JP2017176672A - Medical basket-type treatment instrument and method of use thereof - Google Patents

Abstract

Kind Code: A1 A medical basket-type treatment instrument that facilitates replacement of a catheter tube inside an endoscope, and a method for using the same. A medical basket-type treatment instrument (2) that can be protruded and retracted from a distal end opening (42a) of an endoscope (40). When the passage of the distal end opening 42a is narrowed while the basket portion 22 protrudes from the distal end opening 42a of the endoscope 40, it does not pass through the narrowed passage, but the through hole 5 of the catheter tube 4 does not pass through. A stopper portion 60 that can pass through the interior is provided on the operation wire 4 located on the proximal end side of the basket portion 22 . [Selection drawing] Fig. 6

Description

  The present invention relates to a medical basket type treatment instrument and a method of using the same.

  2. Description of the Related Art A medical basket type treatment instrument is known as a technique that is used together with an endoscope and removes foreign substances in the body such as gallstones in a bile duct. The medical basket type treatment instrument is configured so that foreign matters such as gallstones can be grasped by a basket portion fed out from the distal end opening of the catheter tube (see, for example, Patent Document 1).

  While holding the foreign body such as gallstones in the basket, move the basket with the foreign body from the bile duct to the duodenum through the duodenal papilla and release the foreign body from the basket inside the duodenum. be able to. Alternatively, when the operator operates the basket portion that has grasped the foreign matter so as to draw it into the catheter tube, a force is applied to the foreign matter, and the foreign matter can be crushed.

  However, when the foreign object is too large, the basket part in the state where the foreign object is grasped cannot pass through the duodenal papilla, and the foreign object cannot be crushed, and the grasped foreign object can be easily removed from the basket part. There may not be. In this case, the basket-type treatment instrument cannot be removed from the body unless the foreign matter is removed from the basket portion by some kind of treatment. In the worst case, it is necessary to perform a treatment for removing the basket-type treatment instrument by surgery.

  In such a case, in order to forcibly remove foreign matter from the basket portion, a structure in which the tip end bundling portion of the wire constituting the basket portion is separated by a force exceeding a predetermined value has been proposed. However, in that case, the foreign matter may not be crushed, the basket portion may be destroyed, and the foreign matter may be left in the body.

  In addition, as a catheter tube of a medical basket type treatment instrument that is first introduced into the body, a catheter tube that is relatively excellent in terms of insertion into the body is usually used. There is also known a method of crushing foreign matters by exchanging the catheter tube with another catheter tube having higher rigidity. Even if the basket part that has grasped the foreign substance is pulled into the flexible catheter tube, the catheter tube cannot support the force to pull the basket part, so it is difficult to apply compressive force to the foreign substance, but the catheter tube is replaced with a more rigid one. If possible, the possibility of crushing foreign matter increases.

  However, in the structure of the conventional medical basket type treatment instrument, there is no problem when the catheter tube is pulled out, but a problem arises when a new catheter tube is inserted into the endoscope. That is, the operating wire is pushed together with the catheter tube due to frictional force with the operating wire when a new catheter tube is fed, and the proximal end of the operating wire cannot be taken out from the proximal end of the catheter tube. . In order to pull the basket portion into the catheter tube and apply a compressive force to the foreign matter, it is necessary to grasp the operation wire and pull it into the catheter tube. However, the proximal end of the operation wire is connected to the proximal end of the catheter tube. If it cannot be taken out, the operating wire cannot be retracted, and a compressive force for crushing foreign matter cannot be applied. In order to solve this problem, it may be possible to feed the catheter tube while grasping the operation wire by making the operation wire located outside the body longer than the total length of the catheter tube. There is a problem that the operation wire becomes redundant, and the handleability of the medical basket type treatment instrument in a normal state is inferior.

No. 6-91

  The present invention has been made in view of such a situation, and an object thereof is to provide a medical basket type treatment instrument in which a catheter tube can be easily exchanged inside an endoscope and a method of using the same.

In order to achieve the above object, a medical basket type treatment instrument according to the present invention comprises:
An operation wire that is movably disposed in the longitudinal direction inside the through hole of the catheter tube;
Expanding and contracting by being connected to the distal end of the manipulation wire, moving the manipulation wire along the longitudinal direction inside the through-hole, and entering and exiting from the distal end opening of the catheter tube A basket portion that is enabled, and
A medical basket type treatment instrument that can be protruded and retracted from a distal end opening of an endoscope,
When the path of the distal end opening is narrowed in a state where the basket portion protrudes from the distal end opening of the endoscope, the narrowed path does not pass through, but the passage of the catheter tube does not pass. A stopper portion that can pass through the inside is provided in the operation wire located closer to the proximal end side than the basket portion.

  In the medical basket type treatment instrument according to the present invention, the catheter tube can be easily exchanged inside the endoscope. Specifically, first, with the basket portion holding a foreign object protruding from the distal end opening of the endoscope, the raising stand provided at the distal end of the endoscope is viewed from the proximal end side. Maneuvering narrows the path of the distal end opening.

  Next, in a state where the operation wire is left inside the channel of the endoscope, the catheter tube covering the operation wire is extracted from the proximal end entrance of the endoscope. At that time, since the basket portion connected to the distal end of the operation wire holds a foreign object, even if the frictional force due to the withdrawal of the catheter tube acts on the operation wire, the operation wire is The state that remains inside the entire length of the endoscope channel is maintained.

  Next, the proximal end of the operation wire protruding from the proximal end entrance of the endoscope is inserted into the through hole of a new catheter tube. Then, the distal end of the new catheter tube is fed into the channel of the endoscope along the operation wire and is positioned close to a stopper portion provided at the distal end portion of the operation wire. At that time, even if the frictional force due to the feeding of the catheter tube acts on the operation wire, the stopper portion of the operation wire does not pass through the narrowed distal end opening, and the operation wire stays with the catheter tube. Since it is not pushed in, the proximal end of the manipulation wire can be removed from the proximal end of the catheter tube without making the manipulation wire redundant.

  That is, in the medical basket type treatment instrument according to the present invention, the catheter tube can be easily exchanged inside the endoscope. After that, by operating an elevator or the like provided at the distal end of the endoscope from the proximal end side, the path of the distal end opening is widened and a newly replaced relatively rigid catheter By operating the tube so as to draw the operation wire, force is applied to the foreign matter, and the foreign matter is easily crushed.

Preferably, the basket portion is
Multiple basket wires,
A tip bundling portion provided at a distal end portion of the basket portion, in which the distal end portions of a plurality of basket wires are bundled;
A rear end bundling portion provided at the proximal end portion of the basket portion, the proximal end portions of the plurality of basket wires being bundled;
The stopper portion is provided on the operation wire located closer to the proximal end side than the rear end binding portion.

  With this configuration, even if it is difficult to pull the basket portion into the endoscope without foreign matter coming off the basket portion, the stopper portion is in a position where it can be easily pulled into the endoscope. It becomes easy for the stopper portion to perform its function.

  Preferably, the outer diameter of the stopper portion is larger than the outer diameter of the operation wire.

  With this configuration, the stopper portion reliably engages the narrowed distal end opening without passing through the narrowed distal end opening passage of the endoscope. As a result, when exchanging the catheter tube, the operation wire is not pushed together with the catheter tube.

  Preferably, the rigidity of the stopper portion is larger than the rigidity of the operation wire.

  Even with this configuration, the stopper portion reliably engages with the narrowed distal end opening without passing through the narrowed distal end opening passage of the endoscope. As a result, when exchanging the catheter tube, the operation wire is not pushed together with the catheter tube.

The method of using the medical basket type treatment instrument according to the present invention includes:
Narrowing the path of the distal end opening with the basket portion protruding from the distal end opening of the endoscope;
Withdrawing the catheter tube covering the operation wire from the proximal end entrance of the endoscope while leaving the operation wire inside the endoscope;
The proximal end of the operation wire protruding from the proximal end entrance of the endoscope is inserted into a through hole of a new catheter tube, and the distal end of the new catheter tube extends along the operation wire. And feeding the inside of the endoscope to a position close to a stopper portion provided at a distal end portion of the operation wire.

  According to the method of using the medical basket type treatment instrument according to the present invention, the catheter tube can be easily exchanged inside the endoscope.

FIG. 1 is a cross-sectional view showing the overall configuration of a medical basket type treatment instrument according to an embodiment of the present invention. FIG. 2 is a perspective view showing the basket portion and the distal end portion of the catheter tube shown in FIG. FIG. 3 is an overall perspective view showing a state where the medical basket type treatment instrument shown in FIG. 1 is placed in an endoscope. FIG. 4 is a partial cross-sectional schematic view showing a state where the medical basket type treatment instrument shown in FIG. 1 is used in a bile duct. FIG. 5 is a schematic cross-sectional view of a main part near the distal end opening of an endoscope into which a medical basket type treatment instrument having a basket portion holding a foreign object is inserted. FIG. 6 is a schematic cross-sectional view of a main part near the distal end opening of the endoscope showing a state in which the path of the distal end opening of the endoscope is narrowed. FIG. 7 is a schematic cross-sectional view of the main part near the distal end opening of the endoscope after the catheter tube is pulled out. FIG. 8 is a schematic perspective view showing the entire endoscope showing a state in which the proximal end of the operation wire is inserted into a through hole of a new catheter tube. FIG. 9 is a schematic cross-sectional view of a main part near the distal end opening of the endoscope after a new catheter tube is inserted. FIG. 10 is a schematic cross-sectional view of the main part near the distal end opening of the endoscope showing the subsequent process of FIG. 9.

Hereinafter, the present invention will be described based on embodiments shown in the drawings.
The medical basket type treatment instrument 2 shown in FIGS. 1 and 2 is inserted into the channel of the endoscope 40 shown in FIG. 3 so as to be axially movable, and for example, from the duodenal papilla 51 of the duodenum 50 shown in FIG. It is inserted and used.

  First, the overall configuration of the medical basket type treatment instrument 2 will be described. As shown in FIG. 1, the medical basket type treatment instrument 2 of this embodiment includes a catheter tube 4 having a through hole 5 continuous from a distal end 4 a to a proximal end 4 b, and a proximal end 4 b of the tube 4. It has a connector hub 7 connected via a connector tube 6 and a wire member 20 with a basket that penetrates the through hole 5 of the catheter tube 4 in the axial direction.

  In the present embodiment, the connector hub 7 is formed with two connection ports 8 and 10, but the specific shape of the connector hub 7 is not particularly limited, and a connector having only a single connection port, three or more A connector having a connection port may be used. In general, the rigidity (hardness) of the connector hub 7 is higher than the rigidity (hardness) of the catheter tube 4. It is made of a thermoplastic resin or a metal such as stainless steel. The connector hub 7 is located outside the patient's body and is shaped and shaped to be easily grasped by an operator with one hand.

  The catheter tube 4 is a tube formed of a resin such as polyamide or fluorine resin, for example. The inner diameter of the catheter tube 4 is, for example, 0.5 mm to 5.0 mm, and the wall thickness of the catheter tube 4 is, for example, 0.1 mm to 1.0 mm. Moreover, the axial direction length of the catheter tube 4 is 1000-3000 mm, for example. A contrast ring 4c made of an X-ray opaque material such as a platinum iridium alloy is attached to the outer peripheral surface near the distal end of the catheter tube 4. The medical basket type treatment instrument 2 of the present embodiment is used for the purpose of grasping and removing a foreign substance from the body without crushing the foreign substance in the bile duct such as a gallstone unless the catheter tube 4 is replaced. It is. Therefore, the catheter tube 4 is configured flexibly so as to be easily inserted into the bile duct, and does not have a configuration for crushing foreign matter. However, if necessary, the catheter tube 4 may have a configuration for crushing foreign matter similar to the catheter tube 4A described later.

  A wire member 20 with a basket is inserted into the through hole 5 of the catheter tube 4 so as to be movable along the axial direction thereof. The wire member 20 with a basket includes an operation wire 24 and a basket portion 22 connected to a distal end portion thereof via a joint portion 28.

  As shown in FIG. 2, the basket portion 22 is composed of a plurality (four in this embodiment) of basket wires 22 a to 22 d, and the tip ends of the basket wires 22 a to 22 d are tip tips (an example of a tip bundling portion) 26. Are joined together. The plurality of basket wires 22a to 22d may be formed of separate wires, or two basket wires may be formed by bending one wire within the tip tip 26. In the embodiment, four basket wires 22a to 22d are formed by bending each of the two wires within the tip 26. Further, the rear end portions of the basket wires 22 a to 22 d are bound by a welding method such as silver brazing welding at a joining portion (an example of the rear end binding portion) 28 and joined to the operation wire 24.

  Each of the basket wires 22a to 22d shown in FIG. 2 protrudes from the distal end opening 3 (see FIG. 2) of the distal end 4a of the catheter tube 4 so as to expand radially outward (expanded). As you can see) The inner diameter of the distal end opening 3 is approximately the same as the inner diameter of the catheter tube 4, but may be increased to about 1.0 to 10 mm.

  In the present embodiment, as shown in FIG. 1, a foreign object 30 such as a gallstone can be held in the gap between the basket wires 22 a to 22 d. When the basket portion 22 is pulled into the catheter tube 4, the basket portion 22 is folded (contracted) and can be elastically deformed so that the outer diameter thereof is reduced.

  The operation wire 24 shown in FIG. 2 may be formed by extending the four basket wires 22a to 22d constituting the basket portion 22 in the longitudinal direction, but is completely different from these basket wires 22a to 22d. You may comprise with a wire. The operation wire 24 transmits an operation force acting on the proximal end side thereof to the basket portion 22, and the basket portion 22 folded inside the catheter tube 4 is transferred from the opening 3 of the distal end 4 a of the catheter tube 4 to the outside. It has a rigidity that can be sent to Further, the operation wire 24 has a tensile strength that can transmit a force for crushing a foreign substance 30 such as a gallstone using a force by which the basket portion 22 contracts.

  The basket wires 22a to 22d constituting the basket portion 22 are made of metal wires having a wire diameter of about 0.2 to 1.0 mm, for example. Examples of the material of the wire include stainless steel, nickel titanium alloy, gold, silver, platinum, nickel, iron, titanium, aluminum, tin, zinc, tungsten and the like, but stainless steel or nickel titanium alloy is preferable. . The operation wire 24 may be made of the same material and wire diameter as the basket wires 22a to 22d, or may be made of a different material and wire diameter. However, the operation wire 24 raises the raising base 46 of the endoscope 40 including the raising base 46 used in combination with the medical basket type treatment instrument 2, so that the distal end opening 42 a of the endoscope 40 can be raised. Even when the path is narrowed, it has an outer diameter and rigidity so that it can pass through the narrowed path.

  As shown in FIG. 2, in a state where the basket portion 22 protrudes from the distal end opening 3 of the catheter tube 4 (the same applies to the description of the shape of the basket portion 22), the wires 22 a to 22 d are connected to the basket portion 22. A plurality of bent portions from the proximal end ep (ie, the distal end of the rear end binding portion 28) toward the distal end ed of the basket portion 22 (ie, the proximal end of the tip binding portion 26). In the illustrated example, the bent portions are all outwardly bent portions, but inwardly bent portions may be mixed in part.

  The outward bent portion is a bent portion of the wire that is convex outward in the radial direction with respect to the central axis of the basket portion 22, and the basket portion is opposite to the inward bent portion. 22 is a bent portion of the wire that is convex inward in the radial direction with respect to the central axis of 22. Further, the central axis of the basket portion 22 is on the extension line in the longitudinal direction of the operation wire 24, and the central axis where the wires 22 a to 22 d are bundled when the basket portion 22 is contracted to the minimum in the radial direction. It is. Further, the overall length of the basket portion 22 (when the basket portion 22 is contracted to the inside in the radial direction to the minimum) is determined according to the patient and application, and is not particularly limited, but is usually selected within a range of 10 to 100 mm. Is done.

  In order to mold the basket portion 22 of the present embodiment, first, the distal ends of the wires 22a to 22d are joined to the tip tip 26 by silver soldering or the like, and the proximal ends thereof are silver soldered or the like. Are joined together to form a joint 28. Thereafter, as shown in FIG. 2, the wires 22a to 22d may be bent to form bent portions. Bending is performed using a bending die or tweezers.

  In addition, the code | symbol 12 shown in FIG. 1 shows the operating instrument of the wire 24 for operation. The operation instrument 12 includes a connection tool 15 connected to the connection port 8 and a movable knob 16 that is slidable along the longitudinal direction with respect to the operation instrument main body 14. A fixed knob 18 is fixed to the proximal end portion of the operating instrument main body 14. The proximal end of the operation wire 24 is connected to the movable knob 16, and the movable knob 16 is moved relative to the fixed knob 18 along the longitudinal direction to operate the catheter inside the catheter tube 4. The wire can be moved relative to the catheter tube 4 along the longitudinal direction (also referred to as the axial direction).

  In this embodiment, as shown in FIG. 2, the stopper part 60 is provided in the position of predetermined distance L1 toward the proximal end from the proximal end part ep of the basket part 22. As shown in FIG. The stopper portion 60 may be formed in the same manner as the rear end binding portion 28, but may be formed by a different method. For example, the stopper portion 60 may be formed by mounting a metal pipe or a resin tube on the outer peripheral surface of the operation wire 24, or by performing brazing or the like on a predetermined position of the operation wire 24. You may form by improving the rigidity of a part.

  The stopper portion 60 may be formed so as to also serve as the rear end binding portion 28 (that is, L1 = 0), but the basket portion 22 is placed inside the endoscope 40 without the foreign matter being detached from the basket portion 22 that has grasped the foreign matter. Even if it is difficult to retract the stopper portion 60, the stopper portion 60 is formed on the operation wire 40 positioned closer to the proximal end side than the rear end binding portion 28 so that the stopper portion 60 can be easily pulled into the endoscope 40. Is desirable. In that case, it is preferable that L1 = 20 to 140 mm.

  When the stopper portion 60 is formed separately from the rear end binding portion 28, the outer diameter of the stopper portion 60 is preferably larger than the outer diameter of the rear end binding portion 28, but the distal end opening of the catheter tube 4 is opened. The inner diameter of the catheter tube 4 is smaller than the inner diameter of the catheter tube 4 and is movable in the axial direction. However, as shown in FIG. 6 which will be described later, the stopper portion 60 is provided at the distal end opening 42a which is narrowed by raising the raising base 46 provided at the distal end of the endoscope 40. Even if the operation wire 24 is locked and a pushing force is applied, the stopper portion 60 does not jump out of the distal end opening 42a, and the raising base 46 is not raised. The outer diameter, rigidity, length, and the like are adjusted so as to pass through the distal end opening 42a.

  More specifically, the outer diameter of the stopper portion 60 is preferably 0 to 1.5 mm larger, more preferably 0.1 to 1.0 mm larger than the outer diameter of the operation wire 24. Moreover, as shown in FIG. 2, the length L2 of the stopper part 60 in the axial direction is preferably 1.0 to 5.0 mm.

  Next, a method for using the medical basket type treatment instrument 2 according to the present embodiment will be described. The medical basket type treatment instrument 2 according to the present embodiment is used together with an endoscope 40 which is a side endoscope used for, for example, an endoscopic technique for the bile duct shown in FIG. The endoscope 40 has an endoscope tube 42 whose distal end is inserted into the body. From the distal end opening 42 a of the tube 42, the distal end portion of the catheter tube 4 of the medical basket type treatment instrument 2 can protrude. The distal end of the tube 42 is provided with an elevator 46 that can adjust the orientation of the catheter tube 4 that protrudes from the distal end opening 42a.

  As shown in FIG. 4, when the distal end of the endoscope tube 42 is guided to the vicinity of the duodenal papilla 51 inside the duodenum 50 according to a conventional method, medical treatment is performed from the proximal end of the endoscope tube 42. The basket-type treatment instrument 2 is inserted into the channel 44 (see FIG. 5) of the endoscope tube 42. Thereafter, the distal end portion of the medical basket type treatment instrument 2 is protruded from the distal end opening 42 a of the endoscope tube 42. In this case, unlike FIG. 5, the basket portion 22 is not spread, is located inside the catheter tube 4, and nothing protrudes from the distal end opening 3 of the tube 4.

  In this state, the distal end 4a of the catheter tube 4 is protruded from the distal end opening 42a of the endoscope tube 42, and the elevator 46 provided at the distal end of the endoscope tube 42 is operated. Then, as shown in FIG. 4, the duodenal papilla 51 is inserted into the bile duct 52. Since the contrast ring 4c is attached to the distal end portion of the medical basket type treatment instrument 2, the insertion position of the distal end portion of the medical basket type treatment instrument 2 can be observed by X-ray fluoroscopy. it can.

  Thereafter, if necessary, the contrast medium is allowed to flow into the bile duct 52 from the connection port 10 shown in FIG. 1 through the catheter tube 4, and the inside of the bile duct 52 shown in FIG. 4 is observed by X-ray fluoroscopy. Next, as shown in FIG. 2, the basket portion 22 of the wire member 20 with a basket is popped out from the distal end opening 3 of the catheter tube 4, the basket portion 22 is expanded, and a foreign substance 30 such as gallstones is caused by the basket portion 22. grab.

  Thereafter, the foreign body 30 is moved from the bile duct 52 to the duodenum 50 together with the foreign body 30 in a state where the foreign body 30 is gripped by the basket section 22, and the foreign body 30 is released from the basket section 22 inside the duodenum 50. It can be discharged outside the body.

  However, for example, when the foreign matter 30 is too large, the basket portion 22 that has grasped the foreign matter 30 may not pass through the duodenal papilla 51 and may not be able to remove the foreign matter 30 from the basket portion 22. Further, in this case, even if the basket part 22 that has grasped the foreign substance 30 is operated to be crushed and the basket part 22 is pulled into the catheter tube 4, the catheter tube 4 is flexible, so In some cases, it is difficult to transmit force, and it is difficult to crush the foreign material 30.

  In such a case, in the medical basket type treatment instrument 2 of the present embodiment, the catheter tube 4 is replaced with a higher-rigidity catheter tube 4A (see FIG. 8) as follows, and the foreign object 30 is removed. Crush.

  That is, first, as shown in FIG. 5, the catheter tube 4 is drawn into the channel 44 of the endoscope tube 42 with the foreign matter 30 being caught in the basket portion 22, and at least the stopper portion 60 of the operation wire 24 is moved. Pull into the channel. Next, as shown in FIG. 6, the basket 22 holding the foreign object 30 protrudes from the distal end opening 42 a of the endoscope tube 42 and is provided at the distal end of the endoscope tube 42. By operating a certain elevator 46 from the proximal end side, the path of the distal end opening 42a is narrowed.

  Next, the catheter tube 4 covering the operation wire 24 from the proximal end entrance / exit 42b of the endoscope 40 shown in FIG. 3 with the operation wire 24 left in the channel 44 of the endoscope tube 42. Pull out. At this time, as shown in FIG. 6, since the basket portion 22 connected to the distal end of the operation wire 24 holds the foreign object 30, the frictional force due to the withdrawal of the catheter tube 4 is applied to the operation wire. Even if it acts on 24, the operation wire 24 maintains the state which remained inside over the full length of the channel 44 of the endoscope tube 42, as shown in FIG.

  Next, as shown in FIG. 8, the proximal end 24a of the operation wire 24 protruding from the proximal end entrance 42b of the endoscope 40 is replaced with a new catheter tube 4A having a particularly high rigidity at the distal end. Insert from the distal end into the bore.

  The catheter tube 4A has high rigidity, and is constituted by, for example, a coil tube in which a metal coil is covered with a fluororesin. By constructing the catheter tube 4A with a coil tube, the catheter tube 4A can be inserted into a torsional body cavity and has a certain degree of flexibility, and the basket portion 22 is pulled into the catheter tube 4A to crush foreign substances such as gallstones. Has as much rigidity (or axial strength) as possible. A tubular distal end member 4c1 is connected to the distal end of the catheter tube 4A. The distal end member 4c1 is preferably made of a metal such as stainless steel, for example, from the viewpoint of securing strength for pulling the basket portion 22 into the catheter tube 4A and crushing foreign matter, but is not necessarily a metal. It is not necessary and may be made of other materials, and the distal end member 4c1 may not be provided.

  Then, as shown in FIG. 9, the distal end member 4 c 1 of the new catheter tube 4 A is fed into the channel 44 of the endoscope tube 42 along the operation wire 24, and the distal end of the operation wire 24 is sent. It is located to the vicinity of the stopper part 60 provided in the part. At that time, even if the frictional force due to the feeding of the catheter tube 4A acts on the operation wire 24, the stopper portion 60 of the operation wire 24 does not pass through the narrowed distal end opening 42a. The wire 24 is not pushed together with the catheter tube 4A. Accordingly, the distal end member 4c1 of the catheter tube 4A is positioned near the stopper portion 60 provided at the distal end portion of the operation wire 24, and the proximal end 24a of the operation wire 24 is placed on the catheter tube 4A. Can be removed from the proximal end.

  That is, in the medical basket type treatment instrument 2 according to the present embodiment, the exchange from the catheter tube 4 to 4A is facilitated inside the endoscope tube 42 placed in the body. Thereafter, as shown in FIG. 10, the raising base 60 provided at the distal end of the endoscope tube 42 is operated from the proximal end side so that the raising base 60 is laid, so that the distal end opening 42 a Widen the path. Thereafter, the distal end member 4c1 of the newly replaced relatively rigid catheter tube 4A is fed out of the channel 44 from the distal end opening 42a.

  Before and after that, the connector tube 6A and the connector hub 7A shown in FIG. 8 are connected to, for example, the operating instrument 12 shown in FIG. 3 (or another operating instrument / hereinafter the same), and the proximal end 24a of the operating wire 24 is operated. Connect to instrument 12. Then, the operation instrument 12 is operated, and the basket portion 22 holding the foreign object 30 is drawn into the distal end member 4c1 of the high-rigidity catheter tube 4A using the new catheter tube 4A. Tighten with to crush the foreign material 30. The crushed foreign matter 30 is discharged out of the body from the duodenum 50 shown in FIG.

  According to the method of using the medical basket type treatment instrument 2 according to the present embodiment as described above, the catheter tube 4 and the new high-rigidity catheter tube 4A are easily exchanged inside the endoscope tube 42. can do.

  The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention. For example, in the above-described embodiment, the wire member with a basket to be inserted into the inside of the medical basket type treatment instrument 2 has a basket portion 22 composed of four basket wires 22a to 22d. In addition, you may use the wire member with a basket which has the basket part comprised by the 3 or more multiple basket wire.

  Furthermore, in the above-described embodiment, the elevator 46 is used as a means for narrowing the path of the distal end opening 42a of the endoscope tube 42. However, as long as the purpose is achieved, the means is not particularly limited. .

DESCRIPTION OF SYMBOLS 2 ... Medical basket type treatment instrument 3 ... Distal end opening 4 ... Catheter tube 4a ... Distal end 4b ... Proximal end 4c ... Contrast ring 5 ... Through-hole 6 ... Connector tube 7 ... Connector hub 8, 10 ... Connection port DESCRIPTION OF SYMBOLS 12 ... Operation tool 14 ... Operation tool main body 15 ... Connection tool 16 ... Moving knob 18 ... Fixed knob 20 ... Wire member 22 with a basket ... Basket part 22a-22d ... Basket wire 24 ... Operation wire 26 ... Tip (tip) Unity)
28 ... Joining part (rear end bundling part)
30 ... Gallstone 40 ... Endoscope 42 ... Endoscope tube 42a ... Distal end opening 42b ... Proximal end entrance / exit 44 ... Channel 46 ... Raising stand 50 ... Duodenum 51 ... Duodenal papilla 52 ... Bile duct 60 ... Stopper part

Claims (5)

An operation wire that is movably disposed in the longitudinal direction inside the through hole of the catheter tube;
Expanding and contracting by being connected to the distal end of the manipulation wire, moving the manipulation wire along the longitudinal direction inside the through-hole, and entering and exiting from the distal end opening of the catheter tube A basket portion that is enabled, and
A medical basket type treatment instrument that can be protruded and retracted from a distal end opening of an endoscope,
When the path of the distal end opening is narrowed in a state where the basket portion protrudes from the distal end opening of the endoscope, the narrowed path does not pass through, but the passage of the catheter tube does not pass. A medical basket-type treatment instrument, wherein a stopper portion that can pass through the inside is provided on the operation wire located closer to the proximal end than the basket portion. The basket portion is
Multiple basket wires,
A tip bundling portion provided at a distal end portion of the basket portion, in which the distal end portions of a plurality of basket wires are bundled;
A rear end bundling portion provided at the proximal end portion of the basket portion, the proximal end portions of the plurality of basket wires being bundled;
2. The medical basket type treatment instrument according to claim 1, wherein the stopper portion is provided on the operation wire located closer to the proximal end side than the rear end binding portion.   The medical basket type treatment instrument according to claim 1 or 2, wherein an outer diameter of the stopper portion is larger than an outer diameter of the operation wire.   The medical basket type treatment instrument according to any one of claims 1 to 3, wherein the stopper portion has a rigidity higher than that of the operation wire. A method of using the medical basket type treatment instrument according to any one of claims 1 to 4,
Narrowing the path of the distal end opening with the basket portion protruding from the distal end opening of the endoscope;
Withdrawing the catheter tube covering the operation wire from the proximal end entrance of the endoscope while leaving the operation wire inside the endoscope;
The proximal end of the operation wire protruding from the proximal end entrance of the endoscope is inserted into a through hole of a new catheter tube, and the distal end of the new catheter tube is extended along the operation wire. A method of using the medical basket-type treatment instrument, comprising: feeding the inside of the endoscope to a position close to a stopper portion provided at a distal end portion of the operation wire.

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