WO2016027491A1 - Method for stripping blood vessel and device for stripping blood vessel - Google Patents

Method for stripping blood vessel and device for stripping blood vessel Download PDF

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Publication number
WO2016027491A1
WO2016027491A1 PCT/JP2015/058105 JP2015058105W WO2016027491A1 WO 2016027491 A1 WO2016027491 A1 WO 2016027491A1 JP 2015058105 W JP2015058105 W JP 2015058105W WO 2016027491 A1 WO2016027491 A1 WO 2016027491A1
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Prior art keywords
blood vessel
saphenous vein
guide
movable
peeling
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PCT/JP2015/058105
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French (fr)
Japanese (ja)
Inventor
達徳 藤井
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テルモ株式会社
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Publication of WO2016027491A1 publication Critical patent/WO2016027491A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments

Definitions

  • the present invention relates to a blood vessel peeling method and a blood vessel peeling device.
  • Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, radial artery, and venous grafts typified by the great saphenous vein are used as bypass blood vessels when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years, the vein graft is collected in a state covered with surrounding tissues (fat, connective tissue, etc.) and covered with the tissue.
  • a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass blood vessel, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue.
  • the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection is poor.
  • An object of the present invention is to provide a blood vessel peeling method and a blood vessel peeling device that can suppress damage to blood vessels and are excellent in workability of blood vessel collection (blood vessel peeling).
  • a movable part arranged around the blood vessel and slidably connected to the guide part is moved while being guided by the guide part, and at least a part of the circumference of the blood vessel is covered with surrounding tissue.
  • a blood vessel peeling method comprising: a second step of peeling in a state.
  • the first step includes inserting a puncture portion along the blood vessel while maintaining a predetermined distance from the blood vessel while observing the inside of the living body;
  • the blood vessel detachment method according to (1) further comprising the step of inserting the guide portion into a puncture hole formed by inserting the puncture portion.
  • the blood vessel is peeled off according to any one of (1) to (4) above, in which the blood vessel is peeled off by the movable portion, and a branching blood vessel that branches off from the blood vessel is cut and stopped.
  • a long guide portion disposed along the blood vessel while maintaining a predetermined distance from the blood vessel;
  • a movable part connected to the guide part and disposed around the blood vessel,
  • a blood vessel detachment device wherein the movable portion is moved while being guided by the guide portion, whereby the blood vessel is exfoliated in a state where at least a part of the blood vessel is covered with a surrounding tissue.
  • the blood vessel can be detached from the living body without contact with the blood vessel. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited.
  • the guide portion can be inserted into the living body smoothly and accurately.
  • FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention.
  • FIG. 2 is a cross-sectional view showing a guide portion of the blood vessel peeling device shown in FIG.
  • FIG. 3 is a plan view showing a movable part of the blood vessel peeling device shown in FIG.
  • FIG. 4 is a side view showing the movable part shown in FIG.
  • FIG. 5 is a side view illustrating a processing unit included in the movable unit illustrated in FIG. 3.
  • FIG. 6 is a side view showing a modification of the movable part shown in FIG.
  • FIG. 7 is a view showing a modification of the movable part of the blood vessel peeling device shown in FIG. FIG.
  • FIG. 8 is a cross-sectional view showing an operation unit of the blood vessel peeling device shown in FIG.
  • FIG. 9 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 10 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 11 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 12 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 13 is a cross-sectional view showing a modification of the blood vessel peeling device shown in FIG.
  • FIG. 14 is a view showing a blood vessel peeling device according to a second embodiment of the present invention.
  • FIG. 10 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 11 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in
  • FIG. 15 is a perspective view showing a blood vessel peeling device according to a third embodiment of the present invention.
  • FIG. 16 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fourth embodiment of the present invention.
  • FIG. 18 is a diagram illustrating a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 19 is a cross-sectional view showing a blood vessel peeling device according to a fifth embodiment of the present invention.
  • FIG. 20 is a cross-sectional view showing a blood vessel peeling device according to a sixth embodiment of the present invention.
  • FIG. 16 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fourth embodiment of the present invention.
  • FIG. 18 is a diagram illustrating
  • FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • FIG. 22 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to the eighth embodiment of the present invention.
  • FIG. 23 is a cross-sectional view showing a blood vessel peeling device according to a ninth embodiment of the present invention.
  • FIG. 24 is a plan view and a side view of the blood vessel peeling device shown in FIG.
  • FIG. 25 is a cross-sectional view showing a movable part included in the blood vessel peeling device according to the tenth embodiment of the present invention.
  • FIG. 26 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 27 is a plan view showing a blood vessel peeling device according to an eleventh embodiment of the present invention.
  • FIG. 28 is a side view showing a blood vessel peeling device according to
  • FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention.
  • FIG. 2 is a cross-sectional view showing a guide portion of the blood vessel peeling device shown in FIG.
  • FIG. 3 is a plan view showing a movable part of the blood vessel peeling device shown in FIG.
  • FIG. 4 is a side view showing the movable part shown in FIG.
  • FIG. 5 is a side view illustrating a processing unit included in the movable unit illustrated in FIG. 3.
  • FIG. 6 is a side view showing a modification of the movable part shown in FIG.
  • FIG. 7 is a view showing a modification of the movable part of the blood vessel peeling device shown in FIG. FIG.
  • FIG. 8 is a cross-sectional view showing an operation unit of the blood vessel peeling device shown in FIG. 9 to 12 are views for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 13 is a cross-sectional view showing a modification of the blood vessel peeling device shown in FIG.
  • FIG. 2B is a cross-sectional view taken along line AA in FIG.
  • the right side in FIG. 1 is also referred to as “tip” and the left side is also referred to as “base end”.
  • a blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass blood vessel when performing blood vessel bypass surgery (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue.
  • the blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it is a blood vessel that can be used as a bypass blood vessel.
  • the blood vessel to be collected is preferably the great saphenous vein among them.
  • the blood vessel peeling device 100 As described above, blood vessels can be collected in a state covered with surrounding tissue. Therefore, it is considered that the long-term patency after surgery is increased by collecting the large saphenous vein using the blood vessel peeling device 100 and using it as a bypass blood vessel. Therefore, in the following, an example in which the large saphenous vein is collected using the blood vessel peeling device 100 will be described as a representative.
  • the blood vessel peeling device 100 includes a guide unit 200 arranged along the great saphenous vein 1000 while maintaining a predetermined distance (predetermined distance interval) D from the great saphenous vein 1000; It has an imaging device 400 inserted into the guide unit 200, a movable unit 300 that moves inside the living body while being guided by the guide unit 200, and an operation unit 500 that moves the movable unit 300.
  • a guide unit 200 arranged along the great saphenous vein 1000 while maintaining a predetermined distance (predetermined distance interval) D from the great saphenous vein 1000; It has an imaging device 400 inserted into the guide unit 200, a movable unit 300 that moves inside the living body while being guided by the guide unit 200, and an operation unit 500 that moves the movable unit 300.
  • predetermined distance interval predetermined distance interval
  • the guide part 200 includes a long main body part 210 and a peeling part (observation part) 220 provided at the tip part of the main body part 210.
  • the main body 210 has a tubular shape extending in a straight line.
  • the main body 210 is provided with a slit-shaped rail 211 extending in the axial direction.
  • the rail 211 functions as a guide unit that guides the movement of the movable unit 300.
  • the rail 211 is open to the base end of the main body 210, and the movable part 300 can be connected from this open portion (that is, the base end of the main body 210).
  • the movable part 300 can be easily connected to the guide part 200.
  • the rail 211 may not be a slit as long as it can guide the movement of the movable unit 300, and may be, for example, a concave groove or a convex protrusion.
  • the peeling part 220 is tapered toward the tip of the guide part 200 and has a conical shape. Moreover, the peeling part 220 has ultrasonic permeability. Such a peeling unit 220 has a function of peeling the tissue when the guide unit 200 is advanced in the living body and a function as an observation unit for observing the living body (the great saphenous vein 1000 and its surroundings). Have.
  • a shape of the peeling part 220 it is not limited to a cone shape like this embodiment, For example, the duckbill shape tapering so that a front-end
  • the imaging device 400 includes a long main body 410, and an imaging unit 420 including an ultrasonic probe (ultrasonic wave transmitting / receiving unit) is provided at the distal end of the main body 410.
  • an imaging device 400 can be inserted into the guide unit 200.
  • the imaging device 400 can observe the great saphenous vein 1000 positioned in front of the guide part 200 via the peeling part 220.
  • the configuration of the imaging unit 420 is not limited to the ultrasonic probe as in the present embodiment as long as the position of the great saphenous vein 1000 can be confirmed.
  • the movable unit 300 moves in the living body to separate the large saphenous vein 1000 while it is covered with the surrounding tissue (fat, connective tissue, etc.) 1200 and branch off from the large saphenous vein 1000.
  • the branch blood vessel 1100 that is present is cut and stopped.
  • Such a movable part 300 is detachable from the guide part 200, and as shown in FIGS. 3 and 4, a connector 310 connected to the rail 211 of the guide part 200 and a mounting part 320 attached to the connector 310. And a peeling unit 350 and a processing unit 360.
  • the connector 310 has a base portion 311 that is curved in a substantially arc shape and a connection portion 312 that slidably connects the base portion 311 to the rail 211. Further, grooves 311 a and 311 b for mounting the mounting portion 320 are provided at both ends in the circumferential direction of the base portion 311.
  • the mounting portion 320 has a slit 321 extending in the axial direction and has a tubular shape (cylindrical shape) having a substantially C-shaped cross-sectional shape. Such a mounting portion 320 is mounted to the connector 310 by engaging both end portions in the circumferential direction with the slit 321 between the grooves 311 a and 311 b of the connector 310.
  • the great saphenous vein 1000 is positioned inside the annular annular portion 340 formed by the base 311 and the attachment portion 320. Further, the inner diameter of the annular portion 340 is larger than the outer diameter of the great saphenous vein 1000, and the great saphenous vein 1000 is located on the central axis J when in use. However, the great saphenous vein 1000 may be offset from the central axis J.
  • the annular portion 340 is configured by combining two members (the connector 310 and the mounting portion 320), so that the large saphenous vein 1000 is not cut as described in the “blood vessel peeling method” described later.
  • An annulus 340 can be disposed around the large saphenous vein 1000.
  • the width of the slit 321 is not particularly limited, but is preferably larger than the outer diameter of the large saphenous vein 1000.
  • the attachment part 320 can be attached to the connector 310 in a non-contact manner (or a light contact without damage) with the great saphenous vein 1000. Therefore, damage to the great saphenous vein 1000 when attaching the attachment part 320 to the connector 310 can be suppressed.
  • the width of the slit 321 is not limited to this, and may be smaller than the outer diameter of the large saphenous vein 1000. In this case, for example, the attachment part 320 can be attached to the connector 310 without contact with the large saphenous vein 1000 by expanding the deformation of the attachment part 320 and expanding the slit 321.
  • the annular portion 340 has a groove portion 390 that opens to the tip portion thereof, and a plurality of the groove portions 390 are arranged side by side in the circumferential direction of the annular portion 340.
  • Each groove portion 390 is connected to a tapered blood vessel guide groove portion (first groove portion) 391 whose width gradually decreases toward the proximal end side and a proximal end portion of the blood vessel guide groove portion 391, and the straight width is substantially constant.
  • the blood vessel guide groove portion 391 is a groove portion that guides the branch blood vessel 1100 that contacts when the movable portion 300 is pushed in the living body to the blood vessel processing groove portion 392, and has a tapered shape to smoothly perform this guidance.
  • the branch blood vessel 1100 can be smoothly guided to any one of the blood vessel guide groove portions 391.
  • the blood vessel processing groove 392 is a groove for cutting and stopping the branch blood vessel 1100 guided by the blood vessel guide groove 391, and each blood vessel processing groove 392 is provided with a processing unit 360.
  • the processing unit 360 has a bipolar structure having a pair of electrodes 361 and 362 that can generate an electric field in the blood vessel processing groove 392.
  • the electrode 361 is provided at the proximal end (bottom) of the vascular treatment groove 392, and the electrodes 362 are provided on both sides in the width direction of the vascular treatment groove 392.
  • the branch blood vessel 1100 guided by the blood vessel processing groove 392 is heated and cut, and is thermally coagulated to stop hemostasis.
  • the tip 361 ′ of the electrode 361 is preferably sharp enough to cut the branch blood vessel 1100.
  • the branch blood vessel 1100 can be thermally coagulated (hemostatic) by an electric field generated at least between the electrodes 361 and 362, the branch blood vessel can be physically cut by the electrode 361. Therefore, the certainty of processing by the processing unit 360 is improved.
  • the width W of the blood vessel processing groove 392 is not particularly limited, but is preferably narrower than the outer diameter of the branch blood vessel 1100 as shown in FIG. Thereby, since the branch blood vessel 1100 can be crushed in the blood vessel processing groove 392, the processing (cutting / hemostasis) by the processing unit 360 can be performed more reliably.
  • the annular part 340 is provided with a peeling part 350 for peeling the tissue around the great saphenous vein 1000.
  • the peeling portion 350 is provided along the blood vessel guide groove portion 391 at the distal end portion of the annular portion 340.
  • the exfoliation part 350 has a function of exfoliating the tissue around the large saphenous vein 1000 when the movable part 300 is pushed forward in the living body.
  • Such an exfoliation part 350 preferably has such a sharpness that it can exfoliate the tissue without cutting the branch blood vessel 1100. Thereby, since the cutting
  • the shape of the blood vessel guide groove 391 is not limited to the shape of the present embodiment.
  • the shape may be gradually reduced toward the side. By setting it as such a shape, since the peeling part 350 is rounded, it becomes difficult to cut
  • FIG.6 (b) the adjacent groove parts 390 may be spaced apart.
  • the groove portion 390 and the processing portion 360 are not provided in the base portion 311, but for example, as shown in FIG. 7, the groove portion 390 and the processing portion 360 are also provided in the base portion 311 in the same manner as the mounting portion 320. It may be provided. Thereby, the groove part 390 and the process part 360 are arrange
  • the movable part 300 may be configured to generate heat all around the annular part 340 and advance the structure while burning it.
  • the operation unit 500 has a rod shape and can be inserted into the guide unit 200. Therefore, the movable unit 300 can be moved by inserting the operation unit 500 into the guide unit 200 and pressing the connector 310 with the tip thereof.
  • the operation part 500 can be fixed to the connector 310 by means such as fitting or screwing. Thereby, the movable part 300 can be pushed and pulled by the operation part 500.
  • the blood vessel peeling method (blood vessel sampling method) using the blood vessel peeling device 100 includes a first step of arranging the guide portion 200 along the large saphenous vein 1000 while maintaining a predetermined distance D from the large saphenous vein 1000, and a guide. A second step of moving the movable part 300 connected to the part 200 to peel the large saphenous vein 1000 in a state covered with the surrounding tissue 1200; and a third step of cutting after ligating the saphenous vein 1000 And a fourth step of extracting the great saphenous vein 1000 while being covered with the surrounding tissue 1200.
  • the guide member 200 is inserted into the living body in a state in which a protective member that covers the rail 211 is mounted so that the tissue is not clogged in the rail 211 of the guide portion 200. May be removed from the guide part 200.
  • the guide unit 200 may be inserted into the living body with the guide unit 200 inserted into the tubular outer tube, and the outer tube may be removed after the insertion is completed.
  • a tubular inner tube is inserted into the guide portion 200 to close the rail 211 from the inside of the guide portion 200. In this state, the guide portion 200 is inserted into the living body, and after the insertion is completed, the inner tube is You may make it remove from the guide part 200.
  • the guide part 200 is inserted into the outer tube in which a slit along the axial direction is formed, and the guide part 200 is inserted into the living body in a state where the slit is shifted in the circumferential direction with respect to the rail 211.
  • the rail 211 may be exposed by rotating the outer tube in the circumferential direction and aligning the slit with the rail 211.
  • an inner tube in which a slit along the axial direction is formed in the guide portion 200 is inserted, and the guide portion 200 is inserted into the living body in a state where the slit is shifted in the circumferential direction with respect to the rail 211, After the insertion is completed, the rail 211 may be exposed by rotating the inner tube in the circumferential direction and aligning the slit with the rail 211.
  • the connector 310 is connected to the rail 211 from the base end of the guide part 200 as shown in FIG.
  • the attachment part 320 is attached to the connector 310 so that the saphenous vein 1000 is located.
  • the annular portion 340 is formed, and the large saphenous vein 1000 is disposed in the annular portion 340.
  • the large saphenous vein 1000 is located on the central axis J of the annular portion 340.
  • the guide may be arranged so that the great saphenous vein 1000 can be arranged on the central axis J so that the great saphenous vein 1000 can be arranged in the annular portion 340.
  • the separation distance (predetermined distance D) between the part 200 and the great saphenous vein 1000 is controlled (determined).
  • the annular portion 340 is disposed around the great saphenous vein 1000 without cutting the great saphenous vein 1000. Can do.
  • the connector 310 may be connected to the guide unit 200 without removing the imaging device 400 from the guide unit 200.
  • the connector 310 is connected to the rail 211 from the proximal end of the guide portion 200.
  • the connection can be smoothly performed.
  • the first step can be performed using the guide unit 200 in a state where the movable unit 300 is not connected. Therefore, the movable part 300 does not get in the way and the first step can be performed more smoothly.
  • the movable unit 300 is pushed in using the operation unit 500, and the living body is advanced along the rail 211 (while being guided by the guide unit 200).
  • the tissue 1200 around the great saphenous vein 1000 is peeled off by the peeling part 350, and the branch blood vessel 1100 is guided to the processing part 360 by the groove part 390, and is cut and stopped by the processing part 360.
  • the great saphenous vein 1000 is peeled from the living body in a state covered with the surrounding tissue 1200.
  • the large saphenous vein 1000 is straightened by the guide portion 200 and the large saphenous vein 1000 is located on the central axis J of the annular portion 340. Contact with the vein 1000 is prevented, and the great saphenous vein 1000 can be positioned approximately in the center of the exfoliated tissue 1200. Therefore, the greater saphenous vein 1000 can be exfoliated while being covered with the surrounding tissue 1200 more accurately and without bias.
  • the thickness t1 of the tissue 1200 exfoliated with the great saphenous vein 1000 and located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.
  • peeling work the operation of moving the movable unit 300 and peeling off the large saphenous vein 1000 while being covered with the surrounding tissue 1200 is also referred to as “peeling work”.
  • the large saphenous vein 1000 is cut at the proximal-side planned cut portion 1001 and the distal-side planned cut portion 1002.
  • two sites before and after the proximal end side cut planned portion 1001 of the large saphenous vein 1000 are ligated and the front end side cut planned portion 1002 is sandwiched. Ligate the two places before and after.
  • the ligation on the tip side cut planned portion 1002 side can be performed through the incision portion 1400 by incising the vicinity of the tip side cut planned portion 1002.
  • FIG. 11 (b) the large saphenous vein 1000 is cut at the base end side planned cut portion 1001 and the distal end side cut planned portion 1002.
  • the large saphenous vein 1000 can be collected (extracted) while being covered with the surrounding tissue 1200.
  • the great saphenous vein 1000 collected in such a state may be a bypass blood vessel having a long-term patency rate superior to that of the great saphenous vein not covered with the tissue 1200. This is believed to be due to the following reasons.
  • the great saphenous vein 1000 is used as an arterial bypass blood vessel, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, the large saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced. In addition, the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair. Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, it may lead to blood vessel occlusion in the long term.
  • the tissue 1200 suppresses the expansion of the large saphenous vein 1000 and suppresses the bending of the great saphenous vein 1000 and the like. It can be expected to be effective. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed.
  • damage to the great saphenous vein 1000 specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed.
  • the large saphenous vein 1000 can be removed smoothly and accurately in a state covered with the surrounding tissue 1200.
  • the guide part 200 is arranged at a predetermined distance D from the great saphenous vein 1000 to prevent contact between the guide part 200 and the great saphenous vein 1000. And damage to the great saphenous vein 1000 can be suppressed.
  • the second step since the movable part 300 is moved while being guided by the guide part 200, the movable part 300 can be moved along a predetermined route. 1000 contacts are suppressed. Therefore, according to the above-described method, the large saphenous vein 1000 can be peeled while being covered with the surrounding tissue 1200 while suppressing damage to the large saphenous vein 1000.
  • the second step can be performed more smoothly and accurately. Further, since the great saphenous vein 1000 is not cut until the second step is completed, blood can be passed through the great saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.
  • the large saphenous vein 1000 is collected (exfoliated) in a state where the entire circumference is covered with the tissue 1200, but is not limited to the one where the entire circumference is covered with the tissue 1200, It suffices if the great saphenous vein 1000 can be collected (exfoliated) in a state where at least a part of its circumference is covered with the tissue 1200.
  • the cross-sectional shape of the main-body part 210 is not limited to a circle,
  • the flat shape crushed in the alignment direction with the great saphenous vein 1000 may be sufficient.
  • the branch blood vessel 1100 branches radially and irregularly from the entire circumference of the great saphenous vein 1000.
  • the branch blood vessel 1100 ′ extending toward the guide part 200 is pushed downward by the guide part 200, and the lower side (guide part 200 in the figure). Close to the other side.
  • the branch blood vessel 1100 can be retracted from the movement trajectory of the connector 310 during the peeling operation, and the processing of each branch blood vessel 1100 can be sufficiently performed without providing the connector 310 with the groove portion 390 or the processing portion 360. Will be able to.
  • variety of the guide part 200 in such a form For example, it is preferable that it is larger than the diameter of the great saphenous vein 1000.
  • FIG. 14 is a view showing a blood vessel peeling device according to a second embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the imaging device is different.
  • the imaging device 400A is not used by being inserted into the guide unit 200 as in the first embodiment described above, but observes the inside of the living body from the skin (biological surface) H as shown in FIG.
  • Such an imaging device 400A is not particularly limited as long as it can be observed in a living body.
  • an ultrasonic probe used for ultrasonic diagnosis or the like can be used.
  • an ultrasonic marker 290 that can be recognized by an image (ultrasonic image) obtained from the imaging device 400A is provided at the distal end portion (peeling portion 220) of the guide portion 200A.
  • the peeling part 220 may not have ultrasonic wave permeability.
  • ⁇ Vessel peeling method ⁇ In the blood vessel peeling device 100A having such a configuration, in the first step of the blood vessel peeling method, the inside of the living body is observed using the imaging device 400A, and the positional relationship between the great saphenous vein 1000 and the distal end portion of the guide portion 200A is grasped. Meanwhile, the guide portion 200A is advanced. Even by such a method, the position of the distal end portion of the guide portion 200A can be visualized, so that the positional relationship between the guide portion 200A and the great saphenous vein 1000 can be grasped, and the guide portion 200 can be placed smoothly and accurately in the living body. can do.
  • FIG. 15 is a perspective view showing a blood vessel peeling device according to a third embodiment of the present invention.
  • FIG. 16 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • This embodiment is the same as the first embodiment described above except that the imaging device is mainly omitted.
  • the blood vessel peeling device 100B includes a guide part 200B, a movable part 300, and an operation part 500. That is, the blood vessel peeling device 100B has a configuration in which the imaging device 400 is omitted from the blood vessel peeling device 100 of the first embodiment described above.
  • a notification unit 280 is provided at the tip of the guide unit 200B.
  • the notification unit 280 includes a light emitting unit 281 such as an LED, and can notify the operator of the position of the distal end portion of the guide unit 200B with light emitted from the light emitting unit 281.
  • the light emitting unit 281 may be turned on or blinked.
  • the color of light emitted from the light emitting unit 281 is not particularly limited, and may be white, blue, red, green, or the like.
  • the peeling part 220 may not have ultrasonic wave permeability.
  • the first step of the blood vessel peeling method is to observe the inside of the living body and grasp the position of the great saphenous vein 1000, and then arrange the guide unit 200 based on the grasped position. Do that. Specifically, the position of the great saphenous vein 1000 is grasped based on an image obtained by diagnosis using CT scan (computer tomography), ultrasonic waves, infrared rays (near infrared rays), etc., and the grasped information is obtained from the skin. Marked as H (surface of living body). For example, as shown in FIG.
  • the information is marked on the skin along the great saphenous vein 1000, and from the skin of the great saphenous vein 1000 at each mark X position. Describe the depth.
  • the guide portion 200B is inserted into the living body while causing the light emitting portion 281 to emit light, and based on the light of the light emitting portion 281 that is visible through the skin, the distal end portion of the guide portion 200
  • the guide part 200 ⁇ / b> B is disposed along the great saphenous vein 1000.
  • the planar position of the distal end of the guide part 200B in the living body can be grasped from the position of the light from the light emitting part 281 and the depth from the skin (distance between the guide part 200B and the great saphenous vein 1000). ) Can be grasped by the intensity (brightness) of light seen through the skin.
  • the position of the distal end portion of the guide portion 200B can be visualized, so that the positional relationship between the guide portion 200B and the great saphenous vein 1000 can be grasped, and the guide portion 200 can be placed smoothly and accurately in the living body. can do.
  • FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fourth embodiment of the present invention.
  • FIG. 18 is a diagram illustrating a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • This embodiment is mainly the same as the first embodiment described above except that it further has a puncture portion.
  • the blood vessel peeling device 100C further includes a puncture unit 800 as shown in FIG.
  • the puncture unit 800 includes a main body unit 810 and a peeling unit (observation unit) 820 provided at the tip of the main body unit 810.
  • the main body 810 has a tubular shape extending linearly.
  • the peeling part 820 tapers toward the tip of the puncture part 800 and has a conical shape.
  • the peeling part 820 has ultrasonic permeability.
  • the imaging device 400 can be inserted into the puncture unit 800 having such a configuration. In the present embodiment, the imaging device 400 may not be inserted into the guide part 200, and the peeling part 220 may not have ultrasonic wave permeability.
  • the first step of the blood vessel peeling method is to observe the inside of the living body and keep the puncture portion 800 away from the large saphenous vein 1000 while maintaining a predetermined distance D.
  • the puncture portion 800 in which the imaging device 400 is inserted is inserted into the living body through the incision portion 1300, and the in vivo (large saphenous vein) is detected by the imaging device 400.
  • the puncture unit 800 is advanced along the great saphenous vein 1000 while maintaining a predetermined distance from the great saphenous vein 1000 while observing 1000 and the vicinity thereof.
  • the puncture portion 800 can be smoothly advanced.
  • FIG. 18B the puncture unit 800 is removed from the living body, and the guide unit 200 is inserted into the puncture hole 1500 formed by the puncture of the puncture unit 800.
  • the guide unit 200 is arranged along the large saphenous vein 1000.
  • the guide part 200 is inserted into the puncture hole 1500 formed in advance by the puncture part 800, it is possible to reduce the clogging of the tissue into the rail 211 of the guide part 200, for example. Therefore, the movable part 300 can be moved more smoothly, and the peeling operation in the second step can be performed more smoothly.
  • FIG. 19 is a cross-sectional view showing a blood vessel peeling device according to a fifth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the operation unit is different.
  • the operation unit 500D includes two strings (linear bodies) 511 and 512 as shown in FIG.
  • One end of the string 511 is connected to the connector 310, and the other end is pulled out from the proximal end opening of the guide part 200 via the insertion hole 219 provided in the distal end part of the main body part 210 of the guide part 200.
  • the string 512 has one end connected to the connector and the other end pulled out to the proximal end side of the guide part 200.
  • the movable part 300 can be moved forward (distal side) by pulling the string 511 toward the base end side, and conversely, the movable part 300 can be moved backward (proximal end side) by pulling the string 512 toward the base end side. ).
  • FIG. 20 is a cross-sectional view showing a blood vessel peeling device according to a sixth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the operation unit is different.
  • the operation part 500E has a rod shape that can be inserted into the guide part 200E, and a male screw part 520 is provided on the outer periphery thereof.
  • a female screw portion 218 that is screwed to the male screw portion 520 is provided on the inner peripheral surface of the main body portion 210 of the guide portion 200E. Therefore, by rotating the operation portion 500E in a state where the male screw portion 520 is screwed to the female screw portion 218, the movable portion 300 moves while being guided by the guide portion 200E. According to such a configuration, for example, it becomes easier to control the movement of the movable unit 300 as compared to the first embodiment described above.
  • FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • This embodiment is the same as the first embodiment described above except that the configuration of the movable part is mainly different.
  • the tip end face F1 of the annular portion 340 is inclined with respect to the central axis J as shown in FIG.
  • the peeling part 350 can be made sharper and the more excellent peeling characteristic can be exhibited in the peeling operation in the second step of the blood vessel peeling method.
  • the inclination angle ⁇ of the front end face F1 with respect to the central axis J is not particularly limited, but may be, for example, about 30 ° to 60 °.
  • FIG. 22 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to the eighth embodiment of the present invention.
  • FIG. 22C is a cross-sectional view taken along the line BB in FIG. In FIG. 22A, the second vibration damping unit is not shown.
  • This embodiment is the same as the first embodiment described above except that the configuration of the movable part is mainly different.
  • the movable part 300 ⁇ / b> G further includes a vibration element (vibration part) 380 and a vibration reduction part 370 provided in the annular part 340.
  • the vibration element 380 is a vibration source for vibrating the annular portion 340.
  • the vibration element 380 has a strip shape (long shape), and a plurality of vibration elements 380 are arranged along the circumferential direction of the annular portion 340. More specifically, one vibration element 380 is disposed between a pair of adjacent grooves 390.
  • the configuration of the vibration element 380 is not particularly limited as long as the annular portion 340 can be vibrated at a predetermined frequency.
  • ZnO zinc oxide
  • AlN aluminum nitride
  • PZT lead zirconate titanate
  • a piezoelectric layer made of a piezoelectric material is sandwiched between a pair of electrode layers.
  • the vibration frequency of the annular portion 340 that is vibrated by the vibration element 380 is not particularly limited.
  • the tissue can be removed without dissolving (releasing) blood vessels, skin, and muscles around the saphenous vein 1000.
  • a frequency that can be dissolved (released) is preferable, and such a frequency is preferably about 20 to 60 kHz, and more preferably 30 to 40 kHz. Thereby, substantially only the tissue can be dissolved while protecting the saphenous vein 1000.
  • the vibration damping unit 370 has a function of absorbing and attenuating the vibration of the annular portion 340 caused by the vibration element 380.
  • Such a vibration reduction unit 370 includes a first vibration reduction unit 371 disposed on the inner peripheral surface of the annular part 340 and a second vibration reduction unit 372 disposed on the outer peripheral surface of the annular part 340. is doing.
  • first and second vibration damping units 371 and 372 are arranged so as not to overlap the peeling unit 350, respectively. That is, the peeling part 350 protrudes from between the first and second vibration damping parts 371 and 272, and the part is exposed to the outside. Therefore, when the annular portion 340 is vibrated, the vibration is mainly transmitted to the outside from the peeling portion 350 and hardly transmitted to the outside from other places (for example, the inner peripheral surface and the outer peripheral surface of the annular portion 340). (Slightly transmitted)
  • the second vibration damping unit 372 is disposed so as to cover the vibration element 380 and protects and insulates the vibration element 380.
  • the constituent materials of the first and second vibration damping parts 371 and 372 are not particularly limited as long as the vibration of the annular part 340 can be absorbed and attenuated.
  • natural rubber butadiene rubber, styrene-butadiene rubber
  • Various rubber materials such as urethane rubber, silicone rubber and fluorine rubber can be used.
  • the movable portion 300E is positioned on the front side in the moving direction by vibration transmitted from the peeling portion 350. Since the tissue can be peeled while being dissolved, the operation can be performed more smoothly. Furthermore, the tissue located inside the annular portion 340, that is, the tissue 1200 that is located around the great saphenous vein 1000 and peels off together with the great saphenous vein 1000 is suppressed, so that the large size can be more reliably increased. The saphenous vein 1000 can be exfoliated while covered with the surrounding tissue 1200. In addition, since the dissolution of the tissue located outside the annular portion 340 is suppressed, unnecessary dissolution of the tissue is reduced.
  • the vibration element 380 is disposed on the outer periphery of the annular portion 340.
  • the arrangement of the vibration element 380 is not limited thereto, and is disposed on the inner peripheral surface of the annular portion 340, for example. May be.
  • the vibration element 380 may be disposed at a place other than the annular portion 340, for example, the operation portion 500 as long as vibration can be transmitted to the annular portion 340.
  • FIG. 23 is a cross-sectional view showing a blood vessel peeling device according to a ninth embodiment of the present invention.
  • FIG. 24 is a plan view and a side view of the blood vessel peeling device shown in FIG.
  • the present embodiment is mainly the same as the first embodiment described above except that the structure of the movable part is different.
  • the movable part 300H includes a connector 310 having a base 311 and a connection part 312; a pair of movable pieces 330 (330 ′, 330 ′′) housed (incorporated) in the base 311;
  • the base 311 has a space for accommodating the movable piece 330, and the movable piece 330 is accommodated in this space.
  • one movable piece 330 ′ is one of the base portions 311 in a plan view (hereinafter, also simply referred to as “plan view”) viewed from the axial direction of the guide portion 200.
  • the other movable piece 330 ′′ is slidable so as to protrude and retract from the end portion, and can be slidably protruded and retracted from the other end portion of the base 311.
  • Each movable piece 330 is also slidable.
  • a knob (movable piece operation part) 331 protruding toward the base end side of the base 311 is provided. By operating this knob 331, the movable piece 330 is removed from the base 311.
  • each movable piece 330 can be protruded or retracted to the base 311.
  • the knob 331 When each movable piece 330 is protruded from the base 311 by operating the knob 331, it is as shown in FIGS.
  • the movable piece 33 The distal ends of ', 330 "are connected to each other, and an annular portion 340 is formed by the base 311 and the movable pieces 330', 330".
  • the great saphenous vein 1000 is located in the annular portion 340.
  • Each movable piece 330 is provided with a peeling portion 350, a groove portion 390, and a processing portion 360, as in the first embodiment.
  • the connector 310 in a state where the movable pieces 330 ′ and 330 ′′ are retracted into the base 311 is connected to the rail 211. Then, each movable piece 330, 330 ′′ is protruded from the base portion 311 to form an annular portion 340. Thereby, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000.
  • the movable part 300H may be advanced along the guide part 200 to perform the peeling operation.
  • the knob 331 protrudes toward the proximal end side of the base 311, the knob 331 is not easily caught by the tissue or the branch blood vessel 1100 during the peeling operation, and the peeling operation can be performed more smoothly.
  • FIG. 25 is a cross-sectional view showing a movable part included in the blood vessel peeling device according to the tenth embodiment of the present invention.
  • FIG. 26 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
  • a pair of slits 213 and 214 extending in the axial direction are arranged in the body portion 210 of the guide portion 200I so as to be separated from each other in the circumferential direction.
  • the movable part 300I is attached to the distal end of the imaging device 400, and has a belt-like belt-like body 600 shaped in a substantially arc shape (substantially annular shape).
  • the belt-like body 600 is arranged in the guide part 200I in a state of being wound so as to reduce the diameter.
  • the imaging device 400 also serves as the operation unit 500 that moves the movable unit 300I.
  • the belt-like body 600 is formed on the guide portion 200I via the slit 213 from the distal end side. As shown in FIG. 25 (b), the tip end portion is retracted into the guide portion 200I through the slit 214.
  • An annular portion 340 is formed by a portion protruding from the guide portion 200 of the belt-like body 600.
  • belt-shaped body 600 is provided with the peeling part 350, the groove part 390, and the process part 360 similarly to 1st Embodiment mentioned above, respectively.
  • the groove 390 and the peeling portion 350 are respectively located on the proximal end side of the belt-like body 600 because the movable portion 300I is retracted from the distal end side to the proximal end side of the guide portion 200I. It is arranged facing.
  • the first step is performed in a state where the movable part 300I is accommodated in the guide part 200I.
  • the imaging device 400 is rotated to project the belt-like body 600 from the guide portion 200I to form the annular portion 340. Accordingly, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000.
  • the strip-shaped body 600 (movable part 300I) is moved to the base end side while being guided by the slits 213 and 214, and the peeling operation is performed. .
  • the large saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200.
  • the blood vessel separation step can be reduced as compared with the first embodiment described above.
  • the movable unit 300I is moved from the distal end side to the proximal end side, but conversely, it may be moved from the proximal end side to the distal end side.
  • the groove portion 390 may be provided so as to open to the front end side of the belt-like body 600.
  • the method of pulling to the base end side as in this embodiment is more effective in that it is easier to control the force (control / adjustment of the moving amount and moving speed of the movable portion 300I).
  • FIG. 27 is a plan view showing a blood vessel peeling device according to an eleventh embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
  • the movable part 300J has a connector 310 connected to the rail 211 of the guide part 200, and a pair of injection nozzles 700 provided on the connector 310.
  • the connector 310 has a base portion 311 extending in the width direction orthogonal to the moving direction, and a connection portion 312 that slidably connects the base portion 311 to the rail 211.
  • a peeling portion 350 is provided at the distal end portion of the base portion 311, and an injection nozzle 700 is provided at both end portions of the base portion 311.
  • the pair of injection nozzles 700 are provided so as to be positioned on both sides of the guide part 200 in a plan view (a plan view shown in FIG. 27, hereinafter simply referred to as “plan view”) viewed from the axial direction of the guide part 200. Yes. Further, from each spray nozzle 700, the liquid L is sprayed obliquely toward the inner side (the guide part 200 side).
  • the liquid L ejected from each ejection nozzle 700 intersects in plan view.
  • the large saphenous vein 1000 is positioned in a region S surrounded by the base 311 and the liquid L ejection path when in use.
  • each spray nozzle 700 can spray (discharge) a small amount of liquid L at high speed and in a pulse shape.
  • the branch blood vessel 1100 fine blood vessel
  • nerves can be preserved without being damaged, and heat generation of the tissue can be suppressed. Can preserve the function.
  • the peeling operation can be performed by moving the connector 310 to the distal end side while jetting the liquid L from each jet nozzle 700.
  • the connector 310 can be connected to the guide part 200 without cutting the great saphenous vein 1000, and the great saphenous vein 1000 is covered with the surrounding tissue 1200. Can be peeled off.
  • the branched blood vessel 1100 may not be cut depending on the jetted liquid L. In this case, after the peeling operation, the branch blood vessel 1100 may be cut and hemostatically treated.
  • the groove portion 390 and the processing portion 360 are not provided in the base portion 311 as in the first embodiment, but the groove portion 390 and the processing portion 360 are provided in the base portion 311 in the same manner as in FIG. May be. Thereby, in the passage region of the base 311, the branch blood vessel 1100 can be processed.
  • FIG. 28 is a side view showing a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
  • the movable part 300 ⁇ / b> K includes a first movable part 301 and a second movable part 302 located on the proximal side with respect to the first movable part 301.
  • the first movable portion 301 has the same configuration as the movable portion 300J of the tenth embodiment described above
  • the second movable portion 302 has the same configuration as the movable portion 300 of the first embodiment described above.
  • the branch blood vessel 1100 cannot be cut or stopped by the ejection of the liquid L from the first movable portion 301 even if the tissue can be peeled off. Therefore, the second movable portion 302 is provided behind the first movable portion 301, and the branch blood vessel 1100 is cut and stopped by the processing portion 360 included in the second movable portion 302.
  • the first movable portion 301 and the second movable portion 302 are connected to the guide portion 200, and while the liquid L is ejected from the first movable portion 301, The first and second movable parts 301 and 302 are moved to the distal end side to perform a peeling operation.
  • tissue separation is performed by the first movable unit 301 located in front, and the second movable unit 302 cuts and stops hemostasis of the branch blood vessel 1100 while passing through the separated site. Movement of the movable part 300K in the living body becomes smoother.
  • the great saphenous vein 1000 can be peeled off and the branch blood vessel 1100 can be cut and stopped at the same time, a smoother procedure can be performed.
  • the blood vessel peeling method and the blood vessel peeling device of the present invention have been described on the basis of the illustrated embodiment. Can be substituted. In addition, any other component may be added to the present invention. Moreover, you may combine each embodiment suitably.
  • bypass blood vessel is collected when performing the blood vessel bypass operation.
  • the use of the collected blood vessel is not limited to the bypass blood vessel.
  • the blood vessel peeling method includes a first step of arranging a guide portion along the blood vessel while maintaining a predetermined distance from the blood vessel, and is arranged around the blood vessel and slidably connected to the guide portion. And moving the movable part while being guided by the guide part, and separating the blood vessel in a state where at least a part of the blood vessel is covered with the surrounding tissue. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited. In particular, by observing the inside of the living body and arranging the guide portion, the guide portion can be inserted into the living body smoothly and accurately.
  • the blood vessel peeling device of the present invention is a long guide portion arranged along the blood vessel while maintaining a predetermined distance from the blood vessel, a movable portion connected to the guide portion and arranged around the blood vessel, And moving the movable portion while guiding the movable portion with the guide portion, whereby the blood vessel is separated in a state where at least a part of the blood vessel is covered with the surrounding tissue. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited.
  • each of the blood vessel peeling method and the blood vessel peeling device of the present invention has industrial applicability.

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Abstract

A device for stripping a blood vessel (100) is provided with a guide section (200) and a movable part (300). A main body (210) of the guide section (200) has a straight tubular shape and is provided with a rail (211) in the axial direction. The movable part (300) is provided with a connector (310) that is connected to the rail (211). On a base part (311) of the connector (310), a mounting part (320) is mounted. The base part (311) and the mounting part (320) together constitute a circular part (340). To strip a greater saphenous vein (1000) from a living body, the guide section (200) is disposed along the greater saphenous vein (1000). The movable part (300) is assembled so that the circular part (340) surrounds the greater saphenous vein (1000). A rod-shaped operation part (500) is inserted into the tubular main body (210). When the connector (310) is pushed, the operation part (500) propels the movable part (300) forward along the rail (211). Thus, the movable part (300) strips the greater saphenous vein (1000) and a tissue (1200) surrounding the same from the living body.

Description

血管剥離方法および血管剥離デバイスBlood vessel peeling method and blood vessel peeling device
　本発明は、血管剥離方法および血管剥離デバイスに関するものである。 The present invention relates to a blood vessel peeling method and a blood vessel peeling device.
　心臓における血管バイパス術（冠動脈バイパス術：ＣＡＢＧ）を行う際のバイパス血管として、内胸動脈、胃大網動脈、橈骨動脈に代表される動脈グラフトや、大伏在静脈に代表される静脈グラフトを用いることが広く知られている。また、現在では、動脈グラフト（特に内胸動脈）の方が静脈グラフトよりも長期的な開存率が高いという報告がなされている。このように、長期的な開存率に劣ると言わる静脈グラフトではあるが、近年、静脈グラフトをその周囲の組織（脂肪、結合組織等）に覆われた状態で採取し、組織に覆われたままの状態でバイパス血管として使用することで、長期的な開存率が向上するとの報告もされてきている。そして、静脈グラフトを周囲の組織に覆われた状態で採取することのできるデバイスとして、例えば特許文献１に記載されたデバイスがある。 Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, radial artery, and venous grafts typified by the great saphenous vein are used as bypass blood vessels when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years, the vein graft is collected in a state covered with surrounding tissues (fat, connective tissue, etc.) and covered with the tissue. It has also been reported that the long-term patency rate can be improved by using it as a bypass blood vessel as it is. And as a device which can extract | collect a vein graft in the state covered with the surrounding tissue, there exists a device described in patent document 1, for example.
　特許文献１に記載のデバイスでは、バイパス血管として採取する血管内にガイドワイヤ（ｓｕｐｐｏｒｔ　ｍｅｍｂｅｒ５０）を挿入し、このガイドワイヤに案内させつつ筒状部材（ｐｏｒｔｉｏｎ４０）を押し進めることで、血管をその周囲の組織に覆われた状態で採取することができるようになっている。しかしながら、特許文献１に記載のデバイスでは、ガイドワイヤによって血管の内壁が損傷するおそれがあり、血管採取の作業性が悪いという問題がある。 In the device described in Patent Document 1, a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass blood vessel, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue. However, the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection is poor.
ＵＳ２００６／０２７６８１５号公報US2006 / 0276815
　本発明の目的は、血管の損傷を抑制することができ、血管採取（血管剥離）の作業性に優れる血管剥離方法および血管剥離デバイスを提供することにある。 An object of the present invention is to provide a blood vessel peeling method and a blood vessel peeling device that can suppress damage to blood vessels and are excellent in workability of blood vessel collection (blood vessel peeling).
　このような目的は、下記（１）～（７）の本発明により達成される。
　（１）　血管と所定間隔を保ちつつ、前記血管に沿ってガイド部を配置する第１ステップと、
　前記血管の周囲に配置されると共に前記ガイド部にスライド可能に接続された可動部を、前記ガイド部で案内しつつ移動させ、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離する第２ステップと、を有することを特徴とする血管剥離方法。 Such an object is achieved by the present inventions (1) to (7) below.
(1) a first step of arranging a guide portion along the blood vessel while maintaining a predetermined distance from the blood vessel;
A movable part arranged around the blood vessel and slidably connected to the guide part is moved while being guided by the guide part, and at least a part of the circumference of the blood vessel is covered with surrounding tissue. A blood vessel peeling method comprising: a second step of peeling in a state.
　（２）　前記第１ステップでは、生体内を観察しながら前記ガイド部を前記血管に沿って配置する上記（１）に記載の血管剥離方法。 (2) The blood vessel peeling method according to (1), wherein in the first step, the guide portion is arranged along the blood vessel while observing the inside of a living body.
　（３）　前記第１ステップでは、生体内を観察して前記血管の位置を把握した後、前記把握した位置に基づいて前記ガイド部を配置する上記（１）に記載の血管剥離方法。 (3) The blood vessel peeling method according to (1), wherein, in the first step, after observing the inside of a living body and grasping the position of the blood vessel, the guide portion is arranged based on the grasped position.
　（４）　前記第１ステップは、生体内を観察しながら、前記血管と所定間隔を保ちつつ、前記血管に沿って穿刺部を挿入するステップと、
　前記穿刺部を挿入することで形成された穿刺孔に、前記ガイド部を挿入するステップと、を有する上記（１）に記載の血管剥離方法。 (4) The first step includes inserting a puncture portion along the blood vessel while maintaining a predetermined distance from the blood vessel while observing the inside of the living body;
The blood vessel detachment method according to (1), further comprising the step of inserting the guide portion into a puncture hole formed by inserting the puncture portion.
　（５）　前記第２ステップでは、前記可動部で前記血管の剥離を行うと共に、前記血管から分岐する分岐血管の切断および止血を行う上記（１）ないし（４）のいずれかに記載の血管剥離方法。 (5) In the second step, the blood vessel is peeled off according to any one of (1) to (4) above, in which the blood vessel is peeled off by the movable portion, and a branching blood vessel that branches off from the blood vessel is cut and stopped. Method.
　（６）　前記第２ステップまでは、前記血管を切断せずに行う上記（１）ないし（５）のいずれかに記載の血管剥離方法。 (6) The blood vessel peeling method according to any one of (1) to (5), wherein the steps up to the second step are performed without cutting the blood vessel.
　（７）　血管と所定間隔を保ちつつ、前記血管に沿って配置される長尺なガイド部と、
　前記ガイド部に接続され、前記血管の周囲に配置される可動部と、を有し、
　前記可動部を前記ガイド部で案内しながら移動させることで、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離することを特徴とする血管剥離デバイス。 (7) a long guide portion disposed along the blood vessel while maintaining a predetermined distance from the blood vessel;
A movable part connected to the guide part and disposed around the blood vessel,
A blood vessel detachment device, wherein the movable portion is moved while being guided by the guide portion, whereby the blood vessel is exfoliated in a state where at least a part of the blood vessel is covered with a surrounding tissue.
　本発明によれば、血管に対して非接触で、血管を生体から剥離することができる。そのため、血管の損傷を抑えることができ、優れた作業性を発揮することができる。特に、生体内を観察してガイド部を配置することで、生体内へのガイド部の挿入をスムーズかつ正確に行うことができる。 According to the present invention, the blood vessel can be detached from the living body without contact with the blood vessel. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited. In particular, by observing the inside of the living body and arranging the guide portion, the guide portion can be inserted into the living body smoothly and accurately.
図１は、本発明の第１実施形態に係る血管剥離デバイスを示す斜視図である。FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention. 図２は、図１に示す血管剥離デバイスが有するガイド部を示す断面図である。FIG. 2 is a cross-sectional view showing a guide portion of the blood vessel peeling device shown in FIG. 図３は、図１に示す血管剥離デバイスが有する可動部を示す平面図である。FIG. 3 is a plan view showing a movable part of the blood vessel peeling device shown in FIG. 図４は、図３に示す可動部を示す側面図である。FIG. 4 is a side view showing the movable part shown in FIG. 図５は、図３に示す可動部が有する処理部を示す側面図である。FIG. 5 is a side view illustrating a processing unit included in the movable unit illustrated in FIG. 3. 図６は、図３に示す可動部の変形例を示す側面図である。FIG. 6 is a side view showing a modification of the movable part shown in FIG. 図７は、図１に示す血管剥離デバイスが有する可動部の変形例を示す図である。FIG. 7 is a view showing a modification of the movable part of the blood vessel peeling device shown in FIG. 図８は、図１に示す血管剥離デバイスが有する操作部を示す断面図である。FIG. 8 is a cross-sectional view showing an operation unit of the blood vessel peeling device shown in FIG. 図９は、図１に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 9 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１０は、図１に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 10 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１１は、図１に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 11 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１２は、図１に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 12 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１３は、図１に示す血管剥離デバイスの変形例を示す断面図である。FIG. 13 is a cross-sectional view showing a modification of the blood vessel peeling device shown in FIG. 図１４は、本発明の第２実施形態に係る血管剥離デバイスを示す図である。FIG. 14 is a view showing a blood vessel peeling device according to a second embodiment of the present invention. 図１５は、本発明の第３実施形態に係る血管剥離デバイスを示す斜視図である。FIG. 15 is a perspective view showing a blood vessel peeling device according to a third embodiment of the present invention. 図１６は、図１５に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 16 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１７は、本発明の第４実施形態に係る血管剥離デバイスを示す断面図である。FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fourth embodiment of the present invention. 図１８は、図１７に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 18 is a diagram illustrating a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図１９は、本発明の第５実施形態に係る血管剥離デバイスを示す断面図である。FIG. 19 is a cross-sectional view showing a blood vessel peeling device according to a fifth embodiment of the present invention. 図２０は、本発明の第６実施形態に係る血管剥離デバイスを示す断面図である。FIG. 20 is a cross-sectional view showing a blood vessel peeling device according to a sixth embodiment of the present invention. 図２１は、本発明の第７実施形態に係る血管剥離デバイスが有する可動部を示す側面図である。FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the seventh embodiment of the present invention. 図２２は、本発明の第８実施形態に係る血管剥離デバイスが有する可動部を示す側面図および断面図である。FIG. 22 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to the eighth embodiment of the present invention. 図２３は、本発明の第９実施形態に係る血管剥離デバイスを示す断面図である。FIG. 23 is a cross-sectional view showing a blood vessel peeling device according to a ninth embodiment of the present invention. 図２４は、図２３に示す血管剥離デバイスの平面図および側面図である。FIG. 24 is a plan view and a side view of the blood vessel peeling device shown in FIG. 図２５は、本発明の第１０実施形態に係る血管剥離デバイスが有する可動部を示す断面図である。FIG. 25 is a cross-sectional view showing a movable part included in the blood vessel peeling device according to the tenth embodiment of the present invention. 図２６は、図２５に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。FIG. 26 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 図２７は、本発明の第１１実施形態に係る血管剥離デバイスを示す平面図である。FIG. 27 is a plan view showing a blood vessel peeling device according to an eleventh embodiment of the present invention. 図２８は、本発明の第１２実施形態に係る血管剥離デバイスを示す側面図である。FIG. 28 is a side view showing a blood vessel peeling device according to a twelfth embodiment of the present invention.
　以下、本発明の血管剥離方法および血管剥離デバイスを添付図面に示す好適な実施形態に基づいて詳細に説明する。 Hereinafter, a blood vessel peeling method and a blood vessel peeling device of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.
　＜第１実施形態＞
　図１は、本発明の第１実施形態に係る血管剥離デバイスを示す斜視図である。図２は、図１に示す血管剥離デバイスが有するガイド部を示す断面図である。図３は、図１に示す血管剥離デバイスが有する可動部を示す平面図である。図４は、図３に示す可動部を示す側面図である。図５は、図３に示す可動部が有する処理部を示す側面図である。図６は、図３に示す可動部の変形例を示す側面図である。図７は、図１に示す血管剥離デバイスが有する可動部の変形例を示す図である。図８は、図１に示す血管剥離デバイスが有する操作部を示す断面図である。図９ないし図１２は、それぞれ、図１に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。図１３は、図１に示す血管剥離デバイスの変形例を示す断面図である。なお、図２（ｂ）は、同図（ａ）中のＡ－Ａ線断面図である。また、以下では、説明の便宜上、図１中の右側を「先端」、左側を「基端」とも言う。 <First Embodiment>
FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention. FIG. 2 is a cross-sectional view showing a guide portion of the blood vessel peeling device shown in FIG. FIG. 3 is a plan view showing a movable part of the blood vessel peeling device shown in FIG. FIG. 4 is a side view showing the movable part shown in FIG. FIG. 5 is a side view illustrating a processing unit included in the movable unit illustrated in FIG. 3. FIG. 6 is a side view showing a modification of the movable part shown in FIG. FIG. 7 is a view showing a modification of the movable part of the blood vessel peeling device shown in FIG. FIG. 8 is a cross-sectional view showing an operation unit of the blood vessel peeling device shown in FIG. 9 to 12 are views for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 13 is a cross-sectional view showing a modification of the blood vessel peeling device shown in FIG. FIG. 2B is a cross-sectional view taken along line AA in FIG. In the following, for convenience of explanation, the right side in FIG. 1 is also referred to as “tip” and the left side is also referred to as “base end”.
　≪血管剥離デバイス≫
　図１に示す血管剥離デバイス１００は、血管バイパス術（冠動脈バイパス術：ＣＡＢＧ）を行う際のバイパス血管として用いられる血管を採取するのに用いられるデバイスであり、血管を周囲の組織（脂肪、結合組織等）に覆われた状態で採取することができる。なお、血管剥離デバイス１００を用いて採取する血管としては、バイパス血管として用いることのできる血管であれば特に限定されず、例えば、内胸動脈、胃大網動脈、橈骨動脈、大伏在静脈等が挙げられる。 ≪Vessel peeling device≫
A blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass blood vessel when performing blood vessel bypass surgery (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue. The blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it is a blood vessel that can be used as a bypass blood vessel. For example, the internal thoracic artery, gastroepiploic artery, radial artery, great saphenous vein, etc. Is mentioned.
　ただし、採取する血管としてはこれらの中でも大伏在静脈であることが好ましい。血管剥離デバイス１００を用いることで、前述したように、血管を周囲の組織に覆われた状態で採取することができる。そのため、血管剥離デバイス１００を用いて大伏在静脈を採取し、それをバイパス血管として用いることで、術後の長期的な開存率が高くなると考えられる。したがって、以下では、血管剥離デバイス１００を用いて大伏在静脈を採取する例について代表して説明する。 However, the blood vessel to be collected is preferably the great saphenous vein among them. By using the blood vessel peeling device 100, as described above, blood vessels can be collected in a state covered with surrounding tissue. Therefore, it is considered that the long-term patency after surgery is increased by collecting the large saphenous vein using the blood vessel peeling device 100 and using it as a bypass blood vessel. Therefore, in the following, an example in which the large saphenous vein is collected using the blood vessel peeling device 100 will be described as a representative.
　血管剥離デバイス１００は、図１ないし図８に示すように、大伏在静脈１０００と所定間隔（所定距離間隔）Ｄを保ちつつ、大伏在静脈１０００に沿って配置されるガイド部２００と、ガイド部２００に挿入されるイメージングデバイス４００と、ガイド部２００で案内されながら生体内を移動する可動部３００と、可動部３００を移動操作する操作部５００と、を有している。以下、これら各部について、順次詳細に説明する。 As shown in FIGS. 1 to 8, the blood vessel peeling device 100 includes a guide unit 200 arranged along the great saphenous vein 1000 while maintaining a predetermined distance (predetermined distance interval) D from the great saphenous vein 1000; It has an imaging device 400 inserted into the guide unit 200, a movable unit 300 that moves inside the living body while being guided by the guide unit 200, and an operation unit 500 that moves the movable unit 300. Hereinafter, each of these units will be sequentially described in detail.
　［ガイド部］
　ガイド部２００は、図２に示すように、長尺な本体部２１０と、本体部２１０の先端部に設けられた剥離部（観察部）２２０と、を有している。 [Guide section]
As shown in FIG. 2, the guide part 200 includes a long main body part 210 and a peeling part (observation part) 220 provided at the tip part of the main body part 210.
　本体部２１０は、直線状に延在する管状をなしている。また、本体部２１０には軸方向に延びるスリット状のレール２１１が設けられている。このレール２１１は、可動部３００の移動を案内するガイド部として機能する。また、レール２１１は、本体部２１０の基端に開放しており、この開放した部分（すなわち、本体部２１０の基端）から可動部３００を接続することができるようになっている。後述する「血管剥離方法」でも説明するように、ガイド部２００の基端は、使用中でも生体から露出しているため、ガイド部２００に可動部３００を簡単に接続することができる。なお、レール２１１は、可動部３００の移動を案内することができればスリットでなくてもよく、例えば、凹条の溝であってもよいし、凸条の突起であってもよい。 The main body 210 has a tubular shape extending in a straight line. The main body 210 is provided with a slit-shaped rail 211 extending in the axial direction. The rail 211 functions as a guide unit that guides the movement of the movable unit 300. Further, the rail 211 is open to the base end of the main body 210, and the movable part 300 can be connected from this open portion (that is, the base end of the main body 210). As will be described later in the “blood vessel peeling method”, since the proximal end of the guide part 200 is exposed from the living body even during use, the movable part 300 can be easily connected to the guide part 200. Note that the rail 211 may not be a slit as long as it can guide the movement of the movable unit 300, and may be, for example, a concave groove or a convex protrusion.
　一方、剥離部２２０は、ガイド部２００の先端に向けて先細りしており、円錐形状をなしている。また、剥離部２２０は、超音波透過性を有している。このような剥離部２２０は、ガイド部２００を生体内で前進させる際に、組織を剥離する機能と、生体内（大伏在静脈１０００およびその周囲）を観察する観察部としての機能と、を有している。なお、剥離部２２０の形状としては、本実施形態のような円錐形に限定されず、例えば、先端が線状となるように先細りしたダックビル形状であってもよい。 On the other hand, the peeling part 220 is tapered toward the tip of the guide part 200 and has a conical shape. Moreover, the peeling part 220 has ultrasonic permeability. Such a peeling unit 220 has a function of peeling the tissue when the guide unit 200 is advanced in the living body and a function as an observation unit for observing the living body (the great saphenous vein 1000 and its surroundings). Have. In addition, as a shape of the peeling part 220, it is not limited to a cone shape like this embodiment, For example, the duckbill shape tapering so that a front-end | tip may become linear may be sufficient.
　［イメージングデバイス］
　イメージングデバイス４００は、図２に示すように、長尺な本体部４１０を有し、この本体部４１０の先端部に超音波プローブ（超音波送受信部）からなる撮像部４２０が設けられている。このようなイメージングデバイス４００は、ガイド部２００内に挿入可能となっている。このように、イメージングデバイス４００をガイド部２００内に挿入することで、イメージングデバイス４００によって、剥離部２２０を介してガイド部２００の前方に位置する大伏在静脈１０００を観察可能となる。なお、撮像部４２０の構成としては、大伏在静脈１０００の位置を確認することができれば、本実施形態のような超音波プローブに限定されない。 [Imaging device]
As illustrated in FIG. 2, the imaging device 400 includes a long main body 410, and an imaging unit 420 including an ultrasonic probe (ultrasonic wave transmitting / receiving unit) is provided at the distal end of the main body 410. Such an imaging device 400 can be inserted into the guide unit 200. In this way, by inserting the imaging device 400 into the guide part 200, the imaging device 400 can observe the great saphenous vein 1000 positioned in front of the guide part 200 via the peeling part 220. The configuration of the imaging unit 420 is not limited to the ultrasonic probe as in the present embodiment as long as the position of the great saphenous vein 1000 can be confirmed.
　［可動部］
　可動部３００は、生体内を移動することで、大伏在静脈１０００をその周囲の組織（脂肪、結合組織等）１２００に覆われた状態で剥離すると共に、大伏在静脈１０００から分岐している分岐血管１１００を切断・止血する。このような可動部３００は、ガイド部２００に着脱自在であり、図３および図４に示すように、ガイド部２００のレール２１１に接続されるコネクタ３１０と、コネクタ３１０に装着される装着部３２０と、剥離部３５０と、処理部３６０と、を有している。 [movable part]
The movable unit 300 moves in the living body to separate the large saphenous vein 1000 while it is covered with the surrounding tissue (fat, connective tissue, etc.) 1200 and branch off from the large saphenous vein 1000. The branch blood vessel 1100 that is present is cut and stopped. Such a movable part 300 is detachable from the guide part 200, and as shown in FIGS. 3 and 4, a connector 310 connected to the rail 211 of the guide part 200 and a mounting part 320 attached to the connector 310. And a peeling unit 350 and a processing unit 360.
　コネクタ３１０は、略円弧状に湾曲する基部３１１と、基部３１１をレール２１１にスライド可能に接続する接続部３１２と、を有している。また、基部３１１の周方向の両端部には、装着部３２０を装着する溝３１１ａ、３１１ｂが設けられている。一方、装着部３２０は、軸方向に延びるスリット３２１を有し、略Ｃ字状の断面形状を有する管状（筒状）となっている。このような装着部３２０は、スリット３２１を挟んだ周方向の両端部がコネクタ３１０の溝３１１ａ、３１１ｂに係合することにより、コネクタ３１０に装着される。そして、使用時には、基部３１１と装着部３２０とで構成される環状の環状部３４０の内側に大伏在静脈１０００を位置させる。また、環状部３４０の内径は、大伏在静脈１０００の外径よりも大きく、使用時には、中心軸Ｊ上に大伏在静脈１０００が位置する。ただし、大伏在静脈１０００は、中心軸Ｊからずれていてもよい。 The connector 310 has a base portion 311 that is curved in a substantially arc shape and a connection portion 312 that slidably connects the base portion 311 to the rail 211. Further, grooves 311 a and 311 b for mounting the mounting portion 320 are provided at both ends in the circumferential direction of the base portion 311. On the other hand, the mounting portion 320 has a slit 321 extending in the axial direction and has a tubular shape (cylindrical shape) having a substantially C-shaped cross-sectional shape. Such a mounting portion 320 is mounted to the connector 310 by engaging both end portions in the circumferential direction with the slit 321 between the grooves 311 a and 311 b of the connector 310. In use, the great saphenous vein 1000 is positioned inside the annular annular portion 340 formed by the base 311 and the attachment portion 320. Further, the inner diameter of the annular portion 340 is larger than the outer diameter of the great saphenous vein 1000, and the great saphenous vein 1000 is located on the central axis J when in use. However, the great saphenous vein 1000 may be offset from the central axis J.
　このように、環状部３４０を２つの部材（コネクタ３１０、装着部３２０）を組み合わせて構成することで、後述する「血管剥離方法」でも説明するように、大伏在静脈１０００を切断することなく、大伏在静脈１０００の周囲に環状部３４０を配置することができる。 As described above, the annular portion 340 is configured by combining two members (the connector 310 and the mounting portion 320), so that the large saphenous vein 1000 is not cut as described in the “blood vessel peeling method” described later. An annulus 340 can be disposed around the large saphenous vein 1000.
　なお、スリット３２１の幅としては、特に限定されないが、大伏在静脈１０００の外径よりも太いことが好ましい。これにより、大伏在静脈１０００と非接触（または損傷を伴わない軽い接触）で、コネクタ３１０に装着部３２０を装着することができる。そのため、コネクタ３１０に装着部３２０を装着する際の大伏在静脈１０００の損傷を抑制することができる。ただし、スリット３２１の幅は、これに限定されず、大伏在静脈１０００の外径よりも細くてもよい。この場合には、例えば、装着部３２０を拡径変形させてスリット３２１を広げることで、大伏在静脈１０００と非接触でコネクタ３１０に装着部３２０を装着することができる。 The width of the slit 321 is not particularly limited, but is preferably larger than the outer diameter of the large saphenous vein 1000. Thereby, the attachment part 320 can be attached to the connector 310 in a non-contact manner (or a light contact without damage) with the great saphenous vein 1000. Therefore, damage to the great saphenous vein 1000 when attaching the attachment part 320 to the connector 310 can be suppressed. However, the width of the slit 321 is not limited to this, and may be smaller than the outer diameter of the large saphenous vein 1000. In this case, for example, the attachment part 320 can be attached to the connector 310 without contact with the large saphenous vein 1000 by expanding the deformation of the attachment part 320 and expanding the slit 321.
　また、環状部３４０は、その先端部に開放する溝部３９０を有し、溝部３９０は、環状部３４０の周方向に並んで複数配置されている。各溝部３９０は、その幅が基端側に向けて漸減するテーパー状の血管案内溝部（第１溝部）３９１と、血管案内溝部３９１の基端部に接続され、その幅がほぼ一定であるストレート状の血管処理溝部（第２溝部）３９２と、を有している。 Further, the annular portion 340 has a groove portion 390 that opens to the tip portion thereof, and a plurality of the groove portions 390 are arranged side by side in the circumferential direction of the annular portion 340. Each groove portion 390 is connected to a tapered blood vessel guide groove portion (first groove portion) 391 whose width gradually decreases toward the proximal end side and a proximal end portion of the blood vessel guide groove portion 391, and the straight width is substantially constant. A blood vessel processing groove (second groove) 392.
　血管案内溝部３９１は、可動部３００を生体内で押し進める際に接触する分岐血管１１００を血管処理溝部３９２に案内する溝部であり、この案内をスムーズに行うためにテーパー状となっている。特に、本実施形態では、隣り合う血管案内溝部３９１が接しているため、分岐血管１１００をいずれかの血管案内溝部３９１にスムーズに案内することができる。一方、血管処理溝部３９２は、血管案内溝部３９１によって案内されてきた分岐血管１１００を切断・止血するための溝部であり、各血管処理溝部３９２には処理部３６０が設けられている。 The blood vessel guide groove portion 391 is a groove portion that guides the branch blood vessel 1100 that contacts when the movable portion 300 is pushed in the living body to the blood vessel processing groove portion 392, and has a tapered shape to smoothly perform this guidance. In particular, in this embodiment, since the adjacent blood vessel guide groove portions 391 are in contact with each other, the branch blood vessel 1100 can be smoothly guided to any one of the blood vessel guide groove portions 391. On the other hand, the blood vessel processing groove 392 is a groove for cutting and stopping the branch blood vessel 1100 guided by the blood vessel guide groove 391, and each blood vessel processing groove 392 is provided with a processing unit 360.
　処理部３６０は、図５に示すように、血管処理溝部３９２内に電界を発生させることのできる一対の電極３６１、３６２を有するバイポーラ構造となっている。具体的には、電極３６１は、血管処理溝部３９２の基端部（底部）に設けられており、電極３６２は、血管処理溝部３９２の幅方向の両側に設けられている。このような電極３６１、３６２間に高周波交番電圧を印加することで、血管処理溝部３９２に案内された分岐血管１１００を加熱して切断すると共に、熱凝固して止血する。なお、電極３６１の先端部３６１’は、分岐血管１１００を切断することができる程度に鋭利であることが好ましい。これにより、少なくとも電極３６１、３６２間に発生する電界によって分岐血管１１００を熱凝固（止血）することができれば、電極３６１によって物理的に分岐血管を切断することができる。よって、処理部３６０による処理の確実性が向上する。 As shown in FIG. 5, the processing unit 360 has a bipolar structure having a pair of electrodes 361 and 362 that can generate an electric field in the blood vessel processing groove 392. Specifically, the electrode 361 is provided at the proximal end (bottom) of the vascular treatment groove 392, and the electrodes 362 are provided on both sides in the width direction of the vascular treatment groove 392. By applying a high-frequency alternating voltage between the electrodes 361 and 362, the branch blood vessel 1100 guided by the blood vessel processing groove 392 is heated and cut, and is thermally coagulated to stop hemostasis. Note that the tip 361 ′ of the electrode 361 is preferably sharp enough to cut the branch blood vessel 1100. Accordingly, if the branch blood vessel 1100 can be thermally coagulated (hemostatic) by an electric field generated at least between the electrodes 361 and 362, the branch blood vessel can be physically cut by the electrode 361. Therefore, the certainty of processing by the processing unit 360 is improved.
　ここで、血管処理溝部３９２の幅Ｗとしては、特に限定されないが、図５に示すように、分岐血管１１００の外径よりも細いことが好ましい。これにより、血管処理溝部３９２内で分岐血管１１００を潰すことができるため、処理部３６０による処理（切断・止血）をより確実に行うことができる。 Here, the width W of the blood vessel processing groove 392 is not particularly limited, but is preferably narrower than the outer diameter of the branch blood vessel 1100 as shown in FIG. Thereby, since the branch blood vessel 1100 can be crushed in the blood vessel processing groove 392, the processing (cutting / hemostasis) by the processing unit 360 can be performed more reliably.
　また、環状部３４０には、大伏在静脈１０００の周囲にある組織を剥離する剥離部３５０が設けられている。剥離部３５０は、環状部３４０の先端部に、血管案内溝部３９１に沿って設けられている。後述する「血管剥離方法」でも説明するように、剥離部３５０は、可動部３００を生体内で先端側へ押し進める際に大伏在静脈１０００の周囲にある組織を剥離する機能を有している。このような剥離部３５０は、分岐血管１１００を切断することなく、組織を剥離することができる程度の鋭さを有することが好ましい。これにより、剥離部３５０による分岐血管１１００の切断が抑制されるため、出血を少なく抑えることができ、安全かつスムーズに手技を行うことができる。 Also, the annular part 340 is provided with a peeling part 350 for peeling the tissue around the great saphenous vein 1000. The peeling portion 350 is provided along the blood vessel guide groove portion 391 at the distal end portion of the annular portion 340. As will be described later in the “blood vessel exfoliation method”, the exfoliation part 350 has a function of exfoliating the tissue around the large saphenous vein 1000 when the movable part 300 is pushed forward in the living body. . Such an exfoliation part 350 preferably has such a sharpness that it can exfoliate the tissue without cutting the branch blood vessel 1100. Thereby, since the cutting | disconnection of the branch blood vessel 1100 by the peeling part 350 is suppressed, a bleeding can be suppressed few and a procedure can be performed safely and smoothly.
　以上、可動部３００について説明したが、例えば、血管案内溝部３９１の形状としては、本実施形態の形状に限定されず、例えば、図６（ａ）に示すように、幅の漸減率が基端側に向けて漸減するような形状であってもよい。このような形状とすることで、剥離部３５０が丸み付けされるため、剥離部３５０によって分岐血管１１００が切断され難くなる。また、図６（ｂ）に示すように、隣り合う溝部３９０同士が離間していてもよい。また、本実施形態では、基部３１１に溝部３９０および処理部３６０が設けられていないが、例えば、図７に示すように、基部３１１にも装着部３２０と同様にして溝部３９０および処理部３６０を設けてもよい。これにより、剥離部３５０の全周にわたって溝部３９０および処理部３６０が配置される。 Although the movable part 300 has been described above, for example, the shape of the blood vessel guide groove 391 is not limited to the shape of the present embodiment. For example, as shown in FIG. The shape may be gradually reduced toward the side. By setting it as such a shape, since the peeling part 350 is rounded, it becomes difficult to cut | disconnect the branch blood vessel 1100 by the peeling part 350. FIG. Moreover, as shown in FIG.6 (b), the adjacent groove parts 390 may be spaced apart. In the present embodiment, the groove portion 390 and the processing portion 360 are not provided in the base portion 311, but for example, as shown in FIG. 7, the groove portion 390 and the processing portion 360 are also provided in the base portion 311 in the same manner as the mounting portion 320. It may be provided. Thereby, the groove part 390 and the process part 360 are arrange | positioned over the perimeter of the peeling part 350. FIG.
　また、可動部３００は、環状部３４０の全周で熱を発生させ、組織を焼き切りながら前進させる構成となっていてもよい。 Moreover, the movable part 300 may be configured to generate heat all around the annular part 340 and advance the structure while burning it.
　［操作部］
　操作部５００は、図８に示すように、棒状をなし、ガイド部２００内に挿入可能となっている。そのため、操作部５００をガイド部２００内に挿入し、その先端でコネクタ３１０を押圧することで可動部３００を移動させることができる。なお、操作部５００は、例えば、嵌合、螺合等の手段によってコネクタ３１０に固定することができるようになっていることが好ましい。これにより、操作部５００で可動部３００を押し引きすることができる。 [Operation section]
As shown in FIG. 8, the operation unit 500 has a rod shape and can be inserted into the guide unit 200. Therefore, the movable unit 300 can be moved by inserting the operation unit 500 into the guide unit 200 and pressing the connector 310 with the tip thereof. In addition, it is preferable that the operation part 500 can be fixed to the connector 310 by means such as fitting or screwing. Thereby, the movable part 300 can be pushed and pulled by the operation part 500.
　≪血管剥離方法≫
　血管剥離デバイス１００を用いた血管剥離方法（血管採取方法）は、大伏在静脈１０００と所定間隔Ｄを保ちつつ、大伏在静脈１０００に沿ってガイド部２００を配置する第１ステップと、ガイド部２００に接続された可動部３００を移動させて、大伏在静脈１０００を周囲の組織１２００に覆われた状態で剥離する第２ステップと、大伏在静脈１０００を結紮した後に切断する第３ステップと、大伏在静脈１０００を周囲の組織１２００に覆われた状態で摘出する第４ステップと、を有する。 ≪Vessel peeling method≫
The blood vessel peeling method (blood vessel sampling method) using the blood vessel peeling device 100 includes a first step of arranging the guide portion 200 along the large saphenous vein 1000 while maintaining a predetermined distance D from the large saphenous vein 1000, and a guide. A second step of moving the movable part 300 connected to the part 200 to peel the large saphenous vein 1000 in a state covered with the surrounding tissue 1200; and a third step of cutting after ligating the saphenous vein 1000 And a fourth step of extracting the great saphenous vein 1000 while being covered with the surrounding tissue 1200.
　［第１ステップ］
　まず、採取する大伏在静脈１０００の位置を確認し、その位置に基づいて切開する。次に、図９（ａ）に示すように、イメージングデバイス４００が挿入されたガイド部２００を切開部１３００から生体内に挿入し、イメージングデバイス４００で生体内（大伏在静脈１０００）を観察しながらガイド部２００を大伏在静脈１０００と所定間隔Ｄを保ちつつ、大伏在静脈１０００に沿って前進させる。この際、ガイド部２００の先端部に設けられた剥離部２２０によって、組織を剥離することができるため、ガイド部２００をスムーズに前進させることができる。このように、ガイド部２００を大伏在静脈１０００に沿って配置することで、図９（ｂ）に示すように、大伏在静脈１０００が直線状に矯正された状態となる。 [First step]
First, the position of the great saphenous vein 1000 to be collected is confirmed, and an incision is made based on the position. Next, as shown in FIG. 9A, the guide part 200 in which the imaging device 400 is inserted is inserted into the living body through the incision part 1300, and the living body (large saphenous vein 1000) is observed with the imaging device 400. The guide unit 200 is advanced along the great saphenous vein 1000 while maintaining a predetermined distance D from the great saphenous vein 1000. At this time, since the tissue can be peeled by the peeling portion 220 provided at the distal end portion of the guide portion 200, the guide portion 200 can be smoothly advanced. Thus, by arranging the guide unit 200 along the large saphenous vein 1000, the large saphenous vein 1000 is straightened as shown in FIG. 9B.
　なお、ガイド部２００のレール２１１に組織が詰まってしまわないように、例えば、レール２１１を覆う保護部材を装着した状態でガイド部２００を生体内に挿入し、挿入が完了した後、前記保護部材をガイド部２００から除去するようにしてもよい。また、ガイド部２００を管状の外管に挿入した状態でガイド部２００を生体内に挿入し、挿入が完了した後、前記外管を除去するようにしてもよい。同様に、ガイド部２００内に管状の内管を挿入してガイド部２００の内側からレール２１１を塞ぎ、この状態でガイド部２００を生体内に挿入し、挿入が完了した後、前記内管をガイド部２００から除去するようにしてもよい。また、ガイド部２００を軸方向に沿ったスリットが形成されている外管に挿入し、かつ、スリットをレール２１１に対して周方向にずらした状態でガイド部２００を生体内に挿入し、挿入が完了した後、前記外管を周方向に回転させてスリットをレール２１１に合わせることでレール２１１を露出させてもよい。同様に、ガイド部２００に軸方向に沿ったスリットが形成されている内管を挿入し、かつ、スリットをレール２１１に対して周方向にずらした状態でガイド部２００を生体内に挿入し、挿入が完了した後、前記内管を周方向に回転させてスリットをレール２１１に合わせることでレール２１１を露出させてもよい。 Note that, for example, the guide member 200 is inserted into the living body in a state in which a protective member that covers the rail 211 is mounted so that the tissue is not clogged in the rail 211 of the guide portion 200. May be removed from the guide part 200. Alternatively, the guide unit 200 may be inserted into the living body with the guide unit 200 inserted into the tubular outer tube, and the outer tube may be removed after the insertion is completed. Similarly, a tubular inner tube is inserted into the guide portion 200 to close the rail 211 from the inside of the guide portion 200. In this state, the guide portion 200 is inserted into the living body, and after the insertion is completed, the inner tube is You may make it remove from the guide part 200. FIG. Further, the guide part 200 is inserted into the outer tube in which a slit along the axial direction is formed, and the guide part 200 is inserted into the living body in a state where the slit is shifted in the circumferential direction with respect to the rail 211. After completing the above, the rail 211 may be exposed by rotating the outer tube in the circumferential direction and aligning the slit with the rail 211. Similarly, an inner tube in which a slit along the axial direction is formed in the guide portion 200 is inserted, and the guide portion 200 is inserted into the living body in a state where the slit is shifted in the circumferential direction with respect to the rail 211, After the insertion is completed, the rail 211 may be exposed by rotating the inner tube in the circumferential direction and aligning the slit with the rail 211.
　［第２ステップ］
　次に、ガイド部２００からイメージングデバイス４００を抜去した後、図１０（ａ）に示すように、ガイド部２００の基端からレール２１１にコネクタ３１０を接続し、さらに、コネクタ３１０との間に大伏在静脈１０００が位置するように、コネクタ３１０に装着部３２０を装着する。これにより、環状部３４０が形成され、環状部３４０内に、大伏在静脈１０００が配置される。特に、本実施形態では、環状部３４０の中心軸Ｊ上に大伏在静脈１０００が位置している。言い換えれば、第１ステップにおいて、環状部３４０内に大伏在静脈１０００を配置することができるように、好ましくは、中心軸Ｊ上に大伏在静脈１０００を配置することができるように、ガイド部２００と大伏在静脈１０００の離間距離（所定間隔Ｄ）が制御（決定）されている。 [Second step]
Next, after the imaging device 400 is removed from the guide part 200, the connector 310 is connected to the rail 211 from the base end of the guide part 200 as shown in FIG. The attachment part 320 is attached to the connector 310 so that the saphenous vein 1000 is located. Thereby, the annular portion 340 is formed, and the large saphenous vein 1000 is disposed in the annular portion 340. In particular, in the present embodiment, the large saphenous vein 1000 is located on the central axis J of the annular portion 340. In other words, in the first step, the guide may be arranged so that the great saphenous vein 1000 can be arranged on the central axis J so that the great saphenous vein 1000 can be arranged in the annular portion 340. The separation distance (predetermined distance D) between the part 200 and the great saphenous vein 1000 is controlled (determined).
　このように、コネクタ３１０と装着部３２０とを組み立てることで環状部３４０を形成することで、大伏在静脈１０００を切断することなく、大伏在静脈１０００の周囲に環状部３４０を配置することができる。 In this way, by forming the annular portion 340 by assembling the connector 310 and the mounting portion 320, the annular portion 340 is disposed around the great saphenous vein 1000 without cutting the great saphenous vein 1000. Can do.
　なお、ガイド部２００からイメージングデバイス４００を抜去することなく、ガイド部２００にコネクタ３１０を接続してもよい。 Note that the connector 310 may be connected to the guide unit 200 without removing the imaging device 400 from the guide unit 200.
　また、本ステップでは、ガイド部２００の基端からコネクタ３１０をレール２１１に接続するが、ガイド部２００の基端部が生体から露出しているため、当該接続をスムーズに行うことができる。また、第２ステップにおいて可動部３００をガイド部２００に接続することで、第１ステップを可動部３００が接続されていない状態のガイド部２００を用いて行うことができる。そのため、可動部３００が邪魔にならず、第１ステップをよりスムーズに行うことができる。 In this step, the connector 310 is connected to the rail 211 from the proximal end of the guide portion 200. However, since the proximal end portion of the guide portion 200 is exposed from the living body, the connection can be smoothly performed. Further, by connecting the movable unit 300 to the guide unit 200 in the second step, the first step can be performed using the guide unit 200 in a state where the movable unit 300 is not connected. Therefore, the movable part 300 does not get in the way and the first step can be performed more smoothly.
　次に、図１０（ｂ）に示すように、操作部５００を用いて可動部３００を押し込み、レール２１１に沿って（ガイド部２００で案内しつつ）生体内を前進させる。可動部３００を前進させると、剥離部３５０によって大伏在静脈１０００の周囲の組織１２００が剥離されると共に、溝部３９０によって分岐血管１１００が処理部３６０に案内され、処理部３６０で切断・止血される。これにより、大伏在静脈１０００がその周囲の組織１２００に覆われた状態で生体から剥離される。 Next, as shown in FIG. 10B, the movable unit 300 is pushed in using the operation unit 500, and the living body is advanced along the rail 211 (while being guided by the guide unit 200). When the movable part 300 is advanced, the tissue 1200 around the great saphenous vein 1000 is peeled off by the peeling part 350, and the branch blood vessel 1100 is guided to the processing part 360 by the groove part 390, and is cut and stopped by the processing part 360. The Thereby, the great saphenous vein 1000 is peeled from the living body in a state covered with the surrounding tissue 1200.
　特に、ガイド部２００によって大伏在静脈１０００が直線状に矯正されており、かつ、環状部３４０の中心軸Ｊ上に大伏在静脈１０００が位置しているため、環状部３４０と大伏在静脈１０００との接触が防止され、さらに、剥離した組織１２００のほぼ中心に大伏在静脈１０００を位置させることができる。したがって、より正確にかつ偏りなく、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で剥離することができる。なお、大伏在静脈１０００と共に剥離され、大伏在静脈１０００の周囲に位置する組織１２００の厚みｔ１としては、特に限定されないが、０．１ｍｍ～１０ｍｍ程度であることが好ましく、１ｍｍ～８ｍｍ程度であることがより好ましく、３ｍｍ～５ｍｍ程度であることがさらに好ましい。 In particular, the large saphenous vein 1000 is straightened by the guide portion 200 and the large saphenous vein 1000 is located on the central axis J of the annular portion 340. Contact with the vein 1000 is prevented, and the great saphenous vein 1000 can be positioned approximately in the center of the exfoliated tissue 1200. Therefore, the greater saphenous vein 1000 can be exfoliated while being covered with the surrounding tissue 1200 more accurately and without bias. The thickness t1 of the tissue 1200 exfoliated with the great saphenous vein 1000 and located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.
　なお、説明の便宜上、以下では、可動部３００を移動させて、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で剥離する作業を「剥離作業」とも言う。 For convenience of explanation, in the following, the operation of moving the movable unit 300 and peeling off the large saphenous vein 1000 while being covered with the surrounding tissue 1200 is also referred to as “peeling work”.
　［第３ステップ］
　次に、大伏在静脈１０００を基端側カット予定部１００１および先端側カット予定部１００２で切断する。具体的には、まず、図１１（ａ）に示すように、大伏在静脈１０００の基端側カット予定部１００１を挟んだ前後の２箇所を結紮すると共に、先端側カット予定部１００２を挟んだ前後の２箇所を結紮する。なお、先端側カット予定部１００２側の結紮は、先端側カット予定部１００２付近を切開し、この切開部１４００を介して行うことができる。次に、図１１（ｂ）に示すように、大伏在静脈１０００を基端側カット予定部１００１および先端側カット予定部１００２で切断する。 [Third step]
Next, the large saphenous vein 1000 is cut at the proximal-side planned cut portion 1001 and the distal-side planned cut portion 1002. Specifically, first, as shown in FIG. 11 (a), two sites before and after the proximal end side cut planned portion 1001 of the large saphenous vein 1000 are ligated and the front end side cut planned portion 1002 is sandwiched. Ligate the two places before and after. In addition, the ligation on the tip side cut planned portion 1002 side can be performed through the incision portion 1400 by incising the vicinity of the tip side cut planned portion 1002. Next, as shown in FIG. 11 (b), the large saphenous vein 1000 is cut at the base end side planned cut portion 1001 and the distal end side cut planned portion 1002.
　［第４ステップ］
　次に、切開部１３００を介して、図１２に示すように、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で生体外へ取り出す。 [Fourth step]
Next, as shown in FIG. 12, the large saphenous vein 1000 is taken out of the living body through the incision 1300 while being covered with the surrounding tissue 1200.
　以上のような第１ステップ～第４ステップによって、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で採取（摘出）することができる。このような状態で採取された大伏在静脈１０００は、組織１２００で覆われていない大伏在静脈よりも優れた長期開存率を有するバイパス血管となる可能性がある。これは、次の理由によると考えられている。 Through the first to fourth steps as described above, the large saphenous vein 1000 can be collected (extracted) while being covered with the surrounding tissue 1200. The great saphenous vein 1000 collected in such a state may be a bypass blood vessel having a long-term patency rate superior to that of the great saphenous vein not covered with the tissue 1200. This is believed to be due to the following reasons.
　すなわち、大伏在静脈１０００は、動脈のバイパス血管として用いられるが、動脈は、静脈に比べて血圧（血液により受ける内圧）が高い。そのため、組織１２００に覆われていない剥き出しの状態の大伏在静脈をバイパス血管として用いると、血圧に耐えられずに大伏在静脈が膨張して血流が低下するおそれがある。また、リモデリング（構造的改変）や組織損傷の修復過程において血管壁が肥厚するおそれもある。このような血管壁の肥厚は、動脈硬化の進展に影響すると考えられている。このような原因から、組織１２００に覆われていない剥き出しの状態の大伏在静脈をバイパス血管として用いると、長期的には血管閉塞に繋がってしまうおそれがある。 That is, the great saphenous vein 1000 is used as an arterial bypass blood vessel, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, the large saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced. In addition, the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair. Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, it may lead to blood vessel occlusion in the long term.
　これに対して、本実施形態のように、大伏在静脈１０００を組織１２００で覆うことで、組織１２００によって大伏在静脈１０００の膨張が抑えられると共に、大伏在静脈１０００の折れ曲がり等が抑えられるという効果が期待できる。よって、上記のような血流の低下を抑えることができる可能性がある。また、組織１２００で覆われていることで、大伏在静脈１０００の損傷、具体的には、内皮細胞、平滑筋、栄養血管（小血管網）等の損傷が低減される。よって、上記のような血管壁の肥厚を抑えることができる可能性がある。以上のことから、組織１２００に覆われた大伏在静脈１０００をバイパス血管として用いることで、優れた長期開存率を発揮することができる可能性がある。特に、本実施形態では、大伏在静脈１０００の血管壁や組織１２００に栄養血管が残存しているため、バイパス後も、バイパス血管としての大伏在静脈１０００に栄養が供給され、上記効果の向上が図られると考えられる。 On the other hand, by covering the great saphenous vein 1000 with the tissue 1200 as in the present embodiment, the tissue 1200 suppresses the expansion of the large saphenous vein 1000 and suppresses the bending of the great saphenous vein 1000 and the like. It can be expected to be effective. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed. In addition, by being covered with the tissue 1200, damage to the great saphenous vein 1000, specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed. From the above, there is a possibility that an excellent long-term patency rate can be exhibited by using the great saphenous vein 1000 covered with the tissue 1200 as a bypass blood vessel. In particular, in this embodiment, since the nutritional blood vessels remain in the blood vessel wall and the tissue 1200 of the great saphenous vein 1000, nutrition is supplied to the great saphenous vein 1000 as a bypass blood vessel even after bypassing, and the above effect is achieved. It is thought that improvement will be achieved.
　以上説明したような方法によれば、スムーズかつ的確に大伏在静脈１０００をその周囲の組織１２００に覆われた状態で摘出することができる。具体的に説明すると、第１ステップにおいて、ガイド部２００を大伏在静脈１０００と所定間隔Ｄだけ離間させて配置することで、ガイド部２００と大伏在静脈１０００との接触を防止することができ、大伏在静脈１０００の損傷を抑えることができる。さらに、第２ステップにおいて、可動部３００をガイド部２００で案内しながら移動させているため、可動部３００を定まったルートに沿って移動させることができ、よって、可動部３００と大伏在静脈１０００の接触が抑制される。そのため、上述の方法によれば、大伏在静脈１０００の損傷を抑えつつ、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で剥離することができる。 According to the method described above, the large saphenous vein 1000 can be removed smoothly and accurately in a state covered with the surrounding tissue 1200. Specifically, in the first step, the guide part 200 is arranged at a predetermined distance D from the great saphenous vein 1000 to prevent contact between the guide part 200 and the great saphenous vein 1000. And damage to the great saphenous vein 1000 can be suppressed. Further, in the second step, since the movable part 300 is moved while being guided by the guide part 200, the movable part 300 can be moved along a predetermined route. 1000 contacts are suppressed. Therefore, according to the above-described method, the large saphenous vein 1000 can be peeled while being covered with the surrounding tissue 1200 while suppressing damage to the large saphenous vein 1000.
　特に、第１ステップにおいて、ガイド部２００によって大伏在静脈１０００を直線状に矯正（変形）しているため、第２ステップをよりスムーズにかつ的確に行うことができる。また、第２ステップが終わるまで、大伏在静脈１０００を切断しないため、大伏在静脈１０００になるべく長く血を通わせることができる。よって、虚血状態がより短く、損傷の少ない大伏在静脈１０００を採取することできる。 Particularly, since the large saphenous vein 1000 is straightened (deformed) by the guide portion 200 in the first step, the second step can be performed more smoothly and accurately. Further, since the great saphenous vein 1000 is not cut until the second step is completed, blood can be passed through the great saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.
　なお、本実施形態では、大伏在静脈１０００をその全周が組織１２００に覆われた状態で採取（剥離）しているが、全周が組織１２００で覆われているものに限定されず、大伏在静脈１０００をその周囲の少なくとも一部が組織１２００に覆われた状態で採取（剥離）できればよい。 In the present embodiment, the large saphenous vein 1000 is collected (exfoliated) in a state where the entire circumference is covered with the tissue 1200, but is not limited to the one where the entire circumference is covered with the tissue 1200, It suffices if the great saphenous vein 1000 can be collected (exfoliated) in a state where at least a part of its circumference is covered with the tissue 1200.
　以上、本実施形態について説明したが、本体部２１０の断面形状は、円形に限定されず、例えば、大伏在静脈１０００との並び方向に潰れた扁平形状であってもよい。このような横断面形状とすることで、例えば次のような効果を発揮することができる。図１３（ａ）示すように、分岐血管１１００は、大伏在静脈１０００の全周から放射状に不規則に枝分かれしている。そこへ扁平形状のガイド部２００を配置すると、図１３（ｂ）に示すように、ガイド部２００側に延びる分岐血管１１００’がガイド部２００によって下方に押し下げられ、図中下方側（ガイド部２００と反対側）に寄る。そのため、剥離作業中のコネクタ３１０の移動軌跡上から分岐血管１１００を退避させることができ、コネクタ３１０に溝部３９０や処理部３６０を設けなくても、十分に、各分岐血管１１００の処理を行うことができるようになる。なお、このような形態におけるガイド部２００の幅としては、特に限定されないが、例えば、大伏在静脈１０００の直径よりも大きいことが好ましい。 As mentioned above, although this embodiment was described, the cross-sectional shape of the main-body part 210 is not limited to a circle, For example, the flat shape crushed in the alignment direction with the great saphenous vein 1000 may be sufficient. By setting it as such a cross-sectional shape, the following effects can be exhibited, for example. As shown in FIG. 13A, the branch blood vessel 1100 branches radially and irregularly from the entire circumference of the great saphenous vein 1000. When the flat guide part 200 is arranged there, as shown in FIG. 13B, the branch blood vessel 1100 ′ extending toward the guide part 200 is pushed downward by the guide part 200, and the lower side (guide part 200 in the figure). Close to the other side. Therefore, the branch blood vessel 1100 can be retracted from the movement trajectory of the connector 310 during the peeling operation, and the processing of each branch blood vessel 1100 can be sufficiently performed without providing the connector 310 with the groove portion 390 or the processing portion 360. Will be able to. In addition, although it does not specifically limit as a width | variety of the guide part 200 in such a form, For example, it is preferable that it is larger than the diameter of the great saphenous vein 1000.
　＜第２実施形態＞
　図１４は、本発明の第２実施形態に係る血管剥離デバイスを示す図である。 Second Embodiment
FIG. 14 is a view showing a blood vessel peeling device according to a second embodiment of the present invention.
　以下、この図を参照して第２実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the second embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
　本実施形態は、主に、イメージングデバイスの構成が異なること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the imaging device is different.
　≪血管剥離デバイス≫
　イメージングデバイス４００Ａは、前述した第１実施形態のようにガイド部２００に挿入して使用するものではなく、図１４（ａ）に示すように、皮膚（生体表面）Ｈから生体内を観察する。このようなイメージングデバイス４００Ａとしては、生体内の観察することができれば、特に限定されず、例えば、超音波診断等に用いられる超音波プローブ等を用いることができる。一方、図１４（ｂ）に示すように、ガイド部２００Ａの先端部（剥離部２２０）にはイメージングデバイス４００Ａから得られる画像（超音波画像）で認識可能な超音波マーカー２９０が設けられている。なお、本実施形態では、剥離部２２０が超音波透過性を有していなくてもよい。 ≪Vessel peeling device≫
The imaging device 400A is not used by being inserted into the guide unit 200 as in the first embodiment described above, but observes the inside of the living body from the skin (biological surface) H as shown in FIG. Such an imaging device 400A is not particularly limited as long as it can be observed in a living body. For example, an ultrasonic probe used for ultrasonic diagnosis or the like can be used. On the other hand, as shown in FIG. 14B, an ultrasonic marker 290 that can be recognized by an image (ultrasonic image) obtained from the imaging device 400A is provided at the distal end portion (peeling portion 220) of the guide portion 200A. . In the present embodiment, the peeling part 220 may not have ultrasonic wave permeability.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ａでは、血管剥離方法の第１ステップにおいて、イメージングデバイス４００Ａを用いて生体内を観察し、大伏在静脈１０００とガイド部２００Ａの先端部との位置関係を把握しながら、ガイド部２００Ａを前進させる。このような方法によっても、ガイド部２００Ａの先端部の位置を可視化できるため、ガイド部２００Ａと大伏在静脈１０００との位置関係を把握でき、ガイド部２００を生体内にスムーズにかつ精度よく配置することができる。 ≪Vessel peeling method≫
In the blood vessel peeling device 100A having such a configuration, in the first step of the blood vessel peeling method, the inside of the living body is observed using the imaging device 400A, and the positional relationship between the great saphenous vein 1000 and the distal end portion of the guide portion 200A is grasped. Meanwhile, the guide portion 200A is advanced. Even by such a method, the position of the distal end portion of the guide portion 200A can be visualized, so that the positional relationship between the guide portion 200A and the great saphenous vein 1000 can be grasped, and the guide portion 200 can be placed smoothly and accurately in the living body. can do.
　このような第２実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the second embodiment, the same effect as that of the first embodiment described above can be exhibited.
　＜第３実施形態＞
　図１５は、本発明の第３実施形態に係る血管剥離デバイスを示す斜視図である。図１６は、図１５に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。 <Third Embodiment>
FIG. 15 is a perspective view showing a blood vessel peeling device according to a third embodiment of the present invention. FIG. 16 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
　以下、この図を参照して第３実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the third embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
　本実施形態は、主に、イメージングデバイスが省略されていること以外は、前述した第１実施形態と同様である。 This embodiment is the same as the first embodiment described above except that the imaging device is mainly omitted.
　≪血管剥離デバイス≫
　血管剥離デバイス１００Ｂは、図１５に示すように、ガイド部２００Ｂと、可動部３００と、操作部５００と、を有している。すなわち、血管剥離デバイス１００Ｂは、前述した第１実施形態の血管剥離デバイス１００からイメージングデバイス４００が省略された構成となっている。 ≪Vessel peeling device≫
As shown in FIG. 15, the blood vessel peeling device 100B includes a guide part 200B, a movable part 300, and an operation part 500. That is, the blood vessel peeling device 100B has a configuration in which the imaging device 400 is omitted from the blood vessel peeling device 100 of the first embodiment described above.
　また、ガイド部２００Ｂの先端部には報知部２８０が設けられている。報知部２８０は、ＬＥＤ等の発光部２８１を有しており、発光部２８１が発する光によって術者にガイド部２００Ｂの先端部の位置を報知することができる。なお、発光部２８１は、点灯させてもよいし、点滅させてもよい。また、発光部２８１が発する光の色としては、特に限定されず、白、青、赤、緑等とすることができる。なお、本実施形態では、剥離部２２０が超音波透過性を有していなくてもよい。 Also, a notification unit 280 is provided at the tip of the guide unit 200B. The notification unit 280 includes a light emitting unit 281 such as an LED, and can notify the operator of the position of the distal end portion of the guide unit 200B with light emitted from the light emitting unit 281. Note that the light emitting unit 281 may be turned on or blinked. In addition, the color of light emitted from the light emitting unit 281 is not particularly limited, and may be white, blue, red, green, or the like. In the present embodiment, the peeling part 220 may not have ultrasonic wave permeability.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｂでは、血管剥離方法の第１ステップを、生体内を観察して大伏在静脈１０００の位置を把握した後、把握した位置に基づいてガイド部２００を配置することで行う。具体的には、ＣＴスキャン（コンピュータ断層撮影）や超音波、赤外線（近赤外線）等を用いた診断によって得られた画像を基に大伏在静脈１０００の位置を把握し、把握した情報を皮膚Ｈ（生体表面）に記す。前記情報の印し方としては、例えば、図１６に示すように、大伏在静脈１０００に沿って皮膚上に印Ｘをつけると共に、各印Ｘの位置における大伏在静脈１０００の皮膚からの深さを記す。次に、切開部１３００を形成した後、発光部２８１を発光させながらガイド部２００Ｂを生体内へ挿入し、皮膚から透けて視認される発光部２８１の光に基づいて、ガイド部２００の先端部の位置を把握しながら前進させ、ガイド部２００Ｂを大伏在静脈１０００に沿って配置する。なお、生体内でのガイド部２００Ｂの先端部の平面的な位置は、発光部２８１からの光の位置から把握でき、皮膚からの深さ（ガイド部２００Ｂと大伏在静脈１０００との離間距離）は、皮膚から透けて見える光の強度（明るさ）で把握することができる。 ≪Vessel peeling method≫
In the blood vessel peeling device 100B having such a configuration, the first step of the blood vessel peeling method is to observe the inside of the living body and grasp the position of the great saphenous vein 1000, and then arrange the guide unit 200 based on the grasped position. Do that. Specifically, the position of the great saphenous vein 1000 is grasped based on an image obtained by diagnosis using CT scan (computer tomography), ultrasonic waves, infrared rays (near infrared rays), etc., and the grasped information is obtained from the skin. Marked as H (surface of living body). For example, as shown in FIG. 16, the information is marked on the skin along the great saphenous vein 1000, and from the skin of the great saphenous vein 1000 at each mark X position. Describe the depth. Next, after forming the incision portion 1300, the guide portion 200B is inserted into the living body while causing the light emitting portion 281 to emit light, and based on the light of the light emitting portion 281 that is visible through the skin, the distal end portion of the guide portion 200 The guide part 200 </ b> B is disposed along the great saphenous vein 1000. The planar position of the distal end of the guide part 200B in the living body can be grasped from the position of the light from the light emitting part 281 and the depth from the skin (distance between the guide part 200B and the great saphenous vein 1000). ) Can be grasped by the intensity (brightness) of light seen through the skin.
　このような方法によっても、ガイド部２００Ｂの先端部の位置を可視化できるため、ガイド部２００Ｂと大伏在静脈１０００との位置関係を把握でき、ガイド部２００を生体内にスムーズにかつ精度よく配置することができる。 Also by such a method, the position of the distal end portion of the guide portion 200B can be visualized, so that the positional relationship between the guide portion 200B and the great saphenous vein 1000 can be grasped, and the guide portion 200 can be placed smoothly and accurately in the living body. can do.
　このような第３実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the third embodiment, the same effect as that of the first embodiment described above can be exhibited.
　＜第４実施形態＞
　図１７は、本発明の第４実施形態に係る血管剥離デバイスを示す断面図である。図１８は、図１７に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。 <Fourth embodiment>
FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a fourth embodiment of the present invention. FIG. 18 is a diagram illustrating a blood vessel peeling method using the blood vessel peeling device shown in FIG.
　以下、この図を参照して第４実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the fourth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
　本実施形態は、主に、穿刺部をさらに有すること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that it further has a puncture portion.
　≪血管剥離デバイス≫
　血管剥離デバイス１００Ｃは、図１７に示すように、穿刺部８００をさらに有している。穿刺部８００は、本体部８１０と、本体部８１０の先端部に設けられた剥離部（観察部）８２０と、を有している。本体部８１０は、直線状に延在する管状をなしている。一方、剥離部８２０は、穿刺部８００の先端に向けて先細りしており、円錐形状をなしている。また、剥離部８２０は、超音波透過性を有している。そして、このような構成の穿刺部８００には、イメージングデバイス４００が挿入可能となっている。なお、本実施形態では、ガイド部２００にイメージングデバイス４００を挿入することができなくてもよいし、剥離部２２０が超音波透過性を有していなくてもよい。 ≪Vessel peeling device≫
The blood vessel peeling device 100C further includes a puncture unit 800 as shown in FIG. The puncture unit 800 includes a main body unit 810 and a peeling unit (observation unit) 820 provided at the tip of the main body unit 810. The main body 810 has a tubular shape extending linearly. On the other hand, the peeling part 820 tapers toward the tip of the puncture part 800 and has a conical shape. Moreover, the peeling part 820 has ultrasonic permeability. The imaging device 400 can be inserted into the puncture unit 800 having such a configuration. In the present embodiment, the imaging device 400 may not be inserted into the guide part 200, and the peeling part 220 may not have ultrasonic wave permeability.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｃでは、血管剥離方法の第１ステップが、生体内を観察しながら、穿刺部８００を大伏在静脈１０００との離間距離を所定間隔Ｄに保ちつつ大伏在静脈１０００に沿って挿入するステップと、穿刺部８００を挿入することで形成された穿刺孔１５００に、ガイド部２００を挿入するステップと、を有する。 ≪Vessel peeling method≫
In the blood vessel peeling device 100C having such a configuration, the first step of the blood vessel peeling method is to observe the inside of the living body and keep the puncture portion 800 away from the large saphenous vein 1000 while maintaining a predetermined distance D. A step of inserting along the vein 1000, and a step of inserting the guide unit 200 into the puncture hole 1500 formed by inserting the puncture unit 800.
　具体的に説明すると、まず、図１８（ａ）に示すように、イメージングデバイス４００が挿入された穿刺部８００を切開部１３００から生体内に挿入し、イメージングデバイス４００で生体内（大伏在静脈１０００およびその付近）を観察しながら穿刺部８００を大伏在静脈１０００と所定間隔を保ちつつ、大伏在静脈１０００に沿って前進させる。この際、穿刺部８００の先端部に設けられた剥離部８２０によって組織を剥離することができるため、穿刺部８００をスムーズに前進させることができる。次に、図１８（ｂ）に示すように、穿刺部８００を生体から抜去し、穿刺部８００の穿刺によって形成された穿刺孔１５００にガイド部２００を挿入する。これにより、ガイド部２００が大伏在静脈１０００に沿って配置された状態となる。 More specifically, first, as shown in FIG. 18A, the puncture portion 800 in which the imaging device 400 is inserted is inserted into the living body through the incision portion 1300, and the in vivo (large saphenous vein) is detected by the imaging device 400. The puncture unit 800 is advanced along the great saphenous vein 1000 while maintaining a predetermined distance from the great saphenous vein 1000 while observing 1000 and the vicinity thereof. At this time, since the tissue can be peeled off by the peeling portion 820 provided at the distal end portion of the puncture portion 800, the puncture portion 800 can be smoothly advanced. Next, as shown in FIG. 18B, the puncture unit 800 is removed from the living body, and the guide unit 200 is inserted into the puncture hole 1500 formed by the puncture of the puncture unit 800. As a result, the guide unit 200 is arranged along the large saphenous vein 1000.
　このような方法によれば、穿刺部８００によって予め形成された穿刺孔１５００にガイド部２００を挿入するため、例えば、ガイド部２００のレール２１１に組織が詰まってしまうことを低減することができる。そのため、可動部３００をよりスムーズに移動させることができ、第２ステップ中の剥離作業をよりスムーズに行うことができる。 According to such a method, since the guide part 200 is inserted into the puncture hole 1500 formed in advance by the puncture part 800, it is possible to reduce the clogging of the tissue into the rail 211 of the guide part 200, for example. Therefore, the movable part 300 can be moved more smoothly, and the peeling operation in the second step can be performed more smoothly.
　このような第４実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the fourth embodiment, the same effects as those of the first embodiment described above can be exhibited.
　＜第５実施形態＞
　図１９は、本発明の第５実施形態に係る血管剥離デバイスを示す断面図である。 <Fifth Embodiment>
FIG. 19 is a cross-sectional view showing a blood vessel peeling device according to a fifth embodiment of the present invention.
　以下、この図を参照して第５実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the fifth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、操作部の構成が異なること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the operation unit is different.
　≪血管剥離デバイス≫
　操作部５００Ｄは、図１９に示すように、２本の紐（線状体）５１１、５１２を有している。紐５１１は、一端部がコネクタ３１０に接続され、他端部がガイド部２００の本体部２１０の先端部に設けられた挿通孔２１９を経由してガイド部２００の基端開口から外部へ引き出されている。一方、紐５１２は、一端部がコネクタに接続され、他端部がガイド部２００の基端側へ引き出されている。そのため、紐５１１を基端側へ引っ張ることで可動部３００を前方（先端側）へ移動させることができ、反対に、紐５１２を基端側へ引っ張ることで可動部３００を後方（基端側）へ移動させることができる。 ≪Vessel peeling device≫
The operation unit 500D includes two strings (linear bodies) 511 and 512 as shown in FIG. One end of the string 511 is connected to the connector 310, and the other end is pulled out from the proximal end opening of the guide part 200 via the insertion hole 219 provided in the distal end part of the main body part 210 of the guide part 200. ing. On the other hand, the string 512 has one end connected to the connector and the other end pulled out to the proximal end side of the guide part 200. Therefore, the movable part 300 can be moved forward (distal side) by pulling the string 511 toward the base end side, and conversely, the movable part 300 can be moved backward (proximal end side) by pulling the string 512 toward the base end side. ).
　このような第５実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Also according to the fifth embodiment, the same effect as that of the first embodiment described above can be exhibited.
　＜第６実施形態＞
　図２０は、本発明の第６実施形態に係る血管剥離デバイスを示す断面図である。 <Sixth Embodiment>
FIG. 20 is a cross-sectional view showing a blood vessel peeling device according to a sixth embodiment of the present invention.
　以下、この図を参照して第６実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the sixth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、操作部の構成が異なること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the operation unit is different.
　≪血管剥離デバイス≫
　操作部５００Ｅは、図２０に示すように、ガイド部２００Ｅに挿入可能な棒状をなしており、その外周に雄ネジ部５２０が設けられている。一方、ガイド部２００Ｅの本体部２１０の内周面には、雄ネジ部５２０に螺号する雌ネジ部２１８が設けられている。そのため、雄ネジ部５２０を雌ネジ部２１８に螺号させた状態で、操作部５００Ｅを回転させることにより、可動部３００がガイド部２００Ｅで案内されつつ移動する。このような構成によれば、例えば、前述した第１実施形態と比較して、可動部３００の移動をコントロールし易くなる。 ≪Vessel peeling device≫
As shown in FIG. 20, the operation part 500E has a rod shape that can be inserted into the guide part 200E, and a male screw part 520 is provided on the outer periphery thereof. On the other hand, on the inner peripheral surface of the main body portion 210 of the guide portion 200E, a female screw portion 218 that is screwed to the male screw portion 520 is provided. Therefore, by rotating the operation portion 500E in a state where the male screw portion 520 is screwed to the female screw portion 218, the movable portion 300 moves while being guided by the guide portion 200E. According to such a configuration, for example, it becomes easier to control the movement of the movable unit 300 as compared to the first embodiment described above.
　このような第６実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the sixth embodiment, the same effect as that of the first embodiment described above can be exhibited.
　＜第７実施形態＞
　図２１は、本発明の第７実施形態に係る血管剥離デバイスが有する可動部を示す側面図である。 <Seventh embodiment>
FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the seventh embodiment of the present invention.
　以下、この図を参照して第７実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the seventh embodiment will be described with reference to this drawing, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構成が異なること以外は、前述した第１実施形態と同様である。 This embodiment is the same as the first embodiment described above except that the configuration of the movable part is mainly different.
　≪血管剥離デバイス≫
　可動部３００Ｆでは、図２１に示すように、環状部３４０の先端面Ｆ１が、中心軸Ｊに対して傾斜している。これにより、剥離部３５０をより鋭くすることができ、血管剥離方法の第２ステップ中の剥離作業において、より優れた剥離特性を発揮することができる。なお、中心軸Ｊに対する先端面Ｆ１の傾斜角度θとしては、特に限定されないが、例えば、３０°～６０°程度とすることができる。 ≪Vessel peeling device≫
In the movable portion 300F, the tip end face F1 of the annular portion 340 is inclined with respect to the central axis J as shown in FIG. Thereby, the peeling part 350 can be made sharper and the more excellent peeling characteristic can be exhibited in the peeling operation in the second step of the blood vessel peeling method. Note that the inclination angle θ of the front end face F1 with respect to the central axis J is not particularly limited, but may be, for example, about 30 ° to 60 °.
　このような第７実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the seventh embodiment, the same effects as those of the first embodiment described above can be exhibited.
　＜第８実施形態＞
　図２２は、本発明の第８実施形態に係る血管剥離デバイスが有する可動部を示す側面図および断面図である。なお、図２２（ｃ）は、同図（ａ）中のＢ－Ｂ線断面図である。また、図２２（ａ）では、第２減振部の図示を省略している。 <Eighth Embodiment>
FIG. 22 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to the eighth embodiment of the present invention. FIG. 22C is a cross-sectional view taken along the line BB in FIG. In FIG. 22A, the second vibration damping unit is not shown.
　以下、この図を参照して第８実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the eighth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構成が異なること以外は、前述した第１実施形態と同様である。 This embodiment is the same as the first embodiment described above except that the configuration of the movable part is mainly different.
　≪血管剥離デバイス≫
　可動部３００Ｇは、図２２に示すように、環状部３４０に設けられている振動素子（振動部）３８０および減振部３７０をさらに有している。 ≪Vessel peeling device≫
As shown in FIG. 22, the movable part 300 </ b> G further includes a vibration element (vibration part) 380 and a vibration reduction part 370 provided in the annular part 340.
　振動素子３８０は、環状部３４０を振動させるための振動源である。また、振動素子３８０は、短冊状（長尺状）をなしており、環状部３４０の周方向に沿って複数配置されている。より具体的には、隣り合う一対の溝部３９０の間に１つの振動素子３８０が配置されている。このように、複数の振動素子３８０を環状部３４０の周方向に沿って配置することで、環状部３４０をムラなくより均一に振動させることができる。なお、振動素子３８０の構成としては、所定の周波数で環状部３４０を振動させることができれば、特に限定されないが、例えば、酸化亜鉛（ＺｎＯ）、窒化アルミニウム（ＡｌＮ）、ＰＺＴ（チタン酸ジルコン酸鉛）等の圧電体からなる圧電体層を一対の電極層で挟み込んだ構成のものを用いることができる。 The vibration element 380 is a vibration source for vibrating the annular portion 340. The vibration element 380 has a strip shape (long shape), and a plurality of vibration elements 380 are arranged along the circumferential direction of the annular portion 340. More specifically, one vibration element 380 is disposed between a pair of adjacent grooves 390. Thus, by arranging the plurality of vibration elements 380 along the circumferential direction of the annular portion 340, the annular portion 340 can be vibrated more uniformly without unevenness. The configuration of the vibration element 380 is not particularly limited as long as the annular portion 340 can be vibrated at a predetermined frequency. For example, zinc oxide (ZnO), aluminum nitride (AlN), PZT (lead zirconate titanate) ) Or the like can be used in which a piezoelectric layer made of a piezoelectric material is sandwiched between a pair of electrode layers.
　また、振動素子３８０によって振動させられる環状部３４０の振動周波数としては、特に限定されないが、例えば、大伏在静脈１０００の周囲にある血管、皮膚、筋肉を溶解（遊離）することなく、組織を溶解（遊離）することができる周波数であることが好ましく、このような周波数としては、２０～６０ｋＨｚ程度であることが好ましく、３０～４０ｋＨｚであることがより好ましい。これにより、大伏在静脈１０００を保護しつつ、実質的に組織だけを溶解することができる。 Further, the vibration frequency of the annular portion 340 that is vibrated by the vibration element 380 is not particularly limited. For example, the tissue can be removed without dissolving (releasing) blood vessels, skin, and muscles around the saphenous vein 1000. A frequency that can be dissolved (released) is preferable, and such a frequency is preferably about 20 to 60 kHz, and more preferably 30 to 40 kHz. Thereby, substantially only the tissue can be dissolved while protecting the saphenous vein 1000.
　減振部３７０は、振動素子３８０による環状部３４０の振動を吸収・減衰する機能を有している。このような減振部３７０は、環状部３４０の内周面に配置されている第１減振部３７１と、環状部３４０の外周面に配置されている第２減振部３７２と、を有している。 The vibration damping unit 370 has a function of absorbing and attenuating the vibration of the annular portion 340 caused by the vibration element 380. Such a vibration reduction unit 370 includes a first vibration reduction unit 371 disposed on the inner peripheral surface of the annular part 340 and a second vibration reduction unit 372 disposed on the outer peripheral surface of the annular part 340. is doing.
　また、第１、第２減振部３７１、３７２は、それぞれ、剥離部３５０と重ならないように配置されている。すなわち、第１、第２減振部３７１、２７２の間から剥離部３５０が突出し、当該部分が外部に露出した状態となっている。したがって、環状部３４０を振動させると、その振動は、主に、剥離部３５０から外部へ伝達され、それ以外の場所（例えば環状部３４０の内周面、外周面）からは外部へほとんど伝達されない（伝達されても僅かである）。また、第２減振部３７２は、振動素子３８０を覆うように配置され、振動素子３８０を保護、絶縁している。 Further, the first and second vibration damping units 371 and 372 are arranged so as not to overlap the peeling unit 350, respectively. That is, the peeling part 350 protrudes from between the first and second vibration damping parts 371 and 272, and the part is exposed to the outside. Therefore, when the annular portion 340 is vibrated, the vibration is mainly transmitted to the outside from the peeling portion 350 and hardly transmitted to the outside from other places (for example, the inner peripheral surface and the outer peripheral surface of the annular portion 340). (Slightly transmitted) The second vibration damping unit 372 is disposed so as to cover the vibration element 380 and protects and insulates the vibration element 380.
　なお、第１、第２減振部３７１、３７２の構成材料としては、環状部３４０の振動を吸収・減衰することができれば、特に限定されず、例えば、天然ゴム、ブタジエンゴム、スチレン－ブタジエンゴム、ウレタンゴム、シリコーンゴム、フッ素ゴムのような各種ゴム材料を用いることができる。 The constituent materials of the first and second vibration damping parts 371 and 372 are not particularly limited as long as the vibration of the annular part 340 can be absorbed and attenuated. For example, natural rubber, butadiene rubber, styrene-butadiene rubber Various rubber materials such as urethane rubber, silicone rubber and fluorine rubber can be used.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｇによれば、環状部３４０を振動させながら第２ステップ中の剥離作業を行うことで、剥離部３５０から伝わる振動によって可動部３００Ｅの移動方向前方側に位置する組織を溶解しながら剥離することができるため、当該作業をよりスムーズに行うことができる。さらには、環状部３４０の内側に位置する組織、すなわち、大伏在静脈１０００の周囲に位置し、大伏在静脈１０００と共に剥離する組織１２００の溶解が抑制されているため、より確実に、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で剥離することができる。加えて、環状部３４０の外側に位置する組織の溶解が抑制されているため、不必要な組織の溶解が低減される。 ≪Vessel peeling method≫
According to the blood vessel peeling device 100G having such a configuration, by performing the peeling operation in the second step while vibrating the annular portion 340, the movable portion 300E is positioned on the front side in the moving direction by vibration transmitted from the peeling portion 350. Since the tissue can be peeled while being dissolved, the operation can be performed more smoothly. Furthermore, the tissue located inside the annular portion 340, that is, the tissue 1200 that is located around the great saphenous vein 1000 and peels off together with the great saphenous vein 1000 is suppressed, so that the large size can be more reliably increased. The saphenous vein 1000 can be exfoliated while covered with the surrounding tissue 1200. In addition, since the dissolution of the tissue located outside the annular portion 340 is suppressed, unnecessary dissolution of the tissue is reduced.
　このような第８実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Also in the eighth embodiment, the same effect as that of the first embodiment described above can be exhibited.
　なお、本実施形態では、振動素子３８０が環状部３４０の外周に配置されているが、振動素子３８０の配置としては、これに限定されず、例えば、環状部３４０の内周面に配置されていてもよい。また、振動素子３８０は、環状部３４０に振動を伝達することができれば、環状部３４０以外の場所、例えば、操作部５００に配置されていてもよい。 In this embodiment, the vibration element 380 is disposed on the outer periphery of the annular portion 340. However, the arrangement of the vibration element 380 is not limited thereto, and is disposed on the inner peripheral surface of the annular portion 340, for example. May be. Further, the vibration element 380 may be disposed at a place other than the annular portion 340, for example, the operation portion 500 as long as vibration can be transmitted to the annular portion 340.
　＜第９実施形態＞
　図２３は、本発明の第９実施形態に係る血管剥離デバイスを示す断面図である。図２４は、図２３に示す血管剥離デバイスの平面図および側面図である。 <Ninth Embodiment>
FIG. 23 is a cross-sectional view showing a blood vessel peeling device according to a ninth embodiment of the present invention. FIG. 24 is a plan view and a side view of the blood vessel peeling device shown in FIG.
　以下、この図を参照して第９実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the ninth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構造が異なっていること以外は、前述した第１実施形態と同様である。 The present embodiment is mainly the same as the first embodiment described above except that the structure of the movable part is different.
　≪血管剥離デバイス≫
　可動部３００Ｈは、図２３（ａ）に示すように、基部３１１と接続部３１２を有するコネクタ３１０と、基部３１１に収容（内蔵）された一対の可動片３３０（３３０’、３３０”）と、を有している。基部３１１には可動片３３０を収容する空間が形成されており、この空間内に可動片３３０が収容されている。 ≪Vessel peeling device≫
As shown in FIG. 23A, the movable part 300H includes a connector 310 having a base 311 and a connection part 312; a pair of movable pieces 330 (330 ′, 330 ″) housed (incorporated) in the base 311; The base 311 has a space for accommodating the movable piece 330, and the movable piece 330 is accommodated in this space.
　また、図２３（ｂ）に示すように、ガイド部２００の軸方向から見た平面視（以下、単に「平面視」とも言う。）で、一方の可動片３３０’は、基部３１１の一方の端部から突出・退避可能にスライド可能となっており、他方の可動片３３０”は、基部３１１の他方の端部から突出・退避可能にスライド可能となっている。また、各可動片３３０は、図２４（ａ）に示すように、基部３１１の基端側に突出するつまみ（可動片操作部）３３１を有しており、このつまみ３３１を操作することにより、可動片３３０を基部３１１から突出させたり、基部３１１に退避させたりすることができる。つまみ３３１を操作して、各可動片３３０を基部３１１から突出させた突出状態とすると、図２３（ｂ）～図２４（ｂ）に示すように、可動片３３０’、３３０”の先端同士が接続され、基部３１１および可動片３３０’、３３０”で環状部３４０が形成される。そして、使用時には、この環状部３４０内に大伏在静脈１０００が位置する。このような各可動片３３０には、前述した第１実施形態と同様に、剥離部３５０と、溝部３９０と、処理部３６０と、がそれぞれ設けられている。 In addition, as shown in FIG. 23B, one movable piece 330 ′ is one of the base portions 311 in a plan view (hereinafter, also simply referred to as “plan view”) viewed from the axial direction of the guide portion 200. The other movable piece 330 ″ is slidable so as to protrude and retract from the end portion, and can be slidably protruded and retracted from the other end portion of the base 311. Each movable piece 330 is also slidable. 24A, a knob (movable piece operation part) 331 protruding toward the base end side of the base 311 is provided. By operating this knob 331, the movable piece 330 is removed from the base 311. It can be protruded or retracted to the base 311. When each movable piece 330 is protruded from the base 311 by operating the knob 331, it is as shown in FIGS. As shown, the movable piece 33 The distal ends of ', 330 "are connected to each other, and an annular portion 340 is formed by the base 311 and the movable pieces 330', 330". In use, the great saphenous vein 1000 is located in the annular portion 340. Each movable piece 330 is provided with a peeling portion 350, a groove portion 390, and a processing portion 360, as in the first embodiment.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｈによれば、血管剥離方法の第２ステップにおいて、まず、各可動片３３０’、３３０”が基部３１１内に退避している状態のコネクタ３１０をレール２１１に接続し、次いで、各可動片３３０、３３０”を基部３１１から突出させて環状部３４０を形成する。これにより、大伏在静脈１０００を切断せずに、大伏在静脈１０００の周囲に環状部３４０を配置することができる。そして、この状態で可動部３００Ｈをガイド部２００に沿って前進させて剥離作業を行えばよい。特に、前述したように、つまみ３３１が基部３１１の基端側へ突出しているため、剥離作業の際につまみ３３１が組織や分岐血管１１００に引っ掛かり難く、剥離作業をよりスムーズに行うことができる。 ≪Vessel peeling method≫
According to the blood vessel peeling device 100H having such a configuration, in the second step of the blood vessel peeling method, first, the connector 310 in a state where the movable pieces 330 ′ and 330 ″ are retracted into the base 311 is connected to the rail 211. Then, each movable piece 330, 330 ″ is protruded from the base portion 311 to form an annular portion 340. Thereby, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000. In this state, the movable part 300H may be advanced along the guide part 200 to perform the peeling operation. In particular, as described above, since the knob 331 protrudes toward the proximal end side of the base 311, the knob 331 is not easily caught by the tissue or the branch blood vessel 1100 during the peeling operation, and the peeling operation can be performed more smoothly.
　このような第９実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Even in the ninth embodiment, the same effect as that of the first embodiment described above can be exhibited.
　＜第１０実施形態＞
　図２５は、本発明の第１０実施形態に係る血管剥離デバイスが有する可動部を示す断面図である。図２６は、図２５に示す血管剥離デバイスを用いた血管剥離方法を説明する図である。 <Tenth Embodiment>
FIG. 25 is a cross-sectional view showing a movable part included in the blood vessel peeling device according to the tenth embodiment of the present invention. FIG. 26 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
　以下、この図を参照して第１０実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the tenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構成が異なっていること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
　≪血管剥離デバイス≫
　図２５（ａ）に示すように、ガイド部２００Ｉの本体部２１０には軸方向に延在する一対のスリット２１３、２１４が周方向に離間し配置されている。一方、可動部３００Ｉは、イメージングデバイス４００の先端部に取り付けられ、略円弧状（略環状）に形状付けされた帯状の帯状体６００を有している。帯状体６００は、縮径するように巻回された状態でガイド部２００Ｉ内に配置されている。なお、イメージングデバイス４００は、可動部３００Ｉを移動させる操作部５００を兼ねている。 ≪Vessel peeling device≫
As shown in FIG. 25A, a pair of slits 213 and 214 extending in the axial direction are arranged in the body portion 210 of the guide portion 200I so as to be separated from each other in the circumferential direction. On the other hand, the movable part 300I is attached to the distal end of the imaging device 400, and has a belt-like belt-like body 600 shaped in a substantially arc shape (substantially annular shape). The belt-like body 600 is arranged in the guide part 200I in a state of being wound so as to reduce the diameter. The imaging device 400 also serves as the operation unit 500 that moves the movable unit 300I.
　このような構成の血管剥離デバイス１００Ｉでは、帯状体６００がガイド部２００Ｉ内に収容された状態でイメージングデバイス４００を回転させると、帯状体６００がその先端側からスリット２１３を介してガイド部２００Ｉの外へ突出し、最終的に、図２５（ｂ）に示すように、先端部がスリット２１４を介してガイド部２００Ｉ内に退避する。そして、帯状体６００のガイド部２００から突出している部分によって環状部３４０が形成される。なお、帯状体６００には前述した第１実施形態と同様に、剥離部３５０と、溝部３９０と、処理部３６０と、がそれぞれ設けられている。ただし、本実施形態では、後述するように、可動部３００Ｉをガイド部２００Ｉの先端側から基端側へ後退させる関係で、溝部３９０および剥離部３５０は、それぞれ、帯状体６００の基端側に向いて配置されている。 In the blood vessel peeling device 100I having such a configuration, when the imaging device 400 is rotated in a state where the belt-like body 600 is accommodated in the guide portion 200I, the belt-like body 600 is formed on the guide portion 200I via the slit 213 from the distal end side. As shown in FIG. 25 (b), the tip end portion is retracted into the guide portion 200I through the slit 214. An annular portion 340 is formed by a portion protruding from the guide portion 200 of the belt-like body 600. In addition, the strip | belt-shaped body 600 is provided with the peeling part 350, the groove part 390, and the process part 360 similarly to 1st Embodiment mentioned above, respectively. However, in the present embodiment, as will be described later, the groove 390 and the peeling portion 350 are respectively located on the proximal end side of the belt-like body 600 because the movable portion 300I is retracted from the distal end side to the proximal end side of the guide portion 200I. It is arranged facing.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｉによれば、まず、図２６（ａ）に示すように、ガイド部２００Ｉ内に可動部３００Ｉを収容した状態で第１ステップを行う。そして、第２ステップでは、まず、図２６（ｂ）に示すように、イメージングデバイス４００を回転させて帯状体６００をガイド部２００Ｉから突出させ、環状部３４０を形成する。これにより、大伏在静脈１０００を切断せずに、環状部３４０を大伏在静脈１０００の周囲に配置することができる。次に、イメージングデバイス４００をガイド部２００Ｉから抜去するように基端側へ引っ張ることで帯状体６００（可動部３００Ｉ）をスリット２１３、２１４で案内しつつ基端側へ移動させ、剥離作業を行う。これにより、大伏在静脈１０００が周囲の組織１２００に覆われた状態で剥離される。このような方法によれば、イメージングデバイス４００を抜去すると共に剥離工程が行われるため、前述した第１実施形態と比較して、血管剥離の工程を少なくすることができる。 ≪Vessel peeling method≫
According to the blood vessel peeling device 100I having such a configuration, first, as shown in FIG. 26A, the first step is performed in a state where the movable part 300I is accommodated in the guide part 200I. In the second step, first, as shown in FIG. 26B, the imaging device 400 is rotated to project the belt-like body 600 from the guide portion 200I to form the annular portion 340. Accordingly, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000. Next, by pulling the imaging device 400 to the base end side so as to be removed from the guide part 200I, the strip-shaped body 600 (movable part 300I) is moved to the base end side while being guided by the slits 213 and 214, and the peeling operation is performed. . As a result, the large saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200. According to such a method, since the imaging device 400 is removed and the separation step is performed, the blood vessel separation step can be reduced as compared with the first embodiment described above.
　このような第１０実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Also according to the tenth embodiment, the same effects as those of the first embodiment described above can be exhibited.
　なお、本実施形態の変形例として、本体部２１０に１つのスリットしか形成されておらず、この１つのスリットを介して帯状体６００の突出・退避を行ってもよい。また、本実施形態では、可動部３００Ｉを先端側から基端側へ移動させているが、反対に、基端側から先端側へ移動させてもよい。この場合は、溝部３９０を帯状体６００の先端側に開放するように設ければよい。ただし、本実施形態のように、基端側へ引っ張るような方法の方が、力の制御（可動部３００Ｉの移動量や移動速度の制御・調整）が容易である点で有効である。 As a modification of the present embodiment, only one slit is formed in the main body 210, and the belt-like body 600 may be protruded and retracted through this one slit. In the present embodiment, the movable unit 300I is moved from the distal end side to the proximal end side, but conversely, it may be moved from the proximal end side to the distal end side. In this case, the groove portion 390 may be provided so as to open to the front end side of the belt-like body 600. However, the method of pulling to the base end side as in this embodiment is more effective in that it is easier to control the force (control / adjustment of the moving amount and moving speed of the movable portion 300I).
　＜第１１実施形態＞
　図２７は、本発明の第１１実施形態に係る血管剥離デバイスを示す平面図である。 <Eleventh embodiment>
FIG. 27 is a plan view showing a blood vessel peeling device according to an eleventh embodiment of the present invention.
　以下、この図を参照して第１１実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the eleventh embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構成が異なっていること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
　≪血管剥離デバイス≫
　可動部３００Ｊは、図２７に示すように、ガイド部２００のレール２１１に接続されるコネクタ３１０と、コネクタ３１０に設けられた一対の噴射ノズル７００と、を有している。 ≪Vessel peeling device≫
As shown in FIG. 27, the movable part 300J has a connector 310 connected to the rail 211 of the guide part 200, and a pair of injection nozzles 700 provided on the connector 310.
　コネクタ３１０は、その移動方向に直交する幅方向に延びる基部３１１と、基部３１１をレール２１１にスライド可能に接続する接続部３１２と、を有している。また、基部３１１の先端部に剥離部３５０が設けられていると共に、基部３１１の両端部に噴射ノズル７００が設けられている。一対の噴射ノズル７００は、ガイド部２００の軸方向から見た平面視（図２７に示す平面視。以下単に「平面視」と言う）で、ガイド部２００の両側に位置するように設けられている。また、各噴射ノズル７００からは、液体Ｌが内側（ガイド部２００側）を向いて斜めに噴射される。そして、各噴射ノズル７００から噴射された液体Ｌは、平面視で交差する。このような構成の血管剥離デバイス１００Ｊでは、使用時に、基部３１１と液体Ｌの噴射経路とで囲まれた領域Ｓ内に大伏在静脈１０００を位置させる。 The connector 310 has a base portion 311 extending in the width direction orthogonal to the moving direction, and a connection portion 312 that slidably connects the base portion 311 to the rail 211. In addition, a peeling portion 350 is provided at the distal end portion of the base portion 311, and an injection nozzle 700 is provided at both end portions of the base portion 311. The pair of injection nozzles 700 are provided so as to be positioned on both sides of the guide part 200 in a plan view (a plan view shown in FIG. 27, hereinafter simply referred to as “plan view”) viewed from the axial direction of the guide part 200. Yes. Further, from each spray nozzle 700, the liquid L is sprayed obliquely toward the inner side (the guide part 200 side). Then, the liquid L ejected from each ejection nozzle 700 intersects in plan view. In the blood vessel peeling device 100J having such a configuration, the large saphenous vein 1000 is positioned in a region S surrounded by the base 311 and the liquid L ejection path when in use.
　また、各噴射ノズル７００は、微量の液体Ｌを高速かつパルス状に噴射（吐出）することができる。このような液体Ｌの噴射方法によれば、例えば、分岐血管１１００（細血管）や神経を傷付けずに温存することができ、また、組織の発熱を抑えることができるため、剥離箇所およびその周辺の機能温存を図ることができる。 Further, each spray nozzle 700 can spray (discharge) a small amount of liquid L at high speed and in a pulse shape. According to such an injection method of the liquid L, for example, the branch blood vessel 1100 (fine blood vessel) and nerves can be preserved without being damaged, and heat generation of the tissue can be suppressed. Can preserve the function.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｊによれば、第２ステップにおいて、各噴射ノズル７００から液体Ｌを噴射させながらコネクタ３１０を先端側へ移動させることで剥離作業を行うことができる。このような構成および方法によれば、大伏在静脈１０００を切断することなくコネクタ３１０をガイド部２００に接続することができると共に、大伏在静脈１０００をその周囲の組織１２００に覆われた状態で剥離することができる。なお、噴射された液体Ｌによっては、分岐血管１１００を切断することができない場合があるため、その場合には、剥離作業を行った後に、分岐血管１１００を切断・止血する処理を行えばよい。 ≪Vessel peeling method≫
According to the blood vessel peeling device 100J having such a configuration, in the second step, the peeling operation can be performed by moving the connector 310 to the distal end side while jetting the liquid L from each jet nozzle 700. According to such a configuration and method, the connector 310 can be connected to the guide part 200 without cutting the great saphenous vein 1000, and the great saphenous vein 1000 is covered with the surrounding tissue 1200. Can be peeled off. In some cases, the branched blood vessel 1100 may not be cut depending on the jetted liquid L. In this case, after the peeling operation, the branch blood vessel 1100 may be cut and hemostatically treated.
　このような第１１実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Also according to the eleventh embodiment, the same effects as those of the first embodiment described above can be exhibited.
　なお、本実施形態では、基部３１１に前述した第１実施形態のような溝部３９０および処理部３６０が設けられていないが、図７と同様にして、基部３１１に溝部３９０および処理部３６０を設けてもよい。これにより、基部３１１の通過領域では、分岐血管１１００の処理を行うことができる。 In this embodiment, the groove portion 390 and the processing portion 360 are not provided in the base portion 311 as in the first embodiment, but the groove portion 390 and the processing portion 360 are provided in the base portion 311 in the same manner as in FIG. May be. Thereby, in the passage region of the base 311, the branch blood vessel 1100 can be processed.
　＜第１２実施形態＞
　図２８は、本発明の第１２実施形態に係る血管剥離デバイスを示す側面図である。 <Twelfth embodiment>
FIG. 28 is a side view showing a blood vessel peeling device according to a twelfth embodiment of the present invention.
　以下、この図を参照して第１２実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。 Hereinafter, the twelfth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
　本実施形態は、主に、可動部の構成が異なっていること以外は、前述した第１実施形態と同様である。 This embodiment is mainly the same as the first embodiment described above except that the configuration of the movable part is different.
　≪血管剥離デバイス≫
　可動部３００Ｋは、図２８に示すように、第１可動部３０１と、第１可動部３０１よりも基端側に位置する第２可動部３０２と、を有している。第１可動部３０１は、前述した第１０実施形態の可動部３００Ｊと同様の構成であり、第２可動部３０２は、前述した第１実施形態の可動部３００と同様の構成である。前述した第１１実施形態でも述べたように、第１可動部３０１からの液体Ｌの噴射によっては、組織を剥離することができても分岐血管１１００の切断・止血を行うことができない。そこで、第１可動部３０１の後方に第２可動部３０２を設け、第２可動部３０２が有する処理部３６０によって分岐血管１１００の切断・止血を行うようになっている。 ≪Vessel peeling device≫
As shown in FIG. 28, the movable part 300 </ b> K includes a first movable part 301 and a second movable part 302 located on the proximal side with respect to the first movable part 301. The first movable portion 301 has the same configuration as the movable portion 300J of the tenth embodiment described above, and the second movable portion 302 has the same configuration as the movable portion 300 of the first embodiment described above. As described in the eleventh embodiment, the branch blood vessel 1100 cannot be cut or stopped by the ejection of the liquid L from the first movable portion 301 even if the tissue can be peeled off. Therefore, the second movable portion 302 is provided behind the first movable portion 301, and the branch blood vessel 1100 is cut and stopped by the processing portion 360 included in the second movable portion 302.
　≪血管剥離方法≫
　このような構成の血管剥離デバイス１００Ｋでは、第２ステップにおいて、まず、第１可動部３０１および第２可動部３０２をガイド部２００に接続し、第１可動部３０１から液体Ｌを噴射させつつ、第１、第２可動部３０１、３０２を先端側へ移動させて剥離作業を行う。このような方法によれば、前方に位置する第１可動部３０１によって組織の剥離が行われ、この剥離された箇所を通りつつ第２可動部３０２が分岐血管１１００の切断・止血を行うため、生体内での可動部３００Ｋの移動がよりスムーズになる。また、大伏在静脈１０００の剥離と分岐血管１１００の切断・止血を同時行うことができるため、よりスムーズな手技が可能となる。 ≪Vessel peeling method≫
In the blood vessel peeling device 100K having such a configuration, in the second step, first, the first movable portion 301 and the second movable portion 302 are connected to the guide portion 200, and while the liquid L is ejected from the first movable portion 301, The first and second movable parts 301 and 302 are moved to the distal end side to perform a peeling operation. According to such a method, tissue separation is performed by the first movable unit 301 located in front, and the second movable unit 302 cuts and stops hemostasis of the branch blood vessel 1100 while passing through the separated site. Movement of the movable part 300K in the living body becomes smoother. In addition, since the great saphenous vein 1000 can be peeled off and the branch blood vessel 1100 can be cut and stopped at the same time, a smoother procedure can be performed.
　このような第１２実施形態によっても、前述した第１実施形態と同様の効果を発揮することができる。 Also according to the twelfth embodiment, the same effects as those of the first embodiment described above can be exhibited.
　以上、本発明の血管剥離方法および血管剥離デバイスを、図示の実施形態に基づいて説明したが、本発明はこれに限定されるものではなく、各部の構成は、同様の機能を有する任意の構成のものに置換することができる。また、本発明に、他の任意の構成物が付加されていてもよい。また、各実施形態を適宜組み合わせてもよい。 As described above, the blood vessel peeling method and the blood vessel peeling device of the present invention have been described on the basis of the illustrated embodiment. Can be substituted. In addition, any other component may be added to the present invention. Moreover, you may combine each embodiment suitably.
　また、前述した実施形態では、血管バイパス術を行う際のバイパス血管を採取する場合について説明したが、採取した血管の用途は、バイパス血管に限定されない。 In the above-described embodiment, the case where the bypass blood vessel is collected when performing the blood vessel bypass operation has been described. However, the use of the collected blood vessel is not limited to the bypass blood vessel.
　本発明の血管剥離方法は、血管と所定間隔を保ちつつ、前記血管に沿ってガイド部を配置する第１ステップと、前記血管の周囲に配置されると共に前記ガイド部にスライド可能に接続された可動部を、前記ガイド部で案内しつつ移動させ、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離する第２ステップと、を有することを特徴とする。そのため、血管の損傷を抑えることができ、優れた作業性を発揮することができる。特に、生体内を観察してガイド部を配置することで、生体内へのガイド部の挿入をスムーズかつ正確に行うことができる。 The blood vessel peeling method according to the present invention includes a first step of arranging a guide portion along the blood vessel while maintaining a predetermined distance from the blood vessel, and is arranged around the blood vessel and slidably connected to the guide portion. And moving the movable part while being guided by the guide part, and separating the blood vessel in a state where at least a part of the blood vessel is covered with the surrounding tissue. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited. In particular, by observing the inside of the living body and arranging the guide portion, the guide portion can be inserted into the living body smoothly and accurately.
　本発明の血管剥離デバイスは、血管と所定間隔を保ちつつ、前記血管に沿って配置される長尺なガイド部と、前記ガイド部に接続され、前記血管の周囲に配置される可動部と、を有し、前記可動部を前記ガイド部で案内しながら移動させることで、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離することを特徴とする。そのため、血管の損傷を抑えることができ、優れた作業性を発揮することができる。 The blood vessel peeling device of the present invention is a long guide portion arranged along the blood vessel while maintaining a predetermined distance from the blood vessel, a movable portion connected to the guide portion and arranged around the blood vessel, And moving the movable portion while guiding the movable portion with the guide portion, whereby the blood vessel is separated in a state where at least a part of the blood vessel is covered with the surrounding tissue. Therefore, damage to blood vessels can be suppressed and excellent workability can be exhibited.
　したがって、本発明の血管剥離方法および血管剥離デバイスは、それぞれ、産業上の利用可能性を有している。 Therefore, each of the blood vessel peeling method and the blood vessel peeling device of the present invention has industrial applicability.
１００　　　　血管剥離デバイス
１００Ａ　　　血管剥離デバイス
１００Ｂ　　　血管剥離デバイス
１００Ｃ　　　血管剥離デバイス
１００Ｇ　　　血管剥離デバイス
１００Ｈ　　　血管剥離デバイス
１００Ｉ　　　血管剥離デバイス
１００Ｊ　　　血管剥離デバイス
１００Ｋ　　　血管剥離デバイス
２００　　　　ガイド部
２００Ａ　　　ガイド部
２００Ｂ　　　ガイド部
２００Ｅ　　　ガイド部
２００Ｉ　　　ガイド部
２１０　　　　本体部
２１１　　　　レール
２１３　　　　スリット
２１４　　　　スリット
２１８　　　　雌ネジ部
２１９　　　　挿通孔
２２０　　　　剥離部
２８０　　　　報知部
２８１　　　　発光部
２９０　　　　超音波マーカー
３００　　　　可動部
３００Ｅ　　　可動部
３００Ｆ　　　可動部
３００Ｇ　　　可動部
３００Ｈ　　　可動部
３００Ｉ　　　可動部
３００Ｊ　　　可動部
３００Ｋ　　　可動部
３０１　　　　第１可動部
３０２　　　　第２可動部
３１０　　　　コネクタ
３１１　　　　基部
３１１ａ、３１１ｂ　　　溝
３１２　　　　接続部
３２０　　　　装着部
３２１　　　　スリット
３３０、３３０’、３３０”　　　　可動片
３３１　　　　つまみ
３４０　　　　環状部
３５０　　　　剥離部
３６０　　　　処理部
３６１、３６２　　　　電極
３６１’　　　先端部
３７０　　　　減振部
３７１　　　　第１減振部
３７２　　　　第２減振部
３８０　　　　振動素子
３９０　　　　溝部
３９１　　　　血管案内溝部
３９２　　　　血管処理溝部
４００　　　　イメージングデバイス
４００Ａ　　　イメージングデバイス
４１０　　　　本体部
４２０　　　　撮像部
５００　　　　操作部
５００Ｄ　　　操作部
５００Ｅ　　　操作部
５１１、５１２　　　　紐
５２０　　　　雄ネジ部
６００　　　　帯状体
７００　　　　噴射ノズル
８００　　　　穿刺部
８１０　　　　本体部
８２０　　　　剥離部
１０００　　　大伏在静脈
１００１　　　基端側カット予定部
１００２　　　先端側カット予定部
１１００　　　分岐血管
１２００　　　組織
１３００　　　切開部
１４００　　　切開部
１５００　　　穿刺孔
Ｄ　　　　　　所定間隔
Ｆ１　　　　　先端面
Ｈ　　　　　　皮膚
Ｊ　　　　　　中心軸
Ｌ　　　　　　液体
Ｓ　　　　　　領域
Ｘ　　　　　　印
Ｗ　　　　　　幅
ｔ１　　　　　厚み
θ　　　　　　傾斜角度 DESCRIPTION OF SYMBOLS 100 Blood vessel peeling device 100A Blood vessel peeling device 100B Blood vessel peeling device 100C Blood vessel peeling device 100G Blood vessel peeling device 100H Blood vessel peeling device 100J Blood vessel peeling device 100J Blood vessel peeling device 200K Blood vessel peeling device 200 Guide part 200A Guide part 200B Guide part 200E Guide part 200I Guide Part 210 body part 211 rail 213 slit 214 slit 218 female screw part 219 insertion hole 220 peeling part 280 notification part 281 light emitting part 290 ultrasonic marker 300 movable part 300E movable part 300F movable part 300G movable part 300H movable part 300I movable part 300J movable Part 300K movable part 301 first movable part 302 second movable part 310 connector 31 DESCRIPTION OF SYMBOLS 1 Base part 311a, 311b Groove 312 Connection part 320 Mounting part 321 Slit 330, 330 ', 330 "Movable piece 331 Knob 340 Annular part 350 Separation part 360 Processing part 361, 362 Electrode 361' Tip part 370 Vibration reduction part 371 First reduction Vibration unit 372 Second vibration reduction unit 380 Vibration element 390 Groove part 391 Blood vessel guide groove part 392 Blood vessel processing groove part 400 Imaging device 400A Imaging device 410 Main body part 420 Imaging part 500 Operation part 500D Operation part 500E Operation part 511, 512 String 520 Male screw part 600 Band 700 700 Injection nozzle 800 Puncture part 810 Main body part 820 Peeling part 1000 Greater saphenous vein 1001 Proximal end planned cut part 1002 Distal end cut planned part 1100 Branched blood 1200 tissue 1300 incision 1400 incision 1500 punctures D predetermined distance F1 tip surface H cutaneous J central axis L liquid S region X in W width t1 thickness θ tilt angle

Claims (7)

  1. 　血管と所定間隔を保ちつつ、前記血管に沿ってガイド部を配置する第１ステップと、
    　前記血管の周囲に配置されると共に前記ガイド部にスライド可能に接続された可動部を、前記ガイド部で案内しつつ移動させ、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離する第２ステップと、を有することを特徴とする血管剥離方法。     A first step of arranging a guide portion along the blood vessel while maintaining a predetermined distance from the blood vessel;
    A movable part arranged around the blood vessel and slidably connected to the guide part is moved while being guided by the guide part, and at least a part of the circumference of the blood vessel is covered with surrounding tissue. A blood vessel peeling method comprising: a second step of peeling in a state.
  2. 　前記第１ステップでは、生体内を観察しながら前記ガイド部を前記血管に沿って配置する請求項１に記載の血管剥離方法。 The blood vessel peeling method according to claim 1, wherein, in the first step, the guide portion is arranged along the blood vessel while observing the inside of a living body.
  3. 　前記第１ステップでは、生体内を観察して前記血管の位置を把握した後、前記把握した位置に基づいて前記ガイド部を配置する請求項１に記載の血管剥離方法。 The blood vessel peeling method according to claim 1, wherein, in the first step, after observing the inside of a living body and grasping the position of the blood vessel, the guide portion is arranged based on the grasped position.
  4. 　前記第１ステップは、生体内を観察しながら、前記血管と所定間隔を保ちつつ、前記血管に沿って穿刺部を挿入するステップと、
    　前記穿刺部を挿入することで形成された穿刺孔に、前記ガイド部を挿入するステップと、を有する請求項１に記載の血管剥離方法。     The first step is a step of inserting a puncture part along the blood vessel while maintaining a predetermined distance from the blood vessel while observing the inside of the living body;
    The blood vessel peeling method according to claim 1, further comprising a step of inserting the guide portion into a puncture hole formed by inserting the puncture portion.
  5. 　前記第２ステップでは、前記可動部で前記血管の剥離を行うと共に、前記血管から分岐する分岐血管の切断および止血を行う請求項１ないし４のいずれか１項に記載の血管剥離方法。 5. The blood vessel peeling method according to any one of claims 1 to 4, wherein in the second step, the blood vessel is peeled off by the movable portion, and a branching blood vessel that branches off from the blood vessel is cut and stopped.
  6. 　前記第２ステップまでは、前記血管を切断せずに行う請求項１ないし５のいずれか１項に記載の血管剥離方法。 The blood vessel peeling method according to any one of claims 1 to 5, wherein the steps up to the second step are performed without cutting the blood vessel.
  7. 　血管と所定間隔を保ちつつ、前記血管に沿って配置される長尺なガイド部と、
    　前記ガイド部に接続され、前記血管の周囲に配置される可動部と、を有し、
    　前記可動部を前記ガイド部で案内しながら移動させることで、前記血管をその周囲の少なくとも一部が周囲の組織に覆われた状態で剥離することを特徴とする血管剥離デバイス。     A long guide portion arranged along the blood vessel while maintaining a predetermined distance from the blood vessel,
    A movable part connected to the guide part and disposed around the blood vessel,
    A blood vessel detachment device, wherein the movable portion is moved while being guided by the guide portion, whereby the blood vessel is exfoliated in a state where at least a part of the blood vessel is covered with a surrounding tissue.
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CN107753092B (en) * 2017-11-30 2024-01-19 彭翼 Intra-cavity intima stripping device
CN113194838A (en) * 2018-12-19 2021-07-30 学校法人帝京大学 Blood vessel collecting system

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