JP7336576B1 - Medical equipment - Google Patents

Abstract

An object of the present invention is to provide a medical device that does not require effort when catching a foreign object and moving the foreign object within a bronchi having different diameters. A medical device includes a flexible sliding member 54 that is slidably movable in the direction in which a sheath 52 extends. The gripping portion 60 at the tip of the sliding member 54 includes a plurality of elastic gripping elements 62 . The gripping element 62 has a connecting portion 62a extending along the axis of the sliding member 54, and a reversing portion 62d that is reversed via a curved portion 62b that curves from the tip of the connecting portion 62a in a radial direction perpendicular to the axis. Be prepared. When the gripping portion 60 is located within the sheath 52, the gripping element 62 is held in a first state in which the distance between the inverted portion 62d and the connecting portion 62a is shortened against elasticity. When the gripping part 60 is located outside the sheath 52, the gripping element 62 transitions to a second state in which the distance between the inverted part 62d and the connecting part 62a becomes longer due to elasticity. [Selection diagram] Figure 11

Description

The present invention relates to medical devices.

An airway foreign body is a foreign body lodged in the airway. Airway foreign bodies (hereinafter simply referred to as foreign bodies) include accidentally inhaled teeth, dentures, peanuts, pebbles, and the like. A foreign body obstructs the respiratory tract and may cause suffocation or severe pneumonia, so prompt and reliable removal is required.

There are various methods for removing foreign bodies, but there is bronchoscope-based treatment in which grasping forceps are inserted into the working channel of a bronchoscope to remove foreign bodies.
Grasping forceps include W-shaped grasping forceps, V-shaped grasping forceps, rubber-attached grasping forceps, crocodile-shaped grasping forceps, basket-type grasping forceps, and the like. These grasping forceps are used properly according to foreign foreign matter. The W-shaped grasping forceps are designed to strongly pinch a flat object such as a coin or a button battery. Since the V-shaped grasping forceps have claws, they are suitable for soft foreign objects. Grasping forceps with rubber are suitable for slippery foreign objects such as needles and pins. The alligator-type grasping forceps are used for handling complex-shaped foreign objects because the inside of the forceps is uneven.

Patent documents 1, 2, 3, and 4 disclose examples of W-shaped grasping forceps, basket-type grasping forceps, and basket-type grasping forceps at the time of filing of the present application.
With the grasping forceps mentioned above, some foreign objects are difficult to grasp depending on the location of the bronchi where the foreign objects are located. Non-Patent Document 1 and Non-Patent Document 2 show an example in which a Forgarty balloon catheter is used instead of the above-described grasping forceps to remove foreign substances such as canine teeth and pebbles.

With a balloon catheter, a balloon is inserted into the gap between the foreign body and the bronchial wall under a bronchoscope and positioned deeper than the foreign body. After that, the balloon is inflated to increase its diameter. In this state, the foreign matter is removed by pulling the balloon catheter to move the foreign matter so that it is hooked on the expanded balloon.

In the case of a balloon catheter, if the balloon is inflated insufficiently, it may not be possible to partially contact the bronchial wall. In this case, even if the balloon catheter is pulled, the balloon and the foreign object are not sufficiently hooked, the balloon slips out of the gap between the foreign object and the bronchial wall, and the foreign object cannot move. Therefore, it is necessary to inflate the balloon until the entire peripheral surface of the balloon is in contact with the bronchial wall.

Conventionally, the foreign matter is moved by pulling the balloon catheter and hooking the foreign matter on the expanded diameter balloon. When the balloon is positioned where the diameter of the bronchial wall is wider than before, the balloon is filled with gas or the like to prevent the balloon from slipping out of the gap between the foreign object and the bronchial wall. It is

Then, when the moved foreign matter can be moved to a portion of the bronchus that can be removed by other grasping forceps, the foreign matter is removed by, for example, the other grasping forceps.

JP 2019-017522 A JP 2018-187109 A Japanese Patent Publication No. 2016-056558 JP 2015-123230 A

Showa Medical Journal Vol. 72, No. 4 (pp. 428-434, 2012), "Special Feature: Current Situation of Minimally Invasive Surgery in the Diagnosis and Treatment of Respiratory Diseases Treatment of Airway Foreign Body -Focusing on Foreign Body in the Lower Respiratory Tract-", Yamamoto Shigeru, Naoya Himuro, Mitsutaka Kadokura Otolaryngology 74: 2; 1372-1376, 1981, "A method for removing bronchial foreign bodies using Fogarty cather", Kunio Shoji, Haruki Sosei, Yasuo Sakakura, Yasuro Miyoshi

As described above, with a balloon catheter, if the diameter of the bronchial wall expands while the inflated balloon is moving around a foreign object, it is necessary to fill the balloon with gas, etc., and expand the diameter of the balloon. Become.

For this reason, there is a problem that it takes time and effort to remove the foreign matter as a medical device that hooks the foreign matter and moves the foreign matter in the bronchi having different diameters.
SUMMARY OF THE INVENTION An object of the present invention is to solve the above problems and to provide a medical device that does not require time and effort when hooking a foreign object and moving the foreign object in bronchi having different diameters.

In order to solve the above problems, the present invention provides a medical device to be inserted through a working channel of a bronchoscope, comprising: a sheath slidably inserted through the working channel; a flexible sliding member slidably provided so as to advance and retreat in the extending direction of the sheath; , wherein the gripping element includes a connecting portion extending distally along the axis of the sliding member and a radial direction perpendicular to the axis from the tip of the connecting portion. It includes an inverting portion that inverts via a curved curved portion, the distal end of the inverting portion is a free end, and when the grasping portion is positioned within the sheath, the grasping element resists elasticity. When the first state is maintained in which the distance between the reversing portion and the connecting portion is shortened and the gripping portion is positioned outside the sheath, the elasticity of the gripping element reduces the distance between the reversing portion and the connecting portion. It transitions to a longer second state. Note that the distal side refers to the far side when the side closer to the operator side of the medical device is defined as the proximal side.

In the method of using the medical device configured as described above, the tip of the bronchoscope is positioned in front of the bronchial region where the foreign matter remains, and the grip portion is held in the first state with respect to the working channel in this state. A sheath is inserted.

Then, in front of the foreign object, the sheath is pulled out of the working channel of the bronchoscope and inserted into the gap between the foreign object and the bronchial wall to position the distal end of the sheath behind the foreign object.
After the distal end of the sheath is positioned deeper than the foreign object, the sliding member is pulled out from the distal end of the sheath to position the grasping portion outside the sheath. As a result, the plurality of gripping elements of the gripping portion enter the second state in which the distance between the reversing portion and the connecting portion increases due to elasticity.

In this state, the everted portions of the plurality of grasping elements are able to contact the bronchial wall. Therefore, the foreign matter can be removed by pulling the medical device and moving it in such a manner that the foreign matter is hooked on the reversing portions of the widened grasping elements. Also, contact of the inverted portion of the gripping element with the bronchial wall is permitted until the elastic force of the inverted portion is released. Therefore, within this range of elastic force, contact with the bronchial wall is possible even if the diameter of the bronchial wall is different.

Moreover, it is preferable that a part of the inverted portion of the grasping element contacts the inner surface of the bronchus into which the bronchoscope is inserted when transitioning to the second state (Claim 2).
With the above configuration, when the medical device is pulled forward from the back side of the foreign object stuck in the bronchus, part of the reversing portion moves forward while contacting the bronchus wall, thereby reliably hooking the foreign object on the reversing portion. It is possible to remove the foreign matter.

Further, the connecting portions of the plurality of gripping elements are bundled together,
It is preferable that the inverted portions of the plurality of gripping elements are arranged so as to surround the bundle-shaped connecting portion (Claim 3).

With the above configuration, a part of the plurality of reversing portions arranged so as to surround the bundle-shaped connection portion moves forward while contacting the bronchial wall, so that the foreign matter can be reliably caught on the reversing portion, Foreign matter can be removed.

Moreover, it is preferable that the grasping element and the sliding member on the side opposite to the foreign object are formed so as to be crushable by the foreign object when removing the foreign object remaining in the bronchi (claim 4).
With the above configuration, the grasping element and the sliding member on the anti-foreign body side are crushed by the foreign body when the foreign body staying in the bronchi is removed.

Further, the gripping element is in the second state, and the gripping element with the free end directed toward the connecting portion side is pulled out together with the bronchoscope from the bronchus into which the bronchoscope is inserted. Preferably, during movement in the direction, the free end is inserted between the bronchial wall and a foreign body present in the bronchus (Claim 5).

With the above configuration, when the free end is inserted between the bronchial wall and the foreign body present in the bronchus, the gripping element can reliably remove the foreign body.
Also, the gripping element is preferably made of plastic.

The above arrangement allows the gripping element to be suitably elastic.
Further, the sliding member may be made of plastic.
With the above configuration, the sliding member can be easily made of plastic.

Moreover, it is preferable that the gripping element is integrally formed with the sliding member by adhesive or welding.
With the above configuration, the gripping element and the sliding member can be preferably integrated.

Also, the sheath is preferably made of plastic.
With the above configuration, the sheath can be easily made of plastic.
Further, the proximal end of the sliding member serves as an operating end, and when the operating end is pushed out toward the distal end in an extruding direction, the operating end is operable in the extruding direction and the anti-extrusing direction. .

With the above configuration, when the operating end is pushed out toward the distal end side in the pushing direction, the sliding member extends from the distal end of the sheath to position the grasping portion outside the sheath. As a result, the plurality of gripping elements of the gripping portion enter the second state in which the distance between the reversing portion and the connecting portion increases due to elasticity. In this state, the everted portions of the plurality of grasping elements are able to contact the bronchial wall. Therefore, the foreign matter can be removed by pulling the medical device and moving it in such a manner that the foreign matter is hooked on the reversing portions of the widened grasping elements.

Advantageous Effects of Invention According to the present invention, there is an effect that it is easy to hook a foreign object and move the foreign object in bronchi having different diameters.

1 is a perspective view of a bronchoscope; FIG. 1 is a partial perspective view of a combination bronchoscope and medical device of one embodiment; FIG. FIG. 4 is a partly omitted end view showing a first state of gripping elements of a gripping portion in an embodiment of a medical device; FIG. 10 is an end view, partly omitted, showing a second state of the gripping element of the gripping portion of the medical device of one embodiment. FIG. 11 is a perspective view of a main part showing a second state of gripping elements of a gripping portion in the medical device of one embodiment; FIG. 10 is a side view of the sliding portion viewed from the distal end side when the gripping element of the gripping portion is in the second state; 1 is a diagram of the anatomical parts of the respiratory system; FIG. FIG. 4 is an explanatory diagram of a state in which the tip of a bronchoscope is placed in front of a foreign object stuck on the bronchus wall and the sheath of the medical device is extended. FIG. 4 is an explanatory diagram of a state in which the sheath of the medical device extended from the bronchoscope is interposed between the foreign matter stuck on the bronchial wall and the bronchial wall. FIG. 10 is an explanatory view of the sheath of the medical device in which the sliding member is extended to put the gripping element of the gripping portion in the second state; FIG. 10 is an explanatory diagram of a state in which a foreign object is hooked on the grasping element in the second state and moved within the small-diameter bronchial wall. FIG. 10 is an explanatory view of a state in which a foreign object is hooked on the grasping element in the second state and moved within the large-diameter bronchus wall.

(embodiment)
A medical device 50 embodying the present invention will now be described with reference to FIGS. 1-12.
(bronchoscope 10)
First, the bronchoscope 10 used together with the medical device 50 will be described with reference to FIG. As shown in FIG. 1 , the bronchoscope 10 has an operating head 12 , an insertion section 14 connected to the operating head 12 , and a connector 16 connected to the operating head 12 via a universal cord 15 . The insertion portion 14 is inserted into the bronchi.

The universal cord 15 includes various conduits and signal cables. The connector 16 is detachably connected to a control device (not shown). The control device has a light source section (not shown). The light emitted from the light source section is supplied to the bronchoscope 10 through the connector 16 and the universal cord 15, and transmitted as illumination light to the light guide tube 28 (see FIG. 2) of the illumination system provided at the distal end of the insertion section 14. be.

Various buttons 13 such as an air/water supply button, a suction button, a shutter button, and a function switching button are arranged side by side on the operation head 12 . Further, the operation head 12 is provided with a vertical angle knob 17a and a horizontal angle knob 17d for bending the distal end side of the bronchoscope 10. As shown in FIG.

The insertion portion 14 is composed of a flexible portion 14a, a curve forming portion 14b, and a bronchoscope distal end portion 18 in order from the operation head 12 side. The soft portion 14a has flexibility and is connected to the base end side of the curve forming portion 14b.

The curve forming portion 14b bends up and down by pulling a wire (not shown) inserted in the insertion portion 14 when the up/down angle knob 17a of the operation head 12 is rotated. there is Further, the curve forming portion 14b is bent left and right by pulling a wire (not shown) inserted in the insertion portion 14 by rotating the left and right angle knob 17d of the operation head 12. It's becoming This allows the bronchoscope tip 18 to be oriented in a desired direction.

A connecting portion 19 between the operation head 12 and the insertion portion 14 is provided with a forceps insertion portion 20 into which a treatment tool such as forceps is inserted. As shown in FIG. 2, the treatment instrument inserted from the forceps insertion portion 20 is inserted through a working channel 22 formed in the insertion portion 14 and can be drawn out from a forceps port 24 on the end face of the distal end portion 18 of the bronchoscope. there is

As shown in FIG. 2, the end face of the distal end portion 18 of the bronchoscope is provided with an objective lens 26, a pair of light guide tubes 28, etc. in addition to the forceps port 24. As shown in FIG. The objective lens 26 forms part of the imaging optical system. The imaging optical system has an imaging element (not shown) in the distal end portion 18 of the bronchoscope for imaging the observation site illuminated by the light guide tube 28 .

An imaging signal of an observed image obtained from the imaging element is output to the control device (not shown) through an optical fiber (not shown) included in the insertion portion 14, the connecting portion 19, the universal cord 15, and the connector 16. . The controller displays an image on a monitor (not shown) based on the output imaging signal. In addition, a CCD image sensor and a CMOS image sensor can be mentioned as an imaging device.

Although not shown, the end face of the bronchoscope distal end portion 18 is provided with a nozzle for jetting out water or air to wash away the mucus or blood inside the organ when the objective lens 26 becomes dirty.
(Medical device 50)
Next, the medical device 50 is described.

The medical device 50 includes a sheath 52 shown in FIG. 1, a sliding member 54 shown in FIG. It has a grip portion 60 .

(sheath 52)
As shown in FIGS. 1 and 2, the sheath 52 is formed to extend longitudinally along the longitudinal direction of the sliding member 54 . The length of the sheath 52 is set longer than the length of the working channel 22 of the insertion section 14 and can be extended from the distal end portion 18 of the bronchoscope.

As the material used for the sheath 52, the following plastics can be mentioned.
<Nylon>
Nylon 12, Nylon 11, Nylon 6/12, Nylon 6, Nylon 66, etc. <Polyester>
Polyethylene terephthalate, polybutylene terephthalate, polyethylene naphthalate, polytrimethylene terephthalate <Others>
Copolymers such as polyether, polyurethane, polyvinyl, polyacrylic acid, fluoropolymers, block copolymers composed of polyether and polyamide, and mixtures thereof. It is preferable to coat the outer surface and the inner surface with a hydrophobic or hydrophilic coating agent in order to increase the slidability with respect to the moving member 54 . Thereby, the slidability with respect to the insertion portion 14 and the slidability with respect to the sliding member 54 can be improved.

(Sliding member 54)
As shown in FIGS. 2 and 3, the sliding member 54 is inserted into the sheath 52 so as to be able to move forward and backward. The sliding member 54 is formed in an elongated shape. The sliding member 54 is preferably set to various lengths without being limited to the target site of the anatomy inside the patient's body. The sliding member 54 is set to a length such that the distal end thereof protrudes beyond the distal end of the sheath 52 by being operated by an operation portion 56 which will be described later.

The sliding member 54 is preferably made of a material that is resistant to twisting. A representative example of this material is the plastic mentioned above for the sheath 52 . Materials other than plastic include nickel-titanium alloys (eg, nitinol), titanium, stainless steel, tungsten, nickel, and platinum. The nitinol resists twisting and has high torqueability, resulting in high maneuverability.

In the present embodiment, the entire sliding member 54 has a substantially constant outer diameter except for the end on the operating portion 56 side, but the shape is not limited to this.
For example, the outer diameter of the sliding member 54 is appropriately provided with a small-diameter portion and a large-diameter portion. With this configuration, the small-diameter portion of the sliding member 54 has high mobility. Also, in the sliding member 54, the flexibility is low at the large-diameter portion. By properly arranging the small-diameter portion and the large-diameter portion in this manner, various flexibility can be obtained in different portions of the sliding member 54 . It is also possible to make the flexibility required for the operation of the sliding member 54 appropriate.

(Operation unit 56)
As shown in FIG. 1 , the operating section 56 includes a sheath operating section 53 and a sliding member operating section 55 . The sheath operating portion 53 is integrally connected to the proximal end of the sheath 52 . The sliding member operating portion 55 is integrally connected to the proximal end of the sliding member 54 as the operating end. The sheath 52 can be advanced and retracted with respect to the insertion section 14 by inserting or reversing the sheath operation section 53 into the forceps insertion section 20 . The sliding member 54 can be advanced and retracted with respect to the sheath 52 by inserting or reverse-inserting the sliding member operating portion 55 into or out of the sheath 52 . Here, the direction in which the sliding member operating portion 55 is inserted into the sheath 52 corresponds to the pushing direction in which the operating end (base end) is pushed out to the distal side. In addition, the anti-insertion direction of the sliding member operating portion 55 with respect to the sheath 52 corresponds to the anti-extrusion direction of the operating end (base end).

(Gripping portion 60)
As shown in FIGS. 3 and 4, the grip portion 60 is attached to the tip of the sliding member 54 . Gripping portion 60 comprises a plurality of resilient gripping elements 62 . The number of gripping elements 62 is preferably three or more because it is difficult to remove foreign matter with a single gripping element 62, and the larger the number, the better. Moreover, these gripping elements 62 are preferably arranged so as to be evenly distributed over 360 degrees about the axis of the sliding member 54 . In this embodiment, the number of gripping elements 62 is 16, which is an even number. A pair of gripping elements 62 located in opposite directions by 180 degrees form a set, and are arranged at equal angles.

The material of the gripping element 62 can include plastic.
The following plastics can be mentioned.
<Nylon>
Nylon 12, Nylon 11, Nylon 6/12, Nylon 6, Nylon 66, etc. <Polyester>
Polyethylene terephthalate, polybutylene terephthalate, polyethylene naphthalate, polytrimethylene terephthalate <Others>
Copolymers such as polyether, polyurethane, polyvinyl, polyacrylic acid, fluoropolymers, block copolymers composed of polyether and polyamide, and mixtures thereof Further, the material of the gripping element 62 is limited to plastic. instead, it may be a nickel-titanium alloy (eg, nitinol), titanium, stainless steel, tungsten, nickel, platinum, or the like.

(Second state)
4 and 5 illustrate a second state in which the grasping portion 60 is positioned outside the sheath 52 and will be described later. For convenience of explanation, the configuration of gripping portion 60 and gripping element 62 will be described in the second state of FIG. 3 and 4, only a pair of gripping elements 62 are shown.

As shown in FIG. 4, the gripping element 62 has a connecting portion 62a, a curved portion 62b and an inverted portion 62d. The connecting portion 62a is formed to extend linearly toward the distal side along the axial center of the sliding member 54. As shown in FIG. The curved portion 62b curves from the tip of the connecting portion 62a in a radial direction perpendicular to the axis. The curved portion 62b has a curved portion apex 62c by being curved.

As shown in FIG. 4, the reversing portion 62d is formed to be reversed proximally via the curved portion 62b. Further, the reversing portion 62d is curved so that the distance from the connecting portion 62a becomes smaller toward the free end side. As a result, the free end 62f is oriented toward the connecting portion 62a.

The reversing portion 62d has a reversing portion apex 62e by being curved.
Then, it is assumed that the bronchoscope 10 is moved to the side of the foreign object while the grasping portion 60 in the second state is positioned on the back side of the foreign object with respect to the bronchi into which the bronchoscope 10 is inserted. Then, when the free end 62f is hit by the foreign matter present in the bronchi, the grasping element 62 and the sliding member 54 on the opposite side of the foreign matter can be crushed by the foreign matter when removing the foreign matter remaining in the bronchi. there is Thereby, the grasping element 62 on the foreign body side is formed so as to face between the bronchial wall and the foreign body.

As shown in FIG. 5, the connecting portions 62a of the plurality of gripping elements 62 are bundled together and integrally attached to the end portion of the sliding member 54. As shown in FIG. The method of attaching the connecting portion 62a to the sliding member 54 may be adopted according to the material used by the user. In the case of plastics, welding or bonding with an adhesive may be used. Moreover, if it is between a plastic and a metal, it may be performed by bonding with an adhesive or the like.

As a result, as shown in FIG. 6 , in the second state in which the plurality of gripping elements 62 are exposed from the sheath 52 , the pair of gripping elements 62 are positioned 180 degrees opposite to each other, so that the axis of the sliding member 54 can be adjusted. They are arranged radially at equal angles to the center. In this second state, the pair of sets are positioned 180 degrees opposite to each other, so that the distance between the reversed portion apexes 62e of the respective reversed portions 62d is arranged to have a larger diameter than in the first state, which will be described later. It has become so. The reversing portion 62d is arranged so as to surround the bundle-shaped connecting portion 62a.

As a result, the inverted portion vertex 62e of the inverted portion 62d of the grip element 62 can come into contact with the inner surface of the bronchus into which the bronchoscope 10 is inserted when the first state to be described later transitions to the second state. .

In a first state, which will be described later, the bending portion vertex 62c and the reversing portion 62d are constrained so as to approach the connecting portion 62a. In the second state, this restraint is released, so the elasticity of the gripping element 62 moves the reversing portion 62d so that the distance between the reversing portion 62d and the connecting portion 62a becomes longer than in the first state.

(First state)
FIG. 3 shows a first state of the gripping elements 62 of the gripping portion 60 .
In the first state, the grasping portion 60 is arranged inside the sheath 52 as shown in FIG. 3, and the curved portion 62b and the inverted portion 62d shown in FIG. It is held so as to be in the arranged state. That is, the curved portion 62b and the inverted portion 62d are arranged in the above-described state by being restricted by the inner surface of the sheath 52 against their own elasticity.

(Action of Embodiment)
Next, a method of using the medical device 50 configured as described above will be described with reference to FIGS. 7 to 12. FIG.

First, the respiratory system 30 of the body in which the medical device 50 is used will be described. Respiratory system 30 includes trachea 35 that introduces air from nose 31 or mouth 32 into right mainstem bronchi 33 and left mainstem bronchi 34 . Air enters the right lung 36 from the right main bronchi 33 . Air also enters the left lung 37 from the left mainstem bronchus 34 . A lung 42 is composed of the right lung 36 and the left lung 37 . The left lung 37 consists of only two lobes, while the right lung 36 consists of three lobes.

In the left lung 37, the left main bronchi 34, which reaches into the lung, branches into secondary bronchi, then further into tertiary bronchi, and so on through the terminal bronchi to the pleura. reach. In the right lung 36 as well, it repeats branching multiple times and reaches the pleura via the terminal bronchi. When branched in this way, the bronchus after branching has a smaller inner diameter than the bronchus before branching.

As shown in FIG. 10, in the respiratory system 30, it is assumed that a foreign body B remains, for example, in the secondary bronchi 40 branching off from the left main bronchi 34. FIG. The inner diameter of the secondary bronchi 40 is smaller than the inner diameter of the left main bronchi 34 .

Here, it is assumed that the W-shaped grasping forceps, V-shaped grasping forceps, rubber-attached grasping forceps, alligator-shaped grasping forceps, and basket-type grasping forceps cannot remove this foreign matter. Conventionally, removal with a balloon catheter would be selected in such cases. In this embodiment, the medical device 50 described above is selected instead of the balloon catheter.

In this case, it is assumed that the medical device 50 is prepared with various sizes of the grip portion 60 . When the operator selects the medical device 50, the grasping portion 60 is in the second state so that the inverted portion 62d of the free end 62f can come into contact with the inner surfaces of the secondary bronchi 40 and the left main bronchi 34. The size shall be selected.

The operator inserts the insertion portion 14 of the bronchoscope 10 into the left main bronchi 34 through the mouth 32 or nose 31 . Then, the operator inserts the insertion section 14 and controls the posture of the bronchoscope distal end portion 18 by operating the vertical angle knob 17a and the horizontal angle knob 17d to move the distal end portion 18 of the bronchoscope into the secondary bronchi 40. It is positioned to the position just before the foreign object B (see FIG. 8).

In this state, the operator inserts the sheath 52 of the medical device 50 into the working channel 22 through the forceps insertion portion 20 . Here, it is assumed that the grasping portion 60 inside the sheath 52 is held in the first state. The sheath 52 of the medical device 50 to be inserted into the working channel 22 may be inserted into the working channel 22 in advance.

As shown in FIG. 8, the operator operates the sheath operation portion 53 to project the sheath 52 from the distal end of the bronchoscope distal end portion 18, and as shown in FIG. insert. By inserting the sheath 52 between the foreign body B and the wall surface of the secondary bronchus 40, the tip of the sheath 52 is positioned deeper than the position where the foreign body B remains, as shown in FIG.

As shown in FIG. 10 , in this state, the operator operates the sliding member operating portion 55 to push out the sliding member 54 and project the grasping portion 60 from the distal end of the sheath 52 . As a result, the gripping element 62 of the gripping portion 60 held in the first state within the sheath 52 transitions to the second state due to its own elasticity.

10 to 12, for convenience of explanation, only a pair of gripping elements 62 positioned 180 degrees opposite to each other are illustrated, but in reality, all gripping elements 62 are in the second state. It should be understood that there is

This transition to the second state causes the inverted portion 62d of each grasping element 62 to elastically contact the bronchial wall of the secondary bronchus 40, as shown in FIG. In this state, the operator moves both the insertion portion 14 and the sheath 52 in a direction to remove them from the bronchi. At this time, the sliding member 54 and the grasping element 62 on the side opposite to the foreign object are crushed by the foreign object B as shown in FIG. Therefore, the free end 62f of the inverted portion 62d of the grasping element 62 on the foreign body side enters between the foreign body B and the bronchial wall.

As a result, as shown in FIG. 11, the foreign object B is placed on the sliding member 54, and the free end 62f is interposed between the foreign object B and the bronchial wall. It is sandwiched between the free end 62f and the sliding member 54. As shown in FIG. Depending on the size of the foreign object B, if the foreign object is small, it may be gripped between the free end 62f of the reversing portion 62d of the gripping element 62 and the bundle-like connecting portion 62a. In any of these states, the operator further moves the insertion portion 14 and the sheath 52 in the removal direction with respect to the bronchi, thereby moving the foreign body B in the removal direction. During this movement, the parts (62e, 62f) on the reversing part side are bent against their own elasticity due to the reaction force from the foreign object B, because the force to move in the pulling direction is transmitted through the bending part 62b. do.

Then, as shown in FIG. 12, both the insertion portion 14 and the sheath 52 are moved in the withdrawal direction, and the grasping portion 60 is positioned within the left main bronchi 34 . Then, since the diameter of the left main bronchi 34 is larger than the diameter of the secondary bronchi 40 , the gripping element 62 spreads due to its own elasticity, and the reversing part 62 d contacts the bronchi wall of the left main bronchi 34 . Therefore, as shown in FIG. 12, the foreign object B is further held between the free end 62f of the reversing portion 62d and the connecting portion 62a. In this state, if both the insertion portion 14 and the sheath 52 are moved in the extraction direction, the foreign matter B can be moved and removed.

This embodiment has the following features.
(1) The medical device 50 of the present embodiment includes a sheath 52 that is slidably inserted into the working channel 22 of the bronchoscope 10, and slides on the sheath 52 in the extending direction of the sheath 52. A flexible sliding member 54 is movably provided.

The medical device 50 includes a grasping portion 60 integrally connected to the distal end of the sliding member 54 . Gripping portion 60 comprises a plurality of resilient gripping elements 62 . The grasping element 62 is connected via a connection portion 62a extending distally along the axis of the sliding member 54 and a curved portion 62b that curves from the tip of the connection portion 62a in a radial direction perpendicular to the axis. A reversing portion 62d for reversing is provided.

A free end 62f is formed at the tip of the inverted portion 62d. The grasping element 62 is held in the first state in which the distance between the reversing portion 62d and the connecting portion 62a is reduced against the elasticity when the grasping portion 60 is positioned within the sheath. When the gripping portion 60 is positioned outside the sheath 52, the gripping element 62 is elastically transitioned to a second state in which the distance between the reversing portion 62d and the connecting portion 62a is increased.

As a result, after the sheath 52 holding the grasping element 62 in the first state is moved into the depth of the foreign matter remaining in the bronchus, the sliding member 54 is operated to push out the grasping element 62 in the second state. and will spread. This causes the inverted portion 62d of each gripping element 62 to elastically contact the bronchial wall. In this state, the foreign matter B can be removed by hooking the foreign matter B on the reversing portion 62d of the gripping element 62 and moving it.

Further, contact of the reversing portion 62d of the grasping element 62 with the bronchial wall is allowed until the elastic force of the reversing portion 62d is released. Therefore, within this range of elastic force, contact with the bronchial wall is possible even if the diameter of the bronchial wall is different. In this state, by moving in the pulling direction, it is possible to move the foreign body B in a state where it is gripped in the bronchi having different diameters.

With conventional balloon catheters, if the diameter of the bronchial wall expands while the inflated balloon catches a foreign object and moves, it is necessary to fill the balloon with gas or the like and expand the diameter of the balloon. However, according to the present embodiment, when the diameter of the bronchus wall is widened, there is no need to fill the balloon with gas or the like, so there is no problem of requiring time and effort to remove the foreign matter.

(2) In the medical device 50 of the present embodiment, part of the inverted portion 62d of the gripping element 62 contacts the inner surface of the bronchus into which the bronchoscope 10 is inserted when transitioning to the second state.
As a result, according to this embodiment, when the medical device is pulled forward from the back side of the foreign body stuck in the bronchus, part of the inverted portion moves forward while contacting the bronchus wall, thereby reliably The foreign matter can be caught on the reversing portion, and the foreign matter can be removed.

(3) In the medical device 50 of this embodiment, the connecting portions 62a of the plurality of gripping elements 62 are bundled together. The inverted portions 62d of the plurality of gripping elements 62 are arranged so as to surround the bundle-like connecting portion 62a.

As a result, some of the reversing portions 62d arranged so as to surround the bundle-like connection portion move forward while contacting the bronchial wall, so that the foreign matter can be reliably caught on the reversing portions 62d. , foreign matter can be removed.

(4) In the medical device 50 of the present embodiment, the grasping element and the sliding member on the side opposite to the foreign object are formed so as to be crushable by the foreign object when the foreign object remaining in the bronchi is removed.
As a result, the gripping element and the sliding member on the anti-foreign body side are crushed by the foreign body during removal of the body lodged in the bronchi.

(5) In the medical device 50 of the present embodiment, while the grasping element 62 in the second state, in which the free end 62f is oriented toward the connecting portion 62a side, moves in the pulling direction together with the bronchoscope, the free end 62f is It is inserted between the foreign body in the bronchi and the bronchi wall.

As a result, the gripping element can reliably remove foreign objects.
(6) In the medical device 50 of this embodiment, the grasping element 62 is made of plastic. As a result, it is possible to provide the gripping element with good elasticity.

(7) In the medical device 50 of this embodiment, the sliding member 54 is made of plastic. As a result, it becomes possible to easily configure the sliding member.
(8) In the medical device 50 of this embodiment, the grasping element 62 is integrally formed with the sliding member 54 by adhesive or welding. As a result, the gripping element and the sliding member can be preferably integrated.

(9) In the medical device 50 of this embodiment, the sheath 52 is made of plastic. As a result, the sheath can easily be made of plastic.
(10) In the medical device 50 of this embodiment, the proximal end of the sliding member 54 serves as an operating end. When the operating end is pushed out toward the tip side, the operating end can be operated in the pushing direction and the counter-pushing direction.

Therefore, when the operating end is pushed out toward the distal end side in the pushing direction, the sliding member 54 extends from the distal end of the sheath 52 to position the grasping portion 60 outside the sheath 52 . As a result, the plurality of gripping elements of the gripping portion enter the second state in which the distance between the reversing portion and the connecting portion increases due to elasticity. In this state, the everted portions of the plurality of grasping elements are able to contact the bronchial wall. For this reason, the medical device can be pulled and moved in such a manner that the foreign matter is hooked on the reversing portions of the widened grasping elements, thereby removing the foreign matter.

This embodiment can be implemented with the following modifications.
This embodiment and the following modified examples can be implemented in combination with each other within a technically consistent range.

- In the above embodiment, when the grip element 62 is in the second state, the free end 62f is oriented toward the connecting portion 62a, but the orientation direction of the free end 62f is not limited to this. In the second state, the reversing portion 62d may be arranged parallel to the connecting portion 62a, and the orientation direction of the free end 62f may be oriented toward the base end side of the sliding member 54. FIG.

- Although the said embodiment demonstrated the case where the foreign material B remained in the secondary bronchi 40, this is an illustration. For example, it is assumed that medical devices 50 having various sizes of gripping portions 60 are prepared even when a foreign object remains in a tertiary bronchi or the like. Among these, when the operator grasps and moves the foreign body B from the tertiary bronchus to the secondary bronchus via the foreign body B to the left main bronchus 34, the grasping part 60 has a size that can handle it. should be selected. The same is true for the right lung 36 as well.

DESCRIPTION OF SYMBOLS 10... Bronchoscope 12... Operation head 14... Insertion part 14a... Flexible part 14b... Curve formation part 15... Universal cord 16... Connector 17a... Up-down angle knob 17d... Left-right angle knob 18... Bronchoscope tip part 19... Connecting part 20 Child insertion part 22 Working channel 24 Forceps mouth 26 Objective lens 28 Light guide tube 30 Respiratory system 31 Nose 32 Mouth 33 Right main bronchi 34 Left main bronchi 35 Trachea 36 Right lung 37 Left Lung 40 Secondary bronchi 50 Medical device 52 Sheath 53 Sheath operating part 54 Sliding member 55 Sliding member operating part 56 Operating part 60 Grasping part 62 Grasping element 62a Connecting part 62b Curved Part 62c... Curved part apex 62d... Inverted part 62e... Inverted part apex 62f... Free end B... Foreign matter

Claims (10)

A medical device inserted through a working channel of a bronchoscope, comprising:
a sheath slidably inserted through the working channel;
a sliding member having flexibility provided slidably with respect to the sheath so as to advance and retreat in the extension direction of the sheath;
including a gripping portion integrally connected to the tip of the sliding member;
the gripping portion includes a plurality of elastic gripping elements;
The gripping element is inverted via a connecting portion extending distally along the axial center of the sliding member and a curved portion curving from the tip of the connecting portion in a radial direction perpendicular to the axial center. including an inverting part,
The tip of the reversing portion is a free end,
When the gripping portion is positioned within the sheath, the gripping element is held in a first state in which the distance between the reversing portion and the connecting portion is reduced against elasticity, and
The medical device according to claim 1, wherein when the gripping portion is positioned outside the sheath, the gripping element transitions to a second state in which the distance between the reversing portion and the connecting portion is increased due to the elasticity of the gripping element. 2. The medical device according to claim 1, wherein a portion of said inverted portion of said grasping element contacts the inner surface of a bronchus into which said bronchoscope is inserted when transitioning to said second state. the connecting portions of the plurality of gripping elements are bundled together,
3. The medical device according to claim 2, wherein the inverted portions of the plurality of gripping elements are arranged to surround the bundle-shaped connecting portion. 4. The medical device according to claim 3, wherein the grasping element and the sliding member on the side opposite to the foreign body are formed so as to be crushable by the foreign body when the foreign body staying in the bronchi is removed. The gripping element is in the second state, and the gripping element with the free end directed toward the connecting portion is pulled out of the bronchus into which the bronchoscope is inserted, together with the bronchoscope. 5. The medical device according to claim 4, wherein the free end on the foreign body side is inserted between the bronchial wall and the foreign body in the bronchus during movement. 6. The medical device of any one of claims 1-5, wherein the gripping element is made of plastic. 7. The medical device according to claim 6, wherein said sliding member is made of plastic. 8. The medical device of claim 7, wherein the gripping element is integrally formed with the sliding member by adhesive or welding. The medical device according to any one of claims 1 to 5, wherein the sheath is made of plastic. A proximal end of the sliding member serves as an operating end, and the operating end is operable in the pushing direction and the counter-pushing direction when the operating end is pushed out toward the distal end. 9. The medical device according to 9.

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