JP5377151B2 - Medical instrument and luminal organ communication kit - Google Patents

Description

  The present invention relates to a medical instrument and a luminal organ communication kit including the medical instrument.

  For example, for the treatment of hemodialysis access, vascular occlusion, gastrointestinal tract obstruction, portal venous circulation shunt, etc., there is a case where a treatment is made to connect the lumens of two luminal organs. This procedure is often performed by a surgical technique, but as a transcutaneous technique, for example, transjugular intrahepatic portosystemic shunt (TIPS) is known (see, for example, Non-Patent Document 1 or 2). In this technique, first, two lumen organs are used with a dedicated puncture needle so that the tip of the puncture needle passes through one lumen organ and then exits, and then remains in the lumen of the other lumen organ. Puncture. When only the puncture needle is removed from the puncture needle through the guide wire, a path connecting the lumens of the two luminal organs is created by the guide wire. Next, the path is expanded by pushing the dilator while following the guide wire. Subsequently, the delivery sheath is pushed forward while following the guide wire, and is arranged so as to straddle two luminal organs in the expanded path, and then the guide wire is removed. Then, when the stent is placed in the path via the delivery sheath and the delivery sheath is removed, the lumens of the two luminal organs are communicated by the stent. Here, the puncture needle used in the above method is formed so as to have a length and a curve suitable for the position and shape of the luminal organ for each luminal organ to be treated. Therefore, it is necessary to change the puncture needle according to the luminal organ to be treated, and the same puncture needle cannot be used for various luminal organs.

  On the other hand, for example, Non-Patent Documents 3 to 5 propose a technique called a gun-sight approach using a linear puncture needle. In this method, first, after adjusting the position of the luminal organ so that the parts communicating with each other in the two luminal organs are aligned, the tip of the puncture needle penetrates the luminal organ on the near side and The two luminal organs are punctured with a puncture needle so as to remain in the lumen of the inner luminal organ. Next, the guide wire is passed through the puncture needle, the tip of the guide wire is inserted into the lumen of the hollow organ from the tip of the puncture needle, and is passed through the lumen of the lumen organ to be exposed on the skin surface. After that, the puncture needle is removed leaving the guide wire. The catheter is followed from the distal end side of the remaining guide wire, pushed forward until the distal end of the catheter reaches the lumen of the luminal organ on the near side, and then a new guide wire is passed through the catheter. Is inserted into the lumen of the luminal organ on the near side from the tip of the catheter. Then, when the first guide wire and the catheter are removed, a route connecting the lumens of the two luminal organs is created by the second guide wire. Thereafter, in the same procedure as TIPS described above, the path is expanded by a dilator, a delivery sheath is placed between two luminal organs in this path, and a stent is further placed. With this method, the two luminal organs are adjusted so that they are positioned in a straight line, so that the luminal organs can be punctured straight, and the same puncture needle is used for all the luminal organs to be treated. can do.

Richter GM, Noeldge G, Palmaz JC, et al. Transjugular intrahepatic portacaval stent shunt: preliminary clinical results.Radology 1990; 174: 1027-1030. Rossle M, Haag K, Ochs A, Sellinger M, Noldge G, Perarnau JM, et al. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding.N Engl J Med, 330: 165-171, 1994. Haskal ZJ, Duszak R, Jr., FurthEE.Transjugular intrahepatic transcaval portosystemic shunt: the gun-sight approach.J Vasc Interv Radiol 1996; 7: 139-142 Aytekin C, Boyvat F, Firat A, Coskun M, Boyacioglu S. Portacaval shunt creation using the percutaneous transhepatic-transjugular technique. Abdom Imaging 2003; 28: 287-292. Nyman UR, Semba CP, Chang H, Hoffman C, Dake MD.Percutaneous creation of a mesocaval shunt.J Vasc Interv Radiol 1996; 7: 769-773.

  By the way, in the method as described above, it is necessary to push the dilator forward in order to expand the path created by the guide wire. In the current method, the rear part of the dilator passed through the guide wire is pushed to give a force to advance to the tip part in the body. However, depending on the shape of the luminal organ to be treated, the material of the dilator, and the like, it is difficult for the dilator to transmit force to the tip of the deflection, and it is not easy to push the dilator into the path and expand it.

  Then, this invention makes it a subject to provide the medical instrument and medical kit which can make the lumen | bore of two luminal organs communicate easily.

  The medical device according to the present invention has been made to solve the above problems, and has a cylindrical delivery sheath and a tapered diameter-reduced portion formed at the tip, and the diameter-reduced portion is the delivery device. A dilator inserted into the delivery sheath so as to protrude from the distal end of the sheath, and a pulling wire for pulling the dilator in the protruding direction of the reduced diameter portion, and the dilator is disposed behind the delivery sheath. It can be pulled out only from the end side.

  The medical instrument according to the present invention is used by passing the pulling wire of the medical instrument through a path connecting the lumens of two luminal organs in advance. When the tip end of the pulling wire is pulled in this state, the dilator is pulled in the protruding direction of the reduced diameter portion, and passes through the path while expanding the path by the reduced diameter portion. Since the dilator is configured so that it cannot be pulled out from the distal end side of the delivery sheath, the delivery sheath is drawn into the expanded path following the dilator. When the delivery sheath is pulled to a position straddling the two luminal organs, the pulling of the pulling wire is stopped, and the dilator and the pulling wire are pulled out and removed from the rear end side of the delivery sheath. Thereby, only the delivery sheath remains in the path, and the lumens of the two luminal organs are communicated by the delivery sheath. As described above, since the medical instrument according to the present invention pulls the dilator and passes the path, the force is easily transmitted to the tip of the dilator, and the path connecting the lumens of the two luminal organs can be easily expanded. Can do.

  In the above-mentioned medical instrument, a pulling wire is inserted from the rear end side of the dilator formed in a cylindrical shape, and a sufficient length for communicating two luminal organs from the leading end portion of the pulling wire is from one end of the dilator. It is put out. The pulling wire is formed with a large-diameter portion whose outer diameter is larger than the inner diameter of the tip portion of the dilator at a position of the above length from the tip. According to this configuration, the dilator can be pulled without pulling the pulling wire from the dilator even when the tip of the pulling wire is pulled.

  In the medical instrument, a puller wire may be connected to the tip of the dilator.

  In addition, a luminal organ communication kit including the medical instrument can be configured. The luminal organ communication kit includes a cylindrical first and second insertion sheaths, a first snare wire having a loop-shaped first snare portion that can be opened and closed, A second snare wire having two snare portions, a cylindrical first puncture needle, and a first guide thread are provided and used as follows. First, the distal end portion of the first insertion sheath is percutaneously inserted into the lumen of the first luminal organ, the first snare wire is passed through the first insertion sheath, and the first snare portion is inserted. Is placed in the lumen of the first luminal organ. Similarly, the distal end portion of the second insertion sheath is percutaneously inserted into the lumen of the second luminal organ, and the second snare wire is penetrated into the second insertion sheath so that the second snare is inserted. The part is placed in the lumen of the second luminal organ. Next, puncture is performed with the first puncture needle so that the first puncture needle penetrates the first and second luminal organs and passes through the first and second snare portions. Subsequently, when the first guide thread is penetrated into the first puncture needle and the first puncture needle is removed, the first guide thread penetrates the first and second lumen organs. It remains in the state where it has passed through the second snare section. When the first snare portion is closed to grip one end portion of the first guide thread with the first snare portion, and the rear end portion of the first snare wire is pulled in this state, the first lumen One end of the first guide thread outside the organ is drawn into the first lumen organ, passes through the lumen of the first lumen organ and the first insertion sheath, It is pulled out from the rear end of the insertion sheath. Holding one end of the pulled first guide yarn and pulling the rear end of the second snare wire, the other end of the first guide yarn outside the second lumen organ is It is drawn into the second lumen organ, passes through the lumen of the second lumen organ and the second insertion sheath, and is pulled out from the rear end of the second insertion sheath. Thereafter, either one end or the other end of the drawn first guide yarn is connected to the pulling wire of the medical instrument described above. Thus, according to the above-mentioned luminal organ communication kit, the end portion of the first guide thread outside the first or second luminal organ can be drawn inside the luminal organ. The first puncture needle through which the first guide thread is passed only needs to penetrate the two luminal organs, and the tip of the first puncture needle is used as the lumen of the first or second luminal organ. There is no need to keep on. Thereby, the path | route which connects the lumen | bore of two luminal organs can be created easily.

  In addition, as a method of communicating the lumens of two luminal organs, a step of percutaneously inserting the distal end portion of the cylindrical first insertion sheath into the lumen of the first luminal organ, Disposing an openable and closable loop-shaped first snare portion formed at the tip of the snare wire in the lumen of the first luminal organ through the first insertion sheath, and a cylindrical second A step of percutaneously inserting the distal end portion of the insertion sheath into the lumen of the second luminal organ, and the second insertion of the loop-shaped second snare portion formed at the distal end of the second snare wire. Placing the second lumen organ in a lumen through a sheath, and passing through the first and second snare portions with a cylindrical first puncture needle; A step of penetrating an organ, and a first guide thread is inserted into the first puncture needle so as to penetrate the first puncture needle; The step of removing the first puncture needle while leaving the first guide yarn, and pulling the rear end portion of the first snare wire while holding the first guide yarn by the first snare portion A step of pulling out one end portion of the first guide yarn from the rear end of the first insertion sheath; and pulling the rear end portion of the second snare wire to pull the first end from the rear end of the second insertion sheath. A step of pulling out the other end portion of the one guide yarn, and a step of connecting the pulling wire of the medical device described above to one end portion or the other end portion of the first guide yarn.

  According to the present invention, the lumens of two luminal organs can be easily communicated.

It is front sectional drawing of the medical instrument which concerns on 1st and 2nd embodiment of this invention. 1 is a schematic view of a luminal organ communication kit according to a first embodiment of the present invention. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic of the luminal organ communication kit which concerns on 2nd Embodiment of this invention. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit. It is the schematic which shows the usage method of the same luminal organ communication kit.

  Hereinafter, embodiments of a medical instrument and a luminal organ communication kit including the same according to the present invention will be described with reference to the drawings. In addition, the size ratio of the various instruments in each figure differs from the actual size ratio.

(First embodiment)
Hereinafter, a first embodiment of a medical instrument and a luminal organ communication kit including the same according to the present invention will be described with reference to FIGS.

  First, the medical instrument 1 according to the first embodiment will be described. As shown in FIG. 1, the medical instrument 1 includes a delivery sheath 11 formed in a cylindrical shape, and a dilator 12 is inserted into the delivery sheath 11. The dilator 12 has a tapered diameter-reducing portion 121 that decreases in diameter toward the distal end, and the diameter-reduced portion 121 protrudes from the distal end side of the delivery sheath 11. A flange portion 122 is formed at the rear end of the dilator 12, and the dilator 12 cannot be pulled out from the front end side of the delivery sheath 11 by the flange portion 122 being caught by the rear end of the delivery sheath 11. . The dilator 12 has a cylindrical shape, and a pulling wire 13 passes through the dilator 12. The pulling wire 13 has a loop portion 131 formed at the tip, and a large diameter portion 132 having an outer diameter larger than the inner diameter of the tip of the dilator 12 is attached to the middle portion. When the large diameter portion 132 is caught inside the reduced diameter portion 121, the pulling wire 13 cannot be pulled out from the tip end side of the dilator 12.

  The medical instrument 1 is included in a luminal organ communication kit used for communicating the lumens of two luminal organs. As shown in FIG. 2, this luminal organ communication kit has cylindrical first and second insertion sheaths 2 and 3 in addition to the medical instrument 1, and loop-shaped snare portions 41 and 51 at the tip. The first and second snare wires 4 and 5, the cylindrical first puncture needle 6, and the first guide thread 7 are provided.

Next, a method of communicating the lumens of the _two lumen organs H ₁ and H ₂ using the above-mentioned lumen organ communication kit will be described. In addition, the code | symbol S in each figure represents a skin surface.

First, as shown in FIG. 3, the first insertion sheath 2 than the first insertion position I ₁ on the skin surface S percutaneously inserted, first into the first lumen of the tubular organ H ₁ The distal end portion of the insertion sheath 2 is placed. The first snare wire 4 is inserted from the rear end of the first insertion sheath 2 and pushed forward, and the first communication position P ₁ in the lumen of the first luminal organ H ₁ is visually observed under X-ray fluoroscopy. The 1st snare part 41 is arrange | positioned. Similarly, the second insertion sheath 3 is inserted percutaneously from the second insertion position I _2, and the distal end portion thereof is placed in the lumen of the _second lumen organ H ₂ , and the second insertion sheath 3 is inserted. rear insert the second snare wire 5, arranged while viewing the second snare portion 51 second to communicating position P ₂ in the second hollow organ lumen of H _2. Then, under X-ray fluoroscopy, the first and second snare portions 41 and 51 are punctured by the first puncture needle 6, and the first and second lumen organs H ₁ and H ₂ are also penetrated. The first puncture needle 6 is preferably a commercially available one having a size of 23 to 18 gauge.

Next, as shown in FIG. 4, a first guide thread 7 is inserted from the rear end of the first puncture needle 6 that penetrates the first and second lumen organs H ₁ and H ₂ , and this first The distal end portion (one end portion) 7 a of the guide thread 7 is projected from the distal end of the first puncture needle 6. Thereafter, when only the first puncture needle 6 is removed, as shown in FIG. 5, the first guide thread 7 passes through the first and second snare portions 41 and 51 and the first and second lumens. It remains in the state of penetrating the organs H ₁ and H ₂ . The first guide yarn 7 preferably has a diameter of 0.3 mm to 0.9 mm. Further, the material of the first guide yarn 7 is preferably one having elasticity and flexibility, hardly causing plastic deformation, and having a high tensile breaking strength. For example, copolymer nylon, nickel titanium, stainless steel , Platinum and the like.

Next, as shown in FIG. 6, when the first snare portion 41 is closed, the first guide thread 7 is gripped, and the rear end portion of the first snare wire 4 is pulled, the first lumen organ H ₁ The distal end portion 7a of the first guide thread 7 that is outside the center is pulled into the _first luminal organ H1. When the first snare wire 4 is further pulled, the distal end portion 7a of the first guide thread 7 passes through the lumen of the _first luminal organ H1 together with the first snare portion 41 and passes through the first insertion sheath 2. It enters and is pulled out from the rear end of the first insertion sheath 2. When the rear end portion of the second snare wire 5 is pulled without holding the second snare portion 51 while holding the leading end portion 7a of the drawn first guide yarn 7, as shown in FIG. The guide thread 7 is pulled while sliding inside the second snare portion 51, and the rear end portion (the other end portion) 7b of the first guide thread 7 is drawn into the _second lumen organ H2. When continues to pull the rear end portion of the second snare wire 5, first guide thread 7 rear portion 7b is first with 2 snare portion 51 second hollow organ lumen of H ₂ and a second insertion sheath 3 passes through the rear end of the second insertion sheath 3. As a result, as shown in FIG. 8, the first and second communication positions P ₁ , P ₂ enter the lumen of the _first luminal organ H ₁ from the skin surface S via the first insertion sheath _2. Then, a path is formed by the first guide thread 7 that sequentially passes through the lumen of the _second luminal organ H ₂ and goes out of the skin surface S via the second insertion sheath 3.

Next, as shown in FIG. 9, the second insertion sheath 3 is removed, and the rear end portion 7 b of the first guide thread 7 is tied to the loop portion 131 of the pulling wire 13 in the medical instrument 1. When the distal end portion 7a of the first guide thread 7 drawn from the rear end portion of the first insertion sheath 2 is pulled, as shown in FIG. It is drawn from the position I ₂ into the second luminal organ H ₂ , and the lumen of the second luminal organ H ₂ , the second communication position P _2, the first communication position P ₁ , and the first lumen. It passes through the lumen of the organ H ₁ in order and is pulled out from the rear end of the first insertion sheath 2. Subtracting the pulling wire 13 drawn out, as shown in FIG. 11, dilator 12 and delivery sheath 11 is pulled by the traction wire 13, passes through the second communicating position P ₂ and the first communication position P ₁ To go. When it is confirmed by X-ray fluoroscopy that the delivery sheath 11 has reached the position straddling the first and second communication positions P ₁ and P ₂ , the pulling of the pulling wire 13 is stopped and the rear end side of the delivery sheath 11 is stopped. When the dilator 12 and the pulling wire 13 are pulled out from the first, only the delivery sheath 11 is indwelled as shown in FIG. 12, and the lumens of the first and second luminal organs H ₁ and H ₂ are separated by the delivery sheath 11. The first and second communication positions P ₁ and P ₂ communicate with each other.

Pushed forward by push rod stent 8 and the like placed in the delivery sheath 11 which is placed as described above, is pulled out only delivery sheath 11 Hold the stent 8 in the push rod or the like from the second insertion position I ₂ as shown in FIG. 13, the stent 8 is placed, first and second hollow organ _H 1, the lumen of the _{H 2} is the stent 8, communicating the first and second positions _P 1, _{P 2} Communicated at

As described above, according to the luminal organ communication kit according to the first embodiment, puncture is performed with the first puncture needle 6 so as to penetrate the first and second luminal organs H ₁ and H ₂ , The first guide thread 7 is passed through the first puncture needle 6. Thereby, the first guide thread 7 also penetrates the first and second lumen organs H ₁ and H ₂ , but both ends 7a and 7b of the first guide thread 7 are connected to the first and second lumens. The first and second lumens can be drawn into the organs H ₁ and H ₂ without the operation of inserting the wire while keeping the tip of the puncture needle or the catheter in the lumen organs H ₁ and H ₂ . The organs H ₁ and H ₂ can be easily communicated. Further, since the dilator 12 in the medical instrument 1 is configured to advance through the lumens of the first and second luminal organs H ₁ and H ₂ by being pulled by the pulling wire 13, Force is easily transmitted and can pass smoothly through the _first and _second lumen organs H ₁ and H ₂ .

(Second Embodiment)
Hereinafter, a second embodiment of a luminal organ communication kit according to the present invention will be described with reference to FIGS. In addition, the code | symbol S in each figure represents a skin surface.

  The luminal organ communication kit according to the second embodiment includes the medical instrument 1 similar to that of the first embodiment, and, as shown in FIG. 14, the third to sixth insertion sheaths 101, 102, 103. , 104, third to sixth snare wires 201, 202, 203, 204 having snare portions 2011, 2021, 2031, 2041, second to fourth puncture needles 301, 302, 303, and second to fourth. Guide yarns 401, 402, and 403 are provided.

Next, a method for communicating the lumens of the third and fourth luminal organs H ₃ and H ₄ using the above-mentioned luminal organ communication kit will be described.

First, as shown in FIG. 15, the third insertion sheath 101 is inserted percutaneously from the insertion position I ₃ in the skin surface S, and the distal end portion of the third insertion sheath 101 is inserted into the third lumen organ H _3. Then, the third snare wire 201 is inserted into the third insertion sheath 101, and the third snare portion 2011 is disposed at the _third communication position P3 while visually recognizing under fluoroscopy. To do. Similarly, the fourth insertion sheath 102 is percutaneously inserted from the insertion position I ₄ into the lumen of the _fourth lumen organ H ₄ , and the fourth snare wire 202 is inserted through the fourth insertion sheath 102. placing while viewing the fourth snare portion 2021 to the fourth communication position P _4. Further, the fifth and sixth insertion sheaths 103 and 104 are inserted percutaneously from the insertion positions I ₅ and I ₆ , respectively. Then, the fifth and sixth snare wires 203 and 204 are inserted into the fifth and sixth insertion sheaths 103 and 104, respectively, and the fifth and sixth snare portions 2031 and 2041 are connected to the fifth and sixth communication lines. position _P 5, arranged while visually recognizing the _{P 6.}

Next, as shown in FIG. 16 (a), the second puncture needle 301 punctures the fifth and third snare portions 2031 and 2011 while confirming under fluoroscopy, and the third luminal organ passing the H _3. After passing the second guide thread 401 through the second puncture needle 301, the second puncture needle 301 is removed as shown in FIG. Similarly, as shown in FIG. 17 (a), the third puncture needle 302 punctures the fourth luminal organ H4 while confirming the sixth and fourth snare portions 2041, 2021, and passes through the _fourth luminal organ H4. After passing the third guide thread 402 through the third puncture needle 302, the third puncture needle 302 is removed as shown in FIG. Further, as shown in FIG. 18A, the fourth puncture needle 303 is punctured while confirming the fifth and sixth snare portions 2031 and 2041, and the fourth guide thread 403 is inserted into the fourth puncture needle 303. Then, the fourth puncture needle 303 is removed as shown in FIG.

Next, as shown in FIG. 19, when the third snare portion 2011 is closed and the second guide thread 401 is gripped and the rear end portion of the third snare wire 201 is pulled, the leading end portion 401 a of the guide thread 401 is The distal end portion 401a is pulled out from the rear end of the third insertion sheath 101 together with the third snare portion 2011, being drawn into the _third luminal organ H3. When the leading end portion 401a of the second guide yarn 401 pulled out is held and the rear end portion of the fifth snare wire 203 is pulled, as shown in FIG. 20, the second and fourth guide yarns 401 and 403 are 5, the rear end portions 401 b and 403 b of the second and fourth guide yarns 401 and 403 are pulled out from the rear end of the fifth insertion sheath 103. Thereafter, as shown in FIG. 21, the rear end portions 401b and 403b of the drawn second and fourth guide yarns 401 and 403 are connected to each other. Similarly, the distal end portion 402a of the third guide thread 402 is pulled out from the fourth insertion sheath 102 by the fourth snare wire 202, and the sixth guide snare wire 204 is pulled while holding the distal end portion 402a. The rear end portion 402 b of the yarn 402 and the front end portion 402 a of the fourth guide yarn 403 are pulled out from the sixth insertion sheath 104. Then, as shown in FIG. 22, the third and fourth guide yarns 401 and 403 are tied together. In this state, when the distal end portion 401 a of the second guide wire 401 is pulled, the rear end portions 401 b and 403 b of the second and fourth guide yarns 401 and 403 connected to each other are skinned via the fifth insertion sheath 103. It is drawn under surface S. Further, the rear end portion 402b of the third guide yarn 402 and the front end portion 402a of the fourth guide yarn 403 are also drawn under the skin surface S through the sixth insertion sheath 104, and as shown in FIG. A route passing through the _{third to sixth} communication positions P3 to P6 is created.

Thereafter, the distal end portion 402 a of the third guide thread 402 is tied to the pulling wire 13 of the medical instrument 1, and the distal end section 401 a of the second guide thread 401 is pulled to pull the medical instrument 1. As a result, the dilator 12 and the delivery sheath 11 are drawn into the path as in the first embodiment. In the same manner as in the first embodiment, the delivery sheath 11 is placed so as to straddle the third and fourth lumen organs H ₃ and H ₄ , and the stent 8 is placed through the delivery sheath 11.

As described above, according to the second embodiment, by using the plurality of guide yarns 401, 402, 403, a non-linear path between the third and fourth lumen organs H ₃ , H ₄ is provided. Can be created. Thereby, according to the content of treatment, the path | route which bypasses the organ etc. which exist between two luminal organs to communicate, the path | route which passes the skin surface vicinity, etc. can be created.

  As mentioned above, although embodiment of this invention was described, this invention is not limited to these, A various change is possible unless it deviates from the meaning of this invention. For example, in the medical instrument 1 according to the above embodiment, the pulling wire 13 is inserted into the dilator 12 and the large-diameter portion 131 is formed in the middle portion of the pulling wire. For example, a pulling wire may be connected to the tip of the dilator.

  Moreover, in the said embodiment, the taper shape according to the shape of the taper diameter reduction part 121 lumen | bore of a dilator may be sufficient as the shape of the large diameter part 132.

  In the first embodiment, the pull wire 13 of the medical instrument 1 is tied to the rear end portion 7b of the first guide yarn 7. However, the present invention is not limited to this, and the front end portion of the first guide yarn 7 It is also possible to tie a puller wire to pull in the opposite direction. Similarly, in the second embodiment, the pulling wire 13 is tied to the tip portion 402a of the third guide yarn 402. However, the present invention is not limited to this, and the pulling wire is tied to the tip portion of the second guide yarn. Also good.

  Further, in the first embodiment, the shape of the front end portion 7a or the rear end portion 7b of the guide yarn 7 is made into a loop so that the guide yarn 7 can be connected to the loop portion 131 of the pulling wire 13 by a loop-to-loop. May be. Similarly, in the said 2nd Embodiment, you may make the shape of the front-end | tip part or rear-end part of a 2nd-4th guide thread | yarn into a loop.

DESCRIPTION OF SYMBOLS 1 Medical instrument 11 Delivery sheath 12 Dilator 121 Reduced diameter part 13 Pulling wire 132 Large diameter part 2, 3 1st and 2nd insertion sheath 4, 5 1st and 2nd snare wires 41 and 51 1st and 2nd Snare portion 6 First puncture needle 7 First guide thread

Claims (3)

A tubular delivery sheath,
A dilator inserted into the delivery sheath such that a tapered reduced diameter portion is formed at a distal end, and the reduced diameter portion protrudes from the distal end of the delivery sheath;
A pulling wire for pulling the dilator in the protruding direction of the reduced diameter portion,
The dilator is formed in a cylindrical shape, Ri seen extractable der from the rear end side of the delivery sheath,
A medical instrument in which the pulling wire is inserted into the dilator so that a part thereof protrudes from the tip of the dilator, and a large-diameter portion having an outer diameter larger than the inner diameter of the tip of the dilator is formed . A tubular delivery sheath,
A dilator inserted into the delivery sheath such that a tapered reduced diameter portion is formed at a distal end, and the reduced diameter portion protrudes from the distal end of the delivery sheath;
A pulling wire for pulling the dilator in the protruding direction of the reduced diameter portion,
A flange portion is formed at the rear end of the dilator , and the flange portion is caught by the rear end of the delivery sheath, so that the dilator cannot be pulled out from the distal end side of the delivery sheath, and the rear end of the delivery sheath. A medical device that can only be pulled out from the end side. A luminal organ communication kit used for communicating the lumens of two luminal organs,
A cylindrical first insertion sheath configured to percutaneously insert the tip into the lumen of the first luminal organ;
A loop-shaped first snare portion that can be opened and closed is formed at the tip, and the first snare portion is disposed in the lumen of the first luminal organ through the first insertion sheath. A first snare wire;
A cylindrical second insertion sheath configured to percutaneously insert the distal end portion into the lumen of the second luminal organ;
A loop-shaped second snare part is formed at the tip, and the second snare part is arranged in the lumen of the second luminal organ via the second insertion sheath. A second snare wire;
The first lumen organ passes through the first snare portion disposed in the lumen of the first lumen organ, and is disposed in the lumen of the second lumen organ. The cylindrical first puncture needle configured to penetrate the second luminal organ to pass through the second snare portion;
The first puncture needle penetrates the first and second luminal organs so as to pass through the first and second snare portions, the first puncture needle is removed, and the first puncture needle is removed. One end is gripped by the first snare portion that is closed by pulling the rear end portion of the snare wire, and is pulled out from the rear end of the first insertion sheath. A first guide thread configured to draw the other end from the rear end of the second insertion sheath by pulling the end;
A puller wire is provided at one end of the first guide yarn drawn from the rear end of the first sheath or the other end of the first guide yarn drawn from the rear end of the second sheath. The luminal organ communication kit comprising: the medical instrument according to claim 1 or 2 configured to be coupled.

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