WO2020179045A1

WO2020179045A1 - Medical device

Info

Publication number: WO2020179045A1
Application number: PCT/JP2019/009003
Authority: WO
Inventors: 俊二武井; 善朗岡崎; 和敏熊谷
Original assignee: オリンパス株式会社
Priority date: 2019-03-07
Filing date: 2019-03-07
Publication date: 2020-09-10

Abstract

A medical device (1) which includes: a long tubular sheath body (2) that has a channel (5) through which an endoscope (100) can be inserted; a pair of first balloons (7) which, in positions spaced from a distal end face (2a) of the sheath body (2) in a first direction along the longitudinal direction of the sheath body (2) and spaced apart in a second direction intersecting the first direction, are capable of mainly expanding in a third direction intersecting the first direction and the second direction; and a second balloon (8) which is capable of mainly expanding in the second direction and connects the pair of first balloons (7) at a position spaced from one end side in the third direction.

Description

Medical equipment

The present invention relates to a medical device.

When an endoscope is inserted into a narrow body cavity such as the pericardium for observation or treatment, tissues such as the pericardium hang down in front of the endoscope's visual field and obstruct the visual field. Was sometimes difficult.
In order to solve such a problem, by expanding a pair of rod-shaped balloons so as to project toward the front of the sheath on both left and right sides of the sheath for introducing the endoscope, a space between the pair of balloons is formed. A device for forming a space is known (see, for example, Patent Document 1).

US Patent Application Publication No. 2015/0313634A1

However, in the device of Patent Document 1, since a pair of rod-shaped balloons extend in parallel with an interval, for example, in the pericardium, the pair of balloons move in a direction in which they are approached by being pushed from the pericardium. In that case, the space between the balloons is narrowed and the field of view of the endoscope is narrowed, so that there is an inconvenience that good observation and treatment cannot be performed.

An object of the present invention is to provide a medical device that can more securely secure the field of view of an endoscope inserted into a narrow body and facilitate observation and/or treatment of a target site.

One aspect of the present invention is to provide an elongated tubular sheath main body having a channel through which an endoscope can be inserted, and to separate from the distal end surface of the sheath main body in a first direction along the longitudinal direction of the sheath main body, A pair of first balloons that are mainly inflatable in a third direction that intersects the first direction and the second direction, and a pair of first balloons that are mainly inflatable in the second direction at positions apart from each other in the second direction that intersects the one direction. And a second balloon connecting a pair of the first balloons at a position spaced from one end side in the third direction.

According to the present invention, there is an effect that a field of view of an endoscope inserted into a narrow body can be more surely secured to facilitate observation and/or treatment of a target site.

It is a longitudinal section showing a medical device concerning one embodiment of the present invention. It is a front view which shows the medical device of FIG. It is a perspective view which shows the front-end|tip part of the medical device of FIG. It is a figure which shows the state which inserted the front-end|tip of the medical device of FIG. 1 between a heart and pericardium. It is a figure which shows the state which the tip of the endoscope protrudes from the tip surface of the sheath body of the medical apparatus in the state of FIG. It is a figure which shows the state which expanded the balloon of the front-end|tip of the protrusion part of the state of FIG. FIG. 7 is a cross-sectional view of the balloon of the medical device of FIG. 6. FIG. 5 is a perspective view showing a state in which a balloon is contracting, which is a tip portion of a modified example of the medical device of FIG. It is a perspective view which shows the state which expanded the balloon of the medical device of FIG. It is a perspective view which shows the modification of the medical device of FIG. FIG. 5 is a perspective view showing a state in which a balloon is contracting, which is a tip portion of a modified example of the medical device of FIG. It is a perspective view which shows the state which expanded the balloon of the medical device of FIG.

A medical device 1 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in FIGS. 1 and 2, the medical device 1 according to the present embodiment extends in the longitudinal direction from the distal end surface 2a of the sheath main body 2 to the front, and a long flexible tubular sheath main body 2. It includes a cantilever-shaped protrusion 3 and a balloon 4 arranged at the tip of the protrusion 3.

The sheath body 2 is provided with a channel 5 that penetrates along the longitudinal direction and allows the endoscope 100 to be inserted. The endoscope 100 is a flexible endoscope having a curved portion 110 at its distal end, penetrates the inside of the channel 5 from the proximal end side of the sheath body 2, and is projected forward of the distal end surface 2a. By bending the bending portion 110, the treatment target portion arranged radially outside the sheath body 2 can be arranged within the visual field.

A channel (medium channel) for supplying fluid (medium) to the balloon 4 provided at the tip of the protrusion 3 and discharging fluid from the balloon 4 in the protrusion 3 along the longitudinal direction. 6 is provided.
The balloon 4 is fixed to the side surface of the protruding portion 3 on the channel 5 side. The flow path 6 opens into the balloon 4.

As shown in FIGS. 2 and 3, the balloon 4 is separated from the distal end surface 2a of the sheath body 2 in the first direction along the longitudinal direction by the supply of the fluid via the flow path 6, and the first A pair of first balloons 7 that are mainly inflatable in a first direction and a third direction that is orthogonal to the second direction, and a pair of first balloons that are mainly inflatable in the second direction. A second balloon 8 that connects a pair of first balloons 7 to each other is provided at an end portion on the side of the protruding portion 3 in the three directions. Here, the second balloons 8 are connected to the respective first balloons 7 at positions where a predetermined distance is provided from the tip end side of the pair of inflated first balloons 7 to the protruding portion 3 side. Further, the pair of the first balloon 7 and the second balloon 8 are in communication with the internal space, and can be simultaneously expanded by the supply of the fluid via the single flow path 6. Here, each of the

balloons

7 and 8 has a shape of an elongated cylinder or an elliptic sphere, and is made of a polymer resin material such as polyamide, polyester or polyurethane. The first balloon 7 may be made of a material having greater elasticity in the longitudinal direction than the second balloon 8.

That is, the balloon 4 expands when a fluid is supplied, and at the tip of the protruding portion 3, a pair of rod-shaped first balloons 7 that are spaced apart in the second direction and extend in the third direction, and these first balloons 7. As shown in FIG. 3, the one balloon 7 is connected to one end by a rod-shaped second balloon 8 extending in the second direction to form a portal shape.

The operation of the medical device 1 according to the present embodiment configured as described above will be described.
For example, in order to observe and treat a lesion part of the heart X using the medical device 1 according to the present embodiment, the medical device 1 is inserted into the patient's body from the lower part of the xiphoid process and brought close to the heart X. Next, the tip of the medical device 1 penetrating the pericardium Z is placed between the pericardium Z and the heart X, as shown in FIG.

At this time, the protruding portion 3 of the medical device 1 is arranged so as to face the pericardium Z side with respect to the channel 5. As a result, at the position where the pericardium Z side of the channel 5 in which the endoscope 100 is arranged is covered, the projecting portion 3 is arranged in a cantilever manner in front of the medical device 1, and thus in front of the channel 5. In addition, the pericardium Z is prevented from hanging down, and the field of view in front of the endoscope 100 is secured.
Then, in this state, by operating the endoscope 100 outside the patient's body, the distal end portion of the endoscope 100 is projected from the distal end surface 2a of the sheath body 2 as shown in FIG. Is curved so that the visual field is directed toward the surface of the heart X. In this state, the entire medical device 1 is moved back and forth in the longitudinal direction of the sheath body 2.

When the observation target site, for example, the atrial appendage appears in the visual field in the traveling direction of the endoscope 100, the advance/retreat of the entire medical device 1 is stopped. Then, in this state, the fluid is supplied into the balloon 4 via the flow path 6, and the balloon 4 is inflated as shown in FIG. Press the surface.

As a result, the protruding portion 3 is supported by the tip surface 2a of the sheath body 2 and the balloon 4 in the shape of a double-sided beam. Therefore, even if the protruding portion 3 receives a large pressing force from the pericardium Z, the protruding portion 3 is prevented from bending and the field of view of the endoscope 100 is secured. Here, when the first balloon 7 has greater elasticity in the longitudinal direction than the second balloon 8, even when the pressing force from the pericardium Z differs depending on the size and shape of the heart X, The stress on the pericardium Z is adjusted so as not to become excessive.

In addition, the second balloon 8 is inflated at the same time to maintain the state in which the distance between the pair of first balloons 7 in the second direction is widened.
The second balloon 8 connects the first balloons 7 at the end opposite to the tip of the first balloon 7 in contact with the surface of the heart X, so that the surface of the heart X is connected by the second balloon 8. Are prevented from being covered. As a result, as shown in FIG. 3, the field of view of the endoscope 100 is arranged in a region passing through the gap between the pair of first balloons 7, and the surface of the heart X near the observation target site can be easily overlooked. There is an advantage that.

Further, since the second balloons 8 are mainly inflated in the direction of increasing the distance between the pair of first balloons 7, even if the pair of first balloons 7 receive a force in a direction in which they approach each other from the pericardium Z, It is possible to maintain the space between the first balloons 7 against each other.

As described above, according to the medical device 1 according to the present embodiment, the field of view of the endoscope 100 that is inserted into a narrow body can be more reliably ensured to facilitate observation and/or treatment of an observation target site. The advantage is that

In the present embodiment, the fluid is supplied into the balloon 4 via the single flow path 6 formed in the protrusion 3, but instead of this, as shown in FIG. In addition, the second balloon 8 is divided into two at the center by the partition wall 9, and the halves of the first balloon 7 and the second balloon 8 are independently separated by the fluids supplied via the separate flow paths 10. It may be inflated. As a result, when the external force from the pericardium Z is uneven, the amount of fluid supplied to the first balloon 7 on the side receiving a larger external force is increased, or conversely, on the side receiving a smaller external force. By reducing the amount of fluid supplied to the one balloon 7, a uniform space is always formed when the pair of first balloons 7 is inflated.

In addition, in the present embodiment, the second balloon 8 is provided at the tip of one protruding portion 3, but as shown in FIG. 8, the balloons 4 are arranged in parallel by being deflated during insertion into the body. As shown in FIG. 9, after the insertion into the body, a pair of flexible projecting portions 11 that can be branched so that the distal end portion expands in the second direction by the expansion of the second balloon 8 is adopted. Good. In this case, each of the protrusions 11 may be further provided with a separate flow path 10, and the first balloon 7 and the second balloon 8 may be inflated by the fluid supplied via the flow path 10. As a result, the distal end side of the projecting member 11 expands in the direction intersecting the longitudinal axis of the projecting member 11, so that the pericardium Z can be widely supported, and a wider space can be secured in front of the endoscope 100. it can.

Further, in the present embodiment, the case where the inner space of the second balloon 8 communicates with the inner space of the pair of first balloons 7 is illustrated, but instead of this, as shown in FIG. The second balloon 8 may be disposed at a position which is disposed between the portions 11 and is inflated by the fluid supplied via the flow path different from the flow path 10 connected to the first balloon 7. As a result, the second balloon 8 indirectly connects the pair of the first balloons 7 to each other with the protrusion 11 interposed therebetween. By separating the flow path to the second balloon 8 from the first balloon 7, it is possible to increase the distance between the pair of first balloons 7 with a stronger force.

Further, in the present embodiment, a balloon 4 that is inflated in a portal shape between the tip of the protrusion 3 and the heart X is illustrated. Instead of this, as shown in FIGS. 11 and 12, a pair of first balloons 12 extending forward from the distal end of the protruding portion 3 in the longitudinal direction of the sheath body 2 and curving downward obliquely to the left and right front. It is also possible to employ the balloon 4 including the second balloons 13 which are connected to each other at an intermediate position in the longitudinal direction of the first balloons 12, for example, at a position half the length in the third direction.

Also by this, the 2nd balloon 13 can be arranged in the position which does not obstruct the field of view of endoscope 100, and a pair of 1st balloon 12 can be maintained in the state where it was estranged by the 2nd balloon 13.
Further, although the case where the first direction, the second direction, and the third direction are orthogonal to each other has been illustrated in the present embodiment, the present invention is not limited to this, and the respective directions are arranged to intersect with each other. Just do it.

2 and 3, the second balloon 8 exemplifies the case where the first balloons 7 are connected to each other at the ends of the pair of first balloons 7, but the present invention is not limited to this. It may be connected at an arbitrary position separated from the end portion in contact with the target portion in the third direction.

Further, in the present embodiment, as the medical device 1, it can be applied to the endoscope 100 for the cardiac sac, which is inserted into the cardiac sac and prevents the pericardium Z from hanging down into the field of view of the endoscope 100. The medical device 1 is illustrated.
The present invention is not limited to this, and may be applied to the medical device 1 used for any procedure for securing a space for being inserted into a narrow body and preventing the visual field from being blocked by adjacent tissues.
Further, although the case where the endoscope 100 is not included is illustrated in the present embodiment, the present invention may be applied to the medical device 1 including the endoscope 100.

DESCRIPTION OF SYMBOLS 1 Medical device 2 Sheath main body

2a Tip surface

3,11 Projection part 5

Channel

6,10 Flow path (medium flow path)
7,12

First balloon

8,13 Second balloon 100 Endoscope

Claims

An elongated tubular sheath body having a channel through which an endoscope can be inserted,
A position intersecting the first direction and the second direction at a position apart from the distal end surface of the sheath body in a first direction along the longitudinal direction of the sheath body and in a second direction intersecting the first direction. A pair of first balloons that are mainly inflatable in three directions,
A medical device which is mainly inflatable in the second direction and includes a second balloon connecting a pair of the first balloons at a position spaced from one end side in the third direction.
From the distal end surface of the sheath body, a cantilever-shaped projecting portion that extends along the longitudinal direction of the sheath body is provided in a part of the sheath body in the circumferential direction radially outside of the channel.
The medical device according to claim 1, wherein the pair of first balloons are attached to the distal ends of the protrusions on the other end side in the third direction.
The medical device according to claim 2, wherein the second balloon is attached to the tips of the pair of flexible protrusions.
The medical device according to claim 1 or 2, further comprising a common medium flow path that supplies a medium for inflating the pair of the first balloon and the second balloon.
The medical device according to claim 1 or 2, further comprising separate medium flow paths for supplying a medium for inflating each of the pair of first balloons.
The medical device according to claim 1, wherein the first balloon 7 has greater elasticity than the second balloon.
The medical device according to any one of claims 1 to 6, comprising the endoscope movably arranged in the channel in the longitudinal direction and having a distal end portion protruding from the distal end surface of the sheath body.