JP2016067710A - Medical treatment instrument and medical system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment instrument which performs hemostasis of a treatment part and can easily place a medical material providing an epithelial function on the treatment part.SOLUTION: A medical treatment instrument comprises: a body part 110 which is inserted into a urinary tract 10, can extend and contract in a Y direction in the urinary tract 10, and forms a plurality of layers in a circumferential direction in a contracted state; an extension part 111A which is provided on an innermost layer of the body part, extends the body part while moving to a tip side by being pushed out, and can maintain the position of the body part in the urinary tract in an extended state; and a movable part 113C which is provided on an outermost layer of the body part in a state in which a medical material can be disposed on an outer periphery 113D, and contracts the body part while moving along the extension part.SELECTED DRAWING: Figure 4

Description

  The present invention relates to a medical treatment tool and a medical system.

  Examples of the stenosis in the body cavity of a living body include urethral stricture. Urethral stricture is a disease in which the urethral mucosa is damaged by injury or inflammation, and scarring occurs in the urethral mucosa and the urethral cavernosa surrounding the urethral mucosa in the process of repairing the wound, and the urethra is narrowed by scar tissue. is there. As a treatment method for urethral stricture, there is a treatment method for surgically reconstructing the urethra. In this therapy, in order to prevent recurrence of urethral stricture, transplantation is performed by directly stitching the oral mucosa to the treatment part of the inner wall of the urethra, but the patient is highly invasive and requires long-term hospitalization. .

  On the other hand, there is a balloon catheter inserted transurethrally for treating a stenosis portion of urethral stricture. In this balloon catheter, a stent is disposed around the balloon, and it is described that the stent is expanded together with the balloon in a stenosis portion to alleviate the symptoms of prostatic hypertrophy (see Patent Document 1).

JP 63-214264 A

  However, when placing the device in the stenosis, it is necessary to create a space that allows the device to be inserted by pretreatment depending on the degree of stenosis. This pre-treatment uses a treatment device such as a urethrectomy, which may cause bleeding. In that case, it is necessary for the surgeon to introduce the device to the treatment site and stop the bleeding by stopping the bleeding.

  The present invention has been made in order to solve the above-described problems, and provides a medical treatment instrument that can stop a hemorrhage of a treatment part and can easily place a medical material that provides an epithelial function in the treatment part. The purpose is to provide a medical system.

  The object is achieved by any one of the inventions described in (1) to (9) below.

  (1) A medical treatment tool for placing a medical material that provides an epithelial function in a body cavity of a living body, which is inserted into the body cavity and can be expanded and contracted in the longitudinal direction of the body cavity, and in a contracted state A main body portion that forms a plurality of layers in the circumferential direction, and is provided in the innermost layer of the main body portion, and is moved to the distal end side in the insertion direction by being pushed out to extend the main body portion, and in the extended state, the main body portion An extension portion that can maintain the position in the body cavity and an outermost layer of the main body portion in a state where the medical material can be disposed on the outer periphery, and moves along the extension portion to contract the main body portion A medical treatment instrument having a moving part.

  (2) The main body portion is composed of a plurality of tubular members having a nested structure, and the extending portion is provided on an innermost peripheral tubular member located on the innermost periphery among the plurality of tubular members, The main body portion is extended by being pushed by the first push-out member pushed out to the distal end side, and the moving portion is provided on an outermost peripheral tubular member located at an outermost periphery among the plurality of tubular members, and the tubular member is The medical treatment tool according to (1), wherein the main body portion is contracted by being pushed by a second push-out member pushed toward the distal end side.

  (3) The medical treatment instrument according to (2), wherein the extending portion is pushed by being abutted against a distal end portion of the first pushing member to extend the main body portion.

  (4) The medical treatment instrument according to (2) or (3), wherein the extending portion includes an engaging portion that engages with the first push member.

  (5) The medical treatment instrument according to any one of (1) to (4), wherein the extension portion includes an extension portion that is provided inside the innermost layer and can be expanded and deformed.

  (6) In any one of the above (1) to (5), the moving portion further includes a restricting portion that restricts movement of the innermost layer toward the tip side when the main body portion contracts. The medical treatment instrument described.

  (7) The medical treatment tool according to any one of (1) to (6), wherein the medical material is a biological sheet, and the body cavity is a stenosis portion formed in the urethra.

  (8) The medical treatment instrument according to any one of (1) to (7), a first push-out member that pushes the extending portion toward the distal end side, and a first pusher that pushes the moving portion toward the distal end side. A medical system having two extrusion members.

  (9) The medical system according to (8), wherein the first push member includes an endoscope.

  According to the invention described in (1) above, when a medical material that provides epithelial function is introduced from the urethral entrance to the treatment portion, first, the extension portion is pushed to move to the distal end side in the insertion direction. The main body is extended and the innermost layer of the main body is introduced to the treatment section. Thereafter, the moving part moves along the extending part to contract the main body part. Through this series of operations, the medical material that provides the epithelial function can be placed in the treatment section. Therefore, according to this medical treatment instrument, when the medical material that provides the epithelial function is placed in the treatment portion for a predetermined period, the medical material that provides the epithelial function can be easily obtained in a state in which the treatment portion is hemostatic. A medical treatment instrument that can be placed in the treatment section can be provided.

  According to the invention described in (2) above, when the medical material providing the epithelial function is introduced from the urethral entrance to the treatment portion, first, the elongated portion is pushed by the first push member, so that the nested tubular shape is obtained. The member is pushed out to the distal end side in the insertion direction, and the main body portion made of a plurality of tubular members is extended in the axial direction so that the innermost peripheral tubular member is introduced to the treatment portion. Thereafter, when the moving part is pushed by the second push-out member, the expanded tubular member is pushed out to the distal end side, and the main body part is contracted to be in a nested state. Through this series of operations, the medical material that provides the epithelial function can be placed in the treatment section. Therefore, according to this medical treatment instrument, when the medical material that provides the epithelial function is placed in the treatment portion for a predetermined period, the medical material that provides the epithelial function can be easily obtained in a state in which the treatment portion is hemostatic. A medical treatment instrument that can be placed in the treatment section can be provided.

  According to the invention described in (3) above, since the extension portion is pushed by the first push member by an easy operation, the procedure becomes easy.

  According to the invention as described in said (4), since an expansion | extension part is engaged with a 1st extrusion member by an engaging part, a 1st extrusion member can push an innermost layer more reliably.

  According to the invention as described in said (5), since the expansion | extension part is connected to the 1st extrusion member by the expansion part, the 1st extrusion member can push an innermost layer more reliably.

  According to the invention described in (6) above, when the main body portion is contracted, the restricting portion restricts the innermost layer from moving toward the distal end side, so that the innermost layer can be more reliably disposed in the treatment portion. it can.

  According to the invention as described in said (7), the medical treatment tool corresponding to urethral stricture can be provided.

  According to the invention described in the above (8), since the medical treatment tool is provided, a medical material that provides an epithelial function can be easily placed in the treatment portion in a state where the treatment portion is hemostatic. A medical system that can be provided can be provided.

  According to the invention described in (9) above, the medical material that provides the epithelial function can be placed in the treatment portion while observing the inside of the body cavity with an endoscope, so that the procedure is facilitated.

1A and 1B are diagrams showing a urethra of a living body, in which FIG. 1A is a diagram schematically showing the periphery of the urethra of a living body, and FIG. 1B is a line 1B-1B shown in FIG. It is sectional drawing of the urethra along. It is sectional drawing of the urethra shown in FIG. 1, and its peripheral part, Comprising: It is sectional drawing which follows the 2A-2A line | wire (line in alignment with the extending direction of a urethra) shown to FIG. 1 (A). 3 is an enlarged view of the urethra and the urethral cavernous body, in which FIG. 3A is an enlarged cross-sectional view around the urethra shown in FIG. 1B, and FIG. 3B is FIG. It is sectional drawing to which the broken-line part 3B shown to (A) was expanded. FIG. 4 is a perspective view showing a medical system according to an embodiment of the present invention. FIG. 4A shows a state in which the main body portion is contracted and is nested, and FIG. The state which the main-body part is extending | stretched is shown. It is front sectional drawing which shows the main-body part of an expansion | extension state. It is a figure which shows a mode that the medical treatment tool was inserted from the entrance of the urethra. It is a figure which shows the mode before inserting a 1st extrusion member in the inside of a 1st tubular member. It is a figure which shows a mode that the 1st extrusion member pushed the expansion | extension part to the front end side, and the 1st tubular member was extruded to the treatment part. It is a figure which shows a mode that the 2nd extrusion member pushed the moving part to the front end side, and the 3rd tubular member was extruded to the treatment part. It is a figure which shows a mode after extracting the 1st extrusion member from the inside of a 1st tubular member. It is side surface sectional drawing in the front-end | tip part of the 1st tubular member of the medical treatment tool which concerns on the modification 1. It is the schematic which shows the 1st tubular member and 1st extrusion member of the medical system which concerns on the modification 2. It is the schematic which shows the 1st tubular member and 1st extrusion member of the medical system which concerns on the modification 3. It is the schematic which shows the 1st tubular member and 1st extrusion member of the medical system which concerns on the modification 4. It is front sectional drawing which shows the 1st tubular member and 1st extrusion member of the medical system which concerns on the modification 5. It is front sectional drawing which shows the 1st tubular member and 1st extrusion member of the medical system which concerns on the modification 5. It is side surface sectional drawing in the front-end | tip part of the 1st tubular member of the medical system which concerns on the modification 6, Comprising: FIG. 17 (A) shows a mode that the 1st tubular member and the 1st extrusion member are connected, FIG. (B) is a figure which shows a mode that the connection state of the 1st tubular member and the 1st extrusion member was cancelled | released. It is a figure for demonstrating the structure of the 1st extrusion member of the medical system which concerns on the modification 7. FIG.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In addition, the dimension ratio of drawing is exaggerated on account of description, and may differ from an actual ratio. Further, in the following description, the hand operation side of the medical system 1 according to the present embodiment is referred to as “base end side”, and the side inserted into the urethra 10 is referred to as “distal end side”.

  1 to 3 are diagrams schematically showing a urethra of a living body suffering from urethral stricture, FIGS. 4 to 5 are diagrams showing a medical system 1 according to the present embodiment, and FIGS. It is a figure for demonstrating the procedure using the medical system 1 which concerns on embodiment.

  Here, a stenosis portion formed in the urethra will be described as an example of a treatment site. The medical system 1 according to the present embodiment is a system for suppressing the occurrence of restenosis (re-occlusion) after performing a stenosis portion formed in the urethra. First, the structure around the urethra of the living body, the urethral stricture, and the occurrence mechanism of restenosis will be described.

  1 to 3 schematically show a male urethra 10 and its peripheral portion. As shown in FIG. 1A, the urethra 10 extends through the penis 21 and the prostate 22 to the bladder 23 in the lower abdomen of the living body. In addition, as shown in FIGS. 1B and 3A, the inner surface 11 of the urethra 10 is covered with the urethral mucosa 12. A urethral cavernous body 13 is present outside the urethral mucosa 12. In addition, as shown in FIG. 3B, a blood vessel 14 called a cavernous sinus that runs in a mesh form exists inside the urethral cavernous body 13. In addition, the X-axis attached | subjected to each figure shows the width direction (left-right direction of FIG. 1 (B)) of a urethra, the Y-axis shows the extending | stretching direction (up-down direction of FIG. 2) of a urethra, and Z-axis shows the urethra. The height direction (the vertical direction in FIG. 1B) is shown.

  As shown in FIG. 1B, the urethral cavernous body 13 is covered with a white membrane 24, and the fascia 25 and the penile cavernous body 26 exist outside the white membrane 24. A penile deep artery 26 a exists inside the penile cavernous body 26, and a penile dorsal artery 26 b and a penile dorsal vein 26 c exist above the penile cavernous body 26.

  In the urethral stricture, for example, the urethral mucosa 12 or the urethral cavernous body 13 is damaged by trauma or inflammation, and then repaired, and the tissue is fibrillated and scarred in the urethral cavernous body 13 surrounding the urethral mucosa 12. As shown in FIG. 2, a scar tissue 31 is formed on the inner surface 11 of the urethra, and as a result, the lumen of the urethra 10 becomes narrower. Since the cross-sectional area of the portion (stenosis portion 30) where the scar tissue 31 is formed in the urethra 10 is narrower than other portions of the urethra 10, it is difficult for urine to pass therethrough. When suffering from urethral stricture, urination disorders such as urine not being smoothly drained or urine being not drained at all are caused.

  As a treatment method for urethral strictures, for example, medical instruments such as bougie (urethral dilator), balloon, urethral knife and laser are transurethrally introduced into the urethra, and these strictures are expanded and incised. The method of treating a stenosis part is tried by doing. According to this method, although a temporary therapeutic effect can be obtained, the stenosis 30 is formed again after the treatment once, and the possibility of recurrence of urethral stricture is very high. The urethral cavernous body 13 around the scar tissue 31 and under the scar tissue 31 is constantly exposed to fluid flowing in the urethra 10 (for example, urine and body fluid), thereby inducing a persistent inflammatory reaction and reconstructing epithelial cells. It is because it is inhibited.

  Hereinafter, with reference to FIG.4 and FIG.5, the structure of the medical system 1 which concerns on this embodiment is demonstrated.

  As shown in FIGS. 4 and 5, the medical system 1 includes a medical treatment instrument 100, a first pushing member 120, a second pushing member 130, and a regulating unit 140.

  In general, the medical treatment instrument 100 is a medical treatment instrument 100 for placing a medical material S that provides an epithelial function in a narrowed portion 30 formed in the urethra 10. The medical treatment instrument 100 is inserted into the urethra 10, is extendable in the Y direction (long axis direction) in the urethra 10, and includes a main body 110 that forms three layers in the circumferential direction in the contracted state, and the main body 110. An extension that is provided in the innermost layer and moves to the tip side in the Y direction (insertion direction) by being pushed out to extend the main body 110 and to maintain the position of the main body 110 in the urethra 10 in the extended state. 111A and a moving part 113C that is provided on the outermost layer of the main body part 110 and moves along the extending part 111A and contracts the main body part 110 in a state where the medical material S can be disposed on the outer periphery 113D. Details will be described below.

  The medical treatment tool 100 is a treatment tool for placing a medical material S that provides an epithelial function in a treatment part 30A (see FIG. 6) that has treated the stenosis part 30 formed in the urethra 10, and includes a main body part 110. And an extending part 111A and a moving part 113C. Examples of the medical material used herein include skin graft sheets containing epithelial cells, such as oral mucosa sheets, penile foreskin sheets, and collagen sheets seeded with epithelial cells. Also included are sheets, gels and the like that are composed of a biocompatible material that does not contain epithelial cells and has a function of preventing urine infiltration. Also included are materials that provide factors and stimuli that promote regeneration of the urethral mucosa. The shape is not limited to a sheet, and any shape that can be placed in a treatment site, such as a gel or liquid, may be used. The treatment here may include, for example, incision, cutting, excision, and the like of the scar tissue 31. In addition, the “epithelial function” in the present specification means a barrier function that prevents or reduces the contact of the urinary cavernous body 13 with a liquid such as urine and an inflammation-inducing component contained in the urethra 10.

  The main body 110 includes three tubular members 111 to 113 that can be inserted through the urethra 10 and have a nested structure that can slide in the Y direction. The main body 110 is configured as a first tubular member (innermost peripheral tubular member) 111, a second tubular member 112, and a third tubular member (outermost peripheral tubular member) 113 in order from the innermost periphery in a nested state. Each of the first tubular member 111 to the third tubular member 113 is configured by a hollow cylindrical shape.

  As shown in FIGS. 4 and 5, the first tubular member 111 is pushed by the first pushing member 120 that pushes the first tubular member 111 and the second tubular member 112 to the tip end side in the Y direction, and the main body 110 is moved to the Y direction. It has an extending portion 111A that extends in the direction.

  The extending portion 111A is pushed by being abutted against the distal end portion 121 of the first pushing member 120 and extends the main body portion 110 in the Y direction. As shown in FIG. 5, the extending portion 111 </ b> A is configured by a tapered shape formed smaller than the outer diameter of the first push member 120. The extending portion 111A is abutted against the distal end portion 121 of the first pushing member 120, so that the position of the main body portion 110 in the urethra 10 is maintained in the extended state.

  Further, as shown in FIG. 5, the first tubular member 111 has a flange portion 111B extending outward in the X direction on the proximal end side in the Y direction. Note that a cover (not shown) for preventing the medical material S from twisting when introduced into the urethra 10 may be provided on the distal end side of the first tubular member 111.

  The second tubular member 112 includes a flange portion 112A that extends inward in the X direction on the distal end side in the Y direction, a flange portion 112B that extends outward in the X direction on the proximal end side in the Y direction, and a Y direction. And a flange portion 112C extending inward in the X direction on the base end side.

  The third tubular member 113 is pushed by the second pushing member 130 that pushes the second tubular member 112 and the third tubular member 113 to the front end side in the Y direction, and the moving portion 113C that contracts the main body portion 110 to be in a nested state. Have.

  The third tubular member 113 has a flange portion 113A that extends inward in the X direction on the distal end side in the Y direction, and a flange portion 113B that extends inward in the X direction on the proximal end side in the Y direction. . In addition, the medical material S that provides an epithelial function can be arranged on the outer periphery 113D of the third tubular member 113.

  The material constituting the first tubular member 111 to the third tubular member 113 is, for example, polyolefin, a cross-linked polyolefin, polystyrene, polycarbonate, polyvinyl chloride, polyvinylidene chloride, polyamide, polyamide elastomer, polyester, polyester elastomer, polyurethane, It is a polymer material such as polyurethane elastomer, fluororesin, methacrylic resin, phenol resin, melamine resin, polyimide, or a mixture thereof. The polyolefin is, for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof.

  Since each of the first tubular member 111, the second tubular member 112, and the third tubular member 113 is provided with the flange portion described above, the first pushing member 120 pushes the elongated portion 111A toward the distal end side in the Y direction. The main body 110 is in an extended state. Hereinafter, the mechanism will be described.

  When the first pushing member 120 pushes the elongated portion 111A toward the distal end side in the Y direction, first, the first tubular member 111 moves to the distal end side in the Y direction, and the flange portion 111B and the second portion of the first tubular member 111 are moved. The flange portion 112A of the tubular member 112 is locked. Further, when the first push-out member 120 pushes the extending portion 111A to the tip end side in the Y direction, the first tubular member 111 and the second tubular member 112 move to the tip end side in the Y direction, and the second tubular member 112 is moved. The flange portion 112B and the flange portion 113A of the third tubular member 113 are locked (see FIG. 5), and the main body portion 110 extends in the Y direction. The first pushing member 120 pushes the first tubular member 111 and the second tubular member 112, and then pushes the third tubular member 113 to the front end side in the Y direction by the first tubular member 111 and the second tubular member 112. May be.

  On the other hand, since the first tubular member 111, the second tubular member 112, and the third tubular member 113 are each provided with the above-described flange portion, the second pushing member 130 pushes the moving portion 113C to the tip side in the Y direction. As a result, the main body 110 is contracted into a nested state. Hereinafter, the mechanism will be described.

  In the state in which the main body 110 is extended, the second pushing member 130 pushes the moving portion 113C to the tip end side in the Y direction, so that the third tubular member 113 first moves to the tip end side in the Y direction, and the third tubular member The flange 113B of the member 113 and the flanges 112B and 112C of the second tubular member 112 are locked. Further, when the second push-out member 130 pushes the moving portion 113C to the tip end side in the Y direction, the third tubular member 113 and the second tubular member 112 move to the tip end side in the Y direction, and the second tubular member 112 The flange portion 112C and the flange portion 111B of the first tubular member 111 are locked, and the main body portion 110 is contracted to be in a nested state. In addition, the 2nd extrusion member 130 may extrude the 1st tubular member 111 by the 2nd tubular member 112 and the 3rd tubular member 113 after pushing out the 2nd tubular member 112 and the 3rd tubular member 113.

  The first pushing member 120 pushes the extending portion 111A and pushes the first tubular member 111 and the second tubular member 112 toward the distal end side in the Y direction, thereby extending the main body portion 110 in the Y direction. The first push member 120 can be, for example, an endoscope. If the first push-out member 120 is an endoscope, a transparent member is used for the first tubular member 111 to the third tubular member 113 constituting the main body portion 110, thereby observing the inside of the urethra 10 while the main body The part 110 can be introduced into the urethra 10 and the procedure becomes easy.

  The second pushing member 130 pushes the moving part 113C and pushes the second tubular member 112 and the third tubular member 113 toward the distal end side in the Y direction, thereby contracting the main body part 110 to be a nested state. The second pushing member 130 is fixed to the moving part 113C by, for example, an adhesive. Note that the present invention is not limited to this, and may be brazing, fusion bonding, or the like. Further, the second pushing member 130 may be configured integrally with the third tubular member 113. Further, the second pushing member 130 may be temporarily connected to the moving portion 113C by pressing, fitting, a magnetic member, or the like, and may be removable.

  As shown in FIG. 4, the restricting portion 140 is configured to prevent the first tubular member 111 from moving toward the distal end side when the moving portion 113 </ b> C is pushed by the second push-out member 130 and the main body portion 110 is nested. regulate. The restricting portion 140 is, for example, a thread, and one end is fixed to the first tubular member 111 and the other end is led out of the body via the urethra 10 so that the operator can grasp it.

  Next, with reference to FIGS. 6-10, the usage method of the medical system 1 which concerns on this embodiment is demonstrated. 6 to 10, for easy understanding, the medical system 1 is shown in a front view, and the others are shown in a front sectional view.

  Prior to the introduction of the medical treatment tool 100 according to the present embodiment into the urethra 10, the operator introduces an endoscope known in the medical field into the urethra 10 and observes the inside of the urethra 10 while A predetermined treatment tool is introduced into the urethra 10 through a channel (not shown) provided in the mirror, and the scar tissue 31 formed in the urethra 10 is subjected to treatment such as incision, cutting, and excision. The stenosis part 30 is treated to form a treatment part 30A. When the first push member 120 is an endoscope, the inside of the urethra 10 can be observed by using the first push member 120.

  Next, the surgeon removes the endoscope from the urethra 10 and wraps the medical material S that provides a rectangular epithelial function around the outer periphery 113D of the third tubular member 113, whereby the outer periphery of the third tubular member 113 is wound. Mount on 113D.

  Next, as shown in FIG. 6, the surgeon inserts the medical treatment tool 100 from the entrance E of the urethra 10 in a state where the medical material S that provides an epithelial function is mounted on the outer periphery 113 </ b> D of the third tubular member 113. To do.

  Next, as shown in FIG. 7, the surgeon inserts the first pushing member 120 into the first tubular member 111 and abuts the distal end portion 121 of the first pushing member 120 against the extending portion 111A.

  Next, as shown in FIG. 8, the surgeon pushes the first push-out member 120 toward the distal end side in the Y direction, and extends the body portion 110 that has been in the nested state in the Y direction. At this time, the 1st extrusion member 120 is extruded until the front-end | tip of the 1st tubular member 111 exceeds 30 A of treatment parts in a Y direction.

  In addition, it is preferable that the 1st tubular member 111 has an outer diameter of the grade which closely_contact | adheres with respect to the inner periphery of 30 A of treatment parts. According to this configuration, bleeding that occurs when the scar tissue 31 is treated can be appropriately stopped in the state shown in FIG. 8, the visual field of the endoscope is improved, and the procedure is facilitated.

  Next, the surgeon grasps the restricting portion 140 and restricts the movement of the first tubular member 111 toward the distal end in the Y direction, and pushes the second push-out member 130 toward the distal end in the Y direction ( 8), the third tubular member 113 and the second tubular member 112 are pushed out to the distal end side, and the main body 110 is contracted to be in a nested state. As a result, as shown in FIG. 9, the medical material S that provides the epithelial function mounted on the outer periphery 113 </ b> D of the third tubular member 113 is left in contact with the treatment portion 30 </ b> A.

  Next, as shown in FIG. 10, the surgeon removes the first pushing member 120 from the urethra 10, and places the main body 110 and the medical material S that provides the epithelial function in the urethra 10. In this state, the main body 110 is not placed from the entrance E of the urethra 10 to the treatment portion 30A, but is placed only in the vicinity of the treatment portion 30A. In addition, through this series of operations, the medical material S providing the epithelial function can be easily placed in contact with the treatment portion 30A in a state where the treatment portion 30A is hemostatic. In this way, by placing the medical material S that provides an epithelial function in contact with the treatment portion 30A, it is possible to engraft the epithelial cells in the treatment portion 30A and prevent restenosis of the treatment portion 30A. .

  Then, the operator pulls out the main body 110 from the urethra 10 by pulling the second pushing member 130 toward the proximal end side after a predetermined period of time (see the arrow in FIG. 10).

  A known balloon catheter provided with an outwardly expandable balloon is inserted into the inner circumference of the first tubular member 111 of the main body 110 placed in the urethra 10 in a deflated state, and then the balloon The main body 110 may be removed by removing the balloon catheter while the balloon is in contact with the inner peripheral surface of the first tubular member 111.

  As described above, the medical treatment tool 100 according to the present embodiment is a medical treatment for placing the medical material S that provides an epithelial function in the treatment portion 30A that has treated the stenosis portion 30 formed in the urethra 10. Tool 100. The medical treatment instrument 100 is inserted into the urethra 10 and can be expanded and contracted in the Y direction in the urethra 10, and is provided in the innermost layer of the main body 110 and the main body 110 that forms a plurality of layers in the circumferential direction in the contracted state. The body portion 110 is extended by being pushed and moved to the front end side in the Y direction, and the medical material is provided on the outer periphery 113D and the extension portion 111A that can maintain the position of the body portion 110 in the urethra 10 in the extended state. The movable portion 113C is provided on the outermost layer of the main body 110 in a state where S can be disposed, and moves along the extending portion 111A to contract the main body 110. With this configuration, when the medical material S that provides the epithelial function is introduced from the entrance of the urethra 10 to the treatment portion 30A, first, the extension portion 111A is pushed to move to the distal end side in the Y direction to move to the main body portion. 110 is extended and the innermost layer of the main body 110 is introduced to the treatment section 30A. Thereafter, the moving part 113C moves along the extending part 111A and contracts the main body part 110. Through this series of operations, the medical material S providing the epithelial function can be placed in the treatment section 30A. Therefore, according to the medical treatment tool 100, when the medical material S that provides epithelial function is placed in the treatment section 30A for a predetermined period, the medical material that provides epithelial function in a state in which the treatment section 30A is hemostatic. It is possible to provide a medical treatment instrument 100 that can easily place S in the treatment section 30A.

  The main body 110 is composed of three tubular members 111 to 113 having a nested structure, and the elongated portion 111A is provided on the first tubular member 111 located on the innermost periphery of the three tubular members 111 to 113, The first tubular member 111 and the second tubular member 112 are pushed by the first push-out member 120 that pushes the distal end side to the front end side to extend the main body 110, and the moving portion 113 </ b> C is positioned on the outermost periphery among the three tubular members 111 to 113. The main body 110 is contracted by being pushed by the second pushing member 130 that is provided on the outermost tubular member 113 and pushes the second tubular member 112 and the third tubular member 113 to the distal end side. According to this structure, when the medical material S providing the epithelial function is introduced from the entrance of the urethra 10 to the treatment portion 30A, first, the elongated portion 111A is pushed by the first pushing member 120, so that the nested tubular member 111 to 113 are pushed out to the front end side in the Y direction, and the main body portion 110 including the three tubular members 111 to 113 is extended in the Y direction so that the innermost peripheral tubular member 111 is introduced to the treatment portion 30A. Thereafter, when the moving part 113C is pushed by the second push-out member 130, the expanded tubular members 111 to 113 are pushed out toward the distal end side, and the main body part 110 is contracted to be in a nested state. Through this series of operations, the medical material S providing the epithelial function can be placed in the treatment section 30A. Therefore, according to the medical treatment tool 100, when the medical material S that provides epithelial function is placed in the treatment section 30A for a predetermined period, the medical material that provides epithelial function in a state in which the treatment section 30A is hemostatic. It is possible to provide a medical treatment instrument 100 that can easily place S in the treatment section 30A.

  In addition, the extending portion 111A is pushed by being abutted against the distal end portion 121 of the first pushing member 120 and extends the main body portion 110 in the Y direction. For this reason, since the extending portion 111A is pushed by the first pushing member 120 by an easy operation, the procedure becomes easy.

  Further, when the moving part 113C contracts the main body part 110, the moving part 113C further includes a restricting part 140 that restricts the first tubular member 111 from moving to the front end side in the Y direction. For this reason, the 1st tubular member 111 can be arrange | positioned to the treatment part 30A more reliably.

  In addition, the medical system 1 includes the above-described medical treatment instrument 100, a first push member 120, and a second push member 130. For this reason, it is possible to provide the medical system 1 in which the medical material S providing the epithelial function can be easily placed in the treatment section 30A in a state where the treatment section 30A is hemostatic.

  Further, if the first push-out member 120 is an endoscope, the main body 110 can be placed in the treatment section 30A while observing the inside of the urethra 10 with an endoscope, so that the procedure becomes easy.

  In addition, this invention is not limited to embodiment mentioned above, A various change can be made within a claim.

  In the embodiment described above, the main body 110 is configured by the three tubular members 111 to 113, but may be configured by two tubular members or four or more tubular members.

  In the above-described embodiment, when the main body 110 is placed in the nested state, the first tubular member 111 is provided with the restricting portion 140 for restricting movement to the distal end side. However, the restricting portion 140 is not necessarily provided. There is no need to be provided.

  In the above-described embodiment, the first tubular member 111 and the second tubular member 112 are pushed out to the distal end side after the first tubular member 111 and the second tubular member 112 are completely extended. Before the member 112 is fully extended, the third tubular member 113 may be pushed to the distal end side.

  In the above-described embodiment, the main body 110 includes the three tubular members 111 to 113 having a nested structure. However, the main body portion is not particularly limited as long as the outer peripheral side moves to the distal end side and contracts after the inner peripheral side moves to the distal end side, and is not particularly limited. May be.

  In the above-described embodiment, the medical system 1 is applied to the narrowed portion 30 of the urethra 10. However, the present invention is not limited to this, and can be applied to various body cavities such as the ureter, trachea, esophagus, bile duct, pancreatic duct, digestive tract, ear canal, and nasal canal.

  Hereinafter, the modification example regarding the expansion | extension part of embodiment mentioned above is illustrated.

<Modification 1>
FIG. 11 is a side cross-sectional view of the distal end portion of the first tubular member 211 of the medical treatment tool 200 according to Modification Example 1. FIG. In the above-described embodiment, the extending portion 111 </ b> A is configured by a tapered shape formed smaller than the outer diameter of the first push member 120. However, as shown in FIG. 11, the elongated portion 211 </ b> A according to Modification 1 is provided on the inner periphery of the first tubular member 211 and protrudes inward to the extent that the tip 121 of the first pushing member 120 can abut. The shape to do may be sufficient. The elongated portion 211A is bonded to the inner periphery of the first tubular member 211 with, for example, an adhesive. The elongated portion 211A may be configured integrally with the first tubular member 211. According to this configuration, the extending portion 211 </ b> A is pushed by being abutted against the distal end portion 121 of the first pushing member 120. For this reason, since the extension part 211A is pushed by the first pushing member 120 by an easy operation, the procedure becomes easy.

<Modification 2>
FIG. 12 is a schematic diagram illustrating the first tubular member 311 and the first push member 320 of the medical system 3 according to Modification 2.

  The medical system 3 according to the modified example 2 includes a first tubular member 311 and a first push member 320. Since other configurations are the same as those in the above-described embodiment, description thereof is omitted.

  As shown in FIG. 12, a first magnetic part (extension part) 311 </ b> A is provided on the inner periphery of the first tubular member 311. The first push member 320 includes an endoscope 321, a cap 322 that wraps the endoscope 321, and a second magnetic unit 323 provided on the outer periphery of the cap 322. The first magnetic unit 311A and the second magnetic unit 323 have different magnetism. With this configuration, the first magnetic member 311 </ b> A is connected to the second magnetic portion 323 of the first push member 320 by magnetic force by inserting the first push member 320 into the first tubular member 311. For this reason, the 1st extrusion member 320 can push the 1st tubular member 311 more reliably. Note that the second magnetic unit 323 may be provided directly on the endoscope 321 without the cap 322 being provided.

<Modification 3>
FIG. 13 is a schematic diagram showing the first tubular member 411 and the first push member 420 of the medical system 4 according to Modification 3.

  The medical system 4 according to the modified example 3 includes a first tubular member 411 and a first pushing member 420. Since other configurations are the same as those in the above-described embodiment, description thereof is omitted.

  As shown in FIG. 13, the first tubular member 411 has an engaging portion (extending portion) 411 </ b> A having a spiral groove shape on the distal end side in the insertion direction. The first push-out member 420 includes an endoscope 421, a cap 422 that wraps the endoscope 421, and a spiral convex portion 423 that is provided on the outer periphery of the cap 422 and engages with the engaging portion 411A. Have. With this configuration, by inserting the first push member 420 into the first tubular member 411, the engaging portion 411A is engaged with and connected to the convex portion 423 of the first push member 420. For this reason, the 1st extrusion member 420 can push the 1st tubular member 411 more reliably.

<Modification 4>
FIG. 14 is a schematic diagram illustrating the first tubular member 511 and the first push member 520 of the medical system 5 according to Modification 4.

  The medical system 5 according to the modified example 4 includes a first tubular member 511 and a first push member 520. Since other configurations are the same as those in the above-described embodiment, description thereof is omitted.

  As shown in FIG. 14, the first tubular member 511 includes a linear portion 511B having a groove shape extending in the insertion direction and an engaging portion (extending portion) having a groove shape extending in the circumferential direction on the distal end side of the linear portion 511B. ) 511A. The first push member 520 includes an endoscope 521, a cap 522 that encloses the endoscope 521, and a convex portion 523 that is provided on the outer periphery of the cap 522 and protrudes outward. If it is this structure, the 1st extrusion member 520 will be inserted in the inside of the 1st tubular member 511 so that the convex part 523 of the 1st extrusion member 520 may follow the linear part 511B of the 1st tubular member 511, and a convex part By rotating the first pushing member 520 in a state where the 523 is in contact with the most distal portion of the linear portion 511B, the convex portion 523 is engaged with the engaging portion 511A, and the first pushing member 520 and the first pushing member 520 are engaged. The tubular member 511 is connected. For this reason, the 1st extrusion member 520 can push the 1st tubular member 511 more reliably.

<Modification 5>
15 and 16 are front sectional views showing the first tubular member 611 and the first push member 120 of the medical system 6 according to Modification 5. 15 and 16, the first pushing member 120 is shown in a front view.

  As shown in FIG. 15, inside the first tubular member 611 of the medical system 6 according to the modified example 5, an expansion part (extension part) 611A that can be expanded and deformed, and a pressure medium for sending to the expansion part 611A are sent. A flexible hollow member 612 having a lumen 611L is provided. Specifically, the expansion portion 611A is a balloon. If it is this composition, with the 1st extrusion member 120 inserted in the inside of the 1st tubular member 611, by sending a pressurizing medium via lumen 611L, expansion part 611A is expanded and expansion part 611A The first pushing member 120 can be pressed and held. For this reason, the 1st extrusion member 120 and the 1st tubular member 611 are connected. For this reason, the 1st extrusion member 120 can push the 1st tubular member 611 more reliably. Note that the lumen 611L may be arranged around the inside of the first tubular member 611, or may be provided in the tube wall of the first tubular member 611 as shown in FIG.

<Modification 6>
FIG. 17 is a side cross-sectional view of the distal end portion of the first tubular member 711 of the medical system 7 according to Modification 6. FIG. 17A is a diagram in which the first tubular member 711 and the first pushing member 120 are connected. FIG. 17B is a diagram illustrating a state in which the connection state of the first tubular member 711 and the first push member 120 is released.

  Three elastic members (extension portions) 711A are provided inside the first tubular member 711 of the medical system 7 according to Modification Example 6. The three elastic members 711A and the first tubular member 711 are fixed by, for example, an adhesive. With this configuration, by inserting the first push member 120 into the first tubular member 711, the first push member 120 and the first tubular member 711 are connected by the elastic member 711A. In addition, when extracting the 1st extrusion member 120, the 1st extrusion member 120 is rotated a predetermined angle. As a result, the contact area between the first extruding member 120 and the elastic member 711A is reduced (see FIG. 17B), and can be removed. According to this structure, the 1st extrusion member 120 can push the 1st tubular member 711 more reliably.

<Modification 7>
FIG. 18 is a view for explaining the configuration of the first push member 820 of the medical system 8 according to Modification 7. Since the configuration other than the first pushing member 820 is the same as that of the above-described embodiment, the description thereof is omitted.

  As shown in FIG. 18, the first push-out member 820 according to Modification 7 includes an endoscope 821 and a flexible resin member 822 that is provided on the outer periphery of the endoscope 821 and has lower rigidity than the endoscope 821. Have. The resin member 822 is provided so as to be fixed to the inner periphery of the first tubular member 111. The fixing method with the inner periphery of the resin member 822 and the 1st tubular member 111 is not specifically limited, For example, it is adhesion | attachment by an adhesive agent.

  Hereinafter, a procedure using the medical system 8 according to Modification Example 7 will be described. Here, only the procedure for removing the first push member 820 will be described. As shown in FIG. 18A, the operator removes only the endoscope 821 from the urethra 10 in a state where the main body 110 is placed in the treatment section 30A. Then, after the medical material S providing the epithelial function is placed in the treatment portion 30A for a predetermined period, the resin member 822 is simultaneously removed from the urethra 10 when the second push-out member 130 is removed from the urethra 10. According to this method, the second push-out member 130 removes the third tubular member 113 and the resin member 822 simultaneously removes the first tubular member 111, so that the medical treatment instrument 100 can be more reliably removed.

<Modification 8>
The medical system according to Modification Example 8 is configured such that the second push-out member 130 is removable from the moving unit 113C with respect to the medical system 8 according to Modification Example 7.

  Hereinafter, a procedure using the medical system according to Modification Example 8 will be described. Here, a procedure after the second push-out member 130 pushes the third tubular member 113 to the distal end side and the main body 110 is placed in a nested state will be described. The operator removes the second push-out member 130 from the moving part and removes it from the urethra 10. Then, after the medical material S that provides the epithelial function is placed in the treatment portion 30A for a predetermined period, the resin member 822 is removed from the urethra 10, whereby the main body 110 is removed from the urethra 10. According to this method, when the medical material S is placed in the treatment portion 30A, only the resin member 822 is placed from the entrance E of the urethra 10 to the treatment portion 30A, and therefore follows the body movement during placement. It is easy to place the medical material S in the treatment section 30A with less invasiveness.

1, 3, 4, 5, 6, 7, 8 medical system,
10 urethra,
100, 200 medical treatment tool,
110 body,
111, 211, 311, 411, 511, 611, 711 First tubular member (innermost tubular member),
111A, 211A extension part,
311A 1st magnetic part (elongation part),
411A, 511A engagement portion (extension portion),
611A expansion part (extension part),
711A elastic member (extension part),
112 second tubular member,
113 third tubular member (outermost tubular member),
113C moving part,
120, 320, 420, 520, 820 first extruded member,
130 second extruded member,
140 Regulatory Department,
S Medical material that provides epithelial function.

Claims (9)

A medical treatment tool for placing a medical material providing an epithelial function in a body cavity of a living body,
A body portion that is inserted into the body cavity and is expandable and contractible in the longitudinal direction in the body cavity, and in a contracted state, forms a plurality of layers in the circumferential direction;
An extension that is provided in the innermost layer of the main body part and moves to the distal end side in the insertion direction by being pushed out to extend the main body part and maintain the position of the main body part in the body cavity in the extended state. And
A medical treatment instrument comprising: a moving part that is provided in an outermost layer of the main body part in a state where the medical material can be disposed on an outer periphery, and moves along the elongated part to contract the main body part. The main body portion is composed of a plurality of tubular members having a nested structure,
The extending portion is provided on the innermost peripheral tubular member located on the innermost periphery among the plurality of tubular members, and is extended by the first pushing member that pushes the tubular member toward the distal end side to extend the main body portion. ,
The said moving part is provided in the outermost peripheral tubular member located in the outermost periphery among several said tubular members, The said extrusion is pushed by the 2nd extrusion member which extrudes the said tubular member to the said front end side, The said main-body part is contracted. The medical treatment tool according to 1.   The medical treatment instrument according to claim 2, wherein the extension portion is pushed by being abutted against a distal end portion of the first push-out member to extend the main body portion.   The medical treatment instrument according to claim 2 or 3, wherein the extending portion includes an engaging portion that engages with the first push-out member.   The medical treatment instrument according to any one of claims 1 to 4, wherein the extension portion includes an extension portion that is provided inside the innermost layer and that can be extended and deformed.   The medical treatment instrument according to any one of claims 1 to 5, further comprising a restricting portion that restricts movement of the innermost layer toward the distal end side when the moving portion contracts the main body portion. . The medical material is a biological sheet,
The medical treatment tool according to any one of claims 1 to 6, wherein the body cavity is a narrowed portion formed in the urethra.   The medical treatment instrument according to any one of claims 1 to 7, a first pushing member that pushes the extending portion toward the distal end side, and a second pushing member that pushes the moving portion toward the distal end side. Having medical system.   The medical system according to claim 8, wherein the first push member has an endoscope.