WO2012090513A1

WO2012090513A1 - Instrument for introducing guide wire into membranous tissue cavity

Info

Publication number: WO2012090513A1
Application number: PCT/JP2011/052547
Authority: WO
Inventors: 治今野
Original assignee: オリンパス株式会社
Priority date: 2010-12-28
Filing date: 2011-02-07
Publication date: 2012-07-05
Also published as: JP2012139392A

Abstract

Provided is a treatment instrument capable of introducing a guide wire into a pericardium cavity while preventing the tip of a needle from coming into contact with the heart. A treatment instrument is provided with: a channel section (30) from which a needle (31) is extended, the needle (31) being adapted to be inserted between an organism tissue (A) and a membranous tissue (B) which covers the organism tissue (A); a first holding section (11) and a second holding section (21) which are arranged side-by-side so as to extend in the direction of the axis of the channel section (30) and which holds the membranous tissue (B) in such a manner that the membranous tissue (B) is in close contact with the first holding section (11) and the second holding section (21); and a connection member (40) for moving a first holding member (10) and a second holding member (20) relative to each other so that the first holding section (11) and the second holding section (21) are disposed so as to sandwich the axis of the channel section (30).

Description

[Name of invention determined by ISA based on Rule 37.2] Guide wire introduction device into membranous tissue cavity

The present invention relates to a treatment instrument for introducing a guide wire into a pericardial cavity, for example.

Conventionally, there has been known a treatment instrument that introduces a guide wire into a pericardial cavity by puncturing the pericardium in a pinched state (for example, see Patent Document 1).

US Pat. No. 6,156,009

However, in the case of Patent Document 1, when a needle is passed through the pericardium to open a hole for inserting a guide wire in the pericardium, the tip of the needle may come into contact with the heart adjacent to the pericardium. There is a problem of having sex.
The present invention has been made in view of the above circumstances, and introduces a guide wire into a membranous tissue cavity such as the pericardium while preventing the tip of the needle from contacting a living tissue such as the heart. An object of the present invention is to provide a treatment tool that can be used.

In order to achieve the above object, the present invention employs the following means.
The present invention provides a channel portion for leading a needle inserted between a biological tissue and a membranous tissue covering the biological tissue, and is arranged side by side in the axial direction of the channel portion so that the membranous tissue is brought into close contact with the channel portion. The first holding unit and the first holding unit to hold the first holding unit and the first holding unit so that the first holding unit and the second holding unit are disposed across the axis of the channel unit. And a treatment tool including relative movement means for relatively moving the second holding portion.

According to the present invention, in a state where the membranous tissue (for example, the pericardium) is held in close contact with the first holding unit and the second holding unit, the first holding unit and the second holding unit are used by the relative movement unit. Are moved relative to each other, whereby the first holding portion and the second holding portion are arranged with the axis of the channel portion interposed therebetween. Thereby, the membranous structure | tissue hold | maintained by the 1st holding | maintenance part and the 2nd holding | maintenance part is arrange | positioned on the axis line of a channel part. In this state, by guiding the needle in the axial direction from the channel portion, the needle can penetrate the membranous tissue and can be inserted into the membranous tissue cavity.

In this case, the membranous tissue is held in the direction intersecting the axis of the channel portion by the first holding portion and the second holding portion, while the surface of the living tissue (for example, the heart) is along the axis of the channel portion. Arranged in the direction. Therefore, since the needle is led out in a direction along the surface of the living tissue, the tip of the needle can be prevented from coming into contact with the living tissue, and the living tissue can be prevented from being damaged.

In the above invention, the relative movement unit may move at least one of the first holding unit and the second holding unit in a direction away from the surface of the living tissue.
By moving at least one of the first holding unit and the second holding unit in a direction away from the surface of the living tissue, the membranous tissue held by the first holding unit and the second holding unit is A space is formed between the living tissue and the membranous tissue by being pulled from the surface of the living tissue. By guiding the needle in the axial direction from the channel portion to this space, the needle can be reliably inserted between the living tissue and the membranous tissue, and the tip of the needle is prevented from contacting the living tissue. be able to.

In the above invention, the relative movement means moves at least one of the first holding part and the second holding part in a direction in which the first holding part and the second holding part are close to each other. It is good.
By moving the first holding unit and the second holding unit in the approaching direction, the axis of the channel portion of the membranous tissue held by the first holding unit and the second holding unit (ie, biological tissue) The inclination with respect to the surface) can be increased. By guiding the needle in the axial direction from the channel portion to the membranous tissue held in this way, the needle can be reliably inserted between the living tissue and the membranous tissue, and the tip of the needle is the living body. Contact with tissue can be prevented.

In the above invention, at least one of the first holding part and the second holding part may have a hooking mechanism for hooking and holding the membranous tissue.
By having such a hooking mechanism, the membranous tissue can be easily hooked and held.

In the above-mentioned invention, it is good also as having a fixing mechanism which fixes at least one of the 1st maintenance part and the 2nd maintenance part in the state moved to the direction of an axis of the channel part.
By having such a fixing mechanism, in a state where the membranous tissue is disposed on the axis of the channel portion, that is, in a state where the needle can be led out from the channel portion, at least the first holding portion and the second holding portion One can be fixed. As a result, the operation of inserting the needle into the membranous tissue cavity can be facilitated.

In the above invention, needle insertion for inserting the needle into the membranous tissue cavity when the membranous tissue held by the first holding section and the second holding section reaches a predetermined tension or more. It is good also as having a mechanism.
By having such a needle insertion mechanism, the first holding unit and the second holding unit are relatively moved by the relative moving means, and the film shape is held by the first holding unit and the second holding unit. The needle can be automatically inserted into the membranous tissue cavity when the tissue is above a predetermined tension. As a result, the operation of inserting the needle into the membranous tissue cavity can be facilitated.

In the above invention, a needle fixing mechanism for fixing the needle in a state of being inserted into the membranous tissue cavity may be provided.
By having such a needle fixing mechanism, the needle can be fixed while being inserted into the membranous tissue cavity, and the work can be facilitated and the safety can be improved.

In the above invention, a connecting member that connects the first holding portion and the second holding portion in the axial direction of the channel portion is provided, and the connecting member includes the first holding portion and the second holding portion. It is good also as having a joint part which rocks a part in the direction which cross | intersects the axis line of the said channel part, respectively.
By having such a configuration, the first holding part and the second holding part are respectively swung in the direction intersecting the axis of the channel part, that is, the direction intersecting the surface of the membranous tissue by the joint part. The membranous tissue held by the first holding portion and the second holding portion is pulled from the surface of the living tissue, and a space is formed between the living tissue and the membranous tissue. By guiding the needle in the axial direction from the channel portion to this space, the needle can be reliably inserted between the living tissue and the membranous tissue, and the tip of the needle is prevented from contacting the living tissue. be able to.

According to the present invention, the guide wire can be introduced into a membranous tissue cavity such as the pericardium while preventing the tip of the needle from contacting a living tissue such as the heart.

It is a schematic structure figure of a treatment implement concerning a 1st embodiment of the present invention. It is the front view which expanded the front-end | tip part of the treatment tool of FIG. 1 partially. It is the longitudinal cross-sectional view which expanded the front-end | tip part of the treatment tool of FIG. 1 partially. It is the elements on larger scale of the 1st holding part. It is the elements on larger scale of the 2nd holding part. It is the elements on larger scale of the 1st holding | maintenance part shown as a modification. It is the elements on larger scale of the 2nd holding | maintenance part shown as a modification. It is a figure explaining operation | movement of a treatment tool, and has shown the state which hold | maintained the membranous structure | tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which separated the membranous tissue from the biological tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which inserted the puncture needle into the membranous tissue. It is a front view which shows schematic structure figure of the treatment tool which concerns on the 2nd Embodiment of this invention. It is a longitudinal cross-sectional view which shows the schematic block diagram of the treatment tool which concerns on the 2nd Embodiment of this invention. It is a figure explaining operation | movement of a treatment tool, and has shown the state which hold | maintained the membranous structure | tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which separated the membranous tissue from the biological tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which inserted the puncture needle into the membranous tissue. It is a schematic block diagram of the treatment tool which concerns on the 3rd Embodiment of this invention. It is the front view which expanded the front-end | tip part of the treatment tool of FIG. 8 partially. It is the longitudinal cross-sectional view which expanded the front-end | tip part of the treatment tool of FIG. 8 partially. It is a figure explaining operation | movement of a treatment tool, and has shown the state which hold | maintained the membranous structure | tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which separated the membranous tissue from the biological tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which inserted the puncture needle into the membranous tissue. It is a front view which shows schematic structure of the treatment tool which concerns on a 1st modification. It is a longitudinal cross-sectional view which shows schematic structure of the treatment tool which concerns on a 1st modification. It is a figure explaining operation | movement of a treatment tool, and has shown the state which hold | maintained the membranous structure | tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which separated the membranous tissue from the biological tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which inserted the puncture needle into the membranous tissue. It is a front view which shows schematic structure of the treatment tool which concerns on a 2nd modification. It is a longitudinal cross-sectional view which shows schematic structure of the treatment tool which concerns on a 2nd modification. It is a figure explaining operation | movement of the treatment tool which concerns on the 4th Embodiment of this invention, and has shown the state holding the membranous structure | tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which separated the membranous tissue from the biological tissue. It is a figure explaining operation | movement of a treatment tool, and has shown the state which inserted the puncture needle into the membranous tissue.

[First Embodiment]
Below, the treatment tool 1 which concerns on the 1st Embodiment of this invention is demonstrated with reference to drawings.
The treatment instrument 1 according to the present embodiment is a treatment instrument for introducing a guide wire between a membranous tissue such as the pericardium and a biological tissue such as the heart. As shown in FIG. A rigid insertion portion (main body portion) 51 to be inserted, a distal end portion 52 disposed on the distal end side of the insertion portion 51, and an operation portion 53 that operates the distal end portion 52 by being gripped by an operator. I have.

The insertion portion 51 has an elongated cylindrical shape and is made of a hard material such as metal. In the insertion portion 51, a puncture needle 31, which will be described later, and a wire 54 that connects the distal end portion 52 and the operation portion 53 are inserted in the longitudinal direction.

The operation unit 53 includes a fixed handle 55a fixed to the insertion unit 51, and a movable handle 55b provided to be swingable about the pin 56 with respect to the fixed handle 55a. The movable handle 55b is connected to the distal end portion 52 (first holding member 10 described later) through a wire 54 that transmits a gripping force.

The operation unit 53 is configured such that when the operator grasps the fixed handle 55a and the movable handle 55b, the movable handle 55b approaches the fixed handle 55a and the wire 54 is pulled to the proximal end side. Thereby, the operator can operate the front-end | tip part 52 (1st holding member 10 mentioned later) by grasping both the

handles

55a and 55b. Note that a fixing means (not shown) that holds the operation of the distal end portion 52 constant by fixing the relative positions of both the

handles

55a and 55b may be provided in the operation portion 53.

2A and 2B are partially enlarged views of the distal end portion 52 of the insertion portion 51. FIG.
As shown in FIGS. 2A and 2B, the treatment instrument 1 according to the present embodiment has a first holding member 10 that holds a membranous tissue covering a living tissue and a first holding member 10 at a distal end portion 52 thereof. And a connection member (relative movement means) 40 for connecting the first holding member 10 and the second holding member 20 so as to be capable of relative movement in the axial direction. It has.

The first holding member 10 and the second holding member 20 are arranged side by side in the axial direction, and are connected via a connecting member 40 so as to be relatively movable in the axial direction.
The first holding member 10 is a rod-shaped member made of, for example, a hard material such as metal, and the distal end side member 12 and the proximal end side member 13 are connected by a pin 14 so as to be swingable.

As shown in FIG. 3A, the distal end side member 12 is provided with a first holding portion (hook mechanism) 11 for hooking and holding a membranous tissue.
The first holding portion 11 is a plurality of protrusions made of, for example, metal or hard resin, and has a sharp tip so that it can easily bite into the film-like tissue. The height T of the first holding part 11 is, for example, about 1/10 of the thickness of the membranous tissue. Further, the distal end portion of the first holding portion 11 has a shape inclined from the distal end side of the first holding member 10 toward the proximal end side.
By setting it as such a shape, it can penetrate into the membrane | film | membrane tissue through the mucous membrane of a membrane-like structure | tissue, and a membrane-like tissue can be hooked and hold | maintained reliably and easily.

The second holding member 20 is a cylindrical member made of, for example, a hard material such as metal, and a puncture needle 31 inserted between the living tissue and the membrane tissue is led inside the second holding member 20. A channel portion 30 is formed.
The puncture needle 31 is for forming a hole for inserting a guide wire (not shown) in the membranous tissue, and in the channel portion 30 formed in the longitudinal direction of the second holding member 20, its axial direction It is arranged to be movable.

As shown in FIG. 3B, the second holding member 20 is provided with a second holding portion (hook mechanism) 21 for hooking and holding the membranous tissue.
Similar to the first holding unit 11 described above, the second holding unit 21 is a plurality of protrusions made of, for example, metal or hard resin, and has a sharp tip so as to easily bite into the film-like tissue. ing. The distal end portion of the second holding portion 21 has a shape inclined from the proximal end side of the second holding member 20 toward the distal end side.

With the above configuration, when the second holding member 21 of the second holding member 20 is held in close contact with the membranous tissue, the pin is moved when the first holding member 10 is moved to the distal end side. The first holding portion 11 formed on the distal end side member 12 is brought into close contact with the film-like tissue brought into close contact with the second holding portion 21 by swinging the distal end side member 12 downward about 14. (See FIG. 5A).

Further, from this state, the first holding member 10 is moved to the proximal end side, so that the first holding portion 11 and the second holding portion 21 are arranged with the axis of the channel portion 30 in between. (See FIG. 5B). Detailed operations in FIGS. 5A and 5B will be described later.

In addition, as the 1st holding | maintenance part 11 and the 2nd holding | maintenance part 21, as shown to FIG. 4A and FIG. 4B, it is good also as using a fibrous material. Specifically, as the first holding unit 11 and the second holding unit 21, a plant material such as a cocoon fiber having high biocompatibility or an animal material such as a seal hair is used. By doing in this way, the damage to the membranous structure | tissue at the time of hold | maintaining a membranous structure | tissue can be suppressed.

The operation of the treatment instrument 1 having the above configuration will be described below.
First, the distal end portion 52 is operated by inserting the insertion portion 51 of the treatment instrument 1 into the living body and grasping and releasing both the

handles

55a and 55b of the operation portion 53. Specifically, as shown in FIG. 5A, in a state where the second holding portion 21 of the second holding member 20 is held in close contact with the membranous tissue B, the first holding member 10 is moved to the distal end side. As a result, the distal end side member 12 swings downward about the pin 14, and the first holding portion 11 provided on the distal end side member 12 is brought into close contact with the membranous tissue B.

From this state, when the first holding member 10 is moved to the proximal end side, as shown in FIG. 5B, the distal end side member 12 swings upward about the pin 14 and is separated from the surface of the living tissue A. Move in the direction you want. Thereby, the membranous tissue B held by the first holding unit 11 is pulled from the surface of the living tissue A, and a space is formed between the living tissue A and the membranous tissue B.

Further, at this time, the first holding unit 11 and the second holding unit 21 move in a direction in which they approach each other. Thereby, the inclination of the membranous tissue B held by the first holding unit 11 and the second holding unit 21 with respect to the axis of the channel unit 30 (that is, the surface of the biological tissue A) can be increased.

In this state, as shown in FIG. 5C, puncture is performed between the membranous tissue B held by the first holding unit 11 and the second holding unit 21 and the living tissue A in the axial direction from the channel unit 30. The needle 31 is derived. Thereby, since the puncture needle 31 is derived | led-out in the direction along the surface of the biological tissue A, it prevents that the front-end | tip of the puncture needle 31 contacts the biological tissue A, and prevents damaging the biological tissue A. can do.

As described above, according to the treatment instrument 1 according to the present embodiment, the first holding member 10 is in a state where the membranous tissue B is held in close contact by the first holding unit 11 and the second holding unit 21. And the second holding member 20 are moved relative to each other, whereby the first holding part 11 and the second holding part 21 are arranged with the axis of the channel part 30 in between. Accordingly, the membranous tissue B held by the first holding unit 11 and the second holding unit 21 is arranged on the axis of the channel unit 30. In this state, the puncture needle 31 is led out from the channel portion 30 in the axial direction thereof, so that the puncture needle 31 can penetrate the membranous tissue B and be introduced into the cavity of the membranous tissue B.

In this case, the first holding unit 11 and the second holding unit 21 hold the membranous tissue B in a direction intersecting the axis of the channel unit 30, while the surface of the living tissue A is the channel unit 30. It is arranged in the direction along the axis. Accordingly, since the puncture needle 31 is led out in the direction along the surface of the living tissue A, the tip of the puncture needle 31 is prevented from coming into contact with the living tissue A, thereby preventing the living tissue A from being damaged. be able to.

In addition, by moving the first holding unit 11 in a direction away from the surface of the biological tissue A, the membranous tissue B held by the first holding unit 11 and the second holding unit 21 becomes the biological tissue. A space is formed between the living tissue A and the membranous tissue B by being pulled from the surface of A. By guiding the puncture needle 31 from the channel portion 30 in the axial direction into the space, the puncture needle 31 can be reliably inserted between the living tissue A and the membranous tissue B, and the tip of the puncture needle 31 is Contact with the biological tissue A can be prevented.

Further, the first holding member 10 is held by the first holding unit 11 and the second holding unit 21 by moving the first holding member 10 in the direction in which the first holding unit 11 and the second holding unit 21 approach each other. The inclination of the film-like tissue B with respect to the axis of the channel part 30 (that is, the surface of the biological tissue A) can be increased. The puncture needle 31 is reliably inserted between the biological tissue A and the membrane tissue B by guiding the puncture needle 31 from the channel portion 30 in the axial direction to the membrane tissue B held in this way. Thus, the tip of the puncture needle 31 can be prevented from coming into contact with the living tissue A.

[Second Embodiment]
Next, a treatment tool 2 according to a second embodiment of the present invention will be described mainly with reference to FIGS. 6 and 7. Hereinafter, description of points that are common to the treatment instrument according to the above-described embodiment will be omitted, and different points will be mainly described.
As shown in FIG. 6, the treatment instrument 2 according to the present embodiment has a cylindrical gear (second holding portion) 23 having a plurality of protrusions on the distal end side of the second holding member 20, and a gear 23. And a ratchet (fixing mechanism) 24 to be fitted. The channel portion 30 is provided between the first holding member 10 and the second holding member 20.

The operation of the treatment tool 2 according to this embodiment having the above configuration will be described below.
As shown in FIG. 7A, in the state where the treatment instrument 2 is inserted into the living body and the gear 23 of the second holding member 20 is held in close contact with the membranous tissue B, the first holding member 10 is moved to the distal end side. When moved, the distal end side member 12 swings downward about the pin 14, and the first holding part 11 provided on the distal end side member 12 is brought into close contact with the membranous tissue B.

From this state, when the first holding member 10 is moved to the proximal end side, as shown in FIG. 7B, the distal end side member 12 swings upward about the pin 14 and is separated from the surface of the living tissue A. Move in the direction you want. Thereby, the membranous tissue B held by the first holding unit 11 is pulled from the surface of the living tissue A, and a space is formed between the living tissue A and the membranous tissue B.

At this time, the membranous tissue B is fed to the proximal end side of the channel portion 30 by the gear 23 of the second holding member 20. Thereby, the puncture needle 31 can be reliably inserted into the cavity of the membranous tissue B from the channel portion 30. Further, in this case, the reverse rotation of the gear 23 is prevented by fitting the ratchet 24 to the gear 23, so that the workability when inserting the puncture needle 31 into the cavity of the membranous tissue B is improved. It becomes possible.

In this state, as shown in FIG. 7C, the puncture needle 31 is led out in the axial direction from the channel portion 30 between the membrane tissue B held by the first holding portion 11 and the gear 23 and the living tissue A. To do. Thereby, since the puncture needle 31 is derived | led-out in the direction along the surface of the biological tissue A, it prevents that the front-end | tip of the puncture needle 31 contacts the biological tissue A, and prevents damaging the biological tissue A. can do.

[Third Embodiment]
Next, a treatment tool 3 according to a third embodiment of the present invention will be described mainly with reference to FIGS.
As shown in FIG. 9, the treatment tool 3 according to the present embodiment moves the second holding member 20 in the axial direction with respect to the first holding member 10.
As shown in FIG. 8, the treatment tool 3 according to the present embodiment includes a rigid insertion portion (main body portion) 51 to be inserted into the body, a distal end portion 52 disposed on the distal end side of the insertion portion 51, And an operation unit 53 that operates the distal end portion 52 by a gripping operation by an operator.

The insertion portion 51 has an elongated cylindrical shape and is made of a hard material such as metal. In the insertion part 51, the puncture needle 31, the wire 54 which connects the front-end | tip part 52, and the operation part 53 are penetrated in the longitudinal direction.

The operation unit 53 includes a fixed handle 55a fixed to the insertion unit 51, and a movable handle 55b provided to be swingable about the pin 56 with respect to the fixed handle 55a. The movable handle 55b is connected to the distal end portion 52 (second holding member 20) via a wire 54 that transmits a gripping force.

The operation unit 53 is configured such that when the operator grasps the fixed handle 55a and the movable handle 55b, the movable handle 55b approaches the fixed handle 55a and the wire 54 is pulled to the proximal end side. Thereby, the operator can operate the front-end | tip part 52 (2nd holding member 20) by grasping both the

handles

55a and 55b may be provided in the operation portion 53.

Further, the operation unit 53 is provided with a lock mechanism 57 for holding the puncture needle 31 at a fixed position. By fixing the relative position between the puncture needle 31 and the second holding member 20 by the lock mechanism 57, the second holding member 20 is moved to the proximal side as will be described later. The puncture needle 31 can be moved together with the holding member 20 to the proximal end side. In addition, when the puncture needle 31 is punctured, the puncture needle 31 can be led out from the second holding member 20 by releasing the lock mechanism 57.

The operation of the treatment tool 3 according to this embodiment will be described below.
First, the insertion portion 51 of the treatment instrument 3 is inserted into the living body, and the distal end portion 52 is operated by grasping and releasing both the

handles

55a and 55b of the operation portion 53. Specifically, as shown in FIG. 10A, the second holding member 20 is moved to the proximal end side in advance to insert the treatment instrument 3 into the living body, and the second holding portion 21 of the second holding member 20 is inserted. Is held in close contact with the membranous tissue B. In this state, the distal end side member 12 swings downward about the pin 14, and the first holding portion 11 provided on the distal end side member 12 is brought into close contact with the membranous tissue B.

When the second holding member 20 is moved to the distal end side from this state, as shown in FIG. 10B, the distal end side member 12 swings upward about the pin 14 and is separated from the surface of the living tissue A. Move in the direction. Thereby, the membranous tissue B held by the first holding unit 11 is pulled from the surface of the living tissue A, and a space is formed between the living tissue A and the membranous tissue B.

In this state, as shown in FIG. 10C, puncture is performed between the membranous tissue B and the biological tissue A held by the first holding unit 11 and the second holding unit 21 from the channel unit 30 in the axial direction thereof. The needle 31 is derived. Thereby, since the puncture needle 31 is derived | led-out in the direction along the surface of the biological tissue A, it prevents that the front-end | tip of the puncture needle 31 contacts the biological tissue A, and prevents damaging the biological tissue A. can do.

[First Modification]
As a first modification of the treatment instrument 3 according to this embodiment, a spring (needle insertion mechanism) 25 may be provided on the proximal end side of the second holding member 20 as shown in FIG.
The spring 25 is contracted by a force more than necessary for puncturing the puncture needle 31 into the membranous tissue B.

With the above configuration, as shown in FIG. 12A, the second holding member 20 is moved to the distal end side while the membranous tissue B is held by the first holding unit 11 and the second holding unit 21. Then, as shown in FIG. 12B, the tension of the film-like tissue B held by the first holding unit 11 and the second holding unit 21 increases.

Then, as shown in FIG. 12C, when the membranous tissue B held by the first holding unit 11 and the second holding unit 21 reaches a predetermined tension, it is provided on the proximal end side of the second holding member 20. A force necessary to puncture the puncture needle 31 is applied to the spring 25. As a result, the spring 25 contracts and the second holding member 20 moves to the proximal side, and the puncture needle 31 protrudes in the axial direction from the channel portion 30 provided in the second holding member 20.

As described above, according to the treatment instrument 4 according to the present modification, the first holding unit 10 and the second holding unit 20 are moved by relatively moving the first holding unit 10 and the second holding unit 20. The puncture needle 31 can be automatically punctured into the membranous tissue B when the membranous tissue B held by the above becomes a predetermined tension or higher. Thereby, the work of puncturing the membranous tissue B with the puncture needle 31 can be facilitated.

[Second Modification]
As a second modification of the treatment instrument 3 according to the present embodiment, as shown in FIG. 13, a spring (needle insertion mechanism) 25 is provided on the proximal end side of the second holding member 20 as in the first modification. A latch mechanism (needle fixing mechanism) 28 for fixing the spring 25 in a contracted state may be provided.
The latch mechanism 28 includes a hook portion 27 provided on the second holding portion 20 on the distal end side with respect to the spring 25 and a projection portion 26 provided on the second holding portion 20 on the proximal end side with respect to the spring 25. It is configured.

By having the above configuration, the second holding member 20 is moved to the distal end side in a state where the membranous tissue B is held by the first holding unit 11 and the second holding unit 21, so that the second holding member When a force necessary to puncture the puncture needle 31 is applied to the spring 25 provided on the proximal end side of the 20, the spring 25 contracts and the second holding member 20 moves to the proximal end side. The puncture needle 31 protrudes in the axial direction from the channel portion 30 provided in the second holding member 20. In this case, the hook portion 27 provided on the second holding portion 20 on the distal end side of the spring 25 is fixed to the protrusion 26 provided on the second holding portion 20 on the distal end side of the spring 25. .

By having such a latch mechanism 28, the puncture needle 31 can be fixed while being punctured into the membranous tissue B, and the work can be facilitated and the safety can be improved. In addition, since the latch sound when the hook 27 is fixed to the protrusion 26 indicates that the puncture needle 31 has been punctured into the membrane tissue B, workability when inserting the puncture needle 31 into the membrane tissue B is improved. Can be improved.
Note that, as the latch mechanism 28, the hook portion 27 may be provided on the base end side with respect to the spring 25, and the projection portion 26 may be provided on the base end side with respect to the spring 25.

[Fourth Embodiment]
Next, a treatment tool 6 according to a fourth embodiment of the present invention will be described mainly with reference to FIG.
As shown in FIG. 14, the treatment tool 6 according to the present embodiment has the first holding member 10 and the second holding member 20 arranged in the axial direction (the direction along the surface of the membranous tissue B). And are connected by a connecting member 41.

The first holding member 10 and the connecting member 41 are connected so as to be swingable around a pin (joint portion) 42 provided on the distal end side of the connecting member 41.
The second holding member 20 and the connecting member 41 are connected so as to be swingable around a pin (joint portion) 43 provided on the proximal end side of the connecting member 41.

A wire 44 inserted through the connecting member 41 and the second holding member 20 is connected to the distal end side of the connecting member 41.
By pulling the wire 44 to the proximal end side, the distal end side of the connecting member 41 is separated from the surface of the membranous tissue B.

The operation of the treatment tool 6 according to this embodiment having the above configuration will be described below.
14A, the treatment instrument 6 is inserted into the living body, and the first holding part 11 of the first holding member 10 and the second holding part 21 of the second holding member 20 are brought into close contact with the membranous tissue B. The held state is shown.

In this state, when the wire 44 is pulled toward the proximal end side, the distal end side of the connecting member 41 is separated from the surface of the membranous tissue B as shown in FIG. 14B. Thus, the first holding member 10 connected to the connecting member 41 swings upward around the pin 42 while holding the membranous tissue B. Thereby, the membranous tissue B held by the first holding unit 11 is pulled from the surface of the living tissue A, and a space is formed between the living tissue A and the membranous tissue B.

In this state, as shown in FIG. 14C, puncture is performed between the membranous tissue B held by the first holding unit 11 and the second holding unit 21 and the living tissue A in the axial direction from the channel unit 30. The needle 31 is derived. Thereby, since the puncture needle 31 is derived | led-out in the direction along the surface of the biological tissue A, it prevents that the front-end | tip of the puncture needle 31 contacts the biological tissue A, and prevents damaging the biological tissue A. can do.

As described above, the embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and includes design changes and the like within a scope not departing from the gist of the present invention. For example, the present invention may be applied to a configuration in which the above-described embodiments and modifications are appropriately combined.

1, 2, 3, 4, 5, 6 Treatment instrument 10 First holding member 11 First holding portion (hooking mechanism)
20 2nd holding member 21 2nd holding part (hook mechanism)
23 Gear (second holding part)
24 Ratchet (Fixing mechanism)
25 Spring (needle insertion mechanism)
26 Protruding part 27 Hooking part 28 Latch mechanism (needle fixing mechanism)
30 channel portion 31 puncture needle 40 connecting member (relative movement means)
41 Connecting

member

42, 43 Pin (joint part)
51 Insertion section 52 Tip section 53 Operation section 54 Wire 57 Lock mechanism

Claims

A channel portion for leading a needle inserted between the living tissue and the membranous tissue covering the living tissue;
A first holding part and a second holding part that are arranged side by side in the axial direction of the channel part and hold the membranous tissue in close contact with each other;
Relative moving means for relatively moving the first holding portion and the second holding portion so that the first holding portion and the second holding portion are arranged with the axis of the channel portion interposed therebetween. A treatment instrument comprising:
The treatment instrument according to claim 1, wherein the relative movement unit moves at least one of the first holding unit and the second holding unit in a direction away from the surface of the living tissue.
The relative movement unit moves at least one of the first holding unit and the second holding unit in a direction in which the first holding unit and the second holding unit are close to each other. Item 3. The treatment tool according to Item 2.
The treatment tool according to claim 1, wherein at least one of the first holding part and the second holding part has a hooking mechanism for hooking and holding the membranous tissue.
The treatment tool according to claim 1, further comprising: a fixing mechanism that fixes at least one of the first holding unit and the second holding unit in a state of being moved in the axial direction of the channel unit.
A needle insertion mechanism for inserting the needle into the membranous tissue cavity when the membranous tissue held by the first holding section and the second holding section reaches a predetermined tension or more. Item 2. The treatment tool according to Item 1.
The treatment instrument according to claim 1, further comprising a needle fixing mechanism for fixing the needle in a state of being inserted into the membranous tissue cavity.
A connecting member for connecting the first holding portion and the second holding portion in the axial direction of the channel portion;
The treatment tool according to claim 1, wherein the connecting member has a joint portion that swings the first holding portion and the second holding portion in a direction intersecting with the axis of the channel portion.