JP2018033507A - Medical device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical device capable of improving penetration force for a stenosis lesion, and suppressing dimensions in a circumferential direction.SOLUTION: A medical device 8 includes an imaging core 4 for acquiring an image of a living body lumen, a first tube body 61 forming a lumen 23 for an image, a second tube body 62 forming a first guide wire lumen 24, which is provided in parallel to the first tube body on the tip side of the first tube body, a third tube body 63 forming a second guide wire lumen 25, which is provided from the tip side to the base end side of the first tube body, and a fourth tube body 64 forming a third guide wire lumen 26, which is provided from the tip side to the base end side of the first tube body. The third tube body and the fourth tube body are provided side by side with each other on the base end side of the first tube body in parallel to the first tube body, have a part inclined with respect to an axis line of the second tube body on the tip side of the first tube body, and are provided at symmetrical positions on both sides viewed from the second tube body.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical device that can be inserted into a living body lumen to acquire image information.

  For example, in the treatment of a vascular stenosis that causes myocardial infarction or the like, a surgical technique is used in which the affected area is treated percutaneously with a catheter. Such surgical techniques include a method of pushing the stenosis part with a balloon catheter having a balloon at the tip, a method of placing a metal tube called a stent, and a tool called a rotablator (trademark), etc. Various methods exist, such as a method for excising the stenosis. In the treatment of the vascular stenosis, a preferable method is selected from these various surgical methods according to the properties of the stenosis and the patient's condition.

  Diagnosis catheters are mainly used in the percutaneous treatment of such vascular stenosis, as an aid to the decision for observing the properties of the stenosis and selecting treatment methods. It is also used for observation of the state. Examples of the diagnostic catheter include an ultrasonic catheter that transmits ultrasonic waves toward the affected area and receives ultrasonic waves reflected from the affected area, and an optical coherence tomographic diagnosis apparatus that acquires an image using light interference. .

  Among such diagnostic catheters, the ultrasonic catheter is inserted to a tortuous portion such as a coronary artery of the heart. Therefore, when inserting the ultrasonic catheter, the surgeon first inserts the guide wire up to the affected part, and advances the ultrasonic catheter along the guide wire. For this reason, a lumen (hereinafter referred to as “guide wire lumen”) for inserting a guide wire and moving the ultrasonic catheter along the guide wire is provided at the distal end of the ultrasonic catheter.

  Here, it is desired to operate the guide wire and to penetrate the vascular stenosis part while observing the vascular stenosis part. In other words, the surgeon may wish to operate the guide wire and penetrate the vascular stenosis part while observing the vascular stenosis part. However, in a so-called rapid exchange type ultrasonic catheter in which the guide wire lumen is provided only at the tip of the ultrasonic catheter, it is difficult to efficiently transmit the pushing force of the guide wire by the operator to the vascular stenosis. There is.

  On the other hand, Patent Literature 1 discloses a catheter having a first guide wire lumen through which a first guide wire can be inserted and a second guide wire lumen through which a second guide wire can be inserted. Yes. In the catheter described in Patent Document 1, a so-called rapid exchange structure in which the guide wire lumen is provided only at the distal end of the catheter is employed for the first guide wire lumen. On the other hand, the second guidewire lumen employs an over the wire structure in which the guidewire lumen extends to the vicinity of the proximal housing operated by the operator. As a result, the pushing force of the second guide wire by the operator can be efficiently transmitted to the vascular stenosis. That is, the followability of the catheter with respect to the second guide wire can be improved, and the penetration force with respect to the vascular stenosis can be improved.

JP 2006-20944 A

  However, when a highly stenotic lesion is present in a living body lumen such as a blood vessel or a vessel, the highly stenotic lesion is penetrated when piercing while observing the highly stenotic lesion with the catheter described in Patent Document 1. The second guide wire used for this purpose can only be used alone. Therefore, it may be difficult to efficiently transmit the pushing force of the second guide wire by the operator to the highly stenotic lesion. This is because a highly stenotic lesion is harder than a general stenotic lesion and a relatively large reaction occurs when the second guide wire is penetrated through the highly stenotic lesion. Therefore, when penetrating the second guide wire into the highly stenotic lesion, the ultrasonic catheter may move to the proximal end side or may come out of the highly stenotic lesion. If it does so, the position of the imaging part of an ultrasonic catheter will shift | deviate from the position of the affected part in a biological lumen, and it will become difficult to operate a guide wire and to penetrate a vascular stenosis part, observing a vascular stenosis part. In this respect, the catheter described in Patent Document 1 has room for improvement. In addition, in order to improve the penetration force for highly stenotic lesions, the direction perpendicular to the direction of insertion into the body lumen (circumferential direction) can be obtained simply by providing a guide wire lumen through which the third guide wire is inserted. ) Is increased in size.

  The present invention has been made to solve the above-described problem, and an object of the present invention is to provide a medical device capable of improving the penetration force for a stenotic lesion and suppressing the circumferential dimension. .

  According to the present invention, the object is a medical device that is inserted into a living body lumen and used for diagnosis in the living body lumen, and has an imaging core that acquires an image in the living body lumen A first tubular body that forms an image lumen into which the imaging core is inserted; a first tubular body that is provided in parallel to the first tubular body at a distal end side of the first tubular body; A second tubular body that forms one guide wire lumen; and a third tubular body that is provided from the distal end side to the proximal end side of the first tubular body and forms a second guide wire lumen into which the second guide wire is inserted. A fourth tubular body provided from the distal end side to the proximal end side of the first tubular body and forming a third guidewire lumen into which the third guidewire is inserted, the third tubular body and the first tubular body The four-tube body is the base end side of the first tube body Are provided in parallel to each other and parallel to the first tubular body, and have inclined portions with respect to the axis of the second tubular body on the tip side of the first tubular body, on both sides as viewed from the second tubular body. This is solved by a medical device characterized in that it is provided in a symmetrical position.

  According to the above configuration, the medical device includes a first tube body that forms an image lumen, a second tube body that forms a first guide wire lumen into which the first guide wire is inserted, and a second guide wire. A third tube forming a second guide wire lumen to be inserted; and a fourth tube forming a third guide wire lumen into which the third guide wire is inserted. The first guide wire is inserted in advance to the vicinity of the affected part in the living body lumen before the medical device is inserted into the living body lumen, and is used to guide the medical device to the affected part. After the medical device is inserted into the living body lumen, the second guide wire is inserted through the second guide wire lumen to the affected part in the living body lumen.

  Here, when the highly stenotic lesion is present in the living body lumen, when the second guide wire is penetrated into the highly stenotic lesion, the medical device moves to the proximal end side or comes out of the highly stenotic lesion. For this, a third guide wire can be used. For example, in a state where the first guide wire and the second guide wire are inserted into a main blood vessel in which a highly stenotic lesion exists, the third guide wire is inserted into a side branch blood vessel branched from the main blood vessel through the third guide wire lumen. To do. Then, the third guide wire exhibits an anchor effect, suppresses the movement of the medical device to the proximal end side, and efficiently transmits the pushing force of the second guide wire by the operator to the highly stenotic lesion. it can. In other words, the third guide wire can limit the movement of the medical device, support the penetration of the second guide wire with respect to the highly stenotic lesion, and improve the penetration force of the second guide wire with respect to the highly stenotic lesion. .

  Further, the third tubular body and the fourth tubular body are provided in parallel to the first tubular body alongside each other on the proximal end side of the first tubular body. Here, the second tubular body is provided on the distal end side of the first tubular body. Therefore, even if the third tubular body and the fourth tubular body are arranged side by side on the proximal end side of the first tubular body, they are perpendicular to the axis of the first tubular body on the proximal end side of the first tubular body. It is possible to suppress the dimension in a proper direction (circumferential direction). On the other hand, the third tubular body and the fourth tubular body have a portion inclined with respect to the axis of the second tubular body on the distal end side of the first tubular body, and are provided at symmetrical positions on both sides when viewed from the second tubular body. It has been. Therefore, compared with the case where the third tubular body and the fourth tubular body are arranged side by side in the same manner as the proximal end side on the distal end side of the first tubular body, the circumferential direction is also increased on the distal end side of the first tubular body. Dimensions can be reduced.

  Preferably, the second tubular body is arranged side by side with the first tubular body, and the third tubular body has the first tubular body and the second tubular body on one side as viewed from the second tubular body. The fourth tubular body is disposed on the other side opposite to the one side as viewed from the second tubular body, and the fourth tubular body is disposed in a first recess formed between the first tubular body and the second tubular body. It arrange | positions at the 2nd recessed part formed between the bodies, It is characterized by the above-mentioned.

  According to the said structure, the 3rd tubular body is arrange | positioned in the 1st recessed part formed between the 1st tubular body and the 2nd tubular body in one side seeing from the 2nd tubular body. In addition, the fourth tubular body is disposed in a second recess formed between the first tubular body and the second tubular body on the other side as viewed from the second tubular body. A 1st recessed part and a 2nd recessed part are the hollows formed between the 1st tubular body and the 2nd tubular body, and exist in the both sides of a 2nd tubular body. The 3rd pipe body and the 4th pipe body are arrange | positioned at the hollow of the both sides. Thereby, the dimension of the circumferential direction of a medical device can be suppressed.

  Preferably, the first guide wire led out from the opening on the proximal end side of the first guide wire lumen has the third tubular body and the third tubular body arranged side by side on the proximal end side of the first tubular body. It arrange | positions in the 3rd recessed part formed between the 4th pipe bodies, It is characterized by the above-mentioned.

  According to the above configuration, the first guide wire led out from the opening on the proximal end side of the first guide wire lumen has the third tubular body and the fourth tubular body arranged side by side on the proximal end side of the first tubular body. It arrange | positions in the 3rd recessed part formed between the pipes. The third recess is a recess formed between the third tube body and the fourth tube body. Since the guide wire is disposed in the depression, the size of the medical device in the circumferential direction can be suppressed even on the base end side.

  Preferably, the opening on the distal end side of the second guide wire lumen and the third guide wire lumen is provided on the proximal end side with respect to the distal end portion of the image lumen.

  According to the above configuration, since the opening on the distal end side of the second guide wire lumen and the third guide wire lumen is provided on the proximal end side with respect to the distal end portion of the imaging lumen, the ultrasonic wave passes through the first tubular body. It can be avoided that the third tube body and the fourth tube body overlap the passing window portion (imaging window). Thereby, the defect area | region of the image in a biological lumen can be decreased, and the information content at the time of an operator's diagnosis can be increased.

  Preferably, the opening on the distal end side of the third guide wire lumen is provided closer to the proximal end side than the opening on the distal end side of the second guide wire lumen.

  According to the said structure, the opening part of the front end side of a 3rd guidewire lumen is provided in the base end side rather than the opening part of the front end side of a 2nd guidewire lumen. Therefore, even when a highly stenotic lesion is present on the back side of the main blood vessel (the side in the direction of insertion into the living body lumen) with respect to the branch portion where the side branch blood vessel branches from the main blood vessel, the third guide wire is more It can be reliably inserted into a side branch vessel.

  Preferably, one of the opening on the proximal end side of the second guidewire lumen and the opening on the proximal end side of the third guidewire lumen is an opening on the proximal end side of the second guidewire lumen. It is characterized in that the third guide wire lumen is provided on the distal end side with respect to either one of the opening portions on the proximal end side of the third guide wire lumen.

  According to the above configuration, the surgeon confirms the positions of the opening on the proximal end side of the second guide wire lumen and the opening on the proximal end side of the third guide wire lumen, so that the medical device is a living body lumen. Even when the guide wire is inserted, the proximal end side opening portion of the second guide wire lumen and the proximal end side opening portion of the third guide wire lumen are discriminated at the position where the guide wire is operated. be able to. Accordingly, the surgeon can more accurately insert the second guide wire and the third guide wire used in different applications into the second guide wire lumen and the third guide wire lumen, respectively.

  Preferably, an operation unit that is connected to an external drive device that drives the imaging core and that can operate the imaging core is further provided, and an opening on the proximal end side of the second guidewire lumen is fixed to the operation unit, The third guide wire lumen is provided closer to the base end side than the base end side opening.

  According to the said structure, the opening part of the base end side of a 2nd guidewire lumen is fixed to the operation part, and is provided in the base end side rather than the opening part of the base end side of a 3rd guidewire lumen. Here, the second guide wire is used for penetrating highly stenotic lesions. The third guide wire is used to support penetration of the second guide wire for highly stenotic lesions. Therefore, the usage frequency of the second guide wire is higher than the usage frequency of the third guide wire. That is, the opening on the proximal end side of the second guide wire lumen into which the second guide wire having a higher usage frequency than the usage frequency of the third guide wire is inserted is fixed to the operation unit, and the base of the third guide wire lumen is fixed. It is provided on the base end side with respect to the opening on the end side. Thereby, the operativity of the 2nd guide wire with high use frequency can be improved.

  Preferably, a first communication portion that connects the first guide wire lumen and the second guide wire lumen to each other, a second communication portion that connects the first guide wire lumen and the third guide wire lumen to each other, and And a third communication portion connecting the second guide wire lumen and the third guide wire lumen to each other.

  According to the above configuration, when performing a priming operation for filling the medical device with physiological saline, the physiological saline passes through the first communication portion, the second communication portion, and the third communication portion, and the first guide wire lumen, The second guide wire lumen and the third guide wire lumen are filled. Thereby, even if the 1st guidewire lumen, the 2nd guidewire lumen, and the 3rd guidewire lumen are provided, it can avoid that priming operation becomes complicated.

  Preferably, the inner width of the first communication portion is narrower than the diameters of the first guide wire and the second guide wire, and the inner width of the second communication portion is the first guide wire and the second guide wire. It is narrower than the diameter of three guide wires, and the inner width of the third communication portion is narrower than the diameters of the second guide wire and the third guide wire.

  According to the said structure, it can suppress that a 1st guide wire and a 2nd guide wire pass a 1st communicating part. Therefore, it is possible to suppress the first guide wire and the second guide wire from interfering with each other. Moreover, it can suppress that a 1st guide wire and a 3rd guide wire pass a 2nd communicating part. Therefore, it can suppress that a 1st guide wire and a 3rd guide wire mutually interfere. Moreover, it can suppress that a 2nd guide wire and a 3rd guide wire pass a 3rd communication part. Therefore, it is possible to suppress the second guide wire and the third guide wire from interfering with each other. Thereby, the operativity of a 1st guide wire, a 2nd guide wire, and a 3rd guide wire can be improved.

  ADVANTAGE OF THE INVENTION According to this invention, while being able to improve the penetration force with respect to a stenosis lesion, the medical device which can suppress the dimension of the circumferential direction can be provided.

It is a top view showing the medical device which concerns on embodiment of this invention. It is a top view showing the medical device which concerns on embodiment of this invention. It is a perspective view showing the front-end | tip part of the medical device which concerns on this embodiment. It is a top view showing the front-end | tip part of the shaft part of this embodiment. It is a top view showing the base end part of the shaft part of this embodiment. FIG. 5 is a cross-sectional view taken along a cutting plane C1-C1 illustrated in FIG. 4. FIG. 5 is a cross-sectional view taken along a cutting plane C2-C2 illustrated in FIG. 4. FIG. 5 is a cross-sectional view taken along a cutting plane C3-C3 illustrated in FIG. 4. It is sectional drawing explaining the usage method of the medical device which concerns on this embodiment. It is sectional drawing explaining the usage method of the medical device which concerns on this embodiment. It is a top view showing the front-end | tip part of the shaft part which concerns on the 1st modification of this embodiment. It is a top view showing the hub concerning the 1st modification of this embodiment. It is a top view showing the hub which concerns on the 2nd modification of this embodiment. It is sectional drawing showing the shaft part which concerns on the 2nd modification of this embodiment. It is sectional drawing showing the shaft part which concerns on the 2nd modification of this embodiment.

Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the drawings.
The embodiments described below are preferable specific examples of the present invention, and thus various technically preferable limitations are given. However, the scope of the present invention is particularly limited in the following description. Unless otherwise stated, the present invention is not limited to these embodiments. Moreover, in each drawing, the same code | symbol is attached | subjected to the same component and detailed description is abbreviate | omitted suitably.

1 and 2 are plan views showing a medical device according to an embodiment of the present invention.
FIG. 3 is a perspective view illustrating the distal end portion of the medical device according to the present embodiment.
FIG. 1 shows a state before the transducer unit is pulled back. FIG. 2 shows a state after the transducer unit is pulled back.

  As shown in FIG. 1 and FIG. 2, the medical device 8 according to the present embodiment is an ultrasound catheter that accommodates an imaging core 4 for ultrasound diagnosis and is inserted into a living body lumen. . The medical device 8 is connected to an external drive device (not shown) that holds the medical device 8 and drives the imaging core 4 and is used mainly for diagnosing the inside of a blood vessel. In the present specification, the side to be inserted into the lumen of the living body is referred to as “tip” or “tip side”, and the proximal side for operation is referred to as “base end” or “base end side”.

  The medical device 8 includes an imaging core that transmits an ultrasonic wave toward a tissue in the living body lumen and receives an ultrasonic wave reflected from the tissue in the living body lumen, and the shaft portion 2 inserted into the living body lumen. 4, a hub 5 that penetrates the imaging core 4 and is located on the proximal end side of the shaft portion 2, and an operation portion 3 that operates the imaging core 4.

  The shaft portion 2 includes a shaft tip portion 21 and a shaft main body portion 22. A shaft tip 21 is connected to one end of the shaft body 22. On the other hand, the hub 5 is connected to the other end of the shaft body 22.

  In the shaft tip portion 21 and the shaft main body portion 22, an image lumen 23 into which the imaging core 4 is inserted, a second guide wire lumen 25 into which the second guide wire W2 is inserted, and a third guide wire W3 are inserted. The third guide wire lumen 26 is formed in a triple lumen structure from the distal end side to the proximal end side. That is, for the second guide wire lumen 25 and the third guide wire lumen 26, the proximal end side opening of the second guide wire lumen 25 (the insertion portion 54 of the second guide wire W 2) and the third guide wire lumen 26. An over-the-wire structure is employed in which the proximal end opening (the insertion portion 55 of the third guide wire W3) is present outside the patient's body. In FIG. 1 and FIG. 2, the insertion portion 55 of the third guide wire W3 is shown overlapping the insertion portion 54 of the second guide wire W2, and the back side of the insertion portion 54 of the second guide wire W2 is shown. (See FIG. 5).

  A first guide wire lumen 24 into which the first guide wire W1 is inserted is formed at the shaft distal end portion 21. The first guide wire lumen 24 includes a guide wire lumen distal end portion 241 provided on the distal end side in the axial direction of the shaft portion 2 and a guide wire lumen proximal end portion 242 provided on the proximal end side in the axial direction of the shaft portion 2. And having. The guide wire lumen distal end portion 241 and the guide wire lumen proximal end portion 242 are not connected to each other and are provided apart from each other. The guide wire lumen distal end 241 is disposed on the extension line (coaxially) of the guide wire lumen base end 242. Therefore, the first guide wire W1 passes through the first guide wire lumen 24 linearly.

  As shown in FIG. 3, the opening 243 on the distal end side of the first guide wire lumen 24 is provided on the distal end side of the shaft distal end portion 21. An opening 244 on the proximal end side of the first guide wire lumen 24 is provided on the proximal end side of the shaft distal end portion 21. That is, the lumen between the distal end side opening 243 and the proximal end side opening 244 provided in the shaft distal end portion 21 functions as the first guide wire lumen 24. As described above, the first guide wire lumen 24 employs a rapid exchange structure in which the opening 244 on the proximal end side of the first guide wire lumen 24 exists in the patient's body.

  The shaft portion 2 includes a first tube 61 in which the image lumen 23 is formed, a second tube 62 in which the first guide wire lumen 24 is formed, and a third tube in which the second guide wire lumen 25 is formed. A body 63 and a fourth tubular body 64 in which the third guidewire lumen 26 is formed. The second tubular body 62 is provided in the shaft distal end portion 21 (that is, the distal end side of the first tubular body 61) on an axis different from the first tubular body 61 in parallel with the first tubular body 61. Is heat-sealed (or bonded). The third tubular body 63 is provided on the shaft main body portion 22 (that is, the base end side of the first tubular body 61) on an axis different from the first tubular body 61 in parallel with the first tubular body 61. 61 is heat-sealed (or bonded). The fourth tubular body 64 is provided on the shaft main body portion 22 (that is, the proximal end side of the first tubular body 61) on an axis different from that of the first tubular body 61 in parallel with the first tubular body 61. 61 is heat-sealed (or bonded).

  As shown in FIG. 3, the third tube body 63 and the fourth tube body 64 are arranged side by side in the shaft body 22. In FIGS. 1 and 2, the fourth tubular body 64 is shown overlapping with the third tubular body 63 and is provided on the back side of the third tubular body 63 (see FIG. 3).

  An X-ray contrast marker 29 is provided at the distal end of the first tubular body 61. Thereby, when the shaft portion 2 is inserted into the living body lumen, the operator can confirm the distal end position of the medical device 8 under X-ray fluoroscopy.

  The shaft portion 2 is made of a material having high permeability to ultrasonic waves and having flexibility. The material of the shaft portion 2 is not particularly limited. Examples thereof include various thermoplastic elastomers such as styrene, polyolefin, polyurethane, polyester, polyamide, polyimide, polybutadiene, transpolyisoprene, fluororubber, and chlorinated polyethylene. Moreover, as a material of the shaft part 2, what combined 1 type (s) or 2 or more types of these (a polymer alloy, a polymer blend, a laminated body, etc.) is applicable.

  A distal end tip formed of a material that is more flexible than the material of the shaft portion 2 may be provided at the distal end portion of the first tubular body 61. For example, the tip is formed as a tubular body, and the burden on the living tissue that comes into contact when the medical device 8 moves in the living body lumen can be reduced. The material of the tip is not particularly limited. For example, a material applicable as the material of the shaft portion 2 described above can be applied.

  The imaging core 4 is disposed in the image lumen 23 so as to be slidable in the axial direction of the shaft portion 2. The imaging core 4 transmits an ultrasonic wave from the living body lumen to the living tissue and receives an ultrasonic wave reflected from the living tissue and an oscillator unit 41 at the tip. A drive shaft 42 that is attached and rotated, and a rotation stabilization coil 43 that is attached to the tip of the vibrator unit 41 are included.

  The drive shaft 42 is flexible and has a characteristic capable of transmitting the rotational power generated in the operation unit 3 to the vibrator unit 41. For example, the drive shaft 42 is a multilayer such as a three-layer coil in which the right and left and the winding directions are alternated. It consists of a coiled tube. When the drive shaft 42 transmits the rotational power, the transducer unit 41 rotates in a living body lumen such as a blood vessel, and can acquire an image of the affected area in the circumferential direction. A signal line (not shown) for transmitting a signal detected by the vibrator unit 41 to the operation unit 3 is disposed inside the drive shaft 42.

  The hub 5 accommodates the first tube body 61, the third tube body 63, and the fourth tube body 64 therein, and has a hub casing 56 and a first anti-kink protector 57. However, the first kink protector 57 may be provided integrally with the hub casing 56 and may be a part of the hub casing 56. On the base end side of the hub casing 56, a first hub base end portion 51, a second hub base end portion 52, and a third hub base end portion 53 are branched from each other. That is, the hub casing 56 is branched into a first hub base end portion 51, a second hub base end portion 52, and a third hub base end portion 53 on the base end side. In FIG. 1 and FIG. 2, the third hub base end portion 53 is shown overlapping with the second hub base end portion 52 and is provided on the back side of the second hub base end portion 52 ( (See FIG. 5).

  On the base end side of the second hub base end portion 52, an insertion portion 54 for the second guide wire W2 is provided. For example, the surgeon can insert and remove the second guide wire W2 through the insertion portion 54 of the second guide wire W2. The second guide wire W2 inserted from the insertion portion 54 of the second guide wire W2 passes through the second guide wire lumen 25 and is led into the living body lumen from the opening 251 on the distal end side of the second guide wire lumen 25. .

  On the proximal end side of the third hub proximal end portion 53, an insertion portion 55 for the third guide wire W3 is provided. For example, the operator can insert and remove the third guide wire W3 through the insertion portion 55 of the third guide wire W3. The third guide wire W3 inserted from the insertion portion 55 of the third guide wire W3 passes through the third guide wire lumen 26 and is led into the living body lumen from the opening 261 on the distal end side of the third guide wire lumen 26. . In FIG. 1 and FIG. 2, the insertion portion 55 of the third guide wire W3 is shown overlapping the insertion portion 54 of the second guide wire W2, and the back side of the insertion portion 54 of the second guide wire W2 is shown. (See FIG. 5).

  On the base end side of the first hub base end portion 51, the operation unit 3 is provided. The operation unit 3 is connected to an external drive device for operating the imaging core 4. The operation unit 3 includes an outer tube 32 that is partially inserted into the first hub proximal end 51 and connected to the first tube body 61, a unit connector 37 that is coupled to the proximal end of the outer tube 32, and an outer tube And an operation base end 31 connected to the base end of the inner tube 34.

  The operation base end portion 31 holds the drive shaft 42 and the inner tube 34. When the operation base end portion 31 moves and the inner tube 34 is pushed into the unit connector 37 and the outer tube 32 (see FIG. 1) or pulled out (see FIG. 2), the drive shaft 42 is interlocked with the shaft. Slide in the axial direction in the part 2. A port 311 for injecting physiological saline for priming is formed in the operation base end portion 31. The port 311 communicates with the image lumen 23.

  As shown in FIG. 1, when the inner tube 34 is pushed in the most, the end portion on the distal end side of the inner tube 34 moves inside the outer tube 32 and reaches the vicinity of the first hub base end portion 51. . In this state, as shown in FIG. 1, the transducer unit 41 is located near the tip of the image lumen 23.

  As shown in FIG. 2, when the inner tube 34 is pulled out most, a stopper 315 formed at the tip of the inner tube 34 is caught on the inner wall of the unit connector 37. Portions other than the vicinity of the tip caught on the inner wall of the unit connector 37 are exposed from the unit connector 37 and the outer tube 32. In this state, as shown in FIG. 2, the transducer unit 41 is pulled back inside the image lumen 23 while the shaft portion 2 remains in the living body lumen, and the distal end of the image lumen 23. It is accommodated in a region located on the proximal side from the part. Thus, the transducer unit 41 can move along the axial direction while rotating inside the image lumen 23 in order to create a tomographic image of a blood vessel or the like.

  The operation base end portion 31 includes a joint 312, a hub side connector 313 connected to the base end portion of the drive shaft 42, and a second kink protector 314.

  One end of a signal line arranged inside the drive shaft 42 is connected to the hub side connector 313. The other end of the signal line passes through the drive shaft 42 and is connected to the vibrator unit 41. The ultrasonic wave is irradiated from the transducer unit 41 by a signal transmitted from the external drive device to the transducer unit 41 via the hub side connector 313 and the signal line in the drive shaft 42. Further, the signal detected by the transducer unit 41 by receiving the ultrasonic wave is transmitted to the external drive device via the signal line in the drive shaft 42 and the hub side connector 313.

  The second kink protector 314 is disposed around the inner tube 34 and the operation base end portion 31 and suppresses kinking of the inner tube 34.

  The proximal end portion of the outer tube 32 connected to the first tube body 61 is inserted so as to fit inside the unit connector 37. An inner tube 34 extending from the operation base end portion 31 is inserted into the outer tube 32. The unit connector 37 is connected to and held by an external drive device.

  The material of the hub casing 56, the first kink protector 57, the outer tube 32, the inner tube 34, the unit connector 37, and the operation base end 31 is not particularly limited. For example, polyester such as polyvinyl chloride, polyethylene, polypropylene, cyclic polyolefin, polystyrene, poly- (4-methylpentene-1), polycarbonate, acrylic resin, acrylonitrile-butadiene-styrene copolymer, polyethylene terephthalate, polyethylene naphthalate, etc. And various resins such as butadiene-styrene copolymer and polyamide (for example, nylon 6, nylon 6,6, nylon 6,10, nylon 12).

FIG. 4 is a plan view showing the tip portion of the shaft portion of the present embodiment.
FIG. 5 is a plan view showing the base end portion of the shaft portion of the present embodiment.
FIG. 6 is a cross-sectional view taken along the cutting plane C1-C1 shown in FIG.
FIG. 7 is a cross-sectional view taken along section line C2-C2 shown in FIG.
8 is a cross-sectional view taken along section plane C3-C3 shown in FIG.
4 is a plan view of the tip end portion of the shaft portion 2 as viewed from the direction of the arrow A1 shown in FIG. FIG. 5 is a plan view when the base end portion of the shaft portion 2 is viewed from the direction of the arrow A2 shown in FIG.

  While the first tube body 61, the third tube body 63, and the fourth tube body 64 are arranged side by side at the distal end side of the shaft body portion 22, as shown in FIG. On the end side, the first tubular body 61, the third tubular body 63, and the fourth tubular body 64 are branched from each other. The outer diameter and inner diameter of the shaft body 22 may be different depending on the position in the axial direction. For example, from the base end side toward the tip end side, the outer diameter and the inner diameter of the shaft main body portion 22 are reduced in a tapered shape so as not to cause an extreme change in physical properties, thereby realizing high pushability and passability. Generation of kinks can be suppressed.

  A first tube body 61 is disposed inside the first hub base end portion 51. The first tube body 61 is connected to the outer tube 32 of the operation unit 3 inside the first hub base end portion 51. A third pipe body 63 is disposed inside the second hub base end portion 52. The third tubular body 63 is connected to the insertion portion 54 of the second guide wire W2 on the proximal end side of the second hub proximal end portion 52. That is, the insertion portion 54 of the second guide wire W2 corresponds to the opening on the proximal end side of the second guide wire lumen 25. A fourth tube body 64 is disposed inside the third hub base end portion 53. The fourth tubular body 64 is connected to the insertion portion 55 of the third guide wire W3 on the proximal end side of the third hub proximal end portion 53. That is, the insertion portion 55 of the third guide wire W3 corresponds to the opening on the proximal end side of the third guide wire lumen 26.

  The first kink protector 57 surrounds the front end portion of the hub casing 56 and the shaft main body portion 22 led out from the hub casing 56 in the front end direction, and suppresses kink of the shaft main body portion 22. The first anti-kink protector 57 is connected to an introducer sheath that is percutaneously inserted into the living body lumen.

  Of the portions of the shaft main body portion 22, a portion that branches in the proximal direction is located inside the hub casing 56. Since the first tube body 61, the third tube body 63, and the fourth tube body 64 are not joined to each other at the branching portion of the shaft main body portion 22, the rigidity of this portion is not branched from the shaft main body portion 22. Lower than the rigidity of the part. Such a branched portion of the shaft body 22 is not located outside the hub casing 56. Thereby, high pushability can be exhibited.

  The axis of the first hub base end 51 is substantially parallel to the axis of the shaft main body 22 led out from the hub casing 56 in the distal direction. Therefore, friction between the drive shaft 42 and the first tubular body 61 can be suppressed, and occurrence of uneven rotation of the image can be suppressed. Further, when pulling back the imaging core 4, it is possible to suppress the occurrence of disconnection or image unevenness due to jumping that disturbs the movement of the imaging core 4.

  Further, the first tubular body 61 in which the image lumen 23 for housing the drive shaft 42 is formed extends in the hub casing 56 in parallel with the shaft main body portion 22 led out from the hub casing 56 in the distal direction. Are connected to the outer tube 32 of the operation unit 3. Therefore, the position of the drive shaft 42 rotating in the hub casing 56 can be appropriately maintained. That is, when it is assumed that the drive shaft 42 is not accommodated in the first pipe body 61 and extends in a somewhat wide space in the hub casing 56, the drive shaft 42 is bent by the reciprocating motion of the drive shaft 42. And can cause sliding failure. On the other hand, in the present embodiment, since the drive shaft 42 is held by the first pipe body 61 in the hub casing 56, the drive shaft 42 is unlikely to bend and slide poorly in the hub casing 56. Thus, a good image can be obtained.

  In addition, a third tubular body 63 in which a second guide wire lumen 25 that accommodates the second guide wire W <b> 2 is formed is connected to the insertion portion 54 in the hub casing 56. Therefore, the position of the second guide wire W2 can be appropriately maintained in the hub casing 56. For this reason, in the same manner as the drive shaft 42 that is held by the first tubular body 61 and does not easily cause bending or sliding failure, the second guide wire W2 is less likely to be bent or sliding in the hub casing 56. A good operation of the second guide wire W2 is possible. The same effect can be obtained with respect to the fourth tubular body 64 in which the third guide wire lumen 26 that accommodates the third guide wire W3 is formed.

  As illustrated in FIG. 6, the transducer unit 41 includes an ultrasonic transducer 411 that transmits and receives ultrasonic waves, and a housing 412 that houses the ultrasonic transducer 411. The ultrasonic transducer | vibrator 411 enables formation of the ultrasonic tomogram of an affected part by irradiating an ultrasonic wave toward an affected part and receiving the reflected ultrasonic wave. The housing 412 is formed in a concave shape, holds the ultrasonic transducer 411 in the concave concave portion, and protects the ultrasonic transducer 411.

  The rotation stabilization coil 43 attached to the tip of the transducer unit 41 serves as a guide for the transducer unit 41 to rotate stably when the imaging core 4 rotates. In addition, the rotation stabilization coil 43 can enter the metal coil 232 fixed to the tip of the shaft tip 21. Since the rotation stabilizing coil 43 enters the metal coil 232, the imaging core 4 and the shaft portion 2 are integrated at the tip of the shaft tip portion 21, and the structure is strong against bending when the medical device 8 is inserted into the living body. .

  The medical device 8 according to the present embodiment is connected to and driven by an external drive device. The external drive device includes a motor that rotationally drives the drive shaft 42, a feed mechanism that moves the drive shaft 42 in the axial direction, and the like, and is connected to a control unit that controls the motor and the feed mechanism. An image obtained by the transducer unit 41 is processed by the control unit and displayed on a display unit connected to the control unit.

  The ultrasonic scanning in the medical device 8 is performed by transmitting the rotational motion of the motor to the drive shaft 42 while moving the drive shaft 42 in the axial direction by the feeding mechanism, and fixing the housing 412 to the tip of the drive shaft 42. It is executed by rotating. As a result, the ultrasonic transducer 411 provided in the housing 412 rotates while moving in the longitudinal direction (the axial direction of the shaft main body 22), and the ultrasonic waves transmitted and received by the ultrasonic transducer 411 are substantially radial. Can be scanned. As a result, a 360-degree cross-sectional image of the surrounding tissue body in the axial direction in the blood vessel can be obtained by scanning up to an arbitrary position.

  At this time, as shown in FIG. 6, the first guide wire lumen 24 is divided into a guide wire lumen distal end portion 241 and a guide wire lumen base end portion 242. Therefore, it is possible to suppress the first guide wire lumen 24 from being present in the ultrasonic path, and to prevent the first guide wire lumen 24 from obstructing the transmission and reception of the ultrasonic waves by the transducer unit 41. Thereby, the defect area | region of the image in a biological lumen can be decreased, and the information content at the time of an operator's diagnosis can be increased.

  As will be described later with reference to FIGS. 9 and 10, by operating the operation unit 3 using an external drive device, the vibrator unit 41 is moved in the axial direction within the image lumen 23 via the drive shaft 42. It is also possible to observe the inside of a living body lumen in a wide range.

  As shown in FIG. 4, the third tube body 63 and the fourth tube body 64 have a portion inclined with respect to the axis X <b> 1 of the second tube body 62 at the shaft tip portion 21. That is, at the shaft tip portion 21, a part of the axis X2 of the third tube 63 is inclined with respect to the axis X1 of the second tube 62. Further, in the shaft distal end portion 21, a part of the axis line X 3 of the fourth tube body 64 is inclined with respect to the axis line X 1 of the second tube body 62.

  Specifically, as shown in FIGS. 1 to 3, in the shaft tip portion 21, a part of the axis X2 of the third tube 63 and a part of the axis X3 of the fourth tube 64 are the second pipe. It inclines with respect to the axis line X1 of the body 62, and extends downward as it goes toward the distal end side of the shaft portion 2. As shown in FIGS. 3 and 4, the third tubular body 63 and the fourth tubular body 64 are arranged on the distal end side of the portion inclined with respect to the axis X <b> 1 of the second tubular body 62. As viewed from 62, they are provided at symmetrical positions on both sides.

  Here, in the present specification, the side on which the second tube 62 or the first guide wire W1 is disposed as viewed from the first tube 61 is referred to as “upper” or “upper”, and the second tube 62 or the first tube The side on which the first tubular body 61 is disposed as viewed from the guide wire W1 is referred to as “lower” or “lower”.

  As shown in FIG. 7, in the shaft main body portion 22, the third tube body 61 and the fourth tube body 64 are provided side by side and in parallel with the first tube body 61, and are arranged in the upper half of the first tube body 61. It is heat-sealed (or bonded). The first guide wire W <b> 1 led out from the opening 244 on the proximal end side of the first guide wire lumen 24 is inserted into a third recess 73 formed between the third tubular body 63 and the fourth tubular body 64. Be placed. The third recess 73 is a recess formed between the third tubular body 63 and the fourth tubular body 64.

  On the other hand, as shown in FIG. 8, the second tubular body 62 is arranged side by side with the first tubular body 61 at the shaft distal end portion 21, and is heat-sealed (or bonded) to the upper half of the first tubular body 61. ) The third tubular body 63 extends while being inclined downward with respect to the axis X1 of the second tubular body 62 toward the distal end side of the shaft portion 2, and the first tubular body 63 on the one side as viewed from the second tubular body 62. It arrange | positions at the 1st recessed part 71 formed between the pipe body 61 and the 2nd pipe body 62. FIG. The first recess 71 is a recess formed on one side between the first tube body 61 and the second tube body 62. Further, the fourth tubular body 64 extends obliquely downward with respect to the axis line X1 of the second tubular body 62 toward the distal end side of the shaft portion 2, and one side as viewed from the second tubular body 62. Is disposed in a second recess 72 formed between the first tube body 61 and the second tube body 62 on the other opposite side. The second recess 71 is a recess formed on the other side between the first tube body 61 and the second tube body 62.

Next, the operation | movement at the time of observing a biological tissue from inside the biological lumens, such as a blood vessel, using the medical device 8 which concerns on this embodiment is demonstrated.
9 and 10 are cross-sectional views illustrating a method for using the medical device according to the present embodiment.
FIG. 9 shows a state in which the first guide wire W1 and the second guide wire W2 are used. FIG. 10 shows a state in which the first guide wire W1, the second guide wire W2, and the third guide wire W3 are used.

  First, before inserting the shaft portion 2 of the medical device 8 into the living body lumen, a priming operation for filling the medical device 8 with physiological saline is performed. By performing the priming operation, transmission (propagation) of ultrasonic waves between the ultrasonic transducer 411 and the biological tissue becomes possible, and air in the medical device 8 is removed to enter a biological lumen such as a blood vessel. Prevent air from entering.

  First, when performing priming, the operation base end portion 31 is most pulled from the unit connector 37 to the base end side, that is, the inner tube 34 is most pulled out from the outer tube 32 (see FIG. 2). ). Subsequently, physiological saline is injected into the operation base end 31 using, for example, a syringe or the like through a tube (not shown) connected to the port 311 of the operation base end 31 and a three-way cock. The injected physiological saline passes through the inner tube 34, the unit connector 37 and the outer tube 32 from the operation base end portion 31 and is filled into the image lumen 23 formed in the first tube body 61. When the image lumen 23 is filled with physiological saline, the physiological saline comes out of the opening 231 (see FIGS. 1 to 3) on the distal end side of the image lumen 23. Thereby, the filling of the physiological saline is confirmed, and the priming of the image lumen 23 is completed. In addition, you may perform priming in the state which pushed the operation base end part 31 to the front end side most (refer FIG. 1).

  Subsequently, physiological saline is injected into the insertion portion 54 using, for example, a syringe or the like via a tube (not shown) connected to the insertion portion 54 of the second guide wire W2 and a three-way stopcock. The injected physiological saline passes through the insertion portion 54 and fills the second guide wire lumen 25 formed in the third tubular body 63. The physiological saline solution that has flowed into the second guidewire lumen 25 flows toward the distal end side of the second guidewire lumen 25 and exits from the opening 251 on the distal end side of the second guidewire lumen 25. Thereby, the filling of the physiological saline is confirmed, and the priming of the second guide wire lumen 25 is completed. The priming of the third guide wire lumen 26 can be performed in the same manner as the priming of the second guide wire lumen 25.

  Next, the medical device 8 is connected to an external drive device covered with a sterilized polyethylene bag (not shown). As a result, signals can be transmitted and received between the vibrator unit 41 and the external drive device, and the drive shaft 42 can be rotated.

  Next, the first guide wire W1 is inserted into the blood vessel through the introducer sheath inserted into the blood vessel percutaneously by the Seldinger method. Subsequently, the proximal end portion of the first guide wire W <b> 1 is inserted from the opening 243 on the distal end side of the first guide wire lumen 24, and is inserted into the first guide wire lumen 24. After the first guide wire W1 is led out from the opening 244 on the proximal end side of the first guide wire lumen 24 to the proximal end side, the medical device 8 is pushed along the first guide wire W1, and the medical device 8 Lead to the affected area to observe the tip.

  Here, for example, as shown in FIG. 9, when the highly stenotic lesion 75 is present in the vicinity of the portion where the side branch blood vessel 78 branches from the main vessel blood vessel 77 (branch portion), the guide is obtained while observing the highly stenotic lesion 75. It is desired to manipulate the wire to penetrate the highly constricted lesion 75. That is, when the highly stenotic lesion 75 is present in the vicinity of the bifurcation of the blood vessel, the operator may want to operate the guide wire while penetrating the highly stenotic lesion 75 while observing the highly stenotic lesion 75. . However, when penetrating while observing the highly stenotic lesion 75 with a conventional diagnostic catheter, the second guide wire used for penetrating the highly stenotic lesion 75 can be used alone. Therefore, it may be difficult to efficiently transmit the pushing force of the second guide wire by the operator to the highly stenotic lesion 75.

  This is because the highly stenotic lesion 75 is harder than a general stenotic lesion, and thus a relatively large reaction occurs when the second guide wire W2 is penetrated through the highly stenotic lesion 75. Therefore, as shown by the arrow A3 in FIG. 9, when the second guide wire W2 is penetrated through the highly stenotic lesion 75, the medical device 8 moves to the proximal end side or comes out of the highly stenotic lesion 75. There is. Then, the position of the transducer unit 41 is shifted from the position of the affected part in the living body lumen, and it becomes difficult to operate the guide wire while observing the highly stenotic lesion 75 and penetrate the highly stenotic lesion 75.

  On the other hand, in the medical device 8 according to this embodiment, the second guide wire lumen 25 has an over-the-wire structure. That is, the opening on the proximal end side of the second guide wire lumen 25 (the insertion portion 54 of the second guide wire W2) exists outside the patient's body. Therefore, the surgeon inserts the second guide wire W2 from the insertion portion 54 of the second guide wire W2 while the shaft portion 2 remains in the living body lumen, and reaches the highly stenotic lesion 75. Can do. The state at this time is, for example, as shown in FIG. Further, since the second guide wire lumen 25 is opened at the insertion portion 54 at hand, a contrast medium or a drug is supplied through the second guide wire lumen 25, and the living body lumen is supplied from the opening portion 251 on the distal end side. It can also be released into the interior.

  Furthermore, in the medical device 8 according to the present embodiment, a third guide wire lumen 26 is formed on the shaft portion 2. The third guide wire lumen 26 has an over-the-wire structure. That is, an opening on the proximal end side of the third guide wire lumen 26 (insertion portion 55 of the third guide wire W3) exists outside the patient's body. Therefore, the surgeon can insert the third guide wire W3 from the insertion portion 55 of the third guide wire W3 and guide it to the side branch blood vessel 78 while the shaft portion 2 remains in the living body lumen. . The state at this time is as shown in FIG. 10, for example.

  As a result, the third guide wire W3 exhibits an anchor effect, suppresses the medical device 8 from moving to the proximal end side, and the surgeon pushes the second guide wire W2 efficiently against the highly stenotic lesion 75. Can communicate. In other words, the third guide wire W3 limits the movement of the medical device 8, supports the penetration of the second guide wire W2 with respect to the highly stenotic lesion 75, and the penetration force of the second guide wire W2 with respect to the highly stenotic lesion 75. Can be improved.

  In addition, as described above with reference to FIGS. 1 to 4 and 7, the third tubular body 63 and the fourth tubular body 64 are aligned with each other on the proximal end side of the first tubular body 61 and parallel to the first tubular body 61. Is provided. The second tubular body 62 is provided on the distal end side of the first tubular body 61. That is, for the first guide wire lumen 24, a rapid exchange structure is adopted. Therefore, even if the third tubular body 63 and the fourth tubular body 64 are arranged side by side on the proximal end side of the first tubular body 61, the proximal end side of the first tubular body 61 has the first tubular body 61. The dimension in the direction (circumferential direction) perpendicular to the axis can be suppressed.

  On the other hand, as described above with reference to FIGS. 1 to 4 and FIG. 8, the third tubular body 63 and the fourth tubular body 64 are relative to the axis X <b> 1 of the second tubular body 62 on the distal end side of the first tubular body 61. It has an inclined portion and is provided at symmetrical positions on both sides when viewed from the second tubular body 62. Therefore, compared with the case where the third tubular body 63 and the fourth tubular body 64 are arranged side by side on the distal end side of the first tubular body 61 in the same manner as the proximal end side, on the distal end side of the first tubular body 61. Also, the circumferential dimension can be suppressed.

  Subsequently, as shown in FIG. 10, in a state where the third guide wire W3 is inserted into the side branch blood vessel 78 and the second guide wire W2 reaches the highly stenotic lesion 75, the shaft portion 2 is not moved within the blood vessel. The operation proximal end 31 is moved to the distal end side while being held in such a manner that the inner tube 34 is pushed most into the outer tube 32. As a result, the imaging core 4 moves to the distal end side of the image lumen 23.

  Subsequently, using an external drive device, the drive shaft 42 is moved to the proximal end side while rotating, and a pullback operation is performed. As a result, the ultrasonic transducer 411 is moved along the axial direction of the living body lumen to the proximal side of the affected part while performing radial scanning, and an image of the living tissue including the affected part can be acquired.

  According to the medical device 8 according to the present embodiment, as described above with reference to FIG. 8, the third tube body 63 and the fourth tube body 64 are on both sides between the first tube body 61 and the second tube body 62. Are disposed in the recesses (the first recess 71 and the second recess 72). Therefore, the circumferential dimension of the medical device 8 can be further suppressed.

  Further, as described above with reference to FIG. 7, the first guide wire W <b> 1 led out from the opening 244 on the proximal end side of the first guide wire lumen 24 is between the third tube body 63 and the fourth tube body 64. It arrange | positions in the formed hollow (3rd recessed part 73). Therefore, the dimension of the medical device 8 in the circumferential direction can be further suppressed on the proximal end side of the shaft portion 2.

  Further, as shown in FIGS. 3, 4, and 6, the opening 251 on the distal end side of the second guidewire lumen 25 and the opening 261 on the distal end side of the third guidewire lumen 26 are formed on the image lumen 23. The opening 231 on the distal end side (the distal end portion of the image lumen 23) is provided on the proximal end side. The opening 231 on the distal end side of the image lumen 23 corresponds to the distal end portion of the image lumen of the present invention.

  Therefore, it can be avoided that the third tube body 63 and the fourth tube body 64 overlap the window portion (imaging window) through which the ultrasonic wave passes through the first tube body 61. Thereby, the defect area | region of the image in a biological lumen can be decreased, and the information content at the time of an operator's diagnosis can be increased.

Next, a modification of the present embodiment will be described with reference to the drawings.
FIG. 11 is a plan view showing the tip portion of the shaft portion according to the first modification of the present embodiment.

  In the shaft distal end portion 21 </ b> A of the shaft portion 2 </ b> A according to the first modification, the opening portion 261 on the distal end side of the third guide wire lumen 26 is closer to the proximal end side than the opening portion 251 on the distal end side of the second guide wire lumen 25. Is provided.

  Thereby, as shown in FIG. 10, for example, the highly stenotic lesion 75 is located on the deeper side of the main blood vessel 77 (the side in the insertion direction into the body lumen) than the branching portion where the side branch blood vessel 78 branches from the main blood vessel 77. Even if it exists, the third guide wire W3 can be more reliably inserted into the side branch vessel 78 in a state where the second guide wire W2 has reached the highly stenotic lesion 75.

  Further, by confirming the positions of the opening 251 on the distal end side of the second guide wire lumen 25 and the opening 261 on the distal end side of the third guide wire lumen 26, the opening 251 on the distal end side of the second guide wire lumen 25. The opening 261 on the distal end side of the third guide wire lumen 26 can be discriminated. Accordingly, the surgeon can more accurately insert the second guide wire W2 and the third guide wire W3 used for different applications into the second guide wire lumen 25 and the third guide wire lumen 26, respectively. Can do.

FIG. 12 is a plan view illustrating a hub according to a first modification of the present embodiment.
FIG. 12 corresponds to a plan view of the hub 5A according to the first modification as viewed from the direction of the arrow A2 shown in FIG.

  In the hub 5A according to the first modification, the insertion portion 54 of the second guide wire W2 is provided on the distal end side with respect to the insertion portion 55 of the third guide wire W3. That is, the opening on the proximal end side of the second guide wire lumen 25 is provided on the distal end side with respect to the opening on the proximal end side of the third guide wire lumen 26. Specifically, in the hub casing 56A of the present modification, the axial length of the third hub base end portion 53A is longer than the axial length of the second hub base end portion 52.

  Accordingly, the surgeon confirms the positions of the opening on the proximal end side of the second guide wire lumen 25 and the opening on the proximal end side of the third guide wire lumen 26, so that the medical device 8 is in the living body lumen. Even when the second guide wire W2 and the third guide wire W3 are operated, the proximal end side opening portion of the second guide wire lumen 25 and the third guide wire lumen are disposed at the position where the second guide wire W2 and the third guide wire W3 are operated. The opening on the base end side of 26 can be discriminated. Accordingly, the surgeon can more accurately insert the second guide wire W2 and the third guide wire W3 used for different applications into the second guide wire lumen 25 and the third guide wire lumen 26, respectively. Can do.

  The insertion portion 54 of the second guide wire W2 may be provided on the proximal end side with respect to the insertion portion 55 of the third guide wire W3. That is, the position of the insertion portion 54 of the second guide wire W2 only needs to be different from the position of the insertion portion 55 of the third guide wire W3 in the insertion direction into the living body lumen. Thereby, the same effect as described with reference to FIG. 12 is obtained.

FIG. 13 is a plan view illustrating a hub according to a second modification of the present embodiment.
FIG. 13 corresponds to a plan view of the hub 5B according to the second modification as viewed from the direction of the arrow A2 shown in FIG.

  In the hub 5B according to the second modification, the insertion portion 54 of the second guide wire W2 is fixed to the operation portion 3, and is provided on the proximal end side with respect to the insertion portion 55 of the third guide wire W3. In other words, the opening on the proximal end side of the second guide wire lumen 25 is fixed to the operation portion 3 and is provided on the proximal end side with respect to the opening on the proximal end side of the third guide wire lumen 26. Specifically, the second hub base end portion 52 </ b> A is fixed to the outer tube 32 of the operation unit 3. Accordingly, the insertion portion 54 of the second guide wire W2 is fixed to the outer tube 32 of the operation portion 3 via the second hub proximal end portion 52A, and is closer to the proximal end than the insertion portion 55 of the third guide wire W3. Be placed. The hub casing 56 </ b> B of the present modification is branched into a first hub base end portion 51 and a third hub base end portion 53 on the base end side.

  As described above with reference to FIGS. 9 and 10, the second guide wire W <b> 2 is used to penetrate the highly stenotic lesion 75. The third guide wire W3 is used to support the penetration of the second guide wire W2 into the highly stenotic lesion 75. Therefore, the usage frequency of the second guide wire W2 is higher than the usage frequency of the third guide wire W3. That is, the opening on the proximal end side of the second guide wire lumen 25 into which the second guide wire W2 having a higher usage frequency than the usage frequency of the third guide wire W3 is inserted is fixed to the operation unit 3, and the third guide The proximal end side of the wire lumen 26 is provided on the base end side. Thereby, the operativity of the 2nd guide wire W2 of high use frequency can be improved.

14 and 15 are cross-sectional views showing a shaft portion according to a second modification of the present embodiment.
FIG. 14 corresponds to a cross-sectional view taken along section line C2-C2 shown in FIG. FIG. 15 corresponds to a cross-sectional view taken along section line C3-C3 shown in FIG.

  As shown in FIG. 14, the shaft base end portion 22B of the shaft portion 2B according to the second modification is provided with a third communication portion 67 that connects the second guide wire lumen 25 and the third guide wire lumen 26 to each other. It has been. One end of the third communication portion 67 is connected to the second guide wire lumen 25. The other end of the third communication portion 67 is connected to the third guide wire lumen 26. That is, the second guide wire lumen 25 communicates with the third guide wire lumen 26 via the third communication portion 67.

  As shown in FIG. 15, a first communication portion 65 that connects the first guide wire lumen 24 and the second guide wire lumen 25 to each other is provided at the shaft tip portion 21B of the shaft portion 2B according to the present modification. Yes. One end of the first communication portion 65 is connected to the first guide wire lumen 24. The other end of the first communication portion 65 is connected to the second guide wire lumen 25. That is, the first guide wire lumen 24 communicates with the second guide wire lumen 25 via the first communication portion 65.

  In addition, a second communication portion 66 that connects the first guide wire lumen 24 and the third guide wire lumen 26 to each other is provided at the shaft tip portion 21B of the shaft portion 2B according to this modification. One end of the second communication portion 66 is connected to the first guide wire lumen 24. The other end of the second communication portion 66 is connected to the third guide wire lumen 26. That is, the first guide wire lumen 24 communicates with the third guide wire lumen 26 via the second communication portion 66.

  According to this modification, when performing a priming operation to fill the medical device 8 with physiological saline, the physiological saline passes through the first communication portion 65, the second communication portion 66, and the third communication portion 67, and The first guide wire lumen 24, the second guide wire lumen 25, and the third guide wire lumen 26 are filled. Thereby, even if the 1st guidewire lumen 24, the 2nd guidewire lumen 25, and the 3rd guidewire lumen 26 are provided, it can avoid that priming operation becomes complicated.

  Further, the inner width D1 of the first communication portion 65 is narrower than the diameter of the first guide wire W1 and the diameter of the second guide wire W2. The inner width D2 of the second communication portion 66 is narrower than the diameter of the first guide wire W1 and the diameter of the third guide wire W3. The inner width D3 of the third communication portion 67 is narrower than the diameter of the second guide wire W2 and the diameter of the third guide wire W3.

  According to this, it is possible to prevent the first guide wire W1 and the second guide wire W2 from passing through the first communication portion 65. Therefore, it is possible to suppress the first guide wire W1 and the second guide wire W2 from interfering with each other. Further, it is possible to prevent the first guide wire W1 and the third guide wire W3 from passing through the second communication portion 66. Therefore, it is possible to suppress the first guide wire W1 and the third guide wire W3 from interfering with each other. Further, it is possible to prevent the second guide wire W2 and the third guide wire W3 from passing through the third communication portion 67. Therefore, it is possible to suppress the second guide wire W2 and the third guide wire W3 from interfering with each other. Thereby, the operativity of the 1st guide wire W1, the 2nd guide wire W2, and the 3rd guide wire W3 can be improved.

  The embodiment of the present invention has been described above. However, the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the claims. For example, in the above-described embodiment, the present invention is applied to an imaging diagnostic catheter used in an intravascular ultrasonic sound method (IVUS) for acquiring a diagnostic image for diagnosing a diseased site in a living body. Although the case where it applies is demonstrated, it is also possible to apply to the catheter for image diagnosis which acquires images using light, such as optical coherence tomography (OCT: Optical Coherence Tomography), and the intravascular ultrasonic diagnostic method It is possible to apply to a hybrid type (dual type) diagnostic imaging catheter that can be used for both optical coherence tomography and diagnostic methods. A part of the configuration of the above embodiment may be omitted or may be arbitrarily combined so as to be different from the above.

2, 2A, 2B ... shaft part, 3 ... operation part, 4 ... imaging core, 5, 5A, 5B ... hub, 8 ... medical device, 21, 21A, 21B ... · Shaft tip, 22, 22B ... Shaft base end, 23 ... Image lumen, 24 ... First guide wire lumen, 25 ... Second guide wire lumen, 26 ... Third Guide wire lumen, 29 ... Line contrast marker, 31 ... Operation base end, 32 ... Outer tube, 34 ... Inner tube, 37 ... Unit connector, 41 ... Vibrator unit, 42 ... Drive shaft, 43 ... Rotation stabilization coil, 51 ... First hub proximal end, 52, 52A ... Second hub proximal end, 53, 53A ... Third hub proximal end Part, 54, 55 ... insertion part, 56, 56A, 5 B ... casing for hub, 57 ... first kink protector, 61 ... first tube, 62 ... second tube, 63 ... third tube, 64 ... first 4 pipes, 65 ... 1st communication part, 66 ... 2nd communication part, 67 ... 3rd communication part, 71 ... 1st recessed part, 72 ... 2nd recessed part, 73 ... 3rd recessed part, 75 ... highly stenotic lesion, 77 ... main vessel blood vessel, 78 ... side branch vessel, 231 ... opening, 232 ... metal coil, 241 ... tip end of guide wire lumen 242 ... guide wire lumen proximal end, 243,244, 251,261 ... opening, 311 ... port, 312 ... joint, 313 ... hub side connector, 314 ... first 2 Anti-kink protector, 315 ... Stopper, 411 ... Ultrasonic Moving element, 412 ... Housing, A1, A2, A3 ... Arrow, D1, D2, D3 ... Width, W1 ... First guide wire, W2 ... Second guide wire, W3 ...・ Third guide wire, X1, X2, X3 ... axis

Claims (9)

A medical device that is inserted into a living body lumen and used for diagnosis in the living body lumen,
An imaging core having an imaging unit for acquiring an image in the living body lumen;
A first tube forming an image lumen into which the imaging core is inserted;
A second tubular body that is provided in parallel to the first tubular body on the distal end side of the first tubular body and forms a first guidewire lumen into which the first guidewire is inserted;
A third tube which is provided from the distal end side to the proximal end side of the first tube body and forms a second guide wire lumen into which the second guide wire is inserted;
A fourth tube which is provided from the distal end side to the proximal end side of the first tube body and forms a third guide wire lumen into which the third guide wire is inserted;
With
The third tubular body and the fourth tubular body are provided in parallel with each other on the proximal end side of the first tubular body and parallel to the first tubular body, and the second tubular body is disposed on the distal end side of the first tubular body. A medical device having a portion inclined with respect to an axis of the body and provided at symmetrical positions on both sides when viewed from the second tubular body. The second tubular body is arranged side by side with the first tubular body,
The third tubular body is disposed in a first recess formed between the first tubular body and the second tubular body on one side when viewed from the second tubular body,
The fourth tubular body is disposed in a second recess formed between the first tubular body and the second tubular body on the other side opposite to the one side as viewed from the second tubular body. The medical device according to claim 1.   The first guide wire led out from the opening on the proximal end side of the first guide wire lumen has the third and fourth tubes arranged side by side on the proximal end side of the first tubular body. The medical device according to claim 2, wherein the medical device is disposed in a third recess formed between the body and the body.   The opening part of the front end side of the said 2nd guide wire lumen and the said 3rd guide wire lumen was provided in the base end side rather than the front-end | tip part of the said lumen for images, The any one of Claims 1-3 characterized by the above-mentioned. The medical device according to one.   The medical device according to claim 4, wherein the opening on the distal end side of the third guide wire lumen is provided closer to the proximal end side than the opening on the distal end side of the second guide wire lumen.   One of the proximal end side opening of the second guide wire lumen and the proximal end side opening of the third guide wire lumen is the proximal end side opening of the second guide wire lumen and the third guide wire lumen. The medical device according to any one of claims 1 to 5, wherein the medical device is provided on the distal end side of any one of the openings on the proximal end side of the guide wire lumen. An operation unit connected to an external drive device for driving the imaging core and capable of operating the imaging core;
The opening on the proximal end side of the second guide wire lumen is fixed to the operation portion, and is provided closer to the proximal end than the opening on the proximal end side of the third guide wire lumen. Item 7. The medical device according to Item 6. A first communicating portion that connects the first guidewire lumen and the second guidewire lumen to each other;
A second communicating portion for connecting the first guide wire lumen and the third guide wire lumen to each other;
A third communicating portion for connecting the second guide wire lumen and the third guide wire lumen to each other;
The medical device according to any one of claims 1 to 7, further comprising: The inner width of the first communication portion is narrower than the diameters of the first guide wire and the second guide wire,
The inner width of the second communication portion is narrower than the diameters of the first guide wire and the third guide wire,
The medical device according to claim 8, wherein the inner width of the third communication portion is narrower than the diameters of the second guide wire and the third guide wire.

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