JP2021132806A - Auxiliary instrument for aortic surgery, and surgical auxiliary instrument set - Google Patents

Abstract

To provide a surgical auxiliary instrument and a surgical auxiliary instrument set, which enable an artificial blood vessel appropriate for a valve size to be easily found out during the surgery.SOLUTION: A surgical auxiliary instrument 10 has a cylinder part 12. The cylinder part 12 has one end 12 provided with a plurality of recesses 16 constituted so that a thread can be put thereon during a surgery, and has the other end 18 put toward the valve during the surgery. A surgical auxiliary instrument set 20 has the plurality of surgical auxiliary instruments 10 different in the size of the cylinder part 12.SELECTED DRAWING: Figure 1A

Description

The present invention relates to surgical aids and sets of surgical aids for the aorta.

Non-Patent Document 1 introduces the latest surgical treatment for Malfan syndrome. Marfan syndrome is a disease that develops in a wide range of age groups from children to adults, and is known to develop valvular heart disease and aortic dissection, resulting in sudden death.

As a standard operation for aortic speech dilatation (enlargement of the aortic base = Barsalva sinus) associated with Malfan syndrome, there is a bentol method performed with an artificial valve and an artificial blood vessel. In the Bentall method, the coronary artery is hollowed out in a button shape, the coronary artery is reconstructed by interposing it with a small-diameter artificial blood vessel, an artificial valve is sewn into the artificial blood vessel, and the aortic valve is replaced with a valved artificial blood vessel with a skirt. The caliber prosthesis is sutured to the valved prosthesis to complete the base replacement. However, since the Bentall method uses an artificial valve, there are few applicants.

There is also a method called self-valve-preserving aortic base reconstruction (David surgery) that uses one's own valve. However, when the inventor of the present application used this method, he experienced a case in which the aortic valve leaked due to deformation of the annulus. We also experienced a case in which the aortic valve leaked after using the Valsalva graft temporarily. In addition, we have also experienced that aortic valve leakage is likely to occur during simultaneous surgery with mitral valve formation. Therefore, in the latest method improved by the inventor of the present application, the fixation of the base under the valve is reduced to 3 needles, and the deformation of the annulus is eliminated as much as possible.

Shigeyuki Aomi, "Latest Surgical Treatment for Marfan Syndrome-Latest Self-valve Conserving Surgery and Total Aortic Replacement for Aortic Ring Dilation-", Nihon Rinshosha Publishing, Nihon Rinsho Vol. 75, Special Issue 5 (2017), 402 ~ 407 pages

The prosthesis used during self-valve-preserving aortic root reconstruction should be sized appropriately for the valve. For example, if an artificial blood vessel with a large diameter is selected, the center of the valve will remain open. Even if the size of the artificial blood vessel is calculated and determined by a CT scan before the operation, it may be better to use an artificial blood vessel of another size in the actual operation. In such a case, it is not desirable to select an artificial blood vessel of a different size instead of the artificial blood vessel once taken out and used, because the original artificial blood vessel is wasted.

An object of the present invention is to provide a surgical assisting instrument and a surgical assisting instrument set that make it easy to find an artificial blood vessel suitable for the size of a valve during surgery.

The surgical aid according to one aspect of the present invention is a surgical aid used for aortic surgery, which has a tubular portion, and the tubular portion may be threaded at one end during surgery. It has a plurality of freely configured recesses, the other end of which is directed toward the valve during surgery.

The surgical auxiliary instrument set according to one aspect of the present invention has a plurality of surgical auxiliary instruments having different cylinder sizes.

According to these aspects, when the doctor has the other end of the tube facing the valve during the operation, the plurality of recesses in the tube are arranged so as to be located on the front side when viewed from the doctor. .. Here, for example, if there is a thread fixed to the lower part of the valve, the doctor can pull it to see if the three commissures fit inside the tube. At this time, since the pulled thread can be hung on the concave portion of the cylinder portion, the confirmation work becomes easy. Then, when it is confirmed that the three commissures fit inside the tube, the doctor can select an artificial blood vessel having the same diameter as the tube, and the artificial blood vessel of an appropriate size corresponding to the valve can be selected. You can perform surgery at. On the other hand, if the three commissures do not fit (ie, separate or overlap) inside the tube, the doctor can also try surgical aids on the tube that are larger or smaller in size. , It is possible to find an artificial blood vessel of an appropriate size corresponding to the valve and perform surgery.

In the above aspect, the number of the plurality of recesses is preferably three. By doing so, the number of recesses corresponding to the number of three commissures can be made.

In the above aspect, the plurality of recesses may be arranged at equal intervals. By doing so, the thread can be hung in the recess in a well-balanced manner, which facilitates the work by the doctor.

In the above-mentioned surgical auxiliary instrument set, it is preferable that the plurality of surgical auxiliary instruments have the same height of the tubular portion and different inner diameters of the tubular portion. By doing so, since the heights of the plurality of surgical assist instruments are the same, it becomes easy to handle and manage the plurality of surgical assist instruments corresponding to the plurality of inner diameters.

According to the surgical assist device and the surgical assist device set of the aorta of the present invention, it is easy to find an artificial blood vessel suitable for the size of the valve during the operation.

It is a perspective view of the surgical assist instrument which concerns on embodiment. FIG. 1B is a cross-sectional view taken along the line BB of FIG. 1A. It is a top view of the surgical aid instrument of FIG. It is a side view of the surgical aid instrument of FIG. It is a bottom view of the surgical aid instrument of FIG. It is a perspective view of the surgical assisting instrument set which shows an example which includes a plurality of kinds of surgical assisting instruments which concerns on embodiment. It is a figure which shows the autologous valve preservation aortic base reconstruction, (A) shows the state which the aortic base was excised and the coronary artery was hollowed out in the shape of a button, (B) cut out the valve, and fixed the root of an artificial blood vessel. It shows a state in which a thread for sewn is sewn to the muscle under the valve at three points, and (C) a state in which the valve is fixed in the artificial blood vessel and the coronary artery button is sewn to the artificial blood vessel is shown. It is a figure which shows the surgical auxiliary instrument which concerns on another embodiment, (A) is a side view, (B) is a perspective view. It is a figure which shows the surgical aid instrument which concerns on another embodiment, (A) is a side view, (B) is a perspective view.

A surgical aid according to a preferred embodiment of the present invention will be described with reference to the accompanying drawings. Surgical aids are used, for example, in self-valve-preserving aortic base reconstruction. For convenience of explanation, the front, back, left, right, top and bottom are based on those shown in FIGS. 1A to 3. In each figure, those having the same reference numerals have the same or similar configurations.

As shown in FIGS. 1A-2C, the surgical aid 10 has a tubular portion 12. The tubular portion 12 is made of, for example, a cylindrical member extending in the vertical direction. The upper end portion 14 (one end portion) of the tubular portion 12 is formed with three recesses 16 configured so that a thread can be hung during surgery. The recess 16 is, for example, a notch formed in the upper end portion 14, and is a portion slightly recessed from the upper end surface of the tubular portion 12. The three recesses 16 are evenly spaced in the upper end 14. Therefore, the three recesses 16 are arranged in the circumferential direction of the upper end portion 14 at a pitch of 120 degrees with the central axis of the tubular portion 12 as the center. The lower end 18 of the tubular portion 12 is a portion that is directed toward the valve during surgery. The lower end portion 18 is not formed with a recess, and therefore the lower end surface of the tubular portion 12 is a flat annular surface.

The surgical aid 10 can be made of, for example, plastic. The plastic may be any one that can be used for medical equipment, and for example, various materials such as polyvinyl chloride, polycarbonate, ABS resin, polypropylene, polyethylene, polystyrene, fluororesin, and polyethylene terephthalate can be used. Here, the transparent surgical aid 10 is molded from acrylic.

As shown in FIG. 3, the surgical auxiliary instrument set 20 has a plurality of surgical auxiliary instruments 10A, 10B and 10C (here, three as an example). The surgical aids 10A, 10B and 10C have different cylinder portions 12 from each other. Specifically, the surgical aids 10A, 10B, and 10C each have a tubular portion 12 having a different inner diameter in order to accommodate artificial blood vessels of a plurality of sizes (inner diameters). In the surgical assist instruments 10A, 10B and 10C, the heights of the tubular portions 12 are the same as each other.

An example of the dimensions of the surgical aid 10 is as follows. Regarding the tubular portion 12, the inner diameter is 26 mm, the outer diameter is 30 mm, the thickness is 2 mm, and the height is 40 mm. In the surgical auxiliary instrument set 20, the inner diameter of the tubular portion 12 can be made different from each other in units of several mm (for example, in units of 2 mm), for example, φ26 (surgical auxiliary instrument 10A), φ28 (surgical auxiliary instrument 10B) and φ30 (surgery). It can be an auxiliary device 10C). The recess 16 has a depth of 3 mm and a width (length in the circumferential direction) of 2 to 3 mm. The number of surgical aids 10 included in the surgical aid set 20 is not limited to the above three. For example, those having an inner diameter of φ24 and φ32 of the tubular portion 12 may be added to form a total of five surgical aids 10. Further, considering a special case, other sizes such as φ22 for children and φ34 and φ36 for large people may be included.

In the series of self-valve-preserving aortic base reconstruction (David surgery) shown in FIG. 4, first, as shown in FIG. 4 (A), the balsalva sinus (aortic base) is excised and the coronary artery is hollowed out in a button shape. Then, as shown in FIG. 4 (B), the valve is cut and threads 30, 31, and 32 are hung on the muscle under the valve. The threads 30, 31, and 32 are used to fix the root of the artificial blood vessel, and are fixed and sutured at three places. Then, as shown in FIG. 4C, the excised Valsalva sinus is replaced with the artificial blood vessel 40. The three commissures 50, 51, and 52 are sutured to the inner surface of the artificial blood vessel 40, and the coronary artery buttons 60 and 61 are also sutured to the artificial blood vessel 40. As the artificial blood vessel 40, one corresponding to the size of the valve is used.

The surgical aid set 20 according to the embodiment is used in the state shown in FIG. 4 (B). Specifically, in the state shown in FIG. 4B, the doctor seems to first correspond to the size of the valve among the surgical aids 10A, 10B and 10C in the surgical aid set 20 (). For example, select one having an inner diameter corresponding to the size of the artificial blood vessel (calculated and determined by preoperative CT scan). With respect to the selected surgical aid 10, the lower end 18 of the tubular portion 12 is placed toward the valve, and the surgical assist 10 is fitted to the outside of the valve. Then, the doctor pulls the three commissures 50, 51, 52 with the threads 30, 31, 32, and confirms whether the three commissures 50, 51, 52 fit inside the tubular portion 12. At this time, the doctor can hang the threads 30, 31, and 32 on each of the three recesses 16.

When it can be confirmed that the three commissural portions 50, 51, and 52 fit inside the tubular portion 12, the doctor may select an artificial blood vessel 40 having the same inner diameter as the tubular portion 12. By doing so, surgery can be performed using an artificial blood vessel 40 having an appropriate size corresponding to the valve.

On the other hand, if the three commissures 50, 51, and 52 do not fit inside the tube 12, the doctor may try the same confirmation work using a surgical aid 10 with an inner diameter different from that of the tube 12. good. For example, when the surgical aid 10B is used for the first time, if it can be confirmed that the three commissural portions 50, 51, 52 overlap inside the tubular portion 12, the inner diameter is larger than that of the surgical assist instrument 10B. Try the same with the surgical aid 10C. On the contrary, when the surgical assist instrument 10B is used for the first time, if it can be confirmed that the three commissural portions 50, 51, 52 are separated inside the tubular portion 12, the inner diameter is larger than that of the surgical assist instrument 10B. Try the same with a small surgical aid 10A. By doing so, it is possible to find an artificial blood vessel 40 having an appropriate size corresponding to the valve and perform surgery.

The surgical assist device 10 of the present embodiment described above is a measuring instrument for finding an artificial blood vessel suitable for the valve size in self-valve-preserving aortic base reconstruction. Therefore, during the operation, the artificial blood vessel 40 suitable for the valve size can be smoothly found. Further, since the surgical assist instrument 10 has three recesses 16, the re-fixed positions of the three commissures 50, 51, and 52 (the sewing position of the artificial blood vessel 40 shown in FIG. 4C) on the inner surface. ) Will also be useful in determining. This makes it possible to perform more accurate and highly reproducible surgery.

In addition, the surgical aid 10 is also advantageous in terms of cost. For example, it is not necessary to actually adjust the size using an artificial blood vessel in surgery. Therefore, it is not necessary to waste the artificial blood vessel when the size does not match. Further, since the surgical assist instrument 10 can be made of simple acrylic, the manufacturing cost thereof can be low.

FIG. 5 shows the surgical aid 100 according to another embodiment. In the surgical assist instrument 100, the memory display 122 is added to the outer surface 121 of the tubular portion 120 as compared with the surgical assist instrument 10 described above. The memory display 122 can be provided on the outer surface 121 by various methods, for example, surface shaving printing or ink notation. The memory display 122 has individual scales 124, 125, and 126 arranged at a predetermined pitch (for example, 5 mm pitch or 10 mm pitch) in the height direction of the tubular portion 120. Here, assuming a surgical aid 100 having a height of 40 mm, the memory display 122 has a pitch of 10 mm.

The individual scales 124, 125, and 126 are divided into a plurality of scales (here, three) in the circumferential direction of the tubular portion 120. To give an example, in the scale 124 pointing from the upper end portion 140 to 10 mm, the divided scales 124-1, 124-2, and 124-3 divided into three are arranged at equal intervals. This evenly spaced arrangement corresponds to the evenly spaced arrangement of the three recesses 160. That is, each recess 160 and each division scale of the scales 124, 125, and 126 are aligned in the height direction. However, in another embodiment, the individual scales 124, 125, and 126 may not be divided and may be continuous in the circumferential direction of the tubular portion 120.

FIG. 6 shows a surgical aid 200 according to another embodiment. Compared to the surgical aid 100 shown in FIG. 5, in the surgical aid 200, the memory display 222 includes a vertical line 300 extending in the height direction, and the individual scales 224 and 225 are arranged at a smaller pitch. I'm out. The vertical line 300 crosses the center of the individual scales 224 and 225. The scale 224 and the scale 225 are alternately arranged in the height direction, and the pitch between them is 5 mm. The scales 224 and 225 are all divided into three in the circumferential direction of the tubular portion 220, and the length of each of the divided scales 225 in the circumferential direction is the length of each of the divided scales 224 in the circumferential direction. It is shorter than the length.

The surgical aids 100 and 200 having the memory displays 122 and 222 as shown in FIGS. 5 and 6 further assist the doctor in the surgery. Specifically, the attachment positions of the valves and coronary artery buttons 60 and 61 to the artificial blood vessel 40 can be confirmed by the dimensions of the memory displays 122 and 222. Therefore, it is possible to perform surgery with higher reproducibility. In another embodiment, the memory displays 122 and 222 may include specific dimensions.

The embodiments described above are for facilitating the understanding of the present invention, and are not for limiting and interpreting the present invention. Each element included in the embodiment and its arrangement, material, condition, shape, number, size, and the like are not limited to those exemplified, and can be changed as appropriate.

For example, an example has been described in which threads 30, 31, and 32 are applied to each of the three recesses 16 at the time of surgery, but the relationship between the recesses and the threads is not limited to this. For example, if the aortic valve is uneven, such as a two-pointed valve, the thread at the commissure is fixed in only one place with three recesses, and the thread at the other two commissures is shifted so that the valve does not bend. It may be used. The three recesses may be used at positions where the aortic valve leaflets are assumed to be the same size, and may be shifted according to their morphology.

10, 10A, 10B, 10C ... Surgical aids, 12 ... Cylinder, 14 ... Upper end, 16 ... Recess, 18 ... Lower end, 20 ... Surgical aid set, 30, 31, 32 ... Thread, 40 ... Artificial blood vessels , 50, 51, 52 ... commissure, 60, 61 ... coronary button, 100 ... surgical aid, 120 ... tube, 121 ... outer surface, 122 ... memory display, 124, 125, 126 ... scale, 124-1, 124 -2, 124-3 ... split scale, 140 ... upper end, 160 ... concave, 200 ... surgical aid, 220 ... cylinder, 222 ... memory display, 224, 225 ... scale, 300 ... vertical line

Claims (8)

Surgical aid used for aortic surgery
Has a cylinder
The cylinder part
One end has a plurality of recesses configured to allow threading during the surgery.
A surgical aid with the other end facing the valve during the surgery. The surgical aid according to claim 1, wherein the number of the plurality of recesses is three. The surgical aid according to claim 1 or 2, wherein the plurality of recesses are evenly spaced. The surgical aid according to any one of claims 1 to 3, wherein each recess is a notch formed in one end of the tubular portion. The surgical aid according to any one of claims 1 to 4, wherein the surgical aid is transparent. The surgical aid according to any one of claims 1 to 5, wherein a memory display is provided on the outer surface of the tubular portion. The surgical assisting instrument set according to any one of claims 1 to 6, further comprising a plurality of surgical assisting instruments having different cylinder sizes. The surgical auxiliary instrument set according to claim 7, wherein the plurality of surgical auxiliary instruments have the same height of the tubular portion and different inner diameters of the tubular portion.

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