JPH0194821A - Insert auxiliary jig for treatment device - Google Patents

Abstract

PURPOSE:To arbitrarily adjust the protruding quantity of a treatment device from the end surface of a sheath, by connecting a slide member having a connection part capable of connecting the treatment device to a main body in a freely advancing and retracting state. CONSTITUTION:A main body 10 has a connection member 23 connectable to a sheath in a freely detachable manner. The slide member 22 connected to the main body 10 in an advancement and retraction possible manner has a connection member 43 capable of connecting a treatment device such as an ultrasonic suction device 40. The main body 10 is connected to the sheath and the treatment device is connected to the slide member 22 and, by allowing the slide member 22 to advance and retract with respect to the main body, the protruding quantity of the treatment device from the end surface of the sheath is adjusted. The main body 10 and the slide member 22 are fixed to an arbitrary position by a fixing screw 37.

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention is capable of adjusting and fixing the protrusion from the sheath end surface of a treatment instrument such as an ultrasonic suction device for aspirating and removing a hematoma. This invention relates to a treatment tool insertion aid.

[Problems to be solved by conventional techniques and inventions] In recent years,
Stereotaxic brain surgery using CT (computer tomography) has been performed to remove hematomas caused by cerebral vascular disorders such as cerebral hemorrhage and subarachnoid hemorrhage, as shown in Publication No. 25377/1983, for example. There is. this is,
In this method, a surgical target site in the brain is determined by CT, a sheath is punctured at this target point using a surgical device attached to the skull, and hematoma and the like are suctioned and removed through the sheath.

The surgical device used for this surgery is generally called a stereotactic neurosurgery device.

In conventional stereotactic neurosurgery, urokinase (Llr.

Inject a hematoma lysing agent such as K i nase) into the hematoma cavity,
The method used is to dissolve and fluidize the hematoma, apply negative pressure to a punctured sheath, and suction and remove it. however,
This method has the problem that the hematoma is not completely dissolved, and the undissolved hematoma cannot be suctioned out sufficiently with negative pressure suction, and it gets stuck inside the sheath, often requiring the surgery to be interrupted. there were.

To solve this problem, we used an ultrasonic suction device to
Attempts are being made to remove it. In the ultrasonic suction device,
Despite the risk of suctioning and damaging the brain parenchyma, the surgeon holds the ultrasonic aspiration device in his hand and moves it in a fixed position or in the front-back direction. , it is difficult to keep the hands steady, and
There is a risk of aspiration and damage to the brain parenchyma due to careless operation.

Incidentally, as an insertion aid, there is one shown in the specification of Japanese Patent Application No. 61-290039M previously filed by the present applicant.
This insertion aid is unsuitable for holding heavy objects such as ultrasonic suction devices, and it is difficult to position the ultrasonic suction device. can't know. Furthermore, the ultrasonic suction device cannot be fixed to the sheath at any arbitrary position.

In addition, as an insertion aid for connecting an ultrasonic suction device to an endoscope channel opening, the present applicant has previously filed a patent application filed in 1983.
In this insertion aid, the first cover covers the ultrasonic vibrating part and is fixed to the ultrasonic vibrating part, so the insertion aid It is not possible to adjust the ultrasonic suction device back and forth, and the length of the ultrasonic suction device and the length of the insertion aid vary. Condition) Cannot be adjusted. Furthermore, it is not possible to set a movement range of the ultrasonic suction device probe with respect to the sheath, and to move the ultrasonic suction device freely in the front and rear directions within that range, making it impossible to perform surgery efficiently. Furthermore, it is not possible to arbitrarily set the amount of protrusion of the ultrasonic suction device probe from the end face of the sheath and to fix it in that state.

[Object of the Invention] The present invention has been made in view of the above circumstances, and provides for the ability to arbitrarily adjust the amount of protrusion of a treatment instrument such as an ultrasonic suction device from the end face of the sheath, and to fix it at an arbitrary position. The purpose of the present invention is to provide a treatment tool insertion aid that can be used as a treatment instrument insertion aid.

Means for Solving Problem E] The treatment tool insertion aid of the present invention includes a main body having a sheath connection part that can be detachably connected to a sheath, and a main body that is connected to the main body so as to be able to move forward and backward. a slide member having a connectable connection part; the main body and the slide member;
It is equipped with a fixing means that can be fixed at any position in the front-rear direction.

[Function] In the present invention, the amount of protrusion of the treatment tool from the sheath end surface can be arbitrarily adjusted by connecting the main body to the sheath, connecting the treatment tool to the slide member, and moving the slide member forward and backward with respect to the main body. The main body and the slide member are fixed in arbitrary positions by the fixing means.

[Example] Hereinafter, the present invention will be described in detail with reference to the drawings.

Figures 1 to 6 relate to the first embodiment of the present invention.
The figure is a cross-sectional view showing the adapter, Figure 2 is a cross-sectional view showing the positional relationship between the probe and the sheath mantle when the slide member of the adapter is placed most forward, Figure 3 is a side view of the sheath, and Figure 4 5 is a side view of the adapter with the slider member disposed at the rearmost position, FIG. 5 is a sectional view showing the positional relationship between the probe and the sheath tube when the slide member of the adapter is disposed at the rearmost position, and FIG. 6 is a side view of the adapter with the slider member disposed at the rearmost position. FIG. 2 is an explanatory diagram showing the entire stereotactic brain surgery apparatus.

First, the stereotactic brain surgery apparatus will be explained with reference to FIG.

A bed 2 is installed inside the CT apparatus 1, and a patient is placed on this bed 2.

The stereotactic neurosurgery device 3 is fixed to the bed 2.

The patient's head 4 is inserted into the ring 6 of the stereotactic neurosurgery device 3, and is fixed to the stereotactic neurosurgery device 3 by four head fixing bottles 5 installed in the ring 6. It looks like this. An arm 7 is connected to one side of the ring 6 via a gauge 8, and a sheath fixture 9 for fixing a sheath 10 is fixed to this arm 7. Said sheath 1
0 insertion direction and insertion depth while looking at the CT tomogram.
It is set by gauge 8. After determining the target point using the gauge 8, the sheath 10 is inserted to the target point, and the sheath 10 is fixed to the stereotactic brain surgery apparatus 3 using the sheath fixing device 9.

As shown in FIG. 3, the sheath 10 is composed of a mantle tube 11 and a mandolin 12 inserted into the mantle tube 11, and the mandolin 12 is removed after inserting the sheath 10 into the target point. It is now possible to do so. For example, a ring-shaped connecting portion 13 is formed at the rear end of the mantle tube 11 .

Inside the mantle tube 11 after the mandoline 12 is removed,
An ultrasonic suction device 40 is inserted as a treatment tool via an adapter 20 that serves as a treatment tool insertion aid.

The adapter 20, as shown in FIGS. 1 and 4,
It includes a substantially cylindrical main body 21 and a substantially cylindrical slide member 22 fitted onto the rear end side of the main body 21. A substantially cylindrical connecting member 23 that detachably connects the adapter 20 to the connecting portion 13 of the sheath 10 is connected to the front end of the main body 21 . The connecting member 23 has a ring-shaped flange portion 23a formed at the center in the axial direction, and the rear end side of the seven-runte portion 23a is inserted into the main body 21. Further, a circumferential groove 24 is provided on the outer periphery of the rear end side of the connecting member 23 inserted into the main body 21.
The tip of a removal stopper 25 screwed into the outer periphery of the main body 21 is engaged in the groove 24 . and,
The tip of the main body 21 is connected to the flange 23 of the connecting member 23.
The connecting member 23 and the main body 21 are rotatably connected by the groove 24 and the pull-out stopper 25 engaging with each other. A watertight member 28 such as an O-ring is interposed between the main body 21 and the connecting member 23 near the flange portion 23a to prevent irrigation fluid from leaking to the outside. On the distal end side of the connecting member 23, there is a tapered part 23b having an outer diameter as large as the diameter on the distal end side and inserted into the rear end of the mantle tube 11, and this tapered part 23b.
A ring-shaped ring portion 23c provided on the outer peripheral side of the ring is formed. The tapered portion 23b and the ring portion 23c sandwich the rear end portion of the mantle tube 11, and the connection portion 13 of the mantle tube 11 is connected to the ring portion 23c.
The mantle tube 11 and the connecting member 23 are connected by engaging with the groove in the inner peripheral portion. The inner circumferential surface on the rear end side of the mantle tube 11 is formed into a tapered portion with a larger diameter toward the rear end, and this tapered surface is in close contact with the outer circumferential surface of the tapered portion 23b of the connecting member 23. Mantle tube 11 and connecting member 2
3 to maintain watertightness. Also,
A side part of the main body 21 communicates with a hollow part of the main body 21,
A water supply port 2 with a water supply cock 26 for supplying irrigation fluid such as physiological saline to the target site through the inner cavity of the sheath 10.
7 is provided.

On the other hand, the slide member 22 has a small diameter at its proximal end, and the probe 44 of the ultrasonic suction device 40 can be inserted into this small diameter portion 31 in a watertight manner, and the probe 44 is elastically held. An elastic member 32 having a small hole 32a is externally fitted and fixed.

Furthermore, two spiral grooves 34 and 35 are provided on the outer periphery of the portion of the main body 21 into which the slide member 22 is externally fitted, and are deviated from each other by 180 degrees.

Note that one spiral groove 34 is formed deeper than the other spiral groove 35. The tip of a guide screw 36 screwed from the outer periphery of the slide member 22 is engaged in one of the spiral grooves 34 . Further, the tip of a fixing screw 37 screwed from the outer periphery of the slide member 22 is engaged in the other spiral groove 35 . Then, by rotating the slide member 22 with respect to the main body 21 with the fixing screw 37 loosened, the guide screw 36 is inserted into the spiral groove 34.
The slide member 22 moves back and forth with respect to the main body 21. In addition, the fixing screw 3
By tightening 7, the slide member 22 is attached to the main body 21.
It can be fixed at any position relative to the Furthermore, a watertight member 39 such as an O-ring is interposed between the main body 21 and the slide member 22 to prevent irrigation fluid from leaking to the outside.

Further, as shown in FIG. 4, a scale 38 is provided in the axial direction on the outer periphery of the portion of the main body 21 into which the slide member 22 is fitted.
The position of the slide member 22 relative to the other can be confirmed.

As shown in FIG. 1, the ultrasonic suction device 40 inserted into the sheath 10 via the adapter 20 has a transducer section 41 on the proximal side and a horn 42 at the tip of the transducer section 41. , and an elongated cylindrical probe 44 connected to each other via a connecting member 43. The probe 44 is joined or welded to a connecting member 43, and the connecting member 43 and the horn 42 of the vibrator section 41 are removably fixed with a screw. Further, a watertight part @45 such as an O-ring is interposed between the housing of the vibrator part 41 and the outer periphery of the tip of the horn 42 to prevent liquid from entering the vibrator part 41. The said pool 0-144 is
The elastic member 32 of the adapter 20 is inserted into the sheath 10 through the inside of the adapter 20 through a small hole 32a at the rear end of the elastic member 32. Further, the connecting member 43 comes into contact with the rear end surface of the elastic member 32, and restricts the probe 44 from moving further forward.

FIG. 1 shows a state in which the slide member 22 is disposed at the most forward position, and in this state, as shown in FIG. It protrudes forward from the tip surface of 11.

Further, FIG. 4 shows a state in which the slide member 22 is placed at the rearmost position, and in this state, as shown in FIG. 5, the tip surface of the probe 44 of the ultrasonic suction device 40 is
It is either flush with the distal end surface of the mantle tube 11 of the sheath 10 or is slightly drawn into the mantle tube 11 .

Next, the operation of this embodiment will be explained.

First, as shown in FIG. 6, a surgical target site in the brain is determined using the CT device 1, the sheath 10 is inserted into this target point, and the sheath 10 is attached to the stereotactic neurosurgery device 3 using the sheath fixing device 9. Fix it. Next, as shown in FIG. 4, the slide member 22 of the adapter 20 is placed at the rearmost position with respect to the main body 21, and the fixing screw 37 is tightened to fix the slide member 22 with respect to the main body 21. Connection member 2
3 connects the adapter 20 to the connecting portion 13 of the sheath 10. Next, the blow 144 of the ultrasonic suction device 40 is passed through the small hole 32a of the elastic member 32 of the adapter 20,
Insert into the adapter 20 until the connecting member 43 contacts the elastic member 32. In this state, the distal end surface of the probe 44 is flush with the distal end surface of the mantle tube 11 of the sheath 10, or is slightly retracted into the mantle tube 11. Next, loosen the fixing screw 37 of the adapter 20 and remove the slide member 2.
2 is rotated relative to the main body 21 and moved forward to a predetermined position while looking at the scale 38.

Then, the fixing screw 37 is tightened at a predetermined position to fix the slide member 22 to the main body 21. In this state, the maximum amount of protrusion of the bulb 0-bu 44 from the distal end surface of the mantle tube 11 is set. Then, by moving the ultrasonic suction device 40 forward and backward within the range until the connecting member 43 of the ultrasonic suction device 40 comes into contact with the elastic member 32 of the adapter 20, hematoma etc. can be safely suctioned and removed. Can be done. Further, if necessary, perfusion fluid is supplied from the water supply port 27 via the water supply cock 26, and the drainage fluid together with the hematoma etc. passes through the inner cavity of the probe 44 and is removed by suction by the ultrasonic suction device 40.

As described above, according to the present embodiment, the amount of protrusion of the probe 44 of the ultrasonic suction device 40 from the distal end surface of the mantle tube 11 can be adjusted as desired, and the probe 44 can be fixed with an arbitrary amount of protrusion, so that there is no problem. There is no danger of accidentally protruding the probe 44, and surgery can be performed safely.

Moreover, since the protrusion 44 can be moved forward and backward within the adjusted protrusion amount, the efficiency of surgery is improved.

In addition, probe 44. Adapter 20. If the length of the sheath 10 varies, use the sheath 10° adapter 20 before surgery.
．． By assembling the ultrasonic suction device 40, the zero point (state where the end surface of the sheath 10 and the end surface of the probe 44 are on the same surface) tI! Adjustment is possible.

Therefore, by adjusting the slide member 22 based on the zero point scale, the amount of protrusion of the probe 44 can be accurately grasped at the hand side, and surgery can be performed safely.

Furthermore, even if the operator takes his hand off the ultrasonic suction device 40, the probe 44 will not protrude, so it is extremely safe.

In addition, since the probe 44 is elastically held by the elastic member 32, even if the probe 44 breaks at the welded part with the connecting member 43, the probe 44 will not fall into the cavity, making it safe. It is.

7 and 8 relate to a second embodiment of the present invention, FIG. 7 is a 1J sectional view showing the adapter, and FIG. 8 is a sectional view taken along the line X--X in FIG. 7.

As shown in FIG. 7, the adapter 50 in this embodiment includes a substantially cylindrical main body 51, and the adapter 50 is detachably connected to the connecting portion 13 of the sheath 10 at the front end of the main body 51. A connecting portion 52 is formed. The main body 5
A water supply port 27 with a water supply cock 26 is provided on the side of the tank 1 .

Further, an ultrasonic suction device 40 is provided at the rear end of the main body 51.
An elastic member 53 having a small hole 53a through which the probe 44 can be inserted in a watertight manner and elastically holding the probe 44 is fixedly fitted onto the outside. Furthermore, a protrusion 55 is provided on the side of the main body 51 in a protruding manner. A guide shaft 56 extending rearward in the axial direction is joined to this protrusion 55 . A male threaded portion 57 is formed at the rear end of the guide shaft 56 .

On the other hand, the slide member 61 includes a substantially ring-shaped ring portion 62, as shown in FIG.
The vibrator portion 41 of the ultrasonic suction device 40 is inserted, and the slide member 61 is fixed to the ultrasonic suction device 40 by a fixing screw 63 screwed into the outer circumferential portion of the ring portion 62. On the side of the ring portion 62,
A protrusion 65 is provided in a protruding manner. A slot 66 having a circular hole 66a into which the guide ring 56 is inserted is formed in the protrusion 65 in the axial direction. The protrusion 65 has the slot groove 66 on the outer circumferential side of the circular hole 66a.
A hole 67 is provided perpendicularly to the hole 67 . A female thread 67a is formed on one side of the slot groove 66 of this hole 67,
From the side where this female thread 67a is not formed, the hole 6
A screw 68 is inserted into 7 to tighten the screw 68.
is screwed into the female thread 67a. Then, by inserting the guide shaft 56 into the circular hole 66a and tightening the screw 68, the interval between the slotted grooves 66 is narrowed, and the slide member 61 is fixed to the guide shaft 56. It looks like this. Further, an adjustment nut 70 is screwed into the male threaded portion 57 of the guide shaft 56 inserted into the circular hole 66a. Further, a spring 71 is installed between the protrusion 55 of the main body 51 and the protrusion 65 of the slide member 61, and is fitted onto the guide shaft 56 and biases the slide member 61 backward. . By rotating the adjustment nut 70, the maximum distance between the main body 51 and the slide member 61 can be adjusted so that the end face of the probe 44 and the end face of the mantle tube 11 are aligned with each other. It looks like this.

The other configurations are the same as in the first embodiment.

In this embodiment, the probe 44 of the ultrasonic suction device 40 is
The vibrator section 41 is inserted into the adapter 50 through the small hole 53a of the elastic member 53 of the adapter 50, and the vibrator section 41 is inserted into the ring section 62 of the slide section 61 and fixed with the fixing screw 63. Then, zero point adjustment is performed using the adjustment nut 70.

Further, for tightening, loosen the screw 68, move the slide member 61 forward along the guide shaft 56, and tighten the screw 68 at the desired position, so that the slide member 61 is fixed. The amount of protrusion of the probe 44 of the ultrasonic suction device 40 fixed to the tip surface of the mantle tube 11 is fixed.

Note that the spring 71 is provided to prevent the probe 44 from inadvertently protruding from the end surface of the mantle tube 11 until the slide member 61 is tightened with the screw 68, but it is not necessary. Also good.

In addition, if a scale is attached to the guide shaft 56, the probe 4
The amount of protrusion of 4 can be grasped.

Other functions and effects are the same as in the first embodiment except that the probe 44 cannot be moved forward or backward within the adjusted protrusion amount range.

FIG. 9 is a cross-sectional view showing the connecting portion between the main body and the slide portion of the adapter according to the third embodiment of the present invention.

In this embodiment, a plurality of slots 82 are provided in the rear end portion of the main body 81 of the adapter in the axial direction. Further, on the outer circumference of the rear end of the main body 81, a tapered surface 83 having a small diameter on the rear end side is provided.
is formed, and a male thread 84 is formed on the axially front outer circumference of this tapered surface 83. This main body 8
A tightening put 85 is fitted onto the rear end of 1.

This tightening is achieved by forming a 1i slope 86 on the inner periphery of the front end of the nut 85, which engages with the male screw 84, and on the inner periphery of the rear end, which contacts the tapered surface 83. A tapered surface 87 having a small diameter is formed on the rear end side where it contacts.

A cylindrical slide member 88 is provided at the rear end of the main body 81.
is fitted inside the main body 81 so as to be movable back and forth, and a watertight member 89 is interposed between the main body 81 and the slide member 88.

In this embodiment, by loosening the tightening nut 85, the slide member 88 can move linearly forward and backward relative to the main body 81. In addition, when the nut 85 is tightened, the tapered surface 87 of the nut 85 presses the tapered surface 83 at the rear end of the main body 81 inward, and the inner diameter of the rear end of the main body 81 is narrowed. A slide member 88 is fixed to the main body 81.

Other functions and effects of Configuration 1 are the same as those of the first actual flow example.

FIG. 10 is a sectional view showing the connecting portion between the main body and the slide portion of the adapter according to the fourth embodiment of the present invention.

In this embodiment, a rack 9 is provided on the outer periphery of the main body 91 of the adapter.
A pinion 94 that meshes with the rack 92 is rotatably attached to a slide member 93 that is fitted onto the main body 91.

By rotating a knob (not shown) provided on the extension of the rotating shaft of the pinion 94, the slide member 93 can be moved back and forth with respect to the main body 91.

Further, a screw hole 95 is provided on the side of the slide member 93, and a fixing screw 96 screwed into the screw hole 95 allows the slide member 93 to be securely fixed to the main body. . In addition, the main body 91 and the slide member 9
Between 3 and 3, there is water W! A member 97 is interposed.

Other functions and effects of the configuration 1 are the same as those of the first embodiment.

11 and 12 relate to a fifth embodiment of the present invention, FIG. 11 is a cross-sectional view showing the connecting portion between the main body of the adapter and the slide portion, and FIG. 12 is a cross-sectional view taken along the line Y-Y in FIG. 11. It is a diagram.

In this embodiment, a slide member 1 is provided on the rear end side of the main body 101.
02 is fitted on the outside so that it can move forward and backward.
A large diameter flange portion 103 is formed on the outer periphery of the front end portion of 02. As shown in FIG. 12, the flange portion 1
03, a slotted groove 104 is formed in the axial direction, and portions on both sides of this slotted groove 104 are formed in the slotted groove 10.
The notch is parallel to the end face of 4. Further, a hole 105 perpendicular to the slotted groove 103 is provided through the flange portion 103 . A female thread 105a is formed on one side of the slotted groove 104 of this hole 105, and a tightening screw 106 is inserted into the hole 105 from the side where this female thread 105a is not formed, and this tightening screw 106 is inserted into the female thread. 105a. By tightening the tightening screw 106, the interval between the slotted grooves 104 is narrowed, and the slide member 102 is fixed to the main body 101. Note that a watertight member 107 is interposed between the main body 101 and the slide member 102.

Other functions and effects of the configuration 1 are the same as those of the first embodiment.

Note that the present invention is not limited to the above-mentioned embodiments, and for example, the insertion aid of the present invention is not limited to an ultrasonic suction device, but can also be applied to cases where other treatment tools such as forceps or laser probes are used. be able to.

[Effects of the Invention] As explained above, according to the present invention, the amount of protrusion of a treatment tool such as an ultrasonic suction device from the end face of the sheath can be adjusted arbitrarily,
Moreover, it has the advantage that it can be fixed at any position.

[Brief explanation of the drawing]

Figures 1 to 6 relate to the first embodiment of the present invention.
The figure is a cross-sectional view showing the adapter, Figure 2 is a cross-sectional view showing the positional relationship between the probe and the sheath mantle when the slide member of the adapter is placed most forward, Figure 3 is a side view of the sheath, and Figure 4 5 is a side view of the adapter with the slider member disposed at the rearmost position, FIG. 5 is a sectional view showing the positional relationship between the probe and the sheath tube when the slide member of the adapter is disposed at the rearmost position, and FIG. 6 is a side view of the adapter with the slider member disposed at the rearmost position. FIGS. 7 and 8 are explanatory diagrams showing the entire stereotactic neurosurgery apparatus, and FIGS. 7 and 8 relate to the second embodiment of the present invention. FIG. 7 is a sectional view showing the adapter, and FIG. 9 is a cross-sectional view showing the connection between the main body and the slide portion of the adapter according to the third embodiment of the present invention, and FIG. 10 is a cross-sectional view showing the connection between the main body and the slide portion of the adapter according to the fourth embodiment of the present invention. Cross-sectional view showing the connection part, No. 11
U4 and FIG. 12 relate to the fifth embodiment of the present invention, and FIG.
The figure is a cross-sectional view showing the contact M portion between the main body of the adapter and the slide portion, and FIG. 12 is a Y-Ylil cross-sectional view of FIG. 11. 1...CT device 3...Stereotactic brain surgery device 1
0... Sheath 11... Mantle tube 20...
Adapter 21... Main body 22... Slide member 23... Connection member 32... Elastic member
34.35...Spiral groove 36...Guide screw 3
7...Fixing screw 40...Ultrasonic suction device 43...
・Connection member 44...probe ゛, -111

Claims (1)

[Claims] a main body having a sheath connecting part that can be detachably connected to the sheath; a sliding member that is connected to the main body so as to be movable forwards and backwards and has a connecting part to which a treatment instrument can be connected; the main body and the sliding member; 1. A treatment instrument insertion aid comprising a fixing means that can be fixed at any position in the front-back direction.