JPH0566814B2 - - 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 within a body cavity.

[Prior Art] Stones occurring 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.

As this type of stone crushing device,
As shown in Japanese Patent No. 242848, a basket composed of a plurality of elastic wires is provided at the tip of the operating wire, and this basket is inserted together with the operating wire into a flexible sheath having a hard portion at the tip. A rod-shaped connecting member is connected to the rear end of the operating wire, and the connecting member is moved forward and backward by an operating section. Once the stone is taken into the basket protruding from the tip of the flexible sheath, the basket is pulled into the flexible sheath by operating the operating section to shrink and deform the stone, thereby crushing the stone into small pieces. I try to do that.

By the way, when a basket holding a calculus is drawn into a sheath, it is inevitable that a very large tensile force will be applied to the operating wire and the connecting member, especially if the calculus is hard. Then, the operating wire may break in the middle due to the tensile force, or the coupling member may break at the tip end on the connection end side with the operating wire.

[Problems to be solved by the invention] In this way, the operating wire breaks in the middle,
If the coupling member breaks at the tip, even if the operating portion is removed, the operating wire connected to the basket side and the broken portion of the coupling member may not be exposed to the outside. Then, there was a danger that it would not be possible to remove the stone from the basket by moving the basket holding the stone back and forth.

In this invention, when a large tensile force is applied to the operating wire or the connecting member when crushing a stone taken into the basket, the proximal end of the connecting member is broken, and the advancing and retracting operations of the basket are prevented. It is an object of the present invention to provide a stone crushing device that is prevented from becoming incapacitated.

[Means and effects for solving the problems] The present invention includes a flexible sheath 1 having a hard part 2 at the distal end, and a flexible sheath 1 provided at the proximal end of the flexible sheath 1 and communicating with the inside of the flexible sheath 1. a base 3 having a through hole 7, an operating wire 9 slidably inserted through the flexible sheath 1, a basket 10 provided at the tip of the operating wire 9, and a base end of the operating wire 9. a coupling member 14 that is connected and exposed on the proximal end side of the cap 3; an operating member 16 that is detachably attached to the cap 3 and is coupled to the coupling member 14 to operate the operating wire 9 forwards and backwards; A portion of the member 14 exposed toward the proximal end side of the base 3 is provided with a broken portion 14b that is formed to be weaker than the weakest point against tensile force in the entire length of the operating wire 9. If the tensile force applied to the operating wire 9 or the coupling member 14 is abnormally large, it is made to break at the breakage portion 14b.

[Embodiment] An embodiment of the present invention will be described below with reference to FIGS. 1 to 8. The stone crushing device shown in FIG. 2 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. 1, 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. A liquid-tight tube 8 inserted into the flexible sheath 1 is connected to the first member 5 so as 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 tip of a straight rod-shaped coupling member 14 is fixed to the base end of the operating wire 9. This coupling member 14 is slidably inserted into the through hole 7 of the base 3, and its base end protrudes from the second member 6. 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 1
The coupling member 14 is passed through the hole 5 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. 4 and 5, 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 end with the flattened portion 14a of No. 4 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 in the radial direction in the middle of the axial direction and having a button 32 attached to the upper end is provided in the storage hole 30 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 flat part 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.
Furthermore, a notch 14b serving as a breaking portion shown in FIGS. 1 and 3 is formed at the base end of the coupling member 14. This notch 14b makes the proximal end of the coupling member 14 the most likely to break due to tensile force over the entire length of the operating wire 9 and the coupling member 14.

As shown in FIG. 4, 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. 5, 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 shaft 39 .
A portion corresponding to the middle part of the second support shaft 39 of the main body 17 is a housing portion 42 that is open to the guide groove 24.
is formed. This housing section 42 has the second
A third gear 43 fitted onto the support shaft 39 is provided, and this 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, when the inside of the bile duct is observed through the endoscope and a stone A shown in FIG. It is made to protrude from the tip of the flexible sheath 1 and opened. When the basket 10 is opened in this manner, the calculus A is taken into the interior through the gap between the elastic wires 11, and then the grip portion 27 is moved back to retract the basket 10 as shown in FIG. Since the forward and backward movement of the operating wire 9 up to this point can be quickly performed by the grip portion 27, even if the stone A is removed from the basket 10, it is easy to take it in again.

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.

When such a calculus A is crushed, the bond A may be very hard and difficult to crush. Then,
Since the handle 38 must be rotated with a larger force than usual, the tension applied to the coupling member 14 and the operating wire 9 becomes large. When the tension applied to the connecting member 14 and the operating wire 9 becomes significantly larger than that in the case of crushing a calculus A of normal hardness, the connecting member 14 is the most likely to break in the entire length of the operating wire 9 and the connecting member 14. The notch 14b formed at the proximal end is broken. When the base end portion of the coupling member 14 is broken, when the operating portion 16 is removed from the base 3, the portion of the coupling member 14 connected to the operating wire 9 side is exposed to the outside from the base 3. Therefore, by holding that part of the coupling member 14 by hand and moving the operation wire 9 forward and backward, the stone A can be removed from the basket 10 and the basket 10 can be drawn into the sheath 1.

FIG. 9 shows a second embodiment of the present invention, in which the coupling member 14 is shaped like a hollow pipe, and the operating wire 9 is inserted into the coupling member 14. A fixture 51 is provided with a flat portion 14a formed at the base end of the coupling member 14.
is fitted and fixed. And this fixture 51
The operating wire 9 is connected to, for example, by brazing, and this connecting portion 52 is formed at the broken portion. According to such a structure, when the connecting portion 52 is broken due to a large tensile force, the base end portion of the operating wire 9 is in a state of protruding outside from the base 3, so that the operating wire 9 is broken as in the first embodiment. 9 can be operated forward and backward.

FIG. 10 shows a third embodiment of the invention, which is substantially similar to the second embodiment, but with the operating wire 9
The portion to be inserted into the connecting member 14 is coated with a wax, and this coating portion 52 makes the entire connecting member 14 hard.

[Effects of the Invention] As described above, in the present invention, an operating wire is slidably inserted into a flexible sheath provided with a cap at the proximal end, a basket is provided at the distal end of the operating wire, and a base end is provided with a basket. A coupling member is provided that is exposed on the proximal side of the cap, and an operating member that drives the operating wire forward and backward is connected to the coupling member, and a portion of the coupling member that is exposed on the proximal side of the cap is connected to the coupling member. In addition, a broken portion was formed that was weaker than the weakest point in the entire length of the operating wire. Therefore, if a significantly larger tensile force than usual is applied when crushing a stone, the stone will break at the above-mentioned breakage point, making it impossible to move the operating wire forward or backward as in the past, and removing the stone from the basket. The risk of not being able to pull the lever basket into the sheath is eliminated.

[Brief explanation of the drawing]

1 to 8 show a first embodiment of the present invention, FIG. 1 is a sectional view of a flexible sheath, FIG. 2 is a partially sectional view of the overall configuration, and FIG. 3 is a connecting member. 4 is a sectional view taken along the line X-X in FIG. 2,
Fig. 5 is a sectional view taken along the Y-Y line in Fig. 2, Figs. 6 to 8 are explanatory diagrams sequentially showing the procedure for crushing a stone, and Fig. 9 shows a second embodiment of the present invention. FIG. 10 is a sectional view of a connecting member showing a third embodiment of the present invention. DESCRIPTION OF SYMBOLS 1...Flexible sheath, 2...Hard part, 9...Operation wire, 10...Basket, 14...Coupling member, 14b
... Notch (broken part), 52... Connection part (broken part).

Claims (1)

[Claims] 1. A flexible sheath having a hard part at the tip, a cap provided at the proximal end of the flexible sheath and having a through hole that communicates with the inside of the flexible sheath, and a cap that is slidably inserted into the flexible sheath. a basket provided at the tip of the operating wire; a coupling member connected to the proximal end of the operating wire and exposed toward the proximal end side of the cap; and a connecting member detachably attached to the cap and the An operating member connected to the coupling member for advancing and retracting the operating wire, and a portion of the coupling member exposed toward the proximal end side of the base end further than the weakest point against tensile force in the entire length of the operating wire. A stone breaking frame device characterized by comprising a weakly formed breaking part.