JPH03139341A - Abration implement for lesion part - Google Patents

Abstract

PURPOSE:To make it possible to recover completely abraded pieces in a percutaneous and transluminal part with a simple operation by making a reflux fluid flow in a space between the first expanding and contracting member and the second expanding and contracting member and recovering the abraded pieces gathered in this space. CONSTITUTION:An inner flexible tube 13 whose apex is inserted in an outer flexible tube 12 is freely moved forward and backward to the flexible tube 12 under such a condition that it is projected from the apex of the flexible tube 12 is provided. In addition, the first expanding and contracting member 14 freely expandable and contractable by feeding and discharging a fluid is provided on the projected part of the inner flexible tube projected from the flexible tube 12. In addition, the second expanding and contracting member 15 is provided on the apex part of the flexible tube 12. A grinding member 16 provided between the members 14 and 15 is fixed in such a way that one end thereof is fixed on a projected part of the flexible tube 13 projected from the flexible tube 12 and another end is fixed on the apex part of the flexible part 12 and it is expanded and contracted in the radial direction by changing the amt. of projection of the flexible tube 13 from the flexible tube 12. In addition, a reflux path 18 is opened between members 14 and 15 and a reflux fluid is fed or discharged in space part 26. As the result, abraded pieces 29 can be recovered in a percutaneous and transluminal part.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention relates to a lesion resection tool for resecting a lesion occurring within a living body lumen, such as a thrombus within a blood vessel.

[Conventional technology]

Conventionally, for example, a thrombus removal device for mechanically removing a thrombus generated in a blood vessel has been disclosed in Japanese Patent Laid-Open No. 150888/1988. As shown in FIG. 9, the inner flexible tube 2 is inserted into the outer flexible tube 1 so that it can move forward and backward with its tip protruding from the tip of the outer flexible tube 1. At the same time, one end of the mesh tube 3 is fixed to the tip of the mesh tube 3.
The other end is fixed to the tip of the outer flexible tube 1. Then, the distance between the tips of the outer flexible tube 1 and the inner flexible tube 2 is increased to elongate the reticular tube 3, and in this state, the removal tool is inserted into the blood vessel, and the reticular tube 3 is placed near the thrombus 4. Once placed, the outer flexible tube 1 and the inner flexible tube 2 are connected as shown in FIG.
The reticular tube 3 is expanded in the radial direction by shortening the distance between its tips and brought into pressure contact with the ζ thrombus 4. In this state, the entire removal tool is moved back and forth repeatedly to rub the reticular tube 3 against the thrombus 4 and scrape it off.

[Problem to be solved by the invention]

By the way, the above-mentioned conventional thrombus removal tool does not have a structure for collecting the scraped off piece 5 while it is inserted into the blood vessel, so the removal piece 5 can be collected by removing the removal tool from the blood vessel. I will do it. However, in this case, it is not possible to completely recover the peeled piece 5, and as shown in FIG. 10, a part of the peeled piece 5 that has been broken off is left behind in the blood vessel. If the peeled piece 5 is left behind in this manner, it may cause the formation of a new thrombus, which may lead to an extremely serious accident, for example, in the case of treatment of cerebral blood vessels.

Therefore, in order to completely recover the detached piece 5, it is necessary to perform a surgical operation to expose both sides of the lesion, and remove the detached piece 5 by supplying water from one side and draining water from the other. The patient was forced to undergo major surgery, which placed a heavy burden on the patient.

The present invention was made with an eye on the patient's needs, and its purpose is to completely recover the scraped off pieces into the percutaneous and intraluminal tubes, and to treat lesions that are safe and reliable. The purpose of the present invention is to provide a partial resection tool.

[Means and effects for solving the problem] In order to achieve the above object, the lesion resection tool of the present invention comprises an outer flexible tube,
an inner flexible tube that is inserted into this outer flexible tube and can move forward and backward with respect to the outer flexible tube with its tip protruding from the tip of the outer flexible tube; a first expansion/contraction member provided at the protrusion of the tube and capable of expanding and contracting by sending and discharging fluid; a second expansion/contraction member provided at the distal end of the outer flexible tube; and the first expansion/contraction member. and a second expansion/contraction member, one end of which is fixed to a protrusion of the inner flexible tube from the outer flexible tube, and the other end of which is fixed to the distal end of the outer flexible tube. A cutting member that expands and contracts in the radial direction by changing the amount of protrusion from the outer flexible tube, and an opening between the first expansion and contraction member and the second expansion and contraction member to supply the reflux liquid into the space. and a reflux path for sending and discharging the water. Then, the first inflation/contraction member and the second inflation/contraction member are inflated on both sides of the intraluminal lesion so that they come close to the inner wall of the lumen, and the first inflation/contraction member and the second inflation/contraction member are inflated on both sides of the intraluminal lesion. By refluxing the reflux liquid through the reflux path into the space between the compression member and the shrinking member, the scraped pieces are collected together with the fluid.

〔Example〕

The first embodiment of the present invention will be described below with reference to FIGS. 1 and 2.
This will be explained with reference to the figures.

FIG. 1 shows the entire thrombus removal device 11, and 12 is an outer flexible tube. A longer inner flexible tube 13 is loosely inserted into this outer flexible tube 12, and the inner flexible tube 13 is inserted into the outer flexible tube 12 with its tip protruding from the tip of the outer flexible tube 12. It is set up so that it can move forward and backward. Further, a first balloon (inflating/deflating member) 14 is provided on the outer periphery of the distal end of the inner flexible tube 13 with its both ends fixedly fixed, and a second balloon (inflating/deflating member) 14 is provided on the outer periphery of the distal end of the outer flexible tube 12. A balloon 15 is provided with both ends fixed. A mesh tube (cutting member) 16 is located between the first balloon 14 and the second balloon 15, and one end thereof is fixed to the rear side of the first balloon 14 of the inner flexible tube 3. and connect the other end to the outer flexible tube 1
It is fixedly provided on the front side of the second balloon 15 of No. 2. Therefore, by pushing the inner flexible tube 13 into the outer flexible tube 12 and increasing the distance between the tips of each flexible tube 12.13, the reticular tube 16 is deformed to become longer in the axial direction and thinner in the radial direction. Insert the inner flexible tube 13 into each flexible tube 1.
By shortening the distance between the tips of 2.13, the reticular tube 16 is deformed to become shorter in the axial direction and thicker in the radial direction.

In addition, a first communication hole 17 and a second communication hole 18 are formed in the inner flexible tube 13 along the axial direction, and one end of the first communication hole 17 is connected to the inner flexible tube 13 in the first balloon 14. The other end is opened at the proximal end surface of the inner flexible tube 13.

On the other hand, one end of the second communication hole 18 is connected through one boat,
It is located between the first balloon 14 and the mesh tube 16 and opens at the side surface of the inner flexible tube 13, and the other end opens at the proximal end surface of the inner flexible tube 13. Here, one boat has a central axis '1' of the inner flexible tube 13 as shown in FIG. J It is drilled in a shifted direction. Furthermore, a third communication hole 20 is bored into the side wall of the outer flexible tube 12, one end of which opens into the second balloon 15, and the other end of which opens into the side wall of the proximal end of the outer flexible tube 12. It is open to Then, the outer flexible tube 1
A connecting member 21 is externally fitted and fixed to the proximal end of the connecting member 21, and a first base 22 communicating with the third communicating hole 20 is attached to the side of the connecting member 21, and a connecting member 22 is connected to the outer flexible tube 12 and the inner flexible tube. A second cap 24 is provided in a protruding manner to communicate with the gap 23 between the outer flexible tube 13 and the outer flexible tube 12 at the proximal end of the connecting member 21.
O-ring 2 that closes the gap 23 between the inner flexible tube 13 and the
5 is provided.

Therefore, by sending and discharging fluid into the first balloon 14 through the first communication hole 17, the first balloon 14 is inflated and deflated, and the third communication hole is transferred from the first cap 22 to the third communication hole. The second balloon 15 is inflated and deflated by sending and discharging fluid into the second balloon 15 through the tube 20. In addition, the second communication hole 18 and the outer flexible tube 1
A gap 23 between the first balloon 14 and the inner flexible tube 13 forms a reflux path, and physiological saline or the like enters the space 26 between the first balloon 14 and the second balloon 15 through the second communication hole 18. The reflux liquid is injected, and this reflux liquid passes through the mesh of the mesh tube 16.
The liquid is discharged to the outside from the second base 24 through a gap 23 between the outer flexible tube 12 and the inner flexible TF'1 tube]3.

In order to remove the thrombus 28 generated in the blood vessel 27 using the thrombus removal device 11 having such a configuration, first the first balloon 1 is removed.
4 and the second balloon 15 are deflated, the distance between the tips of the outer flexible tube 12 and the inner flexible tube 13 is increased to elongate the mesh tube 16, and in this state, the removal tool 11 is inserted into the blood vessel 27. insert. Next, once the first balloon 14 and the second balloon 15 are placed on both sides of the thrombus 28,
The first through the first communication hole 17 and the third communication hole 20
Fluid is injected into the first balloon 14 and the second balloon 15, and these balloons 14 and 15 are inflated and brought into close contact with the inner wall surface of the blood vessel 27. Then, the distance between the tips of the outer flexible tube 12 and the inner flexible tube] 3 is shortened to expand the reticular tube 16 in the radial direction and bring it into pressure contact with the thrombus 28. In this state, the entire removal tool 11 is moved back and forth repeatedly, and the reticular tube 16 is rubbed against the thrombus 28 to gradually scrape it off.

The ill that was scraped off in this way 1li 1 piece 2
The water collects in the space 26 between the first balloon 14 and the second balloon 5. At this time, the reflux liquid is refluxed into the space 26 through the second communication hole 18 and the gap 23 between the outer flexible tube 12 and the inner flexible tube 13. Then, the peeling piece 29 in the space 26 passes through the mesh of the mesh tube 16 together with the reflux liquid, and is discharged to the outside from the second cap 24 through the gap 23. Here, the second communication hole 18
Since the port 19 that communicates with the inner flexible tube 13 is opened in a direction shifted from the central axis of the inner flexible tube 13, the swirl effect causes the reflux fluid to be vigorously ejected, thereby preventing the thrombus 28.
Force the two peeling pieces from ill 2ffl.

In this way, the thrombus 28 is removed l, +7, thrombus removal tool] 1
By flowing the reflux liquid into the space 26 between the first balloon 14 and the second balloon 15 while the balloon remains inserted into the blood vessel 27, the two detached pieces accumulated in this space 26 can be removed. Since it is designed to be collected, the two peeled pieces can be completely collected percutaneously and through the tube with a simple operation. Therefore, tl
It is possible to prevent new thrombus from occurring due to the M piece 29 being left behind. Furthermore, the burden on the patient can be reduced compared to the case where the two detached pieces are completely recovered by performing a surgical operation.

3 to 6 show a second embodiment of the invention.

This embodiment differs from the first embodiment in that a cutter member 31 for cutting the thrombus 28 is provided inside the reticular tube 16. That is, as shown in FIG. 3, an insertion hole 32 is formed in the side wall of the outer tube 12 so as to pass through it in the axial direction, and an operating rod 33 is loosely inserted into the insertion hole 32. . One end of a spiral spring-shaped cutter member 31 is fixed to the tip of this operating rod 33, and this cutter member 31 is attached to the reticular tube 1 in a reduced diameter state.
It is housed within 6. Furthermore, Figure 4 shows the cutter section (third section).
1 shows the reduced diameter state, and FIG. 5 also shows the free state.

Therefore, by moving the operating rod 33 forward and backward with respect to the outer flexible tube 12, the cutter member 31 slides in the axial direction while being in pressure contact with the inner circumferential surface of the mesh tube 16, thereby causing the cutter member 31 to slide in the axial direction as shown in FIG. A part of the thrombus 28 that has entered the mesh of the reticular tube 16 is cut off by a cutter member 31.

According to such a configuration, since the thrombus 28 is cut by the cutter member 31, the thrombus removal tool 1 is used to cut the thrombus 28.
It is not necessary to move one body forward or backward, so that the healthy portion of the blood vessel 27 is not abraded by the first balloon 14 and the second balloon 15.

7 and 8 show a third embodiment of the invention.

This embodiment differs from the second embodiment in that a rotary cutter 35 is provided inside the mesh tube 6.

That is, a tip ring 36 of a rotary cutter 35 is fixed to the outer periphery of the inner flexible tube] 3 located within the mesh tube 16, and a proximal ring 37 slides in the axial direction on the inner flexible tube 13. installed as possible.

Further, the tip of the mesh tube roller is rotatably attached to the inner flexible tube 13 via a locking portion 38.

Therefore, by rotating the inner flexible tube 13 with respect to the outer flexible tube 12, the rotary cutter 35 is in pressure contact with the inner circumferential surface of the reticular tube 16 and rotates deafly.
A part of the thrombus 28 that has entered the mesh is removed with a rotary cutter 35.
It is designed to be cut with.

Note that the present invention is not limited to the above-mentioned embodiments; for example, in the first embodiment, there is a second balloon between the first balloon 14 and the reticular tube 16.
Although the communication hole 18 is opened through the port 19, it may be opened into the mesh tube 15. Further, in each of the embodiments, the present invention is applied to a thrombus removal tool for removing a thrombus, but it can also be applied as a lesion removal tool for removing a lesion such as an arteriosclerotic lesion. It goes without saying that the number, shape, position, etc. of the pond, the communication holes forming the reflux path, etc. can be variously modified without departing from the gist of the present invention.

〔Effect of the invention〕

As described above, according to the present invention, the first expansion/contraction member and the second expansion/contraction member are
By flowing the reflux liquid into the space between the expansion and contraction member, the peeled pieces accumulated in this space are collected, so the peeled pieces can be completely removed transdermally and transluminally with a simple operation. It can be recovered. Therefore, safe and reliable treatment can be performed.

[Brief explanation of the drawing]

1 and 2 show a first embodiment of the present invention, in which FIG. 1 is a cross-sectional view of the thrombus removal device in a used state, FIG. 2 is a cross-sectional view taken along the line ■-■ in FIG. Figures 1 to 6 show a second embodiment of the present invention, Figure 3 is a perspective view showing the inside of the reticular tube, Figures 4 and 5 are perspective views of the cutter member, and Figure 6 is a perspective view of the cutter member. FIGS. 7 and 8 are perspective views showing how a thrombus is cut, and FIGS. 7 and 8 show a third embodiment of the present invention. FIG. 7 is a perspective view showing how a rotary cutter is installed, and FIG. 9 and 10 are side views showing the distal end of a conventional thrombus removal tool, respectively. 12...Outer flexible tube, 13...Inner IIF flexible tube, 1
4... First balloon (expansion/contraction member), 15... Second balloon (expansion/contraction member), 16... Reticular tube (cutting member)
18...Second communication hole (reflux path), 23...Gap (
reflux path).

Claims (1)

[Claims] an outer flexible tube, an inner flexible tube that is inserted into the outer flexible tube and can move forward and backward with respect to the outer flexible tube with its tip protruding from the tip of the outer flexible tube; a first expansion/contraction member provided on a protrusion from the outer flexible tube and capable of expanding and contracting by sending and discharging fluid; a second expansion/contraction member provided at the distal end of the outer flexible tube; provided between the first expansion and contraction member and the second expansion and contraction member, one end of which is fixed to the protrusion of the inner flexible tube from the outer flexible tube, and the other end of which is fixed to the distal end of the outer flexible tube; a cutting member that expands and contracts in the radial direction by changing the amount of protrusion of the inner flexible tube from the outer flexible tube, and a space that is opened between the first expansion and contraction member and the second expansion and contraction member. 1. A lesion resection tool characterized by comprising a reflux path for sending and discharging reflux fluid to and from the lesion.