JP4396070B2 - Treatment device for varicose vein removal - Google Patents

Description

[0001]
【Technical field】
The present invention relates to a treatment tool for removing varicose veins, which is inserted into a vein to remove a vein at a site where the varicose vein is formed.
[0002]
[Prior art]
Regarding the varicose treatment method and the treatment instrument for removing the blood vessel at the site where the varicose vein is formed, the following may be mentioned.
(1) A sclerosing agent is injected into a varicose vein to cause inflammation in the wall of the varicose vein and block the blood vessel lumen by thrombus formation, intimal adhesion, or the like.
(2) Venous removal (stripping) method A stripper is inserted into a superficial vein with varicose veins by partial skin incision, and is pulled out to the distal side with a bullet-type head attached to the central end. This is a method of removing a vein at a predetermined site.
(3) Inversion method A method in which a vein stump is ligated to the tip of a wire inserted into a vein lumen, and the vein is inverted from this ligation site to be removed and collected. If the vein is torn, the other vein stump is newly ligated and then inverted and removed from the opposite direction.
[0003]
Problems of the above-mentioned prior art (1) The sclerotherapy of the above (1) is easy to perform, but it takes a long time to block and the effect is uncertain. In addition, recurrence may occur due to recanalization (opening).
(2) Although the stripping method of (2) has few incision sites and the operation itself is simple, invasion of tissues surrounding the vein is unavoidable, accompanied by bleeding / pain, and nerves that run parallel to the vein Complications such as damage occur.
(3) The inversion method of (3) is less damaging to the tissue surrounding the veins, but ties the wire ends, and therefore requires a non-slip or fixing thread, which is somewhat troublesome. In addition, the re-operation in the case where vein rupture occurs during extraction becomes further complicated.
[0004]
[Problems to be solved by the invention]
The inventors of the present invention have previously proposed a wire for removing varicose veins capable of performing inversion stripping from the periphery (Japanese Patent Application No. 2001-93224). It is an object of the present invention to provide a treatment tool for removing varicose veins, particularly a treatment tool for removing varicose veins of the small saphenous vein (SSV). That is,
(1) The operation is simple, and the veins with varicose veins can be removed reliably.
(2) Can be performed with less damage or complications around the blood vessels,
(3) Even if a vein rupture occurs, it is easy to deal with removing the remaining vein.
An object of the present invention is to provide a device for treating varicose veins having such excellent characteristics.
[0005]
[Means for Solving the Problems]
The inventor
(1) It is composed of at least a metal wire and a metal rod bonded to the wire, and the metal rod is inserted into a living tissue at a tip side portion of the metal rod opposite to the connection portion with the metal wire. A curve with rigidity that facilitates protrusion from the tissue and movement in the living tissue, and can substantially maintain its shape when inserted into the living tissue, protruding from the living tissue, and moving in the living tissue A varicose vein removal treatment device having a shape and a venous ligation portion formed by a step structure in a wire portion in the vicinity of the joint portion between the metal stranded wire and the metal rod, and (2) It is composed of at least a metal wire and a metal rod bonded to the wire, and the metal rod facilitates insertion of the metal rod into the living tissue, protrusion from the living tissue, and movement within the living tissue. In addition, the metal stranded wire is capable of manually forming a curved shape having characteristics capable of substantially maintaining its shape when inserted into a living tissue, protruded from the living tissue, and moved. Solving the above-mentioned problem by providing a treatment tool for removing varicose veins (Claim 2) having a venous ligation part formed by a step structure in a wire part in the vicinity of the joint part between the metal rod and the metal rod I was able to.
[0006]
Embodiments of the present invention will be specifically described below with reference to the drawings.
Embodiment
The components of the treatment tool for removing varicose veins of the present invention will be described.
The bending portion 1 on the tip side of the metal rod functions to facilitate insertion of the metal rod into the living tissue, protrusion outside the living tissue, and movement within the living tissue, and living tissue. When inserted into the body, protrudes outside the living tissue, and moves inside the living tissue, it has rigidity capable of substantially maintaining its shape.
The distal end of the metal rod of the treatment tool for removing varicose veins of the present invention is inserted into the vein 2 from the vein central side a scheduled to be removed, moved in the vein 2 and reached the incision b (A in FIG. 1). Since the tip of the metal rod that has reached the incision b is protruded from the incision (B to C in FIG. 1), the bending degree of the bending portion 1 is also determined by the depth from the skin surface where the vein exists in the incision b. It is preferable to determine in consideration.
[0007]
The length of the metal rod needs to exceed the length of the vein to be extracted using the treatment tool for removing varicose veins of the present invention, but the length of the vein to be extracted is usually about 30 cm at the maximum. Therefore, about 25 cm to 35 cm is sufficient.
The diameter of the metal rod is not particularly limited as long as it has a function and rigidity that can be imparted to the bending portion 1 according to the material constituting the metal rod.
The material constituting the metal rod is not particularly limited as long as it can form a curved portion having the above functions and rigidity, but a copper material is particularly preferable.
When a metal such as copper is used as the metal rod, it is preferable to carry out a plating treatment such as silver plating for the purpose of preventing corrosion of the metal or preventing rusting. In addition, a special configuration may be provided for the metal rod so that the bent portion can be easily formed on the metal rod by hand (Claim 4). It is mentioned that the diameter of is smaller than the diameter of the other part (claim 5).
[0008]
Metal Wire The metal wire is preferably flexible so that it can be easily deformed in accordance with the shape of a living tissue, particularly a living tissue from which a vein has been removed (Claim 7). For this purpose, the metal wire used in the present invention is preferably formed by twisting a bundle of a plurality of single wires (claim 6).
Examples of the material constituting the metal wire include steel and stainless steel.
Moreover, the outer diameter of the metal wire preferably has an outer diameter in the range of about 0.5 to 1.5 mm. If the outer diameter of the wire is less than 0.5 mm, it is difficult to obtain even a twisted wire that can be easily deformed in accordance with the shape of a torsional living tissue, particularly a living tissue from which a vein has been removed. On the other hand, if the thickness exceeds 1.5 mm, it is too thick to be inserted into the living tissue lumen, particularly the vein from which the vein has been removed.
[0009]
Since the length of the metal wire is preferably about 20 cm longer than the metal rod, it is about 45 cm to 55 cm.
If the length of the metal wire exceeds the range, the operation becomes difficult. On the other hand, if the length is shorter than the above range, the inverted vein piece cannot be taken out from the affected area or is difficult to take out.
That is, the treatment device for removing varicose veins of the present invention is capable of internal extraction of veins from both the central side and the peripheral side of the vein, but all the veins at a predetermined site are both in the central side and the peripheral side. In order to enable inversion and extraction from the vein, if the length is shorter than the above range, the inverted vein piece cannot be taken out from both the central side and the distal side of the vein, or is difficult to take out.
In addition, the internal retraction of the vein from both the central side and the peripheral side of the vein means that after the high-level ligation of the vein, particularly the small saphenous vein, the varicose vein removal wire is directed toward the periphery of the vein. Reverse to the surgical technique of inserting into the vein and ligating its central end to the venous ligation section 6 and then pulling the wire toward the periphery of the vein and removing the vein while turning the central end inward. Further, it refers to both surgical procedures in which the distal end of the vein is ligated to the venous ligation section 6 and then the wire is pulled toward the central end of the vein and the vein is removed while turning the central end inward.
Therefore, considering the lengths of the metal rod and the metal wire, the entire length of the treatment tool for removing varicose veins of the present invention is about 70 to 90 cm.
In addition, the length of the above-mentioned metal rod is the length of the metal rod before forming a bending part.
[0010]
The metal wire constituting the treatment device for removing varicose veins of the present invention is preferably a metal stranded wire as described above, but if the surface of the wire is not smooth, the insertion into the vein lumen is only poor. In addition, venous contraction (spasm) occurs at the time of wire insertion, and wire insertion becomes very difficult. Therefore, it is preferable to smooth the surface of the wire. The whole is preferably covered with a synthetic resin layer (claim 8).
The synthetic resin to be used is not particularly limited as long as it can form a smooth layer that can prevent the occurrence of venous contraction (spasm), for safety such as low elution, and because it is easy to manufacture. Examples thereof include polyamide resins.
Further, it is preferable that a connection portion 8 to which a bell-shaped head 11 described later is attached is provided at the end of the metal wire 7 opposite to the metal rod inserted into the vein (Claim 9, FIG. 1). A).
[0011]
Moreover, in the treatment tool for removing varicose veins of the present invention, a conduit or the like capable of injecting a drug solution or the like into a living tissue can be used instead of the metal wire or connected to the metal wire. (Claim 10).
For example, before the vein is turned inside out, a tube (not shown) for injecting a chemical solution, for example, a hemostatic drug solution (a hemostatic agent-added saline) is connected to the wire end opposite to the metal rod inserted into the vein. This tube connection method is useful even when the vein is removed to the distal end of the vein by the first removal, or when the vein is torn to the central side of the vein when the vein is torn by the first removal. is there.
[0012]
That is, as shown in FIG. 1, the treatment tool for removing varicose veins of the present invention pulls a metal rod to the distal side and moves it to the distal side in order to invert and remove the vein. It is necessary to penetrate the side vein and to expose the metal rod from the peripheral vein from the skin incision wound (C in FIG. 1), and to completely remove the inverted vein from the peripheral vein side. In this case, it is necessary to move the vein ligation part 6 further to the distal side rather than the position where the vein ligation part 6 is exposed from the distal side (F in FIG. 1). For this purpose, it is conceivable to increase the length of the metal rod and / or the wire, particularly the length of the wire, thereby increasing the total length of the treatment device for removing varicose veins. However, if such a means for increasing the overall length of the varicose vein removal treatment tool is adopted, the usability of the varicose vein removal treatment tool becomes very poor. By connecting and using, the said problem can be solved.
The chemical solution injection tube has a plurality of small holes for injection of chemical solution (preferably opposite side walls) arranged at intervals on the side wall, and one end of the tube is filled with hemostatic agent-added saline or the like as described above. It is preferable that a syringe for injecting the chemical solution can be attached.
[0013]
In order to invert the venous ligation vein, a ligation site is required to fix the vein and the varicose vein removal treatment tool as described above. This ligation site is not the end of the treatment tool for removing varicose veins of the present invention, but is formed in the vicinity of the joint between the wire and the metal rod. Easily remove the remaining veins. Also, by providing a venous ligation part near the joint between the wire and the metal rod, it is easy to invert, and even if the vein ruptures in the middle, the inversion of the vein from the opposite direction can be performed quickly, and in both directions Even if it fails to extract from the inside, it can be changed to the Babcock method as described below, and the remaining veins can be recovered immediately.
[0014]
Examples of the vein ligation portion 6 include a step structure formed by the wire 7 and the two protrusions 4 and 5 in the vicinity of the joint portion of the wire 7 and the metal rod 2 as shown in FIG.
The two protrusions 4 and 5 are provided in the vicinity of the joint between the wire 7 and the metal rod 2 with an interval of about 10 to 15 mm. The thread that is concavo-convex and ligates the vein to the vein ligation portion 7 can be held by the step.
The surface of the two protrusions constituting the vein ligation part 6 is preferably covered with a synthetic resin layer, but if the surface of the protrusion itself is sufficiently smooth, it is covered with the synthetic resin layer. It is not necessary.
Usually, a suture is used to ligate the vein to the vein ligation portion 6, and this suture is coupled to the bell-shaped head 11 and the remaining vein is collected by a conventionally known Babcock method. Can also be used.
[0015]
The treatment device for removing varicose veins of the present invention can be used for inversion of veins in both the distal and central directions of the vein as described above, but when the vein is torn by this inversion, or When the vein is torn by the first inversion method, the bell-type head 11 may be attached to the wire 7 so that the remaining vein can be collected by a conventionally known Babcock method (C in FIG. 2).
The bell type head has a bullet shape with a streamlined tip side and a vertical surface on the base end side, and for example, a head having a diameter of about 9 to 12 mm is used. The bullet head is preferably made of metal and has a smooth surface, but may be made of plastic.
[0016]
Further, a small ring (small ring) through which the thread can be passed on the proximal end side of the bullet head 11, a means that can be attached to the wire 7 on the distal end side, for example, a hole is formed in the central portion on the distal end side, Examples include a thread formed in the lumen so as to be screwable with a wire tip. The small ring is connected to a linear object 10 such as a suture for collecting (pulling) the bell-type head 14 from the proximal incision. For example, a suture thread or the like can be used as the linear object 10 on the peripheral side.
As described above, by connecting the linear object 10 to the small ring (small ring) portion of the bell-shaped head 11, the entire length of the wire 7 can be easily used in use, and the vein is bell-shaped. The head 11 can be moved to remove the remaining vein piece, and the bell-shaped head 11 can be taken out from the central side of the vein having a larger opening than the peripheral side. As a result, there is little damage to the living tissue near the collection-side incision. In addition, the pain given to the patient can be reduced.
[0017]
【Example】
Hereinafter, the present invention will be described more specifically based on examples.
Example 1 (FIGS. 1 and 2)
Inversion-type stripping method for SSV This example is an example for explaining how to use the treatment tool for removing varicose veins of the present invention.
The small saphenous vein 2 is exposed by skin incision in the patient's popliteal region, and all the branches are ligated, and then the small saphenous vein 2 is ligated and disconnected. Next, the leading end of the copper rod of the treatment device for vein removal of the present invention is inserted from the central end a of the small saphenous vein 2 toward the periphery and advanced toward the distal side of the vein (A in FIG. 1). Therefore, while touching the tip of the copper rod, the skin is pushed up at the lowermost end of the main trunk that has been marked in advance, and a small incision b (2 to 3 mm) is added to the site (B in FIG. 1). The small incision b is penetrated and pushed out from the skin (C in FIG. 1). When the central end of the vein is ligated at the venous ligation section 6 (D in FIG. 1) and pulled to the non-treetop side, the vein 2 is naturally inverted (E in FIG. 1) and can be smoothly removed from the peripheral incision b. (F in FIG. 1).
[0018]
If the vein is torn, pull the copper rod to the periphery as it is to remove the torn vein from the incision (Fig. 2a), and then connect the bell-shaped head (extraction head) 11 with a maximum diameter of 9 mm to the proximal end of the wire 7 The remaining vein can be collected by the Babcock method (C in FIG. 2). At that time, since a large-sized head is used as the head of the bell-type head 11, the remaining vein can be removed by forming a nodule in the head portion, and the bell-type head 11 has a ring-shaped protruding portion. Since the bell-shaped head 11 is recovered from the central incision (usually 15 to 20 mm) with the ligated pull-back thread 10, there is an advantage that it is not necessary to expand the incision b (usually 3 to 5 mm). By collecting from the central incision, there is an advantage that it is not necessary to enlarge the peripheral incision.
[0019]
Example 2
This example is an example for explaining the configuration of the treatment device for removing varicose veins of the present invention.
In order to make it easy to manually form the curved portion 1 as described above, the metal rod 3 is gradually reduced in outer diameter toward the tip portion on the side opposite to the coupling portion with the wire 7, The portion 12 where the curved portion is manually formed becomes a minimum diameter portion of the metal rod, and is configured to have a shape in which the diameter gradually increases from the minimum diameter portion toward the tip portion. The maximum diameter portion of the metal rod is about 2.30 ± 0.5 mm, and the minimum diameter portion is about 1.57 ± 0.5 mm.
In addition, the shape of the top portion of the metal rod is that the biological tissue is inserted into a living tissue such as a vein, moved in the living tissue after insertion, for example, moved to the distal side of the vein, and protruded from the incision of the living tissue. A rounded shape is preferable so as not to puncture.
[0020]
The vein ligation part 6 is equipped with a pair of stainless steel caulking tools at positions where the wire 7 and the metal rod 3 are joined to each other and at a distance of 10 to 15 mm from the joint toward the tip of the wire. Two protrusions 4 and 5 having a thickness of 15 mm are formed, and a step structure is formed by a wire between the protrusions 4 and 5.
[0021]
【effect】
(1) The inversion method using the treatment tool for removing varicose veins according to the present invention is easy to operate, and even if it tears, the remaining veins can be reliably recovered by the Babcock method.
(2) According to the operation using the treatment tool for removing varicose veins of the present invention, recurrence or the like does not occur and the curability is high.
(3) According to the operation using the treatment tool for removing varicose veins of the present invention, the treatment is simple and the invasion is small. For this reason, long-term hospitalization is not necessary.
(4) According to the operation using the treatment tool for removing varicose veins of the present invention, even if trouble such as rupture of the vein occurs, it can be dealt with by a simple operation.
[Brief description of the drawings]
FIGS. 1A to 1F are diagrams illustrating a surgical procedure for removing varicose veins using the treatment tool for removing varicose veins of the present invention.
FIG. 2 is a diagram illustrating a surgical technique for removing varicose veins when a vein is torn when the surgical technique of FIG. 1 is performed.
(A) It is a figure which shows the state to which the vein was torn when the operation technique of FIG. 1 was implemented.
(B) It is a figure which shows the state which mounted | wore the twisted wire 7 base part with the bell-type head 11 to the treatment tool for varicose vein removal of invention.
(C) It is the figure explaining operation which attaches the bell-type head 11 to the strand wire 7 in the treatment tool for varicose vein removal of this invention, and directs a venous lumen from the center to the periphery.
FIG. 3 is a schematic diagram illustrating a configuration of a copper rod, a joint between the copper rod and a wire, and a vein ligation portion 6 of the treatment tool for removing varicose veins of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Curved part 2 Vein 3 Metal rod 4 Protrusion part 5 Protrusion part 6 Vein ligation part 7 Strand wire 8 Bell-type head joining member 9 Filamentous material (suture thread)
10 Thread (Suture)
11 BELL TYPE HEAD 12 Site where curved portion is manually formed a Vein central end b Incision

Claims (10)

It is composed of at least a metal wire and a metal rod bonded to the wire, and the metal rod is inserted into the living tissue at the tip side portion of the metal rod opposite to the connecting portion with the metal wire. It has a curved shape with rigidity that makes it easy to protrude and move in the living tissue, and can substantially maintain its shape when inserted into the living tissue, protruding from the living tissue and moved in the living tissue. And a venous ligation removal treatment tool having a venous ligation portion formed by a step structure in a wire portion in the vicinity of the joint portion between the metal stranded wire and the metal rod. The metal rod is composed of a metal wire and a metal rod coupled to the wire, and the metal rod facilitates insertion of the metal rod into the living tissue, protrusion from the living tissue, and movement within the living tissue, and living tissue. It is possible to manually form a curved shape having rigidity capable of substantially maintaining its shape when inserted into, protruded from within the living tissue, and moved within the living tissue, and the metal stranded wire A treatment tool for removing varicose veins, comprising a vein ligation portion formed by a step structure in a wire portion in the vicinity of a joint portion between a wire and a metal rod. The treatment tool for removing varicose veins according to claim 1 or 2, wherein the metal bar is a copper bar and the copper bar is subjected to metal plating. The treatment tool for removing varicose veins according to claim 3, wherein the metal rod has a structure that makes it easy to manually form a curved shape. The treatment tool for removing varicose veins according to claim 4, wherein the diameter of the metal rod in the portion where the curved shape is manually formed is smaller than the diameter of the other portion. The varicose vein removal treatment device according to any one of claims 1 to 5, wherein the metal wire is a metal stranded wire. The treatment tool for removing varicose veins according to any one of claims 1 to 6, which has flexibility that can be easily deformed in accordance with the shape of a living tissue to which a metal wire is moved. The treatment tool for removing varicose veins according to any one of claims 1 to 7, wherein a metal wire surface is coated with a synthetic resin. The treatment tool for removing varicose veins according to any one of claims 1 to 8, wherein a bell-type head can be connected to the other end of the metal wire that is not coupled to the metal rod. The varicose vein removal treatment device according to any one of claims 1 to 9, wherein a drug solution injection conduit is connected to the other end of the metal wire that is not connected to the metal rod.

Images