US20070123911A1 - Catheter - Google Patents

Abstract

A catheter according to an aspect of the present invention comprises a flexible tubular insert section having, in the outer surface of the distal end side of the insert section, a plurality of notches arranged in the longitudinal direction of the insert section on one side of a plane passing through the longitudinal axis of the insert section, an operating wire passed through the insert section and capable of advancing or retreating to bend the distal end side of the insert section having the notches, and a reinforcing tube put on the insert section to cover substantially the overall length of the whole region of the insert section, except the distal end side of the insert section on which the notches are formed, and to restrain longitudinal compression of the insert section.

Description

CROSS REFERENCE
• The present application is a continuation application of U.S. application Ser. No. 10/095,824 filed on Mar. 14, 2002, which claims priority to Japan Patent Application No. 2001-76166 filed on Mar. 16, 2001 each of which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
• The present invention relates to a catheter adapted to be inserted into a narrow region, such as a duct of a living body, and used to perform medical operations, such as injection of a contrast medium, recovery of foreign substances, extraction of cells, ablation of affected parts, insertion of a guide wire, etc.
• A catheter that is inserted into a duct of a living body or the like, in order to perform medical operations, such as injection of a contrast medium, recovery of foreign substances, extraction of cells, ablation of affected parts, insertion of a guide wire, etc., generally comprises a flexible elongate insert section and an operating section on the hand side. The distal end side of the insert section can be bent so that the distal end of the insert section is directed toward a desired region in the living body. More specifically, the distal end side of the insert section can be bent by pushing or pulling an operating wire, which is fixedly connected to the distal end portion of the insert section, by means of the operating section on the hand side.
• Operation for guiding the catheter into a narrow region deep in the living body is very difficult and requires considerable skill.FIG. 12 shows the way acatheter102 is guided through the channel of anendoscope100 to a region near aduodenal papilla105, and anoperative instrument104 is inserted into abile duct106 through the opening of theduodenal papilla105 by means of thecatheter102 that projects from the channel of theendoscope100. In this operation, theoperative instrument104 that is inserted in a lumen of thecatheter102, cannot be inserted through theduodenal papilla105 into thebile duct106 unless the distal end side of aninsert section102aof thecatheter102 is bent to a given degree in a given direction such that the distal end of theinsert section102acan be exactly directed toward the opening of theduodenal papilla105.
• Conventionally, various attempts have been made to direct the distal end of a catheter toward a desired region of a living body. Described in Jpn. Pat. Appln. KOKAI Publication No. 5-38342, for example, is a technique in which the distal end side of theinsert section102aof thecatheter102 is provided with a plurality ofnotches103 that are eccentric to the axis of theinsert section102aso that it easily bends to the side on which thenotches103 are located, as shown inFIG. 12, whereby theinsert section102 can be readily directed toward the target region.
• If theinsert section102ais provided with thenotches103 that are eccentric to its axis, as described in Jpn. Pat. Appln. KOKAI Publication No. 5-38342, the bending direction of theinsert section102acan no doubt be regulated to some degree. However, this alone cannot be said to be a radical solution.
• In order to guide thecatheter102 to theduodenal papilla105, the flexibleelongate insert section102aof thecatheter102 is first inserted into the channel of the winding insert section of theendoscope100 in the living body, and the distal end side of theinsert section102ais caused to project from the distal end of the insert section of theendoscope100. Thereafter, the projected distal end side of theinsert section102ais bent and directed toward the duodenal papilla. The key factor in this operation is to protrude theinsert section102aof thecatheter102 from the distal end of the insert section of theendoscope100 with that side of theinsert section102afor thenotches103 directed toward the duodenal papilla105 (upper side of the drawing), and thereafter, the distal end side of theinsert section102ais bent to a desired degree without failing to maintain this direction of protrusion.
• However, theinsert section102aof thecatheter102 may be inserted in any direction into the channel of theendoscope100. Thus, if thecatheter102 is oriented when thecatheter102 starts to be inserted into the channel of theendoscope100, thecatheter102 may be redirected by its own rotation or the like in the channel of theendoscope100 as thecatheter102 passes through the channel of theendoscope100 that winds intricately in the living body. Consequently, thecatheter102 may fail to be caused to project from theendoscope100 with that side of theinsert section102afor thenotches103 directed toward theduodenal papilla105, in some cases.
• Even in the case where thecatheter102 can be caused to project from theendoscope100 with that side for thenotches103 directed toward theduodenal papilla105, moreover, the distal end of thecatheter102 cannot be directed successfully toward theduodenal papilla105 unless thecatheter102 is bent without changing the direction of its projection. If the distal end portion of thecatheter102 is provided with thenotches103, in particular, the stiffness of the region with thenotches103 lowers, making it hard to steadily maintain the direction of projection of thecatheter102.
• Since the catheter is elongate and flexible, the catheter inevitably meanders as the distal end side of the insert section of thecatheter102 is bent by pushing or pulling the operating wire. In some cases, therefore, a stroke on the hand side cannot be transmitted successfully to the distal end side, meaning that a desired curvature cannot be obtained. If the distal end side of theinsert section102acannot be bent to a necessary degree, the distal end of thecatheter102 cannot be directed successfully toward theduodenal papilla105.
• Thus, if thecatheter102 cannot be caused to project from the endoscope with the specially providednotches103 directed toward theduodenal papilla105, it is hard to direct the distal end of thecatheter102 toward theduodenal papilla105, in consequence. If thecatheter102 can be caused to project from theendoscope100 with thenotches103 directed toward theduodenal papilla105, moreover, the distal end side of thecatheter102 cannot be bent to a desired degree in a desired direction unless a handling force on the hand side can be efficiently accurately transmitted to the distal end side without failing to maintain the direction of its projection. Thus, the distal end of theinsert section102acannot be directed toward theduodenal papilla105 exactly and speedily.
BRIEF SUMMARY OF THE INVENTION
• Objects of the present invention are to provide catheters that can fulfill at least one of functions (1) to cause an insert section to project in a desired direction from the distal end of an endoscope, (2) to maintain the direction of projection steadily, and (3) to transmit a handling force on the hand side efficiently and accurately to the distal end side, thereby directing the distal end of the insert section toward a desired region of a living body exactly and speedily.
• At least one of the above objects is achieved by a catheter described below. More specifically, a catheter according to an aspect of the present invention comprises: a flexible tubular insert section formed having, in the outer surface of the distal end side of the insert section, a plurality of notches arranged in the longitudinal direction of the insert section on one side of a plane passing through the longitudinal central axis of the insert section; an operating wire passed through the insert section and capable of advancing and retreating to bend the distal end side of the insert section having the notches; a reinforcing tube put on the insert section to cover substantially the overall length of the whole region of the insert section except the distal end side of the insert section on which the notches are formed, and to restrain longitudinal compression of the insert section. Preferably, at least two reinforcing wires defining one plane substantially parallel to the longitudinal axis of the insert section are arranged in the longitudinal direction of the insert section on the one side of the insert section on which the notches are formed.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING
• FIG. 1 is a schematic sectional view of an insert section of a catheter according to one embodiment of the present invention;
• FIG. 2 is a sectional view taken along line2-2 ofFIG. 1;
• FIG. 3 is a sectional view taken along line3-3 ofFIG. 2;
• FIG. 4 is a side view of the insert section ofFIG. 1;
• FIG. 5 is a sectional view of an operating section of the catheter according to the one embodiment of the present invention taken along line5-5 ofFIG. 7;
• FIG. 6 is a sectional view taken along line6-6 ofFIG. 7;
• FIG. 7 is a sectional view taken along line7-7 ofFIG. 5;
• FIG. 8 is a sectional view of the body of an operator that constitutes the operating section;
• FIG. 9 is a sectional view taken along line9-9 ofFIG. 8;
• FIG. 10 is a sectional view taken along line10-10 ofFIG. 8;
• FIG. 11A is a plan view of a tool for forming notches;
• FIG. 11B is a side view of the tool ofFIG. 11A; and
• FIG. 12 is a view showing a conventional catheter made to approach a duodenal papilla.
DETAILED DESCRIPTION OF THE INVENTION
• One embodiment of the present invention will now be described with reference to the drawings.
• FIGS.1 to4 show aninsert section2 of a catheter according to the one embodiment of the present invention. As shown in the drawings, theinsert section2 is formed of a flexible tube (flexible sheath)4 having an elongate soft multi-lumen structure. As is definitely shown inFIG. 2, thetube4 is formed having a large-diameter first lumen (liquid feed passage)3 and small-diameter second tofourth lumens5,7 and9, which extend throughout its length in the longitudinal direction. The central axis of thefirst lumen3 has a given eccentricity to a longitudinal central axis O of thetube4 on one side, while the respective longitudinal central axes of the small-diameter second tofourth lumens5,7 and9 have given eccentricities to the longitudinal central axis O of thetube4 on the other side. More specifically, the respective longitudinal central axes of the second andthird lumens5 and7 have eccentricities to the longitudinal central axis O of thetube4 that are opposite to and substantially equal to the eccentricity S of the longitudinal central axis of thefirst lumen3. Further, the respective central axes of thelumens5 and7 are situated substantially symmetrically with respect to a plane that passes through the longitudinal central axis O of thetube4 and the longitudinal central axis of thefirst lumen3. Furthermore, the longitudinal central axis of thefourth lumen9 is much more eccentric to the longitudinal central axis O of thetube4 than those of the second andthird lumens5 and7 are, and is situated between the second andthird lumens5 and7.
• As shown inFIG. 1, the outer surface of thetube4 on the distal end side is formed having a plurality of notches (slits or portions that are lower in resistance to axial compression than the proximal end side of thetube4 is)10 on the opposite side of the longitudinal central axis O of thetube4 to the first lumen3 (i.e., on the side where the second tofourth lumens5,7 and9 are formed). Thesenotches10 are formed by notching thetube4 in a direction substantially perpendicular to its longitudinal central axis O, and are arranged at given spaces from one another in the longitudinal direction of thetube4. The depth of thenotches10 is adjusted to a dimension such that they completely diametrically cross thefourth lumen9 without reaching thefirst lumen3. Thus, on the distal end side of thetube4, thesenotches10 define a plurality oftubular portions19 that are spaced in the longitudinal direction from one another and intermittently form a part of thefourth lumen9.
• FIGS. 11A and 11B show a tool for forming thenotches10 in thetube4. As shown in the drawings, atool60 has alongitudinal groove61 in which thetube4 is placed and a plurality ofcross grooves62 that cross thegroove61 at right angles to it. The shape of thecross grooves62 corresponding to the shape of thenotches10 to be formed in thetube4. The width of thelongitudinal groove61 is substantially equal to the outside diameter of thetube4. The respective depths of thelongitudinal groove61 and thecross grooves62 are adjusted to dimensions such that the width and depth of thenotches10 to be formed in thetube4 can be obtained when thoseregions4aof thetube4 which are exposed in thecross grooves62, as thetool60 is viewed sideways with thetube4 located in thelongitudinal groove61, are cut, as shown inFIG. 11B. Thus, if theregions4aof thetube4 that are exposed in thecross grooves62 as viewed sideways with thetube4 located in thelongitudinal groove61 are cut along the shape of thecross grooves62, as indicated by arrows inFIG. 11B, thenotches10 can be easily formed in a short time, and the working accuracy can be improved.
• As is clearly shown inFIGS. 1 and 3, adistal end portion11 of thetube4 is tapered, and corresponding to this, the respective distal end portions of the second tofourth lumens5,7 and9 definetaper holes5a,7aand9a. The distal end portion of thefirst lumen3 secures an inside diameter that allows injection of a desired quantity of contrast medium and insertion of a guide wire of a desired size, and forms anopening3a(taper hole5ais not shown).
• Anoperating wire13 for bending the distal end side of thetube4 is movably passed through thefourth lumen9. At least a part of theoperating wire13 is formed of a single wire. The distal end side of theoperating wire13 passes through thetubular portions19, which are defined by thenotches10, and reaches the inside of thetaper hole9a. A part of the distal end side is exposed to the outside through thenotches10. In this case, theoperating wire13 is not situated beyond the outside diameter of thetube4 at least on the distal end side of thetube4 on which thenotches10 are formed. Further, anend tip21 having tapered step portions is fixed to the distal end of theoperating wire13. Theend tip21 is composed of a plurality of cylindrical portions having a profile substantially in the shape of a frustum (or having the form of a bamboo shoot) and connected in the longitudinal direction. Theend tip21 and theoperating wire13 are fixed to each other in a manner such that the distal end of theoperating wire13 is plasma-welded to the distal end of theend tip21 with the distal end portion of theoperating wire13 passed through the bore of theend tip21.
• The respective edge portions (corner portions) of the tapered step portions of theend tip21 bite the inner surface of thetube4 that forms thefourth lumen9, or more specifically, the inner surface of thetaper hole9a, whereby theoperating wire13 is fixed to the distal end of thetube4 by means of theend tip21. Thus, if theoperating wire13 is pushed out toward the distal end side in thefourth lumen9, the distal end side of thetube4 bends in the DOWN direction shown inFIG. 1. If theoperating wire13 is pulled toward the hand side (proximal end side) in thefourth lumen9, on the other hand, the distal end side of thetube4 bends in the UP direction shown inFIG. 1. In order to reconfirm the fixation of theoperating wire13 to thetube4, theoperating wire13 may be fixedly bonded to thetube4 with an adhesive agent applied to, for example, the leadingnotch10 through which theoperating wire13 is exposed.
• Reinforcing wires (hereinafter referred to as stabilizers)29 are passed through the second andthird lumens5 and7, individually. The twostabilizers29 define one plane P (seeFIG. 2) that is parallel to the longitudinal central axis O of the tube4 (also parallel to abase17 of eachnotch10 according to the present embodiment). This plane P determines the direction of thenotches10 when thetube4 is introduced into a living body or a channel of an endoscope. Thus, thestabilizers29 serve to stabilize the passing and bending operations for thetube4 in the rotating direction. The respective proximal ends of thestabilizers29 are fixed to an operating section40 (mentioned later) of the catheter.
• Further, a reinforcingtube24 formed of a heat-shrinkable tube is put on the outer peripheral surface of thetube4, substantially covering the overall length of theinsert section2 except the distal end side on which thenotches10 are formed. During the bending operation for thetube4 by means of theoperating wire13, the reinforcingtube24 restrains longitudinal compression of thetube4, thereby preventing thetube4 from meandering.
• As shown inFIGS. 1 and 4, moreover, the distal end portion of thetube4 is provided with a plurality ofmarkings25 that are spaced in the longitudinal direction from one another. Thesemarkings25 can show the depth of insertion of thetube4 in a duodenal papilla. As shown inFIG. 3, moreover, the distal end of thetube4 is provided with an X-ray-impermeable tip27 that indicates the position of the distal end of thetube4.
• FIGS.5 to10 show the operating section (operator)40 of the catheter according to the present invention. As shown inFIG. 5, the operatingsection40 is composed of a connectingportion40A, which is connected to theinsert section2, and anintroducer40B and an operator40C that are separately connected to the proximal end of the connectingportion40A. Theintroducer40B is formed of atubular body43, and is used to introduce the contrast medium, guide wire, etc. Further, the operator40C is formed of connectingpipe portion32 and anoperator body70, and is used to advance and retreat theoperating wire13.
• The operatingsection40 and theinsert section2 constructed in this manner can be connected by fixedly pressing theinsert section2 into astraight portion31aof atube body31 that forms the connectingportion40A. In this case, the reinforcingtube24 of theinsert section2 extends close to the proximal end portion of thestraight portion31aof thetube body31. Further, thetube4 of theinsert section2 extends from the inside of thestraight portion31aof thetube body31 into the connectingpipe portion32 of the operator40C through asecond branch portion31c, and terminates in the middle of the connectingpipe portion32. In this case, theoperating wire13 that is passed through thefourth lumen9 of thetube4 extends beyond the proximal end of thetube4 into the connectingpipe portion32, and is connected to a slider51 (seeFIG. 8, mentioned later) of theoperator body70. Further, thestabilizers29 that are passed through the second andthird lumens5 and7 of thetube4 are caused to project from the proximal end of thetube4 and turned back toward the distal end side in the connectingpipe portion32. Thereafter, thestabilizers29 are inserted into thefirst lumen3 and fixed in the first lumen3 (FIGS. 6 and 7).
• As shown inFIG. 5, atube39 extends from the distal end of thebody43 of theintroducer40B. Thetube39 extends through afirst branch portion31bof thetube body31 of the connectingportion40A, penetrates the side wall of thetube4 of theinsert section2, and is pressed into thefirst lumen3 of thetube4. Further, amouthpiece44 to which a syringe for injecting the contrast medium or the like is connected is formed integrally on the flank of thebody43. In this case, the bore of themouthpiece44 communicates with thefirst lumen3 of theinsert section2 by means of the respective bores of thebody43 and thetube39. If the contrast medium is injected through themouthpiece44, therefore, the contrast medium can be guided into the first lumen3 (and therefore, the contrast medium can be introduced into the living body through the end opening3aof the first lumen3).
• Further, a guidewire inlet cylinder45 is screwed into the basal part of themouthpiece44. In this case, a ring-shapedelastic member49 is interposed between theinlet cylinder45 and themouthpiece44, and the bore of theinlet cylinder45 communicates with the bore of themouthpiece44 by means of the bore of theelastic member49. If theinlet cylinder45 is screwed into themouthpiece44, moreover, theelastic member49 is crushed and elastically deformed so that the bore of theelastic member49 is reduced in diameter. Accordingly, the guide wire that is inserted into theinlet cylinder45 through anopening45aof theinlet cylinder45 is introduced into thefirst lumen3 through the respective bores of theelastic member49 and thebody43, and can project from the end opening3aof thefirst lumen3. If theinlet cylinder45 is screwed into thebody43 to reduce the diameter of theelastic member49 as this is done, moreover, no clearance is formed between theelastic member49 and the guide wire that penetrates it. Thus, watertightness can be secured as the contrast medium is injected with use of the guide wire. In the case where the guide wire is not used, watertightness can be also secured by screwing theinlet cylinder45 into themouthpiece44 in a like manner.
• FIGS.8 to10 show a detailed configuration of theoperator body70. As shown inFIG. 8, theoperator body70 is composed mainly of abody member50 and theslider51 that can advance and retreat in the longitudinal direction of thebody member50. Theslider51 is provided with two finger hooks51aand51b. Further, theslider51 is fitted with awire fixing pin53 that projects into thebody member50. Thiswire fixing pin53 is fixedly connected to the proximal end portion of theoperating wire13 that extends from the inside of the connectingpipe portion32 into thebody member50.
• As is evident fromFIG. 9, aguide hole50afor guiding theslider51 in movement is formed extending in the longitudinal direction in thebody member50. Further, thewire fixing pin53 that is integral with theslider51 can also advance and retreat along theguide hole50a. Furthermore, the outer peripheral surface of thewire fixing pin53 is covered with atube52 that is in sliding contact with the inner surface of theguide hole50awith a given coefficient of friction so that thewire fixing pin53 can slide with the given coefficient of friction with respect to thebody member50, and more specifically, that the moved position of the wire fixing pin53 (and therefore, of the slider51) is maintained with thetube4 bent, whereby the bent state of thetube4 can be maintained.
• In order to regulate the retreat of theslider51 to restrict the curvature of thetube4, moreover, thebody member50 is provided with astopper pin54 that extends across theguide hole50aand can abut against the slider51 (seeFIG. 10).
• If theslider51 is manually advanced or retreated, according to this configuration, therefore, theoperating wire13 is pushed or pulled, and the distal end side of thetube4 is bent in the UP or DOWN direction within a given range that is determined by means of thestopper pin54. If theslider51 is unhanded, theslider51 is held as it is, and the bent state of thetube4 can be maintained.
• The following is a brief description of the way the catheter with the aforementioned configuration is endoscopically guided to, for example, a duodenal papilla.
• As in the case shown inFIG. 12, the insert section of the endoscope is first inserted into a region near the duodenal papilla, and theinsert section2 of the catheter according to the present embodiment is then inserted into the channel of the insert section of the endoscope. In inserting theinsert section2 of the catheter into the channel of the endoscope, theinsert section2 is oriented (in the rotating direction) in advance so that theinsert section2 projects from the distal end of the insert section of the endoscope with thenotches10 directed toward the duodenal papilla. Thus, if theinsert section2 of the catheter of the present embodiment is previously oriented when it is inserted into the channel of the endoscope, there is no possibility of theinsert section2 being redirected by its own rotation or the like as theinsert section2 passes thereafter through the channel of the endoscope even though the insert section of the endoscope winds intricately in the living body. The reason is that theinsert section2 of the catheter of the present embodiment is provided with the twostabilizers29 that define the one plane P parallel to the longitudinal central axis O of the insert section2 (tube4), and that the plane P determines the direction of thenotches10 when theinsert section2 is introduced into the channel of the endoscope. In consequence, therefore, theinsert section2 can be caused to project from the distal end of the endoscope with the side of theinsert section2 for thenotches10 directed toward the duodenal papilla.
• After the distal end side of theinsert section2 of the catheter is thus caused to project from the insert section of the endoscope with thenotches10 directed toward the duodenal papilla, the distal end side of the projected insert section12 is bent and directed toward the duodenal papilla. If the distal end side of theinsert section2 is bent by pulling theslider51 of theoperating section40 to the hand side, the distal end of theinsert section2 can be directed successfully toward the duodenal papilla. In this case, the bending operation of theinsert section2 can also be stabilized in the rotation direction by means of the twostabilizers29.
• During this bending operation, moreover, there is no possibility of thetube4 meandering owing to the flexibility of theelongate tube4. This is because the reinforcingtube24 that is formed of a heat-shrinkable tube is put on the outer peripheral surface of thetube4, substantially covering the overall length of theinsert section2 except the distal end side on which thenotches10 are formed, according to the present embodiment. During the bending operation of thetube4 by means of theoperating wire13, the reinforcingtube24 prevents meandering of thetube4 by restraining its compression, so that a handling force for theslider51 on the hand side can be efficiently accurately transmitted to the distal end side. Thus, the distal end side of theinsert section2 can be bent to a desired degree, so that the distal end of theinsert section2 can be directed toward the duodenal papilla exactly and speedily.
• During this bending operation, moreover, the stiffness of the distal end side of thetube4 is lowered by thenotches10, so that the distal end side can be bent with ease. Accordingly, a desired curvature can be obtained with use of a small handling force, and the eccentric form of thenotches10 can somewhat regulate the bending direction of the insert section2 (the side with thenotches10 is easily bendable).
• In the catheter of the present embodiment, which is thus used in combination with the endoscope, the overall length of thetube4 is about 500 mm greater than the length of the channel of the endoscope. In the case of the present embodiment, therefore, the bent portion of thetube4 in which thenotches10 are formed must be formed extending for a range of 500 mm from the distal end of thetube4 to the proximal end side.
• In the catheter of the present embodiment, as described above, thenotches10 are provided on the distal end side of thetube4, and further, theinsert section2 can be caused to project from the endoscope with thenotches10 directed toward the duodenal papilla by the agency of thestabilizers29, and the handling force on the hand side can be efficiently accurately transmitted to the distal end side by means of the reinforcingtube24 that cooperates with thestabilizers29, without failing to maintain the direction of projection steadily. Thus, the distal end side of theinsert section2 can be bent to a desired degree in a desired direction, so that the distal end of theinsert section2 can be directed toward the duodenal papilla exactly and speedily.
• If theslider51 in the catheter of the present embodiment is unhanded, moreover, theslider51 is held as it is, and the bent state of thetube4 can be maintained, so that theslider51 need not be held down to maintain the bent state. Thus, other treatments and operations, such as the manipulation of the guide wire, injection of the contrast medium, etc., can be concentrated on.
• Although the present embodiment has been described for the case where the catheter is made to approach the duodenal papilla, it is to be understood that the catheter of the present embodiment can be caused to approach various regions of a living body as well as the duodenal papilla with the same functions and effects as aforesaid. Although the twostabilizers29 are used in the present embodiment, moreover, three or more stabilizers may be used as long as they can define the one plane P.
• According to the catheter of the present invention, as described above, the insert section can be caused to project in a desired direction from the distal end of the endoscope, and the direction of its projection can be maintained steadily. Further, the handling force on the hand side can be efficiently and accurately transmitted to the distal end side, so that the distal end of the insert section can be directed toward a desired region of a living body exactly and speedily.

Claims (8)

1. A catheter comprising:

a flexible tubular insert section having a longitudinal central axis defining a first imaginary plane dividing the insert section into first and second regions on both sides thereof, the insert section having a distal end portion;

an operating wire provided in the first region to extend in the longitudinal central axis of the insert section and capable of advancing or retreating to bend the distal end portion of said insert section; and

at least two reinforcing wires provided in the first region, extending along the longitudinal central axis,

the flexible tubular insert section including at least one lumen extending along the longitudinal central axis, the lumen having an opening formed in the distal end portion and a central axis parallel to the longitudinal central axis of the tubular insertion section, and allowing fluid and/or a medical instrument to pass through the lumen and project from the opening,

wherein a second imaginary plane passing the central axis of the lumen and the operating wire is positioned between the reinforcing wires.

2. A catheter according toclaim 1, further comprising a reinforcing tube which covers the insert section except the distal end portion.

3. A catheter according toclaim 1, wherein the central axis of the lumen is positioned in the second region of the insert section.

4. A catheter comprising:

a flexible tubular insert section having a longitudinal central axis defining a first imaginary plane dividing the insertion section into first and second regions on both sides thereof, the insert section having a distal end portion;

an operating wire provided in the first region to extend in the longitudinal central axis of the insert section and capable of advancing or a retreating to bend the distal end of the insert section at a bend portion; and

at least two reinforcing wires provided in the first region, extending along the longitudinal central axis,

the flexible tubular insert section including at least one lumen extending along the longitudinal central axis, the lumen having an opening formed in the distal end portion and a central axis parallel to the longitudinal central axis of the tubular insertion section, and allowing fluid and/or a medical instrument to pass through the lumen and project from the opening,

wherein an imaginary straight line passing a central point of a cross section of the bend portion normal to the longitudinal central axis, the insert section and a longitudinal central axis of the operating wire is extended between the reinforcing wires to cross a line passing the reinforcing wires.

5. A catheter according toclaim 4, wherein the operating wire and lumen are positioned to sandwich an imaginary straight line at least in a region of the bend portion, the imaginary straight line passing two reinforcing wires.

6. A catheter according toclaim 3, wherein a third imaginary plane passing two reinforcing wires divides the insertion section into both elongated areas, and the operating wire and lumen are respectively positioned in the areas to sandwich the third imaginary plane.

7. A catheter according toclaim 3, wherein a distance between one reinforcing wire and the operating wire equals a distance between the other reinforcing wire and the operating wire.

8. A catheter according toclaim 7, wherein a distance between one reinforcing wire and an elongated central axis of the lumen equals a distance between the other reinforcing wire and the elongated central axis of the lumen.

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