JP2020036663A - Guide wire insertion means - Google Patents

Abstract

To provide guide wire insertion means capable of smoothly moving a flexible sheath along a guide wire and inserting the same into a bile duct easily.SOLUTION: Guide wire insertion means 70 comprises: a hollow tip end tip fitting part 70a to which an end tip 6 is fitted; and a guide wire insertion part 70b which is formed in a hollow cylindrical shape with a smaller outer diameter than that of the tip end tip fitting part 70a and protrudes to a tip end side relative to the tip 6. The guide wire insertion part 70b comprises a hole 70c for inserting the guide wire 9 on a base end side peripheral face, and a groove 70d for passing the guide wire 9 into a tip end side peripheral face at a symmetrical position with respect to the hole 70c in a peripheral direction. The guide wire 9 is linearly passed through toward the groove 70d from the hole 70c.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a guide wire insertion means to be inserted into a body cavity and to be attached to a treatment device for a basket type endoscope having a basket type treatment portion used for collecting and crushing foreign substances such as stones in the body cavity.

  Generally, in order to remove a biliary calculus or the like, a basket-type endoscope treatment tool that is inserted through an endoscope channel, protrudes from the end of the endoscope, and collects or crushes foreign matter is used. In this basket-type endoscope treatment tool, a retractable basket-shaped basket portion provided at the distal end of the operation wire is inserted into the flexible sheath together with the operation wire, and connected to the rear end of the flexible sheath. By operating the operation unit, the operation wire is pushed to project the basket portion from the distal end of the flexible sheath, and the calculus is taken into the basket portion in a state where the basket portion is expanded. It is crushed or collected by grasping. Some of the basket type endoscope treatment tools use a guide wire for guiding insertion of a flexible sheath into a bile duct in a papilla of the duodenum, for example. Patent Documents 1 and 2 listed below describe techniques relating to a treatment device for a basket-type endoscope using such a guide wire.

  Patent Literature 1 discloses a flexible sheath in which a main lumen capable of exposing and retracting a distal end of a treatment instrument main body from a distal end side opening is provided. A fixed portion that is fixed and has a length of 3 to 30 mm; and a free portion that extends from the fixed portion to the proximal end side and is not fixed to the flexible sheath but can be separated from the flexible sheath. And a guide wire tube having a guide wire lumen formed therein, which is capable of exposing and retracting the distal end of the guide wire from the distal end side opening, wherein the main lumen of the treatment instrument main body is a guide wire. A treatment device for a basket-type endoscope is described which prevents the guide wire and the treatment device main body from interfering with each other by being separated from the lumen.

  In Patent Literature 2, a basket portion is connected to a distal end portion of an operation wire which is inserted into a long and thin sheath so as to be able to advance and retreat, and a distal tip is fixed to a distal end portion of the basket portion. By providing a guide wire insertion hole communicating with the outer peripheral surface, the guide wire does not cross the inside of the expanded basket portion, and the calculus is easily taken into the basket. A treatment tool is described.

JP 2014-30492 A JP 2011-19937 A

  In the treatment device for a basket-type endoscope described in Patent Document 1 described above, the main lumen and the guide wire lumen of the flexible sheath, which are separated at the free portion, are fixed to the fixing portion at the distal end of the flexible sheath. In this case, the guide wire is bent in the fixed portion of the guide wire lumen of the flexible sheath and projects parallel to the flexible sheath toward the distal end. When a flexible sheath is inserted into a bile duct, the rigid guide wire is pressed against the inner wall of the fixed portion of the guide wire lumen, so that the flexible sheath is difficult to move smoothly and it is difficult to insert the flexible sheath into the bile duct. was there.

  Further, the treatment tool for a basket-type endoscope described in Patent Document 2 has a distal tip provided with a guide wire insertion hole communicating between the front surface of the distal tip and the outer peripheral surface. Also on the operation unit side, the guide wire that has been separated from the distal tip is bent inside the guide wire passage hole, and protrudes from the distal end of the distal tip coaxially with the flexible sheath, and along the guide wire When inserting the flexible sheath into the bile duct, the resistance of the rigid guide wire being bent and pressed against the inner wall of the distal tip makes it difficult for the flexible sheath to move smoothly, making insertion into the bile duct difficult. There were challenges.

  As shown in FIG. 5, the treatment of the treatment device for a basket-type endoscope using a guide wire is performed by a doctor pulling the operation wire to draw the basket portion 4 at the distal end into the inside to reduce the diameter and guide the treatment. The flexible sheath 2 with the wire 9 protruding is positioned near the papilla 210 of the duodenum as shown in FIG. 5A, the guide wire 9 is inserted into the bile duct 22 in the papilla 210, and then FIG. As shown in b), the flexible sheath 2 is inserted into the bile duct 22 while being guided by the guide wire 9, and the operation wire is pushed out while the tip is moved to a position above the calculus 230, and the basket portion 4 is protruded and opened. Then, as shown in FIG. 5C, the guide wire 9 is pulled into the flexible sheath 2 and then the operation wire is pulled in to capture the calculus 230 in the gap between the basket portions 4, and the basket portion 4 is moved to the flexible sheath 2. Within And the calculus 230 is crushed by tightening, or the basket portion 4 at the distal end in a state where the calculus 230 is captured is pulled to a position in contact with the flexible sheath 2, and the flexible sheath 2 in this state is outside the bile duct 22. To collect the calculus 230.

  SUMMARY OF THE INVENTION An object of the present invention is to solve such a problem caused by the conventional technique, and it is possible to smoothly guide a flexible sheath and a basket portion along a guide wire and to easily insert the flexible sheath and a basket into a bile duct in a nipple. The purpose of the present invention is to provide a guide wire insertion means that can perform the above operation.

  In order to achieve the above object, the present invention provides a long cylindrical flexible sheath, an operation wire that is inserted into the cylinder of the flexible sheath so as to be able to advance and retreat, and a rear end of a tip end of the operation wire. A basket portion formed of a plurality of basket wires connected to the tip and formed so as to elastically reduce or expand in diameter in a state where the tip is connected to the tip tip, and guiding the basket portion by a guide wire Guide wire insertion means for a treatment tool for a type endoscope, wherein the guide wire insertion means has a distal tip fitting portion into which the distal tip is fitted, and an outer diameter smaller than the distal tip fitting portion. It has a guide wire insertion portion projecting more distally than the tip, and the guide wire insertion portion has an insertion space in which the guide wire is inclined with respect to the center axis of the distal tip and inserted linearly. , Insertion through space, the first being formed toward the side surface of the distal end side from the guide wire insertion portion proximal end side of the side surface of the.

  Further, the present invention provides a long cylindrical flexible sheath, an operation wire that is inserted into the cylinder of the flexible sheath so as to be able to advance and retreat, and a terminus connected to a rear end tip of the operation wire tip, A basket portion made up of a plurality of basket wires formed so as to elastically contract or expand in a state where the distal end is connected to the distal end tip, and for guiding the basket portion by a guide wire. A guide wire insertion means for a treatment tool, wherein the guide wire insertion means is a hollow tip fitting portion into which the tip is fitted, and a hollow cylindrical and smaller outer diameter than the tip fitting portion. A guide wire insertion portion projecting to the distal end side from the distal end tip, wherein the guide wire insertion portion has a hole for inserting the guide wire into the base end side peripheral surface, and a circumferential symmetry with the hole. A groove for passing the guide wire on the distal end side peripheral surface of the device, wherein the guide wire is linearly penetrated from the hole toward the groove, A third feature is that a step is formed by a diameter difference between the tip wire and the guide wire insertion portion, and a line connecting a base bottom portion of the hole and a base bottom portion of the groove is formed with respect to a center axis of the tip. A fourth feature is that the angle is set in a range inclined from 10 degrees to 45 degrees.

  Further, in the present invention, the distal tip has a narrow portion on the proximal end side and a hemispherical portion on the distal end side, and the guide wire insertion means includes a heat-shrinkable tube, the hemispherical portion of the distal tip, The fifth feature is that the center line of the insertion space is inclined by 10 degrees to 45 degrees with respect to the center axis of the distal end tip. A sixth feature is to set the range to be set.

  The guide wire insertion means according to the present invention has a distal tip fitting portion into which the distal tip is fitted, and a guide wire inserting portion having a smaller outer diameter than the distal tip fitting portion and protruding more distally than the distal tip. The guide wire insertion portion includes an insertion space in which the guide wire is inclined with respect to the center axis of the distal end tip and linearly inserts the guide wire, and the insertion space is extended from the side surface on the proximal end side of the guide wire insertion portion to the distal end. Due to the formation toward the side surface, the flexible sheath can be smoothly moved along the guide wire and easily inserted into the bile duct in the papilla.

The figure which shows the whole structure of the treatment tool for basket type endoscopes provided with the guide wire insertion means by this invention. FIG. 3 is a view for explaining a guide wire insertion unit according to the first embodiment of the present invention. FIG. 3 is a view for explaining a guide wire insertion unit according to the first embodiment of the present invention. FIG. 6 is a view for explaining a guide wire insertion unit according to a second embodiment of the present invention. The figure for demonstrating the subject of the treatment tool for basket-type endoscopes provided with the guide wire insertion means by this invention.

  Hereinafter, embodiments of a guide wire insertion means and a basket type endoscope treatment tool provided with the guide wire insertion means according to the present invention will be described in detail with reference to the drawings. In this embodiment, the side on which the basket portion on the left side in FIG. 1 is located is referred to as the distal end side, and the side on which the operating section on the right side is located is referred to as the proximal end side.

[Example 1]
[Basic configuration]
First, as shown in FIG. 1, an overall configuration of a basket-type endoscope treatment tool provided with a guide wire insertion means according to a first embodiment of the present invention includes an elongated flexible sheath 2 and a flexible sheath 2. , A cylindrical tip metal fitting 20 made of a hard metal material, and an operation wire 3 inserted into the flexible sheath 2 so as to be able to advance and retreat, and an operation for moving the operation wire 3 forward and backward. It includes an operation unit 10 attached to the rear end of the wire 3 and a plurality of basket wires 8 connected to the tip of the operation wire 3. A basket part 4 for calculus grasping or crushing, which is a treatment part, a guide wire 9 which extends along the flexible sheath 2 from the operation part 10 side and is advanced and retracted, and is attached to the tip of the basket part 4; Insert guide wire 9 And a because of the guide wire insertion section 70.

  The basket portion 4 includes a plurality of basket wires 8 which are a plurality of metal wires having an elastic restoring force, and a plurality of basket wires 8 attached to the distal ends of the operation wires 3. A rear end tip 7 that is integrally connected to the operation wire 3 and a front end tip 6 that is a part where the front ends of a plurality of basket wires 8 are integrally connected are provided. Is elongated in the state of being accommodated in the flexible sheath 2 with the interval of being extended, and in the state of being out of the flexible sheath 2, the basket wire 8 is formed by the elastic restoring force of the plurality of basket wires 8. It is configured to elastically contract or expand. Further, in the present embodiment, the distal tip 6 is obtained by combining the distal ends of a plurality of basket wires 8 by welding or the like using a filler material, has a small-diameter cylindrical portion on the proximal end side, and has a distal end side. It is formed in a mushroom shape having a hemispherical portion, but is not limited to this shape, and is formed by using other parts such as inserting and joining a plurality of basket wire tips into a cylindrical metal. You may. In this embodiment, a portion where the tip portions of the plurality of basket wires are connected is called a tip.

  The operation unit 10 penetrates a grip 14 attached to the rear end of the operation wire 3 via an operation pipe 12 and an operation pipe 12 of the grip 14 attached to the operation wire 3, and a water supply port 13 is opened. And an operation section main body 11 that moves the operation wire 3 with respect to the flexible sheath 2 by moving the grip section 14 forward and backward. The water supply port 13 has an inner end communicating with a space in the cylinder of the operation section main body 11, and is configured to be capable of supplying a chemical solution or the like into the flexible sheath 2 by attaching an injection or the like (not shown).

[Guide wire insertion means]
Next, the guide wire insertion means 70 according to this embodiment will be described in detail with reference to FIGS. 2 (a) to 2 (d) and FIG. 2A is a cross-sectional view of the guide wire insertion means, FIG. 2B is a cross-sectional view of the state where the guide wire insertion means is mounted on the distal end tip (other than the guide wire insertion means is not a cross section), and FIG. FIG. 2D is a cross-sectional view showing a state in which the guide wire insertion means is attached to the distal end tip and the guide wire is inserted (the section other than the guide wire insertion means is not shown), and FIG. 2D is a perspective view of the guide wire insertion means; The upper part in FIG. 3 is called the distal end side, and the lower part is called the proximal end side.

As shown in FIGS. 2D and 3, the guide wire insertion means 70 has a small diameter at the distal end and a large diameter at the proximal end, and has a hollow pot-like shape that forms a step 70 e by the diameter difference. The proximal end is a large-diameter portion 70a serving as a distal tip fitting portion for attachment to the distal tip 6, and the distal end is a small-diameter portion 70b serving as a guide wire insertion portion for inserting a guide wire. It protrudes to the tip side from the tip.
The small-diameter portion 70b has a hole 70c for inserting the guide wire 9 at a position adjacent to the step 70e on the proximal end side and adjacent to the step 70e on the proximal end side, and is a distal-end-side peripheral surface of the small diameter portion 70b. At the circumferentially symmetric position of the hole 70c, a substantially V-shaped groove 70d cut from the distal end side for guiding the guide wire 9 is provided. The groove 70d may be formed by cutting the groove 70d obliquely outward from the position approximately one-third from the target position in the circumferential direction of the hole 70c toward the base end and outward. The present invention is not limited to this, and may be formed by another method.
The hole 70c and the groove 70d can be inserted linearly without the guide wire 9 inserted into the insertion space connecting the hole 70c and the groove 70d being coaxial or parallel to the center axis of the tip 6. As described above, the angle θ1 of the line connecting the bottom (base end side) of the hole 70c and the bottom (base end side) of the groove 70d is set to be 10 degrees to 45 degrees with respect to the center axis of the tip end. It is suitable. It is preferable that the angle θ1 be set according to the position in the length direction of the hole 70c and the groove 70d and the height of the step 70e.

[Manufacturing method of guide wire insertion means and mounting method to tip tip]
The manufacture of the guide wire insertion means 70 and the attachment to the tip 6 according to this embodiment are performed as follows. The guide wire insertion means 70 is formed of a tubular heat-shrinkable tube made of, for example, a fluororesin such as PTFE (polytetrafluoroethylene). First, the heat-shrinkable tube is cut into a predetermined length (for example, about 6 mm), and then substantially cut. A hole 70c (for example, about 0.9 mm to 1.2 mm) for passing a guide wire is opened at the center. Then, the heat-shrinkable tube is covered from the tip side of the tip 6. At this time, the heat-shrinkable tube has such a degree that the heat-shrinkable tube protrudes toward the distal end side (for example, about 3 mm) from the distal end tip 6 and reaches a smaller diameter portion than the hemispherical portion of the distal end tip 6. Cover. At this position, heat is applied to the heat-shrinkable tube to cause the heat-shrinkable tube to shrink, so that the heat-shrinkable tube comes into close contact with the tip 6 and the rear end of the heat-shrinkable tube is caught by the end of the hemispherical portion of the tip 6. It is possible to prevent the heat-shrinkable tube (guide wire insertion means 70) from coming off from the tube. Thereafter, a substantially V-shaped groove is formed at the end of the hole 70c of the heat-shrinkable tube at the circumferentially symmetric position.
The manufacture of the guide wire insertion means 70 and the attachment to the distal end tip 6 according to this embodiment can be performed as described above, but are not limited to this order.

In the basket-type endoscope treatment tool provided with the guide wire insertion means according to the present embodiment thus configured, the guide wire 9 is not bent in the insertion space of the guide wire guide means 70 as shown in FIG. When the guide wire 9 is inserted into the guide wire insertion means at an angle (inclined) with respect to the guide wire insertion means 70, the guide wire insertion means 70 is moved along the guide wire 9. Sometimes, it can be moved smoothly with less contact resistance than when moved in parallel or coaxially.
Further, by providing the groove 70d at the distal end of the hole 70c of the guide wire insertion means 70 at the circumferentially symmetric position, the groove 70d becomes a guide when the guide wire 9 is inserted from the distal end side of the guide wire insertion means 70, The guide wire 9 can be easily inserted into the hole 70c, and the work efficiency can be improved.

[Example 2]
In the above-described embodiment, an example has been described in which the guide wire insertion means is formed of a tubular heat-shrinkable tube. However, the present invention is not limited to this, and may be configured as follows.
As shown in FIG. 4, the guide wire insertion means 80 according to the present embodiment includes a distal tip fitting portion 80a into which the distal tip 6 is fitted, and a distal end side smaller than the fitting portion 80a. It has a guide wire insertion portion 80b which protrudes and in which an insertion space 80c for inserting the guide wire 9 is formed. The guide wire insertion means 80 forms a step 80e by a diameter difference between the distal tip fitting portion 80a and the guide wire insertion portion 80b, and the insertion space 80c extends from the base side surface of the guide wire insertion portion 80b to the distal end side. Formed toward the side.
The angle θ2 of the center line of the insertion space 80c with respect to the center axis of the distal end tip 6 is set to 10 degrees to 45 degrees, and the guide wire 9 is inclined with respect to the center axis of the distal end tip 6 and linearly extends through the insertion space 80c. Is inserted through.

  The basket-type endoscope treatment tool provided with the guide wire insertion means 80 of the present embodiment configured as described above has a guide wire 9 which is linearly inserted into the guide wire insertion means without being bent by the guide wire guide means 80. The guide wire 9 is inserted at an angle (inclined) with respect to the guide wire insertion means 80 so as to move the guide wire insertion means 80 along the guide wire 9 in a parallel or coaxial manner. It can be moved smoothly with less contact resistance than that.

2 Flexible sheath, 3 operation wire, 4 basket part, 6 tip,
7 rear end tip, 8 basket wire, 9 guide wire, 10 operation part,
11 operation unit main body, 12 operation pipe, 13 water inlet, 14 gripper, 20 tip fitting,
22 bile duct, 70 guide wire insertion means, 80 guide wire insertion means, 230 calculus

Claims (6)

A long cylindrical flexible sheath, an operation wire inserted into the cylinder of the flexible sheath so as to be able to advance and retreat, and a terminal end connected to a rear end tip of the operation wire tip, and a front end connected to the tip tip And a basket portion comprising a plurality of basket wires formed so as to elastically contract or expand in a retracted state, and a guide wire for a basket-type endoscope treatment tool for guiding the basket portion with a guide wire. Means,
The guide wire insertion means has a distal tip fitting portion into which the distal tip is fitted, and a guide wire inserting portion having a smaller outer diameter than the distal tip fitting portion and protruding more distally than the distal tip,
The guide wire insertion portion has an insertion space for inserting the guide wire in a straight line by inclining the guide wire with respect to the center axis of the distal end tip,
The guide wire insertion means, wherein the insertion space is formed from a base side surface of the guide wire insertion portion to a front end side surface. A long cylindrical flexible sheath, an operation wire inserted into the cylinder of the flexible sheath so as to be able to advance and retreat, and a terminal end connected to a rear end tip of the operation wire tip, and a front end connected to the tip tip And a basket portion comprising a plurality of basket wires formed so as to elastically contract or expand in a retracted state, and a guide wire for a basket-type endoscope treatment tool for guiding the basket portion with a guide wire. Means,
The guide wire insertion means includes a hollow tip fitting portion into which the tip is fitted, a hollow cylindrical shape having an outer diameter smaller than that of the tip fitting portion, and a guide wire protruding distally from the tip. And an insertion part,
The guide wire insertion portion has a hole for inserting the guide wire in a base end side peripheral surface, and a groove for passing the guide wire in a distal end side peripheral surface at a position symmetrical to the hole in the circumferential direction. A guide wire passing through the guide wire linearly from the hole toward the groove.   3. The guide wire insertion means according to claim 1, wherein a step is formed by a diameter difference between the tip tip fitting portion and the guide wire insertion portion.   The line connecting the base bottom of the hole and the base bottom of the groove is set in a range inclined from 10 degrees to 45 degrees with respect to the center axis of the tip. The guide wire insertion means according to the above. The distal tip has a small diameter portion on the proximal end side and a hemispherical portion on the distal end side,
5. The guide wire insertion means according to claim 2, wherein the heat-shrinkable tube is formed by contracting the heat-shrinkable tube in a state where the heat-shrinkable tube projects from the hemispherical portion and the hemispherical portion toward the distal end. 6. The guidewire insertion means according to any one of the above. 2. The guide wire insertion means according to claim 1, wherein a center line of the insertion space is set in a range inclined from 10 degrees to 45 degrees with respect to a center axis of the distal end tip.

Images