JP2009092617A - Isolated living tissue placing apparatus and isolated living tissue fixing method - Google Patents
Isolated living tissue placing apparatus and isolated living tissue fixing method Download PDFInfo
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本発明は、医療における摘出生体組織検査の改良に関するものである。 The present invention relates to an improvement of an extracted biological tissue examination in medical treatment.
医療を進めるには、臨床上疑われる病変の実態を確認することと、該病変が除去されたか如何かを確認することが極めて重要である。このため、生体組織の検査においては、これ等の情報を的確に求め得る必要がある。例えば、腫瘍性病変の摘出組織検査において、該病変が完全に切除されていることが確認できれば、再手術、薬物療法、放射線治療などの追加的治療の必要がないと判断できることになる。これに反し、切除された組織断端の一部のみから標本が作製され、該断端全体が検査できないと、検査結果を信頼して治療を進めることができない。従って、切除断端全体が観察できる標本を作製することが、不可欠となる。 In order to advance medical care, it is extremely important to confirm the actual state of a clinically suspected lesion and whether or not the lesion has been removed. For this reason, in the examination of a living tissue, it is necessary to accurately obtain such information. For example, if it can be confirmed by excisional tissue examination of a neoplastic lesion that the lesion is completely removed, it can be determined that there is no need for additional treatment such as re-operation, drug therapy, or radiotherapy. On the other hand, if a specimen is prepared from only a part of the excised tissue stump and the entire stump cannot be inspected, it is impossible to proceed with the treatment with the test result reliable. Therefore, it is indispensable to prepare a specimen in which the entire excision stump can be observed.
摘出生体組織検査にあたり、顕微鏡による観察に適した組織標本を作製するには、まず組織を固定液(例えばホルマリン液)に浸漬しその固定を行なうが、これは摘出後の変化、自家溶解や腐敗をくいとめるとともに、もとの形態や構造内容物をできるだけ変化させないようにすることで、該固定操作における考慮すべき問題点として、柔らかい生体組織は、固定が進行して硬化する過程で変形しやすく、固定操作時に摘出組織が変形すると、切除断端全体の観察に適した標本の作製を困難にすることにある。そこで、従来行なわれわれてきたように、切除された状態のまま又は固定板を用いて固定液に浸漬し固定する手技の欠点が指摘され、組織の周囲の曲線的形状及び切除面の垂直性の状態を維持することが困難であるとし、切除断端の固定にあたり立体的な型枠を用いた、所謂パンケーキ法或いはペンタゴン法等が提案されているが、前者にあっては板上に固定枠を設け、これに蝶番により取着された可動翼と称する扇形に開閉可能な枠を設けた器具を用いるもので、該器具に収容された切除断端の垂直性を枠によって維持することは可能であるが、組織本来の形状や周囲の曲線的形状は前記従前の手技と同様維持が困難であり、後者にあっても、固定に際し、組織本来の形状とは異なる可能性がある。例えば、平面5角形の筒状型枠に嵌めることにより、固定完了後の組織の形状は型枠の囲む多面体となる。切除組織の形状は、病変の位置や数によって円形、楕円形、ひょうたん形など多彩となるが、これを型に嵌めることで病変の位置も切除組織の中で移動する可能性も考えられる。 In order to prepare tissue specimens suitable for microscopic observation during excisional biopsy, the tissue is first immersed in a fixative solution (eg formalin solution) and fixed. This is a change after excision, including autolysis and decay. As a problem to be considered in the fixing operation, the soft biological tissue is easily deformed in the process of fixing and hardening. If the excised tissue is deformed during the fixing operation, it is difficult to prepare a specimen suitable for observation of the entire excised margin. Therefore, as we have done in the past, the shortcomings of the technique of dipping in and fixing in a fixative solution with the excised state or using a fixing plate are pointed out, the curved shape around the tissue and the perpendicularity of the excised surface The so-called pancake method or the Pentagon method, which uses a three-dimensional formwork for fixing the cut end, has been proposed, but the former is on a plate. Using a device provided with a fixed frame and a fan-shaped frame that can be opened and closed called a movable wing attached by a hinge, and maintaining the perpendicularity of the cut edge accommodated in the device by the frame However, it is difficult to maintain the original shape of the tissue and the curved shape around it as in the previous procedure, and even the latter may be different from the original shape of the tissue in fixation. For example, by fitting in a planar pentagonal cylindrical formwork, the shape of the tissue after completion of fixation becomes a polyhedron surrounded by the formwork. The shape of the excised tissue varies depending on the location and number of lesions, such as a circle, an ellipse, and a gourd, but it is also possible that the location of the lesion will move in the excised tissue by fitting it into a mold.
例えば、乳癌の標準的な治療として行なわれる乳房温存手術の場合、その摘出組織の切除断端の状態が摘出手術後の局所再発リスクを予測するための最も重要な手掛かりとなるので、日本乳癌学会の乳癌取扱い規約のガイドラインによれば、乳頭と癌腫瘤を結ぶ線に直角に5mm間隔で割を入れ、すべてを病理標本として断端の検索を行なうことを推奨しているが、その処理及び診断に多くの時間と労力を費やすこととなる。そこで提案されたのが、上記型枠を用いる方法(以下「型枠法」と略称する。)であり、パンケーキ法の場合全割標本に比べ作成ブロック数は平均55.2%となったとするが、これには幾つかの問題が考えられる。まず、型枠法では、型枠と組織との間になじまない部分が生じる可能性があり、接着させても1mm前後の凹凸が生ずる可能性もあり、真の5mm幅の標本を作ることは困難である。断端面から5mmの部位の病変について判定することは可能としても、断端から5mm未満の病変の有無の確認、断端からの5mm未満の距離の計測は不可能である。断端陽性の判断基準は、5mm、2mm、1mmと様々であり、これらの基準に合わせるためには、実測が必要になるがこれが困難であることは、上記の点から明らかであろう。 For example, in the case of breast-conserving surgery performed as a standard treatment for breast cancer, the condition of the resected margin of the removed tissue is the most important clue for predicting the risk of local recurrence after the surgery. According to the guidelines for breast cancer treatment regulations in Japan, it is recommended to split at 5 mm intervals perpendicular to the line connecting the nipple and the tumor mass, and to search for stumps using all pathological specimens as its processing and diagnosis. It takes a lot of time and effort. Therefore, the method using the above-mentioned formwork (hereinafter referred to as “formwork method”) was proposed. In the case of the pancake method, the number of blocks produced was 55.2% on average compared to the whole sample. However, there are several problems with this. First, in the formwork method, there is a possibility that an unfamiliar part will be formed between the formwork and the structure, and there is a possibility that unevenness of around 1 mm may occur even if it is bonded. Have difficulty. Although it is possible to determine a lesion at a site 5 mm from the stump, it is impossible to confirm the presence or absence of a lesion less than 5 mm from the stump and to measure a distance less than 5 mm from the stump. There are various criteria for judging whether the stump is positive, such as 5 mm, 2 mm, and 1 mm. In order to meet these criteria, it is clear from the above points that actual measurement is required but this is difficult.
上記問題を解決するため、特願2006−281041は、摘出生体組織を板上に載置し、その変形を制御するメッシュ状に形成した帯体、又は多数の孔を穿設した板状体で、用手的に屈曲でき、かつ屈曲形状を維持できる形状保持材で囲んでその端部を閉止し、該形状保持材の上縁にまで満るように前記摘出生体組織上に綿又は布を載せ、この状態で形状保持材、摘出生体組織及び綿又は布の全てを布に包み、適宜の板上に取着し、固定液に浸漬する手段を提案している。しかし、この提案では、未解決の問題が残る。即ち、用いる板を木材やコルク製にし、前記形状保持材、摘出生体組織及び綿又は布を包括した布の周囲を釘で前記板に取着すると、摘出生体組織の固定処理後該釘を抜く手間が煩雑であるし、また、固定液に浸漬する際、前記板の浮力で浮いてしまうので、鉛などの有害な金属を用い、浮かないようにする手段を要した。また、浸漬にあたり、前記板を固定液の垂直方向に入れると、前記のように形状保持材の上縁まで綿又は布を載せているが、摘出生体組織の自重による偏りのため変形するおそれがあった。
解決しようとする問題点は、摘出された生体組織断端の固定過程で該組織断端が変形することなく、固定完了後、これに割を入れて検査標本を作製したとき、組織断端全体が適切に観察できるようにする点にあるが、従来提案されている方法では、変形を十分に防止できない点と手技が煩雑である欠点があった。 The problem to be solved is that the tissue stump is not deformed in the fixing process of the extracted biological tissue stump. However, the conventionally proposed methods have the disadvantage that the deformation cannot be sufficiently prevented and the procedure is complicated.
前記課題を解決するため、摘出生体組織を固定液に浸漬して固定する場合、該摘出生体組織を載置するに用いる載置板は、多数の孔を穿設し、又はメッシュ状に形成された、強磁性体からなる板状体とし、摘出生体組織を後に述べる形状保持材に収容し、載置板へ布を用いて取着する際、該布が形状保持材周囲に接するよう磁石により容易に着脱可能に構成するとともに、浸漬に際し摘出生体組織の変形を防止するため、固定液中において水平を維持できるよう、前記載置板を水平に収納する装置を提案する。 In order to solve the above-mentioned problem, when the extracted biological tissue is immersed and fixed in a fixing solution, the mounting plate used for mounting the extracted biological tissue is formed with a large number of holes or a mesh shape. In addition, a plate-shaped body made of a ferromagnetic material is used, and when the extracted living tissue is accommodated in a shape holding material described later and attached to the mounting plate using a cloth, a magnet is used so that the cloth comes into contact with the shape holding material. In order to prevent the deformation of the extracted living tissue during immersion, an apparatus for horizontally storing the above-mentioned mounting plate is proposed so as to maintain the level in the fixing solution.
本発明によれば、固定にあたり、摘出生体組織断端周囲側面の曲線的形状及び垂直性の状態が摘出時の形状をほぼ維持でき、切除断端と病変の位置関係を損なうことなく検査標本を作製でき、従って、組織断端全体を的確に観察できるという利点がある。 According to the present invention, in fixing, the curved shape and the vertical state of the side surface around the extracted biological tissue stump can substantially maintain the shape at the time of excision, and the test specimen can be obtained without impairing the positional relationship between the excised stump and the lesion. Therefore, there is an advantage that the entire tissue stump can be observed accurately.
本発明の前記載置板の特徴は、強磁性体材例えば、鉄或いはステンレススチールを用い、多数の孔を穿設し、又はメッシュ状に形成したので、固定液に浸漬しても浮き上がることはなく、かつ、固定液が載置された摘出生体組織に過不足なく浸透できることにある。従って、設ける孔等の形状及び大きさは、この点の配慮が必要である。 A feature of the mounting plate according to the present invention is that a ferromagnetic material such as iron or stainless steel is used, and a large number of holes are formed or formed in a mesh shape. In addition, it is possible to penetrate the extracted living tissue on which the fixing solution is placed without excess or deficiency. Therefore, this point needs to be taken into consideration for the shape and size of the holes and the like to be provided.
図1は、多数の孔を穿設し、又はメッシュ状に形成した強磁性体材からなる板状体である摘出生体組織載置板1と、互いに対向する位置に支柱3に固着し、前記摘出生体組織載置板1を水平方向に挿着脱可能に形成した複数の棚4を設けるとともに、上部に固定液へ浸漬する手技に用いる取っ手5を設けた籠状体2からなる摘出生体組織載置装置の構成を示す斜視図である。図示しないが、前記のとおり、摘出生体組織載置板1はメッシュ状に形成してもよい。本図に示すように、固定液浸漬にあたり、摘出生体組織6に固定液が過不足なく接するように籠状に形成してある。材質は、固定液に浸食されない物を適宜選択可能である。
FIG. 1 shows an excised living tissue mounting plate 1 which is a plate-like body made of a ferromagnetic material formed with a large number of holes or meshed, and is fixed to a
図2は、摘出生体組織6を前記摘出生体組織載置板1に載置し、摘出生体組織6の側面周囲形状に沿ってメッシュ状に形成した帯体又は多数の孔を穿設した板状体である形状保持材7で囲み、その端部を閉止した状態を示す説明図である。図3は、摘出生体組織6を形状保持材7で囲み、この状態で布8で覆い、該布8が形状保持材7の周囲に接するように、複数の磁石9で前記摘出生体組織載置板1に取着した状態を示す斜視図である。布8は、容易に固定液が浸透する例えばガーゼなどが好ましく、また、磁石9は、浸食を防ぐため合成樹脂などで被覆したものなどが望ましい。 FIG. 2 shows a plate-like body in which an excised biological tissue 6 is placed on the excised biological tissue placement plate 1 and a band or a number of holes formed in a mesh shape along the peripheral shape of the side of the excised biological tissue 6. It is explanatory drawing which shows the state which enclosed with the shape maintenance material 7 which is a body, and closed the edge part. FIG. 3 shows that the extracted living tissue 6 is surrounded by a shape holding material 7 and covered with a cloth 8 in this state, and the extracted living tissue is placed by a plurality of magnets 9 so that the cloth 8 comes into contact with the periphery of the shape holding material 7. It is a perspective view which shows the state attached to the board. The cloth 8 is preferably made of gauze or the like through which the fixing solution can easily penetrate, and the magnet 9 is preferably coated with a synthetic resin or the like to prevent erosion.
本発明に係る摘出生体組織形状保持材1及び生体組織の固定方法は、種々の病変の実態を的確に把握するうえで極めて有用であるから、手術後の再手術、薬物療法、放射線治療などの追加的治療の必要性の有無を判断する有力な資料を獲得できるので、患者の予後が幸福なものになるし、また社会的規模でみるときは、必要な医療費を低く抑えることができる利点がある。 Since the extracted biological tissue shape-retaining material 1 and the biological tissue fixing method according to the present invention are extremely useful in accurately grasping the actual condition of various lesions, reoperation after surgery, drug therapy, radiation therapy, etc. Providing powerful data to determine whether additional treatment is necessary, so the prognosis of the patient will be happier, and the benefits of keeping the necessary medical costs low on a social scale There is.
1 摘出生体組織載置板
2 籠状体
3 支柱
4 棚
5 取っ手
6 摘出生体組織
7 形状保持材
8 布
9 磁石
DESCRIPTION OF SYMBOLS 1 Extracted biological tissue mounting board 2 Rod-
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DE112010001545T5 (en) | 2009-04-07 | 2012-09-13 | Panasonic Corporation | Electronic component mounting system and electronic component mounting method |
CN104849123A (en) * | 2015-06-10 | 2015-08-19 | 孟雪 | Isolated tumor fixing device and method for producing pathological section by utilizing same |
JP2018105712A (en) * | 2016-12-26 | 2018-07-05 | 学校法人 久留米大学 | Biological specimen preparation tool and biological specimen preparation method |
CN110595864A (en) * | 2019-10-10 | 2019-12-20 | 济南瀚合医疗器械有限公司 | Endoscopic mucosa resection tissue specimen fixing plate |
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CN110595864A (en) * | 2019-10-10 | 2019-12-20 | 济南瀚合医疗器械有限公司 | Endoscopic mucosa resection tissue specimen fixing plate |
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