JP6160153B2 - Repeated organ fixator - Google Patents

Repeated organ fixator Download PDF

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JP6160153B2
JP6160153B2 JP2013059321A JP2013059321A JP6160153B2 JP 6160153 B2 JP6160153 B2 JP 6160153B2 JP 2013059321 A JP2013059321 A JP 2013059321A JP 2013059321 A JP2013059321 A JP 2013059321A JP 6160153 B2 JP6160153 B2 JP 6160153B2
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suture
thread
locking portion
puncture needle
locking
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JP2014183879A (en
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和樹 岡田
和樹 岡田
有川　清貴
清貴 有川
康雅 小城
康雅 小城
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Sumitomo Bakelite Co Ltd
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Sumitomo Bakelite Co Ltd
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Priority to JP2013059321A priority Critical patent/JP6160153B2/en
Application filed by Sumitomo Bakelite Co Ltd filed Critical Sumitomo Bakelite Co Ltd
Priority to CN201480009490.XA priority patent/CN105007831B/en
Priority to US14/764,429 priority patent/US10342527B2/en
Priority to KR1020157021915A priority patent/KR101793801B1/en
Priority to EP14754190.8A priority patent/EP2959837B1/en
Priority to PCT/JP2014/054062 priority patent/WO2014129554A1/en
Priority to TW103105937A priority patent/TWI586308B/en
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Description

この発明は、主として胃瘻造設術（PEG：percutaneous endoscopic gastrostomy）に用いられる臓器固定具であって、縫合具が複数個収納され、操作部本体の操作によって一個ずつ押し出される連発式のものである。   The present invention is an organ fixing tool mainly used for gastrostomy (PEG: percutaneous endoscopic gastrostomy), in which a plurality of suturing tools are housed and are pushed out one by one by operating the operation unit main body.

以前の胃瘻造設術では、２本の穿刺針を体表から胃壁まで穿刺し、穿刺針の一方から縫合糸を挿入し、これを他方から挿入したループ体で引っ掛けて縫合糸を捕捉し、ループさせていた。ループ状になった縫合糸を引き上げることで胃が吊り上げられ、さらに縫合糸同士を互いに縛ることで体壁と胃壁とが固定される。その後、ガイドワイヤやダイレータを体表から深く穿刺して体壁と胃壁に貫通孔を大きく形成し、そこに留置カテーテルを留置して胃瘻を造設する。   In previous gastrostomy procedures, two puncture needles were punctured from the body surface to the stomach wall, a suture was inserted from one side of the puncture needle, and this was hooked by a loop body inserted from the other side to capture the suture, and the loop I was letting. The stomach is lifted by pulling up the looped suture, and the body wall and the stomach wall are fixed by binding the sutures to each other. Thereafter, a guide wire or dilator is deeply punctured from the body surface to form large through holes in the body wall and stomach wall, and an indwelling catheter is placed therein to construct a gastrostoma.

一般的な胃瘻造設術においては、体壁と胃壁とは、胃瘻造設予定部を取り囲むように少なくとも３箇所（場合により４箇所）で固定する必要がある。胃瘻の造設後は、縫合糸は切断して抜糸される。
この方式だと、各固定箇所に２本の穿刺針を穿刺する必要があるため高侵襲であり、また医師の技量によっては胃の中で縫合糸をループ体で捕捉することが難しい場合があった。 In a general gastrostomy, it is necessary to fix the body wall and the gastric wall at at least three (4 in some cases) so as to surround the gastrostomy scheduled part. After the gastrostomy is constructed, the suture is cut and removed.
This method is highly invasive because two puncture needles need to be punctured at each fixed location, and depending on the skill of the doctor, it may be difficult to capture the suture with a loop body in the stomach. It was.

これに対し、特許文献１の器具（先行技術）によれば、その図１１等に示すように、１本の穿刺針のみで胃壁を体壁に固定できるため、低侵襲かつ容易な手技が可能になった。この手技によれば、２本の縫合糸を結ぶのではなく、棒状の係止部の中央に縫合糸が係合したＴ字状の縫合具を胃内に挿入して胃壁を吊り上げることで、１本の穿刺針で手技可能であり、かつ縫合糸をループさせる必要がなくなった。
特許文献１の器具は、穿刺針の内部に複数個の縫合具が装備されて個別に押し出すことが可能な形態（以下、連発式という）である。具体的には、４個の縫合具が穿刺針に収容されている。このため、１回の手技において３〜４箇所で胃壁を体壁に固定するにあたり、１個の器具でこれを実現することができる。このため、器具を廃棄、開封、持ち替えるなどの交換作業が不要になるため簡便である。
特許文献１の縫合具では、係止部に１本の縫合糸が係合している。かかる縫合具を体表に固定するにあたっては、その縫合糸を他の縫合具の縫合糸と体表で互いに結びつける。 On the other hand, according to the instrument (prior art) of Patent Document 1, the stomach wall can be fixed to the body wall with only one puncture needle, as shown in FIG. Became. According to this technique, instead of tying two sutures, by inserting a T-shaped suture tool with a suture engaged in the center of a bar-shaped locking portion into the stomach and lifting the stomach wall, The procedure can be performed with one puncture needle, and it is not necessary to loop the suture.
The instrument of patent document 1 is a form (henceforth a repetitive type) which is equipped with a some suture tool inside a puncture needle, and can be extruded separately. Specifically, four suture tools are accommodated in the puncture needle. For this reason, in fixing a stomach wall to a body wall in 3-4 places in one procedure, this can be realized with one instrument. This eliminates the need for replacement work such as discarding, opening, and changing instruments.
In the suture tool of Patent Document 1, one suture thread is engaged with the locking portion. When fixing such a suture tool to the body surface, the suture thread is tied to each other by the suture thread of the other suture tool and the body surface.

特許文献２には、同じくＴ字状の縫合具を用いた臓器固定具が記載されている。この器具は、棒状の係止部（ロッド）に対して、ループさせた１本の縫合糸を係合させた縫合具を用いる。この臓器固定具は、穿刺針の内部に一個の縫合具のみが装備される形態（以下、単発式という）である。縫合糸にはパッド状のクッション材が装着されている。クッション材を体表に押し当て、また縫合糸のループを切って２本紐の状態にしたうえで、互いに交絡させてクッション材に縛り付ける。これにより、３〜４箇所の固定箇所において、個別の縫合具ごとに体表に固定することが可能である。   Patent Document 2 describes an organ fixing device using a T-shaped suture tool. This instrument uses a suturing tool in which a looped suture thread is engaged with a rod-shaped locking portion (rod). This organ fixing tool is in a form in which only one suturing tool is provided inside the puncture needle (hereinafter referred to as a single shot type). A pad-shaped cushion material is attached to the suture thread. The cushion material is pressed against the body surface, and the suture loop is cut into a two-string state and then entangled with each other and tied to the cushion material. Thereby, it is possible to fix to the body surface for each individual suture tool at 3 to 4 fixing locations.

特開２００６−２９６９１４号公報JP 2006-296914 A 特開２０１０−１５４８８３号公報JP 2010-154883 A

特許文献１の臓器固定具は、４本の縫合糸のすべてが穿刺針の内部に挿通されているため、縫合糸同士が絡まりやすいという課題がある。縫合糸が絡まると、先端の係止部を穿刺針から押し出して穿刺針を体壁から抜去しようとしたときに、他の係止部まで引き出されてしまう虞がある。
また、特許文献１の臓器固定具は、穿刺針が太く高侵襲であるという課題がある。すなわち、特許文献１の臓器固定具は、穿刺針の内部に４本の縫合具を収容すると、最上段、すなわち押出装置側の穿刺針の内部に通る係止部の周囲には４本の縫合糸が分散して配置されることとなる。このため、穿刺針の内径は少なくとも、係止部の外径に加えて、その両側に２本分の縫合糸の太さを合計しただけの寸法が必要である。このため、特許文献１の臓器固定具は、１本の縫合具のみを収納した単発式のものと比較し、穿刺針の外径が太くなる。
したがって、特許文献１の器具は、連発式であることによる手技上のメリットはあるものの、縫合糸が絡まって操作困難になるリスクと、穿刺針が太く高侵襲であるという課題がある。
また、特許文献２の臓器固定具は、単発式であるため、胃壁と体壁との１点の固定ごとに１個の器具が必要であり、器具の交換が煩雑であるとともにコストが高いという課題がある。 The organ fixing device of Patent Document 1 has a problem that sutures tend to be entangled because all of the four sutures are inserted into the puncture needle. If the suture thread is entangled, there is a possibility that when the locking portion at the tip is pushed out from the puncture needle and the puncture needle is removed from the body wall, it is pulled out to another locking portion.
Moreover, the organ fixing tool of patent document 1 has the subject that a puncture needle is thick and highly invasive. That is, when the organ fixing tool of Patent Document 1 accommodates four suture tools inside the puncture needle, four sutures are provided around the uppermost stage, that is, around the locking portion that passes through the puncture needle on the extrusion device side. Yarns are distributed and arranged. For this reason, at least the inner diameter of the puncture needle needs to be a dimension that is the sum of the thicknesses of two suture threads on both sides in addition to the outer diameter of the locking portion. For this reason, the outer diameter of the puncture needle becomes thicker in the organ fixing tool of Patent Document 1 than in the single-shot type that houses only one suture tool.
Therefore, although the instrument of Patent Document 1 has a technical advantage due to the continuous type, there is a risk that the suture becomes entangled and difficult to operate, and there is a problem that the puncture needle is thick and highly invasive.
Moreover, since the organ fixing tool of patent document 2 is a single shot type, one instrument is required for each fixation of the stomach wall and the body wall, and the replacement of the instrument is complicated and the cost is high. There are challenges.

本発明は上記課題に鑑みてなされたものであり、器具を廃棄、開封、持ち替えるなどの交換作業が低減されて簡便であるという連発式のメリットを有し、かつ従来の連発式の臓器固定具よりも縫合糸の絡まりを抑制して動作の安定性を向上するとともに穿刺針を細径化して低侵襲を実現しうる臓器固定具を提供するものである。   The present invention has been made in view of the above problems, and has a continuous-type merit that the exchange work such as discarding, opening, and changing the instrument is reduced and is simple, and the conventional continuous-type organ fixing device. In addition, the present invention provides an organ fixing device that improves the stability of the operation by suppressing the entanglement of the suture thread and can reduce the diameter of the puncture needle to realize minimally invasive.

本発明によれば、棒状の係止部と、上記係止部に端部が連結された縫合糸と、をそれぞれ有する複数個の縫合具と、複数個の上記係止部を収納する穿刺針と、を有し、複数個の上記係止部は上記穿刺針の先端から基端に向かって上記穿刺針の内部の収容部に並んで収容されており、操作部本体の操作によって上記複数個の係止部が上記穿刺針の先端から一個ずつ押し出される連発式の臓器固定具であって、先端側に収納された上記縫合具の縫合糸を上記穿刺針の内部で挿通するための糸通路が、基端側に収納された他の上記縫合具の上記係止部に、上記係止部の押出方向に沿って、当該他の係止部の周面に溝状に形成されており、上記収容部の直径と、上記係止部のうち上記糸通路を除く部位の直径と、の差分である空隙寸法が、上記縫合糸の２本分の直径よりも小さいことを特徴とする連発式の臓器固定具が提供される。
According to the present invention, a plurality of suture tools each having a rod-shaped locking part, and a suture thread having an end connected to the locking part, and a puncture needle that houses the plurality of locking parts And a plurality of the locking portions are housed side by side in a housing portion inside the puncture needle from the distal end to the proximal end of the puncture needle. Threaded passage for inserting a suture thread of the suturing device housed on the distal end side into the puncture needle , wherein the locking portion of the puncture needle is pushed out one by one from the distal end of the puncture needle Is formed in a groove shape on the peripheral surface of the other locking portion along the pushing direction of the locking portion, in the locking portion of the other sewing tool housed on the base end side , The gap dimension that is the difference between the diameter of the accommodating portion and the diameter of the portion of the locking portion excluding the thread passage is the suture thread. Two pins barrage formula organ fasteners, characterized in that less than the diameter of the is provided.

上記発明によれば、係止部に形成された糸通路を通じて穿刺針の内部に縫合糸を挿通することができる。これにより、連発式のメリットを有しつつ、穿刺針を細径化することができるため低侵襲の臓器固定具が実現できる。   According to the said invention, a suture can be penetrated into the inside of a puncture needle through the thread | yarn channel | path formed in the latching | locking part. Thereby, since it is possible to reduce the diameter of the puncture needle while having the merit of repetitive type, a minimally invasive organ fixing device can be realized.

本発明の第一実施形態の穿刺針を示す断面図である。It is sectional drawing which shows the puncture needle of 1st embodiment of this invention. 第一実施形態の穿刺針を示す一部断面図である。It is a partial cross section figure which shows the puncture needle of 1st embodiment. 第一実施形態の臓器固定具を示す概略斜視図である。It is a schematic perspective view which shows the organ fixing tool of 1st embodiment. 第一実施形態の臓器固定具を示す一部側面図である。It is a partial side view which shows the organ fixing tool of 1st embodiment. 第一実施形態の臓器固定具の内部機構を示す一部透視図である。It is a partial perspective view which shows the internal mechanism of the organ fixing tool of 1st embodiment. 第一実施形態の操作部を示す側面図である。It is a side view which shows the operation part of 1st embodiment. 第一実施形態の操作部を示す他の側面図である。It is another side view which shows the operation part of 1st embodiment. 第一実施形態の操作部の係合爪を押し込んだ状態を示す側面図である。It is a side view which shows the state which pushed in the engagement nail | claw of the operation part of 1st embodiment. 第一実施形態の臓器固定具を腹部に穿刺した状態を示す断面図である。It is sectional drawing which shows the state which punctured the abdominal part the organ fixing tool of 1st embodiment. 第一実施形態の臓器固定具の操作部を下降した状態を示す断面図である。It is sectional drawing which shows the state which lowered | hung the operation part of the organ fixing tool of 1st embodiment. 第一実施形態の係止部が胃壁の内部に係合した状態を示す断面図である。It is sectional drawing which shows the state which the latching | locking part of 1st embodiment engaged the inside of a stomach wall. 第一実施形態の変形例の穿刺針を示す断面図である。It is sectional drawing which shows the puncture needle of the modification of 1st embodiment. 本発明の第二実施形態の係止部を示す平面図である。It is a top view which shows the latching | locking part of 2nd embodiment of this invention. 第二実施形態の縫合具を示す断面図である。It is sectional drawing which shows the suturing tool of 2nd embodiment. 本発明の第三実施形態の縫合具を示す一部断面図である。It is a partial cross section figure which shows the suturing tool of 3rd embodiment of this invention. 第三実施形態の縫合具を示す一部斜視図である。It is a partial perspective view which shows the suturing tool of 3rd embodiment. 第三実施形態の縫合具を示す断面図である。It is sectional drawing which shows the suturing tool of 3rd embodiment. 本発明の第四実施形態の縫合具を示す一部断面図である。It is a partial cross section figure which shows the suturing tool of 4th embodiment of this invention. 第四実施形態の係止部を示す斜視図である。It is a perspective view which shows the latching | locking part of 4th embodiment. 本発明の第五実施形態の縫合具を示す一部斜視図である。It is a partial perspective view which shows the suturing tool of 5th embodiment of this invention. 本発明の第六実施形態の係止部を示す一部斜視図である。It is a partial perspective view which shows the latching | locking part of 6th embodiment of this invention.

以下、本発明の実施形態を図面に基づいて説明する。図中、同様の構成要素には同様の符号を付し、重複する説明を省略する場合がある。   Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the drawings, similar components are denoted by the same reference numerals, and redundant description may be omitted.

＜第一実施形態＞
図１は、本発明の第一実施形態の穿刺針を示す。図１は図２のＡ−Ａ線に沿う断面図である。図２は穿刺針を示す一部断面図である。図３は臓器固定具を示す概略斜視図、図４は臓器固定具を示す一部側面図、図５は臓器固定具の内部機構を示す一部透視図、図６は操作部を示す側面図、図７は操作部を示す他の側面図、図８は操作部の係合爪を押し込んだ状態を示す側面図である。図９は臓器固定具を腹部に穿刺した状態を示す断面図、図１０は臓器固定具の操作部を下降した状態を示す断面図、図１１は係止部が胃壁の内部に係合した状態を示す断面図である。 <First embodiment>
FIG. 1 shows a puncture needle according to a first embodiment of the present invention. 1 is a cross-sectional view taken along line AA in FIG. FIG. 2 is a partial cross-sectional view showing the puncture needle. 3 is a schematic perspective view showing the organ fixing device, FIG. 4 is a partial side view showing the organ fixing device, FIG. 5 is a partial perspective view showing the internal mechanism of the organ fixing device, and FIG. 6 is a side view showing the operation unit. FIG. 7 is another side view showing the operation unit, and FIG. 8 is a side view showing a state in which the engaging claw of the operation unit is pushed. 9 is a cross-sectional view showing a state where the organ fixing tool is punctured in the abdomen, FIG. 10 is a cross-sectional view showing a state where the operation part of the organ fixing tool is lowered, and FIG. 11 is a state where the locking part is engaged with the inside of the stomach wall. FIG.

臓器固定具１００は、図１〜図３に示すように、縫合具２０，２０ａ〜２０ｃと、穿刺針３０と、操作部本体６３を有する押出装置４０と、を備える。
縫合具２０，２０ａ〜２０ｃは、図１および図２に示すように、棒状の係止部２１，２１ａ〜２１ｃと、係止部２１，２１ａ〜２１ｃに端部が連結された縫合糸２２，２２ａ〜２２ｃと、からなる。
穿刺針３０は、複数個、本実施形態においてはたとえば４個の係止部２１，２１ａ〜２１ｃを先基端方向に並べて収納するものである。
本実施形態の連発式の臓器固定具１００が備える押出装置４０は、操作部本体６３の操作によって複数個（たとえば２個）の係止部２１，２１ａを穿刺針３０から一個ずつ押し出すものである。
図２に示すように、先端側に収納された縫合具２０，２０ａ，２０ｂの縫合糸２２，２２ａ，２２ｂを穿刺針３０の内部で挿通するための糸通路２３ａ〜２３ｄが、基端側に収納された他の縫合具２０ａ〜２０ｃの係止部２１ａ〜２１ｃに形成されている。 As shown in FIGS. 1 to 3, the organ fixing device 100 includes suture devices 20, 20 a to 20 c, a puncture needle 30, and an extrusion device 40 having an operation unit main body 63.
As shown in FIGS. 1 and 2, the suture tools 20, 20 a to 20 c include rod-shaped locking portions 21, 21 a to 21 c, and sutures 22 having ends connected to the locking portions 21, 21 a to 21 c, 22a-22c.
The puncture needle 30 accommodates a plurality of, for example, four locking portions 21, 21 a to 21 c in this embodiment side by side in the proximal direction.
The extrusion device 40 included in the repetitive organ fixing device 100 of the present embodiment pushes a plurality of (for example, two) locking portions 21 and 21a one by one from the puncture needle 30 one by one by operating the operation portion main body 63. .
As shown in FIG. 2, thread passages 23a-23d for inserting the sutures 22, 22a, 22b of the suture tools 20, 20a, 20b housed on the distal end side into the puncture needle 30 are formed on the proximal end side. It forms in the latching | locking part 21a-21c of the other accommodated suture tools 20a-20c.

次に、本実施形態の縫合具２０，２０ａ〜２０ｃについて詳細に説明する。
縫合具２０，２０ａ〜２０ｃは、図２に示すように、臓器固定具１００に複数本、たとえば４本装填され、連発式で使用される。
縫合具２０，２０ａ〜２０ｃは、穿刺針３０の針先３１側から順に一段目の縫合具２０と、二段目の縫合具２０ａと、三段目の縫合具２０ｂと、四段目の縫合具２０ｃと、からなる。 Next, the suture tools 20 and 20a to 20c of the present embodiment will be described in detail.
As shown in FIG. 2, a plurality of, for example, four suturing tools 20, 20a to 20c are loaded on the organ fixing device 100 and used in a repetitive manner.
The suture tools 20, 20a to 20c are the first-stage suture tool 20, the second-stage suture tool 20a, the third-stage suture tool 20b, and the fourth-stage suture, in order from the needle tip 31 side of the puncture needle 30. And the tool 20c.

次に、本実施形態の係止部２１，２１ａ〜２１ｃは、ステンレス鋼などの金属製の棒状、たとえば円柱形である。
係止部２１，２１ａ〜２１ｃ、すなわち四段目の縫合具２０ｃの係止部２１ｃの周囲には、図１に示すように、糸通路２３ａ〜２３ｄが形成されている。 Next, the latching | locking parts 21 and 21a-21c of this embodiment are metal rod shapes, such as a cylindrical shape, such as stainless steel.
As shown in FIG. 1, thread passages 23a to 23d are formed around the locking portions 21 and 21a to 21c, that is, around the locking portion 21c of the fourth-stage suture tool 20c.

次に、本実施形態の糸通路２３ａ〜２３ｄは、図１に示すように、係止部２１ｃの押出方向に沿って、当該係止部２１ｃの周面に溝状に形成されている。
すなわち、糸通路２３ａ〜２３ｄは、係止部２１ｃの周面から、係止部２１ｃの軸心に向かって凹んだ、断面が半円形の溝状に削成されている。 Next, as shown in FIG. 1, the yarn passages 23a to 23d of the present embodiment are formed in a groove shape on the peripheral surface of the locking portion 21c along the pushing direction of the locking portion 21c.
That is, the thread passages 23a to 23d are cut into a groove shape having a semicircular cross section that is recessed from the peripheral surface of the locking portion 21c toward the axial center of the locking portion 21c.

なお、図２において四段目に位置する係止部２１ｃを例にあげて説明したが、他の一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂにも同様の構造を備える。   In FIG. 2, the locking portion 21c positioned at the fourth stage has been described as an example. However, the locking sections 21, 21, a, and 21b positioned at the first to third stages have the same structure. Prepare.

図１に示す本実施形態の糸通路２３ａ〜２３ｄの幅寸法は、縫合糸２２，２２ａ〜２２ｃの直径以上である。糸通路２３ａ〜２３ｄの幅寸法とは、穿刺針３０の収納部３２の周方向にみた糸通路２３ａ〜２３ｄの寸法である。糸通路２３ａ〜２３ｄの深さも、同様に、縫合糸２２，２２ａ〜２２ｃの直径以上とすることができる。糸通路２３ａ〜２３ｄの深さとは、穿刺針３０の収納部３２の径方向にみた糸通路２３ａ〜２３ｄの寸法である。   The width dimension of the thread passages 23a to 23d of this embodiment shown in FIG. 1 is equal to or larger than the diameter of the suture threads 22 and 22a to 22c. The width dimension of the thread passages 23a to 23d is the dimension of the thread paths 23a to 23d viewed in the circumferential direction of the storage portion 32 of the puncture needle 30. Similarly, the depth of the thread passages 23a to 23d can be equal to or greater than the diameter of the suture threads 22 and 22a to 22c. The depths of the thread passages 23a to 23d are the dimensions of the thread passages 23a to 23d viewed in the radial direction of the storage portion 32 of the puncture needle 30.

糸通路２３ａ〜２３ｄの深さを、縫合糸２２，２２ａ〜２２ｃの直径以上とすると、係止部２１ｃの周囲からの縫合糸２２，２２ａ〜２２ｃの突出をなくし、縫合糸２２，２２ａ〜２２ｃを糸通路２３ａ〜２３ｄの内部に収容することができる。収納部３２の内径と、係止部２１ｃのうち糸通路２３ａ〜２３ｄを除く部位の直径と、の差分（空隙寸法）は、縫合糸２２，２２ａ〜２２ｃの２本分の直径よりも小さく、好ましくは縫合糸２２，２２ａ〜２２ｃの１本分の直径よりも小さい。このため、係止部２１，２１ａ〜２１ｃを順に押し出す際に、縫合糸２２，２２ａ〜２２ｃが糸通路２３ａ〜２３ｄから脱落せず、互いに絡まることがない。   If the depth of the thread passages 23a to 23d is equal to or greater than the diameter of the suture threads 22, 22a to 22c, the protrusion of the suture threads 22, 22a to 22c from the periphery of the locking portion 21c is eliminated, and the suture threads 22, 22a to 22c. Can be accommodated in the yarn passages 23a to 23d. The difference (gap size) between the inner diameter of the storage portion 32 and the diameter of the portion excluding the thread passages 23a to 23d in the locking portion 21c is smaller than the diameter of the two suture threads 22 and 22a to 22c, The diameter is preferably smaller than the diameter of one suture thread 22, 22a to 22c. For this reason, when pushing out the latching | locking parts 21 and 21a-21c in order, the suture thread 22, 22a-22c does not drop from the thread | yarn channel | paths 23a-23d, and does not get entangled with each other.

これに対し、糸通路２３ａ〜２３ｄの深さを、縫合糸２２，２２ａ〜２２ｃの直径未満、すなわち浅くすると、係止部２１ｃの周囲からの縫合糸２２，２２ａ〜２２ｃの一部が突出する。このため、糸通路２３ａ〜２３ｄの深さが深いことが好ましいが、それより浅くても穿刺針３０を細径化に貢献する（図１２に示す変形例を参照）。たとえば縫合糸の本数を４本とし、係止部２１の周囲に９０度間隔で４個の糸通路２３ａ〜２３ｄを分散形成する場合において、各糸通路（２３ａ〜２３ｄ）の深さを、縫合糸２２，２２ａ〜２２ｃの直径の１／２に設定することができる。この場合、各縫合糸２２，２２ａ〜２２ｃは直径の１／２（半径）だけ糸通路２３ａ〜２３ｄから突出することになる。縫合糸２２，２２ａ〜２２ｃの全部を包含する外接円の直径は、係止部２１の直径に加えて、縫合糸２２，２２ａ〜２２ｃの一本分の直径を合せただけの小径に抑制することができる。このため、穿刺針３０を細径化して低侵襲の臓器固定具１００が実現する。   On the other hand, when the depth of the thread passages 23a to 23d is less than the diameter of the suture threads 22, 22a to 22c, that is, shallower, a part of the suture threads 22, 22a to 22c protrudes from the periphery of the locking portion 21c. . For this reason, it is preferable that the depth of the thread passages 23a to 23d is deep, but the puncture needle 30 contributes to reducing the diameter even if the depth is smaller than that (see the modification shown in FIG. 12). For example, in the case where the number of suture threads is four and four thread paths 23a to 23d are dispersedly formed around the locking portion 21 at intervals of 90 degrees, the depth of each thread path (23a to 23d) is set to the suture. It can be set to 1/2 of the diameter of the yarns 22, 22a to 22c. In this case, each of the suture threads 22, 22a to 22c protrudes from the thread passages 23a to 23d by a half (radius) of the diameter. The diameter of the circumscribed circle including all of the suture threads 22, 22 a to 22 c is suppressed to a small diameter that is equal to the diameter of one suture thread 22, 22 a to 22 c in addition to the diameter of the locking portion 21. be able to. For this reason, the diameter of the puncture needle 30 is reduced, and the minimally invasive organ fixing device 100 is realized.

図１２は、変形例にかかる穿刺針３０を示す断面図である。糸通路２３ａ〜２３ｄの幅寸法および深さを縫合糸２２，２２ａ〜２２ｃの直径未満としてもよい。この変形例においては、縫合糸２２，２２ａ〜２２ｃの内径側の一部のみが糸通路２３ａ〜２３ｄに収容されており、縫合糸２２，２２ａ〜２２ｃの外径側は係止部２１ｃよりも外側に位置している。糸通路２３ａ〜２３ｄの凹形状は、縫合糸２２，２２ａ〜２２ｃの外周面に沿う円弧状である。   FIG. 12 is a cross-sectional view showing a puncture needle 30 according to a modification. The width dimension and depth of the thread passages 23a to 23d may be less than the diameter of the suture threads 22 and 22a to 22c. In this modification, only a part on the inner diameter side of the suture threads 22, 22a to 22c is accommodated in the thread passages 23a to 23d, and the outer diameter side of the suture threads 22, 22a to 22c is more than the locking portion 21c. Located on the outside. The concave shapes of the thread passages 23a to 23d are arc shapes along the outer peripheral surfaces of the suture threads 22 and 22a to 22c.

収納部３２の内径と、対向する糸通路２３ａおよび２３ｃの最深部同士を通る係止部２１ｃの直径と、の差分は、縫合糸２２および２２ｂの直径の合計よりも僅かに大きい。また、収納部３２の内径と、係止部２１ｃのうち糸通路２３ａ〜２３ｄを除く部位の直径と、の差分は、縫合糸２２および２２ｂの直径の合計よりも小さい。
同様に、収納部３２の内径と、対向する糸通路２３ｂおよび２３ｄの最深部同士を通る係止部２１ｃの直径と、の差分は、縫合糸２２ａおよび２２ｃの直径の合計よりも僅かに大きい。また、収納部３２の内径と、係止部２１ｃのうち糸通路２３ａ〜２３ｄを除く部位の直径と、の差分は、縫合糸２２ａおよび２２ｃの直径の合計よりも小さい。
係止部２１、２１ａ、２１ｂに関しても同様である。
これにより、本変形例の臓器固定具１００に関しても、係止部２１，２１ａ〜２１ｃを順に押し出す際に、縫合糸２２，２２ａ〜２２ｃは糸通路２３ａ〜２３ｄにそれぞれ係合した状態から脱落することがなく、互いに絡まることがない。 The difference between the inner diameter of the storage portion 32 and the diameter of the locking portion 21c passing through the deepest portions of the opposing thread passages 23a and 23c is slightly larger than the sum of the diameters of the sutures 22 and 22b. Further, the difference between the inner diameter of the storage portion 32 and the diameter of the portion of the locking portion 21c excluding the thread passages 23a to 23d is smaller than the sum of the diameters of the suture threads 22 and 22b.
Similarly, the difference between the inner diameter of the storage portion 32 and the diameter of the locking portion 21c passing through the deepest portions of the opposing thread passages 23b and 23d is slightly larger than the sum of the diameters of the sutures 22a and 22c. Further, the difference between the inner diameter of the storage portion 32 and the diameter of the portion of the locking portion 21c excluding the thread passages 23a to 23d is smaller than the sum of the diameters of the suture threads 22a and 22c.
The same applies to the locking portions 21, 21a, 21b.
Thereby, also with respect to the organ fixing device 100 of this modification, when the locking portions 21, 21a to 21c are sequentially pushed out, the sutures 22 and 22a to 22c are dropped from the state engaged with the thread passages 23a to 23d, respectively. And never get tangled with each other.

次に、本実施形態の糸通路２３ａ〜２３ｄが、図１に示すように、複数個、たとえば４個形成されている。４個の糸通路２３ａ〜２３ｄは、互いに離間するように穿刺針３０の内部に分散形成されている。本実施形態の４個の糸通路２３ａ〜２３ｄは、係止部２１（係止部２１ｃ）の周囲に等間隔で分散配置されている。   Next, as shown in FIG. 1, a plurality of, for example, four yarn passages 23a to 23d of the present embodiment are formed. The four thread passages 23a to 23d are distributed and formed inside the puncture needle 30 so as to be separated from each other. The four yarn passages 23a to 23d of the present embodiment are distributed and arranged at regular intervals around the locking portion 21 (locking portion 21c).

なお、ここでは四段目に位置する係止部２１ｃ（図２を参照）を例にあげて説明したが、他の一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂも同様の構造を備えている。
穿刺針３０の針先３１側から順に一段目の係止部２１は、図示しないが、自身の縫合糸２２が通る１個の糸通路があれば足りるが、糸通路を２個以上設けてもよい。
二段目の係止部２１ａは、図示しないが、自身の縫合糸２２ａが通る１個の糸通路に加え、一段目の縫合糸２２が通る計２個の糸通路があれば足りるが、糸通路を３個以上設けてもよい。
三段目の係止部２１ｂは、図示しないが、自身の縫合糸２２ｂが通る１個の糸通路に加え、一段目、二段目の縫合糸２２，２２ａが通る計３個の糸通路があれば足りるが、糸通路を４個以上設けてもよい。
四段目の係止部２１ｃは、図１に示すように、自身の縫合糸２２ｃが通る１個の糸通路２３ｃに加え、一段目〜三段目の縫合糸２２，２２ａ，２２ｂが通る計４個の糸通路２３ａ〜２３ｄがあれば足りるが、糸通路を５個以上設けてもよい。 Here, the locking portion 21c (see FIG. 2) positioned at the fourth level has been described as an example, but the locking portions 21, 21a, 21b positioned at the first level to the third level are also described. It has the same structure.
Although not shown in the drawings, the first locking portion 21 in order from the needle tip 31 side of the puncture needle 30 suffices if there is one thread passage through which its own suture thread 22 passes, but two or more thread passages may be provided. Good.
Although not shown in the drawing, the second-stage locking portion 21a is sufficient if there are a total of two thread paths through which the first-stage suture thread 22 passes in addition to one thread path through which the own suture thread 22a passes. Three or more passages may be provided.
Although not shown in the figure, the third-stage locking portion 21b has a total of three thread paths through which the first-stage and second-stage suture threads 22 and 22a pass in addition to one thread path through which the own suture thread 22b passes. As long as it is sufficient, four or more yarn paths may be provided.
As shown in FIG. 1, the fourth-stage locking portion 21 c includes a single thread passage 23 c through which its own suture thread 22 c passes, and a total of the first-stage to third-stage suture threads 22, 22 a, 22 b. Although four thread paths 23a to 23d are sufficient, five or more thread paths may be provided.

次に、本実施形態の糸通路２３ａ〜２３ｄは、３個以上、たとえば４個形成されている。４個の糸通路２３ａ〜２３ｄは、穿刺針３０の内部に均等に分散形成されている。すなわち、４個の糸通路２３ａ〜２３ｄは、９０度間隔で形成されている。
なお、図２において四段目に位置する係止部２１ｃを例にあげて説明したが、他の一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂにも同様の構造を備える。 Next, three or more, for example, four yarn paths 23a to 23d of the present embodiment are formed. The four thread passages 23 a to 23 d are uniformly distributed inside the puncture needle 30. That is, the four yarn passages 23a to 23d are formed at intervals of 90 degrees.
In FIG. 2, the locking portion 21c positioned at the fourth stage has been described as an example. However, the locking sections 21, 21, a, and 21b positioned at the first to third stages have the same structure. Prepare.

本実施形態の臓器固定具１００においては、すべての縫合糸２２，２２ａ〜２２ｃの本数（４本）と同数の糸通路２３ａ〜２３ｄが、係止部２１，２１ａ〜２１ｃにそれぞれ形成されている。これにより、係止部２１，２１ａ〜２１ｃを互いに同一の形状とすることができ部品点数の削減に資する。   In the organ fixing device 100 of the present embodiment, the same number of thread passages 23a to 23d as the number of suture threads 22, 22a to 22c (four) are formed in the locking portions 21, 21a to 21c, respectively. . Thereby, the latching | locking parts 21 and 21a-21c can be made into the mutually same shape, and it contributes to reduction of a number of parts.

本実施形態の縫合糸２２，２２ａ〜２２ｃは、ナイロンなどの樹脂製である。縫合糸２２，２２ａ〜２２ｃは、係止部２１，２１ａ〜２１ｃに対して１本ずつ設けられている。縫合糸２２，２２ａ〜２２ｃの一端部は係止部２１，２１ａ〜２１ｃの長さの途中、たとえば中央に熱融着または接着固定されている。縫合糸２２，２２ａ〜２２ｃの他端部は臓器固定具１００の外部に導き出されている。   The suture threads 22 and 22a to 22c of the present embodiment are made of resin such as nylon. One suture thread 22, 22a-22c is provided for each of the locking portions 21, 21a-21c. One end portions of the suture threads 22 and 22a to 22c are heat-sealed or bonded and fixed to the middle of the lengths of the locking portions 21 and 21a to 21c, for example, at the center. The other ends of the sutures 22 and 22a to 22c are led out of the organ fixing device 100.

穿刺針３０は、ステンレス鋼などの金属製の円筒からなる注射針である。穿刺針３０の内部の収納部３２には、図２に示すように、係止部２１，２１ａ〜２１ｃが挿通自在に収納されている。収納部３２は、中空であり、その全長が係止部２１，２１ａ〜２１ｃの４個分の長さ以上に設定されている。すなわち、収納部３２は、穿刺針３０の軸心方向に沿って、係止部２１，２１ａ〜２１ｃを複数個、たとえば４個収納できるものである。
収納部３２は、一端部が針先３１にて開放され、他端部が押出装置４０に連通されている。収納部３２の直径、すなわち穿刺針３０の内径は、図１に示すように、係止部２１，２１ａ〜２１ｃの直径よりも僅かに大きい。 The puncture needle 30 is an injection needle made of a metal cylinder such as stainless steel. As shown in FIG. 2, locking portions 21, 21 a to 21 c are stored in the storage portion 32 inside the puncture needle 30 so as to be freely inserted. The accommodating part 32 is hollow, and the full length is set more than the length for four of the latching | locking parts 21,21a-21c. That is, the storage part 32 can store a plurality of, for example, four locking parts 21, 21 a to 21 c along the axial direction of the puncture needle 30.
The storage portion 32 has one end opened at the needle tip 31 and the other end communicated with the extrusion device 40. The diameter of the storage part 32, that is, the inner diameter of the puncture needle 30, is slightly larger than the diameters of the locking parts 21, 21a to 21c, as shown in FIG.

次に、本実施形態の押出装置４０について詳細に説明する。
押出装置４０は、連発式の動作を行うためのものである。ここでは便宜上、２本の縫合具２０，２０ａを装填して順に送り出すものを例にあげて説明する。
押出装置４０は、図３から図８に示すように、大別すると、筒部５０と、操作部６０と、把持部７０と、ロック装置８０と、からなる。 Next, the extrusion apparatus 40 of this embodiment is demonstrated in detail.
The extrusion device 40 is for performing a continuous operation. Here, for the sake of convenience, a description will be given of an example in which two suture tools 20 and 20a are loaded and sequentially sent out.
As shown in FIGS. 3 to 8, the extrusion device 40 is roughly composed of a cylindrical portion 50, an operation portion 60, a gripping portion 70, and a lock device 80.

筒部５０は、合成樹脂製の円筒であって、図３から図５に示すように、穿刺針３０が固定されるものである。筒部５０は、両端部が開口し、その開口一端部に、針先３１とは反対側の穿刺針３０の基端部が固定され、当該穿刺針３０の収納部３２に連通し、開口他端部からは内部に操作部６０が挿入される。筒部５０には、図５に示すように、内外に貫通する糸出用孔５１が設けられている。糸出用孔５１は、図示しないが、係止部２１，２１ａの糸通路２３ａ〜２３ｄを通って、穿刺針３０の収納部３２内から筒部５０の内部に導き出された２本の縫合糸２２，２２ａが通る。   The cylinder part 50 is a cylinder made of synthetic resin, and the puncture needle 30 is fixed as shown in FIGS. 3 to 5. Both ends of the tube portion 50 are open, and a proximal end portion of the puncture needle 30 on the opposite side of the needle tip 31 is fixed to one end portion of the opening, communicated with the storage portion 32 of the puncture needle 30, and other openings. The operation unit 60 is inserted into the inside from the end. As shown in FIG. 5, the tube portion 50 is provided with a yarn discharge hole 51 penetrating inward and outward. Although not shown, the thread output hole 51 passes through the thread passages 23a to 23d of the locking portions 21 and 21a, and the two suture threads led from the storage portion 32 of the puncture needle 30 to the inside of the tube portion 50. 22 and 22a pass.

操作部６０は、筒部５０の内部を通って穿刺針３０の収納部３２内に収納された係止部２１，２１ａを、穿刺針３０の針先３１から押し出すものである。操作部６０は、図３から図８に示すように、大別すると、押出棒６１と、押圧部６２と、操作部本体６３と、からなる。   The operation unit 60 pushes the locking portions 21 and 21 a stored in the storage unit 32 of the puncture needle 30 through the inside of the tube unit 50 from the needle tip 31 of the puncture needle 30. As shown in FIGS. 3 to 8, the operation unit 60 is roughly composed of an extrusion rod 61, a pressing unit 62, and an operation unit main body 63.

押出棒６１は、ステンレス鋼などの金属製の芯棒である。図５および図９に示すように、押出棒６１は筒部５０の内部から穿刺針３０の収納部３２内に挿入され、収納部３２内をスライドすることで、収納部３２内に収納された係止部２１，２１ａを針先３１から押し出す。すなわち、収納部３２内には、針先３１から順に、一段目の係止部２１と、次段に位置する二段目の係止部２１ａが順に収納されていることから、押出棒６１は、二段目の係止部２１ａに当接する。押出棒６１が針先３１側に進むと、当該押出棒６１に押されて、二段目の係止部２１ａが針先３１側に進む。このため、二段目の係止部２１ａに押されて、一段目の係止部２１も針先３１側に進む。   The extrusion rod 61 is a core rod made of metal such as stainless steel. As shown in FIGS. 5 and 9, the push rod 61 is inserted from the inside of the cylindrical portion 50 into the storage portion 32 of the puncture needle 30 and is stored in the storage portion 32 by sliding in the storage portion 32. The locking portions 21 and 21a are pushed out from the needle tip 31. That is, in the storage portion 32, the first-stage locking portion 21 and the second-stage locking portion 21 a positioned in the next stage are sequentially stored from the needle tip 31. , Abuts on the second-stage locking portion 21a. When the push bar 61 advances to the needle tip 31 side, it is pushed by the push bar 61 and the second-stage locking portion 21a advances to the needle tip 31 side. For this reason, it is pushed by the second stage locking part 21a, and the first stage locking part 21 also advances toward the needle tip 31 side.

押圧部６２は、合成樹脂製の円筒である。図５に示すように、押圧部６２の一端部に押出棒６１が固定されている。押圧部６２の他端部は、後述する操作部本体６３に至り、操作部本体６３の押圧力を押出棒６１に伝達する。押圧部６２は、筒部５０の内部にスライド可能に保持され、同図において上側に開口する開口他端部から筒部５０の外部に突出する。   The pressing part 62 is a synthetic resin cylinder. As shown in FIG. 5, the push rod 61 is fixed to one end portion of the pressing portion 62. The other end of the pressing portion 62 reaches an operation portion main body 63 described later, and transmits the pressing force of the operation portion main body 63 to the push rod 61. The pressing portion 62 is slidably held inside the cylindrical portion 50 and protrudes to the outside of the cylindrical portion 50 from the other open end portion that opens upward in FIG.

操作部本体６３は、合成樹脂製の円板形であって、図５から図８に示すように、押圧操作を行うためのものである。操作部本体６３は、図３に示すように、同図において上側に位置する押圧部６２の上端部から円板形に張り出している。操作部本体６３の外径は、同図において上側に開口する筒部５０の開口他端部の内径より大きく設定され、誤って筒部５０内に嵌り込まないようにしている。   The operation portion main body 63 is a disc shape made of synthetic resin, and is for performing a pressing operation as shown in FIGS. As shown in FIG. 3, the operation portion main body 63 protrudes in a disk shape from the upper end portion of the pressing portion 62 located on the upper side in the drawing. The outer diameter of the operation portion main body 63 is set to be larger than the inner diameter of the other open end of the cylindrical portion 50 that opens upward in the drawing so that the operating portion main body 63 is not accidentally fitted into the cylindrical portion 50.

把持部７０は、合成樹脂製の平板形であって、押出装置４０を把持するものである。把持部７０は、図３に示すように、同図において筒部５０の下側から左右両側に向かって対称に板状に張り出している。   The gripping portion 70 is a flat plate made of synthetic resin and grips the extrusion device 40. As shown in FIG. 3, the gripping part 70 projects symmetrically from the lower side of the cylinder part 50 toward the left and right sides in the same figure.

ロック装置８０は、筒部５０に対して操作部６０が不用意にスライドするのを規制する手段である。ロック装置８０は、図５に示すように、大別すると、係合爪８１と、凹部８２，８２ａと、からなる。これに加え、筒部５０には、ロック装置８０のロック状態を解除する解除用ボタン８３，８４が設けられている。   The lock device 80 is a means for restricting the operation unit 60 from inadvertently sliding with respect to the tube unit 50. As shown in FIG. 5, the locking device 80 is roughly composed of an engaging claw 81 and concave portions 82 and 82a. In addition, the cylinder part 50 is provided with release buttons 83 and 84 for releasing the lock state of the lock device 80.

係合爪８１は、凹部８２，８２ａのいずれかに嵌り込むことで、筒部５０に対する操作部６０の押圧が阻止される。
係合爪８１は、図５から図７に示すように、押圧部６２に設けられ、その外周から凸形に突出する。押圧部６２が、円筒形に形成されていることから、その外周壁を切り欠くことで、凸形の部分が筒内部に弾性的にたわみ込むことができるようにしている。 The engagement claw 81 is fitted into one of the recesses 82 and 82 a, thereby preventing the operation unit 60 from being pressed against the cylinder unit 50.
As shown in FIGS. 5 to 7, the engaging claw 81 is provided in the pressing portion 62 and protrudes in a convex shape from the outer periphery thereof. Since the pressing portion 62 is formed in a cylindrical shape, the convex portion can be elastically bent into the cylinder by cutting out the outer peripheral wall thereof.

凹部８２，８２ａは、図５に示すように、筒部５０に設けられ、同図において上下二段に設けられている。
凹部８２，８２ａは、筒部５０の内外に貫通し、筒部５０の内周側からは係合爪８１が嵌り込み、外周側には後述する解除用ボタン８３，８４がそれぞれ取り付けられている。
図４において上側に位置する凹部８２に、係合爪８１が嵌り込んだ状態では、押出棒６１の先端部が、図８に示すように、穿刺針３０の収納部３２内に収納された二段目、すなわち同図に上側に位置する係止部２１ａに臨む。
上側に位置する凹部８２に、係合爪８１が嵌り込んだ状態では、それ以上、操作部６０が筒部５０の内部に押し込まれるのを阻止し、縫合具２０，２０ａが穿刺針３０の針先３１から押し出されるのを防止する。また、操作部６０が、筒部５０の内部から抜けるのを防止する。
上側に位置する凹部８２に嵌り込んでいた係合爪８１が、図４において下側に位置する凹部８２ａに向かって進むと、押出棒６１に押されて、二段目の係止部２１ａが針先３１側に進む。このため、二段目の係止部２１ａに押されて、一段目の係止部２１が針先３１から押し出される。
当該位置で、下側に位置する凹部８２ａに、係合爪８１が嵌り込む。下側に位置する凹部８２ａに、係合爪８１が嵌り込んだ状態では、それ以上、操作部６０が筒部５０の内部に押し込まれるのを阻止し、二段目の縫合具２０ａが穿刺針３０の針先３１から押し出されるのを防止する。 As shown in FIG. 5, the recesses 82 and 82a are provided in the cylindrical portion 50, and are provided in two upper and lower stages in the figure.
The recesses 82 and 82a penetrate the inside and outside of the cylindrical portion 50, the engaging claw 81 is fitted from the inner peripheral side of the cylindrical portion 50, and release buttons 83 and 84 to be described later are respectively attached to the outer peripheral side. .
In the state where the engaging claw 81 is fitted in the concave portion 82 located on the upper side in FIG. 4, the distal end portion of the push bar 61 is stored in the storage portion 32 of the puncture needle 30 as shown in FIG. 8. It faces the step, that is, the engaging portion 21a located on the upper side in FIG.
In a state where the engaging claw 81 is fitted in the concave portion 82 located on the upper side, the operating portion 60 is further prevented from being pushed into the cylindrical portion 50, and the suture tools 20, 20 a are the needles of the puncture needle 30. It is prevented from being pushed out from the tip 31. Further, the operation unit 60 is prevented from coming off from the inside of the tube unit 50.
When the engaging claw 81 fitted in the concave portion 82 located on the upper side proceeds toward the concave portion 82a located on the lower side in FIG. 4, it is pushed by the push rod 61, and the second-stage locking portion 21 a is Proceed to the needle tip 31 side. For this reason, it is pushed by the second-stage locking portion 21 a and the first-stage locking portion 21 is pushed out from the needle tip 31.
At this position, the engaging claw 81 is fitted into the concave portion 82a located on the lower side. In a state where the engaging claw 81 is fitted in the concave portion 82a located on the lower side, the operation portion 60 is further prevented from being pushed into the cylindrical portion 50, and the second-stage suture tool 20a is inserted into the puncture needle. It is prevented from being pushed out from 30 needle tips 31.

解除用ボタン８３，８４は、合成樹脂製のボタン形であって、図５に示すように、凹部８２，８２ａのいずれかに嵌り込んだ係合爪８１を、凹部８２，８２ａ内から筒部５０の内部に向かって、すなわち筒部５０の中心に向かって半径方向内向きに押し出すものである。
その結果、係合爪８１が、凹部８２，８２ａから係脱し、ロック状態が解除される。
解除用ボタン８３，８４は、図５に示すように、上下の凹部８２，８２ａに筒部５０の外周側から嵌り込み、図示しないが、板バネやコイルバネのバネ力で外周から突出する。 The release buttons 83 and 84 are formed of a synthetic resin button, and as shown in FIG. 5, the engaging claw 81 fitted into one of the recesses 82 and 82a is inserted into the cylindrical portion from the recesses 82 and 82a. It pushes inward in the radial direction toward the inside of 50, that is, toward the center of the cylindrical portion 50.
As a result, the engaging claw 81 is disengaged from the recesses 82 and 82a, and the locked state is released.
As shown in FIG. 5, the release buttons 83 and 84 are fitted into the upper and lower recesses 82 and 82a from the outer peripheral side of the cylindrical portion 50 and project from the outer periphery by the spring force of a plate spring or a coil spring (not shown).

本実施形態の臓器固定具１００の使用方法について説明する。
まず、係合爪８１が、図５において上側に位置する凹部８２に嵌り込んだ状態で臓器固定具１００を使用する。
穿刺針３０を、図９に示すように、患者の体外から体壁（腹壁）Ａおよび胃壁Ｂを貫通するまで穿刺し、胃内に針先３１を露出させる。
次に、図１０に示すように、同図において上側に位置する解除用ボタン８３を押圧する。解除用ボタン８３を押圧すると、同図において、上側に位置する凹部８２に嵌り込んでいた係合爪８１が係脱し、ロック装置８０のロック状態が解除される。
その後、操作部本体６３を、図１０に示すように、筒部５０の内部に向かって押圧する。
操作部本体６３を押圧すると、押出棒６１が穿刺針３０の収納部３２内を進行し、二段目の係止部２１ａを介して、一段目の係止部２１が針先３１から押し出される。
このため、一段目の係止部２１が、図１０に示すように、胃内に投入される。
臓器固定具１００は、穿刺針３０を対外に引き抜いて回収する。
つぎに、一段目の係止部２１の縫合糸２２を、図１１に示すように、体外から引っ張り、係止部２１が胃壁Ｂを体壁Ａ側に引き寄せ、縫合糸２２を体外側に固定することで、胃壁Ｂが体壁Ａに固定される。 A method of using the organ fixing device 100 of this embodiment will be described.
First, the organ fixing tool 100 is used in a state where the engaging claw 81 is fitted in the concave portion 82 located on the upper side in FIG.
As shown in FIG. 9, the puncture needle 30 is punctured from outside the patient's body until it penetrates the body wall (abdominal wall) A and the stomach wall B to expose the needle tip 31 in the stomach.
Next, as shown in FIG. 10, the release button 83 located on the upper side in the figure is pressed. When the release button 83 is pressed, the engagement claw 81 fitted in the concave portion 82 located on the upper side is engaged and disengaged, and the lock state of the lock device 80 is released.
Then, the operation part main body 63 is pressed toward the inside of the cylinder part 50, as shown in FIG.
When the operation portion main body 63 is pressed, the push rod 61 advances in the storage portion 32 of the puncture needle 30, and the first-stage locking portion 21 is pushed out from the needle tip 31 via the second-stage locking portion 21a. .
For this reason, the first stage locking portion 21 is introduced into the stomach as shown in FIG.
The organ fixing device 100 collects the puncture needle 30 by pulling it outward.
Next, as shown in FIG. 11, the suture 22 of the first-stage locking portion 21 is pulled from outside the body, the locking portion 21 pulls the stomach wall B toward the body wall A, and the suture 22 is fixed to the outside of the body. By doing so, the stomach wall B is fixed to the body wall A.

その後、回収した臓器固定具１００の穿刺針３０を、図示しないが、体壁Ａの異なる位置から胃壁Ｂを貫通するまで穿刺し、胃内に針先３１を露出させる。
次に、図５において下側に位置する解除用ボタン８４を押圧する。解除用ボタン８４を押圧すると、同図において、下側に位置する凹部８２ａに嵌り込んでいた係合爪８１が係脱し、ロック装置８０のロック状態が解除される。
その後、操作部本体６３を、筒部５０の内部に向かって押圧する。
操作部本体６３を押圧すると、押出棒６１が穿刺針３０の収納部３２内を進行し、二段目の係止部２１ａが針先３１から押し出される。このため、二段目の係止部２１ａが、胃内に投入される。
二段目の係止部２１ａの縫合糸２２ａを、一段目の縫合糸２２と同様に、体外から引っ張って固定することで、胃壁Ｂが体壁Ａに固定される。 Thereafter, although not shown, the collected puncture needle 30 of the organ fixing device 100 is punctured from a different position of the body wall A until it penetrates the stomach wall B to expose the needle tip 31 in the stomach.
Next, the release button 84 located on the lower side in FIG. 5 is pressed. When the release button 84 is pressed, the engagement claw 81 fitted in the concave portion 82a located on the lower side in FIG. 3 is engaged and disengaged, and the lock state of the lock device 80 is released.
Thereafter, the operation portion main body 63 is pressed toward the inside of the cylindrical portion 50.
When the operation portion main body 63 is pressed, the push rod 61 advances in the storage portion 32 of the puncture needle 30, and the second-stage locking portion 21 a is pushed out from the needle tip 31. For this reason, the second locking portion 21a is introduced into the stomach.
The stomach wall B is fixed to the body wall A by pulling and fixing the suture thread 22a of the second-stage locking portion 21a from outside the body in the same manner as the first-stage suture thread 22.

以上、２本の縫合具２０，２０ａを装填して順に送り出す押出装置４０を説明したが、本発明はこれに限られない。図１および図２に示すように４本の係止部２１，２１ａ〜２１ｃを穿刺針３０に装填して順に送り出す４連発式の臓器固定具１００の場合、解除用ボタン８３、８４に加えて、更に２個の解除用ボタンを押出装置４０に設けるとよい。このように、装填される係止部の個数に応じて、押出装置４０に設ける凹部８２および解除用ボタン８３の数量を設定することができる。   As described above, the extruding device 40 that has been loaded with the two suturing tools 20 and 20a and sequentially feeds them has been described, but the present invention is not limited thereto. As shown in FIGS. 1 and 2, in the case of the four-barrel organ fixing device 100 in which the four locking portions 21, 21 a to 21 c are loaded into the puncture needle 30 and sequentially sent out, in addition to the release buttons 83 and 84. Furthermore, it is preferable to provide two release buttons on the extrusion device 40. As described above, the number of the recesses 82 and the release buttons 83 provided in the extrusion device 40 can be set according to the number of the locking portions to be loaded.

＜第二実施形態＞
図１３は、本発明の第二実施形態の係止部を示す平面図、図１４は縫合具を示す断面図である。
本実施形態の縫合具２０ｃは、その係止部２１ｃに固定溝２００が形成されている点で第一実施形態と相違する。 <Second embodiment>
FIG. 13 is a plan view showing a locking portion of a second embodiment of the present invention, and FIG. 14 is a cross-sectional view showing a suturing tool.
The suturing tool 20c of the present embodiment is different from the first embodiment in that a fixing groove 200 is formed in the locking portion 21c.

本実施形態の係止部２１ｃの長さ方向の中間部の周囲に、縫合糸２２ｃを絡げて固定するための環状の固定溝２００が形成されている。本実施形態の固定溝２００は、係止部２１ｃの長さ方向の中央に、糸通路２３ａ〜２３ｄと直交する方向に延在する環状に形成されている。   An annular fixing groove 200 for binding and fixing the suture thread 22c is formed around the intermediate portion in the length direction of the locking portion 21c of the present embodiment. The fixing groove 200 of the present embodiment is formed in an annular shape extending in the direction perpendicular to the yarn passages 23a to 23d at the center in the length direction of the locking portion 21c.

固定溝２００は、図１３に示すように、係止部２１ｃの周面から、係止部２１ｃの軸心に向かって凹んだ、断面が半円形の溝状に削成されている。
なお、図２において四段目に位置する係止部２１ｃを例にあげて説明したが、他の一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂにも同様の構造を備える。 As shown in FIG. 13, the fixing groove 200 is cut into a semicircular groove shape that is recessed from the peripheral surface of the locking portion 21 c toward the axis of the locking portion 21 c.
In FIG. 2, the locking portion 21c positioned at the fourth stage has been described as an example. However, the locking sections 21, 21, a, and 21b positioned at the first to third stages have the same structure. Prepare.

固定溝２００の内径は、縫合糸２２ｃの直径以上である。固定溝２００の深さは、縫合糸２２ｃの直径未満に形成され、糸通路２３ａ〜２３ｄと比較して浅く形成されている。
固定溝２００の深さと、縫合糸２２ｃの直径との関係は、固定溝２００の深さを、糸通路２３ａ〜２３ｄの深さと同様に、縫合糸２２ｃの直径以上とすると、係止部２１ｃの周囲からの縫合糸２２ｃの突出を無くすることができる。
これに対し、固定溝２００の深さを、縫合糸２２ｃの直径未満、すなわち浅くすると、係止部２１ｃの周囲からの縫合糸２２ｃの径寸法の一部が突出する。穿刺針３０を細径化という点では、固定溝２００の深さを深くするとよい。 The inner diameter of the fixing groove 200 is equal to or larger than the diameter of the suture thread 22c. The depth of the fixing groove 200 is less than the diameter of the suture thread 22c, and is shallower than the thread passages 23a to 23d.
The relationship between the depth of the fixing groove 200 and the diameter of the suture thread 22c is as follows. When the depth of the fixing groove 200 is equal to or greater than the diameter of the suture thread 22c, similar to the depth of the thread passages 23a to 23d, The protrusion of the suture thread 22c from the periphery can be eliminated.
On the other hand, when the depth of the fixing groove 200 is smaller than the diameter of the suture thread 22c, that is, shallower, a part of the diameter of the suture thread 22c protrudes from the periphery of the locking portion 21c. In terms of reducing the diameter of the puncture needle 30, the depth of the fixing groove 200 may be increased.

縫合糸２２ｃの固定方法、ならびに穿刺針（図示せず）への装着方法について、図１３および図１４を用いて説明する。
縫合糸２２ｃの一端部を、固定溝２００に巻き付けて、その先端部を先に巻き付けた長さの途中に結びつけて固定する。その後、係止部２１ｃを穿刺針３０（図２を参照）内に挿入する。このとき、縫合糸２２ｃを、図１４に示すように、糸通路２３ｄに沿わせた状態で穿刺針３０の内部に挿通するとよい。 A method for fixing the suture thread 22c and a method for attaching the suture thread 22c to a puncture needle (not shown) will be described with reference to FIGS.
One end portion of the suture thread 22c is wound around the fixing groove 200, and the distal end portion thereof is tied and fixed in the middle of the previously wound length. Thereafter, the locking portion 21c is inserted into the puncture needle 30 (see FIG. 2). At this time, as shown in FIG. 14, the suture thread 22c may be inserted into the puncture needle 30 in a state along the thread passage 23d.

＜第三実施形態＞
図１５は、本発明の第三実施形態の縫合具２０ｃを示す一部断面図、図１６は縫合具２０ｃを示す一部斜視図、図１７は縫合具２０ｃを示す断面図である。
本実施形態の縫合具２０ｃは、係止部２１ｃを中空構造とし、その中空部３００内に縫合糸２２ｃを固定している点で第一実施形態と相違する。 <Third embodiment>
15 is a partial cross-sectional view showing a suturing tool 20c according to a third embodiment of the present invention, FIG. 16 is a partial perspective view showing the suturing tool 20c, and FIG. 17 is a cross-sectional view showing the suturing tool 20c.
The suture tool 20c of this embodiment is different from the first embodiment in that the locking portion 21c has a hollow structure and the suture thread 22c is fixed in the hollow portion 300.

本実施形態の係止部２１ｃが中空に形成されている。
係止部２１ｃの長さの途中には、内外に貫通する貫通孔３１０が形成されている。貫通孔３１０から挿入された前記縫合糸２２ｃは、係止部２１ｃの周囲をかしめることで中空の内部に固定されている。貫通孔３１０から外部に出た縫合糸２２ｃは、糸通路２３ａ〜２３ｄのいずれかに挿通されている。
なお、図２において四段目に位置する係止部２１ｃを例にあげて説明したが、他の一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂも同様の構造を備えている。 The locking portion 21c of this embodiment is formed in a hollow shape.
In the middle of the length of the locking portion 21c, a through hole 310 that penetrates inside and outside is formed. The suture thread 22c inserted from the through hole 310 is fixed to the hollow interior by caulking around the locking portion 21c. The suture thread 22c that has come out of the through hole 310 is inserted into one of the thread passages 23a to 23d.
In FIG. 2, the locking portion 21c positioned at the fourth level has been described as an example, but the locking portions 21, 21a, and 21b positioned at the first to third levels also have the same structure. ing.

本実施形態の係止部２１ｃはステンレス鋼などの金属製で、中空の円筒形に形成されている。係止部２１ｃの中空部３００の直径は、縫合糸２２ｃの直径以上に設定されている。貫通孔３１０は、糸通路２３ｄ側から中空部３００に貫通し、開口形状が楕円形に形成されている。貫通孔３１０の内径は、縫合糸２２ｃの直径以上に設定されている。本実施形態の貫通孔３１０の開口形状は、楕円形のほか、線状（スリット状）、長円形、方形、または多角形状としてもよい。   The locking portion 21c of this embodiment is made of a metal such as stainless steel and is formed in a hollow cylindrical shape. The diameter of the hollow portion 300 of the locking portion 21c is set to be equal to or larger than the diameter of the suture thread 22c. The through hole 310 penetrates the hollow portion 300 from the yarn passage 23d side, and the opening shape is formed in an elliptical shape. The inner diameter of the through hole 310 is set to be equal to or larger than the diameter of the suture thread 22c. The opening shape of the through-hole 310 of the present embodiment may be an elliptical shape, a linear shape (slit shape), an oval shape, a square shape, or a polygonal shape.

縫合糸２２ｃの固定方法、および穿刺針３０への装着方法について、図１５から図１７を用いて説明する。
係止部２１ｃの外部から、図１６に示すように、縫合糸２２ｃの一端部を、貫通孔３１０を通して中空部３００に挿入する。
次に、図１５に示すように、縫合糸２２ｃが通っている係止部２１ｃの周囲をかしめて、カシメ部３２０とする。カシメ部３２０により、係止部２１ｃがせばめられ、その内壁が縫合糸２２ｃに食い込んでいる。これにより縫合糸２２ｃは中空部３００内に固定され、縫合糸２２ｃは貫通孔３１０から脱落することが防止される。
その後、係止部２１ｃは、穿刺針３０の収納部３２内に挿入される。このとき、カシメ部３２０を穿刺針３０の針先側に向けて挿入し、貫通孔３１０から出た縫合糸２２ｃは、図１７に示すように、糸通路２３ｄを沿わせて穿刺針３０の外部に導き出される。 A method of fixing the suture thread 22c and a method of attaching it to the puncture needle 30 will be described with reference to FIGS.
As shown in FIG. 16, one end of the suture thread 22 c is inserted into the hollow portion 300 through the through hole 310 from the outside of the locking portion 21 c.
Next, as shown in FIG. 15, the periphery of the locking portion 21 c through which the suture thread 22 c passes is caulked to form a caulking portion 320. The locking portion 21c is fitted by the crimping portion 320, and the inner wall bites into the suture thread 22c. Thereby, the suture thread 22c is fixed in the hollow portion 300, and the suture thread 22c is prevented from dropping from the through hole 310.
Thereafter, the locking portion 21 c is inserted into the storage portion 32 of the puncture needle 30. At this time, the caulking portion 320 is inserted toward the needle tip side of the puncture needle 30, and the suture thread 22 c exiting from the through-hole 310 passes along the thread passage 23 d and is outside the puncture needle 30 as shown in FIG. 17. Is derived.

ここでは、図２において四段目に位置する係止部２１ｃを例にあげて説明し、残る一段目から三段目にそれぞれ位置する係止部２１，２１ａ、２１ｂも同様である。図示しないが、一段目の係止部２１の貫通孔は、糸通路２３ａの中間部に形成されている。縫合糸２２は糸通路２３ａに沿って穿刺針３０の内部に挿通される。
二段目の係止部２１ａの貫通孔は、糸通路２３ｂの中間部に形成されている。縫合糸２２ａは糸通路２３ｂに沿って穿刺針３０の内部に挿通される。そして三段目の係止部２１ｂの貫通孔は、糸通路２３ｃの中間部に形成されている。縫合糸２２ｂは糸通路２３ｃに沿って穿刺針３０の内部に挿通される。これにより、４種類の係止部２１，２１ａ〜２１ｃを互いに同一形状とすることができる。 Here, the engaging portion 21c located at the fourth level in FIG. 2 will be described as an example, and the same applies to the remaining engaging portions 21, 21a, and 21b located at the first to third levels. Although not shown, the through hole of the first stage locking portion 21 is formed in the middle portion of the yarn passage 23a. The suture thread 22 is inserted into the puncture needle 30 along the thread passage 23a.
The through hole of the second stage locking portion 21a is formed in the middle portion of the yarn passage 23b. The suture thread 22a is inserted into the puncture needle 30 along the thread passage 23b. And the through-hole of the 3rd step | paragraph latching | locking part 21b is formed in the intermediate part of the thread | yarn channel | path 23c. The suture thread 22b is inserted into the puncture needle 30 along the thread passage 23c. Thereby, four types of latching | locking parts 21,21a-21c can mutually be made into the same shape.

＜第四実施形態＞
図１８は、本発明の第四実施形態の縫合具２０を示す一部断面図、図１９は係止部を示す斜視図である。
本実施形態の縫合具２０は、第一に、係止部２１を中空構造とし、その中空部４００を「糸通路」として使用している点で第一から第三実施形態と相違する。
第二に、本実施形態の縫合具２０は、係止部２１の周囲に平坦部４２０が形成され、平坦部４２０に縫合糸２２を接合している点で第一から第三実施形態と相違する。 <Fourth embodiment>
FIG. 18 is a partial cross-sectional view showing a suturing tool 20 according to a fourth embodiment of the present invention, and FIG. 19 is a perspective view showing a locking portion.
The suturing tool 20 of the present embodiment is different from the first to third embodiments in that first, the locking portion 21 has a hollow structure and the hollow portion 400 is used as a “thread passage”.
Second, the suturing tool 20 of the present embodiment is different from the first to third embodiments in that a flat portion 420 is formed around the locking portion 21 and the suture thread 22 is joined to the flat portion 420. To do.

本実施形態の係止部２１は中空に形成されている。本実施形態は、係止部２１の中空の筒内部、すなわち中空部４００内が糸通路であることを特徴とする。   The locking part 21 of the present embodiment is formed hollow. The present embodiment is characterized in that the inside of the hollow cylinder of the locking portion 21, that is, the inside of the hollow portion 400 is a yarn passage.

また、係止部２１の周面には、縫合糸２２を接合可能な平坦部４２０が形成されている。なお、一段目に位置する係止部２１のみならず、他の二段目から四段目にそれぞれ位置する係止部２１ａ〜２１ｃも同様の構造を備えている。   A flat portion 420 to which the suture thread 22 can be joined is formed on the peripheral surface of the locking portion 21. Not only the locking part 21 positioned at the first stage but also the locking parts 21a to 21c positioned at the other second to fourth stages have the same structure.

係止部２１には、基端側の端面から長さの途中まで延在するスリット４１０が形成されている。係止部２１の先端側の周面の内外のいずれか一方の面、たとえば外側に位置する平坦部４２０に、縫合糸２２が接合されている。接合された縫合糸２２は、スリット４１０を介して係止部２１の中空の筒内部、すなわち中空部４００の内部に引き込まれている。なお、図２において一段目に位置する係止部２１を例にあげて説明したが、他の二段目から四段目にそれぞれ位置する係止部２１ａ〜２１ｃも同様の構造を備えている。   The locking portion 21 is formed with a slit 410 extending from the end face on the base end side to the middle of the length. The suture thread 22 is joined to either the inner or outer surface of the peripheral surface on the distal end side of the locking portion 21, for example, the flat portion 420 located outside. The joined suture 22 is drawn into the hollow cylinder of the locking portion 21, that is, the hollow portion 400 through the slit 410. In addition, although the latching | locking part 21 located in the 1st step was mentioned as an example in FIG. 2, the latching | locking parts 21a-21c each located in the other 2nd to 4th stages are also provided with the same structure. .

本実施形態の係止部２１は、ステンレス鋼などの金属製で、中空の円筒形に形成されている。スリット４１０と平坦部４２０とは、隣接して位置し、係止部２１の片半部にそれぞれ分かれて形成されている。スリット４１０は、係止部２１を穿刺針３０内に挿入した際に、その基端側に位置させ、平坦部４２０は穿刺針の針先側に位置させる。   The locking portion 21 of the present embodiment is made of a metal such as stainless steel and is formed in a hollow cylindrical shape. The slit 410 and the flat part 420 are located adjacent to each other and formed separately in one half of the locking part 21. The slit 410 is positioned on the proximal end side when the locking portion 21 is inserted into the puncture needle 30, and the flat portion 420 is positioned on the needle tip side of the puncture needle.

スリット４１０の溝幅は、縫合糸２２の直径以上に設定されている。平坦部４２０の幅は、縫合糸２２の直径以上に設定されている。   The groove width of the slit 410 is set to be equal to or larger than the diameter of the suture thread 22. The width of the flat portion 420 is set to be equal to or larger than the diameter of the suture thread 22.

縫合糸２２の固定方法、ならびに穿刺針３０（図２を参照）への装着方法について、図１８を用いて説明する。
縫合糸２２の一端部を、図１８に示すように、係止部２１の平坦部４２０に位置させ、熱融着または接着固定して固定部４３０とする。このとき、縫合糸２２の先端部を、スリット４１０と反対側、すなわち穿刺針内に挿入した際に、その針先側に向けて位置させる。
その後、係止部２１を穿刺針３０内に挿入する。このとき、固定部４３０を、図示しないが、穿刺針の針先側に向けて挿入する。縫合糸２２は、図１８に示すように、スリット４１０を介して中空部４００の内部に導き入れ、「糸通路」である中空部４００内を通して外部に導き出す。 A method for fixing the suture thread 22 and a method for attaching the suture thread 22 to the puncture needle 30 (see FIG. 2) will be described with reference to FIG.
As shown in FIG. 18, one end portion of the suture thread 22 is positioned on the flat portion 420 of the locking portion 21 and is heat-sealed or bonded and fixed to form a fixing portion 430. At this time, when the distal end portion of the suture thread 22 is inserted into the side opposite to the slit 410, that is, into the puncture needle, it is positioned toward the needle tip side.
Thereafter, the locking portion 21 is inserted into the puncture needle 30. At this time, although not shown, the fixing portion 430 is inserted toward the needle tip side of the puncture needle. As shown in FIG. 18, the suture thread 22 is led into the hollow portion 400 through the slit 410 and led to the outside through the hollow portion 400 that is a “thread passage”.

＜第五実施形態＞
図２０は、本発明の第五実施形態の縫合具２０を示す一部斜視図である。
本実施形態の縫合具２０は、係止部２１を中空構造とし、その中空部５００の内周面に、縫合糸２２を接合している点で第一から第四実施形態と相違する。 <Fifth embodiment>
FIG. 20 is a partial perspective view showing the suturing tool 20 according to the fifth embodiment of the present invention.
The suturing tool 20 of the present embodiment is different from the first to fourth embodiments in that the locking portion 21 has a hollow structure and the suture thread 22 is joined to the inner peripheral surface of the hollow portion 500.

本実施形態の係止部２１の先端側の筒内部に、縫合糸２２が接合されている。
なお、図２において一段目に位置する係止部２１を例にあげて説明したが、他の二段目から四段目にそれぞれ位置する係止部２１ａ〜２１ｃにも同様の構造を備える。 The suture thread 22 is joined to the inside of the tube on the distal end side of the locking portion 21 of the present embodiment.
In addition, although the latching | locking part 21 located in the 1st step was mentioned as an example in FIG. 2, it has the same structure also in the latching | locking part 21a-21c each located in the other 2nd stage to the 4th stage.

本実施形態の係止部２１は、ステンレス鋼などの金属製であり、中空の円筒形に形成されている。係止部２１の中空の筒内部、すなわち中空部５００内を、糸通路としている。
係止部２１には、基端側の端面から長さの途中まで延在するスリット５１０が形成されている。スリット５１０は、係止部２１の片半部に形成されている。スリット５１０は、係止部２１を穿刺針３０（図２を参照）内に挿入した際に、その基端側に位置させる。スリット５１０の溝幅は、縫合糸２２の直径以上に設定されている。 The locking portion 21 of the present embodiment is made of a metal such as stainless steel and is formed in a hollow cylindrical shape. The inside of the hollow cylinder of the locking portion 21, that is, the inside of the hollow portion 500 is used as a yarn passage.
The locking portion 21 is formed with a slit 510 that extends from the end face on the base end side to the middle of its length. The slit 510 is formed in one half of the locking portion 21. The slit 510 is positioned on the proximal end side when the locking portion 21 is inserted into the puncture needle 30 (see FIG. 2). The groove width of the slit 510 is set to be equal to or larger than the diameter of the suture thread 22.

係止部２１に対する縫合糸２２の固定方法、および穿刺針（図示せず）への装着方法について、図２０を用いて説明する。
縫合糸２２の一端部を、図２０に示すように、スリット５１０を介して、中空部５００の内部に挿入する。つぎに、縫合糸２２の上記一端部の先端を中空部５００の内壁面に位置させ、熱融着または接着固定し、固定部５２０とする。このとき、縫合糸２２の先端部を、スリット５１０と反対側、すなわち穿刺針内に挿入した際に、その針先側に向けて位置させる。 A method for fixing the suture thread 22 to the locking portion 21 and a method for attaching the suture thread 22 to a puncture needle (not shown) will be described with reference to FIG.
One end portion of the suture thread 22 is inserted into the hollow portion 500 through the slit 510 as shown in FIG. Next, the tip of the one end of the suture thread 22 is positioned on the inner wall surface of the hollow portion 500, and is heat-sealed or bonded and fixed to form a fixing portion 520. At this time, the distal end portion of the suture thread 22 is positioned toward the side opposite to the slit 510, that is, toward the needle tip side when inserted into the puncture needle.

その後、係止部２１を穿刺針３０内に挿入する。このとき、固定部５２０を、穿刺針３０の針先側に向けて挿入する。縫合糸２２は、図２０に示すように、スリット５１０を介して中空部５００の内部に導き入れ、「糸通路」である中空部５００内を通して穿刺針３０の外部に導き出される。   Thereafter, the locking portion 21 is inserted into the puncture needle 30. At this time, the fixing portion 520 is inserted toward the needle tip side of the puncture needle 30. As shown in FIG. 20, the suture thread 22 is led into the hollow portion 500 through the slit 510 and led out of the puncture needle 30 through the hollow portion 500 that is a “thread passage”.

＜第六実施形態＞
図２１は、本発明の第六実施形態の係止部を示す一部斜視図である。
本実施形態の係止部２１，２１ａの端面に、互いに嵌合する凹凸部６００，６１０が形成されている点で第一から第五実施形態と相違する。 <Sixth embodiment>
FIG. 21 is a partial perspective view showing the locking portion of the sixth embodiment of the present invention.
This embodiment is different from the first to fifth embodiments in that concave and convex portions 600 and 610 that are fitted to each other are formed on the end surfaces of the locking portions 21 and 21a of the present embodiment.

対向する少なくとも一対の係止部２１，２１ａの端面に、互いに嵌合する凹凸部６００，６１０が形成されている。
なお、図２において一段目、二段目に位置する係止部２１，２１ａを例にあげて説明したが、図示しないが、二段目に位置する係止部２１ａと三段目に位置する係止部２１ｂとの間や、三段目に位置する係止部２１ｂと四段目に位置する係止部２１ｃとの間に、同様の構造の凹凸部を設ける。 Concavity and convexity portions 600 and 610 that are fitted to each other are formed on the end surfaces of at least a pair of engaging portions 21 and 21a that face each other.
In FIG. 2, the first and second locking portions 21 and 21a are described as examples. However, although not shown, the second locking portion 21a and the third locking portion are positioned. An uneven portion having a similar structure is provided between the locking portion 21b and between the locking portion 21b positioned at the third level and the locking portion 21c positioned at the fourth level.

凹凸部６００，６１０は、断面が非円形に形成されている。凹凸部６００，６１０のうち、凹部６００は、図２において一段目の係止部２１の基端側（図２１の上方）の端面に形成されている。本実施形態の凹部６００は横断面が方形の凹状である。横断面とは、係止部２１を軸心方向に対して直交する方向に切った断面である。凹部６００は有底であり、係止部２１の端面の中心から軸心方向に凹状に延びている。凸部６１０は、係止部２１ａの先端側（図２１の下方）の端面の中心に角柱状に突出して形成されている。凸部６１０の横断面形状は、凹部６００と対応している。係止部２１ａの凸部６１０は、その先端側に位置する他の係止部２１の基端側（図２１の上方）の端面の凹部６００と嵌合する。凹部６００の深さと、凸部６１０の全長との関係は、凹部６００の深さが凸部６１０の全長以上であってもよい。   The concavo-convex portions 600 and 610 have a non-circular cross section. Of the concavo-convex portions 600 and 610, the concave portion 600 is formed on the end surface on the base end side (upper side in FIG. 21) of the first-stage locking portion 21 in FIG. The concave portion 600 of the present embodiment is a concave shape having a square cross section. A cross section is a cross section which cut the latching | locking part 21 in the direction orthogonal to an axial center direction. The concave portion 600 has a bottom and extends in a concave shape in the axial direction from the center of the end surface of the locking portion 21. The convex portion 610 is formed so as to protrude in the shape of a prism at the center of the end surface on the distal end side (downward in FIG. 21) of the locking portion 21a. The cross-sectional shape of the convex portion 610 corresponds to the concave portion 600. The convex portion 610 of the locking portion 21a fits with the concave portion 600 on the end surface on the base end side (upper side in FIG. 21) of the other locking portion 21 located on the distal end side thereof. The relationship between the depth of the concave portion 600 and the total length of the convex portion 610 may be such that the depth of the concave portion 600 is equal to or greater than the total length of the convex portion 610.

２個の係止部２１，２１ａは、図示しないが、穿刺針内に挿入した際に、凹凸部６００，６１０が互いに嵌り合うことで、隣接する係止部２１，２１ａの軸心回りの相対的な回転を規制する。これにより、中空部５００の内部で縫合糸２２，２２ａが互いに捩れあって絡まるのを防止できる。   Although not shown in the figure, the two locking portions 21 and 21a are relatively arranged around the axis of the adjacent locking portions 21 and 21a when the concave and convex portions 600 and 610 are fitted to each other when inserted into the puncture needle. Regular rotation. Thereby, it is possible to prevent the sutures 22 and 22a from being twisted and entangled with each other inside the hollow portion 500.

なお、本発明は上述の実施形態に限定されるものではなく、本発明の目的が達成される限りにおける種々の変形、改良等の態様も含む。
たとえば、係止部を中空に形成して筒内部を糸通路にするとともに、さらに係止部の周面に他の糸通路を溝状に形成してもよい。これにより、縫合糸の本数が多いとき、一部の縫合糸を筒内部に挿通し、他の縫合糸を係止部の周面の溝状の糸通路に通すことができる。このため、縫合糸同士の絡まり合いを低減することができる。
また、係止部の内部に、複数の独立した糸通路を通孔形成し、各通孔にそれぞれ縫合糸を一本ずつ挿通することとしてもよい。 The present invention is not limited to the above-described embodiment, and includes various modifications and improvements as long as the object of the present invention is achieved.
For example, the engagement portion may be formed hollow to make the inside of the cylinder a yarn passage, and another yarn passage may be formed in a groove shape on the peripheral surface of the engagement portion. As a result, when the number of sutures is large, a part of the sutures can be inserted into the cylinder, and the other sutures can be passed through the groove-like thread passage on the peripheral surface of the locking portion. For this reason, the entanglement between the sutures can be reduced.
Alternatively, a plurality of independent thread passages may be formed in the locking portion, and one suture thread may be inserted into each through hole.

上記第一実施形態において、係止部を円柱形としたが、これに代えて、中空の円筒形としてもよい。また、係止部の断面形状も円形に限らず、多角形としてもよい。
たとえば上記第一実施形態において、係止部に各１本の縫合糸が固定された縫合具を例示したが、本発明はこれに限られない。複数本の縫合糸を係止部に固定してもよい。
上記実施形態では縫合糸を係止部の中央に固定している状態を例示したが、係止部の端部に縫合糸を固定してもよいし、あるいは１本の縫合糸をループさせてその両端部を係止部の両端部にそれぞれ固定してもよい。 In the first embodiment, the locking portion is a columnar shape, but may be a hollow cylindrical shape instead. Further, the cross-sectional shape of the locking portion is not limited to a circle, and may be a polygon.
For example, in the first embodiment, the suture tool in which one suture thread is fixed to the locking portion is illustrated, but the present invention is not limited to this. A plurality of sutures may be fixed to the locking portion.
In the above embodiment, the state in which the suture is fixed to the center of the locking portion is illustrated, but the suture may be fixed to the end of the locking portion, or a single suture may be looped. You may fix the both ends to the both ends of a latching | locking part, respectively.

また、上記第一および第二実施形態において、図１に示すように糸通路２３ａ〜２３ｄの横断面形状を半円形としたが、これに限られない。糸通路の横断面形状を、たとえばＵ字形、Ω形、矩形あるいは多角形状としてもよい。
たとえば上記第一実施形態において、４個の糸通路２３ａ〜２３ｄを、係止部２１，２１ａ〜２１ｃの周囲に均等に分散形成したが、４個の糸通路２３ａ〜２３ｄを係止部２１，２１ａ〜２１ｃの周囲に不均等に分散形成してもよい。
たとえば上記第一実施形態において、縫合具２０，２０ａ〜２０ｃを４本としたが、２本、３本または５本以上としてもよい。 Moreover, in the said 1st and 2nd embodiment, although the cross-sectional shape of the thread | yarn channel | paths 23a-23d was made into semicircle as shown in FIG. 1, it is not restricted to this. The cross-sectional shape of the yarn passage may be, for example, U-shaped, Ω-shaped, rectangular or polygonal.
For example, in the first embodiment, the four yarn passages 23a to 23d are uniformly distributed around the locking portions 21, 21a to 21c, but the four yarn passages 23a to 23d are connected to the locking portions 21, You may form non-uniformly distributed around 21a-21c.
For example, in the first embodiment, the number of the suture tools 20, 20a to 20c is four, but may be two, three, or five or more.

第二実施形態において、固定溝２００を、係止部２１ｃの中央に形成したが、一方の端部寄りに形成してもよい。
たとえば上記第二実施形態において、縫合糸２２ｃの一端部を、固定溝２００に絡げて固定することを例示したが、これに代えて熱融着または接着してもよい。 In the second embodiment, the fixing groove 200 is formed at the center of the locking portion 21c, but may be formed near one end.
For example, in the second embodiment, it has been illustrated that one end of the suture thread 22c is entangled with the fixing groove 200 and fixed thereto. However, instead of this, heat fusion or adhesion may be performed.

上記実施形態は、以下の技術思想を包含するものである。
（１）棒状の係止部と、前記係止部に端部が連結された縫合糸と、からなる縫合具と、複数個の前記係止部を先基端方向に並べて収納する穿刺針と、を有し、操作部本体の操作によって前記複数個の係止部が前記穿刺針から一個ずつ押し出される連発式の臓器固定具であって、先端側に収納された前記縫合具の縫合糸を前記穿刺針の内部で挿通するための糸通路が、基端側に収納された他の前記縫合具の前記係止部に形成されていることを特徴とする連発式の臓器固定具。
（２）前記係止部が中空に形成されており、前記係止部の中空の筒内部が前記糸通路である上記（１）に記載の連発式の臓器固定具。
（３）前記係止部の周面に、前記縫合糸を接合可能な平坦部が形成されている上記（２）に記載の連発式の臓器固定具。
（４）前記係止部には、基端側の端面から長さの途中まで延在するスリットが形成されており、前記係止部の先端側の周面の内外のいずれか一方の面に、前記縫合糸が接合され、接合された前記縫合糸が前記スリットを介して前記係止部の中空の筒内部に引き込まれている上記（２）または（３）に記載の連発式の臓器固定具。
（５）前記係止部の先端側の筒内部に、前記縫合糸が接合されている上記（２）から（４）のいずれか一項に記載の連発式の臓器固定具。
（６）前記糸通路が、前記係止部の押出方向に沿って、当該係止部の周面に溝状に形成されている上記（１）から（５）のいずれか一項に記載の連発式の臓器固定具。
（７）前記糸通路が、複数個形成され、複数個の前記糸通路が、互いに離間するように前記穿刺針の内部に分散形成されている上記（１）から（６）のいずれか一項に記載の連発式の臓器固定具。
（８）前記糸通路が、３個以上形成され、複数個の前記糸通路が、前記穿刺針の内部に均等に分散形成されている上記（７）に記載の連発式の臓器固定具。
（９）前記係止部の長さ方向の中間部の周囲に、前記縫合糸を絡げて固定するための環状の固定溝が形成されている上記（１）から（８）のいずれか一項に記載の連発式の臓器固定具。
（１０）前記係止部の端面に凹凸部が形成されており、前記凹凸部が、隣接する他の前記係止部の前記凹凸部と互いに嵌合する上記（１）から（９）のいずれか一項に記載の連発式の臓器固定具。
（１１）前記凹凸部は、断面が非円形に形成されている上記（１０）に記載の連発式の臓器固定具。
（１２）前記係止部が中空に形成され、前記係止部の長さの途中には、内外に貫通する貫通孔が形成され、前記貫通孔から挿入された前記縫合糸が、前記係止部の周囲をかしめることで中空の内部に固定されており、前記貫通孔から外部に出た前記縫合糸が前記糸通路に挿通されている上記（１）から（１１）のいずれか一項に記載の連発式の臓器固定具。 The above embodiment includes the following technical idea.
(1) A suturing tool comprising a rod-shaped locking portion, a suture thread having an end connected to the locking portion, and a puncture needle that stores a plurality of the locking portions side by side in the proximal direction. And a plurality of locking portions are pushed out one by one from the puncture needle one by one by operating the operation portion main body, and a suture thread of the suturing device housed on the distal end side is attached. A repetitive organ fixing device, wherein a thread passage for insertion inside the puncture needle is formed in the locking portion of another suturing device housed on the proximal end side.
(2) The repetitive organ fixing device according to (1), wherein the locking portion is formed in a hollow shape, and a hollow cylinder inside the locking portion is the thread passage.
(3) The repetitive organ fixing device according to (2), wherein a flat portion to which the suture can be joined is formed on a peripheral surface of the locking portion.
(4) The locking portion is formed with a slit extending from the end surface on the base end side to the middle of the length, and is formed on either the inner or outer surface of the peripheral surface on the distal end side of the locking portion. The continuous organ fixation according to (2) or (3), wherein the suture is joined and the joined suture is drawn into the hollow cylinder of the locking portion through the slit. Ingredients.
(5) The repetitive organ fixing device according to any one of (2) to (4), wherein the suture is joined inside a tube on a distal end side of the locking portion.
(6) The yarn path according to any one of (1) to (5), wherein the yarn passage is formed in a groove shape on a peripheral surface of the locking portion along the pushing direction of the locking portion. Repeated organ fixing device.
(7) Any one of the above (1) to (6), wherein a plurality of the thread passages are formed, and the plurality of the thread passages are dispersedly formed inside the puncture needle so as to be separated from each other. 2. Repeated organ fixing device according to 1.
(8) The continuous organ fixing device according to (7), wherein three or more of the thread passages are formed, and the plurality of thread passages are uniformly formed in the puncture needle.
(9) Any one of (1) to (8) above, wherein an annular fixing groove is formed around the intermediate portion in the lengthwise direction of the locking portion to bind and fix the suture thread. 2. The continuous organ fixing device according to item.
(10) Any of the above (1) to (9), wherein an uneven portion is formed on an end surface of the engaging portion, and the uneven portion is fitted to the uneven portion of the other adjacent engaging portion. The continuous organ fixing device according to claim 1.
(11) The repetitive organ fixing device according to (10), wherein the uneven portion has a non-circular cross section.
(12) The locking portion is formed hollow, and a through-hole penetrating inward and outward is formed in the middle of the length of the locking portion, and the suture thread inserted from the through-hole is Any one of the above (1) to (11), wherein the suture thread is fixed inside the hollow by caulking the periphery of the portion, and the suture thread that has come out of the through hole is inserted into the thread passage. 2. Repeated organ fixing device according to 1.

２０，２０ａ〜２０ｃ 縫合具
２１，２１ａ〜２１ｃ 係止部
２２，２２ａ〜２２ｃ 縫合糸
２３ａ〜２３ｄ 糸通路
３０ 穿刺針
３１ 針先
３２ 収納部
４０ 押出装置
５０ 筒部
５１ 糸出用孔
６０ 操作部
６１ 押出棒
６２ 押圧部
６３ 操作部本体
７０ 把持部
８０ ロック装置
８１ 係合爪
８２、８２ａ 凹部
８３、８４ 解除用ボタン
１００ 臓器固定具
２００ 固定溝
３００ 中空部
３１０ 貫通孔
３２０ カシメ部
４００ 中空部（糸通路）
４１０ スリット
４２０ 平坦部
４３０ 固定部
５００ 中空部
５１０ スリット
５２０ 固定部
６００ 凹部
６１０ 凸部
Ａ 体壁
Ｂ 胃壁 20, 20a to 20c Suture 21, 21a to 21c Locking portion 22, 22a to 22c Suture thread 23a to 23d Thread passage 30 Puncture needle 31 Needle tip 32 Storage portion 40 Extruding device 50 Tube portion 51 Yarn outlet hole 60 Operation portion 61 Extruding rod 62 Pressing part 63 Operation part main body 70 Holding part 80 Locking device 81 Engaging claw 82, 82a Recessed part 83, 84 Release button 100 Organ fixing tool 200 Fixing groove 300 Hollow part 310 Through hole 320 Caulking part 400 Hollow part ( Thread passage)
410 Slit 420 Flat part 430 Fixed part 500 Hollow part 510 Slit 520 Fixed part 600 Concave part 610 Convex part A Body wall B Stomach wall

Claims (8)

棒状の係止部と、前記係止部に端部が連結された縫合糸と、をそれぞれ有する複数個の縫合具と、複数個の前記係止部を収納する穿刺針と、を有し、複数個の前記係止部は前記穿刺針の先端から基端に向かって前記穿刺針の内部の収容部に並んで収容されており、操作部本体の操作によって前記複数個の係止部が前記穿刺針の先端から一個ずつ押し出される連発式の臓器固定具であって、
先端側に収納された前記縫合具の縫合糸を前記穿刺針の内部で挿通するための糸通路が、基端側に収納された他の前記縫合具の前記係止部に、前記係止部の押出方向に沿って、当該他の係止部の周面に溝状に形成されており、
前記収容部の直径と、前記係止部のうち前記糸通路を除く部位の直径と、の差分である空隙寸法が、前記縫合糸の２本分の直径よりも小さいことを特徴とする連発式の臓器固定具。 A plurality of suture tools each having a rod-shaped locking portion, a suture thread having an end connected to the locking portion, and a puncture needle that houses the plurality of locking portions; A plurality of the locking portions are accommodated side by side in the accommodating portion inside the puncture needle from the distal end to the proximal end of the puncture needle, and the plurality of locking portions are A repetitive organ fixing device that is pushed out one by one from the tip of the puncture needle,
Yarn passage for inserting the suture of the suture tool housed in the distal end side inside of the puncture needle, the locking portion of the other of the suture tool housed in the base end side, the locking portion Is formed in a groove shape on the peripheral surface of the other locking portion along the extrusion direction of
A repetitive type characterized in that a gap dimension which is a difference between a diameter of the accommodating portion and a diameter of a portion of the locking portion excluding the thread passage is smaller than a diameter of two sutures. Organ fixator. 溝状に形成された前記糸通路の深さが、前記縫合糸の直径未満である請求項１に記載の連発式の臓器固定具。  The continuous organ fixing device according to claim 1, wherein a depth of the thread passage formed in a groove shape is less than a diameter of the suture thread. 前記糸通路が、複数個形成され、
複数個の前記糸通路が、互いに離間するように前記穿刺針の内部に分散形成されている請求項１または２に記載の連発式の臓器固定具。 A plurality of the yarn passages are formed,
The repetitive organ fixing device according to claim 1 or 2 , wherein a plurality of the thread passages are dispersedly formed inside the puncture needle so as to be separated from each other. 前記糸通路が、３個以上形成され、
複数個の前記糸通路が、前記穿刺針の内部に均等に分散形成されている請求項３に記載の連発式の臓器固定具。 Three or more yarn passages are formed,
The repetitive organ fixing device according to claim 3 , wherein the plurality of thread passages are uniformly distributed inside the puncture needle. 前記係止部の長さ方向の中間部の周囲に、前記縫合糸を絡げて固定するための環状の固定溝が形成されている請求項１から４のいずれか一項に記載の連発式の臓器固定具。 The repetitive type according to any one of claims 1 to 4 , wherein an annular fixing groove is formed around the intermediate portion in the lengthwise direction of the locking portion to tie and fix the suture thread. Organ fixator. 前記係止部の端面に凹凸部が形成されており、前記凹凸部が、隣接する他の前記係止部の前記凹凸部と互いに嵌合する請求項１から５のいずれか一項に記載の連発式の臓器固定具。 The engagement being stop end surface uneven portion on the formation of the uneven portion is from another claim 1 mating with the concavo-convex portion of the engaging portion adjacent according to any one of the 5 Repeated organ fixing device. 前記凹凸部は、断面が非円形に形成されている請求項６に記載の連発式の臓器固定具。 The repetitive organ fixing device according to claim 6 , wherein the uneven portion has a non-circular cross section. 前記係止部が中空に形成され、
前記係止部の長さの途中には、内外に貫通する貫通孔が形成され、
前記貫通孔から挿入された前記縫合糸が、前記係止部の周囲をかしめることで中空の内部に固定されており、
前記貫通孔から外部に出た前記縫合糸が前記糸通路に挿通されている請求項１から７のいずれか一項に記載の連発式の臓器固定具。 The locking portion is formed hollow,
In the middle of the length of the locking portion, a through-hole penetrating in and out is formed,
The suture thread inserted from the through hole is fixed to the hollow interior by caulking around the locking portion,
The repetitive organ fixing device according to any one of claims 1 to 7 , wherein the suture thread that has come out of the through hole is inserted into the thread passage.
JP2013059321A 2013-02-22 2013-03-22 Repeated organ fixator Active JP6160153B2 (en)

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US14/764,429 US10342527B2 (en) 2013-02-22 2014-02-20 Repeating-type organ-fastening tool
KR1020157021915A KR101793801B1 (en) 2013-02-22 2014-02-20 Repeating-type organ-fastening tool
EP14754190.8A EP2959837B1 (en) 2013-02-22 2014-02-20 Repeating-type organ-fastening tool
CN201480009490.XA CN105007831B (en) 2013-02-22 2014-02-20 The internal organs fixator of repeating type
PCT/JP2014/054062 WO2014129554A1 (en) 2013-02-22 2014-02-20 Repeating-type organ-fastening tool
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US5549630A (en) * 1993-05-14 1996-08-27 Bonutti; Peter M. Method and apparatus for anchoring a suture
CA2133377C (en) * 1993-10-08 2004-09-14 H. Jonathan Tovey Surgical suturing apparatus with loading mechanism
JP4669316B2 (en) * 2005-04-25 2011-04-13 日本シャーウッド株式会社 Organ fixture set
US7850714B2 (en) * 2006-12-15 2010-12-14 Kimberly-Clark Worldwide, Inc. Segmented tissue-to-tissue anchoring device and method of using the same
US9662102B2 (en) * 2009-02-06 2017-05-30 Karl Storz Gmbh & Co. Kg Suture holding system
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