JP2009526558A - 直腸脱および痔核脱出の外科手術のための方法および装置 - Google Patents
直腸脱および痔核脱出の外科手術のための方法および装置 Download PDFInfo
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
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- A—HUMAN NECESSITIES
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- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
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- A—HUMAN NECESSITIES
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Abstract
【選択図】図2
Description
図1は、肛門管の縦断面の概略図である。
図2は、本発明の装置の側面図である。
図3は、図2の装置の第一の部分の透視図である。
図4は、図2の装置の第一の部分の平面図である。
図5は、図2の装置の第一の部分の断面図である。
図6は、図2の装置の第二の部分の側面図である。
図7は、図2の装置の第二の部分の透視図である。
- 一つの痔核脱出2の位置で、例えば縫合糸6を用いて、少なくとも第一の円状縫合1を実施する;
- 同位置、すなわち痔核脱出2の位置で、少なくとも第二の円状縫合4を実施する;
- 痔核脱出2を圧縮するため、第一の円状縫合1と第二の円状縫合4を近づかせる。
Claims (24)
- 患者の直腸において、痔核脱出(22)の第一の部位(2a)で少なくとも第一の円状縫合(1)を行う工程を有し、
さらに、
痔核脱出(2)の第二の部位(2b)で少なくとも第二の円状縫合(4)を行う工程と、
痔核脱出(2)を圧縮するため、前記第一の円状縫合と前記第二の円状縫合とを近づかせる工程とを有する直腸脱および痔核脱出の外科的手術のための方法。 - 前記第一の部位(2a)および前記第二の部位(2b)の間に存在する痔核脱出部分で別の円状縫合(11)を行う工程を有する、請求項1に記載の方法。
- 前記円状縫合(1、4)を行う工程は、痔核脱出(2)の主な伸長方向(X)に垂直な面に含まれる少なくとも1つのループの形成を含む、請求項1または2に記載の方法。
- 前記円状縫合(1、4)を行う工程は、痔核脱出(2)の主な伸長方向(X)に沿って重なり合うように実施される、前記請求項1〜3のいずれかに記載の方法。
- 前記円状縫合(1、4)が、単一の縫合糸(6)を用いて行われる、前記請求項1〜4のいずれかに記載の方法。
- 少なくとも第一の円状縫合(1)の工程を実施する前に、円状縫合(1、4)を近づけるときのアンカーを規定するため、痔核脱出(2)とは無関係な直腸壁部分において、少なくとも基礎的な円状縫合(14)を行う、前記請求項1〜5のいずれかに記載の方法。
- 前記の基礎的な円状縫合(14)が、肛門外口に対して痔核脱出(2)よりも奥にあたる直腸部分(5)で実施される、請求項6に記載の方法。
- 前記円状縫合(1、4)を近づかせる工程には、該円状縫合(1、4)を安定して近づかせる位置を規定するために、縫合糸(6)に結び目を作る工程が含まれる、請求項5に記載の方法。
- 円状縫合(1、4)を実施する各工程には、前記円状縫合(1、4)を引き込む工程が含まれる、請求項1〜8のいずれかに記載の方法。
- 前記縫合糸(6)には、第二の円状縫合(4)とつながっている第一端(9)があり、前記縫合糸(6)で結び目を作る工程には、前記縫合糸(6)の前記第一端(9)を前記の基礎的な円状縫合(14)内部に挿入する工程が含まれる、請求項8に記載の方法。
- 前記縫合糸(6)の結び目を作る工程には、前記円状縫合(1、4)を前記の基礎的な円状縫合(14)の方向に向けて引き上げる工程が含まれる、請求項6または10に記載の方法。
- 進行方向が長手方向の軸(Z)に沿っており、肛門外口より挿入可能な中空状のディバリケーター(17)を有し、該ディバリケーターには、手術領域を規定し、該ディバリケーター(17)の内部のキャビティ(17b)と痔核脱出部分とをつなげる窓(29)があり、手術領域を変えるために前記窓(29)を開閉するための開閉手段(31)を備えている、直腸脱あるいは痔核脱出の外科手術用装置。
- 前記窓(29)の開閉手段(31)は、少なくとも可動壁(32)を備え、前記ディバリケーター(17)とスライド可能な状態でつながっており、前記窓(29)を操作することができる、請求項12に記載の装置。
- 前記窓(29)は、第一の部分(29a)と第二の部分(29b)を備え、前記第二の部分(29b)は、長手方向の軸(Z)に平行に伸びており、前記可動壁(32)は、前記窓が開閉できるように、前記窓(29)の第二の部分(29b)を自由に動くようになっている、請求項13に記載の装置。
- 前記可動壁は、前記窓の前記第二の部分(29b)を完全に塞ぐことになる閉じた位置と、前記窓29の前記第二の部分(29b)が完全に開いている開いた位置と、からなる複数の操作位置を決めるために、ディバリケーター(17)とスライド可能な状態で接続されている、請求項14に記載の装置。
- 前記窓(29)の前記第二の部分(29b)が、前記窓(29)の前記第一の部分(29a)から前記ディバリケーター(17)の後方先端(17e)まで伸びており、前記後方先端(17e)は、肛門外口に入る前記ディバリケーター(17)の挿入方向により決められる、請求項14または15に記載の装置。
- スライドできるように前記ディバリケーター(17)に前記可動壁(32)を接続させるためのスライドガイド(32a)を有する、請求項13から16のいずれかに記載の装置。
- 前記可動壁(32)が、痔核動脈の近接を検知するためのセンサーを取り外しできるように収納する収納場所(33)をもつ、請求項13〜17のいずれかに記載の装置。
- 痔核動脈にセンサーを近づけるために、前記可動壁(32)が、外部の末端開口部(33°)を備える、請求項18に記載の装置。
- 前記可動壁(32)へのセンサーの挿入および固定を助ける目的で、前記可動壁(32)内の前記収納場所(33)は、前記ディバリケーター(17)の前記キャビティ(17b)とつながっており、前記キャビティ(17b)から直接操作できる、請求項18に記載の装置。
- 前記ディバリケーター(17)に固定された柄を備え、該柄は一対の半割状のシェル(18、21)を有すると共に、照明手段(23)を収納するための最初のシート(22)を内部に備えている、請求項12〜20に記載の装置。
- 手術工程に使用する際の誘導操作のために、前記ディバリケーター(17)の前記キャビティ(17b)の内部に固定された誘導手段(34)を有する、請求項12〜21のいずれかに記載の装置。
- 前記ディバリケーター(17)は、肛門外口の内部への該ディバリケーター(17)の挿入方向に対して正面部分(17c)が、肛門外口に挿入しやすいよう、閉じた円錐形となっている、請求項12〜22のいずれかに記載の装置。
- 肛門外口の内部への前記ディバリケーターの進入深さ(10)を調べるために、該ディバリケーターの外側に複数の校正目盛(36)がある、請求項12〜23のいずれかに記載の装置。
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PCT/IT2006/000074 WO2007094016A1 (en) | 2006-02-14 | 2006-02-14 | A process and a device for surgical treatment of rectal and haemorrhoidal prolapse |
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JP4824778B2 JP4824778B2 (ja) | 2011-11-30 |
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US (2) | US8277376B2 (ja) |
EP (3) | EP1858397B1 (ja) |
JP (1) | JP4824778B2 (ja) |
KR (1) | KR101274763B1 (ja) |
CN (1) | CN101316546B (ja) |
AT (3) | ATE507761T1 (ja) |
AU (1) | AU2006338436B2 (ja) |
BR (1) | BRPI0618702B1 (ja) |
CA (1) | CA2630015C (ja) |
DE (2) | DE602006021812D1 (ja) |
DK (2) | DK2163188T3 (ja) |
ES (2) | ES2342970T3 (ja) |
HK (1) | HK1123475A1 (ja) |
IL (1) | IL191466A (ja) |
PL (1) | PL1858397T3 (ja) |
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AT501766A1 (de) * | 2005-01-25 | 2006-11-15 | Ami Gmbh | Einrichtung zur verwendung bei der behandlung eines hämorrhoidenprolaps |
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Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2012504452A (ja) * | 2008-10-06 | 2012-02-23 | ティアッカディ ソチエタ ペル アツィオニ | 脱出の外科手術のための装置 |
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