JP2003116866A - Knife for blood vessel - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a knife for a blood vessel the main body of which an operator can easily see and which the operator can easily prevent from piercing through the underside wall of the blood vessel even under a condition where the heart pulsates. SOLUTION: The knife 10 for the blood vessel is prepared by curving a part of a rod material 12 with a sharp apex 11 and a narrow diameter made of a metal and forming a cutting edge 13 extending from the apex part or the neighborhood of the apex part to the base end direction within a curved face. The tip 11 of the knife 10 for the blood vessel is brought into a little oblique contact with the upper wall 5a of the blood vessel 5 and the knife 10 for the blood vessel is rotated so as to be rotated into a circular arc form to pierce through the wall 5a of the blood vessel. As shown in Fig. 3 (refer to the specification), the apex 11 of the knife 10 for the blood vessel makes a through-hole 5c in the wall 5a of the blood vessel and in addition, it makes a through-hole 5d by piercing the wall 5a for the blood vessel through from the inside to the outside at a position being separated by several mm. A cut 5e is formed by drawing the knife 10 for the blood vessel a little obliquely backward as shown by an arrow B. As the curved knife 10 for the blood vessel is rotated to pierce through the wall 5a of the blood vessel, it is easy to prevent the knife for the blood vessel from piercing through the underside wall 5b of the blood vessel.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical knife, and more particularly to a blood vessel knife suitable for cutting a coronary artery of the heart.

[0002]

2. Description of the Related Art When stenosis or occlusion (thrombosis) occurs in a coronary artery of a heart, a bypass blood vessel transplant operation is performed so as to bridge across the stenosis or occlusion. In this operation, make a cut with a blood vessel knife at the connection site of the blood vessel, insert scissors into this cut to enlarge the cut to the desired size, and sew the end of the blood vessel for transplantation to the enlarged portion to connect To do.

When performing this bypass vascular graft in the coronary arteries of the heart, recently, it has been performed without moving the heart, while keeping it moving. By doing so, it is possible to reduce the burden on the patient and also reduce the operation cost. During these operations,
It is the function of the blood vessel knife to make the first cut in the blood vessel.

FIG. 8 is a diagram of a conventional blood vessel knife.
As shown in the figure, the blood vessel knife 1 includes a grip portion 2, a blade holder 3, and a knife body 4. The grip portion 2 is made of stainless steel in the shape of a round bar, and approximately half the portion 2a on the tip side is knurled to prevent slipping.
The blade holder 3 is inserted and connected to the tip of the grip portion 2, but the blade holder 3 is usually made of synthetic resin. The knife body 4 is inserted and attached to the tip of the blade holder 3. The blood vessel knife 1 has a straight shape from the grip portion 2 to the knife body 4 as a whole.

9A and 9B are enlarged views of the tip portion of the blade holder 3, where FIG. 9A is a front view and FIG. 9B is a bottom view. As shown in these figures, the knife body 4 has a triangular shape with a sharp tip, and of the two sides sandwiching the tip, the bottom side of the triangle is parallel to the axis of the grip portion 2 and the other side. Is a slope, and this slope is a cutting edge 4a. Since the knife body 4 has a small length of about 3 mm, the cutting blade 4
You don't know unless you look carefully where a is. Therefore, the blade holder 3 is provided with a protrusion 3a, and it is indicated that the opposite side of the protrusion 3a is the cutting edge 4a.

FIG. 10 shows a blood vessel 5 with the above-mentioned blood vessel knife 1.
It shows the state of making a cut. The blood vessel 5 is a coronary artery of the heart, and not only the blood vessel 5 is independent, but the periphery is a body tissue such as the heart. The blood vessel wall 5a on the upper side of the blood vessel 5 is the surface side, and the blood vessel wall 5b on the lower side is the heart. In order to make a cut in such a blood vessel 5, conventionally, the blood vessel knife 1 is applied to the blood vessel 5 slightly obliquely, the upper blood vessel wall 5a is penetrated by the tip of the knife body 4, and the cutting edge is the lower blood vessel wall. Make a notch in the blood vessel 5 by moving horizontally for a few millimeters without penetrating the 5b.

At this time, the cutting edge should not penetrate through the lower blood vessel wall 5b. There is a slight resistance when the tip of the knife body 4 penetrates the upper blood vessel wall 5a.
The doctor is very nervous at this moment, taking care that this slight resistance ends only once. This is because if the first resistance cannot be felt, it will penetrate through the lower blood vessel wall 5b. Especially in the case of surgery that does not stop the heart,
Since the blood vessel 5 moves in the vertical direction in the figure due to the beating of the heart, it is possible to penetrate the lower blood vessel wall 5b without moving the blood vessel knife 1, and it is very difficult to make a cut in the blood vessel 5. It is working.

[0008]

However, since the conventional blood vessel knife is straight as shown in FIG. 8, when the doctor holds the knife body 4 against the blood vessel 5 by hand, the knife body 4 is held by the hand. It is hard to see because it is hidden in. Also, the knife body 4
The knife body 4 can also be attached to the blood vessel 5 from a slight angle.
It becomes difficult to see the cutting edge. The thickness of the blood vessels is not so thick, and it is difficult to do because it is moving due to the heartbeat. For these reasons, it is easy to penetrate the lower blood vessel wall 5b.

The present invention has been made to solve these problems, and an object thereof is to provide a blood vessel knife which can easily prevent the lower blood vessel wall 5b from penetrating even when the heart is beating. .

[0010]

In order to achieve the above object, the blood vessel knife of the present invention is configured such that at least a part of a metal thin rod having a sharp tip is curved, and the tip or the vicinity of the tip is formed. It is characterized in that a cutting edge extending in the direction of the base end is formed in the curved surface.

Alternatively, at least a part of a thin metal rod having a sharp tip is curved, and a cutting blade extending in the proximal direction from the tip or the vicinity of the tip is formed in the curved surface, and It is characterized in that it has a grip portion which is connected to the base end side of the knife body and extends in a direction intersecting with the curved surface.

The length of the curved portion is 1/2 of the total length of the thin rod material.
The above configuration may be employed, or the surface of the blood vessel knife or knife body may be coated with silicone.

[0013]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram of a blood vessel knife of the present invention,
(A) is a perspective view, (b) is an AA sectional view of (a).

In the blood vessel knife 10 of the present invention, a metal thin rod 12 having a sharp tip 11 is curved, and a cutting edge 13 extending in the proximal direction from the vicinity of the tip 11 inside the curve in the curved surface.
Is formed. The thin rod 12 is preferably made of the same material as the suture needle used for suturing blood vessels. However, the thickness is not limited to this as long as it is as thick as the suture needle. Further, in the embodiment of the present invention, the cross-sectional shape of the small-diameter rod member 12 is a circle, but it is not limited to a circle, and various shapes such as a triangle and a square can be used.

In this example, the blood vessel knife 10 was manufactured as follows. First, stainless steel SUS
A 302 wire rod with a wire diameter of 0.24 mmφ is 9 mm long
Straight bar with a small diameter that is straightened by cutting it into 12
And

Next, the tip 11 of each thin rod 12 was sharpened with a centerless grinder or the like, and subsequently the whole was curved to be about 3/8 of a circle. Next, the cutting edge 13 is ground by a grinder or the like to move the cutting edge 13 to the tip 11 of the thin rod 12.
It is formed in the proximal direction from a position slightly away from. The length is not particularly limited, but it is desirable to form it over a little more than half the length of the thin rod 12. The cutting edge 13 is a thin rod 12
Is in the curved surface of and is formed inside the curve.
The cross section of the cutting edge 13 has the shape shown in FIG. The apex angle of the cutting edge 13 is preferably around 30 °, but 40-
It may be about 50 °. The curved shape does not necessarily have to be an arc shape, but if it is an arc shape, it is easier to prevent the lower blood vessel wall 5b from being pierced during use as will be described later.

If the wire material has a fiber structure, heat treatment is not necessary and the process is completed. If martensitic stainless steel is used, heat treatment is performed to cure it, and after polishing, it is completed. To do. After this, the entire blood vessel knife 10, or at least the tip 11 from the cutting edge 1
It is desirable to coat the portion where 3 is formed with a silicone resin. By doing so, it is possible to reduce resistance when the blood vessel wall 5a is inserted or incised.

2 to 4 show a blood vessel knife 10 of FIG.
Shows a procedure for making a cut in the blood vessel 5. Blood vessel 5
Like the conventional example, it is a coronary artery of the heart, and the surrounding area is a body tissue such as the heart.

In order to make a cut in the blood vessel 5, first, the position of 1/2 to 2/3 of the length of the thin rod 12 from the tip of the blood vessel knife 10 is grasped by a needle device or the like. Then, as shown in FIG. 2, the blood vessel knife 10 is made substantially vertical to the blood vessel 5, and the tip 11 of the blood vessel knife 10 is applied to the blood vessel wall 5a above the blood vessel 5 at a slight angle, and the blood vessel knife 10 is circled. The blood vessel wall 5a is pierced by rotating like an arc.

As shown in FIG. 3, the distal end 11 of the blood vessel knife 10 penetrates by forming a through hole 5c in the blood vessel wall 5a. Continuing, when it is turned in an arc shape, the tip 11 penetrates the blood vessel wall 5a from the inside to the outside at a position separated by a distance of a few millimeters without penetrating the lower blood vessel wall 5b to form a through hole 5d. The tip 11 of the blood vessel knife 10 is projected from the blood vessel wall 5a. The tip of the cutting blade 13 is projected from the blood vessel wall 5a, and the blood vessel knife 10 is pulled slightly obliquely rearward as shown by the arrow.

Then, the cutting blade 13 cuts the blood vessel wall 5a to form a cut 5e reaching from the through hole 5d to the through hole 5c as shown in FIG. 4, and the blood vessel knife 10 is projected outside the blood vessel 5. Come on. Although not shown, the end of the blood vessel to be bypassed is inserted into the notch 5e thus formed and sutured. The length of the cut 5e can be preset to a desired length by appropriately selecting the size of the blood vessel knife 10 and the degree of curvature.

When the length of the cut 5e is short, the tip 11 of the blood vessel knife 10 is attached to the cut 5e formed as described above.
Then, the tip 5 is extended in a direction in which the cut 5e becomes longer, a new through hole is formed in the upper blood vessel wall 5a, and the cut 5e can be extended in the direction parallel to the arrow in FIG.

Although not shown, the blood vessel knife 1
If a cutting edge is formed on the outer side of the curve within the curved surface of 0 to form a so-called double-edged edge, a cut line connecting the through hole 5c and the through hole 5d is formed, and then a cut line is formed on the outer side of the curve. 5e can be cut open and extended long.

The above-described work can be applied to the usage of the suture needle when suturing a blood vessel almost as it is.
Further, since the surgeon is skilled in handling a suture needle when suturing a blood vessel, the above work is very familiar to the surgeon. Further, since the blood vessel knife 10 is curved in an arc shape and pierces the blood vessel so as to rotate in accordance with the curvature, even if the heart is beating, the tip 11 of the blood vessel knife 10 is located on the lower side. It is easy to prevent breaking through the blood vessel wall 5b.

FIG. 5 (a) is a view showing a blood vessel knife according to the second embodiment of the present invention. The blood vessel knife 2 of this embodiment
As for 0, the entire thin rod 22 is not curved as in FIG. 1, but is divided into a straight portion 22a and a curved portion 22b. Further, the cutting edge 23 is formed from the tip 21. The method of use is the same as in the embodiment of FIG.

As described above, the small-diameter rod member 22 does not need to be curved as a whole, and may be curved at the tip 21 side. However, the length L1 of the straight portion 22a and the curved portion 22b
It is desirable that the length L2 of the curved portion 22b is longer than that of the curved portion 22b. In other words, it is desirable that the length L2 of the curved portion 22b be 1/2 or more of the total length. This is for the following reason.

Most of the current suture needles used in cardiovascular surgery are curved. The degree of curvature of the suture needle is, for example, 1/2 circle or 3/8 circle. On the other hand, the blood vessel knife of the present invention,
The same wire material as the suture needle is used as the material, and the length is almost the same as the suture needle. Therefore, if more than 1/2 of the total length of the thin rods 12 and 22 is curved, the shape will be quite close to that of the suture needle. On the other hand, surgeons are accustomed to handling a suture needle, and if the shape of the blood vessel knife is substantially the same as the shape of the suture needle, the surgeon can easily handle the blood vessel knife.

Although the degree of curvature of the blood vessel knife in this embodiment is 3/8 circle, it is not limited to this and can be changed according to the size of the knife to be used.

Instead of the cutting edge 13 of the embodiment of FIG. 1, FIG.
The cutting edge 13 may be formed up to the tip 11 like the cutting edge 23 of the embodiment, and the cutting edge 23 of the embodiment of FIG. 5 may be formed from the tip 21 like the cutting edge 13 of the embodiment of FIG. It may be formed at a slightly separated position.

FIG. 5 (b) is a view showing a blood vessel knife according to the third embodiment of the present invention. The blood vessel knife 2 of this embodiment
0'is a base end portion 22 having a length on the base end side L1 of the small-diameter rod member 22.
a and the end portion 22c of the length L3 are straight lines, and the middle L2
The central portion 22b of the length is curved in an arc shape. Cutting edge 2
Reference numeral 3 is in the curved surface and is formed not from the tip but from the vicinity of the tip toward the base. In this example,
The length of L2 is 1/2 of the total length of the blood vessel knife 20 '.
The above is preferable, but the present invention is not limited thereto. The method of use is the same as in the embodiment of FIG. In this case, the straight portions 22a and 22c are provided on both ends of the blood vessel knife 20 '.
However, due to the action of the intermediate curved portion 22b, it is possible to effectively prevent the incision of the lower blood vessel wall 5b.

FIGS. 6A and 6B show an embodiment of a blood vessel knife 50 having a grip portion. FIG. 6A is a front view and FIG. 6B is a side view. In this embodiment, the knife body 3 is provided on the proximal side of the knife body 30.
It is characterized in that a grip portion 40 extending in a direction orthogonal to the curved surface of 0 is attached. The grip 40 has a length of 50 mm
In some cases, there is a large diameter portion 41 on the base end side, and the outer peripheral surface of this portion is anti-slip. From the large diameter portion 41 to the knife body 30
Is a tapered portion 42, and the knife body 30 is fixed to the tip. The grip portion 40 and the knife body 30 can be fixed by welding, caulking, or the like.

The blood vessel knife 50 is, so to speak, like the blood vessel knife 10 of FIG. 1 and the needle holder are integrated.
The knife body 30 is basically the same as the blood vessel knife 10 of FIG. Simply, in this embodiment, the cutting edge 33
A vascular knife 1 only in that it is formed from the tip 31
Although it is only different from 0, since the blood vessel knife 10 may have the same configuration as the knife body 30, this difference is practically nonexistent, and both may be considered to be the same. The usage method is the same as that described with reference to FIGS.

In this blood vessel knife 50, the gripping portion 40 is orthogonal to the curved surface of the knife body 30, but the invention is not limited to this orthogonality and can be changed according to the operator's preference.

7A and 7B show an embodiment of a blood vessel knife 70 with a grip portion similar to FIG. 6, in which FIG. 7A is a front view and FIG. 7B is a side view. In this embodiment, the grip portion 60 uses a thin rod having the same thickness as the knife body 30. Therefore, a long material is cut from the thin rod material, and the knife body 3 is attached to one end of the material.
The grip portion 60 can be formed by forming 0 and bending the base end portion of the knife body 30 in a direction orthogonal to the curved surface. Knife body 30 in the embodiment of FIGS. 6 and 7.
Are shown in FIGS. 5 (a) and 5 (b).
It may be 0 '.

[0035]

As described above, according to the blood vessel knife of the present invention, at least a part of a thin metal rod having a sharp tip is curved and extends in the proximal direction from the tip or the vicinity of the tip. Since the cutting edge is formed in the curved surface, it can be handled like a suture needle, the vascular knife is easy to see during use, and it does not penetrate through the lower blood vessel wall even when the heart is beating. Easy to prevent.

[Brief description of drawings]

FIG. 1 is a view of a blood vessel knife of the present invention, in which (a) is a perspective view and (b) is a sectional view taken along line AA of (a).

FIG. 2 is a diagram showing a procedure for making a cut in a blood vessel with a blood vessel knife.

FIG. 3 is a diagram showing a procedure for making a cut in a blood vessel with a blood vessel knife.

FIG. 4 is a diagram showing a procedure for making a cut in a blood vessel with a blood vessel knife.

5A is a diagram showing a blood vessel knife according to a second embodiment of the present invention, and FIG. 5B is a diagram showing a blood vessel knife according to a third embodiment of the present invention.

FIG. 6 is an embodiment of a blood vessel knife with a grip, (a)
Is a front view and (b) is a side view.

FIG. 7 is an example of a blood vessel knife with another grip,
(A) is a front view and (b) is a side view.

FIG. 8 is a view of a conventional blood vessel knife.

9 is an enlarged view of the tip portion of the blade holder shown in FIG. 8, (a) being a front view and (b) being a bottom view.

FIG. 10 is a diagram showing a state in which a blood vessel is cut with the blood vessel knife of FIG. 8;

[Explanation of symbols]

10, 20, 20 ', 50, 70 Blood vessel knife 11,21,31 tip 12,22 Small diameter bar 13,23,33 cutting edge 30 knife body

Claims (3)

[Claims] 1. A small-diameter rod member made of a metal having a sharp tip is curved, and a cutting edge extending in the proximal direction from the tip or the vicinity of the tip is formed in the curved surface. A knife for blood vessels. 2. A knife body in which at least a part of a thin metal rod having a sharp tip is curved, and a cutting edge extending in the proximal direction from the tip or the vicinity of the tip is formed in the curved surface, A blood vessel knife, comprising: a grip portion connected to a proximal end side of a knife body and extending in a direction intersecting the curved surface. 3. The length of the curved portion is 1 / of the total length of the thin rod material.
It is two or more, The knife for blood vessels of Claim 1 or 2 characterized by the above-mentioned.