JP2020081403A - Medical appliance transport device - Google Patents

Abstract

To provide a medical appliance transport device which is hardly caught in a wall part in a body when inserted into the body, and is therefore easily inserted into the body.SOLUTION: A medical appliance transport device 10 comprises an outer sheath 20 and an inner sheath 30, a storage part 40 capable of storing a medical appliance 1 is provided between an inner periphery of an outer sheath distal end part and an outer periphery of an inner sheath distal end part. A distal end cap 50 is attached to a distal end part 31 of the inner sheath 30, the distal end cap 50 has a protrusion part 52, and a proximal end side of the protrusion part 52 can be separated from the outer sheath distal end side, and in a boundary 45 between the protrusion part proximal end side of the distal end cap and the outer sheath distal end side, an insertion guide member 70 covering the boundary 45 at least partially is provided.SELECTED DRAWING: Figure 2

Description

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical device delivery apparatus for placing a medical device such as a stent at a target position such as a tubular organ.

Conventionally, a medical device such as a stent is placed in a narrowed portion or an obstructed portion of a tubular organ such as a bile duct, a ureter, a trachea, and a blood vessel, and the portion is expanded to facilitate the flow of bile, blood, etc. Treatment is being given. At this time, for example, a stent delivery device including an outer sheath and an inner sheath arranged inside the outer sheath is used.

For example, in Patent Document 1 below, an outer sheath and an inner tube slidably inserted into the outer sheath are provided, and a stent is housed between the outer circumference of the inner tube distal end and the outer circumference of the outer sheath distal end. There is described a stent delivery device configured so that the stent can be opened by sliding the outer sheath toward the proximal end side with respect to the inner tube in the arranged state.

A substantially cylindrical head is connected to the tip of the inner tube. The head portion has a top portion with the largest diameter at a predetermined axial position thereof. The top portion has a taper taper gradually decreasing in diameter from the top portion toward the tip side, or partly or entirely. Has a reduced diameter portion that gradually decreases in diameter from the base end side. When the inner peripheral edge of the distal end portion of the outer sheath abuts on the head, the outer peripheral portion of the distal end portion of the inner tube and the inner peripheral edge of the outer sheath distal end portion are enclosed, and the stent is accommodated in a state in which opening of the stent is suppressed. It has become so.

JP, 2016-49415, A

In the stent delivery device described in Patent Document 1, as described above, when the stent is housed between the outer circumference of the distal end portion of the inner tube and the inner circumference of the distal end portion of the outer sheath, the outer sheath of the outer sheath is attached to the head. Since the inner peripheral edge of the distal end portion abuts, a step is formed at the boundary portion between the reduced diameter portion on the proximal end side of the head and the outer sheath distal end.

Therefore, for example, by so-called ultrasonic endoscopic biliary drainage (EUS-BD), for example, in order to place a stent between the stomach and the bile duct, a hole is made in the stomach and the bile duct, and these holes are opened. When the outer sheath or the inner tube is passed from the distal end side of the head, the step may be caught on the wall of the stomach or the bile duct, making it difficult to insert. Further, for example, even when the tubular organ is bent, the step may be easily caught on the inner wall of the tubular organ.

Therefore, an object of the present invention is to provide a medical device transporting device that can be easily caught in a wall portion of the body when inserted into the body and can be easily inserted into the body.

In order to achieve the above-mentioned object, the present invention has an outer sheath and an inner sheath inserted into the outer sheath, and has a distal end inner circumference of the outer sheath and a distal end outer circumference of the inner sheath. An accommodation section capable of accommodating the medical device is provided between the two, and the medical instrument accommodated in the accommodation section is releasable by relatively moving the outer sheath and the inner sheath. In the medical device transporting apparatus, a distal end cap is attached to the distal end portion of the inner sheath, and the distal end cap has a protruding portion protruding from the distal end side of the outer sheath. The end side is separable from the distal end side of the outer sheath, and the axial direction of the outer sheath is between the proximal end side of the protruding portion of the distal end cap and the distal end side of the outer sheath. It is characterized in that the boundary portions which are separated from each other are provided with an insertion guide member which at least partially covers the boundary portions.

According to the present invention, the boundary portion between the base end side of the protruding portion of the distal end cap and the distal end side of the outer sheath, which is a portion separated from the axial direction of the outer sheath, has a boundary between them. Since the insertion guide member that at least partially covers the portion is provided, the insertion guide member causes at least a portion of a gap or a step generated at the boundary portion between the proximal end side of the protruding portion of the distal end cap and the outer sheath distal end side. Since the outer sheath or the inner sheath is covered with the inner sheath, it is possible to prevent the outer sheath or the inner sheath from being caught in the wall portion of the internal organ or the tubular organ when it is inserted into the body from the distal end side, and the insertion into the body can be facilitated.

It is a perspective view showing a 1st embodiment of a medical instrument transportation device concerning the present invention. FIG. 3 is an enlarged cross-sectional view showing a state in which a medical device is stored in a storage portion of the carrier device. It is a principal part enlarged perspective view in the state of FIG. FIG. 7 is an enlarged cross-sectional view of a main part of the carrier device when the medical device is released from the accommodation part. It is a principal part expansion perspective view in the state of FIG. The process at the time of delivering a medical device in a body using the delivery apparatus is shown, (a) is explanatory drawing of the 1st process, (b) is explanatory drawing of the 2nd process. It is a schematic explanatory drawing at the time of leaving a medical device in the body using the same conveying device. It is 2nd Embodiment of the conveying apparatus of the medical device which concerns on this invention, and is a principal part expanded perspective view. The 3rd Embodiment of the conveying apparatus of the medical device which concerns on this invention is shown, (a) is an expanded sectional view of the state which accommodated the medical device in a storage part, (b) shows a medical device from a storage part. It is an expanded sectional view at the time of opening. 4 is a fourth embodiment of the medical device delivery apparatus according to the present invention, and is an enlarged cross-sectional view of a main part thereof. FIG. The 5th Embodiment of the medical instrument delivery apparatus which concerns on this invention is shown, (a) is a principal part enlarged plan view, (b) is sectional drawing in the AA arrow line of (a), 3C is a cross-sectional view taken along the line BB of FIG. FIG. 10A shows a sixth embodiment of the medical device transport device according to the present invention, in which (a) is an enlarged cross-sectional view of a state in which a medical device is housed in a housing portion and a tip opening of the housing portion is not closed, FIG. 6B is an enlarged cross-sectional view of a state in which the medical device is housed in the housing unit and the tip opening of the housing unit is closed.

Hereinafter, a first embodiment of a medical device transport apparatus according to the present invention will be described with reference to FIGS.

As shown in FIGS. 1 and 2, a medical device delivery device 10 of this embodiment (hereinafter, also simply referred to as “delivery device 10 ”) is inserted into an outer sheath 20 and the outer sheath 20 so as to be movable. And an inner sheath 30. In addition, as shown in FIG. 2, a housing portion 40 capable of housing the medical device 1 is provided between the inner circumference of the distal end portion 21 of the outer sheath 20 and the outer circumference of the distal end portion 31 of the inner sheath 30. .. The medical device 1 housed in the housing 40 is releasable by relatively moving the outer sheath 20 and the inner sheath 30 while the medical device 1 is housed in the housing 40.

The medical device 1 in this embodiment is, for example, a stent formed by knitting and/or braiding wire rods into a tubular shape, or a stent formed by forming a metal tube into a mesh shape by laser cutting or the like. It is not limited to such a stent.

When the outer sheath 20 and the inner sheath 30 are relatively moved, for example, the inner sheath 30 is gripped and fixed, and the outer sheath 20 is pulled toward the hand side or pushed to the side opposite to the hand side. This can be performed by holding and fixing the sheath 20 and pulling the inner sheath 30 toward the hand side, pushing the side opposite to the hand side, or pushing and pulling the inner sheath 30 and the outer sheath 20 relative to each other. ..

In the following description, the term "proximal end" or "proximal end" means the end (proximal end) closer to the user's hand who uses the medical device delivery device. The term "part" or "tip" means the above-mentioned base end or the end opposite to the base (distal end).

The outer sheath 20 has a cylindrical tube shape, and a grip portion 24 for gripping the outer sheath 20 is attached to a base end portion 23 of the outer sheath 20. Further, a concave portion 25 having a concave shape is formed on the outer circumference of the distal end portion 21 of the outer sheath 20 along the entire circumference. Further, as shown in FIGS. 2 and 4, a marker 29, which is made of a radiopaque metal such as Au or Pt, is embedded at a predetermined position on the distal end portion 21 side of the outer sheath 20.

On the other hand, the inner sheath 30 has a cylindrical tube shape, and a tip end cap 31 is attached to a tip end portion 31 thereof, which is arranged on the tip end 27 side of the outer sheath 20. When the inner sheath 30 and the outer sheath 20 are inserted into the body, the tip cap 50 serves as an insertion guide at the beginning, and the housing portion 40 between the inner circumference of the outer sheath tip and the outer circumference of the inner sheath tip. , Which closes the front end side opening. A hub 35 for operating the inner sheath is attached to the base end portion 33 of the inner sheath 30. An insertion hole 35 a is formed in the hub 35 and communicates with the inner space of the inner sheath 30. Therefore, the guide wire 2 (see FIG. 6) can be inserted into the inner sheath 30 through the insertion hole 35a of the hub 35.

The outer sheath 20 and the inner sheath 30 as described above are made of, for example, polyethylene (PE), fluororesin, polyoxymethylene (POM), polypropylene (PP), nylon resin, nylon elastomer, polyester, ABS resin, polycarbonate, It is made of polyetheretherketone (PEEK), polyimide or the like. The shapes and structures of the outer sheath and the inner sheath are not limited to the above aspect. Further, a radiopaque marker may be arranged at a predetermined position on the inner sheath.

The distal end cap 50 attached to the distal end portion 31 of the inner sheath 30 has a substantially cylindrical shape with an insertion hole 51 for inserting the guide wire 2 formed therein. Further, the distal end cap 50 has a protruding portion 52 protruding from the distal end side of the outer sheath 20, and the base end side of the protruding portion 52 is separable from the distal end side of the outer sheath 20. .. More specifically, as shown in FIG. 2 and FIG. 4, the distal end cap 50 is connected to the projecting portion 52 projecting from the distal end side of the outer sheath 20 and the proximal end side of the projecting portion 52. , And an insertion portion 53 to be inserted into the inner circumference of the distal end portion 21 of the outer sheath 20.

In addition, the protruding portion 52 in this embodiment has a head portion 55 having a shape in which the diameter is gradually reduced from the most enlarged diameter top portion 54 toward an axial tip end 55a, and an axial base end from the top portion 54. Toward the side, the guide arrangement portion 57 that is reduced in diameter from the top portion 54 and extends with a constant diameter, and the base end portion side of the guide arrangement portion 57, which is gradually provided toward the base end side in the axial direction of the tip cap 50. It has a taper-shaped step portion 59 with a reduced diameter. On the other hand, the insertion portion 53 has a shape that is smaller in diameter than the guide arrangement portion 57 via the step portion 59 of the protruding portion 52 and further extends toward the base end side in the axial direction with a constant diameter. .. Further, the leading edge 55a is processed into an R shape so that there is no edge. It should be noted that it is desirable that the leading edge 55a be R-shaped, but the R-shaped processing may not be performed.

The guide placement portion 57 is a portion on the outer periphery of which a cap-side connecting portion 75 of an insertion guide member 70, which will be described later, is placed and fixed. Further, the stepped portion 59 is arranged so as to face the tip 27 of the outer sheath 20 and is a portion with which the tip 27 can abut (see the enlarged view of FIG. 2).

A taper surface 61 is formed on the outer circumference of the base end portion of the insertion portion 53 to facilitate insertion into the inner circumference of the distal end portion 21 of the outer sheath 20. Further, a sheath mounting portion 62 having a concave groove shape is formed on the inner circumference of the insertion portion 53. The distal end portion 31 of the inner sheath 30 is inserted into the sheath attachment portion 62, and the inner periphery of the sheath attachment portion 62 and the outer periphery of the distal end portion 31 are fixed to each other with an adhesive or the like, whereby the distal end portion of the inner sheath 30 is formed. The tip end cap 50 is attached to 31.

The tip cap 50 is made of, for example, polyethylene (PE), fluororesin, polyoxymethylene (POM), polypropylene (PP), nylon resin, nylon elastomer, polyester, ABS resin, polycarbonate, polyether ether ketone (PEEK). ), polyimide, or the like. The shape and structure of the tip cap is not limited to the above-mentioned aspect. That is, the distal end cap 50 has a shape in which the insertion portion 53 extends from the top portion 54 via the guide disposition portion 57 and the step portion 59 having a constant diameter. For example, as the distal end cap, from the top portion to the proximal end side. It may have a shape in which the diameter is gradually reduced toward (in the case of such a tip cap, a portion which is gradually reduced in diameter from the top is inserted into the inner circumference of the outer sheath tip side constitutes an insertion portion, A portion that is closer to the tip end side than that and that protrudes from the tip end side of the outer sheath constitutes the "projection portion" in the present invention).

The transport device 10 is a portion between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end 27 side of the outer sheath 20 and away from the outer sheath 20 or the inner sheath 30 in the axial direction. The boundary portions 45 (see FIG. 2) are provided with insertion guide members 70 that at least partially cover the boundary portions 45. More specifically, as shown in FIGS. 2 and 4, the boundary portion 45 in this embodiment fixes the inner sheath 30 and pushes the outer sheath 20 to the side opposite to the hand side, or the outer sheath. When 20 is fixed and the inner sheath 30 is pulled toward the hand side, the base end side of the protruding portion 52 of the tip cap 50 (here, it means the step portion 59) and the tip end side of the outer sheath 20 contact each other. The outer sheath 20 and the inner sheath 30 are allowed to come into contact with each other, and the relative movement of the outer sheath 20 and the inner sheath 30 is regulated to close the distal end side opening of the housing portion 40 that houses the medical device 1, and the outer sheath 20 and the inner sheath 30 in the axial direction. It is a place away from them.

The boundary portion 45 in this embodiment is in contact with the distal end 27 of the outer sheath 20 and the stepped portion 59 of the projecting portion 52 of the distal end cap 50 that is arranged axially opposite to the distal end 27. It refers to the location where it is possible and can be separated. Further, as shown in the enlarged view of FIG. 2, in the case of the boundary portion 45 of this embodiment, a gap formed between the distal end 27 of the outer sheath 20 and the stepped portion 59 of the protruding portion 52 of the distal end cap 50 is formed. Is located.

As shown in FIGS. 2 and 3, the insertion guide member 70 in this embodiment is arranged on the outer periphery of the boundary portion 45 between the proximal end side of the projecting portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20, It has a tubular portion 71, and the tubular portion 71 is configured to connect the proximal end side of the distal end cap 50 and the distal end side of the outer sheath 20.

More specifically, the tubular portion 71 of this embodiment has a substantially cylindrical shape, is disposed on the axial proximal end side, and is connected to the distal end side of the outer sheath 20, and the sheath side coupling portion 73, The cap-side connecting portion 75 is arranged on the axially distal end side and is connected to the proximal end side of the projecting portion 52 of the distal end cap 50, and the intermediate portion 77 is arranged between these connecting portions 73, 75. ing.

The sheath side connecting portion 73 is arranged on the outer periphery of the recess 25 provided in the distal end portion 21 of the outer sheath 20, and is connected via an adhesive or the like. In this connected state, as shown in FIG. 2, the outer peripheral surface of the sheath side connecting portion 73 is flush with the outer peripheral surface of the distal end portion 21 of the outer sheath 20 and is flush with the outer peripheral surface of the distal end portion 21 so that no step is formed. ..

On the other hand, the cap-side connecting portion 75 is arranged on the outer periphery of the guide arrangement portion 57 of the protruding portion 52 of the tip cap 50, and is connected via an adhesive or the like. In this connected state, as shown in FIG. 2, the outer peripheral surface of the cap-side connecting portion 75 is flush with the outer peripheral surface of the distal end cap 50 and is flush with the outer peripheral surface of the tip cap 50, so that no step is formed.

In addition, as shown in FIG. 2, in this embodiment, the intermediate portion 77 of the tubular portion 71 that constitutes the insertion guide member 70 is a boundary portion 45 between the proximal end side of the distal end cap 50 and the distal end side of the outer sheath 20. It is designed to cover the entire circumference of.

Partially covering the boundary portion 45 means that the outer peripheral edge portion of the distal end 27 of the outer sheath 20 and the outer peripheral edge portion of the proximal end side of the protrusion 52 of the distal end cap 50 (here, the step of the protrusion 52). It means that the outer peripheral side edge portion of the portion 59 is covered without being exposed to the outside.

Further, in the intermediate portion 77 of the cylindrical portion 71, a plurality of substantially elliptical holes 79 are formed at predetermined intervals along the circumferential direction of the boundary portion 45. Each hole 79 is formed such that its major axis side is along the axial direction of the tip cap 50. Further, since the plurality of elliptical holes 79 are arranged such that the major axis directions thereof are parallel to each other, the maximum diameter portions of the elliptical holes 79, 79 adjacent to each other in the circumferential direction of the tubular portion 71 are provided. The space is the narrowest part with the narrowest width. Note that the hole 79 is not limited to an elliptical shape, but may be, for example, a round hole, a long hole, a square hole, or the like and is not particularly limited. Each hole 79 communicates with the housing portion 40 formed between the inner circumference of the outer sheath tip portion and the outer circumference of the inner sheath tip portion. Further, an easily breakable portion 81 having a perforated cut line is formed in a portion (specifically, the narrow portion) between the holes 79 adjacent to each other in the circumferential direction of the tip cap 50 (specifically, the narrow portion). Has been done.

Therefore, by moving the distal end side of the outer sheath 20 in a direction away from the proximal end side of the inner sheath 30 with a predetermined force (the inner sheath 30 is fixed and the outer sheath 20 is pulled toward the hand side, or , The outer sheath 20 is fixed, and the inner sheath 30 is pushed to the side opposite to the hand side). As shown in FIGS. 4 and 5, the hole 79 and the hole 79 of the intermediate portion 77 of the tubular portion 71 are formed. The part between them is broken through the easily breakable portion 81, and the outer sheath 20 and the inner sheath 30 can be relatively moved.

The insertion guide member 70 is, for example, polyethylene (PE), fluororesin, polyoxymethylene (POM), polypropylene (PP), nylon resin, nylon elastomer, polyester, ABS resin, polycarbonate, polyetheretherketone ( PEEK), polyimide or the like. The shape and structure of the insertion guide member are not limited to the above-mentioned aspect.

Further, as a shape and a structure for at least partially covering the boundary portion between the proximal end side of the distal end cap and the distal end side of the outer sheath in the insertion guide member, the cylindrical portion is provided in the distal end cap as in the above embodiment. It is not limited to the structure. For example, a plurality of linear members may be arranged along the outer periphery of the boundary portion and covered, covered with a plate-shaped extending portion, or covered with an extending member extending from the outer sheath tip. Well, there is no particular limitation.

Further, in this embodiment, the insertion guide member has the proximal end side connected to the outer sheath distal end side, the distal end side connected to the proximal end side of the protruding portion of the distal end cap, and the both axial ends are connected, It is not limited to this aspect. For example, a structure in which only the distal end side of the insertion guide member is connected to the proximal end side of the projecting portion of the distal end cap, and the proximal end side is not connected to the distal end side of the outer sheath, but is arranged on the outer circumference of the distal end portion of the outer sheath. Or, only the proximal end side of the insertion guide member is connected to the distal end side of the outer sheath, and the distal end side is not connected to the proximal end side of the protruding part of the distal end cap, but the protruding part of the distal end cap is You may make it the structure arrange|positioned on the outer periphery at the base end side.

Further, the insertion guide member 70 of this embodiment can be ruptured via the easily breakable portion 81 formed of a cut line. As the easily breakable portion, for example, a portion between holes is Make it narrower (for example, if you arrange circular or elliptical holes in parallel, you can narrow the space between the largest diameter parts that are adjacent to each other), or make a triangular or narrow groove cutout. Alternatively, it may be thin, and may be broken by moving the outer sheath distal end side in a direction away from the inner sheath proximal end side with a predetermined force.

Next, an example of how to use the transporting device 10 having the above configuration will be described with reference to FIGS. 6 and 7.

As shown in FIG. 7, a papilla 3a is provided in the lower part of the duodenum 3, and a bile duct 4 and a pancreatic duct 5 branch and extend from the papilla 3a. Further, the bile generated by the liver 7 is supplied to the bile duct 4 (common bile duct) via the intrahepatic bile duct 8, passes through the papilla 3a, and is supplied to the duodenum 3. However, there are cases where the bile duct 4 is occluded by a tumor or the like and bile cannot flow. In such a case, conventionally, an endoscope (not shown) is inserted into the stomach 6 or the duodenum 3 and the distal end of the endoscope is placed near the papilla 3a, and then a catheter or the like containing a medical device such as a stent. The treatment such as inserting the medical device into the bile duct 4 through the papilla 3a and inserting the medical device into the obstructed portion generated in the bile duct 4 and expanding the device is performed. There is. However, for some reason, the transport device cannot be inserted through the papilla 3a, and the medical device cannot be placed in the closed portion of the bile duct 4 in some cases. In such a case, the medical device 1 is placed between the stomach 6 and the intrahepatic bile duct 8 in order to allow the bile to flow into the stomach 6 and bypass the papilla 3a to be supplied to the duodenum 3 through the stomach 6. The endoscopic biliary drainage (EUS-BD) is known. The delivery device 10 of this embodiment can be suitably used for such an endoscopic biliary drainage surgery. The medical device 1 can be preferably used when the medical device 1 is placed between the duodenum 3 and the bile duct 4 and bypassed.

First, the distal end 27 of the outer sheath 20 is separated from the base end side of the protruding portion 52 of the distal end cap 50, and the medical device 1 is reduced in diameter and placed in the housing part 40 in a state where the housing part 40 is opened. Then, the distal end 27 of the outer sheath 20 is brought close to the proximal end side of the protruding portion 52 of the distal end cap 50. In this state, the sheath side connecting portion 73 of the insertion guide member 70 is arranged and connected to the outer periphery of the recess 25 of the outer sheath 20, and the cap side connecting portion 75 of the insertion guide member 70 is protruded from the tip cap 50. The insertion guide member 70 is attached in a state of covering the boundary portion 45 between the distal end side of the outer sheath and the proximal end side of the projecting portion of the distal end cap by arranging and connecting the outer peripheral surface of the guide disposing portion 57 of the portion 52.

Then, after inserting an ultrasonic endoscope (not shown) from the mouth through the esophagus and arranging the distal end portion thereof near the entrance of the stomach 6, a puncture needle is punctured into the stomach 6 and the intrahepatic bile duct 8 and the stomach 6 A hole (puncture hole 6a, 8a) is formed in the intrahepatic bile duct 8. After that, the guide wire 2 is inserted between the stomach 6 and the intrahepatic bile duct 8 and then a puncture hole 6a formed in the wall of the stomach 6 or the intrahepatic bile duct 8 by an expander such as a dilator. , 8a are expanded. Next, the proximal end side (hand side) of the guide wire 2 is inserted into the insertion hole 35a of the inner sheath 30 from the distal end opening of the insertion hole 51 of the distal end cap 50. Then, while guiding with the guide wire 2, the outer sheath 20 and the inner sheath 30 are inserted into the puncture hole 6a of the stomach 6 with the tip cap 50 at the top, as shown in FIG. 6(a) and FIG. 6(b). I will do it.

At this time, in the carrying device 10, as shown in FIGS. 2 and 3, in the axial direction of the outer sheath 20 between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20. An insertion guide member 70 that covers the boundaries 45 at least partially is provided at the boundaries 45, which are positions away from each other. Therefore, the insertion guide member 70 (here, the tubular portion 71) covers a gap, a step, or the like generated in the boundary portion 45 between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20. Will be inserted into the body. As a result, when the outer sheath 20 and the inner sheath 30 are inserted into the body from the distal end side, they are formed on the peripheral edge of the puncture hole 6a formed on the wall of the stomach 6 and on the wall of the intrahepatic bile duct 8. It is difficult to catch a gap, a step, or the like generated in the boundary portion 45 between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20 on the wall portion of the internal organ or the tubular organ such as the peripheral edge of the puncture hole 8a. Therefore, the outer sheath 20 and the inner sheath 30 can be easily inserted into the body.

Thereafter, with the distal end side of the distal end cap 50 and the outer sheath 20 positioned in the intrahepatic bile duct 8, the inner sheath 30 is fixed by fixing the inner sheath 30 while restricting the movement of the medical device 1 via a pusher or the like. 20 is pulled toward the hand side, or the outer sheath 20 is fixed and the inner sheath 30 is pushed toward the side opposite to the hand side. Since the portion of the intermediate portion 77 of the shaped portion 71 between the holes 79 and 79 is broken through the easily breakable portion 81, the diameter of the medical device 1 is gradually increased from the tip opening side of the housing portion 40. (See FIG. 4), the medical device 1 can be released from the housing portion 40, and as shown in FIG. 7, the medical device 1 can be placed between the stomach 6 and the intrahepatic bile duct 8 in a bypassed state.

Then, in this embodiment, as shown in FIG. 2, the insertion guide member 70 is connected to the proximal end side of the projecting portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20 so as to connect the outer sheath 20 and the inner sheath. Since it is configured to regulate the relative movement with respect to 30, the protrusion 52 of the distal end cap 50 is prevented from separating from the distal end side of the outer sheath 20 until the medical device 1 is opened from the accommodating portion 40, The gap at the boundary portion 45 between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20 can be prevented from expanding easily, and a step can be prevented from occurring, so that the outer sheath 20 and the inner sheath 30 can be kept inside the body. It can be inserted smoothly at the desired location.

When the medical device 1 is released from the housing portion 40, the inner sheath 30 is fixed and the outer sheath 20 is pulled toward the operator's side, or the outer sheath 20 is fixed and the inner sheath 30 is referred to as the operator's side. By pushing the opposite side, the insertion guide member 70 can be broken through the easily breakable portion 81 and the medical device 1 can be released from the accommodating portion 40, so that the medical device 1 can be placed at a desired position in the body. Can be firmly placed.

Further, the insertion guide member 70 is connected to the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20 (here, the cap side connecting portion 75 forming the tubular portion 71 is the distal end cap. 50 is connected to the base end side of the projecting portion 52 and is connected to the distal end side of the outer sheath 20 of the sheath side connecting portion 73), and since both ends thereof are fixed, compared to the structure in which only one side is connected. As a result, the insertion guide member 70 can be prevented from kinking and the boundary portion 45 can be covered firmly.

Further, in this embodiment, as shown in FIG. 2 and FIG. 3, the insertion guide member 70 has a tubular portion 71 arranged on the outer periphery of the boundary portion 45, and the tubular portion 71 has a distal end. The base end side of the cap 50 and the front end side of the outer sheath 20 are connected to each other, and the relative movement of the outer sheath 20 and the inner sheath 30 is regulated. Therefore, the entire circumference of the boundary portion 45 can be reliably covered with the tubular portion 71, and since the insertion guide member 70 has the tubular portion 71, the rigidity thereof can be easily ensured, and the twisting is further difficult. Thus, the boundary portion 45 can be covered more effectively.

Further, the cylindrical portion 71 is provided with a plurality of holes 79 in the circumferential direction along the boundary portion 45 at predetermined intervals, and is easily broken at a portion between the holes 79 adjacent to each other in the circumferential direction. The part 81 is formed. Therefore, a liquid such as a physiological saline solution is made to flow into the inner circumference of the outer sheath 20 and the inner circumference of the inner sheath 30 to smoothly flow out the liquid used for the so-called flushing operation to remove air from the plurality of holes 79. It is possible to facilitate the flash work. Further, since the easily breakable portion 81 is formed between the holes 79 and 79, the hole 79 acts as a so-called notch (notch), so that the easily breakable portion 81 can be easily broken. ..

In the delivery apparatus 10 of this embodiment, the medical device 1 is used as a stent to bypass between the stomach 6 and the intrahepatic bile duct 8. However, for example, from the papilla 3a below the duodenum 3 to the bile duct 4 It can be used when indwelling a stent, or when delivering a medical device into the body such as pancreatic duct 5 other than bile duct 4, tubular organs such as ureter and trachea, and other body cavities of the human body. Is not particularly limited. However, when inserting the outer sheath or inner sheath into a narrow hole or a bent part (bent tubular organ, etc.) in the body, etc. It is suitable for transporting the medical device to a place where a gap or a step generated at the boundary portion of is easily caught.

FIG. 8 shows a second embodiment of the medical device transport apparatus according to the present invention. It should be noted that substantially the same parts as those in the above-described embodiment are designated by the same reference numerals and the description thereof will be omitted.

The medical device transporting apparatus 10A of this embodiment (hereinafter, also simply referred to as "transporting apparatus 10A") is different from the above-described embodiment in the shape and structure of the insertion guide member 70A.

That is, as shown in FIG. 8, the insertion guide member 70A of this embodiment has a substantially cylindrical cap-side connecting portion 75 that is arranged and fixed to the guide arrangement portion 57 of the protruding portion 52 of the distal end cap 50. is doing. Furthermore, from the base end side of the cap-side connecting portion 75, a plate-shaped extending portion 83 that covers the outer periphery of the distal end portion 21 of the outer sheath 20 extends. A plurality of the extending portions 83 are arranged at equal intervals in the circumferential direction along the outer periphery of the boundary portion 45 between the base end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20, and The extension portions 83 extend so as to be parallel to each other. It should be noted that each extending portion 83 is not connected to the outer circumference of the distal end portion 21 of the outer sheath 20, but is simply arranged on the outer circumference of the distal end portion 21.

In this embodiment, as described above, the insertion guide member 70A extends from the base end side of the projecting portion 52 of the distal end cap 50 and has a plate-like shape that covers the outer periphery of the distal end portion 21 of the outer sheath 20. Since the extended portion 83 is provided, the extended portion 83 can be twisted to evenly cover the boundary portion 45 in the circumferential direction, and the outer sheath 20 and the inner sheath 30 can be easily moved relative to each other. can do.

Further, in this embodiment, the plurality of extending portions 83 are provided, and the extending portions 83 extend in parallel to each other. Therefore, when the outer sheath 20 or the inner sheath 30 is inserted into the body, the outer portion is inserted. Even if the distal end side of the sheath 20 or the inner sheath 30 is bent, it is difficult to open the gap between the extending portions 83, and the boundary portion between the proximal end side of the protruding portion 52 of the distal end cap 50 and the distal end side of the outer sheath 20. It is possible to make it easier to cover the gaps, steps, etc. formed in 45.

FIG. 9 shows a third embodiment of the medical device transport apparatus according to the present invention. It should be noted that substantially the same parts as those in the above-described embodiment are designated by the same reference numerals and the description thereof will be omitted.

The medical device transporting device 10B of this embodiment (hereinafter, also simply referred to as "transporting device 10B") is different from the above-described embodiment in the shape and structure of the insertion guide member 70B.

That is, as shown in FIG. 9, the insertion guide member 70B of this embodiment is inserted from the outer peripheral edge of the tapered step portion 59 (the portion facing the tip 27 of the outer sheath 20) of the tip cap 50. It has a shape that extends in a substantially cylindrical shape toward the proximal end side of the distal end cap 50 with a predetermined gap from the portion 53. The insertion guide member 70B is provided integrally with the tip cap 50 and has a double cylindrical shape together with the insertion portion 53.

Then, as shown in FIG. 9A, the outer sheath 20 and the inner sheath 30 are moved relative to each other, and the tip 27 of the outer sheath 20 is inserted between the insertion portion 53 and the insertion guide member 70B to form a tip cap. By bringing it into contact with the stepped portion 59 of 50, the distal end opening of the housing portion 40 is closed, and the medical device 1 is housed and arranged in the housing portion 40. That is, in this embodiment, the portion of the tapered step portion 59 of the distal end cap 50 that is inserted into the inner periphery on the distal end side of the outer sheath 20 forms a part of the insertion portion 53, and is located on the distal end side thereof. The portion will be a part of the protrusion 52. In this state, the insertion guide member 70B having a substantially cylindrical shape covers the entire circumference of the boundary portion 45 between the distal end side of the outer sheath 20 and the proximal end side of the protruding portion 52 of the distal end cap 50.

On the other hand, as shown in FIG. 9B, the outer sheath 20 and the inner sheath 30 are moved relative to each other, and the distal end portion 21 of the outer sheath 20 is pulled out from between the insertion portion 53 and the insertion guide member 70B. The medical device 1 is released from the housing portion 40.

FIG. 10 shows a fourth embodiment of the medical device transport apparatus according to the present invention. It should be noted that substantially the same parts as those in the above-described embodiment are designated by the same reference numerals and the description thereof will be omitted.

The medical device transport device 10C of this embodiment (hereinafter, also simply referred to as "transport device 10C") is different from the above embodiment in the shape and structure of the insertion guide member 70C.

That is, as shown in FIG. 10, the insertion guide member 70C in this embodiment extends from the distal end 27 of the outer sheath 20 in a substantially cylindrical shape, and gradually narrows toward the distal end side in the extending direction. The outer sheath 20 is integrally formed with the outer sheath 20.

On the other hand, an annular insertion groove 65 into which the insertion guide member 70C can be inserted is formed in a tapered step portion 59 of the tip cap 50 (a portion facing the tip 27 of the outer sheath 20). Has been done.

Then, as shown in FIG. 10, the outer sheath 20 and the inner sheath 30 are moved relative to each other, and the insertion guide member 70C extending from the distal end of the outer sheath is inserted into the insertion groove 65 of the distal end cap 50. The distal end opening of 40 is closed, and the medical device 1 is accommodated in the accommodation portion 40. In this state, the insertion guide member 70C covers the entire circumference of the boundary portion 45 between the outer sheath distal end side and the distal end cap proximal end side. In this embodiment, the tapered step portion 59 of the distal end cap 50 forms a part of the insertion portion 53 that is inserted into the inner periphery of the outer sheath 20 on the distal end side, and the portion on the distal end side of the top portion 54 is The protrusion 52 is formed. In this state, the insertion guide member 70B having a substantially cylindrical shape covers the entire circumference of the boundary portion 45 between the distal end side of the outer sheath 20 and the proximal end side of the protruding portion 52 of the distal end cap 50. There is.

FIG. 11 shows a fifth embodiment of the medical device transport apparatus according to the present invention. It should be noted that substantially the same parts as those in the above-described embodiment are designated by the same reference numerals and the description thereof will be omitted.

The medical device transporting device 10D of this embodiment (hereinafter, also simply referred to as "transporting device 10D") is different from the above-described embodiment in the shape and structure of the insertion guide member 70D.

That is, as shown in FIG. 11, the insertion guide member 70D in this embodiment is connected to the first fitting portion 85 connected to the distal end side of the outer sheath 20 and the proximal end side of the protruding portion 52 of the distal end cap 50. The second fitting portion 87 is formed by two parts. The base end side of the first fitting portion 85 is arranged and fixed to the outer periphery of the recess 25 of the distal end portion 21 of the outer sheath 20, and the width gradually narrows from this fixed portion toward the base end side of the distal end cap. A fitting piece 85a extends obliquely inward toward the inner diameter side of the outer sheath 20. Further, a plurality of the fitting pieces 85a are arranged at a predetermined interval in the circumferential direction of the distal end portion 21 of the outer sheath 20.

On the other hand, the second fitting portion 87 has its base end side fixedly arranged on the outer periphery of the guide arrangement portion 57 of the projecting portion 52 of the distal end cap 50, and the width gradually narrows from this fixed portion toward the outer sheath distal end side. In addition, the fitting piece 87a extends obliquely inward toward the inner diameter side of the inner sheath 30. Further, a plurality of the fitting pieces 87a are arranged at predetermined intervals in the circumferential direction of the protruding portion 52 of the tip cap 50. A portion 53b of the protruding portion 52 of the tip cap 50 facing the tip 27 of the outer sheath 20 has an inverse tapered surface shape that is gradually drawn from the outer periphery of the base toward the tip side of the tip cap 50.

Then, as shown in FIG. 11, the outer sheath 20 and the inner sheath 30 are moved relative to each other, and the fitting piece 87a of the second fitting portion 87 is provided between the fitting pieces 85a and 85a of the first fitting portion 85. And the fitting piece 85a of the first fitting portion 85 is fitted between the fitting pieces 87a and 87a of the second fitting portion 87. That is, by fitting the fitting pieces of the other fitting portion between the fitting pieces of the one fitting portion, the fitting portions 85 and 87 are coupled to each other, and the insertion guide member 70D is formed. The distal end side of the outer sheath 20 and the proximal end side of the projecting portion 52 of the distal end cap 50 are connected to each other via the via. As a result, the distal end opening of the housing portion 40 is closed, and the medical device 1 is housed and arranged in the housing portion 40. In this state, the insertion guide member 70D causes the boundary portion 45 (the distal end 27 of the outer sheath 20 and the protruding portion 52 of the distal end cap 50 between the distal end side of the outer sheath 20 and the proximal end side of the protruding portion 52 of the distal end cap 50). It covers the entire circumference of the facing portion 53b).

On the other hand, the outer sheath 20 and the inner sheath 30 are moved relative to each other, and the fitting piece of the other fitting portion is pulled out from between the fitting pieces of the one fitting portion, so that both fitting portions 85, The coupled state of 87 is released, and the medical device 1 is released from the housing section 40.

Further, in this embodiment, unlike the insertion guide member 70 in the first embodiment, it is not necessary to break the tubular portion 71, and as described above, the combined state of the fitting portions 85 and 87 is released. As a result, the medical device 1 can be released from the housing portion 40, and thus the force required when the outer sheath 20 and the inner sheath 30 are relatively moved can be reduced when the medical device 1 is released.

FIG. 12 shows a sixth embodiment of the medical device transport device according to the present invention. It should be noted that substantially the same parts as those in the above-described embodiment are designated by the same reference numerals and the description thereof will be omitted.

The medical device transport device 10E of this embodiment (hereinafter, also simply referred to as “transport device 10E”) is different from the above embodiment in the shape and structure of the insertion guide member 70E.

That is, the insertion guide member 70E of this embodiment is formed of a swellable material such as hydrogel that swells with a liquid such as water or blood. As shown in FIG. 12A, the insertion guide member 70E is attached to the tapered step portion 59 of the distal end cap 50 so as to form an annular shape. In this embodiment, the tapered step portion 59 of the distal end cap 50 forms a part of the insertion portion 53 that is inserted into the inner periphery of the outer sheath 20 on the distal end side, and the portion on the distal end side of the top portion 54 is The protrusion 52 is formed.

Then, when a liquid such as water or blood is immersed in the insertion guide member 70E, the insertion guide member 70E swells and forms a distal end 27 of the outer sheath 20 and a stepped portion 59 forming a part of the insertion portion 53 of the distal end cap 50. The boundary portion 45 between the two is filled so as to cover the entire circumference.

In addition, in this embodiment, it is not necessary to fix the insertion guide member 70E on the distal end side of the outer sheath 20 or the proximal end side of the protruding portion 52 of the distal end cap 50, and the tapered step portion 59 of the distal end cap 50 is provided. Since it is only necessary to attach the insertion guide member 70E made of a swelling material, the structure for covering the boundary portion 45 can be simplified, and the flexibility on the distal end side of the outer sheath can be increased, so that the inside of the body can be improved. The insertability can also be improved.

The present invention is not limited to the above-described embodiment, and various modified embodiments are possible within the scope of the gist of the present invention, and such an embodiment is also included in the scope of the present invention. ..

1 medical device 2 guide wire 10, 10A, 10B, 10C, 10D, 10E medical device transport device (transport device)
20 Outer sheath 21 Tip part 30 Inner sheath 31 Tip part 35 Hub 40 Housing part 45 Boundary part 50 Tip cap 52 Projection parts 70, 70A, 70B, 70C, 70D, 70E Insertion guide member 71 Cylindrical part

Claims (5)

An accommodating device having an outer sheath and an inner sheath inserted into the outer sheath, and capable of accommodating a medical device between an inner circumference of a distal end portion of the outer sheath and an outer circumference of a distal end portion of the inner sheath. A portion is provided, and in the medical device transporting device configured to releasable the medical device housed in the housing part, by relatively moving the outer sheath and the inner sheath,
A distal end cap is attached to the distal end portion of the inner sheath, and the distal end cap has a protruding portion protruding from the distal end side of the outer sheath, and the proximal end side of this protruding portion is the distal end of the outer sheath. It is possible to separate from the side,
At least a portion of the boundary portion between the base end side of the protruding portion of the distal end cap and the tip end side of the outer sheath, which is a portion separated from the outer sheath in the axial direction of the outer sheath. A device for transporting a medical device, which is provided with an insertion guide member that covers physically. The medical instrument according to claim 1, wherein the insertion guide member has a plate-shaped extending portion that extends from the proximal end side of the protruding portion of the distal end cap and covers the outer periphery of the distal end of the outer sheath. Equipment transporter. The medical device transport apparatus according to claim 2, wherein a plurality of the extending portions are provided, and the extending portions extend in parallel with each other. The insertion guide member is connected to a proximal end side of the protruding portion of the distal end cap and a distal end side of the outer sheath, and is configured to restrict relative movement between the outer sheath and the inner sheath. ,
Further, the insertion guide member is provided with an easily breakable portion that breaks the insertion guide member and allows relative movement of the outer sheath and the inner sheath. The medical device transport apparatus according to item 1. The insertion guide member has a tubular portion arranged on an outer periphery of a boundary portion between the proximal end side of the protruding portion of the distal end cap and the distal end side of the outer sheath, and the tubular portion is the distal end cap of the distal end cap. It is configured to connect the base end side of the projecting portion and the tip end side of the outer sheath to restrict relative movement between the outer sheath and the inner sheath,
A plurality of holes are provided in the tubular portion along the boundary portion in the circumferential direction at predetermined intervals, and the easily breakable portion is formed in a portion between the holes adjacent to each other in the circumferential direction. The medical device transport apparatus according to claim 4.

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