JP2015002920A - Guide wire insertion device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a guide wire insertion device which prevents damage to a guide wire and can make a distal end portion of the guide wire move to a prescribed position of a human tissue.SOLUTION: A guide wire insertion device 10 includes: a tubular needle 20 which is composed of a metal pipe and has a distal end constituting a puncture part 21 by obliquely cutting the distal end relative to an axial direction to be able to puncture a human tissue; an operation tube 30 which is connected to a proximal end side of the tubular needle 20 for moving the tubular needle 20 in a prescribed direction; and a guide wire 1 which is inserted into the operation tube 30 and the tubular needle 20 and can appear and disappear from an opening of the puncture part 21 of the tubular needle 20. In the puncture part 21 of the tubular needle 20, a blade surface 23a that can cut into the human tissue is formed on a distal end side, and an inner peripheral surface on the proximal end side has a structure without the blade surface.

Description

  The present invention relates to a guide wire insertion device for inserting a guide wire into a predetermined position of a human tissue such as a tubular organ or a body cavity.

  In the past, a guide wire was inserted into a tubular organ such as the bile duct, pancreatic duct, ureter, trachea, blood vessel, etc., and the distal end portion was moved to a predetermined position, and then a medical tube such as a catheter was passed through this guide wire. Inserting and placing a stent or blood vessel obturator through the tube, or injecting a medical solution such as a contrast agent, an anticancer agent, or a nutrient.

  When the distal end portion of the guide wire is inserted to a predetermined position, for example, the guide wire is inserted while being visually recognized by an endoscope. For example, another tubular organ is inserted from a certain tubular organ through a body cavity. A guide wire cannot be inserted into a place that cannot be viewed with an endoscope, for example, when a catheter is to be inserted into the catheter. Therefore, in such a case, the distal end portion of the guide wire is inserted into a predetermined position using an ultrasonic endoscope.

  For example, in FIGS. 10 to 13, by using the ultrasonic endoscope 2 having the ultrasonic probe 2 a at the tip, another body organ V 1 (for example, stomach / duodenum) is passed through a body cavity V 3 (for example, the abdominal cavity). Describes a method for inserting a catheter into a tubular organ V2 (eg, bile duct).

  That is, the ultrasonic endoscope 2 is inserted into the tubular organ V1, the tip thereof is made to reach a predetermined location of the tubular organ V1 (see FIG. 10A), and the puncture site is confirmed with the ultrasonic probe 2a. The tube 4 containing the cylindrical needle 3 is inserted from the distal end opening of the lumen (not shown) of the ultrasonic endoscope 2, and the cylindrical needle 3 is protruded from the distal end of the tube 4 so that the tube 4 is inserted into the tubular organ V1. The wall is penetrated and inserted into the other tubular organ V2 through the body cavity V3, and the puncture holes 5 are formed in the respective tubular organs V1 and V2 (see FIG. 10B). Note that a flexible operation tube (not shown) is connected to the proximal end side of the cylindrical needle 3, and the cylindrical needle 3 can be moved forward and backward by operating this operation tube. .

  Next, the guide wire 1 is inserted into the lumen of the cylindrical needle 3, the guide wire 1 is inserted from the distal end opening of the cylindrical needle 3, and the distal end portion is moved to a predetermined position in the tubular organ V2 (FIG. 11). Thereafter, the cylindrical needle 3 and the tube 4 are pulled out from the tubular organs V1 and V2 (see FIG. 11B).

  Next, the diameter expansion tube 6 is inserted into the tubular organs V1 and V2 through the guide wire 1 to expand the diameter of the puncture hole 5 (see FIG. 12A), and the diameter expansion tube 6 is tubular. Pull out from the organs V1 and V2 (see FIG. 12B), and then insert a diameter-expanding tube 7 larger in diameter than the diameter-expanding tube 6 into the tubular organs V1 and V2 to further expand the puncture hole 5. (See FIG. 13A).

  When the diameter of the puncture hole 5 is sufficiently expanded, the diameter-expanding tube 7 is pulled out, the catheter 8 containing the covered stent 9 is inserted into the tubular organs V1 and V2 along the guide wire 1, and the distal end portion is inserted. It arrange | positions to the tubular organ V2 (refer FIG.13 (b)), Then, the covered stent 9 is open | released from the catheter front-end | tip, and is detained. Thus, the tubular organs V1 and V2 separated via the body cavity V3 can be connected by the covered stent 9.

  On the other hand, Patent Document 1 below discloses a suturing device including a suturing needle and a tubular member that slidably accommodates the suturing needle. The tubular member has a puncture tube in which a puncture portion formed by obliquely cutting a metal pipe is formed, and a suture needle is projected and retracted from a distal end opening of the puncture tube.

International Publication WO 2010/137256 Specification

  By the way, when a metal pipe is cut diagonally to form a cylindrical needle with a sharp tip, a sharp blade surface is formed at the cut portion. Moreover, since the tip part which carried out the diagonal cut is hard to cut with respect to a human body tissue if it is as it is, attaching a blade surface further to the front-end | tip outer periphery of a cut part is performed. In this specification, the blade surface means a surface in which minute irregularities are formed at the tip of a sharp blade and can be cut into a human tissue or the like.

  However, in the conventional cylindrical needle, the blade surface remains on the inner periphery of the base end of the cut portion. Therefore, when the guide wire is inserted or removed from the distal end opening of the cylindrical needle, or when the cylindrical needle is moved along the guide wire, the guide wire is a blade on the inner periphery of the proximal end of the cut portion of the cylindrical needle. Sometimes it touched the surface and was damaged.

  Accordingly, an object of the present invention is to provide a guide wire insertion device capable of preventing damage to a guide wire when the distal end portion of the guide wire is moved to a predetermined position of human tissue through a cylindrical needle.

  In order to achieve the above object, a guide wire insertion device according to the present invention comprises a cylindrical needle comprising a metal tube, the tip of which is cut obliquely with respect to the axial direction, and which forms a puncture part capable of puncturing human tissue. An operation tube connected to the proximal end side of the cylindrical needle and moving the cylindrical needle in a predetermined direction; inserted into the operation tube and the cylindrical needle; and from an opening of a puncture portion of the cylindrical needle A guide wire that can be projected and retracted, and the puncture portion of the cylindrical needle has a blade surface that can be cut into the human tissue on the distal end side thereof, and an inner peripheral surface on the proximal end side is formed by the blade surface. It is characterized by having no structure.

  In the guide wire insertion device of the present invention, the puncture portion of the cylindrical needle has a blade edge portion having a blade surface and a jaw portion having no blade surface at least on the inner periphery, and the blade edge portion is axially It is preferable that the blade is cut obliquely so that the blade surface spreads on the outer peripheral side when viewed from the side, and the jaw portion is deeply cut so as to be concave when viewed from the side with respect to the cut surface of the blade edge portion.

  In the guide wire insertion device of the present invention, a plurality of diameter expansions having different diameters are provided on the outer circumferences of the cylindrical needle and the operation tube to expand a puncture hole formed in a human tissue by the cylindrical needle. It is preferable that the tubes for use are arranged in multiples, with the small diameter inside and the large diameter outside.

  According to the present invention, the operation tube is operated to puncture a human body tissue such as a body cavity, a tubular organ, or skin with the puncture portion of the puncture needle, and the puncture portion is moved to a desired position. The distal end portion of the guide wire can be moved to a predetermined position by being inserted through the opening of the puncture portion through the operation tube and the cylindrical needle. In addition, after the distal end portion of the guide wire is moved to a predetermined position, the cylindrical needle can be moved along the guide wire and pulled out by pulling the operation tube.

  As described above, when the guide wire is inserted through the operation tube and the cylindrical needle, or is pulled out by moving the cylindrical needle along the guide wire, the inner peripheral surface of the proximal end side of the puncture portion of the cylindrical needle However, in the present invention, since the inner peripheral surface of the proximal end side of the puncture portion of the cylindrical needle has a structure without a blade, the guide wire can be prevented from being damaged. .

It is a perspective view which shows one Embodiment of the guide wire insertion apparatus of this invention. The guide wire insertion device is shown, (a) is a side view, (b) is a plan view, and (c) is a front view. It is explanatory drawing which shows other embodiment of the guide wire insertion apparatus of this invention. It is sectional drawing of the guide wire insertion apparatus. The use state of the guide wire insertion device is shown, (a) is an explanatory view showing a first use state, and (b) is an explanatory view showing a second use state. The use state of the guide wire insertion device is shown, (a) is an explanatory view showing a third use state, and (b) is an explanatory view showing a fourth use state. The use state of the guide wire insertion device is shown, (a) is an explanatory view showing the fifth use state, and (b) is an explanatory view showing the fifth use state. It is explanatory drawing which shows the 9th use condition of the guide wire insertion apparatus. It is explanatory drawing which shows the state which detained the stent in the predetermined position of the human body tissue using the guide wire insertion apparatus. The conventional guide wire insertion method and catheter insertion method are shown, (a) is an explanatory view showing a first state, and (b) is an explanatory view showing a second state. (A) is explanatory drawing which shows a 3rd state, (b) is explanatory drawing which shows a 4th state. (A) is explanatory drawing which shows a 5th state, (b) is explanatory drawing which shows a 6th state. (A) is explanatory drawing which shows a 7th state, (b) is explanatory drawing which shows an 8th state.

  Hereinafter, with reference to FIG.1 and FIG.2, one Embodiment of the guide wire insertion apparatus of this invention is described.

  As shown in FIG. 1, the guide wire insertion device 10 of this embodiment is formed of a cylindrical metal tube, and the tip is cut obliquely with respect to the axial direction so that it can puncture human tissue. A cylindrical needle 20 is formed. The human body tissue means, for example, skin, body cavities, various organs (such as stomach and liver) arranged in the body cavities, bile ducts, pancreatic ducts, tubular organs such as duodenum, and the like.

  The puncture portion 21 has a structure in which a blade surface 23a that can be cut into a human tissue is formed on the distal end side, and the inner peripheral surface on the proximal end side has no such blade surface.

  Specifically, as shown in FIGS. 1 and 2, the puncture portion 21 in this embodiment has a blade edge portion 23 formed with a blade surface 23a that can be cut into a human tissue at the tip side, On the proximal end side adjacent to the blade edge portion 23, there is a jaw portion 25 having no blade surface at least on the inner periphery.

  As shown in FIGS. 1 and 2 (a), the blade edge portion 23 is formed so that the blade surface 23a spreads on the outer peripheral side when viewed from the axial front end side after the cylindrical needle 20 is cut obliquely. Furthermore, it is cut into a slanted shape. That is, the blade surface 23a forms an inclined surface that spreads in a C shape when viewed from the axial front end side.

  On the other hand, as shown in FIG. 2A, the jaw portion 25 has a concave shape that is gently curved with respect to the blade surface 23a of the blade edge portion 23 when the cylindrical needle 20 is viewed from the side. The shape is cut deeply. In addition, although the blade surface is not formed not only on the inner periphery but also on the outer periphery of the jaw portion 25 in this embodiment, a blade surface may be formed on the outer periphery of the jaw portion 25.

  As shown in FIG. 2B, the length L1 along the axial direction from the distal end to the proximal end of the cutting edge portion 23 is 0.3 to 1.2 times the outer diameter D of the cylindrical needle 20. It is preferable that it is 0.4 to 1.0 times. Further, a length L2 (see FIG. 2B) along the axial direction from the distal end to the proximal end of the jaw 25 is 1.3 to 5.0 times the outer diameter D of the cylindrical needle 20. It is preferable that it is 1.5 to 3.0 times.

  When the length L1 of the cutting edge portion 23 is less than 0.3 times the outer diameter D of the cylindrical needle 20, the inclination angle of the cutting edge portion 23 with respect to the axial direction becomes large, and the cutting edge portion 23 is difficult to puncture human tissue. Tend to be. Further, when the length L1 of the blade edge portion 23 exceeds 1.2 times the outer diameter D of the cylindrical needle 20, the blade edge portion 23 becomes longer, so that the guide wire 1 is likely to protrude from the blade edge portion 23 side. . On the other hand, when the length L2 of the jaw portion 25 is less than 1.3 times the outer diameter D of the cylindrical needle 20, the length of the jaw portion 25 is short, so that the guide wire 1 is likely to protrude from the cutting edge portion 23 side. Therefore, when the ratio exceeds 5.0 times, the strength of the puncture portion 21 of the cylindrical needle 20 tends to decrease.

  2A, when the cylindrical needle 20 is viewed from the side, the height H1 along the radial direction from the distal end to the proximal end of the blade edge portion 23 is such that the cylindrical needle 20 has a height H1. The outer diameter D is preferably 0.3 to 0.7 times, and more preferably 0.4 to 0.6 times. Furthermore, when the cylindrical needle 20 is viewed from the side surface, the jaw portion 25 has a height H2 (see FIG. 2A) along the radial direction from the distal end to the proximal end of the cylindrical needle 20. The outer diameter D is preferably 0.3 to 0.7 times, and more preferably 0.4 to 0.6 times.

  If the height H1 of the cutting edge portion 23 is less than 0.3 times the outer diameter D of the cylindrical needle 20, there is a tendency that it is difficult to puncture human tissue. It becomes easy to invade from the part 23 side. On the other hand, when the height H2 of the jaw portion 25 is less than 0.3 times the outer diameter D of the cylindrical needle 20, the guide wire 1 tends to protrude from the blade edge portion 23 side, and exceeds 0.7 times. Since the height H1 of the blade edge portion 23 is reduced, the blade edge portion 23 is less likely to puncture human tissue, and the strength of the puncture portion 21 of the cylindrical needle 20 tends to decrease.

  The cylindrical needle 20 in this embodiment can be manufactured as follows, for example. That is, first, the end of the cylindrical metal tube is cut obliquely in the axial direction, and the blade edge is further cut obliquely so that the blade surface 23a extends to the outer peripheral side. And when forming the blade surface 23a, by grinding with a grinder, a leuter, a grindstone, a file, etc., a minute unevenness | corrugation is formed in the blade edge | tip and it becomes the blade surface 23a which can be cut | incised into a human body tissue.

  On the other hand, from the base end side of the blade edge portion 23, the concave jaw portion 25 is formed as viewed from the side surface by processing means such as wire electric discharge machining, laser machining, and etching. A cut surface formed by a processing means such as wire electric discharge machining, laser machining, etching, or the like has a shape that does not have minute irregularities on the edge portion, that is, has no blade surface. As a result, the inner periphery of the jaw 25 has a structure without a blade surface.

  Further, in the present invention, the “structure having no blade surface” means that there is little or almost no unevenness when visually observed with an electron microscope or an optical microscope, and it cuts into human tissue. It means that it is a structure that does not penetrate into the human body tissue and is not caught.

  In addition, although the said cylindrical needle 20 is formed from the cylindrical metal tube, for example, you may form from a square tube-shaped metal tube etc., There is no limitation in particular.

  The cylindrical needle 20 may be made of, for example, stainless steel, Ni, W, phosphor bronze, Ni—Ti, Ni—Ti—X (X = Fe, Cu, V, Co, etc.), Cu— Shape memory alloys such as Al—Ni and Cu—Zn—X (X = Si, Al, Sn, Fe, etc.) can be used.

  Furthermore, the outer peripheral surface of the cylindrical needle 20 is formed with minute irregularities by, for example, sandblasting, etc., so that ultrasonic waves can be reflected, and it is easy to confirm the presence under an ultrasonic endoscope. ing.

  In addition, the guide wire insertion device 10 includes an operation tube 30 connected to the proximal end side of the cylindrical needle 20 and can move the cylindrical needle 20 in a predetermined direction. Yes.

  The guide wire insertion device 10 further includes a guide wire 1 that is inserted into the operation tube 30 and the cylindrical needle 20 and can be projected and retracted from an opening of the puncture portion 21 of the cylindrical needle 20.

  Next, an example of a method of using the guide wire insertion device 10 of the present invention having the above structure will be described.

  That is, by pushing the puncture portion 21 of the cylindrical needle 20 into the human body tissue such as the skin, body cavity, various organs, tubular organs such as bile ducts, the blade surface 23a of the blade portion 23 is formed. A human body tissue is cut and punctured to form a puncture hole with a predetermined diameter. Thereafter, the cylindrical needle 20 moves through the human body tissue through the puncture hole, and the cutting edge portion 23 of the puncture unit 21 reaches a predetermined position of the human tissue. In this state, the guide wire 1 is inserted from the opening of the puncture portion 21 of the cylindrical needle 20 through the operation tube 30 and the lumen of the cylindrical needle 20, so that the distal end portion of the guide wire 1 is made of human tissue. It can be moved to a predetermined position. Thereafter, by pulling the operation tube 30 toward the hand, the cylindrical needle 20 can be moved along the guide wire 1 to pull out the cylindrical needle 20 from the human tissue.

  As described above, when the guide wire 1 is inserted through the operation tube 30 and the cylindrical needle 20, or when the cylindrical needle 20 is moved and pulled along the guide wire 1, the guide wire 1 punctures the cylindrical needle 20. It will slidably contact the inner peripheral surface of the base end side of the part 21. In particular, in this embodiment, the puncture part 21 is likely to appear and slide while being in sliding contact with the inner peripheral surface of the jaw part 25.

  At this time, in the guide wire insertion device 10, since the inner peripheral surface on the proximal end side of the puncture portion 21 of the cylindrical needle 20, that is, the inner peripheral surface of the jaw portion 25 is configured to have no blade, It is possible to prevent the wire 1 from being damaged.

  Moreover, in this embodiment, since the blade edge | tip part 23 of the puncture part 21 is cut diagonally so that the blade surface 23a may spread on the outer peripheral side seeing from an axial direction (refer FIG.2 (c)), it is a human body tissue. The puncture part 21 can be made easier to puncture.

  Further, since the jaw portion 25 is deeply cut so as to be concave when viewed from the side surface with respect to the blade surface 23a of the blade edge portion 23 (see FIG. 2A), the guide wire 1 is opened to the opening of the puncture portion 21. When the cylindrical needle 20 is moved along the guide wire 1 via the operation tube 30 when being protruded from the guide tube 1, the guide wire 1 is guided to the jaw portion 25 side by the inner peripheral surface of the jaw portion 25, The guide wire 1 is likely to appear and disappear from the opening on the jaw portion 25 side. As a result, the guide wire 1 is less likely to be slidably contacted with the inner periphery of the blade surface on the blade edge portion 23 side, and the guide wire 1 is less likely to be damaged. can do. Moreover, since the opening of the jaw part 25 can be enlarged, the guide wire 1 can be easily put in and out of the opening of the jaw part 25 without contacting the inner periphery of the jaw part 25, and the sliding resistance is reduced. Operability can be improved.

  3 to 9 show an embodiment of the guide wire insertion device of the present invention. Note that substantially the same parts as those of the above-described embodiment are denoted by the same reference numerals, and description thereof is omitted.

  As shown in FIGS. 3 and 4, in the guide wire insertion device 10 a of this embodiment, the first diameter expansion tube 40 having a larger diameter than the cylindrical needle 20 and the operation tube 30 is disposed on the outer periphery of the cylindrical needle 20 and the operation tube 30. Further, a second diameter expansion tube 45 having a diameter larger than that of the first diameter expansion tube 40 is disposed on the outer periphery thereof, thereby forming a multiple cylindrical structure. These diameter-expanding tubes 40 and 50 are for expanding the diameter of the puncture hole 5 (see FIG. 5B) formed in the human tissue by the cylindrical needle 20.

  The operation tube 30, the first diameter expansion tube 40, and the second diameter expansion tube 45 are configured to be slidable in the axial direction.

  Specifically, as shown in FIG. 4, the operation tube 30 has a fixing tube 30a connected to the base end side thereof, and a cylindrical handle 50 is provided on the outer periphery of the fixing tube 30a. Are slidably arranged. A retaining member 31 having a cylindrical shape and a flange provided on the outer periphery of the proximal end is mounted on the proximal end side of the fixing tube 30a.

  A screw hole 52 is formed in the middle of the handle 50 in the axial direction (see FIG. 4), and a stopper 53 having a screw shaft 53a is screwed into the screw hole 52. By tightening the screw shaft 53a and pressing the outer periphery of the fixing tube 30a, the operation tube 30 and the handle 50 are fixed so as not to slide. Further, an annular fitting convex portion 54 projects from the distal end portion of the handle 50 (see FIG. 4).

  Therefore, by loosening the screw shaft 53 a of the stopper 53, the operation tube 30 and the handle 50 can be slid relative to the axial direction, and by tightening the screw shaft 53 a of the stopper 53, The handle 50 can be fixed so as not to slide. Note that the retaining member 31 attached to the proximal end side of the fixing tube 30a engages with the peripheral edge of the proximal end opening of the handle 50, so that the handle 50 cannot be detached from the operation tube 30. ing.

  In addition, the proximal end portion of the first diameter expanding tube 40 and the proximal end portion of the second diameter expanding tube 45 are provided with gripping portions 41 and 46 having a cylindrical shape and a flange provided on the outer periphery of the proximal end. Each is installed. On the outer periphery of the tip of the grip portion 41, an annular fitting convex portion 41a is projected. In addition, annular fitting recesses 41b and 46b are formed on the inner periphery of the base end side of the grips 41 and 46, respectively.

  The cylindrical needle 20 and the operation tube 30 slide through the handle 50, the first diameter expansion tube 40 slides through the grip part 41, and the second diameter expansion tube 45 passes through the grip part 46. The cylindrical needle 20 and the operation tube 30, the first diameter expansion tube 40, and the second diameter expansion tube 45 can be slid relative to each other in the axial direction. .

  Therefore, the first diameter-expanding tube 40 and the puncture portion 21 of the cylindrical needle 20 can be slidable from the opening at the distal end of the second diameter-expanding tube 45, and the distal end of the first diameter-expanding tube 40 The puncture portion 21 of the cylindrical needle 20 can be slid so as to be able to appear and retract from the opening.

  In this embodiment, the cylindrical needle 20 and the operation tube 30, the first diameter expanding tube 40, and the second diameter expanding tube 45 can be relatively rotated. .

  Further, the fitting convex portion 54 of the handle 50 is detachably fitted into the fitting concave portion 41b of the gripping portion 41, so that the cylindrical needle 20, the operation tube 30 and the first diameter expanding tube 40, The sliding operation is locked, and on the other hand, the fitting convex portion 41a of the gripping portion 41 is detachably fitted into the fitting concave portion 46b of the gripping portion 46, so that the first diameter expanding tube 40 and the second diameter expanding are provided. The slide operation with the tube 45 is locked.

  In this embodiment, two diameter expansion tubes 40 and 45 are arranged, but more diameter expansion tubes may be arranged, and there is no particular limitation. In addition, the members for operating the operation tube 30 and the diameter-expanding tubes 40 and 45 are not limited to the handle 50 and the gripping portions 41 and 46 as described above. That's fine.

  Next, an example of how to use the guide wire insertion device 10a of the present invention having the above structure will be described. Here, a case where the guide wire 1 is moved to a predetermined position such as a tubular organ using an ultrasonic endoscope will be described.

  First, the ultrasonic endoscope 2 having the ultrasonic probe 2a at the distal end is inserted into the tubular organ V1, and the distal end portion is disposed at a predetermined position of the tubular organ V1 so as not to move at that position (FIG. 5 (a)).

  Thereafter, the guide wire insertion device 10a in a state where the cylindrical needle 20 and the operation tube 30, the first diameter expansion tube 40, and the second diameter expansion tube 45 are slide-locked to each other (see FIG. 4), Inserted into a lumen (not shown) from the proximal end side of the ultrasonic endoscope 2, the first diameter expanding tube 40 protrudes from the distal end opening of the lumen of the ultrasonic endoscope, and the first diameter expanding tube. The cylindrical needle 20 is protruded from the front end opening of 40.

  Then, an ultrasonic wave is irradiated and reflected by the outer peripheral surface of the cylindrical needle 20 to grasp a portion where the cylindrical needle 20 in the tubular organs V1 and V2 should be punctured. In this state, the puncture portion 21 of the tubular needle 20 is inserted into the tubular organ V2 through the body cavity V3 through the wall of the tubular organ V1, and the puncture holes 5 are punctured through the tubular organs V1 and V2. And the distal end portion of the puncture portion 21 is disposed at a predetermined position of the tubular organ V2 (see FIG. 5B).

  Next, the guide wire 1 is inserted from the proximal end opening of the retaining member 31 (see FIG. 4), and the guide wire 1 is inserted from the opening of the puncture portion 21 of the cylindrical needle 20 through the fixing tube 30a and the operation tube 30. The tip is placed at a predetermined position of the tubular organ V2 (see FIG. 6A). Thereby, the guide wire 1 is arrange | positioned to the tubular organ V1 and the tubular organ V2 via the body cavity V3.

  In the above state, while positioning the distal end portion of the guide wire 1, the first diameter expanding tube 40 is slid to the distal end side of the guide wire along the cylindrical needle 20 and the operation tube 30, and the distal end portion is tubular. The puncture hole 5 is expanded by moving the needle 20 closer to the guide wire tip than the tip of the needle 20 (see FIG. 6B).

  In this state, while holding the first diameter expanding tube 40, the second diameter expanding tube 45 is slid to the distal end side of the guide wire along the first diameter expanding tube 40, and the distal end portion is The puncture hole 5 is further expanded in diameter by moving it closer to the guide wire tip than the tip of the diameter expanding tube 40 (see FIG. 7A).

  In the above state, the cylindrical needle 20, the operation tube 30, the first diameter expansion tube 40, and the second diameter expansion tube 45 are pulled out from the tubular organs V1 and V2 while leaving only the guide wire 1. Next, the catheter 8 containing the covered stent 9 is inserted into the tubular organs V1 and V2 along the guide wire 1, and the distal end portion thereof is disposed in the tubular organ V2 (see FIG. 7B). Thereafter, the covered stent 9 is opened from the distal end of the catheter through a stent delivery system or the like, so that the covered stent 9 is placed in the tubular organ V1 and the tubular organ V2 separated from each other through the body cavity V3. (See FIG. 8).

  Thus, in this embodiment, since the 1st diameter expansion tube 40 and the 2nd diameter expansion tube 45 are arrange | positioned on the outer periphery of the cylindrical needle 20 and the operation tube 30, the puncture part of the cylindrical needle 20 is provided. After puncturing a human tissue such as the tubular organs V1 and V2 at 21, the first diameter expanding tube 40 is moved along the cylindrical needle 20 and the operation tube 30, and along the first diameter expanding tube 40. By moving the second diameter expanding tube 45, the diameter of the puncture hole 5 can be sequentially increased without pulling out the cylindrical needle 20 from the human tissue.

  Here, immediately before the insertion of the catheter 8 containing the covered stent 9, the tubular needle 20, the operation tube 30, the first diameter expanding tube 40, and the second diameter expanding tube 45 are connected to the tubular organs V1, V2. Therefore, unlike the conventional example shown in FIGS. 10 to 13, there is no need to insert and remove the plurality of tubes 6 and 7, and leakage of bodily fluid from the puncture hole 5 can be suppressed as much as possible.

  In the above description, the covered stent 9 configured by covering a self-expanding stent formed by braiding a wire with a cover is placed in the tubular organs V1 and V2, but the cover is covered. There may be no stent, a stent formed by laser cutting a metal tube, a tube stent made of a resin tube, etc., and there is no particular limitation.

  Moreover, the guide wire insertion device 10a of this embodiment can be suitably used, for example, when the covered stent 9 is placed at a site as shown in FIG.

  As shown in FIG. 9, the bile duct 13 and the pancreatic duct 14 branch and extend from the lower part of the duodenum 12 through the nipple, and bile produced by the liver 15 passes through the intrahepatic bile duct 15a. 13 (the common bile duct) is supplied. In order to bypass the nipple and supply bile to the duodenum 12, the covered stent 9 is placed between the duodenum 12 and the bile duct 13 to form an internal fistula, or to supply bile to the stomach 16. In some cases, the covered stent 9 is placed between the stomach 16 and the intrahepatic bile duct 15a to form an internal fistula.

  At this time, when the guide wire insertion device 10a of this embodiment is used, the duodenum 12 and the bile duct 13 are punctured with the cylindrical needle 20 and the guide wire 1 is bridged between the two, and then the duodenum is obtained by the above-described operation. The covered stent 9 is placed between the bile duct 12 and the bile duct 13, while the stomach 16 and the intrahepatic bile duct 15a are punctured with the cylindrical needle 20 and the guide wire 1 is bridged between the two. The covered stent 9 is placed between the stomach 16 and the intrahepatic bile duct 15a.

  At this time, as described above, the two diameter-expanding tubes 40 and 45 are sequentially inserted into the puncture hole 5 in the duodenum 12 and the bile duct 13 or the stomach 16 and the intrahepatic bile duct 15a. Since the tubes 40 and 45 are pulled out together before insertion of the catheter, bile can be prevented from leaking out from the puncture holes 5 of the bile duct 13 and intrahepatic bile duct 15a as much as possible, and invasion to the body can be suppressed. .

  The guide wire insertion device 10a of this embodiment is not limited to the insertion of the guide wire into the duodenum 12 and the bile duct 13 or the stomach 16 and the intrahepatic bile duct 15a as described above. It can be applied to tubular organs such as esophagus, large intestine, blood vessels, and other body tissues, and is not particularly limited. In addition, the guide wire insertion device 10a of this embodiment is used in combination with the ultrasonic endoscope 2, but may be used for a normal endoscope, may be used percutaneously, and is not particularly limited. .

DESCRIPTION OF SYMBOLS 1 Guide wire 10, 10a Guide wire insertion apparatus 20 Cylindrical needle 21 Puncture part 23 Blade edge part 23a Blade surface 25 Jaw part 30 Operation tube 40 First diameter expansion tube 45 Second diameter expansion tube 50 Handle

Claims (3)

A cylindrical needle made of a metal tube, the tip of which is cut obliquely with respect to the axial direction, and forms a puncture part that can be punctured into human tissue;
An operation tube connected to the proximal end side of the cylindrical needle and moving the cylindrical needle in a predetermined direction;
A guide wire which is inserted into the operation tube and the cylindrical needle, and can be projected and retracted from the opening of the puncture portion of the cylindrical needle,
The puncture portion of the cylindrical needle has a blade surface that can be cut into the human tissue at the distal end side, and the inner peripheral surface on the proximal end side has a structure without the blade surface. Guide wire insertion device.   The puncture portion of the cylindrical needle has a blade edge portion having a blade surface and a jaw portion having no blade surface on at least the inner periphery, and the blade edge portion has a blade surface spreading outward on the outer side when viewed from the axial direction. The guide wire insertion device according to claim 1, wherein the jaw portion is deeply cut so as to be concave when viewed from the side with respect to the cut surface of the blade edge portion.   On the outer periphery of the cylindrical needle and the operation tube, a plurality of diameter-expanding tubes having different diameters for expanding the diameter of a puncture hole formed in a human tissue by the cylindrical needle is provided with a small diameter inside. The guide wire insertion device according to claim 1, wherein the guide wire insertion device is arranged in a multiple manner with the one having a large diameter outside.