JP2016179393A - Tissue ligation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a tissue ligation device capable of more steadily forming knots.SOLUTION: A tissue ligation device with a suture threaded therethrough to be used for ligation of tissue, comprises: a connection part 31 having an insertion hole 31A through which one end of the suture is inserted for suture threading; a first arm part 32A extending from the connection part; one of second arm parts 32B configured to be deformable from a first shape in which the second arm part forms a receiving part between the second and first arm parts and the receiving part forms an opening through which the suture is introduced, to a second shape in which the opening is closed; and the other of the second arm parts 32B configured to be deformable from a third shape in which the second arm part forms a second receiving part between the second and first arm parts and the second receiving part forms a second opening through which the suture is introduced, to a fourth shape in which the second opening is closed.SELECTED DRAWING: Figure 2

Description

  The present invention relates to a tissue ligation device, and more particularly, to a tissue ligation device including a suture and a thread fastening member.

  In the medical field, the operation of suturing and ligating tissue occupies a very important position in many procedures, but is a highly difficult operation that requires skill. In recent years, attempts to perform various procedures such as surgery using an endoscope, laparoscope, thoracoscope, etc. have been made for the purpose of reducing the invasion of the patient. Since it is necessary to operate by grasping with a long forceps or the like, the difficulty of suturing, ligating, etc. is further increased.

  In suturing and ligating, a particularly difficult operation is an operation of tying a suture to form a knot. If the knot is loosened, the suture or ligation may be released and cause serious complications. Depending on the procedure, a large number of knots may be formed. In this case, the difficulty level further increases.

  As one method for solving this problem, a medical suturing device described in Patent Document 1 has been proposed. This medical suturing device includes a suture body in which a suture is connected to a suture fix member. The thread fixing member has a housing portion capable of housing a part of the suture thread. When the suture thread locked to the tissue using a curved needle or the like is passed through the accommodation section, the suture thread is drawn and squeezed, and then the accommodation section is deformed by caulking or ultrasonic waves, the suture thread accommodated in the accommodation section A part is fixed to the thread stopper. Since the knot is formed in this way, the knot is easily formed.

Japanese Patent Laid-Open No. 8-140982

  However, the following problems remain in the medical suturing device of Patent Document 1. When a portion of the suture is accommodated in the accommodation portion and then the suture is drawn, the suture may come off from the accommodation portion. In this case, the suture thread must be passed through the receiving portion once again. In addition, in a suture body used in an actual procedure, for example, it is rare that the size of a thread fixing member is 1 mm (mm) square or less and the diameter of a suture is 0.2 to 0.3 mm or less. Absent. In such a case, it is not easy to pass the suture through the accommodating portion. Therefore, if the suture is removed from the accommodating portion in the middle, the working efficiency of the suturing and the like is significantly reduced.

  The present invention has been made in view of the above circumstances, and an object thereof is to provide a tissue ligation device capable of forming a knot more stably.

  The tissue ligation device of the present invention is a tissue ligation device to which a suture is attached and used for ligation of tissue, wherein one end of the suture is inserted and has a connection portion having an insertion port to be attached, and extends from the connection portion. A housing portion is formed between the first arm portion and the first arm portion extending from the first arm portion, and the housing portion is opened so as to form an opening into which the suture thread is introduced. A first arm portion extending from the first arm portion and a second arm portion configured to be deformable from a first shape to a second shape in which the opening is closed. The second opening is closed from the third shape in which the second receiving part is opened so as to form a second opening into which the suture is introduced. And a third arm portion configured to be deformable into a fourth shape to be in a state.

  According to the tissue ligation device of the present invention, a knot can be formed more stably.

It is a figure which shows the tissue ligation device of 1st embodiment of this invention. It is an expansion perspective view which shows the thread fixing member of the tissue ligation device. It is a figure which shows the operation | movement at the time of use of the organization ligation device. It is a figure which shows the operation | movement at the time of use of the organization ligation device. It is a figure which shows the operation | movement at the time of use of the organization ligation device. It is a figure which shows the operation | movement at the time of use of the organization ligation device. (A) And (b) is a figure which shows the behavior of the suture passed through the suture fix member of the tissue ligation device. It is a figure which shows the operation | movement which fixes a suture thread and a thread | yarn fixing member. It is a figure which shows the same structure | tissue ligation device after a knot formation operation | movement. (A) to (c) are all front views showing a thread fixing member in a modified example of the tissue ligating device. (A)-(i) is a front view which shows the thread fixing member in the modification of the tissue ligation device. (A) is a front view which shows the thread fixing member in the modification of the structure | tissue ligation device, (b) is a figure which shows the state by which the thread fixing member was deform | transformed. It is a perspective view which shows the thread | yarn fixing member and its periphery in the tissue ligation device of 2nd embodiment of this invention. It is a figure explaining the behavior of the suture accommodated in the thread stopper. (A) And (b) is a front view which shows the thread fixing member in the modification of the tissue ligation device. (A) to (f) are all front views showing a thread fixing member in a modified example of the tissue ligating device. It is a perspective view which shows the thread | yarn fastening member and its periphery in the tissue ligation device of 3rd embodiment of this invention. It is a front view of the yarn fixing member. (A) to (g) are all front views showing a thread fixing member in a modified example of the tissue ligating device. (A) is a perspective view which shows the thread | yarn fixing member and its periphery in the tissue ligation device of 3rd embodiment of this invention, (b) is a front view of the same thread | yarn fixing member. (A) to (c) are all front views showing a thread fixing member in a modified example of the tissue ligating device. It is a front view which shows the thread fixing member in the tissue ligation device of the modification of this invention. It is a front view which shows the thread fixing member in the tissue ligation device of the modification of this invention. It is a front view which shows the thread fixing member in the tissue ligation device of the modification of this invention. It is a front view which shows the thread fixing member in the tissue ligation device of the modification of this invention. (A) And (b) is a figure which shows the tissue ligation device of the modification of this invention. (A)-(c) is a figure which shows the thread | yarn fixing member in the structure | tissue ligation device of the modification of this invention, all. (A) And (b) is a figure which shows the thread | yarn fixing member in the tissue ligation device of the modification of this invention, and its periphery. (A)-(c) is a figure which shows the thread | yarn fixing member in the structure | tissue ligation device of the modification of this invention, all.

Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. 1 to 12B.
FIG. 1 is a diagram showing a tissue ligating device (hereinafter referred to as “ligating device”) 1 according to the present embodiment. The ligating device 1 includes a suture thread 10, a suture needle 20 attached to the first end portion 10 </ b> A of the suture thread 10, and a thread fixing member 30 attached to the second end portion 10 </ b> B of the suture thread 10. ing.

  The suture 10 is preferably made of resin or metal and preferably has a certain degree of elasticity to maintain a straight state, but may not have elasticity. When the suture thread 10 is formed of a resin material, a bioabsorbable resin is preferable from the standpoint that it is not necessary to remove the thread (in this case, the thread fixing member is also preferably formed of an absorbable resin). It may be non-absorbable. In addition, the suture thread 10 can be selected from a monofilament (single wire) and a multifilament (double wire) in consideration of applications and the like. As a monofilament, a multi-layer structure such as a single wire made of one material or a two-layer structure of a core made of a material having a high tensile strength and a clad made of a material having a good weldability can be used. . As the multifilament, any of those formed by knitting a plurality of strands and those formed by twisting can be used. Moreover, what was formed combining the strand which consists of a several different material may be used.

  Various known needles can be used as the suturing needle 20, such as a straight one, a curved one, a curved portion only at the tip, and other portions formed in a straight line, etc. Can be selected as appropriate. The connection mode between the suture 10 and the suture needle 20 is not particularly limited, and the connection state can be maintained with respect to the amount of force acting on the connection site between the knot forming operation and the operation of passing the suture through the tissue, which will be described later. Anything is acceptable. Specifically, a method such as adhesion, welding, or tying the end of the suture thread 10 through a hole formed at the end of the suture needle can be used.

FIG. 2 is an enlarged perspective view of the thread fixing member 30. The thread fixing member 30 is made of metal, resin, or the like, and includes a connection portion 31 to which the second end portion 10B of the suture 10 is connected and an arm portion 32 extending from the connection portion 31.
The connection portion 31 is formed in a substantially rectangular parallelepiped shape, and has an insertion port 31A into which the second end portion 10B of the suture thread 10 is inserted. The second end portion 10B is inserted into the insertion port 31A, and the suture thread 10 and the thread fixing member 30 are connected and attached by adhesion or the like.

  The arm portion 32 includes a first arm portion 32A extending from the connection portion 31, and a second arm portion 32B extending from the first arm portion 32A and being folded back to the connection portion side. 32 A of 1st arm parts are the direction (henceforth this thickness direction of the thread fixing member 30) of the thread fixing member 30 from the one side 31B in the front (surface in which the insertion opening 31A opens) view of the thread fixing member 30 extending. It extends in a straight line in a direction substantially orthogonal to the above. The two second arm portions 32B branch from the end portion of the first arm portion 32A to both sides in the width direction of the first arm portion 32A, draw a curve, turn back 180 degrees in a hairpin shape, and extend toward the connection portion 31. ing. Thereby, the accommodating part 33 in which a part of the suture thread 10 is inserted is formed on both sides in the width direction of the first arm part 32 </ b> A across the thickness direction of the thread fixing member 30. The two accommodating portions 33 extend substantially parallel to the first arm portion 32 </ b> A in the front view of the thread fixing member 30 due to the shape of the arm portion 32.

  The first arm part 32A and the second arm part 32B have substantially the same width dimension, and the width dimension is shorter than one side 31B of the connection part 31 from which the first arm part 32A extends. Since the first arm portion 32A extends from the middle portion in the longitudinal direction of the side 31B, the region belonging to the end portions on both sides in the longitudinal direction of the side 31B in the connection portion 31 protrudes into the accommodating portion 33. It is said that. The protruding portion 34 functions as a retaining portion that prevents the suture thread 10 inserted into the accommodating portion 33 from being detached from the thread retaining member 30 in the knot forming operation.

  Note that the size of the thread fixing member 30 is not particularly limited, and may be set as appropriate in consideration of a suture site and the like. When the dimension of the thread fixing member 30 is set to be as small as 1 mm square, for example, by performing laser processing, wire electric discharge processing, cutting processing or the like on a rectangular parallelepiped member made of stainless steel or the like. The thread fixing member 30 can be preferably manufactured.

The operation at the time of use of the ligating device 1 configured as described above will be described by taking as an example the case of suturing the wound.
First, the surgeon introduces the ligation device 1 in the vicinity of a treatment target tissue (hereinafter referred to as “target tissue”). In the introduction, an applicator including a sheath as described in Patent Document 1 may be used.

  When the ligating device 1 is introduced into the body, the operator holds the suture needle 20 with forceps or the like and hangs it on the target tissue T1 around the wound W as shown in FIG. Further, as shown in FIG. 4, the suture needle 20 is put on the target tissue T2 facing the target tissue T1 across the wound W, and the suture thread 10 is passed through the target tissue so that the wound W can be sutured.

  Next, as shown in FIG. 5, the surgeon grasps the suture 10 or the suture needle 20 and passes (inserts) a part of the suture 10 into the accommodation portion 33 of the suture fix member 30. The suture thread 10 may be inserted into any of the two accommodation portions 33. Then, as shown in FIG. 6, when the first end 10A side of the suture thread 10 is pulled away from the target tissue, the suture fix member 30 connected to the second end 10B approaches the target tissue T1. Then, the suture thread 10 passing through the target tissue is drawn and drawn so that the target tissue T1 and the target tissue T2 approach each other.

In the above-described operation, the suture thread 10 may move in a direction in which the suture thread 10 is detached from (removed from) the housing portion 33 due to its own elasticity or when an external force is applied. However, since such a movement of the suture thread 10 is hindered by the projection 34 protruding into the accommodating portion 33 as shown in FIG. 7B, the suture thread 10 comes off from the accommodating portion 33 and is fastened. Disengagement from the member 30 is preferably suppressed. That is, in the ligation device, whether the suture thread has elasticity or not can be similarly prevented from coming off from the accommodating portion.
When the suture thread 10 is passed through the accommodating portion 33, the suture thread 10 passes from the outer side in the width direction of the second arm portion 32B through the side of the connecting portion 31 as shown in FIG. Since the projection 34 is inserted into the projection, the projection 34 hardly inhibits the insertion operation.

When the suture thread 10 is sufficiently drawn, the surgeon sandwiches the first arm portion 32A and the second arm portion 32B with forceps or the like and deforms them as shown in FIG. To do. Then, the portion where the suture thread 10 and the thread fixing member 30 are fixed functions as a knot Kn of the suture thread, and the target tissue T1 and the target tissue T2 are sutured so as to block the wound W as shown in FIG. Is done. Thus, the knot forming operation using the ligating device 1 is completed. When forming the knot Kn, pulling the suture 10 while applying tension, the suture can be more reliably performed.
After the formation of the knot Kn, the operator removes the excess suture 10 and collects the excised suture 10 and the suture needle 20 outside the body cavity. If the wound portion W is large, etc., a new ligation device 1 is introduced and the above knot forming operation is repeated. When the wound W is completely sutured, the procedure is finished.
The portion where the suture thread 10 and the thread fastening member 30 are fixed is actually different from a knot formed by a method such as a male knot or a female knot, but the suture 10 hung on the target tissue is not loosened. In the present invention, it is called a knot because it has the same function as a general knot formed in a surgical procedure.

  According to the ligating device 1 of the present embodiment, since the protruding portion 34 is formed in the accommodation member 33 through which the suture thread 10 is inserted in the suture fix member 30, the suture thread 10 is accommodated due to elasticity or the like. Even if the suture thread 10 moves in the direction of detaching from the portion 33, the protruding portion 34 suitably prevents the suture thread 10 from detaching from the accommodating portion 33. Therefore, the protrusion 34 suitably functions as a retaining portion, the knot forming operation can be performed easily and smoothly, and the knot can be formed stably.

Moreover, since the accommodating part 33 is formed over the thickness direction of the thread fixing member 30, the arm part 32 can be sufficiently deformed only by applying force from both sides in the width direction of the arm part 32. The suture thread 10 can be easily fixed by a simple operation.
Note that, in a procedure using an endoscope, a laparoscope, and the like, since the space in which the forceps and the like can be moved is limited, the above-described effect produced by the ligation device of the present invention becomes more remarkable.

In the present embodiment, the thread fixing member has one hook portion 32A and two second arm portions 32B, and a part of the connecting portion 31 is a protruding portion 34. 30 has been described, the shape of the thread stopper can be variously changed.
First, as a change from the above-described bowl shape, only one second arm portion 32B may be provided as in the modification shown in FIG. In this case, the thread fixing member can be easily reduced in size and can be easily adapted to a procedure in a minute region. Further, the area to be deformed when forming the knot is reduced, and the deformation operation is facilitated.

  In addition, a protruding portion may be formed separately from a part of the connecting portion. For example, as in the modification of FIG. 10B, a plurality of protrusions 36 may be formed on the side surface of the first arm portion 32A (or the side surface of the second arm portion 32B) that is the inner surface of the housing portion 33. As in the modification 10 (c), the projections 37 that protrude into the respective accommodating portions 33 may be formed one by one separately from the connection portion 31. In addition, when the protruding portion is formed so as to protrude in the direction away from the opening 33 </ b> A into which the suture thread 10 is introduced in the accommodating portion 33 like the protruding portion 36, the suture thread 10 is passed through the accommodating portion 33. At that time, it is difficult to inhibit the movement, and it is possible to suitably inhibit only the movement of the suture thread 10 in the direction in which the suture thread 10 is removed. In any case, the movement of the suture can be more actively inhibited by the protrusions, and the effect of preventing the suture 10 from coming off can be further enhanced.

Furthermore, the thread fixing member of the present embodiment is not limited to the substantially hook-shaped shape described above. FIG. 11A to FIG. 11I show other modified examples of the thread fixing member 30, respectively.
A thread stopper 30A shown in FIG. 11A is an example in which the second arm portion 32B is formed longer than the first arm portion 32A. In this case, a wider area of the connecting portion 31 functions as a protruding portion. Further, the second arm portion 32B serves as a guide when the suture thread 10 is passed through the accommodating portion, and the knot forming operation can be performed more easily.

11 (b) and FIG. 11 (c) are examples in which the second arm portion 32B is folded at a steep angle so that the accommodating portion 33 has a corner portion 33A. The protrusion 38 is provided at the end of the second arm portion 32B. In this case, the behavior of the suture during the knot forming operation can be stabilized by pulling and pulling the suture 10 in the direction in which the suture 10 inserted into the accommodating portion 33 is pressed against the corner portion 33A. Furthermore, since the suture thread 10 biting into the corner portion 33A is less likely to loosen, the knot Kn after formation can be further stabilized.
Moreover, when the projection part 38 is formed in the 2nd arm part 32B, the connection part 40 may be formed in the width dimension equivalent to an arm part like the thread fixing member 30D shown in FIG.11 (d). In this case, unlike the thread stopper 30A, the first arm portion 32A serves as a guide for the suture thread 10.

A thread fixing member 30E shown in FIG. 11 (e) is an example in which the accommodating portion 33 is formed in a substantially circular shape when viewed from the front. If it does in this way, an accommodating part will become comparatively large with respect to the magnitude | size of a thread stopper, and there exists an advantage that it is easy to visually recognize. In this case, in the arm portion 32, the boundary between the first arm portion and the second arm portion is not clear, and a region having a predetermined length including the tip of the arm portion 32 is the protruding portion 39.
At this time, a protruding portion 41 may be provided separately from the arm portion 32 as in a thread fixing member 30F shown in FIG. In this case, the opening for allowing the suture to pass through the accommodation portion is located farther from the insertion port 31A than the suture fix member 30E. As a result, in the knot forming operation, it is possible to prevent the suture thread from being tangled or mistaken on the side to be pulled.

Thread fixing members 30G, 30H, and 30I shown in FIGS. 11 (g) to 11 (i) are examples in which the arm portion is not folded back and does not have the second arm portion. Also in this case, by providing the projections 44A, 44B, and 44C in the accommodating portion 43 formed between the two arm portions 42, it is possible to suitably prevent the suture 10 from coming out of the accommodating portion 43. it can.
Further, in any of the thread fastening members 30G, 30H, and 30I, a knot can be formed by grasping and crushing the whole thread fastening member with a forceps or the like without aiming at the arm portion, thereby making the operation easier. Become.
Further, when the thread fixing member is formed in a shape like the thread fixing member 30G, as shown in FIG. 12A, the length of the protrusion 44A from the end of the arm part 42 where the protrusion 44A is formed. The notch 42A may be formed so that the width of the arm portion 42 is narrowed in a region corresponding to. In this way, when the thread fixing member is deformed and fixed to the suture thread 10, as shown in FIG. 12B, the projection 44A is accommodated in the notch 42A, and the thread fixing member is suitably deformed. Is done. As a result, the suture thread and the thread fixing member can be more reliably fixed.

  Next, a second embodiment of the present embodiment will be described with reference to FIGS. 13 to 16 (f). The difference between the ligating device 51 of the present embodiment and the above-described ligating device 1 is an aspect of the retaining portion in the thread securing member. In the following description, components that are the same as those already described are assigned the same reference numerals and redundant description is omitted.

  FIG. 13 is an enlarged view showing the thread fixing member 52 and the periphery thereof in the ligating device 51. One arm portion 54 extends from the connection portion 53. The arm portion 54 extends while being bent into a substantially oval shape when the thread fixing member 52 is viewed from the front, and forms a substantially oval accommodating portion 55 inside the curve. The end of the curved arm portion 54 is directed toward the connection portion 53, and is a constricted portion 54 </ b> A that narrows the opening 55 </ b> A through which the suture thread 10 is accommodated in the substantially oval accommodating portion 55. . In the ligating device 51, the narrowed portion 54A functions as a retaining portion.

  In the ligating device 51 of the present embodiment, the opening 55A that is a part of the accommodating portion 55 is narrowed by the narrowed portion 54A in the front view of the yarn fixing member 52. Therefore, even if the suture thread 10 moves due to elasticity or the like in the accommodating portion 55, it often hits the arm portion 54 including the narrowed portion 54A as shown by arrows A1 and A2 in FIG. 14, and passes through the opening 55A. Thus, the probability of detaching from the accommodating portion 55 is reduced. Therefore, similarly to the ligating device 1, it is possible to suitably prevent the suture thread 10 from coming off during the knot forming operation.

  In addition, since the surfaces of the connecting portion 53 and the arm portion 54 that are opposed to each other across the narrowed portion 54A and the opening 55A are formed flat, when the suture thread 10 is passed through the accommodating portion 55, the connecting portion 53 is provided. Further, it can be smoothly moved into the accommodating portion 55 by being along the arm portion 54.

Similar to the first embodiment, the thread fixing member including the narrowed portion as the retaining portion is not limited to the shape like the above-described thread retaining member 52, and various forms can be adopted.
FIG. 15A and FIG. 15B are modifications based on a substantially hook-like shape such as the thread fixing member 30. In the modification shown in FIG. 15A, two arm parts 54 extend from the connection part 31, and in the modification shown in FIG. 15B, four arm parts 54 extend from the connection part 31. Yes. Regardless of which modification is used, a housing part 56 having a substantially triangular shape in front view is formed by two adjacent arm parts. In the modification of FIG. 15A, the distal end side of the arm part 54 is shown in FIG. In the modified example of b), the protrusions 54B provided on the arm portion 54 function as narrowing portions that narrow the opening 56A of the accommodating portion 56, respectively.
If a plurality of accommodating portions are provided, the size of the thread fixing member is slightly increased. However, when passing the suture through the accommodating portion, a part of the suture is placed by aiming at a specific arm portion of the thread retaining member. There is an advantage that the necessity of a fine operation such as movement is reduced, and the knot forming operation becomes easier.

  FIG. 16A to FIG. 16F show other modified examples of the thread fixing member having the narrowed portion. In the thread fastening member of the present embodiment, the arm portion 57 may be formed in a curved shape, as in the thread fastening member 52A shown in FIG. In this case, a certain degree of freedom can be secured in the direction in which a force is applied to cause deformation, and the knot forming operation is facilitated. Further, like the thread fixing member 52B shown in FIG. 16B, the arm portion 59 may be bent at a steep angle so that the accommodating portion 58 has a corner portion 58A. FIG. 16 (c) shows a thread fixing member 52C having an arm portion 60 with a bending degree located between the two. The thread stoppers 52B and 52C are more easily deformed than the thread stopper 52A, and have an advantage that a knot forming operation is easily performed.

In addition, an accommodation portion 61 having a substantially circular shape in front view may be formed like a thread fastening member 52D shown in FIG. 16D, or an arm like a thread fastening member 52E shown in FIG. A part of the part 62 may be formed linearly.
Furthermore, a narrowed portion 63A that narrows a portion that is not an opening in the housing portion may be provided in the arm portion 63 as in a thread fixing member 52F illustrated in FIG. In this case, since the opening 64A of the accommodating portion 64 can be widened, the suture thread 10 can be easily passed, while the accommodated suture thread 10 can be suitably prevented from coming out of the accommodating portion 64.

Next, a third embodiment of the present invention will be described with reference to FIGS. 17 to 19 (g). The difference between the ligating device 71 of the present embodiment and the ligating device of each of the above-described embodiments is the shape of the accommodating portion.
FIG. 17 is a perspective view showing the thread fixing member 72 of the ligating device 71 and its periphery. In the thread fixing member 72, the first arm part 74 </ b> A and the second arm part 74 </ b> B extending from the connection part 73 are formed in a curved shape in a front view of the thread fixing member 72. As a result, the accommodating part 75 formed between the first arm part 74A and the second arm part 74B is bent in the front view of the thread fixing member 72.

Here, “bend” in the present invention means that, when a straight line connecting the opening and the deepest part along the shape of the storage part is drawn from the opening into which the suture enters the storage part, at least, In a state seen from one direction, it means a state in which a straight line that does not contact the arm part cannot be drawn because it contacts the arm part that defines the housing part.
Taking the thread fixing member 72 as an example, as shown in FIG. 18, the deepest portion 75A of the accommodating portion 75 exists near the boundary between the first arm portion 74A and the second arm portion 74B. And in the front view of the thread fixing member 72, the deepest part 75A and the opening 75B cannot be connected with a straight line without contacting the first arm part 74A and the second arm part 74B. That is, the accommodation portion 75 of the thread fixing member 72 is bent in a front view of the thread fixing member 72.

In the ligating device 71 configured as described above, when the suture thread 10 is passed through the accommodating portion 75, it is easily sutured to the vicinity of the deepest portion 75A by being along the first arm portion 74A or the second arm portion 74B. The yarn 10 can be moved.
The movement of the suture thread 10 to return to a straight line due to its elasticity or the like is generally a straight line in one direction. Therefore, the suture thread 10 inserted into the bent accommodating portion 75 will hit the first arm portion 74A or the second arm portion 74B regardless of the direction of movement, and only the above-described substantially linear movement will occur. It is virtually impossible to reach the opening 75B. Therefore, it can be said that the bent accommodating portion 75 has a retaining portion due to the overall shape thereof, and it is possible to suitably prevent the suture thread 10 from being detached from the thread retaining member 72 during the procedure.

In the present embodiment, the specific bent shape of the housing portion can be set in various ways.
A thread fastening member 72A shown in FIG. 19A is a modified example in which two accommodation parts having the same shape as the accommodation part 75 are provided and are symmetrical with respect to the front view. The thread fixing member 72 </ b> A has a substantially hook shape close to the thread fixing member 30 of the first embodiment, and the suture thread that has passed through the housing portion is less likely to come out than the thread fixing member 30. Since there are two accommodating portions, it is easy to pass a suture. Furthermore, since the hole 77 for thinning the first arm portion 76A is formed, it is easy to be deformed while bending the accommodating portion, and there is a relative degree of freedom in the direction of deformation, and the knot forming operation is performed. It becomes easy.
The thread fixing members 72B and 72C shown in FIGS. 19B and 19C, respectively, are provided with a bending point where the bending angle is approximately 90 degrees in the housing portion, and the remaining region of the housing portion is formed in a substantially linear shape. This is a modified example. If it does in this way, the operation | movement which lets the suture thread 10 pass to an accommodating part will become easy.

Thread fixing members 72D and 72E shown in FIG. 19D and FIG. 19E, respectively, are modified examples including a relatively complicated shape containing a plurality of bending points. The bent portion in the housing portion may be formed in a smooth curved shape as shown in FIG. 19 (d), or may be formed so as to have a corner portion as shown in FIG. 19 (e). Moreover, both shapes may be combined. In the thread fixing members 72D and 72E, it is possible to make the thread passed through the accommodation portion more difficult to come off.
Furthermore, like the thread fixing member 72F shown in FIG. 19 (f), the outer shape may not be bent, but only the housing portion may be bent. In this case, since the outer surface is formed flat, a force can be stably applied when deforming, and a knot can be formed efficiently.
Further, like the thread fixing member 72G shown in FIG. 19 (g), the accommodating portion may be formed in a spiral shape in a front view. In this case, similarly to the thread fixing members 72D and 72E, it is possible to make it more difficult for the suture thread that has passed through the housing portion to come off.

Next, a fourth embodiment of the present invention will be described with reference to FIGS. 20 (a) to 21 (c).
FIG. 20A is an enlarged perspective view showing the thread fixing member 152 and its periphery of the ligating device 151 of the present embodiment. As shown in FIG. 20B, the thread fixing member 152 has a substantially oval shape when viewed from the front, and the accommodating portion 153 that opens in the minor axis direction of the approximately oval is bent into a substantially L shape. Is formed.
In the front view of the thread fixing member 152, the first arm portion 154 and the second arm portion 155 that define the shape of the housing portion 153 are larger than the dimension W1 in the width direction (direction perpendicular to the extending direction) of the housing portion 153. A wide portion 156 having a large dimension is included.

  The operation when the ligating device 151 is used is substantially the same as the ligating device of each of the above-described embodiments. kn is formed.

Also in the ligating device 151 of this embodiment, the knot forming operation can be performed easily and smoothly as in the above-described embodiments, and the knot can be formed stably.
In the ligation device of this embodiment, the housing portion 153 is bent as in the third embodiment, and the bent state functions as a retaining portion. Of the accommodating portion 153, the suture thread 10 is actually accommodated in the deepest portion 153A side of the bent intermediate portion, and the inner wall 153C facing the deepest portion 153A on the opening 153B side of the intermediate portion. Exhibits exclusively the retaining function and functions as a substantial retaining part.

  Further, since the first arm portion 154 and the second arm portion 155 have the wide portion 156, even if the dimension of the thread fixing member 152 is small, the operator recognizes the entire thread retaining member as a lump. It is easy to maintain good visibility.

  Moreover, since the shape in front view is a substantially oval shape, it can manufacture efficiently using the columnar material whose cross-sectional shape is a substantially oval shape. That is, it is possible to efficiently manufacture the columnar material by slicing the columnar material in the radial direction after forming the shape of the accommodating portion over the length direction by wire discharge or the like.

  In the present embodiment, the example in which the front view shape of the thread fixing member is substantially oval has been described, but instead, the front view shape may be a perfect circle, an ellipse, or a polygon. Even if it does in this way, while providing a wide part in a 1st arm part or a 2nd arm part and ensuring favorable visibility, manufacturing efficiently using a columnar material which has a section shape corresponding to a front view shape Can do.

Further, as in the modification shown in FIG. 21A, the width of the opening 153 </ b> B of the housing portion 153 may be made wider than other portions to facilitate introduction of the suture into the housing portion. Such processing can also be easily performed by the above-described wire discharge or the like.
Further, as shown in FIG. 21B, a protrusion 157 may be provided in the opening 153B. In this way, the area when the thread fixing member is viewed from the side surface is increased, and the visibility in a side view can be improved. Further, the position of the opening 153B can be easily grasped, and the operation of introducing the suture thread into the accommodating portion can be facilitated.
Further, as shown in FIG. 21 (c), the connecting portions 158 may be provided at different positions.

  The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above-described embodiments, and various modifications may be made to each component without departing from the spirit of the present invention. It is possible to delete or combine the constituent elements of each embodiment.

  For example, in each of the above-described embodiments, the example in which the retaining portion is provided by forming at least a part of the thread securing member in a predetermined shape has been described, but instead of this, the thread retaining member can be detached by attaching another member. A stop may be provided. Hereinafter, a plurality of such modifications will be described.

22 is provided with a substantially brush-like retaining portion 82 by attaching a plurality of bristle members 82A made of resin or the like to the inner surface of the accommodating portion 81.
23, a wheel 88 having a plurality of protrusions 88A is rotatably attached to a portion of the arm portion 86 located near the opening of the housing portion 87. A stopper 89 that has a certain elasticity and interferes with the projection 88A is attached to the arm portion 86, and the wheel 88 is in one direction (indicated by an arrow in FIG. 23) for drawing the suture thread into the housing portion 87. Can rotate but cannot rotate in the opposite direction. Therefore, the movement of the wheel 88 in the direction in which the wheel 88 comes out of the suture accommodating portion 87 is obstructed. That is, in the yarn fixing member 85, the wheel 88 and the stopper 89 constitute a retaining portion.

  FIG. 24 shows a thread fixing member 90 to which an elastic member 91 such as rubber is attached so as to close the housing portion 92 in a front view. Since the elastic member 91 is elastically deformed, the suture thread 10 can be passed through the accommodating portion 92 by using forceps or the like. However, since the force is not sufficient only by the movement of the suture thread 10 to return linearly, the elastic member 91 is elastic. The member 91 is not easily deformed, and the elastic member 91 functions as a retaining portion.

FIG. 25 shows a thread fixing member 95 in which a gel-like retaining material 97 having a certain viscosity is disposed in the accommodating portion 96. Since the suture thread 10 passed through the storage portion 96 generates friction with the retaining material 97, the situation in which the suture thread is pulled out of the storage portion 96 is suitably suppressed.
This modification does not correspond to any of the above-described embodiments, but includes a retaining portion made of the retaining material 97. Note that, if the viscosity of the retaining material 97 is too high, it becomes a resistance when the suture is drawn in the knot forming operation, and the operation is hindered.

Moreover, the retaining portion may not be provided integrally with the thread retaining member. In the ligating device 100 of the modification shown in FIG. 26A, the insertion port 102 formed in the yarn fixing member 101 penetrates the yarn fixing member 101. A retaining member 103 is connected and fixed to the second end portion 10 </ b> B of the suture thread 10 inserted through the insertion opening 102. The retaining member 103 is at least partially larger than the width of the arm portion 104. When the surgeon hangs the suture thread 10 on the target tissue and pulls the suture thread 10, the retaining member 103 comes into contact with the thread retaining member 101 as shown in FIG. Functions as a retaining part. The shape of the retaining member 103 is not particularly limited as long as at least a part of the dimension is larger than the width of the arm portion 104. As shown in FIG. 26 (a), any shape such as a rectangular parallelepiped shape, a spherical shape, a plate shape, etc. Such a shape may be used.
In this modification, the thread fixing member 101 and the suture thread 10 are slidably attached. In the ligating device of the present invention, the suture and the thread fastening member may be in such an attachment relationship.

Furthermore, the retaining portion may be provided in the thickness direction of the thread retaining member.
FIGS. 27 (a) to 27 (c) are examples of a thread fixing member in which a protrusion is formed only in a part in the thickness direction, and FIG. 27 (b) is a view taken along the line XXVb in FIG. 27 (a). FIG. 27C is a view taken along the line XXVc in FIG. The basic shape of the accommodation part 111 of the thread fixing member 110 is substantially linear in a front view of the thread fastening member 110, but only a part in the thickness direction is formed with a protrusion 112 that protrudes into the accommodation part 111. ing.
FIG. 28A is an example of a thread fixing member provided with a narrowed portion in the thickness direction. The end portion of the arm portion 116 of the thread fixing member 115 is curved so as to extend so as to overlap a part of the arm portion 116 extending from the connection portion 117 in the thickness direction. The narrow gap between the overlapped arm portions 116 has a size that allows the suture thread 10 to pass therethrough, and the overlapped arm portion becomes the narrowed portion 118. As shown in FIG. 28 (b), the suture thread 10 passed through the narrowed portion 118 and into the accommodating portion 119 is unlikely to come out of the accommodating portion 119, and the narrowed portion 118 functions as a retaining portion.
29 (a) to 29 (c) are examples of the thread fixing member in which the accommodating portion is bent in the thickness direction, and FIG. 29 (b) is a view taken along the line XXVIIb in FIG. 29 (a). 29 (c) is a view taken along arrow XXVIIc in FIG. 29 (a). The first arm portion 121A and the second arm portion 121B of the yarn fixing member 120 are curved in the thickness direction of the yarn fixing member 120, and as a result, the accommodation between the first arm portion 121A and the second arm portion 121B. The part 122 is bent in the thickness direction. In this way, the suture thread 10 passed through the housing portion 122 can easily come into contact with the side surfaces of the arm portions 121A and 121B, which are the inner surface of the housing portion 122, as shown in the lower side of FIG. Friction is likely to occur between As a result, the suture thread 10 is prevented from coming out of the accommodating portion 122.
The retaining portion formed in the thickness direction as described above may be combined with the configuration of each of the embodiments described above.

  Furthermore, the ligating device of the present invention may not include a suture needle. This is because even when a suture needle is not provided, it can be used for applications such as ligating without passing a suture through tissue. In addition, as for the suture thread, a general suture thread may be attached to the above-described thread stopper member immediately before the procedure. Accordingly, a single thread fixing member provided with a retaining portion may be distributed as a tissue ligation device.

  Further, the above-described concepts such as the protruding portion, the narrowed portion, and the bending are not mutually exclusive. For example, a part of the arm part that forms the constriction part can be regarded as a protruding part protruding into the accommodating part, and vice versa. Further, there may be a form that can be grasped as the accommodating portion being bent by the protrusion. Therefore, the retaining portion does not have to be applied to any one of the above-described aspects, and there is no problem even if the retaining portion has a shape in which a plurality of elements are combined.

1, 51, 71, 100, 151 Tissue Ligation Device 10 Suture 20 Suture Needle 30, 30A, 30B, 30C, 30D, 30E, 30F, 30G, 30H, 30I, 52, 52A, 52B, 52C, 52D, 52E, 52F, 72, 72A, 72B, 72C, 72D, 72E, 72F, 72G, 80, 85, 90, 95, 101, 110, 115, 120, 152 Thread fixing member 33, 43, 55, 56, 58, 61, 64, 75, 81, 87, 92, 97, 105, 111, 119, 122, 153 Housing part 34, 38, 39, 41, 44A, 44B, 44C, 112 Protrusion part (prevention part)
54A, 63A, 118 Stenosis (retaining part)
82 Retaining part

Claims (3)

A tissue ligation device to which a suture is attached and used for tissue ligation,
One end of the suture thread is inserted, and a connection part having an insertion port to be attached;
A first arm portion extending from the connection portion;
From the first shape that extends from the first arm portion, forms a housing portion with the first arm portion, and the housing portion is opened so as to form an opening into which the suture thread is introduced. A second arm portion configured to be deformable into a second shape in which the opening is closed;
A second accommodating portion is formed extending from the first arm portion and between the first arm portion, and the second accommodating portion is opened so as to form a second opening into which the suture thread is introduced. A third arm portion configured to be deformable from a third shape that is in a closed state to a fourth shape in which the second opening is in a closed state;
Comprising
Organization ligation device.   The tissue ligation device according to claim 1, wherein in the first shape, the opening is open toward a side where the connection portion is present.   A part of the connection portion protrudes so as to prevent the suture thread inserted into the housing portion from being pulled out of the opening when the second arm portion has the first shape. Item 3. The tissue ligation device according to Item 2.

Images