JP5941776B2 - Guide wire introduction device - Google Patents

Description

  The present invention relates to a guide wire introducing device.

Conventionally, a guide device for introducing a guide wire into the pericardium is known (see, for example, Patent Document 1).
This guide device is made of a radiopaque material and is operated under fluoroscopic observation to penetrate the pericardium.

JP 2011-78525 A

  However, the guide device of Patent Document 1 has to perforate the pericardium under X-ray fluoroscopic observation and introduce a guide wire. In an X-ray image in which only a shadow image is displayed, the guide wire to be introduced It is difficult to reliably grasp the direction. In other words, the work of introducing the guide wire in a desired direction must be performed while confirming the direction of the guide wire many times using an X-ray image formed of a shadow image, which takes time and labor. There is an inconvenience.

  The present invention has been made in view of the above-described circumstances, and provides a guide wire introduction device that can more reliably grasp the direction of the guide wire and can perform guide wire introduction work easily and in a short time. The purpose is that.

In order to achieve the above object, the present invention provides the following means.
According to one embodiment of the present invention, a cylindrical main body having a first lumen that opens at a distal end in a longitudinal direction and that can penetrate a guide wire, and a second lumen that can insert an endoscope, and a distal end of the main body are provided. Can be penetrated through the pericardium that extends radially outward to the side of the main body that is proximal to the distal end and cannot be penetrated by just pressing. And a hook-shaped hook portion having a sharp tip, and the guide wire introduction in which the hook portion and the opening of the first lumen at the tip of the main body are arranged on the tip end side in the longitudinal axis direction of the second lumen Providing equipment.

  According to this aspect, even if the cylindrical main body is punctured into the tissue from the distal end side in the longitudinal direction and the distal end portion is pressed against the pericardium, the distal end portion is configured to be non-sharp. The pericardium cannot be penetrated, and the pericardium is bent by the pressing force, so that the tip is covered with the pericardium. At this time, the bent pericardium is brought close to the side surface of the main body from the side. On the side of the main body, hook-shaped hooks extending radially outward are arranged with the tips pointing radially outward, so that the tips of the hooks are placed on the pericardium that is close to the side of the main body from the side. Is inserted and perforated, and a part of the pericardium is caught in the hook portion.

  In this case, when an endoscope is inserted into the second lumen and the front end direction of the main body is observed through the second lumen, it is directly determined by the endoscope whether or not a part of the pericardium is caught by the hook portion. Can be confirmed. From this state, when the main body is pulled up to the proximal end side, the pericardium hooked on the hooking portion is lifted, and the hole formed in the pericardium is enlarged.

  Then, when the guide wire is inserted through the first lumen, the guide wire protruding from the opening of the second lumen is introduced into the pericardium from the hole opened in the pericardium. In this case, since the opening of the first lumen is disposed on the distal end side in the longitudinal axis direction of the second lumen, the guide wire protruding from the opening of the first lumen is an endoscope in the second lumen. Is allowed to pass through the field of view. Thereby, whether or not the guide wire has been introduced into the pericardium can also be confirmed directly by the endoscope.

In the said aspect, the said 2nd lumen | rumen may have the opening which can protrude the said endoscope from the front-end | tip of a main body.
In this way, the endoscope inserted into the second lumen protrudes from the distal end of the main body, so that the visual field of the endoscope is not limited by the second lumen, and the pericardium before pressing the main body Can be observed over a wide range. On the other hand, in a state where the endoscope is accommodated in the second lumen, the endoscope can be moved to a position in accordance with the control of the visual field of the endoscope and the focal length by moving the endoscope back and forth in the longitudinal direction.

Moreover, in the said aspect, you may have the window part which consists of a transparent material arrange | positioned in the position which obstruct | occludes this lumen | rumen at the front-end | tip of a said 2nd lumen | rumen.
By doing in this way, observation by an endoscope is performed through a transparent window part, and advance beyond the window part of an endoscope is restricted. As a result, it is possible to prevent interference with the endoscope when the guide wire is projected.

Further, in the above aspect, the guide wire guiding portion is configured such that the first lumen is curved in a direction intersecting with the longitudinal axis of the main body, and the guide wire protrudes in a direction intersecting with the longitudinal axis of the main body. May be provided.
In this way, when the guide wire is inserted through the first lumen, the guide wire is bent by the guide wire guiding portion and protruded in a direction intersecting the longitudinal axis of the main body. As a result, the guide wire can be projected in the direction along the pericardium from the opening of the first lumen at the tip of the main body arranged in the direction intersecting the pericardium, and can be smoothly introduced into the pericardium. it can.

  According to the present invention, the direction of the guide wire can be grasped more reliably, and the guide wire can be introduced easily and in a short time.

It is a fragmentary perspective view which shows the guide wire introduction apparatus which concerns on one Embodiment of this invention. It is a partial longitudinal cross-sectional view of the front-end | tip part which shows the guide wire introduction apparatus of FIG. It is a longitudinal cross-sectional view which shows the state which made the front-end | tip part of the guide wire introduction apparatus of FIG. 1 oppose the outer surface of the pericardium. It is a longitudinal cross-sectional view which shows the state which pressed the pericardium with the front-end | tip part from the state of FIG. It is a longitudinal cross-sectional view which shows the state which cut | disconnected the pericardium by the tip of the hook part from the state of FIG. It is a longitudinal cross-sectional view which shows the state which pulled out the main body from the state of FIG. 5 to the base end side. It is a longitudinal cross-sectional view which shows the state which introduced the guide wire into the pericardium from the state of FIG. It is a fragmentary perspective view which shows the modification of the guide wire introduction apparatus of FIG.

A guide wire introducing device 1 according to an embodiment of the present invention will be described below with reference to the drawings.
The guide wire introducing device 1 according to the present embodiment is punctured from outside the body into the tissue B (see FIG. 3) below the xiphoid process, and allows the distal end portion 3 to reach the pericardium C (see FIG. 3). It has a main body 2 that is long enough to be able to.

The main body 2 of the guide wire introducing device 1 is formed in a cylindrical shape, and has a first lumen 4 and a second lumen 5 penetrating in the longitudinal direction. The first lumen 4 has a diameter slightly larger than the outer diameter of the guide wire 6 so that the guide wire 6 (see FIG. 2) can be inserted.
The second lumen 5 has a diameter slightly larger than the outer diameter of the endoscope 7 so that the endoscope 7 can be inserted.

  In addition, a tip portion 3 is formed at the tip of the main body 2 so as to be non-sharp by being formed in a hemispherical shape. The distal end portion 3 can puncture the tissue B by pressing the main body 2 in the longitudinal direction toward the distal end, but the pericardium A is simply pressed against the outer surface of the pericardium A (see FIG. 3). It is formed in a shape that cannot penetrate.

The distal end portion 3 is provided with an opening 8 that exposes both the openings 4 a and 5 a of the first lumen 4 and the second lumen 5.
A hook-shaped hook 9 having a sharp point 9a is provided at a position adjacent to the non-sharp tip 3 on the base end side of the main body 2.

  That is, the hook portion 9 is provided with a groove 10 orthogonal to the longitudinal direction on the side surface of the main body 2, and two opposing groove walls 10 a and 10 b are arranged on the base end side of the main body 2 outward in the radial direction of the main body 2. It is comprised by making it incline so that it may extend. Accordingly, the hook portion 9 has a sharp pointed end 9a at the outermost edge of the groove wall 10a on the distal end side, and is configured in a hook shape extending toward the proximal end side of the main body 2 toward the outer side in the radial direction of the main body 2. Yes.

As shown in FIGS. 1 and 2, the second lumen 5 extends linearly across the groove 10 constituting the hook portion 9 and opens toward the distal end of the main body 2. .
On the other hand, the first lumen 4 extends along the longitudinal direction of the main body 2 from the base end side of the main body 2 and is bent by 90 ° by the guide wire guiding portion 11 disposed at the distal end portion 3. It opens in the direction perpendicular to the axis.

  As a result, the opening 4a of the first lumen 4 is arranged on the tip side of the opening 5a of the second lumen 5, and the guide wire 6 introduced through the first lumen 4 and protruded from the opening 4a. However, it is made to protrude so that the front end side of the opening 5a of the 2nd lumen 5 may be crossed.

The operation of the guide wire introducing device 1 according to the present embodiment configured as described above will be described below.
In order to introduce the guide wire 6 into the pericardium A using the guide wire introducing device 1 according to the present embodiment, as shown in FIG. 3, the distal end portion penetrates the tissue B below the xiphoid process from outside the body. 3 is opposed to the surface of pericardium A. In the figure, the symbol D is the heart.

At this time, the distal end of the endoscope 7 introduced through the second lumen 5 is disposed in the vicinity of the opening 8 provided in the distal end portion 3 of the main body 2 to ensure a sufficiently wide field of view of the endoscope 7. In this state, the surface of the pericardium A is observed with the endoscope 7.
Then, after confirming the position of the surface of the pericardium A, the state of the puncture position, and the like with the endoscope 7, the tip of the endoscope 7 is based on the groove 10 of the second lumen 5 as shown in FIG. 4. With the body retracted to the end side, the main body 2 is pressed toward the front end side in the longitudinal direction.

  Since the distal end portion 3 is formed non-sharply, the pericardium A cannot be penetrated only by being pressed, but the pericardium A pushed by the distal end portion 3 is recessed as shown in FIG. 3 from the side of the main body 2 so as to cover 3. The pericardium A enters the groove 10 provided on the side surface of the main body 2. The edge of the groove 10 is a sharp point 9a, and a hook-like hooking part 9 is formed with the point 9a facing outward in the radial direction, so that the pericardium A that has entered the groove 10 is caught in the hooking part 9 By being pressed against the tip 9a from the side, the tip 9a is cut and perforated as shown in FIG.

  Since the pericardium A is under tension, the hole formed by the perforation expands to some extent. Further, as shown in FIG. 6, by moving the main body 2 toward the longitudinal base end side in the direction in which the pericardium A is hooked on the hook portion 9, the body 2 is moved out of the body B in the direction to be extracted from the body. The tension is increased and the hole is pushed wide, and the distal end portion 3 of the main body 2 is exposed in the pericardium C. At this time, the opening 8 provided in the distal end portion 3 is also exposed in the pericardium C.

  In this state, when the guide wire 6 is inserted from the proximal end side of the main body 2 through the first lumen 4 and the guide wire 6 is sent out from the opening 4 a provided in the distal end portion 3 of the main body 2, The guide wire 6 is introduced into the pericardium C from the opening 8 exposed in the sac C.

  In this case, according to the guide wire introducing device 1 according to the present embodiment, whether or not the pericardium A is caught on the hook 9 by the endoscope 7 disposed in the second lumen 5 is determined. It is possible to directly confirm whether or not the pericardium A caught on the perforation is perforated by the tip 9a, whether or not the pericardium A is still caught on the catching portion 9 in the operation of pulling out the main body 2.

  Further, as to whether or not the guide wire 6 has been introduced into the pericardium C through the hole formed in the pericardium A, the guide wire 6 that is seen through the pericardium A caught on the hook portion 9 is observed. Thus, the introduction of the guide wire 6 into the pericardium C can be confirmed.

  As a result, under X-ray fluoroscopic observation, the guide wire 6 is more reliably used by using the image acquired by the endoscope 7 as compared with the conventional method in which the guide wire 6 is introduced using only a shadow image as a clue. Can be introduced. Therefore, there is an advantage that the time and labor required for the introduction work can be greatly reduced.

  In the present embodiment, since the first lumen 4 is bent by 90 ° by the guide wire guiding portion 11, the guide wire 6 to be introduced is bent by the guide wire guiding portion 11 and then the opening portion. 8 is projected in a direction intersecting the longitudinal axis of the main body 2. That is, as shown in FIG. 7, since the guide wire 6 is introduced in the direction along the pericardium A, the introduction route is not hindered by the heart D and can be smoothly introduced into the pericardium C. There is also an advantage of being able to do it.

  In addition, after the introduction work of the guide wire 6 is completed, the main body 2 is pushed again toward the distal end side to remove the pericardium A that is hooked on the hook portion 9, and the guide wire 6 is inserted into the pericardium C by the endoscope 7. The main body 2 can be extracted from the body while confirming that is inserted.

In the present embodiment, the second lumen 5 into which the endoscope 7 is inserted is opened in the opening 8 provided in the distal end portion 3 of the main body 2, and the endoscope 7 is located closer to the distal end than the distal end portion 3. It was decided that it could be protruded. Thereby, the wide visual field of the endoscope 7 is securable by making it project.
Instead, as shown in FIG. 8, at least the tip portion (window portion) 13a is transparent in the outer cylinder 12 constituting the main body 2 in which at least the tip portion 3 is made of a transparent material. The inner cylinder 13 made of a material may be disposed, the second lumen 5 may be formed in the inner cylinder 13, and the first lumen 4 may be formed in the gap between the outer cylinder 12 and the inner cylinder 13.

By closing the distal end portion of the inner cylinder 13 with a window portion 13a made of a transparent material, the operation range of the endoscope 7 is limited to the proximal end side with respect to the window portion 13a.
As a result, the endoscope 7 cannot be protruded from the distal end portion 3 of the main body 2 and a wide field of view cannot be ensured. However, when the guide wire 6 is introduced, the endoscope 7 is disposed in the introduction path. Can be prevented from being disturbed.

In the present embodiment, the hook-shaped hooking portion 9 having a single pointed tip 9a is formed by forming the groove 10 on the side surface of the main body 2. However, instead of this, the pointed tip 9a is divided into a plurality of portions. May be.
In addition, the first lumen 4 is bent by 90 ° by the guide wire guiding portion 11, but instead, it may be bent by another arbitrary angle.

A pericardium 1 guide wire introduction device 2 main body 3 tip 4 first lumen 4a, 5a opening 5 second lumen 6 guide wire 7 endoscope 9 hook 9a point 11 guide wire guide 13a window

Claims (4)

A cylindrical main body having a first lumen that is open at the longitudinal tip and can penetrate the guide wire, and a second lumen into which the endoscope can be inserted;
A non-sharp tip that is provided at the tip of the body and cannot penetrate the pericardium just by pressing,
A hook-shaped hooking portion having a pointed end that extends radially outward to the side surface of the main body on the proximal side of the distal end portion and can penetrate the pericardium contacting from the side;
The guide wire introducing device in which the opening of the first lumen at the hook portion and the distal end of the main body is disposed on the distal end side in the longitudinal axis direction of the second lumen.   The guide wire introducing device according to claim 1, wherein the second lumen has an opening through which the endoscope can protrude from a distal end of the main body.   The guide wire introducing device according to claim 1, further comprising: a window portion made of a transparent material disposed at a position where the lumen is closed at a tip of the second lumen.   2. The guide wire guide part according to claim 1, wherein the first lumen includes a guide wire guiding portion that curves in a direction intersecting with the longitudinal axis of the main body and projects the guide wire in a direction intersecting with the longitudinal axis of the main body. Item 4. The guidewire introduction device according to any one of Items3.

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