JPH0321183B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to a stone crushing device for crushing stones formed in the body vagina.

[Prior Art] Stones formed in internal organs such as the biliary tract and bladder are extremely painful for patients.
As a treatment for this purpose, a stone crushing device is inserted through the insertion channel of the endoscope, and the biliary tract is removed under the observation of the endoscope.
It is inserted into a tube or vagina containing a stone, such as the bladder, to crush the stone and expel it from the body, or to grasp and remove the stone. As shown in, for example, Japanese Patent Application Laid-Open No. 60-242848, this calculus crushing device is equipped with a basket composed of a plurality of elastic wires at the tip of an operating wire, and this basket has a hard part at the tip along with the operating wire. It is designed to be inserted into a flexible sheath, and a rod-shaped coupling member is connected to the rear end of this operating wire, so that it can be moved forward and backward by the grip of the operating section. Conventionally, the above-mentioned basket is made up of multiple wires with a high elongation rate in order to expand and contract in the direction perpendicular to the axial direction, and the operating wire is made up of one wire with a low elongation rate and one wire with a high elongation rate in order to move forward and backward in the axial direction. It was made up of two wires. In order to prevent the basket from falling off, at least one of the wires constituting the basket extends and forms part of the operating wire. The stone crushing device configured in this manner protrudes the basket from the tip of the flexible sheath by operating the grip part of the operating part,
A calculus is taken into the basket, and the gripping portion is pulled to draw the basket into the flexible sheath, causing it to shrink and deform, thereby crushing the calculus into small pieces.

[Problems to be Solved by the Invention] In the conventional technology, as shown in FIG. 7, when a basket holding a stone is drawn into the flexible sheath 1, the operation wire 2 and the coupling are particularly difficult when the stone is hard. It is unavoidable that a very large tensile force is applied to the member 3. For this reason, the broken part is exposed to the outside,
The proximal end of the connecting member 3 is breakable so that the basket holding the stone can be moved back and forth to remove the stone from the basket. However, the operating wire 2 stretched due to this large tensile force.
shrinks at the moment of rupture, and the connecting member 3 is pulled in forcefully, so that the wire 4 with a small elongation rate out of the operating wires 2 consisting of one wire 4 with a small elongation rate and the wire 5 with a large elongation rate There were cases of buckling. When the operating wire 2 buckles 6 after the proximal end of the coupling member 3 is broken in this way, the coupling member 3 does not move even if the broken part of the coupling member 3 is exposed, and therefore the basket cannot be moved forward or backward. As a result, there was a disadvantage that it became impossible to remove the stone from the basket.

The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to provide a stone crushing device that does not buckle the operating wire even if the base end of the connecting member breaks, and allows the basket to be moved forward and backward. With the goal.

[Means for solving the problem] In this device, an operating wire is slidably inserted into a flexible sheath having a hard part at the tip, a basket is provided at the tip of the operating wire, and a coupling member is connected to the proximal end. Of the plurality of wires that make up this operating wire, more than half are made of wires that are difficult to stretch and have a small elongation rate.

[Operation] By pushing the operating wire into the flexible sheath, the basket opens and grasps the stone, but if a large tensile force is applied to the wire, which is difficult to stretch during stone crushing because the stone is hard, it will break at the proximal end of the connecting member. However, when the instantaneous coupling member is drawn into the flexible sheath and moved, more than half of the operating wire is made of wire that is difficult to stretch, so the overall elongation of the operating wire becomes small.

[Embodiment] Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. 1 to 6.

The stone crushing device shown in FIG. 2 is equipped with a flexible sheath 11 made of a tightly wound coil or the like. A cylindrical hard part 12 is attached to the tip of the flexible sheath 11, and a base 13 is attached to the base. As shown in FIG. 1, this cap 13 consists of a first member 15 having a liquid feeding port body 14, and a second member 16 screwed onto this first member 15.
These members 15 and 16 are coaxially formed with a through hole 17 that passes through them in the axial direction. Said first member 1
A liquid-tight tube 18 which is inserted into the flexible sheath 11 and made of fluororesin or the like is connected to the through hole 17 to communicate with the through hole 17 . Therefore, a syringe (not shown) is connected to the liquid feeding port body 14 so that a liquid such as a contrast medium can flow into the liquid-tight tube 18.

An operating wire 19 is inserted through the flexible sheath 11 . A basket 20 is provided at the tip of the operating wire 19. This basket 20 is made up of a plurality of elastic wires 21 that are relatively soft and have a high elongation rate, and the front and rear ends of the elastic wires 21 are connected with tips 22, and a bent part 23 is formed in the middle, so that the axis of the operating wire 19 It has a cage shape that can be expanded and contracted in the direction of the heart. The operating wire 19 is made up of a plurality of wires, and one of the plurality of wires is connected to the basket 20 to prevent the basket 20 from falling off.
A wire 24 with a high elongation rate (hereinafter referred to as a wire that is easy to elongate) shown in FIG.
And, unlike the elastic wire 21 of the basket 20, a wire with a low elongation rate (hereinafter referred to as a wire that is difficult to elongate) shown in FIG.
It consists of 25. The operating wire 19 has a structure in which the number of wires 25 that are difficult to stretch is more than half the number of wires 24 that are easy to stretch.

The tip of a straight punch-shaped coupling member 26 is fixed to the base end of the operating wire 19. This connecting member 2
6 is slidably inserted into the through hole 17 of the base 13, and its base end protrudes from the second member 16. An O-ring 27 is provided at the joint between the first member 15 and the second member 16 of the cap 13, and a connecting member 26 is inserted through the O-ring 27 to maintain the through hole 17 liquid-tight. It is becoming more and more common.

And the operating wire 1 connected to the coupling member 26
9 and a tip 22, the basket 20 at the distal end can be pulled out from the flexible sheath 11, as shown in FIG.

On the other hand, the base 13 is detachably connected to the operating section 28. This operating section 28 has a main body 29 as shown in FIG. A grip portion 30 for an operator to grasp is integrally formed at the distal end of the main body 29. An insertion hole 31 is formed coaxially through the main body 29 and the grip portion 30, and a ring body 32 is formed coaxially with the insertion hole 31 at the tip of the grip portion 30.
is provided. This ring body 32 is screwed with a set screw that moves back and forth in the radial direction. Then, the end of the second member 16 of the base 13 is attached to the ring body 3.
2 and screw in the setscrew 33 to engage the tip with the groove 16a formed on the outer circumferential surface of the second member 16, the base 13 can be connected to the operating section 28.

A rack body 34 having a circular cross section is slidably inserted into the insertion hole 31 of the operating section 28.
This rack body 34 has a rack 35 formed on the outer surface of one radial end thereof over almost the entire length in the axial direction. Furthermore, guide grooves 36 that are open to the radial ends are formed at locations other than both axial ends, and through holes 37 communicating with the guide grooves 36 are formed at both axial ends. The proximal end portion of the coupling member 26 protruding from the second member 16 of the base 13 connected to the operation portion 28 is inserted into the through hole 37 and the guide groove 36, and the end thereof is connected to the rack body 34.
protrudes from the proximal end of. In addition, the rack body 34
is prevented from rotating by a guide screw 38 that is screwed onto the main body 29 of the operating section 28 and engaged with a guide groove 36.

A grip portion 39 is connected to the base end of the rack body 34. A mounting hole 40 is formed in the grip portion 39 coaxially with the coupling member 26 inserted into the operating portion 28 . This mounting hole 40 has the coupling member 2
The distal end on which the flat portion 26a of No. 6 is formed is inserted. Furthermore, a storage hole 41 is formed in the grip portion 39 in the radial direction and intersects with the mounting hole 40 . A fixing rod 44 having an engagement hole 42 penetrating in the radial direction in the middle of the axial direction and having a button 43 attached to the upper end is provided in the storage hole 41 and is biased in the projecting direction by a spring 45. It is being Therefore, the fixing rod 44 is pushed in against the spring 45, and with its engagement hole 42 facing the mounting hole 40, the end of the coupling member 26 is inserted into the mounting hole 40, and the flat part 26a is inserted. When the fixing rod 44 is positioned in the engagement hole 42 and then the pressure on the fixing rod 44 is released, the flat portion 26a and the fixing rod 44 engage with each other, so that the coupling member 26 is fixed to the gripping portion 39. Therefore, the grip part 39
The operation wire 19 is connected via the coupling member 26 by
It is now possible to advance and retreat.

The main body 29 of the operating section 28 has a handle (not shown) in a direction perpendicular to the rack body 34, and the first support shaft 46 is rotatably supported by the handle. The main body 29 also has a first
A second support shaft 47 whose axis is parallel to the support shaft 46 is rotatably supported. This second support shaft 47
Although not shown in the figure, at one end there is a first support shaft 4.
A gear that meshes with the gear provided at 6 and has more teeth than that gear is provided, and the second support shaft 47 can be rotated by this gear. Further, a portion of the main body 29 corresponding to the middle part of the second support shaft 47 is a housing portion 48 that is open to the guide groove 36.
is formed. A gear 49 fitted onto the second support shaft 47 is provided in the housing portion 48, and this gear 49 meshes with the rack 35. Therefore, when the handle is rotated, this rotation is decelerated and transmitted to the gear 49, and the gear 49 moves the rack body 34 forward and backward, and the operating wire 19 is interlocked with this through the coupling member 26. It is now possible to do so. The proximal end of the flexible sheath 11 is protected by a cover 50 attached to the base 13, as shown in FIGS. 1 and 2.

Next, the operation of the device having the above structure will be explained.
First, with the operation part 28 removed from the base 13, the flexible sheath 11 is introduced into the body vagina through the channel of the endoscope, and is protruded from the tip of the endoscope, for example, from the duodenal papilla into the bile duct. inserted. Then, the proximal end of the coupling member 26 is attached to the grip part 3 of the operating part 28.
At the same time, the second member 16 of the cap 13 is fitted into the ring body 32 and fixed by the setscrew 33, thereby connecting and fixing the operating portion 28 to the cap 13. Next, the inside of the bile duct is observed through the endoscope, and if a stone is found, the grip part 39 is pushed in, and the operation wire 19 is advanced together with the rack body 34 to move the basket 20 into the flexible sheath 1.
Protrude from the tip of 1 and open it to hold the stone inside. If the stone held in the basket 20 in this way is too large to be removed from the bile duct, the handle of the operation section 28 can be rotated in the direction in which the rack body 34 retreats, that is, in the direction in which it protrudes from the main body 29. The hard-to-stretch wire 25 in the operating wire 19 is linked to the movement of the rack body 34, pulling the basket 20 into the flexible sheath 11 and shrinking it, so that the calculus is tightened by the elastic wire 21 of the basket 20 and crushed. be done. At this time, the stone is hard and the wire 2 is difficult to stretch during stone crushing.
When a large tensile force is applied to the connecting member 5, the connecting member 26 breaks at its base end as shown in FIG. Although it moves as if being drawn into the sheath 11, more than half of the operating wire 19 is wire 25 that is difficult to stretch, so the overall elongation of the operating wire 19 is small, and the entire operating wire 19 is hard, so it does not buckle. Therefore, when the operation part 28 is removed from the base 13 even after the breakage, the part of the coupling member 26 that was connected to the operation wire 29 side is exposed to the outside from the base 13, and that part of the coupling member 26 cannot be removed by hand. Hold the operation wire 19 and move it forward and backward to move the basket 2.
The stone can be removed from the basket 20 and the basket 20 pulled into the flexible sheath 11.

In this way, the operating wire of the stone crushing device is made up of wires that are easy to stretch and wires that are difficult to stretch, and more than half of the wires are wires that are difficult to stretch, so even if a large tensile force is applied during stone crushing, the wires that are difficult to stretch will buckle. This makes it possible to move the basket forward and backward safely.

8 and 9 show a second embodiment of the present invention, and this stone crushing device differs from the first embodiment only in the shape of the wire 25 of the operating wire 19, which is difficult to stretch. The other configurations are the same as those in the first embodiment, so the same configurations are given the same reference numerals and the explanation will be omitted. The hard-to-stretch wire 52 of this operation wire 51 is made of a single wire as shown in FIG. 9, and the other easily stretchable wire 24 is
The wires are twisted as in the example. Similarly to the first embodiment, the wires 52 that are difficult to stretch are made up of more than half of the wires 24 that are easy to stretch.

By doing this, even if a large tensile force acts on the wire 52, which is difficult to stretch during lithotripsy because the stone is hard, and the connecting member 26 moves so as to be drawn into the flexible sheath 11, half of the operation wire 51 Since the above wire 52 is difficult to stretch, the wire 52 has little stretch as a whole and can be moved forward and backward without buckling.

As mentioned above, the wires that are easy to stretch and the wires that are difficult to stretch as the operating wires are made with different stranded wire configurations, but the structure is not limited to this. For example, the wire that is difficult to stretch is made of stainless steel wire
The easily stretchable wires may be made of different materials, such as spring stainless steel wire (SUS 304-WPB).

[Effects of the Invention] As described above, in the present invention, the operation wire with a basket at the tip is divided into wires that are easy to stretch and wires that are difficult to stretch, and out of the number of both wires, the number of wires that are difficult to stretch is more than half. As a result, the stone is hard and a large tensile force is applied to the operating wire during lithotripsy, causing the proximal end of the connecting member to break and buckling the wire, which is difficult to stretch even when the connecting member moves forcefully into the flexible sheath. This eliminates the risk that even if the connecting member breaks, the operation wire cannot be advanced or retracted like in the past, making it impossible to remove the stone from the basket and pull the basket into the flexible sheath. It is operable and allows stones to be removed from the basket.

[Brief explanation of the drawing]

1 to 6 show a first embodiment of the present invention, in which FIG. 1 is a sectional view of a flexible sheath, FIG. 2 is a partial cross-sectional view of the entire structure, and FIG. Figure 4 is a cross-sectional view of one wire with a large elongation rate, Figure 5 is a cross-sectional view of one wire with a small elongation rate, and Figure 6 is a cross-sectional view of the basket and operating wire when removed from the sex sheath. Fig. 7 is a state diagram of the operating wire in the flexible sheath showing a conventional example, and Fig. 8 is a state diagram of the operating wire in the flexible sheath of the second embodiment when removed from the flexible sheath. FIG. 9 is a cross-sectional view of one wire having a small elongation rate shown in FIG. 8. 1, 11... Flexible sheath, 2, 19... Operation wire, 3, 26... Coupling member, 4, 25, 51
...Wire with small elongation rate, 5, 24... Wire with large elongation rate, 6... Buckling, 20... Basket, 28... Operation section.

Claims (1)

[Claims] 1. A flexible sheath having a hard part at the tip, an operating wire slidably inserted into the flexible sheath, and a plurality of elastic wires connected to the tips of the operating wire. In the stone crushing device, the operating wire has two types of wires with different elongation rates. A stone crushing device characterized in that the number of wires with a small elongation rate is more than half the number of wires with a high elongation rate. 2. The calculus crushing device according to claim 1, wherein the two types of operating wires having different elongation rates have different numbers of twisted wires. 3. The stone crushing device according to claim 1, wherein the two types of operating wires having different elongation rates are made of different materials.