JP4870936B2 - Medical device insertion aid - Google Patents

Description

  The present invention relates to a living body insertion aid for a medical instrument that is used when a medical instrument such as an endoscope is inserted into the digestive organ from the oral cavity through the pharynx.

  Conventionally, for example, when diagnosing or treating digestive organs such as the stomach and esophagus, a technique for inserting a medical instrument such as an endoscope into the digestive organ from the oral cavity of a patient has been performed. The operation of inserting this medical instrument into the digestive organ is difficult because the pharynx extending from the oral cavity to the esophagus is curved. In addition, in the case of a procedure in which a medical instrument is taken in and out many times, the number of times the medical instrument passes through the pharynx is increased, which increases the burden on the patient. For these, for example, as disclosed in Patent Document 1, a cylindrical auxiliary tool is inserted and placed from the oral cavity through the pharynx to the entrance of the esophagus, and the inner hole of the auxiliary tool is set. Utilizing medical instruments in and out of digestive organs by using them facilitates the operation of inserting medical instruments and reduces the burden on patients.

The auxiliary tool of Patent Document 1 is configured by embedding a reinforcing member formed by forming a thin elastic wire in a spiral shape into a cylindrical member made of a resin material, and the center line of the reinforcing member and the cylindrical member. Extends in a straight line. By inserting this auxiliary tool into the pharynx, it becomes possible to support the inner wall of the pharynx with the wire of the reinforcing member and prevent the pharynx from becoming narrow. Further, when the auxiliary tool is inserted into the pharynx, the tubular member is elastically deformed so as to correspond to the shape of the pharynx because the pharynx is curved, so that it is entirely curved. In this curved portion, the tubular member tends to be crushed and deformed, but this deformation is suppressed by the reinforcing member. That is, by providing the reinforcing member on the cylindrical member as in Patent Document 1, it is possible to secure the insertion space for the medical instrument in the cylindrical member.
Japanese Patent Laid-Open No. 7-51221 (page 3, FIG. 1, FIG. 4)

  By the way, in recent years, when diagnosing or treating the digestive tract, a medical instrument is inserted into the digestive organ through the oral cavity to give the patient with as little and as little or no laparotomy or thoracotomy as possible There is an increasing demand to reduce invasion. In this case, for example, a plurality of medical instruments such as an excision tool for the affected area and an endoscope for the operator to see the operative field can be simultaneously inserted from the oral cavity, and both the excision function and the endoscopic function of the affected area It is necessary to insert a relatively large diameter medical instrument having a large insertion space for the medical instrument.

  However, in the auxiliary tool of Patent Document 1, since the peripheral wall of the cylindrical member is thickened by the amount of the reinforcing member embedded in the cylindrical member, the insertion space is not sufficient depending on the number and type of medical instruments to be inserted. The insertion of the medical device may be difficult.

  Therefore, it is conceivable to reduce the diameter of the wire constituting the reinforcing member to make the peripheral wall of the tubular member thinner. However, when inserting the cylindrical member into the pharynx, the patient tries to exclude the cylindrical member from the pharynx by recognizing the cylindrical member as a foreign object and reflexively moving the muscles of the pharynx to narrow the inner diameter. . Since the force at this time is quite large, the wire diameter of the reinforcing member cannot be made very thin.

  Further, in Patent Document 1, since the cylindrical member is formed in a straight line, the cylindrical member is brought into contact with the inner wall of the pharynx by an operation of inserting it into the pharynx and is bent along the shape of the pharynx. I have to go. When the tubular member is bent, the curved portion tends to be crushed and deformed, but since the crushed deformation is suppressed by the reinforcing member as described above, the force required to bend the tubular member is increased. As a result, a large force is required when inserting the cylindrical member into the pharynx, so that the insertion workability by the operator is deteriorated and the invasion given to the patient may be increased.

  The present invention has been made in view of such points, and the object of the present invention is to guide a medical instrument to a digestive organ using a cylindrical member that is inserted into the pharynx from the oral cavity and placed in place. The cylindrical member is prevented from being deformed so as to be crushed so that a large insertion space for the medical instrument can be secured, and the workability when the cylindrical member is inserted into the pharynx is improved and the living body is improved. The purpose is to reduce the invasion.

  In order to achieve the above object, in the present invention, the reinforcing member is made of a thin plate material, and the reinforcing member and the cylindrical member are curved so as to correspond to the curved shape of the pharynx.

Specifically, in the invention of claim 1, a cylindrical member in which an inner hole through which a medical instrument can be inserted is formed across both ends, and the cylindrical member is embedded in the peripheral wall portion, and the cylindrical member is A medical member that is configured to guide the medical device to the digestive organ through the inner hole in a state in which the medical device is inserted into the pharynx from the oral cavity of the living body and indwelled. The instrument has an inner cylindrical member that is formed to have a smaller diameter than the inner hole of the cylindrical member, is inserted into the inner hole and is also inserted into the pharynx , and the inner cylindrical member is disposed in the cylindrical shape. It is inserted into the pharynx ahead of the member in time and is guided when the cylindrical member is inserted into the pharynx. The outer diameter of the cylindrical member pushes and expands the pharynx of the living body. It is formed to have a larger diameter than the usual pharynx so as to expand the diameter, and the reinforcing member is the cylindrical shape It consists of a thin plate material formed in a spiral shape continuously extending in the center line direction of the material, and the thickness direction of the thin plate material matches the thickness direction of the peripheral wall portion of the cylindrical member, and the cylindrical member and the reinforcement The member is configured to be bent corresponding to the shape of the pharynx of the living body.

  According to this configuration, since the reinforcing member and the cylindrical member are curved in advance corresponding to the curved shape of the pharynx, there is almost no deformation when the reinforcing member and the cylindrical member are inserted into the pharynx. Can be inserted into. For this reason, the force required to insert the cylindrical member into the pharynx is small.

  In addition, since the reinforcing member is made of a thin plate material extending along the circumferential direction of the inner hole, the thickness of the reinforcing member in the circumferential wall thickness direction, that is, the plate thickness size of the thin plate material, the conventional reinforcing member is made of a wire material. When the thickness of the peripheral wall of the cylindrical member is reduced by making it shorter than the wire diameter of the case, the width of the thin plate material should be longer than the wire diameter of the conventional wire material, and the strength of the reinforcing member will be sufficient To be able to get to. Thereby, it becomes possible to suppress the deformation of the cylindrical member while reducing the thickness of the peripheral wall of the cylindrical member.

  Also, after inserting the inner cylinder member from the oral cavity into the pharynx with the inner cylinder member removed from the inner hole of the cylindrical member, the oral cavity side of the inner cylinder member is inserted into the inner hole of the cylindrical member Then, the reinforcing member and the cylindrical member can be inserted into the pharynx along the inner cylindrical member.

  That is, by first inserting an inner cylindrical member smaller in diameter than the cylindrical member into the pharynx, the inner diameter of the pharynx is first enlarged by the inner cylindrical member, and then the pharyngeal portion is expanded by the large-diameter cylindrical member. It becomes possible to further enlarge the inner diameter. By gradually expanding the inner diameter of the pharynx in this way, invasion given to the living body is reduced when a large-diameter cylindrical member is inserted into the pharynx to ensure a wide insertion space for the medical instrument. The Furthermore, since the inner cylinder member has a smaller diameter than the cylindrical member, it is easy to insert the inner cylindrical member into the pharynx, and the inner cylindrical member allows the reinforcing member and the cylindrical member to be easily inserted into the pharynx.

  Further, the cylindrical member is continuously reinforced in the center line direction.

  According to the invention of claim 2, in the invention of claim 1, the end of the tubular member on the digestive organ side extends to the digestive organ side of the end of the reinforcing member on the digestive organ side.

  According to this structure, the edge part of a cylindrical member is located in the digestive organ side rather than the edge part of a reinforcement member. Thereby, when inserting a reinforcement member and a cylindrical member into a pharynx, it becomes possible to avoid that a reinforcement member contacts a biological tissue.

  In the invention of claim 3, in the invention of claim 1, the end of the tubular member on the digestive organ side is inclined with respect to the center line of the inner hole.

  According to this configuration, the end of the tubular member on the digestive organ side is tapered. For this reason, the operation | work which inserts a cylindrical member in a pharynx becomes still easier.

  According to the first aspect of the present invention, since the reinforcing member is composed of the thin plate material extending along the circumferential direction of the inner hole, the thickness of the peripheral wall of the cylindrical member can be reduced while suppressing the crushing deformation of the cylindrical member. In addition, a wide space for inserting medical instruments can be secured. In addition, since the reinforcing member and the cylindrical member are curved in advance corresponding to the shape of the pharynx, workability when inserting the cylindrical member into the pharynx can be improved and less invasive to the living body. Can be diagnosed and treated.

  In addition, since the auxiliary tool includes an inner cylindrical member that can be inserted into the inner hole, it is possible to secure a wide insertion space for the medical instrument while suppressing invasion to the living body and to insert the cylindrical member into the pharynx. The workability at the time of performing can be further improved.

  Moreover, since the reinforcing member is formed in a spiral shape, the cylindrical member can be continuously reinforced in the center line direction.

  According to the invention of claim 2, since the end of the cylindrical member on the digestive organ side is located on the digestive organ side of the reinforcing member, the living body is inserted when the reinforcing member and the cylindrical member are inserted into the pharynx. The invasion given to can be reduced.

  According to invention of Claim 3, the edge part by the side of the digestive organ of a cylindrical member can be made into a tapered shape, and workability | operativity at the time of inserting a cylindrical member in a pharynx can be made still better. it can.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a cross-sectional view of a living body insertion aid 1 for a medical instrument according to an embodiment of the present invention. The assisting device 1 is inserted into the pharynx when a medical instrument is inserted into the digestive organ from the oral cavity when examining or diagnosing digestive organs such as the human stomach, esophagus, or small intestine, or treating the digestive organ. It is used by detention.

  The auxiliary tool 1 includes a resin tubular member 2, a metal reinforcing member 3 embedded in the peripheral wall 2 a of the tubular member 2, and a first inner tubular member 4 inserted into the tubular member 2. And the second inner cylinder member 5. The cylindrical member 2 is obtained, for example, by allowing molten polyvinyl chloride or the like to flow into a mold (not shown) and then solidifying into a cylindrical shape. FIGS. 2, 3, and 4 are used. As shown in FIG. 5, the curve is formed corresponding to the shape of the pharynx 100 in a state where a human is lying on his back. The length from the oral cavity side end of the cylindrical member 2 to the digestive organ side end is, for example, that the oral cavity side protrudes from the front teeth 101 to the outside of the oral cavity 102, and the digestive organ side exceeds the pharynx 100 near the entrance of the esophagus 103. It is said to reach the length. Specifically, the length along the center line of the cylindrical member 2 is set to 100 mm or more and 300 mm or less.

  As shown in FIG. 3, the inner hole 2 b of the cylindrical member 2 is continuous over both ends of the cylindrical member 2, and is open at both ends. The medical instrument is inserted into the inner hole 2b. Moreover, while the oral cavity side edge part of the cylindrical member 2 is formed so that it may be substantially orthogonal to the centerline of this cylindrical member 2, the digestive organ side edge part is in the direction where the centerline of the cylindrical member 2 extends. It is formed so as to have an inclination angle of 40 ° or more and 70 ° or less. Therefore, the digestive organ side end portion of the cylindrical member 2 has a sharp shape.

  The thickness of the peripheral wall 2a of the cylindrical member 2 is set to 2 mm or more and 4 mm or less, for example. The thickness of the peripheral wall 2a is changed depending on the thickness of a thin plate material (described later) constituting the reinforcing member 3, the thickness of the resin material covering the thin plate material, or the like. Moreover, the internal diameter of the cylindrical member 2 is set to 20 mm or more and 30 mm or less. The inner diameter and the length in the direction of the center line of the cylindrical member 2 can be changed depending on the type and size of the medical instrument inserted into the digestive organ using the auxiliary device 1 and the patient's physique, age, sex, and the like. Is possible.

  Moreover, the outer surface and inner surface of the cylindrical member 2 are comprised by the smooth surface. These outer and inner surfaces are coated with a coating that reduces frictional resistance. This prevents the outer surface of the cylindrical member 2 from being caught by a living tissue when the auxiliary tool 1 is inserted into the pharynx 100, and also when inserting a medical instrument into the inner hole 2b. The medical instrument is prevented from being caught on the inner surface of the tubular member 2. The outer surface and the inner surface of the cylindrical member 2 can be coated by applying a friction reducing agent such as xylocaine jelly.

  As shown in FIG. 1, a concave portion 2 c is provided on the inner surface of the cylindrical member 2 on the oral cavity side, while the convex surface that engages and engages with the concave portion 2 c on the outer surface of the first guide member 4 on the oral cavity side. A portion 4b is provided. The convex portion 4b is positioned so that the digestive organ side end portion of the first guide member 4 and the digestive organ side end portion of the tubular member 2 substantially coincide with each other when engaged with the concave portion 2c. .

  As shown in FIG. 5, the reinforcing member 3 is formed of a long thin plate material. The reinforcing member 3 is formed by continuously connecting a circular portion 3 a extending along the inner hole 2 b of the cylindrical member 2 in the center line direction of the cylindrical member 2. The length along the center line of the reinforcing member 3 is set shorter than the length along the center line of the cylindrical member 2. The reinforcing member 3 is disposed in the middle portion of the cylindrical member 2 in the center line direction. Therefore, as shown in FIGS. 2 and 3, the oral cavity side end portion of the cylindrical member 2 extends to the oral cavity side from the oral cavity side end portion of the reinforcing member 3, and the digestive organ side end portion of the cylindrical member 2 is It extends to the digestive organ side from the digestive organ side end of the reinforcing member 3. In addition, since the reinforcing member 3 is formed in a spiral shape in this way, the central portion in the center line direction of the cylindrical member 2 is continuously reinforced.

  The thin plate material is not particularly limited as long as it has elasticity and can prevent the cylindrical member 2 from being crushed and deformed. For example, a metal material such as stainless steel, polyamide, fluorine resin, or the like The hard resin material or the like can be used. As shown in FIG. 5, the width dimension W of the thin plate material is set to 1.50 mm to 5.50 mm and the thickness dimension T is set to 0.03 mm to 1.00 mm. In this embodiment, the thin plate material is made of SUS304, the width dimension W is about 4.00 mm, and the thickness dimension T is about 0.20 mm. By thinning the thin plate material, it becomes possible to reduce the thickness of the peripheral wall 2a of the cylindrical member 2, but since it becomes weak against the force in the crushing direction, within the above range, 0.05 mm or more 0 It is preferable to set it to 50 mm or less. Further, if the width W of the thin plate material is widened, it can be strengthened against the force in the crushing direction, but when the tubular member 2 is bent, the portion where the thin plate material exists is not bent and has a linear shape. The curved shape of the tubular member 2 is not smoothed and the insertion into the pharynx 100 may be difficult. Therefore, the width W of the thin plate material is preferably set to 2.00 mm or more and 5.00 mm or less in the above range in consideration of the difficulty of being crushed and the workability of insertion into the pharynx 100.

  Further, the separation dimension S between the adjacent circular portions 3a of the reinforcing member 3 is set to be about 1.00 mm. The separation dimension S of the circular portion 3a varies due to an error that occurs when the reinforcing member 3 is manufactured, or because the circular portion 3a is displaced due to the molten resin material flowing in the cavity of the molding die. The range is 0.50 mm or more and 1.50 mm or less. If the separation dimension S of the circular portions 3a is short, the circular portions 3a are densely arranged and become strong against the force in the crushing direction, but the resin material between the circular portions 3a is reduced. It becomes difficult to bend and deform. On the other hand, when the separation dimension S of the circular portion 3a is long, the circular portion 3a is sparsely arranged and weakens against the force in the crushing direction. Considering these, the separation dimension S of the circular portion 3a is within the above range.

  A case where the reinforcing member 3 configured as described above is integrated with the tubular member 2 will be described. First, the reinforcing member 3 is formed in advance. And the reinforcement member 3 is hold | maintained in the cavity of the shaping | molding die which shape | molds the cylindrical member 2. As shown in FIG. At this time, the reinforcing member 3 has a curved shape corresponding to the shape of the pharynx 100 as described above. Thereafter, a molten resin material is caused to flow into the cavity. The molten resin material flows so as to cover the outer surface and the inner surface of the reinforcing member 3, and also flows between the adjacent circular portions 3a to be solidified, whereby the reinforcing member 3 is insert-molded. Thereby, the reinforcing member 3 is embedded in the peripheral wall of the cylindrical member 2.

  As shown in FIG. 1, the first inner cylinder member 4 is formed in a cylindrical shape that can be inserted into the inner hole 2b. Moreover, the said 2nd inner cylinder member 5 is formed in the cylindrical shape which can be inserted in the 1st inner cylinder member 4, as shown also in FIG. The first inner cylinder member 4 and the second inner cylinder member 5 are molded from a resin material harder than the resin material constituting the cylindrical member 2. As shown in FIG. 6, the first inner cylinder member 4 and the second inner cylinder member 5 extend linearly. As shown in FIG. 1, the first inner cylinder member 4 and the second inner cylinder member 5 have flexibility to bend along the curved shape of the cylindrical member 2 in a state of being inserted into the inner hole 2 b. The outer diameter of the first inner cylinder member 4 is set slightly smaller than the inner hole 2b, and the first inner cylinder member 4 can be easily inserted into the inner hole 2b. Further, the outer diameter of the second inner cylinder member 5 is set slightly smaller than the inner diameter of the first inner cylinder member 4 so that the second inner cylinder member 5 can be easily inserted into the first inner cylinder member 4. It has become. The outer diameter of the second inner cylinder member 5 is set to be slightly larger than the inner diameter of the human pharynx 100 to be used by the auxiliary tool 1.

  The thickness of the peripheral walls 4 a and 5 a of the first inner cylinder member 4 and the second inner cylinder member 5 is set to be substantially the same as the thickness of the peripheral wall 2 a of the cylindrical member 2. The length of the first inner cylinder member 4 in the center line direction is set longer than the length of the cylindrical member 2 in the center line direction. The length of the second inner cylinder member 5 in the center line direction is set longer than the length of the first inner cylinder member 4 in the center line direction. Moreover, the oral cavity side edge part and digestive organ side edge part of the 1st inner cylinder member 4 and the 2nd inner cylinder member 5 are the same as the oral cavity side edge part and digestive organ side edge part of the said cylindrical member 2, respectively. Is formed. The outer surface and the inner surface of the first inner cylinder member 4 and the second inner cylinder member 5 may be coated in the same manner as the cylindrical member 2. Further, the first inner cylinder member 4 and the second inner cylinder member 5 may be formed in a curved shape similarly to the cylindrical member 2.

  As shown in FIG. 1, a recess 4 c is provided on the inner surface of the first guide member 4 on the oral cavity side, while the outer surface of the second guide member 5 is engaged with the recess 4 c on the outer surface of the oral cavity side. Protrusions 5b are provided. The convex portion 5b is positioned so that the digestive organ side end portion of the first guide member 4 and the digestive organ side end portion of the second guide member 5 substantially coincide with each other when engaged with the concave portion 4c. Yes.

  By engaging the concave portion 2c of the cylindrical member 2 with the convex portion 4b of the first guide member 4, the concave portion 4c of the first guide member 4 and the convex portion 5b of the second guide member 5 are engaged. The cylindrical member 2, the first guide member 4, and the second guide member 5 can be integrated. Thereby, when the auxiliary tool 1 is moved, it is possible to prevent the first guide member 4 and the second guide member 5 from falling out of the cylindrical member 2 and falling.

  Although not shown, a convex portion may be provided on the inner surface of the cylindrical member 2, and a concave portion that engages with the convex portion of the cylindrical member 2 may be provided on the outer surface of the first guide member 4. Further, a convex portion may be provided on the inner surface of the first guide member 4, and a concave portion that engages with the convex portion of the first guide member 4 may be provided on the outer surface of the second guide member 5. Moreover, the shape of these convex part and recessed part is not restricted to the shape shown in figure.

  Next, a case where a total gastrectomy operation for excising the stomach (not shown) affected by cancer is performed using the auxiliary tool 1 will be described. In this operation, an anastomosis device 20 as disclosed in, for example, JP-A-8-66406 is used as a medical instrument. First, the structure of the anastomosis device 20 will be described with reference to FIGS. The anastomosis device 20 includes a device main body 21 and a head 22 that can be attached to and detached from the device main body 21. The apparatus main body 21 is formed in a substantially cylindrical shape, and its outer diameter dimension is about 25 mm. As shown in FIG. 8A, a large number of slits 24 through which a metal stapler 23 (shown only in FIG. 10) is punched out are provided on the outer periphery of one end surface of the apparatus main body 21. An annular cutter 25 (shown only in FIG. 8) is disposed on the inner peripheral side of the slit 24 on one end surface of the apparatus main body 21. The cutting edge of the cutter 25 is located substantially on the same plane as the one end face of the apparatus main body 21.

  A recess 26 for accommodating a living tissue (described later) cut by the cutter 25 is formed on the inner peripheral side of the cutter body 25 on one end surface of the apparatus main body 21. The bottom surface of the recess 26 extends substantially orthogonal to the center line of the apparatus main body 21 as shown in FIG. A hole 27 extending in the center line direction of the apparatus main body 21 is provided at the center of the bottom surface, and an engagement rod 28 is inserted and held in the hole 27. The engagement rod 28 is formed to extend straight in the direction of the center line of the apparatus main body 21 using a metal material such as stainless steel. The intermediate portion in the longitudinal direction of the engagement rod 28 is formed to be narrower than the proximal end portion and the distal end portion of the engagement rod 28. The tip of the engagement rod 28 is sharply pointed.

  An actuator (not shown) for moving the engaging rod 28 back and forth in the center line direction is provided inside the apparatus main body 21. This actuator has a well-known structure that operates by supplying electric power. A connector 29 is provided at the other end of the apparatus main body 21. One end of a cord 30 for supplying power to the actuator is connected to the connector 29. The anastomosis device 21 includes a controller (not shown) for supplying power to the actuator, and the other end of the cord 30 is connected to the controller. When electric power is supplied to the actuator by the controller and the actuator retracts the engagement rod 28, the engagement rod 28 is pulled into the apparatus main body 21 and accommodated. When the actuator is operated from this state and the engagement rod 28 is advanced, the engagement rod 28 protrudes from the recess 26.

  A large number of staplers 23 are accommodated in the apparatus main body 21 corresponding to the slits 24. Each stapler 23 is formed in a substantially U-shape, and is arranged so that its open side faces outward from the slit 24. Furthermore, a drive-out mechanism (not shown) that drives out the stapler 23 by the operation of the actuator is housed inside the apparatus main body 21. This launching mechanism is also well known.

  The head 22 is generally formed in an umbrella shape. The head 22 includes a disk member 32 corresponding to the shape of one end surface of the apparatus main body 21, a protrusion 33 protruding in the center line direction from the center of the disk member 32, and a protrusion of the disk member 32. 33 and a bulging member 34 formed so as to bulge to the opposite side.

  The disc member 32 is formed by molding a metal material such as stainless steel. As shown in FIG. 8B, the disk member 32 has a number of recesses 35 corresponding to the slits 24 on the outer periphery of the surface facing the apparatus main body 21. The recess 35 is for pressing and bending the open side end portion of the stapler 23 driven out from the slit 24. Further, the cutting edge of the cutter 25 of the apparatus main body 21 is in contact with the inside of the recess 35 of the disk member 32.

  The protruding portion 33 is formed by forming a metal material similar to the disk member 32 into a cylindrical shape. An engagement hole 36 is formed on the opposite side of the protrusion 33 from the disk member 32. The engagement rod 28 is inserted into the engagement hole 36 and engaged therewith. That is, the protrusion 33 has an engagement mechanism (not shown) that engages with the intermediate portion in the longitudinal direction of the inserted engagement rod 28 to prevent the engagement rod 28 from coming out of the engagement hole 36. Is provided. The bulging member 34 is formed by molding a resin material, and is fixed to the disk member 32.

  Next, the point which inserts the cylindrical member 2 of the auxiliary tool 1 in the pharynx 100 is demonstrated. The cylindrical member 2 is inserted after the second inner cylinder member 5 and the first inner cylinder member 4 are inserted into the pharynx 100 with the patient facing upward. Specifically, first, the patient's mouth is opened, although not shown, the second inner cylinder member 5 is inserted into the oral cavity 102 from the digestive organ side of the second inner cylinder member 5 and pushed into the pharynx 100 as it is. At this time, the pointed portion of the second inner cylinder member 5 is directed toward the back side of the patient. The second inner cylinder member 5 is inserted until the end of the digestive organ side is located near the entrance of the esophagus 103. In a state where the second inner cylinder member 5 is completely inserted, the throat 100 is pushed and expanded by the second inner cylinder member 5 and the inner diameter is increased. The second inner cylinder member 5 is longer than the first inner cylinder member 4 and the cylindrical member 2, but can be inserted into the pharynx 100 relatively easily because it has a smaller diameter than these members 4 and 5.

  When the second inner cylinder member 5 is inserted into the pharynx 100, since the digestive organ side of the second inner cylinder member 5 is pointed, each tissue positioned so as to close the pharynx 100 It becomes possible to insert smoothly.

  Thereafter, the first inner cylinder member 4 is inserted into the pharynx 100 from the digestive organ side of the first inner cylinder member 4. In this case, first, the oral cavity side end of the second inner cylinder member 5 is inserted into the first inner cylinder member 4, and the first inner cylinder member 4 is moved along the second inner cylinder member 5 to the digestive organ side. I will let you. At this time, the first inner cylinder member 4 is guided by the second inner cylinder member 5. The first inner cylinder member 4 is inserted until the end of the digestive organ side is located near the end of the second inner cylinder member 5 on the digestive organ side.

  When the first guide member 4 is inserted into the pharynx 100, the concave portion 4c is provided in the first guide member 4, and the convex portion 5b is provided in the second guide member 5, so that the concave portion 4c and the convex portion 5b Are engaged, and the first guide member 4 does not move relative to the second guide member 5. At this time, the digestive organ side end portion of the first guide member 4 is substantially in the same position as the digestive organ side end portion of the second guide member 5. Thereby, the operator can grasp whether the insertion position of the second guide member 4 is accurate with reference to the second guide member 5 only by engaging the concave portion 4c and the convex portion 5b. it can.

  Further, in the state where the first inner cylinder member 4 is completely inserted as described above, the second inner cylinder member 5 is covered with the first inner cylinder member 4, and the pharynx 100 is covered by the first inner cylinder member 4. The inner diameter is further increased by being expanded.

  At this time, since the second inner cylinder member 5 is longer than the first inner cylinder member 4, the oral cavity side end portion of the second inner cylinder member 5 is protruded from the oral cavity side end portion of the first inner cylinder member 4. It is possible. Accordingly, the second inner cylinder member 5 can be easily grasped with a finger and easily pulled out from the oral cavity side end portion of the first guide member 4. In addition, the second inner cylinder member 5 can be easily pulled out by applying the coating to the inner surface of the first inner cylinder member 4 and the outer surface of the second inner cylinder member 5.

  Since the first inner cylinder member 4 and the second inner cylinder member 5 have a smaller diameter than the cylindrical member 2, the operation of inserting the first inner cylinder member 4 and the second inner cylinder member 5 into the pharynx 100 is performed. This is simpler than the case where the cylindrical member 2 is inserted into the pharynx 100. Moreover, since the 1st inner cylinder member 4 and the 2nd inner cylinder member 5 consist only of resin materials, they do not invade the structure | tissue of the oral cavity 102 or the pharynx 100. FIG.

  After removing the second guide member 5 from the first guide member 4, the cylindrical member 2 is inserted into the pharynx 100 from the digestive organ side of the cylindrical member 2, although not shown. In this case, first, the oral cavity side end portion of the first inner cylindrical member 4 is inserted into the inner hole 2b of the cylindrical member 2, and the cylindrical member 2 is moved along the first inner cylindrical member 4 to the digestive organ side. To go. At this time, the cylindrical member 2 is guided by the first inner cylindrical member 4. As shown in FIG. 4, the tubular member 2 is inserted until the end of the digestive organ side is located near the entrance of the esophagus 103.

  When the cylindrical member 2 is inserted into the pharynx 100, the concave portion 2c is provided in the cylindrical member 2, and the convex portion 4b is provided in the first guide member 4, so that the concave portion 2c and the convex portion 4b are engaged. As a result, the cylindrical member 2 does not move relative to the first guide member 4. At this time, the digestive organ side end portion of the tubular member 2 is substantially at the same position as the digestive organ side end portion of the first guide member 4. Thereby, the operator can grasp | ascertain whether the insertion position of the cylindrical member 2 is exact on the basis of the 1st guide member 4 only by engaging the recessed part 2c and the convex part 4b. .

  In the state where the cylindrical member 2 is completely inserted into the pharynx 100 as described above, the first inner cylindrical member 4 is covered with the cylindrical member 2 and the pharynx 100 is expanded by the cylindrical member 2. The inner diameter is further increased. Then, the 1st inner cylinder member 4 is pulled out from the oral cavity side edge part of the cylindrical member 2. FIG. Since the 1st inner cylinder member 4 is longer than the cylindrical member 2 at this time, it is possible to make the oral cavity side edge part of the 1st inner cylinder member 4 protrude from the oral cavity side edge part of the cylindrical member 2. Thus, when pulling out the first inner cylinder member 4, it can be easily grasped with a finger.

  When the cylindrical member 2 is inserted into the pharynx 100, the cylindrical member 2 is curved corresponding to the shape of the pharynx 100, so that the cylindrical member 2 and the reinforcing member 3 may be hardly deformed. . For this reason, the force required to insert the tubular member 2 and the reinforcing member 3 into the pharynx 100 can be reduced. In addition, since the cylindrical member 2 does not have to be deformed as such, the tubular member 2 is not crushed by the deformation, and the shape of the inner hole 2b is maintained.

  Further, by expanding the pharynx 100 with the cylindrical member 2, a force in the crushing direction acts on the cylindrical member 2, but the cylindrical member 2 is reinforced by the reinforcing member 3, so that it is crushed and deformed. Is suppressed.

  Since the reinforcing member 3 is made of a thin plate material extending along the circumferential direction of the inner hole 2b, the thickness of the reinforcing member 3 in the thickness direction of the peripheral wall 2a, that is, the thickness dimension T of the thin plate material is set as a conventional reinforcing member. In order to obtain a sufficient strength of the reinforcing member 3 by making the width W of the thin plate material longer than the wire diameter of the conventional wire material while making the peripheral wall 2a thinner by making the wire wall shorter than the wire diameter when the wire is made of wire. Is possible. Thereby, it becomes possible to suppress crushing deformation of the cylindrical member 2 while making the peripheral wall 2a of the cylindrical member 2 thin. Therefore, the size of the insertion space R of the medical instrument configured by the inner hole 2b of the cylindrical member 2 is maintained so that the apparatus main body 21 having a larger diameter than a general endoscope can be inserted. Is possible.

  Further, after gradually increasing the inner diameter of the pharynx 100 with the second inner cylinder member 5 and the first inner cylinder member 4 having a smaller diameter than the cylindrical member 2, the cylindrical member 2 is inserted into the pharynx 100. Since it was made, the insertion force of the cylindrical member 2 can be made small. In addition, since the tubular member 2 is inserted into the pharynx 100 after gradually expanding the pharynx 100 as described above, the patient is compared with the case where the tubular member 2 is suddenly inserted into the pharynx 100. The invasion to is also reduced.

  On the other hand, the abdomen of the patient is opened to cut the vicinity of the boundary between the esophagus 102 and the stomach, and the vicinity of the boundary between the small intestine 106 and the stomach is cut to remove the stomach.

  And as shown in FIG. 11, the apparatus main body 21 of the said anastomosis apparatus 20 is inserted into the inner hole 2b from the oral cavity side edge part of the cylindrical member 2. As shown in FIG. At this time, by pushing the cord 30 into the inner hole 2b, the apparatus main body 21 is guided to the esophagus 103 by the inner hole 2b and is inserted to the vicinity of the open end of the esophagus 103 as shown in FIG. Then, the engagement rod 28 of the apparatus main body 21 is protruded from the open end of the esophagus 103, and the open end of the esophagus 103 is tied to the base end portion of the engagement rod 28 with the thread 40 and held.

  The head 22 is inserted into the small intestine 106 from the open end of the small intestine 106. The protruding portion 33 of the head 22 is protruded outward from the peripheral wall of the small intestine 106, and the engaging rod 28 is inserted into the engaging hole 36 of the protruding portion 33 and engaged. Thereafter, by supplying electric power to the apparatus main body 21 by the controller, as shown in FIG. 10, the engaging rod 28 is drawn into the apparatus main body 21 so that the head 22 comes close to the apparatus main body 21. The peripheral wall is in contact with the peripheral wall of the small intestine 106.

  The stapler 23 is driven out from the slit 24 of the apparatus main body 21 in a state where the head 22 is close to the apparatus main body 21. The stapler 23 penetrates the peripheral wall of the esophagus 103 and the peripheral wall of the small intestine 106, reaches the recess 35 of the head 22, and is bent, so that the esophagus 103 and the small intestine 106 are anastomosed. At the time of this anastomosis, the cutter 25 of the apparatus main body 21 abuts on the disc member 32 of the head 22, and the inner side of the anastomosis part between the peripheral wall of the esophagus 103 and the peripheral wall of the small intestine 106 is excised, and the recess 26 of the apparatus main body 21 is formed. Be contained. Although not shown, the open end of the small intestine 106 is separately closed with a suture or the like.

  After the anastomosis between the esophagus 103 and the small intestine 106 is completed, the cord 30 protruding from the oral cavity side end of the tubular member 2 is pulled. As a result, the apparatus main body 21 and the head 22 can be extracted from the esophagus 103 through the inner hole 2b of the cylindrical member 2 in a state where the apparatus main body 21 and the head 22 are integrated. After the apparatus main body 21 and the head 22 are extracted from the esophagus 103, the cylindrical member 2 is extracted from the pharynx 100.

  Therefore, according to this embodiment, the tubular member 2 is placed on the pharynx 100 and the apparatus main body 21 is guided to the vicinity of the exit of the esophagus 103 by the tubular member 2, so that the neck and chest are cut open. The apparatus main body 21 can be inserted into the esophagus 103 without any problems. Thereby, when using the anastomosis apparatus 20 by total gastrectomy operation, a patient's incision location can be decreased.

  Further, since the reinforcing member 3 is composed of a thin plate material extending along the circumferential direction of the inner hole 2b of the cylindrical member 2, the thickness of the peripheral wall 2a of the cylindrical member 2 is reduced while suppressing the deformation of the cylindrical member 2. It can be made thin and the insertion space R of the apparatus main body 21 can be secured widely. Moreover, since the cylindrical member 2 and the reinforcing member 3 are curved so as to correspond to the shape of the pharynx 100, the force required when inserting the cylindrical member 2 and the reinforcing member 3 into the pharynx 100 is small. In addition, the workability at the time of inserting the cylindrical member 2 into the pharynx 100 can be improved, and the invasion given to the patient can be reduced.

  In addition, since the pharynx 100 is gradually enlarged by the first inner cylinder member 4 and the second inner cylinder member 5, the cylindrical member 2 is inserted into the pharynx 100, so that the invasion to the patient is suppressed. A wide insertion space R of the apparatus main body 21 can be ensured, and workability when the cylindrical member 2 is inserted into the pharynx 100 can be further improved.

  Moreover, since the resin material which comprises the said 1st guide member 4 and the 2nd guide member 5 is harder than the resin material which comprises the cylindrical member 2, in the state which inserted these guide members 4 and 5 in the pharynx 100, The amount of the guide members 4 and 5 being crushed and deformed can be reduced, and the pharynx 100 can be effectively enlarged. And since the cylindrical member 2 larger in diameter than the first guide member 4 is made of a resin material softer than the resin material of the guide member 4, the invasion given to the patient can be further reduced.

  Further, since the reinforcing member 3 is formed in a spiral shape, the center part in the center line direction of the cylindrical member 2 can be continuously reinforced, and the shape of the inner hole 2b is the desired shape over both sides in the length direction. Can be maintained.

  As shown in FIG. 12, the anastomosis device 20 can also be used when treating a stenosis 110 formed near the exit of the esophagus 103, for example. The narrowed portion 110 is made of a tumor that swells from the inner wall of the esophagus 103 toward the center of the esophagus 103. When the stenosis 103 is treated, the cylindrical member 2 is inserted into the pharynx 100 as in the case of the total gastrectomy, and the apparatus body 21 is inserted to the vicinity of the exit of the esophagus 103 by the cylindrical member 2. To do. At this time, the tube 111 thinner than the cord 30 of the apparatus main body 21 is inserted to the vicinity of the exit of the esophagus 103 by the cylindrical member 2 similarly to the apparatus main body 21. In the tube 111, a thread 112 to be tied to the protruding portion 33 of the head 22 is inserted from the oral cavity side of the tube 111.

  On the other hand, after opening the patient, the head 22 incises the wall portion of the stomach 105 and inserts it into the stomach 105. When inserting the head 22 into the stomach 105, the end of the thread 112 is tied to the protrusion 33 of the head 22. By inserting the head 22 into the stomach 105 and then pulling the thread 112 from the oral cavity side, the protruding portion 33 of the head 22 faces the apparatus main body 21 side. In this state, the engagement rod 28 is inserted into the engagement hole 36 of the protrusion 33 to be engaged. Thereafter, by supplying power to the apparatus main body 21 by the controller, the engagement rod 28 is pulled into the apparatus main body 21 and the head 22 is brought into a state of being close to the apparatus main body 21. As a result, the narrowed portion 110 of the esophagus 103 is sandwiched between the disc member 32 of the head 22 and the cutter 25 and is excised by the cutter 25. The excised part is accommodated in the recess 26 of the apparatus main body 21. Thereafter, the apparatus main body 21 and the head 22 are integrated with each other and pulled out from the esophagus 103 through the inner hole 2b of the cylindrical member 2.

  When it is necessary to insert two medical instruments of the apparatus main body 21 and the tube 111 into the esophagus 103 as in the treatment of the stenosis 110, the use of the assisting tool 1 facilitates the procedure and provides the patient. Can be reduced.

  As shown in FIG. 13, the auxiliary device 1 of the present invention can also be used when removing a tumor 116 formed on the inner wall of the stomach 105 using a resection tool 115 that can be inserted into the digestive organ. It is. The excision tool 115 is conventionally used in the medical field, and a scissors-type blade 117 is attached to the distal end portion in the insertion direction into the digestive organs, and the proximal end portion is used to operate the blade 117. The operation unit (not shown) is provided. When the tumor 116 is excised using the excision tool 115, the excision tool 115 is first passed through the esophagus 103 by the tubular member 2 through the esophagus 103 in the same manner as when the apparatus main body 21 is inserted in the stomach excision operation. Insert up to 105. The position of the distal end portion of the resecting tool 115 can be adjusted by operating the proximal end portion of the resecting tool 115 from outside the oral cavity 102. When adjusting the position of the resection tool 115, the resection tool 115 itself is moved, but the resection tool 115 does not move within the cylindrical member 2 and rub the inner wall of the pharynx 100. The burden on the patient can be reduced. And after positioning the front-end | tip part of the excision tool 115 in the vicinity of the tumor 116, the blade 116 is operated by the operation part, and the tumor 116 is excised. The excised tumor 116 is held at the distal end of the excision tool 115. In this state, the resection tool 115 is removed from the stomach 105.

  When the tumor 116 of the stomach 105 is excised, an endoscope (not shown) may be inserted into the stomach 105 in addition to the excision tool 115. In this way, when two medical instruments are inserted into the stomach 105, the assisting tool 1 is used to facilitate the procedure and reduce the burden on the patient.

  Further, as shown in FIG. 14, the tumor 116 (shown in FIG. 13) of the stomach 105 may be excised with a medical instrument in which a small blade 117 is integrated with an endoscope 119. This endoscope 119 has been used in the medical field from the past, and the distal end portion in the insertion direction is enlarged in diameter. As described above, even when the endoscope 119 having a larger tip than the conventional one is inserted up to the stomach 105, the use of the auxiliary tool 1 facilitates the procedure and reduces the burden on the patient.

  As shown in FIG. 15, the auxiliary device 1 of the present invention can also be used when resecting early gastric cancer 120 formed in the mucous membrane of the stomach 105 using a resecting device 115 that can be inserted into the digestive organ. Is possible. When excising this early gastric cancer 120, first, a small incision is made without opening the abdomen of the patient, and two pins 121 are inserted into the abdominal cavity from this incision using an insertion tool (not shown). These pins 121 are inserted into the stomach 105 through the wall of the stomach 105 and pierce the mucous membrane 122 near the cancer 120. A thread 123 is tied to the pin 121, and an end of the thread 123 opposite to the pin 121 is brought out of the abdominal cavity through an incision in the abdomen. The excision tool 115 is the same as the excision tool 115 used when the tumor 116 of the stomach 105 is excised, and is inserted into the stomach 105 like the excision tool 115. Then, when the thread 123 is pulled outside the abdominal cavity and the mucosa 122 in the vicinity of the cancer 120 is pulled to the inside of the stomach 105, the mucosa 122 becomes a raised shape. By excising the raised portion of the mucous membrane 122 with the blade 117 of the excision tool 115, the early gastric cancer 120 can be excised.

  As described above, in general, in early gastric cancer, only the cancer 120 is formed on the mucosa 122 of the stomach 105, and it is not necessary to remove the wall of the stomach 105. By inserting the resection tool 115 into the stomach 105 as described above, it is possible to remove the early gastric cancer 120 in a minimally invasive manner simply by forming a small hole through the pin 121 in the wall of the stomach 105. .

  As shown in FIG. 16, the assisting device 1 of the present invention can also be used when a stent 125 is placed in the esophagus 103. In the placement of the stent 125, first, the stent 125 is inserted up to the place in the esophagus 103 to be placed. Thereafter, a pin 126 for fixing the stent 125 to the inner wall of the esophagus 103 and a rod-like member 127 as a medical instrument for inserting the pin 126 into the esophagus 103 are inserted into the esophagus 103 by the tubular member 2. Then, after the puncture portion of the pin 126 is directed from the inside of the stent 125 to the inner wall of the esophagus 103, the head of the pin 126 is pressed toward the outside of the esophagus 103 by the rod-shaped member 127, and the puncture portion of the pin 126 is pressed against the stent 125. Is inserted into the esophagus 103. Thereby, the stent 125 can be placed at a predetermined position of the esophagus 103.

  Moreover, the said auxiliary tool 1 can be used also when inserting medical instruments, such as a catheter, into a digestive organ, for example.

  Moreover, in the said embodiment, although the reinforcement member 3 is insert-molded in the cylindrical member 2, you may make it assemble | attach the reinforcement member 3 to the cylindrical member 2 shape | molded previously.

  Further, in the above embodiment, the cylindrical member 2 is inserted after the throat 100 is gradually expanded in diameter by the first inner cylindrical member 4 and the second inner cylindrical member 5. The cylindrical member 2 may be inserted after expanding the diameter of the pharynx 100 with the cylindrical member.

  As described above, the living body insertion aid 1 for a medical instrument according to the present invention is suitable for inserting, for example, an anastomosis device for anastomosing digestive organs from the oral cavity to the digestive organ.

It is sectional drawing of the auxiliary tool which concerns on embodiment of this invention. It is a side view of a cylindrical member. It is sectional drawing of a cylindrical member. It is a figure which shows the state which indwelled the cylindrical member in the larynx of the patient who fell on his back. It is a perspective view of a reinforcing member. It is sectional drawing of a 1st inner cylinder member and a 2nd inner cylinder member. It is a side view of an anastomosis apparatus. (A) is the figure which looked at the apparatus main body from the head side, (b) is the figure which looked at the head from the apparatus main body side. It is a figure which shows the state which inserted the apparatus main body into the esophagus and inserted the head into the small intestine. It is a figure which shows the state which anastomosed the edge part of the esophagus, and the edge part of the small intestine. It is a figure which shows the state which inserted the apparatus main body into the esophagus with the cylindrical member. It is a figure explaining the case where the constriction part of an esophagus is excised using an anastomosis apparatus. It is a figure explaining the case where the tumor of a stomach is excised using an excision tool. It is a figure which shows the state which inserted the endoscope integral with the blade for excision into the stomach. It is a figure explaining the case where early gastric cancer is resected using a resecting tool. It is a figure explaining the case where a stent is detained in an esophagus.

DESCRIPTION OF SYMBOLS 1 Auxiliary tool 2 Cylindrical member 2b Inner hole 3 Reinforcement member 4 1st inner cylinder member 5 2nd inner cylinder member 21 Apparatus main body (medical instrument)
100 pharynx 102 oral cavity 103 esophagus (digestive organ)

Claims (3)

A cylindrical member in which an inner hole through which a medical instrument can be inserted is formed across both ends;
A reinforcing member that is embedded in the peripheral wall portion of the cylindrical member and reinforces the cylindrical member;
In the living instrument insertion assisting device configured to guide the medical instrument to the digestive organ through the inner hole in a state where the medical instrument is inserted into the pharynx from the oral cavity of the living body,
The inner cylindrical member is formed with a smaller diameter than the inner hole of the cylindrical member, and is inserted into the inner hole and is also inserted into the pharynx and can be placed , and the inner cylindrical member is more than the cylindrical member. It is inserted into the pharynx ahead of time and is guided when the cylindrical member is inserted into the pharynx.
The outer diameter of the cylindrical member is formed larger than the usual pharynx so as to expand and expand the pharynx of the living body,
The reinforcing member is a thin plate material formed in a spiral shape continuously extending in the center line direction of the cylindrical member, and the thickness direction of the thin plate material coincides with the thickness direction of the peripheral wall portion of the cylindrical member. And
The tubular member and the reinforcing member are curvedly formed corresponding to the shape of the pharynx of a living body, and the living body insertion aid for a medical instrument. The assisting instrument for inserting a living body of the medical instrument according to claim 1,
The end of the cylindrical member on the digestive organ side extends to the digestive organ side of the end of the reinforcing member on the digestive organ side. The assisting instrument for inserting a living body of the medical instrument according to claim 1,
The end of the tubular member on the digestive organ side is inclined with respect to the center line of the inner hole.

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