JP2016165427A - Vascular clamp - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a vascular clamp capable of intermittently and stepwisely blocking a blood flow by a simple operation in a laparoscopic operation.SOLUTION: The vascular clamp includes: a hard and linear first rod body (1) and second rod body (2); a connecting part (5) at which proximal ends of the first rod body (1) and second rod body (2) are connected, where the first rod body (1) and the second rod body (2) clamp a blood vessel, with the connecting part (5) defined as a fulcrum, so as to block the blood flow; a belt-like body (4) that extends from a distal end of the second rod body (2) and, the tip end of which is fixed to a part between an outer proximal end and an outer central part of the second rod body (2); and a ring-like grip force adjusting member (6) that passes through the belt-like body (4) and the second rod body (2) and causes the distal ends of the first rod body (1) and second rod body (2) to pass through the inside thereof.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a blood vessel clamp that intermittently blocks blood flow in the liver and duodenum and the like in laparoscopic surgery.

In recent years, many open abdominal operations are shifting to a less invasive laparoscopic operation, and the number of laparoscopic hepatectomy is increasing in hepatectomy compared to open hepatectomy. . However, since the liver is an organ that easily bleeds, it is necessary to control the bleed, and various ideas have been made so far.
The most widespread method is the Pringle method (intermittent hepatoduodenal blockage method) in which the liver and duodenum are clamped together and the liver blood flow is interrupted intermittently. To perform the Pringle method, there is a tourniquet method in which a tourniquet is used in which a thin lashing tape is passed through a cut nelaton catheter. However, most of the ready-made products are made for laparotomy, and in the case of laparoscopic surgery, most medical facilities use their own products.
Further, in order to use the tourniquet in the abdominal cavity, it is necessary to additionally construct an abdominal cavity port for inserting forceps into the abdominal cavity in the patient's abdomen.

On the other hand, there is a method called a forceps method in which the liver and duodenum are directly clamped with a detachable intestinal forceps. Such a forceps method has a problem that the applied pressure is weak and sufficient blockage of the liver blood flow cannot be expected. In addition, in the case of forceps, increasing the pressure may damage the blood vessels (hepatic artery, common bile duct, portal vein) that pass through the liver and duodenum, causing fatal complications (mass bleeding). is there.
In the case of the above tourniquet method or forceps method, fine adjustment of the blood flow blocking pressure currently depends on the operator's senses.

  In addition, although not intended to block blood flow, an intestinal tract clamp device that facilitates clamping of the intestinal tract at the time of surgery is known (see Patent Document 1). However, in laparoscopic hepatectomy, a blood vessel clamp that intermittently blocks the blood flow of the hepatoduodenal mesentery is required. However, the intestinal tract clamp disclosed in Patent Document 1 Designed to facilitate pinching, it is possible to completely block or release the blood flow, but it is difficult to make fine adjustments to keep the blood flow to a certain extent. is there.

JP 2006-87671 A

  In the current medical field, the expandability and applicability of laparoscopic surgery, which is minimally invasive to patients and has been recognized by many medical practitioners, is expected to become very large in the future. . However, as described above, there has never been a grasping device that safely and surely blocks a blood vessel that sends blood to an organ and achieves minimally invasiveness in laparoscopic surgery.

  In view of such a situation, an object of the present invention is to provide a blood vessel clamp capable of interrupting blood flow intermittently and stepwise with a simple operation in laparoscopic surgery.

In order to solve the above-mentioned problem, the blood vessel clamp according to the first aspect of the present invention is configured such that the hard and straight first and second rod bodies are connected to the proximal ends of the first and second rod bodies. In the blood vessel clamp in which the connecting portion and the first and second rods sandwich the blood vessel with the connecting portion as a fulcrum and block the blood flow, the second rod extends from the distal end of the second rod. A band-shaped body having a tip fixed between the outer proximal end and the outer central portion of the body, and a space between the band-shaped body and the second rod body, and the distal ends of the first and second rod bodies facing inward It is characterized by having a loop-shaped gripping force adjusting member.
In the blood vessel clamp of the present invention, the distal end of the extended band-shaped body is fixed between the outer proximal end and the outer central portion of the second rod body, and the ring-shaped gripping force adjusting member is connected to the band-shaped body and the second band-shaped body. Since it passes between the rods, the gripping force adjusting member is unlikely to fall off unexpectedly, and can be said to have high operability.

The gripping force adjusting member can also adjust the gripping force by adjusting the length of itself, but it can be adjusted by sliding it parallel to the axial direction of the first and second rods. It is also possible to do. In this way, the gripping force can be adjusted flexibly with a simple operation.
In addition, the blood vessel clamp according to the first aspect of the present invention can be used by inserting the blood vessel clamp of the present invention from an already opened abdominal cavity port, and there is no need to add an abdominal cavity port to the patient. Minimally invasiveness can be achieved without causing extra damage.

A blood vessel clamp according to a second aspect of the present invention includes a rigid and linear first and second rod bodies, a coupling portion to which proximal ends of the first and second rod bodies are coupled, In the blood vessel clamp in which the second rod body sandwiches the blood vessel with the connecting portion as a fulcrum and blocks the blood flow, the first belt-like body extending from the distal end of the first rod body and having a through hole, A second band extending from the distal end of the two rods, and a ring shape attached to the root of the second band and passing through the distal ends of the first and second rods The gripping force adjusting member is provided.
The gripping force adjusting member in the blood vessel clamp according to the second aspect can also adjust the gripping force by adjusting the length of itself.
The blood vessel clamp according to the second aspect of the present invention can be used by inserting the blood vessel clamp of the present invention from an already opened abdominal cavity port, and there is no need to add an abdominal cavity port to the patient. Minimally invasiveness can be realized without damaging.

The gripping force adjusting member constituting the blood vessel clamp of the present invention is composed of one band, and a plurality of protrusions are provided at one end of the band, and a through hole is provided at the other end. It is preferable that the ring-shaped diameter can be reduced by the portion passing through the through hole.
Since the protrusion passes through the through hole and is engaged with the other end, the first and second rod bodies can be firmly held and the gripping force can be kept constant. In addition, by providing a plurality of protrusions, fine adjustment is possible, facilitating intermittent and gradual blockage of blood flow.

The gripping force adjusting member constituting the blood vessel clamp of the present invention is composed of a single band, and is provided with a serrated irregularity at one end of the band and a through hole at the other end. May pass through the through hole to reduce the ring-shaped diameter.
According to such a structure, when inserting a tip with serrated irregularities in the through hole, the diameter of the ring can be reduced by simply pulling the tip, so blood flow can be quickly blocked during the operation. Is suitable.

The gripping force adjusting member that constitutes the blood vessel clamp of the present invention may be provided with a single band and a fastener that press-contacts both ends of the band.
Depending on the scene in which the blood vessel clamp is used, it may be difficult to sufficiently clamp the blood vessel simply by inserting the protrusion or the like into the through hole. In that case, by fixing the both end portions of the band with the pressure-contacting fasteners, the ring-shaped diameter can be firmly fixed so as not to expand by contraction, and the blood flow can be reliably blocked.

In the blood vessel clamp of the present invention, the surfaces of the first and second rod bodies are covered with a cover made of a soft and flexible resin, and the connecting portion is a resin at the proximal end of the first and second rod bodies. It is preferable that is connected.
Since the surfaces of the first rod and the second rod are covered with a cover made of a soft and flexible resin, it is difficult to damage the tissue in the patient's body and safety is increased. Since the place where the resin at the proximal ends of both the first rod body and the second rod body is connected can be used as a connecting portion, another member or mechanism is not required as the connecting portion. By connecting the resin to the connecting portion, the connecting portion can be flexible and stretched.

In the blood vessel clamp of the present invention, it is preferable that the belt-like body, the covering body, and the connecting portion are integrally formed using a soft and flexible resin.
The band-shaped body, the cover, and the connecting portion are integrally formed of a soft and flexible resin, so that the corners are reduced and safety is increased, and the number of parts and materials can be reduced.

In the blood vessel clamp of the present invention, it is preferable that a plurality of filaments having a substantially semicircular cross section are formed on the surfaces of the inner surfaces of the first rod body and the second rod body that contact each other.
By adopting such a shape, a spring effect is generated, and the blood vessel can be sandwiched with a substantially constant and stable pressing force, and can be safely and reliably blocked. Moreover, since the escape structure is generated in the narrowed portion, it is possible to suppress an excessive burden on the blood vessel.

In the blood vessel clamp of the present invention, it is preferable that a plurality of filaments having a substantially trapezoidal cross section are formed on the surfaces of the inner surfaces of the first rod body and the second rod body that are in contact with each other.
By adopting such a shape, a spring effect is generated, and the blood vessel can be sandwiched with a substantially constant and stable pressing force, and can be safely and reliably blocked. In addition, blood flow can be blocked more firmly than when the cross section is substantially semicircular.

  The material of the 1st rod body and the 2nd rod body of the blood vessel clamp of this invention is comprised with the resin which has a metal or hardness. By using a metal or a resin having rigidity, a stable gripping force and durability can be obtained.

  According to the blood vessel clamp of the present invention, there is an effect that blood flow can be interrupted intermittently and stepwise by a simple operation in laparoscopic surgery.

Overall structure diagram of blood vessel clamp of Example 1 1 Structure diagram of gripping force adjusting member of embodiment 1 Sectional drawing of the 1st rod and the 2nd rod, (1) shows Example 1 and (2) shows Example 4. Overall structure diagram 2 of blood vessel clamp of Example 1 Overall structure diagram of blood vessel clamp of Example 1 3 FIG. 4 is a general structural diagram of the blood vessel clamp according to the first embodiment. Overall structure diagram of blood vessel clamp of Example 2 Structure diagram of gripping force adjusting member of embodiment 3 Overall structure diagram of blood vessel clamp of Example 5 1 Overall structure diagram of blood vessel clamp of Example 5 2

  Hereinafter, an example of an embodiment of the present invention will be described in detail with reference to the drawings. The scope of the present invention is not limited to the following examples and illustrated examples, and many changes and modifications can be made.

FIG. 1 is an overall structural view of a blood vessel clamp according to the first embodiment. As shown in FIG. 1, the blood vessel clamp 3 includes a first rod 1, a second rod 2, a strip 4, a connecting portion 5, and a gripping force adjusting member 6. The first rod body 1 and the second rod body 2 are hard and straight rod bodies, and are connected by a connecting portion 5 at the proximal end 1a and the proximal end 2a. In use, the contact surface 1c of the first rod 1 and the contact surface 2c of the second rod 2 are brought into contact with the connecting portion 5 as a fulcrum, sandwiching the liver duodenum mesentery 8 and blocking the blood flow. To do. The band 4 extends from the distal end 2 b of the second rod 2, and the tip 4 a is fixed to the outer proximal end 2 d of the second rod 2. In addition, the gripping force adjusting member 6 is attached in a ring shape, passes between the belt-like body 4 and the second rod body 2, and the distal ends of the first and second rod bodies (1, 2) ( 1b and 2b) are passed inside. Here, a urethane resin is used as the material of the belt-like body 4 and the connecting portion 5.
The surfaces of the first rod body 1 and the second rod body 2 are also covered with a covering body (not shown) made of urethane resin, and the covering body, the belt-like body 4 and the connecting portion 5 are integrally formed. ing. The material of the first rod 1 and the second rod 2 is preferably made of stainless steel, and the length is preferably 30 to 80 mm. The material of the first rod 1 and the second rod 2 may be a metal other than stainless steel or a hard resin. Moreover, the length of the 1st rod 1 and the 2nd rod 2 does not need to be 30-80 mm.

FIG. 2 is a structural diagram of the gripping force adjusting member according to the first embodiment. As shown in FIG. 2, the gripping force adjusting member 6 is composed of a concavo-convex portion 6a, a gripping portion 6b, and a through hole 6c, and grips the concavo-convex portion 6a and the gripping portion 6b, and inserts the concavo-convex portion 6a into the through-hole 6c. The structure is fixed.
When performing the Pringle method, it is necessary not only to block the blood flow, but also to intermittently release the blood flow and to re-block it. Therefore, after fixing, the gripping portion 6b is gripped with forceps, and the uneven portion 6a is pulled or loosened to enable adjustment. Further, the gripping force adjusting member 6 can adjust the gripping force by sliding in parallel with the axial direction of the first rod 1 and the second rod 2 even when the length is fixed. .

Here, the concavo-convex portion 6a and the through-hole 6c may have a structure that is not completely detached once they are engaged at the time of manufacture. If it does so, if the uneven | corrugated | grooved part 6a and the through-hole 6c are engaged in the state which the gripping force adjustment member 6 passed between the strip | belt-shaped body 4 and the 2nd rod 2, the gripping force adjustment member 6 will be the blood vessel clamp 3. The structure will not deviate from the above.
Even in such a state, it is possible to engage the gripping force adjusting member 6 with the first rod 1 or to remove it from the first rod 1, and the engagement between the concavo-convex portion 6a and the through hole 6c. It is also possible to adjust the gripping force of the blood vessel clamp 3 by adjusting the alignment position.
With such a structure, it is possible to prevent the surgeon from dropping the grasping force adjusting member 6 from the blood vessel clamp 3 during the operation.

FIG. 3A is a cross-sectional view of the first rod body and the second rod body according to the first embodiment. As shown in FIG. 3 (1), the insides of the cross sections of the first rod 1 and the second rod 2 are formed in three substantially semicircular shapes, respectively, and come into contact with the contact portion 1f. The part 2f, the contact part 1g and the contact part 2g, and the contact part 1h and the contact part 2h contact each other to sandwich the liver and duodenum. In blocking blood flow, it is necessary to have a sufficient blocking force, but it is also important not to damage a tissue such as a blood vessel.
As in this embodiment, the contact portion is provided with irregularities, so that a relief structure is formed in the contact portion, and it is possible to prevent an excessive load from being damaged when the blood vessel or the like is gripped, thereby damaging the blood vessel. it can. In addition, such a structure gives an appropriate elastic force to the first and second rods (1, 2), and can hold the liver and duodenum mesentery with a substantially constant and stable pressing force. The flow can be cut off.

Next, the usage method of the blood vessel clamp 3 of Example 1 is demonstrated, referring FIG.1 and FIGS. 1 and FIGS. 4 to 6 are views showing the entire structure of the blood vessel clamp according to the first embodiment. FIG. 4 is a state before the gripping force adjusting member is attached to the first and second rods, FIGS. Indicates the state after installation.
First, in order to pinch the liver and duodenum mesentery 8, as shown in FIG. 4, it is necessary to make the gripping force adjusting member 6 disengaged from the first and second rods (1, 2). is there. In this state, the liver and duodenum mesentery 8 is sandwiched between the distal end 1b of the first rod 1 and the distal end 2b of the second rod 2. Here, the gripping force adjusting member 6 is disengaged from the first and second rod bodies (1, 2), but is engaged with the belt-like body 4, and the uneven portion 6a is inserted through the through hole 6c. Therefore, even if the operator does not grasp the grasping force adjusting member 6, the structure does not drop from the blood vessel clamp 3.

Next, as shown in FIG. 1, the gripping force adjusting member 6 is slid along the strip 4 in the direction of the distal end 2 b, and the engagement location is switched from the strip 4 to the second rod 2. . Then, both the first rod 1 and the second rod 2 are passed through the gripping force adjusting member 6 from the distal end (1b, 2b) side and engaged.
Here, when the first rod 1 and the second rod 2 are passed through the inside of the gripping force adjusting member 6, it is desirable to adjust the gripping force adjusting member 6 loosely in advance.
After the gripping force adjusting member 6 is engaged with the first and second rods (1, 2), it clamps slightly stronger than shown in FIG. It has been.

  FIG. 5 shows a state in which the gripping force adjusting member is strongly tightened. As shown in FIG. 5, when the blood flow in the liver and duodenum 8 is required to be blocked, the grip force adjusting member 6 is tightened more strongly than in FIG. 1 to block the blood flow. Is possible.

FIG. 6 shows a state in which the gripping force adjusting member is slid. As shown in FIG. 6, the operator not only tightens the gripping force adjusting member 6 itself, but also grips the gripping force adjusting member 6 to determine the axial direction of the first and second rod bodies (1, 2). It is possible to adjust the gripping force by moving substantially parallel.
Specifically, when the gripping force adjusting member 6 is moved to the proximal end (1a, 2a) side, the gripping force adjusting member 6 can be tightened more strongly and blood flow can be blocked more, and to the distal end (1b, 2b) side. When moved, the tightening degree becomes weaker and blood flow is improved. According to this adjustment method, the hepatic blood flow can be intermittently interrupted by a simpler operation than the adjustment using the through hole 6c, and fine adjustment is also possible.

  FIG. 7 shows an overall structural diagram of the blood vessel clamp according to the second embodiment. As shown in FIG. 7, in the present embodiment, the belt-like body 4 extends from the distal end 2 b of the second rod body 2, and a tip 4 a is formed at the outer central portion 2 e of the second rod body 2. It is fixed. The gripping force adjusting member 6 is attached in a ring shape, passes between the belt-like body 4 and the second rod body 2, and the distal ends (1b, 2) of the first and second rod bodies (1, 2). 2b) is passed inside. The material of the strip 4 is urethane resin, and the cover and the connecting portion 5 are integrally formed.

FIG. 8 is a structural diagram of the gripping force adjusting member of the third embodiment. As shown in FIG. 8, the gripping force adjusting member 7 includes a tape portion 7a and a fastener 7b, and has a structure capable of adjusting the length by gripping and operating the tape portion 7a and the fastener 7b. The fastener 7b is the same as that used for a known drawstring bag, etc., and a spring is provided inside. The fixing portion 7d can be loosened by pressing the button 7c, and the fixing portion 7d can be fixed by releasing the button 7c. Is.
Here, as in the first embodiment, the tape portion 7a and the fastener 7b may be structured so as not to be completely detached once they are engaged at the time of manufacture. When the gripping force adjusting member 7 passes between the belt-like body 4 and the second rod 2 and the fastener 7b is engaged with the tape portion 7a, the gripping force adjusting member 7 becomes the blood vessel clamp 3. The structure will not deviate from the above.

FIG. 3B is a cross-sectional view of the first rod body and the second rod body according to the fourth embodiment. As shown in FIG. 3 (2), in this embodiment, the insides of the cross sections of the first rod 1 and the second rod 2 are each formed in two substantially trapezoidal shapes, and the abutting portion 1i and the contact portion 2i, and the contact portion 1j and the contact portion 2j are in contact with each other to sandwich the liver and duodenum mesentery.
Unlike Example 1, since the contact part (1i, 1j, 2i, 2j) has a planar shape, the blood vessel can be gripped more securely and blood flow can be blocked.

9 and 10 show the entire structure of the blood vessel clamp of Example 5. FIG.
As shown in FIG. 9, the blood vessel clamp 10 includes a first rod 11, a second rod 12, a first strip 13, a second strip 14, a connecting portion 15, and a gripping force adjusting member 16. Consists of. The first rod body 11 and the second rod body 12 are hard and straight rod bodies, and are connected by a connecting portion 15 at the proximal end 11a and the proximal end 12a. In use, the contact surface 11c of the first rod 11 and the contact surface 12c of the second rod 12 are brought into contact with the connecting portion 15 as a fulcrum, sandwiching the liver duodenum mesentery 8 and blocking blood flow. To do.

The first strip 13 is extended from the distal end 11 b of the first rod 11. The first belt-like body 13 is provided with a through hole 16 that can be inserted from the distal end portion 14b of the second belt body 14 to the root portion 14a. The second strip 14 is extended from the distal end 12 b of the second rod 12. The length of the first strip 13 is designed to be shorter than the length of the second strip 14.
The gripping force adjusting member 17 includes a ring-shaped ring-shaped portion 7a, a fastener 7b, a band portion 7e, and a button 7c. By changing the position of the fastener 7b, the length of the band portion 7e and the size of the ring-shaped portion 7a are changed. It can be adjusted. The gripping force adjusting member 17 is attached to the root portion 14 a of the second strip 14. When the distal ends (11b, 12b) of the first and second rod bodies (11, 12) are passed inside the ring portion 7a, the first and second rod bodies (11, 12) are gripped. The power can be adjusted. In addition, the urethane resin is used for the material of the 1st strip | belt-shaped body 13, the 2nd strip | belt-shaped body 14, and the connection part 15. FIG.

As shown in FIG. 10, the second band 14 is inserted into the through hole 16 of the first band 13 through the distal end portion 14 b of the second band 14 to hold the first band 13. When the tip 14b of the body 14 is pulled, the contact surface 11c of the first rod 11 and the contact surface 12c of the second rod 12 approach each other with the connecting portion 15 as a fulcrum. A locking portion is provided at the distal end portion 14b of the second band member 14 so that the second band member 14 does not come off when the ring portion 7a is loosened during the operation.
By passing the distal ends (11b, 12b) of the first and second rod bodies (11, 12) through the inside of the loop portion 7a and changing the position of the fastener 7b while pressing the button 7c, the loop portion 7a The distance between the contact surface 11c of the first rod 11 and the contact surface 12c of the second rod 12 can be maintained at a constant distance.

  The present invention is useful for medical devices for laparoscopic blood vessel clamping.

DESCRIPTION OF SYMBOLS 1,11 1st rod 1a, 11a Proximal end 1b, 11b Distal end 1c, 11c Contact surface 1f, 1g, 1h, 1i, 1j Contact part 2,12 Near 2nd rod 2a, 12a Distal end 2b, 12b Distal end 2c, 12c Abutting surface 2d Outer proximal end 2e Outer central part 2f, 2g, 2h, 2i, 2j Abutting part 3,10 Blood vessel clamp 4 Strip 4a Tip 5,15 Connecting part 6, 7, 17 Gripping force adjusting member 6a Uneven portion 6b Gripping portion 6c Through hole 7a Tape portion (ring portion)
7b Fastener 7c Button 7d Fixing part 7e Band part 8 Liver duodenum 13 13 1st band 14 2nd band 14a Root part 14b Tip part 16 Through-hole

Claims (9)

Hard and straight first and second rods;
A connecting portion to which the proximal ends of the first and second rods are connected;
In the blood vessel clamp in which the first and second rods sandwich the blood vessel with the connecting portion as a fulcrum and block the blood flow,
A strip extending from the distal end of the second rod and having a tip secured between the outer proximal end and the outer central portion of the second rod;
A ring-shaped gripping force adjusting member that passes between the belt-like body and the second rod body and passes the distal ends of the first and second rod bodies inward;
A blood vessel clamp comprising: Hard and straight first and second rods;
A connecting portion to which the proximal ends of the first and second rods are connected;
In the blood vessel clamp in which the first and second rods sandwich the blood vessel with the connecting portion as a fulcrum and block the blood flow,
A first strip extending from the distal end of the first rod and having a through hole;
A second strip extending from the distal end of the second rod;
A ring-shaped gripping force adjusting member attached to the base of the second belt-like body and passing the distal ends of the first and second rods inward;
A blood vessel clamp comprising:   The gripping force adjusting member is composed of a single band, and a plurality of protrusions are provided at one end of the band, a through hole is provided at the other end, and the protrusion is the through hole. The blood vessel clamp according to claim 1 or 2, wherein the diameter of the ring-shaped ring can be reduced by passing through.   The gripping force adjusting member is composed of a single band, a serrated irregularity is provided at the tip of one end of the band, a through hole is provided at the other end, and the serrated irregularity is formed through the through hole. The blood vessel clamp according to claim 1 or 2, wherein the diameter of the ring-shaped diameter can be reduced by passing through.   3. The blood vessel clamp according to claim 1, wherein the gripping force adjusting member includes a single band body and a fastener that press-contacts both ends of the band body.   The surfaces of the first and second rod bodies are covered with a cover made of a soft and flexible resin, and the connecting portion is connected to the resin at the proximal ends of the first and second rod bodies. The vascular clamp according to claim 1, wherein the vascular clamp is provided.   The blood vessel clamp according to any one of claims 1 to 6, wherein the belt-like body, the covering body, and the connecting portion are integrally formed using a soft and flexible resin. On the surfaces of the inner surfaces of the first and second rods that come into contact with each other,
The blood vessel clamp according to any one of claims 1 to 7, wherein a plurality of filaments having a substantially semicircular cross section are formed. On the surfaces of the inner surfaces of the first and second rods that come into contact with each other,
The blood vessel clamp according to any one of claims 1 to 7, wherein a plurality of filaments having a substantially trapezoidal cross section are formed.