JP2014184011A - Medical treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment instrument which quickly becomes firm in performing a treatment even if a soft sheath is used and keeps the bent state firmly.SOLUTION: In a medical treatment instrument which includes: a flexible sheath 2 that has a dog leg shaped bent part 6 in the vicinity of a distal end and is made of a close wound coil; a treatment part 4 provided at a distal end of the sheath 2; an operation wire 15 which is inserted in the sheath 2 and is connected to the treatment part 4; and an operational part which is connected to a proximal end of the operation wire 15 and a proximal end of the sheath 2 and operates the treatment part 4 by operating to advance and retract the operation wire 15, a tension wire 7 for pulling the distal end of the sheath 2 to the proximal end side is disposed in a direction toward a bending inner side 6b of the bent part 6 rather than in an axial center of the sheath 2.

Description

  The present invention relates to a medical treatment instrument used for laparoscopic surgery or the like.

  A medical treatment instrument generally used for laparoscopic surgery or the like is inserted into a trocar, which is a tube-shaped guide tube inserted into the abdominal cavity, and protrudes from the trocar tip into the abdominal cavity. The medical treatment tool such as forceps and scissors is inserted into the cylindrical sheath with an operation wire to which a treatment part consisting of a pair of treatment pieces such as a forceps cup for excision of the affected part at the tip is connected, Generally, the treatment portion is driven to open and close at the distal end of the sheath by advancing and retracting the operation wire.

  Such a medical treatment instrument may be provided with a bent portion where the vicinity of the distal end of the sheath is bent in order to treat a close position within the narrow abdominal cavity, and the bent portion contacts the trocar so that the forceps The sheath is generally formed relatively flexibly for reasons such as avoiding difficulty in passing through the portion and not damaging the organ when it comes into contact with the organ. The following patent documents are listed as documents describing such medical treatment tools according to the prior art.

  In Patent Document 1, a sheath having a tightly wound coil and having a bent portion at the distal end, a forceps portion as a treatment portion provided at the distal end of the sheath, an operation wire inserted into the sheath, and an operation wire are operated. In a treatment instrument comprising an operation part for opening and closing a forceps part, the operation part is constituted by a slider and an operation part main body, and a fixing member attached and fixed to the proximal end of the operation wire is fitted to the slider, and the rotation of the stopping member There is described a technique for providing a stable operation by properly transmitting the rotation operation of the operation portion to the forceps portion by providing a fixing means for preventing the above.

  Patent Document 2 discloses a treatment instrument comprising an insertion pipe (sheath) shape-memoryd at the distal end, a treatment portion provided at the distal end of the insertion pipe, and an operation portion for opening and closing the treatment portion. A technique is described in which hot water or cold water is injected into an insertion pipe from a water supply base provided in an operation unit to heat or cool the shape of the insertion pipe into a bent state or a linear state.

Japanese Utility Model Publication No. 5-21913 Japanese Patent Laid-Open No. 4-135554

The medical treatment instrument described in Patent Document 1 described above describes a technique for well transmitting the rotation operation of the operation unit to the forceps unit. However, since the sheath is formed relatively flexibly, The forceps cannot be pressed firmly against a certain mucosal surface. In addition, if the operation wire is pushed to open the forceps part, it will be bent, but if the operation wire is pulled further after closing the forceps part, the bent part will be in an extended state, so it will be in an extended state or bent There has been a problem that treatment cannot be performed by pressing against the mucosal surface while maintaining the state.
Moreover, although the medical treatment tool described in patent document 2 can maintain the bending state by which shape memory was memorize | stored by heating an insertion pipe with warm water, it inject | pours warm water and inject | pours cold water when making it into a linear state Has a problem that it takes time and hinders quick treatment.

  In view of such a problem, the present invention is intended to solve the above-described problems of the prior art, and can be quickly hardened when a treatment is performed using a flexible sheath. An object of the present invention is to provide a medical treatment instrument that can firmly hold a bent state of a sheath whose vicinity is bent.

  In order to achieve the above-mentioned object, the present invention provides a flexible sheath comprising a close-contact coil having a square-shaped bent portion in the vicinity of the distal end, a treatment portion provided at the distal end of the sheath, and the sheath. And an operation wire connected to the treatment portion, and an operation portion connected to the operation wire base end and the sheath base end and operating the treatment portion by operating the operation wire forward and backward. And the tension wire for pulling the front-end | tip of the said sheath to a base end side is arrange | positioned in the direction which goes to the bending inside of the said bending part from the axial center of the said sheath.

  The present invention is characterized in that a pulling member for pulling the tension wire is attached to the operation portion.

  Further, according to the present invention, the operation portion includes an operation portion main body connected to a proximal end of the sheath, and a slider connected to the proximal end of the operation wire and slidably attached to the operation portion main body. A pulling member for pulling the pulling wire is attached to the operation unit main body.

  Further, according to the present invention, a plurality of engagement grooves are formed in the operation portion, and the traction position is adjusted by engaging the engagement groove and changing the engagement groove engaged with the traction member. An engagement pin is provided for the purpose.

  Further, according to the present invention, a stopper that covers the base end is provided at a base end of the tension wire, and the pulling member has a space in front and rear in the axial direction of the stopper in a non-traction state of the tension wire. And a fixing plate in which a holding hole is formed so that the front of the stopper abuts and is fixed when the tension wire is pulled.

  Further, the present invention is characterized in that a spring that normally urges the engaging pin in the engaging direction is attached to the engaging pin.

  Further, the present invention is characterized in that a distal end support frame for holding the treatment portion in an openable and closable manner is provided at the distal end of the sheath, and the distal end of the tension wire is attached to the distal end support frame.

  In the present invention, the sheath is provided with a plurality of the bent portions.

  A medical treatment instrument according to the present invention includes a flexible sheath having a U-shaped bent portion in the vicinity of the distal end and made of a close-contact coil, a treatment portion provided at the distal end of the sheath, and inserted into the sheath into the treatment portion. A medical treatment instrument including an operation wire to be connected, and an operation unit that is connected to the operation wire base end and the sheath base end and operates the treatment unit by advancing and retreating the operation wire. The tension wire for pulling to the end side is arranged in the direction from the axial center of the sheath toward the inside of the bent portion. When the tension wire is pulled, the tip of the sheath is pulled, thereby forming the close contact of the sheath Since the contacts of the coils are brought into close contact with each other and become strong, even when a flexible sheath is used, it is possible to quickly harden the treatment and keep the bent state firm.

The figure which shows the whole structure of this invention. The figure which shows the structure by the side of the front end by 1st Embodiment of this invention. The figure which shows the structure of the operation part of this invention. The figure which shows the non-traction state and the traction state of the traction member of this invention. The figure which shows the structure by the side of the front end by 2nd Embodiment of this invention. The figure for demonstrating the usage example of this invention.

Hereinafter, embodiments of a medical treatment tool according to the present invention will be described in detail with reference to the drawings.
[First Embodiment]
As shown in FIG. 1, the medical treatment instrument 1 according to the present embodiment includes a flexible sheath 2, a distal end support frame 3 coupled to the distal end of the sheath 2, and a treatment coupled to the distal end support frame 3. A portion 4 and an operation portion 5 provided on the proximal end side of the sheath 2.

As shown in FIG. 2, the sheath 2 is formed of a tightly wound coil pipe such as a stainless steel wire, and is bent in the shape of a letter near the tip, with the apex side of the letter shaped being bent outside 6a and the inner side. Is formed with a bent portion 6 having a bent inner portion 6b. A distal end support frame 3 having a pair of arm portions 3 a extending toward the distal end is fitted and fixed to the distal end of the sheath 2, and the axial center of the sheath 2 is located inside the distal end support frame 3. A tension wire 7 is attached in the direction toward the inside of the bent portion of the bent portion and for pulling the distal end of the sheath 2.
The outer peripheral surface of the sheath 2 may be covered with an outer tube that is an electrically insulating flexible tube such as a tetrafluoroethylene resin tube.

The treatment portion 4 penetrates through the forceps cup 8 (treatment piece) as a pair of treatment pieces and the distal ends of the pair of arm portions 3a of the distal end support frame 3, and can rotate a substantially middle portion of the pair of forceps cups 8. A support shaft 9 that supports the shaft 12, a pair of plate-like links 12 that are pivotally supported on the forceps cup 8 by a pair of slide shafts 10, and a link support that supports the pair of links 12 as a single shaft. A shaft 11 is provided. Then, the forceps cup 8 is rotated about the support shaft 9 through the rod 16 by pushing the operation wire 15 toward the distal end side, the distal ends are separated from each other, and the rod is opened by pulling the operation wire 15. 16, the forceps cup 8 is configured so that the distal ends of the forceps cups 8 are close to each other with the support shaft 9 as a center. In this example, the plate-shaped link 12 is used. However, the present invention is not limited to this. For example, the link wires are connected so as to be divided into two forks, and the distal ends of the link wires are connected to the forceps cup 8. You may make it connect.
Further, the treatment unit 4 is not limited to the forceps cup described in the present embodiment, and may be, for example, a grip piece or an incision knife.

The operation unit 5 is slid with respect to the operation unit main body 5a and the operation unit main body 5a, as shown in FIG. 3 (a) and FIG. And a freely mounted slider 5b. A groove 5c is formed in the operation portion main body 5a in the axial direction over a predetermined length, and the slider 5b is fitted in the groove so as to be slidable in the axial direction. In addition, a sheath stopper 18 attached to the proximal end of the sheath 2 via a fastening ring 17 is fixed to the operation portion main body 5a, and the sheath stopper 18 is configured such that the sheath is folded in the vicinity of the proximal end. It is attached to the proximal end of the sheath 2 by a bend preventing member 19 for preventing the above. An operation wire 15 that is inserted into the inside of the sheath 2 and the operation portion main body 5a is fixed to the slider 5b in a state where the waist 5 is bent and reinforced by attaching a stainless steel pipe 20 to the proximal end. For this reason, the operation wire 15 can be advanced and retracted by operating the slider 5b in the axial direction with respect to the operation portion main body 5a.
Although not shown, the sheath 2 is covered with an electrically insulating sheath tube and a high frequency power source is connected to the slider 5b, whereby a high frequency current is applied to the treatment section 4 via the operation wire 15. You may do it.

  A pulling member 21 for pulling the tension wire 7 is attached to the operation unit main body 5a. The pulling member 21 is fitted in the groove 5c of the operation portion main body 5a so as to be slidable in the axial direction, and holds the stopper 22 attached so as to cover the proximal end of the tension wire 7, and the operation portion main body. An engaging pin 24 that engages with a plurality of engaging grooves 5d to 5g formed on the outer periphery of 5a, and an outer periphery of the operation portion main body 5a are attached to be slidable in the axial direction, and the fixing plate 23 and the engaging pin 24 are connected to each other. A finger hook portion 25 to be held, and a spring 26 that normally biases the engagement pin 24 in the engagement direction (direction in which the engagement grooves 5d to 5g are engaged) are provided.

The fixing plate 23 has a hole 27 through which the operation wire 15 can be inserted in the axial direction, and a space before and after the stopper 22 in the axial direction of the stopper wire 7, and in the pulled state of the tensile wire 7, A holding hole 28 for holding the stopper 22 is provided so that the front of the stopper 22 is fixed in contact. More specifically, in the non-traction state of the tension wire 7 shown in FIG. 6A, the engagement pin 24 is engaged with 5d on the distal end side of the engagement grooves 5d to 5g, and the tension wire 7 has a space before and after the stopper 22 in the axial direction, and the stopper 22 is in a free state in the axial direction. Then, from this state, as shown in FIG. 6 (b), the finger hooking portion 25 is moved to the proximal end side by a distance a from FIG. 6 (a) to engage the engagement pin 24 with the engagement groove 5e. Then, the front (tip side) of the stopper 22 comes into contact with the front (tip side) of the holding hole 28, and the tension wire 7 is pulled.
In order to change the engagement grooves 5d to 5g with which the engagement pin 24 is engaged, the engagement pin 24 is pulled away from the operation portion main body 5a, and the finger hooking portion 25 is moved in the axial direction so as to be desired. When the engagement pin 24 is released in the vicinity of the engagement groove, the engagement pin 24 is engaged with the engagement groove by the urging force of the spring 26.
Moreover, in this embodiment, although the example which provides four engagement grooves 5d-5g was shown, it is not restricted to this, For example, the engagement grooves may be only 5d and 5e, and five engagement grooves are provided. You may provide above.

  The medical treatment tool according to the present embodiment configured as described above can make the sheath 2 flexible or hold the bent state firmly by non-traction and traction of the tension wire 7.

  That is, when using the medical treatment instrument 1 according to the present embodiment, as shown in FIG. 6, for example, the endoscope is inserted into the trocar 104 for insertion through the endoscope by inserting into the abdominal cavity 101 by puncturing the abdomen 100. The medical treatment tool 1 according to this embodiment is inserted into the trocar 103 for inserting the treatment tool inserted into the abdominal cavity 101 by piercing the abdomen 100 while observing the affected part 102 to be treated through the mirror 105. The diseased part 102 is treated by inserting.

  When the medical treatment instrument 1 is inserted into the trocar 103, if the tension wire 7 is not pulled as shown in FIG. 4A, there is a space before and after the stopper 22 of the tension wire 7 in the axial direction. Since the sheath 2 is in a free state, even if the sheath 2 is slightly curved, the tension wire 7 can be pulled to keep the sheath soft, and the bent portion comes into contact with the trocar 103 to pass the treatment portion 4. It does not become difficult and is not damaged when the treatment section 4 comes into contact with the affected area 102 or the like.

When the treatment is performed, if the tension wire 7 is pulled as shown in FIG. 4B, the tension wire 7 is arranged on the side of the bent portion 6 b of the bent portion 6 with respect to the axial center of the sheath 2 and the distal end support frame 3. Since the tip of the sheath 2 is pulled, the contacts of the coils of the close contact coils constituting the sheath 2 are brought into close contact with each other and quickly strengthened, and the engagement pins 24 and the engagement grooves (5e to 5g) The bent state can be firmly held by the engagement. For this reason, it can be treated by pressing against the affected area 102 while maintaining the bent state of the sheath 2.
When the sheath 2 is taken out from the abdominal cavity 101 after the treatment is completed, the sheath 2 is made flexible again by releasing the pulling state of the tension wire by setting the engagement position of the engagement pin 24 to the engagement groove 5d. Since it returns, the inside of the trocar 103 can be smoothly inserted.

[Second Embodiment]
In the above-described embodiment, an example in which one bent portion 6 is formed has been shown. However, the present invention is not limited to this, and for example, a plurality of bent portions 6 are provided in the sheath 2 as shown in FIG. May be.

  The medical treatment instrument according to the second embodiment makes the sheath 2 flexible or holds the bent state firmly by non-traction and traction of the tension wire 7 as in the first embodiment. In addition, it is possible to more suitably perform a treatment at a close position in the abdominal cavity by bending at a plurality of positions.

DESCRIPTION OF SYMBOLS 1 Medical treatment tool 2 Sheath 3 Tip support frame 4 Treatment part 5 Operation part 6 Bending part 7 Stretching wire 8 Forceps cup 15 Operation wire 21 Pulling member 22 Stopper 23 Fixing plate 24 Engagement pin 25 Finger hook part 26 Spring 28 Holding hole

Claims (8)

A flexible sheath comprising a coiled bent portion in the vicinity of the tip and made of a contact coil;
A treatment section provided at the distal end of the sheath;
An operation wire inserted through the sheath and connected to the treatment section;
A medical treatment instrument connected to the proximal end of the operation wire and the proximal end of the sheath, and including an operation unit that operates the treatment unit by moving the operation wire forward and backward,
A medical treatment instrument, wherein a tension wire for pulling the distal end of the sheath toward the proximal end side is disposed in a direction from the axial center of the sheath toward the bent portion of the bent portion.   The medical treatment tool according to claim 1, wherein a pulling member for pulling the tension wire is attached to the operation portion.   The operation unit includes an operation unit main body connected to a base end of the sheath, and a slider connected to the base end of the operation wire and slidably attached to the operation unit main body. 2. A medical treatment instrument according to claim 1, wherein a pulling member for pulling the tension wire is attached.   A plurality of engaging grooves are formed in the operation portion, and an engaging pin for adjusting the pulling position by engaging the engaging groove with the pulling member and changing the engaging groove to be engaged. The medical treatment device according to claim 2, wherein the medical treatment tool is provided.   A stopper that covers the base end is provided at the base end of the tension wire, and the pulling member has a space in front and rear in the axial direction of the stopper when the tension wire is not pulled, and the tension wire The medical treatment instrument according to any one of claims 2 to 4, further comprising a fixing plate in which a holding hole is formed so that the front of the stopper comes into contact with and is fixed in the pulled state. .   The medical treatment instrument according to claim 4 or 5, wherein a spring that normally biases the engagement pin in an engagement direction is attached to the engagement pin.   The distal end of the sheath is provided with a distal end support frame that holds the treatment portion so as to be openable and closable, and the distal end of the tension wire is attached to the distal end support frame. The medical treatment tool described in 1.   The medical treatment instrument according to any one of claims 1 to 7, wherein the sheath includes a plurality of the bent portions.

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