JP6376431B2 - Blood flow maintenance type angioscope system - Google Patents

Description

  The present invention relates to a blood flow maintenance type blood vessel endoscope system.

A blood vessel endoscope has a structure similar to that of a stomach camera, and is a device that can display an image in a blood vessel on a television monitor. For example, with the advent of coronary artery endoscopes, significant progress is expected in the diagnostic treatment of coronary artery lesions.
Unlike a gastrocamera, a vascular endoscope is inserted into a very thin coronary artery having a diameter of 2 to 3 mm. Therefore, the endoscope catheter is inserted into 4 to 5 Fr (French; It is necessary to make it as thin as 6 mm). In addition, it is necessary to inject a transparent drug solution such as physiological saline to temporarily remove the blood to ensure visibility, and because the vascular endothelium is easily damaged, it is necessary to consider the structure and material, Since continuous blockage of the flow induces myocardial ischemia, it is necessary to use a vascular endoscope in consideration of problems such as time constraints.

  As shown in FIG. 7, a catheter part 101 is provided along a guide wire 100 in one of the currently known vascular endoscope catheters, a balloon 102 is provided near the distal end of the catheter part 101, and the catheter part 101 is provided. There is known a catheter of a blood flow blocking type system in which an imaging fiber 103 is extended forward from the distal end portion (see Patent Document 1).

JP-A-11-262528

In the blood vessel endoscope described in Patent Document 1, the tip of the fiber 103 is inserted into the observation site, and then the balloon 102 is inflated to temporarily block the blood flow in the blood vessel. By flushing water etc., the blood flow can be completely eliminated and the inner wall of the blood vessel can be clearly observed.
However, when the blood flow is temporarily blocked by the balloon 102, myocardial ischemia may occur if the observation site is a coronary artery. For example, it is sufficient that imaging is completed within a specified time, and the blood flow is reduced by reducing the balloon 102. However, if it takes time to reduce the size of the balloon 102, it takes time until the blood flow is resumed, which imposes a burden on the heart. There is.
For this reason, a blood flow maintenance type blood vessel endoscope system capable of photographing without using the balloon 102 in a blood vessel endoscope is known.
This blood flow maintenance type blood vessel endoscope system is configured so that saccharified blood can be ejected into the blood vessel from the distal end portion of the outer tube containing the fiber catheter, while replacing a part of the blood flow with a transparent liquid. It is a system to observe.

This blood flow maintenance type vascular endoscopy system is capable of directly observing the inside of the blood vessel in a state where the blood flow is maintained, although there is a somewhat limited visual field. It is used as a system that does not put a burden on the heart even when observing
However, the blood flow maintenance type blood vessel endoscope is a method that replaces part of the blood flow with a transparent liquid, and the anemic region is narrow, so when the inner wall of the blood vessel is imaged from the fiber tip, the field of view is narrow It is necessary to be able to observe in a wider field of view, and it is desired to obtain an image as clear as possible.

  The present invention has been made to solve the above-described problems, and an object of the present invention is to provide a vascular endoscope catheter system capable of widening the visual field and clearing the observation image.

The present invention relates to a catheter body having an image fiber and a light guide fiber, an outer tube of a probing catheter provided so as to cover the image fiber and the light guide fiber, and a guiding provided so as to cover the outer tube of the probing catheter. A blood flow maintaining device in which a first blood spouting portion is formed at a distal end portion of the guiding catheter and a second blood spouting portion is formed at a distal end portion of an outer cylinder of the probing catheter. The present invention relates to a type blood vessel endoscope system.
In the present invention, a guiding catheter is provided so as to be able to extend to the vicinity of the observation site of the blood vessel, and observation of a blood vessel having a smaller diameter than the blood vessel through which the guiding catheter is inserted is ahead of the distal end portion of the guiding catheter. An outer tube of the probing catheter is inserted into the guiding catheter so as to extend forward from a distal end portion of the guiding catheter so as to be extendable to a site, and the first ejection portion at the distal end of the guiding catheter From the above, the probing catheter is preferably configured so as to be able to eject blood spilled around the outer cylinder.

In the present invention, a first pump for supplying lyophobic blood is connected to a proximal end side of the guiding catheter to a flow path between the guiding catheter and an outer tube of the probing catheter inside the guiding catheter. It is preferable that a second pump for supplying lyophobic blood is connected to the flow path between the outer tube of the probing catheter and the catheter main body inside the probing catheter, on the proximal end side of the outer tube of the catheter.
In the present invention, a first connection path for supplying blood sac blood is connected to a first flow path between the guiding catheter and an outer cylinder of the probing catheter inside the guiding catheter on the proximal end side of the guiding catheter. And a second connection path for supplying lyophobic blood to the second flow path between the outer cylinder of the probing catheter and the catheter body inside the probing catheter is connected to the proximal end side of the outer cylinder of the probing catheter. The first connection path and the second connection path are connected to the blood sac blood injection device, and the first connection path and the second connection path are connected to the first connection path and the second connection path. It is preferable that a flow rate adjusting means for controlling the flow rate of the sparse blood flowing through the connection path is incorporated.

According to the present invention, the saccharified blood is ejected from the second ejection portion at the distal end portion of the outer tube of the probing catheter to the observation site to replace a part of the blood flow around the observation site with the saccharified blood, and the position close to the observation site. Since the saccharified blood is also ejected from the first ejection part at the distal end side of the guiding catheter and a part of the blood flow in front of the guiding catheter is replaced with the sparse blood, the blood flow at the distal end side of the image fiber and the light guide fiber is Can be replaced with a lot of sparse blood. For this reason, it is possible to sharpen the image of the blood vessel inner wall imaged at the tip of the image fiber and obtain a clear observation image. In addition, since the blood flow on the tip side of the image fiber and the light guide fiber can be replaced with more sparse blood than before, a blood vessel inner wall image with a wide field of view can be obtained.
By connecting the first pump to the first ejection part and connecting the second pump to the second ejection part, the required flow rate is reduced from the first ejection part and the second ejection part by each pump. Blood can be reliably ejected, and the blood flow at the observation site in the blood vessel can be widely replaced with sparse blood to obtain a sharp image with a wide field of view.
Adjusting the flow rate by distributing the sparse blood sent from the blood sac blood injection device through the first connection path and the second connection path to the first flow path and the second flow path by the flow rate adjusting means at a specified ratio; It is possible to automatically control the amount ratio of the saccharified blood ejected from the first ejection part and the saccharified blood ejected from the second ejection part. Thereby, the blood vessel inner wall image with a clearer visual field can be obtained by optimizing the amount ratio of the sparse blood sent into the blood vessel from the first ejection part and the second ejection part.

1 is a configuration diagram showing an endoscope system according to a first embodiment of the present invention. FIG. The block diagram which shows an example of the endoscope applied to the endoscope system shown in FIG. Explanatory drawing which shows the state which inserted the catheter main-body part and the guiding catheter in the coronary artery. FIG. 4 (a) shows an example of the procedure for inserting the catheter body into the blood vessel. FIG. 4 (a) shows the guide catheter, outer tube, inner tube and guide wire inserted from the state where the guide wire is inserted. 4B is an explanatory view showing a state in which the inner cylinder and the outer cylinder are integrally inserted by a wire system, FIG. 4B is an explanatory view showing a state in which the inner cylinder and the guide wire are removed, and FIG. 4C is a Y-type connector to the outer cylinder. FIG. 4D is an explanatory view showing a state in which the catheter body is inserted into the outer tube. Explanatory drawing which shows the state which connected the blood-sac blood injection | pouring means to the flow path which sends the blood sac blood to the outer cylinder of a probing catheter, and the flow path which sends sac blood to the guiding catheter, and provided the flow volume adjustment means in each flow path. FIG. 6A is a configuration diagram illustrating an example of a pump that sends sparse blood, and FIG. 6B is a configuration diagram illustrating a flow path switching unit of the pump. FIGS. 7A and 7B show an example of a conventional blood flow blocking type vascular endoscope system, in which FIG. 7A is an overall configuration diagram, and FIG. 7B is an explanatory diagram showing a state where a balloon is inflated in a blood vessel.

  FIG. 1 shows a first embodiment of a vascular endoscope catheter system according to the present invention. A vascular endoscope system 1 according to the present embodiment includes a guiding catheter 2 extended to a position near an observation position in a blood vessel. A probing catheter 3 inserted through the guiding catheter 2 and extended to the observation position in the blood vessel and an endoscopic catheter 5 inserted into the probing catheter 3 and extended to the observation position in the blood vessel are provided. It becomes.

  As an example, the guiding catheter 2 is mounted on a guide catheter tube 6 made of polyethylene resin having a diameter of 6 Fr or more and having a length of about 1.4 m and a proximal end portion (rear end portion) 6 a of the guide catheter tube 6. It consists of a Y-shaped connector 7. The connector 7 is composed of a main tube 7a and a branch tube 7b. A base end portion 6a of the guide catheter tube 6 is connected to one end portion of the main tube 7a, and a first pump 8 is connected to an outer end portion of the branch tube 7b. Yes. As an example, the first pump 8 may be an automatic syringe pump connected to a tank 8 </ b> A containing lyophobic blood. This automatic syringe pump can set the flow rate, and can send lysed blood to the first flow path R1 via the connector 7 at a rate of 3.3 ml / s (15.1 seconds) at the maximum, for example.

  The branch pipe 7b of the connector 7 is connected to the peripheral wall of the main pipe 7a, and the internal flow path of the branch pipe 7b is connected to the internal flow path of the main pipe 7a. For this reason, it is possible to inject blood spilled blood sent from the first pump 8 via the branch pipe 7b into the first flow path R1 formed between the guide catheter pipe 6 and the outer cylinder 9. A closed portion 7c that closes one end portion of the first flow path R1 is formed at the end portion of the connector 7 on the outer tube 9 side in close contact with the outer periphery of the outer tube 9. Low molecular dextran (Lactated Ringer's solution) or the like can be used as the saccharified blood.

The probing catheter 3 includes an outer cylinder 9 inserted into the guide catheter tube 6 and a Y-shaped connector 10 attached to a base end portion (rear end portion) 9 a of the outer cylinder 9. The connector 10 includes a main pipe 10a and a branch pipe 10b. The base end 9a of the outer cylinder 9 is connected to one end of the main pipe 10a, and the second pump 11 is connected to the outer end of the branch pipe 10b.
As the second pump 11, a syringe pump with a lock that allows manual fine adjustment of the flow rate can be applied. The second pump 11 is connected to a tank 11A that stores lyophobic blood, and can make a necessary amount of lyophobic blood flow into the second flow path R2 while being finely adjusted by manual injection.

  An outer cylinder 9 is inserted into the guide catheter tube 6, and a catheter body 5 </ b> A of the endoscope catheter 5 is inserted into the outer cylinder 9. The outer tube 9 can employ, for example, a triple tube structure including a parent catheter made of a polyethylene resin having a total length of about 135 cm, and a double small catheter made of a polyamide outer layer and a polypropylene inner layer of about 140 cm in total length. .

The branch pipe 10b of the connector 10 is connected to the peripheral wall of the main pipe 10a, and the internal flow path of the branch pipe 10b is connected to the internal flow path of the main pipe 10a. For this reason, the saccharified blood sent from the 2nd pump 11 can be inject | poured into the 2nd flow path R2 formed between the outer cylinder 9 and the catheter main-body part 5A. In addition, a closing portion 10c that closes one end of the second flow path R2 in close contact with the outer peripheral portion of the catheter main body 5A is formed at the end of the connector 10 on the catheter main body 5A side.
With the above configuration, when the outer cylinder 9 is projected forward from the distal end portion 6b of the guide catheter tube 6 as shown in FIG. 6 A of 1st ejection parts are comprised. Further, when the distal end portion of the catheter main body 5A is made to be embedded in the distal end portion 9b of the outer cylinder 9, the second ejection portion 9A for lyophobic blood is formed in the distal end portion 9b of the outer cylinder 9.

As shown in FIG. 2, the endoscope catheter 5 is provided with a light guide fiber 12 composed of a plurality of optical fibers along an image fiber 13, an objective lens 15 is incorporated at the distal end portion of the image fiber 13, and the distal ends thereof. On the side, a light guide fiber 12, an image fiber 13, and an objective lens 15 are integrally bonded, and a catheter main body 5A having a configuration in which the whole is covered with a protective tube such as a fluororesin is provided. As an example, the total length of the insertion portion of the catheter body 5A is about 160 to 180 cm (total length is about 350 cm), and the insertion portion diameter is about 0.7 mm.
Further, a branch portion 16 having an opening 12b is formed in the middle of the light guide fiber 12, and the image fiber side is branched from the image fiber 13 and protrudes rearward from the branch portion 16 to the rear end portion of the image fiber 13 on the image guide side. A connector 17 is provided, and a light guide side connector 18 is provided at the rear end portion of the light guide fiber 12 protruding rearward from the branching portion 16. The branch portion 16 is covered with a branch portion tube 19 and is protected from an external force or the like.

  A light source 23 such as a lamp is connected to the rear end side of the light guide fiber 12, and illumination light can be introduced into the light guide fiber 12 from the light source 23. Further, an imaging device 24 such as a camera and a display device 25 such as a monitor are connected to the rear end side of the image fiber 13 so that an image from the front end portion of the image fiber 3 can be taken and displayed.

Since the light guide fiber 12 has a structure in which fine fibers of quartz glass are bundled, light can be guided, and light is irradiated to a specific portion in the living body into which the tip of the light guide fiber 12 is inserted and its surroundings. Can do.
The image fiber 13 has a configuration in which several thousand, for example, 6,000 fine fibers of quartz glass are bundled, and is inserted into a blood vessel or the like in a living body and fixed at the tip thereof. The desired imaging target region can be enlarged by the objective lens 15 and image information can be obtained by the imaging device 24 and the display device 25 connected to the rear end side of the image fiber 13.

Next, a case where the blood vessel inner wall is observed or imaged using the blood vessel endoscope system 1 having the above-described configuration will be described.
FIG. 1 shows these proximal end sides in a state where the distal end side of the guide catheter tube 6, the distal end side of the outer tube 9, and the distal end side of the catheter main body 5A are inserted into the blood vessel. FIG. 3 shows a state in which the distal end portion 6 b of the guide catheter tube 6 is inserted into the coronary artery inlet portion 30 and the distal end portion of the outer tube 9 is inserted to the thin arterial branch portion 31 ahead of the coronary artery inlet portion 30.
To obtain the state shown in FIG. 3, the guide catheter tube 6, the outer tube 9, and the catheter body 5A are inserted into the blood vessel according to the procedure described below with reference to FIG.

FIG. 4A shows that the connector 7 is attached to the proximal end portion 6a of the guide catheter tube 6, and the inner cylinder and the outer cylinder are integrated with each other along the guide wire 34 from the state where the guide wire 34 is inserted. It is a figure for demonstrating inserting.
The inner cylinder 33 is made of a resin material having the same flexibility as the outer cylinder 9. As shown in FIG. 4A, the connector 7 is attached to the proximal end portion 6 a of the guide catheter tube 6. A first pump 8 is connected to the connector 7.

The guide catheter tube 6 with the connector 7 attached to the proximal end 6 a is inserted from the artery of the upper arm or thigh, and the distal end is placed in the coronary artery entrance 30. A guide wire 34 is inserted from the connector 7 and guided to the arterial branch 31. The inner cylinder and the outer cylinder are integrally inserted up to the artery branch 31 along the guide wire 34 by an over-the-wire method. Subsequently, as shown in FIG. 4B, the guide wire 34 and the inner cylinder 33 are extracted from the outer cylinder 9 together.
While observing the position of the guide wire 34 with a fluoroscopic image provided separately in the room, carefully determine where the guide wire 34 and the tip of the guide catheter tube 6 are located in the blood vessel so as not to damage the blood vessel. It is preferable to guide to the vicinity of the coronary artery.

If the guide wire 34 and the inner cylinder 33 are extracted from the outer cylinder 9 together, after the air is exhausted from the proximal end portion 9a of the outer cylinder 9 in the state shown in FIG. The connector 10 is attached to the portion 9a. The second pump 11 is connected to the branch pipe 10 b of the connector 10, and the connector 10 is connected to the outer cylinder 9 while sending the sparse blood from the branch pipe 10 b to the main pipe 10 side and overflowing from both ends of the main pipe 10.
As shown in FIG. 4 (d), the catheter body 5A of the endoscope catheter 5 is inserted from the connector 10, and the distal end of the catheter body 5A is inserted to the vicinity of the distal end of the outer tube 9 as shown in FIG. .

In this state, the saccharified blood is sent from the first pump 8 to the first flow path R1, and the saccharified blood is sent to the second flow path R2 by the second pump 11. As shown in FIG. 3, the saccharified blood sent to the first flow path R1 flows into the coronary artery entrance 30 from the first ejection portion 6A of the distal end portion 6b of the guide catheter tube 6, and enters the second flow path R2. The sent blood sac blood flows into the arterial branch 31 from the second ejection portion 9A at the distal end of the outer cylinder 9. The direction of blood flow in the coronary artery inlet 30 flows from the coronary artery inlet 30 toward the arterial branch 31.
As shown in FIG. 3, saccharified blood is introduced from two locations, so that most of the blood can be replaced with saccharified blood at the imaging location of the arterial branch 31, and the objective lens 15 at the distal end of the catheter body 5A can be replaced. A sharp image obtained through the image fiber 13 can be picked up by the image pickup device 24 or observed by the display device 25. That is, the blood spilled from the distal end side of the guide catheter tube 6 flows from the coronary artery inlet portion 30 toward the arterial branch portion 31 side, and therefore flows so as to cover the periphery of the distal end portion of the outer tube 9, in other words, around the objective lens 15. Therefore, the field of view around the tip of the outer cylinder 9 is widened and a sharp image can be taken.

  The ratio of the amount of blood spilled from the distal end portion 6b (first ejection portion 6A) of the guide catheter tube 6 to the amount of saccharified blood introduced from the distal end portion 9b (second ejection portion 9A) of the outer cylinder 9 is 2 It is preferable to allow more blood to flow from the coronary artery inlet 30 side at a ratio of 0.5 to 3: 1. In addition, since this quantity ratio is an example and there are individual differences, it is preferable to select an appropriate quantity ratio as appropriate. Select the volume ratio by performing test injection, etc., calculate the water pressure, flow rate, etc. of the blood from the result data, and operate the first pump 8 and the second pump 11 to reduce the burden on the heart. It is preferable to do.

  As described above, blood can be replaced with a saccharified blood if the saccharified blood is sent out from the two locations of the first squirting part 6A and the second squirting part 9A in a desirable quantity ratio and the blood is replaced well. Therefore, since the field of view of the image obtained from the image fiber 13 and the objective lens 15 can be widened and sharpened, a sharp blood vessel inner wall image with a wide field of view can be captured and observed.

FIG. 5 shows an embodiment in which, instead of providing the first pump 8 and the second pump 11, a flow control function is added to each flow path by dividing the flow path into two from one blood sac blood injection device 35. Show.
The above-described ratio is desirable for the flow ratio of the sparse blood flowing from the first ejection section 6A and the second ejection section 9A into the blood vessel. Therefore, when the above-mentioned flow ratio is determined, the structure shown in FIG. 5 is adopted. it can.
A first pipe (first connection path) 36 is connected from the injection device 35 to the branch pipe 7b side of the first connector 7, and a second pipe is connected from the injection device 35 to the branch pipe 10b side of the second connector 10. A (second connection path) 37 can be connected, a flow rate adjustment valve 38 can be provided in the first pipe 36, and a second flow rate adjustment valve 39 can be provided in the second pipe 37.

  By adopting the configuration shown in FIG. 5, an appropriate amount of sparse blood is ejected to the observation position of the coronary artery entrance 30 and the arterial branch 31 to image and observe the inner wall of the blood vessel at the observation position with a sharp and wide field of view. Can do.

FIG. 6 shows an embodiment in which the second pump is configured as a pedal pump.
The second pump 41 of this embodiment includes a column part 46 that is vertically attached to a part of the frame F of the pedestal in the vicinity of the operating table via a chuck part 45, and vertically along the column part 46. A top plate 47 that is slidably supported, a spring member 49 that supports the top plate 47 from a flange portion 48 formed at the upper end of the column 46, and a syringe 50 that is suspended downward from the top plate 47. And a switching valve 51 attached to the lower end of the syringe 50. Further, a linear body 53 is suspended downward from near the support portion of the support column 46 on the top plate 47, and the linear body 53 is connected to a foot pedal 55 installed on the floor.

  A connecting pipe 52 is connected to the extraction part 51a of the switching valve 51, and the other end of the connecting pipe 52 is connected to the branch part 10b of the connector 10 shown in FIG. Moreover, the 2nd inlet part 51b is formed in the side part of the switching valve 51, the non-return valve 51c is integrated in the 2nd inlet part 51b, and the non-return valve 51c is also integrated in the extraction part 51a. . The check valve 51c provided in the dispensing part 51a allows the flow of fluid only to the side that flows out from the dispensing part 51a, and the check valve 51c provided in the second inlet part 51b extends from the second inlet part 51b. The fluid is allowed to flow only to the dispensing portion 51a side. An infusion device is connected to the second inlet 51 b of the switching valve 51 via a supply pipe 56.

  If the second pump 41 shown in FIG. 6 is used, the foot pedal 55 is operated downward with the foot, and the piston of the syringe 50 is operated, so that a necessary amount of sparse blood is obtained by a stepping operation without using a hand. A necessary amount can be ejected to a necessary position of the branch portion 31. For this reason, if there is no surgeon, the necessary amount of sparse blood can be sent by a stepping operation without bothering the operation assistant.

R1 ... 1st flow path, R2 ... 2nd flow path, 1 ... Vascular endoscope system, 2 ... Guiding catheter, 3 ... Probing catheter, 5 ... Vascular endoscopic catheter, 5A ... Catheter body part, 6 ... guide catheter tube, 6A ... first ejection part, 7 ... first connector, 8 ... first pump, 9 ... outer cylinder, 9A ... second ejection part, 10 ... second connector, 11 ... first 2 pumps, 12 ... light guide fiber, 13 ... image fiber, 23 ... light source, 24 ... imaging device, 25 ... display device, 30 ... coronary artery entrance, 31 ... coronary artery branch, 33 ... inner tube, 34 ... guide wire 35 ... injection device 36 ... first flow path (first pipe) 37 ... second flow path (second pipe) 38, 39 ... flow rate adjusting valve, 41 ... second pump.

Claims (4)

  A catheter body having an image fiber and a light guide fiber; an outer tube of a probing catheter provided to cover the image fiber and the light guide fiber; and a guiding catheter provided to cover the outer tube of the probing catheter. The blood flow maintenance type blood vessel endoscopy in which a first blood spouting portion is formed at the distal end portion of the guiding catheter and a second blood spouting portion is formed at the distal end portion of the outer tube of the probing catheter. Mirror system. A guiding catheter is provided so as to be able to extend to the vicinity of the observation site of the blood vessel, and extends to the observation site of the blood vessel which is in front of the distal end portion of the guiding catheter and smaller in diameter than the blood vessel through which the guiding catheter is inserted. An outer cylinder of the probing catheter is inserted into the guiding catheter so as to be able to extend forward from the distal end portion of the guiding catheter, and the probing catheter from the first ejection portion at the distal end of the guiding catheter. The blood flow maintenance type blood vessel endoscope system according to claim 1, which is configured to be able to eject sparse blood to the outer cylinder surrounding side.   A first pump for supplying lyophobic blood is connected to a flow path between the guiding catheter and the outer tube of the probing catheter inside the guiding catheter, and the outer tube of the probing catheter is connected to the proximal end side of the guiding catheter. The blood flow maintaining type according to claim 2, wherein a second pump for supplying blood sac blood is connected to a flow path between the outer tube of the probing catheter and the catheter body portion inside the probing catheter. Vascular endoscope system.   A first connection path for supplying lyophobic blood is connected to the first flow path between the guiding catheter and the outer tube of the probing catheter inside the guiding catheter, and the probing is performed. A second connection path for supplying lyophobic blood is connected to a second flow path between the outer cylinder of the probing catheter and the catheter main body inside thereof on the proximal end side of the outer cylinder of the catheter, The first connection path and the second connection path are connected to the blood sac blood injection device, and flow through the first connection path and the second connection path through the first connection path and the second connection path. The blood flow maintenance type blood vessel endoscope system according to claim 2, wherein a flow rate adjusting means for controlling the flow rate of the sparse blood is incorporated.

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