JP3162588U - Tip movable catheter - Google Patents

Abstract

Provided is a tip movable catheter which has good operability and is less likely to cause damage to a wire. A first movable member 34a to which a first wire 5a is connected is loosely fitted in an arc-shaped groove 36 of a rotation operation member 32 so that the rotation operation member 32 is rotated in a first direction B1. In this case, the first end portion 35a abuts to rotate according to the rotation of the rotation operation member 34a, and the first wire is pulled by the first movable member 34a. At this time, the second movable member 34b to which the second wire 5b is connected is stopped by coming into contact with the second protrusion 35b by the tensile force of the second wire 5b, and the second wire 5b is not slackened. Similarly, when the rotation operation member 32 is rotated in the second direction opposite to the first direction B1, the first wire 5a is not slackened. [Selection] Figure 19

Description

  The present invention relates to a catheter that is a medical treatment instrument used for performing various treatments, examinations, and the like, and particularly relates to a steerable catheter capable of freely deflecting a distal end portion.

  For catheters (including electrode catheters, ablation catheters, and catheter sheaths) that are inserted through body cavities, lumens, blood vessels, or the like to target tissues such as various organs (for example, the heart). In order to facilitate the access of the catheter, the direction of the distal end (tip) of the catheter inserted into the body is controlled by operating the operation unit provided at the distal end (base end) of the catheter disposed outside the body. A movable tip catheter that can be deflected by this is known (see Patent Document 1 and Patent Document 2).

  The portion to be deflected of the distal end portion of the catheter tube is set to have a stepwise lower hardness as it goes to the distal end, for example, at a position 180 ° opposite to a ring (pull ring) that is integrally inserted at the distal end. By connecting each distal end of a pair of wires, pulling one wire (first wire) and loosening the other wire (second wire) at each proximal end of the pair of wires; The direction of the tube tip can be controlled.

  As an operation portion provided at the proximal end of such a catheter tube, in Patent Document 1, the proximal ends of the first wire and the second wire are connected to a rotary knob provided to be rotatable with respect to the operation hub. When the rotary knob is rotated in the first direction, the first wire is pulled and the second wire is loosened. When the rotary knob is rotated in the second direction opposite to the first direction, the second wire is pulled. Is pulled to loosen the first wire so that the direction of the tube tip can be controlled. At this time, since loosening of the wire may lower the operability, in Patent Document 1, the first protrusion corresponding to the first wire and the second protrusion corresponding to the second wire are used for the rotary knob. When the rotary knob is rotated in the first direction, the second protrusion comes into contact with the second wire to absorb the slack, and when the rotary knob is rotated in the second direction. The first protrusion comes into contact with the first wire to absorb the slack.

Japanese Patent No. 4283703 Special table 2009-537244 gazette

  However, according to the conventional technique as described in Patent Document 1, the protrusion is brought into contact with the wire that has slackened along with the rotation of the rotary knob, and the slack is absorbed. There is a problem that friction is generated between the protrusion and the wire with the operation, and the wire may be damaged. Moreover, in the thing of patent document 1, there also existed a problem that another device (for example, ablation catheter) cannot be inserted and used in a catheter tube via an operation part.

  The present invention has been made in view of these points, and an object of the present invention is to provide a tip movable catheter that has good operability and is less likely to cause damage to a wire.

  A tip movable catheter according to the present invention includes a catheter tube, a ring member provided at a distal end of the catheter tube, a first wire and a second wire each having a distal end connected to the ring member, And an operating portion provided at the proximal end of the catheter tube. The operation portion is attached to the fixed operation member so as to rotate by a predetermined angle in a first direction and a second direction opposite to the first direction, and a fixed operation member having a first protrusion and a second protrusion. A rotation operation member having a substantially arc shape centered on the rotation center and having an arcuate groove having a first end and a second end, and a first movable member and a second movable member that are paired with each other. And.

  When the first movable member is slidably fitted on the side of the arcuate groove of the rotation operation member close to the first end, and the rotation operation member is rotated in the first direction. When the first end portion comes into contact, the first operation member rotates in accordance with the rotation of the rotation operation member, and when the first movable member is rotated in the first direction, the first wire is The proximal end of the first wire is connected so as to be pulled, and the first movable member is rotated by the tensile force of the first wire when the rotary operation member is rotated in the second direction. It is configured to rotate in the second direction and stop in contact with the first protrusion. The second movable member is slidably fitted slidably on a side near the second end of the arcuate groove of the rotation operation member, and the rotation operation member is rotated in the second direction. When the second end portion comes into contact, the second operation member rotates according to the rotation of the rotation operation member. When the second movable member is rotated in the second direction, the second wire is The proximal end of the second wire is connected so as to be pulled, and the second movable member is rotated by the tensile force of the second wire when the rotary operation member is rotated in the first direction. It is configured to rotate in the first direction and stop in contact with the second protrusion.

  In the distal-end movable catheter according to the present invention, the operation portion has a passage for inserting another catheter into the catheter tube via the operation portion, and the first movable member and the second movable member are respectively provided. Can be provided outside the passage regardless of its rotational position.

  In the tip movable catheter according to the present invention, the first movable member has a first arcuate edge portion arranged so as to be substantially concentric with the arcuate groove, and the first arcuate edge portion is provided on the first arcuate edge portion. A first wire guide groove that is recessed along the first wire, the first wire is disposed along the first wire guide groove, and a distal end portion of the first wire is fixed to the first movable member, 2 The movable member has a second arcuate edge arranged so as to be substantially concentric with the arcuate groove, and the second arcuate edge has a second wire guide groove recessed along the second arcuate edge. Then, the second wire can be disposed along the second wire guide groove so that the tip end portion of the second wire is fixed to the second movable member.

  In the tip movable catheter according to the present invention, the ring member has a first groove portion and a second groove portion facing each other on a distal end side thereof, and is fitted into the first groove portion at a distal end of the first wire. A first fitting member is integrally fixed, a second fitting member fitted into the second groove is fixed integrally to a distal end of the second wire, and the first fitting member is fixed to the first wire. The first fitting member is fixed to the ring member by fitting into the one groove portion, and the second fitting member is fixed to the ring member by fitting the second fitting member into the second groove portion. You can In this case, the first groove portion and the second groove portion can be provided at a position facing the ring member at 180 °.

  According to the tip movable catheter of the present invention, the proximal ends of the first wire and the second wire are connected to the first movable member and the second movable member that slide independently of each other along the arcuate groove of the rotation operation member. Since the rotation of the first movable member or the second movable member in the direction in which the first wire or the second wire is loosened is stopped by the first protrusion or the second protrusion, the first wire or the second wire The occurrence of slack itself is suppressed. Therefore, it is possible to suppress damage to the wire due to the contact between the wire and the protrusion, as compared with a structure in which the generated slack is absorbed by the protrusion after approving that the wire is slack as in the prior art. . Further, since the wire is not slackened, it is possible to prevent the operability from being lowered due to the slack of the wire. Furthermore, since the first movable member and the second movable member can slide independently of each other, another device (for example, an ablation catheter) can be inserted into the operation portion by appropriately defining the sliding range. This space can be secured, and other devices can be inserted into the catheter tube via the operation section.

It is a top view which shows the external appearance structure of the tip movable catheter of embodiment of this invention. It is sectional drawing along the AA line of FIG. It is a side view which decomposes | disassembles and shows the structure of the grip part and operation part of the tip movable catheter of embodiment of this invention. It is a top view of the half member which constitutes the grip part of the tip movable catheter of the embodiment of the present invention. It is a bottom view of the half member which constitutes the grip of the tip movable catheter of the embodiment of the present invention. It is a disassembled perspective view which shows the structure of the operation part of the tip movable catheter of embodiment of this invention. It is a top view of the state which removed the 2nd rotation operation member which shows the structure of the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the structure of the operation part of the tip movable catheter of embodiment of this invention. It is a top view which shows the fixed operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the fixed operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a top view which shows the 1st rotation operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the 1st rotation operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the 2nd rotation operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a front view which shows the 2nd rotation operation member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a top view which shows the 1st fan-shaped member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the 1st fan-shaped member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a top view which shows the 2nd fan-shaped member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a rear view which shows the 2nd fan-shaped member which comprises the operation part of the tip movable catheter of embodiment of this invention. It is a figure which shows operation | movement of the operation part of the tip movable catheter of embodiment of this invention, and is a figure which shows the case where a rotation operation member is rotated in the 1st direction. It is a figure which shows operation | movement of the operation part of the tip movable catheter of embodiment of this invention, and is a figure which shows the case where a rotation operation member is rotated in the 2nd direction. It is a perspective view which shows the structure of the pull ring used for the tip movable catheter of embodiment of this invention. In the tip movable catheter of the embodiment of the present invention, it is a perspective view showing a state where a precision pipe is arranged at the distal end of the wire. It is a perspective view which shows the state in the middle of processing the precision pipe arrange | positioned at the distal end of a wire in the tip movable catheter of embodiment of this invention. In the tip movable catheter of the embodiment of the present invention, it is a perspective view showing a state where a precision pipe disposed at a distal end of a wire is processed to form a pull wire portion. In the tip movable catheter of the embodiment of the present invention, it is a perspective view showing a connection structure between a wire and a pull ring, and is a view showing a state in which a pull wire portion is fitted in a notch groove of the pull ring. In the tip movable catheter of the embodiment of the present invention, it is a perspective view showing a connection structure between a wire and a pull ring, and shows a state in which the pull wire portion is fitted into a notch groove of the pull ring and the pull wire portion is welded and fixed to the pull ring. It is.

  Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings. The catheter sheath (tip movable sheath) as the tip movable catheter of this embodiment precedes, for example, an electrode catheter for detecting an electrocardiogram or an ablation catheter for cauterizing an affected part when performing catheter ablation. A catheter that is inserted and guides these electrode catheters, ablation catheters, and the like. Hereinafter, a catheter sheath will be described as an example of the distal movable catheter to which the present invention is applied. However, the present invention can also be applied to an electrode catheter, an ablation catheter, and other distal movable catheters.

  Catheter ablation is a treatment method for treating an arrhythmia occurring in the heart. An ablation catheter having a high-frequency electrode at its distal end is passed through a blood vessel to the myocardial tissue causing the arrhythmia in the heart. This is a treatment method in which the cardiac muscle tissue or its vicinity is cauterized at about 60 to 70 ° C. to cause coagulative necrosis, thereby interrupting the arrhythmia circuit.

  First, FIG. 1 and FIG. 2 will be referred to. The catheter sheath 1 includes a sheath body 2 as a catheter tube, and an operation portion 3 and a grip portion 4 provided at the proximal end of the sheath body 2.

  Although the sheath body 2 is formed of a hollow tube and is not shown in the figure, for example, a multilayer tube including a blade layer made of mesh-like stainless steel and a plurality of resin layers is used. A part of the distal end side of the sheath body 2 is a deflecting portion 21 whose direction can be arbitrarily deflected, and the deflecting portion 21 is set to have a lower hardness (flexibly) than the remaining portion, Further, the deflection portion 21 is set so that the hardness decreases gradually or step by step toward the tip.

  An insertion hole 41 communicating with the main lumen 22 which is a hollow portion of the sheath body 2 is formed in the operation portion 3 and the grip portion 4 attached to the proximal end of the sheath body 2, and when the catheter sheath 1 is used ( At the time of treatment), the electrode catheter and the ablation catheter described above are inserted through the insertion hole 41, guided by the main lumen 22, and guided to the myocardial tissue to be treated.

  In the thick wall of the sheath body 2, a pair of sub-lumens 23 a and 23 b that are substantially parallel to the main lumen 22 are formed. The sub-lumens 23a and 23b are formed at positions opposed to each other by 180 degrees, and the first wire 5a and the second wire 5b made of metal such as stainless steel are respectively inserted into the sub-lumens 23a and 23b. ing.

  An annular pull ring (ring member) 24 is integrally attached to the distal end of the sheath body 2 (near the tip of the deflecting portion 21) so as to be inserted into the main lumen 22. The distal ends of the first wire 5a and the second wire 5b are connected and fixed at the opposite positions. The structure for connecting and fixing the distal ends of the first wire 5a and the second wire 5b to the pull ring 24 will be described in detail later.

  Proximal ends of the first wire 5 a and the second wire 5 b are connected to an operation unit 3 provided at the proximal end of the sheath body 2. The operation portion 3 is held by a holding portion 42 provided on the tip (distal end) side of the grip portion 4. In the present embodiment, as shown in FIGS. 3 to 5, the grip portion 4 is composed of a pair of half-members 4 a and 4 b having substantially symmetrical shapes, and holds the operation portion 3 by sandwiching the operation portion 3 in the holding portion 42. They are integrated with each other. The proximal end of the sheath body 2 is connected to the distal end portion 43 of the grip portion 4. 4 and 5, reference numeral 41 a indicates a hole for forming the insertion hole 41 for inserting the other device described above.

  As shown in FIGS. 6 to 8, the operation unit 3 includes a fixed operation member 31, rotation operation members 32 and 33 rotatably supported by the fixed operation member 31, and a first fan-shaped member (first movable member). 34a and a second fan-shaped member (second movable member) 34b.

  As shown in FIGS. 6, 9, and 10, the fixing operation member 31 includes a front communication portion 31 a that communicates with the sheath body 2, a rear communication portion 31 b that communicates with the insertion hole 41 of the grip portion 4, and a substantially circular shape. An annular edge 31c is provided. The inner side of the edge portion 31c is a penetration portion, and the first protrusion 35a, the second protrusion 35b, and the third protrusion 35c that protrude toward the inner side (center of the edge portion 31c) are integrally formed on the inner surface of the edge portion 31c. Is formed. An inner portion of the edge portion 31c is an annular projecting portion 31d that slightly projects in an annular shape. The front communication part 31a and the rear communication part 31b are integrally formed with protrusions 31e and 31f for positioning when being held by the grip part 4, respectively. These protrusions 31e and 31f are respectively fitted into receiving holes 4e and 4f (see FIG. 4) formed inside the half member 4b of the grip part 4, so that when the grip part 4 holds the operation part, This is for determining the position of 3.

  As shown in FIGS. 1, 6, 7, and 8, the rotation operation members 32 and 33 include a first rotation operation member 32 and a second rotation operation member 33. The first rotation operation member 32 and the second rotation operation member 33 are predetermined in a first direction (counterclockwise in FIG. 1) B1 and a second direction (clockwise in FIG. 1) B2 opposite to the first direction B1. The fixed operation member 31 is rotatably supported so as to be reciprocally rotated by an angle (approximately 270 degrees in the present embodiment).

  As shown in FIGS. 6, 11, and 12, the first rotation operation member 32 includes a substantially disk-shaped disk part 32 a and a pair of divided gripping parts 32 b and 32 b that project left and right. . The divided gripping portion 32b is formed with a concave portion 32c that fits into a convex portion 33c formed on the divided gripping portions 33b and 33b of the second rotation operation member 33 described later. The circular plate portion 32a is formed with a circular depressed portion 32d that is slightly depressed corresponding to the annular projecting portion 31d of the fixing operation member 31 described above.

  A through hole 32e is formed at the center of the circular depression 32d, and an annular protrusion 32f that slightly protrudes outward (downward in FIG. 12) is formed around the through hole 32e. The circular recess 32d is formed with an arcuate groove 36 having a first arc 36a and a second end 36b, which is substantially arc-shaped around the center of the disc 32a. In the present embodiment, the arc-shaped groove 36 is formed over an angle range of approximately 270 degrees. An intermediate portion of the arc-shaped groove 36 is a wide portion 36c having a wide width with respect to a narrow portion on the side close to the first end portion 36a or the second end portion 36b. The wide portion 36c constitutes an introduction portion when a first fan-shaped member 34a and a second fan-shaped member 34b described later are loosely fitted.

  As shown in FIGS. 6, 13, and 14, the second rotation operation member 33 includes a substantially disc-shaped disc portion 33 a and a pair of split gripping portions 33 b and 33 b that project left and right. The split gripping portion 33b is formed with a convex portion 33c that fits into the concave portion 32c formed in the split gripping portion 32b of the first rotation operation member 32 described above. In addition, a pair of window portions 33d and 33d are formed in the disc portion 33a. A through hole 33e is formed at the center of the disc portion 33a, and an annular protrusion 33f that slightly protrudes outward (upper side in FIG. 14) is formed around the through hole 33e.

  The first rotation operation member 32 is disposed on one side (the rear surface in FIG. 6, the lower surface in FIG. 8) side of the fixed operation member 31, and the second rotation is performed on the other surface (front surface in FIG. 6, upper surface in FIG. 8) side. The operation member 33 is arranged, the fixed operation member 31 is sandwiched between the first rotation operation member 32 and the second rotation operation member 33, and the concave portion 32c provided in the divided grip portion 32b of the first rotation operation member 32 and the second The rotation operation members 32 and 33 are rotatably attached to the fixed operation member 31 by fitting the projections 33 c provided on the divided gripping portion 33 b of the rotation operation member 33.

  As shown in FIGS. 6 and 15 to 18, the first fan-shaped member 34 a and the second fan-shaped member 34 b are formed in a symmetrical shape so as to be paired with each other, and have an outer large arc and an inner small arc. It has a substantially fan-like plate-like portion 37a and a substantially arc-shaped leg portion 37b slidably fitted in the arc-shaped groove 36 of the first rotation operation member 32 described above. The front end (the lower end in FIGS. 16 and 18) of the leg portion 37b is formed to be slightly wide to form a wide portion 37c, and the leg portion 37b is loosely fitted into the arc-shaped groove 36 so that the leg portion 37b can be pulled out from the arc-shaped groove 36. It is to be prevented. The outer large arc and the inner small arc of the first fan-shaped member 34a and the second fan-shaped member 34b are substantially concentric with the arc-shaped groove 36 in a state where the leg portions 37b are loosely fitted in the arc-shaped groove 36, respectively. Is formed. Grooves for guiding the wires 5a and 5b (first wire guide groove, second wire guide groove) in the large arc portion (first arc-shaped edge portion, second arc-shaped edge portion) outside the plate-like portion 37a. ) A pair of screw holes 37e into which screws 38 (see FIG. 7) for fixing 37d and the wires 5a and 5b are screwed are formed.

  In a state where the fixed operation member 31 is superimposed on the first rotation operation member 32, the wide portion 36 c of the arc-shaped groove 36 of the first rotation operation member 32 is formed with respect to the first rotation operation member 32 with respect to the fixed operation member 31. The leg member 37a (the wide portion 37c) of the first fan-shaped member 34a is inserted into the wide portion 36c by rotating the fixed operation member 31 so as to be positioned between the first projection 35a and the third projection 35c. By moving to the first end portion 36a side, the first fan-shaped member 34a is slidably fitted in a narrow portion of the arc-shaped groove 36 on the side close to the first end portion 36a.

  The first rotation operation member 32 is fixed to the fixed operation member 31, and the wide portion 36 c of the arc-shaped groove 36 of the first rotation operation member 32 is disposed between the second protrusion 35 b and the third protrusion 35 c of the fixed operation member 31. The second fan-shaped member 34b is rotated by being rotated so as to be positioned, and the leg part 37b (wide part 37c) of the second fan-shaped member 34b is inserted into the wide part 36c and moved to the second end 36b side. Is slidably fitted in a narrow portion on the side close to the second end portion 36 b of the arc-shaped groove 36.

  As shown in FIG. 7, the line passing through the pair of gripping portions 32b of the first rotary operation member 32 is substantially the same as the line passing through the center of the front communication portion 31a and the rear communication portion 31b of the fixed operation member 31. In a state set so as to be orthogonal (hereinafter sometimes referred to as a neutral state), the first end portion 36a of the arc-shaped groove 36 is set at a position overlapping the first protrusion 35a. Since the two end portions 36b are set at positions overlapping the second protrusions 35b, in this state, the first fan-shaped member 34a is formed into the arc-shaped groove 36 at a portion between the first protrusions 35a and the third protrusions 35c. The second fan-shaped member 34b is slidable along the arc-shaped groove 36 at a portion between the second protrusion 35b and the third protrusion 35c.

  The proximal ends of the first wire 5 a and the second wire 5 b are guided from the proximal end of the sheath body 2 through the front communication portion 31 a of the fixed operation member 31. The proximal end of the first wire 5a passes between a groove 37d formed in a portion on the large arc side outside the first fan-shaped member 34a and the edge 31a of the fixed operation member 31, and a pair of screws 38 is provided. Is connected and fixed to the first fan-shaped member 34a. The proximal end of the second wire 5b passes between a groove 37d formed in a portion on the large arc side outside the second fan-shaped member 34b and the edge 31a of the fixing operation member 31, and a pair of screws 38 is provided. Is connected and fixed to the second fan-shaped member 34b.

  In the neutral state shown in FIG. 7, the first fan-shaped member 34a is rotated in the second direction (in the direction of arrow B2 in FIG. 1) by the tensile force of the first wire 5a, and the leg portion 37b of the first fan-shaped member 34a is in the first state. It is in the state where it stopped in contact with one protrusion 35a. Further, the second fan-shaped member 34b rotates in the first direction (the direction of arrow B1 in FIG. 1) by the tensile force of the second wire 5b, and the leg portion 37b of the second fan-shaped member 34b comes into contact with the second protrusion 35b. It is in a stopped state.

  When the first rotation operation member 32 is rotated in the first direction (the direction of the arrow B1 in FIG. 1) from this neutral state, the first end portion 36a of the arc-shaped groove 36 becomes the leg portion 37b of the first fan-shaped member 34a. When abutting and further rotating, the first fan-shaped member 34a rotates with the first rotation operating member 32 and can be rotated until it abuts on the third protrusion 35c as shown in FIG. The first wire 5a is pulled by the rotation of the first fan-shaped member 34a, and the deflection portion 21 at the tip is deflected as indicated by an arrow B3 in FIG. At this time, the second fan-shaped member 34b keeps its leg portion 37b in contact with the second protrusion 35b and stopped by the tensile force of the second wire 5b.

  On the other hand, when the first rotation operation member 32 is rotated in the second direction (the arrow B2 direction in FIG. 1), the second end portion 36b of the arc-shaped groove 36 comes into contact with the leg portion 37b of the second fan-shaped member 34b. When rotated, the second fan-shaped member 34b rotates together with the first rotation operation member 32 and can be rotated until it comes into contact with the third protrusion 35c as shown in FIG. The second wire 5b is pulled by the rotation of the second fan-shaped member 34b, and the deflection portion 21 at the tip is deflected as shown by an arrow B4 in FIG. At this time, the first fan-like member 34a keeps its leg 37b in contact with the first protrusion 35a and stopped by the tensile force of the first wire 5a.

  As described above, according to the present embodiment, the proximal ends of the first wire 5a and the second wire 5b are first fan-shaped that slide independently of each other along the arc-shaped groove 36 of the first rotation operation member 32. The first fan member 34a and the second fan member 34b are connected to the member 34a and the second fan member 34b, and the rotation of the first fan member 34a or the second fan member 34b in the direction in which the first wire 5a or the second wire 5b is loosened is the first protrusion 35a or the second protrusion. Since it stops by 35b, slack does not arise in the 1st wire 5a or the 2nd wire 5b. Therefore, it is possible to suppress the damage to the wire due to the contact between the wire and the protrusion as compared with the structure in which the slack that occurs is recognized by the protrusion after approving that the wire is loose as in the prior art. .

  In addition, the operation unit 3 communicates with an insertion hole 41 (see FIGS. 1, 4, and 5) of the grip unit 4 as indicated by a dotted oval (reference numeral 3 a) in FIGS. 19 and 20. A through hole (passage) is formed. As described above, since the first fan-shaped member 34a rotates along the arc-shaped groove 36 only at the portion between the first protrusion 35a and the third protrusion 35c, the first fan-shaped member 34a is formed in the through hole 3a. The part is not closed. Similarly, since the second fan-shaped member 34b rotates along the arc-shaped groove 36 only at the portion between the second protrusion 35b and the third protrusion 35c, the second fan-shaped member 34b moves the portion of the through hole 3a. It will not be closed. Therefore, another device (for example, an ablation catheter) inserted from the insertion hole 41 of the grip part 4 passes through the through hole 3a in the operation part 3 and has no obstruction, so that the main lumen 22 of the sheath body 2 is not damaged. Led in.

  By the way, the connection between the pull ring and the distal ends of the pair of wires is performed by, for example, using a flat wire as a wire and directly welding the distal end of the flat wire to the side surface of the pull ring as described in Patent Document 2. It was done by sticking. However, welding may be inadequate, or metal fatigue may occur in the welded portion over time due to repeated use, and the wire to the pull ring may come off. If such wire detachment occurs during the procedure, there may be cases where rapid and reliable treatment cannot be performed. In addition, it is desirable that the pair of wires be accurately connected to the 180-degree facing position of the pull ring. However, in the related art, it is not always easy to connect to the accurate position.

  Considering this point, in the present embodiment, the following structure is adopted as a connection structure between the pull ring and the distal end of the wire. This will be described with reference to FIGS.

  First, as shown in FIG. 21, as a pull ring, a notch groove (first groove portion, second groove portion) 24a is formed at a position opposite to the distal end of the annular member made of metal such as stainless steel at 180 degrees. A pull ring 24 is prepared. Next, as shown in FIG. 22, a pair of precision pipes 25 are prepared by precisely machining a metal such as stainless steel into a cylindrical shape, and the tips (distal ends) of the wires 5a and 5b are respectively connected to the precision pipes 25. 23, the precision pipe 25 is deformed by caulking or pressing as shown in FIG. 23, and as shown in FIG. 24, a pull wire portion (first shape) in which the wires 5a and 5b are integrally fixed. (Fitting member, second fitting member) 25a is formed. Next, as shown in FIG. 25, the pull wire portion 25a is fitted into the pair of notch grooves (24a) of the pull ring 24, and the pull wire portion 25a is welded and fixed to the pull ring 24 as indicated by reference numeral 26 in FIG.

  If such a structure is used, even if the connection between the pull ring 24 and the pull wire portion 25a is removed, the pull wire portion 25a is fitted in the notch groove 24a of the pull ring 24. Can continue to hold. Further, since the pull wire portion 24a is welded to the pre-ring 24 without directly welding the wires 5a and 5b to the pull ring 24, heat at the time of welding is hardly transmitted to the wires 5a and 5b, and the wires 5a and 5b are deteriorated. The accompanying strength reduction can be made difficult to occur. Further, when the pull wire portion 25a is fitted into the notch groove 24a, the fitting work can be properly positioned at the 180-degree opposed position, so that the occurrence of misalignment can be prevented and the positioning work is facilitated. be able to.

  The embodiments described above are described for facilitating understanding of the present invention, and are 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.

1 ... tip movable sheath (catheter sheath)
2 ... sheath body 3 ... operation part 4 ... grip part 5a ... first wire 5b ... second wire 21 ... deflection part 22 ... main lumens 23a, 23b ... sub-lumen 24 ... pull ring 31 ... fixed operation member 32 ... first rotation operation Member 33 ... Second rotation operation member 34a ... First fan-like member 34b ... Second fan-like member 35a ... First projection 35b ... Second projection 35c ... Third projection 36 ... Arc-shaped groove 36a ... First end 36b ... Second End 37b ... Leg

Claims (5)

A catheter tube;
A ring member provided at the distal end of the catheter tube;
A first wire and a second wire having respective distal ends connected to the ring member;
An operation portion provided at the proximal end of the catheter tube,
The operation unit is
A fixing operation member having a first protrusion and a second protrusion;
It is attached to the fixed operation member so as to rotate by a predetermined angle in a first direction and a second direction opposite to the first direction, and has a substantially arc shape centered on the rotation center and a first end portion A rotation operation member formed with an arcuate groove having a second end;
A first movable member and a second movable member that are paired with each other;
When the first movable member is slidably fitted on the side of the arcuate groove of the rotation operation member close to the first end, and the rotation operation member is rotated in the first direction. , The first end abuts to rotate according to the rotation of the rotation operation member,
A proximal end of the first wire is connected to the first movable member so that the first wire is pulled when the first movable member is rotated in the first direction;
When the rotation operation member is rotated in the second direction, the first movable member rotates in the second direction by the tensile force of the first wire, and stops by contacting the first protrusion. And
The second movable member is loosely slidably fitted to the side of the arcuate groove of the rotation operation member that is close to the second end, and the rotation operation member is rotated in the second direction. , The second end abuts to rotate according to the rotation of the rotation operation member,
The proximal end of the second wire is connected to the second movable member so that the second wire is pulled when the second movable member is rotated in the second direction.
When the rotation operation member is rotated in the first direction, the second movable member rotates in the first direction by the pulling force of the second wire, and stops in contact with the second protrusion. A tip movable catheter characterized by being configured to do so. The operation part has a passage for inserting another catheter into the catheter tube via the operation part,
2. The distal movable catheter according to claim 1, wherein each of the first movable member and the second movable member is provided outside the passage regardless of a rotational position thereof. The first movable member has a first arcuate edge formed so as to be substantially concentric with the arcuate groove, and the first arcuate edge is recessed along the first arcuate edge. The first wire is disposed along the first wire guide groove, and the tip of the first wire is fixed to the first movable member,
The second movable member has a second arcuate edge formed so as to be substantially concentric with the arcuate groove, and the second arcuate edge is recessed along the second arcuate edge. The second wire is disposed along the second wire guide groove, and a tip end portion of the second wire is fixed to the second movable member. The tip movable catheter according to claim 1. The ring member has a first groove portion and a second groove portion opposed to each other on the distal end side thereof,
A first fitting member fitted into the first groove is integrally fixed to a distal end of the first wire;
A second fitting member fitted into the second groove is integrally fixed to a distal end of the second wire;
Fitting the first fitting member into the first groove and fixing the first fitting member to the ring member;
2. The distal movable catheter according to claim 1, wherein the second fitting member is fitted into the second groove portion, and the second fitting member is fixed to the ring member.   The distal tip movable catheter according to claim 4, wherein the first groove portion and the second groove portion are provided at 180 ° facing positions of the ring member.

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