Conveying device

Abstract

The conveying device comprises: an outer cylinder; the inner cylinder penetrates through the outer cylinder; a shaft member which is a flexible elongated member, is inserted into the inner tube, and is capable of holding a stent between the distal end of the shaft member and the inner tube; an operation mechanism that includes a housing and performs an operation of moving the inner cylinder relative to the shaft member in the longitudinal direction; and an adjuster which is provided between the proximal end of the outer tube and the proximal end of the shaft member, and which is capable of correcting the relative position of the outer tube in the longitudinal direction with respect to at least one of the inner tube and the shaft member.

Description

Technical Field

[0001] The present invention relates to delivery devices. Background Art

[0002] A stent delivery device (e.g., Patent Document 1) is used when a self-expanding stent is placed in a body cavity. Conventional stent delivery devices house a stent in the gap between an inner sheath and an outer sheath. The stent is exposed and expanded by causing the outer sheath to retreat relative to the inner sheath, and then the inner sheath is pulled out from the stent to place the stent in the body cavity. The stent delivery device is inserted through the jaws of an endoscope into an endoscope channel of an endoscope insertion portion that is inserted into the body for use. Since the endoscope insertion portion snakes in the body, the sheath of the stent delivery device also snakes relative to the endoscope channel. In addition, since the portion of the stent delivery device that is exposed to the outside of the jaws does not generate frictional resistance like the portion that is inserted into the endoscope channel, it is easily deformed under the action of external force. Therefore, in the stent delivery device, the portion that is exposed to the outside from the jaws of the endoscope is easily straightened. In the conventional stent delivery device, when the outer sheath is pulled back proximally to place the stent in the body, the relative position of the inner sheath and the outer sheath may deviate from the expected range due to the snaking movement of the sheath in the endoscope channel and the linearization of the portion exposed to the outside from the forceps opening. When placing the stent in the treatment target site, high-precision positioning is required. If the stent delivery device is unexpectedly misaligned, it will take time to make fine adjustments for accurate placement of the stent.

[0003] Prior art literature

[0004] Patent Literature

[0005] Patent Document 1: U.S. Patent No. 5733267 Summary of the invention

[0006] Problem that the invention aims to solve

[0007] The delivery system described in Patent Document 1 has a three-layer structure including an inner shaft for holding a stent, an intermediate shaft, and a reinforced outer shaft. Compared with the conventional two-layer delivery system, the delivery system with a three-layer structure can reduce the above-mentioned unexpected misalignment of the inner shaft when the stent is placed. However, in the delivery system described in Patent Document 1, since an intermediate shaft that can move forward and backward is provided between the reinforced outer shaft fixed by the manifold and the inner shaft, misalignment of the intermediate shaft with respect to the outer shaft occurs. As a result, the delivery system described in Patent Document 1 still has difficulty in achieving accurate placement of the stent and cannot seek to shorten the operation time. In addition, due to the friction of the intermediate sheath relative to the outer sheath, the pulling operation of the intermediate shaft requires a large force.

[0008] In view of the above circumstances, an object of the present invention is to provide a delivery device that can be reliably placed at a target position.

[0009] Solutions for solving problems

[0010] A conveying device of a technical solution of the present disclosure includes: an outer cylinder; an inner cylinder, which passes through the outer cylinder; an axis member, which is a flexible and elongated member, which passes through the inner cylinder and can hold a bracket between the distal end of the axis member and the inner cylinder; an operating mechanism, which includes a shell, and performs an operation to move the inner cylinder relative to the axis member along the length direction; and an adjuster, which is provided between the proximal end of the outer cylinder and the proximal end of the axis member, and can correct the relative position of the outer cylinder in the length direction relative to at least any one of the inner cylinder and the axis member.

[0011] A conveying device of a technical solution of the present disclosure includes: an outer cylinder; an inner cylinder, which passes through the outer cylinder; an axis member, which is a flexible and elongated member, which passes through the inner cylinder and can hold a bracket between the distal end of the axis member and the inner cylinder; an operating mechanism, which includes a shell, and performs an operation to move the inner cylinder relative to the axis member along the length direction; and an adjuster, which is provided between the proximal end of the outer cylinder and the proximal end of the axis member, and can correct the relative position of the proximal end of the outer cylinder and the proximal end of the axis member in the length direction.

[0012] Effects of the Invention

[0013] According to the above technical solution, when the stent is placed, the stent can be positioned and placed with high precision relative to a desired position. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Figure 1 It is a diagram showing an endoscope system according to the first embodiment.

[0015] Figure 2 It is a cross-sectional view showing the overall structure of the transport device according to the first embodiment.

[0016] Figure 3 It is a cross-sectional view showing the overall structure of the transport device according to the first embodiment.

[0017] Figure 4 It is a figure which shows the usage form of the conveyance device of 1st Embodiment.

[0018] Figure 5 It is a figure which shows the usage form of the conveyance device of 1st Embodiment.

[0019] Figure 6 It is a perspective view showing a modified example of the operating portion of the transport device.

[0020] Figure 7 It is a perspective view showing a modified example of the operating portion of the transport device.

[0021] Figure 8 It is a perspective view showing a modified example of the operating portion of the transport device.

[0022] Fig. 9 It is a cross-sectional view showing the overall structure of a transport device of an endoscope system according to a second embodiment.

[0023] Fig.10 It is a cross-sectional view showing the overall structure of a transport device of an endoscope system according to a second embodiment.

[0024] Fig.11 It is a cross-sectional view showing the overall structure of a transport device of an endoscope system according to a third embodiment.

[0025] Fig.12 It is a cross-sectional view showing the overall structure of a transport device of an endoscope system according to a fourth embodiment.

[0026] Fig.13 It is a cross-sectional view showing the overall structure of a transport device according to a fifth embodiment.

[0027] Fig.14 It is a schematic diagram for explaining the transport device according to the first embodiment.

[0028] Fig.15 It is a schematic diagram for explaining the transport device according to the first embodiment. DETAILED DESCRIPTION

[0029] Reference Figure 1 to Figure 5 An embodiment of the present disclosure will be described.

[0030] (First Embodiment)

[0031] [Endoscope system 300]

[0032] Reference Figure 1 The endoscope system 300 will be described. The endoscope system 300 includes an endoscope 200 and a transport device 1. The transport device 1 is inserted into a treatment instrument channel 230 of the endoscope 200.

[0033] [Endoscope 200]

[0034] Reference Figure 1 The endoscope 200 will be described.

[0035] The endoscope 200 is a well-known side-viewing soft endoscope, and includes a longitudinally long insertion portion 210, an operating portion 220, and a treatment instrument channel 230. The operating portion 220 is provided at the proximal end of the insertion portion 210. In the following description, the side of the operating portion 220 of the endoscope 200 is referred to as the proximal direction L2. The side opposite to the operating portion 220 in the length direction of the insertion portion 210 is referred to as the distal direction L1 of the endoscope 200. The treatment instrument channel 230 is a channel through which treatment instruments such as a conveying device 1 pass. The endoscope 200 may also be a direct-viewing soft endoscope.

[0036] The insertion part 210 has a front end hard part 211, a bending part 212, and a flexible tube part 213. The front end hard part 211 is provided at the front end of the insertion part 210. The bending part 212 is attached to the proximal side of the front end hard part 211 and is configured to be able to bend. The flexible tube part 213 is attached to the proximal side of the bending part 212.

[0037] The imaging unit 216 is provided on the side surface of the distal end hard portion 211 in a state of being exposed to the outside. The imaging unit 216 includes a light guide and a CCD.

[0038] A lifting platform 214 is provided at the front end hard portion 211. The proximal end of the lifting platform 214 is rotatably supported at the front end hard portion 211. A lifting platform operation wire (not shown) is fixed to the front end of the lifting platform 214. The lifting platform operation wire (not shown) passes through the insertion portion 210 and extends in the proximal direction L2.

[0039] The bending portion 212 is configured to be bendable in the up-down direction and the left-right direction. In the bending portion 212, the front end of the operating wire is fixed on the distal side of the bending portion 212. The operating wire extends through the insertion portion 210 to the operating portion 220. The up-down direction is the up-down direction of the field of view of the endoscope in the orthogonal directions that bend from the state where the insertion portion 210 extends straight to the direction intersecting the axis. The left-right direction is the left-right direction of the field of view of the endoscope in the orthogonal directions that bend from the state where the insertion portion 210 extends straight to the direction intersecting the axis. The bending direction of the bending portion 212 is not limited to the up-down direction and the left-right direction, and is also bendable in the direction intersecting the axis of the insertion portion 210.

[0040] The distal end of the treatment instrument channel 230 opens at the side surface of the distal end hard portion 211. The proximal end of the treatment instrument channel 230 extends to the operation portion 220.

[0041] A knob 229 for operating the operation wire and a switch 224 for operating the camera unit 216 are provided at the proximal end of the operation section 220. The user can bend the bending section 212 in a desired direction by operating the knob 229. The operation section 220 may be configured to operate the operation wire and the camera unit 216, and is not limited to the above-described configuration.

[0042] A forceps opening 232 communicating with the treatment instrument channel 230 is provided at a position distal to the operation portion 220. The user can insert an endoscopic treatment instrument such as the delivery device 1 through the forceps opening 232. A forceps plug 225 is attached to the forceps opening 232 to prevent leakage of body fluids.

[0043] [Transport device 1]

[0044] Reference Figure 2 to Figure 5 The delivery device 1 is described. The delivery device 1 is a treatment device that holds the stent S at the distal end and places the stent S in the body with the help of an endoscope 200. Figure 2 As shown, the delivery device 1 has an elongated shape as a whole. The delivery device 1 includes an outer tube 9, an inner tube 8, a shaft member 7, an adjuster 6, and an operating portion 3 (operating mechanism). In the delivery device 1, the inner tube 8 and the shaft member 7 are inserted into the outer tube 9 in a manner that allows them to move forward and backward. The operating portion 3 and the adjuster 6 are provided at the proximal portion of the delivery device 1. The shaft member 7, the inner tube 8, and the outer tube 9 are referred to as a treatment device body 10.

[0045] The outer cylinder 9 is a flexible, longitudinally elongated cylindrical member. The outer cylinder 9 may be a tube formed of resin or the like, or a coil sheath. The length of the outer cylinder 9 is shorter than the length of the inner cylinder 8 and the shaft member 7. Figure 2 and Figure 3 As shown, the outer tube 9 has a lumen (internal space) 93 formed in the length direction L from the distal end 91 to the proximal end 92, and is open at the distal end 91 and the proximal end 92. The lumen 93, the distal end 91, and the proximal end 92 are substantially circular openings of a size that can be passed through the inner tube 8. The outer tube 9 has a length that allows the distal end 91 of the outer tube 9 to be arranged at a position on the distal side of the forceps opening 232 when the delivery device 1 is inserted into the treatment instrument channel 230 of the endoscope 200.

[0046] The inner tube 8 is a flexible, longitudinally elongated cylindrical member. The inner tube 8 may be a tube formed of resin or the like, or a coil sheath. Figure 2 and Figure 3 As shown, a lumen (internal space) 83 is formed in the length direction L from the distal end 81 to the proximal end 82 of the inner 8, and is open at the distal end 81 and the proximal end 82. The lumen 83, the distal end 81, and the proximal end 82 are roughly circular and have openings of a size that allows the shaft member 7 and the contracted stent S to pass through. The lumen 83, the distal end 81, and the proximal end 82 may also be opened to a size that allows a guide wire (not shown) to be inserted. Figure 1 and Figure 2 As shown, a handle 4 is provided at the proximal end 82 of the inner tube 8. Figure 2 and Figure 3 As shown, the handle 4 has a through passage 43 communicating with the lumen 83 of the inner tube 8 .

[0047] The shaft member 7 is a flexible longitudinal member that can pass through the lumen 83 of the inner tube 8. The shaft member 7 is configured to hold the stent S between the shaft member 7 and the inner tube 8. The shaft member 7 is, for example, a wire member formed of a metal such as NiTi, a resin, or the like. A head 5 is fixed to the distal end of the shaft member 7. In the case of a transport device used under X-ray fluoroscopy, metallic markers 731 and 732 that are not transparent to X-rays may also be provided at the distal end of the shaft member 7. The metallic markers 731 and 732 indicate the storage positions of the front end and the base end of the stent S in the body cavity under X-ray fluoroscopy when the stent S is indwelling.

[0048] A head 5 is provided at the distal end 71 of the shaft member 7. The diameter of the head 5 is larger than the inner diameter of the lumen 83 of the inner tube 8 and is smaller than the outer diameter of the inner tube 8. The head 5 abuts against the distal end 81 of the inner tube 8 at the position where the shaft member 7 is most retracted. The head 5 is provided to prevent the stent S housed in the inner tube 8 from falling off and to facilitate confirmation of the front end position of the shaft member 7 in the endoscopic image. The head 5 has a substantially conical distal end portion 51 protruding toward the distal side. Figure 2 and Figure 3 As shown, the head 5 is connected to the shaft member 7 at the proximal end portion 52. The diameter of the distal end portion 51 is smaller than the diameter of the proximal end portion 52. Although not shown in the figure, a through hole may be formed in the head 5 so that a guide wire passing through the inner tube 8 can pass therethrough.

[0049] The inner cylinder 8 and the shaft member 7 are arranged in the entire length of the conveying device 1. The length of the shaft member 7 is longer than the length of the inner cylinder 8. Figure 2 and Figure 3 As shown, the shaft member 7 is inserted into the lumen 83 of the inner tube 8. Specifically, the shaft member 7 is inserted into the lumen 83, passes through the respective openings of the distal end 81 and the proximal end 82 of the inner tube 8, and is inserted in a manner relatively movable with respect to the inner tube 8. The head 5 is configured to protrude to a position on the distal side of the distal end 81 of the inner tube 8.

[0050] The operation part 3 is provided at the proximal part of the conveying device 1. The operation part 3 performs operations such as advancing and retracting the inner tube 8 relative to the outer tube 9 and the shaft member 7, advancing and retracting the conveying device 1 in the treatment instrument channel, and bending the outer tube 9, the inner tube 8, and the shaft member 7. The operation part 3 includes a housing 30 and a handle 4. The housing 30 is a portion of the conveying device 1 that is held by the surgical operator P2. The housing 30 includes a distal part 31, a proximal part 32, and an intermediate part 33. The distal part 31 and the proximal part 32 have a flat plate shape that is substantially orthogonal to the longitudinal direction L, and are arranged separately and parallel to each other. The intermediate part 33 extends along the longitudinal direction L and connects the distal part 31 and the proximal part 32. The proximal part 32 has a fixing part 36 for the proximal end 72 of the shaft member 7. An opening part 35 is formed on the distal side of the fixing part 36 in the distal part 31. The opening 35 penetrates the distal portion 31 in the longitudinal direction L and is an opening of a size that allows the inner tube 8 to advance and retreat.

[0051] The inner tube 8 and the proximal region of the shaft member 7 are arranged in the housing 30 of the operation part 3. The inner tube 8 and the shaft member 7 are inserted through the opening 35 of the housing 30. The proximal end portion of the shaft member 7 extends in the length direction L at a position closer to the proximal side than the proximal end 82 of the inner tube 8. The proximal end 72 of the shaft member 7 is fixed to the fixing portion 36.

[0052] The proximal end 72 of the inner tube 8 and the handle 4 are provided in the housing 30. The handle 4 is disposed between the distal portion 31 and the proximal portion 32 of the housing 30. By operating the handle 4 forward and backward in the housing 30, the proximal end 72 of the inner tube 8 moves forward and backward relative to the shaft member 7.

[0053] An outer tube 9 is provided on the distal side of the operating portion 3. An adjuster 6 is provided between the proximal end 92 of the outer tube 9 and the operating portion 3. The adjuster 6 can correct the relative position of the outer tube 9 with respect to at least one of the inner tube 8 and the shaft member 7 in the length direction L. The adjuster 6 can correct the relative position of the proximal end 92 of the outer tube 9 and the proximal end 72 of the shaft member 7 in the length direction L.

[0054] The adjuster 6 is, for example, a coil spring coaxially arranged with the outer tube 9. A specific example of the adjuster 6 is a compression spring. The adjuster 6 receives a force in the proximal direction L2 from the outer tube 9 and contracts in the length direction L. The adjuster 6 can be extended and retracted between a reference length L1 in the length direction L of the adjuster 6 when the outer tube 9 is in a straight state and unloaded and a correction length L2 shorter than the reference length L1 under the action of an external force. The adjuster 6 may be configured to include an elastic member that can contract in the length direction L when an external force is applied.

[0055] The end of the regulator 6 is fixed to the distal portion 31 of the housing 30 or the proximal end 92 of the outer tube 9. Alternatively, the two ends of the regulator 6 in the length direction L are fixed to both the distal portion 31 of the housing 30 and the proximal end 92 of the outer tube 9. Alternatively, the two ends of the regulator 6 in the length direction L are arranged to abut against the distal portion 31 of the housing 30 and the proximal end 92 of the outer tube 9.

[0056] The stent S is a cylindrical self-expanding stent. The stent S is formed, for example, by weaving wires. The stent S has a cylindrical shape extending along the length direction L. The wires forming the stent S are superelastic alloys with NiTi as the main material. The superelastic alloy with NiTi as the main material does not undergo permanent deformation at the time of weaving, but memorizes the weaving shape by applying heat treatment in the weaving state. The stent S has the strength to reduce the diameter compared to the natural state when an external force is applied and to maintain the lumen without blocking the stenosis.

[0057] Although the stent S is an example of a self-expanding stent, the stent S is not limited to a self-expanding stent. The stent S may also be a non-self-expanding stent, and examples thereof include a CoCr alloy stent, a biodegradable stent formed of polylactic acid, polyglycolic acid, and copolymers thereof. The stent S may also be a stent that is expanded by fluid. Examples of stents that are expanded by fluid include a non-self-expanding stent that is expanded by other treatment devices such as a balloon.

[0058] like Figure 3 As shown, the stent S is accommodated in the lumen 83 of the distal end 81 of the inner tube 8. Specifically, the shaft member 7 passes through the inside of the stent S, and the stent S in a reduced diameter state is accommodated in the gap between the inner tube 8 and the outer tube 9. The stent S is locked in a locking portion (not shown) formed on the outer peripheral surface of the inner tube 8. As a result, the stent S is positioned relative to the inner tube 8 in a reduced diameter state and does not move relatively along the longitudinal direction L of the inner tube 8. It is configured so that by pulling the shaft member 7 in the proximal direction L2, the inner tube 8 moves in the proximal direction L2, the stent S expands in diameter, and is released from the delivery device 1.

[0059] Next, the operation of the endoscope system 300 will be described.

[0060] The delivery device 1 has a stent S mounted on the distal end of the shaft member 7, and the stent S is held between the inner tube 8 and the shaft member 7. Specifically, the distal end 71 of the shaft member 7 is protruded to a position on the distal side of the distal end 81 of the inner tube 8, and the expanded stent S is inserted into the head 5 and the distal end 71 of the shaft member 7. When the shaft member 7 is retracted after the stent S is arranged at a position on the distal side of the head 5, the proximal end of the stent S is pressed between the shaft member 7 and the distal opening of the inner tube 8 by the distal end 81 of the inner tube 8, and the stent S is gradually retracted. When the shaft member 7 is retracted until the head 5 abuts against the distal end 81 of the inner tube 8, the stent S is stored between the inner tube 8 and the shaft member 7.

[0061] The delivery device 1 storing the stent S is inserted into the treatment instrument channel 230 of the endoscope 200, and the endoscope 200 is inserted into the body of the patient. The inner tube 8 and the shaft member 7 are inserted to a position protruding from the distal opening 231 of the treatment instrument channel 230. The distal end 91 of the outer tube 9 is inserted into the treatment instrument channel 230 of the endoscope 200 and connected to the treatment instrument channel 230. For example, the distal end of the outer tube 9 is connected to the forceps opening 232 by crimping. The connection position and connection method of the distal end 91 of the outer tube 9 and the treatment instrument channel 230 are not limited to the above example. The distal end 91 of the outer tube 9 is inserted to a position on the distal side of the forceps opening 232 and connected to the endoscope 200. When the delivery device 1 is used, the outer tube 9 suppresses the meandering movement of the portion of the treatment instrument body 10 exposed to the distal side of the forceps opening 232, and suppresses the change in the path length between the inner tube 8 and the shaft member 7.

[0062] exist Figure 4 The diagram schematically shows the paths of the inner tube 8 and the shaft member 7 in the treatment instrument channel 230 and the paths of the inner tube 8 and the shaft member 7 in the outer tube 9 of the exposed portion of the treatment instrument body 10 when the treatment instrument body 10 is moved forward relative to the treatment instrument channel 230. Figure 5 The diagram schematically shows the paths of the inner cylinder 8 and the shaft member 7 in the treatment instrument channel 230 and the paths of the inner cylinder 8 and the shaft member 7 in the outer cylinder 9 of the treatment instrument body 10 exposed to the outside when the stent is indwelling, i.e., when the inner cylinder 8 is retreated. Figure 4 and Figure 5 As shown, since the conveying device 1 passes through the treatment instrument channel 230 of the insertion portion 210 of the endoscope 200 that snakes in the body cavity, the shaft member 7 and the inner tube 8 also snake. When the shaft member 7 and the inner tube 8 snake, the path length of the shaft member 7 in the lumen 83 of the inner tube 8 changes. As a result, the distal end 81 of the inner tube 8 moves in the distal direction L1 against the intention of the operator. Figure 4As shown in the figure, when the treatment instrument body 10 is moved forward relative to the treatment instrument channel 230, the handle 4 is arranged at the most advanced position, the distal end 81 of the inner tube 8 is arranged close to the head 5, and the housing 30 is moved forward as a whole in this state. The head 5 is moved forward to the vicinity of the narrow part of the lumen. By maintaining the position of the housing 30 relative to the forceps opening 232, the position of the treatment instrument body 10 relative to the treatment instrument channel 230 is maintained.

[0063] Next, the support S is released. Specifically, if the housing 30 is kept in position relative to the forceps opening 232, Figure 5 As shown in the figure, the handle 4 is retreated relative to the housing 30 in the proximal direction L2, and the inner tube 8 retreats relative to the shaft member 7 while the position of the head 5 is maintained near the narrow part. By retreating the inner tube 8, the stent S is gradually exposed, and the diameter is expanded by the self-expansion function of the stent S. At this time, the static friction and dynamic friction between the reduced diameter portion of the stent S and the outer peripheral surface of the shaft member 7 are sufficiently large compared with the dynamic friction of the stent S with the inner wall of the lumen 83 of the inner tube 8. Therefore, the stent S remains in the state of being arranged at the distal part of the shaft member 7.

[0064] The disposal instrument body 10 between the position where the surgical operator holds the conveying device 1 and the shell 30 can be bent freely depending on the position of the shell 30, etc. The relative positions of the shaft member 7, inner tube 8 and outer tube 9 of the disposal instrument body 10 are different when the disposal instrument body 10 is in a straight line extending straight along the longitudinal axis direction and when the disposal instrument body 10 is bent. In a straight line, the outer tube 9, the inner tube 8 and the shaft member 7 are arranged roughly coaxially, and the length (path length) of the portion of the shaft member 7 and the inner tube 8 arranged in the outer tube 9 is roughly equal to the length of the outer tube 9. In contrast, when the disposal instrument body 10 is bent to a large extent, the central axes of the outer tube 9, the shaft member 7 and the inner tube 8 are offset from each other, and the path length of the shaft member 7 and the inner tube 8 in the outer tube 9 changes. As Figure 4 and Figure 5 As shown in FIG. 1 , when the proximal end 82 of the inner tube 8 is pulled in the proximal direction L2 while the treatment instrument body 10 is bent and the positions of the shaft member 7 and the outer tube 9 are maintained, the inner tube 8 is pulled toward the inner side of the bent treatment instrument body 10, that is, Figure 5 Under the action of this force, a linear force acts on the outer tube 9 from the inner tube 8 in the direction of arrow B2 in the lumen 93. If the inner tube 8 in the lumen 93 is in a position offset to the outer side of the bend of the outer tube 9, the outer tube 9 will be moved in the direction of arrow B2. Figure 5If a linear force is applied in the direction indicated by the middle arrow B3, the inner tube 8 will also be linearized. As a result, the path length of the inner tube 8 serpentine in the lumen 93 changes, and the relative length of the outer tube 9 relative to the inner tube 8 becomes longer. If the handle 4 is pulled in this state, a compressive force is applied to the outer tube 9 along the length direction L. Since the distal end 81 of the outer tube 9 is connected to the treatment instrument channel 230, the compressive force in the length direction L of the outer tube 9 acts to move the proximal end 92 in the proximal direction L2. Here, refer to Fig.14 and Fig.15 The comparison is made with the case where the regulator 6 is not provided. Fig.14 and Fig.15 This is a diagram assuming that there is no regulator in order to compare the difference caused by the presence or absence of the regulator. Fig.14 As shown in FIG. 1 , if the treatment device body 10 is bent to a large extent, the central axis of the inner tube 8 is offset in the lumen 93. If a linear force is applied to the outer tube 9 in the direction indicated by the arrow B3 in this state, the proximal end 82 that has collided is moved in the proximal direction L2 under the action of the compressive force in the longitudinal direction L of the outer tube 9. In the case where the regulator 6 is not provided, the inner tube 8 is linearized, so that the inner tube 8 moves forward relative to the outer tube 9, as shown in FIG. Fig.15 As shown, the position of the head 5 moves relatively toward the distal side. Compared with the force of the relative movement of the operating portion 3 in the proximal direction L2, the relative movement amount of the inner cylinder 8 to the distal side caused by the linearization of the inner cylinder 8 is larger, so when the regulator is not provided, the position of the head 5 is also deviated in the distal direction L1 against one's will. However, since the conveying device 1 is provided with the regulator 6 at the proximal end 92 of the outer cylinder 9, the force in the proximal direction is applied to the regulator 6 from the outer cylinder 9, and the regulator 6 contracts in the length direction L. The regulator 6 is configured to contract by the same amount as the length of the inner cylinder 8 advancing according to the change in the path length, so that the change in the path length can be corrected. Based on the result of the correction of the change in the path length by the regulator 6, the head 5 can be prevented from deviating in the distal direction L1 as described above, and the dislocation of the distal end 71 of the shaft member 7 can be prevented after the retention position T1 is set.

[0065] Furthermore, as a result of the change in the path length of the inner tube 8 in the lumen 93 of the outer tube 9, the number of places where the inner tube 8 contacts the inner wall of the lumen 93 of the outer tube 9 increases. As a result, the friction between the inner tube 8 and the outer tube 9 increases, and a very large pulling force is required when pulling the handle 4. However, since the regulator 6 is provided at the proximal end 92 of the outer tube 9, when the force of the change in the path length of the inner tube 8 in the lumen 93 acts, the force in the proximal direction L2 acts on the regulator 6 from the outer tube 9, and the regulator 6 contracts along the length direction L, and the change in the path length can be corrected. As a result of the correction of the change in the path length, the number of places where the inner tube 8 contacts the outer tube 9 decreases, the increase in friction is prevented, and the increase in the pulling force of the handle 4 required when the stent S is placed can be suppressed. As a result, smooth operation can be achieved, and the operation time can be prevented from being prolonged.

[0066] In addition, when the regulator 6 is not provided, the compressive force in the length direction L of the outer tube 9 acts on the housing 30, and there is a Figure 5 Similarly, when the adjuster 6 is not provided, as the friction force mentioned above increases, a greater force is required when pulling the handle 4, and as a result, there is a situation such as Figure 5 The imaginary line in the figure shows the case where the middle portion 33 of the shell 30 is bent. If the middle portion 33 is bent, the relative length of the shaft member 7 and the inner tube 8 will change slightly. Since the retention position T1 of the stent S is a very small part and the stent S is also small, a high degree of positioning accuracy is sought when the stent S is retained. Therefore, even if the change in relative length caused by the deflection of the shell 30 is small, the influence on the positioning of the retention position T1 is also large. However, since the regulator 6 is provided in the conveying device 1, the deformation of the shell 30 caused by external force can be prevented, and the reduction of the positioning accuracy when the stent S is retained can be prevented.

[0067] In addition, the recapture operation can be performed when the indwelling position T1 of the stent S is readjusted at the stage before the stent S is completely exposed from the distal end 81 of the inner tube 8. Specifically, while the position of the conveying device 1 relative to the insertion portion 210 of the endoscope 200 is maintained, the inner tube 8 is moved forward again, and the distal end 81 of the inner tube 8 is moved forward relative to the shaft member 7, so that the stent S is re-stored in the stent storage area E1. The operator moves the operating part 3 forward in the distal direction L1 while holding the housing 30. The shaft member 7 and the inner tube 8 move forward from the distal opening 231, and the stent S is stored inside the inner tube 8, and the recapture operation is completed. When the recapture operation is completed, the state before the stent is released is restored.

[0068] like Figure 3As shown, if the stent S is completely exposed from the distal end 81 of the inner tube 8, the diameter of the stent S is expanded to be larger than the diameter of the head 5, and contacts the inner wall of the lumen of the indwelling portion of the stent S, thereby expanding the diameter of the stenosis. If the operating part 3 is retracted in this state, the head 5 passes through the stent S and comes out in the proximal direction L2, and the stent S is indwelled. After the stent S is indwelled, the operating part 3 is pulled in the proximal direction L2, and the delivery device 1 is pulled out from the treatment instrument channel 230.

[0069] According to the above-mentioned delivery device 1 and endoscope system, the change in the path length of the inner tube 8 and the shaft member 7 in the lumen 93 of the outer tube 9 can be corrected by the regulator 6. Therefore, even in the case of the treatment instrument body 10 having a three-layer structure including the outer tube 9 that suppresses large bending of the inner tube 8 and the shaft member 7, since the change in the path length can be corrected by providing the regulator 6, the displacement of the shaft member 7 caused by the change in the path length can be prevented during the pulling operation of the handle 4 when the stent S is placed. Therefore, the placement operation of the stent S can be smoothly performed.

[0070] According to the above-mentioned delivery device 1 and endoscope system 300, the relative position of the proximal end 92 of the outer tube 9 and the proximal end 72 of the shaft member 7 in the length direction L can be corrected by the adjuster 6. Therefore, even in the case of the treatment instrument body 10 having a three-layer structure including the outer tube 9 that suppresses large bending of the inner tube 8 and the shaft member 7, since the above-mentioned change in path length can be corrected by providing the adjuster 6, the displacement of the shaft member 7 caused by the above-mentioned change in path length can be prevented during the pulling operation of the handle 4 when the stent S is placed. Therefore, the placement operation of the stent S can be smoothly performed.

[0071] According to the delivery device 1 and the endoscope system 300 of the above-described embodiment, the stent S can be positioned with high accuracy at a desired position during stent placement.

[0072] The configuration of the operation unit 3 is not limited to the example shown in the above embodiment. Figure 6 to Figure 8 A modification example of the operation unit is shown. Figure 6 The operation portion 3A shown in the figure is a rectangular housing 30A having a distal portion 31 and a proximal portion 32 connected by a pair of intermediate portions 33. In the case of the rectangular housing 30A having a pair of intermediate portions 33, the strength of the housing 30A can be improved, and the deflection of the intermediate portion 33 can be more effectively suppressed.

[0073] For example, it can also be a structure like this: Figure 7The operating portion 3B shown in the figure is a substantially cylindrical housing 30B, and the side hole 34 is opened on the side, and the handle 4 is operated through the side hole 34. In the case of the cylindrical housing 30B, it is not easy to deform in the thickness direction (radial direction) of the middle portion 33, so it is possible to more effectively suppress the deflection of the middle portion 33 caused by the compressive force acting from the outer tube 9. By setting a structure in which the side hole 34 is opened in the housing 30 like the operating portion 3B, the area of ​​the middle portion 33 can be ensured to be large, and the rigidity of the middle portion 33 can be improved.

[0074] For example, it can also be a structure like this: Figure 8 As shown in the operating portion 3C, the housing 30C is provided with a middle portion 33 composed of four side walls and having a cubic shape, and a side hole 34 is opened. The side hole 34 of the housing 30C has a slit shape that is long along the length direction L. A handle 4C is fixed to the proximal end 82 of the inner tube 8. The handle 4C extends from the proximal end 82 in a direction (radial direction) orthogonal to the central axis of the inner tube 8 and protrudes from the side hole 34. The handle 4C can also be a hook shape extending from the radial direction and then in an orthogonal direction as shown in the example. In addition, the handle 4C can also be a straight rod shape extending from the proximal end 82 in a direction (radial direction) orthogonal to the central axis of the inner tube 8 and protruding from the side hole 34. The handle 4C is slightly smaller than the opening of the side hole 34 and is set to be movable along the side hole 34. Since the operating portion 3C is in a cubic shape and the area of ​​the middle portion 33 can be ensured to be large, the rigidity of the middle portion 33 can be improved.

[0075] (Second Embodiment)

[0076] Reference Fig. 9 and Fig.10 A transport device 1D according to a second embodiment will be described. In the following description, the same reference numerals are given to the same configurations as those already described, and duplicate descriptions will be omitted. Fig. 9 and Fig.10 1D is a cross-sectional view of a transport device 1D according to the present embodiment. The transport device 1D is an example in which the structure of an adjuster 6D is different from that of the first embodiment.

[0077] like Fig. 9 and Fig.10 As shown, the regulator 6D is provided in the operating part 3D. The regulator 6D is provided in the middle part 33 of the housing 30D. In the middle part 33, the distal wall 331 and the proximal wall 332 are arranged in a row in the length direction L, and the regulator 6D is provided between the distal wall 331 and the proximal wall 332. The regulator 6D is a coil spring. The regulator 6 is, for example, a compression spring. The regulator 6D can extend or retract the length of the housing 30D in the length direction L. The proximal end 92 of the outer cylinder 9 is fixed to the distal part 31 of the housing 30D.

[0078] When the treatment device body 10 is bent, if a force is applied from the outer tube 9 in the proximal direction L2, the adjuster 6D contracts in the longitudinal direction L. When the bending of the treatment device body 10 is eliminated, the adjuster 6D returns to the initial state. Fig.10 As shown, when the stent S is indwelled, the portion of the treatment instrument body 10 closer to the position than the forceps opening 232 is bent, and the inner tube 8 is biased to the outer side of the bend in the lumen 93. In this state, the handle 4 is pulled in the proximal direction L2, so that a linear force acts on the outer tube 9, and as a result, a compressive force is generated in the longitudinal direction L of the outer tube 9. The compressive force of the outer tube 9 acts on the housing 30D to push in the proximal direction L2, and the regulator 6D contracts. The contraction of the regulator 6D temporarily shortens the length of the middle portion 33 in the longitudinal direction L. In other words, the regulator 6D corrects the force received from the outer tube 9. If the length of the middle portion 33 of the housing 30D in the longitudinal direction L shortens, the distance between the proximal end 82 of the inner tube 8 and the proximal end 72 of the shaft member 7 shortens, and the relative position of the inner tube 8 and the shaft member 7 changes. However, since the regulator 6D can offset the compressive force of the outer tube 9, the change in the path length of the inner tube 8, the shaft member 7, and the outer tube 9 can be corrected.

[0079] According to the above-mentioned delivery device 1D and endoscope system 300, the relative position of the proximal end 92 of the outer tube 9 and the proximal end 72 of the shaft member 7 in the length direction L can be corrected by the adjuster 6D. Therefore, even in the case of the treatment instrument body 10 having a three-layer structure including the outer tube 9 that suppresses large bending of the inner tube 8 and the shaft member 7, since the above-mentioned change in path length can be corrected by providing the adjuster 6D, the displacement of the shaft member 7 caused by the above-mentioned change in path length can be prevented during the pulling operation of the handle 4 when the stent S is placed. Therefore, the placement operation of the stent S can be smoothly performed.

[0080] (Third Embodiment)

[0081] Reference Fig.11 A transport device 1E according to a third embodiment will be described. Fig.11 : is a cross-sectional view of the delivery device 1E of the present embodiment. The delivery device 1E includes a regulator 6 and a reinforcement portion 921 adjacent to the proximal direction L2 of the proximal end 92 of the outer tube 9. The regulator 6 is a coil spring similar to the regulator 6 of the first embodiment. The reinforcement portion 921 is a tube thicker than the outer tube 9. The regulator 6 and the reinforcement portion 921 are coaxially arranged with the outer tube 9. The opening diameter of the lumen of the reinforcement portion 921 is substantially equal to the opening diameters of the outer tube 9 and the regulator 6. The proximal end 922 of the reinforcement portion 921 is fixed to the housing 30.

[0082] The first outer sheath 95 and the second outer sheath 94 are coil sheaths. The first outer sheath 95 and the second outer sheath 94 are different sheaths, and are arranged close to each other in the length direction L. The first outer sheath 95 is provided on the outer side of the portion of the outer tube 9 closer to the forceps opening 232. The first outer sheath 95 is arranged close to the outer peripheral surface of the outer tube 9 from the proximal end 92 of the outer tube 9 to the vicinity of the forceps opening 232. The second outer sheath 94 is provided on the outer peripheral part of the regulator 6 and the reinforcement part 921. The first outer sheath 95 and the second outer sheath 94 may also be an integrated sheath.

[0083] Since the delivery device 1E includes the reinforcement portion 921 between the regulator 6 and the housing 30, the force applied to the contact portion between the proximal end of the delivery device body 10 and the housing 30 by the compressive force acting on the outer cylinder 9 when the treatment device body 10 is bent during stent placement can be withstood, and the longitudinal bending and deformation of the treatment device body 10 can be prevented. As a result, the longitudinal bending and deformation of the outer cylinder 9 caused by the compressive force generated at the proximal end of the outer cylinder 9 during stent placement can be prevented. Since the first outer sheath 95 and the second outer sheath 94 are included, the rigidity of the portion of the treatment device body 10 exposed to the position closer to the side than the forceps opening 232 can be increased, and the influence of the linearizing force acting on the outer cylinder 9 during bending can be reduced. Therefore, like the delivery device 1 of the first embodiment, the relative path length change can be corrected by the regulator 6, and the linearization of the outer cylinder 9 can be suppressed to suppress the path length change. As a result, the unintentional advancement of the inner cylinder 8 can be suppressed, smooth operation can be achieved, and the operation time can be prevented from being prolonged.

[0084] (Fourth Embodiment)

[0085] Reference Fig.12 A transport device 1F according to a fourth embodiment will be described. Fig.12: is a cross-sectional view of the delivery device 1F of this embodiment. The delivery device 1F has a reinforcement portion 921 having a thickness thicker than that of the distal side at the proximal end of the outer tube 9. In addition, the first outer sheath 95 and the second outer sheath 94 are provided on the outer side of the portion of the outer tube 9 closer to the position than the forceps opening 232. The other structures are the same as those of the delivery device 1D of the second embodiment. As a result of the outer tube 9 having the reinforcement portion 921, it is possible to prevent the outer tube 9 from being bent and deformed longitudinally due to the compressive force generated at the proximal end of the outer tube 9 when the stent is placed. Since the first outer sheath 95 and the second outer sheath 94 are provided, the rigidity of the portion of the treatment instrument body 10 exposed to the position closer to the position than the forceps opening 232 can be increased, and the influence of the linearizing force acting on the outer tube 9 during bending can be reduced. Therefore, like the delivery device 1D of the second embodiment, the change in the path length can be corrected by the regulator 6F, and the change in the path length can be suppressed by suppressing the linearization of the outer tube 9. As a result, the unintended advancement of the inner tube 8 is suppressed, smooth operation can be achieved, and an increase in operation time can be prevented.

[0086] (Fifth Embodiment)

[0087] Reference Fig.13 A transport device 1G according to a fifth embodiment will be described. Fig.13 : is a cross-sectional view of a delivery device 1G of the present embodiment. The fifth embodiment is an example in which a reinforcement portion 921 is provided at the proximal end portion of the outer tube 9. The other structures are the same as those of the delivery device 1D of the second embodiment. The reinforcement portion 921 is provided integrally with the outer tube 9. The reinforcement portion 921 is formed in a tapered shape in a manner that the thickness increases from a local area in the distal direction L1 from the proximal end 92 of the outer tube 9 toward the proximal end 92. As a result of the proximal end 92 of the outer tube 9 having the reinforcement portion 921, it is possible to prevent the outer tube 9 from being bent or deformed longitudinally due to the compressive force generated at the proximal end portion of the outer tube 9 when the stent is indwelled. As a result, smooth operation can be achieved and the operation time can be prevented from being prolonged.

[0088] According to the delivery devices 1 , 1D, 1E, 1F, 1G and the endoscope system 300 of the above-described respective embodiments, the stent S can be positioned with high accuracy at a desired position and placed during stent placement.

[0089] According to the delivery devices 1, 1D, 1E, 1F, and 1G of the embodiments, since the outer cylinder 9 is provided outside the inner cylinder 8 and the shaft member 7 for indwelling the stent S, the rigidity of the portion of the treatment instrument body 10 exposed to the position closer to the forceps mouth 232 is high. As a result, when the inner cylinder 8 is pulled in the proximal direction L2 to indwell the stent S, the straightening of the treatment instrument body 10 can be prevented, and the unexpected advancement of the inner cylinder 8 can be suppressed. In addition, since the adjuster 6 is provided, the relative position of the outer cylinder 9 in the longitudinal direction L with respect to at least one of the inner cylinder 8 and the shaft member 7 can be corrected. In other words, since the adjuster 6 is provided, the compressive force generated in the outer cylinder 9 in the operation of pulling the inner cylinder 8 to indwell the stent S can be corrected. Therefore, the unexpected advancement of the inner cylinder 8 after the distal end of the treatment instrument body 10 is aligned with the indwelling position T1 of the stent S is prevented. In addition, the compressive force applied to the outer cylinder 9 during the pulling operation of the inner cylinder 8 for indwelling the stent S can be eliminated to suppress the change in the path length. As a result, the stent S can be placed at a desired position with high accuracy.

[0090] According to the delivery device 1 of the embodiment, since the regulator 6 is provided between the proximal end 92 of the outer cylinder 9 and the proximal end 72 of the shaft member 7, the relative position of the proximal end 92 of the outer cylinder 9 and the proximal end 72 of the shaft member 7 in the length direction L can be corrected during the pulling operation of the inner cylinder 8. That is, since the regulator 6 is provided, the compressive force generated in the outer cylinder 9 in the operation of pulling the inner cylinder 8 to indwell the stent S can be corrected between the proximal end 92 of the outer cylinder 9 and the proximal end 72 of the shaft member 7. Therefore, the unexpected advancement of the inner cylinder 8 after the distal end of the treatment instrument body 10 is aligned with the indwelling position T1 of the stent S is prevented. In addition, the compressive force applied to the outer cylinder 9 during the pulling operation of the inner cylinder 8 for indwelling the stent S can be eliminated to suppress the change in the path length. As a result, the stent S can be indwelled at a desired position with high accuracy.

[0091] According to the conveying device 1 of the embodiment, since the regulator 6 can be extended and retracted from a reference length in the length direction L of the regulator 6 when the outer tube 9 is in a straight state and unloaded to a correction length shorter than the reference length under the action of external force, the compression force of the outer tube 9 can be corrected in the proximal direction L2.

[0092] According to the delivery device 1 of the embodiment, the proximal end 72 of the shaft member 7 is fixed to the housing 30 provided at a position closer to the proximal end 92 of the outer cylinder 9, the proximal end 82 of the inner cylinder 8 is arranged in the housing 30, and the regulator 6 is provided between the proximal end 92 of the outer cylinder 9 and the proximal end 92 of the shaft member 7. Therefore, when the inner cylinder 8 is pulled, the compressive force generated in the outer cylinder 9 can be corrected near the operation portion 3 by the regulator 6. Therefore, after the distal end of the treatment instrument body 10 is positioned at the indwelling position T1, the change in the path length can be eliminated on the proximal side without changing the position of the distal end of the treatment instrument body 10.

[0093] According to the delivery device 1 of the embodiment, since the regulator 6 is provided between the proximal end 92 of the outer tube 9 and the proximal end of the shaft member 7, the compressive force generated in the outer tube 9 can be corrected on the proximal end 92 side of the outer tube 9 by the regulator 6 when the inner tube 8 is pulled. Therefore, after the distal end of the treatment instrument body 10 is positioned at the indwelling position T1, the change in the path length can be eliminated on the proximal side without changing the position of the distal end of the treatment instrument body 10.

[0094] According to the conveying device 1 of the embodiment, since the adjuster 6 is provided in the housing 30 , the housing 30 can be prevented from being bent due to the pulling operation of the inner tube 8 , and a smooth operation can be performed.

[0095] According to the endoscope system 300 of the embodiment, since the above-described conveying device 1 is provided, the stent S can be positioned with high accuracy to a desired position and placed during stent placement. In addition, the endoscope system 300 having excellent operability can be provided.

[0096] In the above embodiment, an example in which the regulator 6 is a coil spring is shown, but the structure of the regulator is not limited to the coil spring. The regulator 6 may be configured to include an elastic member that can shrink along the length direction L when an external force is applied. For example, the regulator 6 may be configured to include a resin tube having a soft portion with a lower hardness than the outer tube 9 in at least a portion of the length direction L, and connected to the proximal end 92 of the outer tube 9. For example, the structure may also be such that the regulator 6 has a telescopic structure, has a force-applying member that applies force in the extension direction, and shrinks along the length direction L when an external force is applied.

[0097] There is no particular limitation on the materials of the outer tube 9, the inner tube 8, the shaft member 7 and the housing 30 as long as they satisfy the desired mechanical properties. In the case of a transport device used under X-ray fluoroscopy, an X-ray opaque metallic marker (e.g., medical X-ray opaque metals and alloys such as platinum, tungsten, and iridium) or a mixed X-ray opaque material (e.g., barium sulfate, etc.) may be added.

[0098] The first embodiment is described in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the components shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and configured.

[0099] Industrial Applicability

[0100] The present invention can be applied to a delivery device for delivering a medical device into the body.

[0101] Description of Reference Numerals

[0102] 1. 1D, 1E, 1F, 1G, conveying device; 3. operating part (operating mechanism); 4. handle; 6, 6F, 6G, regulator; 7. shaft member; 8. inner cylinder; 9. outer cylinder; 30. shell; 200, endoscope; 230, disposal instrument channel; 300, endoscope system; S, bracket.

Claims

1. A conveying device, wherein: The delivery device comprises: outer cylinder; An inner cylinder, which penetrates through the outer cylinder; A shaft member, which is a flexible and elongated member, passes through the inner tube and can hold the stent between the distal end of the shaft member and the inner tube; an operating mechanism including a housing and performing an operation to relatively move the inner tube with respect to the shaft member in a longitudinal direction; and The adjuster is provided between the proximal end of the outer tube and the proximal end of the shaft member and is capable of correcting a relative position of the outer tube with respect to at least one of the inner tube and the shaft member in the longitudinal direction.

2. The delivery device according to claim 1, wherein: The adjuster is configured to include an elastic member that can be stretched and retracted along the longitudinal direction. The adjuster is extendable and retractable between a reference length of the adjuster in the longitudinal direction when the outer tube is in a straight state and under no load and a correction length shorter than the reference length under an external force.

3. The delivery device according to claim 1, wherein: The adjuster contracts in the longitudinal direction by receiving a proximal force from the outer tube.

4. The delivery device according to claim 1, wherein: The operating mechanism includes a handle provided at the proximal end of the inner tube, and the inner tube is moved forward and backward relative to the shaft member by moving the handle forward and backward in the housing. The proximal end of the shaft member is fixed to the housing.

5. The delivery device according to claim 1, wherein: The regulator is arranged on the housing.

6. The delivery device according to claim 1, wherein: The regulator is arranged between the proximal end of the outer tube and the shell.

7. A conveying device, wherein: The delivery device comprises: outer cylinder; An inner cylinder, which penetrates through the outer cylinder; A shaft member, which is a flexible and elongated member, passes through the inner tube and can hold the stent between the distal end of the shaft member and the inner tube; an operating mechanism including a housing and performing an operation to relatively move the inner tube with respect to the shaft member in a longitudinal direction; and The adjuster is provided between the proximal end of the outer tube and the proximal end of the shaft member, and is capable of correcting the relative position of the proximal end of the outer tube and the proximal end of the shaft member in the longitudinal direction.

8. The delivery device according to claim 7, wherein: The adjuster is configured to include an elastic member that can be stretched and retracted along the longitudinal direction. The adjuster is extendable and retractable between a reference length of the adjuster in the longitudinal direction when the outer tube is in a straight state and under no load and a correction length shorter than the reference length under an external force.

9. The delivery device according to claim 7, wherein: The adjuster is configured to include an elastic member that can be stretched and retracted along the longitudinal direction. The adjuster is extendable and retractable between a reference length of the adjuster in the longitudinal direction when the outer tube is in a straight state and under no load and a correction length shorter than the reference length under an external force.

10. The delivery device according to claim 7, wherein: The adjuster contracts in the longitudinal direction by receiving a proximal force from the outer tube.

11. The delivery device according to claim 7, wherein: The operating mechanism includes a handle provided at the proximal end of the inner tube, and the inner tube is moved forward and backward relative to the shaft member by moving the handle forward and backward in the housing. The proximal end of the shaft member is fixed to the housing.

12. The delivery device according to claim 7, wherein: The regulator is arranged on the housing.

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