JP2016030077A - Medical device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To take an object of a living body lumen into a treatment part composed of a plurality of wires by a simple operation and suppress the coming-off of the object.SOLUTION: A medical device 10 includes a long shaft body part 14 inserted into a urinary tract A, and a basket 12 that can shift between a first expanded form and a second expanded form more reduced than the first expanded form in a state of being exposed from the shaft body part 14. The basket 12 includes a plurality of non-rotating wires 66 and rotating wires 64 provided in a circumferential direction of the basket 12. The rotating wires 64 which are located at a position adjacent to the non-rotating wires 66 in the first expanded form rotate relatively to the non-rotating wires 66 with the shift from the first expanded form to the second expanded form, and are separated from the non-rotating wires 66.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical device used for treatment in a living body lumen.

  Treatment such as transurethral ureteric lithotripsy is performed for urinary calculi generated in the ureter, renal pelvis, renal cup, etc. (biological lumen). In this transurethral ureterolithography, the calculus is crushed by forceps, shock waves, laser, etc. while the calculus is confirmed with an endoscope (ureteroscope) inserted into the urinary tract, and the calculus is reduced. Is collected by a medical device.

  As a medical device for recovering a calculus, for example, as disclosed in Patent Document 1, there is a device provided with a basket (treatment section) that can be exposed from the distal end of a sheath. This basket is composed of a plurality of legs (wires). The medical device is inserted into the ureter under the operation of a user such as a doctor, the basket is expanded at a place where the stone is located, and the stone is taken inside the expanded state. Thereafter, the user contracts the basket to grasp the calculus, and further retracts the basket to collect the calculus. In particular, in the medical device disclosed in Patent Document 1, at least one of the legs deployed in the ureter operates independently of the other legs and captures the stone, thereby quickly and easily collecting the stone. It is said that.

JP 2008-68102 A

  By the way, in order to take a calculus in a basket, the above medical devices expand and enlarge the clearance gap between several wires. Therefore, when the basket is contracted, stones may spill out from the gap. In particular, in transurethral ureteric lithotripsy, it is crushed into several tens of small stones by crushing treatment, but it has been difficult for conventional medical devices to collect a plurality of small stones together. Here, in order to suppress spillage of stones, it is conceivable to form the basket in a special shape (for example, a mesh shape). However, in this case, there arises another inconvenience that the operation of taking the stone into the basket by the user becomes complicated.

  The present invention has been made in view of the above circumstances, and it is possible to take in a subject of a living body lumen into a treatment portion with a simple operation, and further suppress the removal of the subject from inside the treatment portion, thereby performing treatment. It aims at providing the medical device which can be performed efficiently.

  In order to achieve the above object, a medical device according to the present invention includes a long shaft main body inserted into a living body lumen, a first expanded configuration in a state of being exposed from the shaft main body. A treatment portion that can be shifted to a second expansion configuration that is smaller than the first expansion configuration, and the treatment portion includes a plurality of first wires provided in a circumferential direction of the treatment portion, and the treatment Provided in the circumferential direction of the portion, in a position close to the first wire in the first expanded configuration, and relative to the plurality of first wires in accordance with the transition from the first expanded configuration to the second expanded configuration. And a second wire that rotates about the axis of the shaft main body and separates from the first wire.

  According to the above, in the medical device, the treatment unit includes a plurality of first wires and a plurality of second wires that can rotate around the axis of the shaft main body. It can be easily and reliably taken into the treatment section. The treatment portion is in the first expanded form, and the first and second wires are arranged at positions close to each other, so that the object of the biological lumen can easily enter the inside of the treatment portion. Then, with the transition from the first expanded form to the second expanded form, the plurality of second wires rotate relative to the plurality of first wires, thereby reducing the gap (angular interval) between adjacent wires. The object can be gripped well. Moreover, even if a treatment part takes in a several target object in the case of a 1st expansion form, it can suppress the omission of a target object in a 2nd expansion form, and can perform a treatment efficiently.

  In this case, it is preferable that the plurality of second wires are arranged at a substantially middle portion between the plurality of first wires adjacent to each other in the second expanded form.

  As described above, the plurality of second wires are arranged in a substantially intermediate portion between the plurality of first wires, whereby the gaps between the adjacent wires can be reduced, respectively, and the omission of the object is further suppressed. be able to.

  Moreover, it is preferable that the said shaft main-body part has a holding part rotated relatively with respect to the said 1st wire in the state holding the said 2nd wire.

  As described above, the medical device has the holding portion, and thus the treatment portion can be rotated by dividing the rotation of the second wire and the non-rotation of the first wire well.

  Further, the holding portion is formed in a cylindrical shape, and has a fixing hole for inserting and fixing the plurality of second wires in an axial center portion thereof, and the plurality of first wires are disposed radially outward from the fixing hole. It is good that the configuration is arranged.

  Thereby, the holding | maintenance part can be rotated by making the 1st wire arrange | positioned radially outside a non-rotation state, and can transmit a rotational force only to the 2nd wire currently hold | maintained. As a result, the treatment unit can favorably vary the relative positions of the first wire and the second wire.

  In addition to the above configuration, the holding portion has an arrangement hole or an arrangement groove in which the plurality of first wires are arranged, and the arrangement hole or the arrangement groove is a circumferential direction in an axial sectional view of the holding portion. It is good to extend to.

  Thus, by having the arrangement | positioning hole or arrangement groove extended in the circumferential direction, even if a holding | maintenance part rotates in the circumferential direction, the non-rotation state of a 1st wire can be maintained easily.

  Alternatively, the holding portion is formed in a cylindrical shape, and a plurality of arrangement holes for arranging the plurality of first wires in an axial center portion thereof and a plurality of the plurality of second wires fixedly held outside in the radial direction from the arrangement hole. It can also be set as the structure which has these fixing | fixed part.

  As described above, the holding unit rotates the second wire even if the first wire is arranged in the arrangement hole of the shaft center part and the second wire is fixed by the fixing part outside the arrangement hole, that is, the treatment part. The rotation operation can be performed satisfactorily.

  Further, the shaft main body portion includes a housing portion that houses the holding portion so as to be able to advance and retreat, the holding portion has a protrusion protruding radially outward, and the housing portion has the protrusion inserted therein, It is preferable to have a guide groove for protrusion that guides the protrusion as it advances and retreats relative to the holding portion, and rotates the holding portion around the axis of the shaft main body.

  As described above, the medical device accommodates the holding portion by the housing portion so that the holding portion can be moved forward and backward, so that the holding portion can be easily rotated when the housing portion advances and retracts relative to the holding portion, and the holding portion is fixed. The second wire can be smoothly rotated.

  Furthermore, it is preferable that the holding portion is provided on the distal end side of the shaft main body portion.

  Thus, by providing the holding portion on the distal end side of the shaft main body portion, the rotational force of the holding portion can be reliably transmitted to the treatment portion provided in the distal direction than the shaft main body portion. The rotation operation can be performed satisfactorily.

  Or the said holding | maintenance part may be provided in the operation part connected to the base end side of the said shaft main-body part, or the base end side rather than the said shaft main-body part.

  As described above, the holding portion is provided on the proximal end side of the shaft main body portion or the operation portion, so that the user can operate the holding portion in the operation portion exposed from the outside of the patient. Therefore, the user can take in the target object by sensuously operating the rotation operation of the treatment section.

  In this case, the protrusion guide groove includes a first groove path that rotates the holding portion around the axis of the shaft main body and a second groove path that guides the holding portion non-rotatingly in the path of the protrusion. It is good to have.

  Thus, since the guide groove for protrusion has the first groove path and the second groove path, the user can select the rotation operation and the non-rotation operation of the holding portion, that is, the second wire, and more versatility. Can be expensive.

  Here, the shaft main body includes an accommodating portion that accommodates the plurality of second wires so that the plurality of second wires can move forward and backward, and the plurality of second wires have a protruding portion that protrudes radially outward. And a convex guide groove that guides the convex portion relative to the second wire with respect to the second wire and rotates the second wire about the axis of the shaft main body. It can also be.

  Thereby, the medical device can rotate the second wire directly by the guide groove for the convex portion of the accommodating portion by moving the accommodating portion forward and backward relative to the second wire. Can be implemented more satisfactorily.

  According to the present invention, the medical device can perform the treatment efficiently by taking in the object of the living body lumen into the treatment part and further suppressing the removal of the object from the treatment part with a simple operation. it can.

It is a side view which shows roughly the 1st expansion form of the medical device which concerns on 1st Embodiment of this invention. It is a perspective view which shows the guide cylinder of the medical device of FIG. It is a perspective view which shows the holding member of the medical device of FIG. It is a side view which shows the 2nd expansion form of the medical device of FIG. 1 schematically. 5A is a cross-sectional view taken along line VA-VA in FIG. 1, and FIG. 5B is a cross-sectional view taken along line VB-VB in FIG. FIG. 6A is a first explanatory diagram illustrating a procedure using the medical device of FIG. 1, and FIG. 6B is a second explanatory diagram of a procedure following FIG. 6A. FIG. 7A is a third explanatory diagram of the treatment following FIG. 6B, and FIG. 7B is a fourth explanatory diagram of the treatment following FIG. 7A. 8A is a cross-sectional view showing a wire according to a first modification, FIG. 8B is a cross-sectional view showing a wire according to a second modification, and FIG. 8C shows a holding member according to a third modification. FIG. 8D is a side cross-sectional perspective view showing a holding member according to a fourth modified example. It is a fragmentary perspective view which shows roughly the 1st expansion form of the front end side of the medical device which concerns on 2nd Embodiment of this invention. 10A is an enlarged perspective view showing the distal end side of the shaft main body portion of FIG. 9, and FIG. 10B is a side cross-sectional view showing the distal end side of the shaft main body portion of FIG. FIG. 10 is a partial perspective view schematically showing a second expanded configuration on the distal end side of the medical device of FIG. 9. It is explanatory drawing which shows the basket of the medical device of FIG. FIG. 13A is a partial side view schematically showing a first expanded form on the distal end side of the medical device according to the third embodiment of the present invention, and FIG. 13B is an enlarged view of the distal end side of the shaft main body in FIG. 13A. 13C is a cross-sectional view taken along line XIIIC-XIIIC in FIG. 13A. 14A is a partial side view schematically showing a second expanded form on the distal end side of the medical device of FIG. 13A, and FIG. 14B is an enlarged side view showing the distal end side of the shaft body portion of FIG. 14A. FIG. 14C is a cross-sectional view taken along the line XIVC-XIVC in FIG. 14A. It is a side view which shows roughly the 1st expansion form of the medical device which concerns on 4th Embodiment of this invention. FIG. 16 is a side view schematically showing a second expanded form of the medical device of FIG. 15. 17A is a cross-sectional view taken along line XVIIA-XVIIA in FIG. 15, and FIG. 17B is a cross-sectional view taken along line XVIIB-XVIIB in FIG. It is a side view which shows roughly the medical device which concerns on a 5th modification.

  Hereinafter, preferred embodiments (first to fourth embodiments) of a medical device according to the present invention will be described and described in detail with reference to the accompanying drawings.

[First Embodiment]
The medical device 10 according to the first embodiment is configured as a medical device that collects a calculus (target object) present in the urinary system such as a ureter, renal pelvis, or renal cup that is a biological lumen. In the procedure, the surgeon delivers the basket 12 (treatment section: see FIG. 1) provided at the distal end of the medical device 10 to a place where there is a calculus in the ureter, takes the calculus into the basket 12, and Collect the calculus by removing the device from it.

  In addition, the medical device 10 can be applied not only to collect stones but also to treatment of various biological lumens. For example, the living body lumen to which the medical device 10 is applied includes a lumen of the cardiovascular system, endocrine system, lymph system, respiratory system, digestive system, or other organs in addition to the urinary system. It is done.

  As shown in FIG. 1, the medical device 10 includes a long shaft main body 14 and an operation unit 16 attached to the proximal end side of the shaft main body 14. The shaft main body 14 has an axial length that can reach the treatment site (the location of the calculus in the ureter) from the outside of the patient. Since the shaft main body 14 is inserted into the ureter through the endoscope 18 (ureteroscope), the shaft main body 14 is formed to have a diameter sufficiently smaller than the outer diameter of the insertion tube 20 of the endoscope 18.

  An endoscope 18 indicated by a two-dot chain line in FIG. 1 includes, for example, an insertion tube 20 and a grip operation unit 22, and further includes a camera 24 and illumination (not shown) at the distal end portion of the insertion tube 20. The endoscope 18 acquires image information in the ureter with the camera 24, displays the image in the ureter on an external monitor (not shown) through an optical fiber in the insertion tube 20, and enables treatment of stones. To do. An insertion lumen 20a having a predetermined inner diameter is formed through the insertion tube 20 of the endoscope 18 along the axial direction. In addition to the shaft main body 14 of the medical device 10 being inserted into the insertion lumen 20a, a medical laser instrument for performing calculus crushing processing is inserted.

  The body portion occupying most of the longitudinal direction of the shaft main body portion 14 is configured in a double tube structure of an outer shaft 26 and an inner shaft 28. The shaft body 14 includes a guide tube 30 (accommodating portion) coupled and fixed to the tip of the outer shaft 26, and a holding member 32 (coupled and fixed to the tip of the inner shaft 28 inside the guide tube 30. Holding part). The basket 12 is provided at the tip of the holding member 32 and can be exposed in the tip direction of the shaft body 14.

  The outer shaft 26 of the shaft body 14 is formed as a coil tube in which a wire is wound spirally. In the straight (normal) state of the outer shaft 26, the adjacent wires in the axial direction are in contact with each other. Wires adjacent in the axial direction may be bonded together. The outer shaft 26 has an outer diameter smaller than the inner diameter of the insertion lumen 20 a of the endoscope 18, and a distal end portion of the outer shaft 26 is fixed to the guide tube 30, while a proximal end portion of the outer shaft 26 is connected to the operation element 70 of the operation portion 16. Fixed. The axial length of the outer shaft 26 is set to about 20 cm to 120 cm, for example, although it depends on the position of the treatment site.

  Further, the outer shaft 26 is provided with an outer shaft insertion hole 34 in an axial center portion thereof by surrounding the periphery with a wire rod. The outer shaft insertion hole 34 penetrates along the axial direction of the outer shaft 26. Furthermore, it is preferable that a lubricant that enhances slidability with other members is applied to the inner peripheral surface or outer peripheral surface of the outer shaft 26 (wire material).

  Similar to the outer shaft 26, the inner shaft 28 of the shaft main body 14 is formed in a coil tube in which a wire is wound in a spiral shape and adjacent wires in the axial direction are in contact with each other. Thus, by making the outer shaft 26 and the inner shaft 28 into a spiral shape, the shaft main body portion 14 is increased in flexibility, and the entire shaft main body portion 14 can be easily bent at the time of delivery. The outer shaft 26 and the inner shaft 28 can be applied not only with a coil tube but also with various configurations. For example, the outer shaft 26 and the inner shaft 28 may be configured with a flexible long tube like a known catheter. .

  The material of the wire which comprises the inner shaft 28 and the outer shaft 26 is not specifically limited, A metal material and a resin material can be applied. Examples of the metal material include pseudoelastic alloys (including superelastic alloys) such as Ni-Ti alloys, shape memory alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405, SUS430). SUS434, SUS444, SUS429, SUS430F, SUS302, etc.), cobalt alloys, tungsten alloys, carbon materials, and the like. Examples of the resin material include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more of these), polystyrene, polychlorinated Examples thereof include polymer materials such as vinyl, polyamide, polyamide elastomer, polyester, polyester elastomer, polyurethane, polyurethane elastomer, polyimide, and fluororesin, and mixtures thereof.

  The inner shaft 28 is formed to have an outer diameter smaller than the inner diameter of the outer shaft insertion hole 34, and is inserted into the outer shaft insertion hole 34. The axial length of the inner shaft 28 is formed slightly longer than the axial length of the outer shaft 26. As a result, the tip of the inner shaft 28 is also inserted into the guide cylinder 30, and the holding member 32 is fixedly supported therein.

  An inner shaft insertion hole 36 is provided in the inner shaft 28 along the axial direction, and a plurality of wires 40 are inserted into the inner shaft insertion hole 36. Further, a lubricant that improves the slidability of the inner shaft 28 may be applied to the outer peripheral surface of the inner shaft 28.

  The plurality of wires 40 are members constituting the basket 12 at the distal end portion of the medical device 10, and eight wires 40 are accommodated in the inner shaft insertion hole 36 in the first embodiment. The eight wires 40 extend to the proximal end portion of the shaft main body portion 14 through the inner shaft insertion hole 36 and are connected and fixed to a hub 72 of the operation portion 16 described later.

  On the other hand, the guide tube 30 of the shaft body 14 is formed in a cylindrical shape having an outer diameter comparable to that of the outer shaft 26. The guide cylinder 30 has a function of accommodating the basket 12 while accommodating the holding member 32 and the inner shaft 28 slidably. The guide tube 30 is preferably formed of a metal material, a resin material, or the like, and is formed to be harder than the outer shaft 26. However, the guide tube 30 may be flexible or may not be flexible depending on the material and shape. Inside the guide tube 30, an accommodation space 42 that communicates with the outer shaft insertion hole 34 is provided.

  As shown in FIG. 2, a pair of guide grooves 44 that communicate with the housing space 42 and the outside are cut out in the peripheral wall of the guide cylinder 30. Each guide groove 44 is short on the distal end side of the guide tube 30 and extends in the distal direction, an inclined groove portion 48 extending to the distal end groove portion 46 and extending obliquely through the guide tube 30, and continuing to the inclined groove portion 48 and in the proximal direction. And a proximal end groove 50 that is sufficiently longer than the distal end groove 46. The distal end groove portion 46 and the proximal end groove portion 50 are formed at positions shifted from each other by 45 ° in the circumferential direction of the guide cylinder 30, and the two inclined groove portions 48 are connected to each other so that each guide groove 44 is connected with the same groove width. It is formed in the groove of the book. The guide groove 44 may be formed on the inner peripheral surface of the guide tube 30 and the outer peripheral surface of the guide tube 30 may be covered with a wall.

  Returning to FIG. 1, the holding member 32 of the shaft main body 14 inserted into the guide cylinder 30 is a cylindrical member having an outer diameter comparable to the outer diameter of the inner shaft 28 (see also FIG. 3). The holding member 32 is disposed so as to be slidable relative to the guide cylinder 30 within the accommodation space 42 of the guide cylinder 30. Moreover, the holding member 32 arrange | positions the some wire 40 in the state which hold | maintains or non-rotatably so that integral rotation is possible.

  As shown in FIG. 3, a pair of protrusions 52 are formed on the outer peripheral surface of the holding member 32 and have a cylindrical shape and protrude radially outward. Each protrusion 52 protrudes with a protrusion amount substantially corresponding to the thickness of the guide tube 30 and is inserted into the pair of guide grooves 44 of the guide tube 30. As a result, the holding member 32 is restricted from coming off the guide tube 30 and is guided to the guide groove 44. That is, the holding member 32 rotates around the circumference in the inclined groove portion 48 when the protrusion 52 moves (or moves in the opposite direction) from the distal end groove portion 46 to the proximal end groove portion 50.

  The holding member 32 has a plurality of holes formed so as to penetrate along the axial direction of the holding member 32. Specifically, one wire fixing hole 54 formed in a circular cross section in the axial center portion, and four wires extending in the circumferential direction by drawing a slight arc at a radially outer position of the wire fixing hole 54 And an arrangement hole 56. The wire arrangement holes 56 are formed at regular intervals (90 ° intervals) along the circumferential direction of the holding member 32.

  Four wires 40 are bundled and inserted into the wire fixing hole 54. Thereby, the holding member 32 contacts and holds the four wires 40 with a strong compression force, and firmly fixes the four wires 40. Conversely, one wire 40 is inserted into each of the four wire arrangement holes 56. Each wire arrangement hole 56 allows each wire 40 to be inserted in a free state without applying a strong contact force to the wire 40.

  Next, the basket 12 that actually collects stones in the medical device 10 will be specifically described with reference to FIGS. The basket 12 is configured by a plurality of wires 40 that are exposed in the distal direction from the tip of the shaft body 14 and are arranged around the axis of the shaft body 14.

  When each wire 40 is exposed from the tip of the shaft main body 14, it extends linearly (inclined in a side view) toward the tip and the radial outer side of the shaft main body 14. Each wire 40 extended by a predetermined length extends in a circular arc at the inflection point at a bending point 40a, and is symmetrical on the opposite side at the tip apex (near the extended portion of the shaft center portion of the shaft main body 14). The wire 40 is continuously formed. In other words, the two wires 40 connected at the top of the tip are, in other words, a portion in which one wire is originally exposed by forming a circular arc-shaped ring at an intermediate portion thereof, and is connected to an intermediate portion of the one wire. It can be said that both lines are inserted into the shaft body 14 and extend in two. In the present specification, the number of wires 40 will be described with reference to the wires 40 extending in the shaft body 14 for easy understanding of the invention.

  Therefore, the medical device 10 has eight wires 40 and each wire 40 can be exposed from the tip of the shaft main body 14. The four-wires 40 that spread radially from the tip of the shaft body 14 at 90 ° intervals connect the base triangle shape and the tip semicircular shape in a side view, and a cross-shaped three-dimensional structure 58 in a front view. Configure. That is, the basket 12 includes two three-dimensional structures 58 by eight wires 40. One three-dimensional structure 58 is configured as a rotating structure 60 that rotates about the axis of the shaft body 14, and the other three-dimensional structure 58 is configured as a non-rotating structure 62 that does not rotate. Yes.

  Four wires 40 (second wire: hereinafter also referred to as a rotating wire 64) constituting the rotating structure 60 are inserted and fixed in the wire fixing holes 54 of the holding member 32. That is, the rotating wire 64 is configured to rotate integrally with the holding member 32, and rotates around the holding member 32 when the holding member 32 rotates around the axis of the shaft body 14. On the other hand, four wires 40 (first wire: hereinafter referred to as non-rotating wire 66) constituting the non-rotating structure 62 are inserted into the four wire arrangement holes 56 of the holding member 32. The non-rotating wire 66 keeps the arrangement position without following and rotating even when the holding member 32 rotates. The two outermost wires 40 of the rotating structure 60 form a ring 60a that circulates small at the top of the tip of the basket 12, and this ring 60a and other wires of the rotating structure 60 are non-rotating structures. It has a function of fastening the object 62.

  The basket 12 configured as described above exhibits a contracted state by being accommodated in the accommodating space 42 of the guide cylinder 30, and exhibits an expanded state with exposure from the tip of the guide cylinder 30. In the expanded state, the object is taken in by the operations of the rotating structure 60 and the non-rotating structure 62. Specifically, as shown in FIG. 1, in a state where the holding member 32 is positioned on the distal end side of the guide tube 30, each rotating wire 64 and each non-rotating wire 66 exposed from the holding member 32 are respectively radially outward. Is the most expanded state (first expanded form).

  In this first expanded form, the holding member 32 has a protrusion 52 disposed in the tip groove portion 46 so that the relative position with respect to the guide tube 30 is defined, and the rotating wire 64 is not rotated as shown in FIG. 5A. It arrange | positions in the proximity | contact position of the wire 66. FIG. In the present embodiment, the proximity of the rotating wire 64 and the non-rotating wire 66 includes a state in which the wires overlap each other.

  In this case, the basket 12 has the first communicating portion 68a (gap) that opens the inside of the basket 12 sufficiently wide between the one rotating wire 64 and the one non-rotating wire 66. In addition, the basket 12 forms a small (or substantially closed) second communication portion 68 b (gap) at a location where the one rotating wire 64 and the non-rotating wire 66 approach each other. The basket 12 rotates so as to narrow the angular interval of the first communication portion 68a during the transition from the first expanded configuration to the second expanded configuration described later.

  Specifically, the angle θo of the first communication portion 68a configured by the rotating wire 64 and the non-rotating wire 66 that are adjacent to each other in the circumferential direction takes a value in the vicinity of 90 ° (for example, 90 ° ≦ θo ≦ 80 °). . Conversely, the angle θc of the second communication portion 68b takes a value around 0 ° (for example, 0 ° ≦ θc ≦ 10 °). In other words, in the first expanded form, the basket 12 opens the first communication portion 68a greatly, so that the calculus can be easily taken into the inside from the first communication portion 68a.

  On the contrary, as shown in FIG. 4, at the stage where the guide cylinder 30 advances relative to the holding member 32 and the projection 52 enters the proximal groove 50 from the first expanded form, Although the non-rotating wire 66 contracts somewhat, the expanded state is maintained (second expanded form). In the second expanded configuration, the holding member 32 rotates about the 45 ° axis with respect to the guide tube 30 by the projection 52 being guided by the proximal groove 50 through the inclined groove 48. Therefore, the rotating wire 64 is also rotated by 45 ° with respect to the non-rotating wire 66, and the rotating wire 64 is disposed at a substantially intermediate portion between the adjacent non-rotating wires 66 as shown in FIG. 5B. That is, the angles θo and θc of the first and second communication portions 68a and 68b adjacent to each other in the circumferential direction are values close to 45 ° (for example, 40 ° ≦ θo, θc ≦ 50 °). Therefore, in the 2nd expansion form, since the basket 12 makes the angle space | interval of the 1st and 2nd communication parts 68a and 68b small, it can suppress the spilling of the calculus taken in inside.

  Returning to FIG. 1, the operation unit 16 of the medical device 10 is a mechanism unit in which an operator grips the medical device 10 and operates the operation of the shaft body 14. The operation unit 16 includes an operation element 70 connected to the base end of the outer shaft 26 and a hub 72 connected to the base end of the inner shaft 28. 1 and 4 show the configuration of the proximal end side of the medical device 10, but for the convenience of illustration, the lower side is shown in a state of being contracted from the distal end side.

  The operating element 70 is a cylindrical member that is made of a resin material and has a larger diameter and is harder than the outer shaft 26. The operating element 70 has the outer shaft 26 firmly fixed therein and is slidably accommodated in the hub 72. The operation element 70 includes an operation projection 74 on the proximal end side in the axial direction, and the operation projection 74 protrudes from the side surface of the operation unit 16 through the sliding long hole 76 of the hub 72.

  The hub 72 is a cylindrical member that is formed to be hard like the operation element 70 and has a diameter larger than that of the operation element 70 so that the operator can easily grasp the hub 72. Further, a long slot 76 for sliding is formed on the outer peripheral surface of the hub 72 in the axial direction to expose a part of the operation element 70 (operation projection 74). Further, a plurality of wires 40 are fixed inside the hub 72. As a result, the operator can operate the operating element 70 relative to the hub 72 to advance and retract the outer shaft 26 and the guide tube 30 integrally. Then, the basket 12 is accommodated and exposed by the advance / retreat operation of the guide cylinder 30, and the first expanded form and the second expanded form are shifted in the exposed state.

  The medical device 10 according to the first embodiment is basically configured as described above, and the operation and effect thereof will be described below. As described above, the medical device 10 is used for transurethral ureteric lithotripsy.

  In transurethral ureteric lithotripsy, the operator anesthetizes the patient and then inserts a guide wire (not shown) into the ureter A from the bladder side so that the guide wire reaches the vicinity of the stone. Thereafter, the endoscope 18 is inserted along the guide wire, and the state in the ureter A (calculus X) is confirmed. Further, a medical laser device (or forceps, electric hydraulic shock wave lithotripsy device, etc.) is inserted through the insertion lumen 20a of the endoscope 18, and the calculus X is crushed by a crushing process such as a laser. Thereby, the calculus X in the ureter A is in a state of being crushed small in the distal direction of the endoscope 18, as shown in FIG. 6A.

  After crushing the calculus X with a laser, the surgeon inserts the medical device 10 described above into the insertion lumen 20a of the endoscope 18 instead of the medical laser device, and enters the ureter A. At the time of entry, since the outer shaft 26 and the inner shaft 28 of the medical device 10 have flexibility, the distal end portion of the shaft main body portion 14 relatively easily moves even in the curved or bent ureter A. Can do.

  At the time of delivery of the medical device 10, the operator stores the basket 12 in the storage space 42 of the guide cylinder 30 by disposing the operation protrusion 74 of the operation element 70 on the distal end side of the slide long hole 76 of the hub 72. Let In this state, the wires 40 are elastically pushed radially inward by the peripheral wall of the guide cylinder 30, and the basket 12 exhibits a contracted state.

  In the medical device 10, the distal end portion of the shaft main body portion 14 advances from the distal end portion of the endoscope 18 into the ureter A by an operator's operation. After the shaft main body portion 14 has advanced, the basket 12 is deployed as shown in FIG. 6B. In other words, the surgeon moves the operating element 70 toward the rear end side of the sliding long hole 76 so that the outer shaft 26 and the guide tube 30 are relatively retracted from the inner shaft 28 and the holding member 32. Thereby, the basket 12 supported by the front end side of the holding member 32 is exposed from the guide cylinder 30, and shifts from the contracted state to the expanded state. At this time, the operator sufficiently retracts the operation protrusion 74 to the base end of the long slot 76 for sliding. Accordingly, the protrusion 52 of the holding member 32 inserted in the guide groove 44 of the guide cylinder 30 is disposed in the distal end groove portion 46. That is, the basket 12 is in a first expanded form that is greatly expanded from the distal end of the guide tube 30 to the distal end and radially outward.

  In the first expanded form, the rotating wire 64 (the rotating structure 60) and the non-rotating wire 66 (the non-rotating structure 62) are close to each other. For this reason, the 1st communication part 68a (refer FIG. 5A) of the basket 12 is open | released largely. Therefore, the surgeon can easily take the calculus X from the outside to the inside of the basket 12 through the first communication portion 68a of the basket 12 in the first expanded form.

  When the calculus X is taken in to the inside to some extent (about 1 to 5 pieces), the surgeon advances the operation element 70 of the operation unit 16 next. As a result, the outer shaft 26 and the guide tube 30 advance relative to the inner shaft 28 and the holding member 32. In the guide groove 44, the protrusion 52 of the holding member 32 moves from the distal end groove portion 46 to the proximal end groove portion 50. Therefore, the holding member 32 rotates 45 ° around the axis of the shaft main body 14.

  As shown in FIG. 7A, the basket 12 shifts to the second expanded form in which the shaft 12 is slightly contracted by the operation of the shaft main body 14 described above. During this transition, the rotating wire 64 rotates 45 ° relative to the non-rotating wire 66. Thereby, the 1st communication part 68a narrows, it is suppressed that the calculus X taken in inside the basket 12 comes off from the wire 40, and the state which caught the some calculus X can be maintained.

  The surgeon further advances the operating element 70 to advance the guide cylinder 30 relative to the basket 12 and contract the wire 40 of the basket 12. At this time, the protrusion 52 of the holding member 32 retreats along the base end groove portion 50 extending linearly, that is, without changing the posture of the holding member 32. As a result, as shown in FIG. 7B, the plurality of wires 40 existing at equal intervals in the circumferential direction (at intervals of 45 °) are reduced so as to be close to each other, and the plurality of stones X are gripped without spilling. . Thereafter, although illustration is omitted, the basket 12 is further contracted while the calculus X is held as the operator 70 advances, and the medical device 10 is retracted through the endoscope 18 to collect the calculus X from the ureter A. It becomes possible to do.

  As described above, according to the medical device 10 according to the first embodiment, the basket 12 includes the plurality of rotating wires 64 and the plurality of non-rotating wires 66, so that the calculus X in the ureter A can be stored in the basket. 12 can be easily and reliably taken in. That is, the basket 12 is a 1st expansion form, and each rotation wire 64 and each non-rotation wire 66 are arrange | positioned in the position which mutually adjoins, It makes it easy to enter the calculus X inside the basket 12. FIG. Then, with the transition from the first expanded form to the second expanded form, each rotating wire 64 rotates relative to each non-rotating wire 66, so that the gap between adjacent wires 40 is reduced and the calculus X is formed. It can be gripped well. Moreover, even if the basket 12 takes in the some calculus X in the 1st expansion form, it is possible to suppress detachment of the calculus X in the 2nd expansion form, and can perform a treatment efficiently.

  In this case, since each rotating wire 64 is positioned at a substantially middle portion of each non-rotating wire 66 in the second expanded form, the gap between adjacent wires 40 can be reduced, and the detachment of the calculus X can be further suppressed. can do.

  In addition, the medical device 10 includes the holding member 32, so that the rotation of each rotating wire 64 and the non-rotating of the non-rotating wire 66 can be well divided to rotate the basket 12. Further, the holding member 32 rotates each non-rotating wire 66 in a non-rotating state by holding each rotating wire 64 in the wire fixing hole 54 and arranging each non-rotating wire 66 in the wire arrangement hole 56. Rotational force can be transmitted only to each rotating wire 64 that is running. As a result, the basket 12 can favorably vary the relative positions of the rotating wires 64 and the non-rotating wires 66. At this time, the wire arrangement hole 56 that is long in the circumferential direction can easily maintain the non-rotating state of the non-rotating wire 66 even if the holding member 32 rotates in the circumferential direction.

  The medical device 10 can easily rotate the holding member 32 when the guide tube 30 advances and retracts relative to the holding member 32, and can smoothly rotate the rotating wire 64 fixed to the holding member 32. . Further, since the holding member 32 is provided on the distal end side of the shaft main body 14, the rotational force of the holding member 32 can be reliably transmitted to the basket 12, and the rotation operation of the basket 12 can be performed satisfactorily. it can.

  The medical device 10 is not limited to the above embodiment, and various modifications and application examples can be taken. For example, the shape of the guide groove 44 of the guide tube 30 is not particularly limited, and the amount of shift (angle) in the circumferential direction between the distal end groove portion 46 and the proximal end groove portion 50 may be freely designed. That is, the rotation angle of the rotating wire 64 can be freely set.

  Further, the number of wires 40 constituting the basket 12 is not limited to eight (four rotating wires 64 and four non-rotating wires 66). It is sufficient if there are two or more rotating wires 66. Further, the rotating wire 64 and the non-rotating wire 66 may be an odd number (for example, a configuration in which three rotating wires 64 and three tip ends are joined).

  The plurality of wires 40 constituting the basket 12 may be formed in different shapes (for example, wire diameter, wire length, etc.) when viewed from the side. Further, the rotating wire 64 may be disposed either on the outer side or on the inner side of the non-rotating wire 66.

  Hereinafter, some other modifications will be described with reference to FIGS. 8A to 8D. For example, the medical device 10 may have a cross-sectional shape formed in a D shape (or a semicircular shape) like the wire 40A according to the first modification shown in FIG. 8A. Further, the medical device 10 may be a device having a crescent-shaped (or C-shaped) cross-sectional shape, such as a wire 40B according to a second modification shown in FIG. 8B. In this case, the wires 40 </ b> A and 40 </ b> B may be arranged with a portion cut out from the circular cross section facing inward. Moreover, you may comprise the basket 12 combining the wire (for example, wire 40, 40A, 40B) from which cross-sectional shape differs.

  The holding member 32A according to the third modification shown in FIG. 8C has a configuration in which a wire arrangement groove 80 is provided on the outer peripheral surface of the holding member 32A instead of the wire arrangement hole 56 of the first embodiment. The wire arrangement groove 80 has a predetermined groove width (corresponding to the length in the longitudinal direction of the wire arrangement hole 56) along the circumferential direction of the outer peripheral surface of the holding member 32A. Even if the wire arrangement groove 80 is provided in this way, the non-rotation wire 66 can be arranged between the wire arrangement groove 80 and the guide tube 30 so that the non-rotation wire 66 does not follow the rotation of the holding member 32A. . Further, by providing the wire arrangement groove 80, the holding member 32A can be formed to be smaller, and the size reduction of the medical device 10 can be further promoted. Furthermore, the protrusion 82 provided on the outer peripheral surface of the holding member 32A may be formed in a prismatic shape as shown in FIG. 8C. In short, the shape and the number of the projections 52 and 82 may be designed freely, and the guide groove 44 may be formed according to the projections 52 and 82.

  The holding member 32B according to the fourth modification shown in FIG. 8D includes a plurality (four) of wire fixing small holes 84 for individually fixing the rotating wires 64, instead of the wire fixing holes 54 according to the first embodiment. It has a configuration. The wire fixing small holes 84 are formed to be inclined inside the holding member 32B so that they are close to each other on the proximal end side of the holding member 32B and are separated from each other on the distal end side of the holding member 32B. Therefore, the rotating wire 64 extends obliquely from the proximal end toward the distal end and is fixed to the holding member 32B. In this way, by fixing the rotating wire 64, the expanded form (first expanded form, second expanded form) of the rotating wire 64 can be more stably guided. In addition, the non-rotating wire 66 is arrange | positioned at the wire arrangement | positioning groove | channel 80 similarly to the 3rd modification.

  As another modification of the holding member 32, a wire fixing small hole 84 for fixing the rotating wire 64 and a wire arrangement hole 56 or a wire arrangement groove 80 for arranging the non-rotating wire 66 are arranged on one concentric circle. May be.

[Second Embodiment]
Next, a medical device 10A according to the second embodiment will be described. In the following description, the same configuration as the medical device 10 according to the first embodiment or the configuration having the same function is denoted by the same reference numeral, and detailed description thereof is omitted.

  As shown in FIGS. 9, 10A and 10B, the medical device 10A according to the second embodiment is a medical device according to the first embodiment in that the arrangement of the rotating wire 64A and the non-rotating wire 66 is reversed. Different from the device 10. Specifically, the shaft main body portion 14 of the medical device 10 </ b> A includes the outer shaft 26, the inner shaft 28, and the guide tube 30, as in the medical device 10, but the configuration of the holding member 100 is different.

  The holding member 100 includes one wire arrangement hole 102 at its axial center, and a plurality (four) of wire fixing holes 104 on the radially outer side of the wire arrangement hole 102. The wire arrangement hole 102 has an inner diameter sufficiently larger than that of the four non-rotating wires 66, and the four non-rotating wires 66 are arranged inside. Therefore, even if the holding member 100 rotates about the axis, the non-rotating wire 66 does not follow.

  On the other hand, each wire fixing hole 104 is formed to have a hole diameter into which one rotating wire 64A can be inserted, and firmly fixes each inserted rotating wire 64A. The fixing means for holding member 100 and each rotating wire 64A is not particularly limited, and for example, an adhesive may be used in addition to the frictional contact. As a result, the rotating wires 64A can be elastically deformed, and the posture in which the rotating wires 64A extend obliquely from the holding member 100 toward the distal direction and radially outward is firmly maintained.

  Each rotating wire 64 </ b> A is cut and short at a location slightly protruding from the base end of the holding member 100. Thus, even if each rotating wire 64A is short, each rotating wire 64A is firmly integrated with the holding member 100, so that it rotates smoothly around the axis of the holding member 100 together with the holding member 100. In addition, since the rotating wire 64A is short, the shaft main body portion 14 is reduced in weight, and the operation of the medical device 10B is facilitated. A stopper 106 that is thicker than the wire fixing hole 104 may be provided at the base end of each rotating wire 64A in order to prevent the rotating wire 64A from coming off the holding member 100.

  On the other hand, the guide tube 30 includes a guide groove 44 that guides the protrusion 52 of the holding member 100, as in the medical device 10. In FIG. 9, the base end groove portion 50 </ b> A of the guide groove 44 is cut out to the base end of the guide tube 30. Thereby, when the holding member 100 is assembled to the guide cylinder 30, the holding member 100 can be smoothly inserted from the notch on the proximal end side. Further, the tip groove portion 46A of the guide groove 44 is longer in the axial direction than the tip groove portion 46 of the first embodiment.

  With the above configuration, only the four non-rotating wires 66 are passed through the inner shaft insertion hole 36 of the inner shaft 28 extending in the proximal direction of the holding member 100. The inner shaft 28 and the non-rotating wire 66 extend through the shaft main body 14 and are connected and fixed to the operation element 70 in the operation portion 16 on the proximal end side of the medical device 10A.

  In addition, the basket 12 exposed to the front end side of the holding member 100 is provided with an annular ring 108 at the top of the front end shown in FIG. 12 so that the non-rotating structure 62 and the rotating structure 60 are rotatably connected. Yes. In this case, the rotating structure 60 and the non-rotating structure 62 have two rings 60a by the rotating wire 64A and two rings 62a by the non-rotating wire 66, and these rings 60a and 62a are connected to the annular ring 108. Are connected. Thereby, the non-rotating structure 62 and the rotating structure 60 can be expanded and contracted more integrally, and the rotating structure 60 can be smoothly rotated with respect to the non-rotating structure 62. Needless to say, the annular ring 108 can also be applied to the medical device 10 according to the first embodiment.

  The medical device 10A according to the second embodiment is basically configured as described above. The medical device 10A is delivered to the vicinity of the calculus X, and the basket 12 is exposed at the tip of the guide cylinder 30 by the retraction of the guide cylinder 30 to constitute the first expanded form. At this time, the operation projection 74 of the operation element 70 is retracted to the base end of the long slot 76 for sliding, so that the projection 52 of the holding member 100 is positioned in the distal end groove portion 46A. Therefore, in the first expanded form, as shown in FIG. 9, the rotating wire 64 </ b> A (the rotating structure 60) and the non-rotating wire 66 (the non-rotating structure 62) are close to each other, and a large gap is formed on the side portion of the basket 12. It is formed.

  After taking the calculus X into the inside of the basket 12, the surgeon advances the operating element 70 of the operating portion 16 to advance the outer shaft 26 and the guide cylinder 30 integrally. As a result, the holding member 100 moves backward relative to the guide tube 30 and the rotating wire 64A also moves backward together with the holding member 100. Then, as shown in FIG. 11, the protrusion 52 moves from the distal end groove portion 46A to the proximal end groove portion 50A via the inclined groove portion 48, whereby the holding member 100 rotates about the axis of the shaft main body portion 14, and the rotating wire 64A also Rotate. On the other hand, the non-rotating wire 66 positioned at the axial center of the holding member 100 maintains its posture without being affected by the rotation of the holding member 100. Therefore, the basket 12 successfully shifts to the second expanded configuration in which the gap between the rotating wire 64A and the non-rotating wire 66 is an even (45 °) interval.

  As described above, even with the medical device 10A according to the second embodiment, the same effects as those of the medical device 10 according to the first embodiment can be obtained. In particular, in the configuration in which the rotating wire 64A is held outside the holding member 100, slipping or the like during rotation of the rotating wire 64A is suppressed, and the rotation operation of the holding member 100 is smoothly transmitted to the rotating wire 64A. Can be rotated well.

[Third Embodiment]
As shown in FIGS. 13A to 13C, the medical device 10 </ b> B according to the third embodiment is configured to rotate the rotating wire 110 itself by the shape of the rotating wire 110 and the guide tube 112. Different from the medical devices 10 and 10A according to the second embodiment. Specifically, the medical device 10B includes the outer shaft 26, the inner shaft 28, the guide tube 112, and the holding member 114, as in the medical device 10, but, unlike the medical device 10A, the medical device 10B is not connected to the rotating wire 110. The arrangement relationship of the rotating wires 66 is reversed. That is, the four non-rotating wires 66 are inserted into the inner shaft insertion hole 36 of the inner shaft 28, and the four rotating wires 110 are arranged outside the inner shaft 28 (outer shaft insertion hole 34).

  In this case, the inner shaft 28 and the holding member 114 are configured to bind and fix the non-rotating wire 66 and to move forward and backward relative to the outer shaft 26. The holding member 114 has a simple cylindrical shape having a wire arrangement hole 56 </ b> A through which the non-rotating wire 66 is passed at the axial center. Note that the holding member 114 may be provided with, for example, a not-shown protruding portion, and the linear movement in the axial direction may be guided by the inner peripheral surface shape (groove or the like) of the guide tube 112. Alternatively, the medical device 10 </ b> B may be configured such that the holding member 114 is omitted and the inner shaft 28 extends to the distal end side of the shaft main body 14.

  In addition, although not illustrated, the outer shaft 26 is connected and fixed to the operation element 70 of the operation unit 16 on the proximal end side of the medical device 10 </ b> B according to the third embodiment, and the outer shaft 26 is operated based on the operation of the operation element 70. In addition, the guide tube 112 is configured to advance and retract integrally. On the other hand, the inner shaft 28, the rotating wire 110, and the non-rotating wire 66 are connected and fixed to the hub 72.

  The four rotating wires 110 pass through the vicinity of the inner peripheral surface constituting the accommodating space 42 of the guide cylinder 112 by extending outside the holding member 114 on the distal end side of the shaft main body portion 14. And the convex part 116 is provided in the predetermined position of each rotation wire 110, respectively. Each convex portion 116 is a rectangular piece protruding from the outer peripheral surface of the rotating wire 110 to the outside in the radial direction of the shaft main body portion 14. Each convex portion 116 may be formed by forming a loop in a part of the rotating wire 110. Each convex portion 116 is formed integrally or separately with the rotating wire 110.

  On the other hand, the guide tube 112 includes four thin wire guide grooves 118 on a cylindrical peripheral wall. Each wire guide groove 118 guides the convex portion 116 when the guide tube 112 advances and retreats by inserting the convex portion 116 of each rotating wire 110. Each wire guide groove 118 has a distal end groove portion 118a, an inclined groove portion 118b, and a proximal end groove portion 118c. The distal end groove portion 118a and the inclined groove portion 118b are shifted by 45 ° in the circumferential direction of the guide tube 112, and are successively formed by the inclined groove portion 118b. Communicate. Thereby, when the convex part 116 moves from the front-end | tip groove part 118a to the proximal end groove part 118c, the rotating wire 110 is rotated in the 45 degree circumferential direction.

  The medical device 10B according to the third embodiment is basically configured as described above. In the medical device 10B, as shown in FIG. 13A, in the first expanded configuration, the convex portion 116 of the rotating wire 110 is positioned in the distal end groove portion 118a. In this state, as shown in FIG. 13C, in the basket 12, the rotating wire 110 and the non-rotating wire 66 come close to each other to form a large gap (first communication portion 68a).

  After taking the calculus X into the inside of the basket 12, the surgeon advances the operation element 70 of the operation unit 16 to advance the outer shaft 26 and the guide tube 112 integrally. At this time, as shown in FIG. 14B, the convex portion 116 of the rotating wire 110 moves from the distal end groove portion 118a to the proximal end groove portion 118c via the inclined groove portion 118b, so that the distal end side of the rotating wire 110 is moved toward the shaft main body portion 14. Rotate around the axis. On the other hand, since the non-rotating wire 66 does not rotate, the clearance between the rotating wire 110 and the non-rotating wire 66 is uniform (45 °) in the basket 12 exposed from the shaft body 14 to the tip as shown in FIGS. 14A and 14C. ) Makes a good transition to the second expanded form with a short interval.

  As described above, even the medical device 10B according to the third embodiment can obtain the same effects as those of the medical devices 10 and 10A according to the first and second embodiments. In particular, since the rotating wire 110 is directly guided, the rotating structure 60 can be reliably rotated.

[Fourth Embodiment]
As shown in FIG. 15, the medical device 10 </ b> C according to the fourth embodiment is similar to the first to third embodiments in that a structure for rotating the basket 12 </ b> A is provided on the proximal end side of the shaft main body 120. Different from the medical devices 10, 10A, 10B. The shaft main body 120 of the medical device 10 </ b> C includes an outer shaft 26, a guide tube 122 connected to the proximal end of the outer shaft 26, and a holding member 32 housed inside the guide tube 122. Furthermore, the medical device 10 </ b> C includes a wire sheath 124 disposed inside the outer shaft 26 and the guide tube 122. Further, a cylindrical nose 125 that is connected to and fixed to the outer shaft 26 is provided on the distal end side of the shaft main body 120 so as to expose the basket 12A.

  As shown in FIGS. 15 and 16, the basket 12 </ b> A of the medical device 10 </ b> C has the rotating wire 64 relative to the non-rotating wire 66 at the time of transition from the first expanded configuration to the second expanded configuration. Rotate to. However, in the basket 12A according to the fourth embodiment, the rotating wire 64 (the rotating structure 60) exists inside the non-rotating wire 66 (the non-rotating structure 62) in the exposed portion. Thus, the presence of the rotating wire 64 on the inner side greatly reduces the possibility of the rotating wire 64 coming into contact with the ureter A when the rotating wire 64 is rotated, and smooth rotation is achieved. The structure of the basket 12A can also be applied to the medical devices 10, 10A, and 10B of the first to third embodiments.

  On the other hand, the guide cylinder 122 of the shaft main body 120 is formed as a cylindrical member, and the holding member 32 is slidably accommodated in the accommodation space 42. The guide cylinder 122 is connected to the operation element 70 of the operation unit 16 of the medical device 10C. In addition, the medical device 10C can also be made to function as the operation unit 16 in which the surgeon performs a gripping operation by forming the guide tube 122 itself to be large. That is, the holding member 32 is provided in the guide tube 122 serving as a hub, and the surgeon can perform expansion, contraction, and rotation of the basket 12A by operating the guide tube 122 and the holding member 32 relative to each other.

  A pair of guide grooves 126 having the same shape as the guide groove 44 according to the first embodiment (having the distal end groove portion 46, the inclined groove portion 48 and the proximal end groove portion 50) are provided on the peripheral wall of the guide cylinder 122. The protrusion 52 of the holding member 32 is inserted. In addition, a window 128 through which the accommodation space 42 can be visually recognized from the outside is provided on the peripheral wall of the guide tube 122. The window 128 is used when the holding member 32 and the wire sheath 124 are bonded together when the medical device 10C is assembled.

  The holding member 32 is basically formed in the same shape as the first embodiment, and has a pair of protrusions 52, one wire fixing hole 54, and four wire arrangement holes 56 as shown in FIGS. 17A and 17B. . Four rotating wires 64 are inserted into the wire fixing holes 54, and one non-rotating wire 66 is inserted into each wire arrangement hole 56. In the fourth embodiment, the four rotating wires 64 are accommodated in the wire sheath 124 and inserted into the wire fixing hole 54 and fixed to the holding member 32 together with the wire sheath 124.

  The wire sheath 124 has a rotating wire accommodation hole 124a and accommodates the four rotating wires 64 in a bundled state. The wire sheath 124 is formed over a predetermined range in the axial direction (with a length reaching the nose 125 from the proximal end portion of the holding member 32). That is, in the outer shaft 26, four rotating wires 64 out of the eight wires 40 extend inside the wire sheath 124, and four non-rotating wires 66 extend outside the wire sheath 124. ing.

  A coil tube can be applied to the wire sheath 124 in the same manner as the inner shaft 28. As a result, the shaft main body 120 is sufficiently flexible. The configuration of the wire sheath 124 is not particularly limited, and a flexible tube may be applied.

  The medical device 10C according to the fourth embodiment is basically configured as described above. In the medical device 10 </ b> C, the tip of the shaft main body 120 is delivered to the vicinity of the calculus X, and the operation element 70 is retracted, whereby the basket 12 </ b> A is exposed and expanded at the tip of the nose 125. When the protrusion 52 of the holding member 32 is positioned at the distal end groove portion 46 of the guide groove 126 during the expansion, the basket 12A exposed at the distal end of the shaft main body 120 (nose 125) has the first expanded configuration shown in FIG. Present. In this state, the rotating wire 64 is disposed at a position close to the non-rotating wire 66, and a large gap is formed.

  After taking the calculus X into the basket 12A, the surgeon advances the operating element 70 and advances the guide cylinder 122 and the outer shaft 26 connected to the tip thereof. As a result, the protrusion 52 in the guide groove 126 moves from the distal groove 46 to the proximal groove 50 via the inclined groove 48. Therefore, the holding member 32 rotates around the axis on the proximal end side of the shaft main body 120, and the wire sheath 124 and the rotating wire 64 rotate integrally. The rotation of the wire sheath 124 is also transmitted to the distal end direction of the shaft main body 120, and the rotating wire 64 exposed from the wire sheath 124 rotates with it. On the other hand, the non-rotating wire 66 existing outside the wire sheath 124 does not rotate. As a result, the basket 12A successfully shifts to the second expanded configuration shown in FIG.

  As described above, even with the medical device 10C according to the fourth embodiment, the same effects as those of the medical devices 10, 10A, and 10B can be obtained. In particular, in a long and curved device, it is difficult to apply a rotational force to the distal end side of the shaft main body 120 even if a rotational force is applied on the proximal end side of the shaft main body 120. By bundling the rotating wire 64 with the wire sheath 124, the rotating wire 64 can be favorably rotated.

  Also, the medical device 10C according to the fourth embodiment can take various modifications and application examples. For example, a lever or the like is joined to the protrusion 52 of the holding member 32, and the operator holds the holding member 32. It may be configured to operate directly.

  In the guide tube 130 of the medical device 10D according to the fifth modification shown in FIG. 18, the guide groove 126A is bifurcated in the proximal direction, and the operator can select rotation or non-rotation of the holding member 32. It has become a structure. Specifically, the guide groove 126 </ b> A includes an inclined groove portion 48 that extends obliquely with respect to the distal end groove portion 46, a rotary groove path 132 having a first proximal end groove portion 50 a that continues to the inclined groove portion 48, and a linear shape on the distal end groove portion 46. And a non-rotating groove 134 having a second base end groove portion 50b extending in the base end direction.

  When the operator wants to rotate the rotating wire 64 of the basket 12 </ b> A, the surgeon moves the protrusion 52 of the holding member 32 backward from the distal groove 46 to the rotating groove 132. On the other hand, when it is not desired to rotate the rotating wire 64 of the basket 12 </ b> A, the protrusion 52 of the holding member 32 is moved backward from the tip groove portion 46 to the non-rotating groove path 134.

  In this manner, by adopting a configuration in which whether or not the rotation wire 64 of the basket 12A can be rotated is switched according to the operator's selection, an operation with higher versatility can be performed at the time of taking in the calculus X. The medical devices 10, 10 </ b> A to 10 </ b> C may include an adjustment mechanism that adjusts the rotation amount (rotation angle) of the rotation wire 64. For example, a rotation adjustment dial connected to the holding member 32 can be provided at the proximal end of the guide tube 130, and the holding member 32, the rotation wire 64, and the like can be rotated based on the rotation of the rotation adjustment dial.

  Further, the medical devices 10, 10 </ b> A to 10 </ b> C may include the guide tube 130 on the distal end side or the intermediate portion of the shaft main body 120. In this case, a groove (not shown) having the same shape as the guide groove 126A (the rotation groove path 132 and the non-rotation groove path 134) is provided in the hub 72 on the proximal end side of the shaft main body 120, and the operation element 70 is moved forward and backward. It may be configured to select whether or not the basket 12A can be rotated.

  In the above description, the present invention has been described with reference to preferred embodiments. However, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention. Yes. For example, a protrusion may be disposed on the guide tube 30 and a guide groove may be disposed on the holding member 32. Further, the medical devices 10, 10A to 10D are not limited to ureteral stone treatment applications, but can be applied to various treatments, and can have configurations and shapes according to the treatment applications.

  Examples of treatments to which the medical devices 10, 10 </ b> A to 10 </ b> D are applied include collection of thrombus in blood vessels, collection of erroneous drinks in the esophagus, and the like. Further, the medical device 10 may be configured to cut out a tumor in the living body lumen based on the rotation of the rotating wire 64 with respect to the non-rotating wire 66 and take it into the basket 12. In short, the medical device 10 can be applied with various configurations that can take in and treat an object in a living body lumen by the operation of the non-rotating wire 66 and the rotating wire 64.

10, 10A to 10D ... Medical device 12, 12A ... Basket 14, 120 ... Shaft body 30, 112, 122, 130 ... Guide tube 32, 32A, 32B, 100, 114 ... Holding member 40, 40A, 40B ... Wire 44, 126, 126A ... guide grooves 52, 82 ... projections 54, 104 ... wire fixing holes 56, 102 ... wire arrangement holes 64, 64A, 110 ... rotating wires 66 ... non-rotating wires 80 ... wire arrangement grooves 116 ... convex portions 118 ... Wire guide groove 124 ... Wire sheath 132 ... Rotating groove 134 ... Non-rotating groove

Claims (11)

A long shaft body inserted into the living body lumen;
A treatment portion capable of transitioning to a first expanded configuration and a second expanded configuration reduced from the first expanded configuration in a state exposed from the shaft main body;
The treatment section includes a plurality of first wires provided in a circumferential direction of the treatment section;
A plurality of first wires are provided in a circumferential direction of the treatment portion, are in positions close to the first wire in the first expanded form, and the plurality of first wires are moved from the first expanded form to the second expanded form. And a second wire that rotates around the axis of the shaft main body and separates from the first wire. The medical device according to claim 1.
The plurality of second wires are arranged in a substantially middle portion between the plurality of first wires adjacent in the second expanded form. The medical device according to claim 1 or 2,
The shaft main body includes a holding portion that rotates relative to the first wire in a state where the second wire is held. The medical device according to claim 3, wherein
The holding portion is formed in a cylindrical shape, and has a fixing hole for inserting and fixing the plurality of second wires in an axial center portion thereof,
The plurality of first wires are disposed radially outside the fixing hole. The medical device. The medical device according to claim 4.
The holding portion has an arrangement hole or an arrangement groove for arranging the plurality of first wires,
The medical device, wherein the placement hole or the placement groove extends in a circumferential direction in a sectional view of the holding portion in the axial direction. The medical device according to claim 3, wherein
The holding portion is formed in a cylindrical shape, and a plurality of fixing holes for fixing and holding the plurality of second wires on an outer side in the radial direction from the arrangement hole, and an arrangement hole for arranging the plurality of first wires in an axial center portion thereof. And a medical device. The medical device according to any one of claims 3 to 6,
The shaft main body includes an accommodating portion that accommodates the holding portion so as to freely advance and retract.
The holding portion has a protrusion protruding outward in the radial direction,
The housing portion has a projection guide groove for guiding the projection as the projection is inserted, relative to the holding portion, and rotating the holding portion around the axis of the shaft main body portion. A medical device characterized. The medical device according to claim 7, wherein
The medical device, wherein the holding portion is provided on a distal end side of the shaft main body portion. The medical device according to claim 7, wherein
The said holding | maintenance part is provided in the operation part connected to the base end side of the said shaft main-body part, or the base end side rather than the said shaft main-body part. The medical device characterized by the above-mentioned. The medical device according to claim 7, wherein
The protrusion guide groove has a first groove path for rotating the holding portion around the axis of the shaft main body portion and a second groove path for guiding the holding portion in a non-rotating manner in the path of the protrusion. A medical device characterized by that. The medical device according to claim 1 or 2,
The shaft main body includes an accommodating portion that accommodates the plurality of second wires so as to freely advance and retract,
The plurality of second wires have convex portions protruding radially outward,
The accommodating portion has the convex portion inserted therein, guides the convex portion with relative advance and retreat with respect to the second wire, and rotates the second wire around the axis of the shaft main body portion. A medical device characterized by having a groove.

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