JP2019037452A - Dilator - Google Patents

Abstract

To provide a dilator for expanding the lumen of narrow-diameter tubes, and securing a space for a needle movement and a visual field in suturing narrow-diameter tubes, such as a biliary duct, a pancreatic duct, a urinary duct, urethral, an oviduct, and a blood vessel with a suture thread, or anastomosing the narrow-diameter tubes to a gastrointestinal tract, a utricle, etc. with a suture thread.SOLUTION: A dilator includes: a slender tip part with a distal end and a proximal end that can be inserted into the lumen of narrow-diameter tubes, which are objects to be dilated; a stopper connected to the proximal end of the tip part for limiting the depth of the insertion of the tip part into the lumen of narrow-diameter tubes; and a handle part connected to the proximal end of the tip part or the stopper. The tip part is formed with at least one groove or slit along the lengthwise direction.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a dilator. More specifically, the present invention relates to a case where a small diameter tube such as a bile duct, a pancreatic duct, a ureter, a urethra, an oviduct, or a blood vessel is sutured with a suture, or a small diameter tube is anastomosed to a digestive tract, a cyst, or the like with a suture. In particular, the present invention relates to a dilator for expanding a lumen of a small-diameter tube and securing a space for carrying a needle and a visual field.

Auxiliary tools have been proposed for pushing and expanding the lumen of a small-diameter tube when anastomosing or suturing a small-diameter tube such as a bile duct, pancreatic duct, ureter, urethra, and fallopian tube with a suture.
For example, in Patent Document 1, a pair of substantially straight branch pieces are juxtaposed so as to form an acute-angled substantially V shape, substantially U shape or substantially X shape, and the distal end side of each branch piece is usually The pair of branches so that an elastic force acts against them when both branch pieces are pressed from the side and the leading end side of each branch piece is closed. A combination of a support part connecting the pieces and a thin linear flexible member connected so as to be passed to the respective ends of the pair of branch pieces of the support part, The pair of branch pieces and the extended thin linear flexible member form a loop shape in a normal state in which the pair of branch pieces are open, and press both the branch pieces from the side. Opening the anastomosis assisting device is characterized in that the distal end side of both branch pieces is closed by this, and the thin linear flexible member is bent. It is.

  Patent Document 2 has a straight portion, a tip portion, an elongated member having a curved portion between the straight portion and the tip portion, and a compatible tip having a tip portion and a root end portion. When the distal end portion of the first member constitutes the first connection portion and the distal end portion of the elongated member constitutes the second connection portion, the first connection portion and the second connection portion that are rotatable about the axis center when these are connected, A surgical suturing guide having a connection mechanism for providing One of the interchangeable tips has a tapered cylindrical surface, and has an elongated portion extending in the axial direction between the tip portion and the root end portion, and the tapered cylinder surface extending in the axial direction from the tip portion. It has a through channel.

JP 2009-050306 A Japanese Patent Laid-Open No. 4-263646

  The problem of the present invention is that when a small diameter tube such as a bile duct, pancreatic duct, ureter, urethra, fallopian tube, blood vessel is sutured with a suture, or the small diameter tube is anastomosed with a suture to a digestive tract, a cyst, etc. It is to provide a dilator for expanding a lumen of a small-diameter tube in a stable manner and ensuring a space for carrying a needle and a visual field.

  As a result of studying to solve the above problems, the present invention including the following modes has been completed.

[1] An elongated tip having a distal end and a proximal end that can be inserted into the lumen of a small-diameter tube to be expanded,
A stopper joined to the proximal end of the distal end to limit the insertion depth of the distal end into the lumen of the small-diameter tube, and a handle joined to the proximal end of the distal end or the stopper And
The tip is formed with at least one groove or slit along the length direction,
Dilator.

[2] The dilator according to [1], wherein the distal end is thinner at the distal end than at the proximal end.
[3] The handle does not bend depending on the force applied when inserted into the lumen, but has a rigidity sufficient to be bent by a force exceeding the force applied when inserted into the lumen. [1] or The dilator according to [2].

  When the dilator of the present invention is sutured with a small diameter tube such as a bile duct, pancreatic duct, ureter, urethra, fallopian tube, blood vessel or the like, or when the small diameter tube is anastomosed with a suture thread to the digestive tract, cyst, etc. The lumen of the small-diameter tube can be expanded to secure a space for carrying the needle and a visual field.

It is a perspective view which shows an example of the dilator of this invention. It is a front view of a stopper when it sees from the handle | pattern part side of the dilator shown in FIG. It is a perspective view which shows another example of the dilator of this invention. It is a perspective view which shows another example of the front-end | tip part of the dilator of this invention. It is a conceptual diagram which shows a pancreas stump. It is a front conceptual diagram which shows the pancreas stump in the state which inserted the front-end | tip part of the dilator shown in FIG. 1 in the pancreatic duct, and made the suture needle penetrate. FIG. 2 is a conceptual cross-sectional view showing a pancreatic stump in a state where the distal end portion of the dilator shown in FIG.

The dilator 101 of the present invention has a tip portion 102, a stopper 103, and a handle portion 104 (see FIGS. 1 and 2). The material used for manufacturing the tip portion 102, the stopper 103, and the handle portion 104 is not particularly limited, but stainless steel, steel, aluminum, and the like are preferably used.
The tip portion 102 is composed of an elongated member having a distal end and a proximal end that can be inserted into the lumen of a small-diameter tube to be expanded. The shape of the external appearance of the front-end | tip part 102 is not specifically limited, For example, a cylindrical shape, a long cylindrical shape, an elliptical column shape, a bullet shape, a hanging bell shape etc. are mentioned.

  The distal end portion 102 has at least one groove 106 formed along the length direction. The groove may be a U-shaped groove, a V-shaped groove, or a groove having another shape, but a U-shaped groove is preferable from the viewpoint of ensuring a wide space for carrying the needle. Although the groove | channel 106 shown in FIG. 1 is formed ranging from the distal end of the front-end | tip part 102 to a proximal end, you may form only in a part from a distal end to a proximal end.

The distal end of the tip portion 102 is not particularly limited as long as it is easy to insert into the small diameter tube. For example, the distal end portion may have a single-cut edge shape as shown in FIG. It may have a cannonball shape.
Moreover, it is preferable that the distal end is thinner at the distal end than at the proximal end. An enlarged diameter portion 107 is provided at the proximal end of the tip portion shown in FIG. As a result, the lumen of the small-diameter tube is further expanded and the space for carrying the needle is increased. It is preferable from the viewpoint of ensuring a space for carrying the needle that the groove or slit in the enlarged diameter portion 107 is increased in width and depth as the diameter is increased (FIG. 7).
As shown in FIG. 6, the edge 108 of the groove 106 is inclined inward, so that the needle tip can be guided to the inside of the groove when the needle tip is about to deviate from the groove.

A stopper 103 is joined to the proximal end of the tip portion 102. The stopper 103 is not particularly limited in its shape and size as long as it can limit the insertion depth of the distal end portion 102 into the lumen of the small diameter tube. The stopper can reduce the problem that the insertion depth of the tip is too deep or too shallow. Further, if the stopper is fixed so as to be in contact with the organ stump, it is possible to prevent a problem that the insertion depth of the distal end portion is changed during carrying the needle.
It is preferable that the stopper 103 is also formed with a groove. It is preferable that this groove is connected to a groove formed in the tip portion 102. It is preferable that the groove formed in the stopper 103 is formed so as to expand toward the proximal side because the space for carrying the needle is increased.

  The handle 104 is joined to the stopper 103. The joining position is not particularly limited. In the dilator 101 shown in FIG. 1, the handle 104 is joined to the lower left (see FIG. 2) of the stopper 103 when viewed from the distal side. For example, when pancreaticoduodenectomy is performed by laparotomy, the stump of the pancreas to be reconstructed faces the right side of the patient. The handle part joined to the position as shown in FIG. 1 or 2 is located on the back side of the patient when the tip part is inserted into the pancreatic duct. As a result, the handle does not obstruct the operator's needle movement and does not obstruct the operator's field of view in carrying the needle through the pancreatic duct into which the distal end is inserted.

The handle portion 104 does not bend depending on the force applied when it is inserted into the lumen, but preferably has a rigidity that can be bent by a force exceeding the force applied when inserted into the lumen. Before inserting the distal end portion into the pancreatic duct, the handle portion can be bent so that the grasping portion 105 and the distal end portion 102 are positioned at an angle desired by the operator.
The pancreatic duct stump 110 is open in the pancreatic duct 111 as shown in FIG. When the distal end portion 102 of the dilator 101 of the present invention is inserted into the pancreatic duct, a space for carrying a needle is formed by the groove 206 as shown in FIG.
When inserted into the pancreatic duct so that the edge 108 of the groove 107 is on the upper side, a suture needle is pierced from the upper side of the pancreas toward the groove 106, and the tip of the needle is taken out from the inner wall of the pancreatic duct (FIG. 7). The inner wall other than the upper side of the pancreatic duct is protected so that the tip of the needle is not pierced by the wall of the distal end portion 102. The needle tip is grasped, the needle is pulled out from the groove 106, and a suture is sewn to the end of the pancreatic duct. Thereafter, pancreaticojejunostomy can be performed according to a conventional method.

The dilator 201 of the present invention has a tip 202, a stopper 203, and a handle 204 (see FIG. 3).
The tip portion 202 has the same structure as the tip portion of the dilator 101. The handle portion 204 is joined to the lower center portion of the stopper 203. The handle may be joined to the proximal end (end surface of the bottom of the groove) of the tip 102. The handle portion 204 may be bent from the beginning as shown in FIG. 3, or may be bent into another shape according to the operator's preference. As shown in FIG. 3, when the crank portion 209 is bent into a crank shape, the insertion depth of the tip end portion 206 can be limited together with the stopper 203.

  The tip end portion 302 of the dilator shown in FIG. At least one groove or slit 307 is formed along the length direction. The proximal end of the tip 302 is joined to a stopper (not shown) or a handle similar to the tip shown in FIG. 1 or FIG.

  The dilator of the present invention is not limited to the embodiment shown in the figure, and the tip, stopper, handle, and gripper are changed in shape, size, color, and material, or the tip, stopper, handle, and gripper. Other known or conventional parts are also included in the technical scope of the present invention.

101, 201: Dilator 102, 202, 302: Tip portion 103, 203: Stopper 104, 204: Handle portion 105, 205: Grip portion 106, 206: Groove 107: Expanded portion 307: Groove or slit 108: Edge of groove 110: Pancreatic stump 111: Pancreatic duct 112: Suture needle 113: Suture

Claims (3)

An elongate tip having a distal end and a proximal end that can be inserted into the lumen of a small diameter tube to be expanded;
A stopper joined to the proximal end of the distal end to limit the insertion depth of the distal end into the lumen of the small-diameter tube, and a handle joined to the proximal end of the distal end or the stopper And
The tip is formed with at least one groove or slit along the length direction,
Dilator.   The dilator according to claim 1, wherein the tip has a narrower distal end than a proximal end.   3. The handle portion according to claim 1 or 2, wherein the handle portion is not bent by a force applied when inserted into the lumen, but has a rigidity enough to be bent by a force exceeding the force applied when inserted into the lumen. Dilator.

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