JP4302246B2 - Medical treatment tool insertion tool - Google Patents

Medical treatment tool insertion tool Download PDF

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JP4302246B2
JP4302246B2 JP23773799A JP23773799A JP4302246B2 JP 4302246 B2 JP4302246 B2 JP 4302246B2 JP 23773799 A JP23773799 A JP 23773799A JP 23773799 A JP23773799 A JP 23773799A JP 4302246 B2 JP4302246 B2 JP 4302246B2
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connector
resin
insertion
medical treatment
surgery
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JP2001061850A (en
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勝志 小田
雅之 廣川
稔 柴田
研二 河井
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住友ベークライト株式会社
雅之 廣川
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【0001】 [0001]
【発明の属する技術分野】 BACKGROUND OF THE INVENTION
本発明は皮下内視鏡下外科手術において、炭酸ガス送気下に皮下組織空間の視野を確保し、一つの皮膚切開創から内視鏡と鉗子を同時に挿入・操作することを可能にするための医療用処置具挿入具に関するものである。 In the present invention subcutaneously endoscopic surgery for securing a visual field of the subcutaneous tissue space, it makes it possible to simultaneously insert and Control of the endoscope and forceps from one skin incision under carbon dioxide insufflation the present invention relates to a medical treatment tool insertion tool.
【0002】 [0002]
【従来の技術】 BACKGROUND OF THE INVENTION
近年、低侵襲外科手術の方法として内視鏡外科手術が広く実施されている。 In recent years, endoscopic surgery has been widely practiced as a method of minimally invasive surgery. 内視鏡下手術は、主に腹部の諸臓器、例えば、胃、脾臓、腸、胆嚢等の手術を行う際、腹腔内に炭酸ガスを注入することにより処置空間を形成し、そこへ、トラカール等の処置器具挿入用の外套管を複数本刺入して、内視鏡から見た映像を画面で見ながら遠隔操作で手術を行う方法である。 The endoscopic surgery, primarily various organs of the abdomen, for example, stomach, spleen, intestine, when performing surgery gallbladder such, the treatment space is formed by implanting carbon dioxide into the abdominal cavity, thereto, trocar the mantle tube for insertion procedure instrument by entering plurality barbs etc., a method of performing surgery remotely while viewing an image viewed from the endoscope screen. 更に、ACバイパス手術における大伏在静脈採取術や下肢静脈瘤手術や乳腺手術等へも皮下内視鏡下手術として応用展開されてきており、従来の手術に比べて切開創が小さいため、術後の切開創が目立たない程小さくできて美容上有効であり、更に、患者の術中術後の負担も軽く入院期間も短くなっているため患者及び病院にとって大きなメリットがある。 For further has been applied deployed as a subcutaneous endoscopic surgery to large saphenous vein harvesting procedure and varicose veins surgery or breast surgery such as in the AC bypass surgery, incision is smaller than the conventional surgery, surgery made smaller the incision after is not conspicuous is valid on beauty, furthermore, there is a great benefit for the patient and the hospital because it has also become shorter lightly hospitalization period the burden of the patient during surgery after surgery.
【0003】 [0003]
現在、皮下内視鏡下手術に用いられているトラカールは腹腔鏡、胸腔鏡手術用のものを元にして作られており、腹腔内手術で用いられるものより短く、バルーンやスポンジなどで気密保持や固定を行っているが、狭い処置空間で使用するには不十分であり、「トラカール自身が硬く長い」「内視鏡または鉗子などを1本しか挿入できないため別のトラカールを挿入して処置具を使用する必要があり傷が2つ以上できる」「創部直下がトラカールの鞘の部分やバルーン等のため死角になる」「創縁が保護されない」「十分な気密が保てない」等の欠点があった。 Currently, trocars used in the subcutaneous endoscopic surgery laparoscopic, are made based on those for thoracoscopic surgery, shorter than those used in intraperitoneal surgery, such as in the gas-tight seal balloon or sponge is performed to and fixed, is insufficient to be used is in a narrow treatment space, and insert another trocar for only be inserted "trocar itself long hard" "endoscopic or like the one forceps treatment ingredients and can have flaws used by two or more "" wound immediately below becomes a blind spot for such sheath portions and balloon trocar "" wound edge is not protected "" sufficient airtightness can not be maintained "such as there is a drawback.
【0004】 [0004]
これらの問題点を解決するため、柔軟で内面と開口端があるエンクロージャーで、開口端には腹壁固定及び気密を守るための展開手段を持ち、更に、エンクロージャーの内部にアクセスするための少なくとも一つのアクセスオープニングがあり、腹腔内あるいはエンクロージャーの内部で外科手術を行うことが可能である装置がUSP5480410号に開示されている。 To solve these problems, there is a flexible, inner surface and an open end enclosure, the open end having a developing means to protect the abdominal wall fixing and airtight, further, for accessing the interior of the enclosure at least one have access opening, intraperitoneal or enclosure inside surgery it is possible to perform device is disclosed in Patent USP5480410. この装置は従来、腹腔鏡、胸腔鏡手術に使用されているような硬質のトラカールではなく、柔軟なシート材で構成されており、腹壁の切開口にあった形状に変形可能な展開手段を切開口から挿入して腹腔内で展開させ、気腹用の炭酸ガスが腹腔内からエンクロージャー内部へ流入してエンクロージャーが膨脹し、展開手段は腹壁との気密を守る。 The apparatus conventional laparoscopic, rather than the trocar rigid as used in thoracoscopic surgery, is composed of a flexible sheet material, incised expansion means deformable in shape matching the incision in the abdominal wall insert the mouth is deployed in the abdominal cavity, carbon dioxide gas for pneumoperitoneum flows from the peritoneal cavity into the interior enclosure enclosure is inflated, expanding means protect the airtightness of the abdominal wall. 更にエンクロージャー外周表面にアクセスオープニングを複数取り付ければ複数の鉗子が挿入でき、創部直下の観察も可能であり、創縁も保護される。 Furthermore by attaching a plurality of access openings in the enclosure periphery surface can insert multiple forceps, observed just under the wound is possible, wound edge is protected. しかし、エンクロージャーは基本的に球状であり、外周表面に取り付けられた各々のアクセスオープニングまでの距離は、設定時に決定され固定されてしまうため、複数の処置具を挿入している際、1本の処置具を大きく動かすと他の処置具も引きずられて動いてしまう欠点があった。 However, the enclosure is basically spherical, the distance to each of the access opening which is attached to the outer peripheral surface, since the result is fixed is determined during configuration when being inserted a plurality of treatment instruments, one When the treatment instrument moves largely had disadvantage that movement is also dragged other treatment instruments.
【0005】 [0005]
【発明が解決しようとする課題】 [Problems that the Invention is to Solve
本発明は、従来の皮下内視鏡手術における処置のこのような欠点を解決するもので、その目的とするところは、皮下のような狭い処置空間で1箇所の皮切箇所より内視鏡や鉗子などの処置具を同時に挿入でき、着脱が簡単で、十分な気密性を持ち、鉗子同士のFightingや移動障害を起こしにくく、更には創部直下が死角にならず、創縁が保護されるような構造をとる医療用処置具挿入具を提供することにある。 The present invention is intended to solve such drawbacks of the treatment in the conventional subcutaneous endoscopic surgery, it is an object of the endoscope Ya from skin cut portion at one location a narrow treating space such as subcutaneous can simultaneously insert a treatment tool such as forceps, removable is simple, has sufficient airtightness, it causes less Fighting and movement disorders among forceps, even not wound directly below the blind spot, so that the wound edge is protected It is to provide a medical treatment instrument insertion instrument to take a structure.
【0006】 [0006]
【課題を解決するための手段】 In order to solve the problems]
すなわち本発明は、Y字型に分かれた空間を持ち、そのうち近位端側の全長の50〜75%の長さが20〜60度の角度でY字型に2つまたは3つに分かれており、近位端には挿入口を持ち、遠位端に出口を持った柔軟な円筒状シートであり、その近位端側の各々の挿入口にあたるコネクターには処置具を挿入していない時に装置内を気密に保つ第1の気密部材と、処置具を挿入した時に装置内を気密に保つ第2の気密部材を付設し、また、遠位端側はその外周に隣接して環状部材を付設し、更に円筒状シートまたはコネクターの一部分に炭酸ガス送気口を有することを特徴とする医療用処置具挿入具である。 That is, the present invention has a space which is divided into Y-shape, of which is divided into two or three in a Y-shape at an angle of 20 to 60 degrees 50% to 75% of the total length of the proximal end cage has an insertion port at the proximal end, a flexible cylindrical sheet having an outlet at the distal end, the proximal end side of each of the insertion opening corresponding to connector when not inserting a treatment tool a first hermetic member to keep the device in an air-tight, and attaching a second hermetic member to keep the device in an airtight upon insertion of the treatment instrument, also the annular member distal end is adjacent to the outer periphery annexed, a medical treatment instrument insertion instrument, characterized by further comprising a carbon dioxide air supply port to a portion of the cylindrical sheet or connector.
【0007】 [0007]
【発明の実施の形態】 DETAILED DESCRIPTION OF THE INVENTION
以下、図面により本発明を具体的に説明する。 Hereinafter, the present invention will be described specifically with reference to the accompanying drawings. 図1は本発明の一実施例となる医療用処置具挿入具の外観図を示しており、図2は本発明の他の実施例となる医療用処置具挿入具の外観図を示しており、図3及び図4は医療用処置具挿入具を小切開口へ挿入して気密にした状態で処置具を挿入している状態を示す図である。 Figure 1 shows an external view of a medical treatment instrument insertion instrument which is an embodiment of the present invention, FIG. 2 shows an external view of a medical treatment instrument insertion instrument of still another example of the present invention 3 and 4 are views showing a state in which by inserting the medical treatment instrument insertion instrument into a small incision are inserted treatment instrument while airtight.
【0008】 [0008]
本発明による医療用処置具挿入具は、図1または図2のように近位端がY字型に2つまたは3つに分かれていて、近位端に各々の挿入口、遠位端に出口を持った柔軟な円筒状シート(1)の近位端に各々鉗子等を挿入するためのコネクター(2)が付設され、コネクター(2)は、鉗子等を挿入していない際に気密を保つために第1の気密部材(3)が配置されコネクター先端をキャップ等で閉じたり、コネクター(2)内部にフラップ弁やダックビル弁等の弁部材を付設しても良い。 The medical treatment tool insert according to the invention, the proximal end as shown in FIG. 1 or FIG. 2 is divided into two or three in a Y-shape, each of the insertion port at the proximal end, a distal end connector for each insert a forceps (2) is attached to the proximal end of the flexible cylindrical sheet having an outlet (1), the connector (2) is an airtight when not inserted the forceps the first closing in an airtight member (3) cap is connector tip is arranged such, the connector (2) may be attached to the valve member, such as a flap valve or a duckbill valve therein to keep. 更に、鉗子等を挿入している際に気密を保つために第2の気密部材(4)が配置され円形の穴の開いたシール弁等を付設しても良い。 Furthermore, second hermetic member (4) is arranged to keep the airtight when you have inserted the forceps or the like may be attached to seal valve like an open circular hole. また、遠位端側はその外周に隣接して変形可能な環状部材(5)を形成し、更に、円筒状シート(1)に接続された接続チューブ(6)又はコネクター(2)へ通ずる炭酸ガス送気口(7)又は(8)からなる。 Further, the distal end side adjacent its outer periphery to form a deformable annular member (5), leading further to the cylindrical connecting connection tube sheet (1) (6) or connector (2) carbonate consists gas inlet port (7) or (8).
【0009】 [0009]
円筒状シート(1)は肉厚0.1〜2mmの薄肉の円筒形状のシート部材であり、通常、インフレーション成形や、熱溶着等のシート加工等により作製されるが特に限定されない。 Cylindrical seat (1) is a sheet member thin cylindrical wall thickness 0.1 to 2 mm, usually, inflation molding and, although being manufactured by a sheet processing such as thermal welding or the like are not particularly limited. 円筒状シート(1)の大きさは処置を行う部位や目的によって異なるが、下肢の皮下手術用に使用される場合は約10cm×15〜20cmの大きさとなる。 The size of the cylindrical seat (1) varies depending on the site and purpose of the treatment, when used for lower extremity subcutaneous surgery a size of about 10 cm × 15 to 20cm. 近位端はY字型に2つまたは3つに分かれていて、内視鏡や鉗子を挿入して各々を操作する時、各々の動きが制限されないように全長の約50〜75%の長さが20〜60度の角度でY字型に分かれており、遠位端方向の残りの長さの部分が一体になっていることが好ましい。 The proximal end is divided into two or three in a Y-shape, when operating each by inserting the endoscope or forceps, about 50% to 75% of the total length such that each movement is not restricted length Saga divided into 20 to 60 degrees angle with Y-shaped, it is preferred that the remaining length of the portion of the distal end direction are integral. また、使用時、遠位端を切開口へ挿入・固定して炭酸ガスによる膨脹状態の中で円筒状シート(1)内を内視鏡や鉗子等の処置具が頻繁に出入りするために、邪魔にならないような、嵩張らず、柔軟で、更に、処置具等が当たっても切れたり割れたり裂けたりし難い材質を選ぶのが良く、例えば、軟質塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリエステル樹脂、シリコーンゴム、天然ゴム等の材質が好ましい。 Further, when used, to a cylindrical seat (1) in an endoscope or treatment instrument such as forceps to the distal end in the expanded state by the carbon dioxide inserted and fixed to the incision is frequently out, that they do not interfere, not bulky, flexible, furthermore, often choose a material that hardly torn cracked or broken even treatment tool or the like hits, for example, soft vinyl chloride resins, polyurethane resins, polyethylene resins, polypropylene resin, polyester resin, silicone rubber, the material of the natural rubber or the like.
【0010】 [0010]
コネクター(2)は通常射出成形により成形されて円筒状シート(1)の近位端に取り付けられ、第1の気密部材(3)及び第2の気密部材(4)が付設または内蔵されている。 Connector (2) it is molded by conventional injection molding attached to the proximal end of the cylindrical seat (1), the first hermetic member (3) and the second hermetic member (4) is attached or built . 皮下手術の場合、内視鏡と鉗子がほぼ並行に入るのでコネクター(2)の外径があまり太いとコネクター(2)同士が当たってしまい操作の妨げになる。 For subcutaneous surgery, the endoscope and hinders the outer diameter is too thick and connector (2) will operate between hits forceps because enters almost parallel connector (2). コネクター(2)の外径は挿入する機器の外径+15mm以下の外径に押さえることが好ましい。 Outer diameter is preferably suppressed to an outer diameter of less than the outer diameter + 15 mm of the device to be inserted in the connector (2). 更に、コネクター(2)は各気密部材が変形せずに取り付けられ、円筒状シート(1)に熱溶着や溶剤又は接着剤による接着ができる材料を選択すべきであり、塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポリカーボネート樹脂、ポリサルフォン樹脂等やや硬質の樹脂であれば良い。 Furthermore, the connector (2) Each airtight member is mounted without modification, should be chosen a material into a cylindrical sheet (1) can adhere by heat welding or solvent or adhesive, vinyl chloride resin, polyurethane resin , polyethylene resins, polypropylene resins, polyacetal resins, polycarbonate resins, may be a resin of slightly hard like polysulfone resin.
【0011】 [0011]
第1の気密部材(3)は鉗子等を挿入していない際に気密を保つために設置するものであり、コネクター先端をキャップ等で閉じたり、コネクター(2)内部にフラップタイプの弁やダックビルタイプの弁等の弁部材を付設しても良い。 First hermetic member (3) is intended to be installed in order to keep the airtightness in a non-inserted forceps, or close the connector tip cap or the like, the connector (2) flap type valves inside or duckbill it may be attached to the valve member, such as a type of valve. キャップ等で閉じる場合はコネクター(2)との凹凸で嵌合させたり、ネジによって固定しても良い。 If closed with a cap or the like or is fitted with irregularities of the connector (2) may be fixed by a screw. キャップは通常射出成形などで成形され、その材質はコネクター(2)と同等か、少し柔らかい方が良く、塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポリカーボネート樹脂、ポリサルフォン樹脂等の樹脂か又はシリコーンゴム、天然ゴム、NBR等の合成ゴムが使用される。 Cap is molded like ordinary injection molding, the material is equal to or a connector (2), it is better slightly softer, vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, such as polysulfone resin resin or silicone rubber, natural rubber, synthetic rubber such as NBR are used. フラップタイプの弁は通常、腹腔鏡外科手術などで使用されるトラカールに内蔵されているような硬質の成型品とバネ部材を組み合わしたものでも、シリコーンゴムのような弾性部材をフラップ形状に成形、加工して使用しても良い。 Flap type of valve is normally be those Kumiawashi the molding and the spring member of hard, such as is built into the trocar, such as those used in laparoscopic surgery, shaping the elastic member such as silicone rubber flap shape, processed and may also be used. フラップタイプの弁は体外側に開くことはなく、体内側にのみに動くので、処置具等が挿入されていない時は体内側の陽圧によりフラップが体外方向に押されて閉じる構造である。 The valve flap type, not be opened outside the body, since only move the body side, when the treatment tool or the like is not inserted is closed structure is pressed flap in the extracorporeal direction by positive pressure in the body side. フラップタイプの弁は射出成形や圧縮成形などで成形され、その材質は塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポリカーボネート樹脂、ポリサルフォン樹脂、シリコーンゴム等が使用される。 The valve flap type is molded by injection molding or compression molding, the material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, silicone rubber or the like is used. ダックビルタイプの弁も同様に射出成形や圧縮成形で成形され、主としてシリコーンゴム等の弾性材料で作製される。 Molded with the valve likewise injection molding or compression molding of the duckbill type, it is produced mainly by an elastic material such as silicone rubber.
【0012】 [0012]
第2の気密部材(4)は鉗子等を挿入している際に気密を保つために配置され、円形の穴の開いたシール弁等を付設しても良い。 Second hermetic member (4) is arranged to keep the airtight when you have inserted the forceps or the like may be additionally provided a sealing valve such that the open circular hole. シール弁は射出成形、圧縮成形、シート加工等により作製され、コネクター(2)に熱溶着または接着される。 Sealing valve is injection molding, compression molding, is produced by the sheet processing or the like, are heat welded or bonded to the connector (2). シール弁の厚さは0.1〜3mm程度が適当である。 The thickness of the sealing valve is suitably about 0.1 to 3 mm. これは、0.1mm未満では炭酸ガスの圧力により弁が変形され易くなり、3mmを超えると鉗子等の処置具を挿入する際の摩擦抵抗が大きくなり、挿入が困難となるためである。 This is less than 0.1mm tends are valve deformed by the pressure of the carbon dioxide, the frictional resistance increases at the time of inserting the treatment instrument such as forceps exceeds 3 mm, because the insertion is difficult. シール弁の内径は処置具等の外径に合わせ、0.5mm〜30mmが適当である。 The inner diameter of the sealing valve is matched to the outer diameter of such treatment instrument, 0.5Mm~30mm are suitable. シール弁の材質は、可とう性を有するものが望ましく例えば天然ゴム、シリコーンゴム、塩化ビニル樹脂、ウレタン樹脂、SEBS樹脂等が好適である。 The material of the sealing valve is desirably such as natural rubber having flexibility, silicone rubber, vinyl chloride resins, urethane resins, SEBS resin and the like.
【0013】 [0013]
環状部材(5)は円筒状シート(1)の遠位端側の外周に隣接して形成される。 The annular member (5) is formed adjacent to the outer periphery of the distal end side of the cylindrical seat (1). 通常、射出成形、圧縮成形または押出成形チューブの加工によって作製され、円筒状シート(1)に包まれ、密着して熱溶着又は接着固定される。 Usually, injection molding, are produced by the processing of compression molding or extrusion tube, is wrapped into a cylindrical seat (1) is heat-welded or adhesively fixed in close contact. 内外径は処置を行う部位や挿入箇所となる小切開口の大きさ及び、挿入する処置具の大きさによるため限定されないが、下肢の皮下内視鏡手術を行う場合、約2〜2.5cmの小切開に対して内径約3cm、外径約5cmに設定することが適当である。 Inner and outer diameter size of the small incision which is a part and the insertion portion to which treatment and include but are not limited for depending on the size of the treatment instrument to be inserted, when performing subcutaneous endoscopic surgery of the lower extremities, about 2~2.5cm an inner diameter of about 3cm to the small incision, it is appropriate to set the outer diameter of about 5 cm. 環状部材(5)の材質は塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、シリコーンゴム等が使用される。 The material of the annular member (5) is a vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, silicone rubber or the like is used.
【0014】 [0014]
炭酸ガス送気口(7)は円筒状シート(1)内部へ通して接続された接続チューブ(6)の末端に取り付けられるか、コネクター(2)に炭酸ガス送気口(8)として設置される。 Either attached to the end of the carbon dioxide gas inlet port (7) is cylindrical seat (1) connection is connected through to the inner tube (6) is installed in the connector (2) as a carbon dioxide gas inlet port (8) that. 接続チューブ(6)に取り付けられる場合、接続チューブ(6)は押出成形で作製され円筒状シート(1)に熱溶着あるいは接着で取り付けられる。 When attached to the connecting tube (6), connecting tube (6) is attached by heat welding or bonding a cylindrical seat is produced by extrusion molding (1). チューブが操作中にふらつかないように円筒状シート(1)の内壁及び外壁に長さ方向に部分的に接着させると良い。 Tube may partially adhere to the length direction of the inner and outer walls of the cylindrical seat (1) so were not unsteady during operation. 接続チューブ(6)の内外径は、通常、内径0.5〜2mm、外径1〜3mmの中で選択される。 Inner and outer diameters of the connecting tube (6) is usually selected internal diameter 0.5 to 2 mm, in outside diameter 1 to 3 mm. 材質は可とう性のある材料であれば良く、軟質塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、シリコーンゴム等が使用される。 The material may be any material that is flexible, soft vinyl chloride resins, polyurethane resins, polyethylene resins, polypropylene resins, polyacetal resins, silicone rubber or the like is used. 炭酸ガス送気口(7)及び(8)は射出成形で成形され、炭酸ガス送気口(7)の場合であれば接続チューブ(6)と溶剤や接着剤により接着され、炭酸ガス送気口(8)の場合であればコネクター(2)成形時に同時に成形される。 Carbon dioxide inlet port (7) and (8) is molded by injection molding, is bonded carbon dioxide inlet port and in the case of (7) connecting tube (6) by a solvent or adhesive, air carbon dioxide in the case of the mouth (8) it is simultaneously molded into the connector (2) during molding. 炭酸ガス送気口は配管から来たチューブと接続するために、嵌合可能な形状に成形されている。 Carbon dioxide insufflation port to connect with tubes coming from the pipe is molded into a shape to be fitted. 材質は塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポリカーボネート樹脂、ポリサルフォン樹脂、シリコーンゴム等が使用される。 The material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, silicone rubber or the like is used.
【0015】 [0015]
次に本発明による医療用処置具挿入具の実際の使用方法について、図3及び図4を用いて説明し、本発明の効果を明確にする。 Then the actual use of the medical treatment tool insert according to the present invention, described with reference to FIGS. 3 and 4, to clarify the effects of the present invention. 下肢の皮下内視鏡手術である内視鏡的筋膜下交通枝切離術を行う場合、約2cm程度の皮膚切開を行い、剥離用処置具を筋膜下等に挿入して内視鏡下に筋膜下を剥離していく。 When performing endoscopic fascia under rami separating procedure subcutaneous endoscopic surgery of the lower extremities, performs skin incision of about 2 cm, the endoscope peeling treatment instrument is inserted into fascia under such continue to peel under the fascia underneath. 剥離した筋膜下等に拡張用のバルーンを挿入し、筋膜下を更に拡張する。 Insert the balloon for expansion to peeled fascia under such further extend the subfascial. 皮膚切開口より筋膜下に本発明による医療用処置具挿入具の環状部材(5)の部分を挿入し、円筒状シート(1)を引張って皮下と環状部材(5)を良く密着させ固定する。 Insert the portion of the annular member (5) of the medical treatment tool insert according to the invention to the fascia below the skin incision, fixed well brought into close contact by pulling the cylindrical seat (1) subcutaneously and the annular member (5) to. 炭酸ガス送気口(7)又は(8)より炭酸ガスを送気すると第1の気密部材(3)により気密は保たれ、筋膜下空間は拡張され、本医療用処置具挿入具は炭酸ガスで満杯になり膨脹する。 Airtight by carbon dioxide inlet port (7) or (8) from the air the carbon dioxide gas when the first airtight member (3) is maintained, muscle subintimal space is expanded, the medical treatment tool insert carbonate the expansion will be filled with gas. コネクター(2)より第2の気密部材(4)を通して内視鏡を挿入すると良好な視野が認められ、もう一方より鉗子等を挿入し対象を処理していく。 Upon insertion of the endoscope through the connector (2) from the second airtight member (4) good viewing was observed, we continue to process the object by inserting forceps or the like than the other. 一方の鉗子等を前後左右に動かしても、円筒状シート(1)が柔軟でY字型に形成されているため、他方のに影響を与えず、動きを制限されたり、処置具同士がぶつかったりすることがない。 It is moved to one of the forceps or the like and fro, since the cylindrical seat (1) is formed in the flexible Y-shaped, without affecting the other of, or limited movement, bumped treatment instrument together It is not able to or. 本発明により、従来、内視鏡挿入用のポートを配置する他に鉗子等を挿入するためのポートを配置するための切開が必要であったものが、約2cmの1箇所の切開で済むことになる。 The present invention, conventionally, those incisions for placing the port for inserting forceps or the like in addition to arranging the port for the endoscope insertion was necessary, it suffices incision at one location approximately 2cm become. また、皮下に挿入される部分が環状部材(5)のみであるため創部直下が死角にならず、円筒状シート(1)により創縁も保護される。 Further, the portion to be inserted subcutaneously not become wound right under dead angle because only the annular member (5), wound edge is protected by a cylindrical seat (1).
【0016】 [0016]
【発明の効果】 【Effect of the invention】
本発明の医療用処置具挿入具により、皮下のような狭い処置空間で1箇所の切開部より内視鏡や鉗子などの処置具を同時に挿入できる。 The medical treatment tool insert of the present invention, can simultaneously insert a treatment instrument such as an endoscope or forceps from the incision at one location a narrow treating space such as subcutaneous. さらに着脱が簡単で十分な気密性を持ち、鉗子同士のFightingや移動障害を起こしにくく、創部直下が死角にならずに安全な処置が可能となる。 Further detachable is has a simple enough airtightness, it causes less Fighting and movement disorders among forceps, wound directly below it is possible to secure treatment without becoming blind spots. 又、創縁がシートにより保護され、更には患者に使用するポートの数が少なくなるため患者の手術による傷の数も減り美容面で有用であり、そのために患者の早期社会復帰、医療費の削減効果が期待できる。 In addition, the wound edge is protected by a sheet, and further is useful in cosmetic surface reduces the number of scratches caused by surgery of the patient to become less number of ports to be used for the patient, the patient for the early rehabilitation, medical expenses reduction effect can be expected.
【図面の簡単な説明】 BRIEF DESCRIPTION OF THE DRAWINGS
【図1】本発明の一実施例となる医療用処置具挿入具の構造の外観を示す図である。 1 is a diagram showing an external structure of a medical treatment instrument insertion instrument which is an embodiment of the present invention.
【図2】本発明の他の実施例となる医療用処置具挿入具の構造の外観を示す図である。 Figure 2 is a view showing an appearance of another the embodiment of the medical treatment instrument insertion instrument structure of the present invention.
【図3】本発明の一実施例となる医療用処置具挿入具の使用方法の一例を示す概略図である。 Figure 3 is a schematic view showing an example of a method for using the medical treatment instrument insertion instrument which is an embodiment of the present invention.
【図4】本発明の一実施例となる医療用処置具挿入具の使用方法の一例の断面図である。 4 is a cross-sectional view of one example of a method for using the medical treatment instrument insertion instrument which is an embodiment of the present invention.
【符号の説明】 DESCRIPTION OF SYMBOLS
1. 1. 円筒状シート2. Cylindrical sheet 2. コネクター3. Connector 3. 第1の気密部材4. First hermetic member 4. 第2の気密部材5. Second hermetic member 5. 環状部材6. The annular member 6. 接続チューブ7. Connection tube 7. 炭酸ガス送気口8. Carbon dioxide gas inlet port 8. 炭酸ガス送気口9. Carbon dioxide gas inlet port 9. 皮膚10. Skin 10. 切開口11. Incision 11. 内視鏡12. Endoscope 12. 鉗子 forceps

Claims (1)

  1. Y字型に分かれた空間を持ち、そのうち近位端側の全長の50〜75%の長さが20〜60度の角度でY字型に2つまたは3つに分かれており、近位端には挿入口を持ち、遠位端に出口を持った柔軟な円筒状シートであり、その近位端側の各々の挿入口にあたるコネクターには処置具を挿入していない時に装置内を気密に保つ第1の気密部材と、処置具を挿入した時に装置内を気密に保つ第2の気密部材を付設し、また、遠位端側はその外周に隣接して環状部材を付設し、更に円筒状シートまたはコネクターの一部分に炭酸ガス送気口を有することを特徴とする医療用処置具挿入具。 Has a space which is divided into Y-shape, and 50% to 75% of the total length of the proximal end side divided into two or three in a Y-shape at an angle of 20 to 60 degrees of which a proximal end It has an insertion opening into a flexible cylindrical sheet having an outlet at the distal end, in an air-tight the inside of the apparatus when not inserting a treatment tool to the connector corresponding to each of the insertion opening of the proximal end side keeping a first hermetic member, and attaching a second hermetic member to keep the device in an airtight upon insertion of the treatment instrument, also the distal end is attached an annular member adjacent its outer periphery, further cylindrical the medical treatment tool insert characterized by having a carbon dioxide gas inlet port to a portion of Jo sheet or connector.
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