JP2007282841A - Medical purpose ring - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical purpose ring suitable for procedure for quickly and easily suturing a puncturing site or others formed after resecting an affected site tissue. <P>SOLUTION: The medical purpose ring 1 is used for covering and suturing the puncturing site and an artificial ulcer formed after resecting the affected site tissue of an inner wall of a body tube using normal tissues around the puncturing site and the artificial ulcer. The medical purpose ring 1 has at least a pair of ring portions 11, 12. The at least pair of ring portions 11, 12 engage with clips 61, 71 indwelled in the body tube. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a perforated part (artificial ulcer part) formed on the inner wall of a body duct after excising the affected tissue on the inner wall of a patient's body duct (for example, large intestine, rectum, esophagus, duodenum, stomach and bronchi). The present invention relates to a medical ring used for treatment of covering and suturing with tissue around a part.

  For example, for resection of a tumor that has developed in a body vessel such as the large intestine, EMR (endoscopic mucosalry) is used to remove a surface type tumor with a snare polypectomy that removes a raised type tumor using an endoscope. Endoscopic submucosal dissection (ESD), which has been applied to the large intestine, has been applied to the large intestine. Along with treatment, endoscopic treatment of the large intestine has also made great progress.

  However, when a tumor that has developed on the inner wall of the large intestine is excised using the endoscopic treatment method as described above, since the thickness of the large intestine wall is thin, perforation (that is, intestinal perforation) tends to occur in the large intestine wall. If this intestinal perforation is left as it is, bacteria in the intestine will flow out into the abdominal cavity from the perforated part, and bacterial peritonitis will occur. In order to prevent this, it may be necessary to perform surgical laparotomy and cleanse, and the colonoscopy treatment requires caution. In order to avoid such a surgical laparotomy during perforation of the intestinal tract, there is a need for a quick suturing method that can sew the perforated portion and the artificial ulcer immediately after resection so that the contents of the intestinal tract do not invade the abdominal cavity. To date, since the development of clip devices and indwelling snares as a countermeasure against accidents such as bleeding after endoscopic resection and intestinal perforation, sutures that combine various medical devices have been performed. Not yet developed.

  Conventionally, when a wide excision ulcer part after excision is sutured only with a clip, a process of suturing from the edge of the excision part toward the center part is performed. Since it takes too much time, there is a possibility that the perforated part or the like may be widened. Further, when a clip is used as a hemostasis countermeasure against bleeding from a wide excision ulcer part, the inherent muscle layer that is weakened by the excision current may be further damaged to cause perforation by performing the clip operation many times. Therefore, in order to safely perform excision when excising a large tumor exceeding 2 cm, it is necessary to develop a thorough suture after the excision and a medical device that enables such a suture.

  The present invention solves the above-mentioned problems that occur in conventional suturing, and is suitable for a conventional suturing treatment suitable for a treatment for quickly and easily suturing a perforated part and an artificial ulcer formed after excision of an affected tissue such as the large intestine. An object is to provide a new medical device which is not included in the device.

  In order to solve the above-mentioned object, the present invention relates to a perforated part and an artificial ulcer formed on the inner wall of a body tube after excising the affected tissue on the inner wall of a patient's body tube, and a normal mucosal tissue around the perforated part and the artificial ulcer. A medical ring used for the treatment of covering and suturing using a clip, and comprising at least a pair of ring portions respectively engaged with clips placed in a body tube. By providing such a medical ring, it is possible to quickly suture a perforated part and an artificial ulcer formed after excision of a diseased tissue such as the large intestine, and it is possible to avoid a surgical laparotomy during perforation of the intestinal tract It became. Also, when excising a large tumor, it is possible to complete the excision safely without causing a perforation or the like by damaging the intrinsic muscle layer by a clip operation. Furthermore, in the past, a two-channel endoscope was used for suturing, but the medical ring according to the present invention enabled a suturing treatment using a one-channel endoscope.

  As another embodiment of the present invention, the clip placed in the body tube is a clip portion of an open / close type clip device that can be opened and closed, and the medical ring is engaged with the clip portion of the first open / close type clip device. A first ring portion; and a second ring portion that engages with the clip portion of the second open / close clip device.

  As another embodiment of the present invention, each medical ring is formed by winding a thin wire in a coil shape, and it is desirable that the thin wire is a stainless steel wire. The medical ring may be formed of a biocompatible synthetic resin.

As another embodiment of the present invention, the medical ring has a generally 8-digit shape or an O-shape as a whole.
As another embodiment of the present invention, the medical ring has a length of 1 mm or less and a width of 5 mm or less, and more specifically, a length of 6 to 7 mm and a width of 2 to 3 mm. desirable.

  As another embodiment of the present invention, the medical ring includes a perforated part and an artificial ulcer (hereinafter referred to as a perforated part) formed on the large intestine wall after excising the affected tissue on the inner wall of the large intestine of the patient. Used for the treatment of covering and suturing with the inner wall tissue of the large intestine around the cervical region, etc., and excising the perforated part formed on the inner wall of the rectum after excising the affected tissue of the inner wall of the rectum of the patient, Used for the treatment of covering and suturing with inner wall tissue, and excision of the affected tissue on the inner wall of the patient's esophagus, then covering the perforation and the like formed on the inner wall of the esophagus with the surrounding inner esophageal tissue such as the perforation and suturing To be used for treatment, and after excision of the affected tissue on the inner wall of the duodenum of the patient, the perforation formed on the inner wall of the duodenum is covered with the inner wall tissue of the duodenum around the perforation, etc. The stomach wall of the patient After excision of the affected tissue on the inner wall of the patient's bronchi, and the use of the perforation formed on the stomach wall after excision of the affected tissue to cover and suture with the surrounding stomach wall tissue such as the perforation It is also suitable for use in a treatment in which a perforated portion or the like formed on the inner wall of the bronchus is covered and sutured with an inner wall tissue of the bronchus around the perforated portion or the like.

  Hereinafter, with reference to the drawings, the medical ring according to the present invention and the method for using the same will be described with respect to a perforated part or the like (that is, excision after excising the perforated part and the affected part formed in the inner wall of the large intestine after excising the affected part of the inner wall of the large intestine) As an example, a case where an artificial ulcer after cauterizing the part is covered with a surrounding large intestine inner wall tissue such as a perforated part and sutured will be described.

  First, a medical ring according to the present invention will be described. FIG. 1 shows a medical ring 1 according to the present invention, and FIG. 2 is an enlarged photograph of the actual one. The medical ring 1 is used together with an openable / closable clip device having a clip portion placed in the large intestine. The medical ring 1 as a whole has a shape of approximately eight characters, and includes a first ring portion 11 and a second ring portion 12. The first ring portion 11 engages with a clip portion 61 of the first open / close type clip device 6 (FIG. 6) as will be described later. As will be described later, the second ring portion 12 engages with a clip portion 71 of the second open / close type clip device 7 (FIG. 7). In the present embodiment, two ring portions are illustrated, but a larger number of ring portions may be included. Furthermore, as shown in FIG. 3, the first ring portion and the second ring portion may have a substantially elongated O shape.

  The first ring portion 11 and the second ring portion 12 are integrally formed by winding a thin wire 13 in a coil shape. Alternatively, instead of winding a single thin wire in a coil shape, the single thin wire 13 can be formed by bending it into an approximately 8-digit shape or an O-shape. This thin wire can be a stainless steel wire. In the embodiment of FIGS. 1 and 2, each of the first ring portion 11 and the second ring portion 12 is formed by winding a thin wire in a coil shape. However, as shown in FIG. The portion may be formed of a biocompatible synthetic resin such as polyurethane or nylon.

The medical ring 1 has a total length l1 of 10 mm or less and a width l2 of 5 mm or less, preferably a total length l1 of 6 to 7 mm and a width l2 of 2 to 3 mm.
Hereinafter, a method of using the medical ring 1 when performing suture treatment will be described. First, an outline of a conventionally known EMR method will be described. 5A to 5D schematically show the EMR method. FIG. 5A shows the state of the inner wall of the large intestine before the affected tissue is excised. In this figure, W indicates the inner wall of the large intestine, and W1 indicates the affected tissue formed on the inner wall of the large intestine. As shown in FIG. 5B, an injection device 4 for injecting ablation fluid is passed through a medical instrument search channel of an endoscope (not shown) in a manner known to those skilled in the art, and the inner wall W of the large intestine is It is inserted to the vicinity of the affected tissue W1, and the excision liquid is injected by puncturing the affected tissue W1 with the tip of the injection device 4 (arrow 3). As a result, the affected tissue W1 expands and rises (FIG. 5B). Next, the injection device 4 is pulled out from the endoscope, and the snare catheter 5 is inserted up to the affected tissue W1 as shown in FIG. 5C. The snare 51 is exposed from the snare catheter 5 to surround the expanded affected tissue W1, and then the snare 51 is drawn into the snare catheter 5 to excise the expanded affected tissue W1. Thereby, as shown in FIG. 5D, an ulcer W2 is formed after the perforated part or the affected part tissue W1 is excised and cauterized at the position of the excised affected part tissue W1.

  If such a state is left as it is, bacteria may flow out from the perforated part or the like, and bacterial peritonitis may occur. Therefore, in order to avoid the concurrent occurrence of bacterial peritonitis after the intestinal perforation is formed, it is necessary to sew the perforated part etc. W2 immediately after excision. Since the EMR method is a treatment method known to those skilled in the art, further explanation is omitted.

Next, a suturing treatment in which the perforated portion W2 is covered with normal mucosal tissue around the perforation using the medical ring 1 according to the present invention will be described with reference to FIGS.
6A to 6D show a stage before the first opening / closing type clip device 6 is inserted into the large intestine. This open / close type clip device 6 is a device known to those skilled in the art of a type in which the doctor in charge can open and close the clip portion 61 from the proximal end side and can place the clip portion 61 in the intestinal tract. Available in the medical device market. Therefore, the description of the configuration of the open / close type clip device is omitted. As shown in FIG. 6A, the clip portion 61 of the first open / close type clip device 6 is exposed from the sheath 62 to the distal end side. Next, the first ring portion 11 of the medical ring 1 is gripped by the clip portion 61 by a clipping operation (FIG. 6B). In this case, it is desirable to apply cretin so that the medical ring 1 is not detached from the open / close type clip device 6 during the suturing treatment. Next, the medical ring 1 is drawn and filled in the sheath 62 with the clip portion 61 sandwiching the first ring portion 11 ((FIGS. 6C and 6D). Is ready to be inserted into the large intestine.

  7A to 7I show a procedure in the case of covering the perforated part or the like W2 with normal mucosal tissue around the perforated part. With the medical ring 1 filled in the sheath 62 of the first open / close type clip device 6, the first open / close type is passed through the medical instrument search channel of the endoscope by a method known to those skilled in the art. The clip device 6 is inserted up to the position of the perforated portion or the like W2 on the inner wall of the large intestine, and the medical ring 1 and the clip portion 61 are pulled out from the distal end side of the sheath 62 (FIG. 7A). The first open / close type clip device is operated while observing with an endoscope, and medical treatment is performed on normal mucosal tissue W3 on the mouth side (upstream side of the large intestine, hereinafter referred to as “mouth side”) of the peripheral portion of the perforation part W2, etc. The first ring portion 11 of the working ring 1 is fastened with the clip portion 61 (FIG. 7B). Next, after the clip portion 61 is separated from the main body of the first open / close type clip device 6 by a method known to those skilled in the art, the main body of the first open / close type clip device 6 is pulled out from the endoscope. On the other hand, the clip portion 61 and the medical ring 1 are placed in the large intestine (FIG. 7C).

  The second open / close type clip device 7 is inserted into the large intestine through the medical instrument searching channel of the endoscope, and the second ring portion 12 of the medical ring 1 is inserted by the clip portion 71 of the second open / close type clip device 7. Is gripped (FIG. 7D). In this state, the second open / close type clip device 7 is moved so as to cover the perforated part W2 and the like (FIG. 7E). In this case, the normal mucosal tissue W3 and the clip portion 61 also move together with the second opening / closing type clip device 7. The second ring portion 12 of the medical ring 1 is fastened with the clip portion 71 to the normal mucosal tissue W4 on the anal side (downstream of the large intestine, hereinafter referred to as “anus side”) of the peripheral edge of the perforated portion W2, etc. (FIG. 7F). ). After the clip portion 71 is separated from the main body of the second open / close type clip device 7 by a method known to those skilled in the art, the main body of the second open / close type clip device 7 is pulled out from the endoscope. On the other hand, the clip portion 71 and the medical ring 1 are placed in the large intestine (FIG. 7G).

  Next, another clip device 8 is inserted into the large intestine through the medical instrument search channel of the endoscope, and the medical ring 1 is clamped between the normal mucosal tissue W4 with the clip 81 (FIG. 7H). Thereafter, the clip 81 is separated from the main body of the clip device 8 by a method known to those skilled in the art, and the main body of the clip device 8 is pulled out from the endoscope (FIG. 7I). The medical ring 1, the first clip portion 61, the second clip portion 71, and the clip 81 are placed in the large intestine (FIG. 7I).

  Thus, by using the medical ring 1 for suturing, complete perforation of the perforated part W2 and the like is achieved, and after excising the affected tissue, a perforated part having a size that is difficult to sew with a clip alone. Combining bleeding prevention measures and bacterial peritonitis with respect to W2 can be avoided, and the perforation can be sutured immediately in a short time at the time of intestinal perforation.

  Furthermore, in the past, a suture was performed using a two-channel endoscope, but as understood from the above description, a suture treatment is performed using a one-channel endoscope with a medical ring according to the present invention. Is possible.

  In the above description, mainly the suture treatment of the inner wall of the large intestine has been described. However, the medical ring of the present invention and the suture using the same are not limited to the large intestine. The same method can be applied to suturing treatments such as perforations in the inner wall of the esophagus, suturing treatments such as perforations in the inner wall of the duodenum, suturing treatment such as perforations in the stomach inner wall, and suturing treatment such as perforations in the inner wall of the bronchus. .

1 is an overall perspective view of a medical ring according to the present invention. It is an enlarged photograph of the actual medical ring according to the present invention. FIG. 6 shows another embodiment of a medical ring according to the present invention. FIG. 6 shows another embodiment of a medical ring according to the present invention. It is a figure which shows the outline of EMR method. It is a figure which shows the outline of EMR method. It is a figure which shows the outline of EMR method. It is a figure which shows the outline of EMR method. It is a figure which shows the procedure which fills a medical ring in a 1st opening-and-closing type clip apparatus. It is a figure which shows the procedure which fills a medical ring in a 1st opening-and-closing type clip apparatus. It is a figure which shows the procedure which fills a medical ring in a 1st opening-and-closing type clip apparatus. It is a figure which shows the procedure which fills a medical ring in a 1st opening-and-closing type clip apparatus. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation. It is a figure which shows the suturing procedure which coat | covers perforation with the colon inner wall tissue of the circumference | surroundings of perforation.

Explanation of symbols

1: Medical ring 4: Injection device 5: Snare catheter 6: First open / close type clip device 7: Second open / close type clip device 8: Clip device

Claims (14)

  Used to treat and perforate the perforated part and artificial ulcer formed in the inner wall of the body tube after excising the affected tissue on the inner wall of the patient's body tube using normal mucosal tissue around the perforated part and artificial ulcer. A medical ring comprising at least a pair of ring portions each engaging a clip that is placed in a body tube.   The clip placed in the body tube is a clip portion of an open / close type clip device that can be opened and closed, and the medical ring includes a first ring portion that engages with the clip portion of the first open / close type clip device; The medical ring according to claim 1, further comprising a second ring portion that engages with a clip portion of the second open / close type clip device.   The medical ring according to claim 1 or 2, wherein each of the medical rings is formed by winding a thin wire in a coil shape.   The medical ring according to claim 3, wherein the thin wire is a stainless steel wire.   The medical ring according to any one of claims 1 and 2, wherein the medical ring is formed of a synthetic resin having biocompatibility.   The medical ring according to any one of claims 1 to 5, wherein the medical ring has an approximately figure-eight shape or an O-shape as a whole.   The medical ring according to any one of claims 1 to 6, wherein the medical ring has a length of 10 mm or less and a width of 5 mm or less.   The medical ring according to any one of claims 1 to 7, wherein the medical ring has a length of 6 to 7 mm and a width of 2 to 3 mm.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of the large intestine.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of the rectum.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of the esophagus.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of a duodenum.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of the stomach.   The medical ring according to any one of claims 1 to 8, wherein the inner wall of the body tube is an inner wall of a bronchus.