JP4458031B2 - Biological suture tool - Google Patents

Description

  The present invention relates to a living body suturing device and a living body suturing method for suturing a living body suture target portion, and more particularly to an improved technique of a stomach wall fixing device for suturing an abdominal wall and a stomach wall with a suture thread.

  When attaching a gastrostomy catheter to a patient, for example, the abdominal wall and the stomach wall are sutured with a suture to temporarily fix the stomach wall to the abdominal wall, and then the abdominal wall and the stomach wall are punctured to form a through hole. In general, a gastrostomy catheter is attached to the through hole. Insufficient fixation may cause various complications. Therefore, various suturing tools for accurately suturing the stomach wall and abdominal wall, which are the suture target parts, have been developed as shown in Patent Documents 1 to 3. ing.

Among them, Patent Document 1 discloses a hollow suture insertion puncture needle into which a suture can be inserted, a hollow suture grasping puncture needle that holds a suture extending from the distal end of the puncture needle, and the suture. A suture comprising a stylet (inductor) that is slidably inserted into the grasping puncture needle, and a fixing member that fixes the suture insertion puncture needle and the suture grasping puncture needle at their proximal ends. A tool is disclosed. At the distal end of the stylet, an annular member made of an elastic material that can be stored in the internal passage of the suture grasping puncture needle is provided, and the suture member is exposed with the annular member exposed from the distal end of the suture grasping puncture needle. The central axis of the suture insertion puncture needle or an extension thereof extends toward the suture insertion puncture needle so as to pass through the inside of the annular member. With this suture tool, the suture insertion puncture needle and the suture grasping puncture needle are punctured into the abdominal wall and stomach wall, and the stylet and the annular member are inserted from the rear end of the suture grasping puncture needle. The annular member is exposed from the tip of the suture grasping puncture needle, the suture is inserted from the rear end of the suture insertion puncture needle, and a part of the suture is inserted into the tip of the suture insertion puncture needle. The suture is captured by the annular member, the stylet is retracted into the suture grasping needle, and the suture insertion needle, the suture grasping needle, the stylet, and the annular member are integrated. The stomach wall and the abdominal wall, which are the suture target parts, can be sutured by retracting them and pulling out the preceding part of the suture thread outside the body.
Japanese Patent Publication No. 6-24533 Japanese Patent No. 3331215 JP-A-2005-245591

However, there are the following problems when the suture target part is sutured using the above-described suture tool.
When performing the suturing, the operator needs to puncture the gastric wall fixing tool from outside the patient's body and efficiently pass the suture thread into the annular member within the stomach. It may be difficult depending on the degree. For this reason, improvement in workability is required.

  In particular, when setting a suture on the gastric wall fixture, the operator needs to insert the suture from the back of the puncture needle, but the stored state of the suture (when stored in a package or a spooler) In some cases, so-called folds are attached, and the direction of the yarn tip is difficult to determine with the yarn immediately after storage, and it is difficult to set it on the puncture needle of the gastric wall fixture. is there.

In the above prior art, the suture thread is inserted when the suture insertion needle, suture grasping needle, stylet, and annular member are integrally retracted and the leading portion of the suture is pulled out of the body. Although it is engaged near the tip of the grasping puncture needle, there is also a concern that the suture is damaged by the sharp suture grasping puncture needle and is severed in the worst case.
Such a problem exists as a problem to be solved in the above-mentioned technical field where there is a requirement that the operation should be completed in tens of minutes.

Therefore, the present invention has been made in view of the above problems, and as a first object, it is possible to prevent the occurrence of damage and reliably engage the suture thread under the operability superior to that of the prior art. Provided is a biological suturing device.
In addition, as a second object, a biological suturing instrument having higher safety than conventional ones is provided.

  To achieve the above object, according to the present invention, the first and second hollow puncture needles are arranged substantially in parallel, and the hollow portion of the first hollow puncture needle has an annular shape formed by a thin line at the end of a long body portion. A suture device for living body through which a stylet having a portion is inserted, wherein at least the annular portion of the stylet extends from the tip of the first hollow puncture needle along the longitudinal direction of the puncture needle, The hollow part of the two hollow puncture needles was configured such that a wire having a distal end region processed so as to curve in a certain direction was inserted into the distal end of the long body part.

Here, it can be set as the structure by which the spherical protection part is arrange | positioned at the front-end | tip of the said wire.
Furthermore, the stylet is composed of a long body part and an annular part provided at the tip of the body part, and the wire is inserted and sandwiched in the annular part so that the engagement is achieved. It can also be set as a structure.

Further, the annular portion is formed along an ellipse whose short axis direction is the stylet longitudinal direction, and the distal end portion of the annular portion is inserted into the hollow portion of the first hollow puncture needle. It can also be set as the structure by which the guide part for encouraging is provided.
Further, the shape memory wire is provided with a knob portion that is inserted into the shape memory wire, and friction locking means that resists the insertion is provided inside the knob portion. It can also be set as the structure currently made.

Moreover, it can also be set as the structure by which the loop part for connection for connecting a suture thread was formed in the rear end of the said shape memory wire.
The connecting loop portion includes a large-diameter loop portion having a constant inner diameter and a small-diameter loop portion having an inner diameter smaller than the large-diameter loop portion, and is sewn to the large-diameter loop portion. It can also be set as the structure by which a thread | yarn is penetrated and is pinched and hold | maintained in a small diameter loop part.

  Furthermore, at the rear end of the shape memory wire, a loop portion inserted into the wire body portion is formed, and a connecting loop portion is formed by the loop body and the wire body portion in a certain downstream region from the loop portion. After the suture thread is inserted into the connecting loop portion, the suture thread is sandwiched and held by reducing the connecting loop portion.

  According to the biological suturing device of the present invention having the above-described configuration, the second hollow puncture needle is configured such that a wire having higher rigidity than a general suture thread is inserted through the second hollow puncture needle. The work efficiency of setting on the needle has been greatly improved. Therefore, it becomes possible to set the suture dramatically and quickly compared with the labor of setting the conventional flexible suture to the second hollow puncture needle, which is good when used for a gastric wall fixture. There is an effect that the stomach wall can be fixed.

Furthermore, since the wire is curved in a certain direction while having excellent rigidity, the soft tip is inadvertently deformed when set on the second hollow puncture needle, and it takes time and effort to insert. There is no problem.
In addition, in the present invention, since the spherical protective portion is disposed at the tip of the wire, even if the amount of curve of the wire is too large and abuts against the stomach wall, the stomach wall is not inadvertently damaged. Therefore, use with high safety is possible.

  Further, in the present invention, since the wire that is harder than the suture is engaged with the stylet at the tip of the puncture needle, there is a risk that the suture is damaged or cut by the puncture needle during the engagement. Has been reduced.

Hereinafter, a gastric wall fixture which is an application example of the present invention and an operation method thereof will be described.
[Embodiment 1]
<Overall configuration>
FIG. 1 is a perspective view illustrating a front configuration of the gastric wall fixture 1 according to the first embodiment. FIG. 2 is a perspective view showing a back configuration of the gastric wall fixture 1.

As shown in FIG. 1, the gastric wall fixture 1 is roughly divided into a main body 2, a slide 5, a pressing unit 6, a first hollow puncture needle 10, a second hollow puncture needle 11, and the like.
The main body 2 has a holder 3 as a center and a stage 4 and hollow rectangular blocks 41 and 42 joined to one main surface thereof.
The holder 3 is a plate-like body provided with fan-shaped flange portions 3R and 3L that are provided with anti-slip processing for the operator to pick them with fingers. A slide bearing for slidably bearing the perforation portions 30a and 30b for inserting the first and second hollow puncture needles 10 and 11 and the guide bars 51R and 51L of the slide portion 5 in the central portion of the main surface. The parts 30c and 30d are respectively disposed at predetermined positions.

  The slide part 5 has a configuration in which both sides of a metal wire (piano wire in this case) bent in a U-shape from the central part, and a silicone rubber or the like excellent in holdability are coated on the central part of the metal line. Both sides from the central portion of the piano wire are guide bars 51R and 51L, and the central portion is a folded portion (grip) 50 that can be picked by a finger with an operator. The leading ends of the guide bars 51R and 51L in the slide part 5 are integrally joined to the main surface 61 of the pressing plate 60 and are slidably held with respect to the main body part 2.

  As shown in FIG. 2, the blocks 41 and 42 have a configuration in which the main body 2 is arranged in two upper and lower layers. Among these, the cylinder part 411 and the opening part 410 are provided in the back end surface of the block 41, and the stylet 8 is penetrated by the opening part so that insertion or extraction is possible. Further, the knob 102 attached to the rear end of the stylet 8 can be fitted into the cylindrical portion 411. Although the blocks 41 and 42 have almost the same configuration, a recess 421 is formed by a notch on the rear end surface of the block 42, and is fitted to the protrusion 1121 of the knob 112 provided at the rear end of the shape memory wire. It is the structure which latches this. Thus, the axial angle of the shape memory wire (that is, the curve angle of the tip region 71) is always grasped by the operator based on the position of the convex portion 1121 of the knob 112.

The main body 2 is connected to the first and second hollow puncture needles 10 and 11 so as to communicate with the openings 410 and 420 (not shown) of the blocks 41 and 42, and the slide portion via the holder 3. Five guide bars 51R and 51L are slidably inserted. These 10, 11, 51R, 51L are all extended in the same direction and are inserted into the pressing portion 6.
The pressing portion 6 is a plate body having a rectangular main surface, and slide bearing portions 60a and 60b are perforated as shown in FIG. 1, and the vicinity of the distal ends of the first and second hollow puncture needles 10 and 11 is formed in this. Each is slidably inserted. In addition, the front ends of the guide bars 51R and 51L of the slide portion 5 are in contact with the main surface 61 facing the holder 3, and the ends of the guide bars 51R and 51L are fixed with resin. The portions 52R and 52L are joined. As a result, when the operator pulls out the folded portion 50 of the slide portion 5, the guide bars 51R and 51L are retracted from the needle tips 100 and 101, and the guide bars 51R and 51L are slid by the slide bearing portions 30c and 30d. The puncture needle near the needle tips 100 and 101 is exposed from the main surface 60. On the other hand, if the operator pushes in the folded portion 50, the reverse operation is performed.

  The first and second hollow puncture needles 10 and 11 are configured such that the needle bodies 101 and 111 made of a stainless material having excellent rigidity are provided with hollow portions 1000 and 1100 penetrating from the needle tips 100 and 110 to the end portions. have. As shown in FIGS. 1 and 2, these are inserted through the main body 2 and the pressing portion 6 from the rear of the main body 2 at positions symmetrical to each other from the center of the main surfaces 60 and 61 of the pressing portion. ing.

A stylet 8 is stored inside the first hollow puncture needle 10, and a shape memory wire 7 is stored inside the second hollow puncture needle 11. Then, when the operator pushes the stylet 8 and the shape memory wire 7 from the knobs 102 and 112 side, it is inserted into the annular portion 801 of the stylet 8 as a feature of the present invention as shown in FIG. Yes.
Next, the configuration of the stylet 8 and the shape memory wire 7 will be described.

<Configuration of stylet and shape memory wire>
Next, FIG. 3A is a diagram showing the overall configuration of the stylet 8.
As shown in the figure, the stylet 8 includes a long main body 80, an annular portion 81 attached to the front end thereof, and a knob 102 provided at the rear end.

The main body portion 80 is made of, for example, a stainless material, and has a diameter that can be inserted into the hollow portion 1000 of the first hollow puncture needle 10.
The annular portion 81 is a thin line made of a shape memory alloy material or the like, and has an elliptical outline having a short axis b along the longitudinal direction of the main body portion 80 and a long axis a along the radial direction of the main body portion 80. Is formed. In addition, a guide portion 801 is provided at the front end in the longitudinal direction. Unlike the conventional configuration (for example, the configuration described in Japanese Patent Application Laid-Open No. 2002-26203), the annular portion 81 is not configured to curve in the needle tip direction of the second hollow puncture needle, but vertically from the needle tip of the first hollow puncture needle. It features a configuration that expands in the direction.

The reason why the annular portion 81 is elliptical is that it is known that the shape memory wire exposed from the second hollow puncture needle 11 is empirically easy to insert inside the stomach.
Further, the guide portion 801 is formed in a sufficiently small size with respect to the insertion port 410. For this reason, once the guide portion 801 is inserted through the insertion port 410, the annular portion 81 having a relatively large diameter can be continuously and smoothly guided and set to the insertion port 410 as it is. Efficiency is exhibited. For this reason, it is desirable that the diameter of the guide portion be smaller than the diameter of the insertion port 410.

In addition, although the stylet 8 showed the cyclic | annular part 81 of the structure which the terminal closed completely, this invention is not limited to this. That is, the “annular shape” of the annular portion referred to in the present invention is not limited as long as the whole is substantially annular, and includes a configuration in which a part or more thereof is missing. Thereby, for example, an annular portion configuration using a U-shaped gutter structure is also included.
FIG. 3B is a diagram showing the overall configuration of the shape memory wire 7.

  The shape memory wire 7 is a metal shape memory wire made of a shape memory alloy material such as stainless steel or bimetal, and the tip region 71 of the main body 70 is formed so as to curve in an arc shape in a certain direction at room temperature. Has been. This curve direction is set in a direction to be inserted into the annular portion 801 exposed from the distal end of the first hollow puncture needle 10 when the gastric wall fixing tool 1 is set. Specifically, a long material is wound around a cylinder having a predetermined diameter and heat treated, or the material is wound around the cylinder at a constant heating temperature and formed into a long shape. The method of cooling is mentioned.

Further, the distal end portion of the distal end region 71 is processed to have a spherical shape or an obtuse angle, and a protective portion 701 is formed. This is a device that protects the inside of the stomach wall and makes it difficult to release the engagement after the shape memory wire is inserted through the annular portion.
At the rear end portion of the shape memory wire 7, a connecting portion 72 is formed in which a perforated portion 720 is provided in a main body portion 721 that is flattened as a whole. The connecting portion 72 is normally fitted to the knob 112, but is fitted in a state where the suture thread A is connected to the knob 112 until puncturing, and thereafter can be separated from the knob 112 as appropriate. Here, FIG. 9B shows a shape at a viewpoint in which the connecting portion 72 in FIG. 9A is rotated 90 degrees in the axial direction of the wire.

  As shown in this figure, since the connecting portion 72 of the shape memory wire 7 is formed with a flat plate-like main body portion 721, this shape is utilized to have a slit-like recess as a fitting portion (not shown). The knob 112 is fitted at a predetermined angle. For this reason, when the knob 112 is rotated in the axial direction of the shape memory wire, it is easy to determine which direction the shape memory wire tip region 71 curves by recognizing the position of the convex portion 1121 provided on the knob 112. Can grasp. This is because the operator can accurately grasp the curve direction of the shape memory wire inside the stomach when using the gastric wall fixture 1.

  The “shape memory” referred to in the present application originates from the characteristics of a metal material such as a so-called bimetal, and is not limited to the characteristics of restoring the shape by a temperature change or the like, but is defined in a broad sense. Therefore, other than that, a structure in which a highly rigid resin material is subjected to a temperature treatment to form a curve (winding wound, etc.) in a certain direction, or a material having a property utilizing a material resistant to plastic deformation such as a stainless steel material is included.

The material of the shape memory wire 7 is not limited to the above bimetal, but may be a configuration using a single metal material or a case where a synthetic resin or the like is used.
Further, the connecting portion 72 is not an essential configuration, and any means capable of connecting the suture thread A to the wire 7 may be used. For example, as shown in FIG. 9C, the diameter of the end of the wire 7 may be partially reduced, and the suture thread A may be tied to the reduced diameter portion 75.

Alternatively, a configuration may be adopted in which a small ring portion 76 is provided at the rear portion of the main body portion 70 and the suture thread A is tied to the ring portion 76.
<Operation method and effect of gastric wall fixture>
According to the gastric wall fixture 1 having the above configuration, the operation is performed as follows. 4 to 6 are diagrams schematically illustrating the process of the operation. Each of FIGS. 4 to 6 is represented as a cross-sectional view along the line XX ′ in FIG. 1, and 150 and 151 denote the abdominal wall and the stomach wall, respectively.

(Puncture to stomach)
First, the operator sets the suture thread A in the connecting portion 72 of the shape memory wire 7 in the gastric wall fixture 1 in advance. Then, the knobs 102 and 112 are operated so that the shape memory wire 7 and the stylet 8 are adjusted so that they are not exposed from the tips 100 and 110 of the first and second hollow puncture needles 10 and 11. In this state, the collars 3R and 3L at both ends of the holder 3 are gripped, and the puncture needles 10 and 11 are punctured vertically from the desired position of the abdominal wall 150 of the patient. At this time, since the pressed 60 in the pressing portion 6 contacts the abdominal wall, the operator uses the so-called “lever principle” to place the puncture needles 10 and 11 from the folded portion 50 of the slide portion 5 as the starting point 3R, Every 3L is punctured by strongly pushing into the abdominal wall 150 and stomach wall 151 of the patient (FIG. 4 (a)).

  Here, the present invention is characterized in that the suture A is not set directly on the second hollow puncture needle 11 as in the prior art, but is set using a shape memory wire 7 having high rigidity. For this reason, it is possible to fundamentally solve the problem that it cannot be easily set when an unnecessary fold is attached to the suture thread A depending on the storage state, and the setting is performed with high work efficiency. It is possible to achieve the effect.

(Release stylet)
When the puncture is performed to a sufficient depth, the operator then operates the knob 102 to push the stylet 8 into the first hollow puncture needle 10. This releases and deploys the annular portion 81 within the stomach wall. At the same time, the shape memory wire 7 is pushed into the second hollow puncture needle 11, but the tip region 71 is not yet pushed in sufficiently (FIG. 4B).

(Insertion between annular part and shape memory wire)
Subsequently, the operator extends the tip region 71 while curving the inside of the annular portion 81 while checking the direction of the knob 102 (FIG. 5A). At this time, in some cases, an endoscope inserted into a patient orally is used. In the present invention, since the shape memory wire 7 is formed so as to curve in a predetermined direction in advance at this time, the tip region 71 can be inserted into the annular portion 81 relatively smoothly (actually in a few seconds). it can.

  Here, in the prior art, a configuration in which the annular portion of the stylet is curved is known, but in the first embodiment, there is a difference in the configuration in which the tip region 71 of the wire 7 is curved. In this case, the curve of the wire 7 needs to be set for only one wire (specifically, only the tip region 71), and in this respect, curve processing can be easily performed as compared to the annular portion of the conventional stylet. There is an advantage.

(Engagement between stylet and shape memory wire)
After the insertion, the operator pulls up the knob 102 and retracts the annular portion 81 into the first hollow puncture needle 10. When the annular portion 81 is almost retracted, the distal end region 71 of the shape memory wire 7 is captured at the distal end 100 of the first hollow puncture needle 10, thereby engaging the stylet and the shape memory wire ( FIG. 5B). The shape memory wire 7 is thin enough to be inserted into the inside of the first hollow puncture needle 10, but if the insertion is performed, the shape memory wire is completely bent. It is. Further, the shape memory wire 7 can be sufficiently grasped even by engagement at the tip of the needle tip 100.

As described above, in Embodiment 1, the wire 7 can be engaged with the stylet 8 by the tip 100 of the first hollow puncture needle 10, so that the suture is made by the sharp tip 100 of the first hollow puncture needle 10 during the engagement. There is also an effect that the risk of the yarn being damaged or cut is reduced.
(Pull out the puncture needle)
After the engagement, the operator grasps the holder 3 again and pulls out the first and second hollow puncture needles 10 and 11 while maintaining the engagement. At this time, the knob 112 is removed at the rear end of the shape memory wire 7 and released. Thereby, the suture thread A connected to the rear end of the shape memory wire 7 is inserted through the puncture needle, and the first and second hollow puncture needles 10 and 11 are pulled out (FIG. 6A). The shape memory wire 7 is pulled out together with the first hollow puncture needle 10 while being engaged at the distal end 100 of the first hollow puncture needle 10, and the suture A is used for suturing.

(Processing of suture A)
After the gastric wall fixture 1 is completely pulled out, both ends of the suture thread A are cut out with scissors or the like. Then, the stitching process is terminated by appropriately tying this (FIG. 6B).
One stitching process is completed as described above, but the stitching process is repeated several times as appropriate depending on the case. Here, as described above, in the present invention, since quick stitching is possible, for example, in an adult PEG construction process, all stitching operations can be completed within approximately 20 minutes.

[Modification of Embodiment 1]
In Embodiment 1 described above, the configuration using the shape memory wire 7 having shape memory characteristics has been described, but the present invention is not limited to this. That is, the present invention can be achieved without using such a shape memory wire.

As a modification of the first embodiment, a shape memory material can be used for the suture thread A. This uses a stainless steel material having excellent rigidity and shape memory characteristics for the suture thread A.
The same effect as that of the first embodiment can also be obtained by the modified gastric wall fixture having such a configuration. Specifically, the shape can be memorized or processed in advance so that the suture A is curved in a predetermined direction, so that the suture can be smoothly set with respect to the second hollow puncture needle 11 and the annular portion. 81 can be successfully inserted and engaged.

Needless to say, the shape memory characteristic has the same effect even if it has at least the tip region set on the gastric wall fixture.
[Embodiment 2]
Next, a second embodiment of the present invention will be described focusing on differences from the first embodiment.

FIG. 7 is an enlarged view showing the configuration around the needle tip of the first and second hollow puncture needles in the gastric wall fixture of the second embodiment.
The feature of the second embodiment is that the configuration of the main body portion 111X of the second hollow puncture needle 11X is not completely hollow, but is constituted by a hollow passage 1102X and a solid needle tip 110X, and in the vicinity of the needle tip 110X It has a feature in that an opening 1100X is provided on the side surface of the. The opening 1100X is configured to communicate with the hollow passage 1102X and the arc-shaped bent passage 1101X inside the main body 111X.

If the second hollow puncture needle 11X having such a configuration is used, a wire that is not made of a normal suture or shape memory alloy can be inserted into the annular portion 81 without using the shape memory wire 7. Is possible.
In order to solve the problem that is difficult to set the suture thread at the rear end insertion port of the hollow puncture needle, which is a problem in the present invention, a thread having higher rigidity than a conventional suture thread (implementation) Or the shape memory wire 7 or the like. However, when the subject is not so prominent, a normal suture A can be used.

When the configuration of the second embodiment is manufactured, parameters such as the angle, the inner diameter, and the bending rate of the bending passage 1101X are adjusted in advance so that the suture thread A can be efficiently inserted into the annular portion 81. It is desirable.
[Modification of shape memory wire]
FIGS. 8A and 8B are configuration diagrams showing another embodiment of the shape memory wire of the present invention.

The embodiment 1 (shape memory wire 7X) shown in FIG. 8A is basically the same as the shape memory wire 7, but the feature is that a spindle-shaped check is first applied to the shape memory wire main body 70. The knob 112X incorporating the valve 1122 is inserted.
The check valve 1122 uses a rubber / synthetic resin spindle, and is inserted so that the apex of the check valve 1122 faces the shape memory wire tip region 71.

  If such a check valve 1122 is used, even when the shape memory wire 7X is directed in the vertical direction, the shape memory wire 7X can be prevented from being accidentally dropped or displaced with respect to the knob 112X. . Also, by pulling out the main body part 70 in the direction of the shape memory wire tip region, it can be drawn out relatively easily, and feeding in the reverse direction is restricted, so that it is possible to ensure good working efficiency. It is.

  In addition, since such a check valve 1122 is used as a friction locking means of the shape memory wire, instead of using the check valve 1122, it can be inserted into the shape memory wire 7X and the insertion operation can be performed. On the other hand, a rubber tube having an inner diameter capable of exerting a predetermined frictional force, a rubber block, or a friction material having a certain friction coefficient may be incorporated in the knob 112X.

  Subsequently, a two-stage loop portion 73 is disposed at the rear end portion of the shape memory wire 7X as a connecting means for connecting the suture thread A. The two-stage loop portion 73 includes a large-diameter portion 731 (a region “A” in the drawing) made of a relatively soft material (in the present invention, a material equivalent to the annular portion 80 is preferable as an example), and the large loop portion 731. A small-diameter portion 732 (region “B” in the drawing) made of a material harder than the diameter portion 731 is included. The large-diameter portion 731 is formed in a direction that opens in advance so as to form a circle, whereas the small-diameter portion 732 is formed so as to form a thin U-shape. The U-shaped gap need only be such that the suture thread A can be sandwiched.

The combination of materials for the large diameter portion 731 and the small diameter portion 732 is an example, and the present invention is not limited to this.
According to this configuration, the suture thread A can be easily inserted by using the large-diameter portion 731 at the time of use. Further, the suture A that is inserted is communicated with the small-diameter portion 732, and the suture A is easily held on the shape memory wire 7X side by tying it together (or holding it while being inserted). Can be made. Thereafter, for example, the operator can hold the knob 112X with the left hand, push the wire 7X into the spindle check valve 1122 with the right hand, and extend the wire 7X into the patient's body.

On the other hand, Example 2 (shape memory wire 7Y) shown in FIG. 8 (b) has a ring portion 741 slidable on the shape memory wire main body 70 as a connecting means for connecting the suture thread A, The slide loop part 74 provided with the large diameter part 742 which can change a diameter is formed.
Even with such a configuration, the suture thread A can be easily inserted through the large-diameter portion 742 during use, and the large-diameter portion 742 can be easily slid onto the wire main body portion 70 and slid freely. The suture thread A can be satisfactorily sandwiched and held by reducing the diameter thereof, and the same effect as the first embodiment can be obtained.

In the first embodiment, the combination of the knob 112X and the two-stage loop portion 73 or the slide loop portion 74 is illustrated. However, in the present invention, the combination of the knob 112X and the loop portions 73 and 74 is not essential, and FIG. Only one of the configurations described may be implemented.
[Other matters]
The present invention is not limited to the case where the stomach wall is sutured to the abdominal wall, but when the suture target part is sutured by inserting the distal end of the suture into the suture target part of the living body and then pulling it out of the suture target part. Widely applicable.

In addition, the second hollow puncture needle may be configured such that the tip is not a needle but a simple cylinder, and the needle is inserted prior to the stylet at the time of puncturing, thereby enabling puncturing.
Furthermore, in the above-described embodiment, the first and second hollow puncture needles have the same length, but the present invention is not limited to this. For example, the first hollow puncture needle is replaced with the second hollow puncture needle. You may comprise longer than. By doing so, the puncture resistance at the time of puncturing the living body can be reduced, which is preferable.

  The living body suturing device according to the present invention can be used for suturing the abdominal wall and the stomach wall with a suture when the gastrostomy catheter is mounted.

It is a figure which shows the front structure of the gastric wall fixing tool which concerns on Embodiment 1. FIG. It is a figure which shows the back surface structure of the gastric wall fixing tool which concerns on Embodiment 1. FIG. It is a figure which shows each structure of a stylet and a shape memory wire. It is a figure which shows the biological suture process using the gastric wall fixing tool of this invention. It is a figure which shows the biological suture process using the gastric wall fixing tool of this invention. It is a figure which shows the biological suture process using the gastric wall fixing tool of this invention. FIG. 6 is a diagram showing a configuration near a puncture needle according to a second embodiment. It is a figure which shows the other Example of the shape memory wire of this invention. It is a figure which shows the rear part structure of the shape memory wire of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Gastric wall fixing tool 2 Main body part 3 Holder 4 Stage 5 Slide part 6 Pushing part 7, 7X, 7Y Shape memory wire 8 Stylet 10 1st hollow puncture needle 11, 11X 2nd hollow puncture needle 70, 80 Main body part 71 Tip Area 72 Connecting portion 73 Two-stage loop portion 74 Slide loop portion 81 Annular portion 100, 110, 110X Needle tip 101, 111, 111X Needle body 112, 112X Knob 701 Protection portion 731, 742 Large diameter portion 732 Small diameter portion 741 Ring portion 800 Elliptical part 801 Guide part 1100X Opening part 1101X Bent passage 1102X Hollow path 1122 Spindle-shaped check valve

Claims (8)

The first hollow puncture needle and the second hollow puncture needle are arranged substantially in parallel, and a stylet having an elongated main body part and an annular part made of a thin line arranged at the tip of the main body part is provided in the main body part. A living body suture tool inserted through a hollow portion of the first hollow puncture needle,
In the stylet, at least the annular portion protrudes from the tip of the first hollow puncture needle along the longitudinal direction of the first hollow puncture needle, which is a direction other than the needle tip direction of the second hollow puncture needle. Extended to
The tip region is processed so as to curve in a direction to be inserted into the annular portion, and a shape memory wire having an elongated main body portion is inserted into the hollow portion of the second hollow puncture needle in the main body portion ,
A living body suturing tool, wherein a connecting portion for connecting a suture is provided at the rear end of the shape memory wire . The living body suturing device according to claim 1, wherein a spherical protection portion is disposed at a tip of the shape memory wire.   The stylet is composed of a long main body part and an annular part provided at the tip of the main body part, and the shape memory wire is inserted and sandwiched in the annular part so that the engagement is achieved. The living body suturing device according to claim 1 or 2, characterized by being configured. The annular portion is formed along an ellipse having the short axis direction of the stylet longitudinal direction, and the distal end portion of the annular portion is urged to be inserted into the hollow portion of the first hollow puncture needle. A living body suturing device according to claim 3, wherein a guide portion is provided. The shape memory wire is provided with a knob portion inserted through the shape memory wire,
The living body suturing device according to any one of claims 1 to 4, wherein frictional locking means that resists the insertion is disposed inside the knob portion. The living body suture tool according to any one of claims 1 to 5 , wherein a connecting loop portion is formed as the connecting portion of the shape memory wire. The connecting loop portion is composed of a large-diameter loop portion having a constant inner diameter, and a small-diameter loop portion having an inner diameter smaller than the large-diameter loop portion,
The living body suturing device according to claim 6, wherein a suture thread is inserted into the large-diameter loop portion and sandwiched and held in the small-diameter loop portion. At the rear end of the shape memory wire, a loop portion inserted into the wire main body portion is formed,
A loop part for connection is formed by the wire main body part in the constant downstream side region from the loop part and the loop part,
The living body suture according to claim 6, wherein the suture thread is sandwiched and held by shrinking the connection loop section after the suture thread is inserted into the connection loop section. Ingredients.

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