JPH07184901A - Internal hemorrhoids treating jig - Google Patents

Abstract

PURPOSE:To perform internal hemorrhoids treatment with a low invasion under no anesthesia. CONSTITUTION:This jig is provided with a cylindrical inserting part 12, its tip part is freely attachably and detachably constituted, a view finder 16 for operator is fitted on the opposite side of the inserting part 12, a lighting means 40 is arranged at the internal part of the inserting part 12, and a slit-shaped window 20 for artery ligation is formed on the peripheral face of the inserting part 12 while being opened over a prescribed angular range. A vibrator 22. for ultrasonic wave 22 is fitted on a peripheral face close to this window 22 and corresponding to the reflected waves of ultrasonic waves, the position detection of the upper hemorrhoids and the decision of the ligated result are performed. Since the ultrasonic waves are used, the upper hemorrhoids artery is extactly detected, since there is the lighting means 40, the operating field of view is lightened and since the ligated result can be confirmed by the reflected waves, the internal hemorrhoids treatment with the low invasion with no anesthesia can be performed without observing any blood.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a jig for treating internal hemorrhoids such that internal hemorrhoids can be operated minimally invasively without anesthesia.

[0002]

2. Description of the Related Art The anus (anal canal) located at the bottom of the rectum
As is well known, thin veins around the surrounding mucous membrane are gathered like a mesh and a venous plexus is developed. When congestion occurs in this part, the blood vessels expand to form varicose veins, and when the varicose veins grow, they bulge on the mucosal surface like warts and varicose veins. This is a hemorrhoid. FIG. 8 is a cutaway view of the vicinity of the anus, showing the hemorrhoids in the anus.

Hemorrhoids occur at the highest frequency among hemorrhoidal diseases, and as treatment methods therefor, there are employed surgical treatments, conservative treatments, and various treatment methods which place less burden on patients. Among them, the surgical treatment that is considered to be a radical treatment is based on what is called ligation and resection, which consists of resection of hemorrhoids and ligation of superior hemorrhoidal arteries.
It is done for ~ IV degrees. Although this treatment is highly curative, it is a surgery under anesthesia and requires a relatively long hospital stay.

[0004]

The hemorrhoidal excision and the ligation of the superior hemorrhoidal artery, which is one of the ligatures of the hemorrhoidal artery in radical surgery, are considered to be quite useful for the treatment of hemorrhoids. After pretreatment such as enema,
Under anesthesia, the anus is opened using an anoscope and the position of the superior hemorrhoidal artery is detected by palpating the pulsation by finger examination, and ligation is performed at that position.

As a simple method, there are rubber ring ligation method and infrared coagulation therapy which are performed under no anesthesia. In these methods, 2-3 cm from the dentate line which is the ideal ligation position of the superior hemorrhoidal artery. Ligation on the oral side is difficult, and therefore its effectiveness is considered to be low.

The present invention, which solves the above problems and enables the ligation of the superior hemorrhoidal artery to be performed simply and reliably, is useful as a non-anesthesia, minimally invasive treatment for internal hemorrhoids.

Therefore, the present invention intends to ligate the superior hemorrhoidal artery, which is considered to be a useful treatment method for hemorrhoids, simply and surely, and is of a minimally invasive type that can be performed in an outpatient setting without anesthesia treatment. Hemorrhoids treatment jig is proposed.

[0008]

In order to solve the above-mentioned problems, according to the present invention, a cylindrical insertion portion is provided, the distal end portion of which is detachable, and the opposite side of the insertion portion is surgically operated. A viewfinder portion for an operator is attached, an illuminating means is arranged inside the insertion portion, and a slit-shaped arterial ligation window is formed in the peripheral surface of the insertion portion in the shape of a slit opened over a predetermined angular range. In addition, an ultrasonic transducer is attached to the peripheral surface close to this window, and the position of the superior hemorrhoidal artery is detected by the ultrasonic wave from this transducer. is there.

[0009]

The tubular treatment jig 10 as shown in FIG. 8 is inserted into the anal canal. In this state, while rotating the treatment jig 360 by 360 °, ultrasonic waves are radiated from the ultrasonic transducer 22 and the upper hemorrhoidal artery is searched while listening to the reflected sound, Doppler sound. Among the searched hemorrhoidal arteries found, scoop the hemorrhoidal arteries with hemorrhoids with a strong needle (not shown).

Therefore, as shown in FIGS. 1 and 3, the above-mentioned strong needle is inserted into the inner space of the insertion portion 12 from the viewfinder portion 16 side, and the hemorrhoid is formed through the arterial ligation window 20. The artery is scooped with this strong needle, and in this state, the superior hemorrhoidal artery is ligated.

The upper hemorrhoidal artery to be ligated is 2 to 3 from the dentate line.
Since it is an enlarging part of the rectum at the back of the cm, and this part is a site without pain sensation, surgery can be performed without anesthesia.

The arterial blood flow on the peripheral side (hemorrhoid side) from the ligation site is irradiated with ultrasonic waves on the peripheral side, and interruption of the arterial blood flow can be confirmed by the presence or absence of the Doppler arterial sound.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Next, an example of an internal hemorrhoid treatment jig according to the present invention will be described in detail with reference to the drawings.

FIG. 1 shows an internal hemorrhoid treatment jig 10 according to the present invention.
Fig. 1 shows an example of a cylindrical insertion part 1
2 is provided, and a tip portion 14 having a thin tip is detachably attached to the insertion portion 12 at one end thereof. The other end of the insertion portion 12 is formed as a viewfinder portion 16 and has a shape slightly larger than the insertion portion 12 so that a practitioner can observe the inside of the insertion portion 12 from the viewfinder portion 16.

Reference numeral 18 is a grip portion for the insertion portion 12,
While holding this, the insertion portion 12 is rotated 360 °, or an operation is performed.

A window 20 for arterial ligation is provided on a part of the peripheral surface of the insertion portion 12, and an ultrasonic transducer 22 ultrasonically transmits ultrasonic waves at a position close to the ligation window 20 (viewfinder section 16 side). It is attached so that the irradiation direction is the outside predetermined angle.

The treatment jig 10 of this example shown in FIG. 1 has an overall length including the viewfinder portion 16 of about 135 mm, the diameter of the insertion portion 12 is about 27 mm, and the distal end portion 14 and the insertion portion 12 have the same diameter. The surface is processed to be smooth.

Next, the details of the treatment jig 10 will be described with reference to FIG.

FIG. 2 is a side view of FIG. 1, and since the insertion portion 12 is hollow when viewed from the viewfinder portion 16,
The operator can see through the inside of the insertion portion 12. The grip portion 18 is fixed to the viewfinder portion 16,
This can be configured to rotate, and after the insertion section 12 is rotated, it can be fixed to the viewfinder section 16 by using another fixing means.

The inside of the grip 18 is an ultrasonic transducer 22 which will be described later.
It is configured as a hollow cylinder so that a signal line for driving the power source and a power line can be passed through.

FIG. 3 is an enlarged sectional view of FIG. 1, in which both the insertion portion 12 and the tip portion 14 are made of a transparent material such as transparent acrylic resin. This is to brighten the operative field so that quick treatment and observation of the mucous membrane can be performed, as will be described later.

As shown in the figure, the tip portion 14 is formed so as to gradually taper toward the tip thereof,
The leading edge is made up of some enormous parts 30. This makes the treatment jig 10 anus (tube) without any discomfort or pain.
This is so that it can be inserted inside.

The distal end portion 14 is constructed so as to be attachable to and detachable from the insertion portion 12, but inside the vicinity of the end portion of the insertion portion 12 to which the distal end portion 14 is mounted, an illuminating means 40 used for illumination during operation is provided. Is attached and fixed.

As shown in the figure, the illuminating means 40 is provided with an illuminating lamp 42 (miniature bulb, LED, etc .; the figure shows a miniature bulb).
The miniature bulb 42 is attached to the holder 44 and fixed to the transparent columnar support portion 48. Therefore, the columnar support portion 48 formed of a transparent acrylic resin or the like has a mounting recess 46 having a shape similar to the miniature light bulb 42 into which the miniature light bulb 42 can be inserted, and the miniature light bulb 42 is mounted therein. It is fixed to the columnar support portion 48 by using the holder 44.
The outer peripheral end portion of the columnar support portion 48 is fixed to the tip end step portion of the insertion portion 12 using an adhesive or the like.

A thread groove is formed on the outer periphery of the columnar support portion 48, and the tip portion 1 is screwed into the thread groove to form the tip portion 1.
4 will be fixed to the insertion part 12 via this illumination means 40. 52 is a rubber ring for preventing liquid leakage.

A light shielding layer 50 is provided in the central bottom portion of the mounting recess 46 over a predetermined range. This is to prevent the light of the miniature bulb 42 from entering the eyes of the practitioner through the viewfinder section 16.

The light of the miniature bulb 42 is diffused by the transparent columnar support portion 48 and brightly illuminates the vicinity of the columnar support portion, so that the intraoperative visual field becomes bright.

A window 20 for arterial ligation is formed near the tip of the insertion portion 12. The ligating window 20 is formed as a slit having a predetermined width and an opening angle θ as shown in FIG. The width and the opening angle θ are selected so as not to hinder the movement of the strong needle used during the operation. In this example, the width is 5 mm, and the opening angle θ is the vertical axis of the insertion portion 12. Each is selected to be ± 45 ° as a standard. These values are examples.

A mold body 52 having an ultrasonic transducer 22 embedded therein is provided in the peripheral notch 23 on the front side of the ligating window 20.
Are fitted and fixed. As the ultrasonic transducer 22, a transducer that is used for both transmission and reception is used and its frequency is about 8 MHz.

The ultrasonic transducer 22 facilitates detection of the position of the superior hemorrhoidal artery of the rectal ampulla.
Direction (the angle with respect to the vertical axis, the direction of which is shown in FIG.
Is indicated by a chain line) and ultrasonic waves are radiated. Therefore, the ultrasonic transducer 22 is attached at a position that is inclined from the horizontal axis (center axis) of the insertion portion 12 and that straddles the vertical axis of the insertion portion 12 (see FIG. 5).

Both the signal line for the ultrasonic transducer 22 and the power line for the miniature bulb 42 described above are guided to the grip 18 along the inner wall surface of the insertion portion 12 or grooved at an appropriate position on the inner wall surface. Is cut and embedded here so that it is guided to the grip portion 18. In any case, they are wired so as not to interfere with the treatment procedure.

FIG. 6 is a schematic configuration diagram of an ultrasonic diagnostic apparatus (ultrasonic Doppler apparatus) 60 used in the above-mentioned treatment jig 10, in which reference numeral 62 is a transmission / reception circuit, which is a diagram for the ultrasonic transducer 22. When an ultrasonic signal (pulse) such as 7A is intermittently applied and the upper hemorrhoidal artery is irradiated with ultrasonic waves, a pulse (Doppler signal) as shown in FIG. 7B can be received. If this is demodulated, the arterial blood flow flowing through the superior hemorrhoidal artery can be heard from the speaker 64 as Doppler pulse sound (blood flow sound). The quality of arterial ligation can be confirmed by interruption of the Doppler arterial sound on the peripheral side of the ligation position. 66 is a power supply circuit for the miniature light bulb 42.

An example of treatment using the treatment jig 10 having the above structure will be described below.

(1) The patient's body position is the Simus body position in the left lateral decubitus position or right lateral decubitus position.

(2) Xylocaine jelly, which is a kind of local anesthetic, is applied over the entire tip portion 14 of the treatment jig 10 according to the present invention, and the ultrasonic transducer 22 of the insertion portion (probe) 12 is attached. A well-known ultrasonic jelly is applied to the peripheral surface to prevent the ultrasonic wave from being attenuated, and the ultrasonic wave is slowly inserted into the anus.

(3) Insert the treatment jig 10 to a predetermined depth. At this depth, the position of the ligation window 20 is 2.
The position is 5 to 3.0 cm deep.

(4) While the treatment jig 10 is inserted, the ultrasonic transducer 22 is excited and rotated by 360 °, and the Doppler arterial sound from the speaker 64 is detected, and the position of the superior hemorrhoidal artery is confirmed. To do. Normally, the superior hemorrhoidal artery is located in the directions of 3 o'clock, 7 o'clock, and 11 o'clock with reference to the hands of the clock. For the hemorrhoids in the 3 o'clock direction, the left lateral decubitus position and for the 7 o'clock and 11 o'clock positions the right lateral recumbent position is used.

(5) The jig insertion position is adjusted while listening to the Doppler arterial sound so that the superior hemorrhoidal artery flowing into the poor hemorrhoidal state faces the ligation window 20.

(6) Next, attach the strong needle to the viewfinder section 1
Insert from the 6 side, the strong needle is directed from the ligation window 20 toward the ampulla of the rectum, and the upper hemorrhoidal artery is scooped from the ligation window 20. A ligature such as a synthetic absorbent thread is used for ligation, and ligation is performed using a thread feed rod.

(7) The normal ligation site is the ampulla of the rectum 2.5 to 3 cm deeper than the dentate line, which is a painless site for the patient, and of the three hemorrhoids at 3 o'clock, 7 o'clock and 11 o'clock. From the superior hemorrhoidal artery. It is possible to ligate at 3 locations at the same time by changing the body position, but at 3 o'clock and 7 o'clock, 1
It is easier for the patient to divide into one operation and two operations.

Even when there is a superior hemorrhoidal artery branch at a position higher than the dentate line or when there is abnormal running of the superior hemorrhoidal artery, its position can be confirmed by the presence or absence of Doppler arterial sound, so that it can be accurately determined regardless of the ligation site. The superior hemorrhoidal artery can be ligated.

(9) Judgment of the ligation result is performed based on the interruption of the arterial blood flow obtained by irradiating the peripheral side of the ligation site with ultrasonic waves. The correct ligation can be confirmed by the disappearance of the Doppler artery sound.

(10) It is not necessary to use postoperative ointment or suppository because ligation is performed at a painless site.

(11) There is sclerotherapy as one of treatment methods for hemorrhoid patients with Goligher II-III degree. This is a treatment method in which a hemorrhoid hardening agent containing a pigment is directly injected into the hemorrhoid to cure and reduce the hemorrhoid.

By pulling out the device 3 to 5 cm forward from the position at the time of ligation, a varicose vein forming an internal hemorrhoid protrudes from the ligation window 20 toward the lumen. Hemorrhoidal sclerosing agent is directly injected into this varicose vein.

The features of the treatment jig 10 according to the present invention which can carry out such treatment for internal hemorrhoids are as follows.

(1) In addition to the ligation of the upper hemorrhoidal artery, this jig can be used for the treatment of internal hemorrhoid sclerotherapy.

(2) There is no need for pretreatment or anesthesia treatment, and the operation can be safely performed in the outpatient clinic.

(3) Since the entire treatment jig is selected to have a smooth finish, shape, size and length so that it can be easily inserted from the anus, it does not damage the mucous membranes and tissues in the anus and rectum. Can be operated.

(4) Since the operating portion can be illuminated by the illumination lamp 42 attached near the distal end portion of the treatment jig 10, it is possible to perform an appropriate treatment. Since the direct light of the illumination lamp 42 is prevented from being applied to the practitioner, the operation is easy.

(5) Since both the insertion part 12 and the tip part 14 are made of transparent acrylic resin, it is possible to directly observe and diagnose the mucosal surface of the hemorrhoid in the rectum.

(6) Since the ultrasonic transducer 22 is attached in front of the arterial ligation window 20, it is easy to detect the position of the superior hemorrhoidal artery, and whether the arterial sound is interrupted or the degree of arterial sound disappearing causes It is easy to judge the quality of the ligation result.

(7) Since all positions of the superior hemorrhoidal artery can be confirmed only by rotating the treatment jig 10 once after inserting the anus 1
It is also possible to ligate all hemorrhoidal arteries with a single insertion operation.
The operation time can be shortened. If the operation is divided into two operations without changing the posture, the burden on the patient can be significantly reduced.

(8) At the same time as arterial ligation, sclerotherapy can be performed together.

(9) Since the insertion portion 12 is made of transparent acrylic resin, the mucosal surface can be observed at the same time. Therefore, it is possible to easily judge the therapeutic effect when a dye-containing drug is used as a hemorrhoid hardening drug.

(10) Since minimally invasive treatment for internal hemorrhoids can be realized, the burden on the patient can be reduced.

[0057]

As described above, according to the treatment jig of the present invention, the position of the superior hemorrhoidal artery can be accurately determined by ultrasonic waves, and the superior hemorrhoidal artery can be accurately identified by the illumination means and the ligation window. You will be able to scoop. The scooping position is the ampulla of the rectum on the rectal side of the dentate line. From the above, according to the present invention, there is a feature that noninvasive and minimally invasive treatment under anesthesia can be achieved in a substantially painless state. Therefore, it is possible to provide a clinically extremely useful treatment jig.

[Brief description of drawings]

FIG. 1 is a plan view showing an example of an internal hemorrhoid treatment jig according to the present invention.

FIG. 2 is a side view of FIG.

FIG. 3 is an enlarged cross-sectional view of FIG.

FIG. 4 is a sectional view taken along the line AA of FIG.

FIG. 5 is a cross-sectional view taken along the line BB of FIG.

FIG. 6 is a system diagram of an ultrasonic diagnostic apparatus.

FIG. 7 is a waveform diagram for explaining the operation.

FIG. 8 is a cross-sectional view near the anus.

[Explanation of symbols]

 10 Internal Hemorrhoids Treatment Jig 12 Insertion Part 14 Tip Part 16 Viewfinder Part 18 Gripping Part 20 Ligation Window 22 Ultrasonic Transducer 40 Illuminating Means 42 Miniature Light Bulb

─────────────────────────────────────────────────── ─── Continuation of the front page (51) Int.Cl. ⁶ Identification code Internal reference number FI technical display area A61B 17/02 17/12 17/36 330

Claims (1)

[Claims] 1. A cylindrical insertion portion, a distal end portion of which is configured to be detachable, a viewfinder portion for an operator is attached to the opposite side of the insertion portion, and the inside of the insertion portion. Illuminating means is provided, and a slit-shaped arterial ligation window is formed on the peripheral surface of the insertion portion and opens over a predetermined angular range, and ultrasonic vibration is applied to the peripheral surface near the window hole. An internal hemorrhoid treatment jig, characterized in that a child is attached and the position of the superior hemorrhoidal artery is detected by ultrasonic waves from the transducer.