JPH08187247A - Blood vessel anastomosis forceps - Google Patents

Abstract

PURPOSE: To provide an anastomosis forceps in which a distance between rings clamped to the clamp parts of a clamp device is sufficient, so a contracted blood vessel can easily be connected to the ring without pulling the blood vessel and a blood vessel wall is not removed from the pin of the ring even if the tension of a blood vessel connected to the ring increases. CONSTITUTION: This device is composed of a main body 11 which is composed of an operation rod 17 having screw portions 19 and 20 that are screwed to the ends in the opposite direction to each other, guide rods 15 and 15 that are provided together with the operation rod 17, and a pair of supports 18a and 18b that are screwed into the screw portions 19 and 20 of the operation rod 17 and that can be moved freely along the guide rods 15 and 15, and also has a pair of clamps 12a and 12b that have clamp portions at their heads for blood vessel anastomosis rings and whose bases are supported by the supports 18a and 18b so that the clamps can be rotated freely.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a vascular anastomotic forceps for suturing microvessels such as peripheral blood vessels before a wrist.

[0002]

2. Description of the Related Art Microvascular suturing is an indispensable method not only for re-adhesion of toes and fingers and vascularized bone grafts, but also for tissue transplantation and organ transplantation. It is the current situation. However, the method of performing microvascular suture by hand sewing is technically difficult for a doctor, and also requires skill and considerable time for microvascular suturing.

[0003] In order to solve the problems associated with manual sewing of microvascular suturing, a disposable type vascular anastomosis apparatus 1 shown in FIG. 5 has been developed. The vascular anastomosis apparatus 1 includes a main body 2 formed of a plastic material, a pair of ring holding plates 3 and 3 rotatably mounted on a shaft 2a provided at one end of the main body 2, and each ring holding plate. A ring 5 for suturing a blood vessel fitted to the ring engaging portion 3 of the third embodiment, and a coil spring 6 mounted on the shaft 2a and elastically pressing the ring holding plates 3 and 3 away from each other. The blood vessel suturing ring 5 is constituted by a ring body formed of a biodegradable and absorbable material, and a pin 7 and a hole 8 provided on one end surface of the ring body. The ring engaging portion 4 of the ring holding plate 3 is formed. Are fitted so that the pin 7 and the hole 8 are located on the side opposite to. The blood vessel 9 to be sutured (FIG. 7) is inserted into the blood vessel suturing ring 5 from the side opposite to the side on which the pin 7 is provided, and the end wall of the blood vessel 9 protruding from the ring 5 is turned 90 degrees. The pin 5 of the ring 5 is connected to the ring 5 by piercing the pin 7.

To join the blood vessels 9 cut by using the blood vessel anastomotic apparatus 1 to each other, the blood vessels 9 to be joined are
A ring 5 fitted to the ring engaging portion 4 of the ring holding plate 3 in an open state as shown in FIG. The blood vessel 9 to be joined is connected to the ring 5 by inverting the end wall by 90 degrees and piercing the pin 7 of the ring 5.

When the rings 5 and 5 are respectively connected to the blood vessels 9 and 9 to be joined, the ring holding plates 3 and 3 are opposed to the force of the coil spring 6 in the closing direction from the open position shown in FIG. Rotate. By the rotation of the ring holding plate 3, the ring holding plates 3, 3 move from the open position shown in FIG. 5 to the closed position shown in FIG. Abut on each other, the pins 7 of one ring 5
Engage with the hole 8 of the other ring 5, and the pin 7 of the other ring 5 engages with the hole 8 of the one ring 5. This allows
The blood vessels 9 to be joined are connected to one another via rings 5,5.

The used vascular anastomotic apparatus 1 is composed of rings 5, 5
Are removed from the ring engaging portions 4 of the ring holding plates 3 and 3 and then discarded.

[0007]

In the above-mentioned vascular anastomosis device,
As shown in FIG. 7, the ring 5 connecting the blood vessels 9 is fitted to the ring engaging portion 4 of the ring holding plate 3 which is pivotally supported by the shaft 2a of the main body, and the ring 5 rotates. Since it is located at a position apart from the axis 2a of the ring holding plate 3 by a radius r,
In order to connect the blood vessels 9 to each other, it is necessary to move the rings 5 and 5 in the direction of the arrow A to join them, and to join the rings 5 and 5, a space S and an inter-ring distance L within the range shown by diagonal lines are required. Becomes

However, in the vascular anastomosis apparatus, a ring 5 is provided in an anastomosis area of a micro blood vessel such as a peripheral blood vessel ahead of a wrist.
Insufficient space S in the range indicated by oblique lines necessary for the connection of No. 5 is not suitable for anastomosis of microvessels such as peripheral blood vessels ahead of the wrist.

In addition, in the above-described blood vessel anastomosis apparatus, the distance L between the rings 5, 5 provided on the ring holding plates 3, 3 cannot be set to a sufficient length. And the operation of attaching the blood vessel 9 to the ring 5 becomes troublesome, and the pin 7 of the ring 5 and the blood vessel wall are inclined when the cut blood vessels 9 and 9 are anastomosed to each other. , The blood vessel may come off from the pin 7.

The present invention has been made in view of the above-mentioned points, and when suturing a blood vessel, the distance between the rings can be set to be large, and the tension of the blood vessel can be reduced to attach the blood vessel to the ring. It is simple, and by translating the rings and connecting them to each other, even if the tension on the blood vessel increases,
An object of the present invention is to provide a vascular anastomotic forceps in which a blood vessel is hardly detached from a pin of a ring.

[0011]

According to a first aspect of the present invention, there is provided a vascular anastomotic forceps having an operating rod having threaded portions which are opposite to each other in an end direction, and a guide rod and an operating rod which are provided alongside the operating rod. A body portion having a pair of support portions which are screwed to the respective screw portions and are movable along the guide rod, and a clamp portion for a blood vessel anastomosis ring on the distal end side, and the proximal end side is provided on each support portion. A pair of clamp devices rotatably supported.

The blood vessel anastomotic forceps according to claim 2 of the present invention is
In the vascular anastomotic forceps according to the first aspect, the clamp device is rotated between a position orthogonal to an axis of the guide rod on which the vascular anastomosis ring is arranged to face and a position outside the support portion. The vascular anastomotic forceps according to claim 1.

[0013] The vascular anastomotic forceps according to claim 3 of the present invention comprises:
3. The vascular anastomotic forceps according to claim 2, wherein the rotation range of the clamp device is set at 6 degrees outward from a position orthogonal to the axis of the guide rod.
It is characterized in that it is set to 0 degree.

[0014] The vascular anastomotic forceps according to claim 4 of the present invention comprises:
In the vascular anastomotic forceps according to the first aspect, the clamp portion of the clamp device is detachable.

[0015]

In the vascular anastomotic forceps of the present invention, the support portion supporting the clamp device is moved in parallel along the guide rod provided on the main body, and the clamp device having the clamp portion is rotatably supported by the support portion. Since the distance between the rings clamped by the clamp portion of the clamp device is sufficiently ensured, it is possible to easily attach the contracted blood vessel to the ring without pulling the blood vessel, and to provide the clamp portion. The ring moves in parallel along the guide rod provided on the main body, so that even if the tension of the blood vessel attached to the ring increases, the blood vessel wall does not come off from the pin of the ring.

In the vascular anastomotic forceps of the present invention, the clamp portion of the clamp device is detachable, and the clamp portion is disposable, so that the clamp portion with the ring attached and the clamp portion with the ring attached to the body side. This simplifies the operation of attaching the ring to the vascular anastomotic forceps.

[0017]

Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 is a perspective view of a vascular anastomotic forceps 10 according to the present invention. The vascular anastomotic forceps 10 is disposed on a main body portion 11 which also serves as a grip portion and on the main body portion 11 so as to be rotatable and movable in parallel. Clamping devices 12a and 12b.

The main body 11 has a pair of guide plates 13a and 13b spaced from each other, and a pair of guide plates 13a and 13b at both ends.
a, 13b (fitting holes provided in the guide plate 13b are not shown) to fit into the guide plates 13a, 13b.
13b are connected to each other, and the guide plates 15 are arranged in parallel with the guide rods 15,
The guide plates 13a, 13b pass through through holes 16 provided in the guide plates 13a, 13b (the through holes provided in the guide plate 13b are not shown).
An operating rod 17 rotatably provided on the guide plates 13a and 13b so as to protrude further outward, and a guide rod 15, 15 and an operating rod 17 having a substantially U-shaped cross section and intermediate portions.
The guide rod 1 is rotated by the operating rod 17 which rotates by engaging with the guide rod 1.
A pair of support portions 18a and 18b that move along
It is formed from and.

The actuating rod 17 has a right-hand threaded portion 19 on one side from the intermediate position in the axial direction and a left-handed thread portion 20 on the other side from the intermediate position in the axial direction, and is located outside the guide plate 13a on the right-handed screw portion 19 side. The adjusting knob 21a is fixed to the protruding end portion, and the adjusting knob 21b is fixed to the end portion protruding outward from the guide plate 13b on the left screw portion 20 side.

In one of the pair of supporting portions 18a and 18b, one supporting portion 18a is formed with a right-handed screw hole to be screwed into the right-handed screw portion of the operating rod 17 and a through hole into which the guide rod 15 is inserted. The other supporting portion 18b is formed with a left-handed screw hole which is screwed into a left-handed screw portion of the actuating rod 17 and a through hole into which the guide rod 15 is inserted. Therefore, the support portions 18a and 18b rotate the adjustment knob 21a provided on the operating rod 17 clockwise or adjust the adjustment knob 21b.
By rotating the adjusting knob 21a clockwise and rotating the adjusting knob 21a counterclockwise at the same time, the guide knobs 15 and 15 are moved parallel to each other in a direction away from each other, and the adjusting knobs 21a and 21b are opposed to each other. By rotating in the direction of, the guide rods 15 and 15 move in parallel in the directions toward each other.

As shown in FIGS. 1 and 2, the clamp device 12a includes projecting portions 22a, 23 of the support portion 18a.
a main body 24a having a shaft portion that extends through a and is axially supported by the support portion 18a, a ring clamp portion 25a provided at a tip portion of the main body 24a, and a support portion 18a of the main body 24a.
And a rotary knob 26a fixed to an end protruding from the protruding portion 23a, and the protruding portions 22a, 23a of the support portion 18a of the shaft portion of the main body 24a to resiliently press the main body 24a in the direction of the ring clamp portion 25a. And a coil spring 27a. As shown in FIG. 3, the rotary knob 26a fixed to the end of the main body 24a has a circumferential surface on the rotary knob 26a.
Recesses 28, 28 that engage with pins (not shown) provided on the support portion 18a are formed at an angular interval of 0 degree.
Therefore, the ring clamp 25a provided on the main body 24a
By changing the position of engagement of the concave portion of the rotary knob 26a with the pin, the inclined position in which the axis of the guide rod 15 shown by the solid line in FIG. 4 is orthogonal to the axis of the guide rod 15 shown by the dotted line in FIG. Is located. This inclined position is 60 degrees in the embodiment, but it can be set to a desired angle by changing the angular interval of the concave portions of the rotary knob 26a.

The ring clamp 25a is provided on the main body 24.
The fixed clamp member 30a is formed integrally with or separate from the fixed clamp member 30a, and the movable clamp member 31a is movable with respect to the fixed clamp member 30a. For example, a vascular anastomosis ring indicated by reference numeral 5 in FIG. 5 is clamped between the fixed clamp member 30a and the movable clamp member 31a.
Slide shaft 32a provided on the movable clamp member 31a
Extends along the fixed clamp member 30a,
From the support portion 33a of the slide shaft 32a penetrating the support portion 33a extending from the slide knob 34a.
Is provided. The movable clamp member 31a is fixed between the movable clamp member 31a of the slide shaft 32a and the support portion 33a extending from the main body 24a.
A coil spring 35a that resiliently presses in the direction a is provided. If the pressing force of the movable clamp member 31a by the coil spring 35a is insufficient and the clamp of the blood vessel anastomosis ring is not sufficient, another fastening means is provided in parallel with the coil spring 35a.

As shown in FIG. 1, the clamp device 12b is provided on a main body 24b which extends through the projecting portions 22b and 23b of the supporting portion 18b and is axially supported by the supporting portion 18a, and a tip portion of the main body 24b. Ring clamp part 25b
A rotary knob 26b fixed to an end of the main body 24b protruding from the protruding portion 23b of the support portion 18b;
8b is disposed between the protruding portions 22b and 23b.
b, and a coil spring 27b for resiliently pressing b in the direction of the ring clamp portion 25b. As with the rotary knob 26a, the rotary knob 26b fixed to the end of the main body 24b has
The support portion 18 is provided on the outer peripheral surface at an angular interval of 60 degrees in the circumferential direction.
A recess is formed which engages with a pin (not shown) provided at a.

The ring clamp 25b is connected to the main body 24.
The fixed clamp member 30b integrated with or separate from the fixed clamp member 30b, and a movable clamp member 31b movable with respect to the fixed clamp member 30b, and clamps a vascular anastomosis ring as indicated by reference numeral 5 in FIG. The slide shaft 32b provided on the movable clamp member 31b extends along the fixed clamp member 30b and extends from the main body 24b.
penetrate b. A slide knob 34b is provided at an end portion of the slide shaft 32b that projects from the support portion 33b.
A coil spring 35b is provided between the movable clamp member 31b of the slide shaft 32b and the support portion 33b extending from the main body 24b to elastically press the movable clamp member 31b in the direction of the fixed clamp member 30b. The above coil spring 3
When the pressing force of the movable clamp member 31b by 5b is insufficient, another fastening means is used together.

Incidentally, the ring clamp portions 25a, 25
By making b detachable from the main bodies 24a and 24b, the ring clamp portions 25a and 25b can be disposable.

Next, the operation will be described.

In order to suture the cut blood vessel 9, for example, a small blood vessel such as a peripheral blood vessel ahead of the wrist, first, the rotary knob 26a of the clamp device 12a is pushed down, and the concave portion of the rotary knob 26a is inserted into the support portion 18a. The ring clamp 25a is moved from the parallel position shown by the solid line to the angular position shown by the dotted line in FIG. 4 by disengaging from the provided pin and turning the rotary knob 26a to engage with the pin provided on the support portion 18a. . Similarly, the rotary knob 26 of the clamp device 12b
b of the rotary knob 26b and the supporting portion 18b.
The ring clamp portion 25b is disengaged from the pin provided on the support member 18b and is rotated by the rotary knob 26b to engage with the pin provided on the support portion 18b. Position).

Then, the slide knob 34a of the slide shaft 32a of the clamp device 12a resists the force of the coil spring 35a and the movable clamp member 3 of the ring clamp portion 25a.
1a is pushed down in a direction away from the fixed clamp member 30a, and the vascular anastomosis ring 5 (FIG. 2) is arranged between the opened movable clamp member 31a and the fixed clamp member 30a such that the pin 7 is located inside. Next, the force applied to the slide knob 34a is relaxed, and the movable clamp member 31a is pushed up in the direction of the fixed clamp member 30a by using the force of the coil spring 35a, so that the vascular anastomosis ring 5 is moved to the movable clamp member of the ring clamp portion 25a. It clamps between 31a and fixed clamp members 30a.

At the same time, the slide knob 34b of the slide shaft 32b of the clamp device 12b is
b, the movable clamp member 31b of the ring clamp portion 25b is pushed down in a direction away from the fixed clamp member 30b, and the vascular anastomotic ring 5 is opened between the opened movable clamp member 31b and the fixed clamp member 30b (FIG. 2). Is arranged so that the pin 7 is located inside, and thereafter, the force applied to the slide knob 34b is relaxed, and the coil spring 35
The movable clamp member 31b is pushed up in the direction of the fixed clamp member 30b using the force of b, and the vascular anastomosis ring 5 is clamped between the movable clamp member 31b and the fixed clamp member 30b of the ring clamp portion 25b.

Next, the ring clamp 25a and the ring clamp 25b are placed in the anastomotic area of the microvessel, and one of the blood vessels 9 to be sutured (FIG. 7) is attached to the vascular anastomotic ring 5 clamped by the ring clamp 25a. The end of the blood vessel 9 protruding from the ring 5 is enlarged in diameter and pierced into the pin 7 of the ring 5, and one of the blood vessels 9 to be sutured is connected to the ring 5. At the same time, the other side of the blood vessel 9 to be sutured (FIG. 7) is attached from the side opposite to the side on which the pin 7 of the blood vessel suture ring 5 clamped by the ring clamp portion 25b is provided. The end of the protruding blood vessel 9 is expanded and pierced into the pin 7 of the ring 5, and the other side of the blood vessel 9 to be sutured is connected to the ring 5. In this case, since the stroke of the blood vessel suturing ring provided on the ring clamp portion can be sufficiently secured, the tension of the blood vessel 9 to be sutured is reduced.

Next, by turning the adjustment knob 21b provided on the operating rod 18 counterclockwise, clockwise of the adjustment knob 21a, or clockwise of the adjustment knob 21a and counterclockwise of the adjustment knob 21b simultaneously, The support portions 18a, 18b of the portions are translated along the guide rods 15, 15 in a direction approaching each other. The clamp device 12a is supported by the support portion 18a, and the clamp device 12b is supported by the support portion 18b.
The ring 5 connecting the one blood vessel 9 provided on the clamp device 12b and the ring 5 connecting the other blood vessel 9 provided on the clamp device 12b,
The rings 5 and 5 connecting the blood vessels 9 to be sutured by moving in parallel in the direction B indicated by the dotted line in FIG.

That is, a sufficient stroke L 'can be secured between the ring 5 provided with the one blood vessel 9 provided on the clamp device 12a and the ring 5 provided with the other blood vessel 9 provided on the clamp device 12b. The tension of the connected blood vessel 9 can be kept low, and even if the tension of the blood vessel connected to the ring increases, the ring 5 connecting the blood vessel 9 moves on the same straight line. It does not come off the pin 7.

When the rings 5 and 5 come into contact with each other, the pin 7 of one ring 5 engages with the hole 8 of the other ring 5, and the pin 7 of the other ring 5 engages with the hole 8 of one ring 5. The blood vessels 9, 9 to be sutured are
The sutures of the cut blood vessels 9, for example, microvessels such as peripheral blood vessels beyond the wrist, are completed by being connected to each other via.

When the suturing of the blood vessel 9 is completed, the slide knob 34a of the clamp device 12a and the clamp device 12
b of the slide knob 34b with the coil springs 35a, 35b.
Clamping device for rings 5 and 5 by pushing down against the force of
2a ring clamp part 25a and clamp device 12
It is disengaged from the ring clamp part 25b of b.

By making the ring clamp 25a of the clamp device 12a and the ring clamp 25b of the clamp device 12b detachable from the main body, the ring clamp 25a and the ring clamp 25b can be disposable.

[0037]

As described above, according to the present invention, the support for supporting the clamp device is moved in parallel along the guide rod provided on the main body, and the clamp having the ring clamp is turned around the support. Since it is movably supported, the distance between the rings clamped by the ring clamp portion of the clamp device is sufficiently ensured, and the mounting of the contracted blood vessel to the ring can be easily performed without pulling the blood vessel. Also, since the ring provided on the ring clamp moves in parallel along the guide rod provided on the main body, even if the tension of the blood vessel attached to the ring becomes stronger, the blood vessel wall may come off from the ring pin. There is no end.

Further, the ring clamp part having the ring of the clamp device and the ring clamp part having the ring are separately provided and detachably attached to the main body side, whereby the operation of attaching the ring to the vascular anastomosis forceps becomes easy. Also, the ring clamp part can be disposable.

[Brief description of drawings]

FIG. 1 is a perspective view of a vascular anastomotic forceps according to the present invention.

FIG. 2 is a side view of a vascular anastomotic forceps according to the present invention.

FIG. 3 is a view showing a rotary knob fixed to a shaft.

FIG. 4 is a view showing an operation of a ring clamp portion of the vascular anastomotic forceps according to the present invention.

FIG. 5 is a diagram showing an open state of a conventional vascular anastomosis device.

FIG. 6 is a diagram showing a closed state of a conventional vascular anastomosis apparatus.

FIG. 7 is a comparison diagram of the working space of the ring of the vascular anastomosis forceps according to the present invention and the conventional vascular anastomosis device.

[Explanation of symbols]

 Reference Signs List 5 ring 9 cut blood vessel 10 vascular anastomotic forceps 11 main body 12a, 12b clamping device 13a, 13b guide plate 15 guide rod 17 operating rod 18a, 18b support 19 right-hand thread 20 left-hand thread 25a, 25b ring clamp 30a , 30b Fixed clamp member 31a, 31b Movable clamp member

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Tsuneaki Arai 1-4-1-203 Akitsu, Narashino City, Chiba Prefecture

Claims (4)

[Claims] An operating rod having threaded portions opposite to each other in an end direction, a guide rod provided in parallel with the operating rod, and a pair of screws which are screwed to the respective threaded portions of the operating rod and are movable along the guide rod. Vascular anastomotic forceps comprising: a main body having a support portion; and a pair of clamp devices having a clamp portion for a vascular suture ring on the distal end side and having a base end side rotatably supported by each support portion. . 2. The clamp device is rotatable between a position orthogonal to the axis of a guide rod opposite to which the blood vessel anastomotic ring is arranged and a position outside the support portion.
The vascular anastomosis forceps described in 1. 3. The vascular anastomotic forceps according to claim 2, wherein the rotation range of the clamp device is 60 degrees outward from a position orthogonal to the axis of the guide rod. 4. The vascular anastomotic forceps according to claim 1, wherein a clamp portion of the clamp device is detachable.