JP2007252408A - Suturing instrument for living body - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To improve reliability of work of holding a suture in a living body in a suturing instrument for a living body. <P>SOLUTION: The suturing instrument 10 for a living body includes a suture inserting cylindrical body 18 for inserting the suture 16 into a living body, a drawing device 32 which has an annular member 44 at the distal end and holds the suture 16 inserted into the living body by the annular member 44, a suture holding cylindrical body 20 for inserting the drawing device 32 into the living body, and a fixing member 22. The annular member 44 is configured to be inserted into the cylindrical body 20 in a deformation state which shows that the annular member 44 is deformed linearly and to be in a restoration state when it reaches the inside of the living body. The annular member 44 forms an annular part, the inside of which an extended line of the axis of the cylindrical body 20 passes in the restored state. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a living body suturing tool for suturing a body to be sutured.

  2. Description of the Related Art Conventionally, a living body suture tool for fixing a sutured portion in a patient's body, for example, an abdominal wall and a visceral wall, has been used.

  For example, for people whose function of taking food from their mouth by their own age or illness is reduced, fluid food and drink such as liquid food and nutrients are supplied using a gastrostomy tube. . The gastrostomy tube is usually attached using an endoscope, forming a hole in the abdomen of the patient (gastrostomy using an endoscope). In order to appropriately attach such a gastrostomy tube, it has been performed in advance to fix the abdominal wall and the stomach wall using a biological suture tool (see Patent Document 1 and Patent Document 2).

  In the living body suturing devices described in Patent Document 1 and Patent Document 2, a stylet having an annular member at the tip of a rod-shaped member is provided so as to be housed inside the suture grasping tubular body. The annular member is formed of an elastic material, and in a state where the annular member protrudes from the distal end of the suture grasping tubular body, the central axis of the suture insertion tubular body or an extension line thereof is formed inside the annular member. It is configured to pass.

Japanese Patent Publication No. 6-24533 Japanese Patent No. 3331215

  By the way, in the above-described conventional configuration, the tip of the rod-shaped member that supports the ring-shaped annular portion formed by projecting and expanding the annular member is positioned at the end of the annular portion, that is, substantially on the circumference. Will be. Therefore, for example, when the stylet shaft rotates, the gripping range of the annular member deviates from the central axis of the suture insertion tubular body or its extension line, and the suture may not be gripped accurately.

  In Patent Document 1, the hub connected to the rear end of the suture grasping puncture needle into which the stylet is inserted is provided with an engaging portion that engages with the stylet hub only in a specific direction. Thus, a device for always projecting the annular member in a predetermined direction is made.

  However, even with such a configuration, since the suture held by the annular member has a flexible shape, it is not possible to project the suture in a living body so as to surely fit within the holding range of the annular member. difficult.

  The present invention has been made in consideration of the above-described conventional problems, and an object of the present invention is to provide a living body suturing tool that can improve the certainty of a suture grasping operation in a living body. .

  The living body suturing device of the present invention has a suture thread insertion tubular body for inserting a suture thread into a living body, and an annular member formed of an elastic material at the tip, and the suture inserted into the living body by the annular member. A traction tool for grasping a thread, a suture grasping tubular body for inserting the traction tool into a living body, and a fixing for fixing the suture insertion tubular body and the suture grasping tubular body at a predetermined distance apart. In the living body suturing device including the member, the annular member is inserted into the suture grasping tubular body in a deformed state substantially linearly, and passes through the suture grasping tubular body into the living body. When it reaches, it is configured to be in a restored state, and in the restored state, the annular member is configured to form an annular part through which an extension line of the central axis of the suture grasping tubular body passes inside. It is characterized by.

  According to the above configuration, the annular member of the traction tool is expanded below the central axis of the suture grasping tubular body. For this reason, the certainty of the grasping operation of the suture is greatly improved, and the suture can be grasped even when a problem such as rotation of the shaft of the traction tool occurs.

  Further, when the radius of the annular portion is equal to or greater than the distance between the distal end of the suture insertion tubular body and the distal end of the suture grasping tubular body, the reliability of the suture grasping operation is further improved. Therefore, it is preferable.

  And a distal end of the tubular body for grasping a suture, which is slidably inserted into the tubular body for grasping a suture and reaches a predetermined position, and protrudes from the distal end of the tubular body for grasping a suture. When the second needle body has a hollow shape, and the traction tool is slidably inserted into the second needle body, the second needle body Thus, the living body can be punctured and the traction tool can be easily restored in the living body through the second needle body.

  Furthermore, it has a distal end that can be pierced by a living body, is slidably inserted into the suture thread insertion tubular body, and protrudes beyond the distal end of the suture thread insertion tubular body when it reaches a predetermined position. A first needle body, wherein the suture insertion tubular body and / or the suture grasping tubular body is formed from the suture insertion tubular body and / or the suture grasping tubular body. When the needle body and / or the second needle body are removed, the tip of one tubular body has an angle portion formed so as to bend toward the tip of the other tubular body. Since the suture can easily pass through the inside of the annular portion, the certainty of the grasping operation of the suture is further improved.

  According to the present invention, in the case of using a living body suturing tool, the reliability of the work of grasping a suture in vivo is greatly improved. For this reason, quick and proper suturing can be performed. In addition, according to the present invention, even when the shaft of the traction tool rotates, the suture thread can be gripped by the annular member.

  Hereinafter, embodiments of the biological suturing device according to the present invention will be described in detail with reference to the accompanying drawings.

  FIG. 1 is a partially cutaway perspective view for explaining a biological suturing device 10 according to an embodiment of the present invention. The living body suturing device 10 is a suturing device for suturing an anterior abdominal wall 12 and an anterior stomach wall 14 using sutures 16 as an example of an abdominal wall and a visceral wall.

  The living body suturing device 10 includes a suture insertion tubular body 18 for inserting the suture thread 16 into a living body (in the stomach), and an annular member 44 formed of an elastic material at the tip. A traction tool 32 for gripping the suture 16 inserted into the body, a suture gripping tubular body 20 for inserting the traction tool 32 into the living body, the suture insertion tubular body 18 and the suture gripping tubular body. And a fixing member 22 for fixing the body 20 at a predetermined distance.

  The annular member 44 is inserted into the suture grasping tubular body 20 in a deformed state deformed substantially linearly, and is restored when it passes through the suture grasping tubular body 20 and reaches the living body. It is configured to be in a state. The annular member 44 is configured to form an annular portion 44b through which the extension line of the central axis of the suture grasping tubular body 20 passes inside in the restored state (see FIGS. 5A and 5B). ).

  The suture thread insertion tubular body 18 and the suture thread gripping tubular body 20 are arranged side by side with the fixing member 22 in a state where the proximal end portions are held at the predetermined distance. A flat plate-like member 24 through which the suture thread insertion tubular body 18 and the suture thread grasping tubular body 20 are slidably inserted is provided on the distal end side (lower side in FIG. 1).

  The suture insertion tubular body 18 is a hollow cylinder (outer cylinder) into which the suture 16 or the first puncture needle 26 (see FIG. 2) can be inserted. The distal end of the suture thread insertion tubular body 18 prevents the suture 16 from being cut or damaged, and suppresses the influence when it comes into contact with the back wall of the stomach. It has a curved surface at its end. Further, the size of the suture thread insertion tubular body 18 is not particularly limited as long as the suture thread 16 or the first puncture needle 26 can be inserted therein, but the outer diameter is 0.7 mm (22 G). About 1.5 mm (17 G), especially about 0.9 mm (20 G) to 1.3 mm (18 G) is preferable. The length is preferably about 60 mm to 120 mm, particularly about 80 to 100 mm.

  Further, a cylindrical hub 28 having a stepped hole and a reduced diameter on the front end side (lower side) is connected to the rear end of the suture thread insertion tubular body 18. The rear end (open end) of the hub 28 forms an insertion port for the suture 16 and is configured to be engageable with the first puncture needle hub 30 of the first puncture needle 26 (see FIGS. 7 to 9).

  On the other hand, the suture thread grasping tubular body 20 is a hollow cylinder (outer cylinder) into which the traction tool 32, the second puncture needle 34, and the suture thread 16 can be inserted. The distal end of the suture grasping tubular body 20 is pierced into the living body in order to prevent the suture 16 from being cut or damaged and to suppress the influence when it comes into contact with the posterior stomach wall or the like, similarly to the suture insertion tubular body 18. For example, it is configured to have a curved surface at the end where the suture thread 16 comes into contact. The size of the suture grasping tubular body 20 is not particularly limited as long as the traction tool 32, the second puncture needle 34, or the like can be inserted therein, but the outer diameter is 0.7 mm (22G ) To about 1.5 mm (17 G), particularly about 0.9 mm (20 G) to 1.3 mm (18 G). The length is preferably about 60 mm to 120 mm, particularly about 80 to 100 mm. The suture grasping tubular body 20 may have the same or similar shape as the suture insertion tubular body 18.

  Further, similarly to the hub 28, a cylindrical hub 36 having a stepped hole and a reduced diameter on the front end side (lower side) is connected to the rear end of the suture grasping tubular body 20. The rear end (open end) of the hub 36 forms an insertion port for the second puncture needle 34 and is configured to be engageable with a second puncture needle hub 38 (see FIG. 3) connected to the second puncture needle 34. The The second puncture needle hub 38 has substantially the same shape that is slightly smaller in outer diameter than the hub 36, and the rear end (open end) forms an insertion port for the traction tool 32 and the traction tool of the traction tool 32. Although it is configured to be engageable with the hub 40, details will be described later.

  Furthermore, the suture insertion tubular body 18 and the suture grasping tubular body 20 are made of a resin having flexibility rather than a metal material such as stainless steel in order to more reliably prevent the suture 16 from being cut or damaged. It is preferable to be formed of a material. In this case, since it is required to have a hardness that can be inserted into the living body via the first puncture needle 26 and the second puncture needle 34 and can temporarily hold the form thereof, for example, a resin material having a Shore D hardness of 60 or more. Is preferred. Examples of the resin material include polyolefin (polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of three or more of these), a crosslinked polyolefin, polychlorinated Examples thereof include a polymer material such as vinyl, polyamide, polyamide elastomer, polyester, polyester elastomer, polyurethane, polyurethane elastomer, fluororesin, polycarbonate, polystyrene, polyacetal, polyimide, polyetherimide, or a mixture thereof.

  The hubs 28 and 36 are made of, for example, polyolefins such as polypropylene and polyethylene, synthetic resins such as vinyl chloride resin and polycarbonate.

  As shown in FIG. 2, the first puncture needle 26 (first needle body) has a solid bar shape made of a metal material such as stainless steel, and the front ends thereof are the front abdominal wall 12 and the stomach front wall. 14 is a sharp shape that can be pierced. For this reason, it functions to puncture the front abdominal wall 12 and the stomach front wall 14 by being inserted into the suture thread insertion tubular body 18 so that the tip is projected.

  The first puncture needle hub 30 is connected to the rear end of the first puncture needle 26. As described above, the first puncture needle hub 30 has a shape that can be engaged with the rear end of the hub 28. Accordingly, when the first puncture needle 26 is inserted into the suture thread insertion tubular body 18 and advanced by a predetermined distance, the first puncture needle hub 30 engages with the hub 28 and cannot advance further (advance limit). ). That is, the length of the first puncture needle 26 is such that the sharp tip of the first puncture needle 26 reaches the advance limit and the sharp tip protrudes from the tip of the suture insertion tubular body 18 by a predetermined distance. Set to

  On the other hand, as shown in FIG. 3, the second puncture needle 34 (second needle body) is made of a metal material such as stainless steel, and is a hollow cylinder in which the traction tool 32 can slide. As with the first puncture needle 26, the tip has a sharp shape that can be pierced through the front abdominal wall 12 and the anterior stomach wall 14. For this reason, it functions to puncture the front abdominal wall 12 and the stomach front wall 14 by being inserted into the suture grasping tubular body 20 so that the tip is protruded.

  In the second puncture needle 34 as well, as with the first puncture needle 26, the sharp tip of the second puncture needle 34 holds the suture thread when the advance limit is reached by the engagement of the second puncture needle hub 38 and the hub 36. The length is set so as to protrude from the tip of the tubular body 20 for a predetermined distance.

  The first puncture needle 26 and the second puncture needle 34 are slidable in the suture insertion tubular body 18 and the suture grasping tubular body 20, respectively.

  As shown in FIG. 4, the traction tool 32 includes a rod-shaped member 42 having an outer diameter smaller than the inner diameter of the suture grasping tubular body 20 and the inner diameter of the second puncture needle 34, and an annular shape fixed to the tip of the rod-shaped member 42. The member 44 and the traction tool hub 40 fixed to the rear end of the rod-shaped member 42 are configured. The rod-like member 42 and the annular member 44 are slidable within the suture grasping tubular body 20 and the second puncture needle 34. That is, the traction tool 32 is detachable and slidable with respect to the suture grasping tubular body 20 and the second puncture needle 34.

  When the annular member 44 is made of an elastic material and protrudes from the distal end of the suture grasping tubular body 20, the annular member 44 is in an expanded state (ring shape) as shown in FIG. On the other hand, in a state where it is not projected, it is substantially linear and is housed in the suture grasping tubular body 20 and the second puncture needle 34 (see FIG. 7). The traction tool 32 can store the annular member 44 in the suture grasping tubular body 20 and the second puncture needle 34 and protrudes from the distal ends of the suture grasping tubular body 20 and the second puncture needle 34. It is not always necessary to be able to remove the suture thread holding tubular body 20 and the second puncture needle 34 so long as they can slide.

  As shown in FIG. 1, the annular member 44 of the traction tool 32 protrudes from the suture grasping tubular body 20, or the central axis of the suture insertion tubular body 18 and the suture grasping tubular body 20 or The extension line is formed so as to extend through the inside of the annular member 44 (inside the annular member 44 expanded in a ring shape). In this case, the radius of the substantially circular (elliptical) -shaped annular portion 44b (see FIG. 5A) formed in a state where the annular member 44 is expanded as described above is set so that the distal end of the suture thread insertion tubular body 18 and the suture are inserted. It is good to set so that it may become more than the distance between the front-end | tips of the tubular body 20 for thread holding. Further, the annular member 44 is substantially perpendicular to the rod-like member 42 so that the inner side of the annular portion 44b intersects with the extension lines of the central axes of the suture insertion tubular body 18 and the suture grasping tubular body 20. It is good to set so that

  That is, the annular member 44 has a circular shape centering on the central axis of the suture grasping tubular body 20 in a plan view when expanded, and the suture insertion tubular body 18 and the suture grasping are provided on the inner side thereof. An extension line of each central axis of the tubular body 20 for use is included (see FIG. 5A). The annular member 44 is configured as described above, so that the flexible suture 16 is not projected on the central axis of the suture insertion tubular body 18 or its extension line, and is slightly bent in either direction. Even if it protrudes, the possibility that the annular member 44 falls within the grippable range is high. For this reason, the certainty at the time of grasping the suture thread 16 can be greatly improved.

  Further, as shown in FIG. 5A, the annular member 44 is easily formed into a pull-in portion 44a connected to the rod-like member 42, an annular portion 44b formed in a substantially circular shape, and the suture grasping tubular body 20 when expanded. And a projecting portion 44c functioning as a bending rod for being drawn into the housing. In addition, as shown in FIG. 5B, such an annular member 44 has one end opened to the outside of the annular portion 44b without taking the shape of the pull-in portion 44a crushing a circle in the annular portion 44b. Various shapes such as a shape can be used.

  The radius of the annular portion 44b (see FIG. 5A) is equal to or greater than the distance between the distal end of the suture insertion tubular body 18 and the distal end of the suture grasping tubular body 20 in, for example, an annular shape in plan view. In a state where the member 44 is protruded and expanded, a line connecting the connection point between the annular member 44 and the rod-shaped member 42 (the axial center of the suture grasping tubular body 20) and the axial center of the suture inserting tubular body 18 is connected. In other words, the annular portion 44b may be larger than the circle having the radius r.

  Examples of the material of the annular member 44 include stainless steel wire (preferably, high-strength stainless steel for spring), piano wire (preferably, nickel-plated or chrome-plated piano wire), or superelastic alloy wire. For example, a Ti—Ni alloy, a Cu—Zn alloy, a Cu—Zn—X alloy (X = Be, Si, Sn, Al, Ga), a Ni—Al alloy, or the like can be preferably used.

  On the other hand, as the material of the rod-shaped member 42, a metal material (for example, stainless steel or amorphous), a resin material (for example, a polyolefin such as polypropylene or polyethylene, or a fluororesin such as PTFE or ETFE) or the like is preferably used. it can.

  Further, as the material of the traction tool hub 40, for example, a polyolefin such as polypropylene and polyethylene, a synthetic resin such as a vinyl chloride resin and a polycarbonate can be suitably used as in the hub 28 and the like.

  As described above, the fixing member 22 is a substantially rectangular flat plate that integrally fixes the vicinity of the proximal ends of the suture thread insertion tubular body 18 and the suture thread gripping tubular body 20 while maintaining a predetermined distance therebetween. . Further, it can be used as a portion that an operator (operator) holds when puncturing the living body suturing instrument 10, and it is preferable that the operator can put a finger.

  The distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 fixed by the fixing member 22 is the length that the suture 16 fixes the front abdominal wall 12 and the stomach front wall 14. It is about 5 to 30 mm, particularly about 10 to 20 mm. When the distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 is within the above range, the front abdominal wall 12 and the stomach front wall 14 can be sufficiently and properly fixed, and the first puncture needle 26 is secured. And the resistance at the time of puncture with the 2nd puncture needle 34 does not become so large.

  As described above, the flat member 24 is slidably inserted into the suture insertion tubular body 18 and the suture grasping tubular body 20, and is provided on the distal end side of the fixing member 22. In the living body suturing device 10, by providing the flat plate member 24, the distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 changes at the time of puncture. It is possible to prevent the distance between the two from becoming close. Further, since the flat member 24 is slidable as described above, the puncture operation is not hindered.

  The flat plate member 24 has holes 24 a and 24 b that are slidable between the suture insertion tubular body 18 and the suture grasping tubular body 20 such as a rectangular shape or a circular shape that is substantially the same as the fixing member 22. It only has to have. Moreover, it is preferable that a lower surface (front abdominal wall 12 side) is a flat surface etc. which do not irritate | stimulate skin (front abdominal wall 12).

  Next, as an embodiment of the living body suturing device 10 basically configured as described above, the suturing portion of the front abdominal wall 12 and the stomach front wall 14 is sutured using the living body suturing device 10. An example will be described based on the flowchart of FIG.

  First, in step S1, the operator inserts an endoscope into the patient's stomach, and further supplies air sufficiently to fill the stomach with air, thereby closely attaching the anterior stomach wall 14 to the anterior abdominal wall 12. Let Then, another operator disinfects the skin surface of the front abdominal wall 12, confirms the position of the stomach with the transmitted light from the endoscope, and performs local anesthesia on the front abdominal wall 12.

  Next, in step S2, as shown in FIG. 7, the first puncture needle 26 and the second puncture needle 34 are pushed into the suture insertion tubular body 18 and the suture grasping tubular body 20, respectively, to the advance limit. And That is, the first puncture needle 26 and the second puncture needle 34 are protruded from the distal ends of the suture thread insertion tubular body 18 and the suture grasping tubular body 20, respectively. In this case, in the suture grasping tubular body 20, the traction tool hub 40 is in a state of being pulled up, and the annular member 44 of the traction tool 32 is completely stored in the second puncture needle 34.

  Then, as shown in FIG. 8, the biological suturing device 10 with the first puncture needle 26 and the second puncture needle 34 protruded is punctured into the front abdominal wall 12 and the stomach front wall 14, and a suture thread is inserted into the stomach. The tubular body 18 and the suture grasping tubular body 20 are projected.

  At this time, in the biological suture instrument 10, the distal ends of the suture insertion tubular body 18 and the suture grasping tubular body 20 are supported by the slidable flat plate member 24, so that the first puncture needle 26 and Puncturing can be easily performed while maintaining a predetermined distance from the second puncture needle 34. The flat plate member 24 moves to the fixing member 22 side while contacting the front abdominal wall 12 as the first puncture needle 26 and the second puncture needle 34 advance.

  In step S 3, when it is confirmed with an endoscope that the suture insertion tubular body 18 and the suture grasping tubular body 20 protrude into the stomach, the operator removes the suture insertion tubular body 18 from the suture insertion tubular body 18. The first puncture needle 26 is removed (see FIG. 9).

  In step S4, as shown in FIG. 10, the second puncture needle 34 is pulled up and the traction tool 32 is pushed in so that the traction tool hub 40 and the second puncture needle hub 38 are engaged. Then, the annular member 44 is protruded from the distal end of the suture grasping tubular body 20.

  As described above, in the state where the annular member 44 protrudes from the suture grasping tubular body 20, each central axis of the suture insertion tubular body 18 and the suture grasping tubular body 20 or its extension line is The annular member 44 is formed so as to extend through the inside. Therefore, the annular member 44 protruding from the distal end of the suture grasping tubular body 20 forms a circular shape centering on the central axis of the suture grasping tubular body 20 in plan view as described above. Then, it is expanded so as to include the lower part of the central axis of the suture insertion tubular body 18 (see FIGS. 5A and 10).

  Next, in step S5, as shown in FIG. 10, the operator inserts and pushes the suture 16 from the rear end of the hub 28 of the suture insertion tubular body 18, and from the distal end of the suture insertion tubular body 18. It protrudes and passes through the inside of the annular member 44. Whether or not the passage is possible is confirmed by an endoscope. In this case, since the annular member 44 is expanded as described above, the suture 16 can be easily passed through the annular member 44.

  Further, when the suture 16 is passed through the annular member 44 as described above, even if the shaft of the traction tool 32 is rotated, the suture 16 can be held by the annular member 44. The certainty at the time of grasping the suture thread 16 is greatly improved.

  In step S6, as shown in FIG. 11, the traction tool 32 and the second puncture needle 34 are pulled up, and the annular member 44 is accommodated in the suture grasping tubular body 20. At this time, the annular member 44 gradually deformed from an approximately circular shape to an oval shape while being gradually constricted at the distal end opening of the suture grasping tubular body 20, and grasped the suture 16 as a substantially linear shape. In this state, the suture thread is pulled up into the tubular body 20 for grasping a suture.

  In this case, in the living body suture tool 10, the distal ends of the suture thread insertion tubular body 18 and the suture grasping tubular body 20 cannot be pierced into the living body, that is, not sharp, for example, the end where the suture thread 16 contacts. Since the portion has a curved surface, the suture thread 16 can be prevented from being cut or damaged. Furthermore, since the suture insertion tubular body 18 and the suture grasping tubular body 20 are formed of a resin material having flexibility, the suture 16 is the suture insertion tubular body 18 and the suture grasping tubular body. Even if it comes into contact with the end of the body 20, the end is bent by the suture 16. Therefore, cutting and breakage of the suture thread 16 can be prevented more reliably.

  Then, as shown in FIG. 12, when the traction tool 32 and the second puncture needle 34 are removed from the rear end of the suture grasping tubular body 20, the suture 16 is inserted through the suture grasping tubular body 20. Thus, the suture thread holding tubular body 20 protrudes from the rear end.

  That is, the suture 16 passes through the stomach (inside the body) from the suture insertion tubular body 18 and is pulled out of the body through the suture grasping tubular body 20.

  Next, in step S7, as shown in FIG. 13, after the biological suturing device 10, that is, the suture insertion tubular body 18 and the suture grasping tubular body 20 are removed from the body, as shown in FIG. The suture 16 is tied outside the body. Thereby, the suturing of the front abdominal wall 12 and the stomach front wall 14 is completed, and the front abdominal wall 12 and the stomach front wall 14 are fixed.

  As described above, according to the biological suturing device 10 according to the present embodiment, the annular member 44 is expanded by drawing a large circular shape centering on the central axis of the suture grasping tubular body 20. For this reason, when the suture thread 16 protrudes from the distal end of the suture thread insertion tubular body 18, the possibility that the suture thread 16 is within the grippable range of the annular member 44 increases. Furthermore, even when the shaft of the traction tool 32 has been rotated, the suture thread 16 can be gripped by the annular member 44, and the reliability when gripping the suture thread 16 is greatly improved. A quick and simple stitching operation is possible.

  Moreover, according to the biological suturing device 10, it is possible to prevent the suture 16 from being cut or damaged during suturing. Furthermore, at the time of the operations in steps S5 to S7, the distal ends of the suture insertion tubular body 18 and the suture grasping tubular body 20 located in the stomach are not sharply shaped, and further, the resin as described above is used. It is made from a material. For this reason, at the time of the operations in Steps S5 to S7, the distal ends of the suture insertion tubular body 18 and the suture grasping tubular body 20 come into contact with the posterior stomach wall and affect the posterior stomach wall. Therefore, it is possible to perform proper suturing with a simple operation.

  Note that, as described above, the distal ends of the suture insertion tubular body 18 and the suture grasping tubular body 20 are not sharply shaped, for example, in the normal use state, the distal ends do not pierce the living body. Say that the shape. Further, for example, each tip has a shape that does not cause cutting or breakage even when the suture thread 16 comes into contact with the suture thread 16 when the suture thread 16 is inserted into the living body or pulled up from the living body. To tell.

  Usually, after each of the above steps, the living body is sutured again substantially in parallel with the stitched portion at a predetermined distance (for example, about 20 mm to 30 mm) away from the stitched portion by the suture thread 16. The procedure for fixing the front abdominal wall 12 and the stomach front wall 14 similar to the above using the instrument 10 is performed.

  For the second and subsequent punctures, the first puncture needle 26 and the second puncture needle 34 used for the first puncture may be used again, but they are replaced with new first puncture needle 26 and second puncture needle 34. By doing so, the sharpness of the blade can be prevented from being lowered and puncture can be performed easily and appropriately. In this case, in the living body suturing device 10 according to the present embodiment, the first puncture needle 26 and the second puncture needle 34 can be easily replaced, so that simple and low-cost suturing can be performed.

  As described above, the suturing operation for the sutured portion of the front abdominal wall 12 and the stomach front wall 14 using the living body suturing device 10 is completed. Thereafter, usually, the stomach using an endoscope is usually performed as follows. We perform erection construction (PEG).

  That is, a puncture device comprising a metal needle having a blade surface at the tip and a resin tube breakable in the axial direction through which the metal needle is inserted in the approximate center of the two stitched portions formed as described above. After puncturing and removing the metal needle, a balloon catheter is inserted into the tube. Next, after confirming with an endoscope that the distal end portion including the balloon portion of the balloon catheter has reached the stomach, the balloon is inflated with distilled water or the like, and the proximal end portion of the tube is pulled outward in two directions. The tube is broken axially and removed from the patient. Then, the balloon catheter is pulled proximally, the inflated balloon part is brought into close contact with the anterior stomach wall 14, and further, the balloon catheter in the part exposed from the skin surface is sutured with an appropriate fixing tool, and the balloon catheter is Secure to the abdominal wall 12. In this way, gastrostomy using an endoscope is completed (see Japanese Patent Publication No. 6-24533).

  In the living body suturing device 10 according to the present embodiment, as shown in FIG. 15, the distal end of the suture insertion tubular body 18 is formed to bend toward the distal end of the suture grasping tubular body 20. You may have the angle part 18a. When the angle portion 18 a is provided in this manner, the suture thread 16 that protrudes from the distal end of the suture thread insertion tubular body 18 is more securely contained within the grippable range of the annular member 44.

  In such a case, the suture thread insertion tubular body 18 is preferably formed of a resin material having flexibility rather than a metal material such as stainless steel. By doing so, when inserting the first puncture needle 26 into the suture thread insertion tubular body 18, the angle portion 18a can be linearly deformed, and the first puncture needle 26 can be easily inserted. It becomes.

  It should be noted that the present invention is not limited to the above-described embodiment, and it is naturally possible to adopt various configurations without departing from the gist of the present invention.

  As an example, the suture insertion tubular body 18 and the suture grasping tubular body 20 are preferably formed of a resin material having flexibility. Only the vicinity of the angle portion 18a may be formed of the resin material.

  In addition, the second puncture needle 34 has a hollow shape. However, for example, the second puncture needle 34 can be formed solid like the first puncture needle 26. In this case, after puncturing with the second puncture needle 34, the second puncture needle 34 is removed, and then the traction tool 32 is inserted into the suture grasping tubular body 20. Good.

It is a partially cutaway perspective view for explaining a living body suturing tool according to an embodiment of the present invention. It is a front view of the 1st puncture needle in the said suture instrument for living bodies. It is a front view of the 2nd puncture needle in the said suture tool for living bodies. It is a front view of the traction tool in the said biological suture tool. FIG. 5A is a plan view of an annular member in the traction tool, and FIG. 5B is a modification of the annular member. It is a flowchart at the time of suturing a to-be-sewn part using the said suture tool for biological bodies. FIG. 6 is an explanatory diagram for explaining a state in which the first puncture needle and the second puncture needle are projected in the biological suturing tool. In the said biological suture tool, it is explanatory drawing for demonstrating the state which has made the 1st puncture needle and the 2nd puncture needle project, and punctures. It is explanatory drawing for demonstrating the state which extracts the 2nd puncture needle in the said suture tool for biological bodies. It is explanatory drawing for demonstrating the state which inserts a suture thread in the said biological suture tool. In the said biological suture tool, it is explanatory drawing for demonstrating the state which pulls up a traction tool. It is explanatory drawing for demonstrating the state which passed the suture thread into the body with the said biological suture tool. It is explanatory drawing for demonstrating the state which extracted the said biological suture tool out of the body. It is explanatory drawing for demonstrating the state which sutured the front abdominal wall and the stomach front wall with the suture thread | strain which passed the body with the said biological suture tool. It is a partially cutaway perspective view for demonstrating the modification of the said biological suture tool.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 ... Living body suture tool 12 ... Front abdominal wall 14 ... Front stomach wall 16 ... Suture 18 ... Tubular body for suture insertion 20 ... Tubular body 22 for holding a suture thread ... Fixing member 24 ... Flat plate member 24a, 24b ... Hole 26 ... 1st puncture needle 28, 36 ... Hub 30 ... 1st puncture needle hub 32 ... Traction tool 34 ... 2nd puncture needle 38 ... 2nd puncture needle hub 40 ... Traction tool hub 42 ... Rod-shaped member 44 ... Ring-shaped member 44a ... Pull-in part 44b ... annular part 44c ... projecting part

Claims (4)

A suture insertion tubular body for inserting a suture into a living body;
A traction tool having an annular member formed of an elastic material at the tip, and holding a suture thread inserted into the living body by the annular member;
A suture grasping tubular body for inserting the traction tool into a living body;
A living body suturing device comprising: a fixing member that fixes the suture thread insertion tubular body and the suture grasping tubular body at a predetermined distance apart;
The annular member is inserted into the suture grasping tubular body in a deformed state deformed substantially linearly, and is configured to be restored when passing through the suture grasping tubular body and reaching the living body. Has been
The living body suturing device, wherein the annular member is configured to form an annular portion through which an extension line of a central axis of the suture grasping tubular body passes inside in a restored state. The biological suturing device according to claim 1,
The living body suturing device according to claim 1, wherein a radius of the annular portion is equal to or more than a distance between a distal end of the suture thread insertion tubular body and a distal end of the suture gripping tubular body. The biological suture tool according to claim 1 or 2,
And a distal end that can be pierced by a living body, is slidably inserted into the suture grasping tubular body, and protrudes beyond the distal end of the suture grasping tubular body when reaching a predetermined position. 2 needles,
The living body suturing tool, wherein the second needle body has a hollow shape, and the traction tool is slidably inserted into the second needle body. The living body suturing device according to claim 3,
Furthermore, it has a distal end that can be pierced by a living body, is slidably inserted into the suture thread insertion tubular body, and protrudes beyond the distal end of the suture thread insertion tubular body when it reaches a predetermined position. 1 needle body,
The suture thread insertion tubular body and / or the suture thread gripping tubular body includes the first needle body and / or the second needle body from the suture thread insertion tubular body and / or the suture thread gripping tubular body. A living body suturing tool having an angle portion formed so that a distal end of one tubular body is bent toward a distal end of the other tubular body in a state where the needle body is removed.

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