JP4145331B2 - Suture and endoscope - Google Patents

Description

  The present invention relates to a suture instrument.

2. Description of the Related Art Conventionally, treatment devices that are introduced into a body cavity and suture a living tissue for the purpose of hemostasis and the like are known. This type of treatment device has a puncture needle that can penetrate a living tissue, and has a configuration in which a retaining tip for a suture thread and a fixing tool are sequentially accommodated in the puncture needle from the distal end side of the puncture needle ( For example, see Patent Document 1).
In such a treatment device, when the two biological tissues to be sutured are penetrated, the retaining tip is first pushed out from the puncture needle. Thereafter, the puncture needle is removed from the two biological tissues, and then the fixture is pushed out of the puncture needle. Finally, the suture is pulled to sew the two living tissues and fasten with a fixture. As a fixture, a taper-shaped elastic fastening member is accommodated in a member having a tapered lumen, and a suture is fixed by a frictional force between the two members.
Japanese Utility Model Publication No. 59-21775 (page 3, FIG. 14, FIG. 23)

  An object of the present invention is to provide a suturing tool capable of reliably suturing a living tissue.

The invention according to claim 1 of the present invention for solving the above-described problems is an engagement member attached to one end of a suture and engaged with a living tissue, and inserted through the other end of the suture. A locking member that contacts the living tissue that has penetrated and functions as a retaining agent for the suture, and the locking member has two bent pieces that are inclined with respect to the base so as to face each other, The folded piece tightens the suture thread passed between the ends when a force is applied so that the opposite ends are closed, and the suture is applied when the force is applied so that the opposite ends are opened. The lock member is configured to release the tightening of the thread, and the lock member is formed of a plate-like member having a hole through which the suture thread is formed at a substantially center, and has a predetermined position on both sides in the long side direction of the plate-like member. 90 degrees or more as the bending position So as to form a side view triangle by bending Ri, wherein bent pieces on the left and right sides of the base portion is formed, that the outer surface of the base having the holes constitutes an abutment surface which abuts the body tissue A characteristic suture tool was obtained.

  According to a second aspect of the present invention, in the suturing device according to the first aspect, the outer shape of the lock member is larger than that of the engagement member.

According to a third aspect of the present invention, in the suturing device according to the first or second aspect, the lock member is constituted by a single member.
The invention according to claim 4 is an endoscope comprising the suturing tool according to any one of claims 1 to 3 which is used by being inserted into a forceps channel.

According to the present invention, when the suture thread moves in the direction from the bent piece toward the base portion, the end portion closes and tightens, so that the lock member does not move in the direction in which the biological tissue is separated, and is sewn. One living tissue will not leave.

  Embodiments of the present invention will be described in detail with reference to the drawings. FIG. 1 is a schematic view of an endoscopic treatment apparatus including a suture instrument in the present embodiment. FIG. 2 is a cross-sectional view showing an insertion portion of the suturing device, and FIG. 3 is a cross-sectional view mainly showing a hand operation portion of the suturing device.

  As shown in FIG. 1, the suturing device 1 of the present embodiment is used by being inserted into a forceps channel 3 of an endoscope treatment apparatus 2. The endoscope treatment apparatus 2 includes an endoscope 4 in which the suturing device 1 is inserted, and an air pump 7 that is a fluid supply unit that supplies a gas such as air as a fluid to the suturing device 1. Furthermore, the endoscope 4 includes an introduction unit 5 that is introduced into a body cavity and has a forceps channel 3 at the tip thereof, a lens for illumination and a camera, and an operation unit 6 that operates the introduction unit 5 from outside the body cavity.

  As shown in FIGS. 2 and 3, the suturing device 1 has a flexible insertion portion 10 that is inserted into a body cavity and a hand operation portion 20 that receives the operation of a practitioner outside the body cavity. 31 and 32 are inserted.

  The insertion portion 10 includes an outer sheath 11 that is a flexible tube, an inner sheath 12 that is accommodated in the outer sheath 11 so as to be able to advance and retreat, and a puncture needle 13 that is attached to the distal end of the inner sheath 12. The puncture needle 13 has a sharp tip formed by inclining the tip at an acute angle to facilitate penetration into the living tissue. The puncture needle 13 has a hollow shape having an opening 14 at the tip of the tip, and accommodates an engagement member 16 and a lock member 17 attached to the suture thread 15 in this lumen.

  As shown in FIGS. 2 and 4A, the engaging member 16 is formed of a cylindrical member, and one end of the suture thread 15 that passes through the living tissue is locked near the center in the longitudinal direction. At the time of suturing, the engaging member 16 abuts on and is engaged with the living tissue over a wide area in the longitudinal direction, and prevents the suture thread 15 from falling out of the living tissue. Because of this shape and function, the engaging member 16 is sometimes called a T-shaped anchor or T-bar.

  The lock member 17 functions as a retainer for the suture thread 15 after stitching, and has two bent pieces 51 and 52 that rise so as to face the base portion 50 at a predetermined angle. The other end of the suture thread 15 drawn out from 16 is passed between the hole 50 a of the base portion 50 and the bent pieces 51 and 52. As shown in the perspective view of FIG. 4A and the developed view of FIG. 4B, the lock member 17 forms a hole 50a through which a suture thread passes in the center of the plate-like member, and the length of the plate-like member. Bending lines 53 and 54 provided at predetermined positions in the side direction are bent positions, the end portions are bent in the same direction to form bent pieces 51 and 52, and a base portion having a contact surface that comes into contact with a living tissue at a portion having a hole 50a 50. The distance between the end portion 51a of the bent piece 51 and the end portion 52a of the bent piece 52 is set to be in contact with each other without the suture 15 or to be equal to or less than the diameter of the suture 15.

  As shown in FIG. 4C, which is a cross-sectional view taken along the line AA of FIG. 4A, the end portion 51a and the end portion 52a are separated from each other so that the base portion 50 faces the end portions 51a and 52a. When the other end of the suture thread 15 is passed through, the bending pieces 51 and 52 generate forces to approach each other. Therefore, when the suture thread 15 is pulled in the direction d1 of the base portion 50, the end portions 51a and 52a are also moved in the direction d1, the distance between the end portions 51a and 52a is reduced, and the suture thread 15 is tightened and locked. The movement of the thread 15 is prevented. That is, when the force that separates the engagement member 16 and the lock member 17 is applied to the suture thread 15, the lock member 17 moves the end part 51 a and the end part 52 a so as to close the movement of the suture thread 15. Acts to lock. In other words, even if the suture target sandwiched between the lock member 17 and the engagement member 16 tries to push the lock member 17 in the direction d2 of the other end of the suture thread 15, the end portions 51a and 52a tighten the suture thread 15 and the suture thread. Since the position of the lock member 17 with respect to 15 is locked, the lock member 17 is not moved in the direction d2.

  On the other hand, when the suture thread 15 is pulled in the direction d2 opposite to the base portion 50, the end portions 51a and 52a are also moved in the direction d2 (the direction in which they are separated from each other), so that the tightening of the suture thread 15 is released. That is, it acts to allow the suture 15 to move in the direction in which the engagement member 16 and the lock member 17 are brought closer. In other words, when the lock member 17 is pressed against the object to be sutured, that is, when the lock member 17 is moved in the direction d1 of one end of the suture 15, the end between the end 51 a and the end 52 a is opened. Since the tightening of the portions 51a and 52a is released, the lock member 17 can be moved in the direction d1.

  Further, the lock member 17 is provided with guide pieces 55 and 56 that extend from the bent pieces 51 and 52 and stably hold the suture 15 in the center. The guide pieces 55 and 56 have a triangular shape including inclined end portions 55a and 56a that extend obliquely from the midpoint of the short side of the plate material of FIG. Since the guide piece 55 and the guide piece 56 are formed in a point-symmetrical position with the hole 50a as the center, they interfere even if the bent pieces 51 and 52 are bent close to each other as shown in FIG. There is nothing. The inclined end portions 55a and 55b guide the suture 15 so as to be stably positioned at the central portion of the lock member 17, so that the suture 15 may come off between the bent pieces 51 and 52 during the suturing procedure. Disappear.

  In the present embodiment, the lock member 17 having a larger outer shape than the engagement member 16 can be used by disposing the lock member 17 on the distal end side of the puncture needle 13 with respect to the engagement member 16. In addition, since the base portion 50 of the lock member 17 is arranged so as to be parallel to the length direction (axial direction) of the puncture needle 13, the base portion 50 that comes into contact with the living tissue is limited in the limited accommodation space of the puncture needle 13. The area, that is, the area of the contact surface can be secured to the maximum.

  One end of the suture thread 15 is fixed to the engaging member 16, and the other end is tied into a ball shape as a terminal treatment. The terminal processing is performed after the lock member 17 is slidably inserted, and plays a role of preventing the lock member 17 from falling off and facilitating gripping by other forceps. Other examples of terminal processing include tying the ends of the suture 15 in a ring shape, or melting the ends to form a lump.

  The pushing member that pushes the engaging member 16 and the locking member 17 out of the puncture needle 13 includes a first pushing member 31 that pushes the locking member 17 before the engaging member 16 as shown in FIGS. The second push-out member 32 that pushes out 16 is inserted into the inner sheath 12 or the puncture needle 13 from the hand operation unit 20 side. The first pushing member 31 is made of a pipe having an outer diameter smaller than the inner diameter of the puncture needle 13, and the second pushing member 32 and the engaging member 16 are slidably accommodated therein. For this purpose, a slit 31a for pulling out the suture thread 15 attached to the engaging member 16 is provided at the tip portion. In addition, it is desirable to provide clearance between the inner wall of the puncture needle 12 and the first pusher member 31 so as to allow gas flow.

  3 includes a holding member 21 connected to the outer sheath 11, a puncture needle operation unit 22 connected to the inner sheath 12, and used for performing an operation of moving the puncture needle 13 back and forth. The push-out member handle 23 includes a ring attached to the end of the first push-out member 31 and on which the practitioner places a finger, and the push-out member knob 24 attached to the end of the second push-out member 32.

  The puncture needle operation unit 22 has a bottomed cylindrical shape, and includes a knob 26 in which a groove on which an operator puts a finger is formed at an end 22a corresponding to the bottom, and the opened end 22b is the inner sheath 12. It is connected to the. On the side surface between the end portion 22a and the end portion 22b, there is an air supply port 25 which is a fluid introduction portion used when introducing gas into the gap portion 28 formed in the puncture needle operation portion 22. The first pushing member 31 and the second pushing member 32 are passed through the puncture needle operation unit 22 so as to penetrate from the end 22b to the opening 22c of the end 22a. Since the airtightness between the opening 22 c and the first pushing member 31 is held by the packing 27, the gas does not flow out from the gap portion 28 in the puncture needle operation unit 22. By moving the puncture needle operation unit 22 relative to the holding member 21, the puncture needle 13 can be moved back and forth with respect to the outer sheath 11 within the body cavity.

The pushing member handle 23 is attached to the outer periphery of the first pushing member 31 drawn from the operation holding unit 22. When the push-out member handle 23 is pushed toward the puncture needle operation unit 22, the lock member 17 can be pushed out from the puncture needle 13.
The pushing member knob 24 is attached to the end portion 32 b of the second pushing member 32 drawn from the end portion 31 b of the first pushing member 31. When the pushing member knob 24 is pushed toward the pushing member handle 23 and the puncture needle operation unit 22, the engaging member 16 can be pushed out from the puncture needle 13.

  An air supply mechanism for supplying gas to the air supply port 25 will be described with reference to FIG. The air supply mechanism has an air pump 7 that sucks the atmosphere and discharges it at a predetermined pressure. On the discharge side of the air pump 7, an electromagnetic valve 8a that selects air supply and exhaust, and the flow rate of the gas to be supplied are adjusted. The flow rate adjusting valve 8b and the flow meter 8c for monitoring the flow rate of the actually supplied gas are connected by piping in this order, and the CPU (Central Processing Unit) 9 performs necessary control. The CPU 9 accepts a command signal from a foot switch or hand switch for switching air supply start and air supply stop, and monitors the flow meter 8c while switching the electromagnetic valve 8a and adjusting the opening of the flow rate adjustment valve 8b. I do. The flow meter 8c and the air supply port 25 are also connected by piping.

  Next, a procedure for suturing a tissue such as an organ with the suturing device 1 will be described with reference to FIGS. 1 to 3 and FIGS. 5, 6, and 7 as appropriate. 5 and 6 are diagrams for explaining the suturing procedure and the position of the pushing member at that time, and FIG. 7 is an explanatory diagram of the suturing procedure.

  First, together with the flexible endoscope 2 of FIG. 1, the insertion portion 10 of the suturing device 1 shown in FIG. 2 is introduced into the body cavity. At this time, since the puncture needle operation unit 22 of the hand operation unit 20 is pulled out from the holding member 21 by a predetermined amount, the puncture needle 13 is accommodated in the outer sheath 11. Since the pushing member handle 23 is pulled out from the puncture needle operation unit 22 by a predetermined amount, the first pushing member 31 is retracted to a position where the locking member 17 is not pressed while the engaging member 16 is accommodated. Since the pushing member knob 24 is pulled out from the pushing member handle 23 by a predetermined amount, the second pushing member 32 is moved back to a position where the engaging member 16 is not pressed in the first pushing member 32.

  From this state, the distal end portion of the outer sheath 11 is moved to a position facing the living tissue to be sutured, and then the puncture needle operation member 22 is pushed toward the holding member 21 by a predetermined amount to expose the puncture needle 13 from the outer sheath 11. Let Then, a foot switch or a hand switch (not shown) is turned on to guide the gas discharged from the air pump 7 shown in FIG. The gas guided to the air supply port 25 is introduced into the inner sheath 12 of the insertion portion 10 through the gap portion 28 of the puncture needle operation member 22 shown in FIG. Then, the air is ejected from the opening 14 at the tip of the puncture needle 13 through the clearance between the first pusher member 31 and the inner sheath 12 and the puncture needle 13 and between the lock member 17 and the puncture needle 13. In addition, since the lock member 17 is in contact with the inner wall of the puncture needle 13 in a direction orthogonal to the length direction of the puncture needle 13, the lock member 17 does not fall off the puncture needle 13 when gas flows.

  Further, when the puncture needle operation member 22 is pushed in, the puncture needle 13 penetrates the biological tissue of the organ while ejecting gas from the tip. The organ swells when gas is supplied from the puncture needle 13. When a predetermined amount of gas is supplied and it is determined that the organ has expanded to the extent necessary for the treatment, a foot switch or a hand switch (not shown) is turned off to stop supplying gas to the air supply port 25.

  When the push-out member handle 23 shown in FIG. 3 is pushed toward the puncture needle operation member 22 with the organ inflated, the tip of the first push-out member 31 presses the lock member 17 as shown in FIG. Then, the lock member 17 is pushed out from the opening 14 of the puncture needle 13. As shown in FIG. 5A, since the lock member 17 is pushed out to the living tissue B1 to be sutured, when the puncture needle operating member 22 is pulled out from the holding member 21, the puncture needle 13 is retracted and the biological tissue B1 is pulled out. The puncture needle 13 is pulled out from. Thereby, the suture thread 15 penetrates the living tissue B1, and the lock member 17 is left in the living tissue B1. Since the suture thread 15 passes through the center of the base portion 50 of the lock member 17, the base portion 50 comes into contact with the living tissue B1 when the suture thread 15 is pulled.

  Next, after the suturing device 1 is moved to a position facing the living tissue B2 by an operating means (not shown), the puncture needle operation member 22 is pushed into the holding member 21, and gas is ejected from the tip of the puncture needle 13. The puncture needle 13 is pierced through the living tissue B2 as shown in FIG. Here, when the pushing member knob 24 (see FIG. 3) is pushed toward the pushing member handle 23, the second pushing member 32 protrudes from the tip of the first pushing member 31 as shown in FIG. The engaging member 16 accommodated in the one extruding member 31 is pushed out from the puncture needle 13. Thereafter, the puncture needle operating member 22 is pulled back and the puncture needle 13 is pulled out from the living tissue B2.

  Thereby, as shown in FIG. 7A, the suture thread 15 penetrates the living tissue B2, and the engaging member 16 is left in the living tissue B2. Then, the suture thread 15 extending from the lock member 17 is held by another treatment instrument 70 having the forceps 71 in the sheath 72, and the lock member 17 is pressed by the distal end of the sheath 72 so that the base 50 abuts on the biological tissue B1. However, the suture thread 15 is pulled out from the lock member 17. Since this direction is a direction in which the end portions 51 a and 52 a are opened as described above, the lock member 17 allows the suture 15 to move. Accordingly, the engaging member 16 connected to the suture thread 15 is pulled, and the living tissue B2 with which the engaging member 16 abuts is pulled to the living tissue B1 side, and as shown in FIG. The tissue B2 is sutured. At this time, since the lock member 17 has a wide contact area with the living tissue B1, a positive anchor effect is exhibited and the locking member 17 does not bite into the living tissue B1. Further, as described above, the lock member 17 acts to close and tighten the end portions 51a and 52a when the suture thread 15 is about to move from the bent pieces 51 and 52 toward the base portion 50. Therefore, the biological tissue B1 and the biological tissue B2 do not move in the direction in which they are separated from each other, and the suture thread 15 is not moved, so that the two biological tissues B1 and B2 that are sutured are not separated.

The present invention is not limited to the above embodiments and can be widely applied.
For example, the lock member 17 may have the shape shown in FIG. A lock member 81 shown in FIGS. 8A and 8B is formed by bending the short sides of a rectangular member in the same manner to form bent pieces 82 and 83. The suture thread 15 is passed between the end portion of the bent piece 82 and the end portion of the bent piece 83 which are brought close to each other in the direction from the bent position of the bent pieces 82 and 83 toward the end portion. The lock function such as 15 tightening and releasing the tightening is realized. In this case, the base 84 having an elongated shape and having the largest area is a contact surface that comes into contact with the living tissue.

  9A and 9B, a lock member 91 shown in FIGS. 9A and 9B is provided with a hole 92 through which the suture thread 15 is passed at the center of an elongated member having an arcuate cross section, and an end portion orthogonal to the long side is formed in the hole 92. The bent pieces 93 and 94 are formed by bending in the direction. The lock member 91 also passes the suture thread 15 between the end of the bent piece 93 and the end of the bent piece 94 in the direction from the bent position of the bent pieces 93, 94 toward the end, thereby Similarly, the lock function is realized. The surface of the lock member 91 that faces the hole 92 is a base, that is, a contact surface that contacts the living tissue.

The lock member 101 in FIG. 10 has a shape obtained by cutting and raising the bent pieces 102 and 103 by making an H-shaped cut in the center of the elongated plate. A direction from the bent position of the bent pieces 102 and 103 toward the end between the end of the bent piece 102 and the end of the bent piece 103, which does not have such a hole but is inclined so as to be close to each other. By passing the suture thread 15 therethrough, a locking function is realized as described above.
In the lock member 101, a portion excluding the bent pieces 102 and 103 serves as a contact surface that contacts the living tissue as a base. The lock members 81, 91, 101 shown in FIGS. 8 to 10 are also accommodated in the lumens so that the contact surfaces are parallel to the axial direction of the puncture needle 13. In addition, it is arranged closer to the distal end side of the puncture needle 13 than the engaging member 16.

  The fluid ejected from the tip of the puncture needle 13 may be air or other gas, but may be a liquid such as physiological saline.

It is the schematic of the endoscopic treatment apparatus containing the suturing device of this invention. It is sectional drawing which shows the structure of the insertion part of a suturing device. It is sectional drawing which mainly shows the structure of the hand operation part of a suturing device. It is a figure which shows a locking member, (a) A perspective view, (b) An expanded view, (c) It is sectional drawing. (A) A figure explaining a suturing treatment, (b) A figure explaining a position of an extrusion member. (A) A figure explaining a suturing treatment, (b) A figure explaining a position of an extrusion member. It is a figure explaining a suture treatment. It is a figure which shows a locking member, (a) Front view, (b) It is a perspective view. It is a figure which shows a locking member, (a) Front view, (b) It is a perspective view. It is a perspective view of a locking member.

Explanation of symbols

15 Suture 16 Engagement member 17 Lock member 50 Base 51 Bending piece 51a End 52 Bending piece 52a End

Claims (4)

An engagement member attached to one end of the suture and engaged with the biological tissue, and inserted into the other end of the suture, and functions as a stopper for the suture to come into contact with the biological tissue penetrated by the suture. And a locking member
The lock member has two bent pieces that are inclined with respect to the base so as to face each other, and the bent pieces are placed between the ends when a force is applied to close the opposite ends. It is configured to tighten the passed suture and to release the tightening of the suture when a force is applied so that the opposite ends are opened .
The lock member is formed by a plate-like member having a hole through which the suture thread is passed at a substantially center, and is bent by 90 degrees or more with a predetermined position on both sides in the long side direction of the plate-like member as a bending position. The bent pieces are formed on the left and right sides of the base so as to form a triangular view,
A suturing tool, wherein an outer surface of the base having the hole constitutes a contact surface that contacts a living tissue .   The suture tool according to claim 1, wherein the lock member has an outer shape larger than that of the engagement member.   The suturing tool according to claim 1 or 2, wherein the lock member is formed of a single member. An endoscope comprising: a suture tool according to any one of claims 1 to 3, which is used by being inserted into the forceps channel.

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