JP2005058458A - Insertion device of treating tool for tubular organ - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a insertion device of a treating tool for tubular organs capable of smoothly discharging the treating tool from the inside of a sheath and detaining it without causing position shifts in the case of inserting the treating tool such as a stent into the tubular organ. <P>SOLUTION: The insertion device 10 of the treating tool for the tubular organs comprises: the sheath 20 composed of a flexible tube to be inserted into the tubular organ; a flexible shaft 30 to be inserted into the sheath; a head part 32 attached to the tip part of the flexible shaft, whose tip surface is in a curved surface shape; an elastic resin coating part 31 covering the outer periphery of the flexible shaft at the part of a prescribed length from the part near the base part of the head part; and the treating tool (a stent graft 40, for instance) for the tubular organ arranged on the outer periphery of the elastic resin coating part and housed inside the sheath in the state. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an insertion device for a tubular organ treatment tool for inserting a treatment tool such as a stent or a stent graft into a tubular organ of a human body such as a blood vessel, a ureter, a bile duct, or a trachea.

  In recent years, for the treatment of human tubular organs such as blood vessels, ureters, bile ducts, and trachea, a stent is inserted and placed through a catheter. For example, a treatment method is known in which a stent is placed in a stenosis of a blood vessel to be expanded, or a stent is placed in a place where an aneurysm is formed to prevent rupture of the aneurysm. Particularly in the treatment of aneurysms, stent grafts are used in which the outer periphery of a stent is covered with a tubular cover such as a woven fabric.

As a method for indwelling the stent at a desired position, in Patent Document 1 below, irregularities with which the stent engages are formed on the outer periphery of the distal end portion of the core material, and the stent is disposed on the outer periphery and accommodated in the sheath. A stent insertion device is disclosed.
Special table 2003-500104 gazette

  In the conventional stent insertion device, the stent is accommodated in the sheath, the distal end of the sheath reaches the treatment site in the tubular organ, and then the stent is pulled to the base side while holding the stent with a pusher or the like. It is made to expand by discharging from the tip of the sheath.

  However, when the stent is reduced in diameter and accommodated in the sheath, the frictional force between the stent and the inner wall of the sheath is strong, so the stent cannot be discharged smoothly from the sheath, and it is easy to cause displacement and mold deformation. was there.

  On the other hand, in the stent insertion device of the above-mentioned patent document 1, an unevenness that engages the stent is formed on the outer periphery of the distal end portion of the core material, the stent is more strongly engaged with the core material, and the core material is not moved. By pulling the sheath toward the base side, the stent is smoothly ejected from the sheath while attached to the core material.

  However, since the core material is relatively thin, it is estimated that it is not easy to make the unevenness on the outer periphery of which the stent is effectively engaged.

  Therefore, an object of the present invention is to provide a tubular organ treatment device in which when a treatment device such as a stent is inserted into a tubular organ, the treatment device can be smoothly discharged from the sheath and can be placed without causing a displacement. To provide an insertion device.

  In order to achieve the above object, a first aspect of the present invention includes a sheath made of a flexible tube inserted into a tubular organ, a flexible shaft inserted into the sheath, and a distal end portion of the flexible shaft. A head having a curved end surface attached thereto, an elastic resin coating covering the outer periphery of the flexible shaft at a portion of a predetermined length from a portion near the base of the head, and an outer periphery of the elastic resin coating And a tubular organ treatment instrument which is disposed in the sheath and accommodated in the sheath in that state.

  According to the above invention, when the tubular organ treatment device is disposed on the outer periphery of the elastic resin coating portion at the distal end portion of the flexible shaft, and the diameter of the treatment device is reduced in this state and accommodated in the sheath, the treatment device becomes the elastic resin coating portion. It is pressed and bites into engagement. As a result, when the sheath is pulled to the base side with respect to the flexible shaft, only the sheath moves while the treatment tool is attached to the flexible shaft, so that the treatment tool can be smoothly discharged from the distal end of the sheath, It can be placed in a tubular organ.

  In addition, after the treatment tool is placed in the tubular organ, when the flexible shaft is pulled back into the sheath and pulled out from the tubular organ together with the sheath, the elastic resin coating portion of the flexible shaft is relatively smooth. Since it has a soft surface, it can be pulled back into the sheath without being caught by the expanded treatment device, and there is no fear of damaging the inner wall of a tubular organ or the like.

  According to a second aspect of the present invention, there is provided the stent insertion device according to the first aspect, wherein the tubular organ treatment tool is a stent or a stent graft having a cylindrical cover on an outer periphery or an inner periphery of a stent body. is there.

  According to the above-described invention, the stent can be expanded by disposing the stent in the occlusion portion of the tubular organ, or the stent graft can be disposed inside the aneurysm of the blood vessel to prevent the rupture of the aneurysm.

  According to a third aspect of the present invention, in the second aspect, the tubular organ treatment device includes a stent graft having a cover member on an outer periphery of the stent body, and the cover member is fixed only to an end portion of the stent body. An apparatus for inserting a treatment tool for a tubular organ in which the stent body is housed in the sheath and the cover member is covered on the outer periphery of the sheath is provided.

  According to the above invention, there is no need to insert a cover member on the outer periphery of the stent body inside the sheath, and only the stent body is accommodated, so that the inside of the sheath is not cramped and the clearance between the sheath and the elastic resin coating portion is reduced. Since many can be maintained, the stent body can be pushed out more smoothly.

  According to a fourth aspect of the present invention, in any one of the first to third aspects of the invention, the end of the tubular organ treatment device is pulled by being entangled with and pulled around the outer periphery of the end of the tubular organ treatment device. It is an object of the present invention to provide an insertion device for a tubular organ treatment tool including a linear member that can be reduced in diameter.

  According to the above invention, when the tubular organ treatment instrument is inserted into the sheath, the end of the treatment instrument is reduced in diameter by tangling and pulling a linear member around the outer periphery of the end of the treatment instrument. And can be easily pulled into the sheath.

  According to a fifth aspect of the present invention, in any one of the first to fourth aspects, a recess is formed on an outer periphery of the flexible shaft or an outer periphery of a tube attached to the outer periphery of the flexible shaft. The insertion device of the treatment tool for tubular organs in which the elastic resin coating portion is configured by filling the recess with the elastic resin is provided.

  According to the above invention, when the therapeutic instrument for tubular organ is inserted into the sheath in a state of being arranged on the outer periphery of the elastic resin coating portion, the therapeutic instrument is filled with the elastic resin or the tube filled in the concave portion on the outer periphery of the flexible shaft. While engaging in the elastic resin filled in the concave portion on the outer periphery and engaging with the peripheral wall of the concave portion surrounding the elastic resin, the engagement force can be increased. In addition, after the treatment tool is opened, the elastic resin returns to its original shape and the surface becomes smooth, so that it can be accommodated in the sheath without being caught by the treatment tool, and damage to the inner wall of the tubular organ can be prevented. .

  According to the present invention, when the tubular organ treatment device is disposed on the outer periphery of the elastic resin coating portion at the distal end portion of the flexible shaft, and the diameter of the treatment device is reduced in this state and accommodated in the sheath, the treatment device is attached to the elastic resin coating portion. Since they are pressed and engaged and engaged, when the sheath is pulled toward the base side with respect to the flexible shaft, only the sheath moves while the treatment tool is attached to the flexible shaft. For this reason, the treatment tool can be smoothly discharged from the distal end portion of the sheath and can be placed without being displaced in the tubular organ.

  In the present invention, as described above, as a treatment device for tubular organs, a stent or a stent graft having a cylindrical cover on the outer periphery or inner periphery of the stent body can be preferably applied. You can also

  1 to 6 show an embodiment in which the present invention is applied to a stent graft insertion device. FIG. 1 is a perspective view showing the entire stent graft insertion device, FIG. 2 is an explanatory view showing a procedure for entanglement and pulling a linear member around the outer periphery of the end of the stent graft, and reducing the diameter of the end, and FIG. FIG. 4 is an explanatory view showing the clearance between the sheath and the elastic resin coating portion, FIG. 5 is an explanatory view showing the clearance between the sheath and the elastic resin coating portion. FIG. 6 is an explanatory view showing a state in which the stent graft is discharged from the sheath and expanded in the blood vessel, and FIG. 6 is an explanatory view showing a state in which the stent graft is placed in the blood vessel.

  As shown in FIG. 1, the stent insertion device 10 includes a sheath 20 made of a flexible tube inserted into a tubular organ, a flexible shaft 30 inserted into the sheath 20, and a flexible shaft 30. A distal end portion 32 having a curved distal end surface attached to the distal end portion thereof, an elastic resin coating portion 31 covering the outer periphery of the flexible shaft 30 in a portion having a predetermined length from a portion near the base portion of the distal end portion, and elastic A stent graft 40 is provided which is disposed on the outer periphery of the resin coating portion 31 and is accommodated in the sheath 20 in this state.

  As the material of the sheath 20, a fluororesin, polypropylene, polyethylene, polyvinyl chloride, polyurethane, polyimide, polyamide, or a composite material such as a resin material and a metal wire is preferably used. The inner surface of the sheath 20 does not bite the stent body, and can smoothly extrude the stent and the flexible shaft 30.

  In this embodiment, the flexible shaft 30 has a hollow cylindrical shape, but may be a solid wire. When the flexible shaft has a hollow cylindrical shape, a guide wire or the like (not shown) can be inserted into the flexible shaft. The material of the flexible shaft 30 is preferably a material having properties such as strength and the ability to impart a shape when stress is applied. For example, a metal such as stainless steel, aluminum, Ni-Ti alloy, or the like A composite material with a resin is preferably used.

  A head 32 having a curved tip surface is formed at the tip of the flexible shaft 30. The head 32 prevents the inner wall of the tubular organ from being damaged when the inside of the tubular organ such as a blood vessel is gradually advanced. The material of the head 32 of the flexible shaft 30 is, for example, a flexible shaft such as a resin such as polyimide or fluororesin, a metal such as stainless steel, aluminum, or a Ni—Ti alloy, or a composite material of these and a resin. A biocompatible synthetic resin selected from the materials used is preferably used.

  The distal end surface of the head 32 of the flexible shaft 30 has a structure that does not damage the inner surface of the tubular organ of the human body. For example, the distal end surface of the flexible shaft 30 is preferably curved so that the distal end is not sharp.

  An elastic resin coating 31 is formed at a predetermined length from the base side of the head 32 of the flexible shaft 30. The material of the elastic resin coating 31 may be any hardness that allows the stent body to bite into the elastic resin coating 31. For example, in the durometer hardness test method, the material is 10 to 100, preferably 20 to 95, and more preferably 30. It is preferable to use one having a hardness of about ~ 90. As a material of the elastic resin coating portion 31, for example, a resin or an elastomer such as perfluoropolyolefin, polyolefin, polyurethane, polyester, or polyamide can be preferably used. The thickness of the elastic resin coating portion 31 may be any thickness that allows the stent main body to effectively bite into the elastic resin coating portion 31, and is preferably in the range of 0.05 to 5 mm, for example.

  Furthermore, as shown in FIG. 4, with the flexible shaft 30 inserted into the sheath 20, the clearance 34 between the elastic resin coating portion 31 and the sheath 20 should be appropriately selected depending on the stent used, the organ to be inserted, and the like. For example, the thickness is preferably about 0.1 to 5 mm.

  As shown in FIG. 1, the stent graft 40 is configured by covering a stent body 41 formed by knitting a metal wire into a mesh shape and a tubular shape with a graft 42 which is a tubular cover.

  As a material of the metal wire forming the stent body 41, a shape memory effect by heat treatment or a shape memory alloy to which superelasticity is imparted is preferably adopted, but depending on applications, stainless steel, tantalum, titanium, platinum, gold, tungsten Etc. may be used. As the shape memory alloy, Ni—Ti, Cu—Al—Ni, Cu—Zn—Al, and the like are preferably used. Further, the surface of the metal wire may be coated with gold, platinum or the like by means such as plating. Although the thickness of a metal wire is not specifically limited, For example, in the case of a blood vessel stent etc., 0.08-1 mm is preferable.

  As the graft 42, a thermoplastic resin formed into a cylindrical shape processed by a molding method such as extrusion molding or blow molding, a knitted fabric of thermoplastic resin fibers formed into a cylindrical shape, or a thermoplastic resin formed into a cylindrical shape. A resin non-woven fabric, a flexible resin sheet formed in a cylindrical shape, a porous sheet, or the like can be used. As the knitted fabric, known knitted fabrics and woven fabrics such as plain weave and twill weave can be used. Moreover, the thing with a crimp, such as crimping, can also be used.

  Among these, as the graft 42, a knitted fabric of thermoplastic resin fibers formed in a cylindrical shape, and a plain weave fabric of thermoplastic resin fibers formed in a cylindrical shape are particularly suitable for strength, porosity, and productivity. Is preferable because it is excellent.

  Thermoplastic resins include polyolefins such as polyethylene, polypropylene, and ethylene-α-olefin copolymers, polyamides, polyurethanes, polyethylene terephthalate, polybutylene terephthalate, polycyclohexane terephthalate, polyesters such as polyethylene-2,6-naphthalate, and polyfluoride. A resin having little durability and a tissue reaction such as a fluororesin such as fluorinated ethylene or polyfluorinated propylene can be used.

  In particular, polyesters such as polyethylene terephthalate, fluorine resins such as polyfluorinated ethylene and polyfluorinated propylene, which are chemically stable and have high durability and little tissue reaction, can be preferably used.

  The graft 42 is connected to the stent body 41 by means such as sewing, adhesion, and welding. In this case, the graft 42 needs to be coated and connected so as not to affect the expansion and contraction of the stent body 41.

  The stent graft 40 preferably has an outer diameter of 2 to 50 mm and a length of about 1 to 50 cm when expanded.

  As shown in FIG. 2, the stent insertion device 10 further includes a linear member 33 for reducing the diameter of the end portion of the stent graft 40 and facilitating insertion into the sheath 20. The linear member 33 is a linear member such as a string, a thread, or a wire, and is entangled with the outer periphery of the end portion of the stent body 41 as shown in FIG. When the stent graft 40 is inserted into the sheath 20, the end of the stent graft 40 is reduced in diameter by pulling the linear member 33 as shown in FIG. It can be easily stored. As the material of the linear member 33, a thermoplastic resin that forms a graft, a metal wire material that forms a stent body, natural fibers such as cotton and silk, and the like can be preferably used.

  Further, as shown in FIG. 3B, the insertion device 10 includes a tubular pusher 50 that is disposed on the outer periphery of the flexible shaft 30 and is inserted into the sheath 20 from the proximal end side of the sheath 20. It is preferable. The distal end of the pusher 50 abuts on the proximal end portion of the stent graft 40 inserted into the sheath 20, and serves to regulate the movement of the stent graft 40 when the stent graft 40 is discharged from the sheath 20. The pusher 50 may be made of any material that can extrude the stent body. For example, a thermoplastic resin that forms the graft, a metal wire material that forms the stent body, and the like can be preferably used.

  Next, a method for using the insertion device for the tubular organ treatment tool will be described with reference to an example applied to the treatment of a blood vessel aneurysm.

  As an initial step, as shown in FIG. 3, the stent graft 40 needs to be accommodated in the sheath 20 in a reduced diameter state. In this case, when the linear member 33 shown in FIG. 2 is provided, it can be easily accommodated inside the sheath 20 by the procedure described below.

  That is, the flexible shaft 30 is inserted into the sheath 20, and the distal end portion of the flexible shaft 30 protrudes from the distal end of the sheath 20. In this state, the stent graft 40 is disposed on the outer periphery of the elastic resin coating portion 31. The linear member 33 is entangled with the end portion of the stent main body 41 of the stent graft 40, and the end portion is passed through the sheath 20 together with the flexible shaft 30, and pulled out from the proximal end portion of the sheath 20.

  By pulling the linear member 33 in this state, as shown in FIG. 2B, the end of the stent graft 40 is reduced in diameter like a drawstring bag. Then, as shown in FIG. 3A, the stent graft 40 is moved together with the flexible shaft 30, and is drawn into the sheath 20 from the end of the stent graft 40 and inserted.

  In this way, the stent graft 40 can be accommodated in the sheath 20 as shown in FIG. At this time, a part of the wire constituting the stent main body 41 of the stent graft 40 bites into the elastic resin coating portion 30 covered on the outer periphery of the distal end portion of the flexible shaft 30 to give a strong engagement force. Further, a tube-like pusher 50 is inserted from the proximal end portion of the sheath 20 along the outer periphery of the flexible shaft 30. When the stent graft 40 is accommodated in the sheath 20, the linear member 33 is preferably pulled out from the end of the stent body 41 and removed.

  In this state, the insertion device 10 is inserted to the treatment site where the vascular aneurysm is formed. In this case, a guide wire (not shown) is inserted percutaneously into the blood vessel, and after the tip reaches the treatment site, the parent catheter is inserted along the guide wire, and the tip of the parent catheter reaches the treatment site. You may let them. Then, the sheath 20 into which the stent graft 40 and the flexible shaft 30 are inserted is inserted into the parent catheter, and the distal end of the sheath 20 is disposed at the treatment site.

  Note that a guide wire (not shown) is inserted through the flexible shaft 30, and this guide wire is percutaneously inserted into the blood vessel to reach the treatment site, so that the stent graft 40 and the flexible The sheath 20 into which the shaft 30 is inserted may be directly inserted into the blood vessel along the guide wire.

  As the next step, the pusher 50 is inserted into the sheath 20 and is placed in contact with the proximal end portion of the stent graft 40. However, the pusher 50 may be inserted when the stent graft 40 is accommodated. Further, the sheath 20 may be further advanced by inserting a guide wire (not shown) into the flexible shaft 30.

  In this state, while confirming the position on the X-ray monitor, the distal end portion of the sheath 20 is arranged so that the distal end portion of the stent graft 40 is positioned slightly beyond the aneurysm B of the blood vessel A as shown in FIG. To do. Then, while holding the flexible shaft 30 and the pusher 50, the sheath 20 is moved to the base side (the direction of arrow C in FIG. 5) with respect to them. Then, the stent graft 40 accommodated in the sheath is gradually exposed from the distal end portion of the sheath 20. As a result, the exposed portion of the stent graft 40 is expanded in diameter by the self-expanding force and is pressed and fixed to the inner wall of the blood vessel B.

  At this time, as described above, a part of the wire constituting the stent body 41 bites into the elastic resin coating portion 30 covered on the outer periphery of the distal end portion of the flexible shaft 30 and is given a strong frictional engagement force. Therefore, the stent graft 40 is held integrally with the flexible shaft 30 and does not move together with the sheath 20.

  When the stent graft 40 is completely pushed out, as shown in FIG. 6, the stent graft 40 is disposed so as to be fully expanded and pressed against the inner wall of the blood vessel A and sufficiently cover the inner circumference of the aneurysm B. Thus, the stent graft 40 is placed in a state of covering the inner circumference of the aneurysm B of the blood vessel A, and the blood flow passes through the inside of the stent graft 40 and does not flow into the aneurysm B, thereby preventing the rupture of the aneurysm B. Thus, the risk of aneurysm can be prevented.

  FIG. 7 shows another embodiment in which the present invention is applied to a stent graft insertion device. In this insertion device 10 a, a stent graft 40 a having a graft 42 on the outer periphery of the stent body 41 and the graft 42 being fixed only to the end of the stent body 41 is used.

  According to this embodiment, as shown in FIG. 6A, while pulling the wire 33 entangled with the end of the stent body 41, only the stent body 41 is drawn into the sheath 20 and accommodated, and the graft 42 Cover the outside of the sheath 20. Thus, as shown in FIG. 5B, the stent body 41 is accommodated in the sheath 20, and the graft 42 is disposed on the outer periphery of the distal end portion of the sheath 20. In order to bind the graft 42 to the outer periphery of the sheath 20, the graft 42 may be tied with a wire (not shown), and the wire may be pulled out and opened when inserted into the blood vessel.

  The insertion device 10a can insert the stent graft 40 into the tubular organ by the same method as in the above embodiment. In that case, since only the stent main body 41 needs to be accommodated in the sheath 20, the insertion and extrusion of the stent main body 41 into the sheath 20 can be performed smoothly and easily.

  The pusher 50 moves the sheath 20 to the base side with respect to the flexible shaft 30 and when the stent graft 40 is pushed out from the distal end portion of the sheath 20, the pusher 50 restrains the stent graft 40 and causes the stent graft 40 to move inside the sheath 20. It can project more reliably. However, in the case of the present invention, the wire rod of the stent body 41 of the stent graft 40 bites into the elastic resin coating 31 and engages with a strong frictional force, so even if there is no pusher 50, it is relatively easy. It is possible to project the stent into

  FIG. 8 illustrates the shape of the head 32 of the flexible shaft 30 used in the present invention. That is, (A) has a rugby ball shape, (B) has a balloon shape, (C) has a hemispherical cylindrical shape at both ends, and (D) has a curved end at both ends. It has a spindle shape.

  9, 10 and 11 show other examples of the elastic resin coating portion of the flexible shaft 30 used in the present invention.

  In the example shown in FIGS. 9A and 9B, a tube 31a having a plurality of annular recesses formed on the surface thereof at predetermined intervals in the axial direction, and an elastic resin 31b filled in the recesses of the tube 31a, Thus, the elastic resin coating portion is configured.

  In the example shown in FIGS. 10A and 10B, an elastic resin coating is formed by a tube 31c having an annular concave portion formed on a surface thereof and an elastic resin 31d filled in the concave portion of the tube 31c. The part is composed.

  In the example shown in FIGS. 11A and 11B, a tube 31e having a plurality of parallel recesses formed linearly along the axial direction on the surface, and an elastic resin filled in the recesses of the tube 31e. The elastic resin coating portion is constituted by 31f.

  As described above, the elastic resin coating portion may be formed of a tube partially covered with the elastic resin.

  Although not particularly illustrated, the elastic resin coating portion can be configured by forming a predetermined recess on the outer periphery of the flexible shaft 30 and filling the recess with an elastic resin. In this case, when the stent graft 40 is accommodated in the sheath 20, a part of the wire constituting the stent main body 41 of the stent graft 40 bites into the elastic resin filled in the concave portion on the outer periphery of the flexible shaft 30. Thus, a strong engagement force is applied.

It is a perspective view of the whole insertion apparatus which shows one Embodiment which applied this invention to the insertion apparatus of a stent graft. It is explanatory drawing which shows the procedure which entangles and pulls a linear member to the outer periphery of the edge part of a stent graft, and reduces the diameter of this edge part. It is explanatory drawing which shows the procedure which arrange | positions a stent graft to the front-end | tip part outer periphery of a flexible shaft, and accommodates in a sheath, pulling a linear member. It is explanatory drawing which shows the clearance between a sheath and an elastic resin film part. It is explanatory drawing which shows the state which discharges a stent graft from a sheath and expands it in the blood vessel. It is explanatory drawing which shows the state which left the stent graft in the blood vessel. It is explanatory drawing which shows another embodiment which applied this invention to the insertion apparatus of a stent graft. It is explanatory drawing which shows the example of the shape of the head attached to the front-end | tip part of the flexible shaft used for this invention. It is sectional drawing which shows the other example of the elastic resin coating | coated part of the flexible shaft 30 used by this invention. It is sectional drawing which shows the further another example of the elastic resin coating | coated part of the flexible shaft 30 used by this invention. It is sectional drawing which shows the further another example of the elastic resin coating | coated part of the flexible shaft 30 used by this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Stent graft insertion apparatus 20 Sheath 30 Flexible shaft 31 Elastic resin coating | cover part 31a, 31c, 31e Tube 31b, 31d, 31f Elastic resin 32 Head 33 Linear member 34 Clearance of elastic resin coating | coated part and sheath 40 Stent graft 41 Stent body 42 Graft 50 Pusher

Claims (5)

  A sheath made of a flexible tube to be inserted into the tubular organ, a flexible shaft to be inserted into the sheath, and a head having a curved end surface attached to the tip of the flexible shaft; An elastic resin covering portion covering the outer periphery of the flexible shaft in a portion of a predetermined length from a portion near the base portion of the head, and an outer periphery of the elastic resin covering portion, and is accommodated in the sheath in that state. An apparatus for inserting a tubular organ treatment tool, comprising: a tubular organ treatment tool.   The stent insertion device according to claim 1, wherein the tubular organ treatment tool is a stent or a stent graft having a cylindrical cover on an outer periphery or an inner periphery of a stent body.   The tubular organ treatment device has a cover member on the outer periphery of a stent body, the cover member is formed of a stent graft fixed only to an end portion of the stent body, the stent body is accommodated in the sheath, and the cover The apparatus for inserting a therapeutic instrument for tubular organs according to claim 2, wherein the member is coated on the outer periphery of the sheath.   The linear member which can reduce the diameter of the edge part of the said tubular organ treatment tool by entangled and pulling around the outer periphery of the edge part of the said tubular organ treatment tool is provided. The insertion apparatus of the treatment tool for tubular organs as described in one.   A recess is formed in the outer periphery of the flexible shaft or the tube attached to the outer periphery of the flexible shaft, and the elastic resin coating portion is configured by filling the recess with an elastic resin. The insertion apparatus of the treatment tool for tubular organs as described in any one of Claims 1-4.

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