JPH10118074A - Stomach wall-fixing tool and its use method - Google Patents
Stomach wall-fixing tool and its use methodInfo
- Publication number
- JPH10118074A JPH10118074A JP8279567A JP27956796A JPH10118074A JP H10118074 A JPH10118074 A JP H10118074A JP 8279567 A JP8279567 A JP 8279567A JP 27956796 A JP27956796 A JP 27956796A JP H10118074 A JPH10118074 A JP H10118074A
- Authority
- JP
- Japan
- Prior art keywords
- fixing device
- gastric
- wall
- wall fixing
- port
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Landscapes
- Surgical Instruments (AREA)
Abstract
Description
【０００１】[0001]
【発明の属する技術分野】本発明は内視鏡を用いた処置
を腹壁・胃壁を通して行うために、その通路を確保する
ための胃壁固定用具に関するものであり、更にはその固
定・留置を容易にするための胃壁固定具挿入補助具の構
造および使用方法に関するものである。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a stomach wall fixing device for securing a passage for performing treatment using an endoscope through an abdominal wall and a stomach wall, and furthermore, to easily fix and retain the stomach wall. The present invention relates to a structure and a method for using a gastric wall fixing device insertion assisting device for carrying out the method.
【０００２】[0002]
【従来の技術】近年内視鏡による治療が盛んになり、そ
の手技・工夫も数多くみられる。またそれに伴って適応
範囲の拡大も著しく、従来食道のみであったが、胃、大
腸へも適応が拡大され、良性疾患から悪性疾患への適応
拡大もなされている。胃内粘膜の悪性腫瘍に対しては従
来、内視鏡的にはスネア鉗子を用いた切除（ＥＭＲ）が
古くから行われてきた。（消化器内視鏡治療マニュアル
・南江堂・１９９２、Ｐ．２７〜Ｐ．４４）これによれ
ばスネア鉗子により、腫瘍に絞厄をかけ高周波通電によ
り腫瘍を切離する。本法では良性の腫瘍はもちろん、悪
性の腫瘍の軽度なもの（I、IIの型：内視鏡分類）が適
応となるが、一方で切除する大きさは３ｃｍ程度が最大
となる。2. Description of the Related Art In recent years, treatment with an endoscope has become popular, and many techniques and devices have been found. In addition, the range of adaptation has been remarkably expanded, and conventionally, only the esophagus was used. For malignant tumors in the gastric mucosa, excision (EMR) using snare forceps has been conventionally performed endoscopically for a long time. (Gastrointestinal endoscopy treatment manual, Nankodo, 1992, pp. 27-44) According to this, the tumor is squeezed by snare forceps, and the tumor is cut off by high-frequency power supply. In this method, not only benign tumors, but also mild malignant tumors (types I and II: endoscopic classification) are indicated, but the maximum size to be resected is about 3 cm.
【０００３】この適応拡大のため様々な手法が考えられ
てきた。２チャンネルの内視鏡を用いて一方の鉗子孔よ
り挿入した鉗子より絞厄部位に牽引を掛け、より大きな
切除片を得る方法（２チャンネル法）、井上らの透明フ
ードを用いた方法（早期胃癌に対する内視鏡的粘膜切除
術−透明プラスチックキャップを用いる方法（ＥＭＲ
Ｃ）−Ｇａｓｔｒｏｅｎｔｅｒｏｌ Ｅｎｄｏｓｃ３
５：６００−６０４，１９９３）、増田らの内視鏡的食
道静脈瘤結紮具（ＥＶＬデバイス）を用いた方法（Ｌｉ
ｇａｔｉｎｇ ｄｅｖｉｃｅを利用した内視鏡的粘膜切
除術（ＥＭＲＬ）、消化器内視鏡５（９）：１２１５−
１２１９，１９９３）などが開発されている。[0003] Various techniques have been considered for expanding the adaptation. A method of using a two-channel endoscope to pull a squeezed area with forceps inserted from one forceps hole to obtain a larger resected piece (two-channel method), a method using a transparent hood of Inoue et al. Endoscopic mucosal resection for gastric cancer-method using transparent plastic cap (EMR
C) -Gastroenterol Endosc3
5: 600-604, 1993), a method using an endoscopic esophageal varices ligation device (EVL device) by Masuda et al. (Li
Endoscopic mucosal resection (EMRL) using a gating device, gastrointestinal endoscope 5 (9): 1215-
1219, 1993).
【０００４】しかしながら大きさ２ｃｍ近くの腫瘍の完
全切除は一般的には非常に困難である。一方で近年急速
に普及した腹腔鏡下手術の一つとしてＴバーにより胃壁
を吊り上げ、切除を行う大上らのリージョンリフティン
グ法（早期胃癌に対する新しい治療法、ｌｅｓｉｏｎ
ｌｉｆｔｉｎｇ法による腹腔鏡下胃局所切除術、胃と腸
２８：１４６１−１４６８、１９９３）によれば２ｃｍ
以上の進達度ｍ（内視鏡分類）の悪性腫瘍は十分に切離
可能であるが、比較的高価な器具を使用している。[0004] However, complete resection of a tumor near 2 cm in size is generally very difficult. On the other hand, as one of the laparoscopic surgeries that have spread rapidly in recent years, the region lifting method of Ogami et al., Which lifts the stomach wall with a T-bar and performs resection (a new treatment method for early gastric cancer, region
laparoscopic local gastrectomy by the lifting method, stomach and intestine 28: 1461-1468, 1993), 2 cm
Malignant tumors with the above-mentioned degree of progress m (endoscope classification) can be sufficiently separated, but relatively expensive instruments are used.
【０００５】その２つの中間に位置するものとして、大
橋らによる腹腔鏡下胃内手術（腹腔鏡下胃内手術、手術
４８：３３３−３３７、１９９４）や共同発明人である
村井の考案した経皮経胃壁内視鏡下粘膜切除術（早期胃
癌に対する経皮経胃壁内視鏡下粘膜切除術（ＰＴＥＭ
Ｒ）、手術４９：１３４３−１３４８）が開発された。
腹腔鏡下胃内手術ではバルーン付のトラカールを用いて
直接腹壁より胃壁を穿刺して、胃内部の処置を行う。経
皮経胃壁内視鏡下粘膜切除術も同様に内視鏡下胃瘻造設
術用のボタンを用いて胃粘膜の処置を行う。[0005] In between the two, a laparoscopic intragastric operation by Ohashi et al. (Laparoscopic intragastric operation, operation 48: 333-337, 1994) and a process devised by co-inventor Murai. Percutaneous transgastric wall endoscopic mucosal resection for early gastric cancer
R), Surgery 49: 1343-1348) was developed.
In laparoscopic intragastric surgery, the inside of the stomach is treated by puncturing the stomach wall directly from the abdominal wall using a trocar with a balloon. Similarly, in percutaneous transgastric wall endoscopic mucosal resection, the gastric mucosa is treated using a button for endoscopic gastrostomy.
【０００６】これらの方法では胃病変部位の十分な牽引
が可能であり、切除径も１５×１０〜３５×２５とＥＭ
Ｒと比較すると大きなものとなる。また従来のＥＭＲで
はアプローチ困難であった胃体上部前壁や胃体上部小彎
へのアプローチが可能であった。[0006] In these methods, sufficient traction of the stomach lesion can be performed, and the resected diameter is 15 × 10 to 35 × 25, which is EM.
It is larger than R. In addition, it was possible to approach the upper anterior wall of the stomach and the lesser curvature of the upper stomach, which were difficult to approach with the conventional EMR.
【０００７】ＰＴＥＭＲで使用されるボタンは、ポンス
キーらの開発した胃造瘻術用具（特表平６−５０３２４
３）であり、これは本来在宅での経胃瘻栄養術に使用さ
れるもので、比較的柔軟な物性を有しており硬性の鉗子
を使用するには不向きであり、またその価格も比較的高
価であったため、容易に行える手技とは言えなかった。The button used in PTEMR is a gastrostomy device developed by Ponsky et al.
3), which is originally used for transgastric fistula feeding at home, has relatively soft physical properties and is unsuitable for using hard forceps, and its price is comparable. It was not easy to perform because it was expensive.
【０００８】[0008]
【発明が解決しようとする課題】本発明は、ポート部の
内腔を通して胃内の処置を行うための胃壁固定用具のこ
れらの問題点を解決するため、種々検討の結果なされた
もので、その目的とするところは、安価で安全・簡単に
胃壁固定具を留置できる胃壁固定具挿入補助具及びその
使用方法を提供することにある。DISCLOSURE OF THE INVENTION The present invention has been made as a result of various studies to solve these problems of a gastric wall fixing device for performing intragastric treatment through the lumen of a port. It is an object of the present invention to provide a gastric wall fixing device insertion assisting device which can inexpensively, safely and easily hold a gastric wall fixing device, and a method of using the same.
【０００９】[0009]
【課題を解決するための手段】即ち本発明は、開口した
ポート部及びポート固定具より構成される胃壁固定具、
及び誘導部、可撓性を有する屈曲部、固定部より構成さ
れ、該誘導部はその一端を該屈曲部に接合され、また該
屈曲部のもう一つの端部は該固定部に接合されており、
該固定部を該誘導部方向に該固定部に一時的に接合され
た牽引ワイヤーにより圧縮すると、該屈曲部はその可撓
性により該誘導部の外径よりもさらに外側に拡張し、ま
た該固定部の圧縮を解除することにより該屈曲部の拡張
が元に戻り、その外径が該誘導部の外径とほぼ同一とな
る胃壁固定具挿入補助具と、留置する際に該胃壁固定具
及び該胃壁固定具挿入補助具を誘導し、また該胃壁固定
具挿入補助具の該固定部を圧縮・解放するための牽引ワ
イヤーと、該牽引ワイヤーを体内へ誘導するための穿刺
針の組み合わせよりなる胃壁固定用具であり、該誘導
部、該屈曲部及び該固定部がおのおの１つ以上の内腔を
有し、また該屈曲部は可撓性を有し、その軸方向に１以
上の切れ目の入っていることを特徴とする胃壁固定具挿
入補助具であり、内視鏡下に腹壁及び胃壁を穿刺針によ
り穿刺し、牽引ワイヤーを胃内に導入し、更に内視鏡よ
り導入した把持鉗子により該牽引ワイヤーを患者の口よ
り取り出し、該牽引ワイヤーに胃壁固定具のポート部及
び胃壁固定具挿入補助具を装着し、該牽引ワイヤーを腹
壁側より牽引し、該ポート部を胃壁、腹壁を通過させた
後、該牽引ワイヤーを押し戻し、該胃壁固定具挿入補助
具と該牽引ワイヤーを抜去し、該ポート部をポート固定
具で、腹壁に固定することにより、該ポート部の内腔を
通して遠隔操作により胃内粘膜の牽引、切除などの処置
を行うことを特徴とする胃壁固定用具の使用方法であ
る。That is, the present invention provides a gastric wall fixing device comprising an open port portion and a port fixing device.
And a guide portion, a flexible bent portion, and a fixed portion, the guide portion having one end joined to the bent portion, and the other end portion of the bent portion joined to the fixed portion. Yes,
When the fixing part is compressed in the direction of the guiding part by a pulling wire temporarily joined to the fixing part, the bending part expands further outside the outer diameter of the guiding part due to its flexibility, and The expansion of the bent portion is returned to the original state by releasing the compression of the fixing portion, and the gastric wall fixing device insertion assisting tool whose outer diameter is substantially the same as the outer diameter of the guiding portion, and the gastric wall fixing device when indwelling And a combination of a traction wire for guiding the gastric wall fixing device insertion assisting device, for compressing and releasing the fixing portion of the gastric wall fixing device insertion assisting device, and a puncture needle for guiding the traction gas wire into the body. A stomach wall fixing device, wherein each of the guiding portion, the bending portion, and the fixing portion has one or more lumens, and the bending portion has flexibility, and has one or more cuts in its axial direction. Is a gastric wall fixation device insertion aid characterized by containing The abdominal wall and stomach wall are punctured with a puncture needle under a mirror, a traction wire is introduced into the stomach, and the traction wire is taken out of the patient's mouth with a grasping forceps introduced from an endoscope. A port portion and a gastric wall fixing device insertion aid are attached, the traction wire is pulled from the abdominal wall side, the port portion is passed through the stomach wall, the abdominal wall, and then the traction wire is pushed back, and the gastric wall fixing device insertion aid is By withdrawing the traction wire and fixing the port portion to the abdominal wall with a port fixing device, a procedure such as traction and resection of the gastric mucosa is remotely performed through the lumen of the port portion. This is how to use the gastric wall fixing device.
【００１０】[0010]
【発明の実施の形態】以下、図示した実施例に基づい
て、本発明を詳細に説明する。図１は本発明の一実施例
となる胃壁固定具挿入補助具の外観図で、図２は胃壁固
定具挿入補助具の固定部の詳細図、図３は牽引ワイヤー
による一連の脱着操作を表し、図４は患者に胃壁固定具
を装着する動作を表す図である。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, the present invention will be described in detail based on illustrated embodiments. FIG. 1 is an external view of a gastric wall fixing device insertion assisting device according to an embodiment of the present invention, FIG. 2 is a detailed view of a fixing portion of the gastric wall fixing device inserting assisting device, and FIG. FIG. 4 is a view showing an operation of attaching a stomach wall fixture to a patient.
【００１１】本発明による胃壁固定具挿入補助具（１
１）は図１に示すように、誘導部（１）、屈曲部
（２）、固定部（３）より構成されている。誘導部
（１）は１以上、望ましくは１つの内腔を有し、該内腔
はその内側に牽引ワイヤー（４）などが通過する。また
屈曲部（２）と接合される部位と反対側はテーパー状と
なっていることが望ましい。テーパー状になることによ
り拡張時の抵抗を押さえることが可能となる。使用され
る材質は塩化ビニル樹脂などの合成樹脂またはステンレ
ス鋼等があり、特に硬質の合成樹脂が適当である。外径
及び全長は特に制限しないが、患者への侵襲、患者の腹
壁（６）、胃壁（７）の厚さを考慮すると、おのおのφ
３〜φ３０ｍｍ、３０〜３００ｍｍが適当である。内腔
の内径は牽引ワイヤー（４）一本分の外径よりも大き
く、また牽引ワイヤー（４）二本分の外径よりも小さい
ことが望ましく、それにより後に示す牽引ワイヤー
（４）の固定がより強固なものとなる。[0011] The gastric wall fixture insertion aid (1) according to the present invention.
As shown in FIG. 1, 1) is composed of a guide portion (1), a bent portion (2), and a fixed portion (3). The guide (1) has one or more, preferably one, lumen through which a traction wire (4) or the like passes. It is desirable that the side opposite to the part to be joined to the bent portion (2) is tapered. The tapered shape makes it possible to reduce the resistance during expansion. The material used is a synthetic resin such as a vinyl chloride resin or stainless steel, and a hard synthetic resin is particularly suitable. Although the outer diameter and the total length are not particularly limited, considering the invasion to the patient and the thickness of the patient's abdominal wall (6) and stomach wall (7), each of them is φ
3 to 30 mm and 30 to 300 mm are appropriate. Preferably, the inner diameter of the lumen is larger than the outer diameter of one pulling wire (4) and smaller than the outer diameter of two pulling wires (4), thereby securing the pulling wire (4) as described later. Will be more robust.
【００１２】屈曲部（２）は１以上望ましくは１つの内
腔を有し、かつその内腔は誘導部（１）のそれに比して
大きく、これにより必要十分な柔軟性を有する。該屈曲
部（２）はその両端が誘導部（１）および固定部（３）
と接合されている。該屈曲部（２）は軸方向に１以上、
望ましくは３ないし４つのスリットを有する。３ないし
４つのスリットが加工上コストが低く、かつ有効な固定
力が得られる。その外径は誘導部（１）のそれに等しい
が、圧縮されるとスリット部が屈曲し、外径が拡大す
る。拡大された外径は特に規定しないが、望ましくは誘
導部（１）の外径の２倍くらいの大きさである。２倍程
度の大きさであれば、その外側に固定する胃壁固定具
（１３）が抜ける恐れもなく、また食道内腔を牽引する
際に、引っかかりとなる恐れも少ない。使用される材質
は天然ゴム、合成ゴムまたは軟質塩化ビニル樹脂などの
合成樹脂である。外径及び全長は特に制限しないが、患
者への侵襲、患者の腹壁（６）、胃壁（７）の厚さを考
慮すると、おのおのφ３〜φ３０ｍｍ、３〜１００ｍｍ
が適当である。またスリットの大きさは強度を考慮する
と１〜３０ｍｍが適当である。The bend (2) has one or more preferably one lumen, and the lumen is larger than that of the guide (1), so that it has necessary and sufficient flexibility. Both ends of the bent portion (2) are the guide portion (1) and the fixed portion (3).
And are joined. The bent portion (2) is one or more in the axial direction,
Preferably, it has three or four slits. Three or four slits are low in processing cost, and provide an effective fixing force. Its outer diameter is equal to that of the guide part (1), but when compressed, the slit part bends and the outer diameter increases. Although the enlarged outer diameter is not particularly defined, it is desirably about twice as large as the outer diameter of the guiding portion (1). If the size is about twice, there is no danger that the stomach wall fixing device (13) fixed to the outside of the stomach will fall out, and there is little possibility that the stomach wall is caught when the esophageal lumen is towed. The material used is a synthetic resin such as natural rubber, synthetic rubber or soft vinyl chloride resin. Although the outer diameter and the total length are not particularly limited, considering the invasion to the patient and the thickness of the patient's abdominal wall (6) and stomach wall (7), each is φ3 to φ30 mm and 3 to 100 mm.
Is appropriate. Also, the size of the slit is suitably 1 to 30 mm in consideration of the strength.
【００１３】該胃壁固定挿入補助具（１１）の形状は特
に限定されるものではないが、該誘導部（１）、該屈曲
部（２）、該固定部（３）が共に同一の外径を有する円
筒形で構成されることが望ましく、同一外径となること
により着脱がスムーズになる。固定部（３）は１以上、
望ましくは２つの内腔を有し、その片端が屈曲部（２）
に接合されている。２つの内腔を有することにより、図
２に示すように誘導部（１）内腔を通過した牽引ワイヤ
ー（４）は一旦固定部（３）の内腔より外に飛び出し、
Ｕターンして固定部（３）のもう一つの内腔を通り、再
び固定部（３）の内腔へ戻る。使用される材質は塩化ビ
ニル樹脂などの合成樹脂又はステンレス鋼等があり、特
に硬質の合成樹脂が適当である。The shape of the gastric wall fixing / insertion assisting device (11) is not particularly limited, but the guiding portion (1), the bent portion (2), and the fixing portion (3) have the same outer diameter. It is desirable to be constituted by a cylindrical shape having the same outer diameter. The fixed part (3) is one or more,
Preferably it has two lumens, one end of which is bent (2)
Is joined to. By having two lumens, as shown in FIG. 2, the pulling wire (4) that has passed through the guide part (1) lumen once jumps out of the lumen of the fixed part (3),
It makes a U-turn, passes through another lumen of the fixed part (3), and returns to the lumen of the fixed part (3) again. The material used is a synthetic resin such as a vinyl chloride resin or stainless steel, and a hard synthetic resin is particularly suitable.
【００１４】患者への侵襲を考慮すると、外径はφ３〜
φ３０ｍｍ、望むらくは誘導部（１）の外径と同じであ
ることが望ましい。外径が同じであることにより、胃壁
固定具（１３）の脱着がスムーズになる。接着強度を考
慮すると、全長は１〜３０ｍｍ程度が望ましい。従っ
て、図３に示すように牽引ワイヤー（４）を誘導部
（１）側に引っ張ると（ａ）、屈曲部（２）が折れ曲が
り、その外径は拡大し、逆に牽引ワイヤー（４）のみ戻
してやると（ｂ）、屈曲部（２）が伸びて外径が誘導部
（１）と同一になる。さらに牽引ワイヤー（４）を戻し
てやると（ｃ）、一端が固定部（３）より離れ、今度は
牽引ワイヤー（４）を引っ張ると今度は牽引ワイヤー
（４）のみ抜ける（ｄ）。[0014] Considering the invasion of the patient, the outer diameter is φ3 to
It is preferable that the outer diameter of the guide part (1) is the same as φ30 mm, and hopefully. When the outer diameter is the same, the gastric wall fixing device (13) can be smoothly attached and detached. Considering the adhesive strength, the total length is desirably about 1 to 30 mm. Accordingly, as shown in FIG. 3, when the pulling wire (4) is pulled toward the guiding portion (1) (a), the bent portion (2) is bent, and its outer diameter is enlarged, and conversely, only the pulling wire (4) is provided. When it is returned (b), the bent portion (2) expands and the outer diameter becomes the same as that of the guide portion (1). When the pulling wire (4) is further returned (c), one end is separated from the fixing portion (3), and when pulling the pulling wire (4), only the pulling wire (4) comes off (d).
【００１５】図４に示すように、胃壁固定具挿入補助具
（１１）、牽引ワイヤー（４）、穿刺針（５）、ポート
部（１０）により容易に胃壁（７）の固定および胃内腔
への処置通路の確保を行うことが可能である。内視鏡
（８）下に腹壁（６）および胃壁（７）を穿刺針（５）
により穿刺し、牽引ワイヤー（４）を胃内に導入する。
内視鏡（８）の鉗子孔より導入した把持鉗子（９）によ
り牽引ワイヤー（４）を把持し（ａ）、内視鏡（８）ご
と抜去する。患者の口より牽引ワイヤー（４）を取り出
し（ｂ）、ポート部（１０）及び胃壁固定具挿入補助具
（１１）を（ｃ）の様に牽引ワイヤー（４）にセットす
る。牽引ワイヤー（４）を腹壁（６）側より牽引し、胃
壁（７）、腹壁（６）を固定する（ｄ）。固定後前述の
方法により、胃壁固定具挿入補助具（１１）、牽引ワイ
ヤー（４）を抜去し（ｅ）、ポート部（１０）をポート
固定具（１２）により腹壁（６）に固定する（ｆ）。造
設された胃壁固定具（１３）を介して胃壁内の処置を行
う。As shown in FIG. 4, the stomach wall (7) can be easily fixed and the stomach cavity can be easily fixed by the gastric wall fixture insertion aid (11), the pulling wire (4), the puncture needle (5), and the port (10). It is possible to secure a treatment path to the patient. A puncture needle (5) through the abdominal wall (6) and stomach wall (7) under the endoscope (8)
And the traction wire (4) is introduced into the stomach.
The pulling wire (4) is gripped by the gripping forceps (9) introduced from the forceps hole of the endoscope (8) (a), and the entire endoscope (8) is removed. The traction wire (4) is taken out from the mouth of the patient (b), and the port (10) and the gastric wall fixture insertion aid (11) are set on the traction wire (4) as shown in (c). The traction wire (4) is pulled from the abdominal wall (6) side to fix the stomach wall (7) and the abdominal wall (6) (d). After the fixation, the stomach wall fixture insertion aid (11) and the traction wire (4) are removed by the above-mentioned method (e), and the port (10) is fixed to the abdominal wall (6) by the port fixture (12) ( f). The treatment in the stomach wall is performed via the constructed stomach wall fixture (13).
【００１６】胃壁固定具はナットとボルトの組み合わせ
に限定されるものでなく、ロック・解除機構を有する構
造であれば、その形状は特に限定されない。本法による
胃壁固定用具及びその使用方法はポート部の固定のみな
らず、胃瘻造設用のボタンの固定にも応用可能である。The stomach wall fixing device is not limited to a combination of a nut and a bolt, and its shape is not particularly limited as long as it has a lock / release mechanism. The gastric wall fixing device according to the present method and the method of using the same can be applied not only to fixing of the port portion but also to fixing of a button for gastrostoma construction.
【００１７】[0017]
【発明の効果】本発明による胃壁固定用具は安価で造設
が容易かつ安全であり、胃癌の切除範囲の拡大が可能と
なる。As described above, the gastric wall fixing device according to the present invention is inexpensive, easy to construct, and safe, and makes it possible to expand the resection range of gastric cancer.
【図１】本発明の実施の一形態となる胃壁固定具挿入補
助具の外観図である。FIG. 1 is an external view of a gastric wall fixing device insertion aid according to an embodiment of the present invention.
【図２】胃壁固定具挿入補助具の固定部の拡大図。FIG. 2 is an enlarged view of a fixing portion of the gastric wall fixing device insertion aid.
【図３】牽引ワイヤーによる一連の脱着操作を表す図。FIG. 3 is a diagram showing a series of detaching operations using a pulling wire.
【図４】患者に胃壁固定具を装着する動作を表す図。FIG. 4 is a diagram illustrating an operation of attaching a gastric wall fixing device to a patient.
１．誘導部 ２．屈曲部 ３．固定部 ４．牽引ワイヤー ５．穿刺針 ６．腹壁 ７．胃壁 ８．内視鏡 ９．把持鉗子 １０．ポート部 １１．胃壁固定具挿入補助具 １２．ポート固定具 １３．胃壁固定具 1. Guidance part 2. Bending part 3. Fixing part 4. Traction wire 5. Puncture needle 6. Abdominal wall 7. Stomach wall 8. Endoscope 9. Grasping forceps 10. Port section 11. 11. Gastric wall fixture insertion aid Port fixture 13. Stomach wall fixture
─────────────────────────────────────────────────────
────────────────────────────────────────────────── ───
【手続補正書】[Procedure amendment]
【提出日】平成８年１２月２６日[Submission date] December 26, 1996
【手続補正１】[Procedure amendment 1]
【補正対象書類名】図面[Document name to be amended] Drawing
【補正対象項目名】図４[Correction target item name] Fig. 4
【補正方法】変更[Correction method] Change
【補正内容】[Correction contents]
【図４】 FIG. 4
Claims (2)
構成される胃壁固定具、及び誘導部、可撓性を有する屈
曲部、固定部より構成され、該誘導部はその一端を該屈
曲部に接合され、また該屈曲部のもう一つの端部は該固
定部に接合されており、該固定部を該誘導部方向に該固
定部に一時的に接合された牽引ワイヤーにより圧縮する
と、該屈曲部はその可撓性により該誘導部の外径よりも
さらに外側に拡張し、また該固定部の圧縮を解除するこ
とにより該屈曲部の拡張が元に戻り、その外径が該誘導
部の外径とほぼ同一となる胃壁固定具挿入補助具と、留
置する際に該胃壁固定具及び該胃壁固定具挿入補助具を
誘導し、また該胃壁固定具挿入補助具の該固定部を圧縮
・解放するための牽引ワイヤーと、該牽引ワイヤーを体
内へ誘導するための穿刺針の組み合わせよりなる胃壁固
定用具であり、該誘導部、該屈曲部及び該固定部がおの
おの１つ以上の内腔を有し、また該屈曲部は可撓性を有
し、その軸方向に１以上の切れ目の入っていることを特
徴とする胃壁固定用具。1. A stomach wall fixing device comprising an open port portion and a port fixing device, and a guide portion, a flexible bent portion and a fixed portion, and one end of the guide portion is connected to the bent portion. And the other end of the bent portion is connected to the fixed portion, and when the fixed portion is compressed in the direction of the guide portion by a pulling wire temporarily connected to the fixed portion, the bent portion is bent. The portion expands further outside the outer diameter of the guide portion due to its flexibility, and the expansion of the bent portion returns to its original state by releasing the compression of the fixed portion, and the outer diameter of the guide portion becomes smaller. A gastric wall fixing device insertion aid having substantially the same outer diameter, and a gastric wall fixing device and the gastric wall fixing device insertion auxiliary device for guiding the gastric wall fixing device during indwelling; A pulling wire for releasing and a guiding wire for guiding the pulling wire into the body. A gastric wall fixing device comprising a combination of a puncture needle, wherein the guiding portion, the bending portion, and the fixing portion each have one or more lumens, and the bending portion has flexibility and has an axial direction. A gastric wall fixing device, characterized in that the device has one or more cuts.
穿刺し、牽引ワイヤーを胃内に導入し、更に内視鏡より
導入した把持鉗子により該牽引ワイヤーを患者の口より
取り出し、該牽引ワイヤーに胃壁固定具のポート部及び
胃壁固定具挿入補助具を装着し、該牽引ワイヤーを腹壁
側より牽引し、該ポート部を胃壁、腹壁を通過させた
後、該牽引ワイヤーを押し戻し、該胃壁固定具挿入補助
具と該牽引ワイヤーを抜去し、該ポート部をポート固定
具で、腹壁に固定することにより、該ポート部の内腔を
通して遠隔操作により胃内粘膜の牽引、切除などの処置
を行うことを特徴とする胃壁固定用具の使用方法。2. An abdominal wall and a stomach wall are punctured with a puncture needle under an endoscope, a traction wire is introduced into the stomach, and the traction wire is taken out of a patient's mouth by grasping forceps introduced from the endoscope. Attach the port portion of the gastric wall fixing device and the gastric wall fixing device insertion aid to the pulling wire, pull the pulling wire from the abdominal wall side, pass the port portion through the stomach wall, the abdominal wall, and then push back the pulling wire. By removing the gastric wall fixing device insertion aid and the traction wire, and fixing the port portion to the abdominal wall with the port fixing device, treatment such as traction and resection of the gastric mucosa by remote control through the lumen of the port portion. A method for using a gastric wall fixing device, comprising:
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP27956796A JP3714569B2 (en) | 1996-10-22 | 1996-10-22 | Gastric wall fixation device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP27956796A JP3714569B2 (en) | 1996-10-22 | 1996-10-22 | Gastric wall fixation device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH10118074A true JPH10118074A (en) | 1998-05-12 |
| JP3714569B2 JP3714569B2 (en) | 2005-11-09 |
Family
ID=17612782
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP27956796A Expired - Fee Related JP3714569B2 (en) | 1996-10-22 | 1996-10-22 | Gastric wall fixation device |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP3714569B2 (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| KR101082762B1 (en) | 2011-02-18 | 2011-11-10 | 이정삼 | Retractor system for laparoscopic surgery |
| CN109528383A (en) * | 2018-12-07 | 2019-03-29 | 上海交通大学医学院附属第九人民医院 | Percutaneous stomach stoma merging guiding device and its operating method |
-
1996
- 1996-10-22 JP JP27956796A patent/JP3714569B2/en not_active Expired - Fee Related
Cited By (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| KR101082762B1 (en) | 2011-02-18 | 2011-11-10 | 이정삼 | Retractor system for laparoscopic surgery |
| US9247932B2 (en) | 2011-02-18 | 2016-02-02 | Jeong Sam Lee | Retraction system for laparoscopic surgery |
| CN109528383A (en) * | 2018-12-07 | 2019-03-29 | 上海交通大学医学院附属第九人民医院 | Percutaneous stomach stoma merging guiding device and its operating method |
| CN109528383B (en) * | 2018-12-07 | 2024-02-20 | 上海交通大学医学院附属第九人民医院 | Percutaneous gastrostomy tube implantation guiding device and operation method thereof |
Also Published As
| Publication number | Publication date |
|---|---|
| JP3714569B2 (en) | 2005-11-09 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US9610184B2 (en) | Endoscopic tools for the removal of balloon-like intragastric devices | |
| JP4197963B2 (en) | Anastomosis system for anastomosis in vivo | |
| US9554824B2 (en) | Orifice introducer device | |
| US8573226B2 (en) | Apparatus and methods for performing transluminal gastrointestinal procedures | |
| JP4754574B2 (en) | Apparatus and method for obesity treatment | |
| US5906620A (en) | Surgical cauterization snare with ligating suture | |
| US8540706B2 (en) | Organ incision method | |
| US20060167473A1 (en) | Instrument for use in the treatment of prolapsed hemorrhoids | |
| US20070135825A1 (en) | Methods and devices for anchoring to tissue | |
| US20060052660A1 (en) | Apparatus and methods for cardiac restraint | |
| JP2010131413A (en) | Tissue capturing device | |
| MX2007005480A (en) | A device and method for the therapy of obesity. | |
| WO2007037335A1 (en) | Suturing device | |
| JP2003310537A (en) | Guide tube | |
| WO2007145684A2 (en) | Methods and devices for anchoring to soft tissue | |
| JP2008054739A (en) | Gastrostomy catheter introducing apparatus | |
| CN208388669U (en) | A kind of sewing needle having suture for digestive endoscopy operation | |
| JPH10118074A (en) | Stomach wall-fixing tool and its use method | |
| KR102115663B1 (en) | System for marking lesion location in minimally invasive surgery | |
| CN109381229B (en) | Suture needle with suture thread for digestive endoscopy operation | |
| JPH0871074A (en) | Internal organ hanging-up tool | |
| CN208404689U (en) | A kind of sewing needle release recyclable device for digestive endoscopy operation | |
| JP2021171329A (en) | Clip-type traction instrument | |
| CN109381231A (en) | A kind of sewing needle release recyclable device for digestive endoscopy operation | |
| JPH1014931A (en) | Trocar |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| A977 | Report on retrieval |
Free format text: JAPANESE INTERMEDIATE CODE: A971007 Effective date: 20041222 |
|
| A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20050114 |
|
| A521 | Written amendment |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20050310 |
|
| A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20050520 |
|
| A521 | Written amendment |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20050713 |
|
| TRDD | Decision of grant or rejection written | ||
| A01 | Written decision to grant a patent or to grant a registration (utility model) |
Free format text: JAPANESE INTERMEDIATE CODE: A01 Effective date: 20050819 |
|
| A61 | First payment of annual fees (during grant procedure) |
Free format text: JAPANESE INTERMEDIATE CODE: A61 Effective date: 20050819 |
|
| R150 | Certificate of patent or registration of utility model |
Free format text: JAPANESE INTERMEDIATE CODE: R150 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20080902 Year of fee payment: 3 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20090902 Year of fee payment: 4 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20100902 Year of fee payment: 5 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20110902 Year of fee payment: 6 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20120902 Year of fee payment: 7 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20130902 Year of fee payment: 8 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20140902 Year of fee payment: 9 |
|
| LAPS | Cancellation because of no payment of annual fees |