JP2012075604A - Therapeutic instrument - Google Patents

Therapeutic instrument Download PDF

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Publication number
JP2012075604A
JP2012075604A JP2010222670A JP2010222670A JP2012075604A JP 2012075604 A JP2012075604 A JP 2012075604A JP 2010222670 A JP2010222670 A JP 2010222670A JP 2010222670 A JP2010222670 A JP 2010222670A JP 2012075604 A JP2012075604 A JP 2012075604A
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Prior art keywords
forceps
guide wire
pericardium
gripping
treatment tool
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Japanese (ja)
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Satoru Kikuchi
悟 菊池
Masayuki Kobayashi
雅之 小林
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Olympus Corp
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Olympus Corp
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Priority to JP2010222670A priority Critical patent/JP2012075604A/en
Priority to PCT/JP2011/053528 priority patent/WO2012042920A1/en
Publication of JP2012075604A publication Critical patent/JP2012075604A/en
Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M25/09041—Mechanisms for insertion of guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0482—Needle or suture guides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Pulmonology (AREA)
  • Ophthalmology & Optometry (AREA)
  • Biophysics (AREA)
  • Surgical Instruments (AREA)

Abstract

PROBLEM TO BE SOLVED: To introduce a guide wire into a pericardial space, while preventing the tip of the guide wire from coming into contact with the heart.SOLUTION: A therapeutic instrument 1 provided herein includes forceps 3 which grasp a living tissue, a body 2 which is provided on the forceps 3, an actuator 5 which is provided on the body 2 and operates the forceps 3, a channel part 10 which leads out the guide wire 9 to be introduced into the living tissue, and an articulated mechanism 4 which is provided in the body 2 and rocks the forceps 3 in the direction crossing the direction of the longitudinal axis of the body 2. According to this invention, the guide wire 9 is introduced into the pericardial space along the almost tangential direction of the heart by inclining the forceps 3 to a pericardium by the articulated mechanism 4.

Description

本発明は、処置具に関するものである。   The present invention relates to a treatment instrument.

従来、心膜をつまんだ状態で穿刺することにより、ガイドワイヤを心膜腔内に導入する処置具が知られている（例えば、特許文献１参照。）。   Conventionally, there has been known a treatment instrument for introducing a guide wire into a pericardial cavity by puncturing the pericardium in a pinched state (for example, see Patent Document 1).

米国特許第５９３１８１０号明細書US Pat. No. 5,931,810

しかしながら、特許文献１の場合、ガイドワイヤを心膜に貫通させたときに、心膜と隣接する心臓にガイドワイヤの先端が接触してしまう可能性があるという問題がある。
本発明は、上述した事情に鑑みてなされたものであって、ガイドワイヤの先端が心臓に接触することを防止しながらガイドワイヤを心膜腔内に導入することができる処置具を提供することを目的とする。 However, in the case of Patent Document 1, when the guide wire is penetrated through the pericardium, there is a problem that the tip of the guide wire may come into contact with the heart adjacent to the pericardium.
The present invention has been made in view of the above-described circumstances, and provides a treatment instrument capable of introducing a guide wire into the pericardial cavity while preventing the tip of the guide wire from contacting the heart. With the goal.

上記目的を達成するため、本発明は以下の手段を提供する。
本発明は、生体組織を把持する鉗子部と、該鉗子部に設けられた本体部と、該本体部に設けられ、前記鉗子部を操作する操作部と、前記生体組織に導入するガイドワイヤを導出するチャネル部と、前記本体部に設けられ、該本体部の長手軸方向に交差する方向に前記鉗子部を揺動させる関節機構とを備える処置具を提供する。 In order to achieve the above object, the present invention provides the following means.
The present invention provides a forceps part for gripping a living tissue, a main body part provided on the forceps part, an operation part provided on the main body part for operating the forceps part, and a guide wire introduced into the living tissue. There is provided a treatment instrument including a channel portion to be led out and a joint mechanism that is provided in the main body portion and swings the forceps portion in a direction intersecting a longitudinal axis direction of the main body portion.

本発明によれば、本体部を体内に挿入して鉗子部を心膜まで到達させ、該鉗子部により心膜を把持した状態でチャネル部内に挿入されたガイドワイヤを押し出すことにより、ガイドワイヤを心膜に貫通させて心膜腔内に導入することができる。
この場合に、鉗子部で心膜を把持した状態で関節機構により鉗子部を揺動させ、鉗子部を心膜に沿って傾けた姿勢でガイドワイヤを押し出す。これにより、鉗子部の先端が心臓表面の略接線方向に向けられて該略接線方向に沿ってガイドワイヤが突出させられるので、ガイドワイヤが心膜腔内に導入されたときにその先端が心臓に接触することを防止することができる。 According to the present invention, the main body is inserted into the body, the forceps part reaches the pericardium, and the guide wire inserted into the channel part in a state where the pericardium is gripped by the forceps, It can be introduced into the pericardial cavity through the pericardium.
In this case, the forceps unit is swung by the joint mechanism while the pericardium is gripped by the forceps unit, and the guide wire is pushed out with the forceps unit tilted along the pericardium. As a result, the distal end of the forceps part is directed in a substantially tangential direction of the heart surface, and the guide wire is projected along the substantially tangential direction. Therefore, when the guide wire is introduced into the pericardial cavity, the distal end of the forceps part becomes the heart. Can be prevented from touching.

上記発明においては、前記関節機構に設けられ、前記鉗子部の揺動方向を制限する制限手段を備えることとしてもよい。
このようにすることで、鉗子部の揺動方向が予め分かるので、鉗子部を揺動させたときのガイドワイヤと心膜との位置関係を把握してガイドワイヤをより確実に心膜に貫通させることができる。 In the said invention, it is good also as providing the limiting means which is provided in the said joint mechanism and restrict | limits the rocking | fluctuation direction of the said forceps part.
By doing so, the swinging direction of the forceps portion can be known in advance, so that the positional relationship between the guide wire and the pericardium when the forceps portion is swung can be grasped and the guide wire can be more securely penetrated into the pericardium. Can be made.

また、上記発明においては、前記関節機構に設けられ、前記鉗子部の揺動を固定する固定手段を備えることとしてもよい。
このようにすることで、鉗子部により心膜を把持する必要がないときは鉗子部を閉じた状態で操作することにより、鉗子部が意図せずに揺動してしまうことにより操作が妨げられることを防ぎ、操作性を向上することができる。 Moreover, in the said invention, it is good also as providing the fixing means provided in the said joint mechanism and fixing rocking | fluctuation of the said forceps part.
In this way, when it is not necessary to grip the pericardium with the forceps, the operation is hindered by unintentionally swinging the forceps by operating with the forceps closed. This can be prevented and the operability can be improved.

また、上記発明においては、前記鉗子部と連結し、前記操作部の把持動作を前記鉗子部に伝達する把持力伝達部材と、前記本体部に設けられ、前記把持力伝達部材を嵌合させる嵌合部とを備え、前記固定手段が、前記嵌合部を介して前記鉗子部の揺動方向を固定することとしてもよい。
このようにすることで、操作者の操作部の把持操作に伴って把持力伝達部材が嵌合部に嵌合させられることにより鉗子部の揺動が固定されるので、鉗子部が不要に揺動して操作の妨げとなることを防ぐことができる。 Further, in the above invention, a gripping force transmission member that is connected to the forceps portion and transmits a gripping operation of the operation portion to the forceps portion, and a fitting provided on the main body portion for fitting the gripping force transmission member. It is good also as comprising the joint part and the said fixing means fixing the rocking | fluctuation direction of the said forceps part via the said fitting part.
By doing so, the gripping force transmission member is fitted into the fitting portion in accordance with the gripping operation of the operation portion by the operator, so that the swinging of the forceps portion is fixed. It can be prevented from moving and obstructing operation.

また、上記発明においては、前記鉗子部が、生体組織面に沿った形状に形成されていることとしてもよい。
このようにすることで、鉗子部を心膜上に倒したときに鉗子部が心膜の形状に沿って配置されるので、鉗子部の姿勢を安定させることができる。 Moreover, in the said invention, the said forceps part is good also as being formed in the shape along the biological tissue surface.
By doing so, since the forceps portion is arranged along the shape of the pericardium when the forceps portion is tilted on the pericardium, the posture of the forceps portion can be stabilized.

また、上記発明においては、前記関節機構が、複数の関節を備えることとしてもよい。
このようにすることで、鉗子部を傾けたときに心膜の形状に沿って各関節が揺動して関節機構が心膜に沿って配置されるので、鉗子部の姿勢を安定させることができる。 In the invention described above, the joint mechanism may include a plurality of joints.
In this way, when the forceps part is tilted, each joint swings along the pericardium shape and the joint mechanism is arranged along the pericardium, so that the posture of the forceps part can be stabilized. it can.

本発明によれば、ガイドワイヤの先端が心臓に接触することを防止しながらガイドワイヤを心膜腔に導入することができるという効果を奏する。   According to the present invention, the guide wire can be introduced into the pericardial space while preventing the tip of the guide wire from contacting the heart.

本発明の一実施形態に係る処置具の全体構成図であり、鉗子部を開いた状態を示している。It is a whole block diagram of the treatment tool which concerns on one Embodiment of this invention, and has shown the state which opened the forceps part. 図１の処置具の鉗子部を閉じた状態を示す図である。It is a figure which shows the state which closed the forceps part of the treatment tool of FIG. 図１の処置具の先端側の一部を拡大した側面図であり、鉗子部を閉じた状態を示している。It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. 図１の処置具の先端側の一部を拡大した平面図であり、鉗子部を閉じた状態を示している。It is the top view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. 図１の処置具の先端側の一部を拡大した側面図であり、鉗子部を開いた状態を示している。It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which opened the forceps part. 関節部による鉗子部の揺動動作を説明する図である。It is a figure explaining rocking | fluctuation operation | movement of the forceps part by a joint part. 図１の処置具の使用方法を説明する図であり、鉗子部を心膜まで挿入した状態を示している。It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which inserted the forceps part to the pericardium. 図１の処置具の使用方法を説明する図であり、鉗子部により心膜を把持して該心膜を引っ張った状態を示している。It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which hold | gripped the pericardium with the forceps part and pulled this pericardium. 図１の処置具の使用方法を説明する図であり、ガイドワイヤを心膜に貫通させた状態を示している。It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which penetrated the pericardium. 鉗子部の変形例を示す図である。It is a figure which shows the modification of a forceps part. 関節部の変形例を示す図である。It is a figure which shows the modification of a joint part.

以下に、本発明の一実施形態に係る処置具１について図面を参照して説明する。
本実施形態に係る処置具１は、図１および図２に示されるように、体内に挿入される硬性の挿入部（本体部）２と、該挿入部２の先端側に配置された鉗子部３と、該鉗子部３を挿入部２の先端に揺動可能に連結する関節部（関節機構）４と、操作者によって把持操作されることにより鉗子部３を開閉する操作部５とを備えている。図１は鉗子部３が開いた状態を示し、図２は鉗子部３が閉じた状態を示している。 Hereinafter, a treatment tool 1 according to an embodiment of the present invention will be described with reference to the drawings.
As shown in FIGS. 1 and 2, the treatment instrument 1 according to the present embodiment includes a rigid insertion portion (main body portion) 2 that is inserted into the body and a forceps portion that is disposed on the distal end side of the insertion portion 2. 3, a joint part (joint mechanism) 4 that pivotally connects the forceps part 3 to the distal end of the insertion part 2, and an operation part 5 that opens and closes the forceps part 3 when operated by an operator. ing. FIG. 1 shows a state in which the forceps portion 3 is opened, and FIG. 2 shows a state in which the forceps portion 3 is closed.

挿入部２は、細長い筒状であり、金属などの硬質な材料からなる。挿入部２内には、両端が開口したルーメン（嵌合部）２ａが長手方向に沿って形成されている。
鉗子部３は、図３および図４に示されるように、一対の把持片６ａ，６ｂを備え、該把持片６ａ，６ｂは、基端側がリンク機構７により互いに連結されている。リンク機構７は、図３に示されるように、後述する把持力伝達部材８が後退したときに把持片６ａ，６ｂを閉じさせ、図５に示されるように、把持力伝達部材８が前進したときに把持片６ａ，６ｂを開かせるようになっている。一方の把持片６ａには、ガイドワイヤ９を挿入可能なチャネル（チャネル部）１０が形成されている。チャネル１０は、把持片６ａの先端と外面に開口している。 The insertion portion 2 has an elongated cylindrical shape and is made of a hard material such as metal. In the insertion portion 2, a lumen (fitting portion) 2a having both ends opened is formed along the longitudinal direction.
As shown in FIGS. 3 and 4, the forceps portion 3 includes a pair of gripping pieces 6 a and 6 b, and the gripping pieces 6 a and 6 b are connected to each other by a link mechanism 7 on the base end side. As shown in FIG. 3, the link mechanism 7 closes the gripping pieces 6 a and 6 b when a gripping force transmission member 8, which will be described later, retreats, and the gripping force transmission member 8 moves forward as shown in FIG. 5. Sometimes the gripping pieces 6a and 6b are opened. A channel (channel portion) 10 into which a guide wire 9 can be inserted is formed on one gripping piece 6a. The channel 10 opens at the tip and outer surface of the gripping piece 6a.

関節部４は、連結部材１１を介して鉗子部３を挿入部２に連結している。連結部材１１は、先端側がリンク機構７の先端側の節の位置において把持片６ａ，６ｂを揺動可能に取り付け、基端側が関節部４によって挿入部２の先端に連結されている。関節部４は、図６に示されるように、該関節部４を揺動の中心にして、把持片６ａ，６ｂが開閉する方向と略同一方向に揺動可能に、鉗子部３を挿入部２に連結している。連結部材１１には、関節部４による鉗子部３の揺動方向を、チャネル９を有する側の把持片６ａが外側に向けられる方向のみに制限するストッパ（制限手段）１１ａが設けられている。   The joint portion 4 connects the forceps portion 3 to the insertion portion 2 via the connecting member 11. The connecting member 11 has a distal end side attached to the gripping pieces 6 a and 6 b so as to be swingable at the position of the distal end side of the link mechanism 7, and a proximal end side connected to the distal end of the insertion portion 2 by the joint portion 4. As shown in FIG. 6, the joint portion 4 has the forceps portion 3 inserted into the insertion portion so that the joint portion 4 can swing in the substantially same direction as the direction in which the gripping pieces 6 a and 6 b open and close. 2 is connected. The connecting member 11 is provided with a stopper (restricting means) 11a that restricts the swinging direction of the forceps portion 3 by the joint portion 4 only in the direction in which the grip piece 6a on the side having the channel 9 is directed outward.

操作部５は、挿入部２に対して固定された固定ハンドル１２ａと、可動ハンドル１２ａとを備えている。可動ハンドル１２ａは、把持力伝達部材８を介して鉗子部３と接続されている。把持力伝達部材８は、ルーメン２ａ内に進退方向に移動可能に挿入され、関節部４を貫通して把持片６ａ，６ｂの基端に接続されている。   The operation unit 5 includes a fixed handle 12a fixed to the insertion unit 2 and a movable handle 12a. The movable handle 12 a is connected to the forceps portion 3 through the gripping force transmission member 8. The gripping force transmitting member 8 is inserted into the lumen 2a so as to be movable in the forward / backward direction, penetrates the joint portion 4, and is connected to the base ends of the gripping pieces 6a, 6b.

操作部５は、操作者が固定ハンドル１２ａおよび可動ハンドル１２ｂを握ったときに、可動ハンドル１２ｂが固定ハンドル１２ａに接近し、把持力伝達部材８が基端側に引っ張られるように構成されている。これにより、操作者は、両ハンドル１２ａ，１２ｂを握ることにより把持片６ａ，６ｂを閉じることができる。一方、操作部５は、操作者が両ハンドル１２ａ，１２ｂから手を離したときには、把持力伝達部材８が前進して把持片６ａ，６ｂを開かせるようになっている。両ハンドル１２ａ，１２ｂの相対位置を固定することにより把持片６ａ，６ｂの開き角度を一定に保持する図示しない固定手段が操作部５に設けられていてもよい。   The operation unit 5 is configured such that when the operator grips the fixed handle 12a and the movable handle 12b, the movable handle 12b approaches the fixed handle 12a and the gripping force transmission member 8 is pulled to the proximal end side. . Thereby, the operator can close the gripping pieces 6a and 6b by grasping both the handles 12a and 12b. On the other hand, the operation unit 5 is configured such that when the operator releases his / her hands from both the handles 12a and 12b, the gripping force transmitting member 8 moves forward to open the gripping pieces 6a and 6b. Fixing means (not shown) for holding the opening angle of the gripping pieces 6a, 6b constant by fixing the relative positions of the two handles 12a, 12b may be provided in the operation unit 5.

また、把持力伝達部材８は、ルーメン２ａの内面との間に十分狭い隙間を形成する径寸法を有する硬質なシャフト部（固定手段）８ａと、該シャフト部８ａの先端側に設けられた可撓性を有するワイヤ部（可撓部）８ｂとを有している。シャフト部８ａは、前進させられたときに、関節部４を貫通してその先端が関節部４よりも前方に配され、一方後退させられたときに、関節部４よりも後方に配されるように設けられている。   The gripping force transmission member 8 includes a hard shaft portion (fixing means) 8a having a diameter that forms a sufficiently narrow gap with the inner surface of the lumen 2a, and a movable shaft 8a provided on the distal end side of the shaft portion 8a. And a flexible wire portion (flexible portion) 8b. When the shaft portion 8a is advanced, the shaft portion 8a penetrates the joint portion 4 and the tip thereof is disposed forward of the joint portion 4. On the other hand, when the shaft portion 8a is retracted, the shaft portion 8a is disposed rearward of the joint portion 4. It is provided as follows.

ここで、関節部４よりも前方に配されたシャフト部６ａの先端が嵌合させられる溝（嵌合部、固定手段）１３が連結部材１１に形成されている。これにより、把持片６ａ，６ｂを開いた状態においては、シャフト部８ａが、関節部４を間に挟んで、連結部材１１の溝１３と挿入部２のルーメン２ａの両方に嵌合させられることにより、挿入部２に対する鉗子部３の角度が、挿入部２の長手方向に沿う方向に固定されるようになっている。一方、把持片６ａ，６ｂが閉じた状態においては、関節部４の位置にワイヤ部８ｂが配され、鉗子部３が揺動可能な状態となる。   Here, a groove (fitting portion, fixing means) 13 into which the tip of the shaft portion 6 a disposed in front of the joint portion 4 is fitted is formed in the connecting member 11. Thereby, in a state where the gripping pieces 6a and 6b are opened, the shaft portion 8a is fitted into both the groove 13 of the connecting member 11 and the lumen 2a of the insertion portion 2 with the joint portion 4 interposed therebetween. Thus, the angle of the forceps portion 3 with respect to the insertion portion 2 is fixed in a direction along the longitudinal direction of the insertion portion 2. On the other hand, in the state where the gripping pieces 6a and 6b are closed, the wire portion 8b is arranged at the position of the joint portion 4, and the forceps portion 3 can swing.

次に、このように構成された処置具１の作用について説明する。
本実施形態に係る処置具１を使用してガイドワイヤ９を心膜腔Ａ内に導入するためには、ガイドワイヤ９の先端部分をチャネル１０内に収納した状態で挿入部２を体内に挿入し、鉗子部３を心膜Ｂの外側に配置する。このときに、図７に示されるように、把持片６ａ，６ｂを開いた状態で処置具１を体内に挿入することにより、シャフト部８ａが嵌合するので、鉗子部３が不要に揺動したり体内の組織に引っ掛かったりすることを防いでスムーズに挿入部２を走行させることができる。 Next, the operation of the treatment instrument 1 configured as described above will be described.
In order to introduce the guide wire 9 into the pericardial cavity A using the treatment instrument 1 according to the present embodiment, the insertion portion 2 is inserted into the body while the distal end portion of the guide wire 9 is housed in the channel 10. Then, the forceps 3 is disposed outside the pericardium B. At this time, as shown in FIG. 7, when the treatment tool 1 is inserted into the body with the gripping pieces 6a and 6b opened, the shaft portion 8a is fitted, so that the forceps portion 3 swings unnecessarily. It is possible to smoothly run the insertion portion 2 while preventing it from being caught or caught on the tissue in the body.

鉗子部３を心膜Ｂの外側まで到達させた後、図８に示されるように、把持片６ａ，６ｂで心膜Ｂを把持し、挿入部２を若干引き戻すことにより、心膜Ｂを引っ張る。この状態で、シャフト部８ａが溝１３との嵌合から外れるので、関節部４により鉗子部３を揺動させて傾け、心膜Ｂ上に倒す。これにより、図９に示されるように、ガイドワイヤ９を有する側の把持片６ａが折り畳まれた心膜Ｂの間に挟まれるとともに、その把持片６ａの先端に設けられたチャネル１０の開口が、心臓Ａ表面の接線方向に向けられる。この状態で、ガイドワイヤ９を基端側で押してチャネル１０から突出させることにより、ガイドワイヤ９の先端を張力がかかった状態の心膜Ｂに容易に貫通させて、ガイドワイヤ９を心膜腔Ａ内に導入することができる。   After the forceps portion 3 reaches the outside of the pericardium B, as shown in FIG. 8, the pericardium B is gripped by the gripping pieces 6a and 6b, and the insertion portion 2 is pulled back slightly to pull the pericardium B. . In this state, since the shaft portion 8 a is disengaged from the fitting with the groove 13, the forceps portion 3 is rocked and tilted by the joint portion 4 and is tilted on the pericardium B. As a result, as shown in FIG. 9, the grip piece 6a on the side having the guide wire 9 is sandwiched between the pericardium B folded, and the opening of the channel 10 provided at the tip of the grip piece 6a is opened. , Directed tangential to the surface of the heart A. In this state, the guide wire 9 is pushed proximally to protrude from the channel 10 so that the distal end of the guide wire 9 can easily penetrate the pericardium B in a tensioned state, and the guide wire 9 is inserted into the pericardial cavity. A can be introduced into A.

チャネル１０からガイドワイヤ９を押し出す前に、図示しない穿刺針をガイドワイヤ９に沿って心膜Ｂまで挿入し、チャネル１０内から穿刺針を押し出して心膜Ｂに穿刺することにより、ガイドワイヤ９を貫通させるための穿孔を心膜Ｂに予め形成してもよい。
ガイドワイヤ９を心膜腔Ａ内の所望の位置まで挿入した後は、ガイドワイヤ９を留置したまま、該ガイドワイヤ９に沿って処置具１を体内から引き抜く。これにより、内視鏡などのデバイスを、体外と心膜腔Ａ内との間でガイドワイヤ９に沿って容易に挿脱することができる。 Before pushing out the guide wire 9 from the channel 10, a puncture needle (not shown) is inserted into the pericardium B along the guide wire 9, and the puncture needle is pushed out from the channel 10 to puncture the pericardium B. Perforation for penetrating the pericardium may be formed in the pericardium B in advance.
After the guide wire 9 is inserted to a desired position in the pericardial cavity A, the treatment instrument 1 is pulled out from the body along the guide wire 9 while the guide wire 9 remains in place. Thereby, a device such as an endoscope can be easily inserted and removed along the guide wire 9 between the outside of the body and the pericardial cavity A.

この場合に、従来の処置具では、心臓Ｃ表面に略垂直な方向にガイドワイヤ９を押し出して心膜Ｂに貫通させていた。つまり、ガイドワイヤ９が、先端を心臓Ｃに向けた状態で心膜腔Ａ内に導入されるため、ガイドワイヤ９の先端が心膜Ｂを貫通した後に心臓Ｃに接触しやすかった。これに対し、本実施形態によれば、ガイドワイヤ９が、心臓Ｃ表面の略接線方向に沿って、すなわち、先端を心臓Ｃからそれた方向に向けた状態で心膜Ｂに貫通させられる。これにより、ガイドワイヤ９の先端を心臓Ｃに接触させることなくガイドワイヤ９を心膜腔Ａ内に導入することができるという利点がある。   In this case, in the conventional treatment instrument, the guide wire 9 is pushed out in a direction substantially perpendicular to the surface of the heart C and penetrated into the pericardium B. In other words, since the guide wire 9 is introduced into the pericardial cavity A with the distal end directed toward the heart C, the guide wire 9 easily contacts the heart C after passing through the pericardium B. On the other hand, according to the present embodiment, the guide wire 9 is penetrated through the pericardium B along the substantially tangential direction of the surface of the heart C, that is, with the tip directed away from the heart C. Accordingly, there is an advantage that the guide wire 9 can be introduced into the pericardial cavity A without bringing the tip of the guide wire 9 into contact with the heart C.

本実施形態においては、ガイドワイヤ９を挿入するチャネル１０が一方の把持片６ａにのみ設けられていることとしたが、これに代えて、両方の把持片６ａ，６ｂに設けられていてもよい。この場合には、ストッパ１１ａは不要である。
このように構成された処置具１を使用するときは、例えば、ガイドワイヤ９をチャネル１０に装着せずに挿入部２を体内に挿入し、把持片６ａ，６ｂにより心膜Ｂを把持した鉗子部３を心膜Ｂ上に倒した後、心膜Ｂと隣接した側に配置された把持片６ａ，６ｂのチャネル１０を選択して該チャネル１０にガイドワイヤ９を挿入してもよい。 In the present embodiment, the channel 10 into which the guide wire 9 is inserted is provided only in one gripping piece 6a. Alternatively, the channel 10 may be provided in both gripping pieces 6a and 6b. . In this case, the stopper 11a is not necessary.
When using the treatment instrument 1 configured as described above, for example, forceps in which the insertion portion 2 is inserted into the body without attaching the guide wire 9 to the channel 10 and the pericardium B is grasped by the grasping pieces 6a and 6b. After tilting the part 3 on the pericardium B, the channel 10 of the gripping pieces 6 a and 6 b arranged on the side adjacent to the pericardium B may be selected and the guide wire 9 may be inserted into the channel 10.

また、本実施形態においては、図１０に示されるように、チャネル１０を有する把持片６ａの外面が心膜Ｂの表面形状に沿った凹んだ湾曲形状に形成されていてもよい。このようにすることで、鉗子部３を心膜Ｂ上に倒したときに、把持片６ａの外面が心膜Ｂの形状に沿って配置されることにより、心膜Ｂに対して把持片６ａ，６ｂの姿勢を安定させることができる。
なお、チャネル１０が一方の把持片６ａにのみ設けられている場合でも、ストッパ１１ａがなくてもよい。 In the present embodiment, as shown in FIG. 10, the outer surface of the gripping piece 6 a having the channel 10 may be formed in a concave curved shape along the surface shape of the pericardium B. By doing in this way, when the forceps part 3 is fallen on the pericardium B, the outer surface of the gripping piece 6a is arranged along the shape of the pericardium B, so that the gripping piece 6a with respect to the pericardium B is arranged. , 6b can be stabilized.
Even when the channel 10 is provided only on one gripping piece 6a, the stopper 11a may not be provided.

また、本実施形態においては、図１１に示されるように、関節部４が、鉗子部３を挿入部２に連結する位置の他に、挿入部２の長手方向に間隔を空けて複数（図示する例では２つ）の関節４ａを有していてもよい。
このようにしても、鉗子部３を心膜Ｂ上に倒したときに、各関節部４ａの位置で曲がり関節部４が心膜Ｂの形状に沿って配置されることにより、鉗子部３の姿勢を安定させることができる。 Further, in the present embodiment, as shown in FIG. 11, in addition to the position where the forceps portion 3 is connected to the insertion portion 2, a plurality of joint portions 4 are spaced apart in the longitudinal direction of the insertion portion 2 (illustrated). In this example, two joints 4a may be provided.
Even if it does in this way, when the forceps part 3 is fall | descended on the pericardium B, it will bend in the position of each joint part 4a, and the joint part 4 will be arrange | positioned along the shape of the pericardium B, Therefore The posture can be stabilized.

１ 処置具
２ 挿入部（本体部）
２ａ ルーメン（嵌合部）
３ 鉗子部
４ 関節部（関節機構）
４ａ 関節
５ 操作部
６ａ，６ｂ 把持片
７ リンク機構
８ 把持力伝達部材
８ａ シャフト部（固定手段）
８ｂ ワイヤ部（可撓部）
９ ガイドワイヤ
１０ チャネル（チャネル部）
１１ 連結部材
１１ａ ストッパ（制限手段）
１２ａ 固定ハンドル
１２ｂ 可動ハンドル
１３ 溝（嵌合部、固定手段）
Ａ 心膜腔
Ｂ 心膜（生体組織）
Ｃ 心臓 1 treatment tool 2 insertion part (main part)
2a Lumen (Fitting part)
3 Forceps part 4 Joint part (joint mechanism)
4a joint 5 operation section 6a, 6b gripping piece 7 link mechanism 8 gripping force transmitting member 8a shaft section (fixing means)
8b Wire part (flexible part)
9 Guide wire 10 Channel (channel part)
11 Connecting member 11a Stopper (limitation means)
12a Fixed handle 12b Movable handle 13 Groove (fitting part, fixing means)
A Pericardial cavity B Pericardium (living tissue)
C heart

Claims (6)

生体組織を把持する鉗子部と、
該鉗子部に設けられた本体部と、
該本体部に設けられ、前記鉗子部を操作する操作部と、
前記生体組織に導入するガイドワイヤを導出するチャネル部と、
前記本体部に設けられ、該本体部の長手軸方向に交差する方向に前記鉗子部を揺動させる関節機構とを備える処置具。 Forceps for gripping the living tissue;
A main body provided in the forceps portion;
An operation unit provided on the main body unit for operating the forceps unit;
A channel portion for deriving a guide wire to be introduced into the living tissue;
A treatment instrument comprising: a joint mechanism provided on the main body portion and configured to swing the forceps portion in a direction intersecting a longitudinal axis direction of the main body portion. 前記関節機構に設けられ、前記鉗子部の揺動方向を制限する制限手段を備える請求項１に記載の処置具。   The treatment tool according to claim 1, further comprising a limiting unit that is provided in the joint mechanism and limits a swinging direction of the forceps portion. 前記関節機構に設けられ、前記鉗子部の揺動を固定する固定手段を備える請求項１に記載の処置具。   The treatment tool according to claim 1, further comprising a fixing unit that is provided in the joint mechanism and fixes swinging of the forceps portion. 前記鉗子部と連結し、前記操作部の把持動作を前記鉗子部に伝達する把持力伝達部材と、
前記本体部に設けられ、前記把持力伝達部材を嵌合させる嵌合部とを備え、
前記固定手段が、前記嵌合部を介して前記鉗子部の揺動方向を固定する請求項３に記載の処置具。 A gripping force transmission member that is connected to the forceps portion and transmits a gripping operation of the operation portion to the forceps portion;
A fitting portion provided on the main body portion and fitted with the gripping force transmission member;
The treatment tool according to claim 3, wherein the fixing means fixes the swinging direction of the forceps portion via the fitting portion. 前記鉗子部が、生体組織面に沿った形状に形成されている請求項１に記載の処置具。   The treatment tool according to claim 1, wherein the forceps portion is formed in a shape along a biological tissue surface. 前記関節機構が、複数の関節を備える請求項１に記載の処置具。   The treatment tool according to claim 1, wherein the joint mechanism includes a plurality of joints.
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KR20140037037A (en) * 2011-01-06 2014-03-26 스미스 앤드 네퓨, 인크. Cannulated guide tools
JP2014507975A (en) * 2011-01-06 2014-04-03 スミス アンド ネフュー インコーポレーテッド Cannulated guide tool
US9826992B2 (en) 2007-12-21 2017-11-28 Smith & Nephew, Inc. Multiple portal guide
US9888936B2 (en) 2010-09-27 2018-02-13 Smith & Nephew, Inc. Device and methods for use during arthroscopic surgery
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Families Citing this family (2)

* Cited by examiner, † Cited by third party
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Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5033477A (en) * 1987-11-13 1991-07-23 Thomas J. Fogarty Method and apparatus for providing intrapericardial access and inserting intrapericardial electrodes
US5827323A (en) * 1993-07-21 1998-10-27 Charles H. Klieman Surgical instrument for endoscopic and general surgery
US5931810A (en) * 1996-12-05 1999-08-03 Comedicus Incorporated Method for accessing the pericardial space
JP2002291765A (en) * 2001-03-30 2002-10-08 Olympus Optical Co Ltd Retainer for surgical treatment appliance
JP4391762B2 (en) * 2003-05-08 2009-12-24 オリンパス株式会社 Surgical instrument

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US9826992B2 (en) 2007-12-21 2017-11-28 Smith & Nephew, Inc. Multiple portal guide
US9913636B2 (en) 2007-12-21 2018-03-13 Smith & Nephew, Inc. Multiple portal guide
US9888936B2 (en) 2010-09-27 2018-02-13 Smith & Nephew, Inc. Device and methods for use during arthroscopic surgery
US10219812B2 (en) 2010-11-03 2019-03-05 Smith & Nephew, Inc. Drill guide
KR20140037037A (en) * 2011-01-06 2014-03-26 스미스 앤드 네퓨, 인크. Cannulated guide tools
JP2014507975A (en) * 2011-01-06 2014-04-03 スミス アンド ネフュー インコーポレーテッド Cannulated guide tool
US9962212B2 (en) 2011-01-06 2018-05-08 Smith & Nephew, Inc. Cannulated guide tools

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