JPH09173340A - Ligature appliance for surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To make it possible to rapidly and easily execute ligature, such as surgical knot, by a prescribed ligature method in a sutured site while viewing the monitor of a telescope in an operation, etc., under an endoscope. SOLUTION: This appliance is constituted to hold a thread twisting part 4 formed by twisting one end side 3a of a ligature 3 to the outer periphery of the twist guiding part 2 of an appliance body 1 in correspondence to the ligature method, such as surgical knot, and to execute suture with the other end side 3b of this ligature 3. The suture is dawn out through a pulling thread guiding part 7 of the appliance body 1 from the front end of the appliance body 1 toward the rear end, and while the one end side 3a is held, the other end side 3b drawn out to the rear of the appliance body 1 is pulled until the thread twisting part 4 is disengaged from the front end of the twist guiding part 2. The sutured part is then ligated by the required ligature method, such as surgical knot. In such a case, both end sides 3a, 3b of the ligature 3 are releasably held by a holding part 12 in the intermediate part of the appliance body 1. Only the other end side 3b is released in the state of holding the one and side 3a of the ligature 3 at the time of suture. The suture operation is thus rapidly and easily carried out.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical ligating instrument useful for endoscopic surgery and the like.

[0002]

In the surgical field, it is tyin to tie a thread.
g. Ligation is referred to as “ligature”, but in the present specification, the entire tying is generally referred to as “ligation”. It is an important technique that the basics of surgical procedures begin with the training of thread knotting, and failure to ligate only one thread can affect the patient's life, and during one operation. Since the number of times of ligation is extremely large, in order to perform agile, smooth and safe surgery, not only beginners but also skilled persons are required to practice the rapid and reliable ligation method. Conventionally, a surgical ligation instrument used for endoscopic surgery has a one-sided ligature that is curved in a ring shape and wound around the middle part of the ligature to make a lasso loop. Tie the knot, and guide the other end of the ligature from the tip of the instrument body to the rear end through the hollow hole so that the knot is located at the tip of the hollow rod-like instrument body. When they are brought into contact with each other and the other end side is pulled, the ring-shaped portion ahead of the knot is reduced, and the reduced ring-shaped portion is used to ligate the object.

[0003]

In the device having the above-mentioned structure, the thread is pulled through the ring-shaped portion by pulling the other end side of the ligature thread and tightening the object with the reduced ring-shaped portion. If is loosened, the ring-shaped part expands and the tightening becomes loose, making it impossible to ligate. In addition, there is a problem that the suture cannot be tied.

[0004]

SUMMARY OF THE INVENTION Therefore, according to the present invention, there is provided a twisting means for holding a thread twisting portion, which is formed by twisting one end side of a ligature thread on the outer periphery in accordance with a required ligation method so as to be slidable toward a distal end direction. A guide portion is provided at the tip of the elongated rod-shaped instrument body, and a pulling thread guide portion for guiding the other end side of the ligature from the tip portion of the instrument body to the rear end direction through the inside of the twisting portion. In the surgical ligation instrument provided inside the twist guide, a surgical ligature in which a holding portion for releasably holding one end side and the other end side of the ligature is provided in an intermediate portion of the instrument body. It is intended to provide equipment. Also,
The present invention provides the above-mentioned surgical ligation instrument, wherein a twist guide portion for holding a thread twisting portion obtained by twisting one end side of the ligature on the outer periphery in accordance with a required ligation method so as to be slidable toward the distal end direction. Is provided at the tip of the device body in the form of an elongated rod, and the twisting thread guide part for guiding the other end side of the ligature from the tip of the device body toward the rear end through the inside of the twisting part. In a surgical ligation instrument provided inside a guide part, a stopper part for preventing backward movement of the thread twisting part is provided in the twist guide part, and one end side and the other end side of the ligature thread are released. An object of the present invention is to provide a surgical ligation instrument in which a holding portion that holds the instrument is provided in an intermediate portion of the instrument body.

Further, in the surgical ligation instrument of the present invention, the thread twisting portion obtained by twisting one end side of the ligature thread on the outer periphery in accordance with a required ligation method can be slid toward the distal end direction. A pulling thread that is provided with a twisting guide portion for holding the distal end portion of an elongated rod-shaped instrument body, and guides the other end side of the ligature thread from the tip portion of the instrument body to the rear end direction through the inside of the twisting portion. In a surgical ligation instrument having a guide part inside the twist guide part, a holding part for releasably holding one end side and the other end side of the ligature is provided in an intermediate part of the instrument main body, and An object of the present invention is to provide a surgical ligation instrument having a storage groove for storing and guiding the one end side and the other end side of the ligature thread between the twist guide portion and the holding portion. Further, the present invention provides the surgical ligation instrument according to claim 1, wherein a twisting portion is provided which slidably holds a thread twisting portion obtained by twisting one end side of the ligature thread on the outer periphery in accordance with a required ligation method. A guide portion is provided at the tip of the elongated rod-shaped instrument body, and a pulling thread guide portion for guiding the other end side of the ligature from the tip portion of the instrument body to the rear end direction through the inside of the twisting portion. In a surgical ligation instrument provided inside the twist guide portion, a holding portion that releasably holds both end sides of the ligature is provided in an intermediate portion of the instrument body, and the twist guide portion and the holding portion are provided. An object of the present invention is to provide a surgical ligation instrument having a storage groove for storing and guiding one end side and the other end side of the ligature therebetween.

In the surgical ligation instrument according to the present invention, the pulling thread for guiding the other end side of the ligature thread from the distal end portion of the instrument body to the rear end direction through the inside of the twisted portion. The guide portion is configured as a guide hole that penetrates the inside of the twist guide portion, and a pulling thread member that grasps the other end side of the ligature and draws it toward the proximal end side of the instrument body is inserted into the guide hole. An object of the present invention is to provide a surgical ligation instrument characterized by being provided freely. Further, the present invention, in the surgical ligation instrument described above, one end side and the other end side of the ligature thread of the thread twisting part twisted to the twist guide part are inserted into the connecting tool to fix the thread twisting part. An object of the present invention is to provide a surgical ligation instrument characterized in that it is held so as to be slidable simultaneously in the distal direction. Further, the present invention provides the above-described surgical ligation device, wherein the twisting part is formed by twisting one end side of the ligature in the twist guide part by a ligation method consisting of a surgical knot in which the first knot of male knot is repeated twice. An object of the present invention is to provide a surgical ligation instrument characterized in that the ligature is held slidably in the distal direction.
Further, the present invention provides the surgical ligation instrument as described above,
It is an object of the present invention to provide a surgical ligation instrument characterized in that a holding portion for releasably holding one end side and the other end side of the ligature is provided at an intermediate portion of the instrument body.

[0007]

According to the surgical ligation instrument of the present invention having the above-mentioned structure, the twisted portion of the ligature twisted to the outer periphery of the twist guide portion of the distal end of the elongated rod-shaped instrument body is connected to one end of the ligature. It is possible to guide the side and the other end side to the holding portion at the intermediate portion of the instrument body and maintain the state in which the middle of the ligature is held. In this state, for example, one end side can be guided to the proximal end side of the instrument body held by the operator, and the other end side can be guided to the distal end direction of the instrument body. The other end side of the ligature can be brought into a state in which it is guided to the proximal end side of the instrument body by inserting the pulling thread guide portion at the tip end of the instrument body. In this state, the distal end portion of the instrument body of the present invention is inserted through the hollow tubular guide member in the vicinity of the sutured site and the like, the holding portion is released, and the twisting guide portion is pulled out to pull the yarn at the tip portion of the instrument body. The ligature to be ligated is inserted into the slack of the ligature formed on the other end entering the guide part, and one end of the ligature is loosely held by the proximal end of the instrument body, or the twist guide part The ligature on one end side of the thread twisting part is loosely grasped by the grasping forceps that is guided to the suture site via another guide member, and the other end of the ligature pulled out to the rear of the instrument main body via the cord guide When the part side is pulled, there is no slack in the ligature thread into which the object to be ligated has been inserted, and the thread twisting part is pulled in the distal direction of the twist guide part and slides,
When it comes off from the tip of the instrument body, with the object tightened,
For the ligature of the part that enters the pull thread guide part of the tip of the instrument body,
The thread twisting portion twisted according to the required ligation method is entangled, and a knot is formed by the required ligation method.

[0008] Also, with one end side and the other end side of the ligature being held in the middle holding part of the instrument body, the one end side is the base of the instrument body grasped by the operator. Guide to the end side, attach a suture needle to the other end side and guide in the distal direction of the instrument body, insert the tip of the instrument body of the present invention through the hollow tubular guide member and near the suture site, etc. After releasing the holding part and suturing the suture part with the suture needle, the suture needle is attached or the suture needle is cut off, and the other end side is passed through the pull thread guide part and passed inside the twist guide part. Guide the thread to the rear end of the instrument body and pull the thread on the other end side, the thread twisting part is pulled toward the tip of the twist guide and slides to move, and the thread twisting part comes off from the tip of the instrument body. By the same means as described above, a knot is formed at the suture site by a predetermined ligation method. Further, in the surgical ligation instrument according to the present invention, the twist guide portion is provided with a stopper portion for preventing the thread twisting portion from moving rearward, and one end side and the other end side of the ligature thread are released. In a surgical ligation instrument in which a holding portion that holds the ligation is provided in the middle part of the instrument body,
Even if the one end side and the other end side of the ligature are pulled relatively strongly toward the holding part, the thread twisting part of the twisting guide part is prevented from moving backward by the stopper part, and the thread twisting part is twisted by the twisting guide part. It is possible to prevent the ligature from being tightly wound around and detached from the ligature, and to attach the ligature to the holding portion in a state where one end side and the other end side thereof are taut.

In the surgical ligation instrument according to the present invention, a storage groove for accommodating and guiding one end side and the other end side of the ligature thread is provided between the twist guide portion and the holding portion. In the surgical ligation instrument provided, one end side and the other end side of the ligature can be stored in the storage groove from the twist guide part to the holding part, and one end of the ligature It is possible to prevent the side and the other end from twisting, and the storage groove also acts as a stopper groove that prevents the yarn twisting portion from moving backward from the yarn twisting portion.
Further, the present invention provides the surgical ligation instrument as described above,
A pulling thread guide part for guiding the other end side of the ligature from the tip part of the instrument body to the rear end part is configured as a guide hole penetrating the inside of the twist guide part, and the ligature is provided in the guide hole. In the case where the pulling thread member that grasps the other end side of the thread and pulls out to the proximal end side of the instrument body is provided so that it can be inserted, the suture needle is still attached after the suturing or the suture needle is cut off. Since then
The other end of the ligature is easily guided to the rear end of the instrument body by grasping the other end side with the pulling thread member and pulling it out to the rear of the instrument body, and a knot is formed at the suture site by a predetermined ligation method. Can be formed. Further, the present invention, in the surgical ligation instrument described above, one end side and the other end side of the ligature thread of the thread twisting part twisted to the twist guide part are inserted into the connecting tool to fix the thread twisting part. Since the slidable portions are held so as to be slidable toward the distal end direction at the same time, when the other end side of the ligature pulled out to the rear of the instrument main body is pulled through the pulling thread guide portion, the thread twisting portion causes the connecting tool to move. By this, the knot is pulled and slid integrally in the direction of the tip of the twist guide, and it slides and moves, and it is sequentially removed from the tip of the instrument body, and in the state where the object is tightened, the knot is smoothly and reliably formed by the required ligation method. The Rukoto. In particular, the first and second knot portions in which the thread twisting portion including the first knot and the second knot is separated from the twist guide portion only in the first knot portion and the second knot portion is prevented from coming off the twist guide portion. Is pulled in the direction of the tip of the twist guide without sliding, slides, and is sequentially disengaged from the tip of the instrument body, so that the knot by the required ligation method consisting of the first knot and the second knot is swift,
It will be formed smoothly and surely.

Further, the present invention relates to the above-mentioned surgical ligation device, which corresponds to a ligation method comprising a surgical knot in which only one first knot of a male knot is repeated twice in the twist guide portion on one end side of the ligature. By holding the thread twisting portion that has been twisted by sliding so that it can slide toward the tip direction, the other end side of the ligature drawn to the rear of the instrument body via the pulling thread guide portion can be pulled to With the thread twisting portion consisting of the knot and the second knot disengaged from the tip of the instrument body and the ligation portion is tightened,
A nodule will be formed by the required surgical knot ligation method. Further, the present invention provides the surgical ligation instrument as described above, in which a holding portion for individually releasably holding one end side and the other end side of the ligature is provided at an intermediate portion of the instrument main body. While holding one end side and the other end side of the thread individually in the holding part at the middle part of the instrument body, guide the one end side to the proximal end side of the instrument body grasped by the operator and the other suture needle Guide the other end of the instrument body toward the tip of the instrument body, and insert the tip of the instrument body of the present invention into the vicinity of the suture site or the like through the hollow tubular guide member. After releasing the holding part and suturing the suture part with the suture needle, either with the suture needle attached, or after separating the suture needle, pass the other end side through the pull thread guide part and pass through the inside of the twist guide part. Guide to the rear end of the instrument body, release the holding part on the one end side at this stage, and Pulling the yarn torsion portion is moved by sliding pulled in the distal direction of the torsion guide portion, the thread twisting portion is disengaged from the tool body distal end, by the same means,
A knot is formed at the sutured site by a predetermined ligation method. Therefore, while the suturing needle is attached, only the other end side is released and the one end side can be held in the instrument body while the suturing operation is performed, and the suturing operation can be performed quickly and smoothly. .

[0011]

EXAMPLES The present invention will be described in detail with reference to the examples shown below. First, the principle of the present invention will be described with reference to FIGS. 15 to 19. In the figure, only the distal end portion of the instrument main body 1 of the surgical ligation instrument according to the present invention having an elongated hollow rod shape is shown by a solid line. The instrument body 1 is made of a transparent or translucent plastic product in the shape of an elongated hollow rod having a length of about 7 cm to 40 cm and a diameter of about 2 mm to 12 mm. Reference numeral 2 denotes a twist guide portion which is gradually and slenderly provided on the outer periphery of the tip portion of the instrument body 1 toward the tip. The twist guide 3 has a ligature 3
A thread twisting portion 4 in which one end side 3a is twisted according to a required ligation method is held slidably in the distal direction. As a means for holding the thread twisting portion 4 slidably in the distal direction, it may be only a tapered shape as shown in the drawing, but although it is omitted in the figure, it can be slightly moved when a tensile force is applied. A thread fitting groove having thread holding force, a thread fitting projection, a thread holding projection, a friction resistance member, an adhesive, or the like can be used depending on the material of the thread.

There are many ligation methods and various names, but the main ones are male knots, female knots, and surgical knots, and the most commonly used ones are surgical knots and male knots. As shown in FIG. 20, the surgical knot is twisted by repeating the first nodule twice to reduce looseness by friction, and twisting the second nodule once in the direction opposite to that of the first nodule. It is generally applied to most places of surgery such as places where tension is applied to the thread at difficulty points. Surgical knots are also surgical nodules, s
surgical knot, surgion's kno
It is called t. As shown in FIG. 21, the male knot is a single nodule in which both the first and second nodules are twisted once, and the twisting directions are opposite between the first and second nodules, and the simplest and most difficult to solve. It is commonly used for hemostatic ligation and the like.
Men's knots are other common knots, main knots, true knots, booth knots,
Boat knot, boat knot, reefknot, square
It is called knot, true knot, or the like. Like the male knot, the female knot is a single nodule in which both the first and second knots are twisted once, and the twist direction is the same in the first and second knots, resulting in a vertical knot. Generally, it is a ligature that is easy to untie and uncertain, and should not be performed by a surgical operation, but it can be used when hemostasis is ligated with a fine silk thread. The female knot is also called a female knot, a false knot, a reverse knot, a vertical knot, a granny knot, or the like. FIG. 22 shows a triple knot in which a third knot is added to the male knot consisting of the first and second knots in order to prevent loosening. Triple knot, triple ligation, reinfo
It is called “rced knot” or “triple knot”.

The method of ligating the thread twisting portion 4 in the illustrated example is as follows.
It consists of a surgical knot, and twists the first nodule 5 toward the tip side of the twist guide portion 2 twice in the distal direction, and then turns it to the rear end direction to turn the second nodule 6 into the first nodule 5 and the twisting direction. On the contrary, it is constructed by twisting once in the distal direction. If the first knot 5 of the surgical knot is twisted only once, it becomes a male knot, and if the twisting direction of the second knot 6 is reversed by a male knot, it becomes a female knot. Also, if a third knot is further provided behind the second knot 6 with a male knot and the twisting direction is reversed, a triple knot is formed.
On the other hand, inside the twist guide portion 2, there is provided a drawstring guide portion 7 formed of a hollow portion penetrating from the tip portion of the instrument body 1 in the rear end direction, and the other end portion side of the ligature 3 is provided. 3b is constructed so that it can be pulled by being inserted from the front end portion of the pulling yarn guide portion 7 toward the rear end portion. In the illustration of FIG. 16, a ligature needle 8 is provided at the tip of the other end side 3b of the ligature 3,
After the suture portion 9 is sewn with the needle 8, the ligature needle 8 side is grasped by the grasping forceps or the like which is inserted from the rear end portion to the distal end of the pulling thread guide portion 7 and The other end side 3b of the ligature 3 can be inserted toward the rear end. In this case, if the device main body 1 is transparent or translucent, it is preferable because the ligature 3 passing through the thread guide portion can be visually recognized. FIG.
In the case of the explanation example of No. 7, the other end side 3b of the ligature 3 is provided by being inserted in advance from the front end to the rear end of the pulling thread guide portion 7. Reference numeral 10 denotes a connector in which the one end portion side 3a and the other end portion side 3b of the ligature 3 of the thread twisting portion 4 twisted in the twist guide portion 2 are inserted, and the first knot 5, the second knot 6, etc. The thread twisting portion 4 made of is simultaneously slidably connected to the distal end direction of the instrument body 1. Connector 10
Is a shape provided with holes for freely inserting one end side 3a and the other end side 3b of the ligature 3 at predetermined intervals,
Any material that can be removed later without hindering the ligated state may be used, but it may be formed of the same nylon as the ligature 3, silk, or an absorbent thread that binds to the tissue and is tied in a ring shape.

According to the surgical ligation instrument of the present invention in the above-described example, the twisting guide of the distal end portion of the instrument main body 1 is passed through a hollow tubular guide member or the like (not shown) to the vicinity of the suture site or the like. In the case of the example illustrated in FIG. 16, the portion 2 is introduced, and after the suture portion 9 is sewn with the ligature needle 8 provided at the tip of the other end portion side 3b of the ligature 3, the pulling thread guide portion 7 is attached to the rear end. 1 is grasped on the side of the ligature needle 8 with a grasping forceps or the like which is inserted from the end portion to the distal end portion.
8, the other end portion side 3b of the ligature 3 is inserted from the front end portion to the rear end portion of the pulling thread guide portion 7, and in the case of the example illustrated in FIG. 7, the other end side 3b of the ligature 3 provided through the distal end to the rear end of the ligature 7 comes out of the twist guide portion 2 and enters the pulling yarn guide portion 7 of the distal end portion of the instrument body 1. In the slack of the ligature thread 3 formed in the part,
Insert the sewn portion 9 and guide the ligature 3a on one end side of the thread twisting portion 4 of the twisting guide 2 from the gap between the instrument body 1 and the guide member to the rear of the guide member, while holding it loosely, or Ligation thread 3a on one end side of the thread twisting section 4 of the twisting guide section 2
Is loosely grasped by the grasping forceps guided to the sutured portion via another guide member, and the other end side 3b of the ligature 3 pulled out to the rear of the instrument body 1 via the tug guide 7 is pulled, The ligature 3 having the sutured portion 9 sutured or inserted therein has no slack, and the first knot 5 and the second knot 6 of the thread twisting part 4 are pulled toward the tip end of the twist guide part 2 to slide and move. As described above, when the ligature 3b is removed from the tip of the instrument body 1 and the suture portion 9 is tightened, the ligature 3b in the portion of the tip of the instrument body 1 that enters the drawstring guide portion 7 is ligated with a required surgical knot. The thread twisting portion 4 composed of the first and second knots 5 and 6 twisted corresponding to the above is entangled, and a ligature by a required surgical knot is formed, as schematically shown in FIG. Become.

At this time, as shown in the figure, one end side 3a and the other end side 3b of the ligature 3 of the thread twisting portion 4 twisted by the twist guide portion 2 are inserted into the connecting tool 10. For example, when the other end side 3b of the ligature 3 pulled out to the rear of the instrument main body 1 via the pulling thread guide portion 7 is pulled, the first knot 5 and the second knot 6 of the thread twisting part 4 are connected to each other. In the state in which it is pulled integrally in the direction of the distal end of the twist guide portion 2 by 10 and slides and moves, and is simultaneously and sequentially removed from the distal end of the instrument body 1 as shown in FIG. As shown in FIG. 15, the nodule by the required surgical knot is formed smoothly and surely. In particular, the thread twisting portion 4 including the first knot 5 and the second knot 6 may be disengaged only from the first knot 5 from the twist guide portion 2, and the second knot 6 may not be removed by tightening the twist guide portion 2. It disappears and the first and second knots are pulled in the direction of the tip of the twist guide part 2 without being divided and slide, and they are sequentially disengaged from the tip of the instrument body 1 and consist of a first knot and a second knot. A nodule formed by the required ligation method can be formed quickly, smoothly, and surely. And FIG.
As can be seen from FIG. 5 or FIG. 19, the coupling tool 10 engages in a ring shape with a portion of the first knot 5 that is in contact with the suture portion 9 and the outer end of the second knot 6 that is 3a. Since there is no interposition between the knot 5 and the second knot 6, it does not hinder tightening of the knot, and the ligature 3 is easily cut by cutting the ring-shaped part after ligation.
Can leave.

Next, the present invention will be described in detail with reference to the embodiments shown in FIGS. 1 to 15. Reference numeral 1 denotes an instrument main body of a surgical ligating instrument according to the present invention, which has an elongated hollow rod shape. The instrument body 1 is made of a transparent or translucent plastic product in the shape of an elongated hollow rod having a length of about 7 cm to 40 cm and a diameter of about 2 mm to 12 mm. Reference numeral 2 denotes a taper-shaped twist guide portion which is gradually and slenderly provided on the outer periphery of the tip portion of the instrument body 1 toward the tip. The twisting guide portion 2 holds a thread twisting portion 4 in which one end side 3a of the ligature 3 is twisted according to a desired ligation method so as to be slidable toward the distal end direction. As a means for holding the thread twisting portion 4 slidably in the distal direction, it may be only a tapered shape as shown in the drawing, but although it is omitted in the figure, it can be slightly moved when a tensile force is applied. A thread fitting groove having thread holding force, a thread fitting projection, a thread clamping projection, a friction resistance member, an adhesive agent, or the like may be provided or provided in the tapered twist guide portion 2 depending on the material of the thread.

The method of ligating the thread twisting portion 4 in the illustrated embodiment is as follows.
As shown in FIGS. 13 and 14, FIG.
6 to 19 one end side 3 of the ligature 3 of the thread twisting portion 4
The lower slack portion 11 of a is lifted upward from the rear of the twist guide portion 2 and both ends 3a and 3b of the ligature 3 are pulled so as to eliminate the slack, and the thread twist portion 4 is pulled. Since it has a form in which the slack is removed from the periphery of and is wound, the surgical knot shown in FIG. That is, the thread twisting section 4 repeatedly twists the first knot 5 toward the tip side of the twist guide section 2 twice in the tip direction, and then reverses it in the rear end direction to turn the second knot 6 into the first knot 5. It is twisted once in the direction of the tip opposite to the twisting direction, and is wound so that both ends 3a, 3b of the ligature 3 pass through the inside of the slack portion 11 and extend to the outside of the twisting guide 2. There is. If the first knot 5 of the surgical knot is twisted only once, it becomes a male knot, and if the twisting direction of the second knot 6 is reversed by a male knot, it becomes a female knot. Also, if a third knot is further provided behind the second knot 6 with a male knot and the twisting direction is reversed, a triple knot is formed. Further, the twist guide portion 2 is provided with a stopper portion 19 for preventing the backward movement of the thread twist portion 4. In the case of the embodiment, the stopper portion 19 is formed as a small step portion so that the ligature 3 is hooked at the end of the tapered portion which is the boundary between the twist guide portion 2 and the intermediate portion 13 of the instrument body 1. A thread-fitting groove having a thread-holding force to the extent that a pulling force is applied to both ends 3a, 3b of the ligature thread 3 of the thread twisting portion 4 to prevent the movement thereof when pulled backward,
A thread fitting protrusion, a thread holding protrusion, a friction resistance portion, an adhesive agent, or the like may be provided or used according to the material of the thread.

Further, the intermediate portion 13 of the instrument body 1 is provided with a holding portion 12 for releasably holding both ends 3a, 3b of the ligature 3. In the case of the embodiment of FIGS. 1 and 2,
A small diameter shaft portion 14 is integrally extended to the intermediate portion 13 of the instrument body 1 via a step portion 15, and a hollow shaft-shaped spacer 16 is axially movable on the outer periphery of the small diameter shaft portion 14. It is provided by fitting. The screw part 1 is provided at the rear end of the small diameter shaft part 14.
2, the spacer 16 is fitted and then the tightening nut 18 is screwed into the threaded portion 17 so that the tightening nut 18 is tightened. Both ends 3a and 3b of the ligature 3 are clamped and held between them and the tightening nut 18 is loosened so that the one end 3a of the ligature 3 and the other can be removed from the gap between the step 15 and the spacer 16. Edge side 3
The holding portion 12 capable of releasing b is configured. The holding portion 12 has the ligature 3
The method of holding one end side 3a and the other end side 3b of
The one end side 3a to be released later may be wound first and the other end side 3b to be released later may be wound around and gripped, or the one end side 3a to be released later may be wound around a half or one turn. By wrapping a lot and winding the other end side 3b to be released later by a little less than a half turn from the back and gripping, or changing the holding method between the one end side 3a and the other end side 3b,
The one end side 3a and the other end side 3b can be individually released.

A storage groove 20 for storing and guiding the one end 3a and the other end 3b of the ligature 3 is provided between the twist guide 2 and the holder 12. Storage groove 20
Can be provided so as to project from the outer peripheral surface of the body of the instrument body 1, but as in the illustrated embodiment, it is provided so as not to project so that it does not interfere with other appearance and handling. preferable. The storage groove 20 is provided on one end side 3a of the ligature 3
And the other end portion side 3b can be housed and organized from the twist guide portion 2 to the holding portion 12, and the one end portion side 3 of the ligature 3
It is possible to prevent the a and the other end side 3b from being entangled and twisted, and also to function as a stopper groove that prevents the thread twisting section 4 from moving backward from the thread twisting section 2. In addition, the storage groove 20 is provided in two threads or in a bifurcated thread so that the one end portion side 3a and the other end portion side 3b of the ligature 3 are individually housed and guided from the twist guide portion 2 to the holding portion 12. be able to. In addition, when one end portion side 3a or the other end portion side 3b of the ligature 3 is inserted by applying a tensile force at one or a plurality of locations along the longitudinal direction of the storage groove 20, the ligature 3 can be clamped and the tensile force can be applied. A nipping and holding portion including elastically deformable protrusions having a nipping elastic force that can be removed by lifting while being added is provided, and one end side 3a or the other end side 3b of the ligature 3 is held in the storage groove 20. Can be configured. In this case, the accommodating groove 20 having the sandwiching and holding portion may be used as a holding member on the one end portion side 3a or the other end portion side 3b of the ligature 3 as a cooperating member with the holding portion 12 or as a single member. it can. Also,
The storage groove 20 does not need to be provided continuously between the twist guide portion 2 and the holding portion 12, and for example, the boundary portion between the twist guide portion 2 and the tip end side 31 tubular portion, and the tip portion adjacent to the holding portion 12. Even if the side portion 31 is divided into two portions and the intermediate portion is omitted, the one end portion side 3a and the other end portion side 3b of the ligature 3 from the twist guide portion 2 to the holding portion 12 It can be housed in the housing groove 20 in a taut state. In this case, if the holding holding portion is provided in the storage groove 20, the holding portion 12 is omitted, and the one end portion side 3 of the ligature 3 is omitted.
It is possible to make a or the other end side 3b function as a holding portion that can hold along the side surface of the instrument body.

On the other hand, inside the twist guide portion 2, there is provided a draw thread guide portion 7 consisting of a hollow portion which penetrates the axial core of the instrument body 1 in the direction from the front end portion to the rear end portion. The other end portion side 3b of 3 is configured to be inserted and pulled toward the rear end portion from the leading end portion of the pulling thread guide portion 7. In the case of the embodiment shown in FIG. 2, the pulling thread guide portion 7 is configured as a guide hole 7 penetrating the inside of the twist guide portion 2 and penetrates into the guide hole 7, and the ligature 3 is formed at the tip thereof. A pulling string member 21 that holds the other end portion side 3b and pulls out to the base end portion side of the instrument body 1 is provided so as to be insertable. In the case of the embodiment, the pull string member 21 is shown in FIG.
As shown in FIG. 5, the hollow pipe member 22 has a sufficient length to penetrate the guide hole 7, and the operation shaft member 23 is movably inserted into the pipe. At the tip of the hollow tube member 22, a gripping notch 24 is provided by cutting out the outer tube portion to a depth that allows the other end side 3b of the ligature 3 to traverse the inside of the tube. At the tip of the
4 is provided with a thread introduction notch 26 having a shape corresponding to No. 4 and a grasping protrusion 25 capable of closing the grasping notch 24 at its tip, and the grasping notch 2 of the hollow tube member 22.
4 and the thread introducing notch 26 of the operation shaft member 23 are introduced at a position where they cross the other end side 3b of the ligature 3 into the grasping notch 24, and the hollow tube is introduced in the introduced state. The operation shaft member 23 is moved with respect to the member 22 in a pulling direction or a pushing direction, and the other end side 3b of the ligature 3 is clamped between the end of the gripping notch 24 and the gripping projection 25. It is configured so that it can be gripped.

When the ligature needle 8 is provided at the tip of the other end 3b of the ligature 3, the notch 22 for grasping is provided.
After grasping the other end side 3b of the ligature 3 between the end of the ligature and the grasping protrusion 25, the ligature 3 on the needle 8 side is cut off by a cutter or the like, and the ligature guide 7 is pulled from the ligature member. By pulling 21 out, the other end portion side 3 b of the ligature 3 can be inserted from the front end portion to the rear end portion of the pulling yarn guide portion 7. Further, in the case of the example illustrated in FIG. 17, the other end portion side 3b of the ligature 3 is provided by being inserted in advance from the leading end portion to the rear end portion of the pulling thread guide portion 7. As a form of the ligature holding part of the pulling string member 21, the operating shaft member 23 is projected from the tip of the hollow tube member 22, and the hook-shaped part for hooking the other end side 3b of the ligature 3 to the tip. Alternatively, it may be configured such that it can be held as an annular portion. Further, it is preferable that the instrument body 1 is transparent or translucent because the ligature 3 passing through the pulling thread guide portion can be visually recognized. Also, one end side 3a of the ligature 3
By color-coding the thread on the other end side 3b and the other end side 3b, for example, the other end side 3b of the ligature thread 3 having the ligature needle 8 to be cut off with a cutter or the like can be easily visually recognized and distinguished. . Reference numeral 10 denotes a connector in which the one end side 3a and the other end side 3b of the ligature 3 of the thread twisting portion 4 twisted in the twist guide portion 2 are inserted, and the first knot 5 and the second knot 6 are provided.
The thread twisting portion 4 made of, for example, is connected so as to be slidable simultaneously toward the tip of the instrument body 1. Connector 1
0 is a shape in which holes are formed to allow the one end side 3a and the other end side 3b of the ligature 3 to freely pass through at a predetermined interval and can be removed later without hindering the ligation state. good. For example, the ligature 3 may be made of the same nylon, silk, or an absorbent thread that is dissolved in a tissue and is tied in a ring shape.

6 and 7 show another embodiment of the instrument main body 1, which is characterized in that a one-touch lock type holding portion 12 is provided in the intermediate portion 13 of the instrument main body 1. The instrument body 1 is provided in the holding portion 12 so as to be divided into a tip end side 31 and a base end side 32, and in the case of the embodiment of FIG. 6, a male type having a fitting protrusion 27 on the outer circumference on the tip end side 31. A female fitting in which the fitting shaft portion 28 is integrally provided, and the fitting projection 27 is provided at two positions on the base end side 32 with the fitting projections 27 fitted at the holding position and the releasing position. A hole 30 is provided. In FIG. 6, the fitting protrusion 27 of the fitting shaft portion 28 has the engagement groove 29 on the inner side of the fitting hole portion 30.
In the holding position where it is elastically fitted to the holding portion 12
Is closed and one end side 3a and the other end side 3 of the ligature 3
b and can be held. When the fitting shaft portion 28 is pulled out from the fitting hole portion 30, the fitting protrusion 2 of the fitting shaft portion 28 is pulled out.
7 is in a release position where it is elastically fitted into the locking groove 29 on the front side of the fitting hole 30, and the holding portion 12 is in a released state, so that the one end side 3a and the other end side 3b of the ligature 3 are placed. And can be released. Therefore, in this released state, the intermediate portion between the one end side 3a and the other end side 3b of the ligature 3 guided rearward from the twist guide portion 2 is housed in the holding portion 12, and the fitting shaft portion 28 is fitted. If pushed into the hole 30, the fitting protrusion 27 of the fitting shaft 28
Elastically fits into the locking groove 29 on the inner side of the fitting hole 30 to reach the holding position, and the holding portion 12 holds the intermediate portion between the one end side 3a and the other end side 3b of the ligature 3. Can be held inside.

In the case of the embodiment shown in FIG. 7, a male fitting screw portion 34 having a large pitch thread 33 on the outer periphery is integrally provided on the tip end side 31, and the screw is provided on the base end side 32. A female fitting screw hole 35 is provided with a thread groove 36 in which the crest 33 is screwed between the holding position and the releasing position. In FIG. 7, the screw thread 33 of the fitting screw portion 34 has a fitting screw hole portion 35.
The holding portion 12 is in the closed position, which is screwed all the way into the thread groove 36, and the holding portion 12 is in the closed state.
It is possible to hold a and the other end side 3b. Further, when the base end side 32 is reversely rotated with respect to the tip end side 31 and the fitting screw part 34 is rotated in the unscrewing direction from the fitting screw hole part 35, the holding part 12 is released and the ligature 3 One end side 3
It is possible to release a and the other end side 3b. Therefore,
In this released state, the ligature 3 guided rearward from the twist guide portion 2
The intermediate portion between one end side 3a and the other end side 3b of the holding portion 12
It is housed inside, and the base end side 32 is normally rotated in the screwing direction with respect to the tip end side 31, and the screw thread 33 of the fitting screw portion 34 is screwed into the screw groove 36 of the fitting screw hole portion 35 to the back. The holding portion 12 is in the closed state and can hold the one end portion side 3a and the other end portion side 3b of the ligature 3. 6 or 7, the components having the same functions as those of the embodiments of FIGS. 1 and 2 are designated by the same reference numerals, and the description of the components will be omitted. Further, in FIG. 6 or FIG. 7, a concave-convex groove 37 for preventing slippage is provided on the outer periphery of the rear end portion 32 of the proximal end portion 32 of the instrument body 1.

The embodiment shown in FIGS. 8 to 11 is the same as the surgical ligation instrument described above, except that the one end side 3 of the ligature 3 is used.
One-touch lock type holding portions 12a and 12b for holding a and the other end side 3b releasably are provided in the intermediate portion 13 of the instrument body 1. The tool body 1 has a holding portion 12
In the embodiment shown in FIG. 8, the holding cylinder portion 40 is provided so as to be divided into a distal end portion side 31 and a proximal end portion side 32 between a and 12b, and in the case of the embodiment shown in FIG. Male fitting screw portions 38 and 39 having screw threads with a large pitch in a reverse screw relation are provided integrally on the outer periphery, and the fitting screw portions 38 and 39 are released from the holding position to the holding cylinder portion 40. Female type fitting screw hole portions 41 and 42 each having a screw groove to be screwed to and from the position are provided. In FIG. 8, the fitting screw portions 38 and 39 are respectively engaged with the fitting screw hole portion 4 in a reverse screw relationship.
It is in the state of the holding position screwed all the way into 1, 42,
The holding portions 12a and 12b are respectively on one end side 3 of the ligature 3
It is in a closed state in which a and the other end side 3b are individually held.
Here, when the base end side 32 is rotated forward in the direction indicated by the arrow A in FIG.
From this, the fitting screw hole portion 41 rotates in the screw removing direction, and the holding portion 12a is released so that the other end portion side 3b of the ligature 3 can be released. At this time, the fitting screw part 39 on the base end side 32 receives a rotational force in the fitting screw hole part 42 in the screwing direction, and the holding part 12b maintains the closed state, and the one end part side 3a of the ligature 3 is held. Keeps hold. Therefore,
The other end portion side 3b of the ligature 3 guided rearward from the twist guide portion 2 in the released state of the holding portion 12a is housed in the holding portion 12a, and the holding tubular portion 40 of the arrow B is attached to the tip end side 31. The other end side 3b of the ligature 3 can be held by the holding portion 12a by rotating in the screwing direction. On the contrary, in the closed state in which the one end portion side 3a and the other end portion side 3b of the ligature 3 are individually held by the holding portions 12a and 12b, respectively, the proximal end portion side 32 with respect to the distal end side 31, In Fig. 9, arrow B
When rotated backward in the direction indicated by, the fitting screw portion 39 on the base end side 32 rotates in the screwing-out direction with respect to the fitting screw hole portion 42, the holding portion 12b is in the released state, and one end of the ligature 3 is The part side 3a can be released. At this time, the tip side 3
The fitting screw hole portion 41 receives the rotational force in the screwing direction with respect to the fitting screw portion 38 of No. 1, the holding portion 12a is maintained in the closed state, and the one end side 3a of the ligature 3 is maintained.
Therefore, in this released state, the other end side 3a of the ligature 3 guided rearward from the twist guide portion 2 is accommodated in the holding portion 12b, and the base end side 32 of the holding cylinder portion 40 is indicated by the arrow A. Rotating in the screwing direction, the other end side 3a of the ligature 3 is attached to the holding portion 12b.
Can be held. In addition, in the embodiment shown in FIG. 8, the holding cylinder portion 40 is integrally provided with male fitting screw portions 38 or 39 each having a large pitch thread thread on the outer periphery in a reverse screw relationship, and the holding cylinder portion 40 is provided with A female fitting screw hole portion 41 or 42 in which the fitting screw portion 38 or 39 has a screw groove to be screwed between a holding position and a releasing position.
It is of course possible to provide each of them.

In the case of the embodiment shown in FIG. 10, the instrument main body 1 has the holding portions 12a and 12b, and the holding tubular portion 40 is interposed therebetween.
1 and the base end side 32 are provided so as to be separable, and the holding cylinder 4
0 is a member for fitting the fitting protrusion 27 at the holding position and the releasing position with respect to the male fitting shaft portion 28 having the fitting protrusion 27 integrally provided on the tip end side 31 on the outer periphery. Stop groove 44 2
A female fitting hole 43 provided at a position is provided, and a holding position and a releasing position are provided with respect to the two locking grooves 29 of the female fitting hole 30 on the base end side 32. The male fitting shaft portion 45 having the fitting protrusion 46 that fits in the outer periphery is integrally provided. In FIG. 10, the fitting protrusions 27 and 46 of the fitting shaft portions 28 and 45 of the holding portions 12 a and 12 b are the fitting hole portions 4 respectively.
The holding portions 12a, 12b are in the state of the holding position where they are elastically fitted into the locking grooves 44, 29 on the inner side of 3, 30, respectively.
Is in a closed state and holds one end side 3a and the other end side 3b of the ligature 3. The holding force of the holding portion 12b is set to be larger than that of the holding portion 12a.
When a pulling force is applied to the base end side 32 with respect to, first,
In the fitting shaft portion 28 of the holding portion 12a, the fitting protrusion 27 extends from the fitting hole portion 43 to the engagement groove 44 on the rear side to the engagement groove 44 on the entrance side.
The holding portion 12a is released by moving to. Next, when a stronger pulling force is applied to the base end side 32 with respect to the tip end side 31, the fitting shaft portion 45 of the holding portion 12b moves from the fitting hole portion 30 to the fitting projection 46 on the rear side of the locking groove. By moving from 29 to the engaging groove 29 on the entrance side, the holding portion 12b
To release. In this state, when a pressing force is applied to the base end portion side 32 with respect to the tip end portion side 31, first, the fitting shaft portion 28 of the holding portion 12a and the fitting protrusion 27 in the fitting hole portion 43 are engaged on the front side. By moving from the stop groove 44 to the locking groove 44 on the inner side, the fitting is performed and the holding portion 12a is closed. Next, when a stronger pressing force is applied to the base end portion side 32 with respect to the tip end portion side 31, the fitting shaft portion 45 of the holding portion 12b is inserted into the fitting hole portion 30 and the fitting protrusion 4 is inserted.
6 moves from the locking groove 29 on the front side to the locking groove 29 on the back side to fit and close the holding portion 12b. Therefore,
The one end portion side 3a and the other end portion side 3b of the ligature 3 guided rearward from the twist guide portion 2 in the released state of the holding portions 12a and 12b are housed in the respective holding portions 12a and 12b, and the tip end side 31 When a pressing force is applied to the base end side 32, the fitting shaft portion 28 is first pushed into the fitting hole portion 43 and elastically fitted, and the holding portion 12a holds the other end portion side 3b. Then, the fitting shaft portion 45 is pushed into the fitting hole portion 30 and elastically fitted, and the one end side 3a of the ligature 3 is held by the holding portion 12.
can be held at b. In the embodiment shown in FIG. 10, the holding cylinder portion 40 is a female fitting having two locking grooves 44 that are integrally provided on the distal end side 31 and are fitted at a holding position and a releasing position. The fitting protrusion 2 with respect to the dowel hole 43
7 is provided on the outer circumference of a male fitting shaft portion 28, or a male fitting shaft having a fitting protrusion 46 that fits between the holding position and the releasing position of the base end side 32 on the outer circumference. It is of course possible to integrally form the female fitting hole portion 30 having the two engaging grooves 29 with respect to the portion 45.

In the case of the embodiment shown in FIG. 11, the instrument main body 1 has the holding portions 12a and 12b, and the holding tubular portion 40 is interposed therebetween.
1 and the base end side 32 are provided so as to be separable, and the holding cylinder 4
At 0, with respect to a male fitting screw portion 38 having a large pitch screw thread integrally provided on the tip end side 31, the fitting screw portion 38 is provided between the holding position and the releasing position. A female fitting screw hole portion 41 having a screw groove to be screwed is provided, and the female fitting hole portion 30 on the base end side 32 is held in two locking grooves 29. A male fitting shaft portion 45 having a fitting projection 46 that fits between the position and the release position is integrally provided. It is preferable that the fitting hole portion 30 and the fitting protrusion 46 have a fitting relationship that does not rotate relative to each other, such as a polygonal cross section, a key insertion cross section, or an elliptical cross section. In FIG. 11, the fitting screw portion 3 of the holding portion 12a
8 is in the state of the holding position where it is screwed all the way into the fitting screw hole portion 41, and the fitting protrusion 4 of the fitting shaft portion 45 of the holding portion 12b.
6 is in a holding position where it is elastically fitted into the locking groove 29 on the far side of the fitting hole portion 30, the holding portions 12a and 12b are in the closed state, and the one end side 3a of the ligature 3 and the other The end side 3b can be held individually. In this holding state, when the base end side 32 or the holding cylinder portion 40 is rotated with respect to the tip end side 31 to one side so that the fitting screw hole portion 41 is rotated in the screw removing direction from the fitting screw portion 38, The holding portion 12a is in the released state, and the other end side 3b of the ligature 3 can be released. Further, when the proximal end side 32 is pulled with respect to the distal end side 31, the fitting shaft portion 45 moves from the fitting hole portion 30 to the fitting protrusion 46.
Moves from the locking groove 29 on the back side to the locking groove 29 on the entrance side to release the holding portion 12b. Therefore, the one end portion side 3a and the other end portion side 3b of the ligature 3 guided rearward from the twist guide portion 2 in the released state of the holding portions 12a and 12b are housed in the respective holding portions 12a and 12b, and first, When the base end side 32 is rotated with respect to the tip end side 31 in a direction in which the fitting screw portion 38 is screwed into the fitting screw hole portion 41, the holding portion 12a.
Is closed and can hold the other end side 3b of the ligature 3, and then the proximal end side 32 with respect to the distal end side 31.
When a pressing force is applied to the fitting shaft portion 45, the fitting shaft portion 45 is pushed into the fitting hole portion 30 and is elastically fitted to the holding portion 12b.
a can be held. In the holding portion 12a or 12b of the embodiment of FIG. 11, the holding cylinder portion 40 has a female fitting screw hole portion 41 having a large pitch screw groove integrally provided on the tip end side 31 on the outer periphery. On the other hand, a configuration is provided in which a male fitting screw portion 38 having a screw thread with which the fitting screw hole portion 41 is screwed between the holding position and the releasing position is provided, or on the base end side 32. Of course, the male fitting shaft portion 45 may be integrally provided with the female fitting hole portion 30 into which the two engaging grooves 29 are fitted at the holding position and the releasing position. It is possible.

In the description of the embodiment shown in FIGS. 8 to 11, the one end side 3a of the ligature 3 is held by the holding portion 12b, and the other end side 3b is held by the holding portion 12a. , The holding portion 12b close to the base end portion of the instrument body 1 is released later, and the holding portion 12a far from the base end portion is released first. In this case, one end portion of the ligature 3 is described. With the side 3a held by the holding portion 12b, the holding portion 12
When a is released first, the holding cylinder body 40 is twisted or pulled from the tip end side 31 to provide the holding portion 12a with a gap for releasing the other end side 3b.
With the release of the other end portion side 3b from above, a tensile force is exerted on the one end portion side 3a of the ligature 3 held by the holding portion 12b. However, since the thickness of the ligation stopper 3 is 0.5 mm or less and usually about 0.3 mm or less, the clearance for releasing the other end side 3b in the holding portion 12a is also 0.5 mm or less, and the description will be made. In the figure, the length of the instrument body 1 is described as about 6 to 7 times the thickness, but since it actually has a length of about 50 to 100 times the thickness, for example, 3
When it is set to 00 mm, a tensile force having an elongation rate of about 1/600 or less is applied to the one end side 3a of the ligature 3 held by the holding portion 12b, and the elongation and twisting of the one end side 3a of the ligature 3 are performed. By moving the thread twisting section 4 toward the stopper section 19 and removing the slack in the guide section 2, it can be sufficiently absorbed, and one end side 3a of the ligature thread 3 held by the holding section 12b is detached or cut. Can be prevented in advance. However, contrary to the description of the embodiment shown in FIGS. 8 to 11, the one end side 3a of the ligature 3 is held by the holding part 12a, and the other end side 3b is held by the holding part 12b. Instrument body 1
It is of course possible to release the holding portion 12b near the base end portion first and release the holding portion 12a farther from the base end portion later. Therefore, in the case of such a configuration, the ligation Even if the other end side 3b is first released from the holding part 12b in a state where the one end side 3a of the thread 3 is held by the holding part 12a,
Since no tensile force is applied to the one end side 3a of the ligature 3 held by the holding portion 12a, the holding portion 12a
The holding state of the one end portion side 3a of the ligature thread 3 held by is reliably maintained. In addition, the holding unit 12,
The one-touch type ligature attaching / detaching mechanism of 12a, 12b is not limited to the above-mentioned configuration, and all conventionally known configurations involving rotation or push / pull operation can be applied within the technical scope of the present invention. Is.

According to the surgical ligation instrument of the present invention having the configuration of the above embodiment, the distal end side 3a of the ligature 3 of the thread twisting portion 4 around the twist guide portion 2 of the instrument body 1 and the other end. When the part side 3b is pulled, as shown in FIG. 5, the first knot 5
The distal end side 3a and the other end side 3b of the ligature 3 that is twisted by forming the second knot 6 pass through the inside of the slack 11 between the first and second knots 5, 6 and the twist guide portion. It is wound so as to extend to the outside of 2, and even if it is pulled strongly, the slack 11 part becomes tense, and it tightly wraps around the tapered twist guide portion 2,
Attach the tip side 3a and the other end side 3b of the ligature 3 to the instrument body 1
It will not come off even if it is pulled to the back of. The tip end side 3a and the other end side 3b of the ligature 3 wound around the twist guide portion 2 can be guided backward through the storage groove 20 to the intermediate portion 13 of the instrument body 1 and held in the holding portion 12. It is possible to prevent the one end portion side and the other end portion side 3a, 3b of the ligature 3 from being entangled and tangled, and even if the thread twisting portion 4 is moved backward from the thread twisting portion 2, the stopper portion 19 Can be stopped.

The twisting guide portion 2 at the tip of the instrument body 1 is introduced into the vicinity of the sutured portion or the like through a hollow tubular guide member or the like (not shown), and the holding portion 12 is loosened and the tip portion of the ligature 3 is inserted. The side 3a and the other end side 3b are released, and in the case of the example illustrated in FIG. 12, after the suture portion 9 is sewn with the ligature needle 8 provided at the tip of the other end side 3b of the ligature 3, the pull string The other end side 3b of the ligature 3 is clamped and grasped between the grasping protrusion 22 and the grasping notch 22 at the distal end of the stringing member 21 having the guide portion 7 inserted from the rear end to the distal end. As shown in FIG. 13, with the straight needle-shaped ligature needle 8 attached, or as shown in FIG. 14, the ligature thread 3 on the side to which the ligature needle 8 is attached is cut to guide the pulling thread. From the front end to the rear end of the part 7,
The thread pulling member 21 is pulled out and the other end side 3b of the ligature 3 is inserted, and the ligature 3a on one end side of the thread twisting part 4 of the twist guide 2 is passed through the gap between the instrument body 1 and the guide member to the rear of the guide member. While holding it loosely, or loosely grasping the ligature 3a on one end side of the thread twisting portion 4 of the twisting guide 2 with the grasping forceps guided to the sutured site via another guide member, and pulling thread When the other end side 3b of the ligature 3 pulled out to the rear of the instrument body 1 via the guide portion 7 is pulled, the slack of the ligature 3 sewn or inserted with the suture portion 9 disappears, and the thread twisting portion 4
The first knot 5 and the second knot 6 are pulled toward the tip of the twist guide portion 2 and moved by sliding, and when they come off the tip of the instrument body 1 as shown in FIG. 14, the suture portion 9 is tightened. The thread twisting consisting of the first and second knots 5 and 6 twisted on the ligature 3b in the portion of the distal end of the instrument body 1 that enters the pulling thread guide 7 in accordance with the required surgical knot ligation method. Part 4
Entanglement will result in the formation of the required surgical knot ligature, as shown schematically in FIG.

At this time, as shown in the drawing, one end side 3a and the other end side 3b of the ligature 3 of the thread twisting part 4 twisted in the twist guide part 2 are inserted into the connecting tool 10. For example, when the other end side 3b of the ligature 3 pulled out to the rear of the instrument main body 1 via the pulling thread guide portion 7 is pulled, the first knot 5 and the second knot 6 of the thread twisting part 4 are connected to each other. In the state in which 10 is pulled integrally in the direction of the distal end of the twist guide portion 2 and slid and moved, and simultaneously removed simultaneously from the distal end of the instrument body 1 as shown in FIG. 14 and the suture portion 9 is tightened, As shown in FIG. 15, the nodule by the required surgical knot is formed smoothly and surely. In particular, the thread twisting portion 4 including the first knot 5 and the second knot 6 may be disengaged only from the first knot 5 from the twist guide portion 2, and the second knot 6 may not be removed by tightening the twist guide portion 2. It disappears and the first and second knots are pulled in the direction of the tip of the twist guide part 2 without being divided and slide, and they are sequentially disengaged from the tip of the instrument body 1 and consist of a first knot and a second knot. A nodule formed by the required ligation method can be formed quickly, smoothly, and surely. And FIG.
4 or FIG. 15, the connector 10 engages in a ring shape with a portion of the first knot 5 that is in contact with the suture portion 9 and the outer end of the second knot 6 that is 3a. Since there is no interposition between the knot 5 and the second knot 6, it does not hinder tightening of the knot, and the ligature 3 is easily cut by cutting the ring-shaped part after ligation.
Can leave.

Further, holding portions 12a, 12b for individually releasably holding one end side 3a and the other end side 3b of the ligature 3 respectively.
If the device is provided in the intermediate portion 13 of the instrument body 1, the ligature 3
One end side 3a and the other end side 3b of the holding portions 12a, 12b
In the state where they are individually held, the one end side 3a is guided to the proximal end side 32 of the instrument body 1 that is grasped by the operator, and the other end side 3b with the other suture needle 8 attached is attached to the tip direction of the instrument body 1. Lead to
At the stage of inserting the tip of the instrument body 1 of the present invention through the hollow tubular guide member into the vicinity of the suture site 9 and the like, the holding portion 12a is released only on the other end side 3b, and the suture portion 9 is sutured by the suture needle 8. After suturing, the suture needle 8 is attached or the suture needle 8 is cut off, and then the other end side 3b is passed through the pulling thread guide portion 7 through the inside of the twist guide portion 2 and the base end of the instrument main body 1 The holding portion 12 on the one end side 3a at this stage.
When b is released and the thread on the other end side 3b is pulled, the thread twisting portion 4
Is pulled toward the tip of the twist guide portion 2 and slides to move, the thread twist portion 4 is disengaged from the tip of the instrument body 1, and a knot is formed at the suture site by a predetermined ligation method. Therefore, the one end side 3a can be held in the instrument body 1 while the suturing operation is performed by releasing only the other end side 3b with the suture needle 8 attached, and the suturing work can be performed quickly and smoothly. It can be carried out.

[0032]

As described above, according to the surgical ligation instrument of the present invention, the thread twisting portion obtained by twisting the one end side of the ligature on the outer periphery in accordance with the required ligation method is slid toward the distal end direction. A twist guide portion that holds the device is provided at the tip of the elongated rod-shaped instrument body, and the other end of the ligature is guided through the inside of the twist portion from the tip of the instrument body toward the rear end. In a surgical ligation instrument including a pulling thread guide portion inside the twisting guide portion, a holding portion for releasably holding one end side and the other end side of the ligature is provided in an intermediate portion of the instrument body. With this configuration, one end side and the other end side of the ligature are held in the middle part of the instrument body from the twisted portion of the ligature twisted around the outer circumference of the twist guide part at the tip of the elongated rod-shaped instrument body. Can be held in the state of holding the middle of the ligature, One end side and other end side 3a of the 紮糸 3,
There is an effect that it is possible to prevent the 3b from becoming entangled and twisted. In this state, for example, one end side can be guided to the proximal end side of the instrument body to be grasped by the operator, and the other end side can be guided to the distal end direction of the instrument body. Since the part side can be put in a state of being guided to the base end side of the instrument body by inserting the pulling thread guide part at the tip of the instrument body,
The distal end portion of the instrument body of the present invention is inserted through the hollow tubular guide member in the vicinity of the suture site and the like, and the holding portion is released to come out of the twist guide portion and enter the pulling thread guide portion at the tip portion of the instrument body. The ligature to be ligated is inserted into the slack of the ligature formed on the other end side, and one end side of the ligature is loosely held at the proximal end side of the instrument body, or the thread twisting part of the twist guide part. Loosely grasp the ligature on one end side of the ligature with a thread-drawing member that is guided to the suture site via another guide member, and pull the other end of the ligature that has been pulled out to the rear of the instrument body via the draw-thread guide portion. When the ligature thread into which the object to be ligated has been inserted is no longer slackened, the thread twisting portion is pulled toward the tip of the twist guide portion and slides and moves, and when the thread twisting portion comes off the tip of the instrument body, the object is tightened. The required ligation method is applied to the ligature at the portion of the tip of the instrument body that enters the tug guide. With leno the yarn twisting unit was allowed twisted correspondingly has an effect capable of forming nodules by required ligation methods.

Further, with one end side and the other end side of the ligature being held in the middle holding part of the instrument body with the middle of the ligature being held, one end side is the base of the instrument body grasped by the operator. Guide to the end side, attach a suture needle to the other end side and guide in the distal direction of the instrument body, insert the tip of the instrument body of the present invention through the hollow tubular guide member and near the suture site, etc. After releasing the holding part and suturing the suture part with the suture needle, the suture needle is attached or the suture needle is cut off, and the other end side is passed through the pull thread guide part and passed inside the twist guide part. Guide the thread to the rear end of the instrument body and pull the thread on the other end side, the thread twisting part is pulled toward the tip of the twist guide and slides to move, and the thread twisting part comes off from the tip of the instrument body. By the same means as described above, there is an effect that a knot can be formed at the suture site by a predetermined ligation method. That. Further, in the surgical ligation instrument according to the present invention, the twist guide portion is provided with a stopper portion for preventing the thread twisting portion from moving rearward, and one end side and the other end side of the ligature thread are released. In a surgical ligation instrument in which a holding portion that holds the ligature is provided in an intermediate portion of the instrument body, even if one end side and the other end side of the ligature are pulled relatively strongly toward the holding portion. The thread twisting part of the twisting guide part is prevented from moving backward by the stopper part, so that the thread twisting part can be prevented from being strongly wound around the twisting guide part and coming off, and one end side and the other end side of the ligature thread can be prevented. There is an effect that it can be attached to the holding portion in a taut state.

In the surgical ligation instrument according to the present invention, a storage groove for accommodating and guiding one end side and the other end side of the ligature thread is provided between the twist guide portion and the holding portion. In the surgical ligation instrument provided, one end side and the other end side of the ligature can be stored in the storage groove from the twist guide part to the holding part, and one end of the ligature The side and the other end can be prevented from twisting, and the storage groove has an effect of functioning as a stopper groove for preventing the yarn twisting portion from moving backward from the yarn twisting portion. Further, in the surgical ligation instrument according to the present invention, in the surgical ligation instrument, the other end portion side of the ligature is guided to a rear end direction from a distal end portion of the instrument body, and a twist guide portion is provided inside the twist guide portion. In the case of a guide hole penetrating therethrough, in which a pulling thread member for grasping the other end side of the ligature and pulling it out to the proximal end side of the instrument main body is inserted is provided. With the suture needle attached after the suturing or after the suture needle is cut off, the other end side is grasped by the pull string member and pulled out to the rear of the instrument main body, so that the other end side of the ligature can be easily attached. There is an effect that the knot can be easily guided to the proximal end portion and a knot can be formed at the sutured portion by a predetermined ligation method.

Further, according to the present invention, in the surgical ligation instrument described above, one end side and the other end side of the ligature thread of the thread twisting portion twisted by the twist guide portion are inserted into the connecting tool, and the thread is inserted. By holding the twisting portion so that the twisting portion can slide simultaneously toward the distal end direction, when the other end of the ligature pulled out to the rear of the instrument main body through the pulling yarn guiding portion is pulled, Is pulled in the direction of the tip of the twist guide part integrally by the connecting tool, slides and moves, and is sequentially released from the tip of the instrument body, and with the object tightened, the knot by the required ligation method is smooth and secure. Has the effect of being formed. In particular, the first and second knot portions in which the thread twisting portion including the first knot and the second knot is separated from the twist guide portion only in the first knot portion and the second knot portion is prevented from coming off the twist guide portion. Is pulled in the direction of the tip of the twist guide without sliding, slides, and is sequentially disengaged from the tip of the instrument body. The knot by the required ligation method consisting of the first knot and the second knot is swift, smooth, and ,
It has the effect of being reliably formed. Further, the present invention provides the above surgical ligation instrument, wherein the twist guide portion is twisted at one end side thereof in accordance with a ligation method comprising a surgical knot in which only the first knot of a male knot is repeated twice. By holding the thread twisting portion slidably toward the distal end, the first knot and the first knot can be removed by simply pulling the other end side of the ligature drawn to the rear of the instrument body via the pulling thread guide. There is an effect that a thread knot formed by two knots is disengaged from the tip of the instrument body, and a knot is formed by a required surgical knot ligation method in a state where the ligation part is tightened.

Further, according to the present invention, in the surgical ligation instrument described above, a holding portion for releasably holding one end side and the other end side of the ligature is provided at an intermediate portion of the instrument body. By having the one end side and the other end side of the ligature individually held in the holding portion of the intermediate portion of the instrument body,
One end side is guided to the base end side of the instrument body that the operator holds,
At the stage where the other end side with the other suture needle attached is guided toward the tip of the instrument body, and the tip of the instrument body of the present invention is inserted near the suture site or the like through the hollow tubular guide member,
After releasing the holding part only on the other end side and suturing the suture part with the suture needle, the other end side is twisted and guided through the pull thread guide part with the suture needle attached or after the suture needle is cut off. It can be guided to the rear end of the instrument body through the inside of the part, and at this stage, when the holding part on the one end side is released and the thread on the other end side is pulled, the thread twisting part causes the twisting guide part. Is pulled in the direction of the tip of the to slide and move, the thread twisting part comes off from the tip of the instrument body,
By means similar to the above, a knot can be formed at the suture site by a predetermined ligation method, and therefore, only the other end side where the suture needle is attached is released to perform the suturing operation of the suture portion,
Since one end side can be held in the instrument body,
There is an effect that it is possible to prevent the both ends of the ligature from being released and to be complicated, and to perform the suturing work quickly and smoothly.

[Brief description of the drawings]

FIG. 1 is a schematic explanatory view schematically showing one usage mode of a main part of one embodiment of the present invention.

FIG. 2 is a schematic explanatory view schematically showing a part of a main portion of the embodiment shown in FIG.

FIG. 3 is a schematic explanatory view schematically showing another main part of one embodiment of the present invention.

FIG. 4 is a schematic explanatory view schematically showing an enlarged main part of one embodiment of FIG.

FIG. 5 is a schematic explanatory view showing, in an enlarged manner, one usage mode of a main part of one embodiment of the present invention.

FIG. 6 is a schematic explanatory view schematically showing one usage mode of a main part of another embodiment of the present invention.

FIG. 7 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 8 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 9 is a schematic left side view for explaining a usage mode of a main part of the embodiment of FIG.

FIG. 10 is a schematic explanatory view schematically showing one usage mode of a main part of another embodiment of the present invention.

FIG. 11 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 12 is a schematic explanatory view schematically showing one usage mode of a main part of one embodiment of the present invention.

FIG. 13 is a schematic explanatory view schematically showing another usage mode of the main part of the embodiment of the present invention.

FIG. 14 is a schematic explanatory view schematically showing another usage mode of the main part of the embodiment of the present invention.

FIG. 16 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 17 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 18 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 19 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 20 is a schematic explanatory view for explaining a method of ligating a main part of one embodiment of the present invention.

FIG. 21 is a schematic explanatory view for explaining a ligation method of a main part according to one embodiment of the present invention.

FIG. 22 is a schematic explanatory view for explaining a method of ligating a main part according to one embodiment of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Instrument main body 2 Twist guide part 3 Ligation thread 3a One end side of ligature thread 3b Other end part side of ligature thread 4 Thread twist part 5 1st knot 6 2nd knot 7 Pull thread guide part 8 Knotting needle 9 Suture part 10 Connection Tool 11 Sagging part 12 Holding part 12a Holding part 12b Holding part 13 Intermediate part 14 Small diameter shaft part 15 Step part 16 Spacer 17 Screw part 18 Tightening nut 19 Stopper part 20 Storage groove 21 Threading member 22 Hollow tube member 23 Operation shaft member 24 Notch for gripping 25 Protrusion for gripping 26 Notch for thread introduction 27 Fitting protrusion 28 Fitting shaft 29 Locking groove 30 Fitting hole 31 Tip side 32 Base end side 33 Thread 34 Fitting screw 35 Fitting screw hole portion 36 Screw groove 37 Uneven groove 38 Fitting screw portion 39 Fitting screw portion 40 Holding tube portion 41 Fitting screw hole portion 42 Fitting screw hole portion 43 Fitting hole portion 44 Locking groove 45 Fitting Mating part 46 Fitting protrusion

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[Procedure amendment]

[Submission date] April 24, 1996

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name] Brief description of drawings

[Correction method] Change

[Correction contents]

[Brief description of the drawings]

FIG. 1 is a schematic explanatory view schematically showing one usage mode of a main part of one embodiment of the present invention.

FIG. 2 is a schematic explanatory view schematically showing a part of a main portion of the embodiment shown in FIG.

FIG. 3 is a schematic explanatory view schematically showing another main part of one embodiment of the present invention.

FIG. 4 is a schematic explanatory view schematically showing an enlarged main part of one embodiment of FIG.

FIG. 5 is a schematic explanatory view showing, in an enlarged manner, one usage mode of a main part of one embodiment of the present invention.

FIG. 6 is a schematic explanatory view schematically showing one usage mode of a main part of another embodiment of the present invention.

FIG. 7 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 8 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 9 is a schematic left side view for explaining a usage mode of a main part of the embodiment of FIG.

FIG. 10 is a schematic explanatory view schematically showing one usage mode of a main part of another embodiment of the present invention.

FIG. 11 is a schematic explanatory view schematically showing one mode of use of a main part of another embodiment of the present invention.

FIG. 12 is a schematic explanatory view schematically showing one usage mode of a main part of one embodiment of the present invention.

FIG. 13 is a schematic explanatory view schematically showing another usage mode of the main part of the embodiment of the present invention.

FIG. 14 is a schematic explanatory view schematically showing another usage mode of the main part of the embodiment of the present invention.

FIG. 15 is a schematic explanatory view schematically showing another usage mode of the main part of the embodiment of the present invention.

FIG. 16 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 17 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 18 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 19 is a schematic explanatory view for explaining the principle of the ligating means of the surgical ligation instrument of the present invention.

FIG. 20 is a schematic explanatory view for explaining a method of ligating a main part of one embodiment of the present invention.

FIG. 21 is a schematic explanatory view for explaining a ligation method of a main part according to one embodiment of the present invention.

FIG. 22 is a schematic explanatory view for explaining a method of ligating a main part according to one embodiment of the present invention.

[Explanation of symbols] 1 instrument main body 2 twist guide part 3 ligature 3a one end side of ligature 3b other end side of ligature 4 thread twisting part 5 first knot 6 second knot 7 pulling yarn guide 8 ligature needle 9 stitching part 10 connecting tool 11 slack part 12 holding part 12a holding part 12b holding part 13 middle part 14 small diameter shaft part 15 step part 16 spacer 17 screw part 18 tightening nut 19 stopper part 20 storage groove 21 string pulling member 22 hollow tube member 23 Operation Shaft Member 24 Grip Notch 25 Grip Protrusion 26 Threading Notch 27 Fitting Protrusion 28 Fitting Shaft 29 Locking Groove 30 Fitting Hole 31 Tip Side 32 Base End Side 33 Screw Thread 34 Fitting screw part 35 Fitting screw hole part 36 Screw groove 37 Uneven groove 38 Fitting screw part 39 Fitting screw part 40 Holding tube part 41 Fitting screw hole part 42 Fitting screw hole part 43 Fitting hole part 4 Locking groove 45 fitting shaft 46 fitting protrusion

Claims (7)

[Claims] 1. A twist guide portion for slidably holding a thread twisting portion, which is obtained by twisting one end side of a ligature thread according to a required ligation method on an outer periphery, in a distal end of an elongated rod-shaped instrument body. And a pulling thread guide part inside the twisting guide part for guiding the other end side of the ligature from the front end part to the rear end part of the instrument body through the inside of the thread twisting part. A surgical ligation instrument, wherein the surgical ligation instrument is provided with a holding portion for releasably holding one end side and the other end side of the ligature thread in an intermediate portion of the instrument body. 2. A distal end of an elongated rod-shaped instrument main body having a twist guide portion for holding a thread twisting portion, which is obtained by twisting one end side of a ligature thread on the outer periphery in accordance with a required ligation method, slidably in a distal direction. Surgery in which the other end side of the ligature thread is guided inside the twisting portion in the direction from the front end to the rear end of the instrument body. In a surgical ligation instrument, the twist guide portion is provided with a stopper portion that prevents the thread twisting portion from moving rearward, and a holding portion that releasably holds one end side and the other end side of the ligature instrument is the instrument. A surgical ligation device provided in the middle part of the main body. 3. A distal end of an elongated rod-shaped instrument main body having a twist guide portion for slidably holding a thread twisting portion obtained by twisting one end side of a ligature thread on an outer periphery in accordance with a required ligation method. Surgery in which the other end side of the ligature thread is guided inside the twisting portion in the direction from the front end to the rear end of the instrument body. In the surgical ligation instrument, a holding part for releasably holding one end side and the other end side of the ligature is provided in an intermediate part of the instrument body, and the ligature is provided between the twist guide part and the holding part. A surgical ligation instrument comprising a storage groove for storing and guiding one end side and the other end side of a thread. 4. The surgical ligation instrument according to claim 1, 2 or 3, wherein the other end side of the ligature is passed through the inside of the twisted portion in the direction from the front end to the rear end of the instrument main body. The pulling thread guide portion to be guided is configured as a guide hole penetrating the inside of the twisting guide portion, and the other end side of the ligature is held in the guide hole and pulled out to the proximal end side of the instrument body. A ligation instrument for surgery, wherein a thread member is provided so as to be inserted therethrough. 5. The surgical ligation instrument according to claim 1, 2, 3 or 4, wherein one end side and the other end side of the ligature of the thread twisting portion twisted by the twisting guide portion,
A ligation instrument for surgery, characterized in that it is inserted into a connecting tool, and the thread twisting portion is held so as to be simultaneously slidable toward the distal end direction. 6. The surgical ligation device according to claim 1, 2, 3, 4, or 5, wherein the twist guide has one end of the ligature and the first knot of the male knot is repeated twice. A surgical ligation instrument characterized in that a thread twisting portion twisted by a ligation method is held slidably in the distal direction. 7. The method of claim 1, 2, 3, 4, or 5.
Or the surgical ligation instrument according to item 6, wherein a holding portion for releasably holding one end side and the other end side of the ligature is provided in an intermediate portion of the instrument body. Ligation device.