JP2015006262A - Positioning medical apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a positioning medical apparatus which makes it possible to easily position a tip at an intended position in bending a bend unit by drawing an operation wire by operation at an operation unit, and has excellent operability.SOLUTION: A positioning medical apparatus 1 includes an operation unit 3 and a flexible sheath 2 in a tubular shape connected to the operation unit 3. The flexible sheath 2 is composed of: a tubular flexible unit 5 extending from the operation unit 3 side; a bend unit 6 which is connected to the tubular flexible unit 5 and is bent by operation at the operation unit 3; and a tip side tubular unit 7 which is connected to the bend unit 6 and has an action site for acting on a treatment target. Drawing the operation wire 4 arranged in the flexible sheath 2 by operation at the operation unit 3 makes the tip side tubular unit 7 be drawn to bend the bend unit 6. The tubular flexible unit 5 is configured so that deformation easiness of a face connected to the inside in a bending direction of the bend unit 6 is different from that of a face connected to the outside in the bending direction over a predetermined length.

Description

  The present invention relates to a positioning medical device that is inserted into a human body and can be arbitrarily bent by a remote operation.

Generally, the positioning medical device is used as an endoscope or a high-frequency treatment catheter, or as a guide tube for introducing the endoscope or the high-frequency treatment catheter into the body. Such a positioning medical device is provided with a bending portion at the tip that can be bent by a remote operation from an operation portion provided on the proximal end side so that the tip can be directed in a desired direction in the body. Yes.
As such a conventional positioning medical device, there exists a thing of patent document 1, for example.

JP 2007-29120 A

  A medical catheter tube which is a positioning medical device described in Patent Document 1 has an inner layer tube, a reinforcing material layer, a marker made of a metal having radiopacity, and a flexibility covering the reinforcing material layer and the marker. A medical catheter tube in which an outer layer resin made of a resin tube is integrated, and braided with a tungsten wire and a stainless steel wire of the same diameter on the inner layer tube as a reinforcing material layer, and the number of tungsten wires is At least one and not more than half of the total number of strands, and has the most advanced part where the reinforcing material layer and marker do not exist, and the bending rigidity from the base part to the tip part gradually decreases due to the presence of the outer layer resin. With this configuration, the medical catheter tube has high flexibility and no torque transmission anisotropy.

However, in the case of the conventional technique such as the catheter tube described in Patent Document 1, when the distal end side is bent by the operation by the hand operation section, an unintended bending occurs, and the distal end section, which is the working part of the device, is operated. There is a problem that it may be away from the position intended by the person, which hinders accurate and quick operation.
More specifically, as shown in FIG. 5, an operation unit 3 and a tubular flexible sheath 200 extending from the operation unit 3 are provided, and the flexible sheath 200 is connected to the tubular flexible unit from the operation unit 3 side. 50, a bending medical unit 60 that is bent by the operation of the operation unit 3, and a distal medical tubular unit 70, the operation wire disposed in the flexible sheath 200 is pulled by the operation of the operation unit 3. Thus, when the bending portion 60 is bent by pulling the tip, the bending portion 60 is outside the bending direction (the X direction in the drawing) opposite to the central axis N of the flexible sheath 200 (the X direction in the drawing). It has a shape that slides back in the direction of the arrow Y).
That is, the distal tubular portion 70 and the bending portion 60 are bent by the force of the pulled operation wire, but the tubular flexible portion 50 is flexible to release the compressive force received by the polymer or the like of the distal tubular portion 70. Since it bends to the outside in the bending direction from the central axis N of the sheath 200 and is curved in an S shape as a whole, it will be displaced by a distance L from the tip position intended by the operator. The amount of operation is difficult to predict and the operability is reduced.

  In view of such a problem, the present invention is a positioning medical device that can easily position the tip at an intended position and has good operability when the operation wire is pulled by the operation of the operation unit to bend the bending portion. The purpose is to provide equipment.

  In order to achieve the above object, the present invention has an operation portion and a tubular flexible sheath connected to the operation portion, and the flexible sheath extends from the operation portion side. A bending portion that is joined to the tubular flexible portion and is bent by the operation of the operation portion, and a distal-side tubular portion that is joined to the bending portion and has an action portion that acts on a treatment target, and is operated by the operation of the operation portion. A positioning medical device that pulls the distal tubular portion by bending an operation wire disposed in the flexible sheath to bend the bending portion, wherein the tubular flexible portion is connected to the bending portion. The first feature is that the surface of the bending portion that is continuous on the inner side in the bending direction and the surface that is continuous on the outer side of the bending direction are different from each other in a predetermined length from the adjacent position.

  Further, in the positioning medical device according to the first feature, the predetermined length is approximately the same as a length obtained by combining at least the curved portion and the distal tubular portion, In the positioning medical device according to the first or second feature, the tubular flexible portion has the ease of deformation by increasing the hardness of the surface continuous on the inner side in the bending direction than the hardness of the surface continuous on the outer side in the bending direction. The third feature is that they are configured differently.

  Furthermore, in the positioning medical device according to any one of the first to third features, the tubular flexible portion is impregnated with a crosslinkable substance on a surface continuous on the inner side in the bending direction, and is continuous on the inner side in the bending direction. The fourth feature is that the ease of deformation is different by making the elastic modulus of the surface larger than the elastic modulus of the surface continuous to the outside in the bending direction, and the feature of any one of the first to fourth features In the positioning medical device, the tubular flexible portion is configured such that the ease of deformation is different by making the wall thickness of the surface continuous in the bending direction thicker than the wall thickness of the surface continuous in the bending direction outer side. In the positioning medical device according to any one of the first to fifth features, a built-in object such as a lead wire connected to the working site is disposed in the flexible sheath. A and sixth characteristic of said deformation easiness was configured differently by unevenly distributed in the curved inward in the flexible sheath.

  Further, in the positioning medical device according to the first or second feature, the tubular flexible portion is configured such that the hardness of the surface continuous on the outer side in the bending direction is higher than the hardness of the surface continuous on the inner side in the bending direction. In the positioning medical device according to any one of the first, second, and seventh features, the tubular flexible portion is cross-linked to a surface continuous outward in the bending direction. In the eighth aspect, the deformability is made different by impregnating and cross-linking the active substance so that the elastic modulus of the surface continuous on the outer side in the bending direction is larger than the elastic modulus of the surface continuous on the inner side in the bending direction. In the positioning medical device according to any one of the first, second, seventh, and eighth features, the tubular flexible portion has a wall thickness of a surface that continues to the outside in the bending direction and continues to the inside in the bending direction. Face wall thickness In the positioning medical device according to any one of the first, second, seventh, eighth, and ninth features, the flexible sheath is configured such that the ease of deformation is different by increasing the thickness. Is configured such that a built-in object such as a lead wire connected to the working site is arranged, and the deformability is different by unevenly distributing the built-in object to the outside in the bending direction in the flexible sheath. Is a tenth feature.

Therefore, from the above description, according to the positioning medical device according to the present invention, the tubular flexible portion is formed in a curved direction and a surface continuous from the position adjacent to the curved portion to the inside of the curved direction of the curved portion over a predetermined length. It is configured so that the deformability is different from the surface that is continuous on the outside, and the surface that is continuous on the inside in the bending direction is made harder than the surface that is continuous on the outside in the bending direction, or the elastic modulus is increased. If it is difficult to deform the surface continuous in the bending direction by increasing the wall thickness, etc., the tubular flexible part is less likely to slide in the direction opposite to the bending direction than the central axis of the flexible sheath. The tip can be easily positioned at the position, and the operability is good.
Conversely, by increasing the hardness of the surface continuous in the bending direction outside the surface continuous in the bending direction, increasing the elastic modulus, or increasing the wall thickness, the surface continuous in the bending direction is changed. If it is difficult to deform, the tubular flexible portion is greatly displaced to the opposite side of the bending direction from the flexible sheath central axis, so that the distal end of the distal annular body is directed in a direction perpendicular to the extension of the central axis of the sheath (i.e. The tip is directed to the side), and the tip is easily brought into contact with the treatment target.

The figure which shows the whole positioning medical device of this invention. Sectional drawing which shows the front end side of 1st Embodiment of this invention. Sectional drawing which shows the front end side of 2nd Embodiment of this invention. The figure for demonstrating the effect of this invention The figure for demonstrating the conventional positioning medical device.

[First Embodiment]
Hereinafter, a positioning medical device according to a first embodiment of the present invention will be described in detail with reference to the drawings. FIG. 1 is a diagram showing the entire positioning medical device of the present invention.
The positioning medical device 1 according to the present invention is, for example, a catheter for performing diagnosis or treatment, and the schematic structure thereof is a cylindrical flexible made of resin or the like for insertion into the body as shown in FIGS. The flexible sheath 2 and an operation portion 3 for bending the distal end side of the flexible sheath 2 are inserted into the flexible sheath 2, and the inner distal end side of the flexible sheath 2 and the inside of the operation portion 3 are provided. The operation wire 4 is made of a stranded wire, and is flexible by pulling the operation wire 4 to the proximal end side which is the operation unit 3 side by operating the bending knob 3a of the operation unit 3. The distal end side of the sheath 2 is pulled and curved.

The flexible sheath 2 has a relatively flexible tubular flexible portion 5 extending from the operation portion 3 side, and has a lower hardness than the tubular flexible portion 5 and is joined to the tubular flexible portion 5 to operate the operation portion 3. And the distal end side tubular portion 7 having an action portion that is higher in hardness than the bending portion 6 and lower in hardness than the tubular flexible portion 5 and that acts on the treatment target. .
A platinum ring 11 is attached to the flexible sheath 2 (symbol 2a is a jacket) in the vicinity of the distal end portion, and a distal end cap 10 made of a platinum electrode is welded to the distal end of the flexible sheath 2, and an electric conductor (not shown) It is an action site that can be applied by, for example, diagnosis of the affected area. A flat plate 15 disposed without twisting the surface at the center along the axial direction inside the flexible sheath 2 is bonded to the inner side of the distal end cap 10 with an adhesive 21.
Tubes 13 made of resin such as PTFE are disposed in the lumens of the flexible sheath 2 partitioned by the flat plate 15, and the tubes 13 are bonded to the inner wall of the flexible sheath 2. The operation wire 4 inserted into each tube 13 is fixed to both ends of the flat plate penetrating member 16 attached in the vicinity of the distal end of the flat plate 15 and the operation unit 3, so that the bending direction is obtained by the operation of the operation unit 3. When the operation wire 4 arranged on the inner side (X direction in the drawing) is pulled toward the operation unit 3, the distal end side of the flexible sheath 2 is configured to bend.

In addition, the tubular flexible portion 5 has a predetermined length from a position adjacent to the bending portion 6, specifically, at least as long as the combined length of the bending portion 6 and the distal tubular portion 7 (normally the bending portion 6 The length of the tubular flexible portion 5 is about 30 cm and the length of the tubular flexible portion 5 is about 80 to 120 cm. Therefore, the length of the tubular flexible portion 5 is adjacent to the curved portion 6. The surface of the bending portion 6 that is continuous on the inner side in the bending direction (X direction side) and the surface that is continuous on the outer side of the bending direction (Y direction side) are configured so that the deformability is different.
Specifically, as shown in FIG. 2B, which shows a cross section of the tubular flexible portion 5 in FIG. 2A, the tubular flexible portion 5 is bent inward in the bending direction with the flat plate 15 as the center (X direction in the figure). ) The half part 5a is made of a resin having higher hardness than the outer half part 5b in the bending direction (Y direction in the figure).
In addition, in order to increase the safety and efficiency of diagnostic treatment, in the case where it is necessary to provide contrast, etc., in addition to the above configuration, for example, barium sulfate, bismuth subcarbonate, tungsten as a contrast agent in the bending direction inner half 5a. It is possible to use a compound containing barium oxide, barium phosphate, bismuth oxide, bismuth sulfide, bismuth titanate, molybdenum oxide, tungsten trioxide, or the like.
At this time,

  The positioning medical device 1 configured in this way is configured such that the bending direction inner half 5a and the bending direction outer half 5b of the tubular flexible portion 5 are made of resins of different hardness, and the bending direction inner half 5a is bent. By making the hardness higher than that of the outer half portion 5b, the bending direction inner half portion 5a becomes more resistant to traction force than the bending direction outer half portion 5b when compressed by the operation wire 4, and is compressed. Since it becomes difficult, it is possible to avoid the sliding of the tubular flexible portion to the outside in the bending direction as in the prior art, and the tip can be easily positioned at the position intended by the operator, and the operability is good.

  As described above, the bending direction inner half 5a and the bending direction outer half 5b of the tubular flexible portion 5 are replaced with or combined with the resins having different hardnesses. On the other hand, a crosslinkable substance such as an isocyanate compound or an epoxy compound may be impregnated to crosslink, and the elastic modulus may be larger than that of the outer half portion 5b in the bending direction, and the tube of the tubular flexible portion 5 is extruded. At this time, the inner half 5a in the bending direction may be pushed out more thickly than the outer half 5b in the bending direction.

  Further, in the present embodiment, the bending direction inner half 5a is made of a resin having higher hardness than the bending direction outer half 5b, or the bending direction inner half 5a is cross-linked to change the elastic modulus to the bending direction outer side. Although an example in which the inner half 5a in the bending direction is made thicker than the outer half 5b in the bending direction when the tube of the tubular flexible portion 5 is extruded and formed larger than the half 5b, The bending direction outer half part 5b is made of a resin having a higher hardness than the bending direction inner half part 5a, or the bending direction outer half part 5b is impregnated with a crosslinkable substance or the like to be crosslinked. When the bay curve direction outer half part 5b is thicker than the curve direction inner half part 5a when extruding the tube of the tubular flexible part 5 to be larger than the curve direction inner half part 5a, Tubing when pulling operation wire 4 rather than technology Since the bending portion 5 is greatly bent outward in the bending direction, as shown in FIG. 4, the distance between the distal end of the distal end side tubular portion 7 (the distal end cap 10 in the present embodiment) and the central axis N changes substantially. Therefore, the tip is oriented in a direction perpendicular to the central axis N (that is, the tip is directed sideways), which makes it easy to contact the treatment target, and in this case also, the tip is positioned at the position intended by the operator. It is easy to operate.

[Second Embodiment]
Next, a second embodiment of the present invention will be described. FIG. 3 is a sectional view of a positioning medical device according to the second embodiment of the present invention.
In the above-described embodiment, the tubular flexible portion 5 is configured such that the deformability of the surface continuous in the bending direction (X direction) of the bending portion 6 and the surface continuous in the bending direction outer side (Y direction) are different. In order to achieve this, the hardness of the bending direction inner half part 5a and the bending direction outer half part 5b of the tubular flexible part 5 is changed. However, the present invention is not limited to this, and as shown in FIG. 5 is made of the same material on the inside in the bending direction (X direction) and the outside in the bending direction (Y direction), and the passage of the operation wire 4 is composed of the tube 13 and the close contact coils 23 and 24 arranged on the distal end side of the tube 13. The close contact coil 24 disposed on the outer side in the bending direction is a close contact coil with zero initial tension disposed from the bending portion 6 to a part of the tubular flexible portion 5, and the close contact coil 23 disposed on the inner side in the bending direction is the bending portion 6. Adhesion coil with high initial tension placed inside , It may be different deformation ease with curved inwardly curved outward of the tubular flexible portion 5.
Other configurations are the same as those in the first embodiment.

  Since the positioning medical device according to the second embodiment uses a close-contact coil having different tension in the passage of the operation wire 4, when receiving the traction force by the operation wire 4, the inner side in the bending direction is the same as in the first embodiment. Since the resistance force to the traction force is larger than the outer side in the bending direction and it is difficult to compress, the sliding of the tubular flexible portion 5 to the outer side in the bending direction can be avoided, and the tip can be easily positioned at the position intended by the operator. It is easy to operate.

In the present embodiment, an example in which a contact coil having different tension is used in the passage of the operation wire 4 is shown. However, the present invention is not limited to this, and instead of the contact coil, the inside of the bending direction is made of a resin having a high friction coefficient. A tube may be used, and a tube made of a resin having a low friction coefficient may be used on the outer side in the bending direction.
Further, when the arrangement of the close contact coils used in the passage of the operation wire 4 or the tubes having different friction coefficients is reversed between the inside in the bending direction and the outside in the bending direction, the tube is more tubular when the operation wire 4 is pulled than in the prior art. As shown in FIG. 4, the distance between the distal end of the distal end side tubular portion 7 (the distal end cap 10 in this embodiment) and the center axis N changes substantially as shown in FIG. Without being oriented in the direction perpendicular to the central axis N of the flexible sheath 2 (that is, the distal end faces sideways), which makes it easier to bring the distal end into contact with the treatment target. The tip can be positioned at the position where it is placed, and operability is good.

  Further, the present invention is not limited to the above-described embodiment, and instead of or in combination with the above-described configuration, a built-in object such as a lead wire (not shown) connected to an electrode, a sensor, or the like is bent inward or outward in the bending direction. By being unevenly distributed, deformation resistance can be given to the unevenly distributed side, and the same effect as in the above embodiment can be generated.

DESCRIPTION OF SYMBOLS 1 Positioning medical device 2 Flexible sheath 3 Operation part 4 Operation wire 5 Tubular flexible part 5a Curve direction inner side half part 5b Curve direction outer side half part 6 Curve part 7 Tip side tubular part X Curve direction inner side Y Curve direction outer side

Claims (10)

An operation portion; and a tubular flexible sheath connected to the operation portion, the flexible sheath extending from the operation portion side, and the tubular flexible portion joined to the tubular flexible portion. A bending portion that is bent by the operation of the operation portion and a distal-side tubular portion that is joined to the bending portion and has an action portion that acts on a treatment target, and is disposed in the flexible sheath by the operation of the operation portion. A positioning medical device that pulls the distal tubular portion by pulling an operation wire to bend the bending portion,
The tubular flexible portion is configured so that the deformability of a surface continuous on the inside in the bending direction of the bending portion and a surface continuous on the outside in the bending direction are different from each other for a predetermined length from a position adjacent to the bending portion. Positioning medical device characterized by that.   The positioning medical device according to claim 1, wherein the predetermined length is at least as long as a combined length of the bending portion and the distal tubular portion.   The tubular flexible portion is configured such that the ease of deformation is different by making the hardness of a surface continuous on the inner side in the bending direction higher than the hardness of a surface continuous on the outer side in the bending direction. The positioning medical device according to 1 or 2.   The tubular flexible portion is formed by impregnating a cross-linking substance into a surface continuous on the inside in the bending direction and cross-linking the surface, and the elastic modulus of the surface continuous on the inside in the bending direction is higher than the elastic modulus of the surface continuous on the outside in the bending direction. The positioning medical device according to any one of claims 1 to 3, wherein the ease of deformation is changed by increasing the size.   The tubular flexible portion is configured such that the ease of deformation is different by making the wall thickness of the surface continuous on the inside in the bending direction thicker than the wall thickness of the surface continuous on the outside in the bending direction. The positioning medical device according to any one of claims 1 to 4.   The flexible sheath is provided with a built-in object such as a lead wire connected to the working site, and the deformability is different by making the built-in object unevenly distributed in the bending direction inside the flexible sheath. The positioning medical device according to any one of claims 1 to 5, wherein the positioning medical device is configured as described above.   The tubular flexible portion is configured such that the ease of deformation is different by making the hardness of the surface continuous on the outside in the bending direction higher than the hardness of the surface continuous on the inside in the bending direction. The positioning medical device according to 1 or 2.   The tubular flexible portion is formed by impregnating a cross-linkable substance into a surface continuous on the outside in the bending direction and cross-linking the surface, so that the elastic modulus of the surface continuous on the outside in the bending direction is higher than the elastic modulus of the surface continuous on the inside in the bending direction. The positioning medical device according to any one of claims 1, 2, and 7, wherein the deformability is changed by increasing the size.   The tubular flexible part is configured such that the ease of deformation is different by making the wall thickness of the surface continuous to the outside in the bending direction thicker than the wall thickness of the surface continuous to the inside of the bending direction. The positioning medical device according to any one of claims 1, 2, 7, and 8.   The flexible sheath is provided with a built-in object such as a lead wire connected to the action site, and the deformability is different by making the built-in object unevenly distributed outside the bending direction in the flexible sheath. The positioning medical device according to any one of claims 1, 2, 7, 8, and 9, wherein the positioning medical device is configured as described above.

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