JP4506982B2 - Puncture device - Google Patents

Description

  The present invention is inserted into a treatment instrument insertion passage provided in an insertion portion of an ultrasonic endoscope or the like, for example, in performing cytodiagnosis, for example, collecting tissue cells from a lesioned portion or the like in the body. The present invention relates to a puncture device used for performing.

  As a device that is inserted into a body cavity of a subject and obtains information related to the state of a body tissue, there is an in-body type ultrasonic diagnostic device. In addition, an ultrasonic endoscope in which an ultrasonic inspection unit and an endoscope observation unit are integrated is also widely used. Since these are inserted into the body cavity, the insertion unit is connected to the main body operation unit, and the ultrasonic transducer that constitutes the ultrasonic inspection means at the distal end of the insertion unit is also an ultrasonic endoscope. Are equipped with an endoscope observation means comprising a camera device and the like together with an ultrasonic transducer. When the ultrasonic transducer is operated, the tomographic information of the body tissue can be obtained, so that a region that may be a lesion, that is, a region of interest (ROI) can be set. In order to acquire detailed information such as the presence / absence and type of a lesion and the degree of progression, tissue cells in this region of interest must be collected and subjected to cytodiagnosis. A puncture device is used for this purpose.

  In an ultrasonic endoscope or the like, since a treatment instrument insertion passage is provided in the insertion portion, the puncture device is inserted into the body cavity via the treatment instrument insertion passage, and the puncture device is inserted from the body cavity inner wall. Can be inserted into the body. For example, Patent Document 1 discloses a puncture device of this type. The puncture device of Patent Document 1 is configured such that a puncture needle is inserted into a coil sheath, and the operation of the puncture needle can be operated by an operating means provided at the end of the coil sheath. In order to project the puncture needle from the distal end of the coil sheath by operating means, as a first step, the puncture needle is projected from the coil sheath by manual operation, and the puncture needle is inserted to a certain depth in the body. Sometimes, the second stage operation is performed, and the puncture needle is projected at a high speed by the biasing force of the spring.

Here, the reason why the puncture needle is projected at a high speed by the biasing force of the spring is that the tissue is a hard part, and it may be difficult to insert the puncture needle by manual operation, so that the part can be easily inserted. is there. The operation member is provided with a switch part, and by operating this switch part, the puncture needle will project, but taking into account that the switch part will be activated by mistake, to ensure safety In order to prevent the puncture needle from immediately operating even when the switch unit is operated, a restricting member is provided. Therefore, if the restriction is not released, the puncture needle is prevented from protruding from the coil sheath even if the switch portion is operated.
JP 2001-37765 A

  By the way, since the puncture needle is inserted into the body, it is necessary to prevent a situation such as damaging a blood vessel or the like. However, in the case where the puncture needle is protruded by manual operation, it is difficult to ensure the stability of the position of the puncture needle, and there is no possibility that the amount and direction of puncture will be wrong. And about the operation | movement which makes a puncture needle protrude by the urging | biasing force of a spring, even if the safety measure by a control member is given, the control by this control member is a safety measure which works at the time of the operation start of a puncture needle, When the movement of the puncture needle is started, it cannot be stopped halfway, and the movement stroke end position cannot be controlled. Therefore, the possibility of an unforeseen situation occurring when operating the puncture needle cannot be denied.

  The present invention has been made in view of the above points, and an object of the present invention is to ensure that the puncture needle has good operability and that the treatment by operating the puncture needle can be performed extremely safely. There is.

  In order to achieve the above-mentioned object, the present invention comprises a flexible sheath and a puncture member that is inserted into the flexible sheath and has a puncture needle connected to the distal end of the flexible tube. A puncture device that is inserted through a treatment instrument insertion passage provided in an insertion member into the holder, and is detachably fixed to an inlet portion of the treatment instrument insertion passage, and a holder member through which the flexible sheath is inserted; The sheath holding member, which is inserted into the holder member and to which the rear end portion of the flexible sheath is fixed, is connected to the rear end portion of the puncture member, and the puncture member is inserted from the distal end of the flexible sheath. An operation member for performing an operation of moving the puncture needle in and out, and the operation member includes an urging means for urging the puncture member in a direction protruding from the distal end of the flexible sheath, and the puncture member is Feed intermittently at regular intervals by the biasing force of the biasing means That it has a structure and a to pitch feed means it is for its features.

  Here, the puncture needle may have a single configuration, or may be a double puncture needle of an inner needle and an outer needle. In the case of this double puncture needle, the inner needle is inserted into the body with a predetermined length protruding from the outer needle, and an opening for taking in tissue is inserted into the peripheral body of the distal end portion of the inner needle. Form. Then, when the tissue is taken in from the opening of the inner needle by suction or the like, the outer needle is protruded to operate to cut out the tissue sucked by the inner needle. Therefore, in this case, when the inner needle and the outer needle are fed together from the flexible sheath, pitch feeding by the pitch feeding means is performed.

  The holder member is detachably fixed to the treatment instrument introduction portion at the entrance of the treatment instrument insertion path. In general, a forceps plug is detachably attached to the treatment instrument introduction portion, and a syringe or the like can be held with the forceps plug removed. The flexible sheath through which the puncture member is inserted is inserted into the treatment instrument insertion path, and the flexible sheath is drawn into the treatment instrument insertion path and the state in which the flexible sheath is led out from the treatment instrument insertion path. In order to displace, the sheath holding member is connected and fixed so as to be fitted to the holder member, and the position of the fitting portion can be adjusted. In this way, by making it possible to adjust the positional relationship between the sheath holding member and the holder member, the length of protrusion of the flexible sheath from the distal end of the insertion member can be increased while the holder member is fixed to the treatment instrument introduction portion. Can be controlled. The flexible sheath is flexible in the bending direction, and may be formed of, for example, a resin tube, but the flexible sheath is damaged by the sharp tip of the puncture needle inserted inside. In order to prevent this, it is desirable that the flexible sheath is formed of a contact coil.

  The pitch feeding means intermittently feeds the puncture needle from the flexible sheath by the urging force, and the pitch interval is appropriately set from the viewpoint of safety and functionality. The feed may be configured to be electrically controlled, or may be configured to be mechanically controlled. In any case, the operation of feeding out the puncture needle from the distal end of the flexible sheath is not performed manually, but the feeding thrust of the puncture needle is applied using the biasing force of the biasing means such as a spring. For example, a cam mechanism can be used to control the operation of the puncture needle, but the following configuration can also be adopted.

That is, when the puncture needle is pulled into the flexible sheath, the biasing means is configured to accumulate the biasing force, and the pitch feeding means is provided to push out the puncture member at regular pitch intervals. . The pitch feed means has a rear end portion of the puncture member fixedly connected, and a slide member urged by the urging means, and two sets of sawtooth rows are provided at opposing portions of the surface of the slide member. It is constituted by, sawtooth constituting each sawtooth row, the inclined surface which rises at the side or al swash Me facing the biasing means becomes a vertical plane perpendicular to the apex of the inclined surface with the axis of the slide member, each The saw blades in the row are arranged at positions shifted by one pitch or more from each other in the axial direction, and the slide member is provided with a stopper ring that can reciprocate in a direction perpendicular to the axial line. It can be set as the structure which can selectively contact | abut to the vertical surface of each sawtooth of a sawtooth row | line | column.

  As described above, when the puncture needle is inserted into the body, the urging force by the urging means is used as a thrust, so that the urging force applied to the puncture needle is increased by increasing the urging force of the urging means. The operability of the puncture needle can be stopped at a desired position even after the puncture needle has been inserted into the body. Yes.

  Embodiments of the present invention will be described below with reference to the drawings. First, FIG. 1 shows the overall configuration of the puncture apparatus 1. This puncture device 1 is, for example, a treatment instrument insertion path extending from the main body operation unit 3 of the ultrasonic endoscope 2 shown in FIGS. 2 and 3 to the insertion unit 4 in order to collect tissue cells in the body. 5 is inserted. The proximal end side of the treatment instrument insertion path 5 is connected to a treatment instrument introduction section 6 provided in the main body operation section 3, and the distal end portion is open to the distal end surface of the insertion section 4. An ultrasonic transducer 7 is attached to the distal end portion of the insertion portion 4, and an inclined surface 8 is formed at a position closer to the proximal end than the attachment portion of the ultrasonic transducer 7. Endoscopic observation means including a section 9 (see FIG. 6) is provided.

  The puncture device 1 includes an operation unit 10 that is detachably attached to the treatment instrument introduction unit 6 and a cord 11 that extends from the operation unit 10. As shown in an enlarged view in FIG. 4, the cord 11 has a puncture needle 12 with a sharp tip, and the puncture needle 12 is connected to the tip of the flexible tube 13. In this way, the puncture member 14 composed of the puncture needle 12 to which the flexible tube 13 is connected is inserted into the flexible sheath 15 composed of a close-contact coil. From the state of being drawn into the flexible sheath 15, it can be operated so that a predetermined length is derived from the distal end of the flexible sheath 15. Here, an opening 12a is formed at the tip of the puncture needle 12, and a negative pressure suction force can be applied from the opening 12a.

  The operation unit 10 has a holder member 20 that is detachably fixed to the treatment instrument introducing portion 6. A sheath holding member 21 is fitted to the holder member 20. A sheath connecting member 22 that connects and fixes the rear end portion of the flexible sheath 15 is screwed into the distal end portion of the sheath holding member 21. The sheath holding member 21 has a fitting portion 21 a to the holder member 20, and this fitting portion 21 a is movable in the axial direction of the holder member 20 by a predetermined length and is screwed into the holder member 20. The fixing screw 23 can be fixed to an arbitrary position of the fitting portion so that the position can be adjusted.

  A circumferential barrel portion 21b extends from the rear end side of the fitting portion 21a of the sheath holding member 21, and a guide tube 24 is fixed to the circumferential barrel portion 21b by means such as screwing. A slide shaft 25 is inserted into the guide tube 24, and a receiving tube 26 is fixed to the rear end portion of the slide shaft 25 by screwing. Further, a tube connecting member 27 is inserted into the receiving tube 26 and fixed by a set screw 28.

  The flexible tube 13 connected to the puncture needle 12 extends from the rear end portion of the flexible sheath 15 fixed by the sheath holding member 21 and is inserted through the slide shaft 25 so as to penetrate in the axial direction. It passes through the hole 25 a and is fixed to the tube connecting member 27. The tube connecting member 27 is provided with a communication hole 27a communicating with the flexible tube 13, and the communication hole 27a communicates with a connection portion 27b to which a syringe or the like is connected.

  By moving the slide shaft 25 in the axial direction thereof, the puncture member 14 formed of the flexible tube 13 connected to the puncture needle 12 is pushed and pulled in the flexible sheath 15, and thus the puncture needle 12 is moved to the flexible sheath 15. Can be infested from the tip of the. For this reason, the slide shaft 25 is slidable with respect to the inner surface of the peripheral barrel portion 21 b of the sheath holding member 21 at a position near the tip thereof, and the rear end portion of the slide shaft 25 is on the rear end side of the guide tube 24. It is slidable with respect to the guide portion 24a formed in an inward annular shape.

  The slide shaft 25 is movable in the axial direction of the sheath holding member 21 to which the guide tube 24 is connected, and includes a pitch feeding means therebetween. This pitch feeding means is provided between the guide cylinder 24 and the slide shaft 25. As shown in FIG. 5, the rear end side and the front end side of the slide shaft 25 are cylindrical, and the sliding surface portions slide with the guide portion 24 a of the guide tube 24 and the fitting portion 21 a of the sheath holding member 21, respectively. 25b and 25c, the part between these sliding surface parts 25b and 25c is the action | operation part 25d which consists of a square pole. The operating portion 25d is provided with sawtooth rows 30A and 30B on opposite surfaces thereof. In the sawtooth rows 30A and 30B, the leading end side, that is, the side facing the sliding surface 25c is a vertical surface 31a composed of a vertical wall having substantially the same width as the surface of the operating portion 25d. A plurality of saw teeth 31 that are inclined surfaces 31b toward the moving surface 25b are provided at predetermined pitch intervals in the axial direction of the slide shaft 25. The front and rear saw blades 31 are arranged with an interval of one pitch, and the saw blades 30A and 30B are alternately arranged. Therefore, the saw-tooth 31 which comprises the other saw-tooth row | line | column is arrange | positioned in the space | interval between the front-and-back saw-tooth 31 in one saw-tooth row | line | column.

  A stopper ring 32 is fitted to the operating portion 25 d of the slide shaft 25. The stopper ring 32 has an outer surface shape of the operating portion 25d and an opening slightly larger than one saw tooth 31 formed on the operating portion 25d. The stopper ring 32 fitted to the slide shaft 25 is provided with push operation portions 33A and 33B projecting up and down, that is, at portions where the sawtooth rows 30A and 30B are provided. 33A and 33B penetrate the guide cylinder 23 and are led out to the outside, and flat pushing portions 33aA and 33aB are formed at their tip portions. Therefore, the stopper ring 32 is displaced by the height of the sawtooth 31 in the direction orthogonal to the slide shaft 25 by pushing the pushing portions 33aA and 33aB with fingers.

  The slide shaft 25 is further provided with a flange portion 25e at a boundary portion between the operating portion 25d and the slide portion 25b. The slide shaft 25 is interposed between the flange portion 25e and the guide portion 24a of the guide tube 24. A compression spring 34 is provided as urging means for urging so as to push toward the distal end side. On the other hand, a positioning sleeve 35 is mounted on the side of the guide tube 24 where the sheath holding member 21 is fitted, and the stopper ring 32 is always in contact with the end surface of the positioning sleeve 35 by the urging force of the compression spring 34. Yes. Further, a regulating ring 36 is inserted inside the fitting portion 21a of the sheath holding member 21, and this regulating ring 36 can be fixed at an arbitrary position in the axial direction of the fitting portion 21a by a set screw 37. ing. For this purpose, a slit 38 through which the set screw 37 is inserted is formed in the fitting portion 21a over a predetermined length in the axial direction. As a result, when the slide shaft 25 moves toward the distal end side, the end surface of the slide shaft 25 comes into contact with the restriction ring 36, so that the most advanced position is restricted. Thereby, the most derived position of the puncture needle 12 from the distal end of the flexible sheath 15 is regulated.

  The present invention is configured as described above, and the puncture device 1 is inserted into the treatment instrument insertion path 5 provided in the main body operation section 3 of the ultrasonic endoscope 2 and the cord 11 is inserted into the insertion section. A treatment for collecting cells or injecting a chemical solution is performed by deriving from the tip of 4.

  Here, what is shown in FIG. 1 is a stroke start end position of the puncture needle 12 in which the slide shaft 25 is pulled out to the rear end side and the puncture needle 12 is pulled into the flexible sheath 15. With the puncture device 1 in this state, the cord 11 is inserted into the treatment instrument insertion path 5 and the operation unit 10 is fixed to the treatment instrument introduction section 6. That is, the holder member 20 is fixed to the treatment instrument introducing portion 6, and the sheath holding member 21 is connected to the holder member 20 by the fixing screw 23. Initially, the distal end of the cord 11 is not led out from the distal end of the insertion portion 4 by adjusting the fixing position of the sheath holding member 21 to the holder member 20. The puncture device 1 is incorporated into the ultrasonic endoscope 2 as described above, but the puncture device 1 can be incorporated at a stage before the insertion portion 4 of the ultrasonic endoscope 2 is inserted into the body cavity. Alternatively, the insertion portion 4 can be inserted into a body cavity to perform endoscopic examination and ultrasonic examination, and can be incorporated when it is necessary to perform treatment using the puncture apparatus 1. Then, for example, a suction syringe (a syringe for feeding a chemical solution when a chemical solution is injected) is connected to the receiving tube 26.

  As shown in FIG. 6, when the region of interest ROI is detected as a result of performing the ultrasonic examination by operating the ultrasonic transducer 7, the puncture apparatus 1 is used to remove tissue cells from the region of interest ROI. Collect. In order to prevent air from intervening between the ultrasonic transducer 7 and the inner wall of the body cavity, a balloon B is attached to the arrangement portion of the ultrasonic transducer 7 and an ultrasonic transmission medium is sealed inside. It is desirable to bulge B so as to contact the inner wall of the body cavity.

  Therefore, first, the fixing screw 23 in the operation unit 10 fixed to the treatment instrument introducing portion 6 is loosened, and the sheath holding member 21 is operated to be pushed into the holder member 20. As a result, as shown in FIG. 7, the cord 11 protrudes from the distal end of the insertion portion 4. Here, the protruding amount of the cord 11 is preferably a position where it abuts against the inner wall of the body cavity. This operation is performed based on the in-vivo image obtained from the observation window 9 constituting the endoscope observation means.

  In this state, as shown in FIG. 8, the puncture needle 12 is inserted into the region of interest ROI by pitch-feeding the puncture needle 12. Thus, the puncture member 14 composed of the puncture needle 12 and the flexible tube 13 connected thereto is inserted into the flexible sheath 15 so as to be movable in the axial direction, so that the flexible sheath 15 is fixed. The puncture needle 12 is led out from the distal end of the flexible sheath 15 by advancing the flexible tube 13 therein, and inserted into the body. However, the insertion of the puncture needle 12 into the body is not performed by a series of operations, but the puncture needle 12 advances by an intermittent operation at predetermined intervals, and the pitch feed is applied to the compression spring 34. This is performed by force, and the compression spring 34 is moved in a shocking manner by the spring force.

  That is, the slide shaft 25 is provided with sawtooth rows 30A and 30B. One of the sawtooth rows 30A or 30B, for example, a stopper ring on the vertical surface 31a of the sawtooth 31 on the most distal side of the sawtooth row 30A. The vertical surface 31 a is in pressure contact with the stopper ring 32 by the action of the compression spring 34. Therefore, one of the push operation portions 33A and 33B provided on the stopper ring 32, specifically, the push operation portion 33B is moved in a direction perpendicular to the axis of the slide shaft 25. As a result, the slide shaft 25 is moved in the direction of the arrow in FIG. 1 by the urging force of the compression spring 34. However, the stopper ring 32 faces the vertical surface 31a of the sawtooth 31 on the most distal side of the sawtooth row 30B. Thereafter, by operating the push operation portion 33A and pushing the stopper ring 32 in the direction opposite to that described above, the stopper ring 32 is separated from the sawtooth 31 on the most distal side of the sawtooth row 30B, and 2 from the tip of the sawtooth row 30A. It progresses to the position which contact | abuts with the vertical surface 31a of the sawtooth 31 located in the 2nd. Accordingly, the puncture needle 12 is gradually inserted deeply as shown by the phantom line in FIG. 8 and reaches the region of interest ROI.

  As described above, by alternately pushing the push operation portions 33A and 33B of the stopper ring 32, the slide shaft 25 is positioned on the vertical surface 31a of the saw blade 31 of the saw blade row 30A and the saw blade positioned on the rear end side thereof. The pitch between the vertical surfaces 31a of the saw-tooth 31 of the row 30B, and the vertical surface 31a of the saw-tooth 31 of the saw-tooth row 30B and the vertical surface 31a of the saw-tooth 31 of the saw-tooth row 30A located on the rear end side thereof are defined as one pitch. The puncture needle 12 protrudes intermittently and is inserted into the body. Here, the feeding pitch interval of the puncture needle 12 described above depends on the site to be treated, but is preferably 1 cm or less, for example, about 5 mm.

  As described above, the puncture needle 12 is pitch-fed so that it can be operated while confirming safety at the time of puncture. For example, when there is a blood vessel or the like in the puncture route, it is surely avoided. When the action can be taken and cannot be avoided, the puncture operation is interrupted and the puncture needle 12 is pulled back. In addition, the puncture needle 12 is driven by the action of the urging force accumulated in the compression spring 34 in spite of being pitch-fed, so that the movement is performed at high speed and impact, and the tissue in the region of interest ROI. Even if it is hard, a thrust for reliably inserting the tissue can be obtained. In addition, since the insertion depth of the puncture needle 12 can be easily controlled, the stopper ring 32 is operated while confirming the distal end position of the puncture needle 12 with the ultrasonic transducer 7 to reach a predetermined position in the region of interest ROI. When the puncture needle 12 advances, the advancement operation of the slide shaft 25 by the operation of the stopper ring 32 is stopped, whereby the insertion depth of the puncture needle 12 can be accurately adjusted. In addition, a restriction ring 36 is attached to the guide cylinder 24, and the restriction stroke 36 restricts the end position of the protruding stroke of the puncture needle 12. Therefore, a safer treatment can be performed by preliminarily restricting the maximum protruding position of the puncture needle 12 in consideration of the observation range of the ultrasonic transducer 7 and the examination site.

  When the puncture needle 12 reaches the region of interest ROI, the suction syringe connected to the receiving cylinder 26 is operated, and the tissue is collected by sucking the body tissue from the opening 12a. When the puncture needle 12 is a double needle, an opening is formed in the inner needle, and the outer needle is configured to be slidable with respect to the inner needle, the tissue sucked into the inner needle is slid with the outer needle. Can be cut.

  After the body tissue is collected by the puncture needle 12, the puncture needle 12 is pulled back into the flexible sheath 15. This operation moves the slide shaft 25 in the direction opposite to the arrow in FIG. The saw blades 31 of the saw blade rows 30A and 30B provided on the slide shaft 25 are alternately arranged and have an inclined surface 31b in the direction in which the puncture needle 12 is pulled back. 32 rides on the inclined surface 31 b and gets over the sawtooth 31. Therefore, the movement of the slide shaft 25 causes the stopper ring 32 to reciprocate in a direction perpendicular to the axis thereof, thereby successively overcoming the saw blade 31. When the slide shaft 25 moves in this direction, the stopper ring 32 It does not interfere with the sawtooth 31 and lock. The compression spring 34 is compressed by the displacement of the slide shaft 25.

  When the puncture needle 12 is drawn into the flexible sheath 15, the pulling force on the slide shaft 25 is released. As a result, the compression spring stopper ring 32 is pressed against the vertical surface 31a of one of the saw teeth 31 constituting the saw tooth row 30A or 30B, and the slide shaft 25 stops at that position. Thereafter, the cord 11 is pulled out from the treatment instrument insertion path 5. Thereby, tissue cells of the region of interest ROI are collected, and cytodiagnosis can be performed with the tissue cells collected in this way.

It is sectional drawing of the puncture apparatus which shows one Embodiment of this invention. It is a schematic block diagram of the ultrasonic endoscope incorporating the puncture apparatus. It is structure explanatory drawing which shows the connection part to the treatment tool introduction part of a puncture device. It is an expanded sectional view of the tip part of the cord which constitutes a puncture device. It is an external view of the slide shaft and stopper ring which comprise a pitch feed means. It is action | operation explanatory drawing of the puncture apparatus which shows the state before operation. It is action | operation explanatory drawing of the puncture apparatus which shows the state which made the front-end | tip of a code | cord | lead lead out from the treatment tool insertion path. It is action | operation explanatory drawing of the puncture apparatus which shows the state which is pitching the puncture needle.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Puncture apparatus 2 Ultrasound endoscope 4 Insertion part 5 Treatment tool insertion path 6 Treatment tool introduction part 10 Operation unit 11 Code 12 Puncture needle 12a Opening part 13 Flexible tube 14 Puncture member 15 Flexible sheath 20 Holder member 21 Sheath Holding member 22 Sheath connecting member 24 Guide tube 25 Slide shaft 25b, 25c Sliding surface portion 25d Actuating portion 26 Receiving tube 27 Tube connecting member 30A, 30B Sawtooth row 31 Sawtooth 31a Vertical surface 31b Inclined surface 32 Stopper ring 33A, 33B Pushing operation Portion 34 Compression spring 35 Positioning sleeve 36 Restriction ring

Claims (3)

It consists of a flexible sheath and a puncture member that is inserted into the flexible sheath and connected to the distal end of the flexible tube with a puncture needle. In the puncture device to be inserted,
A holder member that is detachably fixed to an inlet portion of the treatment instrument insertion passage and through which the flexible sheath is inserted;
A sheath holding member that is inserted into the holder member and to which a rear end portion of the flexible sheath is fixed;
A rear end portion of the puncture member is connected, and comprises an operation member for performing an operation of retracting a puncture needle of the puncture member from a distal end of the flexible sheath,
The operating member includes an urging unit that urges the puncture member in a direction protruding from the distal end of the flexible sheath, and a pitch at which the puncture member is intermittently sent at regular intervals by the urging force of the urging unit. A puncture apparatus comprising a feeding means. The puncture apparatus according to claim 1, wherein the sheath holding member is configured to fix the position of the fitting portion to the holder member so as to be adjustable. The pitch feeding means includes a slide member that is fixedly connected at a rear end portion of the puncture member, and two sets of saw teeth at opposing portions of the surface of the slide member. is constituted by providing a row, saw-tooth constituting the front Symbol each sawtooth row, the inclined surface which rises at the side or al swash Me facing the biasing means, the axis of the slide member from the apex of the inclined surface Stopper rings that are perpendicular to each other and that are arranged so that the saw teeth in each row are shifted by one pitch or more in the axial direction, and are reciprocally movable in the direction perpendicular to the axis of the slide member The puncture apparatus according to claim 1, wherein the stopper ring is configured to be capable of selectively contacting a vertical surface of each saw tooth of each saw tooth row.

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