JP4500283B2 - Biological suture tool - Google Patents

Description

  The present invention relates to a living body suturing tool for suturing a body to be sutured.

  2. Description of the Related Art Conventionally, a living body suture tool for fixing a sutured portion in a patient's body, for example, an abdominal wall and a visceral wall, has been used.

  For example, for people whose function of taking food from their mouth by their own age or illness is reduced, fluid food and drink such as liquid food and nutrients are supplied using a gastrostomy tube. . The gastrostomy tube is usually attached using an endoscope, forming a hole in the abdomen of the patient (gastrostomy using an endoscope). In order to appropriately attach such a gastrostoma-forming tube, the abdominal wall and the stomach wall are fixed in advance using a biological suture tool.

  A living body suturing device (medical device) described in Patent Document 1 includes two hollow puncture needles (a puncture needle for inserting a suture thread and a puncture needle for grasping a suture thread) that are installed in parallel at a distance from each other. And both puncture needles are fixed by a fixing member at the proximal end. Further, by providing a flat plate-like member through which two puncture needles slidably penetrate on the distal end side with respect to the fixing member, the interval between the puncture needles is prevented from shifting during puncture.

  Patent Document 2 discloses a living body suturing tool configured to insert a hollow fixed puncture needle for inserting a suture and a movable puncture needle having a sharp tip into a hollow outer cylinder having a sharp tip. Is described. In this biological suturing tool, the fixed puncture needle and the outer cylinder are held by a holder, and the holder is configured so that the holding position can be adjusted in the axial direction.

Japanese Examined Patent Publication No. 6-24533 Japanese Patent No. 3331215

  By the way, in the above-described conventional configuration, the protruding length of the two puncture needles can be adjusted by a flat plate member or a holder, but there is a mechanism for fixing (locking) the flat plate member or the holder at a predetermined position. Not done.

  Therefore, when puncturing the living body, for example, if the operator (operator) has insufficient force to grip the flat plate member or the holder, the flat plate member or the holder moves backward in the direction opposite to the puncture direction due to contact with the skin. The puncture needle may be inserted to an excessive depth. That is, it has been difficult to reliably set the puncture depth of the puncture needle.

  SUMMARY OF THE INVENTION The present invention has been made in consideration of the conventional problems, and is a suture for living body that can control the protruding length of the puncture needle at the time of puncturing the living body and prevent the puncture needle from being inserted to an excessive depth. The purpose is to provide ingredients.

  The living body suturing device of the present invention has a suture thread insertion tubular body for inserting a suture thread into a living body, and an annular member formed of an elastic material at the tip, and the suture inserted into the living body by the annular member. A traction tool for gripping a thread, a suture grasping tubular body for inserting the traction tool into a living body, and a fixing for fixing the suture insertion tubular body and the suture grasping tubular body at a predetermined distance apart. A living body suturing instrument comprising: a member; and a flat plate member provided on a distal end side of the fixing member and through which the suture thread insertion tubular body and the suture grasping tubular body slidably pass. And a protruding length adjusting mechanism for changing a protruding length of the suture thread insertion tubular body and the suture grasping tubular body protruding from the flat plate member by moving the flat plate member to a predetermined position. And

  According to such a structure, the length which the front-end | tip of the tubular body for suture insertion and the tubular body for suture grasping protrudes from a flat member can be changed into predetermined length. For this reason, the insertion depth of the tubular body for inserting suture and the tubular body for grasping suture can be adjusted to a predetermined value, and the puncture portion can be prevented from being inserted to an excessive depth.

  Further, the protrusion length adjusting mechanism moves the flat plate member to a predetermined position to adjust a distance between the fixing member and the flat plate member, and the predetermined changed by the support unit If the fixing means for fixing the flat plate member at the position is provided, the changed protrusion length can be fixed, so that the puncture portion can be more easily and reliably prevented from being inserted to an excessive depth.

  Further, the support means is a rod-like member having one end supported by the flat plate-like member and penetrating through the fixing member so as to move forward and backward, and the fixing means is installed on the fixing member, and the rod-like member is fixed to the predetermined member. If the protrusion length is adjusted by changing the position of the rod-shaped member fixed by the engagement member, the protrusion length can be easily adjusted. Furthermore, the rod-shaped member may have an engaging portion with which the engaging member engages, and the engaging portion may be constituted by a plurality of annular grooves.

  Further, the support means is a rod-like member having one end rotatably supported by the flat plate-like member, penetrating the fixing member so as to be movable forward and backward, and having a threaded portion. Provided is a hole portion into which the screw portion is screwed, and the protrusion length is adjusted by changing the position of the screw portion screwed into the hole portion by rotating the rod-shaped member; The protrusion length can be easily adjusted simply by rotating the rod-shaped member having the threaded portion.

  Further, the support means is supported at one end by the flat plate-like member, penetrates the fixing member so as to be movable forward and backward, and has two legs having a plurality of grooves, and a head connecting the two legs. The fixing means is two holes provided in the fixing member and engaged with the groove, and the two legs are bent in a direction approaching or separating from each other. When the protrusion length is adjusted by releasing the engagement state between the groove and the hole and changing the position where the leg is fixed to the hole, The protrusion length can be easily adjusted by simply holding the arch member with the fingertip.

  According to the present invention, it is possible to change and fix the protruding length of the suture thread insertion tubular body and the suture thread gripping tubular body. The length can be set and fixed. For this reason, it is possible to prevent the puncture needle from being inserted into the living body to an excessive depth, and it is possible to perform proper suturing by a safe and simple operation.

  Hereinafter, embodiments of the biological suturing device according to the present invention will be described in detail with reference to the accompanying drawings.

  FIG. 1 is a partially cutaway perspective view for explaining a living body suturing device 10 according to a first embodiment of the present invention. The living body suturing device 10 is a suturing device for suturing an anterior abdominal wall 12 and an anterior stomach wall 14 using sutures 16 as an example of an abdominal wall and a visceral wall.

  The living body suturing device 10 includes a suture insertion tubular body 18 for inserting the suture thread 16 into a living body (in the stomach), and an annular member 44 formed of an elastic material at the tip. A traction tool 32 for gripping the suture 16 inserted into the body, a suture gripping tubular body 20 for inserting the traction tool 32 into the living body, the suture insertion tubular body 18 and the suture gripping tubular body. And a fixing member 22 for fixing the body 20 at a predetermined distance. The living body suturing device 10 is provided on the distal end side (lower side in FIG. 1) with respect to the fixing member 22, and a flat plate through which the suture insertion tubular body 18 and the suture grasping tubular body 20 are slidably inserted. A shaped member 24 is provided.

  In the biological suturing device 10, the protruding lengths of the suture insertion tubular body 18 and the suture grasping tubular body 20 protruding from the flat member 24 are set by moving the flat member 24 to a predetermined position. A protrusion length adjusting mechanism to be changed is provided.

  The living body suture tool 10 is provided between the suture insertion tubular body 18 and the suture grasping tubular body 20 substantially in parallel with each other, and one end is fixed (supported) to the flat plate member 24. It includes a support rod 27 (support means, rod-shaped member) penetrating through a hole 22a provided in the fixing member 22 (see FIGS. 1 and 3B). The support rod 27 has an engaging portion 25 in which a plurality of annular grooves 23 are formed at equal intervals along the axial direction on the peripheral wall thereof. The biological suturing device 10 further includes an engaging member 29 (fixing means) that can engage with the annular groove 23 of the support rod 27.

  The suture thread insertion tubular body 18 is a hollow cylindrical body into which the suture thread 16 can be inserted, and has a puncture portion 18a having a sharp shape that can be inserted into a living body at the tip. The size of the suture thread insertion tubular body 18 is not particularly limited as long as the suture thread 16 can be inserted therein, but the outer diameter is about 0.6 mm (23 G) to 1.27 mm (18 G). In particular, about 0.81 mm (21 G) to 1.07 mm (19 G) is preferable. The length is preferably about 60 mm to 120 mm, particularly about 80 to 100 mm.

  Further, a cylindrical hub 28 having a stepped hole and a reduced diameter on the front end side (lower side) is connected to the rear end of the suture thread insertion tubular body 18. The rear end (open end) of the hub 28 forms an insertion port for the suture 16.

  On the other hand, the suture grasping tubular body 20 is a hollow cylindrical body into which the traction tool 32 or the suture thread 16 can be inserted. Like the suture insertion tubular body 18, the distal end can be pierced with a living body. It has a puncture portion 20a having a sharp shape. The size of the suture thread holding tubular body 20 is not particularly limited as long as the traction tool 32 can be inserted therein, but the outer diameter is approximately 0.6 mm (23 G) to 1.27 mm (18 G). In particular, about 0.81 mm (21 G) to 1.07 mm (19 G) is preferable. The length is preferably about 60 mm to 120 mm, particularly about 80 to 100 mm. The suture grasping tubular body 20 may have the same or similar shape as the suture insertion tubular body 18.

  Further, similarly to the hub 28, a cylindrical hub 36 having a stepped hole and a reduced diameter on the front end side (lower side) is connected to the rear end of the suture grasping tubular body 20. The rear end (open end) of the hub 36 forms an insertion port for the traction tool 32 and is configured to be engageable with the traction tool hub 40 (see FIG. 2) of the traction tool 32, which will be described in detail later.

  The suture insertion tubular body 18 and the suture grasping tubular body 20 are made of, for example, a metal material such as stainless steel in order to easily and reliably puncture a living body with the puncture portions 18a and 20a provided at the distal ends. Composed.

  The hubs 28 and 36 are made of, for example, polyolefins such as polypropylene and polyethylene, synthetic resins such as vinyl chloride resin and polycarbonate.

  As shown in FIG. 2, the traction tool 32 includes a rod-shaped member 42 having an outer diameter smaller than the inner diameter of the suture-gripping tubular body 20, an annular member 44 fixed to the tip of the rod-shaped member 42, and the rod-shaped member 42. It is comprised from the traction tool hub 40 fixed to a rear end. The rod-like member 42 and the annular member 44 are slidable within the suture grasping tubular body 20. That is, the traction tool 32 is detachable and slidable to the suture grasping tubular body 20.

  When the annular member 44 is made of an elastic material and protrudes from the distal end of the suture grasping tubular body 20, the annular member 44 is expanded in an annular shape (ring shape) as shown in FIG. 1. On the other hand, in a state where it is not projected, it is substantially straight and is accommodated in the suture grasping tubular body 20 (see FIG. 7). The traction tool 32 is not necessarily limited as long as the annular member 44 can be accommodated in the suture grasping tubular body 20 and can slide so as to protrude from the distal end of the suture grasping tubular body 20. It is not necessary that the tubular body 20 for grasping a suture can be removed.

  As shown in FIG. 1, in the state where the annular member 44 of the traction tool 32 protrudes from the suture grasping tubular body 20, the central axis of the suture insertion tubular body 18 or an extension thereof is the annular member 44. It is formed so as to be able to extend in the direction of the suture insertion tubular body 18 so as to penetrate the inside (the inside of the annular member 44 expanded in a ring shape).

  Examples of the material of the annular member 44 include a stainless steel wire (preferably high-strength stainless steel for spring), a piano wire (preferably a piano wire plated with nickel or chrome), or a superelastic alloy wire. For example, a Ti—Ni alloy, a Cu—Zn alloy, a Cu—Zn—X alloy (X = Be, Si, Sn, Al, Ga), a Ni—Al alloy, or the like can be preferably used.

  On the other hand, as the material of the rod-shaped member 42, a metal material (for example, stainless steel or amorphous), a resin material (for example, a polyolefin such as polypropylene or polyethylene, or a fluororesin such as PTFE or ETFE) or the like is preferably used. it can.

  Further, as the material of the traction tool hub 40, for example, a polyolefin such as polypropylene and polyethylene, a synthetic resin such as a vinyl chloride resin and a polycarbonate can be suitably used as in the hub 28 and the like.

  As described above, the fixing member 22 is a substantially rectangular flat plate that integrally fixes the vicinity of the proximal ends of the suture thread insertion tubular body 18 and the suture thread gripping tubular body 20 while maintaining a predetermined distance therebetween. .

  In this case, the fixing member 22 can also be used as a portion that the operator (operator) holds when puncturing the biological suturing instrument 10, and it is preferable that the operator can put a finger.

  The distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 fixed by the fixing member 22 is the length that the suture 16 fixes the front abdominal wall 12 and the stomach front wall 14. It is about 5 to 30 mm, particularly about 10 to 20 mm. If the distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 is within the above range, the front abdominal wall 12 and the stomach front wall 14 can be sufficiently and appropriately fixed, and the puncture portions 18a, 20a Therefore, the resistance when puncturing does not increase too much.

  As described above, the flat plate member 24 is slidably inserted into the suture insertion tubular body 18 and the suture grasping tubular body 20, and is provided on the distal end side of the fixing member 22. Further, the lower end of the support rod 27 is vertically attached to the substantially central portion of the upper surface (on the fixing member 22 side) of the flat plate member 24 (see FIG. 1). In the living body suturing device 10, by having the flat plate member 24 on the distal end side (downward) from the fixing member 22, the distance between the suture insertion tubular body 18 and the suture grasping tubular body 20 changes at the time of puncturing. Specifically, it is possible to prevent the distance between the two from becoming close, particularly near the tip.

  The flat plate member 24 has holes 24 a and 24 b that are slidable between the suture insertion tubular body 18 and the suture grasping tubular body 20 such as a rectangular shape or a circular shape that is substantially the same as the fixing member 22. It only has to have. The lower surface is preferably a flat surface that does not irritate the skin (anterior abdominal wall 12).

  As described above, the support rod 27 is a substantially cylindrical rod shape provided between the suture insertion tubular body 18 and the suture grasping tubular body 20 in a substantially parallel manner, and is a flat plate member. A lower end (one end) is attached to a substantially central portion of the upper surface of 24, and the engagement portion 25 penetrates the hole portion 22 a of the fixing member 22 movably. A support rod hub 46 is coupled to the upper end (the other end) that penetrates the hole 22a of the fixing member 22.

  As shown in FIG. 3A, the engaging member 29 is formed of a substantially U-shaped flat plate and has a recess 29 a that can be engaged with the annular groove 23 of the support rod 27. That is, the width W of the recess 29 a is larger than the diameter of the annular groove 23 and smaller than the diameter of the land portion 21 that is a portion sandwiched between the adjacent annular grooves 23, 23 in the engaging portion 25 of the support rod 27. (See FIG. 3B).

  As described above, in the biological suturing device 10, the support rod 27 protrudes (fixes) at the substantially central portion of the flat plate member 24 and penetrates the hole 22 a of the fixing member 22 movably. The suture insertion tubular body 18 and the suture grasping tubular body 20 slidably penetrate the holes 24a and 24b of the flat plate member 24, respectively, and the suture insertion tubular body 18 and the suture grasping tubular body 20 are slidable. The vicinity of the proximal end portion of the tubular body 20 is fixed to the fixing member 22.

  For this reason, for example, when the support rod hub 46 is gripped and the support rod 27 is moved forward and backward in the vertical direction (axial direction), the flat plate member 24 is also moved forward and backward simultaneously, so that the suture thread can be inserted from the flat plate member 24. The protruding lengths of the tubular body 18 and the suture grasping tubular body 20 can be appropriately changed. At this time, for example, when the recess 29a of the engagement member 29 is engaged with the annular groove 23 of the support rod 27 on the upper surface of the fixing member 22 in a state where the protrusion length is a predetermined length, the flat plate member 24 The protruding lengths of the suture insertion tubular body 18 and the suture grasping tubular body 20 are positioned at a predetermined length.

  As described above, the width W of the recess 29 a of the engagement member 29 is larger than the diameter of the annular groove 23 and smaller than the diameter of the land portion 21 in the engagement portion 25 of the support rod 27. Accordingly, the support rod 27 and the flat plate member 24 are securely fixed to the fixing member 22 by the engaging action of the engaging member 29 and the engaging portion 25, and as a result, the suture thread from the flat plate member 24. The protruding lengths of the insertion tubular body 18 and the suture grasping tubular body 20 are fixed to a predetermined length. That is, in the biological suturing device 10, the support rod 27, the engaging member 29, the fixing member 22, and the flat plate member 24 function as a protrusion length adjusting mechanism. 4 and 5 exemplify a case where the protruding length is minimum and maximum in the biological suturing device 10.

  The support rod 27 and the engagement member 29 are preferably made of a material having rigidity and wear resistance, and are made of a metal material such as stainless steel, for example.

  Further, the change widths of the protruding lengths of the suture insertion tubular body 18 and the suture grasping tubular body 20 from the flat plate member 24 using the support rod 27 are different between the annular grooves 23 provided in the engagement portion 25. This depends on the interval and the number of the annular grooves 23, and these may be changed according to the use conditions of the living body suture tool 10. For example, in the living body suturing device 10 according to this embodiment, the interval between the annular grooves 23 is preferably about 1 to 5 mm, and the number of the annular grooves 23 is preferably about 5 to 30.

  Next, as an embodiment of the living body suturing device 10 basically configured as described above, the suturing portion of the front abdominal wall 12 and the stomach front wall 14 is sutured using the living body suturing device 10. An example will be described based on the flowchart of FIG.

  First, in step S1, the operator inserts an endoscope into the patient's stomach, and further supplies air sufficiently to fill the stomach with air, thereby closely attaching the anterior stomach wall 14 to the anterior abdominal wall 12. Let Then, another operator disinfects the skin surface of the front abdominal wall 12, confirms the position of the stomach with the transmitted light from the endoscope, and performs local anesthesia on the front abdominal wall 12.

  Next, in step S2, as shown in FIG. 7, the position of the flat plate member 24 is changed by moving the support rod 27 up and down. The protruding lengths of the puncture portions 18a and 20a of the suture thread insertion tubular body 18 and the suture grasping tubular body 20 from the flat plate member 24 functioning as a puncture needle are the positions where the length L is optimum for the puncture operation. The engaging member 29 is engaged with the annular groove 23 and fixed. In this case, in the tubular body 20 for grasping a suture, the traction tool hub 40 is in a state of being pulled up, and the annular member 44 of the traction tool 32 is completely stored.

  In step S3, as shown in FIG. 7, the biological suturing device 10 is punctured into the front abdominal wall 12 and the anterior stomach wall 14, and the suture insertion tubular body 18 and the suture grasping tubular body 20 are inserted into the stomach. To protrude.

  At this time, in the biological suturing device 10, the protruding lengths of the suture thread insertion tubular body 18 and the suture grasping tubular body 20 from the flat plate member 24 are fixed to the length L, that is, the flat plate member. 24 is also fixed to the fixing member 22 via the support rod 27. For this reason, at the time of puncturing, when the suture insertion tubular body 18 and the suture grasping tubular body 20 are punctured into the body to a depth of the length L, the flat plate member 24 comes into contact with the front abdominal wall 12 (see FIG. 8). ), It becomes impossible to puncture further.

  As described above, in the living body suturing device 10, the tabular member 24 is caused to function as a stop member by the engaging action of the support rod 27 and the engaging member 29, so that the suture insertion tubular body 18 and the suture grasping tubular body. The depth at which the body 20 is punctured can be set in advance. For this reason, it is possible to avoid puncturing to an excessive depth, and it is possible to perform proper suturing by a safe and simple operation.

  In step S4, as shown in FIG. 8, when the state in which the suture insertion tubular body 18 and the suture grasping tubular body 20 protrude into the stomach is confirmed by the endoscope, the operator pulls. The tool 32 is pushed in so that the traction tool hub 40 and the hub 36 are engaged. Then, the annular member 44 is protruded from the distal end of the suture grasping tubular body 20.

  As described above, when the annular member 44 protrudes from the suture grasping tubular body 20, the central axis of the suture insertion tubular body 18 or an extension line thereof penetrates the inside of the annular member 44. Further, it is formed so as to extend in the direction of the tubular body 18 for inserting a suture thread. For this reason, the annular member 44 protruding from the distal end of the suture grasping tubular body 20 is expanded so as to include the lower part of the central axis of the suture insertion tubular body 18.

  Next, in step S5, as shown in FIG. 8, the operator inserts and pushes the suture 16 from the rear end of the hub 28 of the suture insertion tubular body 18, and from the distal end of the suture insertion tubular body 18. It protrudes and passes through the inside of the annular member 44. The success or failure of the passage is confirmed by an endoscope. In this case, since the annular member 44 is expanded as described above, the suture 16 can be easily passed through the annular member 44.

  In step S <b> 6, as shown in FIG. 9, the traction tool 32 is pulled up to accommodate the annular member 44 in the suture grasping tubular body 20. At this time, the annular member 44 gradually deforms from a substantially circular shape to an oval shape while being gradually constricted at the distal end opening of the suture grasping tubular body 20, and grasps the suture 16 in a substantially linear shape. In this state, the suture thread is pulled up into the tubular body 20 for grasping a suture.

  Then, as shown in FIG. 10, when the traction tool 32 is removed from the rear end of the suture grasping tubular body 20, the suture 16 passes through the suture grasping tubular body, and the suture grasping tubular body. 20 is projected from the rear end.

  That is, the suture 16 passes through the stomach (inside the body) from the suture insertion tubular body 18 and is pulled out of the body through the suture grasping tubular body 20.

  Next, in step S7, as shown in FIG. 11, after the biological suturing device 10, that is, the suture insertion tubular body 18 and the suture grasping tubular body 20 are removed from the body, as shown in FIG. The suture 16 is tied outside the body. Thereby, the suturing of the front abdominal wall 12 and the stomach front wall 14 is completed, and the front abdominal wall 12 and the stomach front wall 14 are fixed.

  As described above, according to the biological suture instrument 10 according to the present embodiment, the depth at which the suture insertion tubular body 18 and the suture grasping tubular body 20 are punctured by the support rod 27 and the engagement member 29 is reduced. It can be set in advance. Therefore, it is possible to prevent the suture insertion tubular body 18 and the suture grasping tubular body 20 from being punctured to an excessive depth, and appropriate sewing can be performed by a simple operation.

  Usually, after each of the above steps, the living body is sutured again substantially in parallel with the stitched portion at a predetermined distance (for example, about 20 mm to 30 mm) away from the stitched portion by the suture thread 16. The operation | work which fixes the front abdominal wall 12 and the stomach front wall 14 similar to the above using the instrument 10 will be implemented.

  As described above, the suturing operation for the sutured portion of the front abdominal wall 12 and the stomach front wall 14 using the living body suturing device 10 is completed. Thereafter, usually, gastrostomy using an endoscope is performed as follows. (PEG) is applied.

  That is, a puncture device comprising a metal needle having a blade surface at the tip and a resin tube breakable in the axial direction through which the metal needle is inserted in the approximate center of the two stitched portions formed as described above. After puncturing and removing the metal needle, a balloon catheter is inserted into the tube. Next, after confirming with an endoscope that the distal end portion including the balloon portion of the balloon catheter has reached the stomach, the balloon is inflated with distilled water or the like, and the proximal end portion of the tube is pulled outward in two directions. The tube is broken axially and removed from the patient. Then, the balloon catheter is pulled proximally, the inflated balloon part is brought into close contact with the anterior stomach wall 14, and further, the balloon catheter in the part exposed from the skin surface is sutured with an appropriate fixing tool, and the balloon catheter is Secure to the abdominal wall 12. In this way, gastrostomy using an endoscope is completed (see Japanese Patent Publication No. 6-24533).

  Next, a second embodiment of the present invention will be described with reference to FIG. In FIG. 13, the same reference numerals as those shown in FIGS. 1 to 12 indicate the same or similar configurations, and the same applies to the same or similar functions and effects.

  The living body suture tool 48 according to the second embodiment is different from the living body suture tool 10 in that a support screw rod 50 is provided instead of the support rod 27.

  Like the support rod 27, the support screw rod 50 (support means, rod-like member) is provided between the suture insertion tubular body 18 and the suture grasping tubular body 20 in a substantially circular shape. It is a columnar bar shape. The lower end (one end) of the support screw rod 50 is rotatably supported by a rotation support member 52 provided at a substantially central portion of the upper surface of the flat plate member 24 and substantially the same as the engagement portion 25 of the support rod 27. A screw portion 54 formed in the same position in the axial direction passes through the fixing member 22 while being screwed into a threaded hole portion 22b (fixing means, hole portion) provided at a substantially central portion of the fixing member 22. is doing.

  A support screw hub 56 is coupled to the upper end (the other end) of the fixing member 22 that passes through the threaded hole 22b.

  Therefore, in the living body suturing device 48 according to the present embodiment, for example, when the support screw hub 56 is rotated in a predetermined direction, the support screw rod 50 and the threaded hole portion 22b are screwed together. The flat plate member 24 provided with the rotation support member 52 that rotatably supports the support screw rod 50 can be moved forward and backward in the vertical direction (the axial direction of the support screw rod 50). For this reason, similarly to the biological suturing device 10, the protruding lengths of the suture insertion tubular body 18 and the suture grasping tubular body 20 from the flat plate member 24 can be appropriately changed. At this time, since the support screw rod 50 and the fixing member 22 are screwed together, the living body suturing tool 48 does not include a member such as the engaging member 29 in the living body suturing tool 10 separately. The protruding lengths of the suture insertion tubular body 18 and the suture grasping tubular body 20 can be fixed to a predetermined length.

  In the living body suturing tool 48, the support screw rod 50, the fixing member 22, and the flat plate member 24 function as a protrusion length adjusting mechanism.

  Next, a third embodiment of the present invention will be described with reference to FIGS. The living body suture tool 58 according to the third embodiment is different from the living body suture tool 10 in that a support arch member 60 is provided instead of the support bar 27.

  The support arch member 60 (support means, arch member) is a substantially arch-shaped belt-like member in a side view (see FIG. 17), and both ends (lower ends) are on the upper surface (fixed member 22 side) of the flat plate member 24. The holes 24a and 24b are attached in a direction substantially perpendicular to the direction in which the holes 24a and 24b are arranged (see FIG. 16). Further, on both side straight portions (leg portions) of the support arch member 60, engagement portions 64a, in which a plurality of grooves 62a, 62b are formed in the vertical direction at substantially the same position as the engagement portions 25 of the support rod 27, 64b is provided (see FIG. 17), and the engaging portions 64a and 64b pass through the engaging hole portions 22c and 22d (fixing means and hole portions) of the fixing member 22, respectively. Further, the grooves 62a and 62b are configured to be engageable with the engagement holes 22c and 22d.

  The engaging hole portions 22 c and 22 d of the fixing member 22 are similar to the connecting position of the support arch member 60 in the flat plate member 24, and the suture inserting tubular body 18 and the suture grasping tubular body 20 are attached to the fixing member 22. The fixed positions are formed in directions substantially perpendicular to the direction in which the positions are arranged.

  In the biological suturing instrument 58 configured as described above, as shown in FIG. 17, in the linear portions on both sides of the support arch member 60, the vicinity of the fixing member 22 of the engaging portions 64 a and 64 b is positioned in the direction of the arrow (inside ), The support arch member 60 bends inwardly with the upper end head portion 60a (head portion) and the attachment portion of the lower end flat plate member 24 as fulcrums. As a result, the engagement state between the groove portions 62 a and 62 b and the engagement hole portions 22 c and 22 d of the fixing member 22 is released, and the support arch member 60 becomes movable in the vertical direction together with the flat plate member 24.

  Therefore, in the biological suture instrument 58 according to the present embodiment, the engagement portions 64a and 64b of the support arch member 60 are pressed inward, and the engagement state between the groove portions 62a and 62b and the engagement hole portions 22c and 22d is released. In this state, the support arch member 60 is moved back and forth in the vertical direction to change the position of the flat plate member 24, whereby the suture insertion tubular body 18 and the suture grasping tubular body 20 from the flat plate member 24 are changed. The protrusion length can be appropriately changed. Further, when the protrusion length reaches a predetermined length, the grooves 62a and 62b and the engagement holes 22c and 22d are engaged again by releasing the pressing of the engagement portions 64a and 64b, The support arch member 60 and the flat plate member 24 are fixed to the fixing member 22 (see FIG. 18).

  As described above, in the living body suture tool 58, the support arch member 60, the fixing member 22, and the flat plate member 24 function as a protrusion length adjusting mechanism.

  Further, the support arch member 60 is made of a material having sufficient rigidity for the joint portion between the upper end head portion 60a and the lower end flat plate-like member 24, and the both linear portions where the engaging portions 64a and 64b are provided are moderate. It is preferably formed of a material having rigidity, for example, a leaf spring that is an elastic member. When the support arch member 60 is configured in this manner, it is possible to suitably perform the change in the protruding length and the fixing operation as described above.

  The support arch member 60 in the biological suturing device 58 includes, for example, the two straight portions (leg portions) formed of two plate-like members, and the two plate-like members formed above the fixing member 22. You may make it connect directly through the connection member which complements between both plate-shaped members, or complements.

  Further, the groove portions 62a and 62b may be formed on, for example, the opposing surfaces (inner side surfaces) of the two linear portions. In this case, the groove portions 62a and 62b and the engagement hole portions 22c and 22d of the fixing member 22 are formed. In order to release the engaged state, the engaging portions 64a and 64b may be bent in the direction opposite to the arrow in FIG.

  It should be noted that the present invention is not limited to the above-described embodiment, and it is naturally possible to adopt various configurations without departing from the gist of the present invention.

1 is a partially cutaway perspective view for explaining a living body suturing tool according to a first embodiment of the present invention. It is a front view of the traction tool in the suture instrument for living body. FIG. 3A is a perspective view of an engaging member in the biological suturing tool, and FIG. 3B is a cross-sectional view taken along line IIIB-IIIB in FIG. 1. FIG. 6 is an explanatory diagram for explaining a state in which the protruding lengths of the suture insertion tubular body and the suture grasping tubular body are minimized in the biological suture instrument. FIG. 6 is an explanatory diagram for explaining a state in which the protruding length of the suture thread insertion tubular body and the suture grasping tubular body is maximized in the biological suture instrument. It is a flowchart at the time of suturing a to-be-sewn part using the said suture tool for biological bodies. FIG. 5 is an explanatory diagram for explaining a state in which the suture insertion tubular body and the suture grasping tubular body are punctured in the living body suturing device. It is explanatory drawing for demonstrating the state which inserts a suture thread in the said biological suture tool. In the said biological suture tool, it is explanatory drawing for demonstrating the state which pulls up a traction tool. It is explanatory drawing for demonstrating the state which passed the suture thread into the body with the said biological suture tool. It is explanatory drawing for demonstrating the state which extracted the said biological suture tool out of the body. It is explanatory drawing for demonstrating the state which sutured the front abdominal wall and the stomach front wall with the suture thread | strain which passed the body with the said biological suture tool. It is a perspective view for demonstrating the biological suture tool which concerns on the 2nd Embodiment of this invention. It is a front view for demonstrating the biological suture tool which concerns on the 3rd Embodiment of this invention. It is sectional drawing in line XV-XV of FIG. It is sectional drawing in line XVI-XVI of FIG. It is explanatory drawing for demonstrating the state which is pressing the support arch member of the biological suture tool which concerns on the said 3rd Embodiment by the cross section in line | wire XVII-XVII of FIG. It is explanatory drawing for demonstrating the state which moved the said support arch member.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10, 48, 58 ... Living body suture tool 12 ... Front abdominal wall 14 ... Gastric front wall 16 ... Suture thread 18 ... Tubular body 18a, 20a ... Puncture part 20 ... Tubular body 22 for holding suture thread 22 ... Fixing member 22a 24a, 24b ... hole 22b ... threaded hole 22c, 22d ... engagement hole 23 ... annular groove 24 ... flat plate member 25, 64a, 64b ... engagement part 27 ... support rod 28, 36 ... hub 29 ... Engagement member 29a ... Recess 32 ... Traction tool 40 ... Traction tool hub 42 ... Rod-shaped member 44 ... Ring member 46 ... Support rod hub 50 ... Support screw rod 54 ... Screw part 56 ... Support screw hub 60 ... Support arch member 62a, 62b ... Groove

Claims (1)

A suture insertion tubular body for inserting a suture into a living body;
A traction tool having an annular member formed of an elastic material at the tip, and holding a suture thread inserted into the living body by the annular member;
A suture grasping tubular body for inserting the traction tool into a living body;
A fixing member for fixing the suture insertion tubular body and the suture grasping tubular body at a predetermined distance apart from each other;
A flat plate-like member that is provided on the distal end side of the fixing member and through which the suture insertion tubular body and the suture grasping tubular body slidably penetrate ;
A living body provided with a projecting length adjusting mechanism for changing the projecting length of the suture thread insertion tubular body and the suture grasping tubular body projecting from the planar member by moving the planar member to a predetermined position. A suturing tool,
The protrusion length adjusting mechanism is configured to move the flat plate member to a predetermined position to adjust a distance between the fixing member and the flat plate member, and a predetermined position changed by the support unit. And fixing means for fixing the flat plate member,
One end of the support means is supported by the flat plate-like member, penetrates the fixing member so as to be movable forward and backward, and has two leg portions having a plurality of groove portions, and a head portion connecting the two leg portions. An arch member having,
The fixing means is two holes provided in the fixing member and engaged with the groove,
Flexing the two legs in a direction approaching or separating from each other to release the engagement state between the groove and the hole, thereby changing the position at which the leg is fixed to the hole; The living body suturing tool is characterized in that the protruding length is adjusted .

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