JP6462176B1 - Training kit - Google Patents

Abstract

An aortic valve reconstruction operation training for aorta having a plurality of diameters can be performed.
When the tooth portions of a first adjustment member 41, a second adjustment member 42, and a third adjustment member 43 are all fitted in a recess 211, a recess 212, a recess 221, a recess 222, a recess 231 and a recess 232 The distance between the commissures is shortened by the center of the first wall 21, the second wall 22, and the third wall 23. In addition, when the adjustment member is fitted in the recess so that the teeth of the adjustment member fitted in the recess are reduced, the first wall portion 21, the second wall portion 22, and the third wall portion 23 spread outward, and between the commissure portions The distance gets longer. In this way, the distance between the commissures can be changed by changing the position when the adjustment member is fitted in the recess, and training can be performed when the distance between the commissures is different.
[Selection] Figure 4

Description

  The present invention relates to a training kit.

  As a training kit for aortic valve reconstruction, for example, there is a training kit disclosed in Patent Document 1. This training kit has a blood vessel model that is made of a plastic material and imitates an aorta, and a pedestal that supports the blood vessel model. The blood vessel model is open at the upper end so that the valve leaflet model imitating the leaflet can be sewn to the inner wall.

JP 2016-212233 A

  In aortic valve reconstruction, the distance between commissures after resection of the leaflets was measured, for example, with a leaflet sizer disclosed in Patent Document 1, and leaflets corresponding to the measured distance were collected from the patient. It is formed using the pericardium. Since the distance between commissures varies depending on the patient, it is preferable to perform training with a plurality of blood vessel models having different diameters when performing training for aortic valve reconstruction. However, in the case of the training kit disclosed in Patent Document 1, since the diameter of the blood vessel model cannot be changed, it is necessary to prepare a plurality of blood vessel models having different diameters when training aorta having different diameters.

  An object of the present invention is to enable training for aortic valve reconstruction corresponding to aorta having a plurality of diameters.

  The present invention relates to a cylindrical part that is open at least at one end, at least two commissural parts formed on the inner surface of the cylindrical part, and a diameter of a part of the cylindrical part where the commissural part is formed. A training kit is provided that includes a changing means for changing.

  In this invention, it is good also as a structure which equips the inner surface of the said cylindrical part with the several mark which shows the position which stitches a leaflet model.

  Moreover, in this invention, it is good also as a structure by which the three said commissure parts are formed in the inner surface of the said cylindrical part.

  In the present invention, a first angle formed by a line connecting the first commissure part and the center of the tubular part, a line connecting the second commissure part and the center of the tubular part, and the second commissure part And a line connecting the center of the cylindrical part, a second angle formed by a line connecting the third commissure part and the center of the cylindrical part, and a line connecting the first commissure part and the center of the cylindrical part The third angle formed by the third commissure portion and the line connecting the centers of the cylindrical portions may be different from each other.

  According to the present invention, it is possible to perform aortic valve reconstruction training corresponding to aorta having a plurality of diameters.

1 is a front view of a training kit 1 according to an embodiment of the present invention. The top view of training kit 1. FIG. 1 is a perspective view of a training kit 1. FIG. The figure which showed the state which removed the 1st adjustment member 41, the 2nd adjustment member 42, and the 3rd adjustment member 43 from the cylindrical part 20. FIG. The figure which showed an example of the leaflet sizer 6. FIG. The figure which showed an example of the template 7, the sheet | seat member 8, and the leaflet model 50. FIG. The top view of training kit 1A concerning a modification. The top view of training kit 1B concerning a modification. The top view of training kit 1B concerning a modification.

[Embodiment]
FIG. 1 is a front view of a training kit 1 according to an embodiment of the present invention, and FIG. 2 is a plan view of the training kit 1. FIG. 3 is a perspective view of the training kit 1.

  The training kit 1 is used for training of a tricuspid aortic valve reconstruction, and is formed in a shape simulating a human aorta. The training kit 1 is cylindrical and has an upper end and a lower end that are open. The training kit 1 may have a configuration in which the upper end is open and the lower end is not open.

  As a material of the training kit 1, a known material as a material of the biological model can be appropriately adopted. For example, as a material for the training kit 1, a flexible material (elastomer) such as silicone, urethane, styrene, synthetic rubber, or natural rubber is used. The material of the training kit 1 may be a flexible material that can maintain its shape and has elasticity similar to that of a living tissue.

  The training kit 1 may be composed of a single layer of flexible material, or may be configured by overlapping a plurality of flexible materials in the radial direction. In addition, when the training kit 1 is composed of a plurality of layers, the material of each layer may be different. A valve leaflet model 50, which will be described later, is sewn on the inner wall of the training kit 1. For example, the hardness of the plastic material that becomes the inner wall of the training kit 1 is determined from the hardness of the plastic material that becomes the outer wall of the training kit 1. It may be soft. According to this configuration, the leaflet model 50 can be easily sutured to the soft inner wall while maintaining the shape of the training kit 1 with the hard outer wall.

  The training kit 1 includes a base 10 and a cylindrical portion 20. The base 10 is cylindrical, and has an inner diameter and a predetermined diameter. The cylindrical portion 20 has a constricted portion 24 in which the inner diameter and the outer shape are reduced as compared with the base 10 from the lower side to the upper side, and the inner diameter and the outer shape are minimized. Above the constricted portion 24, the inner diameter and the outer shape are larger than the constricted portion 24. The constricted portion 24 may have a thickness in the radial direction that is thicker than other portions.

  The cylindrical portion 20 has a shape in which three circumferential portions are cut from the upper end side toward the constricted portion 24, and includes a first wall portion 21, a second wall portion 22, and a third wall portion 23. The circumferential widths of the first wall portion 21, the second wall portion 22 and the third wall portion 23 become wider from the upper end toward the constricted portion 24.

  An angle formed by a line connecting the center of the cylindrical portion 20 and the center of the first wall 21 in the circumferential direction and a line connecting the center of the cylindrical portion 20 and the center of the second wall 22 in the circumferential direction is θ1. It has become. Further, an angle formed by a line connecting the center of the cylindrical portion 20 and the center of the second wall portion 22 in the circumferential direction and a line connecting the center of the cylindrical portion 20 and the center of the third wall portion 23 in the circumferential direction. Is θ2, a line connecting the center of the cylindrical portion 20 and the center of the third wall portion 23 in the circumferential direction, and a line connecting the center of the cylindrical portion 20 and the center of the first wall portion 21 in the circumferential direction. Is the angle θ3. θ1, θ2, and θ3 may be the same, but are preferably different angles.

  FIG. 4 is a view showing a state in which the first adjustment member 41, the second adjustment member 42, and the third adjustment member 43 are removed from the cylindrical portion 20. The first adjustment member 41, the second adjustment member 42, and the third adjustment member 43 are members that adjust the distances from the center of the training unit 2 to the first wall 21, the second wall 22, and the third wall 23. The first adjustment member 41, the second adjustment member 42, and the third adjustment member 43 have the same shape as the gear teeth at both ends in the circumferential direction.

  A recess 211 into which the first adjustment member 41 is fitted and a recess 212 into which the third adjustment member 43 is fitted are formed at the upper end of the first wall portion 21. A recess 221 into which the second adjustment member 42 is fitted and a recess 222 into which the first adjustment member 41 is fitted are formed at the upper end of the second wall portion 22. At the upper end of the third wall portion 23, a recess 231 into which the third adjustment member 43 is fitted and a recess 232 into which the second adjustment member 42 is fitted are formed. In the concave portion 211, the concave portion 212, the concave portion 221, the concave portion 222, the concave portion 231, and the concave portion 232, the same shape as the gear teeth is formed on the center side of the training portion. The 1st adjustment member 41, the 2nd adjustment member 42, the 3rd adjustment member 43, the recessed part 211, the recessed part 212, the recessed part 221, the recessed part 222, the recessed part 231, and the recessed part 232 are examples of the change means based on this invention.

  A first reference portion 31, a second reference portion 32, and a third reference portion 33 are formed on the inner side of the tubular portion 20 and above the constricted portion 24 as a reference for suturing the valve leaflet model 50. The 1st standard part 31, the 2nd standard part 32, and the 3rd standard part 33 are string-like, and the section is circular. The positions where the first reference part 31, the second reference part 32, and the third reference part 33 are formed correspond to the positions where the leaflets are sutured during aortic valve reconstruction. The portion where the first reference portion 31 and the third reference portion 33 are in contact, the portion where the first reference portion 31 and the second reference portion 32 are in contact, and the portion where the second reference portion 32 and the third reference portion 33 are in contact with each other are included in the present invention. It is an example of the commissural part which concerns.

  The first reference portion 31 has one end located on the first wall portion 21 and the other end located on the second wall portion 22. A central portion of the first reference portion 31 is located between the first wall portion 21 and the second wall portion 22, and is located below the both ends and on the constricted portion 24. The second reference portion 32 has one end located on the second wall portion 22 and the other end located on the third wall portion 23. A central portion of the second reference portion 32 is located between the second wall portion 22 and the third wall portion 23, and is located below the both ends and on the constricted portion 24. The third reference portion 33 has one end located on the third wall portion 23 and the other end located on the first wall portion 21. A central portion of the third reference portion 33 is located between the third wall portion 23 and the first wall portion 21, and is located below the both ends and above the constricted portion 24.

  On the surfaces of the first reference portion 31, the second reference portion 32, and the third reference portion 33, a mark 35 and a mark 36 that indicate the stitching position of the valve leaflet model 50 are formed. The mark 35 is a mark indicating the start position of suturing when the leaflet model 50 is sutured. The first reference part 31 is centered in the length direction, the second reference part 32 is centered in the length direction, and the third reference. It is formed at the center in the length direction of the portion 33. The mark 36 is a mark indicating a position when the valve leaflet model 50 is sutured, and a plurality of marks 36 are formed at intervals from the mark 35 toward both ends.

  Next, a usage example of the training kit 1 will be described. A user who performs aortic valve reconstruction training fixes the training kit 1 to, for example, a pedestal, and measures the distance between commissures with the leaflet sizer 6 shown in FIG. The leaflet sizer 6 includes a sizer block 610 having an arc surface 611 and a handle 620 attached to the sizer block 610 and gripped by an operator.

  The sizer block 610 measures the distance between adjacent commissures, and has a circular arc surface 611 when a cylinder is cut in advance at an angle (for example, 120 degrees) according to the central angle of the commissures of the aortic valve. Since the distance between the commissures varies depending on the patient, a plurality of leaflet sizers 6 having different arc surface 611 sizes (arc lengths) are prepared in advance. As for the size of the leaflet sizer 6, for example, the diameter of the columnar shape before being divided into three equal parts is used as a nominal diameter for specifying the size of the leaflet, and the nominal diameter is an odd number from 17 to 35. . The size of the nominal diameter is described on the upper surface 613 of the sizer block 610. In the case of the leaflet sizer 6 shown in FIG. The size of the nominal diameter of the leaflet sizer 6 may be an even number, or may be configured to include both odd and even numbers. At both ends of the arc surface 611 of the sizer block 610, stylus portions 612 are formed for positioning by contacting the commissure portion. The upper surface 613 of the sizer block 610 is formed to be curved so that the commissures can be seen when the stylus parts 612 at both ends are brought into contact with the commissures. The top surface 613 is provided with a mark 614 for specifying the center between the commissures.

  The user inserts the leaflet sizer 6 into the tubular portion 20 from above, and specifies the leaflet sizer 6 in which the stylus portions 612 at both ends coincide with the positions of the adjacent commissure portions. Specifically, the user uses the leaflet sizer 6 in which the stylus portions 612 at both ends coincide with the positions of the commissure portions in the first wall portion 21 and the commissure portions in the second wall portion 22, and the stylus portions at both ends. The leaflet sizer 6 where the part 612 coincides with the position of the commissure part on the second wall part 22 and the commissure part on the third wall part 23, and the commissure part where the stylus parts 612 at both ends are on the first wall part 21 The leaflet sizer 6 that matches the position of the commissure portion on the third wall portion 23 is specified.

  Here, if the distance between the commissures is fixed in the training kit 1, the opportunity for training when the distance between the commissures is different is reduced. Therefore, by changing the position where the first adjustment member 41 is fitted into the concave portion 211 and the concave portion 222, the position where the second adjustment member 42 is fitted into the concave portion 221 and the concave portion 232, and the position where the third adjustment member 43 is fitted into the concave portion 231 and the concave portion 212. Training can be performed when the distance between the commissures is changed and the distance between the commissures is different.

  For example, as illustrated in FIG. 2, the tooth portions of the first adjustment member 41, the second adjustment member 42, and the third adjustment member 43 are all recessed portions 211, recessed portions 212, recessed portions 221, recessed portions 222, recessed portions 231, and recessed portions 232. When the first wall 21, the second wall 22, and the third wall 23 are centered, the distance between the commissures is shortened. Further, when the adjustment member is fitted in the recess so that the teeth of the adjustment member fitted in the recess are reduced, the first wall portion 21, the second wall portion 22, and the third wall portion are compared with the state shown in FIG. 23 spreads outside and the distance between commissures becomes long. In this way, the distance between the commissures can be changed by changing the position when the adjustment member is fitted in the recess, and training can be performed when the distance between the commissures is different.

  When the user finishes specifying the leaflet sizer 6 in which the stylus parts 612 at both ends coincide with the positions of the adjacent commissure parts, the valve leaflet model 50 corresponding to the nominal diameter of the specified leaflet sizer 6 is created. FIG. 6 is a view showing the template 7 and the sheet member 8 used for creating the leaflet model 50.

  The sheet member 8 is a flexible material such as silicone, urethane, styrene, synthetic rubber, or natural rubber. The sheet member 8 may be a flexible material having elasticity similar to that of a living tissue. The thickness of the sheet member 8 is preferably the thickness of a human pericardium.

  The template 7 is an instrument for drawing a leaflet-shaped line on the sheet member 8 in accordance with the specified nominal diameter of the leaflet sizer 6. The template 7 describes the nominal diameter value of the leaflet sizer 6, and an opening 710 corresponding to the nominal diameter value is formed below the nominal diameter value.

  For example, when the nominal diameter of the leaflet sizer 6 in which the stylus parts 612 at both ends coincide with each other at the position of the adjacent commissure part is 17, the user places the template 7 on the sheet member 8 and says “17”. A line is drawn with a surgical skin marker along the edge of the opening 710 below the description. For example, when the nominal diameter of the leaflet sizer 6 in which the stylus parts 612 at both ends coincide with the positions of adjacent commissure parts is 29, the user places the template 7 on the sheet member 8, A line is drawn with a surgical skin marker along the edge of the opening 710 underneath. The user cuts the sheet 8 along the drawn line to form the leaflet model 50. Thus, the operation of forming the leaflet model 50 corresponding to the distance between the commissures using the leaflet sizer 6 from the sheet member 8 using the template 7 is also performed as part of the training for aortic valve reconstruction. .

  Next, the user inserts the formed valve leaflet model 50 into the tubular portion 20 and stitches it inside the tubular portion 20. When sewing is performed, the positions of the marks 35 and 36 are stitched along the first reference portion 31, the second reference portion 32, and the third reference portion 33.

  According to this embodiment, since the distance between the commissure parts of the cylindrical part 20 can be changed, the training corresponding to the aorta having a plurality of diameters can be performed in the training of the aortic valve reconstruction.

[Modification]
As mentioned above, although embodiment of this invention was described, this invention is not limited to embodiment mentioned above, It can implement with another various form. For example, the present invention may be implemented by modifying the above-described embodiment as follows. In addition, you may combine each of embodiment mentioned above and the following modifications.

  In the above-described embodiment, the training kit 1 includes the first reference part 31, the second reference part 32, and the third reference part 33. However, the first reference part 31, the second reference part 32, and the third reference part 33 are provided. The structure which is not provided with the part 33 may be sufficient. FIG. 7 is a diagram illustrating an example of a configuration that does not include the first reference unit 31, the second reference unit 32, and the third reference unit 33.

  The training kit 1A includes a first commissure portion 37, a second commissure portion 38, and a third commissure portion 39 in place of the first reference portion 31, the second reference portion 32, and the third reference portion 33. The first commissure portion 37 projects from the first wall portion 21, the second commissure portion 38 projects from the second wall portion 22, and the third commissure portion 39 projects from the third wall portion 23. . The 1st commissure part 37, the 2nd commissure part 38, and the 3rd commissure part 39 are formed in the position corresponding to the commissure part of a leaflet.

  The first commissure portion 37, the second commissure portion 38, and the third commissure portion 39 are not limited to the projecting configuration, and may be, for example, a concave configuration, and a mark is drawn. It may be a configuration. Also in the training kit 1A, the distance between the first commissural portion 37 and the second commissural portion 38, the distance between the second commissural portion 38 and the third commissural portion 39, the first commissural portion 37 and the third commissural portion In the training for aortic valve reconstruction, the training corresponding to the aorta having a plurality of diameters can be performed.

  Although the training kit 1A shown in FIG. 7 includes three commissures corresponding to the case of the three leaflets, the training kit for aortic valve reconstruction may have a configuration corresponding to the case of the two leaflets. . FIG. 8 is a plan view of a training kit 1B corresponding to the case of two leaflets.

  In the training kit 1B, the cylindrical part 20 is cylindrical. The cylindrical portion 20 includes a plurality of cuts 90 from the upper end downward, and a first commissure portion 37 and a second commissure portion 38 are formed. The cut 90 is preferably provided at a position that is not a position that can newly become a commissure. For example, within a predetermined range from a position of 120 ° clockwise from the first commissural portion 37, within a predetermined range from a position of 120 ° counterclockwise from the first commissural portion 37, the second commissural portion 38 It is preferable not to provide the notch 90 within a predetermined range from a position of 120 ° clockwise from the position of 120 ° and a predetermined range from a position of 120 ° counterclockwise from the second commissure 38. A groove 100 is provided at the upper end of the cylindrical portion 20, and a ring 101 is fitted into the groove 100. The ring 101 has a plurality of diameters, and the diameter of the cylindrical portion 20 can be increased as shown in FIG. 9 by changing the ring 101 fitted into the groove 100. The groove 100, the ring 101, and the notch 90 are examples of changing means according to the present invention.

  The user inserts the leaflet sizer 6 on the left side of the first commissure portion 37 and the second commissure portion 38, and the stylus portions 612 at both ends coincide with the positions of the first commissure portion 37 and the second commissure portion 38. The nominal diameter of the pointed sizer 6 is specified. Further, the user inserts the leaflet sizer 6 on the right side of the first commissure portion 37 and the second commissure portion 38, and the stylus portions 612 at both ends coincide with the positions of the first commissure portion 37 and the second commissure portion 38. The nominal diameter of the valve leaflet sizer 6 is specified.

  The user obtains a value obtained by adding the two specified nominal diameters and dividing the sum by three. If the calculated value matches one of the nominal diameters of the leaflet sizer 6, use the valve leaflet sizer 6 with the same nominal diameter, and use a skin marker at the position to be the new commissure and the start position of the suture. Draw a placemark. For example, when the value obtained by adding the two specified nominal diameters and dividing by 3 is 21, the leaflet sizer 6 having a nominal diameter of 21 is inserted on the left side of the first commissure portion 37 and the second commissure portion 38. The user brings one of the stylus parts 612 of the inserted leaflet sizer 6 into contact with the first commissure part 37 and draws a mark of the commissure part with a skin marker at a position where the other stylus part 612 is in contact, A mark at the sewing start position is drawn with a skin marker at a position where the mark 614 is in contact. Further, the user inserts the leaflet sizer 6 having a nominal diameter of 21 on the right side of the first commissure portion 37 and the second commissure portion 38. The user brings one of the stylus parts 612 of the inserted leaflet sizer 6 into contact with the first commissure part 37 and draws a mark of the commissure part with a skin marker at a position where the other stylus part 612 is in contact, A mark at the sewing start position is drawn with a skin marker at a position where the mark 614 is in contact.

  Note that the value obtained by adding the two specified nominal diameters and dividing by three may not match the nominal diameter of the leaflet sizer 6. In this case, the three leaflet sizers 6 are selected so that the total value of the nominal diameters of the three leaflet sizers 6 matches the result of adding the nominal diameters. For example, when the total value of the identified nominal diameters is 65, the value divided by 3 does not match the nominal diameters of the odd-numbered leaflet sizers 6 from 17 to 35. In this case, for example, three leaflet sizers 6 having a nominal diameter of 23, 21 and 21 are selected so as to coincide with the total value. In addition, when providing the leaflet sizer 6 with an even nominal diameter, you may combine the leaflet sizer 6 with an even nominal diameter.

  First, the user inserts the leaflet sizer 6 having a nominal diameter of 23 into the left side of the first commissure portion 37, makes one of the stylus portions 612 contact the first commissure portion 37, and the other stylus portion 612 The mark of the commissure part is drawn with the skin marker at the contact position, and the mark of the sewing start position is drawn with the skin marker at the position where the mark 614 is in contact. Further, the user inserts the leaflet sizer 6 having a nominal diameter of 21 into the right side of the first commissure portion 37, makes one of the stylus portions 612 contact the first commissure portion 37, and the other stylus portion 612 The mark of the commissure part is drawn with the skin marker at the contact position, and the mark of the sewing start position is drawn with the skin marker at the position where the mark 614 is in contact. The user inserts the leaflet sizer 6 having a nominal diameter of 21, the stylus part 612 contacts one of the drawn commissure marks, and the stylus part 612 contacts one of the drawn commissure marks. Make sure.

  According to this modification, training for aortic valve reconstruction from two leaflets to three leaflets can be performed.

  In the above-described training kit 1B, the first commissure portion 37 and the second commissure portion 38 are formed. However, like the training kit 1A shown in FIG. 7, the first commissure portion 37, the second commissure portion 38, and the second commissure portion 38 are formed. The structure in which the three commissure parts 39 are formed may be sufficient. Moreover, although the above-mentioned training kit 1B is provided with the cut 90, the structure which does not have the cut 90 may be sufficient as it is the raw material which expands / contracts to radial direction.

  In the embodiment described above, the distance between the commissures is changed by the first adjustment member 41, the second adjustment member 42, and the third adjustment member 43, but the configuration for changing the distance between the commissures is an embodiment. It is not limited to the configuration of For example, the distance between the commissures may be changed by the ring 101 as in the training kit 1B.

DESCRIPTION OF SYMBOLS 1, 1A, 1B ... Training kit, 6 ... Valve leaf sizer, 7 ... Template, 8 ... Sheet member, 10 ... Base part, 20 ... Cylindrical part, 21 ... 1st wall part, 22 ... 2nd wall part, 23 ... 3rd wall part, 24 ... Constriction part, 31 ... 1st reference | standard part, 32 ... 2nd reference | standard part, 33 ... 3rd reference | standard part, 35 ... Mark, 36 ... Mark, 37 ... 1st commissure part, 38 ... 2nd Commissural part, 39 ... third commissural part, 41 ... first adjusting member, 42 ... second adjusting member, 43 ... third adjusting member, 50 ... leaflet model, 90 ... incision, 100 ... groove, 101 ... ring, 211 , 212, 221, 222, 231, 232 ... recess, 610 ... sizer block, 611 ... arc surface, 612 ... stylus, 613 ... upper surface, 614 ... mark, 710 ... opening

Claims (4)

A cylindrical part that is cylindrical and open at least at one end;
At least two commissures formed on the inner surface of the tubular part;
Changing means for changing the diameter of the portion where the commissure portion is formed in the tubular portion;
Training kit with The training kit according to claim 1, wherein a plurality of marks indicating positions where the valve leaflet model is stitched are provided on an inner surface of the cylindrical portion. The training kit according to claim 1, wherein the three commissure portions are formed on an inner surface of the cylindrical portion. A first angle formed by a line connecting the first commissure part and the center of the cylindrical part, a line connecting the second commissure part and the center of the cylindrical part, and a center of the second commissure part and the cylindrical part , A second angle formed by a line connecting the third commissure part and the center of the cylindrical part, a line connecting the first commissure part and the center of the cylindrical part, and the third commissural part, The training kit according to claim 3, wherein third angles formed by lines connecting the centers of the cylindrical portions are different from each other.

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