JP5615112B2 - Organ fixing device and organ fixing device - Google Patents

Description

  The present invention relates to an organ fixing tool for holding a built-in wall such as a stomach or a bladder from the outside of the body to the abdominal wall side and an introducing tool for the organ fixing tool.

  For example, when a gastrostomy is constructed by percutaneous endoscopic gastrostomy (PEG), it is necessary to form a through-hole penetrating the patient's abdominal wall and visceral wall. And in order to perform this through-hole formation easily, the technique which fixes the internal organ wall which is easy to move to an abdominal wall is proposed.

  Conventionally, as a technique for fixing the visceral wall and the abdominal wall, `` a puncture needle for inserting a suture system, and a puncture needle for grasping a suture system provided substantially in parallel with a predetermined distance from the puncture needle for inserting a suture system; A viscera comprising a stylet slidably inserted into the suturing system grasping puncture needle, and a fixing member to which the suturing system insertion puncture needle and the proximal end of the suturing system grasping puncture needle are fixed. A fixture has been proposed (see, for example, Patent Document 1).

  As another technique, there is an organ fixing technique using a so-called “T fastener”. When using this T-fastener, the T-fastener is housed in a hollow puncture needle that is an introduction tool for the T-fastener, and the puncture needle is punctured in order on the abdominal wall and the visceral wall. Then, the T fastener is released from the puncture needle within the visceral wall, and only the puncture needle is removed. If it does in this way, a T fastener will remain in a visceral wall, and a visceral wall and an abdominal wall can be fixed by pulling the thread | yarn of a T fastener from the body surface side (for example, refer patent document 2).

Japanese Unexamined Patent Publication No. 04-226643 (page 3, page 4, FIG. 1) JP 2000-511785 (page 7, pages 9-12, FIG. 5)

  When using the visceral fixing device described in Patent Document 1, the suture is delivered within the visceral wall using two puncture needles, and both ends of the suture taken out on the body surface side are ligated. Fix the visceral and abdominal walls. Since such a procedure has many procedures and is complicated, time is required for technical skill.

  When the T fastener described in Patent Document 2 is used, when fixing of the visceral wall becomes unnecessary, the thread of the T fastener is cut and the rod of the T fastener is dropped into the viscera such as the stomach. For this reason, the rod that has fallen into the internal organs remains in the body until it is excreted. The rod dropped into the internal organs can be recovered using, for example, an endoscope. However, it is troublesome for the operator and is invasive and has a heavy burden on the patient.

  Further, in order to effectively fix the visceral wall, it is necessary to fix it at a plurality of points. For example, when fixing the stomach wall, it is usually fixed at four points. For this reason, when using any technique of patent documents 1 and 2, it was necessary to repeat the same technique 4 times, and time and labor were required for the technique.

  The present invention has been made to solve the above-described problems, and can fix an organ in a short time with a simpler technique, and can easily collect a used organ fixing device. It is intended to provide an organ fixing tool that can be used. Moreover, the introduction tool of this organ fixing tool is provided.

The organ fixing device introducer according to the present invention has a first rod and a second rod, one end connected to the substantially central position in the axial direction of the first rod, and the other end connected to a substantially central position in the axial direction of the second rod. A lifting thread connecting the first rod and the second rod, a first pulling thread connected to one axial end of the first rod, and a second pulling connected to one axial end of the second rod An organ fixing device including a thread , two puncture needles having a lumen, a needle holding member that holds the two puncture needles at a predetermined distance from each other, and two And an extruding member configured by connecting upper portions of two extruding rods that can penetrate the lumen of the puncture needle .

Introducer of organ-fixing instrument pertaining to the present invention, the rod of the organ-fixing instrument is constituted by a hollow member, connects the lifting yarn and a pull-out string of two within the hollow portion of the rod of the organ-fixing instrument, two and pull-out string with lifting yarn is one that is composed of one thread member.

The organ fixing tool introduction tool according to the present invention is an organ fixing tool provided with a length adjusting mechanism for adjusting the length of the lifting thread.

The introducer of the organ fixing device according to the present invention includes a threading portion that holds the thread fed from the distal end of the puncture needle at a position closer to the proximal end than the distal end of the puncture needle .

The organ fixing device according to the present invention has a first rod and a second rod, one end connected to an approximately central position in the axial direction of the first rod, and the other end connected to an approximately central position in the axial direction of the second rod. A lifting thread connecting the first rod and the second rod, a first pulling thread connected to one axial end of the first rod, and a second pulling thread connected to one axial end of the second rod; It is provided with two elastic materials through which the lifting thread is inserted .

In the organ fixing device according to the present invention , the rod is constituted by a hollow member, and the two drawn yarns and the lifting yarn are connected to each other by connecting the lifting yarn and the two drawing yarns in the hollow portion of the rod. It is composed of a thread member .

  According to the organ fixing device according to the present invention, since the first rod and the second rod are connected by the lifting thread, two points can be fixed by one procedure, and the organ can be fixed quickly. In addition, the used organ fixing tool can be easily taken out of the body by pulling the pull-out thread from the outside of the body.

  According to the organ fixing device according to the present invention, the lifting thread and the two lead-out threads can be constituted by a single thread. For this reason, the number of parts of the organ fixing device can be reduced.

  According to the organ fixing device according to the present invention, the length of the lifting thread can be adjusted, so that the organ can be fixed with the lifting thread having a more appropriate length that matches the patient's body shape. In addition, it is not necessary to arrange other types of lifting threads that match the patient's body shape.

  According to the organ fixing device of the present invention, when the organ is fixed, the elastic material comes into contact with the patient's body surface, so that the force for fixing the organ can be made substantially constant by the repulsive force of the elastic material. For this reason, the organ can be fixed with an appropriate force regardless of the skill and skill level of the operator.

  According to the organ fixing device introduction device of the present invention, the organ fixing device can be introduced into the organ by puncturing the patient with two puncture needles in one procedure. For this reason, the organ can be quickly fixed, and the labor of the operator can be reduced and the burden on the patient can be reduced.

  According to the organ fixing device introducing tool of the present invention, the thread feeding portion that holds the thread fed from the distal end of the puncture needle at a position closer to the proximal end than the distal end of the puncture needle is provided. For this reason, when puncturing a patient with a puncture needle, the thread | yarn sent out from the front-end | tip of a puncture needle does not interfere with puncture. Further, it is possible to prevent the thread from falling off from the tip of the puncture needle.

2 is a schematic cross-sectional view of the organ fixing device according to Embodiment 1. FIG. FIG. 3 is an external view of an organ fixing tool introduction tool according to Embodiment 1. FIG. 3 is a perspective view of an introducer of the organ fixing tool according to Embodiment 1. FIG. 6 is a diagram for explaining a state where an organ fixing tool is mounted on the introduction tool according to the first embodiment. It is a principal part enlarged view of FIG. FIG. 6 is a cross-sectional view of a main part for explaining a state in which the organ fixing tool is mounted on the introducing tool according to the first embodiment. It is a figure explaining the usage method of the organ fixing tool which concerns on Embodiment 1, and its introduction tool. FIG. 6 is a diagram for explaining a method for taking out an organ fixing device according to the first embodiment. It is a figure explaining the organ fixing tool which concerns on Embodiment 2. FIG. FIG. 10 is a diagram for explaining a state in which an organ fixing tool is attached to the introducing tool according to the third embodiment. It is a figure explaining the organ fixing tool which concerns on Embodiment 3. FIG.

Embodiment 1 FIG.
In the first embodiment, an organ fixing tool and an organ fixing tool introduction tool will be described by way of example of fixing the stomach wall to the abdominal wall.

[Organ fixation device]
1 is a schematic cross-sectional view of an organ fixing device according to Embodiment 1. FIG.
As shown in FIG. 1, the organ fixing device 100 includes two rods 1a and 1b, a lifting thread 2 connected to the rod 1a and the rod 1b, and a drawn thread 3a connected to one axial end of the rod 1a. And a lead-out thread 3b connected to one axial end of the rod 1b. Since the rod 1a and the rod 1b have the same configuration, they may be collectively referred to as the rod 1 in some cases. Further, since the lead-out yarn 3a and the lead-out yarn 3b have the same configuration, they may be collectively referred to as the lead-out yarn 3 in some cases. Further, the rods 1a and 1b correspond to the first rod and the second rod of the present invention, respectively, and the drawn yarn 3a and the drawn yarn 3b correspond to the first drawn yarn and the second drawn yarn of the present invention, respectively.

  The rod 1 is a rod-shaped member made of a material having rigidity such as stainless steel. A lifting thread 2 is connected to a substantially central position in the axial direction of the rod 1, and a pulling thread 3 is connected to one end (hereinafter referred to as a pulling end 12) of both ends in the axial direction of the rod 1. Yes. Both ends of the rod 1 are rounded by chamfering. By doing in this way, it can control that living tissue, such as a visceral wall, is damaged at the time of lifting, and it becomes easy to pull out the rod 1 from the visceral wall when collecting the rod 1.

  The lifting thread 2 and the lead-out thread 3 are made of a material (for example, nylon thread) having a flexibility that can be bent along the living tissue when inserted into the living body and a tensile strength that can lift the internal organs. ). In addition, the lifting thread 2 and the withdrawal thread 3 are cut when the organ fixing device 100 is attached to or removed from the patient, as will be described in detail later. For this reason, it is preferable that the lifting thread 2 and the withdrawal thread 3 are made of a material and a diameter that can be cut by a tool provided in a medical field such as scissors.

  In the first embodiment, the lifting thread 2 and the lead-out threads 3a and 3b connected to the rods 1a and 1b are constituted by one suture thread 4, respectively. As shown in FIG. 1, in the first embodiment, the inside of the rod 1 is hollow, and both ends of the rod 1 are open. Further, a through hole 11 orthogonal to the axial direction is provided in the central portion of the rod 1 in the axial direction. One suture thread 4 is inserted between the through hole 11 and the leading end 12. With the suture thread 4 penetrated, the portion between the through hole 11 and the lead-out end 12 of the rod 1 is pressed and recessed to form the fixing portion 13, thereby fixing the suture thread 4 to the rod 1. ing. The method of fixing the suture thread 4 to the rod 1 is not limited to this. For example, a knot is formed on the suture thread 4 on the outside of the through hole 11 and the outside of the lead-out end 12 so that the suture thread 4 is attached to the rod. Any method such as fixing to 1 can be used. Further, in the first embodiment, an example in which the lifting thread 2 and the two pulling threads 3a and 3b are configured by one suture thread 4 is shown, but the lifting thread 2 and the pulling threads 3a and 3b are not connected. These may be configured individually.

[Introduction tool]
Next, an introduction tool 200 for introducing the organ fixing tool 100 to a patient will be described.
2 is an external view of the introduction tool 200 according to Embodiment 1, and FIG. 3 is a perspective view of the introduction tool 200. FIG. As shown in FIGS. 2 and 3, the introducer 200 includes two puncture needles 21a and 21b, needle holding members 31a and 31b for holding the puncture needles 21a and 21b, a thread hooking portion 32, and an extrusion member. 33. Since puncture needle 21a and puncture needle 21b have the same configuration, they may be collectively referred to as puncture needle 21 in some cases.

  The puncture needle 21 is made of stainless steel, for example, and has a lumen into which the rod 1 and the withdrawal thread 3 of the organ fixing device 100 can be inserted. Near the distal end of the puncture needle 21 is formed a puncture portion 22 that is sharply cut so that the puncture needle 21 can be cut obliquely to pierce the abdominal wall or organ of the living body. In the example shown in FIGS. 2 and 3, the blade surface of the puncture portion 22 of the puncture needle 21a and the blade surface of the puncture portion 22 of the puncture needle 21b face the same direction, but both blade surfaces may face each other. Moreover, the double-edged surface may face in any direction. Further, the peripheral wall of the puncture needle 21 is cut out from the proximal end portion of the puncture portion 22 along the axial direction of the puncture needle 21 to form a cutout portion 23.

  The needle holding member 31 holds the two puncture needles 21a and 21b in a state where they are separated from each other by a predetermined distance in a substantially parallel manner so that the tip position of the puncture portion 22 is substantially the same position. In the first embodiment, the needle holding member 31 is constituted by the two needle holding members 31a and 31b. The needle holding members 31a and 31b are made by molding a material such as synthetic resin into a rectangular parallelepiped, and the puncture needles 21a and 21b pass through the needle holding members 31a and 31b, respectively. That is, the two needle holding members 31a and 31b and the two puncture needles 21a and 21b are in a state of being assembled in a cross beam. The needle holding member 31a holds the proximal end sides of the puncture needle 21a and the puncture needle 21b, and the needle holding member 31b holds the puncture needle 21a and the puncture needle 21b at a portion closer to the tip than the needle holding member 31a.

  It is preferable to provide the distance between the needle holding member 31a and the needle holding member 31b so that the swinging of the puncture needles 21a and 21b can be suppressed. Further, the needle holding members 31a and 31b are portions to be held when the operator punctures the patient with the puncture needles 21a and 21b. For this reason, by adjusting the arrangement of the needle holding member 31a and the needle holding member 31b so that the upper end of the needle holding member 31a and the lower end of the needle holding member 31b can be gripped by the thumb and the other four fingers. , Handling by the surgeon can be facilitated.

  In the first embodiment, the puncture needles 21a and 21b are held by the two needle holding members 31a and 31b. However, the axial distal end and the proximal end of the puncture needles 21a and 21b swing. The needle holding member can be configured with an arbitrary shape and an arbitrary number of members as long as it can be suppressed.

The push-out member 33 includes two push-out bars 34a and 34b and a connecting portion 35 that connects the two at the upper part of the push-out bars 34a and 34b. The push rods 34a and 34b have the same configuration and may be collectively referred to as the push rod 34.
The push rod 34 is a rod-shaped member for releasing the rod 1 inserted into the lumen of the puncture needle 21 from the puncture portion 22 of the puncture needle 21. The push rod 34 has an outer diameter that can pass through the lumen of the puncture needle 21. By pushing the push rod 34 from the proximal end side toward the distal end side of the puncture needle 21, the rod 1 inserted into the lumen of the puncture needle 21 is released from the puncture portion 22 of the puncture needle 21. The material of the push-out bar 34 is not particularly limited, but a material such as stainless steel having such a hardness that the rod 1 in the puncture needle 21 can be pushed and pushed out can be used.

  The connecting portion 35 connects the push bar 34a and the push bar 34b at the upper part thereof so that both can be handled as a unit. The connecting portion 35 also functions as an operation portion that is pressed when the surgeon pushes the push bar 34 into the puncture needle 21. Therefore, it is preferable to form the outer surface of the connecting portion 35 smoothly so that the surgeon can easily press it by hand. In addition, a wide part that can receive the operator's finger when pressed may be formed in the connecting portion 35, and the operability of the operator can be improved in this way. In the first embodiment, the extruding bar 34a, the connecting portion 35, and the extruding bar 34b are integrally formed by bending one bar-like member substantially at a right angle. However, the extruding bars 34a, 34b, The connecting portion 35 may be composed of another member and connected by welding or the like. The connection position of the connecting portion 35 is preferably in the vicinity of the upper portions of the push-out bars 34a and 34b, but it is not always necessary to connect the upper ends of the push-out bars 34a and 34b.

  The threading portion 32 holds the lifting thread 2 fed from the distal end of the puncture needle 21 at a position closer to the proximal end than the distal end of the puncture needle 21 when the organ fixing device 100 is attached to the introducer 200. belongs to. In the first embodiment, a rectangular parallelepiped threading portion 32 protruding in a direction orthogonal to the axial direction of the puncture needle 21 is provided on the surface of the needle holding member 31. The shape of the thread hook portion 32 is not particularly limited, and may be any shape as long as the lifting thread 2 can be held so as not to fall down when the puncture needle 21 is pierced into a patient. Also good. Moreover, it is preferable that the yarn hooking portion 32 is configured in a position or shape that allows the lifting thread 2 fed from the tip of the puncture needle 21 to be held in a moderately tensioned state. By doing so, it is possible to prevent the lifting thread 2 from unintentionally dropping from the threading portion 32 when handling the introducer 200 to which the organ fixing tool 100 is attached.

[A state where the organ fixation device is attached to the introduction device]
Next, a state where the organ fixing tool 100 is mounted on the introduction tool 200 will be described. 4 is a diagram for explaining a state where the organ fixing tool 100 is mounted on the introducer 200, FIG. 5 is an enlarged view of a main part of FIG. 4, and FIG. 6 is a diagram for explaining a state where the organ fixing tool 100 is mounted on the introducer 200. It is a principal part cross-sectional schematic diagram. For the sake of explanation, the pushing member 33 is not shown in FIG.

  As shown in FIGS. 4 to 6, the rods 1 a and 1 b are inserted into the lumens of the puncture needles 21 a and 21 b in the vertical direction so that the axial direction thereof coincides with the axial direction of the puncture needle 21. The rod 1 is inserted into the puncture needle 21 in a direction in which the lead-out end 12 faces the distal end side of the puncture needle 21. The withdrawal threads 3a and 3b extending from the withdrawal end 12 of the rods 1a and 1b are folded back in the vicinity of the withdrawal end 12 and inserted into the lumens of the puncture needles 21a and 21b toward the proximal side in the axial direction. The lifting thread 2 connected to the rods 1 a and 1 b is pulled out of the puncture needle 21 from a notch 23 provided in the puncture needle 21 and is hooked on the thread hook 32.

  Since the puncture needle 21 is provided with a notch 23, the rod 1 is pushed into the puncture needle 21 until the through hole 11 to which the lifting thread 2 is connected substantially coincides with the base end of the notch 23. Can do. For this reason, the rod 1 can be accommodated in the puncture needle 21 without the rod 1 protruding from the blade surface of the puncture needle 21. Moreover, since the notch 23 is provided, the lifting thread 2 can be pulled out from the notch 23 and the lifting thread 2 can be prevented from being cut by the blade surface of the puncture needle 21.

  In the first embodiment, as shown in FIG. 6, an example in which the rod 1 is inserted into the puncture needle 21 in a direction in which the pull-out end 12 of the rod 1 faces the distal end side of the puncture needle 21 is shown. The rod 1 can also be inserted into the puncture needle 21 in a direction toward the proximal end side of the puncture needle 21.

Here, the dimension of each part of the organ fixing device 100 and the introducing device 200 will be described.
For example, the rod 1 of the organ fixing device 100 has an outer diameter of about 0.6 mm and a length of about 10 mm.
The organ fixing device 100 fixes the internal wall (stomach wall) and the abdominal wall in the state shown in FIG. For this reason, the lifting thread 2 has a length shorter than the length obtained by adding the separation distance between the puncture needles 21a and 21b of the introducer 200 to twice the combined length of the built-in wall and the abdominal wall. Since the thickness of the built-in wall and the thickness of the abdominal wall vary depending on the patient, it is preferable to prepare a plurality of types of lifting threads 2 according to the patient's body shape. The lead-out thread 3 has a length obtained by adding together the thickness of the built-in wall, the thickness of the abdominal wall, 1/2 of the axial length of the rod 1 and the length that can be pinched with a finger or the like.

  The inner diameter of the puncture needle 21 of the introducer 200 is larger than the outer diameters of the rod 1 and the lead-out thread 3, and the length of the puncture needle 21 is, for example, about 70 mm to 150 mm. The distance between the puncture needle 21a and the puncture needle 21b is at least twice as long as 1/2 the axial length of the rod 1, and is, for example, about 10 mm to 15 mm. If the distance between the puncture needle 21a and the puncture needle 21b is too long, it will be difficult to secure the surgical field when puncturing the patient with the puncture needles 21a and 21b, and the effect of fixing the visceral wall and abdominal wall will be achieved. It will weaken. Conversely, if the distance between the puncture needle 21a and the puncture needle 21b is shorter than twice the length of the rod 1 in the axial direction, as shown in FIG. When the fixing tool 100 is fixed to a patient, the rod 1a and the rod 1b may be overlapped.

The length in the axial direction of the notch 23 of the puncture needle 21 is about ½ of the length of the rod 1 of the organ fixing device 100. The width of the notch 23 is a width that allows the lifting thread 2 to pass therethrough.
The length of the push-out bar 34 is such that the rod 1 inserted into the puncture needle 21 is released from the tip of the puncture needle 21 when the push-out bar 34 is pushed in from the proximal end side to the distal end side of the puncture needle 21. It must be at least long enough to be

[Internal wall fixing procedure]
Next, a method of using the organ fixing device 100 and the introducing device 200 when fixing the stomach wall to the abdominal wall will be described. FIG. 7 is a diagram for explaining a method of using the organ fixing device 100 and the introducing device 200 according to the first embodiment. In addition, as shown in FIGS. 4-6, it demonstrates as what is the state with which the organ fixing tool 100 was mounted | worn with the introduction tool 200. FIG.

  As shown in FIG. 7A, first, the puncture needles 21a and 21b of the introducer 200 to which the organ fixing device 100 is attached are punctured into the abdominal wall 41 and the stomach wall 42, and the puncture portion 22 reaches the stomach 43. Then, the lifting thread 2 is removed from the threading portion 32. When the puncture needle 21 is punctured, the lifting thread 2 drawn out from the notch 23 of the puncture needle 21 penetrates the abdominal wall 41 and the stomach wall 42 together with the puncture needle 21 and enters the stomach 43. Since the puncture needle 21 is provided with the notch 23 and the withdrawal thread 2 is pulled out from the notch 23, the puncture resistance when the withdrawal thread 2 is inserted into the body surface 44 can be reduced. Further, since the withdrawal thread 2 is pulled out from the notch 23, it is possible to prevent the withdrawal thread 2 from being cut by the blade surface of the distal end portion 22 of the puncture needle 21. Further, since the rod 1 is housed in the puncture needle 21 so that it does not protrude from the distal end portion 22 of the puncture needle 21, the rod 1 does not hinder puncture when puncturing with the puncture needle 21.

  Next, as shown in FIG. 7B, push-out bars 34a and 34b are inserted into the lumens of the puncture needles 21a and 21b. Then, by pressing the connecting portion 35 of the push-out member 33, the rods 1a and 1b inserted in the lumens of the puncture needles 21a and 21b are pushed by the tips of the push-out bars 34a and 34b. In this way, the rod 1 is fed out from the puncture portion 22 of the puncture needle 21. Since the lifting thread 2 is connected to the substantially central position of the rod 1 fed out from the puncture needle 21, the direction changes in a direction substantially perpendicular to the lifting direction of the lifting thread 2.

  Next, the puncture needles 21 a and 21 b are removed from the stomach wall 42 and the abdominal wall 41.

  When the puncture needles 21a and 21b are removed, the lifting thread 2 and the rod 1 form an inverted “T” shape as shown in FIG. Further, the withdrawal thread 3 inserted into the puncture needle 21 at the time of puncture comes out of the puncture needle 21 as the puncture needle 21 is removed, and penetrates the abdominal wall 41 and the stomach wall 42 along the lifting thread 2. The leading end of the lead-out thread 3 comes out to the body surface 44 side. Thus, the abdominal wall 41 and the stomach wall 42 are fixed at two points by the two rods 1a and 1b and the lifting thread 2.

  As shown in FIG. 6, in the first embodiment, the rod 1 is inserted into the puncture needle 21 in a direction in which the withdrawal end 12 of the rod 1 faces the distal end side of the puncture needle 21. The lead-out thread 3 extending from is folded back and inserted into the puncture needle 21. For this reason, while the organ fixing device 100 is mounted on the introducing device 200, the lead-out thread 3 is attached along the rod 1. Therefore, when the puncture needle 21 is removed, the lead-out thread 3 does not spread and the rod 1 can be placed in the stomach 43 with the lead-out thread 3 substantially along the rod 1.

  Moreover, the stomach wall 42 can be pulled up to the abdominal wall 41 side by pulling the lifting thread 2 coming out on the body surface 44. Since the thickness of the patient's abdominal wall 41 varies from person to person, even if the lifting thread 2 is pulled toward the body surface 44 in accordance with the thickness of the abdominal wall 41 and the lifting thread 2 on the body surface 44 side is ligated in a properly pulled state, Good. It should be noted that it is preferable to cut the lead-out thread 3 that has come out on the body surface 44 side at a position close to the body surface 44. By doing in this way, it can control that the drawer | drawing-out thread | yarn 3 is pulled accidentally from the body surface side, or an object is caught in the drawer | draw-out thread | yarn 3.

[Procedure for removing organ fixator]
A procedure for taking out the organ fixing device 100 when fixing by the organ fixing device 100 is no longer necessary will be described. FIG. 8 is a diagram for explaining a method of taking out the organ fixing device 100 according to the first embodiment.

  First, as shown in FIG. 8A, the lifting thread 2 exposed on the body surface 44 is cut.

Next, the drawer thread 3 exposed on the body surface 44 is pulled.
When the pull-out thread 3 is pulled, as shown in FIG. 8B, the pull-out end 12 of the rod 1 to which the pull-out thread 3 is connected is pulled upward, and the rod 1 gradually becomes vertically oriented. When the pull-out thread 3 is further pulled, the pull-out end 12 of the rod 1 is pulled out to the body surface 44 side through the stomach wall 42 and the abdominal wall 41. Since the end of the rod 1 in the axial direction is chamfered and rounded, it is possible to prevent the stomach wall 42 from being damaged when the rod 1 is taken out from the stomach wall 42, and the rod 1 is extracted from the stomach wall 42. It becomes easy.

  As the rod 1 is pulled out, the lifting thread 2 connected to the substantially central position of the rod 1 is also pulled out along the rod 1 through the stomach wall 42 and the abdominal wall 41 to the body surface 44 side. Thus, the rod 1 and the lifting thread 2 inside the stomach can be taken out of the body simply by pulling the pull-out thread 3 from outside the body.

  As described above, the organ fixing device 100 according to the first embodiment has one end connected to the axial center position of the rod 1a and the other end connected to the axial center position of the rod 1b. A lifting thread 2 is provided to connect 1b. Thus, since the rod 1a and the rod 1b are connected by the lifting thread 2, two points can be fixed by one procedure. Therefore, the visceral wall and the abdominal wall can be fixed in a shorter time than conventional.

  A pull-out thread 3 was connected to a pull-out end 12 which is one end of the rod 1 in the axial direction. For this reason, when the organ fixing tool 100 becomes unnecessary, the organ fixing tool 100 can be easily taken out of the body simply by pulling the pull-out thread 3 from the outside of the body, and the work burden on the operator can be reduced. Moreover, since the organ fixing tool 100 that is no longer needed can be quickly removed, the metal rod 1 does not remain in the body. In addition, since a tool such as an endoscope is not necessary for taking out the organ fixing device 100, the invasion to the patient is slight and the burden on the patient can be reduced.

  Further, the rod 1 is constituted by a hollow member, and the lifting thread 2 and the two lead-out threads 3a and 3b are constituted by one suture thread 4. For this reason, the number of parts can be reduced, and the manufacturing cost of the organ fixing device 100 can be reduced.

  In addition, the introduction tool 200 according to Embodiment 1 includes two puncture needles 21a and 21b to which the rods 1a and 1b can be attached. For this reason, it is possible to puncture the patient with the two puncture needles 21a and 21b and introduce the two rods 1a and 1b into the organ in one procedure. For this reason, a visceral wall and an abdominal wall can be fixed in a shorter time than before.

  In addition, since the introduction device 200 according to the first embodiment is provided with the thread hooking portion 32, when the puncture needle 21 is erected and pierced into the patient, the lifting thread 2 attached to the introduction device 200 falls downward. Can be prevented. In addition, by hooking the lifting thread 2 on the thread hook 32, the rod 1 inserted into the lumen of the puncture needle 21 can be prevented from falling downward from the tip of the puncture needle 21.

  Further, as shown in FIG. 7, the introducer 200 according to the first embodiment has three steps of puncture with the puncture needle 21, extension of the rod 1 with the push-out member 33, and removal of the puncture needle 21. Can be introduced to the patient. Thus, for example, compared with the technique described in Patent Document 1, the procedure of the procedure is fewer and simpler, so that the burden on the operator can be reduced. In addition, the time until the operator gets used to the introduction of the organ fixing device 100 can be shortened.

Embodiment 2. FIG.
FIG. 9 is a diagram illustrating an organ fixing device 100A according to the second embodiment. The organ fixing device 100A shown in the second embodiment is characterized in that a mechanism for adjusting the length of the lifting thread 2 is provided. In the second embodiment, differences from the first embodiment will be mainly described, and the same or corresponding components as those in the first embodiment are denoted by the same reference numerals.

  As shown in FIG. 9, the organ fixing device 100 </ b> A includes a crimping material 5. The caulking material 5 is made of a relatively soft metal such as aluminum, and includes two cylindrical portions 6a and 6b through which the lifting thread 2 can pass. The caulking material 5 is slidably attached to the lifting thread 2 so that the lifting thread 2 has a loop shape. Further, the lifting thread 2 is configured to be longer than the length described in the first embodiment.

  The organ fixing device 100A configured as described above is introduced into the patient by the same procedure as described in the first embodiment. As shown in FIG. 9A, the organ fixing device 100A introduced into the patient is in a state in which the lifting thread 2 and the caulking material 5 are exposed on the body surface 44 side. The surgeon adjusts the position of the caulking material 5 while pulling the lifting thread 2 according to the thickness of the patient's abdominal wall 41 and stomach wall 42. Then, the crimping material 5 is fixed to the lifting thread 2 by pressing the cylindrical portions 6 a and 6 b of the crimping material 5 using an instrument such as forceps, for example. By doing in this way, the stomach wall 42 can be fixed to the abdominal wall 41 as shown in FIG.9 (b). That is, by adjusting the position of the caulking material 5, the length of the lifting thread 2 connecting the rod 1a and the rod 1b, that is, the distance for lifting the stomach wall 42 to the abdominal wall 41 side can be adjusted.

  In addition, after fixing the crimping | crimped material 5 to the lifting thread 2, it is preferable to cut the loop-shaped part of the lifting thread 2 short. This is because if the loop-like lifting thread 2 is exposed on the body surface 44, a finger, an instrument or the like may be caught by the loop portion and pull the rod 1 from the body surface side.

  As described above, the organ fixing device 100A according to the second embodiment is provided with the caulking material 5 as a length adjusting mechanism for adjusting the length of the lifting thread 2 that connects the rod 1a and the rod 1b. For this reason, the visceral wall can be fixed to the abdominal wall in an appropriate state according to the thickness of the patient's abdominal wall or visceral wall. In addition, the assortment of lifting threads 2 having a length corresponding to the thickness of the patient's abdominal wall or internal organ wall is not necessary, and the manufacturing cost can be reduced. Further, since the surgeon can use the same organ fixing device 100A regardless of the patient's body shape, the management burden of the organ fixing device 100A can be reduced.

  Further, the caulking material 5 that is the length adjusting mechanism of the second embodiment is made of a soft metal such as aluminum. For this reason, the caulking material 5 can be fixed to the lifting thread 2 using a tool such as a forceps provided in an operating room or the like for organ fixation without using a dedicated tool.

  The specific configuration of the length adjusting mechanism of the lifting thread 2 is not limited to the caulking material 5 shown in the second embodiment. For example, the lifting thread 2 may be looped through a hollow portion of a relatively soft cylindrical member made of metal such as aluminum. Then, the length of the lifting thread 2 may be adjusted by pressing the cylindrical member from the outside, tightening the lifting thread 2 by the cylindrical member, and fixing the cylindrical member to the hanging thread 2. In any case, any length can be used as long as the length of the lifting thread 2 from the rod 1a to the rod 1b can be adjusted in a state where the organ fixing device is attached to the patient.

Embodiment 3 FIG.
FIG. 10 is a diagram illustrating a state in which the organ fixing device 100B according to Embodiment 3 is attached to the introduction device 200. FIG. Moreover, FIG. 11 is a figure explaining the organ fixing tool 100B which concerns on Embodiment 3, and has shown the state attached to the patient. In the third embodiment, differences from the first embodiment will be mainly described, and the same or corresponding components as those in the first embodiment are denoted by the same reference numerals.

  As shown in FIGS. 10 and 11, the organ fixing device 100B includes two coil springs 7a and 7b (sometimes collectively referred to as coil springs 7). The lifting thread 2 is inserted through the coil springs 7a and 7b. That is, the coil springs 7a and 7b are attached so as to surround a part of the lifting thread 2. The coil springs 7a and 7b correspond to the elastic material of the present invention.

  The organ fixing device 100B configured as described above is introduced into the patient by the same procedure as described in the first embodiment. As shown in FIG. 11, in the organ fixing device 100B introduced into the patient, the lifting thread 2 and the coil springs 7a and 7b are exposed on the body surface 44, and the lower ends of the coil springs 7a and 7b are placed on the patient's body surface 44. Abut. That is, the stomach wall 42 and the body surface 44 of the patient are sandwiched between the coil spring 7 and the rod 1. For this reason, the force which fixes the stomach wall 42 and the abdominal wall 41 by the repulsive force of the coil spring 7 becomes constant.

  As described above, the organ fixing device 100B according to the third embodiment includes the two coil springs 7a and 7b through which the lifting thread 2 is inserted. For this reason, the force which fixes a visceral wall and an abdominal wall becomes constant by the repulsive force of the coil springs 7a and 7b. For example, in the case of the prior art described in Patent Document 2 above, the surgeon is left to the operator to adjust the force for fixing the visceral wall and the abdominal wall. For this reason, if the force to fix is too strong, there is a risk of stasis and ulceration, and if the force to fix is too weak, the visceral wall cannot be fixed sufficiently, which may cause inconveniences depending on the skill of the operator. was there. However, according to the organ fixing device 100B of the third embodiment, the force for fixing the visceral wall and the abdominal wall can be made constant, so that it is fixed with an appropriate force regardless of the skill and skill level of the operator. can do.

  Moreover, you may provide the buffer material comprised by the felt etc. between the body surface 44 and the coil spring 7a, and between the body surface 44 and the coil spring 7b, for example. By doing in this way, the contact with the body surface 44 of the coil springs 7a and 7b can be made soft.

  Further, the specific configuration of the elastic material is not limited to the coil spring 7 shown in the third embodiment. Any member can be used as long as it can exert a restoring force when pressed. For example, a bellows-like tube made of synthetic resin or a rubber member having a predetermined thickness can be used.

  In addition, the said Embodiment 1-3 can be combined suitably. In the first to third embodiments, the introduction tool including two puncture needles is shown. However, three or four puncture needles may be provided in the introduction tool.

  In the above description, the case where the stomach wall is fixed to the abdominal wall has been described as an example, but the organ fixing device and the introduction device of the present invention can also be used when other organs such as the bladder are fixed to the abdominal wall.

  1 rod, 1a rod, 1b rod, 2 lifting thread, 3 withdrawal thread, 3a withdrawal thread, 3b withdrawal thread, 4 suture thread, caulking material, 6a cylinder section, 6b cylinder section, 7a coil spring, 7b coil spring, 11 through hole , 12 Pull-out end, 13 Fixed part, 21 Puncture needle, 21a Puncture needle, 21b Puncture needle, 22 Puncture part, 23 Notch part, 31 Needle holding member, 31a Needle holding member, 31b Needle holding member, 32 Threading part, 33 Extruding member, 34 Extruding rod, 34a Extruding rod, 34b Extruding rod, 35 Connecting portion, 41 Abdominal wall, 42 Gastric wall, 43 Intragastric, 44 Body surface, 100 Organ fixing device, 100A Organ fixing device, 100B Organ fixing device, 200 Introduction Ingredients.

Claims (6)

A first rod and a second rod;
One end is connected to a substantially central position in the axial direction of the first rod, the other end is connected to a substantially central position in the axial direction of the second rod, and a lifting thread that connects the first rod and the second rod; ,
A first draw thread connected to one axial end of the first rod;
An organ fixing tool introduction tool comprising a second lead thread connected to one axial end of the second rod ,
Two puncture needles having a lumen;
A needle holding member that holds the two puncture needles at a predetermined distance apart in a substantially parallel manner;
And an extruding member configured by connecting upper portions of two extruding bars that can pass through the lumens of the two puncture needles.
An organ fixing tool introduction device characterized by the above. The rod of the organ-fixing instrument is constituted by a hollow member,
By connecting the lifting thread and the two withdrawal threads within the hollow portion of the rod of the organ fixing device, the two withdrawal threads and the lifting thread are configured by a single thread member . The organ fixing device introducing device according to claim 1, wherein the organ fixing device is an introductory device . The organ fixing tool introduction tool according to claim 1 or 2, wherein the organ fixing tool includes a length adjusting mechanism for adjusting a length of the lifting thread. A yarn hooking portion that holds the thread fed from the distal end of the puncture needle at a position closer to the proximal end than the distal end of the puncture needle is provided.
The organ fixing device introducing device according to any one of claims 1 to 3, wherein the organ fixing device is an introducing device. A first rod and a second rod;
One end is connected to a substantially central position in the axial direction of the first rod, the other end is connected to a substantially central position in the axial direction of the second rod, and a lifting thread that connects the first rod and the second rod; ,
A first draw thread connected to one axial end of the first rod;
A second lead thread connected to one axial end of the second rod;
Provided with two elastic materials through which the lifting thread is inserted
An organ fixing device characterized by that. The rod is composed of a hollow member,
By connecting the lifting thread and the two withdrawal threads in the hollow portion of the rod, the two withdrawal threads and the lifting thread are configured by a single thread member.
The organ fixing tool according to claim 5.

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