JP2007105182A - Blood vessel holder - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To eliminate any possibility of damaging intima of a blood vessel by holding the blood vessel using a suction force by a negative pressure, hold an anastomotic site of the blood vessel in an opened state, surely and easily anastomose blood vessels to each other, and suitably apply to a cut-back graft particuarly in a coronary-artery bypass surgery. <P>SOLUTION: This blood vessel holder includes a blood vessel holding member 1 holding the blood vessel in a lumen, and a suction force transmission means 2 communicated with the lumen, the blood vessel holding member 1 has one end 11a having an approximately C-cross-section tubular shape with a slit 112 and the other end 11b having a planar cross section or an approximately C-shape with a slit gentler than the said C-cross-section, and the slit 112 is connected from one end to the other end and the slit width has a part 112b expanding to the other end direction. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a blood vessel gripping tool. More specifically, the present invention relates to a blood vessel gripper capable of gripping a blood vessel with an anastomosis opening opened by negative pressure when performing coronary artery bypass surgery.

  Treatment methods for ischemic heart diseases such as angina pectoris and myocardial infarction include percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG). PTCA, which is less invasive, is the first choice. However, CABG is preferably selected for patients with a left main coronary artery lesion, patients with three major branch lesions, patients with frequent occurrence of restenosis after PTCA treatment, and the like. Currently, CABG is performed about 15,000 cases a year in Japan and about 10 times in Europe and America.

  CABG is an operation performed by a surgeon, and uses a part of an autologous blood vessel such as the saphenous vein and the internal thoracic artery as a bypass blood vessel (graft) under general anesthesia. Specifically, this is an operation in which one end of the graft is sutured to the aorta, and the other end is sutured to a portion ahead of the stenosis site of the coronary artery. After surgery, blood bypasses the stenosis and flows from the aorta to the myocardium through the newly grafted graft.

  When the graft is anastomosed to the aorta or coronary artery, it is necessary to hold the graft with the anastomosis opening opened, and an insulator or the like is conventionally used. However, gripping with an insulator or the like damages the intima of the bypass blood vessel. This is due to mechanical damage due to the tip of the insulator contacting the intima. Many insulators and the like are made of a hard material such as metal, and may be provided with uneven processing for preventing slipping, which may further damage the intima. When the intima of the bypass blood vessel is damaged, thrombus adhesion or intimal thickening occurs at the damaged site, which increases the possibility of causing restenosis. When restenosis occurs, re-operation is necessary, increasing the burden on the patient. In addition, when only a part of the anastomosis is grasped with a lever or the like, the anastomosis of the graft cannot be greatly opened. In addition, there are currently no devices that open the anastomosis without grasping the intima.

  As a blood vessel gripping means that replaces a conventional insulator or the like, there has been an invention in which a graft is sucked and gripped by a gripping portion formed of a circular hollow tube having a plurality of suction ports provided on an inner wall (Patent Document 1). An invention of a blood vessel gripping tool including a flexible tubular gripping portion has also been made (Patent Document 2).

JP 2002-360593 A JP 2004-167214 A

  However, since the grasping portion of the blood vessel grasping tool described in Patent Document 1 has a tubular shape, when the graft is sucked and grasped, the contact area between the grasping portion and the graft is small, and the graft is separated from the grasping portion with a slight force during the operation. There is a fear. That is, in order to obtain sufficient operability while holding the graft, the contact area between the holding portion and the graft must be increased. In addition, when grasping a blood vessel having the same diameter as the inner diameter of the grasping portion, the break of the grasping portion must be opened widely, and the grasping portion must be sufficiently flexible in order to open the grasping portion large. It must be made of a material with However, when such a soft flexible material is used for the grip portion, the grip portion may be crushed by the suction force, and the bypass blood vessel may not be sucked and gripped. The blood vessel gripping tool described in Patent Document 1 has no means for preventing the gripping portion from being crushed. Furthermore, the graft anastomosis is often cut back (incision is made in the graft). However, when the graft is to be grasped by the blood vessel grasping means described in Patent Document 1, it is separated from the tip of the anastomosis. It will be gripped at the position. In that case, there is a possibility that the anastomosis opening may not be greatly opened.

  Since the blood vessel gripping tool of the present invention can grip a blood vessel by using a suction force due to negative pressure, there is no possibility of causing intimal damage which is a problem in the conventional method using an insulator or the like. Since the anastomosis opening can be grasped in an open state, anastomosis between blood vessels can be performed reliably and easily. In particular, an object of the blood vessel gripping tool of the present invention is to be suitably used for a graft cut back in coronary artery bypass surgery.

  The inventors of the present invention have arrived at the present invention as a result of intensive studies to solve the above-mentioned problems. That is, the present invention is a blood vessel gripping device including a blood vessel gripping member that grips a blood vessel in a lumen, and a suction force transmitting means that communicates with the lumen, wherein the blood vessel gripping member has a transverse end with a slit. The surface is a substantially C-shaped tube, and the other end has a cross-sectional plane or a substantially C-shape having a slit that is looser than the C-shaped cross section. Is a blood vessel gripping tool having a portion whose width extends in the direction of the other end. In addition, the blood vessel gripping member includes a grip portion in which a portion including at least a communication portion with the suction force transmission means is formed in an inner wall in a recess, a perforated sheet having a plurality of holes covered with the recess, A mesh-like sheet interposed in a space defined between the recess and the sheet. Furthermore, the said recessed part is formed in the whole inner wall except the adjacent part with the one end and other end of the blood vessel holding member, and the adjacent part with a slit. Further, the suction force transmitting means includes a suction tube. In addition, a connector is provided at the proximal end of the suction tube.

  According to the blood vessel gripping tool of the present invention, since the blood vessel can be gripped by using the suction force due to the negative pressure, there is no possibility of causing intimal damage which is a problem in the conventional method using an insulator or the like. . In addition, since the blood vessel anastomosis opening can be grasped in an open state, the blood vessel anastomosis can be reliably and easily performed. The blood vessel grasper of the present invention can be suitably used for coronary artery bypass surgery. In particular, it can be suitably used for grafts cut back in coronary artery bypass surgery.

Further, according to the invention according to claim 1, the graft anastomosis is often cut back (incision is made with respect to the graft), and the graft anastomosis is connected from the cut end to the tip. Since the incision becomes wider, the shape of the blood vessel gripping member according to claim 1 is the same as the shape of the graft, so that the graft and the blood vessel gripping member are stabilized by wider contact, and the graft anastomosis is greatly opened. it can.
Further, according to the second aspect of the invention, when negative pressure (or suction pressure) is applied, the effective sheet closely contacts the concave portion of the blood vessel gripping member (the defined concave portion is crushed), and the negative portion is uniformly applied to the entire concave portion. There is a risk that pressure cannot be applied. The mesh sheet interposed in the space defined between the recess and the effective sheet can prevent the effective sheet from coming into contact with the recess and uniformly apply negative pressure to the entire recess. Thereby, the graft can be sucked and held uniformly.
Furthermore, according to the third aspect of the present invention, the graft can be sucked and held over a wide range of the blood vessel gripping member by forming the blood vessel gripping member concave portion on the entire inner wall.
In addition, according to the fourth and fifth aspects of the present invention, by including the suction tube and the connector, it can be easily connected to the suction machine.

Next, embodiments of the present invention will be described with reference to the drawings.
1 is a front view showing an embodiment of the present invention, FIG. 2 is a left side view of FIG. 1, FIG. 3 is a right side view of FIG. 1, and FIG. 5 is an enlarged view of the portion of FIG. 4, FIG. 6 is an enlarged sectional view taken along line BB of FIG. 1, and FIG. 7 is an enlarged sectional view taken along line CC of FIG. 8 to 13 are explanatory diagrams of coronary artery bypass surgery using the blood vessel gripping tool of the present invention.

  As shown in FIGS. 1 to 7, the blood vessel gripping tool of the present invention has a slit 112 connected from one end 11 a to the other end 11 b, and has a flexible gripping part 11 whose diameter can be easily expanded. The blood vessel gripping member 1 includes the suction tube 2 that is connected to the side wall of the gripping portion 11 and communicates with the lumen 111 of the gripping portion 11. In addition, the inner wall of the grip portion 11 is formed with a concave portion 114 including a communication port 113 that communicates at least the lumen 21 of the suction tube 2 and the lumen 111 of the grip portion 11. The recess 114 is covered with a perforated sheet 13, and a mesh-like mesh sheet 14 is interposed between the recess 114 and the perforated sheet 13.

  As shown in FIGS. 1, 2, and 3, the blood vessel gripping member 1 includes a grip portion 11 as a portion that functions as a blood vessel gripping means. The gripping part 11 is a flexible member having a slit 112 comprising a slit 112a having a constant width on one end 11a side and a slit 112b widening on the other end 11b side while being connected to the side wall from one end 11a to the other end 11b. There is a lumen 111 for softly grasping a blood vessel. In this lumen 111, the slit 112a portion on the one end 11a side has a substantially C-shaped cross section (see FIG. 5), and the slit 112b portion on the other end 11b side has a cross section plane. Alternatively, it has a substantially C shape that is looser than the C shape in cross section (see FIG. 6).

The grip portion 11 can be easily expanded in diameter by the slit 112, and before and after the blood vessel anastomosis, the slit 112 is opened to allow the blood vessel to be taken in and out of the grip portion 11.
In addition, the gripping portion 11 can securely grip the graft by the substantially C-shaped cross section of the slit 112a portion, and the graft has a substantially C-shape that is looser than the cross-sectional C shape of the slit 112b portion. The cutback portion can also be securely gripped.

  The slit may be provided at a position substantially perpendicular to the attachment angle of the suction tube 2 or may be provided at a symmetrical position. By doing so, when the suction tube 2 is pulled, it becomes easy to remove the grip portion 11 from the blood vessel.

  The side wall of the gripping part 11 is provided with a communication port 113 that serves as a communication part with the lumen 21 of the suction tube 2. The communication port 113 projects from the side wall of the gripping part 11 and is connected to the suction tube connecting part 12. Is provided. The suction tube 2 is connected to the suction tube connection portion 12.

  The gripping part 11 is a tubular member generally formed of a soft flexible resin such as polyurethane, polyethylene, silicone, etc. As shown in FIGS. 4 to 7, the inner wall of the gripping part 11 has at least a communication port 113. The part to be included is formed in the recess 114. The recess 114 is covered with a perforated sheet 13 having a plurality of holes 131, and a mesh-shaped sheet 14 is interposed in a space defined between the recess 114 and the perforated sheet 13. Yes. The length and inner diameter of the gripping part 11 may be appropriately selected depending on the diameter of the blood vessel used as a bypass. For example, a length of about 10 to 15 mm and an inner diameter of about 2 mm, 3 mm, 4 mm, and 5 mm can be adopted. Yes, one having the same diameter as the graft to be used can be selected.

  The recess 114 is preferably formed large so that the attachment port to the anastomosis site of the blood vessel serving as a bypass gripped by the blood vessel gripping tool is opened widely, and the suction force of the suction tube 2 is applied to substantially the entire blood vessel. In order to extend, it is preferably formed on the entire inner wall excluding the adjacent portion 115 to the distal end and the proximal end of the grip portion 11 and the adjacent portion 116 to the slit 112.

  The perforated sheet 13 is bonded to the inner wall of the grip portion 11 with a portion adjacent to the recess 114 as a margin, and in FIGS. 5, 6, and 7, the adjacent portion 115 between the distal end and the base end of the grip portion 11. And the adjacent part 116 with the slit 112 becomes a margin. The diameter and the number of the holes 131 of the perforated sheet are not particularly limited as long as the suction force is widely transmitted to the lumen 111 through the holes 131 so that the blood vessel can be gripped softly and surely. About 2 mm and a number of about 5 to 10 are appropriate. The material for forming the perforated sheet 13 is not particularly limited as long as it can be bonded or welded to the grip portion 11, but the same material as the material for forming the grip portion 11 is preferable.

The mesh sheet 14 is formed of a material that can be bonded to the gripping portion 11. For example, as illustrated in FIG. 5, the stepped portion 117 provided in the portion adjacent to the paste margin 116 is used as a margin for the gripping portion 11. Although it may be bonded or welded, it may not be bonded to the grip portion 11 but may be merely interposed in a space formed between the recess 114 and the perforated sheet 13 (in this case, the forming material is limited to the forming material of the grip portion 11) Not)
For example, the mesh sheet 14 is formed of a flexible flexible resin such as polyurethane, polyethylene, polyester, polypropylene, polyamide, soft polyvinyl chloride, or fluorine resin, and the size of the mesh is larger than the hole 131 of the effective sheet 13. And a size that does not block the communication port 113 is preferable.

  When sucking and grasping a blood vessel, the perforated sheet 13 may be in close contact with the recess 114 due to the negative pressure generated between the lumen 111 and the perforated sheet 13. In particular, when the perforated sheet 13 is in close contact with the recess 114 so as to block the communication port 113, the suction force is transmitted only through the hole 131 of the perforated sheet 13 portion corresponding to the communication port 113 portion. There is a risk that a force cannot be obtained and problems such as the opening of the blood vessel anastomosis (311 in FIG. 8) may not occur. The mesh sheet 14 prevents the perforated sheet 13 from coming into direct contact with the recess 114, and allows the suction force to be transmitted to the holes 131 of the perforated sheet 13 portion not corresponding to the communicating hole 113 portion via the mesh. It is. And according to said structure which consists of the recessed part 114, the perforated sheet | seat 13, and the mesh-like sheet | seat 14, in the state (it has not yet been in the holding state) which hold | maintained the blood vessel (3 of FIG. 9) in the lumen 111, The suction force transmitted from the suction tube 2 spreads widely in the lumen 111. That is, in this configuration, the wall of the lumen 111 of the grasping portion 11 is the inner surface of the perforated sheet 13, and the suction tube 2 is held in a state where a blood vessel (see 3 in FIG. 10) is held in the lumen 111. The suction force transmitted through the lumen 21 from the communication port 113 into the concave portion 114 of the grasping portion 11 passes through the mesh sheet 14 and through the hole 131 of the perforated sheet 13, and is widely spread in the lumen 111. Go around. Then, the blood vessel is uniformly expanded by the transmitted suction force and is adsorbed on the inner surface of the perforated sheet 13 and is held by the holding portion 11.

  The suction tube 2 is made of a flexible resin such as polyurethane, polyethylene, polyester, polypropylene, polyamide, soft polyvinyl chloride, fluorine resin, or silicone. The distal end of the suction tube 2 is connected to the suction tube connection portion 12 of the blood vessel gripping member 1, and a connector 22 for connecting to a suction machine (not shown) is preferably provided at the proximal end. . As a material for forming the connector 22, a synthetic resin such as polypropylene, ABS resin, polyvinyl chloride, polyethylene, polyethylene terephthalate, or polycarbonate can be used. A metal rod having pseudoelasticity may be embedded in the wall of the suction tube. By doing so, it is possible to perform an operation with the suction tube, and it is possible to fix the suction tube in a bent shape so as not to disturb the operation.

Next, coronary artery bypass surgery using the blood vessel gripping tool of the present invention will be described with reference to FIGS.
First, after surgically incising the sternum to confirm the heart, a blood vessel (graft 3) serving as a bypass is prepared, and an incision 31 is made (cutback). As shown in FIG. 9, the graft 3 is passed through the blood vessel gripping tool GH. Using a suction machine (not shown) connected to the suction tube 2, negative pressure is applied to the lumen 111 of the grasping portion 11. Then, as shown in FIG. 10, the outer wall of the graft 3 is sucked by the negative pressure, and the anastomosis opening 311 is opened and firmly held. As shown in FIG. 11, the coronary artery is incised (incision 41), and the three to five needle suture thread 6 is passed through the heel portion (single needle continuous parachute anastomosis). Next, the blood vessel gripping tool GH is released, and the graft 3 is brought close to the coronary artery 4 while applying tension to the suture thread 6. As it is, the anastomosis is continuously advanced, and the suture is finished (see FIG. 13).

It is a front view which shows one Example of this invention. It is a left view of FIG. It is a right view of FIG. It is the sectional view on the AA line of FIG. It is a principal part enlarged view of FIG. It is a BB line expanded sectional view of Drawing 1. FIG. 3 is an enlarged sectional view taken along the line CC in FIG. 2. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention. It is explanatory drawing of the coronary artery bypass surgery using the blood vessel gripping tool of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Blood vessel gripping member 11 Gripping part 111 Lumen 112 Slit 113 Communication port 114 Recessed part 115 Adjacent part with the front end and base end of the gripping part (margin)
116 Adjacent part to the slit (margin)
117 Steps (Margin)
12 Suction tube connecting part 13 Perforated sheet 131 Hole 14 Mesh-like sheet 2 Suction tube 21 Lumen 22 Connector 3 Graft 31 Cut 311 Anastomosis 4 Coronary artery 41 Cut 5 Suture needle 6 Suture thread GH Blood vessel gripping tool

Claims (5)

A blood vessel gripping tool including a blood vessel gripping member for gripping a blood vessel in a lumen and suction force transmitting means communicating with the lumen, wherein the blood vessel gripping member has a substantially C-shaped cross section with one end having a slit. The other end is a substantially C-shape having a flat cross-sectional plane or a slit that is looser than the C-shaped cross-section. The slit is connected from one end to the other end, and the width of the slit is the other end. A blood vessel gripping device having a portion extending in a direction. The blood vessel gripping member includes a grip portion in which a portion including at least a communication portion with the suction force transmitting means is formed in an inner wall in a recess, a perforated sheet having a plurality of holes covered with the recess, and the recess The blood vessel grasping device according to claim 1, further comprising a mesh sheet interposed in a space defined between the sheet and the sheet. The blood vessel gripping device according to claim 2, wherein the concave portion is formed on the entire inner wall excluding a portion adjacent to one end and the other end of the blood vessel gripping member and a portion adjacent to the slit. The blood vessel gripping device according to claim 1 or 2, wherein the suction force transmitting means includes a suction tube. The blood vessel gripping device according to claim 4, wherein a connector is provided at a proximal end of the suction tube.

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