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WO2016027489A1 - Procédé d'éveinage d'un vaisseau sanguin et dispositif d'éveinage d'un vaisseau sanguin - Google Patents

Procédé d'éveinage d'un vaisseau sanguin et dispositif d'éveinage d'un vaisseau sanguin Download PDF

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Publication number
WO2016027489A1
WO2016027489A1 PCT/JP2015/058091 JP2015058091W WO2016027489A1 WO 2016027489 A1 WO2016027489 A1 WO 2016027489A1 JP 2015058091 W JP2015058091 W JP 2015058091W WO 2016027489 A1 WO2016027489 A1 WO 2016027489A1
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WIPO (PCT)
Prior art keywords
blood vessel
guide
main body
saphenous vein
movable
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Application number
PCT/JP2015/058091
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English (en)
Japanese (ja)
Inventor
達徳 藤井
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テルモ株式会社
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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
Publication of WO2016027489A1 publication Critical patent/WO2016027489A1/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

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 is insufficient as a guide for the cylindrical member because the guide wire is flexible and easily deformed.
  • the device described in Patent Document 1 has a problem that blood vessel collection workability is poor.
  • An object of the present invention is to provide a blood vessel peeling method and a blood vessel peeling device excellent in workability of blood vessel collection (blood vessel peeling).
  • a first step of inserting a guide portion into a blood vessel A second step for increasing the bending rigidity of the guide portion as compared with the first step;
  • a blood vessel detachment method characterized by comprising:
  • a guide part capable of changing the bending rigidity
  • a movable part disposed around the guide part, After inserting the guide part body into the blood vessel, the bending rigidity of the guide part body is increased, and the movable part is moved while being guided by the guide part.
  • a blood vessel peeling device characterized by peeling in a state covered with tissue.
  • the guide portion includes a flexible guide portion main body and a reinforcing portion that reinforces the guide portion main body.
  • the bending rigidity of the guide part is changed during the procedure so that the guide part is flexible in the first step and the guide part is hard in the third step. Therefore, in the first step, the followability of the guide portion to the blood vessel is good, and the guide portion can be smoothly inserted into the blood vessel.
  • the third step since the deformation of the guide portion is suppressed, the movable portion can be smoothly guided by the guide portion, and the blood vessel is smoothly covered with at least a part of the periphery thereof in the surrounding tissue. Can be peeled off.
  • the second step by deforming the guide part in a straight line, the blood vessel can be straightened and the movable part can be moved in a straight line. It can be done accurately.
  • FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention.
  • 2 is a perspective view and a plan view showing a movable part of the blood vessel peeling device shown in FIG.
  • FIG. 3 is a plan view illustrating a processing unit included in the movable unit illustrated in FIG. 2.
  • FIG. 4 is a plan view showing a modification of the movable part shown in FIG.
  • FIG. 5 is a plan view showing an attachment included in the blood vessel peeling device shown in FIG. 1.
  • FIG. 6 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 1.
  • FIG. 7 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG.
  • FIG. 8 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 1.
  • 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 perspective view and a plan view showing a movable part of a blood vessel peeling device according to the second embodiment of the present invention.
  • 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 perspective view and a plan view showing a movable part of a blood vessel peeling device according to the third embodiment of the present invention.
  • FIG. 14 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 15 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to the fourth embodiment of the present invention.
  • FIG. 16 is sectional drawing which shows the guide part which the blood vessel peeling device which concerns on 5th Embodiment of this invention has.
  • FIG. 17 is a plan view showing a guide part included in the blood vessel peeling device according to the sixth embodiment of the present invention.
  • FIG. 18 is a plan view showing a guide part included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • FIG. 19 is a cross-sectional view showing an attachment included in the blood vessel peeling device according to the eighth embodiment of the present invention.
  • FIG. 20 is a side view showing a movable part included in the blood vessel peeling device according to the ninth embodiment of the present invention.
  • FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the tenth embodiment of the present invention.
  • FIG. 22 is a plan view and a side view showing a movable part included in the blood vessel peeling device according to the eleventh embodiment of the present invention.
  • FIG. 23 is a plan view and a side view showing a movable part of a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • FIG. 24 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 25 is a cross-sectional view showing a blood vessel peeling device according to a fourteenth embodiment of the present invention.
  • FIG. 26 is a cross-sectional view showing a blood vessel peeling device according to a fifteenth embodiment of the present invention.
  • FIG. 27 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 28 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
  • FIG. 29 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 30 is a perspective view showing a guide part included in the blood vessel peeling device according to the seventeenth embodiment of the present invention.
  • FIG. 31 is a perspective view showing a guide part included in the blood vessel peeling device according to the eighteenth embodiment of the present invention.
  • FIG. 32 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
  • FIG. 33 is a perspective view and a cross-sectional view showing a guide portion included in the blood vessel peeling device according to the twentieth embodiment of the present invention.
  • FIG. 34 is a perspective view showing a guide part included in the blood vessel peeling device according to the twenty-first embodiment of the present invention.
  • FIG. 35 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.
  • FIG. 36 is a perspective view showing a guide part included in a blood vessel peeling device according to a twenty-second embodiment of the present invention.
  • FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention.
  • 2 is a perspective view and a plan view showing a movable part of the blood vessel peeling device shown in FIG.
  • FIG. 3 is a plan view illustrating a processing unit included in the movable unit illustrated in FIG. 2.
  • FIG. 4 is a plan view showing a modification of the movable part shown in FIG.
  • FIG. 5 is a plan view showing an attachment included in the blood vessel peeling device shown in FIG. 1.
  • 6 to 10 are views for explaining a blood vessel peeling method using the blood vessel peeling device shown 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, the blood vessel can be collected in a state of being covered with the surrounding tissue. Therefore, the great saphenous vein is collected using the blood vessel peeling device 100 and bypassed. By using it as a blood vessel, the long-term patency after surgery is considered to be high. For this reason, below, the example which extract
  • the blood vessel peeling device 100 includes a guide unit 200 inserted into the great saphenous vein 1000, a movable unit 300 that moves in the living body while being guided by the guide unit 200, and is movable to the guide unit 200. And an attachment (connecting portion) 400 for connecting the portion 300.
  • a guide unit 200 inserted into the great saphenous vein 1000
  • a movable unit 300 that moves in the living body while being guided by the guide unit 200, and is movable to the guide unit 200.
  • an attachment (connecting portion) 400 for connecting the portion 300.
  • the guide part 200 includes a wire-shaped guide part main body 210 and a reinforcing part 220 that reinforces the guide part main body 210 and increases the bending rigidity of the guide part 200 as a whole.
  • the guide unit main body 210 is flexible, thin and long, and can be inserted into the great saphenous vein 1000 like a guide wire.
  • the constituent material of the guide body 210 is not particularly limited.
  • various metal materials such as stainless steel, Ni—Ti alloy, Cu—Zn alloy, polyolefin, polyamide, polyester, polycarbonate, poly
  • resin materials such as vinyl chloride can be used.
  • the reinforcing portion 220 reinforces the guide portion main body 210, thereby increasing the bending rigidity of the guide portion 200 in the large saphenous vein 1000.
  • a reinforcing portion 220 has a long tubular shape, and the guide portion main body 210 can be inserted into the inner cavity 221 thereof.
  • the reinforcing part 220 is hard and extends substantially linearly.
  • the “tubular” includes a tube having a substantially C-shaped cross section in which a slit is formed and a part in the circumferential direction is missing, and the like.
  • the guide portion main body 210 is inserted into the inner cavity 221 of the reinforcing portion 220, and the guide portion main body 210 is covered with the reinforcing portion 220, whereby the bending rigidity of the guide portion 200 as a whole is increased.
  • the reinforcing portion 220 is linear, the large saphenous vein 1000 can be straightened by inserting the reinforcing portion 220 into the large saphenous vein 1000.
  • the diameter of the inner cavity 221 of the reinforcing portion 220 is only required to be able to insert the guide portion main body 210, but is equal to or slightly larger than the outer diameter of the guide portion main body 210. Thereby, the diameter of the lumen 221 can be reduced as much as possible, and the diameter of the reinforcing portion 220 can be reduced accordingly.
  • the diameter of the lumen 221 is not limited to this, and may be larger than the outer diameter of the guide body 210, for example.
  • the bending rigidity of the reinforcing portion 220 is not particularly limited, but depending on the stress generated when the reinforcing portion 220 is inserted and arranged in the large saphenous vein 1000 or the stress generated when the movable portion 300 is guided, It is preferable that it is high enough not to substantially deform. Thereby, the greater saphenous vein 1000 can be straightened more reliably and the movable portion 300 can be guided more smoothly.
  • the constituent material of the reinforcing portion 220 is not particularly limited, but various metal materials such as stainless steel, Ni—Ti alloy, Cu—Zn alloy, polyolefin, polyamide, polyester, polycarbonate, polychlorinated, for example. Various resin materials such as vinyl can be used.
  • the cross-sectional shape of the reinforcing portion 220 is not particularly limited, and may be a circle, an ellipse, an oval, a triangle, a quadrangle, a pentagon, or the like. However, a shape without corners such as a circle, an ellipse, and an oval is preferable. This reduces damage to the great saphenous vein 1000.
  • 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. This is a site for cutting and hemostasis the branch blood vessel 1100 that is present.
  • the movable unit 300 has a movable unit main body 310, and a peeling unit 320 and a processing unit 330 provided on the movable unit main body 310.
  • the movable part main body 310 has a tubular shape and is formed with a slit 311 extending in the axial direction thereof. That is, the movable part main body 310 is a tubular body (cylindrical body) having a substantially “C” cross-sectional shape. Further, the inner diameter of the movable part main body 310 is larger than the outer diameter of the large saphenous vein 1000.
  • Such a movable part main body 310 is attached to the guide part 200 via the attachment 400, and as shown in FIG. 2B, the guide part 200 along the central axis J of the movable part main body 310 in the attached state. Is located.
  • the slit 311 is formed to dispose the movable portion main body 310 around the guide portion 200 without cutting the large saphenous vein 1000. ing.
  • the width W11 of the slit 311 is preferably larger than the outer diameter of the large saphenous vein 1000 as shown in FIG. Thereby, since the movable part main body 310 can be arrange
  • the width W11 of the slit 311 is not limited to this, and may be smaller than the outer diameter of the large saphenous vein 1000. Further, the slit 311 may not have a substantial width. That is, both end portions 318 and 319 in the circumferential direction of the movable portion main body 310 may be in contact with each other. By setting the slit 311 to such a width, the slit 311 can be made thinner than in the present embodiment, and the peeling effect of the movable part 300 can be enhanced. In the above case, the movable part main body 310 can be arranged around the guide part 200 by expanding the diameter of the movable part main body 310 to widen the slit 311.
  • the movable part main body 310 has a plurality of groove parts 390 opened at the tip thereof, and the plurality of groove parts 390 are arranged side by side in the circumferential direction of the movable part main body 310.
  • Each of the groove portions 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 width thereof 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 main body 310 is pushed forward in the living body to the blood vessel processing groove portion 392, and has a tapered shape in order 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 330.
  • the processing unit 330 has a bipolar structure having a pair of electrodes 331 and 332 capable of generating an electric field in the blood vessel processing groove 392, as shown in FIG.
  • the electrode 331 is provided at the proximal end (bottom) of the vascular treatment groove 392, and the electrodes 332 are provided on both sides in the width direction of the vascular treatment groove 392.
  • the tip 331 ′ of the electrode 331 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 331 and 332, the branch blood vessel can be physically cut by the electrode 331. Therefore, the certainty of processing by the processing unit 330 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 and hemostasis) by the processing unit 330 can be performed more reliably.
  • the movable part main body 310 is provided with a peeling part 320 for peeling the tissue around the large saphenous vein 1000.
  • the peeling portion 320 includes a first peeling portion 321 provided along the blood vessel guide groove portion 391 at a distal end portion of the movable portion main body 310, and a second portion provided at a circumferential end portion 318 of the movable portion main body 310. And a peeling portion 322. As will be described later in “2.
  • the first exfoliation part 321 is a part that exfoliates the tissue when pushing the movable part main body 310 toward the distal end side in the living body
  • the part 322 is a part that peels the tissue when the movable part main body 310 is arranged around the guide part 200.
  • These first and second peeling portions 321 and 322 preferably have such a sharpness that the tissue can be peeled 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.
  • the adjacent groove parts 390 may be spaced apart.
  • the attachment 400 has a fixed portion 410 fixed to the reinforcing portion 220, and is slidably supported by the fixed portion 410, and its distal end portion is connected to the movable portion main body 310.
  • the fixing portion 410 may be detachable with respect to the reinforcing portion 220 or may not be detachable. In the former case, workability is improved in that the reinforcing portion 220 can be used in a state where the fixing portion 410 is not attached until the middle of the procedure. On the other hand, in the case of the latter, workability
  • Two through holes 411 are formed in such a fixing portion 410, and the operation portion 420 is slidably inserted into the through holes 411. Further, the distal end portion of the operation unit 420 is connected to a connection unit 317 provided on the movable unit main body 310. Therefore, by operating the operation unit 420, the movable unit main body 310 can be moved in the axial direction while being guided by the guide unit 200.
  • the configuration of the attachment 400 is not particularly limited.
  • the number of operation units 420 is not limited to two, but may be one or three or more.
  • the blood vessel peeling method (blood vessel collection method) using the blood vessel peeling device 100 includes a first step of inserting the guide portion main body 210 into the large saphenous vein 1000, and a guide portion by attaching the reinforcing portion 220 to the guide portion main body 210. A second step of increasing the bending rigidity of 200, and a third step of connecting the movable part 300 to the guide part 200 and moving the movable part 300 to peel off the large saphenous vein 1000 while being covered with the surrounding tissue 1200. A step, a fourth step of cutting the large saphenous vein 1000 after ligation, and a fifth step of extracting the large saphenous vein 1000 while being covered with the surrounding tissue 1200.
  • the reinforcing portion 220 is inserted into the great saphenous vein 1000 while being guided by the guide portion main body 210.
  • the guide body 210 is inserted into the lumen 221 of the reinforcing portion 220 in the large saphenous vein 1000, and the bending rigidity of the guide portion 200 in the large saphenous vein 1000 is higher than that in the first step. Will also increase.
  • the great saphenous vein 1000 is corrected substantially linearly by the reinforcing portion 220.
  • the movable part 300 is arranged around the guide part 200 through the incision part 1300. Specifically, first, after positioning the slit 311 with respect to the guide part 200, when the movable part main body 310 is rotated while being pushed into the living body with the second peeling part 322 as the head, the guide part is interposed via the slit 311. 200 enters the inside of the movable part 300, and the movable part 300 is arranged around the guide part 200 without cutting the saphenous vein 1000.
  • tissue is peeled by the 2nd peeling part 322
  • the movable part 300 can be rotated smoothly.
  • the work of placing the movable part 300 around the guide part 200 is also referred to as “mounting work”.
  • the order of the attaching operation is not limited to this, and may be performed before inserting the reinforcing portion 220 into the great saphenous vein 1000 or before inserting the guide body 210 into the great saphenous vein 1000. Also good.
  • the fixing portion 410 is fixed to the proximal end portion of the reinforcing portion 220 (the portion not inserted into the great saphenous vein 1000), and the operation portion 420 is attached to the fixing portion 410. Further, the operation unit 420 is connected to the movable unit main body 310. Thereby, the movable part main body 310 is positioned (centered) with respect to the guide part 200 so that the guide part 200 is positioned on the central axis J of the movable part main body 310.
  • the operation part 420 is pushed in, and the movable part main body 310 is advanced in the living body as shown in FIG.
  • the tissue 1200 around the great saphenous vein 1000 is peeled off by the first peeling part 321 and the branch blood vessel 1100 is guided to the blood vessel processing groove part 392, and the processing part 330 cuts and stops hemostasis. Is done.
  • the large saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200.
  • the guide of the movable part main body 310 by the guide part 200 can be performed smoothly. Further, since the large saphenous vein 1000 is straightened by the guide part 200 and the movable part main body 310 is centered with respect to the guide part 200, the movable part main body 310 is connected to the large saphenous vein 1000. Is moved on the central axis J. Therefore, the contact between the movable part main body 310 and the great saphenous vein 1000 is prevented, and furthermore, the great saphenous vein 1000 can be positioned almost at 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.
  • the operation of moving the movable part main body 310 and peeling off the large saphenous vein 1000 while being covered with the surrounding tissue 1200 is also referred to as “peeling work”.
  • the peeling work is performed by changing the direction of the movable part 300 (position of the slit 311). It is preferable to go around or rotate the movable part main body 310 around the axis. Moreover, you may peel the structure
  • the large saphenous vein 1000 is cut at the proximal-side planned cut portion 1001 and the distal-side planned cut portion 1002.
  • the front and rear two cut portions 1001 of the large saphenous vein 1000 sandwiching the proximal end cut portion 1001 are ligated and the distal cut end 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. 9 (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.
  • blood pressure internal pressure received by blood
  • the large saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced.
  • 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 tissue 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 flexible in the first step, and the bending rigidity of the guide part 200 is increased in the second step. Therefore, in the first step, the followability of the guide unit 200 to the great saphenous vein 1000 is good, and the guide portion 200 can be smoothly inserted into the great saphenous vein 1000.
  • the third step since the deformation of the guide part 200 is suppressed, the movable part 300 can be smoothly guided by the guide part 200, and the large saphenous vein 1000 is smoothly covered with the surrounding tissue 1200. Can be peeled off.
  • the third step can be performed more smoothly and accurately.
  • the movable portion 300 is arranged around the guide portion 200 without cutting the large saphenous vein 1000, so that the large saphenous vein 1000 can pass blood 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.
  • FIG. 11 is a perspective view and a plan view showing a movable part of a blood vessel peeling device according to the second embodiment of the present invention.
  • FIG. 12 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 configuration of the movable part is mainly different.
  • the movable part main body 310A included in the movable part 300A has a tubular shape (cylindrical shape) in which the slit 311 is omitted from the movable part main body 310 of the first embodiment described above.
  • the 1st peeling part 321 can be provided over the perimeter, it can exhibit more excellent peelability compared with 1st Embodiment mentioned above, for example. it can.
  • the blood vessel peeling method using the blood vessel peeling device 100A includes a first step of inserting the guide body 210 into the great saphenous vein 1000, a second step of increasing the bending rigidity of the guide portion 200, and the great saphenous vein 1000. After the proximal end is ligated and cut, a third step for mounting and peeling work, a fourth step for ligating and cutting the distal end of the greater saphenous vein 1000, and the greater saphenous vein 1000 around it And a fifth step of extracting in a state covered with the tissue 1200.
  • the great saphenous vein 1000 can be removed while being covered with the surrounding tissue 1200.
  • FIG. 13 is a perspective view and a plan view showing a movable part of a blood vessel peeling device according to the third embodiment of the present invention.
  • FIG. 14 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 attachment is different and the blood vessel peeling method is different accordingly.
  • each operation unit 420 is fixed to the fixing unit 410. Therefore, the movable part 300 connected to the reinforcing part 220 via the attachment 400 is also fixed to the reinforcing part 220. In addition, the movable part 300 is located on the proximal side with respect to the distal end of the reinforcing part 220 in a state of being fixed to the reinforcing part 220. That is, the reinforcing part 220 protrudes from the inner side of the movable part 300 to the tip side.
  • the first step of inserting the guide part body 210 into the large saphenous vein 1000 and the bending part of the guide part 200 are enhanced by the reinforcing part 220, while the movable part 300 increases the bending rigidity.
  • a fifth step of extracting 1000 in a state covered with the surrounding tissue 1200 is a fifth step of extracting 1000 in a state covered with the surrounding tissue 1200.
  • the large saphenous vein 1000 can be collected smoothly and accurately while being covered with the surrounding tissue 1200, as in the first embodiment described above.
  • the reinforcement part 220 is inserted and the movable part 300 is moved simultaneously, the procedure can be performed more efficiently.
  • FIG. 15 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to the fourth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide portion is different.
  • the guide part 200C has a guide part main body 210C and a reinforcing part 220C.
  • the guide body 210C has a flexible tubular shape (cylindrical shape) with the distal end closed, and has a lumen 211C that opens to the proximal end.
  • the reinforcing portion 220C has a hard rod shape and can be inserted into the lumen 211C of the guide portion main body 210C.
  • the bending rigidity of the guide part 200 can be increased by inserting the reinforcing part 220C into the lumen 211C of the guide part main body 210C.
  • the diameter of the inner cavity 211 ⁇ / b> C only needs to be able to insert the reinforcing portion 220, but is equal to or slightly larger than the outer diameter of the reinforcing portion 220.
  • the diameter of the lumen 211C can be made as small as possible, and the diameter of the guide body 210C can be reduced accordingly.
  • the diameter of the inner cavity 211C is not limited to this, and may be larger than the outer diameter of the reinforcing portion 220C, for example.
  • FIG. 16 is sectional drawing which shows the guide part which the blood vessel peeling device which concerns on 5th Embodiment of this invention has.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide portion is different.
  • the guide part 200D includes a guide part body 210D.
  • the guide portion main body 210D has a flexible tubular shape (cylindrical shape) with the distal end closed, and has a lumen 211D that opens to the proximal end portion.
  • the bending rigidity of the guide part 200D is increased by supplying (filling) the filler Y into the lumen 211D of the guide part main body 210D.
  • the tip portion of the guide portion main body 210D has a gas-permeable structure while being liquid-tight so that no bubbles remain in the guide portion main body 210D when filling the filler Y. .
  • a configuration for preventing bubbles from remaining in the guide body 210D when the filler Y is filled for example, a configuration as shown in FIG. That is, by providing the partition wall 212D in the guide portion main body 210D, a one-way flow path of the filler Y that flows in from one opening at the proximal end and flows out from the other opening at the proximal end through the distal end portion. Form. Even with such a configuration, it is possible to suppress the remaining of bubbles by filling the filler Y along the flow path.
  • the filler Y is not particularly limited, but is preferably a curable material that is cured in response to an external stimulus such as heat or light, such as a thermosetting resin or a photocurable resin.
  • an external stimulus such as heat or light
  • thermosetting resin or a photocurable resin such as a thermosetting resin or a photocurable resin.
  • the bending rigidity of the guide part 200D is increased by supplying the filler Y into the lumen 211D.
  • the bending rigidity of the guide part 200D may be increased by increasing the air pressure in the lumen 211D, and the bending rigidity of the guide part 200D is supplied by supplying the liquid into the lumen 211D and solidifying the liquid. May be increased.
  • the guide portion main body 210D is inserted into the large saphenous vein 1000 in the first step of the blood vessel peeling method, and in the lumen 211D of the guide portion main body 210D in the second step. What is necessary is just to raise the bending rigidity of guide part 200D by supplying the filler Y and making it harden
  • FIG. 17 is a plan view showing a guide part included in the blood vessel peeling device according to the sixth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide portion is different.
  • the guide part 200E is composed of a guide part body 210E. Further, the guide body 210E has a shape memory property, and even if it is deformed below a predetermined temperature (transformation point), it has a property of being restored to its original shape (memory shape) when heated above the transformation point. ing.
  • the guide body 210E is usually soft and flexible, but becomes strong when heated by applying voltage (external stimulus). Therefore, the bending rigidity of the guide part 200E can be increased by applying a voltage to the guide part body 210E to make the guide part body 210E strong.
  • the material constituting the guide body 210E is not particularly limited as long as it can exhibit the above-described properties.
  • a Ni—Ti alloy such as a Ni—Ti alloy of 49 to 52 atomic% Ni can be used. , 38.5 to 41.5 wt% Zn Cu—Zn alloy, 1 to 10 wt% X Cu—Zn—X alloy (where X is at least one of Be, Si, Sn, Al, Ga) Cu—Zn alloys such as Ni—Al alloys such as 36 to 38 atomic% Al—Al—Al alloys.
  • the guide body 210E is subjected to an insulation treatment or the like as necessary.
  • the guide body 210E in a flexible state (voltage non-applied state) is inserted into the great saphenous vein 1000 in the first step of the blood vessel peeling method, and in the second step. What is necessary is just to apply a voltage to the guide part main body 210E and to raise the bending rigidity of the guide part 200E.
  • FIG. 18 is a plan view showing a guide part included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide portion is different.
  • the guide part 200F has a guide part main body 210F and a reinforcing part 220F.
  • the guide unit body 210F is flexible, thin and long.
  • One reinforcing portion 220F has a plurality of elements 230 that are slidably arranged in the guide portion main body 210F.
  • each element 230 has a tubular shape (tubular shape), and the guide portion main body 210F is inserted through the lumen thereof.
  • a concave portion 231 is formed at the base end portion of each element 230, and a convex portion 232 that engages with the concave portion 231 of another element 230 located on the distal end side is formed at the distal end portion.
  • the adjacent elements 230 are connected by a flexible linear body 233 such as a string in order to prevent excessive separation.
  • the bending rigidity of the guide part 200F can be lowered by separating the adjacent elements 230 from each other. As shown in b), by engaging adjacent elements 230 (the convex portion 232 of the element 230 on the proximal end side and the concave portion 231 of the element 230 on the distal end side), the guide portion 200 is made linear. The bending rigidity of the guide part 200 can be increased.
  • the guide body 210F in a state where each element 230 is separated (flexible state) in the first step of the blood vessel peeling method is inserted into the great saphenous vein 1000, and the second What is necessary is just to raise the bending rigidity of the guide part 200F by engaging each element 230 at a step.
  • FIG. 19 is a cross-sectional view showing an attachment included in the blood vessel peeling device according to the eighth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the movable part can be rotated.
  • the attachment 400 ⁇ / b> G includes a fixing unit 410 ⁇ / b> G and two operation units 420.
  • the fixing portion 410G includes a base portion 430 fixed to the guide portion 200 and an annular rotating portion 440 disposed around the base portion 430, and a through hole 441 formed in the rotating portion 440.
  • the operation unit 420 is slidably inserted.
  • a gear 431 is disposed on the base 430, and the gear 431 meshes with a tooth mold 442 formed along the inner periphery of the rotating part 440. Therefore, the movable unit 300 can be rotated together with the rotating unit 440 by rotating the gear 431 by a driving source or human power (not shown).
  • the tissue can be peeled more smoothly by performing the peeling operation in the third step of the blood vessel peeling method while rotating the movable portion 300.
  • FIG. 20 is a side view showing a movable part included in the blood vessel peeling device according to the ninth 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 slit 311 formed in the movable part main body 310 is provided to be inclined with respect to the axial direction of the movable part main body 310. Further, in the circumferential direction of the movable portion main body 310, the proximal end side of the other end portion 319 is between the distal end side 318 ′ and the proximal end side 318 ′′ of the one end portion 318 of the movable portion main body 310. Is located at the end 319 ′′.
  • the second peeling portion 322 is provided along both the end portion 318 and the end portion 319.
  • the peeling function can be exhibited all around the movable portion main body 310.
  • the tissue cannot be peeled between the ends 318 ′ and 319 ′, but this peeling is not possible.
  • the tissue can be peeled at the second peeling portion 322 (portion 322 ′) located behind them. Therefore, according to the movable part 300H, the peeling function can be exhibited all around the movable part main body 310. Therefore, the peeling work in the third step can be performed smoothly.
  • FIG. 21 is a side view showing a movable part included in the blood vessel peeling device according to the tenth 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 distal end face F1 of the movable portion main body 310 is inclined with respect to the central axis J, as shown in FIG.
  • the 1st peeling part 321 can be made sharper and the more excellent peeling characteristic can be exhibited in the peeling operation
  • 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 °.
  • the same effects as those of the first embodiment described above can be exhibited.
  • the distal end 310 ′ of the movable portion main body 310 moves forward in a spiral manner in the third step of the peeling operation. Tissue can be peeled off.
  • FIG. 22 is a plan view and a side view showing a movable part included in the blood vessel peeling device according to the eleventh 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 movable part 300 ⁇ / b> J has a slide part (lid part) 340 that is slidably supported by the movable part main body 310.
  • the slide part 340 is disposed along the inner periphery of the movable part main body 310 and is slidable in the circumferential direction of the movable part main body 310. Further, similarly to the movable part main body 310, the slide part 340 is provided with a first peeling part 321, a groove part 390, and a processing part 330.
  • the movable part 300 having such a configuration, by sliding the slide part 340 with respect to the movable part main body 310, the slit 311 as shown in FIG. 22A is opened to the state shown in FIG. 22B.
  • the slit 311 can be closed by the slide portion 340 as shown.
  • the movable part 300J is provided with a lock part for maintaining the closed state. Thereby, a closed state can be maintained more reliably.
  • the movable portion 300J is opened when the mounting operation is performed, and the movable portion 300J is closed when the peeling operation is performed. And it is sufficient. Since the slit 311 is open in the open state, the mounting operation can be performed in the same manner as in the first embodiment. On the other hand, since the slit 311 is closed in the closed state, excellent peelability can be exhibited.
  • FIG. 23 is a plan view and a side view showing a movable part of a blood vessel peeling device according to a twelfth 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 movable part 300 ⁇ / b> K has a mounting part (lid part) 350 that can be attached to the movable part main body 310.
  • the mounting portion 350 can be mounted on the movable portion main body 310 so as to close the slit 311.
  • the mounting part 350 is provided with a first peeling part 321, a groove part 390, and a processing part 330.
  • the attachment part 350 is attached to the movable part main body 310, so that the slit 311 as shown in FIG.
  • the slit 311 can be closed by the appropriate mounting portion 350.
  • the movable part 300K is provided with a lock part for maintaining the closed state. Thereby, a closed state can be maintained more reliably.
  • the movable portion 300K is opened when performing the mounting operation, and the mounting portion 350 is mounted when performing the peeling operation.
  • the movable portion 300K may be closed. Since the slit 311 is open in the open state, the mounting operation can be performed in the same manner as in the first embodiment. On the other hand, since the slit 311 is closed in the closed state, excellent peelability can be exhibited.
  • FIG. 24 is a side view and a cross-sectional view showing a movable part included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 24C is a cross-sectional view taken along the line BB in FIG. In FIG. 24A, 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 300L further includes a vibration element (vibration source) 360 and a vibration damping part 370 provided in the movable part main body 310.
  • the vibration element 360 is a vibration source for vibrating the movable part main body 310.
  • the vibration element 360 has a strip shape (long shape), and a plurality of vibration elements 360 are arranged along the circumferential direction of the movable portion main body 310. More specifically, one vibration element 360 is disposed between a pair of adjacent groove portions 390. In this way, by arranging the plurality of vibration elements 360 regularly along the circumferential direction of the movable part main body 310, the movable part main body 310 can be vibrated more uniformly without unevenness.
  • the configuration of the vibration element 360 is not particularly limited as long as the movable part main body 310 can be vibrated at a predetermined frequency.
  • ZnO zinc oxide
  • AlN aluminum nitride
  • PZT zirconate titanate
  • the vibration frequency of the movable part main body 310 that is vibrated by the vibration element 360 is not particularly limited.
  • the tissue without dissolving (releasing) blood vessels, skin, and muscles around the saphenous vein 1000 It is preferable that the frequency be able to dissolve (release), 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 movable part main body 310 caused by the vibration element 360.
  • a vibration reduction unit 370 includes a first vibration reduction unit 371 disposed on the inner peripheral surface of the movable unit main body 310, a second vibration reduction unit 372 disposed on the outer peripheral surface of the movable unit main body 310, have.
  • the first and second vibration damping units 371 and 372 are arranged so as not to overlap with the peeling unit 320 (first and second peeling units 321 and 322), respectively. That is, the peeling part 320 protrudes from between the first and second vibration damping parts 371 and 372, and the part is exposed to the outside. Therefore, when the movable part main body 310 is vibrated, the vibration is mainly transmitted from the peeling part 320 to the outside, and from other places (for example, the inner peripheral surface and the outer peripheral surface of the movable part main body 310) to the outside. Not transmitted (slightly transmitted). Further, the second vibration damping unit 372 is disposed so as to cover the vibration element 360, thereby protecting and insulating the vibration element 360.
  • the constituent materials of the first and second vibration damping units 371 and 372 are not particularly limited as long as the vibration of the movable unit main body 310 can be absorbed and damped.
  • natural rubber butadiene rubber, styrene-butadiene
  • rubber materials such as rubber, urethane rubber, silicone rubber, and fluorine rubber can be used.
  • the vibration of the movable portion 300L is caused by vibration transmitted from the second peeling portion 322. Since the tissue located on the front side in the rotation direction can be peeled while being dissolved, the operation can be performed more smoothly.
  • the peeling operation in the third step while vibrating the movable portion main body 310, the tissue located on the front side in the moving direction of the movable portion 300L is peeled off by the vibration transmitted from the first peeling portion 321. Therefore, the operation can be performed more smoothly.
  • first vibration damping portion 371 dissolution of the tissue located inside the movable portion main body 310 (first vibration damping portion 371), that is, the tissue 1200 located around the great saphenous vein 1000 and peeled off together with the great saphenous vein 1000 is suppressed. Therefore, the greater saphenous vein 1000 can be more reliably exfoliated while being covered with the surrounding tissue 1200.
  • second vibration damping portion 372 since the dissolution of the tissue located outside the movable portion main body 310 (second vibration damping portion 372) is suppressed, unnecessary dissolution of the tissue is reduced.
  • the vibration element 360 is disposed on the outer periphery of the movable part main body 310.
  • the arrangement of the vibration element 360 is not limited to this, and is disposed on the inner peripheral surface of the movable part main body 310, for example. May be.
  • the vibration element 360 may be disposed in a place other than the movable part main body 310, for example, the operation part 420 of the attachment 400 as long as vibration can be transmitted to the movable part main body 310. In this case, the vibration of the vibration element 360 is transmitted to the movable part main body 310 via the operation part 420.
  • FIG. 25 is a cross-sectional view showing a blood vessel peeling device according to a fourteenth embodiment of the present invention.
  • FIG. 25B is a cross-sectional view taken along the line CC of FIG.
  • This embodiment is the same as the first embodiment described above except that the movable part is mainly positioned with respect to the guide part using a magnet.
  • the blood vessel peeling device 100M includes a guide part 200M, a movable part 300M, and a pressing part 500. That is, the blood vessel peeling device 100M has a configuration in which the pressing unit 500 is added to the blood vessel peeling device 100 of the first embodiment instead of the attachment 400 being omitted.
  • the permanent part 240 for positioning the movable part 300M is provided in the reinforcement part 220 of the guide part 200M.
  • the permanent magnets 240 have a rod shape extending along the axial direction of the reinforcing portion 220, and two permanent magnets 240 are arranged at substantially equal intervals along the circumferential direction of the reinforcing portion 220.
  • Each permanent magnet 240 has an S pole on the inner peripheral side of the reinforcing portion 220 and an N pole on the outer peripheral side. That is, each permanent magnet 240 is magnetized along the radial direction of the reinforcing portion 220.
  • Such a permanent magnet 240 is embedded in the outer periphery of the reinforcing portion 220, and thereby the protrusion of the permanent magnet 240 from the reinforcing portion 220 is suppressed.
  • the movable part main body 310 of the movable part 300M is provided with a permanent magnet 315 for positioning with respect to the reinforcing part 220.
  • Two permanent magnets 315 are arranged at substantially equal intervals along the circumferential direction of the movable portion main body 310.
  • Each permanent magnet 315 has an N pole on the inner peripheral side of the movable portion main body 310 and S on the outer peripheral side. That is, the permanent magnet 315 is magnetized along the radial direction of the movable portion main body 310 and in a direction repelling the permanent magnet 240 disposed in the reinforcing portion 220.
  • Such a permanent magnet 315 is embedded in the inner periphery of the movable part main body 310, whereby the protrusion of the permanent magnet 315 from the movable part main body 310 is suppressed.
  • the movable portion main body 310 when the movable portion main body 310 is disposed around the reinforcing portion 220, the reinforcing portion 220 is positioned on the central axis J of the movable portion main body 310 due to magnetic repulsion between the opposing permanent magnets 240 and 315.
  • the movable part main body 310 is positioned (centered) with respect to the reinforcing part 220. Therefore, for example, as in the first embodiment described above, the positioning can be performed without using the attachment 400, and the procedure can be performed smoothly as much as the labor for attaching the attachment 400 can be saved.
  • the permanent magnets 240 and 315 are not particularly limited.
  • various permanent magnets such as a neodymium magnet, a samarium cobalt magnet, a ferrite magnet, and an alnico magnet can be used.
  • the pressing portion 500 is a member for moving the movable portion main body 310 positioned with respect to the reinforcing portion 220, and has a long bar shape.
  • the shape of the pressing portion 500 is not particularly limited as long as the movable portion main body 310 can be pressed and moved.
  • the blood vessel peeling device 100M has been described above.
  • the number of permanent magnets 240 and 315 is not particularly limited, and may be three or more.
  • an annular radial magnet (a magnet magnetized in the radial direction) may be used as the permanent magnet 240, and a substantially C-shaped radial magnet may be used as the permanent magnet 315.
  • the movable portion 300M is arranged around the reinforcing portion 220 in the mounting operation during the third step of the blood vessel peeling method, the repulsive force of the permanent magnets 240 and 315 Naturally, the movable part 300M is positioned (centered) with respect to the reinforcing part 220. Therefore, as compared with the first embodiment described above, the attachment 400 can be omitted, so that the operation can be performed more smoothly.
  • the movable part main body 310 may be pressed from behind using the pressing part 500 and the movable part main body 310 may be advanced in the living body.
  • the repulsive force of the permanent magnets 240 and 315 works even while the movable portion main body 310 is advanced, and thus the movable portion.
  • the main body 310 continues to be centered on the reinforcing portion 220. Therefore, the greater saphenous vein 1000 can be more reliably peeled while being covered with the surrounding tissue 1200.
  • FIG. 26 is a cross-sectional view showing a blood vessel peeling device according to a fifteenth embodiment of the present invention.
  • FIG. 27 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 26B is a cross-sectional view taken along the line DD in FIG. 26A, and
  • FIG. 26C is a cross-sectional view taken along the line EE in FIG.
  • the first described above is mainly except that the movable portion is positioned with respect to the guide portion using a magnet, and that the peeling operation in the second step and the third step is simultaneously performed. This is the same as the embodiment.
  • the blood vessel peeling device 100N includes a guide part 200N and a movable part 300N.
  • the reinforcing portion 220 of the guide portion 200N is provided with a permanent magnet 240 for positioning the movable portion 300N, and a permanent magnet 250 for causing the movable portion main body 310 to follow the movement of the reinforcing portion 220.
  • Two permanent magnets 240 are arranged at substantially equal intervals along the circumferential direction of the reinforcing portion 220, and in both cases, the inner peripheral side of the reinforcing portion 220 is an S pole and the outer peripheral side is an N pole.
  • the permanent magnets 250 are located on the base end side of the permanent magnets 240 and are arranged at almost equal intervals along the circumferential direction of the reinforcing portion 220.
  • the inner peripheral side of the reinforcing portion 220 is the S pole.
  • the outer peripheral side is an N pole.
  • Such permanent magnets 240 and 250 are respectively embedded in the outer periphery of the reinforcing portion 220, and thereby the protrusion of the permanent magnets 240 and 250 from the reinforcing portion 220 is suppressed.
  • the permanent magnets 240 and 250 may be integrated.
  • the movable part main body 310 of the movable part 300N is provided with a permanent magnet 315 for positioning with respect to the guide part 200N and a permanent magnet 316 for following the movement of the guide part 200N.
  • Two permanent magnets 315 are arranged at substantially equal intervals along the circumferential direction of the movable part main body 310, and both have an N pole on the inner peripheral side and an S pole on the outer peripheral side of the movable part main body 310.
  • the two permanent magnets 316 are located on the base end side of the permanent magnet 315 and are arranged at almost equal intervals along the circumferential direction of the movable part main body 310.
  • the outer peripheral side is an N pole.
  • Such permanent magnets 315 and 316 are respectively embedded in the inner periphery of the movable part main body 310, and thereby the protrusion of the permanent magnets 315 and 316 from the movable part main body 310 is suppressed.
  • the movable portion main body 310 by disposing the movable portion main body 310 around the reinforcing portion 220, the permanent magnet 315 of the movable portion main body 310 is opposed to the permanent magnet 240 of the reinforcing portion 220, and the reinforcing portion
  • the permanent magnet 316 of the movable part main body 310 can be opposed to the 220 permanent magnets 250.
  • the movable portion main body 310 is positioned with respect to the reinforcing portion 220 so that the reinforcing portion 220 is positioned on the central axis J of the movable portion main body 310 by the magnetic repulsive force between the permanent magnets 240 and 315 ( Centered). Further, the movable portion main body 310 can follow the reinforcing portion 220 by the magnetic attractive force between the permanent magnets 250 and 316.
  • the movable portion main body 310 is located on the proximal end side with respect to the distal end of the reinforcing portion 220. That is, the reinforcing part 220 protrudes from the inner side of the movable part main body 310 to the tip side.
  • the set of permanent magnets 240 and 315 and the set of permanent magnets 250 and 316 are arranged sufficiently apart from each other so as not to be affected by the mutual magnetic force.
  • the second step and the third step of peeling work can be performed at the same time as in the third embodiment described above.
  • the distal end portion of the reinforcing portion 220 is inserted into the great saphenous vein 1000 and the mounting operation of the movable portion main body 310 is performed. .
  • the movable part main body 310 is positioned with respect to the reinforcing part 220, and the movable part main body 310 can follow the reinforcing part 220.
  • the reinforcing portion 220 is gradually inserted into the great saphenous vein 1000. Then, the bending rigidity of the guide portion 200N is increased from the proximal end side in the large saphenous vein 1000, and the large saphenous vein 1000 is straightened. By moving (following), the great saphenous vein 1000 is peeled off while being covered with the surrounding tissue 1200.
  • FIG. 28 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
  • FIG. 29 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 reinforcing portion is different.
  • the reinforcing portion 220P includes a rigid main body portion 270 having a tubular shape having a lumen 271 into which the guide portion main body 210 can be inserted, and a balloon ( (Expanded diameter portion) 275.
  • the balloon 275 extends in the axial direction of the main body 270 and is connected to a balloon port (not shown).
  • a balloon expansion device such as a syringe can be connected to the balloon port, and when a working fluid (liquid such as physiological saline, gas, etc.) is supplied from the balloon expansion device to the balloon 275, it is shown in FIG. As such, balloon 275 expands.
  • the outer diameter of the balloon 275 when the diameter is expanded is substantially constant along the extending direction.
  • the reinforcing portion 220P in a state where the balloon 275 has a reduced diameter is provided in the large saphenous vein 1000. Insert into.
  • the diameter of the balloon 275 is expanded as shown in FIG.
  • the large saphenous vein 1000 has a thickness corresponding to the diameter of the balloon 275, and the large saphenous vein 1000 is separated from the inner periphery of the movable body 310. The distance can be controlled.
  • the tissue 1200 that is peeled together with the large saphenous vein 1000 by the peeling operation can be made to have an appropriate thickness. Therefore, it is possible to suppress variation in the thickness of the tissue 1200 around the great saphenous vein 1000 depending on the patient and the place (on the knee or below the knee).
  • FIG. 30 is a perspective view showing a guide part included in the blood vessel peeling device according to the seventeenth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the reinforcing portion is different.
  • the reinforcing portion 220Q is detachably attached to a rigid main body 280 having a tubular shape having a lumen 281 into which the guide main body 210 can be inserted, and the main body 280.
  • a slider (a reduced diameter state maintaining portion) 285 that maintains a state in which the main body portion 280 has a reduced diameter.
  • the main body 280 is provided with a slit 282 extending in the axial direction, and the diameter of the slit 282 can be reduced so as to be narrowed.
  • a slider 285 is disposed in the slit 282 in order to maintain the state where the main body 280 has a reduced diameter.
  • the slider 285 slidably engages with a pair of grooves 283 provided in the main body 280 to prevent the main body 280 from returning to the natural state. Therefore, by removing the slider 285 from the main body 280, the diameter of the main body 280 is expanded so as to return to the natural state, as shown in FIG.
  • the reinforcing portion 220Q in which the slider 285 is attached to the main body portion 280 is inserted into the large saphenous vein 1000.
  • the slider 285 is removed to increase the diameter of the main body 280 before performing the peeling operation.
  • the large saphenous vein 1000 has a thickness corresponding to the diameter of the main body 280 regardless of the thickness of the original large saphenous vein 1000.
  • FIG. 31 is a perspective view showing a guide part included in the blood vessel peeling device according to the eighteenth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the reinforcing portion is different.
  • the reinforcing portion 220R has a slit 228 extending in the axial direction and has a tubular shape having a substantially C-shaped cross section.
  • a reinforcing part 220R has a shape memory property, and even if it is deformed at a predetermined temperature or lower, it has a property of being restored to its original shape when heated above the transformation point. Therefore, as shown in FIG. 31 (b), the reinforcing portion 220R can maintain the diameter reduced so as to narrow the width of the slit 228 with respect to the memorized shape. It is possible to return to the storage state shown.
  • the reinforcing portion 220R can insert the guide portion main body 210 into the inner cavity in the reduced diameter state shown in FIG. 31 (b).
  • the reduced diameter reinforcing portion 220Q shown in FIG. 31B is inserted into the large saphenous vein 1000.
  • the reinforcement part 220R is returned to a memory
  • the large saphenous vein 1000 has a thickness corresponding to the diameter of the reinforcing portion 220R.
  • FIG. 32 is a cross-sectional view showing a guide portion included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
  • 32 (b) and 32 (c) are cross-sectional views taken along the line FF in FIG. 32 (a).
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the reinforcing portion is different.
  • the reinforcing portion 220S has a tubular shape having a lumen 221 into which the guide portion main body 210 can be inserted. Further, the reinforcing portion 220S is provided with a plurality of suction holes 229 that open to the outer periphery thereof, and each of the suction holes 229 is connected to a suction port (not shown). Further, a suction device such as a suction pump can be connected to the suction port, and the suction device is operated in a state where the reinforcing portion 220S is disposed in the great saphenous vein 1000, as shown in FIG. 32 (c). In addition, the large saphenous vein 1000 can be adsorbed on the outer periphery of the reinforcing portion 220S.
  • the large saphenous vein 1000 is adsorbed on the outer periphery of the reinforcing portion 220S before performing the peeling operation. Thereby, the diameter of the large saphenous vein 1000 is reduced, and the large saphenous vein 1000 has a thickness corresponding to the diameter of the reinforcing portion 220S regardless of the original thickness of the large saphenous vein 1000.
  • the tissue 1200 exfoliated together with the great saphenous vein 1000 can be made to have an appropriate thickness as in the sixteenth embodiment described above.
  • FIG. 33 is a perspective view and a cross-sectional view showing a guide portion included in the blood vessel peeling device according to the twentieth embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the reinforcing portion is different.
  • the reinforcing portion 220T has a slit 228 extending in the axial direction and has a tubular shape having a substantially C-shaped cross section.
  • the reinforcing portion 220T is provided with a plurality of suction holes 229 that open to the outer periphery and the inner periphery thereof, and each of the suction holes 229 is connected to a suction port (not shown).
  • a suction device such as a suction pump can be connected to the suction port, and by operating the suction device in a state where the reinforcing portion 220T is disposed in the great saphenous vein 1000, as shown in FIG.
  • the large saphenous vein 1000 can be adsorbed on the outer periphery and inner periphery of the reinforcing portion 220T.
  • the slit 228 and the suction hole 229 do not need to be disposed over the entire length of the reinforcing portion 220T, but may be disposed at least in a region inserted into the great saphenous vein 1000.
  • the guide body 210 is removed from the large saphenous vein 1000 before the peeling operation, and then the outer periphery of the reinforcing portion 220T and The large saphenous vein 1000 is adsorbed on the inner periphery. Thereby, the diameter of the large saphenous vein 1000 is reduced, and the large saphenous vein 1000 has a thickness corresponding to the diameter of the reinforcing portion 220T regardless of the thickness of the original large saphenous vein 1000.
  • the tissue 1200 exfoliated together with the great saphenous vein 1000 can be made to have an appropriate thickness as in the sixteenth embodiment described above.
  • this embodiment since a part of the large saphenous vein 1000 enters the inside of the reinforcing portion 220T through the slit 228, generation of wrinkles and sagging associated with the diameter reduction of the large saphenous vein 1000 can be reduced. And the effect can be further enhanced.
  • FIG. 34 is a perspective view showing a guide part included in the blood vessel peeling device according to the twenty-first embodiment of the present invention.
  • FIG. 35 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 guide portion is different.
  • the guide part 200U of the blood vessel peeling device 100U includes a guide part body 210, a reinforcing part 220U, and a suction part 290. Further, as shown in FIG. 34, the reinforcing portion 220U has a slit 228 extending in the axial direction and has a tubular shape having a substantially C-shaped cross section. Moreover, the suction part 290 can be arrange
  • the guide body 210 is removed from the large saphenous vein 1000 before performing the peeling operation, and the suction portion is placed in the reinforcing portion 220U. 290 is inserted. Then, as shown in FIG. 35A, the suction part 290 is protruded from the reinforcing part 220U through the slit 228, and the suction part 290 is pressed against the inner wall of the great saphenous vein 1000. Next, the suction portion 290 is retracted into the reinforcing portion 220U while the large saphenous vein 1000 is adsorbed by the suction portion 290.
  • the large saphenous vein 1000 has a thickness corresponding to the diameter of the reinforcing portion 220U.
  • the tissue 1200 exfoliated together with the great saphenous vein 1000 can be made to have an appropriate thickness as in the sixteenth embodiment described above.
  • the protruded suction part 290 can be brought into contact with the inner wall of the great saphenous vein 1000, the great saphenous vein 1000 can be more reliably adsorbed.
  • FIG. 36 is a perspective view showing a guide part included in a blood vessel peeling device according to a twenty-second embodiment of the present invention.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the guide portion is different.
  • the guide part 200V of the blood vessel peeling device 100V has a guide part main body 210, a reinforcing part 220V, and a suction part 290V. Further, as shown in FIG. 36, the reinforcing portion 220V has a slit 228 extending in the axial direction and has a substantially C-shaped cross section.
  • the suction part 290 ⁇ / b> V has a base 293 that can move in the slit 228, and a plurality of suction holes 294 are provided in the base 293.
  • the guide portion main body 210 is removed from the large saphenous vein 1000, and the inside of the slit 228 of the reinforcing portion 220V is removed.
  • the base 293 is disposed on the base. First, the base 293 is slightly advanced, and the large saphenous vein 1000 is adsorbed to the base 293. Thereby, the diameter of the large saphenous vein 1000 is reduced. Therefore, regardless of the original thickness of the large saphenous vein 1000, the large saphenous vein 1000 has a thickness corresponding to the diameter of the reinforcing portion 220V.
  • the movable part 300 is advanced a little, and the part of the large saphenous vein 1000 adsorbed by the base part 293 is peeled off.
  • the peeling operation can be completed by advancing a series of operations consisting of the advancement of the base 293, the adsorption of the great saphenous vein 1000, and the advancement of the movable part 300 a plurality of times.
  • the tissue 1200 to be exfoliated together with the great saphenous vein 1000 can be aligned to an appropriate thickness, as in the sixteenth embodiment described above.
  • the blood vessel peeling method and the blood vessel peeling device of the present invention have been described based on the illustrated embodiment.
  • the present invention is not limited to this, and the configuration of each part is an arbitrary configuration having the same function. Can be substituted.
  • any other component may be added to the present invention.
  • the guide portion in the second step of the blood vessel peeling method, is corrected substantially linearly and the great saphenous vein is corrected substantially linearly.
  • the first step is the first step. If the rigidity of the guide portion can be increased as compared to the step, it is not necessary to straighten the guide portion. That is, the guide portion whose rigidity is increased by the second step may be curved into a predetermined shape.
  • the fifth embodiment described above will be described as a representative example.
  • the filler Y is filled in the guide body 210D. It may be configured to return to a predetermined shape.
  • 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 of the present invention is arranged around the guide portion, the first step of inserting the guide portion into the blood vessel, the second step of increasing the bending rigidity of the guide portion as compared with the time of the first step, and And a third step of peeling the blood vessel in a state where at least a part of the periphery of the blood vessel is covered with the surrounding tissue by moving the movable portion while being guided by the guide portion. Therefore, in the first step, the followability of the guide portion to the blood vessel is good, and the guide portion can be smoothly inserted into the blood vessel.
  • the movable portion can be smoothly guided by the guide portion, and the blood vessel is smoothly covered with at least a part of the periphery thereof in the surrounding tissue. Can be peeled off.
  • the second step by deforming the guide part in a straight line, the blood vessel can be straightened and the movable part can be moved in a straight line. It can be done accurately.
  • the blood vessel peeling device of the present invention has a guide portion that can change bending rigidity, and a movable portion that is disposed around the guide portion, and after inserting the guide portion main body into the blood vessel, The guide portion main body is increased in bending rigidity, and the blood vessel is peeled off in a state where at least a part of the blood vessel is covered with surrounding tissue by moving the movable portion while guiding the movable portion with the guide portion. To do. Therefore, the blood vessel can be smoothly peeled in a state where at least a part of the blood vessel is covered with the surrounding tissue.
  • each of the blood vessel peeling method and the blood vessel peeling device of the present invention has industrial applicability.

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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Abstract

Le procédé selon la présente invention d'éveinage d'un vaisseau sanguin comprend : une première étape consistant à insérer une section de guidage (200) dans une veine grande saphène (1000) ; une deuxième étape pour améliorer la rigidité à la courbure de la section de guidage (200) ; et une troisième étape pour déplacer une partie mobile (300) qui est disposée autour de la section de guidage (200) en fonction du guidage de la section de guidage (200) permettant ainsi l'éveinage de la veine grande saphène (1000) dans l'état recouvert d'un tissu environnant (1200). Dans la troisième étape, la veine grande saphène (1000) est éveinée par la partie mobile (300) et, en même temps, un vaisseau de ramification (1100) ramifié depuis cette dernière est coupé et une hémostase est réalisée.
PCT/JP2015/058091 2014-08-21 2015-03-18 Procédé d'éveinage d'un vaisseau sanguin et dispositif d'éveinage d'un vaisseau sanguin WO2016027489A1 (fr)

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JP2014168851 2014-08-21
JP2014-168851 2014-08-21

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112244903A (zh) * 2020-11-04 2021-01-22 胡行健 冠脉搭桥手术使用大隐静脉切除后处理装置

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5373840A (en) * 1992-10-02 1994-12-20 Knighton; David R. Endoscope and method for vein removal
WO1999039632A1 (fr) * 1998-02-06 1999-08-12 Evans David K Dispositif de visualisation, detection et prelevement de vaisseaux
US20060276815A1 (en) * 2005-06-01 2006-12-07 Converge Medical, Inc. Devices and methods for vessel harvesting

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5373840A (en) * 1992-10-02 1994-12-20 Knighton; David R. Endoscope and method for vein removal
WO1999039632A1 (fr) * 1998-02-06 1999-08-12 Evans David K Dispositif de visualisation, detection et prelevement de vaisseaux
US20060276815A1 (en) * 2005-06-01 2006-12-07 Converge Medical, Inc. Devices and methods for vessel harvesting

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112244903A (zh) * 2020-11-04 2021-01-22 胡行健 冠脉搭桥手术使用大隐静脉切除后处理装置

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