JP6243212B2 - Postoperative adhesion prevention device - Google Patents

Description

  The present invention relates to a postoperative adhesion preventing device for preventing intraperitoneal adhesion after laparotomy.

  In recent years, with the widespread use of laparoscopic surgery, there have been increased opportunities for patients who have had a history of laparoscopic cholecystectomy to perform laparoscopic surgery again. Laparoscopic cholecystectomy is less intense and less frequent than laparotomy, but there may be adhesions in the gallbladder excision and hepatoduodenal ligament during new surgery, which may be difficult to perform .

  In the case of laparotomy, adhesion of an anti-adhesion absorptive barrier film has been widely performed for the purpose of preventing adhesion, and its usefulness has been demonstrated. However, preparation and tips are required for insertion and pasting into body cavities, and methods for using devices and techniques have been reported.

  For example, in Non-Patent Document 1, an end of Sepra film (registered trademark) cut to a predetermined size is gripped with forceps and the Sepra film is wound into a cylindrical shape, and the Sepra film wound in the cylindrical shape is abdominal cavity via a trocar. The method of inserting in is described. However, in this method, since it is necessary to operate the body cavity while taking care not to attach the Sepra film to the organ around the target site, it can be said that the Sepra film can be easily introduced into the target site in the body cavity. Absent.

  Also, for example, in Non-Patent Document 2, only a holder is taken out from a regular size Sepra film, divided into four in the minor axis direction, the holder is used as a slider, the slider is folded in half and cut into a predetermined size. A technique for sandwiching Sepra film between the sliders is described. When inserting the Sepra film into the body cavity, the fold portion of the slider folded in half is grasped with forceps and inserted so as to fold along the wall of the trocar. However, in this method, when removing the Sepra film from the slider folded in half in the body cavity, it is necessary to grasp the end of the slider and move the slider several times in the predetermined direction. It cannot be said that a Sepra film can be easily introduced into a site.

"Anti-adhesion barrier barrier Sepra film information" Sepra film laparoscopic direct insertion method Kaken Pharmaceutical Co., Ltd. September 2007 "Adhesion prevention absorbable barrier Sepra film information" Sepra film delivery method in laparoscopic surgery -Sliding technique- Kaken Pharmaceutical Co., Ltd. January 2012

  The present invention has been made in view of such a problem, and provides a postoperative adhesion prevention device that can easily introduce an antiadhesive absorbent barrier film for preventing intraperitoneal adhesion after laparotomy to a target site in a body cavity. The purpose is to provide.

  The postoperative adhesion preventing device according to the present invention is characterized by comprising a laminate formed by laminating an adhesion preventing and absorbing barrier film and a rubber sheet.

  ADVANTAGE OF THE INVENTION According to this invention, an adhesion prevention absorptive barrier film can be easily introduce | transduced into the target site | part in a body cavity.

It is a figure which illustrates typically the postoperative adhesion prevention tool concerning this embodiment. It is a figure explaining the state which formed the postoperative adhesion prevention tool concerning this embodiment in roll shape. It is a figure explaining the state of the winding start of the laminated body of a Sepra film and a rubber sheet. It is a figure explaining the state which inserted the roll-shaped laminated body in the trocar. It is a figure explaining the state which expands a Sepra film in the space of a liver lower surface. It is a figure explaining the state which affixes a Sepra film on the target site | part.

  Hereinafter, embodiments of the present invention will be specifically described with reference to the accompanying drawings. However, the embodiments are for facilitating understanding of the principle of the present invention, and the scope of the present invention is as follows. The present invention is not limited to the embodiments, and other embodiments in which those skilled in the art appropriately replace the configurations of the following embodiments are also included in the scope of the present invention.

  FIG. 1 is a diagram schematically illustrating a postoperative adhesion preventing device according to the present embodiment. As shown in FIG. 1, the postoperative adhesion preventing device 900 according to the present embodiment is formed of a laminate formed by laminating an adhesion preventing and absorbing barrier film 100 and a rubber sheet 200.

  Anti-adhesion-absorbing barrier film 100 is a film that prevents post-surgical adhesion, and after adhering to wet tissue, it absorbs the surrounding water and gels, and is present as a barrier at the wound for several days to prevent adhesion. It is a film that demonstrates.

  The anti-adhesion absorbable barrier film 100 is preferably formed of a bioabsorbable material mainly composed of sodium hyaluronate and carboxymethyl cellulose. Since the adhesion-preventing absorbable barrier film 100 has high adhesion to wet tissue, it is not necessary to be sutured and fixed to the tissue. The adhesion preventing / absorbing barrier film 100 is not particularly limited, and is, for example, Sepra film (registered trademark). FIG. 1 shows only one anti-adhesion barrier film 100, but the present invention is not limited to such an embodiment. For example, the anti-adsorption barrier film is divided into a plurality of sheets. A form on a rubber sheet is also possible.

  Since the postoperative adhesion preventing device 900 according to this embodiment is carried into the living body, it is preferable that the rubber sheet 200 used in the postoperative adhesion preventing device 900 has a low possibility of causing latex allergy. Latex allergy causative agents are believed to be multiple proteins that elute from natural rubber products. Therefore, it is preferable that the rubber sheet 200 used for the postoperative adhesion preventing device 900 is made of synthetic rubber.

  The synthetic rubber is not particularly limited, but examples thereof include polychloroprene, polybutadiene, butadiene styrene rubber, butadiene acrylonitrile rubber, polyisoprene, chlorosulfonated polyethylene, polyisobutylene, isobutylene isoprene rubber, acrylic rubber, urethane rubber, Sulfuric synthetic rubber, fluorine rubber, silicone rubber, and the like can be used, and polychloroprene rubber is particularly preferable.

  The Young's modulus of the rubber sheet 200 is not particularly limited, but is, for example, 2.0 to 8.0 GPa. As will be described later, when the postoperative adhesion preventing device 900 according to the present embodiment is used, a laminate composed of the adhesion preventing and absorbing barrier film 100 and the rubber sheet 200 is rolled to form a roll. This is because, when the rubber sheet 200 is inserted into the trocar, if the Young's modulus of the rubber sheet 200 is greater than 8.0 GPa, it may be difficult to form in a roll shape. Further, as will be described later, after inserting the roll-shaped laminate into the body, the rubber sheet 200 has a Young's modulus of 2. This is because if it is less than 0 GPa, the roll-shaped shape is stored and it may be difficult to develop.

  Although the thickness of the rubber sheet 200 is not specifically limited, For example, it is possible to set it as 0.15 mm-0.20 mm. This is because if the thickness of the rubber sheet 200 is larger than 20 mm, the rigidity of the rubber sheet 200 is increased and it may be difficult to form the roll sheet. In addition, if the thickness of the rubber sheet 200 is less than 15 mm, the rigidity of the rubber sheet 200 is reduced, and the roll-shaped shape may be stored and may not be easily developed. Further, the rubber sheet 200 is thin. This is because there is a possibility that the adhesion preventing and absorbing barrier film 100 may be insufficiently protected from external impact.

  Next, the usage aspect of the postoperative adhesion prevention tool 900 concerning this embodiment is demonstrated.

  FIG. 2 is a diagram illustrating a state in which the postoperative adhesion preventing device according to the present embodiment is formed in a roll shape. As shown in FIG. 2, the postoperative adhesion preventing device 900 according to the present embodiment is wound to form a roll. At the beginning of winding, the end of the adhesion preventing absorbent barrier film 100 is sandwiched between the rubber sheet 200 and wound in a roll shape, so that the positional deviation between the rubber sheet 200 and the adhesion preventing absorbent barrier film 100 hardly occurs.

  As will be described later, since the postoperative adhesion preventing device 900 formed in a roll shape is inserted into the trocar, the outer diameter of the postoperative adhesion preventing device 900 formed in a roll shape is particularly limited if it is smaller than the inner diameter of the trocar. It is not limited, For example, it is 7.0 mm-9.0 mm.

  Then, the postoperative adhesion preventing device 900 formed in a roll shape is inserted into the trocar, inserted into a body cavity site where a space is secured, and placed and deployed. Since the adhesion preventing / absorbing barrier film 100 is protected by waterproofing with the rubber sheet 200, it can be inserted into the body cavity without paying special attention to moisture adhesion from the surroundings.

  Next, the adhesion preventing absorbent barrier film 100 is attached so as to cover the target site, and the adhesion preventing absorbent barrier film 100 is adhered to the target site through the rubber sheet 200. Since the adhesion preventing and absorbing barrier film 100 is stuck to the target site through the rubber sheet 200, the possibility that the adhesion preventing and absorbing barrier film 100 is stuck to a site other than the target site can be reduced. Thereafter, the rubber sheet 200 is grasped with forceps and taken out of the body cavity from the trocar. Thereby, an adhesion prevention absorptive barrier film can be simply introduced into a target site in a body cavity.

  The invention according to the present embodiment can be used for, for example, laparoscopic cholecystectomy, but is not limited thereto. To other laparoscopic operations, such as laparoscopic pylorus gastrectomy, to the lower surface of the liver and the front of the pancreas It is also possible to apply it to a peeling surface in laparoscopic ileus release surgery.

  Sepra film was used as an anti-adhesion absorbing barrier film. Sepra film was taken out of the protective package and cut into 2/3 size. As a rubber sheet, use latex-free and powder-free polychloroprene sterilized surgical gloves (JIS 9107 compliant, DermaTexII NO POWDER Sterile Surgical Gloves Medical Device Approval Number: 218ADBZX00006000). Used to create a rubber sheet that is one size larger than the size of Sepra film. In this example, it was applied by laparoscopic cholecystectomy.

  As shown in FIG. 3, the Sepra film was placed on a rubber sheet, and at the beginning of winding, the end of the Sepra film was sandwiched between the rubber sheets, and rolled into a roll shape so as to be thinner than the inner diameter of the 10 mm trocar (hereinafter, A laminate of the rubber sheet and the Sepra film wound in a cylindrical shape is referred to as Sepra roll). Sepra film is thin and lacks flexibility, so it is necessary to wait for moisture softening time before opening the Sepra film into a shape suitable for insertion. In this example, the Sepra film is reinforced with a rubber sheet. As a result, it was possible to make Seplarol immediately after opening.

  As shown in FIG. 4, in order to stop the insufflation and avoid the breakage of the Sepra film, the Sepura roll was grasped and inserted into the trocar with the forceps passed through the trocar housing.

  As shown in FIG. 5, by using forceps or Tuppel inserted through a trocar under the auxiliary arch after rebreathing, a space is secured on the lower surface of the liver so that the front of the gallbladder is removed and the front surface of the hepatoduodenal ligament can be seen, Was inserted, placed, and deployed. Sepura roll after insertion into the body cavity was deployed with the assistance of slight forceps due to the restoring force of the rubber, and the Sepra film was instantaneously placed on the rubber sheet.

  Thereafter, as shown in FIG. 6, the Sepra film was applied with forceps so as to cover the gallbladder excised portion on the lower surface of the liver and the liver duodenal ligament, and pressed through a rubber sheet. The rubber sheet was grasped with forceps and taken out of the body cavity from the trocar. Since the rubber sheet is very flexible, it could be taken out of the body cavity from the trocar without stress if it was grasped with forceps.

  It can be used to prevent intraperitoneal adhesions after open surgery.

100: Adhesion prevention absorbable barrier film 200: Rubber sheet 900: Postoperative adhesion prevention device

Claims (4)

Anti-adhesion-absorbing barrier film having adhesiveness on both front and back surfaces, and polychloroprene, butadiene styrene rubber, butadiene acrylonitrile rubber, or polyisoprene laminated only on one side of said anti-adhesion-absorbing barrier film A rubber sheet made of a synthetic rubber selected from the above, and the rubber sheet is a support material for forming the laminated body in a roll shape, and the anti-adhesion absorbing barrier film A postoperative adhesion prevention device characterized by being a waterproof protective material before being attached to a site .   The postoperative adhesion preventing device according to claim 1, wherein the laminate is formed in a roll shape. The postoperative adhesion prevention tool according to claim 1 or 2 , wherein the rubber sheet has a Young's modulus of 2.0 to 8.0 GPa. The postoperative adhesion preventing device according to any one of claims 1 to 3 , wherein the rubber sheet has a thickness of 0.15 mm to 0.20 mm.