JP2002102234A - Hemostatic clip - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a technique substituting for the application of bone wax for preventing bleeding on the cut surface of the sternum. SOLUTION: The hemostatic clip 10 is for stop bleeding from the cut surface of the sternum in the median sternotomy. The hemostatic clip 10 is provided with a clasp part 11 consisting of plural claws 15a and 15b for clasping the cut surface of the sternum from both sides in the cross direction, an operating part 12 consisting of an operating knob 16 for operating the clasp part 11 in the clasping action state or in the non-clasping action state, and a hemostatic part 13 for covering the cut surface of the sternum in the clasping action state. The hemostatic part 13 is made of a urethane foam 18 to cover the cut surface of the sternum.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a technique for performing hemostasis from a cut surface of a sternum in a median sternotomy.

[0002]

2. Description of the Related Art In cardiac surgery performed in cardiovascular surgery, a median sternotomy is the most widely used standard method of reaching the heart. In this method, the median sternum is incised vertically from just below the upper edge of the sternum to the lower part of the xiphoid process. When such an incision is made, it is necessary to prevent bleeding from the cut surface of the sternum (bone marrow). Therefore, bone wax is applied to the cut surface of the sternum.

[0003]

However, the method of applying bone wax does not have a sufficient hemostatic effect, and
Since this bone wax becomes a hotbed of infection after surgery, a method other than bone wax application is desired. That is, in the case of bone wax, the wax adheres to the cut surface of the sternum, so that the wax remains after the operation, and the remaining wax becomes a hotbed of infection. In recent years, minimally invasive surgery (MICS) has also been increasing in cardiovascular surgery,
Small incision surgery for making wounds smaller is becoming widespread. In MICS, the amount of incision is smaller than before, but bleeding from the cut surface of the sternum cannot be avoided. Therefore, even in the case of MICS, a method other than bone wax application is desired.

[0004] The present invention has been made in view of the above circumstances, and an object thereof is to provide a technique that can replace bone wax application for preventing bleeding on a cut surface of a sternum.

[0005]

In order to solve the above-mentioned problems, the present invention is directed to a holding portion for holding the cut surface of the sternum from both sides in the width direction, and a holding action state and a non-holding action state of the holding portion. And a hemostatic portion capable of covering the cut surface of the sternum in the state of the pinching action.

[0006] According to this configuration, since the cut surface of the sternum is held by the holding portion from both sides in the width direction, it is possible to hold and press the cut surface of the sternum (first hemostatic effect). In order to perform the clamping by the hemostatic clip, the operating portion is operated to bring the clamping portion into the non-clamping operation state to the position of the sternum cut surface, and then the clamping portion is brought into the clamping operation state.
In addition, in the state of the pinching action, the cut surface of the sternum can be covered with the hemostatic portion, whereby the hemostatic effect can be enhanced (second hemostatic effect). A hemostatic agent may be applied to the hemostatic portion in advance, or may be applied at the time of surgery. As described above, a hemostatic clip having the above-described characteristic configuration can be provided as a technique that replaces the application of bone wax for preventing bleeding on the cut surface of the sternum.

[0007] In a preferred embodiment of the present invention, the holding portion is provided with a plurality of claw portions for performing a holding action along a sternum cutting direction. When the sternum cut surface is pinched by the pinching part, if the area of the part that performs the pinching action along the sternum cutting direction is large, the pinching force will be large, which may block blood circulation and amplify damage to living tissue There is. Therefore, by configuring the holding portion with a plurality of claw portions, it is possible to prevent accidental detachment while having an appropriate holding force, and it is possible to reduce damage to the affected part.

According to another preferred embodiment of the present invention, the hemostatic portion is made of a porous liquid absorbing material such as urethane foam. Urethane foam is a material that is easily elastically deformed, and can correspond (deform) itself to a curved sternum cut surface to effectively cover the bone cross section. Therefore, the hemostatic effect of the hemostatic portion can be further enhanced.

[0009] In still another preferred embodiment of the present invention,
A length of the hemostatic portion along the sternum cutting direction is set to be longer than a length of the holding portion along the sternum cutting direction. When using the hemostatic clip according to the present invention, a plurality of hemostatic clips may be used along the sternum cutting direction. In this case, if a gap is formed between the hemostatic clips used adjacent to each other, there is a possibility that the hemostatic effect at that portion may not be obtained.
Therefore, by making the length of the hemostatic portion along the cutting direction of the sternum longer than the same length of the holding portion, it is possible to prevent bleeding at a portion between adjacent hemostatic clips, thereby further enhancing the hemostatic effect. be able to.

[0010] In still another preferred embodiment of the present invention,
The operation unit may be a holding claw for holding a distal end portion of the operation tool.

Thus, by operating the operating tool in a state where the tip of the operating tool is held by the holding claw, the holding portion can be switched between the holding action state and the non-holding action state.

In still another preferred embodiment of the present invention,
The operation unit may be an insertion opening into which a distal end of an operation tool is inserted.

Thus, by operating the operating tool with the tip of the operating tool inserted into the insertion slot, the holding portion can be switched between the holding action state and the non-holding action state.

[0014]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Preferred embodiments of a hemostatic clip according to the present invention will be described with reference to the drawings. FIG. 1 is a diagram showing the position of the heart in the rib cage. The outside of the heart 1 is covered by a sternum 2, a rib 3, a collarbone 4, and a xiphoid process 5.

In cardiac surgery performed in cardiovascular surgery, a method called median sternotomy is most commonly used as a thoracotomy to reach the heart 1 because the entire heart can be exposed. This is a method of vertically incising the sternum midline from just below the upper edge of the sternum to the lower part of the xiphoid process 5. In FIG. 1, the cutting line is indicated by L, and the state after cutting is shown in FIG.
Shown in

The length along the cutting direction of the cut surface of the sternum 2a according to the above method is about 15 cm for an adult (30 cm on both sides since the cut surface 2a is on both sides). Of these, it is necessary to stop bleeding from the sternum cut surface 2a using several hemostatic clips (described later) other than the fixing part of the thoracotomy device. A hemostatic clip for performing such hemostasis will be described.

<Structure of Hemostatic Clip According to First Embodiment> FIG. 3 is a view showing the appearance of the hemostatic clip 10.
(A) is a plan view, (b) is a front view, and (c) is a side view. The hemostatic clip 10 is roughly divided into
, An operation unit 12, a hemostasis unit 13, and a main unit 14. The holding portion 11 includes a first claw portion 15 a and a second claw portion 15.
b faces each other. The width of each of the claws 15a and 15b (indicated by the symbol w in FIG. 3B) is about 3 mm. The distance between the tips of the first claw 15a and the second claw 15b is about 6 mm. The claws 15a and 15b are arranged at predetermined intervals in a direction along the sternum cutting direction. Claw part 15
The number of a and 15b can be appropriately changed according to the size of the hemostatic clip 10 and the like. Each of the claws 15a and 15b is formed integrally with the tip (the tip of the C-shape) of the main body 14 having a substantially C-shaped cross section.

The operation section 12 has an operation knob 16 (corresponding to an operation tool), which has the same shape as the operation knob of an office clip. The base 16a of the operation knob 16 is held by a holding portion 17 (also included in the operation portion 12) formed on a holding claw having a substantially C-shaped cross section. Move the operation knob 16 to the arrow A in FIG.
, The space between the first claw 15a and the second claw 15b can be increased.

The hemostatic portion 13 is made of urethane foam 18 and is attached to the C-shaped inner portion of the main body portion 14 by other methods. The length x1 (about 70 mm) of the urethane foam 18 along the sternum cutting direction is the length x2 (5 mm) of the holding portion 11 along the sternum cutting direction.
(About 0 mm), and has protruding portions 18a protruding from the holding portion 11 on both sides thereof. When the hemostatic clip 10 is attached to the sternum cut surface 2a, the curved sternum cut surface 2a is covered with the covering portion 18a of the urethane foam 18 to exhibit a hemostatic effect. The protruding length of the protruding portion 18a (indicated by the symbol x3 in FIG. 3A) is 10
mm.

The holding section 11, the main body section 14, and the holding section 1
7 are integrally formed. A preferred material is stainless steel having a thickness of about 0.6 mm.

<Explanation at the time of use> Next, the operation of the hemostatic clip 10 according to the present embodiment will be described. First, a hemostatic agent is impregnated into the urethane foam 18. Examples of the hemostatic agent include oxycellulose and fibrin glue. FIG. 4 shows the hemostasis clip 10 on the sternum cut surface 2a.
It is sectional drawing which shows the state which attached. First claw 15a
And the second claw portion 15b, the sternum cut surface 2a is clamped from both sides in the width direction (clamping operation state). The holding force is given by the elastic restoring force of the material itself. Further, the sternum cut surface 2a is covered with urethane foam 18 impregnated with a hemostatic agent, thereby enhancing the hemostatic effect. Since the urethane foam 18 is a material that is easily deformed, it can conform to the cut surface shape of the sternum cut surface 2a, so that the sternum cut surface 2a can be completely covered. Urethane foam 18 is also excellent in that it has no adverse effect on the human body. In addition, operation knob 1
6 can be removed after attaching the hemostatic clip 10 to the sternum cut surface 2a.

FIG. 5 shows two (or more) along the sternum cut surface.
FIG. 2 is a view showing a state where the hemostatic clip 10 of FIG.
In this case, if a gap is formed between the hemostatic clips 10 used adjacent to each other, there is a possibility that the hemostatic effect at that portion may not be obtained. Therefore, since the covering portion 18a is provided by making the length of the urethane foam 18 along the cutting direction longer than the length of the holding portion 11, the gap between the hemostatic clips 10 is stopped by the covering portion 18a. be able to.

As described above, in the hemostatic clip according to the present invention, the urethane foam functioning as a hemostatic portion is used.
The sternum cut surface can be covered. Since the blood absorbed by the urethane foam coagulates, it alone has a sufficient hemostatic effect, but the effect can be further enhanced by adding a hemostatic agent to the urethane foam.
The hemostatic agent only permeates the urethane foam, and only a small amount of the hemostatic agent remains on the cut surface of the sternum after the operation. Therefore, it is not a source of infection.

<Hemostatic Clip According to Second Embodiment> Next, the configuration of a hemostatic clip according to a second embodiment will be described.
FIG. 6 is a perspective view showing the appearance of the hemostatic clip according to the second embodiment. Portions having the same functions as in the first embodiment are denoted by the same reference numerals.

The hemostatic clip 10 also includes a holding portion 11
And a main body 14. The holding portion 11 includes the first claw portion 1.
5a and the second claw portion 15b face each other (the same as in the first embodiment). Each of the claws 15a and 15b has a substantially C-shaped cross section.
It is integrally formed at the tip of the main body portion 14 formed in a U-shape. In addition, insertion holes 20 for inserting the tips of detachable pliers (corresponding to an operating tool) are formed at four positions on the upper and lower surfaces of the main body portion 14. A tapered surface 14a is formed on the near side in the insertion direction of the insertion hole 20 so that the tip of the detachable pliers can be easily inserted. Furthermore, insertion hole 2
Reinforcing ribs 14b are formed in the vicinity of 0 to prevent deformation during the attaching / detaching operation. The reinforcing rib 14b is formed as a convex or a concave with respect to the surrounding surface. Note that the reinforcing ribs 14b can be appropriately formed in portions other than the insertion hole 20. The urethane foam functioning as a hemostatic part is attached to the inside of the C-shape of the main body part 14 as in the first embodiment, but is not shown.

FIG. 7 is an external perspective view showing the shape of the detachable pliers 21. The detachable pliers 21 have a pair of operation knobs 22 and 23 connected by a connection shaft 24 and are urged in a closing direction by a spring 25. Each operation knob 22, 2
3 has a tip portion 22a inserted into the insertion portion 20,
23a is provided. The detachable pliers 21 and the insertion opening 20 of the hemostatic clip 10 correspond to an operation unit.

FIG. 8 shows the tip 22a of the detachable pliers 21.
23 shows a state in which 23a is inserted into the insertion hole 20 of the hemostatic clip 10. 9A and 9B are cross-sectional views illustrating a state where the detachable pliers 21 are inserted. FIG. 9A illustrates a state where the hemostatic clip 10 is closed, and FIG. FIG. 9 illustrates the urethane foam 18.

FIG. 10 shows a modification of the second embodiment.
(B) As shown in (c), the urethane foam 18 is also attached to the inner wall surface of the insertion hole 20.

<Embodiment> In this embodiment, the hemostatic portion is made of urethane foam. The functions of the hemostatic portion include (1) a high degree of coverage of the curved sternum cut surface, (2) easy holding of the hemostatic agent, and (3) a thrombus is generated with blood permeation to produce a hemostatic effect. Thing 3
Points. A porous sponge-like urethane foam is most suitable as having this advantage. As a second best configuration example, it may be made of a flexible gel material.

[Brief description of the drawings]

FIG. 1 shows a position of a heart in a rib cage.

FIG. 2 is a view showing a state in which a sternum is incised in FIG. 1;

FIG. 3 is a view showing the appearance of the hemostatic clip according to the first embodiment (a plan view, a front view, and a side view).

FIG. 4 is a diagram showing a usage state of the hemostatic clip according to the first embodiment.

FIG. 5 is a diagram showing a state where two hemostatic clips are attached along a cut surface of the sternum;

FIG. 6 is a perspective view showing the appearance of a hemostatic clip according to a second embodiment.

FIG. 7 is an external perspective view showing the shape of a detachable pliers.

FIG. 8 is a perspective view showing a use state of the hemostatic clip according to the second embodiment.

FIG. 9 is a sectional view showing a use state of the hemostatic clip according to the second embodiment.

FIG. 10 is a diagram showing a modification of the second embodiment.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 10 Hemostatic clip 11 Nipping part 12 Operation part 13 Hemostatic part 14 Main part 15a 1st nail | claw part 15b 2nd nail | claw part 18 Urethane foam 18a Coating part 20 Insertion hole 21 Detachable pliers

Claims (6)

[Claims] 1. A hemostatic clip for performing hemostasis from a cut surface of a sternum in a median sternotomy, comprising: a holding portion for holding the cut surface of the sternum from both sides in a width direction thereof; A hemostatic clip, comprising: an operation unit that operates in a non-clamping state; and a hemostatic unit that can cover the cut surface of the sternum in the clamping state. 2. The hemostatic clip according to claim 1, wherein the holding portion has a plurality of claw portions for performing a holding action along a sternum cutting direction. 3. The hemostatic clip according to claim 1, wherein the hemostatic portion is formed of a porous liquid absorbing material. 4. The length of the hemostatic portion along the sternum cutting direction is set to be longer than the length of the holding portion along the sternum cutting direction. The hemostatic clip according to any one of the above items. 5. The hemostatic clip according to claim 1, wherein the operation portion is a holding claw for holding a distal end portion of the operation tool. 6. The hemostatic clip according to claim 1, wherein the operation section is an insertion port into which a distal end portion of an operation tool is inserted.