JP2016042993A - Blood vessel ablation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood vessel ablation device excellent in workability of blood vessel harvesting.SOLUTION: A blood vessel ablation device 100G includes: a long guide part 200; and a movable part 300G including a connector 311 slidably connected to the guide part 200 and movable pieces 330' and 330" stored in the connector 311 that can project from the connector 311. The guide part 200 is arranged along the outer wall of a blood vessel, and the movable part 300G in a state that the movable pieces 330' and 330" project from the connector 311 is moved while it is guided by the guide part 200 so that the blood vessel is ablated together with tissues in the surrounding.SELECTED DRAWING: Figure 19

Description

  The present invention relates to a blood vessel peeling device.

  Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass tubes when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years, the vein graft is collected in a state covered with surrounding tissues (fat, connective tissue, etc.) and covered with the tissue. It has been reported that the long-term patency rate can be improved by using it as a bypass pipe in an as-is state. And as a device which can extract | collect a vein graft in the state covered with the surrounding tissue, there exists a device described in patent document 1, for example.

  In the device described in Patent Document 1, a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass tube, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue. However, the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection is poor.

US2006 / 0276815

  An object of the present invention is to provide a blood vessel peeling device excellent in workability of blood vessel collection (blood vessel peeling).

Such an object is achieved by the present inventions (1) to (8) below.
(1) a long guide part;
A movable part comprising: a connector slidably connected to the guide part; and a movable piece housed in the connector and projectable from the connector;
Placing the guide portion along the outer wall of the blood vessel;
The movable part in a state in which the movable piece protrudes from the connector is moved while being guided by the guide part, and the blood vessel is peeled off in a state where at least a part of the periphery is covered with a surrounding tissue. Blood vessel peeling device.

(2) A pair of movable pieces are accommodated in the connector,
In a plan view seen from the axial direction of the guide part,
One of the movable pieces protrudes from one end of the connector,
The other movable piece is the blood vessel peeling device according to (1), wherein the other movable piece projects from the other end of the connector.

(3) In a plan view seen from the axial direction of the guide part,
The blood vessel peeling device according to (2), wherein the distal end portions of the movable pieces protruding from the connector are connected on the opposite side of the guide portion from the connector.

  (4) The tip portion of each movable piece protruding from the connector is connected to each other, so that the connector and each movable piece constitute an annular portion, and the guide portion is located in the annular portion ( The blood vessel peeling device according to 3).

  (5) The blood vessel peeling device according to any one of (1) to (4), wherein the movable portion includes a movable piece operation portion that causes the movable piece to protrude from the connector.

  (6) The blood vessel peeling device according to (5), wherein the operation unit is a knob connected to the movable piece and protruding outside the connector.

  (7) Any of the above (1) to (6), wherein the movable piece is provided with a peeling portion for peeling the blood vessel, and a processing portion for cutting and stopping the branching blood vessel branched from the blood vessel. The blood vessel peeling device according to claim 1.

  (8) The blood vessel separation device according to any one of (1) to (7), further including an operation unit that moves the movable unit relative to the guide unit.

  According to the present invention, since the guide portion is disposed along the outer wall of the blood vessel, damage to the blood vessel due to the guide portion can be suppressed. Moreover, since the movable part is guided by the guide part and moved, the contact between the movable part and the blood vessel is suppressed. Furthermore, as described above, according to the present invention, damage to blood vessels, surrounding tissues, and nerves can be suppressed, and excellent workability can be exhibited.

It is a perspective view which shows the blood vessel peeling device which concerns on a 1st structural example. It is sectional drawing which shows the guide part which the blood vessel peeling device shown in FIG. 1 has. It is a top view which shows the movable part which the blood vessel peeling device shown in FIG. 1 has. It is a side view which shows the movable part shown in FIG. It is a side view which shows the process part which the movable part shown in FIG. 3 has. It is a side view which shows the modification of the movable part shown in FIG. It is a figure which shows the modification of the movable part which the blood vessel peeling device shown in FIG. 1 has. It is sectional drawing which shows the operation part which the blood vessel peeling device shown in FIG. 1 has. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is a perspective view which shows the blood vessel peeling device which concerns on a 2nd structural example. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is sectional drawing which shows the blood vessel peeling device which concerns on a 3rd structural example. It is sectional drawing which shows the blood vessel peeling device which concerns on a 4th structural example. It is sectional drawing which shows the blood vessel peeling device which concerns on a 5th structural example. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is sectional drawing which shows the modification of the blood vessel peeling device shown in FIG. It is a side view which shows the movable part which the blood vessel peeling device which concerns on a 6th structural example has. It is the side view and sectional drawing which show the movable part which the blood vessel peeling device which concerns on a 7th structural example has. It is sectional drawing which shows the blood vessel peeling device which concerns on an 8th structural example. It is sectional drawing which shows the blood vessel peeling device which concerns on 1st Embodiment of this invention. It is the top view and side view of the blood vessel peeling device shown in FIG. It is sectional drawing which shows the movable part which the blood vessel peeling device which concerns on a 9th structural example has. It is a figure explaining the blood vessel peeling method using the blood vessel peeling device shown in FIG. It is a top view which shows the blood vessel peeling device which concerns on a 10th structural example. It is a side view which shows the blood vessel peeling device which concerns on the 11th structural example.

  Hereinafter, the blood vessel peeling device of the present invention will be described in detail based on preferred configuration examples and embodiments shown in the accompanying drawings.

<First configuration example>
FIG. 1 is a perspective view showing a blood vessel peeling device according to a first configuration example. FIG. 2 is a cross-sectional view showing a guide portion of the blood vessel peeling device shown in FIG. FIG. 3 is a plan view showing a movable part of the blood vessel peeling device shown in FIG. FIG. 4 is a side view showing the movable part shown in FIG. FIG. 5 is a side view illustrating a processing unit included in the movable unit illustrated in FIG. 3. FIG. 6 is a side view showing a modification of the movable part shown in FIG. FIG. 7 is a view showing a modification of the movable part of the blood vessel peeling device shown in FIG. FIG. 8 is a cross-sectional view showing an operation unit of the blood vessel peeling device shown in FIG. 9 to 12 are views for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 2B is a cross-sectional view taken along the line AA in FIG. In the following, for convenience of explanation, the right side in FIG. 1 is also referred to as “tip” and the left side is also referred to as “base end”.

≪Vessel peeling device≫
A blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass tube when performing a blood vessel bypass operation (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue. The blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it can be used as a bypass tube. For example, the internal thoracic artery, gastroepiploic artery, radial artery, great saphenous vein, etc. Is mentioned.

  However, among these blood vessels, the greater saphenous vein is preferable. By using the blood vessel peeling device 100, as described above, blood vessels can be collected in a state covered with surrounding tissue. Therefore, it is considered that the long-term patency after surgery is increased by collecting the large saphenous vein using the blood vessel peeling device 100 and using it as a bypass tube. Therefore, in the following, an example in which the large saphenous vein is collected using the blood vessel peeling device 100 will be described as a representative.

  As shown in FIGS. 1 to 8, the blood vessel peeling device 100 includes a guide unit 200 disposed along the outer wall of the great saphenous vein 1000, an imaging device 400 inserted into the guide unit 200, and the guide unit 200. A movable unit 300 that moves in the living body while being guided, and an operation unit 500 that moves the movable unit 300 are provided. Hereinafter, each of these units will be sequentially described in detail.

[Guide section]
As shown in FIG. 2, the guide part 200 includes a main body part 210 and a peeling part (observation part) 220 provided at the tip of the main body part 210.

  The main body 210 has a tubular shape extending in a straight line. The main body 210 is provided with a slit-shaped rail 211 extending in the axial direction. The rail 211 functions as a guide unit that guides the movement of the movable unit 300. Further, the rail 211 is open to the base end of the main body 210, and the movable part 300 can be connected from this open portion (that is, the base end of the main body 210). Since the proximal end of the guide part 200 is exposed from the living body as will be described later in the “blood vessel peeling method”, the connection is made possible by connecting the movable part 300 from the proximal end side of the guide part 200. Can be done more easily. The cross-sectional shape of the main body 210 is not limited to the circular shape as in this configuration example, and may be, for example, a flat shape crushed in the direction in which the main saphenous vein 1000 is aligned. Moreover, the rail 211 may not be slit-shaped as long as it can guide the movement of the movable part 300, and may be a groove of a ridge or a protrusion of a ridge.

  On the other hand, the peeling part 220 is tapered toward the tip of the guide part 200 and has a conical shape. Moreover, the peeling part 220 is substantially colorless and transparent, and has light transmittance. Such an exfoliation part 220 has a function of exfoliating tissues (fat, connective tissue, etc.) and an observation of observing the in vivo (large saphenous vein 1000 and its surroundings) when the guide part 200 is advanced in vivo. And function as a part. In addition, as a shape of the peeling part 220, it is not limited to a cone shape like this structural example, For example, the duckbill shape tapered so that the front end may become linear may be sufficient. Further, the peeling portion 220 is not limited to being colorless and transparent as long as it has light transparency, and may be colored red, blue, green, or the like.

[Imaging device]
As shown in FIG. 2, the imaging device 400 includes a long main body 410, and an imaging unit that images the front of the guide unit 200 and an illumination unit 420 that emits illumination light at the tip of the main body unit 410. Part 430. The imaging unit 430 includes, for example, an objective lens system provided at the distal end portion of the main body 410 and an imaging device (for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor) disposed to face the objective lens system. I have.

  Such an imaging device 400 can be inserted into the guide unit 200 described above, as shown in FIG. Thus, by inserting the imaging device 400 into the guide part 200, the imaging device 400 can observe the front of the guide part 200 via the peeling part 220.

[movable part]
The movable unit 300 moves in the living body to separate the large saphenous vein 1000 while it is covered with the surrounding tissue (fat, connective tissue, etc.) 1200 and branch off from the large saphenous vein 1000. The branch blood vessel 1100 that is present is cut and stopped. Such a movable part 300 is detachable from the guide part 200, and as shown in FIGS. 3 and 4, a connector 310 connected to the rail 211 of the guide part 200 and a mounting part 320 attached to the connector 310. And a peeling unit 350 and a processing unit 360.

  The connector 310 includes a base portion 311 that is curved in a substantially arc shape, and a connection portion 312 that slidably connects the base portion 311 to the rail 211. Further, grooves 311 a and 311 b for mounting the mounting portion 320 are provided at both ends in the circumferential direction of the base portion 311. On the other hand, the mounting portion 320 has a slit (321) extending in the axial direction and has a cylindrical shape (tubular shape) having a substantially C-shaped cross-sectional shape. Such a mounting portion 320 is mounted to the connector 310 by engaging both end portions in the circumferential direction with the slit 321 between the grooves 311 a and 311 b of the connector 310. And the guide part 200 is located inside the cyclic | annular annular part 340 comprised by the base 311 and the mounting part 320. FIG. Further, the inner diameter of the annular portion 340 is larger than the outer diameter of the large saphenous vein 1000, and when in use, the large saphenous vein is located inside the annular portion 340 and on the central axis J as shown in FIG. 1000 is located.

  The width of the slit 321 is not particularly limited, but is preferably larger than the outer diameter of the large saphenous vein 1000. Thereby, the attachment part 320 can be attached to the connector 310 in a non-contact manner (or a light contact without damage) with the great saphenous vein 1000. Therefore, damage to the great saphenous vein 1000 when attaching the attachment part 320 to the connector 310 can be suppressed. However, the width of the slit 321 is not limited to this, and may be smaller than the outer diameter of the large saphenous vein 1000. In this case, for example, the attachment part 320 can be attached to the connector 310 without contact with the large saphenous vein 1000 by expanding the deformation of the attachment part 320 and expanding the slit 321.

  Further, the annular portion 340 has a groove portion 390 that opens to the tip portion, and a plurality of the groove portions 390 are arranged side by side in the circumferential direction of the annular portion 340. Each groove portion 390 is connected to a tapered blood vessel guide groove portion (first groove portion) 391 whose width gradually decreases toward the proximal end side and a proximal end portion of the blood vessel guide groove portion 391, and the straight width is substantially constant. A blood vessel processing groove (second groove) 392.

  The blood vessel guide groove portion 391 is a groove portion that guides the branch blood vessel 1100 that contacts when the movable portion 300 is pushed in the living body to the blood vessel processing groove portion 392. The blood vessel guide groove portion 391 has a tapered shape to smoothly perform the guide. In particular, in the present configuration example, since the adjacent blood vessel guide groove portions 391 are in contact with each other, the branch blood vessel 1100 can be smoothly guided to any one of the blood vessel guide groove portions 391. On the other hand, the blood vessel processing groove 392 is a groove for cutting and stopping the branch blood vessel 1100 guided by the blood vessel guide groove 391, and each blood vessel processing groove 392 is provided with a processing unit 360.

  As shown in FIG. 5, the processing section 360 has a bipolar structure having a pair of electrodes 361 and 362 that can generate an electric field in the blood vessel processing groove section 392. Specifically, the electrode 361 is provided at the proximal end (bottom) of the vascular treatment groove 392, and the electrodes 362 are provided on both sides in the width direction of the vascular treatment groove 392. By applying a high-frequency alternating voltage between the electrodes 361 and 362, the branch blood vessel 1100 guided by the blood vessel processing groove 392 is heated and cut, and is thermally coagulated to stop hemostasis. Note that the tip 361 ′ of the electrode 361 is preferably sharp enough to cut the branch blood vessel 1100. Accordingly, if the branch blood vessel 1100 can be thermally coagulated (hemostatic) by an electric field generated at least between the electrodes 361 and 362, the branch blood vessel can be physically cut by the electrode 361. Therefore, the certainty of processing by the processing unit 360 is improved.

  Here, the width W of the blood vessel processing groove 392 is not particularly limited, but is preferably narrower than the outer diameter of the branch blood vessel 1100 as shown in FIG. Thereby, since the branch blood vessel 1100 can be crushed in the blood vessel processing groove 392, the processing (cutting / hemostasis) by the processing unit 360 can be performed more reliably.

  In addition, the annular portion 340 is provided with a peeling portion 350 that peels tissue around the large saphenous vein 1000. The peeling portion 350 is provided along the blood vessel guide groove portion 391 at the distal end portion of the annular portion 340. As will be described later in the “blood vessel exfoliation method”, the exfoliation part 350 has a function of exfoliating the tissue around the large saphenous vein 1000 when the movable part 300 is pushed forward in the living body. . Such an exfoliation part 350 preferably has such a sharpness that it can exfoliate the tissue without cutting the branch blood vessel 1100. Thereby, since the cutting | disconnection of the branch blood vessel 1100 by the peeling part 350 is suppressed, a bleeding can be suppressed few and a procedure can be performed safely and smoothly.

  Although the movable part 300 has been described above, for example, the shape of the blood vessel guide groove 391 is not limited to the shape of the present configuration example. For example, as illustrated in FIG. The shape may be gradually reduced toward the side. By setting it as such a shape, since the peeling part 350 is rounded, the branch blood vessel 1100 becomes difficult to cut | disconnect by the peeling part 350 more. Moreover, as shown in FIG.6 (b), the adjacent groove parts 390 may be spaced apart. Further, in this configuration example, the groove portion 390 and the processing portion 360 are not provided in the base portion 311, but for example, as shown in FIG. 7, the groove portion 390 and the processing portion 360 are also provided in the base portion 311 in the same manner as the mounting portion 320. It may be provided. Thereby, the groove part 390 and the process part 360 are arrange | positioned over the perimeter of the movable part 300. FIG.

[Operation section]
As shown in FIG. 8, the operation unit 500 has a rod shape and can be inserted into the guide unit 200. Therefore, the movable unit 300 can be moved by inserting the operation unit 500 into the guide unit 200 and pressing the connector 310 with the tip thereof. In addition, it is preferable that the operation part 500 can be fixed to the connector 310 by means such as fitting or screwing. Thereby, the movable part 300 can be pushed and pulled by the operation part 500.

≪Vessel peeling method≫
The blood vessel peeling method (blood vessel sampling method) using the blood vessel peeling device 100 includes a first step of inserting the guide portion 200 along the outer wall of the great saphenous vein 1000, and a movable portion 300 connected to the guide portion 200. A second step of peeling the large saphenous vein 1000 while being covered with the surrounding tissue 1200 by moving, a third step of cutting after ligating the large saphenous vein 1000, and surrounding the large saphenous vein 1000 And a fourth step of extraction in a state of being covered with the tissue 1200.

[First step]
First, the position of the great saphenous vein 1000 to be collected is confirmed, and an incision is made based on the position. Next, as shown in FIG. 9A, the guide part 200 in which the imaging device 400 is inserted is inserted into the living body through the incision part 1300, and the living body (large saphenous vein 1000) is observed with the imaging device 400. The guide unit 200 is advanced along the outer wall of the great saphenous vein 1000. At this time, since the tissue can be peeled from the large saphenous vein 1000 by the peeling portion 220 provided at the distal end portion of the guide portion 200, the guide portion 200 can be smoothly advanced. In this way, by moving the guide unit 200 forward along the outer wall of the great saphenous vein 1000, the great saphenous vein 1000 is straightened as shown in FIG. 9B.

[Second step]
Next, after the imaging device 400 is removed from the guide part 200, the connector 310 is connected to the rail 211 from the base end of the guide part 200 as shown in FIG. The attachment part 320 is attached to the connector 310 so that the saphenous vein 1000 is located. Thereby, the annular portion 340 is formed, and the large saphenous vein 1000 is disposed in the annular portion 340. In particular, in the present configuration example, the large saphenous vein 1000 is located on the central axis J of the annular portion 340. In this way, by forming the annular portion 340 by assembling the connector 310 and the mounting portion 320, the annular portion 340 is disposed around the great saphenous vein 1000 without cutting the great saphenous vein 1000. Can do. Note that the connector 310 may be connected to the guide unit 200 without removing the imaging device 400 from the guide unit 200.

  In this step, the connector 310 is connected to the rail 211 from the proximal end of the guide portion 200. However, since the proximal end portion of the guide portion 200 is exposed from the living body, the connection can be smoothly performed. Moreover, the movable part 300 is detachable from the guide part 200, and the movable part 300 is connected to the guide part 200 in the second step, whereby the first step is performed in the state where the movable part 300 is not connected. Can be used. Therefore, the movable part 300 does not get in the way and the first step can be performed more smoothly.

  Next, as illustrated in FIG. 10B, the movable unit 300 is pushed into the living body using the operation unit 500, and the living body is advanced along the rail 211 (while being guided by the guide unit 200). When the movable part 300 is advanced, the tissue 1200 around the great saphenous vein 1000 is peeled off by the peeling part 350, and the branch blood vessel 1100 is guided to the processing part 360 by the groove part 390, and is cut and stopped by the processing part 360. The As a result, the large saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200.

  In particular, since the large saphenous vein 1000 is straightly corrected by the guide unit 200 and the large saphenous vein 1000 is located on the central axis J of the movable unit 300, the movable unit 300 and the large saphenous vein 1000 are located. Contact with the vein 1000 is prevented, and the great saphenous vein 1000 can be positioned approximately in the center of the exfoliated tissue 1200. Therefore, the greater saphenous vein 1000 can be exfoliated while being covered with the surrounding tissue 1200 more accurately and without bias. The thickness t1 of the tissue 1200 that is peeled off together with the great saphenous vein 1000 and is located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. It is more preferable that it is about 3 mm to 5 mm.

  In the following, for convenience of explanation, the operation of moving the movable part 300 to peel off the large saphenous vein 1000 while being covered with the surrounding tissue 1200 is also referred to as “peeling work”.

[Third step]
Next, the large saphenous vein 1000 is cut at the proximal-side planned cut portion 1001 and the distal-side planned cut portion 1002. Specifically, first, as shown in FIG. 11 (a), two sites before and after the proximal end side cut planned portion 1001 of the large saphenous vein 1000 are ligated and the front end side cut planned portion 1002 is sandwiched. Ligate the two places before and after. In addition, the ligation on the tip side cut planned portion 1002 side can be performed through the incision portion 1400 by incising the vicinity of the tip side cut planned portion 1002. Next, as shown in FIG. 11 (b), the large saphenous vein 1000 is cut at the base end side planned cut portion 1001 and the distal end side cut planned portion 1002.

[Fourth step]
Next, as shown in FIG. 12, the large saphenous vein 1000 is taken out of the living body through the incision 1300 while being covered with the surrounding tissue 1200.

  By the first step to the fourth step as described above, the large saphenous vein 1000 can be collected (extracted) while being covered with the surrounding tissue 1200. The great saphenous vein 1000 collected in such a state becomes a bypass tube having a long-term patency rate superior to that of the great saphenous vein not covered with the tissue 1200. This is believed to be due to the following reasons.

  That is, the great saphenous vein 1000 is used as an arterial bypass tube, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, when a large saphenous vein that is not covered with the tissue 1200 is used as a bypass tube, the large saphenous vein is expanded without being able to withstand blood pressure, and blood flow is reduced. In addition, the vessel wall thickens during remodeling (structural alteration) and repairing tissue damage. Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass tube, it will lead to vascular occlusion in the long term.

  On the other hand, by covering the great saphenous vein 1000 with the tissue 1200 as in this configuration example, the tissue 1200 suppresses the expansion of the large saphenous vein 1000 and suppresses bending of the great saphenous vein 1000 and the like. It is done. Therefore, a decrease in blood flow as described above can be suppressed. In addition, by being covered with the tissue 1200, damage to the great saphenous vein 1000, specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, the thickening of the blood vessel wall as described above can be suppressed. From the above, by using the great saphenous vein 1000 covered with the tissue 1200 as a bypass tube, an excellent long-term patency rate can be exhibited. In particular, in this configuration example, since the nutritional blood vessels remain in the blood vessel wall and the tissue 1200 of the great saphenous vein 1000, the nutrient is supplied to the great saphenous vein 1000 as a bypass tube even after the bypass, and the above effect is achieved. It is thought that improvement will be achieved.

  According to the method described above, the large saphenous vein 1000 can be extracted smoothly and accurately while being covered with the surrounding tissue 1200. More specifically, in the first step, the guide portion 200 is disposed along the outer wall of the great saphenous vein 1000, whereby damage to the great saphenous vein 1000 can be suppressed. Furthermore, in the second step, since the movable part 300 is moved while being guided by the guide part 200, the contact between the movable part 300 and the great saphenous vein 1000 is suppressed. Therefore, according to the above-described method, the large saphenous vein 1000 can be peeled while being covered with the surrounding tissue 1200 while suppressing damage to the large saphenous vein 1000.

  In particular, in the first step, since the large saphenous vein 1000 is straightened (deformed) by the guide portion 200, the second step can be performed more smoothly and accurately. Further, since the great saphenous vein 1000 is not cut until the second step is completed, blood can be passed through the great saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.

  In this configuration example, the large saphenous vein 1000 is collected (exfoliated) in a state where the entire circumference is covered with the tissue 1200, but is not limited to the one where the entire circumference is covered with the tissue 1200, It suffices if the great saphenous vein 1000 can be collected (exfoliated) in a state where at least a part of its circumference is covered with the tissue 1200.

<Second configuration example>
FIG. 13 is a perspective view showing a blood vessel peeling device according to a second configuration example. FIG. 14 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.

  Hereinafter, the second configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and description of similar matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the operation unit is different.

≪Vessel peeling device≫
As shown in FIG. 13, the blood vessel peeling device 100 </ b> A of this configuration example has the guide portion 200 positioned outside the movable portion 300 (annular portion 340) with the movable portion 300 connected to the guide portion 200. In such a blood vessel peeling device 100A, first, as shown in FIG. 14 (a), the guide portion 200 is arranged along the great saphenous vein 1000, and then, as shown in FIG. 14 (b), By moving the movable part 300 along the guide part 200 and performing a peeling operation, the large saphenous vein 1000 can be peeled while being covered with the surrounding tissue 1200.

  Also by such a 2nd structural example, the effect similar to the 1st structural example mentioned above can be exhibited.

<Third configuration example>
FIG. 15 is a cross-sectional view showing a blood vessel peeling device according to a third configuration example.

  Hereinafter, the third configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and the description of the same matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the operation unit is different.

≪Vessel peeling device≫
As illustrated in FIG. 15, the operation unit 500 </ b> B includes two strings (linear bodies) 511 and 512. One end of the string 511 is connected to the connector 310, and the other end is pulled out from the proximal end opening of the guide part 200 via the insertion hole 219 provided in the distal end part of the main body part 210 of the guide part 200. ing. On the other hand, the string 512 has one end connected to the connector and the other end pulled out to the proximal end side of the guide part 200. Therefore, the movable part 300 can be moved forward (distal side) by pulling the string 511 toward the base end side, and conversely, the movable part 300 can be moved backward (proximal end side) by pulling the string 512 toward the base end side. ).

  Such a third configuration example can also exhibit the same effect as the first configuration example described above.

<Fourth configuration example>
FIG. 16 is a cross-sectional view showing a blood vessel peeling device according to a fourth configuration example.

  Hereinafter, the fourth configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and description of similar matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the operation unit is different.

≪Vessel peeling device≫
As shown in FIG. 16, the operation unit 500 </ b> C has a rod shape that can be inserted into the guide unit 200 </ b> C, and a male screw part 520 is provided on the outer periphery thereof. On the other hand, on the inner peripheral surface of the main body portion 210 of the guide portion 200C, a female screw portion 218 that is screwed to the male screw portion 520 is provided. Therefore, by rotating the operation portion 500C in a state where the male screw portion 520 is screwed to the female screw portion 218, the movable portion 300 moves while being guided by the guide portion 200C. According to such a configuration, for example, it becomes easier to control the movement of the movable unit 300 as compared to the first configuration example described above.

  Such a fourth configuration example can also exhibit the same effects as those of the first configuration example described above.

<Fifth configuration example>
FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fifth configuration example. FIG. 18 is a diagram illustrating a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 19 is a cross-sectional view showing a modified example of the blood vessel peeling device shown in FIG.

  Hereinafter, the fifth configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and the description of the same matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
The main body portion 210 of the guide portion 200D is provided with a slit 212 extending in the axial direction. On the other hand, the connecting portion 312 of the movable portion 300D has a lumen (through hole) 312a into which the imaging device 400 can be inserted at a position located in the guide portion 200D in a state of being connected to the rail 211, and a lumen 312a. An observation unit 312b that covers the opening on the distal end side and has optical transparency is provided. In the blood vessel peeling device 100D of this configuration example, the imaging device 400 also serves as the operation unit 500.

≪Vessel peeling method≫
According to the blood vessel peeling device 100D having such a configuration, in the second step, after the connector 310 is connected to the rail 211 of the guide part 200D and the attachment part 320 is attached to the connector 310, first, in the lumen 312a. The imaging device 400 is inserted. Thus, the imaging device 400 can observe the outer wall of the great saphenous vein 1000 via the observation unit 312b and the slit 212. Next, as shown in FIG. 18, the imaging device 400 is pushed forward to move the movable part 300 </ b> D to perform a peeling operation. According to this configuration example, since the peeling operation can be performed while observing the large saphenous vein 1000 and its periphery with the imaging device 400, the operation can be performed with higher accuracy.

  Such a fifth configuration example can also exhibit the same effects as those of the first configuration example described above.

  As a modification of this configuration example, as shown in FIG. 19, a configuration in which the guide unit 200 is located outside the movable unit 300 as in the second configuration example described above may be used. In this case, the outer wall of the great saphenous vein 1000 can be observed by the imaging device 400 via the rail 211 for guiding the movable part 300D. Therefore, the slit 212 can be omitted, and the configuration of the guide part 200D becomes simpler. Further, by omitting the slit 212, for example, the living tissue is prevented from entering the guide part 200D through the slit 212, and the movable part 300 can be moved more smoothly.

<Sixth configuration example>
FIG. 20 is a side view showing a movable part included in the blood vessel peeling device according to the sixth configuration example.

  Hereinafter, the sixth configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and description of similar matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
In the movable portion 300E, the tip end face F1 of the annular portion 340 is inclined with respect to the central axis J as shown in FIG. Thereby, the peeling part 350 can be made sharper and the more excellent peeling characteristic can be exhibited in the peeling operation in the second step of the blood vessel peeling method. In addition, although it does not specifically limit as inclination-angle (theta) of the front end surface F1 with respect to the central axis J, For example, it can be set as about 30 degrees-60 degrees.

  Such a sixth configuration example can also exhibit the same effects as those of the first configuration example described above.

<Seventh configuration example>
FIG. 21 is a side view and a cross-sectional view showing a movable part included in the blood vessel peeling device according to the seventh configuration example. FIG. 21C is a cross-sectional view taken along the line BB in FIG. Further, in FIG. 21A, the second vibration damping unit is not shown.

  Hereinafter, the seventh configuration example will be described with reference to this drawing. However, the difference from the configuration example described above will be mainly described, and the description of the same matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
As shown in FIG. 21, the movable part 300 </ b> F further includes a vibration element (vibration part) 380 and a vibration reduction part 370 provided in the annular part 340.

  The vibration element 380 is a vibration source for vibrating the annular portion 340. The vibration element 380 has a strip shape (long shape), and a plurality of vibration elements 380 are arranged along the circumferential direction of the annular portion 340. More specifically, one vibration element 380 is disposed between a pair of adjacent grooves 390. Thus, by arranging the plurality of vibration elements 380 along the circumferential direction of the annular portion 340, the annular portion 340 can be vibrated more uniformly without unevenness. The configuration of the vibration element 380 is not particularly limited as long as the annular portion 340 can be vibrated at a predetermined frequency. For example, zinc oxide (ZnO), aluminum nitride (AlN), PZT (lead zirconate titanate) ) Or the like can be used in which a piezoelectric layer made of a piezoelectric material is sandwiched between a pair of electrode layers.

  Further, the vibration frequency of the annular portion 340 that is vibrated by the vibration element 380 is not particularly limited. For example, the tissue can be removed without dissolving (releasing) blood vessels, skin, and muscles around the saphenous vein 1000. It is preferable that it is a frequency which can be melt | dissolved (free | released), and as such a frequency, it is preferable that it is about 20-60 kHz, and it is more preferable that it is 30-40 kHz. Thereby, substantially only the tissue can be dissolved while protecting the saphenous vein 1000.

  The vibration damping unit 370 has a function of absorbing and attenuating the vibration of the annular portion 340 caused by the vibration element 380. Such a vibration reduction unit 370 includes a first vibration reduction unit 371 disposed on the inner peripheral surface of the annular part 340 and a second vibration reduction unit 372 disposed on the outer peripheral surface of the annular part 340. doing.

  In addition, the first and second vibration damping units 371 and 372 are disposed so as not to overlap with the peeling unit 350, respectively. That is, the peeling part 350 protrudes from between the first and second vibration damping parts 371 and 372, and the part is exposed to the outside. Therefore, when the annular portion 340 is vibrated, the vibration is mainly transmitted to the outside from the peeling portion 350 and hardly transmitted to the outside from other places (for example, the inner peripheral surface and the outer peripheral surface of the annular portion 340). (Slightly transmitted) The second vibration damping unit 372 is disposed so as to cover the vibration element 380 and protects and insulates the vibration element 380.

  The constituent material of the first and second vibration damping parts 371 and 372 is not particularly limited as long as the vibration of the annular part 340 can be absorbed and attenuated. For example, natural rubber, butadiene rubber, styrene-butadiene rubber Various rubber materials such as urethane rubber, silicone rubber and fluorine rubber can be used.

≪Vessel peeling method≫
According to the blood vessel peeling device 100F having such a configuration, the peeling operation in the second step is performed while vibrating the annular portion 340, so that the movable portion 300F is positioned on the front side in the moving direction by the vibration transmitted from the peeling portion 350. Since the tissue can be peeled while being dissolved, the operation can be performed more smoothly. Furthermore, the tissue located inside the annular portion 340, that is, the tissue 1200 that is located around the great saphenous vein 1000 and peels off together with the great saphenous vein 1000 is suppressed, so that the large size can be more reliably increased. The saphenous vein 1000 can be exfoliated while covered with the surrounding tissue 1200. In addition, since the dissolution of the tissue located outside the annular portion 340 is suppressed, unnecessary dissolution of the tissue is reduced.

  Also according to the seventh configuration example, the same effect as that of the first configuration example described above can be exhibited.

  In this configuration example, the vibration element 380 is arranged on the outer periphery of the annular portion 340. However, the arrangement of the vibration element 380 is not limited to this, and for example, is arranged on the inner peripheral surface of the annular portion 340. May be. Further, the vibration element 380 may be disposed at a place other than the annular portion 340, for example, at the connection portion 312 as long as vibration can be transmitted to the annular portion 340. In this case, the vibration of the vibration element 380 is transmitted to the annular portion 340 via the connection portion 312.

<Eighth configuration example>
FIG. 22 is a cross-sectional view showing a blood vessel peeling device according to an eighth configuration example. In addition, FIG.22 (b) is CC sectional view taken on the line in Fig.22 (a).

  Hereinafter, the eighth configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example described above, and the description of the same matters will be omitted.

  This configuration example is the same as the first configuration example described above except that the movable portion is mainly positioned with respect to the guide portion using a magnet.

≪Vessel peeling device≫
As shown in FIG. 22, the main body 210 of the guide part 200G is provided with a permanent magnet 240 for connecting (positioning) the movable part 300G. The permanent magnet 240 has a bar shape extending along the axial direction of the main body 210 and is disposed at a position facing the rail 211 of the main body 210. The permanent magnet 240 has an S pole on the inner peripheral side of the main body 210 and an N pole on the outer peripheral side. That is, each permanent magnet 240 is magnetized along the radial direction of the main body 210. Such a permanent magnet 240 is embedded in the outer periphery of the main body 210, and the protrusion of the permanent magnet 240 from the main body 210 is suppressed.

  On the other hand, in the movable part 300G, the connection part 312 of the connector 310 is inserted into the guide part 200 via the rail 211. The annular part 340 is provided with a permanent magnet 315 for positioning with respect to the main body part 210. The permanent magnet 315 is disposed at a position facing the connection portion 312 (that is, a position separated from the connection portion 312 by about 180 °). The permanent magnet 315 has an N pole on the inner peripheral side of the annular portion 340 and an S on the outer peripheral side. That is, the permanent magnet 315 is magnetized along the radial direction of the annular portion 340 and in a direction repelling the permanent magnet 240 disposed in the main body portion 210. Such a permanent magnet 315 is embedded in the inner periphery of the annular portion 340, thereby preventing the permanent magnet 315 from protruding from the annular portion 340.

  In such a configuration, when the connecting portion 312 is inserted into the guide portion 200G via the rail 211, the movable portion 300G is directed downward of the guide portion 200G due to magnetic repulsion between the opposing permanent magnets 240 and 315. Is energized. Then, when the connecting portion 312 contacts the inner periphery of the guide portion 200G, the movable portion 300G is positioned with respect to the guide portion 200G.

  The permanent magnets 240 and 315 are not particularly limited, and various permanent magnets such as a neodymium magnet, a samarium cobalt magnet, a ferrite magnet, and an alnico magnet can be used.

  Although the blood vessel peeling device 100G has been described above, for example, the number of permanent magnets 240 and 315 is not particularly limited, and may be two or more. In addition, an annular radial magnet (a magnet magnetized in the radial direction) may be used as the permanent magnet 240, and a substantially C-shaped radial magnet may be used as the permanent magnet 315.

≪Vessel peeling method≫
According to the blood vessel peeling device 100G having such a configuration, if the movable portion 300G is arranged around the guide portion 200G as shown in FIG. 22 in the second step of the blood vessel peeling method, the repulsive force of the permanent magnets 240 and 315 is obtained. Thus, the movable part 300G is naturally positioned (centered) with respect to the guide part 200G. Then, the peeling operation can be performed by moving the movable unit 300G forward using the operation unit 500. As described above, since the permanent magnet 240 extends in the axial direction of the guide portion 200G, the repulsive force of the permanent magnets 240 and 315 works while the movable portion 300G is advanced, and thus the movable portion 300G. Continues to be centered on the guide portion 200G. Therefore, the greater saphenous vein 1000 can be more reliably peeled while being covered with the surrounding tissue 1200.

  Also according to the eighth configuration example, the same effects as those of the first configuration example described above can be exhibited.

<First Embodiment>
FIG. 23 is a cross-sectional view showing the blood vessel peeling device according to the first embodiment of the present invention. FIG. 24 is a plan view and a side view of the blood vessel peeling device shown in FIG.

  Hereinafter, the first embodiment will be described with reference to this figure, but the description will focus on the differences from the configuration example described above, and the description of the same matters will be omitted.

  This embodiment is mainly the same as the first configuration example described above except that the structure of the movable portion is different.

≪Vessel peeling device≫
As shown in FIG. 23A, the movable part 300H includes a connector 310 having a base 311 and a connection part 312; a pair of movable pieces 330 (330 ′, 330 ″) housed (incorporated) in the base 311; The base 311 has a space for accommodating the movable piece 330, and the movable piece 330 is accommodated in this space.

  In addition, as shown in FIG. 23B, one movable piece 330 ′ is one of the base portions 311 in a plan view (hereinafter, also simply referred to as “plan view”) viewed from the axial direction of the guide portion 200. The other movable piece 330 ″ is slidable so as to protrude and retract from the end portion, and can be slidably protruded and retracted from the other end portion of the base 311. Each movable piece 330 is also slidable. 24A, a knob (movable piece operation part) 331 protruding toward the base end side of the base 311 is provided. By operating this knob 331, the movable piece 330 is removed from the base 311. It can be protruded or retracted to the base 311. When the movable piece 330 is protruded from the base 311 by operating the knob 331, the state shown in FIGS. As shown, the movable piece 330 , 330 ″ are connected to each other below the guide portion 200 (on the side opposite to the base portion 311 of the guide portion 200), and an annular portion 340 is formed by the base portion 311 and the movable pieces 330 ′, 330 ″. The guide part 200 is located in the annular part 340. Each movable piece 330 has a peeling part 350, a groove part 390, and a processing part 360, as in the first configuration example described above. Each is provided.

≪Vessel peeling method≫
According to the blood vessel peeling device 100H having such a configuration, in the second step of the blood vessel peeling method, first, the connector 310 in a state where the movable pieces 330 ′ and 330 ″ are retracted into the base 311 is connected to the rail 211. Then, each movable piece 330, 330 ″ is protruded from the base portion 311 to form an annular portion 340. Thereby, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000. In this state, the movable portion 300G may be advanced along the guide portion 200 to perform the peeling operation. In particular, as described above, since the knob 331 protrudes toward the proximal end side of the base 311, the knob 331 is not easily caught by the tissue or the branch blood vessel 1100 during the peeling operation, and the peeling operation can be performed more smoothly.

  Also by such 1st Embodiment, the effect similar to the 1st structural example mentioned above can be exhibited.

<Ninth configuration example>
FIG. 25 is a cross-sectional view showing a movable part included in the blood vessel peeling device according to the ninth configuration example. FIG. 26 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.

  Hereinafter, the ninth configuration example will be described with reference to this drawing. However, the difference from the configuration example and the embodiment described above will be mainly described, and description of similar matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
As shown in FIG. 25A, a pair of slits 213 and 214 extending in the axial direction are arranged in the body portion 210 of the guide portion 200I so as to be separated from each other in the circumferential direction. On the other hand, the movable part 300I is attached to the distal end of the main body part 410 of the imaging device 400, and has a belt-like belt-like body 600 shaped in a substantially arc shape (substantially annular shape). And the strip | belt-shaped body 600 is arrange | positioned in the guide part 200I in the state wound so that it might reduce in diameter. The imaging device 400 also serves as the operation unit 500 that moves the movable unit 300I.

  In the blood vessel peeling device 100I having such a configuration, when the imaging device 400 is rotated in a state where the belt-like body 600 is accommodated in the guide portion 200I, the belt-like body 600 is formed on the guide portion 200I via the slit 213 from the distal end side. As shown in FIG. 25 (b), the tip end portion is retracted into the guide portion 200I through the slit 214. An annular portion 340 is formed by a portion protruding from the guide portion 200I of the belt-like body 600. The strip 600 is provided with a peeling portion 350, a groove portion 390, and a processing portion 360, as in the first configuration example described above. However, in this configuration example, as described later, the groove 390 and the peeling portion 350 are based on the base of the belt-like body 600 because the movable portion 300I is moved so as to retreat from the distal end side to the proximal end side of the guide portion 200I. It is arranged facing the end side.

≪Vessel peeling method≫
According to the blood vessel peeling device 100I having such a configuration, first, the first step is performed as shown in FIG. 26A in a state where the movable part 300I is accommodated in the guide part 200I. In the second step, first, as shown in FIG. 26B, the imaging device 400 is rotated to project the belt-like body 600 from the guide portion 200I to form the annular portion 340. Accordingly, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000. Next, by pulling the imaging device 400 to the base end side so as to be removed from the guide part 200I, the strip-shaped body 600 (movable part 300I) is moved to the base end side while being guided by the slits 213 and 214, and the peeling operation is performed. . As a result, the large saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200. According to such a method, since the imaging device 400 is removed and the separation step is performed, the blood vessel separation step can be reduced as compared with the first configuration example described above.

  The ninth configuration example can also exhibit the same effects as those of the first configuration example described above.

  As a modification of the present configuration example, only one slit is formed in the main body 210, and the belt-like body 600 may be protruded and retracted through this one slit. In the present configuration example, the movable unit 300I is moved from the distal end side to the proximal end side, but conversely, it may be moved from the proximal end side to the distal end side. In this case, the groove portion 390 may be provided so as to open to the front end side of the belt-like body 600. However, the method of pulling to the base end side as in this configuration example is more effective in that it is easier to control the force (control and adjustment of the moving amount and moving speed of the movable portion 300I).

<10th configuration example>
FIG. 27 is a plan view showing a blood vessel peeling device according to a tenth configuration example.

  Hereinafter, the tenth configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example and the embodiment described above, and the description of the same matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
As shown in FIG. 27, the movable part 300J has a connector 310 connected to the rail 211 of the guide part 200, and a pair of injection nozzles 700 provided on the connector 310.

  The connector 310 includes a base portion 311 extending in the width direction orthogonal to the moving direction, and a connection portion 312 that slidably connects the base portion 311 to the rail 211. In addition, a peeling portion 350 is provided at the distal end portion of the base portion 311, and an injection nozzle 700 is provided at both end portions of the base portion 311. The pair of injection nozzles 700 are provided so as to be positioned on both sides of the guide part 200 in a plan view (a plan view shown in FIG. 27, hereinafter simply referred to as “plan view”) viewed from the axial direction of the guide part 200. Yes. Further, from each spray nozzle 700, the liquid L is sprayed obliquely toward the inner side (the guide part 200 side). The liquid L ejected from each ejection nozzle 700 intersects below the guide portion 200 (on the side opposite to the connector 310 of the guide portion 200) in plan view. Further, the guide portion 200 and the great saphenous vein 1000 are located in a region S surrounded by the base 311 and the ejection path of the liquid L.

  Further, each ejection nozzle 700 can eject (discharge) a small amount of liquid L at high speed and in a pulse shape. According to such an injection method of the liquid L, for example, the branch blood vessel 1100 (fine blood vessel) and nerves can be preserved without being damaged, and heat generation of the tissue can be suppressed. Can preserve the function.

≪Vessel peeling method≫
According to the blood vessel peeling device 100J having such a configuration, in the second step of the blood vessel peeling method, the connector 310 is moved to the distal end side while ejecting the liquid L from each jet nozzle 700, so that the peeling work can be performed. it can. According to such a configuration and method, the connector 310 can be connected to the guide part 200 without cutting the great saphenous vein 1000, and the great saphenous vein 1000 is covered with the surrounding tissue 1200. Can be peeled off. In some cases, the branched blood vessel 1100 may not be cut depending on the jetted liquid L. In this case, after the peeling operation, the branch blood vessel 1100 may be cut and hemostatically treated.

  The tenth configuration example can also exhibit the same effects as those of the first configuration example described above.

  In this configuration example, the groove portion 390 and the processing portion 360 are not provided in the base portion 311 as in the first configuration example described above, but the groove portion 390 and the processing portion 360 are provided in the base portion 311 in the same manner as in FIG. May be. Thereby, in the passage region of the base 311, the branch blood vessel 1100 can be processed.

<Eleventh configuration example>
FIG. 28 is a side view showing the blood vessel peeling device according to the eleventh configuration example.

  Hereinafter, the eleventh configuration example will be described with reference to this drawing, but the description will focus on the differences from the configuration example and the embodiment described above, and the description of the same matters will be omitted.

  This configuration example is mainly the same as the first configuration example described above except that the configuration of the movable portion is different.

≪Vessel peeling device≫
As shown in FIG. 28, the movable part 300 </ b> K includes a first movable part 301 and a second movable part 302 located on the proximal side with respect to the first movable part 301. The first movable portion 301 has the same configuration as the movable portion 300J of the tenth configuration example described above, and the second movable portion 302 has the same configuration as the movable portion 300 of the first configuration example described above. As described in the tenth configuration example described above, the branching blood vessel 1100 cannot be cut or stopped by the ejection of the liquid L from the first movable portion 301 even if the tissue can be peeled off. Therefore, the second movable portion 302 is provided behind the first movable portion 301, and the branch blood vessel 1100 is cut and stopped by the processing portion 360 included in the second movable portion 302.

≪Vessel peeling method≫
According to the blood vessel peeling device 100K having such a configuration, in the second step of the blood vessel peeling method, first, the first movable portion 301 and the second movable portion 302 are connected to the guide portion 200, and the liquid is discharged from the first movable portion 301. While jetting L, the first and second movable parts 301 and 302 are moved to the tip side to perform the peeling operation. According to such a method, tissue separation is performed by the first movable unit 301 located in front, and the second movable unit 302 cuts and stops hemostasis of the branch blood vessel 1100 while passing through the separated site. Movement of the movable part 300K in the living body becomes smoother. In addition, since the great saphenous vein 1000 can be peeled off and the branch blood vessel 1100 can be cut and stopped at the same time, a smoother procedure can be performed.

  Also according to the eleventh configuration example, the same effects as those of the first configuration example described above can be exhibited.

  As mentioned above, although the blood vessel peeling device of the present invention has been described based on the illustrated configuration example and embodiment, the present invention is not limited to this, and the configuration of each part is an arbitrary configuration having the same function. Can be substituted. In addition, any other component may be added to the present invention. In addition, each configuration example and embodiment may be appropriately combined.

  Further, in the configuration example and the embodiment described above, the case of collecting the bypass tube when performing the vascular bypass operation has been described, but the use of the collected blood vessel is not limited to the bypass tube.

DESCRIPTION OF SYMBOLS 100 Blood vessel peeling device 100A Blood vessel peeling device 100D Blood vessel peeling device 100F Blood vessel peeling device 100G Blood vessel peeling device 100H Blood vessel peeling device 100I Blood vessel peeling device 100J Blood vessel peeling device 100K Blood vessel peeling device 200 Guide part 200C Guide part 200D Guide part 200G Guide part 200I Guide Part 210 body part 211 rail 212 slit 213 slit 214 slit 218 female screw part 219 insertion hole 220 peeling part 240 permanent magnet 300 movable part 300D movable part 300E movable part 300F movable part 300G movable part 300H movable part 300I movable part 300J movable part 300K Movable portion 301 First movable portion 302 Second movable portion 310 Connector 311 Base portions 311a, 311b Groove 312 Connection portion 312a Lumen 312 Observation part 315 Permanent magnet 320 Mounting part 321 Slit 330 Movable piece 330 'Movable piece 330 "Movable piece 331 Knob 340 Annular part 350 Peeling part 360 Processing part 361, 362 Electrode 361' Tip part 370 Vibration damping part 371 First vibration damping part 372 Second vibration reduction unit 380 Vibration element 390 Groove portion 391 Blood vessel guide groove portion 392 Blood vessel processing groove portion 400 Imaging device 410 Main body portion 420 Illumination portion 430 Imaging portion 500 Operation portion 500B Operation portion 500C Operation portion 511, 512 String 520 Male screw portion 600 Band-shaped Body 700 Injection nozzle 1000 Great saphenous vein 1001 Proximal end cut planned portion 1002 Distal end cut planned portion 1100 Branched blood vessel 1200 Tissue 1300 Incised portion 1400 Incised portion F1 Front end surface J Central axis L Liquid S region t1 Thickness θ Inclination angle

Claims (8)

A long guide,
A movable part comprising: a connector slidably connected to the guide part; and a movable piece housed in the connector and projectable from the connector;
Placing the guide portion along the outer wall of the blood vessel;
The movable part in a state in which the movable piece protrudes from the connector is moved while being guided by the guide part, and the blood vessel is peeled off in a state where at least a part of the periphery is covered with a surrounding tissue. Blood vessel peeling device. In the connector, a pair of the movable pieces are accommodated,
In a plan view seen from the axial direction of the guide part,
One of the movable pieces protrudes from one end of the connector,
The blood vessel peeling device according to claim 1, wherein the other movable piece projects from the other end of the connector. In a plan view seen from the axial direction of the guide part,
The blood vessel peeling device according to claim 2, wherein tips of the movable pieces protruding from the connector are connected to each other on the opposite side of the guide portion from the connector.   The annular part is comprised by the said connector and each said movable piece by connecting the front-end | tip parts of each said movable piece protruded from the said connector, The said guide part is located in the said annular part. Blood vessel peeling device.   The blood vessel peeling device according to any one of claims 1 to 4, wherein the movable portion includes a movable piece operating portion that causes the movable piece to protrude from the connector.   The blood vessel peeling device according to claim 5, wherein the operation unit is a knob connected to the movable piece and protruding out of the connector.   The said movable piece is provided with the peeling part which peels the said blood vessel, and the process part which cut | disconnects and stops hemostasis of the branch blood vessel branched from the said blood vessel. Vascular exfoliation device.   The blood vessel peeling device according to any one of claims 1 to 7, further comprising an operation unit that moves the movable unit with respect to the guide unit.

Images