JP6401816B2 - Access port - Google Patents

Description

  The present invention relates to an access port.

  Conventionally, a balloon or superelastic expansion member that can be expanded radially is provided at the distal end, and the balloon or superelastic expansion member is prevented from coming out by expanding the balloon or superelastic expansion member while the distal end is inserted into the body through the tissue wall. Gastrostomy catheters and trocars are known (see, for example, Patent Documents 1 and 2).

JP 2010-158486 A JP-A-9-28666

  However, in these apparatuses of Patent Documents 1 and 2, since the stopper is constituted by a member having elasticity such as a balloon or a superelastic expansion member, it functions effectively for a relatively thick tissue wall. There is an inconvenience that it does not function as an effective stopper against a thin and highly stretchable biological membrane such as the pericardium.

  The present invention has been made in view of the above-described circumstances, and an object thereof is to provide an access port that can be fixed to a biological membrane such as a pericardium while penetrating the biological membrane. .

In order to achieve the above object, the present invention provides the following means.
One aspect of the present invention comprises an inner cylinder and an outer cylinder fitted relatively movably in the axial direction, before Symbol barrel tip pull one end strip of resilient material attached to the member is provided A storage portion for storing the pull-in member in a state along the outer surface of the outer cylinder at the tip of the inner cylinder, and facing the outer surface of the outer cylinder and the outer surface of the outer cylinder in the stored state; by the surface of the pulling member, clamping face which is brought close to or separated from each other by a relative movement between the outer cylinder and the inner cylinder to provide an access port constructed.

  According to this aspect, the inner cylinder and the outer cylinder are relatively moved in the axial direction in a state where the inner cylinder is penetrated through the biological membrane through the hole formed in the biological membrane. After separating the sandwiching surfaces and disposing the biological membrane between the sandwiching surfaces, the biological membrane is made thicker by moving the inner cylinder and the outer cylinder relative to each other in the axial direction to bring the sandwiching surfaces closer to each other. Can be sandwiched in the direction. In this case, since the sandwiching surface has a substantially complementary shape, the biological membrane can be sandwiched by the surface over a wide range, and it is ensured that the access port does not fall out in a state of penetrating the biological membrane. Can be fixed. Thereby, a device can be easily inserted into the biological membrane from outside the biological membrane via the through hole inside the inner cylinder.

In one aspect of the present invention, the clamping surface, an outer surface of the outer cylinder, Ru is constituted by the surface of the pulling member opposed to the outer surface of the outer cylinder in the retracted state.

  In this way, the distal end of the outer cylinder can be obtained by relatively moving the inner cylinder and the outer cylinder in the axial direction with the inner cylinder penetrating the biological membrane through the hole formed in the biological membrane. The retracting member attached to the inner surface of the biological membrane comes into contact with the inner surface of the biological membrane, and when the outer tube and the retracting member are folded and housed in the housing portion of the inner tube, the living body is placed between the outer surface of the outer tube and the surface of the retracting member. It is accommodated in the accommodating part across the membrane. If the retracting member is provided at one place, the biological membrane is provided at one place, and if a plurality of retracting members are provided along the circumferential direction of the outer cylinder, the biological membrane is provided at the outer face of the outer cylinder at a plurality of locations in the circumferential direction. And the surface of the retracting member. Thereby, in the state which made the access port penetrate the biological membrane, it can fix firmly so that it may not fall out.

In another aspect of the present invention comprises an inner cylinder and an outer cylinder fitted axially movable relative the outer cylinder, two outer cylindrical portion which is fitted relatively movably in the axial direction the provided, each outer tube tip end is provided, respectively Re strip pulling member pixels made of an elastic material attached to the, the tip of the inner cylinder, cross each pulling member of two of the outer tube portion A storage portion is provided that is in close contact with the outer surface of the outer cylindrical portion and is disposed along the outer surface of the outer cylindrical portion, and the two outer cylindrical portions are separated from each other by the opposing surfaces of the drawing members provided in the two outer cylindrical portions. the clamping face which is brought close to or separated from each other by the relative movement to provide an access port that consists of.

  By doing so, the retracting member disposed on the distal end side is disposed on the inner side of the biological membrane, and the retractable member disposed on the rear end side is opened on the biological membrane to a position where it is disposed on the outer side of the biological membrane. The two outer cylinders are inserted in the state in which the inner cylinder and the outer cylinder are inserted into the biological membrane through the holes, the two outer cylindrical portions are moved in the axial direction and the biological membrane is sandwiched between the two retracting members. When the part is moved in the distal direction of the inner cylinder part, the biological membrane is drawn into the storage part of the inner cylinder while being sandwiched between the two drawing members. Thereby, it can accommodate in a storage part in the state which pinched | interposed the biomembrane with two drawing-in members, and can draw in a biomembrane more reliably.

Moreover, in 1 aspect of this invention, the processus | protrusion member may be provided with the processus | protrusion on the surface.
By doing in this way, it is prevented that the biological membrane which contacted the drawing-in member shifts | deviates to the surface direction of a drawing-in member by a processus | protrusion, and can make it easy to draw in a biological membrane in a storage part.

In the reference aspect of the invention as a reference example of the present invention, the clamping surface is provided on the most distal surface of the outer cylinder and the opposed surface provided at the tip of the inner cylinder at a position facing the most distal surface. It is made up of.
By doing in this way, the inner cylinder has a one-step smaller diameter from the front end side to the rear end side at the position of the facing surface, so when the biomembrane is pushed through and penetrated through the inner cylinder, When the opposite surface is exceeded, the inner inner cylinder has a small diameter, and the hole of the biological membrane contracts due to its elasticity, and is disposed between the most distal surface of the outer cylinder and the opposite surface of the inner cylinder. Therefore, by moving the outer cylinder in the distal direction of the inner cylinder with respect to the inner cylinder, the biological membrane can be easily sandwiched between the clamping surfaces composed of the foremost surface and the opposing surface.

Further, in the above reference aspect, even if the foremost surface of the outer cylinder has a tapered surface shape that tapers toward the tip, and the opposing surface of the inner cylinder has a tapered inner surface shape. Good.
By doing in this way, a biological membrane is pinched | interposed between the clamping surfaces which consist of a taper surface-shaped most advanced surface and the opposing surface of a taper inner surface shape. As a result, the area can be increased compared to the clamping surface orthogonal to the axial direction, the biological membrane can be more securely clamped in a wider area, and the access port can be securely fixed to the biological membrane. .

  Further, the portion around the hole of the biological membrane sandwiched by the sandwiching surfaces formed in this way is folded back toward the distal end of the inner cylinder as it goes inward in the radial direction. As a result, even if a force in the pulling direction acts on the access port, the acute edge of the outermost edge of the opposing surface of the tapered inner surface is pressed against the biological membrane, and the biological membrane is extracted from between the holding surfaces. It is possible to prevent the slipping out and improve the retaining effect.

  In particular, the access port can be inserted into the body through a small hole, and it is desirable to secure a large-diameter through-hole inside, so that the radial thickness of the inner cylinder and the outer cylinder cannot be secured large. There are many. Therefore, by adopting the above-described sandwiching surface, it is possible to secure a large area of the sandwiching surface while suppressing the thickness dimension of the inner cylinder and the outer cylinder, and improve the retaining effect of the biological membrane.

Moreover, in the said reference aspect, the unevenness | corrugation may be provided in the said most advanced surface and the said opposing surface.
By doing in this way, while being able to further increase the area of a clamping surface, the effect of maintaining the state which pinched | interposed the biological membrane pinched | interposed between them by meshing a recessed part and a convex part can be improved.

Moreover, in the said reference aspect, the unevenness | corrugation of the said most advanced surface and the said opposing surface may be provided in the circumferential direction.
By doing so, the area of the clamping surface can be increased, and the concave portion and the convex portion provided in the circumferential direction mesh with each other to prevent the inner cylinder and the outer cylinder from rotating relative to each other in the circumferential direction. it can. Accordingly, it is possible to prevent the biological membrane sandwiched between the sandwiching surfaces from being extracted due to the displacement between the sandwiching surface and the biological membrane due to the relative rotation.

  According to the present invention, the biological membrane such as the pericardium can be fixed while penetrating the biological membrane.

It is an access port concerning a reference embodiment of the invention as a reference example of the present invention, and is a longitudinal section showing (a) a state where lock is released, and (b) a state where it is locked and a dilator is inserted. Fig. 1 is a longitudinal section showing (a) a state in which the access port of Fig. 1 is passed through the pericardium, (b) a state in which the outer cylinder is retracted relative to the inner cylinder, and (c) a state in which the pericardium is sandwiched between the clamping surfaces. FIG. FIG. 9 is a partially enlarged longitudinal sectional view of a tip portion showing a first modification of the access port of FIG. 1. FIG. 9 is a partially enlarged longitudinal sectional view of a tip portion showing a second modification of the access port of FIG. 1. FIG. 10 is a partially enlarged longitudinal sectional view of a tip portion showing a third modification of the access port of FIG. 1. FIG. 10 is a partially enlarged longitudinal sectional view of a tip portion showing a fourth modification of the access port of FIG. 1. 1A and 1B are access ports according to an embodiment of the present invention, each showing (a) a state in which the outer cylinder is retracted relative to the inner cylinder, and (b) a state in which the outer cylinder is advanced relative to the inner cylinder. FIG. 7 (a) a state in which the access port is penetrated through the pericardium, (b) a state in which the outer tube is retracted relative to the inner tube, (c) a state in which the inner tube is retracted relative to the outer tube, It is a partial enlarged longitudinal cross-sectional view which respectively shows the state pulled in between clamping surfaces. FIG. 8 is a modification of the access port of FIG. 7, showing (a) a state in which the retracting members of the two outer cylinder portions are separated from each other, and (b) a state in which the pericardium is sandwiched between the retracting portions and accommodated in the accommodating portion. It is a partial expanded longitudinal cross-sectional view.

An access port 1 according to a reference embodiment of the invention as a reference example of the present invention will be described below with reference to the drawings.
In the present embodiment, the pericardium A will be described as an example of a biological membrane to which the access port 1 is attached.

The access port 1 according to the present embodiment includes an inner cylinder 2 and an outer cylinder 3 as shown in FIG.
The inner cylinder 2 is provided with a through-hole 2a penetrating the entire length in the longitudinal direction, a small diameter portion 2b having a constant outer diameter, and a large diameter portion 2c having a larger outer diameter than the small diameter portion 2b. .

The large diameter portion 2 c is disposed on the distal end side of the inner cylinder 2. On the distal end side of the large diameter portion 2c, a slope 2d having a diameter that smoothly increases from the distal end of the inner cylinder 2 toward the outermost diameter of the large diameter portion 2c is provided. Further, on the rear end side of the large diameter portion 2c, a step having an annular flat surface 2e extending in the radial direction is provided at the boundary between the large diameter portion 2c and the small diameter portion 2b.
Further, a flange portion 2 f is provided at the rear end of the inner cylinder 2.

  The outer cylinder 3 is formed in a straight tube shape having a through hole 3a for fitting the small diameter portion 2b of the inner cylinder 2 so as to be relatively movable, and includes a flange portion 3b and a lock mechanism 4 at the rear end. The outer diameter dimension of the outer cylinder 3 is configured to be a constant dimension substantially equal to that of the large diameter portion 2 c of the inner cylinder 2. By fitting the small diameter portion 2b of the inner cylinder 2 into the through hole 3a of the outer cylinder 3, the inner cylinder 2 and the outer cylinder 3 are assembled so as to be relatively movable in the axial direction.

  The lock mechanism 4 includes a swing piece 4b that is swingable about an axis 4a extending in the circumferential direction of the outer cylinder 3. As shown in FIG. 1A, the lock is released in a state where the swinging piece 4b stands in the radial direction, and the inner cylinder 2 and the outer cylinder 3 can be moved relative to each other. On the other hand, when the swing piece 4b is swung to a position along the outer surface of the inner cylinder 2 as shown in FIG. 1B, the swing end of the swing piece 4b is brought into contact with the flange portion 2f of the inner cylinder 2. The contact is made to fill the gap between the outer cylinder 3 and the flange portion 2f, and the inner cylinder 2 and the outer cylinder 3 are locked so that they cannot move relative to each other in the axial direction.

Then, as shown in FIG. 1B, in the state where the inner cylinder 2 and the outer cylinder 3 are locked so as not to move relative to each other by the lock mechanism 4, an annular flat surface 3c (tip surface) at the tip of the outer cylinder 3 is used. , Hereinafter also referred to as a clamping surface) and an annular flat surface 2e (opposite surface, hereinafter also referred to as a clamping surface) at the rear end of the large-diameter portion 2c of the inner cylinder 2 or the pericardium A It is arranged to face each other with a gap narrower than the thickness. As a result, the two flat surfaces 2e and 3c constitute a sandwiching surface for sandwiching the pericardium A.

The operation of the access port 1 according to this embodiment configured as described above will be described below.
In order to fix the access port 1 according to this embodiment in a state of penetrating the pericardium A, first, the pericardium A is penetrated by a puncture needle (not shown), and a guide wire (not shown) is installed through the puncture needle. Then, the puncture needle is removed, and only the guide wire is placed in a state of penetrating the pericardium A.

  In this state, as shown in FIG. 1 (b), the dilator 5 is assembled in the through hole 2a of the inner cylinder 2 of the access port 1 according to this embodiment. At this time, the lock mechanism 4 of the outer cylinder 3 is operated to lock the inner cylinder 2 and the outer cylinder 3 so that they cannot move relative to each other.

  The dilator 5 has a tapered portion 5a that smoothly connects to the tip of the inner cylinder 2 at its tip, and a through hole 5b having a diameter that can penetrate the guide wire. With the guide wire passing through the through hole, the assembly of the dilator 5 and the access port 1 is advanced along the guide wire. Thereby, the tissue is pushed open by the tapered portion 5a at the tip of the dilator 5 to advance the assembly, and further, the hole formed in the pericardium A is expanded by the tapered portion 5a.

Then, as shown in FIG. 2A, the dilator 5 and the guide wire are removed in a state where the assembly is advanced until the large-diameter portion 2c of the inner cylinder 2 enters the pericardium A completely.
In this state, as shown in FIG. 2B, the lock mechanism 4 is released, and the outer cylinder 3 is moved backward with respect to the inner cylinder 2. As a result, a gap is formed between the large-diameter portion 2c of the inner cylinder 2 and the distal end surface 3c of the outer cylinder 3, so that the pericardium A that has been spread contracts the hole by its elasticity, Get in.

  Thereafter, as shown in FIG. 2C, the outer cylinder 3 is advanced again with respect to the inner cylinder 2 to face the front end surface 3c of the outer cylinder 3 and the opposing surface 2e of the large-diameter portion 2c of the inner cylinder 2. The pericardium A is sandwiched between the clamping surfaces consisting of the above and the rocking piece 4b of the lock mechanism 4 is tilted to a position along the outer surface of the inner cylinder 2. As a result, the inner cylinder 2 and the outer cylinder 3 are locked so as not to move relative to each other with the peripheral portion of the hole of the pericardium A sandwiched between the clamping surfaces over the entire circumference.

Since the distal end surface 3c of the outer cylinder 3 and the opposing surface 2e of the inner cylinder 2 are both parallel planes and have complementary shapes, the pericardium A is sandwiched between the clamping surfaces. Thereby, a large frictional force can be generated between the pericardium A and the clamping surface, and the pericardium A having elasticity can be maintained in a state of being sandwiched between the clamping surfaces.
That is, according to the access port 1 according to the present embodiment, there is an advantage that it can be securely fixed to the pericardium A while penetrating the pericardium A, and does not fall out from the pericardium A.

  In the present embodiment, planes 2e and 3c that are provided in the inner cylinder 2 and the outer cylinder 3 and that are orthogonal to the two axial directions of the inner cylinder are used as the clamping surfaces that clamp the peripheral part of the hole of the pericardium A over the entire circumference. However, the present invention is not limited to this.

  For example, as shown in FIG. 3, the tip surface 3c of the outer cylinder 3 may have a tapered surface shape that tapers toward the tip, and the opposing surface 2e of the inner cylinder 2 may have a tapered inner surface shape complementary thereto. . By configuring in this way, the areas of the distal end surface 3c and the opposing surface 2e as sandwiching surfaces sandwiching the pericardium A can be enlarged as compared with the case of FIG. As a result, the frictional force generated between the clamping surface and the pericardium A can be increased, and the access port 1 can be more securely fixed to the pericardium A.

  That is, it is desirable that the outer diameter of the access port 1 be as small as possible in order to penetrate the tissue or the pericardium A with minimal invasiveness, and the through hole 2a of the inner cylinder 2 is a treatment instrument or endoscope that is passed through the inside. Since it is desirable that it be as large as possible so that the inner cylinder 2 and the outer cylinder 3 can be easily passed, the radial thickness of the inner cylinder 2 and the outer cylinder 3 cannot be secured so large. Under such conditions, if the clamping surface is constituted by the tapered tip surface 3c and the opposing surface 2e as described above, the clamping surfaces 2e and 3c for clamping the pericardium A even if the wall thickness is small. A large area can be secured, and a larger fixing force can be generated. That is, there is an advantage that it is possible to provide the access port 1 capable of generating a high fixing force for the pericardium A while forming the outer diameter dimension as small as possible and the inner diameter dimension as large as possible.

  In addition, by adopting the tapered sandwiching surfaces 2e and 3c that expand toward the rear end side in this way, the access port 1 is pulled out in a state where the pericardium A is sandwiched between the sandwiching surfaces 2e and 3c. When a force is applied, the sharpest edge of the outermost edge of the opposing surface 2e having the tapered inner surface shape is pressed against the inner surface of the pericardium A, and the biological membrane A is extracted from between the sandwiching surfaces 2e and 3c. Can be prevented, and the retaining effect can be improved.

Further, as shown in FIG. 4, the clamping surfaces 2e and 3c may be provided with a plurality of irregularities in the radial direction, and as shown in FIG. 5, a plurality of irregularities may be provided in the circumferential direction. It may be.
By providing a plurality of projections and depressions in the radial direction, the contact area can be further expanded, and even if a force is applied to the pericardium A sandwiched in the radial direction, the frictional force against this can be increased. There are advantages.

  Also, by providing a plurality of irregularities in the circumferential direction, the contact area can be further expanded, and the sandwiching surfaces 2e and 3c that sandwich the pericardium A are prevented from rotating in the circumferential direction. Similarly, the pericardium A can be prevented from being pulled out.

  Further, as shown in FIG. 6, by providing a convex portion 6a on one of the clamping surfaces 2e and 3c and a concave portion 6b on the other and engaging each other, both effects of FIG. 4 and FIG. 5 are achieved. May be. Although the convex portion 6a and the concave portion 6b are provided in one place in the radial direction in FIG. 6, a plurality of places may be provided. Moreover, you may provide in multiple places at intervals in the circumferential direction.

  In the reference embodiment of the invention as a reference example of the present invention, the clamping surface that clamps the pericardium A is configured by the tip surface 3c of the outer cylinder 3 and the opposing surface 2e of the inner cylinder 2, but one embodiment of the present invention. Instead of this, as shown in FIG. 7, the outer cylinder 3 has two clamping surfaces.

  That is, in the example shown in FIG. 7A, a plurality of strip-shaped drawing members 7 made of a material such as spring steel having elasticity are fixed in the distal end of the outer cylinder 3 in the circumferential direction, and the inner cylinder 2 On the side, as shown in FIG. 7B, a storage portion 8 is provided that can be stored in a state in which the pull-in member 7 is placed along the outer surface of the outer cylinder 3. A plurality of protrusions 9 are provided on the surface of the drawing member 7 on the side facing the outer surface of the outer cylinder 3. Thereby, the clamping surface is constituted by the surface 7 a of the drawing member 7 and the outer surface 3 d of the outer cylinder 3.

  The access port 1 configured as described above penetrates the pericardium A in a state where the distal end of the outer cylinder 3 and the retracting member 7 are accommodated in the accommodating portion 8 of the inner cylinder 2 as shown in FIG. After that, as shown in FIG. 8 (b), the outer cylinder 3 is moved backward with respect to the inner cylinder 2, and the retracting member 7 is pulled out from the storage portion 8, and the surface 7 a is brought into close contact with the inner surface of the pericardium A. . Thereafter, as shown in FIG. 8C, the inner cylinder 2 is moved backward with respect to the outer cylinder 3.

  Thereby, the drawing member 7 and the tip of the outer cylinder 3 are drawn into the storage portion 8 of the inner cylinder 2. At this time, the pericardium A that is in close contact with the surface 7a of the retracting member 7 is sandwiched between the sandwiching surfaces constituted by the surface 7a of the retracting member 7 and the outer surface 3d of the outer cylinder 3, and both of the inner cylinder 2 It is drawn into the storage unit 8. Since a plurality of pull-in members 7 are provided in the circumferential direction, the pericardium A is pulled into the storage portion 8 in a state where the pericardium A is sandwiched between the clamping surfaces at various locations in the circumferential direction.

  By doing in this way, since the clamping surfaces 3d and 7a sandwiching the pericardium A are arranged along the axial direction of the inner cylinder 2, it is possible to secure a larger area and to enhance the retaining prevention effect. be able to. Further, by causing the protrusion 9 provided on the surface 7a of the retracting member 7 to bite into the pericardium A, there is an advantage that the effect of preventing the removal can be further improved. 7 and 8, a plurality of strip-shaped pulling members 7 are provided in the circumferential direction. Further, the strip shape is not limited to a rectangular shape, and may be a fan shape that becomes wider from the proximal end side to the distal end side of the drawing member 7 or a shape in which the leading end of the drawing member 7 is divided into a plurality of pieces. Good.

  Further, as shown in FIG. 9, a pair of outer cylinder portions 10a and 10b and strip-like drawing members 7b and 7c that are movable relative to each other are provided, and sandwiched by the opposing surfaces of the two drawing members 7b and 7c. You may decide to accommodate in the accommodating part 8 of the inner cylinder 2 in the state which pinched | interposed the pericardium A between the surfaces. By doing so, since the pericardium A is stored after being sandwiched between the sandwiching surfaces, there is an advantage that the pericardium A can be more reliably drawn into the storage unit 8.

In the present embodiment, the pericardium A is exemplified as the biological membrane. However, the present invention is not limited to this, and the present invention is not limited to this and may be applied to the access port 1 that is fixed to penetrate through any other biological membrane. Good.
Moreover, although the lock mechanism 4 is also constituted by the swing piece 4b, it can be replaced with any structure instead.
Moreover, you may decide to provide an unevenness | corrugation in the clamping surface which consists of the planes 2e and 3c extended in a radial direction as shown in FIG.

1 Access port 2 Inner cylinder 2e Plane (opposite surface, clamping surface)
3 Outer cylinder 3c Flat surface (tip surface, clamping surface)
3d outer surface (clamping surface)
7, 7b, 7c Pull-in member 7a Surface (clamping surface)
8 Storage part 9 Protrusion 10a, 10b Outer cylinder part

Claims (3)

Inner cylinder in the axial direction is fitted movable relative and an outer tube,
Strip pulling member is provided made of an elastic material having one end attached to the distal end of the previous SL outer cylinder,
A storage portion for storing the pull-in member in a state along the outer surface of the outer cylinder is provided at the tip of the inner cylinder ;
And the outer surface of the outer cylinder, by a surface of the pulling member opposed to the outer surface of the outer cylinder, clamping face which is brought close to or separated from each other by a relative movement between the outer cylinder and the inner cylinder is formed in a retracted state Access port. It has an inner cylinder and an outer cylinder that are fitted so as to be relatively movable in the axial direction,
The outer cylinder is provided with two outer cylinder parts fitted so as to be relatively movable in the axial direction,
Each outer tube tip end is provided, respectively Re strip pulling member pixels made of an elastic material attached to the,
At the tip of the inner cylinder, there is provided a storage part for storing the retracting members of the two outer cylinder parts in close contact with each other and along the outer surface of the outer outer cylinder part ,
The opposing surfaces of the pulling member provided on two of the outer cylindrical portion, clamping face which is brought close to or away from each other by said relative movement of each other two of the outer cylindrical portion is formed luer access port. The pull on the surface of the member, the access port of claim 1 or claim 2 protrusions is provided.

Images