JP4716333B2 - Coronary artery bypass surgery instrument - Google Patents

Description

  The present invention relates to a treatment tool for coronary artery bypass surgery.

  In recent years, catheter intervention for patients with ischemic heart diseases such as myocardial infarction has been rapidly spreading. Typical catheter interventions include coronary vasodilation and endovascular stenting, but these treatments are characterized by low invasiveness to the patient and a short hospital stay.

  On the other hand, the effectiveness of coronary artery bypass surgery (hereinafter abbreviated as CABG) using cardiopulmonary bypass is widely recognized for patients who are not subject to catheter treatment. This method is intended to eliminate ischemia by anastomosing one end of bypass blood vessels such as the internal thoracic artery and gastroepiploic artery that have been exfoliated to the peripheral side of the coronary artery where the stenosis causing ischemia has occurred. .

  In recent years, attempts have been made to anastomote bypass grafts under heartbeat without using heart-lung machines, and good results have been obtained. This method is called off-pump coronary artery anastomosis (hereinafter abbreviated as OPCAB).

  The problem with OPCAB is that it requires skill to perform a perfect anastomosis in a short time because the heart is moving. If the anastomosis is poor, a blood clot is generated in the coronary artery or bypass blood vessel from the anastomosis, causing the blockage. The problem is that by using an instrument (stabilizer) that stabilizes the anastomosis by suppressing the heart anastomosis and relaxing the heart beat, the bypass vessel can be anastomosed in a stable state. Since it became possible, the results of OPCAB improved dramatically (for example, refer patent document 1).

  This stabilizer includes a pair of U-shaped adsorption members that can be adsorbed to the surface of the heart, an arm for adjusting and holding the position of the adsorption member, an aspiration tube that communicates with the adsorption member and can be connected to one aspiration source It is composed of

However, the above-described stabilizer has a problem that the arm and the suction tube are separately connected to the suction member, so that the bulk around the suction member increases and the surgical field near the anastomosis portion becomes narrow. It was.
JP-T-2002-524183

  The present invention has been made in view of the above circumstances, and it is an object of the present invention to provide a treatment device for coronary artery bypass surgery that is excellent in visibility of the surgical field of the anastomosis portion and can safely perform anastomosis in off-pump coronary artery anastomosis. .

The treatment tool for coronary artery bypass surgery according to the present invention is a long flexible tube, an adsorption member provided on the distal end side of the flexible tube , adsorbing to the wall surface of the heart, and stabilizing the anastomosis part , An opening / closing member provided on the proximal end side of the flexible tube; and a check valve provided further on the proximal end side of the flexible tube than an installation position of the opening / closing member. in sex tube, the distal end side of the closing member, is contained the shape maintaining member, wherein the shape maintaining member is a stainless steel pipe, the inner diameter of the stainless steel pipe is 4mm or more, the outer diameter of the stainless steel pipe is 10mm or less Thus, the shape maintaining member has elasticity, is deformable when an external force is applied, and maintains the deformed shape by itself .

In this treatment tool for coronary artery bypass surgery, a shape maintaining member is provided on the distal end side of the flexible tube . Thereby, an arm for fixing the position of the suction tube around the flexible tube serving as the suction tube is not required, and a treatment device for coronary artery bypass surgery that can secure a wide surgical field can be realized.

  ADVANTAGE OF THE INVENTION According to this invention, in the off-pump coronary artery anastomosis, the treatment tool for coronary artery bypass surgery which is excellent in the visibility of the surgical field of an anastomosis part and can implement an anastomosis safely can be provided.

  Hereinafter, preferred embodiments of a treatment tool for coronary artery bypass surgery according to the present invention will be described in detail with reference to the drawings. The treatment device for coronary artery bypass surgery shown below is a stabilizer that stabilizes the anastomosis. This instrument is preferably used when performing, for example, coronary artery bypass surgery. In the description of the drawings, the same reference numerals are assigned to the same elements, and duplicate descriptions are omitted.

  FIG. 1 is a schematic view showing an embodiment of a treatment tool for coronary artery bypass surgery according to the present invention. The treatment instrument 10 for coronary artery bypass surgery includes a long tubular body 1, an adsorption member 2 provided on the distal end side of the tubular body 1, and an opening / closing member 3 provided on the proximal end side of the tubular body 1. And a check valve 4 provided on the proximal end side of the cylindrical body 1. A shape maintaining member 5 that maintains a deformed shape when an external force is applied is provided on the distal end side of the cylindrical body 1.

  The cylindrical body 1, the adsorbing member 2, the opening / closing member 3, and the check valve 4 are in communication, and the base end portion of the cylindrical body 1 can be connected to a suction source. When using a positioner which is another treatment device for coronary artery bypass surgery with one suction source, for example, it can be connected via a bifurcated Y connector.

  In the treatment tool 10 for coronary artery bypass surgery, the cylindrical body 1 is a flexible tube 1. The material of the flexible tube 1 can be, for example, a material such as polyurethane resin, soft vinyl chloride resin, or silicone resin. Moreover, the flexible tube 1 is formed by extrusion molding, for example. The flexible tube 1 can have a total length of, for example, 200 mm or more, preferably 300 mm or more, and an inner diameter of, for example, 2 mm or more, preferably 4 mm or more.

In the treatment tool 10 for coronary artery bypass surgery, the shape maintaining member 5 is preferably deformable.
Further, it may be included in the distal end side of the cylindrical body 1. The shape maintaining member 5 is, for example, a pipe shape made of a metal such as stainless steel, and can be connected to and fixed to the thoracotomy via a commercially available surgical arm. The shape maintaining member 5 can have a length of 50 mm or more, preferably 100 mm or more, an inner diameter of 2 mm or more, preferably 4 mm or more, and an outer diameter of 15 mm or less, preferably 10 mm. It can be as follows. By using stainless steel having elasticity and excellent rigidity as the shape maintaining member 5, it can be deformed by applying external force relatively easily. Further, if the inner diameter and the outer diameter are within these ranges, the shape maintaining member 5 is not kinked at the bent portion. Furthermore, it is possible to maintain a deformed shape by applying an external force. Then, as shown in FIG. 3, it can be deformed toward the adsorbing member 2, and can be deformed in any direction, up and down, left and right, and the deformed shape can be maintained. Therefore, it is possible to increase the degree of freedom of the organ-fixing.

  In the treatment tool 10 for coronary artery bypass surgery, the adsorbing member 2 is provided on the distal end side of the flexible tube 1. The adsorbing member 2 is negatively applied by a suction source through the flexible tube 1 and adsorbs on the surface of the object to be adsorbed by suction.

  Here, the object to be adsorbed is a heart. For this reason, the adsorption | suction member 2 can be made into the material excellent in the adhesiveness with respect to the heart wall surface. The material of the adsorption member 2 can be an elastic body, for example. By doing so, it is possible to sufficiently fit the heart wall surface and ensure adhesion. Specifically, the elastic body may be an elastomer such as a silicone resin, a styrene-ethylene-butadiene-styrene resin, or a urethane elastomer. Further, the material of the adsorbing member 2 may be a hard plastic such as polycarbonate resin or hard vinyl chloride resin for the purpose of improving the stability of the anastomosis. In this case, in order to improve the adhesion to the heart wall surface, it is preferable to apply the above-described elastic body to the adsorption surface.

  Further, as shown in FIG. 2A, the shape of the adsorbing member 2 can be a cup shape having a substantially elliptical plane. By doing so, the blood vessel on the heart wall surface can be adsorbed to the heart wall surface with the maximum contact area without aspiration.

  The length of the adsorbing member 2 can be set to, for example, 20 mm or more, preferably 30 mm or more, from the viewpoint of more stably adsorbing the adsorbing member 2 to the heart wall surface. In addition, the length can be set to, for example, 60 mm or less, preferably 50 mm or less from the viewpoint of further improving workability. Further, the width of the adsorbing member 2 can be set to, for example, 5 mm or more, preferably 10 mm or more, from the viewpoint of more stably adsorbing the adsorbing member 2 to the heart wall surface. Further, the width can be set to, for example, 30 mm or less, preferably 20 mm or less, from the viewpoint of further improving workability. Furthermore, the height of the adsorption member 2 can be set to, for example, 5 mm or more and 30 mm or less from the viewpoint of further improving workability.

  By configuring the length, width, and height of the adsorbing member 2 as described above, the adsorbing member 2 can be reliably adsorbed on the surface of the heart and the anastomosis portion can be stabilized. Moreover, the workability of the treatment can be ensured.

  Moreover, as shown in FIG.2 (b), the adsorption | suction member 2 may be provided with the opening part 6 in the adsorption | suction surface. The opening 6 can be configured to communicate with the flexible tube 1. Further, a mesh or the like having a plurality of small holes covering the opening 6 of the adsorption member 2 may be provided. At this time, the wall surface of the heart comes into contact with the adsorption member 2 through the mesh.

  Further, for example, a convex portion may be provided around the suction opening 6 and a mesh or the like may be provided so as to provide a gap between the suction opening 6. By doing so, it is possible to prevent a reduction in suction area. Therefore, the suction force in the adsorption member 2 can be improved. The material such as the mesh may be polyester fiber such as polyethylene terephthalate, polyamide fiber such as nylon, non-woven fabric or cotton having a water absorbing effect.

  Moreover, it is preferable that a plurality of concave slits 7 are formed on the inner surface of the opening 6 provided in the suction member 2. The adsorbing member 2 is further provided with a communication port communicating with the flexible tube 1 and a plurality of concave slits 7 extending from the end of the adsorbing member 2 toward the communication port. The concave slit 7 is a groove formed on the inner surface of the adsorption member 2. By providing the concave slit 7, the liquid in the adsorption member 2 can be efficiently discharged from the concave slit 7 to the flexible tube 1 through the communication port. Therefore, it is possible to prevent liquid from accumulating in the adsorbing member 2 and blocking the discharge path, to obtain a draining effect of body fluid on the tissue surface, and to prevent a side slip of the adsorbing member 2 with respect to the tissue. it can. Moreover, it can be set as the structure by which the some concave slit 7 is provided in the mutually substantially parallel while extending in a substantially perpendicular direction (suction direction) with respect to the adsorption | suction surface.

  The plurality of concave slits 7 extend from the center of the adsorption member 2 toward the periphery, and are formed radially. For this reason, the liquid in the adsorption member 2 can be efficiently discharged from the inside of the opening toward the outside. A plurality of concave slits 7 may be provided in the circumferential direction of the inner surface of the adsorption member 2. Furthermore, it is preferable that the concave slit 7 is formed up to the vicinity of the end of the adsorption member 2. By doing so, in addition to the above draining effect, an effect that the suction pressure can be reliably applied to the end of the adsorbing member 2 is obtained. For this reason, suction force can be improved.

  The width of the concave slit 7 is preferably 0.2 mm to 1 mm, and the depth is preferably 0.5 mm to 5 mm, for example. By carrying out like this, it can suppress that a structure | tissue penetrate | invades into the concave slit 7 completely, and impairs the draining effect of the concave slit 7. FIG. For this reason, the draining effect of the adsorption member 2 can be improved.

  Next, in the treatment instrument 10 for coronary artery bypass surgery, the flexible tube 1 is provided with an opening / closing member 3. The opening / closing member 3 can be a cock 3 as shown in FIG.

Further, for example, when the opening / closing member 3 is a cock 3, for example, a structure that can be adjusted only in two directions by providing a stopper so as not to rotate in one direction may be adopted. In this way, by adjusting the rotation of the cock 3,
i) A reliable suction operation when suctioning the heart wall by the suction member 2 and ii) an operation of releasing the atmosphere while reliably blocking from the suction source when removing the suction member 2 from the heart wall.

  Further, as a structure in which the opening / closing member 3 can be adjusted only in two directions, for example, a member corresponding to the cock 3 can be slid in a vertical direction with respect to the flexible tube 1 in addition to a structure in which the cock 3 is rotated. It is good also as a structure which can implement i) and ii) mentioned above by setting it as a structure.

  Next, in the treatment instrument 10 for coronary artery bypass surgery, the flexible tube 1 is provided with a check valve 4 in which the direction from the adsorption member 2 to the suction source side is the forward direction.

  The check valve 4 is configured so as to be able to suppress the backflow via the check valve 4 without being subjected to an external operation. That is, the check valve 4 has a function of circulating the fluid only in one direction. Specifically, the check valve 4 is opened when the proximal end side (suction source side) is negative with respect to the suction member 2 side, and the suction member 2 is attached to the heart wall surface by the suction pressure. . On the other hand, the check valve 4 is configured to be closed when the proximal end side (suction source side) is relatively positive with respect to the suction member 2 side.

  Such a check valve 4 has, for example, a pair of valve bodies provided so as to come into contact with each other at the tip on the suction source side and to be in a closed state. In the closed state, the valve bodies continuously incline from the wall surface side to the inside of the flexible tube 1 and are in contact with each other at the proximal end, that is, the end portion on the suction source side. The road is blocked. Further, in the open state, the tip of the valve body is separated, so that a fluid passage is formed between the valve bodies.

  The check valve 4 can be a duckbill valve 4 (detailed shape is omitted) as shown in FIG. A housing that encloses the duckbill valve 4 can be provided outside the duckbill valve 4 so as to be connected to the flexible tube 1. In this way, when the positioner, which is another coronary artery bypass surgery instrument, is used together with a single suction source, if the positioner suction member 2 comes off the heart, the stabilizer suction member adsorbed to the heart The suction pressure applied to the inside of the flexible tube 1 on the suction source side with respect to the duckbill valve 4 attached to the flexible tube 1 communicating with the duckbill 2 is higher than the suction pressure in the adsorption member 2 from the duckbill valve 4 ( That is, it becomes a relatively positive pressure). Due to this differential pressure, a backflow of air is generated, the check valve 4 is closed by this backflow, and the suction pressure in the adsorption member 2 of the stabilizer is maintained, so that the stability of the anastomosis portion of the heart is maintained. be able to. Further, when the adsorption member 2 of the positioner is detached, the backflow can be automatically shut off without requiring an operator to perform any operation on the duckbill valve 4. For this reason, the safety of the anastomosis operation can be improved.

  The check valve 4 can be made of an elastomer such as silicone resin, acrylonitrile rubber, isoprene rubber, urethane elastomer, or the like. The check valve 4 is not limited to a duckbill valve, and may be another check valve 4 such as an umbrella shape. These check valves 4 can be formed by compression molding or the like. Moreover, the material of the housing that encloses the check valve 4 can be, for example, hard vinyl chloride resin or polycarbonate resin. These housings can be formed by injection molding or the like. The housing can be composed of two parts so that the check valve 4 can be included, and the two-part housing can be assembled with the check valve 4 included, for example, by ultrasonic welding.

  Moreover, in the treatment instrument 10 for coronary artery bypass surgery, an opening / closing member (cock 3) and a check valve (on the back side of the suction member 2 provided on the distal end side of the flexible tube 1 (that is, the suction source side) The duckbill valve 4) may be provided in the flexible tube 1 in this order in series. By doing so, it is possible to release the atmosphere inside the adsorption member 2 for removing the adsorption member 2 from the heart wall by operating the opening / closing member 3 without impairing the effect of the check valve 4. In other words, when the opening / closing member 3 is provided in the flexible tube 1 in series behind the check valve 4 (base end side, that is, the suction source side), the adsorption member 2 by operating the opening / closing member 3 is provided. Since the check valve 4 obstructs opening the atmosphere inside the adsorption member 2 for removal from the heart wall, it is not preferable.

  Therefore, in the treatment instrument 10 for coronary artery bypass surgery, the cylindrical body 1 has the shape maintaining member 5 and the cylindrical body 1 has the check valve 4 so that the shape maintaining member separated from the cylindrical body 1 is obtained. Compared to conventional treatment tools that have 5 and no check valve 4, the surgical field near the anastomosis is superior, and even one suction source can be used safely with other treatment tools. Coronary artery bypass surgery can be performed safely and simply.

  Moreover, it becomes easy to handle by making the cylindrical body 1 into the flexible tube 1, and operativity can be improved.

  Although not shown, the shape maintaining member 5 can be fixed by connecting to a thoracotomy device. The connection to the chest opener can be made via a surgical arm that can be connected to the chest opener. Further, the shape maintaining member 5 itself may be provided with a connection portion with a thoracotomy device and directly connected to the thoracotomy device.

  In the treatment instrument 10 for coronary artery bypass surgery, the cylindrical body 1 is a suction flow path communicating with a suction source, and can be a flexible tube 1. By doing so, handling becomes easy and operability can be improved.

  In the treatment tool 10 for coronary artery bypass surgery, the shape maintaining member 5 can be structured to be included in the cylindrical body 1. By doing so, the bulkiness of the treatment tool in the vicinity of the anastomosis portion can be further reduced, and a good surgical field can be obtained, so that the safety and certainty of the operation can be improved.

  In the off-pump coronary artery anastomosis, it is possible to provide a treatment device for coronary artery bypass surgery that can be safely used even with one suction source without complicating the operation. Further, according to the present invention, it is possible to provide a treatment device for coronary artery bypass surgery that is excellent in the surgical field of the anastomosis portion and can safely perform anastomosis in the off-pump coronary artery anastomosis.

  The present invention has been described based on the embodiments. It is to be understood by those skilled in the art that these embodiments are merely examples, and that various modifications are possible and that such modifications are within the scope of the present invention.

It is a figure which shows typically one Embodiment of the treatment tool for coronary-artery bypass surgery by this invention. It is a figure which shows the enlarged top view and bottom view of an adsorption | suction member. It is the schematic which shows the state which applied and applied and deform | transformed.

Explanation of symbols

1 Cylindrical body (flexible tube)
2 Adsorbing member 3 Opening / closing member (cock)
4 Check valve (duck bill valve)
5 shape maintaining member 6 opening 7 concave slit 10 treatment tool for coronary artery bypass surgery

Claims (1)

A long flexible tube,
An adsorbing member that is provided on the distal end side of the flexible tube , adsorbs to the wall surface of the heart, and stabilizes the anastomosis portion ;
An opening and closing member provided on the proximal end side of the flexible tube;
A check valve provided on the proximal side of the flexible tube from the installation position of the opening and closing member;
In the flexible tube, the distal end side of the opening and closing member, shape maintaining member is included,
The shape maintaining member is a stainless steel pipe, and the stainless steel pipe has an inner diameter of 4 mm or more and an outer diameter of the stainless steel pipe of 10 mm or less, whereby the shape maintaining member has elasticity and an external force is applied. A treatment tool for coronary artery bypass surgery , which is deformable at times and maintains its deformed shape by itself .

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