JP2008017865A - Laser induced liquid jet generating device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a laser induced liquid jet generating device which controls a direction of a liquid jet blown out of the distal end of a thin tube and breaks up a blood clot extensively. <P>SOLUTION: In the device which generates the jet J by emitting laser beams from a laser irradiation part 1 to a liquid W in a liquid introducing part 9 and makes the liquid W flow through the thin tube 11 for blowing outside, a rotary means R for rotating a distal end side member B2 relative to a proximal end side member B1 is provided at a joint part C for mutually joining both the proximal end side member B1 and the distal end side member B2 which are formed by dividing between a laser oscillator 1 and a thin tube connecting part 10 into a proximal end side and a distal end side. The thin tube 11 is rotated about the axial line by the rotary means R independently of an optical fiber 2 when the distal end side member B2 is rotated. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a laser-induced liquid jet generating device that generates a jet flow by irradiating laser light toward a liquid.

  In recent years, as a means for treating a thrombosis in which a human blood vessel is blocked, a method of generating a liquid jet flow by laser light and physically crushing it has been performed. This treatment method is highly expected as a treatment for thrombosis because it is not necessary to administer a large amount of a thrombolytic agent having serious side effects, and early blood resumption is possible. In particular, when the ischemic state continues for 6 hours or more in the brain tissue, it is considered difficult to recover the associated neurological symptoms, but if the blood flow can be resumed within a few hours after the onset, the therapeutic effect is extremely high. .

  In the following Patent Documents 1 and 2 and Non-Patent Document 1, a laser from a laser oscillator is pulse-guided into an optical fiber inserted into a catheter, and physiological saline or the like filled in the catheter is rapidly ripened to obtain a liquid. A method of inducing a jet flow and crushing and removing thrombus and the like by the force of the liquid jet flow is described.

  In this method, in order to reach the thrombus without reducing the force of the liquid jet flow and enhance the treatment effect, the catheter with the optical fiber inserted inside is guided close to the thrombus and the liquid jet flow is generated I am letting.

  However, a conventional catheter is a long and thin tube (such as a liquid feeding tube) formed of polypropylene or polyimide as a material, as described in polyvinyl chloride, PCB (polychlorobiphenyl), or Patent Document 2 below. In order to distinguish it from the above, it is also referred to as a “thin tube” hereinafter), and it is a material that easily absorbs a laser.

  In particular, when an optical fiber having an outer diameter (core diameter) of about 0.4 mm is inserted into a thin and flexible catheter (usually about 0.9 mm of outer diameter) made of such a material, the inner surface of the catheter and the optical fiber of the optical fiber are inserted. There is only a very small gap between the outer surface. If strong laser light is irradiated in this state, the heat of the laser light is transmitted to the catheter, and the laser energy is absorbed by the catheter material, so that the catheter may be deformed and perforated. The injection may be hindered and the life of the catheter itself may be shortened.

  For this reason, in the device disclosed in Patent Document 3, laser light is irradiated in a heat-resistant and rigid main body, and the generated liquid jet flow force is filled in the main body and the catheter. Is transmitted to the affected area. In this way, even when a thin catheter is used, the laser irradiation can be performed more strongly without being affected by the photothermal effect of the laser beam, and the laser can be used for a long time and can be operated smoothly.

  However, although this device can certainly avoid the photothermal effect of laser light, there is room for improvement in the operability of the device. In general, endovascular treatment requires the use of a catheter having a considerably smaller diameter than the diameter of the blood vessel, so that the action of the force of the liquid jet flow is limited to the front of the catheter or the vicinity thereof.

  For this reason, even if the liquid jet flow is ejected toward a thrombus that blocks a blood vessel having a diameter larger than that of the catheter, the thrombus in front of the distal end of the catheter can be effectively crushed, but it is difficult to quickly crush the thrombus as a whole. In particular, since it is difficult to control the direction of the liquid jet flow ejected from the distal end of the catheter, it is difficult to remove the thrombus stuck to the blood vessel wall, and the therapeutic effect depends greatly on the skill of the operator.

Moreover, since the optical fiber and the laser oscillator must be connected in a completely fixed state, when the operator rotates the catheter so that the injection direction of the liquid jet flow is intended, the optical fiber is twisted, Operation may be hindered, and in the worst case, the optical fiber may be damaged.
JP2003-111766 (paragraph numbers [0014] [0015], see FIG. 1) JP 2002-52084 A (see paragraph numbers [0004] [0010] [0096], FIG. 27E) Japanese Patent Laying-Open No. 2005-169094 (see abstract, paragraph number [0019], FIG. 2) Japan-Japan Medical Journal Vol. 22 No. 3 (2001) (see page 217)

  The present invention has been made to solve the above-described problems, and provides a laser-induced liquid jet generating device capable of controlling the direction of the liquid jet flow ejected from the thin tube tip and crushing the thrombus in a wide range. The purpose is to do.

  It is another object of the present invention to provide a laser-induced liquid jet generating device that can rotate a thin tube without adverse effects such as twisting on an optical fiber and can improve the therapeutic effect with good operability.

  The laser-induced liquid jet generating device of the present invention that achieves the above-described object includes a liquid introduction part that is filled with a predetermined liquid that absorbs laser light, and a liquid introduction part that is disposed in the liquid introduction part and that guides the laser light from the laser oscillator. An optical fiber accommodating portion that accommodates a laser irradiation portion of the optical fiber, and a jet flow generated in the liquid by laser light irradiated toward the liquid from the laser irradiation portion at the tip of the liquid introducing portion In a laser-induced liquid jet generating device that ejects outside through a thin tube connected through a thin tube connection portion, by dividing the space between the laser oscillator and the thin tube connection portion into a proximal end side and a distal end side The base end side member and the tip end side member to be formed are connected to each other by a connecting portion, and the tip end side member is connected to the base end side portion to the connecting portion. Rotating means which is rotatable provided to, when rotating the distal side member, wherein said thin tube by the rotating means is adapted to rotate independently of the optical fiber around the axis.

  The present invention divides an area between the laser oscillator of the laser-induced liquid jet generating device and the thin tube connecting portion into a proximal end side and a distal end side, and connects with a connecting portion, and the distal end side member is connected to the connecting portion on the proximal end side. A rotating means that can rotate with respect to the member is provided, and by rotating the tip side member, the thin tube rotates around the axis independently of the optical fiber. A thin tube inserted into the body can be rotated. For example, when a side hole is established at the tip or side of the thin tube, the directivity of the liquid jet flow ejected from this side hole The device can be controlled in the direction intended by the operator, improving the operability of the device and easily crushing the thrombus at a predetermined position without depending on the skill of the operator. It is possible to increase.

  In addition, since the liquid jet flow can be ejected not only in a certain direction but also in multiple directions, the liquid jet flow can be applied not only to the thrombus on the front surface of the thin tube but also to the entire thrombus. Thrombus can be crushed.

  Furthermore, since the operator can rotate only the thin tube inside the body by operating the rotating means outside the body, the optical fiber is not twisted, and the thin tube is rotated while supplying the liquid jet flow. The thrombus can be crushed while the fine tube passes well through the thrombus, so that the thrombus can be removed more easily and more reliably, and the therapeutic effect can be further enhanced.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

<First Embodiment>
FIG. 1 is a schematic view showing the entire first embodiment of the present invention, FIG. 2 is an enlarged cross-sectional view showing the main part of FIG. 1, FIG. 3 is an enlarged cross-sectional view of part A of FIG. It is an expanded sectional view. In this specification, the “base end side” refers to the side close to the laser oscillation source, and the “tip end side” refers to the side from which the liquid jet flow is ejected.

  As shown in FIG. 1, the laser-induced liquid jet device of the present embodiment generally holds a laser oscillator 1, an optical fiber 2 through which laser light from the laser oscillator 1 is guided, and a proximal end portion of the optical fiber 2. A ferrule 4 for connecting the portion 3, the laser oscillator 1 and the optical fiber 2 (a cylindrical body extending into the laser oscillator 1 and including the optical fiber 2; only the nut is shown in the figure), and extending from the laser oscillator 1 A protective tube 5 (also referred to as a liquid feeding tube) provided so as to enclose the optical fiber 2 formed, a jet generating pipe portion 6 for injecting a liquid jet flow generated by the laser light is provided inside the partition member 7 and An outer fiber 8 is provided at the outermost part, and an optical fiber housing part 20 capable of housing the laser irradiation part 13 of the optical fiber 2 is further provided. The liquid introduction part 9, the thin tube connection part 10 provided at the distal end of the outer tube 8 via a rotating means R described later, and the distal end of the thin tube connection part 10 are percutaneously inserted into the body. A proximal end member B1 and a distal end side member B2 generated by dividing a predetermined position between the thin tube 11 (a catheter in this embodiment) and the laser oscillator 1 from the thin tube connecting portion 10 into a proximal end side and a distal end side. And a rotating means R that enables the distal end side member B2 to rotate relative to the proximal end side member B1. Since the laser oscillator 1, the optical fiber 2, and the ferrule 4 are well known, the description thereof is omitted.

  Further details will be described. First, the holding unit 3 is a so-called Y connector having a main pipe 3a and a branch pipe 3b. The branch pipe 3b has a predetermined liquid W (a drug such as physiological saline or a thrombolytic agent) that absorbs laser light. A liquid supply pump P (syringe pump, infusion pump, etc.) for supplying a liquid such as a chemical solution in which the liquid W is dissolved is shown, and a liquid W supplied from the branch pipe 3b is connected to the main pipe 3a. A protective tube 5 is connected to the liquid inlet 9 and the thin tube 11 and protects the optical fiber 2 inside.

  As shown in FIG. 2, the liquid introduction part 9 has an outer tube 8 connected to the tip of the protective tube 5, and a partition wall member 7 and a jet generating tube part 6 are provided in the outer tube 8. In the jet generating pipe section 6, the laser irradiation section 13 of the optical fiber 2 is accommodated, but this accommodation section may be referred to as an optical fiber accommodation section 20.

  The partition member 7 is a tube made of a resin such as polyurethane. However, the partition member 7 is not a member that requires mechanical strength. Therefore, the partition member 7 may be any material that does not cause deformation when left horizontally. Good. The base end side of the partition wall member 7 is sealed with a conical partition wall 7a to reduce the flow path resistance, and the distal end side is an open end using a support having a liquid flow path. It is preferably supported by the jet generating pipe section 6 or the outer pipe 8.

  The jet generating pipe section 6 extends from the base end side of the partition wall member 7 to the thin tube connection section 10 and the optical fiber 2 is inserted therein. The optical fiber 2 passes through the conical partition wall 7a of the partition wall member 7. However, it is only extended to the middle part of the jet generating pipe part 6 and is not fixed to the jet generating pipe part 6.

  The jet generating tube portion 6 is a thin hollow straight tube having a predetermined length, and the proximal end side is an open end, but the distal end portion is inserted into the thin tube connecting portion 10. The optical fiber 2 is inserted into the jet generating pipe section 6 up to a predetermined portion, and the jet flow J generated here is jetted toward the thin tube 11. In order to prevent the loss of the jet flow J, the distal end of the jet generating tube portion 6 is preferably brought into contact with the inner surface that spreads toward the proximal end side of the thin tube connecting portion 10 (catheter hub 16). As a result, the jet generating pipe section 6 and the thin tube 11 are securely connected in a liquid-tight manner, and loss of the jet flow J is prevented.

  When laser irradiation is performed inside the jet generation tube section 6, it is necessary to prevent leakage of laser light. In this embodiment, the liquid passage itself formed inside the outer tube 8 (jet generation tube section 6). , Partition member 7, outer tube 8, and the like) and the liquid W passing through the liquid passage, and the photothermal influence of the laser beam on the outside is blocked.

  Since the jet generating tube section 6 performs laser irradiation inside, it is desirable that the constituent material is a material that resists laser light and heat induced thereby. For example, examples of the material having a high laser reflectance include gold, platinum, silver, copper, aluminum, and alloys thereof (for example, 18 gold and platinum iridium). Examples of the heat-resistant material include high melting point materials such as titanium, tungsten, and nickel and alloys thereof (for example, stainless steel, Inconel (trade name) and Hastelloy (trade name)). Therefore, it is more preferable to coat the above-described material having high reflectivity by a method such as plating or pressure bonding, or to use the above-described pipe made of a material having high reflectivity of laser on the inner surface.

  Further, not only such a metal material but also a synthetic resin having the following high laser transmittance can be used. For example, fluororesin (tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), polytetrafluoroethylene (PTFE), tetrafluoroethylene / hexafluoropropylene copolymer (FEP)), anhydrous quartz, glass, sapphire However, when PTFE is irradiated with laser in a state of contact with water, whitening proceeds and there is a possibility that transmission loss may be increased. Therefore, among fluororesins, all PFA and C—H bonds are not included. As the fluorinated polymer, Asahi Glass KK's Lucina (registered trademark) and its Cytop (registered trademark) are preferable.

  By using such a laser transmissive material, it is possible to prevent the laser energy from being absorbed by the jet generating tube portion 6 and causing high heat. The laser light that has passed through the jet generation tube portion 6 is absorbed by the liquid W flowing outside the jet generation tube portion 6 and therefore does not leak outside.

  The jet generating tube section 6 made of such a material can jet the jet flow J generated by irradiating laser light in a pulse manner from the tip of the thin tube 11 without substantially losing. In addition, it is preferable that it does not expand in the radial direction even when it receives a high pressure generated when the jet stream J is generated.

  The extension rate is not particularly limited as long as the jet flow J can be jetted without substantially losing it. Specifically, the jet generating pipe section 6 or the jet generating pipe section 6 is not limited. Further, when the one end of the longer tube is sealed in a liquid-tight state, the expansion rate in the radial direction when the hydrostatic water of 20 atm is flowed into the jet generating pipe section 6 or the tube and pressurized (the diameter at the time of expansion) If the ratio of the difference from the diameter before expansion to the diameter before expansion) is less than 1%, more preferably less than 0.5%, the jet stream J can be more reliably injected, which is preferable.

  Moreover, since it is preferable that the jet flow J is directed forward efficiently so that the reaction of the jet flow J does not escape, the jet generating pipe section 6 is connected to the optical fiber 2 as shown in FIGS. The gap Lo between the gap G and the length Lo of the portion where the optical fiber 2 and the jet generating tube portion 6 overlap (hereinafter, for simplicity, the overlap portion) is determined. As the gap G becomes narrower and the length Lo of the overlap portion becomes longer, the resistance against the reverse flow of the jet stream J toward the base increases, so that a stronger jet stream J is jetted forward. can do. If a mechanism (not shown) for adjusting the length Lo of the overlapping portion of the surgeon is provided, the strength of the jet flow J can be adjusted and controlled, and convenience and operability are improved.

  The outer diameter of the optical fiber 2 and the inner diameter of the jet generating tube section 6 are not particularly limited. Specifically, when the jet stream J is generated in a low-viscosity liquid such as water or physiological saline, The inner diameter of the jet generating tube section 6 is preferably 1.05 to 1.50 times the outer diameter of the optical fiber 2, and the length Lo of the overlapping portion is preferably 30 to 150 mm, more preferably the outer diameter of the optical fiber 2 is 600. The inner diameter of the jet generating pipe section 6 is preferably 700 to 1000 μm. That is, the gap G is 50 μm to 200 μm.

  In the illustrated example, the outer tube 8 and the jet generating tube portion 6 are separated from each other. However, the present invention is not limited to this, and the characteristics required for the jet generating tube portion 6 described above are provided. As long as it is provided, a part of the inside of the outer tube 8 may be formed in a tubular shape to form the jet generating tube portion 6.

  As shown in FIGS. 3 and 4, the laser irradiation unit 13 is formed at the tip of the optical fiber 2, but only the tip of the coating h (polyimide resin) covering the outer periphery of the optical fiber 2 is peeled off. is doing. Illustratively, as shown in FIG. 4, the diameter d1 of the core portion 2a is 0.60 mm, the diameter d2 of the cladding portion 2b is 0.66 mm, and the diameter d3 of the coating h portion is 0.71 mm. The length s of the peeled portion is preferably about 3 mm.

  It is preferable that the position of the laser irradiation unit 13 has a predetermined distance L <b> 1 between the tip of the jet generating tube unit 6. In this way, the jet flow J generated in the jet generating pipe section 6 can be ejected powerfully toward the outlet of the liquid introduction section 9 without being unnecessarily diffused or substantially weakened. become.

  In particular, in the present embodiment, as shown in FIG. 3, the proximal end side and the distal end side are divided between the distal end of the liquid introducing portion 9 and the thin tube connecting portion 10, and the proximal end side member B1 and the distal end side generated thereby. Rotating means R is provided that connects the member B2 to each other by a connecting portion C and allows the distal end side member B2 to rotate relative to the proximal end side member B1.

  The connecting portion C is composed of a protrusion 30 provided at the tip of the outer tube 8 and a recess 31 provided in the main body 14 of the thin tube connecting portion 10. The proximal end side member B1 and the distal end side member B2 are connected.

  The rotating means R may be anything as long as the distal end side member B2 can be rotated with respect to the proximal end side member B1, but in the present embodiment, the rotating means R is provided at an intermediate portion of the protrusion 30. The annular projection 32 is formed, a retaining projection 33 formed on the proximal end side of the thin tube connecting portion 10, and an O-ring O provided between the annular projection 32 and the recess 31. When connecting the tube 8 to the thin tube connecting portion 10, the annular protrusion 32 is engaged beyond the retaining protrusion 33, the outer tube 8 and the thin tube connecting portion 10 are detachably engaged, and the tip side member B2 can rotate with respect to the base end side member B1. The O-ring O also has a function of sealing the liquid W inside, but may be provided between the annular protrusion 32 and the protrusion 33 for retaining.

  Here, the outer tube 8 is made of synthetic resin such as polycarbonate, etc., but not only this, but also vinyl chloride resin, acrylic resin, ABS resin, polycarbonate resin, polyethylene resin which are usually used for cutting and injection molding. Further, polymer materials such as polypropylene resin, stainless steel, other metals and alloys may be used.

  The outer surface of the jet generating tube portion 6 is liquid-tightly fixed to the inner surface of the main body 14 with an adhesive or the like, but is not fixed to the outer tube 8 (base end side member B1). For this reason, when the main body 14 is rotated with respect to the outer tube 8 (base end side member B1), the jet generating tube portion 6 can be rotated without rotating the optical fiber 2 in conjunction therewith.

  The thin tube connecting portion 10 has a long and elongated joint protruding portion 14a integrally formed at the distal end of the main body 14, and a bulge whose outer peripheral surface bulges out in an arc shape on the proximal end side of the joint protruding portion 14a. A portion 14b is formed. The bulging portion 14b is configured such that the base end portion of the sleeve member 15 is fitted beyond this and can be connected in a so-called one-touch manner. The distal end portion of the sleeve member 15 is screwed with the proximal end side of the catheter hub 16.

  The catheter hub 16 is provided with a kink protector 17 at the distal end portion to prevent the inner thin tube 11 from being bent, and the distal end portion of the jet generating tube portion 6 is inserted into the catheter hub 16. The generator pipe part 6 is connected. The inner surface of the catheter hub 16 and the distal end portion of the jet generating tube portion 6 are in close contact with each other so that the liquid W does not leak. It may be fixed.

  The thin tube 11 is generally called a catheter, and is a tube that is thin and flexible as a whole so as to be easily inserted even if it is a thin and winding blood vessel, but also has strength at the same time. In this embodiment, the thin tube 11 has a curved shape at the tip, or one or an appropriate number of through holes (not shown) or a liquid jet flow in the longitudinal direction of the thin tube at the side near the tip. On the other hand, it is desirable to form a lumen that is directed sideways or obliquely.

  As a constituent material of such a thin tube 11, there is, for example, one layer of HDPE (High Density Polyethylene) or two layers of LLDPE (Linear Low Density Polyethylene). However, not only this but, for example, polyolefins such as polyvinyl chloride, polyethylene, polypropylene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, polyesters such as polyethylene terephthalate and polybutylene terephthalate, polystyrene, polyurethane, polyamide , Polyimide, polyoxymethylene, polyvinyl alcohol, polytetrafluoroethylene, polyvinylidene fluoride, other thermoplastic resins such as fluororesin, thermosetting resin, polyamide elastomer, thermoplastic elastomer such as polyester elastomer, silicone rubber, latex Various rubbers such as rubber can also be used.

  In the rotating means R having such a configuration, the base end side member B1 is the outer tube 8, the partition wall member 7, the optical fiber 2, and the like, and the front end side member B2 is the thin tube connecting portion 10 and the jet generating tube portion 6. In addition, although the thin tube 11 and the like are provided, the rotating means R including the concave portion 31 and the convex portion 30 exists between the proximal end side member B1 and the distal end side member B2. In addition, the optical fiber 2 passes from the laser oscillator 1 through the protective tube 5 and is covered with the jet generating tube portion 6 and the partition wall member 7 in the outer tube 8, and is not connected to the distal end side member B2. Yes. Therefore, even if the distal end side member B2 is rotated while holding the distal end side member B2, the thin tube 11 rotates independently of the optical fiber 2 around the axis, and the optical fiber 2 is not twisted.

  Even when the jet generating tube 6 is brought into contact with the inner surface of the thin tube connecting portion 10 (catheter hub 16), the jet generating tube 6 is interlocked with the main body 14 and the thin tube connecting portion 10 (catheter hub 16). Therefore, only the thin tube connecting portion 10 (catheter hub 16) rotates without rotating the jet generating tube portion 6, and the inner surface of the thin tube connecting portion 10 (catheter hub 16) is hard. It is possible to reliably maintain the liquid tightness between the jet generating tube portion 6 and the thin tube connecting portion 10 (catheter hub 16) without being scraped or worn at the tip.

  Next, the operation of this embodiment will be described.

  The optical fiber 2, the holding part 3, the ferrule 4, and the liquid introduction part 9 that become the base end side member B1 are assembled in advance by a method such as fitting or adhesion.

  Further, the protrusion 30 of the outer tube 6 that is the connecting portion C and the concave portion 31 of the thin tube connecting portion 10 are ruggedly fitted, and the thin tube connecting portion 10 is connected to the tip of the liquid introducing portion 9. Thereby, the rotating means R is also formed at the same time. At this stage, the thin tube 11 and the catheter hub 16 are not connected to the thin tube connecting portion 10.

  When the ferrule 4 and the laser oscillator 1 are connected and the liquid inlet 3a of the holding unit 3 and the liquid supply pump 10 are connected, the preliminary preparation is completed.

  When the liquid W is supplied from the liquid supply pump 10, the liquid W is stored in the holding unit 3 → the protective tube 5 → the outer periphery of the partition member 7 → the internal channel of the outer tube 8 → the internal channel of the partition member 7 → the jet generating tube unit 6. It flows in the order. When the liquid W flows out from the tip of the jet generating pipe section 6, the liquid is filled, and so-called priming is completed.

  The surgeon inserts a guide wire (not shown) into the living body, and then protrudes the proximal end side of the guide wire from the living body through a guiding catheter (not shown) connected to a Y connector (not shown). Both are advanced to the vicinity of the thrombus.

  When the tip of the guide wire reaches the thrombus position and the guiding catheter reaches the front of the guide wire, the thin tube 11 is inserted into the blood vessel using the guide wire as a guide. When the tip of the thin tube 11 protrudes from the tip of the guiding catheter and reaches the vicinity of the thrombus, the guide wire is removed.

  Then, the catheter hub 16 is liquid-tightly connected to the thin tube connecting portion 10, and the liquid supply pump P is operated after the proximal end side of the thin tube 11 and the distal end side of the jet generating tube portion 6 are liquid-tight. .

  The liquid W is full in the holding portion 3, the protective tube 5 and the outer tube 8, but in the outer tube 8, it makes a U-turn at the front end side of the partition member 7 and enters the partition member 7, and the jet generating tube A U-turn is made on the base end side of the portion 6 and flows from the jet generating tube portion 6 to the thin tube 11. In such a flow state, the fresh liquid W hits the tip of the jet generating tube portion 6 at the time of laser irradiation, the cooling efficiency is improved, and the photothermal effect of the laser light can be suppressed.

  When the liquid W flows out from the distal end of the thin tube 11, it is known that the liquid is full. When the laser oscillator 1 is operated here, the laser light is pulsed from the laser irradiation unit 13 at the distal end of the optical fiber 2. Irradiated.

  A part of the liquid W in the jet generation tube portion 6 is rapidly evaporated by the laser irradiation, and the volume expansion due to the generated bubbles is applied pressure, and the liquid W in the jet generation tube portion 6 is suddenly moved to the tip side. Extrude. In the present embodiment, since the laser irradiation is performed not in the thin tube 11 but in the jet generating tube portion 6, the jet generating tube portion 6 is not deformed by the applied pressure, and the pressure applied by the bubble is It acts on the liquid W in front of it.

  As a result, a liquid jet flow J is generated, and the generated liquid jet flow J propagates through the liquid W in the thin tube 11 and is jetted toward the thrombus in front of the tip of the thin tube 11 to form a thrombus. Collide and crush it. In some cases, a drug such as a thrombolytic agent is used, and the thrombus may be crushed with the aid of this drug.

  During such treatment, the surgeon manually rotates the distal end side member B2 relative to the proximal end side member B1. The base end side member B1, that is, the outer tube 8, the partition wall member 7, and the optical fiber 2 are in a fixed state, and the distal end side member B2, that is, the thin tube connecting portion 10, the jet generating tube portion 6 and the thin tube 11 are outside. It rotates around the convex part 12 of the tube 8.

  When the rotation means R is provided between the base end side member B1 and the distal end side member B2 as described above, only the thin tube connecting portion 10, the jet generating tube portion 6 and the thin tube 11 rotate, and the other portions rotate. Is not transmitted. Accordingly, the rotation is not transmitted to the optical fiber 2, and the optical fiber 2 is included in the jet generation tube portion 6 and the protection tube 5, so that no twisting occurs. Further, even when the jet generating tube portion 6 rotates, since it is sealed by the O-ring O, there is no leakage of the liquid W, and the jet generating tube portion 6 also rotates together with the rotating means R and the thin tube 11, so that the catheter hub 16 is neither scraped off nor worn by the jet generating pipe section 6. Therefore, the liquid-tight state between the jet generating tube portion 6 and the thin tube 11 or the catheter hub 16 is reliably maintained.

  When the entire thin tube 11 rotates about its axis, the tip position of the thin tube 11 can be changed as appropriate, and the direction in which the liquid jet stream J is ejected can be adjusted.

  In this case, if the tip of the thin tube 11 is curved, or if a through hole or a lumen is formed in the vicinity of the tip, the jet direction of the liquid jet stream J can be further changed, and the procedure becomes easier. The operability will be further improved.

  Further, if the thin tube 11 is rotated, the thin tube 11 can be easily inserted into the thrombus. When the tip of the thin tube 11 is advanced and retracted in the axial direction while rotating in the thrombus, a liquid jet is brought into the thrombus. A flow can be applied, and thrombus can be crushed and removed more easily, more quickly, and more reliably.

  As a result, even in the case of the thin tube 11 whose outer diameter is smaller than the blood vessel diameter, the crushing range of the thrombus is increased, and all thrombus can be easily removed, thereby shortening the procedure time and greatly improving the treatment effect. Will do.

  When crushing of the thrombus is confirmed, the thrombus crushing piece is sucked from the port of the Y connector connected to the proximal end portion of the guiding catheter and taken out from the body. By the above procedure, recirculation of blood in the blood vessel is started.

<Second Embodiment>
FIG. 5 is an enlarged cross-sectional view of a main part of a jet generating pipe portion showing a second embodiment of the present invention. In the figure, the same reference numerals are used for the same members as in the above embodiment, and the description thereof will be omitted below.

  In this embodiment, a tube connector 18 is provided as a connecting portion C at the distal end of the protective tube 5, and a rotating means R is provided between the distal end side of the tube connector 18 and the proximal end side of the outer tube 8.

  The configuration of the rotating means R is basically the same as that of the first embodiment, but in this embodiment, an annular protrusion 32 is provided on the distal end side of the tube connector 18 and is pulled out to the proximal end side of the outer tube 8. When the projection 33 for stopping is formed and the outer tube 8 and the tube connector 18 are connected, the annular projection 32 is engaged beyond the projection 33 for retaining. An O-ring O that seals the liquid W inside is also provided between the annular protrusion 32 and the recess 31 of the outer tube 8.

  As described above, when the tube connector 18 is used as the connecting portion C and the rotation means R is provided between the distal end side of the tube connector 18 and the proximal end side of the outer tube 8, the proximal end side member B1 is provided with the protective tube 5, The tube connector 18, the partition wall member 7, and the optical fiber 2 are formed, and the distal end side member B 2 is the outer tube 8, the jet generating tube portion 6, and the thin tube connecting portion 10. In the first embodiment, the partition wall member 7 is supported by the outer tube 8 or the jet generating tube portion 6, but in the present embodiment, it can also be supported by using the tube connector 18.

  In the present embodiment, the rotation means R is provided by using a part of the liquid introduction part 9, so that the rotation means R is provided separately on the tip side of the liquid introduction part 9 as in the first embodiment. In addition, the device can be made compact by the size of the rotating means R, and as a result, the operability of the device is improved.

  Also in this embodiment, even if the rotation means R is rotated, only the distal end side member B2 rotates, so that the optical fiber 2 is not twisted. The position where the rotating means R is provided is not limited to the proximal end side of the outer tube 8 but may be the distal end side of the outer tube 8.

<Third Embodiment>
FIG. 6 is an enlarged cross-sectional view of a main part of a jet generating tube portion showing a third embodiment of the present invention, and FIG. 7 is an enlarged view of a rotating means of the same embodiment. In the figure, the same reference numerals are used for the same members as in the above embodiment, and the description thereof will be omitted below.

  In this embodiment, when the thin tube 11 is rotated by operating the rotation means R, the positioning mechanism 40 is provided so that the rotation position or rotation angle can be maintained.

  For example, when the rotating means R is provided between the thin tube connecting portion 10 and the distal end of the outer tube 8 as in the first embodiment, as shown in FIG. A ratchet mechanism is provided as a positioning mechanism 40 between the base end side end face of the main body 14 of the tube connecting portion 10 and the end face on the front end side of the outer tube 8 that is the base end side member B1.

  For example, as shown in FIG. 7, one or more ratchet mechanisms are provided on the end surface on the distal end side of the outer tube 8 in an annular manner and one or more on the proximal end surface of the thin tube connecting portion 10. And a protrusion 42 having a circular arc at the tip. However, the protrusion 42 and the claw 41 are elastically meshed with each other, and between the annular protrusion 32 and the recess 31 of the rotating means R and between the annular protrusion 32 and the retaining protrusion 33, respectively. It is preferable to provide an O-ring O. These O-rings O not only establish an elastic engagement between the protrusion 42 and the claw portion 41, but also prevent liquid leakage inside the outer tube 8 when the rotating means R is operated.

  In the rotating means R having such a ratchet mechanism, when the thin tube connecting portion 10 which is the distal end side member B2 is rotated, the projection 42 is elastically engaged with the claw portion 41, so that the operator can connect the thin tube. Even if the hand is released from the portion 10, the rotation position or rotation angle is maintained.

  As a result, the operator can accurately adjust the position of the thin tube 11 after determining the direction in which the liquid jet flow is desired to be ejected, and continuously perform jet ejection without causing a positional shift. Therefore, the operability is greatly improved, and the therapeutic effect associated therewith can be further enhanced.

  In addition, although the positioning mechanism 40 of this embodiment uses the ratchet mechanism by a ratchet-shaped nail | claw, various things, such as a square-tooth type | mold and a sawtooth shape, can be used for a nail | claw shape. . Further, the positioning mechanism 40 does not need to be composed of simple machine elements, and may be accompanied by a complicated control system. For example, a stepping motor or the like can be used.

<Fourth embodiment>
FIG. 8 is an enlarged cross-sectional view of the main part of the jet generating pipe portion showing the fourth embodiment of the present invention. In the figure, the same reference numerals are used for the same members as in the above embodiment, and the description thereof will be omitted below.

  In the present embodiment, the rotation of the distal end side member B2 by the rotating means R is increased or decreased and transmitted to the thin tube 11. Increasing the rotation speed of the thin tube 11 with respect to the rotation of the distal end side member B2 is convenient when the liquid jet flow is acted on the wide range of thrombus several times. If it is decreased, it is possible to effectively cause the liquid jet flow to act on the locally attached thrombus, and as a whole, the therapeutic effect of the device can be improved, which is preferable.

  In order to vary the rotation of the distal end side member B2 by the rotation means R, the rotation transmission mechanism 50 is used. For example, when the rotation means R is provided between the thin tube connecting portion 10 and the distal end of the outer tube 8 as in the first embodiment, as shown in FIG. The main body 14 of the thin tube connecting portion 10 that is the side member B2 and the joint protrusion 14a are divided and provided between the distal end side end of the main body 14 and the base end side end of the joint protrusion 14a. The joint protrusion 14 a is rotatably supported via a bearing portion 52 at the tip of a substantially U-shaped support portion racket 51 protruding from the outer tube 8.

  In the rotation transmission mechanism 50, for example, a drive gear G1 is formed on the outer peripheral surface of the front end side portion of the main body 14, a face gear G2 is rotatably provided at the bottom portion of the support bracket 51, A gear G3 is rotatably provided, and a shaft 53 through which the support bracket 51 is inserted projects from the proximal end side of the joint projecting portion 14a. The shaft 53 is rotatably supported by the support bracket 51 via a bearing 52. The driven gear G4 is fixed to the base end side.

  Then, when the main body 14 is rotated, the drive gear G1 is rotated, and this rotation is transmitted to the driven gear G4 via the face gear G2 and the intermediate gear G3, and finally the rotation is transmitted to the joint protrusion 14a. The thin tube 11 rotates around the axis.

  In addition, the speed increase / decrease of rotation can be performed by appropriately selecting the diameter and the number of teeth of the above-mentioned various gears, and in some cases, the number of the gears, and the rotation transmission mechanism 50 is limited to only the gears. Instead, various machine elements such as a belt or a roller can be used.

<Fifth Embodiment>
FIG. 9 is an enlarged cross-sectional view of a main part of a jet generating pipe portion showing a fifth embodiment of the present invention. In the figure, the same reference numerals are used for the same members as in the above embodiment, and the description thereof will be omitted below.

  In each of the embodiments described above, the operator manually rotates the rotating means R, but this may be performed using a rotational power source.

  For example, when the rotating means R is provided between the thin tube connecting portion 10 and the distal end of the outer tube 8 as in the first embodiment, the distal end side of the outer tube 8 is shown in FIG. A drive motor M is provided as a rotational power source in the section, and a drive gear G5 is attached to the motor shaft. On the other hand, a driven gear G6 is formed on the outer peripheral surface of the proximal end side of the thin tube connecting portion 10.

  When the drive motor M is rotated in a state where the drive gear G5 is engaged with the driven gear G6, the thin tube connection portion 10 rotates around the protrusion 30 of the outer tube 8 and is provided in the thin tube connection portion 10. The thin tube 11 can be rotated.

  When the thin tube 11 is rotated using the drive motor M in this manner, the operator only needs to pay attention to the operation of the thin tube 11 and not only the operability of the device is improved but also the certainty of treatment is improved. .

  The rotational power source may be rotated not only by the drive motor M but also by a mainspring spring or the like, and the installation position of the drive motor M is limited to the tip side of the outer tube 8. Instead, it may be provided on the proximal end side of the outer tube 8.

<Sixth Embodiment>
FIG. 10 is an enlarged cross-sectional view of a main part of a jet generating tube portion showing a sixth embodiment of the present invention. In the figure, the same reference numerals are used for the same members as in the above embodiment, and the description thereof will be omitted below.

  In the present embodiment, an intermediate cap 19 is provided on the distal end side of the jet generating pipe section 6. As a material for the intermediate cap 19, a resin having high flexibility such as silicone rubber is desirable.

  In this way, the jet generating tube portion 6 and the thin tube 11 can be connected in a more pressurized state via the thin tube connecting portion 10 (catheter hub 16), and the liquid tightness of the device is further increased. The jet can be more efficiently transmitted to the thin tube 11, and as a result, the performance of the device is improved.

  Further, by interposing the intermediate cap 19, the force of fitting the jet generating tube portion 6 in a pressurized state to the thin tube connecting portion 10 can be made stronger than that of the other embodiments described above, The thin tube 11 can be rotated by the rotating means R in a state where the jet generating pipe portion 6 is fixed and stably held. However, in this case, the jet generating tube section 6 is fixed to the outer tube 8 with an adhesive or the like, and is not bonded and fixed to the thin tube connecting section 10 (main body 14). The liquid-tight state is maintained by press fitting of the intermediate cap 19. Accordingly, the distal end side member B2 rotates with respect to the proximal end side member B1.

  The present invention is not limited to the above-described embodiments, and various modifications can be made by those skilled in the art within the technical idea of the present invention. For example, in the above-described embodiment, the rotating means R is provided in the vicinity of the outer tube 8, but the present invention is not limited to this. For example, in the vicinity of the holding unit 3, the protective tube 5. It may also be provided in the middle part of the.

    The present invention irradiates laser light having a wavelength that is easily absorbed by the liquid filled in the liquid introduction portion in a pulse form from the tip of the optical fiber, rapidly heats and evaporates the liquid, and the liquid generated by the pressure applied by the vapor It can be used as a therapeutic tool for crushing thrombus by jet flow.

It is the schematic which shows the whole 1st Embodiment of this invention. It is an expanded sectional view which shows the principal part of FIG. It is the A section expanded sectional view of FIG. It is an expanded sectional view of a laser irradiation part. It is a principal part expanded sectional view of the jet generation pipe part which shows 2nd Embodiment of this invention. It is a principal part expanded sectional view of the jet generation pipe part which shows 3rd Embodiment of this invention. It is an enlarged view of the rotation means of the same embodiment. It is a principal part expanded sectional view of the jet generation pipe part which shows 4th Embodiment of this invention. It is a principal part expanded sectional view of the jet generation pipe part which shows 5th Embodiment of this invention. It is a principal part expanded sectional view of the jet generation pipe part which shows 6th Embodiment of this invention.

Explanation of symbols

1 ... Laser oscillator,
2 ... Optical fiber,
3 ... holding part,
4 ... Ferrule,
5 ... Protection tube (liquid feeding tube)
6 ... jet generating pipe part,
7 ... partition member,
8 ... Outer pipe,
9 ... Liquid introduction part,
10: Fine tube connection part,
11 ... Fine tube,
13 ... Laser irradiation part,
14 ... body,
18 ... Tube connector,
19 ... Intermediate cap,
20 ... optical fiber housing,
30 ... protrusions,
31 ... recess,
32 ... annular protrusion,
33 ... Protrusions for retaining,
40 ... positioning mechanism,
41 ... nail part,
42 ... protrusions,
50 ... rotation transmission mechanism,
51. Supporting racket,
B1 ... base end side member,
B2 ... tip side member,
C: connecting part,
G1-G6 ... gear,
J ... Jet flow,
M: Drive motor,
O ... O-ring,
R ... rotating means,
W ... Liquid.

Claims (9)

A liquid introduction part filled with a predetermined liquid that absorbs laser light, an optical fiber accommodation part that is arranged in the liquid introduction part, and that accommodates a laser irradiation part of an optical fiber through which laser light from a laser oscillator is guided; A jet flow generated in the liquid by laser light irradiated toward the liquid from the laser irradiation unit, and the outside through a thin tube connected to a tip of the liquid introduction unit via a thin tube connection unit In a laser-induced liquid jet generating device
A proximal end member and a distal end member formed by dividing the laser oscillator from the thin tube connecting portion into a proximal end side and a distal end side are connected to each other by a connecting portion, and the distal end is connected to the connecting portion. Rotating means for rotating the side member with respect to the base end side member is provided, and when the distal end side member is rotated, the rotating means rotates the thin tube about the axis independently of the optical fiber. A laser-induced liquid jet generating device characterized by that.   The laser-induced liquid jet generating device according to claim 1, wherein the rotating means is rotatably connected by fitting the distal end side member and the proximal end side member into an uneven shape.   The laser-induced liquid jet generating device according to claim 1, wherein the rotating unit includes a rotational power source that rotates the tip side member.   4. The laser-induced liquid according to claim 1, wherein the rotation unit includes a rotation transmission mechanism that increases or decreases the rotation from the rotation power source and transmits the rotation to the tip side member. Jet generation device.   5. The laser-induced liquid jet generating device according to claim 1, wherein the rotating unit includes a positioning mechanism that arbitrarily adjusts a rotation angle of the tip-side member and fixes the member at a predetermined position.   The laser-induced liquid jet generating device according to claim 1, wherein the rotating means is provided between the liquid introducing portion and the thin tube connecting portion.   The liquid introduction part can accommodate the laser irradiation part inside and has a jet generation pipe part that generates the jet flow, and the tip of the jet generation pipe part and the thin tube connection part are liquid-tight. The laser-induced liquid jet generating device according to claim 6, wherein the narrow tube can be rotated through the thin tube connecting portion around the tip of the jet generating tube portion.   The laser-induced liquid jet generating device according to claim 6, wherein the liquid introducing section is connected so that the jet generating tube section can rotate together with the thin tube connecting section.   The laser-induced liquid jet generating device according to claim 1, wherein the thin tube is configured by a catheter.

Images