JP2012019841A - Anastomosis device - Google Patents

Anastomosis device Download PDF

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JP2012019841A
JP2012019841A JP2010158239A JP2010158239A JP2012019841A JP 2012019841 A JP2012019841 A JP 2012019841A JP 2010158239 A JP2010158239 A JP 2010158239A JP 2010158239 A JP2010158239 A JP 2010158239A JP 2012019841 A JP2012019841 A JP 2012019841A
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anastomosis
anastomosis device
state
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engaged
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Masatoshi Iida
雅敏 飯田
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Olympus Corp
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Abstract

PROBLEM TO BE SOLVED: To provide an anastomosis device which prevents a treatment condition from being released even when an external force is applied after treatment and is structured so as to be downsized.SOLUTION: The anastomosis device 1 is structured so as to make a needlelike portion 2a pierce a subject of anastomosis and anastomose the subject of anastomosis jointly with the other end in the process of the one end provided with the needlelike portion 2a moving to the other end. In other words, the anastomosis device is provided with a first holding portion 4a provided in the region between the one end and the other end and a second holding portion 4b provided in the region facing the first holding portion 4a while anastomosing the subject of anastomosis and holding the anastomosing condition by engaging with the first holding portion 4a.

Description

本発明は、例えば生体組織等の吻合対象物を吻合する為の吻合デバイスに関する。   The present invention relates to an anastomosis device for anastomosing an anastomosis object such as a living tissue.

２つの管状体（例えば血管など）を相互に連結する外科手術として、吻合術が知られている。この吻合術では、連結した管状体の内腔内を流体が流れるように、２つの管状体を吻合して連結する。この吻合術では、前記連結に係る部位において流体が漏れることがないように吻合しなくてはならない。   Anastomosis is known as a surgical operation for connecting two tubular bodies (for example, blood vessels) to each other. In this anastomosis, two tubular bodies are anastomosed and connected so that fluid flows in the lumens of the connected tubular bodies. In this anastomosis, the anastomosis must be performed so that fluid does not leak at the site related to the connection.

このような吻合術は、心臓の閉塞をバイパスする為に多く用いられている。例えば、冠動脈バイパス移植術（ＣＡＢＧ術）においては、移植用血管を、閉塞部位の下流側の冠動脈に吻合し、大動脈血液を移植用血管に通して冠動脈の閉塞部を迂回させる。
このような吻合術で用いられている具体的な吻合方法としては、例えば手技による血管の縫合を挙げることができる。しかしながら、手技による血管の縫合には次のような欠点がある。すなわち、煩雑且つ時間が掛かり、外科医の経験と技術に大きく依存してしまう。また、このような手技による血管の縫合は、鼓動している心臓のＣＡＢＧ術において特に困難である。 Such anastomosis is often used to bypass heart occlusion. For example, in coronary artery bypass grafting (CABG), the graft blood vessel is anastomosed to the coronary artery downstream of the occlusion site, and aortic blood is passed through the graft blood vessel to bypass the coronary artery obstruction.
As a specific anastomosis method used in such an anastomosis, for example, a suture of a blood vessel by a technique can be mentioned. However, the suture of the blood vessel by the procedure has the following drawbacks. That is, it is cumbersome and time consuming, and relies heavily on the experience and skill of the surgeon. In addition, the suturing of blood vessels by such a technique is particularly difficult in the CABG operation of the beating heart.

このような事情を鑑みて、例えば特許文献１には、ＣＡＢＧ術に用いられる次のような外科用クリップが開示されている。すなわち、吻合対象物である血管を穿刺する為の針部が一端に形成され、他端には血管を把持する為の把持部が形成されている外科用クリップが特許文献１に開示されている。   In view of such circumstances, for example, Patent Document 1 discloses the following surgical clip used in CABG surgery. That is, Patent Document 1 discloses a surgical clip in which a needle portion for puncturing a blood vessel that is an anastomosis target is formed at one end and a grip portion for grasping a blood vessel is formed at the other end. .

詳細には、特許文献１に開示されている外科用クリップは、ステンレス鋼等の金属から成り、一端には対象物としての血管を刺すための針部が設けられており、他端には血管を把持するための把持部が設けられている。そして、所定のアプリケータを用いて当該外科用クリップを塑性変形させて、針部の末端点で組織を穿刺して貫通し、クリップ本体の内面と外面とで血管を把持することで吻合し、その状態を保持する。   Specifically, the surgical clip disclosed in Patent Document 1 is made of a metal such as stainless steel, and is provided with a needle portion for piercing a blood vessel as an object at one end and a blood vessel at the other end. A gripping part for gripping is provided. And by plastically deforming the surgical clip using a predetermined applicator, puncturing the tissue at the end point of the needle part, anastomosing by grasping the blood vessel between the inner surface and the outer surface of the clip body, Hold that state.

この特許文献１に開示されている外科用クリップは、その構造上、吻合処置後に外力が加わった場合に、前記把持に係る部分が広がってしまうことで、針部が血管から外れてしまう可能性がある。つまり、処置後の外乱要因により、当該処置状態が解除されてしまう可能性がある。   The surgical clip disclosed in Patent Document 1 has a structure that, when an external force is applied after an anastomosis procedure, the needle portion may be detached from the blood vessel when the gripping portion expands. There is. That is, the treatment state may be canceled due to a disturbance factor after the treatment.

ところで、処置後の状態が安定的に維持されるデバイスとして、特許文献２に次のような技術が開示されている。すなわち、特許文献２には、生体組織を外側から挟持することにより前記生体組織を結紮して止血等を行なう組織結紮具が開示されている。具体的には、一対の把持部材を互いに回動自在に交差して接続することにより構成される結紮具本体と、この結紮具本体の一端における前記一対の把持部材の端部から成る開閉自在な結紮部と、前記結紮具本体の他端に設けられ前記結紮部を閉じた状態で前記把持部材を保持する保持手段と、を具備する組織結紮具が開示されている。このような構造を採ることで、特許文献２に開示されている組織結紮具によれば、高い結紮力を得られ、処置後の状態が安定的に保持され得る。   By the way, the following technique is disclosed by patent document 2 as a device by which the state after treatment is stably maintained. That is, Patent Document 2 discloses a tissue ligation tool that performs hemostasis and the like by ligating the living tissue by pinching the living tissue from the outside. Specifically, the ligation tool main body constituted by connecting a pair of gripping members so as to be able to rotate and cross each other, and an openable / closable structure comprising the ends of the pair of gripping members at one end of the ligation tool main body. There is disclosed a tissue ligation tool comprising a ligation part and a holding means that is provided at the other end of the ligation tool body and holds the gripping member in a state where the ligation part is closed. By adopting such a structure, according to the tissue ligation tool disclosed in Patent Document 2, a high ligation force can be obtained and the state after treatment can be stably maintained.

米国特許第６２５４６１５号明細書US Pat. No. 6,254,615 特開平６−２３３７７４号公報JP-A-6-233774

ところで、特許文献２に開示されている組織結紮具では、当該組織結紮具本体の一端に設けられた開閉自在な結紮部を閉じた状態（即ち結紮状態）に保持するための保持手段が当該組織結紮具本体の他端（当該組織結紮具本体の外側）に設けられている。このような構造は、結紮力を向上させる上で有効な構造である一方、小型化が困難な構造でもある。そして、上述したような用いられ方をするデバイスである以上、小型化が困難であることは大きなデメリットである。   By the way, in the tissue ligation tool disclosed in Patent Document 2, the holding means for holding the openable / closable ligation portion provided at one end of the tissue ligature body in a closed state (that is, a ligated state) It is provided at the other end of the ligation tool body (outside the tissue ligation tool body). Such a structure is an effective structure for improving the ligation force, but is also a structure that is difficult to reduce in size. And since it is a device used as mentioned above, it is a big demerit that size reduction is difficult.

本発明は、前記の事情に鑑みて為されたものであり、処置後に外力が加わった場合であっても当該処置状態が解除されることなく、且つ、小型化が容易な吻合デバイスを提供することを目的とする。   The present invention has been made in view of the above circumstances, and provides an anastomosis device that is easy to miniaturize without releasing the treatment state even when an external force is applied after the treatment. For the purpose.

前記の目的を達成するために、本発明の第１の態様による吻合デバイスは、
穿刺部が設けられた一端が他端に向かって移動する過程で、前記穿刺部が吻合対象物を穿刺して前記他端と共に前記吻合対象物を吻合する吻合デバイスであって、
前記一端と前記他端との間の部位に設けられた係合部と、
前記吻合対象物を吻合した状態において前記係合部と対向する部位に設けられ、前記係合部と係合することで当該吻合した状態を保持する被係合部と、
を具備することを特徴とする。 In order to achieve the above object, an anastomosis device according to the first aspect of the present invention comprises:
In the process in which one end provided with the puncture part moves toward the other end, the puncture part punctures the anastomosis object, and anastomoses the anastomosis object together with the other end,
An engaging portion provided at a portion between the one end and the other end;
An engaged portion that is provided in a portion facing the engaging portion in a state where the anastomosing object is anastomosed, and holds the anastomosed state by engaging with the engaging portion;
It is characterized by comprising.

本発明によれば、処置後に外力が加わった場合であっても当該処置状態が解除されることなく、且つ、小型化が容易な吻合デバイスを提供することができる。   According to the present invention, it is possible to provide an anastomosis device that is easy to miniaturize without being released from the treatment state even when an external force is applied after the treatment.

本発明の一実施形態に係る吻合デバイス（閉状態時）の一構成例を示す図。The figure which shows the example of 1 structure of the anastomosis device (at the time of a closed state) which concerns on one Embodiment of this invention. 本発明の一実施形態に係る吻合デバイス（開状態時）の一構成例を示す図。The figure which shows the example of 1 structure of the anastomosis device (at the time of an open state) which concerns on one Embodiment of this invention. 吻合デバイスにおける針状部及び組織支持部近傍の拡大図。The enlarged view of the needle-shaped part and tissue support part vicinity in an anastomosis device. 本発明の一実施形態に係る吻合デバイスによる特有の作用を示す図。The figure which shows the characteristic effect | action by the anastomosis device which concerns on one Embodiment of this invention. 本発明の一実施形態に係る吻合デバイスによる冠動脈バイパス手術を示す図。The figure which shows the coronary artery bypass surgery by the anastomosis device which concerns on one Embodiment of this invention. 第１変形例に係る吻合デバイスの一構成例を示す上面図。The top view which shows the example of 1 structure of the anastomosis device which concerns on a 1st modification. 閉状態時の第２変形例に係る吻合デバイスの上面図。The top view of the anastomosis device concerning the 2nd modification at the time of a closed state. 開状態時の第２変形例に係る吻合デバイスの上面図。The top view of the anastomosis device concerning the 2nd modification at the time of an open state. 吻合状態時の第２変形例に係る吻合デバイスの保持手段に係る側断面図。The sectional side view concerning the holding means of the anastomosis device concerning the 2nd modification at the time of an anastomosis state. 開状態時の第２変形例に係る吻合デバイスの斜視図。The perspective view of the anastomosis device concerning the 2nd modification at the time of an open state. 第３変形例に係る吻合デバイスの一構成例を示す上面図。The top view which shows the example of 1 structure of the anastomosis device which concerns on a 3rd modification. 吻合処置後の孔部及び凸部の側面図。The side view of the hole and convex part after an anastomosis treatment. 第４変形例に係る吻合デバイスの一構成例を示す上面図。The top view which shows the example of 1 structure of the anastomosis device which concerns on a 4th modification.

以下、図面を参照して本発明の実施形態について説明する。
以下、本発明の一実施形態に係る吻合デバイスについて、図面を参照して説明する。本一実施形態に係る吻合デバイスは、吻合対象物として、例えば生体組織（特に血管）等を想定している。
図１及び図２は、本発明の一実施形態に係る吻合デバイス（図１は閉状態時、図２は開状態時；詳細は後述する）の一構成例を示す図である。図１及び図２のそれぞれにおいて、当該吻合デバイスの上面図（平面視図）と側面図とを上下に並べて示し、且つ、破線によってそれらの対応関係を示している。まず、本一実施形態に係る吻合デバイスの“閉状態”と“開状態”とについて説明する。 Hereinafter, embodiments of the present invention will be described with reference to the drawings.
Hereinafter, an anastomosis device according to an embodiment of the present invention will be described with reference to the drawings. The anastomosis device according to the present embodiment assumes, for example, a living tissue (particularly blood vessel) as an anastomosis target.
1 and 2 are diagrams showing an example of the configuration of an anastomosis device (FIG. 1 in a closed state, FIG. 2 in an open state; details will be described later) according to an embodiment of the present invention. In each of FIG. 1 and FIG. 2, a top view (plan view) and a side view of the anastomosis device are shown side by side, and their corresponding relationship is indicated by a broken line. First, the “closed state” and “open state” of the anastomosis device according to the present embodiment will be described.

“閉状態”とは、後述する針状部２ａと組織支持部２ｂとが径方向において重複しており、後述する第１保持部４ａと第２保持部４ｂとが係合した状態であり、本一実施形態においては略楕円環状を呈する状態である。なお、閉状態時に呈する形状としては、図１に示すような略楕円環状の他、例えば矩形状等の他の形状であっても勿論よい。
“開状態”とは、初期状態（何ら外力が印加されていない状態）のことであり、後述する針状部２ａと組織支持部２ｂとが図２に示すように互いに離間した状態である。 The “closed state” is a state in which a needle-like part 2a and a tissue support part 2b, which will be described later, overlap in the radial direction, and a first holding part 4a and a second holding part 4b which will be described later are engaged. In this embodiment, it is a state which exhibits a substantially elliptical ring shape. In addition, as a shape shown at the time of a closed state, other shapes, such as a rectangular shape, for example besides the substantially elliptical ring shape as shown in FIG.
The “open state” is an initial state (a state in which no external force is applied), and is a state in which a needle-like part 2a and a tissue support part 2b described later are separated from each other as shown in FIG.

吻合デバイス１の初期状態をこのような開状態とする為に、前記吻合デバイス１は例えば次のように製造される。すなわち、弾性を有する材料（例えばＮｉ−Ｔｉ）のシート材から、例えばレーザ加工等によって開状態の形状に成形されて（当該吻合デバイス１全体が一体成形されて）製造される。この開状態における開き角度（針状部２ａと組織支持部２ｂとの離間具合）については、上述の成形時に所望の角度に設定することができる。   In order to set the initial state of the anastomosis device 1 to such an open state, the anastomosis device 1 is manufactured as follows, for example. That is, the sheet is made of an elastic material (for example, Ni—Ti) and formed into an open shape by, for example, laser processing (the entire anastomosis device 1 is integrally formed). The opening angle in this open state (the degree of separation between the needle-like part 2a and the tissue support part 2b) can be set to a desired angle during the molding described above.

具体的には、本一実施形態に係る吻合デバイス１の材料としては、超弾性合金（例えばチタン合金、より詳しくはＮｉ−Ｔｉを一例としてあげることができる）が好ましい。しかしながら、これらの材料に限られないことは勿論である。
図１及び図２に示すように本一実施形態に係る吻合デバイス１は、曲部１２を境にして一方側に、針状部２ａと第１把持部３ａと第１保持部４ａとを具備し、且つ、曲部１２を境にして他方側に、組織支持部２ｂと第２把持部３ｂと第２保持部４ｂとを具備する。以降、曲部１２側を“基端側”と称し、針状部２ａ及び組織支持部２ｂが設けられている部位側を“末梢側”と称する。 Specifically, the material of the anastomosis device 1 according to the present embodiment is preferably a superelastic alloy (for example, titanium alloy, more specifically, Ni—Ti can be mentioned as an example). However, it is needless to say that the material is not limited to these materials.
As shown in FIGS. 1 and 2, the anastomosis device 1 according to the present embodiment includes a needle-like part 2a, a first holding part 3a, and a first holding part 4a on one side of the curved part 12 as a boundary. In addition, the tissue support portion 2b, the second grasping portion 3b, and the second holding portion 4b are provided on the other side with the curved portion 12 as a boundary. Hereinafter, the curved portion 12 side is referred to as “proximal end side”, and the site side where the needle-like portion 2a and the tissue support portion 2b are provided is referred to as “peripheral side”.

前記針状部２ａは、次のように形成された穿刺部材である。すなわち、図１に示すように略楕円環状を呈する当該吻合デバイス１のうち曲部１２に対向する部位が、外周面から内周面に向かって（径方向内側に）所定の傾きで切り込まれ、所定の長さを有する略弧状を呈するように成形されることで、前記針状部２ａ及び前記組織支持部２ｂが形成されている。   The needle-like part 2a is a puncture member formed as follows. That is, as shown in FIG. 1, a portion of the anastomosis device 1 that has a substantially elliptical annular shape is cut at a predetermined inclination from the outer peripheral surface toward the inner peripheral surface (inward in the radial direction). The needle-like portion 2a and the tissue support portion 2b are formed by being formed so as to exhibit a substantially arc shape having a predetermined length.

このように前記針状部２ａが形成されることで、図１及び図３に示すような閉状態において、組織支持部２ｂが針状部２ａの内側（当該吻合デバイス１の内径側）に位置する構成となる。図３は針状部２ａ及び組織支持部２ｂ近傍の拡大図である。
ここで、吻合デバイス１の末梢側には、図１〜図３に示すように端線２Ｔｅに向かって厚みが減少するテーパ部２Ｔが形成されている。そして、当該テーパ部２Ｔの端線２Ｔｅ上に、針状部２ａの穿刺要素先端２ａ１（図３参照）が形成されている。 By forming the needle-like part 2a in this way, the tissue support part 2b is positioned inside the needle-like part 2a (inner diameter side of the anastomosis device 1) in the closed state as shown in FIGS. It becomes the composition to do. FIG. 3 is an enlarged view of the vicinity of the needle-like part 2a and the tissue support part 2b.
Here, on the distal side of the anastomosis device 1, as shown in FIGS. 1 to 3, a tapered portion 2T whose thickness decreases toward the end line 2Te is formed. And the puncture element front-end | tip 2a1 (refer FIG. 3) of the needle-like part 2a is formed on the end line 2Te of the said taper part 2T.

このようにテーパ部２Ｔの端線２Ｔｅ上に針状部２ａの穿刺要素先端２ａ１を形成することで、穿刺要素先端２ａ１を、三次元的に鋭利な形状を呈するように形成することができる。つまり、針状部２ａの穿刺力を向上させることができる。
詳細には、当該吻合デバイス１を、例えば研磨加工等により当該吻合デバイス１の内周面から外周面に向かって厚みが減少するようテーパ状に加工する。このように加工することで、針状部２ａの先端を鋭利な形状に形成することができる。また、当該吻合デバイス１を、テーパ部２Ｔが形成されたシート材から、針状部２ａの穿刺要素先端２ａ１が三次元的に尖鋭形状を呈するように、レーザ加工等によって切り出してもよい。また、例えば弾性を有する棒状部材を加工することで当該吻合デバイス１を形成しても勿論良い。 Thus, by forming the puncture element tip 2a1 of the needle-like portion 2a on the end line 2Te of the taper portion 2T, the puncture element tip 2a1 can be formed to have a three-dimensional sharp shape. That is, the puncture force of the needle-like part 2a can be improved.
Specifically, the anastomosis device 1 is processed into a taper shape so that the thickness decreases from the inner peripheral surface to the outer peripheral surface of the anastomosis device 1 by, for example, polishing. By processing in this way, the tip of the needle-like part 2a can be formed into a sharp shape. Further, the anastomosis device 1 may be cut out from the sheet material on which the tapered portion 2T is formed by laser processing or the like so that the puncture element tip 2a1 of the needle-like portion 2a has a three-dimensional sharp shape. Further, for example, the anastomosis device 1 may be formed by processing a rod-like member having elasticity.

前記組織支持部２ｂは、吻合処置後の吻合対象物を針状部２ａと共に支持する。
前記第１把持部３ａは、針状部２ａのうち閉状態時に組織支持部２ｂと重複する部位近傍において、当該吻合デバイス１の径方向内側に凸に設けられた突出部である。
前記第２把持部３ｂは、組織支持部２ｂのうち閉状態時に針状部２ａと重複する部位近傍において、当該吻合デバイス１の径方向内側に凸に設けられた突出部である。 The tissue support part 2b supports the anastomosis target object after the anastomosis treatment together with the needle-like part 2a.
The first grasping portion 3a is a protruding portion that is provided on the radially inward side of the anastomosis device 1 in the vicinity of a portion of the needle-like portion 2a that overlaps the tissue support portion 2b when closed.
The second grasping portion 3b is a projecting portion provided on the radially inward side of the anastomosis device 1 in the vicinity of a portion of the tissue support portion 2b that overlaps the needle-like portion 2a when closed.

詳細には、図３に示すように前記第１把持部３ａ及び前記第２把持部３ｂは互いに対向する面をそれぞれ備え（第１把持面３ａｆ、第２把持面３ｂｆ）、それらによって、吻合処置後の吻合対象物を挟持する。つまり、前記第１把持面３ａｆ及び前記第２把持面３ｂｆは、吻合処置後の吻合対象物に対して互いに逆側から（挟み込むように）それぞれ当接する。   Specifically, as shown in FIG. 3, the first gripping portion 3a and the second gripping portion 3b are provided with surfaces facing each other (a first gripping surface 3af and a second gripping surface 3bf), and thereby, an anastomosis treatment is performed. A later anastomosis object is clamped. That is, the first gripping surface 3af and the second gripping surface 3bf are in contact with the anastomosis target object after the anastomosis treatment from the opposite side (so as to be sandwiched).

前記第１保持部４ａは、当該吻合デバイス１のうち曲部１２と針状部２ａと間の部位に設けられており、後述する第２保持部４ｂと係合する楔形状を呈する突起部である。
前記第２保持部４ｂは、当該吻合デバイス１のうち曲部１２と組織支持部２ｂとの間の部位であって、吻合状態時に前記第１保持部４ａに対して対向する部位に設けられており、第１保持部４ａと係合する楔形状を呈する突起部である。 The first holding portion 4a is provided at a portion of the anastomosis device 1 between the curved portion 12 and the needle-like portion 2a, and is a protruding portion having a wedge shape that engages with a second holding portion 4b described later. is there.
The second holding part 4b is provided in a part of the anastomosis device 1 between the curved part 12 and the tissue support part 2b and facing the first holding part 4a in the anastomosis state. And a protrusion having a wedge shape that engages with the first holding portion 4a.

換言すれば、第１保持部４ａと第２保持部４ｂとの関係は、係合部と被係合部との関係である。
なお、第１保持部４ａ及び第２保持部４ｂを設ける部位は、当該吻合デバイス１の内径側において、吻合状態時に互いに対向する部位（吻合デバイス１を２分する中心線ｃについて線対称の位置）である。 In other words, the relationship between the first holding portion 4a and the second holding portion 4b is the relationship between the engaging portion and the engaged portion.
In addition, the site | part which provides the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b is a position symmetrical with respect to the site | part (the center line c which bisects the anastomosis device 1) mutually opposing in the inner diameter side of the said anastomosis device 1 ).

本一実施形態に係る吻合デバイスでは、第１保持部４ａと第２保持部４ｂとは所謂ラチェット機構を構成している。上述したように吻合デバイス１は、開状態に変形する付勢力を有している。従って、第１保持部４ａと第２保持部４ｂとが係合した後、この付勢力により（開状態に戻ろうとする力により）、互いの楔形状が強く噛み合うことで、当該係合状態が強固に保持される。   In the anastomosis device according to this embodiment, the first holding part 4a and the second holding part 4b constitute a so-called ratchet mechanism. As described above, the anastomosis device 1 has a biasing force that deforms into an open state. Accordingly, after the first holding part 4a and the second holding part 4b are engaged, the engagement state is strongly engaged with each other by the biasing force (by the force to return to the open state). Firmly held.

以下、本一実施形態に係る吻合デバイスによる特有の作用について詳細に説明する。
まず、吻合デバイス１に外力が印加されていない場合、上述の弾性力により吻合デバイス１は図２に示す開状態を呈する。このとき、第１保持部４ａと第２保持部４ｂとは互いに離間した状態である。当然ながら、針状部２ａと組織支持部２ｂとについても互いに離間した状態であり、第１把持部３ａと第２把持部３ｂとについても互いに離間した状態である。 Hereinafter, a specific action of the anastomosis device according to the present embodiment will be described in detail.
First, when an external force is not applied to the anastomosis device 1, the anastomosis device 1 exhibits the open state shown in FIG. At this time, the first holding unit 4a and the second holding unit 4b are in a state of being separated from each other. Naturally, the needle-like part 2a and the tissue support part 2b are also separated from each other, and the first grasping part 3a and the second grasping part 3b are also separated from each other.

この開状態の吻合デバイス１の針状部２ａと組織支持部２ｂとの間に、吻合対象物（例えば図４に示す膜組織ｔ１，ｔ２）を挿入する。そして、不図示の鉗子・鑷子等を用いて、当該吻合デバイス１の外側を挟持して、上述の付勢力に抗する方向に力を印加する。換言すれば、図１に示す閉状態へ変形させるように外力を加える。   An anastomosis object (for example, membrane tissues t1 and t2 shown in FIG. 4) is inserted between the needle-like part 2a and the tissue support part 2b of the opened anastomosis device 1. Then, force is applied in a direction against the above-described urging force by sandwiching the outside of the anastomosis device 1 using forceps, a lever, etc. (not shown). In other words, an external force is applied so as to deform the closed state shown in FIG.

この操作により、当該吻合デバイス１自身が有する付勢力に抗して、針状部２ａと組織支持部２ｂとが互いに近接する状態へ変形し、針状部２ａの穿刺要素先端２ａ１が吻合処置対象物（図４に示す例では、膜組織ｔ１，ｔ２）を貫通した後、当該針状部２ａの第１把持部３ａと組織支持部２ｂの第２把持部３ｂとが、膜組織ｔ１，ｔ２を、互いに対向する側から把持する。換言すれば、図４に示すように、第１把持面３ａｆと第２把持面３ｂｆとによって、吻合処置対象物である膜組織ｔ１，ｔ２が挟持される。   By this operation, the needle-like part 2a and the tissue support part 2b are deformed to be close to each other against the biasing force of the anastomosis device 1 itself, and the puncture element tip 2a1 of the needle-like part 2a is subjected to the anastomosis treatment target. After penetrating an object (in the example shown in FIG. 4, the membrane tissues t1 and t2), the first grasping portion 3a of the needle-like portion 2a and the second grasping portion 3b of the tissue support portion 2b become the membrane tissues t1 and t2. Are gripped from opposite sides. In other words, as shown in FIG. 4, the membrane tissues t <b> 1 and t <b> 2 that are the anastomosis treatment objects are sandwiched between the first grasping surface 3 af and the second grasping surface 3 bf.

この状態においては、第１把持部３ａと第２把持部３ｂとが吻合処置対象物である膜組織ｔ１，ｔ２に対してストッパーの機能を果たすので、吻合処置後の吻合デバイス１が回転してしまうことを防止し、吻合処置後の状態を安定して維持する。つまり、吻合デバイス１は、２枚の膜組織ｔ１，ｔ２を各一面同士を合わせた状態で吻合した後、第１把持面３ａｆと第２把持面３ｂｆとによって挟持することで当該吻合状態を維持する。   In this state, the first grasping portion 3a and the second grasping portion 3b serve as a stopper for the membrane tissues t1 and t2 that are the anastomosis treatment objects, so that the anastomosis device 1 after the anastomosis treatment rotates. And maintain a stable state after the anastomosis treatment. That is, the anastomosis device 1 maintains the anastomosis state by anastomosing the two membrane tissues t1 and t2 in a state where the respective surfaces are aligned with each other and then sandwiching the membrane tissue between the first grasping surface 3af and the second grasping surface 3bf. To do.

ところで、この吻合状態においては、上述したように第１保持部４ａと第２保持部４ｂとが係合する。詳細には、第１保持部４ａと第２保持部４ｂとは上述したようにラチェット機構を構成し、当該吻合デバイス１自身が有する弾性力に抗して当該係合状態を維持している。   By the way, in this anastomosis state, as mentioned above, the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b engage. In detail, the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b comprise a ratchet mechanism as mentioned above, and maintain the said engagement state against the elastic force which the said anastomosis device 1 itself has.

このように第１保持部４ａと第２保持部４ｂとは強固に噛み合った状態であり、当該吻合状態が安定的に保持される。従って、吻合処置後の吻合デバイス１に外力が加わった場合であっても、当該吻合状態が解除されてしまうことが抑制される。
以下、本一実施形態に係る吻合デバイスによる血管吻合処置について、冠動脈バイパス手術を例に、図５を参照して具体的に説明する。 Thus, the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b are the states meshed | engaged firmly, and the said anastomosis state is hold | maintained stably. Therefore, even when an external force is applied to the anastomosis device 1 after the anastomosis treatment, the anastomosis state is prevented from being released.
Hereinafter, the blood vessel anastomosis treatment by the anastomosis device according to the present embodiment will be specifically described with reference to FIG. 5 by taking coronary artery bypass surgery as an example.

まず、術者は、冠動脈１１１を切開して開口部１１１Ｈを形成する。続いて、冠動脈１１１の開口部１１１Ｈの縁部である開口縁１１１ｈと、バイパス血管であるグラフト１１３の開口縁１１３ｈと、の位置合わせを行う。
この位置合わせにおいては、冠動脈１１１の開口縁１１１ｈと、グラフト１１３の開口縁１１３ｈと、をそれぞれ捲り上げ、この捲り上げにより露出させた冠動脈１１１の開口縁１１１ｈの内面と、グラフト１１３の開口縁１１３ｈの内面と、を当接させる。以降、この当接部位を吻合対象部位と称する。 First, the operator cuts through the coronary artery 111 to form the opening 111H. Subsequently, alignment of the opening edge 111h that is the edge of the opening 111H of the coronary artery 111 and the opening edge 113h of the graft 113 that is a bypass blood vessel is performed.
In this alignment, the opening edge 111h of the coronary artery 111 and the opening edge 113h of the graft 113 are raised, and the inner surface of the opening edge 111h of the coronary artery 111 and the opening edge 113h of the graft 113 exposed by this raising. And the inner surface of the. Hereinafter, this contact part is referred to as an anastomosis target part.

そして、この状態において、複数の吻合デバイス１により冠動脈１１１とグラフト１１３とを吻合処置する。具体的には、次のように吻合処置する。
上述したように、吻合デバイス１は初期状態においては、針状部２ａと組織支持部２ｂとは離間している。術者は、この針状部２ａと組織支持部２ｂとの間の離間部位（第１把持部３ａと第２把持部３ｂとの離間部位）に、冠動脈１１１及びグラフト１１３の前記吻合対象部位を挿入する。 In this state, the coronary artery 111 and the graft 113 are anastomosed with the plurality of anastomosis devices 1. Specifically, an anastomosis is performed as follows.
As described above, in the initial state of the anastomosis device 1, the needle-like part 2a and the tissue support part 2b are separated from each other. The surgeon places the anastomosis target sites of the coronary artery 111 and the graft 113 in the spaced portion (the separated portion between the first gripping portion 3a and the second gripping portion 3b) between the needle-like portion 2a and the tissue support portion 2b. insert.

続いて、術者は、例えばピンセットや挟み手段を有するマニピュレータやアプリケータ等の器具を利用して、当該吻合デバイス１の外側を挟持して、上述の付勢力に抗する方向に力を印加する（吻合状態／閉状態へ変形させるように外力を印加する）。
この変形過程において、針状部２ａが吻合対象部位（冠動脈１１１の開口縁１１１ｈ及びグラフト１１３の開口縁１１３ｈ）を貫通し、且つ、針状部２ａの第１把持部３ａと組織支持部２ｂの第２把持部３ｂとが当該吻合対象部位を挟持する。 Subsequently, the surgeon clamps the outside of the anastomosis device 1 using an instrument such as a manipulator or an applicator having tweezers or pinching means, for example, and applies a force in a direction against the urging force. (External force is applied to deform the anastomosis state / closed state).
In this deformation process, the needle-like part 2a penetrates the site to be anastomosed (the opening edge 111h of the coronary artery 111 and the opening edge 113h of the graft 113), and the first grasping part 3a of the needle-like part 2a and the tissue support part 2b The second grasping portion 3b holds the anastomosis target portion.

換言すれば、針状部２ａが吻合対象部位を貫通した後、第１把持面３ａｆと第２把持面３ｂｆとが、互いに対向する側から当該吻合対象部位を挟みこんで把持する。
そして、この吻合状態においては、第１保持部４ａと第２保持部４ｂとがラチェット機構を構成して、各楔形状が当該吻合デバイス１自身が有する弾性力に抗して係合する。このように第１保持部４ａと第２保持部４ｂとが強固に噛み合った状態になる為、上述のように吻合と共に把持された状態が安定的に保持される。 In other words, after the needle-like portion 2a penetrates the anastomosis target site, the first gripping surface 3af and the second gripping surface 3bf sandwich and hold the anastomosis target site from the opposite sides.
In this anastomosis state, the first holding part 4a and the second holding part 4b constitute a ratchet mechanism, and each wedge shape engages against the elastic force of the anastomosis device 1 itself. As described above, the first holding portion 4a and the second holding portion 4b are firmly engaged with each other, so that the state held together with the anastomosis as described above is stably held.

以上説明した吻合デバイス１による吻合処置を、図５に示すように複数箇所において行うことで、冠動脈バイパス手術が完了する。
なお、１度に１つの吻合デバイス１による吻合処置を複数回繰り返してもよいし、複数の吻合デバイス１の吻合操作を同時に行うことが可能なアプリケータを用いることで、１度に複数の吻合デバイス１による吻合処置を行っても勿論よい。 The anastomosis treatment by the anastomosis device 1 described above is performed at a plurality of locations as shown in FIG.
In addition, the anastomosis treatment by one anastomosis device 1 may be repeated a plurality of times at once, or a plurality of anastomoses may be performed at a time by using an applicator capable of simultaneously performing the anastomosis operation of the plurality of anastomosis devices 1. Of course, the anastomosis treatment by the device 1 may be performed.

以上説明したように、本一実施形態によれば、処置後に外力が加わった場合であっても当該処置状態が解除されることなく、且つ、小型化が容易な構造の吻合デバイスを提供することができる。具体的には、例えば次のような効果を奏する。
・第１保持部４ａと第２保持部４ｂとから成る保持手段を、当該吻合デバイス１の内径側において針状部２ａ及び組織支持部２ｂとは別体として設けている為、吻合処置後に外力が加わった場合であっても針状部２ａが吻合対象物から外れにくく且つ小型化が容易である。
・第１保持部４ａと第２保持部４ｂとから成るラチェット機構が当該吻合デバイス１の外側に突出していない為、これらが作業を阻害することも処置後に邪魔になることもない。
・上述の弾性力に抗して第１保持部４ａと第２保持部４ｂとが係合することにより、係合後においては上述の弾性力が作用して第１保持部４ａと第２保持部４ｂとが強固に噛み合い、当該吻合状態が安定的に保持される。
・一対の把持部（第１把持部３ａ、第２把持部３ｂ）によって、吻合処置後に吻合対象部位を把持することで、吻合状態を安定させることができる。従って、当該吻合デバイス１が吻合処置後に回転等してしまうことを防止することができる。
・針状部２ａを、図１に示すように側面から観て基端側から抹消側へ向かって厚みが薄くなるテーパ形状とすることで、針状部２ａの穿刺要素先端２ａ１を尖鋭に形成することができ、穿刺力を高めることができる。
・一対の把持部（第１把持部３ａ、第２把持部３ｂ）によって、吻合対象部位への針状部２ａの刺さりこみがより容易になる。これは、針状部２ａによる穿刺時に、一対の把持部（第１把持部３ａ、第２把持部３ｂ）によって、吻合対象部位が逃げないように押さえられるからである。 As described above, according to the present embodiment, it is possible to provide an anastomosis device having a structure that is easy to miniaturize without releasing the treatment state even when an external force is applied after the treatment. Can do. Specifically, for example, the following effects can be obtained.
Since the holding means composed of the first holding part 4a and the second holding part 4b is provided separately from the needle-like part 2a and the tissue support part 2b on the inner diameter side of the anastomosis device 1, external force is applied after the anastomosis treatment. Even if is added, the needle-like part 2a is unlikely to be detached from the anastomosis target and can be easily downsized.
-Since the ratchet mechanism which consists of the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b does not protrude outside the said anastomosis device 1, these do not disturb work and do not become obstructive after treatment.
-The first holding part 4a and the second holding part 4b are engaged against the above-described elastic force, so that the first holding part 4a and the second holding part are acted upon after the engagement by the above-mentioned elastic force. The part 4b meshes firmly, and the anastomosis state is stably maintained.
The anastomosis state can be stabilized by gripping the anastomosis target site after the anastomosis treatment by the pair of gripping portions (first gripping portion 3a, second gripping portion 3b). Therefore, the anastomosis device 1 can be prevented from rotating after the anastomosis treatment.
・ As shown in FIG. 1, the needle-like portion 2a has a tapered shape with a thickness that decreases from the base end side to the peripheral side when viewed from the side surface, thereby sharply forming the puncture element tip 2a1 of the needle-like portion 2a. And the puncture force can be increased.
The pair of gripping parts (first gripping part 3a and second gripping part 3b) makes it easier to insert the needle-like part 2a into the site to be anastomosed. This is because at the time of puncturing with the needle-like part 2a, the pair of gripping parts (the first gripping part 3a and the second gripping part 3b) are pressed so that the site to be anastomosed does not escape.

ところで、前記テーパ部２Ｔは必須な構成要件ではなく、前記テーパ部２Ｔを形成せずとも、処置後に外力が加わった場合であっても当該処置状態が解除されることなく、且つ、小型化が容易な構造の吻合デバイスを提供することができる。
また、第１把持部３ａ及び第２把持部３ｂも必須な構成要件ではなく、それらを設けずとも、処置後に外力が加わった場合であっても当該処置状態が解除されることなく、且つ、小型化が容易な構造の吻合デバイスを提供することができる。 By the way, the taper portion 2T is not an essential constituent element. Even if the taper portion 2T is not formed, even when an external force is applied after the treatment, the treatment state is not released and the size can be reduced. An anastomosis device having an easy structure can be provided.
In addition, the first gripping part 3a and the second gripping part 3b are not essential constituent elements, and even if an external force is applied after the treatment without providing them, the treatment state is not released, and An anastomosis device having a structure that can be easily miniaturized can be provided.

さらには、組織支持部２ｂの代わりに針状部を設け、両針タイプの吻合デバイスとして構成しても勿論よい。
なお、上述の例では第１保持部４ａ及び第２保持部４ｂを、針状部２ａ及び組織支持部２ｂとは別体として設けているが、必ずしも別体として設ける必要はない。つまり、第１保持部４ａ及び第２保持部４ｂと、針状部２ａ及び組織支持部２ｂとを一体的に設けてもよい。 Furthermore, a needle-like portion may be provided instead of the tissue support portion 2b, and it may be configured as a double-needle type anastomosis device.
In the above example, the first holding part 4a and the second holding part 4b are provided separately from the needle-like part 2a and the tissue support part 2b, but are not necessarily provided separately. That is, the first holding part 4a and the second holding part 4b, and the needle-like part 2a and the tissue support part 2b may be provided integrally.

なお、上述の弾性力は、曲部１２を境にして針状部２ａ側及び組織支持部２ｂ側のうち少なくとも一方が有していればよい。すなわち、曲部１２を境にして一方側と他方側とが互いに近接する弾性力を両者が有しておらずとも、何れか一方が前記弾性力を有していれば上述の効果を得ることができる。   In addition, the above-mentioned elastic force should just have at least one among the acicular part 2a side and the structure | tissue support part 2b side from the curved part 12. That is, the above-described effects can be obtained as long as either one has the elastic force even if the other side does not have an elastic force in which the one side and the other side are close to each other with the curved portion 12 as a boundary. Can do.

ところで、本一実施形態に係る吻合デバイス１の製造方法は、上述したシート材から一体成形する製造方法に限られない。例えば、第１保持部４ａ及び第２保持部４ｂを、その他の部位とは別体として製造し、それらを例えば接着等することで製造してもよい。   By the way, the manufacturing method of the anastomosis device 1 which concerns on this one embodiment is not restricted to the manufacturing method integrally molded from the sheet | seat material mentioned above. For example, you may manufacture the 1st holding | maintenance part 4a and the 2nd holding | maintenance part 4b as a different body from another site | part, and adhering them etc., for example.

以上、一実施形態に基づいて本発明を説明したが、本発明は上述した実施形態に限定されるものではなく、本発明の要旨の範囲内で、種々の変形及び応用が可能なことは勿論である。
［第１変形例］
以下、第１変形例に係る吻合デバイスについて説明する。説明の重複を避ける為、前記一実施形態に係る吻合デバイスとの相違点について説明する。この相違点とは、保持手段（前記一実施形態に係る吻合デバイス１における第１保持部４ａ及び第２保持部４ｂに相当）の構成である。 The present invention has been described based on one embodiment. However, the present invention is not limited to the above-described embodiment, and various modifications and applications are possible within the scope of the gist of the present invention. It is.
[First Modification]
Hereinafter, the anastomosis device according to the first modification will be described. In order to avoid duplication of explanation, differences from the anastomosis device according to the embodiment will be described. This difference is the configuration of the holding means (corresponding to the first holding part 4a and the second holding part 4b in the anastomosis device 1 according to the embodiment).

図６は、本第１変形例に係る吻合デバイスの一構成例を示す上面図である。本第１変形例に係る吻合デバイス１では、第１保持部４ａｅと第２保持部４ｂｅとが次のように構成されている。
すなわち、第１保持部４ａｅには、当該吻合デバイス１の厚み方向に長さを有するピン部材４ｐが設けられている。第２保持部４ｂｅには、当該吻合デバイス１の厚み方向に対して垂直な平面上で前記ピン部材４ｐと係合する切り欠け部４ｃが設けられている。 FIG. 6 is a top view showing a configuration example of the anastomosis device according to the first modification. In the anastomosis device 1 according to the first modification, the first holding portion 4ae and the second holding portion 4be are configured as follows.
That is, the first holding portion 4ae is provided with a pin member 4p having a length in the thickness direction of the anastomosis device 1. The second holding portion 4be is provided with a notch portion 4c that engages with the pin member 4p on a plane perpendicular to the thickness direction of the anastomosis device 1.

このような構成を採ることで、吻合状態においては、切り欠け部４ｃとピン部材４ｐとが上述の弾性力に抗して係合する為、係合後において外力が加わった場合であっても、当該吻合状態が解除されにくくなる。つまり、吻合状態が安定的に保持される。
以上説明したように、本第１変形例によれば、前記一実施形態に係る吻合デバイスと同様の効果を奏する吻合デバイスを提供することができる。
［第２変形例］
以下、第２変形例に係る吻合デバイスについて説明する。説明の重複を避ける為、前記一実施形態に係る吻合デバイスとの相違点について説明する。この相違点とは、保持手段（前記一実施形態に係る吻合デバイス１における第１保持部４ａ及び第２保持部４ｂに相当）の構成である。また、本第２変形例を適用する場合は、上述の弾性力は不要となる。従って、本第２変形例によれば材料選択の幅が拡大する。 By adopting such a configuration, in the anastomosis state, the notch 4c and the pin member 4p are engaged against the above-described elastic force, so even if an external force is applied after the engagement. The anastomosis state becomes difficult to be released. That is, the anastomosis state is stably maintained.
As described above, according to the first modification, it is possible to provide an anastomosis device that exhibits the same effect as the anastomosis device according to the embodiment.
[Second Modification]
Hereinafter, the anastomosis device according to the second modification will be described. In order to avoid duplication of explanation, differences from the anastomosis device according to the embodiment will be described. This difference is the configuration of the holding means (corresponding to the first holding part 4a and the second holding part 4b in the anastomosis device 1 according to the embodiment). In addition, when the second modification is applied, the above-described elastic force is not necessary. Therefore, according to the second modification, the range of material selection is expanded.

図７〜図１０は、本第２変形例に係る吻合デバイスの一構成例を示す上面図である。図７は、閉状態時の本第２変形例に係る吻合デバイスの上面図である。図８は、開状態時の同吻合デバイスの上面図である。図９は、吻合状態時の同吻合デバイスの保持手段に係る側断面図である。図１０は、開状態時の同吻合デバイスの斜視図である。本第２変形例に係る吻合デバイス１では、第１保持部４ａｅと第２保持部４ｂｅとは次のように構成されている。   7 to 10 are top views showing an example of the configuration of the anastomosis device according to the second modification. FIG. 7 is a top view of the anastomosis device according to the second modification example in the closed state. FIG. 8 is a top view of the anastomosis device in the open state. FIG. 9 is a side sectional view according to the holding means of the anastomosis device in the anastomosis state. FIG. 10 is a perspective view of the anastomosis device in the open state. In the anastomosis device 1 according to the second modification, the first holding unit 4ae and the second holding unit 4be are configured as follows.

すなわち、第１保持部４ａｅには、当該吻合デバイス１の厚み方向に正立するピン部材４ｐ´が設けられている。第２保持部４ｂｅには、前記ピン部材４ｐ´の外周と略同径で略半円形状の切り欠け部４ｃ´が、第１保持部４ａｅとの対向部位に設けられている。   That is, the first holding portion 4ae is provided with a pin member 4p ′ that stands upright in the thickness direction of the anastomosis device 1. The second holding portion 4be is provided with a substantially semicircular cutout portion 4c 'having the same diameter as the outer periphery of the pin member 4p' at a portion facing the first holding portion 4ae.

吻合時には、図９に示すように前記切り欠け部４ｃ´に、前記ピン部材４ｐ´を入れ込み、ピン部材４ｐ´の先端部を当該吻合デバイス１の厚み方向にかしめ工具にてかしめる（押しつぶす）ことで、当該ピン部材４ｐ´によって第１保持部４ａｅと第２保持部４ｂｅとを係合させる。
上述の構造を採ることで、吻合状態の第１保持部４ａｅと第２保持部４ｂｅとを強固にに保持することができる。従って、吻合後に外力が加わった場合であっても、当該吻合状態が解除されにくくなる。つまり、吻合状態が安定的に保持される。 At the time of anastomosis, as shown in FIG. 9, the pin member 4p ′ is inserted into the notch 4c ′, and the tip of the pin member 4p ′ is caulked (crushed) with a caulking tool in the thickness direction of the anastomosis device 1. Thus, the first holding portion 4ae and the second holding portion 4be are engaged by the pin member 4p ′.
By adopting the above-described structure, the first holding part 4ae and the second holding part 4be in the anastomosis state can be firmly held. Therefore, even when an external force is applied after the anastomosis, the anastomosis state is hardly released. That is, the anastomosis state is stably maintained.

以上説明したように、本第２変形例によれば、前記一実施形態に係る吻合デバイスと同様の効果を奏する上に、材料選択の幅が拡大した吻合デバイスを提供することができる。
［第３変形例］
以下、第３変形例に係る吻合デバイスについて説明する。説明の重複を避ける為、前記一実施形態に係る吻合デバイスとの相違点について説明する。この相違点とは、保持手段（前記一実施形態に係る吻合デバイス１における第１保持部４ａ及び第２保持部４ｂに相当）の構成である。 As described above, according to the second modification, it is possible to provide an anastomosis device having the same effects as the anastomosis device according to the embodiment and an expanded material selection range.
[Third Modification]
Hereinafter, an anastomosis device according to a third modification will be described. In order to avoid duplication of explanation, differences from the anastomosis device according to the embodiment will be described. This difference is the configuration of the holding means (corresponding to the first holding part 4a and the second holding part 4b in the anastomosis device 1 according to the embodiment).

図１１は、本第３変形例に係る吻合デバイスの一構成例を示す上面図である。本第３変形例に係る吻合デバイス１では、第１保持部４ａｅと第２保持部４ｂｅとは次のように構成されている。
すなわち、第１保持部４ａｅには、当該吻合デバイス１の厚み方向に凸の略四角錐形状の凸部４ｓが設けられている。第２保持部４ｂｅには、当該吻合デバイス１の厚み方向に貫通している孔部４ｈが設けられている。そして、第１保持部４ａｅと第２保持部４ｂｅのうち少なくとも一方が弾性力を有することが好ましい。但し、凸部４ｓは弾性を有しないことが好ましい。 FIG. 11 is a top view showing a configuration example of the anastomosis device according to the third modification. In the anastomosis device 1 according to the third modification, the first holding unit 4ae and the second holding unit 4be are configured as follows.
That is, the first holding portion 4ae is provided with a substantially quadrangular pyramid-shaped convex portion 4s that is convex in the thickness direction of the anastomosis device 1. The second holding portion 4be is provided with a hole portion 4h penetrating in the thickness direction of the anastomosis device 1. It is preferable that at least one of the first holding part 4ae and the second holding part 4be has an elastic force. However, it is preferable that the convex part 4s does not have elasticity.

吻合時には、第１保持部４ａｅと第２保持部４ｂｅのうち少なくとも一方に有する弾性力に抗して孔部４ｈに凸部４ｓを挿入し、且つ、凸部４ｓの先端部を当該吻合デバイス１上面に向かって折り曲げる。これにより、孔部４ｈと凸部４ｓとの係合が固定化され、当該吻合状態が強固に保持される。従って、吻合後に外力が加わった場合であっても、当該吻合状態が解除されにくくなる。つまり、吻合状態が安定的に保持される。なお、本変形例では、凸部４ｓの先端部を折り曲げることで孔部４ｈより径方向外方に位置するように変形させて係合させているが、上述の第２変形例のように凸部４ｓの先端部をかしめる（押しつぶす）ことで孔部４ｈより径方向外方に位置するように変形させて係合させてもよい。   At the time of anastomosis, the convex part 4s is inserted into the hole part 4h against the elastic force possessed by at least one of the first holding part 4ae and the second holding part 4be, and the tip part of the convex part 4s is connected to the anastomosis device 1 Bend towards the top. Thereby, engagement with the hole 4h and the convex part 4s is fixed, and the anastomosis state is firmly maintained. Therefore, even when an external force is applied after the anastomosis, the anastomosis state is hardly released. That is, the anastomosis state is stably maintained. In this modified example, the tip of the convex portion 4s is bent and deformed so as to be positioned radially outward from the hole 4h. However, the convex portion as in the second modified example described above is engaged. The tip of the portion 4s may be deformed and engaged so as to be positioned radially outward from the hole 4h by crimping (crushing) the tip.

以上説明したように、本第３変形例によれば、前記一実施形態に係る吻合デバイスと同様の効果を奏する吻合デバイスを提供することができる。
［第４変形例］
以下、第４変形例に係る吻合デバイスについて説明する。説明の重複を避ける為、前記一実施形態に係る吻合デバイスとの相違点について説明する。この相違点とは、保持手段（前記一実施形態に係る吻合デバイス１における第１保持部４ａ及び第２保持部４ｂに相当）の構成である。 As described above, according to the third modification, it is possible to provide an anastomosis device that exhibits the same effect as the anastomosis device according to the embodiment.
[Fourth Modification]
Hereinafter, an anastomosis device according to a fourth modification will be described. In order to avoid duplication of explanation, differences from the anastomosis device according to the embodiment will be described. This difference is the configuration of the holding means (corresponding to the first holding part 4a and the second holding part 4b in the anastomosis device 1 according to the embodiment).

図１３は、本第４変形例に係る吻合デバイスの一構成例を示す上面図である。本第４変形例に係る吻合デバイス１では、第１保持部４ａｅと第２保持部４ｂｅとは次のように構成されている。
すなわち、第１保持部４ａｅは、後述する孔部４ｈ´の径よりも小さい径の部位と大きい径の部位とが交互に形成され、第２保持部４ｂｅに向かう多段の略矢印形状を呈する。第２保持部４ｂｅには、当該吻合デバイス１の厚み方向に貫通している孔部４ｈ´が設けられており、第１保持部４ａｅに対向する部位には切り欠け部４ｈｃが形成されている。そして、第１保持部４ａｅと第２保持部４ｂｅのうち少なくとも一方が弾性力を有することが好ましい。 FIG. 13 is a top view illustrating a configuration example of the anastomosis device according to the fourth modification. In the anastomosis device 1 according to the fourth modification, the first holding part 4ae and the second holding part 4be are configured as follows.
That is, the first holding portion 4ae has a portion having a diameter smaller than a diameter of a hole 4h ′ to be described later and a portion having a larger diameter, and has a multistage substantially arrow shape toward the second holding portion 4be. The second holding part 4be is provided with a hole 4h 'penetrating in the thickness direction of the anastomosis device 1, and a notch part 4hc is formed at a portion facing the first holding part 4ae. . It is preferable that at least one of the first holding part 4ae and the second holding part 4be has an elastic force.

吻合時においては、孔部４ｈ´に対して第１保持部４ａｅを圧入することで、孔部４ｈ´と第１保持部４ａｅとを固定的に係合させることができる。
また、上述したように第１保持部４ａｅは多段の略矢印形状を呈しているので、吻合対象物の厚みに応じて、孔部４ｈ´への第１保持部４ａｅの挿入深度を適切な挿入深度とすることができる。 At the time of anastomosis, the hole 4h ′ and the first holding part 4ae can be fixedly engaged by press-fitting the first holding part 4ae into the hole 4h ′.
Further, as described above, since the first holding portion 4ae has a multi-stage substantially arrow shape, the insertion depth of the first holding portion 4ae into the hole portion 4h ′ is appropriately inserted according to the thickness of the anastomosis object. It can be depth.

上述の構造を採ることで、第２保持部４ｂｅの孔部４ｈ´に圧入された第１保持部４ａｅによって、吻合状態を強固に保持することができる。従って、吻合後に外力が加わった場合であっても、当該吻合状態が解除されにくくなる。つまり、吻合状態が安定的に保持される。   By adopting the above-described structure, the anastomosis state can be firmly held by the first holding portion 4ae press-fitted into the hole 4h ′ of the second holding portion 4be. Therefore, even when an external force is applied after the anastomosis, the anastomosis state is hardly released. That is, the anastomosis state is stably maintained.

以上説明したように、本第４変形例によれば、前記一実施形態に係る吻合デバイスと同様の効果を奏する吻合デバイスを提供することができる。
さらに、上述した実施形態には種々の段階の発明が含まれており、開示した複数の構成要件の適当な組み合わせにより種々の発明が抽出され得る。例えば、実施形態に示す全構成要件からいくつかの構成要件が削除されても、発明が解決しようとする課題の欄で述べた課題が解決でき、発明の効果の欄で述べられている効果が得られる場合には、この構成要件が削除された構成も発明として抽出され得る。 As described above, according to the fourth modification, it is possible to provide an anastomosis device that exhibits the same effect as the anastomosis device according to the embodiment.
Further, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements. For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the column of the effect of the invention can be achieved. In the case of being obtained, a configuration from which this configuration requirement is deleted can also be extracted as an invention.

１…吻合デバイス、 ２ａ…針状部、 ２ｂ…組織支持部、 ２ａ１…穿刺要素先端、 ２Ｔｅ…端線、 ２Ｔ…テーパ部、 ３ａ…第１把持部、 ３ｂ…第２把持部、 ３ａｆ…第１把持面、 ３ｂｆ…第２把持面、 ４ａ，４ａｅ…第１保持部、 ４ｂ，４ｂｅ…第２保持部、 ４ｐ…ピン部材、 ４ｈ…孔部、 ４ｓ…凸部、 １２…曲部。     DESCRIPTION OF SYMBOLS 1 ... Anastomosis device, 2a ... Needle-shaped part, 2b ... Tissue support part, 2a1 ... Tip of puncture element, 2Te ... End line, 2T ... Tapered part, 3a ... First gripping part, 3b ... Second gripping part, 3af ... First 1 gripping surface, 3bf: second gripping surface, 4a, 4ae ... first holding portion, 4b, 4be ... second holding portion, 4p ... pin member, 4h ... hole portion, 4s ... convex portion, 12 ... curved portion.

Claims (8)

穿刺部が設けられた一端が他端に向かって移動する過程で、前記穿刺部が吻合対象物を穿刺して前記他端と共に前記吻合対象物を吻合する吻合デバイスであって、
前記一端と前記他端との間の部位に設けられた係合部と、
前記吻合対象物を吻合した状態において前記係合部と対向する部位に設けられ、前記係合部と係合することで当該吻合した状態を保持する被係合部と、
を具備することを特徴とする吻合デバイス。 In the process in which one end provided with the puncture part moves toward the other end, the puncture part punctures the anastomosis object, and anastomoses the anastomosis object together with the other end,
An engaging portion provided at a portion between the one end and the other end;
An engaged portion that is provided in a portion facing the engaging portion in a state where the anastomosing object is anastomosed, and holds the anastomosed state by engaging with the engaging portion;
An anastomosis device comprising: 当該吻合デバイスは、前記一端と前記他端とを離間させる弾性力を有し、
前記吻合した状態において、前記弾性力に抗して前記係合部と前記被係合部とが係合する
ことを特徴とする請求項１に記載の吻合デバイス。 The anastomosis device has an elastic force to separate the one end and the other end,
The anastomosis device according to claim 1, wherein in the anastomosed state, the engaging portion and the engaged portion are engaged against the elastic force. 前記係合部と前記被係合部との係合はラチェット機構を構成する
ことを特徴とする請求項２に記載の吻合デバイス。 The anastomosis device according to claim 2, wherein the engagement between the engagement portion and the engaged portion constitutes a ratchet mechanism. 前記係合部は、当該吻合デバイスの厚み方向に正立する棒状部材であり、
前記被係合部は、前記弾性力に抗して前記吻合した状態を維持するように前記棒状部材と係合する切り欠け部である
ことを特徴とする請求項２に記載の吻合デバイス。 The engagement portion is a rod-like member that stands upright in the thickness direction of the anastomosis device,
The anastomosis device according to claim 2, wherein the engaged portion is a cutout portion that engages with the rod-shaped member so as to maintain the anastomosed state against the elastic force. 前記係合部は、当該吻合デバイスの厚み方向に正立するピンであり、
前記被係合部は、前記ピンの外周と略同径の切り欠け部を備え、前記吻合した状態において、前記切り欠け部に入れ込まれた前記ピンによって、当該吻合デバイスの厚み方向に前記ピンによってかしめられる
ことを特徴とする請求項１に記載の吻合デバイス。 The engaging portion is a pin erecting in the thickness direction of the anastomosis device,
The engaged portion includes a notch portion having substantially the same diameter as the outer periphery of the pin, and the pin inserted in the notch portion in the anastomosing state in the thickness direction of the anastomosis device. The anastomosis device according to claim 1, wherein the anastomosis device is caulked by. 前記係合部は、当該吻合デバイスの厚み方向に貫通している貫通孔であり、
前記被係合部は、当該吻合デバイスの厚み方向に凸の突起部であり、前記吻合した状態において前記貫通孔に挿入された後に前記突起部の先端部が前記貫通孔より径方向外方に位置するように変形される
ことを特徴とする請求項１に記載の吻合デバイス。 The engagement portion is a through-hole penetrating in the thickness direction of the anastomosis device,
The engaged portion is a protruding portion that is convex in the thickness direction of the anastomosis device, and the distal end portion of the protruding portion is radially outward from the through hole after being inserted into the through hole in the anastomosed state. The anastomosis device according to claim 1, wherein the anastomosis device is deformed to be positioned. 前記係合部は当該吻合デバイスの厚み方向に貫通している貫通孔であり、
前記被係合部は、前記貫通孔の径よりも大きい径の部位と小さい径の部位とが交互に形成された多段凸部であり、
前記吻合した状態において、前記多段凸部は前記貫通孔に圧入される
ことを特徴とする請求項１に記載の吻合デバイス。 The engaging portion is a through-hole penetrating in the thickness direction of the anastomosis device,
The engaged portion is a multi-stage convex portion in which a portion having a diameter larger than a diameter of the through hole and a portion having a small diameter are alternately formed,
2. The anastomosis device according to claim 1, wherein the multi-stage convex portion is press-fitted into the through hole in the anastomosed state. 前記一端における前記他端との対向部位に設けられ、吻合処置後の前記吻合対象物に対して当接する第１当接部と、
前記他端における前記一端との対向部位に設けられ、吻合処置後の前記吻合対象物に対して当接する第２当接部と、
を具備し、
吻合処置後の前記吻合対象物は、前記第１当接部と前記第２当接部とによって把持される
ことを特徴とする請求項１に記載の吻合デバイス。 A first abutting portion that is provided at a portion of the one end facing the other end and abuts against the anastomotic object after the anastomosis treatment;
A second contact portion provided at a portion of the other end facing the one end and contacting the anastomotic object after the anastomosis treatment;
Comprising
The anastomosis device according to claim 1, wherein the anastomosis target object after the anastomosis treatment is gripped by the first contact part and the second contact part.
JP2010158239A 2010-07-12 2010-07-12 Anastomosis device Withdrawn JP2012019841A (en)

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