JPH0833641A - バットレス部材と患部組織の除去手術を実行する方法 - Google Patents

バットレス部材と患部組織の除去手術を実行する方法

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Publication number
JPH0833641A
JPH0833641A JP7021969A JP2196995A JPH0833641A JP H0833641 A JPH0833641 A JP H0833641A JP 7021969 A JP7021969 A JP 7021969A JP 2196995 A JP2196995 A JP 2196995A JP H0833641 A JPH0833641 A JP H0833641A
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tissue
animal
buttress
strip
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JP3040930B2 (ja
Inventor
Joel Cooper
クーパー ジョエル
Sally L Winegar-Hentges
エル．ウィネガー − ヘントゲ サリー
Robert P Nelson
ピー．ネルソン ロバート
Kemal Schankereli
シャンケレリ ケマル
Kristine M Teich
エム．タイヒ クリスチン
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Bio Vascular 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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads

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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)
  • Materials For Medical Uses (AREA)

Abstract

(57)【要約】 【目的】 患部組織の切除の後組織が裂けて流体あるい
は空気が漏れるのを阻止するために縫合線を強化する用
品と方法を提供する。 【構成】 宿主組織のステープル縫合線を強化するため
に、馬、牛、豚、羊、人間から採取した交差結合の心膜
あるいは硬膜のような異種固体あるいは自原的な組織の
帯片をステープルガンのアンビルの並置協働面に接着さ
せ、切除すべき組織をジョーの間に置き、ステープルガ
ンを作動させると、ステープルが動物の組織と、その間
に介在する宿主組織の２枚の層に進入する。切断刃によ
り縫合線に沿って宿主の組織と動物の組織を切断する。
肺縮小手術に用いると、動物組織の強化帯片がステープ
ルの周りで空気の漏れを阻止する気密シールを形成す
る。動物の組織帯片を保持する構造体はバットレス部材
を含む。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】本発明は一般に、手術の方法を改
良する方法と装置であって、吻合のため、すなわち患部
の組織の除去に続いて境界部分を閉鎖するためにステー
プルが用いられる方法と装置に関し、特に、その後組織
が破れて流体が漏洩したり、あるいは肺切開の場合、空
気の漏洩を阻止するために縫合線を強化する装置に関す
る。
【０００２】
【従来の技術】水疱状気腫を患っている患者の肺に対し
て実行した容積減少手術あるいはその他の手術に続いて
起る頻発し、かつ厄介な合併症は定常的に発生し、そし
て数週間も続くことが多い頑固な空気漏洩である。肺組
織における最も小さい気孔であっても著しく、かつ長期
の空気損失をもたらしうる。呼吸機能を向上させるため
に肺の容積減少手術を実行する場合、健康な組織と患部
の組織との間の境界の肺組織を通して複数の千鳥状の列
に近接隔置したステープルを位置させるために直線手術
ステープラが用いられることが多い。次に、肺は最外方
の縫合線に沿って、あるいは縫合線の間の組織を分割す
ることにより切除される。この手順を用いる場合、肺を
ふくらませると、空気の漏れは肺の切除面からではな
く、ステープルの孔自体から発生する傾向がある。ステ
ープルは激しい肺気腫性肺組織に位置されると肺が再び
ふくらまされるにつれて拡大したり、あるいは裂ける。
【０００３】巨大な胞の場合、医師は従来は縫合線の基
部を強化するために切開した胞の壁をそらせて使用して
きた。この方法は、１９８１年度の「胸部心臓血管手術
誌」（Ｊｏｕｒｎａｌ ｏｆ Ｔｈｏｒａｃｉｃ Ｃａ
ｒｄｉｏｖａｓｃｕｌａｒＳｕｒｇｅｒｙ）の８２巻８
９２−８９７頁に記載されている「肺気腫胞の両側切除
のための中央胸骨切開法」（Ｍｅｄｉａｎ Ｓｔｅｒｎ
ｏｔｏｍｙ ｆｏｒＢｉｌａｔｅｒａｌ Ｒｅｓｅｃｔ
ｉｏｎ ｏｆ Ｅｍｐｈｙｓｅｍａｔｏｕｓ Ｂｕｌｌ
ａｅ）という名称のジェイ．ディ．クーパ他（Ｊ．Ｄ．
Ｃｏｏｐｅｒ，ｅｔ ａｌ）による論文に報告されてい
る。容積減少手術が実行される病理学的条件は前述のよ
うな巨大な胞を含むことは稀れであるので、縫合線を強
化するに適した材料についての研究が継続されてきた。
ジュートナ（Ｊｕｅｔｔｎｅｒ）と彼の同僚はＴＡタイ
プのステープル装置に関連してポリジオキサノン（ｐｏ
ｌｙｄｉｏｘａｎｏｎｅ）リボンの使用を述べている。
ここでは１９８９年の「胸部心臓血管手術誌」の９７巻
３６２頁〜３６３頁に記載の「激しい肺気腫の肺におけ
る強化縫合線」という名称の論文を参照する。本論文に
記載の方法は可成り良く作用するが、リボン材料は外科
用ステープラにおいて実施されているナイフでは容易に
切断されず、また縫合線を重ねるのに適していない。
【０００４】１９８９年の「胸部心臓血管手術誌」の９
７巻６１頁においてアール．エム．ピータース（Ｒ．
Ｍ．Ｐｅｔｅｒｓ）は接着帯片によりステープル装置に
取り付けた薄いテフロンのフエルトの使用を報告してい
る。ティ．ナカムラ（Ｔ．Ｎａｋａｍｕｒａ）他は、１
９９２年度「日本肺外科誌」（Ｊａｐａｎ ＬｕｎｇＳ
ｕｒｇ．Ｊ．）の４０巻（１０）１８２６頁において、
気管支断端を閉鎖する綿撒糸として、あるいは肺の切除
境界部を手で重ね縫いするためのパッチとしてポリグリ
コール酸の不織布の使用を記述している。
【０００５】本発明は、患部の組織の除去に続いて縫合
線を効果的に強化する外科用ステープルガンと共に用い
る改良された用品であって、縫合線における組織の破断
の発生を低下させるのみならず、肺容積減少手段の場
合、患部の肺組織の除去に続いて除去境界部を閉鎖する
ために用いたステープルに沿った術後の空気の漏れの発
生を大いに低下させる改良された用品に関する。本発明
の使用を使用環境として肺の手術を用いて説明するが、
本発明による用品は、例えば漏れを排除するために腸断
片を接合するように設計されたもののような非直線ジョ
ーを有するステープルガンと共に使用することもでき
る。
【０００６】
【発明が解決しようとする課題】本発明によれば、患部
の組織を除去する方法は、一方がステープルのカートリ
ッジを保持し、他方が、それに対してステープルが発進
されるアンビル部材である一対の並置したジョーを有す
る外科用ステープルガンをまず提供する段階を含む。手
術時、好ましくは牛、馬あるいはその他の適当な動物の
心膜あるいは硬膜の適当になめした片から形成された、
宿主組織と適合しうる異種固体あるいは自原的な（以下
単に動物の組織と称する）組織帯片を外科ステープラの
並置したジョーに適当に固定する。次いで、患者に開口
を作り切除すべき患部の組織を露出させ、動物の組織帯
片を取り付けた外科ステープルガンを、切断すべき患者
の組織が対のジョーの間に配置されるように位置させ
る。ステープルガンが作動され、なめした動物の組織帯
片と患者自身の組織の間で、かつアンビル部材に対して
複数列の近接隔置したステープルをカートリッジから同
時に発射すると、患者の組織は動物の組織帯片の間で効
果的に挟圧される。次に、ステープルガンすなわちメス
（ｓｃａｌｐｅｌ）を採用してステープルの列の間の線
に沿って動物の組織帯片と患者の組織とを切断する。グ
ルタルアルデヒドでなめした牛、馬、豚、羊、および人
間の心膜または硬膜が動物の組織帯片の材料として用い
られる場合、それらは穿孔のために用いられたステープ
ルに対する自己閉鎖性を示すので、肺切除あるいは肺に
係わるその他の手術法の場合ステープル本体に沿った空
気の逃げに対して効果的に密閉することが判明してい
る。
【０００７】
【課題を解決するための手段】一実施例により前記の方
法を実行する場合、ステープルガンのジョーと嵌合し、
緊密に囲繞するような寸法とされたチューブ状スリーブ
が、デュポン社（ＤｕＰｏｎｔ Ｃｏｍｐａｎｙ）によ
ってＴＹＶＥＫTMの商標で販売されているもののような
不織製ポリエチレン材料からバットレス部材を作ること
により形成される。この材料の長方形の帯片がＵ字形に
曲げられ、前述した種類のなめした動物の組織の帯片が
次に、例えば仮縫いによりバットレス部材の並置した側
部に取り付けられ、仮縫いの継目を合わせて閉鎖された
チューブ状構造体を形成する。これらのチューブ状スリ
ーブは動物の組織帯片を作動カートリッジおよびステー
プルガンのアンビル面上に位置させてステープルガンの
ジョーの上を容易に滑べらせることができる。スリーブ
は、なめした動物の組織の帯片がステープラガンの使用
の間ステープラのジョーの相合面から容易に回転した
り、あるいはステープラから滑り落ちないように設計さ
れている。
【０００８】ステープラの作動の後で、手術手順を完了
する前に、動物の組織帯片をバットレス部材に取り付け
るために使用されるフィラメントがバットレス部材自体
と同様に切断され、かつ取り外され、なめされた動物の
組織帯片を残しステープルによる縫合線を強化させる。
【０００９】本発明による方法とバットレス部材（用
品）とを用いることにより、患者の肺の拡散肺気腫を伴
う水泡状および非水泡状部分の双方に双方向の楔状切開
を実行し肺力学を向上させた。塩水を加えてステープル
を付与し、それに続いて肺を再びふくらませたが、殆ん
どの患者はステープル縫合線に沿って何ら確認しうるよ
うな空気の漏れは発生しなかった。その結果、殆んどの
患者に対して入院時間が著しく低減した。本発明による
用品を用いることによりステープルガンを発射する前に
ステープルガンにステープル縫合線強化帯片を位置さ
せ、かつ保持するのに要する時間を大きく低減させる。
【００１０】本発明の前述の特徴、目的および利点は、
特に添付図面と関連して検討すると本発明の好適実施例
の以下の詳細説明から当該技術分野の専門家には明らか
となる。
【００１１】
【実施例】図１を参照すれば、手術の手順の過程におい
て縫合線を強化するために使用する本発明の一実施例に
より構成された用品が示されている。前記用品は全体的
にＵ字形のバットレス部材１０を提供するように折り曲
げられた可撓性の合成樹脂材の全体的に長方形のシート
すなわちフィルムからなることが判る。限定的ではない
が、バットレス部材１０を構成するフィルムは、例えば
デュポン社からＴｙｖｅｋの商標で販売されている不織
のポリエチレンシートから構成してもよい。前記材料は
殺菌可能で、手術時に使用するに先立って殺菌水中に１
％の酸化プロピレンを入れたような液中で貯蔵すること
ができる。
【００１２】バットレス部材１０の全体的に平行の側部
の間には適当になめした組織の帯片１２が支持されてお
り、該帯片の好適な材料は交差結合した牛、馬、豚、
羊、人間あるいはその他の適当な動物の心膜あるいは硬
膜である。この材料の中の一種類（牛の心膜）は本特願
の譲受人によって、ＰＥＲＩ−ＧＵＡＲＤTMおよびＳＵ
ＰＰＬＥ ＰＥＲＩＧＵＡＲＤの商標で市販されてい
る。人間の組織に使用する牛の心膜を採取し、処理する
場合、該材料はグルタルアルデヒド溶液中で交差結合さ
れる。ＳＵＰＰＬＥ ＰＥＲＩ−ＧＵＡＲＤおよびＰＥ
ＲＩＧＵＡＲＤ材料は過去ヘルニア修復や人間の心臓手
術に続く心膜閉鎖において使用するパッチとして使用さ
れてきた。牛の心膜はその他の殆んどの結合組織よりも
膠原の密度がはるかに高く、かつ例えば滑らかな筋肉や
脂質のような非膠原組織成分の含有がはるかに少ないの
で、かつ心膜がグルタルアルデヒドと交差結合され、組
織の抗原性を低下させるので、隣接する組織における炎
症反応は殆んど無いか、あるいは皆無であることは明ら
かである。
【００１３】なめした（交差結合した）動物の組織の帯
片１２はフィラメント１４を縫製材料として用いてバッ
トレス部材１０の自由端に沿って相互に仮縫いすること
により一時的にバットレス部材１０に固定される。限定
的でないが、例えばジョンソン．アンド．ジョンソン社
のエッチコン事業部（Ｅｔｈｉｃｏｎ Ｄｉｖ． ｏｆ
Ｊｏｈｎｓｏｎ ＆ Ｊｏｈｎｓｏｎ Ｃｏｒｐ．）
から市販されている３．０ ＰｒｏｌｅｎｅTM縫合材料
は優れた結果を提供する。
【００１４】さて、図２を参照すれば、外科用ステープ
ラが全体的に１８で指示されている。図示した特定の外
科用ステープラは３Ｍ社のヘルスケア事業部（Ｈｅａｌ
ｔｈｃａｒｅ Ｄｉｖｉｓｉｏｎ ｏｆ ｔｈｅ ３Ｍ
Ｃｏｍｐａｎｙ）から市販されているＩＬＡ−７５型
の使い捨てステープラである。しかしながら、本発明は
３Ｍ社で製造されているもの以外の外科用ステープラに
使用可能で、図示装置に限定されないことを理解すべき
である。外科用ステープル装置１８の構造と作動モード
に関するより多くの情報を希望する向きは本明細におい
て引用している米国特許第５，１４１，１４４号および
それ以外の特許を参照されたい。
【００１５】本発明の実施に係わる特定モデルの外科用
ステープラとは無関係に、外科用ステープラはステープ
ルカートリッジを支持するジョー２０と、固定部分２４
と該固定部分に２８において取外し可能にヒンジ接続さ
れている可動部分２６とを含む二部分構成のハンドルか
ら延びているアンビル支持ジョー２２とを一般に有して
いる。カートリッジ支持ジョー２０は、前記部分２４と
２６とが閉鎖位置にあると、ジョー２２によって支持さ
れるアンビル３０と対向してジョーの部分２０に対して
長手方向に向いた列に配置された複数のステープルを入
れたカートリッジ本体（図示せず）を保持している。
【００１６】図１に示す用品は、その長手方向の開口す
なわちルーメン１３が、動物の組織帯片１２をジョー２
０のステープルカートリッジに対して、かつジョー２２
のアンビル３０に対して位置させて外科用ステープラの
ジョー２０，２２の一方を受け入れるような寸法とされ
ている。本発明の用品は適当な寸法で提供されるので、
バットレス部材１０と、該部材が装嵌されるジョーの外
面との間で緊密な嵌合が達成される。図１に示す用品
は、それが取り付けられているジョーの周りで回転しな
いように抑制されることにより、ステープラのジョーが
縫合し、後で切断すべき組織と係合するにつれてジョー
２０，２２の協働する面の間に確実に残るようにする。
【００１７】図３のフロー線図に示すように、医師はま
ず、切開すべき患部の組織に外科的にアクセスする。次
に、医師あるいは助手は図１に示す用品を、それらが貯
蔵されている容器と殺菌溶液から取り出し、既存のプロ
トコルに従って洗滌し、前記用品の２個を外科用ステー
プラ１８の並置したジョーの間へ滑り込ませ、ジョーの
並置した面が宿主に適合する動物の組織の帯片１２によ
って被覆される。医師は次に、外科用ステープラガン１
８の被覆されたジョーを切開すべき組織の周りに位置さ
せる。このように位置させると、医師は次にステープル
ガンを作動させ、多数の列の緊密隔置のステープルを同
時に発射させる。ステープルは並置した動物の組織の第
１の層１２を通してステープルカートリッジまで進入
し、次に宿主組織を通して、そして最終的にアンビルを
被覆している動物の組織の帯片１２を通って進入する。
ステープルはアンビルに衝突すると曲げられ、動物の組
織帯片の外層の間で切断すべき組織を閉鎖し、緊密に密
封する。
【００１８】外科用ステープルガンは一般に、往復運動
可能のブレードを組み入れており、外科用ステープラの
ハンドル部分にレバーを滑べらせることにより作動させ
られるとブレードを隣接する列のステープルの間の線で
横行させる。このため１列以上のステープルによって画
成される境界に沿って切開すべき組織を切断する。ブレ
ードはまた、本発明と共に用いられると患者の組織と共
に２枚の動物の組織を長手方向に切断するように機能す
る。もしもステープルガンがブレードを組み込んでいな
い場合はこの目的に対して標準的なメスを用いることが
できる。
【００１９】ブレードあるいはメスの作動に続いて、医
師あるいは助手は仮縫いフィラメント１４を外し、バッ
トレス１０を動物の組織帯片から外し、バットレスおよ
び切開した患部の組織を閉鎖に先立って患者から取り除
くことができる。
【００２０】本特願譲受人によって使用される製造方法
によりなめされた牛の心膜並びに前述したその他の異種
固体あるいは自原的組織は、該組織を穿孔するために作
られた目標を密封すなわち閉鎖する特性を示す。このよ
うに、肺の縮小手術において前述の手順が用いられる
と、なめした動物の組織材料がステープルの周りで閉鎖
するため空気の漏洩を阻止するシールを創り出す。
【００２１】本発明による用品は、ステープラを追って
切断する組織に位置させる間で、かつステープルガンを
作動させる前に外科用ステープラのジョーの協働面に対
して動物の組織帯片１２を保持するように作用するが、
ステープラのジョーの並置した面に組織帯片を一時的に
固定するその他の方法も利用できる。例えばステープラ
の並置した面あるいはなめした動物の組織帯片の一方の
面に非毒性の生物分解性の接着材料を付与してステープ
ルガンが作動するまで前記帯片を適所に保持することが
できる。また、組織帯片を通り、ステープルガンのジョ
ーに適合するように配置されている縫合ループがバット
レス部材１０の代替として作用しうる。さらに、図示し
たステープルガンと、ステープル用バットレスは一般に
直線形であるが、本発明はその形状に限定されるものと
解釈すべきでない。Ｃ字形をしたり、あるいはその他の
アンビルやステープルカートリッジを支持するジョーの
形状を有するその他の種々の外科用ステープラが各種の
特殊な外科手法において用いるように市販されている
が、当該技術分野の専門家はこれらのその他の装置に適
合する適当な形状のバットレスを構成する方法を考える
ことができる。
【００２２】本発明を特許制定法を満足するために、か
つ当該技術分野の専門家に対して新規な原理を適用し、
前述のような特殊な要素を構成し、かつ使用する上で必
要とする情報を必要に応じて提供するために可成り詳細
に本発明を説明してきた。しかしながら、本発明は詳し
くは相違する装置や設備によって実行でき、かつ設備の
細部や作動手順について本発明の範囲から逸脱すること
なく種々の修正を達成しうることを理解すべきである。
【図面の簡単な説明】
【図１】本発明の好適実施例の斜視図。
【図２】外科用ステープラに位置した図１に示す装置を
示す図。
【図３】本発明による方法の段階を説明するフロー線
図。
【符号の説明】
１０ バットレス部材 １２ 組織帯片 １４ フィラメント １８ 外科用ステープラ ２０ ステープルカートリッジ支持ジョー ２２ アンビル支持ジョー ２４ ハンドルの固定部分 ２６ ハンドルの可動部分 ２８ 枢着点 ３０ アンビル
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ロバート ピー．ネルソン アメリカ合衆国ミネソタ州オロノ，ミネト ンカ ハイランド レイン 679 (72)発明者 ケマル シャンケレリ アメリカ合衆国ミネソタ州スティルウオー ター，ニール アベニュー ノース 7979 (72)発明者 クリスチン エム．タイヒ アメリカ合衆国ミネソタ州エデン プレイ リー，ブラケット ロード 6448

Claims (24)

    【特許請求の範囲】
  1. 【請求項１】 バットレス部材によって支持され、チュ
    ーブ状形状を画成する宿主組織と適合しうる動物の組織
    材料の帯片を含むバットレス部材であって、前記の動物
    の組織材料の帯片に取外し可能に取り付けられているこ
    とを特徴とするバットレス部材。
  2. 【請求項２】 前記の宿主組織と適合しうる動物の組織
    材料が、馬、牛、豚、羊および人間を含む群から選択し
    た動物から採取した交差結合の心膜であることを特徴と
    する請求項１に記載のバットレス部材。
  3. 【請求項３】 宿主組織と適合しうる動物の組織材料が
    馬、牛、豚、羊および人間を含む群から選択した動物か
    ら採取した交差結合の硬膜であることを特徴とする請求
    項１に記載のバットレス部材。
  4. 【請求項４】 前記動物の組織材料が前記帯片を穿孔す
    る対象物の周りで密封性を示すことを特徴とする請求項
    １に記載のバットレス部材。
  5. 【請求項５】 前記バットレス部材が可撓性の、殺菌可
    能の自立性フィルムシートからなることを特徴とする請
    求項１から４までのいずれか１項に記載のバットレス部
    材。
  6. 【請求項６】 前記フィルムシートが不織ポリエチレン
    であることを特徴とする請求項５に記載のバットレス部
    材。
  7. 【請求項７】 宿主組織と適合しうる動物の組織の前記
    帯片がフィラメントにより前記バットレスに取り付けら
    れていることを特徴とする請求項１に記載のバットレス
    部材。
  8. 【請求項８】 前記フィラメントがポリエチレンの縫合
    糸であることを特徴とする請求項７に記載のバットレス
    部材。
  9. 【請求項９】 切断された組織の境界を接合し、かつ閉
    鎖するために使用する外科用ステープルガンであって、
    閉鎖すべき切断された組織を通してステープルガンが作
    動されるとアンビル支持ジョーに対して概ね同時に発射
    すべき複数の列に配列された複数のステープルを入れた
    ステープルカートリッジを保持するステープルカートリ
    ッジ支持ジョーを有し、さらにカートリッジ支持ジョー
    とアンビル支持ジョーの中の一方において往復運動可能
    の組織切断手段を含む外科用ステープルガンと、ステー
    プルカートリッジからステープルが発射される前にカー
    トリッジ支持ジョーとアンビル支持ジョーとにそれぞれ
    作動結合された宿主組織と適合しうる動物の組織材料の
    第１と第２の帯片との組合わせ。
  10. 【請求項１０】 前記動物の組織が馬、牛、豚、および
    羊を含む群から選択した動物から採取し、なめした心膜
    であることを特徴とする請求項９に記載の組合わせ。
  11. 【請求項１１】 前記動物の組織が、馬、牛、豚、羊お
    よび人間を含む群から選択した動物から採取し、なめし
    た硬膜であることを特徴とする請求項９に記載の組合わ
    せ。
  12. 【請求項１２】 前記第１と第２の帯片が各々第１と第
    ２のバットレス部材によって支持され、各々がカートリ
    ッジ支持ジョーとアンビル支持ジョーの中の一方を受け
    入れるようにつくられた個別のチューブ状形態を形成す
    ることを特徴とする請求項９から１１までのいずれか１
    項に記載の組合わせ。
  13. 【請求項１３】 前記第１と第２のバットレス部材の各
    々が、第１と第２の帯片の一方を並置の側縁部に解放可
    能に接合させてチューブ状形態を形成している全体的に
    長方形で、可撓性で、殺菌可能で自立性のフィルムから
    なることを特徴とする請求項１２に記載の組合わせ。
  14. 【請求項１４】 チューブ状形態の寸法が、カートリッ
    ジ支持ジョーあるいはアンビル支持ジョーの周りで自由
    に回転しないようなものであることを特徴とする請求項
    １３に記載の組合わせ。
  15. 【請求項１５】 前記第１と第２の帯片がそれぞれ、第
    １と第２のバットレス部材を構成するフィルムに取り付
    けられていることを特徴とする請求項１３に記載の組合
    わせ。
  16. 【請求項１６】 前記第１と第２の帯片が第１と第２の
    バットレス部材を構成するフィルムにモノフィラメント
    により取り付けられていることを特徴とする請求項１５
    に記載の組合わせ。
  17. 【請求項１７】 前記モノフィラメントがポリエチレン
    の縫合材料であることを特徴とする請求項１６に記載の
    組合わせ。
  18. 【請求項１８】 前記第１と第２のバットレス部材を構
    成するフィルムが不織ポリエチレンシート材料であるこ
    とを特徴とする請求項１３に記載の組合わせ。
  19. 【請求項１９】 患部組織を除去する手術手順を実行す
    る方法において、 （ａ） 患者に開口を作り切開すべき患部組織を露出さ
    せる段階と、 （ｂ） 一方がステープルのカートリッジを保持し、他
    方がステープルが発射されるアンビル部材である一対の
    並置ジョーを有する外科用ステープルガンを提供する段
    階と、 （ｃ） 前記対の並置ジョーの少なくとも一部を宿主組
    織と適合しうる動物の組織の帯片で被覆する段階と、 （ｄ） 患者の切断すべき組織が前記対のジョーの間に
    配置されるように外科用ステープルガンを位置決めする
    段階と、 （ｅ） 前記動物の組織帯片を通して、かつ患者の組織
    を前記アンビル支持部材に対して前記カートリッジから
    少なくとも二列の緊密隔置のステープルを同時に射出す
    るようにステープルガンを作動させる段階と、 （ｆ） 前記列のステープルの間線に沿って前記動物の
    組織帯片と前記患者の組織とを切断する段階と、 （ｇ） 患者の前記開口を閉鎖する段階とを含む手術手
    順を実行する方法。
  20. 【請求項２０】 前記対の並置ジョーの少なくとも一部
    を被覆する段階が、各々バットレスに接着された前記動
    物の組織帯片を含む一対のチューブ状部材を前記対の並
    置ジョーの上で個別に滑べらせることを含むことを特徴
    とする請求項１９に記載の方法。
  21. 【請求項２１】 請求項１９に記載の（ｆ）の段階に続
    き、そして（ｇ）の段階の前に前記動物の組織帯片から
    前記バットレスを取り除く段階をさらに含むことを特徴
    とする請求項２０に記載の方法。
  22. 【請求項２２】 前記動物の組織の帯片が、馬、牛、
    豚、羊および人間を含む群から選択した動物から採取
    し、なめした心膜の帯片であることを特徴とする請求項
    １９から２１までのいずれか１項に記載の方法。
  23. 【請求項２３】 前記動物の組織帯片が、馬、牛、豚、
    羊、人間を含む群から選択した動物から採取し、なめし
    た硬膜の帯片であることを特徴とする請求項１９から２
    １までのいずれか１項に記載の方法。
  24. 【請求項２４】 前記バットレスが、Ｖ字形に形成さ
    れ、並置した側縁部が相互から離隔された不織ポリエチ
    レンの可撓性の長方形シートであり、前記動物の組織帯
    片がフィラメントによってシートの並置した側縁部の間
    で仮縫いされており、動物の組織からバットレスを取り
    外す段階がフィラメントを切断し、取り除くことを含む
    ことを特徴とする請求項２１に記載の方法。
JP7021969A 1994-02-10 1995-02-09 バットレス部材と組織材料の帯片とを含む製品 Expired - Lifetime JP3040930B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/194,382 US5503638A (en) 1994-02-10 1994-02-10 Soft tissue stapling buttress
US194382 1994-02-10

Publications (2)

Publication Number Publication Date
JPH0833641A true JPH0833641A (ja) 1996-02-06
JP3040930B2 JP3040930B2 (ja) 2000-05-15

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Country Link
US (3) US5503638A (ja)
EP (1) EP0667119B1 (ja)
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WO2005007208A1 (ja) * 2003-07-17 2005-01-27 Gunze Limited 自動縫合器用縫合補綴材
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US5549628A (en) 1996-08-27
EP0667119A1 (en) 1995-08-16
DE69500014D1 (de) 1996-08-22
CA2139830C (en) 1999-04-13
DE69500014T2 (de) 1997-02-20
EP0667119B1 (en) 1996-07-17
US5575803A (en) 1996-11-19
US5503638A (en) 1996-04-02
CA2139830A1 (en) 1995-08-11
JP3040930B2 (ja) 2000-05-15

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