JP2003000606A - Instrument for intercepting blood flow - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a means for eliminating a defect of an arterial graft due to an interception of blood flow in coronary bypass operation under heart beat, thereby maintaining the patency of an anastomosed arterial graft. SOLUTION: In a holder consisting of flexible materials having partially defective circular, U-shaped or hook-shaped sections, the inner sides of the holder are partially or entirely integrated to blockade an inner cavity by inflation.

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a blood flow blocking device used in a surgical operation, and moreover, to a device for performing a coronary artery bypass operation under a heartbeat. The present invention relates to a blood flow blocking device used for blocking blood flow in a blood vessel for use. 2. Description of the Related Art In recent years, catheter intervention for patients with ischemic heart disease such as myocardial infarction has become increasingly popular. Typical catheter interventions include coronary vasodilation and endovascular stenting, but these treatments are characterized by being minimally invasive to patients and requiring short hospital stays. On the other hand, the effectiveness of coronary artery bypass grafting (hereinafter abbreviated as CABG) is widely recognized for patients who are not to be subjected to catheter treatment. In this method, a bypass blood vessel is anastomosed to the peripheral side of a coronary artery having a stenosis which causes ischemia, and blood is sent. For bypass vessels,
A vein graft collected from the lower limb and an arterial graft such as the internal thoracic artery are used.The former method uses a free blood vessel, while the latter method uses an exfoliated artery to anastomize the coronary artery. Is often adopted. In recent years, it has become clear that the long-term prognosis of the latter is good, and it is frequently used. [0004] Patients who are subject to CABG may have multiple coronary arteries occluded or stenotic, ascending aorta may be calcified,
Because they often have chronic diseases such as brain, kidney and respiratory organs and are elderly, CABG of these patients
The risk to is not low. In particular, the greatest risk the patient has to take is to stop the heart,
Extracorporeal circulation will be performed using a heart-lung machine.
The use of cardiopulmonary bypass in patients with advanced atherosclerosis
Equivalent to sending water at high pressure to a rusty water pipe, and as a result,
There is a possibility that extraneous matter in the blood vessels will be washed away and occlude other blood vessels, leading to complications such as cerebral infarction. For these patients, in recent years, without heart-lung machine, under heartbeat,
Attempts to anastomose the graft for bypass have been attempted and have been successful. This method is called off-pump coronary anastomosis (hereinafter abbreviated as OPCAB). [0005] The problem with OPCAB is that it takes a lot of skill to perform a perfect anastomosis in a short time because the heart is moving. If the anastomosis is poor, a blood clot is generated from the anastomosis portion in the coronary artery or the bypass blood vessel, which causes occlusion. This problem is described, for example, in Japanese Patent No. 3036686.
A device called a stabilizer as disclosed in US Pat. By using the stabilizer, the movement of the anastomosis part was regulated, and it became possible to anastomose the bypass blood vessel in a stable state, so that the accuracy of the anastomosis was improved, and the performance of the OPCAB was dramatically improved. . [0006] However, despite the successful anastomosis,
Arterial grafts used as bypass vessels after surgery may be obstructed. One of the causes is a problem that blood vessels are damaged when blood flow of the arterial graft is temporarily blocked during surgery. Conventionally, as a method of blocking the blood flow of an arterial graft, a method of clamping a blood vessel with forceps called a metal bulldog has been used, but this method is to maintain a clamped state by the compressive stress of a spring. However, there is a disadvantage that the force for clamping the arterial graft cannot be adjusted. In addition, a plurality of anti-slip grooves are provided in a portion where the device actually clamps the arterial graft, which may promote damage to blood vessels. Furthermore, it is heavy because it is made of metal, and if it is clamped near the anastomosis, there may be a problem in managing the arterial graft during the anastomosis. [0007] Although the indication of OPCAB is gradually widening and the number of cases is expanding, attempts for OPCAB under thoracoscopy have been started with the aim of further invasive surgery.
In thoracoscopic surgery, the diameter of the port is 10-15mm
Are provided on the patient's chest, and an anastomosis operation in the thoracic cavity is remotely performed through the port. However, the bulldog is not sized to be inserted through the port into the thoracic cavity, and even if it can be inserted, it is difficult to remotely clamp the arterial graft. In the thoracic cavity, means for reliably blocking the blood flow of the arterial graft by a simpler operation is required. [0008] An object of the present invention is to provide an OP
The purpose of the present invention is to provide a means for eliminating arterial graft damage due to blood flow obstruction in CAB and maintaining the patency of the anastomotic artery graft. It is another object of the present invention to provide a means for reliably blocking the blood flow of an arterial graft with a simpler operation in the thoracic cavity. SUMMARY OF THE INVENTION The present invention is a holder made of a flexible material having a partially cut circular, U-shaped or U-shaped cross section. A blood flow blocking device, which is integrated with a part or the whole surface and provided with a means for expanding and closing an inner cavity. Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is a view showing a blood flow blocking device for a bypass blood vessel according to one embodiment of the present invention, wherein a is a perspective view showing an overall image, and b is a component member of the present invention, which is a means for expanding and closing a lumen. It is a figure which shows the structure of the balloon which is. 2 and 3 are diagrams for explaining the method of use. As shown in FIG. 1A, a holder (1)
Has a U-shaped cross section, and a balloon (2) is integrally provided on the entire inner surface thereof. One end of the holder (1) has a shape extended from the other end, so that the cross section has an asymmetric shape. At least one gripper (4) is provided outside the holder (1), and the holder (1)
Is used for gripping with a gripper. A tube (3) is attached to one end of the balloon (2), and the tube (3)
The inflation and deflation of the balloon are controlled by feeding and removing the fluid through the balloon to the balloon. The other end of the tube (3) is provided with a one-way valve (5). In the figure, a one-way valve is used, but since it is sufficient that the fluid can be plugged in this portion, means such as a three-way cock may be used. Gripper (4)
There are no particular restrictions on the position, shape, and number of these, but they are appropriately set according to the site where the blocking device is used and the method of gripping the holder. As shown in FIG. 1B, the balloon (2)
Is provided with two partitions and is partitioned into expansion chambers a to c, but each of the expansion chambers is not completely separated by the partition (10). That is, the partition (10) is for individually inflating the expansion chambers a to c formed by the partition. Since the expansion chambers a to c are in communication with each other, a fluid (balloon) is supplied from the tube (3). All the expansion chambers can be expanded by inserting them into the lumen of 2). Since the balloon (2) is formed of a stretchable material, when the balloon (2) is completely inflated, the inside of the holder (1) is completely closed by the balloon and the state is maintained. In the figure, there are two partitions, but the number of partitions is not limited to this in the present invention. At least one partition (10) is required, but depending on the shape of the holder (1), the holder (1) may be used when the balloon is completely inflated.
What is necessary is just to determine suitably so that the inside of 0) may be completely closed. The material usable for the balloon (2) preferably has a tensile elongation at break of 400% or more, more preferably 500% or more. If the degree of elongation is lower than this, it is not preferable because free deformation cannot be obtained and a completely closed state cannot be maintained. On the other hand, if the tensile elongation at break is less than 500%, more fluid than necessary is injected into the balloon in order to obtain complete occlusion, and pressure higher than the breaking load may be applied to the balloon, which is not preferable. As a material satisfying this condition, for example,
Examples include polyurethane, polyolefin elastomer, silicone rubber, and natural rubber. Since the holder (1) is made of a flexible material, it is possible to temporarily reduce the entire size by applying an external stress and elastically deforming the holder.
Further, when the balloon (2) is over-inflated, the holder (1) is elastically deformed and the U-shape is opened, which has the effect of reducing the load on the balloon due to over-inflation. If the material of the holder (1) is not a flexible material such as stainless steel, titanium, ceramic or the like, the elastic deformation of the holder cannot be obtained, which causes a problem in use described later, which is not preferable. As a flexible material capable of realizing such elastic deformation, for example,
Examples include rigid polyvinyl chloride, ABS, nylon, polyolefin, and polyoxymethylene. Next, the use procedure of the present invention will be described with reference to FIG. The surgeon grasps the detached arterial graft (23) inside the holder (1) by holding the grip (4). At this time, the arterial graft (23) is not yet cut. Next, a fluid is fed into the lumen of the balloon (2) from the one valve (5) through the tube (3) by a syringe or the like, and the balloon (2) is inflated. Three expansion chambers a to
c expands and presses from the outside so as to envelop the arterial graft (2), and the blood flow of the arterial graft (22) is blocked. The distal side of the blocking part is cut off and its end face is processed to prepare the artery graft (23) for anastomosis to the coronary artery. According to the present invention, there is almost no risk of damaging the home arterial graft because it comes into surface contact with the arterial graft and compresses it from almost the entire circumference to block blood flow. Further, since the degree of inflation of the balloon (2) can be arbitrarily adjusted, the blood flow can be cut off with a minimum necessary load. Also, even if it is inflated too much, it prevents the holder (1) from opening due to elastic deformation and applying too much load to the arterial graft (23). Furthermore, since the present invention is made of a flexible resin, it is lightweight, and even if blood flow is blocked in the vicinity of the anastomosis, no trouble occurs in the operation of the arterial graft. Therefore, a sequential bypass in which one arterial graft is bypassed to two or more coronary arteries is extremely effective. Next, the effect of the present invention will be further clarified by exemplifying a case in which the arterial graft (23) is detached under thoracoscopy and is anastomosed to the periphery of the coronary artery (22). The internal thoracic artery is usually used for the arterial graft (23). FIG. 3 is a cross-sectional view when the thoracic cavity is sliced. A plurality of ports 1 (15) and ports 2 (16) are mounted on the chest wall to allow the chest cavity to enter and exit from the outside. The arterial graft (23) has been detached from the inside of the chest wall by detaching means inserted from the port 1 (15). Since the blood flow blocking device according to the present invention is small and lightweight, it has the advantage that it can be freely inserted and removed from the port. The blocking device inserted into the thoracic cavity from the port 2 (16) is operated by gripping the grip portion (4) with the grip forceps inserted from the port 1 (15). The arterial graft (23) is hooked by the extended end of the holder (1), taken into the holder (1), and the blood flow of the arterial graft (23) is shut off by inflating the balloon (2). . As is evident from this embodiment, the extended end of the holder (1) is very effective for introducing the arterial graft (23) inside the holder in a restricted chest cavity. When the anastomosis to the coronary artery (22) is completed, fluid is drained from the lumen of the balloon (2), the balloon is deflated, and the entire port is taken out of the body. As is apparent from the above description, when the present invention is used, the blood flow of the arterial graft can be cut off by the balloon with the minimum necessary stress, so that the occlusion after the operation can be avoided. . Further, the present invention can be introduced into the thoracic cavity through a port during thoracoscopic surgery, and is extremely useful as a means for blocking blood flow of an arterial graft under thoracoscopy.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a view showing a blood flow blocking device for a bypass blood vessel according to an embodiment of the present invention. FIG. 2 is a view for explaining a method of using a blood flow blocking device for a bypass blood vessel. FIG. 3 is a view for explaining a method of using a blood flow blocking device for a bypass blood vessel under thoracoscopy. [Explanation of reference numerals] Holder 2. Balloon 3. Tube 4. Grip part 5. One-way valve8. Needle 9. Thread 10. Partition 15. Port 1 16. Port 2 17. Grasping forceps 20. Lung 21. Heart 22. Coronary artery 23. Arterial graft

Claims (1)

Claims 1. A holder made of a flexible material having a partially cut circular, U-shaped or U-shaped cross section, and a part or the whole of the holder is integrally formed inside the holder. And
A blood flow blocking device provided with means for expanding and closing a lumen of a blood vessel.