JP5977601B2 - Medical sheath - Google Patents

Description

  The present invention relates to a medical sheath.

  2. Description of the Related Art Conventionally, a pericardial puncture method is known in which the inside of a sheath is depressurized, and a puncture needle is inserted into the pericardium in a state where the pericardium is adsorbed and separated from the heart (for example, see Patent Document 1).

Special table 2001-516625 gazette

  However, if the suction force is excessively increased, the pericardium is damaged, and eventually the heart is adsorbed and the heart beats. Thus, it is difficult to stably maintain the pericardium moving in an adsorbed state, and it is difficult to reliably puncture the puncture needle only into the pericardium.

  The present invention has been made in view of the above-described circumstances, and can maintain the pericardium in a state of being stably spaced from the surface of the heart and can puncture only the pericardium more reliably. The object is to provide a sheath.

In order to achieve the above object, the present invention provides the following means.
One aspect of the present invention is a cylindrical sheath body having a distal end opening, and an arcuate shape disposed along the circumferential direction with a radial spacing from an inner wall surface of the sheath body near the distal end opening. There is provided a medical sheath comprising a needle-like member, wherein a gap between the needle-like member and an inner wall surface in the vicinity of the distal end opening has substantially the same dimension as the thickness of the pericardium .

  According to this embodiment, the distal end opening of the sheath body is brought into close contact with the pericardium, and the inside of the sheath body is depressurized, so that the sheath body is drawn into the sheath body and the sheath body is rotated around its axis. An arc-shaped needle-like member provided near the distal end opening of the sheath body is punctured into the pericardium, and a part of the pericardium is hooked on the needle-like member and suspended. After this, even if the decompressed state in the sheath body is released, the pericardium can be maintained in the state of being sucked into the sheath body. That is, even if the pericardium does not continue to be pulled into the sheath body by a strong suction force, the puncture needle is introduced from the proximal end side to the distal end side through the inside of the sheath body while maintaining the pericardium in a state separated from the heart. Can puncture only the pericardium without damaging the heart.

In the above aspect, the needle-like member may extend toward the proximal end side of the sheath main body from the distal end toward the proximal end side.
In this way, when the sheath body is rotated about its axis, the needle-like member is punctured into the pericardium, and the punctured portion is gradually moved toward the proximal end side of the sheath body as the sheath body rotates. Can be moved to. That is, even if the pericardium is sucked into the sheath body with a low suction force, it can be gradually drawn into the sheath body by the rotation of the sheath body, and the pericardium can be sufficiently separated from the heart.

Moreover, in the said aspect, the said acicular member may be formed in the coil shape by which the base end part was fixed to the said sheath main body.
In this way, when the sheath body is rotated about its axis, the pericardium can be gradually drawn into the sheath body according to the lead of the needle-like member formed in a coil shape.

Moreover, in the said aspect, the said acicular member may be provided with two or more, and the front-end | tip of each said acicular member may be arrange | positioned at intervals in the circumferential direction of the said sheath main body.
By doing so, a plurality of needle-like members are punctured into the pericardium at different positions in the circumferential direction of the sheath body, and the pericardium is drawn at a plurality of locations by the rotation of the sheath body. Can be suspended.

Moreover, in the said aspect, the front-end | tip of each said acicular member may be arrange | positioned in the substantially the same position of the length direction of the said sheath main body.
By doing so, the pericardium is drawn almost equally at a plurality of locations by the rotation of the sheath body, so that the drawn pericardium can be arranged perpendicular to the longitudinal axis of the sheath body, and the puncture operation with the puncture needle can be performed. It can be made easier.

Moreover, in the said aspect, the flat part distribute | arranged to the substantially same position of the length direction of the said sheath main body may be provided in at least one part of the longitudinal direction of the said acicular member.
In this way, by supporting the drawn pericardium with a flat part, the pericardium can be arranged in a state of being stretched perpendicular to and perpendicular to the longitudinal axis of the sheath body. It can be made easier.

Moreover, in the said aspect, you may provide the decompression means which decompresses the inside of the said sheath main body.
By doing so, the pericardium that has been decompressed in the sheath body and brought close to the distal end opening can be easily sucked into the distal end opening and suspended on the hook portion by the operation of the decompressing means.

  According to the present invention, the pericardium is maintained in a state of being stably spaced from the surface of the heart, and there is an effect that the puncture needle can be punctured only more reliably.

It is a longitudinal section showing a medical sheath concerning one embodiment of the present invention. It is a perspective view which shows the dilator used in combination with the medical sheath of FIG. It is a figure explaining the treatment which introduces a guide wire in the pericardium using the medical sheath of Drawing 1, and is a figure showing the state where the puncture needle was punctured from the outside of the body. It is a figure explaining the process of introduce | transducing a guide wire through the puncture needle punctured in FIG. It is a figure explaining the process of removing a puncture needle, leaving the guide wire introduced in FIG. It is a figure which shows the assembly of a medical sheath and a dilator. FIG. 7 is a diagram illustrating a process of introducing the assembly of FIG. 6 into the body using the guide wire left in the body in FIG. 5 as a guide. It is a figure explaining the process of removing a dilator leaving the medical sheath introduced in FIG. It is a figure explaining the process of attracting | sucking a pericardium in the inner hole of a sheath main body, and suspending it on a hook part. It is a figure explaining the process of puncturing a puncture needle to the pericardium suspended on the hook part in FIG. It is a figure explaining the process of introduce | transducing a guide wire in a pericardium through the puncture needle punctured in FIG. It is a top view which shows the 1st modification of the medical sheath of FIG. It is a top view which shows the 2nd modification of the medical sheath of FIG. It is a longitudinal cross-sectional view which shows the 3rd modification of the medical sheath of FIG.

A medical sheath 1 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in FIG. 1, a medical sheath 1 according to this embodiment includes a cylindrical sheath body 3 having a distal end opening 2 and a needle-like member 4 disposed in the vicinity of the distal end opening 2 inside the sheath body 3. And a decompression pump 5 for decompressing the inside of the sheath body 3.

  The sheath body 3 includes an inner hole 3a that penetrates the entire length of the sheath body 3 so that a dilator 6, a guide wire 7, a puncture needle 8, and the like, which will be described later, can penetrate from the proximal end side to the distal end opening 2. Yes.

The needle-like member 4 is formed in a coil shape in the vicinity of the distal end opening 2 in the inner hole 3a of the sheath body 3 with a constant gap radially inward from the inner wall surface of the inner hole 3a. The base end portion is fixed to the inner hole 3 a of the sheath body 3.
Thereby, the needle-like member 4 is arranged with its sharp tip directed in the circumferential direction.

Next, the dilator 6 for disposing the distal end of the medical sheath 1 according to this embodiment close to the pericardium A will be described.
As shown in FIG. 2, the dilator 6 is a cylindrical member that is inserted into the inner hole 3 a of the sheath body 3, and has a through hole 6 a that penetrates the entire length and has an opening at the tip. . The through hole 6a has a diameter into which the guide wires 7 and 9 can be inserted.

The outer diameter dimension of the dilator 6 is slightly smaller than the inner diameter dimension of the inner hole 3a of the sheath body 3, and when the dilator 6 is inserted into the inner hole 3a, the dilator 6 fits into the inner hole 3a of the sheath body 3 exactly. ing.
Further, the dilator 6 is provided with a tapered distal end portion 6b whose outer diameter dimension gradually increases from the distal end, and an outer side smaller than the inner diameter of the coiled needle-like member 4 which is disposed on the proximal end side relative to the distal end portion 6b. A small diameter portion 6c having a diameter is provided.

A procedure for penetrating the pericardium A through the guide wire 7 using the medical sheath 1 according to the present embodiment configured as described above will be described below.
First, as shown in FIG. 3, a hollow puncture needle 10 is inserted from outside the body into the lower part of the xiphoid process B, and the tip of the puncture needle 10 is arranged in the vicinity of the pericardium A. As shown in FIG. The guide wire 9 is introduced to the vicinity of the pericardium A through the inner hole of the puncture needle 10. Then, as shown in FIG. 5, the puncture needle 10 is removed leaving the guide wire 9.

  Next, as shown in FIG. 6, the dilator 6 is inserted into the inner hole 3 a of the sheath body 3 of the medical sheath 1, and the tapered tip portion 6 b of the dilator 6 protrudes from the tip opening 2 of the sheath body 3. Prepare the assembled assembly. The base end of the guide wire 9 is inserted into the through hole 6a from the tip of the through hole 6a of the dilator 6 of this assembly.

  Next, as shown in FIG. 7, using the guide wire 9 as a guide, the assembly of the medical sheath 1 and the dilator 6 is inserted into the subcutaneous tissue while pushing the subcutaneous tissue by the distal end portion 6 b of the dilator 6. . Then, with the tip of the dilator 6 placed close to the pericardium A, the dilator 6 is removed leaving the medical sheath 1 as shown in FIG.

  Thereby, the medical sheath 1 is arranged in a state where the distal end opening 2 of the sheath body 3 is opposed to the pericardium A and the proximal end side opening is exposed outside the body. In this state, the decompression pump 5 is operated to depressurize the inner hole 3a of the sheath body 3, thereby adsorbing the pericardium A that has been close to the distal end opening 2 of the sheath body 3, and from the distal opening 2 to the inner hole. Aspirate into 3a.

  As shown in FIG. 9, by rotating the sheath body 3 around its longitudinal axis while the pericardium A is drawn into the inner hole 3 a of the sheath body 3 to the tip position of the needle-like member 4. The needle-like member 4 can be moved along the circumferential direction of the sheath body 3 with respect to the pericardium A, and the pericardium A can be punctured by the sharp tip. As a result, the pericardium A is maintained so as not to be caught by the needle-like member 4 and to escape to the distal end opening 2 side of the sheath body 3.

That is, as the sheath body 3 rotates, the pericardium A is pulled away from the surface of the heart C by being drawn into the sheath body 3 according to the lead of the coiled needle-like member 4. Since it is suspended, it is maintained in a state separated from the surface of the heart C even if the decompressed state is released.
In order to confirm whether or not the pericardium A is caught by the needle-like member 4, it can be easily confirmed by introducing an endoscope (not shown) through the inner hole 3 a of the sheath body 3. it can.

  In this state, the hollow puncture needle 8 is introduced through the inner hole 3a of the sheath body 3, and punctures the pericardium A that is kept floating from the surface of the heart C as shown in FIG. . Since the pericardium A is separated from the surface of the heart C, it is avoided that the tip of the puncture needle 8 penetrating the pericardium A contacts the surface of the heart C and prevents the heart C from being damaged. be able to.

  Then, by introducing the guide wire 7 through the inner hole of the puncture needle 8 and projecting the guide wire 7 from the tip of the puncture needle 8, the tip of the guide wire 7 can be placed in the pericardium without damaging the heart C. A can be placed in A. Thereafter, as shown in FIG. 11, the guide wire 7 can be placed in a state where the tip is disposed in the pericardium A by removing the puncture needle 8. And there exists an advantage that the endoscope which is not shown in figure can be easily introduce | transduced in the pericardium A by making the indwelled guide wire 7 into a guide.

  As described above, according to the medical sheath 1 according to the present embodiment, the pericardium A sucked into the sheath body 3 is hooked on the needle-like member 4, so that the inside of the sheath body 3 does not need to be maintained at a high decompressed state. Damage to the pericardium A due to strong suction can be prevented. In addition, after the pericardium A is once caught on the needle-like member 4, the decompressed state in the sheath body 3 can be released, and even if the heart C beats, the pericardium A can be stably kept in the heart C. It can be kept away from the surface. As a result, there is an advantage that the puncture operation of only the pericardium A by the puncture needle 8 can be facilitated, and the heart C can be prevented from being damaged by the tip of the puncture needle 8.

  In this embodiment, since the needle-like member 4 is formed in a coil shape, the pericardium A is placed in the sheath main body 3 according to the lead of the needle-like member 4 simply by rotating the sheath main body 3 around its longitudinal axis. You can pull in. Therefore, if the sheath body 3 is rotated only by pulling the pericardium A in a relatively low pressure state to the tip position of the needle-like member 4 disposed in the vicinity of the tip opening 2, the pericardium A is moved to the back of the inner hole 3a. There is an advantage that it can be pulled in.

  Further, according to the present embodiment, the pericardium A can be drawn by rotating the sheath body 3 in one direction, and the pericardium A can be released by rotating the sheath body 3 in the reverse direction. Therefore, when the sheath body 3 is removed from the body, the pericardium A can be easily released simply by rotating the sheath body 3 in the opposite direction, and damage to the pericardium A can be minimized. There is also an advantage.

In the present embodiment, an example in which a single needle-like member 4 is provided has been shown, but instead of this, two needle-like members 4 may be provided as shown in FIG. Three or more needle-like members 4 may be provided.
In the example shown in FIG. 12, the tips of the two needle-like members 4 are disposed at substantially the same position in the longitudinal direction of the sheath body 3, and the leads of the two needle-like members 4 are also provided approximately equally.

  By doing so, the needle-like member 4 can be punctured simultaneously at two locations in the pericardium A drawn into the sheath body 3, and can be drawn in the same amount according to the same lead. As a result, the drawing force applied to the pericardium A can be dispersed in two places, and an excessive drawing force can be prevented from being applied locally to the pericardium A.

  Moreover, although the coiled needle-like member 4 was illustrated, instead of this, as shown in FIG. 13, as shown in FIG. 13, an arc-shaped needle disposed along the circumferential direction at the same longitudinal position of the sheath body 3. The shaped member 4 may be adopted. By doing so, the sheath body 3 is depressurized, and the sheath body 3 is rotated around the longitudinal axis in a state where the pericardium A is drawn into the inner hole 3a to the position of the needle-like member 4, The needle-like member 4 can be punctured into the pericardium A.

  Thereby, since the pericardium A is maintained in a state of being caught by the needle-like member 4, the pericardium A can be maintained in a state of being separated from the heart C even when the decompressed state is released. In this case, the pericardium A suspended on the two needle-like members 4 is suspended on a flat plane perpendicular to the longitudinal direction of the sheath body 3, so that the penetrating operation with the puncture needle can be facilitated. .

Further, instead of the coiled needle-like member 4, as shown in FIG. 14, an inclined portion 4 a that gradually changes its position in the longitudinal direction along the circumferential direction of the sheath body 3, and the inclined portion 4 a is based on the inclined portion 4 a. You may employ | adopt the acicular member 4 which has the flat part 4b arrange | positioned in the end side at the substantially the same position of a longitudinal direction along the circumferential direction.
By doing in this way, the pericardium A punctured by the needle-like member 4 is drawn into the inner hole 3a by the inclined portion 4a along with the rotation of the sheath body 3, and is then stretched flat by the flat portion 4b. Suspended by.

A pericardium 1 medical sheath 2 distal end opening 3 sheath body 4 needle-like member 4b flat part 5 pressure reducing pump (pressure reducing means)

Claims (7)

A cylindrical sheath body having a tip opening;
An arcuate needle-like member disposed along the circumferential direction at a radial interval with respect to the inner wall surface in the vicinity of the distal end opening of the sheath body ,
A medical sheath , wherein a gap between the needle-like member and an inner wall surface in the vicinity of the distal end opening has substantially the same dimension as the thickness of the pericardium .   The medical sheath according to claim 1, wherein the needle-like member extends toward the proximal end side of the sheath body as it goes from the distal end to the proximal end side.   The medical sheath according to claim 2, wherein the needle-like member is formed in a coil shape with a base end portion fixed to the sheath body.   The medical sheath according to any one of claims 1 to 3, wherein a plurality of the needle-like members are provided, and tips of the needle-like members are arranged at intervals in a circumferential direction of the sheath body. .   The medical sheath according to claim 4, wherein a distal end of each needle-like member is disposed at substantially the same position in the length direction of the sheath body.   The medical part according to any one of claims 1 to 5, wherein a flat portion disposed at substantially the same position in the longitudinal direction of the sheath body is provided on at least a part of the needle-like member in the longitudinal direction. sheath.   The medical sheath according to any one of claims 1 to 6, further comprising a decompression unit that decompresses the inside of the sheath body.

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