JP2021058572A - catheter - Google Patents

Abstract

To provide a catheter capable of achieving excellent operability.SOLUTION: A catheter 100 as a catheter 100 which is detained in the coronary sinus of the heart and supplies a heart muscle protective liquid to the coronary artery comprises: a tubular body 10 having a plurality of lumens 20; a pore part 13 for supplying a heart muscle protective liquid, formed in a distal end part 10a of the tubular body 10, and communicated with a first lumen 21; a reinforcement tube 40 inserted into a second lumen 22; and an operation wire 50 inserted into the reinforcement tube 40. The reinforcement tube 40 extends from a proximal side to the distal end part 10a of the tubular body 10. A tip 50a of the operation wire 50 is derived from a distal end of the reinforcement tube 40, and is fixed to the distal end part 10a of the tubular body 10 at a distal side from a distal end 40a of the reinforcement tube 40.SELECTED DRAWING: Figure 1

Description

The present invention relates to a catheter.

As the catheter, for example, there is one described in Patent Document 1.
The catheter of Patent Document 1 is a tubular body having a first lumen (described as a main lumen in the same document) and a second lumen (described as a wire lumen in the same document) (catheter tube in the same document). (Description) and two operation lines (described as the first wire and the second wire in the same document) inserted through the second lumen.
The tips of the two operating lines are fixed to the distal ends of the tubular body, respectively.

JP-A-2015-173821

According to the study of the inventor of the present application, there is room for improvement in the operability of the catheter in the structure of the catheter of Patent Document 1.

The present invention has been made in view of the above problems, and provides a catheter capable of realizing good operability.

According to the present invention, a catheter is placed in the coronary sinus of the heart to supply cardioplegic fluid to the coronary arteries.
A tubular body with multiple lumens and
A hole for supplying the cardioplegic solution, which is formed at the distal end of the tubular body and communicates with the first lumen.
A reinforcing tube inserted through the second lumen and
The operation line inserted through the reinforcing tube and
Have,
The reinforcing tube extends from the proximal side of the tubular body to the distal end.
A catheter is provided in which the tip of the operating line is derived from the distal end of the stiffening tube and is anchored to the distal end of the tubular body distal to the distal end of the stiffening tube. Will be done.

According to the present invention, good operability of the catheter can be realized.

It is a figure which shows the whole structure of the catheter which concerns on embodiment. 2 (a) and 2 (b) are views showing the distal end of the catheter according to the embodiment, of which FIG. 2 (a) is a side view and FIG. 2 (b) is in the axial direction of the catheter. It is a cross-sectional view along. 3 (a) and 3 (b) are views showing the catheter according to the embodiment, of which FIG. 3 (a) is a cross-sectional view taken along the line AA of FIG. 2 (a), FIG. 3 (a). b) is a cross-sectional view taken along the line BB of FIG. 2 (a). It is a figure which shows the whole structure of the introducer to which the catheter which concerns on embodiment is connected. 5 (a) and 5 (b) are views showing a state in which the catheter according to the present embodiment is connected to the introducer, and in FIG. 5 (a), the distal end of the catheter is the introducer. A state in which the distal end does not protrude from the distal end is shown, and FIG. 5 (b) shows a state in which the distal end of the catheter protrudes from the distal end of the introducer. 6 (a) and 6 (b) are views showing a connection structure between the catheter and the introducer according to the present embodiment, and FIG. 6 (a) shows a state in which the catheter and the introducer are separated. 6 (b) is a diagram showing a state in which the catheter and the introducer are connected. It is a figure which shows the whole structure of the catheter which concerns on the 1st modification. 8 (a) and 8 (b) are side views showing the internal structure of the operation portion in the first modification, of which FIG. 8 (a) swings the operation receiving portion in one direction in the circumferential direction. FIG. 8B shows a state in which the operation receiving portion is swung in the opposite direction in the circumferential direction. It is a top view of the operation part in the 1st modification. 10 (a) to 10 (f) are views for explaining the operation of the catheter according to the first modification, and FIG. 10 (a) shows a state in which the distal end is extended. 10 (b) shows a state in which the distal end is bent, and FIG. 10 (c) shows a state in which the distal end is further bent than in the state shown in FIG. 10 (b). The state is shown, FIG. 10 (d) is a side view showing the internal structure of the operation unit in the state corresponding to FIG. 10 (a), and FIG. 10 (e) is the state corresponding to FIG. 10 (b). FIG. 10 (f) is a side view showing the internal structure of the operation unit, and FIG. 10 (f) is a side view showing the internal structure of the operation unit in a state corresponding to FIG. 10 (c). 11 (a) to 11 (f) show the operation receiving portion in the first modification, of which FIG. 11 (a) is a perspective view, FIG. 11 (b) is a plan view, and FIG. 11 (c). 11 (d) is a bottom view, FIG. 11 (d) is a side view showing the operation receiving portion 75 and its peripheral structure, and FIG. 11 (e) is a cross-sectional view taken along the line AA shown in FIG. 11 (d). (F) is a cross-sectional view taken along the line BB shown in FIG. 11 (d). 12 (a) and 12 (b) are side views of the operation portion in the second modification, and FIG. 12 (a) shows a state in which the operation receiving portion is swung in one direction in the circumferential direction. FIG. 12B shows a state in which the operation receiving portion is swung in the opposite direction in the circumferential direction.

Hereinafter, embodiments of the present invention will be described with reference to FIGS. 1 to 6 (b). In all drawings, similar components are designated by the same reference numerals, and description thereof will be omitted as appropriate.
In addition, although FIG. 1 shows a state in which the balloon 60 is inflated for convenience, in reality, the balloon 60 is not inflated in the normal state before use. Further, the left-right positional relationship between the connecting portion 15 and the second connecting portion 113 is reversed between FIGS. 5 (a) and 5 (b) and FIGS. 6 (a) and 6 (b). doing.
The second hole portion 13b faces the front side of the paper surface in FIG. 2A and faces downward in FIG. 2B. 2 (a) shows the distal end of the catheter 100 viewed in the direction of arrow A shown in FIGS. 3 (a) and 3 (b), and FIG. 2 (b) shows FIG. 3 (a). And is a cross-sectional view taken along the line BB shown in FIG. 3 (b). Further, in FIG. 2A, the first lumen 21 and the balloon 60 are shown by broken lines, but the second lumen 22, the third lumen 23, and the fourth lumen 24 are not shown. .. In FIG. 2B, the third lumen 23 is shown by a broken line.

It should be noted that the embodiments described below are merely examples for facilitating the understanding of the present invention, and do not limit the present invention. That is, the shapes, dimensions, arrangements, etc. of the members described below can be changed or improved without departing from the spirit of the present invention, and the present invention includes equivalents thereof.
It should be noted that the various components of the catheter 100 of the present invention do not have to be individually independent. A plurality of components are formed as one member, one component is formed of a plurality of members, one component is a part of another component, and one of the components. Allows overlaps between parts and some of the other components, etc.
Further, in the following, the distal side of the catheter 100 is also referred to as the distal end side, and the proximal side thereof is also referred to as the proximal end side. Further, the distal end means a certain range including the distal end (state-of-the-art) and its periphery, and the proximal end is a certain range including the proximal end (the most proximal end) and its periphery. Shall mean.

As shown in any of FIGS. 1 to 3 (b), the catheter 100 according to the present embodiment is placed in the coronary sinus of the heart to supply a cardioplegic solution to the coronary artery.
The catheter 100 is formed on a tubular body 10 (FIG. 1 or the like) having a plurality of lumens 20 (FIG. 3 (a) or the like) and a distal end portion 10a of the tubular body 10 and has a first lumen 21 (FIG. 1 or the like). Holes 13 (FIGS. 2 (a), 2 (b), etc.) for supplying the cardioplegic solution communicating with 2 (a), FIG. 2 (b), etc.) and a second lumen 22 (FIG. 2 (a), FIG. It has a reinforcing tube 40 (FIG. 3 (a), etc.) inserted through the reinforcing tube 40 (FIG. 3 (a), etc.) and an operation line 50 (FIG. 2 (b), etc.) inserted through the reinforcing tube 40.
The reinforcing tube 40 extends from the proximal side of the tubular body 10 to the distal end 10a, and the tip 50a of the operation line 50 is led out from the distal end 40a of the reinforcing tube 40 to reinforce. It is fixed to the distal end 10a of the tubular body 10 on the distal side of the tube 40.

According to the present embodiment, since the portion of the tubular body 10 proximal to the distal end 40a of the reinforcing tube 40 is reinforced by the reinforcing tube 40, an appropriate stiffness of the tubular body 10 can be obtained, and the biological tube can be obtained. The catheter 100 can be easily inserted into the lumen.
On the other hand, in the tubular body 10, the portion distal to the distal end 40a of the reinforcing tube 40 (hereinafter referred to as the flexible portion 14) is not reinforced by the reinforcing tube 40, and is therefore proximal to the portion. It is more flexible than the part. Therefore, by pulling the operation line 50, the local range in the tubular body 10, that is, the flexible portion 14, can be selectively bent with a large curvature. Moreover, since the flexible portion 14 can be easily bent with a large curvature, the branch selectivity of the catheter 100 is improved.
As described above, since it is possible to achieve both moderate elasticity and good flexibility in the tubular body 10, it is possible to realize good operability of the catheter 100.

The catheter 100 according to the present embodiment is an intravascular catheter used by inserting a tubular body 10 into a blood vessel. It is possible to bend the flexible portion 14 (see FIG. 1) of the tubular body 10 and direct the catheter 100 in one direction by operating the operating portion 70 described later.
More specifically, the flexible portion 14 means a range from the distal end 40a of the reinforcing tube 40 to the most distal end of the operation line 50 in the tubular body 10.

In the case of the present embodiment, the tubular body 10 is a long tubular member, and has a plurality of lumens 20 formed along the longitudinal direction of the tubular body 10 inside the tubular body 10.

As shown in FIG. 2A, the plurality of lumens 20 includes a first lumen 21, a second lumen 22, a third lumen 23, and a fourth lumen 24. .. However, the number of lumens 20 included in the tubular body 10 is not particularly limited, and may be, for example, 5 or more, or 3 or less, for example.

The diameter (circle equivalent diameter) of the first lumen 21 is set to be larger than any diameter (circle equivalent diameter) of the second lumen 22, the third lumen 23, and the fourth lumen 24. More specifically, the diameter of the first lumen 21 occupies, for example, more than two-thirds of the diameter of the tubular body 10.
The diameter of the second lumen 22 is set to be larger than the diameter of the third lumen 23 and the fourth lumen 24, for example.
The diameter of the fourth lumen 24 is set to a size larger than the diameter of the third lumen 23, for example.
However, the magnitude relationship of the diameter of each lumen 20 is not limited to the above example, and can be appropriately set according to the use of each lumen 20.

Each lumen 20 is dispersedly arranged in the cross section of the tubular body 10, for example.
More specifically, for example, the center of each lumen 20 is eccentrically arranged with respect to the axial center of the tubular body 10. The second lumen 22, the third lumen 23, and the fourth lumen 24 are arranged around the first lumen 21, respectively, and the third lumen 23 and the second lumen 24 are arranged in the circumferential direction of the tubular body 10. The lumens 22 and the fourth lumen 24 are arranged in this order. Further, the second lumen 22, the third lumen 23, and the fourth lumen 24 are arranged eccentrically in the direction opposite to the direction in which the first lumen 21 is eccentric with respect to the axial center of the tubular body 10, respectively. ing.

The first lumen 21 is used, for example, as a fluid feeding lumen for supplying a cardioplegic solution to the coronary arteries. As described above, since the first lumen 21 into which the cardioplegic solution is injected is formed to have a relatively large diameter, the cardioplegic solution can be satisfactorily circulated in the lumen of the tubular body 10.
The first lumen 21 is formed over the entire length of the tubular body 10. The distal end of the first lumen 21 opens at the distal end of the tubular body 10, and the proximal end of the first lumen 21 communicates with the liquid delivery branch pipe 31 (see FIG. 1).
The cross-sectional shape of the first lumen 21 is not particularly limited, but is substantially circular in the present embodiment. The diameter of the first lumen 21 may be uniform regardless of the position of the tubular body 10 in the axial direction, or may be different depending on the position in the axial direction.

As described above, a hole 13 is formed in the distal end 10a of the tubular body 10. The foramen 13 communicates with the first lumen 21, and the cardioplegic solution injected into the first lumen 21 is discharged from the foramen 13 into the coronary arteries.

The tubular body 10 has a first hole portion 13a formed at the distal end of the tubular body 10 and a second hole portion formed on the peripheral surface of the distal end portion 10a of the tubular body 10 as holes 13. 13b and.
The first hole 13a is an opening at the distal end of the first lumen 21.
The second hole portion 13b is arranged proximal to the distal end of the tubular body 10. The second hole portion 13b is a side hole whose depth direction is a direction orthogonal to the axis of the tubular body 10. One end of the second hole 13b communicates with the first lumen 21, and the other end of the second hole 13b is open on the outer peripheral surface of the distal end 10a of the tubular body 10.
As an example, the second hole portion 13b is formed at a position 180 degrees opposite to the second lumen 22 in the circumferential direction of the tubular body 10. However, the position where the second hole portion 13b is formed is not particularly limited, and any position may be sufficient as long as it is in a position where it can communicate well with the first lumen 21 on the peripheral surface of the distal end portion 10a of the tubular body 10.

Since the tubular body 10 is formed with two holes 13 (first hole 13a and second hole 13b), one of the first hole 13a and the second hole 13b is a living tissue. Even if it is blocked by, the cardioplegic solution can be satisfactorily discharged from the other hole 13 of the first hole 13a and the second hole 13b.

A reinforcing tube 40 is inserted into the lumen of the second lumen 22, and an operation line 50 is inserted into the lumen of the reinforcing tube 40.
The second lumen 22 is formed, for example, from the proximal end to the distal end 10a of the tubular body 10. The distal end of the second lumen 22 terminates proximally to the distal end of the tubular body 10, and the proximal end of the second lumen 22 communicates with a bifurcation 30 described below.
The cross-sectional shape of the second lumen 22 is not particularly limited, but in the present embodiment, it is a substantially elliptical shape that is long in the circumferential direction of the tubular body 10. The diameter of the second lumen 22 may be uniform regardless of the position of the tubular body 10 in the axial direction, or may be different depending on the position in the axial direction.

The third lumen 23 is used, for example, to inject a liquid into the balloon 60 described later.
The third lumen 23 is formed from the proximal end to the distal end 10a of the tubular body 10. The distal end of the third lumen 23 is located in the formation region of the balloon 60 described below, and the proximal end of the third lumen 23 communicates with the balloon branch tube 32 (see FIG. 1).
The cross-sectional shape of the third lumen 23 is not particularly limited, but is substantially elliptical in the present embodiment. The diameter of the third lumen 23 may be uniform regardless of the position of the tubular body 10 in the axial direction, or may be different depending on the position in the axial direction.

The fourth lumen 24 is used, for example, to measure the fluid pressure inside the biological lumen.
The fourth lumen 24 is formed from the proximal end to the distal end of the tubular body 10. The distal end of the fourth lumen 24 opens at the distal end of the tubular body 10, and the proximal end of the fourth lumen 24 communicates with a pressure monitoring branch tube 33 (see FIG. 1).
The cross-sectional shape of the fourth lumen 24 is not particularly limited, but in the present embodiment, it is a substantially elliptical shape that is long in the circumferential direction of the tubular body 10. The diameter of the fourth lumen 24 may be uniform regardless of the position of the tubular body 10 in the axial direction, or may be different depending on the position in the axial direction.

The tubular body 10 is made of a resin material such as polyurethane or polyamide. By forming the tubular body 10 with a resin material such as polyurethane or polyamide, the workability of the tubular body 10 is improved.

It is also preferable that, for example, a hydrophilic layer (not shown) is formed on the outer peripheral surface of the tubular body 10. This makes it possible to reduce the sliding resistance when the catheter 100 is inserted into the lumen of the introducer 110 or the inside of the coronary sinus, which will be described later.
The hydrophilic layer may be formed over the entire length of the tubular body 10, or may be formed in a partial length region on the distal end side of the tubular body 10.
The material of the hydrophilic layer is not particularly limited, and examples thereof include a maleic anhydride-based polymer such as polyvinyl alcohol (PVA), a copolymer thereof, and a hydrophilic resin material such as polyvinylpyrrolidone.

The diameter of the tubular body 10 is not particularly limited, but is preferably 2 mm or more and 5 mm or less. The total length of the tubular body 10 is not particularly limited, but is preferably 500 mm or more and 1000 mm or less. Further, as shown in FIGS. 2A and 2B, the outer diameter of the most distal end portion of the tubular body 10 may be slightly enlarged toward the distal side.

As described above, the reinforcing tube 40 is inserted through the second lumen 22. In the case of the present embodiment, the diameter of the second lumen 22 is larger than the diameter of the reinforcing tube 40. Therefore, when the tubular body 10 is bent by the operation of the operation line 50, the relative movement of the reinforcing tube 40 with respect to the tubular body 10 is allowed in the axial direction.
The reinforcing tube 40 is formed, for example, in a long hollow tubular shape. For example, the inner and outer diameters of the reinforcing tube 40 are constant, and therefore the wall thickness of the reinforcing tube 40 is constant.
However, the reinforcing tube 40 may be formed in a tapered shape in which the inner diameter and the outer diameter are reduced toward the distal side, for example.

The reinforcing tube 40 is made of a metal material such as stainless steel (SUS).
However, the material constituting the reinforcing tube 40 is not particularly limited, and any material having a higher bending rigidity than the material constituting the tubular body 10 may be used.

The reinforcing tube 40 extends from the proximal side of the tubular body 10 to a portion near the proximal side of the placement region of the balloon 60. More specifically, the distal end 40a of the reinforcing tube 40 is located proximal to the placement area of the balloon 60. In other words, the balloon 60 is provided on the flexible portion 14. Therefore, the direction (posture) of the balloon 60 can be adjusted by pulling the operation line 50 and bending the flexible portion 14.
The reinforcing tube 40 is introduced from the second lumen 22 into the inside of the branch portion 30 described later, for example.

The operation line 50 is slidably inserted into the reinforcing tube 40 with respect to the reinforcing tube 40. The tip portion 50a of the operation line 50 is led out to the distal side from the distal end 40a of the reinforcing tube 40. The tip portion 50a of the operation line 50 led out from the reinforcing tube 40 is fixed to the distal end of the tubular body 10 through the second lumen 22.

The tip portion 50a of the operation line 50 is fixed to the distal end portion 10a of the tubular body 10 on the distal side of the formation region of the balloon 60. When the operation line 50 is pulled, the tubular body 10 bends. When the tubular body 10 bends, the portion distal to the distal end 40a of the reinforcing tube 40, that is, the flexible portion 14, mainly bends.

The operation wire 50 is, for example, a stranded wire formed by twisting a plurality of strands to each other. However, the operation line 50 may be composed of a single wire rod.
The diameter of the operation line 50 is not particularly limited, but is preferably 0.2 mm or more and 1 mm or less.
The operation wire 50 is not particularly limited, and examples thereof include low carbon steel (piano wire), stainless steel (SUS), corrosion-resistant coated steel wire, titanium or titanium alloy, or a metal wire such as tungsten. Be done.

For example, an annular marker 11 is embedded in the vicinity of the distal end of the tubular body 10. The outer peripheral surface of the marker 11 may be exposed on the outer peripheral surface of the tubular body 10, for example.
The tip portion 50a of the operation line 50 is fixed to, for example, the marker 11.
More specifically, as shown in FIG. 2B, the tip portion 50a of the operation line 50 is fixed to the marker 11 by, for example, an adhesive 12.
However, the method of fixing the operation line 50 to the marker 11 is not particularly limited, and solder bonding, caulking, or the like may be used.

The marker 11 is made of an X-ray opaque material such as platinum or tungsten. By using the position of the marker 11 as an index, the position of the distal end portion 10a of the tubular body 10 in the living lumen can be accurately recognized under X-ray (radiation) observation.

As shown in FIGS. 2 (a) and 2 (b), the catheter 100 is provided on the outer periphery of the distal end portion 10a of the tubular body 10, for example, and is a balloon communicating with the third lumen 23. It also has 60.

The balloon 60 is, for example, an elastic member formed in a sheet shape from a soft resin material. The soft resin material is not particularly limited, but is not limited to a soft resin material such as polyamide, polyolefin, polyvinyl chloride, polyurethane, polyphenylene sulfide, fluororesin, polyester, and rubber such as polyurethane elastomer, polyamide elastomer, silicone rubber, or latex rubber. It can be mentioned that it is a material.

The balloon 60 is composed of, for example, a single layer or two or more layers of resin sheets. The balloon 60 is formed into a tubular shape or the like, and is liquid-tightly attached to the tubular body 10 in a state of surrounding the outer peripheral surface of the distal end portion 10a of the tubular body 10 in a circumferential shape.
In the case of the present embodiment, as an example, the distal end 61 and the proximal end 62 of the balloon 60 are each provided with a fixing portion (not shown) such as an adhesive, and the balloon 60 is liquid with respect to the tubular body 10. It is tightly and cyclically fixed. In the balloon 60, a portion (an intermediate portion excluding the distal end portion 61 and the proximal end portion 62) that is not fixed to the outer peripheral surface of the tubular body 10 is referred to as an intermediate portion 63.
However, the method of attaching the balloon 60 to the tubular body 10 is not particularly limited, and the balloon 60 is tubular by winding a string-shaped member around the proximal end 62 and the distal end 61 of the balloon 60, respectively. It may be attached to the body 10.

Here, the tubular body 10 has a balloon hole portion 23a formed on the outer peripheral surface of the distal end portion 10a of the tubular body 10. The balloon hole 23a communicates with the third lumen 23, and a liquid (not shown) such as physiological saline injected into the third lumen 23 is discharged from the balloon hole 23a into the balloon 60. Will be done.
More specifically, the balloon hole 23a is formed in the formation region of the balloon 60. The balloon hole portion 23a is, for example, a side hole whose depth direction is orthogonal to the axial direction of the tubular body 10. One end of the balloon hole 23a communicates with the inside of the balloon 60, and the other end of the balloon hole 23a communicates with the distal end of the third lumen 23.

When a liquid such as physiological saline is injected into the balloon 60 through the third lumen 23 and the balloon hole 23a, the balloon 60 expands outward of the tubular body 10 (see FIG. 2B). ). More specifically, as shown in FIG. 2A, the peripheral surface of the balloon 60 is arranged along the outer peripheral surface of the tubular body 10 in a state where the balloon 60 is not inflated. In the inflated state of the balloon 60, as shown in FIG. 2B, the intermediate portion 63 of the balloon 60 is inflated (protruded) toward the outside of the tubular body 10.
Here, in the case of the present embodiment, the formation region of the balloon 60 is a region proximal to the second hole 13b in the tubular body 10.

As shown in FIG. 1, the proximal end of the tubular body 10 is connected to a cylindrical bifurcation portion 30. The branch portion 30 is provided with a liquid feeding branch pipe 31, a balloon branch pipe 32, and a pressure monitoring branch pipe 33.

Inside the branch portion 30, for example, four through holes are formed along the axial direction of the branch portion 30. Here, the four through holes are referred to as a first through hole, a second through hole, a third through hole, and a fourth through hole, respectively.
A first lumen 21 is connected to the first through hole. A branch pipe 31 for liquid feeding is connected to the first through hole. Therefore, the first lumen 21 and the liquid feeding branch pipe 31 communicate with each other via the branch portion 30. A liquid feeding connector 31a (see FIG. 1) is provided at the proximal end of the liquid feeding branch pipe 31. A liquid feeding syringe (not shown) is attached to the liquid feeding connector 31a.
A second lumen 22 is connected to the second through hole. A reinforcing tube 40 and an operation line 50 are inserted through the second through hole. From the second through hole, the proximal end portion of the reinforcing tube 40 and the operation line 50 is led out toward the operation portion 70 (see FIG. 1).
A third lumen 23 is connected to the third through hole. A balloon branch tube 32 is connected to the third through hole. Therefore, the third lumen 23 and the balloon branch pipe 32 communicate with each other via the branch portion 30. A balloon connector 32a (see FIG. 1) is provided at the proximal end of the balloon branch tube 32. A balloon syringe (not shown) is attached to the balloon connector 32a.
A fourth lumen 24 is connected to the fourth through hole. A branch pipe 33 for pressure monitoring is connected to the fourth through hole. Therefore, the fourth lumen 24 and the pressure monitoring branch pipe 33 communicate with each other via the branch portion 30. A pressure monitor connector 33a (see FIG. 1) is provided at the proximal end of the pressure monitor branch pipe 33. The pressure monitor connector 33a is connected to a pressure measuring device (not shown). A pressure monitor cap 33b is attached to the proximal end of the pressure monitor connector 33a.

In the case of the present embodiment, by supplying the cardioplegic solution from the liquid feeding syringe to the liquid feeding connector 31a, the liquid feeding branch pipe 31, the first through hole, the first lumen 21, and the first The cardioplegic solution can be injected into the coronary artery through the foramen 13a and the second foramen 13b.
Further, as shown in FIG. 1, an opening / closing member 34 is attached to the outer peripheral surface of the liquid feeding branch pipe 31. By opening and closing the opening / closing member 34, it is possible to switch between supplying and stopping the cardioplegic solution.
In the case of the present embodiment, the opening / closing member 34 is, for example, a Robert clamp. However, the opening / closing member 34 is not particularly limited, and examples thereof include a roller clamp and a pinch clamp.
When the opening / closing member 34 is closed, the opening / closing member 34 sandwiches the liquid feeding branch pipe 31 to block the lumen (flow path) of the liquid feeding branch pipe 31 and stop the supply of the cardioplegic solution. Will be done.
When the opening / closing member 34 is opened, the lumen (flow path) of the liquid feeding branch pipe 31 is opened, and the cardioplegic liquid is supplied.

As shown in FIG. 1, the operation unit 70 is connected to the proximal end portion of the operation line 50 led out from the proximal end of the branch portion 30 (second through hole). By operating the operation unit 70, the tubular body 10 can be bent.

In the case of the present embodiment, the operation unit 70 includes a main body case 72 held by the operator and a wheel operation unit 71 rotatably provided with respect to the main body case 72. The proximal end (not shown) of the operating line 50 derived from the reinforcing tube 40 is directly or indirectly connected to the wheel operating portion 71.
The proximal end of the reinforcing tube 40 may be introduced inside the main body case 72 or may be arranged outside the main body case 72.

By rotating the wheel operating portion 71 in one direction, the operating line 50 can be pulled toward the proximal end side and the tubular body 10 can be bent in one direction.
More specifically, when the wheel operation unit 71 is rotated in one direction, the tubular body 10 is mainly located on the side of the second lumen 22 through which the operation line 50 is inserted, with reference to the axis of the tubular body 10. The flexible portion 14 bends.

Further, the operation unit 70 has, for example, a holding mechanism 74 (see FIG. 1) that holds the operation line 50 in a towed state. By activating the holding mechanism 74, the bending operation of the catheter 100 is restricted, and the shape of the distal end portion 10a of the tubular body 10 is held in the extended state or the bent state.
As described above, the catheter 100 according to the present embodiment further includes an operation unit 70 for bending the distal end portion 10a of the tubular body 10 by the traction operation of the operation line 50, and the operation unit 70 is gripped by the operator. It has a main body case 72 to be operated, and an operation receiving portion (wheel operation portion 71) to which the base end portion 50b of the operation line 50 is fixed and swingably supported with respect to the main body case 72. The traction operation is an operation of swinging the operation receiving portion 75, and the operating portion 70 further has a holding mechanism 74 for holding the distal end portion 10a in a bent state.

In the reinforcing tube 40 and the operation line 50, the portion (the portion arranged between the branch portion 30 and the operation portion 70) from being derived from the branch portion 30 to being introduced into the operation portion 70 is, for example, It is inserted into the lumen of the cylindrical cover member 35 (see FIG. 1).
The cover member 35 is formed, for example, in a tapered shape that tapers toward the distal side. The base end portion of the cover member 35 is attached to the tip end portion of the operation portion 70.

In the case of the present embodiment, by supplying a liquid such as physiological saline from the balloon syringe to the balloon connector 32a, the balloon branch tube 32, the third through hole, the third lumen 23, and the balloon are used. The liquid is injected into the balloon 60 through the holes 23a. As a result, the balloon 60 changes from a contracted state (see FIG. 2A) to an expanded state (see FIG. 2B). The liquid preferably contains, for example, a contrast medium, which makes it possible to recognize that the balloon 60 has expanded to a desired diameter under X-ray (radiation) observation.

The balloon connector 32a has, for example, a one-sided valve (not shown). The one-way valve regulates the flow of liquid from the distal side to the proximal side, so that the inflated state of the balloon 60 is maintained.

In the case of the present embodiment, the catheter 100 is connected to the pressure measuring device through the fourth lumen 24, the branch pipe 33 for pressure monitoring, and the connector 33a for pressure monitoring.
The pressure measuring device is used to measure and monitor the pressure inside the coronary sinus in each of the inflated state and the contracted state of the balloon 60.
The pressure measuring device is not particularly limited, and examples thereof include a transducer for detecting hydraulic pressure.

As shown in FIGS. 5 (a) and 5 (b), the catheter 100 according to the present embodiment is inserted into a vein through, for example, a percutaneously punctured introducer 110, and is tubular. A flexible sleeve 65 that is extrapolated to the body 10 and can be expanded and contracted in the axial direction, and is provided in a circumferentially liquid-tight manner with respect to the distal end of the sleeve 65 in the axial direction with respect to the tubular body 10. The tubular connecting portion 15 is further provided with a slidable tubular connecting portion 15, and the connecting portion 15 can be detachably connected to the introducer 110.

As shown in FIG. 1, the sleeve 65 is formed, for example, in a long hollow tubular shape.
The sleeve 65 is made of, for example, a soft resin material and can be easily expanded and contracted in the axial direction. The soft resin material is not particularly limited, and examples thereof include a soft resin material such as polyamide, polyolefin, polyvinyl chloride, polyurethane, polyphenylene sulfide, fluororesin, and polyester.

The proximal end of the sleeve 65 is cyclically and liquid-tightly fixed to the proximal end of the tubular body 10 by, for example, a bifurcation. The distal end portion of the sleeve 65 is liquid-tightly fixed to the connecting portion 15 in a circumferential manner, and is slidable in the axial direction with respect to the tubular body 10. Therefore, as the connecting portion 15 slides axially with respect to the tubular body 10, the distal end of the sleeve 65 also slides with respect to the tubular body 10. On the other hand, since the proximal end of the sleeve 65 is fixed to the proximal end of the tubular body 10 by the branch portion 30, it does not displace relative to the tubular body 10.
More specifically, as shown in FIG. 6A, when the connecting portion 15 slides on the proximal side of the tubular body 10, the sleeve 65 shortens in an axially bellows shape. When the sleeve 65 is shortened, the portion of the tubular body 10 exposed from the sleeve 65 becomes longer. On the other hand, as shown in FIG. 6B, when the connecting portion 15 slides to the distal side of the tubular body 10, the sleeve 65 extends in the axial direction. Further, when the sleeve 65 is extended, the portion of the tubular body 10 exposed from the sleeve 65 becomes shorter.

The total length of the sleeve 65 in the most extended state is not particularly limited, but is longer than, for example, the total length of the tubular body 10. As a result, the connecting portion 15 can be slid to the distal end of the tubular body 10. That is, the entire tubular body 10 can be housed inside the sleeve 65.

As shown in FIGS. 6 (a) and 6 (b), the connecting portion 15 is, for example, a cylindrical member.
The inner diameter of the connecting portion 15 is set to a size slightly larger than the outer diameter of the tubular body 10, for example. As a result, the connecting portion 15 can slide in the axial direction with respect to the tubular body 10.

The connecting portion 15 is formed of, for example, a hard resin material. The hard resin material is not particularly limited, and examples thereof include polyolefins such as polyethylene and polypropylene, polyamide, polycarbonate, and polystyrene.
The connecting portion 15 may be integrally molded as a whole, or may be formed by combining different members.

As shown in FIGS. 4 and 5, the introducer 110 is formed into a tubular main body 112 through which the tubular body 10 can be inserted and a tubular main body 112 through which the tubular body 10 can be inserted, and is proximal to the tubular main body 112. A second connecting portion 113, which is provided in a circular manner with respect to the end portion, is provided.
In the case of the present embodiment, the connecting portion 15 can be connected to the second connecting portion in a circular manner in a liquid-tight manner.

The tubular main body 112 is formed, for example, in a long cylindrical shape. The distal end of the tubular body 112 is formed in a tapered shape with a slightly smaller diameter toward the tip side.
The inner diameter of the tubular body 112 is set to be larger than the outer diameter of the tubular body 10. Therefore, the tubular body 10 can be inserted into the lumen of the tubular main body 112.

The tubular body 112 is made of, for example, a hard resin material. The hard resin material is not particularly limited, and is, for example, polyolefin, polyolefin elastomer, polyolefin crosslinked product, polyvinyl chloride, polyamide, polyamide elastomer, polyester, polyester elastomer, polyurethane, polyurethane elastomer, fluororesin, polycarbonate, polystyrene, polyacetal. , Polyamide, polyetherimide and the like.

As shown in FIG. 4, the second connecting portion 113 is formed, for example, in a cylindrical shape. The outer diameter and inner diameter of the second connecting portion 113 are constant, and therefore the wall thickness of the second connecting portion 113 is also constant.
The lumen of the second connecting portion 113 communicates with the lumen of the tubular main body 112.
A plurality of (for example, two) convex portions 116 protruding outward in the radial direction are formed on the outer peripheral surface of the base end portion of the second connecting portion 113.
The two convex portions 116 are formed at positions facing each other by 180 degrees in the circumferential direction of the second connecting portion 113, for example.

Here, for example, the connecting portion 15 is formed with a notch-shaped portion 18 that is open toward the distal end side.
The cutout shape portion 18 has, for example, a straight line portion 18a and an intersection portion 18b that are connected to each other.
The straight portion 18a extends linearly along the axial direction from the distal end to the proximal side of the connecting portion 15.
The intersecting portion 18b extends from the proximal end of the straight portion 18a in a direction intersecting the extending direction of the straight portion 18a. The intersecting portion 18b extends in a direction having a circumferential component and an axial component of the connecting portion 15, and is displaced to the proximal side as the distance from the proximal end of the straight portion 18a increases.
In the case of the present embodiment, for example, two notched shape portions 18 are formed in the connecting portion 15. The two notch-shaped portions 18 are arranged so as to face each other 180 degrees in the circumferential direction of the connecting portion 15, and are rotationally symmetrical with each other, for example.

The outer diameter of the second connecting portion 113 is set to be slightly smaller than the inner diameter of the connecting portion 15. Further, the diameter of the convex portion 116 is equal to or slightly smaller than the width dimension of the notch shape portion 18.

In order to connect the connecting portion 15 and the second connecting portion 113 to each other, first, the second connecting portion 113 is inserted into the connecting portion 15 through the opening on the distal end side of the connecting portion 15. At this time, each convex portion 116 is inserted into each notch shape portion 18 from the opening on the distal end side of the straight portion 18a of each notch shape portion 18 and reaches the boundary portion between the straight portion 18a and the intersection 18b. ..
Next, the connecting portion 15 and the second connecting portion 113 are relatively rotated around the axis. For example, the second connecting portion 113 is rotated in the direction of the arrow shown in FIG. 6 (b). As a result, each convex portion 116 is guided by the intersection 18b and moves to the proximal end of the intersection 18b (see FIG. 6B).
As a result, the connecting portion 15 and the second connecting portion 113 are connected to each other, and the relative displacement of the tubular body 10 with respect to the tubular main body 112 is regulated in the axial direction. In this way, the introducer 110 is attached to the catheter 100.
Here, as each convex portion 116 moves toward the proximal end of the intersection 18b, the second connecting portion 113 is inserted deeper into the connecting portion 15, but during this insertion operation, It is also preferable that at least one of the outer peripheral surface of the second connecting portion 113 and the inner peripheral surface of the connecting portion 15 is formed in a tapered shape so that the second connecting portion 113 is press-fitted into the connecting portion 15.

Further, in the state where the connecting portion 15 is connected to the second connecting portion 113 (the state shown in FIG. 6B), the connecting portion 15 is rotated in the opposite direction of the arrow shown in FIG. 6B by rotating the connecting portion 15 in the opposite direction. As shown in FIG. 6A, the connecting portion 15 can be removed from the second connecting portion 113.
That is, when the connecting portion 15 is rotated in the opposite direction of the arrow shown in FIG. 6 (b), each convex portion 116 is guided by the intersecting portion 18b and becomes a straight portion 18a from the proximal end of the intersecting portion 18b. It moves to the boundary with the intersection 18b. In this state, the tubular body 10 is removed from the tubular body 112 by pulling the catheter 100 proximally.

The second connecting portion 113 is made of, for example, a hard resin material. The hard resin material is not particularly limited, and examples thereof include polyolefins such as polyethylene and polypropylene, polyamide, polycarbonate, and polystyrene.

As shown in FIG. 4, the second connecting portion 113 is formed with, for example, a tubular side port 114 communicating with the lumen of the second connecting portion 113 and the lumen of the tubular main body 112. One end of a tube 114a made of, for example, a long tubular member is liquid-tightly connected to the end of the side port 114 that is not connected to the second connecting portion 113. For example, a three-way stopcock 114b is attached to the other end of the tube 114a. A liquid such as physiological saline can be injected into the introducer 110 from the three-way stopcock 114b via the tube 114a.

Further, for example, a check valve (not shown) that regulates the flow of liquid from the distal end side to the proximal end side may be provided inside the second connecting portion 113. By providing a check valve inside the second connecting portion 113, unintentional leakage of blood flowing through the biological lumen is suppressed when the catheter 100 is removed from the introducer 110 and the biological lumen. Can be done.
The check valve is not particularly limited, but may be, for example, a Duckville type check valve.

Further, for example, the connecting portion 15 may be provided with a lock operating portion 17 capable of locking and unlocking the connecting portion 15 at a desired position with respect to the tubular body 10.
By rotating the lock operating portion 17 around the axis at a desired position on the tubular body 10, the sliding of the connecting portion 15 in the axial direction of the tubular body 10 can be restricted. That is, the insertion / removal of the tubular body 10 with respect to the tubular main body 112 can be locked.

Hereinafter, an example of how to use the catheter 100 of the present embodiment will be described.
It should be noted that the introducer 110 is percutaneously punctured into a vein such as a jugular vein in advance, and the introducer 110 communicates the inside and the outside of the living lumen.
In this state, at least the distal end of the tubular body 112 of the introducer 110 is placed inside the biological lumen, and the second connecting portion 113 provided at the proximal end of the tubular body 112 , Exposed from the biological lumen.
In the following, a method of inserting the distal end portion 10a of the tubular body 10 in the order of the jugular vein, the right atrium, and the coronary sinus under fluoroscopy and retrogradely delivering cardioplegic fluid to the coronary artery will be described. To do.

First, the distal end portion 10a of the tubular body 10 of the catheter 100 is inserted into the introducer 110 through the opening on the proximal end side of the introducer 110. In this state, the connecting portion 15 and the sleeve 65 are externally attached to the second connecting portion 113 on the proximal side of the second connecting portion 113. Then, the connecting portion 15 and the second connecting portion 113 are relatively rotated around the axis, and each convex portion 116 is moved from the straight portion 18a to the proximal end portion of the intersecting portion 18b, whereby the connecting portion 15 is moved to the second position. 2 Connected to the connecting portion 113. As a result, the catheter 100 is attached to the introducer 110.

In a state where the second connecting portion 113 is connected to the connecting portion 15, the operator brings the operating portion 70 closer to the introducer 110, whereby the tubular body is formed through the lumen of the tubular main body 112. 10 is introduced into the jugular vein. Here, since the sleeve 65 is fixed to the connecting portion 15, it is not introduced into the lumen and jugular vein of the tubular main body 112, but is shortened in a bellows shape as shown in FIG. 6 (b). ..

The surgeon then pushes the distal end 10a of the tubular body 10 into the right atrium. Subsequently, the operator pulls the operation line 50 and bends the distal end portion 10a in a J shape. Then, the operator makes the distal end 10a bent in a J shape by the traction of the operation line 50 so that the most distal end of the tubular body 10 faces the desired insertion direction, that is, the coronary sinus. In addition, the operation unit 70 is torque-rotated. Further, if necessary, the bending angle and the pushing amount of the tubular body 10 are adjusted. As a result, the flexible portion 14 and the balloon 60 are inserted into the coronary sinus. Subsequently, the holding mechanism 74 of the operation unit 70 is operated.

Next, the cardioplegic solution is injected from a liquid feeding syringe (not shown) filled with the cardioplegic solution via the liquid feeding connector 31a. The injected cardioplegic solution is supplied to the coronary sinus from the foramen 13 (first foramen 13a and second foramen 13b) through the delivery branch tube 31 and the first lumen 21.
Next, the operator further inserts the flexible portion 14 and the balloon 60 into the coronary sinus while checking the hydraulic pressure at the distal end of the catheter 100 with a pressure measuring device.
If necessary, a contrast medium is injected into the liquid feeding connector 31a from a syringe (not shown), and it is confirmed that the distal end portion 10a is inserted into the coronary sinus.

Next, a balloon syringe (not shown) filled with a liquid such as physiological saline is attached to the balloon connector 32a. The surgeon injects a liquid from the balloon syringe into the balloon connector 32a. The injected liquid is injected into the balloon 60 through the balloon hole 23a through the balloon branch tube 32 and the third lumen 23, and inflates the balloon 60. The inflated balloon 60 is fixed to the coronary sinus in a state of pressing the inner wall of the coronary sinus. This makes it possible to prevent the distal end 10a of the tubular body 10 from being displaced relative to the coronary sinus from a desired position.
Since the balloon connector 32a is provided with a one-sided valve, when the liquid is injected into the balloon 60 and when the balloon 60 is inflated, the liquid from the distal side to the proximal side is charged. Flow is regulated.
As described above, the distal end 40a of the reinforcing tube 40 is located proximal to the balloon 60 placement region, and the balloon 60 placement region is included in the flexible portion 14. The flexible portion 14 including the balloon 60 is allowed to swing with the proximal end of the flexible portion 14 as a fulcrum. Therefore, in the process of inflating the balloon 60, the balloon 60 is autonomously adjusted to a stable posture inside the coronary sinus, and the balloon 60 fits well to the coronary vein.

Once the balloon 60 has been fixed to the coronary sinus, the operator supplies cardioplegic fluid into the coronary artery. During the infusion of cardioplegic fluid, the operator can monitor the pressure inside the coronary sinus by checking the measured values measured by the pressure measuring device.
In addition, the surgeon switches between supplying and stopping the cardioplegic solution by opening and closing the opening / closing member 34 according to the situation during the procedure.

When the balloon 60 is removed from the coronary vein, the balloon 60 is moved from the inflated state to the contracted state by performing a draining operation of the liquid inside the balloon 60. Then, while the second connecting portion 113 is connected to the connecting portion 15, the operating portion 70 is grasped and the catheter 100 is pulled, and the tubular body 10 is pulled from the living lumen through the tubular main body 112. Remove to the outside.
At this time, it is assumed that blood is attached to the portion of the tubular body 10 that has been inserted into the living body. However, in the case of the present embodiment, the tubular body 10 removed from the living body is housed inside the sleeve 65. More specifically, the portion of the tubular body 10 that has been inserted into the living body is removed from the living body and the introducer 110 while being housed inside the sleeve 65 without being exposed to the outside. Therefore, it is possible to prevent the operator from coming into contact with the blood attached to the tubular body 10.

After removing the entire tubular body 10 from the inside of the biological lumen and from the introducer 110, the operator disconnects the connecting portion 15 to the second connecting portion 113 and removes the catheter 100 from the introducer 110. As described above, since the total length of the sleeve 65 is longer than the total length of the tubular body 10, the length from the proximal end to the most distal end of the tubular body 10 can be accommodated inside the sleeve 65.
Further, when the connecting portion 15 is provided with the above-mentioned lock operating portion 17, the operator operates the lock operating portion 17 in a state where the connecting portion 15 is arranged near the distal end of the tubular body 10. By locking the sliding of the connecting portion 15 in the axial direction of the tubular body 10, the state in which the sleeve 65 and the connecting portion 15 accommodate the entire tubular body 10 can be suitably maintained.
Further, for example, a check valve (not shown) that regulates the flow of liquid from the proximal side to the distal side may be provided inside the connecting portion 15. The check valve can prevent blood adhering to the tubular body 10 from leaking to the outside through an opening on the distal side of the connecting portion 15.

In the above description, an example in which the catheter 100 is inserted into the living lumen under fluoroscopy has been described, but the present invention is not limited to this example, and the insertion of the catheter 100 into the living lumen is performed by transesophageal ultrasound. It may be performed under transesophageal echocardiography in combination with endoscopic ultrasonography.

<First modification>
Next, a first modification of the embodiment will be described with reference to FIGS. 7 to 11 (f).
The catheter 100 according to the present modification is different from the catheter 100 according to the above embodiment in that it is described below, and is configured in the same manner as the catheter 100 according to the above embodiment in other respects. ..
In the following description, the upper side (upper side) in FIGS. 8 (a) and 8 (b) is simply referred to as the upper side, and the lower side (lower side) in FIGS. 8 (a) and 8 (b) is simply referred to as the lower side. .. Further, the depth direction in FIGS. 8 (a) and 8 (b) is referred to as a left-right direction. Of the left-right directions, the front side in FIGS. 8 (a) and 8 (b) is referred to as the left side, and the opposite side is referred to as the right side.
Further, regarding the description of the operation unit 70, the left side in FIGS. 8 (a) and 8 (b) is referred to as the tip end side, and the right side in FIGS. 8 (a) and 8 (b) is referred to as the base end side. Further, the direction toward the tip end side and the base end side is referred to as a tip base end direction.
However, the positional relationship of each part (particularly the vertical positional relationship) when the catheter 100 is used is not limited to the positional relationship described in the present specification.

Similar to the above embodiment, the catheter 100 according to the present modification further includes an operation unit 70 for bending the distal end portion 10a of the tubular body 10 by a traction operation of the operation line 50, and the operation unit 70 includes an operation unit 70. It has a main body case 72 that is gripped by the operator, and an operation receiving portion 75 that is fixed to the base end portion 50b of the operation line 50 and is pivotally supported with respect to the main body case 72. The traction operation is an operation of swinging the operation receiving portion 75, and the operating portion 70 further has a holding mechanism 74 for holding the distal end portion 10a in a bent state.
However, in the case of this modification, the holding mechanism 74 of the operation unit 70 is a mechanism that holds the operation receiving unit 75 at any of a plurality of preset swing angles. As will be described in the second modification described later, the holding mechanism 74 may be a mechanism for holding the operation receiving portion 75 at a stepless swing angle.

According to this modification, since the holding mechanism 74 of the operating portion 70 can hold the operating receiving portion 75 at any of a plurality of preset swing angles, the tubular body 10 The distal end portion 10a of the can be bent at a plurality of bending angles. Therefore, since the distal end portion 10a of the tubular body 10 can be flexed by the traction operation to selectively direct the catheter 100 in a plurality of directions, better operability of the catheter 100 can be realized.

The main body case 72 is a hollow member, for example, is formed in a substantially rectangular parallelepiped shape that is long in one direction, and is tapered toward the tip side.
As shown in FIGS. 8 (a), 8 (b) and 9, a fan-shaped portion 80, which will be described later, a contact member 77 and an urging portion 79 are arranged inside the main body case 72. In FIG. 9, the fan-shaped portion 80 of the internal structure of the main body case 72 is shown by a broken line.
As shown in FIG. 9, in the case of the present modification, the main body case 72 has, for example, a first main body member 72a and a second main body member 72b, and the first main body member 72a and the second main body member 72b. The main body case 72 is formed by assembling the 72b and the 72b to each other. In addition, in FIG. 8A, FIG. 8B, FIG. 10D, FIG. 10E, and FIG. 10F, the second main body member 72b is not shown. Is a side view of the internal structure in a visible state.
The first main body member 72a and the second main body member 72b are formed in a substantially symmetrical shape in the left-right direction.

In the case of this modification, as shown in FIGS. 8A and 8B, the base end of the reinforcing tube 40 is introduced inside the main body case 72, for example, and is fixed to the main body case 72. Has been done. The base end portion 50b of the operation line 50 drawn out from the opening on the base end side of the reinforcing tube 40 is connected to the operation receiving portion 75. The base end portion 50b of the operation line 50 is arranged along the longitudinal direction of the main body case 72, and the base end portion of the reinforcing tube 40 is also arranged along the longitudinal direction of the main body case 72, for example.

Here, as shown in FIGS. 8A, 8B, and 9, in the case of the present embodiment, the holding mechanism 74 is a concavo-convex structure portion 76 including a plurality of concavo-convex structures 76a and a concavo-convex structure portion 76. Among the plurality of irregularities 76a, there is a fitting portion 78 that fits into the unevenness 76a according to the swing angle of the operation receiving portion 75.
Then, either one of the concavo-convex structure portion 76 and the fitting portion 78 is formed in the operation receiving portion 75, and the fitting portion 78 is fitted to the concavo-convex 76a of any of the concave-convex structure portions 76. , The operation receiving portion 75 is held at any of a plurality of swing angles.
More specifically, in the case of this modification, the operating portion 70 adjusts the swing angle of the operating receiving portion 75 by a traction operation to make the fitting portion 78 into the unevenness 76a of any one of the concave-convex structure portions 76. On the other hand, it can be selectively fitted. Therefore, when the traction operation is released, the operation receiving unit 75 can be held at the swing angle when the traction operation is released. Therefore, the operability of the catheter 100 can be improved.

In the case of this modification, as an example, the concave-convex structure portion 76 is formed in the operation receiving portion 75, and the holding mechanism 74 has a contact member 77 including the fitting portion 78 and the fitting portion 78 is the operation receiving portion 75. It has an urging portion 79 that urges the abutting member 77 so as to be in pressure contact with the abutting member 79.
As a result, in a state where the fitting portion 78 is fitted to any of the irregularities 76a of the concave-convex structure portion 76, the fitting portion 78 is urged by the urging portion 79 to the operation receiving portion 75. It will be pressure-welded. Therefore, when the traction operation is released, the operation receiving unit 75 can be more reliably held at the swing angle when the traction operation is released.

Further, as shown in FIGS. 11A to 11F, the operation receiving portion 75 has, for example, a fan-shaped portion 80 formed in a fan shape, and can swing in the circumferential direction of the fan-shaped portion 80. It is axially supported, and a plurality of irregularities 76a are arranged side by side in the circumferential direction of the arcuate peripheral surface 80a of the fan-shaped portion 80. That is, the concave-convex structure portion 76 is formed on the peripheral surface 80a of the fan-shaped portion 80.
As a result, the concave-convex structure portion 76 can be formed on the peripheral surface 80a having a larger radius of curvature, and the operation receiving portion 75 can be housed in the compact main body case 72. Further, the traction operation can be performed for a sufficient distance with a smaller swing angle of the operation receiving portion 75, and the range of the bending angle of the distal end portion 10a can be satisfactorily secured.
11 (b) is a plan view of the fan-shaped portion 80 in a state where the swing angle of the operation receiving portion 75 is the angle shown in FIG. 8 (a), and FIG. 11 (c) is a plan view of the operation receiving portion 75. It is a bottom view of the fan-shaped portion 80 in a state where the swing angle of is the angle shown in FIG. 8 (a). Further, in FIGS. 11 (d) to 11 (f), the third shaft member 88, which will be described later, is illustrated.
Further, in the following description, the circumferential direction of the peripheral surface 80a of the fan-shaped portion 80 may be simply referred to as the circumferential direction.

The fan-shaped portion 80 is formed in a side view fan shape, for example. More specifically, the fan-shaped portion 80 includes a plate-shaped portion 81b formed in a side view fan shape, an arc-shaped peripheral wall portion 81a arranged along the arc-shaped peripheral edge portion of the plate-shaped portion 81b, and a fan-shaped portion, respectively. It has a first wall portion 81c and a second wall portion 81d extending in the radial direction of 80.
The aggregate of the peripheral wall portion 81a, the first wall portion 81c, and the second wall portion 81d forms a side view fan-shaped frame, and the plate-shaped portion 81b is a plate-shaped portion formed in the same shape as the frame. Yes, it is placed inside the frame.
More specifically, the plate-shaped portion 81b is formed in a flat plate shape. Each plate surface of the plate-shaped portion 81b is arranged so as to face the left-right direction.
Here, the plate-shaped portion 81b has side edge portions extending in the radial direction on both side edges of the plate-shaped portion 81b in the circumferential direction. Among these edge portions, the first wall portion 81c is arranged along the edge portion on the distal end side, and the second wall portion 81d is arranged along the edge portion on the proximal end side.
The first wall portion 81c and the second wall portion 81d are each formed in a flat plate shape. Each of the first wall portion 81c and the second wall portion 81d is arranged so that the plate surfaces of the first wall portion 81c and the second wall portion 81d face the circumferential direction of the fan-shaped portion 80.
Each of the peripheral wall portion 81a, the first wall portion 81c, and the second wall portion 81d stands up from the plate-shaped portion 81b in the left-right direction. Further, each of the peripheral wall portion 81a, the first wall portion 81c, and the second wall portion 81d is set to have the same left-right width dimensions as each other.
Further, the outer end portion of the first wall portion 81c in the radial direction is connected to the tip end portion of the peripheral wall portion 81a, and the outer end portion of the second wall portion 81d in the radial direction is the base end of the peripheral wall portion 81a. It is connected to the unit.
Further, the inner end portion of the first wall portion 81c in the radial direction and the inner end portion of the second wall portion 81d in the radial direction are connected to each other. Therefore, in the side view, the angle formed by the first wall portion 81c and the second wall portion 81d is the central angle of the fan-shaped portion 80.
The center angle of the fan-shaped portion 80 is not particularly limited, but is preferably 70 degrees or more and 170 degrees or less, and preferably 90 degrees or more and 150 degrees or less.
Further, in the peripheral wall portion 81a, the first wall portion 81c side is the tip end side, and the second wall portion 81d side is the base end side.
Further, inside the main body case 72, the fan-shaped portion 80 is pivotally supported in a posture in which the peripheral surface 80a is arranged on the upper side and the swing shaft of the fan-shaped portion 80 is arranged on the lower side.

In the case of this modification, the fan-shaped portion 80 is pivotally supported at the central portion of the fan-shaped portion 80 (near the connection portion between the first wall portion 81c and the second wall portion 81d). The swing axis of the fan-shaped portion 80 extends in the left-right direction. Therefore, the operation receiving portion 75 can swing, for example, in one direction in the circumferential direction of the peripheral surface 80a of the fan-shaped portion 80 and in a direction opposite to the one direction in the circumferential direction of the peripheral surface 80a of the fan-shaped portion 80. It has become.
The swing axis of the fan-shaped portion 80 is orthogonal to the longitudinal direction of the main body case 72, that is, the direction including the component in the tip base end direction. Therefore, the swing direction of the fan-shaped portion 80, that is, the swing direction of the operation receiving portion 75 is the direction including the component in the tip base end direction, and the pulling direction of the operation line 50 is also the direction including the component in the tip base end direction. is there.
In the case of this modification, by swinging the operation receiving portion 75 in one direction in the circumferential direction, the operation line 50 can be pulled toward the proximal end side and tension can be applied. Further, by swinging the operation receiving portion 75 in the circumferential direction in the direction opposite to the one, the operation line 50 can be moved to the tip side and relaxed. In this way, the distal end 10a of the tubular body 10 can be flexed or extended.

More specifically, as shown in FIGS. 8A and 8B, a first shaft hole portion 85 penetrating the fan-shaped portion 80 in the left-right direction is formed in the central portion of the fan-shaped portion 80. Has been done. Further, on the inner side surfaces of the first main body member 72a and the second main body member 72b, holding portions (not shown) are formed at locations facing the first shaft hole portion 85, respectively. The holding portion has a holding hole arranged coaxially with the first shaft hole portion 85. A single first shaft member 86 formed in a long rod shape in the left-right direction is inserted from one holding hole through the first shaft hole portion 85 to the other holding hole. In this way, the fan-shaped portion 80 is pivotally supported by the first shaft member 86.

Here, as shown in FIGS. 11 (e) and 11 (f), a blank 95 is formed in the plate-shaped portion 81b. The blank 95 is formed as a whole in the thickness direction of the plate-shaped portion 81b. The blank 95 extends in the circumferential direction along the peripheral wall portion 81a.
Further, on each plate surface of the plate-shaped portion 81b, for example, second plate-shaped portions 87a and 87b are arranged in the portion corresponding to the blank 95, respectively. The second plate-shaped portions 87a and 87b are formed in a flat plate shape, respectively. Each plate surface of each of the second plate-shaped portions 87a and 87b is arranged so as to face in the left-right direction. Further, the second plate-shaped portions 87a and 87b are arranged so as to face each other.
The left side surface of the second plate-shaped portion 87a is arranged on the same plane as the right side surface of the plate-shaped portion 81b. Further, the right side surface of the second plate-shaped portion 87b is arranged on the same plane as the left side surface of the plate-shaped portion 81b. Then, the second plate-shaped portion 87a closes the blank 95 from the right side. Further, the second plate-shaped portion 87b closes the end portion of the blank 95 on the base end side from the left side, and the portion of the blank 95 on the tip side of the second plate-shaped portion 87b is opened toward the left side. ..
Further, the second plate-shaped portions 87a and 87b are provided with cylindrical portions 84a and 84b (see FIGS. 11 (e) and 11 (f), respectively). The cylindrical portion 84a provided on the second plate-shaped portion 87a protrudes toward the first main body member 72a side, and the cylindrical portion 84b provided on the second plate-shaped portion 87b is the second main body member 72b. It protrudes toward the side.
The cylindrical portions 84a and 84b are formed symmetrically with respect to the axial center of the main body case 72. Each of the cylindrical portions 84a and 84b is formed in a cylindrical shape, and the axial direction thereof is parallel to the swing axis of the operation receiving portion 75. Further, the cylindrical portions 84a and 84b are arranged coaxially with each other. Further, the second plate-shaped portion 87a has a through hole arranged coaxially with the cylindrical portion 84a, and the second plate-shaped portion 87b has a through hole arranged coaxially with the cylindrical portion 84b.
Here, one third shaft member 88 formed in a long rod shape in the left-right direction is inserted from the cavity of the cylindrical portion 84a through the second shaft hole portion 77d to the lumen of the cylindrical portion 84b. ing.
The respective lumens of the cylindrical portions 84a and 84b communicate with the blank 95 through the through holes of the second plate-shaped portions 87a and 87b, and the central portion in the length direction of the third shaft member 88. Is placed inside the blank 95. A base end portion 50b of the operation line 50 is connected to the central portion of the third shaft member 88.
More specifically, the base end of the operation line 50 is an annular hook portion 51, and the hook portion 51 is locked to the third shaft member 88, so that the base end portion of the operation line 50 50b is connected to the operation receiving unit 75.
When the operation receiving portion 75 swings, the third shaft member 88 swings in an arc shape around the first shaft member 86, and the base end portion 50b of the operation line 50 accompanies the third shaft member 88. It is towed by an arc-shaped path.

Here, as shown in FIGS. 11 (a), 11 (b) and 11 (c), a slit portion 83a is formed over the peripheral wall portion 81a and the first wall portion 81c.
In the case of this modification, the slit portion 83a communicates with the blank 95, and the proximal end portion 50b of the operation line 50 drawn from the opening on the proximal end side of the reinforcing tube 40 is, for example, via the slit portion 83a. , Is guided to the third shaft member 88 in the blank 95.
The shape and dimensions of the slit portion 83a are set so that the fan-shaped portion 80 and the base end portion 50b of the operation line 50 do not interfere with each other at any angle of the operation receiving portion 75.
More specifically, a part of the slit portion 83a is formed on, for example, a portion on the peripheral surface 80a on the distal end side, and the remaining portion of the slit portion 83a is formed on the portion on the distal end side of the first wall portion 81c. ing.
In the slit portion 83a, the portion formed in the peripheral wall portion 81a extends in the circumferential direction and penetrates the peripheral wall portion 81a in the radial direction of the fan-shaped portion 80. Further, in the slit portion 83a, the portion formed in the first wall portion 81c extends in the radial direction of the fan-shaped portion 80 and penetrates the first wall portion 81c in the circumferential direction of the fan-shaped portion 80. ing.

In the case of this modification, the outer peripheral surface of the peripheral wall portion 81a constitutes the peripheral surface 80a. That is, a concavo-convex structure portion 76 including a plurality of concavo-convex 76a is formed on the peripheral wall portion 81a.
More specifically, the concave-convex structure portion 76 is formed on a portion on the peripheral surface 80a on the proximal end side. The plurality of irregularities 76a are arranged adjacent to each other in the circumferential direction.
Each of the concave portions of the plurality of irregularities 76a is formed concave inward in the radial direction of the fan-shaped portion 80, and each convex portion of the plurality of irregularities 76a is formed outward in the radial direction of the fan-shaped portion 80, respectively. It is formed convexly toward it.
In the case of this modification, as an example, the number of unevenness 76a is seven. Therefore, the operation receiving portion 75 is held at any one of the seven stages of swing angle, and the bending angle of the tubular body 10 is also held at any one of the seven stages of bending angle. Will be done.
However, the number of irregularities 76a is not particularly limited, and can be appropriately set according to the desired number of steps of the swing angle.

Here, in the plurality of irregularities 76a, a recess is arranged at the most advanced end, and the bottom surface of the recess is, for example, a sliding portion 75a in which the fitting portion 78 slides without fitting in a fixed position (FIG. 8 (FIG. 8). b) etc.). Further, in the plurality of unevenness 76a, the remaining unevenness 76a (hereinafter, may be simply referred to as the remaining unevenness 76a) excluding the concave portion on which the sliding portion 75a is formed is formed in the same shape as each other. , For example, from the tip side, they are arranged alternately in the order of convex and concave.
More specifically, in the circumferential direction, the length dimension of the recess in which the sliding portion 75a is formed is larger than the length dimension of each recess of the remaining unevenness 76a. The entire sliding portion 75a is an arc-shaped smooth curved surface centered on the swing axis of the operation receiving portion 75. Therefore, the sliding portion 75a has the same distance from the swing axis regardless of the position in the circumferential direction. Further, the formation depth of the concave portion in which the sliding portion 75a is formed is larger than the formation depth of each concave portion of the remaining unevenness 76a. That is, the position of the sliding portion 75a is closer to the axis of the fan-shaped portion 80 than the deepest portion in each recess of the remaining unevenness 76a. Further, the inclination of the convex portion defining the concave portion on which the sliding portion 75a is formed is larger than the inclination of each convex portion of the remaining uneven portion 76a (a steep angle).
Further, each concave portion of the remaining unevenness 76a has an arc shape in a side view. In the case of this modification, such substantially arcuate concave portions are arranged in a row, and the boundary portion between the concave portions is a convex portion. Therefore, each of the convex portions of the remaining unevenness 76a has a shape that is tapered toward the tip end side (the tip end side in the protruding direction of the convex portion) in the side view. Then, in the case of this modification, in the remaining unevenness 76a, the portion from the apex of the convex portion to the apex of the next convex portion is a concave portion.
Further, in the remaining unevenness 76a, the dimensions of the convex portions are equal to each other, and the distance from the swing axis of the fan-shaped portion 80 to the apex of each convex portion is equal to each other.
Further, as shown in FIG. 9, each concave portion of the plurality of concave-convex 76a is formed in a groove shape extending along the swing axis of the fan-shaped portion 80, for example. That is, each recess is a curved surface recessed toward the center. For this reason, each convex portion is a ridge extending along the swing axis of the fan-shaped portion 80.

The fan-shaped portion 80 is integrally molded as a whole by, for example, a hard resin material. The hard resin material is not particularly limited, and examples thereof include polyolefins such as polyethylene and polypropylene, polyamides, polycarbonates, polystyrenes, and acrylonitrile-butadiene-styrene copolymers.
The fan-shaped portion 80 may be configured by, for example, combining different members.

As shown in FIGS. 8A and 8B, in the case of this modification, the contact member 77 is oscillatingly supported with respect to the main body case 72.
More specifically, the contact member 77 is formed with a second shaft hole portion 77d that penetrates the contact member 77 in the left-right direction. Further, on each inner side surface of the first main body member 72a and the second main body member 72b, a second holding portion (not shown) is formed at a position facing the second shaft hole portion 77d. Each second holding portion has a second holding hole arranged coaxially with the second shaft hole portion 77d. A second shaft member 721c formed in a long rod shape in the left-right direction is inserted from one second holding hole through the second shaft hole portion 77d to the other second holding hole.
In this way, the contact member 77 can swing around the axis of the second shaft member 721c. Therefore, the swing direction of the contact member 77 coincides with the swing direction of the operation receiving portion 75. Inside the main body case 72, the position of the swing shaft of the contact member 77 is arranged, for example, on the base end side of the swing shaft of the operation receiving portion 75. Further, the swing region of the contact member 77 is arranged on the proximal end side of the swing region of the operation receiving portion 75, which is similar to that of the contact member 77.

Here, in the contact member 77, a fitting portion 78 is formed at a portion facing the plurality of irregularities 76a.
Further, in the contact member 77, the urging portion 79 acts on the surface on the side opposite to the side on which the fitting portion 78 is formed.
In the case of this modification, the urging portion 79 is, for example, a coil spring.
Here, an accommodating portion 89 for accommodating the urging portion 79 is formed inside the main body case 72.
More specifically, on the inner surface of the first main body member 72a, a U-shape (U-shape) (U-shape open toward the fan-shaped portion 80 side) is arranged. Three plate-shaped portions are formed. Each plate-shaped portion stands up from a portion of the inner surface of the first main body member 72a facing the second main body member 72b toward the second main body member 72b. The three plate-shaped portions include a pair of first plate-shaped portions 89a arranged parallel to each other and a second plate-shaped portion 89b connecting the ends of the pair of first plate-shaped portions 89a. ,It is included.
The accommodating portion 89 is defined by a pair of first plate-shaped portions 89a, a second plate-shaped portion 89b, an inner surface of the first main body member 72a, and an inner surface of the second main body member 72b. The urging unit 79 is arranged inside, for example, the accommodating unit 89.
The urging portion 79 is sandwiched between the second plate-shaped portion 89b and the abutting member 77, and urges the abutting member 77 toward the peripheral surface 80a side of the fan-shaped portion 80. More specifically, one end of the urging portion 79 is in contact with the contact member 77, and the other end of the urging portion 79 is in contact with the second plate-shaped portion 89b. The pair of first plate-shaped portions 89a guide the expansion and contraction of the urging portion 79 in the axial direction.
Further, a columnar protrusion 77a is formed on the surface of the contact member 77 on the side on which the urging portion 79 acts so that the coil spring does not shift, and the urging portion 79 is outside the protrusion 77a. It has been inserted.
As described above, in the case of this modification, the holding mechanism 74 urges the contact member 77 including the fitting portion 78 and the contact member 77 so that the fitting portion 78 is pressed against the operation receiving portion 75. It has an urging unit 79 and a urging unit 79.

The entire abutting member 77 is integrally molded with, for example, a hard resin material. The hard resin material is not particularly limited, and examples thereof include polyolefins such as polyethylene and polypropylene, polyamides, polycarbonates, polystyrenes, and acrylonitrile-butadiene-styrene copolymers.
The contact member 77 may be configured by, for example, combining different members.

As shown in FIGS. 8 (a) and 8 (b), the abutting member 77 is formed, for example, in a plate shape bent into a dogleg shape (L-shape with an obtuse central angle). Has been done.
More specifically, the abutting member 77 has a distal end side portion 77b on which the fitting portion 78 is formed, and a proximal end side portion 77c connected to the distal end side portion 77b.
The distal end side portion 77b and the proximal end side portion 77c are each formed in a flat plate shape. Each plate surface of the distal end side portion 77b and the proximal end side portion 77c is arranged along the left-right direction.
In the tip side portion 77b, a fitting portion 78 is formed on the surface facing the plurality of irregularities 76a, a protrusion 77a is formed on the surface on the opposite side thereof, and the urging portion 79 is in contact with the surface. I'm in contact. A second shaft hole portion 77d is formed in the central portion of the proximal end side portion 77c (the central portion in the extending direction of the proximal end side portion 77c).
The fitting portion 78 is formed in a columnar shape protruding from the tip end side portion 77b toward the unevenness 76a, for example. The protruding direction of the fitting portion 78 substantially coincides with, for example, the radial direction of the fan-shaped portion 80.
Further, the protruding portion 77a protrudes in a direction opposite to the protruding direction of the fitting portion 78. The tip end portion of the protrusion 77a (the tip end portion in the protrusion direction of the protrusion 77a) is arranged inside, for example, the accommodating portion 89.
In the case of this modification, the urging direction of the urging portion 79 substantially coincides with, for example, the protruding direction of the fitting portion 78.

Then, the urging portion 79 urges the tip end side portion 77b toward the peripheral surface 80a of the fan-shaped portion 80, so that at least a part of the tip end surface 78a of the fitting portion 78 comes into contact with the peripheral surface 80a.
More specifically, the tip surface 78a of the fitting portion 78 comes into contact with either the concave-convex structure portion 76 or the sliding portion 75a according to the swing angle of the operation receiving portion 75.
As shown in FIG. 8A, the operation receiving portion 75 is restricted from swinging by being urged by the urging portion 79 and fitting the fitting portion 78 to any one of the irregularities 76a. To.
Then, by swinging the operation receiving portion 75, the fitting portion 78 is released from the unevenness 76a, and the fitting portion 78 is fitted to the other unevenness 76a, or on the sliding portion 75a. Can be moved to.
More specifically, the dimensions of each of the recesses of the plurality of irregularities 76a in the circumferential direction are set to, for example, substantially the same as the diameter of the fitting portion 78. Therefore, the fitting portion 78 fits well with respect to the unevenness 76a.
Further, as shown in FIG. 8B, when the tip surface 78a of the fitting portion 78 is in contact with the sliding portion 75a, the operation receiving portion 75 has any of a plurality of swing angles. Not held at that angle.
More specifically, the length dimension of the sliding portion 75a is set to be larger than the diameter of the fitting portion 78, for example. Therefore, the fitting portion 78 can be displaced with respect to the operation receiving portion 75 in a state where the fitting portion 78 is in contact with the sliding portion 75a.
Further, as described above, the formation depth of the concave portion in which the sliding portion 75a is formed is larger than the formation depth of each concave portion of the remaining unevenness 76a. Therefore, the urging portion 79 is in contact with the sliding portion 75a as compared with the state in which the fitting portion 78 is in contact with the remaining unevenness 76a. Since it is in a state of being extended longer in the axial direction, the urging force of the urging portion 79 becomes smaller. Therefore, the operation receiving unit 75 can easily swing.
The operation receiving portion 75 may not have, for example, the sliding portion 75a. In this case, the plurality of irregularities 76a have, for example, the same shape as each other.

Here, a protruding portion 82 that receives a traction operation is formed on the peripheral surface 80a. As an example, the protruding portion 82 is formed in a portion closer to the tip side than the forming region of the plurality of irregularities 76a. A protruding portion 82 (see FIGS. 9 and 11 (a)) that protrudes outward in the radial direction of the fan-shaped portion 80 is formed.
The tip 82a of the protrusion 82 (the tip in the extending direction of the protrusion 82) is wider in the circumferential direction than, for example, the base end 82b of the protrusion 82 (the base end in the extending direction of the protrusion 82). It is formed on the surface and tapers toward the tip side.

Further, an opening 73 (see FIG. 9 and the like) is formed at the upper end of the main body case 72 so that the internal space of the main body case 72 and the outside of the main body case 72 communicate with each other. The opening 73 is formed, for example, in a substantially rectangular shape that is long in the longitudinal direction of the main body case 72 in a plan view. The tip end portion 82a of the projecting portion 82 projects to the outside of the main body case 72 through the opening portion 73. For example, the operator swings the operation receiving portion 75 by swinging the tip portion 82a in the circumferential direction with the fingers of the hand holding the main body case 72 while gripping the main body case 72 with one hand. Can be done. That is, the towing operation can be easily performed while holding the main body case 72 with one hand.
More specifically, for example, the operation unit 70 has a structure suitable for operating the protrusion 82 with the first finger while gripping the lower portion of the main body case 72 with the second to fifth fingers and the palm. It has become. The finger that operates the protrusion 82 is not particularly limited, and may be a second finger or the like.

Further, in the case of this modification, the range of the swing angle of the protrusion 82 is limited by the opening 73, so that the range of the swing angle of the operation receiving portion 75 is limited.
More specifically, the protrusion 82 is the base end portion of the protrusion 82 from a position where the base end portion 82b of the protrusion 82 abuts against the edge portion on the tip end side of the opening 73 (see FIG. 8A). The 82b can be moved within an angle range up to a position (see FIG. 8B) where the 82b abuts on the edge on the proximal end side of the opening 73. Therefore, the operation receiving portion 75 can swing within the range of the angle from the edge portion on the distal end side of the opening 73 to the edge portion on the proximal end side of the opening 73.
Further, by limiting the range of the swing angle of the operation receiving portion 75, the fitting portion 78 does not abut on the region on the peripheral surface 80a on the distal end side of the sliding portion 75a, and is closest to the proximal end side. The structure is such that it is suppressed from getting over the arranged convex portion (it is suppressed from falling off to the proximal end side). In other words, at any swing angle of the operation receiving portion 75, the fitting portion 78 comes into contact with either the sliding portion 75a or the concave-convex structure portion 76.

Then, in the case of this modification, by swinging the protruding portion 82 in the direction approaching the edge portion on the proximal end side of the opening 73, the operation line 50 can be pulled toward the proximal end side and tension can be applied. Further, by swinging the protruding portion 82 in the direction approaching the edge portion on the tip end side of the opening 73, the operation line 50 can be moved toward the tip end side and relaxed. In this way, the distal end 10a of the tubular body 10 can be flexed or extended.

More specifically, for example, as shown in FIGS. 10A and 10D, in a state where the base end portion 82b of the protrusion 82 is in contact with the edge portion on the distal end side of the opening 73. , The distal end 10a of the tubular body 10 is elongated (not bent). Further, the fitting portion 78 is fitted to the unevenness 76a arranged on the most proximal side.
Then, when the protruding portion 82 is swung toward the proximal end side as shown in FIGS. 10 (b) and 10 (e) from the state shown in FIG. 10 (a), the proximal end portion 50b of the operation line 50 is changed. The distal end portion 10a of the tubular body 10 is bent toward the second lumen 22 side, which is pulled toward the base end side and through which the operation line 50 is inserted, with reference to the axial center of the tubular body 10. Further, the fitting portion 78 is pressed by the operation receiving portion 75 and swings in the direction opposite to the swing direction of the operation receiving portion 75, and is arranged on the tip side of the unevenness 76a arranged on the most proximal side. It will be fitted to any of the irregularities 76a.
Next, from the state shown in FIG. 10 (b), as shown in FIGS. 10 (c) and 10 (f), the operation receiving portion 75 is further shaken in a direction closer to the edge portion on the proximal end side of the opening 73. When moved, the proximal end portion 50b of the operating line 50 is further pulled toward the proximal end side, and the tubular body 10 is placed on the second lumen 22 side through which the operating line 50 is inserted, with reference to the axial center of the tubular body 10. The distal end 10a of the bends at a larger bending angle. Further, the fitting portion 78 will be fitted to any of the irregularities 76a arranged on the more advanced side. Then, when the operation receiving portion 75 is swung to a position where the base end portion 82b abuts or approaches the edge portion on the base end side of the opening 73, the fitting portion 78 with respect to the unevenness 76a is released. , The fitting portion 78 comes into contact with the sliding portion 75a arranged on the tip end side of the concave-convex structure portion 76.
On the other hand, when the operation receiving portion 75 is swung in a direction approaching the edge portion on the distal end side of the opening 73, the operation line 50 is relaxed by moving the proximal end portion 50b toward the distal end side, and the distal end portion 10a The bending angle becomes smaller. Then, as shown in FIGS. 10A and 10D, when the operation receiving portion 75 is swung in one direction until the protruding portion 82 comes into contact with the edge portion on the tip end side of the opening portion 73, The distal end 10a of the tubular body 10 is in an elongated state. That is, the bent state of the distal end portion 10a of the tubular body 10 can be released by swinging the operation receiving portion 75 in the other direction until the protruding portion 82 abuts on the front end portion of the opening 73. ..
In this way, the operation line 50 is pulled or relaxed by the operation of the operation unit 70 with respect to the operation receiving unit 75, so that the distal end portions 10a of the tubular body 10 are selectively selected in a plurality of directions included in the same plane as each other. Can be bent into.

The range of the swing angle of the operation receiving unit 75 is not particularly limited, but for example, it is preferably set to 20 degrees or more and 60 degrees or less, and more preferably 30 degrees or more and 50 degrees or less.
When the range of the swing angle of the operation receiving portion 75 is set to 20 degrees or more, the range of the bending angle of the distal end portion 10a of the tubular body 10 can be sufficiently secured.
Since the range of the swing angle of the operation receiving unit 75 is set to 60 degrees or less, the finger of the hand holding the operation unit 70 is the smallest while maintaining the state of gripping the operation unit 70 with one hand. The operation receiving unit 75 can be easily swung from the swing angle to the maximum swing angle.

<Second modification>
Next, a second modification of the embodiment will be described with reference to FIGS. 12 (a) and 12 (b).
The catheter 100 according to the second modification is different from the catheter 100 according to the first modification in that it is described below, and is the same as the catheter 100 according to the first modification in other respects. It is configured in. Note that the second main body member 72b is not shown in FIGS. 12 (a) and 12 (b).

The holding mechanism 74 in this modification is, for example, a mechanism for holding the operation receiving portion 75 at a stepless swing angle.
As a result, the holding mechanism 74 of the operating portion 70 can hold the operating receiving portion 75 at any angle of the stepless swing angle, so that the distal end portion 10a of the tubular body 10 is absent. It can be adjusted to a stepped bending angle. Thereby, the bending angle of the distal end portion 10a can be adjusted more finely.

As described above, the catheter 100 according to the present modification further includes an operation unit 70 for bending the distal end portion 10a of the tubular body 10 by the traction operation of the operation line 50, and the operation unit 70 is gripped by the operator. It has a main body case 72 to be operated, and an operation receiving portion 75 to which the base end portion 50b of the operation line 50 is fixed and swingably supported with respect to the main body case 72, and the traction operation is performed. It is an operation of swinging the operation receiving portion 75, and the operating portion 70 further has a holding mechanism 74 for holding the distal end portion 10a in a bent state, and the holding mechanism 74 has a stepless operation receiving portion 75. It is a mechanism that holds the swing angle.

In the case of this modification, as shown in FIGS. 12A and 12B, the holding mechanism 74 has a friction portion 91 and a pressure contact portion 92 that is pressed against the friction portion 91. By pressing the pressure contact portion 92 against the friction portion 91, the operation receiving portion 75 is held at any of the stepless swing angles.
More specifically, the operation unit 70 is configured such that, for example, when a traction operation is performed, the pressure contact portion 92 is pressed against any region of the friction portion 91. In this state, the pressure contact portion 92 regulates the swing of the operation receiving portion 75. Therefore, when the towing operation is released, the operation receiving unit 75 can be held at the swing angle when the towing operation is released without performing another operation. Therefore, the operability of the catheter 100 can be improved.
In the case of this modification, the pressure contact portion 92 can be pressure contacted to any region of the friction portion 91. Therefore, the operation receiving portion 75 can be held at a stepless swing angle.
More specifically, in a state where the pressure contact portion 92 is in pressure contact with the friction portion 91, the tip corner portion of the tip surface 92a of the pressure contact portion 92 bites into, for example, the friction portion 91.

Further, in the case of this modification, a friction portion 91 is arranged on the fan-shaped arcuate peripheral surface 80a of the fan-shaped portion 80 instead of the concave-convex structure portion 76. Further, as in the first modification, the sliding portion 93 is arranged on the peripheral surface 80a.
In the case of this modification, the frictional force generated between the friction portion 91 and the pressure contact portion 92 is larger than the friction force generated between the sliding portion 93 and the pressure contact portion 92. Then, in a state where the pressure contact portion 92 is in pressure contact with any region of the friction portion 91, the swing of the operation receiving portion 75 is regulated, and the operation receiving portion 75 swings steplessly. It is held at one of the angles. Further, in a state where the pressure contact portion 92 is in pressure contact with the sliding portion 93, the swing of the operation receiving portion 75 is not regulated.
The sliding portion 93 has, for example, the same structure as the sliding portion 75a in the first modification. That is, a recess is formed in the peripheral surface 80a on the base end side of the friction portion 91 inward in the radial direction of the fan-shaped portion 80, and the bottom surface of the recess forms the sliding portion 93. It is configured.
Further, the pressure contact portion 92 also has a structure similar to that of the fitting portion 78 in the first modification, for example. Therefore, the pressure contact portion 92 is urged by the urging portion 79 and is pressure-welded to the operation receiving portion 75. Further, by performing a traction operation, the position of the friction portion 91 with respect to the pressure contact portion 92 can be changed, and the swing angle of the operation receiving portion 75 can be changed.

The friction portion 91 is formed by, for example, attaching a sheet material made of a material having a friction coefficient larger than that of the resin material forming the fan-shaped portion 80 described above.
Such a material is not particularly limited, and examples thereof include rubber materials such as polyurethane elastomer, polyamide elastomer, silicone rubber, and latex rubber.
However, the friction portion 91 may be, for example, a rough surface on which a plurality of minute irregularities are formed.

Although each embodiment has been described above with reference to the drawings, these are examples of the present invention, and various configurations other than the above can be adopted.

For example, in the above description, an example in which the inner wall of the tubular body 10 defines a plurality of lumens 20 has been described, but the present invention is not limited to this example, and a plurality of tubes are embedded inside the tubular body 10. The inner walls of the plurality of tubes may define the plurality of lumens 20, respectively.

Further, in the first modification, the example in which the concave-convex structure portion 76 is formed on the operation receiving portion 75 has been described, but for example, the concave-convex structure portion 76 may be formed on the inner surface of the main body case 72. In this case, for example, the fitting portion 78 is provided in the plate-shaped portion 81b of the fan-shaped portion 80 (operation receiving portion 75), and the fitting portion 78 is fitted to the concave-convex structure portion 76 for operation. The swing angle of the receiving portion 75 is maintained within a predetermined angle range.

Further, for example, in the second modification, the swing of the operation receiving portion 75 is regulated by the friction between the friction portion 91 arranged in the operation receiving portion 75 and the pressure contact portion 92 included in the contact member 77. An example was explained. However, the present invention is not limited to this example, and the swing of the operation receiving portion 75 may be restricted by the friction between the operation receiving portion 75 and the inner surface of the main body case 72.
More specifically, for example, the friction portion 91 may be formed on the fan-shaped portion 80, and the pressure contact portion 92 may be formed on the inner surface of the main body case 72, or the pressure contact portion 92 may be formed on the fan-shaped portion 80. At the same time, a friction portion 91 may be formed on the inner surface of the main body case 72.
When the friction portion 91 is formed on the inner side surface of the main body case 72, the pressure contact portion 92 is preferably formed on the side surface of the fan-shaped portion 80, for example. Further, it is preferable that, for example, a thin-walled portion having a relatively small thickness in the left-right direction and a thick-walled portion having a relatively large thickness in the left-right direction are formed on the inner surface of the main body case 72. The thin-walled portion and the thick-walled portion can switch between a state in which the pressure-welding portion 92 is in pressure contact with the friction portion 91 and a state in which the pressure-welding portion 92 is not in pressure contact with the friction portion 91.
The thin-walled portion and the thick-walled portion may be formed in the fan-shaped portion 80, respectively.
Further, on the inner surface of the main body case 72, for example, a projecting region that projects relatively toward the fan-shaped portion 80 side and a non-projecting region in which the projecting region is not formed may be formed. preferable. Depending on the protruding region and the non-protruding region, it is possible to switch between a state in which the pressure contact portion 92 is in pressure contact with the friction portion 91 and a state in which the pressure contact portion 92 is not in pressure contact with the friction portion 91.
The protruding region and the non-protruding region may be formed in the fan-shaped portion 80, respectively.

Further, for example, in the second modification, the swing of the operation receiving portion 75 is regulated by the friction between the friction portion 91 arranged in the operation receiving portion 75 and the pressure contact portion 92 included in the contact member 77. An example was explained. However, the present invention is not limited to this example, and the swing of the operation receiving portion 75 may be restricted by the friction between the first shaft member 86 that pivotally supports the fan-shaped portion 80 and the fan-shaped portion 80.
More specifically, for example, the swing of the operation receiving portion 75 may be restricted by the friction between the first shaft member 86 that pivotally supports the fan-shaped portion 80 and the first shaft hole portion 85 of the fan-shaped portion 80. .. In this case, the friction portion 91 may be formed on the first shaft member 86, and the pressure contact portion 92 may be formed on the inner peripheral surface of the first shaft hole portion 85, or the pressure contact portion 92 may be formed on the first shaft member 86. Is formed, and the friction portion 91 may be formed on the inner peripheral surface of the first shaft hole portion 85.
Further, for example, the swing of the operation receiving portion 75 may be restricted by the friction between the first shaft member 86 and the holding portion formed on the main body case 72. In this case, the friction portion 91 is formed in the holding portion, and the pressure contact portion 92 may be formed in the first shaft member 86, or the pressure contact portion 92 is formed in the holding portion, and the first shaft member 86 is formed. The friction portion 91 may be formed on the surface.

Further, for example, in the first modification and the second modification, the range of the swing angle of the operation receiving portion 75 is restricted by the protrusion 82 contacting the tip end portion or the base end portion of the opening 73. The example to be done was explained. However, the present invention is not limited to this example, and the swing of the operation receiving portion 75 is caused by, for example, a convex portion (not shown) formed on the inner surface of the main body case 72 contacting the operation receiving portion 75. , The range of the swing angle of the operation receiving portion 75 may be regulated.

This embodiment includes the following technical ideas.
(1) A catheter placed in the coronary sinus of the heart to supply cardioplegic fluid to the coronary arteries.
A tubular body with multiple lumens and
A hole for supplying the cardioplegic solution, which is formed at the distal end of the tubular body and communicates with the first lumen.
A reinforcing tube inserted through the second lumen and
The operation line inserted through the reinforcing tube and
Have,
The reinforcing tube extends from the proximal side of the tubular body to the distal end.
A catheter in which the tip of the operating line is derived from the distal end of the reinforcing tube and is fixed to the distal end of the tubular body on the distal side of the distal end of the reinforcing tube.
(2) Further having a balloon provided on the outer periphery of the distal end of the tubular body and communicating with the third lumen.
The catheter according to (1), wherein the reinforcing tube extends from the proximal side of the tubular body to a portion near the proximal side of the balloon placement region.
(3) The catheter according to (2), wherein the distal end of the reinforcing tube is located proximal to the balloon placement region.
(4) As the hole, a first hole formed at the distal end of the tubular body and a second hole formed on the peripheral surface of the distal end of the tubular body are provided. The catheter according to any one of (1) to (3) having.
(5) The catheter is inserted into the vein through an introducer that is percutaneously punctured into the vein.
A flexible sleeve that is extrapolated to the tubular body and can be expanded and contracted in the axial direction.
A tubular connecting portion that is provided in a circumferentially liquid-tight manner with respect to the distal end of the sleeve and is slidable in the axial direction with respect to the tubular body.
Further prepare
The catheter according to any one of (1) to (4), wherein the connecting portion can be detachably connected to the introducer.
(6) Further provided with an operation portion for bending the distal end portion of the tubular body by the traction operation of the operation line.
The operation unit
The main body case held by the surgeon and
An operation receiving portion in which the base end portion of the operation line is fixed and is pivotally supported with respect to the main body case.
Have,
The traction operation is an operation of swinging the operation receiving portion.
The operating portion further has a holding mechanism for holding the distal end portion in a bent state.
The holding mechanism is a mechanism that holds the operation receiving portion at one of a plurality of preset swing angles, or holds the operation receiving portion at a stepless swing angle. The catheter according to any one of (1) to (5), which is a mechanism.
(7) The holding mechanism is fitted to a concavo-convex structure portion including a plurality of concavo-convex structures and to the concavo-convex structure corresponding to the swing angle of the operation receiving portion among the plurality of concavo-convex parts of the concavo-convex structure portion. With a part,
Either one of the concave-convex structure portion and the fitting portion is formed in the operation receiving portion.
4. The operation receiving portion is held at any of the plurality of swing angles by fitting the fitting portion with respect to any of the irregularities of the concave-convex structure portion (6). catheter.
(8) The operation receiving portion has a fan-shaped portion formed in a fan shape, and is pivotally supported so as to be swingable in the circumferential direction of the fan-shaped portion.
The catheter according to (7), wherein the plurality of irregularities are arranged side by side in the circumferential direction of the arcuate peripheral surface of the fan-shaped portion.
(9) The concave-convex structure portion is formed on the operation receiving portion, and the concave-convex structure portion is formed on the operation receiving portion.
The holding mechanism includes a contact member including the fitting portion and an urging portion for urging the contact member so that the fitting portion is in pressure contact with the operation receiving portion (7). Or the catheter according to (8).

10 Tubular body 10a Distal end 11 Marker 12 Adhesive 13 Hole 13a First hole 13b Second hole 14 Flexible part 15 Connecting part 17 Lock operation part 18 Notch shape part 18a Straight part 18b Crossing part 20 Lumen 21 No. 1 lumen 22 2nd lumen 23 3rd lumen 23a Balloon hole 24 4th lumen 30 Branch 31 Liquid feed branch pipe 31a Liquid feed connector 32 Balloon branch pipe 32a Balloon connector 33 For pressure monitor Branch pipe 33a Pressure monitor connector 33b Pressure monitor cap 34 Opening / closing member 35 Cover member 40 Reinforcing tube 40a Distal end 50 Operation line 50a Tip 50b Base end 51 Hooking part 60 Balloon 61 Distal end 62 Proximal end 63 Intermediate part 65 Sleeve 70 Operation part 71 Wheel operation part 72 Main body case 72a First main body member 721c Second shaft member 72b Second main body member 73 Opening 74 Holding mechanism 75 Operation receiving part 75a Sliding part 76 Concavo-convex structure part 76a Concavo-convex 77 Abutment member 77a Projection 77b Tip side 77c Base end 77d Second shaft hole 78 Fitting 78a Tip surface 79a Tip corner 79 Bias 80 Fan 80a Peripheral surface 81a Peripheral wall 81b Plate-shaped portion 81c 1st wall 81d 2nd wall 82 Protruding 82a Tip 82b Base end 83a Slits 84a, 84b Cylindrical 85 1st shaft hole 86 1st shaft member 87 2nd plate 88 3rd shaft member 89 Accommodating part 89a First plate-shaped part 89b Second plate-shaped part 91 Friction part 92 Pressure contact part 92a Tip surface 93 Sliding part 95 Blank 100 Cauterine 110 Introducer 112 Cylindrical body 113 Second connecting part 114 Side port 114a Tube 114b Three-way stopper 116 protruding part

Claims (9)

A catheter that is placed in the coronary sinus of the heart to supply cardioplegic fluid to the coronary arteries.
A tubular body with multiple lumens and
A hole for supplying the cardioplegic solution, which is formed at the distal end of the tubular body and communicates with the first lumen.
A reinforcing tube inserted through the second lumen and
The operation line inserted through the reinforcing tube and
Have,
The reinforcing tube extends from the proximal side of the tubular body to the distal end.
A catheter in which the tip of the operating line is derived from the distal end of the reinforcing tube and is fixed to the distal end of the tubular body on the distal side of the distal end of the reinforcing tube. It further comprises a balloon provided on the outer periphery of the distal end of the tubular body and communicating with the third lumen.
The catheter according to claim 1, wherein the reinforcing tube extends from the proximal side of the tubular body to a portion near the proximal side of the balloon placement region. The catheter according to claim 2, wherein the distal end of the reinforcing tube is located proximal to the balloon placement region. A claim having a first hole formed at the distal end of the tubular body and a second hole formed on the peripheral surface of the distal end of the tubular body as the hole. The catheter according to any one of 1 to 3. The catheter is inserted into the vein through an introducer that is percutaneously punctured into the vein.
A flexible sleeve that is extrapolated to the tubular body and can be expanded and contracted in the axial direction.
A tubular connecting portion that is provided in a circumferentially liquid-tight manner with respect to the distal end of the sleeve and is slidable in the axial direction with respect to the tubular body.
Further prepare
The catheter according to any one of claims 1 to 4, wherein the connecting portion can be detachably connected to the introducer. An operation portion for bending the distal end portion of the tubular body by a traction operation of the operation line is further provided.
The operation unit
The main body case held by the surgeon and
An operation receiving portion in which the base end portion of the operation line is fixed and is pivotally supported with respect to the main body case.
Have,
The traction operation is an operation of swinging the operation receiving portion.
The operating portion further has a holding mechanism for holding the distal end portion in a bent state.
The holding mechanism is a mechanism that holds the operation receiving portion at one of a plurality of preset swing angles, or holds the operation receiving portion at a stepless swing angle. The catheter according to any one of claims 1 to 5, which is a mechanism. The holding mechanism includes a concavo-convex structure portion including a plurality of concavo-convex structures, and a fitting portion that fits against the concavo-convex structure corresponding to the swing angle of the operation receiving portion among the plurality of concavo-convex structures of the concavo-convex structure portion. Have,
Either one of the concave-convex structure portion and the fitting portion is formed in the operation receiving portion.
The sixth aspect of claim 6, wherein the operation receiving portion is held at any of the plurality of swing angles by fitting the fitting portion with respect to any of the irregularities of the concave-convex structure portion. catheter. The operation receiving portion has a fan-shaped portion formed in a fan shape, and is pivotally supported so as to be swingable in the circumferential direction of the fan-shaped portion.
The catheter according to claim 7, wherein the plurality of irregularities are arranged side by side in the circumferential direction of the arcuate peripheral surface of the fan-shaped portion. The uneven structure portion is formed on the operation receiving portion, and the concave-convex structure portion is formed on the operation receiving portion.
7. The holding mechanism includes a contact member including the fitting portion and an urging portion for urging the contact member so that the fitting portion is pressed against the operation receiving portion. Alternatively, the catheter according to claim 8.

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