JP2006230635A - Medical treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment instrument 1 of a high-quality sheathed structure which is provided with a fore-end treatment part 5, a back-end hand operation part 4 and a sheathed body 2 of an elongated and flexible solid coiling body penetrated by a core material 3 for operation connecting the fore-end treatment part 5 and the hand operation part 4 and which is not elongated by increase in space between coils even it is crooked in a body cavity or whose core material 3 is not subjected to a tensile load due to bending. <P>SOLUTION: The sheathed body 2 of the medical treatment instrument 1 is composed of a coil of an irregular shaped double strand which is a combination of a tapered isosceles hypotenuse strand 7 and an arcuate circumference strand 8. Their mutually joining edge can relatively slide in the radial direction of the coil body by the bending external force. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to an endoscopic treatment instrument, an endoscopic biopsy forceps, a multi-function surgical instrument, and the like, which are inserted into a body cavity to perform a predetermined treatment such as collection of a living body. It is about.

  The medical treatment tool for treatment in the body cavity is inserted into the body cavity of a narrow and slender blood vessel, and the hand operation part located outside the body is manually operated by “pushing / pulling / rotating” and the front end treatment part is moved. Because it is operated to perform the required intracorporeal treatment, the flexible core material is replaced with an elongated flexible sheath body, and the core material is treated at the proximal end of the sheath body and the distal end treatment of the sheath body front end. The basic form connected to the unit is widespread, and there are background arts shown in Patent Documents 1 to 4.

  That is, the medical treatment instrument of Patent Document 1 is characterized by a structure in which a core material is inserted into a sheath body of a “single-wire closely wound long coil body”. Both the endoscopic treatment tool of Document 3 and the multi-function surgical instrument of Patent Document 4 are characterized by the sheath structure of a “single-element tightly wound coil body”.

JP 2001-017386 A JP 2002-011017 A Japanese Patent Laid-Open No. 10-290803 JP 2002-282261 A

  Since the sheath body of the medical treatment device of the above background art is composed of “a close coil form in which a single coil element wire is tightly wound around a required diameter”, if a long sheath body is inserted into a winding blood vessel, the sheath body is bent. In the sheath body at the site, the coil wire on the outside of the bending that generates a tensile load due to bending is bent and deformed by generating a gap between the wires according to the bending external force, and the bending is maintained while maintaining the bending stress. The coil wire inside the bend that generates a compressive load due to bending is similarly bent and deformed while keeping the bending compressive stress, and the bent state is maintained.

  From the above bending process, the bending deformation portion of the sheath body always has a restoring stress to the straight form, and thus the restoring force brings the vessel wall into a state of being strongly pressed against the vessel wall and causing damage to the vessel wall. Inhibits the body's insertion advanceability.

  Further, the bending neutral line of the center line of the sheath body expands and deforms due to the bending deformation, and the sheath body inevitably undergoes an elongated deformation. Accordingly, the effective length of the core material penetrating the hollow portion of the sheath body is changed and a strong tensile load is generated. Therefore, a harmful operating force is generated in the distal treatment section 5 during the insertion into the body cavity, or the hand operation is performed. There is a difficulty that the operability of pushing, pulling, and rotating the core material by the part is hindered and the therapeutic property is impaired. In addition, the detailed description of the sheath body of this background art will be supplementarily described in the paragraph of the effect of the present invention to be described later in comparison with the operation effect of the sheath body of the present invention.

  The medical treatment instrument 1 of the present invention that solves the above technical problems (see FIG. 1 showing its basic form) is provided with a front-end distal treatment section 5 and a rear-end hand operation section 4, and the distal treatment section 5 In a medical treatment instrument 1 comprising a sheath body 2 of an elongated flexible close-wound coil body through which an operation core material 3 connected with a hand operation section 4 is inserted, the sheath body 2 is a tapered isosceles strand 7 having a tapered isosceles side. And an arc outer peripheral wire 8, and is characterized by a structure comprising a deformed complex wire coil portion in which the mutual joint edges are relatively slidable in the radial direction of the coil body by a bending external force ”.

  That is, the sheath body of the medical treatment device of the present invention having the above-described basic structure has the above-mentioned isosceles elemental wire and arcuate outer peripheral wire that are paired by joining the side surfaces to each other by the bending external force of the sheath body. Easily composed of the concept of “relatively sliding in the direction approaching or moving away from the center of the sheath body to absorb the tensile stress / compressive stress caused by bending deformation and to be able to bend and deform without causing gaps between wires” It is.

  In addition, the tapered isosceles strand 7 in the above-mentioned constituent elements means an isosceles triangle (see FIG. 1 (C)), and the isosceles are a straight surface and a gently curved surface aligned with the outer periphery of the arc outer periphery. And rounded corners are included. The arc outer peripheral line 8 means “a circular line / notched circular line having a chord”, and the strands 7 and 8 are formed by mutually joining the isosceles hypotenuse and the arc outer periphery as illustrated in FIG. Combine with.

  The medical treatment tool 1 according to the present invention, which has the basic structure sheath body 2 as a main part, has the following specific main functions and effects. That is, (see FIG. 2 (B)) the sheath 30 of the background art composed of the single-strand coil body 31 is subjected to a bending external force at the bending portion in the body cavity, and the coil element outside the coil center line 6 of the bending neutral plane. The wire 31 creates a gap C between the wires that is proportional to the tensile stress caused by bending, and the wire 31 is bent and deformed while maintaining the restoring stress to the straight state. Therefore, both ends of the bending deformation are pressed against the blood vessel wall by the restoring stress, and sliding insertion is continued or set, so that the body cavity wall such as the blood vessel wall is damaged, and the insertion into the body cavity to be performed subsequently is performed. Inhibits insertion.

  Further, the coil body on the tension side of the sheath body 30 in the bent state becomes longer due to the generation of the inter-element gaps C, and is bent very many times in the body cavity, so that the above-mentioned lengthening phenomenon is accumulated at each bending point. In the body cavity insertion set state, a considerable amount of the sheath body 30 is elongated. Thus, the effective operation length of the core material 3 in the sheath body 30 is remarkably reduced by the lengthening of the core material, or harmful tension is generated in the core material 3 to reduce the operation function of the distal treatment section 5 by the hand operation section 4. Therefore, there is a difficulty in impairing the therapeutic properties.

  On the other hand, the sheath body 2 of the medical treatment instrument 1 of the present invention having the above-described basic structure is composed of the above-described relatively slidable element combination by bending stress (see FIG. 2 (A)) and passes through the body cavity bending portion. In some cases, the pushing force of the sheath body 2 is easily and freely bent and deformed without generating any gap between the strands 7 and 8. And without bending stress, it can bend and deform in conformity with the bent shape of blood vessels, etc., and can be easily bent and deformed easily with a little external force. It has the property of being straight and maintaining its shape.

  Therefore, when inserting into a body cavity that is bent in a complicated manner, the distal treatment section 5 is being inserted due to the tension of the core material 3 because the insertion progresses very smoothly without adapting to the bent shape and generating a gap between the strands. Therefore, the function is stably ensured, and the operation function of the distal treatment section 5 by the hand operation section 4 after arrival of the lesioned part is extremely well stabilized. And there is almost no restoring force repulsion force by the bending deformation during the insertion progress of the sheath body 2 or after the insertion set, and there is no possibility that the blood vessel wall or the like is damaged by the bending deformation.

  In other words, in the above-mentioned constituent element “tapered isosceles element wire 7 and arc outer periphery element wire 8” which joins the side edges of the inclined surface and the arc surface to each other as separate element wires, the joining part approaches the coil center. Because of the “slope and arc joint” configuration, which easily slips in the direction of the wire or away from the wire, it is extremely easy to generate a relative slip due to the “external compression or tensile force between the wires in the sheath body length direction” due to the bending external force. The coil form of the sheath body 2 is accurately maintained without generating an interstitial gap and absorbing the bending external force without causing an increase in length due to bending.

  When a straight restoring external force is applied in the bent state, the element wire receives an external force in the direction opposite to the bending deformation, causing a relative slip of returning to the original position, and restoring to a straight configuration without causing stress to remain. And it is possible to repeat the straight-line change. In addition, since the relative slip amount of the sheath body 2 in the body cavity is a very small amount, and the “slope side and arc joining form”, there is no possibility that the joining element wire is detached and the coil form is lost, and the normal coil The shape can be maintained.

  If supplementary (see FIG. 2 (C)), when the “basic specifications and the free length (L) of the core material 3 in the straight state” are the same, the amount of change in the free length by the sheath body 30 of the background art is δ1. It becomes (A1-L) and the sheath body 30 side is drawn (minus side). On the other hand, the amount of change in the floating length by the sheath body 2 of the present invention is δ2 (A2-L), and is far from the sheath body 2 although it is minute. The reason why the free length (L) by the sheath body 30 of the background art is reduced is that when the sheath body 30 is bent, a gap is opened between the coil strands and the entire length is increased, and the core material is inserted into the sheath body 30 accordingly. Because it is drawn. The reason why the floating length (L) by the sheath body 2 of the present invention is slightly increased is that when the sheath body 2 is bent, each strand does not generate a gap between the strands due to relative sliding movement, and the sheath body 2 This is because the overall length of 2 hardly changes, and the core material is disposed within the sheath body 2 at the shortest distance at the bent portion.

  Furthermore, the sheath body 2 of the present invention has the following specific effects. That is, (see FIG. 2 (D)), the deformed complex line forming the sheath body 2 has a form in which the air gap 12 is generated by sliding relative to each other at the bending portion, and the air gap 12 functions as a reflection echo portion. By providing a known resin coating F on the outer periphery of the body 2, the reflection echo portion functions as a “reflection air layer”, and a clearer ultrasonic observation image can be drawn under the “ultrasonic three-dimensional echo” at the time of treatment.

  This is because such voids 12 are more likely to reflect ultrasonic waves than body tissue, and the body tissue and the air layer have a difference in acoustic impedance (product ρC of tissue density ρ and sound velocity C). This is because the ultrasonic wave is almost reflected at this boundary surface in order to make it very large. And since such a space | gap 12 is a continuous spiral groove, it can be made to recognize an image as a continuous bending form part. As a result, under the “ultrasonic three-dimensional echo”, the therapeutic property can be further improved.

  A preferred embodiment of the present invention having the above basic form will be described below with reference to FIGS.

  First, FIG. 3 shows a distal operation section 5 including a hand operation section 4 including a push-pull operation piece 11 at both ends of a sheath body 2 through which the core material 3 is inserted, and a biopsy cup 12 opened and closed by pushing and pulling the core material 2. 2 shows a medical treatment tool of “endoscopic treatment tool 20 and endoscopic biopsy forceps 21” having a known form, and the sheath body 2 has a structure with the resin coating F of the basic form. Is set to

  The embodiment shown in FIG. 3 has the following special effects. In other words, the sheath body of the background art is in a state in which the core member 3 is operated only by bending the sheath body 2 due to the generation of gaps between the strands due to the rapid bending of the curved portion in the body cavity and the accumulation of the bending forms. In addition, the biopsy cup 12 opens and closes or rotates against the surgeon's intention at the bent portion or the like in the body cavity, and there is a trouble that impairs the therapeutic properties such as damaging the inner wall of the body cavity. However, in the present embodiment, due to the above-mentioned unique action, even if the bending due to insertion into the body cavity becomes large, it does not open / close or rotate against the operator's intention, and good rotational operability / length of the sheath body 2 The opening / closing operability of the biopsy cup 12 can be secured satisfactorily by preventing the scaling. Then, a clear image can be drawn by the formation of a reflective echo portion and a reflective air layer in an ultrasonic environment, and treatment for collecting a living tissue can be performed very easily and accurately.

  Next, FIG. 4A shows a biopsy tissue by expanding and contracting the loop portion 13 of the distal treatment section 5 at the distal end of the sheath body 2 by “pushing / pulling / rotating operation” of the hand operation section 4 at the rear end of the sheath body 2. FIG. 4B shows a distal end treatment of the front end of the sheath body 2 by a pull operation of the hand operation section 4 at the rear end of the sheath body 2. FIG. 4 shows a medical treatment instrument 1 of a multi-function surgical instrument 23 in a known form in which the clip 14 of the section 5 is placed in a living tissue, and any of the sheath bodies 2 in FIGS. 4A and 4B is also in the basic form. Is set in the structure.

  The above-described embodiment of FIG. 4 has the following specific actions based on the main specific actions of the present invention. That is, the endoscopic treatment tool of the background art has poor operability of the loop portion 13 due to the generation of the tensile force of the core material 3 due to bending deformation, and the binding force of the polyp by the loop portion 13 changes, resulting in insufficient binding force. There are troubles that cause polyps to drop out or cause poor polyp binding. However, in FIG. 4A of the present embodiment, even if the sheath body 2 inserted into the body cavity has an extremely bent form, each strand of the sheath body 2 causes relative sliding movement, and the core material 3 is effective. Since the operating length is not significantly reduced, the opening operation of the loop portion 13 for collecting the biological tissue is stably maintained, and the good collection of the biological tissue can be ensured by preventing the swinging of the loop portion 13 and performing a good operation. And the said therapeutic property improves especially by the clear ultrasonic observation image drawing by the said reflective echo part and reflective air layer formation.

  4 (B) shows that in the prior art “sheath body is in the form of tightly wound coil”, when it is bent in the body cavity, the coil wire on the pulling side of the bent portion is opened and the effective length of the core 3 is increased. There are troubles that greatly change and cause position fluctuation / swing of the clip 14 to make the operability difficult or cause the clip 14 to be placed in the body. However, since the sheath body 2 has the above basic form, the amount of change in the length of the sheath body 2 is extremely small even when extremely bent and deformed in the body cavity, and the operability is extremely stable without causing a shortage of the operation stroke. The therapeutic properties of 14 body cavity placements are particularly improved.

  For details (see FIG. 4 (C)), when the multi-function surgical instrument 23 is operated by pulling the hand operating portion 4, the clip coil 15 is extended by receiving and supporting the reaction force of the sheath body 2 wound with a close coil. This is an operation process in which the clip 14 is placed in the body. In this case, when the sheath body according to the background art is bent, a gap is formed between the lines on the pulling side where the radius of curvature is large, so that the clip 14 enters the sheath body and the clip position from the tip changes. When the compression reaction force is received by the hand operation, the gap between the lines becomes small, and the sheath body swings due to the magnitude of the operation force thereby causing damage to the digestive tract and the like.

  Furthermore, since the operation stroke is absorbed by the coil spring of the sheath body, it becomes difficult to transmit the required tension stroke to the distal end portion, and there is a problem that the clip hook 15 is not stretched and cannot function in the body.

  However, the sheath body 2 of the present invention has an extremely small length change amount even when bent, and there is no shortage of the operation stroke. Moreover, the operation responsiveness is extremely good and stable regardless of the bending form. Clip placement can be secured.

  Next, another embodiment will be described with reference to FIG. That is, FIG. 5A shows a known form of endoscope in which the endoscope of the distal treatment section 5 is varied by adjusting the tension of the core material 3 (wire) in the sheath body 2 by rotating the hand operation section 4. In FIG. 5B, a “lead wire 26 that hits the core material 3” is inserted into the sheath body 2, and a sensor 27 connected to the distal end of the lead wire 26 (on the distal treatment section 5). A guide wire 25 with a sensor provided) is shown, and any of the sheath bodies 2 is set to the structure of the basic form.

  5 (A) and 5 (B) above are the basic configuration in which the sheath body 2 exhibits the main effects described above, the endoscope 24 has the operability of the distal treatment section 5 of the sheath body 2. Since it is not influenced by the bending form, the therapeutic performance is further improved by a particularly high performance that does not cause fluctuations / oscillations caused only by bending and also does not cause an operation contrary to the operator's intention. The sensor-equipped guide wire 25 is a special subordinate such as “preventing blood pressure wave instability waveform due to turbulent flow from the gap between the coil wires of the background art” and “preventing image stop trouble due to disconnection of the lead wire 26”. Has a working effect.

  That is, when the “guide wire with sensor” made of the sheath body of the background art is inserted into the blood vessel for confirmation of the postoperative effect of the coronary artery occlusion portion, the lead wire 26 is pulled due to bending deformation by the blood vessel bending portion, and the wire breaks. Then, there is a trouble of losing the function of the sensor 27, and furthermore, an excessively large wire gap is generated in a sudden bending part, and the blood flow may be turbulent. This turbulent flow causes blood wave measurement to show an unstable waveform. There is a defective phenomenon that hinders measurement. However, in the case of the sheath body of the present invention, since there is no generation between the wire gaps, unnecessary tension is not generated on the lead wire 26, and the above conventional problems are solved.

  Next, another embodiment will be described with reference to FIG. That is, in the medical treatment instrument 1 having the sheath body 2 as a main part, the one shown in FIG. 6A is a distal end side zone 2A having the basic form and a hollow stranded coil body connected in series to the distal end side zone 2A. It is set to the two-zone form of the hand side zone 2C. In FIG. 6B, the tip side zone 2A also comprising the basic configuration, the intermediate zone 2B comprising a hollow stranded coil body, and the hand side zone 2C comprising a flexible hollow tube are connected in series. It is set to a linked three-zone form.

  The above FIG. 6 has the following specific actions. That is, since the medical treatment instrument 1 is inserted deeply into the body cavity of a bent tubule such as a meandering blood vessel or a digestive tract, it has a slanting characteristic in the longitudinal direction and has good pushing / rotating operability due to the rigidity at hand. 6A and 6B is a “preferable general technical concept” for ensuring smooth insertion and smooth insertion / deep insertion into the body cavity by the tip softness. Therefore, the embodiment of FIG. In addition, the general technical characteristics of the pre-flexible go-go by the multi-zone form can be provided together.

  And if it supplements further, since the thing of FIG. 6 (A) uses a hollow stranded wire coil body unlike the case of a single strip coil body, the rotational transmission force to the front end side can be improved. The reason for this is that when the proximal side operation part is rotated, in the case of a single-strand coil body, the structure that supports the rotational force with a single wire, the contact between the bent part and the body cavity inner wall, etc. This is because a homogeneous twist pool has occurred. On the other hand, since the hollow stranded coil body uses a large number of strands, each strand is inclined toward the central axis side of the hollow stranded coil body, and this inclination angle is a single coil body. Since it is “larger” than the case of, a smoother rotational force can be transmitted to the tip side.

  The hollow stranded wire coil body used here is preferably in a twisted form by a rope stranded wire machine. The reason is that by forming a work-affected layer (cured layer) on the entire circumference of the strand simultaneously with twisting, the hollow stranded coil body can be homogenized over the entire length (in the multi-strand mandrel winding method, Multiple gaps are likely to occur in multiple winding units). And since the thing of FIG. 6 (B) consists of a hollow tube body, it becomes a structure which becomes easy to transmit a hand side rotational force to a front end side, and has the inclination function corresponding to bending forms, such as a body cavity.

  If supplemented, the hollow stranded coil body used in the multi-zone configuration is a hollow configuration in which a large number of strands are twisted into a rope shape using a rope twisting machine, and the central member is removed, or a large number A form in which the strands are twisted in a hollow shape is preferable, and this form is “processed alteration layer (cured layer) on the entire circumference of the wire by passing a jig for corrugation and shaping with a rope twisting machine” Is formed. The zone connection is performed by a method such as “brazing / welding / caulking by pipe piece”.

As an example of a hollow stranded wire coil body, for example, 12 stainless steel wire rods (austenite type) having a wire diameter of 0.33 mm are twisted so that the outer diameter of the coil body becomes 1.6 mm. Further, the configuration having a wire diameter of 0.33 mm may be a configuration in which seven strands having a diameter of 0.11 mm are twisted. And you may use the twisted structure made into the mixed stranded wire of the stainless steel wire and the nickel-titanium alloy wire which has a superelastic characteristic, or any one. The material used for the hollow tube may be a stainless steel wire or the nickel / titanium alloy wire. Furthermore, the deformed complex wire used in the present invention is an arc outer peripheral wire with a diameter of 0.3 mm, an isosceles strand with a base of 0.35 mm and a height of 0.3 mm, and the material used is a stainless steel wire. In order to facilitate the coil forming process, one of the two types of wire is softened by heat treatment (tensile strength is 80 to 120 kgf / mm ² ) and hard material (tensile strength is 180 to 300 kgf / mm ² ). It is good also as a structure using the combination. Moreover, you may use the said nickel-titanium alloy wire which has a shape memory characteristic.

The basic form of the sheath body of the medical treatment tool of this invention is shown, (A) is the whole front view, (B) is the structure explanatory drawing of the sheath body, (C) is the shape explanatory drawing of the strand of a sheath body 1A and 1B are explanatory views of the bending form, and FIGS. 1C and 1D are explanatory views of the specific action. 1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are front views thereof. The medical treatment tool of this invention 1 example is shown, (A) (B) is the front view, (C) is action explanatory drawing. 1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are front views thereof. 1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are partial front views thereof.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Medical treatment tool 2 Sheath body 3 Core material 4 Hand operation part 5 Tip treatment part 6 Coil centerline 7 Tapered isosceles hypotenuse element 8 Arc outer periphery strand 12 Biopsy cup 13 Loop part 14 Clip 20 Endoscope treatment Tool 21 Endoscopic biopsy forceps 22 Endoscopic treatment tool 23 Multi-function surgical instrument 24 Endoscope 25 Sensor-equipped guide wire 30 Background art sheath body C Cavity F Covering

Claims (10)

  It comprises a sheath body of an elongated flexible close-wound coil body having a front end treatment section and a rear end hand operation section, and through which an operation core material connecting the front treatment section and the hand operation section is inserted. In the medical treatment instrument, the deformed complex wire coil in which the sheath body is a combination of a tapered isosceles hypotenuse element wire and an arc outer periphery element wire, and the mutual joining edge is relatively slidable in the radial direction of the coil body by a bending external force A medical treatment tool characterized by a structure comprising:   The medical treatment instrument according to claim 1, wherein the tapered isosceles hypotenuse element wire is an isosceles triangle line of an equilateral concave arc.   The medical treatment instrument according to claim 1, wherein the arc outer peripheral wire is formed of a notched circular line in which a chord is formed in parallel with the coil center line.   Endoscopic treatment of a biological tissue collection structure comprising the sheath body according to any one of claims 1 to 3, wherein the biopsy cup of the distal treatment section is opened and closed by a push / pull operation of a core material by a hand operation section. Medical treatment instrument for biopsy forceps for endoscopes and endoscopes.   An endoscopic treatment instrument structure comprising the sheath body according to any one of claims 1 to 3, wherein the core tissue pulling operation of the distal treatment section is reduced in diameter by pulling the core material by a hand operation section. Medical treatment tool.   A medical treatment instrument having a multifunctional surgical instrument structure comprising the sheath body according to any one of claims 1 to 3, wherein a clip of a distal treatment section is placed in a living tissue by a pulling operation of a core material by a hand operation section.   A medical treatment of an endoscope structure comprising the sheath body according to any one of claims 1 to 3, wherein the distal end treatment portion is variably operated by adjusting the tension of the wire by a rotating operation of the core material wire by the hand operation portion. Treatment tool.   A medical treatment instrument having a guide wire structure with a sensor, comprising the sheath body according to any one of claims 1 to 3, wherein a sensor is incorporated in a coil body of the sheath body.   A two-zone configuration in which the sheath body is composed of a distal-side zone comprising the deformed complex wire coil portion of any one of claims 1 to 3 and a proximal-side zone comprising a hollow stranded coil body connected in series to the distal-side zone. Medical treatment tool. A sheath body comprises a distal end side zone comprising the deformed complex wire coil portion according to any one of claims 1 to 3, an intermediate zone comprising a hollow stranded coil body connected in series to the distal end side zone, and an intermediate zone. A medical treatment instrument in a three-zone configuration comprising a proximal zone comprising hollow tubes connected in series.

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