JP4616796B2 - Medical suture tool - Google Patents

Description

  The present invention relates to a medical suturing device for suturing a sutured portion in a patient's body.

  2. Description of the Related Art Conventionally, a medical suturing tool has been used to sew and fix a sutured portion in a patient's body, particularly a sutured portion composed of skin and internal organs. For example, for people whose function of ingesting food by their own mouth has decreased due to aging or illness, fluid food and drink such as liquid food and nutrients are supplied into the stomach using a gastrostomy tube. However, the gastrostomy tube is attached with a hole formed in the abdomen of the patient. In such a case, in order to properly attach the gastrostomy tube, it has been performed in advance to fix the abdominal wall and the stomach wall using a medical suturing tool (see, for example, Patent Document 1).

This medical suturing device is provided with two puncture needles installed in parallel at a distance, and when performing suturing, first, the two puncture needles are simultaneously punctured into a sutured portion of a patient. To do. Next, while passing the suture through one puncture needle, the other puncture needle was passed through the inner needle with a loop body made of a wire connected to the tip, and the suture body was grasped by the loop body within the patient's body. Pull out the inner needle from the puncture needle. Then, after pulling out the two puncture needles from the patient, the suture is completed by tying both side portions of the suture thread protruding outside the patient's body. In addition, the distal end of the puncture needle into which the inner needle is inserted is formed in a curved portion and the distal end opening faces sideways, so that when the inner needle is pushed into the puncture needle, the loop body moves in the lateral direction. The suture thread can be grasped by extending to the outside and projecting outside.
JP-A-5-161655

  However, in the conventional medical suturing tool, when the two puncture needles are pulled out from the patient, the suture thread grasped by the loop body must be operated with the two puncture needles while maintaining the state. There are problems that the operation becomes complicated and the stability of the stitching is lacking.

  The present invention has been made to cope with such problems, and an object of the present invention is to provide a medical suturing tool that is easy to operate and has improved stability of suturing.

In order to achieve the above-described object, a structural feature of the medical suturing device according to the present invention is that a linear gripping member is inserted from the proximal end side of the insertion hole of the extraction puncture needle. The proximal end of the insertion hole of the insertion puncture needle that protrudes from the opening formed on the distal end side of the extraction puncture needle and that is disposed substantially parallel to the extraction puncture needle while maintaining a predetermined distance. With the suture inserted from the side, the tip of the suture protrudes from the opening formed on the tip of the insertion puncture needle and extends toward the grip of the linear gripping member. a medical suturing tool capable of grasping the suture bunch lifting of O Ri linear gripping member to retract the gripper to the proximal end of the retrieval puncture needle member, the linear grasping member The advancing / retracting operation member can be connected to the proximal end side of the lens, and the advancing / retreating operation member can be advanced / retracted to the proximal end side of the puncture needle for removal When the retracting operation member is retracted and the gripping portion of the linear gripping member is retracted to the proximal end side of the extraction puncture needle, the advancement / retraction operation member moves forward relative to the extraction puncture needle. set only the advancement preventing means for preventing the, and the advancement prevention means, and the member for advancing and retracting operation while covering the outer peripheral surface of the proximal portion of the linear grasping member and the proximal side of the retrieval puncture needle And a member for advancing / retracting operation is constituted by a coil spring that urges the member toward the outside on the proximal end side of the puncture needle for extraction .

  In the medical suturing device according to the present invention configured as described above, the advancement / retraction operation member connected to the proximal end side of the linear gripping member and the advancement prevention for preventing the advancement / retraction operation member from moving forward from the retracted position. Means. Then, by moving the advance / retreat operation member back and forth, the grip portion of the linear grip member can be advanced and retracted from the opening formed on the distal end side of the puncture needle for extraction. Further, when the advancement / retraction operation member is retracted and the grip portion of the linear gripping member is retracted toward the proximal end side in the extraction puncture needle, the advancement / retraction operation member is moved relative to the extraction puncture needle by the advance prevention means. It prevents you from moving forward.

  That is, when the advancing / retracting operation member is retracted and the gripping portion of the linear gripping member is retracted to the proximal end side in the extraction puncture needle, when the suture is gripped by the gripping portion, or the suture thread Is grasped by the grasping portion and pulled into the extraction puncture needle, so that the advancement / retraction operation member can be prevented from moving inward of the extraction puncture needle, thereby grasping (engaging) the suture by the grasping portion. ) Can be prevented from being released. Thereby, in particular, the extraction puncture needle and the insertion puncture needle can be pulled out from the patient's body without manually operating the linear gripping member and the suture thread. In addition, since the engagement between the grip portion of the linear grip member and the suture is difficult to be released, the stability for the operation for stitching is increased.

  In this case, the advancement of the advance / retreat operation member refers to the movement of the linear gripping member to the inside of the patient's body with the medical suturing device punctured on the patient's body, and the advance / retreat operation member moves backward. This is to move the linear gripping member to the outside of the patient's body. Further, the forward movement preventing means is constituted by an urging means for urging the advance / retreat operation member to the backward side, an engagement means having a release means, etc., and the advance / retreat operation member is moved forward by the operator's intention. When moving to the position, it is possible to move forward by a predetermined method.

The medical suturing tool according to the present invention, the advancement prevention means are constituted by coil springs you biases the reciprocating operation member to the outside of the base end side of the retrieval puncture needle. According to this, the advance prevention means can be configured with a simple member. In this case , the magnitude of the elastic force of the coil spring is such that the operator can move the advance / retreat operation member forward against the elasticity of the coil spring , and the extraction puncture needle and the insertion puncture needle. When the needle is pulled out from the patient's body, it is set to a size that can prevent the advancement / retraction operation member from being advanced by being pulled by the suture . Another structural feature of the medical suturing device according to the present invention is that it is provided at the proximal end portion of the extraction puncture needle, and is connected to the insertion hole of the extraction puncture needle and one of the coil springs. A cylindrical gripping portion having a bottom portion for supporting the end portion of the coil and a peripheral surface provided with an engagement hole, and a telescopic engagement fixed to the other end portion of the coil spring and engageable with the engagement hole When the advancing / retracting operation member is advanced and the gripping portion of the linear gripping member is protruded from the opening of the puncture needle for removal, the engaging hole and the expansion / contraction engaging portion are engaged to advance / retreat. Advancing side fixing means for fixing the operation member to the extraction puncture needle is provided.

Another structural feature of the medical suturing device according to the present invention is that the linear gripping member is inserted from the proximal end side of the insertion hole of the extraction puncture needle, and the gripping portion on the distal end side of the linear gripping member is inserted. The suture thread is protruded from the opening formed on the distal end side of the extraction puncture needle, and the suture thread is inserted from the proximal end side of the insertion hole of the insertion puncture needle arranged substantially parallel to the extraction puncture needle at a predetermined interval. Insert and remove the gripping portion of the linear gripping member with the distal end portion of the suture thread projecting from the opening formed on the distal end side of the insertion puncture needle and extending to the gripping portion side of the linear gripping member A medical suturing tool capable of gripping a suture with a gripping portion of a linear gripping member by retreating to the proximal end side of the puncture needle for use, and a member for advancing and retracting to the proximal end side of the linear gripping member And attaching the advance / retreat operation member to the proximal end side of the puncture needle for removal in a state where it can be advanced / retracted, Preventing the advancement / retraction operation member from moving forward relative to the removal puncture needle when the retraction operation member is retracted and the grip portion of the linear gripping member is retracted toward the proximal end side of the extraction puncture needle. Providing advancement prevention means, and providing a vertically long rail portion on the proximal end side of the extraction puncture needle, and advancing and retreating operation member is constituted by a slide portion movable along the rail portion, the advancement prevention means, It is constituted by a retreat-side fixing member including an engaging portion provided at the base end portion of the rail portion and an engaged portion provided at the slide portion and engageable with the engaging portion . Retreating side fixing member in this case, it is possible to fix the retractable operating member by the engagement between the engaging portion and the engaged portion, and releases the engagement of its engaging portion and the engaged portion By doing so, the advancing / retreating operation member can be moved . According to this, it is possible to more reliably prevent the advance / retreat operation member from moving forward.

  Still another structural feature of the medical suturing device according to the present invention is that the advance / retreat operation is performed when the advance / retreat operation member is advanced to cause the grip portion of the linear grip member to protrude from the opening of the puncture needle for extraction. Advancing side fixing means for fixing the member to the extraction puncture needle is provided. According to this, since the position of the gripping portion when the gripping portion of the linear gripping member is protruded from the opening portion of the puncture needle for extraction can be fixed, the distal end portion of the suture is formed on the distal end side of the insertion puncture needle. The operation when protruding from the opened opening and engaging with the gripping portion of the linear gripping member becomes easy. That is, when the suture thread is inserted into the insertion puncture needle, it is not necessary to hold the advance / retreat operation member by hand.

(First embodiment)
A first embodiment of the present invention will be described below with reference to the drawings. 1 and 2 show a medical suturing device 10 according to the embodiment. The medical suturing tool 10 includes an upper holder 11 and a lower holder 12, and an insertion puncture needle 13 and an extraction puncture needle 14 that are detachably attached to the upper holder 11 and the lower holder 12. A pair of puncture needles, a linear gripping member 15 (see FIGS. 6 to 9), and a suture 16 are configured.

  The upper holder 11 and the lower holder 12 are each made of a molded body of a resin material, and the upper holder 11 is formed in a substantially square plate shape with a corner portion notched and formed into a curved surface. The tool 12 is formed in a substantially rectangular plate shape with a corner portion notched and formed into a curved surface. And the circular holding holes 11a and 11b are formed in the both sides of the upper holder 11 so that it may become a fixed distance on both sides of the center point of the upper holder 11, and it follows the longitudinal direction of the lower holder 12 On both sides, circular holding holes 12a and 12b are formed at the same interval as the holding holes 11a and 11b.

  The insertion puncture needle 13 is composed of a stainless steel cylindrical body having an insertion hole 13a (see FIGS. 6 to 9) formed therein, and a resin gripping portion 17 at the base end (upper end). Is attached. The gripping portion 17 is formed in a cylindrical shape having a large diameter on the upper side and a small diameter on the lower side, and a guide hole 17a communicating with the insertion hole 13a is formed therein. The guide hole 17a is formed with a large diameter on the upper side and a small diameter on the lower side along the outer peripheral surface of the gripping part 17, so that the guide hole 17a can be inserted into the insertion hole 13a of the insertion puncture needle 13 from above the gripping part 17. It is easy to insert the suture thread 16 into.

  Further, the distal end portion (lower end portion) of the insertion puncture needle 13 is cut in an oblique direction so that the opening 13b can be seen from the lateral direction (extraction puncture needle 14 side). The insertion puncture needle 13 has the opening 13b directed toward the center side of the upper holder 11 and the lower holder 12, and the holding holes 11a of the upper holder 11 and the lower holder 12 It is inserted and held in the holding hole 12a. The upper holder 11 holds a portion in the vicinity of the proximal end portion of the insertion puncture needle 13, and the lower holder 12 is slightly more than the proximal end portion of the insertion puncture needle 13 at a distance from the upper holder 11. Holding the lower part. In this case, the attachment position of the lower holder 12 to the insertion puncture needle 13 is appropriately set according to the protruding amount of the lower portion of the insertion puncture needle 13 from the lower holder 12.

  Similarly to the insertion puncture needle 13, the extraction puncture needle 14 is composed of a stainless steel cylindrical body having an insertion hole 14a formed therein, and a resin gripping portion 18 is attached to the base end portion. Yes. The gripping portion 18 is formed in a cylindrical shape having a large diameter on the upper side and a small diameter on the lower side, and an insertion hole 18a that communicates with the insertion hole 14a is formed through the top and bottom in the center along the axial direction. ing. Further, as shown in FIGS. 3 to 5, an engagement hole 18 b penetrating from the inside to the outside is provided in the upper portion of the peripheral surface of the grip portion 18. Further, the distal end portion of the extraction puncture needle 14 is cut in an oblique direction so that the opening 14b can be seen from the lateral direction (the insertion puncture needle 13 side).

  As shown in FIGS. 6 to 9, the linear gripping member 15 includes a linear insertion rod 15a composed of a thin stainless steel rod and a bifurcated portion extending from the tip of the insertion rod 15a. It is comprised with the holding part 15b which consists of a thin line | wire by which the bending part was formed in the front-end | tip part. The linear gripping member 15 can be inserted into the insertion hole 14a of the extraction puncture needle 14, and the gripping portions 15b are spaced from each other in the direction orthogonal to the insertion rod 15a from the distal end portion of the insertion rod 15a. It extends to spread. Further, the gripping portion 15b can be deformed, and when it is located in the insertion hole 14a of the extraction puncture needle 14, it extends and becomes substantially linear as shown in FIGS. 6 and 9, and the extraction puncture needle When projecting from the opening 14b of the needle 14 to the outside, as shown in FIGS. 7 and 8, the needle 14 extends from the insertion rod 15a perpendicularly to the insertion puncture needle 13 side.

  In addition, a columnar gripping portion 19 as an advancing / retreating operation member of the present invention is attached to the upper end portion of the insertion rod 15a in the linear gripping member 15. In addition, the expansion / contraction engagement portion 21 is attached to the insertion rod 15a in the vicinity of the grip portion 19, and the coil spring 22 covering the outer peripheral surface of the upper portion of the insertion rod 15a is fixed to the lower end surface of the expansion / contraction engagement portion 21. Has been. The lower end portion of the coil spring 22 is supported by the bottom portion of the grip portion 18.

  The expansion / contraction engagement portion 21 is made of a flexible resin material, and a recess 23a is formed on one side of the upper surface, and a recess 23b is formed on the other side of the lower surface to apply a predetermined force. Therefore, it can be expanded and contracted in the longitudinal direction (left and right direction in FIGS. 3 to 5). Further, the lower surface of the end portion 24 on one side of the expansion / contraction engagement portion 21 is formed on an inclined surface 24a. Therefore, when the expansion / contraction engagement portion 21 is pressed downward (moving the insertion rod 15a downward) from the state shown in FIG. 3 to contract the coil spring 22, the expansion / contraction engagement portion 21 is shown in FIG. In this manner, the inclined surface 24a and the other end are contracted while being pressed against the inner peripheral surface of the insertion hole 18a, and enter the insertion hole 18a of the grip portion 18.

  And when the edge part 24 of the expansion-contraction engagement part 21 is located in the engagement hole 18b, the expansion-contraction engagement part 21 expand | extends and the edge part 24 and the engagement hole 18b engage. The expansion / contraction engagement portion 21 is fixed to the grip portion 18 by the engagement between the end portion 24 and the engagement hole 18b. When the end 24 of the telescopic engagement portion 21 is engaged with the engagement hole 18b, the gripping portion 15b of the linear gripping member 15 protrudes outside from the opening 14b of the extraction puncture needle 14, and the insertion puncture is performed. It is configured to extend and extend toward the needle 13 side.

  The coil spring 22 constitutes an elastic member as advance prevention means of the present invention, and the advance side fixing means of the present invention is constituted by the expansion / contraction engagement portion 21 and the engagement hole 18b of the grip portion 18. The extraction puncture needle 14 is inserted and held in the holding hole 11b of the upper holder 11 and the holding hole 12b of the lower holder 12 with the opening 14b facing the insertion puncture needle 13 side. The upper holder 11 and the lower holder 12 hold the extraction puncture needle 14 in parallel with the insertion puncture needle 13. The gripping portions 18 and 19 are made of a resin material molded product, and the suture thread 16 is made of a thin line made of a resin material.

  In this configuration, for example, when the patient's abdominal wall and stomach wall are sutured using the medical suturing device 10, first, the elastic engagement portion 21 is pulled up and inserted above the grip portion 18 by the elasticity of the coil spring 22. The upper side portion of the rod 15a is protruded above the grip portion 18. As a result, the linear gripping member 15 is pulled upward and is positioned in the insertion hole 14 a of the extraction puncture needle 14. The medical suturing device 10 in this state is pushed into the skin surface of the patient's abdomen, and the insertion puncture needle 13 and the extraction puncture needle 14 are inserted into the abdominal wall A and the stomach wall B as shown in FIG. . 6 to 9 used in the following description are drawings schematically showing the medical suturing tool 10, and the size and the like of each part are shown in FIGS. 1 and 2. It is different from the ingredient 10.

  In this case, the insertion puncture needle 13 and the extraction puncture needle 14 are inserted until the lower holder 12 hits the skin surface of the abdominal wall A so that the openings 13b and 14b are located on the inner side of the stomach wall B. Next, the grip portion 19 is pushed downward to push the upper side portion of the insertion rod 15a into the insertion hole 14a of the puncture needle 14 for extraction. As a result, the gripping portion 15b of the linear gripping member 15 is drawn out from the opening 14b to the outside of the extraction puncture needle 14, bent in the horizontal direction, and widened between the two piercing needles 13 side. To the state shown in FIG.

  In this case, the end 24 of the expansion / contraction engagement portion 21 and the engagement hole 18 b of the gripping portion 18 are engaged, and the expansion / contraction engagement portion 21 is fixed to the gripping portion 18. For this reason, the linear gripping member 15 is also stationary and the state shown in FIG. 7 is maintained. Next, as shown in FIGS. 1 and 8, the suture thread 16 is inserted into the insertion hole 13 a of the insertion puncture needle 13 from the guide hole 17 a of the grip portion 17. As a result, the distal end portion of the suture thread 16 proceeds downward in the insertion hole 13a and extends outwardly downward from the opening 13b. At this time, the distal end portion of the suture thread 16 enters the fork between the expanded gripping portion 15b.

  Next, the end portion 24 of the telescopic engagement portion 21 is pushed into the gripping portion 18 to release the engagement between the end portion 24 and the engagement hole 18b. At this time, due to the elasticity of the coil spring 22, the upper side portion of the insertion rod 15a rises so as to protrude above the gripping portion 18, and the gripping portion 15b is pulled upward together with the insertion rod 15a. It will be in the state shown in. At this time, the gripping portion 15b of the linear gripping member 15 is deformed so as to narrow the bifurcated portion, and the suture thread 16 is sandwiched, and the distal end portion of the suture thread 16 is gripped by the gripping portion 15b and is taken out. It enters into the 14 insertion holes 14a.

  Therefore, by pulling out the medical suturing device 10 from the patient's body in the state of FIG. 9, the suture thread 16 is in a state where both side portions are extended outside the patient's body so as to join the stomach wall B to the abdominal wall A. . By cutting the protruding side portions of the suture thread 16 so as to have a predetermined length, the state shown in FIG. 10 is obtained. Then, by connecting both ends of the suture thread 16, the state shown in FIG. The elastic force of the coil spring 22 is set to be larger than the force with which the linear gripping member 15 is pulled by the suture 16 when the medical suturing device 10 is pulled out from the patient's body. For this reason, when the medical suturing device 10 is pulled out from the patient's body, the linear gripping member 15 is prevented from returning to the inside of the insertion hole 14a of the extraction puncture needle 14, and the suture 16 is connected to the gripping portion 15b. The engaged state is maintained. As a result, stable stitching is possible.

  As described above, in this medical suturing device 10, the insertion rod 15 a on the proximal end side of the linear gripping member 15 is urged upward by the coil spring 22. Therefore, when the suture thread 16 is grasped by the grasping portion 15b and pulled into the insertion hole 14a of the extraction puncture needle 14, the insertion rod 15a is pulled into the insertion hole 14a, and the suture thread by the grasping portion 15b. 16 can be prevented from being released. Accordingly, the extraction puncture needle 14 and the insertion puncture needle 13 can be pulled out from the patient's body without holding and operating the linear gripping member 15 and the suture thread 16 by hand.

  Further, at that time, since the engagement between the grasping portion 15b and the suture thread 16 is difficult to be released, the operational stability is improved. Furthermore, the insertion rod 15a is provided with the expansion / contraction engagement part 21, and the gripping part 18 is provided with the engagement hole 18b that can be engaged with the end 24 of the expansion / contraction engagement part 21, so that the gripping part 15b of the linear gripping member 15 is provided. It is possible to fix the position of the gripping part 15b when it is protruded from the opening part 14b of the puncture needle 14 for extraction. For this reason, the operation when the distal end portion of the suture thread 16 protrudes from the opening portion 13b of the insertion puncture needle 13 and engages with the grip portion 15b is facilitated. That is, when the suture thread 16 is inserted into the insertion puncture needle 13, it is not necessary to hold the grip portion 19 by hand.

(Second Embodiment)
12 and 13 show a medical suturing tool 30 according to a second embodiment of the present invention. In this medical suturing tool 30, as shown in FIGS. 14 and 15, the advancing / retracting member connected to the upper end portion of the linear gripping member 35 and the retracting side fixing member as the advance preventing means are slidably engaged. The member 31 is configured. The slide engagement member 31 includes a vertically long rail portion 32 that extends in the vertical direction, a slide portion 33 that can slide up and down along the rail portion 32, and an insertion tube 39 that is connected to the center of the lower end of the rail portion 32. It consists of and.

  The rail portion 32 is formed in a frame shape having a space inside, and a ring-shaped grip portion 32a is provided at the upper end portion. An engaging portion 34 having a substantially L-shaped cross section is formed at the upper end portion of the rail portion 32 after protruding forward and then bending and extending downward. Although not shown, an engagement protrusion is provided on the back surface of the piece extending below the engagement portion 34. The slide portion 33 is formed of an oval plate that is elongated in the left-right direction, and gripping holes 33a, 33b are formed on both the left and right sides. An engaging recess 36 that can engage with an engaging portion 34 (an engaging protrusion thereof, hereinafter referred to as an engaging portion 34) is formed in the upper center of the front surface of the slide portion 33.

  The engagement portion 34 and the engagement recess 36 are engaged when the slide portion 33 is moved to the upper side of the rail portion 32, and the slide portion 33 is moved to the lower side of the rail portion 32 from this state. Sometimes the engagement is released. The insertion tube 39 is composed of a resin tube body into which the linear gripping member 35 can be inserted. And the upper end part of the insertion rod 35a of the linear holding member 35 is connected with the center part of the lower end of the slide part 33. FIG. The linear gripping member 35 moves within the extraction puncture needle 14 as the slide portion 33 moves up and down. 14 and 15 show the state of the linear gripping member 35 in this case.

  For convenience of explanation, FIGS. 14 and 15 do not show the extraction puncture needle 14, but when the slide part 33 is moved to the lower side of the rail part 32 as shown in FIG. The upper end portion of the bar 35 a enters the extraction puncture needle 14, and the grip portion 35 b protrudes from the distal end portion of the extraction puncture needle 14. As a result, the gripping portion 35b expands. Further, as shown in FIG. 15, when the slide portion 33 is moved to the upper side of the rail portion 32, the upper end side portion of the insertion rod 35a enters the frame-shaped inner side of the rail portion 32, and the grip portion 35b. The most part of the retracted part enters into the extraction puncture needle 14. As a result, the gripping portion 35b extends linearly.

  The slide portion 33 constitutes the advancing / retracting operation member according to the present invention, and the engaging portion 34 and the engaging recess 36 constitute the retreat-side fixing member as the advance preventing means according to the present invention. Further, the medical suturing tool 30 is not provided with the advancing side fixing means. The configuration of the other parts of the medical suturing tool 30 is the same as that of the medical suturing tool 10 described above. Accordingly, the same parts are denoted by the same reference numerals and the description thereof is omitted.

  When the patient's abdominal wall A and stomach wall B are sutured using the medical suturing device 30 configured as described above, first, the slide portion 33 is pulled up to the upper side of the rail portion 32 to engage with the engaging portion 34. The recess 36 is engaged. As a result, the linear gripping member 35 is pulled upward, and the gripping portion 35 b is positioned in the insertion hole 14 a of the extraction puncture needle 14. FIG. 15 shows the linear gripping member 35 in this state. Next, the medical suture tool 30 in this state is pushed into the skin surface of the patient's abdomen, and as shown in FIG. 16, the insertion puncture needle 13 and the extraction puncture needle 14 are inserted into the abdominal wall A and the stomach wall B. Stab.

  16 to 19 used in the following description are also drawings schematically showing the medical suturing tool 30, and the size and the like of each part are shown in FIGS. 12 and 13. Different from the tool 30. Next, the slide part 33 is moved downward to push the insertion rod 35a of the linear gripping member 35 into the insertion hole 14a of the puncture needle 14 for removal. As a result, the gripping portion 35b of the linear gripping member 35 is drawn out from the opening 14b to the outside of the extraction puncture needle 14 and is in the state shown in FIG. FIG. 14 shows the linear gripping member 35 in this state. In FIG. 14, the slide engagement member 31 shows a state seen from the front, and the linear gripping member 35 shows a state seen from a direction different from FIG.

  In this case, the slide portion 33 is stationary with respect to the rail portion 32 due to the frictional force. For this reason, the linear gripping member 35 is also stationary and the state shown in FIG. 17 is maintained. Next, as shown in FIGS. 12 and 18, the suture thread 16 is inserted into the insertion hole 13 a of the insertion puncture needle 13 from the guide hole 17 a of the grasping portion 17. As a result, the distal end portion of the suture thread 16 extends outward and downward from the opening 13b, and enters the fork between the expanded gripping portion 35b.

  Next, the slide part 33 is moved upward to engage the engaging part 34 and the engaging concave part 36 to obtain the state shown in FIG. At this time, the gripping portion 35b of the linear gripping member 35 is deformed so as to narrow the bifurcated portion, and the suture thread 16 is sandwiched, and the distal end portion of the suture thread 16 is engaged with the gripping portion 35b and the extraction puncture is performed. The needle 14 enters the insertion hole 14a. In this case, the suture thread 16 is fixed by being pressed against the opening portion 14b of the extraction puncture needle 14 by the distal end portion of the grasping portion 35b. Accordingly, by pulling out the medical suturing tool 30 from the patient's body in the state of FIG. 19, the suture thread 16 is in a state where both side portions are extended outside the patient's body so that the stomach wall B is joined to the abdominal wall A. .

  By cutting the protruding side portions of the suture thread 16 so as to have a predetermined length, the state shown in FIG. 10 is obtained, and by connecting both ends of the suture thread 16, the state shown in FIG. 11 is obtained. Thus, the suturing is finished. The engaging force between the engaging portion 34 and the engaging recess 36 is set to be larger than the force with which the linear gripping member 35 is pulled by the suture 16 when the medical suturing tool 30 is pulled out from the patient's body. Yes. For this reason, when the medical suturing device 30 is pulled out from the patient's body, the linear gripping member 35 is prevented from returning to the inside of the insertion hole 14a of the extraction puncture needle 14, and the suture 16 is connected to the gripping portion 35b. The engaged state is maintained.

  As described above, in this medical suturing tool 30, the advance prevention means is constituted by the engaging portion 34 provided in the rail portion 32 and the engaging concave portion 36 provided in the slide portion 33. By engaging the mating recess 36, the slide portion 33 and the linear gripping member 35 can be reliably fixed. Further, by releasing the engagement between the engagement portion 34 and the engagement recess 36, the slide portion 33 and the linear gripping member 35 can be moved. The other effects of the medical suturing tool 30 are the same as those of the medical suturing tool 10 described above.

  Moreover, the medical suturing device according to the present invention is not limited to the above-described embodiments, and can be implemented with appropriate modifications. For example, in the above-described medical suturing devices 10 and 30, the gripping portions 15b and 35b are formed of a bifurcated linear body, and the gripping portion is formed of a loop-shaped linear body. May be. Further, the structure of the insertion puncture needle 13 and the extraction puncture needle 14 is not limited to the above-described embodiment, and the gripping portion 15b and the suture thread 16 can be engaged with each other outside the openings 13b and 14b. Any structure may be used as long as the structure is possible. Further, in each of the embodiments described above, the insertion puncture needle 13 and the extraction puncture needle 14 are made of stainless steel, but the material constituting them may be a resin material.

  Moreover, the shape of the upper holder 11 and the lower holder 12 is not plate-shaped, and can be constituted by members that are long in the vertical direction. According to this, it becomes easy to hold the upper holder 11 and the lower holder 12 by hand, and the operation at the time of puncturing becomes easy. Further, the insertion puncture needle 13 and the extraction puncture needle 14 are firmly fixed to the holder. Thereby, it is possible to prevent the distal end portions of the insertion puncture needle 13 and the extraction puncture needle 14 from being bent or bent so as to widen each other during puncturing. Furthermore, the upper holding tool 11 and the lower holding tool 12 can be configured as large ones, and a plurality of pairs of insertion puncture needles 13 and extraction puncture needles 14 can be provided thereon. According to this, since a plurality of places can be sewn in one operation, the operation can be performed efficiently in a short time. Furthermore, the medical suturing devices 10 and 30 according to the present invention can be used not only for suturing the abdominal wall A and the stomach wall B but also for suturing other parts of the body.

It is the perspective view which showed the medical suturing tool which concerns on 1st Embodiment of this invention. It is the perspective view which showed the state which engaged the suture of the medical suturing tool shown in FIG. 1 with the linear holding member. It is the front view which showed the state which pushed the expansion-contraction engagement part downward and was brought close to the holding part. It is the front view which showed the state which pushed the expansion-contraction engagement part in the holding part. It is the front view which showed the state which put the expansion-contraction engagement part in the holding part, and engaged the edge part with the engagement hole. It is sectional drawing which showed the state which stabbed the medical suturing tool in the abdomen. It is sectional drawing which showed the state which protruded the holding part of the linear holding member from the opening part of the puncture needle for extraction. It is sectional drawing which showed the state which put the suture thread in the holding part of a linear holding member. It is sectional drawing which showed the state which made the suture thread engage with a holding part. It is sectional drawing which showed the suture after extracting the medical suturing device from the abdomen. It is sectional drawing which showed the state which completion | finished sewing. It is the perspective view which showed the medical suturing tool which concerns on 2nd Embodiment of this invention. FIG. 13 is a perspective view showing a state where the suture thread of the medical suturing tool shown in FIG. 12 is engaged with the linear gripping member. It is the front view which showed the slide engagement member and linear holding member of the medical suturing tool of the state which made the holding part protrude from the puncture needle for extraction, and was extended. It is the front view which showed the slide engagement member and linear holding member of the medical suturing tool of the state which retracted the holding | grip part in the puncture needle for extraction, and was extended linearly. It is sectional drawing which showed the state which stabbed the medical suturing tool which concerns on 2nd Embodiment in the abdomen. It is sectional drawing which showed the state which made the holding part of the medical suturing device which concerns on 2nd Embodiment protrude from the opening part of the puncture needle for extraction. It is sectional drawing which showed the state which put the suture thread in the holding part of the medical suturing tool which concerns on 2nd Embodiment. It is sectional drawing which showed the state which engaged the suture thread of the medical suturing tool which concerns on 2nd Embodiment with the holding part.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10,30 ... Medical suture tool, 13 ... Insertion puncture needle, 13a ... Insertion hole, 13b, 14b ... Opening part, 14 ... Extraction puncture needle, 14a ... Insertion hole, 15, 35 ... Linear gripping member, 15b 35b ... gripping part, 16 ... suture, 18b ... engagement hole, 21 ... expansion / contraction engagement part, 22 ... coil spring, 24 ... end part, 31 ... slide engagement member, 32 ... rail part, 33 ... slide part 34 ... engagement part, 36 ... engagement recessed part.

Claims (4)

A linear gripping member is inserted from the proximal end side of the insertion hole of the extraction puncture needle, and the gripping portion on the distal end side of the linear gripping member protrudes from an opening formed on the distal end side of the extraction puncture needle And inserting a suture from the proximal end side of the insertion hole of the insertion puncture needle arranged substantially parallel to the extraction puncture needle, and inserting the distal end of the suture into the insertion The gripping part of the linear gripping member is extended to the proximal end side of the extraction puncture needle in a state of protruding from the opening formed on the distal end side of the puncture needle and extending to the gripping part side of the linear gripping member a medical suturing tool capable of gripping the suture bunch lifting portion of the linear grasping member by retracting,
The advance / retreat operation member is connected to the proximal end side of the linear gripping member, and the advance / retreat operation member is attached to the proximal end side of the extraction puncture needle in a state where the advance / retreat operation member can be advanced and retracted. Advance that prevents the advance / retreat operation member from moving forward with respect to the extraction puncture needle when the gripper of the linear gripping member is retracted and retracted toward the proximal end side of the extraction puncture needle setting the prevention means only, and,
The advance prevention means is provided between the advance / retreat operation member and the proximal end side of the take-out puncture needle in a state of covering the outer peripheral surface of the proximal end side portion of the linear gripping member, and the advance / retreat operation A medical suturing tool comprising a coil spring that biases the member for use toward the outside of the proximal end side of the extraction puncture needle . Provided at the proximal end portion of the extraction puncture needle, provided with an insertion hole communicating with the insertion hole of the extraction puncture needle, a bottom portion supporting one end portion of the coil spring, and an engagement hole A cylindrical gripping portion having a peripheral surface, and an expansion / contraction engaging portion fixed to the other end of the coil spring and engageable with the engaging hole. When the gripping portion of the linear gripping member is protruded from the opening of the extraction puncture needle, the engagement hole and the expansion / contraction engagement portion are engaged with each other to move the advance / retreat operation member to the extraction puncture The medical suturing device according to claim 1, further comprising an advancing side fixing means for fixing to the needle . A linear gripping member is inserted from the proximal end side of the insertion hole of the extraction puncture needle, and the gripping portion on the distal end side of the linear gripping member protrudes from an opening formed on the distal end side of the extraction puncture needle And inserting a suture from the proximal end side of the insertion hole of the insertion puncture needle arranged substantially parallel to the extraction puncture needle, and inserting the distal end of the suture into the insertion The gripping portion of the linear gripping member is moved to the proximal end side of the extraction puncture needle in a state of protruding from an opening formed on the distal end side of the puncture needle and extending to the gripping portion side of the linear gripping member A medical suturing tool capable of gripping the suture by the gripping portion of the linear gripping member by retracting,
The advance / retreat operation member is connected to the proximal end side of the linear gripping member, and the advance / retreat operation member is attached to the proximal end side of the extraction puncture needle in a state where the advance / retreat operation member can be advanced and retracted. Advance that prevents the advance / retreat operation member from moving forward with respect to the extraction puncture needle when the gripper of the linear gripping member is retracted and retracted toward the proximal end side of the extraction puncture needle Providing prevention means, and
A vertically long rail portion is provided on the proximal end side of the extraction puncture needle, and the advance / retreat operation member is configured by a slide portion that can move along the rail portion, and the advance prevention means is provided on the base of the rail portion. A medical suturing tool comprising a retracting side fixing member including an engaging portion provided at an end portion and an engaged portion provided on the slide portion and engageable with the engaging portion. Advancement for fixing the advance / retreat operation member to the extraction puncture needle when the advance / retreat operation member is advanced to cause the gripping portion of the linear gripping member to protrude from the opening of the extraction puncture needle The medical suturing device according to claim 1 or 3, further comprising a side fixing means.

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