JP5297826B2 - Endoscopic treatment tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a treatment tool for an endoscope, which continuously and smoothly performs a treatment to form a puncture hole in a biological wall and a treatment to enlarge the diameter of the puncture hole through the use of one treatment tool which is made to pass through the treatment put-through channel of the endoscope. <P>SOLUTION: The treatment tool for the endoscope includes: a balloon 5 expansibly attached to an outer peripheral part at the distal end of a flexible sheath 1; a liquid through-hold 6 formed in the side wall of the flexible sheath 1 in a state for communication between the inner part of the flexible sheath 1 and the inner part of the balloon 5; a conductive operation wire 3 axially put through in the flexible sheath 1 so as to be freely projectable/retreatable; a high frequency electrode 2 to be axially projected/retreated at the distal end of the flexible sheath 1 by the projecting/retreating action of the operation wire 3; and an operation stopper 7 for clogging the distal end of the flexible sheath 1 in a state where the high frequency electrode 2 is retreated, and releasing clogging at the distal end of the flexible sheath 1 in a state where the high frequency electrode 2 is projected forward. <P>COPYRIGHT: (C)2010,JPO&amp;INPIT

Description

  The present invention relates to an endoscope treatment tool.

In mucosal resection or surgical procedures using an endoscope, it may be necessary to form a perforation for passing a surgical endoscope, a surgical instrument, or the like in a living body wall.
In such a case, conventionally, after first forming a perforation in the living body wall with a high-frequency incision tool passed through the treatment instrument insertion channel of the endoscope, a balloon dilator or the like passed through the treatment instrument insertion channel is inserted into the perforation, The perforations were enlarged to the required size.

  However, in order to perform such treatment, it is necessary to replace and use a plurality of treatment tools in the treatment tool insertion channel of the endoscope. For this reason, there has been a disadvantage that, for example, it is necessary to start over the guidance of the endoscope by losing sight of the target site when replacing the treatment tool.

  Therefore, it is conceivable to attach a balloon dilator to the high-frequency incision tool so that high-frequency incision and hole diameter expansion can be performed continuously with one treatment tool. A treatment tool is described.

JP-A-10-179603

  In the invention described in Patent Document 1, a high-frequency electrode for incising a living body wall and a balloon that can be expanded and contracted are provided at the distal end portion of a flexible sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope. ing.

  In the invention described in Patent Document 1, an air supply path for inflating the balloon is provided independently in the flexible sheath. Therefore, the cross-sectional area of the air supply path is very small. The diameter of the flexible sheath is generally about 2 mm, and the air supply path has to be very thin compared to that.

  Therefore, in the invention described in Patent Document 1, even if the balloon can be inflated with air, it is difficult to inflate smoothly with a liquid such as water (hereinafter simply referred to as “water”) because the pipe resistance is too large. Is impossible.

  However, since a balloon inflated with air contracts and contracts when a compressive force is applied from the periphery, the function of satisfactorily expanding the perforation cannot be obtained. Since the balloon of the invention described in Patent Document 1 is intended to fix the distal end portion of the flexible sheath in a narrow duct, there is no problem even if the balloon is inflated with air.

  The present invention can perform a treatment for forming a perforation in a living body wall and a treatment for enlarging the diameter of the perforation continuously and smoothly with one treatment tool passed through a treatment instrument insertion channel of an endoscope. An object is to provide a treatment instrument for an endoscope.

  In order to achieve the above object, an endoscope treatment tool according to the present invention is a flexible sheath that is inserted into and removed from a treatment tool insertion channel of an endoscope, and is expandable / contractible at the outer periphery of the distal end of the flexible sheath. A balloon attached to the fluid sheath, a fluid passage hole formed in a side wall of the flexible sheath so as to allow the inside of the flexible sheath to communicate with the inside of the balloon, and a substantially full length that can be moved forward and backward in the axial direction in the flexible sheath. A conductive operation wire inserted through the wire, a high-frequency electrode connected to the tip of the operation wire so as to advance and retreat in the axial direction at the tip of the flexible sheath by the advancement and retraction of the operation wire, and a base of the high-frequency electrode An operating plug is provided that closes the distal end of the flexible sheath when the high-frequency electrode is retracted, and unblocks the distal end of the flexible sheath when the high-frequency electrode protrudes forward. Is.

  In addition, a fixed stopper is fixedly disposed in the distal end of the flexible sheath so that the rear end of the operation plug contacts when the high-frequency electrode is retracted. The distal end of the flexible sheath may be closed.

  The contact portion between the operation plug and the fixed stopper is a seal portion, and the distal end of the flexible sheath may be closed there, and the distal end side and the rear end side of the operation plug are communicated with each other. A ventilation groove may be formed on the outer peripheral portion of the operation plug.

  The fixed stopper may be formed with a through-hole through which the operation wire loosely passes in the axial direction. The flexible sheath comes into contact with the rear end of the fixed stopper when the high-frequency electrode advances in the operation wire. A movement stopper that regulates the protruding amount of the high-frequency electrode from the tip of the electrode may be attached. Further, a seal member may be disposed on the tip surface portion of the fixed stopper.

  According to the present invention, the high-frequency electrode can be protruded forward to perform a high-frequency incision and the like, and when the high-frequency electrode is retracted, the distal end of the flexible sheath is closed with the operating plug, Using the entire inside of the sheath as a water supply channel, water can be sent into the balloon and the balloon can be inflated, so a single treatment tool passed through the treatment instrument insertion channel of the endoscope forms a perforation in the living body wall The treatment to be performed and the treatment to enlarge the hole diameter of the perforation can be performed continuously and extremely smoothly.

It is side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes which concerns on 1st Example of this invention. It is II-II sectional drawing in FIG. 1 of the 1st Example of this invention. It is side surface sectional drawing of the front-end | tip part of the state which the balloon inflated in the treatment tool for endoscopes which concerns on 1st Example of this invention. 1 is an overall configuration diagram of an endoscope treatment tool according to a first embodiment of the present invention. FIG. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a schematic diagram illustrating in sequence the usage state of an endoscope treatment tool according to a first embodiment of the present invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a schematic diagram illustrating in sequence the usage state of an endoscope treatment tool according to a first embodiment of the present invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a schematic diagram illustrating in sequence the usage state of an endoscope treatment tool according to a first embodiment of the present invention. It is side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes which concerns on 2nd Example of this invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 4 shows the overall configuration of the endoscope treatment tool according to the first embodiment of the present invention.
Reference numeral 1 denotes a flexible sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown), and is formed of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube. Yes.

  A high-frequency electrode 2 for high-frequency cauterization of a living body is disposed at the tip of the flexible sheath 1 so as to protrude and retract, and is inserted into the flexible sheath 1 so as to be movable back and forth in the axial direction over substantially the entire length. The tip of the conductive operation wire 3 is connected to the high frequency electrode 2. A balloon 5 that can be inflated and contracted is attached to the outer periphery of the distal end of the flexible sheath 1.

  A slide operation member 22 that is slidable in the direction of arrow A with respect to the operation unit main body 21 to which the base end of the flexible sheath 1 is connected is provided on the operation unit 20 disposed on the base end side of the flexible sheath 1. Is provided.

  A base end portion 3 e of the operation wire 3 is connected to the slide operation member 22. In addition, a connection terminal 23 for connecting a high-frequency power cord (not shown) is arranged on the slide operation member 22 so as to be electrically connected to the operation wire 3.

  As a result, when the slide operation member 22 is slid in the operation section 20, the operation wire 3 moves back and forth in the axial direction in the flexible sheath 1, so that the high frequency electrode 2 is axially moved at the distal end of the flexible sheath 1. And retracts from the tip of the flexible sheath 1. Further, a high frequency treatment can be performed by supplying a high frequency current to the high frequency electrode 2 through the operation wire 3.

  In the vicinity of the connecting portion between the operation portion 20 and the flexible sheath 1, an injection cap 24 that communicates with the space in the flexible sheath 1 is disposed so as to protrude. The inlet metal 24 and the operation unit 20 are sealed in a watertight manner by a built-in sealing member 25 such as an O-ring. As a result, it is possible to inject a syringe or the like to the injection cap 24 and inject water for inflating the balloon 5 into the flexible sheath 1, and the water does not leak out to the operation unit 20 side.

  FIG. 1 shows a distal end portion of a flexible sheath 1, and a balloon 5 has a flexible sheath in which both end portions of a cylindrical material made of a soft, stretchable and elastic material such as silicon rubber are used. The outer periphery of 1 is fixed in a watertight manner. Both end portions may be reinforced by binding or the like.

  On the side wall of the flexible sheath 1 located inside the balloon 5, a liquid passage hole 6 is formed to communicate the space in the flexible sheath 1 with the inside of the balloon 5. A plurality of the fluid passage holes 6 are formed at different positions in the circumferential direction and / or the axial direction so that water for inflating the balloon 5 can pass smoothly.

  The operation wire 3 is formed of, for example, a stainless steel stranded wire. And only the core wire of the operation wire 3 is extended ahead, and the short rod-shaped high frequency electrode 2 is formed in the extension part. However, the high frequency electrode 2 made of a member different from the operation wire 3 may be connected to the tip of the operation wire 3, and the high frequency electrode 2 may have a shape other than a short rod shape.

  At the base of the high-frequency electrode 2, an operation plug 7 that closes the distal end of the flexible sheath 1 when the high-frequency electrode 2 is retracted and is immersed in the flexible sheath 1 is disposed. In this embodiment, the operation plug 7 is firmly fixed to the most distal end portion of the flexible sheath 1 by welding or adhesion, and the operation plug 7 cooperates with the operation wire 3 and the high-frequency electrode 2 integrally.

  Reference numeral 8 denotes a fixed stopper having a stopper surface 8 s with which the rear end portion 7 e of the operation plug 7 comes into contact when the high-frequency electrode 2 is retracted to the inside of the flexible sheath 1. The fixed stopper 8 is fixedly disposed in the distal end of the flexible sheath 1.

  In this embodiment, the portion near the rear end of the cylindrical cap-like member fixed to the tip of the flexible sheath 1 is a fixed stopper 8. However, the fixing stopper 8 may have other shapes and configurations.

  The operation plug 7 is fitted and arranged in the front half of the cap-shaped member on which the fixed stopper 8 is formed so as to be movable forward and backward in the axial direction, and the contact portions 7e and 8s between the operation plug 7 and the fixed stopper 8 are arranged. Is a sealing portion having a plug effect, and the tip of the flexible sheath 1 can be closed.

  A through hole 9 through which the operation wire 3 passes loosely in the axial direction is formed at the axial position of the fixed stopper 8. Further, as shown in FIG. 2 illustrating the II-II cross section, a plurality of ventilation grooves 10 for communicating the front end side and the rear end side of the operation plug 7 are formed on the outer periphery of the operation plug 7. ing.

  At a position behind the fixed stopper 8, there is a moving stopper 11 that contacts the rear end portion of the fixed stopper 8 when the high-frequency electrode 2 moves forward and regulates the protruding amount of the high-frequency electrode 2 from the tip of the flexible sheath 1. It is fixed to the operation wire 3.

  Note that a gap is formed between the inner peripheral surface of the flexible sheath 1 and the movement stopper 11 so as not to hinder ventilation. Further, the movement stopper 11 has a cross-sectional shape such as a C-shape or a half-moon shape so that water permeability with the through-hole 9 is ensured when the movement stopper 11 is in contact with the rear end surface of the fixed stopper 8. Is formed.

  With such a configuration, when the operation wire 3 is pushed in from the operation unit 20 side in the distal direction, the high frequency electrode 2 protrudes from the distal end of the flexible sheath 1 as shown in FIG. By applying a high-frequency current, treatment such as high-frequency incision can be performed.

  When inflating the balloon 5, when water is injected into the flexible sheath 1 from the injection cap 24, the air in the flexible sheath 1 first vents the through hole 9 of the fixed stopper 8 and the working plug 7. It is discharged from the tip of the flexible sheath 1 through the groove 10 and the like.

  When water comes out from the distal end of the flexible sheath 1, the operation wire 3 is pulled by the operation unit 20 side. Then, as shown in FIG. 3, the high-frequency electrode 2 is immersed in the flexible sheath 1, and the rear end portion 7 e of the operation plug 7 and the stopper surface 8 s of the fixed stopper 8 come into contact with each other so that the flexible sheath 1. The tip of is closed.

  Therefore, when water is further injected into the flexible sheath 1 from the injection cap 24, the water in the flexible sheath 1 is fed into the balloon 5 through the liquid passage hole 6, and the balloon 5 is filled with water. As a result, the balloon 5 is inflated. In this process, since the entire inside of the flexible sheath 1 becomes a water passage to the balloon 5, the balloon 5 can be smoothly inflated with a small pipe resistance.

  In this way, the balloon 5 inflated by being filled with a liquid such as water does not shrink in volume even when a compression force is applied from the surroundings. Therefore, it has a function of expanding endoscopically the perforation of the body wall.

  When the balloon 5 is constricted, the operation wire 3 is pushed from the operation unit 20 side. Then, as shown in FIG. 1, the high-frequency electrode 2 protrudes from the distal end of the flexible sheath 1 until the movement stopper 11 comes into contact with the rear end portion of the fixed stopper 8.

  At the same time, the rear end portion 7 e of the operation plug 7 is separated from the stopper surface 8 s of the fixed stopper 8, so that the end of the flexible sheath 1 is unblocked, and the elasticity of the balloon 5 allows water in the balloon 5 to flow. The hole 5 is discharged from the distal end of the flexible sheath 1 through the through hole 9 of the fixed stopper 8 and the ventilation groove 10 of the operation plug 7 and the like, and the balloon 5 is squeezed.

  5 to 7 sequentially illustrate the usage states of the endoscope treatment tool of the above-described embodiment. As shown in FIG. 5, the book passed through the treatment tool insertion channel 51 of the endoscope 50. The tip of the high-frequency treatment instrument of the invention is pressed against the living body wall 100 to perform high-frequency cauterization with the high-frequency electrode 2 to form a perforation 101 in the living body wall 100.

  Next, as shown in FIG. 6, the high-frequency electrode 2 is retracted into the flexible sheath 1 to inflate the balloon 5, thereby expanding the perforation 101 to a diameter that allows the endoscope 50 to pass easily.

  Then, as shown in FIG. 7, when the perforation 101 spreads to a sufficient diameter as a whole, the endoscope 50 can be passed through the perforation 101 and the next treatment or operation can be performed. Thus, with one treatment tool passed through the treatment instrument insertion channel 51 of the endoscope 50, a treatment for forming the perforation 101 in the living body wall 100 and a treatment for expanding the hole diameter of the perforation 101 are successively performed. It can be done smoothly.

  FIG. 8 shows the distal end portion of the endoscope treatment instrument according to the second embodiment of the present invention. A seal member 12 such as an O-ring is attached to the distal end surface portion of the fixed stopper 8. It is arranged as a part. By comprising in this way, the front-end | tip obstruction | occlusion function of the flexible sheath 1 by the operation plug 7 can be made more reliable. Other configurations are the same as those in the first embodiment.

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 High frequency electrode 3 Operation wire 5 Balloon 6 Liquid passage hole 7 Operation plug 7e Rear end part (contact part)
8 Fixed stopper 8s Stopper surface (contact part)
DESCRIPTION OF SYMBOLS 9 Through-hole 10 Ventilation groove 11 Movement stopper 12 Seal member 20 Operation part 50 Endoscope 51 Treatment instrument insertion channel

Claims (7)

A flexible sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope;
A balloon attached to the outer periphery of the distal end of the flexible sheath so as to be freely expandable and contractible;
A fluid passage hole formed in a side wall of the flexible sheath so as to communicate the inside of the flexible sheath and the inside of the balloon;
A conductive operating wire rod inserted and disposed over substantially the entire length in the flexible sheath so as to be movable back and forth in the axial direction;
A high-frequency electrode connected to the distal end of the manipulation wire so as to advance and retreat in the axial direction at the distal end of the flexible sheath by the advance and retreat operation of the manipulation wire;
Located at the base of the high-frequency electrode, when the high-frequency electrode is retracted, the distal end of the flexible sheath is closed, and when the high-frequency electrode is projected forward, the flexible sheath distal end is An endoscopic treatment tool comprising: an operation plug for releasing occlusion.   A fixed stopper is fixedly disposed in the distal end of the flexible sheath so that the rear end of the operating plug contacts when the high-frequency electrode is retracted, and the operating plug contacts the fixed stopper. The endoscope treatment tool according to claim 1, wherein the distal end of the flexible sheath is closed.   The endoscopic treatment instrument according to claim 2, wherein a contact portion between the operation plug and the fixed stopper is a seal portion, and the distal end of the flexible sheath is closed there.   The treatment instrument for endoscope according to claim 2 or 3, wherein a ventilation groove for communicating the front end side and the rear end side of the operation plug is formed in an outer peripheral portion of the operation plug.   The endoscope treatment tool according to any one of claims 2 to 4, wherein a through-hole through which the operation wire passes loosely in the axial direction is formed in the fixed stopper.   The operation wire is attached with a movement stopper that abuts a rear end portion of the fixed stopper when the high-frequency electrode advances, and regulates a protruding amount of the high-frequency electrode from the distal end of the flexible sheath. Item 6. The endoscopic treatment tool according to any one of Items 2 to 5.   The endoscope treatment tool according to any one of claims 2 to 6, wherein a seal member is disposed on a distal end surface portion of the fixed stopper.

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