WO2003092783A1 - Indwelling tube guide device - Google Patents
Indwelling tube guide device Download PDFInfo
- Publication number
- WO2003092783A1 WO2003092783A1 PCT/JP2003/005581 JP0305581W WO03092783A1 WO 2003092783 A1 WO2003092783 A1 WO 2003092783A1 JP 0305581 W JP0305581 W JP 0305581W WO 03092783 A1 WO03092783 A1 WO 03092783A1
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- WO
- WIPO (PCT)
- Prior art keywords
- tube
- indwelling tube
- indwelling
- stent
- guide
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/94—Stents retaining their form, i.e. not being deformable, after placement in the predetermined place
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0017—Catheters; Hollow probes specially adapted for long-term hygiene care, e.g. urethral or indwelling catheters to prevent infections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2002/041—Bile ducts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0091—Three-dimensional shapes helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
- A61M2025/0681—Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
Definitions
- the present invention relates to an indwelling tube guide device used for performing an operation of inserting an indwelling tube into a body cavity of a patient and performing indwelling using an endoscope.
- the following treatment is performed as a treatment for discharging bile and the like accumulated in the bile duct. That is, the stent serving as an indwelling tube is guided to the stenotic part of the bile duct through the channel of the endoscope, and the stent is indwelled in the stenotic part. In this state, the bile collected in the bile duct is drained through the lumen of the stent.
- the stent is made of a polymer material such as polyethylene or silicone rubber. It is a flexible hollow pipe. Flaps facing each other are provided on the outer peripheral portions near both ends of the station to prevent removal.
- the procedure for guiding the stent configured as described above into the body cavity endoscopically and placing it in the stenosis of the bile duct is performed in the following procedure. That is, as shown in FIG. 23A, a long guide wire 3 made of a flexible wire is previously inserted into the forceps channel 2 provided in the insertion section 4 of the endoscope 1. In this state, the guide wire 3 is guided to the bile duct 5 together with the insertion section 4 of the endoscope 1. Next, the guide wire 3 is advanced by the operation on the hand side to pass through the stenosis 6. Thereafter, as shown in FIG. 23B, the guide wire 3 that has passed through the stenosis portion 6 is used as a guide, and the stent 7 is pushed in by the pusher tube 8, enters the stenosis portion 6, and is left.
- the stenosis 6 is located deep within the body cavity. Therefore, the stenosis 6 cannot be directly observed with the endoscope 1.
- the stenosis 6 is treated under radiography. In this case, when the stent 7 is pushed into the stenosis 6 by the pusher tube 8, the stent 7 may be pushed too far. The state 7 and the pusher tube 8 are not connected. For this reason, if the pusher tube 8 is pulled back as shown by the arrow in FIG. 23B when the state 7 is pushed too much, the state 7 cannot be pulled back. There is inconvenience.
- Patent Document 2 a train catheter delivery system disclosed in US Pat. No. 5,921,952 (Patent Document 2) was developed.
- the pusher tube and the stent are connected by a thread. If the pusher tube is pulled back when the stent is pushed in too much, the stent can be pulled back through the thread.
- a through hole for passing a thread is provided at a distal end of a pusher tube.
- the stall has an opening that is opened by forming a flap. Then, a thread (soil) entangled with the guide wire is led out from the opening of the stent. Next, pass the thread through the through hole of the pusher tube. It is linked by tying.
- the stent can be pulled back through the thread.
- the guide wire is pulled back.
- the distal end of the guide wire comes off the entangled portion with the yarn, the yarn is pulled out by the stent force.
- the stent and the pusher tube are separated from each other.
- the present invention has been made in view of the above circumstances, and the purpose thereof is to allow the indwelling tube to be pulled back even if it is excessively pushed in during the operation of indwelling the indwelling tube. Even if the bending strength of the indwelling tube is high and the bending angle of the bending portion of the endoscope is large, the indwelling tube can be pushed forward to the target site, and furthermore, when the liquid is sent, liquid leakage may occur.
- An object of the present invention is to provide an indwelling tube guide device without fear.
- the present invention relates to an indwelling tube guide device, an indwelling tube, a guide member having at least a distal portion insertable into the indwelling tube, and having a lumen, and a lumen of the indwelling tube.
- a locking part inserted between the guide member and the guide member to lock the indwelling tube in a detachable manner, and at least a part of a lumen of the guide member.
- a piercing portion that penetrates, a traction member that traction-operates the indwelling tube when the locking portion and the indwelling tube are engaged, and moves the traction member in an axial direction of the guide member.
- the locking member connected to the distal portion of the traction member is positioned in an engaged state between the indwelling tube and the guide member. Therefore, by moving the guide member forward, the indwelling tube can be approached and indwelled at the target site. If the indwelling tube is pushed too far, the indwelling tube can be pulled back by retracting the traction member in the proximal direction.
- the engaging state between the locking member and the indwelling tube is released by pulling the traction member in the proximal direction while holding the guide member, and placing the indwelling tube.
- the tube can be placed at the target site. Further, since the distal portion of the guide member penetrates through the lumen of the indwelling tube, the indwelling tube can be pushed to the target site following the bending of the bending portion of the endoscope.
- FIG. 1A is a side view showing the entire indwelling tube guide device according to the first embodiment of the present invention.
- FIG. 1B is a longitudinal sectional view of a distal end portion of the indwelling tube guide device according to the first embodiment. ⁇ —
- FIG. 2A is a side view in which a part of an indwelling tube guide device according to a second embodiment of the present invention is cut away.
- FIG. 2B is a cross-sectional view taken along the line IIB-IB of FIG. 2A.
- Fig. 2C is a cross-sectional view taken along the line IIC-ICC in Fig. 2A.
- FIG. 2D is a side view of the indwelling tube guide device according to the second embodiment.
- FIG. 3A is a longitudinal sectional view showing a distal end portion of an indwelling tube guide device according to a third embodiment of the present invention.
- Figure 3B shows the distal end of the indwelling tube guide device of Figure 3A. Side view.
- FIG. 4A is a side view in which a part of an indwelling tube guide device according to a fourth embodiment of the present invention is cut away.
- FIG. 4B is a cross-sectional view taken along the line IVB-IVB of FIG. 4A.
- FIG. 4C is a cross-sectional view taken along the line IVC-IVC in FIG. 4A.
- FIG. 4D is a side view of the indwelling tube guide device according to the fourth embodiment.
- FIG. 5A is a side view showing a state where a part of the indwelling tube guide device according to the fourth embodiment is cut away to separate a flexible wire and a stent.
- FIG. 5B is a side view showing a state in which the flexible wire and the stent of the indwelling tube guide device of the fourth embodiment are separated.
- FIG. 6A is a longitudinal sectional view of a distal end showing a state in which a stent is indwelled in a stenosis by the indwelling tube guide device according to the fourth embodiment.
- FIG. 6B is a longitudinal sectional view of a main part showing a modification of the indwelling tube guide device of the fourth embodiment.
- FIG. 6C is a longitudinal sectional view showing a state where the flexible wire of the indwelling tube guide device of FIG. 6B is pushed.
- FIG. 7 is a side view showing an indwelling tube guide device according to a fifth embodiment of the present invention.
- FIG. 8A is a longitudinal sectional view showing a distal end portion of an indwelling tube guide device according to a sixth embodiment of the present invention.
- FIG. 8B is a longitudinal sectional view of a main part showing a first modification of the indwelling tube guide device according to the sixth embodiment.
- FIG. 8C is a longitudinal sectional view of a main part showing a second modification of the indwelling guide device according to the sixth embodiment.
- FIG. 8D is a longitudinal cross-sectional view of a main part showing a third modification of the indwelling guide device according to the sixth embodiment.
- FIG. 8E is a longitudinal sectional view of a main part showing a fourth modification of the indwelling tube guide device of the sixth embodiment.
- FIG. 8F is a longitudinal sectional view of a main part showing a fifth modification of the indwelling guide device according to the sixth embodiment.
- FIG. 8G is a longitudinal sectional view of a main part showing a sixth modification of the indwelling tube guide device of the sixth embodiment.
- FIG. 8H is a longitudinal sectional view of a main part showing a seventh modification of the indwelling tube guide device of the sixth embodiment.
- FIG. 8I is a longitudinal sectional view of an essential part showing an eighth modification of the indwelling tube guide device of the sixth embodiment.
- FIG. 9 is a side view in which a part of an indwelling tube guide device according to a seventh embodiment of the present invention is cut away.
- FIG. 10 is a plan view showing a state in which the stent and the locking member of the indwelling tube guide device according to the seventh embodiment are engaged.
- FIG. 11A is a longitudinal sectional view showing a state where a locking member of the indwelling tube guide device according to the seventh embodiment is set at a position where the locking member is engaged with a stent.
- FIG. 11B is a longitudinal sectional view showing a state in which the locking member of the indwelling tube guide device according to the seventh embodiment is pushed forward and disengaged from the state.
- FIG. 11C shows an indwelling tube guide device according to the seventh embodiment.
- FIG. 6 is a longitudinal sectional view showing a state where the locking member of FIG.
- FIG. 12 is an explanatory diagram illustrating an operation state of a locking member of the indwelling tube guide device according to the seventh embodiment.
- FIG. 13A is a perspective view showing a state where a stent and a pusher tube are connected in an indwelling tube guide device according to an eighth embodiment of the present invention.
- FIG. 13B is a perspective view showing a state where a stent and a pusher tube are separated in the indwelling tube guide device according to the eighth embodiment.
- FIG. 13C is a longitudinal sectional view of a portion A in FIG. 13A.
- FIG. 14 is a longitudinal sectional view of a connection portion between a stent and a pusher tube according to a ninth embodiment of the present invention.
- FIG. 15 is a longitudinal sectional view of a connection portion between a stent and a pusher tube according to a tenth embodiment of the present invention.
- FIG. 16A is a perspective view showing a state where the stent and the pusher tube are connected in the indwelling tube guide device according to the first embodiment of the present invention.
- FIG. 16B is a perspective view showing a state in which the stent and the pusher tube in the device according to the first embodiment are separated.
- FIG. 16C is a longitudinal sectional view of a portion B in FIG. 16A.
- FIG. 17A is a cross-sectional view showing a state where the cylindrical member in the device according to the 12th embodiment of the present invention is press-fitted into the lumen of the stent and the pusher tube.
- FIG. 17B is a cross-sectional view showing a modification of the stent of the first and second embodiments.
- 18 is a perspective view showing a state in which the stent and the pusher tube are connected in the device according to the thirteenth embodiment of the present invention.
- FIG. 19 is a longitudinal sectional view of a portion B in FIG.
- FIG. 20 is a perspective view showing a state in which the stent and the pusher tube in the device of the thirteenth embodiment are separated.
- FIG. 21A is a longitudinal sectional view of a main part showing a state in which a state and a pusher tube in the device according to the fourteenth embodiment of the present invention are connected.
- FIG. 21B is a longitudinal cross-sectional view of a main part of the device according to the fourteenth embodiment, showing a state where the stud and the pusher tube are separated.
- FIG. 22A is a longitudinal sectional view of a main part showing a state in which a stent and a pusher chip are connected in a modified example of the device of the fourteenth embodiment.
- Fig. 22B is a longitudinal sectional view of a main part showing a state in which the stent and the pusher tube in Fig. 22A are separated.
- FIG. 23A is an explanatory view for explaining a procedure for guiding a stent into a body cavity transendoscopically.
- FIG. 23B is a view for explaining a state in which the stent is pushed in by the pusher tube, inserted into the stenosis, and left in place, and the best mode for carrying out the invention.
- FIGS. 1A and 1B show an indwelling tube guide device according to a first embodiment.
- the indwelling tube guide device of the present embodiment is provided with a long guide catheter 11 that can pass through a forceps channel of an endoscope (not shown).
- the guide catheter 11 is formed of a flexible synthetic resin material, for example, a fluorine resin or a nylon resin.
- the guide catheter 11 has a lumen 12 formed over the entire length.
- a guide catheter cock 13 is provided at the proximal end of the guide catheter 11.
- one small hole 14 is formed in the side wall near the distal end of the guide catheter 11.
- a fixed ring 15 as an enlarged portion having a large outer diameter is fitted on the outer peripheral surface of the guide catheter 11 at a position corresponding to the small hole 14.
- the fixing ring 15 is arranged so as to close a part of the small hole 14.
- a hollow pipe-shaped stent 16 as an indwelling tube is provided on the outer peripheral surface of the guide catheter 11 on the distal side of the fixed ring 15. With the stent 16 fitted in the guide catheter 11, the small hole 14 of the guide catheter 11 is closed by the fixing ring 15 and the stent 16.
- the stent 16 is made of a biocompatible resin such as, for example, polyethylene, fluorine resin, nylon resin, thermoplastic elastomer, silicon rubber and the like. It is desirable to coat a hydrophilic lubricant on the outer peripheral surface of the stent 16. The outer periphery near both ends of the stent 16 is attached to each other to prevent removal. Opposing flaps 17 are provided.
- a guide wire 18 and a flexible wire 19 as a traction member are passed through the lumen 12 of the guide catheter 11.
- the flexible wire 19 is made of a long metal wire. At least a part of the flexible wire 19 may be a linear body such as stainless steel, nickel, titanium alloy, nylon, liquid crystal polymer, or silk. Further, the flexible wire 19 may have a substantially rectangular cross section and a substantially circular diameter, and may have an enlarged portion at the distal end.
- the guide wire 18 may be a long metal wire, a stranded wire, or a coil, particularly a metal having a superelastic property made of a nickel-titanium alloy. I like it.
- the distal end of the guide 18 is tapered.
- the proximal end of the guide wire 18 is led out of the guide catheter cock 13 to the outside.
- the distal side of the flexible wire 19 is led out of the inner cavity of the guide catheter 11 to the outside of the guide catheter 11 through the small hole 14.
- the distal end of the flexible wire 19 is press-fitted between the inner peripheral surface of the stent 16 and the outer peripheral surface of the guide catheter 11.
- An operating ring 20 is provided at the proximal end of the flexible wire 19.
- distal end of the flexible wire 19 is not necessarily
- Pressure contact force that can be moved to the proximal side integrally with It only needs to be engaged to the extent that it is possible. For example, it is sufficient that about 5 mm or more in the axial direction of the flexible wire 19 is located in the stent 16.
- the indwelling tube guide device of this embodiment is set as follows.
- a flexible wire 19 is passed through the lumen 12 of the guide catheter 11 of the indwelling tube guide device, and the distal end thereof is led out from the small hole 14. Then, a stent 16 is fitted to the guide catheter 11 from its distal end. Further, the distal portion of the flexible wire 19 is press-fitted between the stent 16 and the guide catheter 11. As a result, as shown in FIG. 1B, the guide catheter 11, the stent 16 and the flexible wire 19 are set in a state where they are assembled.
- the insertion portion of the endoscope is inserted into the body cavity in advance, and the distal end component disposed at the distal end of the insertion portion of the endoscope is guided to the vicinity of the bile duct.
- the guide wire 18 is passed through the forceps channel of the endoscope inserted into the body. At this time, the guide wire 18 is advanced to guide the distal end of the guide wire 18 to the narrowed portion of the bile duct under observation using an endoscope and observation using X-rays.
- the guide with stent 16 set The catheter 11 is passed through the guide wire 18, and the guide catheter 11 is passed through the forceps channel using the guide wire 18 as a guide.
- the guide catheter 11 is advanced by a manual operation on the proximal end side of the guide catheter 11. Then, the guide catheter 11 is led out from the distal end component of the endoscope, and the guide catheter 11 and the stent 16 are passed through the stenosis.
- the stent 16 is held in a state of being fitted to the guide catheter 11. Therefore, the bending strength of the stent 16 is high, and the stent 16 does not buckle even when the guide wire 18 is bent at a large bending angle. Then, the stent 16 can be advanced integrally with the guide catheter 11 and guided to the target site.
- the stent 16 After the stent 16 is inserted into the stenosis by the guide catheter 11, observation by X-ray is performed. If it is confirmed by this X-ray observation that the stem 16 has been pushed too deeply, the work of pulling the stent 16 back to the proximal side is performed. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at a target portion.
- the guide wire 18 is held in a state of being inserted into the guide catheter 11.
- the distal end of this guidewire 18 remains at the stenosis. Therefore, it is possible to use the guide wire 18 as a guide to perform the following measures.
- the guide catheter 11 has the lumen 12, it is also possible to feed or suck the liquid from the guide catheter cock 13.
- the above configuration has the following effects. That is, in the indwelling tube guide device of the present embodiment, the stent 16 is fitted to the guide catheter 11, and furthermore, the flexible member is provided between the stent 16 and the guide catheter 11. The distal part of the sex wire 19 is press-fitted. As a result, as shown in FIG. 1B, the guide catheter 11, the stent 16 and the flexible wire 19 are set in a state where they are integrally assembled. ing. For this reason, when the stent 16 is placed in the constriction of the bile duct, even if the stent 16 is pushed too much, the stent 16 can be pulled back through the flexible wire 19 to the proximal side. And can be.
- the stent 16 is held in a state of being fitted to the guide catheter 11. Therefore, even when the bending strength of the stent 16 is high and the bending angle of the bending portion of the endoscope is large, the stent 16 can be pushed forward to a target portion.
- small holes 14 of guide catheter 11 are fixed rings 1 Since it is closed by 5 and the stent 16, there is no danger of the liquid leaking from the small holes 14 when feeding the liquid.
- FIGS. 2A to 2D show a second embodiment of the present invention.
- the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.
- a stent 16 is externally fitted to the distal end of the guide catheter 11.
- a pusher tube 21 is fitted to the outer peripheral surface of the guide catheter 11 on the proximal side of the stent 16 so as to be able to advance and retreat in the axial direction.
- the pusher tube 21 is made of a synthetic resin material having flexibility.
- a pusher tube cock 22 is provided at the proximal end of the pusher tube 21, .
- a flexible wire 19 as a pulling member is passed between the outer peripheral surface of the guide catheter 11 and the inner peripheral surface of the pusher tube 21 so as to be able to advance and retreat in the axial direction.
- the distal end of the flexible wire 19 is pressed and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the guide catheter 11.
- the proximal end of the flexible wire 19 is led out of the pusher tube cock 22.
- An operating ring 20 is provided at the proximal end of the flexible wire 19. '
- the indwelling tube guide device is set as follows.
- a flexible wire 19 is passed between the guide catheter 11 and the pusher tube 21 of the indwelling tube guide device.
- the distal end of the flexible wire 19 is press-fitted between the stent 16 and the guide catheter 11.
- the guide catheter 11, the stent 16, the flexible wire 19, and the pusher tube 21 are set in a state where they are assembled. Is done.
- the guide wire 18 is passed through the forceps channel of the endoscope, and then the stent 16 is guided to the stenotic part of the bile duct via the guide catheter 11. It is. This method is the same as in the first embodiment. Then, in the present embodiment, the pusher tube 21 is advanced to pass the stent 16 to the stenosis.
- X-ray observation is performed. If it is confirmed by this X-ray observation that the state 16 has been pushed too deeply, the work of returning the state 16 to the proximal side is performed. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at the target portion.
- the guide catheter 11 has the lumen 12, it is possible to feed or suck the liquid from the guide catheter cock 13.
- the stent 16 can be inserted through the flexible wire 19. 6 can be pulled back.
- the stent 16 is held in a state of being fitted to the guide catheter 11. Further, since the distal portion of the flexible wire 19 is penetrated through the lumen of the stem 16, the bending strength of the stent 16 is high. Therefore, even when the bending angle of the bending portion of the endoscope is large, the stent 16 can be pushed to the target site by following the bending of the bending portion of the endoscope.
- the flexible wire 19 is pulled in the proximal direction while the guide force table 11 is held. Disengage the distal end of the tube from the stent 16. This allows the stent 16 to be placed at the target site.
- 3A and 3B show a third embodiment of the present invention.
- the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.
- a small-diameter portion 23a is formed at the tip.
- a large-diameter portion 23 b is formed at the base end of the state 23.
- the large diameter portion 23b is set to the same diameter as the pusher tube 21.
- the distal end of the flexible wire 19 is pressed into and engaged between the inner peripheral surface of the large-diameter portion 23 b of the stem 23 and the outer peripheral surface of the guide catheter 11. Have been.
- the small-diameter portion 2 is the small-diameter portion 2
- FIGS. 4A to 6A show a fourth embodiment of the present invention.
- a pusher tube 24 having a configuration different from that of the pusher tube 21 of the second embodiment (see FIGS. 2A to 2D) is provided.
- the other portions have the same configuration as the second embodiment. Note that the same components as those of the second embodiment are denoted by the same reference numerals, and description thereof is omitted.
- a small diameter portion 24 a is provided at the distal end of the pusher tube 24. This small diameter part 2
- the pusher tube 24 is provided with a step 24c between the small-diameter portion 24a and the large-diameter portion 24b on the proximal end side of the small-diameter portion 24a.
- This step portion 24c is provided with a through hole 25. I have.
- the distal end of the flexible wire 19 passed through the lumen of the pusher tube 24 is guided to the outside of the small diameter portion 24 a through the through hole 25.
- the distal end of the flexible wire 19 is press-fitted and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the small diameter portion 24a.
- a side hole 26 is provided on a side wall of the pusher tube 24.
- the proximal end of the flexible wire 19 is led out from a side hole 26 of the pusher tube 24.
- the indwelling tube guide device of this embodiment is set as follows.
- a flexible wire 19 is passed through the lumen of the pusher tube 24, and its distal end is led out of the small diameter portion 24 a through the through hole 25. Subsequently, the state 16-is fitted to the small diameter portion 24 a at the distal end of the pusher tube 24. Then, as shown in FIG. 4B, the distal end of the flexible wire 19 is pressed into and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the small diameter portion 24a. I do. As a result, as shown in FIG. 4A, the pusher 24, the stent 16 and the flexible wire 19 are set in a state where they are assembled.
- Step 24 c abuts the proximal end of stent 16.
- the stent 16 passes through the stenosis.
- the stent 16 is inserted into the stenosis by the pusher tube 24, observation by X-ray is performed. At this time, if it is confirmed by X-ray observation that the stage 16 has been pushed too deeply, the position of the stage 16 is pulled back to the proximal side. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. Thus, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned at the target portion.
- the guide wire 18 is held in a state of being passed through the pusher tube 24.
- the distal end of this guidewire 18 remains at the stenosis. Therefore, it is possible to use the guide wire 18 as a guide to perform the following measures.
- the stent 16 can be kept at hand via the flexible wire 19. Pull back to the side I can do it.
- the guide catheter 11 can be omitted, the cost can be reduced.
- FIGS. 6B and 6C show modified examples of the indwelling tube guide device according to the fourth embodiment.
- the guide wire 18 is inserted into the inside of the pusher tube 24 through the side hole 26 of the pusher tube 24.
- FIG. 7 shows a fifth embodiment of the present invention.
- the indwelling tube guide device of the fourth embodiment (see FIGS. 48 to 6) is modified as follows. Note that the same parts as those in the fourth embodiment are denoted by the same reference numerals, and description thereof is omitted.
- the operation ring 20a is fitted to the proximal portion of the guide catheter 11 so as to be able to advance and retreat in the axial direction.
- the proximal end of the flexible wire 19 passed through the pusher tube 24 is connected to the operation ring 20.
- FIG. 8A shows a sixth embodiment of the present invention.
- the same parts as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.
- a bent portion 19c that is bent upward is provided at the distal end of the flexible wire 19. This bent part 19 c is pressed against the wall of stent 16 It was done.
- FIG. 8B shows a first modification of the indwelling tube guide device according to the sixth embodiment.
- a wavy bent portion 27 is provided at the distal end of the flexible wire 19. The wavy bent portion 27 is pressed against the inner wall of the stent 16.
- FIG. 8C shows a second modification of the indwelling tube guide device according to the sixth embodiment.
- an S-shaped bent portion 28 is provided at the distal end of the flexible wire 19.
- the S-shaped bent portion 28 is pressed against the inner wall of the stent 16.
- FIG. 8D shows a third modification of the indwelling tube guide device according to the sixth embodiment.
- a widened portion 29 is provided by expanding the distal end of the flexible wire 19 in the width direction.
- the widened portion 29 is pressed against the inner wall of the stage 16.
- FIG. 8E shows a fourth modification of the indwelling tube guide device according to the sixth embodiment.
- one flexible wire 19 is bent inside the stent 1 & to provide a folded portion 30-and the folded portion 30 is pressed against the inner wall of the stent 16. Things.
- FIG. 8F shows a fifth modification of the indwelling tube guide device according to the sixth embodiment.
- a meandering portion 31 is provided at the distal end of the flexible wire 19. This meandering part 31 is pressed against the inner wall of the state 16.
- FIG. 8G shows a sixth modification of the indwelling tube guide device of the sixth embodiment.
- a wavy bent portion 32 that bends in the width direction in a wavy manner is provided at the distal end of the flexible wire 19. The wavy bent portion 32 is pressed against the inner wall of the stent 16.
- FIG. 8H shows a seventh modification of the indwelling tube guide device according to the sixth embodiment. In this modification, a spiral portion 33 is provided at the distal end of the flexible wire 19. The spiral portion 33 is pressed against the inner wall of the stent 16.
- FIG. 8I shows a first modification of the indwelling tube guide device of the sixth embodiment.
- two flexible wires 19a and 19b are provided in parallel. The distal ends of the two flexible wires 19a and 19b are pressed against the inner wall of the stem 16.
- FIGS. 9 to 12 show a seventh embodiment of the present invention.
- This embodiment is a modification of the indwelling tube guide device of the second embodiment (see FIGS. 2A to 2D) as follows. Note that, in the indwelling tube guide device of the present embodiment, the same portions as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.
- the stent 16 of the indwelling tube guide device of the present embodiment has an opening 17a formed by a flap 17 on the front end side as shown in FIG.
- a locking member 42 is provided at the tip of the flexible wire 19 as a pulling member.
- the locking member 42 is provided with a plate spring-shaped locking plate 43.
- the locking plate 43 has a spring characteristic, and for example, a substantially plate-shaped member made of stainless steel spring material is used.
- the front end of the locking plate 43 is fixed to the front end of the flexible wire 19 by means such as a lip. Then, as shown in FIG. 9 and FIG. 10, the rear end of the lock ⁇ 43 It is detachably engaged while being inserted into the side hole 17 a formed by the tap 17.
- the rear end of the locking plate 43 is inserted into the side hole 17 a of the stent 16 as shown in FIGS. 11A and 12. And set to the locked state.
- the guide wire 18 is passed through the forceps channel of the endoscope similarly to the first embodiment, and then the stent 16 is stenotically constricted through the guide catheter 11. An operation leading to the department is performed. This method is the same as in the first embodiment.
- the stent 16 passes through the stenosis by moving the pusher tube 21 forward.
- X-ray observation is performed. If it is confirmed by this X-ray observation that the state 16 has been pushed too deeply, the work of returning the state of the state 16 to the proximal side is performed. — During this operation, put your finger on the operation ring 20 and pull it proximally. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at the target portion.
- the operating ring 20 is pushed in once. Thereby, the flexible wire 19 is pushed forward and operated. At this time, the locking plate 43 is detached from the side hole 41 of the state 16 due to the elastic deformation of the locking member 42. Then, as shown in FIG. 11B, the rear end of the locking plate 43 is pulled out from the side hole 41 of the stent 16. This and At this time, the locking plate 4 3 returns to its original shape that was immediately extended. Therefore, in this state, by pulling the flexible wire 19 backward, the locking plate 43 is moved to the side hole of the stent 16 as shown in FIG. 11C. It is pulled back over 4 1. As a result, the flexible wire 19 and the stent 16 are separated, and the stent 16 is placed in the stenosis.
- the above configuration has the following effects. That is, in the present embodiment, the rear end of the locking plate 43 of the locking member 42 is inserted into the side hole 17a of the state 16 and is set to be locked. Is done. Therefore, when the stent 16 is indwelled in the constriction of the bile duct, even if the stent 16 is pushed too far, the stent 16 is pulled back through the flexible wire 19 to the hand side. it can.
- the flexible wire 19 is connected across the state 16 and the pusher tube 21. Therefore, at the connection between the stent 16 and the pusher tube 21 Since the bending strength of the endoscope is high, buckling at the connection between the stem 16 and the pusher tube 21 is reduced even if the bending angle of the bending portion of the endoscope is large.
- FIGS. 13A to 13C show an indwelling chip guide device according to an eighth embodiment of the present invention.
- the indwelling tube guide device of the present embodiment is provided with a long guide catheter 111 that can pass through a forceps channel of an endoscope (not shown).
- the guide catheter 111 is formed of a flexible synthetic resin material, for example, a fluorine-based resin or a nylon-based resin.
- the guide catheter 111 has a lumen 112 formed over the entire length.
- a guide catheter cock 113 is provided at the proximal end of the guide catheter 111.
- a stent 114 is provided as an indwelling tube while being fitted to the guide catheter 111.
- a pusher tube 1 15 is provided on the outer peripheral surface of the guide catheter 1 1 1 on the proximal side of the stent 1 1 4. The pusher tube 115 is held in a state fitted to the guide catheter 111.
- the stent 114 is a relatively flexible hollow pipe made of a biocompatible polymer compound such as, for example, polyethylene or silicone rubber. It is desirable that the outer surface of the stent 114 be coated with a hydrophilic lubricant. Flaps 116 facing each other are provided on the outer peripheral portion near both ends of the stent 114 to prevent removal.
- the pusher tube 115 is formed of a flexible synthetic resin material, for example, a fluorine-based resin or a nylon-based resin.
- a pusher tube cock 117 is provided at the proximal end of the pusher tube 115.
- the guide catheter 111 is guided through the lumen of the guide catheter 111 in the S-axis direction.
- Guide wires 1 18 are made of long metal strands.
- the distal end of the guidewire 1 18 is tapered and shaped.
- the proximal end of guidewire 118 is led out of guidewire 113.
- a cylinder as a connection mechanism spans the lumen at the proximal portion of the stent 114 and the lumen at the distal portion of the pusher tube 115.
- Member 1 19 is press-fitted.
- the stem 114 and the pusher tube 115 are detachably connected by the cylindrical member 119.
- This cylindrical member 119 is formed of a synthetic resin material or a metal material.
- a guide catheter 111 is passed through the lumen of the cylindrical member 119.
- One end of an operation wire 120 as a releasing means is connected to a proximal end of the cylindrical member 1 19.
- the other end of the operation wire 120 extends through the lumen of the pusher tube 115 to the vicinity of the pusher tube cock 117.
- the pusher tube 115 near the pusher tube cock 117 has a side hole 121.
- the operation wire 120 is led out of the side hole 122 and is connected to the operation ring 122. Therefore, the above configuration has the following effects. That is, according to the indwelling tube guide device configured as described above, the stent 114 and the pusher tube 115 are connected by the cylindrical member 119.
- the stem 114 can move physically in the axial direction by the reciprocation of the pusher tuple 115 in the axial direction.
- the cylindrical member 1 19 is press-fitted into the lumen of the stem 114 and the pusher tube 115. Therefore, the bending strength at the connection between the stent 114 and the pusher tube 115 is high. Thereby, even if the bending angle of the bending portion of the endoscope is large, the stent 114 can be pushed to the target portion without buckling at the connection portion.
- the distal portion of the cylindrical member 119 becomes a stent. It escapes from the lumen of 114 and is pulled into the lumen of pusher tube 115. Therefore, the stent 114- and the pusher tube 115 are separated from each other.
- the indwelling tube guide device of this embodiment is used, the indwelling tube guide device is set as follows.
- the operation wire 120 is passed through the pusher tube 1 15. Subsequently, the proximal portion of the cylindrical member 119 is pressed into the lumen at the distal portion of the pusher tube 115. The operation wire 12 0 is connected to the cylindrical member 1 19.
- a stent 114 is passed through the distal portion of the guide catheter 111.
- the distal end of the cylindrical member 1 19 is press-fitted into the lumen of the stent 1 14 to abut the proximal end of the stent 1 14 with the distal end of the pusher tube 1 15 .
- the pusher tube 115, the state 114, and the cylindrical member 119 are set in a state where they are assembled.
- the insertion portion of the endoscope is inserted into the body cavity in advance, and the distal end component disposed at the distal end of the insertion portion of the endoscope is guided to the vicinity of the bile duct.
- the guide wire 118 is passed through the forceps channel of the endoscope inserted into the body. At this time, based on the observation by the endoscope and the observation by X-ray, the guide wire 118 is advanced to guide the distal end of the guide wire 118 to the stenosis of the bile duct.
- the guide catheter 111 in which the stent 114 and the pusher tube 115 are set is connected to the guide wire 118.
- Communicate the guide catheter 111 is passed through the guide wire 111 from the proximal end of the guide wire 111, and the guide catheter 111 is passed through the forceps channel using the guide wire 118 as a guide.
- the guide catheter 1 11 and the pusher tube 1 15 are advanced by a manual operation on the proximal end side of the guide catheter 1 1 1, and are drawn out from the distal end component of the endoscope.
- the guide catheter 111 and the stent 114 are passed through the stenosis.
- the stent 114 is fitted to the guide catheter 111, and the stent 114 and the pusher tube 114 are also fitted.
- the cylindrical member 1 19 is press-fitted into the bore 15. Therefore, even if the guide wire 118 is bent at a large bending angle, it does not buckle, and the stent 114 moves forward integrally with the guide catheter 111 and the pusher tube 115. It can lead to the target site.
- the stent 114 After the stent 114 is inserted into the stenosis by the guide catheter 111, observation by X-ray is performed. If the X-ray observation confirms that the stent 114 has been pushed too deep, pull the pusher tube 115 back proximally. As a result, the stent 114 can be pulled back through the cylindrical member 119, and the stent 114 can be reliably positioned and retained at the target portion.
- the distal ends of the guide catheter 111 and the guide wire 118 are in a state of being inserted into the stenosis, so that the guide catheter 111 is used as a guide to send a contrast medium or the like. And use the guidewire 1 18 as a guide to perform the following steps: This is also possible.
- FIG. 14 shows a ninth embodiment.
- a part of the indwelling tube guide device of the eighth embodiment is modified as follows. Note that the same parts as those in the eighth embodiment are denoted by the same reference numerals, and description thereof will be omitted.
- This embodiment is an embodiment that does not use the guide catheter 111 of the eighth embodiment. Therefore, in the present embodiment, the cost can be reduced by simplifying the configuration. Furthermore, the stent 114 and the pusher tube 115 can be made thinner, so that the stent 114 can be easily inserted when the stenosis is narrow. It is.
- FIG. 15 shows a tenth embodiment of the present invention.
- This embodiment is an embodiment in which the guide catheter 111 is not used.
- a substantially cylindrical member as a connecting member is formed by the spiral body 123.
- the distal part of the spiral body 123 is press-fitted into the lumen of the stent 114, and the proximal part is press-fitted into the lumen of the pusher tube 115.
- the restoring force of the elastic deformation at the connection portion is excellent, and the buckling resistance of the connection portion can be further improved.
- FIGS. 16A to 16C show a eleventh embodiment of the present invention.
- the present embodiment is an embodiment in which the guide catheter 111 is not used.
- the cylindrical member 124 is tightly fitted to the outer peripheral surface of the stent 114 and pusher tube 115, and is laid.
- a side hole 125 is provided on the side wall of the distal portion of the pusher tube 115.
- the operation wire 120 connected to the cylindrical member 124 is introduced into the lumen of the pusher tube 115 through the side hole 125.
- the stent 114 is inserted into the stenosis, observation using X-rays is performed. If it is confirmed by this X-ray observation that the stage 114 has been pushed too deeply, the pusher tube 115 is pulled back to the proximal side. Thus, the stent 114 can be pulled back through the cylindrical member 124, and the stent 114 can be reliably positioned and retained at the target portion.
- the cylindrical member 122 is moved through the operation wire 120. 4 is drawn into the outer peripheral surface of the pusher tube 1 15. Therefore, as shown in FIG. 16B, the distal portion of the cylindrical member 124 comes off the outer peripheral surface of the stent 114, and the stent 114 and the pusher tube 115 are separated. The stent 114 is left in the stenosis.
- the inner diameter of the stent 114 and the pusher tube 115 has no built-in material, so that the diameter can be further reduced.
- FIG. 17A shows a twelfth embodiment of the present invention.
- the cylindrical member 1 19 as a connection mechanism of the indwelling tube guide device of the eighth embodiment is modified as follows.
- the cylindrical member 1 2 6 of the present embodiment has a plurality of Uneven portions 127 are provided. Each concavo-convex portion 127 extends in the axial direction of the cylindrical member 126. Then, the cylindrical member 126 of the present embodiment is press-fitted into the lumen of the stent 114 and the pusher tube 115. In this case, the cylindrical member 1 26 and the pusher tube 1 15 are firmly pressed into the lumens of the S-state S 114 and the pusher tube 115 to be fixed.
- FIG. 17B shows a modification of the cylindrical member 126 of the first embodiment.
- a convex ridge portion 1229 is provided on a part of the outer peripheral surface of the cylindrical member 128 along the axial direction thereof.
- the cylindrical member 128 of the present embodiment is press-fitted into the lumen of the stent 114 and the pusher tube 115.
- the cylindrical member 128 is firmly pressed into the lumen of the stem 114 and the pusher tube 115.
- FIGS. 18 to 20 show a thirteenth embodiment of the present invention.
- the cylindrical member 124 of the first embodiment (see FIGS. 16A to 16C) is formed by a heat-shrinkable tube.
- a recess 131 is provided on the outer peripheral surface of the stent 114 at a part of the covering portion of the cylindrical member 124.
- a ball chip 13 2 is buried in the recess 13 1.
- the pole tip 132 is connected to the tip of the operation wire 120.
- the heat shrink tube of the cylindrical member 124 is covered with the pole tip 132 attached to the concave portion 131 of the stent 114, and the cylindrical member 124 and the stent 134 are covered.
- the pole tip 13 2 is to be buried between the recess 14 and the recess 14 You.
- the stent 114 and the pusher tube 115 are connected by the cylindrical member 124. Therefore, the state of the pusher tube 114 can be moved in the axial direction by moving the pusher tube 115 in the axial direction. Moreover, the cylindrical member 1 19 is covered so as to straddle the outer peripheral surfaces of the stent 114 and the pusher tube 1 15. Therefore, the bending strength at the connection between the stem 114 and the pusher tube 115 is high. Thus, even when the bending angle of the bending portion of the endoscope is large, the stent 114 can be pushed to the target portion without buckling at the connection portion.
- the pole tip 13 2 becomes the cylindrical member 1 2 4 and the stain 1. It is pulled out from between the recessed portion 1 3 and the recessed portion 1 3.
- the pusher tube 1 15 is pulled out of the bore of the cylindrical member 124 by pulling out the port 13 2 and the state 1 14 and the pusher tube are removed.
- the stent 114 is left in the stenosis.
- the same effects as in the eleventh embodiment can be obtained. Furthermore, in the present embodiment, in particular, when the stent 114 and the pusher tube 115 are separated, the separation is performed in a state where the cylindrical member 124 is connected to the stem 114. Is done. Therefore, when replacing the stem 114, the cylindrical part of the stem 114 is replaced. The part of the material 124 can be grasped, and the work of removing the stent 114 can be facilitated.
- FIGS. 21A and 21B show a fifteenth embodiment of the present invention.
- the cylindrical member 119 of the eighth embodiment (see FIGS. 13A to 13C) is formed by a shape memory alloy pipe.
- the shape memory alloy pipe of this cylindrical member 119 expands to an outer diameter larger than that of the stent 114 as shown in Fig. 21A. Have been. At this time, the stent 114 and the pusher tube 115 are detachably connected by the cylindrical member 119.
- the shape memory alloy pipe of the cylindrical member 1 19 is heated to a temperature higher than the reference temperature or cooled to a temperature lower than the reference temperature, for example, as shown in FIG. 21B.
- the outer diameter is set so as to be deformed into a smaller diameter than the stent 1 14.
- the stent 114 and the busher tube 115 can be separated by deforming the shape memory alloy pipe of the cylindrical member 119 into a reduced shape. You.
- the shape memory alloy pipe of the cylindrical member 1 19 may be heated by electric heating.
- FIGS. 22A and 22B show a modification of the fourteenth embodiment.
- a coil-shaped locking member 141 is provided in place of the shape memory alloy pipe of the cylindrical member 119 of the fourteenth embodiment (see FIGS. 21A and 21B). Have been.
- the material 14 1 is formed by a spiral body of a shape memory alloy.
- the shape memory alloy of the locking member 141 is expanded, for example, at room temperature (reference temperature) into a shape having an outer diameter larger than that of the stent 114 as shown in FIG. 22A. I have.
- the stage 114 and the pusher tube 115 are separably connected by the locking member 141.
- the shape memory alloy of the locking member 141 is heated to a temperature higher than the reference temperature or cooled to a temperature lower than the reference temperature, for example, as shown in FIG. 22B.
- the outer diameter is set so that it can be deformed into a shape smaller than the diameter of the stains. Therefore, in the present embodiment, the stent 114 and the pusher tube 115 can be separated by deforming the shape memory alloy of the locking member 141 into a reduced shape. .
- the present invention relates to the field of an indwelling tube guide device used for performing an operation of inserting an indwelling tube into a body cavity of a patient and performing indwelling using an endoscope. It is effective in the technical field of manufacturing and using this indwelling tube guide device.
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Abstract
It comprises a indwelling tube (16, 114), a guide member (11), an engaging section (19, 119) inserted in a clearance between the bore of the indwelling tube (16, 114) and the guide member (11) to removably lock the indwelling tube (16, 14), and a penetrating section penetrating through the bore of the guide member (11), wherein it further comprises a traction member (19, 120) for drawing the indwelling tube (16, 114) at the time of engagement between the engaging section (19, 119) and the indwelling tube (16, 114), and a disengaging section (20, 122) for disengaging the engaging section (19, 119) and the indwelling tube (16, 114) from each other.
Description
明 細 書 Specification
留置チューブガイ ド装置 Indwelling tube guide device
技術分野 Technical field
この発明は、 内視鏡を用いて留置チューブを患者の体腔內 に挿入して留置する操作を行な う 際に使用 される留置チュー ブガイ ド装置に関する。 The present invention relates to an indwelling tube guide device used for performing an operation of inserting an indwelling tube into a body cavity of a patient and performing indwelling using an endoscope.
背景技術 Background art
例えば、 胆管内に溜まった胆汁等を排出する処置と して次 のよ う な処置が行なわれる。 すなわち、 内視鏡のチャンネル 内を通して留置チューブと してのステン ト を胆管の狭窄部に 導き、 ステ ン ト を狭窄部に留置する。 この状態で、 胆管に溜 まった胆汁をステン ト の内腔を介 して排液する こ とが行われ る。 For example, the following treatment is performed as a treatment for discharging bile and the like accumulated in the bile duct. That is, the stent serving as an indwelling tube is guided to the stenotic part of the bile duct through the channel of the endoscope, and the stent is indwelled in the stenotic part. In this state, the bile collected in the bile duct is drained through the lumen of the stent.
ステン ト は、 例えば、 実開昭 6 3 — 2 0 8 5 4 号公報 (特 許文献 1 ) に示すよ う に、 ポ リ エチレン、 シ リ コ ンゴム等の 高分子化合物を素材とする比較的柔軟な中空パイ プである。 このステ ン ト の両端近傍の外周部には抜去防止のための互い に向き合 う フラ ップが設け られている。 As shown in, for example, Japanese Utility Model Application Laid-open No. 63-20854 (Patent Document 1), the stent is made of a polymer material such as polyethylene or silicone rubber. It is a flexible hollow pipe. Flaps facing each other are provided on the outer peripheral portions near both ends of the station to prevent removal.
そ して、 前述のよ う に構成されたステン ト を経内視鏡的に 体腔内に導き、 胆管の狭窄部に留置する手技は次のよ う な手 順で行われる。 すなわち、 図 2 3 Aに示すよ う に、 内視鏡 1 の揷入部 4 に設けられた鉗子チャ ンネル 2 に予め可撓性ワイ ャからなる長尺なガイ ドワイヤ 3 を揷入しておく 。 この状態 で、 ガイ ドワイヤ 3 を内視鏡 1 の揷入部 4 と と もに胆管 5 に 導く 。
次に、 ガイ ドワイヤ 3 を手元側の操作によって前進させて 狭窄部 6 に通す。 その後、 図 2 3 B に示すよ う に狭窄部 6 を 通過 したガイ ドワイヤ 3 をガイ ドと してステン ト 7 をプッシ ャチューブ 8 によって押し込み、 狭窄部 6 に揷入して留置さ せている。 The procedure for guiding the stent configured as described above into the body cavity endoscopically and placing it in the stenosis of the bile duct is performed in the following procedure. That is, as shown in FIG. 23A, a long guide wire 3 made of a flexible wire is previously inserted into the forceps channel 2 provided in the insertion section 4 of the endoscope 1. In this state, the guide wire 3 is guided to the bile duct 5 together with the insertion section 4 of the endoscope 1. Next, the guide wire 3 is advanced by the operation on the hand side to pass through the stenosis 6. Thereafter, as shown in FIG. 23B, the guide wire 3 that has passed through the stenosis portion 6 is used as a guide, and the stent 7 is pushed in by the pusher tube 8, enters the stenosis portion 6, and is left.
と ころが、 狭窄部 6 は体腔内の深部に位置 している。 その ため、 狭窄部 6 を内視鏡 1 によって直接、 観察する こ と はで きない。 一般には、 狭窄部 6 を X線撮影下で処置が行われる。 この場合、 ステン ト 7 をプッ シャチューブ 8 によって狭窄部 6 に押し込む際に、 押し込みすぎて しま う こ とがある。 し力 し、 ステ ン ト 7 とプッ シャチューブ 8 と は連結されていない。 そのため、 ステ ン ト 7 を押 し込みすぎた際に、 図 2 3 B 中に 矢印で示すよ う にプッ シャチューブ 8 を引 き戻しても、 ス テ ン ト 7 を引き戻すこ と ができないとい う不都合がある。 However, the stenosis 6 is located deep within the body cavity. Therefore, the stenosis 6 cannot be directly observed with the endoscope 1. Generally, the stenosis 6 is treated under radiography. In this case, when the stent 7 is pushed into the stenosis 6 by the pusher tube 8, the stent 7 may be pushed too far. The state 7 and the pusher tube 8 are not connected. For this reason, if the pusher tube 8 is pulled back as shown by the arrow in FIG. 23B when the state 7 is pushed too much, the state 7 cannot be pulled back. There is inconvenience.
そこで、 米国特許第 5, 9 2 1 , 9 5 2 号明細書 (特許文 献 2 ) に示す ト レイ ンカテーテルデリ ノ リ シス テ ムが開発さ - れた。 このシス テ ムでは、 プッシャチューブと ステン ト と を 糸によって連結している。 そ して、 ステン ト を押 し込みすぎ た際に、 プッシャチューブを引き戻すと、 糸を介 してステン ト を引き戻すこ とができ る よ う に している。 Thus, a train catheter delivery system disclosed in US Pat. No. 5,921,952 (Patent Document 2) was developed. In this system, the pusher tube and the stent are connected by a thread. If the pusher tube is pulled back when the stent is pushed in too much, the stent can be pulled back through the thread.
特許文献 2 のシス テ ムは、 プ ッ シャチューブの遠位端に糸 を揷通する揷通孔を設けている。 ステ ン ト にはフラ ップを形 成する こ と によって開口 した開 口 を設けている。 そ して、 ガ ィ ドワイヤに絡めた糸 (スーチヤ一) をステン トの開口から 導出する。 続いて、 糸をプッ シャチューブの揷通孔に通 して
結ぶこ と によ り 連結したものである。 In the system of Patent Document 2, a through hole for passing a thread is provided at a distal end of a pusher tube. The stall has an opening that is opened by forming a flap. Then, a thread (soil) entangled with the guide wire is led out from the opening of the stent. Next, pass the thread through the through hole of the pusher tube. It is linked by tying.
従って、 ステ ン ト を押し込みすぎた際に、 プッ シャチュー ブを引き戻すと、 糸を介してステン ト を引き戻すこ とができ る。 また、 ステ ン ト を狭窄部に留置した後、 ガイ ドワイヤを 引き戻す。 この と き、 ガイ ドワイ ヤの遠位端が糸 との絡み部 分から外れる と、 糸がステン ト力、ら抜ける。 これによ り 、 ス テン ト と プッシャチューブとが分離される よ う になつている。 Therefore, if the push-in tube is pulled back when the stent is pushed in too much, the stent can be pulled back through the thread. After the stent is placed in the stenosis, the guide wire is pulled back. At this time, if the distal end of the guide wire comes off the entangled portion with the yarn, the yarn is pulled out by the stent force. As a result, the stent and the pusher tube are separated from each other.
特許文献 2 のシステムは、 ステ ン ト を狭窄部に留置した後、 ガイ ドワイ ヤを引き戻す。 この と き、 ガイ ドワイ ヤの遠位端 が糸 と の絡み部分から外れない と ステン ト と プッシャチュー ブとが分離されない構造である。 In the system of Patent Document 2, the guidewire is pulled back after the stent is placed in the stenosis. At this time, if the distal end of the guide wire does not come off the entangled portion with the thread, the stent and the pusher tube cannot be separated.
従って、 ステン ト を留置する作業時に、 ガイ ドワイヤを抜 いて しまっている。 そのため、 ステン ト を留置した後、 再び ガイ ドワイヤをガイ ドと して次の処置を行お う と してもその 処置をする こ とができない。 Therefore, the guide wire was pulled out during the work of placing the stent. For this reason, after the stent is detained, even if the next treatment is performed using the guidewire as a guide again, the treatment cannot be performed.
また、 特許文献 2 のシステムは、 使用前のセ ッ ト状態では ステン トがガイ ドワイヤに揷通され、 ステ ン ト の遠位端がプ ッシャチューブの遠位端と 当接した状態で保持されている。 そのため、 プッシャチューブと ステン ト と の連結部分はプッ シャチューブと ステン ト と の端面同士が当接しただけの状態 で保持されているので、 プッシャチューブと ステ ン ト と の連 結部の屈曲強度が弱い。 従って、 ステン ト を狭窄部に留置す る作業時に、 プッシャチューブを押し進める際に、 プッ シャ チューブとステン ト と の連結部で座屈 し、 ステン トを目的部 位にアプローチできない可能性が有る。
さ らに、 プッシャチューブの遠位端には糸を揷通するため の揷通孔を設ける必要がある。 そのため、 プッシャチューブ を介 して送液する際に、 液が揷通孔から漏れて しま う と い う 不都合がある。 Also, in the system of Patent Document 2, in a set state before use, the stent is passed through the guide wire, and the distal end of the state is held in contact with the distal end of the pusher tube. I have. For this reason, the connecting portion between the pusher tube and the stent is held in a state where the end faces of the pusher tube and the stent are in contact with each other, so that the bending strength of the connecting portion between the pusher tube and the stent is maintained. Is weak. Therefore, when the pusher tube is pushed forward during the operation of placing the stent in the stenosis, the joint between the pusher tube and the stent may buckle, and the stent may not be able to approach the target position. Further, it is necessary to provide a through hole for passing a thread at the distal end of the pusher tube. Therefore, there is an inconvenience that the liquid leaks from the through hole when the liquid is sent through the pusher tube.
この発明は、 前記事情に着目 してなされたもので、 その 目 的とする と こ ろは、 留置チューブを留置する作業時に、 留置 チューブを押 し込みすぎても引き戻すこ と ができ、 しかも、 留置チューブの屈曲強度が高く 、 内視鏡の湾曲部の湾曲角度 が大き く ても留置チューブを 目的部位に押 し進める こ と がで き、 さ らに、 送液する際に、 液漏れの虞がない留置チューブ ガイ ド装置を提供する こ と にある。 The present invention has been made in view of the above circumstances, and the purpose thereof is to allow the indwelling tube to be pulled back even if it is excessively pushed in during the operation of indwelling the indwelling tube. Even if the bending strength of the indwelling tube is high and the bending angle of the bending portion of the endoscope is large, the indwelling tube can be pushed forward to the target site, and furthermore, when the liquid is sent, liquid leakage may occur. An object of the present invention is to provide an indwelling tube guide device without fear.
発明の開示 Disclosure of the invention
この発明は、 留置チューブガイ ド装置において、 留置チュ ーブと、 少な く ども遠位部が前記留置チューブ内に挿通可能 で、 かつ内腔を有したガイ ド部材と、 前記留置チューブの內 腔と前-記ガィ ド部材と の慷間に挿入されて前記留置チ ーブ · を係脱可能に係止する係止部と、 前記ガイ ド部材の内腔の少 なく と も一部を揷通 している揷通部と を備え、 前記係止部と 前記留置チューブとの係合時に前記留置チューブを牽引操作 する牽引部材と 、 前記牽引部材を前記ガイ ド部材の軸方向に 移動させる こ どによ り 前記係止部と前記留置チューブと の係 合状態を解除する係合解除部と を具備する こ と を特徴とする 留置チューブガイ ド装置である。 The present invention relates to an indwelling tube guide device, an indwelling tube, a guide member having at least a distal portion insertable into the indwelling tube, and having a lumen, and a lumen of the indwelling tube. A locking part inserted between the guide member and the guide member to lock the indwelling tube in a detachable manner, and at least a part of a lumen of the guide member. A piercing portion that penetrates, a traction member that traction-operates the indwelling tube when the locking portion and the indwelling tube are engaged, and moves the traction member in an axial direction of the guide member. Thus, there is provided an indwelling tube guide device, comprising: an engagement releasing portion that releases an engagement state between the locking portion and the indwelling tube.
前記構成によれば、 牽引部材の遠位部に接続している係止 部材が留置チューブと ガイ ド部材との間に係合状態で位置し
ている為、 ガイ ド部材を前進させる こ と によ り 留置チューブ を目的部位にアプローチして留置させる こ とができ る。 留置 チューブを押し込みすぎた際には牽引部材を近位方向に引き 込むこ と によ り 留置チューブを引戻すこ と ができ る。 According to the above configuration, the locking member connected to the distal portion of the traction member is positioned in an engaged state between the indwelling tube and the guide member. Therefore, by moving the guide member forward, the indwelling tube can be approached and indwelled at the target site. If the indwelling tube is pushed too far, the indwelling tube can be pulled back by retracting the traction member in the proximal direction.
また、 留置チューブを 目的部位に配置後、 ガイ ド部材を保 持した状態で牽引部材を近位方向に引 く こ と によ り係止部材 と留置チューブとの係合状態を解除し、 留置チューブを 目的 部位に留置する こ と ができ る。 さ らに留置チューブの内腔に ガイ ド部材の遠位部が揷通されているため、 留置チューブを 内視鏡の湾曲部の湾曲に追従して目的部位に押し進める こ と ができ る。 Also, after placing the indwelling tube at the target site, the engaging state between the locking member and the indwelling tube is released by pulling the traction member in the proximal direction while holding the guide member, and placing the indwelling tube. The tube can be placed at the target site. Further, since the distal portion of the guide member penetrates through the lumen of the indwelling tube, the indwelling tube can be pushed to the target site following the bending of the bending portion of the endoscope.
図面の簡単な説明 BRIEF DESCRIPTION OF THE FIGURES
図 1 Aは、 この発明の第 1 の実施形態の留置チューブガ ィ ド装置全体を示す側面図。 FIG. 1A is a side view showing the entire indwelling tube guide device according to the first embodiment of the present invention.
図 1 B は、 第 1 の実施形態の留置チューブガイ ド装置の 先端部の縦断面図。 · — FIG. 1B is a longitudinal sectional view of a distal end portion of the indwelling tube guide device according to the first embodiment. · —
図 2 Aは、 この発明の第 2 の実施形態の留置チューブガ ィ ド装置の一部を切欠 して示す側面図。 FIG. 2A is a side view in which a part of an indwelling tube guide device according to a second embodiment of the present invention is cut away.
図 2 B は 図 2 Aの I I B — I I B線断面図。 FIG. 2B is a cross-sectional view taken along the line IIB-IB of FIG. 2A.
図 2 Cは 図 2 Aの I I C — I I C線断面図。 Fig. 2C is a cross-sectional view taken along the line IIC-ICC in Fig. 2A.
図 2 Dは 第 2 の実施形態の留置チューブガイ ド装置の 側面図。 FIG. 2D is a side view of the indwelling tube guide device according to the second embodiment.
図 3 Aは この発明の第 3 の実施形態の留置チューブガ ィ ド装置の先端部を示す縦断面図。 FIG. 3A is a longitudinal sectional view showing a distal end portion of an indwelling tube guide device according to a third embodiment of the present invention.
図 3 B は、 図 3 Aの留置チューブガイ ド装置の先端部の
側面図。 Figure 3B shows the distal end of the indwelling tube guide device of Figure 3A. Side view.
図 4 Aは、 この発明の第 4 の実施形態の留置チューブガ ィ ド装置の一部を切欠 して示す側面図。 FIG. 4A is a side view in which a part of an indwelling tube guide device according to a fourth embodiment of the present invention is cut away.
図 4 B は 図 4 Aの I V B — I V B線断面図。 FIG. 4B is a cross-sectional view taken along the line IVB-IVB of FIG. 4A.
図 4 Cは 図 4 Aの I V C — I V C線断面図。 FIG. 4C is a cross-sectional view taken along the line IVC-IVC in FIG. 4A.
図 4 Dは 第 4 の実施形態の留置チューブガイ ド装置の 側面図。 FIG. 4D is a side view of the indwelling tube guide device according to the fourth embodiment.
図 5 Aは 第 4 の実施形態の留置チューブガイ ド装置の 一部を切欠 して可撓性ワイヤと ステン ト と を分離した状態を 示す側面図。 FIG. 5A is a side view showing a state where a part of the indwelling tube guide device according to the fourth embodiment is cut away to separate a flexible wire and a stent.
図 5 B は、 第 4 の実施形態の留置チューブガイ ド装置の 可撓性ワイヤと ステン ト と を分離した状態を示す側面図。 FIG. 5B is a side view showing a state in which the flexible wire and the stent of the indwelling tube guide device of the fourth embodiment are separated.
図 6 Aは、 第 4 の実施形態の留置チューブガイ ド装置に よってステン ト を狭窄部に留置した状態を示す先端部の縦断 面図。 FIG. 6A is a longitudinal sectional view of a distal end showing a state in which a stent is indwelled in a stenosis by the indwelling tube guide device according to the fourth embodiment.
図 6 B は、 '第 4 の実施形態の留置チューブガイ ド装置の 変形例を示す要部の縦断面図。 FIG. 6B is a longitudinal sectional view of a main part showing a modification of the indwelling tube guide device of the fourth embodiment.
図 6 Cは、 図 6 Bの留置チュ ^ "ブガイ ド装置の可撓性ヮ ィ ャの押込み状態を示す縦断面図。 FIG. 6C is a longitudinal sectional view showing a state where the flexible wire of the indwelling tube guide device of FIG. 6B is pushed.
図 7 は、 この発明の第 5 の実施形態の留置チューブガイ ド装置を示す側面図。 FIG. 7 is a side view showing an indwelling tube guide device according to a fifth embodiment of the present invention.
図 8 Aは、 この発明の第 6 の実施形態の留置チューブガ ィ ド装置の先端部を示す縦断面図。 FIG. 8A is a longitudinal sectional view showing a distal end portion of an indwelling tube guide device according to a sixth embodiment of the present invention.
図 8 B は、 第 6 の実施形態の留置チューブガイ ド装置の 第 1 の変形例を示す要部の縦断面図。
図 8 C は、 第 6 の実施形態の留置チ ブガイ ド装置の 第 2 の変形例を示す要部の縦断面図。 FIG. 8B is a longitudinal sectional view of a main part showing a first modification of the indwelling tube guide device according to the sixth embodiment. FIG. 8C is a longitudinal sectional view of a main part showing a second modification of the indwelling guide device according to the sixth embodiment.
図 8 Dは、 第 6 の実施形態の留置チ ブガイ ド装置の 第 3 の変形例を示す要部の縦断面図。 FIG. 8D is a longitudinal cross-sectional view of a main part showing a third modification of the indwelling guide device according to the sixth embodiment.
図 8 E は、 第 6 の実施形態の留置チ ーブガイ ド装置の 第 4 の変形例を示す要部の縦断面図。 FIG. 8E is a longitudinal sectional view of a main part showing a fourth modification of the indwelling tube guide device of the sixth embodiment.
図 8 F は、 第 6 の実施形態の留置チ ブガイ ド装置の 第 5 の変形例を示す要部の縦断面図。 FIG. 8F is a longitudinal sectional view of a main part showing a fifth modification of the indwelling guide device according to the sixth embodiment.
図 8 Gは、 第 6 の実施形態の留置チ ーブガイ ド装置の 第 6 の変形例を示す要部の縦断面図。 FIG. 8G is a longitudinal sectional view of a main part showing a sixth modification of the indwelling tube guide device of the sixth embodiment.
図 8 Hは、 第 6 の実施形態の留置チュープガイ ド装置の 第 7 の変形例を示す要部の縦断面図。 FIG. 8H is a longitudinal sectional view of a main part showing a seventh modification of the indwelling tube guide device of the sixth embodiment.
図 8 I は、 第 6 の実施形態の留置チューブガイ ド装置の 第 8 の変形例を示す要部の縦断面図。 FIG. 8I is a longitudinal sectional view of an essential part showing an eighth modification of the indwelling tube guide device of the sixth embodiment.
図 9 は、 こ の発明の第 7 の実施形態の留置チューブガイ ド装置の一部を切欠 して示す側面図。 FIG. 9 is a side view in which a part of an indwelling tube guide device according to a seventh embodiment of the present invention is cut away.
図 1 0 は、 第 7 の実施形態の留置チューブガイ ド装置の ステン ト と係止部材と が係合している状態を示す平面図。 FIG. 10 is a plan view showing a state in which the stent and the locking member of the indwelling tube guide device according to the seventh embodiment are engaged.
図 1 1 Aは、 第 7 の実施形態の留置チューブガイ ド装置 の係止部材がステン ト と係合している位置にセ ッ ト された状 態を示す縦断面図。 FIG. 11A is a longitudinal sectional view showing a state where a locking member of the indwelling tube guide device according to the seventh embodiment is set at a position where the locking member is engaged with a stent.
図 1 1 Bは、 第 7 の実施形態の留置チューブガイ ド装置 の係止部材が前方に押 し出されてステ ン ト と の係合が解除さ れた状態を示す縦断面図。 FIG. 11B is a longitudinal sectional view showing a state in which the locking member of the indwelling tube guide device according to the seventh embodiment is pushed forward and disengaged from the state.
図 1 1 Cは、 第 7 の実施形態の留置チュープガイ ド装置
の係止部材を手元側に引っ張り 操作した状態を示す縦断面図。 図 1 2 は、 第 7 の実施形態の留置チューブガイ ド装置の 係止部材の動作状態を説明する説明図。 FIG. 11C shows an indwelling tube guide device according to the seventh embodiment. FIG. 6 is a longitudinal sectional view showing a state where the locking member of FIG. FIG. 12 is an explanatory diagram illustrating an operation state of a locking member of the indwelling tube guide device according to the seventh embodiment.
図 1 3 Aは、 この発明の第 8 の実施形態の留置チューブ ガイ ド装置におけるステン ト と プッ シャチューブが接続され ている状態を示す斜視図。 FIG. 13A is a perspective view showing a state where a stent and a pusher tube are connected in an indwelling tube guide device according to an eighth embodiment of the present invention.
図 1 3 Bは、 第 8 の実施形態の留置チューブガイ ド装置 におけるステン ト と プッシャチューブが分離した状態を示す 斜視図。 FIG. 13B is a perspective view showing a state where a stent and a pusher tube are separated in the indwelling tube guide device according to the eighth embodiment.
図 1 3 Cは、 図 1 3 A中の A部の縦断面図。 FIG. 13C is a longitudinal sectional view of a portion A in FIG. 13A.
図 1 4 は、 この発明の第 9 の実施形態を示すステン ト と プッ シャチューブと の接続部の縦断面図。 FIG. 14 is a longitudinal sectional view of a connection portion between a stent and a pusher tube according to a ninth embodiment of the present invention.
図 1 5 は、 この発明の第 1 0 の実施形態を示すステン ト とプッ シャチューブとの接続部の縦断面図。 FIG. 15 is a longitudinal sectional view of a connection portion between a stent and a pusher tube according to a tenth embodiment of the present invention.
図 1 6 Aは、 この発明の第 1 1 の実施形態の留置チュー ブガイ ド装置におけるステン ト と プッシャチューブが接続さ ■ れている状態を示す斜視図。 FIG. 16A is a perspective view showing a state where the stent and the pusher tube are connected in the indwelling tube guide device according to the first embodiment of the present invention.
図 1 6 Bは、 第 1 1 の実施形態の装置におけるステ ン ト とプッシャチューブが分離した状態を示す斜視図。 FIG. 16B is a perspective view showing a state in which the stent and the pusher tube in the device according to the first embodiment are separated.
図 1 6 Cは、 図 1 6 A中で B部の縦断面図。 FIG. 16C is a longitudinal sectional view of a portion B in FIG. 16A.
図 1 7 Aは、 この発明の第 1 2 の実施形態の装置におけ る円筒部材がステン ト及びプッシャチューブの内腔に圧入さ れた状態を示す横断面図。 FIG. 17A is a cross-sectional view showing a state where the cylindrical member in the device according to the 12th embodiment of the present invention is press-fitted into the lumen of the stent and the pusher tube.
図 1 7 Bは、 第 1 2 の実施形態のステン トの変形例を示 す横断面図。
1 8 は、 この発明の第 1 3 の実施形態の装置における ステン ト と プッ シャチューブが接続されている状態を示す斜 視図。 FIG. 17B is a cross-sectional view showing a modification of the stent of the first and second embodiments. 18 is a perspective view showing a state in which the stent and the pusher tube are connected in the device according to the thirteenth embodiment of the present invention.
図 1 9 は、 図 1 8 の B部の縦断面図。 FIG. 19 is a longitudinal sectional view of a portion B in FIG.
図 2 0 は、 第 1 3 の実施形態の装置におけるステン ト と プッ シャチューブが分離した状態を示す斜視図。 FIG. 20 is a perspective view showing a state in which the stent and the pusher tube in the device of the thirteenth embodiment are separated.
図 2 1 Aは、 この発明の第 1 4 の実施形態の装置におけ るステ ン ト とプッシャチューブが接続されている状態を示す 要部の縦断面図。 FIG. 21A is a longitudinal sectional view of a main part showing a state in which a state and a pusher tube in the device according to the fourteenth embodiment of the present invention are connected.
図 2 1 Bは 第 1 4の実施形態の装置におけるステ ン ト とプッシャチュ ブが分離した状態を示す要部の縦断面図。 FIG. 21B is a longitudinal cross-sectional view of a main part of the device according to the fourteenth embodiment, showing a state where the stud and the pusher tube are separated.
図 2 2 Aは 第 1 4の実施形態の装置の変形例のステン ト と プッシャチ ープが接続されている状態を示す要部の縦 断面図。 FIG. 22A is a longitudinal sectional view of a main part showing a state in which a stent and a pusher chip are connected in a modified example of the device of the fourteenth embodiment.
図 2 2 Bは 図 2 2 Aのステン ト とプッ シャチューブが 分離した状態を示す要部の縦断面図。 Fig. 22B is a longitudinal sectional view of a main part showing a state in which the stent and the pusher tube in Fig. 22A are separated.
図 2 3 Aはステン トを経内視鏡的に体腔内に導く 手技を 説明するための説明図。 FIG. 23A is an explanatory view for explaining a procedure for guiding a stent into a body cavity transendoscopically.
図 2 3 B はステン ト をプッ シャチューブによって押 し込 み、 狭窄部に挿入して留置させた状態を説明するための説明 発明を実施するための最良の形態 FIG. 23B is a view for explaining a state in which the stent is pushed in by the pusher tube, inserted into the stenosis, and left in place, and the best mode for carrying out the invention.
以下、 この発明の各実施の形態を図面に基づいて説明する 図 1 Aおよび図 1 Bは、 第 1 の実施形態の留置チューブガ ィ ド装置を示す。
図 1 Aに示すよ う に本実施形態の留置チューブガイ ド装置 には、 図示 しない内視鏡の鉗子チャンネルに揷通可能な長尺 のガイ ドカテーテル 1 1 が設け られている。 このガイ ドカテ 一テル 1 1 は、 可撓性を有する合成樹脂材料、 例えばフ ッ素 系の樹脂、 ナイ ロ ン系の樹脂によって成形されている。 ガイ ドカテーテル 1 1 は全長に亘つて内腔 1 2 が形成されている。 ガイ ドカテーテル 1 1 の近位端にはガイ ドカテーテルコ ック 1 3 が設け られている。 Hereinafter, each embodiment of the present invention will be described with reference to the drawings. FIGS. 1A and 1B show an indwelling tube guide device according to a first embodiment. As shown in FIG. 1A, the indwelling tube guide device of the present embodiment is provided with a long guide catheter 11 that can pass through a forceps channel of an endoscope (not shown). The guide catheter 11 is formed of a flexible synthetic resin material, for example, a fluorine resin or a nylon resin. The guide catheter 11 has a lumen 12 formed over the entire length. At the proximal end of the guide catheter 11, a guide catheter cock 13 is provided.
図 1 B に示すよ う にガイ ドカテーテル 1 1 の遠位端近傍の 側壁には 1 個の小孔 1 4が穿設されている。 ガイ ドカテーテ ル 1 1 の外周面には小孔 1 4 と対応する位置に外径寸法が大 きい拡大部と しての固定リ ング 1 5 が嵌着されている。 固定 リ ング 1 5 は、 小孔 1 4の一部を閉塞する よ う に配置されて いる。 As shown in FIG. 1B, one small hole 14 is formed in the side wall near the distal end of the guide catheter 11. A fixed ring 15 as an enlarged portion having a large outer diameter is fitted on the outer peripheral surface of the guide catheter 11 at a position corresponding to the small hole 14. The fixing ring 15 is arranged so as to close a part of the small hole 14.
さ らに、 ガイ ドカテーテル 1 1 の外周面には固定リ ング 1 5 の遠位側に留置チューブと しての中空パイプ状のステン ト 1 6 が設け られている。 このステン ト 1 6 がガイ ドカテーテ ル 1 1 に嵌合した状態で、 ガイ ドカテーテル 1 1 の小孔 1 4 は、 固定リ ング 1 5 とステン ト 1 6 と によって閉塞されてい る。 Further, a hollow pipe-shaped stent 16 as an indwelling tube is provided on the outer peripheral surface of the guide catheter 11 on the distal side of the fixed ring 15. With the stent 16 fitted in the guide catheter 11, the small hole 14 of the guide catheter 11 is closed by the fixing ring 15 and the stent 16.
ステン ト 1 6 は、 例えばポ リ エチレン、 フ ッ素樹脂、 ナイ ロ ン系の樹脂、 熱可塑性エラス トマ一、 シリ コンゴム等の生 体適合性を有する樹脂からなる。 このステン ト 1 6 の外周面 には、 親水性潤滑材をコーティ ングする こ とが望ま しい。 ス テン ト 1 6 の両端近傍の外周部には抜去防止のための互いに
向き合う フ ラ ップ 1 7が設けられている。 The stent 16 is made of a biocompatible resin such as, for example, polyethylene, fluorine resin, nylon resin, thermoplastic elastomer, silicon rubber and the like. It is desirable to coat a hydrophilic lubricant on the outer peripheral surface of the stent 16. The outer periphery near both ends of the stent 16 is attached to each other to prevent removal. Opposing flaps 17 are provided.
また、 ガイ ドカテーテル 1 1 の内腔 1 2 にはガイ ドワイヤ 1 8 と、 牽引部材と しての可撓性ワイヤ 1 9 が揷通されてい る。 可撓性ワイ ヤ 1 9 は、 長尺の金属製燃り 線からなる。 な お、 可撓性ワイヤ 1 9 は、 少な く と も一部がステ ンレス、 二 ッケル、 チタ ン合金、 ナイ ロ ン、 液晶ポリ マー、 シルク等の 線状体でも よい。 さ らに、 可撓性ワイ ヤ 1 9 は、 断面が略矩 形、 略円径でも よ く 、 また遠位端に拡大部を設けたものでも よい。 Further, a guide wire 18 and a flexible wire 19 as a traction member are passed through the lumen 12 of the guide catheter 11. The flexible wire 19 is made of a long metal wire. At least a part of the flexible wire 19 may be a linear body such as stainless steel, nickel, titanium alloy, nylon, liquid crystal polymer, or silk. Further, the flexible wire 19 may have a substantially rectangular cross section and a substantially circular diameter, and may have an enlarged portion at the distal end.
ガイ ドワイヤ 1 8 は長尺の金属製の線状体、 撚り線状、 コ ィル状のものカゝらな り 、 特にニ ッケル一チタ ン合金からなる 超弾性特性を有する金属からなる ものが好ま しい。 ガイ ドヮ ィャ 1 8 の遠位端は、 先細に形成されている。 さ らに、 ガイ ドワイヤ 1 8 の近位端は、 ガイ ドカテーテルコ ック 1 3 力 ら 外部側に導出されている。 可撓性ワイ ヤ 1 9 の遠位側はガイ ドカテーテル 1 1 の内-腔から小孔 1 4 を介 してガイ ドカテ ^- テル 1 1 の外部に導出されている。 The guide wire 18 may be a long metal wire, a stranded wire, or a coil, particularly a metal having a superelastic property made of a nickel-titanium alloy. I like it. The distal end of the guide 18 is tapered. In addition, the proximal end of the guide wire 18 is led out of the guide catheter cock 13 to the outside. The distal side of the flexible wire 19 is led out of the inner cavity of the guide catheter 11 to the outside of the guide catheter 11 through the small hole 14.
そ して、 可撓性ワイヤ 1 9 の遠位端はステン ト 1 6 の内周 面と ガイ ドカテーテル 1 1 の外周面との間に圧入状態で係合 されている。 可撓性ワイヤ 1 9 の近位端には操作リ ング 2 0 が設け られている。 The distal end of the flexible wire 19 is press-fitted between the inner peripheral surface of the stent 16 and the outer peripheral surface of the guide catheter 11. An operating ring 20 is provided at the proximal end of the flexible wire 19.
こ こで、 可撓性ワイヤ 1 9 の遠位端は、 必ずしもステ ン ト Here, the distal end of the flexible wire 19 is not necessarily
1 6 の全長に亘つて圧入する必要はない。 可撓性ワイヤ 1 9 を近位側に引き戻したと き にステン ト 1 6 を可撓性ワイヤ 1There is no need to press fit over the entire length of 16. When the flexible wire 19 is pulled back proximally, the stent 16 is moved to the flexible wire 1
9 と一体的に近位側に移動させる こ とができ る圧接力が得ら
れる程度の長さ に係合していればよい。 例えば、 可撓性ワイ ャ 1 9 の軸方向に 5 m m以上程度がステン ト 1 6 内に位置し ていればよい。 Pressure contact force that can be moved to the proximal side integrally with It only needs to be engaged to the extent that it is possible. For example, it is sufficient that about 5 mm or more in the axial direction of the flexible wire 19 is located in the stent 16.
また、 ステン ト 1 6 が固定リ ング 1 5 に当接した状態で、 可撓性ワイ ヤ 1 9 をさ らに強く 近位側に引き戻したと き に、 係合が解除されてステン ト 1 6 と可撓性ワイ ヤ 1 9 が分離す る よ う になっている。 + Also, when the flexible wire 19 is pulled further strongly to the proximal side with the stent 16 in contact with the fixing ring 15, the engagement is released and the stent 16 is released. And the flexible wire 19 are separated from each other. +
次に、 第 1 の実施形態の作用について説明する。 本実施形 態の留置チューブガイ ド装置の使用時には留置チューブガイ ド装置は次の通 り セ ッ ト される。 Next, the operation of the first embodiment will be described. When the indwelling tube guide device of this embodiment is used, the indwelling tube guide device is set as follows.
まず、 留置チューブガイ ド装置のガイ ドカテーテル 1 1 の 内腔 1 2 に可撓性ワイ ヤ 1 9 を揷通し、 その遠位端を小孔 1 4から外部に導出する。 そ して、 ガイ ドカテーテル 1 1 にそ の遠位端からステン ト 1 6 を嵌合する。 さ らに、 ステン ト 1 6 とガイ ドカテーテル 1 1 との間に可撓性ワイヤ 1 9 の遠位 部を圧-入する。 これによ り 、 図 1 B に示すよ う にガイ ドカテ 一テル 1 1 と、 ステン ト 1 6 と、 可撓性ワイヤ 1 9 とが組み 付け られた状態にセ ッ ト される。 First, a flexible wire 19 is passed through the lumen 12 of the guide catheter 11 of the indwelling tube guide device, and the distal end thereof is led out from the small hole 14. Then, a stent 16 is fitted to the guide catheter 11 from its distal end. Further, the distal portion of the flexible wire 19 is press-fitted between the stent 16 and the guide catheter 11. As a result, as shown in FIG. 1B, the guide catheter 11, the stent 16 and the flexible wire 19 are set in a state where they are assembled.
その後、 予め体腔内に内視鏡の揷入部を挿入し、 内視鏡の 揷入部の先端に配置された先端構成部を胆管の近傍まで導く 。 Thereafter, the insertion portion of the endoscope is inserted into the body cavity in advance, and the distal end component disposed at the distal end of the insertion portion of the endoscope is guided to the vicinity of the bile duct.
続いて、 体内に揷入された内視鏡の鉗子チャ ンネルにガイ ドワイヤ 1 8 を揷通する。 この と き、 内視鏡によ る観察、 お よび X線による観察のも と で、 ガイ ドワイヤ 1 8 を前進させ てガイ ドワイヤ 1 8 の遠位端を胆管の狭窄部に導く 。 Subsequently, the guide wire 18 is passed through the forceps channel of the endoscope inserted into the body. At this time, the guide wire 18 is advanced to guide the distal end of the guide wire 18 to the narrowed portion of the bile duct under observation using an endoscope and observation using X-rays.
その後、 上述した通 り 、 ステン ト 1 6 をセ ッ ト したガイ ド
カテーテル 1 1 をガイ ドワイヤ 1 8 に揷通 し、 ガイ ドワイヤ 1 8 をガイ ドと してガイ ドカテーテル 1 1 を鉗子チャンネル に揷通する。 After that, as described above, the guide with stent 16 set The catheter 11 is passed through the guide wire 18, and the guide catheter 11 is passed through the forceps channel using the guide wire 18 as a guide.
この と き、 ガイ ドカテーテル 1 1 の近位端側の手元操作に よってガイ ドカテーテル 1 1 を前進させる。 そ して、 内視鏡 の先端構成部からガイ ドカテーテル 1 1 を導出 し、 ガイ ドカ テーテル 1 1及ぴステ ン ト 1 6 を狭窄部に揷通する。 At this time, the guide catheter 11 is advanced by a manual operation on the proximal end side of the guide catheter 11. Then, the guide catheter 11 is led out from the distal end component of the endoscope, and the guide catheter 11 and the stent 16 are passed through the stenosis.
また、 ガイ ドカテーテル 1 1 の揷入作業中は、 ステン ト 1 6 はガイ ドカテーテル 1 1 に嵌合された状態で保持される。 そのため、 ステン ト 1 6 の屈曲強度が高く 、 ガイ ドワイヤ 1 8 が大きな湾曲角で湾曲 していてもステン ト 1 6 が座屈する こ とがない。 そ して、 ステン ト 1 6 をガイ ドカテーテル 1 1 と一体的に前進させ、 目的部位に導く こ と ができ る。 Also, during the operation of inserting the guide catheter 11, the stent 16 is held in a state of being fitted to the guide catheter 11. Therefore, the bending strength of the stent 16 is high, and the stent 16 does not buckle even when the guide wire 18 is bent at a large bending angle. Then, the stent 16 can be advanced integrally with the guide catheter 11 and guided to the target site.
また、 ガイ ドカテーテル 1 1 によってステ ン ト 1 6 を狭窄 部に挿入 したのち、 X線による観察が行なわれる。 この X線 観察によづてステン ド 1 6 を深く 押し込みすぎたこ と を確認 した場合にはステン ト 1 6 の位置を近位側に引き戻す作業が 行なわれる。 この作業時には、 操作リ ング 2 0 に手指を掛け て近位側に引張り操作する。 これによ り 、 可撓性ワイヤ 1 9 を介 してステン ト 1 6 を引 き戻すこ とができ、 ステン ト 1 6 を目 的部位に確実に位置決め して留置する こ とができ る。 After the stent 16 is inserted into the stenosis by the guide catheter 11, observation by X-ray is performed. If it is confirmed by this X-ray observation that the stem 16 has been pushed too deeply, the work of pulling the stent 16 back to the proximal side is performed. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at a target portion.
その後、 ガイ ドカテーテル 1 1 を保持したまま、 操作リ ン グ 2 0 に手指を掛けて可撓性ワイヤ 1 9 を近位側に引き込む 操作が行なわれる。 こ の操作時には、 可撓性ワイヤ 1 9 の遠 位端はガイ ドカテーテル 1 1 と ステン ト 1 6 との間から抜け
る。 そのため、 可撓性ワイヤ 1 9 とステン ト 1 6 とが分離さ れ、 ステ ン ト 1 6 は狭窄部に留置される。 Thereafter, while holding the guide catheter 11, an operation is performed in which a finger is put on the operation ring 20 to pull the flexible wire 19 to the proximal side. During this operation, the distal end of the flexible wire 19 comes out from between the guide catheter 11 and the stent 16. You. Therefore, the flexible wire 19 and the stent 16 are separated, and the stent 16 is placed in the stenosis.
この と き、 ガイ ドワイヤ 1 8 はガイ ドカテーテル 1 1 に挿 通された状態で保持されている。 このガイ ドワイ ヤ 1 8 の遠 位端は狭窄部の位置に残されている。 そのため、 ガイ ドワイ ャ 1 8 をガイ ドと して次の処置を行う こ と も可能である。 At this time, the guide wire 18 is held in a state of being inserted into the guide catheter 11. The distal end of this guidewire 18 remains at the stenosis. Therefore, it is possible to use the guide wire 18 as a guide to perform the following measures.
また、 ガイ ドカテーテル 1 1 は内腔 1 2 を有しているため、 ガイ ドカテーテルコ ック 1 3 から送液した り 、 吸引する こ と も可能である。 Further, since the guide catheter 11 has the lumen 12, it is also possible to feed or suck the liquid from the guide catheter cock 13.
そこで、 上記構成のものにあっては次の効果を奏する。 す なわち、 本実施形態の留置チューブガイ ド装置ではガイ ドカ テーテル 1 1 にステ ン ト 1 6 を嵌合し、 さ らに、 ステン ト 1 6 と ガイ ドカテーテル 1 1 との間に可撓性ワイャ 1 9 の遠位 部を圧入させている。 これによ り 、 図 1 B に示すよ う にガイ ドカテーテル 1 1 と 、 ステ ン ト 1 6 と 、 可撓性ワイ ヤ 1 9 と を一体的に組み付け ら 'れた状態にセ ッ ト されている。 そのた め、 ステ ン ト 1 6 を胆管の狭窄部に留置する作業時に、 ステ ン ト 1 6 を押し込みすぎても可撓性ワイヤ 1 9 を介してステ ン ト 1 6 を手元側に引き戻すこ と ができる。 Therefore, the above configuration has the following effects. That is, in the indwelling tube guide device of the present embodiment, the stent 16 is fitted to the guide catheter 11, and furthermore, the flexible member is provided between the stent 16 and the guide catheter 11. The distal part of the sex wire 19 is press-fitted. As a result, as shown in FIG. 1B, the guide catheter 11, the stent 16 and the flexible wire 19 are set in a state where they are integrally assembled. ing. For this reason, when the stent 16 is placed in the constriction of the bile duct, even if the stent 16 is pushed too much, the stent 16 can be pulled back through the flexible wire 19 to the proximal side. And can be.
しかも、 ガイ ドカテーテル 1 1 の揷入作業中は、 ステン ト 1 6 はガイ ドカテーテル 1 1 に嵌合された状態で保持される。 そのため、 ステン ト 1 6 の屈曲強度が高く 、 内視鏡の湾曲部 の湾曲角度が大き く てもステ ン ト 1 6 を目 的部位に押 し進め る こ とができ る。 Moreover, during the operation of inserting the guide catheter 11, the stent 16 is held in a state of being fitted to the guide catheter 11. Therefore, even when the bending strength of the stent 16 is high and the bending angle of the bending portion of the endoscope is large, the stent 16 can be pushed forward to a target portion.
さ らに、 ガイ ドカテーテル 1 1 の小孔 1 4 は固定リ ング 1
5 とステン ト 1 6 と によって閉塞されているので、 送液する 際に、 液が小孔 1 4 から漏れて しま う液漏れの虞がない。 In addition, small holes 14 of guide catheter 11 are fixed rings 1 Since it is closed by 5 and the stent 16, there is no danger of the liquid leaking from the small holes 14 when feeding the liquid.
図 2 A〜 2 Dは本発明の第 2 の実施形態を示す。 なお、 第 1 の実施形態と 同一構成の部分は同一の符号を付して説明を 省略する。 ガイ ドカテーテル 1 1 の遠位端にはステン ト 1 6 が外嵌されている。 2A to 2D show a second embodiment of the present invention. The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. A stent 16 is externally fitted to the distal end of the guide catheter 11.
さ らに、 ガイ ドカテーテル 1 1 の外周面には、 ステン ト 1 6 よ り 近位側にプッ シャチューブ 2 1 が軸方向に進退自在に 嵌合されている。 プッシャチューブ 2 1 は、 可撓性を有する 合成樹脂材料からなる。 このプッシャチューブ 2 1 の近位端 にはプッ シャチューブコ ック 2 2 が設け られている。 Further, a pusher tube 21 is fitted to the outer peripheral surface of the guide catheter 11 on the proximal side of the stent 16 so as to be able to advance and retreat in the axial direction. The pusher tube 21 is made of a synthetic resin material having flexibility. At the proximal end of the pusher tube 21, a pusher tube cock 22 is provided.
また、 ガイ ドカテーテル 1 1 の外周面と プッシャチューブ 2 1 の内周面と の間には牽引部材と しての可撓性ワイヤ 1 9 が軸方向の進退自在に揷通されている。 可撓性ワイヤ 1 9 の 遠位端はステン ト 1 6 の内周面と ガイ ドカテーテル 1 1 の外 周面との間に圧入されて係合されている。 A flexible wire 19 as a pulling member is passed between the outer peripheral surface of the guide catheter 11 and the inner peripheral surface of the pusher tube 21 so as to be able to advance and retreat in the axial direction. The distal end of the flexible wire 19 is pressed and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the guide catheter 11.
可撓性ワイヤ 1 9 の近位端はプッシャチューブコ ック 2 2 から外部に導出されている。 そ して、 この可撓性ワイ ヤ 1 9 の近位端に操作リ ング 2 0 が設け られている。 ' The proximal end of the flexible wire 19 is led out of the pusher tube cock 22. An operating ring 20 is provided at the proximal end of the flexible wire 19. '
次に、 第 2 の実施形態の留置チューブガイ ド装置の作用に ついて説明する。 本実施形態の留置チューブガイ ド装置の使 用時には留置チューブガイ ド装置は次の通 り セ ッ ト される。 Next, the operation of the indwelling tube guide device according to the second embodiment will be described. When the indwelling tube guide device of the present embodiment is used, the indwelling tube guide device is set as follows.
まず、 留置チューブガイ ド装置のガイ ドカテーテル 1 1 と プッ シャチューブ 2 1 と の間に可撓性ワイヤ 1 9 を揷通する。 続いて、 ガイ ドカテーテル 1 1 の遠位端にステン ト 1 6 を外
嵌する。 その後、 ステン ト 1 6 とガイ ドカテーテル 1 1 との 間に可撓性ワイヤ 1 9 の遠位端を圧入する。 これによ り 、 図 2 Aに示すよ う にガイ ドカテーテル 1 1 と、 ステン ト 1 6 と 、 可撓性ワイ ヤ 1 9 と、 プッシャチューブ 2 1 とが組み付けら れた状態にセ ッ ト される。 First, a flexible wire 19 is passed between the guide catheter 11 and the pusher tube 21 of the indwelling tube guide device. Next, remove the stent 16 at the distal end of the guide catheter 11. Fit. Thereafter, the distal end of the flexible wire 19 is press-fitted between the stent 16 and the guide catheter 11. As a result, as shown in FIG. 2A, the guide catheter 11, the stent 16, the flexible wire 19, and the pusher tube 21 are set in a state where they are assembled. Is done.
その後、 第 1 の実施形態と同様に内視鏡の鉗子チャ ンネル にガイ ドワイヤ 1 8 を揷通 したのち、 ガイ ドカテーテル 1 1 を介してステン ト 1 6 を胆管の狭窄部に導く 操作が行なわれ る。 こ の方法は第 1 の実施形態の同様である。 そ して、 本実 施形態ではプッ シャチューブ 2 1 を前進させる こ と によ り 、 ステ ン ト 1 6 を狭窄部に揷通する。 After that, similarly to the first embodiment, the guide wire 18 is passed through the forceps channel of the endoscope, and then the stent 16 is guided to the stenotic part of the bile duct via the guide catheter 11. It is. This method is the same as in the first embodiment. Then, in the present embodiment, the pusher tube 21 is advanced to pass the stent 16 to the stenosis.
また、 プッ シャチューブ 2 1 によってス テ ン ト 1 6 を狭窄 部に挿入したのち、 X線による観察が行なわれる。 こ の X線 観察によってステ ン ト 1 6 を深く 押し込みすぎたこ と を確認 した場合には、 ステ ン ト 1 6 の位置を近位側に引 き戻す作業 が行なわれる。 この作業時には、 操作リ ング 2 0 に手指を掛 けて近位側に引張り 操作する。 これによ り 、 可撓性ワイヤ 1 9 を介 してス テ ン ト 1 6 を引き戻すこ とができ、 ステン ト 1 6 を 目的部位に確実に位置決め留置する こ とができる。 After the stent 16 is inserted into the stenosis by the pusher tube 21, X-ray observation is performed. If it is confirmed by this X-ray observation that the state 16 has been pushed too deeply, the work of returning the state 16 to the proximal side is performed. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at the target portion.
その後、 ガイ ドカテーテル 1 1 を保持したまま、 操作リ ン グ 2 0 に手指を掛けて可撓性ワイヤ 1 9 を近位側に引き込む 操作が行なわれる。 こ の操作時には、 可撓性ワ イ ヤ 1 9 の遠 位端はガイ ドカテーテル 1 1 と ステン ト 1 6 との間から抜け る。 そのため、 可撓性ワイヤ 1 9 とステン ト 1 6 とが分離さ れ、 ス テ ン ト 1 6 は狭窄部に留置される。
このと き、 ガイ ドワイヤ 1 8 はガイ ドカテーテル 1 1 に揷 通された状態で保持されている。 こ のガイ ドワイヤ 1 8 の遠 位端は狭窄部の位置に残されている。 そのため、 ガイ ドワイ ャ 1 8 をガイ ド と して次の処置を行う こ と も可能である。 Thereafter, while holding the guide catheter 11, an operation is performed in which a finger is put on the operation ring 20 to pull the flexible wire 19 to the proximal side. During this operation, the distal end of the flexible wire 19 is withdrawn from between the guide catheter 11 and the stent 16. Therefore, the flexible wire 19 and the stent 16 are separated, and the stent 16 is left in the stenosis. At this time, the guide wire 18 is held in a state of being passed through the guide catheter 11. The distal end of the guide wire 18 is left at the position of the stenosis. Therefore, it is possible to use the guide wire 18 as a guide to perform the following measures.
また、 ガイ ドカテーテル 1 1 は内腔 1 2 を有しているため、 ガイ ドカテーテルコ ッ ク 1 3力 ら送液した り 、 吸引する こ と も可能である。 Further, since the guide catheter 11 has the lumen 12, it is possible to feed or suck the liquid from the guide catheter cock 13.
そこで、 上記構成のものにあってもステン ト 1 6 を胆管の 狭窄部に留置する作業時に、 ス テ ン ト 1 6 を押し込みすぎて も可撓性ワイヤ 1 9 を介してス テ ン ト 1 6 を手元側に引き戻 すこ とができ る。 Therefore, even when the stent 16 is placed in the stenotic part of the bile duct even in the above configuration, even if the stent 16 is pushed too much, the stent 16 can be inserted through the flexible wire 19. 6 can be pulled back.
しかも、 ガイ ドカテーテル 1 1 の揷入作業中は、 ステン ト 1 6 はガイ ドカ テーテル 1 1 に嵌合された状態で保持される。 さ らに、 ス テ ン ト 1 6 の内腔に可撓性ワ イ ヤ 1 9 の遠位部が 揷通されているため、 ス テ ン ト 1 6 の屈曲強度が高い。 その ため、 内視鏡の湾曲部の湾曲角度が大き く てもス テ ン ト 1 6 を内視鏡の湾曲部の湾曲に追従して 目的部位に押 し進めるこ とができ る。 Moreover, during the operation of inserting the guide catheter 11, the stent 16 is held in a state of being fitted to the guide catheter 11. Further, since the distal portion of the flexible wire 19 is penetrated through the lumen of the stem 16, the bending strength of the stent 16 is high. Therefore, even when the bending angle of the bending portion of the endoscope is large, the stent 16 can be pushed to the target site by following the bending of the bending portion of the endoscope.
また、 ステン ト 1 6 を目的部位に配置後、 ガイ ド力テーテ ル 1 1 を保持した状態で可撓性ワイヤ 1 9 を近位方向に引 く こ と によ り 、 可撓性ワイヤ 1 9 の遠位端とステン ト 1 6 との 係合状態を解除する。 これによ り 、 ステン ト 1 6 を目的部位 に留置する こ と ができ る。 Also, after the stent 16 is placed at the target site, the flexible wire 19 is pulled in the proximal direction while the guide force table 11 is held. Disengage the distal end of the tube from the stent 16. This allows the stent 16 to be placed at the target site.
さ らに、 ガイ ドカテーテル 1 1 は送液する際に、 液が漏れ て しま う 虞もない。
図 3 Aおよび図 3 B は本発明の第 3 の実施形態を示す。 な お、 第 1 の実施形態と 同一構成の部分は同一の符号を付して 説明を省略する。 Further, there is no possibility that the guide catheter 11 leaks when the liquid is sent. 3A and 3B show a third embodiment of the present invention. The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.
本実施形態のステン ト 2 3 には、 先端部に細径部 2 3 a が 形成されている。 このステ ン ト 2 3 の基端部には太径部 2 3 b が形成されている。 この太径部 2 3 b は、 プッシャチュー ブ 2 1 と 同径に設定されている。 In the stent 23 of the present embodiment, a small-diameter portion 23a is formed at the tip. A large-diameter portion 23 b is formed at the base end of the state 23. The large diameter portion 23b is set to the same diameter as the pusher tube 21.
そ して、 ステ ン ト 2 3 の太径部 2 3 b の内周面とガイ ドカ テーテル 1 1 の外周面との間には可撓性ワイヤ 1 9 の遠位端 が圧入されて係合されている。 The distal end of the flexible wire 19 is pressed into and engaged between the inner peripheral surface of the large-diameter portion 23 b of the stem 23 and the outer peripheral surface of the guide catheter 11. Have been.
従って、 本実施形態ではステン ト 2 3 の先端部に細径部 2 Therefore, in the present embodiment, the small-diameter portion 2
3 a が形成されているため、 ステ ン ト 2 3 を胆管の狭窄部に 揷入する際に、 揷入しゃすいとい う効果がある。 Due to the formation of 3a, there is an effect of penetrating the stent 23 when penetrating the stenosis of the bile duct.
図 4 A〜図 6 Aは本発明の第 4 の実施形態を示す。 本実施 形態では、 第 2 の実施形態 (図 2 A〜 2 D参照) のプッ シャ チューブ 2 1 と は異なる構成のプッシャチューブ 2 4 が設け られている。 これ以外の部分は第 2の実施形態と 同一構成に なっている。 なお、 第 2の実施形態と同一構成の部分は同一 の符号を付して説明を省略する。 4A to 6A show a fourth embodiment of the present invention. In this embodiment, a pusher tube 24 having a configuration different from that of the pusher tube 21 of the second embodiment (see FIGS. 2A to 2D) is provided. The other portions have the same configuration as the second embodiment. Note that the same components as those of the second embodiment are denoted by the same reference numerals, and description thereof is omitted.
本実施形態では、 図 4 Aに示すよ う にプッシャチューブ 2 4 の遠位端に細径部 2 4 a が設け られている。 この細径部 2 In the present embodiment, as shown in FIG. 4A, a small diameter portion 24 a is provided at the distal end of the pusher tube 24. This small diameter part 2
4 a は、 ステン ト 1 6 の内腔に揷入される。 4 a is inserted into the lumen of the stent 16.
プッシャチューブ 2 4 には細径部 2 4 a と、 こ の細径部 2 4 a の近位端側の太径部 2 4 b と の間に段差部 2 4 c が設け られている。 この段差部 2 4 c には揷通孔 2 5 が設け られて
いる。 The pusher tube 24 is provided with a step 24c between the small-diameter portion 24a and the large-diameter portion 24b on the proximal end side of the small-diameter portion 24a. This step portion 24c is provided with a through hole 25. I have.
また、 プッ シャチューブ 2 4 の内腔に揷通された可撓性ヮ ィャ 1 9 の遠位端は揷通孔 2 5 カゝら細径部 2 4 a の外部に導 出される。 そ して、 可撓性ワイヤ 1 9 の遠位端はステン ト 1 6 の内周面と細径部 2 4 a の外周面と の間に圧入されて係合 されている。 In addition, the distal end of the flexible wire 19 passed through the lumen of the pusher tube 24 is guided to the outside of the small diameter portion 24 a through the through hole 25. The distal end of the flexible wire 19 is press-fitted and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the small diameter portion 24a.
さ らに、 プッ シャチューブ 2 4 の側壁には側孔 2 6 が設け られている。 可撓性ワイヤ 1 9 の近位端はプッシャチューブ 2 4 の側孔 2 6 力 ら外部に導出されている。 Further, a side hole 26 is provided on a side wall of the pusher tube 24. The proximal end of the flexible wire 19 is led out from a side hole 26 of the pusher tube 24.
次に、 第 4 の実施形態の作用について説明する。 本実施形 態の留置チューブガイ ド装置の使用時には留置チューブガイ ド装置は次の通 り セ ッ ト される。 Next, the operation of the fourth embodiment will be described. When the indwelling tube guide device of this embodiment is used, the indwelling tube guide device is set as follows.
まず、 プッ シャチューブ 2 4 の内腔に可撓性ワイヤ 1 9 を 揷通 し、 その遠位端を揷通孔 2 5 から細径部 2 4 a の外部に 導出する。 続いて、 プッシャチューブ 2 4 の遠位端の細径部 2 4 a にステ ン ト 1 6-を外嵌する。 その後、 図 4 B に示すよ う に可撓性ワイ ヤ 1 9 の遠位端をステ ン ト 1 6 の内周面と細 径部 2 4 a の外周面と の間に圧入して係合する。 これによ り 、 図 4 Aに示すよ う にプッ シャチュ ^ "プ 2 4 と、 ステン ト 1 6 と、 可撓性ワイ ヤ 1 9 とが組み付け られた状態にセ ッ ト され る。 First, a flexible wire 19 is passed through the lumen of the pusher tube 24, and its distal end is led out of the small diameter portion 24 a through the through hole 25. Subsequently, the state 16-is fitted to the small diameter portion 24 a at the distal end of the pusher tube 24. Then, as shown in FIG. 4B, the distal end of the flexible wire 19 is pressed into and engaged between the inner peripheral surface of the stent 16 and the outer peripheral surface of the small diameter portion 24a. I do. As a result, as shown in FIG. 4A, the pusher 24, the stent 16 and the flexible wire 19 are set in a state where they are assembled.
また、 内視鏡の鉗子チャ ンネルにガイ ドワイヤ 1 8 を揷通 したのち、 プッ シャチューブ 2 4 を介 してステン ト 1 6 を胆 管の狭窄部に導く 方法は、 第 1 の実施形態の同様である。 そ して、 本実施形態ではプッシャチューブ 2 4 を前進させる と
段差部 2 4 c がステン ト 1 6 の近位端に当接する。 プッシャ チューブ 2 4 をさ らに前進させる とステン ト 1 6 が狭窄部に 揷通される。 Further, a method of passing the guide wire 18 through the forceps channel of the endoscope and guiding the stent 16 to the constriction of the bile duct via the pusher tube 24 is described in the first embodiment. The same is true. In the present embodiment, when the pusher tube 24 is advanced, Step 24 c abuts the proximal end of stent 16. When the pusher tube 24 is further advanced, the stent 16 passes through the stenosis.
そ して、 プッシャチューブ 2 4 によってステン ト 1 6 を狭 窄部に挿入 したのち、 X線による観察が行なわれる。 この と き、 X線観察によ ってステ ン ト 1 6 を深く 押し込みすぎたこ と を確認した場合には、 ステン ト 1 6 の位置を近位側に引き 戻す作業が行なわれる。 この作業時には、 操作リ ング 2 0 に 手指を掛けて近位側に引張り操作する。 これによ り 、 可撓性 ワイヤ 1 9 を介してステン ト 1 6 を引き戻すこ と ができ、 ス テン ト 1 6 を 目的部位に確実に位置決めする こ と ができ る。 Then, after the stent 16 is inserted into the stenosis by the pusher tube 24, observation by X-ray is performed. At this time, if it is confirmed by X-ray observation that the stage 16 has been pushed too deeply, the position of the stage 16 is pulled back to the proximal side. During this operation, fingers should be placed on the operation ring 20 and pulled in the proximal direction. Thus, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned at the target portion.
その後、 プッシャチューブ 2 4 を保持したまま、 操作リ ン グ 2 0 に手指を掛けて可撓性ワイ ヤ 1 9 を近位側に引き込む 操作が行なわれる。 この操作時には、 図 5 Aに示すよ う に可 撓性ワイヤ 1 9 の遠位端がプッシャチューブ 2 4 とステ ン ト 1 6 と の間力 ら抜ける。 これによ り 、 図 6 Aに示すよ う に、 可撓性ワイヤ 1 9 と ステン ト 1 6 とが分離される。 従って、 ステン ト 1 6 は狭窄部に留置される。 Thereafter, while holding the pusher tube 24, an operation is performed in which a finger is put on the operation ring 20 to pull the flexible wire 19 to the proximal side. During this operation, the distal end of the flexible wire 19 is pulled out of the force between the pusher tube 24 and the state 16 as shown in FIG. 5A. As a result, as shown in FIG. 6A, the flexible wire 19 and the stent 16 are separated. Therefore, the stent 16 is left in the stenosis.
このと き、 ガイ ドワイヤ 1 8 はプッ シャチューブ 2 4 に揷 通された状態で保持されている。 このガイ ドワイ ヤ 1 8 の遠 位端は狭窄部の位置に残されている。 そのため、 ガイ ドワイ ャ 1 8 をガイ ドと して次の処置を行う こ と も可能である。 At this time, the guide wire 18 is held in a state of being passed through the pusher tube 24. The distal end of this guidewire 18 remains at the stenosis. Therefore, it is possible to use the guide wire 18 as a guide to perform the following measures.
そこで、 上記構成のものにあってもステン ト 1 6 を胆管の 狭窄部に留置する作業時に、 ステン ト 1 6 を押し込みすぎて も可撓性ワイヤ 1 9 を介してステ ン ト 1 6 を手元側に引き戻
すこ とができる。 Therefore, even when the stent 16 is placed in the stenotic part of the bile duct even in the above configuration, even if the stent 16 is pushed too much, the stent 16 can be kept at hand via the flexible wire 19. Pull back to the side I can do it.
また、 本実施の形態ではガイ ドカテーテル 1 1 を省略する こ と ができ るので、 コス ト削減が図れる。 さ らに、 ステン ト Further, in the present embodiment, since the guide catheter 11 can be omitted, the cost can be reduced. In addition,
1 6 とプッ シャチューブ 2 4 を細径化する こ とが可能であ り 、 狭窄部が狭い場合な どにステン ト 1 6 の揷入を容易にする。 It is possible to make the diameter of the pusher tube 24 smaller than that of the pusher tube 24, which makes it easier to insert the stent 16 when the stenosis is narrow.
また、 図 6 B、 6 Cは、 第 4 の実施形態の留置チューブガ イ ド装置の変形例を示す。 こ こでは、 ガイ ドワイ ヤ 1 8 をプ ッシャチューブ 2 4 の側孔 2 6 を通してプッ シャチューブ 2 4 の内部に揷入 している。 6B and 6C show modified examples of the indwelling tube guide device according to the fourth embodiment. Here, the guide wire 18 is inserted into the inside of the pusher tube 24 through the side hole 26 of the pusher tube 24.
図 7 は本発明の第 5 の実施形態を示す。 本実施の形態は第 4 の実施形態 (図 4 八〜図 6 。参照) の留置チューブガイ ド 装置を次の通り 変更 したものである。 なお、 第 4 の実施形態 と 同一部分は同一の符号を付して説明を省略する。 FIG. 7 shows a fifth embodiment of the present invention. In this embodiment, the indwelling tube guide device of the fourth embodiment (see FIGS. 48 to 6) is modified as follows. Note that the same parts as those in the fourth embodiment are denoted by the same reference numerals, and description thereof is omitted.
本実施形態では、 ガイ ドカテ一テル 1 1 の近位部に操作リ ング 2 0 a が軸方向に進退自在に嵌合されている。 この操作 リ ング 2 0 ·· a にはプッ シャチューブ 2 4内に揷通'された可撓 性ワイヤ 1 9 の近位端が連結されている。 In the present embodiment, the operation ring 20a is fitted to the proximal portion of the guide catheter 11 so as to be able to advance and retreat in the axial direction. The proximal end of the flexible wire 19 passed through the pusher tube 24 is connected to the operation ring 20.
そこで、 本実施形態によれば、 操作リ ング 2 0 a を後退さ せる こ と によ り 、 可撓性ワイヤ 1 9 を牽引 してステン ト 1 6 との係合状態を解除する こ とができる。 Therefore, according to the present embodiment, by retracting the operation ring 20a, it is possible to pull the flexible wire 19 to release the engagement state with the stent 16. it can.
図 8 Aは本発明の第 6 の実施形態を示す。 なお、 本実施の 形態で第 2 の実施形態 (図 2 A〜 2 D参照) と 同一部分には 同一の符号を付して説明を省略する。 本実施の形態では可撓 性ワイヤ 1 9 の遠位端に上方へ屈曲する屈曲部 1 9 c が設け られている。 この屈曲部 1 9 c をステン ト 1 6 の內壁に圧接
したものである。 FIG. 8A shows a sixth embodiment of the present invention. In this embodiment, the same parts as those of the second embodiment (see FIGS. 2A to 2D) are denoted by the same reference numerals, and description thereof will be omitted. In the present embodiment, a bent portion 19c that is bent upward is provided at the distal end of the flexible wire 19. This bent part 19 c is pressed against the wall of stent 16 It was done.
図 8 Bは、 第 6 の実施形態の留置チューブガイ ド装置の第 1 の変形例を示す。 本変形例は可撓性ワイ ヤ 1 9 の遠位端に 波状屈曲部 2 7 を設けている。 この波状屈曲部 2 7 をステン ト 1 6 の内壁に圧接したものである。 FIG. 8B shows a first modification of the indwelling tube guide device according to the sixth embodiment. In this modification, a wavy bent portion 27 is provided at the distal end of the flexible wire 19. The wavy bent portion 27 is pressed against the inner wall of the stent 16.
図 8 Cは、 第 6 の実施形態の留置チューブガイ ド装置の第 2 の変形例を示す。 本変形例は可撓性ワイ ヤ 1 9 の遠位端に S字状屈曲部 2 8 を設けている。 この S字状屈曲部 2 8 をス テン ト 1 6 の内壁に圧接したものである。 FIG. 8C shows a second modification of the indwelling tube guide device according to the sixth embodiment. In this modification, an S-shaped bent portion 28 is provided at the distal end of the flexible wire 19. The S-shaped bent portion 28 is pressed against the inner wall of the stent 16.
図 8 Dは、 第 6 の実施形態の留置チューブガイ ド装置の第 3 の変形例を示す。 本変形例は可撓性ワイヤ 1 9 の遠位端を 幅方向に拡げた拡幅部 2 9 を設けている。 こ の拡幅部 2 9 を ステ ン ト 1 6 の内壁に圧接したものである。 FIG. 8D shows a third modification of the indwelling tube guide device according to the sixth embodiment. In this modification, a widened portion 29 is provided by expanding the distal end of the flexible wire 19 in the width direction. The widened portion 29 is pressed against the inner wall of the stage 16.
図 8 Eは、 第 6 の実施形態の留置チューブガイ ド装置の第 4 の変形例を示す。 本変形例は 1本の可撓性ワイヤ 1 9 をス テン ト 1 & の内部で屈折して折り 返し部 3 0 を設け-、 折り返 し部 3 0 をステン ト 1 6 の内壁に圧接したものである。 FIG. 8E shows a fourth modification of the indwelling tube guide device according to the sixth embodiment. In this modification, one flexible wire 19 is bent inside the stent 1 & to provide a folded portion 30-and the folded portion 30 is pressed against the inner wall of the stent 16. Things.
図 8 F は、 第 6 の実施形態の留置チューブガイ ド装置の第 5 の変形例を示す。 本変形例は可撓性ワイ ヤ 1 9 の遠位端に 蛇行状部 3 1 を設けている。 この蛇行状部 3 1 をステ ン ト 1 6 の内壁に圧接したものである。 FIG. 8F shows a fifth modification of the indwelling tube guide device according to the sixth embodiment. In this modification, a meandering portion 31 is provided at the distal end of the flexible wire 19. This meandering part 31 is pressed against the inner wall of the state 16.
図 8 Gは、 第 6 の実施形態の留置チューブガイ ド装置の第 6 の変形例を示す。 本変形例は可撓性ワイ ヤ 1 9 の遠位端に 幅方向に波状に屈曲する波状屈曲部 3 2 を設けている。 この 波状屈曲部 3 2 をステン ト 1 6 の内壁に圧接したものである。
図 8 Hは、 第 6 の実施形態の留置チューブガイ ド装置の第 7 の変形例を示す。 本変形例は可撓性ワイ ヤ 1 9 の遠位端に 螺旋状部 3 3 を設けている。 この螺旋状部 3 3 をステン ト 1 6 の内壁に圧接したものである。 FIG. 8G shows a sixth modification of the indwelling tube guide device of the sixth embodiment. In this modified example, a wavy bent portion 32 that bends in the width direction in a wavy manner is provided at the distal end of the flexible wire 19. The wavy bent portion 32 is pressed against the inner wall of the stent 16. FIG. 8H shows a seventh modification of the indwelling tube guide device according to the sixth embodiment. In this modification, a spiral portion 33 is provided at the distal end of the flexible wire 19. The spiral portion 33 is pressed against the inner wall of the stent 16.
図 8 I は、 第 6 の実施形態の留置チューブガイ ド装置の第 1 の変形例を示す。 本変形例は 2本の可撓性ワイヤ 1 9 a , 1 9 b を平行状態に設けている。 そ して、 2本の可撓性ワイ ャ 1 9 a, 1 9 b の遠位端をステ ン ト 1 6 の内壁に圧接した ものである。 FIG. 8I shows a first modification of the indwelling tube guide device of the sixth embodiment. In this modification, two flexible wires 19a and 19b are provided in parallel. The distal ends of the two flexible wires 19a and 19b are pressed against the inner wall of the stem 16.
また、 図 9乃至図 1 2 は、 この発明の第 7の実施形態を示 す。 本実施の形態は第 2 の実施形態 (図 2 A〜図 2 D参照) の留置チューブガイ ド装置を次の通 り 変更 したものである。 なお、 本実施の形態の留置チューブガイ ド装置では第 2 の実 施形態と 同一部分は同一の符号を付して説明を省略する。 9 to 12 show a seventh embodiment of the present invention. This embodiment is a modification of the indwelling tube guide device of the second embodiment (see FIGS. 2A to 2D) as follows. Note that, in the indwelling tube guide device of the present embodiment, the same portions as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.
本実施の形態の留置チューブガイ ド装置のステン ト 1 6 に は図 9 に示すよ う に前端部側にフラ ップ 1 7 によ る開口部 1 7 a が形成されている。 The stent 16 of the indwelling tube guide device of the present embodiment has an opening 17a formed by a flap 17 on the front end side as shown in FIG.
さ らに、 牽引部材と しての可撓性ワイヤ 1 9 の先端部には 係止部材 4 2 が設け られている。 この係止部材 4 2 には、 板 ばね状の係止板 4 3 が設け られている。 こ の係止板 4 3 はバ ネ特性を有 してお り 、 例えばステンレス鋼のバネ材からなる 略板状の部材を用いている。 Further, a locking member 42 is provided at the tip of the flexible wire 19 as a pulling member. The locking member 42 is provided with a plate spring-shaped locking plate 43. The locking plate 43 has a spring characteristic, and for example, a substantially plate-shaped member made of stainless steel spring material is used.
この係止板 4 3 の前端部は可撓性ワイ ヤ 1 9 の先端部に口 一付けなどの手段で固定されている。 そ して、 図 9 、 図 1 0 に示すよ う にこの係止扳 4 3 の後端部がステン ト 1 6 のフ ラ
ップ 1 7 によ る側孔 1 7 a に挿入された状態で係脱可能に係 止されている。 The front end of the locking plate 43 is fixed to the front end of the flexible wire 19 by means such as a lip. Then, as shown in FIG. 9 and FIG. 10, the rear end of the lock ラ 43 It is detachably engaged while being inserted into the side hole 17 a formed by the tap 17.
そ して、 本実施の形態の留置チューブガイ ド装置では図 1 1 Aおよび図 1 2 に示すよ う に係止板 4 3 の後端部がステン ト 1 6 の側孔 1 7 a に挿入されて係止された状態にセッ ト さ れる。 こ の状態で、 第 1 の実施形態と 同様に内視鏡の鉗子チ ヤ ンネルにガイ ドワイヤ 1 8 を揷通したのち、 ガイ ドカテ一 テル 1 1 を介してステ ン ト 1 6 を胆管の狭窄部に導く 操作が 行なわれる。 この方法は第 1 の実施形態の同様である。 そ し て、 本実施形態ではプッシャチューブ 2 1 を前進させる こ と によ り 、 ステン ト 1 6 を狭窄部に揷通する。 Then, in the indwelling tube guide device of the present embodiment, the rear end of the locking plate 43 is inserted into the side hole 17 a of the stent 16 as shown in FIGS. 11A and 12. And set to the locked state. In this state, the guide wire 18 is passed through the forceps channel of the endoscope similarly to the first embodiment, and then the stent 16 is stenotically constricted through the guide catheter 11. An operation leading to the department is performed. This method is the same as in the first embodiment. In the present embodiment, the stent 16 passes through the stenosis by moving the pusher tube 21 forward.
また、 プ ッ シャチューブ 2 1 に よ ってステ ン ト 1 6 を狭窄 部に挿入したのち、 X線による観察が行なわれる。 この X線 観察によってステ ン ト 1 6 を深く 押 し込みすぎたこ と を確認 した場合には、 ステ ン ト 1 6 の位置を近位側に引き戻す作業 が行なわれる。— この作業時には、 操作リ ング 2 0 に手指'を掛 けて近位側に引張り 操作する。 これによ り 、 可撓性ワイヤ 1 9 を介 してステン ト 1 6 を引き戻すこ とができ、 ステン ト 1 6 を 目的部位に確実に位置決め留置する こ と ができ る。 After the stent 16 is inserted into the stenosis by the pusher tube 21, X-ray observation is performed. If it is confirmed by this X-ray observation that the state 16 has been pushed too deeply, the work of returning the state of the state 16 to the proximal side is performed. — During this operation, put your finger on the operation ring 20 and pull it proximally. As a result, the stent 16 can be pulled back via the flexible wire 19, and the stent 16 can be reliably positioned and retained at the target portion.
また、 可撓性ワイ ヤ 1 9 と ステ ン ト 1 6 と を分離させる場 合には、 操作リ ング 2 0 を一度押 し込む。 これによ り 、 可撓 性ワイヤ 1 9 を前方に押し出 し操作する。 このと き、 係止部 材 4 2 の弹性変形によ り係止板 4 3 がステ ン ト 1 6 の側孔 4 1 力 ら外れる。 そ して、 図 1 1 B に示すよ う に係止板 4 3 の 後端部がステン ト 1 6 の側孔 4 1 から引き抜かれる。 このと
き、 係止板 4 3 はまつすぐに伸びた元の形状に戻る。 そのた め、 この状態で、 可撓性ワイ ヤ 1 9 を後方に引っ張り 操作す る こ と によ り 、 図 1 1 Cに示すよ う に係止板 4 3 がステン ト 1 6 の側孔 4 1 を乗り 越えて後方に引き抜かれる。 これによ り 、 可撓性ワイ ヤ 1 9 と ステン ト 1 6 とが分離され、 ステン ト 1 6 は狭窄部に留置される。 Also, when separating the flexible wire 19 and the stud 16, the operating ring 20 is pushed in once. Thereby, the flexible wire 19 is pushed forward and operated. At this time, the locking plate 43 is detached from the side hole 41 of the state 16 due to the elastic deformation of the locking member 42. Then, as shown in FIG. 11B, the rear end of the locking plate 43 is pulled out from the side hole 41 of the stent 16. This and At this time, the locking plate 4 3 returns to its original shape that was immediately extended. Therefore, in this state, by pulling the flexible wire 19 backward, the locking plate 43 is moved to the side hole of the stent 16 as shown in FIG. 11C. It is pulled back over 4 1. As a result, the flexible wire 19 and the stent 16 are separated, and the stent 16 is placed in the stenosis.
そこで、 上記構成のものにあっては次の効果を奏する。 す なわち、 本実施の形態では係止部材 4 2 の係止板 4 3 の後端 部がステ ン ト 1 6 の側孔 1 7 a に揷入されて係止された状態 にセ ッ ト される。 そのため、 ステン ト 1 6 を胆管の狭窄部に 留置する作業時に、 ステン ト 1 6 を押 し込みすぎても可撓性 ワイヤ 1 9 を介してステン ト 1 6 を手元側に引き戻すこ と力 S でき る。 Therefore, the above configuration has the following effects. That is, in the present embodiment, the rear end of the locking plate 43 of the locking member 42 is inserted into the side hole 17a of the state 16 and is set to be locked. Is done. Therefore, when the stent 16 is indwelled in the constriction of the bile duct, even if the stent 16 is pushed too far, the stent 16 is pulled back through the flexible wire 19 to the hand side. it can.
また、 可撓性ワイヤ 1 9 と ステ ン ト 1 6 と を分離させる場 合には、 操作リ ング 2 0 を一度押 し込むこ と によ り 、 可撓性 ワイ ヤ 1 9 を前方-に押し出 し操作する。 これによ り 、 係'止部 材 4 2 の弾性変形によ り係止板 4 3 がステ ン ト 1 6 の側孔 4 1 から外れた状態で、 可撓性ワイヤ 1 9 を後方に引っ張 り 操 作する。 この状態で、 図 1 1 Cに示すよ う に係止板 4 3 がス テ ン ト 1 6 の側孔 4 1 を乗 り 越えて後方に引き抜く こ と によ り 、 可撓性ワイ ヤ 1 9 と ステン ト 1 6 とが分離され、 ステン ト 1 6 を狭窄部に留置させる こ と ができる。 When the flexible wire 19 and the stay 16 are separated from each other, the flexible wire 19 is pushed forward by pushing the operating ring 20 once. Extrude operation. As a result, the flexible wire 19 is pulled backward with the locking plate 43 detached from the side hole 41 of the state 16 due to the elastic deformation of the locking member 42. Operate. In this state, as shown in FIG. 11C, the locking plate 43 pulls over the side hole 41 of the stem 16 and is pulled out rearward, thereby forming the flexible wire 1. 9 and the stent 16 are separated, and the stent 16 can be left in the stenosis.
さ らに、 本実施の形態では可撓性ワイヤ 1 9がステ ン ト 1 6 と プッ シャチューブ 2 1 に跨って接続されている。 そのた め、 ステン ト 1 6 とプッシャチューブ 2 1 と の接続部におけ
る屈曲強度が高いので、 内視鏡の湾曲部の湾曲角度が大き く てもステ ン ト 1 6 と プッ シャチューブ 2 1 との接続部での座 屈が軽減される。 Further, in the present embodiment, the flexible wire 19 is connected across the state 16 and the pusher tube 21. Therefore, at the connection between the stent 16 and the pusher tube 21 Since the bending strength of the endoscope is high, buckling at the connection between the stem 16 and the pusher tube 21 is reduced even if the bending angle of the bending portion of the endoscope is large.
図 1 3 A乃至図 1 3 Cは本発明の第 8 の実施形態の留置チ ユ ープガイ ド装置を示す。 図 1 3 Aに示すよ う に本実施形態 の留置チューブガイ ド装置には、 図示しない内視鏡の鉗子チ ヤ ンネルに揷通可能な長尺のガイ ドカテーテル 1 1 1 が設け られている。 このガイ ドカテーテル 1 1 1 は、 可撓性を有す る合成樹脂材料、 例えばフ ッ素系の樹脂、 ナイ ロ ン系の樹脂 によって成形されている。 ガイ ドカテーテル 1 1 1 は全長に 亘つて内腔 1 1 2 が形成されている。 ガイ ドカテーテル 1 1 1 の近位端にはガイ ドカテーテルコ ッ ク 1 1 3 が設け られて いる。 FIGS. 13A to 13C show an indwelling chip guide device according to an eighth embodiment of the present invention. As shown in FIG. 13A, the indwelling tube guide device of the present embodiment is provided with a long guide catheter 111 that can pass through a forceps channel of an endoscope (not shown). . The guide catheter 111 is formed of a flexible synthetic resin material, for example, a fluorine-based resin or a nylon-based resin. The guide catheter 111 has a lumen 112 formed over the entire length. A guide catheter cock 113 is provided at the proximal end of the guide catheter 111.
ガイ ドカテーテル 1 1 1 の遠位部にはガィ ドカテーテル 1 1 1 に嵌合した状態で留置チューブと してのステン ト 1 1 4 が設け られている。 ガイ ドカテーテル 1 1 1 の外周面には、 ステン ト 1 1 4 よ り 近位側にプッシャチューブ 1 1 5 が設け られている。 プッシャチューブ 1 1 5 は、 ガイ ドカテーテル 1 1 1 に嵌合した状態で保持されている。 At the distal portion of the guide catheter 111, a stent 114 is provided as an indwelling tube while being fitted to the guide catheter 111. A pusher tube 1 15 is provided on the outer peripheral surface of the guide catheter 1 1 1 on the proximal side of the stent 1 1 4. The pusher tube 115 is held in a state fitted to the guide catheter 111.
ステン ト 1 1 4 は、 例えばポ リ エチレン、 シ リ コ ンゴム等 の生体適合性の高分子化合物を素材とする比較的柔軟な中空 パイ プである。 ステン ト 1 1 4 の外周面には、 親水性潤滑材 をコーティ ングしたものが望ま しい。 ステン ト 1 1 4 の両端 近傍の外周部には抜去防止のための互いに向き合 う フラ ップ 1 1 6 が設け られている。
前記プッシャチューブ 1 1 5 は、 可撓性を有する合成樹脂 材料、 例えばフ ッ素系の樹脂、 ナイ ロ ン系の樹脂によって成 形されている。 プッ シャチューブ 1 1 5 の近位端にはプッシ ャチューブコ ック 1 1 7 が設け られている。 The stent 114 is a relatively flexible hollow pipe made of a biocompatible polymer compound such as, for example, polyethylene or silicone rubber. It is desirable that the outer surface of the stent 114 be coated with a hydrophilic lubricant. Flaps 116 facing each other are provided on the outer peripheral portion near both ends of the stent 114 to prevent removal. The pusher tube 115 is formed of a flexible synthetic resin material, for example, a fluorine-based resin or a nylon-based resin. A pusher tube cock 117 is provided at the proximal end of the pusher tube 115.
ガイ ドカテーテル 1 1 1 の内腔にはガイ ドワイヤ 1 1 8 力 S 軸方向に揷通されている。 ガイ ドワイヤ 1 1 8 は長尺の金属 製撚り線からなる。 ガイ ドワイ ヤ 1 1 8 の遠位端は先細に形 成されてレヽる。 ガイ ドワイヤ 1 1 8 の近位端はガイ ドカテ一 テルコ ッ ク 1 1 3 力、ら外部に導出 されている。 The guide catheter 111 is guided through the lumen of the guide catheter 111 in the S-axis direction. Guide wires 1 18 are made of long metal strands. The distal end of the guidewire 1 18 is tapered and shaped. The proximal end of guidewire 118 is led out of guidewire 113.
また、 図 1 3 Cに示すよ う にステン ト 1 1 4 の近位部の内 腔と、 プッ シャチューブ 1 1 5 の遠位部の内腔と に跨って接 続機構と しての円筒部材 1 1 9 が圧入されている。 この円筒 部材 1 1 9 によってステン ト 1 1 4 と プッ シャチューブ 1 1 5 と が分離可能に接続されている。 この円筒部材 1 1 9 は合 成樹脂材料または金属材料によ っ て形成されている。 円筒部 材 1 1 9 の内腔にはガイ ドカテーテル 1 1 1 が揷通されてい る。 Further, as shown in FIG. 13C, a cylinder as a connection mechanism spans the lumen at the proximal portion of the stent 114 and the lumen at the distal portion of the pusher tube 115. Member 1 19 is press-fitted. The stem 114 and the pusher tube 115 are detachably connected by the cylindrical member 119. This cylindrical member 119 is formed of a synthetic resin material or a metal material. A guide catheter 111 is passed through the lumen of the cylindrical member 119.
円筒部材 1 1 9 の近位端部には解除手段と しての操作ワイ ャ 1 2 0 の一端部が接続されている。 この操作ワイヤ 1 2 0 の他端部はプッシャチューブ 1 1 5 の内腔を揷通 してプッシ ャチューブコ ック 1 1 7 の近傍まで延長されている。 プッシ ャチューブコ ック 1 1 7 の近傍のプッ シャチューブ 1 1 5 に は側孔 1 2 1 が設け られている。 操作ワイヤ 1 2 0 は側孔 1 2 1 から外部に導出されて操作リ ング 1 2 2 と接続されてい る。
そこで、 上記構成のものにあっては次の効果を奏する。 す なわち、 前述のよ う に構成された留置チューブガイ ド装置に よれば、 円筒部材 1 1 9 によってステン ト 1 1 4 とプッシャ チューブ 1 1 5 が接続されている。 そのため、 プッシャチュ ープ 1 1 5 の軸方向の進退によってステン ト 1 1 4がー体的 に軸方向に移動でき る。 しかも、 円筒部材 1 1 9 がステ ン ト 1 1 4及ぴプッシャチューブ 1 1 5 の内腔に圧入されている。 そのため、 ステン ト 1 1 4 とプッシャチューブ 1 1 5 と の接 続部における屈曲強度が高い。 これによ り 、 内視鏡の湾曲部 の湾曲角度が大き く ても接続部で座屈する こ とな く 、 ステン ト 1 1 4 を 目的部位に押し進める こ と ができ る。 One end of an operation wire 120 as a releasing means is connected to a proximal end of the cylindrical member 1 19. The other end of the operation wire 120 extends through the lumen of the pusher tube 115 to the vicinity of the pusher tube cock 117. The pusher tube 115 near the pusher tube cock 117 has a side hole 121. The operation wire 120 is led out of the side hole 122 and is connected to the operation ring 122. Therefore, the above configuration has the following effects. That is, according to the indwelling tube guide device configured as described above, the stent 114 and the pusher tube 115 are connected by the cylindrical member 119. Therefore, the stem 114 can move physically in the axial direction by the reciprocation of the pusher tuple 115 in the axial direction. Moreover, the cylindrical member 1 19 is press-fitted into the lumen of the stem 114 and the pusher tube 115. Therefore, the bending strength at the connection between the stent 114 and the pusher tube 115 is high. Thereby, even if the bending angle of the bending portion of the endoscope is large, the stent 114 can be pushed to the target portion without buckling at the connection portion.
さ らに、 プッ シャチューブ 1 1 5 を保持した状態で操作リ ング 1 2 2 によ って操作ワイヤ 1 2 0 を近位側に引き込むと、 円筒部材 1 1 9 の遠位部はステン ト 1 1 4 の内腔から脱出 し てプッシャチューブ 1 1 5 の内腔に引き込まれる。 そのため、 ステン ト 1 1 4-と プッ シャチューブ 1 1 5 と が分離される よ う になっている。 In addition, when the operation wire 122 is pulled in the proximal direction by the operation ring 122 while holding the pusher tube 115, the distal portion of the cylindrical member 119 becomes a stent. It escapes from the lumen of 114 and is pulled into the lumen of pusher tube 115. Therefore, the stent 114- and the pusher tube 115 are separated from each other.
次に、 第 8 の実施形態の作用について説明する。 本実施形 態の留置チューブガイ ド装置の使用時には留置チューブガイ ド装置は次の通 り セ ッ ト される。 Next, the operation of the eighth embodiment will be described. When the indwelling tube guide device of this embodiment is used, the indwelling tube guide device is set as follows.
まず、 図 1 3 Aに示すよ う に、 プッ シャチューブ 1 1 5 に 操作ワイヤ 1 2 0 を揷通する。 続いて、 プッ シャチューブ 1 1 5 の遠位部の内腔に円筒部材 1 1 9 の近位部を圧入する。 円筒部材 1 1 9 には操作ワイヤ 1 2 0 に接続されている。 First, as shown in FIG. 13A, the operation wire 120 is passed through the pusher tube 1 15. Subsequently, the proximal portion of the cylindrical member 119 is pressed into the lumen at the distal portion of the pusher tube 115. The operation wire 12 0 is connected to the cylindrical member 1 19.
さ らに、 プッ シャチューブ 1 1 5 にガイ ドカテーテル 1 1
1 を揷通 した後、 このガイ ドカテーテル 1 1 1 の遠位部にス テン ト 1 1 4 を揷通する。 この状態で、 ステン ト 1 1 4 の内 腔に円筒部材 1 1 9 の遠位部を圧入してステ ン ト 1 1 4 の近 位端とプッシャチューブ 1 1 5 の遠位端と を当接する。 これ によ り 、 図 1 3 Aに示すよ う にプッシャチューブ 1 1 5 と、 ステ ン ト 1 1 4 と、 円筒部材 1 1 9 とが組み付け られた状態 にセ ッ ト される。 In addition, guide catheter 1 1 5 in pusher tube 1 1 5 After passing through 1, a stent 114 is passed through the distal portion of the guide catheter 111. In this state, the distal end of the cylindrical member 1 19 is press-fitted into the lumen of the stent 1 14 to abut the proximal end of the stent 1 14 with the distal end of the pusher tube 1 15 . As a result, as shown in FIG. 13A, the pusher tube 115, the state 114, and the cylindrical member 119 are set in a state where they are assembled.
その後、 予め体腔内に内視鏡の揷入部を挿入し、 内視鏡の 揷入部の先端に配置された先端構成部を胆管の近傍まで導く 。 Thereafter, the insertion portion of the endoscope is inserted into the body cavity in advance, and the distal end component disposed at the distal end of the insertion portion of the endoscope is guided to the vicinity of the bile duct.
続いて、 体内に揷入された内視鏡の鉗子チャ ンネルにガイ ドワイヤ 1 1 8 を揷通する。 この と き、 内視鏡による観察、 および X線による観察のも とで、 ガイ ドワイヤ 1 1 8 を前進 させてガイ ドワイヤ 1 1 8 の遠位端を胆管の狭窄部に導く 。 Subsequently, the guide wire 118 is passed through the forceps channel of the endoscope inserted into the body. At this time, based on the observation by the endoscope and the observation by X-ray, the guide wire 118 is advanced to guide the distal end of the guide wire 118 to the stenosis of the bile duct.
また、 内視鏡の鉗子チャ ンネルにガイ ドワイヤ 1 1 8 を揷 通 したのち、 ステン ト 1 1 4及びプッシャチューブ 1 1 5 を セ ッ ト したガイ ドカテ テル 1 1 1 をガイ ドワイヤ 1 1 8 に 揷通する。 この と き、 ガイ ドワイヤ 1 1 8 の近位端からガイ ドカテーテル 1 1 1 を揷通 し、 ガイ ドワイヤ 1 1 8 をガイ ド と してガイ ドカテーテル 1 1 1 を鉗子チャ ンネルに揷通する。 続いて、 ガイ ドカテーテル 1 1 1 の近位端側の手元操作に よってガイ ドカテーテル 1 1 1 及びプッシャチューブ 1 1 5 を前進させ、 内視鏡の先端構成部から導出する。 この状態で、 ガイ ドカテーテル 1 1 1 及ぴステン ト 1 1 4 を狭窄部に揷通 する。 この と き、 ステン ト 1 1 4 はガイ ドカテーテル 1 1 1 に嵌合され、 しかもステン ト 1 1 4及びプッシャチュ プ 1
1 5 の内腔に円筒部材 1 1 9 が圧入された状態である。 その ため、 ガイ ドワイヤ 1 1 8 が大きな湾曲角で湾曲 していても 座屈する こ と な く 、 ステン ト 1 1 4 はガイ ドカテーテル 1 1 1及びプッシャチューブ 1 1 5 と一体的に前進し、 目的部位 に導く こ と ができ る。 After passing the guide wire 118 through the forceps channel of the endoscope, the guide catheter 111 in which the stent 114 and the pusher tube 115 are set is connected to the guide wire 118. Communicate. At this time, the guide catheter 111 is passed through the guide wire 111 from the proximal end of the guide wire 111, and the guide catheter 111 is passed through the forceps channel using the guide wire 118 as a guide. . Subsequently, the guide catheter 1 11 and the pusher tube 1 15 are advanced by a manual operation on the proximal end side of the guide catheter 1 1 1, and are drawn out from the distal end component of the endoscope. In this state, the guide catheter 111 and the stent 114 are passed through the stenosis. At this time, the stent 114 is fitted to the guide catheter 111, and the stent 114 and the pusher tube 114 are also fitted. The cylindrical member 1 19 is press-fitted into the bore 15. Therefore, even if the guide wire 118 is bent at a large bending angle, it does not buckle, and the stent 114 moves forward integrally with the guide catheter 111 and the pusher tube 115. It can lead to the target site.
そ して、 ガイ ドカテーテル 1 1 1 によ ってステン ト 1 1 4 を狭窄部に挿入したのち、 X線によ る観察が行なわれる。 こ の X線観察によってステン ト 1 1 4 を深く 押 し込みすぎたこ と を確認した場合には、 プッシャチューブ 1 1 5 を近位側に 引き戻す。 これによ り 、 円筒部材 1 1 9 を介 してステン ト 1 1 4 を引 き戻すこ と ができ、 ステン ト 1 1 4 を 目的部位に確 実に位置決め留置する こ とができ る。 After the stent 114 is inserted into the stenosis by the guide catheter 111, observation by X-ray is performed. If the X-ray observation confirms that the stent 114 has been pushed too deep, pull the pusher tube 115 back proximally. As a result, the stent 114 can be pulled back through the cylindrical member 119, and the stent 114 can be reliably positioned and retained at the target portion.
その後、 ガイ ドカテーテル 1 1 1 及びガイ ドワイヤ 1 1 8 をそのままの状態で、 プッシャチューブ 1 1 5 の近位部を把 持して保持し、 操作リ ング 1 2 2 に手指を掛けて近位側に引 き込む。 これによ り 、 円筒部材 1 1 9 が操作ワイヤ 1 2 0 を 介してプッ シャチューブ 1 1 5 の内腔に引き込まれる。 従つ て、 図 1 3 B に示すよ う に、 円筒部材 1 1 9 の遠位部がステ ン ト 1 1 4 の内腔から抜け、 ステン ト 1 1 4 と プッシャチュ ーブ 1 1 5 とが分離される。 これによ り 、 ステン ト 1 1 4 は 狭窄部に留置される。 Then, with the guide catheter 1 1 1 and the guide wire 1 1 8 as it is, grasp and hold the proximal portion of the pusher tube 1 1 5 and put fingers on the operation ring 1 2 To the side. As a result, the cylindrical member 1 19 is drawn into the lumen of the pusher tube 115 via the operation wire 120. Therefore, as shown in FIG. 13B, the distal portion of the cylindrical member 119 is removed from the lumen of the stent 114, and the stent 114 and the pusher tube 115 are separated. Separated. As a result, the stent 114 is left in the stenosis.
このと き、 ガイ ドカテーテル 1 1 1 及びガイ ドワイヤ 1 1 8 の遠位端は狭窄部に挿通された状態であるため、 ガイ ドカ テーテル 1 1 1 をガイ ドと して造影剤等を送液する こ と もで き、 またガイ ドワイヤ 1 1 8 をガイ ドと して次の処置を行う
こ と も可能である。 At this time, the distal ends of the guide catheter 111 and the guide wire 118 are in a state of being inserted into the stenosis, so that the guide catheter 111 is used as a guide to send a contrast medium or the like. And use the guidewire 1 18 as a guide to perform the following steps: This is also possible.
図 1 4 は第 9 の実施形態を示す。 本実施の形態は第 8 の実 施形態 (図 1 3 A乃至図 1 3 C参照) の留置チューブガイ ド 装置の一部を次の通 り 変更 したものである。 なお、 第 8 の実 施形態と 同一部分は同一の符号を付して説明を省略する。 FIG. 14 shows a ninth embodiment. In this embodiment, a part of the indwelling tube guide device of the eighth embodiment (see FIGS. 13A to 13C) is modified as follows. Note that the same parts as those in the eighth embodiment are denoted by the same reference numerals, and description thereof will be omitted.
本実施形態は、 第 8 の実施形態のガイ ドカテーテル 1 1 1 を使用 しない実施形態である。 そのため、 本実施の形態では、 構成を簡単にする こ と によ り 、 コ ス ト削減が図れる。 さ らに、 ステ ン ト 1 1 4及びプッシャチューブ 1 1 5 を細く する こ と が可能であ り 、 狭窄部が狭い場合等にステン ト 1 1 4 の揷入 を容易にする こ とが可能である。 This embodiment is an embodiment that does not use the guide catheter 111 of the eighth embodiment. Therefore, in the present embodiment, the cost can be reduced by simplifying the configuration. Furthermore, the stent 114 and the pusher tube 115 can be made thinner, so that the stent 114 can be easily inserted when the stenosis is narrow. It is.
本実施形態の作用 · 効果は第 8 の実施形態と同一である。 図 1 5 は本発明の第 1 0 の実施形態を示す。 本実施の形態 は、 ガイ ドカテーテル 1 1 1 を使用 しない実施形態である。 そ して、 接続部材と しての略円筒部材が螺旋体 1 2 3 によつ て形成されている-。 この螺旋体 1 2 3 の遠位部はステン ト 1 1 4 の内腔に圧入され、 近位部はプッシャチューブ 1 1 5 の 内腔に圧入されている。 螺旋体 1 2 3 と してばね材を使用す る こ と によ り 、 接続部における弾性変形の復元力が優れ、 よ り 接続部の耐座屈性を向上させる こ と ができ る。 The operation and effect of this embodiment are the same as those of the eighth embodiment. FIG. 15 shows a tenth embodiment of the present invention. This embodiment is an embodiment in which the guide catheter 111 is not used. Further, a substantially cylindrical member as a connecting member is formed by the spiral body 123. The distal part of the spiral body 123 is press-fitted into the lumen of the stent 114, and the proximal part is press-fitted into the lumen of the pusher tube 115. By using a spring material as the spiral body 123, the restoring force of the elastic deformation at the connection portion is excellent, and the buckling resistance of the connection portion can be further improved.
本実施形態の作用 ' 効果は第 8 の実施形態と同一である。 図 1 6 A〜 1 6 Cは本発明の第 1 1 の実施形態を示す。 本 実施の形態は、 ガイ ドカテーテル 1 1 1 を使用 しない実施形 態である。 円筒部材 1 2 4 がステン ト 1 1 4及ぴプッシャチ ユープ 1 1 5 の外周面に密に嵌合されてレヽる。
プッ シャチューブ 1 1 5 の遠位部の側壁には側孔 1 2 5 が 設け られている。 円筒部材 1 2 4 に接続された操作ワイ ヤ 1 2 0 は側孔 1 2 5 からプッシャチューブ 1 1 5 の内腔に導入 されている。 The operation and effect of this embodiment are the same as those of the eighth embodiment. FIGS. 16A to 16C show a eleventh embodiment of the present invention. The present embodiment is an embodiment in which the guide catheter 111 is not used. The cylindrical member 124 is tightly fitted to the outer peripheral surface of the stent 114 and pusher tube 115, and is laid. A side hole 125 is provided on the side wall of the distal portion of the pusher tube 115. The operation wire 120 connected to the cylindrical member 124 is introduced into the lumen of the pusher tube 115 through the side hole 125.
第 8 の実施形態と 同様に、 ステン ト 1 1 4 を狭窄部に揷入 したのち、 X線によ る観察が行なわれる。 この X線観察によ つてステ ト 1 1 4 を深く 押し込みすぎたこ と を確認した場 合には、 プッシャチューブ 1 1 5 を近位側に引き戻す。 これ によ り 、 円筒部材 1 2 4 を介してステン ト 1 1 4 を引き戻す こ とができ、 ステン ト 1 1 4 を 目的部位に確実に位置決め留 置する こ と ができ る。 Similar to the eighth embodiment, after the stent 114 is inserted into the stenosis, observation using X-rays is performed. If it is confirmed by this X-ray observation that the stage 114 has been pushed too deeply, the pusher tube 115 is pulled back to the proximal side. Thus, the stent 114 can be pulled back through the cylindrical member 124, and the stent 114 can be reliably positioned and retained at the target portion.
また、 プッ シャチューブ 1 1 5 の近位部を把持して保持し、 操作リ ング 1 2 2 に手指を掛けて近位側に引き込むと、 操作 ワイ ヤ 1 2 0 を介して円筒部材 1 2 4 がプッシャチューブ 1 1 5 の外周面に引き込まれる。 従って、 図 1 6 B に示すよ う に、 円筒部材 1 2 4 の遠位部がステン ト 1 1 4 の外周面から 抜け、 ステ ン ト 1 1 4 とプッ シャチューブ 1 1 5 とが分離さ れ、 ステン ト 1 1 4 は狭窄部に留置される。 When the proximal portion of the pusher tube 1 15 is gripped and held, and the fingers are put on the operation ring 122 and pulled toward the proximal side, the cylindrical member 122 is moved through the operation wire 120. 4 is drawn into the outer peripheral surface of the pusher tube 1 15. Therefore, as shown in FIG. 16B, the distal portion of the cylindrical member 124 comes off the outer peripheral surface of the stent 114, and the stent 114 and the pusher tube 115 are separated. The stent 114 is left in the stenosis.
本実施形態によれば、 ステン ト 1 1 4及ぴプッ シャチュー ブ 1 1 5 の内腔に内蔵物がないため、 よ り 細径化を図る こ と が可能である。 According to the present embodiment, the inner diameter of the stent 114 and the pusher tube 115 has no built-in material, so that the diameter can be further reduced.
図 1 7 Aは本発明の第 1 2 の実施形態を示す。 本実施の形 態は第 8 の実施形態の留置チューブガイ ド装置の接続機構と しての円筒部材 1 1 9 を次の通 り 変更 したものである。 FIG. 17A shows a twelfth embodiment of the present invention. In the present embodiment, the cylindrical member 1 19 as a connection mechanism of the indwelling tube guide device of the eighth embodiment is modified as follows.
本実施の形態の円筒部材 1 2 6 には外周面に周方向に複数
の凹凸部 1 2 7が設け られている。 各凹凸部 1 2 7 は円筒部 材 1 2 6 の軸方向に延設されている。 そして、 本実施の形態 の円筒部材 1 2 6 はステン ト 1 1 4及びプッシャチューブ 1 1 5 の内腔に圧入されている。 この場合、 円筒部材 1 2 6 力 S ステ ン ト 1 1 4及びプッシャチューブ 1 1 5 の内腔にそれぞ れ強固に圧入されて固定される。 The cylindrical member 1 2 6 of the present embodiment has a plurality of Uneven portions 127 are provided. Each concavo-convex portion 127 extends in the axial direction of the cylindrical member 126. Then, the cylindrical member 126 of the present embodiment is press-fitted into the lumen of the stent 114 and the pusher tube 115. In this case, the cylindrical member 1 26 and the pusher tube 1 15 are firmly pressed into the lumens of the S-state S 114 and the pusher tube 115 to be fixed.
図 1 7 B は第 1 2 の実施形態の円筒部材 1 2 6 の変形例を 示す。 本変形例では図 1 7 B に示すよ う に円筒部材 1 2 8 の 外周面の一部にその軸方向に亘つて凸条部 1 2 9 が設け られ ている。 そ して、 本実施の形態の円筒部材 1 2 8 はステン ト 1 1 4及びプッシャチューブ 1 1 5 の内腔に圧入されている。 この場合、 円筒部材 1 2 8 はステ ン ト 1 1 4及びプッシャチ ユ ープ 1 1 5 の内腔に強固に圧入される。 FIG. 17B shows a modification of the cylindrical member 126 of the first embodiment. In this modified example, as shown in FIG. 17B, a convex ridge portion 1229 is provided on a part of the outer peripheral surface of the cylindrical member 128 along the axial direction thereof. Then, the cylindrical member 128 of the present embodiment is press-fitted into the lumen of the stent 114 and the pusher tube 115. In this case, the cylindrical member 128 is firmly pressed into the lumen of the stem 114 and the pusher tube 115.
図 1 8 乃至図 2 0 は、 この発明の第 1 3 の実施形態を示す。 本実施の形態では第 1 1 の実施形態 (図 1 6 A 〜 1 6 C参 照) の円筒部材 1 2 4 が熱収縮チューブによって形成されて - いる。 さ らに、 図 1 9 に示すよ う にステン ト 1 1 4 の外周面 には円筒部材 1 2 4 の被覆部位の一部に凹陥部 1 3 1 が設け られている。 この凹陥部 1 3 1 にはボールチップ 1 3 2 が埋 設されている。 このポールチップ 1 3 2 は操作ワイヤ 1 2 0 の先端部に連結されている。 FIGS. 18 to 20 show a thirteenth embodiment of the present invention. In the present embodiment, the cylindrical member 124 of the first embodiment (see FIGS. 16A to 16C) is formed by a heat-shrinkable tube. Further, as shown in FIG. 19, a recess 131 is provided on the outer peripheral surface of the stent 114 at a part of the covering portion of the cylindrical member 124. A ball chip 13 2 is buried in the recess 13 1. The pole tip 132 is connected to the tip of the operation wire 120.
そ して、 ステン ト 1 1 4 の凹陥部 1 3 1 にポールチップ 1 3 2 が装着された状態で円筒部材 1 2 4 の熱収縮チューブが 被せられて、 円筒部材 1 2 4 とステン ト 1 1 4 の凹陥部 1 3 1 と の間にポ ルチップ 1 3 2 が埋設される よ う になってい
る。 Then, the heat shrink tube of the cylindrical member 124 is covered with the pole tip 132 attached to the concave portion 131 of the stent 114, and the cylindrical member 124 and the stent 134 are covered. The pole tip 13 2 is to be buried between the recess 14 and the recess 14 You.
次に、 第 1 3 の実施形態の作用について説明する。 本実施 形態の留置チューブガイ ド装置の使用時には円筒部材 1 2 4 によってステン ト 1 1 4 と プッシャチューブ 1 1 5 が接続さ れている。 そのため、 プッ シャチューブ 1 1 5 の軸方向の進 退によってステ ン ト 1 1 4がー体的に軸方向に移動でき る。 しかも、 円筒部材 1 1 9 がステン ト 1 1 4及びプッシャチュ ープ 1 1 5 の外周面に跨った状態で被覆されている。 そのた め、 ステ ン ト 1 1 4 と プッシャチューブ 1 1 5 と の接続部に おける屈曲強度が高い。 これによ り 、 内視鏡の湾曲部の湾曲 角度が大き く ても接続部で座屈する こ と な く 、 ステン ト 1 1 4 を 目的部位に押し進める こ とができ る。 Next, the operation of the thirteenth embodiment will be described. When using the indwelling tube guide device of the present embodiment, the stent 114 and the pusher tube 115 are connected by the cylindrical member 124. Therefore, the state of the pusher tube 114 can be moved in the axial direction by moving the pusher tube 115 in the axial direction. Moreover, the cylindrical member 1 19 is covered so as to straddle the outer peripheral surfaces of the stent 114 and the pusher tube 1 15. Therefore, the bending strength at the connection between the stem 114 and the pusher tube 115 is high. Thus, even when the bending angle of the bending portion of the endoscope is large, the stent 114 can be pushed to the target portion without buckling at the connection portion.
さ らに、 プッ シャチューブ 1 1 5 を保持した状態で操作リ ング 1 2 2 によって操作ワイヤ 1 2 0 を近位側に引き込むと ポールチップ 1 3 2 が円筒部材 1 2 4 と ステ ン ト 1 1 4 の凹 陥部 1 3 1 との間カ ら引き抜かれる。 この と き、 ポ^"ルチッ プ 1 3 2 の引き抜によって図 2 0 に示すよ う に 円筒部材 1 2 4 の内腔からプッ シャチューブ 1 1 5 が抜け ステ ン ト 1 1 4 と プッシャチューブ 1 1 5 と が分離される これによ り ステン ト 1 1 4 は狭窄部に留置される。 In addition, when the operation wire 1 22 is pulled into the proximal side by the operation ring 1 2 2 while holding the pusher tube 1 1 5, the pole tip 13 2 becomes the cylindrical member 1 2 4 and the stain 1. It is pulled out from between the recessed portion 1 3 and the recessed portion 1 3. At this time, as shown in FIG. 20, the pusher tube 1 15 is pulled out of the bore of the cylindrical member 124 by pulling out the port 13 2 and the state 1 14 and the pusher tube are removed. Thus, the stent 114 is left in the stenosis.
そこで、 本実施の形態でも第 1 1 の実施形態と 同様の効果 が得られる。 さ らに、 本実施の形態では特に、 ステン ト 1 1 4 と プッ シャチューブ 1 1 5 と が分離された際に、 ステ ン ト 1 1 4 に円筒部材 1 2 4が接続された状態で分離される。 そ のため、 ステン ト 1 1 4 の交換時にステン ト 1 1 4 の円筒部
材 1 2 4 の部分を掴むこ とができ、 ステン ト 1 1 4 を取外す 作業を行ないやすく する こ とができ る。 Therefore, in the present embodiment, the same effects as in the eleventh embodiment can be obtained. Furthermore, in the present embodiment, in particular, when the stent 114 and the pusher tube 115 are separated, the separation is performed in a state where the cylindrical member 124 is connected to the stem 114. Is done. Therefore, when replacing the stem 114, the cylindrical part of the stem 114 is replaced. The part of the material 124 can be grasped, and the work of removing the stent 114 can be facilitated.
図 2 1 Aおよぴ図 2 1 B は、 この発明の第 1 4 の実施形態 を示す。 本実施の形態は第 8 の実施形態 (図 1 3 A乃至図 1 3 C参照) の円筒部材 1 1 9 を形状記憶合金パイ プによって 形成 したものである。 FIGS. 21A and 21B show a fifteenth embodiment of the present invention. In this embodiment, the cylindrical member 119 of the eighth embodiment (see FIGS. 13A to 13C) is formed by a shape memory alloy pipe.
こ の円筒部材 1 1 9 の形状記憶合金パイ プは例えば常温 (基準温度) では図 2 1 Aに示すよ う に外径寸法がステ ン ト 1 1 4 よ り も大径な形状に拡開されている。 この と き、 円筒 部材 1 1 9 によってステン ト 1 1 4 と プッ シャチューブ 1 1 5 と が分離可能に接続されている。 For example, at room temperature (reference temperature), the shape memory alloy pipe of this cylindrical member 119 expands to an outer diameter larger than that of the stent 114 as shown in Fig. 21A. Have been. At this time, the stent 114 and the pusher tube 115 are detachably connected by the cylindrical member 119.
また、 円筒部材 1 1 9 の形状記憶合金パイ プは例えば基準 温度よ り も高温に加熱される、 或いは基準温度よ り も低温に 冷却される こ と によ り 、 図 2 1 B に示すよ う に外径寸法がス テン ト 1 1 4 よ り も小径な形状に変形する よ う に設定されて いる。 In addition, the shape memory alloy pipe of the cylindrical member 1 19 is heated to a temperature higher than the reference temperature or cooled to a temperature lower than the reference temperature, for example, as shown in FIG. 21B. As described above, the outer diameter is set so as to be deformed into a smaller diameter than the stent 1 14.
そのため、 本実施の形態では円筒部材 1 1 9 の形状記憶合 金パイプを縮小形状に変形させる こ と によ り 、 ステン ト 1 1 4 と ブッ シャチューブ 1 1 5 と を分離させる こ と ができ る。 Therefore, in the present embodiment, the stent 114 and the busher tube 115 can be separated by deforming the shape memory alloy pipe of the cylindrical member 119 into a reduced shape. You.
なお、 円筒部材 1 1 9 の形状記憶合金パイ ブは、 通電加熱 によって加熱する構成に しても よい。 The shape memory alloy pipe of the cylindrical member 1 19 may be heated by electric heating.
図 2 2 Aおよび図 2 2 B は、 第 1 4 の実施形態の変形例を 示す。 本変形例では、 第 1 4 の実施形態 (図 2 1 Aおよぴ図 2 1 B参照) の円筒部材 1 1 9 の形状記憶合金パイプに代え てコイル状の係止部材 1 4 1 が設け られている。 この係止部
材 1 4 1 は形状記憶合金の螺旋体によって形成されている。 この係止部材 1 4 1 の形状記憶合金は例えば常温 (基準温 度) では図 2 2 Aに示すよ う に外径寸法がステン ト 1 1 4 よ り も大径な形状に拡開 されている。 この と き、 係止部材 1 4 1 によってステ ン ト 1 1 4 とプッ シャチューブ 1 1 5 と が分 離可能に接続されている。 FIGS. 22A and 22B show a modification of the fourteenth embodiment. In this modification, a coil-shaped locking member 141 is provided in place of the shape memory alloy pipe of the cylindrical member 119 of the fourteenth embodiment (see FIGS. 21A and 21B). Have been. This locking part The material 14 1 is formed by a spiral body of a shape memory alloy. The shape memory alloy of the locking member 141 is expanded, for example, at room temperature (reference temperature) into a shape having an outer diameter larger than that of the stent 114 as shown in FIG. 22A. I have. At this time, the stage 114 and the pusher tube 115 are separably connected by the locking member 141.
また、 係止部材 1 4 1 の形状記憶合金は例えば基準温度よ り も高温に加熱される、 或いは基準温度よ り も低温に冷却さ れる こ と によ り 、 図 2 2 B に示すよ う に外径寸法がステ ン ト 1 1 4 よ り も小径な形状に変形する よ う に設定されている。 そのため、 本実施の形態では係止部材 1 4 1 の形状記憶合 金を縮小形状に変形させる こ と によ り 、 ステン ト 1 1 4 とプ ッシャチューブ 1 1 5 と を分離させる こ と ができ る。 Further, the shape memory alloy of the locking member 141 is heated to a temperature higher than the reference temperature or cooled to a temperature lower than the reference temperature, for example, as shown in FIG. 22B. The outer diameter is set so that it can be deformed into a shape smaller than the diameter of the stains. Therefore, in the present embodiment, the stent 114 and the pusher tube 115 can be separated by deforming the shape memory alloy of the locking member 141 into a reduced shape. .
産業上の利用可能性 Industrial applicability
以上説明 したよ う にこの発明は、 内視鏡を用いて留置チュ ーブを患者の体腔内に挿入して留置する操作を行な う際に使 用 される留置チューブガイ ド装置の分野、 この留置チューブ ガイ ド装置を製造、 使用する技術分野に有効である。
As described above, the present invention relates to the field of an indwelling tube guide device used for performing an operation of inserting an indwelling tube into a body cavity of a patient and performing indwelling using an endoscope. It is effective in the technical field of manufacturing and using this indwelling tube guide device.
Claims
1 . 留置チューブガイ ド装置において、 1. In the indwelling tube guide device,
留置チューブと、 An indwelling tube,
少なく と も遠位部が前記留置チューブ内に揷通可能で、 か つ内腔を有したガイ ド部材と、 A guide member having at least a distal portion penetrating into the indwelling tube and having a lumen;
前記留置チューブの内腔と前記ガイ ド部材と の隙間に揷入 されて前記留置チューブを係脱可能に係止する係止部と 、 前 記ガイ ド部材の内腔の少な く と も一部を揷通 している揷通部 と を備え、 前記係止部と前記留置チューブと の係合時に前記 留置チューブを牽引操作する牽引部材と、 A locking portion that is inserted into a gap between the lumen of the indwelling tube and the guide member and locks the indwelling tube in a detachable manner; and at least a part of the lumen of the guide member A pulling member that pulls through the indwelling tube when the locking portion and the indwelling tube are engaged with each other;
前記牽引部材を前記ガイ ド部材の軸方向に移動させる こ と によ り 前記係止部と前記留置チューブと の係合状態を解除す る係合解除部と An engagement release portion for releasing the engagement between the locking portion and the indwelling tube by moving the traction member in the axial direction of the guide member;
を具備する こ と を特徴とする留置チューブガイ ド装置。 An indwelling tube guide device, comprising:
2 . 前記ガイ ド部材は、 前記留置チューブの内径よ り も外径 が大きいプッシヤチューブを有する こ と を特徴とする請求項 1 に記載の留置チューブガイ ド装置。 2. The indwelling tube guide device according to claim 1, wherein the guide member has a pusher tube having an outer diameter larger than an inner diameter of the indwelling tube.
3 . 前記留置チューブは、 近位側に前記留置チューブの内径 よ り も大きい外径を有する拡大部を設けたこ と を特徴とする 請求項 2 に記載の留置チューブ。 3. The indwelling tube according to claim 2, wherein the indwelling tube is provided with an enlarged portion having an outer diameter larger than an inner diameter of the indwelling tube on a proximal side.
4 . 前記牽引部材は、 近位側の少な く と も一部が前記プッシ ャチューブの内腔に位置する こ と を特徴とする請求項 2 に記 載の留置チューブガイ ド装置。 4. The indwelling tube guide device according to claim 2, wherein at least a part of the traction member on the proximal side is located in a lumen of the pusher tube.
5 . 前記牽引部材は、 近位操作部が前記プッシャチューブの 近位部に位置し、 前記プッシャチューブの軸方向に対して進
退可能である こ と を特徴とする請求項 2 に記載の留置チュー プガイ ド装置。 5. The traction member has a proximal operating portion located at a proximal portion of the pusher tube, and is advanced in an axial direction of the pusher tube. 3. The indwelling tube guide device according to claim 2, wherein the device is retractable.
6 . 前記留置チューブは、 内部に複数の前記牽引部材が配置 されている こ と を特徴とする請求項 1 に記載の留置チューブ ガイ ド装置。 6. The indwelling tube guide device according to claim 1, wherein the indwelling tube has a plurality of the traction members disposed therein.
7 . 前記係止部は、 前記留置チューブ内に少なく と も湾曲部、 螺旋状部も しく は屈曲部のいずれか 1 つを有している こ と を 特徴とする請求項 1 に記載の留置チューブガイ ド装置。 7. The indwelling device according to claim 1, wherein the locking portion has at least one of a curved portion, a spiral portion, and a bent portion in the indwelling tube. Tube guide device.
8 . 前記留置チューブは、 少な く と も 1 つ以上の側孔を有し、 前記係止部材は、 パネ弾性を有し、 かつ前記留置チューブ の側孔と前記留置チューブの内腔と前記ガイ ド部材と の隙間 に跨って配置されている こ と を特徴とする請求項 1 に記載の 留置チューブガイ ド装置。 8. The indwelling tube has at least one or more side holes, the locking member has panel elasticity, and the side holes of the indwelling tube, the lumen of the indwelling tube, and the guides. The indwelling tube guide device according to claim 1, wherein the device is arranged so as to extend over a gap between the indwelling tube guide and the member.
9 . 留置チューブガイ ド装置において、 9. In the indwelling tube guide device,
留置チューブと、 An indwelling tube,
内腔を有 じ前記留置チューブの内径よ り 大きい外径を有す るプッシャチューブと、 A pusher tube having an inner cavity and an outer diameter larger than the inner diameter of the indwelling tube;
遠位部が前記留置チューブの近位部に位置し、 近位部が前 記プッシャチューブの遠位部に位置し、 前記留置チューブと 前記プッシャチューブと を分離可能に接続する略円筒形の接 続部材と、 A distal portion is located at a proximal portion of the indwelling tube, a proximal portion is located at a distal portion of the pusher tube, and a substantially cylindrical contact for detachably connecting the indwelling tube and the pusher tube. A continuation member,
遠位端が前記接続部材の近位端に接合し、 かつ少なく と も 一部が前記プッシャチューブの内腔を揷通 している牽引部材 と、 A traction member having a distal end joined to the proximal end of the connecting member, and at least a portion of which extends through the lumen of the pusher tube;
前記牽引部材を軸方向に移動させる操作によって前記留置
チューブの係合状態を解除する係合解除部と The detention is performed by an operation of moving the traction member in the axial direction. An engagement release section for releasing the engagement state of the tube;
を具備する こ と を特徴とする留置チューブガイ ド装置。 An indwelling tube guide device, comprising:
1 0 . 少な く と も遠位部が前記留置チューブの内腔に揷通可 能な外径を有し、 かつ内腔を有したガイ ド部材を設けたこ と を特徴とする請求項 9 に記載の留置チューブガイ ド装置。 10. The guide member according to claim 9, wherein at least a distal portion has an outer diameter capable of penetrating the lumen of the indwelling tube, and a guide member having a lumen is provided. An indwelling tube guide device as described.
1 1 . 前記接続部材は、 遠位部において前記留置チューブと 内周若しく は外周において圧入状態で嵌合し、 近位部におい て前記プッシャチューブと 内周若しく は外周において揷通自 在である こ と を特徴とする請求項 9 に記載の留置チューブガ ィ ド装置。 1 1. The connection member is press-fitted at the inner or outer periphery of the indwelling tube at the distal portion, and is self-contained at the inner or outer periphery of the pusher tube at the proximal portion. 10. The indwelling tube guide device according to claim 9, wherein:
1 2 . 前記接続部材は、 前記留置チューブ及び前記プッシャ チューブの内腔に圧入される外周面に少な く と も 1 つ以上の 凸部を有しているこ と を特徴とする請求項 9 に記載の留置チ ユ ーブガィ ド装置。 12. The connection member according to claim 9, wherein the connection member has at least one or more projections on an outer peripheral surface of the indwelling tube and the pusher tube that are press-fitted into the lumen. An indwelling tube guide device as described.
1 3 . 前記接続部材は、 バネ特性を有している螺旋体である こ と を特徴'とする請求項 9 に記載の留置チューブガイ ド装置。 13. The indwelling tube guide device according to claim 9, wherein the connecting member is a spiral having a spring characteristic.
1 4 . 前記接続部材は、 前記留置チューブに接合されてお り 、 前記係合解除部は、 前記接続部材を前記プッシャチューブ から取り 外すこ と を特徴とする請求項 9 に記載の留置チュー ブガイ ド装置。 14. The indwelling tube guide according to claim 9, wherein the connecting member is joined to the indwelling tube, and the disengagement portion removes the connecting member from the pusher tube. Device.
1 5 . 前記接続部材は、 前記留置チューブ及び前記プッシャ チューブの内腔に圧入される圧入部を有し、 15. The connection member has a press-fit portion that is press-fitted into the lumen of the indwelling tube and the pusher tube,
前記圧入部は、 第 1 の形状、 この第 1 の形状は前記留置チ ユ ーブ及ぴ前記プッシャチューブと係合可能な第 1 の外径を 有する, と、
第 2 の形状、 この第 2 の形状は前記留置チューブの係合状 態を解除したと き に前記第 1 の外径と は異なる第 2 の外径を 有する, と、 に変形する こ と を特徴とする請求項 9 に記載の 留置チューブガイ ド装置。
The press-fitting portion has a first shape, and the first shape has a first outer diameter engageable with the indwelling tube and the pusher tube; A second shape, wherein the second shape has a second outer diameter different from the first outer diameter when the indwelling tube is released from the engaged state; The indwelling tube guide device according to claim 9, characterized in that:
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE10392575T DE10392575T5 (en) | 2002-05-01 | 2003-05-01 | Stent delivery device |
JP2004500964A JPWO2003092783A1 (en) | 2002-05-01 | 2003-05-01 | Indwelling tube guide device |
US10/977,650 US20050085892A1 (en) | 2002-05-01 | 2004-10-29 | Stent delivery device |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2002-129961 | 2002-05-01 | ||
JP2002129961 | 2002-05-01 | ||
JP2002133127 | 2002-05-08 | ||
JP2002-133127 | 2002-05-08 |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/977,650 Continuation US20050085892A1 (en) | 2002-05-01 | 2004-10-29 | Stent delivery device |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2003092783A1 true WO2003092783A1 (en) | 2003-11-13 |
Family
ID=29405308
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2003/005581 WO2003092783A1 (en) | 2002-05-01 | 2003-05-01 | Indwelling tube guide device |
Country Status (3)
Country | Link |
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JP (1) | JPWO2003092783A1 (en) |
DE (1) | DE10392575T5 (en) |
WO (1) | WO2003092783A1 (en) |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP2010178869A (en) * | 2009-02-05 | 2010-08-19 | Fujifilm Corp | Drainage tube |
JPWO2015146321A1 (en) * | 2014-03-26 | 2017-04-13 | オリンパス株式会社 | Stent delivery system and endoscope system |
JP2021037080A (en) * | 2019-09-03 | 2021-03-11 | シルックス株式会社 | Tube stent delivery system |
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JPH05220227A (en) * | 1991-04-03 | 1993-08-31 | Olympus Optical Co Ltd | Retention tube |
JPH0737200U (en) * | 1993-12-21 | 1995-07-11 | 加藤発条株式会社 | Tubular organ treatment tool |
JPH0838617A (en) * | 1994-07-29 | 1996-02-13 | Honda Seiki Kk | Insertion appliance and insertion method of in-vivo indwelling appliance for improving urination |
JPH1176419A (en) * | 1997-09-03 | 1999-03-23 | Asahi Optical Co Ltd | Indwelling basket for endoscope |
US5895391A (en) * | 1996-09-27 | 1999-04-20 | Target Therapeutics, Inc. | Ball lock joint and introducer for vaso-occlusive member |
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JP2000152985A (en) * | 1998-11-20 | 2000-06-06 | Olympus Optical Co Ltd | Manipulator for endoscope |
-
2003
- 2003-05-01 DE DE10392575T patent/DE10392575T5/en not_active Withdrawn
- 2003-05-01 WO PCT/JP2003/005581 patent/WO2003092783A1/en active Application Filing
- 2003-05-01 JP JP2004500964A patent/JPWO2003092783A1/en not_active Withdrawn
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JPH05220227A (en) * | 1991-04-03 | 1993-08-31 | Olympus Optical Co Ltd | Retention tube |
JPH0737200U (en) * | 1993-12-21 | 1995-07-11 | 加藤発条株式会社 | Tubular organ treatment tool |
JPH0838617A (en) * | 1994-07-29 | 1996-02-13 | Honda Seiki Kk | Insertion appliance and insertion method of in-vivo indwelling appliance for improving urination |
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JP2010178869A (en) * | 2009-02-05 | 2010-08-19 | Fujifilm Corp | Drainage tube |
JPWO2015146321A1 (en) * | 2014-03-26 | 2017-04-13 | オリンパス株式会社 | Stent delivery system and endoscope system |
JP2021037080A (en) * | 2019-09-03 | 2021-03-11 | シルックス株式会社 | Tube stent delivery system |
Also Published As
Publication number | Publication date |
---|---|
DE10392575T5 (en) | 2005-07-28 |
JPWO2003092783A1 (en) | 2005-09-08 |
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