JP2016158762A - Baloon clamp for blocking lumen - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a baloon clamp which can block a lumen completely even in an abdominoscope surgery and can easily perform a blocking/opening operation of the lumen.SOLUTION: The baloon clamp for blocking a lumen comprises a tabular body having a rectangular shape. The body includes a baloon 5 on a surface in a length direction, and rigid plates for baloon reinforcement embedded in a front generally half part and a rear generally half part in the length direction of the body on a back side of the baloon with a predetermined interval, and is bendable into two at an intermediate portion in the length direction with the interval of the rigid plates as a boundary. An engagement part 11 is provided at one edge of the body in the length direction. At the other edge, an engagement part 12 is provided detachably which engages the aforementioned engagement part in a state in which the body is bent. On the other edge side of the body, an airway tube 15 is arranged which supplies and discharges a fluid for expanding/shrinking the baloon. A thread 22 for pulling outside a body is provided on the airway tube and a thread 21 for guiding inside a body is provided on the engagement part at the one edge.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a lumen-clamping balloon clamp, and more particularly to a technique of a balloon-type clamp used for luminal tissue blocking during laparoscopic surgery.

  In recent years, laparoscopic surgery is frequently performed for the purpose of minimally invasive patients in digestive surgery. For example, laparoscopic surgery has increased the number of cases in the liver, but since the liver is a real tissue rich in blood vessels, hemostasis operation at the time of organ resection is important. Therefore, in laparotomy, the duodenal ligament is periodically blocked to stop blood flow to the liver and perform hepatectomy. Metal blocking forceps are used for blocking the duodenal ligament at this time, but incision is small in laparoscopic surgery, and it is difficult to insert the blocking forceps into the body cavity.

  In view of the situation as described above, an intestinal tract clamp is proposed as an alternative to the blocking forceps (Patent Document 1). As is apparent from FIG. 2 of the document 1, the two rigid rods 4 and 5 each having one flexible strip 1 and 2 that can be wound around the intestinal tract in a strip shape, It is comprised by the connection part 6 with which a rod-shaped body is connected, and the at least 1 or more through-hole 3 provided in one strip | belt body 1, and let the other strip | belt body pass through the through-hole 3 from the front-end | tip part side. Thus, the two rod-like bodies 4 and 5 can sandwich the intestinal tract with the connecting portion 6 as a fulcrum. This bowel clamp is the same in that it cuts off the lumen under an endoscope. The joint portion needs to be released and opened, and the operation becomes complicated in order to repeat periodic shut-off. In other words, the intestinal tract clamp has a problem that it cannot be switched between open and closed because the interruption is temporarily interrupted during use.

  As another example, there is an example in which the duodenal ligament is blocked using a ligation tool that ligates blood vessels (Patent Document 2). As apparent from FIG. 2 of the document 2, this is a cylindrical body 11 into which at least two string-like bodies 12 can be inserted, and a cord-like body that brings the biological tube 2 close to the tip of the cylindrical body. 12 is the same in that the lumen is blocked under the endoscope, but the ligature tool 1 cannot be repeatedly blocked and opened periodically. There was a problem that the surgeon felt inconvenience in the operation of blocking and opening the duodenal ligament.

  As another example, there is an example in which a balloon is inflated after wrapping around the upper part of the stomach to form a small hole smaller than the normal inner diameter of the stomach to restrict the movement of food (Patent Document 3). ). This is a gastric band 410 including a balloon 414, a belt 412, and a connecting layer 413, as is apparent from FIGS. However, since this gastric band 410 completely occludes the inside of the lumen, a high compression force is required to block the lumen, but the strength of the belt 412 is weak and the balloon 414 is inflated to block the lumen. If it tries to do so, the belt 412 (base) part will be deformed and the lumen cannot be completely occluded. Further, when the balloon 414 is inflated to block the lumen, the balloon 414 itself is also deformed, and the force for efficiently blocking the lumen does not work, and the lumen cannot be completely blocked. was there.

Japanese Patent No. 4090058 WO2012 / 046757 Japanese Patent No. 5557988

  Therefore, in view of the conventional problems as described above, the present inventors can be used for luminal tissue blockage during laparoscopic surgery, and concisely deal with luminal tissue without causing user stress. We have developed a balloon-type clamp that can be opened and closed. In other words, the present invention can solve the problem that the repetition of the conventional lumen blocking-opening operation is complicated or there is a possibility that the lumen cannot be completely blocked although a balloon is used. It is an object of the present invention to provide a balloon-type clamp that can completely close a lumen and can easily perform a blocking-opening operation of the lumen.

  In order to solve the above-mentioned problem, the invention according to claim 1 has a main body which has a rectangular shape and can be bent in half from an intermediate portion in the length direction, and the main body is a surface on the bending side. And a rigid plate for reinforcing the balloon is embedded in the main body on the back side of the balloon, and a locking portion is provided on one end of the main body. An end of the main body is provided with an engaging portion for detachably engaging the engaging portion with the main body bent, and the other end of the main body is inflated or deflated. An airway tube for supplying and discharging fluid is provided, and this airway tube is provided with a thread for drawing out from the body, and a side hole to which a connector with a stopcock is connected when the airway tube is pulled out of the body is provided. To the locking portion of the one end Wherein the yarns for the induction body is provided.

  According to a second aspect of the present invention, in the first aspect of the invention, when the locking portion at one end and the locking portion at the other end are locked, the main body is folded into two substantially in parallel. It is characterized by.

  The invention described in claim 3 is characterized in that, in claim 1 or 2, the balloon is provided with a plate-like sheet on the surface thereof.

  This invention is as described above, and according to the invention described in claim 1, the main body has a rectangular shape and can be bent in half from the middle portion in the length direction. A balloon is provided in the length direction of the surface on the bent side, and a rigid plate for reinforcing the balloon is embedded in the main body on the back side of the balloon, and a locking portion is provided at one end of the main body. The other end portion is provided with a locking portion for detachably locking the locking portion in a state where the main body is bent, and the balloon is provided on the other end portion side of the main body. An airway tube that supplies and discharges fluid to inflate or contract is provided, and this airway tube is provided with a thread for drawing out from the body, and a connector with a stopcock is connected when the airway tube is drawn out of the body. Side holes are provided and said one end Since the locking portion is provided with a thread for induction body lumen by the balloon during laparoscopic surgery it can be completely closed, can be used for the luminal tissue blocking. That is, since this balloon clamp can change the amount of inflation of the balloon, the blocking force can be adjusted according to the size of the lumen. Moreover, since the rigid plate is embedded in the main body, the main body does not deform even when the balloon is inflated to completely close the lumen, and the balloon itself is not deformed. In addition, the lumen can be easily blocked and opened, and can be simply opened and closed with respect to the lumen tissue without causing stress to the user. Therefore, it is possible to solve the problem that the repetition of the operation of blocking and opening the lumen is complicated as in the conventional case, or there is a possibility that the lumen cannot be completely blocked although a balloon is used.

  According to the second aspect of the present invention, the main body is folded into two substantially parallel when the locking portion at one end and the locking portion at the other end are locked. In addition to the effect, it is possible to reliably and stably close the lumen with the balloon.

  According to the third aspect of the present invention, since the plate-like sheet is provided on the surface of the balloon, the sheet moves following the balloon expansion or contraction in addition to the function and effect. Therefore, even if the blocking force is changed, the lumen of any thickness can be completely blocked while preventing tissue damage of the lumen. Further, the plate-like sheet distributes the force for blocking the lumen, and even when the blocking force is strong, it can be used without damaging the luminal tissue.

It is the top view which abbreviate | omitted a part of airway tube of the balloon type clamp which concerns on one embodiment of this invention. It is a front view same as the above. It is a bottom view same as the above. It is an expansion right side same as the above. It is an enlarged left side view as above. It is sectional drawing which follows the AA 'line of FIG. FIG. 3 is an enlarged end view taken along line BB ′ in FIG. 2. FIG. 3 is an enlarged end view taken along the line CC ′ of FIG. 2. FIG. 3 is an enlarged end view taken along the line DD ′ in FIG. 2. (A), (B) is drawing which shows a connection connector. It is an effect | action figure for demonstrating operation of a thread hook. It is an effect | action figure for demonstrating operation of a thread hook. It is an effect | action figure for demonstrating operation of a thread hook. It is an effect | action figure for demonstrating operation of a thread hook. It is an action figure for explaining interception and opening operation of a duodenal ligament. It is an action figure for explaining interception and opening operation of a duodenal ligament. It is an action figure for explaining interception and opening operation of a duodenal ligament. It is an action figure for explaining interception and opening operation of a duodenal ligament. FIG. 8 is an enlarged end view corresponding to FIG. 7, showing another example of a balloon.

  A lumen blocking balloon clamp according to an embodiment of the present invention will be described below with reference to the drawings.

  1 to 6, reference numeral 1 denotes a balloon-type clamp. The clamp 1 has a rectangular plate-like main body 2 that can be inserted into a trocar, and the main body has a longitudinal front half and a rear half half. Metal plates 3 and 4 as rigid plates are embedded in the portion at a predetermined interval, and can be bent in half from the intermediate portion in the length direction with the interval between the two metal plates as a boundary. The main body 2 is made of flexible silicone rubber, stainless steel, a thermoplastic resin such as PU or PVC used for medical purposes, or a composite material thereof, and the length L is about 155 mm, the width W is about 10 mm, and the thickness. T is about 7 mm. The metal plates 3 and 4 are provided to prevent the main body 2 from being deformed at the time of clamping and to prevent a later-described balloon from expanding to a circular cross-section for balloon reinforcement. The material of the metal plates 3 and 4 is not particularly limited, and any material other than metal can be used as long as it is rigid.

  In the longitudinal direction of the surface of the main body 2 in which the metal plates 3 and 4 are embedded, a clamping balloon 5 is provided so as to surround the outer periphery in the short direction of the main body 2 (see FIG. 7). In FIG. 7, the lower portion of the balloon 5 is fixed to the bottom surface of the main body 2, and the balloon 5 can be expanded and contracted so that the upper portion approaches or separates from the top surface of the main body 2. As a material for the balloon 5, flexible silicone rubber, PU, or the like is suitable.

  A plate-like sheet 7 having the same length and width as the main body 2 is attached to the surface of the upper part of the balloon 5 from one end to the other end in the length direction of the main body 2, A catch caused by a step when the clamp 1 is passed through an organ gap is reduced. However, when the balloon 5 is clamped, the surface of the sheet 7 on the lumen side can be provided with unevenness having a slip prevention function in order to prevent slippage with the surface of the lumen. Further, in order to increase the shape maintaining force of the sheet 7 itself, a reinforcing material such as a metal plate can be embedded in the sheet 7.

  As apparent from FIGS. 2 and 6, the sheet 7 has both end portions and intermediate portions that are thin, and the other portions corresponding to the metal plates 3 and 4 are relatively thick. In addition, the thickness of the intermediate portion is reduced, so that the main body 2 can be easily bent. Reference numerals 8 and 9 indicate gaps for reducing the thickness. A gap 8 at both ends is formed near both ends of the balloon 5, and a gap 9 at the middle is formed in correspondence with the distance between the metal plates 3 and 4 of the main body 2. By forming such a gap 9 in the middle part in particular, the main body 2 is easily bent on the gap 9 side by bringing the one metal plate 3 side and the other metal plate 4 side closer to each other in the direction of the arrow in FIG. .

  In order to fix the main body 2 in a bent state, a bullet-type stopper 11 is provided at one end in the length direction of the main body 2, and the stopper is fitted and locked at the other end. A hole 12 is provided for this purpose. Further, one end side of each of the airway tubes 13 and 14 for the balloon is provided on both sides in the short direction of the main body 2 on the end side from the hole portion 12 so as to communicate with the balloon 5. The other end side of the airway tubes 13 and 14 is a single airway tube 15 formed by bundling the bifurcated portions, and a connector mounting side hole 17 is provided near the sealing portion 16 of the tube. Is provided. A separately provided connection connector with a stopcock, which will be described later, can be attached to the side hole 17, and a balloon inflation fluid can be sent from the connector into the balloon 5 through the airway tube 15 and the airway tubes 13 and 14. It can be done.

  A loop-like thread 21 is provided at the tip of the stopper 11 for grasping with a forceps and guiding the clamp 1 into the body. A loop-shaped thread 22 for pulling out the clamp 1 to the outside of the body is provided at the rear end of the airway tube 15. In addition, the loop-shaped threads 21 and 22 provided for guiding the clamp 1 into the body or pulling it out of the body are loop-shaped in order to make it easy to hook a hook of a thread hooking member described later in this example. However, depending on the thread hook member, it may not necessarily be a loop.

  FIG. 10 shows the connection connector, where (A) shows before connection and (B) shows after connection. That is, the connection connector 25 includes a head portion 26 that is inserted into the side hole 17 of the airway tube 15 and a main body portion 28 that is detachably connected to the head portion and has a stopcock 27.

  Next, an example of using this clamp for the duodenal ligament B will be described with reference to FIG.

<Operation of thread hook>
First, as shown in FIG. 11, the trocar T and the port P are stabbed at a predetermined position on the abdominal wall so that the distal end opening reaches the body cavity. Then, the clamp 1 is inserted into the body cavity from the trocar T, and a separately prepared thread hook member 31 is inserted from the port P. Next, as shown in FIG. 12, forceps are inserted into the body cavity from the trocar T, and the loop-like thread 22 provided at the rear end of the airway tube 15 is gripped to hook the hook 31 a at the tip of the thread hook member 31. Hang on. FIG. 13 is an enlarged view of the hook tip of the XIII portion of FIG. 12, and shows a state where the thread 22 is hooked on the hook 31a.

  Next, as shown in FIG. 14, the thread hook member 31 with the thread 22 hooked on the hook 31a is pulled up in the port P so that the airway tube 15 appears outside the body.

<Blocking and opening the duodenal ligament>
Next, the tip loop-shaped thread 21 of the clamp 1 inserted into the body cavity is grasped with forceps and guided to the back surface of the duodenal ligament B which is a lumen to be clamped, as shown in FIG. Then, after guiding the main body 2 to an appropriate position, the forceps are once removed from the loop-shaped thread 21, the forceps are passed through the hole 12 on the terminal side, and the loop-shaped thread 21 is re-gripped to hold the forceps. As shown in FIG. 16, the stopper 11 is guided to the hole 12 together with the gripped loop-like thread 21, and the tip and the end are engaged and locked. Further, as described above, the connection connector 25 with a stopcock is attached to the side hole 17 of the airway tube 15 that has been pulled out of the body.

  When the clamp 1 is wound around the duodenal ligament B as described above, the metal plates 3 and 4 may also be present, and the folded main body 2 slightly crushes the duodenal ligament B to be in a substantially parallel state. When a balloon inflation fluid is injected from a fluid supply source (for example, a syringe barrel) connected to the connector 25 in this state, the fluid enters the balloon 5 via the balloon airway tube 15 and the airway tubes 13 and 14. Inflate. As the balloon 5 is inflated, the duodenal ligament B is gradually blocked and clamped as shown in FIG. 18 is a top view of the state where the lumen of the duodenal ligament B in FIG. 17 is blocked.

  In order to reopen the lumen of the blocked duodenal ligament B, the stopcock 27 of the connector 25 may be opened, whereby the fluid in the balloon 5 flows back through the airway tubes 13 and 14 and the airway tube 15 and is discharged outside the body. As a result, the balloon 5 spontaneously contracts, and the blood flow is resumed by the natural contraction of the balloon 5.

  As described above, in this balloon-type clamp 1, the body 2 is bent during laparoscopic surgery, and the stopper 11 is engaged with the hole 12 to make it substantially parallel, and the balloon 5 is inflated. Thus, the lumen of the duodenal ligament B can be completely closed. Moreover, since the metal plates 3 and 4 are embedded in the main body 2, the main body 2 will not be deformed even if the balloon 5 is inflated to completely close the lumen of the duodenal ligament B. Further, the balloon itself is not deformed unlike the conventional one. Further, the operation of blocking and opening the lumen of the duodenal ligament B can be easily performed by inflating or deflating the balloon 5 by supplying and discharging the fluid from the fluid supply source, and can be simply performed without causing stress on the user. Opening and closing operations for the lumen of the ligament B can be performed. For this reason, it is possible to solve the problem that the repetition of the operation of blocking and opening the lumen is complicated as in the conventional case, or the balloon 5 is used but the lumen may not be completely blocked.

  Since the balloon clamp 1 can change the expansion amount of the balloon 5, the blocking force can be adjusted according to the size of the lumen. Therefore, the sheet 7 installed on the balloon 5 moves following the expansion or contraction of the balloon 5, that is, the balloon 7 is positioned on the opposing inner surface of the main body 2 that is folded in two and becomes parallel. Since the sheet 7 on the sheet 5 moves in parallel with the expansion or contraction of the balloon 5, the sheet 7 moves toward or away from each other. However, it is possible to completely block the lumen while preventing tissue damage. Moreover, in the balloon clamp 1, since the plate-like sheet 7 is provided on the surface of the balloon 5, the force for blocking the lumen is dispersed. Therefore, even when the blocking force is strong, it can be used without damaging the luminal tissue.

  With respect to this point, the rod-like bodies 4 and 5 of the conventional patent document 1 are not parallel to each other, but are V-shaped. On the side of the hole 3, the blocking force is weakened, so that only a part of the lumen located on the connecting part 6 side is blocked, and the lumen located near the locking part is not blocked or the blocking force is weak ( There is a problem that the lumen itself moves to the locking portion) and the lumen cannot be completely blocked, but the balloon clamp 1 does not have such a problem.

  Moreover, in the thing of patent document 1, since the cross section of the rod-shaped bodies 4 and 5 is circular, an ellipse, or a polygon, there are few surfaces to install in a lumen, Therefore The force which interrupts | blocks a lumen concentrates. However, in this balloon clamp 1, since the plate-like sheet 7 is provided on the surface of the balloon 5, the force for blocking the lumen is dispersed. Therefore, even when the blocking force is strong, it can be used without damaging the luminal tissue.

  In order to remove the clamp 1 from the body cavity after the laparoscopic surgery is completed, the balloon 5 is deflated and the connector 25 is removed, while the forceps are again inserted into the body cavity from the trocar T, and the stopper 11 and the hole 12 are removed. Unlocking and returning the main body 2 to a flat state before being bent. After that, the tip loop-shaped thread 21 is again gripped with forceps, and the main body 2 is pulled out of the trocar T. At this time, the airway tube 15 on the rear end side of the main body 2 follows the main body 2 from the port P into the body cavity and further to the trocar T.

  In the above embodiment, an example of use for the duodenal ligament B has been described, but it can also be used for clamping other organs (intestinal tract, stomach) and blood vessels in laparoscopic surgery.

  Moreover, in the said embodiment, although the stopper 11 was provided in one edge part of the main body 2, and this stopper was latched in the hole 12 provided in the other edge part, the example as these latching | locking parts was shown. The stopper and the hole are a preferred example, and may be other locking portions. Further, in the embodiment, as shown in FIG. 7, the lower part of the balloon 5 is fixed to the bottom surface of the main body 2, and the entire balloon clamp including the main body 2 and the airway tubes 13 and 14 is covered with the balloon 5. Although it has a structure, it is also possible to have a structure that does not cover the bottom surface of the main body 2 as shown in FIG. As described above, the embodiment is merely a preferable example, and it is needless to say that the design and the like of the details can be arbitrarily changed and modified within the scope of the claims.

1 Balloon clamp 2 Body 3, 4 Metal plate (rigid plate)
5 Balloon 7 Sheet 8, 9 Clearance 11 Stopper (locking part)
12 hole (locking part)
13, 14, 15 Airway tube 16 Sealing portion 17 Side holes 21, 22 Thread 25 Connection connector 26 Leading portion 27 Stopcock 28 Body portion B Duodenal ligament

Claims (3)

  The main body has a rectangular plate-like body, and the main body is provided with a balloon in the longitudinal direction of the surface, and the front half of the main body in the longitudinal direction and the rear half of the main body on the back side of the balloon. A rigid plate for reinforcing the balloon is embedded in the portion at a predetermined interval, and it can be bent in half from the intermediate portion in the longitudinal direction with the interval of the rigid plate as a boundary. A locking portion is provided at one end, a locking portion is provided at the other end to removably lock the locking portion in a state where the main body is bent, and the other end of the main body. An airway tube for supplying and discharging fluid to inflate or deflate the balloon is provided on the part side, and a thread for extracorporeal drawing is provided on the airway tube, and when the airway tube is pulled out of the body, the stopcock The side hole to which the attached connector is connected Vignetting, lumen blocking balloon clamp, wherein the yarns for the induction body is provided on the engaging portion of said one end.   2. The lumen blocking balloon clamp according to claim 1, wherein the main body is folded into two substantially parallel when the locking portion at one end and the locking portion at the other end are locked.   The balloon clamp for lumen blocking according to claim 1 or 2, wherein a plate-like sheet is provided on a surface of the balloon.