JP2006304928A - Organ fastener, and organ fastener set - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an organ fastener which can surely perform the fixation of an organ by a simple operation, and to provide an organ fastener set. <P>SOLUTION: This organ fastener 10 is constituted of a fastening section 11 and a suture 12. Then, the fastening section 11 is constituted of a bar-like section 13, and a coil spring 14 which covers the bar-like section 13 and is fixed to one end section 13a of the bar-like section 13. The suture 12 is passed through the inside of the coil spring 14 from the other end section 13b side of the bar-like section 13, and is connected with the center of the bar-like section 13. Also, an insertion utensil 20 which is used when the organ fastener 10 is attached is constituted of a puncturing needle 21 for insertion which can house the fastening section 11, and a cylindrical extruding section 22 which is inserted in the puncturing needle 21 for insertion and can extrude the fastening section 11 from the distal end section 25 of the puncturing needle 21 for insertion. In addition, a taking-out utensil 30 which is used when the organ fastener 10 is removed is constituted of a cylindrical section 32 and a gripping section 33. A spiral notch section 34a is formed from the distal end section 32a of the cylindrical section 32 to the proximal end side section. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an organ fixing device and an organ fixing device set used for fixing a predetermined organ in a patient's body to a body wall.

  2. Description of the Related Art Conventionally, an organ fixing device set including an organ fixing device is used to fix a sutured portion in a patient's body, particularly an organ such as a body wall and a built-in organ. For example, fluid foods and drinks such as liquid foods and nutrients are supplied to gastrostomy tubes for people whose function of ingesting food by their mouth due to aging or illness is reduced. The gastrostomy tube is attached by forming a hole in the abdomen of the patient. In such a case, in order to appropriately attach the gastrostomy tube, it has been performed in advance to fix the abdominal wall and stomach wall using an organ fixing device set including an organ fixing device (for example, patents). Reference 1).

This organ fixing device set is provided with two puncture needles installed in parallel at a distance. When fixing the abdominal wall and stomach wall, first, the two puncture needles are simultaneously attached to the patient. Puncture the sutured part. Next, the suture thread was passed through one of the puncture needles, and the inner needle with a loop body made of a wire connected to the tip was passed through the other puncture needle, and the suture thread was grasped by the loop body inside the stomach wall. Pull out the inner needle from the puncture needle. Then, after the tip of the suture is pulled up from the other puncture needle, the two puncture needles are withdrawn from the sutured part, and the abdominal wall and stomach wall are fixed by connecting both side portions of the suture protruding outside the patient's body. To do.
JP-A-5-161655

  However, the above-described conventional organ fixture set has a problem that it is necessary to puncture two puncture needles at the same time and to pass an inner needle and a suture thread through each puncture needle, which makes the operation complicated. Further, if the inner needle is not inserted into the puncture needle well, the projecting direction and shape of the loop body may not be in an appropriate state and the suture may not be grasped. For this reason, there also exists a problem that skill is required for operation. In addition, when there is not enough space on the inner side of the sutured part, it is difficult to hold the suture with the loop body, and there is a problem that reliability is lowered.

  The present invention has been made to cope with such problems, and an object of the present invention is to provide an organ fixing device and an organ fixing device set that can reliably fix an organ by a simple operation.

  In order to achieve the above-mentioned object, the structural features of the organ fixing device according to the present invention include a locking part installed on the inner wall side of a predetermined organ in the body of a patient, and a locking part connected to the locking part. An organ fixing tool for fixing the organ to the body wall, which is composed of a suture thread that extends outside the patient's body through a hole formed in the patient's organ and body wall. And an elastic expansion / contraction member fixed to one end side portion of the rod-shaped portion in a state of covering the outer peripheral surface of the rod-shaped portion, and elastically expanding and contracting by exposing the suture thread from the substantially central portion in the axial direction of the rod-shaped portion. Extending from the other end of the member to the outside, pulling the suture away from the other end side portion of the rod-shaped portion, the elastic elastic member contracts, and the other end of the elastic elastic member is rod-shaped The suture is positioned at the exposure start part of the suture at the approximate center in the axial direction of the part. When releasing the force tensioning, by expanding the resilient and elastic members, the other end of the resilient and elastic members are in that so as to be positioned at the other end side of the rod-shaped portion.

  As described above, the organ fixing device according to the present invention is composed of a rod-shaped locking portion installed on the inner wall side of the organ and a suture thread extending from the locking portion to the outside through a hole provided in the patient. Has been. Further, the locking portion is composed of a rod-shaped portion and an elastic elastic member fixed to one end portion side portion of the rod-shaped portion in a state of covering the outer peripheral surface of the rod-shaped portion, and the distal end portion of the suture thread is the other portion of the rod-shaped portion. It passes through the inner side of the elastic elastic member from the end side and reaches the substantially central part of the rod-shaped part.

  Here, the substantially central portion in the axial direction of the rod-shaped portion is a substantially central portion in the longitudinal direction of the rod-shaped portion, and when the suture is pulled against the latch portion, the latch portion and the suture are T-shaped. It is a position that can be made into a shape. Further, one end of the rod-shaped portion indicates one end, one end indicates the direction of one end, and the one end portion is a predetermined portion located in the vicinity of the end including the one end. Indicates the part. Similarly, the other end portion of the rod-shaped portion indicates an end portion opposite to one end portion, the other end portion side indicates the direction of the end portion opposite to the one end portion, and the other end portion side portion is The predetermined part located in the edge part vicinity including the edge part opposite to one edge part is shown.

  Therefore, when attaching the organ fixing tool, the elastic elastic member can be extended to make the locking portion and the suture thread linear. When the locking portion is positioned in the organ and the suture is pulled against the locking portion, the locking portion is along the inner wall of the organ, and the locking portion and the suture are in a T-shape. Then, fix the organ and body wall.

  Further, when removing the organ fixing tool, the elastic stretchable member is extended by releasing the force of pulling the suture with respect to the locking portion, so that the locking portion and the suture are linearized. For this reason, a latching | locking part can be easily removed from a hole. In this case, the distal end of the suture thread may be directly connected to the substantially central portion of the rod-shaped portion by caulking or using an adhesive, or connected to another portion of the rod-shaped portion to You may make it expose to the exterior side from the approximate center part of a part. In addition, the body wall in this invention means walls, such as a body cavity located in the skin side, and shall exclude a visceral wall.

  In addition, another structural feature of the organ fixing device according to the present invention is that the distal end portion of the suture thread is fixed to a substantially central portion in the axial direction of the rod-shaped portion. Further, the rod-shaped portion in this case may be a columnar rod shape or a cylindrical rod shape.

  Further, another structural feature of the organ fixing device according to the present invention is that the rod-shaped portion of the locking portion is formed of a cylindrical body, and the suture thread is provided from the substantially central portion in the axial direction to the other end portion of the cylindrical body. The notch part which can pass is provided by penetrating from the inner peripheral surface of the cylindrical body to the outer peripheral surface. According to this, when the elastic elastic member is extended to linearly form the locking portion and the suture, the suture is accommodated inside the rod-like portion, so that the suture is better accommodated. In addition, for example, even when the elastic elastic member is constituted by a linear member such as a coil spring, there is an advantage that the elastic elastic member and the suture thread are hardly entangled.

  Further, another structural feature of the organ fixing device according to the present invention is that an engaging portion is provided at the distal end portion of the suture thread, and an opening edge portion of one end portion of a rod-shaped portion having a cylindrical body as the engaging portion. In this state, the suture thread is passed through the inside of the one end portion side portion of the rod-like member and extended to the outside from the notch portion or the opening portion of the other end portion. According to this, the connection between the locking portion and the suture is easy and reliable. In this case, any engagement portion can be used as long as it can be engaged with an opening edge of a cylindrical portion, such as a sphere, rod, plate, or frame, and can be connected to a suture thread. Can be used. In addition, the engagement portion can be formed by connecting the distal end portions of the suture thread into a lump. According to this, the separate member which comprises an engaging part becomes unnecessary.

  Further, the constitutional feature of the organ fixing device set according to the present invention is an organ fixing device set including an organ fixing device and an insertion device used when attaching the organ fixing device to an organ, the After inserting the locking part of the fixture into the patient's body, the locking part can be discharged into the organ and force can be applied to keep the suture away from the other end of the bar. In addition, the suturing tool and the locking portion are formed in a T-shape and are configured with members that can be removed from the patient. The insertion tool in this case may be configured with a needle that can be inserted into the patient's body by puncturing, or may be configured with a cylindrical body that has a sharp tip that can be inserted into a hole formed in the patient's body in advance. . Moreover, the suture thread may be passed through the inside of the insertion tool, or may be along the outer peripheral surface of the insertion tool. According to this, the operation of attaching the organ fixing tool to the organ becomes easy.

  In addition, another structural feature of the organ fixing device set according to the present invention is that the insertion tool includes an insertion puncture needle that can accommodate the locking portion, and an insertion puncture needle that has a suture thread inserted therein. The locking portion inserted into the insertion puncture needle and accommodated in the insertion puncture needle is constituted by a cylindrical push-out portion that can be pushed out from the distal end opening of the insertion puncture needle.

  According to this, since the suture thread passes through the insertion puncture needle together with the cylindrical push-out portion, the operation when the insertion tool is punctured into the patient's body becomes smooth. In addition, the locking portion positioned in the organ is opened with respect to the suture passing through the hole of the patient through the insertion puncture needle, and the suture and the locking portion are formed in a T shape. Easy to operate. That is, the proximal end portion of the suture thread (the portion projecting to the outside) in a state where the locking portion is pushed out from the puncture needle for insertion into the organ by the cylindrical push-out portion and the tubular push-out portion is applied to the locking portion. By pulling, the distal end portion of the suture can be separated from the rod-shaped portion while contracting the elastic elastic member. In this case, for example, the distal end portion of the cylindrical push-out portion can be tapered so that the distal end portion of the tubular push-out portion bites into the gap between the suture thread and the rod-shaped portion of the locking portion. According to this, when the proximal end side portion of the suture is pulled after the locking portion is pushed out from the insertion puncture needle by the cylindrical push-out portion, the locking portion naturally opens in a direction perpendicular to the suture. .

  Further, another structural feature of the organ fixing device set according to the present invention is an organ fixing device set including an organ fixing device and an extraction device used when the organ fixing device is removed from the organ. The output device is composed of a cylindrical body into which the suture thread and the locking part can be inserted, and inserted into the hole of the patient while accommodating the suture thread, and the locking part is separated from the inner wall of the organ. The locking portion and the suture thread are straightened, and then the proximal end portion of the suture thread is pulled so that the locking portion can be accommodated inside.

  This facilitates the operation of removing the organ fixing device. That is, according to this extraction tool, the locking portion can be separated from the inner wall of the organ by inserting the suture thread into the hole and pushing the locking portion. As a result, the force for pulling the suture against the rod-like body of the locking portion is released, and the elastic elastic member is extended. Due to the extension of the elastic elastic member, the locking portion and the suture thread become linear, so that the locking portion can be accommodated inside the extraction tool. As a result, an operation for taking out the locking portion is facilitated.

  Further, another structural feature of the organ fixing device set according to the present invention is that the extractor comprises a cylindrical portion and a grip portion provided at the proximal end portion of the cylindrical portion, and the distal end portion of the cylindrical portion. In other words, a spiral notch that extends in the axial direction while extending in the circumferential direction from the base end portion to the base end portion is formed so as to penetrate between the outer peripheral surface and the inner peripheral surface of the cylindrical portion. According to this, it is possible to insert the suture into the hole while rotating the extraction tool so that the suture thread is put into the notch. As a result, the locking portion and the suture can be effectively linearized, accommodated in the extraction tool, and taken out from the patient's body.

(First embodiment)
Hereinafter, a first embodiment of the present invention will be described in detail with reference to the drawings. 1 and 2 show an organ fixing device 10 according to the embodiment. This organ fixing tool 10 is used for, for example, sewing and fixing abdominal wall A which is a body wall of a patient and stomach wall B which is a visceral wall (see FIG. 5), and is a locking portion formed in a rod shape. 11 and a suture thread 12 connected to the central portion of the locking portion 11 in the axial direction. The locking portion 11 includes a rod-shaped portion 13 made of a stainless steel cylindrical body, and a stainless steel coil spring as an elastic elastic member of the present invention attached to the rod-shaped portion 13 while covering the outer peripheral surface of the rod-shaped portion 13. 14.

  One end portion 14 a of the coil spring 14 is fixed to one end portion 13 a of the rod-shaped portion 13. For this reason, the coil spring 14 can be expanded and contracted in the axial direction with the one end portion 14a as a base point. In the extended state, the other end portion 14b is connected to the other end portion 13b of the rod-like portion 13 as shown in FIG. It is comprised so that it may extend. At that time, the distal end portion (locking portion 11 side portion) of the suture thread 12 passes between the other end portion 13b side portion of the rod-like portion 13 and the other end portion 14b side portion of the coil spring 14, and is externally It extends to.

  That is, in the organ fixing device 10, the distal end portion of the suture thread 12 is in a state along the other end portion 13 b side portion of the rod-like portion 13 as the coil spring 14 extends, as shown in FIG. 2. Furthermore, the suture thread 12 and the locking portion 11 are in a straight line state. Further, when a force is applied between the engaging portion 11 and the suture thread 12 to separate the suture thread 12 from the other end portion 13 b side portion of the rod-shaped portion 13, the coil spring 14 is moved to the one end portion 13 a side of the rod-shaped portion 13. As shown in FIG. 1, the engaging portion 11 and the suture thread 12 are orthogonal to each other to form a T shape. Therefore, the coil spring 14 expands and contracts while moving the other end portion 14 b between the connection portion 15 between the suture thread 12 and the rod-shaped portion 13 and the other end portion 13 b of the rod-shaped portion 13. The suture thread 12 is made of a thread made of nylon. Moreover, the connection part 15 comprises the exposure start part which concerns on this invention.

  When this organ fixing tool 10 is attached to a patient's abdomen, the insertion tool 20 shown in FIG. 3 is used. The insertion tool 20 includes an insertion puncture needle 21 and a cylindrical push-out portion 22 that is inserted into the insertion puncture needle 21. The insertion puncture needle 21 is composed of a stainless steel cylindrical body having an insertion hole 23 formed therein, and a grip portion 24 is attached to a proximal end portion (upper end portion in FIG. 3). The grip portion 24 is formed in a cylindrical shape having a large diameter on the upper side and a small diameter on the lower side, and a guide hole (not shown) communicating with the insertion hole 23 is formed inside.

  The diameter of the guide hole is set to be larger than the diameter of the insertion hole 23, which makes it easy to insert the cylindrical push-out portion 22 from the upper end portion of the insertion puncture needle 21. Further, the diameter of the insertion hole 23 is set to a size that allows the locking portion 11 and the suture thread 12 of the organ fixing device 10 to be inserted in a state of being linearly aligned as shown in FIG. Yes. Further, the distal end portion 25 of the insertion puncture needle 21 is cut and sharpened in a direction inclined with respect to the axial direction, and the opening portion is formed to face in the lateral direction.

  A protrusion 26 is formed at the same position as the opening of the insertion puncture needle 21 in the position around the axis on the outer peripheral surface of the grip portion 24. With this protrusion 26, the opening direction of the distal end portion 25 of the insertion puncture needle 21 can be confirmed. The cylindrical extrusion part 22 is comprised with the cylindrical body made from stainless steel in which the insertion hole 27 was formed in the inside. In addition, the outer diameter of the cylindrical push-out portion 22 is set to a size that can be inserted through the insertion hole 23 of the insertion puncture needle 21, and the inner diameter of the insertion hole 27 can pass the suture thread 12 therein. The stop 11 is set to a size that cannot be passed.

  When the organ fixing tool 10 is attached to the insertion tool 20 configured in this way, first, the locking part 11 is vertically placed in the insertion hole 23 of the insertion puncture needle 21 with the tubular pushing part 22 removed. It is inserted from the upper end side of the insertion hole 23 in the direction. In this case, the suture thread 12 is placed along the other end portion 13b side portion of the rod-shaped portion 13, and the one end portion 13a is moved downward while the locking portion 11 and the suture thread 12 are linearly formed as shown in FIG. The other end 13b is positioned above. Next, the proximal end side portion of the suture thread 12 that protrudes from the upper end of the grasping portion 24 is inserted into the insertion hole 27 from the distal end opening of the cylindrical push-out portion 22 and is protruded to the outside from the upper end opening.

  Then, the organ fixing device 10 and the cylindrical pushing portion 22 in this state are inserted from the upper end portion of the guide hole of the grasping portion 24 and are inserted into the insertion puncture needle 21. At this time, the proximal end portion side of the suture thread 12 is lightly pulled so that the suture thread 12 is not bent. And while pushing the latching | locking part 11 with the front-end | tip part 22a of the cylindrical extrusion part 22, the cylindrical extrusion part 22 is moved to the front-end | tip part 25 side of the insertion puncture needle 21, and the lower end part (rod-like part 13) of the latching part 11 is carried out. When one end portion 13a) is located in the vicinity of the lower end portion of the insertion hole 23, the insertion of the cylindrical push-out portion 22 is stopped, and the state shown in FIG.

  Next, the insertion device 20 to which the organ fixing device 10 is attached in this way is punctured from the skin surface in the abdomen of the patient, and as shown in FIGS. 5 and 6, the abdominal wall A and the stomach wall B are The insertion puncture needle 21 is pierced. In this case, the insertion tool 20 is pushed in until the opening of the distal end portion 25 of the insertion puncture needle 21 is located on the inner side of the stomach wall B. Next, the cylindrical push-out portion 22 is pushed into the lower side (inside) of the insertion puncture needle 21, and as shown in FIG. 7 and FIG. Make a part protrude.

  Then, the cylindrical push-out portion 22 is further pushed into the lower side of the insertion puncture needle 21, and the distal end portion 22a of the cylindrical push-out portion 22 is inserted into the distal end portion of the insertion puncture needle 21, as shown in FIGS. Project from 25. As a result, the locking portion 11 is pushed out of the insertion puncture needle 21 and positioned on the inner side of the stomach wall B. In this state, the base end side portion of the suture thread 12 (the portion protruding from the upper end portion 22b of the cylindrical pushing portion 22) is pulled to obtain the state shown in FIGS. In this case, when the suture thread 12 is pulled, the distal end portion 22 a of the cylindrical push-out portion 22 contracts the coil spring 14 so as to pry between the suture thread 12 and the other end portion 13 b side portion of the rod-like portion 13. Then, it proceeds toward the connecting portion 15 between the suture thread 12 and the rod-shaped portion 13.

  And when the front-end | tip part 22a of the cylindrical extrusion part 22 reaches the connection part 15, the latching | locking part 11 and the suture thread 12 become a T-shape shown in FIG.11 and FIG.12. In this state, until the locking portion 11 contacts the stomach wall B, the organ fixing device 10 is retracted in the pulling direction, and the distal end portion 25 of the insertion puncture needle 21 is removed from the stomach wall B and the abdominal wall A, as shown in FIGS. The state shown in FIG. Then, after removing the insertion puncture needle 21 from the cylindrical push-out portion 22, the tubular push-out portion 22 is pulled and pulled out from the patient's body while the organ fixing device 10 remains on the patient's body. As a result, the locking portion 11 extends laterally along the stomach wall B and engages with the stomach wall B as shown in FIG.

  Next, the above-described operation is repeated to attach another organ fixing device 10 to the vicinity of the organ fixing device 10 in the abdomen of the patient to which the organ fixing device 10 is attached in this way. Then, the proximal end portions of the suture thread 12 extending outside the patient's body of both organ fixing tools 10 are connected to form the suture portion 28 shown in FIG. As a result, the stomach wall B is fixed to the abdominal wall A. Further, if necessary, another stitched portion 28 can be formed in the vicinity of the stitched portion 28 to obtain the state shown in FIG. In this way, the next treatment for attaching a gastrostomy tube or the like is performed in a state where the stomach wall B is fixed to the abdominal wall A with the organ fixing device 10.

  When the predetermined treatment is completed and the organ fixing tool 10 is removed from the patient's body, the extraction tool 30 shown in FIG. 18 is used. The extraction tool 30 is composed of a stainless steel cylindrical portion 32 having a hole 31 (see FIG. 19) formed therein, and a resin gripping portion 33 provided at the base end portion of the cylindrical portion 32. . The cylindrical portion 32 has a notch 34 penetrating between the outer peripheral surface and the inner peripheral surface from the distal end portion 32a to the proximal end portion side. The lower side portion of the notch 34 is constituted by a spiral notch 34a extending in the axial direction while rotating in the circumferential direction, and the upper side portion of the notch 34 is constituted by a linear groove 34b extending in the axial direction. Yes. And the holding | gripping part 33 is formed in a column shape, and the uneven | corrugated | grooved part 35 for slip prevention is formed in the surrounding surface.

  When the organ fixing device 10 is removed from the patient's body using the extraction tool 30 configured as described above, first, the exposed portion of the suture thread 12 in the suture portion 28 is cut, and each organ fixing device is cut. The proximal end portion of the ten sutures 12 is released. Next, as shown in FIG. 20, the distal end portion 32 a of the cylindrical portion 32 is applied to the protruding portion of the suture thread 12 on the surface of the abdominal wall A, and the lower end portion of the notch 34 is applied to the suture thread 12. Then, in a state where a part of the suture thread 12 is hooked in the notch portion 34, the suture thread 12 is wound around the outer peripheral surface of the cylindrical portion 32 of the extractor 30 and is put into the notch portion 34. The cylindrical portion 32 is inserted into the hole 29 formed in the abdominal wall A and the stomach wall B.

  Next, the distal end portion 32a of the cylindrical portion 32 is brought into contact with the locking portion 11, and the extraction portion 30 is further pushed into the inner side of the hole portion 29 so that the locking portion 11 is positioned on the inner side of the stomach wall B. Then, a part of the proximal end side portion of the suture thread 12 that protrudes to the outside is put into the cylindrical portion 32 to loosen the tension of the suture thread 12. As a result, the force for contracting the coil spring 14 is released, and the coil spring 14 expands as shown in FIG. As a result, the distal end side portion of the suture thread 12 is along the other end portion 13b side portion of the rod-shaped portion 13, and the locking portion 11 and the suture thread 12 extend in a straight line. At that time, the upper end portion of the locking portion 11 (the other end portion 13b of the rod-shaped portion 13) is positioned below the distal end portion 32a of the cylindrical portion 32. In this state, the proximal end side of the suture thread 12 is slowly pulled.

  Thereby, as shown in FIG. 22, the locking portion 11 rises and enters the cylindrical portion 32. And when the latching | locking part 11 enters in the cylindrical part 32, the extraction tool 30 is pulled and it pulls out from a patient's body. Thereby, the locking part 11 is taken out from the patient's body together with the extraction tool 30. Similarly, the removal operation of the organ fixing device 10 is completed by removing the other organ fixing device 10 from the patient's body. In the present embodiment, the organ fixing tool 10 and the insertion tool 20 or the organ fixing tool 10 and the extraction tool 30 constitute an organ fixing tool set according to the present invention.

  As described above, the organ fixing device 10 includes the rod-shaped locking portion 11 and the suture thread 12 connected to the locking portion 11. The locking portion 11 includes the rod-shaped portion 13 and the rod-shaped portion 13. The coil spring 14 is configured such that one end portion 14a is fixed to one end portion 13a of the rod-like portion 13 in a state of covering the outer peripheral surface. The distal end portion of the suture thread 12 is connected to the substantially central portion in the longitudinal direction of the rod-shaped portion 13 from the other end 13 b side of the rod-shaped portion 13 through the inner side of the coil spring 14.

  Therefore, when the locking portion 11 is engaged with the inner side of the stomach wall B and the suture 12 is pulled, the locking portion 11 and the suture 12 become T-shaped, and the end side of the suture 12 The part protrudes outside the patient's body. For this reason, the two organ fixing devices 10 are attached to predetermined positions of the abdomen, and the sutures 12 protruding outside the body are tied together to form the sutured part 28, whereby the stomach wall B can be fixed to the abdominal wall A. . At that time, the use of the insertion tool 20 facilitates the operation of attaching the organ fixing tool 10 to the patient's body.

  That is, the insertion tool 20 can accommodate the locking part 11 and the insertion puncture needle 21 having a sharp tip 25 and the locking part 11 in the insertion puncture needle 21 are connected to the distal end of the insertion puncture needle 21. It is comprised with the cylindrical extrusion part 22 which can be extruded from opening. Accordingly, the insertion puncture needle 21 is punctured into the patient's body while the locking portion 11 is housed in the insertion puncture needle 21, and the cylindrical push-out portion 22 is pushed into the insertion puncture needle 21. The stop 11 can be smoothly pushed into the stomach wall B.

Further, when removing the organ fixing device 10 from the patient's body, the removal operation of the organ fixing device 10 from the patient's body is facilitated by using the extraction tool 30. That is, when the locking portion 11 installed on the inner wall of the stomach wall B is pushed and moved to the inside of the stomach wall B by the extraction tool 30 and the suture thread 12 is loosened in this state, the coil spring 14 expands and the locking portion 11 and the suture thread 12 are in a straight line state. In this state, by pulling the suture thread 12, the locking portion 11 can be put into the cylindrical portion 32 of the extraction tool 30, so that the locking portion 11 can be taken out together with the extraction tool 30.

(Second Embodiment)
23 to 26 show an organ fixing device 40 according to a second embodiment of the present invention. In this organ fixing device 40, the rod-like portion 43 constituting the locking portion 41 is constituted by a cylindrical body having a through-hole formed in the central portion, as shown in FIG. A notch portion 46 penetrating between the inner peripheral surface and the outer peripheral surface of the rod-shaped portion 43 is formed between the portion 43b. An engagement sphere 47 as an engagement portion of the present invention is connected to the distal end portion of the suture thread 42. The engagement sphere 47 is formed in a size that can be engaged with the opening edge of the one end portion 43 a of the rod-like portion 43. Further, the suture thread 42 passes from the engagement sphere 47 through the inside of the one end portion 43 a side portion of the rod-like portion 43 and extends to the outside from the end portion 46 a of the notch portion 46. In addition, the exposure start part of this invention is comprised by this edge part 46a.

  About the structure of the other part of this organ fixing tool 40, it is the same as the organ fixing tool 10 of 1st Embodiment mentioned above. Accordingly, the same parts are denoted by the same reference numerals and the description thereof is omitted. With this configuration, when the state shown in FIGS. 25 and 26 is established, the suture thread 42 is positioned at the inner center of the rod-shaped portion 43, so that it is not entangled with the coil spring 14. Further, by pulling the suture thread 42 from the state of FIGS. 25 and 26 to the outside of the notch 46, the organ fixing device 40 can be easily brought into the state of FIGS. 23 and 24. For this reason, the operation of the organ fixing device 40 is smooth and reliable. Other functions and effects of the organ fixing device 40 are the same as those of the organ fixing device 10 described above.

  FIG. 28 shows an insertion tool 50 used in an organ fixing tool set including the organ fixing tool 40. This insertion tool 50 is comprised by the cylinder by which the hole 51 was provided in the inside, and the front-end | tip part 55 is cut | disconnected in the direction inclined with respect to an axial direction, and is formed sharply. And the notch part 54 is straightly formed toward the upper part side of the insertion tool 50 from the upper end part of opening of the front-end | tip part 55. As shown in FIG. When the organ fixing tool 40 is attached to the patient's body using the insertion tool 50, the locking part 41 is inserted into the notch 54 from the distal end 55 of the insertion tool 50 with the suture thread 42 exposed to the outside. Put in.

  Then, after the insertion tool 50 is punctured into the patient's body, the rod-shaped portion 43 is pushed out from the hole 51 of the insertion tool 50 with a pressing portion (not shown), and the insertion tool 50 is pulled out of the patient's body, whereby the organ The fixture 40 can be attached. At this time, the locking portion 41 comes out of the distal end portion 55 of the insertion tool 50 and remains in the stomach wall B. Thereafter, the suture thread 42 that is outside the patient's body is passed through the lumen of the cylindrical pressing portion 22, and the cylindrical pressing portion 22 is inserted into the patient's body. Then, by pulling the suture thread 42, the locking part 41 is pulled toward the notch part 54 and tilted in a direction perpendicular to the suture thread 42. This also makes the attachment of the organ fixing device 40 easy and reliable.

  FIG. 29 shows an extraction tool 60 used in an organ fixing tool set including the organ fixing tool 40. The cylindrical portion 62 provided in the extraction tool 60 is formed of a cylindrical body having no notch. Further, the inside of the cylindrical portion 62 communicates with the upper end portion of the grip portion 63, and the upper end portion of the grip portion 63 is open. About the structure of the other part of this extraction tool 60, it is the same as the extraction tool 30 mentioned above. Accordingly, the same parts are denoted by the same reference numerals and the description thereof is omitted. According to this, the structure of the extraction tool 60 becomes simple and manufacture becomes easy. When removing the organ fixing device 40, the same operation as described above is performed in a state where the suture thread 42 is passed from the distal end portion 32a of the cylindrical portion 62 to the upper end of the grasping portion 63. This also facilitates and surely removes the organ fixing device 40. About the other effect of this extractor 60, it is the same as that of the extractor 30 mentioned above.

  Moreover, the organ fixing device and the organ fixing device set according to the present invention are not limited to the above-described embodiments, and can be implemented with appropriate modifications. For example, in the first embodiment described above, the organ fixing tool set includes the organ fixing tool 10, the insertion tool 20, and the extraction tool 30, and in the second embodiment, the organ fixing tool set includes the organ fixing tool 40 and the insertion tool 30. Although comprised with the tool 50 and the extraction tool 60, these combinations can be changed suitably. In the above-described embodiment, the sutures 12 and 42 constituting the organ fixing devices 10 and 40 are made of nylon. However, the sutures are not limited to nylon, and are made of polyester, silk, polyolefin, or the like. Also good. Moreover, it can be used if it can be contracted by pulling the suture threads 12 and 42 against the locking portions 11 and 41 such as a cylindrical elastic member instead of the coil spring 14 of the locking portions 11 and 41. It is.

  Furthermore, although the front-end | tip parts 25 and 55 of the insertion tools 20 and 50 are formed sharply, as this insertion tool, it can also be comprised with the cylinder body whose front-end | tip part is not sharp. Moreover, the outer peripheral surface of the front-end | tip part 22a of the cylindrical extrusion part 22 can also be formed so that a lower part may become a small diameter gradually. According to this, the coil spring 14 is contracted so that the distal end portion 22a of the cylindrical push-out portion 22 opens between the suture thread 12 and the other end portion 13b side portion of the rod-shaped portion 13, and the locking portion 11 and the suture portion 11 are sewn. The operation when the thread 12 is formed into a T-shape is more reliable. 29 may be configured with only the cylindrical portion 62 by omitting the gripping portion 63.

  Furthermore, it can change suitably also about structures, such as a shape and material of an insertion tool or an extraction tool. For example, as a material constituting the insertion tools 20 and 50, nitinol, titanium or the like can be used in addition to stainless steel. Moreover, as a material which comprises the extraction tools 30 and 60, metal materials, such as nitinol and titanium, and resin materials, such as a polycarbonate, nylon, and a fluororesin other than stainless steel, can be used. Furthermore, the organ fixing device and the organ fixing set according to the present invention are not limited to the suture between the abdominal wall A and the stomach wall B, but can also be used for the suture between the body wall and the organ in other parts of the body such as the kidney and the bladder. Can do.

It is the front view which showed the state at the time of fixation in the organ fixing tool which concerns on 1st Embodiment of this invention. It is the front view which showed the organ fixing tool at the time of extraction from which the coil spring extended | stretched and the latching | locking part and the suture thread extended linearly. It is a partially cutaway sectional view showing an insertion tool. FIG. 4 is a partially cutaway cross-sectional view showing a state in which an organ fixing tool is attached to the insertion tool shown in FIG. 3. It is sectional drawing which showed the state which punctured the abdomen with the insertion tool shown in FIG. It is sectional drawing which showed the state which expanded the principal part of FIG. It is a partially notched cross-sectional view showing a state in which the locking portion is pushed out into the stomach wall by the cylindrical push-out portion. It is sectional drawing which showed the state which expanded the principal part of FIG. It is a partially cutaway sectional view showing a state where the locking part is inserted into the stomach wall. It is sectional drawing which showed the state which expanded the principal part of FIG. FIG. 6 is a partially cutaway cross-sectional view showing a state in which the suture thread is pulled and the locking portion and the suture thread are in a T-shape. It is sectional drawing which showed the state which expanded the principal part of FIG. FIG. 6 is a partially cutaway cross-sectional view showing a state in which the insertion tool is retracted to bring the locking portion into contact with the stomach wall. It is sectional drawing which showed the state which expanded the principal part of FIG. It is sectional drawing which showed the state which removed the insertion tool and engaged the latching | locking part with the stomach wall. It is sectional drawing which showed the state which fixed the stomach wall to the abdominal wall with the stitching | suture part. It is the top view which showed the state in which two stitching | suture parts were formed in the abdominal part. It is the front view which showed the extraction tool. It is a bottom view of FIG. It is sectional drawing which showed the state which positioned the extraction tool along the suture in the hole. It is sectional drawing which showed the state which made the latching | locking part and the suture thread into the linear state. It is sectional drawing which showed the state which put the latching | locking part in the inside of the extraction tool. It is the front view which showed the state at the time of fixation in the organ fixing tool which concerns on 2nd Embodiment of this invention. It is a top view of FIG. It is the front view which showed the organ fixing tool at the time of extraction from which the latching | locking part and the suture thread extended linearly. It is a side view of FIG. It is the side view which showed the rod-shaped part with which the organ fixing tool shown in FIG. 23 is provided. It is the perspective view which showed the insertion tool used with the organ fixing tool set which concerns on 2nd Embodiment. It is the front view which showed the extraction tool used with the organ fixing tool set which concerns on 2nd Embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 ... Organ fixing tool, 11 ... Locking part, 12 ... Suture thread, 13 ... Bar-shaped part, 13a, 14a ... One end part, 13b, 14b ... Other end part, 14 ... Coil spring, 15 ... Connection part, 20, 40 DESCRIPTION OF SYMBOLS ... Inserting tool, 21 ... Insertion puncture needle, 22 ... Cylindrical extrusion part, 22a, 25, 32a, 45, 52a ... Tip part, 23, 27 ... Insertion hole, 29 ... Hole part, 30, 50 ... Extraction tool, 31, 41 ... hole, 32,52 ... cylindrical part, 33,53 ... gripping part, 34,46 ... notch, 34a ... spiral notch, 46a ... end, A ... abdominal wall, B ... gastric wall.

Claims (8)

A locking portion installed on the inner wall side of a predetermined organ in the patient's body, and connected to the locking portion and through a hole formed in the patient's organ and body wall from the locking portion. An organ fixing tool for fixing the organ to the body wall, comprising a suture extending outside the body,
The locking portion is constituted by a rod-shaped portion and an elastic elastic member fixed to one end portion side portion of the rod-shaped portion in a state of covering the outer peripheral surface of the rod-shaped portion, and the suture thread of the rod-shaped portion Exposed from the substantially central portion in the axial direction and extended from the other end of the elastic elastic member to the outside,
When the suture is pulled away from the other end side portion of the rod-shaped portion and the suture is pulled, the elastic elastic member contracts, and the other end of the elastic elastic member is in the axial direction of the rod-shaped portion. When the release force of the suture is released, the elastic elastic member expands and the other end of the elastic elastic member is the other end of the rod-like part. An organ fixing tool characterized by being positioned on the side of the head.   The organ fixing tool according to claim 1, wherein a distal end portion of the suture thread is fixed to a substantially central portion in the axial direction of the rod-shaped portion.   The rod-shaped portion of the locking portion is formed of a cylindrical body, and a notch portion through which the suture thread can pass from the substantially central portion in the axial direction to the other end portion of the cylindrical body is formed from the inner peripheral surface of the cylindrical body to the outer peripheral surface. The organ fixing tool according to claim 1, which is provided so as to penetrate through the organ.   An engagement portion is provided at a distal end portion of the suture thread, and the suture thread of the rod-shaped member is engaged with the engagement portion engaged with an opening edge of one end portion of the rod-shaped portion formed of the cylindrical body. The organ fixing tool according to claim 3, wherein the organ fixing tool is passed through the inside of the one end side portion and extended outward from the opening of the notch or the other end.   An organ fixing device set comprising the organ fixing device according to any one of claims 1 to 4 and an insertion device used when attaching the organ fixing device to the organ, wherein the insertion device is After being inserted into the patient's body in a state in which the locking portion of the organ fixing device is housed inside, the locking portion can be discharged into the organ and the suture thread is placed on the other end side of the rod-shaped portion An organ fixing device set constituted by a member that can be removed from the patient in a state where the suturing device and the locking portion are formed in a T shape by applying a force so as to be away from the portion.   The insertion tool is inserted into the insertion puncture needle in a state where the suture thread is inserted into the insertion puncture needle that can accommodate the locking portion, and the engagement is accommodated in the insertion puncture needle. The organ fixing device set according to claim 5, wherein the stop portion is constituted by a cylindrical push-out portion that can be pushed out from a distal end opening of the insertion puncture needle.   An organ fixing device set comprising the organ fixing device according to any one of claims 1 to 4 and an extraction device used when removing the organ fixing device from the organ, wherein the extraction device is It is composed of a cylindrical body that can be inserted into the suture thread and the locking portion, and is inserted into the patient's hole while accommodating the suture thread, and the locking portion is separated from the inner wall of the organ. An organ fixing in which the elastic elastic member is extended to linearly form the locking portion and the suture, and then the proximal portion of the suture is pulled to accommodate the locking portion inside. Ingredient set.   The extraction tool is composed of a cylindrical portion and a grip portion provided at the proximal end portion of the cylindrical portion, and has a spiral shape extending in the axial direction while rotating in the circumferential direction from the distal end portion to the proximal end portion of the cylindrical portion. The organ fixing device set according to claim 7, wherein the notch portion is formed so as to penetrate between the outer peripheral surface and the inner peripheral surface of the cylindrical portion.

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