JP5674545B2 - Liver lifting excluder device - Google Patents

Liver lifting excluder device Download PDF

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JP5674545B2
JP5674545B2 JP2011096601A JP2011096601A JP5674545B2 JP 5674545 B2 JP5674545 B2 JP 5674545B2 JP 2011096601 A JP2011096601 A JP 2011096601A JP 2011096601 A JP2011096601 A JP 2011096601A JP 5674545 B2 JP5674545 B2 JP 5674545B2
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JP2012228282A (en
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道隆 藤原
道隆 藤原
貴之 中村
貴之 中村
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オオサキメディカル株式会社
国立大学法人名古屋大学
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本発明は、腹腔鏡下手術において肝臓を吊り上げて圧排する技術に関する。 The present invention relates to a retraction technique to lift the liver in laparoscopic surgery.

患者の胃や腹部食道を手術する際、手術個所の前側、腹側に覆い被さる肝臓の左葉を吊り上げて、術野を確保する。 When surgery the stomach and abdominal esophagus of a patient, the front side of the surgery location, and lifting the left lobe of the liver covering over the ventral side, to ensure the operative field.

腹腔鏡下手術で用いられる肝臓吊上げ圧排具は、術者が扁平断面のシリコンチューブとナイロン糸で手作りしている。 Liver lifting retraction device for use in laparoscopic surgery, the surgeon is handmade with silicone tube and nylon yarn of flat cross section. シリコンチューブは、ペンローズと言われる医療用のドレン管である。 Silicon tube is a drain pipe for medical use is said to Penrose. ナイロン糸は、医療用の縫合糸である。 Nylon yarn is a suture medical. シリコンチューブは、両端位置と中央位置にそれぞれナイロン糸を結び付ける。 Silicone tubing, tying the nylon yarn at each end position and the center position.

このナイロン糸付きシリコンチューブは、二つ折りにし、患者の腹壁を貫通したトロカールを経て患者の腹腔に持ち込む。 The nylon thread with silicone tubing, folded in two, bringing into the abdominal cavity of the patient through the trocar through the patient's abdominal wall. 二つ折り状態のシリコンチューブの両端と両端位置のナイロン糸は、肝臓左葉の上側、頭側の後側、背側から下側、足側を経て前側、腹側の頭側に通す。 Nylon yarn ends and both end positions of the silicone tube clamshell state, the upper left lobe of liver, after cranial side, the lower side from the back side, via the foot side forward, through the head side of the ventral side. 肝臓左葉を背側から腹側に潜らせる。 To dive into the ventral side of the liver left lobe from the back side. シリコンチューブの中央部分と中央位置のナイロン糸は肝臓左葉の背側に、シリコンチューブの両端部分と両端位置のナイロン糸は肝臓左葉の腹側に配置する。 Nylon yarn of the central portion and the central position of the silicone tubing on the back side of the left lobe of liver, nylon yarn of both end portions and both end positions of the silicon tube are located on the ventral side of the left lobe of liver. 中央位置のナイロン糸と両端位置のナイロン糸は、それぞれ、端部を腹壁を貫通して腹腔外に出す。 Nylon yarn of nylon yarn and both end positions of the central position, respectively, going out of the abdominal cavity end portion through the abdominal wall. 腹腔外のナイロン糸の端部は、引っ張り、シリコンチューブを引き寄せ、シリコンチューブ上の肝臓左葉を持ち上げる。 Ends of nylon yarn outside the abdominal cavity pulls attract silicone tube, lift the liver left lobe on silicone tubing. 腹腔外のナイロン糸の端部は、腹壁に対して固定する。 Ends of nylon yarn outside the abdominal cavity is secured to the abdominal wall. すると、肝臓左葉は、吊り上げ状態に保持される。 Then, liver left lobe is held in the lifting state.

なお、人の肝臓は、左右に左葉と右葉がある。 It should be noted that the liver of humans, there is a left lobe and right lobe of the left and right. 左葉は、鎌状間膜があり、鎌状間膜により左側の外側区域と右側の内側区域に分けられる。 The left lobe, there is sickle mesentery divided into outer zone and the right inner zone of the left by sickle mesentery.

1. 1. 課 題 上記の肝臓吊上げ圧排具は、シリコンチューブが肝臓左葉を潜る位置が左側に寄ると、鎌状間膜とその右側位置の内側区域が持ち上がらないことがある。 Issues above the liver lifting retraction device, when the position where the silicon tube dive liver left leaves stop at the left side, may sickle between film and inner areas of the right position not lifted. また、鎌状間膜に掛かったシリコンチューブが滑ってずれ、鎌状間膜が持ち上がらないことがある。 Further, deviation slips silicone tube took a sickle between film may not be lifted sickle mesentery. 更に、肝臓左葉が大きいと、又は、シリコンチューブが肝臓左葉を潜る位置が右側に寄ると、鎌状間膜の左側位置の外側区域が持ち上がらないことがある。 Furthermore, the left lobe of liver is large, or if the position where the silicon tube dive liver left leaves stop at the right side, may not lifted outer area of ​​the left position of the sickle between membranes. 結局、腹腔鏡下手術において肝臓左葉を確実に持ち上げて圧排することが容易であるとは言い難い。 After all, it is difficult to say that it is easy to retraction reliably lift the left lobe of liver in laparoscopic surgery.

2. 2. 着 想 Wearing virtual
2.1 肝臓吊上げ圧排具は、肝臓左葉を十分に支持するため、シート状の本体に3本より多数の糸を付けることにした。 2.1 Liver lifting retraction device in order to fully support the left lobe of liver was to put a large number of threads than three in a sheet-like body.
シート状の本体は、左右方向に延びる横帯部を設け、横帯部の左端と右端にそれぞれ糸を連結する。 Sheet body, a horizontal band portion extending in the left-right direction is provided, each connecting the yarn to the left and right ends of the lateral belt portion. 横帯部は、中央部の上側に縦片部を設け、縦片部の上端部を二股部にする。 Horizontal band portion is provided with a longitudinal strip portion on the upper side of the central portion, the upper end of the vertical piece portion into two portions. 二股部は、左側の先端と右側の先端にそれぞれ糸を連結する。 Bifurcated portion, respectively connecting the yarn to the left side of the tip and right side of the tip. また、縦片部は、左側に糸を連結する。 The vertical piece portion connects the yarn to the left.

この糸付きの本体は、トロカールを経て腹腔に持ち込み、肝臓左葉を背側から腹側に潜らせる。 This yarn with the body, bring into the abdominal cavity through a trocar, to dive on the ventral side of the liver left lobe from the back side. 横帯部の左側部分と横帯部左端の糸は、肝臓左葉の外側区域の背側に配置する。 Yarn left portion and the lateral band portions left end of the horizontal band section is arranged on the back side of the lateral segment of the liver left lobe. 横帯部の右側部分と横帯部右端の糸、縦片部と二股部左右の糸、縦片部左側の糸は、肝臓左葉の腹側に配置する。 Right part and a lateral belt portion right end of the thread of the lateral band portions, longitudinal piece and bifurcated portion left of the yarn, the yarn of the vertical piece portion left, arranged on the ventral side of the left lobe of liver. 二股部には、肝臓左葉の鎌状間膜を嵌める。 The bifurcated portion, fitting the sickle mesentery liver left lobe. 二股部の左右の糸は鎌状間膜の左右に配置する。 Yarn of the left and right bifurcated portion is disposed on the left and right of the sickle between membranes. 鎌状間膜は、縦片部の二股部に嵌められ、左側と右側を糸で挟まれる。 Sickle mesentery is fitted into bifurcated portions of the vertical piece portion, the left and right sandwiched by the thread. 縦片部左側の糸は、鎌状間膜左側の外側区域に配置する。 Yarn vertical piece portion left is located outside the area of ​​the sickle between film left. 横帯部の右側部分と横帯部右端の糸は、鎌状間膜右側の内側区域に配置する。 Yarn right part and lateral belt portion right end of the horizontal band portion is located inside the area of ​​the sickle mesentery right.

各糸の端部は、腹壁を貫通して腹腔外に出す。 End of each yarn, put out the abdominal cavity through the abdominal wall. 腹腔外の各糸端部は、引っ張り、腹壁に対して固定する。 Each yarn ends outside the abdominal cavity, pulling, fixed relative to the abdominal wall. 本体上の肝臓左葉は、持ち上げて吊り上げ状態に保持する。 Liver left lobe on the body is maintained at lifting lifting state.

すると、横帯部は、左右方向に緊張し、肝臓左葉に密着し、位置決めされる。 Then, horizontal band portion is tensioned in the lateral direction, in close contact with the left lobe of liver, it is positioned. 縦片部も、肝臓左葉に密着し、位置決めされる。 Vertical piece also in close contact with the left lobe of liver, is positioned. 肝臓左葉は、鎌状間膜が縦片部と二股部左右の糸で支えられる。 Liver left lobe is sickle between membranes is supported by yarns of the left and right and bifurcated portion vertical piece. 外側区域が横帯部の左側部分、横帯部左端の糸、縦片部左側の糸と二股部左側の糸で支えられる。 Left portion of the outer zone lateral belt portion, the thread of the lateral band portions left, supported by yarns of the yarn and the bifurcated portion left vertical piece portion left. 内側区域が横帯部の右側部分、横帯部右端の糸と二股部右側の糸で支えられる。 Right portion of the inner zone lateral belt portion, is supported by the thread and the bifurcated portion right yarn of the lateral band portions right end.
肝臓左葉を確実に持ち上げて圧排することが容易になる。 The liver left lobe surely lift it is easy to retraction.

2.2 本体の縦片部は、左側に糸を連結するに当たり、左側に突出部を設け、突出部の先端に糸を連結する。 2.2 Vertical piece of the body, when connecting the thread to the left side, the projecting portions provided on the left side, to connect the yarn to the tip of the projecting portion. 突出部とその左側の糸は、肝臓左葉の外側区域を支える。 And yarn of the left protruding portion, supports the outer zone of the left lobe of liver.

2.3 上記の着想では、本体の横帯部は、右端に糸を連結し、糸の端部を腹腔外に出して腹壁に対して固定する。 2.3 In the above idea, the lateral band portions of the body, connecting the yarn to the right end, fixed with respect to the abdominal wall out the end of the thread outside the abdominal cavity. これに換え、横帯部右端に錘を糸を介して又は介せずに連結し、錘を腹腔の右側の背側、例えば肝臓右葉の右側の背側に定置することもできる。 Instead this, the weight on the lateral belt portion right end is connected with or without through through the yarn, the weight of the right dorsal abdominal cavity, can be placed on the right side of the back side of the example liver right lobe. 要するに、横帯部左端の糸や縦片部左側の糸の引っ張りによる横帯部の左側への移動を止める構成にする。 In short, a configuration to stop the movement of the left lateral band portions by the lateral zones of the thread and the vertical piece portion yarn left left pull.

2.4 本体は、医療用の合成樹脂のフイルム、メッシュや合成樹脂繊維の織物、医療用のガーゼなどの医療用の材料でシート状に構成される。 2.4 body film of the synthetic resin of the medical, textile mesh or synthetic resin fibers, configured into a sheet of a material for medical use such as gauze medical. 医療用の合成樹脂には、シリコンやポリエステルが例示される。 The synthetic resin for medical, silicon or polyester are exemplified. 医療用のガーゼには、綿織物のガーゼや不織布のガーゼが挙げられる。 The gauze for medical use, include gauze cotton fabric gauze or nonwoven fabric.
糸は、医療用の合成樹脂の糸、ナイロン糸が例示される。 Yarn, yarn of the synthetic resin of the medical, nylon thread are exemplified.
本体に糸を連結するのには、本体に糸を結び付ける、縫い付ける、溶着することが例示される。 To connect the yarn in the main body, linking thread body, sewn, it is exemplified to weld.
なお、X線造影糸を付けることが望ましい。 Incidentally, it is desirable to attach a X-ray opaque filament.

1. 1. 腹腔鏡下手術において肝臓を吊り上げる圧排具において、 In excluder device lifting the liver in laparoscopic surgery,
圧排具の本体はシート状にし、 The body of the retraction device is in sheet form,
シート状の本体は左右方向に延びる横帯部を設け、横帯部は左端と右端にそれぞれ糸を連結し、 Sheet-like body is a horizontal band portion extending in the lateral direction is provided, lateral belt portion connecting the thread respectively to the left and right ends,
横帯部は中央部の上側に縦片部を設け、縦片部は上端部を二股部にし、二股部は左側の先端と右側の先端にそれぞれ糸を連結し、縦片部は左側に糸を連結し、 Lateral belt portion provided vertical piece portion on the upper side of the central portion, the vertical piece portion is an upper portion in the forked portion, forked portion respectively connecting the yarn to the left side of the tip and right side of the tip, the thread vertical piece portion on the left It was ligated,
圧排具はトロカールを経て腹腔に持ち込み可能にし、 Excluder device will allow bring into the abdominal cavity through a trocar,
圧排具は肝臓左葉を背側から腹側に潜らせ、横帯部の左側部分と横帯部左端の糸は肝臓左葉の外側区域の背側に配置し、横帯部の右側部分と横帯部右端の糸、縦片部と二股部左右の糸、縦片部左側の糸は肝臓左葉の腹側に配置し、二股部に肝臓左葉の鎌状間膜を嵌め、二股部左右の糸は鎌状間膜の左右に配置し、縦片部左側の糸は鎌状間膜左側の外側区域に配置し、横帯部の右側部分と横帯部右端の糸は鎌状間膜右側の内側区域に配置し、糸は引っ張って固定し、肝臓左葉を持ち上げて吊り上げ状態に保持する構成にしたことを特徴とする肝臓吊上げ圧排具。 Retraction device causes dive ventral liver left lobe from the back side, the yarn of the left portion and the lateral belt portion leftmost lateral belt portion is arranged on the back side of the lateral segment of the liver left lobe, and right portions of the lateral band portions lateral belt portion right end of the thread, longitudinal pieces and bifurcated portion left of the yarn, the yarn of the vertical piece portion left is placed on the ventral side of the left lobe of liver, fitted sickle mesentery liver left lobe into two portions, the bifurcated portion yarn left is disposed on the left and right of the sickle between membranes, threads of the vertical piece portion left is located outside the area of ​​the sickle between film left, the yarn of the right portion and the lateral belt portion right end of the lateral belt portion between sickle placed inside area of ​​the film right, yarn is fixed by pulling, lifting the liver is characterized in that the arrangement for retaining the state lifted by lifting the left lobe of liver retraction device.
2. 2. 上記の肝臓吊上げ圧排具において、 In the above-mentioned liver lifting retraction device,
本体の縦片部は、左側に糸を連結するに当たり、左側に突出部を設け、突出部の先端に糸を連結したことを特徴とする。 Vertical piece of the body, when connecting the thread to the left side, the projecting portions provided on the left side, characterized in that the concatenation of the yarn on the tip of the protrusion.
3. 3. 上記の肝臓吊上げ圧排具において、 In the above-mentioned liver lifting retraction device,
本体の横帯部は、右端に錘を糸を介して又は介せずに連結し、錘を腹腔の右側の背側に定置可能にし、横帯部の左側への移動を止める構成にしたことを特徴とする。 Lateral belt portion of the body to the weight at the right end is connected without through the yarn or through, the weight permits placed on the back side of the right side of the abdominal cavity, and the arrangement to stop the movement of the left lateral band portions the features.
4. 4. 上記の肝臓吊上げ圧排具において、 In the above-mentioned liver lifting retraction device,
本体はX線造影糸を付けたことを特徴とする。 The body is characterized in that with the X-ray opaque filament.

腹腔鏡下手術において、肝臓左葉を確実に持ち上げて圧排することが容易である。 In laparoscopic surgery, it is easy to retraction lifts the liver left lobe reliably.

本発明の実施形態における肝臓吊上げ圧排具の中間省略の正面図。 A front view of an intermediate omitted liver lifting excluder device in the embodiment of the present invention. 図1のA−A線断面拡大図。 A-A line cross-sectional enlarged view of FIG. 同肝臓吊上げ圧排具の素材、シート材の正面図。 The liver lifting of the excluder device material, a front view of the sheet material. 同肝臓吊上げ圧排具の製作途中を示す一部欠載正面図。 Ketsuno front view of a portion showing an intermediate production of the same liver lifting excluder device. 同肝臓吊上げ圧排具の使用状態を示す正面図。 Front view illustrating a use state of the liver lifting excluder device.

実施形態の肝臓吊上げ圧排具は、図1に示すように、シート状の本体1に5本の糸3、4、8、9、12を付けている。 Liver lifting excluder device embodiments, as shown in FIG. 1, with a 5 yarns 3,4,8,9,12 a sheet-like body 1.

[構 成] [Constitution]
シート状の本体1は、下側部を帯状にして横帯部2を設けている。 Body 1 shaped sheet has a horizontal band part 2 is provided with a lower portion in a strip. 横帯部2は、左右方向に延び、左端と右端にそれぞれ糸3、4を連結している。 Lateral belt portion 2 extends in the left-right direction, and each of the left and right ends connected to the thread 3 and 4. また、細長い横帯部2は、中央部の上側に太くて短い縦片部6を右側に傾けて設けている。 Further, the elongated lateral belt portion 2 is provided with inclined longitudinal piece 6 stubby above the central portion on the right. 縦片部6は、上端部を二股状にして二股部7にしている。 Vertical piece portion 6 is in the forked portion 7 and the upper end bifurcated. 二股部7は、左側の先端と右側の先端にそれぞれ糸8、9を連結している。 Bifurcated portion 7 are respectively on the left side of the tip and right side of the distal end connecting thread 8,9. 縦片部6の左側は、二股部7と横帯部2との間に突出部11を設けている。 Left vertical piece portion 6 is provided with a projecting portion 11 between the forked portion 7 and Yokotai section 2. 山形状の突出部11は、先端に糸12を連結している。 Chevron shaped protrusion 11 is coupled to the thread 12 on the tip.

本体1は、図2に示すように、2枚のシート材21を重ねて糸22で縫い、二重構造にしている。 Body 1, as shown in FIG. 2, sewing with thread 22 overlapping the two sheet materials 21, and a double structure. 両シート材21の間には、X線造影糸23を配置している。 Between the two sheets 21 are arranged an X-ray opaque filament 23.
糸3、4、8、9、12は、医療用のナイロン糸にしている。 Yarn 3,4,8,9,12 is in the nylon yarn for a medical. シート材21は、医療用のポリエステル繊維の織物にし、メッシュにしている。 Sheet material 21 to the fabric of a polyester fiber medical, and a mesh. 糸22は、医療用の綿糸にしている。 Yarn 22, are in the cotton yarn of medical. X線造影糸23は、硫酸バリウムを含む合成樹脂糸にしている。 X-ray opaque filament 23 is a synthetic resin yarns containing barium sulfate.
糸3、4、8、9、12付きの本体1は、湾曲自在、折れ曲り自在にしている。 Body 1 with yarn 3,4,8,9,12 is bendable, and freely described bending. トロカールを通過する形状寸法にしている。 Are the geometry passing a trocar.

[製作方法] [Production Method]
素材のシート材21は、図3に示すように、本体1より一回り大きい形状寸法にしている。 Sheet material 21 of the material, as shown in FIG. 3, and a large geometry slightly from the main body 1. 2枚のシート材21は、重ね合わせ、図4に示すように、周辺部を一部を残して糸22で縫い合わせる。 Two sheet materials 21, superimposed, as shown in FIG. 4, sewing with thread 22, leaving a portion of the periphery. 未縫合部を開口とする袋状にする。 The non-sewn portions into a bag shape to the opening. 袋状になった両シート材21は、横帯部2の左端と右端になる端に、それぞれ、糸3、4を結び付ける。 Both sheet material 21 which becomes a bag shape, the left and becomes the right end edge of the horizontal band section 2, respectively, linking the yarns 3 and 4. 二股部7の左側の先端と右側の先端になる端には、それぞれ、糸8、9を結び付ける。 The end to be left at the tip and right tips of the bifurcated portion 7, respectively, linking the yarns 8,9. 突出部11の先端になる端には、糸12を結び付ける。 The end comprising the tip of the projecting portion 11, tying yarn 12.

糸付き袋状の両シート材21は、裏返して内外を逆にする。 Thread with bag-shaped both the sheet material 21, to reverse the out turned over. 袋の内側になった各糸3、4、8、9、12は、それぞれ、結び付け部付近のシート材21を貫通して袋の外側に出す。 Each yarn 3,4,8,9,12 became inside of the bag, respectively, through the sheet material 21 near the bound portion put on the outside of the bag. 袋の内側には、未縫合部の開口からX線造影糸23を入れる。 Inside the bag, put an X-ray opaque filament 23 from the opening of the non-sewn portions. 未縫合部の開口は、糸22で縫って閉鎖する。 Opening of the non-sewn portions closes sewn with thread 22. 肝臓吊上げ圧排具が製作される。 Liver lifting retraction device is fabricated.

[使用方法] [how to use]
腹腔鏡下の胃や腹部食道の手術において、肝臓吊上げ圧排具は、二つ折りにし、患者の腹壁を貫通したトロカールを通過させて患者の腹腔に持ち込む。 In gastric surgery and abdominal esophagus laparoscopic liver lifting retraction device is folded in two, bringing into the abdominal cavity of the patient is passed through the trocar through the patient's abdominal wall. 腹腔において、肝臓吊上げ圧排具は、把持用の鉗子を用いて、肝臓左葉を背側から腹側に潜らせる。 In peritoneal cavity, the liver lifting retraction device, using forceps for grasping, to dive into ventral liver left lobe from the back side. その際、肝臓左葉の外側区域の背側に位置する左三角間膜には、孔を切開する。 At that time, the left intertrigonal film located on the back side of the lateral segment of the liver left lobe, cutting the hole. 肝臓吊上げ圧排具は、右側の大部分を上側、頭側から左三角間膜の孔に通し、肝臓左葉の下側、足側を通過して肝臓左葉の腹側の頭側に引き出す。 Liver lifting retraction device draws the majority of the right upper side, through the head side hole of the left intertrigonal film, the lower left lobe of liver, it passes through the foot end to the head side of the ventral side of the left lobe of liver.

この肝臓吊上げ圧排具は、図5に示すように、横帯部2の左側部分と横帯部左端の糸3を肝臓左葉Lの外側区域sの背側に配置する。 The liver lifting retraction device, as shown in FIG. 5, a left portion and a lateral belt portion leftmost yarn 3 of the horizontal band section 2 is placed on the back side of the lateral segment s of liver left lobe L. 横帯部2の右側部分と横帯部右端の糸4、縦片部6と二股部左右の糸8、9、突出部11と突出部左側の糸12は、肝臓左葉Lの腹側に配置する。 Right part and a lateral belt portion right end of the thread 4 of the horizontal band section 2, the vertical piece portion 6 and the crotch left and right thread 8,9, the projection 11 and the projection thread 12 on the left ventral liver left lobe L Deploy. 二股部7には、鎌状間膜kを嵌める。 The bifurcated portion 7, fitting the sickle mesentery k. 二股部左側の糸8は鎌状間膜kの左側に、二股部右側の糸9は鎌状間膜kの右側に配置する。 Bifurcated portion left of the thread 8 to the left of sickle mesentery k, forked portion right yarn 9 is disposed on the right side of the sickle mesentery k. 鎌状間膜kは、二股部7に嵌められ、左側と右側を糸8、9で挟まれる。 Sickle mesentery k is fitted to the bifurcated portion 7, the left and right sandwiched with thread 8,9. 突出部11と突出部左側の糸12は、鎌状間膜左側の外側区域sに配置する。 Protrusion 11 and the protrusion thread 12 of the left side is located outside the area s of sickle between film left. 横帯部2の右側部分と横帯部右端の糸4は、鎌状間膜右側の内側区域uに配置する。 Right part and a lateral belt portion yarn 4 at the right end of the horizontal belt section 2 is arranged inside area u of sickle mesentery right.

各糸3、4、8、9、12は、それぞれ、糸引出用の鉗子を用い、端部を腹壁を貫通して腹腔外に引き出す。 Each yarn 3,4,8,9,12, respectively, using a forceps for the thread draw out, draw out the abdominal cavity end portion through the abdominal wall. 腹腔外の各糸3、4、8、9、12の端部は、それぞれ、引っ張って、本体1上の肝臓左葉Lを吊り上げる。 End of each yarn 3,4,8,9,12 outside the abdominal cavity, respectively, pulling, lifting the liver left lobe L on the body 1. そして、糸3、4、8、9、12の端部は、それら同士を結んで、又は、クリップで留めて、腹壁に対して固定する。 The end portion of the thread 3,4,8,9,12 is connects these to each other, or in clipped and secured to the abdominal wall. 肝臓左葉Lは、吊り上げ圧排状態に保持する。 Liver left lobe L is maintained at lifting retraction state.

すると、横帯部2は、左右方向に緊張し、肝臓左葉Lに密着し、位置決めされる。 Then, the lateral band portions 2, nervous in the lateral direction, in close contact with the liver left lobe L, are positioned. 縦片部6、二股部7と突出部11も、肝臓左葉Lに密着し、位置決めされる。 The vertical piece portion 6, the bifurcated portion 7 and the protruding portion 11 is also in close contact with the liver left lobe L, are positioned. 肝臓左葉Lは、鎌状間膜kが縦片部6と二股部左右の糸8、9で支えられる。 Liver left lobe L is sickle mesentery k is supported by the vertical piece portion 6 and the crotch left and right thread 8,9. 外側区域sが横帯部2の左側部分、横帯部左端の糸3、突出部11、突出部左側の糸12と二股部左側の糸8で支えられる。 Left portion of the outer zone s are horizontal band section 2, lateral belt portions leftmost yarn 3, the projecting portion 11, is supported by the protruding portion left of the thread 12 and the bifurcated portion left of the thread 8. 内側区域uが横帯部2の右側部分、横帯部右端の糸4と二股部右側の糸9で支えられる。 Medial segment u is the right portion of the horizontal band section 2, it is supported by the lateral band portions right end of the thread 4 and the bifurcated portion right thread 9.

肝臓左葉Lの吊り上げ位置の調節は、各糸3、4、8、9、12の腹壁貫通位置の変更と、腹腔外の引き出し長さ、腹腔内の長さの増減で行う。 Adjustment of the lifting position of the liver left lobe L performs the change of the abdominal wall through the position of the yarn 3,4,8,9,12, abdominal out drawer length, with increasing or decreasing the length of the abdominal cavity.

[変形例] [Modification]
1. 1. 上記の実施形態において、シート状の本体1は、二重構造にしているが、一重構造や三重構造にする。 In the above embodiment, the sheet-like body 1, although a double structure, to single structure or a triple structure.
2. 2. 上記の実施形態において、縦片部6の左側は、突出部11を設けて突出部11に糸12を付けている。 In the above embodiment, the left vertical piece portion 6 with a yarn 12 to the protruding portion 11 provided with a protrusion 11. この構成に換え、縦片部6の左側には、突出部11を設けず、糸12を突出部11を介せずに直接付ける。 Instead this configuration, on the left side of the vertical piece portion 6, without providing the protruding portions 11, attached directly to the yarn 12 without through the projecting portion 11.
3. 3. 上記の実施形態において、横帯部右端の糸4は、端部に何も付けておらず、端部を腹腔外に出して腹壁に対して固定する。 In the above embodiment, the yarn 4 of the lateral belt portion rightmost anything not attached to the end portion is fixed with respect to the abdominal wall out the ends outside the abdominal cavity. この構成と使用方法に換え、横帯部右端の糸4は、端部にトロカールを通過する形状寸法の錘を付け、錘を腹腔の右側の背側に定置する構成にする。 Instead the configuration and use, the yarn 4 of the lateral belt portion right end, with a weight of geometry passing a trocar to an end, a configuration of placing the weight on the back side of the right side of the abdominal cavity. 例えば、錘は、肝臓右葉の右側の背側に配置する。 For example, the weight is placed on the back side of the right liver right lobe. 横帯部左端の糸3が引っ張られると、錘は、肝臓右葉の右側面に引っ掛かり、横帯部2の左側への移動を止める。 The lateral band portions left end of the thread 3 is pulled, the weight is caught by the right side surface of the liver right lobe, stop moving to the left of the horizontal band section 2. 横帯部2は、緊張し、肝臓左葉Lに密着し、位置決めされる。 Lateral belt portion 2, tense, close contact with the liver left lobe L, are positioned.
更に、横帯部2の右端に糸4を介して錘を付ける構成に換え、横帯部2は、右側部分を右方に延ばし、右端に錘を糸を介せずに直接付ける。 Further, the right end of the lateral belt portion 2 via the yarn 4 instead configure attaching a weight, horizontal band section 2 extends the right part to the right, attached directly to the weight at the right end without through the yarn.

L 肝臓左葉k 鎌状間膜s 外側区域u 内側区域1 本体、シート状の本体2 本体の横帯部3 糸、横帯部の左端の糸4 糸、横帯部の右端の糸6 本体の縦片部7 縦片部の二股部8 糸、二股部の左側の先端の糸9 糸、二股部の右側の先端の糸11 縦片部の突出部12 糸、突出部の先端の糸、突出部左側の糸、縦片部左側の糸21 シート材22 糸23 X線造影糸 L liver left lobe k sickle mesentery s outer zone u inner zone 1 body, a sheet-like main body 2 lateral belt portion 3 the thread of the body, the left end of the yarn 4 yarn horizontal band portion, the right end of the thread 6 the body of the lateral band portions the forked portion 8 yarns vertical piece 7 vertical piece portion, the left side of the front end yarn 9 yarns of the bifurcated portion, the bifurcated portion right end projecting portion 12 yarn thread 11 vertical pieces of the yarn of the tip of the protrusion, thread protrusions left, the vertical piece portion thread 21 sheet 22 yarn 23 X-ray opaque filament of the left

Claims (4)

  1. 腹腔鏡下手術において肝臓を吊り上げる圧排具において、 In excluder device lifting the liver in laparoscopic surgery,
    圧排具の本体はシート状にし、 The body of the retraction device is in sheet form,
    シート状の本体は左右方向に延びる横帯部を設け、横帯部は左端と右端にそれぞれ糸を連結し、 Sheet-like body is a horizontal band portion extending in the lateral direction is provided, lateral belt portion connecting the thread respectively to the left and right ends,
    横帯部は中央部の上側に縦片部を設け、縦片部は上端部を二股部にし、二股部は左側の先端と右側の先端にそれぞれ糸を連結し、縦片部は左側に糸を連結し、 Lateral belt portion provided vertical piece portion on the upper side of the central portion, the vertical piece portion is an upper portion in the forked portion, forked portion respectively connecting the yarn to the left side of the tip and right side of the tip, the thread vertical piece portion on the left It was ligated,
    圧排具はトロカールを経て腹腔に持ち込み可能にし、 Excluder device will allow bring into the abdominal cavity through a trocar,
    圧排具は肝臓左葉を背側から腹側に潜らせ、横帯部の左側部分と横帯部左端の糸は肝臓左葉の外側区域の背側に配置し、横帯部の右側部分と横帯部右端の糸、縦片部と二股部左右の糸、縦片部左側の糸は肝臓左葉の腹側に配置し、二股部に鎌状間膜を嵌め、二股部左右の糸は鎌状間膜の左右に配置し、縦片部左側の糸は鎌状間膜左側の外側区域に配置し、横帯部の右側部分と横帯部右端の糸は鎌状間膜右側の内側区域に配置し、糸は引っ張って固定し、肝臓左葉を持ち上げて吊り上げ状態に保持する構成にしたことを特徴とする肝臓吊上げ圧排具。 Retraction device causes dive ventral liver left lobe from the back side, the yarn of the left portion and the lateral belt portion leftmost lateral belt portion is arranged on the back side of the lateral segment of the liver left lobe, and right portions of the lateral band portions lateral belt portion right end of the thread, longitudinal pieces and bifurcated portion left of the yarn, the yarn of the vertical piece portion left is placed on the ventral side of the left lobe of liver, fitted with a sickle between the membranes into two portions, the thread of right and left forked portions was disposed on the left and right of the sickle between membranes, threads of the vertical piece portion left is located outside the area of ​​the sickle between film left, the yarn of the right portion and the lateral belt portion right end of the lateral belt portion inner sickle between film right place in the area, the thread is fixed by pulling, liver lifting retraction device is characterized in that the arrangement for holding the lifting state lifts the liver left lobe.
  2. 本体の縦片部は、左側に糸を連結するに当たり、左側に突出部を設け、突出部の先端に糸を連結したことを特徴とする請求項1に記載の肝臓吊上げ圧排具。 Vertical piece of the body, when connecting the thread to the left side, the projecting portions provided on the left side, liver lifting retraction device according to claim 1, characterized in that the concatenation of the yarn on the tip of the protrusion.
  3. 本体の横帯部は、右端に錘を糸を介して又は介せずに連結し、錘を腹腔の右側の背側に定置可能にし、横帯部の左側への移動を止める構成にしたことを特徴とする請求項1又は2に記載の肝臓吊上げ圧排具。 Lateral belt portion of the body to the weight at the right end is connected without through the yarn or through, the weight permits placed on the back side of the right side of the abdominal cavity, and the arrangement to stop the movement of the left lateral band portions liver lifting excluder device according to claim 1 or 2, characterized in.
  4. 本体はX線造影糸を付けたことを特徴とする請求項1、2又は3に記載の肝臓吊上げ圧排具。 Liver lifting retraction device of claim 1, 2 or 3 body is characterized in that with the X-ray opaque filament.
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US5681341A (en) * 1995-03-14 1997-10-28 Origin Medsystems, Inc. Flexible lifting apparatus
US8147515B2 (en) * 2006-06-30 2012-04-03 Jichi Medical University Medical holding apparatus and method of using medical holding apparatus
JP4696087B2 (en) * 2006-09-12 2011-06-08 信行 櫻澤 Organ traction tool
JP5019394B2 (en) * 2008-06-06 2012-09-05 日洋 松本 Organ gripper
EP2332469B1 (en) * 2008-09-01 2015-05-27 Kawamoto Corporation Endoscope excluder
GB2467960A (en) * 2009-02-23 2010-08-25 Neosurgical Ltd Laparoscopic surgical retraction device with expanding element and anchor arrangement
JP5627029B2 (en) * 2009-02-25 2014-11-19 フリーホールド・サージカル・インコーポレイテッド Apparatus and method for the first organs in the abdominal cavity moves into a position away from the second organ, and then to hold the first organ even without manual put in its place
US20100292540A1 (en) * 2009-05-12 2010-11-18 Hess Christopher J Surgical retractor and method
US20100298629A1 (en) * 2009-05-20 2010-11-25 Huang Chih-Kun Device and method for suspending an organ during surgery
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