WO2016027492A1 - Method for stripping blood vessel and device for stripping blood vessel - Google Patents

Abstract

The method according to the present invention for stripping a blood vessel comprises: a first step for disposing a tubular stripping part 300 around a greater saphenous vein 1000; and a second step for, while grasping the position of the greater saphenous vein 1000, operating an operating part 200 in the state of being separated from the greater saphenous vein 1000 so as to move the stripping part 300 along the greater saphenous vein 1000 and thus stripping, by the stripping part 300, the greater saphenous vein 1000 in the state of being covered with a surrounding tissue 1200.

Description

Blood vessel peeling method and blood vessel peeling device

The present invention relates to a blood vessel peeling method and a blood vessel peeling device.

Arterial grafts typified by the internal thoracic artery, gastric omental artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass blood vessels when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years, the vein graft is collected in a state covered with surrounding tissues (fat, connective tissue, etc.) and covered with the tissue. It has also been reported that the long-term patency rate can be improved by using it as a bypass blood vessel as it is. And as a device which can extract | collect a vein graft in the state covered with the surrounding tissue, there exists a device described in patent document 1, for example.

In the device described in Patent Document 1, a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass blood vessel, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue. However, the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection is poor.

US2006 / 0276815

An object of the present invention is to provide a blood vessel peeling method and a blood vessel peeling device excellent in workability of blood vessel collection (blood vessel peeling).

Such an object is achieved by the present inventions (1) to (9) below.
(1) a first step of arranging a cylindrical peeling portion around a blood vessel;
By grasping the position of the blood vessel, operating an operation unit connected to the peeling part, and moving the peeling part along the blood vessel, the blood vessel is covered at least partially around the surrounding tissue. A blood vessel peeling method comprising: a second step of peeling in a broken state.

(2) The blood vessel peeling method according to (1), wherein the second step is performed while observing the blood vessel with an imaging device.

(3) The operation unit also serves as the imaging device,
In the second step, the blood vessel peeling method according to (2), wherein the peeling portion is moved while observing the blood vessel from inside the living body by the imaging device.

(4) The blood vessel peeling method according to (2), wherein the peeling part is moved while observing the blood vessel from the surface of the living body with the imaging device.

(5) A mark indicating the position of the blood vessel grasped by the imaging device is provided on the surface of the living body,
In the second step, the blood vessel peeling method according to (2), wherein the peeling portion is moved along the mark.

(6) A light emitting unit for notifying a position of the peeling unit is provided in the peeling unit or the operation unit,
In the second step, in (4) or (5) above, the position of the peeling portion in the living body is grasped based on the position and intensity of the light from the light emitting portion visually recognized through the living body surface. The blood vessel peeling method as described.

(7) The blood vessel peeling method according to any one of (1) to (6), wherein, in the second step, the peeling is performed at the peeling portion, and a branched blood vessel branched from the blood vessel is cut and stopped.

(8) The blood vessel peeling method according to any one of (1) to (7), wherein the steps up to the second step are performed without cutting the blood vessel.

(9) a long operation unit;
A cylindrical peeling portion provided at the tip of the operation portion,
The peeling part is arranged around the blood vessel, the operation part is operated away from the blood vessel, and the peeling part is moved along the blood vessel, so that the blood vessel is at least partly around the blood vessel. A blood vessel peeling device characterized by peeling in a state covered with tissue.

According to the present invention, since the blood vessel can be peeled off without being in contact with the blood vessel, the blood vessel can be prevented from being damaged and excellent workability can be exhibited. In particular, more excellent workability can be exhibited by cutting and hemostasis of a branched blood vessel branched from the blood vessel while peeling the blood vessel. Moreover, since the state where blood has passed through the blood vessel can be maintained as long as possible by cutting without cutting the blood vessel, a blood vessel with a shorter ischemic state and less damage can be collected.

FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention. FIG. 2 is a cross-sectional view of the blood vessel peeling device shown in FIG. FIG. 3 is a plan view of a peeling portion of the blood vessel peeling device shown in FIG. FIG. 4 is a side view of the peeling portion shown in FIG. FIG. 5 is a plan view illustrating a processing unit included in the peeling unit illustrated in FIG. 3. FIG. 6 is a plan view showing a modification of the peeling portion shown in FIG. FIG. 7 is a view showing a modification of the peeling portion of the blood vessel peeling device shown in FIG. FIG. 8 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. 1. FIG. 9 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 10 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 11 is a partial cross-sectional side view showing a blood vessel peeling device according to a second embodiment of the present invention. FIG. 12 is a view showing a blood vessel peeling device according to a third embodiment of the present invention. FIG. 13 is a perspective view showing a blood vessel peeling device according to a fourth embodiment of the present invention. FIG. 14 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. FIG. 15 is a side view showing a peeling portion included in a blood vessel peeling device according to a fifth embodiment of the present invention. FIG. 16 is a side view and a cross-sectional view showing a peeling portion included in a blood vessel peeling device according to a sixth embodiment of the present invention. FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a seventh embodiment of the present invention. 18 is a plan view and a side view of the blood vessel peeling device shown in FIG. FIG. 19 is a perspective view showing a blood vessel peeling device according to an eighth embodiment of the present invention.

Hereinafter, a blood vessel peeling method and a blood vessel peeling device of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.

<First Embodiment>
FIG. 1 is a perspective view showing a blood vessel peeling device according to a first embodiment of the present invention. FIG. 2 is a cross-sectional view of the blood vessel peeling device shown in FIG. FIG. 3 is a plan view of a peeling portion of the blood vessel peeling device shown in FIG. FIG. 4 is a side view of the peeling portion shown in FIG. FIG. 5 is a plan view illustrating a processing unit included in the peeling unit illustrated in FIG. 3. FIG. 6 is a plan view showing a modification of the peeling portion shown in FIG. FIG. 7 is a view showing a modification of the peeling portion of the blood vessel peeling device shown in FIG. 8 to 10 are diagrams for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG. In the following, for convenience of explanation, the right side in FIG. 1 is also referred to as “tip”, and the left side is also referred to as “base end”.

≪Vessel peeling device≫
A blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass blood vessel when performing blood vessel bypass surgery (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue. The blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it is a blood vessel that can be used as a bypass blood vessel. For example, the internal thoracic artery, gastroepiploic artery, radial artery, great saphenous vein, etc. Is mentioned.

However, the blood vessel to be collected is preferably the great saphenous vein among them. By using the blood vessel peeling device 100, as described above, the blood vessel can be collected in a state covered with the surrounding tissue. Therefore, it is considered that the long-term patency after surgery is increased by collecting the large saphenous vein using the blood vessel peeling device 100 and using it as a bypass blood vessel. Therefore, in the following, an example in which the large saphenous vein is collected using the blood vessel peeling device 100 will be described as a representative.

As shown in FIGS. 1 to 6, the blood vessel peeling device 100 includes a long operation unit 200, an imaging device 400 inserted (attached) to the operation unit 200, and a peeling provided at the distal end of the operation unit 200. Part 300. Hereinafter, each of these units will be sequentially described in detail.

[Operation section]
As shown in FIG. 2, the operation unit 200 includes a long main body 210 and a peeling unit (observation unit) 220 provided at the tip of the main body 210.

The main body 210 has a tubular shape extending in a straight line. On the other hand, the peeling part 220 is tapered toward the tip of the operation part 200 and has a conical shape. Moreover, the peeling part 220 has ultrasonic permeability. Such a peeling unit 220 has a function of peeling the tissue when the operation unit 200 is advanced in the living body and a function as an observation unit for observing the living body (the great saphenous vein 1000 and its surroundings). Have. In addition, as a shape of the peeling part 220, it is not limited to a cone shape like this embodiment, For example, the duckbill shape tapering so that a front-end | tip may become linear may be sufficient.

[Imaging device]
As illustrated in FIG. 2, the imaging device 400 includes a long main body 410, and an imaging unit 420 including an ultrasonic probe (ultrasonic wave transmitting / receiving unit) is provided at the distal end of the main body 410. Such an imaging device 400 can be inserted into the operation unit 200. In this manner, by inserting the imaging device 400 into the operation unit 200, the imaging device 400 can observe the great saphenous vein 1000 positioned in front of the operation unit 200 via the peeling unit 220. The configuration of the imaging unit 420 is not limited to the ultrasonic probe as in the present embodiment as long as the position of the great saphenous vein 1000 can be confirmed.

[Peeling part]
The peeling unit 300 is attached to the tip of the operation unit 200. The peeling part 300 is covered with the surrounding tissue (fat, connective tissue, etc.) 1200 by moving in the living body while being arranged around the great saphenous vein 1000. In addition to being peeled off in the state, it has a function of cutting and hemostasis the branch blood vessel 1100 branched from the great saphenous vein 1000. As shown in FIGS. 3 and 4, the peeling unit 300 includes a connector 310 that is fixed to the operation unit 200, a mounting unit 320 that is mounted on the connector 310, a blade unit 350, a processing unit 360, have.

The connector 310 has a base portion 311 that is curved in a substantially arc shape, and a connection portion 312 that connects the base portion 311 to the operation portion 200. Further, grooves 311 a and 311 b for mounting the mounting portion 320 are provided at both ends in the circumferential direction of the base portion 311. On the other hand, the mounting portion 320 has a slit (321) extending in the axial direction and has a cylindrical shape (tubular shape) having a substantially C-shaped cross-sectional shape. Such a mounting portion 320 is mounted to the connector 310 by engaging both end portions in the circumferential direction with the slit 321 between the grooves 311 a and 311 b of the connector 310. In use, the great saphenous vein 1000 is positioned inside the annular annular portion 340 formed by the base 311 and the attachment portion 320. Further, the inner diameter of the annular portion 340 is larger than the outer diameter of the great saphenous vein 1000, and the great saphenous vein 1000 is located on the central axis J when in use. However, the great saphenous vein 1000 may be offset from the central axis J.

As described above, the annular portion 340 is configured by combining two members (the connector 310 and the mounting portion 320), so that the large saphenous vein 1000 is not cut as described in the “blood vessel peeling method” described later. An annulus 340 can be disposed around the large saphenous vein 1000.

The width of the slit 321 is not particularly limited, but is preferably larger than the outer diameter of the large saphenous vein 1000. Thereby, the attachment part 320 can be attached to the connector 310 in a non-contact manner (or a light contact without damage) with the great saphenous vein 1000. Therefore, damage to the great saphenous vein 1000 when attaching the attachment part 320 to the connector 310 can be suppressed. However, the width of the slit 321 is not limited to this, and may be smaller than the outer diameter of the large saphenous vein 1000. In this case, for example, the attachment part 320 can be attached to the connector 310 without contact with the large saphenous vein 1000 by expanding the deformation of the attachment part 320 and expanding the slit 321.

Further, the annular portion 340 (mounting portion 320) has a groove portion 390 that opens to the tip portion, and a plurality of the groove portions 390 are arranged side by side in the circumferential direction of the annular portion 340. Each groove portion 390 is connected to a tapered blood vessel guide groove portion (first groove portion) 391 whose width gradually decreases toward the proximal end side and a proximal end portion of the blood vessel guide groove portion 391, and the straight width is substantially constant. A blood vessel processing groove (second groove) 392.

The blood vessel guide groove portion 391 is a groove portion that guides the branch blood vessel 1100 that contacts when the peeling portion 300 is pushed in the living body to the blood vessel processing groove portion 392, and has a tapered shape in order to smoothly perform this guidance. In particular, in this embodiment, since the adjacent blood vessel guide groove portions 391 are in contact with each other, the branch blood vessel 1100 can be smoothly guided to any one of the blood vessel guide groove portions 391. On the other hand, the blood vessel processing groove 392 is a groove for cutting and stopping the branch blood vessel 1100 guided by the blood vessel guide groove 391, and each blood vessel processing groove 392 is provided with a processing unit 360.

As shown in FIG. 5, the processing unit 360 has a bipolar structure having a pair of electrodes 361 and 362 that can generate an electric field in the blood vessel processing groove 392. Specifically, the electrode 361 is provided at the proximal end (bottom) of the vascular treatment groove 392, and the electrodes 362 are provided on both sides in the width direction of the vascular treatment groove 392. By applying a high-frequency alternating voltage between the electrodes 361 and 362, the branch blood vessel 1100 guided by the blood vessel processing groove 392 is heated and cut, and is thermally coagulated to stop hemostasis. Note that the tip 361 ′ of the electrode 361 is preferably sharp enough to cut the branch blood vessel 1100. Accordingly, if the branch blood vessel 1100 can be thermally coagulated (hemostatic) by an electric field generated at least between the electrodes 361 and 362, the branch blood vessel 1100 can be physically cut by the electrode 361. Therefore, the certainty of processing by the processing unit 360 is improved.

Here, the width W of the blood vessel processing groove 392 is not particularly limited, but is preferably narrower than the outer diameter of the branch blood vessel 1100 as shown in FIG. Thereby, since the branch blood vessel 1100 can be crushed in the blood vessel processing groove 392, the processing (cutting and hemostasis) by the processing unit 330 can be performed more reliably.

Further, the annular portion 340 is provided with a blade portion 350 for peeling the tissue around the large saphenous vein 1000. The blade portion 350 is provided along the blood vessel guide groove portion 391 at the distal end portion of the annular portion 340. As will be described later in the “blood vessel exfoliation method”, the blade part 350 has a function of exfoliating the tissue around the large saphenous vein 1000 when the exfoliation part 300 is pushed forward in the living body. . It is preferable that such a blade part 350 has such a sharpness that the tissue can be peeled without cutting the branch blood vessel 1100. Thereby, since the cutting of the branch blood vessel 1100 by the blade portion 350 is suppressed, bleeding can be suppressed to a low level, and the procedure can be performed safely and smoothly.

Although the peeling part 300 has been described above, for example, the shape of the blood vessel guide groove part 391 is not limited to the shape of the present embodiment. For example, as shown in FIG. The shape may be gradually reduced toward the side. By setting it as such a shape, since the blade part 350 is rounded, the branch blood vessel 1100 becomes difficult to be cut | disconnected by the blade part 350. FIG. Moreover, as shown in FIG.6 (b), the adjacent groove parts 390 may be spaced apart. In the present embodiment, the groove portion 390 and the processing portion 360 are not provided in the base portion 311, but for example, as shown in FIG. 7, the groove portion 390 and the processing portion 360 are also provided in the base portion 311 in the same manner as the mounting portion 320. It may be provided. Thereby, the groove part 390 and the process part 360 are arrange | positioned over the perimeter of the peeling part 300. FIG.

≪Vessel peeling method≫
The blood vessel peeling method (blood vessel sampling method) using the blood vessel peeling device 100 includes a first step of placing the peeling portion 300 around the large saphenous vein 1000, and the operation unit 200 while grasping the position of the large saphenous vein 1000. By operating and moving the peeling part 300 along the great saphenous vein 1000, the second step of peeling the large saphenous vein 1000 in a state covered with surrounding tissue and the large saphenous vein 1000 were ligated. A third step of cutting later and a fourth step of extracting the great saphenous vein 1000 while being covered with the surrounding tissue 1200 are included.

[First step]
First, the position of the great saphenous vein 1000 to be collected is confirmed, and an incision is made based on the position. Next, as shown in FIG. 8A, a part of the great saphenous vein 1000 is exposed through the incision 1300, and the peeling part 300 is disposed around the part. At this time, after disposing the large saphenous vein 1000 between the separated connector 310 and the mounting portion 320, the large saphenous vein 1000 is cut without being cut by assembling them. The peeling part 300 can be arrange | positioned around.

For convenience of explanation, the operation of disposing the peeling portion 300 around the large saphenous vein 1000 is also referred to as “mounting operation” below.

[Second step]
Next, as illustrated in FIG. 8B, the operation unit 200 in which the imaging device 400 is inserted is operated to push the peeling unit 300 into the living body along the great saphenous vein 1000. Specifically, while observing the living body (large saphenous vein 1000) with the imaging device 400, the operation unit 200 is pushed into the living body while being separated from the large saphenous vein 1000, and the large saphenous vein is placed on the central axis J. The peeling part 300 is advanced while 1000 is positioned. At this time, since the tissue can be peeled off by the peeling portion 220 provided at the distal end portion of the operation portion 200 and the blade portion 350 provided at the distal end portion of the peeling portion 300, the blood vessel peeling device 100 can be easily operated with a small force. Can be operated.

When the peeling part 300 is advanced in this way, the tissue 1200 around the large saphenous vein 1000 is peeled by the blade part 350, and the branch blood vessel 1100 is cut and stopped by the processing part 360. Thereby, the great saphenous vein 1000 is peeled from the living body in a state covered with the surrounding tissue 1200. In particular, as described above, in order to advance the peeling portion 300 so that the great saphenous vein 1000 is positioned on the central axis J, the large saphenous vein 1000 is covered with a tissue 1200 having a relatively uniform thickness over the entire circumference. It can be peeled in a broken state. The thickness t1 of the tissue 1200 exfoliated with the great saphenous vein 1000 and located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.

For convenience of explanation, in the following, the operation of moving the exfoliation part 300 and exfoliating the large saphenous vein 1000 while being covered with the surrounding tissue 1200 is also referred to as “exfoliation operation”.

[Third step]
Next, the large saphenous vein 1000 is cut at the proximal-side planned cut portion 1001 and the distal-side planned cut portion 1002. Specifically, first, as shown in FIG. 9 (a), the front and rear two cut portions 1001 of the large saphenous vein 1000 sandwiching the proximal end cut portion 1001 are ligated and the distal cut end portion 1002 is sandwiched. Ligate the two places before and after. In addition, the ligation on the tip side cut planned portion 1002 side can be performed through the incision portion 1400 by incising the vicinity of the tip side cut planned portion 1002. Next, as shown in FIG. 9 (b), the large saphenous vein 1000 is cut at the base end side planned cut portion 1001 and the distal end side cut planned portion 1002.

[Fourth step]
Next, as shown in FIG. 10, the large saphenous vein 1000 is taken out of the living body through the incision 1300 while being covered with the surrounding tissue 1200.

Through the first to fourth steps as described above, the large saphenous vein 1000 can be collected (extracted) while being covered with the surrounding tissue 1200. The great saphenous vein 1000 collected in such a state may be a bypass blood vessel having a long-term patency rate superior to that of the great saphenous vein not covered with the tissue 1200. This is believed to be due to the following reasons.

That is, the great saphenous vein 1000 is used as an arterial bypass blood vessel, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, the large saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced. In addition, the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair. Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with the tissue 1200 is used as a bypass blood vessel, it may lead to blood vessel occlusion in the long term.

On the other hand, by covering the great saphenous vein 1000 with the tissue 1200 as in the present embodiment, the tissue 1200 suppresses the expansion of the large saphenous vein 1000 and suppresses the bending of the great saphenous vein 1000 and the like. Can be expected. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed. In addition, by being covered with the tissue 1200, damage to the great saphenous vein 1000, specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed. From the above, there is a possibility that an excellent long-term patency rate can be exhibited by using the great saphenous vein 1000 covered with the tissue 1200 as a bypass blood vessel. In particular, in this embodiment, since the nutritional blood vessels remain in the blood vessel wall and the tissue 1200 of the great saphenous vein 1000, nutrition is supplied to the great saphenous vein 1000 as a bypass blood vessel even after bypassing, and the above effect is achieved. It is thought that improvement will be achieved.

According to the method described above, the large saphenous vein 1000 can be removed smoothly and accurately in a state covered with the surrounding tissue 1200. Specifically, in the second step, the operation unit 200 is pushed in while being separated from the great saphenous vein 1000, whereby contact between the operation unit 200 and the great saphenous vein 1000 can be prevented. Damage to the vein 1000 can be suppressed. Furthermore, since the peeling part 300 is advanced so that the large saphenous vein 1000 is positioned on the central axis J, the contact between the peeling part 300 and the large saphenous vein 1000 is also suppressed. Therefore, according to the above-described method, the large saphenous vein 1000 can be peeled while being covered with the surrounding tissue 1200 while suppressing damage to the large saphenous vein 1000. In particular, since the great saphenous vein 1000 is not cut until the second step is completed, blood can be passed through the great saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.

In the present embodiment, the state in which the entire circumference of the great saphenous vein 1000 is covered with the tissue 1200 has been described. However, if at least a part of the circumference of the great saphenous vein 1000 is covered with the tissue 1200, Good. In addition, the operation unit 200 is separated from the great saphenous vein 1000 to perform the peeling operation. However, for example, the operation unit 200 may contact the large saphenous vein 1000 during the peeling operation.

Second Embodiment
FIG. 11 is a partial cross-sectional side view showing a blood vessel peeling device according to a second embodiment of the present invention.

Hereinafter, the second embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the imaging device also serves as an operation unit.

≪Vessel peeling device≫
As shown in FIG. 11, the connecting portion 312 of the peeling portion 300 </ b> A is provided so as to close the insertion hole 313 into which the imaging device 400 can be inserted and the distal end side opening of the insertion hole 313, and has an ultrasonic permeability. (Observation part) 314. Then, by inserting the distal end portion of the imaging device 400 into the insertion hole 313, the imaging device 400 is connected to the peeling portion 300, and the imaging device 400 can observe the front of the peeling portion 300 via the peeling portion 314. .

In the present embodiment, the imaging device 400 also serves as the operation unit 200. As described above, the imaging device 400 is operated in a state where the imaging device 400 is connected to the peeling unit 300, so that the peeling unit 300 is changed. It can be moved along the great saphenous vein 1000.

<Third Embodiment>
FIG. 12 is a view showing a blood vessel peeling device according to a third embodiment of the present invention.

Hereinafter, the third embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the configuration of the imaging device is different.

≪Vessel peeling device≫
The imaging device 400B is not used by being inserted into the operation unit 200 as in the first embodiment described above, but observes the inside of the living body from the skin (biological surface) H as shown in FIG. Such an imaging device 400B is not particularly limited as long as the inside of the living body can be observed. For example, an X-ray irradiation apparatus used for X-ray imaging or the like, an ultrasonic probe used for ultrasonic diagnosis, or the like is used. Can be used. On the other hand, as shown in FIG. 12B, a marker 290 that is recognizable by an image (an X-ray image, an ultrasonic image) obtained from the imaging device 400B is provided at the distal end portion (peeling portion 220) of the operation portion 200B. ing. In the present embodiment, the peeling part 220 may not have ultrasonic wave permeability.

≪Vessel peeling method≫
In the blood vessel peeling device 100B having such a configuration, in the second step of the blood vessel peeling method, the inside of the living body is observed using the imaging device 400B, and the large saphenous vein 1000 and the distal end portion (the peeling portion 300) of the operation portion 200B are used. While grasping the positional relationship, the operation unit 200B is advanced. Also by such a method, the position of the distal end portion of the operation unit 200B (the position of the peeling unit 300) can be visualized, so that the positional relationship between the peeling unit 300 and the great saphenous vein 1000 can be grasped, and the peeling unit 300 can be used in vivo. Can move (advance) more smoothly and accurately.

Even in the third embodiment, the same effect as that of the first embodiment described above can be exhibited.

<Fourth embodiment>
FIG. 13 is a perspective view showing a blood vessel peeling device according to a fourth embodiment of the present invention. FIG. 14 is a diagram for explaining a blood vessel peeling method using the blood vessel peeling device shown in FIG.

Hereinafter, the fourth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.

This embodiment is the same as the first embodiment described above except that the imaging device is mainly omitted.

≪Vessel peeling device≫
As shown in FIG. 13, the blood vessel peeling device 100C includes an operation unit 200C and a peeling unit 300. That is, the blood vessel peeling device 100C of the present embodiment has a configuration in which the imaging device 400 is omitted from the blood vessel peeling device 100 of the first embodiment described above.

Also, a notification unit 280 is provided at the tip of the operation unit 200C. The notification unit 280 includes a light emitting unit 281 such as an LED, and can notify the operator of the position of the distal end of the operation unit 200C (the position of the peeling unit 300) by light emitted from the light emitting unit 281. Note that the light emitting unit 281 may be turned on or blinked. In addition, the color of light emitted from the light emitting unit 281 is not particularly limited, and may be white, blue, red, green, or the like. In the present embodiment, the peeling part 220 may not have ultrasonic wave permeability.

≪Vessel peeling method≫
In the blood vessel peeling device 100C having such a configuration, in the first step of the blood vessel peeling method, the position of the great saphenous vein 1000 is grasped by observing the inside of the living body, and based on the grasped position of the great saphenous vein 1000, the first step. The peeling work in 2 steps is performed. Specifically, the position of the great saphenous vein 1000 was grasped based on an image obtained by diagnosis using CT scan (computed tomography), ultrasound, infrared (near infrared), X-ray or the like. Information is written on the skin H (surface of the living body). As a method of marking the information, for example, as shown in FIG. 14, a mark X is marked on the skin along the great saphenous vein 1000, and from the skin of the great saphenous vein 1000 at the position of each mark X. Describe the depth. Next, a peeling operation is performed while the light emitting unit 281 is caused to emit light. During the peeling operation, the position of the distal end portion of the operation unit 200 (the position of the peeling unit 300) can be grasped based on the light of the light emitting unit 281 that is visible through the skin. It can be moved (moved forward) more smoothly and accurately. Note that the planar position of the peeling unit 300 in the living body can be grasped from the position of light from the light emitting unit 281, and the depth from the skin is grasped by the intensity (brightness) of light seen through the skin. be able to.

Also by such a method, since the position of the peeling part 300 can be visualized, the positional relationship between the peeling part 300 and the great saphenous vein 1000 can be grasped, and the peeling part 300 can be advanced more smoothly and accurately in the living body. Can do.

Even in the fourth embodiment, the same effects as those of the first embodiment described above can be exhibited.

<Fifth Embodiment>
FIG. 15 is a side view showing a peeling portion included in a blood vessel peeling device according to a fifth embodiment of the present invention.

Hereinafter, the fifth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the configuration of the peeling portion is different.

≪Vessel peeling device≫
In the peeling portion 300 </ b> D, the tip surface F <b> 1 of the annular portion 340 is inclined with respect to the central axis J as shown in FIG. 15. Thereby, the blade part 350 can be made sharper and more excellent peeling characteristics can be exhibited in the peeling work during the second step of the blood vessel peeling method. Note that the inclination angle θ of the front end face F1 with respect to the central axis J is not particularly limited, but may be, for example, about 30 ° to 60 °.

Also according to the fifth embodiment, the same effect as that of the first embodiment described above can be exhibited.

<Sixth Embodiment>
FIG. 16 is a side view and a cross-sectional view showing a peeling portion included in a blood vessel peeling device according to a sixth embodiment of the present invention. FIG. 16C is a cross-sectional view taken along the line AA in FIG. In FIG. 16A, the second vibration damping unit is not shown.

Hereinafter, the sixth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the configuration of the peeling portion is different.

≪Vessel peeling device≫
As shown in FIG. 16, the peeling part 300 </ b> E further includes a vibration element (vibration part) 380 and a vibration reduction part 370 provided in the annular part 340.

The vibration element 380 is a vibration source for vibrating the annular portion 340. The vibration element 380 has a strip shape (long shape), and a plurality of vibration elements 380 are arranged along the circumferential direction of the annular portion 340. More specifically, one vibration element 380 is disposed between a pair of adjacent grooves 390. Thus, by arranging the plurality of vibration elements 380 along the circumferential direction of the annular portion 340, the annular portion 340 can be vibrated more uniformly without unevenness. The configuration of the vibration element 380 is not particularly limited as long as the annular portion 340 can be vibrated at a predetermined frequency. For example, zinc oxide (ZnO), aluminum nitride (AlN), PZT (lead zirconate titanate) ) Or the like can be used in which a piezoelectric layer made of a piezoelectric material is sandwiched between a pair of electrode layers.

Further, the vibration frequency of the annular portion 340 that is vibrated by the vibration element 380 is not particularly limited. For example, the tissue can be removed without dissolving (releasing) blood vessels, skin, and muscles around the saphenous vein 1000. A frequency that can be dissolved (released) is preferable, and such a frequency is preferably about 20 to 60 kHz, and more preferably 30 to 40 kHz. Thereby, substantially only the tissue can be dissolved while protecting the saphenous vein 1000.

The vibration damping unit 370 has a function of absorbing and attenuating the vibration of the annular portion 340 caused by the vibration element 380. Such a vibration reduction unit 370 includes a first vibration reduction unit 371 disposed on the inner peripheral surface of the annular part 340 and a second vibration reduction unit 372 disposed on the outer peripheral surface of the annular part 340. is doing.

Further, the first and second vibration damping units 371 and 372 are arranged so as not to overlap with the blade unit 350, respectively. That is, the blade part 350 protrudes from between the first and second vibration damping parts 371 and 372 and the part is exposed to the outside. Therefore, when the annular portion 340 is vibrated, the vibration is mainly transmitted from the blade portion 350 to the outside, and is hardly transmitted to the outside from other places (for example, the inner peripheral surface and the outer peripheral surface of the annular portion 340). (Slightly transmitted) The second vibration damping unit 372 is disposed so as to cover the vibration element 380 and protects and insulates the vibration element 380.

The constituent materials of the first and second vibration damping parts 371 and 372 are not particularly limited as long as the vibration of the annular part 340 can be absorbed and attenuated. For example, natural rubber, butadiene rubber, styrene-butadiene rubber Various rubber materials such as urethane rubber, silicone rubber and fluorine rubber can be used.

≪Vessel peeling method≫
According to the blood vessel peeling device 100E having such a configuration, the peeling operation in the second step is performed while vibrating the annular portion 340, so that the peeling portion 300E is positioned on the front side in the moving direction by the vibration transmitted from the blade portion 350. Since the tissue can be peeled while being dissolved, the operation can be performed more smoothly. Furthermore, the tissue located inside the annular portion 340, that is, the tissue 1200 that is located around the great saphenous vein 1000 and peels off together with the great saphenous vein 1000 is suppressed, so that the large size can be more reliably increased. The saphenous vein 1000 can be exfoliated while covered with the surrounding tissue 1200. In addition, since the dissolution of the tissue located outside the annular portion 340 is suppressed, unnecessary dissolution of the tissue is reduced.

Even in the sixth embodiment, the same effect as that of the first embodiment described above can be exhibited.

In this embodiment, the vibration element 380 is disposed on the outer periphery of the annular portion 340. However, the arrangement of the vibration element 380 is not limited thereto, and is disposed on the inner peripheral surface of the annular portion 340, for example. May be. Further, the vibration element 380 may be disposed at a place other than the annular portion 340, for example, the operation portion 200 as long as vibration can be transmitted to the annular portion 340.

<Seventh embodiment>
FIG. 17 is a cross-sectional view showing a blood vessel peeling device according to a seventh embodiment of the present invention. 18 is a plan view and a side view of the blood vessel peeling device shown in FIG.

Hereinafter, the seventh embodiment will be described with reference to this drawing, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the structure of the peeling portion is different.

≪Vessel peeling device≫
As shown in FIG. 17A, the peeling portion 300F includes a connector 310 having a base portion 311 and a connection portion 312; a pair of movable pieces 330 (330 ′, 330 ″) housed (incorporated) in the base portion 311; The base 311 has a space for accommodating the movable piece 330, and the movable piece 330 is accommodated in this space.

In addition, as shown in FIG. 17B, one movable piece 330 ′ is one of the base portions 311 in a plan view (hereinafter, also simply referred to as “plan view”) viewed from the axial direction of the operation unit 200. The other movable piece 330 ″ is slidable so as to protrude and retract from the end portion, and can be slidably protruded and retracted from the other end portion of the base 311. Each movable piece 330 is also slidable. As shown in FIG. 18A, a knob (movable piece operating portion) 331 protruding toward the base end side of the base portion 311 is provided. By operating this knob 331, the movable piece 330 is removed from the base portion 311. It can be protruded or retracted to the base 311. When each movable piece 330 is protruded from the base 311 by operating the knob 331, it is as shown in FIGS. As shown, the movable piece 330 , 330 ″ are connected to each other, and an annular portion 340 is formed by the base 311 and the movable pieces 330 ′, 330 ″. In use, the great saphenous vein 1000 is located in the annular portion 340. Each movable piece 330 is provided with a blade portion 350, a groove portion 390, and a processing portion 360, as in the first embodiment described above.

≪Vessel peeling method≫
According to the blood vessel peeling device 100F having such a configuration, in the first step of the blood vessel peeling method, first, the connector 310 in a state where the movable pieces 330 ′ and 330 ″ are retracted into the base 311 is connected to the large saphenous vein. Next, the movable pieces 330 and 330 ″ are projected from the base 311 to form the annular portion 340. Thereby, the annular portion 340 can be disposed around the large saphenous vein 1000 without cutting the large saphenous vein 1000. And the peeling operation | work in a 2nd step should just be performed in this state. In particular, as described above, since the knob 331 protrudes toward the proximal end side of the base 311, the knob 331 is not easily caught by the tissue or the branch blood vessel 1100 during the peeling operation, and the peeling operation can be performed more smoothly.

Even in the seventh embodiment, the same effects as those of the first embodiment described above can be exhibited.

<Eighth Embodiment>
FIG. 19 is a perspective view showing a blood vessel peeling device according to an eighth embodiment of the present invention.

Hereinafter, the eighth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.

This embodiment is mainly the same as the first embodiment described above except that the arrangement of the operation units is different.

≪Vessel peeling device≫
In the blood vessel peeling device 100G, the operation unit 200 is positioned so as to be inserted inside the annular portion 340. By adopting such a configuration, the operation unit 200 is brought closer to the central axis J of the annular portion 340 as compared with a configuration in which the operation portion 200 as in each of the above-described embodiments is located outside the annular portion 340. be able to. Therefore, the operability of the peeling unit 300 by the operation unit 200 is improved, and the peeling operation can be performed more smoothly.

Here, from the viewpoint of the operability of the blood vessel peeling device 100G, it is preferable to dispose the operation portion 200 along the central axis J of the annular portion 340. However, in this case, the operation unit 200 becomes an obstacle, and the peeling portion 300 cannot be moved while the large saphenous vein 1000 is positioned on the central axis J. Therefore, the large saphenous vein 1000 has a substantially uniform thickness. It cannot be peeled while covered with the tissue 1200. Therefore, in the present embodiment, the operation unit 200 is positioned so as to be shifted from the central axis J of the annular portion 340. Accordingly, the peeling portion 300 can be moved while the large saphenous vein 1000 is positioned on the central axis J, and the large saphenous vein 1000 can be peeled in a state of being covered with the tissue 1200 having a substantially uniform thickness. it can.

Also in the eighth embodiment, the same effect as that of the first embodiment described above can be exhibited.

As described above, the blood vessel peeling method and the blood vessel peeling device of the present invention have been described based on the illustrated embodiment. However, the present invention is not limited to this, and the configuration of each part is an arbitrary configuration having the same function. Can be substituted. In addition, any other component may be added to the present invention. Moreover, you may combine each embodiment suitably.

In the above-described embodiment, the case where the bypass blood vessel is collected when performing the blood vessel bypass operation has been described. However, the use of the collected blood vessel is not limited to the bypass blood vessel.

The blood vessel peeling method of the present invention includes a first step of arranging a cylindrical peeling portion around a blood vessel, grasping a position of the blood vessel, operating an operation portion connected to the peeling portion, and removing the peeling portion. And a second step of peeling the blood vessel in a state where at least a part of the blood vessel is covered with the surrounding tissue by moving along the blood vessel. As described above, since the blood vessel can be peeled off without being in contact with the blood vessel, the blood vessel can be prevented from being damaged and excellent workability can be exhibited.

The blood vessel peeling device of the present invention has a long operation part and a cylindrical peeling part provided at a distal end of the operation part, the peeling part is arranged around a blood vessel, and the operation part By separating the blood vessel from the blood vessel and moving the peeling part along the blood vessel to peel the blood vessel in a state where at least a part of the blood vessel is covered with the surrounding tissue. To do. As described above, since the blood vessel can be peeled off without being in contact with the blood vessel, the blood vessel can be prevented from being damaged and excellent workability can be exhibited.

Therefore, each of the blood vessel peeling method and the blood vessel peeling device of the present invention has industrial applicability.

DESCRIPTION OF SYMBOLS 100 Blood vessel peeling device 100B Blood vessel peeling device 100C Blood vessel peeling device 100E Blood vessel peeling device 100F Blood vessel peeling device 100G Blood vessel peeling device 200 Operation part 200B Operation part 200C Operation part 210 Main body part 220 Separation part 280 Notification part 281 Light emission part 290 Marker 300 Separation part 300A peeling part 300D peeling part 300E peeling part 300F peeling part 310 connector 311 base 311a, 311b groove 312 connection part 313 insertion hole 314 peeling part (observation part)
320 Mounting portion 321 Slit 330 Movable piece 330 ′ Movable piece 330 ”Movable piece 331 Knob 340 Annular portion 350 Blade portion 360 Processing portion 361, 362 Electrode 361 ′ Tip portion 370 Vibration damping portion 371 First vibration damping portion 372 Second vibration damping Section 380 Vibration element 390 Groove section 391 Blood vessel guide groove section 392 Blood vessel processing groove section 400 Imaging device 400B Imaging device 410 Main body section 420 Imaging section 432 Separating section 1000 Large saphenous vein 1001 Proximal end cut planned section 1002 Distal end cut planned section 1100 Branched blood vessel 1200 Tissue 1300 Incision 1400 Incision F1 Tip surface H Skin J Center axis X Mark W Width t1 Thickness θ Inclination angle

Claims (9)

A first step of placing a cylindrical peel around the blood vessel;
By grasping the position of the blood vessel, operating an operation unit connected to the peeling part, and moving the peeling part along the blood vessel, the blood vessel is covered at least partially around the surrounding tissue. A blood vessel peeling method comprising: a second step of peeling in a broken state. The blood vessel peeling method according to claim 1, wherein the second step is performed while observing the blood vessel with an imaging device. The operation unit also serves as the imaging device,
The blood vessel peeling method according to claim 2, wherein in the second step, the peeling portion is moved while observing the blood vessel from inside the living body by the imaging device. 3. The blood vessel peeling method according to claim 2, wherein the peeling portion is moved while observing the blood vessel from the surface of the living body with the imaging device. A mark indicating the position of the blood vessel grasped by the imaging device is provided on the surface of the living body,
The blood vessel peeling method according to claim 2, wherein in the second step, the peeling portion is moved along the mark. In the peeling part or the operation part, a light emitting part for notifying the position of the peeling part is provided,
The blood vessel according to claim 4 or 5, wherein, in the second step, the position of the peeling part in the living body is grasped based on the position and intensity of the light from the light emitting part visually recognized through the surface of the living body. Peeling method. The blood vessel peeling method according to any one of claims 1 to 6, wherein, in the second step, the peeling is performed at the peeling portion, and a branching blood vessel branched from the blood vessel is cut and stopped. The blood vessel peeling method according to any one of claims 1 to 7, wherein the steps up to the second step are performed without cutting the blood vessel. A long operation part,
A cylindrical peeling portion provided at the tip of the operation portion,
The peeling part is arranged around the blood vessel, the operation part is operated away from the blood vessel, and the peeling part is moved along the blood vessel, so that the blood vessel is at least partly around the blood vessel. A blood vessel peeling device characterized by peeling in a state covered with tissue.

Images