JP2005177035A - Medical treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment instrument capable of performing "foreign matter eliminating treatment in a body lumen for catching and collecting a foreign matter within the body lumen via an endoscope" by inserting the same and blood clot eliminating treatment in high quality and high efficiency. <P>SOLUTION: The medical treatment instrument has a flexible linear object in which a core material for operation is slidably threaded through a main linear object section of a hollow twisted wire coil body with a covering outer layer, both the ends of the core material for operation are connected to a front end of the main linear object section and to a proximal side operating section of a rear end of the main linear object section. Further, the medical treatment instrument has an expanding and contracting diameter section comprising the hollow twisted wire coil body with a straight form removing the covering outer layer at the vicinity of the front end of the main linear object section, and has such a structure allowing basket-shaped expanding diameter deformation and contracting diameter deformation from the basket-shaped expanding diameter deformation of the expanding and contracting diameter section by relative slides between the core material for operation and the main linear object section using the proximal side operating section. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a medical treatment instrument that is inserted into a body cavity and used for “intrabody foreign body removal treatment for capturing and collecting foreign bodies in the body cavity via an endoscope”, thrombus removal therapy, and the like.

  A medical treatment instrument used for capturing and collecting foreign matter in a body cavity has a background technique disclosed in Patent Documents 1 and 2, and a typical flexible patent document 1 (see FIG. 4) describes a long flexible tube. An “advanceable operation wire 31” and “several basket wires 32 with a“ bend ”that can be easily deformed into a basket shape at the tip portion” are arranged on the outer periphery of the operation wire 31. A structure in which the tip is integrally connected to the operation wire 31 is shown.

  Then, the operation wire 31 is moved forward and backward by the operation portion at the rear end of the sheath 30, and the “bent portion” of the basket wire 32 is protruded from the distal end of the sheath 30. A treatment method is adopted in which a basket portion 33 having a ball shape contour is formed by enlarging itself, and foreign matter in the body cavity is stored in the basket portion 33, and the stored foreign matter is held and taken out of the body.

Japanese Patent Laid-Open No. 9-19439 JP 2002-159503 A

  In the medical treatment device of the above background art, when each basket wire 32 forming the basket portion 33 is formed into a straight bundle in the sheath 30 and protrudes from the distal end of the sheath 30, each basket wire 32 is centered. It is characterized by a structure that is deformed into a basket-like enormous form that has a free bow shape with the operation wire 31 present in the common string as a common string and gathers with an adjacent interval.

  However, “variation” of bends applied to the basket wire 32 and “dispersion variation in the sheath 30” “inner body viscosity” in which the basket wire 32 comes into contact with the body cavity, contact resistance with the inner wall of the body cavity Due to `` variation '' etc., the individual bow shape becomes `` variable shape that falls or falls and the adjacent gap is excessively large or small '', and the intended basket shape is unstable and tends to be distorted, The enormous form of the basket portion 33 is limited to a single pattern. Further, each strand of the basket wire 32 is pre-pressed with a die and subjected to necessary heat treatment, and then the wires are bound at equal intervals. Therefore, complicated processing means to make it into a basket shape is indispensable, and the structure is complicated and the molding processability is inferior.

  Due to the above-mentioned characteristics of the basket portion, it is difficult to capture and store the foreign substance in the body cavity, and the captured foreign substance may be dropped into the body cavity, which hinders the therapeutic properties.

  The present invention provides a therapeutic treatment tool that solves the above-mentioned problems of the background art.

  The medical treatment tool of the present invention that solves the above technical problems is a flexible linear body in which an operation core material is slidably inserted into a main linear portion of a hollow stranded wire coil body having a coating outer layer, Both ends of the core material for operation are connected to the front end of the main wire portion and the hand operation portion at the rear end of the main wire portion, and the straight outer shape is formed by peeling the outer coating layer in the vicinity of the front end of the main wire body. An expansion / contraction diameter portion composed of a hollow stranded wire coil body, and a basket-like expansion-diameter variation of the expansion / contraction diameter portion and the basket-like expansion / contraction portion by means of relative sliding of the operation core material and the main wire portion by the hand operation portion. It is characterized by a “structure that makes it possible to change the diameter of a diameter from its diameter”.

  That is, the medical treatment instrument of the present invention having the above-described configuration is disclosed in Japanese Patent Application Laid-Open No. 2002-275774, etc. “A hollow stranded wire of a flexible linear body in which a large number of coil wires are twisted on the same circumference. A part of the hollow stranded wire coil body is constituted by constituting a main part by the operation core material inserted in the coil body and the flexible linear body and performing a “pull operation” on the operation core material. It is characterized by the idea that it is made to function as a therapeutic basket portion by deforming the bulge elastically.

  The “relative slide between the operation core and the main filament” in the above configuration means “the relative slide movement between the main filament and the operation core by the pull operation of the operation core by the hand operation unit”. This means that the hollow stranded coil body has a high degree of rotational followability and straightness that is twisted or heat-treated based on a twisting resistance load. Is included.

  And the medical treatment tool of the present invention having the above-mentioned configuration is based on the technical intention to further improve the specific action and effect described later, and the coil strand group of the hollow strand wire coil body at both end portions of the inflated and contracted diameter portion. Aspect with bundling means "Aspect in which the 360 ° twist pitch (coil pitch of the coil wire) of the coil wire of the hollow stranded wire coil body and the length of the expansion / contraction diameter portion before expansion are set to be substantially the same ”Or“ The hand operating part is a screwing mechanism between the female threaded body and male threaded body on the main wire section side and the operating core material side, or an approaching / separating slide mechanism of the operating piece on the main wire section side and the operating core material side. "Aspects comprising:" "Aspects provided with set lock means for locking the arbitrarily expanded diameter state of the expanded / contracted diameter portion" "The operation core material is a stranded wire, and the twist direction of the stranded wire and the hollow stranded wire coil body is changed. It is not the same, and the operation core material is pulled by pulling the operation core material. Ri adopted as needed direction form "twist which tightened.

  In the medical treatment device of the present invention in the basic form, the expansion / contraction diameter portion functioning as a foreign body capturing / recovering portion is constituted by an “exposed form of hollow stranded wire coil body without a coating outer layer”, and Since it has a continuous integrated structure with a “hollow stranded wire coil body having a coating outer layer” other than the expansion / contraction diameter portion, the straight expansion of the straight wire is caused by the pull external force applied to the operation core material in the hollow portion of the main wire portion. The coil wire of the reduced diameter part reacts and reacts elastically and “displaces into an enlarged shape in the shape of a rib assembly basket with an intermediate enlarging / both ends throttle”. When the pull external force is absent, the coil element wire restores itself to the original straight shape by the restoring reaction force of each coil wire and acts to reduce the diameter. When the pull external force is applied, the hollow stranded coil body of the main wire portion other than the expansion / contraction diameter portion has a coating outer layer, so that there is no risk of the expansion diameter change and a normal straight shape is maintained.

  And the coil strand of the hollow stranded coil body in the expanded diameter deformed state is based on the twisting angle (lead angle) by the coil winding, with respect to the operation core material of the center line of the deformed basket shape. It has a `` spiral shape '' and is elastically deformed with the processing stress due to coil winding remaining, so that there is very little geometric distortion due to external force, and the basket part that the spiral coil element group outlines is a gap between the element wires. The basket has a very good basket shape with little collapse, and there is no risk of deformation due to contact resistance or "viscosity" in the body cavity. Have

  Furthermore, the basket portion is composed of a set of “symbols of a spiral coil wire” whose operation core is a string, and the length of the string can be adjusted by the relative sliding degree. By adjusting the chord length, the "flat shape basket part with a large enormous diameter and small enormous span", "spindle form basket part with a small enormous diameter and large enormous span", and an "intermediate form of both" set In addition, since the expansion / contraction diameter portion of the base of the basket portion can be set at an arbitrary position of the main striate portion, it is possible to set various shape patterns of the basket portion that match the circumstances of the body cavity treatment site. Be free. The above shape characteristics and shape changeability make it easy to capture foreign matter in the body cavity and prevent troubles of falling of the captured foreign matter.

  That is, for example, foreign matter in the body cavity is captured in the basket portion by the spindle-shaped basket portion / intermediate shape basket portion, and then the trapped foreign matter in the basket portion is pressed and caught without being dropped by being deformed into the flat shape. Removal treatment is possible.

  Furthermore, the therapeutic treatment device of the present invention can be configured with a main part by two elements of “a hollow stranded wire coil body with a coating outer layer and an operation core material inserted into the hollow stranded wire coil body”. The three elements “sheath 30, operation wire 31, basket wire 32” make the structure simpler than those constituting the main part, and the mechanical structure is stabilized.

  Specifically, in the background art, the basket wire 32 requires “bending” processing and heat treatment processing for holding the bending, and the processing basket wire 32 is bound and arranged on the inner periphery of the sheath 30. Therefore, the moldability of the basket portion 33 is extremely inferior due to the indispensable molding process, and there is a high risk of causing an arrangement error and the shape stability is lacking. However, according to the present invention, it is possible to form an accurate expansion / contraction diameter portion by simply peeling the outer sheath layer of the hollow stranded wire coil body to the required length, and changing the peeling position, and the position of the basket portion can be changed. It can be set freely, can be molded very easily, and can be formed with an accurately shaped expansion / contraction diameter portion.

  Due to the above-mentioned specific action, the medical treatment instrument of the present invention has a high practicality that makes the treatment such as capture and collection of a foreign substance in a body cavity extremely accurate and quick, and particularly improves the therapeutic performance. There are the above main effects.

  Hereinafter, a preferred embodiment based on the basic mode will be described.

  First, a medical treatment instrument 1 (hereinafter simply referred to as a treatment instrument 1) according to an embodiment of the present invention will be described with reference to FIGS. That is, an “inflated / reduced diameter portion 3 that allows the basket portion B for capturing and collecting foreign matter in the body cavity to freely expand and contract” is provided in the vicinity of the front end of the elongated flexible main linear portion 2, and the rear of the main linear portion 2. In the treatment tool 1 for capturing and treating a foreign substance in a body cavity provided with a “hand operating part 5 for inflating / contracting the inflated / reduced diameter part 3” at the end, the main filament part 2 of this embodiment is “a number of wire rods”. A hollow twisted wire coil body 6 formed by forming a hollow portion 10 that is formed by twisting and forming a central core material, or twisting a plurality of wires on the same circumference and penetrating the central portion in the length direction. "Having a structure in which a resinous coating outer layer 8 is integrally provided".

  The resin of the outer coating layer 8 may be any of thermoplastic resins (polyamide, fluorine resin, etc.) and thermosetting resins (phenol resin, epoxy resin, etc.). If it is a thermoplastic resin, Rockwell hardness 80 (R scale) or higher Those having relatively high hardness are preferred.

  In the hollow portion 10 of the main line portion 2, there is an operation core material 4 having a front end connected to the front end of the main line portion 2 and a rear end connected to the front end of the male screw body 12 of the hand operation portion 5. Further, the expansion / contraction diameter portion 3 is “a structure in which only the outer sheath layer 8 of the main wire portion 2 is peeled off and the straight outer periphery of the hollow stranded coil body 6 is exposed as it is”. The length L is set near the tip of the main striated portion 2. In addition, 15 in the figure is a top plug in which the front end of the core 4 for operation is connected by closing the front end of the hollow portion 10 of the main wire portion 2.

  The hand operating section 5 (see FIG. 1 (D)) “cylindrical female screw body 11 having a female screw hole 17 fixed to the rear end of the main wire strip 2 and a male screw screwed into the female screw body 11. The screw 18 has a screwing mechanism comprising a combination of male screw bodies 12 projecting in front of a rod-shaped gripping portion 13, and a handle fin 14 projecting from the outer periphery of the female screw body 11 is held by a fingertip. When the other fingertip is operated to rotate, a pull operation force is generated in the operation core material 4, and the operation core material 4 slides in the hollow portion 10 of the hollow stranded wire coil body 6 of the main wire portion 2, Relative sliding operation of the main line part 2 and the operation core material 4 can be performed.

  The operating core material 4 of this embodiment is a known “1” in which a set of seven strands having a diameter of 0.16 mm, one of which is twisted to the core and the other six to the core. The diameter D3 is about 0.5 mm in the case of a x7 "stranded wire. The hollow stranded coil body 6 is formed by twisting 10 pieces of “twisted strands having a diameter = 0.3 mm” in which a set of 7 strands having a diameter of 0.1 mm is twisted to “1 × 7”. And formed into a long hollow coil body by the following method. That is, after twisting and forming in a rope shape using the twisted strand and the center core material, the center core material is extracted and molded, or the twisted strands are formed without using the center core material. Formed by twisting on the same circumference.

  The hand operating portion 5 of this embodiment uses a screwing mechanism for the female screw body 11 and the male screw body 12 to rotate the male screw body 12 (left rotation for a right screw or right rotation for a left screw) and retreat. Since the operation core material 4 is pulled and operated, the twist direction of the operation core material 4 hollow stranded wire coil body 6 is set as follows. That is, the stranded wire of the operation core material 4 is set in the twist direction (S twist / Z twist) according to the rotation direction of the pull operation, and the coil of the hollow stranded coil body 6 is twisted. The direction is set to a twisted form that is the same as the twisting direction of the twisted wire of the operation core material 4.

  The treatment instrument 1 of FIG. 1 embodiment (see FIG. 2) is inserted into the body cavity from the front plug 15 to capture and treat the foreign body in the body cavity. When pulling the material 4 toward the hand side to move backward within the main striated portion 2 ”, the sliding movement creates an external force that draws the head plug 15 toward the hand side and expands and contracts as an absorption cushion for the external force. The diameter part 3 functions.

  Thus, an expansion force balanced with the pulling external force is generated in the expansion / contraction diameter portion 3, and each of the coil strands 7 is elastically strained outwardly in a middle and high mountain shape, and each of the coil strands 7 has an appropriate amount of interval. As a result, it is deformed enormously into a “basket portion B1 of enormous diameter D1 and enormous span S1” which becomes a contour rib line.

  Then, when the hand operating part 5 is operated in this state to remove the pulling force due to the pulling operation, the basket B1 has the restoring contraction force of the coil wire 7 itself and the forward operating force or the main wire portion of the operating core material 4. With the support of the retreating force 2, each of the coil wires 7 in the enormous deformation state can return to the original position or the original position approximation and can be reduced in diameter to the original posture.

  In the treatment, foreign bodies in the body cavity are captured and collected in the basket portion B1 in the bulging deformation state. After that, in order to prevent the contained foreign matter from falling, the hand operating section 5 is operated to adjust the pull amount of the operation core material 4 so that the basket B1 having the enormous span S1 and the enormous diameter D1 is expanded to the enormous span S2. A treatment method is carried out as needed, which is deformed into a basket B2 having an enormous diameter D2 flat shape, and the foreign substance is pinched and held by the coil wire 7 and accurately recovered outside the body.

  In this embodiment, in order to lock the shape of the baskets B1 and B2 and facilitate the treatment, the lock nut 27 for locking the set position of the female screw body 11 and the male screw body 12 is provided. An “expanded set lock means” attached to the male screw body 12 is provided, and this set lock means operates as follows. That is, since the basket B1 and B2 in the expanded state tries to collapse the expanded shape by the elastic restoring force of the coil wire 7, the collapse of the shape is prevented by the lock nut 27, and the expanded shape of the basket portions B1 and B2 is deformed. Can be locked to the operator's arbitrary shape to further improve the therapeutic properties.

  The treatment tool 1 of the embodiment shown in FIG. 1 has the above-mentioned main effects and the unique action of the good capture and recovery of the trapped foreign matter, and the trapping and recovering treatment of the foreign matter in the body cavity is extremely simple and accurate. Can be significantly improved.

  And since the core material 4 for operation and the hollow strand wire coil body 6 consist of the said twisted structure, while there is no relaxation of the strand wire of the core material 4 for operation by pull operation, and the transmission property of pull operation force becomes favorable ( The hollow stranded wire coil body 6 that is affected by the pull operation rotation in the T1 direction of the operation core material 4 receives an acting force for returning the coil twist in the T2 direction, and has an expansion / contraction diameter existing in the vicinity. There is a specific action for supporting the bulging diameter changing action of the portion 3.

  Furthermore, since the coil wire 7 of the hollow stranded wire coil body 6 constituting the basket portion B is a stranded wire, the following specific effects are obtained. That is, since the coil wire 7 that spirally twists and outlines the basket portion B has a larger surface area than that of the “same shape of straight wires”, the flexibility is improved. It becomes easier to capture and collect the blood and the like, and the blood vessel wall and the like are not damaged.

  Next, a treatment tool 1 according to another embodiment of the present invention will be described with reference to FIG. That is, in the case where the main part is the same as in the embodiment of FIG. 1, the main line 2, the operation core 4, and the expansion / contraction diameter part 3, the treatment instrument 1 shown in FIG. Yes.

  3A, the hand operating section 5 is configured as a proximity / separation slide mechanism for the operation pieces 21 and 22 described in detail below.

  Specifically, a male operating piece 22 which is a tube body connected and fixed to the rear end of the main line portion 2 and has a fingertip locking hole 23 at the rear end, and a male operating piece which passes through the trunk of the male operating piece 22 and passes through. The proximity / separation slide mechanism is constituted by a female operation piece 21 which is slidably moved in the longitudinal direction through a slit 25 cut in the peripheral wall 22 and provided with fingertip locking holes 23 on both sides. .

  Then, by inserting a fingertip into the fingertip locking hole 23 and pulling the female operation piece 21, the main wire portion 2 and the operation core material 4 are relatively slid to move the B1. It is set to the hand operating part 5 which forms the expanded diameter variation and contraction diameter variation of B2. The proximity / separation slide mechanism shown in FIG. 3A also functions in the same manner as the screw engagement mechanism shown in FIG.

  In addition, although not shown in the figure, this embodiment also has an expansion / contraction diameter portion 3 composed of a lock bolt that locks the enormous shape of the basket portion B to an arbitrary shape by set-locking the slide relative positions of the female / male operating pieces 21 and 22. There is provided a set lock means in the expanded state.

  Next, in FIG. 3B, the hand operating portion 5 is composed of the female screw body 11 and the male screw body 12 and has a screwing mechanism, and the operation core 4 is connected to the female screw body 11 and the male screw body 12. It is loosely inserted into the core hole 16 provided, and its rear end is connected to the rear end of the gripping portion 13 via the bearing portion 19 so as to be “relatively rotatable with the male screw body 12”. The “rotating external force preventing means for the operating core material 4” for preventing harmful rotating external force of the operating core material 4 is provided. This rotation external force preventing means is particularly effective when the twist of the operation core material 4 cannot be set in the tightening direction by the pull operation force due to design restrictions or the like. Note that P in the figure is a cap of the bearing portion 19.

  On the other hand, what is shown in FIG. 3C is “binding fixing means by a binding ring body 26 that binds and fixes the coil strands 7 of the hollow stranded wire coil body 6 in a coiled state” at both end portions of the expansion / contraction diameter portion 3. Alternatively, a bundling fixing means for the coil strands 7 group, which is composed of "bundling fixing means for welding and fixing the coil strands 7 in a coil shape", is provided. The binding ring body 26 may be either a pipe-shaped or a close coil spring.

  In the embodiment of FIG. 3 (C), when the expanded diameter deformed portion of the expanded / contracted diameter portion 3, the “stress based on the expanded diameter variation” generated in the coil wire 7 at both ends of the basket portion B is supported by the binding fixing means. As a result, the coil wire 7 prevents the loosening of the coil wire 7, so that the shape of the expansion / contraction diameter portion 3 does not collapse even when the shapes of the expansion / contraction diameter portion 3 and basket portion B are stably changed repeatedly. The unique action becomes more stable and good.

  On the other hand, although not shown, as another embodiment of the present invention, the length L of the expansion / contraction diameter portion 3 may be set to be substantially the same as the 360 ° twisted one pitch of the coil wire 7. In this configuration, when the expansion / contraction diameter portion 3 is deformed, the coil wire 7 constituting the basket portion B has a spiral configuration in which the center line of the expansion / contraction diameter portion 3 is twisted by 360 °. In particular, the foreign matter catching force can be increased in the basket B2 having a large diameter D2 flat shape, and further, when the operation core material 4 is pulled, the spiral-shaped coil strands 7 are brought into contact with each other, The unique action is more stable and improved.

  The hollow stranded wire coil body 6 of the treatment instrument 1 of the present invention is not limited to the above-described embodiments, and is disclosed in Japanese Patent Application No. 2002-358851 of a prior document in the field “twist on the basis of twist resistance load”. "Hollow stranded wire coil body formed in a form of imparting high degree of rotational followability and straightness that has been subjected to heat treatment for removing residual stress by machining" and "coil wire 3 is made of austenitic stainless steel wire. "Hollow twisted wire coil body", "Hollow twisted wire coil body using Ni-Ti alloy wire material showing shape memory characteristics / superelasticity properties as a part of coil wire or the whole coil wire" "The form in which the coating outer layer 8 is partially omitted as long as it does not impede the specific action of the present invention" and "the coating outer layer form of a metal pipe body such as a stainless steel pipe or a copper pipe instead of the resin coating" Main wire strip / hollow stranded wire Le body is the configuration requirements. The operation core material 4 includes a single wire type.

  In the above-described embodiment, only the “expanded diameter portion 3 in an exposed form from which the outer covering layer 8 has been peeled” has been described, but the following form may be adopted. That is, the “expanded diameter part structure with coating” in which a flexible coating such as rubber (natural rubber, urethane rubber, etc.) is formed on the expanded diameter part 3 after the outer sheath layer 8 is peeled off, for example, a catheter or the like. In combination, there may be a configuration in which a treatment method or the like for collecting a foreign substance in a body cavity into a catheter tube may be made while enormously transforming the “inflated / reduced diameter portion with coating” and slidingly contacting the blood vessel wall.

  The basic configuration of the present invention can be widely applied not only for the above-described capture and recovery treatment of foreign matter in a body cavity but also as an “intravascular foreign matter removal treatment tool” and the like.

1 shows a medical treatment instrument according to an embodiment of the present invention, in which (A) is an overall front view of the structure description, and (B) to (D) are partially enlarged front views. (A) and (B) are diagrams explaining the usage and action of the medical treatment instrument of the embodiment of FIG. The other examples of the medical treatment instrument of the present invention are shown, and (A), (B), and (C) are structural explanatory views of the main part thereof. Structure explanatory drawing of medical treatment instrument of background art

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Medical treatment tool 2 Main wire part 3 Expansion / contraction diameter part 4 Operation core material 5 Hand operation part 6 Hollow twisted wire coil body 7 Coil strand 8 Coating outer layer 10 Hollow part of hollow twisted wire coil body 11 Female screw body 12 Male screw Body 13 Grasping part 16 Core hole 17 Female threaded hole 18 Male threaded part 21 Female operating piece 22 Male operating piece 23 Fingertip locking hole 26 Bundling ring body B Basket part D Enormous diameter S Enormous span

Claims (7)

  A flexible wire body in which an operation core material is slidably inserted into a main wire portion of a hollow stranded wire coil body having a coating outer layer, and both ends of the operation core material are connected to a front end of the main wire portion and the main wire portion. It is connected to a hand operation part at the rear end of the main wire part, and has an expansion / contraction diameter part made of the hollow stranded wire coil body in a straight form in which the covering outer layer is peeled off in the vicinity of the front end of the main wire part, A medical device characterized by a structure in which a basket-like expanded diameter of the expansion / contraction diameter portion and a diameter reduction deformation from the basket-shaped expansion diameter are made free by relative sliding of the operation core material and the main striate portion by an operation portion. Treatment tool.   The medical treatment instrument according to claim 1, wherein a bundle fixing means for the coil strand group is provided in the hollow stranded coil body at both side portions of the expansion / contraction diameter portion.   The medical treatment instrument according to claim 1 or 2, wherein the length of the expansion / contraction diameter portion before expansion is set to be substantially the same as the 360 ° twist pitch of the coil strand group of the hollow stranded coil body.   The hand operating section comprises a screwing mechanism of a female threaded body and a male threaded body on the main wire section side and the operating core material side, or a proximity / separation sliding mechanism of an operating piece on the main wire section side and the operating core material side. The medical treatment tool according to any one of claims 1 to 3.   The medical treatment tool according to any one of claims 1 to 4, wherein the coil strand of the hollow stranded coil body is formed of a stranded wire.   The hand operating part is composed of a screwing mechanism, the twisting direction of the operating core material is the same as the rotation direction of the pulling operation of the operating core material by the screwing mechanism, and the twisting direction of the hollow stranded wire coil body The medical treatment tool according to claim 4 or 5, comprising the same twisted form. The medical treatment instrument according to any one of claims 1 to 6, further comprising a set lock means in an expanded state of the expanded / contracted diameter portion.

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