JPS6320140B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Technical Field of the Invention] The present invention relates to a stone crushing device for crushing stones formed within a body cavity.

[Technical background of the invention and its problems]

Stones that occur in organs such as the biliary tract or bladder have a negative impact on patients. In particular, enlarged stones cause extremely great pain to patients.

Therefore, as a treatment for this, a stone crushing device is used endoscopically to crush the stone generated in the body cavity and discharge or remove it from the body.

This type of stone crushing device includes a basket made of a plurality of elastic wires provided at the tip of the operating wire, and this basket and the operating wire inserted into a flexible sheath having a hard part at the tip.
Some models have operating wires that move forward and backward from the rear end. Once the stone is grasped by the basket protruding from the tip of the flexible sheath by operating the operating wire, the basket is pulled into the flexible sheath and reduced in size, thereby removing the stone. I try to crush it finely.

By the way, as a means for opening and closing the above-mentioned basket, a slider mechanism disclosed in Japanese Utility Model Application No. 55-34810 has conventionally been used. However, with such a slider mechanism, when the operating wire is pulled in and the basket is reduced and the stone held in the basket is crushed, the sliding resistance of the operating wire is instantly released. The momentum causes the basket to suddenly sink into the flexible sheath. Therefore, this force causes the crushed stones to scatter, posing a risk of damaging the inner wall of the body cavity.

[Object of the Invention] The object of the present invention is to provide a stone crushing device that can crush stones without forcefully scattering them around.

[Summary of the invention]

This invention connects the main body of the operating section to the proximal end of the flexible sheath, provides a rack on the main body in a slidable manner, and connects the rack to the handle provided on the main body via a speed reduction mechanism consisting of a plurality of gears. By driving the rack forward and backward and interlocking the operating wire, which is inserted into the flexible sheath and has a basket attached to its tip, the stone can be gradually crushed by the deceleration effect of the deceleration mechanism. , attaching a grip to the end of the rack for moving the rack forward and backward without using the handle;
This grip portion also allows the basket to be opened and closed.

[Embodiments of the invention]

An embodiment of the present invention will be described below with reference to the drawings. The stone crushing device shown in FIG. 1 is equipped with a flexible sheath 1 made of a tightly wound coil or the like. A cylindrical hard part 2 is attached to the tip of the flexible sheath 1, and a cap 3 is attached to the base.
As shown in FIG. 2, this cap 3 consists of a first member 5 having a liquid feeding port body 4 and a second member 6 screwed onto this first member 5.
A through hole 7 passing through in the axial direction is coaxially bored in the. The flexible sheath 1 is attached to the first member 5.
A liquid-tight tube 8 inserted therein is connected to communicate with the through hole 7. Therefore, a syringe (not shown) is connected to the liquid feeding port body 4 so that a liquid such as a contrast medium can flow into the liquid-tight tube 8.

An operating wire 9 is inserted through the flexible sheath 1. A basket 10 is provided at the tip of the operating wire 9. This basket 10 has tips 12 at the front and rear ends of a plurality of elastic wires 11, respectively.
At the same time, a bent part 13 is formed in the middle of the operating wire 9, and the operating wire 9 has a cage shape that can be freely expanded and contracted in the axial direction, that is, can be opened and closed. The distal end of a straight rod-shaped coupling member 14 is fixed to the base end of the upper operating wire 9 . This coupling member 14 is connected to the base 3.
It is slidably inserted into the through hole 7 of, and its base end protrudes from the second member 6. Note that an O-ring 15 is provided at the joint between the first member 5 and the second member 6 of the base 3, and this O-ring 15
The coupling member 14 is passed through the through hole 7 so that the through hole 7 is maintained liquid-tight.

On the other hand, the base 3 is detachably connected to the operating section 16. This operating section 16 has a main body 17 as shown in FIG. A grip portion 18 for the operator to grasp is integrally formed at the distal end of the main body 17. An insertion hole 19 is formed coaxially through the main body 17 and the grip portion 18, and a ring body 20 is provided coaxially with the insertion hole 19 at the tip of the grip portion 18. A set screw 21 that moves back and forth in the radial direction is screwed into the ring body 20.
Then, the end of the second member 6 of the cap 3 is fitted into the ring body 20, and the set screw 21 is screwed in so that the tip engages with the groove 6a formed on the outer peripheral surface of the second member 6. If you do so, move the cap 3 to the operating section 16.
can be connected to.

A rack body 22 is provided in the insertion hole 19 of the operating section 16.
is inserted so that it can slide freely. As shown in FIGS. 3 and 4, this rack body 22 has a circular cross section, and a rack 23 is formed on the outer surface of one radial end thereof over almost the entire length in the axial direction. Furthermore, a guide groove 24 that is open to the other radial end is formed at a location other than both axial ends, and a through hole 25 communicating with the guide groove 24 is formed at both axial ends. The base end portion of the coupling member 14 protruding from the second member 6 of the base 3 connected to the operating portion 16 is connected to the through hole 25 and the guide groove 2.
4, and its end protrudes from the proximal end of the rack body 22. In addition, the rack body 22 is
The guide groove 24 is screwed onto the main body 17 of the operating section 16.
Rotation is prevented by a guide screw 26 that engages with.

A grip portion 27 is connected to the base end of the rack body 22. A mounting hole 28 is formed in the grip portion 27 coaxially with the coupling member 14 inserted into the operating portion 16 . This mounting hole 28 has the above-mentioned coupling member 1.
The distal end on which the fixing portion 14a of No. 4 is formed is inserted. Furthermore, a storage hole 29 is formed in the grip portion 27 in the radial direction, intersecting with the mounting hole 28 . A fixing rod 33 having an engagement hole 31 penetrating radially in the middle of the axial direction and having a button 32 attached to the upper end is provided in the storage hole 29 and is biased in the projecting direction by a spring 34. It is being Therefore, the fixing rod 33 is pushed in against the spring 34, and with its engagement hole 31 facing the mounting hole 28, the end of the coupling member 14 is inserted into the mounting hole 28, and the fixing portion 14a is inserted. If the fixing rod 33 is positioned in the engagement hole 31 and then the pressure on the fixing rod 33 is released, the flat portion 14
Since the fixing rod 33 is engaged with the fixing rod 33, the coupling member 14 is fixed to the grip portion 27. Therefore, the operating wire 9 can be moved forward and backward by the grip portion 27 via the coupling member 14.

As shown in FIG. 3, a first support shaft 35 is rotatably supported on the main body 17 of the operating section 16 by a bearing 36 in a direction perpendicular to the rack body 22. As shown in FIG. A first gear 37 is provided at one end of this first support shaft 35, and a handle 38 is provided at the other end. Further, as shown in FIG. 4, a second support shaft 39 whose axis is parallel to the first support shaft 35 is rotatably supported on the main body 17 by a bearing 40. As shown in FIG. A second gear 41 that meshes with the first gear 37 and has more teeth than the first gear 37 is provided at one end of the second support 39 .
A portion of the main body 17 corresponding to the middle portion of the second support shaft 39 is formed in a housing portion 42 that is open to the insertion hole 19 . A third gear 43 fitted to the second support shaft 39 is provided in the accommodating portion 42, and the third gear 43 meshes with the rack 23. Therefore, when the handle 38 is rotated, this rotation is decelerated by the first and second gears 37 and 41 and transmitted to the third gear 43. The rack body 22 can be moved forward and backward, and the operating wire 9 can be interlocked therewith via the coupling member 14.

The proximal end of the flexible sheath 1 is protected by a cover 45 attached to the cap 3, as shown in FIG.

Next, how to use the device having the above structure will be explained. First, with the operating portion 16 removed from the base 3, the flexible sheath 1 is endoscopically introduced into the body cavity, and is projected from the tip of the endoscope and inserted into the bile duct, for example, from the duodenal papilla. Next, the operating section 16 is connected and fixed to the base 3. That is, the base end portion of the coupling member 14 is fixed to the grip portion 27 with the fixing rod 33, and the second member 6 of the cap 3 is fitted into the ring body 20 and fixed with the set screw 21.

Next, push the grip part 27 into the rack body 22.
At the same time, by advancing the operating wire 9, the basket 10 is made to protrude from the distal end of the flexible sheath 1 and opened. When the basket 10 is opened in this way, the stone A is taken into the basket through the gap between the elastic wires 11, and then the gripping portion 27 is moved to the rear end to retract the basket 10 as shown in FIG. Since the movement of the operating wire 9 up to this point can be quickly performed by the grip part 27, the stone A
Even if it comes off from the basket 10, it is easy to take it back in.

If the stone A held in the basket 10 in this way is too large to be removed from the bile duct, the handle 38 of the operating section 16 should be moved in the direction in which the rack body 22 retreats, that is, as shown in FIG. It rotates in the direction of protruding from the main body 17. Then, the operation wire 9 interlocks with the movement of the rack body 22 to pull the basket 10 into the flexible sheath 1 and shrink it, so that the calculus A is tightened by the elastic wire 11 of the basket 10 and crushed. be done. At this time, the moving speed of the rack body 22,
That is, the tightening force applied to the calculus A is transmitted to the rack body 22 by reducing the rotational speed of the handle 38 via the first and second gears 37 and 41. Therefore, since the stone A is crushed at a slow speed, there is no risk of the stone A being scattered with force and damaging the inner wall of the bile duct when it is crushed. Moreover, since the rotation of the handle 38 is decelerated by the first and second gears 37 and 41, the handle 38 only needs to be rotated with a slight force compared to the force needed to crush the calculus A.

Furthermore, as another means of crushing the calculus A, the calculus A may be repeatedly abutted against the hard part 2 provided at the distal end of the flexible sheath 1 by sliding the grip part 27 back and forth.

In the above embodiment, the coupling member 14 connected to the base end of the operating wire 1 is fixed to the grip portion 27, but the coupling member 14 may be fixed to the rack body 22.

〔Effect of the invention〕

As described above, according to the present invention, the rotation of the handle provided on the operating section is transmitted to the rack body through the deceleration mechanism, and the operation wire is linked to the movement of the rack body to reduce the basket. Made it possible to crush stones. Therefore, since the rotational operating force of the handle can be transmitted to the operating wire in a gentle and amplified manner, stones are not scattered too vigorously during crushing, and the stones can be crushed with a small operating force. Further, the operating wire can be moved forward and backward not by the handle but also by a grip connected to the rack body. In this case, the operating wire advances and retreats at the same speed as the moving speed of the grip, so
The basket can be opened and closed quickly and easily.

[Brief explanation of the drawing]

The drawings show one embodiment of the present invention; FIG. 1 is a cross-sectional view of the entire configuration of the main parts, FIG. 2 is a cross-sectional view of a flexible sheath, and FIG. 3 is a cross-sectional view taken along the line of FIG. 1. , FIG. 4 is a sectional view taken along the line of FIG. 1, and FIG.
7 to 7 are explanatory diagrams sequentially showing the procedure for crushing a stone. DESCRIPTION OF SYMBOLS 1... Flexible sheath, 2... Hard part, 9... Operating wire, 10... Basket, 11... Elastic wire, 14... Coupling member, 16... Operating section, 17
...Main body, 22... Rack body, 27... Gripping part,
33...Fixing rod (fixing means), 37, 41, 43
...gear, 38...handle.

Claims (1)

[Claims] 1. Formed from a flexible sheath having a hard part at the tip, an operating wire slidably inserted through the flexible sheath, and a plurality of elastic wires connected to the tip of the operating wire. a connecting member connected to the proximal end of the operating wire;
A main body of the operating section connected to the proximal end of the flexible sheath, a rack body slidably provided on the main body, a handle rotatably provided on the main body, and a rack body that decelerates the rotation of the handle. a deceleration mechanism consisting of a plurality of gears that transmits information to the rack body and drives the rack body forward and backward, and a grip portion attached to an end of the rack body for driving the rack body forward and backward without using the handle. . A stone crushing device comprising: a fixing means for fixing the coupling member to the rack body or the gripping portion and interlocking the operation wire with the movement of the rack body. 2. The stone crushing device according to claim 1, wherein means for fixing the connecting member is provided on the gripping portion.