JPS60174159A - Expander - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION [Technical Field of the Invention] The present invention relates to a dilator used for inserting a medical instrument such as an endoscope.

[Technical background of the invention and its problems] In recent years, by inserting a small diameter insertion part into the body cavity,
Medical endoscopes that enable observation of a desired affected area within a body cavity without making an incision are now in wide use.

The above-mentioned endoscopes include a flexible endoscope whose insertion section is bendable, and a rigid endoscope whose insertion section is rigid and approximately straight. There is a J2 mirror.

Is it within the above hardness? J! In addition to cases where the speculum can be inserted in a straight line such as the urethra, when the speculum is inserted toward the target site within the body cavity,
In most cases, it is necessary to provide a hole to serve as a guide for insertion, but since it has good targeting properties, it is useful for diagnosing or treating affected areas such as the abdominal cavity or joints of the limbs.
Widely used.

For example, stones are likely to form in the kidney, which is a bag-shaped part of the kidney that collects urine from the kidney and sends it to the bladder. Treatment to remove the stone or crush the stone so that it can be expelled from the body is required. In this case, it is necessary to insert a rigid endoscope into the kidney and perform the above-mentioned treatment following observation.

Is it within the above hardness? J! In order to insert a speculum, it is necessary to make a transdermal aneurysm in the kidney, and the trocar needle disclosed in Japanese Utility Model Application Publication No. 54-87693 or German No. 3025785 is used.
The dilator etc. disclosed in the published patent publication No.
□ The above trocar needle is punctured with an inner needle equivalent to a sonde,
By inserting a tapered, large-diameter outer needle into the punctured hole, the hole formed in the skin is expanded to an inner diameter that allows insertion of the insertion section of the rigid endoscope. However, since the inner needle and outer needle cannot be separated, there is a drawback that it is difficult to thoroughly clean the needle. In addition, it is necessary to prepare trocar needles each having an outer diameter that corresponds to the insertion portion of the rigid endoscope, resulting in an increase in cost.

On the other hand, in the conventional dilator mentioned above, a bulb is attached to the tip of the probe with the smallest diameter that is first inserted into the punctured area, and the bulb can be slid outward in sequence like a radio antenna (Rondo antenna), gradually increasing the diameter. When the hole is expanded by moving the multiple tubes that form the diameter forward, it is regulated by the above law and functions as a stopper to prevent the tubes from going forward beyond the sonde, but because of this ball, the tip is sharp. As a result, the insertability as a function that should be provided has deteriorated.

Also, during use, this ball is out! Because the bulb is frequently pushed by the probe tube, it is easy to fall off from the tip of the probe due to its small diameter, which makes it difficult to increase mechanical strength against fixed observation. Not only is there a risk that the probe may remain without being expelled, but since it no longer functions as a stopper, the tube around the sonde may protrude and create a hole in the body cavity wall, creating a dangerous situation. It was something.

[Object of the Invention] The present invention has been made in view of the above-mentioned points, and an object of the present invention is to provide a dilator with good insertion performance and high safety.

[Summary of the Invention] The present invention provides a dilator in which a 1111-length sonde and a plurality of tubes of gradually increasing diameter are slidably fitted around the outer periphery of the sonde, and the tip of the sonde is made into a sharp shape. In addition, for the stopper of the tube that can be slid on the outer periphery, insertion performance is improved by providing a step part for position adjustment at a rear position corresponding to the length of the outer tube from the tip of the sonde. Moreover, it is possible to ensure safety.

[Embodiments of the invention] Hereinafter, the present invention will be specifically explained with reference to the drawings.

Figures 1 and 2 relate to the first embodiment of the present invention, with the first figure showing a side view and the second figure showing a sectional view thereof.

The dilator 1 of the first embodiment includes a hollow and elongated cylindrical probe 2 into which a small diameter wire can be inserted;
A first tube 3 that is slidable and fitted around the outer periphery of the first tube 3, and a second tube 4 that is slidable and fitted around the outer periphery of the first tube 3. 5,6.7
．． It consists of 8.9 etc. In other words, on the outer circumference of the sonde 2, there are a plurality of tubes having an appropriate length (for example, the length of the insertion part of a rigid endoscope) and an inner diameter whose outer diameter gradually increases by approximately the thickness of the inner tube. Pipe 3, 4, 5.6° 7.8.9
are slidably fitted on the outside of each tube (tube 3,
4. The number of ... is not limited to this number. ).

The sonde 2 has a tapered conical shape with a tapered outer circumferential wall near the tip so that the sonde 2 has a sharp tip shape that is easy to insert.

Further, from near the tip of the sonde 2, a locking step portion 2a is provided at an outer peripheral position corresponding to the length of the first tube 3, and the rear side of the step portion 2a has a slightly smaller diameter in a step shape. A protrusion 3a is formed at the rear end of the first casing 3 which is externally fitted onto the sonde 2, and which projects inward in the radial direction. The protrusion 3a of the first tube 3 that has been
A is provided with a position regulating means that does not move forward beyond the state in which it is in contact with the end surface.

Also, at the rear end of the second tube 4, there is a protrusion 4 which protrudes radially inward and whose inner diameter is at least smaller than the outer diameter of the first tube 3.
a is formed to prevent the protrusion 4a from moving forward beyond the position where it is in contact with the rear end of the first tube 3 (the first tube 3 is also prevented from moving forward). If it is)
. In this state where the protrusion 4a is in contact with the rear end of the first tube 3, the front end of the second tube 4 is located on the outer periphery of the front end of the first tube 3, as shown in FIG. , so as not to protrude forward beyond the front end of the first tube 3.

Similarly, the third. 4th. ..., seventh tube 5, 6 . ....

9 also have protrusions 5a, 5a, . . .
, 9a are formed.

Multi-tube 3, 4. . . , 9 has a tapered outer peripheral side that gradually becomes thinner so that the difference in level due to the wall thickness is reduced.

By the way, multi-tube 3, 4. ..., 9 slides backward to open each tube 3, 4°...,
9 can be separated and washed easily. However, in cases where there is no need to separate,
By the stopper 10 fitted onto the sonde 2 from the rear,
Multi-tube 3, 4. ..., 9 is restricted from moving backward from sonde 2 to prevent it from slipping out. This stopper 10 can be removed by moving it backwards with a certain amount of force or more. Of course, it can be attached and detached with screws etc.
Moreover, it can also be made to be strongly fixed.

In addition, multi-tube 3, 4. ..., 9 are separable for easy cleaning, and the tubes 3, 4, . ... by changing the number of inserts used within the hardness? J! The guide hole can be formed according to the outer diameter of the insertion section of the mirror, and by preparing just one dilator 1, it can be used with many rigid endoscopes with different outer diameters of the insertion section. It has become.

Also, the distal end surface and multi-tube of the sonde 2, 3. ..., 9 are chamfered to have an angle more acute than 45 degrees, for example.

The operation (example of use) of the dilator 1 according to the eleventh embodiment of the present invention configured as described above will be described below.

First, a needle is punctured into the kidney while being monitored using X-rays, ultrasound, etc., a wire is passed through the kidney through a small hole made by the needle, and the needle is removed. Using this wire as a guide, the probe 2 of the dilator 1 is inserted into the kidney.

Following this sonde 2, a first tube 3. Second tube4. By moving forward one after another and inserting them into the kidney, the small diameter punctured hole can be enlarged to a size that allows insertion of the guiding sheath of the insertion section of the rigid endoscope.

When the first tube 3 is moved forward, the protrusion 3a at the rear end engages with the stepped portion 2a in the middle of the sonde 2 and is no longer inserted into the kidney. 1
The tip of the tube 3 does not protrude and therefore does not damage the body cavity wall or the like.

Other tubes 4, 5. The same applies to...

After expanding the hole diameter to the desired size as described above, insert a hollow sheath through which the insertion section of the rigid endoscope can be inserted into the outside of the outermost tube (reference numeral 9 in Fig. 2). After the sheath is inserted into the kidney, when the sonde 2 is pulled out, the tubes 3, 4, etc. inserted with the sonde 2 are removed.
・You can pull everything out.

After that, insert the insertion part of the rigid endoscope into the above sheath,
The condition of the stone in the kidney can be checked, and if necessary, treatment such as stone removal or stone crushing can be performed by inserting a stone removal device.

According to the first embodiment, which operates in this manner, the tip of the probe 2 inserted while being guided by the wire is sharpened, so that the probe 2 can be inserted easily.

Further, since the locking step portion 2a is provided in the middle of the sonde 2, the first tube 3 on the outer peripheral side cannot be projected forward from the position where the protrusion 3a abuts the step portion 2a. Without,
Also, other pipes 4, 5. . . . also for each protrusion 4a, 5a
It is secured to the rear end of the inner tube and does not protrude forward beyond that position, which prevents damage to the body cavity wall, internal organs, etc., and is safe.

Even if the operation of pushing out the main pipes 3, 4, etc. on the outer periphery of the sonde 2 is repeated, the portion of the sonde 2 in front of the stepped portion 2a remains stepped and has a large diameter over a long distance. The step portion 2a has sufficient strength. In addition, the protrusion 3a at the rear end of the first tube 3 also has sufficient strength even if the operation of pushing it forward is repeated, so that the protrusion 3a is always positioned at the step 2a, and the protrusion 3a is always positioned at this position. It does not protrude further forward, ensuring sufficient safety. Other tubes 4, 5. The same applies to...

Incidentally, the protrusions 3a, 4a, . . . , etc. can be made even stronger than those shown in FIG. 2 (the strength can also be increased in the longitudinal direction).

Further, by removing the stopper 10, the main pipes 3, 4, . . . and the sonde 2 can be separated, making cleaning easier. Furthermore, by changing the number of tubes 3, 4, etc. to be overlapped (combined), it can be used for rigid endoscopes with different diameters of insertion portions.

FIG. 3 shows a second embodiment of the invention.

In the dilator 11 of this second embodiment, the rear end portion of the first tube 13 fitted around the outer periphery of the sonde 2 similar to the first embodiment is pressurized radially inward. The protrusion 13 is fixed to the stepped portion 2a of the sonde 2 by plastic deformation or the like.
a is formed.

Similarly, for other tubes 14, 15, etc. (up to the third tube 15 is shown, but of course the number is not limited to this number),
Projections 14a, 158, etc. are formed.

The rest of the structure is the same as that of the first embodiment, and the effects are also substantially the same. It should be noted that this embodiment has the advantage that the protrusions 13a, 14a, . . . can be formed more easily than the first embodiment.

FIG. 4 shows a third embodiment of the invention.

In the dilator 11- of this embodiment, similarly to the second embodiment, the periphery of the rear end of the first tube 13 is plastically deformed to form a protrusion that comes into close contact with the rear outer periphery of the stepped portion 2a of the sonde 2. 13
a-Nishishi. Similarly, the second tube 14. ．． M3 tube 15
By plastically deforming the rear end periphery of each of the protrusions 14a +,
15a- is formed. Above main pipe 13.14.1
In the case of crucian carp with 5 moved most forward, the main pipe is 13, 14.15
They are set so that their front ends are substantially aligned, and their rear ends are also aligned, as shown in FIG. Therefore, the main pipe 13
．． 14. When inserting 15 to the specified position, its maneuver d
The insertion deviation until the line is aligned is white (as you can see). By plastically deforming the rear end side of the main pipe 13, 14, and 15 to a small diameter in a stepped shape, each protrusion 13a'-, 14a-,
When forming 15a-, a groove can be formed in its longitudinal direction to facilitate formation.

The effects of this embodiment are also substantially similar to those described above.

In addition, in each of the above-mentioned embodiments, the protrusions 3a and 4a.

..., 13a, 13a-, 14a, 14a', etc. must be formed over the entire circumferential direction.
Instead of this, it may be formed on a part of the circumferential direction.

In addition, grooves etc. are provided on the outer periphery of the Iji end of the tube, and on the other hand, the tubes on the outer periphery of the tube move together, and at a predetermined position roughly delineated from the inner tube, It is also possible to provide an R regulating means such that the protrusion provided at the end abuts the front end of the groove and does not move forward by one step.

Note that the dilator 1, 11, 11- of the present invention is limited in its application to those used for inserting the insertion portion of a rigid endoscope or a hollow sheath for introducing the insertion portion. For example, it can be applied to the insertion of external fence resection instruments, etc., and in short, it can be widely applied to the insertion of medical instruments inserted into body cavities (more broadly, inside living bodies). It is.

Furthermore, the present invention is not limited to a device that expands a punctured hole so that a target medical device can be inserted therein. This can also be applied to cases in which a sheath can be inserted. In this case, a closed sonde is used (a probe whose tip is closed with a non-sharp member may also be used).

) It is also possible to attach to its outer circumference a number of tubes to reach the required diameter and expand it for sheath guidance. Also, without using the inner sonde or the tube around the sonde and its outer periphery, the trocar obturator is inserted inside (using the trocar obturator and one or more snowflakes fitted around its outer periphery). The urethra may be widened for sheath guidance. In this way, it is possible to supplement the 1-Rakar obturator with a constant outer diameter.

Furthermore, as mentioned above, the present invention also includes a sonde that can be used interchangeably with one with a sharp tip and one with a non-sharp tip depending on the insertion site.

Furthermore, by using a conical stopper instead of a stopper with a flat front surface, as shown by the symbol @10 in Fig. 2, the tips of the plurality of tubes can be made into a conical shape, so that they can be used as trocar needles. You can also.

[Effects of the Invention] As described above, according to the present invention, the distal end of the sonde is made into a sharp tapered shape to facilitate insertion, a stepped portion is provided in the middle of the sonde, and a step is provided at the rear end of the main pipe. A position regulating means is provided that prevents the externally fitted tube from protruding beyond the tip of the sonde by providing a regulating protrusion, and this position regulating means does not deteriorate its function even after repeated use, ensuring high safety. It can be used safely as a medical device. Furthermore, since the sonde and main pipe can be separated, cleaning is easy.

Furthermore, it has the advantage that it can be applied to medical instruments with different outer diameters of insertion portions.

[Brief explanation of drawings]

1 and 2 show a dilator according to a first embodiment of the present invention, FIG. 1 is a side view thereof, and FIG. 2 is a vertical sectional view. FIG. 4 is a vertical sectional view showing a dilator according to a third embodiment of the present invention. 1.11.11-... Dilator 2... Sonde 2a... Step portion 3.13... First tube 3a, 4a, 13a, 13a'-, 14a, 14a
'... Protrusion 4.14... Pipe 2 of Joy 5.15... @ 10 of Ka3... Stopper agent
Patent Attorney Susumu Ito Figure 1 Figure 3 Figure 4

Claims (6)

[Claims] (1) In order to insert a medical instrument such as an endoscope into a body cavity, an elongated probe and a plurality of tubes that are movable around the outer circumference of the probe and gradually increase in outer diameter are used. In the dilator, the tip of the sonde is made into a sharp tapered shape, and a stepped portion is provided at a position on the outer periphery approximately equal to the length of the tube fitted on the outer periphery of the rear side from approximately the tip of the sonde, In addition, a protrusion projecting radially inward is provided at the rear end of the multi-tube, and the multi-tube abuts against the stepped portion of the sonde inside the multi-tube or the rear end of the inner tube of the multi-tube, thereby regulating forward movement. - A dilator characterized in that it is provided with a position regulating means. (2) The sonde has a hollow substantially circular tube shape through which a wire or the like can be inserted.
Dilator as described in section. (3) The dilator according to claim 1, wherein the multiple tubes can be separated from each other by moving rearward, and the outer diameter of the dilator can be variably set. □ (4) The dilator according to claim 1, wherein the protrusion i is formed over the entire circumference of the rear end of the multitube. (5) The dilator according to claim 1, wherein the sonde and the multi-tube are chamfered at an angle more acute than 45 degrees at their distal end surfaces. (6) The dilator according to claim 1, wherein the multi-tube can be prevented from coming off backward from the sonde by a stopper that is detachably attached to the sonde.