JP2006247148A - Medical treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment instrument which has remarkably improved operability, enables a biological tissue to be accurately and speedily collected in a short period of time and provides considerably enhanced treatment property to a patient. <P>SOLUTION: With advancing/retracting operation of a long sheath 11, the distal end part 8a of a treatment instrument sheath 8 is set at a desired biological tissue collecting position in the cardiac ventricle H. Thereafter, a wire 7 of a hand operation part 1 is operated to open/close a collection cup 9 to collect the biological tissue at the interventicular septum J. In this case, a formed shape at the distal end part 8a of the treatment instrument sheath 8 is varied, so that the biological tissue in the vicinity of the interventicular septum J can be collected extending a wide area. The long sheath 11 housing the treatment instrument sheath 8 inside is curved and deformed so as to follow the shape of the inside of the cardiac ventricle H, so that advancing/retracting operation of the treatment instrument sheath 8 inside the cardiac ventricle H is facilitated without damaging the ventricular wall etc. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a medical treatment instrument that is percutaneously inserted into a living tissue collection site for tissue collection using a long sheath sheathed on the treatment instrument sheath.

  In recent years, hospitals have been equipped with medical treatment tools that collect biological tissues such as the heart ventricle and treat diseases at an early stage. At this time, in inserting the medical treatment instrument into the body, consideration is given to improving operability and reducing the burden on the patient. In particular, it is important to improve the malfunction that the sheath structure made of the single-contact tightly wound coil spring body has on the collection of living tissue in the variable structure at the distal end of the medical treatment instrument. That is, when the single-strand closely wound coil spring body is bent and deformed, its outer peripheral side is extended, and a gap is generated between the coil wires. If the core wire is pushed in this state, the reaction force is absorbed in the portion where the gap is generated, resulting in a malfunction that causes a shortage of stroke.

Among medical treatment tools, there are electrode catheters (for example, Patent Document 1), endoscope treatment tools (for example, Patent Document 2), deflection type catheters (for example, Patent Document 3), and ultrasonic puncture needles (for example, Patent Documents). Various medical devices such as 4) have appeared.
In the electrode catheter of Patent Document 1, a hollow bending restricting body is interposed in the exterior of a core material that has been subjected to shape memory processing using a superelastic wire and having a distal end portion as a bending portion, and these are flexible. The hollow tube is inserted into the tube to adjust the bending of the tube at the tip.

In the endoscope treatment tool disclosed in Patent Document 2, the one-handed operation in which the distal end portion of the sheath has a variable structure by bending the distal end portion of the sheath into a fixed shape and inserting and moving the hard member into the sheath from the curved portion. It is configured in a shape.
In the deflection type catheter of Patent Document 3, a wire rope is connected to the distal end portion and the hand portion is operated, so that the shape of the distal end portion can be changed and operated with one hand.

In the ultrasonic puncture needle of Patent Document 4, a plurality of annular grooves are formed on a needle tube based on a processing pattern by a YAG laser or the like, and a large number of reflection echoes are obtained with respect to incidence of ultrasonic waves. .
JP 2002-191571 A JP 2002-253563 A JP-T 9-504445 JP 2004-181095 A

However, Patent Document 1 is an improvement that includes an electrode catheter that adjusts the shape of the tip, and there is no means to eliminate the drawbacks of the sheath structure formed of a single-strand closely wound coil spring body. There is no description of a configuration that greatly improves the performance.
Moreover, in patent document 2, only the description example of the treatment tool for endoscopes is shown, and there is no measure for eliminating the defect of the sheath structure composed of the single-contact tightly wound coil spring body. There is no mention.

Further, in Patent Document 3, although there is a description that the shape of the distal end portion of the deflecting catheter is variable, there is no mention of the point of eliminating the defect of the sheath structure and the configuration of the biological tissue collection system as in Patent Document 2. Is.
Furthermore, in Patent Document 4, although a needle tube image is clearly depicted on an ultrasonic observation image at the time of collection of a tissue or body fluid in a body cavity, there is no configuration for eliminating the disadvantages of a single-strip close-coiled coil spring body. Is the same as in Patent Documents 1 to 3.

  The present invention has been made in view of the above circumstances, and the purpose thereof is to improve the operability dramatically by accurately and quickly collecting a living tissue, thereby causing pain to the patient. An object of the present invention is to provide a high-performance medical treatment instrument that can be significantly reduced and can significantly enhance the therapeutic properties.

  According to the first aspect of the present invention, in the medical treatment instrument in which the distal end treatment instrument is opened and closed by penetrating the core line in the treatment instrument sheath and pushing and pulling the core wire at the hand operation unit, The long sheath is sheathed, and the distal end of the long sheath and the distal end of the treatment instrument sheath are shaped so that the radius of curvature of the distal end of the long sheath is larger than the curvature radius of the distal end of the treatment instrument sheath, The shaping shape at the distal end portion of the treatment instrument sheath is made variable by the advance / retreat operation of the long sheath.

  As the long sheath is advanced or retracted, for example, the desired living tissue collection position is set in the heart ventricle, and then the core wire of the hand operation unit is operated to open and close the distal treatment instrument to move the living body to the ventricular septum position. Collect tissue. At this time, since the shaping shape at the distal end portion of the treatment instrument sheath is variable, it is possible to collect biological tissue in the vicinity of the heart-ventricular septum over a wide range.

  In addition, since the radius of curvature of the distal end portion of the long sheath is set to be larger than the radius of curvature of the distal end portion of the treatment instrument sheath, the long sheath in which the treatment instrument sheath is housed is the shape of the inside of the heart ventricle Accordingly, the operation instrument sheath can be easily advanced and retracted inside the heart ventricle without damaging the ventricular wall. For this reason, biological tissue collection can be performed accurately and quickly in a short time, pain to the patient can be greatly reduced, and effective therapeutic properties can be greatly improved.

  According to the second aspect of the present invention, the distal end treatment instrument is opened and closed by penetrating the core wire in the treatment instrument sheath and pushing and pulling the core wire at the hand operation portion, and between the core wire and the treatment instrument sheath. This is a hand-operated operating part that can be advanced and retracted through a hollow pipe. The shaping shape at the distal end portion of the treatment instrument sheath is made variable by advancing and retracting the hollow pipe.

  In this case, the treatment instrument sheath is variable by a forward / backward operation of a hollow pipe penetrating between the core wire and the treatment instrument sheath. For this reason, unlike the long sheath advance / retreat operation, the treatment instrument sheath can penetrate into the deep part of the living tissue collection position on a straight line without being affected by the position of the long sheath, even in a narrow collection space. The robot moves forward while maintaining a certain rigidity. As a result, as in the case of claim 1, it is possible to collect biological tissue accurately and quickly in a short period of time, and it is possible to greatly relieve pain to the patient and remarkably enhance effective therapeutic properties.

In the invention according to claim 3, the long sheath is sheathed on the treatment instrument sheath, and the distal end of the long sheath and the distal end of the treatment instrument sheath are arranged such that the radius of curvature of the distal end of the long sheath is that of the distal end of the treatment instrument sheath. It is shaped so as to be larger than the radius of curvature, and the shaped shape at the distal end portion of the treatment instrument sheath is made variable by advancing and retracting the hollow pipe.
Since the radius of curvature of the distal end portion of the long sheath is set to be larger than the radius of curvature of the distal end portion of the treatment instrument sheath, the long sheath in which the treatment instrument sheath is accommodated conforms to the shape of the inside of the heart chamber. Thus, the medical treatment instrument can be easily advanced and retracted in the heart ventricle without damaging the ventricular wall or the like.

In the invention of claim 4, the treatment instrument sheath is sheathed with a long sheath, and a rotation / position holding mechanism is provided at the proximal end of the long sheath so that the proximal operating portion can be set and held at a desired position. Features.
The rotation / position holding mechanism functions as a set-lock means, and the distal end of the treatment instrument sheath can be rotated / positioned at a location convenient for collection of biological tissue, and accurate and quick biological tissue collection is performed. be able to.

In the treatment instrument sheath according to the fifth and sixth aspects of the present invention, a coil wire having a substantially circular cross section and a coil wire having a substantially triangular cross section having a tapered inclined side toward the center are alternately adjacent to each other. It is characterized by the structure of a hollow coil body.
In this case, when the hollow coil body is bent, a slight relative sliding movement occurs between the adjacent coil wires, unlike the single-strand wound coil spring body, and there is a gap between the adjacent coil wires on the outer peripheral side of the hollow coil body. Will not occur. For this reason, even when the degree of bending of the hollow coil body is increased, the stroke amount by the hand operation unit is not insufficient, and the necessary stroke amount is transmitted to the distal treatment instrument, and the stable opening / closing operation of the distal treatment instrument can be maintained. .

  Since no gap is generated between adjacent coil wires, even if a reaction force due to the operation on the hand side is applied to the treatment instrument sheath, the swinging displacement on the distal end side of the treatment instrument sheath can be minimized. Thereby, the tip treatment instrument does not damage the heart-ventricular wall or inadvertently collects excessive biological tissue, and the amount to be collected can be made constant.

  Also, when the hollow coil body is bent, the coil element wire having a substantially triangular cross section protrudes outward from the coil element wire having a substantially circular cross section inside the hollow coil body due to a slight relative sliding movement that occurs between the coil wires. An uneven curved surface is formed along the inner side. Since the uneven curved surface becomes a reflection echo portion, the distal treatment instrument for collecting the biological tissue can be clearly depicted on the image simply by bending the hollow coil body. Unlike Patent Document 4, in which an annular groove is concavely processed with a YAG laser, it is automatically generated when the hollow coil body is bent, so that processing for forming a reflection echo portion is not required.

  In the treatment instrument sheath according to the seventh and eighth aspects of the present invention, a coil wire having a substantially semicircular cross section and a coil wire having a substantially isosceles triangle shape having a recess in an isosceles portion toward the center are attached. Thus, the structure is characterized by being alternately combined.

  Also in this case, when the treatment instrument sheath is bent, a slight relative sliding movement occurs between the adjacent coil strands, and no gap is generated between the adjacent coil strands. An effect is obtained and good torque response, torque transmission, and high indentation characteristics can be ensured.

  In the inventions according to claim 9 and claim 10, the structure of the treatment instrument sheath includes a hollow stranded wire coil body provided on the proximal side, a coil wire having a substantially circular cross section located on the distal end side, and a central portion. A coil element wire having a substantially triangular cross section having an inclined side that tapers in a direction is connected to a hollow coil body alternately adjacent to each other.

  In this treatment instrument sheath, when it is bent, a slight relative sliding movement occurs between adjacent coil strands, and no gap is generated between adjacent coil strands. Therefore, the same effect as in claims 5 and 6 is achieved. Is obtained. Also, in the hollow stranded coil body, unlike the single-strand wound coil spring body, because of the multi-strands, the rotational transmission in the tip direction is high, and the twisted portion does not cause uneven twisting. Smooth rotation of the tip of the instrument sheath can be realized.

In the hollow stranded coil body according to the eleventh aspect of the present invention, the coil wire having a substantially semicircular cross section is engaged with the coil wire having a substantially isosceles triangle shape having a recess in the isosceles portion toward the center. It is characterized by being a structure alternately combined with each other.
Even in this treatment instrument sheath, a slight relative sliding movement occurs between the adjacent coil wires at the time of bending, and there is no gap between the adjacent coil wires as in the case of Claims 5 and 6, so that the stroke is insufficient. Without this, the stable opening / closing operation of the distal treatment instrument can be maintained.

In the twelfth aspect of the invention, the distal end side of the treatment instrument sheath is formed in a substantially arcuate shape so as to be substantially perpendicular to the opening direction of the collection cup provided at the distal end of the treatment instrument sheath so as to be opened and closed. And
For this reason, when the collection cup opens, it does not move up and down while pushing against the septum of the heart ventricle, for example. Thereby, the opening position of the collection cup does not change, and a desired living tissue can be accurately collected without damaging normal tissues such as the heart-ventricular septum.

The invention according to claim 13 is characterized in that the distal end side of the treatment instrument sheath is shaped into a substantially spiral three-dimensional shape. For this reason, it is possible to collect a living tissue at a desired position by detouring while avoiding obstacles (for example, chordae and papillary muscle elongated site network) with respect to the traveling direction of the long sheath and the treatment instrument sheath.
When the collection site of the biological tissue has a curved surface shape, a desired biological tissue can be collected by moving the distal end side of the treatment instrument sheath along the curved surface in a gentle contact state.

In the inventions according to claims 14 and 15, the combined curved shape of the long sheath having the distal end shaped and the treatment instrument sheath is set to be substantially parallel to the curved shape of the biological tissue collection site. It is characterized by.
For this reason, when the long sheath and the treatment instrument sheath are combined, the long sheath and the treatment instrument sheath after the combination move along a curved shape of a living tissue collection site such as the heart ventricle. Thus, the long sheath or the treatment instrument sheath can facilitate the advancement / retraction operation of the medical treatment instrument without damaging the heart ventricle wall or the like.

  In the medical treatment instrument of the present invention, the long sheath is sheathed on the treatment instrument sheath, and the distal end portion of the long sheath and the distal end portion of the treatment instrument sheath are shaped, and the radius of curvature of the distal end portion of the long sheath is treated by this shaping. The relationship is set to be larger than the radius of curvature of the distal end portion of the sheath. Thereby, the shaping shape in the front-end | tip part of a treatment tool sheath becomes variable at the time of advance / retreat operation of a long sheath.

A first embodiment of the present invention will be described with reference to FIGS. 1 to 3, 8 and 10 to 14.
In FIG. 1 which shows a medical treatment tool, the hand operation part 1 has the structure which fitted the operation piece 3 orthogonal to the accommodation thin tube 2 so that sliding was possible to an axial direction. The rear end portion of the storage thin tube 2 connects the fixed piece 4 having the finger penetration hole 4a, and both end portions of the operation piece 3 form the operation hole 3a as an operation portion. The storage thin tube 2 is formed with a slit 5 having a predetermined stroke length along the axial direction.

  The operation piece 3 is connected to a rear end portion of a wire 7 as a core wire accommodated in the storage thin tube 2 by a pin 6 driven in the direction of the slit 5. At this time, as shown by an arrow A in FIG. 1A, the operation piece 3 and the wire 7 are urged in the direction toward the rear end by the spring member S provided inside the storage thin tube 2.

  The wire 7 is inserted into the treatment instrument sheath 8, and a pantograph type link mechanism {see FIG. 7 (b)} is operated by pushing and pulling operation at the hand operation unit 1 to treat the pair of collection cups 9 at the distal end. It is designed to open and close as a tool {see FIGS. 1B to 1E}. A tubular socket 10 is slidably mounted on the middle portion of the treatment instrument sheath 8. The long sheath 11 is slidably attached to the outside of the treatment instrument sheath 8, the rear end portion 11 b is connected to the tubular socket 10, and the distal end portion 11 a can be extended to the collection cup 9. Yes.

  At this time, the distal end portion 11 a of the long sheath 11 and the distal end portion 8 a of the treatment instrument sheath 8 are in a relationship in which the curvature radius of the distal end portion 11 a of the long sheath 11 is larger than the curvature radius of the distal end portion 8 a of the treatment instrument sheath 8. The shaping shape at the distal end portion 8a of the treatment instrument sheath 8 is variable by the advance / retreat operation of the long sheath 11. 1 (b) and 1 (c), the distal end portion 8a of the treatment instrument sheath 8 is substantially perpendicular to the opening direction of the collection cup 9 provided at the distal end of the treatment instrument sheath 8 so as to be opened and closed. The side is shaped like a bow by heat treatment.

  As shown in FIG. 2, the treatment instrument sheath 8 has a hollow stranded coil body 17 having a substantially circular cross section provided on the proximal side, a coil wire 18a having a substantially circular cross section located on the distal end 8a side, and a center. The coil element wire 18b having a substantially triangular cross section having a tapered inclined side toward the portion is connected to the hollow coil bodies 18 that are alternately adjacent to each other.

  A rotation / position holding mechanism 12 is provided at the proximal end of the long sheath 11 as a set lock means so that the distal end portion 8a of the treatment instrument sheath 8 and the collection cup 9 can be set and held at desired positions. That is, as shown in FIGS. 3A to 3D, the rotation / position holding mechanism 12 includes a plastic lock ring nut 13, a throttle tube portion 14 with a split groove, an intermediate ring nut 15, and a rotating ring nut 16. Are respectively mounted on the treatment instrument sheath 8 so as to be movable and adjustable {see FIG. 1 (a)}.

A small diameter portion 15 a of the intermediate ring nut 15 is screwed into the lock ring nut 13 and is inserted between the lock ring nut 13 and the throttle tube portion 14 fitted in the lock ring nut 13. By tightening the lock ring nut 13 to the intermediate ring nut 15, the throttle tube portion 14 is reduced in diameter and wound around the treatment instrument sheath 8. The rotating ring nut 16 has a small-diameter portion 16 a screwed into the large-diameter portion 15 b of the intermediate ring nut 15, and the large-diameter portion 16 b is screwed to the rear end outer peripheral portion of the tubular socket 10.
A small protrusion 10a is integrally formed on the outer peripheral portion of the tubular socket 10 so as to be screwed into the female thread portion of the large-diameter portion 16b of the rotating ring nut 16, and the intermediate ring nut 15 is formed on the small-diameter portion 16a. The microprotrusion 16c that is screwed into the female screw portion of the large-diameter portion 15b is integrally formed.

  In addition, as shown in FIG. 4 as a modified example, the structure of the treatment instrument sheath 8 is such that the hollow coil body 19 continuous from the hollow stranded wire coil body 17 provided on the proximal side to the distal end side is adjacent to the coil wire 19a. , 19b are formed so as to be wound around each other. That is, the hollow coil body 19 is alternately combined so that the adjacent coil wire 19a having a substantially semicircular cross section and the coil wire 19b having a substantially isosceles triangle shape having a recess in the isosceles portion toward the center are in close contact with each other. Has been. In this case, the treatment instrument sheath 8 may be constituted by the hollow coil bodies 18 and 19 (see FIGS. 5 and 6) over the entire length as a modification.

  In the above configuration, the treatment instrument sheath 8 whose tip is shaped by heat treatment is inserted into the long sheath 11 having the tip 11a shaped prior to the operation of the medical treatment instrument, and the bent shape is formed after the merge. Is substantially in conformity with the shape in the heart ventricle H. Specifically, the long sheath 11 has a single radius of curvature of approximately 50 mm and a bent portion bent by 100 °, and after the long sheath 11 and the treatment instrument sheath 8 are combined, the radius of curvature is approximately 80 mm and the bent portion is bent. Set to be 135 ° bend.

  At the time of operation of the medical treatment instrument, the long sheath 11 is advanced and retracted while observing an ultrasonic image by echo of the heart ventricle H on a monitor (not shown), so that the treatment instrument sheath 8 is moved as shown in FIG. The distal end portion 8a is set in a desired living tissue collection position in the heart ventricle H. Thereafter, using the rotation / position holding mechanism 12 at the proximal end of the long sheath 11, the distal end portion 8a of the treatment instrument sheath 8 is set and held at a desired set position. In this state, the operation piece 3 of the hand operation unit 1 is pushed in the direction opposite to the arrow A in FIG. 1A (push operation), and the wire 7 is slid to the tip along the axial direction. As a result, the collection cup 9 located at the distal end of the treatment instrument sheath 8 is opened and collected by sandwiching a part of the biological tissue located in the heart ventricular septum J.

When the rotation / position holding mechanism 12 is operated in the heart ventricle H, the following procedure is performed.
(A) First, the treatment instrument sheath 8 is inserted into the long sheath 11 so that the distal end portion 8 a of the treatment instrument sheath 8 is not exposed from the distal end portion 11 a of the long sheath 11.
(B) In this state, the lock ring nut 13 is fastened to the intermediate ring nut 15, and the treatment instrument sheath 8 is temporarily fixed to the long sheath 11. At this time, the rotating ring nut 16 is fixed to the tubular socket 10, and the intermediate ring nut 15 is fixed to the rotating ring nut 16. (C) Next, the long sheath 11 is advanced / retracted / rotated integrally with the treatment instrument sheath 8, and the bent portion of the distal end portion 11 a of the long sheath 11 is directed toward the cardiac ventricular septum J.

(D) Then, the lock ring nut 13 is loosened, and the treatment instrument sheath 8 is advanced or retracted or rotated to match the bending degree of the distal end portion 8a of the treatment instrument sheath 8 with the living tissue collection position. Thereafter, the lock ring nut 13 is tightened to fix the treatment instrument sheath 8.
(E) The hand operation unit 1 is pushed, the collection cup 9 is opened via the wire 7, and the biological tissue of the cardiac ventricular septum J is collected.
(F) When changing the position where the biological tissue is collected, the lock ring nut 13 is temporarily loosened to move the treatment instrument sheath 8 forward or backward, or rotate to make the collection position relative to the heart ventricular septum J desired. set. After setting, the same procedure as described in (e) is repeated.

  When changing the collection position of the living tissue in the heart ventricle H, the rotation / position holding mechanism 12 is loosened to release the lock on the treatment instrument sheath 8, and then the long sheath 11 is slid to displace the heart ventricle septum J. The length of the distal end portion 8a of the treatment instrument sheath 8 is adjusted as desired along the same operation straight line. By rotating the lock ring nut 13, the distal end portion 8a of the treatment instrument sheath 8 can be set and adjusted to a desired position in a direction perpendicular to the operation straight line.

  After the set adjustment, the rotational displacement of the long sheath 11 and the rotational displacement of the treatment instrument sheath 8 are locked by the rotation / position holding mechanism 12. In this state, the operation piece 3 of the hand operation unit 1 is pushed as described above, the wire 7 is slid, and another living tissue located in the heart ventricular septum J is collected by the collection cup 9.

For this reason, the following effect is obtained in the above configuration.
That is, the treatment instrument sheath 8 having the distal end portion 8a shaped by heat treatment is combined by insertion into the long sheath 11 having the distal end portion 11a formed therein, and the bent shape after the combination is substantially in line with the shape in the heart ventricle H. It is in form. Accordingly, the long sheath 11 can be advanced and retracted quickly and easily without damaging the heart ventricle wall and the like.

Further, as the long sheath 11 is advanced and retracted, the shape of the distal end portion 8a of the treatment instrument sheath 8 is made variable, and the rotation / position holding mechanism 12 changes the sliding displacement of the long sheath 11 and the rotation displacement of the treatment instrument sheath 8. Since it is locked at a desired position, it is possible to collect a wide range of living tissue existing in the vicinity of the heart ventricular septum J.
In addition, as a supplement, the rotation / position holding mechanism 12 has a structure that is detachable from the distal end portion of the treatment instrument sheath in the conventional product, so that it can be used by being attached to the conventional product.

  Since the treatment instrument sheath 8 is configured by connecting the hollow coil bodies 18 in which the coil wire 18a having a substantially circular cross section and the coil wire 18b having a substantially triangular cross section are adjacent to each other, the following operational effects can be obtained. That is, even when the bending degree (total bending angle: Σθ) of the treatment instrument sheath 8 is increased, an accurate and stable opening operation of the collection cup 9 can be maintained at the time of biological tissue collection operation.

  The treatment instrument sheath 50 conventionally used is a round single wire tightly wound coil spring body as shown in FIG. For this reason, when the core wire passing through the treatment instrument sheath 50 is pushed on the hand side as a wire 51 (about 7 mm), the treatment instrument sheath 50 is bent to a U-shape (total bending angle Σθ: 180 °) Although the collection cup 52 can be opened / closed, the collection cup 52 cannot be opened / closed when the S-shaped bent form (Σθ: 360 °) is obtained.

The reason for this is considered to be that a gap G is generated between adjacent coil wires on the outer peripheral side of the single-strand wound coil spring body by the bending operation of the treatment instrument sheath 50.
In this state, when the wire 51 is pushed from the hand side as shown in FIG. 7B, the operating force is transmitted from the pantograph type link mechanism 53 to the collection cup 52. At this time, the treatment instrument sheath 50 that has received a reaction force based on the push operation force has a gap G between the coil wires, and therefore, the reaction force is absorbed by the gap G, resulting in an insufficient operation stroke. The shortage of the operation stroke increases in proportion to the bending degree of the treatment instrument sheath 50. Therefore, when the bending degree is increased, it is considered that the opening / closing operation of the collection cup 52 is hindered.

  On the other hand, in the hollow coil body 18 composed of the coil wire 18a and the coil wire 18b, the bending degree of the treatment instrument sheath 8 is increased from the state of FIG. 8A as shown in FIG. 8B. However, there is no gap between the coil wires 18a and 18b. The existence or nonexistence of this gap can be grasped as the amount of displacement δ (δ1, δ2) of the distal end portion 8a that occurs during bending when the bending displacement is simplified only in the wire 7 as the core and the treatment instrument sheath 8. {FIG. 8 (c)}.

  From this point of view, when comparing the treatment instrument sheath 8 of the present invention and the conventional treatment instrument sheath 50 shown in FIG. 7, as shown in FIG. As Σθ increases, a displacement amount δ1 occurs in the exposed length L of the exposed portion of the core wire 71 in the straight line state. That is, when the exposure length in the bent form of the core wire 71 is A1, the displacement amount δ1 is (A1-L), and it can be seen that the core wire 71 is drawn into the treatment instrument sheath 50 (minus side). On the other hand, in the treatment instrument sheath 8 of the present invention, when the exposure length in the bent form of the wire 7 is A2, the displacement amount δ2 of the exposed portion is (A2-L), and FIG. As shown, it can be seen that the wire 7 moves away from the treatment instrument sheath 8 while being minute (plus side).

In the conventional treatment instrument sheath 50, the reason why the exposed length (L) of the core wire 71 is reduced when bent is that when the treatment instrument sheath 50 is bent, a gap is generated between the coil strands and the entire length is increased. It is considered that the core wire 71 is drawn into the ingredient sheath 50.
In the treatment instrument sheath 8 of the present invention, the reason why the exposed length (L) of the wire 7 is slight but long is that when the treatment instrument sheath 8 is bent, there is a slight relative difference between the coil strands 18a and 18b of the hollow coil body 18. Since the sliding movement occurs, it is considered that the gap 7 is not generated and the entire length hardly changes, and the wire 7 is disposed in the treatment instrument sheath 8 at the shortest distance. For comparison, the exposed length of the conventional core wire 71 and the wire 7 of the present invention is represented using the same symbol L in a straight line state.

Since the treatment instrument sheath 8 is the hollow coil body 18 composed of the coil element wire 18a and the coil element wire 18b, the distal end portion 8a of the treatment instrument sheath 8 does not fluctuate when collecting a living tissue, and only a predetermined amount is obtained. Biological tissue can be collected accurately.
As shown in FIG. 7, when a conventional treatment instrument sheath 50 made of a single-strand wound coil spring body is used, only the push operation force is applied to the wire 51 of the collection cup 52 at the time of biological tissue collection. The distal end portion 50a moves about 6 mm toward the cardiac ventricular septum J side (collection direction) as shown in FIG. In contrast, when a pull operation force is applied to the wire 51, the distal end portion 50a of the treatment instrument sheath 50 behaves about 13 mm in the reverse direction.

For this reason, in the conventional treatment instrument sheath 50, the distal end portion 50a of the treatment instrument sheath 50 is oscillated and displaced during the push operation of the wire 51 in an attempt to collect a living tissue at a desired position in the heart ventricle H. There is a possibility that the collection cup 52 will bite into the biological tissue, and excessive biological tissue may be collected. On the other hand, when a pull operation force is applied to the wire 51, the distal end portion 50a of the treatment instrument sheath 50 may move to the heart ventricle wall side and damage the ventricle wall.
The reason why the distal end portion 50a of the treatment instrument sheath 50 fluctuates and swings only by this push / pull operation force is that a gap G is generated between the coil strands of the single-strand wound coil spring body of the treatment instrument sheath 50. This is probably because {see FIG. 7A}.

  On the other hand, in the treatment instrument sheath 8 of the hollow coil body 18 composed of the coil wire 18a and the coil wire 18b, it is bent when the distal end portion 8a is bent due to a slight relative sliding movement between the coil wires 18a and 18b. It follows and displaces {refer to Drawing 8 (a) and (b)}. For this reason, there is no gap between the coil wires 18a and 18b of the hollow coil body 18, the fluctuation and swinging of the distal end portion 8a of the treatment instrument sheath 8 can be minimized, and a predetermined amount of living tissue can be obtained. Accurate collection is possible.

When the medical treatment tool is used, the coil strands 18a and 18b of the hollow coil body 18 form an ultrasonic reflection part in the ultrasonic three-dimensional echo, so that a clear ultrasonic observation image can be drawn on the monitor. .
When the distal end portion 8a of the treatment instrument sheath 8 is bent, no gap is formed between the coil strands 18a and 18b of the hollow coil body 18 on the outer peripheral side, and on the inner peripheral side having a small curvature radius, FIG. As shown in b), a concave portion 20 having a tapered depth is formed by a slight relative sliding movement and has a deep back and a narrow outer periphery.

  In general, in order to clearly display an ultrasonic image on a monitor, for example, as shown in Patent Document 4, it is necessary to process an annular groove with a YAG laser to form a reflection echo portion. Then, when the hollow coil body 18 is bent, only the treatment instrument sheath 8 is bent, and the concave portion 20 is automatically generated as a reflection echo portion. Therefore, the distal end portion 8a that is bent in the treatment instrument sheath 8 can be clearly depicted as an ultrasound image at the living tissue collection position. In addition, since the concave portion 20 can be formed only by bending the treatment instrument sheath 8, there is no need to separately process the reflection echo portion.

In addition, as shown in FIG. 11, by using a thin film coating 21 such as a resin coating on the distal end portion 8a of the treatment instrument sheath 8, the reflection echo portion formed by the recess 20 functions as a reflection air layer, and the monitor has a clear super It is possible to render a sound wave observation image.
The reason for this is that the concave portion 20 is more likely to reflect ultrasonic waves than biological tissue, and the difference in mutual acoustic impedance (product ρc of biological tissue density ρ and sound velocity c) between the biological tissue and the reflective air layer is determined. It can be very large. Therefore, most of the ultrasonic waves can be reflected at the boundary surface between the living tissue and the reflective air layer, and the concave portion 20 forms a continuous spiral groove, and the distal end portion 8a of the continuous treatment instrument sheath 8 is bent. The form can be recognized as a clear ultrasonic observation image.

  For this reason, the concave portion 20 shown in FIG. 10 can be automatically formed as a reflection echo portion only by bending the distal end portion 8a of the treatment instrument sheath 8, and the most important living tissue collection position can be visually recognized clearly. It becomes possible to make it. Thus, it is considered that the use of the thin film coating 21 is an extremely effective technical means particularly when the reflection echo layer is formed on the distal end portion 8a of the treatment tool 8 having a reduced diameter.

As shown in FIGS. 2 and 4, a treatment in which a hollow coil body 18 (19) at the distal end made of coil strands 18 a and 18 b (19 a and 19 b) and a hollow stranded coil body 17 on the proximal side are connected and combined. In the ingredient sheath 8, the following effects are obtained.
That is, when the treatment instrument sheath 8 is rotated to change the living tissue collection position, the rotational followability of the distal end portion 8a in the treatment instrument sheath 8 based on the rotation operation is improved, and the rotation / position holding mechanism 12 is used. A stable holding function of the tip 8a can be maintained.

  As shown in FIG. 12 (a), when the conventionally used single-strand wound coil spring body 54 is rotated, the rotational transmission force becomes weaker as the transmission distance becomes longer, and as shown in FIG. Different uneven twist pools are generated for each contact point of the bent portion and each of the part sections 54a, 54b, 54c in the strip-contact wound coil spring body 54. If the torsional pool becomes excessive, the distal end portion of the treatment instrument sheath, which is the single wound coiled coil spring body 54, suddenly rotates or buckles and deforms so that the distal end portion is accurately placed at a desired living tissue collection position. It becomes difficult to set to.

The reason for this is that the single-strand closely wound coil spring body 54 has a structure in which the rotational force is supported by a single strip, that is, the winding force of a single wire. It is thought that it becomes easy to do and lacks stability.
On the other hand, in the hollow stranded coil body 17 of the treatment instrument sheath 8, as compared with the case of the single-strand closely wound coil spring body 54 shown in FIGS. 12 (c) and 12 (d), FIG. As shown in (f), the inclination angle (ω) of the coil wire with respect to the rotation direction becomes large by using the multi-strands, and the structure can easily transmit the rotational force to the distal end portion 8a. Smooth rotation of the tip 8a can be realized.

  By forming the distal end portion 8a of the treatment instrument sheath 8 in a substantially arcuate shape in a state orthogonal to the opening direction of the collection cup 9, the following effects can be obtained.

  As shown in FIGS. 13 (a) and 13 (b), as a forming method for shaping the distal end portion of the sheath coil body 55, the sheath coil body 55 is first formed by winding a stainless steel wire (SUS304), and the sheath coil body 55 is formed. A cored bar (not shown) is inserted into the inside and bent into a predetermined shape. Alternatively, the sheath coil body 55 is placed in a mold (not shown) provided with a recess having a predetermined shape and bent so as to match the shape of the treatment instrument sheath 8. Then, in this state, the sheath coil body 55 placed in the furnace is subjected to heat treatment (heating temperature 600 ° × 5 minutes) and then subjected to electropolishing. At the time of the electric field polishing treatment, the sheath coil body 55 may be either with or without the core metal inserted.

Since the distal end portion 8a of the treatment instrument sheath 8 is orthogonal to the opening direction of the collection cup 9, unlike the comparative example shown in FIG. 14 (a), the treatment instrument sheath R connects the collection cup q to the cardiac ventricle when collecting biological tissue. It does not open while pressing against the septum J. That is, since the collection cup 9 opens as shown in FIG. 14B, the biological tissue collection position does not change carelessly, and the cardiac ventricular septum J is not damaged. For this reason, it can be useful for accurate collection of a desired living tissue.
In addition, the effect about the hollow coil body 18 which consists of the coil strand 18a and the coil strand 18b mentioned above is the same also about the hollow coil body 19 which consists of the coil strand 19a and the coil strand 19b.

FIG. 15 shows Embodiment 2 of the present invention.
The difference between the second embodiment and the first embodiment is that a straight hollow pipe 22 that can change the shape of the distal end portion 8a of the treatment instrument sheath 8 by advancing and retracting operation is provided {FIG. 15 (a), (B) Reference}. The hollow pipe 22 is sheathed by the wire 7 and inserted into the treatment instrument sheath 8 so as to be slidable.

  The proximal end portion of the hollow pipe 22 is located in the storage thin tube 2, and the distal end portion 22 a extends to the distal end portion 8 a of the treatment instrument sheath 8. In the storage thin tube 2, a restriction slit 23 whose stroke length (L 1) is set to about 25 mm is formed at a portion located immediately before the slit 5. The knob 24 connected to the hollow pipe 22 through the restriction slit 23 is provided so as to be operable within the length range of the restriction slit 23. The knob portion 24 has a screwed structure, and when the knob portion 24 is rotated at a position having an arbitrary stroke length, the knob portion 24 can press the storage thin tube 2 and be fixed at a desired position. .

  The mounting structure of the lock ring nut 13, the intermediate ring nut 15, the throttle tube portion 14, and the rotating ring nut 16 of the rotation / position holding mechanism 12 is the same as that of the first embodiment shown in FIG.

  The combined bending shape of the treatment instrument sheath 8 and the long sheath 11 is the same as that described in the first embodiment. In the operation of the medical treatment instrument, when the knob 24 of the hand operation section 1 is pulled toward the hand side, the hollow pipe 22 is slid to the hand side with respect to the treatment tool sheath 8 {the arrow M in FIG. reference}.

At this time, since the radius of curvature of the distal end portion 11a of the long sheath 11 is set to be larger than the curvature radius of the distal end portion 8a of the treatment instrument sheath 8 due to the shaping, The shaping shape at the distal end portion 8a of the treatment instrument sheath 8 is variable {see FIG. 15 (c)}.
That is, the extension amount K of the hollow pipe 22 with respect to the distal end portion 8a of the treatment instrument sheath 8 changes due to the difference in the operation amount for pulling the knob portion 24 in the arrow M direction, and the shape of the distal end portion 8a in the treatment instrument sheath 8 is changed. It becomes possible to change to a desired radius of curvature.

In the second embodiment, in order to operate the rotation / position holding mechanism 12 in the heart ventricle H, the following procedure is performed.
(A) First, as in the case of the first embodiment, the treatment instrument sheath 8 is inserted into the long sheath 11 so that the distal end portion 8a of the treatment instrument sheath 8 is not exposed from the distal end portion 11a of the long sheath 11. .
(B) In this state, the lock ring nut 13 is fastened to the intermediate ring nut 15, and the treatment instrument sheath 8 is temporarily fixed to the long sheath 11. At this time, the rotating ring nut 16 is fixed to the tubular socket 10, and the intermediate ring nut 15 is fixed to the rotating ring nut 16. (C) Next, the long sheath 11 is advanced and retracted and rotated integrally with the treatment instrument sheath 8 so that the bent portion of the distal end portion 11a of the long sheath 11 is directed toward the heart ventricular septum J (see FIG. 16). .

(D) Then, the lock ring nut 13 is loosened, and the treatment instrument sheath 8 is advanced with respect to the long sheath 11. At this time, the knob 24 is moved back and forth along the restriction slit 23 to move the hollow pipe 22 forward or backward, or the long sheath 11 is rotated together with the treatment instrument sheath 8 to rotate the distal end of the treatment instrument sheath 8. The bending degree or the like of 8a is matched with the living tissue collection position. Thereafter, the knob portion 24 is tightened to fix the hollow pipe 22 to the storage thin tube 2.
(E) The hand operation unit 1 is pushed, the collection cup 9 is opened via the wire 7, and the biological tissue of the cardiac ventricular septum J is collected (see FIG. 16).
(F) When changing the position where the biological tissue is collected, the knob 24 is temporarily loosened and the hollow pipe 22 is advanced or retracted, or the long sheath 11 is rotated integrally with the treatment instrument sheath 8 to enter the heart ventricle. Set the sampling position for interval J as desired. After setting, the same procedure as described in (e) is repeated.

In Example 2, the following effects are obtained.
Regardless of the sliding displacement of the long sheath 11, the distal end portion 8a of the treatment instrument sheath 8 is made variable by the sliding of the hollow pipe 22, so that it is not affected by the position of the long sheath 11 as shown in FIG. The treatment instrument sheath 8 can be penetrated into the deep part of the heart ventricle H by a long stroke h that moves the treatment instrument sheath 8 linearly alone.

  Accordingly, the distal end portion 8a of the treatment instrument sheath 8 can be advanced while maintaining a certain rigidity even in the narrow collection space m. Further, the combination with the long sheath 11 allows the shape of the distal end portion 8a of the treatment instrument sheath 8 to be variable, and the effect that the biological tissue can be collected over a wide range using the rotation / position holding mechanism 12 as a set lock means is the same as in the second embodiment. It is.

FIG. 17 shows Embodiment 3 of the present invention.
In Example 3, as shown in FIGS. 17 (a), (b), (c), and (d), the distal end portion 8a of the treatment instrument sheath 8 has a twist pitch instead of the arch shape of Example 1. It is shaped into a relatively large spiral solid shape.
By forming the distal end portion 8a of the treatment instrument sheath 8 into a spiral three-dimensional shape, the following effects can be obtained. The method of shaping the distal end portion 8a of the treatment instrument sheath 8 is the same as the case of shaping in a substantially arcuate shape except for the spiral solid shape.

As shown in FIG. 17A, the distal end portion 8a of the treatment instrument sheath 8 having a spiral three-dimensional shape is used to block obstacles in the traveling direction (for example, chords in the heart ventricle H, elongated part network of papillary muscles, etc.). While avoiding, it is possible to bypass and reach the living tissue at a desired position and collect the living tissue.
Also, as shown in FIG. 18, when the collection site 60 of the biological tissue has a curved surface shape, the distal end portion 8a of the treatment instrument sheath 8 is moved along the curved surface in a gentle and smooth contact state to obtain a desired biological tissue. Can be collected.
The distal end portion 8a of the treatment instrument sheath 8 may be shaped like an articulated finger that is bent inward by a plurality of joint portions T as shown in FIG.

[Modification]
The distal end opening of the long sheath 11 may be formed in a taper shape that gradually decreases so that the inner diameter gradually decreases from the proximal side to the distal end side. Thereby, it is possible to prevent a large amount of liquid from flowing into the gap between the long sheath 11 and the treatment instrument sheath 8 and to further enhance the echo effect of the concave portion 20 as a reflection echo portion. As the material of the long sheath 11, polyamide, polyester, an elastomer thereof, or the like may be used, and the outer diameter may be 3 mm and the wall thickness may be 0.1 to 0.2 mm.

  The coil strands 18a and 18b of the treatment instrument sheath 8 are made of stainless steel wire (SUS304), the diameter of the coil strand 18a is 0.3 mm, and the bottom dimension of the coil strand 18b is 0.35 mm. It is also good.

The material of the coil strands 19a and 19b is the same as described above, and the diameter of the substantially semicircular shape of the coil strand 19a may be 0.45 mm, and the bottom dimension of the coil strand 19b may be 0.35 mm. In order to facilitate coil forming of the hollow coil bodies 18 and 19, one of the coil wires 18a and 18b (19a and 19b) is heat-treated to form a soft material having a tensile strength of 80 to 120 kgf / mm ^2. May be.

  Furthermore, the hollow stranded wire coil body 17 connected to the hollow coil body 18 (19) is obtained by twisting a plurality of (for example, 12) stainless steel wire rods 17a having a wire diameter (d) of 0.33 mm, as shown in FIG. The outer diameter (D) may be 1.6 mm as shown in FIG.

  At this time, the outer peripheral portions of the hollow coil body 18 (19) and the hollow stranded coil body 17 may be reduced in diameter by swaging. Thereby, in the hollow coil body 18 (19) and the hollow stranded wire coil body 17, the adjacent coil strands can be further brought into close contact with each other, and a hollow coil body having a uniform overall outer diameter and high straightness is realized. And good torque response, torque transmission and high indentation characteristics can be secured.

  In the medical treatment instrument of the present invention, since the radius of curvature of the distal end portion of the long sheath is set larger than the curvature radius of the distal end portion of the treatment instrument sheath, the long sheath in which the treatment instrument sheath is housed is a heart Bending and deforming along the shape of the inside of the ventricle. For this reason, there is no risk of damaging the ventricular wall, etc., and the convenience of facilitating the advancement / retraction operation of the treatment instrument sheath inside the heart ventricle is obtained. It can be widely applied to the mechanical industry through the distribution of chemical and mechanical parts.

(A) is a plan view showing a cross section of the medical treatment instrument, (b) and (c) are a side view and a front view of the distal end portion of the treatment instrument sheath, and (d) and (e) are views of the distal end portion. (Example 1) which is a front view which shows that a shaping direction is orthogonal to the opening direction of a collection cup. (Example 1) which is a front view which shows a partial cross section of a hollow coil body. (A) is a partial longitudinal sectional view and a front view of a lock ring nut, (b) is a partial longitudinal sectional view and a front view of a throttle tube portion, (c) is a partial longitudinal sectional view and a front view of an intermediate ring nut, (d) ) Is a partial longitudinal sectional view and a front view of a rotating ring nut (Example 1). It is a side view which shows a hollow coil body in partial cross section (modification). It is a side view which shows a hollow coil body in partial cross section (modification). It is a side view which shows a hollow coil body in partial cross section (modification). (A) is a longitudinal cross-sectional view which shows the principal part of the conventional medical treatment instrument sheath, (b) is a top view which partially shows the principal part of the conventional medical treatment instrument sheath. (A) is a partial longitudinal sectional view of a hollow coil body (Example 1), (b) is a partial longitudinal sectional view showing a hollow coil body at the time of bending (Example 1), and (c) is a conventional one at the time of bending. Schematic which shows the amount of displacement of a single line contact winding coil spring and the hollow coil body of Example 1, (d) is the displacement amount and total bending angle of the conventional single line contact winding coil spring and the hollow coil body of Example 1. It is a graph which shows the relationship. It is the schematic which shows the effect | action of the conventional sheath coil body. (A) is the fragmentary longitudinal cross-sectional view which shows the effect | action of a hollow coil body, (b) is the partial expansion longitudinal cross-sectional view (Example 1). It is a fragmentary longitudinal cross-sectional view of the hollow coil body which gave the thin film coating (Example 1). (A), (b) is explanatory drawing which shows the effect | action of the conventional single strip | belt close_contact | adherence winding coil spring body, (c) is a front view which shows a partial cross section of the conventional single strip close winding coil spring body, (d) Fig. 4 is a cross-sectional view of a conventional single-strand wound coil spring body, (e) is a front view showing a partially sectioned hollow stranded coil body, and (f) is a cross-sectional view of the hollow stranded coil body ( Example 1). (A), (b) is explanatory drawing which shows the shaping direction of a sheath coil body (Example 1). (A) is explanatory drawing which shows the effect | action of the collection cup in a comparative example, (b) is explanatory drawing which shows the effect | action of the collection cup in Example 1. FIG. (A) is a side view showing the medical treatment instrument partially omitted, (b) is a plan view of the medical treatment instrument partially broken away, and (c) is a partial sectional view of the distal end portion of the treatment instrument sheath. (Example 2) which is a side view shown. (Example 2) which is explanatory drawing which shows the effect | action of the front-end | tip part of a treatment tool sheath. (A) is explanatory drawing which shows the effect | action of a treatment tool sheath, (b), (c) is a side view of the front-end | tip part in a treatment-tool sheath, (d) is a front view of the front-end | tip part in a treatment tool sheath (Example) 3). (Example 3) which is explanatory drawing which shows the effect | action of the front-end | tip part in a treatment tool sheath. (A), (b), (c) is a side view in the front-end | tip part of the treatment tool sheath which shows sequentially the aspect displaced by operation (modification). It is a perspective view of the hollow stranded wire coil body which set the wire diameter dimension and the outer diameter dimension (modification).

Explanation of symbols

1 Hand control section 7 Wire (core wire)
8 treatment instrument sheath 8a tip 9 collection cup (tip treatment instrument)
DESCRIPTION OF SYMBOLS 11 Long sheath 11a Tip part of long sheath 12 Rotation / position holding mechanism 13 Lock ring nut 14 Throttle tube portion 15 Intermediate ring nut 16 Rotating ring nut 17 Hollow stranded wire coil body 18, 19 Hollow coil body 18a, 18b Coil element wire 19a, 19b Coil wire 22 Hollow pipe 22a Tip of hollow pipe H Heart ventricle J Heart ventricular septum

Claims (15)

In the medical treatment instrument that opens and closes the distal treatment instrument by penetrating the core wire in the treatment instrument sheath and pushing and pulling the core wire at the hand operation unit,
The long sheath is sheathed on the treatment instrument sheath, and the curvature radius of the distal end portion of the long sheath and the distal end portion of the treatment instrument sheath is larger than the curvature radius of the distal end portion of the treatment instrument sheath. Shape the relationship that will be great,
A medical treatment instrument characterized in that a shaping shape at a distal end portion of the treatment instrument sheath is made variable by an advance / retreat operation of the long sheath. A core wire is penetrated into the treatment instrument sheath, and the distal treatment instrument is opened and closed by pushing and pulling the core wire at the hand operation part, and a hollow pipe is penetrated between the core wire and the treatment instrument sheath. And no hand control that can move forward and backward,
A medical treatment instrument characterized in that the shape of the distal end portion of the treatment instrument sheath is variable by an advance / retreat operation of the hollow pipe. The medical treatment instrument according to claim 2, wherein a long sheath is sheathed on the treatment instrument sheath, and the distal end of the long sheath and the distal end of the treatment instrument sheath have a radius of curvature of the distal end of the long sheath. Shaped in a relationship larger than the radius of curvature of the distal end portion of the treatment instrument sheath,
A medical treatment instrument characterized in that the shaping shape at the distal end portion of the treatment instrument sheath is variable by an advance / retreat operation of the hollow pipe.   3. The medical treatment instrument according to claim 1, wherein the long sheath is sheathed on the treatment instrument sheath, and a rotation / position holding mechanism is provided at a proximal end of the long sheath to provide the proximal operation unit. A medical treatment instrument characterized in that it can be set and held at the position.   The medical treatment instrument according to any one of claims 1 to 3, wherein the treatment instrument sheath has a substantially triangular cross section having a coil wire having a substantially circular cross section and an inclined side tapered toward a central portion. A medical treatment instrument characterized by having a structure of a hollow coil body in which the coil strands are alternately adjacent.   5. The medical treatment instrument according to claim 4, wherein the treatment instrument sheath is alternately adjacent to a coil wire having a substantially circular cross section and a coil wire having a substantially triangular cross section having a tapered inclined side toward the center. A medical treatment instrument characterized by having a structure of a hollow coil body.   The medical treatment instrument according to any one of claims 1 to 3, wherein the treatment instrument sheath has a substantially semi-circular coil wire having a substantially semicircular cross section and a recess in an isosceles part toward the center. A medical treatment instrument having a structure in which triangular coil wires are alternately combined so as to be engaged.   5. The medical treatment instrument according to claim 4, wherein the treatment instrument sheath includes a coil element wire having a substantially semicircular cross section and a coil element element having a substantially isosceles triangle shape having a recess in an isosceles part toward the center. A medical treatment instrument characterized by having a structure alternately combined so as to be worn.   The medical treatment instrument according to any one of claims 1 to 3, wherein the structure of the treatment instrument sheath includes a hollow stranded wire coil body provided on a proximal side and a cross-section substantially located on a distal end side. A medical treatment instrument comprising a circular coil element and a hollow coil body in which circular coil elements and a coil element having a substantially triangular cross-section having a tapered inclined side toward the center are alternately connected.   5. The medical treatment instrument according to claim 4, wherein the treatment instrument sheath has a hollow stranded wire coil provided on the proximal side, a coil wire having a substantially circular cross section located on the distal end side, and a central part. A medical treatment instrument comprising a connection form of hollow coil bodies alternately adjacent to coil wires having a substantially triangular cross-section having a tapered inclined side.   The medical treatment instrument according to claim 10, wherein the hollow stranded wire coil body includes a coil wire having a substantially semicircular cross section and a coil wire having a substantially isosceles triangle shape having a recess in an isosceles portion toward the center. A medical treatment instrument characterized by having a structure that is alternately combined so as to be engaged.   The medical treatment instrument according to any one of claims 1 to 3, wherein the treatment instrument case is substantially orthogonal to an opening direction of a collection cup provided at the distal end of the treatment instrument case so as to be openable and closable. A medical treatment instrument characterized in that the distal end side of the is shaped like a substantially arc.   The medical treatment instrument according to any one of claims 1 to 3, wherein a distal end side of the treatment instrument sheath is shaped into a substantially spiral three-dimensional shape.   4. The medical treatment instrument according to claim 1 or 3, wherein a combined curved shape of the long sheath having a distal end portion and the treatment tool sheath is substantially parallel to a curved shape of a biological tissue collection site. A medical treatment instrument characterized by being set to a state. 14. The medical treatment instrument according to claim 13, wherein a combined curved shape of the long sheath having the distal end formed therein and the treatment tool sheath is set in a state substantially parallel to the curved shape of the biological tissue collection site. A medical treatment tool characterized by that.

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