JP2019170521A - Medical care basket-shaped treatment instrument - Google Patents

Abstract

To facilitate capturing a foreign matter such as calculus.SOLUTION: A medical care basket-shaped treatment instrument comprises: an operation wire 30 to be inserted into a first lumen 22 of a catheter tube 20 so as to be movable in an axial direction; a basket part 32 which is connected to a distal end of the operation wire 30, which is contracted in the first lumen 22, and which expands when being pushed out from a basket opening 22a at a distal end of the first lumen 22; and a balloon 40 which is attached in the vicinity of the distal end of the catheter tube 20, and which is expanded by feeding of a fluid for balloon expansion to the balloon through a second lumen 24 of the catheter tube 20. The basket opening 22a is provided on an outer surface of the catheter tube 20 and on a proximal end side relative to the balloon 40.SELECTED DRAWING: Figure 4

Description

  The present invention relates to a medical basket type treatment instrument used for extracting foreign substances such as stones generated in the body.

  As a medical instrument that is used together with an endoscope and removes a calculus (for example, a gallstone) in a body lumen (for example, a bile duct), for example, a medical basket type treatment instrument disclosed in Patent Document 1 is known. This basket-type treatment instrument includes a catheter tube (sheath), an operation wire inserted in the catheter tube so as to be axially movable, a basket portion connected to a distal end portion of the operation wire, and a distal end of the catheter tube. A balloon provided in the vicinity of the end is roughly provided.

  When gallstones are removed from the body using this basket-type treatment instrument, first, the catheter tube is inserted into the bile duct from the duodenal papilla of the duodenum through the endoscope channel with the basket portion housed inside. To do. Next, after inflating the balloon to secure a space in the bile duct, by operating the operation wire from the proximal end side (outside the body), the basket portion is pushed out from the opening at the distal end of the catheter tube. Expand and take gallstones inside. Then, the gallstone can be extracted by pulling the basket portion out of the body as it is, or the gallstone can be crushed by pulling the operation wire strongly toward the proximal end side.

  However, in the conventional basket-type treatment instrument, when the expanded basket portion is pushed out in order to capture the gallstone in the bile duct, the gallstone does not enter the inside of the basket portion but is pushed by the basket portion, and the bile duct In some cases, it was difficult to capture gallstones.

JP 2006-304835 A

  This invention is made | formed in view of such a point, and it aims at providing the medical basket type treatment instrument which can capture | acquire foreign materials, such as a calculus, easily.

In order to achieve the above object, a medical basket type treatment instrument according to the present invention comprises:
A catheter tube comprising a first lumen and a second lumen;
An operation wire inserted into the first lumen of the catheter tube so as to be axially movable;
A cage connected to the distal end of the manipulation wire, contracted within the first lumen of the catheter tube, and expanded when pushed out of the basket opening at the distal end of the first lumen A basket-shaped part,
A balloon attached near the distal end of the catheter tube and inflated by feeding balloon inflation fluid through a second lumen of the catheter tube;
In the medical basket type treatment instrument, the basket opening is provided on an outer surface of the catheter tube and closer to the proximal end than the balloon.

  In the medical basket type treatment instrument according to the present invention, the opening for the basket of the first lumen of the catheter tube through which the basket portion is pushed out is provided on the outer surface of the catheter tube on the proximal end side of the balloon. Yes. For this reason, for example, when the balloon is inflated behind the target foreign matter inside the body and the basket portion is pushed out to catch the foreign matter, the foreign matter does not enter the basket portion, Even when pushed to the back side, the presence of the balloon makes it difficult for the foreign matter to escape to the back side, making it easier to enter the inside of the basket portion, and capturing the foreign matter by the basket portion becomes easier.

  In the medical basket type treatment instrument according to the present invention, the balloon may be an eccentric balloon that inflates eccentrically with respect to the central axis of the catheter tube, and the basket opening is provided on an eccentric inflating side of the eccentric balloon. it can. With such a configuration, it is possible to secure a larger space for the basket portion to expand in the body, and it becomes easier to capture foreign matters and the like by the basket portion.

  In the medical basket type treatment instrument according to the present invention, the basket opening is preferably provided within a range of 20 to 100 mm from a proximal end of the balloon. If the position of the basket opening is too close to the proximal end of the balloon, the inflated balloon may interfere with the expansion of the basket portion. In addition, if the position of the basket opening is too far from the proximal end of the balloon, the distal end of the catheter tube may not be sufficiently separated from the body wall even when the balloon is inflated. There is a possibility that the basket portion may not be sufficiently expanded by contacting the body wall before being expanded. Such a problem can be suppressed by setting the position of the basket opening within the above range.

FIG. 1 is a cross-sectional view showing a main part of a medical basket type treatment instrument according to an embodiment of the present invention. FIG. 2 is a cross-sectional view taken along the line II-II in FIG. FIG. 3 is a perspective view illustrating an example of a configuration of a basket portion of the medical basket type treatment instrument illustrated in FIG. 1. FIG. 4 is a cross-sectional view showing a state in which gallstones are captured in the basket portion of the medical basket type treatment instrument shown in FIG.

  Hereinafter, a medical basket type treatment instrument according to the present invention will be described in detail based on embodiments shown in the drawings. First, FIG. 1 and FIG. 2 will be referred to. The medical basket type treatment instrument 10 is an instrument used to remove (capture / recover) gallstones by being inserted into the bile duct mainly through an endoscope channel (treatment instrument guide tube).

  The medical basket type treatment instrument 10 includes a catheter tube 20 having an operation wire lumen 22 (first lumen) and a balloon lumen 24 (second lumen), and an operation wire lumen 22 approximately along the axial direction. An operation wire 30 that is inserted in the axial direction, a basket-like basket portion 32 connected to the distal end of the operation wire 30, and a balloon 40 attached to the outer peripheral surface of the catheter tube 20. I have.

  When the operation portion 30 is operated from the proximal end side and the basket portion 32 is pulled inward from the basket opening 22a at the distal end of the operation wire lumen 22, the crease, the bent portion, and the like constituting the basket portion 32 are formed. By forcibly extending each of the plurality of wires, the basket portion of the basket portion 32 contracts and is accommodated in the operation wire lumen 22. In addition, when the basket portion 32 is pushed out of the basket wire opening 22a of the operation wire lumen 22 by operating the operation wire 30 from that state, the shape before being pulled in due to the shape recoverability of each wire constituting the basket portion 32. It is comprised so that it may expand.

  The catheter tube 20 is a tube made of a flexible material, and includes a distal end portion that is an end portion to be inserted into the body endoscopically and a proximal end portion that is disposed outside the body. And have. The catheter tube 20 includes a manipulation wire lumen 22 that is a lumen having a relatively large cross-sectional area and a balloon lumen 24 that is a lumen having a relatively small cross-sectional area along the central axis direction. It is a tubular body having a guide wire lumen 26 having a large cross-sectional area and a contrast medium lumen 28 having a relatively small cross-sectional area. Although not shown, a connector hub described later is connected to the proximal ends of the lumens 22, 24, 26, and 28. FIG. 1 is a cross-sectional view showing the main part of the medical basket type treatment instrument 10 of the present embodiment, but it is not actually present on the same axial cross section of the catheter tube 20 for convenience of explanation. The lumens 22, 24, 26, and 28 are shown on the same axial cross section, and the actual positional relationship of the lumens 22, 24, 26, and 28 in the catheter tube 20 is shown in the radial cross sectional view of FIG. It is as follows.

  The operation wire lumen 22 is a lumen through which the operation wire 30 is inserted. The balloon lumen 24 is a lumen used as a flow path for sending a balloon inflation fluid for inflating the balloon 40 from the proximal end side of the catheter tube 20 into the balloon 40. The guide wire lumen 26 is a lumen through which the guide wire is slidably inserted when the catheter tube 20 is inserted into the body along the guide wire (not shown). The contrast medium lumen 28 is a lumen used as a contrast medium channel when performing X-ray contrast in the bile duct for the purpose of confirming the position of the gallstone.

  The operation wire lumen 22 is a lumen that penetrates from the proximal end of the catheter tube 20 to the basket opening 22 a provided on the side surface of the catheter tube 20 on the distal end side. The basket opening 22 a is formed so as to be located closer to the proximal end than the proximal end of the balloon 40. The operation wire lumen 22 is substantially parallel to the central axis of the catheter tube 20 from the proximal end thereof to the vicinity of the basket opening 22a, and in the vicinity of the basket opening 22a with respect to the central axis of the catheter tube 20. It is curved so as to be inclined and opens to the side surface (outer wall) of the catheter tube 20. The angle θ of the central axis of the basket wire opening 22a of the operation wire lumen 22 with respect to the central axis of the catheter tube 20 is preferably set in the range of 10 to 90 °.

  In the present embodiment, the balloon 40 described in detail later is an eccentric balloon that expands eccentrically with respect to the central axis of the catheter tube 20, and the basket opening 22 a is provided on the side of the balloon 40 that expands eccentrically. More specifically, circumferential positions of a maximum bulge portion of the balloon 40, which will be described later, and the basket opening 22a are substantially matched. With this configuration, when the balloon 40 is inflated, the basket opening 22a can be easily moved away from the bile duct wall and the like, so that a relatively wide space can be defined in the portion. The portion 32 can be easily expanded and the gallstones can be easily captured.

  The distance (dimension) L from the proximal end of the balloon 40 of the basket opening 22a is preferably in the range of 20 to 100 mm. If the position of the basket opening 22 a is too close to the proximal end of the balloon 40, the inflated balloon 40 may interfere with the expansion of the basket portion 32. If the position of the basket opening 22a is too far from the proximal end of the balloon 40, the distal end of the catheter tube 20 may not be sufficiently separated from the bile duct wall even when the balloon 40 is inflated. There is a possibility that the basket portion 32 may not be sufficiently expanded by contacting the bile duct wall before the basket portion 32 is sufficiently expanded. Such a problem can be suppressed by setting the position of the basket opening 22a within the above range.

  The balloon lumen 24 is a lumen that penetrates from the proximal end of the catheter tube 20 to the balloon inflation opening 24 a provided on the side surface of the catheter tube 20. The guide wire lumen 26 is a lumen that penetrates from the proximal end of the catheter tube 20 to the guide wire opening 26 a that opens from the proximal end to the distal end. The contrast agent lumen 28 is a lumen that penetrates from the proximal end of the catheter tube 20 to the contrast agent opening 28 a provided on the side surface of the catheter tube 20. In this embodiment, the contrast agent opening 28a is provided on the proximal end side of the balloon 40 and on the distal end side of the basket opening 22a. However, the present invention is not limited to this, and the contrast agent opening 28 a may be provided on the distal end side of the balloon 40.

  The outer diameter of the catheter tube 20 is not particularly limited, but is usually 0.5 to 3.0 mm, and the length of the catheter tube 20 is not particularly limited, but is usually 500 to 2500 mm.

The operation wire lumen 22 of the catheter tube 20 is preferably circular in cross section, like the cross section of a general operation wire 30, and the cross sectional area is preferably 0.2 to 1.2 mm ^2. . The balloon lumen 24 is not particularly limited in cross-sectional shape, and the cross-sectional area is usually 0.03 to 0.3 mm ² . The guide wire lumen 26 preferably has a circular cross-sectional shape similar to that of a general guide wire, and the cross-sectional area is preferably 0.2 to 1.2 mm ² . The cross-sectional shape of the contrast agent lumen 28 is not particularly limited, and the cross-sectional area is usually 0.08 to 0.8 mm ² . In the catheter tube 20, the guide wire lumen 26 and / or the contrast medium lumen 28 may be omitted depending on circumstances, and other lumens having functions other than those described above can be formed. .

  In the present embodiment, the catheter tube 20 is formed of a multi-lumen tube in which a plurality of lumens 22, 24, 26, and 28 are arranged inside a single linear member. However, the catheter tube 20 may be configured by combining a plurality of tubes. In this case, another tube may be inserted into one tube, or a plurality of tubes may be adjacent to each other without being inserted.

  The material of the catheter tube 20 is not particularly limited as long as it is a flexible material, but is preferably a polymer material, and particularly preferably a polyamide resin, a polyamide-based elastomer, or a fluororesin. The catheter tube 20 may be made of resin and reinforcing metal. Examples of the form in which the catheter tube 20 is reinforced with metal include a coil tube and a blade tube.

  The balloon 40 is attached to the distal end portion of the catheter tube 20 so as to cover the balloon inflation opening 24a. In this embodiment, the balloon 40 is made of a stretchable material, and is inflated by introducing a fluid into the inside through the balloon lumen 24 of the catheter tube 20. It is also possible to remove gallstones from the bile duct by scraping or pushing out the gallstones by the inflated balloon 40.

  The stretchable material forming the balloon 40 is preferably one having a 100% modulus (measured in accordance with JIS K 6251) of 0.1 to 10 MPa, particularly preferably 1 to 5 MPa. If the 100% modulus is too small, the strength of the balloon 40 may be insufficient, and if it is too large, the balloon 40 may not be expanded to a sufficient size. Specific examples of the stretchable material suitable for forming the balloon 40 include natural rubber, silicone rubber, polyurethane elastomer, and the like.

  When the balloon 40 is deflated, the balloon 40 has a tubular shape as a whole, and joint portions 40a and 40b to be joined to the outer peripheral surface of the catheter tube 20 are formed at both ends thereof. The shape of the joint portions 40a and 40b located at both ends of the inflatable portion 40c of the balloon 40 is not particularly limited as long as it can be joined to the distal end portion of the catheter tube 20, but is preferably cylindrical. When the joint portions 40a and 40b of the balloon 40 are cylindrical, the inner diameter is preferably substantially equal to the outer diameter of the catheter tube 20, and the length is preferably 0.5 to 5 mm. Further, the thickness of the joint portions 40a and 40b of the balloon 40 is not particularly limited, and may be substantially equal to the inflatable portion 40c, for example. In addition, the method of joining the joining parts 40a and 40b of the balloon 40 and the distal end part of the catheter tube 20 is not particularly limited, and for example, bonding with an adhesive, thermal fusion, welding with a solvent, ultrasonic welding, and the like. Can be mentioned.

  In the balloon 40, an inflatable portion 40c that is inflated by introducing a fluid into the internal space 40d is formed between the joint portions 40a and 40b. In FIG. 1, an inflated balloon 40 is shown.

  The inflated portion 40c of the balloon 40 preferably has a maximum outer diameter in the inflated state of 200 to 1500% of the outer diameter in the deflated state. If this ratio is too small, the balloon 40 may not expand to a sufficient size, and if it is too large, the balloon 40 may become an obstacle when the catheter tube 20 is inserted into the body. Further, the length of the inflatable portion 40c in the balloon 40 (the length along the axial direction of the catheter tube 20) is preferably 5 to 20 mm, and the wall thickness is preferably 0.10 to 0.50 mm. The wall thickness of the balloon 40 is preferably uniform along the circumferential direction.

  In the present embodiment, an expansion regulating member 40e is provided as an eccentric expansion means provided at a part in the circumferential direction of the balloon 40 so that the expansion portion 40c expands eccentrically with respect to the central axis of the catheter tube 20. The expansion regulating member 40e is an elongated member made of a material having a higher elastic modulus than the material constituting the balloon 40 (i.e., hardly stretched), and the entire side surface of the balloon 40 in the membrane of the balloon 40 along the longitudinal direction thereof. Are buried in an integrally joined state. When the fluid is introduced into the balloon 40 by the expansion restriction member 40e, the balloon 40 is restricted from being expanded at a portion where the expansion restriction member 40e is embedded, and is decentered with respect to the central axis of the catheter tube 20. Then, it expands so as to have the maximum bulge portion on the opposite side of the expansion regulating member 40e.

  The material constituting the expansion regulating member 40e is not particularly limited as long as it has a higher elastic modulus than the material constituting the balloon 40. For example, a polymer material such as polyethylene, polypropylene, polyamide, polyacetal, polyetheretherketone, Or metals, such as iron, stainless steel, gold | metal | money, platinum, a tantalum, tungsten, nickel titanium alloy, can be mentioned. Further, the shape of the expansion regulating member 40e is not particularly limited, and examples thereof include a rod shape, a thread shape, a stranded wire shape, and a plate shape.

  In the present embodiment, an expansion regulating member 40e is embedded in the balloon 40 so as to be located on the substantially opposite side to the position where the basket opening 22a is provided in the circumferential direction of the catheter tube 20. Therefore, when a fluid is introduced into the balloon 40, the balloon 40 is inflated so as to have a maximum bulge portion on substantially the same side as the circumferential position of the basket opening 22a. By substantially matching the circumferential position of the maximum bulge portion of the balloon 40 and the basket opening 22a, the basket opening 22a can be easily moved away from the bile duct wall when the balloon 40 is inflated. Sufficient space can be defined to expand, and gallstones can be easily captured.

  Since the expansion regulating member 40e is embedded in a state of being integrally joined to the membrane of the balloon 40, the expansion portion 40c of the balloon 40 is offset with respect to the central axis of the catheter tube 20 as shown in FIG. It expands with a heart. The eccentric amount of the expansion center of the expansion portion 40c with respect to the central axis of the catheter tube 20 is preferably 50 to 100%, more preferably 75 to 100%, with respect to the expansion radius of the expansion portion 40c. Note that the balloon 40 does not need to be completely inflated in a radial cross section, and may be inflated into an elliptical shape or other shapes.

  The maximum expansion diameter of the balloon 40 is preferably 12 mm or more, and more preferably 18 mm or more. When the balloon 40 is inflated only to an outer diameter of 12 mm or less, the distal end portion of the catheter tube 20 (the portion near the proximal end side of the balloon 40) is separated from the bile duct wall even when the balloon 40 is inflated. There is a possibility that the basket portion 32 may not be sufficiently separated. As a result, the basket portion 32 may not be sufficiently expanded by contacting the bile duct wall before the basket portion 32 is sufficiently expanded.

  The method for manufacturing the balloon 40 is not particularly limited, and a known method may be used as a method for forming the stretchable material. For example, a dipping method may be used. Further, the eccentric inflating means for decentering the balloon 40 is not limited to the above-described expansion regulating member 40e, and may be one that adheres a tape member to the surface of the balloon.

  In the medical basket type treatment instrument 10 of the present embodiment, the balloon 40 is inflated after the catheter tube 20 is inserted into the bile duct, whereby the distal end of the catheter tube 20 (near the proximal end side of the balloon 40). Can be located away from the bile duct wall. Therefore, by operating the operation wire 30 in this state, the basket portion 32 is pushed out from the basket opening 22a of the operation wire lumen 22, and the basket portion 32 is expanded, so that the basket portion 32 is completely expanded. As a result, it is easy to sufficiently expand the basket portion 32.

  As shown in FIG. 3, the basket portion 32 is formed of four wires (wires) 33, and the distal end portion of the wire 33 is bound by a tip tip 34. Further, the proximal end portion of the wire 33 is bundled at the bundling portion 37 by a welding method such as silver soldering or caulking, and is joined to the operation wire 30 at the bundling portion 37.

  Each wire 33 includes a wire 33 constituting the basket portion 32 so as to bulge out elastically outward in the radial direction in a state where the wire 33 protrudes from the basket opening 22 a at the distal end of the operation wire lumen 22 of the catheter tube 20. An inner bent portion 35 and an outer bent portion 36 are formed, and the entire wire 33 is formed in a basket-like basket portion 32. As a result, the gallstone 50 can be captured in the basket portion 32 through the gap between the wires 33 as shown in FIG. The basket portion 32 can be elastically deformed so as to contract in a state where the basket portion 32 is pulled into the operation wire lumen 22.

  The operation wire 30 may be configured by extending the wire 33 configuring the basket portion 32 in the longitudinal direction, but may be configured by a completely different wire from these wires 33. The operation wire 30 transmits an operation force acting on the proximal end side thereof to the basket portion 32, and the basket portion 32 stored in a contracted state in the operation wire lumen 22 of the catheter tube 20 is moved away from the operation wire lumen 22. It has such a rigidity that it can be sent out from the basket opening 22a at the rear end.

  The wire 33 and the operation wire 30 which comprise the basket part 32 are comprised, for example with the metal wire whose wire diameter is 0.1 mm-1.5 mm. Examples of the material of these wires include nickel titanium alloy, stainless steel, gold, silver, platinum, nickel, iron, titanium, aluminum, tin, zinc, and tungsten. Moreover, the number of the wires 33 for constituting the basket portion 32 is not particularly limited, but is preferably 2 to 10 wires.

  A joint pipe (not shown) is joined to the proximal end portion of the operation wire 30 by means such as welding so as to cover the operation wire 30. The joining pipe is made of stainless steel or the like, and has a function of increasing the rigidity of the operation wire 30 and facilitating the operation of the basket portion 32 via the operation wire 30.

  A connector hub (not shown) is connected to the proximal end of the catheter tube 20. The connector hub is a member having a lumen, and has four openings (an operation wire insertion port, a contrast medium injection port, a guide wire insertion port, and a balloon inflation fluid injection port) that communicate the lumen with the outside. Yes. The operation wire insertion port communicates with the operation wire lumen 22 of the catheter tube 20, and the contrast agent injection port communicates with the contrast agent lumen 28 of the catheter tube 20. The guide wire insertion port communicates with the guide wire lumen 26, and the balloon inflation fluid injection port communicates with the balloon lumen 24.

  The operation wire insertion port of the connector hub is used as an inlet for guiding the operation wire 30 to the operation wire lumen 22 of the catheter tube 20. The contrast agent injection port of the connector hub is used as an injection port for feeding the contrast agent into the bile duct when performing fluoroscopy to confirm the position of the gallstone in the bile duct. The contrast medium injected from the contrast medium injection port is released into the bile duct from the contrast medium opening 28a via the contrast medium lumen 28 of the catheter tube 20. The balloon inflation fluid inlet of the connector hub is used as an inlet for sending a balloon inflation fluid for inflating the balloon 40 into the balloon 40. A fluid such as air is injected into the balloon inflation fluid inlet through, for example, a syringe, and the fluid is sent into the balloon 40 through the balloon lumen 24 and the balloon inflation opening 24a of the catheter tube 20. It is.

  The material used to form the connector hub is not particularly limited, but is preferably selected so that the connector hub has higher rigidity than the catheter tube 20, for example, a thermoplastic resin such as polycarbonate, polyamide, polysulfone, or polyacrylate. Or it forms with metals, such as stainless steel. Further, the connector hub is preferably formed in a shape and size that can be easily grasped by an operator with one hand.

  Next, as an example of a method of using the medical basket type treatment instrument 10 according to the present embodiment, when the medical basket type treatment instrument 10 is inserted into a bile duct through an endoscope channel and a gallstone is removed. Will be described with reference to FIG. FIG. 4 is a cross-sectional view showing a state in which gallstones are captured by the basket portion 32 of the medical basket type treatment instrument 10, but for convenience of explanation, the catheter tube 20 is actually in the same axial direction. Lumens 22, 24, 26, and 28 that do not exist on the cross section are shown on the same axial cross section.

  First, an endoscope used for inserting the medical basket type treatment instrument 10 into the body is inserted to the vicinity of the duodenal papilla inside the patient's duodenum. Next, the catheter tube 20 of the medical basket type treatment instrument 10 is inserted into the endoscope channel from the proximal end side of the endoscope. At this time, the balloon 40 of the medical basket type treatment instrument 10 is in a deflated state, and the basket portion 32 is in a state of being housed in the operation wire lumen 22.

  When the distal end side portion of the catheter tube 20 of the medical basket type treatment instrument 10 protrudes from the opening on the distal end side of the endoscope channel, the portion is inserted into the nipple, Insert into the bile duct 52. The nipple may be expanded in advance using a balloon catheter or the like as necessary. The catheter tube 20 is further inserted (advanced) to a certain position in the bile duct 52, and then the contrast agent is passed through the contrast agent lumen 28 of the catheter tube 20 from the contrast agent inlet into the bile duct 52 as necessary. Then, the inside of the bile duct 52 is observed by X-ray fluoroscopy, and the position of the distal end of the catheter tube 20 is adjusted so that the balloon 40 is located behind the gallstone 50.

  Next, air is fed into the balloon 40 through the balloon lumen 24 of the catheter tube 20 from the balloon inflation fluid inlet, until the entire circumference of the balloon 40 comes into contact with the inner wall of the bile duct 52 (approximately 16 mm in outer diameter). Inflated to the extent that By inflating the balloon 40 in this way, the distal end portion of the catheter tube 20 is positioned substantially along the portion of one side (opposite side 52b where the gallstone 50 is present) 52a of the inner wall of the bile duct 52, It will be in the state away from the other side (side where the gallstone 50 exists) 52b of the inner wall of the bile duct 52.

  When the balloon 40 is inflated, the operation wire 30 is operated to feed the operation wire 30 to the distal end side, thereby causing the basket portion 32 to pop out from the basket opening 22 a of the operation wire lumen 22. Thereby, the basket part 32 is expanded.

  In the basket-type treatment instrument 10 of the present embodiment, the balloon 40 is inflated so that the distal end of the catheter tube 20 is substantially along the one side 52a of the inner wall of the bile duct 52 and away from the other side 52b. It can be made. For this reason, a relatively wide space S can be defined on the proximal end side of the balloon 40 of the bile duct 52, and it is difficult to contact the inner wall of the bile duct 52 until the basket portion 32 is completely expanded. It is easy to sufficiently expand the basket portion 32.

  When the fully expanded basket portion 32 is further pushed out in order to capture the gallstone 50, the balloon inflating portion 40c exists on the back side of the gallstone 50. It becomes easy to enter the inside of the basket part 32 without being pushed by 32 and escaping to the back side, and the gallstone 50 can be easily and reliably captured.

  When the gallstone 50 is captured by the basket portion 32, the fluid is discharged through the balloon lumen 24, the balloon 40 is deflated, and the catheter tube 20 including the basket portion 32 that has captured the gallstone 50 is entirely removed from the bile duct 52. By pulling out, the gallstone 50 is collected.

  The medical basket type treatment instrument 10 of the above-described embodiment is mainly used through an endoscope channel, and is configured for the purpose of extracting a gallstone in a relatively small bile duct. It may be configured for the purpose of extracting foreign matters such as calculus generated in the portion, and the configuration may be changed according to the purpose. Moreover, you may comprise as what aims at crushing foreign materials, such as a comparatively big stone. Furthermore, it does not necessarily have to be used via a channel of an endoscope, and may be used by being inserted directly into the body percutaneously, for example.

  The configuration of the basket portion 32 is not limited to that described above, and a basket portion configured by combining a plurality of wires formed in a substantially spiral shape as disclosed in, for example, Japanese Patent Application Laid-Open No. 2005-2195. The basket portion may have other configurations.

  In the above-described embodiment, the basket opening 22 a is provided on the side surface of the catheter tube 20, but may be provided on the outer side surface of the catheter tube 20 other than the side surface as long as it is closer to the proximal end side than the balloon 40. . Specifically, the portion of the catheter tube 20 on the extension line of the operation wire lumen 22 is cut out at a portion on the distal end side of the basket opening 22a of the catheter tube 20 in the above-described embodiment. A step surface may be formed in the basket, and a basket opening 22a may be provided on the step surface.

  In the above-described embodiment, the balloon 40 is formed of a stretchable material, but the balloon 40 may be formed of a non-stretchable material. When the balloon 40 is formed of a non-stretchable material, the membrane of the balloon 40 before being inflated is folded so as to form a plurality of vanes, and the vanes are wound around the catheter tube 20 to form a medical basket type. The treatment instrument 10 may be inserted into an endoscope channel or the like. Examples of the non-stretchable material used when the balloon 40 is formed of a non-stretchable material include non-stretchable thermoplastic resins such as polyethylene, polypropylene, polyamide, and polyamide elastomer.

  Furthermore, in the above-described embodiment, the eccentric balloon that is eccentric and inflated with respect to the central axis of the catheter tube 20 is illustrated as the balloon 40. However, the eccentric balloon can define a relatively large space for expanding the basket portion 32 in the bile duct 52, and when the gallstone 50 is captured by the basket portion 32, the gallstone 50 is in the bile duct 52. It is advantageous because it can be more effectively suppressed from escaping to the back side.

  The embodiment described above is described for facilitating understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

DESCRIPTION OF SYMBOLS 10 ... Medical basket type treatment instrument 20 ... Catheter tube 22 ... Operation wire lumen (1st lumen)
22a ... Basket opening 24 ... Balloon lumen (second lumen)
24a ... Balloon inflation opening 26 ... Guide wire lumen 26a ... Guide wire opening 28 ... Contrast medium lumen 28a ... Contrast medium opening 30 ... Operation wire 32 ... Basket section 40 ... Balloon 50 ... Gallstones (foreign substances such as stones)
52 ... Bile duct

Claims (3)

A catheter tube comprising a first lumen and a second lumen;
An operation wire inserted into the first lumen of the catheter tube so as to be axially movable;
A cage connected to the distal end of the manipulation wire, contracted within the first lumen of the catheter tube, and expanded when pushed out of the basket opening at the distal end of the first lumen A basket-shaped part,
A balloon attached near the distal end of the catheter tube and inflated by feeding balloon inflation fluid through a second lumen of the catheter tube;
A medical basket-type treatment instrument in which the basket opening is provided on the outer surface of the catheter tube and closer to the proximal end than the balloon.   2. The medical basket type treatment instrument according to claim 1, wherein the balloon is an eccentric balloon that is eccentrically inflated with respect to a central axis of the catheter tube, and the basket opening is provided on an eccentric inflating side of the eccentric balloon.   The medical basket type treatment instrument according to claim 1 or 2, wherein the basket opening is provided in a range of 20 to 100 mm from a proximal end of the balloon.

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