WO2020196857A1 - Dispositif de promotion de fusion - Google Patents

Dispositif de promotion de fusion Download PDF

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Publication number
WO2020196857A1
WO2020196857A1 PCT/JP2020/014146 JP2020014146W WO2020196857A1 WO 2020196857 A1 WO2020196857 A1 WO 2020196857A1 JP 2020014146 W JP2020014146 W JP 2020014146W WO 2020196857 A1 WO2020196857 A1 WO 2020196857A1
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WO
WIPO (PCT)
Prior art keywords
slit
sheet
fusion promoting
fusion
main body
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Application number
PCT/JP2020/014146
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English (en)
Japanese (ja)
Inventor
直希 荒巻
美穂 甲斐
杏梨 藤井
研介 内富
Original Assignee
テルモ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by テルモ株式会社 filed Critical テルモ株式会社
Priority to JP2021509653A priority Critical patent/JP7361098B2/ja
Publication of WO2020196857A1 publication Critical patent/WO2020196857A1/fr

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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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis

Definitions

  • the present invention relates to a fusion promoting device.
  • Patent Document 1 a method of suturing a living organ with a biodegradable suture and a mechanical joining device for anastomosis with a stapler.
  • Patent Document 1 A method using (see) has been proposed.
  • the bonding force between biological organs at the joint can be increased as compared with the method using sutures, which reduces the risk of suture failure. Will be possible.
  • the degree of progression of fusion at the junction also depends on the condition of the living tissue at the junction target site (joint site) of the patient. Therefore, for example, even when a joining device as described in Patent Document 1 is used, the risk of suture failure may not be sufficiently reduced depending on the condition of the patient's living tissue.
  • the present inventors have performed surgery and the like by placing a biodegradable sheet having a plurality of through holes sandwiched between joint sites. It was newly found that it can promote the fusion of the anastomotic site later.
  • the present inventors form a circular insertion hole in the above-mentioned sheet so that the operator can easily perform the procedure, and insert a medical instrument used for the procedure for joining a living organ such as the above-mentioned joining device.
  • a medical instrument used for the procedure for joining a living organ such as the above-mentioned joining device.
  • the diameter of the insertion hole is even slightly larger than the maximum dimension of the insertion portion of the medical device in the radial direction (direction intersecting the insertion direction), the medical device may not be able to sufficiently hold the above-mentioned sheet. I found that there is.
  • an object of the present invention is to provide a fusion promoting device that can reduce the risk of suture failure after surgery or the like and can be sufficiently held by a medical instrument used for a procedure for joining biological organs.
  • the fusion-promoting device has a fusion-promoting sheet, and the fusion-promoting sheet is formed of a biodegradable sheet having a plurality of through holes, and is a living body among biological organs to be joined.
  • the fusion promoting sheet includes a main body portion that promotes tissue fusion, and the fusion promoting sheet is formed with a slit through which a medical device used for a procedure for joining the biological organs can be inserted.
  • the fusion of the biological tissue of the biological organ can be promoted by sandwiching the main body portion of the fusion promoting sheet between the bonded sites of the biological organs to be joined.
  • the portion of the fusion promoting sheet located around the slit bends with the insertion of the medical instrument, and the outer peripheral surface of the medical instrument is bent. Contact. Therefore, the fusion promoting sheet can be sufficiently held by the medical instrument used for the procedure of joining the biological organs. From the above, the fusion promoting device according to the present invention can reduce the risk of suture failure after surgery or the like, and can be sufficiently held by a medical instrument used for a procedure for joining biological organs.
  • FIG. 1 It is a perspective view which shows one form of the fusion promotion device of this invention, and is the figure which looked at the fusion promotion device from the back side of the fusion promotion sheet. It is sectional drawing which shows the part of the cross section along line 2-2 of FIG. 1 enlarged. It is a top view of the fusion promotion device shown in FIG. 1 viewed from the surface side of the fusion promotion sheet, and is a view showing a state before inserting a medical instrument used for a procedure for joining a living organ into a slit. It is a top view of the fusion promotion device shown in FIG.
  • FIG. 1 viewed from the surface side of the fusion promotion sheet, and is a view showing an example of a state in which a medical instrument used for a procedure for joining a living organ is inserted into a slit. It is sectional drawing which shows the part of the cross section along line 4-4 of FIG. 3B enlarged. It is a top view which shows the modification 1 of the fracture
  • FIG. 5 is an enlarged cross-sectional view showing a part of a cross section taken along the line 5B-5B of FIG. 5A. It is a top view which shows the modification 2 of the fracture suppressing part in a fusion promotion device.
  • FIG. 6 is a schematic cross-sectional view for explaining pancreatic parenchymal-jejunal anastomosis.
  • FIG. 6 is a schematic cross-sectional view for explaining pancreatic parenchymal-jejunal anastomosis.
  • It is a schematic perspective view for explaining a pancreatic parenchymal-jejunal anastomosis.
  • It is a schematic perspective view for explaining a pancreatic parenchymal-jejunal anastomosis.
  • It is a schematic perspective view for explaining a pancreatic parenchymal-jejunal anastomosis. It is a figure which serves as the explanation of the other use example of the fusion promotion device of this invention.
  • FIG. 1 is a perspective view showing one form of the fusion promoting device 100 of the present invention, and is a view of the fusion promoting device 100 viewed from the back surface 114 side of the fusion promoting sheet 110.
  • FIG. 2 is an enlarged cross-sectional view showing a part of a cross section taken along line 2-2 of FIG.
  • FIG. 3A is a plan view of the fusion promoting device 100 shown in FIG. 1 as viewed from the surface 113 side of the fusion promoting sheet 110, and shows a state before inserting the medical instrument used for the procedure of joining the living organs into the slit 120. It is a figure which shows.
  • FIG. 3B is a plan view of the fusion promoting device 100 shown in FIG.
  • FIG. 1 is an example of a state in which a medical instrument used for a procedure for joining biological organs is inserted into a slit 120. It is a figure which shows.
  • FIG. 4 is an enlarged cross-sectional view showing a part of the cross section taken along the line 4-4 of FIG. 3B.
  • through holes 112 and 141 which will be described later, are omitted.
  • the fusion promoting device 100 has a fusion promoting sheet 110.
  • the fusion promoting sheet 110 is formed of a biodegradable sheet having a plurality of through holes 112, and includes a main body portion 111 that promotes fusion of biological tissues between biological organs to be joined.
  • the fusion promoting sheet 110 is formed with a slit 120 through which a medical instrument (hereinafter, also simply referred to as “medical instrument”) used for a procedure for joining biological organs can be inserted.
  • a medical instrument hereinafter, also simply referred to as “medical instrument”
  • the slit 120 is formed in the main body portion 111, and the fusion promoting device 100 has a fracture suppressing portion 130 that suppresses the main body portion 111 from breaking in the slits 120 extending directions X1 and X2. Have more.
  • the fusion promoting device 100 can be applied to a procedure for joining predetermined biological organs (for example, gastrointestinal anastomosis).
  • predetermined biological organs for example, gastrointestinal anastomosis
  • the fusion promoting device 100 is applied to a procedure for joining the pancreatic parenchyma and the jejunum, and the medical device used for the procedure for joining a living organ is a pancreatic duct tube 910.
  • the pancreatic duct tube 910 is a medical device used to suppress the leakage of pancreatic juice discharged from the pancreatic duct to the joint where the pancreatic parenchyma and the jejunum are joined.
  • the pancreatic duct tube is in vivo with one end of the pancreatic duct tube inserted into the pancreatic duct and the other end of the pancreatic duct tube led out of the body via the inside of the jejunum or the like. Detained in.
  • the indwelling pancreatic duct tube suppresses the leakage of pancreatic juice to the joint by discharging the pancreatic juice discharged from the pancreatic duct to the outside of the body.
  • the shape of the pancreatic duct tube 910 inserted through the slit 120 is not limited to the shapes shown in FIGS. 3B and 10 to 17.
  • the insertion direction Z of the pancreatic duct tube 910 is from the front surface 113 side to the back surface 114 side of the fusion promoting sheet 110.
  • the insertion direction Z of the pancreatic duct tube 910 may be a direction from the back surface 114 side to the front surface 113 side of the fusion promoting sheet 110.
  • the direction extending radially outward from the substantially center C of the portion through which the medical device (pancreatic duct tube 910) is inserted is referred to as the radial direction.
  • the fusion promoting sheet 110 is formed of a biodegradable sheet having a plurality of through holes 112, and has a main body portion 111 that promotes fusion of living tissues.
  • the through holes 112 formed in the main body 111 are regularly and periodically provided in the plane direction of the main body 111. However, each through hole 112 may be randomly provided in each portion of the main body portion 111 in the surface direction.
  • each through hole 112 extends substantially vertically between the front surface 113 and the back surface 114 along the thickness direction of the main body 111 (vertical direction in FIG. 2).
  • each through hole 112 may be bent or curved in a zigzag shape between the front surface 113 and the back surface 114 in the cross section along the thickness direction of the main body portion 111.
  • Each through hole 112 has a substantially circular planar shape (the shape when the front surface 113 of the main body 111 or the back surface 114 of the main body 111 is viewed in a plan view).
  • the planar shape of each through hole 112 is not particularly limited, and may be, for example, an ellipse or a polygon (rectangle, triangle, etc.). Further, the plane shape and the cross-sectional shape may be different for each through hole 112.
  • the main body 111 has a substantially circular planar shape.
  • the planar shape of the main body 111 is not particularly limited, and may be, for example, an ellipse or a polygon (rectangle, triangle, etc.).
  • the thickness of the main body 111 is not particularly limited, but is preferably 0.05 to 0.3 mm, more preferably 0.1 to 0.2 mm.
  • the strength is such that the main body 111 is not damaged when the fusion promoting sheet 110 is handled.
  • the thickness of the main body 111 is 0.3 mm or less (particularly 0.2 mm or less)
  • the main body 111 adheres to the biological tissue to which the main body 111 is applied and follows the biological tissue. It can be provided with sufficient flexibility.
  • the main body 111 is a value of the ratio of the hole diameter D (distance D shown in FIG. 2) of the through hole 112 to the pitch P (distance P shown in FIG. 2 and the distance between adjacent through holes 112) of the through hole 112. However, it is preferably 0.25 or more and less than 40. When the planar shape of the through hole 112 is a perfect circle, the hole diameter D of the through hole 112 is equal to the diameter of the perfect circle.
  • the diameter of a perfect circle having the same area as the area of the opening of the through hole 112 (the portion of the through hole 112 facing the front surface 113 or the back surface 114) ( The equivalent circle diameter) can be the hole diameter D of the through hole 112.
  • the main body 111 has a plurality of through holes 112, there are a plurality of values of the hole diameter D corresponding to each through hole 112. Therefore, in the present embodiment, in calculating the above-mentioned ratio value, the arithmetic mean value of two or more points of the hole diameter D values corresponding to the plurality of through holes 112 is used as the representative value of the hole diameter D. ..
  • the pitch P of the plurality of through holes 112 is defined by the shortest distance between the openings of the two through holes 112. However, as for the value of the pitch P, there are a plurality of values of the pitch P corresponding to the combination of the adjacent through holes 112. Therefore, in the present embodiment, in calculating the above-mentioned ratio value, the arithmetic mean value of two or more points of the pitch P values corresponding to the combinations of the adjacent through holes 112 is used as the representative value of the pitch P. And.
  • the pitch P, the hole diameter D, the ratio of the hole diameter D to the pitch P, and the like of the through hole 112 are merely examples, and are not limited thereto.
  • the main body 111 can be made of a biodegradable material.
  • the constituent material of the main body 111 is not particularly limited, and examples thereof include biodegradable resins.
  • biodegradable resin for example, those described in Japanese Patent Publication No. 2011-528275, Japanese Patent Publication No. 2008-514719, International Publication No. 2008-1952, Japanese Patent Publication No. 2004-509205 and the like are known.
  • Biodegradable (co) polymers can be used. Specifically, it is selected from the group consisting of (1) aliphatic polyester, polyester, polyacid anhydride, polyorthoester, polycarbonate, polyphosphazene, polyphosphate ester, polyvinyl alcohol, polypeptide, polysaccharide, protein, and cellulose.
  • the biodegradable sheet is selected from the group consisting of aliphatic polyesters, polyesters, polyacid anhydrides, polyorthoesters, polycarbonates, polyphosphazenes, polyphosphates, polyvinyl alcohols, polypeptides, polysaccharides, proteins, and celluloses. It preferably contains at least one biodegradable resin selected from the group consisting of a polymer and a copolymer composed of one or more monomers constituting the polymer.
  • the manufacturing method of the main body 111 is not particularly limited, and examples thereof include a method of manufacturing a fiber made of the above-mentioned biodegradable resin and manufacturing a mesh-shaped sheet using the fiber.
  • the method for producing the fiber made of a biodegradable resin is not particularly limited, and examples thereof include an electrospinning method (electrospinning method / electrostatic spinning method) and a melt blow method. As the main body 111, only one of the above methods may be selected and used, or two or more of the above methods may be selected and appropriately combined.
  • the biodegradable sheet according to the present invention is obtained by spinning the fibers made of the biodegradable resin described above according to a conventional method and knitting the obtained fibers into a mesh shape. May be manufactured.
  • the main body 111 induces a biological reaction by a constituent material such as a biodegradable resin constituting the main body 111.
  • the main body 111 induces the expression of biological components such as fibrin by this action.
  • the biological components induced in this way can promote fusion by accumulating so as to penetrate through the through hole 112 of the main body 111. Therefore, by arranging the main body 111 of the fusion promoting sheet 110 between the biological organs to be joined, the fusion is promoted by the above mechanism.
  • the slit 120 is formed substantially in the center of the main body 111 in the plane direction when the main body 111 is viewed in a plan view.
  • the position where the slit 120 is formed in the main body 111 is not limited to the above.
  • the “slit” means a gap extending in at least one direction that penetrates the fusion promoting sheet in the thickness direction and intersects the insertion direction Y of the medical device.
  • extending in one direction includes not only extending linearly in one direction but also extending in one direction while meandering or the like.
  • the slit 120 includes a pair of cuts 121 and 122 that intersect each other in the present embodiment. According to such a configuration, the operator can easily insert the pancreatic duct tube 910 into the slit 120 as compared with the case where the slit 120 is composed of only one cut.
  • the number of cuts constituting the slit 120 is not particularly limited as long as it is one or more.
  • each of the pair of cuts 121 and 122 will be referred to as a first cut 121 and a second cut 122.
  • the first cut 121 extends in the first radial direction X1.
  • the second cut 122 extends in a second radial direction X2 different from the first radial direction X1.
  • the first cut 121 and the second cut 122 extend linearly in the radial directions X1 and X2, but may extend in the radial directions X1 and X2 while meandering or the like.
  • the first radial direction X1 is also referred to as the extending direction X1 of the first cut 121
  • the second radial direction X2 is also referred to as the extending direction X2 of the second cut 121.
  • the first radiation direction X1 and the second radiation direction X2 are also referred to as extension directions X1 and X2 of the slit 120.
  • the length of the first cut 121 (dimension along the extension direction X1) and the length of the second cut 122 (dimension along the extension direction X2) are the insertion portions of the medical instruments to be inserted (in this embodiment, the pancreatic duct tube). It can be appropriately set according to the maximum dimension in the radial direction (end of 910). Note that FIG. 3A illustrates a form in which the length of the first cut 121 and the length of the second cut 122 are the same, but the length of the first cut 121 and the length of the second cut 122 are different. May be good.
  • the fracture suppressing portion 130 includes a reinforcing sheet 140 formed from a biodegradable sheet having a plurality of through holes 141 in the present embodiment.
  • the reinforcing sheet 140 can be formed by a biodegradable sheet similar to the biodegradable sheet forming the main body 111.
  • the reinforcing sheet 140 shows a form having a circular outer shape in a plan view.
  • the outer shape of the reinforcing sheet 140 in a plan view is not particularly limited, and may be, for example, an ellipse or a polygon.
  • the reinforcing sheet 140 is formed with an insertion hole 142 through which a medical instrument used for a procedure for joining a living organ can be inserted.
  • the insertion hole 142 penetrates the reinforcing sheet 140 in the thickness direction.
  • FIG. 3A illustrates an example in which the insertion holes 142 are composed of a pair of cuts 143 and 144 that intersect each other.
  • the insertion hole 142 may be a hole having an outer shape such as a round shape, an elliptical shape, or a polygonal shape in a plan view as long as the insertion portion of the medical instrument can be inserted.
  • each of the pair of cuts 143 and 144 will be referred to as a third cut 143 and a fourth cut 144.
  • the third cut 143 extends in the third radial direction X3.
  • the fourth cut 144 extends in a fourth radial direction X4, which is different from the third radial direction X3.
  • the third cut 143 and the fourth cut 144 extend linearly in the radial directions X3 and X4, but may extend in the radial directions X3 and X4 while meandering or the like.
  • the reinforcing sheet 140 is arranged on the main body 111 so that the peripheral edge 142a of the insertion hole 142 intersects the peripheral edge 120a of the slit 120 in a plan view.
  • the reinforcing sheet 140 is arranged on the main body 111 so as to overlap the portion where the third cut 143 and the fourth cut 144 intersect and the portion where the first cut 121 and the second cut 122 intersect in a plan view.
  • the reinforcing sheet 140 is arranged so that the third cut 143 and the fourth cut 144 extend in a direction different from the first radiation direction X1 and the second radiation direction X2.
  • the position of the reinforcing sheet 140 is not particularly limited as long as the peripheral edge 142a of the insertion hole 142 intersects the peripheral edge 120a of the slit 120 in a plan view.
  • the reinforcing sheet 140 is arranged on the back surface 114 of the main body 111 in the present embodiment.
  • the reinforcing sheet 140 may be arranged on the surface 113 of the main body 111.
  • the vicinity 140a of the outer peripheral edge of the reinforcing sheet 140 is joined to the main body portion 111.
  • the vicinity 140a of the outer peripheral edge of the reinforcing sheet 140 may be joined to the main body 111 over the entire circumference, or may be partially joined to the main body 111.
  • the method of joining the reinforcing sheet 140 to the main body 111 is not particularly limited, and examples thereof include a method of using a biodegradable thread or a biodegradable adhesive material.
  • the length of the third cut 143 (dimension along the extending direction X3 of the third cut 143) and the length of the fourth cut 144 (dimension along the extending direction X4 of the fourth cut 143).
  • FIG. 3A illustrates a form in which the length of the third cut 143 and the length of the fourth cut 144 are the same, but the length of the third cut 143 and the length of the fourth cut 144 are different. May be good.
  • FIG. 3A illustrates a form in which the lengths of all the cuts 121, 122, 143, and 144 are the same, but the lengths of all the cuts 121, 122, 143, and 144 are not the same. Good.
  • the medical instrument is inserted into the slit 120 formed in the main body 111 and the insertion hole 142 formed in the reinforcing sheet 140.
  • the state of each part of the fusion promoting device 100 at that time will be described.
  • the portion 110a located around the slit 120 in the fusion promoting sheet 110 (main body 111) is the pancreatic duct tube. It bends with the insertion of the 910 and comes into contact with the outer peripheral surface of the pancreatic duct tube 910. Therefore, the fusion promoting sheet 110 can be sufficiently held by the pancreatic duct tube 910. Therefore, the operator can hold the pancreatic duct tube 910 to hold the fusion promoting sheet 110, and can easily arrange the fusion promoting sheet 110 on the pancreatic parenchyma to be joined.
  • the slit 120 is formed in the main body 111.
  • a plurality of through holes 112 are formed in the main body 111. Therefore, when the pancreatic duct tube 910 is inserted into the slit 120 or with the pancreatic duct tube 910 inserted through the slit 120, the operator pulls the main body 111 to position the main body 111 with respect to a biological organ such as the pancreatic parenchyma B1. At the time of adjustment or the like, the main body 111 may be torn in the extending directions X1 and X2 of the slit 120.
  • the fusion promoting device 100 has a fracture suppressing portion 130 that suppresses the main body portion 111 from breaking in the extending directions X1 and X2 of the slit 120. Therefore, when the pancreatic duct tube 910 is inserted into the slit 120, it is possible to prevent the main body 111 from breaking in the extending directions X1 and X2 of the slit 120.
  • the pancreatic duct tube 910 inserts not only the slit 120 formed in the main body 111 but also the insertion hole 142 of the reinforcing sheet 140 constituting the fracture suppressing portion 130.
  • the reinforcing sheet 140 is arranged so that the peripheral edge 142a of the insertion hole 142 intersects the peripheral edge 120a of the slit 120 in a plan view. Therefore, as shown in FIG. 3B, the peripheral edge 142a of the insertion hole 142 prevents the pancreatic duct tube 910 from expanding the slit 120. Therefore, it is possible to prevent the main body 111 from breaking in the extending directions X1 and X2 of the slit 120. Further, since the peripheral edge 142a of the insertion hole 142 suppresses the pancreatic duct tube 910 from expanding the slit 120, the pancreatic duct tube 910 can preferably hold the fusion promoting sheet 110.
  • the fusion promoting device 100 has a fusion promoting sheet 110.
  • the fusion promoting sheet 110 is formed of a biodegradable sheet having a plurality of through holes 112, and includes a main body portion 111 that promotes fusion of living tissues between living organs to be joined.
  • the fusion promoting sheet 110 is formed with a slit 120 through which a medical instrument used for a procedure for joining biological organs can be inserted.
  • the fusion of the biological tissue of the biological organ can be promoted by sandwiching the main body 111 of the fusion promoting sheet between the bonded sites of the biological organs to be joined. Further, in a state where the medical instrument used for the procedure of joining the biological organ is inserted into the slit 120, the portion 110a located around the slit 120 in the fusion promoting sheet 110 bends with the insertion of the medical instrument, and the medical instrument Contact the outer peripheral surface of. Therefore, the fusion promoting sheet 110 can be sufficiently held by the medical instrument used for the procedure of joining the biological organs. From the above, the fusion promoting device 100 can reduce the risk of suture failure after surgery or the like, and can be sufficiently held by a medical instrument used for a procedure for joining biological organs.
  • the slit 120 is formed in the main body portion 111, and the fusion promoting device 100 further has a fracture suppressing portion 130 for suppressing the main body portion 111 from breaking in the extending directions X1 and X2 of the slit 120. Therefore, the main body 111 is formed with a plurality of through holes 112, and when a medical device is inserted, it is likely to break in the extending directions X1 and X2 of the slit 120, but the fracture suppressing portion 130 has the medical device in the slit 120. It is possible to prevent the main body 111 from breaking when the main body 111 is inserted.
  • the fracture suppressing portion 130 includes a reinforcing sheet 140 formed from a biodegradable sheet having a plurality of through holes 141.
  • the reinforcing sheet 140 is formed with an insertion hole 142 through which a medical instrument can be inserted.
  • the reinforcing sheet 140 is arranged on the main body 111 so that the peripheral edge 142a of the insertion hole 142 intersects the peripheral edge 120a of the slit 120 in a plan view. According to such a configuration, the peripheral edge 142a of the insertion hole 142 suppresses the medical instrument from pushing the slit 120 open. Therefore, it is possible to prevent the main body 111 from breaking in the extending directions X1 and X2 of the slit 120. Further, since the peripheral edge 142a of the insertion hole 142 suppresses the medical instrument from expanding the slit 120, the medical instrument can preferably hold the fusion promoting sheet 110.
  • the slit 120 includes a pair of cuts 121 and 122 that intersect each other. Therefore, the operator can easily insert the pancreatic duct tube 910 into the slit 120 as compared with the case where the slit 120 has one cut.
  • FIG. 5A is a plan view showing a modification 1 of the fracture suppressing portion 130 in the fusion promoting device 100, and is a view of the fusion promoting device 100 viewed from the surface 113 side of the fusion promoting sheet 110.
  • FIG. 5B is an enlarged cross-sectional view showing a part of the cross section taken along the line 5B-5B of FIG. 5A.
  • the insertion hole 242 formed in the reinforcing sheet 140 constituting the fracture suppressing portion 130 may be circular.
  • the diameter of the insertion hole 242 is preferably smaller than the length of the cuts 121 and 122 constituting the slit 120, and is not more than the maximum dimension in the radial direction of the insertion portion of the medical instrument inserted into the slit 120.
  • the reinforcing sheet 140 is preferably provided on the side (rear surface 114 side) opposite to the side (front surface 113 side) where the pancreatic duct tube 910 is inserted in the fusion promoting sheet 110.
  • the portion 110a located around the slit 120 of the fusion promoting sheet 110 is formed by the peripheral edge 242a of the insertion hole 242 when it is bent with the insertion of the pancreatic duct tube 910. Be supported. Since the diameter of the insertion hole 242 is equal to or less than the maximum dimension in the radial direction of the insertion portion of the medical instrument inserted into the slit 120, the peripheral edge 242a of the insertion hole 242 has a portion 110a folded in the fusion promoting sheet 110 as the medical instrument. Encourage them to come into contact with the outer peripheral surface of the insertion part. Thereby, the contact area between the fusion promoting sheet 110 and the medical device can be increased. Therefore, the pancreatic duct tube 910 can suitably hold the fusion promoting sheet 110.
  • the reinforcing sheet 140 may be joined to the main body 111 over the entire surface.
  • FIG. 6 is a plan view showing a modification 2 of the fracture suppressing portion 130 in the fusion promoting device 100.
  • the fracture suppressing portion 130 includes holes 151 to 154 formed in the vicinity of the end portion of the slit 120 in the main body portion 111, and each hole portion 151 to 154 includes each hole portion in the slit 120. It extends in a direction intersecting the extending direction of the portion closest to 151 to 154.
  • each of the plurality of hole portions 151 to 154 will be referred to as a first hole portion 151, a second hole portion 152, a third hole portion 153, and a fourth hole portion 154.
  • the first hole portion 151 and the second hole portion 152 are connected to both ends of the first cut 121 in the extending direction X1.
  • the third hole portion 153 and the fourth hole portion 154 are connected to both ends of the second cut 122 in the extending direction X2.
  • the first hole portion 151 and the second hole portion 152 extend in a direction intersecting the extending direction X1 of the first cut 121 closest to the first hole portion 151 and the second hole portion 152.
  • the third hole portion 153 and the fourth hole portion 154 extend in a direction intersecting the extending direction X2 of the second cut 122 closest to the third hole portion 153 and the fourth hole portion 154.
  • the stress acting on the main body 111 by the pancreatic duct tube 910 expanding the slit 120 is dispersed in the direction intersecting the extending directions X1 and X2 of the slit 120. Therefore, it is possible to effectively prevent the main body 111 from breaking in the extending directions X1 and X2 of the slit 120.
  • first hole portion 151 and the second hole portion 152 may be provided in the vicinity of the end portion of the first cut 121, and may be separated from the end portion of the first cut 121.
  • third hole portion 153 and the fourth hole portion 154 may be provided in the vicinity of the end portion of the second cut 122, and may be separated from the end portion of the second cut 122.
  • Near the end of the slit is not particularly limited, but means, for example, a range of about 0 to 2 mm from the end of the slit.
  • each hole portion 151 to 154 is composed of a cut extending in an arc shape.
  • the shape of each of the holes 151 to 154 is not particularly limited as long as it extends in the direction intersecting the extending direction X1 of the first cut 121.
  • each of the holes 151 to 154 may be formed of a linearly extending cut, a meandering cut, or the like, or may be formed of a through hole having an outer shape such as an ellipse or a rectangle in a plan view instead of the cut. Good.
  • a biodegradable reinforcing body may be provided on the periphery of each of the holes 151 to 154. As a result, the peripheral edges of the holes 151 to 154 can be reinforced.
  • the fracture suppressing portion 130 includes holes 151 to 154 formed in the vicinity of the end portion of the slit 120 in the main body portion 111, and each of the hole portions 151 to 154 is a slit.
  • the holes may extend in a direction intersecting the extending direction of the portion closest to each of the holes 151 to 154. According to such a configuration, the stress acting on the main body 111 by the pancreatic duct tube 910 expanding the slit 120 can be dispersed in the direction intersecting the extending directions X1 and X2 of the slit 120. Therefore, the holes 151 to 154 can effectively prevent the main body 111 from breaking in the extending directions X1 and X2 of the slit 120.
  • FIG. 7 is a plan view showing a modification 3 of the fracture suppressing portion 130 in the fusion promoting device 100.
  • the slit 220 includes four cuts 221 to 224. Then, the remaining cuts 222 to 224 intersect with one of the four cuts 221 to 224.
  • the fusion promoting sheet 110 and the pancreatic duct tube 910 are compared with the form in which only a pair of cuts 121 and 122 intersecting each other are formed on the fusion promoting sheet 110 as described above. The frictional force acting can be increased. Therefore, the medical device can suitably hold the fusion promoting sheet 110.
  • the fracture suppressing portion 130 may include a reinforcing body 160 provided at an end portion of each slit 220.
  • the reinforcing body 160 can be formed of a biodegradable material. Since the end portion of the slit 220 can be reinforced by the reinforcing body 160, it is possible to effectively prevent the main body portion 111 from breaking in the extending directions X1 and X2 of the slit 220.
  • the reinforcing body 160 is provided only at the end of the slit 220, but the reinforcing body may be provided on the entire circumference of the peripheral edge of the slit 220.
  • the fusion promoting sheet 110 can be suitably held by a medical device.
  • the fracture suppressing portion may include 130 and the reinforcing body 160 provided at the end of the slit 120. According to such a configuration, it is possible to effectively prevent the main body portion 111 from breaking in the extending directions X1 and X2 of each slit 120.
  • the slit 220 includes three or more cuts 221 to 224, and the remaining cuts 222 to 224 may intersect with one of the three or more cuts 221 to 224. According to such a configuration, the medical device can suitably hold the fusion promoting sheet 110.
  • the fracture suppressing portion may include at least two or more of the reinforcing sheet 140, the holes 151 to 154, and the reinforcing body 160. Further, the configuration of the fracture suppressing portion is not particularly limited as long as the main body portion can be suppressed from breaking in the extending direction of the slit.
  • the fracture suppressing portion may be a hole in which the end portion of the slit is punched out in a circular shape. According to such a configuration, the stress acting on the end portion of the slit can be dispersed.
  • FIG. 8 is a flowchart showing each procedure of the treatment method using the fusion promoting device.
  • the treatment method includes preparing a fusion promoting device and a medical device (S11).
  • the insertion part of the medical device is further inserted into the slit formed in the fusion promoting sheet, and the fusion promoting device is placed between the pair of joined sites while the medical device holds the fusion promoting sheet. That (S12) is included.
  • Joining one jointed portion and the other bonded portion with at least a part of the main body of the fusion promoting sheet arranged between one bonded portion and the other bonded portion (S13). including.
  • the living organ to be joined by the treatment method and the joining site in the living organ are not particularly limited and can be arbitrarily selected.
  • pancreatic parenchymal-jejunal anastomosis will be described as an example.
  • the above-mentioned treatment method may be applied to colon anastomosis or gastric tube anastomosis.
  • the fusion promoting device used in each procedure described below for example, any one can be selected from the above-mentioned fusion promoting devices, and other fusion promoting devices can be selected. You can also.
  • an example of using a specific fusion promoting device will be described as a typical example that can be suitably used for each procedure.
  • detailed description of known procedure procedures, known medical devices, medical instruments, etc. will be omitted as appropriate.
  • arranging the fusion promoting sheet between the living organs means that the fusion promoting sheet is arranged in a state of being in direct or indirect contact with the living organ, and the living organ
  • the fusion-promoting sheet is placed with a spatial gap formed between the two, or the fusion-promoting sheet is placed in both states (for example, the fusion-promoting sheet comes into contact with one of the biological organs).
  • the fusion promoting sheet is placed in contact with the other living organ).
  • the term "periphery” does not define a strict range (region), but a predetermined range (region) as long as the purpose of treatment (bonding between biological organs) can be achieved. Means.
  • FIG. 9 is a flowchart showing the procedure of the embodiment of the treatment method (pancreatic parenchymal-jejunal anastomosis), and FIGS. 10 to 17 are diagrams used for explaining the pancreatic parenchymal-jejunal anastomosis.
  • the biological organs to be joined are the pancreatic parenchyma B1 after pancreaticoduodenectomy and the jejunum B2.
  • a procedure for joining the periphery of the cut surface B1a of the cut pancreatic parenchyma B1 (one joined site) and an arbitrary site of the intestinal wall of the jejunum B2 (the other joined site) will be described. Further, in the present embodiment, an example of using the fusion promoting device 100 shown in FIG. 1 will be described.
  • the fusion promoting device 100 and the pancreatic duct tube 910 are prepared (S101), and the end portion 912 of the pancreatic duct tube 910 is formed in the fusion promoting sheet 110.
  • the fusion promoting device 100 is placed on the pancreatic parenchyma B1 with the fusion promoting sheet 110 held in the pancreatic duct tube 910 (S102), and the fusion promoting sheet 110 is fixed to the pancreatic parenchyma B1 with a fixing member.
  • the fusion promoting sheet 110 is sandwiched between the pancreatic parenchyma B1 and the jejunum B2 (S104), and the fusion promoting sheet 110 is sandwiched between the pancreatic parenchyma B1 and the jejunum B2 (S105). It comprises placing a fusion promoting sheet 110 between the pancreatic parenchyma B1 and the jejunum B2 (S106).
  • FIG. 15 a plurality of both end needles 920a to 920e, which will be described later, are omitted.
  • the operator prepares the fusion promoting device 100 and the pancreatic duct tube 910.
  • the operator inserts the end portion 912 of the pancreatic duct tube 910 into the slit 120 formed in the fusion promoting sheet 110, and holds the fusion promoting sheet 110 in the pancreatic duct tube 910.
  • the fusion promoting device 100 is placed on the pancreatic parenchyma B1.
  • the specific procedure for arranging the fusion promoting device 100 on the cut surface B1a of the pancreatic parenchyma B1 is not particularly limited, but for example, the following procedure can be performed.
  • the operator performs the pancreatic duct tube so that the end 911 of the pancreatic duct tube 910 passes through the inside of the jejunum B2 through the through hole B2a of the planned anastomosis site of the jejunum B2 and exits from the through hole B2b of the jejunum B2 to the outside of the jejunum B2.
  • the 910 is inserted into the jejunum B2.
  • the operator temporarily inserts the end portion 912 of the pancreatic duct tube 910 into the pancreatic duct B1b of the pancreatic parenchyma B1 in a state where the pancreatic duct tube 910 is inserted through the slit 120 of the fusion promoting sheet 110 to hold the fusion promoting sheet 110. .. Then, the operator attaches the fusion promoting sheet 110 to the cut surface B1a of the pancreatic parenchyma B1.
  • a known resin tube having a bump (convex portion) formed at the end portion 912 to prevent removal can be used.
  • the pancreatic duct tube 910 temporarily inserted into the pancreatic duct B1b suppresses the leakage of body fluid such as pancreatic juice from the pancreatic duct B1b during the procedure. According to such a procedure, the operator can arrange the fusion promoting device 100 and temporarily insert the pancreatic duct tube 910 at the same time.
  • the surgeon may pull the fusion promotion sheet 110 to adjust the position of the fusion promotion sheet 110.
  • the operator fixes the fusion promoting sheet 110 to the pancreatic parenchyma B1 with a fixing member.
  • a procedure for fixing the fusion promoting sheet 110 to the pancreatic parenchyma B1 by using a plurality of both end needles 920a to 920e as fixing members will be described.
  • known needles having a bioabsorbable absorbent thread (suture) and a biocompatible needle portion attached to both ends of the absorbent thread can be used.
  • the needles 930 and 940a to 940e at both ends which will be described later, are also configured to include an absorbent thread and a needle portion.
  • the surgeon starts with the posterior wall B1c of the pancreatic parenchyma B1 (the dorsal portion of the pancreatic parenchyma B1 in the circumferential direction) and the portion arranged on the posterior wall B1c in the fusion promoting sheet 110.
  • Both ends needles 920a are moved toward the anterior wall B1d of the pancreatic parenchyma B1 (the ventral portion of the pancreatic parenchyma B1 in the circumferential direction) and the portion of the fusion promoting sheet 110 arranged on the anterior wall B1d.
  • the operator moves both ends of the needle 920a so as to insert the jejunal serosal muscular layer at the planned anastomosis site of the jejunum B2 (around the through hole B2a).
  • the operator repeats such an operation, and inserts a plurality of both end needles 920a to 920e into the jejunal serosal muscular layer of the fusion promoting sheet 110, the pancreatic parenchyma B1, and the jejunum B2 as shown in FIG.
  • the operator can fix the fusion promoting sheet 110 to the pancreatic parenchyma B1 by using a plurality of both end needles 920a to 920e that suture the pancreatic parenchyma B1 and the jejunum B2.
  • the number of both-end needles to be inserted into the jejunal serosal muscular layer of the pancreatic parenchyma B1 and the jejunum B2 and the position to insert the both-end needles are not particularly limited. Further, the operator may fix the fusion promoting sheet 110 to the pancreatic parenchyma B1 by using biodegradable staples or the like as a fixing member instead of the plurality of needles 920a to 920e at both ends.
  • the operator passes the needles 930 at both ends from the lumen side of the pancreatic duct B1b toward the anterior wall B1d side of the cut surface B1a of the pancreatic parenchyma B1.
  • the needles 930 at both ends are held by a gripping instrument such as tweezers (not shown) so as not to interfere with the procedure in a state where the jejunum B2 is not inserted.
  • the operator moves one end of the needles 940a at both ends from the lumen side of the pancreatic duct B1b toward the cut surface B1a of the pancreatic parenchyma B1.
  • the operator inserts the other end of the needles 940a at both ends into the through hole B2a of the jejunum B2, and the needles 940a at both ends toward the outside of the jejunum B2 from the inside of the jejunum B2. Move the other end.
  • the operator inserts a plurality of both-end needles 940a to 940e into different sites in the circumferential direction of the pancreatic duct B1b and the jejunum B2.
  • the operator brings the posterior wall B1c of the pancreatic parenchyma B1 and the pancreatic duct B1b into close contact with the planned anastomosis site of the jejunum B2. Then, of the plurality of needles 940a to 940e at both ends, the needles 940c to 940e at both ends that insert the dorsal side (rear wall B1c side) of the pancreatic duct B1b in the circumferential direction are ligated.
  • the operator reinserts the end 912 of the pancreatic duct tube 910 into the pancreatic duct B1b, as shown in FIG.
  • the operator inserts the needle portion 931 extending from the inside of the pancreatic duct B1b with the needles 930 at both ends into the through hole B2a formed in the jejunum B2, and moves the needle portion 931 from the inside of the jejunum B2 toward the outside of the jejunum B2.
  • the operator ligates the needles 930, 940a, and 940b at both ends (not shown).
  • the number of both-end needles to be inserted into the pancreatic duct B1b and the jejunum B2 and the position to insert the both-end needles are not particularly limited.
  • the operator ligates the needles 920a to 920e at both ends while pressing the jejunum B2 against the pancreatic parenchyma B1 with the operator's finger.
  • the pancreatic parenchyma B1 and the jejunum B2 are sutured with the fusion promoting sheet 110 sandwiched between them.
  • the jejunum B2 is deformed by the tension generated at the time of suturing so as to wrap the cut surface B1a of the pancreatic parenchyma B1 and the main body 111 of the fusion promoting sheet 110.
  • the surgeon indwells the fusion promoting sheet 110 with the main body 111 of the fusion promoting device 100 sandwiched between the cut surface B1a of the pancreatic parenchyma B1 and the intestinal wall of the jejunum B2.
  • the main body 111 of the fusion promoting sheet 110 is placed between the cut surface B1a of the pancreatic parenchyma B1 and the intestinal wall of the jejunum B2 while being in contact with the cut surface B1a of the pancreatic parenchyma B1 and the intestinal wall of the jejunum B2. This promotes the fusion of the biological tissue of the pancreatic parenchyma B1 and the biological tissue of the intestinal wall of the jejunum B2.
  • the treatment method according to the present embodiment is applied to the procedure for joining the pancreatic parenchyma B1 and the jejunum B2. Further, in the above treatment method, the periphery of the cut surface B1a of the cut pancreatic parenchyma B1 and the intestinal wall (jejunal serosal muscular layer) of the jejunum B2 are joined. According to this treatment method, the biological tissue of the pancreatic parenchyma B1 and the biological tissue of the intestinal wall of the jejunum B2 are formed by the main body 111 of the fusion promoting sheet 110 sandwiched between the cut surface B1a of the pancreatic parenchyma B1 and the intestinal wall of the jejunum B2. Can promote fusion and reduce the risk of suture failure after pancreatic parenchymal-jejunostomy.
  • the end portion 912 of the pancreatic duct tube 910 is temporarily inserted into the pancreatic duct B1b of the pancreatic parenchyma B1 while the pancreatic duct tube 910 is inserted through the slit 120 of the fusion promoting sheet 110 to hold the fusion promoting sheet 110. Therefore, the operator can arrange the fusion promoting device 100 and temporarily insert the pancreatic duct tube 910 at the same time. At this time, the portion of the fusion promoting sheet 110 located around the slit 120 bends with the insertion of the pancreatic duct tube 910 and comes into contact with the outer peripheral surface of the pancreatic duct tube 910. Therefore, the fusion promoting sheet 110 can be sufficiently held by the pancreatic duct tube 910. As a result, the operator can easily arrange the fusion promoting sheet 110.
  • the fusion promoting device according to the present invention may be applied to the junction between the oral side A1 of the large intestine and the anal side A2 of the large intestine.
  • a joining device 950 that sews the circumference of the living tissue in a circumferential shape with staples can be used.
  • the joining device 950 includes a first engaging portion 951 having an engaged portion 951a and a second engaging portion 952 including an engaging pin 952a that engages with the engaged portion 951a.
  • the fusion promoting sheet 310 used for joining the oral side A1 of the large intestine and the anal side A2 of the large intestine may be formed with, for example, a slit 320 through which the engaged portion 951a (or the engaging pin 952a) can be inserted.
  • the joining device 950 hold the fusion promoting sheet 310 in this way, the fusion promoting sheet 310 can be easily arranged between the oral side A1 of the large intestine and the anal side A2 of the large intestine.
  • the first engaging portion 951 and the second engaging portion 952 punch out a region including the slit 320 in the fusion promoting sheet 310 (not shown). )
  • the region to be punched out (region to be excised) in the fusion promoting sheet 310 does not necessarily have to be composed of a biodegradable sheet in which a plurality of through holes are formed. That is, the slit 320 is not necessarily formed in the main body of the fusion promoting sheet 310 (a portion formed from a biodegradable sheet having a plurality of through holes and promoting fusion of biological tissues between biological organs to be joined). It does not have to be.
  • 100 fusion promotion device 110, 310 Healing promotion sheet, 111 body, 112 through hole, 120, 220, 320 slits, 120a Slit margin, 121, 122, 221 to 224 breaks, 130 Break suppression part, 140 reinforcement sheet, 141 through hole, 142, 242 insertion holes, 142a, 242a, the periphery of the insertion hole, 151-154 holes, 160 reinforcement, 910 Pancreatic duct tube (medical instrument used for the procedure of joining biological organs), 950 joining device (medical instrument used for the procedure of joining living organs), A1 Oral side of the large intestine, A2 Anal side of the large intestine, B1 pancreatic parenchyma, B2 jejunum, X1, X2 Slit extension direction, Z Insertion direction of medical equipment used for the procedure of joining biological organs

Abstract

L'invention aborde le problème de la réalisation d'un dispositif de promotion de fusion grâce auquel le risque d'un échec de suture après une opération telle qu'une opération chirurgicale peut être réduit, et qui peut être retenu suffisamment par un instrument médical qui est utilisé lors d'une procédure destinée à joindre des organes biologiques. La solution selon l'invention consiste en un dispositif de promotion de fusion (100) qui inclut une feuille de promotion de fusion (110). La feuille de promotion de fusion a une partie de corps (111) qui est formée d'une feuille biodégradable ayant une pluralité de trous traversants (112), et qui promeut la fusion de tissus biologiques entre des organes biologiques à joindre. Une fente (120), dans laquelle un instrument médical qui est utilisé lors d'une procédure destinée à joindre les organes biologiques peut être inséré, est formée dans la feuille de promotion de fusion.
PCT/JP2020/014146 2019-03-28 2020-03-27 Dispositif de promotion de fusion WO2020196857A1 (fr)

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022168984A1 (fr) * 2021-02-08 2022-08-11 国立大学法人 長崎大学 Culture cellulaire stratiforme pour recouvrir la surface coupée du pancréas
WO2023032692A1 (fr) * 2021-09-03 2023-03-09 テルモ株式会社 Élément médical

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007505708A (ja) * 2003-09-17 2007-03-15 ゴア エンタープライズ ホールディングス，インコーポレイティド 円形ステープラーのバットレス
JP2011015966A (ja) * 2009-07-08 2011-01-27 Tyco Healthcare Group Lp 外科用ガスケット
JP2013154166A (ja) * 2012-01-26 2013-08-15 Covidien Lp Ｅｅａアンビル用のバットレス支持設計
JP2019103802A (ja) * 2017-12-08 2019-06-27 コヴィディエン リミテッド パートナーシップ 円形ステープリングのための外科用バットレス

Family Cites Families (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5176703A (en) * 1991-10-30 1993-01-05 Peterson Meldon L Sutureless closure for a skin wound or incision
IL152817A0 (en) * 2000-05-19 2003-06-24 Coapt Systems Inc Tissue approximation device and a method using it
US8372094B2 (en) * 2004-10-15 2013-02-12 Covidien Lp Seal element for anastomosis
US7942890B2 (en) * 2005-03-15 2011-05-17 Tyco Healthcare Group Lp Anastomosis composite gasket
GB2430372B (en) * 2005-09-19 2010-09-29 Stephen George Edward Barker Reinforcement device
US8052699B1 (en) * 2007-05-15 2011-11-08 Cook Medical Technologies Llc Viscerotomy closure device and method of use
US8439945B2 (en) * 2010-05-03 2013-05-14 Zipline Medical, Inc. Methods for biopsying tissue
US8464925B2 (en) * 2010-05-11 2013-06-18 Ethicon Endo-Surgery, Inc. Methods and apparatus for delivering tissue treatment compositions to stapled tissue
US8967448B2 (en) * 2011-12-14 2015-03-03 Covidien Lp Surgical stapling apparatus including buttress attachment via tabs
US10052105B2 (en) * 2013-11-18 2018-08-21 Ethicon, Inc. Recessed surgical fastening devices
DE102015205056A1 (de) * 2015-03-20 2016-09-22 Aesculap Ag Chirurgisches Gewebefusionsinstrument und Stützstruktur hierfür

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007505708A (ja) * 2003-09-17 2007-03-15 ゴア エンタープライズ ホールディングス，インコーポレイティド 円形ステープラーのバットレス
JP2011015966A (ja) * 2009-07-08 2011-01-27 Tyco Healthcare Group Lp 外科用ガスケット
JP2013154166A (ja) * 2012-01-26 2013-08-15 Covidien Lp Ｅｅａアンビル用のバットレス支持設計
JP2019103802A (ja) * 2017-12-08 2019-06-27 コヴィディエン リミテッド パートナーシップ 円形ステープリングのための外科用バットレス

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022168984A1 (fr) * 2021-02-08 2022-08-11 国立大学法人 長崎大学 Culture cellulaire stratiforme pour recouvrir la surface coupée du pancréas
WO2023032692A1 (fr) * 2021-09-03 2023-03-09 テルモ株式会社 Élément médical

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