JPH02249540A - Device for joining together blood vessels - Google Patents

Abstract

PURPOSE:To smooth joining operation by a method wherein a title device is manufactured by a material not adhered to an urethane prepolymer, and when operation to join together blood vessels by using an adhesive for surgery, the device forms a tapered rod a part which is insertable into the blood vessel. CONSTITUTION:A title device is manufactured by a material prevented from adhesion to an urethane prepolymer and is a device for joining being a tapered rod a part of which is insertable in a blood vessels when operation to join together blood vessels by using an adhesive for surgery. A synthetic polymer, e.g. silicone resin, fluororesin, polyethylene resin, polypropylene resin, is listed as the material prevented from adhesion to the urethane prepolymer. A method of manufacturing the device of a synthetic polymer alone, and a method of coating or lining a device made of other material with the synthetic polymer are listed as a method of manufacturing the device for joining. This constitution enables to prevent from blockage of the blood vessel at a joining period even when sewing of a microscopic blood vessel, and enables to execute a safe and rapid operation.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention relates to a blood vessel coaptation device. For more details,
The present invention relates to an instrument used to smoothly perform a surgical operation when joining blood vessels using surgical adhesive.

[Prior art] Conventionally, blood vessels have been joined by a suturing method using suture thread ("Surgical MOOK-4 - Suturing and Anastomosis", Metal Publishing, 1978) and a joining method using surgical adhesive (Japanese Patent Application Laid-Open No. 11-12-2011). −
148GeB Publication) etc.

[Problems to be Solved by the Invention] Suturing and anastomosis of blood vessels is a surgical technique that is naturally required in general surgery, such as repair of vascular damage during surgery and vascular resection and transplantation accompanying radical surgery for expansion of malignant tumors.

Regarding large blood vessels, suturing with suture threads does not pose much of a problem in terms of surgical technique;
■The following blood vessels) are involved in microsurgery and require special techniques using a binocular microscope with a magnification of 6 to 40 times, which is time consuming and difficult. It's true. For this reason, studies have been actively conducted in recent years on bonding methods using surgical adhesives that do not use sutures. However, although the joining of microvessels using surgical adhesives shortens the surgical time and provides good adhesion to the tissue, the adhesive joining is performed with the blood vessel in a collapsed shape during surgery, so the inside of the blood vessel at the joint is As the cross-section becomes smaller, the problem of vascular occlusion has been pointed out in terms of surgical techniques.

[Means for Solving the Problems] In view of the above-mentioned problems, the present inventors have developed a method to maintain the intravascular cross section of the junction and ensure a reliable As a result of extensive research to find a device for joining blood vessels that can shorten surgical time, we have arrived at the present invention.

That is, the present invention is a tapered rod that is made of a material that does not adhere to urethane prepolymer and that can be partially inserted into a blood vessel when performing blood vessel joining surgery using surgical adhesive. This is a blood vessel joining device characterized by the following.

Examples of substances that do not adhere to the urethane prepolymer of the present invention include silicone resin, fluororesin, polyethylene resin,
Examples include synthetic polymers such as polypropylene resin. These resins may be used alone or in combination with other resins. Among these, silicone resins and fluororesins are preferred, and fluororesins are particularly preferred.

The method of manufacturing the blood vessel joining device of the present invention includes a method of manufacturing the above-mentioned synthetic polymer alone, and a method of manufacturing the device made of other materials (metal, plastic, ceramic, etc.) with the above-mentioned synthetic polymer. Examples include a method to do so.

The shape of the blood vessel joining device of the present invention is rod-like, and in order to insert a portion into the blood vessel, it must be tapered. The tip may be conically pointed or rounded. For example, if the blood vessel joining device is made of a hard material, the tip should be rounded or hemispherical, since a sharp tip will easily damage the blood vessel wall. On the other hand, if it is made of a soft material, it is better to have a sharp tip for handling.

Furthermore, since it is inserted into a blood vessel, the distal end needs to be smaller than the inner diameter of the target blood vessel, and the outer diameter of the other end needs to be larger than the inner diameter of the blood vessel. The outer diameter of the side inserted into the blood vessel is usually 3II11 or less, preferably 1 mm or less. The outside diameter of the other end is usually 3m1
Above, preferably 5 to 10 mm.

The surgical adhesive used in the present invention includes:
Aromatic polyisocyanates, aliphatic polyisocyanates, alicyclic polyisocyanates (tolylene diisocyanate (TDI), diphenylmethane diisocyanate CMDI), p-phenylene diisocyanate (PPD I) W described in JP-A-82-148G88 polyisocyanates, etc.) and hydrophilic polyether polyols (
Adducts of compounds having at least two active hydrogens (ethylene glycol, propylene glycol, etc.) with ethylene oxide and other alkylene oxides if necessary)
NGO-terminated hydrophilic urethane prepolymers, ■Fluorine-containing polyisocyanates described in Japanese Patent Application No. 63-52918 (general formula: OCN・Rt' NGO and general formula: OCN * CIItRrCHg 11NCO
(However, Rt is a perfluoroalkylene group having 1 to 20 carbon atoms, including those containing 1 g or more of ether bond), hydrophilic polyether polyols (small
Examples include fluorine-containing NGO-terminated hydrophilic urethane prepolymers of compounds having two active hydrogens (ethylene glycol, propylene glycol, etc.) and adducts of ethylene oxide and, if necessary, other alkylene oxides. Among these urethane prepolymers, preferred is a fluorine-containing NGO-terminated hydrophilic urethane prepolymer.

Surgical adhesives may contain physiologically active drugs (central nervous system drugs, allergy drugs, circulatory organ drugs,
Respiratory organ drugs, digestive organ drugs, hormones, metabolic drugs, antineoplastic agents, antibiotic preparations, chemotherapy drugs, etc.), fillers (carbon black, red iron, calcium silicate, sodium silicate, titanium oxide) , acrylic resin powder, various ceramic powders, etc.), softeners [dibutyl phthalate] (DBP), dioctyl phthalate) (DOP),
Tricresyl phosphate (TCP), ) ribtoxyethyl phosphate, and other various esters J1
Stabilizers (trimethyldihydroquinone, phenyl-β-naphthylamine, p-impropoxydiphenylamine,
diphenyl-p-phenylenediamine, etc.) can be blended. The amount of these compounds is usually 0 to 20% by weight, preferably 0 to 5% by weight, based on the surgical adhesive.

In the case of blood vessel joining surgery using the blood vessel joining instrument of the present invention, for example, end-to-end blood vessel anastomosis surgery, it is performed as follows. This will be explained according to the drawing (FIG. 3). In Figure 3, 1
2 is a blood vessel, 2 is a blood vessel joining instrument of the present invention, 3 is a surgical adhesive, 4 is a cut surface of the surgical adhesive, and 5 is a cross section of a blood vessel.

(2) Insert the blood vessel joining device 2 of the present invention into one blood vessel l. The maximum diameter of the blood vessel joining device must be selected to be larger than the inner diameter of the blood vessel. This results in the insertion of only a portion of the blood vessel coaptation device, with the remainder remaining outside the blood vessel (FIG. 3(a)).

■Apply surgical adhesive 3 to the entire blood vessel 1 and the blood vessel splicing device, focusing on the area where the blood vessel splicing device 2 has been inserted (
Figure 3(b)).

(2) After the surgical adhesive 3 has solidified, the blood vessel joining instrument 2 is removed, so that the end of the blood vessel 1 is fixed by the surgical adhesive 3.

■ Cut the solidified surgical adhesive 3 with a scalpel, scissors, etc. to expose the cross section of the blood vessel (
Figure 3 (C)).

■Perform the same operation for the other blood vessel l.

■Vessels! The solidified surgical adhesive 3 is brought together so that the cross sections of the two sides are in contact with each other, and the surgical adhesive is applied around the solidified surgical adhesive 3.
and/or terminate the anastomosis with sutures (FIG. 3(d)).

[Examples] The present invention will be further explained below with reference to Examples and Comparative Examples, but the present invention is not limited thereto. In the following, EO represents ethylene oxide and PO represents propylene oxide. The surgical adhesives used in Examples and Comparative Examples are as follows.

Surgical adhesive AI: OCR@C■2 (CF2) 40H211NCO and polyether polyol (EO/PO random copolymer, average molecular weight 3,000, oxyethylene content 80%) dehydrated under reduced pressure were heated at 80°C. After reacting at temperature for 8 hours, a urethane prepolymer surgical adhesive was obtained (NGO
content 2°5%).

Example 1 A rod of WJJ (tetrafubuted ethylene/perfluoroalkyl vinyl ether copolymer) was shaped into a cone (diameter of the lower surface:
51m% Length: 150mm) to obtain a blood vessel joining device of the present invention.

The adult dog's artery (outer diameter approximately 1.5 av) was placed with forceps, temporarily tied and cut, and an end-to-end anastomosis was performed. The above blood vessel joining device was inserted into the − side of the blood vessel.

The distal end of the instrument entered the blood vessel, and the rear half extended outside, so that the blood vessel joining instrument was in the form of a plug against the blood vessel. Surgical adhesive A around the end of the blood vessel (insertion site)
+ was applied. Eight minutes later, after the surgical adhesive had hardened, the blood vessel joining instrument was removed, and the surgical adhesive, including the blood vessel, was cut with a scalpel. A doughnut-shaped adhesive end was obtained with a circular vessel cross-section retained within the adhesive cross-section. Similar treatment was performed on the other blood vessel. Holding the adhesive part, both vessel sections were brought into contact and surgical adhesive was reapplied around the circumference to join the vessels.

Five minutes later, the blood flow was resumed, but no bleeding was observed, and the blood flow was smooth, indicating a good recovery.

Example 2 A conical needle made of stainless steel with a cut tip (diameter of bottom surface = 7 mm, diameter of tip: 0.5 mm, length:
15hm) was coated with silicone resin to obtain a blood vessel joining device of the present invention.

The adult dog's artery (approximately 3 mm outer diameter) was placed with forceps, temporarily tied, and an end-to-side anastomosis using autologous veins was performed. Since the autologous vein used as the transplanted blood vessel has a bicuspid valve and blood flows only in a certain direction, the direction of the transplantation was confirmed. The above blood vessel joining device was inserted into one end of the transplanted blood vessel. The distal end of the instrument entered the blood vessel, and the rear half extended outside, so that the blood vessel joining instrument was in the form of a plug against the blood vessel. Surgical adhesive A+ was applied around the end of the blood vessel (insertion site).

After the surgical adhesive has hardened, the blood vessel joining instrument is removed.
The surgical adhesive, including the blood vessels, was cut with a scalpel. A doughnut-shaped adhesive end was obtained with a circular vessel cross-section retained within the adhesive cross-section. The surgical adhesive, including the blood vessels, was cut with a scalpel. A donut-shaped end was obtained with a circular vessel cross-section within the adhesive cross-section. Next, the same operation was performed on the anastomotic site of the host blood vessel, and the anastomotic site was cut so that an oval opening was obtained in the side wall of the sclerosing vessel. Holding the adhesive part, touch the cross sections of both blood vessels and temporarily suture (Sta
After applying two stitches of 5 y 5 ture, surgical adhesive was applied again to the surrounding area to join the blood vessels. Five minutes later, the blood flow was resumed, but no bleeding was observed, and the blood flow was smooth, indicating a good recovery.

Comparative Example 1 An adult dog's artery (outer diameter: 1.5 mm) was combed, temporarily ligated and cut, and end-to-end anastomosis was performed. Bring the cut surfaces of both blood vessels into contact with each other, and apply a temporary suture (staySture).
), and then surgical adhesive A1 was applied to the surrounding area to join the blood vessels. After 5 minutes, the blood flow was resumed, but because the cross section of the blood vessel at the joint was not sufficiently maintained, although good adhesion performance was exhibited, the blood flow was not smooth, resulting in post-operative occlusion.

[Effects of the Invention] The blood vessel joining instrument of the present invention is excellent as a blood vessel surgical instrument for making full use of the adhesive properties of surgical adhesives. That is, (1) the intravascular cross section is sufficiently maintained by inserting the main plane tube joining instrument into the blood vessel; - By using surgical adhesive, a cut cross section with an easy-to-handle shape can be obtained.

■Since the main tube joining device has a tapered shape, it can be applied to blood vessels of almost all diameters with one size. Based on the above, by using the blood vessel joining instrument of the present invention, suturing of microvessels, which has conventionally been considered extremely difficult, can be done safely and quickly by avoiding occlusion of blood vessels during joining. It became possible to perform the surgery on time. In addition, the joining method using this device is suitable for joining not only microvessels but also general tubular living tissues that require maintaining the inner diameter (e.g. blood vessels in general including veins, lymphatic vessels, trachea, gastrointestinal tract, etc.). It is also effective in providing high reliability and high performance in all medical fields.

Blood vessel suturing using surgical adhesive has been shown to have significant effects, such as more reliable joining, shorter surgical time, and hemostasis from the joint, compared to conventional methods using sutures. However, there are some problems in joining microvessels even when using surgical adhesives. In particular, it has been pointed out that the operation for joining is extremely difficult because the blood vessels to be joined are handled in a collapsed state, and that the internal cross section of the blood vessel is not sufficiently maintained during joining, resulting in the problem of vascular occlusion. According to the blood vessel joining device of the present invention,
Such problems are solved.

[Brief explanation of drawings]

FIG. 1 is a perspective view showing a blood vessel joining device of the present invention made of a urethane prepolymer and a non-adhesive material (fluorocarbon resin). FIG. 2 is a perspective view showing a blood vessel joining device of the present invention in which the distal end of the stainless steel device is coated with a substance (fluorocarbon resin) that does not adhere to urethane prepolymer. FIG. 31 is an explanatory diagram showing how to use the blood vessel joining device of the present invention on the carotid artery of an adult dog. l: Blood vessel, 2: Blood vessel joining instrument, 3: Surgical adhesive, 4
: Cross section of surgical adhesive, 5: Cross section of blood vessel. Engraving of the drawings (no changes to the contents) Figure 1, -, -5II-I Figure 2 Ikkakuichi: ---E Figure 3 Procedural amendments 1 Go 1 Agency Director Furuta Fumiki 1゜Heisei 1 year patent application No. 71409 Name of the invention Blood vessel joining device 1 Number of claims increased due to voluntary amendment by the person making the correction

Claims (1)

[Claims] 1. A tapered material that is made of a material that does not adhere to the urethane prepolymer and that can be partially inserted into a blood vessel when performing blood vessel joining surgery using surgical adhesive. A device for connecting blood vessels, characterized in that it is a rod. 2. The blood vessel joining device according to claim 1, wherein the substance that does not adhere to the urethane prepolymer is a silicone resin and/or a fluororesin. 3. The surgical instrument for blood vessel joining according to claim 1 or 2, wherein the instrument is coated or lined with a substance that does not adhere to the urethane prepolymer, or is manufactured from a substance itself that does not adhere to the urethane prepolymer. utensils.