JP2005118410A - Implement for treating lower extremity varicose vein - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To easily and inexpensively treat the lower extremity varicose vein in a short period of time. <P>SOLUTION: A normal saline solution S heated to about 80°C is made to flow into a tube 102 inserted to a greater saphenous vein 14, so as to generate heat in the tube 102 and allow the greater saphenous vein 14 to be uniformly cauterized for clogging in a short period of time. An implement to be used is inexpensive, including the tube 102 and an infusion set for adults 104, etc. When compared with an intravascular cautery by radio wave or a laser beam, a treatment is more inexpensively performed in a short period of time. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a treatment device for varicose veins of the lower limb.

  There are "arteries" and "veins" in blood vessels. The blood from the heart travels through the arteries to every corner of the body and then returns to the heart via the veins.

  As shown in FIG. 1, in the lower limb 10, blood flows through a deep vein 12 that runs deep and a superficial vein that runs near the skin surface, that is, the great saphenous vein 14 and the small saphenous vein 16. The large saphenous vein 14, the small saphenous vein 16 and the deep vein 12 are connected by a short blood vessel called a traffic branch (penetrating branch) 18.

  Although arterial blood can maintain blood flow even against gravity due to the pumping action of the heart, venous blood in the lower limb 10 is pumped by the contraction of muscles in the lower limb 10 and the venous valve 22 in the vein shown in FIG. And the like, and gradually return to the heart while staying between the venous valves 22. In humans who are standing on two legs, blood tries to return downward with its weight, but it is the venous valve 22 that prevents this downward flow. Since the venous valve 22 has a cross-sectional shape when viewed in cross section, even if blood flows upward as shown in FIG. 2 (A), it flows downward as shown in FIG. 2 (B). Because there is no.

  FIG. 3 (A) shows normal blood recirculation, and FIG. 3 (B) shows that the venous valve 22 malfunctions, and blood flows from the deep vein 12 with high pressure into the large saphenous vein 14 (or small saphenous vein 16). ) Shows a backflow. If the venous valve 22 does not work normally, the blood flows backward as shown in FIG. 3B, and the blood accumulates below the foot. As a result, the vein expands as shown in FIG. A bump 30 is formed. As described above, many varicose veins 30 of the lower limbs are generated by breaking the venous valves 22 of the large saphenous vein 14 and the small saphenous vein 16.

  When the varicose vein 30 develops, the veins of the lower limb 10 are thick and come out. Many of the varicose veins 30 are not only thick, but also winding. There are also various thicknesses. Among the varicose veins 30 of the lower limbs, the “sacral varicose vein” is the thickest, and most patients have the varicose veins 30 of this type.

  Although there may be no symptom even if the varicose vein 30 is formed, in general, symptoms such as “swelling, sluggish, heavy, aching, hot flash” are likely to appear. In addition, the so-called “smoothness” that the leg muscles hang easily occurs.

  However, the varicose veins 30 basically do not endanger life even if they are left alone. Also, it does not affect other organs such as the heart or arteries, nor does it have to cut the leg. However, even if left untreated, it does not heal naturally and gradually deteriorates. As a result, the leg varicose vein 30 gradually increases. In addition, pigmentation and ulcers may occur.

  Currently, the following treatments can be performed on the varicose vein 30 of the lower limb.

(1) Elastic stocking method By wearing an elastic stocking, the foot is pressed and the backflow of blood by the varicose vein 30 is suppressed. However, the varicose vein 30 itself is not cured.

(2) Stripping operation The stripping operation is a procedure for removing the varicose vein 30 by passing a wire through a deteriorated blood vessel and pulling out the wire. The large saphenous vein 14 or the small saphenous vein 16 is withdrawn, and the varicose vein 30 is excised by a smaller skin incision. When the large saphenous vein 14 or the small saphenous vein 16 is removed, it is accompanied by a strong pain, and is performed with general anesthesia or lower body anesthesia. Surgery scars remain, but any large leg varicose vein 30 can be treated reliably.

(3) Sclerotherapy The sclerotherapy is a treatment in which a sclerosing agent is directly injected into the varicose vein 30 of the leg. The sclerosing agent acts as an adhesive that adheres and crushes the great saphenous vein 14 and the small saphenous vein 16. As a result, the varicose veins 30 are small and inconspicuous, and blood does not collect, so there is no looseness or swelling. After sclerotherapy, lump and pigmentation occur at the site of injection, but gradually fade and disappear. The time required for sclerotherapy is about 10 to 15 minutes at a time. In addition, only one or two treatments are required. However, severe pain may occur if thrombus occurs in large quantities.

(4) Combined method of high-order ligation (sessing) The above-mentioned sclerotherapy does not cure the root cause of the disease, so the great saphenous vein 14 in which the venous valve 22 is broken and blood flows backward If the small saphenous vein 16 is left unattended, there is a risk of recurrence in the future. (See FIG. 3B). Therefore, ligation of the great saphenous vein 14 and the small saphenous vein 16 is performed for patients with strong blood reflux.

As shown in FIG. 5, in the ligation, a small incision is made in the skin and the upper part 50 of the treatment unit 40 of sclerotherapy is tightened. This stops the backflow of blood. Even if the blood vessels are tied, there is no problem because the blood flows through the deep vein 12 much thicker than the superficial vein (the large saphenous vein 14 or the small saphenous vein 16). (See Figure 1)
The ligation can be done by local anesthesia and takes about 15 minutes at one place. Depending on the state of the varicose vein 30, ligation is performed at one to three positions. The ligation technique is often performed at a hospital visit, and the original work and daily life are possible from the next day. In consideration of the type of varicose vein 30 and the strength of blood reflux, treatment is performed only by sclerotherapy or ligation is added to sclerotherapy. (For example, see Non-Patent Document 1)
In recent years, in surgical treatment, in addition to curative properties, there has been a demand for minimally invasive treatment, that is, treatment with as little damage to the patient as possible and with minimal pain to the patient.

  Therefore, as a method for treating varicose veins 30 of the lower limb, treatment by an intravascular ablation method using radio waves or laser has been recently reported. This is done by inserting a probe into the great saphenous vein 14 and cauterizing the vein lumen from the vicinity of the junction 20 between the great saphenous vein 14 and the common femoral vein 21 (see FIG. 1) by radio waves or laser. Occluding blood vessels.

Intravascular cauterization using radio waves or lasers is a method that is cosmetically superior because it is minimally invasive and does not perform incision. (For example, see Non-Patent Document 2 and Non-Patent Document 3)
Department of Cardiology, Sapporo Welfare Hospital, “Venous Varicose of Lower Extremity”, [online], [Search September 19, 2003], Internet <URL: http://www.gik.gr.jp/~skj/peripheral/varix .php3> “Angiology” Vol. 43 No4 “Surgical treatment for lower limb vein disease” (pages 111-116) “Hinology” 2002 Vol. 13 No. 5 “Endovascular Obliteration of the Greater Saphenous Vein: The Closure Procedure” (pages 325-333)

  The intravascular ablation method using radio waves is effective because the tip of the probe is approximately 85 degrees and the inner wall of the blood vessel is damaged, so that the lumen becomes 1 to 2 mm instantaneously and the thrombus attaches to it as a plug. It is. However, since the probe damages the inner wall of the blood vessel at a rate of 2 to 3 cm / min, it takes about 20 to 30 minutes from the knee to the groin. For this reason, the procedure takes time.

  On the other hand, the intravascular ablation method using a laser requires the laser fiber to be pulled out by 3 to 5 mm, and the procedure is complicated. In addition, laser devices are more expensive than radio waves, and there are many recurrences of varicose veins 30 in the legs.

  Thus, the intravascular ablation method using radio waves or lasers is technically complicated and takes time. There is also a problem in terms of cost. Furthermore, postoperative sclerotherapy is necessary because branch varices remain.

  The present invention has been made to solve the above problems, and an object of the present invention is to provide a therapeutic device for lower limb varices that can easily treat lower limb varices in a short time and at low cost.

  The treatment device for lower limb varices according to claim 1 includes a tube that can be inserted into the lower limb vein, and heat generation means provided over substantially the entire length of the tube.

  The therapeutic device for lower limb varices according to claim 1 is, for example, inserting a wire or the like into the lower limb vein to pass through the lower limb vein, connecting the tube to the wire, and pulling the wire to insert the tube into the lower limb vein. . Next, the tube generates heat over substantially the entire length by the heating means provided in the tube. Due to this fever, the whole leg vein portion into which the tube is inserted is cauterized in a short time and the leg vein is occluded.

  Accordingly, by cauterizing and closing the lower limb vein in this way, it is possible to easily treat the lower limb varices in a short time. After cauterization, the tube is removed from the lower limb vein.

  The therapeutic device for varicose veins according to claim 2 is the configuration of claim 1, wherein the heat generating means is a warm liquid passing through the tube, and the warm liquid is introduced from one mouth of the tube, It is characterized by being discharged from the mouth.

  The therapeutic device for lower limb varices according to claim 2 heats the tube by flowing the warm liquid from one mouth of the tube and discharging it from the other mouth. That is, it is possible to treat the lower limb varices by inexpensively heating the tube uniformly and cauterizing and closing the lower limb veins at low cost.

  The treatment device for varicose veins according to claim 3 is the constitution of claim 1, wherein the heat generating means is a warm liquid passing through the tube, and the tube is at least in an outer tube whose one end is closed. An inner tube having both ends opened is passed to one end, and the other end of the outer tube is extended from the other end of the outer tube, and the hot liquid is at the other end of the outer tube. It flows in from a mouth part, and is discharged | emitted from the mouth part of the other end of the said inner tube.

  The treatment device for varicose veins according to claim 4 is the constitution of claim 1, wherein the heat generating means is a warm liquid passing through the tube, and the tube is at least in an outer tube whose one end is closed. An inner tube having both ends opened is passed to one end, and the other end of the inner tube is extended from the other end of the outer tube, and the hot liquid is at the other end of the inner tube. It flows in from a mouth part, and is discharged | emitted from the mouth part of the other end of the said outer tube, It is characterized by the above-mentioned.

  The therapeutic device for lower limb varices according to claim 3 or claim 4, wherein an inner tube having at least both ends opened is passed through one end portion into an outer tube whose one end is closed, and the other end portion of the outer tube is passed through. It has the structure of the tube which the opening part of the other end of the inner tube came out. For this reason, warm liquid flows in from the mouth part of the other end of an outer tube or an inner tube, and is discharged | emitted from the mouth part of the other end of an inner tube or an outer tube. That is, the warm liquid flows in and out only from the other end side of the tube.

  Therefore, the inflow and discharge of the warm liquid can be performed only by inserting one end side of the tube from one place of the lower limb vein. That is, in the treatment of varicose veins, only one incision site of the lower limb vein is possible. For this reason, a less invasive and cosmetically excellent treatment can be performed.

  Further, since the warm liquid flows through the tube both at the time of inflow and at the time of discharge, the heat generation effect is great. Therefore, the lower limb vein part into which the tube is inserted is cauterized and closed in a shorter time.

  The treatment device for lower limb varices according to claim 5 is characterized in that, in the configuration according to claim 3 or claim 4, a side hole is formed in a side wall of the inner tube.

  The treatment device for lower limb varices according to claim 5, wherein the warm liquid flowing from the mouth of the other end of the outer tube or the inner tube flows into the inner tube or the outer tube from the side hole of the side wall of the inner tube, After filling up to one end of the tube 202, the tube 202 is folded and flows into the inner tube or the outer tube. The inflowing hot liquid flows back through the inner tube or the outer tube and is discharged from the mouth of the other end of the inner tube or the outer tube.

  For this reason, a warm liquid distribute | circulates the inside of a tube uniformly. Accordingly, the whole generates heat more uniformly, which is preferable.

  The treatment device for lower limb varices according to claim 6 is the configuration according to any one of claims 2 to 5, wherein the discharged warm fluid is allowed to flow again and the discharged warm fluid. And a heater device for warming to a predetermined temperature.

  In the treatment device for lower limb varices according to claim 6, the discharged warm liquid is warmed to a predetermined temperature by the heater device and is again introduced by the circulation pump. That is, the warm liquid at a predetermined temperature circulates in the tube without cooling the warm liquid.

  Furthermore, by controlling, for example, the circulation amount, the circulation time, and the temperature of the hot liquid circulating in the tube, it is possible to perform an optimal treatment according to various conditions such as the degree of symptoms of varicose veins.

  The treatment device for varicose veins according to claim 7 is the treatment device for varicose veins according to claim 1, wherein the heat generating means is a heater wire passing through the tube.

  In the treatment device for varicose veins according to claim 7, the tube is heated when the heating means generates heat from the heater wire passing through the tube, and the lower limb vein is cauterized and closed. That is, the tube can be easily heated to a predetermined temperature. Therefore, it is possible to easily treat varicose veins.

  Moreover, since the heater wire can arbitrarily control the heat generation temperature and the heat generation time arbitrarily, optimal treatment according to various conditions such as the degree of symptoms of varicose veins can be performed.

  The treatment device for lower limb varices according to claim 8 is characterized in that, in the configuration according to any one of claims 1 to 7, the tube is made of silicone rubber.

  In the treatment device for varicose veins according to claim 8, the tube is made of silicone rubber. Silicone rubber is soft and bendable, so it can be inserted smoothly along the lower limb vein. It is also safe to insert into the human body. Therefore, it is a suitable tube.

  The treatment device for varicose veins according to claim 9 is characterized in that, in the configuration according to any one of claims 1 to 7, the tube is made of vinyl chloride.

  In the treatment device for lower limb varices according to claim 9, the tube is made of vinyl chloride. Since vinyl chloride is soft and flexible, it can be inserted smoothly along the lower limb vein. It is also safe to insert into the human body. Therefore, it is a suitable tube.

  The treatment device for lower limb varices according to claim 10 is characterized in that, in the configuration according to any one of claims 1 to 7, the tube is made of stainless steel.

  The therapeutic device for varicose veins according to claim 10 has an appropriate hardness because the tube is made of stainless steel. Therefore, when inserting into the lower limb vein, for example, it is not necessary to connect with a wire or the like.

  Moreover, since stainless steel has a high thermal conductivity, heat generation efficiency is good. Therefore, the lower limb vein part into which the tube is inserted is cauterized and closed in a shorter time.

  The treatment device for lower limb varices according to claim 11 is characterized in that, in the configuration according to claim 10, the tube made of stainless steel has a bellows-like surface.

  The treatment device for varicose veins of the eleventh aspect is flexible because the surface of the stainless steel tube has a bellows shape. Therefore, when inserting into the lower limb vein, it can be inserted more smoothly.

  As described above, according to the present invention, there is an effect that the lower limb vein can be easily cauterized and the varicose vein can be treated in a short time.

  A first embodiment of a treatment apparatus for varicose veins according to the present invention will be described.

  As shown in FIG. 6, the treatment device 100 for varicose veins includes an adult infusion set 104 in which a mouth 106B on one end side of a hollow tube 102 of 10F / 50 cm having both ends opened is connected. . The adult drip set 104 includes a pack 110 containing 200 ml of physiological saline S heated to about 80 ° C. The tube 102 is passed through the great saphenous vein 14 and the mouth 102A at the other end is arranged on the basin 106.

  The tube 102 is made of a material that does not cause safety even when inserted into the human body, for example, made of vinyl chloride or silicon, and is soft and flexible.

Next, a surgical method using the treatment apparatus 100 for lower limb varices of the first embodiment, specifically, an intravenous thermosetting therapy will be described. In this embodiment, intravenous thermosetting therapy was performed using intraoperative sclerotherapy and high-level ligation in combination.
"Preoperative preparation"
The lower limb 10 is marked while monitoring with an ultrasonic inspection apparatus (not shown). The marking is performed along the great saphenous vein 14 and the common femoral vein 21 while confirming the depth from the skin surface. Also mark the traffic branch 18 and large branches along the way. (See FIG. 1). The marking is performed in the same posture as during the operation, that is, with the affected limb lightly bent in the supine position so that the marking site does not shift.

An automatic sphygmomanometer (not shown), an electrocardiogram monitor (not shown), and a pulse oximeter (not shown) are attached to the patient, and blood pressure, electrocardiogram, and oxygen saturation are monitored.
"anesthesia"
Anesthesia is performed by a mass low concentration infiltrated local anesthesia (hereinafter referred to as “TLA”) method. Specifically, using a 16G TLA injection needle (JMS) and a 50 ml syringe, about 200 to 300 ml of TLA solution is infiltrated around the saphenous vein 14 while monitoring with an ultrasonic examination apparatus. In addition, since the TLA method is local anesthesia, the patient's consciousness is clearly maintained, and walking and eating are possible after a short time after the operation. Moreover, since the effect lasts for a long time, there is almost no pain after surgery.
"Method"
Prior to surgery, pre-anesthetic medication is not used, and veins are reserved. Begin surgery in a supine position with the affected limb lightly bent.

  First, normal high-level ligation is performed. All the branches in the vicinity of the joint portion 20 (see FIG. 1) between the great saphenous vein 14 and the common femoral vein 21 are ligated and separated to separate the great saphenous vein 14.

  Subsequently, even in the knee, the vicinity of the joint 20 between the great saphenous vein 14 and the common femoral vein 21 is ligated at a high level, and intraoperative knee sclerotherapy is performed from the stump of the great saphenous vein 14 toward the periphery. 10% to 20 ml of 10% hypertonic saline (saline with higher osmotic pressure than human body fluid) is injected from an atom tube (not shown). At the time of injection, as shown in FIG. 14, the patient himself / herself moves the foot 11, and the lower limb 10 is well milked so that no curing agent remains. With intraoperative sclerotherapy, the sclerosing agent is injected retrogradely into the area of venous insufficiency and the healthy part is preserved.

  After the intraoperative sclerotherapy is completed, 300 ml to 400 ml of TLA fluid is applied along the marking of the great saphenous vein 14 on the knee, and then antegrade from the above-knee stump 32 as shown in FIG. 7 (A). A stripping wire 108 (JMS) with an outer diameter of 1.5 mm is inserted into the lumen of the great saphenous vein 14. When the stripping wire 108 reaches outside the stump 34 of the great saphenous vein 14 in the vicinity of the joint 20 between the great saphenous vein 14 and the common femoral vein 21, as shown in FIG. The tip of 102 is connected to stripping wire 108.

  The stripping wire 108 is withdrawn retrogradely and the tube 102 is inserted into the greater saphenous vein 14. Since the tube 102 is soft and bendable as described above, it can be smoothly inserted along the great saphenous vein 14.

  When the tube 102 comes out from the stump 34 to the above-knee stump 32 as shown in FIG. 7C, it is confirmed that the tube 102 is inserted into the blood vessel lumen with an intraoperative ultrasonic examination apparatus.

  As shown in FIG. 6, the mouth portion 102B on one end side of the tube 104 is connected to an infusion set 104 for adults including a pack 110 containing about 200 ml of physiological saline S warmed to about 80 ° C. The other end side mouth portion 102 </ b> A is disposed on the basin 106.

  200 ml of physiological saline S warmed to about 80 ° C. is spontaneously dropped in about one minute, and the physiological saline S warmed to about 80 ° C. flows into the tube 102 and is discharged onto the basin 106 from the mouth 102A.

  When the physiological saline S200 ml warmed to about 80 ° C. passes through the tube 102, the tube 102 generates heat uniformly, and the large saphenous vein 14 is cauterized by the heat generation and the blood vessel is occluded.

  The tube 102 is extracted and the stump 34 of the great saphenous vein 14 is ligated. Then, the wound is closed and the operation is completed.

  After the operation, an elastic bandage (not shown) is wound up along the great saphenous vein 14 to the thigh. The elastic bandage is wound up to the thigh for 2 days. Then, wind up to below the knee for one week. Finally, an elastic stocking (not shown) is worn for one month.

"result"
14 patients with saphenous varicose veins with 14 limbs (average age 59.6 years (age 35-74 years), 6 men, 8 women) Intravenous thermosetting was performed.

  The average operation time was 69.6 minutes.

  There were no postoperative burns, subcutaneous bleeding, gait disturbance, or saphenous neuropathy as a joint disease. One week after the operation, all the saphenous veins 14 were confirmed to have thrombotic closure by ultrasonography. Furthermore, there was no recurrence during the observation period of an average of 3 months.

  Now, the physiological saline S heated to about 80 ° C. flows into the tube 102 inserted into the great saphenous vein 14 in this way, so that the tube 102 is heated, and the great saphenous vein 14 is made uniform in a short time. It can be cauterized and occluded. Moreover, the device used is about the tube 102 and the drip set 104 for adults, and is inexpensive. In particular, treatment can be performed in a short time and at a very low cost as compared with an intravascular ablation method using radio waves or lasers.

  Further, as can be seen from the above-described results, high curability is obtained, and the treatment method is minimally invasive.

  In addition, as a joint disease, there is a possibility that the surrounding burns caused by heat and deep vein thrombosis may occur together with the intravascular ablation method using radio waves or lasers. In order to prevent this, local anesthesia is performed by the TLA method in which epinephrine and sodium bicarbonate are added to 0.05 to 0.1% lidogine at 4 ° C. over the entire length of the great saphenous vein 14.

  Further, when there is a branch failure or dilation in the vicinity of the junction 20 between the great saphenous vein 14 and the common femoral vein 21, high-level ligation is performed. In the case of performing intravascular closure therapy in the vicinity of the joint 20 between the great saphenous vein 14 and the common femoral vein 21 by the puncture method, the vicinity of the joint 20 between the great saphenous vein 14 and the common femoral vein 21. There is a risk of damage to the deep veins 12 and thrombosis of the deep veins 12. Therefore, it is preferable to perform high-level ligation from the viewpoint of curability and safety, and to determine and disconnect all branches near the joint 20 between the great saphenous vein 14 and the common femoral vein 21.

  High-level ligation can be performed with local anesthesia, and can be performed in a short time with a small incision, so that minimally invasiveness is not impaired. Furthermore, as described above, sclerotherapy for residual varicose veins after surgery is not necessary by using in combination with intraoperative sclerotherapy.

  Next, a second embodiment of the treatment device for varicose veins according to the present invention will be described. In addition, the same code | symbol is attached | subjected to the member demonstrated in 1st Embodiment, and the overlapping description is abbreviate | omitted.

  As shown in FIG. 8A, the tube 202 includes an outer tube 204 whose one end is closed by a guide 208 having a conical shape and a spherical tip. An inner tube 206 having both ends opened through the outer tube 204 penetrates from the outer peripheral wall of the outer tube 204 and is inserted to the front of the guide 208. Further, as shown in an enlarged view of the distal end portion 202B of the tube 202, FIG. 8B, a gap is formed between the guide 208 and the opening 206B on one end side of the inner tube 206 so that the physiological saline S can flow back. ing.

  Further, as shown in FIG. 8C, several side holes 206 </ b> C are opened in the side wall of the inner tube 206. Note that the greater the number of side holes 206C, the more physiological saline S flows from the outer tube 204 to the inner tube 206, but this leads to a decrease in strength. Therefore, it is desirable to provide an appropriate number of the physiological saline S that balances the amount of inflow from the outer tube 204 to the inner tube 206 and the strength. Note that the tube 202 of this embodiment is provided with three side holes 206C.

  A cap 204A is attached to the mouth of the other end of the outer tube 204, and a cap 206A is attached to the mouth of the other end of the inner tube.

  Both the outer tube 204 and the inner tube 206 are made of a material that does not cause safety problems when inserted into the human body, for example, made of vinyl chloride or silicon, and are soft and flexible.

  Since the tube 202 is configured as described above, the physiological saline S flowing in from the cap 204A of the outer tube 204 flows into the inner tube 206 from the side hole 206B as shown in FIG. After filling up to the tip portion 202B of 202, as shown in FIG. 8B, it is folded back and flows into the inner tube 206 also from the opening 206B at one end of the inner tube 206. The physiological saline S that has flowed in flows backward through the inner tube 206 and is discharged from the cap 206A at the other end. That is, the tube 202 can inject and discharge the physiological saline S only from the other end side. Further, since the side hole 206C is provided, the physiological saline S flows through the tube 202 more uniformly.

  As shown in FIG. 9, the varicose vein treatment device 200 includes an adult infusion set 104 to which a cap 204A of an outer tube 204 is connected. Similar to the first embodiment, the adult infusion set 104 includes a pack 110 containing 200 ml of physiological saline S heated to about 80 ° C. Further, the cap 206 </ b> A of the inner tube 206 is arranged on the basin 106.

  Next, a surgical method using the treatment apparatus 200 for lower limb varices of the second embodiment will be described. In this embodiment as well, intravenous thermosetting therapy was performed using intraoperative sclerotherapy and high-order ligation in combination.

  “Pre-operative preparation” and “anaesthesia” are the same as those described in the first embodiment.

"Method"
Intraoperative sclerotherapy and high-level ligation are performed as in the first embodiment.

  As shown in FIG. 10A, the stripping wire 108 is passed through the tube 202, and the stump 34 of the great saphenous vein 14 near the junction 20 between the great saphenous vein 14 and the common femoral vein 21 is obtained. To the lumen of the greater saphenous vein 14.

  As shown in FIG. 10B, the large saphenous vein 14 is inserted to a predetermined position. In addition, since the front-end | tip part of the guide part 208 is spherical shape, the inside of the great saphenous vein 14 advances smoothly, and the blood vessel inner wall is not damaged.

  Then, as shown in FIG. 10C, only the stripping wire 108 is pulled out and only the tube 202 is left in the great saphenous vein 14. It is confirmed that the tube 202 is inserted into the lumen of the great saphenous vein 14 with an intraoperative ultrasonic examination apparatus (not shown).

  As shown in FIG. 9, the cap 204A of the outer tube 204 is connected to an infusion set 104 for adults including a pack 110 containing about 200 ml of physiological saline S heated to about 80 ° C. The cap 206 </ b> A of the inner tube 206 is disposed on the basin 106.

  200 ml of physiological saline S warmed to about 80 ° C. is spontaneously dropped in about one minute, and the physiological saline S warmed to about 80 ° C. flows into the tube 202 and is discharged onto the basin 106 from the cap 206A of the inner tube 206. To do.

  When the physiological saline S200 ml warmed to about 80 ° C. passes through the tube 202, the tube 202 generates heat, and the large saphenous vein 14 is cauterized by the heat generation and the blood vessel is blocked. In addition, since the physiological saline S distribute | circulates the inside of the tube 202 at the time of inflow (outer tube 204) and discharge | emission (inner tube 206), the heat_generation | fever effect is large. Therefore, it cauterizes and closes in a shorter time. In addition, since the side holes 206C are provided, the physiological saline S uniformly flows through the tube 202, so that heat is generated more uniformly.

  The tube 202 is extracted and the stump 34 of the great saphenous vein 14 is ligated. Then, the wound is closed and the operation is completed.

  Subsequent post-surgery processing and the like are the same as in the first embodiment.

  As described above, the tube 202 of the treatment device 200 for the lower limbs of the second embodiment is inserted from only one place (the stump 34 of the great saphenous vein 14). It can be performed. For this reason, the excision location of the patient's lower limb 10 is only one. Therefore, it is a less invasive surgical method for patients.

  Furthermore, since the physiological saline S flows through the tube 202 both at the time of inflow and at the time of discharge, the heat generation effect is great. Therefore, the greater saphenous vein 14 is cauterized and occluded in a shorter time.

  Next, a third embodiment of the therapeutic device for varicose veins according to the present invention will be described. In addition, the same code | symbol is attached | subjected to the member demonstrated in 1st Embodiment and 2nd Embodiment, and the overlapping description is abbreviate | omitted.

  As shown in FIG. 11, the treatment device 300 for varicose veins includes a pack 111 to which a cap 204 </ b> A of an outer tube 204 of a tube 202 is connected. This pack 111 contains 200 ml of physiological saline S warmed to about 80 ° C.

  In addition, a roller pump 302, a heater device 304, and a sensor device 306 connected to a control device 308 are provided. The inner tube 206 of the tube 202 passes through the roller pump 302, the heater device 304, and the sensor device 306, and the cap 206A is connected to the upper portion of the pack 111.

  The roller pump 302 includes a rotating plate 312 that rotates integrally with the pump shaft 310 and one or a plurality of rollers 314 (two diagonally in this embodiment) disposed near the outer periphery of the rotating plate 312. Have. On the other hand, the inner tube 206 is arranged so as to partially surround the rotating plate 312, and the roller 314 crushed the inner tube 206 locally. Accordingly, when the rotating plate 312 rotates in the counterclockwise direction (the direction of the arrow K in FIG. 11), the roller 314 moves so as to squeeze the inner tube 206, and the physiological saline S in the inner tube 206 is transferred to the heater device 304. It pushes out to the (cap 206A of the inner tube 206) side.

  The heater device 304 has a heat generating portion (not shown) inside, and is heated when the physiological saline S passes through the inner tube 206 passing through the heat generating portion.

  The sensor device 306 includes a temperature sensor and a flow rate sensor (not shown). The flow rate of the physiological saline S sent by the roller pump 302 is measured by the flow rate sensor, and the temperature of the physiological saline S heated by the heater device 304 is measured by the temperature sensor. Then, information on the measured temperature and flow rate of the physiological saline S is sent to the control device 308.

  Now, when the roller pump 302 is driven, the physiological saline S in the pack 111 flows in from the cap 204A of the outer tube 204, fills up to the tip portion 202B while flowing into the inner tube 206 from the side hole 206B, and then turns back. , The inner tube 206 flows backward. (See FIG. 8).

  The physiological saline S that has flowed back is sent to the heater device 304 by the roller pump 302. The physiological saline S is heated to about 80 ° C. by the heater device 304, and the temperature and flow rate of the physiological saline S are measured by the sensor device 306, and then discharged back to the pack 110.

  That is, the physiological saline S heated to about 80 ° C. is circulated.

  In addition, based on the information on the flow rate and temperature measured by the sensor device 306, the control device 308 controls the roller pump 302 and the heater device 304, so that the circulation amount, the circulation time, and the temperature of the physiological saline S can be arbitrarily set. Can be controlled.

  Next, a surgical method using the treatment apparatus 300 for lower limb varices of the third embodiment will be described.

  The present embodiment is a surgical method almost the same as the second embodiment, but the process of cauterizing and occluding the blood vessel by the heat of the physiological saline S in which the great saphenous vein 14 is heated to about 80 ° C. through the tube 202. , The physiological saline S circulates without cooling. Therefore, it is preferable because the tube 202 can generate heat at a constant temperature for a long time.

  Further, the circulation amount, circulation time (cauterization time), and temperature of the physiological saline S in the tube 202 can be arbitrarily controlled by the control device 308. Therefore, optimal cauterization (treatment) according to various conditions such as the length of the great saphenous vein 14 and the degree of symptom of the varicose vein 30 can be performed.

  Next, a fourth embodiment of the therapeutic device for varicose veins according to the present invention will be described. In addition, the same code | symbol is attached | subjected to the member demonstrated in 1st Embodiment and 2nd Embodiment, and the overlapping description is abbreviate | omitted.

  As shown in FIG. 12, the treatment device 400 for varicose veins includes a tube 404 whose one end is closed by a guide 412 having a conical shape and a spherical tip. A heater wire 406 is inserted into the tube 404 up to the front of the guide 412. Further, the power supply device 408 connected to the controller 410 is provided, and the heater wire 406 is connected to the power supply device 408.

  By energizing the heater wire 406 from the power supply device 408, the heater wire 406 generates heat, and the tube 404 is warmed by this heat generation. The heat generation temperature of the heater wire 406 can be arbitrarily set by the controller 410.

  It should be noted that the tube 404 is made of a material that does not cause safety even when inserted into the human body, for example, made of vinyl chloride or silicon, and is soft and flexible.

  Next, a surgical method using the treatment apparatus 400 for lower limb varices in the fourth embodiment will be described.

  This embodiment is a surgical method almost the same as the second embodiment, but it is not necessary to connect to the adult drip set 104 (see FIG. 9). In addition, the great saphenous vein 14 generates heat by heating the heater wire 406 of the tube 402 to about 80 ° C., and the tube 402 generates heat, which causes the large saphenous vein 14 to cauterize and block the blood vessel.

  In the cauterization process, the heat generation temperature and heat generation time of the heater wire 406 can be arbitrarily and easily controlled. Therefore, optimal cauterization (treatment) according to various conditions such as the length of the great saphenous vein 14 and the degree of symptom of the varicose vein 30 can be performed.

  Next, a fifth embodiment of the therapeutic device for varicose veins according to the present invention will be described. In addition, the same code | symbol is attached | subjected to the member demonstrated in 1st Embodiment and 2nd Embodiment, and the overlapping description is abbreviate | omitted.

  As shown in FIG. 13, the tube 502 includes an outer tube 504 whose one end is closed by a guide 508 having a conical shape and a spherical end portion. An inner tube 506 having both ends opened to the outer tube 504 passes through the outer peripheral wall of the outer tube 504 and is inserted to the front of the guide 508. Although not shown, in the distal end portion 502B of the tube 502, a gap through which the physiological saline S can flow back is formed between the guide 508 and the opening on one end side of the inner tube 506, like the tube 202 of the second embodiment. ing. (See FIG. 8B). Further, similarly to the tube 202 of the second embodiment, a side hole is formed in the side wall of the inner tube 506, and physiological saline also flows backward from this side hole. (See FIG. 8C).

  A cap 504A is attached to the mouth of the other end of the outer tube 504, and a cap 506A is attached to the mouth of the other end of the inner tube 506.

  The outer tube 504 is made of stainless steel, and the surface is on the bellows. The inner tube 506 is made of, for example, vinyl chloride or silicon and is soft and bendable.

  Similarly to the tube 202 of the second embodiment, the tube 502 is filled with the physiological saline S flowing in from the cap 504A of the outer tube 504 up to the distal end portion 502B while flowing into the inner tube 506 from the side hole. The folded inner tube 506 flows into the inner tube 506 from the opening at one end and is discharged from the cap 506A at the other end. (See FIG. 8B).

  The varicose vein treatment device 500 is not shown in FIG. 13, but, as in the second embodiment, an infusion for adults provided with a pack 110 containing 200 ml of physiological saline S heated to about 80 ° C. A set 104 (see FIG. 9) is provided. The cap 504A of the outer tube 504 of the tube 502 is connected to the drip set 104 for adults, and the cap 506A of the inner tube 506 is arranged on the basin 106 (see FIG. 9).

  Next, a surgical method using the treatment apparatus 500 for lower limb varices of the fifth embodiment will be described.

  In this embodiment, the surgical method is almost the same as that of the second embodiment. However, in the process of inserting the tube 502 into the great saphenous vein 14, the outer tube 504 of the tube 502 is a stainless steel tube whose surface is bellows. Because there is, it is flexible but has a suitable hardness. For this reason, the tube 502 can be smoothly inserted into the great saphenous vein 14 without using the stripping wire 108 (see FIG. 10). Therefore, the tube 502 can be inserted into the greater saphenous vein 14 more easily.

  Furthermore, since the outer tube 504 is made of stainless steel as described above, the thermal conductivity is high. Therefore, the heat generation efficiency is good. Therefore, the greater saphenous vein 14 is cauterized and occluded in a shorter time.

  Next, another operation method using the treatment apparatus 200, 300, 400, 500 for the leg varicose veins of the second to fifth embodiments will be described. In FIG. 15 and the following description, the treatment device 200 for lower limb varices is used as an example, but other treatment devices 300, 400, and 500 for lower limb varices may be used. In this surgical method, intravenous thermosetting therapy was performed in combination with intraoperative sclerotherapy.

  “Pre-operative preparation” and “anesthesia” are the same as those described in the first embodiment.

"Method"
First, after intraoperative sclerotherapy, as shown in FIG. 15, a stripping wire (see FIG. 10) is passed through the tube 202, and the great saphenous vein 14 is antegradely passed from the upper knee stump 32. Insert to the vicinity of the joint 20 with the common femoral vein 21.

  Pull only the stripping wire and leave only the tube 202 in the great saphenous vein 14. It is confirmed that the tube 202 is inserted into the lumen of the great saphenous vein 14 with an intraoperative ultrasonic examination apparatus (not shown).

  The cap 204A of the outer tube 204 is connected to an adult infusion set 104 including a pack 110 containing about 200 ml of physiological saline S warmed to about 80 ° C. The cap 206 </ b> A of the inner tube 206 is disposed on the basin 106.

  200 ml of physiological saline S warmed to about 80 ° C. is spontaneously dropped in about one minute, and the physiological saline S warmed to about 80 ° C. flows into the tube 202 and is discharged onto the basin 106 from the cap 206A of the inner tube 206. To do.

  When the physiological saline S200 ml warmed to about 80 ° C. passes through the tube 202, the tube 202 generates heat, and the large saphenous vein 14 is cauterized by the heat generation and the blood vessel is blocked.

  The tube 202 is extracted, the upper knee stump 32 of the great saphenous vein 14 is closed, and the operation is completed.

  Subsequent post-surgery processing and the like are the same as in the first embodiment.

  In the case of the method of inserting the tube 202 of the treatment device 200 for the varicose veins of the lower limbs in this manner antegradely to the predetermined position of the great saphenous vein 14, for example, similarly to the insertion of the catheter. Only a slight incision in the patient's lower limb 10 is required. Therefore, it is a surgical method that is less invasive to the patient and cosmetically better.

  In the second embodiment, the third embodiment, and the fifth embodiment of the varicose vein treatment device 200, 300, 500, the physiological saline S flows from the caps 204A, 504A of the outer tubes 204, 504, Although it was discharged | emitted from the cap 206A of the tube 206, it is good also as a structure which flows in from the cap 206A of the inner tube 206, and discharges | emits from the caps 204A and 504A of the outer tubes 204 and 504.

  Further, in the treatment device 100, 200, 300, 500 for the lower limb varices of the first embodiment, the second embodiment, the third embodiment, and the fifth embodiment, the liquid flowing into the tubes 102, 202, 502 is physiological saline. Although it was water S, it is not limited to this. Other liquids may be used. For example, distilled water, glucose solution, lingual solution, etc. may be used.

It is a figure which shows typically a leg vein. It is a figure which shows typically the venous valve of a leg vein. (A) is a figure which shows a mode that normal is flowing into the blood, and (B) is a figure which shows a mode that the venous valve is malfunctioning and the blood flows backward. It is a figure which shows typically a leg varicose vein. It is a figure which shows typically the treatment which used sclerotherapy and high-order ligation together. It is a figure which shows typically the operation | movement using the leg varicose vein treatment apparatus which concerns on 1st Embodiment of this invention. It is a figure which shows typically the process which inserts the tube of the leg varicose vein treatment apparatus which concerns on 1st Embodiment of this invention into a great saphenous vein from (A) to (C). (A) is a figure which shows typically the tube of the varicose vein treatment apparatus which concerns on 2nd Embodiment of this invention, (B) is an enlarged view inside the (circle) part of the tube front-end | tip part of (A). , (C) is an enlarged view of the inside of the □ portion of the tube middle portion of (A). It is a figure which shows typically the operation using the leg varicose vein treatment apparatus which concerns on 2nd Embodiment of this invention. It is a figure which shows typically the process which inserts the tube of the leg varicose vein treatment apparatus which concerns on 2nd Embodiment of this invention into a great saphenous vein from (A) to (C). It is a figure which shows typically the operation using the leg varicose vein treatment instrument which concerns on 3rd Embodiment of this invention. It is a figure which shows typically the operation using the leg varicose vein treatment instrument which concerns on 4th Embodiment of this invention. It is a figure which shows typically the tube of the varicose vein treatment apparatus which concerns on 5th Embodiment of this invention. It is a figure which shows typically a mode that a foot | leg part is moved during a surgery. It is a figure which shows typically another operation using the leg varicose vein treatment apparatus which concerns on 2nd Embodiment of this invention.

Explanation of symbols

10 Lower limbs 12 Deep veins 14 Large saphenous veins (lower limb veins)
16 Small saphenous vein (lower limb vein)
30 Lower limb varicose 100 Lower limb varices treatment instrument 102 Tube 200 Lower limb varices treatment instrument 202 Tube 204 Outer tube 206 Inner tube 300 Lower limb varices treatment instrument 302 Roller pump (circulation pump)
304 Heater Device 400 Lower Limb Varicose Treatment Instrument 404 Tube 406 Heater Wire 500 Lower Limb Varicose Treatment Instrument 502 Tube S Saline (warm solution)

Claims (11)

A tube that can be inserted into the lower limb vein;
Heating means provided over substantially the entire length in the tube;
A treatment device for varicose veins of the lower limb.   The varicose veins according to claim 1, wherein the heat generating means is a warm liquid passing through the tube, and the warm liquid flows in from one mouth portion of the tube and is discharged from the other mouth portion. Therapeutic instruments. The heating means is a warm liquid passing through the tube;
The tube has a configuration in which an inner tube having at least both ends opened is passed to one end portion in an outer tube whose one end is closed, and a mouth portion at the other end of the inner tube is protruded from the other end portion of the outer tube. And
The therapeutic device for lower limb varices according to claim 1, wherein the warm liquid flows in from the mouth of the other end of the outer tube and is discharged from the mouth of the other end of the inner tube. The heating means is a warm liquid passing through the tube;
The tube has a configuration in which an inner tube having at least both ends opened is passed to one end portion in an outer tube whose one end is closed, and a mouth portion at the other end of the inner tube is protruded from the other end portion of the outer tube. And
The treatment device for lower limb varices according to claim 1, wherein the warm liquid flows in from the mouth at the other end of the inner tube and is discharged from the mouth at the other end of the outer tube.   The varicose vein treatment apparatus according to claim 3 or 4, wherein a side hole is formed in a side wall of the inner tube. A circulation pump for allowing the discharged warm liquid to flow again;
A heater device for warming the discharged hot liquid to a predetermined temperature;
The varicose vein treatment device according to any one of claims 2 to 5, characterized by comprising:   The varicose vein treatment apparatus according to claim 1, wherein the heat generating means is a heater wire passing through the tube.   The varicose vein treatment instrument according to any one of claims 1 to 7, wherein the tube is made of silicone rubber.   The said tube consists of vinyl chloride, The therapeutic device of the leg varicose vein in any one of Claim 1-7 characterized by the above-mentioned.   The treatment device for lower limb varices according to any one of claims 1 to 7, wherein the tube is made of stainless steel.   The therapeutic device for varicose veins according to claim 10, wherein the tube made of stainless steel has a bellows-like surface.

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