WO2016021591A1 - Introduction assistance instrument with side hole - Google Patents
Introduction assistance instrument with side hole Download PDFInfo
- Publication number
- WO2016021591A1 WO2016021591A1 PCT/JP2015/072070 JP2015072070W WO2016021591A1 WO 2016021591 A1 WO2016021591 A1 WO 2016021591A1 JP 2015072070 W JP2015072070 W JP 2015072070W WO 2016021591 A1 WO2016021591 A1 WO 2016021591A1
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- WO
- WIPO (PCT)
- Prior art keywords
- introduction
- side hole
- tubular organ
- tubular
- tubular body
- Prior art date
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Classifications
-
- 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
-
- 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
Definitions
- the present invention relates to an introduction assisting device that includes a tubular body that is inserted into a tubular organ of a human body and that can introduce a medical device into the tubular organ through the tubular body.
- an introduction assisting instrument such as a sheath introducer as described in Patent Document 1 or a guiding catheter as described in Patent Document 2 is inserted into the tubular organ, and after placement, A therapeutic instrument such as a therapeutic catheter is introduced into the lesion site through the internal passage of the introduction assisting instrument.
- the guide wire for the treatment instrument When introducing a treatment instrument to a lesion site through an introduction aid placed in a tubular organ, first insert a guide wire for the treatment instrument into the internal passage of the introduction aid placed in the tubular organ. After the distal end reaches the vicinity of the lesion site, the proximal end of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument such as a treatment catheter, and the treatment instrument is guided along the guide wire for the treatment instrument to the lesion site. invite. At this time, the guide wire for the therapeutic instrument or the therapeutic instrument is advanced by transmitting the pushing force applied to the therapeutic instrument guide wire or the therapeutic instrument from the base end side (the operation side at hand of the doctor) to the distal end. .
- introduction blood vessel a blood vessel into which an introduction assisting device is inserted
- introduction blood vessel a blood vessel into which an introduction assisting device is inserted
- the introduction assisting device having a curved portion formed in advance so that the distal end of the introduction assisting device can be easily oriented toward the entrance of the target side branch blood vessel
- the distal end of the introduction assisting device is moved to the side branch blood vessel.
- a treatment instrument guide wire or a treatment instrument (hereinafter referred to as a guide wire or the like) is extended from the distal end of the introduction assisting instrument and inserted into the side branch vessel for treatment.
- a reaction force is received when the tip of the guide wire or the like passes through the stenosis, and the received reaction force acts on the introduction assisting device.
- a part of the bending portion described above is used.
- a method is also used in which the inner wall of the introduced blood vessel is brought into contact with each other so as to receive a reaction force.
- the introduction assisting device In the conventional introduction assisting device, a guide wire or the like is extended from the distal end. Therefore, when introducing a guide wire or the like into a side branch vessel branched from the introduction blood vessel, as described above, the distal end of the introduction assisting device is It must be placed at the entrance of the side branch vessel. Therefore, the introduction assisting devices as described in Patent Document 2 and Patent Document 3 are also provided with a curved portion at the distal end portion so that the distal end can be directed to the entrance of the side branch blood vessel. Etc. can be introduced.
- the right renal artery, the left renal artery, the left subclavian artery, the left common carotid artery, the brachiocephalic artery branch at an acute angle from the descending aorta and the ascending aorta, which are introduction blood vessels, with respect to the direction of travel of the introduction assisting device.
- the introduction assisting devices as described in Patent Document 2 and Patent Document 3 are provided as described above by providing, between the distal end portion and the main body portion, a curved portion that is curved so that the distal end is directed toward the side branch vessel. It is possible to introduce a guide wire or the like into a side branch vessel.
- the tip of the introduction assisting device is directed to the entrance of the side branch blood vessel that branches at an acute angle from the introduction blood vessel with respect to the traveling direction of the introduction assisting device. It has been difficult to place or insert into the inlet, and there is a risk of damaging the inlet of the side branch vessel with the tip of the introduction assisting device.
- an object of the present invention is to solve the problems existing in the prior art and reduce the occurrence of damage to the entrance of the side branch tubular organ and to provide sufficient backup when inserting the medical device into the side branch tubular organ through the introduction assisting device. It is to be able to provide power.
- the present invention includes a tubular body that extends along a central axis and is inserted into an introduction tubular organ, and a side hole is provided in a peripheral wall of the tubular body, and the side hole is formed through the side hole of the tubular body.
- An introduction assist device with a side hole capable of introducing a medical device into a side branch tubular organ branched from an introduction tubular organ, wherein the tubular body includes a tip portion, a body portion, and the tip portion and the body portion.
- a backup providing unit including one or a plurality of bending portions, one of the one or more bending portions is provided with the side hole, and the one or more bending portions are provided. At least one of them provides a side-hole introduction assisting device formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ when the tubular body is inserted into the introduction tubular organ.
- the medical device is introduced into the side branch tubular organ branched from the introduction tubular organ through the side hole of the tubular body inserted into the introduction tubular organ. It is not necessary to arrange it toward or in the entrance, and the occurrence of damage to the entrance of the side branch tubular organ due to the distal end of the tubular body of the side hole introduction assisting device can be suppressed.
- the side hole of the tubular body in the inlet tubular organ at the entrance of the side branch tubular organ.
- the reaction force acting on the tip of the medical instrument when passing through the stenosis part is It becomes easy to be transmitted to the peripheral wall of the curved portion near the hole.
- the bending portion is deformed or moved to cause the positional deviation of the side hole, it becomes difficult to insert the medical instrument into the side branch tubular organ.
- at least one of the one or a plurality of curved portions included in the backup providing portion can be brought into contact with the inner wall of the introduction tubular organ.
- the side hole is provided in one of the one or a plurality of curved portions supported in contact with the inner wall of the introduction tubular organ in this way, and the side hole is a portion of the contact portion with the inner wall of the introduction tubular organ. Since the reaction force acting on the medical device is transmitted to the peripheral wall of the tubular body in the vicinity of the side hole, the position of the side hole is not easily displaced and the reaction force is resisted when the medical device is inserted. Effectively providing a backup force to advance the medical device into the side branch tubular organ.
- “place the side hole at the entrance of the side branch tubular organ” includes not only the position facing the entrance of the side branch tubular organ but also the placement of the side hole in the vicinity of the entrance.
- the backup providing unit includes a first curved portion and a second curved portion that curves to the opposite side of the first curved portion with respect to the central axis, It is preferable that the side hole is provided in one of the first bending portion and the second bending portion.
- the reaction force received when the medical device extending from the side hole arranged at the entrance of the side branch tubular organ passes through the stenosis or the like in the side branch tubular organ causes the curved portion near the side hole to be separated from the entrance of the side branch tubular organ. Acting on the back-up providing part in a direction transverse to the introduction tubular conduit.
- the first bending portion and the second bending portion included in the backup providing portion are bent on opposite sides with respect to the central axis (that is, the first bending portion and the second bending portion are entirely Therefore, in the state where the side hole is arranged at the entrance of the side branch tubular organ, the curved portion opposite to the curved portion provided with the side hole is arranged on the side facing the side branch tubular organ. It can be brought into contact with the inner wall of the introducer tubular organ. Accordingly, the backup providing portion is supported by the inner wall of the introduction tubular organ on the side opposite to the inlet of the side branch tubular organ and acts on the backup supply portion in a direction transverse to the introduction tubular conduit so as to be separated from the inlet of the side branch tubular organ. It is possible to provide an effective backup force against the force, and to suppress the positional deviation of the side holes.
- the first curved portion and the second curved portion arrange the tubular body in the introduction tubular organ so that the side hole is located at an inlet of the side branch tubular organ. More preferably, both the first curved portion and the second curved portion are formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ. In one embodiment, the side hole is provided between the contact portion of the first bending portion and the contact portion of the second bending portion.
- the backup providing unit includes a first curved part provided with the side hole, and the first curved part is arranged such that the side hole is located at an inlet of the side branch tubular organ.
- the tubular body When the tubular body is disposed therein, the tubular body may be formed in a shape that generates a contact portion with the inner wall of the introduction tubular organ on the distal side and the proximal side of the side hole.
- the backup providing unit may include a spiral curved portion extending in a spiral shape, and the side hole may be provided in the spiral curved portion. In this case, you may make it the said side hole be provided in the surrounding wall part of the said helical curved part which faced the axial direction of the said introduction tubular organ.
- the introduction assist device with a side hole can be a sheath introducer, a guiding catheter, or a stenosis penetration catheter.
- the introduction aid with a side hole of the present invention it is not necessary to arrange the tip of the introduction aid with a side hole at the entrance of the side branch tubular organ when the medical device is introduced into the side branch tubular organ.
- the occurrence of damage to the entrance of the side branch tubular organ due to the tip of the auxiliary instrument can be reduced.
- the side hole is provided in the backup providing unit including the curved portion supported in contact with the inner wall of the introduction tubular organ, the side hole is less likely to be displaced, and the medical device is backed up when the medical device is inserted. Power can be provided effectively.
- the introduction assisting device 11 is inserted into a tubular organ such as a blood vessel (hereinafter referred to as an introduction tubular organ), and introduces a medical device 29 such as a guide wire or a treatment device into a side branch tubular organ branched from the introduction tubular organ. It is an instrument to make it easier.
- a tubular organ such as a blood vessel (hereinafter referred to as an introduction tubular organ)
- a medical device 29 such as a guide wire or a treatment device into a side branch tubular organ branched from the introduction tubular organ. It is an instrument to make it easier.
- the introduction tubular organ is, for example, the ascending aorta or the descending aorta
- the side branch tubular organ is, for example, the brachiocephalic artery, right subclavian artery, right common carotid artery, left common carotid artery, left common carotid artery, left clavicle branching from the ascending or descending aorta Inferior artery, left renal artery, right renal artery.
- these are examples, and the introduction tubular organ and the side branch tubular organ are not limited thereto.
- the introduction assisting device 11 will be described as an example of the introduction assisting device 11 using the sheath introducer.
- the introduction assisting device 11 is not limited to a sheath introducer as long as it is a device for assisting the introduction of the medical device 29 into a tubular organ such as a human body. It can also be used as a catheter.
- the introduction auxiliary instrument 11 includes a tubular body 13 extending along the central axis, an instrument body 15, a connection tube 17 extending from the instrument body 15, and a three-way switching valve 19.
- the tubular body 13 is a flexible tube such as a sheath tube formed from an appropriate synthetic resin material.
- the instrument body 15 is a substantially cylindrical member such as a sheath hub formed of an appropriate synthetic resin material, and is externally fixed to the proximal end portion of the tubular body 13.
- the connection tube 17 is a flexible tube formed of an appropriate synthetic resin material, and is connected to the instrument body 15 so as to communicate with the interior of the instrument body 15.
- a three-way switching valve 19 is connected to the free end of the connection tube 17 (the end opposite to the end connected to the instrument body 15), and any one of the three ports can be operated by operating the lever. The two can be communicated.
- Such a three-way switching valve is well-known and has nothing to do with the essential features of the present invention, so a detailed description of its structure is omitted.
- the tubular body 13 is provided with an internal passage through which a medical device 29 can be inserted, and a tip portion 21 located at a distal end portion, a main body portion 23 having a substantially linear shape, a tip portion 21 and a main body.
- the backup providing unit 25 is provided between the unit 23 and the unit 23.
- the backup providing unit 25 includes one or a plurality of curved portions 25a and 25b, and a side hole 27 that allows passage of the medical instrument 29 is provided on one peripheral wall of the single or plural curved portions 25a and 25b. ing.
- the side hole 21 is provided in the curved portion 25 a located on the side closest to the distal end portion 21.
- the side hole 27 may be provided in the bending part 25b other than the bending part 25a, and one side hole 27 may be provided in each of the bending parts 25a and 25b.
- the backup providing unit 25 introduces at least one of the curved portions 25a and 25b included in the backup providing unit 25 when the tubular body 13 is arranged in the introduction tubular organ so that the side hole 27 is located at the entrance of the side branch tubular organ. It is formed in a shape and a size so as to generate a contact portion that contacts the inner wall of the tubular organ. That is, the shape and size of the curved portions 25a and 25b of the backup providing unit 25 and the position where the side hole 27 is provided in the curved portion 25a or 25b are the shape and size of the introduced tubular organ into which the tubular body 13 is inserted and the introduced tubular organ. Depending on the position of the entrance of the side branch tubular organ at, various designs can be made.
- the side hole 27 fulfills the function of allowing the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 to pass through and extending outside.
- the size and shape of the side hole 27 can be arbitrarily selected as long as the medical instrument 29 can be passed therethrough. For example, the largest medical instrument 29 whose length in the minor axis direction is expected to pass through is selected.
- the oval shape can be larger than the outer diameter.
- the side hole 27 as described above is provided in the tubular body 13, and therefore, the side hole 27 is arranged in advance at the inlet (including the vicinity thereof) of the side branch tubular organ, and is tubular from the instrument body 15.
- the medical instrument 29 By extending the medical instrument 29 inserted into the body 13 to the outside through the side hole 27, the medical instrument 29 can be easily introduced into the side branch tubular organ. That is, when the medical device 29 is introduced into the side branch tubular organ, it is not necessary to bring the distal end of the tubular body 13 of the introduction assisting device 11 close to the inlet of the side branch tubular organ or to be inserted into the inlet of the side branch tubular organ.
- the introduction assisting device 11 in order to make it easy to direct the distal end of the tubular body to the inlet of the side branch tubular organ branched from the introduction tubular organ, the tubular body is adjusted in accordance with the branching angle of the side branch tubular organ with respect to the introduction tubular organ. It is common to bend the front end of the.
- the medical device 29 inserted into the tubular body 13 is extended to the outside from the side hole 27, the medical device 29 is curved in the vicinity of the side hole 27 in the tubular body 13. It extends from the side hole 27.
- a reaction force acts on the medical instrument 29 when passing through a stenosis or the like in the side branch tubular organ, the medical instrument 29 is extended from the distal end of the tubular body 13 arranged toward the entrance of the side branch tubular organ.
- the reaction force is easily transmitted to the peripheral wall near the side hole 27 of the backup providing portion 25 of the tubular body 13, and the reaction force separates the backup providing portion 25 near the side hole 27 from the entrance of the side branch tubular organ.
- the backup providing unit 25 acts on the backup providing unit 25 in the direction in which the side holes 27 are displaced, and the side holes 27 are likely to be displaced.
- the medical instrument 29 meanders in the introduction tubular organ, so that the force for pressing the applied medical instrument 29 is dispersed and efficiently transmitted to the distal end of the medical instrument 29. This makes it difficult to insert the medical device 29 into the side branch tubular organ against the reaction force.
- the introduction assisting device 11 at least one of the curved portions 25a and 25b of the backup providing portion 25 provided with the side hole 27 can be brought into contact with the inner wall of the introduction tubular organ to generate a contact portion. It is like that.
- the backup providing part 25 provided with the side hole 27 is supported by the inner wall of the introduction tubular organ, the medical instrument 25 receives a reaction force, and the reaction force is a peripheral wall in the vicinity of the side hole 27 of the tubular body 13. Even if transmitted to the side, the displacement of the side hole 27 with respect to the entrance of the side branch tubular organ can be suppressed against the reaction force. Further, since the backup providing unit 25 is supported by the inner wall of the introduction tubular organ, deformation of the backup providing unit 25 and positional displacement of the side hole 27 are suppressed, so that a backup force against the reaction force can be provided.
- the medical device 29 can be advanced within the side branch tubular organ.
- the introduction assisting instrument 11 is provided with the side hole 27, and the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 can be extended to the outside from the side hole 27. Therefore, it is not necessary to extend the medical device 29 from the tip of the tubular body 13. Therefore, as shown in FIG. 1, the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is allowed to pass the guide wire for the introduction assisting device for guiding the introduction assisting device 11 in the introduction tubular organ. You may connect the front-end
- the diameter of the tip opening of the through hole of the tip member 31 is determined so as to allow the passage of the guide wire for the introduction assisting device to the minimum, intrusion of body fluid or the like into the tubular body 13 of the introduction assisting device 11 Can be suppressed.
- the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is located in the introduction tubular organ and the side hole 27 is located outside the introduction tubular organ, the distal end of the tubular body 13 enters the tubular body 13. For example, there is an effect of preventing body fluid from entering and flowing back through the side hole 27 to the outside of the introduction tubular organ.
- distal end member 31 is formed so that the outer peripheral surface has a tapered shape as it goes toward the distal end side, insertion of the introduced tubular organ through the puncture hole or the like and expansion of the puncture hole or the like can be performed. Has the effect of facilitating.
- the backup providing unit 25 includes two curved portions 25 a and 25 b, and the curved portion 25 a and the curved portion 25 b are opposite to each other with respect to the central axis of the tubular body 13. Curved sideways to form a generally S-shape.
- the curved portion of the backup providing unit 25 can have another curved shape as long as it can be brought into contact with the inner wall of the introduction tubular organ at at least one contact location.
- the backup providing unit 25 ′ is provided with one bending portion 25a, and the bending portion 25a is arranged so that the distal end portion 21 of the tubular body 13 faces the proximal end side.
- the curved portion 25a provided in the backup providing unit 25 ′′ spirals around the central axis, such as the backup providing unit 25 ′′ shown in FIG. 2B. You may make it have the spiral shape extended in a shape.
- the side hole 27 is provided in the curved portion 25a on the side close to the distal end portion 21 among the two curved portions 25a and 25b provided in the backup providing unit 25. As shown in FIG. 2C, a side hole 27 may be provided in the curved portion 25 b far from the tip portion 21.
- a guide wire for an introduction assisting instrument (not shown) is inserted into the descending aorta 33 until the tip reaches the vicinity of the entrance of the right renal artery 35 in the descending aorta 33 (introducing tubular organ). Insert).
- the proximal end portion of the guide wire for the introduction assisting device is inserted into the tubular body 13 through the through hole of the tip member 31 connected to the distal end (distal end portion) of the introduction assisting device 11, thereby introducing the introduction assisting device.
- the tubular body 13 of the introduction assisting device 11 is inserted into the descending aorta 33 along the guide wire.
- the introduction assisting device 11 When the introduction assisting device 11 is placed in the descending aorta 33 so that the side hole 27 of the tubular body 13 is positioned in the vicinity of the entrance of the right renal artery 35 branched from the descending aorta 33, the guide wire for the introduction assisting device from the introduction assisting device 11. Is removed. Since a backflow prevention valve and a three-way switching valve are provided at the proximal end of the instrument body 15 of the introduction assisting instrument 11 and the free end of the connection tube 17, it is inserted into the descending aorta 33 up to the side hole 27 of the tubular body 13.
- the introduction assisting device 11 Even if the introduction assisting device 11 is left in the descending aorta 33 in this state, blood that has entered the lumen of the tubular body 13 from the side hole 27 can be prevented from flowing out of the body.
- the diameter of the tip opening of the through hole of the tip member 31 is determined so as to have a minimum size that allows the guide wire for the introduction aid to pass, the introduction aid can be inserted when the introduction aid 11 is inserted. Even when the distal end portion 21 of the 11 tubular body 13 is located in the blood vessel while the side hole 27 is located outside the blood vessel, blood enters the tubular body 13 from the distal end portion 21 of the tubular body 13. , It is possible to suppress backflow out of the blood vessel through the side hole 27.
- the guide wire for the introduction aid is used when the introduction aid 11 is inserted into the descending aorta 33 along the guide wire for the introduction aid.
- 11 is inserted into the tubular body 13, the curved portions 25a, 25b of the backup providing unit 25 are in a form close to a straight line. Therefore, the introduction assisting device 11 can be smoothly moved in the descending aorta 33.
- the guide wire for the introduction assisting device is removed from the introduction assisting device 11, and backup is provided.
- the curved portions 25a and 25b of the portion 25 are restored to the curved shape, and the curved portion 25a is in a state where the side hole 27 of the backup providing portion 25 is positioned near the entrance of the right renal artery 35 as shown in FIG. , 25b can be brought into contact with the inner wall of the descending aorta 33.
- the backup providing portion 25 of the tubular body 13 is arranged in the descending aorta 33 so that the side hole 27 of the backup providing portion 25 is located near the entrance of the right renal artery 35, the curved portions 25a, It is assumed that the backup providing unit 25 is formed so that both of 25b come into contact with the inner wall of the descending aorta 33.
- the backup providing unit 25 presses the curved portions 25a and 25b against the opposite sides of the inner wall of the descending aorta 33. It becomes a state. Therefore, in a state where the side hole 27 of the tubular body 13 is located near the entrance of the right renal artery 35, the backup providing unit 25 is securely anchored in the descending aorta 33, whereby a force is applied to the backup providing unit 25 from the outside. Even if it acts, it becomes possible to suppress the position shift of the side hole 27 provided in the backup providing unit 25.
- a guide wire for a therapeutic instrument as a medical instrument 29 is inserted into the inside of the tubular body 13 of the introduction assisting instrument 11 through a backflow prevention valve (not shown) provided at the proximal end of the instrument body 15 of the introducing assisting instrument 11. It is inserted into the passage and extends from the side hole 27 toward the entrance of the right renal artery 35, and further pushed until the tip exceeds the lesion site. Even if there is a stenosis at the lesion site and a reaction force acts on the distal end portion of the guide wire for the therapeutic instrument when passing through the stenosis, the side hole of the backup providing unit 25 that is supported in contact with the inner wall of the descending aorta 33 is supported. Since the peripheral wall in the vicinity of 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the therapeutic instrument guide wire, which facilitates the passage of the narrowed portion of the therapeutic instrument guide wire.
- the proximal end portion of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument as another medical instrument 29, and the introduction assist is made through the backflow prevention valve provided at the proximal end portion of the instrument body 15 of the introduction assisting instrument 11.
- the therapeutic instrument is inserted into the tubular body 13 of the instrument 11. Further, along the guide wire for the therapeutic instrument, the therapeutic instrument is pushed forward in the tubular body 13 of the introduction assisting instrument 11 and introduced into the right renal artery 35 through the side hole 27 to treat the lesion site.
- the side of the backup providing unit 25 supported by being in contact with the inner wall of the descending aorta 33 as in the case of the guide wire for the treatment instrument Since the peripheral wall in the vicinity of the hole 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the treatment instrument, and the passage of the constriction portion of the treatment instrument is facilitated.
- the introduction assisting device 11 is in a state where the backup providing unit 25 presses the curved portions 25 a and 25 b against the opposite sides of the inner wall of the descending aorta 33, and the right renal artery
- the backup providing unit 25 is securely anchored in the descending aorta 33. Therefore, even when a reaction force acts on a medical instrument 29 such as a guide wire for a therapeutic instrument or a therapeutic instrument when passing through a narrowed portion of a lesion site and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing unit 25.
- the pushing force applied to the medical instrument 29 can be efficiently transmitted to the distal end of the medical instrument 29. Further, since the backup providing unit 25 is moored in the descending aorta 33, the medical device 29 is effectively provided with a backup force against the reaction force, and the right renal artery 35 is allowed to pass through the stenosis and medical. The instrument 29 can be advanced.
- the side hole 27 is in contact with the inner wall of the descending aorta 33 as shown in FIG. If the bending portion 25a is deformed by the reaction force acting on the medical instrument 29, the amount of movement is small and positional displacement is unlikely to occur. Further, as shown in FIG. 3, a side hole 27 is provided between a contact portion between the bending portion 25 a and the inner wall of the descending aorta 33 and a contact portion between the bending portion 25 and the inner wall of the descending aorta 33.
- the portion between the two abutting locations is supported with both end portions abutting against the inner wall of the descending aorta 33, for example, closer to the tip 21 than the abutting location of the curved portion 25a.
- deformation is reduced against an external force, so that an effect of further suppressing the displacement of the side hole 27 provided in the portion can be achieved.
- the effect that the pushing force applied to the medical device 29 can be efficiently transmitted to the tip of the medical device 29 and the effect of providing the medical device 29 with a backup force against the reaction force can be further improved. it can.
- the backup providing units 25 ′, 25 ′′, 25 shown in FIGS. 2A to 2C are used instead of the backup providing unit 25 of the introduction assisting device 11 shown in FIG. 1 is the same as the method of using the introduction assisting instrument 11 shown in FIG. 1 except for the arrangement method of the backup providing units 25, 25 ′, 25 ′′. Therefore, in the following, the introduction assisting device using the backup providing units 25 ′ and 25 ′′ shown in FIGS. 2A and 2B, which are arranged differently from the backup providing unit 25 of the introduction assisting device 11 shown in FIG. The arrangement method in 11 introduction
- transduction tubular organs is demonstrated.
- the backup providing unit 25 ′ shown in FIG. 2A includes, for example, an arm carotid artery 43 branched from an aortic arch 41 extending between the descending aorta 33 and the ascending aorta 39, and the right clavicle. It is suitable for use when the medical device 29 is introduced into the lower artery 45, the right common carotid artery 47, the left common carotid artery 49, the left subclavian artery 51, and the like.
- an arrangement method of the back-up providing unit 25 ′ illustrated in FIG. 2A will be described.
- the substantially J-shaped curved portion 25 a of the backup providing portion 25 ′ of the tubular body 13 is disposed in the aortic arch 41 so that the side hole 27 of the backup providing portion 25 ′ is located near the entrance of the left common carotid artery 49.
- An abutment point 53 that sometimes curves to the aortic arch 41 and abuts the inner wall of the aortic arch 41 (including the descending aorta 33 and the ascending aorta 39 adjacent thereto) at the distal and proximal sides of the side hole 27. , 55 are formed in advance in a shape and dimensions.
- the curved portion 25 a can be brought into contact with the inner wall of the aortic arch 41 at the contact points 53 and 55 located on the distal side and the proximal side of the left common carotid artery 49 on the same side as the entrance of the left common carotid artery 49. it can.
- the contact points 53 and 55 located on the distal side and the proximal side of the entrance of the left common carotid artery 49 are substantially J-shaped.
- the backup providing portion 25 ′ presses the curved portion 25a against the inner wall of the aortic arch 41 on the left common carotid artery 49 side. It becomes a state.
- the backup providing unit 25 ′′ is suitable for use. Taking the case where the medical instrument 29 is introduced into the right renal artery 35 as an example, an arrangement method of the backup providing unit 25 ′′ shown in FIG. 2B will be described.
- the spiral-shaped curved portion 25a of the backup providing portion 25 ′′ of the tubular body 13 is disposed in the descending aorta 33 such that the side hole 27 of the backup providing portion 25 ′′ is located near the entrance of the right renal artery 35.
- the spiral-shaped curved portion 25a is formed in advance so as to generate a contact portion that contacts the inner wall of the descending aorta 33 over 360 ° or more around the central axis of the descending aorta 33.
- the backup providing portion 25 ′′ shown in FIG. 2B is moved along the guide wire (not shown) for the introduction assisting instrument inserted in advance until reaching the position of the descending aorta 33 beyond the entrance of the right renal artery 35.
- the tubular body 13 of the introduction assisting device 11 to be used is inserted into the descending aorta 33 and arranged so that the side hole 27 provided in the backup providing unit 25 ′′ is located near the entrance of the right renal artery 35.
- the side hole 27 of the backup providing unit 25 ′′ is positioned near the entrance of the right renal artery 35 as shown in FIG.
- the curved portion 25 a can be brought into contact with the inner wall of the descending aorta 33 near the entrance of the right renal artery 35 over 360 ° or more around the central axis of the descending aorta 33.
- the backup providing unit 25 ′′ shown in FIG. 2B makes almost the entire curved portion 25a contact the descending aorta 33 (introducing tubular organ), the direction facing the inner wall of the descending aorta 33 (ie, spiral shape) If the side hole 27 is provided on the outer side of the curved portion 25a, the side hole 27 may be closed by the inner wall of the descending aorta 33. Therefore, the side hole 27 is shown in FIG. Thus, it is preferable to be provided on the peripheral wall portion of the curved portion 25 a facing the central axis direction of the descending aorta 33.
- the spiral curved portion 25a is brought into contact with the inner wall of the descending aorta 33 in the vicinity of the entrance of the right renal artery 35.
- the portion 25 ′′ is in a state where the bending portion 25a is pressed against the inner wall of the descending aorta 33.
- the entire bending portion 25a including the portion where the side hole 27 of the bending portion 25a of the backup providing portion 25 ′′ is provided. Is supported by being pressed against the inner wall of the descending aorta 33 around the entrance of the right renal artery 35.
- the curved portion 25a is in contact with the inner wall of the descending aorta 33 for 360 ° or more around the central axis of the descending aorta 33, and is also in contact with and supported by the inner wall of the descending aorta 33 facing the entrance of the right renal artery 35.
- the reaction force acts on the medical device 29 when passing through the narrowed portion of the lesion site, and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing portion 25 ′′ in the direction away from the entrance of the right renal artery 35.
- the backup providing unit 25 shown in FIG. 2C has a side hole 27 in the curved portion 25a closer to the distal end portion 21 of the two curved portions 25a and 25b in the backup providing unit 25 shown in FIG. 1 except that the side hole 27 is provided in a curved portion 25b other than the curved portion 25a on the side closer to the distal end portion 21 except that the side hole 27 is provided in the curved portion 25b.
- the side hole 27 may be arranged near the entrance of the side branch tubular conduit, which is the same as the backup providing unit 25 shown in FIG. 1. Since this is the same, the description is omitted here.
- the side hole 27 is provided between the portions where the two curved portions 25 a and 25 b having a substantially S-shape form contact portions.
- one of the two curved portions 25 a and 25 b having a substantially S shape is provided on either side of the curved portion 25 a or 25 b.
- the side hole 27 may be provided at a position closer to the distal end portion 21 than the contact portion in the curved portion 25a.
- both of the two curved portions 25a and 25b having a substantially S-shape are arranged so as to generate a contact portion with the inner wall of the introduction tubular organ. As shown in FIG.
- the side wall 27 is in contact with the inner wall of the introduction tubular organ on the opposite side, so that the movement of the side hole 27 can be suppressed against the reaction force and a backup force can be provided.
- the tip member 31 is not an essential configuration, and the tip member 31 may not be connected to the tip portion 21 of the tubular body 13 as shown in FIG.
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Abstract
An introduction assistance instrument (11) is provided with a tubular body (13) that extends along a central axis and that is inserted into an organ having an introduction tube shape. The tubular body (13) comprises a tip section (21), a main body section (23), and a backup-providing section (25) that is provided between the tip section (21) and the main body section (23) and that includes one or more bent sections (25a, 25b). A side hole (27) is provided to one of the one or more bent sections (25a, 25b) and it is possible to introduce a medical instrument via the side hole (27) into a laterally branched tubular organ that branches from an organ having an introduction tube shape. In addition, at least one of the one or more bent sections (25a, 25b) is formed so that a contact location at which contact occurs with the inner wall of an organ having an introduction tube shape is created when the tubular body (13) is inserted into the organ having an introduction tube shape.
Description
本発明は、人体の管状器官内へ挿入される管状体を備え、該管状体を通して前記管状器官内へ医療器具を導入させることができる導入補助器具に関する。
The present invention relates to an introduction assisting device that includes a tubular body that is inserted into a tubular organ of a human body and that can introduce a medical device into the tubular organ through the tubular body.
血管等の人体の管状器官内の手術では、特許文献1に記載のようなシースイントロデューサや特許文献2に記載のようなガイディングカテーテルなどの導入補助器具を管状器官内に挿入、留置後に、導入補助器具の内部通路内を通して病変部位に治療用カテーテルなどの治療器具を導入する。
In an operation in a tubular organ of a human body such as a blood vessel, an introduction assisting instrument such as a sheath introducer as described in Patent Document 1 or a guiding catheter as described in Patent Document 2 is inserted into the tubular organ, and after placement, A therapeutic instrument such as a therapeutic catheter is introduced into the lesion site through the internal passage of the introduction assisting instrument.
管状器官内に留置された導入補助器具を通して病変部位まで治療器具を導入する際には、最初に、管状器官内に留置された導入補助器具の内部通路内に治療器具用ガイドワイヤを挿入して、その先端を病変部位付近まで到達させた後、治療器具用ガイドワイヤの基端部を治療用カテーテルなどの治療器具の先端に挿入し、治療器具を治療器具用ガイドワイヤに沿って病変部位まで案内する。このとき、治療器具用ガイドワイヤや治療器具に基端部側(医師の手元の操作側)から与えられる押す力をその先端部に伝達させることにより、治療器具用ガイドワイヤや治療器具を前進させる。
When introducing a treatment instrument to a lesion site through an introduction aid placed in a tubular organ, first insert a guide wire for the treatment instrument into the internal passage of the introduction aid placed in the tubular organ. After the distal end reaches the vicinity of the lesion site, the proximal end of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument such as a treatment catheter, and the treatment instrument is guided along the guide wire for the treatment instrument to the lesion site. invite. At this time, the guide wire for the therapeutic instrument or the therapeutic instrument is advanced by transmitting the pushing force applied to the therapeutic instrument guide wire or the therapeutic instrument from the base end side (the operation side at hand of the doctor) to the distal end. .
導入補助器具を挿入した血管(以下、「導入血管」と記載する。)から分岐する側枝血管に病変部位がある場合、例えば、特許文献2に記載のように、先端部と本体部との間に、導入補助器具の先端を標的となる側枝血管の入口へ容易に向けて配置できるような形状に予め形成された湾曲部を有した導入補助器具を用いて、導入補助器具の先端を側枝血管の入口へ向けて配置した後、導入補助器具の先端から治療器具用ガイドワイヤや治療器具(以下、ガイドワイヤ等と記載する。)を延出させ、側枝血管内に挿入して治療を行う。また、側枝血管に狭窄部位があると、ガイドワイヤ等の先端部が狭窄部を通過する際に、反力を受け、受けた反力が導入補助器具に作用する。これにより導入補助器具の先端が側枝血管の入口から外れると、ガイドワイヤ等を狭窄部内に押し進めることが困難となるため、例えば特許文献3に記載されているように、上述の湾曲部の一部と導入血管の内壁を接触させて反力を受けることができるようにする方法も利用されている。
When there is a lesion site in a side branch blood vessel that branches off from a blood vessel into which an introduction assisting device is inserted (hereinafter referred to as “introduction blood vessel”), for example, as described in Patent Document 2, between the distal end portion and the main body portion. In addition, using the introduction assisting device having a curved portion formed in advance so that the distal end of the introduction assisting device can be easily oriented toward the entrance of the target side branch blood vessel, the distal end of the introduction assisting device is moved to the side branch blood vessel. Then, a treatment instrument guide wire or a treatment instrument (hereinafter referred to as a guide wire or the like) is extended from the distal end of the introduction assisting instrument and inserted into the side branch vessel for treatment. Also, if there is a stenosis site in the side branch vessel, a reaction force is received when the tip of the guide wire or the like passes through the stenosis, and the received reaction force acts on the introduction assisting device. This makes it difficult to push the guide wire or the like into the stenosis when the distal end of the introduction assisting device is disengaged from the entrance of the side branch vessel. For example, as described in Patent Document 3, a part of the bending portion described above is used. A method is also used in which the inner wall of the introduced blood vessel is brought into contact with each other so as to receive a reaction force.
従来の導入補助器具では、先端からガイドワイヤ等を延出させるようになっているので、導入血管から分岐する側枝血管にガイドワイヤ等を導入する場合、上述したように、導入補助器具の先端を側枝血管の入口に配置する必要がある。したがって、特許文献2や特許文献3に記載されているような導入補助器具も、先端部に湾曲部を設け、先端を側枝血管の入口へ向けられるようにすることにより、側枝血管へのガイドワイヤ等の導入を可能とさせている。
In the conventional introduction assisting device, a guide wire or the like is extended from the distal end. Therefore, when introducing a guide wire or the like into a side branch vessel branched from the introduction blood vessel, as described above, the distal end of the introduction assisting device is It must be placed at the entrance of the side branch vessel. Therefore, the introduction assisting devices as described in Patent Document 2 and Patent Document 3 are also provided with a curved portion at the distal end portion so that the distal end can be directed to the entrance of the side branch blood vessel. Etc. can be introduced.
一方、例えば、大腿動脈に設けた穿刺孔から下行大動脈や上行大動脈に導入補助器具を進める場合、これらから分岐する右腎動脈、左腎動脈、左鎖骨下動脈、左総頚動脈、腕頭動脈、右鎖骨下動脈、右総頚動脈などは、導入補助器具の進行方向に対して導入血管である下行大動脈や上行大動脈から鋭角的に分岐している。特許文献2や特許文献3に記載されているような導入補助器具は、先端部と本体部との間に、先端を側枝血管へ向けるように湾曲させた湾曲部を設けることにより、上記のような側枝血管へのガイドワイヤ等の導入を可能とさせている。しかしながら、特許文献2や特許文献3に記載のような導入補助器具を用いて、導入補助器具の進行方向に対して導入血管から鋭角的に分岐する側枝血管の入口に導入補助器具の先端を向けて配置する又は入口内に挿入することは困難であり、導入補助器具の先端で側枝血管の入口を傷つける恐れがあった。
On the other hand, for example, when advancing the introduction assisting device from the puncture hole provided in the femoral artery to the descending aorta and the ascending aorta, the right renal artery, the left renal artery, the left subclavian artery, the left common carotid artery, the brachiocephalic artery, The right subclavian artery, the right common carotid artery, and the like branch at an acute angle from the descending aorta and the ascending aorta, which are introduction blood vessels, with respect to the direction of travel of the introduction assisting device. The introduction assisting devices as described in Patent Document 2 and Patent Document 3 are provided as described above by providing, between the distal end portion and the main body portion, a curved portion that is curved so that the distal end is directed toward the side branch vessel. It is possible to introduce a guide wire or the like into a side branch vessel. However, using the introduction assisting device as described in Patent Document 2 and Patent Document 3, the tip of the introduction assisting device is directed to the entrance of the side branch blood vessel that branches at an acute angle from the introduction blood vessel with respect to the traveling direction of the introduction assisting device. It has been difficult to place or insert into the inlet, and there is a risk of damaging the inlet of the side branch vessel with the tip of the introduction assisting device.
また、側枝血管の狭窄部位を通過させる際に、ガイドワイヤ等に作用する反力により、導入補助器具の先端が側枝血管の入口から外れることを防止するために、特許文献3に記載されているように、導入補助器具の先端に設けた湾曲部の一部と導入血管を接触させて反力を導入血管の内壁で受けることができるようにしても、導入補助器具の先端から接触点までの距離が長いため、接触点から導入補助器具の先端までの間が撓んで、導入補助器具の先端が側枝血管の入口から外れてしまう可能性がある。この結果、導入補助器具が反力に抗するための十分なバックアップ力(すなわち支持力)をガイドワイヤ等に提供できなくなり、狭窄部へのガイドワイヤ等の挿入が困難となるという問題を生じる。
Further, in order to prevent the distal end of the introduction assisting device from coming off from the entrance of the side branch blood vessel due to the reaction force acting on the guide wire or the like when passing through the constricted portion of the side branch blood vessel, it is described in Patent Document 3. As described above, even if a part of the curved portion provided at the tip of the introduction assisting device is brought into contact with the introduction blood vessel so that the reaction force can be received by the inner wall of the introduction blood vessel, Since the distance is long, the distance from the contact point to the distal end of the introduction assisting device may bend, and the distal end of the introduction assisting device may be disengaged from the entrance of the side branch vessel. As a result, a sufficient backup force (that is, support force) for the introduction assisting device to resist the reaction force cannot be provided to the guide wire or the like, and there arises a problem that it becomes difficult to insert the guide wire or the like into the narrowed portion.
よって、本発明の目的は、従来技術に存する課題を解決して、導入補助器具を通して側枝管状器官に医療器具を挿入する際に、側枝管状器官の入口の損傷の発生を低減させ且つ十分なバックアップ力を提供できるようにすることにある。
Accordingly, an object of the present invention is to solve the problems existing in the prior art and reduce the occurrence of damage to the entrance of the side branch tubular organ and to provide sufficient backup when inserting the medical device into the side branch tubular organ through the introduction assisting device. It is to be able to provide power.
本発明は、上記目的に鑑み、中心軸線に沿って延び且つ導入管状器官内へ挿入される管状体を備え、該管状体の周壁に側孔が設けられており、管状体の側孔を通して前記導入管状器官から分岐する側枝管状器官内へ医療器具を導入させることができる側孔付き導入補助器具であって、前記管状体が、先端部と、本体部と、該先端部と本体部との間に設けられ且つ単数又は複数の湾曲部を含むバックアップ提供部とを有し、前記単数又は複数の湾曲部の一つに前記側孔が設けられていると共に、前記単数又は複数の湾曲部のうちの少なくとも一つが、前記管状体を前記導入管状器官に挿入したときに前記導入管状器官の内壁と当接する当接箇所を生じるように形成されている側孔付き導入補助器具を提供する。
In view of the above-described object, the present invention includes a tubular body that extends along a central axis and is inserted into an introduction tubular organ, and a side hole is provided in a peripheral wall of the tubular body, and the side hole is formed through the side hole of the tubular body. An introduction assist device with a side hole capable of introducing a medical device into a side branch tubular organ branched from an introduction tubular organ, wherein the tubular body includes a tip portion, a body portion, and the tip portion and the body portion. And a backup providing unit including one or a plurality of bending portions, one of the one or more bending portions is provided with the side hole, and the one or more bending portions are provided. At least one of them provides a side-hole introduction assisting device formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ when the tubular body is inserted into the introduction tubular organ.
上記側孔付き導入補助器具では、導入管状器官内へ挿入される管状体の側孔を通して導入管状器官から分岐する側枝管状器官内に医療器具を導入するので、管状体の先端を側枝管状器官の入口へ向けて又は入口内に配置する必要がなく、側孔付き導入補助器具の管状体の先端による側枝管状器官の入口の損傷の発生を抑制することができる。一方、側孔を通して側枝管状器官内へ医療器具を導入するためには、導入管状器官内において管状体の側孔を側枝管状器官の入口に配置する必要がある。管状体内に挿通された医療器具は、湾曲部内における側孔の近傍で湾曲させられて側孔から延出するため、狭窄部などを通過させるときに医療器具の先端に作用する反力が、側孔付近の湾曲部の周壁に伝達されやすくなる。これにより、湾曲部が変形したり移動して側孔の位置ずれを起こすと、側枝管状器官内に医療器具を挿入するのが困難となる。しかしながら、上記側孔付き導入補助器具では、バックアップ提供部に含まれる単数又は複数の湾曲部のうちの少なくとも一つを導入管状器官の内壁に当接させることができる。側孔は、このように導入管状器官の内壁に当接して支持される単数又は複数の湾曲部のうちの一つに設けられており、側孔が導入管状器官の内壁との当接箇所の近くに配置されるので、医療器具に作用する反力が側孔の近傍の管状体の周壁に伝達されても、側孔の位置ずれを起こしにくいと共に、医療器具の挿入時に反力に抗するためのバックアップ力を効果的に提供して、側枝管状器官内に医療器具を前進させることができる。なお、本願において、「側孔を側枝管状器官の入口に配置する」とは、側枝管状器官の入口に面する位置のみならず、当該入口の近傍に側孔を配置することを含むものとする。
In the introduction aid with side holes, the medical device is introduced into the side branch tubular organ branched from the introduction tubular organ through the side hole of the tubular body inserted into the introduction tubular organ. It is not necessary to arrange it toward or in the entrance, and the occurrence of damage to the entrance of the side branch tubular organ due to the distal end of the tubular body of the side hole introduction assisting device can be suppressed. On the other hand, in order to introduce a medical device into the side branch tubular organ through the side hole, it is necessary to arrange the side hole of the tubular body in the inlet tubular organ at the entrance of the side branch tubular organ. Since the medical instrument inserted through the tubular body is bent in the vicinity of the side hole in the bending part and extends from the side hole, the reaction force acting on the tip of the medical instrument when passing through the stenosis part is It becomes easy to be transmitted to the peripheral wall of the curved portion near the hole. As a result, when the bending portion is deformed or moved to cause the positional deviation of the side hole, it becomes difficult to insert the medical instrument into the side branch tubular organ. However, in the introduction aid with a side hole, at least one of the one or a plurality of curved portions included in the backup providing portion can be brought into contact with the inner wall of the introduction tubular organ. The side hole is provided in one of the one or a plurality of curved portions supported in contact with the inner wall of the introduction tubular organ in this way, and the side hole is a portion of the contact portion with the inner wall of the introduction tubular organ. Since the reaction force acting on the medical device is transmitted to the peripheral wall of the tubular body in the vicinity of the side hole, the position of the side hole is not easily displaced and the reaction force is resisted when the medical device is inserted. Effectively providing a backup force to advance the medical device into the side branch tubular organ. In the present application, “place the side hole at the entrance of the side branch tubular organ” includes not only the position facing the entrance of the side branch tubular organ but also the placement of the side hole in the vicinity of the entrance.
上記側孔付き導入補助器具では、前記バックアップ提供部は、第1の湾曲部と、前記中心軸線に対して該第1の湾曲部と反対側に湾曲する第2の湾曲部とを含み、前記第1の湾曲部及び前記第2の湾曲部の一方に前記側孔が設けられていることが好ましい。側枝管状器官の入口に配置した側孔から延出する医療器具が側枝管状器官内の狭窄部などを通過する際に受ける反力は、側孔付近の湾曲部を側枝管状器官の入口から離れさせるように導入管状導管を横断する方向にバックアップ提供部に作用する。一方、バックアップ提供部に含まれる第1の湾曲部と第2の湾曲部は中心軸線に対して互いに反対側に湾曲している(すなわち、第1の湾曲部と第2の湾曲部とは全体として概略S字形状をなしている)ので、側孔を側枝管状器官の入口に配置した状態で、側孔が設けられている湾曲部と反対側の湾曲部を側枝管状器官と対向する側の導入管状器官の内壁に当接させることができる。したがって、バックアップ提供部が側枝管状器官の入口と対向する側の導入管状器官の内壁によって支持され、側枝管状器官の入口から離れさせるように導入管状導管を横断する方向にバックアップ提供部に作用する反力に対して効果的なバックアップ力を提供して、側孔の位置ずれを抑制することができる。
In the introduction assisting device with a side hole, the backup providing unit includes a first curved portion and a second curved portion that curves to the opposite side of the first curved portion with respect to the central axis, It is preferable that the side hole is provided in one of the first bending portion and the second bending portion. The reaction force received when the medical device extending from the side hole arranged at the entrance of the side branch tubular organ passes through the stenosis or the like in the side branch tubular organ causes the curved portion near the side hole to be separated from the entrance of the side branch tubular organ. Acting on the back-up providing part in a direction transverse to the introduction tubular conduit. On the other hand, the first bending portion and the second bending portion included in the backup providing portion are bent on opposite sides with respect to the central axis (that is, the first bending portion and the second bending portion are entirely Therefore, in the state where the side hole is arranged at the entrance of the side branch tubular organ, the curved portion opposite to the curved portion provided with the side hole is arranged on the side facing the side branch tubular organ. It can be brought into contact with the inner wall of the introducer tubular organ. Accordingly, the backup providing portion is supported by the inner wall of the introduction tubular organ on the side opposite to the inlet of the side branch tubular organ and acts on the backup supply portion in a direction transverse to the introduction tubular conduit so as to be separated from the inlet of the side branch tubular organ. It is possible to provide an effective backup force against the force, and to suppress the positional deviation of the side holes.
上記側孔付き導入補助器具では、前記第1の湾曲部と前記第2の湾曲部は、前記側孔が前記側枝管状器官の入口に位置するように前記導入管状器官内に前記管状体を配置したときに前記第1の湾曲部と前記第2の湾曲部の両方が前記導入管状器官の内壁と当接する当接箇所を生じるように形成されていることがさらに好ましい。一つの実施形態では、前記側孔が前記第1の湾曲部の前記当接箇所と前記第2の湾曲部の前記当接箇所との間に設けられる。
In the introduction assisting device with a side hole, the first curved portion and the second curved portion arrange the tubular body in the introduction tubular organ so that the side hole is located at an inlet of the side branch tubular organ. More preferably, both the first curved portion and the second curved portion are formed so as to generate a contact portion that contacts the inner wall of the introduction tubular organ. In one embodiment, the side hole is provided between the contact portion of the first bending portion and the contact portion of the second bending portion.
また、前記バックアップ提供部が、前記側孔を設けられた第1の湾曲部を含み、該第1の湾曲部が、前記側孔が前記側枝管状器官の入口に位置するように前記導入管状器官内に前記管状体を配置したときに前記側孔の遠位側及び近位側において前記導入管状器官の内壁と当接箇所を生じるような形状に形成されていてもよい。
In addition, the backup providing unit includes a first curved part provided with the side hole, and the first curved part is arranged such that the side hole is located at an inlet of the side branch tubular organ. When the tubular body is disposed therein, the tubular body may be formed in a shape that generates a contact portion with the inner wall of the introduction tubular organ on the distal side and the proximal side of the side hole.
前記バックアップ提供部が螺旋形状に延びる螺旋状湾曲部を含み、該螺旋状湾曲部に前記側孔が設けられているようにすることもできる。この場合、前記側孔が前記導入管状器官の軸線方向に向いた前記螺旋状湾曲部の周壁部分に設けられているようにしてもよい。
The backup providing unit may include a spiral curved portion extending in a spiral shape, and the side hole may be provided in the spiral curved portion. In this case, you may make it the said side hole be provided in the surrounding wall part of the said helical curved part which faced the axial direction of the said introduction tubular organ.
また、前記側孔付き導入補助器具は、シースイントロデューサ、ガイディングカテーテル又は狭窄部貫通用カテーテルとすることができる。
Further, the introduction assist device with a side hole can be a sheath introducer, a guiding catheter, or a stenosis penetration catheter.
本発明の側孔付き導入補助器具によれば、医療器具を側枝管状器官内に導入する際に側孔付き導入補助器具の先端を側枝管状器官の入口に配置する必要がなく、側孔付き導入補助器具の先端による側枝管状器官の入口の損傷の発生を低減させることができる。また、側孔が導入管状器官の内壁と当接して支持される湾曲部を含むバックアップ提供部に設けられるので、側孔の位置ずれを起こしにくいと共に、医療器具の挿入時に医療器具に対してバックアップ力を効果的に提供することができる。
According to the introduction aid with a side hole of the present invention, it is not necessary to arrange the tip of the introduction aid with a side hole at the entrance of the side branch tubular organ when the medical device is introduced into the side branch tubular organ. The occurrence of damage to the entrance of the side branch tubular organ due to the tip of the auxiliary instrument can be reduced. In addition, since the side hole is provided in the backup providing unit including the curved portion supported in contact with the inner wall of the introduction tubular organ, the side hole is less likely to be displaced, and the medical device is backed up when the medical device is inserted. Power can be provided effectively.
以下、図面を参照して、本発明による側孔付き導入補助器具の実施の形態を説明する。
最初に、図1を参照して、本発明による側孔付き導入補助器具11の全体構成を説明する。導入補助器具11は、血管などの管状器官内(以下、導入管状器官と記載する。)に挿入され、導入管状器官から分岐する側枝管状器官へガイドワイヤや治療器具などの医療器具29を導入することを容易にするための器具である。導入管状器官は、例えば、上行大動脈や下行大動脈などであり、側枝管状器官は、例えば、上行大動脈や下行大動脈から分岐する腕頭動脈、右鎖骨下動脈、右総頚動脈、左総頚動脈、左鎖骨下動脈、左腎動脈、右腎動脈などである。しかしながら、これらは例示であり、導入管状器官や側枝管状器官はこれらに限定されるものではない。 DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of an introduction assisting device with a side hole according to the present invention will be described with reference to the drawings.
Initially, with reference to FIG. 1, the whole structure of the introductionauxiliary instrument 11 with a side hole by this invention is demonstrated. The introduction assisting device 11 is inserted into a tubular organ such as a blood vessel (hereinafter referred to as an introduction tubular organ), and introduces a medical device 29 such as a guide wire or a treatment device into a side branch tubular organ branched from the introduction tubular organ. It is an instrument to make it easier. The introduction tubular organ is, for example, the ascending aorta or the descending aorta, and the side branch tubular organ is, for example, the brachiocephalic artery, right subclavian artery, right common carotid artery, left common carotid artery, left common carotid artery, left clavicle branching from the ascending or descending aorta Inferior artery, left renal artery, right renal artery. However, these are examples, and the introduction tubular organ and the side branch tubular organ are not limited thereto.
最初に、図1を参照して、本発明による側孔付き導入補助器具11の全体構成を説明する。導入補助器具11は、血管などの管状器官内(以下、導入管状器官と記載する。)に挿入され、導入管状器官から分岐する側枝管状器官へガイドワイヤや治療器具などの医療器具29を導入することを容易にするための器具である。導入管状器官は、例えば、上行大動脈や下行大動脈などであり、側枝管状器官は、例えば、上行大動脈や下行大動脈から分岐する腕頭動脈、右鎖骨下動脈、右総頚動脈、左総頚動脈、左鎖骨下動脈、左腎動脈、右腎動脈などである。しかしながら、これらは例示であり、導入管状器官や側枝管状器官はこれらに限定されるものではない。 DESCRIPTION OF EMBODIMENTS Hereinafter, embodiments of an introduction assisting device with a side hole according to the present invention will be described with reference to the drawings.
Initially, with reference to FIG. 1, the whole structure of the introduction
以下では、シースイントロデューサを導入補助器具11の例として、導入補助器具11を説明する。しかしながら、導入補助器具11は、医療器具29を人体などの管状器官内へ導入することを補助するための器具であればシースイントロデューサに限定されるものではなく、例えばガイディングカテーテルや狭窄部貫通用カテーテルなどとすることも可能である。
Hereinafter, the introduction assisting device 11 will be described as an example of the introduction assisting device 11 using the sheath introducer. However, the introduction assisting device 11 is not limited to a sheath introducer as long as it is a device for assisting the introduction of the medical device 29 into a tubular organ such as a human body. It can also be used as a catheter.
導入補助器具11は、中心軸線に沿って延びる管状体13と、器具本体15と、器具本体15から延びる接続チューブ17と、三方切換弁19とを備える。管状体13は、適宜の合成樹脂材料から形成された例えばシースチューブなどの可撓性管である。器具本体15は、適宜の合成樹脂材料から形成されたシースハブのような概略円筒形状の部材であり、管状体13の基端部に外嵌固定されている。接続チューブ17は、適宜の合成樹脂材料から形成されている可撓性管であり、器具本体15の内部に連通するように器具本体15に接続されている。接続チューブ17の自由端部(器具本体15に接続されている端部と反対側の端部)には、三方切換弁19が接続されており、レバーの操作により三つのポートのうちの任意の二つを連通させることができるようになっている。このような三方切換弁は周知のものであり、本発明の本質的な特徴とは無関係のものであるので、その構造についての詳しい説明は省略する。
The introduction auxiliary instrument 11 includes a tubular body 13 extending along the central axis, an instrument body 15, a connection tube 17 extending from the instrument body 15, and a three-way switching valve 19. The tubular body 13 is a flexible tube such as a sheath tube formed from an appropriate synthetic resin material. The instrument body 15 is a substantially cylindrical member such as a sheath hub formed of an appropriate synthetic resin material, and is externally fixed to the proximal end portion of the tubular body 13. The connection tube 17 is a flexible tube formed of an appropriate synthetic resin material, and is connected to the instrument body 15 so as to communicate with the interior of the instrument body 15. A three-way switching valve 19 is connected to the free end of the connection tube 17 (the end opposite to the end connected to the instrument body 15), and any one of the three ports can be operated by operating the lever. The two can be communicated. Such a three-way switching valve is well-known and has nothing to do with the essential features of the present invention, so a detailed description of its structure is omitted.
管状体13は、内部に医療器具29を挿通することができる内部通路が設けられており、遠位端部に位置する先端部21と、概略直線形状の本体部23と、先端部21と本体部23との間に設けられたバックアップ提供部25とを有する。バックアップ提供部25は、単数又は複数の湾曲部25a,25bを有し、単数又は複数の湾曲部25a,25bのうちの一つの周壁に、医療器具29の通過を許容する側孔27が設けられている。図1に示されている実施形態では、先端部21に最も近い側に位置する湾曲部25aに側孔21が設けられている。しかしながら、湾曲部25a以外の湾曲部25bに側孔27が設けられていてもよく、各湾曲部25a,25bにそれぞれ一つの側孔27が設けられていてもよい。
The tubular body 13 is provided with an internal passage through which a medical device 29 can be inserted, and a tip portion 21 located at a distal end portion, a main body portion 23 having a substantially linear shape, a tip portion 21 and a main body. The backup providing unit 25 is provided between the unit 23 and the unit 23. The backup providing unit 25 includes one or a plurality of curved portions 25a and 25b, and a side hole 27 that allows passage of the medical instrument 29 is provided on one peripheral wall of the single or plural curved portions 25a and 25b. ing. In the embodiment shown in FIG. 1, the side hole 21 is provided in the curved portion 25 a located on the side closest to the distal end portion 21. However, the side hole 27 may be provided in the bending part 25b other than the bending part 25a, and one side hole 27 may be provided in each of the bending parts 25a and 25b.
バックアップ提供部25は、側孔27が側枝管状器官の入口に位置するように導入管状器官内に管状体13を配置したときにバックアップ提供部25に含まれる湾曲部25a,25bの少なくとも一つが導入管状器官の内壁と当接する当接箇所を生じるような形状及び寸法に形成されている。すなわち、バックアップ提供部25の湾曲部25a,25bの形状及び寸法並びに湾曲部25a又は25bにおいて側孔27が設けられる位置は、管状体13が挿入される導入管状器官の形状及び寸法並びに導入管状器官における側枝管状器官の入口の位置に応じて、様々に設計され得る。
The backup providing unit 25 introduces at least one of the curved portions 25a and 25b included in the backup providing unit 25 when the tubular body 13 is arranged in the introduction tubular organ so that the side hole 27 is located at the entrance of the side branch tubular organ. It is formed in a shape and a size so as to generate a contact portion that contacts the inner wall of the tubular organ. That is, the shape and size of the curved portions 25a and 25b of the backup providing unit 25 and the position where the side hole 27 is provided in the curved portion 25a or 25b are the shape and size of the introduced tubular organ into which the tubular body 13 is inserted and the introduced tubular organ. Depending on the position of the entrance of the side branch tubular organ at, various designs can be made.
側孔27は、器具本体15から管状体13内に挿通された医療器具29を通過させ外部に延出させる機能を果たす。側孔27の大きさ及び形状は、医療器具29を通過させることができれば、任意に選択することができ、例えば、短軸方向の長さが通過させることを予定している最大の医療器具29の外径よりも大きい長楕円形状とすることができる。
The side hole 27 fulfills the function of allowing the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 to pass through and extending outside. The size and shape of the side hole 27 can be arbitrarily selected as long as the medical instrument 29 can be passed therethrough. For example, the largest medical instrument 29 whose length in the minor axis direction is expected to pass through is selected. The oval shape can be larger than the outer diameter.
導入補助器具11では、管状体13に上述したような側孔27が設けられているので、側孔27を側枝管状器官の入口(その近傍を含む)に予め配置して、器具本体15から管状体13内に挿通された医療器具29を側孔27を通して外部に延出させることにより、医療器具29を容易に側枝管状器官内に導入させることができる。すなわち、側枝管状器官内への医療器具29の導入の際に、導入補助器具11の管状体13の先端を側枝管状器官の入口へ接近させたり側枝管状器官の入口内に挿入する必要がなく、バックアップ提供部25の周壁に設けられた側孔27を側枝管状器官の入口に配置すればよい。したがって、導入補助器具11を使用すれば、管状体13の先端により側枝管状器官の入口を損傷させることを抑制できる。また、従来の導入補助器具では、導入管状器官から分岐する側枝管状器官の入口へ管状体の先端を向けるのを容易にするために、導入管状器官に対する側枝管状器官の分岐角度に合せて管状体の先端部を湾曲させることが一般的である。しかしながら、特に導入補助器具の挿入方向に対して導入管状導管が45°以上の鋭角をなして分岐する側枝管状器官に導入補助器具の先端を向けることができるような湾曲部を形成することは技術的にも導入管状器官の空間的にも困難であった。しかしながら、導入補助器具11では、上述したように、管状体13の先端を側枝管状器官の入口へ向ける必要がないので、このような問題が生じない。
In the introduction assisting instrument 11, the side hole 27 as described above is provided in the tubular body 13, and therefore, the side hole 27 is arranged in advance at the inlet (including the vicinity thereof) of the side branch tubular organ, and is tubular from the instrument body 15. By extending the medical instrument 29 inserted into the body 13 to the outside through the side hole 27, the medical instrument 29 can be easily introduced into the side branch tubular organ. That is, when the medical device 29 is introduced into the side branch tubular organ, it is not necessary to bring the distal end of the tubular body 13 of the introduction assisting device 11 close to the inlet of the side branch tubular organ or to be inserted into the inlet of the side branch tubular organ. What is necessary is just to arrange | position the side hole 27 provided in the surrounding wall of the backup provision part 25 at the entrance of a side branch tubular organ. Therefore, if the introduction assisting device 11 is used, it is possible to suppress damage to the entrance of the side branch tubular organ due to the distal end of the tubular body 13. Further, in the conventional introduction assisting device, in order to make it easy to direct the distal end of the tubular body to the inlet of the side branch tubular organ branched from the introduction tubular organ, the tubular body is adjusted in accordance with the branching angle of the side branch tubular organ with respect to the introduction tubular organ. It is common to bend the front end of the. However, in particular, it is a technique to form a curved portion so that the distal end of the introduction assisting device can be directed to a side branch tubular organ where the introduction tubular conduit branches at an acute angle of 45 ° or more with respect to the insertion direction of the introduction assisting device. Both spatially and spatially of the introduced tubular organ. However, in the introduction assisting device 11, as described above, there is no need to direct the distal end of the tubular body 13 to the entrance of the side branch tubular organ.
また、導入補助器具11では、管状体13内に挿通された医療器具29を側孔27から外部に延出させるとき、医療器具29は管状体13内における側孔27の近傍で湾曲させられて側孔27から延出する。このため、側枝管状器官内において狭窄部などを通過させるときに医療器具29に反力が作用すると、側枝管状器官の入口へ向けて配置した管状体13の先端から医療器具29を延出させる場合と比較して、反力が管状体13のバックアップ提供部25の側孔27の近傍の周壁に伝達されやすく、反力が側孔27の近傍のバックアップ提供部25を側枝管状器官の入口から離れさせる方向にバックアップ提供部25に作用して、側孔27の位置ずれを生じさせやすくなる。側孔27の位置ずれが生じると、導入管状器官内で医療器具29が蛇行することとなるので、付与された医療器具29を押す力が分散されて医療器具29の先端に効率的に伝達することができず、反力に抗して医療器具29を側枝管状器官内に挿入することが困難となる。しかしながら、導入補助器具11では、側孔27が設けられているバックアップ提供部25の湾曲部25a,25bの少なくとも一つを導入管状器官の内壁と当接させて当接箇所を生じさせることができるようになっている。これにより、側孔27を設けられているバックアップ提供部25が導入管状器官の内壁によって支持されるので、医療器具25が反力を受け、反力が管状体13の側孔27の近傍の周壁に伝達されても、反力に抗して側枝管状器官の入口に対する側孔27の位置ずれを抑制することができる。また、バックアップ提供部25が導入管状器官の内壁に支持されていることにより、バックアップ提供部25の変形及び側孔27の位置ずれが抑制されるので、反力に抗するバックアップ力を医療器具29に効果的に提供して、側枝管状器官内において医療器具29を前進させることができる。
Further, in the introduction assisting device 11, when the medical device 29 inserted into the tubular body 13 is extended to the outside from the side hole 27, the medical device 29 is curved in the vicinity of the side hole 27 in the tubular body 13. It extends from the side hole 27. For this reason, when a reaction force acts on the medical instrument 29 when passing through a stenosis or the like in the side branch tubular organ, the medical instrument 29 is extended from the distal end of the tubular body 13 arranged toward the entrance of the side branch tubular organ. The reaction force is easily transmitted to the peripheral wall near the side hole 27 of the backup providing portion 25 of the tubular body 13, and the reaction force separates the backup providing portion 25 near the side hole 27 from the entrance of the side branch tubular organ. It acts on the backup providing unit 25 in the direction in which the side holes 27 are displaced, and the side holes 27 are likely to be displaced. When the position shift of the side hole 27 occurs, the medical instrument 29 meanders in the introduction tubular organ, so that the force for pressing the applied medical instrument 29 is dispersed and efficiently transmitted to the distal end of the medical instrument 29. This makes it difficult to insert the medical device 29 into the side branch tubular organ against the reaction force. However, in the introduction assisting device 11, at least one of the curved portions 25a and 25b of the backup providing portion 25 provided with the side hole 27 can be brought into contact with the inner wall of the introduction tubular organ to generate a contact portion. It is like that. Thereby, since the backup providing part 25 provided with the side hole 27 is supported by the inner wall of the introduction tubular organ, the medical instrument 25 receives a reaction force, and the reaction force is a peripheral wall in the vicinity of the side hole 27 of the tubular body 13. Even if transmitted to the side, the displacement of the side hole 27 with respect to the entrance of the side branch tubular organ can be suppressed against the reaction force. Further, since the backup providing unit 25 is supported by the inner wall of the introduction tubular organ, deformation of the backup providing unit 25 and positional displacement of the side hole 27 are suppressed, so that a backup force against the reaction force can be provided. The medical device 29 can be advanced within the side branch tubular organ.
なお、導入補助器具11には、上述したように、側孔27が設けられており、器具本体15から管状体13内に挿通された医療器具29を側孔27から外部に延出させることができるので、管状体13の先端から医療器具29を延出させる必要がない。したがって、図1に示されているように、導入補助器具11の管状体13の先端部21に、導入補助器具11を導入管状器官内で案内するための導入補助器具用ガイドワイヤの通過を許容する貫通孔(図示せず)が設けられた先端部材31を接続してもよい。
As described above, the introduction assisting instrument 11 is provided with the side hole 27, and the medical instrument 29 inserted into the tubular body 13 from the instrument body 15 can be extended to the outside from the side hole 27. Therefore, it is not necessary to extend the medical device 29 from the tip of the tubular body 13. Therefore, as shown in FIG. 1, the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is allowed to pass the guide wire for the introduction assisting device for guiding the introduction assisting device 11 in the introduction tubular organ. You may connect the front-end | tip member 31 provided with the through-hole (not shown) to do.
導入補助器具用ガイドワイヤの通過を許容する最小限の大きさとなるように先端部材31の貫通孔の先端開口の直径を定めれば、導入補助器具11の管状体13内への体液などの侵入を抑制することが可能となる。これにより、導入補助器具11の管状体13の先端部21が導入管状器官内に位置し且つ側孔27が導入管状器官外に位置する状態のときに、管状体13の先端から管状体13内に例えば体液が侵入し、側孔27を通して導入管状器官外に逆流することを抑制する効果を奏する。また、外周面が先端側に向かうにつれてテーパ状に細くなる形状を有するように先端部材31を形成すれば、穿刺孔などを通した導入管状器官の穿刺孔への挿入及び穿刺孔などの拡張を容易にする効果を奏する。
If the diameter of the tip opening of the through hole of the tip member 31 is determined so as to allow the passage of the guide wire for the introduction assisting device to the minimum, intrusion of body fluid or the like into the tubular body 13 of the introduction assisting device 11 Can be suppressed. As a result, when the distal end portion 21 of the tubular body 13 of the introduction assisting device 11 is located in the introduction tubular organ and the side hole 27 is located outside the introduction tubular organ, the distal end of the tubular body 13 enters the tubular body 13. For example, there is an effect of preventing body fluid from entering and flowing back through the side hole 27 to the outside of the introduction tubular organ. Further, if the distal end member 31 is formed so that the outer peripheral surface has a tapered shape as it goes toward the distal end side, insertion of the introduced tubular organ through the puncture hole or the like and expansion of the puncture hole or the like can be performed. Has the effect of facilitating.
図1に示されている実施形態では、バックアップ提供部25は、二つの湾曲部25a,25bを含んでおり、湾曲部25aと湾曲部25bとが管状体13の中心軸線に対して互いと反対側に湾曲して概略S字形状を形成している。しかしながら、バックアップ提供部25の湾曲部は、導入管状器官の内壁と少なくとも一つの当接箇所で当接させることができるようになっていれば、他の湾曲形状とすることも可能である。例えば、図2Aに示されているバックアップ提供部25’のように、バックアップ提供部25’に一つの湾曲部25aを設け、湾曲部25aが、管状体13の先端部21が基端側に向かって延びるような概略J字形状を有するようにしてもよく、図2Bに示されているバックアップ提供部25”のように、バックアップ提供部25”に設けられた湾曲部25aが中心軸線周りに螺旋状に延びる螺旋形状を有するようにしてもよい。また、図1に示されている実施形態では、バックアップ提供部25に設けられた二つの湾曲部25a,25bのうち先端部21に近い側の湾曲部25aに側孔27を設けているが、図2Cに示されているように、先端部21から遠い側の湾曲部25bに側孔27を設けてもよい。
In the embodiment shown in FIG. 1, the backup providing unit 25 includes two curved portions 25 a and 25 b, and the curved portion 25 a and the curved portion 25 b are opposite to each other with respect to the central axis of the tubular body 13. Curved sideways to form a generally S-shape. However, the curved portion of the backup providing unit 25 can have another curved shape as long as it can be brought into contact with the inner wall of the introduction tubular organ at at least one contact location. For example, like the backup providing unit 25 ′ shown in FIG. 2A, the backup providing unit 25 ′ is provided with one bending portion 25a, and the bending portion 25a is arranged so that the distal end portion 21 of the tubular body 13 faces the proximal end side. The curved portion 25a provided in the backup providing unit 25 ″ spirals around the central axis, such as the backup providing unit 25 ″ shown in FIG. 2B. You may make it have the spiral shape extended in a shape. In the embodiment shown in FIG. 1, the side hole 27 is provided in the curved portion 25a on the side close to the distal end portion 21 among the two curved portions 25a and 25b provided in the backup providing unit 25. As shown in FIG. 2C, a side hole 27 may be provided in the curved portion 25 b far from the tip portion 21.
次に、図3を参照して、下行大動脈33から分岐する右腎動脈35及び左腎動脈37のうち右腎動脈35に医療器具29を導入するときを例に、導入補助器具11の使用方法を説明する。
Next, referring to FIG. 3, the method of using the introduction assisting device 11, for example, when the medical device 29 is introduced into the right renal artery 35 among the right renal artery 35 and the left renal artery 37 that branches from the descending aorta 33. Will be explained.
まず、セルジンガー法などで、穿刺針を用いて下行大動脈33(導入管状器官)内の右腎動脈35の入口付近に先端が到達するまで下行大動脈33内に導入補助器具用ガイドワイヤ(図示せず)を挿入する。次に、導入補助器具11の先端(遠位端部)に接続された先端部材31の貫通孔を通して管状体13内に導入補助器具用ガイドワイヤの基端部を挿入することにより、導入補助器具用ガイドワイヤに沿って下行大動脈33内に導入補助器具11の管状体13を挿入する。下行大動脈33から分岐する右腎動脈35の入口付近に管状体13の側孔27が位置するように導入補助器具11を下行大動脈33内に留置したら、導入補助器具11から導入補助器具用ガイドワイヤを抜去する。導入補助器具11の器具本体15の基端部や接続チューブ17の自由端部には逆流防止弁や三方切換弁が設けられているので、管状体13の側孔27まで下行大動脈33内に挿入された状態で下行大動脈33内に導入補助器具11を留置したままであっても、側孔27から管状体13の内腔内に侵入した血液が体外に流出することを防止することができる。また、導入補助器具用ガイドワイヤの通過を許容する最小限の大きさとなるように先端部材31の貫通孔の先端開口の直径が定められていれば、導入補助器具11の挿入時に、導入補助器具11の管状体13の先端部21が血管内に位置する一方で側孔27が血管外に位置する状態となったときでも、管状体13の先端部21から管状体13内に血液が侵入し、側孔27を通して血管外に逆流することを抑制することができる。
First, by a Seldinger method or the like, using a puncture needle, a guide wire for an introduction assisting instrument (not shown) is inserted into the descending aorta 33 until the tip reaches the vicinity of the entrance of the right renal artery 35 in the descending aorta 33 (introducing tubular organ). Insert). Next, the proximal end portion of the guide wire for the introduction assisting device is inserted into the tubular body 13 through the through hole of the tip member 31 connected to the distal end (distal end portion) of the introduction assisting device 11, thereby introducing the introduction assisting device. The tubular body 13 of the introduction assisting device 11 is inserted into the descending aorta 33 along the guide wire. When the introduction assisting device 11 is placed in the descending aorta 33 so that the side hole 27 of the tubular body 13 is positioned in the vicinity of the entrance of the right renal artery 35 branched from the descending aorta 33, the guide wire for the introduction assisting device from the introduction assisting device 11. Is removed. Since a backflow prevention valve and a three-way switching valve are provided at the proximal end of the instrument body 15 of the introduction assisting instrument 11 and the free end of the connection tube 17, it is inserted into the descending aorta 33 up to the side hole 27 of the tubular body 13. Even if the introduction assisting device 11 is left in the descending aorta 33 in this state, blood that has entered the lumen of the tubular body 13 from the side hole 27 can be prevented from flowing out of the body. In addition, if the diameter of the tip opening of the through hole of the tip member 31 is determined so as to have a minimum size that allows the guide wire for the introduction aid to pass, the introduction aid can be inserted when the introduction aid 11 is inserted. Even when the distal end portion 21 of the 11 tubular body 13 is located in the blood vessel while the side hole 27 is located outside the blood vessel, blood enters the tubular body 13 from the distal end portion 21 of the tubular body 13. , It is possible to suppress backflow out of the blood vessel through the side hole 27.
管状体13は導入補助器具用ガイドワイヤよりも柔軟であるため、導入補助器具用ガイドワイヤに沿って下行大動脈33内に導入補助器具11を挿入する際、導入補助器具用ガイドワイヤが導入補助器具11の管状体13内に挿通された状態になると、バックアップ提供部25の湾曲部25a,25bは直線状に近い形態となる。したがって、下行大動脈33内において導入補助器具11を円滑に移動させることが可能となる。一方、右腎動脈35の入口付近に側孔27が配置されるように導入補助器具11を下行大動脈33内に留置した後に、導入補助器具11から導入補助器具用ガイドワイヤを抜去すると、バックアップ提供部25の湾曲部25a,25bが湾曲形状に回復し、図3に示されているように、右腎動脈35の入口付近にバックアップ提供部25の側孔27が位置する状態で、湾曲部25a,25bを下行大動脈33の内壁に当接させることができる。なお、バックアップ提供部25の側孔27が右腎動脈35の入口付近に位置するように下行大動脈33内に管状体13のバックアップ提供部25を配置したときにバックアップ提供部25の湾曲部25a,25bの両方が下行大動脈33の内壁と当接する箇所を生じるようにバックアップ提供部25が形成されているものとする。
Since the tubular body 13 is more flexible than the guide wire for the introduction aid, the guide wire for the introduction aid is used when the introduction aid 11 is inserted into the descending aorta 33 along the guide wire for the introduction aid. 11 is inserted into the tubular body 13, the curved portions 25a, 25b of the backup providing unit 25 are in a form close to a straight line. Therefore, the introduction assisting device 11 can be smoothly moved in the descending aorta 33. On the other hand, when the introduction assisting device 11 is placed in the descending aorta 33 so that the side hole 27 is arranged near the entrance of the right renal artery 35, the guide wire for the introduction assisting device is removed from the introduction assisting device 11, and backup is provided. The curved portions 25a and 25b of the portion 25 are restored to the curved shape, and the curved portion 25a is in a state where the side hole 27 of the backup providing portion 25 is positioned near the entrance of the right renal artery 35 as shown in FIG. , 25b can be brought into contact with the inner wall of the descending aorta 33. When the backup providing portion 25 of the tubular body 13 is arranged in the descending aorta 33 so that the side hole 27 of the backup providing portion 25 is located near the entrance of the right renal artery 35, the curved portions 25a, It is assumed that the backup providing unit 25 is formed so that both of 25b come into contact with the inner wall of the descending aorta 33.
概略S字形状をなす二つの湾曲部25a,25bの両方が下行大動脈33の内壁に当接するとき、バックアップ提供部25は湾曲部25a,25bを下行大動脈33の内壁の互いに対向する側に押し付けた状態となる。したがって、右腎動脈35の入口付近に管状体13の側孔27が位置する状態で、バックアップ提供部25が下行大動脈33内に確実に係留され、これにより、バックアップ提供部25に外部から力が作用しても、バックアップ提供部25に設けられた側孔27の位置ずれを抑制することが可能となる。
When both of the two curved portions 25a and 25b having a substantially S-shape are in contact with the inner wall of the descending aorta 33, the backup providing unit 25 presses the curved portions 25a and 25b against the opposite sides of the inner wall of the descending aorta 33. It becomes a state. Therefore, in a state where the side hole 27 of the tubular body 13 is located near the entrance of the right renal artery 35, the backup providing unit 25 is securely anchored in the descending aorta 33, whereby a force is applied to the backup providing unit 25 from the outside. Even if it acts, it becomes possible to suppress the position shift of the side hole 27 provided in the backup providing unit 25.
次に、導入補助器具11の器具本体15の基端部に設けられた逆流防止弁(図示せず)を通して、医療器具29としての治療器具用ガイドワイヤを導入補助器具11の管状体13の内部通路内に挿通して、側孔27から右腎動脈35の入口へ向かって延出させ、さらに先端が病変部位を越えるまで押し進める。病変部位に狭窄部があり狭窄部を通過させる際に治療器具用ガイドワイヤの先端部に反力が作用しても、下行大動脈33の内壁に当接して支持されたバックアップ提供部25の側孔27の近傍の周壁がバックアップ力を提供するため、押す力を治療器具用ガイドワイヤの先端に効率的に伝達し、治療器具用ガイドワイヤの狭窄部の通過が容易になる。
Next, a guide wire for a therapeutic instrument as a medical instrument 29 is inserted into the inside of the tubular body 13 of the introduction assisting instrument 11 through a backflow prevention valve (not shown) provided at the proximal end of the instrument body 15 of the introducing assisting instrument 11. It is inserted into the passage and extends from the side hole 27 toward the entrance of the right renal artery 35, and further pushed until the tip exceeds the lesion site. Even if there is a stenosis at the lesion site and a reaction force acts on the distal end portion of the guide wire for the therapeutic instrument when passing through the stenosis, the side hole of the backup providing unit 25 that is supported in contact with the inner wall of the descending aorta 33 is supported. Since the peripheral wall in the vicinity of 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the therapeutic instrument guide wire, which facilitates the passage of the narrowed portion of the therapeutic instrument guide wire.
次に、別の医療器具29としての治療器具の先端に治療器具用ガイドワイヤの基端部を挿入し、導入補助器具11の器具本体15の基端部に設けられた逆流防止弁を通して導入補助器具11の管状体13内に治療器具を挿通する。さらに、治療器具用ガイドワイヤに沿って、導入補助器具11の管状体13内で治療器具を押し進めて、側孔27を通して右腎動脈35内に導入し、病変部位の治療を行う。病変部位の狭窄部を通過する際に反力が治療器具に作用しても、治療器具用ガイドワイヤの場合と同様に、下行大動脈33の内壁に当接して支持されたバックアップ提供部25の側孔27の近傍の周壁がバックアップ力を提供するため、押し込み力を治療器具の先端に効率的に伝達し、治療器具の狭窄部の通過が容易になる。
Next, the proximal end portion of the guide wire for the treatment instrument is inserted into the distal end of the treatment instrument as another medical instrument 29, and the introduction assist is made through the backflow prevention valve provided at the proximal end portion of the instrument body 15 of the introduction assisting instrument 11. The therapeutic instrument is inserted into the tubular body 13 of the instrument 11. Further, along the guide wire for the therapeutic instrument, the therapeutic instrument is pushed forward in the tubular body 13 of the introduction assisting instrument 11 and introduced into the right renal artery 35 through the side hole 27 to treat the lesion site. Even when the reaction force acts on the treatment instrument when passing through the stenosis of the lesion site, the side of the backup providing unit 25 supported by being in contact with the inner wall of the descending aorta 33 as in the case of the guide wire for the treatment instrument Since the peripheral wall in the vicinity of the hole 27 provides a backup force, the pushing force is efficiently transmitted to the distal end of the treatment instrument, and the passage of the constriction portion of the treatment instrument is facilitated.
図3に示されている使用方法では、導入補助器具11は、バックアップ提供部25が湾曲部25a,25bを下行大動脈33の内壁の互いに対向する側に押し付けた状態となっており、右腎動脈35の入口付近に管状体13の側孔27が位置する状態で、バックアップ提供部25が下行大動脈33内に確実に係留される。したがって、病変部位の狭窄部を通過する際に反力が治療器具用ガイドワイヤや治療器具のような医療器具29に作用し、バックアップ提供部25の側孔27の近傍の周壁に伝達されても、側孔27の位置ずれを抑制することができるので、医療器具29に付与した押し込み力を医療器具29の先端に効率的に伝達させることができる。また、バックアップ提供部25が下行大動脈33内に係留されていることにより、反力に抗するバックアップ力を医療器具29に効果的に提供して、右腎動脈35において狭窄部を通過させて医療器具29を前進させることができる。
In the method of use shown in FIG. 3, the introduction assisting device 11 is in a state where the backup providing unit 25 presses the curved portions 25 a and 25 b against the opposite sides of the inner wall of the descending aorta 33, and the right renal artery In the state where the side hole 27 of the tubular body 13 is located near the entrance of 35, the backup providing unit 25 is securely anchored in the descending aorta 33. Therefore, even when a reaction force acts on a medical instrument 29 such as a guide wire for a therapeutic instrument or a therapeutic instrument when passing through a narrowed portion of a lesion site and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing unit 25. Since the displacement of the side hole 27 can be suppressed, the pushing force applied to the medical instrument 29 can be efficiently transmitted to the distal end of the medical instrument 29. Further, since the backup providing unit 25 is moored in the descending aorta 33, the medical device 29 is effectively provided with a backup force against the reaction force, and the right renal artery 35 is allowed to pass through the stenosis and medical. The instrument 29 can be advanced.
また、湾曲部25aは押し付けられた状態で下行大動脈33の内壁と当接しているので、図3に示されているように側孔27が湾曲部25aと下行大動脈33の内壁との当接箇所の近くに設けられていれば、医療器具29に作用した反力により湾曲部25aが変形しても移動量が小さくなり位置ずれを生じにくい。さらに、図3に示されているように、湾曲部25aと下行大動脈33の内壁との当接箇所と湾曲部25と下行大動脈33の内壁との当接箇所との間に側孔27が設けられている場合、二つの当接箇所の間の部分は、両端部が下行大動脈33の内壁に当接して支持されており、例えば湾曲部25aの当接箇所よりも先端部21に近い側の片持ち状態の部分と比較して、外部からの力に抗して変形が低減されるので、当該部分に設けられた側孔27の位置ずれをさらに抑制する効果を奏することができる。この結果、医療器具29に付与した押し込み力を医療器具29の先端に効率的に伝達させることができる効果と、反力に抗するバックアップ力を医療器具29に提供する効果をさらに向上させることができる。
Further, since the bending portion 25a is in contact with the inner wall of the descending aorta 33 in a pressed state, the side hole 27 is in contact with the inner wall of the descending aorta 33 as shown in FIG. If the bending portion 25a is deformed by the reaction force acting on the medical instrument 29, the amount of movement is small and positional displacement is unlikely to occur. Further, as shown in FIG. 3, a side hole 27 is provided between a contact portion between the bending portion 25 a and the inner wall of the descending aorta 33 and a contact portion between the bending portion 25 and the inner wall of the descending aorta 33. In this case, the portion between the two abutting locations is supported with both end portions abutting against the inner wall of the descending aorta 33, for example, closer to the tip 21 than the abutting location of the curved portion 25a. Compared to the cantilevered portion, deformation is reduced against an external force, so that an effect of further suppressing the displacement of the side hole 27 provided in the portion can be achieved. As a result, the effect that the pushing force applied to the medical device 29 can be efficiently transmitted to the tip of the medical device 29 and the effect of providing the medical device 29 with a backup force against the reaction force can be further improved. it can.
図1に示されている導入補助器具11のバックアップ提供部25に代えて、図2A~図2Cに示されているバックアップ提供部25’,25”,25を使用する場合も、導入管状器官内におけるバックアップ提供部25,25’,25”の配置方法を除いて、図1に示されている導入補助器具11の使用方法と同様である。したがって、以下では、図1に示されている導入補助器具11のバックアップ提供部25と配置方法が異なる図2A及び図2Bに示されているバックアップ提供部25’,25”を使用する導入補助器具11の導入管状器官内における配置方法について説明する。
When the backup providing units 25 ′, 25 ″, 25 shown in FIGS. 2A to 2C are used instead of the backup providing unit 25 of the introduction assisting device 11 shown in FIG. 1 is the same as the method of using the introduction assisting instrument 11 shown in FIG. 1 except for the arrangement method of the backup providing units 25, 25 ′, 25 ″. Therefore, in the following, the introduction assisting device using the backup providing units 25 ′ and 25 ″ shown in FIGS. 2A and 2B, which are arranged differently from the backup providing unit 25 of the introduction assisting device 11 shown in FIG. The arrangement method in 11 introduction | transduction tubular organs is demonstrated.
図2Aに示されているバックアップ提供部25’は、例えば、図4に示されているように、下行大動脈33と上行大動脈39との間に延びる大動脈弓41から分岐する腕頚動脈43、右鎖骨下動脈45、右総頚動脈47、左総頚動脈49、左鎖骨下動脈51などに医療器具29を導入するときの使用に適している。ここでは、左総頚動脈49に医療器具29を導入するときを例に、図2Aに示されているバックアアップ提供部25’の配置方法を説明する。
As shown in FIG. 4, the backup providing unit 25 ′ shown in FIG. 2A includes, for example, an arm carotid artery 43 branched from an aortic arch 41 extending between the descending aorta 33 and the ascending aorta 39, and the right clavicle. It is suitable for use when the medical device 29 is introduced into the lower artery 45, the right common carotid artery 47, the left common carotid artery 49, the left subclavian artery 51, and the like. Here, taking the case where the medical instrument 29 is introduced into the left common carotid artery 49 as an example, an arrangement method of the back-up providing unit 25 ′ illustrated in FIG. 2A will be described.
管状体13のバックアップ提供部25’の概略J字形状の湾曲部25aは、バックアップ提供部25’の側孔27が左総頚動脈49の入口付近に位置するように大動脈弓41内に配置されたときに大動脈弓41に合せて湾曲し且つ側孔27の遠位側及び近位側において大動脈弓41(これに隣接する下行大動脈33及び上行大動脈39を含む)の内壁と当接する当接箇所53,55を生じるような形状及び寸法に予め形成されている。大動脈弓41内に到達するまで予め挿入されている導入補助器具用ガイドワイヤ(図示せず)に沿って、図2Aに示されているバックアップ提供部25’を使用する導入補助器具11の管状体13を大動脈弓41内に挿入して、バックアップ提供部25’に設けられた側孔27が左総頚動脈49の入口付近に位置するように配置する。次に、導入補助器具11から導入補助器具用ガイドワイヤを抜去すると、図4に示されているように、左総頚動脈49の入口付近にバックアップ提供部25’の側孔27が位置する状態で、左総頚動脈49の入口と同じ側の左総頚動脈49の入口の遠位側及び近位側に位置する当接箇所53,55において湾曲部25aを大動脈弓41の内壁と当接させることができる。
The substantially J-shaped curved portion 25 a of the backup providing portion 25 ′ of the tubular body 13 is disposed in the aortic arch 41 so that the side hole 27 of the backup providing portion 25 ′ is located near the entrance of the left common carotid artery 49. An abutment point 53 that sometimes curves to the aortic arch 41 and abuts the inner wall of the aortic arch 41 (including the descending aorta 33 and the ascending aorta 39 adjacent thereto) at the distal and proximal sides of the side hole 27. , 55 are formed in advance in a shape and dimensions. The tubular body of the introduction assisting device 11 using the backup providing portion 25 'shown in FIG. 2A along the guide wire (not shown) for the introduction assisting device that is inserted in advance until reaching the aortic arch 41. 13 is inserted into the aortic arch 41 so that the side hole 27 provided in the backup providing unit 25 ′ is positioned near the entrance of the left common carotid artery 49. Next, when the guide wire for the introduction assisting device is removed from the introduction assisting device 11, the side hole 27 of the backup providing unit 25 ′ is located near the entrance of the left common carotid artery 49 as shown in FIG. The curved portion 25 a can be brought into contact with the inner wall of the aortic arch 41 at the contact points 53 and 55 located on the distal side and the proximal side of the left common carotid artery 49 on the same side as the entrance of the left common carotid artery 49. it can.
側孔27が大動脈弓41内において左総頚動脈49の入口付近に位置する状態で、左総頚動脈49の入口の遠位側及び近位側に位置する当接箇所53,55において概略J字形状の湾曲部25aを大動脈弓41の内壁と当接させると、図4に示されているように、バックアップ提供部25’が左総頚動脈49側の大動脈弓41の内壁に湾曲部25aを押し付けた状態となる。これにより、バックアップ提供部25’の湾曲部25aの側孔27の前後両側部分が左総頚動脈49側の大動脈弓41の内壁に押し付けられて支持される。したがって、病変部位の狭窄部を通過する際に反力が医療器具29に作用し、左総頚動脈49の入口から離れさせる方向にバックアップ提供部25の側孔27の近傍の周壁に伝達されても、側孔27の位置ずれを抑制すると共に、反力に抗するバックアップ力を提供することができる。
In a state where the side hole 27 is located in the aortic arch 41 in the vicinity of the entrance of the left common carotid artery 49, the contact points 53 and 55 located on the distal side and the proximal side of the entrance of the left common carotid artery 49 are substantially J-shaped. When the curved portion 25a is brought into contact with the inner wall of the aortic arch 41, as shown in FIG. 4, the backup providing portion 25 ′ presses the curved portion 25a against the inner wall of the aortic arch 41 on the left common carotid artery 49 side. It becomes a state. Thereby, the front and rear side portions of the side hole 27 of the curved portion 25a of the backup providing portion 25 'are pressed against and supported by the inner wall of the aortic arch 41 on the left common carotid artery 49 side. Therefore, even when the reaction force acts on the medical device 29 when passing through the narrowed portion of the lesion site and is transmitted to the peripheral wall near the side hole 27 of the backup providing unit 25 in a direction away from the entrance of the left common carotid artery 49. In addition to suppressing the displacement of the side hole 27, it is possible to provide a backup force against the reaction force.
図2Bに示されているバックアップ提供部25”は、例えば、下行大動脈33から分岐する右腎動脈35及び左腎動脈37などに医療器具29を導入するときの使用に適している。ここでは、右腎動脈35に医療器具29を導入するときを例に、図2Bに示されているバックアップ提供部25”の配置方法を説明する。
2B is suitable for use when introducing the medical device 29 into, for example, the right renal artery 35 and the left renal artery 37 branched from the descending aorta 33. Here, the backup providing unit 25 ″ is suitable for use. Taking the case where the medical instrument 29 is introduced into the right renal artery 35 as an example, an arrangement method of the backup providing unit 25 ″ shown in FIG. 2B will be described.
管状体13のバックアップ提供部25”の螺旋形状の湾曲部25aは、バックアップ提供部25”の側孔27が右腎動脈35の入口付近に位置するように下行大動脈33内に配置されたときに螺旋形状の湾曲部25aを行大動脈33の中心軸線周りに360°以上にわたって下行大動脈33の内壁と当接する当接箇所を生じるような寸法に予め形成されている。下行大動脈33の右腎動脈35の入口を越える位置に到達するまで予め挿入されている導入補助器具用ガイドワイヤ(図示せず)に沿って、図2Bに示されているバックアップ提供部25”を使用する導入補助器具11の管状体13を下行大動脈33内に挿入して、バックアップ提供部25”に設けられた側孔27が右腎動脈35の入口付近に位置するように配置させる。次に、導入補助器具11から導入補助器具用ガイドワイヤを抜去すると、図5に示されているように、右腎動脈35の入口付近にバックアップ提供部25”の側孔27が位置する状態で、湾曲部25aを下行大動脈33の中心軸線周りに360°以上にわたって右腎動脈35の入口付近の下行大動脈33の内壁と当接させることができる。
When the spiral-shaped curved portion 25a of the backup providing portion 25 ″ of the tubular body 13 is disposed in the descending aorta 33 such that the side hole 27 of the backup providing portion 25 ″ is located near the entrance of the right renal artery 35. The spiral-shaped curved portion 25a is formed in advance so as to generate a contact portion that contacts the inner wall of the descending aorta 33 over 360 ° or more around the central axis of the descending aorta 33. The backup providing portion 25 ″ shown in FIG. 2B is moved along the guide wire (not shown) for the introduction assisting instrument inserted in advance until reaching the position of the descending aorta 33 beyond the entrance of the right renal artery 35. The tubular body 13 of the introduction assisting device 11 to be used is inserted into the descending aorta 33 and arranged so that the side hole 27 provided in the backup providing unit 25 ″ is located near the entrance of the right renal artery 35. Next, when the guide wire for the introduction assisting device is removed from the introduction assisting device 11, the side hole 27 of the backup providing unit 25 ″ is positioned near the entrance of the right renal artery 35 as shown in FIG. The curved portion 25 a can be brought into contact with the inner wall of the descending aorta 33 near the entrance of the right renal artery 35 over 360 ° or more around the central axis of the descending aorta 33.
なお、図2Bに示されているバックアップ提供部25”は、湾曲部25aのほぼ全体を下行大動脈33(導入管状器官)と当接させるので、下行大動脈33の内壁と対面する向き(すなわち螺旋形状の湾曲部25aの径方向外向き)に側孔27を設けると、側孔27が下行大動脈33の内壁によって閉鎖される可能性がある。したがって、側孔27は、図5に示されているように、下行大動脈33の中心軸線方向に向いた湾曲部25aの周壁部分に設けられることが好ましい。
In addition, since the backup providing unit 25 ″ shown in FIG. 2B makes almost the entire curved portion 25a contact the descending aorta 33 (introducing tubular organ), the direction facing the inner wall of the descending aorta 33 (ie, spiral shape) If the side hole 27 is provided on the outer side of the curved portion 25a, the side hole 27 may be closed by the inner wall of the descending aorta 33. Therefore, the side hole 27 is shown in FIG. Thus, it is preferable to be provided on the peripheral wall portion of the curved portion 25 a facing the central axis direction of the descending aorta 33.
側孔27が下行大動脈33内において右腎動脈35の入口付近に位置する状態で、螺旋形状の湾曲部25aを右腎動脈35の入口付近の下行大動脈33の内壁と当接させると、バックアップ提供部25”が下行大動脈33の内壁に湾曲部25aを押し付けた状態となる。これにより、バックアップ提供部25”の湾曲部25aの側孔27が設けられている部分を含む湾曲部25aのほぼ全体が右腎動脈35の入口の周辺の下行大動脈33の内壁に押し付けられて支持される。したがって、湾曲部25aに外力が作用しても湾曲部25aの移動又は変形が抑制され、側孔27の位置ずれを抑制することができる。さらに、湾曲部25aが下行大動脈33の中心軸線周りに360°以上にわたって下行大動脈33の内壁と当接しており、右腎動脈35の入口と対向する下行大動脈33の内壁とも当接して支持されているので、病変部位の狭窄部を通過する際に反力が医療器具29に作用し、右腎動脈35の入口から離れさせる方向にバックアップ提供部25”の側孔27の近傍の周壁に伝達されても、反力に抗するバックアップ力を提供することができる。
In the state where the side hole 27 is located in the descending aorta 33 in the vicinity of the entrance of the right renal artery 35, the spiral curved portion 25a is brought into contact with the inner wall of the descending aorta 33 in the vicinity of the entrance of the right renal artery 35. The portion 25 ″ is in a state where the bending portion 25a is pressed against the inner wall of the descending aorta 33. Thereby, the entire bending portion 25a including the portion where the side hole 27 of the bending portion 25a of the backup providing portion 25 ″ is provided. Is supported by being pressed against the inner wall of the descending aorta 33 around the entrance of the right renal artery 35. Therefore, even if an external force is applied to the bending portion 25a, the movement or deformation of the bending portion 25a is suppressed, and the displacement of the side hole 27 can be suppressed. Further, the curved portion 25a is in contact with the inner wall of the descending aorta 33 for 360 ° or more around the central axis of the descending aorta 33, and is also in contact with and supported by the inner wall of the descending aorta 33 facing the entrance of the right renal artery 35. Therefore, the reaction force acts on the medical device 29 when passing through the narrowed portion of the lesion site, and is transmitted to the peripheral wall in the vicinity of the side hole 27 of the backup providing portion 25 ″ in the direction away from the entrance of the right renal artery 35. However, it is possible to provide a backup force against the reaction force.
図2Cに示されているバックアップ提供部25は、図1に示されているバックアップ提供部25では二つの湾曲部25a,25bのうちの先端部21に近い側の湾曲部25aに側孔27が設けられているのに対して、側孔27が先端部21から近い側の湾曲部25a以外の湾曲部25bに設けられている点を除き、図1に示されているバックアップ提供部25と同じ構成であり、図1に示されているバックアップ提供部25の場合と同様に、側孔27を側枝管状導管の入口付近に配置すればよく、図1に示されているバックアップ提供部25と効果も同様であるので、ここでは説明を省略する。
The backup providing unit 25 shown in FIG. 2C has a side hole 27 in the curved portion 25a closer to the distal end portion 21 of the two curved portions 25a and 25b in the backup providing unit 25 shown in FIG. 1 except that the side hole 27 is provided in a curved portion 25b other than the curved portion 25a on the side closer to the distal end portion 21 except that the side hole 27 is provided in the curved portion 25b. As in the case of the backup providing unit 25 shown in FIG. 1, the side hole 27 may be arranged near the entrance of the side branch tubular conduit, which is the same as the backup providing unit 25 shown in FIG. 1. Since this is the same, the description is omitted here.
以上、図示されている実施形態を参照して、本発明による側孔付き導入補助器具11を説明したが、本発明は図示されている実施形態に限定されるものではない。例えば、図1に示されている実施形態では、概略S字形状をなす二つの湾曲部25a,25bが当接箇所を生じる部分の間に側孔27が設けられているが、側孔27は湾曲部25a,25bの何れかに設けられていればよく、例えば図6に示されているように、概略S字形状をなす二つの湾曲部25a,25bのうちの先端部21に近い側の湾曲部25aにおいて当接箇所よりも先端部21に近い位置に側孔27を設けてもよい。この場合、側孔27が設けられている部分が片持ち支持状態となり、図1に示されている実施形態と比較すると側孔27の位置ずれを生じやすくなるが、少なくとも湾曲部25aを硬質の材料により形成することにことにより、位置ずれを抑制することが可能である。また、図1に示されている実施形態では、概略S字形状をなす二つの湾曲部25a,25bの両方が導入管状器官の内壁と当接箇所を生じるように配置されているが、例えば、図7に示されているように、側孔27が設けられた湾曲部25bと管状体13の中心軸線に対して反対側に湾曲した湾曲部25aのみを導入管状器官に当接させ、側孔27が設けられた湾曲部25bを導入管状導管の内壁と当接させなくてもよい。この場合でも、医療器具29に作用する反力により、側孔27の近傍の湾曲部25bを側枝管状器官の入口から離れさせる方向に力が作用しても、湾曲部25aが側枝管状器官の入口と対向する側の導入管状器官の内壁と当接箇所を生じているので、反力に抗して側孔27の移動を抑制すると共に、バックアップ力を提供することができる。また、先端部材31も必須の構成ではなく、図7に示されているように、先端部材31が管状体13の先端部21に接続されていなくてもよい。
As mentioned above, although the introduction auxiliary instrument 11 with a side hole by this invention was demonstrated with reference to embodiment illustrated, this invention is not limited to embodiment shown in figure. For example, in the embodiment shown in FIG. 1, the side hole 27 is provided between the portions where the two curved portions 25 a and 25 b having a substantially S-shape form contact portions. For example, as shown in FIG. 6, one of the two curved portions 25 a and 25 b having a substantially S shape is provided on either side of the curved portion 25 a or 25 b. The side hole 27 may be provided at a position closer to the distal end portion 21 than the contact portion in the curved portion 25a. In this case, the portion in which the side hole 27 is provided is in a cantilever support state, and the side hole 27 is likely to be displaced as compared with the embodiment shown in FIG. By forming it with a material, it is possible to suppress displacement. Further, in the embodiment shown in FIG. 1, both of the two curved portions 25a and 25b having a substantially S-shape are arranged so as to generate a contact portion with the inner wall of the introduction tubular organ. As shown in FIG. 7, only the curved portion 25b provided with the side hole 27 and the curved portion 25a curved to the opposite side with respect to the central axis of the tubular body 13 are brought into contact with the introducing tubular organ, The curved portion 25b provided with 27 may not be in contact with the inner wall of the introduction tubular conduit. Even in this case, even if a force acts in a direction in which the bending portion 25b in the vicinity of the side hole 27 is separated from the entrance of the side branch tubular organ due to the reaction force acting on the medical instrument 29, the bending portion 25a becomes the entrance of the side branch tubular organ. The side wall 27 is in contact with the inner wall of the introduction tubular organ on the opposite side, so that the movement of the side hole 27 can be suppressed against the reaction force and a backup force can be provided. Further, the tip member 31 is not an essential configuration, and the tip member 31 may not be connected to the tip portion 21 of the tubular body 13 as shown in FIG.
11 導入補助器具
13 管状体
21 先端部
23 本体部
25 バックアップ提供部
25a,25b 湾曲部
27 側孔
29 医療器具
53,55 当接箇所 DESCRIPTION OFSYMBOLS 11 Introduction assistance instrument 13 Tubular body 21 Tip part 23 Main body part 25 Backup providing part 25a, 25b Bending part 27 Side hole 29 Medical instrument 53, 55 Contact location
13 管状体
21 先端部
23 本体部
25 バックアップ提供部
25a,25b 湾曲部
27 側孔
29 医療器具
53,55 当接箇所 DESCRIPTION OF
Claims (8)
- 中心軸線に沿って延び且つ導入管状器官内へ挿入される管状体を備え、該管状体の周壁に側孔が設けられており、管状体の側孔を通して前記導入管状器官から分岐する側枝管状器官内へ医療器具を導入させることができる側孔付き導入補助器具であって、
前記管状体が、先端部と、本体部と、該先端部と本体部との間に設けられ且つ単数又は複数の湾曲部を含むバックアップ提供部とを有し、前記単数又は複数の湾曲部の一つに前記側孔が設けられていると共に、前記単数又は複数の湾曲部のうちの少なくとも一つが、前記管状体を前記導入管状器官に挿入したときに前記導入管状器官の内壁と当接する当接箇所を生じるように形成されていることを特徴とする側孔付き導入補助器具。 A side branch tubular organ comprising a tubular body extending along the central axis and inserted into the introduction tubular organ, the side wall of the tubular body being provided with a side hole, and branching from the introduction tubular organ through the side hole of the tubular body An introduction auxiliary device with a side hole capable of introducing a medical device into the inside,
The tubular body has a distal end portion, a main body portion, and a backup providing portion provided between the distal end portion and the main body portion and including one or more curved portions, One of the side holes is provided, and at least one of the one or more curved portions abuts against an inner wall of the introduction tubular organ when the tubular body is inserted into the introduction tubular organ. An introduction assisting device with a side hole, characterized in that it is formed so as to produce a contact point. - 前記バックアップ提供部は、第1の湾曲部と、前記中心軸線に対して該第1の湾曲部と反対側に湾曲する第2の湾曲部とを含み、前記第1の湾曲部及び前記第2の湾曲部の一方に前記側孔が設けられている、請求項1に記載の側孔付き導入補助器具。 The backup providing unit includes a first bending unit, and a second bending unit that curves to the opposite side of the first bending unit with respect to the central axis, and the first bending unit and the second bending unit. The introduction aid with a side hole according to claim 1, wherein the side hole is provided in one of the curved portions.
- 前記第1の湾曲部と前記第2の湾曲部は、前記側孔が前記側枝管状器官の入口に位置するように前記導入管状器官内に前記管状体を配置したときに前記第1の湾曲部と前記第2の湾曲部の両方が前記導入管状器官の内壁と当接する当接箇所を生じるように形成されている、請求項2に記載の側孔付き導入補助器具。 The first curved portion and the second curved portion are arranged when the tubular body is disposed in the introduction tubular organ so that the side hole is located at an entrance of the side branch tubular organ. The introduction assisting device with a side hole according to claim 2, wherein both of the second curved portion and the second curved portion are formed so as to generate an abutting portion that abuts against an inner wall of the introducing tubular organ.
- 前記側孔が前記第1の湾曲部の前記当接箇所と前記第2の湾曲部の前記当接箇所との間に設けられる、請求項3記載の側孔付き導入補助器具。 The introduction aid with a side hole according to claim 3, wherein the side hole is provided between the contact portion of the first bending portion and the contact portion of the second bending portion.
- 前記バックアップ提供部が、前記側孔を設けられた第1の湾曲部を含み、該第1の湾曲部は、前記側孔が前記側枝管状器官の入口に位置するように前記導入管状器官内に前記管状体を配置したときに前記側孔の遠位側及び近位側において前記導入管状器官の内壁と当接箇所を生じるような形状に形成されている、請求項1に記載の側孔付き導入補助器具。 The backup providing portion includes a first curved portion provided with the side hole, and the first curved portion is formed in the introduction tubular organ such that the side hole is located at an inlet of the side branch tubular organ. 2. With a side hole according to claim 1, wherein when the tubular body is arranged, the side hole is formed in a shape so as to generate a contact portion with an inner wall of the introduction tubular organ on a distal side and a proximal side of the side hole. Introduction aids.
- 前記バックアップ提供部が螺旋形状に延びる螺旋状湾曲部を含み、該螺旋状湾曲部に前記側孔が設けられている、請求項1に記載の側孔付き導入補助器具。 The introduction assisting device with a side hole according to claim 1, wherein the backup providing unit includes a spiral bending portion extending in a spiral shape, and the side hole is provided in the spiral bending portion.
- 前記側孔が前記導入管状器官の軸線方向に向いた前記螺旋状湾曲部の周壁部分に設けられている、請求項6に記載の側孔付き導入補助器具。 The introduction assisting device with a side hole according to claim 6, wherein the side hole is provided in a peripheral wall portion of the spiral curved portion facing the axial direction of the introduction tubular organ.
- 前記側孔付き導入補助器具は、シースイントロデューサ、ガイディングカテーテル又は狭窄部貫通用カテーテルである、請求項1から請求項7の何れか一項に記載の側孔付き導入補助器具。 The introduction auxiliary device with a side hole according to any one of claims 1 to 7, wherein the introduction auxiliary device with a side hole is a sheath introducer, a guiding catheter, or a catheter for stenosis penetration.
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Citations (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPS6058169A (en) * | 1983-06-14 | 1985-04-04 | トマス・ジエイ・フオガテイ− | Catheter deflection guide apparatus and method |
US4909258A (en) * | 1988-08-08 | 1990-03-20 | The Beth Israel Hospital Association | Internal mammary artery (IMA) catheter |
JP2009142357A (en) * | 2007-12-12 | 2009-07-02 | Piolax Medical Device:Kk | Intracorporeal catheter |
JP2009273640A (en) * | 2008-05-14 | 2009-11-26 | Nipro Corp | Guiding catheter |
JP2011072468A (en) * | 2009-09-30 | 2011-04-14 | Terumo Corp | Catheter for coronary artery |
JP2014030672A (en) * | 2012-08-06 | 2014-02-20 | Asahi Intecc Co Ltd | Catheter |
WO2015022972A1 (en) * | 2013-08-13 | 2015-02-19 | 株式会社カテラ | Introduction assistance instrument with side hole |
JP2015119829A (en) * | 2013-12-24 | 2015-07-02 | テルモ株式会社 | Guiding catheter |
-
2014
- 2014-08-05 JP JP2014159908A patent/JP5977291B2/en active Active
-
2015
- 2015-08-04 WO PCT/JP2015/072070 patent/WO2016021591A1/en active Application Filing
Patent Citations (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPS6058169A (en) * | 1983-06-14 | 1985-04-04 | トマス・ジエイ・フオガテイ− | Catheter deflection guide apparatus and method |
US4909258A (en) * | 1988-08-08 | 1990-03-20 | The Beth Israel Hospital Association | Internal mammary artery (IMA) catheter |
JP2009142357A (en) * | 2007-12-12 | 2009-07-02 | Piolax Medical Device:Kk | Intracorporeal catheter |
JP2009273640A (en) * | 2008-05-14 | 2009-11-26 | Nipro Corp | Guiding catheter |
JP2011072468A (en) * | 2009-09-30 | 2011-04-14 | Terumo Corp | Catheter for coronary artery |
JP2014030672A (en) * | 2012-08-06 | 2014-02-20 | Asahi Intecc Co Ltd | Catheter |
WO2015022972A1 (en) * | 2013-08-13 | 2015-02-19 | 株式会社カテラ | Introduction assistance instrument with side hole |
JP2015119829A (en) * | 2013-12-24 | 2015-07-02 | テルモ株式会社 | Guiding catheter |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN109876280A (en) * | 2019-04-03 | 2019-06-14 | 张健 | A kind of the Big Dipper moulding superslide Yarn guide component |
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