end side of the ligature to the bobbin, a strong pulling force can be applied to the base end side of the ligature when knotting, and a strong knot can be formed and the free end side Is provided so as to be freely latched, so that it can be released from the wound body, freely inserted into the ligature or the thread insertion groove, and ligated. Also, the present invention provides the multiple ligating device according to claim 5, 6, 7, 8 or 9, wherein the free end of the ligature can be passed through the bobbin by communicating with the thread insertion groove of the bobbin portion. An object of the present invention is to provide a multiple ligating device characterized by providing a thread insertion groove. With the above configuration, the free end of the ligature can be inserted into the thread insertion groove of the thread winding portion communicating with the thread insertion groove.

[0015]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described in detail below with reference to the illustrated embodiments. First, the principle of the present invention will be described with reference to FIGS. 8 to 12. In FIG. 8, the ligature 10 to which the base end portion 4 is fixed is connected to the first, second, and third three knots 1 and 2. In accordance with the triple ligating method in which
Thread insertion groove 1 whose side is open from the base to the tip
A third knot 3, a second knot 2, and a first knot 1, which are in the reverse order of knots, are wound around three winding portions 7, 8, 9 provided with 1, 12, 13 respectively, and the free end 5 of the ligature 10 is After passing through the ligature with the needle 6, the ligature is removed from the thread winding portion 7 through the thread insertion groove 11 of the first knot 1, and in FIG. 9, the ligature 14 on the fixed side and the ligature 15 on the free side are separated. Is pulled, the first knot 1 of the double winding in FIG. 10 can be formed. At this time, since the number of times of winding the first knot 1 around the bobbin 7 in FIG. 8 is two, the first knot 1 of double winding is formed. If the number of windings is 1, the first nodule 1 having the number of windings 1 can be formed as shown in FIG.

Next, referring to FIG.
The needle 6 at the free end 5 of the thread is inserted into the thread insertion groove 1 of the thread winding portion 8 of the second knot 2.
2, the ligature of the wound part 8 is removed, and the ligature 16 on the fixed side and the ligature 17 on the free side are pulled in FIG.
The single knot second knot 2 in FIGS. 10 and 11 can be formed, and then the needle 6 at the free end 5 of the ligature 10 can be threaded through the thread 9 of the third knot 3 again at 8. Groove 13
When the ligature of the wound part 9 is removed and the ligature 18 on the fixed side and the ligature 5 on the free side are pulled in FIG.
2 can form a third nodule 3 of a single turn. In FIG. 9, reference numeral 19 denotes a fixing member for fixing the base end 4 of the ligature 10. In the embodiment, a fixing member for holding the base end 4 of the ligature 10 in a fixing hole formed in the lower surface 29 of the bobbin 20. Although it is configured so that the base 19 is inserted and fixed, if the base end portion 4 of the ligature 10 can be firmly fixed, various conventionally known thread fixing means can be adopted without particular need for illustration. Of course you can. FIG.
As shown in FIGS. 11 and 12, if the number of nodules is terminated at the first and second nodules, a double knot is obtained. 8 and 10 can be ligated, and the ligature can be wound around the bobbins 7, 8, 9,. If you increase the number of times instead of one,
Of course, a knot of double, triple,.

In the embodiment of the multiple ligating device shown in FIGS. 1 to 5, a spool 20 has three spools 7, 8, 9 on a lower surface of a spindle 25 at a predetermined angular interval. Each of the thread winding portions 7, 8, 9 is provided with a thread insertion groove 11, 12, 13 which is opened radially toward the outer surface around the support shaft 25. As shown in FIG. In a state in which the ligature 10 with the base end 4 fixed to the fixing member 19 in the state where the fins 8 and 9 protrude upward from the bobbin 20, as shown in FIG.
According to a triple ligating method in which the second and third three knots 1, 2, 3 are overlapped and tied, the three pegs 7, 8, 9 are connected in the reverse order of the knots from the base to the tip. The three nodes 3, the second node 2, and the first node 1 can be wound in this order. In the case of the embodiment, the method of winding the ligature around the bobbin is shown in FIG. 8, in which the lower end of the bobbin is a base end and the upper end is an open end.
The base end 4 of the ligature is fixed in the order of the third knot 3, the second knot 2, and the first knot 1 in the reverse order of the knot, and the right side is wound around the thread winding portion 9 of the third knot 3 from bottom to top. One turn, then change the winding direction,
One turn of the left winding from the bottom to the winding part 8 of the second knot 2, then change the winding direction, and wind the winding part 7 of the first knot 1 from the bottom to the top of the left winding two turns, Free end 5 of ligature 10
The needle 6 of each of the thread insertion grooves 11, 12,
13 is inserted from the base end side toward the open end, and the insertion direction and the opening direction of the wound thread are configured to match.

In the case of the embodiment, the thread winding body 20 is formed so that the thread insertion grooves 21, 22, 23 are continuous with the thread insertion grooves 11, 12, 13.
Are provided radially open around the support shaft 25 toward the outer side surface, and the respective thread insertion grooves 11, 1 of the thread winding portions 7, 8, 9 are provided.
The needles 6 and the like on the free end 5 side of the ligature 10 are configured to be easily inserted into the open ends 2 and 13 from the base end side of the peg portion toward the open end. These thread insertion grooves 21, 22, 2
If there is no ligature 3, the ligature 10 is inserted between the ligature wound around the base end of the bobbin by mechanical winding or the like and the insertion grooves 11, 12, 13.
There is no gap for inserting the needle 6 and the like on the free end 5 side, and the insertion becomes difficult. Accordingly, when there is no thread insertion groove 21, 22, 23, the thread winding portions 7, 8, 9 are so exposed that the respective thread insertion grooves 11, 12, 13 are exposed above the base end of the thread winding portion.
Must be provided in a form protruding outward from the outer peripheral portion of the bobbin 20.

In the case of the embodiment, the bobbin is formed in a columnar shape and is provided straight in parallel with the support shaft 25. As shown in the above, they may be provided radially outward.
At this time, in the case of being provided in the middle direction, the bobbin of the bobbin can be configured to be small, and the wound thread tends to not easily come off from the bobbin, which is advantageous when tightly tying a knot. In this method, the wound thread can be easily wound around the wound portion, and the wound thread can be easily released from the wound portion, so that there is an effect that smooth ligation operability can be obtained. In addition, the shape of the wound portion may be substantially the same in outer diameter from the base end portion to the distal end portion, but the wound thread portion is easily opened by providing a slightly smaller outer diameter in the distal end portion direction. It will be. In addition to the cylindrical shape of the embodiment, the outer shape of the thread winding portion can be formed into an appropriate shape such as an elliptical cross section, a semicircular shape, a sector shape, a triangular shape, a polygonal shape, and the like. In addition to the angular shape whose depth is almost the same as the opening of the embodiment, the opening of a semi-elliptical cross section, a semicircular shape, a sector shape, a triangular shape, a polygonal shape, or the like is wide or narrow with respect to the depth or the center. The portion can be formed into an appropriate shape consisting of a combination such as deep, etc., and is substantially the same, or becomes wider, narrower, or deeper in the thread insertion direction from the base end to the distal end of the bobbin. Alternatively, it can be configured in an appropriate shape such as being shallow or a combination thereof. In addition, the thread insertion grooves 21, 22,
The shape of 23 can also be configured appropriately so that the needle 6 and the like of the free end 5 of the ligature 10 can easily pass through. FIG.
In the embodiment, the bobbin 20 is described to be about three times as long as the bobbins 7, 8, and 9; Of course, the length can be set equal to or less than that.

The support shaft 25 may be integrally fixed through the axis of the bobbin 20 so that the bobbin 20 can be rotated by the support shaft 25. In the case of the embodiment, the support shaft 25 can be rotated. The shaft portion 25 is provided so as to be rotatable through a shaft hole 24 provided in the bobbin 20 through the shaft center, and a key piece 26 provided at the upper end of the support shaft 25 has a key piece insertion hole 27. The bobbin 20 is rotatably operated integrally with the support shaft 25 by being fitted from above into an engaging groove 28 provided at the top of the bobbin 20. In the case of the embodiment shown in FIG. 1, the support shaft 25 has a sealing surface 31 and a sealing release surface 32 facing the winding portions 7, 8, 9 of the winding body 20.
Are rotatably penetrated through a shaft hole 33 of the sealing body 30 having a top portion. Although not shown in the drawing, the sealing body 30 and the support shaft 25 are provided so as to be operably connected to the distal end of an elongated operating instrument having a remote operation unit at the base end. Sealing surface 31
Abuts against the end portions of the bobbin portions 7, 8, 9 to block the bobbin portions and their thread insertion grooves 11, 12, 13 to prevent the winding thread from being released, and the unblocking surface 32 is separated from the bobbin portions. It is configured to release the blockade. In the case of the embodiment, the sealing surface 31 and the sealing release surface 32 are arranged adjacent to each other in a fan shape around the shaft hole 33 as shown in FIG. From the position where all of the seals 8 and 9 are closed, relative rotation about the support shaft 25 is performed, and the bobbins 7, 8 and 9 are successively opposed to the seal release surface 32 in the knotting order and are opened.

The sealing surface 31 adjacent to the sealing release surface 32 of the sealing body 30 which rotates relatively around the support shaft 25 first communicates with the thread insertion groove 11 of the thread winding portion 7 of the first knot 1. Thus, the free end 5 of the ligature 10 can be inserted, and a communication groove 34 is provided for sequentially communicating with the thread winding portions 8 and 9 of the second and third knots with the relative rotation. A passage guide surface 35 for the needle 6 is provided on the bottom surface of the communication groove 34. In FIG. 4, the spool 2 is
0 rotates in the counterclockwise direction, and the communication grooves 34 sequentially communicate with the thread winding portions 7, 8, 9 of the first, second, and third knots that have been sealed by the sealing surface 31, and the sealing release surface sequentially. The state in which the double ligature is opened relative to 32 and the triple ligature is performed is described in order in the plan view seen from above in the embodiment of FIG.

In the upper left view of FIG. 4, all the thread winding portions 7, 8, and 9 of the first, second, and third knots are in contact with the sealing surface 31, and the support shaft 25 is rotated counterclockwise from this state. As shown by the arrowhead, when the lower right state is reached, the thread insertion groove 11 of the first knot coincides with the communication groove 34. Here, after passing through the ligature with the needle 6 at the free end 5 of the ligature 10,
The thread insertion groove 11 is passed from the base end toward the distal end (from above to below, or from a distance to the front). Then, spindle 2
5 is rotated counterclockwise to the lower left position as indicated by the arrow mark, the thread winding portion 7 and the thread insertion groove 11 of the first knot 1 are opened facing the sealing release surface 32, and When the free end 5 side of the ligature 10 is pulled so as to take up slack, the wound thread that has come off from the thread part 7 forms the first knot 1 around the ligature. At this time, since the thread insertion groove 12 of the second knot coincides with the communication groove 34, the free end 5 is inserted into the thread insertion groove 12 from the base end of the thread winding portion 8 toward the distal end. Next, when the support shaft 25 is rotated counterclockwise to a lower right state as indicated by an arrow mark, the thread winding portion 8 and the thread insertion groove 12 of the second knot 2 face the sealing release surface 32. Opening and pulling the free end 5 side of the ligature 10 to remove the slack,
The wound yarn deviating from the yarn winding portion 8 forms the second knot 2 on the first knot 1. At this time, since the thread insertion groove 13 and the communication groove 34 of the third knot are located at the same position,
The free end 5 is inserted into the thread insertion groove 13 from the base end of the thread winding portion 9 toward the distal end. Next, when the support shaft 25 is rotated counterclockwise to the lower left position as shown by the arrow mark, the thread winding portion 9 and the thread insertion groove 13 of the third knot 3 are opened facing the sealing release surface 32. Then, when the free end 5 side of the ligature 10 is pulled so as to remove the slack of the thread, the wound thread coming off the thread winding portion 9 forms the third knot 3 on the second knot 2, and the triple ligature is Will be completed.

Further, in the embodiment shown in FIG.
The key shaft 26 is moved upward with respect to
8, when the key piece 26 is aligned with the key piece insertion hole 27, the thread winding body 20 can be separated from the support shaft 25. Therefore, in this case, in FIG.
At 0, the ligature 10 having the base end 4 fixed by the fixing member 19 is connected to the first, second, and third three knots 1, 2, and 3 according to a triple ligating method in which the knots are sequentially overlapped and tied. , Thread insertion grooves 11, 12, the side portions of which are open from the base side to the tip end,
13 can be wound in the order of the third knot 3, the second knot 2, and the first knot 1 in the reverse order of knots on the three bobbins 7, 8, 9 respectively. In order to keep the ligature 10 wound around the ligature 10, a lid 35 fitted to each of the thread winding portions 7, 8, 9 is detachably provided. Therefore, by attaching the lid 35 to the bobbin 20 on which the ligature is wound, the bobbin 20 with the ligature 10 is independently manufactured, transported, and stored. By attaching to the distal end and detaching the lid 35, ligating preparation can be easily performed as shown in FIG.

In the embodiment shown in FIG. 1, the upper and lower relations of the bobbin 20 and the closing body 30 are provided in reverse with respect to the support shaft 25, and the bobbin 20 is remote-mounted with the bobbin portions 7, 8, 9 upward. By attaching to the tip of the operating member and rotating the sealing body 30 having the sealing surface 31, the sealing release surface 32, and the communication groove 34 opposite to the bobbin by the support shaft 25 above the bobbin 20, FIG. It can be configured to form a triple ligature in the same manner as described above, with the same relative rotation operation of the two bodies 20 and 30.
In the case of the embodiment of FIG. 1, the thread insertion grooves 11, 12, 1
The direction in which the needle 6 of the free end 5 of the ligature 10 is inserted into the ligature 10 is viewed from the front of the remote operation member, and is inserted from the far side. This is advantageous in that it is easy to see from the front, and that the detachment of the wound yarn from the wound body can be easily monitored from the front. In this regard,
In the configuration in which the vertical relationship between the bobbin 20 and the closing body 30 is reversed, the direction in which the needle 6 of the free end 5 of the ligature 10 is inserted into the thread insertion grooves 11, 12, and 13 is set in front of the remote control member. The distal end of the needle 6 coming out of the thread insertion groove may be difficult to see as a shadow of an operating instrument such as a forceps since it is inserted far away from the needle. FIG. 6 is an explanatory view schematically showing another embodiment, and as described with reference to FIGS.
The plate-shaped closure 30 having the open window 36 is relatively moved to the spools 7, 8, 9 provided in parallel to the spools 7, 8, 9.
8, 9 and the respective thread insertion grooves 11, 12, 13 are sequentially opened, and a triple ligature in which the first, second, and third three knots 1, 2, 3 are sequentially overlapped and tied is performed. be able to. FIG. 7 is an explanatory view schematically showing another embodiment. A box-shaped closure having fitting holes 7, 8 and 9 having different heights arranged in parallel on a plane wound body 20 and having a fitting hole. The relative movement of the thread 30 and the thread winding portions 7, 8, 9 and the respective thread insertion grooves 11, 1
2, 13 are sequentially opened, and the first, second, and third three knots 1, 2, and 3 are sequentially overlapped and tied.

[0025]

As described above, according to the multiple ligating method according to the present invention, as described in claim 1 of the claims,
A plurality of thread winding portions each having a thread insertion groove whose side portion is open from one side to the tip in accordance with a predetermined multiple ligating method in which a plurality of knots are overlapped on a free end side of a ligature having a fixed base end portion. , And the open ends of the respective thread winding portions are sequentially closed with a detachable sealing body, and the free end of the ligature is passed through the ligated object, and then passed through the thread insertion groove of the first knot. ,
Next, the sealing body is removed to open the bobbin portion, the thread of the bobbin portion is removed and pulled to form a first knot, and then the same is passed through the thread insertion groove of the second knot, and the sealing body is removed. The ligature with the proximal end fixed is wound around the free end of the ligature by releasing the wound portion of the ligature, removing the thread of the wound portion and pulling to form a second knot, and sequentially forming the knot. The free end fixed earlier than the conventional method of fixing the free end side and winding the base end side around the bobbin in the order of knots and fixing the base end by winding in the reverse order of the knot order This eliminates the necessity of the means and the method for releasing the fixing on the side, and has the effect that when the free end side is opened from the peg portion and ligated, it can be smoothly opened in the order of the knots. In addition, by closing the open ends of the respective bobbins with a blocking body and sequentially removing them, it is possible to reliably maintain the binding yarn wound around the respective bobbins at the time of the blockage. When pulling the thread passed through to loosen or knotting the knot without loosening, there is no fear that the thread wound around the thread part will come off, and the closures will be sequentially connected from the open end of each thread part in the order of knots. By separating, there is an effect that each nodule can be sequentially and reliably connected without loosening.

Further, according to the multiple ligating method according to the present invention, in the multiple ligating method according to the first aspect, the ligature whose base end is fixed is attached to each of the bobbins by the third, second, and first knots. And in the order of the first, second, and third nodules,
By removing the sealing member and opening the bobbin portion, removing the thread of the bobbin portion and pulling, the knots are formed in a triple knot in the order of the first, second, and third knots. The free end side of the ligature with the fixed portion is smoothly wound around the bobbin in the reverse order of knots in the order of third, second, and first knots, and each knot is sequentially formed in the order of the first, second, and third knots. There is an effect that a triple knot can be securely connected without loosening.

Further, according to the multiple ligating method according to the present invention, in the multiple ligating method according to claim 1 or 2, the free end of the ligature is inserted into the thread insertion groove from the base end of the bobbin to the open end. And pulling the ligature of the bobbin in the direction of the open end to form each knot, so that the free end of the ligature can be moved from the base end of the bobbin to the open end in the bobbin insertion groove. By inserting the ligature, the insertion direction of the ligature and the pulling direction of releasing the ligature from the bobbin portion match, which has an effect that the thread of the bobbin portion can be smoothly removed in the open end direction.

Further, according to the multiple ligating method according to the present invention, in the multiple ligating method according to the first, second or third aspect, the open end of the bobbin has a communication groove capable of communicating with the thread insertion groove. When the communication groove communicates, the thread insertion groove is closed with a sealing body through which the free end of the ligature can be inserted, and the open end of the other thread winding part is closed with a sealing body without the communication groove, and the free end of the ligature is closed. By having a configuration in which the sealing body is removed from the thread insertion groove of the bobbin portion in which the communication groove communicates with the thread insertion groove, the bobbin portion is opened, the ligature of the bobbin portion is removed, and a pull knot is formed. Since the free end of the ligature can be inserted through the thread insertion groove when the communication groove of the sealing body communicates with the thread insertion groove of the portion, for example, when the communication groove communicates with the thread insertion groove of the thread winding portion of the first knot The open end of the bobbin portion and the thread insertion groove after the second knot are closed with another blocking member having no communication hole. Since the free end of the ligature cannot be inserted into the thread insertion groove after the second knot, it is certain that the ligature is ligated into the thread insertion groove of the first knot where the communication groove communicates with the thread insertion groove of the spool. The thread can be inserted, and there is an effect that the order of knots is not afraid to be mistaken. The sealing body of the first knot is removed, the thread insertion groove and the bobbin portion are opened, and the ligature of the bobbin portion is removed to pull the first knot. The knot can be formed smoothly, and then, by connecting the communication groove to the thread insertion groove of the bobbin in the order of the second and third knots, there is an effect that a multiple knot can be reliably formed.

Further, according to the multiple ligating device of the present invention, a plurality of thread winding portions having a thread insertion groove having a side portion opened from one side to the tip end are provided, and a plurality of thread winding portions are provided on the plurality of thread winding portions. The free end of the ligature with the base end fixed is provided by winding in the reverse order of the knot order in accordance with a predetermined multiple ligating method in which a plurality of knots are overlapped, and the open ends of the respective thread winding portions are closed and unsealed in the knot order. By having a configuration in which a sealing body is provided, a free end of a ligature having a base end fixed to a plurality of bobbins, in the reverse of the knot order according to a predetermined multiple ligating method in which a plurality of knots overlap. Because it is provided wound in order,
The free end of the wound ligature can be passed through the object to be ligated as it is, and the ligature can be smoothly opened from the wound portion in the order of the knot and used. By closing the open end, the wound state of the thread wound around the thread winding portion can be maintained, so that the thread passed through the ligature can be pulled to loosen, or the knot can be tied without loosening. Therefore, there is no fear that the thread wound around the bobbin may come off, and the knots can be sequentially and securely connected without loosening by sequentially separating the closures from the open ends of the bobbins in the order of the knots. effective.

Further, according to the multiple ligating device of the present invention, in the multiple ligating device according to the fifth aspect, a thread wound body having a plurality of thread winding portions at predetermined angular intervals around a support shaft;
A sealing surface having a sealing surface that faces the bobbin portion and abuts on the bobbin portion around the spindle to close the bobbin portion, and a sealing body having an unblocking surface adjacent to the sealing surface and separated from the bobbin portion to release the sealing. And a communication groove provided on the sealing surface adjacent to the unsealing surface of the sealing body, the communication groove communicating with the thread insertion groove of the bobbin portion and allowing the free end of the ligature to be inserted. By having, the sealing surface comes into contact with the equally-wound bobbin portion of the bobbin around the support shaft, thereby closing the bobbin, and relatively rotating, so that the unblocking surface adjacent to the blocking surface is opposed. From
While there is an effect that the wound body can be opened in the order of ligation, a knot is formed by providing a communication groove in the sealing surface that communicates with the thread insertion groove of the peg portion and allows the free end of the ligature to be inserted. When the free end of the ligature is inserted into the thread insertion groove of the thread part where the communication groove communicates, it means that the ligature has been inserted into the correct knot, and the relative thread rotates to open the inserted thread part and pull the thread. This has the effect of reliably creating multiple nodules.

According to the multiple ligating device according to the present invention, in the multiple ligating device according to the sixth aspect, a support shaft for rotating operation is provided on the bobbin, and the support shaft is penetrated through the closing body to be closed. With the configuration in which the wound body is provided so as to be relatively rotatable with respect to the body, it is possible to rotate the wound body so as to be relatively rotatable with respect to the sealed body by the support shaft provided through the closed body. There is an effect that multiple ligations can be performed smoothly by operating the sealing body and the support shaft. Further, according to the multiple ligating device according to the present invention, in the multiple ligating device according to claim 6 or 7, the configuration is such that the bobbin is provided so as to be separable from the spindle and the sealing member, so that the bobbin is supported. Since it can be divided from the shaft and the sealing body, it is easy to wind a ligature around the wound part of the wound body, and the wound body wound with the ligature is a part independent from the spindle and the sealing body. It has the effect that it can be manufactured, packed, transported, and marketed.

Further, according to the multiple ligating device according to the present invention, in the multiple ligating device according to claim 5, 6, 7 or 8, the base end side of the ligature is firmly fixed to the wound body. By having a configuration in which the free end side is freely opened and latched, the base end side of the ligature is firmly fixed to the wound body, so that the base end side of the ligature is knotted when knotting. A strong pulling force can be applied, and a strong knot can be formed, and the free end side can be freely hooked and released, so that it can be released from the wound body and freely inserted into the ligature or thread insertion groove. And there is an effect that can be ligated. According to the multiple ligating device of the present invention,
6. The multiple ligating device according to 6, 7, 8 or 9, wherein the thread wound body is provided with a thread insertion groove which communicates with a thread insertion groove of a thread winding portion and enables insertion of a free end of a ligature. By having this, there is an effect that the free end of the ligature can be inserted into the thread insertion groove of the thread winding portion communicating from the thread insertion groove.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a main part of one embodiment of the present invention.

FIG. 2 is a bottom view of a main part of the embodiment of FIG. 1;

FIG. 3 is a plan view of another main part of the embodiment of FIG. 1;

FIG. 4 is a schematic plan view sequentially showing an operation mode of a main part of the embodiment of FIG. 1;

FIG. 5 is a schematic bottom view showing another embodiment of a main part of the embodiment of FIG. 1;

FIG. 6 is a schematic perspective view showing a main part of another embodiment of the present invention.

FIG. 7 is a schematic perspective view showing a main part of another embodiment of the present invention.

FIG. 8 is a perspective view showing a principal part of an embodiment of the present invention in principle.

FIG. 9 is a perspective view showing an essential part of an embodiment of the present invention in principle.

FIG. 10 is a schematic explanatory view for explaining a ligation method of a main part according to one embodiment of the present invention.

FIG. 11 is a schematic explanatory view for explaining a method of ligating a main part according to one embodiment of the present invention.

FIG. 12 is a schematic explanatory view for explaining a method of ligating a main part according to one embodiment of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 1st knot 2 2nd knot 3 3rd knot 4 Base end part 5 Free end 6 Needle 7 1st ligation thread part 8 2nd ligation thread part 9 3rd ligation thread part 10 Ligation thread 11, 12, 13 Thread insertion groove 14 Fixed-side ligature 15 Free-side ligature 16 Fixed-side ligature 17 Free-side ligature 18 Fixed-side ligature 19 Fixing member of base end 4 20 Thread body 21,22,23 Thread Insertion groove 24 Shaft hole 25 Support shaft 26 Key piece 27 Key piece insertion hole 28 Engagement groove 29 Lower surface of thread winding body 30 Sealing body 31 Sealing surface 32 Sealing release surface 33 Shaft hole 34 Communication groove 35 Lid 36 Open window

Claims (10)

[Claims] 1. A ligature having a fixed base end,
According to a predetermined multiple ligating method in which a plurality of knots overlap, a plurality of knots are wound around a plurality of pegs provided with a thread insertion groove whose side is open from one side toward the tip in the reverse order of knot order, and The open end is sequentially closed with a detachable sealing body, the free end of the ligature is passed through the ligature, then through the thread insertion groove of the first knot, and then the sealing body is removed to open the wound part. Then, the ligature of the bobbin is removed and pulled to form a first knot. Then, similarly, the second knot is passed through the thread insertion groove, the sealing body is removed, the bobbin is opened, and the ligature of the bobbin is removed. And forming a second knot and pulling the knot in sequence to form a second knot. 2. The multiple ligating method according to claim 1, wherein a ligature having a fixed base end is wound around the bobbin in the order of third, second, and first knots, and first, second, and first knots. Multiple knots formed by removing the sealing body in the order of the three knots, opening the bobbin, removing the ligature of the bobbin and pulling, forming the knots in a triple knot in the order of the first, second, and third knots Method. 3. The ligature of claim 1, wherein the free end of the ligature is pulled by inserting the free end of the ligature through the thread insertion groove from the base end of the spool to the open end. A plurality of nodules in the direction of the open end to form each nodule. 4. The multiple ligating method according to claim 1, wherein the open end of the thread winding portion has a communication groove that can communicate with the thread insertion groove, and the thread insertion groove is ligated when the communication groove communicates. A bobbin where the free end of the thread is closed with a blocking body that can be inserted, the open end of the other bobbin is closed with a blocking body without a communication groove, and the free end of the ligature is connected with the communication groove with the thread insertion groove. And removing the closed body from the thread insertion groove, opening the wound part, removing the ligature of the wound part, and forming a pull knot. 5. A plurality of thread winding portions each having a thread insertion groove whose side portion is open from one side portion to the distal end, and a free end of a ligature having a base end fixed to the thread winding portion. A multiple ligating device comprising a plurality of knots wound in a reverse order of the knot order according to a predetermined multiple ligating method and provided with a closing member for closing the open ends of the respective bobbin portions and releasing the sealing in the knot order. 6. The multiple ligating device according to claim 5, wherein a bobbin having a plurality of bobbin portions at predetermined angular intervals around a spindle, and a bobbin portion facing the bobbin around the spindle. A sealing surface having an unsealing surface adjacent to the sealing surface and unsealing away from the bobbin portion together with the sealing surface that abuts against the sealing member so as to be relatively rotatable about the support shaft, and the unsealing of the sealing body is performed. A multiple ligating device, wherein a communication groove is provided on a sealing surface adjacent to the surface so as to communicate with a thread insertion groove of a bobbin portion to enable insertion of a free end of a ligature. 7. The multiple ligating device according to claim 6, wherein a support shaft for rotation operation is provided on the bobbin, and the support shaft is penetrated through the closing member so that the bobbin can be rotated relative to the closing body. A multiple ligating device, comprising: 8. The multiple ligating device according to claim 6, wherein the wound body is provided so as to be separable from the support shaft and the closing member. 9. The multiple ligating device according to claim 5, wherein the base end side of the ligature is firmly fixed to the wound body, and the free end side is openably hooked. A multiple ligating device characterized in that it is provided. 10. The multiple ligating device according to claim 5, 6, 7, 8 or 9, wherein the free end of the ligature can be passed through the bobbin by communicating with a thread insertion groove of a bobbin portion. A multiple ligating device comprising a thread insertion groove.