JPH0560933B2 - - Google Patents
Info
- Publication number
- JPH0560933B2 JPH0560933B2 JP2087774A JP8777490A JPH0560933B2 JP H0560933 B2 JPH0560933 B2 JP H0560933B2 JP 2087774 A JP2087774 A JP 2087774A JP 8777490 A JP8777490 A JP 8777490A JP H0560933 B2 JPH0560933 B2 JP H0560933B2
- Authority
- JP
- Japan
- Prior art keywords
- patch
- patches
- thread
- defect opening
- defect
- 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.)
- Expired - Fee Related
Links
- 239000004744 fabric Substances 0.000 claims description 9
- 230000007547 defect Effects 0.000 description 41
- 238000005520 cutting process Methods 0.000 description 22
- 229910052751 metal Inorganic materials 0.000 description 10
- 239000002184 metal Substances 0.000 description 10
- 230000002093 peripheral effect Effects 0.000 description 8
- 230000002265 prevention Effects 0.000 description 8
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 4
- 238000000034 method Methods 0.000 description 4
- 238000009958 sewing Methods 0.000 description 3
- 208000019622 heart disease Diseases 0.000 description 2
- 208000025339 heart septal defect Diseases 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 238000001356 surgical procedure Methods 0.000 description 2
- CVOFKRWYWCSDMA-UHFFFAOYSA-N 2-chloro-n-(2,6-diethylphenyl)-n-(methoxymethyl)acetamide;2,6-dinitro-n,n-dipropyl-4-(trifluoromethyl)aniline Chemical compound CCC1=CC=CC(CC)=C1N(COC)C(=O)CCl.CCCN(CCC)C1=C([N+]([O-])=O)C=C(C(F)(F)F)C=C1[N+]([O-])=O CVOFKRWYWCSDMA-UHFFFAOYSA-N 0.000 description 1
- 206010002329 Aneurysm Diseases 0.000 description 1
- 208000032544 Cicatrix Diseases 0.000 description 1
- 208000002251 Dissecting Aneurysm Diseases 0.000 description 1
- 208000035478 Interatrial communication Diseases 0.000 description 1
- 229910000990 Ni alloy Inorganic materials 0.000 description 1
- 208000001910 Ventricular Heart Septal Defects Diseases 0.000 description 1
- HZEWFHLRYVTOIW-UHFFFAOYSA-N [Ti].[Ni] Chemical compound [Ti].[Ni] HZEWFHLRYVTOIW-UHFFFAOYSA-N 0.000 description 1
- 208000013914 atrial heart septal defect Diseases 0.000 description 1
- 206010003664 atrial septal defect Diseases 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 230000002950 deficient Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 210000003191 femoral vein Anatomy 0.000 description 1
- 238000012148 non-surgical treatment Methods 0.000 description 1
- 208000003278 patent ductus arteriosus Diseases 0.000 description 1
- 229920000728 polyester Polymers 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 230000037387 scars Effects 0.000 description 1
- 201000003130 ventricular septal defect Diseases 0.000 description 1
Description
【発明の詳細な説明】
［産業上の利用分野］
本発明は、中隔欠損等の心臓病における短絡口
を非手術的に閉鎖する器具に関するものである。DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to an instrument for non-surgically closing a shunt in heart disease such as a septal defect.
［従来の技術］
心臓病には、壁に孔が空き（中隔欠損）、血液
が短絡する病気が多い。こに対しては従来は開心
術によりパツチを縫合する治療法が行なわてい
る。[Prior Art] Many heart diseases include a hole in the wall (septal defect), which causes blood to short-circuit. Conventionally, this has been treated by suturing a patch through open heart surgery.
また、非手術的法としては米国で開発さたアン
ブレラ法がある。 Additionally, as a non-surgical method, there is an umbrella method developed in the United States.
［発明が解決しようとする課題］
しかして、上記従来例のうち、開心術による治
療法は、侵襲が大きく、また、体表に傷が残ると
いう欠点がある。[Problems to be Solved by the Invention] However, among the conventional methods described above, the treatment method using open heart surgery has the drawbacks of being highly invasive and leaving scars on the body surface.
また、アンブレラ法は必ずしも欠損口がパツチ
の中央部に当たたるとは限らず、そのため、パツ
チがずれて、漏れが生じたり、また、パツチが外
れたりするという問題がある。 Furthermore, in the umbrella method, the defective opening does not always hit the center of the patch, and as a result, there is a problem that the patch may shift, causing leakage or coming off.
本発明は上記の従来例の問題点に鑑みて発明し
たものであつて、その目的とするところは、体表
が傷付くことがなく、非手術的に簡単且つ確実に
短絡口を閉鎖することができる非手術的に短絡口
を閉鎖する器具を提供するにある。 The present invention was devised in view of the problems of the prior art described above, and its purpose is to easily and reliably close the shunt in a non-surgical manner without damaging the body surface. An object of the present invention is to provide a device that can non-surgically close a shunt.
［問題を解決するための手段］
本発明の非手術的に短絡口を閉鎖する器具は、
弾性を有するリング状をした折り曲げ自在なリン
グ状フレーム１に布２を張設した２枚のパツチ３
を隙間を介して対面配置すると共に一方のパツチ
３側に導出した糸４を引くことで２枚のパツチ３
が近接するように２枚のパツチ３を縫合して成る
ことを特徴とするものである。[Means for solving the problem] The device for non-surgically closing the shunt of the present invention has the following features:
Two patches 3 in which a cloth 2 is stretched over an elastic ring-shaped frame 1 that can be bent freely.
The two patches 3 are arranged facing each other through a gap, and by pulling the thread 4 led out to one patch 3 side.
This patch is characterized by being made by sewing two patches 3 together so that they are close to each other.
ここで、２枚のパツチ３の外周端縁よりもやや
内側位置を同心円状に糸４で縫合してもよい。 Here, the two patches 3 may be sutured concentrically with the thread 4 at positions slightly inside the outer peripheral edges.
また、一方のパツチ３側に導出した糸４の導出
部分を一方のパツチ３の中央部分としてもよい。 Further, the part where the thread 4 is led out to the side of one patch 3 may be the central part of one patch 3.
更に、一方のパツチ３の他方のパツチ３と対向す
る側にパツチ３の外周端縁のやや内側からパツチ
３の中央部付近に至るように配置された縮み防止
部材５を設けてもよい。Furthermore, a shrinkage preventing member 5 may be provided on the side of one patch 3 facing the other patch 3, which is arranged from slightly inside the outer peripheral edge of the patch 3 to near the center of the patch 3.
［作用］
しかして、弾性を有するリング状をした折り曲
げ自在なリング状フレーム１に布を張設した２枚
のパツチ３をそれぞれ折り畳んでカーテル６内に
挿入してし、目的場所である欠損口７に運んで、
前方のパツチ３のみを欠損口７の向こう側でリン
グ状フレーム１の弾性復元力によりリング状に復
元し、次に、欠損口７の手前側で後方のパツチ３
をリング状フレーム１の弾性復元力によりリング
状に復元し、次に、手前のパツチ３から導出した
糸４を引いて欠損口７の両側に位置する２つのパ
ツチ３を近接させて欠損口７の外周縁部を両パツ
チ３により挾持すると共に両パツチ３により欠損
口７を閉じるものである。[Function] Two patches 3 made of elastic ring-shaped and bendable ring-shaped frame 1 covered with cloth are each folded and inserted into the catheter 6, and the desired location is the defect opening. Take it to 7,
Only the front patch 3 is restored to a ring shape on the other side of the defect opening 7 by the elastic restoring force of the ring-shaped frame 1, and then the rear patch 3 is restored to the ring shape on the opposite side of the defect opening 7.
is restored to a ring shape by the elastic restoring force of the ring-shaped frame 1, and then the thread 4 led out from the front patch 3 is pulled to bring the two patches 3 located on both sides of the defect opening 7 close together, and the defect opening 7 is closed. The outer periphery of the hole 7 is held between the two patches 3, and the defect opening 7 is closed by both the patches 3.
そして、２枚のパツチ３の外周端縁よりもやや
内側位置を同心円状に糸４で縫合することで、欠
損口７の外周縁部のやや内側において両パツチ３
が縫合一体化されて両パツチ３の外周端部により
確実に欠損口７の外周縁部を挾持できるものであ
る。 Then, by suturing the two patches 3 concentrically with thread 4 at positions slightly inside the outer peripheral edges of the two patches 3, both patches 3 are sutured slightly inside the outer peripheral edges of the defect opening 7.
are integrally sewn together so that the outer circumferential edge of the defect opening 7 can be reliably clamped by the outer circumferential edges of both patches 3.
また、一方のパツチ３側に導出した糸４の導出
部分を一方のパツチ３の中央部分とすることで、
糸４を引つ張つて２枚のパツチ３を近接させるに
当たり、糸４を引つ張る操作が一方のパツチ３の
中央部分からできて、効率良く且つバランスよく
引つぱつることができるものである。 In addition, by making the lead-out part of the thread 4 led out to one patch 3 side the central part of one patch 3,
When pulling the thread 4 to bring two patches 3 close to each other, the thread 4 can be pulled from the center of one of the patches 3, and can be pulled efficiently and in a well-balanced manner. be.
更に、一方のパツチ３の他方のパツチ３と対向
する側にパツチ３の外周端縁のやや内側からパツ
チ３の中央部付近に至るように配置された縮み防
止部材５を設けることで、糸４を引つ張つた際
に、パツチ３が半径方向に縮むのを防止して２枚
のパツチ３による欠損口７の閉鎖が確実にできる
ものである。 Furthermore, by providing a shrinkage preventing member 5 disposed on the side of one patch 3 opposite to the other patch 3 so as to extend from slightly inside the outer circumferential edge of the patch 3 to near the center of the patch 3, the thread 4 This prevents the patch 3 from shrinking in the radial direction when the two patches 3 are pulled, and the defect opening 7 can be reliably closed by the two patches 3.
［実施例］
以下本発明を添付図面に示す実施例に基づいて
詳述する。[Examples] The present invention will be described in detail below based on examples shown in the accompanying drawings.
パツチ３は第１図に示すように弾性を有するリ
ング状をした折り曲げ自在なリング状フレーム１
に布２を張設して構成してある。リング状フレー
ム１に布２を張設するにあたつては縫着あるいは
他の種々の手段が採用できる。ここで、パツチ３
の形状は円のみに限定さず、楕円形状をしていて
もよいものである。布２はポリエステルなどによ
り形成してあるが、必ずしもこれにのみ限定さる
ものではない。また、リング状フレーム１の材料
としては弾性復元力が優れた柔軟な材質のもの、
例えば、チタンニケル合金針金等が使用される
が、必ずしもこれにのみ限定さるものではない。
２枚のパツチ３を隙間を介して対面配置し、両パ
ツチ３を糸４により縫合し、糸４の端部を一方の
パツチ３から外に導出し、この糸４の端部の導出
部分を引くと２枚のパツチ３が近接するようにし
てある。第１図の実施例では、２枚のパツチ３の
外周端縁よりもやや内側位置を同心状に交互に糸
４で連続して縫合した実施例が示してあり、こ
の、糸４の両端部は一方のパツチ３の中央部から
外に導出してあつて、外に導出した部分は長く残
してある。ここで、更に、この一方のパツチ３の
中央部の出口付近の糸４の両端部に両パツチ３の
間において別の糸１９を第５図に示すようにコイ
ル状に巻装してこの別の糸１９は結束してもよ
い。このように別の糸１９で糸４を巻装すると、
上記２枚のパツチ３を縫合した糸４の端部を引い
て両パツチ３を近接した後、糸４が緩まないよう
にできるものである。 The patch 3 is an elastic ring-shaped frame 1 which is bendable as shown in
A cloth 2 is stretched over the top. Sewing or other various means can be used to stretch the cloth 2 onto the ring-shaped frame 1. Here, patch 3
The shape is not limited to a circle, but may be an ellipse. Although the cloth 2 is made of polyester or the like, it is not necessarily limited to this. In addition, the ring-shaped frame 1 is made of a flexible material with excellent elastic restoring force;
For example, a titanium nickel alloy wire or the like may be used, but the material is not necessarily limited to this.
Two patches 3 are placed facing each other with a gap in between, and both patches 3 are sewn together with a thread 4. The end of the thread 4 is led out from one of the patches 3, and the lead-out portion of the end of the thread 4 is When drawn, the two patches 3 come close to each other. In the embodiment shown in FIG. 1, two patches 3 are sewn concentrically and alternately with threads 4 at positions slightly inside the outer circumferential edges of the two patches 3. Both ends of the threads 4 is led out from the center of one patch 3, and the part led out is left long. Here, another thread 19 is further wound in a coil shape between both patches 3 at both ends of the thread 4 near the central exit of one of the patches 3, as shown in FIG. The threads 19 may be tied together. When thread 4 is wound with another thread 19 in this way,
It is possible to prevent the thread 4 from loosening after the two patches 3 are brought close to each other by pulling the ends of the thread 4 used to stitch the two patches 3 together.
カテーテル６内には２重の金属チユーブ８が挿
入されるものであり、この２重の金属チユーブ８
は外チユーブ９と外チユーブ９内に挿入さる内チ
ユーブ１０とで構成してある。この外チユーブ９
と内チユーブ１０とは金属製である。内チユーブ
９は第４図に示す実施例では斜めに切断してあつ
て注射針の先端形状をしていて切断用エツジ部１
１となつており、外チユーブ９の先端付近からや
や後方位置（実施例では先端から約３cm後方位
置）で鈍角に屈曲してあつて切断用屈曲部１２と
なつている。 A double metal tube 8 is inserted into the catheter 6.
It is composed of an outer tube 9 and an inner tube 10 inserted into the outer tube 9. This outside tube 9
and the inner tube 10 are made of metal. In the embodiment shown in FIG. 4, the inner tube 9 is cut obliquely and has the tip shape of a hypodermic needle, and has a cutting edge portion 1.
1, and is bent at an obtuse angle at a position slightly rearward from the vicinity of the tip of the outer tube 9 (in the embodiment, approximately 3 cm rearward from the tip) to form a cutting bent portion 12.
しかして、まず、前方に位置するパツチ３を４
つに折り畳んでカテーテル６の後端から内部に挿
入し、次に後方に位置するパツチ３を４つに折り
畳んでカテーテル６内に挿入する。第６図にパツ
チ３をそぞ４つに折り畳だ状態を示している。こ
こで、後方に位置するパツチ３が糸４の端部を外
部に導出している方のパツチ３である。両パツチ
３を繋く糸４は適当に弛させておき、更に、後方
のパツチ３から外に引き出した糸４の端部を外チ
ユーブ９に挿入する。この状態で外チユーブ９を
カテーテル６の後端から挿入して内部のパツチ３
を押し出すようにするものである。ところで、実
際の体内での操作は、例えば、足の付け根の股静
脈に穿刺して第２図ａのように患部の欠損口７ま
でカテーテル６の先端を送り込み、カテーテル６
の先端を欠損口７に通過させる。次に、第２図
ｂ，ｃの順序で外チユーブ９を更に押し込で前方
のパツチ３のみをカテーテル６の先端から押し出
すと前方のパツチ３は弾性を有するリング状をし
た折り曲げ自在なリング状フレーム１の弾性復元
力により欠損口７の向こう側で自動的に広がるも
のである。次に、第２図ｄに示すようにカテーテ
ル６を少し引くと前方に位置するパツチ３が欠損
口７の向こう側の外周の壁部に押し当てらる。こ
こで、パツチ３は予め欠損口７よりも大き目に形
成してあるので欠損口７を通過することなく欠損
口７の向こう側の周辺の壁部に当接さるのであ
る。次に、第２図ｅに示すように外チユーブ９を
更に少し押し込で欠損口７の手前側において後方
のパツチ３をカテーテル６の先端から押し出し、
欠損口７の手前側において弾性を有するリング状
をした折り曲げ自在なリング状フレーム１の弾性
復元力により自動的に広るものである。次に、外
チユーブ９を後方のパツチ３に押し当てた状態
で、後方のパツチ３から外に導出した糸４の端部
を引つ張つて、欠損口７の両側に位置する２つの
パツチ３を近接させて第２図ｆのように欠損口７
の外周縁部を両パツチ３により強く挾持して固定
すると共に両パツチ３により欠損口７を閉じるの
である。ここで、糸４を強く引くと、円周状に縫
合された縫合線がより小さい円周に絞られ、周囲
の布２が引つ張らてより強く両パツチ３により欠
損口７の周囲が挾持されるものである。また、縫
合線の円形が欠損口７の大きさに近ければ、より
確実に欠損口７は閉鎖され、漏れも生じないもの
であり、糸４を強く引つ張ると両パツチ３の周辺
は強く寄つて欠損口７の周囲を強く挾持すること
になる。このようにして欠損口７を２枚のパツチ
３により閉じるのであるが、糸４を後方のパツチ
３から導出部分の付近で切断するには次のように
して行う。つまり、第２図ｇに示すように内チユ
ーブ１０を外チユーブ９内に挿入すると共に糸４
の端部を内チユーブ１０の先端から挿入して後端
から出し、外チユーブ９の先端付近の切断用屈曲
部１２を糸４を切断したい部位まで運び、次に、
外チユーブ９の後端から内チユーブ１０を挿入
し、内チユーブ１０の先端の切断用エツジ部１１
を第４図ａの状態から更に第４図ｂのように切断
用屈曲部１２に押し当たるまで押し込む。する
と、金属製の外チユーブ９内を通り、更に外チユ
ーブ１０内に挿入さた金属製の内チユーブ１０を
挿通する糸４が金属製の内チユーブ１０の先端の
切断用エジ部１１により金属製の外チユーブ９の
切断用屈曲部１２に強く押し当てられ、切断用エ
ジ部１１により切断されるものである。切断が終
わると、内チユーブ１０を挿入した外チユーブ９
を差し込んだ状態でカテーテル６を引き抜くもの
である。 Therefore, first, the patch 3 located in the front is
Then, the patch 3 located at the rear is folded in four and inserted into the catheter 6 from the rear end. Figure 6 shows the patch 3 folded into four parts. Here, the patch 3 located at the rear is the one from which the end of the thread 4 is led out. The thread 4 connecting both patches 3 is loosened appropriately, and the end of the thread 4 pulled out from the rear patch 3 is inserted into the outer tube 9. In this state, insert the outer tube 9 from the rear end of the catheter 6 and connect the inner patch 3.
It is intended to push out the By the way, the actual operation inside the body involves, for example, puncturing the femoral vein at the base of the leg and feeding the tip of the catheter 6 to the defect opening 7 in the affected area as shown in Figure 2a.
The tip of the is passed through the defect opening 7. Next, when the outer tube 9 is pushed further in the order shown in FIG. It automatically expands on the other side of the defect opening 7 due to the elastic restoring force of the frame 1. Next, as shown in FIG. 2d, when the catheter 6 is pulled slightly, the patch 3 located at the front is pressed against the outer peripheral wall on the other side of the defect opening 7. Here, since the patch 3 is previously formed larger than the defect opening 7, it comes into contact with the peripheral wall on the other side of the defect opening 7 without passing through the defect opening 7. Next, as shown in FIG. 2e, push the outer tube 9 a little further to push out the patch 3 on the front side of the defect opening 7 from the tip of the catheter 6.
It automatically expands due to the elastic restoring force of the bendable ring-shaped frame 1 which is elastic and has a ring shape on the near side of the defect opening 7. Next, with the outer tube 9 pressed against the patch 3 at the rear, the ends of the threads 4 led out from the patch 3 at the rear are pulled and tightened to connect the two patches 3 located on both sides of the defect opening 7. Close the defect opening 7 as shown in Fig. 2 f.
The outer circumferential edge of the hole 7 is firmly clamped and fixed by both patches 3, and the defect opening 7 is closed by both patches 3. When the thread 4 is strongly pulled, the circumferential suture line is narrowed to a smaller circumference, the surrounding cloth 2 is pulled, and the area around the defect opening 7 is pinched more strongly by both patches 3. It is something that will be done. Furthermore, if the circular shape of the suture line is close to the size of the defect opening 7, the defect opening 7 will be more securely closed and no leakage will occur, and when the thread 4 is pulled strongly, the areas around both patches 3 will be tightly The area around the defect opening 7 will be strongly clamped. In this way, the defect opening 7 is closed with the two patches 3, and the thread 4 is cut near the part where it is led out from the rear patch 3 in the following manner. That is, as shown in FIG. 2g, the inner tube 10 is inserted into the outer tube 9, and the thread 4
Insert the end from the tip of the inner tube 10 and take it out from the rear end, carry the cutting bend 12 near the tip of the outer tube 9 to the part where you want to cut the thread 4, and then,
Insert the inner tube 10 from the rear end of the outer tube 9, and insert the cutting edge 11 at the tip of the inner tube 10.
from the state shown in FIG. 4a until it presses against the cutting bend 12 as shown in FIG. 4b. Then, the thread 4 passing through the metal outer tube 9 and further through the metal inner tube 10 inserted into the metal outer tube 10 is cut into metal by the cutting edge 11 at the tip of the metal inner tube 10. It is strongly pressed against the cutting bent part 12 of the outer tube 9 and is cut by the cutting edge part 11. After the cutting is completed, the outer tube 9 into which the inner tube 10 has been inserted is removed.
The catheter 6 is pulled out with the catheter 6 inserted.
上記実施例においては、内内チユーブ１０を切
断時に外チユーブ９に挿入した実施例を示した
が、はじめから内チユーブ１０を外チユーブ９に
挿入しておいてもよい。この場合には、切断作業
までの間は内チユーブ９の先端の切断用エジ部１
１が外チユーブの先端付近の切断用屈曲部１２に
当らないように内チユーブ１０を手前側に引いて
おくものである。 In the above embodiment, the inner tube 10 is inserted into the outer tube 9 during cutting, but the inner tube 10 may be inserted into the outer tube 9 from the beginning. In this case, until the cutting operation, the cutting edge 1 at the tip of the inner tube 9 is
1 to pull the inner tube 10 toward you so that it does not hit the cutting bend 12 near the tip of the outer tube.
第９図には切断装置の他の実施例が示してあ
る。この実施例では、金属製の外チユーブ９の先
端を先細とし、金属製の内チユーブ１０を２股状
または３股以上にカツトして２股または３股以上
の縁辺部分を鋭利にして切断用刃部１３を形成
し、第９図ａのように外チユーブ９内に内チユー
ブ１０を入れ、更に、第９図ｂのように外チユー
ブ９の先細部１４部分に２股状部分または３股状
部分を強く押し込むと２股状部分または３股状部
分の縁辺である切断用刃部１３が互いに寄り合
い、糸４を締め付けるものである。糸４はこの状
態で切断するが、切断しない場合にはこの状態で
糸４を強く引つ張ると切断されるものである。 FIG. 9 shows another embodiment of the cutting device. In this embodiment, the tip of the metal outer tube 9 is tapered, and the metal inner tube 10 is cut into two or more forks, and the edges of the two or more forks are sharpened for cutting. The blade part 13 is formed, the inner tube 10 is inserted into the outer tube 9 as shown in FIG. When the shaped part is pushed strongly, the cutting blade parts 13, which are the edges of the bifurcated part or the trifurcated part, come together and tighten the thread 4. The thread 4 is cut in this state, but if it is not cut, the thread 4 is pulled strongly in this state to be cut.
第１０図には切断装置の更に他の実施例が示し
てある。この実施例では、金属製の外チユーブ９
の先端付近に側口１５を設け、内チユーブ１０の
先端を斜めに切断した形状の切断端部１６とし、
この斜めに切断した形状の切断端部１６を少し外
側に曲げておく。そして、外チユーブ９の先端か
ら挿入した糸４を内チユーブ１０の先端から挿入
すると共に内チユーブ１０を外チユーブ９の後端
から挿入し、内チユーブ１０の切断端部１６を側
口１５から出し、更に、内内チユーブ１０を押し
込むと切断端部１６が側口１５の縁に強く当たつ
て両者の間に位置する糸４が切断されるものであ
る。この場合、第１０図ａのようにあらかじめ切
断端部１６を少しだけ側口１５から出した状態に
セトしておき、パツチ３による欠損口７を閉鎖し
た後、内内チユーブ１０を押し込んで第１０図ａ
の状態から第１０図ｂの状態にして糸４を切断す
るようにしてもよいものである。 FIG. 10 shows yet another embodiment of the cutting device. In this embodiment, a metal outer tube 9
A side opening 15 is provided near the tip of the inner tube 10, and a cut end 16 is formed by cutting the tip of the inner tube 10 diagonally,
This obliquely cut end 16 is bent slightly outward. Then, the thread 4 inserted from the tip of the outer tube 9 is inserted from the tip of the inner tube 10, and the inner tube 10 is inserted from the rear end of the outer tube 9, and the cut end 16 of the inner tube 10 is taken out from the side port 15. Further, when the inner tube 10 is pushed in, the cutting end 16 strongly hits the edge of the side opening 15, and the thread 4 located between the two is cut. In this case, as shown in FIG. 10a, the cut end 16 is set in advance so that it is slightly protruding from the side opening 15, and after the defect opening 7 is closed with the patch 3, the inner tube 10 is pushed in. Figure 10a
The thread 4 may be cut from the state shown in FIG. 10b.
第８図には本発明の他の実施例が示してある。
この実施例では、２枚のパツチ３を近接自在に縫
合するに当たり、一方のパツチ３の他方のパツチ
３と対向する側にパツチ３の外周端縁のやや内側
からパツチ３の中央部付近に至るように配置され
てパツチ３の外周端縁から中央部付近に縮み防止
部材５を配設した実施例が示してある。この実施
例において縮み防止部材５はリング状フレーム１
に比べて弾性力に乏しい筒状の部材であり、この
筒状の縮み防止部材５内内にパツチ３の外周端縁
のやや内側から中央部に引き出す糸４の端部を通
すものであり、このように縮み防止部材５を設け
ておくことで、外に導出した糸４の端部を強く引
いた場合にパツチ３が縮み過ぎて欠損口７から抜
けたりするのを確実に防止することができるよう
になつている。そして、この縮み防止部材５を配
設したものはカテーテル６に折り畳んで挿入する
際、縮み防止部材５をカテーテル６の軸芯と同方
向となるようにパツチ３を折り畳んで入れること
で縮み防止部材５を折り畳むことなく挿入できる
ものである。この第８図の実施例では、２枚のパ
ツチ３を縫合する糸４として複数本の糸４を用い
て実施例が示してあて、複数本（実施例では４
本）の糸４を後方のパツチ３の外周付近ら中央部
に導くに当たり上記筒状の縮み防止部材５内をし
ている実施例を示している。この実施例において
は複数本の糸４は円周状に縫合する場合のそれぞ
れの糸４により円周の一部を構成るように縫合し
て全体として円周状に縫合するものである。ここ
で、各糸４の一端部のみ一方のパツチ３の中央部
から外に導出し、糸４の他方の端部は結でパツチ
３から抜けないようにしておいてもよい。そし
て、この結び目２０は両パツチ３の間に位置させ
るようにするのが好ましい。なお、第７図には縮
も防止部材５を用いることなく別の糸１９をコイ
ル状に巻設した実施例のものにおいて、糸４の一
端部に結び目２０を設け、糸４の他端部を後方の
パツチ３の中央部から外方に導出した実施例であ
つて、結び目２０がコイル状に巻設した別の糸１
９の存在により抜けないようになつている。 Another embodiment of the invention is shown in FIG.
In this embodiment, when suturing two patches 3 so that they can come close to each other, the patch 3 extends from slightly inside the outer circumferential edge of one patch 3 to near the center of the patch 3 on the side opposite to the other patch 3. An embodiment is shown in which a shrinkage prevention member 5 is arranged from the outer peripheral edge of the patch 3 to the vicinity of the center. In this embodiment, the shrinkage prevention member 5 is a ring-shaped frame 1
It is a cylindrical member with poor elasticity compared to the cylindrical shrinkage prevention member 5, through which the end of the thread 4 drawn out from slightly inside the outer peripheral edge of the patch 3 to the center is passed. By providing the shrinkage prevention member 5 in this manner, it is possible to reliably prevent the patch 3 from shrinking too much and coming off from the defect opening 7 when the end of the thread 4 led out is pulled strongly. I'm starting to be able to do it. When the shrinkage preventing member 5 is folded and inserted into the catheter 6, the shrinkage preventing member 5 can be inserted by folding the patch 3 so that the shrinkage preventing member 5 is in the same direction as the axis of the catheter 6. 5 can be inserted without folding it. In the embodiment shown in FIG. 8, a plurality of threads 4 are used as threads 4 for sewing two patches 3 together.
This figure shows an embodiment in which the thread 4 of the main patch 3 is guided from the vicinity of the outer periphery of the patch 3 at the rear to the center within the cylindrical shrinkage prevention member 5. In this embodiment, the plurality of threads 4 are sewn together so as to form a part of the circumference, and the threads 4 are sewn together circumferentially as a whole. Here, only one end of each thread 4 may be led out from the center of one patch 3, and the other end of the thread 4 may be tied to prevent it from coming off from the patch 3. Preferably, this knot 20 is located between both patches 3. In addition, FIG. 7 shows an embodiment in which another thread 19 is wound in a coil shape without using the shrinkage prevention member 5, and a knot 20 is provided at one end of the thread 4, and the other end of the thread 4 is In this embodiment, the knot 20 is led out from the center of the rear patch 3, and the knot 20 is connected to another thread 1 wound in a coil.
The presence of 9 prevents it from falling out.
ところで、本発明の非手術的に短絡口を閉鎖す
る器具は心房中隔欠損病、心室中隔欠損病、動脈
管開存病、解離性動脈瘤（解離口閉鎖）、動脈瘤
の破裂口の閉鎖等の疾患の非手術的治療に用いる
ものである。 By the way, the device of the present invention for non-surgically closing the shunt port can be used to treat atrial septal defect disease, ventricular septal defect disease, patent ductus arteriosus disease, dissecting aneurysm (dissecting port closure), and ruptured port of aneurysm. It is used for non-surgical treatment of diseases such as atresia.
［発明の効果］
本発明にあつては、叙述のように弾性を有する
リング状をした折り曲げ自在なリング状フレーム
に布を張設した２枚のパツチを隙間を介して対面
配置すると共に一方のパツチ側に導出した糸を引
くことで２枚のパツチが近接するように２枚のパ
ツチを縫合してあるので、弾性を有するリング状
をした折り曲げ自在なリング状フレームに布を張
設した２枚のパツチをそれぞれ折り畳んでカテー
テル内に挿入して通し、目的場所である欠損口に
運で、欠損口の前後でそれぞれ放出してリング状
フレームの弾性復元力によりリング状に復元し、
糸を引いて欠損口の両側に位置する２つのパツチ
を近接させて欠損口の外周縁部を両パツチにより
挾持ると共に両パツチにより欠損口を閉じること
ができ、この結果、体表が傷付くことがなく、非
手術的に簡単且つ確実に短絡口を閉鎖することが
できるものである。[Effects of the Invention] As described above, in the present invention, two patches each having a cloth stretched over a bendable ring-shaped elastic ring-shaped frame are placed facing each other with a gap in between, and one The two patches are sewn together so that they come close to each other by pulling the thread led out to the patch side. Each patch is folded and inserted into the catheter, delivered to the target defect opening, released before and after the defect opening, and restored to a ring shape by the elastic restoring force of the ring-shaped frame.
By pulling the thread, the two patches located on both sides of the defect opening can be brought close together, and the outer periphery of the defect opening can be pinched by both patches, and the defect opening can be closed by both patches. As a result, the body surface is injured. Therefore, the short circuit can be easily and reliably closed non-surgically.
また、２枚のパツチの外周端縁よりもやや内側
位置を同心円状に糸で縫合すると、欠損口の外周
縁部のやや内側において両パツチが縫合一体化さ
れて両パツチの外周端部により確実に欠損口の外
周縁部を挾持でき、パツチが欠損口からはずれな
いものである。 In addition, if the two patches are sutured concentrically with thread slightly inside the outer edges of the defect, both patches will be sutured together slightly inside the outer edges of the defect opening, and the outer edges of both patches will be more secure. The patch can hold the outer periphery of the defect opening and the patch will not come off from the defect opening.
また、一方のパツチ側に導出した糸の導出部分
を一方のパツチの中央部分とすることで、糸を引
つ張つて２枚のパツチを近接させるに当たり、糸
を引つ張る操作が一方のパツチの中央部分からで
きて、効率良く且つバランスよく引つぱつること
ができるものである。 In addition, by setting the lead-out part of the thread led out to one patch side to be the center part of one patch, when pulling the thread to bring two patches closer together, the operation of pulling the thread is applied to one patch. It is made from the central part of the body and can be pulled efficiently and in a well-balanced manner.
更に、一方のパツチの他方のパツチと対向する
側にパツチの外周端縁のやや内側からパツチの中
央部付近に至るように配置された縮み防止部材を
設けることで、糸を引つ張つた際に、パツチが半
径方向に縮むのを防止して２枚のパツチによる欠
損口の閉鎖が確実にできるものである。 Furthermore, by providing a shrinkage prevention member on the side of one patch facing the other patch, which extends from slightly inside the outer edge of the patch to near the center of the patch, when the thread is pulled, In addition, the patch can be prevented from shrinking in the radial direction, and the defect can be reliably closed with two patches.
第１図は本発明の一実施例の斜視図、第２図
ａ，ｂ，ｃ，ｄ，ｅ，ｆ，ｇ，ｈは同上の使用順
序を示す説明図、第３図ａ，ｂ，ｃは同上の第２
図の順序における欠損口の両側でパツチを開いた
状態の斜視図、向こう側のパツチを欠損口周辺の
壁部に当接した状態の斜視図及び欠損口を閉鎖し
た状態の斜視図、第４図ａ，ｂは第２図ｇにおけ
るＸ部分での糸の切断を示す拡大説明図、第５図
は同上の後方のパツチにおける糸の引き出し部分
の説明のための概略説明図、第６図は同上のパツ
チの折り畳み状態の斜視図、第７図は同上の後方
のパツチにおける糸の引き出し部分の他の実施例
の説明のための概略説明図、第８図は本発明の他
の実施例の斜視図、第９図ａ，ｂは本発明の糸の
切断装置の他の実施例の作用説明図、第１０図
ａ，ｂは本発明の糸の切断装置の他の実施例の作
用説明図であつて、１はリング状フレーム、２は
布、３はパツチ、４は糸、５は縮み防止部材であ
る。
Fig. 1 is a perspective view of one embodiment of the present invention, Fig. 2 a, b, c, d, e, f, g, h is an explanatory diagram showing the order of use of the same, Fig. 3 a, b, c is the second part of the same
In the order of the figures, a perspective view with the patch open on both sides of the defect opening, a perspective view with the patch on the other side in contact with the wall around the defect opening, and a perspective view with the defect opening closed. Figures a and b are enlarged explanatory views showing the cutting of the thread at the X portion in Figure 2g, Figure 5 is a schematic explanatory view for explaining the pulling out part of the thread in the rear patch of the same as above, and Figure 6 is A perspective view of the above patch in a folded state, FIG. 7 is a schematic explanatory view for explaining another embodiment of the thread pull-out portion in the rear patch of the above, and FIG. 8 is a perspective view of another embodiment of the present invention. A perspective view, FIGS. 9A and 9B are explanatory views of the operation of another embodiment of the thread cutting device of the present invention, and FIGS. 10A and 10B are operation explanatory views of another embodiment of the thread cutting device of the present invention. 1 is a ring-shaped frame, 2 is a cloth, 3 is a patch, 4 is a thread, and 5 is a shrinkage prevention member.
Claims (1)
リング状フレームに布を張設した２枚のパツチを
隙間を介して対面配置すると共に一方のパツチ側
に導出した糸を引くことで２枚のパツチが近接す
るように２枚のパツチを縫合して成ることを特徴
とする非手術的に短絡口を閉鎖する器具。 ２ ２枚のパツチの外周端縁よりもやや内側位置
を同心円状に糸で縫合して成ることを特徴とする
請求項１記載の非手術的に短絡口を閉鎖する器
具。 ３ 一方のパツチ側に導出した糸の導出部分を一
方のパツチの中央部分として成ることを特徴とす
る請求項１記載の非手術的に短絡口を閉鎖する器
具。 ４ 一方のパツチの他方のパツチと対向する側に
パツチの外周端縁のやや内側からパツチの中央部
付近に至るように配置さた縮み防止部材を設けて
成ることを特徴とする請求項１記載の非手術的に
短絡口を閉鎖する器具。[Scope of Claims] 1. Two patches in which cloth is stretched over an elastic ring-shaped ring-shaped frame that can be freely folded are placed facing each other with a gap between them, and a thread led out to one of the patches is pulled. An instrument for non-surgically closing a shunt, characterized by suturing two patches so that they are close to each other. 2. The device for non-surgically closing a shunt according to claim 1, characterized in that the two patches are sutured concentrically with a thread at positions slightly inside the outer circumferential edges of the two patches. 3. The instrument for non-surgically closing a shunt according to claim 1, wherein the part of the thread led out to one patch side is the central part of one patch. 4. Claim 1, characterized in that a shrinkage preventing member is provided on the side of one patch that faces the other patch from slightly inside the outer circumferential edge of the patch to near the center of the patch. An instrument for non-surgically closing the shunt.
Priority Applications (7)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2087774A JPH03286752A (en) | 1990-04-02 | 1990-04-02 | Implement for closing non-surgically short circuit port |
| AT91906572T ATE107150T1 (en) | 1990-04-02 | 1991-03-30 | DEVICE FOR CLOSING A SHUTTLE OPENING BY A NON-OPERATIONAL METHOD. |
| EP91906572A EP0474887B1 (en) | 1990-04-02 | 1991-03-30 | Device for closing shunt opening by nonoperative method |
| DE69102515T DE69102515T2 (en) | 1990-04-02 | 1991-03-30 | DEVICE FOR CLOSING A SHUTTER OPENING BY MEANS OF A NON-OPERATIONAL METHOD. |
| US07/777,258 US5171259A (en) | 1990-04-02 | 1991-03-30 | Device for nonoperatively occluding a defect |
| PCT/JP1991/000426 WO1991015155A1 (en) | 1990-04-02 | 1991-03-30 | Device for closing shunt opening by nonoperative method |
| CA002057018A CA2057018C (en) | 1990-04-02 | 1991-03-30 | Device for nonoperatively occluding a defect |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2087774A JPH03286752A (en) | 1990-04-02 | 1990-04-02 | Implement for closing non-surgically short circuit port |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH03286752A JPH03286752A (en) | 1991-12-17 |
| JPH0560933B2 true JPH0560933B2 (en) | 1993-09-03 |
Family
ID=13924329
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2087774A Granted JPH03286752A (en) | 1990-04-02 | 1990-04-02 | Implement for closing non-surgically short circuit port |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JPH03286752A (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2007519502A (en) * | 2004-02-04 | 2007-07-19 | カラク アーゲー | Implants for occluding passages in the body |
Families Citing this family (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE60234698D1 (en) * | 2002-10-25 | 2010-01-21 | Radi Medical Systems | Resorbable medical device for surgical sealing |
| JP4750683B2 (en) * | 2006-12-13 | 2011-08-17 | メドトロニック バスキュラー インコーポレイテッド | Transluminal method and apparatus for at least one of closing a luminal anatomical structure, forming an attachment to the luminal anatomical structure, and forming an anastomosis to the luminal anatomical structure |
-
1990
- 1990-04-02 JP JP2087774A patent/JPH03286752A/en active Granted
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2007519502A (en) * | 2004-02-04 | 2007-07-19 | カラク アーゲー | Implants for occluding passages in the body |
Also Published As
| Publication number | Publication date |
|---|---|
| JPH03286752A (en) | 1991-12-17 |
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| Date | Code | Title | Description |
|---|---|---|---|
| LAPS | Cancellation because of no payment of annual fees |