JPH04226644A - 患者の胃と食道との吻合部を陥入させる装置 - Google Patents
患者の胃と食道との吻合部を陥入させる装置Info
- Publication number
- JPH04226644A JPH04226644A JP3264019A JP26401991A JPH04226644A JP H04226644 A JPH04226644 A JP H04226644A JP 3264019 A JP3264019 A JP 3264019A JP 26401991 A JP26401991 A JP 26401991A JP H04226644 A JPH04226644 A JP H04226644A
- Authority
- JP
- Japan
- Prior art keywords
- stomach
- invagination
- esophagus
- guide
- anastomosis
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 210000002784 stomach Anatomy 0.000 title claims abstract description 104
- 210000003238 esophagus Anatomy 0.000 title claims abstract description 102
- 238000000034 method Methods 0.000 title claims abstract description 45
- 230000000881 depressing effect Effects 0.000 title abstract 3
- 230000003872 anastomosis Effects 0.000 claims abstract description 64
- 238000007789 sealing Methods 0.000 claims description 12
- 238000009423 ventilation Methods 0.000 claims description 10
- 238000003780 insertion Methods 0.000 claims description 6
- 230000037431 insertion Effects 0.000 claims description 6
- 239000002184 metal Substances 0.000 claims description 5
- 238000013022 venting Methods 0.000 claims description 5
- 229920003023 plastic Polymers 0.000 claims description 3
- 239000004033 plastic Substances 0.000 claims description 3
- 210000002599 gastric fundus Anatomy 0.000 claims description 2
- 229920001684 low density polyethylene Polymers 0.000 claims description 2
- 239000004702 low-density polyethylene Substances 0.000 claims description 2
- 230000003213 activating effect Effects 0.000 claims 5
- 238000005452 bending Methods 0.000 claims 2
- 239000003550 marker Substances 0.000 claims 2
- 230000003287 optical effect Effects 0.000 claims 2
- 230000003247 decreasing effect Effects 0.000 claims 1
- 208000006881 esophagitis Diseases 0.000 abstract description 2
- 208000007882 Gastritis Diseases 0.000 abstract 1
- 238000010992 reflux Methods 0.000 abstract 1
- 208000021302 gastroesophageal reflux disease Diseases 0.000 description 7
- 238000001356 surgical procedure Methods 0.000 description 6
- 238000010586 diagram Methods 0.000 description 5
- 241000283216 Phocidae Species 0.000 description 4
- 230000000712 assembly Effects 0.000 description 3
- 238000000429 assembly Methods 0.000 description 3
- 238000002513 implantation Methods 0.000 description 3
- 206010054949 Metaplasia Diseases 0.000 description 2
- 208000031481 Pathologic Constriction Diseases 0.000 description 2
- 208000025865 Ulcer Diseases 0.000 description 2
- 230000010339 dilation Effects 0.000 description 2
- 230000002496 gastric effect Effects 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 230000015689 metaplastic ossification Effects 0.000 description 2
- 230000000717 retained effect Effects 0.000 description 2
- 230000028327 secretion Effects 0.000 description 2
- 208000037804 stenosis Diseases 0.000 description 2
- 230000036262 stenosis Effects 0.000 description 2
- 231100000397 ulcer Toxicity 0.000 description 2
- 208000023514 Barrett esophagus Diseases 0.000 description 1
- 208000023665 Barrett oesophagus Diseases 0.000 description 1
- 206010030216 Oesophagitis Diseases 0.000 description 1
- 241001671982 Pusa caspica Species 0.000 description 1
- 210000003815 abdominal wall Anatomy 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 230000006978 adaptation Effects 0.000 description 1
- 208000009956 adenocarcinoma Diseases 0.000 description 1
- 230000000151 anti-reflux effect Effects 0.000 description 1
- 230000001684 chronic effect Effects 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 238000002347 injection Methods 0.000 description 1
- 239000007924 injection Substances 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 229920001179 medium density polyethylene Polymers 0.000 description 1
- 239000004701 medium-density polyethylene Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 210000002445 nipple Anatomy 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 210000004303 peritoneum Anatomy 0.000 description 1
- 229920001296 polysiloxane Polymers 0.000 description 1
- 229910052710 silicon Inorganic materials 0.000 description 1
- 239000010703 silicon Substances 0.000 description 1
- 229910001220 stainless steel Inorganic materials 0.000 description 1
- 239000010935 stainless steel Substances 0.000 description 1
- 238000007920 subcutaneous administration Methods 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
- A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
- A61B2017/22077—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00553—Sphincter
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
Abstract
め要約のデータは記録されません。
Description
に関するものである。より具体的には、本発明は、最小
の侵入状態にて胃と食道との吻合部に食道を陥入させる
新規かつユニークな方法及びこの新たに開発された方法
に有用な装置に関するものである。
狭窄症、及び正常な鱗状内壁の柱状化生を起こし勝ちで
ある。バレット(Barrett)食道と称される柱状
化生は、胃食道逆流症を患う患者の約10%に発生し、
狭窄症、深い潰瘍及び腺癌の発生に関係する。胃食道逆
流症は米国内で毎年500,000人以上の人に発生し
、その内ほんの約35,000人が抗逆流矯正手術を受
けている。
侵入が少なく、しかも慢性の酸減少治療法よりもコスト
的に有利である胃食道逆流症の新しい治療法求められて
いる。かかる方法を利用し得ることにより、より早期に
かつより広範囲の外科手術治療を可能にし、長期に亙っ
て内科的治療を受けている間に病気が進行することによ
り生じる深刻な合併症を回避することが出来る。
は、胃底ヒダ形成術を内視鏡手術によって行うことによ
り胃食道逆流症を治療する新規かつ改良された方法、並
びにこの新しい技術に有用な新しい装置に関するもので
ある。本発明の一実施例によれば、陥入装置が食道内に
経口的に導入される。この陥入装置は、食道の外径に略
等しい外径と、その外径面まで伸長する複数の針受け入
れ内腔とを有する導入子ガイドを備えている。又、この
陥入装置は多数の針を有する係合組立体を備えている。 これら針の各々は、針受け入れ内腔内に位置し、ガイド
から半径方向に突出して食道に係合するための退却位置
を有している。次に、係合組立体を作動させて、針を食
道に係合する伸長位置に配置し、係合した陥入装置を胃
に向けかつ胃内に進ませ、胃と食道との吻合部を3−4
cmの距離に亙って胃内へ陥入させる。遠隔操作可能な
締結組立体をその前に埋め込んだ手術用通路/通気ポー
トを通じて胃の中に進め、次に操作して、陥入された食
道を隣接する内側に曲がった胃に締結する。これは、締
結組立体の1つのアームを陥入装置の表面に予め形成し
た溝内に摺動させ、その他方のアームを内側に曲がった
胃の上に置き、次に、損傷を生じないような方法にて陥
入された食道壁を内側に曲がった胃壁にステープル止め
することによって行われる。この「ニップル」弁を締結
組立体によって固着した後、針はその針受け入れ内腔に
戻し、陥入装置及び締結組立体を除去する。埋め込んだ
手術用通路/通気ポートはその他の器具を除去した後、
ある期間密封し且つ適所に残し、新たに形成した弁を固
定状態に維持し得るようにする。
と胃との間に新たな弁を形成し、これにより、酸の逆流
を阻止するものである。
するため、以下に図面に図示した実施例を参照し、該実
施例の説明のため、特定の用語を使用する。しかしなが
ら、これは本発明の範囲を限定するものではなく、図示
した装置の変形例、及び応用例、更に、ここに示した本
発明の更なる応用例は、本発明が関係する技術の当業者
に通常、案出されるものである。
する胃と食道の吻合部10にてこの陥入法を実施する逐
次的段階を示す図1a乃至1dを参照しながら、本発明
の好適な実施例について説明する。
ポートを胃30に経皮的に形成し、一方のポートは内視
鏡を受け入れ得る寸法とし(7mm)、第2のポートは
遠隔操作可能な締結組立体を受け入れ得るように約12
mmの径にする。これは、一般に、1)ガイドワイヤを
経皮的に胃内に導入し、2)内視鏡を使用してガイドワ
イヤを引っ掛けて口を通じて引き出し、3)目盛りの付
いた拡張器手術用通路ポート組立体を、張力状態のガイ
ドワイヤに沿って経口的に進め、その一部を皮膚から突
出させ、4)該組立体を適所に固定することによって行
われる。この方法の段階は、図3a乃至3dを参照して
、本明細書において、更に詳細に説明する。
を通じて通気した後、別の針を腹壁を通じて胃内に挿入
し、内視鏡の案内の下、ガイドワイヤ5を口内に導入し
かつ口外に引き出す。次に、陥入装置70をガイドワイ
ヤ5に沿って進め、食道20内に導入する。この陥入装
置70の食道20内への導入及びその前進は、陥入装置
70がその長さに沿って可撓性でありかつその末端の形
状がテーパー付きの形状であることによって容易となる
。食道20内での陥入装置70のガイドは、陥入装置7
0を前進させる間ガイドワイヤ5に適当な張力を付与す
ることで一層容易にすることが出来る。5mmの腹腔鏡
40を7mmのポートを通じて導入し、該腹腔鏡40に
よって直接観察しながら陥入装置70を胃と食道との吻
合部10に配置する。胃と食道との吻合部10に対する
陥入装置70の位置決めは、陥入装置70の末端から所
定の距離(3cm)の箇所にマーキング71を付けるこ
とによって容易となる。図1aには、食道20内に前進
させ、胃と食道との吻合部10にそのように位置決めさ
れた陥入装置70が図示されている。
せ、針88を内腔78外に進めて陥入装置70から半径
方向外方に突出させ、食道20に係合させる。針88を
突出させて食道20に係合させる機構は、本明細書にお
いて図2a及び図2bに関して更に詳細に説明する。図
1bには、その係合組立体をそのように作動させ、針8
8を伸長させ、胃と食道との吻合部付近にて食道20に
係合させる陥入装置70が図示されている。図1bはこ
の係合状態の概念図であり、正確な縮尺図ではないこと
に注意すべきである。実際上、針88と食道20との係
合は可能な限り胃と食道との吻合部付近にて行われるよ
うにする。この係合は、胃と食道との吻合部10で直接
行ない、食道内壁が長期に亙って胃の分泌液にさらされ
ないようにすることが望ましい。
を胃30に向けて押し込み、この動きにより食道20が
胃30に向けて付勢され、胃と食道との吻合部10を陥
入させ、周囲の胃底壁25を内側に曲げる。次に、10
mmの遠隔操作可能なステープル止め装置50を前もっ
て形成した12mmの手術用通路/通気ポートを通じて
進め、胃底壁25を陥入した胃と食道との吻合部10に
ステープル止めする。導入子ガイド75のテーパー付き
末端部分の溝72は、安定した支持手段を提供すること
によってステープル止め装置50のステープル止め動作
を促進する。図1cには、胃30に向けて前進され、胃
と食道との吻合部10に陥入し得るようにした係合陥入
装置70が図示されており、図1cには、ステープル止
め装置50によって陥入した胃と食道との吻合部10に
締結した胃底壁25が更に図示されている。
、針88を退却させて、それぞれの内腔78内に戻し、
陥入装置70、及びガイドワイヤ5を除去する。 又、腹腔鏡40も除去する。次に、手術用通路/通気ポ
ートを密封し、新たに形成した弁を定着させるのに十分
な期間、適所に維持する。図1dには、食道20と胃3
0との間に新たに形成された弁が図示されており、陥入
装置70、及びその他の器具は除去し、ステープル55
が胃底壁25を胃と食道との吻合部10に対して保持し
ている。2又は3列のステープル55が形成した折り重
ね部分を適所に保持し、このように形成された弁の機能
を維持するのに十分であると考えられる。
0について、部分破断側面図で示す図2a乃至図2bを
参照しながら、詳細に説明する。図2aには、その係合
組立体を不作動状態の陥入装置が図示されており、係合
針がそれぞれの内腔内に保持されている。図2bには、
その係合組立体が作動して、針をそれぞれの内腔外に突
出させ、食道壁に係合させた陥入装置が図示されている
。
径の導入子ガイド75を備えている。導入子ガイド75
は、生物学的に適合しかつ可撓性である材料(低密度ポ
リエチレンがこの目的に特に適している)から成ってお
り、食道内への挿入及び前進が容易であるようにその末
端にテーパーが付けられている。導入子ガイド75はそ
の長さに沿って伸長し、ガイドワイヤを受け入れるため
の中央内腔76を画成する。又、導入子ガイド75のか
かる中央内腔76は、針突出器80も受け入れる。導入
子ガイド75の中央内腔76からは、10本の針を受け
入れる内腔78が伸長しており、これら針受け入れ内腔
は導入子ガイド75の周縁に沿って等間隔に配置されて
おり、その外径面まで伸長している。導入子ガイド75
の基端には、雄ねじ式コネクタ77がある。
係合組立体は、針88をそれぞれの針受け入れ内腔78
から外に突出させて食道に係合させるように作動する。 針88を突出させるこの係合組立体は、針突出器80、
前進部材90、及びコネクタ77を備えている。
末端に金属製ハブ81を備えている。針突出器80は、
その基端に、前進部材90の凹所93内に着座した第2
の金属製ハブ82を備えている。針突出器80の軸83
はその長さに沿って伸長し、金属製の内側コア84、及
びプラスチック製の外管85を備えている。金属製の内
側コア84は、ガイドワイヤを受け入れることの出来る
中央内腔86を画成する。金属製の内側コア84はステ
ンレス鋼から成っており、軸83に対して軸方向強度及
び剛性を提供、一方、低乃至中程度の密度のポリエチレ
ンから成るプラスチック製外管85は、軸83の可撓性
を増進しかつ導入子ガイド75の中央内腔76内におけ
る横方向の安定性に寄与する。ハブ81、82、及び軸
83は共に「プッシュロッド」を形成し、このプッシュ
ロッドは、ガイド75の中央内腔76内を前進するとき
、針88をそれぞれの針受け入れ内腔78の外に突出さ
せ、食道に係合させる。
、前進部材90を作動させることによって行われる。 前進部材90は、その末端に、コネクタ77の雄ねじ部
分に螺合可能に係合する雌ねじ式部分91を有しており
、その基端には、ハブ82を凹所93内に保持する保持
部分92を有している。前進部材90を通る中央内腔9
6が針突起器80の軸83及び基端ハブ82を受け入れ
、前進部材90の基端を通って続いており、ガイドワイ
ヤが陥入装置70の全長を通って進むことを許容する。
タ77の周りにねじ込むことにより、針突出器80は導
入子ガイド75内を前進せしめられて針88を針受け入
れ内腔78を通って突出させ、針88を陥入装置70の
周縁に沿って半径方向及び前方に伸長させかつ食道に係
合させる。前進部材90がコネクタ77に完全に螺合し
たとき、針88は導入子ガイド75から完全に伸長する
。螺着係合状態を利用して前進させることで針88は平
滑にかつ均一に突出され、食道壁と安定的にかつ確実に
係合する。針88は陥入装置70の縦軸線に対して約3
0°の角度にて針受け入れ内腔78により案内される。 この30°の突出角度にて、10本の針を陥入装置70
の周縁に沿って36°の角度で等間隔に離間すれば、食
道壁に安定的に係合しかつ該壁を前進させるのに十分で
あることが判明している。
ープル止め装置50を導入するのに有用な手術用通路/
通気ポート組立体について、図3a乃至図3dに関して
特に具体的に説明する。手術用通路/通気ポート組立体
100は、ガイドワイヤ105、手術用通路/通気ポー
ト110、皮膚フランジ120、取り付け可能なバルー
ン拡張ノズル130、取り付け可能な通気弁140、密
封部材150、及び密封キャップ160を備えている。
最初に経皮的に胃内に導入する一方、内視鏡を経口的に
胃内に導入し、この内視鏡を使用してガイドワイヤ10
5を引っ掛けて、該ガイドワイヤ105を口から退却さ
せる。次に、手術用通路/通気ポート110を張力をか
けたガイドワイヤ105上を経口的に進ませ、皮膚から
一部突出させる。ガイドワイヤ105の除去後、皮膚フ
ランジ120をポート110の管状部分上に配置し、皮
膚に向けて進める。次に、取り付け可能なバルーン拡張
ノズル130を拡張ポート112に取り付け、該ポート
を介しバルーン118に接続された膨張内腔113を介
してバルーン118内にCO2を注入し、これにより拡
張バルーン118を胃内の適所にて拡張させる。次に、
皮膚フランジ120を皮膚に対して調節し、ポート11
0を適所に固着する。次に、手術用通路/通気ポート1
10のテーパー付き末端部分111をマーク111′か
ら切断し、これにより手術用通路114を通じて胃内へ
のアクセス口を開口する。
たならば作動させて通気内腔116を通じてCO2を胃
内に供給し、通気口117から排出する。コック142
を回転させて、胃内へのCO2の供給量を必要に応じて
増減可能に制御及び調節することが出来る。
んだとき、その周囲の組織の弾性に適合する可撓性材料
にて形成することが望ましい。この目的上、シリコンが
特に適していると考えられる。埋め込み中、更なる強度
及び安定性を付与するため、ポート110のテーパー付
き部分111は、ガイドワイヤ105を受け入れるのに
十分な寸法の内腔104を有している。上述のように、
このテーパー付き部分111は、埋め込み後に切断して
、中央の手術用通路114を露出させ、これによって、
行うべき手術に関連して使用される器具を遠隔操作する
ための胃内へのアクセス口を形成する。
成されており、円板状フランジ21と、管状ハンドル部
分122とを備えている。スロット123がフランジ1
20をポート110に沿って進めるのを容易にする。シ
ールキャップ150がポート110の端部を密封し、こ
のポートの周囲に取り付けられて、シールキャップ15
0の突起151とポート110の凹陥部119との間に
密封嵌めを形成する。図3b乃至図3dには、各種の手
術段階における組立体の拡大断面図が図示されている。 図3bには、埋め込んだ手術用通路/通気ポート110
、バルーン拡張用ノズル130、通気弁140、及びそ
れぞれの接続ポートから取外したノズル130、及び弁
140が図示されている。図3bにおいて、テーパー付
き部分111はガイドワイヤ105を受け入れ得る寸法
とした中央内腔104を有し、これによって、埋め込み
中、付加的な強度及び安定性を付与する一方、管状部分
110aは遠隔操作可能な器具を受け入れ得る寸法(例
えば、締結組立体用には12mm、及び腹腔鏡用には7
mm)とした大きい手術用通路114を画成する。 バルーン拡張ポート112、及び該ポート112をバル
ーン118の内側に接続するバルーン拡張内腔113が
上記管状壁部分110aの壁に形成されている。ポート
112の入口には、シール112aがある。外側の通気
ポート115を内側の通気ポート117に接続する通気
内腔116が管状部分110aの壁に形成されている。 ポート115の入口には、シール115aがある。
112、115に接続可能であるバルーン注入ノズル1
30及び通気弁140の断面図が図示されている。図3
cに図示するように、ポート115内に配置したとき、
シール115aが開放し、弁通路141、及び通気内腔
116を通じてCO2を胃内に注入することを許容する
。図3dに図示するように、弁140をポート115か
ら除去したとき、シール115aが再度閉じる。バルー
ン拡張ノズル130は、ポート112に対すると同一の
方法にて作動し、通路131及び拡張内腔113を通じ
てバルーン118を拡張させる。
付き部分111は切断されており、締結組立体50は中
央の手術用通路114内に挿入されている。又、図3c
において、通気弁140が通気ポート115に取り付け
られ、通気内腔116を通じて胃を通気する。密封部材
150がポート110の周囲に配置され、ステープル止
め装置50と密封係合状態に位置決めされて、これによ
り、手術/通気中、ガスが手術用通路114を通って漏
洩するのを阻止する。密封部材150の突起151がポ
ート110の凹陥部分119に密封係合状態に嵌入する
一方、内側フランジ152はステープル止め装置50と
密封係合し、漏洩を効果的に防止する。図3dにおいて
、ステープル止め装置50が除去されており、通気弁1
40が取り外され、シールキャップ160をポート11
0の周囲に取り付けて、胃に出入るするためのアクセス
口を密封する。このように密封されたとき、ポート11
0は、上述の手術の後、胃を腹膜に定着させておくため
、又胃に対する排出ポートを提供するためにある期間だ
け、埋め込んだままとしてもよい。
方法にて、図4a乃至図4dには、別の形状の陥入装置
と共に、本発明に従った陥入方法を実行するための逐次
的な段階が図示されている。格別の説明をする場合を除
いて、図4a乃至図4dの全ての形態は、図1a乃至図
1dに示したものと同一であり、図4a乃至図4dにお
いては、図1a乃至図1dの符号にプライム符号(′)
を付して表示した。故に、説明の重複を避けるため、次
の相違点を除いて、付加的な図面についての説明は省略
する。
溝72′がガイド70′のテーパー開始部分から内腔7
8′を経て基端方向に向けて長手方向に伸長し、内腔7
8′は溝72′が伸長するためのスペースを提供し得る
形態としてある。この修正した形態は、締結組立体50
′のあご状アンビル部材を食道内腔内に位置決めするの
を容易にし、又、図4cに図示するように、ステープル
止め動作中、締結組立体50′を針88′を経て位置決
めするのを許容し、これによって胃と食道との吻合部1
0に針を直接係合させることを可能にする。針を胃と食
道との吻合部10に直接係合させる結果、食道の内壁が
胃の分泌液に長期間さらされるのを防止することが出来
る。
方向の間隔を示す、陥入ガイド70′の拡大端面図が図
示されている。図5bは内腔78′を経て伸長する溝7
2′を示す、陥入ガイド70′の拡大部分側面図である
。
明したが、これは単に一例であり、本発明の特徴を限定
するものではなく、単に好適な実施例のみを図示し説明
したものであり、本発明の精神に含まれる全ての変形例
及び応用例は保護の対象とすることを希望するものであ
る。
な実行段階を示す概念図である。1aは食道内に進め、
胃と食道との吻合部に位置決めされた陥入装置の図であ
る。1bはその係合組立体を作動させ、複数の針を伸長
させて胃と食道との吻合部付近にて食道に係合させた1
aの陥入装置の図である(針の係合は可能な限り胃と食
道との吻合部に近接させる)。1cは胃に向けて進め、
胃と食道との吻合部にて食道壁を陥入させた係合状態の
陥入装置を示し、更に陥入させた胃と食道との吻合部が
適所に締結された状態を示す図である。1dは陥入装置
及びその他の装置を除去した、食道と胃との間に新たに
形成された弁を示す図である。
装置の部分破断側面図である。2aはその係合組立体を
不作動にし、係合針をそれぞれの内腔内に保持した装置
を示す図である。2bはその係合組立体を作動させ、針
をそれぞれの内腔から突出させ、食道壁に係合させた装
置を示す図である。
は食道を導入するため、胃内への皮下的アクセス手段を
提供しかつ胃への通気手段を提供する手術用通路/通気
組立体を示す図である。3aは完全な組立体の側面図で
ある。3b乃至3dは各種の手術段階における組立体の
一部を示す拡大断面図である。3bは埋め込まれた手術
用通路/通気ポート110、バルーン拡張ノズル130
、通気弁140、それぞれの接続ポートから取り外した
ノズル130、弁140を示す図である。3cはポート
110のテーパー付き部分111を切断し、締結組立体
50を中央の手術用通路114内に挿入し、通気内腔1
16を通じて胃を通気するため通気弁140を通気ポー
ト115に取り付け、密封部材150をポート110の
周囲に配置しかつ締結組立体50と密封係合状態に位置
決めし、これにより手術用/通気中、手術用通路114
を通ってガスが漏洩するのを防止する状態を示す図であ
る。3dは締結組立体50を除去し、通気弁140を取
り外し、密封キャップ160をポート110の周囲に配
置し、胃に出入りするためのアクセス手段を密封する状
態を示す図である。
と共に、本発明による陥入技術の逐次的な実行段階を示
す図である。4aは食道内に進めかつ胃と食道との吻合
部に位置決めした陥入装置を示す図である。4bはその
係合装置を作動させ、複数の針を伸長させ、胃と食道と
の吻合部にて食道に係合させた4aの陥入装置を示す図
である。4cは胃に向けて進め、胃と食道との吻合部に
て食道壁を陥入させる係合状態の陥入装置、及び適所に
締結された陥入させた胃と食道との吻合部を示す図であ
る。4dは陥入装置及びその他の装置を除去し、食道と
胃との間に新たに形成された弁を示す図である。
る陥入装置70′に対する形状の変化を示す拡大図であ
る。5aは内腔78′及び溝72′の周縁方向の間隔を
示す陥入ガイド70′の拡大端面図である。5bは内腔
78′経て伸長する溝72′を示す陥入ガイド70′の
拡大部分側面図である。
10 胃と食道との吻合部 20 食道
25 胃底壁30 胃
40 腹腔鏡
50 ステープル止め装置 55
ステープル70 陥入装置
71 マーキング72 溝
75 導入子ガイド 76 中央内腔
77 雄ねじ式コネクタ
Claims (39)
- 【請求項1】 患者の胃と食道との吻合部を陥入させ
る方法にして、導入子ガイド及び係合組立体を備え、前
記導入子ガイドが食道の外径に略等しい外径を有し、前
記係合組立体が複数の針を備え、前記針が、該針が導入
子ガイド内に位置する退却位置と、該針が導入子ガイド
外に伸長し、前記ガイドから半径方向に突出する伸長位
置とを有し、前記係合組立体が、針を導入子ガイド外に
突出させ、胃と食道との吻合部付近にて食道に係合させ
る手段を更に備えている、陥入装置を経口的に食道内に
導入する段階と、係合組立体を作動させ、針をその伸長
位置に配置し、胃と食道との吻合部付近にて食道に係合
させる段階と、係合した陥入装置を胃に向けて進め、胃
と食道との吻合部を胃内に陥入させ、その周囲の胃底壁
を内側に曲げる段階と、遠隔操作可能な締結組立体を胃
内に導入し、締結組立体を作動させ、陥入させた胃と食
道との吻合部を内側に曲がる周囲の胃底壁に固着する段
階と、係合組立体を不作動にし、伸長させた針を係合状
態から退却させ、導入子ガイドの針受け入れ内腔内に復
帰させる段階と、陥入装置及び締結組立体を患者の身体
から除去する段階とを備えることを特徴とする陥入方法
。 - 【請求項2】 請求項1に記載の陥入方法にして、口
外から胃内に伸長するガイドワイヤを食道内に導入する
段階を更に備え、陥入装置を導入する前記段階が、陥入
装置により画成された中央内腔を通じて陥入装置をガイ
ドワイヤ上を進ませる段階を備えることを特徴とする陥
入方法。 - 【請求項3】 請求項2に記載の陥入方法にして、ガ
イドワイヤを食道を通じ経皮的に胃外から口の外へと伸
長させる段階と、前記伸長させたガイドワイヤに張力を
付与する段階とを更に備え、陥入装置をガイドワイヤ上
に沿って進める前記段階が、ガイドワイヤに前記張力を
付与しつつ行われることを特徴とする陥入方法。 - 【請求項4】 請求項1に記載の陥入方法にして、前
記針が、導入子ガイド外に伸長させたとき、ガイドから
半径方向前方に突出し、胃と食道との吻合部に係合する
ことを特徴とする陥入方法。 - 【請求項5】 請求項1に記載の陥入方法にして、食
道内における陥入装置を内視鏡により観察する段階を更
に備えることを特徴とする陥入方法。 - 【請求項6】 請求項5に記載の陥入方法にして、陥
入装置がその末端に関する所定の位置に光学的に標識が
付されることを特徴とする陥入方法。 - 【請求項7】 患者の胃と食道との吻合部を陥入させ
る方法にして、導入子ガイド及び係合組立体を備え、導
入子ガイドが食道の外径に略等しい外径を有し、前記導
入子ガイドが、ガイドの外径面に伸長する複数の針受け
入れ内腔を更に有し、前記係合組立体が複数の針を備え
、前記針が、該針が導入子ガイド内に位置する退却位置
と、該針が内腔外に伸長し、前記ガイドから半径方向に
突出する伸長位置とを有し、前記係合組立体が針を内腔
外に突出させ、胃と食道との吻合部付近にて食道に係合
させる手段を更に備える陥入装置を経口的に食道内に導
入する段階と、係合組立体を作動させ、針をその伸長位
置に配置し、胃と食道との吻合部付近にて食道に係合さ
せる段階と、係合した陥入装置を胃に向けて進め、胃と
食道との吻合部を胃内に陥入させ、その周囲の胃底壁を
内側に曲げる段階と、遠隔操作可能な締結組立体を胃内
に導入し、締結組立体を作動させ、陥入させた胃と食道
との吻合部を内側に曲がる周囲の胃底壁に固着する段階
と、係合組立体を不作動にし、針を係合状態から退却さ
せ、導入子ガイドの針受け入れ内腔内に復帰させる段階
と、陥入装置及び締結組立体を患者の身体から除去する
段階とを備えることを特徴とする陥入方法。 - 【請求項8】 請求項7に記載の陥入方法にして、口
外から胃内に伸長するガイドワイヤを食道内に導入する
段階を更に備え、陥入装置を導入する前記段階が、陥入
装置により画成された中央内腔を通じて陥入装置をガイ
ドワイヤの上方に進める段階を備えることを特徴とする
陥入方法。 - 【請求項9】 請求項8に記載の陥入方法にして、ガ
イドワイヤを食道を通じ且つ口から及び経皮的に胃外に
伸長させる段階と、前記伸長させたガイドワイヤに張力
を付与する段階とを更に備え、陥入装置をガイドワイヤ
上を進める前記段階が、ガイドワイヤに前記張力を付与
しつつ行われることを特徴とする陥入方法。 - 【請求項10】 請求項8に記載の陥入方法にして、
前記針が、それぞれの内腔外に伸長させたとき、ガイド
から半径方向前方に突出して食道に係合することを特徴
とする陥入方法。 - 【請求項11】 請求項7に記載の陥入方法にして、
食道内における陥入装置を内視鏡により観察する段階を
更に備えることを特徴とする陥入方法。 - 【請求項12】 請求項11に記載の陥入方法にして
、陥入装置がその末端に対して所定の位置に光学的に標
識が付されることを特徴とする方法。 - 【請求項13】 患者の胃と食道との吻合部を陥入さ
せる方法にして、遠隔操作可能な締結組立体を受け入れ
るのに十分な寸法の少なくとも1つの手術用通路ポート
を胃に形成する段階と、導入子ガイド及び係合組立体を
備え、前記導入子ガイドが食道の外径に略等しい外径を
有し、前記導入子ガイドが、ガイドの外径面に伸長する
複数の針受け入れ内腔を備え、係合組立体が複数の針を
備え、前記針が、該針が導入子ガイド内に位置する退却
位置と、該針が内腔外に伸長し前記ガイドから半径方向
に突出する伸長位置とを有し、前記係合組立体が、針を
内腔外に突出させ胃と食道との吻合部に係合させる手段
を更に備える陥入装置を、経口的に食道内に導入する段
階と、係合組立体を作動させ、針を、胃と食道との吻合
部に係合するその伸長位置に配置する段階と、係合した
陥入装置を胃に向けて進め、胃と食道との吻合部を胃内
に陥入させ、その周囲の底壁を内側に曲げる段階と、遠
隔操作可能な締結組立体を開放した手術用通路を通じて
胃内に導入し、締結組立体を作動させて陥入させた胃と
食道との吻合部を内側に曲がる周囲の底壁に固着する段
階と、係合組立体を不作動にし、針を胃と食道との吻合
部から退却させ、導入子ガイドの針受け入れ内腔内に復
帰させる段階と、陥入装置及び締結組立体を患者の身体
から除去し、前記手術用通路を閉じる段階とを備えるこ
とを特徴とする陥入方法。 - 【請求項14】 患者の胃と食道との吻合部を陥入さ
せる装置にして、食道の外径に略等しい外径を有する導
入子ガイドと、患者の胃と食道との吻合部に係合する係
合手段であって、複数の針を備え、前記針が、該針が導
入子ガイド内に位置する退却位置と、該針が導入子ガイ
ド外に伸長し前記ガイドから半径方向に突出する伸長位
置とを有する係合手段とを備え、 前記係合手段が、
針を導入子ガイド外に突出させ、胃と食道との吻合部付
近にて食道に係合させる手段を更に備えることを特徴と
する陥入装置。 - 【請求項15】 請求項14に記載の陥入装置にして
、前記導入子ガイドが食道内への挿入を容易にする手段
を備えることを特徴とする陥入装置。 - 【請求項16】 請求項15に記載の陥入装置にして
、前記挿入容易化手段がその長さに沿って可撓性であり
且つその末端にテーパーが付けられた前記ガイドを備え
ることを特徴とする陥入装置。 - 【請求項17】 請求項14に記載の陥入装置にして
、前記針が、その伸長位置にあるとき、前記ガイドから
半径方向前方に突出し、胃と食道との吻合部に係合する
ことを特徴とする陥入装置。 - 【請求項18】 請求項15に記載の陥入装置にして
、前記針が、伸長位置にあるときに前記導入子ガイドの
中心軸線に関して約30°の角度にて前記ガイドから半
径方向前方に突出することを特徴とする陥入装置。 - 【請求項19】 請求項18に記載の陥入装置にして
、前記針が前記導入子ガイドの周縁に沿って等間隔に離
間されることを特徴とする陥入装置。 - 【請求項20】 請求項19に記載の陥入装置にして
、前記係合組立体が前記導入子ガイドの周縁に沿って等
間隔に離間された10本の針を備えることを特徴とする
陥入装置。 - 【請求項21】 請求項14に記載の陥入装置にして
、前記導入子ガイドが食道内における前記陥入装置の相
対的位置の識別を容易にする手段を備え、前記位置識別
手段が前記ガイドの外側の所定の位置に配置された光学
的標識を有することを特徴とする陥入装置。 - 【請求項22】 患者の胃と食道との吻合部を陥入さ
せる装置にして、食道の外径に略等しい外径を有する導
入子ガイドであって、前記ガイドの外径面に伸長する複
数の針受け入れ内腔を更に有する導入子ガイドと、患者
の胃と食道との吻合部に係合する係合手段であって、複
数の針を有し、前記針が、該針が前記導入子ガイドの針
受け入れ内腔内に位置する退却位置と、該針が前記内腔
外に伸長しかつ前記ガイドから半径方向に突出する伸長
位置とを有し、前記針を前記針受け入れ内腔外に突出さ
せて胃と食道との吻合部付近にて食道に係合させる手段
を更に備える係合手段とを備えることを特徴とする陥入
装置。 - 【請求項23】 請求項22に記載の陥入装置にして
、前記ガイドがその中心軸線に沿って中央内腔を更に有
し、前記複数の針受け入れ内腔が前記中央内腔から前記
ガイドの外径面まで伸長し、前記係合組立体がプッシュ
ロッドを備え、前記プッシュロッドが前記中央内腔に受
け入れられ且つ前記複数の針に接続され、更に、前記ガ
イドの前記中央内腔内を軸方向に動き、前記針を針受け
入れ内腔外に突出させ、胃と食道との吻合部に係合させ
ることを特徴とする陥入装置。 - 【請求項24】 請求項23に記載の陥入装置にして
、前記プッシュロッドがガイドワイヤを受け入れるため
の中央内腔を画成することを特徴とする陥入装置。 - 【請求項25】 請求項22に記載の陥入装置にして
、前記導入子ガイドが食道内への挿入を容易にする手段
を備えることを特徴とする陥入装置。 - 【請求項26】 請求項25に記載の陥入装置にして
、前記挿入容易化手段が、その長さに沿って可撓性であ
り且つその末端にテーパーが付けられた前記ガイドを備
えることを特徴とする陥入装置。 - 【請求項27】 請求項22に記載の陥入装置にして
、前記針が、その伸長位置にあるとき前記ガイドから半
径方向前方に突出して胃と食道との吻合部に係合するこ
とを特徴とする陥入装置。 - 【請求項28】 請求項27に記載の陥入装置にして
、前記針が、その伸長位置にあるとき前方導入子ガイド
の中心軸線に関して約30°の角度にて前記ガイドから
半径方向前方に突出することを特徴とする陥入装置。 - 【請求項29】 請求項27に記載の陥入装置にして
、前記針が前記導入子ガイドの周縁に沿って等間隔に離
間されることを特徴とする陥入装置。 - 【請求項30】 請求項28に記載の陥入装置にして
、前記係合組立体が前記導入子ガイドの周縁に沿って等
間隔に離間された10本の針を備えることを特徴とする
陥入装置。 - 【請求項31】 請求項23に記載の陥入装置にして
、前記プッシュロッドが前記導入子ガイドと螺合可能に
係合し、前記螺合により前記プッシュロッドが前記ガイ
ドの前記中央内腔内を前進して前記針を針受け入れ内腔
から突出させ、胃と食道との吻合部に係合させることを
特徴とする陥入装置。 - 【請求項32】 請求項22に記載の陥入装置にして
、前記導入子ガイドが食道内における前記陥入装置の相
対的位置の識別を容易にする手段を備え、前記位置識別
手段が前記ガイドの外側の所定の位置に配置された光学
的標識を備えることを特徴とする陥入装置。 - 【請求項33】 請求項23に記載の陥入装置にして
、前記プッシュロッドが金属製の内側コアと、プラスチ
ック製の外側管とを備えることを特徴とする陥入装置。 - 【請求項34】 請求項26に記載の陥入装置にして
、前記導入子ガイドが低密度のポリエチレンから成るこ
とを特徴とする陥入装置。 - 【請求項35】 患者の胃と食道との吻合部を陥入さ
せる方法にして、前記手術用通路/通気ポートが、手術
用通路を通じて遠隔的に操作可能な締結組立体に対する
胃内への経皮的アクセス手段を提供し、更に、通気内腔
を通じて胃を通気するための胃内への第2のアクセス手
段を提供するようになされた少なくとも1つの手術用通
路/通気ポートを埋め込む段階と、前記埋め込んだ手術
用通路/通気ポートの通気内腔を通じて胃を通気する段
階と、導入子ガイド及び係合組立体を備え、前記導入子
ガイドが食道の外径に略等しい外径を有し、係合組立体
が胃と食道との吻合部付近にて食道に退却可能に係合す
る手段を備える陥入装置を経口的に食道内に導入する段
階と、前記係合組立体を作動させて胃と食道との吻合部
付近にて食道に係合させる段階と、係合した陥入装置を
胃に向けて進め、胃と食道との吻合部を胃内に陥入させ
、周囲の胃底壁を内側に曲げる段階と、埋め込んだ手術
用通路/通気ポートの手術用通路を通じて遠隔的に操作
可能な締結組立体を胃内に導入し、締結組立体を作動さ
せ、陥入させた胃と食道との吻合部を周囲の内側に曲げ
た胃底壁に固着する段階と、係合組立体を胃と食道との
吻合部との係合から退却させる段階と、陥入装置及び締
結組立体を患者の身体から除去する段階とを備えること
を特徴とする陥入方法。 - 【請求項36】 請求項35に記載の陥入方法にして
、手術用通路を通じて内視鏡が胃内に経皮的にアクセス
するための第2の手術用ポートを胃内に埋め込む段階と
、前記第2の埋め込んだ手術用通路/通気ポートの手術
用通路を通じて内視鏡を胃内に導入し、前記導入された
内視鏡を通じて胃と食道との吻合部にて陥入装置及び締
結組立体を観察する段階とを更に備えることを特徴とす
る陥入方法。 - 【請求項37】 請求項36に記載の陥入方法にして
、前記第2のポートが通気内腔を通じて胃を通気するた
めの胃内への第2のアクセス手段を更に提供し、前記第
2のポートの前記通気内腔を通じて胃を通気する段階を
更に備えることを特徴とする陥入方法。 - 【請求項38】 請求項35に記載の陥入方法にして
、前記陥入装置及び締結組立体の前記除去後、ある時間
、前記埋め込んだポートを適所に残すことにより陥入し
且つ固着した胃と食道との吻合部を固定状態に維持する
段階を更に備えることを特徴とする陥入方法。 - 【請求項39】 手術用通路/通気ポート組立体にし
て、手術用通路/通気ポート部材であって、遠隔的に操
作可能な器具を受け入れ得る寸法とした手術用通路を画
成すると共に前記ポート部材の外側に配置された通気ポ
ートに接続する通気内腔を更に画成する手術用通路/通
気ポート部材と、胃内まで経皮的に伸長し、前記ポート
部材を適所に固定する固定手段とを備え、遠隔的に操作
可能な器具が前記手術用通路を通じて胃内に前進可能で
あり、前記通気内腔を通じて胃内にCO2を導入するこ
とが出来るようにし、更に、前記通気ポートに接続可能
な通気弁部材であって、前記通気内腔を通じて胃内に供
給されるCO2の供給量を増減可能に制御する手段を備
える通気弁部材と、手術/通気中、ガスの漏洩を阻止す
る手術用通路の密封手段であって、前記手術用通路/通
気ポート部材と受け入れられた遠隔的に操作可能な器具
との間にシールを提供する手段を有する密封手段とを備
えることを特徴とする手術用通路/通気ポート組立体。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US595977 | 1984-04-02 | ||
US59597790A | 1990-10-11 | 1990-10-11 | |
US608339 | 1990-11-02 | ||
US07/608,339 US5088979A (en) | 1990-10-11 | 1990-11-02 | Method for esophageal invagination and devices useful therein |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH04226644A true JPH04226644A (ja) | 1992-08-17 |
JPH0638802B2 JPH0638802B2 (ja) | 1994-05-25 |
Family
ID=27082425
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP3264019A Expired - Lifetime JPH0638802B2 (ja) | 1990-10-11 | 1991-10-11 | 患者の胃と食道との吻合部を陥入させる装置 |
Country Status (10)
Country | Link |
---|---|
US (1) | US5088979A (ja) |
EP (1) | EP0480428B1 (ja) |
JP (1) | JPH0638802B2 (ja) |
AT (1) | ATE137941T1 (ja) |
AU (2) | AU643076B2 (ja) |
CA (1) | CA2053130C (ja) |
DE (1) | DE69119530T2 (ja) |
DK (1) | DK0480428T3 (ja) |
ES (1) | ES2087200T3 (ja) |
GR (1) | GR3020477T3 (ja) |
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- 1991-10-10 DK DK91117302.9T patent/DK0480428T3/da active
- 1991-10-10 AT AT91117302T patent/ATE137941T1/de not_active IP Right Cessation
- 1991-10-10 CA CA002053130A patent/CA2053130C/en not_active Expired - Lifetime
- 1991-10-10 DE DE69119530T patent/DE69119530T2/de not_active Expired - Lifetime
- 1991-10-10 ES ES91117302T patent/ES2087200T3/es not_active Expired - Lifetime
- 1991-10-10 EP EP91117302A patent/EP0480428B1/en not_active Expired - Lifetime
- 1991-10-11 JP JP3264019A patent/JPH0638802B2/ja not_active Expired - Lifetime
-
1993
- 1993-09-07 AU AU46178/93A patent/AU652101B2/en not_active Expired
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1996
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Also Published As
Publication number | Publication date |
---|---|
AU4617893A (en) | 1993-11-18 |
AU8569791A (en) | 1992-06-11 |
CA2053130C (en) | 1998-06-02 |
AU643076B2 (en) | 1993-11-04 |
ATE137941T1 (de) | 1996-06-15 |
US5088979A (en) | 1992-02-18 |
AU652101B2 (en) | 1994-08-11 |
EP0480428B1 (en) | 1996-05-15 |
CA2053130A1 (en) | 1992-04-12 |
GR3020477T3 (en) | 1996-10-31 |
DE69119530T2 (de) | 1996-09-26 |
DE69119530D1 (de) | 1996-06-20 |
EP0480428A2 (en) | 1992-04-15 |
JPH0638802B2 (ja) | 1994-05-25 |
EP0480428A3 (en) | 1992-07-08 |
DK0480428T3 (da) | 1996-10-07 |
ES2087200T3 (es) | 1996-07-16 |
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