JP2009297548A - Medical obturator - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical obturator which can obturate transbronchially a bronchial tube to solve problems in the surgical treatment of pulmonary emphysema, and can be easily fabricated. <P>SOLUTION: The medical obturator includes anchor matter 2 that can be anchored on the bifurcation H4b at which the lumen of a bronchial tube H4 is bifurcated into a plurality of lumens, wherein the anchor matter 2 includes a first obturation 9, a second obturation 10, and an engagement 11; the first obturation 9 can obturate the first bifurcated lumen H4c, i.e., one of the bifurcation H4b; the second obturation 10 can obturate the second bifurcated lumen H4d which is different from the first bifurcated lumen H4c; and the engagement 11 can be engaged with the edge of a junction positioned between the first bifurcated lumen H4c and the second bifurcated lumen H4d. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a medical obturator that is used in the lumen of a luminal organ of a subject, for example, when the bronchus is occluded during the treatment of emphysema.

  In general, emphysema is a lesion mainly formed by extensive destruction of the peripheral airways and alveoli, which is mainly caused by inhalation of harmful substances by smoking or the like. The formation of the lesion is chronic progressive, and respiratory function is severely impaired in advanced patients. Respiratory disturbance due to emphysema is caused by a decrease in ventilation efficiency and a decrease in respiratory reserve due to a combination of multiple dysfunction factors, with reduced elasticity and reduced respiratory membrane area due to alveolar destruction as a basic dysfunction factor .

  The lung tissue of the emphysema lesion is over-expanded and cannot contract sufficiently with expiration. As the volume of the lesion in the thoracic cavity increases, the diaphragm and thorax shift to the expanded position, and the driving force for respiratory movement decreases. Further, the remaining normal lung tissue cannot be sufficiently expanded in the thoracic cavity, and the ventilation efficiency is significantly reduced.

  The main treatment methods for emphysema are the administration of bronchodilators, anti-inflammatory agents, and antibiotics to treat comorbid infections, and oxygen inhalation performed in patients with advanced lesions. Although these medical treatments may relieve the patient's symptoms, the progression of the condition cannot be stopped.

  On the other hand, surgical treatments currently performed on patients with emphysema include lung volume reduction surgery and lung transplantation. Lung volume reduction surgery restores the remaining normal lung function by surgically removing the site where the emphysema lesion is formed. This can improve the patient's quality of life, but generally it requires resection of a large part, which is about 30% of the entire lung, and it is a heavy burden on the patient, so it is necessary for recovery after surgery. take time.

  When emphysema lesions and normal lung tissue are mixed, it is difficult to isolate only the affected tissue, so normal lung tissue must be resected, or the outer surface of the lung is included. Since the serosa shape may change and prevent the remaining lungs from expanding, the function of normal lung tissue left in the patient may not be sufficiently maintained. In addition, unlike the natural state of the excised part line, non-uniform pressure is applied, so that the tissue may collapse and pneumothorax may occur. Since emphysema is a progressive lesion, lesions will eventually be formed in the patient's remaining lungs. However, excision of lung tissue is difficult to repeat because of the heavy burden on the patient's body.

  Lung transplantation, on the other hand, is the only way to cure emphysema by replacing the patient's lungs with normal lungs. However, the physical burden on the patient is very large, and there are problems specific to transplantation medicine such as immunological problems and securing of donors. Lung volume reduction surgery and lung transplantation both require a large operation, and thus there is a problem that treatment is very expensive and cannot be easily performed.

  Patent Document 1 describes an obturator that treats emphysema by obstructing the bronchus distributed in the emphysema lesion as a tool for solving the above-described problems in surgical treatment of emphysema. . The obturator has a configuration in which a locking member is provided on the outer peripheral portion of the obturator main body so as to be hooked and locked on the living tissue. And when this obturator is detained in the body, the obturator is detained at a desired position in the body by hooking and locking the locking member on the outer periphery of the obturator body to the living tissue. .

International Publication No. 98/48706 Pamphlet

The following problems are associated with lung volume reduction surgery and lung transplantation, which are performed as a surgical treatment for emphysema.
(1) A large wound must be made on the patient's body by performing a large surgical operation.
(2) It cannot be repeated for the same patient.
(3) Cannot be performed unless the lesion is easily excised (pulmonary volume reduction surgery).
(4) In some cases, the function of the remaining lungs cannot be fully exerted (pulmonary volume reduction surgery).
(5) A huge cost is required.
(6) Pneumothorax may occur after surgery.
(7) There are large obstacles to overcome such as securing donors and transplant rejection (lung transplantation).

  Further, the obturator disclosed in Patent Document 1 has a configuration in which a locking member is provided at an outer peripheral portion of the obturator body in order to place the obturator body at a desired position in the body. However, since the overall size of the obturator for treating emphysema is extremely small, it is technically difficult to correctly assemble a plurality of extremely small parts. Therefore, there is a problem that it is difficult to provide a special locking member to prevent the occlusion body from falling off, and it is difficult to manufacture the entire obturator.

  The present invention has been made paying attention to the above circumstances, and its purpose is to solve the above-mentioned problems in surgical treatment of emphysema by performing transbronchial bronchial obstruction and to be easily manufactured. The object is to provide a medical obturator.

The invention of claim 1 is a medical obturator used in the lumen of a hollow organ of a subject, and can be placed in a branching portion of a lumen that branches into a plurality of lumens of the hollow organ. A first occlusion portion that can seal one first branch lumen of the branch portion and another second branch lumen that is different from the first branch lumen. The indwelling elastic body is provided with a second occlusion portion and a locking portion that can be locked to an end edge portion of the joint portion between the first and second branch lumens. Obturator.
According to the first aspect of the present invention, one first branch lumen of the branch portion of the lumen that branches into a plurality of lumens in the lumen of the bronchus that is a lumen organ distributed in the emphysema lesion is formed by the first occlusion portion. Sealing and closing the other second branch lumen different from the first branch lumen with the second occlusion portion, at the edge of the joint portion between the first and second branch lumens By locking the locking portion, the indwelling elastic body is detained at the branch portion. Thereby, the lumen of the bronchus distributed in the emphysema lesion is completely occluded by the indwelling elastic body, and new air is prevented from flowing into the emphysema lesion. The volume of the emphysema lesion before treatment is very large due to the accumulation of excess air, but this air is carried locally via the bronchus of the lesion, so air supply to the lesion is not possible. When blocked, the air stored in the bloodstream and the like naturally decreases. As a result, the volume of the pulmonary emphysema lesion part that has been expanded by air is reduced, and as a result, the same effect as the lung volume reduction operation is obtained.

The invention of claim 2 is a medical obturator used in the lumen of a hollow organ of a subject, and can be placed in a lumen in the vicinity of a branching portion existing in the lumen of the hollow organ, The medical obturator has an occluding member having an outer shape capable of sealing the lumen, and an occluding portion fixing means attached to the occluding member and capable of gripping the branch portion.
In the invention of claim 2, the occlusion portion is inserted in the lumen in the vicinity of the branching portion of the lumen that branches into a plurality of lumens in the lumen of the bronchus that is a luminal organ distributed in the emphysema lesion. By holding the branch portion by the fixing means, the blocking member is placed in the lumen in the vicinity of the branch portion. As a result, the lumen of the bronchus distributed in the emphysema lesion is completely occluded by the indwelling elastic body to prevent new air from flowing into the emphysema lesion.

The invention of claim 3 is a medical obturator used in the lumen of a luminal organ of a subject, comprising a wire having a shape memory property and a film attached to the wire. The medical obturator is characterized.
In the invention of claim 3, the wire of the medical obturator in which a specific expanded shape having a large diameter is stored in advance is preferably distributed in an emphysema lesion by a bronchoscope or the like in a state of being elongated. Insert into the lumen of the lumen of the bronchus, which is a luminal organ Thereafter, the wire of the medical obturator is pushed out from the bronchoscope or the like at the indwelling target site so that the wire of the medical obturator is restored to a specific expanded shape. Place in the lumen of the lumen. At this time, the lumen of the bronchus distributed in the emphysema lesion is blocked by the film attached to the wire to prevent new air from flowing into the emphysema lesion. Note that the wire shape when inserted into the lumen by a bronchoscope or the like is not limited to the elongated shape, and may be a coil shape, for example.

  According to the present invention, transbronchial bronchial occlusion can solve problems in surgical treatment of emphysema and is easy to manufacture.

1 shows a first embodiment of the present invention, in which (A) is a perspective view showing a bronchial occlusion device, (B) is a longitudinal sectional view of the bronchial occlusion device, and (C) is a side view showing an indwelling material. . The schematic block diagram which shows the lesion distribution state immediately after occlusion in the usage example in which the indwelling material of 1st Embodiment was detained in the branch part of the lumen | bronch lumen. The schematic block diagram which shows the local obstruction | occlusion state which is the usage example of the indwelling material of 1st Embodiment. The schematic block diagram which shows the lesion distribution state after time passes after the obstruction | occlusion in the usage example indwelled in the branch part of the lumen | bronch of the bronchus of 1st Embodiment. The 1st modification of the indwelling material of 1st Embodiment is shown, (A) is a longitudinal cross-sectional view which shows an indwelling material, (B) is a body by the operation by an insertion device with the indwelling material of (A). The longitudinal cross-sectional view of the principal part for demonstrating the operation | work to insert. (A) is a longitudinal sectional view showing a second modification of the indwelling material of the first embodiment, (B) is a longitudinal sectional view showing a third modification of the indwelling material of the first embodiment, (C) is a perspective view which shows the 4th modification of the indwelling material of 1st Embodiment, (D) is a perspective view which shows the 5th modification of the indwelling material of 1st Embodiment. The longitudinal cross-sectional view which shows the 6th modification of the indwelling material of 1st Embodiment. (A) The longitudinal cross-sectional view which shows the 7th modification of the indwelling material of 1st Embodiment, (B) is the use which placed the indwelling material of the 7th modification in the branch part of the lumen of the bronchus The schematic block diagram which shows an example. The 2nd Embodiment of this invention is shown, (A) is a perspective view which shows a T-shaped indwelling material, (B) is a front view which shows a Y-shaped indwelling material, (C) is an indwelling material. The schematic block diagram which shows the usage example which was detained in the branch part of the lumen | bronch of the bronchus. (A) is a longitudinal sectional view showing a first modification of the Y-shaped indwelling material of the second embodiment, and (B) is a second view of the Y-shaped indwelling material of the second embodiment. The perspective view which shows a modification. FIGS. 3A and 3B show a third embodiment of the present invention, in which FIG. 3A is a plan view showing an entire bronchial occlusion device, FIG. 3B is a longitudinal sectional view of a distal end portion of an insertion device, and FIG. The top view of the whole bronchial obstruction | occlusion apparatus which shows the state when doing, (D) is a longitudinal cross-sectional view of the front-end | tip part of the insertion apparatus of the state of (C). The modification of the indwelling material of 3rd Embodiment is shown, (A) is a longitudinal cross-sectional view which shows the contraction shape of the balloon which stored the indwelling material, (B) is the expansion | swelling shape of the balloon which stored the indwelling material. FIG. (A) is a schematic block diagram which shows the state which connected the balloon which put the indwelling material inside to the catheter, (B) is a schematic block diagram which shows the state which cut | disconnected the balloon which put the indwelling material inside from the catheter. 1 shows a device for separating a balloon from a catheter using a double catheter, (A) is a longitudinal sectional view of the main part showing a state in which the balloon is connected to the double catheter, and (B) is an indwelling material inside. The longitudinal cross-sectional view of the principal part which shows the state which cut | disconnected the balloon put into the double catheter from the double catheter. The apparatus which inserts a balloon with the thin diameter holding tool which can be inserted and used in the channel of a bronchoscope is shown, (A) is a side view of the principal part which shows the state which hold | gripped the balloon with the holding tool, (B) is the side view of the principal part which shows the state which cut | disconnected the balloon from the holding tool. The apparatus for collect | recovering the indwelling material which has the indwelling balloon in the bronchus is shown, (A) is the longitudinal cross-sectional view of the principal part which shows the state which made the front-end | tip part of the collection | recovery apparatus approach the indwelling material, (B ) Is a longitudinal sectional view of the main part showing a state in which the indwelling material is recovered by the recovery device. The schematic block diagram of the whole insertion apparatus of the indwelling material in the 4th Embodiment of this invention. 5A and 5B show a fifth embodiment of the present invention, in which FIG. 5A is a side view showing an indwelling material of a medical obturator, and FIG. 5B is a schematic view showing a state in which the indwelling material is fixed to the bronchial wall from the bronchial lumen. Diagram. 6A and 6B show a sixth embodiment of the present invention, in which FIG. 6A is a longitudinal sectional view of a main part showing a state in which a balloon is attached to a side surface of a transparent cap, and FIG. The longitudinal cross-sectional view of the principal part which shows the state which covered the transparent cap. The schematic block diagram which shows the state which inserted the indwelling material of 6th Embodiment into the target bronchial lumen by the bronchoscope. 7A and 7B show a seventh embodiment of the present invention, in which FIG. 7A is a perspective view of a main part showing a state where a sheath and an indwelling material are attached to an endoscope distal end, and FIG. The perspective view of the principal part which shows the state which extruded the material to the front-end | tip direction of the endoscope. 8A and 8B show an eighth embodiment of the present invention, in which FIG. 8A is a plan view showing a state in which the indwelling material is in a first linear shape, and FIG. The top view which shows the state of the shape of. The schematic block diagram which shows the state which is performing obstruction | occlusion of the bronchial lumen using the indwelling material in the medical obturator of the 9th Embodiment of this invention.

  A first embodiment of the present invention will be described below with reference to FIGS. 1 (A) to (C) to FIG. FIGS. 1A and 1B show a bronchial occlusion device 1 used to occlude a bronchi in a patient's body. The bronchial occlusion device 1 includes an indwelling material (indwelling elastic body) 2 that is a medical obturator according to the present embodiment, and an insertion device 3 for inserting the indwelling material 2 into the body.

  The insertion device 3 is provided with a gripping tool 4 for gripping the indwelling material 2. The gripping tool 4 is provided with a gripping portion 6 that grips the indwelling material 2 at the tip of an elongated shaft 5. Here, the shaft 5 is made of a flexible or hard material. Furthermore, a handle 7 for operating the grip portion 6 is provided at the base end portion of the shaft 5. In this gripping tool 4, the distal end side of the shaft 5 is an insertion portion 4 a that is inserted into the body together with the gripping portion 6. In addition, it is desirable to minimize irritation to the patient's respiratory tract by attaching a sheath 8 having a smooth surface to the outer peripheral surface of the insertion portion 4a of the grasping tool 4.

  In addition, as shown in FIG. 1C, the indwelling material 2 of the present embodiment is a rod-like member that does not have a lumen and is made of a flexible material that is compatible with a living body that does not irritate the airway mucosa. Note that both end portions 2a and 2b of the indwelling material 2 may have a curved shape with rounded corners in order to minimize irritation to the airway.

  Next, the operation of the above configuration will be described. The indwelling material 2 of the present embodiment is inserted into the body of the patient H as shown in FIG. 2 by the insertion device 3 of FIGS. 1 (A) and 1 (B). In FIG. 2, H1 is the chest cavity, H2 is the lung, H3 is the trachea, H4 is the bronchi, and H5 is the emphysema lesion. Then, the indwelling material 2 of the present embodiment is inserted into the lumen of the bronchi H4 distributed in the emphysema lesion H5 while being held by the holding tool 4 of the insertion device 3. Here, the indwelling material 2 to be inserted into the lumen of the bronchus H4 is inserted from the bronchus H4a on the central side toward the branch H4b side of the bronchus H4 as shown in FIG. The indwelling material 2 is guided to the indwelling site using X-ray fluoroscopy or an endoscope.

  Furthermore, the indwelling material 2 of the present embodiment inserted into the lumen of the bronchus H4 is bent into a substantially V shape at the center. The one end 2a side of the indwelling material 2 is inserted into the first branch lumen H4c which is one bronchi H4c of the two bronchi H4c and H4d on the distal side from the branch H4b of the bronchi H4. A first blocking portion 9 capable of sealing one branch lumen H4c is formed. Further, the other end portion 2b side of the indwelling material 2 is inserted into the second branch lumen H4d which is the other bronchus H4d, and a second blocking portion 10 capable of sealing the second branch lumen H4d is formed. The

  Further, the V-shaped bent portion between the first occlusion portion 9 and the second occlusion portion 10 of the indwelling material 2 has first and second branch lumens H4c and H4d in the branch portion H4b of the bronchi H4. The latching | locking part 11 which can be latched at the edge part of the junction part in between is formed. Then, with the indwelling material 2 of the present embodiment, as shown in FIG. 3, the two bronchi H4c and H4d on the distal side of the branch part H4b of the bronchi H4, and the bronchi H4a on the central side of the branch part H4b By obstructing, the lumen of the target bronchi H4 is completely occluded. Note that the indwelling material 2 of the present embodiment may be placed using forceps or the like of a bronchoscope instead of the insertion device 3 of FIGS. 1 (A) and 1 (B).

  Next, the emphysema treatment according to the present invention will be described with reference to schematic views showing a human chest cavity H1 as shown in FIGS. FIG. 2 shows a state in which the lumen of the bronchi H4 distributed in the emphysema lesion H5 is blocked with the indwelling material 2. Here, at the time immediately after occlusion with the indwelling material 2, the emphysema lesion H5 has a large volume and occupies the patient's chest cavity H1, but the air accumulated in the lesion is absorbed as time passes. As shown in FIG. 4, the volume of emphysema lesion H5 decreases. As a result, the patient's healthy lung H2, which has been crushed by the emphysema lesion H5 and whose ventilation function has been reduced, can be expanded, and the improvement of the ventilation function improves the quality of life of the patient.

  Therefore, the above configuration has the following effects. That is, when the indwelling material 2 of the present embodiment is used, one first branch lumen H4c of the branch portion of the lumen that branches into a plurality of lumens of the bronchi H4 distributed in the emphysema lesion H5 is used as the first occlusion portion. 9 and the other second branch lumen H4d is closed by the second closing portion 10 and locked to the edge of the joint portion between the first and second branch lumens H4c and H4d. By locking the part 11, the indwelling material 2 is placed in the branch part H4b. As a result, the lumen of bronchi H4 distributed in emphysema lesion H5 can be completely occluded by indwelling material 2, and new air can be prevented from flowing into emphysema lesion H5. The volume of the emphysema lesion before treatment is very large due to the accumulation of excess air, but this air is carried locally via the bronchus of the lesion, so air supply to the lesion is not possible. By blocking, the air that has been carried and stored in the bloodstream and the like naturally decreases. As a result, the volume of the pulmonary emphysema lesion H5 that has been expanded by air is reduced, and as a result, the same effect as the lung volume reduction operation can be obtained. Therefore, emphysema can be treated without the large invasion to the patient's body like the conventional surgical treatment of emphysema.

  Moreover, in this Embodiment, the structure of the indwelling material 2 and the insertion apparatus 3 is simple, and it is low-cost. Furthermore, the treatment of pulmonary emphysema with the indwelling material 2 of the present embodiment also has an effect that can be used for repeated treatments.

  It should be noted that by increasing the length of the rod-shaped indwelling material 2 of the present embodiment, the movement preventing effect of increasing the area where the indwelling material 2 contacts the bronchial wall and making the indwelling material 2 difficult to move in the bronchial lumen. You may make it the structure which carries out. The indwelling material 2 of the present embodiment may be gripped and collected by an apparatus having the same configuration as the insertion apparatus, for example.

  5A and 5B show a first modification of the indwelling material 2 of the first embodiment. In this modification, a protrusion 21 is provided on the outer peripheral surface of the rod-shaped indwelling material 2 of the first embodiment for facilitating the operation by the gripping tool 4 of the insertion device 3. The position of the protrusion 12 may be anywhere as long as it is the outer surface of the indwelling material 2.

  When the indwelling material 2 of this modification is inserted into the body by the operation of the grasping tool 4 of the insertion device 3, the indwelling material 2 is moved by the grasping portion 6 at the distal end of the grasping tool 4 as shown in FIG. The protrusion 21 can be gripped. Therefore, the operation of gripping the indwelling material 2 by the gripper 4 can be facilitated.

  Moreover, you may comprise like each modification shown to FIG. 6 (A)-(D) as another structure of the rod-shaped indwelling material 2 of 1st Embodiment. FIG. 6A shows a second modification of the indwelling material 2 of the first embodiment. In this modification, a notch 22 for facilitating bending is provided in at least one location of the indwelling material 2.

  FIG. 6B shows a third modification of the indwelling material 2 of the first embodiment. In this modified example, flange-like retaining portions 23a and 23b for preventing shaking in the airway are provided at both end portions 2a and 2b of the indwelling material 2. In addition, you may provide the radiopaque marker 24 which is a radiopaque mark in each retaining part 23a, 23b.

  FIG. 6C shows a fourth modification of the indwelling material according to the first embodiment. In this modification, a plurality of large-diameter convex portions 25 are arranged in parallel along the axial direction on the outer peripheral surface of the indwelling material 2, and the diameter of the indwelling material 2 is continuous between the concave portions 26 between the front and rear convex portions 25. It is a configuration that changes with time. Here, the interval between the front and rear convex portions 25 is set to about 3 mm to 10 mm according to the irregularities of the bronchial lumen, for example.

  FIG. 6D shows a fifth modification of the indwelling material 2 of the first embodiment. In this modification, a tapered surface 27 having a substantially truncated cone shape is formed on the outer peripheral surface of the indwelling material 2 so that the diameter of one indwelling material 2 continuously changes. Note that the insertion device 3 is changed and placed depending on the shape of the placement material 2.

  Moreover, FIG. 7 shows the 6th modification of the indwelling material 2 of 1st Embodiment. This modification is provided with an indwelling material 31 which is made of a flexible material into a cylindrical shape. Thus, in the case of the cylindrical indwelling material 31, it can be inserted so as to cover the distal end of the insertion device 3.

  Moreover, in the cylindrical indwelling material 31, as shown in FIG. 7, in addition to the simple cylindrical shape used with both ends 31a and 31b of the cylinder being opened, one of the both ends 31a and 31b of the cylinder is closed. It may be used in the shape. The combination of the open end portion and the closed end portion of these cylinders can change the occlusion site, for example, when only one peripheral bronchus is occluded or when both peripheral bronchi are occluded.

  8A and 8B show a seventh modification of the indwelling material 2 according to the first embodiment. In this modification, as shown in FIG. 8 (A), a cylindrical indwelling material 31 is provided with a closed end 32 on the one end 31a side and an open end 33 on the other end 31b side. Furthermore, in this modification, a circular hole 34 is formed in the central portion of the outer peripheral surface of the indwelling material 31.

  When the indwelling material 31 of this modification is used, as shown in FIG. 8B, for example, the closed end portion 32 on one end side of the indwelling material 31 is connected to the first branch lumen H4c which is one bronchus on the distal side. After inserting and sealing the first branch lumen H4c, the distal end of the insertion device 3 is inserted into the circular hole 34 in the central portion of the indwelling material 31, and the open end 33 of the other end of the indwelling material 31 is moved to the distal side. It is possible to introduce into the lumen of the second branch lumen H4d, which is the other bronchus. As shown in FIG. 8B, in the use example in which the indwelling material 31 of the seventh modified example is placed in the branch portion of the lumen of the bronchus H4, the first branch lumen H4c that is one of the bronchi on the distal side. And the second branch lumen H4d, which is the other bronchus on the distal side, can be held in an open state.

  Therefore, in the case of the cylindrical indwelling material 31 of this modification, the occlusion state of the lumen of the bronchus H4 after indwelling is arbitrarily determined by the combination of the closed end portion 32, the open end portion 33, and the circular hole 34. It is possible to change. In addition, you may make it the structure which provides the notch of a major axis direction etc. in the outer peripheral surface of the cylindrical indwelling material 31. FIG.

  FIGS. 9A to 9C show a second embodiment of the present invention. In the present embodiment, a T-shaped indwelling material is used as shown in FIG. 9A instead of the rod-shaped indwelling material 2 of the first embodiment (see FIGS. 1A to 1C to 4). 41 or a Y-shaped indwelling material 42 as shown in FIG. 9B. Here, as shown in FIG. 9A, the T-shaped indwelling material 41 includes one central tube 41a located on the central side when the indwelling material 41 is used, and two peripheral tubes located on the distal side. 41b and 41c.

  Further, the Y-shaped indwelling material 42 is similarly composed of one central tube 42a located on the central side and two peripheral tubes 42b and 42c located on the distal side as shown in FIG. 9B. Has been.

  When the indwelling materials 41 and 42 of the present embodiment are used, the central bronchus 41a and 42a or the peripheral tubes 41b, 41c and 42b are used in order to close the two bronchi H4c and H4d on the distal side of the bifurcation H4b of the bronchi H4. 42c, at least one of the lumens is completely occluded. The central tubes 41a and 42a and the peripheral tubes 41b, 41c, 42b, and 42c preferably have a diameter that matches the inner diameter of the bronchus at the indwelling site.

  Next, the operation of the present embodiment having the above configuration will be described. FIG. 9C shows a state after the indwelling material 41 of the present embodiment is placed in the lumen of the bronchus H4 of the bronchial bifurcation H4b distributed in the lesion. Here, the central tube 41a is inserted into the lumen of the bronchus H4a on the central side with respect to the bronchi branching portion H4b, and the peripheral tubes 41b and 41c are inserted into the lumens of the two bronchi H4c and H4d on the distal side. In this state, since the peripheral tubes 41b and 41c branch from the bronchial bifurcation H4b and expand toward the distal side, the peripheral tubes 41b and 41c prevent the indwelling material 2 from shaking in the lumen of the bronchi H4. .

  In addition, in the indwelling material 41, at least one of the peripheral tubes 41b and 41c is completely occluded, so that at least one of the lumens of the two bronchi H4c and H4d on the distal side of the indwelling bronchial bifurcation H4b is completely removed. Blocked. When all the portions of the indwelling material 41 have a hollow shape, at least one of the peripheral tubes 41d and 41c or the central tube 41a is completely closed using a stopper or the like after the placement.

  Therefore, in the present embodiment, the T-shaped indwelling material 41 or the Y-shaped indwelling material 42 is placed in the bifurcation H4b of the bronchus H4 to close the two distal bronchial bronchi H4c and H4d. As in the first embodiment, the lumen of the bronchi H4 distributed in the emphysema lesion H5 is completely occluded by the T-shaped indwelling material 41 or the Y-shaped indwelling material 42, and the emphysema lesion H5. It is possible to prevent new air from flowing in. Therefore, the same effect as that of the first embodiment can be obtained.

  In the present embodiment, in particular, since the T-shaped indwelling material 41 or the Y-shaped indwelling material 42 that is close to the shape of the branch part H4b of the bronchi H4 is provided, the bronchial mucosa is entered regardless of the material of the indwelling material. There is less effect of irritation. Furthermore, there is also an effect that the fixation to the bronchi can be surely performed.

  FIG. 10 (A) shows a first modification of the Y-shaped indwelling material 42 of the second embodiment. In this modification, a closing member 44 that plugs the central tube 42a of the indwelling material 42 is provided. Here, a closing member locking claw 43 projects inwardly on the inner peripheral surface of the central tube 42a of the indwelling material 42.

  Further, the closing member 44 is made of an elastic material and is a solid member having substantially the same shape as the lumen of the central tube 42a. The outer diameter of the closing member 44 is set to be approximately the same as the inner diameter of the central tube 42a. Further, a protrusion 45 is provided at one end of the closing member 44 so as to facilitate operation by the insertion device 3.

  In the present modification, when the central tube 42a of the indwelling material 42 is not closed, the closing member 44 is inserted into the lumen of the central tube 42a by the insertion device 3, so that the central tube 42a of the indwelling material 42 is inserted. Can be plugged. Here, when the blocking member 44 is inserted into the central tube 42a, the blocking member locking claw 43 engages with the end edge of the blocking member 44, and the blocking member 44 is firmly attached to the lumen of the central tube 42a. And can be fixed.

  Moreover, like the 2nd modification of the Y-shaped indwelling material 42 of 2nd Embodiment shown to FIG. 10 (B), the radiopaque raw material, for example, metal, on the outer peripheral surface of the indwelling material 42 You may provide the radiopaque marker 46 comprised with the wire of this.

  The indwelling material 2 of the first embodiment (see FIGS. 1A to 1C to 4) and the T-shape of the second embodiment (see FIGS. 9A to 9C). The indwelling material 41 and the Y-shaped indwelling material 42 may have protrusions and holes for assisting the operation by the insertion device 3 when used in combination with the insertion device 3. Moreover, the indwelling materials 41 and 42 once indwelled using these protrusions and holes may be recoverable. Furthermore, in the case where the indwelling material 2 of the first embodiment, the T-shaped indwelling material 41 of the second embodiment, and the Y-shaped indwelling material 42 are hollow and at least one end is closed, The material of the closing surface may be constituted by a transparent member. In this case, the indwelling operation is performed by placing the indwelling material 2 of the first embodiment, the T-shaped indwelling material 41, and the Y-shaped indwelling material 42 of the second embodiment on the outside of the endoscope. In this case, there is an effect that does not disturb the visual field of the endoscope. Furthermore, an X-ray opaque marker, which is a radiopaque marker, may be provided on the insertion device 3 together with the indwelling material as a position confirmation means during and after treatment.

  FIGS. 11A to 11D show a third embodiment of the present invention. FIG. 11A shows a bronchial occlusion device 51. As shown in FIG. 11B, the occlusion device 51 includes an indwelling material 52, which is a medical obturator according to the present embodiment, and an insertion device 53 for inserting the indwelling material 52 into the body. .

  The insertion device 53 is provided with an elongated insertion portion 54 to be inserted into the body, and a hand side operation portion 55 connected to the proximal end portion of the insertion portion 54. Here, the insertion portion 54 is provided with an elongated outer tube 56. An indwelling material storage portion 57 for storing the indwelling material 52 is provided at the distal end portion of the outer tube 56. Further, an elongated wire-like push-out member 58 is inserted into the outer tube 56 so as to be able to advance and retreat behind the indwelling material storage portion 57.

  The operation unit 55 is provided with a substantially tubular elongated operation unit main body 59. A slot-like guide groove 60 extends in the axial direction in the operation portion main body 59. Further, the operation section 55 is provided with an operation knob 61 of the push-out member 58 so as to be movable along the guide groove 60. The operation knob 61 is connected to the base end portion of the pushing member 58. When the operation knob 61 is moved in the front-rear direction, the push-out member 58 moves in the axial direction with respect to the outer tube 56.

  Here, in the state where the operation knob 61 is moved to the position of the base end portion (right end portion in FIG. 11A) of the guide groove 60 of the operation portion main body 59 as shown in FIG. As shown in B), the distal end portion of the pushing member 58 is held in a state of being pushed into the outer tube 56. An indwelling material storage portion 57 is formed in the distal end portion of the pushing member 58 in the outer tube 56, and the indwelling material 52 can be stored in the indwelling material storage portion 57.

  Further, when the operation knob 61 is moved to the position of the front end portion (left end portion in FIG. 11C) of the guide groove 60 of the operation portion main body 59 as shown in FIG. 11C, FIG. As shown in FIG. 8, the distal end portion of the pushing member 58 enters the indwelling material storage portion 57 and is pushed out to the distal end position of the outer tube 56. Thereby, the indwelling material 52 in the indwelling material storage part 57 is pushed out.

  In addition, the indwelling material 52 can take two shapes: a shape with a small volume when stored in the indwelling material storage portion 57 of the insertion device 53 and a shape with a large volume when placed in the target site. It has a possible configuration. For example, the indwelling material 52 is composed of a sponge having a very large expansibility that exhibits an expansion ratio of 10 times or more in volume ratio. The indwelling material 52 can be put into the indwelling material storage portion 57 of the insertion device 53 in a compressed shape.

  The sponge-like indwelling material 52 may have a configuration that does not require an external force or a storage tool in order to maintain a compressed shape. For example, a material having such a configuration can be made of a material that can be expanded greatly by maintaining a compressed shape in air and absorbing moisture.

  And also in the bronchial obstruction device 51 of the present embodiment, the sponge-like indwelling material 52 is placed in the branch part H4b of the bronchi H4 by the same operation as in the first embodiment, and the distal side of the branch part H4b of the bronchus H4 is placed. The lumen of the target bronchus H4 can be completely occluded by occlusion of the two bronchi H4c and H4d and the bronchi H4a on the central side of the branch H4b. Therefore, the same effect as the first embodiment can be obtained.

  Further, in the present embodiment, two shapes are taken: a shape with a small volume when stored in the indwelling material storage portion 57 of the insertion device 53 and a shape with a large volume when placed in the target site. Since the indwelling sponge-like indwelling material 52 is provided, the applicable range of the diameter of the bronchus to be placed in a single indwelling material 72 shape is wide.

  FIGS. 12A and 12B show a modified example of the indwelling material 52 of the third embodiment (see FIGS. 11A to 11D). In this modification, an indwelling material 72 made of an inflatable material, such as sponge, is housed in a balloon 71. The balloon 71 has a communication port 73 at least partially with the outer space.

  Furthermore, the indwelling material 72 of this modification has an outer peripheral surface covered with a balloon 71. The inflatable material of the indwelling material 72 accommodated in the balloon 71 is held in a compressed reduced shape as shown in FIG. 12A when it is accommodated in the indwelling material accommodation portion 57 of the insertion device 53. Has been. When the indwelling material 72 is pushed out from the indwelling material storage unit 57 by the pushing member 58 during the indwelling in the body, the indwelling material 72 comes out of the indwelling material storage unit 57 and then is restored by the restoring force of the sponge itself. As shown in FIG. 12 (B), the balloon 71 is naturally inflated and placed in the bronchial lumen.

  In addition, the communication port 73 of the indwelling material 72 in the balloon 71 is preferably configured to be closed after indwelling, for example, can be welded by heat, or can be mechanically closed by operation with forceps or the like.

  Moreover, as an insertion device of the indwelling material 72 having the balloon 71, as shown in FIG. 13 (A), it is preferable that the device communicates with the proximal side by a thin catheter 74. Here, the balloon 71 in which the inflating material constituting the indwelling material 72 is placed is connected to the distal end portion of the catheter 74. The proximal end of the catheter 74 is provided with an opening 76 and a valve that opens and closes the opening 76 and keeps airtight when the opening 76 is closed, for example, a three-way cock 75.

  Before indwelling, air or the like in the balloon 71 is sucked from the opening 76 at the proximal end of the catheter 74 as shown in FIG. deep. After insertion into the indwelling part in the body, when the three-way stopcock 75 is operated to open the opening 76 at the proximal end of the catheter 74, air enters the balloon 71 through the catheter 74, and the indwelling material 72 in the balloon 71. Sponge expands due to restoring force.

  In addition, what is put into the balloon 71 from the catheter 74 may be liquid as well as gas. For example, when the inflation material in the balloon 71 is a material that is inflated with water, water is injected from the opening 76 at the proximal end of the catheter 74.

  A heating element 77 that generates heat by energization is provided near the connection portion with the balloon 71 at the distal end portion of the catheter 74. One end of a coaxial cable 78 is connected to the heating element 77. The other end of the coaxial cable 78 reaches the proximal side along the inside or outside of the catheter 74 and is connected to the power supply box 79.

  Then, when the coaxial cable 78 is energized, the balloon 71 containing the indwelling material 72 is separated from the catheter 74 as shown in FIG. At this time, when the catheter 74 is cut, the stump of the catheter 74 is welded and closed.

  14A and 14B show a modification of the device for separating the balloon 71 containing the indwelling material 72 from the catheter 74. FIG. This modification uses a double-tube catheter 81. The double-tube catheter 81 is provided with an outer catheter 82 and an inner catheter 83. 14A, the outer catheter 82 and the inner catheter 83 are connected to the balloon 71, respectively.

  Further, the outer catheter 82 is divided into a short end portion 82a connected to the balloon 71 and a long catheter main body portion 82b reaching the proximal portion. Before the placement, the distal end portion of the inner catheter 83 extends to the distal end portion 82a of the outer catheter 82, as shown in FIG.

  Further, by sliding the inner catheter 83 toward the proximal side during indwelling, an indwelling unit 84 composed of the balloon 71 in which the indwelling material 72 is housed and the end portion 82a of the outer catheter 82 as shown in FIG. The outer catheter 82 is detached from the catheter body 82b and the inner catheter 83.

  Note that when the indwelling material 72 in the balloon 71 does not need to inject liquid or the like into the balloon 71 from the opening 76 at the proximal end, the inner catheter 83 does not need to be hollow.

  FIGS. 15A and 15B show a device for inserting the balloon 71 by a thin diameter gripping tool 91 that can be used by being inserted into a channel of a bronchoscope. Here, the indwelling material 72 is made of an inflatable material whose outer side is covered with the balloon 71, and has a communication port 73 in a part of the balloon 71.

  Further, the communication port 73 is disposed at a part that can be gripped by the gripper 91. Before insertion, as shown in FIG. 15A, the balloon 71 and the indwelling material indwelling material 72 therein are grasped by the grasping portion 92 of the grasping tool 91 in a sufficiently compressed state. At this time, in the state of being gripped by the grip portion 92 of the gripper 91, the airtightness of the balloon 71 is maintained by completely closing the communication port 73 of the balloon 71.

  Further, when the indwelling material 72 is indwelled, as shown in FIG. 15B, when the grasping tool 91 is removed from the balloon 71, the communication port 73 of the balloon 71 is opened and the inflatable material in the balloon 71 is inflated, and bronchi Occlude. At this time, what is necessary when the inflatable material in the balloon 71 is inflated is injected into the balloon 71 from the communication port 73.

  When the indwelling material 72 is inserted into the bronchus using the bronchial endoscope channel, an elongated gripper 91 that can pass through the bronchial endoscope channel is temporarily inserted into the endoscopic channel. The indwelling material 72 can be gripped after the distal end portion of the gripper 91 is projected from the distal end portion of the endoscope.

  In such a method, since the diameter of the indwelling material 72 does not need to be so small that it can pass through the endoscope channel, it is possible to insert a large indwelling material 72 and consequently block the bronchus having a large diameter. Is possible.

  FIGS. 16A and 16B show an apparatus 101 for recovering an indwelling material 72 having a balloon 71 once indwelled in a bronchus, for example. The recovery device 101 is provided with a grasping portion 103 for grasping the indwelling material 72 and a hollow needle 104 having a sharp tip for puncturing the balloon 71 at the distal end portion of the wire-like elongated insertion portion 102. The hollow needle 104 is located in the grip portion 103 when the grip portion 103 of the recovery apparatus 101 is closed, and is exposed when the grip portion 103 is opened.

  Further, the distal end portion of the recovery device 101 reaches the indwelling material 72 that is inserted into the channel of the bronchoscope 105 and placed in the lumen of the bronchus H4. Then, as shown in FIG. 16 (A), the distal end portion of the collection device 101 is pressed against the indwelling material 72 with the gripping portion 103 opened, so that the distal end portion of the hollow needle 104 penetrates the balloon 71 and the inside of the balloon 71. Reach the cavity. At this time, the balloon 71 is broken by the hollow needle 104 and the inside and outside of the balloon 71 communicate with each other, and the contents of the balloon 71 leak out. As a result, the tension of the balloon 71 is relaxed, so that the balloon 71 can be easily compressed.

  Thereafter, as shown in FIG. 16B, the grasping portion 103 of the collecting apparatus 101 is closed, the balloon 71 is grasped, and it can be easily pulled out of the airway. In addition, when the hollow needle 104 is connected to the proximal-side operation unit with a tube, after puncturing the hollow needle 104 and grasping the balloon 71, the contents of the balloon 71 of the indwelling material 72 are removed from the proximal side of the tube. By sucking, the indwelling material 72 can be made small and easily removed from the airway.

  The collection device 101 may be a combination of a simple tubular member having a relatively large diameter, a bronchoscope, and a gripping tool. The bronchial obstruction device 51 according to the third embodiment may be configured by combining the balloon 71 in which the indwelling material 72 is accommodated, the insertion device 53, and the collection device 101. In this case, since the indwelling material 72 can be easily collected, the indwelling position can be changed or the indwelling material 72 can be removed after healing.

  FIG. 17 shows a fourth embodiment of the present invention. In the present embodiment, the configuration of the indwelling material 72 in the balloon 71 shown in FIGS. 13A and 13B is changed as follows. The other parts have the same configuration as the apparatus shown in FIGS. 13A and 13B, and the same parts as those shown in FIGS. 13A and 13B are denoted by the same reference numerals. Then, the explanation is omitted.

  That is, in this embodiment, the indwelling material 111 in the balloon 71 has a fluid first shape such as liquid, and a relatively low fluidity second material such as gel or solid. Is formed by. The change from the first shape to the second shape of the injecting material that is the indwelling material 111 is performed by, for example, a method of mixing two fluid liquids. Examples of the material having such properties include a material that changes from liquid to gel by adding specific ions, and a material such as silicon that changes from liquid to solid by adding a curing agent.

  In addition, the catheter 74 connected to the balloon 71 that houses the indwelling material 111 may have a simple tubular tube structure, and has two lumens 74a that have two lumens and can inject two injection materials separately. The structure provided with 74b may be sufficient.

  And in this Embodiment, the content of the indwelling material 111 in the balloon 71 shall be a thing with low fluidity, and can make the balloon 71 of the indwelling material 111 difficult to deform | transform. Moreover, by making the indwelling material 111 in the balloon 71 into a fluid first shape such as a liquid, it becomes possible to make the shape of the indwelling material 111 coincide with the bronchial shape of the occlusion site.

  FIGS. 18A and 18B show a fifth embodiment of the present invention. In the occlusion device of the present embodiment, as shown in FIG. 18 (A), a clip-shaped fixing portion 122 is connected to an end portion of an indwelling material 121 that is in close contact with the lumen of the bronchi H4 and occludes the bronchi H4. ing. This fixing part 122 fixes the indwelling material 121 to the bronchial wall from the lumen of the bronchus H4, and has, for example, a clip 123 that is hooked not only on the bronchial mucosa but also on the bronchial cartilage. The clip 123 of the fixing portion 122 has a ridge 124 at the tip, and can firmly hold the bronchial cartilage. In addition, the fixing part 122 of the indwelling material 121 may be constituted by a needle-like member with a barb in addition to the clip 123.

  And in this Embodiment, as shown to FIG. 18 (B), it can fix simply and safely by making the position of the fixing | fixed part 122 into the branch part H4b of the bronchial cartilage bronchus. Even when the fixing portion 122 is constituted by a needle with a barb, the bronchial branch H4b can be punctured relatively safely.

  Therefore, the present embodiment can provide the same effects as those of the first embodiment. Furthermore, in the present embodiment, the configuration of the blocking portion of the indwelling material 121 can be simplified.

  FIGS. 19A, 19B, and 20 show a sixth embodiment of the present invention. The indwelling material 131 according to the present embodiment includes a transparent cap 133 having a diameter that can be put on the distal end portion of the endoscope 132. The distal end portion of the transparent cap 133 is closed by a transparent closing member 133a. In this embodiment, as shown in FIG. 19B, the transparent cap 133 is attached in a state of covering the distal end portion of the bronchoscope 132, and the bronchoscope 132 forms an insertion device for the bronchial obstruction device. Has been.

  Further, for example, an inflatable balloon 134 is attached to the outer peripheral surface of the transparent cap 133 as shown in FIG. A distal end portion of a small-diameter catheter 135 is connected to the balloon 134. The proximal end portion of the catheter 135 extends to the proximal side. Then, the substance can be injected into the lumen of the balloon 134 through the catheter 135 from the proximal side. Note that a separation mechanism 136 from the indwelling material 131 such as the heating element 77 shown in FIGS. 13A and 13B is provided at the distal end portion of the catheter 135, for example.

  Then, the transparent cap 133 of the indwelling material 131 of the present embodiment is put on the distal end portion of the endoscope 132 as shown in FIG. 19A, and the lumen of the target bronchus H4 as shown in FIG. Is inserted. Here, when the distal end of the endoscope 132 reaches the target site, the balloon 134 is inflated by injecting a substance into the lumen of the balloon 134 using the catheter 135 or the like. Thereby, the bronchus H4 is closed so that the outer peripheral surface of the indwelling material 131 is in close contact with the bronchial wall. Thereafter, the placement of the indwelling material 131 is completed by separating the catheter 135 from the indwelling material 131.

  Therefore, in the present embodiment, the indwelling material 131 can be inserted into the lumen of the target bronchi H4 by the bronchoscope 132, and the bronchi H4 can be closed by the indwelling material 131. 1 has the same effect as that of the first embodiment (see FIGS. 1A to 1C to 4).

  In the present embodiment, since the bronchoscope 132 can be used as an insertion device for a bronchial occlusion device, no special insertion device is required. Furthermore, since the indwelling material 131 is formed by the transparent cap 133 that covers the distal end portion of the endoscope 132, there is an effect that the visual field of the endoscope 132 is not obstructed when the endoscope 132 is inserted.

  In addition, as a configuration not using the catheter 135, the member attached to the side surface of the transparent cap 133 is not the above-described balloon 134 but is inflated by containing moisture, for example, a water-absorbing polymer material or compressed when dried. It may be a sponge that keeps its shape. In this case, the transparent cap 133 is inserted into the bronchus while being attached to the bronchoscope 132 and guided to the target site, and then the absorbent material expands and is securely fixed to the bronchial wall. In this state, only the bronchoscope 132 is removed. Further, the portion of the side surface of the transparent cap 133 that contacts the bronchial wall may be made of a biocompatible material such as silicon.

  In the case of such a configuration, the catheter 135 for inflating the contact member of the inflatable material on the side surface of the transparent cap 133 is not required, and it is inserted into the bronchus as thin as possible while being attached to the distal end of the endoscope 132. Thus, the indwelling material 131 can be placed so as to be in close contact with the bronchial wall.

  In addition, as an active means for removing the indwelling material 131 placed on the distal end portion of the endoscope 132 at the indwelling site, the bronchial endoscope 132 having a channel injects fluid such as liquid or gas from the channel. There is also a method for increasing the pressure between the indwelling material 131 and the bronchoscope 132.

  FIGS. 21A and 21B show a seventh embodiment of the present invention. The present embodiment shows a modification of the indwelling material 131 of the sixth embodiment (see FIGS. 19A, 19B and 20).

  That is, in this embodiment, instead of the indwelling material 131 constituted by the transparent cap 133 as in the sixth embodiment, the indwelling material constituted by the coil 141 and the thin film 142 bonded around the coil 141. 143 is provided.

  Furthermore, a sheath 144 is provided for use over the bronchoscope 132. The sheath 144 includes a distal sheath 144a that covers the outer periphery of the distal end portion of the bronchoscope 132, and an elongated operation sheath 144b that can project and retract into the distal sheath 144a. Here, an indwelling material storage portion 145 for storing the indwelling material 143 is formed between the distal sheath 144 a and the distal end portion of the bronchoscope 132.

  Then, as shown in FIG. 21A, the indwelling material 143 can be stored in the indwelling material storage unit 145 in a state where the operation sheath 144b is held at the retracted position that is retracted from the indwelling material storage unit 145. In this state, the indwelling material 143 is stored in the indwelling material storage portion 145 at the distal end portion of the sheath 144 and attached to the outer peripheral surface of the distal end portion of the bronchoscope 132.

  Further, in this state, as shown in FIG. 21 (B), the operation sheath 144b is pushed out in the distal direction, thereby pushing out the indwelling material 143 stored in the indwelling material storage unit 145 in the distal direction. It can be pushed out of the material storage portion 145. Here, if the coil 141 of the indwelling material 143 has a property that restores to a specific form such as a shape memory alloy, for example, when the indwelling material 143 is pushed out from the indwelling material storage unit 145, It is possible to expand to a shape having a larger diameter than the case where it is located.

  And the indwelling material 143 of this Embodiment is stored in the indwelling material storage part 145 of the front-end | tip part of the sheath 144, and is attached to the outer peripheral surface of the front-end | tip part of the bronchoscope 132, The target bronchi H4 Inserted into the lumen. Here, when the distal end portion of the endoscope 132 reaches the target site, the operation sheath 144b is pushed out in the distal direction, whereby the indwelling material 143 stored in the indwelling material storage portion 145 is moved in the distal direction. Extrude into. Accordingly, the bronchus H4 is closed so that the outer peripheral surface of the indwelling material 143 is in close contact with the bronchial wall.

  Therefore, in the present embodiment, the indwelling material 143 can be inserted into the lumen of the target bronchi H4 by the bronchoscope 132, and the bronchi H4 can be blocked by the indwelling material 143. 1 has the same effect as that of the first embodiment (see FIGS. 1A to 1C to 4).

  In the present embodiment, the bronchoscope 132 can be used as an insertion device for the bronchial occlusion device as in the sixth embodiment, so that no special insertion device is required. In addition, by using the coil 141 of the indwelling material 143 that has a property of restoring to a specific form such as a shape memory alloy, when the indwelling material 143 is pushed out from the indwelling material storage unit 145, Since it can be expanded to a shape having a larger diameter than the case where it is located, the bronchus having a large inner diameter can be closed.

  FIGS. 22A and 22B show an eighth embodiment of the present invention. In the present embodiment, an indwelling material 151 made of a shape memory material such as a shape memory alloy is provided. This indwelling material 151 has a first shape of a linear shaft portion 152 as shown in FIG. 22 (A) and a shaft portion 152 deformed into a ring shape or a coil shape as shown in FIG. 22 (B). The second shape can be deformed. And the indwelling material 151 of this Embodiment can be deform | transformed into a 1st shape with external forces, such as putting in a thin tube, but when there is no external force, it is hold | maintained with a 2nd shape. Further, a thin film 153 is attached to the shaft portion 152 of the indwelling material 151 along the long axis.

  And the indwelling material 151 of this Embodiment is the state which deform | transformed the axial part 152 into the linear 1st shape, as shown to FIG. 22 (A), this indwelling material 151 is a thin catheter or endoscope. Can pass through. Therefore, the indwelling material 151 is inserted into the bronchus in the state of the first form.

  In addition, after the indwelling material 151 passes through the thin catheter or endoscope channel in the state of the first form, the indwelling material 151 is pushed out of the thin catheter or endoscope channel in the bronchus, thereby In this case, the shaft 152 of the indwelling material 151 returns to the second shape because the external force acting on the 152 is eliminated. 22B, when the shaft portion 152 of the indwelling material 151 is returned to the second shape, the film 153 attached to the shaft portion 152 has a ring-shaped or coil-shaped shaft portion 152. The bronchi are occluded by overlapping each other at the center.

  Therefore, in this embodiment, as shown in FIG. 22A, the indwelling material 151 is passed through a thin catheter or endoscope channel in a state where the shaft portion 152 is deformed into the first linear shape. Is inserted into the lumen of the bronchus H4 and the shaft 152 of the indwelling material 151 is returned to the second shape in the lumen of the bronchi H4 as shown in FIG. Since H4 can be closed, this embodiment has the same effect as that of the first embodiment (see FIGS. 1A to 1C to 4).

  In the present embodiment, the indwelling material 151 once indwelled can be collected by holding it with a forceps for bronchoendoscopy, etc., drawing it into the endoscope channel, and making it into the first shape.

  The film 153 attached to the shaft portion 152 of the indwelling material 151 may be bonded to each other by welding by heating or a biocompatible adhesive such as fiplin glue.

  In addition, the shaft portion 152 of the indwelling material 151 is provided with a stopper such as a protrusion at a portion corresponding to the outer peripheral surface when returning to the second shape in order to prevent dropping or shaking after indwelling in the bronchi. May be.

  FIG. 23 shows a ninth embodiment of the present invention. In the present embodiment, an indwelling material 161 made of a biocompatible material capable of taking two shapes of liquid and solid is provided. Examples of the material having such properties include a resin that is polymerized by light such as blood and ultraviolet light, and a silicon resin that changes from a liquid state to a solid state when mixed with a curing agent.

  Furthermore, in the occlusion device of the present embodiment, a catheter 162 for injecting the liquid indwelling material 161 into the lumen of the bronchus H4 is provided. The catheter 162 is inserted into the channel 164 of the bronchoscope 163, for example, and is inserted into the lumen of the bronchus H4 through the channel 164 of the bronchoscope 163.

  One or a plurality of catheters 162 are provided depending on the properties of the indwelling material 161. Further, the bronchoscope 163 is provided with a light guide 165 for sending light from a light source outside the body to the local area. In the configuration in which the light source is at the distal end portion of the endoscope 163, the light guide 165 may be omitted.

  In the occlusion apparatus of the present embodiment, as shown in FIG. 23, the catheter 162 is inserted into the lumen of the bronchus H4 through the channel 164 of the bronchoscope 163, and the liquid indwelling material 161 is passed through the catheter 162 to the bronchus H4. Injected into the lumen. At this time, the indwelling material 161 injected into the lumen of the bronchus solidifies to block the bronchi H4. Here, the indwelling material 161 injected into the bronchus lumen and solidified enters the bronchus to be obstructed and the complex-shaped bronchus lumen located at the periphery thereof, so that no special configuration is required to prevent the occlusion. .

  Further, in order to prevent the liquid indwelling material 161 from flowing into a place other than the site to be occluded, an obstruction for backflow prevention is placed on the site to be occluded immediately after the indwelling material 161 is injected until solidification is completed. May be detained.

  Therefore, in this embodiment, the catheter 162 is inserted into the lumen of the bronchus H4 through the channel 164 of the bronchoscope 163, and the liquid indwelling material 161 is injected into the lumen of the target bronchus H4 through the catheter 162. After that, the bronchial H4 can be occluded by the solidified indwelling material 161. Therefore, the present embodiment also has the same effect as the first embodiment (see FIGS. 1A to 1C to 4). is there.

  Furthermore, since the liquid indwelling material 161 is used in the present embodiment, it can be used regardless of the shape of the bronchus to be occluded. In addition, there is an effect that the procedure becomes simple.

  The indwelling material 161 and the insertion device may have a structure for passing a guide wire.

Furthermore, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention.
Next, other characteristic technical matters of the present application are appended as follows.
Record
(Additional Item 1) A medical obturator used in the lumen of a subject's luminal organ, comprising an elastic body that can be placed in a branching portion existing in the lumen of the luminal organ. A first occlusion portion having an outer shape capable of sealing one of the lumens branched into a plurality of the luminal organs, and another tube different from the lumen in which the first occlusion portion can be sealed A medical obturator comprising: a second occlusion portion having an outer shape capable of occluding a cavity; and a fixing portion capable of abutting against the branch portion.

  (Additional Item 2) The elastic body is a rod-shaped member having two end portions, the first closing portion includes one end portion of the rod-shaped member, and the second closing portion is the other end of the rod-shaped member. The medical obturator according to Additional Item 1, wherein the medical obturator is included.

  (Additional Item 3) The medical obturator according to Additional Item 2, wherein the elastic body has a diameter at one end larger than a diameter at the other end.

  (Additional Item 4) The medical obturator according to Additional Item 1 or 2, wherein the elastic body is a rod-shaped member and has an undulating portion on an outer surface thereof.

  (Additional Item 5) The medical obturator according to Additional Item 4, wherein the elastic body has a notch portion between the first and second blocking portions.

  (Additional Item 6) The medical obturator according to Additional Item 4, wherein the elastic body has a protrusion on its outer surface.

  (Additional Item 7) The medical obturator according to Additional Item 4, wherein the elastic body has an outer shape in which substantially spherical elastic bodies are integrally connected.

  (Additional Item 8) A medical obturator used in the lumen of a hollow organ of a subject, comprising a hollow rod-like elastic body that can be placed in a branch portion existing in the lumen of the hollow organ, The rod-shaped elastic body has a diameter that allows an outer periphery of the rod-shaped elastic body to be in contact with a lumen wall of the hollow organ, and is inserted into one of the lumens branched into a plurality of the hollow organs. An insertion portion; a second insertion portion that can be inserted into another lumen different from the lumen into which the first insertion portion can be inserted; and a fixing portion that can contact the branch portion. A medical obturator characterized by comprising:

  (Additional Item 9) The rod-shaped elastic body has two end portions, the first insertion portion includes one end portion of the rod-shaped elastic body, and the second insertion portion is the rod-shaped elastic body. The medical obturator according to claim 8, wherein an opening connected to the hollow portion of the rod-like elastic body is formed in at least one of the two end portions.

  (Additional Item 10) The Additional Item, wherein the elastic body has an opening connected to the hollow portion between the two end portions, and one end portion of the rod-shaped elastic body is closed. 9. The medical obturator according to 9.

  (Additional Item 11) A medical obturator used in the lumen of a hollow organ of a subject, comprising an elastic body that can be placed in a branching portion existing in the lumen of the hollow organ, and the elastic body Has a T-shape or a Y-shape, and has a plurality of rod-shaped portions extending in three different directions, and a fixing portion that is configured by the intersection of the plurality of rod-shaped portions and that can contact the branch portion. And at least one of the said rod-shaped parts has the external shape which can seal the lumen of the said luminal organ, The medical obturator characterized by the above-mentioned.

  (Additional Item 12) A medical obturator used in the lumen of a hollow organ of a subject, comprising a hollow rod-like elastic body that can be placed in a branch portion existing in the lumen of the hollow organ, The elastic body has a diameter that allows an outer periphery of the elastic body to be in contact with a lumen wall of the luminal organ, has a T-shape or a Y-shape, and has a plurality of rod-shaped portions extending in three different directions, A medical device comprising: a fixed portion that can be brought into contact with the branch portion; and a blocking member that is inserted into a hollow portion of the rod-shaped portion and can seal a lumen. Obturator.

  (Additional Item 13) A medical obturator used in the lumen of a subject's luminal organ, which can be placed in front of a branching portion existing in the lumen of the luminal organ, A medical obturator comprising: an occluding member having a sealable outer shape; and an occluding portion fixing means attached to the occluding member and capable of locking the branch portion.

  (Additional Item 14) A medical obturator used in the lumen of a luminal organ of a subject, characterized by having a wire having a shape memory property and a film attached to the wire. Medical obturator.

  (Additional Item 15) A human or animal bronchus or bronchiole occlusion device comprising an indwelling material and an insertion device is characterized in that the indwelling material is a flexible rod-shaped member.

  (Additional Item 16) In the closing device according to Additional Item 15, the shape of the indwelling material is T-shaped or Y-shaped.

  (Additional Item 17) In the closing device according to Additional Item 15, the indwelling material is a rod-shaped member having a plurality of diameters between 3 mm and 10 mm.

  (Additional Item 18) In the closing device according to Additional Item 15, the indwelling material is characterized in that the diameter of one end is larger than the diameter of the other end.

  (Additional Item 19) In a human or animal bronchi or bronchiole occlusion device comprising an indwelling material and an insertion device, the indwelling material is constituted by a balloon and an inflatable material accommodated in the balloon.

  (Additional Item 20) In the closing device according to Additional Items 15 and 19, a clip is connected to the indwelling material.

  (Additional Item 21) In the occlusion device according to Additional Items 15 and 19, the indwelling material is attached to and inserted into the outer peripheral surface of the endoscope.

  (Additional Item 22) A human or animal bronchi or bronchiole occlusion device comprising an indwelling material and an insertion device is characterized in that the occlusion material can take two forms, liquid and solid.

  (Additional Item 23) A human or animal bronchus or bronchiole occlusion device comprising an indwelling material and an insertion device is composed of a wire having a shape memory property and a membrane attached to the wire.

  (Additional Item 24) In the closing device according to Additional Item 23, the indwelling material is made of a material that can be bonded to each other.

  (Additional Item 25) In the closing device according to Additional Items 15, 19, 22, and 23, the insertion device has a configuration in which a plurality of indwelling materials can be continuously placed.

  (Additional Item 26) An occlusion device for human or animal bronchi or bronchiole comprising an indwelling material and an insertion device is characterized in that the indwelling material once placed can be collected.

  (Additional Item 27) A method for treating emphysema, pulmonary fistula, bronchial fistula and other pulmonary diseases by placing an obstruction in the bronchi or bronchioles of humans and animals.

  (Additional Item 28) A medical occlusion device used in the lumen of a hollow organ of a subject, and a tubular elastic body that can be placed in a branch portion of a lumen that branches into a plurality of lumens in the lumen of the hollow organ And the outer circumference of the tubular elastic body has a diameter that allows contact with the wall surface of the lumen of the luminal organ, and is inserted into one first branch lumen of the branch portion of the lumen. An insertion portion, a second insertion portion that can be inserted into another second branch lumen different from the first branch lumen, and a joint between the first and second branch lumens are locked. A medical obturator characterized in that a possible locking portion is provided on the tubular elastic body.

  (Operation of Additional Item 28) In the additional item 28, the first branch lumen of the branch portion of the lumen that branches into a plurality of lumens in the lumen of the bronchus that is a luminal organ distributed in the emphysema lesion is provided in the first branch lumen. The end of the joint portion between the first and second branch lumens with the insertion portion inserted and the second insertion portion inserted into another second branch lumen different from the first branch lumen The tubular elastic body is detained at the branch portion by engaging the engaging portion with the edge portion. As a result, the lumen of the bronchus distributed in the emphysema lesion is completely occluded by the tubular elastic body, and new air is prevented from flowing into the emphysema lesion.

  (Additional Item 29) A medical obturator used in the lumen of a hollow organ of a subject, comprising an indwelling elastic body that can be placed in a branching portion existing in the lumen of the hollow organ, The indwelling elastic body extends in three different directions, is formed in a T-shape or Y-shape, and a portion where the rod-like portion inserted into each different lumen of the branch portion of the lumen intersects the rod-like portion in the three directions And a locking portion that can be locked to the branch portion, and at least one of the rod-shaped portions has an outer shape capable of sealing the lumen of the luminal organ. Obturator.

  (Operation of Additional Item 29) In the additional item 29, T-shaped or Y-shaped shapes are formed in different lumens of the branching portion of the lumen that branches into a plurality of lumens of the bronchial lumen that is a luminal organ distributed in the emphysema lesion. In the state where the formed three-way rod-shaped portion is inserted, the retaining elastic portion is retained at the branch portion by retaining the retaining portion at the branch portion. As a result, the lumen of the bronchus distributed in the emphysema lesion is completely occluded by the indwelling elastic body to prevent new air from flowing into the emphysema lesion.

  (Additional Item 30) A medical obturator used in the lumen of a hollow organ of a subject, comprising a tubular elastic body that can be placed in a branching portion existing in the lumen of the hollow organ, and the tubular The elastic body has a diameter that allows the outer periphery of the elastic body to come into contact with the wall of the lumen of the luminal organ, extends in three different directions and extends in a T-shape or a Y-shape, and each of the branch portions of the lumen is different. An extending portion to be inserted into the lumen and a portion where the extending portions in the three directions intersect with each other, a locking portion that can be locked to the branch portion, and a lumen that is inserted into the inner tube portion of the extending portion. And a closure member capable of sealing.

  (Operation of Additional Item 30) In the additional item 30, a T-shape or a Y-shape is formed in different lumens of a branching portion of a lumen that branches into a plurality of lumens of a bronchial lumen that is a luminal organ distributed in an emphysema lesion. The tubular elastic body is detained at the branching portion by locking the locking portion at the branching portion in a state where the formed extending portions in the three directions are inserted. Further, the lumen is sealed by inserting a blocking member into the tube portion of the extended portion. As a result, the lumen of the bronchus distributed in the emphysema lesion is completely occluded by the tubular elastic body, and new air is prevented from flowing into the emphysema lesion. In addition, by arbitrarily selecting the extending portion into which the occluding member is inserted, it is possible to block only a part of the branching portion of the lumen branching into a plurality of portions and hold the rest in the opened state.

  (Object of Additional Items 1 to 30) The present invention solves the above problems in surgical treatment of emphysema by performing transbronchial bronchial obstruction.

  (Operation of Additional Item 1) Provided is an occlusion device for completely blocking an indwelling material by placing an indwelling material in a lumen of a bronchus distributed in an emphysema lesion, and preventing new air from flowing into the emphysema lesion. The volume of the emphysema lesion before treatment is very large due to the accumulation of excess air, but this air is carried locally via the bronchus of the lesion, so air supply to the lesion is not possible. When blocked, the air stored in the bloodstream and the like naturally decreases. As a result, the volume of the pulmonary emphysema lesion that has been expanded by air is reduced, and as a result, the same effect as the lung volume reduction operation can be obtained.

    2 ... Indwelling material (elastic body for indwelling), H4 ... Bronchi (luminal organ), H4b ... Branching part, H4c ... First branching lumen, H4d ... Second branching lumen, 9 ... First obstruction part 10 ... 2nd obstruction | occlusion part, 11 ... Locking part.

Claims (3)

  A medical obturator used in the lumen of a subject's luminal organ, comprising a resilient elastic body that can be placed in a branching portion of a lumen that branches into a plurality of lumens of the luminal organ, A first occlusion portion capable of sealing one first branch lumen of the bifurcation portion, and a second occlusion portion capable of closing another second branch lumen different from the first branch lumen; A medical obturator, wherein the indwelling elastic body is provided with a locking portion that can be locked to an end edge portion of a joint portion between the first and second branch lumens.   A medical obturator used in the lumen of a subject's luminal organ, which can be placed in a lumen in the vicinity of a branching portion existing in the lumen of the luminal organ, and the lumen is hermetically sealed A medical obturator comprising: an occluding member having a possible outer shape; and an occluding portion fixing means attached to the occluding member and capable of locking the branch portion.   A medical obturator used in the lumen of a luminal organ of a subject, comprising a wire having a shape memory property and a film attached to the wire. .

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