JP2016168103A - Foreign object removing device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To simultaneously execute a rotating operation and an intake operation by a simple manipulation.SOLUTION: A foreign object removing device 10 includes: a cylinder 30 having a space 46 and a tip opening 50a in communication with the space 46; a rotatable body 18 extending from the cylinder 30 and capable of rotation relative to the cylinder 30; and a plunger 32 movably disposed in the space 46 for generating negative pressure from the tip opening 50a toward the space 46 during movement. The foreign object removing device 10 further includes a rotation mechanism 34 for converting locomotion of the plunger 32 into torque to rotate the rotatable body 18.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a foreign matter removing device that removes foreign matter in a living organ.

  A blood vessel (biological organ) such as an artery may be blocked or constricted due to an atheroma or thrombus as a foreign substance. For such a lesion, a treatment for removing the foreign matter is performed by an intervention technique using the foreign matter removing device.

  For example, as a foreign substance removing device, there is a thrombus removing catheter (foreign substance removing device) as disclosed in Patent Document 1 that cuts and sucks a thrombus that has blocked the inside of a blood vessel. A head member having a blade for cutting a thrombus and a groove and a hole for sucking the thrombus is provided at the distal end of the catheter. The head member is rotated by a motor connected to the proximal end of the catheter to cut the thrombus, and the vacuum pump connected to the proximal end of the catheter is brought into a negative pressure state to suck the cut thrombus.

JP 2006-149988 A

  Incidentally, a motor for rotating the distal end of the catheter and a vacuum pump for performing a suction operation from the distal end of the catheter are separately provided at the proximal end portion of the foreign substance removing device disclosed in Patent Document 1. For this reason, the foreign substance removal device has a problem that the mounting structure of each component at the proximal end of the catheter is complicated, and it takes time to set each component on the catheter during the procedure. Further, simultaneously performing the rotation operation and the suction operation during the procedure also requires a difficult operation for the operator. If the rotation operation and the suction operation are performed separately, the procedure will take time, and the previously cut thrombus may flow (diffuse) into the blood vessel.

  The present invention has been made in order to solve the above-described problems, and by simultaneously performing a rotation operation and a suction operation by a simple operation, the procedure can be shortened and the burden on the patient can be greatly increased. It is an object of the present invention to provide a foreign matter removing device that can be reduced.

  In order to achieve the above object, the foreign substance removing device according to the present invention includes a hollow cylindrical member having a space portion, an opening that can communicate with the space portion, and a treatment portion at the distal end portion. A medical elongated body that extends from the tubular member and is rotatable relative to the tubular member, and a suction force that is movably disposed in the space portion and that moves toward the space portion from the opening during movement. And a rotating mechanism that converts the moving force of the movable member into a rotating force to rotate the medical elongated body.

  According to the above, the foreign substance removing device has a suction operation that generates a negative pressure by the movement of the movable member, and a rotational operation that rotates the medical elongated body by converting the moving force of the movable member into a rotational force by the rotation mechanism unit. Can be carried out simultaneously and easily. That is, during the procedure, the treatment part of the medical long body rotates and the lesion in the living organ is crushed (treated) by a simple operation in which the surgeon moves the movable member relative to the cylindrical member. At the same time, the crushed foreign matter can be recovered by performing a suction operation. Therefore, the foreign substance removing device can effectively recover the foreign substance while facilitating the operation of the operator, can promote the shortening of the procedure, and can greatly reduce the burden on the patient.

  In this case, it further has a protective sheath that covers the medical elongated body extending from the cylindrical member, and the proximal end portion of the protective sheath communicates the lumen of the protective sheath and the opening. It is preferable that at least a part of the treatment portion protrudes from the distal end of the protective sheath.

  As described above, the foreign substance removal device has the protective sheath that covers the medical elongated body, so that the suction force generated by the movement of the movable member can be easily transmitted near the lesion. Further, the protective sheath can protect the long medical body (particularly the shaft) when the foreign substance removing device is delivered to the lesion.

  In addition, the movable member generates a negative pressure in the space portion during relative movement in the first direction with respect to the cylindrical member, and in the space portion during relative movement in the second direction opposite to the first direction. A configuration that generates positive pressure is preferable.

  Thus, the surgeon can reciprocate the movable member during the procedure, thereby repeating the rotation operation and the suction operation, and the procedure can be performed more efficiently.

  The cylindrical member may have a valve body that brings the opening and the space into communication when the negative pressure is generated and shuts off the communication when the positive pressure is generated.

  In this way, the foreign matter removing device is a fluid that contains foreign matter in the space due to the negative pressure by making the opening and the space communicate with each other when the negative pressure is generated by the valve body and shuts off the communication when the positive pressure is generated. After flowing in, even if a positive pressure is generated, the fluid can be prevented from flowing backward. Also, for example, when removing foreign substances in the blood vessel, if a gas such as air is present in the space of the cylindrical member, the communication between the opening and the space is interrupted when a positive pressure is generated. It is possible to prevent gas from flowing into the living body lumen.

  Furthermore, the cylindrical member may include a discharge portion that closes at least when the negative pressure is generated and opens when the positive pressure is generated, thereby discharging the fluid in the space portion to the outside of the cylindrical member.

  As described above, the foreign matter removing device includes the discharge portion, and discharges the fluid in the space portion when the positive pressure is generated. Therefore, when the negative pressure is generated after the discharge, another foreign matter can flow into the space portion satisfactorily. Can do.

  Here, the rotation mechanism unit is attached to a proximal end portion of the medical long body, and is engaged with the first bevel gear and rotates with the first bevel gear, and the movable member is moved. It is preferable to have a second bevel gear that rotates with the rotation.

  Thus, by having the first bevel gear and the second bevel gear, the foreign substance removal device can easily configure a path for transmitting the rotational force from the movable member to the medical elongated body.

  In addition to the above configuration, the rotation mechanism portion may include a shaft rod portion that is coaxially connected to the second bevel gear, and a wire that is wound around the shaft rod portion and connected to the movable member. preferable.

  Thus, by having the shaft rod portion and the wire, the rotation mechanism portion can use the moving force of the movable member as the rotation force that rotates the shaft rod portion via the wire. Therefore, this rotational force can be transmitted in the order of the second bevel gear and the first bevel gear to rotate the medical elongated body satisfactorily.

  Further, the rotating mechanism unit stores a spring force as the movable member moves in one direction, rotates the shaft rod portion by the spring force, and winds the wire around the peripheral surface of the shaft rod portion. A take-off mechanism may be provided.

  As described above, the foreign matter removing device includes the winding mechanism, so that the wire can be wound after the movable member is moved in one direction. Therefore, when the movable member is re-moved in one direction, the medical long body can be rotated again by the rotation mechanism unit.

  Still further, the second bevel gear is coupled to the shaft bar portion via a one-way clutch mechanism, and the one-way clutch mechanism is configured to move the second bevel gear and the shaft rod portion in one direction of movement of the movable member. It is preferable to transmit a rotational force so that the shaft rotates integrally, and to allow relative rotation of the shaft bar portion with respect to the second bevel gear when the movable member moves in the other direction.

  As described above, the foreign substance removal device includes the one-way clutch mechanism, so that the second bevel gear does not rotate when the movable member moves in the other direction, and the medical elongated body does not rotate. Sometimes the treatment of the lesion can be avoided.

  According to the present invention, the foreign substance removal device can simultaneously reduce the burden on the patient by promoting the shortening of the procedure by simultaneously performing the rotation operation and the suction operation by a simple operation.

It is a fragmentary side sectional view showing a foreign substance removal device concerning one embodiment of the present invention. FIG. 2A is a perspective view showing a rotation mechanism portion, and FIG. 2B is a partial plan sectional view showing a one-way clutch mechanism of a second bevel gear. FIG. 3A is a first explanatory diagram showing an operation when the plunger of the foreign substance removal device is retracted, and FIG. 3B is a second explanatory diagram showing an operation when the plunger of the foreign substance removal device is advanced. It is a fragmentary sectional side view which shows the foreign material removal device which concerns on a modification.

  Hereinafter, preferred embodiments of the foreign matter removing device according to the present invention will be described and described in detail with reference to the accompanying drawings.

  The foreign substance removal device 10 is used as an intervention technique, and is configured as a medical device that removes foreign substances in a living organ. Hereinafter, an atherectomy device that collects foreign matters such as atheroma and blood clots deposited on the endothelium of blood vessels (biological organs) by a rotating operation and a suction operation will be described in detail. For example, atheroma includes lipids such as cholesterol and neutral fat, lymphocytes, calcium and cells (macrophages) containing various fibrous connective tissues. The foreign substance removing device 10 can be applied to various biological organs (bile duct, trachea, esophagus, urethra, nasal cavity, or other organs) in addition to blood vessels. For example, foreign substances such as pus and tumors are removed from the biological organs. It can be applied as a collecting device.

  As shown in FIG. 1, the foreign substance removal device 10 according to the present embodiment is formed in an elongated shape, and is connected to an insertion portion 12 that is mainly inserted into a blood vessel during a procedure, and a proximal end side of the insertion portion 12. And an operation unit 14 that is exposed to the outside of the body during a procedure and is gripped by an operator. Furthermore, the insertion part 12 is comprised by the tube 16 (protective sheath) and the rotary body 18 (medical elongate body) which penetrates the inside of this tube 16 and protrudes at a front-end | tip.

  The tube 16 rotatably arranges the rotating body 18 and performs a suction operation for collecting an atheroma, a thrombus (hereinafter, typically referred to as an atheroma) by generating a suction force during the procedure. The tube 16 is formed to be thinner than the inner diameter of the blood vessel and to reach the lesion. A lumen 20 is provided in the tube 16 along the axial direction. The tube 16 has a distal end opening 20 a communicating with the lumen 20 at the distal end, and a proximal end portion is connected to the operation unit 14. The foreign object removal device 10 takes in the atheroma from the distal end opening 20 a into the lumen 20 under the operation of the operation unit 14.

  In addition, although illustration is abbreviate | omitted, it is preferable in the tube 16 that the guide wire lumen for inserting the guide wire which guides the foreign material removal device 10 other than the lumen | bore 20 is arranged in parallel. Alternatively, the tube 16 may not include a guide wire lumen and the guide wire may be passed through the lumen 20.

  It is preferable that the tube 16 has flexibility (flexibility) that can easily follow a meandering blood vessel and has an appropriate rigidity that cannot be bent in the blood vessel. For example, the constituent material of the tube 16 includes polyolefin (for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or a mixture of two or more thereof), polyvinyl chloride, and the like. , Polyamides, polyamide elastomers, polyesters, polyester elastomers, polyurethanes, polyurethane elastomers, polyimides, fluororesins and the like, or a mixture thereof, or the above two or more polymer materials. The tube 16 may be a multilayer tube in which a plurality of these materials are stacked. Further, a contrast marker (not shown) having radiographic properties may be provided in the vicinity of the distal end opening 20a of the tube 16.

  On the other hand, the rotating body 18 disposed in the lumen 20 of the tube 16 includes a shaft 22 that is formed in a solid rod shape and is elongated in the axial direction, and a rotation treatment unit 24 that is connected to the tip of the shaft 22. The shaft 22 shown in FIG. 1 has an axial length that is slightly longer than the axial length of the tube 16, and penetrates both axial ends of the tube 16 (the distal end opening 20a and the proximal end opening 20b) in an assembled state. The shaft 22 may be shorter than the axial length of the tube 16. In that case, at least a part of the rotation treatment portion 24 protrudes from the distal end opening 20a of the tube 16 in an assembled state. That is, the rotating body 18 composed of the shaft 22 and the rotation treatment portion 24 has an axial length that is slightly longer than the axial length of the tube 16, and both axial ends of the tube 16 in the assembled state (the distal end openings 20 a and It penetrates the proximal end opening 20b). The shaft 22 is formed to be sufficiently thinner than the diameter of the lumen 20.

  The end of the shaft 22 opposite to the rotation treatment section 24 is inserted into the operation section 14 and a rotational force is applied within the operation section 14. The shaft 22 is rotated around the axis by the rotational force from the operation unit 14, and the rotation treatment unit 24 is also integrally rotated.

  Although the material which comprises the shaft 22 is not specifically limited, In order to transmit the rotational force of the operation part 14 to the rotation treatment part 24, the resin material and metal material harder than the tube 16 are preferable. Examples of the resin material include phenol resin, melamine resin, polyester resin, epoxy resin, polyethylene, polypropylene, ABS resin, AS resin, polyurethane, polyamide, polycarbonate, polybutadiene, polyvinyl chloride, and ethylene-vinyl acetate copolymer. Examples thereof include polyolefins. Examples of the metal material include pseudoelastic alloys (including superelastic alloys) such as Ni-Ti alloys, shape memory alloys, stainless steel (for example, SUS304, SUS303, SUS316, SUS316L, SUS316J1, SUS316J1L, SUS405, SUS430). SUS434, SUS444, SUS429, SUS430F, SUS302, etc.), cobalt-based alloys, noble metals such as gold and platinum, tungsten-based alloys, carbon-based materials (including piano wires), and the like.

  The rotation treatment unit 24 is fixedly held at the tip of the shaft 22 and performs a rotation operation by transmission of a rotational force from the shaft 22. The rotation treatment unit 24 is supported by the shaft 22 and protrudes from the distal end opening 20a of the tube 16 in the distal direction, and performs treatments such as cutting, crushing, collapsing, or dividing the atheroma with the rotation operation. The rotation treatment unit 24 is not particularly limited as long as this kind of treatment can be performed, and an appropriate shape can be adopted.

  For example, as shown in FIG. 1, the rotation treatment unit 24 includes a rotation plate 26 having a central portion connected to the tip of the shaft 22 and a plurality of projections 28 protruding from the tip surface of the rotation plate 26. can give. The plurality of convex portions 28 contact the lesion while rotating, thereby making the lesion a fine atheroma. In addition, the rotation treatment part 24 may not be provided with the convex part 28, and may form the rotary plate 26 with a shape and material with high frictional resistance.

  Further, the rotation treatment unit 24 includes one or a plurality of blades (including shapes such as a rod shape, a plate shape, and a block shape) protruding outward in the distal end direction and / or the radial direction of the shaft 22, and crushes the atheroma by rotation. You may do it. Furthermore, the rotation treatment unit 24 may be a drill in which a spiral or annular crest is formed on the peripheral surface of the shaft 22 or a coil wound with a wire. Alternatively, the rotation treatment unit 24 may be a porous body that is formed in a spherical shape and has a plurality of holes (concave portions) on the surface thereof. In addition, the installation position of the rotation treatment unit 24 may not be the forefront of the shaft 22, and may be the outer peripheral surface on the distal end side of the shaft 22.

  The insertion portion 12 (the tube 16 and the rotating body 18) is accommodated in a sheath (not shown) and inserted into a blood vessel during the procedure. Then, after delivering the distal end portion of the sheath to the position close to the lesion, the surgeon exposes the rotation treatment portion 24 and the tube 16 from the distal end of the sheath, and rotates the rotation treatment portion 24 from the distal end opening 20a. Perform suction operation. The sheath may be a device for introducing and guiding the foreign substance removal device 10 to the vicinity of the lesion. For example, the sheath may be an introducer sheath, a guiding catheter, a guiding sheath, or the like.

  The tube 16 may be separable from the foreign substance removal device 10 and may be used as a sheath for introducing and guiding various other catheters. In such a case, the cylinder 30 can be connected to the proximal end of the tube 16 after delivering the distal end of the tube 16 to the proximal position of the lesion. Thereby, the foreign substance removal device 10 accommodates the rotation treatment unit 24 in the lumen 20 to protect the blood vessel during movement in the blood vessel, and exposes the rotation treatment unit 24 from the tube 16 in the vicinity of the lesion to rotate and suck. Operations can be performed.

  Next, the operation unit 14 for operating the rotation operation and the suction operation of the insertion unit 12 will be specifically described. The operation unit 14 applies a rotational force to the rotating body 18 on the proximal end side of the insertion unit 12 and applies a suction force (negative pressure) to the tube 16 at the same timing. The operation unit 14 includes a cylinder 30 (cylindrical member), a plunger 32 (movable member) that moves in the cylinder 30, and a rotation mechanism unit 34 that converts the moving force of the plunger 32 into a rotational force and transmits the rotational force to the rotating body 18. And a reservoir tank 36 attached to the periphery of the cylinder 30.

  The cylinder 30 includes a cylindrical peripheral wall 40, an end wall 42 that is continuous with the distal end of the peripheral wall 40 and closes radially inward, and a hooking portion 44 that protrudes radially outward on the base end side of the peripheral wall 40. The end wall 42 forms a space 46 having a relatively large volume. The space part 46 has a function of storing the plunger 32 and the rotation mechanism part 34 therein and storing the atheroma sucked by the suction operation. The cylindrical member may be formed not only in a cylindrical shape but also in a rectangular tube shape, a box shape, or the like.

  Further, an attachment cylinder portion 48 for attaching the tube 16 is integrally formed on the end wall 42 of the cylinder 30 in the distal direction. The outer diameter of the mounting cylinder 48 is formed in a cylindrical shape that matches (or is somewhat larger) the inner diameter of the lumen 20 of the tube 16, and has a small space 50 that communicates with the space 46. In addition, a tip opening 50 a (opening) of the operation unit 14 that communicates with the small space portion 50 is provided at the tip of the mounting cylinder portion 48. The tip opening 50a is configured by a protruding end that protrudes slightly inward in the radial direction of the mounting cylinder 48 and circulates in an annular shape. A coil spring 52 is accommodated in the small space 50 of the mounting cylinder 48.

  The coil spring 52 is accommodated so as to be extendable and contractable along the axial direction of the mounting cylinder portion 48, and its tip is fixed to the inside of the protruding end. The coil spring 52 is formed to have an axial length that is exactly the same as the axial length of the small space portion 50 (or slightly shorter than the small space portion 50). The valve body 54 to be accommodated is fixed.

  The valve body 54 is made of a resin material such as an elastomer, and is formed in a flat plate shape having an outer edge larger than the inner diameter of the small space portion 50. Further, a valve hole 54a is provided in the central portion of the valve body 54 to close the peripheral surface of the shaft 22 in a liquid-tight manner while allowing the shaft 22 to rotate therethrough. The valve body 54 is held at the base end of the coil spring 52, so that the valve body 54 is disposed so as to be in contact with and away from the end wall 42 of the cylinder 30. The valve body 54 closes the space portion 46 and the small space portion 50 in a normal state (a state where there is no pressure difference between the space portion 46 and the small space portion 50) or in a positive pressure state. Then, when the space 46 becomes negative pressure as the operation unit 14 is operated, the valve body 54 is displaced from the end wall 42 in the proximal direction against the elastic force of the coil spring 52, and the space 46 and the small space 50. Allow communication.

  On the other hand, the plunger 32 accommodated in the cylinder 30 includes a rod 56 extending along the axial direction of the cylinder 30, a gasket 58 attached to the tip of the rod 56, and a gripping portion 60 formed at the base end of the rod 56. Is provided. The rod 56 is formed in a solid rod shape thicker than the shaft 22 and has a predetermined length along the axial direction of the cylinder 30 (a length at which the gasket 58 does not contact the rotation mechanism portion 34).

  The gasket 58 is made of a resin material such as an elastomer, and is accommodated so that the outer peripheral portion thereof is in close contact with the entire inner peripheral surface of the cylinder 30 and closes the space portion 46 of the cylinder 30. Therefore, a part of the space 46 sandwiched between the gasket 58 and the valve body 54 of the cylinder 30 is configured to be airtight. Hereinafter, this part is referred to as a distal end side space 46a. The gasket 58 slides along the axial direction of the cylinder 30 together with the rod 56.

  The grasping portion 60 is a portion for the operator to operate the plunger 32 during the procedure, and a flange portion 62 connected to the rod 56 and a ring into which the operator's finger can be inserted on the proximal end side of the flange portion 62. Part 64. The flange portion 62 contacts the hook portion 44 of the cylinder 30 in a displacement state in the distal end direction of the plunger 32 and restricts further movement in the distal end direction. The ring portion 64 makes it possible to apply a finger when the operator pulls the plunger 32 and facilitates the operation. In addition, you may form the holding part 60 in arbitrary shapes.

  The foreign matter removing device 10 according to the present embodiment accommodates the rotating mechanism 34 in the space portion 46 of the cylinder 30 on the tip side (tip side space 46a) of the plunger 32. The rotating mechanism unit 34 mechanically converts the moving force in the backward direction accompanying the pulling operation of the plunger 32 into the rotating force of the rotating body 18. As shown in FIG. 2A, the rotation mechanism 34 is fixed to the base end of the shaft 22 and has a first bevel gear 66 having a rotation axis coaxial with the axis of the shaft 22, and a rotation axis of the first bevel gear 66. And a second bevel gear 68 having a rotation axis orthogonal to the first bevel gear 66. Further, the rotation mechanism 34 has a shaft rod portion 70 that is connected to the second bevel gear 68 and orthogonal to the axis of the cylinder 30, and the shaft rod portion 70 includes a wire 72 that is connected to the plunger 32, and A mainspring 74 (winding mechanism) is provided.

  The first bevel gear 66 is formed in a disk shape having a sufficient thickness, and the center portion thereof is coupled to the shaft 22 of the rotating body 18. The first bevel gear 66 has a tapered portion 67 on the side facing the plunger 32, and includes a plurality of teeth 67 a on the surface of the tapered portion 67 along the circumferential direction. On the other hand, the second bevel gear 68 is formed in the same shape as the first bevel gear 66 and is close to the peripheral wall 40 shifted from the axis of the cylinder 30 (above the tip side space 46a in FIG. It is connected to the shaft rod part 70. The second bevel gear 68 has a tapered portion 69 that faces the axis of the cylinder 30, and includes a plurality of teeth 69 a on the surface of the tapered portion 69 along the circumferential direction. The first and second bevel gears 66, 68 are engaged with each other by teeth 67 a, 69 a so that the rotational force around the shaft center of the shaft rod portion 70 is transmitted from the second bevel gear 68 through the first bevel gear 66. The shaft 22 is rotated around the axis of the shaft 22.

  Further, as shown in FIG. 2B, the second bevel gear 68 is rotated integrally with the second bevel gear 68 and the shaft rod portion 70 when rotating in one direction (counterclockwise in plan view). A one-way clutch mechanism 76 that allows only the shaft rod portion 70 to rotate when rotating in the other direction (clockwise in plan view) of the shaft rod portion 70 is provided. The one-way clutch mechanism 76 and the mainspring spring 74 are attached to repeat the backward and forward movement of the plunger 32.

  For example, the one-way clutch mechanism 76 includes an inner ring 78 fixed to the shaft rod portion 70, a plurality of cylindrical rolling elements 80 provided on the outer peripheral surface of the inner ring 78, and an outer ring disposed outside the rolling element 80. 82. The main body of the second bevel gear 68 having the taper portion 69 and the teeth 69 a is fixed to the outer peripheral surface of the outer ring 82.

  A groove 84 for accommodating the rolling element 80 is provided inside the outer ring 82. A stepped surface 84a on which the rolling element 80 is caught when the shaft rod portion 70 rotates counterclockwise and an inclined surface 84b that gently tilts from the stepped surface 84a are formed on the facing surface of the inner ring 78 in the groove 84. Has been. When the shaft 70 rotates clockwise, the main body of the second bevel gear 68 meshes with the first bevel gear 66 and the inclined surface 84b allows the rolling element 80 to pass, so that the rotation of the outer ring 82 is suppressed. As a result, the shaft 70 rotates idly. The one-way clutch mechanism 76 may include a brake portion that restricts the rotation of the outer ring 82 when the shaft rod portion 70 rotates clockwise. The one-way clutch mechanism 76 is not limited to the above configuration, and various configurations can be adopted.

  1 and 2A, the shaft rod portion 70 is rotatably supported by a pair of upper and lower bearings 86 provided on the peripheral wall 40 of the cylinder 30. The shaft bar 70 crosses the axis of the cylinder 30 and bridges between the upper and lower peripheral walls 40, and holds the second bevel gear 68 fixed above the intersection of the axes of the cylinder 30.

  Then, the rotating mechanism 34 winds the wire 72 around the axial center of the outer peripheral surface of the shaft rod portion 70 (intersection of the shaft rod portion 70 and the axis of the cylinder 30). The wire 72 is made of, for example, a fiber or metal wire having appropriate flexibility and rigidity, and one end is fixed to the outer peripheral surface of the shaft rod portion 70 and the other end is fixed to the tip of the plunger 32. The other end of the wire 72 is pulled in the proximal direction by the retraction of the plunger 32, thereby rotating the shaft rod portion 70 around the axis of the shaft rod portion 70 and extending linearly from the wound state. The axial length of the wire 72 may be set to a length that prevents the gasket 58 from coming out of the space 46 when the plunger 32 is retracted.

  A spiral spring 74 wound in a spiral shape is provided on the outer peripheral surface near the lower portion in the axial direction of the shaft rod portion 70. The spring spring 74 is made of a plate material having elasticity, and one end is fixed to the outer peripheral surface of the shaft rod portion 70 and the other end is fixed to the protrusion 41 of the peripheral wall 40 of the cylinder 30. The mainspring 74 is elastically contracted inward in the radial direction of the mainspring 74 in accordance with the counterclockwise rotation of the main shaft portion 70, thereby applying a clockwise rotational force (spring force) to the main shaft portion 70. It becomes like this.

  That is, the rotation mechanism portion 34 applies a reverse rotational force to the shaft rod portion 70 by the mainspring spring 74 when the surgeon retracts the plunger 32 in the proximal direction and rotates the shaft rod portion 70. Therefore, when the plunger 32 moves in the distal direction, the wire 72 that is extended by rotating the shaft rod portion 70 can be wound around the shaft rod portion 70 again. At this time, the reverse rotation force of the mainspring spring 74 can prevent the wire 72 from being bent when the plunger 32 moves in the distal direction.

  Since the positive pressure is applied to the distal end side space 46a when the plunger 32 returns in the distal direction, the foreign substance removing device 10 discharges the fluid (such as blood containing atheroma) that has flowed into the space 46 with the application of the positive pressure. For this purpose, a reservoir tank 36 is provided. The reservoir tank 36 has a storage space 36a for storing fluid therein, and an exhaust hole 36b for exhausting the gas in the storage space 36a to the outside is provided in the upper wall portion.

  The cylinder 30 includes a duckbill valve 88 (discharge portion) on the peripheral wall 40 where the upper portion of the reservoir tank 36 is connected. The duckbill valve 88 opens when a positive pressure is applied to the distal end side space 46a, and closes when the pressure in the distal end side space 46a does not change or a negative pressure is applied. Thereby, the fluid discharged to the reservoir tank 36 continues to be stored in the storage space 36 a even when the plunger 32 is retracted.

  The foreign substance removal device 10 according to the present embodiment is basically configured as described above, and the use method and effects thereof will be described with reference to FIGS. 3A and 3B. The foreign body removal device 10 is used when performing an interventional procedure on a patient with atherosclerosis.

  In the foreign substance removal device 10, the distal end portion of the insertion portion 12 (the rotational treatment portion 24 and the distal end opening 20 a of the tube 16) is delivered to the lesion AD (the deposition site of the atheroma) through the blood vessel V by the operator. At this time, the foreign substance removal device 10 smoothly advances in the blood vessel V by accommodating the distal end of the insertion portion 12 with a sheath (not shown). The foreign substance removal device 10 can perform priming by inserting the distal end portion of the insertion portion 12 into physiological saline or the like and retracting the plunger 32 to perform a suction operation.

  Then, after reaching the position where the rotation treatment unit 24 is brought into contact with the lesion AD, the surgeon simultaneously performs the rotation operation of the rotation treatment unit 24 and the suction operation of the distal end opening 20a of the tube 16. Specifically, as shown in FIG. 3A, the plunger 32 (gripping portion 60) of the operation unit 14 exposed outside the body is gripped, and the plunger 32 is moved in the proximal direction (first direction) relative to the cylinder 30. , Retreat in one direction).

  Thereby, in the cylinder 30, the wire 72 connected to the plunger 32 is pulled in the proximal direction, and the shaft rod portion 70 around which the wire 72 is wound is rotated counterclockwise. As the shaft rod portion 70 rotates counterclockwise, the second bevel gear 68 connected to the shaft rod portion 70 via the one-way clutch mechanism 76 also rotates counterclockwise. Therefore, the first bevel gear 66 meshed with the second bevel gear 68 also rotates around the axis of the cylinder 30, and the shaft 22 connected at the center rotates around the axis. When the rotation of the shaft 22 is transmitted to the tip, the rotation treatment unit 24 rotates and crushes the lesion AD into fine atheroma.

  Further, as the plunger 32 moves backward, the inside of the distal end side space 46a of the cylinder 30 becomes negative pressure, and the valve body 54 that has closed the small space 50 is moved away from the end wall 42 and displaced in the proximal direction. . As a result, the distal end side space 46 a and the small space portion 50 communicate with each other, and a suction force (negative pressure) for sucking the fluid in the lumen 20 of the tube 16 is generated in the distal end opening 20 a of the cylinder 30. At this time, the duckbill valve 88 of the cylinder 30 maintains the closed state. The suction force of the operation unit 14 is transmitted to the distal end opening 20a of the tube 16, and the atheroma crushed by the rotation treatment unit 24 is immediately sucked into the lumen 20 from the distal end opening 20a. Therefore, fluid including atheroma and blood flows into the distal end side space 46 a of the cylinder 30 through the lumen 20 and the small space 50.

  Further, when the plunger 32 is retracted, the mainspring spring 74 is elastically contracted to store a reverse force that rotates the shaft rod portion 70 clockwise. When the operator stops the retraction operation of the plunger 32 and releases the hand from the grasping portion 60, the operation unit 14 automatically advances the plunger 32 in the distal direction (second direction, other direction). That is, as shown in FIG. 3B, the wire 72 is pulled in the distal direction by the clockwise rotation of the shaft rod portion 70 by the mainspring 74, and the plunger 32 is pulled back. Further, as the shaft rod portion 70 is rotated by the mainspring 74, the wire 72 is wound around the peripheral surface of the shaft rod portion 70 again. When the operation unit 14 does not automatically advance in the distal end direction of the plunger 32, the surgeon manually winds the plunger 32 forward in the distal end direction, thereby winding the wire 72 around the peripheral surface of the shaft rod portion 70 again. Can do.

  At this time, the second bevel gear 68 is disengaged from the shaft rod portion 70 by the one-way clutch mechanism 76 and meshed with the first bevel gear 66 so as not to rotate. Therefore, the rotation operation of the rotation treatment unit 24 is stopped.

  Further, when the plunger 32 moves forward, the front end space 46 a of the cylinder 30 becomes positive pressure, and the fluid in the cylinder 30 flows backward to the small space portion 50 and the lumen 20 by closely contacting the valve body 54 to the end wall 42. Avoid that. On the other hand, the duckbill valve 88 of the cylinder 30 is opened by a positive pressure, and the fluid in the cylinder 30 flows into the storage space 36 a of the reservoir tank 36.

  When the surgeon is further collected after the plunger 32 returns to the tip of the cylinder 30, the surgeon performs the backward operation of the plunger 32 again. At this time, since the foreign substance removal device 10 is in a state of discharging the fluid in the distal end side space 46a through the duckbill valve 88, another fluid is caused to flow from the lumen 20 into the distal end side space 46a due to generation of negative pressure. Therefore, the foreign substance removal device 10 can continuously recover the atheroma by repeating the backward and forward operations of the plunger 32. After the atheroma is collected, the procedure is completed by removing the foreign substance removal device 10 from the blood vessel V.

  As described above, the foreign matter removing device 10 performs a suction operation that generates a negative pressure by the movement of the plunger 32 and a rotation that rotates the rotation treatment unit 24 by converting the moving force of the plunger 32 into a rotating force by the rotating mechanism unit 34. The operation can be performed simultaneously and easily. That is, at the time of the procedure, the rotation treatment unit 24 rotates and crushes the lesion AD in the blood vessel V by a simple operation in which the operator retreats the plunger 32 relative to the cylinder 30. At the same time, by performing a suction operation through the distal end opening 20a of the tube 16, the crushed atheroma is recovered well. Therefore, the foreign substance removing device 10 can effectively recover the foreign substance while facilitating the operation of the operator, can promote the shortening of the procedure, and can greatly reduce the burden on the patient.

  In this case, the foreign substance removal device 10 has the tube 16 that covers the rotating body 18 so that the suction force generated by the movement of the plunger 32 can be easily transmitted to the vicinity of the lesion AD. Further, the tube 16 can protect the rotating body 18 (particularly the shaft 22) when the foreign object removal device 10 is delivered to the lesion AD.

  The operation unit 14 can simultaneously perform the rotation operation and the suction operation when the plunger 32 is retracted, and can return the plunger 32 to the original position by the advancement of the plunger 32 after the retraction. Therefore, the foreign material removal device 10 can repeatedly perform the rotation operation and the suction operation, and can further promote the efficiency of the procedure. Further, the foreign substance removal device 10 makes the tip opening 50a and the tip side space 46a communicate with each other when the negative pressure is generated by the valve body 54, and blocks the communication state when a positive pressure is generated. For this reason, it is possible to prevent the fluid from flowing backward even if a positive pressure is generated after flowing the fluid containing atheroma into the space 46.

  Further, the foreign matter removing device 10 includes the mainspring spring 74 so that the wire 72 can be taken up again by rotating the shaft bar portion 70 after the plunger 32 is retracted. 18 can be rotated again. Furthermore, the foreign substance removal device 10 includes the one-way clutch mechanism 76, so that the second bevel gear 68 and the shaft rod portion 70 are separated when the plunger 32 moves forward, and treatment of the lesion AD (rotation treatment portion) is stopped when the suction operation is stopped. 24 rotations) can be avoided.

  In addition, the foreign material removal device 10 which concerns on this invention is not limited to the said embodiment, A various application example and a modification can be taken. For example, the winding mechanism of the rotation mechanism portion 34 is not limited to the spring spring 74, and an air spring that rotates the shaft rod portion 70 by changing the pressure in the space portion 46 may be applied. The foreign matter removing device 10 may be configured to generate a negative pressure in the space 46 when the plunger 32 moves forward and to generate a positive pressure in the space 46 when retreating.

  Further, as in the modification shown in FIG. 4, the foreign substance removal device 10A may have a configuration in which a rotation mechanism portion 34A is provided outside the cylinder 30A. This foreign matter removing device 10 </ b> A has a hollow rotating tube 90 that is rotatable about an axis as the insertion portion 12, and includes a rotation treatment unit 92 that performs a rotating operation at the distal end of the rotating tube 90. Further, the inner cavity 94 of the rotating tube 90 communicates with the space portion 46 of the cylinder 30A on the proximal end side, and a negative pressure is applied from the cylinder 30A to the distal end opening 94a to collect the atheroma broken by the rotating treatment portion 94. A suction operation is performed. The insertion portion 12 may be accommodated in the sheath 96 and delivered to the lesion AD in the blood vessel V.

  The operation unit 14 of the foreign matter removing device 10A includes a cylinder 30A having a space 46, a plunger 32A (movable member) slidably accommodated in the space 46, and the rotation mechanism 34A. The end wall 42 of the cylinder 30 </ b> A is provided with a check valve 98 (for example, a duckbill valve) that opens and closes the small space portion 50 and the space portion 46 of the mounting cylinder portion 48. The rotation mechanism 34A includes a first bevel gear 100 connected to the base end of the rotation tube 90, a second bevel gear 102 that meshes with the first bevel gear 100 and is rotatably attached to the peripheral wall 40 of the cylinder 30A, and a second bevel gear 102. And a pulley 104 fixed to the bevel gear 102. A wire 72A is wound around the pulley 104, and the wire 72A extends in the base end direction of the cylinder 30A and is connected to the grip portion 60 of the plunger 32A. The foreign matter removal device 10A may include a case that covers the rotation mechanism 34A.

  The foreign matter removing device 10A is configured as described above, and operates the rotating mechanism 34A (the pulley 104, the second bevel gear 102, the first bevel gear 100) in accordance with the retreat of the plunger 32A, thereby rotating the rotating tube. 90 can be rotated to crush (treat) the lesion AD. Further, the retraction of the plunger 32A generates a negative pressure at the distal end opening 94a of the rotating tube 90, and the crushed atheroma can be collected in the distal end side space 46a.

  As shown in FIG. 4, the foreign substance removal device 10 </ b> A has a long (or large) cylinder 30 </ b> A formed so that the rotation operation and the suction operation can be completed by one retraction of the plunger 32 </ b> A. it can. In other words, the foreign matter removing device 10A may not include the one-way clutch mechanism 76, the mainspring 74, the reservoir tank 36, the duckbill valve 88, and the like. In addition, the rotation mechanism parts 34 and 34A can increase or decrease the rotation amount of the rotation treatment parts 24 and 92 with respect to the movement distance of the plungers 32 and 32A by changing the gear ratio of the constituting teeth.

DESCRIPTION OF SYMBOLS 10, 10A ... Foreign substance removal device 12 ... Insertion part 14 ... Operation part 16 ... Tube 18 ... Rotating body 20, 94 ... Lumen 30, 30A ... Cylinder 32, 32A ... Plunger 34, 34A ... Rotation mechanism part 46 ... Space part 46a ... distal end side space 48 ... mounting cylinders 50a, 94a ... tip opening 52 ... coil spring 54 ... valve element 66, 100 ... first bevel gear 68, 102 ... second bevel gear 70 ... shaft rod 72, 72A ... wire 74 ... Spring spring 76 ... One-way clutch mechanism 88 ... Duck bill valve AD ... Lesions

Claims (9)

A hollow cylindrical member having a space and an opening that can communicate with the space;
A treatment part is provided at the distal end, extends from the cylindrical member, and is a medical elongate body rotatable relative to the cylindrical member;
A movable member that is movably disposed in the space, and generates a suction force from the opening toward the space when moving;
A rotating mechanism that converts the moving force of the movable member into a rotating force to rotate the medical elongated body. The foreign matter removing device according to claim 1,
A protective sheath covering the medical elongated body extending from the tubular member;
The proximal end portion of the protective sheath is connected to the tubular member so as to communicate the lumen of the protective sheath and the opening,
At least a part of the treatment portion protrudes from the distal end of the protective sheath. The foreign matter removing device according to claim 1 or 2,
The movable member generates a negative pressure in the space portion when moving relative to the cylindrical member in the first direction, and positive pressure is applied to the space portion during relative movement in the second direction opposite to the first direction. A foreign matter removing device characterized by producing The foreign matter removing device according to claim 3,
The cylindrical member includes a valve body that brings the opening and the space into communication when the negative pressure is generated, and shuts off the communication when the positive pressure is generated. The foreign matter removing device according to claim 3 or 4,
The cylindrical member includes a discharge portion that closes at least when the negative pressure is generated and opens when the positive pressure is generated to discharge the fluid in the space portion to the outside of the cylindrical member. Removal device. In the foreign matter removal device according to any one of claims 1 to 5,
The rotation mechanism unit is
A first bevel gear attached to a proximal end of the medical elongated body and rotating integrally with the medical elongated body;
A foreign matter removing device comprising: a second bevel gear that meshes with the first bevel gear and rotates as the movable member moves. The foreign matter removing device according to claim 6,
The rotation mechanism unit is
A shaft bar portion coaxially connected to the second bevel gear;
A foreign matter removing device comprising: a wire wound around the shaft rod portion and connected to the movable member. The foreign matter removing device according to claim 7,
The rotating mechanism portion stores a spring force as the movable member moves in one direction, rotates the shaft rod portion by the spring force, and winds the wire around the shaft rod portion. A foreign matter removing device comprising: The foreign matter removing device according to claim 7 or 8,
The second bevel gear is connected to the shaft bar portion via a one-way clutch mechanism,
The one-way clutch mechanism transmits a rotational force so that the second bevel gear and the shaft rod portion rotate integrally with the movement of the movable member in one direction, and the second bevel gear is moved in the other direction. A foreign matter removing device that allows relative rotation of the shaft bar portion with respect to a bevel gear.

Images