JP2007068858A - Forceps - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To close the incised region of an internal organ or an organ in such a manner that body fluids can be discharged. <P>SOLUTION: In forceps, a pair of operation levers 2a and 2b and a pair of holding levers 3a and 3b are protruded in directions different from each other around a pivot 1. The incised region of the internal organ, the organ, or the like is held as it remains sandwiched by closing the pair of holding levers through the use of the urging force of an elastomer 4 which is provided in a prescribed place, and opened by opening the holding levers through the operation of the pair of operation levers. Recesses 14a and 14b are formed in the opposed parts of the pair of holding levers. When the holding levers are closed, the incises region is closed by using the opposed parts, and a place, into which a tube is inserted, of the incised region is closed as it remains fitted in the recess. This can prevent intraperitoneal contamination from being caused by the body fluids, and can prevent an increase in the internal pressure of the internal organ, the organ, or the like. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a medical forceps for closing an incision by an operation of an organ or an organ.

  For surgical procedures that require excision of the bile ducts such as the common bile duct and the common hepatic duct, the bile duct and digestive tract at the excision margin are anastomosed after the process of excision of the lesion is completed.

  For example, pancreatoduodenectomy (or total gastric pylorus-preserving pancreaticoduodenectomy) is performed for diseases of pancreatic cancer, duodenal papilla cancer, lower bile duct cancer, duodenal cancer, mass-forming pancreatitis, intraductal papillary mucinous tumor Cholangiotomy is performed for biliary pancreatic duct confluence, biliary dilatation, and early gallbladder cancer, and right hepatectomy or left hepatectomy is performed for hilar cholangiocarcinoma. When such an operation method is selected, it is necessary to close the cut-off end of the bile duct in order to prevent intra-abdominal contamination due to bile outflow from the bile duct resection to the reconstruction.

  Conventionally, forceps called bulldog forceps are used to close the cut end of the bile duct. In this bulldog forceps, a pair of operating levers and a pair of gripping levers project in different directions around the pivot axis, and the pair of gripping levers are closed by an urging force of an elastic body provided at a predetermined location. The incision part of the bile duct is opened by the operation of a pair of operation levers and the incision part is opened to open the incision part. It pinches and stops the outflow of bile completely.

  The closing time of the bile duct with the bulldog forceps varies from 2 to 5 hours depending on the surgical procedure. During this time, bile secretion continues in the liver, resulting in an increase in intra-bile duct pressure. It is thought that the increase in intra-bile duct pressure becomes a factor of retrograde infection as well as physical cholangitis, and cholangitis is started during the operation and becomes an exacerbation factor of postoperative liver dysfunction.

  In order to prevent postoperative liver dysfunction caused by increased intra-biliary pressure during surgery, bile should be continuously drained from the cut end of the bile duct during surgery. However, there has been no method for discharging the abdominal cavity without contaminating it.

  Accordingly, an object of the present invention is to provide a forceps that can realize such a method.

  In order to solve the above problems, the invention according to claim 1 is characterized in that the pair of operation levers (2a, 2b) and the pair of grip levers (3a, 3b) protrude in different directions around the pivot (1), The pair of grip levers (3a, 3b) are closed by the urging force of the elastic body (4) provided at a predetermined location to sandwich the incision (A) of the organ, organ, etc., and the pair of operation levers (2a, 2b) In the forceps in which the barb levers (3a, 3b) are opened by the operation to open the incision (A), a recess (in the one or both of the opposed parts of the pair of barb levers (3a, 3b) ( 14a, 14b) is formed, and when the barb lever (3a, 3b) is closed, the incision (A) is closed by the facing portion, and the tube (18) of the incision (A) is inserted. Placed in the recess (14a, 14b) To adopt a forceps was to be closed in the state I do.

  The invention according to claim 2 is the forceps according to claim 1, except that the concave portions (14a, 14b) are excluded from the opposing portions of the pair of grip levers (3a, 3b). 12) is adopted.

  According to a third aspect of the present invention, in the forceps for use in the first or second aspect, a pinching force adjusting means (9) for adjusting a pinching force of the pair of grip levers (3a, 3b) is provided. Adopt forceps.

The invention according to claim 4 is the forceps according to any one of claims 1 to 3, wherein a convex portion is provided on a side opposite to the concave portion (14a, 14b) of the grip lever (3a, 3b). A forceps having (19a, 19b) formed therein.
Is adopted.

  According to the first aspect of the present invention, the pair of operation levers (2a, 2b) and the pair of grip levers (3a, 3b) project in different directions around the pivot (1) and are provided at predetermined positions. The pair of grip levers (3a, 3b) are closed by the biasing force of the elastic body (4), the incision (A) of the organ, organ, etc. is sandwiched, and the handle is operated by operating the pair of control levers (2a, 2b). In the forceps in which the levers (3a, 3b) are opened to open the incision (A), the recesses (14a, 14b) are formed in one or both of the opposing portions of the pair of grip levers (3a, 3b). When the barb lever (3a, 3b) is formed, the incision part (A) is closed by the facing part, and the part of the incision part (A) where the tube (18) is inserted is Closed in a state of being fitted in the recess (14a, 14b) Because of the forceps, the incision (A) of the organ, organ, etc. can be closed to prevent intra-abdominal contamination due to the outflow of bodily fluid from the inside of the organ, organ, etc. Of course, the body fluid generated inside the organ, organ, etc. can be discharged from the tube (18) to the outside, which is caused by the increase in internal pressure of the organ, organ, etc. during the operation. Various functional disorders after surgery can be prevented.

  The invention according to claim 2 is the forceps according to claim 1, except that the concave portions (14a, 14b) are excluded from the opposing portions of the pair of grip levers (3a, 3b). Since the forceps 12) are formed, the incision (A) of the organ, organ, etc. can be properly closed.

  According to a third aspect of the present invention, in the forceps for use in the first or second aspect, a pinching force adjusting means (9) for adjusting a pinching force of the pair of grip levers (3a, 3b) is provided. Therefore, the forceps levers (3a, 3b) can adjust the force to pinch the incision (A) of the organ, organ, etc., and can close the incision (A) with an appropriate force.

  The invention according to claim 4 is the forceps according to any one of claims 1 to 3, wherein a convex portion is provided on a side opposite to the concave portion (14a, 14b) of the grip lever (3a, 3b). Since the forceps are characterized in that (19a, 19b) are formed, the operator can confirm the position of the recess (14a, 14b) while looking at the position of the protrusion (19a, 19b), and the tube (18) can be accurately arranged at the positions of the recesses (14a, 14b).

  The best mode for carrying out the invention will be described below with reference to the drawings.

  As shown in FIGS. 1 and 2, this forceps is called a bulldog forceps, and a pair of operating levers 2a and 2b and a pair of grip levers 3a and 3b are arranged in different directions around a pivot 1. The pair of barb levers 3a and 3b are closed by an urging force of a compression coil spring 4 which is an elastic body provided in a predetermined position, and closes an incision part of an organ, organ, etc., and is operated by a pair of operation levers 2a and 2b The barbs 3a and 3b are opened to open the incision.

  One operation lever 2a of the pair of operation levers 2a and 2b is integrated as one lever member together with one of the pair of levers 3a and 3b. The other operation lever 2b is integrated with the other barb lever 3b as another lever member.

  As shown in FIGS. 2 and 3 (A) and 3 (B), hinge pieces 5 and 6 are formed at substantially the center portions of the two lever members, respectively, and the two lever members are vertically stacked. The two hinge pieces 5 and 6 are overlapped on the left and right, and the pin which is the pivot 1 is inserted between the hinge pieces 5 and 6. A disk 7 is fixed to the tip of the pin by caulking or the like, and two lever members are sandwiched between the disk 7 and the head 1 a of the pivot 1. As a result, the two lever members can rotate about the pivot 1 as a fulcrum.

  Each of the operation levers 2a and 2b is provided with a finger hook piece 8 for the operator to put a finger on. As shown in FIG. 1, a compression coil spring 4 that is an elastic body is interposed between the pair of operation levers 2a and 2b. The pair of operating levers 2a and 2b expands with the pivot 1 as a fulcrum by the urging force of the compression coil spring 4, and the pair of grip levers 3a and 3b closes with the pivot 1 as a fulcrum. Conversely, when the pair of operating levers 2a and 2b are closed against the urging force of the compression coil spring 4, the pair of grip levers 3a and 3b are expanded.

  The operation levers 2a and 2b are provided with pinching force adjusting means for adjusting the pinching force between the pair of gripping levers 3a and 3b by adjusting the biasing force of the compression coil spring 4. As shown in FIG. 1, the clamping force adjusting means includes a nut 9 that holds one end of the compression coil spring 4 and a screw rod 10 that is screwed into the nut 9. The screw rod 10 is fixed to one operation lever 2b, and projects through the compression coil spring 4 toward the other operation lever 2a. The nut 9 can be screwed back and forth on the screw rod 10, and the operator can screw the nut 9 back and forth on the screw rod 10 to change the length of the compression coil spring 4. The force to pinch an incision such as an organ is adjusted.

  As shown in FIG. 2, the grip levers 3 a and 3 b are curved as necessary to facilitate gripping the incision portion. In addition, saw blade-like projections 11 and 12 are formed at opposing portions of the pair of gripping levers 3a and 3b. The incision is properly closed by the engagement of the saw blade projections 11 and 12. In order to prevent the saw blade projections 11 and 12 from excessively biting into organs, organs, etc., as shown in FIG. 4, a stopper lever protruding toward the other barb lever 3b is provided on one barb lever 3a. 13 is provided. The stopper 13 is specifically a pin, which is embedded and fixed in one holding lever 3a. When the other grip lever 3b hits the tip of the stopper pin, the pair of grip levers 3a and 3b are closed with a proper interval as shown in FIG.

  As shown in FIG. 1, concave portions 14 a and 14 b are formed at the opposing portions of the pair of grip levers 3 a and 3 b so as to face each other. The recesses 14a and 14b may have a shape obtained by dividing a circular shape, a polygonal shape, or the like into two parts, but are preferably formed into a shape obtained by dividing a long hole into two parts on the major axis. The long hole is formed, for example, so that the short axis diameter is about 6 mm.

  As shown in FIG. 5, the forceps are attached to a stump A that is an incision portion of the bile duct. In FIG. 5, reference numeral 15 indicates the common hepatic duct leading to the liver, and reference numeral 16 indicates the common bile duct leading to the gallbladder 17 and leading to the duodenum. When the clamp levers 3a and 3b of the forceps sandwich the stump A of the total hepatic duct 15, the stump A is closed by the facing portion of the grip levers 3a and 3b. Further, a 14 Fr nelaton catheter 18 as a tube is inserted from the stump A into the total hepatic duct 15. As shown in FIG. 6, the portion of the stump A where the nelaton catheter 18 is inserted is closed in a state of being fitted in the recesses 14a and 14b of the grip levers 3a and 3b. This prevents intra-abdominal contamination due to bile outflow from the liver during surgery. In addition, bile produced in the liver during the operation is discharged from the nelaton catheter 18 to the outside of the abdominal cavity, preventing an increase in the internal pressure of the biliary tract and preventing various functional disorders after the operation.

  As shown in FIGS. 1 and 6, convex portions 19a and 19b are formed on the side opposite to the concave portions 14a and 14b in the tail levers 3a and 3b. The convex portions 19a and 19b are preferably formed as curved protrusions following the curved arcs of the concave portions 14a and 14b. The surgeon can confirm the positions of the recesses 14a and 14b while observing the positions of the projections 19a and 19b, whereby the neraton catheter 18 can be gripped by the levers 3a and 3b.

  Next, the operation of the forceps having the above configuration will be described.

(1) The case where pancreaticoduodenectomy is performed will be described as an example. As shown in FIG. 5, the common hepatic duct 15 of the bile duct is cut off and the duodenum side is ligated with 1-0 silk thread 20.
In addition, a small incision is made in the bile duct and the stored bile is sucked as much as possible.

(2) A 14 Fr nelaton catheter 18 is inserted into the total hepatic duct 15 on the liver side.

(3) Turn the nut 9 of the forceps to adjust the length of the compression coil spring 4 and adjust the clamping force of the grip levers 3a and 3b.

(4) The operator holds the forceps operating levers 2a and 2b and presses them against the urging force of the compression coil spring 4 to open the barb levers 3a and 3b.

(5) The bile duct stump A and the nelaton catheter 18 are guided between the open handle levers 3a and 3b, and the operation levers 2a and 2b are opened. At this time, the nelaton catheter 18 is aligned with the recesses 14a and 14b while registering the positions of the recesses 14a and 14b at the positions of the projections 19a and 19b. Simultaneously with the opening of the operation levers 2a and 2b, the barb levers 3a and 3b sandwich the bile duct wall at the stump A and the nelaton catheter 18 together by the biasing force of the compression coil spring 4. As shown in FIG. 6, the stump A of the bile duct is closed by saw blade-like projections 11 and 12 at the opposite portions of the barbs 3a and 3b, and the portion of the stump A where the nelaton catheter 18 is inserted is a recess. It is sealed without gaps in the state of being fitted in 14a, 14b. The nelaton catheter 18 is kept hollow in the recesses 14a and 14b, and the bile produced in the liver is discharged out of the body by guiding the nelaton catheter 18 outside the surgical field during the operation. For example, the nelaton catheter 18 is guided outside the body, and a plastic bag or the like (not shown) is connected to the tip. As a result, the operative field is not contaminated with bile, and the bile duct pressure is kept normal.

  The present invention is not limited to the above embodiment. For example, in the above embodiment, the case where the bile duct is closed has been described. However, the present invention can also be applied to closing other organs and incisions of organs. In the above embodiment, the recesses are formed in both the holding levers. However, it is also possible to form the recesses only in one of the holding levers.

It is a front view which shows the forceps which concern on this invention. It is a top view of the forceps shown in FIG. FIG. 2 is a partial cutaway view showing the vicinity of the pivot of the forceps shown in FIG. 1, wherein (A) shows an upper lever member and (B) shows a lower lever member. FIG. 2 is a partial cutaway view in the vicinity of a pivot of the forceps shown in FIG. 1. It is explanatory drawing of the surgery example using the forceps shown in FIG. It is the elements on larger scale which show the state which pinched the bile duct with the forceps shown in FIG. 1 with the tube.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Pivot 2a, 2b ... Operation lever 3a, 3b ... Tail lever 4 ... Compression coil spring 9 ... Nut 11, 12 ... Saw blade-like protrusion 14a, 14b ... Concave part 18 ... Neraton catheter 19a, 19b ... Convex part A ... Stump

Claims (4)

  A pair of control levers and a pair of gripping levers project in different directions around the pivot axis, and the pair of gripping levers close by the urging force of an elastic body provided at a predetermined location to open an incision part such as an organ or organ. In the forceps in which the handle lever is opened by opening and closing the incision portion by operating the pair of operation levers, a recess is formed in one or both of the opposing portions of the pair of handle levers, A forceps characterized in that when closed, the incision portion is closed by the facing portion, and the portion of the incision portion into which the tube is inserted is closed in the recessed portion.   2. The forceps according to claim 1, wherein a saw blade-like protrusion is formed at an opposing portion of the pair of grip levers except for the concave portion.   The forceps according to claim 1 or 2, further comprising a pinching force adjusting means for adjusting a pinching force between the pair of grip levers.   4. The forceps according to claim 1, wherein a convex portion is formed on a side opposite to the concave portion of the barb lever.

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