DE3107392A1 - Medical instrument - Google Patents

Description

Applicant; Stuttgart, February 7th, 1981

Willy Rüsch GmbH & Co. KG P 3997

7053 cores

Representative;

Koehler - Sehwindling - Späth

Patent attorneys

Hohentwielstrasse 41

7OOO Stuttgart 1

Medical instrument

The invention relates to a medical instrument for insertion into physiological channels such as ureters, bile ducts, arteries, veins, bronchi, trachea and esophagus and the like is arranged displaceably
or is insertable.

Medical instruments of this type are used for the most varied of purposes and are accordingly known in different embodiments. For example, vascular catheters are used to remove or supply liquids or gases into or out of the physiological channels mentioned at the beginning. A known instrument (DE-PS 28 2Λ 048) has not since been used as a catheter, but is used to remove bodies from physiological channels that have formed or established there, such as kidney, ureter or gallstones, emboli and from Thrombi. For this purpose, the known medical instrument has a basket-shaped element in its insertion-side end region which assumes the shape of a mesh tube for insertion and can then be expanded into a cup shape by an adjusting element. This known instrument is inserted into the physiological canal and pushed past the body to be removed with its inner end. The expandable element is then spread into a cup shape, for which purpose an adjusting element in the form of a wire, which is guided displaceably through the tubular instrument, is used, the end of which is attached to the insertion-side end region of the expandable mesh tube section. The body caught in the cup can then be removed.

The removal of such bodies is, for example, at Kidney or gallstones are often impaired or made impossible by the fact that the physiological canal is affected the tissues that form become cramped. However, it is not possible to supply an antispasmodic because the affected area is inaccessible and another instrument is not available cannot be introduced, for example when extracting gallstones, kidney stones or ureteral stones. Even

in the case of embolus or thrombus extraction, whereby the space available Because of the narrowness of the veins and arteries, the introduction of a dissolving agent is often more difficult By means (such as heparin, streptokinase, etc.) desirable, but not possible. It is also in some In some cases it is desirable to smooth the surface of the canal roughened and damaged by the extraction.

It is an object of the present invention to provide the known to improve medical instruments so that they can be used more versatile or their use in certain cases can be carried out with improved possibilities.

This object is achieved in a medical instrument of the type mentioned according to the invention in that the mandrin is hollow and provided at its applicator-side end with a connection for passing a gas or liquid and at its insertion-side end with a passage opening, and that a corresponding one Eye and / or a central opening is incorporated into the instrument end on the insertion side.

The design of the medical instrument according to the invention opens up completely new possibilities. This is because it can practically be an additional instrument without increasing the external diameter of the instrument Lumen are housed in the instrument, which is used to supply or discharge gases or liquids can also be used to fill a balloon attached to the instrument. This has not resulted since then realizable advantages, as will be explained below in connection with embodiments of the invention will.

In a preferred embodiment of the invention the through-opening is arranged on the end face of the stylet end and an opening is arranged on the end face of the instrument. For example, a conventional thrombus or gallstone extractor can be converted, its only one Lumen has since been used to fill a balloon attached to the instrument end on the insertion side. Through the hollow stylet and the additional opening at the front end of the Instrument, a second lumen is provided through which, for example, an antispasmodic or a thrombo-dissolving agent can be suppliedThis makes the treatment of the patient more successful, perform faster and more reliably.

In another embodiment of the invention, the JThrough opening on the lateral surface of the stylet end and there is at least one eye on the surface of the instrument arranged. This enables, which is desirable in certain applications, a supply or discharge of gas or liquid at a distance from the instrument tip with a direction of flow radial to the instrument.

In a known instrument with at least one Spreading member, which can be spread by an adjusting element which can be displaced longitudinally in the interior of the instrument, is shown in FIG In a preferred embodiment of the invention, the hollow stylet is used as an adjusting element. The spreader consists, as already mentioned, of a fabric tube section that extends through the control element a cup shape can be expanded. This instrument has compared to the instruments in which an expandable Element in the form of a balloon is provided, the advantage that even sharp-edged and not so easily

Removable bodies, such as gallstones or kidney stones, can be removed because of the risk of the removal Body wedged between the instrument, balloon and inner surface of the physiological canal, through the cup fona is greatly reduced. Through training of the adjusting element as a hollow stylet, it is possible to use antispasmodic or anesthetic agents apply. The instrument can even be provided with an inflatable balloon that is at least covering one eye of the instrument on that

The instrument is attached . This balloon can through the

Through the stylet. If this balloon is, for example, on the instrument in addition to the spreader member provided, it is possible to facilitate the extraction by the fact that the balloon is in front of the withdrawal movement is arranged in the basket that carries the body and for. Stretching the physiological canal is used to To facilitate removal of the instrument with the basket. Or it's the balloon on the opposite Side of the basket attached to the end of the instrument and serves to reduce the roughening or damage caused by the body to be extracted and the basket the surface of the physiological canal to smooth out.

In some cases it is necessary that the Mandrin formed lumen is sealed against the lumen formed by the instrument itself. To ensure this In preferred embodiments of the invention, the instrument is in its insertion-side end region provided with a seal for the inner stylet end area. For example, the instrument a constriction with conical access in this area

against which the face of the stylet rests in a sealing manner. Or the inner surface of the constriction serves as a seal in such a way that it rests tightly against the surface of the mandrel pushed through. The seal is easiest to achieve if the stylet end is fixed and covered at the same time by means of an adhesive layer surrounding it in a ring shape.

Further details and refinements of the present invention will then be described with reference to some in FIG Drawing illustrated embodiments explained and described in more detail. It show in simplified and strong Schematic representation omitting details not necessary for understanding the invention:

Fig. 1 is a view of a medical instrument with a double expanded spreader member, shown in a spread position,

Fig. 2 shows another embodiment of the instrument with a double spreader member and an additional one Balloon, '.

3 shows an instrument with a simple spreader and an additional balloon,

Fig. 4 · an instrument with a double spreader and additional balloon in the area of one eye and

Fig. 5 shows a balloon catheter.

6 shows an enlarged section,

7 shows an enlarged longitudinal section through the area of a connection, and FIG

8 shows an instrument with a spreader and balloon.

The one in the Pig. 1 to 4 illustrated instruments are based on a medical instrument known from DE-PS 28 21 048. This instrument comprises a flexible tube 1, which is preferably made of plastic and whose diameter can be down to less than 2 mm, so that it can also be designed as a blood vessel catheter. Depending on the application, the diameter can be selected to be as large as desired, because there are no difficulties in terms of production technology. At the applicator-side end of the tube 1 a plunger plate 2 is provided which comprises a sleeve with a radially screwable screw, by means of which a wire-shaped tube 4 guided through the sleeve can be clamped. The tube 4 can consist of a stiff, flexible plastic or also of steel, copper or the like. It must be designed so that it withstands the possible and necessary bends to which the pipe 1 can be subjected. At the free end of the tube 4, a connection 5 is attached, which is used for the tight and firm attachment of a conveyor, for example a syringe. For this purpose, the connection 5 can be designed as a commercially available Luer-Lok connection. The tube 4 serves as a hollow stylet. In the case of the instruments according to FIGS. 1 to 4, the insertable end of the tube facing away from the connection 5 is fastened to the end of the tube 1 on the insertion side. The tube 1 is interrupted in a known manner in the areas in which there are spreading members & which are initially formed as net tube sections and which can be expanded to a cup shape. By pulling out the tube 4, the expansion members 6 are expanded from the tubular shape to the cup shape, in that the insertion-side end of the tube 1 is moved in the direction of the locking device 2 by pulling on the tube. According to Fig. 1, the insertion end of the tube 1 is closed and it has both the tube: 1 and the tube 4 in the area of a section Λ ^{1 of} the tube 1, which is between the two expansion

/ 10.

subdivide 6 is located, each with a transverse bore, optionally in the form of an eye 7>. The tube 4 is sealed in the lumen of the section 1 'in order to ensure that gas or liquid can only be supplied or removed through the eye 7 of the section 1'. If it is not important that the upstream or downstream take place exclusively through the eye, these seals in section 1 'can also be dispensed with. In general, a seal is provided for the tube 4- in the tube Λ , for example in the area of the plague plate 2. The tube 1 can have transverse bores or eyes 7 below, above and between the expansion members 6 or at the same time at all three points, preferably for Discharge of rinsing fluid, body excretions and body secretions serve. Or it can be through a syringe connected to connector 5, regardless of whether the. Spreading members 6 are widened or stretched, a liquid, for example an antispasmodic, can be supplied, which exits through the transverse bore made laterally in the tube 4 and further through the eye 7 in the section V of the tube 1. This can make it easier to remove a gallstone or kidney stone.

In the instrument shown in FIG. 2, the tube serving as a mandrin is 4 to the end of the tube 1 carried out and tightly fastened here. The tube 1 has an end opening 8 at its inlet end,. through which a connection to the tube 4, which also has an opening at the end, is created. Here too liquid or gas can be supplied or discharged. In the embodiment according to FIG. 2, preference is given to the The front opening 8 is covered by a balloon 9 which is fastened tightly to the outer surface of the tube 1 in a region 10 is. The balloon 9 can be filled or filled as desired through the hollow mandrin in the form of the tube 4

be emptied. For example, when extracting a stone, it is possible to remove the possibly roughened, to smooth the furrowed surface of the vessel gently and gently.

However, the instrument according to the illustration in FIG. 5 can also be provided with only one spreading member 6 and a balloon 9 ′ can be provided on the side of the spreading member 6 facing the locking device 2. In this case, the tube 4 again has a lateral outlet opening at a distance from its front end and the tube 1 is provided with an eye 7 ¹ . The tube is also sealed in the lumen of the tube 1 above and below the eye 7 (16; 17).

In the embodiments described above, the lumen of the tube 1 serves only as a receptacle and guide for the tube 4, but is not used as a line for supplying or removing gases or liquids. at the instruments explained above is therefore either a balloon or an outwardly free eye 7 or a Uncovered front opening 8 is provided. However, it may also be desirable to have both a free eye 7 and to have a balloon available. In such an embodiment shown in Fig. 4, the lumen of the Tube 1 is not only used as a receptacle and guide for the tube 4, but it also serves as a separate line from it, so it offers an additional channel. As a result, without the outer diameter of the pipe 1 needs to be enlarged, a two-lumen instrument is created. One lumen is formed by the tube 4 and can be used via connection 5. The lumen of the tube 1 goes into a short, flexible hose section near the applicator-side end of the instrument

about, at the free end of a terminal 13 is attached. The lumen of the tube 1 connected to the hose section 12 leads, for example, to the eye 7'j which is arranged inside a balloon 9 ¹ . ^{The balloon 9 1} can therefore be filled and deflated through the connection 15. It goes without saying that the lumen of the tube 1 is sealed in the tube 1 both in the area of the locking device 2 and in an area beyond the eye 7 '. The tube 4 with the connection 5, on the other hand, is either connected to an eye 7 via its transverse bore, as is the case with the instrument according to FIG but is not covered by any balloon 9. In the instrument according to FIG. 4, a balloon 9 covering the forehead opening 8 could also be provided instead of the balloon 9 ', in which case the eye 7' could be omitted and the eye 7 would instead be connected to the lumen of the tube 1 which is connected to the hose section 12 ifr. Connection. The aforementioned seal 16 or 17 is provided on both sides of the eye 7 or 7 ', which is intended to be connected to the lumen of the tube 4 through the transverse bore 14. In this case the tube 4 with the eye 7 or the front opening must in the instrument of FIG. ^ Be connected 8, because when the lumen of the Rohrchens 4 would be connected to the eye 7 ^1, by the required sealing, the connection from terminal 13 to Eye 7 would be interrupted. Such a seal is shown schematically in FIG. 6; it fills, as shown in FIG. 6, the annular space between the. Tube 1 and the tube, but allows, as far as this is necessary, a longitudinal displacement of the tube 4 relative to the tube 1. There is a defined connection from the outside through this seal provided on both sides of an eye 7

through the eye 7 and through the transverse bore 14 into the Iiumen of the tube 4.

In Fig. 7 is a longitudinal section through a .Anschlussstück shown as it is customary in the trade. This practically comprises a pipe section 11, which then subsequently merges into tube 1. The tube section 12, which is connected to the tube section 11, opens into this tube section 11 is made in one piece and comprises a longitudinal bore 15, which is led to the connection 13. Within

/ -ν of the lumen of the tube section 11 is the tube 4, which is sealed and fixed in the pipe section 11, for example by means of a simultaneously as a seal 16 serving annular adhesive layer, the for example from a liquid applied and hardening to a rubber-elastic mass synthetic resin, for example a silicone rubber. The tube can be fixed in the seal 16 or in the you · ^ Device 17 be guided longitudinally, depending on whether the Tube 4 is used to spread a spreading member 6 or, as in the case of an instrument according to FIG an additional lumen is used. In the latter case, an O-ring serves as a seal 17, for example

- ^/ " ^{v can} optionally be fixed against longitudinal displacement on the inner surface of the tube 1 or the outer surface of the tube 4. It goes without saying that the same type of seal, 16 or 17, is provided on both sides of an eye 7 or 7 '.

The use of a hollow stylet in the shape of a tube 4 with a connection 5 is by no means restricted to instruments which are provided with an expansion member are. The instrument according to FIG. 5 again consists

au .; a tube 1, the lumen receiving the tube 4 and also being connected to the tube section 12 and the connection ^A o . A locking device can be absent or provided to fix the position of the tube 4 serving as a hollow mandrin relative to the tube 1, unless the tube 4 is attached anyway or additionally to the insertion end of the tube 1. The tube 4 opens into an end opening 8, whereas the lumen of the tube 1, which is connected to the tube section 12, is led to an eye 7 ″, which is covered by a balloon 9 ¹ , the two end regions 10 'of which are close to the Tube 1 is fastened, for example glued or vulcanized on. The end of the tube 4 is preferably glued into the end of the tube 1 on the insertion side.

In the instrument shown in Fig. 8 is im Applicator-side end area a locking device -2 is provided with a screw 3, which is used to set the serving as a stylet tube 4, which is in the lumen of the tube 1 is displaceable. The insertion end of the tube 4 is fastened in the end region 10 ' and sealed, the lumen of the tube 4 jmit communicates with the forehead opening 8, that is to say is in communication with the forehead opening 8. The import side The end is covered in the area of the forehead opening 8 by the balloon 9, the portion forming the area 10 ' of the tube 1 is tightly fastened in a known manner. One eye 7 is on the one facing away from the balloon 9 Side of the expansion member 6 incorporated into the tube 1 and is in communication with its lumen. The tube

chen 4- is both between the eye 7 and the spreading member 6 as well as between the mouth of the hose section 12 and the locking device 2 or in the locking device 2 sealed with seals (not shown), which can be designed, for example, in accordance with the seal of FIG. 6 and which despite the seal Allow a displacement of the tube 4- relative to the tube 1.

The instrument according to FIG. 8 is used to remove emboli. For this purpose, the instrument is inserted into the physiological canal blocked by the embolus with the balloon 9 resting on the end region 10 'of the tube 1 and the unspread, i.e. tubular section-shaped expansion member 6, and pushed through the embolus or past it until it is the embolus is located between the unspread spreading member 6 and the end of the instrument on the applicator side, preferably in the area of the eye 7. A dissolving fluid such as heparin is now supplied through the connection 13 and the hose section 12, which dissolves the embolus or at least dissolves it superficially. This dissolving liquid flows through the lumen of the tube 1 and Γ exits through the eye 7. Subsequently, the expansion member 6 is then expanded into a cup shape by pulling out the tube 4 - and the balloon 9 is then filled through the tube 4 (state shown in FIG. 1). The embolus, which is caught in the basket-shaped spreader 6, can now be removed by pulling out the instrument, with the filled elastic balloon 9 smoothing the surface of the canal wall of the physiological canal at the same time. This smoothing counteracts the formation of new emboli (and thrombi).

It is essential for all illustrated embodiments that by using a hollow stylet in Shape of the Röhx'chens ^ t- an additional channel created is used to supply or discharge gases or 'liquids, for example sucking off blood or adding stone or antispasmodic agents as well such as the intake of thrombolytic agents such as streptokinase can serve. Despite this additional channel, the outside diameter of the instrument does not need to be increased which in many applications, such as the removal of bodies from physiological channels, is of great importance, although a hollow stylet is possible without difficulty and advantageously even with catheters or tubes of any larger diameter.

It goes without saying that the invention is not limited to the exemplary embodiments shown, but rather Deviations from this are possible without departing from the scope of the invention. In particular, some of the Features of the invention can be used alone or in combination with several.

Claims (7)

Claims Medical instrument for insertion into physiological channels such as ureters, bile ducts, arteries, Veins, bronchi, trachea and esophagus and the like., With a flexible, to be introduced into the relevant channel ^ - the tube with at least one lumen in which a stylet is arranged to be longitudinally displaceable or can be inserted, characterized in that the mandrin (4) is hollow and is provided at its applicator-side end with a connection (5) for the passage of a gas or a liquid and at its insertion-side end with a through opening, and that a corresponding eye (7, 7 ¹ ) and / or a central opening (8) is arranged on the instrument end on the insertion side. 2. Medical instrument according to claim 1, characterized in that that the through opening on the end face of the stylet end and the central opening (8) on the Front end of the instrument is arranged. 3. Medical instrument according to claim 1 or 2, characterized in that at least one through opening or transverse bore (14) on the lateral surface of the The stylet and at least one eye connected to it (7s 7 ') are incorporated into the surface of the instrument. 4. Medical instrument according to one of claims 1 to 3, with at least one spreader member, which is longitudinally displaceable by a inside the instrument Adjusting element is expandable, characterized in that that the hollow stylet (4) is used as an adjusting element is. 5. Medical instrument according to one of the preceding claims, characterized in that a inflatable balloon (9 or 9 ¹ ) is attached to the instrument so as to cover at least one eye (7 ¹ ) or the central opening (8) of the instrument. 6. Medical instrument according to one of the preceding claims, characterized in that in its insertion-side end area seals in each case before and after a transverse bore (14-) or eye (7 or 7 ¹ ) between the mandrin (4) and the tube (1 ) are provided. 7. Medical instrument according to one of claims to 6, with a locking device provided on the applicator-side end, characterized in that in or on the locking device (2) a seal (17) permitting displacement of the stylet is hollow and serving as an adjusting element Stylet (4) is provided.