JP2015116399A - Medical treatment tool - Google Patents
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- JP2015116399A JP2015116399A JP2013262739A JP2013262739A JP2015116399A JP 2015116399 A JP2015116399 A JP 2015116399A JP 2013262739 A JP2013262739 A JP 2013262739A JP 2013262739 A JP2013262739 A JP 2013262739A JP 2015116399 A JP2015116399 A JP 2015116399A
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本発明は、細管状に延び可撓性のあるシースと、該シース内に進退可能に挿通された操作ワイヤと、該操作ワイヤの先端に設けられて前記シースより出没し、バスケット状に拡開ないし収縮可能な処置部とを備えた医療用処置具に関し、特に、内視鏡を介して体腔内に挿入され、体腔内に生じた結石等の異物を回収するためのバスケット型把持鉗子に関するものである。 The present invention provides a flexible sheath extending in a thin tube, an operation wire inserted in the sheath so as to be able to advance and retreat, and provided at the distal end of the operation wire so as to protrude and retract from the sheath and expand into a basket shape. In particular, the present invention relates to a medical treatment instrument having a retractable treatment portion, and more particularly, to a basket-type grasping forceps that is inserted into a body cavity via an endoscope and collects a foreign substance such as a calculus generated in the body cavity. It is.
従来、この種のバスケット型把持鉗子は、いずれも複数の弾性ワイヤをバスケット状に拡開するように構成したものであり、胆道、膀胱等の体腔内に挿入したシースの先端口より突出させて拡開し、体腔内に生じた結石を把持して回収する。このようなバスケット型把持鉗子を、弾性ワイヤの線数で大別すると、一般的には、４線、６線、８線、４線と８線の複合型の４種類が知られている。 Conventionally, this type of basket-type grasping forceps is configured such that a plurality of elastic wires are expanded in a basket shape, and protrudes from the distal end of a sheath inserted into a body cavity such as a biliary tract or a bladder. Expand and grasp and collect calculus in the body cavity. When such basket-type grasping forceps are roughly classified by the number of elastic wires, there are generally known four types of 4-wire, 6-wire, 8-wire, 4-wire and 8-wire composite types.
一般的には、小さい結石を回収する時は、バスケットの隙間が狭くなるよう線数の多いもの（６または８線）が使用され、逆に大きめの結石を回収する時には、バスケットの隙間が広くなるように線数の少ないもの（４線）が使用される。このように、それぞれの線数が持つ特性により使い分けされている。図１１において、線数別におけるメリットとデメリットを記す。具体的には例えば、特許文献１には、代表的な４線（図１参照）や、４線の途中で分岐した４線と８線の複合型（図５参照）等が開示されている。 In general, when collecting small stones, one with a large number of lines (6 or 8 lines) is used so that the gap between the baskets is narrowed. Conversely, when collecting large stones, the gap between the baskets is wide. As shown, the one with a small number of lines (four lines) is used. In this way, each line number is properly used depending on the characteristics. In FIG. 11, merits and demerits according to the number of lines are described. Specifically, for example, Patent Document 1 discloses a typical four-line (see FIG. 1), a combined type of four-line and eight-line (see FIG. 5) branched in the middle of the four-line, and the like. .
結石を回収する手法は、シース内で縮径した状態のバスケットを体腔内にて結石を越える位置まで挿入した後、結石より前方上側でバスケットを拡開し、この拡開した状態のバスケット内に異物を取り込み、そのままバスケットを引き抜くように回収する。従って、大きめの結石をバスケット内に取り込むには、バスケットにおいて手元側の基端部分の隙間は広い方が良いが、回収時には引き抜く動作上、結石が手元と反対側の先端部分から脱落しないように、先端部分の間隔は狭い方が望ましい。このような要望に応じて改良されたのが、前述の複合型である。 The method for collecting the calculus is to insert the basket with a reduced diameter in the sheath to a position exceeding the calculus in the body cavity, then expand the basket in front of the calculus and place it in the expanded basket. Take in the foreign material and collect the basket as it is. Therefore, in order to take a large calculus into the basket, it is better to have a wide gap at the proximal end of the hand side of the basket. It is desirable that the distance between the tip portions is narrow. The above-described composite type has been improved in response to such a demand.
しかしながら、従来のバスケット型把持鉗子では、いずれかの線数に予め定められて構成されており、様々な結石等の異物の大きさに対応するために、臨床の場では、複数種類の線数の鉗子を前もって準備しておく必要がある。そのため、鉗子の準備に手間やコストがかかるだけでなく、必要に応じて鉗子を適宜交換して使用しなければならず、処置が煩雑で面倒となるという問題点があった。 However, the conventional basket-type grasping forceps are configured to have a predetermined number of lines, and in order to deal with the size of various foreign objects such as stones, a plurality of types of lines are used in clinical settings. It is necessary to prepare the forceps in advance. For this reason, there is a problem that not only labor and cost are required for preparing the forceps, but also the forceps must be appropriately exchanged and used as necessary, and the treatment is complicated and troublesome.
また、特許文献１に開示された複合型であっても、バスケットの先端部分で弾性ワイヤの間隔が密になり、結石等の異物の保持能力が高まる効果を得られるが（特許文献１の段落０００８）、図１１でも記したように、デメリットとして、バスケットの全域に亘っては４線ほどの空間（弾性ワイヤの間隔）は得られない。そのため、複合型であっても、４線の代わりとして使用するには適さず、結局、状況に応じて鉗子自体を交換しなければならなかった。 Further, even in the composite type disclosed in Patent Document 1, the distance between the elastic wires becomes close at the tip portion of the basket, and an effect of increasing the holding ability of foreign matters such as stones can be obtained (paragraph of Patent Document 1). [0008] As described in FIG. 11, as a demerit, a space of about four lines (a space between elastic wires) cannot be obtained over the entire area of the basket. Therefore, even if it is a composite type, it was not suitable for use as a substitute for four wires, and eventually the forceps themselves had to be replaced depending on the situation.
さらに、前述したように結石を回収する時は、異物を取り込んだバスケットをそのまま引き抜くように動かすが、拡開した状態のバスケットは、シース内に収める手元に近い基端側より徐々に縮径することになる。そのため、最後に縮径するバスケットの先端側よりなおさら異物が脱落しやすい状況となる。しかしながら、従来の鉗子ではその構造上、バスケットの先端側より異物が脱落しないように窄めるような操作は困難であった。 Further, as described above, when collecting the calculus, the basket in which the foreign matter has been taken is moved so as to be pulled out as it is, but the basket in the expanded state is gradually reduced in diameter from the proximal end side close to the hand to be stored in the sheath. It will be. For this reason, the foreign matter is more likely to drop out from the tip end side of the basket whose diameter is finally reduced. However, due to the structure of the conventional forceps, it has been difficult to perform the operation of squeezing the foreign matter from the tip side of the basket so as not to drop off.
本発明は、以上のような従来の技術が有する問題点に着目してなされたものであり、状況に応じて複数の線数を使い分けることが可能であり、準備に手間やコストがかかることなく、処置も容易であり異物を確実かつ効率良く回収することができ、しかも、バスケットを異物が脱落しやすい先端側より収縮させることが可能であり、よりいっそう異物の取りこぼしを防止することができる医療用処置具を提供することを目的としている。 The present invention has been made paying attention to the problems of the conventional techniques as described above, and it is possible to properly use a plurality of lines depending on the situation, without preparation and cost. Medical treatment that is easy to treat, can collect foreign matter reliably and efficiently, and can shrink the basket from the tip side where foreign matter can easily fall off, further preventing foreign matter from being dropped. It aims to provide a treatment tool.
前述した目的を達成するための本発明の要旨とするところは、以下の各項の発明に存する。
［１］細管状に延び可撓性のあるシース（１１）と、該シース（１１）内に進退可能に挿通された操作ワイヤ（２０）と、該操作ワイヤ（２０）の先端に設けられて前記シース（１１）より出没し、バスケット状に拡開ないし収縮可能な処置部（３０）とを備えた医療用処置具（１０）において、
前記操作ワイヤ（２０）は、主操作ワイヤ（２１）と、副操作ワイヤ（２２）とを備え、
前記処置部（３０）は、前記主操作ワイヤ（２１）と組みを成す主処置部（３１）と、前記副操作ワイヤ（２２）と組みを成す副処置部（３２）とを備え、
前記主処置部（３１）と前記副処置部（３２）は、それぞれ弾性のある複数の処置ワイヤ（３３，３４）から構成され、各処置ワイヤ（３３，３４）は、前記シース（１１）から突出した時、該シース（１１）の軸心より拡開する屈曲ないし湾曲した形状に復元する一方、前記シース（１１）に没入した時、該シース（１１）の軸心に沿って収縮するように弾性変形し、
前記主処置部（３１）は、その各処置ワイヤ（３３）の手元側の基端を、前記主操作ワイヤ（２１）の遠位側の先端に固結する一方、各処置ワイヤ（３３）の遠位側の先端同士は、チップ状の接続端部（３５）により互いに固結して成り、
前記副処置部（３２）は、その各処置ワイヤ（３４）の手元側の基端を、前記副操作ワイヤ（２２）の遠位側の先端に固結する一方、各処置ワイヤ（３４）の遠位側の先端同士は、リング状の接続環部（３６）により互いに固結して成り、
前記副処置部（３２）の接続環部（３６）は、前記主処置部（３１）の各処置ワイヤ（３３）の途中を束ねた状態にして外嵌しており、前記副処置部（３２）が没入した時に当接するシース（１１）の先端口（１２）から、前記主処置部（３１）にてシース（１１）の先端口（１２）より進退する接続端部（３５）までの間で、前記副操作ワイヤ（２２）の操作に伴い軸方向に移動可能であることを特徴とする医療用処置具（１０）。
The gist of the present invention for achieving the object described above resides in the inventions of the following items.
[1] A flexible sheath (11) extending in a thin tube, an operation wire (20) inserted in the sheath (11) so as to be able to advance and retreat, and provided at the distal end of the operation wire (20) In the medical treatment instrument (10) provided with a treatment portion (30) that appears and disappears from the sheath (11) and can be expanded or contracted in a basket shape,
The operation wire (20) includes a main operation wire (21) and a sub operation wire (22).
The treatment section (30) includes a main treatment section (31) that forms a pair with the main operation wire (21), and a sub treatment section (32) that forms a pair with the sub operation wire (22),
The main treatment section (31) and the auxiliary treatment section (32) are each composed of a plurality of elastic treatment wires (33, 34), and each treatment wire (33, 34) is formed from the sheath (11). When projecting, it is restored to a bent or curved shape that expands from the axis of the sheath (11), while when it is immersed in the sheath (11), it contracts along the axis of the sheath (11). Elastically deformed into
The main treatment section (31) consolidates the proximal end of each treatment wire (33) to the distal tip of the main operation wire (21), while each treatment wire (33) The distal tips are joined together by a tip-like connecting end (35),
The secondary treatment section (32) consolidates the proximal end of each treatment wire (34) to the distal tip of the secondary operation wire (22), while each treatment wire (34) The distal tips are joined together by a ring-shaped connecting ring (36),
The connection ring part (36) of the sub-treatment part (32) is externally fitted in a state where the treatment wires (33) of the main treatment part (31) are bundled in the middle, and the sub-treatment part (32). ) From the distal end (12) of the sheath (11) that comes into contact with the main treatment portion (31) to the connecting end (35) that advances and retreats from the distal end (12) of the sheath (11). The medical treatment instrument (10) is capable of moving in the axial direction in accordance with the operation of the sub-operation wire (22).
［２］前記副処置部（３２）の各処置ワイヤ（３４）は、前記主処置部（３１）の各処置ワイヤ（３３）の外側で拡開し、該拡開した最大外周を、前記主処置部（３１）の各処置ワイヤ（３３）が拡開した最大外周よりも大きく形成したことを特徴とする前述の［１］に記載の医療用処置具（１０）。 [2] Each treatment wire (34) of the auxiliary treatment section (32) is expanded outside each treatment wire (33) of the main treatment section (31), and the expanded maximum outer periphery is expanded to the main treatment section (31). The medical treatment instrument (10) according to [1] above, wherein each treatment wire (33) of the treatment section (31) is formed larger than the expanded maximum outer periphery.
［３］前記シース（１１）の先端口（１２）の内側に、前記副処置部（３２）の接続環部（３６）、および／または該接続環部（３６）に固結した処置ワイヤ（３４）の先端の少なくとも一部を収納可能な凹部（１２ａ）を形成したことを特徴とする前述の［１］または［２］に記載の医療用処置具（１０）。 [3] Inside the distal end opening (12) of the sheath (11), the connection ring part (36) of the sub-treatment part (32) and / or a treatment wire solidified to the connection ring part (36) ( 34) The medical treatment instrument (10) according to [1] or [2] above, wherein a recess (12a) capable of accommodating at least a part of the tip of 34) is formed.
［４］前記シース（１１）の内部に、前記主操作ワイヤ（２１）と前記副操作ワイヤ（２２）とを別々に挿通させる挿通孔（１３，１４）を形成し、各挿通孔（１３，１４）内にて各操作ワイヤ（２０）は軸回りに回転不能な状態で挿通されることを特徴とする前述の［１］，［２］または［３］に記載の医療用処置具（１０）。 [4] In the sheath (11), through holes (13, 14) for inserting the main operation wire (21) and the sub operation wire (22) separately are formed, and each insertion hole (13, 14) The medical treatment instrument (10) according to [1], [2] or [3] above, wherein each operation wire (20) is inserted in a non-rotatable state around the axis. ).
［５］前記主処置部（３１）の接続端部（３５）、および／または前記副処置部（３２）の接続環部（３６）を、Ｘ線透視下で確認可能な材質により形成したことを特徴とする前述の［１］，［２］，［３］または［４］に記載の医療用処置具（１０）。 [5] The connection end portion (35) of the main treatment portion (31) and / or the connection ring portion (36) of the sub treatment portion (32) are formed of a material that can be confirmed under fluoroscopy. The medical treatment instrument (10) according to [1], [2], [3] or [4] above.
次に、前記本発明の作用について説明する。
前記［１］に記載の医療用処置具（１０）によれば、バスケット状に拡開する処置部（３０）は、主処置部（３１）と副処置部（３２）とを組み合わせて成り、副処置部（３２）の各処置ワイヤ（３４）の先端を固結した接続環部（３６）は、主処置部（３１）の各処置ワイヤ（３３）の途中を束ねた状態に外嵌しており、この接続環部（３６）は、シース（１１）の先端口（１２）から主処置部（３１）の先端に渡って移動させることができる。
Next, the operation of the present invention will be described.
According to the medical treatment instrument (10) described in [1], the treatment portion (30) that expands in a basket shape is formed by combining the main treatment portion (31) and the sub treatment portion (32), The connection ring portion (36) obtained by consolidating the distal ends of the treatment wires (34) of the sub-treatment portion (32) is externally fitted in a state where the middle of the treatment wires (33) of the main treatment portion (31) are bundled. The connecting ring portion (36) can be moved from the distal end (12) of the sheath (11) to the distal end of the main treatment portion (31).
副処置部（３２）の各処置ワイヤ（３４）はシース（１１）内に没入させたまま、該シース（１１）の先端口（１２）に当接した接続環部（３６）より、主処置部（３１）の各処置ワイヤ（３３）だけをシース（１１）外に突出させれば、処置部（３０）は、主処置部（３１）の各処置ワイヤ（３３）だけが拡開した線数の少ない状態となる。さらに、主処置部（３１）のみならず、副処置部（３２）の各処置ワイヤ（３４）も、前記接続環部（３６）を押し出しつつシース（１１）外に突出させれば、処置部（３０）は、主処置部（３１）と副処置部（３２）の両方の各処置ワイヤ（３３，３４）が全て拡開した線数の多い状態となる。 Each treatment wire (34) of the auxiliary treatment portion (32) is immersed in the sheath (11), and is connected to the main treatment from the connection ring portion (36) that is in contact with the distal end (12) of the sheath (11). If only the treatment wires (33) of the part (31) are protruded outside the sheath (11), the treatment part (30) is a line in which only the treatment wires (33) of the main treatment part (31) are expanded. It becomes a state with few numbers. Furthermore, if not only the main treatment part (31) but also each treatment wire (34) of the sub-treatment part (32) protrudes outside the sheath (11) while pushing out the connection ring part (36), the treatment part (30) is in a state with a large number of wires in which all the treatment wires (33, 34) of both the main treatment portion (31) and the sub treatment portion (32) are expanded.
このようにメインの主処置部（３１）に対して、副処置部（３２）は主処置部（３１）を内包する形で拡開ないし収縮するように移動する。よって、副処置部（３２）と組みを成す副操作ワイヤ（２２）による手元側の操作により、前記接続環部（３６）をシース（１１）外に押し出したり引き戻すだけで、体内外での処置ワイヤ（３３，３４）の線数を容易に切り替えることができる。すなわち、１つの医療用処置具（１０）だけで、異物の大きさ等の状況に応じて複数の線数を選択的に使い分けることが可能となる。 In this way, the sub-treatment portion (32) moves relative to the main main treatment portion (31) so as to expand or contract in such a manner as to include the main treatment portion (31). Therefore, the treatment inside and outside the body can be performed simply by pushing the connection ring portion (36) out of the sheath (11) or pulling it back by the operation on the hand side with the sub operation wire (22) forming a pair with the sub treatment portion (32). The number of wires (33, 34) can be easily switched. That is, with only one medical treatment instrument (10), it is possible to selectively use a plurality of numbers of lines according to the situation such as the size of a foreign substance.
また、主処置部（３１）と副処置部（３２）の両方を拡開した状態から収縮する時は、主操作ワイヤ（２１）よりも副操作ワイヤ（２２）の操作を先行させつつ引き戻すことにより、拡開したバスケット状にてシース（１１）に近い基端側からではなく、遠い先端側から徐々に窄めるような操作が可能となる。これにより、処置部（３０）内より異物が脱落しやすい先端側の隙間から徐々に狭くなり、引き抜く時に異物が脱落することを確実に防止することもできる。 Further, when both the main treatment portion (31) and the sub treatment portion (32) are contracted from the expanded state, the sub operation wire (22) is pulled back with the operation of the sub operation wire (22) preceding the main operation wire (21). Thus, it is possible to perform an operation of gradually narrowing from the distal end side, not from the proximal end side close to the sheath (11), in an expanded basket shape. Thereby, it becomes narrow gradually from the clearance at the front end side from which the foreign matters easily fall out from within the treatment section (30), and it is possible to reliably prevent the foreign matters from dropping off when being pulled out.
前記［２］に記載の医療用処置具（１０）によれば、副処置部（３２）の各処置ワイヤ（３４）は、主処置部（３１）の各処置ワイヤ（３３）の外側で拡開し、該拡開した最大外周を、主処置部（３１）の各処置ワイヤ（３３）が拡開した最大外周よりも大きく形成されるので、特に、副処置部（３２）の各処置ワイヤ（３４）によって、体腔内での展開（スペースの確保）を容易に行うことが可能となる。また、主処置部（３１）と副処置部（３２）は、拡開した時の最大外周の違いにより、互いの干渉を低減することができる。 According to the medical treatment instrument (10) described in [2], each treatment wire (34) of the sub-treatment part (32) is expanded outside each treatment wire (33) of the main treatment part (31). Since the maximum outer periphery that is opened and expanded is larger than the maximum outer periphery that each treatment wire (33) of the main treatment portion (31) is expanded, in particular, each treatment wire of the auxiliary treatment portion (32). (34) makes it possible to easily perform deployment (securing space) in the body cavity. Moreover, the main treatment part (31) and the sub treatment part (32) can reduce mutual interference by the difference in the maximum outer periphery when it expands.
前記［３］に記載の医療用処置具（１０）によれば、シース（１１）の先端口（１２）の内側に、副処置部（３２）の接続環部（３６）、および／または該接続環部（３６）に固結した処置ワイヤ（３４）の先端の少なくとも一部を収納可能な凹部（１２ａ）が形成されるので、副処置部（３２）の接続環部（３６）の手元側をシース（１１）の先端口（１２）に隙間なく当接させることができる。これにより、隙間をなくすことで、段差がなくなり、スムーズに挿入できる。 According to the medical treatment instrument (10) described in [3] above, the connection ring part (36) of the auxiliary treatment part (32) and / or the inside of the distal end (12) of the sheath (11). Since the concave portion (12a) capable of accommodating at least a part of the distal end of the treatment wire (34) solidified on the connection ring portion (36) is formed, the hand of the connection ring portion (36) of the sub treatment portion (32) is formed. The side can be brought into contact with the distal end opening (12) of the sheath (11) without any gap. Thereby, by eliminating the gap, there is no step and the insertion can be smoothly performed.
前記［４］に記載の医療用処置具（１０）によれば、シース（１１）の内部に、主操作ワイヤ（２１）と副操作ワイヤ（２２）とを別々に挿通させる挿通孔（１３，１４）を形成し、各挿通孔（１３，１４）内にて各操作ワイヤ（２０）は軸回りに回転不能な状態で挿通されるから、シース（１１）内にて各ワイヤ同士が絡まることを防止でき、また、主処置部（３１）と副処置部（３２）の各処置ワイヤ（３３，３４）の相対的な位置関係（各ワイヤ間の拡開角度等）を一定に維持することができる。 According to the medical treatment instrument (10) described in [4], the insertion holes (13, 13) through which the main operation wire (21) and the sub operation wire (22) are separately inserted into the sheath (11). 14), and the operation wires (20) are inserted in the insertion holes (13, 14) in a state in which they cannot rotate about the axis, so that the wires are entangled in the sheath (11). In addition, the relative positional relationship between the treatment wires (33, 34) of the main treatment portion (31) and the sub treatment portion (32) (expansion angle between the wires, etc.) can be maintained constant. Can do.
前記［５］に記載の医療用処置具（１０）によれば、主処置部（３１）の接続端部（３５）、および／または副処置部（３２）の接続環部（３６）を、Ｘ線透視下で確認可能な材質により形成したから、シース（１１）を体内に挿入する時に、シース（１１）先端にある接続端部（３５）や接続環部（３６）の位置をＸ線で確認しながら所望の位置に挿入することが容易となり、また、Ｘ線で確認しながら操作することが可能となり、主処置部（３１）や副処置部（３２）の拡開ないし縮小状態を把握することもできる。 According to the medical treatment instrument (10) described in the above [5], the connection end portion (35) of the main treatment portion (31) and / or the connection ring portion (36) of the auxiliary treatment portion (32), Since it is made of a material that can be confirmed under fluoroscopy, when the sheath (11) is inserted into the body, the positions of the connection end (35) and the connection ring (36) at the distal end of the sheath (11) are determined by X-ray. It becomes easy to insert in a desired position while confirming with, and it is possible to operate while confirming with X-rays, and the expanded or contracted state of the main treatment part (31) or the sub-treatment part (32) can be changed. It can also be grasped.
本発明に係る医療用処置具によれば、除去する異物の大きさ等の状況に応じて、１つの処置具でありながら複数の線数を選択的に使い分けることが可能であり、複数の処置具を用意したり準備する手間やコストがかかることなく、処置も容易であり、異物を確実かつ効率良く回収することができる。
しかも、バスケット状に拡開した処置部においては、異物の回収時に異物が脱落しやすいバスケット状の先端側より窄めるように収縮させることが可能となり、よりいっそう異物の取りこぼしを確実に防止することができる。
According to the medical treatment tool according to the present invention, it is possible to selectively use a plurality of lines according to the situation such as the size of a foreign substance to be removed, while using a single treatment tool. The procedure is easy without preparing and preparing the tools and costs, and foreign materials can be collected reliably and efficiently.
In addition, the treatment section expanded in a basket shape can be contracted so as to be narrowed from the front end side of the basket shape where foreign matters are easily dropped when collecting the foreign matters, thereby further reliably preventing foreign matters from being missed. be able to.
以下、図面に基づき本発明を代表する一実施の形態を説明する。
図１〜図７は、本発明の一実施の形態を示している。
図１は、医療用処置具１０を示す縦断面図である。図２は、医療用処置具１０を２通りに拡開させた状態を示す正面図および側面図である。図３は、医療用処置具１０のシース１１を示す正面図、縦断面図および横断面図である。図４は、医療用処置具１０の主処置部３１を示す正面図および側面図であり、図５は、医療用処置具１０の副処置部３２を示す正面図および縦断面図である。また、図６は、医療用処置具１０の操作動作を示す説明図であり、図７は、医療用処置具１０の操作部４０を示す側面図である。
Hereinafter, an embodiment representing the present invention will be described with reference to the drawings.
1 to 7 show an embodiment of the present invention.
FIG. 1 is a longitudinal sectional view showing a medical treatment instrument 10. FIG. 2 is a front view and a side view showing a state where the medical treatment instrument 10 is expanded in two ways. FIG. 3 is a front view, a longitudinal sectional view, and a transverse sectional view showing the sheath 11 of the medical treatment instrument 10. 4 is a front view and a side view showing the main treatment portion 31 of the medical treatment instrument 10, and FIG. 5 is a front view and a longitudinal sectional view showing the auxiliary treatment portion 32 of the medical treatment instrument 10. FIG. FIG. 6 is an explanatory diagram showing the operation of the medical treatment instrument 10, and FIG. 7 is a side view showing the operation unit 40 of the medical treatment instrument 10.
図１、図２および図７に示すように、医療用処置具１０は、細管状に延び可撓性のあるシース１１と、該シース１１内に進退可能に挿通された操作ワイヤ２０と、該操作ワイヤ２０の先端に設けられて前記シース１１より出没し、バスケット状に拡開ないし収縮可能な処置部３０、加えて操作ワイヤ２０を操作するための操作部４０を備えて成る。以下に、医療用処置具１０を、バスケット型把持鉗子に適用した例について説明する。 As shown in FIGS. 1, 2, and 7, a medical treatment instrument 10 includes a flexible sheath 11 that extends in a narrow tube shape, an operation wire 20 that is inserted into the sheath 11 so as to advance and retract, The treatment wire 30 is provided at the distal end of the operation wire 20 and protrudes and retracts from the sheath 11 and can be expanded or contracted in a basket shape. In addition, an operation portion 40 for operating the operation wire 20 is provided. Hereinafter, an example in which the medical treatment tool 10 is applied to a basket-type grasping forceps will be described.
シース１１は、医療用処置具１０の基体を成すものであり、可撓性の材質で成形された細管状のチューブ材から構成される。シース１１は、図示省略した内視鏡のチャンネルを通して体腔内に挿入される。シース１１の手元側の基端には、後述する操作部４０が設けられており、シース１１の遠位側となる先端口１２より操作ワイヤ２０は出没する。なお、シース１１の具体的な材質としては、例えば、ポリテトラフルオロエチレン(PTFE)、ポリ塩化ビニル（PVC）、ポリウレタン(PU)、ポリエチレン(PE)あるいはポリプロピレン(PP)樹脂等の合成樹脂が適している。 The sheath 11 constitutes the base of the medical treatment instrument 10 and is composed of a thin tubular tube material formed of a flexible material. The sheath 11 is inserted into a body cavity through a channel of an endoscope (not shown). An operation unit 40 described later is provided at the proximal end of the sheath 11 on the hand side, and the operation wire 20 protrudes and retracts from the distal end 12 on the distal side of the sheath 11. As a specific material of the sheath 11, for example, a synthetic resin such as polytetrafluoroethylene (PTFE), polyvinyl chloride (PVC), polyurethane (PU), polyethylene (PE), or polypropylene (PP) resin is suitable. ing.
図１、図３に示すように、シース１１の内部には、操作ワイヤ２０である主操作ワイヤ２１と副操作ワイヤ２２とを別々に挿通させる２つの挿通孔１３，１４が形成されている。各挿通孔１３，１４は、少なくとも一部がそれぞれ内部に挿通させる各操作ワイヤ２１，２２の断面形状より僅かに大きな楕円形断面に形成されている。このように各挿通孔１３，１４を、それぞれ孔中心より偏心させた断面形状とすることで、各操作ワイヤ２１，２２は軸回りに回転不能な状態で挿通される。なお、挿通孔１３，１４の全体を楕円形にしなくても、挿通孔１３，１４の一部（例えば先端側）と結束部２３，２４が楕円形であれば良い。 As shown in FIGS. 1 and 3, two insertion holes 13 and 14 through which a main operation wire 21, which is an operation wire 20, and a sub operation wire 22 are inserted separately are formed inside the sheath 11. Each insertion hole 13, 14 is formed in an elliptical cross section that is slightly larger than the cross sectional shape of each operation wire 21, 22, at least a part of which is inserted inside. Thus, by making each insertion hole 13 and 14 the cross-sectional shape eccentric from the center of each hole, each operation wire 21 and 22 is inserted in the state which cannot rotate around an axis. In addition, even if it does not make the whole insertion holes 13 and 14 elliptical, a part (for example, front end side) of the insertion holes 13 and 14 and the binding parts 23 and 24 should just be elliptical.
操作ワイヤ２０は、前述したように主操作ワイヤ２１と、副操作ワイヤ２２とを備える。各操作ワイヤ２１，２２は、それぞれ弾性のある線材から成り、具体的には例えば、ステンレス線材等が適している。各操作ワイヤ２１，２２は、後述する操作部４０によって別々にシース１１内を進退させることができる。また、各操作ワイヤ２１，２２は、略円形断面もしくは前述した各挿通孔１３，１４に合致した楕円形断面に形成されている。以下、主操作ワイヤ２１と副操作ワイヤ２２を総称する際は、操作ワイヤ２０と表記する。 The operation wire 20 includes the main operation wire 21 and the sub operation wire 22 as described above. Each of the operation wires 21 and 22 is made of an elastic wire, and specifically, for example, a stainless wire is suitable. The operation wires 21 and 22 can be advanced and retracted separately in the sheath 11 by an operation unit 40 described later. The operation wires 21 and 22 are formed in a substantially circular cross section or an elliptical cross section that matches the insertion holes 13 and 14 described above. Hereinafter, the main operation wire 21 and the sub operation wire 22 are collectively referred to as the operation wire 20.
処置部３０は、前記主操作ワイヤ２１と組みを成す主処置部３１と、前記副操作ワイヤ２２と組みを成す副処置部３２とを備える。主処置部３１と副処置部３２は、それぞれ弾性のある複数の処置ワイヤ３３，３４から構成され、各処置ワイヤ３３，３４は、前記シース１１から突出した時、該シース１１の軸心より拡開する湾曲した形状に復元する一方、前記シース１１に没入した時、該シース１１の軸心に沿って収縮するように弾性変形する。 The treatment section 30 includes a main treatment section 31 that forms a pair with the main operation wire 21 and a sub treatment section 32 that forms a pair with the sub operation wire 22. The main treatment portion 31 and the sub treatment portion 32 are each composed of a plurality of elastic treatment wires 33 and 34, and each treatment wire 33 and 34 expands from the axis of the sheath 11 when protruding from the sheath 11. While being restored to the open curved shape, when it is immersed in the sheath 11, it is elastically deformed so as to contract along the axis of the sheath 11.
主処置部３１を構成する処置ワイヤ３３の数は、２〜６本程度で足りるが、本実施の形態では４本の処置ワイヤ３３で構成している。処置ワイヤ３３の具体的な材質としては、例えばステンレス線材のほか、形状記憶合金（Ni-Ti）等の線材を用いても良い。
一方、副処置部３２を構成する処置ワイヤ３４の数も、１〜６本程度で足りるが、本実施の形態では２本の処置ワイヤ３４で構成している。処置ワイヤ３４の具体的な材質は、前記処置ワイヤ３３と同じである。
Although the number of treatment wires 33 constituting the main treatment portion 31 is about 2 to 6, it is constituted by four treatment wires 33 in the present embodiment. As a specific material of the treatment wire 33, for example, a wire such as a shape memory alloy (Ni-Ti) may be used in addition to a stainless wire.
On the other hand, the number of treatment wires 34 constituting the auxiliary treatment section 32 is also about 1 to 6, but in the present embodiment, the treatment wires 34 are constituted by two treatment wires 34. The specific material of the treatment wire 34 is the same as that of the treatment wire 33.
詳しく言えば、図４に示すように、主処置部３１は、各処置ワイヤ３３の手元側の基端を、前記主操作ワイヤ２１の遠位側の先端にチップ状の結束部２３を介して固結する一方、各処置ワイヤ３３の遠位側の先端同士は、チップ状の接続端部３５により互いに固結して成る。結束部２３は、少なくともその一部が前述した各挿通孔１３，１４に合致した楕円形断面に形成されている。ここで各処置ワイヤ３３は、前述したように、シース１１の軸心より拡開する湾曲した形状（図２（ａ）参照）に復元するものである。なお、図４では便宜上、各処置ワイヤ３３を直線状に延ばした状態を示している。 More specifically, as shown in FIG. 4, the main treatment portion 31 is configured such that the proximal end of each treatment wire 33 is connected to the distal end of the main operation wire 21 via a chip-like bundling portion 23. On the other hand, the distal ends of the treatment wires 33 are fixed to each other by a tip-like connection end 35. The bundling portion 23 is formed in an elliptical cross section that matches at least part of the insertion holes 13 and 14 described above. Here, as described above, each treatment wire 33 is restored to a curved shape (see FIG. 2A) that expands from the axis of the sheath 11. In FIG. 4, for convenience, each treatment wire 33 is shown in a linearly extended state.
また、図５に示すように、副処置部３２は、各処置ワイヤ３４の手元側の基端を、前記副操作ワイヤ２２の遠位側の先端にチップ状の結束部２４を介して固結する一方、各処置ワイヤ３４の遠位側の先端同士は、リング状の接続環部３６により互いに固結して成る。結束部２４は、少なくともその一部が前述した各挿通孔１３，１４に合致した楕円形断面に形成されている。ここで各処置ワイヤ３４は、前述したように、シース１１の軸心より拡開する湾曲した形状（図２（ｂ）参照）に復元するものである。 Further, as shown in FIG. 5, the auxiliary treatment section 32 is configured to fix the proximal end of each treatment wire 34 to the distal end of the auxiliary operation wire 22 via a chip-like bundling portion 24. On the other hand, the distal ends of the treatment wires 34 are fixed to each other by a ring-shaped connecting ring portion 36. The bundling portion 24 is formed in an elliptical cross section at least a part of which is matched with each of the insertion holes 13 and 14 described above. Here, as described above, each treatment wire 34 is restored to a curved shape (see FIG. 2B) that expands from the axis of the sheath 11.
ここで、副処置部３２の各処置ワイヤ３４は、前記主処置部３１の各処置ワイヤ３３の外側で拡開し、該拡開した最大外周は、前記主処置部３１の各処置ワイヤ３３が拡開した最大外周よりも大きく形成すると良い。また、接続環部３６の外径は、前記接続端部３５の外径と同程度にして、これらが前後に連なった時（図６（ａ）参照）、外周に凸凹が生じないように設定すると良い。これは、内視鏡のチャンネル内や体腔内における動きを良くするためである。なお、図５でも便宜上、各処置ワイヤ３４を直線状に延ばした状態を示している。 Here, each treatment wire 34 of the secondary treatment section 32 expands outside each treatment wire 33 of the main treatment section 31, and each treatment wire 33 of the main treatment section 31 has a widened outer periphery. It is good to form larger than the expanded maximum outer periphery. Further, the outer diameter of the connection ring portion 36 is set to be approximately the same as the outer diameter of the connection end portion 35, and when these are connected back and forth (see FIG. 6A), the outer circumference is set so as not to be uneven. Good. This is to improve the movement of the endoscope in the channel or body cavity. Note that FIG. 5 also shows a state in which each treatment wire 34 is extended linearly for convenience.
図１、図６に示すように、副処置部３２の接続環部３６は、前記主処置部３１の各処置ワイヤ３３の途中を束ねた状態にして外嵌している。この接続環部３６は、副処置部３２がシース１１内に没入した時に当接するシース１１の先端口１２から、前記主処置部３１にてシース１１の先端口１２より進退する接続端部３５までの間で、前記副操作ワイヤ２２の操作に伴い軸方向に移動可能となっている。ここで接続端部３５は、接続環部３６の抜け止め防止のためのストッパの役割を果たす。 As shown in FIGS. 1 and 6, the connection ring portion 36 of the auxiliary treatment portion 32 is externally fitted with the treatment wires 33 of the main treatment portion 31 being bundled in the middle. The connection ring portion 36 extends from the distal end port 12 of the sheath 11 that contacts when the auxiliary treatment portion 32 is immersed in the sheath 11 to the connection end portion 35 that advances and retracts from the distal end port 12 of the sheath 11 at the main treatment portion 31. In between, it can move to an axial direction with operation of the sub-operation wire 22. Here, the connection end portion 35 serves as a stopper for preventing the connection ring portion 36 from coming off.
接続環部３６が当接するシース１１の先端口１２の内側には、図３に示すように、接続環部３６および／または該接続環部３６に固結した処置ワイヤ３４の先端の少なくとも一部を収納可能な凹部１２ａが形成されている。本実施の形態では、図３に示すように、処置ワイヤ３４の先端の一部として、接続環部３６の外周に固結した箇所からシース１１内に収めると軸心内側寄りに屈曲する部位（図５（ｂ）中にて２点破線で囲む）が、シース１１の先端口１２の内側に収まるように、当該部位の挿通孔１３，１４の先端同士が連通接続する空間として形成されている。 As shown in FIG. 3, as shown in FIG. 3, at least a part of the distal end of the treatment wire 34 fixed to the connection ring portion 36 and / or the connection ring portion 36 is disposed inside the distal end 12 of the sheath 11 with which the connection ring portion 36 abuts. The recessed part 12a which can accommodate is formed. In the present embodiment, as shown in FIG. 3, as a part of the distal end of the treatment wire 34, a portion that is bent toward the inner side of the axial center when it is housed in the sheath 11 from a portion solidified on the outer periphery of the connection ring portion 36 ( 5 (b) is formed as a space in which the distal ends of the insertion holes 13 and 14 of the part are in communication with each other so as to fit inside the distal end opening 12 of the sheath 11. .
また、接続端部３５、および／または接続環部３６は、Ｘ線透視下で確認可能な材質により形成されている。具体的には例えば、接続端部３５、および接続環部３６の材質として、造影性に優れたタングステン等を用いて形成すると良い。なお、前記結束部２３，２４は、ステンレス等の金属材を用いれば良いが、これらも接続端部３５、もしくは接続環部３６と同様に、タングステン等のＸ線透視下で確認可能な材質により形成しても良い。 Further, the connection end portion 35 and / or the connection ring portion 36 are formed of a material that can be confirmed under X-ray fluoroscopy. Specifically, for example, as the material of the connection end portion 35 and the connection ring portion 36, it is preferable to use tungsten or the like excellent in contrast. The bundling portions 23 and 24 may be made of a metal material such as stainless steel. However, like the connection end portion 35 or the connection ring portion 36, the binding portions 23 and 24 are made of a material that can be confirmed under X-ray fluoroscopy, such as tungsten. It may be formed.
ところで、図２に示すように、主処置部３１の４本の処置ワイヤ３３は、軸心を間にして互いに対向する一対が略同一平面上に並ぶ１組を成している。ここで２組ある処置ワイヤ３３の組同士の前記軸心を中心とした交差角度は、各処置ワイヤ３３間に適度な隙間が生じる範囲で適宜定めると良い。本実施の形態では、図２（ａ）に示すように、２組の平面同士の交差角度は、大きい方の優角（１２０度）が小さい方の劣角（６０度）の２倍に配されている。 By the way, as shown in FIG. 2, the four treatment wires 33 of the main treatment portion 31 form a pair in which a pair facing each other with the axial center in between are arranged on substantially the same plane. Here, the crossing angle of the two pairs of treatment wires 33 around the axis is preferably determined as long as an appropriate gap is generated between the treatment wires 33. In the present embodiment, as shown in FIG. 2 (a), the intersection angle between the two sets of planes is set to be twice the larger dominant angle (120 degrees) and the smaller minor angle (60 degrees). Has been.
副処置部３２の処置ワイヤ３４も、前記同様に軸心を間にして互いに対向する一対が１組を成すが、本実施の形態で副処置部３２を構成する処置ワイヤ３４は、２本で１組だけである。このような処置ワイヤ３４は、図２（ｂ）に示すように、前記各処置ワイヤ３３の成す優角を等分する位置になるように配され、各処置ワイヤ３４，３５は拡開した時に略等間隔に並ぶように設定されている。 Similarly, the pair of treatment wires 34 of the auxiliary treatment section 32 that are opposed to each other with an axial center therebetween form one set. However, the number of the treatment wires 34 that constitute the auxiliary treatment section 32 in this embodiment is two. There is only one set. As shown in FIG. 2B, such a treatment wire 34 is arranged so as to be at a position that equally divides the dominant angle formed by each treatment wire 33, and when each treatment wire 34, 35 is expanded. They are set so that they are arranged at substantially equal intervals.
このような各処置ワイヤ３３，３４の前記軸心を間とする角度は、適宜定め得る設計事項である。また、各処置ワイヤ３３，３４は、前記軸心より拡開する湾曲した形状であるが、なだらかに湾曲させることなく、基端から先端に至る途中部位を適宜屈曲させた形状としても良い。いずれの形状にせよ、シース１１内に没入させた時は、該シース１１の軸心に沿って収縮するように弾性変形するものであれば足りる。 Such an angle between the axial centers of the treatment wires 33 and 34 is a design matter that can be appropriately determined. The treatment wires 33 and 34 have a curved shape that expands from the axis, but may be appropriately bent at a midpoint from the proximal end to the distal end without being gently bent. In any shape, it is sufficient if it is elastically deformed so as to contract along the axis of the sheath 11 when immersed in the sheath 11.
図７に示すように、操作部４０は、前記シース１１の手元側まで延びた基端に設けられ、手動で前記各操作ワイヤ２１，２２を進退させるハンドル本体４１を備えている。ハンドル本体４１は、各操作ワイヤ２１，２２の軸方向に延びた形状であり、その外周には、軸方向に細幅状に延びるガイド溝４２が形成されている。このハンドル本体４１には、ガイド溝４２に沿って摺動可能な２つのスライダ４３，４４が取り付けられている。なお、ハンドル本体４１の基端には、指掛け用のリング４５が設けられている。 As shown in FIG. 7, the operation unit 40 includes a handle body 41 that is provided at a proximal end that extends to the proximal side of the sheath 11 and that manually moves the operation wires 21 and 22 back and forth. The handle main body 41 has a shape extending in the axial direction of each operation wire 21, 22, and a guide groove 42 extending in the axial direction is formed on the outer periphery thereof. Two sliders 43 and 44 slidable along the guide groove 42 are attached to the handle body 41. Note that a finger hanging ring 45 is provided at the proximal end of the handle main body 41.
各スライダ４３，４４にて、前記ガイド溝４２よりシース１１内を臨む内側部分には、当該部位まで前記シース１１からガイド溝４２内に延ばされた各操作ワイヤ２１，２２の基端が連結されている。ここで、一方のスライダ４３には主操作ワイヤ２１が連結され、他方のスライダ４４には副操作ワイヤ２２が連結されており、各スライダ４３，４４の進退操作によって、各操作ワイヤ２１，２２を別々にシース１１より出没させることができる。 The base ends of the operation wires 21 and 22 extending from the sheath 11 to the guide groove 42 are connected to the inner portions of the sliders 43 and 44 facing the inside of the sheath 11 from the guide groove 42. Has been. Here, the main operation wire 21 is connected to one slider 43, and the sub operation wire 22 is connected to the other slider 44, and each operation wire 21, 22 is moved by the advance / retreat operation of each slider 43, 44. It can be made to appear and disappear from the sheath 11 separately.
次に、本実施の形態に係る医療用処置具１０の作用を説明する。
処置部３０をシース１１内に収納した状態にして（図６参照）、体腔内に挿入してある図示省略した内視鏡のチャンネル内にシース１１を挿入する。そして、シース１１の先端側を、内視鏡先端より体腔内の目的部位の近くまで突き出す。処置部３０の先端側が結石のある位置を越えた時、操作部４０の操作により操作ワイヤ２０を前進させて、シース１１の先端から処置部３０を突出させる。
Next, the operation of the medical treatment tool 10 according to the present embodiment will be described.
The treatment section 30 is housed in the sheath 11 (see FIG. 6), and the sheath 11 is inserted into a channel of an endoscope (not shown) inserted into the body cavity. Then, the distal end side of the sheath 11 is protruded from the endoscope distal end to the vicinity of the target site in the body cavity. When the distal end side of the treatment section 30 exceeds the position where the calculus is present, the operation wire 20 is advanced by the operation of the operation section 40 and the treatment section 30 is projected from the distal end of the sheath 11.
図２に示すように、処置部３０は、主処置部３１と副処置部３２とを組み合わせて成り、副処置部３２の各処置ワイヤ３４の先端を固結した接続環部３６は、主処置部３１の各処置ワイヤ３３の途中を束ねた状態に外嵌しており、この接続環部３６は、シース１１の先端口１２から主処置部３１の先端に渡って移動させることができる。これにより、１つの医療用処置具１０だけで、結石の大きさ等の状況に応じて複数の線数を選択的に使い分けることが可能となる。 As shown in FIG. 2, the treatment section 30 is formed by combining a main treatment section 31 and a sub-treatment section 32, and a connection ring portion 36 in which the distal ends of the treatment wires 34 of the sub-treatment section 32 are consolidated is a main treatment section. The connection wire 36 is externally fitted in a bundled state in the middle of each treatment wire 33 of the section 31, and can be moved from the distal end 12 of the sheath 11 to the distal end of the main treatment section 31. Thereby, it becomes possible to selectively use a plurality of lines according to the situation such as the size of the calculus with only one medical treatment instrument 10.
すなわち、大きな結石を取り込む場合には、操作部４０のスライダ４４は操作せず、副処置部３２の各処置ワイヤ３４をシース１１内に没入させた状態で、操作部４０のスライダ４３だけを前進させれば、シース１１の先端口１２に当接した接続環部３６より、主処置部３１の各処置ワイヤ３３だけがシース１１外に突出する。この場合、図６（ｃ）に示すように、主処置部３１の各処置ワイヤ３３が弾性力によって拡開するように復元し、４本の処置ワイヤ３３が拡開した線数の少ない状態となる。 That is, when a large calculus is taken in, the slider 44 of the operation unit 40 is not operated, and only the slider 43 of the operation unit 40 is advanced with each treatment wire 34 of the sub-treatment unit 32 being immersed in the sheath 11. Then, only the treatment wires 33 of the main treatment portion 31 protrude out of the sheath 11 from the connection ring portion 36 in contact with the distal end port 12 of the sheath 11. In this case, as shown in FIG. 6C, each treatment wire 33 of the main treatment section 31 is restored so as to be expanded by elastic force, and the four treatment wires 33 are expanded and the number of wires is small. Become.
一方、比較的小さな結石を取り込む場合には、前述したスライダ４３の操作に続いて、スライダ４４も前進させれば、図６（ｄ）に示すように、接続環部３６は押し出されつつ、前記各主処置部３１の各処置ワイヤ３３の途中を一時的に束ねながら前方へ移動する。そして、副処置部３２の各処置ワイヤ３４もシース１１外に突出する。すると、図６（ｅ）に示すように、副処置部３２の各処置ワイヤ３４も弾性力によって拡開するように復元し、処置部３０は、４本の処置ワイヤ３３と２本の処置ワイヤ３４が全て拡開した線数の多い状態となる。 On the other hand, when a relatively small calculus is taken in, if the slider 44 is also advanced following the operation of the slider 43 described above, the connecting ring portion 36 is pushed out as shown in FIG. It moves forward while temporarily bundling the middle of each treatment wire 33 of each main treatment section 31. Then, each treatment wire 34 of the auxiliary treatment section 32 also protrudes outside the sheath 11. Then, as shown in FIG. 6 (e), each treatment wire 34 of the sub-treatment unit 32 is restored so as to expand by elastic force, and the treatment unit 30 has four treatment wires 33 and two treatment wires. 34 becomes a state with many lines which all expanded.
このように、操作部４０（のスライダ４４）の操作により、副処置部３２の接続環部３６をシース１１外に押し出したり引き戻すだけで、体内外での処置ワイヤ３３，３４の線数を容易に切り替えることができる。いずれの線数に拡開した場合であっても、拡開した処置部３０を結石のある位置まで引き寄せるようにして、結石を処置部３０内に取り込むことができる。その後、操作部４０で操作ワイヤ２０を引き戻しつつ処置部３０を縮少させることにより、処置部３０内に結石を確実に保持する。そして、医療用処置具１０を内視鏡と共に体腔内から引き抜いて結石を回収する。 In this way, the number of treatment wires 33 and 34 inside and outside the body can be easily increased by simply pushing the connection ring portion 36 of the auxiliary treatment portion 32 out of the sheath 11 or pulling it back by operating the operation portion 40 (the slider 44). You can switch to Regardless of the number of lines expanded, the expanded treatment part 30 can be taken into the treatment part 30 by pulling the expanded treatment part 30 to a position where the stone is located. Thereafter, the treatment section 30 is contracted while the operation wire 20 is pulled back by the operation section 40, so that the calculus is reliably held in the treatment section 30. Then, the medical treatment tool 10 is pulled out from the body cavity together with the endoscope, and the calculus is collected.
ここで、主処置部３１と副処置部３２の両方を拡開した状態から収縮する時は、操作部４０におけるスライダ４４の操作をスライダ４３の操作より先行させると良い。すなわち、主操作ワイヤ２１よりも副操作ワイヤ２２を引き戻す操作を先行させることにより、拡開したバスケット状の処置部３０は、シース１１に近い基端側からではなく、遠い先端側から徐々に窄めるような操作が可能となる。これにより、処置部３０内より異物が脱落しやすい先端側の隙間から徐々に狭くなり、引き抜く時に異物が脱落することを確実に防止することもできる。 Here, when both the main treatment portion 31 and the sub treatment portion 32 are contracted from the expanded state, the operation of the slider 44 in the operation portion 40 may be preceded by the operation of the slider 43. That is, by causing the sub operation wire 22 to be pulled back before the main operation wire 21, the expanded basket-like treatment section 30 is gradually constricted from the distal end side, not from the proximal end side close to the sheath 11. Operation is possible. Thereby, it becomes narrow gradually from the front-end | side clearance | gap which a foreign material tends to drop out from the inside of the treatment part 30, and it can also prevent reliably that a foreign material falls out when pulling out.
また、本実施の形態に係る医療用処置具１０では、副処置部３２の各処置ワイヤ３４は、主処置部３１の各処置ワイヤ３３の外側で拡開し、該拡開した最大外周を、主処置部３１の各処置ワイヤ３３が拡開した最大外周よりも大きく形成されるので、特に、副処置部３２の各処置ワイヤ３４によって、体腔内での展開スペースの確保を容易に行うことが可能となる。また、主処置部３１と副処置部３２は、拡開した時の最大外周の違いにより、互いの干渉を低減することができる。 Further, in the medical treatment instrument 10 according to the present embodiment, each treatment wire 34 of the sub-treatment unit 32 is expanded outside each treatment wire 33 of the main treatment unit 31, and the expanded maximum outer circumference is Since each treatment wire 33 of the main treatment part 31 is formed larger than the expanded outer periphery, it is particularly easy to secure a deployment space in the body cavity by each treatment wire 34 of the sub-treatment part 32. It becomes possible. Moreover, the main treatment part 31 and the secondary treatment part 32 can reduce mutual interference by the difference in the maximum outer periphery when it expands.
なお、副処置部３２の各処置ワイヤ３４が拡開した最大外周を、主処置部３１の各処置ワイヤ３３が拡開した最大外周よりも大きく形成しなくとも、副処置部３２の各処置ワイヤ３４の硬度を、主処置部３１の各処置ワイヤ３３よりも上げることによっても、体腔内での展開スペースの確保を容易に行うことが可能となる。 Each treatment wire of the secondary treatment section 32 may be formed even if the maximum outer circumference where each treatment wire 34 of the secondary treatment section 32 is expanded is not larger than the maximum outer circumference where each treatment wire 33 of the main treatment section 31 is expanded. It is also possible to easily secure a deployment space in the body cavity by raising the hardness of 34 higher than that of each treatment wire 33 of the main treatment portion 31.
また、前述した医療用処置具１０では、シース１１内部の挿通孔１３，１４の少なくとも一部を、各操作ワイヤ２０の断面形状に合致した楕円形に形成されるので、各挿通孔１３，１４内にて各操作ワイヤ２０は軸回りに回転不能な状態で挿通される。これにより、シース１１内にて各操作ワイヤ２０が捻れることを防止でき、また、処置ワイヤ３３と処置ワイヤ３４との相対的な位置関係（互いの拡開角度等）を一定の状態に維持することができる。 Further, in the medical treatment instrument 10 described above, at least a part of the insertion holes 13 and 14 inside the sheath 11 is formed in an elliptical shape that matches the cross-sectional shape of each operation wire 20. Each operation wire 20 is inserted in a state in which it cannot rotate around the axis. As a result, the operation wires 20 can be prevented from being twisted in the sheath 11 and the relative positional relationship (the mutual opening angle, etc.) between the treatment wire 33 and the treatment wire 34 is maintained in a constant state. can do.
また、前述した医療用処置具１０では、シース１１の先端口１２の内側に、副処置部３２の接続環部３６、および／または該接続環部３６に固結した処置ワイヤ３４の先端の少なくとも一部を収納可能な凹部１２ａを形成したから、副処置部３２の接続環部３６の手元側をシース１１の先端口１２に隙間なく当接させることができる。 Further, in the medical treatment instrument 10 described above, at least the distal end of the treatment ring 34 fixed to the connection ring portion 36 and / or the connection ring portion 36 inside the distal treatment port 32 inside the distal end opening 12 of the sheath 11. Since the recessed portion 12a capable of accommodating a part is formed, the proximal side of the connection ring portion 36 of the auxiliary treatment portion 32 can be brought into contact with the distal end port 12 of the sheath 11 without a gap.
さらに、前述した医療用処置具１０によれば、主処置部３１の接続端部３５、および／または副処置部３２の接続環部３６を、Ｘ線透視下で確認可能な材質により形成されているので、シース１１を体内に挿入する時に、シース１１先端にある接続端部３５や接続環部３６の位置をＸ線で確認しながら所望の位置に挿入することが容易となり、また、Ｘ線で確認しながら操作することが可能となり、主処置部３１や副処置部３２の拡開ないし縮小の状態を把握することもできる。 Furthermore, according to the medical treatment instrument 10 described above, the connection end portion 35 of the main treatment portion 31 and / or the connection ring portion 36 of the auxiliary treatment portion 32 are formed of a material that can be confirmed under fluoroscopy. Therefore, when the sheath 11 is inserted into the body, it is easy to insert the sheath 11 at a desired position while confirming the positions of the connection end 35 and the connection ring portion 36 at the distal end of the sheath 11 with X-rays. It is possible to perform the operation while confirming, and it is possible to grasp the state of expansion or contraction of the main treatment unit 31 or the sub treatment unit 32.
以上、本発明の実施の形態を図面によって説明してきたが、具体的な構成はこれらの実施の形態に限られるものではなく、本発明の要旨を逸脱しない範囲における変更や追加があっても本発明に含まれる。例えば、主処置部３１および副処置部３２における各処置ワイヤ３３，３４の数や大きさ、互いの角度は、図２に示したものに限られることなく、図８〜図１０に変形例を示すような様々な配置にしても良い。 As described above, the embodiments of the present invention have been described with reference to the drawings. However, the specific configuration is not limited to these embodiments, and the present invention can be modified or added without departing from the scope of the present invention. Included in the invention. For example, the number and size of the treatment wires 33 and 34 in the main treatment section 31 and the sub treatment section 32, and the mutual angle are not limited to those shown in FIG. Various arrangements as shown may be used.
また、前記シース１１の各挿通孔１３，１４において、それぞれに挿通させる各操作ワイヤ２１，２２の回転を防止するための断面形状は、前述した楕円形に限られることなく多角形としたり、あるいは、突条を備えたキー構造としても良い。また、主操作ワイヤ２１および挿通孔１３と、副操作ワイヤ２２および挿通孔１４の断面形状やその大きさは、それぞれ同一に揃える必要はなく、別々に異ならせてもかまわない。 In addition, the cross-sectional shape for preventing the rotation of the operation wires 21 and 22 to be inserted into the insertion holes 13 and 14 of the sheath 11 is not limited to the above-described elliptical shape, but may be a polygon, or Also, a key structure with protrusions may be used. The cross-sectional shapes and sizes of the main operation wire 21 and the insertion hole 13 and the sub operation wire 22 and the insertion hole 14 do not have to be the same, and may be different from each other.
さらに、前記シース１１の先端口１２の内側には、接続環部３６に固結した処置ワイヤ３４の先端の屈曲した部位だけ収まる凹部１２ａを形成したが、他に例えば、処置ワイヤ３４の先端の一部のみならず、接続環部３６の一部も収まるような凹部として形成しても良い。 Furthermore, a recess 12a is formed inside the distal end 12 of the sheath 11 so that only the bent portion of the distal end of the treatment wire 34 fixed to the connection ring portion 36 can be accommodated. You may form as a recessed part which can accommodate not only a part but a part of connection ring part 36. FIG.
さらに、処置ワイヤ３４は図５に示すような、接続環部３６の側面に固結させる他、接続環部３６の基端側端面に固結させてもよい。 Further, as shown in FIG. 5, the treatment wire 34 may be solidified to the side surface of the connection ring portion 36 or may be solidified to the proximal end side end surface of the connection ring portion 36.
本発明は、内視鏡を介して体腔内に挿入され、体腔内に生じた結石等の異物を回収するためのバスケット型把持鉗子として広く利用することができる。 INDUSTRIAL APPLICABILITY The present invention can be widely used as a basket-type grasping forceps that is inserted into a body cavity via an endoscope and collects foreign substances such as calculi generated in the body cavity.
１０…医療用処置具
１１…シース
１２…先端口
１２ａ…凹部
１３…挿通孔
１４…挿通孔
２０…操作ワイヤ
２１…主操作ワイヤ
２２…副操作ワイヤ
２３…結束部
２４…結束部
３０…処置部
３１…主処置部
３２…副処置部
３３…処置ワイヤ
３４…処置ワイヤ
３５…接続端部
３６…接続環部
４０…操作部
４１…ハンドル本体
４２…ガイド溝
４３…スライダ
４４…スライダ
DESCRIPTION OF SYMBOLS 10 ... Medical treatment tool 11 ... Sheath 12 ... Tip port 12a ... Recess 13 ... Insertion hole 14 ... Insertion hole 20 ... Operation wire 21 ... Main operation wire 22 ... Sub operation wire 23 ... Bundling part 24 ... Bundling part 30 ... Treatment part DESCRIPTION OF SYMBOLS 31 ... Main treatment part 32 ... Sub-treatment part 33 ... Treatment wire 34 ... Treatment wire 35 ... Connection end part 36 ... Connection ring part 40 ... Operation part 41 ... Handle body 42 ... Guide groove 43 ... Slider 44 ... Slider
Claims (5)
前記操作ワイヤは、主操作ワイヤと、副操作ワイヤとを備え、
前記処置部は、前記主操作ワイヤと組みを成す主処置部と、前記副操作ワイヤと組みを成す副処置部とを備え、
前記主処置部と前記副処置部は、それぞれ弾性のある複数の処置ワイヤから構成され、各処置ワイヤは、前記シースから突出した時、該シースの軸心より拡開する屈曲ないし湾曲した形状に復元する一方、前記シースに没入した時、該シースの軸心に沿って収縮するように弾性変形し、
前記主処置部は、その各処置ワイヤの手元側の基端を、前記主操作ワイヤの遠位側の先端に固結する一方、各処置ワイヤの遠位側の先端同士は、チップ状の接続端部により互いに固結して成り、
前記副処置部は、その各処置ワイヤの手元側の基端を、前記副操作ワイヤの遠位側の先端に固結する一方、各処置ワイヤの遠位側の先端同士は、リング状の接続環部により互いに固結して成り、
前記副処置部の接続環部は、前記主処置部の各処置ワイヤの途中を束ねた状態にして外嵌しており、前記副処置部が没入した時に当接するシースの先端口から、前記主処置部にてシースの先端口より進退する接続端部までの間で、前記副操作ワイヤの操作に伴い軸方向に移動可能であることを特徴とする医療用処置具。 A flexible sheath extending in a thin tube, an operation wire inserted in the sheath so as to be able to advance and retreat, and provided at the distal end of the operation wire so as to protrude and retract from the sheath, and can be expanded or contracted in a basket shape. In a medical treatment instrument comprising a treatment section,
The operation wire includes a main operation wire and a sub operation wire,
The treatment portion includes a main treatment portion that forms a set with the main operation wire, and a sub treatment portion that forms a set with the sub operation wire,
The main treatment section and the sub-treatment section are each composed of a plurality of elastic treatment wires, and each treatment wire has a bent or curved shape that expands from the axis of the sheath when protruding from the sheath. On the other hand, when it is immersed in the sheath, it is elastically deformed to contract along the axis of the sheath,
The main treatment unit is configured to fix the proximal end of each treatment wire to the distal tip of the main operation wire, while the distal tips of the treatment wires are connected in a chip shape. Consolidated together by the ends,
The sub-treatment unit is configured to fix the proximal end of each treatment wire to the distal tip of the sub-operation wire, while the distal tips of the treatment wires are connected in a ring shape. Consists of each other by annulus,
The connecting ring portion of the auxiliary treatment portion is externally fitted with the treatment wires of the main treatment portion being bundled in the middle, and from the distal end of the sheath that comes into contact when the auxiliary treatment portion is submerged, A medical treatment instrument that is movable in the axial direction in accordance with the operation of the sub-operation wire between a treatment portion and a connection end portion that advances and retreats from the distal end of the sheath.
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
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| JPWO2019155796A1 (en) * | 2018-02-08 | 2021-02-04 | 株式会社カネカ | Basket catheter |
| US11504143B2 (en) | 2018-06-28 | 2022-11-22 | Olympus Corporation | Endoscope treatment tool |
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