JP6153133B2 - 吻合部位をバイパスするためのシステムおよび方法 - Google Patents
吻合部位をバイパスするためのシステムおよび方法 Download PDFInfo
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Classifications
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Description
(i)組織内に固定することなく、吻合部位の内部的なバイパスを提供する。
(ii)吻合部位における内部組織壁を生体物質から完全に遮蔽することによって、吻合部位からの漏出を防止する。
(iii)吻合手順中、または吻合手順後に、容易に配置および位置決めすることができる。
(iv)吻合手順中、およびバイパスを取り外す前に、吻合部位漏出試験を行うことができる。
(v)バイパスは、吻合手順の直後に完全に機能する。
(vi)組織が損傷することなく、または侵襲的手順を使用することなく、システムの要素を取り外すことができる。
以下の実施例を参照する。これらの実施例は上の説明と合わせて本発明について説明する(ただし本発明はこれらの実施例に制限されない)。
本発明者は、外側バンドによって所定の位置に保持されている内部バイパススリーブの固定能力および密封能力を評価する目的で、シリコーン管を利用した。内部スリーブは、長さ200mm、直径28mm、厚さ0.6mmのシリコーン管から作製した。この管を、直径2mmのステンレス鋼ばねからなる内部リングに取り付けた。肛門から500mmの長さのブタの新鮮な結腸を、試験体として以下に説明するように使用した。外側リングをシリコン管から作製し、専用のコネクタを取り付けた。
ブタの結腸の周囲で外側バンドを閉じ、デリバリー管を使用してスリーブおよび内部リングを送り込んで配置した後、結腸の周囲に外側バンドを締め付けてスリーブを所定の位置に固定した。肛門からスリーブを手で引っ張り、外側リングによる固定をチェックした。
バイパススリーブが固定されているブタの結腸を、流入管と流出管との間に取り付けることにより、流れ試験装置において密封についてチェックした。結腸の中を流れる水は、結腸壁に接触することなく完全に内部スリーブに迂回した。
固定能力および密封能力をインビボで評価する目的で、実施例1において説明したシステムに類似するシステムを、試験動物(ブタ)に14日間にわたり配置した。外側リングを少し変更し、結腸の腸間膜組織の中に容易に挿入できるように、金属製の導入部を加えた(図22)。
腸の細菌負荷を減少させ、したがって術後の創傷感染の確率を低減するため、手術の48時間前に、ブタにCefalysin(7mg/kg、IM、q 24時間)を筋肉内投与した。手術の1時間前に、Cefalysin IM(7mg/kg、IM、q 24時間)およびメトロニダゾール(500mg/1頭、I.V.1日1回3日間)を投与した。緩下剤および浣腸によって結腸を準備した。
実施例3において説明したシステムに似ているが、内部リングを囲むシリコーン「クラウン」(図23)を有するシステムを作製し、動物において試験した。クラウンは、リングの安定性を高め、スリーブが外側バンドをすべり抜けることを防止する目的で使用した。外側バンドにも修正を加え、プロピレン2/0縫合糸によって結合された標準の10mmフラット型シリコンドレインから作製した(図23)。実施例2において説明したように、システムを送り込んだ。
新しい設計のスリーブは、第2の試験ブタの結腸内に容易に挿入された。外側バンドの配置も容易であったが、所定の位置にいったん配置された外側バンドの内径を正確に測定することは難しかった。手術時間は20分間であったが、手術後4日目に、動物は最初の排便によって内部スリーブを排出した。
新しい外側バンドの設計と、新しいデリバリー管およびスリーブを、2匹の動物において試験した。試作品のシステムは、長さ300mm、直径30mmの、0.4mmシリコンスリーブを含んでいる(図25)。スリーブに、その近位端部において、0.2mmのシリコンリングをかぶせて接着した。リングの近位側には、より厚いシリコン「クラウン」が存在し、このクラウンは、リングの安定性を高め、外側バンドの中を移動することを防止するはずである。外側バンド(図24)は、7mmフラット型シリコンドレインから作製し、特殊なプラスチックコネクタを有する。ポリプロピレンの内部縫合糸をフラット型ドレインの内側に通し、縫合糸を結合して外側バンドを閉じた。デリバリーシステムは、プラスチックから作製した。
上述した方法論を使用して、新しいシステムを2匹の動物(ブタ)において試験した。第1の試験動物においては、システムを所定の位置に14日間にわたり取り付けた後、動物を切開した。試験動物から得られた結腸試料には、結腸壁の損傷の痕跡が見られた(図26)。試料を病理検査室で分析すると、筋層の広範な壊死および線維症が存在し、その周囲には壊死性残屑の大きな領域が広がっており、膨大な好中球および細菌も存在した。この領域は、好中球および反応性線維組織(膿瘍)によって囲まれている。損傷は、筋層および粘膜下組織に及ぶ。粘膜筋層や粘膜固有層に及ぶ形跡は見られなかった。結腸直腸粘膜における陰窩は、正常範囲内である。好中球、少ないマクロファージ、およびリンパ球を含む、軽度の固有層の間質浸潤(mild proprial interstitial infiltration)が存在した。粘膜上皮のほとんどは激しくは損傷していないが、変化は人工的なものであり、おそらくは組織の扱いおよび配置状態に起因する。
外側バンドに起因する組織のびらんが生じ、さらに外側バンドに対してスリーブが移動したため、本発明者は、外側バンドおよび内部スリーブを再設計した。
試験動物の中にシステムを14日間にわたり維持した後、ブタを切開して結腸を切除した。切除した結腸から3つの試料を採取した(図30〜図32)。結腸の試料には、壁の損傷は見られなかった。
Claims (8)
- 結腸において吻合部位をバイパスするためのシステムであって、
(a)前記結腸の内面において前記吻合部位にまたがるように構成された管状スリーブであって、前記管状スリーブは、第1の管状領域が隣接する第2の管状領域に取り付けられており、前記第1の管状領域は、おのおの直径が膨張時において前記隣接する第2の管状領域の直径よりも大きい第1のバルーンおよび第2のバルーンを含む、管状スリーブと、
(b)直径が固定され、かつ、前記結腸の外壁に圧縮力をかけることなく前記結腸を囲むように位置決めするように構成されたバンドであって、前記バンドの前記直径は、前記第1のバルーンおよび前記第2のバルーンが膨張したときに、前記管状スリーブの前記第1の管状領域が前記バンドから離れるのを許容しつつ、一方で、前記管状スリーブの前記第1の管状領域が前記バンドを超えて移動するのを阻止するようなサイズを有し、前記第1のバルーンと前記第2のバルーンの間の距離は、前記第1のバルーンおよび前記第2のバルーンの膨張後の直径の1.2〜2倍である、バンドと、
を備えている、システム。 - 前記バンドの前記直径は、前記結腸の外径以上であり、かつ、前記第1の管状領域の前記膨張可能構造の外径未満である、請求項1に記載のシステム。
- 前記バンドは、前記結腸を囲むように位置決めされたときに前記バンドの一部が身体の外側に延びるように構成されている、請求項1に記載のシステム。
- 前記第1の管状領域は、前記第2の管状領域よりも、その長さの方向に硬い、請求項1に記載のシステム。
- 前記第1の管状領域は、前記長さの方向の硬さを増加させる要素を含んでいる、請求項4に記載のシステム。
- 前記要素は、前記長さの方向の支柱である、請求項5に記載のシステム。
- 前記管状スリーブは、前記結腸の中に流体を注入するための流体管路を含んでいる、請求項1に記載のシステム。
- 前記バンドは、生分解性材料から作製されている、請求項1に記載のシステム。
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CN103370016A (zh) | 2013-10-23 |
US20140188029A1 (en) | 2014-07-03 |
IL226843B (en) | 2018-04-30 |
JP2014504915A (ja) | 2014-02-27 |
US9789291B2 (en) | 2017-10-17 |
EP2651314A4 (en) | 2016-12-21 |
US20170087343A1 (en) | 2017-03-30 |
ES2689500T3 (es) | 2018-11-14 |
WO2012081005A1 (en) | 2012-06-21 |
US8690817B2 (en) | 2014-04-08 |
US10188839B2 (en) | 2019-01-29 |
EP2651314B1 (en) | 2018-07-18 |
CN103370016B (zh) | 2016-10-19 |
US9511208B2 (en) | 2016-12-06 |
US20130158463A1 (en) | 2013-06-20 |
EP2651314A1 (en) | 2013-10-23 |
US20150045715A1 (en) | 2015-02-12 |
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