JP2006129979A - Elastic tape for proctocele surgery - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an elastic tape for the proctocele surgery, permitting excellent suturing of the anal ring with a low return rate of the condition and without any such problems as a burden on a patient when the vastus membrane of the patient's own is used. <P>SOLUTION: The elastic tape 1 is made of synthetic resin fiber to be used for suturing the anal ring in the anal surgery of the proctocele. The elastic tape 1 consists of a tape body 2 made of polyester fiber mesh to be elastic in the longitudinal direction, guide pieces 3 with a tapered distal end connected to both ends of the tape body, and an introduction string 4 attached to the distal end of each guide piece 3. The tape body 2 is 2-50 mm in width, and 10-300 mm in length. The tape 1 is used by annularly inserting the tape body 2 under the skin of the anal region, sewing both ends of the tape, and cutting off the distal ends from the guide piece 3. The anal ring, which is expanded/contracted in response to the passage of excrement, is appropriately sutured with the annular tape body 2 under the skin of the anal region in such a way that the anal ring can be expanded/contracted. The suturing function of the tape is stably exhibited, and the return rate of the condition can be significantly reduced. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to an elastic tape for use in transanal surgery for rectal prolapse.

  Rectal prolapse is a disease in which the ability of the tissue support and anal sphincter muscles to decrease due to aging, etc., weakening the contraction force of the anus, and the rectum droops from the anus. In the past, a method of lifting and fixing the rectum by laparotomy was used, but in recent years, the abdominal laparotomy is not performed, and the CANT-Miwa-Thiersh method, which is a transanal surgical method, is performed.

  In this surgical procedure, the rectal mucosa is sewed from the anus and returned to the anus, and then the anal ring is sewed to a prescribed thickness that matches the patient's physique by passing an artificial thread such as nylon under the anus. To do. However, the sewing with the artificial thread has a disadvantage that the anal ring that expands and contracts with the passage of the stool is less effective to expand and contract freely, and the recurrence rate is as high as several tens of percent. On the other hand, as a modified method of the CANT-Miwa-Thiersh method, a method using the periosteum of the patient's own thigh for anastomosis of the anus is known (see, for example, Non-Patent Document 1).

This method is autotransplantation using the patient's own tissue, has a high effect of sewing the anal ring in a freely expandable / contractible manner, and the recurrence rate can be kept low, for example, less than 10%. However, there is a problem that the burden on the patient is large because it is necessary to remove a broad fascia having a size of about 3 cm × 14 cm from the center of the patient's outer thigh.
"GANT-Miwa-Thiersh method for the rectal prolapse and remote procedure of Yoshida modified method" (Japanese Journal of Colorectal Anal 54: 156-160, 2001)

  Therefore, when the anus ring is stitched and the rectal prosthesis is operated transanally, the rate of recurrence of the disease is low, and there is no problem of the burden on the patient when using the patient's own fascia. The development of seams was desired.

  For this reason, the problem of the present invention is that the anal ring can be satisfactorily sewn, the disease recurrence rate is low, and there is no problem of the burden on the patient when using the patient's own fascia. It is to provide an elastic tape for rectal prosthesis made of artificial material.

  In order to solve the above-mentioned problems, the elastic tape for rectal prosthesis of the present invention is a synthetic resin fiber tape used in the transanal surgery for rectal prolapse, which is used for stitching of the anal ring, and stretches in the longitudinal direction. The tape body is composed of a flexible mesh, the guide portions tapered at both ends of the tape body are tapered guide pieces, and the introduction string attached to the tip ends of the guide pieces. According to the present invention, preferably, at least the mesh constituting the tape body is made of polyester fibers. The tape body has a width of 2 to 50 mm and a length of 10 to 300 mm.

  The above-mentioned elastic tape is used by introducing the tape body into the anus subcutaneously and stitching both ends, and cutting off the excess part from the guide piece. The tape body expands and contracts in the longitudinal direction. Because it is made of a synthetic resin fiber mesh, the anus ring that expands and contracts with the passage of stool can be satisfactorily squeezed freely, and its squeezing function can be demonstrated stably, and the disease recurrence rate Can also be significantly reduced.

  As a synthetic fiber constituting the tape, any fiber can be used as long as it is used in medicine, but a polyester fiber is suitable in terms of stability such as compatibility with tissue and mechanical strength. Therefore, it is preferable that at least the tape body remaining in the subcutaneous region is formed of polyester fibers.

  According to the elastic tape for rectal prosthesis of the present invention, the anus ring can be satisfactorily sewn and the disease recurrence rate is low, and there is no problem of the burden on the patient when using the patient's own fascia.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. FIG. 1 is a plan view showing an elastic tape for rectal prosthesis of the present invention. As shown in FIG. 1, the stretchable tape 1 includes a stretchable tape body 2, guide pieces 3 connected to both ends of the stretchable tape body 2, and introduction strings 4 attached to the tips of the guide pieces 3. ing. The stretchable tape main body 2 is used to sew the anus ring under the anus subcutaneously, and is introduced into the subcutaneous part by a deschant (strong gourd round needle). Each introduction string 4 is inserted into one incision wound slightly cut in two places around the anus with a deschant, and the tape body 2 is annularly formed in the subcutaneous part by passing through the subcutaneous part in an annular shape and withdrawing from the other incision. It is for introduction to. Each guide piece 3 is for facilitating the introduction of the tape body 2 and includes a tapered tip 3a.

  The tape main body 2 is made of a mesh in which synthetic fibers are entangled vertically and horizontally in a form in which loops are provided in some places, and is formed to be stretchable in the longitudinal direction. The present invention is greatly characterized in that such a mesh tape body 2 is used for anastomosis, and the tape body 2 expands and contracts according to the expansion and contraction of the anal ring accompanying the passage of stool, It is possible to stably exert the sewn effect of the anal ring.

  The expansion / contraction rate of the tape body 2 is a ratio of the length when stretched to the contracted length without stretching, for example, about 1.5 to 2.0. In this embodiment, it is about 1.7. The dimensions of the tape body 2 may vary depending on the physique of the patient to be used, but preferably the width is about 2 to 50 mm, the length is about 10 to 300 mm, and the thickness is preferably thin, but considering the strength and the like Then, it is about 1 to 3 mm. In this example, the width of the tape body 2 was 10 mm, the length was 75 mm, and the thickness was 2 mm.

  As a synthetic fiber constituting the mesh, as long as it is used for medical purposes, it is possible in principle. However, since the tape body 2 is a portion where the anal ring is sewn and left under the anus, the synthetic fiber of the mesh is used. Polyester fibers that are excellent in terms of stability such as compatibility with tissue and mechanical strength are suitable. As such a mesh made of polyester fiber that is stretchable in the longitudinal direction, a commercially available product manufactured by Kairos of England can be used.

  As described above, the guide piece 3 includes the tapered tip portion 3a in order to facilitate introduction of the tape body 2 into the subcutaneous portion. The guide piece 3 is made of a synthetic fiber cloth, and is attached to both ends of the tape body 2 by sewing. The length of the guide piece 3 is about 10 to 50 mm, the width is about the same as that of the tape body 2, and the thickness may be thinner than that of the tape body 2. In this example, the width was 10 mm, the length was 50 mm, and the thickness was 1.5 mm. As the guide piece 3, synthetic fibers constituting the cloth are used for medical purposes, and in the present embodiment, the guide piece 3 is made of polyester fiber like the mesh of the tape body 2.

  As described above, the introduction string 4 is used to introduce the tape body 2 into the subcutaneous portion in an annular shape. The length of the introduction string 4 is about 50 to 150 mm and the thickness is about 1 to 3 mm. In this embodiment, the length is 100 mm and the thickness is 1.5 mm. The introduction string 4 is attached to the distal end portion 3a of the guide piece 3. At this time, in order to form the loop 4a of the introduction string 4 at the distal end portion 3a, the string 4 is passed through the distal end portion 3a from the bottom to the top and loosely pulled out. Pass the cord from the top to the bottom with a small gap in the same way, pull it loosely and pass it from the bottom to the top at the point where it was first passed through. The welded part is also welded. When the introduction string 4 is attached to the deschanter, the end of the string 4 passed through the needle hole is entangled with the loop 4a of the distal end portion 3a of the guide piece 3, so that the string 4 can be easily attached to the deschanter. One loop 4a may be formed.

  In order to perform anorectal surgery for rectal prolapse using the elastic tape 1, the following procedure may be performed. First, for the patient in the meteorite position, the rectal mucosa is sewn and returned from the anus, and as shown in FIG. 2 (a), around the anus 5 at 1 o'clock, 7 o'clock or 11 o'clock, Two small incisions 6a and 6b that reach the subcutaneous tissue are inserted at two positions, and then, as shown in FIG. 2 (b), the deschant 7 is inserted subcutaneously from one of the incisions 6a, for example, and the other half of the subcutaneous is placed around the other. The needle tip is taken out from the incision 6b, and as shown in FIG. 2C, one introduction string 4 of the tape 1 is tied to the needle hole 7a, and the string 4 is attached to the deschant 7. Next, the deschant 7 is returned halfway and extracted from the incision 6a, and the string 4 is pulled out from the incision 6a as shown in FIG. 2 (d). As a result, a part of the tape body 2 is introduced under the anus subcutaneously with the guide piece 3 as a lead.

  Then, the deschant 7 is again placed under the incision 6a subcutaneously, and as shown in FIG. 2 (d), the hypodermis is half-turned on the opposite side to the front, and the needle tip is taken out from the other incision 6b. The other introduction string 4 is attached to the deschant 7. Then, the deschant 7 is returned halfway and extracted from one incision 6a, and the other string 4 is pulled out from the incision 6a as shown in FIG. 2 (e). As a result, the tape body 2 is introduced into the anus subcutaneously with the guide piece 3 as a lead.

  Subsequently, as shown in FIG. 3A, both strings 4 are pulled to completely pull out both guide pieces 3 from the incision 6a, so that both ends of the tape body 2 are exposed. Next, as shown in FIG. 3 (b), the two guide pieces 3 are overlapped, and are heated by sandwiching them with the heating sandwiches 8, and both ends of the tape body 2 are lightly heated. Prevent the department from breaking down. After that, as shown in FIG. 3 (c), the tape body 2 is sewn with the suture thread 9 so as to form narrow portions at both ends. Next, as shown in FIG. 3 (d), both ends of the tape body 2 are sandwiched between the outsides of the narrowed portion with a thermal notch (not shown), and portions beyond the guide piece 3 are cut off from both ends. Thereby, if the stitched end of the tape body 2 is returned subcutaneously, the anastomosis by the annular tape body 2 under the anus is completed, and finally, as shown in FIG. When the incision 6 (6a, 6b) is sewn and closed with the suture thread 10, the operation for rectal prolapse is completed.

  As described above, the elastic tape for rectal prosthesis of the present invention has a tape body made of a synthetic resin fiber mesh, and thus stably exhibits a good function of stitching the anal ring, and recurrence of the disease state. The rate can also be significantly reduced.

It is a figure which shows the elastic tape for rectal prosthesis of this invention, and is a top view (a) and a side view (b). It is explanatory drawing which shows the process of the transanal operation of the rectal prolapse using the tape of FIG. FIG. 3 is an explanatory diagram showing a continuation process of FIG. 2.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Elastic tape 2 Tape main body 3 Guide piece 4 Introductory string 5 Anus 6a, 6b Incision wound 7 Deshan (strongly strong round needle) 9, 10 Suture thread

Claims (3)

  Synthetic resin fiber tape used for rectal prosthesis in transanal surgery for rectal prolapse, the tape body made of a mesh stretchable in the longitudinal direction, and connected to both ends of the tape body An elastic tape for rectal prosthesis comprising a guide piece having a tapered tip and an introduction string attached to the tip of each guide piece.   The stretchable tape according to claim 1, wherein at least the mesh constituting the tape body is made of a polyester fiber. The elastic tape according to claim 1 or 2, wherein the tape body has a width of 2 to 50 mm and a length of 10 to 300 mm.

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