JP4495492B2 - Endoscopic treatment tool for endoscope - Google Patents

Description

  The present invention relates to an endoscopic projection type treatment tool that is used by being passed through a treatment tool insertion channel of an endoscope.

There are a huge variety of endoscopic treatment tools, but a distal treatment piece that protrudes forward and backward from the distal end of the flexible sheath is inserted and disposed in the flexible sheath so as to be movable forward and backward in the axial direction. Endoscopic treatment tools for endoscopes connected to the tip of an operation wire are widely used as high-frequency incisions (for example, Patent Document 1).
JP-A-8-299355

  However, in the structure in which the distal treatment piece is simply connected to the distal end of the operation wire as described above, the distal treatment piece is protruded to the maximum from the distal end of the flexible sheath, or is maximum in the distal end of the flexible sheath. Except for the state where it is pulled to the limit, the protrusion length of the distal treatment piece from the distal end of the flexible sheath is unstable, so it is difficult to maintain a constant protrusion length during use, and appropriate measures should be taken. There were cases where it could not be performed accurately.

  Also, if the tip treatment piece is pressed against the mucosal surface, the tip treatment piece easily rotates around the axis at the tip of the flexible sheath. There were many cases where I could not.

  In view of this, the present invention makes it possible to arbitrarily adjust and hold the protruding length of the distal treatment piece from the distal end of the flexible sheath, and also to arbitrarily adjust and hold the rotational direction around the axis. An object of the present invention is to provide an endoscopic protrusion-type treatment tool that can easily perform an appropriate and accurate endoscopic treatment as desired by an operator.

  In order to achieve the above object, the projecting type treatment instrument for an endoscope of the present invention is provided with a distal treatment piece projecting forward from the distal end of the flexible sheath, and is provided in the flexible sheath. In a projecting type treatment instrument for an endoscope in which a distal treatment piece is connected to the distal end of an operation wire that is inserted and removably moved in the axial direction, at least a portion near the distal end of the flexible sheath is formed of a flexible tube. In addition, a wide portion is formed in the vicinity of the base portion of the distal treatment piece, which is formed in a shape extending from the distal treatment piece in the radial direction of the flexible tube and pushes the flexible tube in the radial direction.

  In addition, it is preferable that the operation wire and the flexible sheath can be rotated around the axis relative to the proximal end side. In this case, the distal end portion of the operation wire is the center line of the width of the wide portion of the distal treatment piece. It is good to arrange on the extension line.

  The distal treatment piece may be formed in an elongated rod shape having a flat cross-sectional shape, or may be formed in a spatula shape in which the distal end portion of the elongated rod having a flat cross-sectional shape is formed wide.

  According to the present invention, at least a portion near the distal end of the flexible sheath is formed of the flexible tube, and the flexible tube is formed in a shape extending from the distal treatment piece in the radial direction of the flexible tube. By forming the wide part that spreads in the direction near the base of the distal treatment piece, the length of the arbitrarily adjusted distal treatment piece from the distal end of the flexible sheath can be stably held, Since the rotation direction around the arbitrarily adjusted axis can be stably held, an appropriate and accurate endoscopic treatment as desired by the operator can be easily performed.

  A distal treatment piece projecting forward and backward from the distal end of the flexible sheath is provided, and the distal treatment piece is connected to the distal end of an operation wire that is inserted into the flexible sheath so as to be movable forward and backward in the axial direction. In the endoscope retractable treatment tool, at least a portion near the distal end of the flexible sheath may be formed of a flexible tube, and may be formed in a shape that extends from the distal treatment piece in the radial direction of the flexible tube. A wide portion for expanding the flexible tube in the radial direction is formed near the base of the distal treatment piece.

Reference examples and examples of the present invention will be described with reference to the drawings.
FIG. 2 shows the overall configuration of an endoscopic projection-type treatment tool according to a reference example of the present invention. For example, a flexible tube made of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube or the like. A conductive operation wire 2 is inserted and disposed throughout the entire length of the conductive sheath 1 so as to advance and retract in the axial direction. In addition, the flexible sheath 1 should just be formed by the flexible tube at least tip part vicinity.

  A distal treatment piece 3 made of, for example, a stainless steel plate or the like is connected to the distal end of the flexible sheath 1 through a connection pipe 4 made of a stainless steel pipe material or the like so as to protrude and retract from the distal end of the flexible sheath 1.

  An operation unit 10 for advancing and retracting the operation wire 2 is connected to the proximal end side of the flexible sheath 1, and a fixed finger hook 12 is provided at the proximal side end of the operation unit main body 11. A proximal end of the operation wire 2 drawn straight from the flexible sheath 1 to the operation unit 10 side is connected to a movable finger hook 13 slidably attached to the main body 11.

  Therefore, when the movable finger hook 13 is advanced and retracted as indicated by the arrow P in the operation unit 10, the operation wire 2 advances and retracts in the axial direction within the flexible sheath 1, whereby the distal treatment piece 3 is indicated by the arrow Q. As shown, it projects from the tip of the flexible sheath 1.

  FIG. 1 shows a distal end portion of a projection type treatment instrument for an endoscope, and the distal treatment piece 3 is an elongated rod having a flat cross-sectional shape that is parallel to the axis of the distal end portion of the flexible sheath 1. The rod-shaped part 3a functions as a mechanical needle-shaped knife. However, a high-frequency current can be supplied to the distal treatment piece 3 via the operation wire 2.

  A wide portion 3c is formed on the base side of the distal treatment piece 3 so as to spread evenly on both sides laterally from the base of the rod-shaped portion 3a. The distal portion 2a of the operation wire 2 is the center line of the wide portion 3c It arrange | positions so that it may be located on the extended line of X.

  The wide portion 3 c is chamfered at 45 ° so that the wide portion 3 c is not caught on the end surface of the flexible sheath 1 when being pulled into the flexible sheath 1. However, they may be chamfered. Reference numeral 3 d denotes a narrow portion that extends backward from the wide portion 3 c in order to connect with the connection pipe 4.

  The width W of the wide portion 3 c of the distal treatment piece 3 is formed to be slightly larger than the inner diameter (diameter) d of the flexible sheath 1. That is, W> d, and the dimensional difference (W−d) is, for example, about 0.1 to 0.4 mm when d is 1.5 mm (that is, 1.07d ≦ W ≦ 1.26d). It is.

  As a result, as shown in FIG. 3, when the operation wire 2 is pulled from the operation unit 10 side as indicated by the arrow A and the wide portion 3 c is drawn into the distal end of the flexible sheath 1, the IV-IV cross section is obtained. As shown in FIG. 4, the wide portion 3 c is fitted into the flexible sheath 1 made of a flexible tube without looseness in a state where the distal end portion of the flexible sheath 1 is expanded.

  Then, as shown in FIG. 5, when the operation wire 2 is pulled to the maximum extent as indicated by the arrow B from the operation unit 10 side, the distal treatment piece 3 is completely drawn into the distal end of the flexible sheath 1. Can do.

  When using the endoscope retractable treatment tool formed in this way, as shown in FIG. 6, the operation wire 2 is advanced and retracted to an appropriate state as indicated by an arrow C from the operation unit 10 side. Accordingly, the distal treatment piece 3 can be stopped in a state where the distal treatment piece 3 protrudes from the distal end of the flexible sheath 1 by an arbitrary length L.

  In this state, the distal treatment piece 3 is fixed to the distal end portion of the flexible sheath 1 by the reaction force (pressing force) received by the wide portion 3c from the flexible sheath 1, and an external force smaller than this fixing force is applied to the distal end. Even if it acts on the treatment piece 3, the distal treatment piece 3 does not move relative to the distal end of the flexible sheath 1.

  Therefore, a phenomenon in which the distal treatment piece 3 is retracted into the flexible sheath 1 just by pressing the distal treatment piece 3 against the mucosal surface does not occur, and the treatment as intended by the operator can be easily performed. Can do.

Figure 7 shows the distal portion of the endoscopic project and retract type treatment instrument real施例of the present invention, forming a scoop-like portion 3b to the distal end portion of the rod-like portion 3a of the tip jaw 3 of Reference Example It is a thing.

The width W ′ of the spatula portion 3b is formed to be substantially the same as or slightly smaller than the width W of the wide portion 3c. Since the configuration of other tip portions is the same as that of the reference example, description thereof will be omitted.

Figure 8 shows the overall configuration of the endoscope protruding and retracting type treatment instrument real施例, the movable finger hook 13 of the operation unit 10, a connection for connecting a high-frequency power source cord (not shown) the terminal 14 Is attached, and a high-frequency current can be applied to the distal treatment piece 3 through the operation wire 2.

  In addition, the proximal end portion of the flexible sheath 1 is fixed in the axial direction with respect to the operation unit main body 11 of the operation unit 10, but is rotatably attached around the axis. A holding ring 5 is fixed to the proximal end of the flexible sheath 1.

  Therefore, by holding the holding ring 5 and rotating the operation unit 10 around the axis as indicated by the arrow R, the operation wire 2 rotates around the axis in the flexible sheath 1 in a fixed state. As a result, the distal treatment piece 3 rotates around the axis at the distal end of the flexible sheath 1.

  Accordingly, as shown in FIGS. 7 and 8, the operation wire 2 is axially arranged with respect to the flexible sheath 1 in the operation section 10 in a state where the entire distal treatment piece 3 is projected from the distal end of the flexible sheath 1. If the rotation operation is performed, the direction of the spatula portion 3b at the tip of the flexible sheath 1 can be arbitrarily controlled.

Endoscopic project and retract type treatment instrument real施例thus constructed, as shown in FIG. 9, when pulling the operating wire 2 from the operation unit 10 side to the maximum as indicated by the arrow D The distal treatment piece 3 can be completely drawn into the distal end of the flexible sheath 1.

  When using the endoscope retractable treatment tool, as shown in FIG. 10, the distal end treatment is performed by moving the operation wire 2 forward and backward from the operation unit 10 to an appropriate state as indicated by an arrow E. The piece 3 can be stopped in a state where it protrudes from the tip of the flexible sheath 1 by an arbitrary length L ′.

  In this state, the distal treatment piece 3 is fixed to the distal end portion of the flexible sheath 1 by the reaction force (pressing force) received by the wide portion 3c from the flexible sheath 1, and an external force smaller than this fixing force is applied. Even if it acts on the cylindrical portion 3 b, the distal treatment piece 3 does not move in the axial direction relative to the distal end of the flexible sheath 1 and does not rotate around the axial line.

  Therefore, the distal treatment piece 3 rotates around the axis at the distal end portion of the flexible sheath 1 or is retracted into the flexible sheath 1 simply by pressing the spatula portion 3b against the mucosal surface. The phenomenon does not occur, and it is possible to easily perform the treatment as intended by the surgeon.

  In addition, as shown in FIG. 11, when the entire distal treatment piece 3 is protruded from the distal end of the flexible sheath 1, a spatula is formed at the distal end portion of the flexible sheath 1 by an operation from the operation unit 10. The direction of the portion 3b (the direction of rotation around the axis) can be arbitrarily controlled as indicated by the arrow r.

  Then, with the spatula-shaped portion 3b in the desired orientation, as shown in FIG. 12, the operation wire 2 is pulled from the operation portion 10 side to retract the wide portion 3c into the flexible sheath 1. The spatula-like portion 3b can be brought into a stable state in which a desired length L ″ protrudes from the distal end of the flexible sheath 1 in a desired direction, and a high-frequency incision treatment or the like can be performed safely in this state.

Figure 13 is protruded such an endoscopic project and retract type treatment instrument actual施例from the treatment instrument insertion channel 51 of the endoscope 50, while observing through the observation window 52, mucosal a spatula-shaped portion 3b FIG. 14 shows a state in which mucosal dissection treatment is performed by horizontally inserting the spatula portion 3b into the back side of the mucosal surface 100. FIG. Therefore, such advanced endoscopic treatment can be performed easily and safely.

The present invention is not limited to the above embodiments, for example, the cross-sectional shape of the wide portion 3c of the above end jaw 3, as shown in FIGS. 15 and 16, there in an oval or square, etc. There is no problem.

It is a side perspective view of a tip part in the state where a tip treatment piece of a projection type treatment tool for endoscopes of a reference example of the present invention completely protrudes from a tip of a flexible sheath. It is an external view which shows the whole structure of the protrusion type treatment tool for endoscopes of the reference example of this invention. It is a side perspective view of the tip part in the state where the wide part of the tip treatment piece of the projection type treatment instrument for endoscopes of the reference example of the present invention was drawn into the tip of the flexible sheath. It is IV-IV sectional drawing in FIG. 3 of the protrusion type treatment tool for endoscopes of the reference example of this invention. FIG. 5 is a side perspective view of the distal end portion in a state in which the distal treatment piece of the endoscopic projection type treatment tool of the reference example of the present invention is pulled into the distal end of the flexible sheath to the maximum extent. It is a side perspective view of the front-end | tip part state in the state by which the front-end | tip treatment piece of the protrusion type treatment tool for endoscopes of the reference example of this invention was pulled in in the front-end | tip of the flexible sheath to the middle. It is a side perspective view of a distal portion of a state where the top jaw of the endoscopic project and retract type treatment instrument of the real施例is fully extended from the distal end of the flexible sheath of the present invention. Is an external view showing the overall configuration of the endoscope protruding and retracting type treatment instrument real施例of the present invention. It is a side perspective view of a distal portion of a state where the top jaw is drawn to the maximum in the tip of the flexible sheath of the endoscopic project and retract type treatment instrument real施例of the present invention. Tip jaws of the endoscopic project and retract type treatment instrument real施例of the present invention is a side perspective view of a distal portion of the state of being drawn into the distal end of the flexible sheath halfway. Is a side perspective view of a distal portion of the state is rotated around the axis of the distal end jaw of the endoscopic project and retract type treatment instrument real施例of the present invention. Of the tip portion of the real施例endoscopic tip jaw mirror for projecting and retracting type treatment tool is rotated around the axis retracted until the middle of the spatula-like portion in the distal end of the flexible sheath state of the present invention It is a side perspective view. An example of actual施例use state of the endoscope protruding and retracting type treatment instrument of the present invention is a schematic view showing. Another example of a use state of the endoscope protruding and retracting type treatment instrument real施例of the present invention is a schematic view showing. It shows a modification of the endoscope protruding and retracting type treatment instrument real施例of the present invention, is a cross-sectional view corresponding to IV-IV cross-sectional view of a reference example. Showing another modification of the endoscope protruding and retracting type treatment instrument real施例of the present invention, it is a cross-sectional view corresponding to IV-IV cross-sectional view of a reference example.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Operation wire 3 Tip treatment piece 3a Rod-shaped part 3b Spatula-shaped part 3c Wide part 10 Operation part

Claims (4)

A distal treatment piece projecting forward and backward from the distal end of the flexible sheath is provided, and the distal treatment piece is connected to the distal end of an operation wire that is inserted into the flexible sheath so as to be movable forward and backward in the axial direction. In the projected type treatment instrument for endoscope,
The operation wire is arranged so as to be able to rotate in the direction around the axis from the proximal end side with respect to the flexible sheath,
At least a portion near the distal end of the flexible sheath is formed of an unbroken flexible tube, and is formed into a shape that extends in the radial direction of the flexible tube from the distal treatment piece . A projection-type treatment instrument for an endoscope, wherein a wide portion that expands the flexible tube in a radial direction by being pulled in is formed in the vicinity of the base of the distal treatment piece. Endoscopic project and retract type treatment tool according to claim 1, wherein the tip portion of the operation wire is arranged on the extension of the center line of the width of the wide portion of the distal jaw. The projecting type treatment instrument for an endoscope according to claim 1 or 2 , wherein the distal treatment piece is formed in an elongated rod shape having a flat cross-sectional shape. The distal end treatment piece, the endoscope protruding and retracting type treatment tool according to claim 1 or 2, wherein the cross-sectional shape is formed to the tip portions of the flat elongated rods formed wider the paddle.

Images