JP2020044282A - Suture guide - Google Patents
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- JP2020044282A JP2020044282A JP2018177473A JP2018177473A JP2020044282A JP 2020044282 A JP2020044282 A JP 2020044282A JP 2018177473 A JP2018177473 A JP 2018177473A JP 2018177473 A JP2018177473 A JP 2018177473A JP 2020044282 A JP2020044282 A JP 2020044282A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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Abstract
Description
本発明は、手術時において縫合を支援する器具に関する。 The present invention relates to an instrument for assisting suturing during surgery.
外科手術において、生体組織同士を縫合する場合に、縫い始め／終わりの位置、縫い目の間隔ができるだけ術者の意図した通りになっているか否かは手術の成否に関わる重要の事項である。ところが、縫合箇所の形状が複雑だったり術者に見えにくい位置だったりするなどの要因により、理想的な縫合位置に針を通すことが難しい場合がある。
血管の内側に生体組織を縫合するような手術がその一例である。とりわけ、石灰化した弁尖を切除して自己心膜等から形成した弁尖を大動脈の弁輪に縫い付ける大動脈弁形成術においては、縫い目の位置が適切でないと、縫合した弁尖が大動脈弁として正常に機能しない可能性があるが、理想的な縫合に到達するには熟練が必要である。
When suturing living tissues in a surgical operation, it is important to determine whether the start / end positions of the stitches and the interval between the stitches are as intended by the operator as much as possible. However, it may be difficult to pass the needle to the ideal suturing position due to factors such as the shape of the suturing portion being complicated or a position that is difficult for the operator to see.
One example is an operation in which a living tissue is sutured inside a blood vessel. In particular, in aortic valvuloplasty in which a calcified leaflet is removed and a leaflet formed from an autologous pericardium or the like is sewn to the aortic annulus, if the stitch position is not appropriate, the sutured cusp may cause May not function properly, but skill is required to reach an ideal suture.
図８および図９を用いて、詳細に説明する。術者は、切開した大動脈７の切開面から大動脈７の内部を覗き込み、まず石灰化弁尖を切除する。続いて、弁輪のサイズを弁尖サイザーと呼ばれる器具を用いて計測し、計測したサイズに応じて、縫合対象のサイズの弁尖を心膜から切り出すなどして弁尖素材６を作成する。作成した弁尖素材６を大動脈７の内壁の弁輪に縫い付け、最後に隣り合う弁尖同士を縫い付ける。 This will be described in detail with reference to FIGS. The surgeon looks into the inside of the aorta 7 from the incised surface of the incised aorta 7, and first removes the calcified leaflets. Subsequently, the size of the valve annulus is measured using an instrument called a leaflet sizer, and a leaflet having a size to be sutured is cut out from the pericardium according to the measured size, thereby creating a leaflet material 6. The prepared leaflet material 6 is sewn to the annulus on the inner wall of the aorta 7, and finally, the adjacent leaflets are sewn.
具体的には、図８に示すように、弁尖素材６において、目印４Ａから目印４Ｃまでを結ぶ仮想線を想定した場合、仮想線より外側は、大動脈７へ縫合するときの縫い代となる。術者は、上方からみて弁尖素材６が仮想線Ｌ１で谷折りされた状態で目印４Ａに糸をかけて大動脈７に縫合し、目印４Ａから交連部に向かって目印４Ｂの位置を順次縫い進める。術者は、交連部の近くまで縫い進めると、目印４Ｃに最も近い目印４Ｂから大動脈７の外へ針を突き出す。 Specifically, as shown in FIG. 8, when a virtual line connecting the mark 4 </ b> A to the mark 4 </ b> C is assumed in the valve leaflet material 6, a portion outside the virtual line is a seam allowance when sewing to the aorta 7. The operator sutures the mark 4A with a thread in the state where the valve leaflet material 6 is folded in a trough along the imaginary line L1 and sew the mark 4A toward the aorta 7, and sequentially sews the position of the mark 4B from the mark 4A toward the commissure. Proceed. When the operator advances the sewing near the commissure, the operator projects the needle out of the aorta 7 from the mark 4B closest to the mark 4C.
術者は、目印４Ｃと目印４Ｄの位置については、図９に示すように、縫合の開始位置から交連部へ縫い進めた糸とは別の糸であって両端に針がついた糸８の一端側の針（図示略）を、目印４Ｃの位置から隣り合う弁尖素材６の目印４Ｃの位置へ貫通させる。隣り合う弁尖素材６を貫通した一端側の針は、隣り合う弁尖素材６にある目印４Ｄの位置から大動脈７の外へ突き出され、糸８の他端側の針（図示略）は、弁尖素材６にある目印４Ｄの位置から大動脈７の外へ突き出される。 Regarding the positions of the marks 4C and 4D, the operator, as shown in FIG. 9, uses a thread 8 different from the thread sewn from the start position of the suturing to the commissure and having needles at both ends. A needle (not shown) at one end is penetrated from the position of the mark 4C to the position of the mark 4C of the adjacent leaflet material 6. The needle at one end penetrating the adjacent leaflet material 6 is projected out of the aorta 7 from the position of the mark 4D on the adjacent leaflet material 6, and the needle (not shown) at the other end of the thread 8 is It is projected out of the aorta 7 from the position of the mark 4D on the leaflet material 6.
術者は、大動脈７の外側にプレジェットを当て、縫合の開始位置から縫い進められて目印４Ｂを通って大動脈７の外へでた糸９Ａと、隣り合う弁尖素材６の目印４Ｂを通って大動脈７の外へ出た糸９Ｂをプレジェット上で結び、目印４Ｄを通って両端が血管外で出た糸８をプレジェット上で結んで弁尖素材６を大動脈７へ固定する。 The surgeon applies a pledget to the outside of the aorta 7, sewn from the start position of the suture, passes through the mark 4 </ b> B to the outside of the aorta 7, and passes through the mark 4 </ b> B of the adjacent leaflet material 6. Then, the thread 9B that has come out of the aorta 7 is tied on the pledget, and the thread 8 that has both ends out of the blood vessel through the mark 4D is tied on the pledget to fix the leaflet material 6 to the aorta 7.
ここで、図９に示すように、弁尖素材６に縫合位置を示す目印を予め付すことは簡単だが、大動脈７に明確な目印があるわけではない。視点や視野が制限された状態で大動脈の内壁の縫合位置を正確に把握するのは困難である。加えて、患者によっては弁尖（弁輪）の形状は理想的な円弧からずれていることも多く、症例に応じた理想的な縫合位置を見極めるのは簡単ではない。例えば、縫い目の間隔が均等でない場合、弁尖素材６や大動脈７に想定外の力が加わって、弁尖素材６の形状が撓み、弁としての機能に悪影響が出る虞がある。 Here, as shown in FIG. 9, it is easy to put a mark indicating the suturing position on the leaflet material 6 in advance, but the aorta 7 does not always have a clear mark. It is difficult to accurately grasp the suture position on the inner wall of the aorta in a state where the viewpoint and the visual field are restricted. In addition, depending on the patient, the shape of the leaflets (annulus) often deviates from the ideal arc, and it is not easy to determine the ideal suture position according to the case. For example, if the stitch intervals are not uniform, an unexpected force is applied to the leaflet material 6 and the aorta 7, and the shape of the leaflet material 6 may be bent, which may adversely affect the function as a valve.
本発明は、縫合の位置決めを支援することを目的とする。 The present invention aims to assist in positioning a suture.
本発明は、一の態様において、変形自在な線材の表面に縫合位置を示す目印が付され、生体に固定することができる縫合ガイドを提供する。
好ましくは、前記線材の複数の箇所に尖鋭部が設けられる。
好ましくは、前記目印は、前記線材の長さ方向の中心を基準とした距離を示す目盛りである。
好ましくは、前記線材の長さは、患者の弁輪のサイズに対応し、前記目盛りの間隔は、前記中心から第１の距離までは第１の間隔であり、前記第１の距離から端部までは、前記第１の間隔よりも大きい第２の間隔である。
The present invention, in one aspect, provides a suture guide that has a mark indicating a suture position on a surface of a deformable wire rod and can be fixed to a living body.
Preferably, sharp portions are provided at a plurality of locations on the wire.
Preferably, the mark is a scale indicating a distance based on a center in a length direction of the wire.
Preferably, the length of the wire corresponds to the size of the annulus of the patient, the interval between the scales is a first interval from the center to a first distance, and the distance from the first distance to the end is Up to the second interval is larger than the first interval.
本発明によれば、縫合の位置決めが支援される。 According to the present invention, positioning of a suture is assisted.
＜実施例＞
図１の（ａ）は、切開された大動脈７を上から（長さ方向から）みた図、（ｂ）および（ｃ）は、大動脈７を横方向からみた図である。（ａ）に示すように、弁輪Ｆ１、Ｆ２、Ｆ３は、それぞれ、交連部Ｃ１から交連部Ｃ３まで、交連部Ｃ２から交連部Ｃ１まで交連部Ｃ２から交連部Ｃ３まで、大動脈７の内壁に形成される。各弁輪Ｆは、ここでは便宜上、同一の形状および大きさであって、左右対称の略円弧状となっている。すなわち、中心（頂部Ｔ）から両交連部までの距離をＬ１、Ｌ２とすると、Ｌ１＝Ｌ２である。よって、各弁輪Ｆの長さは２*Ｌ１（＝２*Ｌ２）となる。
<Example>
FIG. 1A is a diagram of the incised aorta 7 as viewed from above (from the longitudinal direction), and FIGS. 1B and 1C are diagrams of the aorta 7 as viewed from the lateral direction. As shown in (a), the annuluses F1, F2, and F3 are provided on the inner wall of the aorta 7 from the commissure C1 to the commissure C3, from the commissure C2 to the commissure C1, from the commissure C2 to the commissure C3, respectively. It is formed. Here, for convenience, each annulus F has the same shape and size, and has a substantially symmetrical substantially circular arc shape. That is, if the distances from the center (apex T) to both commissures are L1 and L2, then L1 = L2. Therefore, the length of each valve annulus F is 2 * L1 (= 2 * L2).
図２は縫合ガイド１０の外観図である。（ａ）は縫合ガイド１０を適当に折り曲げた状態を、（ｂ）は縫合ガイド１０を直線状にした状態の詳細を示す。縫合ガイド１０は、全長がＬで変形自在なワイヤ状（紐状）である。縫合ガイド１０には、所定の位置に目盛Ｍ０〜目盛Ｍ６が形成されている。目盛Ｍ０〜目盛Ｍ６は、縫合ガイド１０の色とは異なる色で形成される。色付けは、染料を用いた印刷でもよいし、化学処理によるものであってもよい。縫合ガイド１０は、例えば高分子材料で形成されることができるが、材質は問わない。より具体的には、縫合ガイド１０は、対象の生体部位の3次元形状に沿わせることができる程度に柔軟であるが、少なくとも長さ方向（目盛り線に垂直な方向）については必要以上に伸縮しないことが好ましい。 FIG. 2 is an external view of the suturing guide 10. (A) shows a state in which the suture guide 10 is appropriately bent, and (b) shows a state in which the suture guide 10 is straightened. The suturing guide 10 is in the form of a wire (string) having a total length L and being freely deformable. Scales M0 to M6 are formed at predetermined positions on the suturing guide 10. The scales M0 to M6 are formed in colors different from the color of the suturing guide 10. The coloring may be performed by printing using a dye or by chemical treatment. The suture guide 10 can be formed of, for example, a polymer material, but the material is not limited. More specifically, the suture guide 10 is flexible enough to conform to the three-dimensional shape of the target body part, but expands and contracts more than necessary at least in the length direction (direction perpendicular to the scale line). Preferably not.
目盛Ｍ０は長さ方向の中心に形成され、最初に糸を通す位置を示す。目盛Ｍ１〜Ｍ６は、その順番に糸を通す位置を示す。つまり、目盛Ｍ１は目盛Ｍ０の次に糸を通す位置であり、目盛Ｍ２はその次に通す位置である。目盛Ｍ０は、目盛Ｍ１〜Ｍ６と区別するために、形状、線幅、線種、および／または色が異なっている。なお、同図では中心から右側のみ符号が示されているが、目盛りは左側にも同様に形成される。目盛Ｍ０〜Ｍ４までは等間隔（ｄ１）となっており、目盛Ｍ４〜Ｍ６（端部）まで等間隔（ｄ２、ｄ１＜ｄ２）となっている。例えば、ｄ１＝１ｍｍ、ｄ２＝５ｍｍである。換言すると、各目盛りは、線材の長さ方向の中心を基準とした距離を示す。 The scale M0 is formed at the center in the length direction, and indicates a position where the thread is first passed. The scales M1 to M6 indicate positions where the thread is passed in that order. That is, the scale M1 is a position where the thread is passed next to the scale M0, and the scale M2 is a position where the thread is passed next. The scale M0 has a different shape, line width, line type, and / or color to distinguish it from the scales M1 to M6. In the figure, reference numerals are shown only on the right side from the center, but the scale is similarly formed on the left side. The scales M0 to M4 are equally spaced (d1), and the scales M4 to M6 (ends) are equally spaced (d2, d1 <d2). For example, d1 = 1 mm and d2 = 5 mm. In other words, each scale indicates a distance based on the center in the length direction of the wire.
また、縫合ガイド１０の表面には尖鋭部Ｐ（Ｐ１、Ｐ２、Ｐ３、Ｐ４）が形成される。尖鋭部Ｐは、先端が尖っており、生体（この例では大動脈７）に突き刺して縫合ガイド１０を固定するための手段である。尖鋭部Ｐは、例えば化学処理によって形成されるが、その材質や形成方法は問わない。 A sharp portion P (P1, P2, P3, P4) is formed on the surface of the suture guide 10. The sharp portion P is a means for fixing the suture guide 10 by piercing a living body (the aorta 7 in this example) and having a sharp tip. The sharp portion P is formed by, for example, a chemical treatment, but the material and the forming method are not limited.
図３は、縫合ガイド１０を大動脈７に固定する様子を示す。術者は、大動脈７が形成されてる面を縫合ガイド１０に向け、大動脈７の内壁の弁輪に沿うように縫合ガイド１０を折り曲げつつ大動脈７に押し当てる。これにより、縫合ガイド１０が弁輪の形状に沿って弁輪近傍の大動脈７に固定される。 FIG. 3 shows how the suture guide 10 is fixed to the aorta 7. The surgeon turns the surface on which the aorta 7 is formed toward the suturing guide 10 and presses the suturing guide 10 against the aorta 7 while bending the suturing guide 10 along the annulus on the inner wall of the aorta 7. Thereby, the suture guide 10 is fixed to the aorta 7 near the annulus along the shape of the annulus.
図４は、縫合ガイド１０に対応する弁尖素材６の例を示す。弁尖素材６には、予め縫合位置を示す目印４Ａ、目印４Ｂ、目印４Ｃ、目印４Ｄが形成される。縫合ガイド１０の長さ（Ｌ）、目盛Ｍの位置や数は、弁尖素材６に対応して設定されている。すなわち、縫合ガイド１０は弁尖素材６のサイズごとに予め用意され、術者は弁尖素材６のまずサイズが決定すると、そのサイズに合う縫合ガイド１０を選択して使用することになる。 FIG. 4 shows an example of the leaflet material 6 corresponding to the suturing guide 10. A mark 4A, a mark 4B, a mark 4C, and a mark 4D indicating the suturing position are formed on the leaflet material 6 in advance. The length (L) of the suturing guide 10 and the position and number of the scales M are set corresponding to the leaflet material 6. That is, the suturing guide 10 is prepared in advance for each size of the leaflet material 6, and when the operator first determines the size of the leaflet material 6, the operator selects and uses the suturing guide 10 that matches the size.
同図の符号「４Ａ（Ｍ０）」のカッコ内の文字は、対応する大動脈７の縫合位置を示す。例えば、「目印４Ｂ-３（目盛Ｍ３）」について、術者は目印４Ｂ-３の位置を通した糸を、大動脈７に固定された縫合ガイド１０の目盛Ｍ３を目印として、大動脈７に糸を通す位置を決定する。 The characters in the parentheses of the reference numeral “4A (M0)” in the figure indicate the corresponding suturing positions of the aorta 7. For example, for “mark 4B-3 (scale M3)”, the surgeon applies a thread passing through the position of the mark 4B-3 to the aorta 7 using the scale M3 of the suture guide 10 fixed to the aorta 7 as a mark. Decide where to pass.
図５を用いて、縫合ガイド１０を用いた手術の方法を説明する。なお、同図においては目盛り等の縫合ガイド１０の詳細な形態や弁尖素材に付された目印については、便宜上、捨象している。
（ａ）に示すように、まず、用いるサイズの弁尖素材６とそのサイズに対応する縫合ガイド１０を決定すると、術者は、まず、縫合ガイド１０を所望の形状に折り曲げ、大動脈７の内壁に固定する。具体的には、弁尖素材６を縫い付ける箇所である、新しく形成したい弁輪のすぐ下側（術者からみて奥側）に、当該弁輪の形状に沿わせて固定する。固定する位置は、縫合作業に邪魔にならず、位置決めの目印となるように視認でき、縫合完了後に縫合ガイド１０を取り外せる位置であることが好ましい。なお、縫合対象の弁尖素材６の数が３つである場合（３弁尖）の場合は、各弁尖（サイズが同一とは限らない）に対応する縫合ガイド１０を３つ用意し、その３つの縫合ガイド１０を、弁輪を形成したい位置に対応する位置に固定する。
An operation method using the suturing guide 10 will be described with reference to FIG. In the figure, the detailed form of the suturing guide 10 such as the scale and the marks attached to the leaflet material are omitted for convenience.
As shown in (a), first, when the valve leaflet material 6 of the size to be used and the suturing guide 10 corresponding to the size are determined, the operator first folds the suturing guide 10 into a desired shape, and the inner wall of the aorta 7. Fixed to. Specifically, it is fixed along the shape of the valve annulus just below the valve annulus to be newly formed, which is the place where the valve leaflet material 6 is to be sewn (back side as viewed from the operator). It is preferable that the fixing position is a position where the suturing guide 10 can be detached after the suturing is completed, so that the suturing guide 10 can be visually recognized as a positioning mark without obstructing the suturing operation. If the number of leaflet materials 6 to be sutured is three (three leaflets), three suture guides 10 corresponding to each leaflet (not necessarily the same size) are prepared, The three suturing guides 10 are fixed at positions corresponding to positions where the annulus is to be formed.
続いて、（ｂ）に示すように、術者は、各縫合ガイド１０が固定された大動脈７の内壁に弁尖素材６を縫合する。この例では、３つの弁尖を縫合する手術の例である。縫合の方法は、図８および図９を用いて説明したものと同じである。（ｃ）に示すように、縫合後、各縫合ガイド１０を取り外す。 Subsequently, as shown in (b), the operator sutures the leaflet material 6 to the inner wall of the aorta 7 to which the respective suturing guides 10 are fixed. This example is an example of an operation for suturing three leaflets. The suturing method is the same as that described with reference to FIGS. As shown in (c), after suturing, each suturing guide 10 is removed.
本発明によれば、術者は弁尖素材６と縫合ガイド１０とを目印として縫い進めればよいので、目検討なしに、理想的な位置で縫合が行われる。特に、弁輪が左右非対称である場合に顕著である。これを、図６を用いて説明する。同図は、交連部Ｃ２から交連部Ｃ３までの弁輪Ｆ３が非対称の例である。このような場合、縫い始めの位置（目印４Ａ対応する目盛Ｍ０）は、頂部Ｔ１とも、交連部Ｃ２と交連部Ｃ３とを直線で結んで線上にあるＥ１とも異なる位置にある。大動脈７側に目印がないと、例えば頂部Ｔ１やＥ１を縫い始めの位置だと錯覚してしまう可能性がある。仮に、尖鋭部Ｐ２から縫い始めてしまうと、右側（交連部Ｃ３まで）の縫い目の間隔が小さくなってしまう一方、逆に左側（交連部Ｃ２まで）の縫い目の間隔は広くなりすぎ、結果として縫合後の弁尖素材６が想定の通りに機能しない可能性がある。 According to the present invention, since the operator only has to sew the leaflet material 6 and the suturing guide 10 as a mark, suturing is performed at an ideal position without visual examination. This is particularly noticeable when the annulus is asymmetrical. This will be described with reference to FIG. The figure shows an example in which the valve annulus F3 from the commissure part C2 to the commissure part C3 is asymmetric. In such a case, the sewing start position (the scale M0 corresponding to the mark 4A) is different from the top T1 and the position E1 on the line connecting the commissure C2 and the commissure C3 with a straight line. If there is no mark on the side of the aorta 7, there is a possibility that, for example, the apex T1 or E1 may be illusioned as a position where sewing is started. If the sewing is started from the sharp portion P2, the interval between the right stitches (up to the commissure C3) is reduced, while the interval between the left stitches (up to the commissure C2) is too large. The later leaflet material 6 may not function as expected.
これに対し、縫合ガイド１０を用いれば、弁輪Ｆ３の形状に沿わせて縫合ガイド１０を固定することで、縫合開始位置が目盛Ｍ０によって示されることになる、目盛Ｍ０を目印に縫合開始することができる。また、縫合ガイド１０は左右対称に形成されているので、目盛Ｍ１〜Ｍ６を目標に糸を通していけば中心から交連部Ｃ３までの部分と中心から交連部Ｃ２までの部分とで、縫い目の間隔が不揃いになるといったことがない。 On the other hand, when the suturing guide 10 is used, the suturing guide 10 is fixed along the shape of the valve annulus F3, and the suturing start position is indicated by the scale M0. be able to. Further, since the suturing guide 10 is formed bilaterally symmetrically, the interval between the stitches between the portion from the center to the commissure portion C3 and the portion from the center to the commissure portion C2 is increased if the thread is passed through the scales M1 to M6. There will be no irregularities.
図２に例示した尖鋭部Ｐの形成態様は一例にすぎない。例えば、図７の（ａ）に示すように、縫合ガイド１０Ａに同一断面内において２個の尖鋭部Ｐが形成されてもよい。これにより固定力や安定性が向上する。あるいは（ｂ）に示すように、縫合ガイド１０Ｂに同一断面内に複数（この例では目印４個）の尖鋭部Ｐが形成されてもよい。この場合、術者が取り付けの際に縫合ガイド１０の向きを確認する必要がない。また、尖鋭部Ｐは縫合ガイド１０の長さ方向に一直線に配列されている必要はない。例えば（ｃ）に示すように、縫合ガイド１０Ｃにおいて、隣り合う尖鋭部Ｐが螺旋状に配列されていてもよい。また、各目盛Ｍと尖鋭部Ｐとの位置関係は任意であり、尖鋭部Ｐ上に目盛Ｍが形成されていてもよい。 The formation mode of the sharp part P illustrated in FIG. 2 is only an example. For example, as shown in FIG. 7A, two sharp portions P may be formed in the same cross section on the suturing guide 10A. Thereby, the fixing force and the stability are improved. Alternatively, as shown in (b), a plurality of (in this example, four marks) sharp portions P may be formed in the same cross section in the suture guide 10B. In this case, the surgeon does not need to check the orientation of the suture guide 10 at the time of attachment. Further, the sharp portions P need not be arranged in a straight line in the length direction of the suture guide 10. For example, as shown in (c), adjacent sharp portions P may be spirally arranged in the suturing guide 10C. Further, the positional relationship between each scale M and the sharp part P is arbitrary, and the scale M may be formed on the sharp part P.
本発明に係る縫合ガイドは、大動脈弁形成術に限定されず、いかなる生体組織の縫合においても用いることができる。また、２つの縫合対象のうち少なくともいずれか一方の側に縫合ガイド１０を固定すればよく、他方の側には他の目印があってもなくてもよい。また、縫合ガイド１０の生体への固定に関し、尖鋭部Ｐのように突き刺さす機構ではなく、生体と接着する機構が採用されてもよい。例えば、取り外しが可能な程度に接着力のある材料を縫合ガイド１０の表面の全体または一部に塗布してもよい。要するに、本発明に係る縫合ガイドは生体に固定する機能を有していればよい。 The suture guide according to the present invention is not limited to aortic valvuloplasty, and can be used for suturing any living tissue. Further, the suture guide 10 may be fixed to at least one side of the two suturing objects, and the other side may or may not have another mark. Further, regarding the fixing of the suturing guide 10 to the living body, a mechanism that adheres to the living body may be employed instead of a mechanism that pierces like the sharp portion P. For example, a material that is adhesive enough to be removable may be applied to all or part of the surface of the suture guide 10. In short, the suture guide according to the present invention only needs to have a function of fixing to the living body.
４Ａ、４Ｂ、４Ｃ、４Ｄ・・・目印、６・・・弁尖素材、７・・・大動脈、１０、１０Ａ、１０Ｂ、１０Ｃ・・・縫合ガイド、Ｍ・・・目盛、Ｃ１、Ｃ２、Ｃ３・・・交連部、Ｔ、Ｔ１・・・頂部、Ｆ・・・弁輪、Ｐ・・・尖鋭部 4A, 4B, 4C, 4D: mark, 6: leaflet material, 7: aorta, 10A, 10B, 10C: suture guide, M: scale, C1, C2, C3 ... commissible part, T, T1 ... top part, F ... annulus, P ... sharp part
本発明は、一の態様において、変形自在な線材の表面に縫合位置を示す目印が付され、生体に、取り外し可能に固定することができる縫合ガイドを提供する。
好ましくは、前記線材の複数の箇所に尖鋭部が設けられる。
好ましくは、前記目印は、前記線材の長さ方向の中心を基準とした距離を示す目盛りである。
好ましくは、前記線材の長さは、患者の弁輪のサイズに対応し、前記目盛りの間隔は、前記中心から第１の距離までは第１の間隔であり、前記第１の距離から端部までは、前記第１の間隔よりも大きい第２の間隔である。
SUMMARY OF THE INVENTION In one aspect, the present invention provides a suturing guide that has a mark indicating a suturing position on a surface of a deformable wire rod and that can be detachably fixed to a living body.
Preferably, sharp portions are provided at a plurality of locations on the wire.
Preferably, the mark is a scale indicating a distance based on a center in a length direction of the wire.
Preferably, the length of the wire corresponds to the size of the annulus of the patient, the interval between the scales is a first interval from the center to a first distance, and the distance from the first distance to the end is Up to the second interval is larger than the first interval.
Claims (4)
縫合ガイド。 A mark indicating the suture position is attached to the surface of the deformable wire, and the wire can be fixed to a living body.
Suture guide.
請求項１に記載の縫合ガイド。 Having sharp portions provided at a plurality of locations of the wire rod,
The suturing guide according to claim 1.
請求項１または２に記載の縫合ガイド。 The mark is a scale indicating a distance based on the center in the length direction of the wire,
The suture guide according to claim 1.
前記目盛りの間隔は、前記中心から第１の距離までは第１の間隔であり、前記第１の距離から端部までは、前記第１の間隔よりも大きい第２の間隔である、
請求項３に記載の縫合ガイド。 The length of the wire corresponds to the size of the patient's annulus,
The interval between the scales is a first interval from the center to a first distance, and a second interval from the first distance to an end is greater than the first interval.
The suturing guide according to claim 3.
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| JP2018177473A JP6523540B1 (en) | 2018-09-21 | 2018-09-21 | Suture guide |
| PCT/JP2019/036882 WO2020059839A1 (en) | 2018-09-21 | 2019-09-20 | Suture guide |
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| JPH0749936Y2 (en) * | 1990-02-06 | 1995-11-15 | 泉工医科工業株式会社 | Medical artificial valve suture auxiliary wheel |
| US6602288B1 (en) * | 2000-10-05 | 2003-08-05 | Edwards Lifesciences Corporation | Minimally-invasive annuloplasty repair segment delivery template, system and method of use |
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