JP7182959B2 - Guide wire insertion means - Google Patents

Description

TECHNICAL FIELD The present invention relates to a guide wire inserting means that is inserted into a body cavity and attached to a basket-type endoscopic treatment instrument having a basket-shaped treatment section that is used for recovering and crushing foreign substances such as calculus in the body cavity.

In order to remove a biliary stone or the like, a basket-type endoscopic instrument is generally used that is inserted through an endoscope channel and protrudes from the distal end of the endoscope to collect and crush foreign substances. In this basket-type endoscopic treatment instrument, a retractable cage-shaped basket portion provided at the distal end of the operating wire is inserted into the flexible sheath together with the operating wire, and connected to the rear end of the flexible sheath. By operating the operation part, the operating wire is pushed to extend the basket part from the distal end of the flexible sheath, and the calculus is taken into the basket part. It is to be gripped and pulverized or collected. Some basket-type endoscopic treatment tools use, for example, a guide wire for guiding the insertion of a flexible sheath into the bile duct within the papilla of the duodenum. Patent Documents 1 and 2 below are cited as documents describing techniques related to basket-type endoscopic treatment instruments using such guide wires.

Patent Document 1 discloses a flexible sheath in which a main lumen capable of exposing and retracting the distal end of a treatment instrument main body from a distal end side opening is formed, and a distal end portion of the flexible sheath. A fixed portion having a length of 3 to 30 mm and a freedom extending proximally from the fixed portion and not fixed to the flexible sheath but separable from the flexible sheath. and a guidewire tube inside which is formed a guidewire lumen capable of exposing and retracting the distal end of the guidewire from the distal end side opening, and the main lumen of the treatment instrument main body is provided with the guidewire. Disclosed is a basket-type endoscopic treatment instrument that is separated from the lumen to prevent the guide wire from interfering with the treatment instrument main body.

In Patent Document 2, a basket portion is connected to the distal end portion of an operation wire that is inserted reciprocally into an elongated sheath, and a distal tip is fixed to the distal end portion of the basket portion. , for a basket-type endoscope that facilitates taking calculus into the basket by preventing the guide wire from crossing the expanded basket part by providing a guide wire insertion hole that communicates with the outer peripheral surface. A treatment device is described.

JP 2014-30492 A JP 2011-19937 A

In the basket-type endoscopic treatment instrument described in the above-mentioned Patent Document 1, the main lumen of the flexible sheath and the guide wire lumen, which are separated in the free portion, are replaced by the fixed portion at the distal end of the flexible sheath. Since the guide wire is fixed in parallel in the flexible sheath, the guide wire is bent in the fixing portion of the guide wire lumen of the flexible sheath and protrudes toward the distal end in parallel with the flexible sheath. When the flexible sheath is inserted into the bile duct, the resistance of the rigid guidewire against the inner wall of the fixed part of the guidewire lumen makes it difficult to move the flexible sheath smoothly, making insertion into the bile duct difficult. was there.

Further, in the basket-type endoscopic treatment instrument described in Patent Document 2, the distal tip is provided with a guide wire insertion hole that communicates between the front surface of the distal tip and the outer peripheral surface. On the side of the operation part, the guide wire, which was separated from the distal tip, is bent inside the guide wire passage hole, and protrudes from the tip of the distal tip coaxially with the flexible sheath, along the guide wire. When the flexible sheath is inserted into the bile duct, the resistance of the rigid guide wire being bent and pressed against the inner wall of the distal tip makes it difficult to move the flexible sheath smoothly, making insertion into the bile duct difficult. I had a problem.

In addition, as shown in FIG. 5, the treatment with the basket-type endoscopic treatment instrument using a guide wire is performed by a doctor pulling the operating wire to pull the basket portion 4 at the distal end portion inside to reduce the diameter and guide it. The flexible sheath 2 with the wire 9 protruding is positioned near the papilla 210 of the duodenum as shown in FIG. As shown in b), the flexible sheath 2 is inserted into the bile duct 22 while being guided by the guide wire 9, and with the distal end moved above the calculus 230, the operating wire is pushed out to protrude and open the basket portion 4. Next, as shown in FIG. 5(c), the guide wire 9 is pulled into the flexible sheath 2, and then the operation wire is pulled in to trap the calculus 230 in the gap of the basket portion 4, and the basket portion 4 is pulled into the flexible sheath 2. The calculus 230 is further pulled inward to clamp and crush the calculus 230 , or the distal end basket portion 4 with the calculus 230 captured is pulled to a position where it contacts the flexible sheath 2 , and the flexible sheath 2 in this state is moved to the bile duct 22 . The calculus 230 is recovered by pulling it out.

An object of the present invention is to solve the problems of the prior art, and to enable smooth guidance of the flexible sheath and basket along the guide wire and easy insertion into the bile duct within the papilla. It is to provide a guide wire inserting means capable of

In order to achieve the above object, the present invention provides a long cylindrical flexible sheath, an operation wire that is inserted into the cylinder of the flexible sheath so as to be able to move back and forth, and a distal end of the operation wire that terminates in the rear end of the distal end of the operation wire. a basket portion connected to the tip and made up of a plurality of basket wires formed so as to elastically contract or expand in a state where the tips are connected to the distal tip, and the basket portion is guided by a guide wire. A guide wire inserting means of a treatment tool for a type endoscope, wherein the guide wire inserting means is composed of a hollow distal tip fitting portion in which the distal tip is fitted and an outer diameter smaller than that of the distal tip fitting portion. a hollow cylindrical guidewire insertion portion protruding distally beyond the distal tip, wherein the guidewire insertion portion includes a hole through which the guidewire is inserted in the peripheral surface on the proximal side; and the hole. A first feature is that grooves for passing the guide wire are provided on the peripheral surface on the distal end side at symmetrical positions in the circumferential direction, and the guide wire is linearly passed from the hole toward the groove.

A second feature of the present invention is that a step is formed by a diameter difference between the distal tip fitting portion and the guide wire insertion portion, and the base end side bottom portion of the hole and the base end side bottom portion of the groove. A third feature is that the line connecting .

Further, according to the present invention, the distal tip has a narrow diameter portion on the base end side and a hemispherical portion on the distal side, and the guide wire inserting means includes a heat-shrinkable tube that is inserted into the hemispherical portion of the distal tip and the hemispherical portion on the distal end side. A fourth feature is that the hemispherical portion is formed by contracting the portion while protruding from the hemispherical portion toward the distal end side.

The guidewire inserting means according to the present invention has a distal tip fitting portion into which the distal tip is fitted, and a guidewire inserting portion having a smaller outer diameter than the distal tip fitting portion and protruding distally beyond the distal tip. The guide wire insertion portion has an insertion space through which the guide wire is inserted linearly while being inclined with respect to the central axis of the distal tip, and the insertion space extends from the side surface of the guide wire insertion portion on the proximal side to the distal end. By forming the flexible sheath toward the lateral side, the flexible sheath can be smoothly moved along the guide wire and easily inserted into the bile duct within the papilla.

1 is a diagram showing the overall configuration of a basket-type endoscopic treatment instrument having guide wire insertion means according to the present invention; FIG. FIG. 2 is a diagram for explaining a guidewire inserting means according to Example 1 of the present invention; FIG. 2 is a diagram for explaining a guidewire inserting means according to Example 1 of the present invention; FIG. 4 is a diagram for explaining a guide wire inserting means according to a reference example of the present invention; FIG. 4 is a diagram for explaining a problem of the basket-type endoscopic treatment instrument having guide wire insertion means according to the present invention;

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of a guide wire inserting means and a basket-type endoscopic treatment instrument provided with the guide wire inserting means according to the present invention will be described in detail with reference to the drawings. In this embodiment, the left side of FIG. 1 where the basket portion is located is called the distal side, and the right side where the operation portion is located is called the proximal side.

[Example 1]
[Basic configuration]
First, as shown in FIG. 1, the overall configuration of a basket-type endoscopic treatment instrument having guide wire insertion means according to a first embodiment of the present invention consists of an elongated flexible sheath 2 and the flexible sheath 2. a cylindrical distal end fitting 20 made of a hard metal material attached to the distal end of the sheath, an operating wire 3 inserted through the flexible sheath 2 so as to advance and retreat, and an operation for advancing and retreating the operating wire 3 It includes an operation part 10 attached to the rear end of the wire 3 and a plurality of basket wires 8 connected to the tip of the operation wire 3, and can protrude and retract from inside the flexible sheath 2 by advancing and retracting the operation wire 3. A basket portion 4 for grasping or crushing calculus, which is a treatment portion, a guide wire 9 extending along the flexible sheath 2 from the operation portion 10 side and operated to advance and retreat, and attached to the distal end of the basket portion 4, A guide wire insertion means 70 for inserting the guide wire 9 is provided.

The basket part 4 is attached to a plurality of basket wires 8, which are a plurality of metal wires having an elastic restoring force, and to the distal ends of the operation wires 3. A rear end tip 7 that is integrally connected to the operation wire 3 and a front end tip 6 that is a portion in which the distal end sides of a plurality of basket wires 8 are integrally connected are provided. When it is housed in the flexible sheath 2 with the space between them extended, it has a long shape, and when it is taken out of the flexible sheath 2, it is shaped like a basket by the elastic restoring force of the plurality of basket wires 8. It is configured to elastically contract or expand. In this embodiment, the distal tip 6 is formed by joining the distal ends of a plurality of basket wires 8 by welding or the like using a filler material. Although it is formed in a mushroom shape with a hemispherical part, it is not limited to this shape, and is formed using other parts such as inserting and connecting multiple basket wire tips in a cylindrical metal. You can In this embodiment, the portion where the distal end portions of the plurality of basket wires are joined is called a distal tip.

The operation portion 10 has a grip portion 14 attached to the rear end of the operation wire 3 via an operation pipe 12, and the operation pipe 12 of the grip portion 14 attached to the operation wire 3 passes through, and a water supply port 13 is opened. and an operation portion main body 11 for moving the operation wire 3 with respect to the flexible sheath 2 by advancing and retreating the grip portion 14 . The water supply port 13 has an inner end communicating with the space inside the cylinder of the operation portion main body 11 , and is configured so that an injection device (not shown) or the like can be attached to the water supply port 13 so that a liquid medicine or the like can be supplied into the flexible sheath 2 .

[Guide wire insertion means]
Next, the guide wire inserting means 70 according to this embodiment will be described in detail with reference to FIGS. 2(a) to 2(d) and FIG. 2(a) is a cross-sectional view of the guide wire insertion means, (b) is a cross-sectional view of the guide wire insertion means attached to the distal tip (except for the guide wire insertion means is not a cross section), and (c) is a cross-sectional view of the guide wire insertion means. A cross-sectional view of a state in which the guide wire inserting means is attached to the distal tip and the guide wire is inserted (except for the guide wire inserting means is not a cross section), (d) is a perspective view of the guide wire inserting means, FIG. 2 and FIG. 3 is called the distal side, and the lower side is called the proximal side.

As shown in FIGS. 2(d) and 3, the guide wire inserting means 70 has a hollow pot-like shape with a small diameter on the distal end side and a large diameter on the proximal end side, forming a step 70e due to the difference in diameter. The base end side is a large diameter portion 70a that serves as a distal tip fitting portion for attaching to the distal tip 6, and the distal side is a small diameter portion 70b that serves as a guide wire insertion portion for inserting a guide wire. It protrudes to the tip side more than the tip tip.
The small-diameter portion 70b has a hole 70c for inserting the guide wire 9 at a position adjacent to the proximal-side step 70e on the proximal-side peripheral surface. A substantially V-shaped groove 70d cut from the distal end side for guiding the guide wire 9 is provided at a circumferentially symmetrical position of the hole 70c. The groove 70d may be formed by cutting the hole 70c from a position approximately one-third of the circumferentially symmetrical position toward the proximal direction and outward so as to obliquely cut the groove 70d. It is not limited and may be formed by other methods.
In addition, the hole 70c and the groove 70d allow the guide wire 9 inserted into the insertion space connecting the hole 70c and the groove 70d to be linearly inserted without being coaxial or parallel to the central axis of the distal tip 6. , the angle θ1 of the line connecting the bottom (base end side) of the hole 70c and the bottom (base end side) of the groove 70d is set to be 10 to 45 degrees with respect to the center axis of the tip. preferred. The angle θ1 is preferably set according to the lengthwise positions of the hole 70c and the groove 70d and the height of the step 70e.

[Manufacturing method of guide wire inserting means and attaching method to distal tip]
Manufacture of the guide wire inserting means 70 according to the present embodiment and attachment to the distal tip 6 are performed as follows. The guide wire inserting means 70 is made of a cylindrical heat-shrinkable tube made of a fluorine resin such as PTFE (polytetrafluoroethylene). A hole 70c (for example, about 0.9 mm to 1.2 mm) is opened in the center for passing the guide wire. Then, the heat-shrinkable tube is covered from the distal end side of the distal tip 6 . At this time, the heat shrinkable tube protrudes from the distal tip 6 toward the distal end (for example, about 3 mm) and reaches a portion slightly smaller in diameter than the hemispherical portion of the distal tip 6. cover it with At this position, heat is applied to the heat-shrinkable tube to shrink it, so that the heat-shrinkable tube adheres tightly to the distal tip 6 , and the rear end of the heat-shrinkable tube is caught by the end of the hemispherical portion of the distal tip 6 . It is possible to prevent the heat-shrinkable tube (guide wire insertion means 70) from coming off. After that, substantially V-shaped grooves are formed at the tips of the holes 70c of the heat-shrinkable tube at symmetrical positions in the circumferential direction.
The guide wire insertion means 70 according to this embodiment can be manufactured and attached to the distal tip 6 as described above, but the order is not limited to this order.

In the basket-type endoscopic treatment instrument having the guide wire insertion means according to this embodiment, the guide wire 9 is not bent in the insertion space of the guide wire guide means 70, as shown in FIG. The guide wire 9 is inserted linearly through the guide wire insertion means, and the guide wire 9 is inserted at an angle (inclined) to the guide wire insertion means 70, thereby moving the guide wire insertion means 70 along the guide wire 9. It can be moved smoothly with less contact resistance than parallel or coaxial movement.
In addition, since the grooves 70d are provided at the distal ends of the holes 70c of the guidewire insertion means 70 at symmetrical positions in the circumferential direction, the grooves 70d serve as guides when the guidewire 9 is inserted from the distal end side of the guidewire insertion means 70. Since the guide wire 9 can be easily inserted into the hole 70c, work efficiency can be improved.

[Reference example]
In the above-described embodiment, an example in which the guide wire inserting means is configured by a cylindrical heat-shrinkable tube has been shown, but the present invention is not limited to this, and may be configured as follows, for example.
As shown in FIG. 4, the guide wire inserting means 80 according to this reference example includes a distal tip fitting portion 80a into which the distal tip 6 is fitted, and a tip fitting portion 80a having a smaller outer diameter than the fitting portion 80a and extending to the distal side of the distal tip 6. It has a guide wire insertion portion 80b that protrudes and has an insertion space 80c for inserting the guide wire 9 therethrough. The guidewire inserting means 80 forms a step 80e due to the difference in diameter between the distal tip fitting portion 80a and the guidewire inserting portion 80b. Formed towards the side.
The angle θ2 of the center line of the insertion space 80c with respect to the central axis of the distal tip 6 is set from 10 degrees to 45 degrees, and the guide wire 9 is inclined with respect to the central axis of the distal tip 6 and linearly inserted into the insertion space 80c. is inserted into the

In the basket-type endoscopic treatment instrument having the guide wire insertion means 80 of this reference example configured as described above, the guide wire 9 is linearly inserted into the guide wire insertion means without being bent by the guide wire guide means 80 . The guidewire 9 is inserted at an angle (obliquely) to the guidewire passing means 80, thereby allowing the guidewire passing means 80 to move parallel or coaxially as it moves along the guidewire 9. It has less contact resistance and can be moved smoothly.

2 flexible sheath, 3 operating wire, 4 basket part, 6 distal tip,
7 posterior tip, 8 basket wire, 9 guide wire, 10 operation part,
11 operation part main body, 12 operation pipe, 13 water supply port, 14 grip part, 20 tip metal fitting,
22 bile duct, 70 guidewire passing means, 80 guidewire passing means, 230 calculus

Claims (4)

An elongated cylindrical flexible sheath, an operation wire that is inserted into the cylinder of the flexible sheath so as to be able to move back and forth, a terminal end of which is coupled to a rear tip at the tip of the operation wire, and a tip end of which is coupled to the distal tip. A basket-type endoscopic treatment instrument having a basket part formed of a plurality of basket wires formed so as to elastically contract or expand in a compressed state, and guiding the basket part by a guide wire. being a means
The guide wire inserting means comprises a hollow distal tip fitting portion into which the distal tip is fitted, and a hollow cylindrical guide wire having an outer diameter smaller than that of the distal tip fitting portion and protruding distally beyond the distal tip. and an insertion portion,
The guidewire insertion portion has a hole through which the guidewire is inserted on the peripheral surface on the proximal end side, and a groove through which the guidewire is passed through on the peripheral surface on the distal side at positions symmetrical to the hole in the circumferential direction. A guide wire inserting means characterized in that the guide wire is linearly passed from the hole toward the groove . 2. The guide wire inserting means according to claim 1, wherein a step is formed by a diameter difference between the distal tip fitting portion and the guide wire inserting portion. 3. The method according to claim 1 or 2 , characterized in that a line connecting the base end side bottom of said hole and the base end side bottom of said groove is set in a range of inclination from 10 degrees to 45 degrees with respect to the central axis of said tip. Guidewire threading means as described. The distal tip has a narrow diameter portion on the proximal side and a hemispherical portion on the distal side,
4. The method according to any one of claims 1 to 3 , wherein said guide wire inserting means is formed by shrinking a heat-shrinkable tube while protruding from said hemispherical portion of said distal tip and from said hemispherical portion toward the distal end. Guidewire insertion means according to any one of the preceding claims.

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