JP6950905B2

JP6950905B2 - Dilator

Info

Publication number: JP6950905B2
Application number: JP2017161321A
Authority: JP
Inventors: 裕司兼田
Original assignee: Jichi Medical University
Current assignee: Jichi Medical University
Priority date: 2017-08-24
Filing date: 2017-08-24
Publication date: 2021-10-13
Anticipated expiration: 2037-08-24
Also published as: JP2019037452A

Description

本発明は、ダイレータに関する。より詳細に、本発明は、胆管、膵管、尿管、尿道、卵管、血管などの細径管を縫合糸で縫合、若しくは細径管を消化管、胞嚢などに縫合糸で吻合する際に、細径管の内腔を押し広げ、針運びのスペースと視野とを確保するためのダイレータに関する。 The present invention relates to a dilator. More specifically, the present invention relates to suturing small ducts such as bile ducts, pancreatic ducts, ureters, urethra, oviducts, and blood vessels with sutures, or anastomosing small ducts to gastrointestinal tracts, cysts, etc. with sutures. In addition, it relates to a dilator for expanding the lumen of a small duct to secure a space for carrying a needle and a field of view.

胆管、膵管、尿管、尿道、卵管などの細径管を、縫合糸で、吻合または縫合する際に、細径管の内腔を押し拡げるための補助具が提案されている。
例えば、特許文献１は、１対の略直線状の分枝片を鋭角的な略Ｖ字状、略Ｕ字状ないし略Ｘ字状をなすように並置しそれぞれの分枝片の先端側が通常の開いた状態にあり両分枝片を側方から押圧して前記それぞれの分枝片の先端側が閉じた状態になる際にこれに抗する弾性力が作用するように前記１対の分枝片を連結した支桿部と、前記支桿部の１対の分枝片のそれぞれの先端に渡されるように接続された細い線状の可撓性部材とを組み合わせてなり、前記支桿部の１対の分枝片が開いた通常の状態で該１対の分枝片及び伸張した前記細い線状の可撓製部材がループ形状をなし、両分枝片を側方から押圧することにより両分枝片の先端側が閉じた状態になり前記細い線状の可撓性部材が屈撓するようにしたことを特徴とする吻合補助器具を開示している。 Auxiliary tools have been proposed for expanding the lumen of small ducts such as the bile duct, pancreatic duct, ureter, urethra, and oviduct when anastomosing or suturing small ducts with sutures.
For example, in Patent Document 1, a pair of substantially linear branch pieces are juxtaposed so as to form a sharp V-shaped, substantially U-shaped or substantially X-shaped branch piece, and the tip side of each branch piece is usually When the tip side of each branch piece is closed by pressing both branch pieces from the side in the open state, the pair of branches exerts an elastic force against this. The support rod portion connecting the pieces and the thin linear flexible member connected so as to be passed to the tips of each of the pair of branch pieces of the support rod portion are combined, and the support rod portion is formed. In the normal state where the pair of branch pieces of the above is open, the pair of branch pieces and the extended thin linear flexible member form a loop shape, and both branch pieces are pressed from the side. Disclosed is an anastomosis assisting device characterized in that the tip end side of both branch pieces is closed and the thin linear flexible member is bent and flexed.

特許文献２は、ストレート部分と、先端部と、前記ストレート部分と先端部との間のカーブ部分とを有する細長部材と、先端部と根元端部とを有する互換可能チップとを有し、チップの先端部が第一接続部分を構成し、細長部材の先端部が第二接続部分を構成した際、これらが接続された最、軸中心に回転可能な第一接続部分と第二接続部分とを提供する接続機構を有する手術用縫合ガイドを開示している。互換可能チップのひとつは、テーパ状のシリンダ状表面を有し、先端部と根元端部との間を軸方向に延びる細長部位と、前記先端部から軸方向に伸び前記テーパ状のシリンダ表面を貫通するチャネルを有する。 Patent Document 2 has an elongated member having a straight portion, a tip portion, a curved portion between the straight portion and the tip portion, and a compatible tip having a tip portion and a root end portion. When the tip of the slender member constitutes the second connection, the tip of the slender member constitutes the second connection, and the first connection and the second connection that are rotatable around the axis are the most connected. Discloses a surgical suture guide with a connecting mechanism that provides. One of the compatible tips has a tapered cylinder surface, with an elongated portion extending axially between the tip and the root end and the tapered cylinder surface extending axially from the tip. It has a penetrating channel.

特開２００９−０５０３０６号公報JP-A-2009-050306 特開平４−２６３８４６号公報Japanese Unexamined Patent Publication No. 4-263846

本発明の課題は、胆管、膵管、尿管、尿道、卵管、血管などの細径管を縫合糸で縫合、若しくは細径管を消化管、胞嚢などに縫合糸で吻合する際に、安定した形で細径管の内腔を広げ、針運びのスペースと視野とを確保するためのダイレータを提供することである。 An object of the present invention is to suture small diameter tubes such as bile ducts, pancreatic ducts, ureters, urethra, oviducts, and blood vessels with sutures, or to anastomose small diameter tubes to gastrointestinal tracts, cysts, etc. with sutures. It is to provide a dilator to widen the lumen of the ureter in a stable manner and to secure a space for needle movement and a field of view.

上記課題を解決すべく検討した結果、下記の形態を包含する本発明を完成するに至った。 As a result of studies for solving the above problems, the present invention including the following forms has been completed.

〔１〕押し広げる対象となる細径管の内腔に挿入可能な遠位端と近位端を有する細長い先端部、
先端部の近位端に接合された、前記細径管の内腔への先端部の挿入深さを制限するためのストッパ、および
先端部の近位端若しくはストッパに接合された柄部を有し、
先端部は長さ方向に沿って少なくとも１つの溝若しくはスリットが形成されている、
ダイレータ。 [1] An elongated tip having a distal end and a proximal end that can be inserted into the lumen of a small diameter tube to be expanded.
It has a stopper joined to the proximal end of the tip to limit the insertion depth of the tip into the lumen of the small diameter tube, and a handle joined to the proximal end of the tip or the stopper. death,
The tip is formed with at least one groove or slit along the length direction.
Dilator.

〔２〕先端部は、近位端よりも遠位端の方が細い、〔１〕に記載のダイレータ。
〔３〕柄部は、内腔に挿入する際に加わる力によっては折れ曲がらないが、内腔に挿入する際に加わる力を超える力によって折り曲げることができる程度の剛性を有する、〔１〕または〔２〕に記載のダイレータ。 [2] The dilator according to [1], wherein the distal end is thinner at the distal end than at the proximal end.
[3] The handle does not bend due to the force applied when it is inserted into the lumen, but has enough rigidity to be bent by a force exceeding the force applied when it is inserted into the lumen, [1] or. The dilator according to [2].

本発明のダイレータは、胆管、膵管、尿管、尿道、卵管、血管などの細径管を縫合糸で縫合、若しくは細径管を消化管、胞嚢などに縫合糸で吻合する際に、細径管の内腔を押し広げ、針運びのスペースと視野とを確保することができる。 The dilator of the present invention is used when suturing small-diameter ducts such as bile ducts, pancreatic ducts, ureters, urethra, oviducts, and blood vessels with sutures, or anastomosing small-diameter ducts with gastrointestinal tracts, cysts, etc. with sutures. The lumen of the small-diameter duct can be expanded to secure a space for carrying the suture and a field of view.

本発明のダイレータの一例を示す斜視図である。It is a perspective view which shows an example of the dilator of this invention. 図１に示すダイレータの柄部の側から見たときのストッパの正面図である。It is a front view of the stopper when viewed from the side of the handle portion of the dilator shown in FIG. 本発明のダイレータの別の一例を示す斜視図である。It is a perspective view which shows another example of the dilator of this invention. 本発明のダイレータの先端部の別の一例を示す斜視図である。It is a perspective view which shows another example of the tip part of the dilator of this invention. 膵臓断端を示す概念図である。It is a conceptual diagram which shows the pancreatic stump. 図１に示すダイレータの先端部を膵管に挿入し、縫合針を貫通させた状態における膵臓断端を示す正面概念図である。FIG. 5 is a front conceptual view showing a pancreatic stump in a state where the tip of the dilator shown in FIG. 1 is inserted into the pancreatic duct and a suture needle is penetrated. 図１に示すダイレータの先端部を膵管に挿入し、縫合針を貫通させた状態における膵臓断端を示す断面概念図である（破線は溝の底の内面を示す。）。It is a cross-sectional conceptual view which shows the pancreatic stump in the state which the tip part of the dilator shown in FIG. 1 is inserted into a pancreatic duct, and the suture needle is penetrated (the broken line shows the inner surface of the bottom of a groove).

本発明のダイレータ１０１は、先端部１０２、ストッパ１０３、および柄部１０４を有する（図１および図２参照）。先端部１０２、ストッパ１０３、および柄部１０４の製造に用いられる材料は特に制限されないが、ステンレス鋼、鋼鉄、アルミニウムなどが好ましく用いられる。
先端部１０２は、押し広げる対象となる細径管の内腔に挿入可能な遠位端と近位端を有する細長部材からなる。先端部１０２の外観の形状は、特に限定されず、例えば、円柱形、長円柱形、楕円柱形、砲弾形、吊鐘形などが挙げられる。 The dilator 101 of the present invention has a tip portion 102, a stopper 103, and a handle portion 104 (see FIGS. 1 and 2). The materials used for manufacturing the tip portion 102, the stopper 103, and the handle portion 104 are not particularly limited, but stainless steel, steel, aluminum, and the like are preferably used.
The tip 102 comprises an elongated member having a distal end and a proximal end that can be inserted into the lumen of the small diameter tube to be expanded. The external shape of the tip portion 102 is not particularly limited, and examples thereof include a cylindrical shape, a long cylindrical shape, an elliptical pillar shape, a cannonball shape, and a hanging bell shape.

先端部１０２は長さ方向に沿って少なくとも１つの溝１０６が形成されている。溝は、Ｕ字溝でも、Ｖ字溝でも、その他形状の溝でもよいが、針運びのスペースを広く確保する観点からＵ字溝が好ましい。図１に示す溝１０６は先端部１０２の遠位端から近位端までに亘って形成されているが、遠位端から近位端までの一部にだけ形成されていてもよい。 At least one groove 106 is formed in the tip portion 102 along the length direction. The groove may be a U-shaped groove, a V-shaped groove, or a groove having another shape, but a U-shaped groove is preferable from the viewpoint of securing a wide space for carrying needles. The groove 106 shown in FIG. 1 is formed from the distal end to the proximal end of the tip portion 102, but may be formed only in a part from the distal end to the proximal end.

先端部１０２の遠位端は細径管に挿入しやすい形状であれば特に制限されず、例えば、図１に示すような片切刃状を成していてもよいし、図４のような砲弾状を成していてもよい。
また、先端部は、近位端よりも遠位端の方が細くなっていることが好ましい。図１に示す先端部の近位端には拡径部１０７が設けられている。これにより細径管の内腔がより拡がって針運びのスペースが大きくなる。拡径部１０７における溝またはスリットは径の拡張に伴って幅や深さが大きくなっていることが針運びのスペースを確保する観点から好ましい（図７）。
図６に示すように、溝１０６の縁１０８が、内側に傾斜していることによって、針先が溝から逸れそうになったときに、溝の内側へと針先を誘導できる。 The distal end of the tip 102 is not particularly limited as long as it has a shape that can be easily inserted into a small-diameter tube. For example, it may have a single-sided cutting edge shape as shown in FIG. It may be in the shape of a cannonball.
Further, the tip portion is preferably thinner at the distal end than at the proximal end. A diameter-expanded portion 107 is provided at the proximal end of the tip portion shown in FIG. As a result, the lumen of the small-diameter tube is further expanded, and the space for carrying the needle is increased. It is preferable that the width and depth of the groove or slit in the enlarged diameter portion 107 increase as the diameter increases from the viewpoint of securing a space for carrying the needle (FIG. 7).
As shown in FIG. 6, since the edge 108 of the groove 106 is inclined inward, the needle tip can be guided to the inside of the groove when the needle tip is about to deviate from the groove.

先端部１０２の近位端にはストッパ１０３が接合されている。ストッパ１０３は、細径管の内腔への先端部１０２の挿入深さを制限できるものであれば、その形状、大きさなどは特に制限されない。ストッパによって、先端部の挿入深さが、深すぎたり、浅すぎたりするという問題を軽減できる。また、ストッパが臓器断端に接するように固定しておけば針運び中に先端部の挿入深さが変わるという問題を防ぐことができる。
ストッパ１０３にも溝が形成されていることが好ましい。この溝は先端部１０２に形成されている溝と繋がっていることが好ましい。ストッパ１０３に形成された溝は、近位側に向かって広がるように形成することが、針運びのスペースが広がるので好ましい。 A stopper 103 is joined to the proximal end of the tip 102. The shape and size of the stopper 103 are not particularly limited as long as the insertion depth of the tip portion 102 into the lumen of the small diameter tube can be limited. The stopper can alleviate the problem that the insertion depth of the tip is too deep or too shallow. Further, if the stopper is fixed so as to be in contact with the organ stump, the problem that the insertion depth of the tip portion changes during needle movement can be prevented.
It is preferable that the stopper 103 also has a groove. It is preferable that this groove is connected to the groove formed in the tip portion 102. It is preferable that the groove formed in the stopper 103 is formed so as to widen toward the proximal side because the space for carrying the needle is widened.

柄部１０４はストッパ１０３に接合されている。接合位置は特に制限されない。図１に示すダイレータ１０１においては、柄部１０４が遠位側から見てストッパ１０３の左下（図２参照）に接合されている。例えば、開腹手術で、膵頭十二指腸切除を行うと、再建すべき膵臓の断端は、患者の右側に向く。図１または２に示すような位置に接合された柄部は、先端部を膵管に挿入したときに、患者の背中側に位置する。その結果、先端部の挿入された膵管での針運びにおいて柄部が、術者の針運びを妨げず、また術者の視野を遮らない。 The handle 104 is joined to the stopper 103. The joining position is not particularly limited. In the dilator 101 shown in FIG. 1, the handle 104 is joined to the lower left of the stopper 103 (see FIG. 2) when viewed from the distal side. For example, in open surgery, pancreaticoduodenectomy results in the stump of the pancreas to be reconstructed pointing to the right side of the patient. The peduncle joined at the position shown in FIG. 1 or 2 is located on the back side of the patient when the tip is inserted into the pancreatic duct. As a result, the stalk does not interfere with the operator's needle movement and does not block the operator's field of view when the tip is carried through the inserted pancreatic duct.

柄部１０４は、内腔に挿入する際に加わる力によっては折れ曲がらないが、内腔に挿入する際に加わる力を超える力によって折り曲げることができる程度の剛性を有することが好ましい。膵管に先端部を挿入する前に術者の好みの角度に把持部１０５と先端部１０２とが位置するように柄部を折り曲げることができる。
膵管断端１１０は図５に示すように膵管１１１が開口しているが、スペースが狭い。本発明のダイレータ１０１の先端部１０２を膵管に挿入すると、図６のように、溝２０６によって針運びのスペースが形成される。
溝１０７の縁１０８が上側になるようにして膵管に挿入した場合、膵臓の上側から溝１０６に向かって縫合針を突刺して、膵管の内壁から針の先を出す（図７）。膵管の上側以外の内壁は先端部１０２の壁にて針の先が刺さらないように保護される。針の先を把持し溝１０６から針を引き出し、縫合糸を膵管の端に縫い付ける。その後、定法に従って膵管空腸吻合を行うことができる。 The handle portion 104 does not bend depending on the force applied when it is inserted into the lumen, but it is preferably rigid enough to be bent by a force exceeding the force applied when it is inserted into the lumen. Before inserting the tip into the pancreatic duct, the handle can be bent so that the grip 105 and the tip 102 are located at an angle of the operator's preference.
The pancreatic duct stump 110 has an open pancreatic duct 111 as shown in FIG. 5, but the space is narrow. When the tip 102 of the dilator 101 of the present invention is inserted into the pancreatic duct, a space for carrying a needle is formed by the groove 206 as shown in FIG.
When inserted into the pancreatic duct with the edge 108 of the groove 107 facing upward, the suture needle is pierced from the upper side of the pancreas toward the groove 106, and the tip of the needle is extended from the inner wall of the pancreatic duct (FIG. 7). The inner wall other than the upper side of the pancreatic duct is protected by the wall of the tip 102 so that the tip of the needle does not stick. The tip of the needle is grasped, the needle is pulled out from the groove 106, and the suture is sewn to the end of the pancreatic duct. Then, a pancreatojejunostomy can be performed according to a conventional method.

本発明のダイレータ２０１は、先端部２０２、ストッパ２０３、および柄部２０４を有する（図３参照）。
先端部２０２はダイレータ１０１における先端部と同じ構造である。柄部２０４はストッパ２０３の中央下部に接合されている。柄部は先端部１０２の近位端（溝の底の端面）に接合してもよい。柄部２０４は、最初から、図３に示すように折り曲げられていてもよいし、術者の好みに応じて別の形に折り曲げてもよい。図３に示すようにクランク状に折り曲げると、クランク部２０９がストッパ２０３と伴に先端部２０６の挿入深さを制限することができる。 The dilator 201 of the present invention has a tip portion 202, a stopper 203, and a handle portion 204 (see FIG. 3).
The tip portion 202 has the same structure as the tip portion of the dilator 101. The handle portion 204 is joined to the lower center of the stopper 203. The handle may be joined to the proximal end of the tip 102 (the end face of the bottom of the groove). The handle portion 204 may be bent from the beginning as shown in FIG. 3, or may be bent into another shape according to the preference of the operator. When bent in a crank shape as shown in FIG. 3, the crank portion 209 can limit the insertion depth of the tip portion 206 together with the stopper 203.

図４に示すダイレータの先端部３０２は、遠位端が先に細く砲弾状になっている。そして、長さ方向に沿って少なくとも１つの溝若しくはスリット３０７が形成されている。先端部３０２の近位端は図１または図２に示す先端部と同じようにストッパ（図示せず）若しくは柄部と接合されている。 The distal end of the dilator tip 302 shown in FIG. 4 has a tapered end and is in the shape of a cannonball. Then, at least one groove or slit 307 is formed along the length direction. The proximal end of the tip 302 is joined to a stopper (not shown) or handle in the same manner as the tip shown in FIG. 1 or 2.

本発明のダイレータは、図に示す実施形態に限られず、先端部、ストッパ、柄部および把持部の形状、大きさ、色、材質を変更したもの、または先端部、ストッパ、柄部および把持部以外の周知または慣用の部品を追加したものも本発明の技術的範囲に包含される。 The dilator of the present invention is not limited to the embodiment shown in the figure, and the shape, size, color, and material of the tip, stopper, handle, and grip are changed, or the tip, stopper, handle, and grip are changed. Those to which other well-known or commonly used parts are added are also included in the technical scope of the present invention.

１０１，２０１：ダイレータ
１０２，２０２，３０２：先端部
１０３，２０３：ストッパ
１０４，２０４：柄部
１０５，２０５：把持部
１０６，２０６：溝
１０７：拡径部
３０７：溝若しくはスリット
１０８：溝の縁
１１０：膵臓断端
１１１：膵管
１１２：縫合針
１１３：縫合糸 101, 201: Dilator 102, 202, 302: Tip 103, 203: Stopper 104, 204: Handle 105, 205: Grip 106, 206: Groove 107: Enlarged diameter 307: Groove or slit 108: Edge of groove 110: Pancreatic stump 111: Pancreatic duct 112: Suture needle 113: Suture

Claims

An elongated tip with a distal end and a proximal end that can be inserted into the lumen of the small diameter tube to be expanded,
It has a stopper joined to the proximal end of the tip to limit the insertion depth of the tip into the lumen of the small diameter tube, and a handle joined to the proximal end of the tip or the stopper. death,
The tip is formed with at least one groove along the length direction to secure a space for carrying the needle.
Dilator.

An elongated tip with a distal end and a proximal end that can be inserted into the lumen of the small diameter tube to be expanded,
It has a stopper joined to the proximal end of the tip to limit the insertion depth of the tip into the lumen of the small diameter tube, and a handle joined to the proximal end of the tip or the stopper. death,
The tip is formed with at least one groove or slit to secure a space for carrying the needle along the length direction .
The stopper is composed of a plate-shaped member, and the plate surface of the plate-shaped member is substantially perpendicular to the longitudinal direction of the tip portion .
Dilator.

An elongated tip with a distal end and a proximal end that can be inserted into the lumen of the small diameter tube to be expanded,
A stopper joined to the proximal end of the tip to limit the insertion depth of the tip into the lumen of the small diameter tube ,
One handle joined to the proximal end of the tip or the stopper , and
It has a grip that is joined to the proximal end of the handle and
The tip is formed with at least one groove or slit to secure a space for carrying the needle along the length direction .
The handle is bent to the desired shape or angle ,
Dilator.