JPH067831B2 - 内臓アンカー - Google Patents

内臓アンカー

Info

Publication number
JPH067831B2
JPH067831B2 JP62122387A JP12238787A JPH067831B2 JP H067831 B2 JPH067831 B2 JP H067831B2 JP 62122387 A JP62122387 A JP 62122387A JP 12238787 A JP12238787 A JP 12238787A JP H067831 B2 JPH067831 B2 JP H067831B2
Authority
JP
Japan
Prior art keywords
anchor
visceral
crossbar
suture
sheath
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 - Lifetime
Application number
JP62122387A
Other languages
English (en)
Other versions
JPS6323651A (ja
Inventor
コンスタンティン・コープ
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cook Inc
Original Assignee
Cook Inc
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Cook Inc filed Critical Cook Inc
Publication of JPS6323651A publication Critical patent/JPS6323651A/ja
Publication of JPH067831B2 publication Critical patent/JPH067831B2/ja
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0454—Means for attaching and blocking the suture in the suture anchor the anchor being crimped or clamped on the suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Rheumatology (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Otolaryngology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgical Instruments (AREA)
  • Piles And Underground Anchors (AREA)
  • Road Signs Or Road Markings (AREA)
  • Media Introduction/Drainage Providing Device (AREA)
  • Nitrogen- Or Sulfur-Containing Heterocyclic Ring Compounds With Rings Of Six Or More Members (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Hydrogenated Pyridines (AREA)
  • Panels For Use In Building Construction (AREA)

Description

【発明の詳細な説明】 （産業上の利用分野） 本発明は一般的に腹内内臓に排出孔を設ける装置に関す
る。
（従来技術とその問題点） 胃や胆のうやその他腹部の内臓にドレーンチューブを挿
入することは、若し内臓が管の膨脹時に侵入するか又は
ワイヤーガイドが腹腔内で巻かれ且つドレーンチューブ
を再び挿入できない場合、胃液や胆汁や病毒混入流体が
腹腔に漏れる危険を生ずる。したがって、本発明の１つ
の特徴は大形の保持ループやその他のドレーンチューブ
を挿入する前に、胃，腸，胆のうの壁並びに（又は）外
面の膿瘍を腹部又は胸部の壁に対し孔あけ(mobilize)し
且つ詰めものをする(tamponade)ための内臓アンカーを
提供することである。
腹内内臓にドレーンチューブを容易に挿入する目的で色
々の装置と方法が提案されてきた。米国特許第3,961,63
2号に胃のカテーテル配置システムが記載されている。
このシステムは磁気ナソガストリック(nasogastric)挿
管装置を使用して胃壁に孔をあける方法を提供する。胃
壁が一旦腹壁に接近させられるとFoley型カテーテルが
腹壁を通って胃の中に挿入される。胃壁は前記カテーテ
ル上の膨脹性環と外部固定板によって保持される。米国
特許第3,598,124号に尿排出の方法と装置が記載されて
いる。これは胆のうにドレンチューブを保持するためFo
ley型カテーテルを使用している。経皮的の搬送管を作
り、保持し且つ除去するため数種の回収可能の機械的装
置が当業者に知られている。その例は(1)米国特許第4,3
93,873号、(2)米国特許第3,039,468号、(3)米国特許第
3,835,863号である。(1)の米国特許において、胃の中に
入れた搬送管が不注意で取出されることは、保持用バイ
ンデイングを分解する際に外方にふくらんだ形状を帯び
る弾力性チップによって阻止される。(2)の米国特許は
伸縮自在のフインガーを有する套管針を示している。前
記フインガーは胃壁と接触し且つ摺動可能のクランプが
外側の皮膚又はスキンと接触して胃壁とスキンを一緒に
カニュールの周りに引張る。(3)の米国特許の装置は外
科的にダクトの中に移植される丁形ドレーンチューブで
ある。クロスチューブは可撓性を有するのでダクトの孔
から引き出されるとき該クロスチューブのアームは大体
平行の位置に折り重なる。
導管システムの中にカテーテルを挿入する外科方法にガ
イドワイヤーを使用することが米国特許第4,534,363号
に示されている。この米国特許はアンジオグラフイック
(angiographic)ガイドワイヤーの進歩した塗装法とガイ
ドワイヤーの製造法を記載している。
特に本発明に関するように、腹内内臓の壁を腹部又は胸
部の壁に対してアトラウマチカリ(atraumatically)に孔
をあけ(mobilize)且つ内部に詰めものをする(tanpomadi
ng)ための簡単な装置及び経皮的方法はこれまで提供さ
れなかった。
（問題点を解決するための手段） 本発明は中空状内臓の壁を通って内臓内腔の中に挿入す
るための内臓アンカーを提供する。この内臓アンカーは
バイオ適応性の細長いクロスバーと、該クロスバーの中
心近くに１端を固定した可撓性でバイオ適応性の縫合線
を備えている。
本発明の目的は中空状内臓の中に経皮的挿入を行うため
の内臓アンカーを提供することである。
関連した本発明の目的及び効果が次の説明から明らかと
なるであろう。
（実施例） 本発明の原理の理解を促進するために図面に示す実施例
を参照し且つこれを説明するために特殊用語を使用す
る。しかし本発明の範囲は図示装置の修正や変更にも及
び、且つ図示の本発明のその他の応用は当業者に通常考
えられることである。
特に第１図を参照すれば、本発明の好適な実施例に係る
内臓アンカー10が図示されている。第１図に示す実施例
において前記内臓アンカー10はクロスバー11を縫合線12
を備えている。クロスバー11は細長く且つ円筒形であ
り、両端部13,14の間に中央部15が介在している。縫合
線12は付着端部17と非着端部18を有する。付着端部17は
クロスバー11に対し大体その中心に取付けられている。
更にアンカー10はクロスバー11の端部13に取付けた非着
端部21と付着端部22を有する縫合線20を備えている。縫
合線12,20は例えば普通の縫合線材料で作られている。
例えば、好適な実施例において、４−０TEVDEK縫合線材
料を使用している。前記縫合線12,20はなるべく長さが
大体40cmである。
クロスバー11の内部構造を第２図に示す。クロスバー11
の中央部15はらせん状スプリングシース16によって被覆
された剛性ロッド30を備えている。好適な前記実施例に
おいて、シース16は外径が凡そ0.87mmの標準型不銹鋼製
の外科用ワイヤーガイド材料である。ロッド30は不銹鋼
製カニュール又はロッドである。前記実施例において、
ロッド30は長さが凡そ10mmである。シース16がロッド30
の両端より長くのびて可撓性の端部32,33を形成してい
る。アンカー10が腹内の内臓の内壁に係合できるように
するために可撓性端部を設けることが望ましい。第２図
に示す実施例において、縫合線12,20がシース16の中空
部の中に延び且つ位置31においてロッド30の周囲に連結
されている。縫合線12,20は製造を容易にするため１本
の縫合線を構成する。
クロスバー11の端部13,14は丸味があり、またらせん状
スプリングシース16の両端より長くのびている。端部1
3,14はシース16に接着することができる任意の適当なバ
イオコンパチブルすなわちバイオ適応性材料で作る。例
えばシース16に溶接した金属の玉やエポキシで作る。前
記実施例においてシース16に対し端部13,14を形成して
一体に接着するためエポキシを備えている。縫合線20の
付着端はクロスバー11に縫合線20を固定するため端部13
の中に封入されている。かくして縫合線20は固定されて
いるが、エポキシ材料の中を通って位置31において前述
のように固定される。
内臓アンカーを利用した内臓壁のモビライゼイション法
すなわち孔あけ法を第３図乃至第７図に示す。第３図を
参照すれば、前記方法の好適な実施例において、身体の
外側から皮膚と内臓壁を貫いて内臓の内腔まで針を刺し
て通路すなわち道が形成されている。前記実施例におい
て、カニュールすなわち16ゲージのプラスチック製シー
ル40を上部に付着した長さ15cmの22ゲージの針39を針刺
しに使用している。膨脹した内臓内腔に突出針を入れる
と外側のカニュールすなわちシースはその上を前進し、
シースがその場所に残って道を作る。シースが固定する
と針は除かれる。第３図は身体の外側から腹壁41と内臓
壁43と貫いて内臓42の内腔44にのびている道を形成する
プラスチックのシース40を示している。
第４図はシース40によってできた道から内腔44の中にク
ロスバー11が挿入される方法の別の工程を示す。クロス
バー11は挿入中に道の長手方向軸線に沿って整列し、縫
合線12,20がシース40の中を引きずられ、それらの非着
端部18,21が体の外側に留まっている。クロスバー11が
0.038インチ“Ｔ”型チップドワイヤーガイド45によっ
てシース40から押し込まれる。第４図はワイヤーガイド
45によってシース40が押し込まれた後の内腔44内のクロ
スバー11を示す。
次に縫合線12がシース40と一緒につかんで引張られ、ク
ロスバー11は道の長手方向軸線に対し直角に配置され且
つクロスバー11は中空状内臓の壁に係合させられる。引
張る力は矢印Ａで示す方向に縫合線12に加えられる。シ
ース40が縫合線12,20の上から除かれ第５図の状態にな
る。第５図はクロスバー11が針48に直角となり且つ内臓
壁47に接触している。クロスバー11の長さは針道48の直
径より大きく、そのためクロスバー11が内臓壁と接触す
る。内臓壁を腹壁に接近するまで更に引張力を縫合線12
に加える。内臓壁がしっかりと腔壁に引き寄せられると
内腹漏洩の機会が少くなる。縫合線12の引張力は標準型
の外科用針を使用して縫合線12を皮膚にしめつけること
によって与えられる。
ワイヤーガイド45は寸法が段々大きくなる１本以上の拡
張器をワイヤーガイドの上から内臓内腔に押し込むこと
によって針道48を拡げるために使用される。このような
拡張器は市販されているので図示しない。次にドレーン
チューブ50を容易に挿入して内臓の内腔と身体の外側を
連通できるようにする。第６図は挿入したドレーンチュ
ーブ50を示し、クロスバー11は内臓壁43を腹壁41にくっ
つけたまま保持する。ゆるんだ縫合線20がドレーンチュ
ーブ50から出される。
ドレーン道が出来て数回後に内臓アンカー10は最早必要
でなくなり、容易に除去することができる。特に第７図
と第８図を参照すると、縫合線12は切断されしたがって
クロスバー11にかかる引張力はゆるんでいる。例えば５
Frenchカニュールを使用して内臓アンカー10を除去す
る。カニュール55は第７図に示すように縫合線20の上を
通り、ドレーンチューブ50に沿って内臓の内腔に挿入さ
れる。カニュール55の末端56が内臓内腔に入ると矢印Ｂ
の方向の静かな力が縫合線20に加えられる。クロスバー
11がそれ自身でカニュール55の長手方向軸線に第８図の
如く整合しカニュールと共に容易に引張り出すことがで
きる。クロスバー11の端部は縫合線20にかゝる引張力に
よってカニュールの末端56と接触したままであり、した
がってカニュール55とクロスバー11を引張り出すとき軸
線方向に並んだままである。クロスバー11とカニュール
が引張り出されるとき縫合線12がクロスバー11を引きず
る。
本発明を図面とその説明において詳述したが、これは説
明のためのものであり、決して限定するつもりはなく、
好適な実施例を図示し説明したに過ぎず、本発明の思想
に入っているすべての変更と修正は保護されることを望
んでいる。
例えば第９図は縫合線20が存在しない点以外は第１図と
第２図の実施例と同一である別の実施例の内臓アンカー
10′を示している。第９図の１本の縫合線の実施例は、
上述の回収可能なアンカー10と違ってアンカー10′を回
収できない場合に使用している。このような内臓アンカ
ー10′は第10図に示すように挿入針の末端近くに取付け
られ且つ最初の孔あけ時中に配置される。第10図におい
て、針100はその中空内部にアンカー10′とワイヤーガ
イド101を備え、前記ワイヤーガイドは内臓の孔あけが
行われるときアンカー10′を針から押し出すために使用
される。正しい針の位置はアンカー10′を射出する前に
針孔105から粘性流体を吸い出すか又はラジオパッケ(ra
diopaque)染料を注入することによって決められる。針
の中の細孔の長さはアンカーより僅かに長く、染料を注
入する“注入口”102を設けるようになっている。つぎ
に針とワイヤーガイドが引張り出され、内臓がしっかり
と、上述のように腹壁にくっつけられる。
【図面の簡単な説明】
第１図は本発明の代表的実施例に係る内臓アンカーの拡
大斜視図、第２図は第１図の内臓アンカーの拡大断面
図、第３図は本発明の内臓アンカーを用いる内臓壁孔あ
け方法の工程を示す略図、第４図は第３図の方法の次の
工程を示す断面図で特に中空の内臓に挿入した後の内臓
アンカーを示す略図、第５図は特にアンカーを道の長手
方向軸線に対し垂直に配置し且つ内臓壁に接触させた状
態を示す第３図の方法を示す略図、第６図は特に腹壁に
くっつけた内臓壁と内臓内腔に挿入したドレーンチュー
ブを示す第３図の方法を示す略図、第７図は特に内臓壁
との接触から分離した内臓アンカーとカニュールの中を
のびている端部縫合線を示す本発明の内臓アンカーを用
いる方法の中のアンカー除去工程の１実施例の略図、第
８図は特にカニュールと一緒に除去する前にカニュール
の長手方向軸線に沿って整合した内臓アンカーを示す第
７図のアンカー除去工程の略図、第９図は本発明の内臓
アンカーの別の実施例の斜視図、第10図は本発明の内臓
アンカーを用いる内臓壁の孔あけ方法の別の実施例の行
程を示す略図、第10Ａ図は第10図に比較して90度の角度
で針を見た略図である。 10…内臓アンカー、11…クロスバー 12…縫合線、13,14…端部 15…中央部、17…付着端部 18…非着端部、20…縫合線 22…付着端部、30…ロッド 31…位置、39…針 40…シース、41…腹壁 43…内臓壁、44…内臓内腔 45…ワイヤーガイド、47…内側内臓壁 50…ドレーンチューブ、55…カニュール 56…末端

Claims (7)

    【特許請求の範囲】
  1. 【請求項１】両端を有する細長いバイオ適応性クロスバ
    ー、 第１付着端部と第２非着端部を有し該第１付着端部が前
    記クロスバーの大体中心の位置において前記クロスバー
    に取付けられている可撓性でバイオ適応性の第１縫合
    線、 を包含する内臓アンカー。
  2. 【請求項２】第３付着端部と第４非着端部を有し、該第
    ３付着部が前記クロスバーの両端の中に一つに取付けら
    れている特許請求の範囲第１項記載の内臓アンカー。
  3. 【請求項３】前記クロスバーの両端が可撓性を有し、こ
    の両端の間に剛性のある中央部が介在し、前記第１付着
    部が前記中央部に取付けられている特許請求の範囲第１
    項記載の内臓アンカー。
  4. 【請求項４】第３付着部と第４非着端部を備え、前記第
    ３付着部が前記クロスバーの両端の中の一方に取付けら
    れている可撓性でバイオ適応性の第２縫合線を包含する
    特許請求の範囲第３項記載の内臓アンカー。
  5. 【請求項５】前記クロスバーがバイオ適応性の剛性ロッ
    ドとバイオ適応性のらせん状スプリングシースを包含
    し、前記ロッドが前記シースによって被覆され、前記シ
    ースが前記ロッドの両端から突出し前記可撓性端部を形
    成する特許請求の範囲第４項記載の内臓アンカー。
  6. 【請求項６】前記クロスバーがその両端の最も外側の位
    置にエポキシ材料を包含し、前記エポキシが前記らせん
    状スプリングシースに接着されている特許請求の範囲第
    ５項記載の内臓アンカー。
  7. 【請求項７】前記第１縫合線及び第２縫合線が一体構造
    をなし、前記第１付着部と第３付着部がシースの下に接
    続されている特許請求の範囲第６項記載の内臓アンカ
    ー。
JP62122387A 1986-05-19 1987-05-19 内臓アンカー Expired - Lifetime JPH067831B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US06/864,340 US5123914A (en) 1986-05-19 1986-05-19 Visceral anchor for visceral wall mobilization
US864340 1986-05-19

Publications (2)

Publication Number Publication Date
JPS6323651A JPS6323651A (ja) 1988-01-30
JPH067831B2 true JPH067831B2 (ja) 1994-02-02

Family

ID=25343058

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Application Number Title Priority Date Filing Date
JP62122387A Expired - Lifetime JPH067831B2 (ja) 1986-05-19 1987-05-19 内臓アンカー

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US (1) US5123914A (ja)
EP (1) EP0246836B1 (ja)
JP (1) JPH067831B2 (ja)
AT (1) ATE70425T1 (ja)
AU (2) AU7314387A (ja)
CA (1) CA1325940C (ja)
DE (1) DE3775272D1 (ja)
DK (1) DK169986B1 (ja)
ES (1) ES2028075T3 (ja)
GR (1) GR3003392T3 (ja)

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AU2955989A (en) 1989-05-18
EP0246836B1 (en) 1991-12-18
GR3003392T3 (en) 1993-02-17
US5123914A (en) 1992-06-23
EP0246836A3 (en) 1988-06-01
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CA1325940C (en) 1994-01-11
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AU7314387A (en) 1987-11-26
DK169986B1 (da) 1995-04-24
JPS6323651A (ja) 1988-01-30
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ATE70425T1 (de) 1992-01-15

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