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WO2018139055A1 - Système de mesure et de réglage de pression intrathoracique et son procédé de fonctionnement - Google Patents

Système de mesure et de réglage de pression intrathoracique et son procédé de fonctionnement Download PDF

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Publication number
WO2018139055A1
WO2018139055A1 PCT/JP2017/043288 JP2017043288W WO2018139055A1 WO 2018139055 A1 WO2018139055 A1 WO 2018139055A1 JP 2017043288 W JP2017043288 W JP 2017043288W WO 2018139055 A1 WO2018139055 A1 WO 2018139055A1
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WO
WIPO (PCT)
Prior art keywords
opening
intrathoracic
adjustment system
intrathoracic pressure
pressure
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2017/043288
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English (en)
Japanese (ja)
Inventor
浩由紀 金田
巌 木幡
崇厳 中家
惣一 輪地
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
KANSAI MEDICAL UNIVERSITY EDUCATIONAL Corp
KOBATA GAUGE Manufacturing Co Ltd
Original Assignee
KANSAI MEDICAL UNIVERSITY EDUCATIONAL Corp
KOBATA GAUGE Manufacturing Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by KANSAI MEDICAL UNIVERSITY EDUCATIONAL Corp, KOBATA GAUGE Manufacturing Co Ltd filed Critical KANSAI MEDICAL UNIVERSITY EDUCATIONAL Corp
Priority to JP2018564136A priority Critical patent/JP6960121B2/ja
Publication of WO2018139055A1 publication Critical patent/WO2018139055A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems

Definitions

  • the present invention relates to an intrathoracic pressure measuring and adjusting system capable of easily measuring an intrathoracic pressure and adjusting the intrathoracic pressure in an initial medical treatment for pneumothorax treatment, and an operation method thereof.
  • Pneumothorax is a symptom in which air flows into the thoracic cavity through a hole opened in the side wall pleura covering the inner surface of the chest wall or the visceral pleura covering the lungs, and the lungs collapse (smallly atrophy).
  • spontaneous pneumothorax a portion of the alveoli is cystized or directly under the pleura It develops when the resulting cyst is torn and inspiration leaks into the chest cavity (air leak).
  • the thoracic cavity is a human or animal body space surrounded by the ribs, thoracic vertebrae, sternum and diaphragm, and the pressure in the thoracic cavity space is called intrathoracic pressure.
  • intrathoracic pressure usually, the inside of the thoracic cavity is maintained at a negative pressure ( ⁇ 4 to ⁇ 10 cmH 2 O from atmospheric pressure), so that the lung is pulled in the expansion direction and balanced with the elasticity (contracting force) of the lung itself and inflated. Holding.
  • pneumothorax occurs, the pressure in the thoracic cavity increases and the negative pressure cannot be maintained. As a result, the lung cannot swell and atrophy.
  • Thoracic drainage is for discharging body fluid (blood, pus, exudate / leakage fluid, etc.) and air accumulated in the chest cavity to the outside of the body.
  • This chest drainage has a water seal, and air discharged from the patient's chest cavity becomes a bubble that passes through the water seal and is discharged to the outside.
  • thoracic drainage is a treatment that requires hospitalization, and during the treatment there is severe pain due to the drainage tube compressing the intercostal nerve, etc., and body movement is restricted, so it is painful for the patient .
  • Thoracic drainage is less necessary when air leaks stop, but it is difficult to accurately determine whether it is necessary before treatment.
  • the present invention has been made in consideration of the above-described conventional problems and demands from the medical field, and in particular, the intrathoracic pressure can be easily measured even in a state where chest drainage is not performed, and the chest cavity It is an object of the present invention to provide an intrathoracic pressure measurement adjustment system capable of adjusting an internal pressure and a method of operating the same.
  • the inventors of the present invention have intensively studied to solve the above-mentioned problems.
  • the intrathoracic pressure is a physiological state
  • the negative pressure around ⁇ 8 cmH 2 O
  • the intrathoracic pressure can be measured in real time, the presence or absence of air leakage can be immediately determined, measuring whether it is physiologically normal intrathoracic pressure, high or conversely low, and At the same time, it was thought that the treatment could be performed, and the present invention was completed.
  • the intrathoracic pressure measurement and adjustment system of the present invention that has solved the above-described problems is to mutually measure and adjust the intrathoracic pressure, and to measure the intrathoracic pressure, and an indwelling needle portion that punctures the chest cavity toward the thorax.
  • a pressure gauge part, a container part for collecting excess air in the thoracic cavity, and a discharge port part for releasing the collected excess air to the outside air, and further, the indwelling needle part and the pressure gauge A first path connecting parts, a second path connecting the indwelling needle part and the container part, a third path connecting the container part and the discharge port part, the pressure gauge part and the discharge port part A first path, the second path, the third path, and the fourth path with one or two direction switching stopcocks, respectively. It is characterized in that it can be switched to a route.
  • a first direction switching stopcock is interposed in the first route, and a path branched from the first direction switching stopcock is connected to the container portion via a second direction switching stopcock.
  • the first direction switching stopcock performs switching of the excess air in the direction of the discharge port, in addition to the direction of sending the excess air to the pressure gauge unit. It is preferable that the direction switching stopcock of 2 performs switching to open the excess air to the outside air in the direction of the discharge port, in addition to the direction of collecting the excess air in the container.
  • the container part in the present invention is preferably a syringe.
  • a sterilizing filter is provided in the middle of the path from the first direction switching cock to the pressure gauge unit or at the attachment port of the first direction switching cock.
  • the intrathoracic pressure measurement and adjustment system of the present invention that has solved the above-described problems has an intrathoracic gas exhaust pipe, and the intrathoracic gas exhaust pipe includes a first opening for connecting to the indwelling needle portion, and a pressure gauge. A second opening for connecting to the part, a third opening for connecting to the suction device, and a stopper for blocking ventilation between the second opening and the third opening. .
  • the intrathoracic gas discharge tube further has a fourth opening for releasing the intrathoracic gas to the outside air.
  • the first opening is connected to an indwelling needle portion and the third opening is connected to a suction device.
  • the second opening is connected to a pressure gauge unit.
  • the pressure gauge unit measures pressure at intervals of 20 milliseconds or less.
  • a tube is connected to the first opening.
  • An operation method of the intrathoracic pressure measurement and adjustment system of the present invention that has solved the above-described problems includes an intrathoracic gas discharge tube having first to third openings, an indwelling needle portion connected to the first opening, A pressure gauge connected to the second opening; a suction device connected to the third opening; and a stopper for blocking ventilation between the second opening and the third opening.
  • An operation method of an intrathoracic pressure measurement adjustment system comprising: (1) measuring the atmospheric pressure in the intrathoracic gas discharge tube with the pressure gauge unit in a state where the first opening and the second opening are in communication with each other. And (2) a second step of conveying gas from the indwelling needle portion to the suction device in a state where the first opening and the third opening are in communication with each other.
  • the intrathoracic pressure measurement adjustment system and the operation method thereof according to the present invention since the intrathoracic pressure can be measured and the intrathoracic pressure can be adjusted based on the measurement result, the medical staff can perform It becomes possible to know the situation such as pneumothorax in almost real time.
  • intrathoracic pressure measurement and adjustment system of the present invention it is possible to provide a new treatment policy for pneumothorax in contrast to the diagnosis and treatment policies that depend on the conventional chest drainage, chest X-ray, CT, etc. It can be expected to contribute to the medical field.
  • (A) And (b) is an external view of the intrathoracic pressure measurement adjustment system which concerns on Embodiment 1 of this invention. It is the figure which showed an example of the direction switching stopcock of the intrathoracic pressure measurement adjustment system which concerns on Embodiment 1 of this invention. It is the figure which showed another example of the direction switching stopcock of the intrathoracic pressure measurement adjustment system which concerns on Embodiment 1 of this invention. It is the figure which showed another example of the direction switching stopcock of the intrathoracic pressure measurement adjustment system which concerns on Embodiment 1 of this invention. It is the figure which showed another example of the direction switching stopcock of the intrathoracic pressure measurement adjustment system which concerns on Embodiment 1 of this invention.
  • FIG. 1A shows an external view of an intrathoracic pressure measurement adjustment system according to a first embodiment of the present invention.
  • an intrathoracic pressure measurement adjustment system 1 according to a first embodiment of the present invention includes an indwelling needle unit 2 that punctures the chest cavity toward the thorax and a pressure gauge unit 3 that measures the intrathoracic pressure. And a container part 4 for collecting excess air in the thoracic cavity, and a discharge port part 5 for releasing the collected excess air to the outside air.
  • the intrathoracic pressure measurement adjustment system 1 of the present invention includes a first path R1 that connects the indwelling needle part 2 and the pressure gauge part 3, a second path R2 that connects the indwelling needle part 2 and the container part 4, and a container part. 4 and the discharge port part 5, and a fourth path R 4 that connects the pressure gauge part 3 and the discharge port part 5.
  • the first route R1, the second route R2, the third route R3, and the fourth route R4 can be switched to each route by the two direction switching stopcocks 6A. .
  • FIG. 1 (b) shows the vicinity of the indwelling needle portion 2 in the intrathoracic pressure measurement adjustment system shown in FIG. 1 (a).
  • a tube member 9 is connected to the proximal side of the indwelling needle portion 2 as shown in FIG.
  • the tube member 9 serves as a movement buffer member, so that the indwelling needle portion 2 can be prevented from moving. . Therefore, the pain of the patient during treatment can be reduced.
  • the direction switching stopcock opens a path connecting two adjacent L-shaped directions as shown in FIGS.
  • One direction-switching stopcock 6B that can be used may be used. Specifically, the direction toward the container part 4 and the direction toward the discharge port part 5 can be closed to open the first path R1 connecting the indwelling needle part 2 and the pressure gauge part 3 (see FIG. 2). . Moreover, the direction which goes to the pressure gauge part 3 and the direction which goes to the discharge port part 5 are closed, and 2nd path
  • the direction which goes to the indwelling needle part 2 and the direction which goes to the pressure gauge part 3 can be closed, and the 3rd path
  • the direction switching stopcock can be a commercially available medical cock used for adjusting the flow path of the drug solution when performing intravenous anesthesia, infusion therapy, infusion, or the like.
  • a structure composed of a polycarbonate main body and a polyethylene handle can be used, and the flow path direction can be changed depending on the direction of the handle.
  • the indwelling needle unit 2 is a medical instrument that is generally inserted and indwelled in a vein when blood is collected or infused. However, in the practice of the present invention, an indwelling needle for thoracic puncture is used. (Manufactured by Medikit Co., Ltd.).
  • the pressure gauge unit 3 can be a commercially available digital manometer. Specifically, when pressure is applied to the diaphragm (diaphragm), pressure corresponding to the deflection of the diaphragm is generated, and the resistivity of the gauge resistance (piezoresistance) changes in proportion to this pressure. This is converted into a digital signal and processed, and then converted into a digital pressure value and output as data. More specifically, a sensor that senses pressure is used, and a MEMS (Micro Electro Mechanical System) system can be used. For example, a digital manometer DMH-01 (manufactured by Kiso Keiki Seisakusyo Co., Ltd.) is cited. be able to.
  • DMH-01 manufactured by Kiso Keiki Seisakusyo Co., Ltd.
  • the container part 4 is for collecting excess air in the thoracic cavity. From the viewpoint of measuring the collected amount without leaking the collected excess air to the outside, a syringe barrel (syringe) is used. preferable.
  • the intrathoracic pressure measurement adjustment system 1 includes an indwelling needle unit 2 that punctures the chest cavity into the thorax, a pressure gauge unit 3 that measures the intrathoracic pressure, and excess air in the chest cavity.
  • the container 4 is provided, and the first path R1 connecting the indwelling needle part 2 and the pressure gauge part 3 is provided with a first direction switching cock 6A1 and branches off from the first direction switching cock 6A1.
  • the route is connected to the container part 4 via the second route R2 via the second direction switching stopcock 6A2.
  • the first direction switching stopcock 6A1 can switch the excess air in the direction of the discharge port 5 in addition to the direction of sending excess air in the thoracic cavity to the pressure gauge unit 3.
  • the second direction switching stopcock 6A2 has a direction to collect excess air discharged from the thoracic cavity in the container part 4 and a direction to open the collected excess air to the outside air from the discharge port part 5. Can be switched.
  • the direction of the handle of the first direction switching cock 6A1 is the same as in FIG. 6, and the direction of the handle of the second direction switching cock 6A2 is set as shown in FIG.
  • the third path R3 to be connected is opened, and the air collected in the container part 4 flows to the discharge port part 5 via the third path R3, is released to the outside, and is discharged.
  • the direction of the handle of the second direction switching stopcock 6A2 is the same as that in FIG. 7, and the direction of the handle of the first direction switching stopcock 6A1 is set as shown in FIG.
  • the first path R1 connecting the two is opened, and the path from the first direction switching cock 6A1 to the second direction switching cock 6A2 is closed.
  • excess air in the thoracic cavity flows to the pressure gauge unit 3 via the first path R1, and the intrathoracic pressure is measured.
  • first path R1 excess air accumulated in the chest cavity of the patient is directly sterilized in the middle of the path (first path R1) from the first direction switching cock 6A1 of the above configuration (see FIG. 8) to the pressure gauge unit 3.
  • a sterilizing filter 7 in the middle of the path as shown in FIG.
  • the sterilization filter 7 may be provided at the attachment port of the first direction switching cock 6A1 in addition to the middle of the path.
  • the intrathoracic pressure measurement adjustment system of the present invention a simple breathing model capable of easily measuring the intrathoracic pressure is prepared, taking as an example only the chest puncture state without performing chest drainage, and the intrathoracic pressure measurement adjustment of the present invention The system was verified.
  • the direction switching stopcock was performed using a single three-way stopcock and without a container for collecting excess air in the chest cavity. This will be described below with reference to the drawings.
  • FIG. 10 is a drawing-substituting photograph of a simple breathing model used for verification of the intrathoracic pressure measurement adjustment system of the present invention.
  • the simple breathing model 11 is produced as follows. As shown in FIG. 10, the bottom of the PET bottle 12 was cut out and a separately prepared rubber balloon 13A was attached to the cut-out trace of the PET bottle 12 to prepare a human diaphragm (simulated diaphragm 15). Next, the rubber balloon 13B is put in the plastic bottle 12, and the mouth of the plastic balloon 12 is covered while inverting the mouth of the rubber balloon 13B, thereby simulating a human airway / lung (simulated airway 16). A simulated lung 14) was prepared. In this way, the simple breathing model 11 including the simulated diaphragm 15, the simulated airway 16, and the simulated lung 14 was configured.
  • FIG. 11 is a drawing-substituting photograph showing the overall configuration of verification of the intrathoracic pressure measurement adjustment system 1.
  • the intrathoracic pressure measurement adjustment system 1 is attached by puncturing the thorax portion (thoracic puncture portion 17) of the simple breathing model 11 using 18G Happy Cass (manufactured by Medikit Co., Ltd.) of the indwelling needle portion 2. did.
  • the simulated diaphragm 15 was pressed toward the inside of the PET bottle 12, and the simulated diaphragm 15 was repeatedly pulled down or released repeatedly to simulate the breathing motion, and the intrathoracic pressure as a model of normal breathing was measured. (Measurement 1).
  • the pressure gauge unit 3 of the intrathoracic pressure measurement adjustment system 1 used a digital manometer DMH-01 (manufactured by Kiso Keiki Seisakusho Co., Ltd.).
  • the analysis of intrathoracic pressure data was performed by connecting an external communication unit provided in the pressure gauge unit 3 and a data analysis PC.
  • the specifications of the pressure gauge unit 3 and the data analysis software are as follows.
  • FIG. 12 shows an example of data in the normal respiration model obtained in the measurement 1. From FIG. 12, it was found that the periodic change in intrathoracic pressure from the flat pressure to the negative pressure can be continuously measured.
  • FIG. 13 shows an example of data in the model of tension pneumothorax obtained in the above measurement 2. From FIG. 13, it was found that intrathoracic pressure can be measured continuously in a tension pneumothorax model that gradually becomes positive pressure from normal negative pressure breathing.
  • FIG. 14 shows an example of data in the puncture deaeration model of the tension pneumothorax obtained in the measurement 3 above. From FIG. 14, it was confirmed that in the model for treatment of tension pneumothorax, the hyperthoracic pressure can be avoided by continuously measuring the intrathoracic pressure and performing deaeration treatment.
  • the intrathoracic pressure measurement adjustment system in Embodiment 1 of the present invention can reproduce the treatment status of normal breathing, tension pneumothorax, and tension pneumothorax,
  • the simulated intrathoracic pressure could be measured continuously and in real time.
  • the intrathoracic pressure measurement adjustment system of the present invention is not limited to such an application, For example, it can be used even when chest drainage is being performed.
  • the measurement of the intrathoracic pressure by the system is quantitative. Will be done.
  • FIG. 15 is a configuration diagram of the intrathoracic pressure measurement adjustment system according to the second embodiment of the present invention.
  • the intrathoracic gas discharge tube 19 is connected to the first opening V ⁇ b> 1 for connecting to the indwelling needle unit 2, the second opening V ⁇ b> 2 for connecting to the pressure gauge unit 3, and the suction device 4.
  • the third opening V3 has a stopper that blocks airflow between the second opening and the third opening, for example, the stopper 20a and the stopper 20b, and the basic configuration is the first embodiment. Since this is the same as the intrathoracic pressure measurement and adjustment system, a duplicate description will not be given.
  • the position where the first opening V1 to the third opening V3 are provided in the intrathoracic gas exhaust pipe 19 is not particularly limited.
  • the first opening V1, the second opening V2, and the third opening V3 are arranged in this order from the upstream portion. be able to.
  • the first opening V1, the third opening V3, and the second opening V2 can be arranged in order from the upstream portion.
  • the intrathoracic gas sucked into the suction device 4 connected to the third opening V3 may be directly released from the suction device 4 to the outside air.
  • the fourth opening V4 for opening the chest cavity gas to the outside air is further provided.
  • the fourth opening V4 may be provided on the downstream side of the second opening V2 or the third opening V3.
  • the intrathoracic gas exhaust pipe 19 When the intrathoracic gas exhaust pipe 19 is a disposable product, a plastic material such as polyethylene, polypropylene, or polycarbonate can be preferably used as the material of the intrathoracic gas exhaust pipe 19. When the intrathoracic gas exhaust pipe 19 is not a disposable product, glass can be used as the material of the intrathoracic gas exhaust pipe 19.
  • the intrathoracic gas discharge tube 19 may be a member in which a portion including the first opening V1 to the third opening V3 is integrally formed.
  • the first tube including the first opening V1 and the second opening V2 ( (Not shown) and a second pipe (not shown) provided with the third opening V3 and the fourth opening V4 may be connected to each other.
  • the three-way cock 18 as described in the first embodiment can be used.
  • the pressure gauge unit 3 measures pressure at intervals of 20 milliseconds or less, more preferably 15 milliseconds or less, and even more preferably 10 milliseconds or less. This is because if the measurement interval is short, the output value can be obtained as a smooth output graph of the intrathoracic pressure in real time.
  • the tube member 9 is connected between the indwelling needle portion 2 and the first opening as in the first embodiment. This is because even when the intrathoracic gas discharge tube 19 moves during the treatment by the doctor, the tube member 9 functions as a buffer member for movement, so that the indwelling needle portion 2 can be prevented from moving. .
  • the intrathoracic pressure measurement adjustment system can be operated by at least the following two steps. (1) Step of measuring the pressure in the intrathoracic gas discharge pipe 19 with the pressure gauge unit 3 in a state where the first opening V1 and the second opening V2 are in communication with each other (2) the first opening V1 and the third opening Step of conveying gas from the indwelling needle part 2 to the suction device 4 in a state where the V3 is in communication
  • step (1) and step (2) can be performed even if the order is changed, and step (1) and step (2) may be repeated alternately. While step (1) or step (2) is performed, the ventilation between the second opening V2 and the third opening V3 is blocked so that the pressure gauge unit 3 and the suction device 4 do not interfere with each other.
  • the stopper to be closed (for example, the stopper 20a and / or the stopper 20b) is closed.
  • the intrathoracic pressure measurement and adjustment system and the operation method thereof since the intrathoracic pressure can be measured while exhausting excess air accumulated in the thoracic cavity, the medical staff can monitor the situation of the patient's pneumothorax and the like almost in real time It becomes possible to know at.
  • the intrathoracic pressure measurement adjustment system of the present invention makes it possible to determine the presence or absence of air leakage during puncture deaeration, and provides an index for determining a treatment policy for pneumothorax. Further contribution can be expected.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
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Abstract

L'objectif de la présente invention est de fournir un système de mesure et de réglage de pression intrathoracique qui mesure de manière pratique la pression intrathoracique et règle la pression intrathoracique. Ce système de mesure et de réglage de pression intrathoracique, qui à la fois mesure la pression intrathoracique et ajuste la pression intrathoracique, comprend : une partie aiguille à demeure pour effectuer une ponction intrathoracique vers l'intérieur du thorax ; une partie jauge de pression pour mesurer la pression intrathoracique ; une partie récipient pour collecter l'excès d'air à l'intérieur de la cavité thoracique ; et une partie orifice de décharge pour décharger l'excès d'air collecté vers l'atmosphère, ce système ayant un premier trajet qui relie la partie aiguille à demeure et la partie jauge de pression, un deuxième trajet qui relie la partie aiguille à demeure et la partie récipient, un troisième trajet qui relie la partie récipient et la partie orifice de décharge, et un quatrième trajet qui relie la partie jauge de pression et la partie orifice de décharge, et comprend également une soupape de commutation de direction qui peut commuter le premier trajet, le deuxième trajet, le troisième trajet et le quatrième trajet.
PCT/JP2017/043288 2017-01-25 2017-12-01 Système de mesure et de réglage de pression intrathoracique et son procédé de fonctionnement Ceased WO2018139055A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4447235A (en) * 1981-05-07 1984-05-08 John M. Clarke Thoracentesis device
JP2004508070A (ja) * 2000-04-12 2004-03-18 シャーウッド　サーヴィシス　アクチェンゲゼルシャフト 超高感度検出機構を有している胸腔穿刺器具
JP2005501667A (ja) * 2001-09-13 2005-01-20 アレジアンス、コーポレイション 多数の取り外し可能な部品を有する改良穿刺術装置

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4447235A (en) * 1981-05-07 1984-05-08 John M. Clarke Thoracentesis device
JP2004508070A (ja) * 2000-04-12 2004-03-18 シャーウッド　サーヴィシス　アクチェンゲゼルシャフト 超高感度検出機構を有している胸腔穿刺器具
JP2005501667A (ja) * 2001-09-13 2005-01-20 アレジアンス、コーポレイション 多数の取り外し可能な部品を有する改良穿刺術装置

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