JP2019013321A - Suture thread with needle - Google Patents

Abstract

To provide suture threads with needles that can improve, for example, the work effectiveness such as the pancreaticogastrostomy after the pancreatoduodenectomy.SOLUTION: Suture threads with needles include first, second and third of 3-sutures 3A, 3B, 3C, and first and second of 2-suture needles 2A, AB. The first suture needle is fixed and installed to the first and second suture threads by a fact that one end of the first suture thread and one end of the second suture thread are inserted in a thread attachment hole axially provided in the proximal end of the first suture needle and caulked. The second suture needle is fixed and installed to the first and third suture threads by a fact that the other end of the first suture thread and the one end of the third suture thread are inserted in the thread attachment hole axially provided in the proximal end of the second suture needle and caulked.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a suture with a needle, for example, a suture with a needle used for pancreaticogastric anastomosis after pancreaticoduodenectomy.

  For example, pancreaticoduodenectomy is a surgical procedure in which the pancreatic head (the right side of the pancreas) and the duodenum are removed together. Because of the biliary reconstruction, the gallbladder and lower middle bile duct are also removed at the same time. It is one of the most invasive surgery in the field of gastroenterology.

  Pancreaticogastric anastomosis is performed after pancreaticoduodenectomy. Pancreatico-gastric anastomosis is an anastomosis of the pancreas (residual pancreas) and stomach (residual stomach). There are various methods of anastomosis, but in general, a pancreatic stump is inserted into the stomach and sutured with a needle It is performed using a thread (also called a suture needle with a thread).

  As described above, pancreatico-gastric anastomosis is performed using a suture thread with a needle (hereinafter sometimes abbreviated as “thread with needle”). By the way, the conventional needle-attached suture is generally configured by attaching one suture needle to one end of one suture. When performing pancreaticogastric anastomosis using this conventional needle-attached thread, in order to insert four sutures through the tissue one by one using four needle-attached threads, In addition to poor workability, the doctor is troublesome and the operation time is long.

  Therefore, in order to solve the above problem, the present inventor has tried to adopt a pancreatogastric anastomosis method (hereinafter referred to as “the present method”) different from the conventional method. This method is a method of performing pancreaticogastric anastomosis on the stomach posterior wall after incision of the anterior stomach wall. Specifically, an incision for anastomosis is made in the posterior stomach wall, and the pancreatic stump is inserted into the stomach. As shown in FIG. 3, the stomach and pancreas are anastomosed by one gastric wall full layer-pancreatic through-gastric mattress suture and two gastric wall full layer-pancreatic through-gastric suture. According to this method, it is possible to contribute to solving the above-mentioned problems.

  However, as described above, the conventional needle-attached thread is configured by attaching one suture needle to one end of one suture thread. Therefore, this needle-attached thread is suitable for use in this surgical method. Not.

  Further, for example, Japanese Patent Application Laid-Open No. 2005-80761 and Japanese Patent Application Laid-Open No. 2013-66639 disclose a suture thread with a needle in which suture needles are attached to both ends of the suture thread. However, these sutures with needles have been developed for ophthalmic surgery and tendon sutures, and are not suitable for pancreatic gastric anastomosis because of their construction. Even if the needle-attached suture described in the above publication is improved so that it can be used for pancreaticogastric anastomosis, the above workability and other problems cannot be solved.

JP-A-2005-80761 JP 2013-66639 A

  In view of the above circumstances, the present invention is suitable for the implementation of the above-mentioned surgical method, improves the work efficiency of pancreaticogastric anastomosis performed after pancreaticoduodenectomy, and shortens the labor and operation time of the doctor. It is an object of the present invention to provide a suture with a needle that can make the above-mentioned possible.

In order to achieve the above object, the present invention is provided with a needle provided with three first, second and third sutures, and first and second two suture needles attached to these sutures. A suture,
The first and second suture needles have a thread attachment hole provided in the base end portion of the needle body in the axial direction;
The first and second suture needles are formed by inserting one end portion of the first suture thread and one end portion of the second suture thread into a thread attachment hole of the first suture needle. Fixedly attached to the thread,
The second suturing needle is configured such that the other end portion of the first suturing thread and one end portion of the third suturing thread are inserted into thread attachment holes of the second suturing needle, and the first and third suturing needles are inserted. It is fixedly attached to the suture thread.

  According to the above configuration, by inserting the first and second suture needles into the living tissue and penetrating them, two sutures each (however, the first suture is half-side) can be simultaneously applied to the tissue. The same part can be penetrated. Since the first suture thread has a loop shape, mattress sewing can be performed. Further, the penetration suture can be performed by the second and third sutures. Thereby, the said operation method can be performed smoothly and satisfactorily.

  In the suture with a needle of the present invention, it is preferable that the first and second suture needles are constituted by straight needles.

  In the present invention, a “straight needle” is a straight needle, that is, a needle (straight needle) having an overall appearance formed in a linear shape, and has a cross-sectional shape at the tip of the needle. Is used as a term meaning a needle (round needle) formed in a circular or substantially circular shape. Further, the “round needle” of the present invention is a round needle (tip pyramid shape) formed with a flat tip at the tip of the round needle, for example, the tip of the round needle is cut into three planes at about 120 ° about the axis center. A round needle having a triangular cross-section (tip pyramid shape) is also included.

  In the needle-attached suture according to the present invention, it is preferable that the first suture and the second and third sutures are composed of yarns of different colors.

  According to the above configuration, since the suture threads are color-coded, it is possible to smoothly work while visually confirming the handling of the suture threads after penetrating the living tissue.

  Further, the suture thread with a needle of the present invention is configured for suture of pancreatic stomach anastomosis and other organs after pancreaticoduodenectomy.

  According to the present invention, it is possible to provide a suture with a needle that can improve work efficiency such as pancreaticogastric anastomosis performed after pancreaticoduodenectomy and can save labor of a doctor and shorten operation time. . Moreover, the suture thread with a needle | hook suitable for implementation of the above-mentioned this operative method can be provided.

It is an explanatory front view showing roughly the composition of the suture thread with a needle of one embodiment of the present invention. The front view (a) shown in order to expand the suture thread with a needle of FIG. 1 and explaining the structure, and the longitudinal section which expands the proximal end side of the needle body of one suture needle and schematically shows the structure It is a surface view (b). 3 (a) and 3 (b) are explanatory views showing an example of a state in which pancreaticogastric anastomosis is performed using the suture with a needle shown in FIG.

  Hereinafter, an example of an embodiment of the present invention will be described with reference to the drawings.

  1 to 3 show a suture with a needle (a suture needle with a thread) according to an embodiment of the present invention. The suture thread with needle 1 (suture needle with thread) according to the present embodiment is configured mainly for pancreatogastric anastomosis performed mainly after pancreaticoduodenectomy.

  As shown in FIGS. 1 to 3, the suture thread with needle 1 of the present embodiment includes first and second two suture needles 2 </ b> A and 2 </ b> B, and first, second, and third sutures. Yarns 3A, 3B and 3C are provided.

  The first and second suture needles 2A and 2B of the present embodiment are configured with straight needles having the same configuration. Both the suture needles 2A and 2B are composed of a needle tip part 22 (tip end part of the needle) formed on one end side of the body part 21 (body) of the needle body 20, and the other end side (base end of the needle body). A needle base portion 23 formed on the portion). Further, both the suture needles 2A and 2B are provided with a thread attachment hole 24 for attaching a suture thread provided in the needle base portion 23 (base end portion of the needle body) in the axial direction of the needle body 20. Both suture needles 2A and 2B are fixedly attached by inserting a suture into the hole 24 and caulking. This point will be further described later.

  The needle body 20 can employ, for example, a round bar-shaped needle material such as austenitic stainless steel (for example, SUS304) or other stainless steel. The length of the needle body 20 (the dimension from the distal end to the proximal end of the needle body) is not particularly limited. For example, when configured for pancreaticogastric anastomosis after pancreaticoduodenectomy, for example, about 30 What is formed in a millimeter to about 40 mm can be employed. In this embodiment, it is formed to be about 35 mm.

  The thickness of the body portion 21 of the needle body 20 is not particularly limited. For example, when used for pancreaticogastric anastomosis after pancreaticoduodenectomy, the diameter is about 0.5 mm to about 1.2 mm. (However, it is not limited to the above range).

  The needle tip portion 22 (tip end portion of the needle) of the needle body 20 is configured by a tapered portion that gradually tapers (diameter or cross-sectional area is reduced) in the tip portion side direction, and a insertion tip 25 is formed at the tip of the tapered portion. Has been. The cross-sectional shape of the needle tip portion 22 is formed in a circular or substantially circular shape. The needle tip body is formed in a straight line.

  The first and second suture needles 2A and 2B of the present embodiment are constituted by straight needles having the above-described configuration. That is, a needle (straight needle) in which the overall appearance of the needle is formed linearly, and a needle (round) in which the cross-sectional shape of the tip (needle tip 22) of the needle is circular or substantially circular. Needle). The configuration of the suturing needle itself is substantially the same as that of a generally used suturing needle.

  The material of the first, second and third sutures 3A, 3B and 3C is not particularly limited, and can be arbitrarily selected from chemical fibers such as synthetic fibers and natural fibers according to the use. For example, when used for pancreaticogastric anastomosis after pancreaticoduodenectomy, for example, nylon thread can be employed. In this embodiment, a nylon thread (nylon thread) is employed.

  The thickness of each suture thread is not particularly limited, but an extremely fine thread (for example, a diameter of about 0.025 mm to about 0.05 mm) can be adopted (however, it is not limited to the above range).

  The lengths of the first, second, and third sutures can be arbitrarily determined according to the type and site of the anastomosis and the organ to be sutured. For example, when it is configured for pancreaticogastric anastomosis after pancreaticoduodenectomy, for example, it is possible to adopt one formed in a size of about 50 cm to about 80 cm. In addition, the first suture and the second and third sutures can employ different lengths of yarn.

  In the present embodiment, a thread of about 60 cm is employed as the first suture 3A. In addition, the second and third sutures 3B and 3C each employ a thread of about 50 cm.

  Each of the sutures can be blue, black, or any other colored thread, and can also be an uncolored thread.

  In the present embodiment, the first suture thread 3A and the second and third suture threads 3B and 3C are configured using different color threads. Specifically, for example, the first suture 3A employs a blue thread, and the second and third sutures employ a white or black thread. This makes it possible to work while visually confirming the suture thread. In this case, the second suture thread 3B and the third suture thread 3C can also be composed of different colors.

  The suture thread with a needle of this embodiment inserts one end portion of the first suture thread 3A and one end portion of the second suture thread 3B into the thread attachment hole 24 of the first suture needle 2A, and caulking or the like. The first suture needle 2A is fixedly attached to the first and second suture threads 3A and 3B. Further, the other end of the first suture 3A and one end of the third suture 3C are inserted into the thread attachment hole 24 of the second suture needle 2B, and the second suture needle 2B is attached by caulking or the like. Is fixedly attached to the first and third sutures 3A and 3C.

  The suture thread 1 with a needle according to the present embodiment is configured as described above. By inserting the first suture needle 2A into a living tissue and penetrating the tissue, one half part side of the first suture thread 3A is obtained. And the second suture 3B penetrate through the same part of the living tissue at the same time. Further, by inserting the second suture needle 2B into the living tissue and penetrating the tissue, the other half of the first suture 3A and the third suture 3C penetrate the same portion of the living tissue at the same time. Is configured to do.

  Next, an example of pancreatogastric anastomosis after pancreaticoduodenectomy using the suture with a needle of this embodiment will be described with reference to FIG. FIG. 3 is an explanatory view showing an outline of a process of performing the above-described pancreaticogastric anastomosis using the “main method” using the needle-attached suture.

  The “main surgical method” is a method of performing pancreaticogastric anastomosis on the rear wall (back stomach wall) of the stomach 4 after incising the front wall (front stomach wall) of the stomach 4 (residual stomach). As shown in FIG. 4, an incision 5 for anastomosis is made in the back wall of the stomach, and the stump of the pancreas 5 (residual pancreas) is inserted into the remaining stomach.

  Next, as shown in FIG. 4 (a), the first suture needle 2A is inserted into the living tissue using a needle holder (not shown) and penetrates the entire stomach wall and pancreas, that is, the stomach wall → The first suture needle is penetrated in the order of pancreas → gastric wall. As a result, one half of the first suture 3A and the second suture 3B penetrate through the same part of the stomach and pancreas simultaneously. Similarly to the first suture needle 2A, the second suture needle 2B penetrates the entire stomach wall and pancreas. Thus, the other half of the first suture 3A and the third suture 3C penetrate through the same part of the stomach and pancreas at the same time.

  Next, the penetration state and the like of each of the sutures are confirmed. As shown in FIG. 3B, the second and third sutures 3B and 3C are attached to the suture needles using the scissors 7 or the like at a desired time. Cut from near the proximal end, and ligate the second sutures and the third sutures together. The first suture is also ligated and cut in the same manner as described above.

  By the above operation, the pancreas (residual pancreas) and the stomach (residual stomach) are anastomosed with the entire stomach wall-pancreatic penetration mattress suture by one thread and the entire stomach wall-pancreatic penetration suture by two threads.

  In the present embodiment, an example of performing pancreaticogastric anastomosis after pancreaticoduodenectomy has been disclosed, but the use of the suture with a needle of the present embodiment is not limited to the above. For example, the present invention can be used for pancreatic stump closure at the time of caudal pancreatectomy or when the excised pancreas is covered with a bicyclyl sheet (for example, J & J product) and sutured.

  The suture with a needle described above is disclosed as an example, and the present invention is not limited to the above-described embodiment, and can be arbitrarily changed without departing from the technical idea described in the claims. Is.

2A First suture needle 2B Second suture needle 3A First suture 3B Second suture 3C Third suture 4 Stomach (residual stomach)
5 Incision 6 Pancreas (residual pancreas)
20 Needle body 22 Needle tip 23 Needle base 24 Thread mounting hole

Claims (4)

A suture with a needle comprising three first, second and third sutures, and first and second two suture needles attached to these sutures,
The first and second suture needles have a thread attachment hole provided in the base end portion of the needle body in the axial direction;
The first and second suture needles are formed by inserting one end portion of the first suture thread and one end portion of the second suture thread into a thread attachment hole of the first suture needle. Fixedly attached to the thread,
The second suturing needle is configured such that the other end portion of the first suturing thread and one end portion of the third suturing thread are inserted into thread attachment holes of the second suturing needle, and the first and third suturing needles are inserted. A needle-attached suture characterized by being fixedly attached to a suture.   The suture with a needle according to claim 1, wherein the first and second suture needles are constituted by straight round needles.   2. The suture with a needle according to claim 1, wherein the first suture and the second and third sutures are made of different colored yarns.   The suture with a needle according to any one of claims 1 to 3, wherein the suture with a needle is used for pancreatic gastric anastomosis or organ suture after pancreaticoduodenectomy.

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