JP6984809B2 - Suture with needle - Google Patents

Description

The present invention relates to a suture with a needle, for example, a suture with a needle used for pancreatic gastric anastomosis after pancreaticoduodenectomy.

For example, pancreaticoduodenectomy is a surgical procedure to remove the pancreatic head (the right part of the pancreas) and the duodenum at once. Due to biliary reconstruction, the gallbladder and middle and lower bile ducts are also resected at the same time. It is one of the most invasive surgery in the field of gastrointestinal surgery.

Pancreatogastric anastomosis is performed after pancreaticoduodenectomy. Pancreatic-gastric anastomosis is an anastomosis between the pancreas (residual pancreas) and the stomach (residual stomach). It is done using a thread (also called a threaded anastomotic needle).

Pancreatic gastric anastomosis is performed using a needle-attached suture (hereinafter, may be abbreviated as "needle-attached thread") as described above. By the way, a conventional suture with a needle is generally configured by attaching one suture to one end of one suture. When performing pancreatic-gastric anastomosis using this conventional needle-attached thread, four needle-attached threads are used to pierce the living tissue one by one and allow the four sutures to pass through the tissue. There is a problem that the workability is poor, the labor of the doctor becomes complicated, and the operation time becomes long.

Therefore, in order to solve the above problem, the present inventor is trying to adopt a pancreatic gastric anastomosis method (hereinafter referred to as "this surgical method"), which is a surgical method different from the conventional method. This surgical method is a method of performing a pancreatic gastric anastomosis on the posterior wall of the stomach after incising the anterior wall of the stomach. Specifically, an anastomotic incision is made in the posterior wall of the stomach, and the pancreatic stump is inserted into the stomach. Then, as shown in FIG. 3, the anastomosis between the stomach and the pancreas is performed by one gastric wall full-thickness-pancreatic gastric penetrating mattress suture and two gastric wall full-thickness-pancreatic gastric penetrating sutures. According to this technique, it is possible to contribute to solving the above-mentioned problems.

However, as described above, the conventional thread with a needle is configured by attaching one suture to one end of one suture, so this thread with a needle is suitable for this surgical method. Not.

Further, for example, Japanese Patent Application Laid-Open No. 2005-80761 and Japanese Patent Application Laid-Open No. 2013-66639 disclose sutures with needles to which sutures are attached to both ends of the suture. However, these needle-attached sutures have been developed for ophthalmic surgery and tendon sutures, and are unsuitable for pancreatic-gastric anastomosis due to their composition. Even if the needle-attached suture described in the above-mentioned publication is improved so that it can be used for pancreatic-gastric anastomosis, the above-mentioned workability and other problems cannot be solved.

Japanese Unexamined Patent Publication No. 2005-80761 Japanese Unexamined Patent Publication No. 2013-66639

In view of the above-mentioned circumstances, the present invention is suitable for carrying out the above-mentioned surgical method, thereby improving work efficiency such as pancreatogastric anastomosis performed after pancreaticoduodenectomy, and shortening the labor and operation time of the doctor. It is an object of the present invention to provide a suture with a needle which can make it possible.

To achieve the above object, the present invention includes a needle comprising three sutures, first, second and third, and two sutures, a first and a second, attached to these sutures. It ’s a suture,
The first and second suture needles have a thread mounting hole provided in the proximal end portion of the needle body in the axial direction.
In the first suture needle, one end of the first suture and one end of the second suture are inserted into the thread attachment holes of the first suture, and the first and second sutures are made. It is fixed to the thread and attached,
In the second suture needle, the other end of the first suture and one end of the third suture are inserted into the thread attachment holes of the second suture, and the first and third sutures are used. It is characterized in that it is fixedly attached to a suture.

According to the above configuration, by inserting the first and second suture needles into the living tissue and penetrating them, two sutures each (however, the first suture is on the half side) of the tissue are simultaneously applied. It can be penetrated into the same site. Since the first suture has a loop shape, mattress suture can be performed. In addition, penetrating suture can be performed with the second and third sutures. As a result, the present surgical method can be smoothly and smoothly performed.

In the suture with a needle of the present invention, it is preferable that the first and second suture needles are composed of straight round needles.

In the present invention, the "straight needle" is a straight needle-shaped round needle, that is, a needle (straight needle) in which the overall shape of the appearance is linearly formed, and the cross-sectional shape of the tip of the needle. Is used as a term to mean a needle (round needle) formed in a circular or substantially circular shape. Further, in the "round needle" of the present invention, a round needle (tip pyramid shape) in which the tip of the round needle is formed in a plane, for example, the tip of the round needle is cut into three planes at approximately 120 ° intervals around the axis. A round needle with a triangular cross section (pyramidal shape at the tip) is also included.

In the suture with a needle of the present invention, it is preferable that the first suture and the second and third sutures are composed of threads having different colors.

According to the above configuration, since the suture thread is color-coded, it is possible to work smoothly while visually confirming the handling of the suture thread after penetrating the living tissue or the like.

Further, the suture with a needle of the present invention is configured for pancreatic gastric anastomosis and other organ sutures after pancreaticoduodenectomy.

According to the present invention, it is possible to provide a suture with a needle that can improve the work efficiency of pancreatogastric anastomosis and the like performed after pancreaticoduodenectomy, and can save the labor of a doctor and shorten the operation time. .. In addition, it is possible to provide a suture with a needle suitable for carrying out the above-mentioned surgical method.

It is explanatory front view which shows typically the structure of the suture with a needle of one Embodiment of this invention. A front view (a) showing an enlarged needle-attached suture in FIG. 1 to explain its configuration, and a longitudinal section in which the proximal end side of the needle body of one of the suture needles is enlarged and its configuration is schematically shown. It is a top view (b). 3 (a) and 3 (b) are explanatory views showing an example of a state in which a pancreatic gastric anastomosis is performed using the suture with a needle of FIG.

Hereinafter, an example of an embodiment of the present invention will be described with reference to the drawings.

1 to 3 show a suture with a needle (suture with a thread) according to an embodiment of the present invention. The needle-attached suture 1 (thread-attached suture) of the present embodiment is configured, for example, for pancreatogastric anastomosis mainly performed after pancreaticoduodenectomy.

As shown in FIGS. 1 to 3, the suture thread 1 with a needle of the present embodiment has two suture needles 2A and 2B of the first and second stitches, and three sutures of the first, second and third stitches. It includes threads 3A, 3B and 3C.

The first and second suture needles 2A and 2B of the present embodiment are composed of straight needles having the same configuration. Both suture needles 2A and 2B have a needle tip 22 (needle tip) formed on one end side of the body 21 (body) of the needle body 20 and the other end side of the body 21 (base end of the needle body). A needle base 23 formed in the portion) is provided. Further, both the suture needles 2A and 2B are provided with a thread attachment hole 24 for attaching a suture thread provided in the needle base portion 23 (base end portion of the needle body) in the axial direction of the needle body 20. Both suture needles 2A and 2B are fixed and attached by inserting a suture into the hole 24 and caulking or the like. This point will be described further later.

As the material of the needle body 20, a round bar-shaped needle material such as austenitic stainless steel (for example, SUS304) or other stainless steel can be adopted. The length of the needle body 20 (dimension from the tip to the base of the needle body) is not particularly limited, but is, for example, about 30 when configured for pancreatogastric anastomosis after pancreaticoduodenectomy. Those formed to about 40 mm to about 40 mm can be adopted. In this embodiment, it is formed to be about 35 mm.

The thickness of the body 21 of the needle body 20 is not particularly limited, but when used for pancreatogastric anastomosis after pancreaticoduodenectomy, for example, the diameter is about 0.5 mm to about 1.2 mm. It can be formed to some extent (however, it is not limited to the above range).

The needle tip portion 22 (needle tip portion) of the needle body 20 is composed of a tapered portion that gradually tapers (diameter or cross-sectional area decreases) toward the tip portion side, and the insertion tip 25 is formed at the tip of the tapered portion. Has been done. The cross-sectional shape of the needle tip portion 22 is formed into a circular or substantially circular shape. Further, the needle tip body is formed in a straight line.

The first and second suture needles 2A and 2B of the present embodiment are composed of straight round needles having the above configuration. That is, it is a needle (straight needle) in which the overall shape of the appearance of the needle is linearly formed, and the cross-sectional shape of the tip portion (needle tip portion 22) of the needle is formed into a circular or substantially circular shape (round). Needle). The configuration of the suture needle itself is substantially the same as that of a commonly used suture needle.

The materials of the first, second and third sutures 3A, 3B and 3C are not particularly limited, and can be arbitrarily selected from chemical fibers such as synthetic fibers and natural fibers depending on the intended use and the like. For example, when used for pancreatogastric anastomosis after pancreaticoduodenectomy, for example, nylon thread or the like can be adopted. In this embodiment, a nylon thread (nylon thread) is used.

The thickness of each suture is not particularly limited, but a very fine thread (for example, about 0.025 mm to about 0.05 mm in diameter) can be adopted (however, the thickness is not limited to the above range).

The lengths of the first, second and third sutures can be arbitrarily determined according to the type and site of the anastomosis and the organ to be sutured. For example, in the case of configuring for pancreatogastric anastomosis after pancreaticoduodenectomy, for example, one formed to about 50 cm to about 80 cm can be adopted. Further, as the first suture and the second and third sutures, threads having different lengths can be adopted.

In this embodiment, a thread of about 60 cm is used as the first suture thread 3A. Further, the second and third suture threads 3B and 3C each adopt a thread of about 50 cm.

As each suture, a blue-based, black-based or any other colored thread can be used, and an uncolored thread can also be used.

In this embodiment, the first suture thread 3A and the second and third suture threads 3B and 3C are configured by using threads of different colors. Specifically, for example, the first suture 3A uses a blue thread, and the second and third sutures use a white or black thread. This makes it possible to work while visually checking the suture. In this case, the second suture thread 3B and the third suture thread 3C may also be composed of different colored threads.

In the suture with a needle of the present embodiment, one end of the first suture 3A and one end of the second suture 3B are inserted into the thread attachment hole 24 of the first suture 2A, and the suture is caulked or the like. , The first suture needle 2A is fixedly attached to the first and second suture threads 3A and 3B. Further, the other end of the first suture 3A and one end of the third suture 3C are inserted into the thread attachment hole 24 of the second suture needle 2B, and the second suture needle 2B is caulked or the like. Is fixedly attached to the first and third sutures 3A and 3C.

The suture thread 1 with a needle of the present embodiment is configured as described above, and by inserting the first suture needle 2A into a living tissue and penetrating the tissue, one half side of the first suture thread 3A And the second suture 3B penetrate the same site of the living tissue at the same time. Further, by inserting the second suture needle 2B into the living tissue and penetrating the tissue, the other half side of the first suture thread 3A and the third suture thread 3C penetrate the same part of the living tissue at the same time. It is configured to do.

Next, an example of pancreatogastric anastomosis after pancreaticoduodenectomy performed using the suture with a needle of the present embodiment will be described with reference to FIG. FIG. 3 is an explanatory diagram showing an outline of a process of performing pancreatic gastric anastomosis by the above-mentioned "this surgical method" using the suture with a needle.

The above-mentioned "this surgical method" is a method of performing a pancreatic gastric anastomosis on the posterior wall of the stomach 4 (posterior wall of the stomach) after incising the anterior wall (anterior wall of the stomach) of the stomach 4 (residual stomach). As shown in FIG. 3 , an anastomotic incision 5 is made in the posterior wall of the stomach, and the stump of the pancreas 6 (residual pancreas) is inserted into the residual stomach.

Then, as shown in FIG. 3 (a), the first suture needle 2A is inserted into the living tissue using a needle holder (not shown) and penetrates the entire layer of the stomach wall and the pancreas, that is, the stomach wall → Penetrate the first suture needle in the order of pancreas → stomach wall. As a result, one half side of the first suture 3A and the second suture 3B penetrate the same site of the stomach and pancreas at the same time. The second suture needle 2B also penetrates the entire stomach wall and the pancreas in the same manner as the first suture needle 2A. Thereby, the other half side of the first suture 3A and the third suture 3C penetrate the same site of the stomach and pancreas at the same time.

Next, the penetration state of each suture is confirmed, and as shown in FIG. 3 (b), the second and third sutures 3B and 3C are attached to the suture needle by using a shear 7 or the like at a desired time. Cut from near the base end and ligate the second sutures and the third sutures. The first suture is also ligated and cut in the same manner as described above.

By the above operation, the pancreas (residual pancreas) and the stomach (residual stomach) are anastomosed with a single thread for full-thickness gastric wall-penetrating pancreas mattress and two threads for full-thickness gastric wall-penetrating pancreas.

Although the present embodiment discloses an example in which pancreatogastric anastomosis is performed after pancreaticoduodenectomy, the use of the needle-attached suture of the present embodiment is not limited to the above. For example, it can be used for pancreatic stump closure at the time of caudal pancreatic resection, or for suturing the excised pancreas by covering it with a Vicryl sheet (for example, J & J product).

Further, the suture with a needle described above is disclosed as an example, and the present invention is not limited to the above embodiment, and can be arbitrarily changed as long as the technical idea described in the claims is not exceeded. It is a thing.

2A 1st suture 2B 2nd suture 3A 1st suture 3B 2nd suture 3C 3rd suture 4 Gastric (residual stomach)
5 Incision 6 Pancreas (residual pancreas)
20 Needle body 22 Needle tip 23 Needle base 24 Thread mounting hole

Claims (4)

A needle-attached suture comprising a first, second and third suture and a first and second suture attached to these sutures.
The first and second suture needles have a thread mounting hole provided in the proximal end portion of the needle body in the axial direction.
In the first suture needle, one end of the first suture and one end of the second suture are inserted into the thread attachment holes of the first suture, and the first and second sutures are made. It is fixed to the thread and attached,
In the second suture needle, the other end of the first suture and one end of the third suture are inserted into the thread attachment holes of the second suture, and the first and third sutures are used. A suture with a needle, characterized in that it is fixed and attached to the suture. The suture with a needle according to claim 1, wherein the first and second suture needles are composed of straight round needles. The suture with a needle according to claim 1, wherein the first suture and the second and third sutures are composed of threads of different colors. The suture with a needle according to any one of claims 1 to 3, wherein the suture with a needle is used for pancreatic gastric anastomosis after pancreaticoduodenectomy.

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