JP2013103075A - Guidance medical system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To easily insert a medical device into an intended blood vessel route.SOLUTION: A guidance medical system 10 includes a tube-like or wire-like guide wire 12 composed of an elastic body insertable into a blood vessel and including a magnet head 25 including a magnet; and a guiding device 14 including a device head part insertable into a body and holding a permanent magnet 55. The permanent magnet 55 of the device head part exerts a magnetic repulsion force on the magnet of the guide wire 12 inserted into the blood vessel to guide the magnet head 25.

Description

  The present invention relates to a guided medical system.

  Conventionally, a guided medical system that guides a medical instrument such as a guide wire or a catheter inserted into a blood vessel to a desired blood vessel route at a blood vessel branch point is known (see, for example, Patent Document 1 and Patent Document 2). ). The guided medical system described in Patent Document 1 is configured to guide a catheter on which a magnet is mounted in a blood vessel or a heart by arranging a strong magnet outside a patient's body and generating a magnetic field gradient in the body. Yes.

US Pat. No. 6,975,197 JP 2005-161052 A

  However, the guided medical systems described in Patent Document 1 and Patent Document 2 have a strong magnet, and thus have a disadvantage that the apparatus main body is large and expensive.

  An object of the present invention is to provide a guided medical system in which a medical instrument can be easily inserted into a desired route of a blood vessel.

In order to achieve the above object, the present invention provides the following means.
The present invention has a cylindrical or linear medical device made of an elastic body that has a magnet at the tip and can be inserted into a blood vessel, and an insertion portion that can be inserted into the body while holding the magnet. Provided is a guiding medical system including a guiding device that guides the distal end portion by applying a magnetic repulsive force to the magnet of the medical instrument inserted into the magnet by the magnet of the insertion portion.

  According to the present invention, the distal end of the medical device is inserted by inserting the insertion portion of the guide device into the body of the patient and applying a magnetic repulsive force to the magnet of the medical device inserted into the blood vessel by the magnet of the guide device. The part can be moved in a direction to repel the insertion part of the guidance device.

  Therefore, in the branch portion of the blood vessel that branches into a plurality of routes, the insertion portion of the guide device is arranged on the entrance of a route different from the desired route, and the magnet of the medical device is directed to the entrance of the desired route by the magnetic repulsive force. By repelling, the tip of the medical instrument can be guided to a desired route. Thereby, the medical instrument can be easily inserted into a desired route of the blood vessel.

  In the above invention, the insertion portion of the guidance device has a facing portion that faces the tip of the medical device, and the magnetic force directed in the tip direction of the magnet of the medical device and the facing of the magnet of the guidance device The magnetic force directed in the partial direction may have the same polarity.

  With this configuration, if the facing portion of the insertion portion of the guiding device is inclined with respect to the traveling direction in front of the distal end portion of the medical device, the traveling direction of the magnet of the medical device can be changed by the magnetic repulsion force. It can change along the facing part of an insertion part. Therefore, if the facing part of the insertion part of the guidance device is inclined along the desired route on the entrance of the route different from the desired route at the branching portion of the blood vessel, the tip of the medical device is guided. Can be easily inserted into a desired route.

  The present invention also has a cylindrical or linear medical instrument made of an elastic body that has a magnet at the tip and can be inserted into a blood vessel, and an insertion section that can be inserted into the body while holding the magnet. A guiding medical system is provided that includes a guiding device that guides the distal end portion by applying a magnetic attraction force to the magnet of the medical instrument inserted into the blood vessel by the magnet of the insertion portion.

  According to the present invention, the distal end of the medical device is inserted by inserting the insertion portion of the guide device into the body of the patient and applying a magnetic attraction force by the magnet of the guide device to the magnet of the medical device inserted into the blood vessel. The part can be moved in a direction close to the insertion part of the guidance device.

  Therefore, in the branch part of the blood vessel that branches into a plurality of routes, the insertion part of the guidance device is arranged on the entrance of the desired route, and the magnet of the medical device is attracted to the insertion part of the guidance device by the magnetic attraction force. The tip of the instrument can be guided to the desired route. Thereby, the medical instrument can be easily inserted into a desired route of the blood vessel.

  In the above invention, the insertion portion of the guidance device has a facing portion that faces the tip of the medical device, and the magnetic force directed in the tip direction of the magnet of the medical device and the facing of the magnet of the guidance device The magnetic force directed in the partial direction may have a polarity of a counter electrode.

  With this configuration, when the facing portion of the insertion portion of the guidance device is disposed in front of the distal end portion of the medical instrument, the distal end portion of the medical device can be attracted to the insertion portion by a magnetic attraction force. Therefore, if the opposite end of the insertion portion of the guidance device is arranged in the direction in which the distal end of the medical device is inserted on the entrance of the desired route at the branch of the blood vessel, the distal end of the medical device is guided. Can be easily inserted into a desired route.

Moreover, in the said invention, the magnet of the said medical device is good also as having a substantially spherical shape and having a polarity in radial direction.
By comprising in this way, the influence which the counter electrode of the magnet of a medical instrument has on guidance operation | movement with the magnet of a guidance apparatus can be reduced.

Moreover, in the said invention, it is good also as the insertion part of the said guidance apparatus exposing and holding the said magnet.
By comprising in this way, the magnet of an insertion part can be visually recognized. Therefore, positioning of the magnet of the guidance device with respect to the blood vessel can be facilitated.

Moreover, in the said invention, it is good also as providing the transparent member which covers the said magnet which the insertion part of the said guidance apparatus hold | maintained.
By comprising in this way, it can visually recognize and position easily, protecting with a transparent member, without exposing the magnet of an insertion part.

Moreover, in the said invention, it is good also as a magnet of the said guidance apparatus having an outer edge part which took the edge | corner of the edge on the surface on the opposite side to the surface made to adjoin to the said blood vessel.
With this configuration, when the endoscope is inserted into the body and the position of the insertion portion of the guidance device is confirmed, the edge of the surface brought close to the blood vessel of the magnet becomes a shadow of the edge of the opposite surface. Can be prevented from becoming hidden. Therefore, visibility of the edge of the surface on the blood vessel side of the magnet can be improved by the outer edge portion having a corner on the surface opposite to the blood vessel side of the magnet, and the insertion portion of the guide device can be positioned with high accuracy.

Moreover, in the said invention, the insertion part of the said guidance apparatus is good also as providing the magnet position adjustment mechanism which can advance / retreat the held said magnet in the direction which cross | intersects the longitudinal direction of the said insertion part.
With this configuration, in the state where the insertion portion of the guide device is positioned and fixed close to the blood vessel, the magnet position adjustment mechanism moves only the magnet without moving the insertion portion, and the positional relationship with the magnet of the medical device. Can be fine-tuned.

  According to the present invention, there is an effect that a medical instrument can be easily inserted into a desired route of a blood vessel.

It is the schematic which shows the guidance type medical system which concerns on 1st Embodiment of this invention, and the heart vicinity of a patient. It is the schematic which shows the guide wire of FIG. It is a general view of the guidance device of FIG. (A) is a figure which shows the shape where the shaft part of FIG. 3 extended linearly, (b) is a figure which shows the state which the shaft part curved by the action | operation of the bending mechanism. (A) is the figure which looked at the device head part of FIG. 3 in the thickness direction, (b) is sectional drawing which looked at the LL 'cross section of (a) toward the base end side of a device head part. (C) is a view of the device head portion of (a) as viewed from the opening side of the notch. FIG. 4 is a view showing a state where the guide wire of FIG. 2 and the guide device of FIG. 3 are inserted in the vicinity of the heart of a patient. It is a figure which shows the positional relationship of the guide wire and guidance apparatus in the branch part of the blood vessel. (A) is a figure which shows the positional relationship of the permanent magnet of the guidance apparatus in the branch part of a blood vessel, and the magnet head of a guide wire, (b) is sectional drawing which shows the MM 'cross section of (a), c) is a sectional view showing an NN ′ section of (a). It is sectional drawing of the guide wire of the guidance type medical system which concerns on the modification of 1st Embodiment of this invention. It is sectional drawing which cut | disconnected the device head part of the guidance apparatus of the guidance type medical system which concerns on 2nd Embodiment of this invention in the width direction. It is sectional drawing which cut | disconnected the device head part of the guidance apparatus of the guidance type medical system which concerns on the modification of 2nd Embodiment of this invention in the width direction.

[First Embodiment]
A guided medical system according to a first embodiment of the present invention will be described below with reference to the drawings.
As shown in FIG. 1, the guided medical system 10 according to the present embodiment includes a medical instrument 12 such as a cylindrical or linear guide wire or catheter that is inserted into a coronary vein (blood vessel) C of a patient A. The device has a device head portion (insertion portion) 51 that can be inserted into the body of the patient A, and a guide device 14 that guides the medical instrument 12 inserted into the coronary vein C. Hereinafter, a guide wire will be described as an example of the medical instrument 12. In FIG. 1, symbol E indicates the heart and symbol G indicates the pericardium.

  As shown in FIG. 2, the guide wire 12 includes a substantially cylindrical shaft 21 extending in the axial direction, a coil 23 disposed so as to cover the periphery of the shaft 21, and a magnet head ( Tip part) 25.

The shaft 21 has a base end portion 21a having an outer diameter size substantially the same as the outer diameter size of the magnet head 25, and a tapered portion 21b having a tapered shape extending from the base end portion 21a toward the tip end. By gradually decreasing the diameter of the shaft 21 toward the tip by the tapered portion 21b, the tip of the guide wire 12 is easily bent and deformed.
The coil 23 is disposed around the taper portion 21b of the shaft 21 and is wound with a gap in the radial direction so as to have substantially the same outer dimension as the outer diameter dimension of the magnet head 25.

The magnet head 25 includes a magnetic member 27 made of a bullet-shaped or hemispherical magnetic material that protrudes toward the distal end of the guide wire 12, and a ring-shaped permanent magnet disposed closer to the base end side than the magnetic member 27. And a magnet 29.
The magnet 29 is disposed so as to be coaxial with the shaft 21 and, for example, is fixed by a magnetic force so that the magnetic member 27 side becomes an N pole. The magnet 29 is coated with a protective layer (not shown) for preventing oxidation.

The shaft 21, the coil 23, and the magnet head 25 are covered with a hydrophilic coating layer (not shown). Thereby, the guide wire 12 reduces the frictional force by contact with the introducer 67 and the blood vessel inner wall, and makes it easy to advance and retreat.
The guide wire 12 configured in this manner has the original function of the guide wire, and the magnet 29 is magnetized by the magnet 29 so that the outer surface of the tip has N pole magnetism.

As shown in FIG. 3, the guide device 14 includes a grip portion 31 that is held by an operator, and a shaft portion 41 that extends from the grip portion 31 toward the distal end and to which the device head portion 51 is connected.
The grip portion 31 includes a lever 33 that operates the shaft portion 41.

The shaft portion 41 includes a shaft main body 43 and a bending mechanism 45 that bends the shaft main body 43 in a direction crossing the axial direction as shown in FIGS.
The shaft main body 43 is preshaped so that the myocardial tissue contact surface of the device head portion 51 draws a gentle curve in the direction of the heart E in the pericardium G. As a result, the device head 51 can be brought into close contact with the surface of the heart E without a vertical steering mechanism.

The bending mechanism 45 is accommodated in the shaft main body 43 and includes two sets of steering coils 47 and a steering wire 49.
The two sets of the steering coils 47 are each fixed to the shaft main body 43 with a surplus force that pushes both ends. Each steering coil 47 is connected to the lever 33 of the grip portion 31 via a steering wire 49.

  In the bending mechanism 45, when one steering wire 49 is pulled and the other steering wire 49 is loosened by the operation of the lever 33, the steering coil 47 connected to the pulled steering wire 49 contracts, and the other steering wheel 49 is retracted. A steering coil 47 connected to the wire 49 extends. Thereby, the shaft main body 43 can be changed from a linearly extending state as shown in FIG. 4A to a curved state in one direction as shown in FIG. In contrast, the bending operation of the shaft 21 that is bent in the horizontal direction is possible.

As shown in FIGS. 5A, 5B, and 5C, the device head portion 51 includes a U-shaped magnet fixing portion 53 in which a notch 52 having a depth in the width direction is formed, and a magnet fixing portion. 53 and a permanent magnet (magnet) 55 held by 53.
As shown in FIG. 5A, the magnet fixing portion 53 includes a distal end side support portion 53A disposed on the distal end side of the device head portion 51 and a proximal end side support disposed on the proximal end side of the device head portion 51. A portion 53B and a connecting portion 53C for connecting them are provided.

  Further, as shown in FIGS. 5B and 5C, the magnet fixing portion 53 is located on the entire surface in the thickness direction from the distal end side support portion 53A to the proximal end side support portion 53B via the connecting portion 53C. It has a groove 53D that is recessed to the end. A permanent magnet 55 is fitted in the groove 53D.

  One surface (facing portion; hereinafter referred to as heart contact surface 53E) on which the groove 53D is formed in the magnet fixing portion 53 has a gently concave curved surface as shown in FIG. A silicone resin coating layer is formed on the heart contact surface 53E. As a result, when the heart contact surface 53E is brought into contact with the heart E, the magnet fixing portion 53 enables stable contact fixation with respect to the curved surface of the heart tissue surface and reduces damage to the heart surface. It can be done.

  The permanent magnet 55 is fitted into the groove 53D in such a direction that the heart contact surface 53E side of the magnet fixing portion 53 is an N pole, and the surface of the permanent magnet 55 and the position where the concave curved surface of the heart contact surface 53E is most depressed are substantially flush. It is arranged to be. The surface of the permanent magnet 55 is exposed from the heart contact surface 53E side of the magnet fixing portion 53 to the opposite side through the opening of the notch 52. The permanent magnet 55 arranged in this way can form a magnetic field in the heart tissue including blood vessels by fixing the heart contact surface 53E of the magnet fixing portion 53 to the heart tissue. .

  Further, the permanent magnet 55 has an outer edge portion 55A having a corner on the surface opposite to the heart contact surface 53E of the magnet fixing portion 53, that is, the surface on the S pole side. The outer edge portion 55 </ b> A is disposed on the opening side of the notch 52 of the magnet fixing portion 53 that holds the permanent magnet 55. By disposing the outer edge portion 55A on the opening side of the notch 52 of the magnet fixing portion 53, when the endoscope is inserted into the pericardium G and the position of the permanent magnet 55 is confirmed on the screen, the permanent magnet 55 The edge of the heart contact surface 53E side (N pole side surface) is prevented from being shadowed by the edge of the opposite side (S pole side surface), and the permanent magnet 55 in the pericardium G is prevented from being hidden. The visibility of the position can be improved.

The operation of the guided medical system 10 according to this embodiment configured as described above will be described below.
For example, in the treatment of coronary artery disease, in order to place the guide wire 12 of the guided medical system 10 according to the present embodiment in a coronary artery blood vessel, for example, Sosa's method (reference: Sosa E et al., Non-linear surgical epithelial catheter) Using ablation to treat recurrent ventricular tachycardia occurringlate after mycardial inflection. J Am Coll Cardiol 2000; 35: 1442-1449), a sheath with a steering mechanism under the sword that is accessed in the pericardial sac. Two indwelling. And as shown in FIG. 6, the endoscope 63 and the guidance device 14 for observing the inside of the pericardial G are inserted into the pericardial G through each sheath.

  Subsequently, the guide wire 12 is inserted into the coronary sinus B through the sheath (or introducer) 67 from the subclavian vein. Then, by operating the grip portion 31, the guide wire 12 is advanced into the coronary vein C by going backward from the coronary sinus B to the blood flow. As the structure of the blood vessel into which the guide wire 12 is inserted, such as a blood vessel branching portion, becomes complicated, it becomes difficult to advance the guide wire 12 to a desired blood vessel route only by the operation of the grip portion 31.

  Therefore, as shown in FIG. 7, the endoscope 63 inserted into the pericardium G visually recognizes the blood vessel branching portion K where the entrance of the desired blood vessel route into which the guide wire 12 is desired to be inserted, and what is the desired blood vessel route? The device head portion 51 of the guidance device 14 is placed on the entrance of a different blood vessel route with the heart contact surface 53E in contact therewith.

  At this time, for example, as shown in FIGS. 7 and 8A, 8B, and 8C, the device head portion 51 is placed in a direction that intersects the direction in which the vascular route different from the desired vascular route extends. The permanent magnet 55 is arranged so as to be inclined and fixed, and along the direction in which a desired blood vessel route extends. When the guide wire 12 is pushed forward in this state, when the guide wire 12 advances toward a blood vessel route different from the desired blood vessel route, the permanent magnet 55 of the guide device 14 and the magnet head of the guide wire 12 are near the entrance. 25 (magnet 29) faces each other.

  In this case, since the polarity directed toward the tip of the magnet head 25 in the guide wire 12 and the polarity directed toward the facing portion 51A of the permanent magnet 55 in the guide device 14 have N poles, the magnet head 25 (magnet 29) and the permanent magnet 55 act as a magnetic repulsive force. As a result, the device head 51 of the guide wire 12 is moved in a direction in which the device head 51 repels the device head 51 of the guide device 14 fixed on the blood vessel.

  Specifically, the device head portion 51 of the guide wire 12 is caused to move by the permanent magnet 55 of the device head portion 51 that is arranged so as to be inclined along the direction in which the desired blood vessel route extends with respect to the traveling direction of the guide wire 12. The direction of travel can be changed toward the entrance of the desired vascular route. Thereby, the guide wire 12 can be inserted into a desired blood vessel route.

  As described above, according to the guided medical system 10 according to the present embodiment, in the blood vessel branching section K that branches into a plurality of blood vessel routes, the guidance device 14 is placed on the entrance of the blood vessel route different from the desired blood vessel route. The device head portion 51 is disposed to be inclined, and the magnet 29 of the guide wire 12 is repelled toward the entrance of the desired blood vessel route by the magnetic repulsive force, thereby guiding the magnet head 25 of the guide wire 12 to the desired blood vessel route. can do. Thereby, the guide wire 12 can be easily inserted into a desired blood vessel route.

  In the present embodiment, the permanent magnet 55 of the device head portion 51 is exposed in order to improve the visibility of the positional relationship between the permanent magnet 55 of the guidance device 14 and the blood vessel by the endoscope. The permanent magnet 55 held by the fixed portion 53 may be covered with a transparent cover (transparent member) made of a transparent material. Even in this case. The visibility of the permanent magnet 55 can be ensured and the positioning of the permanent magnet 55 with respect to the blood vessel can be facilitated.

This embodiment can be modified as follows.
In the present embodiment, the ring-shaped magnet 29 is exemplified as the magnet of the medical instrument, and the magnet head 25 includes the magnet 29 and the magnetic member 27. However, the hemispherical or shell-shaped hemispherical surface is used as the magnet of the medical instrument. However, the magnetic member 27 may be omitted by using a magnet magnetized with N pole. At this time, in order to shift the effect of the south pole of the counter electrode to the proximal end side of the guide wire 12, the shaft 21 and the coil 23 of the guide wire 12 may be made of a magnetic material or a plurality of magnets. It is good as well.

  In this modification, as shown in FIG. 9, a magnet 125 having a substantially spherical shape and having a polarity in the radial direction may be employed as the magnet of the medical instrument. Even in this case, the magnetic polarity on the distal end side of the guide wire 12 can be set to the N pole. In this modification, a soft resin may be injected as a support layer into the space between the tapered portion 21b of the shaft 21 and the coil 23. The guide wire 12 is not particularly limited in the shape and arrangement of the magnet as long as the magnet is mounted so that the tip of the magnet head 25 has an N pole.

[Second Embodiment]
Next, a guided medical system according to a second embodiment of the present invention will be described.
As shown in FIG. 10, the guided medical system 110 according to the present embodiment is a linear motion conversion device in which the device head unit 51 can advance and retract the permanent magnet 155 in a direction intersecting the longitudinal direction of the device head unit 51. The second embodiment is different from the first embodiment in that a mechanism (magnet position adjusting mechanism) 160 is provided.
In the following, parts that have the same configuration as those of the guided medical system 10 according to the first embodiment are denoted by the same reference numerals and description thereof is omitted.

  The permanent magnet 155 has a trapezoidal shape, and has an N-pole polarity on the heart contact surface 53E side of the device head portion 51. The permanent magnet 155 is arranged such that the trapezoidal slope side faces the opening side of the notch 52 of the magnet fixing portion 153. In this way, when the device head portion 51 is fixed along the direction orthogonal to the direction in which the blood vessel extends, the N pole side surface of the permanent magnet 155 is arranged at an angle with respect to the blood vessel. In addition, the effective length of the permanent magnet 155 can be increased. The permanent magnet 155 has a concave guide recess (not shown) on the long side, and has an outer edge 55A with a corner on the S pole side along a trapezoidal slope.

  The magnet fixing portion 153 can accommodate the permanent magnet 155 in the notch 52 so as to be able to advance and retreat in the width direction of the device head portion 51, that is, in the depth direction of the notch 52. The connecting portion 53C of the magnet fixing portion 153 and the permanent magnet 155 are connected by a spring 152 to which a force in a direction in which the permanent magnet 155 is housed in the notch 52 is applied. Further, the magnet fixing portion 153 includes a convex guide convex portion 153F that guides the guide concave portion of the long side portion of the permanent magnet 155 in the distal end side support portion 53A, and the rotation / linear motion conversion mechanism 160 is provided in the proximal end side support portion 53B. It has.

  The rotation / linear motion conversion mechanism 160 is provided at one end of the screw part 161 having a screw part 161 having a screw structure rotatable around an axis extending in the width direction of the device head part 51 and having the same axis as the screw part 161. A pulley 163, a wire 165 having one end wound around the pulley 163, and a linear motion member 167 having a female screw structure for fitting the screw portion 161 are provided.

The screw portion 161 has a proximal end portion on which the pulley 163 is provided disposed on the opening side of the notch 52 of the magnet fixing portion 153 and a distal end portion disposed on the depth side of the notch 52 of the magnet fixing portion 153.
The other end of the wire 165 passes through a wire hole (not shown) provided in the shaft portion 41 and is connected to a member (not shown) that operates in conjunction with the lever 33 of the grip portion 31.
The short side portion of the permanent magnet 155 is fixed to the linear motion member 167. The linear motion member 167 moves in the axial direction of the screw portion 161 when the screw portion 161 is rotated together with the pulley 163 by the wire 165.

According to the guided medical system 110 according to the present embodiment configured as described above, when the wire 165 is pulled by operating the lever 33 of the grip portion 31 in the guide device 14, the pulley 163 and the screw portion 161 rotate. Thus, the linear motion member 167 moves to the proximal end side of the screw portion 161. As a result, the permanent magnet 155 moves in a direction protruding from the notch 52 of the magnet fixing portion 153. On the other hand, when the wire 165 is released by the operation of the lever 33, the pulley 163 and the screw part 161 are rotated in the opposite directions by the restoring force of the spring 152, and the linear motion member 167 moves to the tip part side of the screw part 161. As a result, the permanent magnet 155 moves in a direction in which the permanent magnet 155 is housed in the notch 52 of the magnet fixing portion 153.
Except for the drive mechanism of the permanent magnet 155 of the guide device 14, it is the same as the first embodiment.

  Therefore, the position of the permanent magnet 155 in the width direction of the device head portion 51 can be finely adjusted by the rotation / linear motion conversion mechanism 160 simply by operating the lever 33 while the device head portion 51 is fixed on the blood vessel. . Thereby, the permanent magnet 155 of the guidance device 14 can be disposed at a more appropriate position, and the guide wire 12 can be more accurately inserted into a desired blood vessel route.

  In the present embodiment, the spring 152 is disposed between the coupling portion 53C of the magnet fixing portion 153 and the permanent magnet 155. However, the spring 152 is limited to the case where the spring 152 is disposed at the site shown in the present embodiment. Instead, the wire 165 may be disposed at a position where a force to return the permanent magnet 155 in the direction in which it is housed in the notch 52 of the magnet fixing portion 153 when the tensile force of the wire 165 is released. For example, a structure in which a spring is inserted and fixed in the screw portion 161 of the rotation / linear motion conversion mechanism 160 and a rotational force in a direction in which the permanent magnet 155 is accommodated may be applied to the spring.

This embodiment can be modified as follows.
For example, in the present embodiment, the rotation / linear motion conversion mechanism 160 that can move the permanent magnet 155 forward and backward in the width direction of the device head portion 51 is described as an example of the magnet position adjustment mechanism. 11, a magnet position adjustment mechanism 260 that can rotate the permanent magnet 155 about the magnet fixing fulcrum 254 of the tip side support portion 53A of the magnet fixing portion 153 as a fulcrum may be provided.

  The permanent magnet 155 according to this modification is formed in a substantially arc shape whose one side opposite to the corner supported by the magnet fixing fulcrum 254 is centered on the magnet fixing fulcrum 254. A concave guide recess (not shown) is provided on one side of the permanent magnet 155 formed in a substantially arc shape.

  The magnet fixing part 153 has a convex guide convex part (not shown) in which the wall surface of the base end side support part 53B has an arc shape centered on the magnet fixing fulcrum 254 and guides the guide concave part of the permanent magnet 155. ing.

  The magnet position adjusting mechanism 260 includes a pulley 263 disposed on the proximal end side support portion 53B of the magnet fixing portion 153, a wire 265 connected to the permanent magnet 155 via the pulley 263, and the permanent magnet 155. And a spring 252 to which a force to be housed in the notch 52 is applied.

The pulley 263 is provided to be rotatable around an axis extending in the thickness direction of the magnet fixing portion 253.
One end of the wire 265 is connected to a corner located diagonally to the corner supported by the magnet fixing fulcrum 254 in the permanent magnet 255. The wire 265 passes through a wire hole (not shown) of the shaft portion 41 and is connected to a member (not shown) that operates in conjunction with the lever 33 of the grip portion 31.
The spring 252 connects the connecting portion 53C of the magnet fixing portion 253 and the corner portion of the permanent magnet 255 to which the wire 265 is connected.

  A transparent cover (not shown) that covers the magnet positioning mechanism 260 is disposed on the surface of the device head portion 51 opposite to the heart contact surface 53E, and the surrounding tissue is protected from the magnet positioning mechanism 260. In addition, the visibility of the permanent magnet 155 by the cover is prevented from being deteriorated.

  According to the guiding medical device 110 according to the present modification, when the wire 265 is pulled by operating the lever 33 of the grip portion 31, the permanent magnet 155 protrudes from the notch 52 while rotating with the magnet fixing fulcrum 254 as a fulcrum. On the other hand, when the wire 265 is returned to the original position by operating the lever 33, the permanent magnet 155 is housed in the notch 52 while rotating around the magnet fixing fulcrum 254 by the restoring force of the spring 252.

Thereby, the position of the permanent magnet 155 in the direction intersecting the longitudinal direction of the device head portion 51 can be finely adjusted only by operating the lever 33 while the device head portion 51 is fixed on the blood vessel.
In this modification, a stopper that limits the operating range of the permanent magnet 155 may be provided in order to prevent the permanent magnet 155 from falling off.

  As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the specific structure is not restricted to this embodiment, The design change etc. of the range which does not deviate from the summary of this invention are included. For example, the present invention is not limited to those applied to the above-described embodiments and modifications, but may be applied to embodiments in which these embodiments and modifications are appropriately combined, and is not particularly limited. . Further, for example, in each of the above-described embodiments, the permanent magnet is exemplified as the magnet of the medical instrument and the magnet of the guidance device, but an electromagnet may be employed instead.

  In each of the above embodiments, the polarity of the tip of the magnet 29 mounted on the magnet head 25 of the guide wire 12 and the side of the myocardial tissue contact surface of the permanent magnets 55 and 155 mounted on the device head portion 51 of the guide device 14 are described. Although both polarities are N poles, it is sufficient that the polarities of both magnets are the same, and S poles may be arranged on both.

  In each of the above embodiments, the magnet head 25 of the guide wire 12 and the permanent magnets 55 and 155 of the guide device 14 are arranged so that the same poles face each other, and the guide wire 12 is guided by a magnetic repulsive force. However, the magnet head 25 of the guide wire 12 and the permanent magnets 55 and 155 of the guide device 14 may be arranged so that the opposite poles face each other, and the guide wire 12 may be guided by a magnetic attractive force.

  In this case, for example, when the guide wire 12 has the north pole on the distal end side, the permanent magnets 55 and 155 are arranged with the south pole facing the heart contact surface 53E side of the device head portion 51 of the guidance device 14. That's fine. By doing in this way, if the front-end | tip of the guide wire 12 is brought close to the permanent magnets 55 and 155 of the guidance device 14 fixed on the blood vessel, the magnetic head 25 of the guide wire 12 is moved by the magnetic attraction force. It can be moved in the direction approaching the device head portion 51.

  For example, in the blood vessel branch portion K that branches into a plurality of routes, the permanent magnets 55 and 155 of the guide device 14 are arranged on the entrance of the desired blood vessel route, and the magnet 29 of the guide wire 12 is moved by the magnetic attraction force. By attracting the device head 51, the magnet head 25 of the guide wire 12 can be guided to a desired blood vessel route. Thereby, the guide wire 12 can be easily inserted into a desired blood vessel route.

  That is, in the above embodiment, the embodiment using the repulsive force of the magnetic force has been described, but the attractive force of the magnet can also be used. In this case, for example, the polarity on the tip side of the magnet 29 mounted on the magnet head 25 of the guide wire 12 and the polarity on the myocardial tissue contact surface side of the permanent magnets 55 and 155 mounted on the device head portion 51 of the guide device 14 are the same polarity. However, each may have magnetism with different polarity, or one may have a magnetic force and the other may be made of a magnetic material.

  In the case where the attractive force of the magnet is used, in the above embodiment, the point where the magnet mounted on the device head portion 51 of the guide device 14 is brought into contact with the desired blood vessel route, and the tip of the guide wire 12 enters the desired blood vessel route. In this case, the same operation may be performed except that the guide wire 12 is advanced distally after the magnet mounted on the device head unit 51 is moved away or disabled by turning off the electromagnet.

When using the attractive force of the magnet, it is necessary to invalidate the magnetic force of the device head portion 51 when the guide wire 12 is advanced distally as described above. However, in the embodiment using the repulsive force of the magnet, This is not necessary, and is excellent in that the guide wire 12 can be operated while the position of the device head portion 51 is fixed.
On the other hand, when the attractive force of the magnet is used, there is an advantage in that the magnetic body member only needs to be disposed without disposing a magnetic member at the tip of the guide wire 12.

Further, in each of the above-described embodiments, the case where the guide wire 12 is placed in the coronary vein when placing the left ventricular lead for the cardiac resynchronization therapy (CRT) device has been described as an example. Needless to say, the present invention can also be applied when the guide wire 12 is inserted into the coronary artery.
In each of the above embodiments, the bending mechanism 45 of the shaft portion 41 has been described as being bent only in one axial direction, but instead of this, a biaxial shaft having a serpentine tube structure for an endoscope, which is a known technique, is used. A direction bending mechanism may be employed.

10,110 Guided medical system 12 Medical instrument 14 Guide device 25 Magnet head (tip)
29 Magnet 51 Device head part (insertion part)
53E Heart contact surface (face-to-face)
55,155 Permanent magnet (magnet)
55A Outer edge 160 Rotational linear motion conversion mechanism (magnet position adjustment mechanism)
260 Magnet position adjustment mechanism

Claims (9)

A cylindrical or linear medical instrument made of an elastic body that has a magnet at the tip and can be inserted into a blood vessel;
It has an insertion part that can be inserted into the body while holding a magnet, and induces the distal end part by applying a magnetic repulsive force to the magnet of the medical instrument inserted into the blood vessel by the magnet of the insertion part. A guided medical system comprising a guiding device. The insertion part of the guidance device has a facing part that faces the tip of the medical instrument,
The guiding medical system according to claim 1, wherein the magnetic force directed toward the tip of the magnet of the medical instrument and the magnetic force directed toward the facing portion of the magnet of the guiding device have the same polarity. A cylindrical or linear medical instrument made of an elastic body that has a magnet at the tip and can be inserted into a blood vessel;
It has an insertion portion that can be inserted into the body while holding a magnet, and induces the distal end portion by applying a magnetic attraction force to the magnet of the medical instrument inserted into the blood vessel by the magnet of the insertion portion. A guided medical system comprising a guiding device. The insertion part of the guidance device has a facing part that faces the tip of the medical instrument,
The induction medical system according to claim 3, wherein the magnetic force directed toward the tip of the magnet of the medical instrument and the magnetic force directed toward the facing portion of the magnet of the guidance device have opposite polarities.   The guidance type medical system according to any one of claims 1 to 4, wherein the magnet of the medical device has a substantially spherical shape and has a radial polarity.   The guiding medical system according to any one of claims 1 to 5, wherein an insertion portion of the guiding device holds the magnet exposed.   The guiding medical system according to any one of claims 1 to 5, further comprising a transparent member that covers the magnet held by the insertion portion of the guiding device.   The guiding medical system according to any one of claims 1 to 7, wherein the magnet of the guiding device has an outer edge portion with a corner edge on a surface opposite to a surface close to the blood vessel.   The induction type according to any one of claims 1 to 8, wherein the insertion portion of the guidance device includes a magnet position adjustment mechanism capable of moving the held magnet back and forth in a direction intersecting the longitudinal direction of the insertion portion. Medical system.

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