JP2009039216A - Liquid jet flow release tube - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a liquid jet flow release tube obliquely, orthogonally and widely jetting a liquid jet flow against a body cavity inner wall from a flexible tube to be inserted into the body cavity and surely and easily removing the adhesion in the body cavity. <P>SOLUTION: This liquid jet flow release tube is characterized in that the distal end of a tube 7 is sealed, and a long, curved and slit-shaped jet opening part 20 orthogonal to the axis O-O of the tube 7 is provided at the side near the distal end and jets the liquid jet flow J to the side. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a liquid jet discharge tube for jetting a jet flow induced by irradiating a laser beam toward a liquid over a wide range.

  In recent years, as a means for treating thrombosis or the like, a method in which a liquid jet flow is generated by laser light to physically crush a thrombus or the like 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 to 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.

  Patent Document 3 below is a laser-induced liquid jet generating device that irradiates laser light outside a catheter and guides the liquid jet flow induced here to the inside of the catheter. There has been disclosed a technique capable of irradiating with a stronger laser beam without being influenced by light and heat due to light, and enabling use over a long period of time and smooth operation.

  In endovascular treatment using such a catheter, a catheter having an outer diameter that is considerably smaller than the inner diameter of the blood vessel is generally used. In this case, since the liquid jet flow is ejected from the distal end of the catheter along the axis in those disclosed in Patent Documents 1, 2, 3 and Non-Patent Document 1, the effect of the liquid jet flow is It will be limited to the front of the catheter or its periphery.

For this reason, an obstruction that closes the blood vessel such as a thrombus or an adhering substance adhering to the inner wall of the blood vessel such as cholestrol (hereinafter, such an obstructing substance or an adhering substance will be simply referred to as “adhering substance”. ), It is difficult to remove the thrombus completely by applying a liquid jet flow to the entire thrombus closing the blood vessel larger than the catheter, or to quickly remove the adhering material that has adhered over a wide area. In addition, there is a possibility that deposits remain on the blood vessel wall, and the treatment results are greatly influenced by the skill of the operator in operating the catheter.
JP2003-111766 (paragraph numbers [0014] [0015], see FIG. 1) JP-T-2002-521084 (see paragraph numbers [0004] [0010] [0096], FIG. 27E) Japanese Patent Laying-Open No. 2005-169094 (see abstract, paragraph number [0019], FIG. 1 and FIG. 2) Japan-Japan Medical Journal Vol. 22 No. 3 (2001) (see page 217)

  The present invention has been made in order to solve the above-described problems. A liquid jet flow is ejected from a flexible tube to be inserted into a body cavity over a wide range so as to be inclined or orthogonal to the inner wall of the body cavity. An object of the present invention is to provide a liquid jet discharge tube capable of reliably and quickly removing a kimono.

  The liquid jet discharge tube of the present invention that achieves the above object has a tube tip sealed and a long curved slit-like jet opening that intersects the axis of the tube on the side near the tip. It is characterized by.

  In the present invention, a curved slit-shaped ejection opening having a crossing portion with the axis of the tube is provided in the vicinity of the distal end portion of the tube sealed at the distal end, which is used by being inserted into a body cavity, and the liquid jet Since the flow is ejected toward the inner wall of the body cavity, even in a thin tube, the liquid jet stream is ejected over a wide range inclined or orthogonal to the inner wall of the body cavity, so that the deposits on the inner wall of the body cavity can be reliably and quickly It is possible to improve the therapeutic effect by speeding up and facilitating the procedure.

  If the jet opening has a crescent shape projecting toward the front end side or the base end side, the vicinity of the center of the jet opening has the maximum width, and the width decreases toward the end. The range in which the flow exhibits a predetermined jetting force or crushing force has an arc shape, and when used in a portion having an arcuate inner wall such as the inner wall of a body cavity, the physical crushing force of the liquid jet flow is not weakened. It can be reliably transmitted to the inner wall of the body cavity, the range of crushing with respect to the adhering matter is expanded, and the operation of rotating the tube can be minimized.

  If a check valve that prevents the flow from the inside to the outside is provided at the tip of the tube, not only can the liquid jet flow be laterally injected, but also, for example, a guide can be passed from the tip of the tube through the check valve. The wire can be inserted into the tube, and the tube can reach the vicinity of the deposit under the guide of the guide wire.

  If the main flow channel that transmits the liquid jet flow is a tube with at least one lumen portion, for example, a guide wire is inserted into the lumen portion, and the tube reaches the vicinity of the deposit under the guide of the guide wire. In addition, the tube can be easily moved along the guide wire even in a complicated body cavity inner diameter path, and the ease of the procedure is improved.

  If the tube has a main flow path for transmitting the liquid jet flow and at least one sub flow path provided independently of the main flow path, the sub flow path is formed while jetting the liquid jet flow in the main flow path. For example, guides using a guide wire, administration of a contrast medium or a chemical solution, suction of crushed deposits, and the like can be performed, thereby further improving the ease of the procedure.

  The width (a) between the end portions in the direction perpendicular to the tube axis is 75% to 85% of the outer diameter (D) of the tube, and the maximum opening width (b) in the tube axial direction is 0. By forming a flat slit of 1 mm to 0.5 mm, the physical crushing ability of the liquid jet flow is high, and the liquid jet flow is ejected over a wide range to the inner wall of the body cavity, and the deposits on the inner wall of the body cavity are removed quickly and reliably. Can improve the therapeutic effect.

  If the injection opening is formed so that the cutting depth (d) in the radial direction from the outer peripheral edge is 15% to 20% of the outer diameter (D) of the tube, a slit shape is formed near the tip of the tube. Even if the jetting opening is provided, the liquid having a desired jetting force without opening the jetting opening by the reaction force when the liquid jet flow is jetted to open the jetting opening, resulting in a large jetting opening. A jet stream can be injected over a wide range.

  The incision angle (θ) formed by the straight line passing through the circumferential center point (M1) and the midpoint (M2) between the end portions and the axis of the tube is 10 degrees to 20 degrees or If formed so as to have a complementary angle, the liquid jet flow can be ejected over a wide range in a state where the direction in which the liquid jet flow is ejected is not orthogonal to the inner wall of the body cavity and is balanced both in the axial direction and in the radial direction.

  If the injection opening is formed within 5 cm from the tip of the tube, the deposit can be crushed using the tip, and the opening of the injection opening due to the reaction force of the liquid jet flow can be reliably prevented.

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

<First Embodiment>
FIG. 1 is a schematic cross-sectional view showing an entire first embodiment according to the present invention, FIG. 2 is an enlarged cross-sectional view showing a jet flow discharge portion, FIG. 3 is an enlarged cross-sectional view showing a tube, and FIGS. The typical example of the injection opening part formed in the part vicinity is shown, (A) is a top view, (B) is sectional drawing of (A). 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.

  In this embodiment, a liquid jet discharge tube is applied to a laser-induced liquid jet device. As shown in FIG. 1, the laser-induced liquid jet device generally includes a laser oscillator 1, an optical fiber 2 through which laser light from the laser oscillator 1 is guided, a holding unit 3 that holds a base end portion of the optical fiber 2, A jet ferrule 4 that connects a laser oscillator 1 and an optical fiber 2 and a liquid that absorbs laser light from the laser oscillator and is filled with a liquid jet, and jets a liquid jet generated by irradiating the liquid with pulsed laser light. A long and flexible thin liquid jet discharge tube 7 (hereinafter referred to as a jet pipe discharge section 5) having a base end connected to the section 5 and the jet flow discharge section 5 via a tube connection section 6 and ejecting a liquid jet flow from the tip end side. And abbreviated as “tube”).

  In FIG. 1, “P” is a liquid supply pump including a syringe pump or an infusion pump that supplies a predetermined liquid that absorbs laser light, and “8” is a liquid jet supplied from the liquid supply pump P. This is a liquid supply pipe that leads to the discharge unit 5 and the like. 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, as shown in FIG. 2, the jet flow discharge unit 5 includes an outer tube 10 connected to the tip of the liquid feeding tube 8, and a partition wall member 11 and a jet generation tube unit 12 are provided in the outer tube 10. In the jet generation tube portion 12, a laser irradiation portion 13 of the optical fiber 2 is accommodated.

  The outer tube 10 is made of polycarbonate or the like, and the partition member 11 is made of polyurethane or the like. The proximal end side of the partition wall member 11 is sealed by the partition wall 11a, the distal end side is opened, a zigzag flow path is formed in the outer tube 10, and the jet flow is surely directed toward the distal end side. . The partition wall 11a is formed in a conical shape in order to reduce the flow path resistance.

  The jet generating pipe section 12 jets the jet stream J toward the tube 7, extends from the proximal end side of the partition wall member 11 to the tube connecting section 6, and the optical fiber 2 is inserted therein to a predetermined position. The optical fiber 2 passes through the conical partition wall 11 a of the partition wall member 11, extends only to a substantially intermediate portion of the jet generating tube portion 12, and is not fixed to the jet generating tube portion 12.

  In the present embodiment, the means for preventing the leakage of laser light from the inside of the jet generating tube portion 12 to the outside is the liquid passage itself formed inside the outer tube 10 (the jet generating tube portion 12, the partition member 11, The outer tube 10 or the like) and the liquid W passing through the liquid passage are used to prevent the external photothermal effect of the laser light. As a constituent material of the jet generating tube section 12, it is desirable to be a material that resists laser light and heat induced thereby. For example, materials having high laser reflectivity 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)), and laser transmissible materials such as fluorine resins and the like. Examples include anhydrous quartz, glass, and sapphire. Even when such a laser transmissive material is used, the laser energy is absorbed and the external photothermal effect is prevented. Further, since the laser light that has passed through the jet generation tube portion 12 is absorbed by the liquid W flowing outside the jet generation tube portion 12, this also prevents the external photothermal effect.

  The jet generation tube portion 12 may not extend in the radial direction even under high pressure so that the jet flow J generated by the laser light irradiation can be ejected from the tip of the tube 7 without substantial loss. Further, it is preferable that the tip of the tube connection portion 6 is liquid-tightly fixed to the inner surface of the main body 14 of the tube connection portion 6 with an adhesive or the like so that the jet flow J is smoothly guided to the tube 7.

  The tube connecting portion 6 includes a main body 14 that is connected to the distal end portion of the outer tube 10 via a rotating portion R, a hub 16, and a kink protector 17. The rotating portion R is configured by fitting the tip of the outer tube 10 and the main body 14 in a liquid tight manner using an O-ring. If the rotating part R is provided between the outer tube 10 and the main body 14 in this way, the main body 14 can be rotated with respect to the outer tube 10, and the tube 7 can be rotated without rotating the optical fiber 2.

  The main body 14 and the hub 16 can be connected in a so-called one-touch manner by means of a sleeve member 15. The hub 16 is closely fitted with a long kink protector 17 at the tip, thereby the inner tube 7. However, the distal end portion of the jet generating tube portion 6 and the tube 7 are in communication with each other inside the hub 16.

  The tube 7 is a very thin and long tube having an outer diameter generally referred to as a catheter of, for example, about 1 mm to 3 mm, and has a hollow portion. The tube 7 is generally flexible and strong so that it can be easily inserted without bending even if it is a thin and winding blood vessel. For example, one layer of HDPE (High Density Polyethylene) or two layers of LLDPE (Linear Low Density Polyethylene) is used as the constituent material. 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 fluorine resins, thermosetting resins, thermoplastic elastomers such as polyamide elastomer, polyester elastomer, silicone rubber, latex Various rubbers such as rubber can also be used.

  In particular, in this embodiment, as shown in FIG. 3, the tip of the tube 7 is sealed, and an ejection opening 20 that ejects the liquid jet stream J is provided on the side surface near the tip. The injection opening 20 (general name of 20a, 20b, and 20c described later) may be anything as long as it communicates the outside of the tube 7 and the lumen, but is attached to the inner wall of the blood vessel. Is removed by the liquid jet flow J, it is preferably a curved slit having a portion intersecting the axis of the tube 7 so as to extend over a wide range of the inner wall of the blood vessel. And it is more preferable that the elongated curved slit-shaped injection opening 20 has a portion that generally intersects the axis of the tube 7 substantially at a right angle. More specifically, the injection opening 20 has a portion that intersects the axis of the tube 7 (or a tangent at the mouth edge of the arc when the intersecting portion forms an arc) with respect to the axis of the tube 7. A curved slit shape intersecting at substantially right angles is more preferable. Specific examples include those shown in FIGS.

  As shown in FIG. 4A, the injection opening 20a shown in FIG. 4 is inclined (curved) toward the proximal end side from the large central opening portion 21 intersecting the axis OO of the tube 7 and the opening portion 21. ) And a long slit having a side opening portion 22 extending in a circular arc shape, and protrudes toward the distal end side of the tube 7 as a whole, and the proximal end portion 23 is opened, that is, separated. It is a crescent-shaped slit. The injection opening 20 is curved at a portion protruding toward the distal end side of the tube 7.

  In the injection opening 20a, the distance between the end portions 23 in the direction orthogonal to the axis OO of the tube 7 (the distance between the both end portions 23 of the injection opening 20 and not the distance on the outer periphery of the tube 7, , Referred to as “end width”) is “a” as shown in FIG. Further, as shown in FIG. 4B, the injection opening 20a is cut so as to incline obliquely backward from the top of the outer peripheral edge of the tube 7, and the opening width gradually becomes narrower toward the end 23. However, the maximum opening width (width of the central opening portion 21) in the axial direction of the tube at the top of the crescent moon shape is “b”. The opening width b may be different depending on the shape of the injection opening 20a, but in any case, the opening width b is the maximum width in the axial direction of the injection opening 20a.

  The depth of cut at the injection opening 20a is “d”. The depth of cut is the point farthest from the point on the tube outer periphery and the point on the tube outer periphery of the injection opening 20a in the perpendicular drawn from the point on the tube outer periphery of the injection opening 20a toward the tube central axis. This is a connected straight distance, and is the length in the radial direction of the injection opening 20a reaching the lumen of the tube 7 when the injection opening 20a is viewed from the side.

  The inclined state of the injection opening 20a includes a straight line N passing through a circumferential midpoint M1 (circumferential midpoint of the central opening 21) and a midpoint M2 between the end portions 23, and an axis OO of the tube. Is defined by the angle (hereinafter referred to as the cutting angle), and this cutting angle is defined as “θ”. Therefore, the lip portion of the ejection opening 20a is an inclined surface as shown. That is, when the injection opening 20a is viewed from the side surface (when viewed as shown in FIG. 4B), the injection opening 20a is not in a straight line connecting the outer peripheral position of the tube 7 to the end 23, and the injection opening 20a The opening 20a has a portion inclined (curved) so as to slightly protrude from the straight line in a direction close to the center (axis) of the tube 7. As a result, the liquid jet flow J is guided to some extent, the flow resistance at the mouth edge portion is reduced, and the liquid jet flow J is smoothly ejected.

  The crescent shape of the present embodiment is specified by the end width a, the maximum opening width b, the cutting depth d, and the cutting angle θ, and does not ask for the curvature radius of the tip.

  The injection opening 20b shown in FIG. 5 is a long crescent-shaped slit that intersects the axis OO of the tube 7 like the injection opening 20a, but the injection opening 20a is a direction in which the crescent moon protrudes. Is different and protrudes toward the base end side. However, the end 23 is preferably formed in an arc shape, unlike the injection opening 20a. This is to make it easy to flow out from the flow direction of the liquid jet flow J.

  In addition, since the injection opening part 20b is a structure substantially the same as the injection opening part 20a, the same code | symbol is used in a figure and description is abbreviate | omitted.

  Although it does not restrict | limit especially as a formation method of the injection opening part 20, It is preferable to form under magnification using a cutter, for example, a razor.

  Next, the operation of this embodiment will be described.

  The optical fiber 2, the holding unit 3, the ferrule 4, and the jet flow discharge unit 5 are assembled in advance. Therefore, the assembly is completed by simply connecting the ferrule 4 and the laser oscillator 1 and connecting the liquid supply pump P to the holding unit 3.

  When the liquid is supplied from the liquid supply pump P in this state, the liquid flows in the order of the holding unit 3 → the liquid feeding pipe 12 → the outer periphery of the partition wall member 11 → the inside of the partition wall member 11 → the jet generating pipe unit 12. When the liquid flows out from the tip of the jet generating pipe section 12, the liquid is filled and so-called priming is completed.

  The surgeon inserts a guide wire (not shown) into the living body, and then passes a guiding catheter (not shown) connected to the Y connector (not shown) from the base side along the guide wire. The catheter is further advanced into the living body. When the tip of the guide wire reaches the position of the deposit F such as a thrombus and the guiding catheter reaches the front, the guide wire is removed, and the tube 7 reaches the vicinity of the deposit F using the guiding catheter as a guide. Until it is inserted into the blood vessel.

  Next, the tube connection portion 6 is liquid-tightly connected to the hub 16 to connect (contact) the tube 7 and the jet generating tube portion 12 in a liquid-tight manner, and the liquid supply pump P is operated to cause the liquid to the tube 7. Supply. When the laser oscillator 1 is operated in this state, laser light is irradiated in a pulse form from the tip of the optical fiber 2, which causes the liquid to rapidly evaporate. The volume expansion due to the bubbles formed at this time becomes a pressing force, and the liquid in the jet generating pipe portion 12 that has not evaporated is rapidly pushed out to the tip side. As a result, a liquid jet flow J is generated.

  In the present embodiment, since laser irradiation is performed not in the tube 7 but in the jet generation tube portion 12, the pressure exerted by bubbles generated by laser irradiation also acts on the jet generation tube portion 12. However, since the jet generating pipe portion 12 has sufficient mechanical strength, deformation or the like does not occur, and as a result, the pressure applied by the bubbles surely acts on the liquid.

  The liquid jet flow J generated by the laser irradiation propagates from the inside of the jet generation tube portion 12 into the tube 7 and is jetted toward the front deposit F from the jet opening 20 provided on the tip side surface of the tube 7. The deposit F is crushed with the aid of this collision and, in some cases, a drug such as a thrombolytic agent. This crushing will be described with reference to the drawings.

  6A is a cross-sectional view showing a thrombus crushing state by a general tube, FIG. 6B is an arrow view along the line BB in FIG. 6A, and FIG. Sectional drawing which shows the thrombus crushing state by this tube, FIG.7 (B) is an arrow line view which follows the BB line of FIG. 7 (A).

  As shown in FIG. 6A, the outer diameter of the tube 7 generally called a catheter is considerably smaller than the inner diameter of the blood vessel K. In the case where the liquid jet flow J is ejected and crushed to the deposit F such as a thrombus or the like in the blood vessel or the inner wall, in the conventional tube 7, the liquid jet flow J is only ejected linearly from the tip of the tube 7. The injection force or crushing force Y only acts in a direction parallel to the inner wall of the body cavity only toward a narrow range of a predetermined range on the front side of the tube 7. As a result, the range X1 in which the deposits can be crushed or removed by the action of the injection force or the crushing force is limited to the front end of the tube 7 only as shown by the broken line in the figure. In order to crush the deposit F over a wide range, the operator must adjust the direction of the liquid jet flow J by operating the tube 7 and so on. However, when a thin and long tube is rotated, the tube may be twisted, the operation may be hindered, and there may be a situation where injection is impossible.

  In this regard, in the present invention, as shown in FIG. 7 (A), since the injection opening 20 is provided in the vicinity of the distal end portion of the tube 7, so-called side injection, that is, a direction inclined or orthogonal to the inner wall of the body cavity. The liquid jet stream J can be ejected to the crushing range, and the crushing range or removal range X2 is wide as shown by the broken line in the figure. Moreover, since the injection force or crushing force Y acts on the inner wall of the body cavity at a predetermined angle or at a right angle, the deposit F can be crushed and removed reliably and quickly.

  Further, since the tip of the tube 7 is sealed, the tube 7 itself can be inserted into the deposit F and destroyed, and even if the liquid jet stream J is intermittently ejected, There is little risk of a drop in jetting power due to clogging. As a result, shortening of the procedure time and improvement of the therapeutic effect can be expected.

  Even in such a tube 7, if the tip is curved, removal of the thrombus is facilitated in a blood vessel having a large inner diameter, the operability is improved, and the therapeutic effect can be further improved.

  When the crushing of the deposit F is confirmed, the crushing piece of the deposit F is sucked from the port of the Y connector connected to the base of the guiding catheter and taken out from the body. Through the above procedure, recirculation of blood in the blood vessel is started.

Second Embodiment
FIG. 8 is an enlarged cross-sectional view of a main part of a tube showing a second embodiment of the present invention. In addition, regarding FIGS. 8-10, the same code | symbol is used for the member similar to the said embodiment, and description is abbreviate | omitted.

  In this embodiment, as shown in FIG. 8, a check valve 30 that prevents the flow from the inside to the outside is attached to the tip of the tube 7. In the first embodiment, the tip of the tube 7 is sealed in order to effectively irradiate the liquid jet stream J from the ejection opening 20, but in the present embodiment, in consideration of the convenience of the procedure, a check is made. The guide wire can be inserted through the valve 30 from the distal end side of the tube 7 to the inside. In this way, the tube 7 can reach the vicinity of the thrombus under the guide of the guide wire, and the operability of the laser-induced liquid jet device and other devices is improved.

  However, depending on the laser-induced liquid jet device, there is a case where the guide wire cannot be inserted into the jet flow discharge section 5. In such a case, the tube connection section 6 is connected to the tube connection section 6 as shown by a one-dot chain line in the figure. A Y connector 31 may be provided, and a guide wire may be drawn from the Y connector 31 to be operable.

  Since the guide wire passes through the inside of the tube 7 like the liquid jet flow, it is necessary to remove the guide wire when the liquid jet flow J is irradiated.

<Third Embodiment>
FIG. 9 is an enlarged cross-sectional view of a main part of a tube showing a third embodiment of the present invention. In the present embodiment, as shown in FIG. 9, at least one lumen portion 32 is provided around the distal end portion of the tube 7. When the liquid jet stream J is ejected while the guide wire is inserted using the lumen portion 32 and the tube 7 is operated under the guide of the guide wire, the operability of the laser-induced liquid jet device and other devices is improved. improves. For example, when the tube 7 is moved along a guide wire (not shown) inserted into the lumen 32 at a branch portion of the blood vessel where the peripheral blood vessel and the central blood vessel are branched, the tube 7 is moved in a desired direction. This makes it easy to select a blood vessel at a blood vessel bifurcation.

<Fourth embodiment>
FIG. 10 is an enlarged cross-sectional view of a main part of a tube showing a fourth embodiment of the present invention. In the present embodiment, as shown in FIG. 10, a main flow path 7 a that transmits the liquid jet flow J into the tube 7, and at least one sub flow path 7 b that is provided in the main flow path 7 a and has a distal end open. It is what has. The auxiliary flow path 7b may be inserted separately into the tube 7 or may be formed by partitioning with a partition wall. In this way, the sub-channel 7b can be used as a lumen for inserting a wire, and when a guide wire is inserted there, a liquid jet flow can be ejected in parallel with the guide of the tube 7. As in the embodiment described above, the selection of blood vessels at the blood vessel bifurcation is facilitated, and the operability of the laser-induced liquid jet device and other devices is improved. In particular, in the present embodiment, by removing the guide wire used for the guide, the sub-channel 7b is removed from the sub-flow channel 7b by administration of a drug such as a contrast agent, or by removing the debris of the deposit F such as crushed thrombus, etc. It can be used for multiple purposes, and the functionality of the device can be enhanced. In addition, you may seal the front-end | tip of the subchannel 7b using the non-return valve 30 mentioned above.

  The elements such as the end width a, the maximum opening width b, the cutting depth d, and the cutting angle θ of the injection opening 20 described above were specifically verified.

<Experimental example 1>
A urethane resin piece is inserted into the tip 1 mm of a commercially available angiographic catheter 4Fr (outer diameter: 1.33 mm, manufactured by Terumo Corporation), and bonded using a cyanoacrylate adhesive to completely seal the hole at the tip of the catheter. Stopped. A razor was used to make a cut at a position 1 mm from the tip, and a crescent-shaped injection opening 20 projecting (curved) to the tip side as shown in FIG. 4 was formed.

  The catheter is different for each element of the end width a, the maximum opening width b, the cutting depth d, and the cutting angle θ of the injection opening 20 in order to examine in detail the optimum dimensions of each element of the injection opening 20. Eighteen kinds of values were prepared. The assignment method and experiment method of these elements are based on “Introduction to Quality Engineering Calculation Method” by Hiroshi Yano, published by the Japanese Standards Association.

(Evaluation 1)
From these 18 types of catheters, a liquid jet stream J was ejected toward 0.5% (w / w) Agarose as a sample, and this was crushed, and the amount of change in mass of the sample before and after crushing was measured. The results are shown in Table 1. In the table, the degree of mass change is indicated by the number of “+”. The larger the mass change, that is, the higher the crushing capacity, the greater the number of “+”.

  From this result, it was found that when the maximum opening width b reaches 1 mm, the crushing amount decreases. On the other hand, with regard to the end width a and the cutting depth d, it has been found that optimum dimensions are within the scope of this experiment. Further, it was found that when the catheter was fixed without moving, the amount of crushing decreased when the cutting angle θ exceeded 30 °.

<Experimental example 2>
In order to further narrow down the value of each element from the result of evaluation 1, the above-mentioned conditions were corrected, and 18 types of catheters shown in Table 2 were newly produced again.

(Evaluation 2)
Similarly to Experimental Example 1, the liquid jet stream J was jetted toward 0.5% (w / w) Agarose using 18 types of catheters, and the mass change amount of the sample before and after crushing was measured. The results are shown in Table 2.

  FIG. 11 is a graph showing an index of the effectiveness of the set value in each element of the injection opening 20. When the index of the effectiveness of each element is obtained from Table 2, it is as shown in FIG. In FIG. 11, it shows that it contributes with respect to crushing, so that the value of effectiveness is high.

<Experimental example 3>
The value to be set for each element of the ejection opening 20 was estimated from the index result of the effectiveness of evaluation 2, and 11 types of catheters were newly produced again. That is, in FIG. 11, if the value of effectiveness is 2 or more, it has practicality, and the end opening width a of the injection opening 20 is 0.95 mm and 1.05 mm. b having 0.10 mm, 0.25 mm and 0.50 mm, cutting angles θ of 10 °, 15 ° and 20 °, and cutting depths d of 0.20 mm and 0.25 mm were prepared. .

(Evaluation 3)
Using these 11 types of catheters, as in the previous experiment, a liquid jet flow was injected into 0.5% (w / w) agarose, and the mass change of the sample before and after crushing was measured. The results are shown in Table 3.

  No. No. 11 has the highest amount of disruption of 0.5% (w / w) agarose. The value of 11 was the optimum value to be set for each component of the injection opening 20. At this time, the value of the end width a corresponds to 78.7% of the outer diameter D of the catheter, and the cutting depth d corresponds to 18.8% of the outer diameter D of the catheter.

<Experimental example 4>
(Evaluation 4)
Subsequently, in order to examine the strength of the liquid jet flow in which the ejection opening 20 acts effectively and the size of the tube 7, the tube connection portion 6 is connected to various commercially available catheters (manufactured by Terumo Corporation), and the liquid jet flow from the tip. The impact force when jetting out was measured. The result shown in FIG. 12 was obtained.

  As can be seen from FIG. 12, any catheter having an inner diameter of 0.49 mm to 2.10 mm can eject the liquid jet flow, but the peak of the impact force is 1.05 mm to 1.12 mm. I found out.

<Experimental example 5>
(Evaluation 5)
In order to investigate the relationship between the impact force and the crushing ability of the liquid jet flow determined from Evaluation 4, the tube connection portion 6 was connected to various commercially available Terumo Corporation catheters used in Evaluation 4, and the liquid jet flow J was supplied from the tip. 0.5% (w / w) Agarose was crushed while jetting, and the change in mass of the sample before and after crushing was measured. The results are shown in Table 4.

  With a catheter with an inner diameter of 0.49 mm, 0.5% (w / w) agarose could be crushed by the liquid jet flow, but with a catheter with an inner diameter of 2.10 mm, it could not be crushed effectively and sufficiently.

<Experimental example 6>
A urethane tube having an outer diameter of 2.10 mm and an inner diameter of 1.80 mm is heat-sealed to the tip of a commercially available guiding catheter 6Fr (outer diameter: 2.00 mm, manufactured by Terumo Corporation), and a urethane resin piece is inserted into the tip of 1 mm. Then, the tip of the catheter was sealed by using a cyanoacrylate adhesive. A crescent-shaped injection opening 20 as shown in FIG. 3 was formed at a position 1 mm from the tip using a razor under magnification. In order to investigate the optimum dimensions of the injection opening 20 when the catheter is 6 Fr, the conditions of the injection opening 20 obtained in Evaluation 3 were changed in accordance with the increase in diameter, and four types of catheters were produced.

(Evaluation 6)
The liquid jet stream J was jetted into 0.5% (w / w) Agarose and crushed using four types of catheters, and the change in mass of the sample before and after crushing was measured. The results are shown in Table 5.

  As can be seen from Table 5, no. No. 3 catheter had the highest mass change before and after the test. From this result, it has been found that when the diameter of the catheter changes, the condition of the injection opening 20 should be enlarged in the radial direction with the same magnification (1.5 times according to Table 5). In addition, No. The end width a of the catheter 3 corresponds to 80.0% of the outer diameter D of the catheter, and the cutting depth d corresponds to 20.0% of the outer diameter D of the catheter.

  In the tube 7 provided with such an ejection opening 20, the liquid jet stream J ejected from the ejection opening 20 when the liquid jet stream J is transmitted to the tip of the tube 7 has no problem in practical use. It was found to have an impact force of 0.04 gf or more.

  Summarizing such verification results from the point that the impact force is 0.04 gf or more, the end width a is preferably 75% to 85% of the outer diameter (D) of the tube.

  The opening width b is preferably 0.1 mm to 0.5 mm, and more preferably about 0.25 mm.

  The cutting depth d is also defined by the cutting angle θ, but is preferably about 7% to about 20% of the outer diameter D of the tube 7, more preferably about 15% to about 20%. Length.

  The cutting angle θ is in the range of about 10 to about 30 ° or about 150 ° to about 170 °, more preferably 10 ° to 20 ° or about 160 ° to about 170 °, that is, 10 ° to 20 ° or the like. It has been found that the liquid jet stream J can be ejected over a wide range in a balanced manner both in the axial direction and in the radial direction if it is formed to have a complementary angle.

  The injection opening 20 is provided in the vicinity of the distal end portion of the tube 7 and the position thereof is not particularly limited. However, in consideration of operability in the blood vessel, it is used within 5 cm from the distal end. Above preferred.

  INDUSTRIAL APPLICABILITY The present invention can be used as a therapeutic device for crushing a thrombus by jetting a jet flow introduced from a liquid introduction part over a wide range from the tube tip.

It is a schematic sectional drawing which shows the whole 1st Embodiment which concerns on this invention. It is an expanded sectional view which shows a jet flow discharge part. It is an expanded sectional view showing a tube. The example of an injection opening part is shown, (A) is a top view, (B) is sectional drawing of (A). The example of an injection opening part is shown, (A) is a top view, (B) is sectional drawing of (A). (A) is sectional drawing which shows the thrombus crushing state by a general tube, (B) is an arrow line view which follows the BB line of (A). (A) is sectional drawing which shows the thrombus crushing state by the tube concerning this invention, (B) is an arrow line view which follows the BB line of (A). It is a principal part expanded sectional view of the tube which shows 2nd Embodiment of this invention. It is a principal part expanded sectional view of the tube which shows 3rd Embodiment of this invention. It is a principal part expanded sectional view of the tube which shows 4th Embodiment of this invention. It is a graph which shows the effectiveness of the setting value in each element of a jet opening part. It is a graph which shows the relationship between the internal diameter of a catheter, and the impact force by a liquid jet flow.

Explanation of symbols

6 ... Jet discharge part,
7 ... Liquid jet discharge tube,
7a ... main flow path,
7b ... Sub channel,
20 ... injection opening,
20a: crescent-shaped injection opening (convex on the tip side),
20b ... crescent shaped injection opening (convex to the base end side),
20c ... long hole-shaped injection opening,
30 ... Check valve,
32 ... Lumen part,
a ... end width b ... maximum opening width,
d: Depth of cut,
D: outer diameter of the tube,
J ... Liquid jet flow,
M1: circumferential midpoint of the injection opening,
M2: Midpoint between the ends,
θ: Cutting angle.

Claims (9)

In a long and flexible liquid jet discharge tube that is connected to a jet flow discharge section that discharges a liquid jet flow and jets the liquid jet flow from the tip end side,
The tube is sealed at the tip, and is provided with a curved slit-like jet opening having a portion intersecting the axis of the tube on the side near the tip. tube.   The liquid jet discharge tube according to claim 1, wherein the ejection opening has a crescent shape that projects toward a distal end side or a proximal end side.   3. The liquid jet discharge tube according to claim 1, wherein a tip of the tube is sealed by a check valve that prevents flow from the inside to the outside of the tube.   The liquid jet according to any one of claims 1 to 3, wherein the tube has a main flow path for transmitting the liquid jet flow, and at least one lumen portion attached to the main flow path. Discharge tube.   The said tube has the main flow path which transmits the said liquid jet flow, and the at least 1 subchannel provided in the said main flow path, and the front-end | tip open | released, The any one of Claims 1-3 characterized by the above-mentioned. A liquid jet discharge tube according to claim 1.   The injection opening has a width (a) between ends in a direction orthogonal to the axis of the tube of 75% to 85% of the outer diameter (D) of the tube, and a maximum opening width (b of the tube in the axial direction). The liquid jet discharge tube according to claim 1, wherein the liquid jet discharge tube is formed to have a thickness of 0.1 mm to 0.5 mm.   The said injection | emission opening part was formed so that the cutting depth (d) to radial direction from an outer periphery might be 15 to 20% of the outer diameter (D) of the said tube. The liquid jet discharge tube according to any one of claims 6 to 6.   The injection opening has a cut angle (θ) formed by a straight line passing through a circumferential midpoint (M1) and a midpoint (M2) between the end portions and an axis of the tube of 10 degrees to 20 degrees or The liquid jet discharge tube according to claim 2, wherein the liquid jet discharge tube is formed so as to have a complementary angle.   The liquid jet discharge tube according to claim 1, wherein the ejection opening is formed within 5 cm from the tip of the tube.

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