JPH0638802B2 - 患者の胃と食道との吻合部を陥入させる装置 - Google Patents

患者の胃と食道との吻合部を陥入させる装置

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Publication number
JPH0638802B2
JPH0638802B2 JP3264019A JP26401991A JPH0638802B2 JP H0638802 B2 JPH0638802 B2 JP H0638802B2 JP 3264019 A JP3264019 A JP 3264019A JP 26401991 A JP26401991 A JP 26401991A JP H0638802 B2 JPH0638802 B2 JP H0638802B2
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Japan
Prior art keywords
esophagus
guide
invagination device
stomach
needle
Prior art date
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JPH04226644A (ja
Inventor
チャールズ・ジョセフ・フィリピ
トーマス・アール・デメスター
レベッカ・コペンハーバー・ギッブス
ロナルド・エイ・ヒンダー
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Cook Endoscopy
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Wilson Cook Medical Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22072—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A61B2017/22074—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
    • A61B2017/22077—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00553—Sphincter

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】本発明は、胃食道逆流症の治癒に
用いる装置に関するものである。より具体的には、本発
明は、最小の侵入状態にて胃と食道との吻合部に食道を
陥入させる新規かつユニークな方法に有用な装置に関す
るものである。
【０００２】
【従来の技術】胃食道逆流症の患者は、食道炎、潰瘍、
狭窄症、及び正常な鱗状内壁の柱状化生を起こし勝ちで
ある。バレット（Barrett）食道と称される柱状化生
は、胃食道逆流症を患う患者の約１０％に発生し、狭窄
症、深い潰瘍及び腺癌の発生に関係する。胃食道逆流症
は米国内で毎年500,000人以上の人に発生し、その内ほ
んの約35,000人が抗逆流矯正手術を受けている。
【０００３】
【発明が解決しようとする課題】一般の外科手術よりも
侵入が少なく、しかも慢性の酸減少治療法よりもコスト
的に有利である胃食道逆流症の新しい治療法求められて
いる。かかる方法を利用し得ることにより、より早期に
かつより広範囲の外科手術治療を可能にし、長期に亙っ
て内科的治療を受けている間に病気が進行することによ
り生じる深刻な合併症を回避することが出来る。
【０００４】
【課題を解決するための手段】一般的にいって、本発明
は、胃底ヒダ形成術を内視鏡手術によって行うことによ
り胃食道逆流症を治療する新規かつ改良された方法に有
用な新しい装置に関するものである。本発明の一実施例
によれば、陥入装置が食道内に経口的に導入される。こ
の陥入装置は、食道の外径に略等しい外径と、その外径
面まで伸長する複数の針受け入れ内腔とを有する導入子
ガイドを備えている。又、この陥入装置は多数の針を有
する係合組立体を備えている。これら針の各々は、針受
け入れ内腔内に位置し、ガイドから半径方向に突出して
食道に係合するための退却位置を有している。次に、係
合組立体を作動させて、針を食道に係合する伸長位置に
配置し、係合した陥入装置を胃に向けかつ胃内に進ま
せ、胃と食道との吻合部を３−４ｃｍの距離に亙って胃
内へ陥入させる。遠隔操作可能な締結組立体をその前に
埋め込んだ手術用通路／通気ポートを通じて胃の中に進
め、次に操作して、陥入された食道を隣接する内側に曲
がった胃に締結する。これは、締結組立体の１つのアー
ムを陥入装置の表面に予め形成した溝内に摺動させ、そ
の他方のアームを内側に曲がった胃の上に置き、次に、
損傷を生じないような方法にて陥入された食道壁を内側
に曲がった胃壁にステープル止めすることによって行わ
れる。この「ニップル」弁を締結組立体によって固着し
た後、針はその針受け入れ内腔に戻し、陥入装置及び締
結組立体を除去する。埋め込んだ手術用通路／通気ポー
トはその他の器具を除去した後、ある期間密封し且つ適
所に残し、新たに形成した弁を固定状態に維持し得るよ
うにする。
【０００５】この侵入が最小で済む新規な方法は、食道
と胃との間に新たな弁を形成し、これにより、酸の逆流
を阻止するものである。
【０００６】本発明の原理を一層良く理解し得るように
するため、以下に図面に図示した実施例を参照し、該実
施例の説明のため、特定の用語を使用する。しかしなが
ら、これは本発明の範囲を限定するものではなく、図示
した装置の変形例、及び応用例、更に、ここに示した本
発明の更なる応用例は、本発明が関係する技術の当業者
に通常、案出されるものである。
【０００７】
【実施例】以下に、食道２０を胃３０に解剖学的に接続
する胃と食道の吻合部１０にてこの陥入法を実施する逐
次的段階を示す図１ａ乃至１ｄを参照しながら、本発明
の好適な実施例について説明する。
【０００８】準備段階として、２つの手術用通路／通気
ポートを胃３０に経皮的に形成し、一方のポートは内視
鏡を受け入れ得る寸法とし（７ｍｍ）、第２のポートは
遠隔操作可能な締結組立体を受け入れ得るように約１２
ｍｍの径にする。これは、一般に、１）ガイドワイヤを
経皮的に胃内に導入し、２）内視鏡を使用してガイドワ
イヤを引っ掛けて口を通じて引き出し、３）目盛りの付
いた拡張器手術用通路ポート組立体を、張力状態のガイ
ドワイヤに沿って経口的に進め、その一部を皮膚から突
出させ、４）該組立体を適所に固定することによって行
われる。この方法の段階は、図３ａ乃至３ｄを参照し
て、本明細書において、更に詳細に説明する。
【０００９】胃を前もって埋め込んだポートの通気内腔
を通じて通気した後、別の針を腹壁を通じて胃内に挿入
し、内視鏡の案内の下、ガイドワイヤ５を口内に導入し
かつ口外に引き出す。次に、陥入装置７０をガイドワイ
ヤ５に沿って進め、食道２０内に導入する。この陥入装
置７０の食道２０内への導入及びその前進は、陥入装置
７０がその長さに沿って可撓性でありかつその末端の形
状がテーパー付きの形状であることによって容易とな
る。食道２０内での陥入装置７０のガイドは、陥入装置
７０を前進させる間ガイドワイヤ５に適当な張力を付与
することで一層容易にすることが出来る。５ｍｍの腹腔
鏡４０を７ｍｍのポートを通じて導入し、該腹腔鏡４０
によって直接観察しながら陥入装置７０を胃と食道との
吻合部１０に配置する。胃と食道との吻合部１０に対す
る陥入装置７０の位置決めは、陥入装置７０の末端から
所定の距離（３ｃｍ）の箇所にマーキング７１を付ける
ことによって容易となる。図１ａには、食道２０内に前
進させ、胃と食道との吻合部１０にそのように位置決め
された陥入装置７０が図示されている。
【００１０】次に、陥入装置７０の係合組立体を作動さ
せ、針８８を内腔７８外に進めて陥入装置７０から半径
方向外方に突出させ、食道２０に係合させる。針８８を
突出させて食道２０に係合させる機構は、本明細書にお
いて図２ａ及び図２ｂに関して更に詳細に説明する。図
１ｂには、その係合組立体をそのように作動させ、針８
８を伸長させ、胃と食道との吻合部付近にて食道２０に
係合させる陥入装置７０が図示されている。図１ｂはこ
の係合状態の概念図であり、正確な縮尺図ではないこと
に注意すべきである。実際上、針８８と食道２０との係
合は可能な限り胃と食道との吻合部付近にて行われるよ
うにする。この係合は、胃と食道との吻合部１０で直接
行ない、食道内壁が長期に亙って胃の分泌液にさらされ
ないようにすることが望ましい。
【００１１】このように係合したならば、陥入装置７０
を胃３０に向けて押し込み、この動きにより食道２０が
胃３０に向けて付勢され、胃と食道との吻合部１０を陥
入させ、周囲の胃底壁２５を内側に曲げる。次に、１０
ｍｍの遠隔操作可能なステープル止め装置５０を前もっ
て形成した１２ｍｍの手術用通路／通気ポートを通じて
進め、胃底壁２５を陥入した胃と食道との吻合部１０に
ステープル止めする。導入子ガイド７５のテーパー付き
末端部分の溝７２は、安定した支持手段を提供すること
によってステープル止め装置５０のステープル止め動作
を促進する。図１ｃには、胃３０に向けて前進され、胃
と食道との吻合部１０に陥入し得るようにした係合陥入
装置７０が図示されており、図１ｃには、ステープル止
め装置５０によって陥入した胃と食道との吻合部１０に
締結した胃底壁２５が更に図示されている。
【００１２】最後に、ステープル止め装置５０を除去
し、針８８を退却させて、それぞれの内腔７８内に戻
し、陥入装置７０、及びガイドワイヤ５を除去する。
又、腹腔鏡４０も除去する。次に、手術用通路／通気ポ
ートを密封し、新たに形成した弁を定着させるのに十分
な期間、適所に維持する。図１ｄには、食道２０と胃３
０との間に新たに形成された弁が図示されており、陥入
装置７０、及びその他の器具は除去し、ステープル５５
が胃底壁２５を胃と食道との吻合部１０に対して保持し
ている。２又は３列のステープル５５が形成した折り重
ね部分を適所に保持し、このように形成された弁の機能
を維持するのに十分であると考えられる。
【００１３】次に、上述の方法に使用される陥入装置７
０について、部分破断側面図で示す図２ａ乃至図２ｂを
参照しながら、詳細に説明する。図２ａには、その係合
組立体を不作動状態の陥入装置が図示されており、係合
針がそれぞれの内腔内に保持されている。図２ｂには、
その係合組立体が作動して、針をそれぞれの内腔外に突
出させ、食道壁に係合させた陥入装置が図示されてい
る。
【００１４】陥入装置７０は、食道の外径に略等しい外
径の導入子ガイド７５を備えている。導入子ガイド７５
は、生物学的に適合しかつ可撓性である材料（低密度ポ
リエチレンがこの目的に特に適している）から成ってお
り、食道内への挿入及び前進が容易であるようにその末
端にテーパーが付けられている。導入子ガイド７５はそ
の長さに沿って伸長し、ガイドワイヤを受け入れるため
の中央内腔７６を画成する。又、導入子ガイド７５のか
かる中央内腔７６は、針突出器８０も受け入れる。導入
子ガイド７５の中央内腔７６からは、１０本の針を受け
入れる内腔７８が伸長しており、これら針受け入れ内腔
は導入子ガイド７５の周縁に沿って等間隔に配置されて
おり、その外径面まで伸長している。導入子ガイド７５
の基端には、雄ねじ式コネクタ７７がある。
【００１５】陥入装置は係合組立体を備えており、この
係合組立体は、針８８をそれぞれの針受け入れ内腔７８
から外に突出させて食道に係合させるように作動する。
針８８を突出させるこの係合組立体は、針突出器８０、
前進部材９０、及びコネクタ７７を備えている。
【００１６】針突出器８０は、針８８が接続されるその
末端に金属製ハブ８１を備えている。針突出器８０は、
その基端に、前進部材９０の凹所９３内に着座した第２
の金属製ハブ８２を備えている。針突出器８０の軸８３
はその長さに沿って伸長し、金属製の内側コア８４、及
びプラスチック製の外管８５を備えている。金属製の内
側コア８４は、ガイドワイヤを受け入れることの出来る
中央内腔８６を画成する。金属製の内側コア８４はステ
ンレス鋼から成っており、軸８３に対して軸方向強度及
び剛性を提供、一方、低乃至中程度の密度のポリエチレ
ンから成るプラスチック製外管８５は、軸８３の可撓性
を増進しかつ導入子ガイド７５の中央内腔７６内におけ
る横方向の安定性に寄与する。ハブ８１、８２、及び軸
８３は共に「プッシュロッド」を形成し、このプッシュ
ロッドは、ガイド７５の中央内腔７６内を前進すると
き、針８８をそれぞれの針受け入れ内腔７８の外に突出
させ、食道に係合させる。
【００１７】中央内腔７６内での針突出器８０の前進
は、前進部材９０を作動させることによって行われる。
前進部材９０は、その末端に、コネクタ７７の雄ねじ部
分に螺合可能に係合する雌ねじ式部分９１を有してお
り、その基端には、ハブ８２を凹所９３内に保持する保
持部分９２を有している。前進部材９０を通る中央内腔
９６が針突起器８０の軸８３及び基端ハブ８２を受け入
れ、前進部材９０の基端を通って続いており、ガイドワ
イヤが陥入装置７０の全長を通って進むことを許容す
る。
【００１８】前進部材９０を導入子ガイド７５のコネク
タ７７の周りにねじ込むことにより、針突出器８０は導
入子ガイド７５内を前進せしめられて針８８を針受け入
れ内腔７８を通って突出させ、針８８を陥入装置７０の
周縁に沿って半径方向及び前方に伸長させかつ食道に係
合させる。前進部材９０がコネクタ７７に完全に螺合し
たとき、針８８は導入子ガイド７５から完全に伸長す
る。螺着係合状態を利用して前進させることで針８８は
平滑にかつ均一に突出され、食道壁と安定的にかつ確実
に係合する。針８８は陥入装置７０の縦軸線に対して約
３０°の角度にて針受け入れ内腔７８により案内され
る。この３０°の突出角度にて、１０本の針を陥入装置
７０の周縁に沿って３６°の角度で等間隔に離間すれ
ば、食道壁に安定的に係合しかつ該壁を前進させるのに
十分であることが判明している。
【００１９】次に、腹腔鏡４０及び遠隔操作可能なステ
ープル止め装置５０を導入するのに有用な手術用通路／
通気ポート組立体について、図３ａ乃至図３ｄに関して
特に具体的に説明する。手術用通路／通気ポート組立体
１００は、ガイドワイヤ１０５、手術用通路／通気ポー
ト１１０、皮膚フランジ１２０、取り付け可能なバルー
ン拡張ノズル１３０、取り付け可能な通気弁１４０、密
封部材１５０、及び密封キャップ１６０を備えている。
【００２０】手順を説明すれば、ガイドワイヤ１０５を
最初に経皮的に胃内に導入する一方、内視鏡を経口的に
胃内に導入し、この内視鏡を使用してガイドワイヤ１０
５を引っ掛けて、該ガイドワイヤ１０５を口から退却さ
せる。次に、手術用通路／通気ポート１１０を張力をか
けたガイドワイヤ１０５上を経口的に進ませ、皮膚から
一部突出させる。ガイドワイヤ１０５の除去後、皮膚フ
ランジ１２０をポート１１０の管状部分上に配置し、皮
膚に向けて進める。次に、取り付け可能なバルーン拡張
ノズル１３０を拡張ポート１１２に取り付け、該ポート
を介しバルーン１１８に接続された膨張内腔１１３を介
してバルーン１１８内にＣＯ2を注入し、これにより拡
張バルーン１１８を胃内の適所にて拡張させる。次に、
皮膚フランジ１２０を皮膚に対して調節し、ポート１１
０を適所に固着する。次に、手術用通路／通気ポート１
１０のテーパー付き末端部分１１１をマーク１１１′か
ら切断し、これにより手術用通路１１４を通じて胃内へ
のアクセス口を開口する。
【００２１】通気弁１４０を通気ポート１１５に接続し
たならば作動させて通気内腔１１６を通じてＣＯ2を胃
内に供給し、通気口１１７から排出する。コック１４２
を回転させて、胃内へのＣＯ2の供給量を必要に応じて
増減可能に制御及び調節することが出来る。
【００２２】手術用通路／通気ポート１１０は、埋め込
んだとき、その周囲の組織の弾性に適合する可撓性材料
にて形成することが望ましい。この目的上、シリコンが
特に適していると考えられる。埋め込み中、更なる強度
及び安定性を付与するため、ポート１１０のテーパー付
き部分１１１は、ガイドワイヤ１０５を受け入れるのに
十分な寸法の内腔１０４を有している。上述のように、
このテーパー付き部分１１１は、埋め込み後に切断し
て、中央の手術用通路１１４を露出させ、これによっ
て、行うべき手術に関連して使用される器具を遠隔操作
するための胃内へのアクセス口を形成する。
【００２３】又、皮膚フランジ１２０はシリコンにて形
成されており、円板状フランジ２１と、管状ハンドル部
分１２２とを備えている。スロット１２３がフランジ１
２０をポート１１０に沿って進めるのを容易にする。シ
ールキャップ１５０がポート１１０の端部を密封し、こ
のポートの周囲に取り付けられて、シールキャップ１５
０の突起１５１とポート１１０の凹陥部１１９との間に
密封嵌めを形成する。図３ｂ乃至図３ｄには、各種の手
術段階における組立体の拡大断面図が図示されている。
図３ｂには、埋め込んだ手術用通路／通気ポート１１
０、バルーン拡張用ノズル１３０、通気弁１４０、及び
それぞれの接続ポートから取外したノズル１３０、及び
弁１４０が図示されている。図３ｂにおいて、テーパー
付き部分１１１はガイドワイヤ１０５を受け入れ得る寸
法とした中央内腔１０４を有し、これによって、埋め込
み中、付加的な強度及び安定性を付与する一方、管状部
分１１０ａは遠隔操作可能な器具を受け入れ得る寸法
（例えば、締結組立体用には１２ｍｍ、及び腹腔鏡用に
は７ｍｍ）とした大きい手術用通路１１４を画成する。
バルーン拡張ポート１１２、及び該ポート１１２をバル
ーン１１８の内側に接続するバルーン拡張内腔１１３が
上記管状壁部分１１０ａの壁に形成されている。ポート
１１２の入口には、シール１１２ａがある。外側の通気
ポート１１５を内側の通気ポート１１７に接続する通気
内腔１１６が管状部分１１０ａの壁に形成されている。
ポート１１５の入口には、シール１１５ａがある。
【００２４】又、図３ｂ乃至図３ｄは、それぞれポート
１１２、１１５に接続可能であるバルーン注入ノズル１
３０及び通気弁１４０の断面図が図示されている。図３
ｃに図示するように、ポート１１５内に配置したとき、
シール１１５ａが開放し、弁通路１４１、及び通気内腔
１１６を通じてＣＯ2を胃内に注入することを許容す
る。図３ｄに図示するように、弁１４０をポート１１５
から除去したとき、シール１１５ａが再度閉じる。バル
ーン拡張ノズル１３０は、ポート１１２に対すると同一
の方法にて作動し、通路１３１及び拡張内腔１１３を通
じてバルーン１１８を拡張させる。
【００２５】図３ｃにおいて、ポート１１０のテーパー
付き部分１１１は切断されており、締結組立体５０は中
央の手術用通路１１４内に挿入されている。又、図３ｃ
において、通気弁１４０が通気ポート１１５に取り付け
られ、通気内腔１１６を通じて胃を通気する。密封部材
１５０がポート１１０の周囲に配置され、ステープル止
め装置５０と密封係合状態に位置決めされて、これによ
り、手術／通気中、ガスが手術用通路１１４を通って漏
洩するのを阻止する。密封部材１５０の突起１５１がポ
ート１１０の凹陥部分１１９に密封係合状態に嵌入する
一方、内側フランジ１５２はステープル止め装置５０と
密封係合し、漏洩を効果的に防止する。図３ｄにおい
て、ステープル止め装置５０が除去されており、通気弁
１４０が取り外され、シールキャップ１６０をポート１
１０の周囲に取り付けて、胃に出入るするためのアクセ
ス口を密封する。このように密封されたとき、ポート１
１０は、上述の手術の後、胃を腹膜に定着させておくた
め、又胃に対する排出ポートを提供するためにある期間
だけ、埋め込んだままとしてもよい。
【００２６】図１ａ乃至図１ｄに図示した方法と同一の
方法にて、図４ａ乃至図４ｄには、別の形状の陥入装置
と共に、本発明に従った陥入方法を実行するための逐次
的な段階が図示されている。格別の説明をする場合を除
いて、図４ａ乃至図４ｄの全ての形態は、図１ａ乃至図
１ｄに示したものと同一であり、図４ａ乃至図４ｄにお
いては、図１ａ乃至図１ｄの符号にプライム符号（′）
を付して表示した。故に、説明の重複を避けるため、次
の相違点を除いて、付加的な図面についての説明は省略
する。
【００２７】具体的には、図４ａ乃至図４ｄにおいて、
溝７２′がガイド７０′のテーパー開始部分から内腔７
８′を経て基端方向に向けて長手方向に伸長し、内腔７
８′は溝７２′が伸長するためのスペースを提供し得る
形態としてある。この修正した形態は、締結組立体５
０′のあご状アンビル部材を食道内腔内に位置決めする
のを容易にし、又、図４ｃに図示するように、ステープ
ル止め動作中、締結組立体５０′を針８８′を経て位置
決めするのを許容し、これによって胃と食道との吻合部
１０に針を直接係合させることを可能にする。針を胃と
食道との吻合部１０に直接係合させる結果、食道の内壁
が胃の分泌液に長期間さらされるのを防止することが出
来る。
【００２８】図５ａには、内腔７８′及び溝７２′の周
方向の間隔を示す、陥入ガイド７０′の拡大端面図が図
示されている。図５ｂは内腔７８′を経て伸長する溝７
２′を示す、陥入ガイド７０′の拡大部分側面図であ
る。
【００２９】本発明は添付図面に関して詳細に図示し説
明したが、これは単に一例であり、本発明の特徴を限定
するものではなく、単に好適な実施例のみを図示し説明
したものであり、本発明の精神に含まれる全ての変形例
及び応用例は保護の対象とすることを希望するものであ
る。
【図面の簡単な説明】
【図１】１ａ乃至１ｄは本発明による陥入技術の逐次的
な実行段階を示す概念図である。１ａは食道内に進め、
胃と食道との吻合部に位置決めされた陥入装置の図であ
る。１ｂはその係合組立体を作動させ、複数の針を伸長
させて胃と食道との吻合部付近にて食道に係合させた１
ａの陥入装置の図である（針の係合は可能な限り胃と食
道との吻合部に近接させる）。１ｃは胃に向けて進め、
胃と食道との吻合部にて食道壁を陥入させた係合状態の
陥入装置を示し、更に陥入させた胃と食道との吻合部が
適所に締結された状態を示す図である。１ｄは陥入装置
及びその他の装置を除去した、食道と胃との間に新たに
形成された弁を示す図である。
【図２】２ａ及び２ｂは本発明の方法に使用される陥入
装置の部分破断側面図である。２ａはその係合組立体を
不作動にし、係合針をそれぞれの内腔内に保持した装置
を示す図である。２ｂはその係合組立体を作動させ、針
をそれぞれの内腔から突出させ、食道壁に係合させた装
置を示す図である。
【図３】３ａ乃至３ｄは遠隔操作可能な締結具及び／又
は食道を導入するため、胃内への皮下的アクセス手段を
提供しかつ胃への通気手段を提供する手術用通路／通気
組立体を示す図である。３ａは完全な組立体の側面図で
ある。３ｂ乃至３ｄは各種の手術段階における組立体の
一部を示す拡大断面図である。３ｂは埋め込まれた手術
用通路／通気ポート１１０、バルーン拡張ノズル１３
０、通気弁１４０、それぞれの接続ポートから取り外し
たノズル１３０、弁１４０を示す図である。３ｃはポー
ト１１０のテーパー付き部分１１１を切断し、締結組立
体５０を中央の手術用通路１１４内に挿入し、通気内腔
１１６を通じて胃を通気するため通気弁１４０を通気ポ
ート１１５に取り付け、密封部材１５０をポート１１０
の周囲に配置しかつ締結組立体５０と密封係合状態に位
置決めし、これにより手術用／通気中、手術用通路１１
４を通ってガスが漏洩するのを防止する状態を示す図で
ある。３ｄは締結組立体５０を除去し、通気弁１４０を
取り外し、密封キャップ１６０をポート１１０の周囲に
配置し、胃に出入りするためのアクセス手段を密封する
状態を示す図である。
【図４】４ａ乃至４ｄは選択可能な形状とした陥入装置
と共に、本発明による陥入技術の逐次的な実行段階を示
す図である。４ａは食道内に進めかつ胃と食道との吻合
部に位置決めした陥入装置を示す図である。４ｂはその
係合装置を作動させ、複数の針を伸長させ、胃と食道と
の吻合部にて食道に係合させた４ａの陥入装置を示す図
である。４ｃは胃に向けて進め、胃と食道との吻合部に
て食道壁を陥入させる係合状態の陥入装置、及び適所に
締結された陥入させた胃と食道との吻合部を示す図であ
る。４ｄは陥入装置及びその他の装置を除去し、食道と
胃との間に新たに形成された弁を示す図である。
【図５】５ａ及び５ｂは４ａ乃至４ｄに関して使用され
る陥入装置７０′に対する形状の変化を示す拡大図であ
る。５ａは内腔７８′及び溝７２′の周縁方向の間隔を
示す陥入ガイド７０′の拡大端面図である。５ｂは内腔
７８′経て伸長する溝７２′を示す陥入ガイド７０′の
拡大部分側面図である。
【符号の説明】
５ ガイドワイヤ １０ 胃と食道との
吻合部 ２０ 食道 ２５ 胃底壁 ３０ 胃 ４０ 腹腔鏡 ５０ ステープル止め装置 ５５ ステープル ７０ 陥入装置 ７１ マーキング ７２ 溝 ７５ 導入子ガイ
ド ７６ 中央内腔 ７７ 雄ねじ式コ
ネクタ ７８ 内腔 ８０ 針突出器 ８１ 金属製ハブ ８２ 金属製ハブ ８３ 軸 ８４ 内側コア ８５ 外管 ８６ 中央内腔 ８８ 針 ９０ 前進部材 ９１ 雌ねじ部分 ９２ 保持部分 ９３ 凹所 ９６ 中央内腔
───────────────────────────────────────────────────── フロントページの続き (72)発明者 トーマス・アール・デメスター アメリカ合衆国カリフォルニア州91108− 1726，サン・マリノ，ハンティングトン・ ガデン・ドライブ 892 (72)発明者 レベッカ・コペンハーバー・ギッブス アメリカ合衆国ノース・カロライナ州 27215，バーリントン，サウス・フィッシ ャー・ストリート 307 (72)発明者 ロナルド・エイ・ヒンダー アメリカ合衆国ネブラスカ州68154，オマ ハ，ローズ・レーン 12370

Claims (22)

    【特許請求の範囲】
  1. 【請求項１】 患者の胃と食道との吻合部を陥入させる
    装置にして、食道の外径に略等しい外径を有する導入子
    ガイドと、患者の胃と食道との吻合部に係合する係合手
    段であって、複数の針を備え、前記針が、該針が導入子
    ガイド内に位置する退却位置と、該針が導入子ガイド外
    に伸長し前記ガイドから半径方向に突出する伸長位置と
    を有する係合手段とを備え、 前記係合手段が、針を導入子ガイド外に突出させ、胃と
    食道との吻合部付近にて食道に係合させる手段を更に備
    えることを特徴とする陥入装置。
  2. 【請求項２】 請求項１に記載の陥入装置にして、前記
    導入子ガイドが食道内への挿入を容易にする手段を備え
    ることを特徴とする陥入装置。
  3. 【請求項３】 請求項２に記載の陥入装置にして、前記
    挿入容易化手段がその長さに沿って可撓性であり且つそ
    の末端にテーパーが付けられた前記ガイドを備えること
    を特徴とする陥入装置。
  4. 【請求項４】 請求項１に記載の陥入装置にして、前記
    針が、その伸長位置にあるとき、前記ガイドから半径方
    向前方に突出し、胃と食道との吻合部に係合することを
    特徴とする陥入装置。
  5. 【請求項５】 請求項２に記載の陥入装置にして、前記
    針が、伸長位置にあるときに前記導入子ガイドの中心軸
    線に関して約３０°の角度にて前記ガイドから半径方向
    前方に突出することを特徴とする陥入装置。
  6. 【請求項６】 請求項５に記載の陥入装置にして、前記
    針が前記導入子ガイドの周縁に沿って等間隔に離間され
    ることを特徴とする陥入装置。
  7. 【請求項７】 請求項６に記載の陥入装置にして、前記
    係合組立体が前記導入子ガイドの周縁に沿って等間隔に
    離間された１０本の針を備えることを特徴とする陥入装
    置。
  8. 【請求項８】 請求項１に記載の陥入装置にして、前記
    導入子ガイドが食道内における前記陥入装置の相対的位
    置の識別を容易にする手段を備え、前記位置識別手段が
    前記ガイドの外側の所定の位置に配置された光学的標識
    を有することを特徴とする陥入装置。
  9. 【請求項９】 患者の胃と食道との吻合部を陥入させる
    装置にして、食道の外径に略等しい外径を有する導入子
    ガイドであって、前記ガイドの外径面に伸長する複数の
    針受け入れ内腔を更に有する導入子ガイドと、 患者の胃と食道との吻合部に係合する係合手段であっ
    て、複数の針を有し、前記針が、該針が前記導入子ガイ
    ドの針受け入れ内腔内に位置する退却位置と、該針が前
    記内腔外に伸長しかつ前記ガイドから半径方向に突出す
    る伸長位置とを有し、前記針を前記針受け入れ内腔外に
    突出させて胃と食道との吻合部付近にて食道に係合させ
    る手段を更に備える係合手段とを備えることを特徴とす
    る陥入装置。
  10. 【請求項１０】 請求項９に記載の陥入装置にして、前
    記ガイドがその中心軸線に沿って中央内腔を更に有し、
    前記複数の針受け入れ内腔が前記中央内腔から前記ガイ
    ドの外径面まで伸長し、前記係合組立体がプッシュロッ
    ドを備え、前記プッシュロッドが前記中央内腔に受け入
    れられ且つ前記複数の針に接続され、更に、前記ガイド
    の前記中央内腔内を軸方向に動き、前記針を針受け入れ
    内腔外に突出させ、胃と食道との吻合部に係合させるこ
    とを特徴とする陥入装置。
  11. 【請求項１１】 請求項１０に記載の陥入装置にして、
    前記プッシュロッドがガイドワイヤを受け入れるための
    中央内腔を画成することを特徴とする陥入装置。
  12. 【請求項１２】 請求項９に記載の陥入装置にして、前
    記導入子ガイドが食道内への挿入を容易にする手段を備
    えることを特徴とする陥入装置。
  13. 【請求項１３】 請求項１２に記載の陥入装置にして、
    前記挿入容易化手段が、その長さに沿って可撓性であり
    且つその末端にテーパーが付けられた前記ガイドを備え
    ることを特徴とする陥入装置。
  14. 【請求項１４】 請求項９に記載の陥入装置にして、前
    記針が、その伸長位置にあるとき前記ガイドから半径方
    向前方に突出して胃と食道との吻合部に係合することを
    特徴とする陥入装置。
  15. 【請求項１５】 請求項１４に記載の陥入装置にして、
    前記針が、その伸長位置にあるとき前方導入子ガイドの
    中心軸線に関して約３０°の角度にて前記ガイドから半
    径方向前方に突出することを特徴とする陥入装置。
  16. 【請求項１６】 請求項１４に記載の陥入装置にして、
    前記針が前記導入子ガイドの周縁に沿って等間隔に離間
    されることを特徴とする陥入装置。
  17. 【請求項１７】 請求項１５に記載の陥入装置にして、
    前記係合組立体が前記導入子ガイドの周縁に沿って等間
    隔に離間された１０本の針を備えることを特徴とする陥
    入装置。
  18. 【請求項１８】 請求項１０に記載の陥入装置にして、
    前記プッシュロッドが前記導入子ガイドと螺合可能に係
    合し、前記螺合により前記プッシュロッドが前記ガイド
    の前記中央内腔内を前進して前記針を針受け入れ内腔か
    ら突出させ、胃と食道との吻合部に係合させることを特
    徴とする陥入装置。
  19. 【請求項１９】 請求項９に記載の陥入装置にして、前
    記導入子ガイドが食道内における前記陥入装置の相対的
    位置の識別を容易にする手段を備え、前記位置識別手段
    が前記ガイドの外側の所定の位置に配置された光学的標
    識を備えることを特徴とする陥入装置。
  20. 【請求項２０】 請求項１０に記載の陥入装置にして、
    前記プッシュロッドが金属製の内側コアと、プラスチッ
    ク製の外側管とを備えることを特徴とする陥入装置。
  21. 【請求項２１】 請求項１３に記載の陥入装置にして、
    前記導入子ガイドが低密度のポリエチレンから成ること
    を特徴とする陥入装置。
  22. 【請求項２２】 手術用通路／通気ポート組立体にし
    て、 手術用通路／通気ポート部材であって、遠隔的に操作可
    能な器具を受け入れ得る寸法とした手術用通路を画成す
    ると共に前記ポート部材の外側に配置された通気ポート
    に接続する通気内腔を更に画成する手術用通路／通気ポ
    ート部材と、胃内まで経皮的に伸長し、前記ポート部材
    を適所に固定する固定手段とを備え、遠隔的に操作可能
    な器具が前記手術用通路を通じて胃内に前進可能であ
    り、前記通気内腔を通じて胃内にＣＯ2を導入すること
    が出来るようにし、 更に、前記通気ポートに接続可能な通気弁部材であっ
    て、前記通気内腔を通じて胃内に供給されるＣＯ2の供
    給量を増減可能に制御する手段を備える通気弁部材と、 手術／通気中、ガスの漏洩を阻止する手術用通路の密封
    手段であって、前記手術用通路／通気ポート部材と受け
    入れられた遠隔的に操作可能な器具との間にシールを提
    供する手段を有する密封手段とを備えることを特徴とす
    る手術用通路／通気ポート組立体。
JP3264019A 1990-10-11 1991-10-11 患者の胃と食道との吻合部を陥入させる装置 Expired - Lifetime JPH0638802B2 (ja)

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US59597790A 1990-10-11 1990-10-11
US595977 1990-10-11
US608339 1990-11-02
US07/608,339 US5088979A (en) 1990-10-11 1990-11-02 Method for esophageal invagination and devices useful therein

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JPH04226644A JPH04226644A (ja) 1992-08-17
JPH0638802B2 true JPH0638802B2 (ja) 1994-05-25

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AU (2) AU643076B2 (ja)
CA (1) CA2053130C (ja)
DE (1) DE69119530T2 (ja)
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AU652101B2 (en) 1994-08-11
AU4617893A (en) 1993-11-18
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AU643076B2 (en) 1993-11-04
CA2053130A1 (en) 1992-04-12
AU8569791A (en) 1992-06-11
ATE137941T1 (de) 1996-06-15
JPH04226644A (ja) 1992-08-17
DK0480428T3 (da) 1996-10-07
US5088979A (en) 1992-02-18
EP0480428A3 (en) 1992-07-08
CA2053130C (en) 1998-06-02
EP0480428B1 (en) 1996-05-15
GR3020477T3 (en) 1996-10-31
DE69119530T2 (de) 1996-09-26
ES2087200T3 (es) 1996-07-16
EP0480428A2 (en) 1992-04-15

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