JP2019017500A - Medical equipment - Google Patents

Abstract

To provide medical equipment that enables the position of a treated biological tissue to be tracked from outside a living body.SOLUTION: Medical equipment includes: a cylindrical member having a cylinder tip part where a tip opening is formed, which partitions a hollow part whose one end is the tip opening; a puncture member located in the hollow part, which protrudes from the tip opening for puncturing the biological tissue; and a marker located in the hollow part, which can be tracked from outside. The marker can be indwelled in the biological tissue through the tip opening based on the puncture motion for casing the puncture member to protrude from the tip opening.SELECTED DRAWING: Figure 4

Description

  The present invention relates to a medical device.

  Currently, in the treatment of heart failure and the like, treatments that are expected to have a therapeutic effect by injecting biological materials such as cells or biomaterials into tissues are being studied. In such procedures, instruments such as catheters are used for tissue injection. In cell therapy using such a catheter or the like, the position of the infarct is specified by performing 3D mapping or the like on a living tissue such as a heart ventricle before the injection procedure. Thereafter, injection of cells or the like as the administration target is performed toward a desired location according to treatment such as a boundary portion between the infarct and normal myocardial tissue.

  For example, Patent Document 1 discloses a technique of embedding a traceable marker having a position specifying characteristic by being made of a radiopaque material or the like in an organ tissue.

Japanese Patent Laying-Open No. 2015-513952

  By the way, if the position of the treated living tissue can be specified from the outside of the living body, it is beneficial for the treatment. However, when treatment is performed after mapping in advance, although the position of the catheter on the 3D mapping can be grasped, it is difficult to specify the position of the biological tissue actually treated from the outside of the living body. Moreover, although the technique disclosed in Patent Document 1 discloses embedding a marker in an organ tissue, it is not a technique for embedding a marker in the vicinity of a position of a treated biological tissue.

  In view of the above problems, an object of the present disclosure is to provide a medical instrument that can track the position of a treated biological tissue from outside the living body.

  A medical instrument as one aspect of the present invention has a cylindrical tip portion in which a tip opening is formed, a cylindrical member that defines a hollow portion having the tip opening as one end, and is positioned in the hollow portion, A puncture member that protrudes from the distal end opening and is punctured into the living tissue; and a marker that is located in the hollow portion and can be traced from the outside, and the marker performs a puncture operation for projecting the puncture member from the distal end opening. Based on this, the living tissue can be placed through the tip opening.

  The medical instrument as an embodiment of the present invention is located in the hollow portion, and the puncture member moves toward the proximal end. The power in the extraction operation after the puncture operation is directed toward the living tissue by the marker. It further includes a power conversion member that converts the power to move.

  As one embodiment of the present invention, the outer surface of the puncture member is provided with a convex portion protruding radially outward, the power conversion member is rotatably fixed to the inner peripheral surface of the cylindrical member, The marker is moved by engaging and rotating with the convex portion.

  As one embodiment of the present invention, the marker is detained in the living tissue by partitioning a through-hole in which at least the puncture member after the puncture operation is penetrating and moving along the puncture member Is possible.

  As an embodiment of the present invention, the marker includes a valve body that is located in the through hole and allows insertion and removal of the puncture member.

  As one embodiment of the present invention, the marker includes a clip portion that presses and pinches the puncture member penetrating the through-hole from the radially outer side to the inner side.

  As one embodiment of the present invention, the marker includes a puncture unit, and can be placed in the biological tissue by puncturing the biological tissue.

  As one embodiment of the present invention, the marker includes a radiopaque material or includes an ultrasonic reflection unit.

  According to the medical instrument of the present disclosure, it is possible to track the position of a biological tissue that has been treated from the outside of the living body.

It is a figure showing a medical instrument as a 1st embodiment of the present invention. It is a longitudinal cross-sectional view which shows a part including the distal end of the medical device shown in FIG. It is a figure which shows the state by which the puncture member of the medical device shown in FIG. 1 was punctured by the biological tissue. It is a figure which shows the state by which the marker of the medical device shown in FIG. 1 was punctured by the biological tissue. It is a longitudinal cross-sectional view which shows a part including the distal end of the medical device as the 2nd Embodiment of this invention. It is sectional drawing which follows the AA line of FIG. It is a figure which shows the state which the puncture member has not penetrated the through-hole of the marker shown in FIG. It is a figure which shows the state by which the puncture member of the medical device shown in FIG. 5 was punctured by the biological tissue. It is a figure which shows the state by which the marker of the medical device shown in FIG. 5 was punctured by the biological tissue. It is a longitudinal cross-sectional view which shows a part containing the distal end of the medical device as the 3rd Embodiment of this invention. It is sectional drawing which follows the BB line of FIG. It is a figure which shows the state by which the puncture member of the medical device shown in FIG. 10 was punctured by the biological tissue. It is a figure which shows the state by which the marker of the medical device shown in FIG. 10 was punctured by the biological tissue. It is a figure which shows the state by which the marker of the medical device shown in FIG. 10 was detained in the biological tissue.

  Hereinafter, each aspect of the present disclosure will be described with reference to the drawings. In each figure, the same code | symbol is attached | subjected to the common member. Hereinafter, among the medical instruments 1 to 3 described later, the distal ends of the long members inserted into the body of the subject such as the puncture member 20, the catheter 30, and the tubular member 40 are referred to as “distal ends” The end is referred to as “proximal end”, the direction in which the “distal end” is located with respect to the “proximal end” is referred to as “tip side”, and the opposite direction is referred to as “base end side”.

(First embodiment)
FIG. 1 is a diagram showing a medical instrument 1 as a first embodiment of the present invention. FIG. 2 is a longitudinal sectional view showing a part including the distal end of the medical device 1. As shown in FIGS. 1 and 2, the medical device 1 includes a marker 10, a puncture member 20, a catheter 30, a tubular member 40, and a power conversion member 50. 1 and 2, the cylindrical member 40 extends from the subject's femoral artery FA through the aorta AO to the aortic valve AV which is the entrance of the left ventricle LV of the heart lumen, and the marker 10 and the puncture member 20, the catheter 30 and the power conversion member 50 are delivered to the left ventricle LV through the tubular member 40. The tubular member 40 is not limited to the subject's femoral artery FA, and may extend from the radial artery or the like of the subject's wrist to the aortic valve AV, for example.

  As shown in FIG. 2, the cylindrical member 40 has a cylindrical tip portion 41 in which a first tip opening 42 is formed, and defines a first hollow portion 43 having the first tip opening 42 as one end. . The tubular member 40 accommodates the marker 10, the puncture member 20, the catheter 30, and the power conversion member 50 in the first hollow portion 43.

  The puncture member 20 is a cylindrical member that has a puncture tip portion 21 in which a second tip opening 22 is formed, and divides a second hollow portion 23 having the second tip opening 22 as one end. On the outer surface of the puncture member 20, a convex portion 24 that protrudes radially outward is provided. The convex portion 24 includes an inclined surface 25 that is inclined with respect to the radial direction and a step surface 26 that is substantially parallel to the radial direction. The convex portion 24 is positioned at a position overlapping with an engaging portion 52 of a power conversion member 50 described later in the extending direction, for example, by an inner peripheral surface of a third hollow portion 31 of the catheter 30 described later. The puncture member 20 is located in the first hollow portion 43 of the tubular member 40, and the puncture tip portion 21 protrudes from the first tip opening 42, thereby enabling puncture of the living tissue. The puncture distal end portion 21 of the puncture member 20 is an object to be administered such as a medical solution for treating biological tissue that is accommodated in the second hollow portion 23 or supplied to the second hollow portion 23 from the proximal end side. It can be administered to the living tissue through the second tip opening 22 while being punctured into the living tissue. Hereinafter, the operation of causing the puncture member 20 to protrude from the first hollow portion 43 of the tubular member 40 is appropriately referred to as “puncture operation”. In addition, an operation after the puncturing operation, in which the puncture member 20 moves to the proximal end side, is appropriately referred to as “extraction operation”. The puncture operation and the removal operation may be performed, for example, by an operator such as a medical worker directly moving the puncture member 20 with a hand or the like, or by a motor or the like connected to the proximal end of the puncture member 20. It may be performed by operating. Examples of the material for forming the puncture member 20 include metals such as stainless steel.

  The marker 10 can be tracked from the outside. In addition, the marker 10 of this embodiment includes a puncture unit 11. The marker 10 can be placed in the living tissue by piercing the living tissue with the puncture unit 11. Specifically, the marker 10 can be placed in the living tissue through the first tip opening 42 based on the puncturing operation of the puncture member 20. The marker 10 includes an externally traceable material such as a radiopaque material. Examples of the radiopaque material include metals such as platinum, gold, silver, titanium, and tungsten, or alloys thereof (stainless steel and the like). The marker 10 is not limited to the above-described radiopaque material as long as it can be traced from the outside. Therefore, the marker 10 may have an ultrasonic reflection part having ultrasonic reflectivity. Ultrasonic reflectivity can be improved by adopting a configuration including an ultrasonic reflective material and making the marker surface a predetermined shape. The ultrasonic reflective material may be any material that can easily reflect ultrasonic waves at the interface with surrounding living tissue. For example, in addition to the specific examples of metals and alloys listed as radiopaque materials, acoustic impedance Other metals such as aluminum, iron, copper, etc., which have a relatively high density can be mentioned. Examples of the predetermined shape of the marker surface that improves the visibility by reflecting ultrasonic waves include an uneven shape formed by uneven processing on the marker surface. The marker 10 is located in the first hollow portion 43 of the tubular member 40.

  The power conversion member 50 is located in the first hollow portion 43 of the tubular member 40, and converts the power in the removal operation of the puncture member 20 into power for moving the marker 10 toward the distal-side living tissue. Specifically, the power conversion member 50 is fixed to the inner peripheral surface 44 of the tubular member 40 so as to be rotatable about the rotation shaft 51, and has an engaging portion 52 that engages with the convex portion 24 of the puncture member 20. When the puncture member 20 moves to the proximal end side, the power conversion member 50 rotates about the rotation shaft 51 and the marker 10 moves to the distal end side by engaging the engaging portion 52 and the convex portion 24 with each other. Move.

  The catheter 30 defines a third hollow portion 31 inside. The third hollow portion 31 penetrates from the proximal end to the distal end of the catheter 30. The catheter 30 houses the puncture member 20 in the third hollow portion 31.

  The material for forming the catheter 30 is preferably a material having a certain degree of flexibility, and examples thereof include metals and resins. Examples of the metal include pseudo-elastic alloys (including superelastic alloys) such as Ni-Ti alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405, SUS430, SUS434, SUS444, SUS429, SUS430F, SUS302, etc., all types of SUS), cobalt-based alloys, noble metals such as gold and platinum, tungsten-based alloys, carbon-based materials (including piano wires), and the like. Examples of the resin include polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, polyamide, polyamide. Examples thereof include polymer materials such as elastomers, polyesters, polyester elastomers, polyurethanes, polyurethane elastomers, polyimides, fluororesins, mixtures thereof, and the above two or more polymer materials. Furthermore, engineering plastics represented by polyetheretherketone can be mentioned. Moreover, it can also be comprised with the multilayer tube etc. which consist of a composite formed from these metals and resin.

  FIG. 3 is a diagram showing a state where the puncture member 20 of the medical instrument 1 is punctured into the myocardium 301 as a living tissue. In FIG. 3, the white arrow indicates the direction in which the puncture member 20 moves by the puncture operation. As shown in FIG. 3, the puncture member 20 moves to the distal end side by the puncture operation and is punctured into the myocardium 301 in a state where the distal end portion 41 of the tubular member 40 is in contact with the inner wall of the heart. When the puncture member 20 moves to the distal end side, the power conversion member 50 does not rotate. For example, the rotational direction of the power conversion member 50 is restricted to one direction (the clockwise direction in FIG. 3). Therefore, when the puncture member 20 is moved to the distal end side, the inclined surface 25 of the convex portion 24 slides with the power conversion member 50 without rotating the power conversion member 50. The medical device 1 administers an administration target such as a medicinal solution stored in the second hollow portion 23 of the puncture member 20 to the myocardium 301 through the second distal end opening 22 while the puncture member 20 is punctured into the myocardium 301. Can do.

  FIG. 4 is a diagram illustrating a state where the marker 10 of the medical device 1 is punctured into the myocardium 301 as a biological tissue. In FIG. 4, the white arrow indicates the direction in which the puncture member 20 moves by the extraction operation, the white rotation arrow indicates the direction in which the power conversion member 50 rotates, and the black arrow indicates the direction in which the marker 10 moves. As shown in FIG. 4, the puncture member 20 moves to the proximal side by the removal operation and is removed from the myocardium 301 while keeping the distal end of the tubular member 40 in contact with the inner wall of the heart. When the puncture member 20 moves to the proximal end side, the convex portion 24 engages with the engaging portion 52 of the power conversion member 50 via the step surface 26, and the power conversion member 50 is centered on the rotation shaft 51 as shown in FIG. Rotate clockwise. The power conversion member 50 moves the marker 10 to the tip side with rotation. The marker 10 moves to the distal end side and punctures the myocardium 301 with the puncture part 11. Thereafter, contact of the tubular member 40 with the myocardium 301 is released, and the puncture member 20, the catheter 30, the tubular member 40, and the power conversion member 50 are separated from the inner wall of the heart, so that the marker 10 is placed in the myocardium 301. can do.

  As described above, in the medical instrument 1 according to the present embodiment, the marker 10 can be placed in the living tissue through the first tip opening 42 based on the puncturing operation that causes the puncture member 20 to protrude from the first tip opening 42 of the tubular member 40. It becomes. Further, since the marker 10 is placed through the same first tip opening 42 as that of the puncture member 20, the marker 10 is placed within the range of the first tip opening 42 that is in the vicinity of the position treated by the puncture member 20. Therefore, according to the medical instrument 1, by tracking the marker 10, the position of the treated biological tissue can be tracked from outside the living body.

  Further, as described above, in the medical instrument 1 of the present embodiment, the power conversion member 50 converts the power for moving the puncture member 20 by the removal operation into the power for moving the marker 10 toward the living tissue. Accordingly, since the marker 10 is placed in the living tissue in conjunction with the operation of removing the puncture member 20 used for the treatment from the living tissue, the marker 10 can be placed in the living tissue without requiring a special operation.

(Second Embodiment)
FIG. 5 is a longitudinal sectional view showing a part including the distal end of the medical device 2 as the second embodiment of the present invention. As shown in FIG. 5, the medical device 2 includes a marker 10 a, a puncture member 20 a, a catheter 30, and a tubular member 40. Since the cylindrical member 40 of this embodiment is the same as the cylindrical member 40 with which the medical device 1 of 1st Embodiment is provided, description is abbreviate | omitted. 5, 8, and 9, illustration of the second tip opening 22 and the second hollow portion 23 of the puncture member 20 a is omitted for convenience of explanation.

  The puncture member 20a is the same as the puncture member 20 provided in the medical instrument 1 of the first embodiment except that the puncture member 20a is not provided.

  In addition to having the same configuration as the marker 10 included in the medical device 1 of the first embodiment, the marker 10a defines the through hole 12. The through-hole 12 is in a state where at least the puncture member 20a after the puncture operation passes therethrough. In the example shown in FIG. 5, for example, the puncture member 20 a is passed through the through-hole 12 in advance outside the body of the subject, and in this state, the marker 10 a and the puncture member 20 a are stored in the cylindrical member 40. Yes. In other words, the puncture member 20a may be previously penetrated through the through hole 12 before the puncture operation. However, the puncture member 20a may be penetrated through the through hole 12 along with the puncture operation. The marker 10a can be placed in the living tissue by being moved to the distal end side along the puncture member 20a penetrating the through hole 12. The medical instrument 2 may include a plurality of markers 10a along the extending direction of the puncture member 20a. FIG. 5 shows an example in which the medical device 2 includes five markers 10a that are connected in contact with each other.

  FIG. 6 is a cross-sectional view taken along line AA in FIG. 5 and shows a state where the puncture member 20a penetrates the through hole 12 of the marker 10a. FIG. 7 is a diagram illustrating a state where the puncture member 20a does not penetrate the through hole 12 of the marker 10a. As shown in FIGS. 6 and 7, the marker 10 a includes a valve body 13 that is located in the through hole 12 and that allows insertion and removal of the puncture member 20 a. As shown in FIG. 6, the valve body 13 holds the puncture member 20 a by elastic force when the puncture member 20 a penetrates the through hole 12. As shown in FIG. 7, the valve body 13 closes the through hole 12 when the puncture member 20 does not penetrate the through hole 12. The valve body 13 is formed of an elastic body such as a rubber material or a thermoplastic elastomer.

  As shown in FIG. 5, the catheter 30 has the same configuration as the catheter 30 included in the medical device 1 of the first embodiment. In the example shown in FIG. 5, for example, an operator such as a medical worker can move the catheter 30 directly to the distal end side by hand or the like, whereby the marker 10 a can be pushed out to the distal end side by the catheter 30. The pushing out of the marker 10a by the catheter 30 may be performed by operating the catheter 30 by a motor or the like connected to the proximal end of the catheter 30, for example.

  FIG. 8 is a diagram showing a state where the puncture member 20a of the medical instrument 2 is punctured through the inner wall of the heart muscle 301 as a biological tissue. In FIG. 8, the white arrow indicates the direction in which the puncture member 20a moves by the puncture operation. As shown in FIG. 8, the puncture member 20a is moved to the distal end side by the puncture operation and punctured into the myocardium 301 in a state where the tube tip portion 41 which is the distal end of the tubular member 40 is in contact with the inner wall of the heart. The medical instrument 2 is housed in the second hollow portion 23 (see FIG. 6) of the puncture member 20a in a state where the puncture member 20a is pierced into the myocardium 301, or is supplied to the second hollow portion 23 from the proximal end side. In addition, a substance to be administered such as a drug solution can be administered to the myocardium 301 through the second tip opening 22 (see “second tip opening 22” of “medical device 1” in FIG. 2 and the like).

  FIG. 9 is a diagram illustrating a state where the marker 10a of the medical device 2 is punctured into the myocardium 301 as a biological tissue. In FIG. 9, the white arrow indicates the direction in which the catheter 30 moves, and the black arrow indicates the direction in which the marker 10a moves. As shown in FIG. 9, the marker 10 a is pushed out to the distal end side by the catheter 30 while the puncture member 20 a is punctured into the myocardium 301. The pushed marker 10a moves to the distal end side along the puncture member 20a penetrating the through hole 12, and the puncture portion 11a is punctured into the myocardium 301. In the example shown in FIG. 9, the most proximal marker 10 a among the five markers 10 a connected by the catheter 30 is pushed to the distal end side by the catheter 30, so that the most distal marker 10 a is opened to the first distal end. 42 is pushed out and inserted into the myocardium 301. Thereafter, by moving the puncture member 20a to the proximal end side by an extraction operation, the most distal marker 10a can be placed on the myocardium 301. The valve body 13 of the marker 10a placed on the myocardium 301 closes the through hole 12 as shown in FIG. Thereby, the puncture hole 302 of the myocardium 301 formed by the puncture of the puncture member 20a is closed or reduced in diameter. Therefore, it is possible to reduce the risk of infection from the puncture hole 302 and the leakage of the administered substance such as the administered drug solution.

  As described above, in the medical instrument 2 of the present embodiment, as in the medical instrument 1 of the first embodiment, based on the puncturing operation that causes the puncture member 20a to protrude from the first tip opening 42 of the tubular member 40, the first The marker 10a can be placed in the living tissue through the one end opening 42. Therefore, similarly to the medical instrument 1 of the first embodiment, according to the medical instrument 2, by tracking the marker 10a, the position of the treated biological tissue can be traced from outside the living body. .

  Further, as described above, in the medical instrument 2 of the present embodiment, the marker 10a defines at least the through-hole 12 in which the puncture member 20a after the puncture operation is penetrating and moves along the puncture member 20a. Can be placed in a living tissue. Therefore, the marker 10a can be placed in the biological tissue with the puncture member 20 as a guide in a state where the puncture member 20a is punctured in the biological tissue.

(Third embodiment)
FIG. 10 is a longitudinal sectional view showing a part including a distal end of a medical device 3 as a third embodiment of the present invention. As shown in FIG. 10, the medical device 3 includes a marker 10 b, a puncture member 20 a, a catheter 30, and a tubular member 40. The puncture member 20a, the catheter 30, and the cylindrical member 40 of the present embodiment are the same as the puncture member 20a, the catheter 30, and the cylindrical member 40 provided in the medical device 2 of the second embodiment, respectively. Is omitted. In FIG. 10, FIG. 12, and FIG. 13, illustration of the second tip opening 22 and the second hollow portion 23 of the puncture member 20a is omitted for convenience of explanation.

  In addition to having the same configuration as the marker 10 included in the medical device 1 of the first embodiment, the marker 10b defines the through hole 12. The through-hole 12 is in a state where at least the puncture member 20a after the puncture operation passes therethrough. In the example shown in FIG. 10, for example, the puncture member 20a is previously passed through the through-hole 12 outside the body of the subject, and the marker 10b and the puncture member 20a are accommodated in the tubular member 40 in this state. Yes. In other words, the puncture member 20a may be previously penetrated through the through hole 12 before the puncture operation. However, the puncture member 20a may be penetrated through the through hole 12 along with the puncture operation. The marker 10b can be placed in the living tissue by being moved to the distal end side along the puncture member 20a penetrating the through hole 12. The medical device 3 may include a plurality of markers 10b along the extending direction of the puncture member 20a. FIG. 10 shows an example in which the medical device 3 includes three markers 10b connected in contact with each other.

  FIG. 11 is a cross-sectional view taken along line B-B in FIG. 10 and shows a state where the puncture member 20a penetrates the through hole 12 of the marker 10b. As shown in FIGS. 10 and 11, the marker 10 b includes a clip portion 14 that presses and pinches the puncture member 20 a penetrating the through hole 12 from the radially outer side of the puncture member 20 a. The clip portion 14 approaches in a natural state with a gap smaller than the diameter of the through hole 12, and in a state where the puncture member 20a penetrates the through hole 12, the gap is pushed wider than the natural state by the puncture member 20a, and the elastic force The puncture member 20 is sandwiched between them. The clip part 14 of this embodiment is comprised by the puncture part 11b.

  FIG. 12 is a diagram illustrating a state in which the puncture member 20a of the medical instrument 3 is punctured into the myocardium 301 as a biological tissue. In FIG. 12, the white arrow indicates the direction in which the puncture member 20a moves by the puncture operation. As shown in FIG. 12, the puncture member 20a is moved to the distal end side by the puncturing operation and punctured into the myocardium 301 in a state where the tube tip portion 41 which is the distal end of the cylindrical member 40 is in contact with the inner wall of the heart. The medical device 3 is housed in the second hollow portion 23 (see FIG. 11) of the puncture member 20a in a state where the puncture member 20a is punctured into the myocardium 301, or is supplied to the second hollow portion 23 from the proximal end side. In addition, a substance to be administered such as a drug solution can be administered to the myocardium 301 through the second tip opening 22 (see “second tip opening 22” of “medical device 1” in FIG. 2 and the like).

  FIG. 13 is a diagram illustrating a state where the marker 10b of the medical instrument 3 is punctured into the myocardium 301 as a biological tissue. In FIG. 13, the white arrow indicates the direction in which the catheter 30 moves, and the black arrow indicates the direction in which the marker 10b moves. As shown in FIG. 13, the marker 10 b is pushed out to the distal end side by the catheter 30 while the puncture member 20 a is punctured into the myocardium 301. The pushed marker 10b moves to the distal end side along the puncture member 20a penetrating the through-hole 12, and punctures the myocardium 301 with the puncture portion 11b. In the example shown in FIG. 13, the most proximal marker 10b among the three markers 10b connected by the catheter 30 is pushed to the distal end side by the catheter 30, so that the most distal marker 10b is opened to the first distal end. 42 is pushed out and inserted into the myocardium 301.

  FIG. 14 is a diagram illustrating a state in which the marker 10b of the medical instrument 3 is placed on the myocardium 301 as a biological tissue. In FIG. 14, a black arrow indicates a direction in which the puncture portion 11b as the clip portion 14 of the marker 10b moves. After the state shown in FIG. 13, when the puncture member 20 a moves to the proximal end side by the extraction operation, the most distal marker 10 b is placed on the myocardium 301. The puncture portion 11b as the clip portion 14 of the marker 10b placed on the myocardium 301 sandwiches the puncture hole 302 of the myocardium 301 formed by the puncture of the puncture member 20a. Thereby, the puncture hole 302 is closed or reduced in diameter. Therefore, the risk of infection from the puncture hole 302 can be reduced.

  As described above, in the medical instrument 3 of the present embodiment, the puncture member 20a is replaced with the first tip opening of the tubular member 40, as in the medical instrument 1 of the first embodiment and the medical instrument 2 of the second embodiment. The marker 10b can be placed in the living tissue through the first tip opening 42 based on the puncturing operation that protrudes from 42. Therefore, similarly to the medical instrument 1 of the first embodiment, according to the medical instrument 3, by tracking the marker 10b, the position of the treated biological tissue can be traced from outside the living body.

  Further, as described above, in the medical instrument 3 of the present embodiment, as in the medical instrument 2 of the second embodiment, the marker 10b penetrates at least the puncture member 20a after the puncture operation. The hole 12 can be demarcated and moved along the puncture member 20a to be placed in the living tissue. Therefore, the marker 10b can be placed in the biological tissue with the puncture member 20a as a guide in a state where the puncture member 20a is punctured into the biological tissue.

  The present invention is not limited to the configurations specified in the above-described embodiments, and various modifications can be made without departing from the spirit of the invention described in the claims.

  For example, in each of the above embodiments, the marker includes a puncture unit. However, the marker is not limited to a configuration including a puncture unit. For example, the marker may be placed on the surface of a biological tissue to be placed on the biological tissue. Good. However, the marker is preferably provided with a puncture part in that the marker can be firmly fixed to the living tissue.

1, 2, 3: Medical instruments 10, 10a, 10b: Markers 11, 11a, 11b: Puncture part 12: Through hole 13: Valve body 14: Clip part 20, 20a: Puncture member 21: Puncture tip part 22: Second Tip opening 23: second hollow portion 24: convex portion 25: inclined surface 26: stepped surface 30: catheter 31: third hollow portion 40: tubular member 41: tube tip portion 42: first tip opening 43: first hollow Portion 44: Inner peripheral surface 50: Power conversion member 51: Rotating shaft 52: Engagement portion 301: Myocardium (living tissue)
302: Puncture AO: Aorta AV: Aortic valve FA: Femoral artery LV: Left ventricle

Claims (8)

A cylindrical member having a cylindrical tip portion in which a tip opening is formed, and defining a hollow portion having the tip opening as one end;
A puncture member that is located in the hollow portion and protrudes from the tip opening to puncture a living tissue;
A marker located in the hollow portion and traceable from the outside,
The marker is a medical instrument that can be placed in the living tissue through the tip opening based on a puncturing operation in which the puncture member protrudes from the tip opening.   A power conversion member that is located in the hollow portion and that moves the puncture member toward the proximal end and that converts power in the removal operation after the puncture operation into power that moves the marker toward the living tissue is further provided. The medical instrument according to claim 1. The outer surface of the puncture member is provided with a convex portion protruding radially outward,
The medical device according to claim 2, wherein the power conversion member is rotatably fixed to an inner peripheral surface of the cylindrical member, and moves the marker by rotating by engaging with the convex portion.   2. The marker according to claim 1, wherein the marker can be placed in the living tissue by defining a through-hole in which the puncture member has penetrated at least after the puncture operation and moving along the puncture member. The medical device described.   The medical instrument according to claim 4, wherein the marker includes a valve body that is located in the through-hole and allows insertion and removal of the puncture member.   The said marker is a medical device of Claim 4 provided with the clip part which presses and pinches | interposes the said puncture member which penetrates the said through-hole toward the inner side from a radial direction outer side.   The medical instrument according to any one of claims 1 to 6, wherein the marker includes a puncture unit, and can be placed in the biological tissue by puncturing the biological tissue.   The medical instrument according to any one of claims 1 to 7, wherein the marker includes a radiopaque material or includes an ultrasonic reflection unit.

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