JPH0871081A - High frequency incision device for endoscope - Google Patents

Abstract

PURPOSE: To prevent not only the insertion deficiency of a guide wire when the guide wire is inserted in the lumen among a plurality of the lumens formed to the sheath main body but also the lowering of injection capacity at the time of the injection of a contrast medium through said lumen of the sheath main body. CONSTITUTION: An X-ray impervious pipe 21 is arranged in the cavity of a wire lumen 17a other than the cavity forming a multi-purpose liumen 17b among the cavities of a sheath main body 15a.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high frequency incision device for an endoscope which is inserted endoscopically into a body cavity and incises a living tissue, particularly a lumen outlet such as the duodenal papilla, by a high frequency current. .

[0002]

2. Description of the Related Art Generally, there is known an incision device which is inserted endoscopically into a body cavity and incises a living tissue in the body cavity with a high frequency current. In this type of endoscopic high-frequency incision device, an insertion portion to be inserted into the patient's body and an operation portion on the proximal side which is disposed on the proximal end side of the insertion portion and is disposed outside the patient's body. It is provided.

12 (A) and 12 (B) show a schematic structure of the distal end portion of the insertion portion 1 of the high-frequency incision device for an endoscope. The insertion portion 1 is provided with an elongated electrically insulating sheath 2. The sheath body 2 of this electrically insulating sheath 2
Two lumens 3a extending in the axial direction in a,
3b is formed.

Here, one lumen 3 in the sheath body 2a
A conductive wire 4 is inserted into the inside of a, and a guide wire (not shown) is inserted into the other inner cavity 3b, or a liquid feeding path for injecting a liquid is formed.

Two wire outlets 5a and 5b are formed on the outer peripheral surface of the sheath body 2a in the vicinity of the distal end portion. These wire lead-out ports 5a and 5b are the sheath body 2a.
It is arranged at two front and rear positions along the axial direction of. Further, the conductive wire 4 inserted into the inner cavity 3a of the insertion portion 1
Of the wire is led out to the outside of the sheath body 2a through the two wire lead-out ports 5a and 5b, and the wire exposed portion 4a exposed to the outside of the sheath body 2a forms a knife portion 6 for high-frequency incision. It is like this.

When the high-frequency cutting device for an endoscope is used, the conductive wire 4 is pulled to bend the distal end of the sheath body 2a and expose the wire exposed portion 4a on the outside of the sheath body 2a. To form the knife portion 6. Further, by the above-mentioned operation, a high-frequency current is passed through the conductive wire 4 in a state where the knife portion 6 formed at the distal end portion of the sheath body 2a is brought into contact with the living tissue to be treated, so that the knife portion 6 causes the living body to move. The tissue is incised.

Such an incision device is, for example, a papillary sphincterotomy (hereinafter referred to as EST) for incising the sphincter at the end of the bile duct when the outlet of the bile duct that carries bile to the duodenum is narrowed by a tumor or stone. Used.

Here, when inserting the insertion portion 1 of the incision device into the bile duct from the papilla, it is confirmed under fluoroscopy that the distal end position of the sheath body 2a is surely inserted into the bile duct. It is necessary to accurately confirm where in the bile duct the tip position of the sheath body 2a is located. Therefore, the X-ray opaque ring 7 is placed in the lumen 3b of the sheath body 2a for forming the liquid supply path at the distal end portion of the insertion portion 1 of the incision device.
Is arranged, and the position of the X-ray opaque ring 7 is confirmed under fluoroscopy, whereby the tip position of the sheath body 2a is accurately confirmed.

Further, in order to improve the insertability of inserting the insertion portion 1 of the incision device into the bile duct, a guide wire is provided in the lumen 3b for forming the liquid supply path of the sheath body 2a of the insertion portion 1 of the incision device. There is a case where the sheath main body 2a is inserted while being inserted through the guide wire and guided by the guide wire.

Before performing EST, a contrast agent is injected into the bile duct through the lumen 3b of the sheath body 2a of the insertion section 1 of the incision device to observe the bile duct morphology under fluoroscopy. There is also.

[0011]

In the above-mentioned conventional structure, the X-ray radiation is not provided in the inner cavity 3b of the sheath body 2a at the distal end portion of the insertion portion 1 of the incision device for forming the liquid supply path. Since the inner peripheral portion of the transmission ring 7 is projected into the inner cavity 3b, the guide wire is pulled to the protruding portion of the inner peripheral portion of the X-ray opaque ring 7 when the guide wire is inserted into the inner cavity 3b. Therefore, there is a risk that the guide wire may be inserted incorrectly.

Further, since the area of the liquid supply path of the lumen 3b for forming the liquid supply path of the sheath body 2a is smaller at the portion of the X-ray impermeable ring 7 than the other portions and is narrowed, the liquid supply is reduced. There is also a problem that causes a decrease in contrast agent injection ability when injecting a contrast agent through the channel forming lumen 3b.

Further, in order to solve the above-mentioned problems, the disposition of the X-ray impermeable ring 7 in the lumen 3b for forming the liquid feeding path of the sheath body 2a is abolished, and instead, the actual flat opening is performed. It is conceivable to apply the X-ray contrasting catheter disclosed in JP-A-5-21960 to the sheath body 2a of the incision device.

However, in this case, since the radiopaque sheath is much more expensive than the radiopaque sheath, it is difficult to manufacture the entire incision device at low cost. .

In USP 5,256,158, a ring which is mounted in the lumen like the X-ray opaque ring 7 of this incision device and the inner peripheral surface of the tubular body such as the sheath body 2a. A technique is disclosed in which the boundary between the ring and the inner peripheral surface of the tubular body is smoothed so that there is no step at the boundary.

However, the above USP 5,256,1
Since the processing technique for a single tube such as 58 is difficult to apply to the multi-lumen tube (perforated tube) used as the sheath body 2a of the insertion portion 1 of this incision device, in the case of a multi-lumen tube, the sheath body 2a X-ray opaque ring 7 disposed in the inner cavity 3b for forming a liquid supply path
The boundary between the inner wall surface of the inner cavity 3b and
There is a problem that it is difficult to make the surface smooth by the processing techniques of 256 and 158.

The present invention has been made in view of the above circumstances, and an object thereof is to cause a poor guidewire insertion when the guidewire is inserted into the lumen of the sheath body having a plurality of lumens formed therein. Another object of the present invention is to provide a high-frequency endoscopic incision device for an endoscope that is inexpensive and easy to manufacture by preventing a decrease in contrast agent injection ability when injecting a contrast agent through this lumen.

[0018]

SUMMARY OF THE INVENTION According to the present invention, a plurality of lumens extending in the axial direction are formed in a sheath body of an electrically insulating sheath, and a conductive wire is inserted through one lumen to conduct electricity. Wire insertion lumen and a multipurpose lumen into which a guide wire is inserted and / or a liquid is injected by another lumen, and a wire formed on the outer peripheral surface near the distal end of the sheath body. The high-frequency incision device for an endoscope in which the conductive wire is led out to the outside of the sheath body from an outlet and an exposed portion of the conductive wire on the outside of the sheath body forms a knife portion for high-frequency incision. The X-ray opaque member is disposed in at least one of the lumens of the sheath body other than the lumen forming the multipurpose lumen.

[0019]

The radiopaque member is provided in at least one of the lumens of the sheath body other than the lumen forming the multipurpose lumen, and the guidewire of the incision device is inserted or the liquid is injected. By eliminating the step due to the X-ray opaque member in the lumen, the insertion of the guide wire and the injection of the liquid are prevented.

[0020]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows the overall appearance of a high-frequency incision apparatus 11 for an endoscope, which uses a high-frequency current to incise a living tissue in a body cavity, particularly a duodenal papillary sphincter (so-called EST).

The high frequency incision device 11 for an endoscope has an insertion portion 13 to be inserted into a patient's body through a treatment instrument insertion channel (not shown) of an endoscope 12 (see FIGS. 3 to 8) and a base of the insertion portion 13. An operating section 14 on the proximal side, which is disposed on the end side and is used by an operator outside the patient's body to operate the incision device 11.
It consists of and.

Further, the insertion portion 13 of the incision device 11 is shown in FIG.
As shown in (A), an electrically insulating sheath 15 is provided. The sheath body 15a of the electrically insulating sheath 15 is formed by a 4-lumen flexible perforated tube made of a thermoplastic resin, particularly fluororesin such as PTFE or FEP.

That is, FIG.
As shown in (B), the wire lumen (lumen) 17a for inserting the conductive wire 16 and the guide wire 18 (see FIG. 8) may be inserted and / or the liquid (particularly the contrast agent) may be injected. A multipurpose lumen (inner cavity) 17b having a sufficient inner diameter and two thinned lumens (inner cavity) 17c for imparting flexibility to the sheath body 15a are provided, each extending in the axial direction. It is set up.

Here, as shown in FIG. 2A, the conductive wire 16 is inserted into the wire lumen 17a in the sheath body 15a, and the guide wire 18 is inserted into the multipurpose lumen 17b, or a liquid is used. A liquid supply path for injecting is formed.

Two wire outlets 19a and 19b communicating with the wire lumen 17a are formed on the outer peripheral surface of the sheath body 15a in the vicinity of the distal end. These wire lead-out ports 19a and 19b are arranged at two front and rear positions along the axial direction of the sheath body 15a.

Further, the tip of the conductive wire 16 inserted into the wire lumen 17a of the sheath body 15a has two ends.
From the wire outlets 19a and 19b to the sheath body 15a
The wire exposure portion 16a that is led out to the outside of the sheath body 15a and is exposed to the outside of the sheath body 15a forms the knife portion 20 for high-frequency incision.

The conductive wire 16 is a flexible wire made of metal, particularly stainless steel. The tip of the conductive wire 16 is inserted into the inner cavity of an X-ray opaque pipe (X-ray opaque member) 21 made of metal, particularly stainless steel, gold, silver, platinum, or tungsten, and fixed. It is fixed by means of an agent (especially soldering, brazing, adhesion) or welding (especially laser welding, plasma welding).

Further, the outer diameter of the X-ray impermeable pipe 21 is set to be slightly larger than the inner diameter of the wire lumen 17a of the sheath body 15a. The X-ray opaque pipe 21 is connected to the front wire outlet 1
It is fixed to the wire lumen 17a further on the tip side than 9a by means such as press fitting or adhesion.

Further, a thin diameter portion 15b having an outer diameter dimension D ₂ smaller than the outer diameter dimension D ₁ of the intermediate portion of the sheath body 15a is formed at the most distal end portion of the sheath body 15a. The small diameter portion 15b is formed, for example, by heating the distal end portion of the sheath body 15a and narrowing it down into the die.
At this time, the tip openings of the wire lumen 17a and the two lightening lumens 17c are closed or in a state close to the closure, and only the tip openings of the multipurpose lumen 17b are opened.

Further, as shown in FIG. 1, a marking portion 22 is provided on the outer peripheral surface of the distal end portion of the sheath body 15a. In the marking portion 22, a plurality of red markings 22a ... Black markings 22b ... Are alternately arranged at equal intervals along the axial direction of the sheath body 15a.

Next, the operating portion 14 of the lancing device 11 will be described. The operation portion 14 is provided with a substantially Y-shaped connecting member 23 as shown in FIG. 2 (C). A common connecting portion 23a is provided on the front end side of the connecting member 23, and a pair of branch connecting portions 23b, 2 is provided on the rear end side.
3c is provided. The base end side of the insertion portion 13 is connected to the common connection portion 23a.

Further, one branch connecting portion 2 of the connecting member 23.
An operation section body 24 is fixed to 3b. A slider 25 is mounted on the operation section body 24 so as to be movable in the longitudinal direction of the operation section body 24. Further, the base end of the conductive wire 16 is fixed to the slider 25 via a conductive operation pipe 26 and a conductive plug 27.

As shown in FIG. 2D, the connecting member 23 has an operation pipe lumen 28 which communicates with the wire lumen 17a of the sheath body 15a and a branch multipurpose lumen which communicates with the multipurpose lumen 17b of the sheath body 15a. And 29 are formed. Here, the operation pipe lumen 28 is arranged on one side of the branch connecting portion 23b of the connecting member 23, and the branch multipurpose lumen 29 is arranged on the other side of the connecting member 23 branch connecting portion 23c. Further, a base 30 for detachably fixing the syringe barrel is provided at the end of the branched multipurpose lumen 29.

Next, the operation of the high-frequency endoscopic cutting device 11 having the above-mentioned structure will be described. First, when the endoscope high-frequency incision device 11 is not used, the slider 25 of the operating portion 14 is held at the standby position moved to the front end side with respect to the operating portion main body 24. At this time, the sheath body 15a
The front end of the is held in a state of being stretched in a substantially straight line.

In this state, as shown in FIG. 3, the insertion portion 13 of the incision device 11 is inserted into the treatment instrument insertion channel (not shown) of the endoscope 12 previously inserted in the duodenum 41, and the endoscope 12 is inserted. The insertion portion 13 of the incision device 11 is projected to the outside from the distal end opening of the treatment instrument insertion channel.

Subsequently, the distal end of the insertion portion 13 of the incision device 11 is moved to the papilla by bending the endoscope 12, operating the treatment instrument raising device, or pushing and pulling the entire insertion portion 13 of the incision device 11. It is inserted from 42 into the bile duct 43.

Thereafter, if necessary, an unillustrated injection cylinder is attached to the mouthpiece 30 on the side of the branch connecting portion 23c of the connecting member 23. Then, the contrast medium injected from this injection cylinder is sent into the bile duct 43 through the branch multipurpose lumen 29 and the multipurpose lumen 17b of the sheath body 15a, and the inside of the bile duct 43 is imaged.

Next, under X-ray see-through, the sheath body 15a
The position of the X-ray opaque pipe 21 at the distal end of the sheath main body 15a is checked to see if the distal end of the sheath body 15a is securely inserted into the bile duct 43. Alternatively, when the inside of the bile duct 43 is filled with a contrast agent, the portion of the sheath body 15a is not imaged under fluoroscopy, and therefore the position of the silhouette of the sheath body 15a is confirmed to check the sheath body 15a.
Check the position of the tip of.

Here, after confirming that the distal end of the sheath body 15a has entered the bile duct 43, the sheath body 1
The insertion depth of the sheath body 15a into the teat 42 is adjusted using the marking portion 22 on the outer peripheral surface of the distal end portion of 5a as a guide.

Next, the slider 25 of the operating portion 14 is moved to the rear end side with respect to the operating portion main body 24. This slider 2
Since the conductive wire 16 is pulled toward the operator's side with the operation of 5, the distal end portion of the sheath body 15a is curved in a substantially arc shape as shown in FIG.
The wire exposed portion 16a exposed to the outside of the wire 5a is stretched in a chord shape of a bow to form the knife portion 20.

As another method, when the slider 25 of the operating portion 14 is moved to the tip side with respect to the operating portion main body 24, the conductive wire 16 is pushed as shown in FIG.
The arc-shaped knife portion 20 is formed.

Further, after forming the knife portion 20 in the shape of a chord of a bow or in the shape of an arc, a high frequency current is passed through the knife portion 20 to incise the papillary sphincter. After the incision is completed, the slider 25 is returned to the original position and is pulled out from the treatment instrument insertion channel of the endoscope 12.

Next, the incision device 11 is attached to the guide wire 1.
An example of the method used in combination with No. 8 will be described. First,
As shown in FIG. 5, an imaging catheter 51 is inserted into a treatment instrument insertion channel (not shown) of the endoscope 12 which is previously inserted into the duodenum 41, and the distal end opening of the treatment instrument insertion channel of the endoscope 12 is inserted. The tip of the catheter 51 is projected.

Next, the distal end portion of the catheter 51 is moved from the papilla 42 to the bile duct 43 by bending the endoscope 12, operating the treatment instrument raising device, or pushing and pulling the catheter 51.
Insert inside. Then, a contrast agent is injected from the proximal end of the catheter 51 to image the inside of the bile duct 43.

After imaging, the guide wire 18 is inserted from the proximal end of the catheter 51 into the lumen of the catheter 51, and the distal end of the guide wire 18 is inserted from the distal end of the catheter 51 into the bile duct 43 as shown in FIG. Make it protrude.

Next, as shown in FIG.
Is left in the bile duct 43, only the catheter 51 is removed from the treatment tool insertion channel of the endoscope 12. Further, after removing the catheter 51, the proximal end portion of the guide wire 18 is inserted into the distal end opening portion of the multipurpose lumen 17b of the sheath body 15a of the incision device 11, and along the guide wire 18, the insertion portion of the incision device 11 is inserted. 13 is inserted into the treatment instrument insertion channel of the endoscope 12, and the bile duct 4 is inserted as shown in FIG.
It is made to project in 3.

The guide wire 18 is left in the bile duct 43 with the insertion portion 13 of the incision device 11 left inserted.
Only the chisel is removed from the treatment instrument insertion channel of the endoscope 12. After that, the knife portion 20 is formed into a chordal shape of a bow or an arc shape in the same manner as described above, and then the knife portion 20 is formed.
Apply a high-frequency current to the incision of the papillary sphincter.

Therefore, the following effects are obtained with the above-mentioned structure. That is, since the X-ray opaque pipe 21 of the incision device 11 is fixed not in the multipurpose lumen 17b of the sheath body 15a but in the wire lumen 17a, the X-ray opaque pipe 21 is inside the multipurpose lumen 17b.
There is no step formed by. Therefore, the guide wire 1 is inserted into the multipurpose lumen 17b of the sheath body 15a.
When inserting the guide wire 18, there is no risk that the guide wire 18 will be caught in the step due to the X-ray opaque pipe 21, and the occurrence of defective insertion of the guide wire 18 can be prevented.

Further, since the area of the multi-purpose lumen 17b of the sheath body 15a in the liquid feeding path is smaller in the portion of the X-ray opaque pipe 21 than in the other portions and there is no possibility of being squeezed, an image is imaged through the multi-purpose lumen 17b. It is also possible to prevent the contrast agent injecting ability from being lowered when injecting the agent.

Further, since the pipe is used as the X-ray opaque member and the X-ray opaque pipe 21 also serves to fix the conductive wire 16 to the sheath body 15a, it can be manufactured at a low cost. Is.

Since the X-ray opaque pipe 21 is fixed to the sheath body 15a by means of press-fitting, adhesion or the like, the entire high-frequency incision device 11 for an endoscope can be easily assembled.

Further, FIGS. 9A and 9B show the second embodiment of the present invention.
FIG. 9 (A) and 9 (B)
In the figure, parts having the same configurations as those of the first embodiment are designated by the same reference numerals, and the description thereof will be omitted.

That is, in this embodiment, the sheath body 15a of the insertion portion 13 of the high-frequency incision device 11 for an endoscope has a flexible two-lumen porous body made of a thermoplastic resin, particularly PTFE or FEP. It is formed by a tube.

That is, FIG.
As shown in (B), the wire lumen (lumen) 17a for inserting the conductive wire 16 and the guide wire 18 (see FIG. 8) may be inserted and / or the liquid (particularly the contrast agent) may be injected. A multipurpose lumen (lumen) 17b having a sufficient inner diameter is provided, and each extends in the axial direction.

The tip of the conductive wire 16 is inserted into the inner cavity of a tubular X-ray opaque tip 61 made of metal, particularly stainless steel, gold, silver, platinum, or tungsten, and the adhesive ( In particular, they are fixed by means such as soldering, brazing, adhesion, or welding (in particular, laser welding and plasma welding).

Further, on the outer peripheral surface of the X-ray opaque chip 61, an X-ray opaque chip fixing portion 62 having a wedge-shaped step having a substantially saw-tooth cross section is formed. Here, the maximum outer diameter portion of the X-ray opaque tip fixing portion 62 on the outer peripheral surface of the X-ray opaque tip 61 is the wire lumen 17a of the sheath body 15a.
It is set to be slightly larger than the inner diameter dimension of. The X-ray opaque tip 61 has a wire lumen 17 that is located further toward the tip side than the wire lead-out port 19a on the front side.
It is fixed in a by means such as press fitting or adhesion.

The method of fixing the radiopaque tip 61 and the sheath body 15a is as follows. That is, first, the distal end portion of the wire lumen 17a of the sheath body 15a is expanded by thermoforming so that the inner diameter of the distal end portion of the wire lumen 17a is substantially the same as the maximum outer diameter portion of the radiopaque tip 61, and then the radiopaque tip 61 is attached to the wire. Insert in the lumen 17a. continue,
It is fixed by heating the tip portion of the sheath body 15a, squeezing it into the die, and closing the tip of the sheath body 15a.

The method of fixing the X-ray opaque tip 61 and the sheath body 15a is not particularly limited to the fixing method described here, and means such as press fitting or adhesion may be used. I don't care.

Therefore, the following effects can be obtained with the above-mentioned structure. That is, since the X-ray opaque tip 61 of the incision device 11 is fixed not in the multipurpose lumen 17b of the sheath body 15a but in the wire lumen 17a, the X-ray opaque tip 61 is fixed in the multipurpose lumen 17b.
There is no step formed by. Therefore, the guide wire 1 is inserted into the multipurpose lumen 17b of the sheath body 15a.
When inserting the guide wire 18, there is no risk that the guide wire 18 will be caught by the step due to the X-ray opaque tip 61, and the occurrence of defective insertion of the guide wire 18 can be prevented.

Further, the area of the liquid feeding path of the multipurpose lumen 17b of the sheath body 15a is smaller in this X-ray opaque tip 61 than in other parts, and there is no possibility of being squeezed. It is also possible to prevent the contrast agent injecting ability from being lowered when injecting the agent.

Further, as the X-ray opaque member, since the pipe-shaped member in which the X-ray opaque tip fixing portion 62 having a step on the outer diameter portion is formed is adopted, the sheath main body is more than the first embodiment. The X-ray opaque chip 61 is securely fixed to the 15a.

Further, since the X-ray opaque tip 61 also serves to fix the conductive wire 16 to the sheath body 15a,
It can be manufactured at low cost. Further, the X-ray opaque tip 61 is fixed to the sheath body 15a by fixing it to the sheath body 1
Since the method is performed by expanding the wire lumen 17a of 5a by thermoforming, or by means such as press-fitting or adhesion, the entire high-frequency incision device 11 for an endoscope can be easily assembled.

Further, FIGS. 10A to 10C show a third embodiment of the present invention. This is because the distal end portions of the two lightening lumens 17c of the sheath body 15a in the insertion portion 13 of the high frequency incision device 11 for an endoscope of the first embodiment are made of metal, particularly stainless steel, gold, silver, An X-ray opaque rod 71 made of platinum or tungsten is inserted. The outer diameter of the X-ray opaque rod 71 is set to be slightly smaller than the inner diameter of the lightening lumen 17c.

The outer peripheral surface of the sheath body 15a is shown in FIG.
As shown in FIG. 0 (C), a thinned lumen 17 is formed from the outer peripheral surface of the sheath body 15a on both sides of the insertion portion of the X-ray opaque rod 71.
An opening 72 that is open toward c is formed. An edge portion 73 of the opening 72 is provided so as to project inside the lightening lumen 17c, and the edge portions 73 of the opening 72 allow the lightening lumen 17 of the X-ray opaque rod 71 to be removed.
It is designed to prevent movement within c.

The edge 73 of the opening 72 can be easily manufactured by making a hole from the outer peripheral surface of the sheath body 15a toward the thinned lumen 17c with a sharp object such as a needle. The X-ray opaque rod 71 may be inserted into both of the two thinned lumens 17c or one of them.

Therefore, the following effects can be obtained with the above-mentioned structure. That is, since the X-ray opaque pipe 21 of the incision device 11 is inserted in the wire lumen 17a and the X-ray opaque rod 71 is inserted in the thinned lumen 17c, the multipurpose lumen 17b of the sheath body 15a. No step is formed inside the X-ray opaque pipe 21. Therefore, similar to the first embodiment, when the guide wire 18 is inserted into the multipurpose lumen 17b of the sheath body 15a, the guide wire 18 may be caught by the step due to the X-ray impermeable pipe 21 and the X-ray impermeable rod 71. Therefore, it is possible to prevent the occurrence of defective insertion of the guide wire 18.

Further, the multipurpose lumen 17b of the sheath body 15a has an X-ray opaque pipe 21 and an X-ray opaque rod 71.
Since such an X-ray opaque member is not inserted, there is no possibility that the area of the liquid supply path of the multipurpose lumen 17b is restricted by this X-ray opaque member. Therefore, it is possible to prevent deterioration of the contrast agent injection capability when injecting the contrast agent through the multipurpose lumen 17b.

In addition to the X-ray opaque pipe 21, X
By adopting the radiopaque rod 71, the X-ray is better reflected than in the first embodiment, and the incision device 1 under X-ray fluoroscopy.
The tip position of No. 1 can be easily confirmed.

Since a pipe and a rod are used as the X-ray opaque member, and the X-ray opaque pipe 21 also serves to fix the conductive wire 16 to the sheath body 15a, it can be manufactured at a low cost. Is possible.

Further, since the X-ray opaque pipe 21 and the X-ray opaque rod 71 are fixed to the sheath body 15a by means of press fitting, adhesion, punching or the like, the incision device 11 can be easily assembled. It can be carried out.

11A and 11B show the fourth embodiment of the present invention. This is made of metal, in particular, on the distal end side of the X-ray opaque pipe 21 inside the wire lumen 17a at the distal end of the sheath body 15a in the insertion portion 13 of the high frequency incision device 11 for an endoscope of the first embodiment. , Gold, silver, platinum, tungsten powder,
An X-ray opaque portion 81 is formed by injecting an adhesive, in particular, a paste-like material mixed with a silicon-based material and curing it.

Therefore, the following effects can be obtained with the above configuration. That is, since the X-ray opaque pipe 21 and the X-ray opaque portion 81 of the incision device 11 are inserted into the wire lumen 17a, not inside the multipurpose lumen 17b of the sheath body 15a, the X inside the multipurpose lumen 17b.
No step is formed by the radiopaque pipe 21 and the X-ray opaque portion 81. Therefore, as in the first embodiment, when the guide wire 18 is inserted into the multipurpose lumen 17b of the sheath body 15a, the guide wire 18 may be caught by the step due to the X-ray opaque pipe 21 and the X-ray opaque portion 81. Therefore, it is possible to prevent the occurrence of defective insertion of the guide wire 18.

Further, the multipurpose lumen 17b of the sheath body 15a is provided with an X-ray opaque pipe 21 and an X-ray opaque rod 71.
Since such an X-ray opaque member is not inserted, there is no possibility that the area of the liquid supply path of the multipurpose lumen 17b is restricted by this X-ray opaque member. Therefore, it is possible to prevent deterioration of the contrast agent injection capability when injecting the contrast agent through the multipurpose lumen 17b.

In addition to the X-ray opaque pipe 21, X
By adopting the radiopaque portion 81, the X-ray is better reflected than in the first embodiment, and the incision device 1 under X-ray fluoroscopy is adopted.
The tip position of No. 1 can be easily confirmed.

Further, since a pipe or paste is used as the X-ray opaque member and the X-ray opaque pipe 21 also serves to fix the conductive wire 16 to the sheath body 15a, it is inexpensive. It is possible to manufacture.

The X-ray opaque pipe 21 is fixed to the sheath body 15a by means of press-fitting or adhesion, and the X-ray opaque portion 81 is formed only by injecting a paste-like material. The incision device 11 can be easily assembled.

The present invention is not limited to the above embodiments, and it goes without saying that various modifications can be made without departing from the gist of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows.

(Additional Item 1) A first lumen through which a conductive wire is inserted and a second lumen through which a guide wire is inserted and / or a liquid is injected
An electrically insulative sheath having at least two or more lumens including an lumen, and a high frequency wave for an endoscope in which the wire is exposed from a wire outlet near the distal end of the sheath to an outer wall surface of the sheath to form a knife portion. In the incision device, an X-ray opaque member is disposed in an inner cavity of the sheath other than the second inner cavity in the vicinity of the distal end portion of the sheath. Incision device.

(Additional Item 2) Electricity having at least two or more lumens including a first lumen through which a conductive wire is inserted and a second lumen through which a guide wire is inserted and / or a liquid is injected. An insulative sheath and a high-frequency endoscopic incision device for an endoscope, which forms a knife portion by exposing the wire from a wire outlet near the sheath distal end to a sheath outer wall surface to form a knife portion of the sheath. A high-frequency incision device for an endoscope, wherein an X-ray opaque member is arranged in a first lumen of the lumen through which a conductive wire is inserted.

(Additional Item 3) Includes a first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and a third lumen through which nothing is inserted. An electric insulating sheath having at least three or more lumens, and a high-frequency endoscopic incision device for an endoscope, wherein the wire is exposed from a wire outlet near the distal end of the sheath to a sheath outer wall surface to form a knife portion. A high-frequency incision device for an endoscope, wherein an X-ray opaque member is disposed in an inner cavity of the sheath other than the second inner cavity in the vicinity of the distal end portion of the sheath.

(Additional Item 4) Includes a first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and a third lumen through which nothing is inserted. An electric insulating sheath having at least three or more lumens, and a high-frequency endoscopic incision device for an endoscope, wherein the wire is exposed from a wire outlet near the distal end of the sheath to a sheath outer wall surface to form a knife portion. A high-frequency incision device for an endoscope, wherein an X-ray opaque member is disposed in a first lumen of the lumen near the distal end of the sheath, through which a conductive wire is inserted.

(Additional Item 5) Includes a first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and a third lumen through which nothing is inserted. An electric insulating sheath having at least three or more lumens, and a high-frequency endoscopic incision device for an endoscope, wherein the wire is exposed from a wire outlet near the distal end of the sheath to a sheath outer wall surface to form a knife portion. An endoscopic high-frequency incision device, wherein an X-ray opaque member is arranged in a third inner cavity of the sheath in the vicinity of the distal end of the sheath, through which nothing is inserted.

(Additional Item 6) Includes a first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and a third lumen through which nothing is inserted. An electric insulating sheath having at least three or more lumens, and a high-frequency endoscopic incision device for an endoscope, wherein the wire is exposed from a wire outlet near the distal end of the sheath to a sheath outer wall surface to form a knife portion. Among the inner cavities of the sheath in the vicinity of the distal end portion of the sheath, a radiopaque member is provided in a first inner cavity through which a conductive wire is inserted and a third inner cavity through which nothing is inserted. High-frequency incision device for endoscopes.

(Additional Item 7) A first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and two third lumens through which nothing is inserted. An electrically insulating sheath having four lumens including: and a high-frequency incision device for an endoscope, wherein the wire is exposed from a wire outlet near the sheath tip to an outer wall surface of the sheath to form a knife portion. Of the lumen of the sheath near the distal end of the first lumen through which the conductive wire is inserted,
A high-frequency incision device for an endoscope, which is provided with an X-ray opaque member.

(Additional Item 8) A first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and two third lumens through which nothing is inserted. An electrically insulating sheath having four lumens including: and a high-frequency incision device for an endoscope, wherein the wire is exposed from a wire outlet near the sheath tip to an outer wall surface of the sheath to form a knife portion. A high-frequency incision device for an endoscope, wherein an X-ray opaque member is provided in at least one of two third lumens through which nothing is inserted, in the vicinity of the distal end of the sheath. .

(Additional Item 9) A first lumen through which a conductive wire is inserted, a second lumen through which a guide wire is inserted and / or a liquid is injected, and two third lumens through which nothing is inserted. An electrically insulating sheath having four lumens including: and a high-frequency incision device for an endoscope, wherein the wire is exposed from a wire outlet near the sheath tip to an outer wall surface of the sheath to form a knife portion. A first lumen, of the lumens of the sheath, in the vicinity of the distal end of the
At least one of the two third lumens, through which nothing is inserted,
A high-frequency incision device for an endoscope, which is provided with an X-ray opaque member.

(Additional Item 10) The high-frequency incision device for an endoscope according to Additional Items 1 to 9, wherein the X-ray opaque member is made of metal. (Additional Item 11) The radiofrequency incision device for an endoscope according to Additional Items 1 to 9, wherein the X-ray opaque member is made of a metal pipe.

(Additional Item 12) The high-frequency incision device for an endoscope according to Additional Items 1 to 9, wherein the X-ray opaque member is made of metal and has a pipe shape having a step on the outer diameter portion. (Additional Item 13) The radiofrequency incision device for an endoscope according to Additional Items 1 to 9, wherein the X-ray opaque member is made of a metal rod. (Additional Item 14) The radiofrequency incision device for an endoscope according to Additional Items 1 to 9, wherein the X-ray opaque member contains at least a powdery metal.

[0089]

According to the present invention, among a plurality of lumens in the sheath body, at least one lumen other than the lumen forming the multipurpose lumen into which the guide wire is inserted and / or the liquid is injected. Since the X-ray opaque member is provided, when the guide wire is inserted into the inner lumen of the sheath body having a plurality of inner lumens, there is no risk of poor guide wire insertion and It is possible to prevent the deterioration of the contrast agent injection ability when injecting the contrast agent, and to inexpensively and easily manufacture.

[Brief description of drawings]

FIG. 1 is a schematic configuration diagram showing an external appearance of the entire high-frequency incision device for an endoscope according to a first embodiment of the present invention.

FIG. 2A is a vertical cross-sectional view showing the distal end portion of the insertion portion of the high-frequency dissection device, FIG. 2B is a cross-sectional view taken along line L ₁ -L _{1 of} FIG.
(C) is a longitudinal cross-sectional view showing an operating portion on the proximal side of the high-frequency incision device, and (D) is a longitudinal cross-sectional view of a main portion showing a connecting portion between the end portion of the conductive wire and the operation pipe of the slider.

FIG. 3 is a vertical cross-sectional view showing a state in which a distal end portion of an incision device which is projected from a distal end opening portion of an endoscope inserted into the duodenum is inserted into the bile duct from the papilla.

FIG. 4 is a vertical cross-sectional view showing a state where an arc-shaped knife portion is formed by a conductive wire.

FIG. 5 is a vertical cross-sectional view for explaining the operation of injecting a contrast agent into the bile duct through the catheter with the distal end portion of the catheter inserted into the bile duct from the papilla.

FIG. 6 is a vertical cross-sectional view showing a state where a guide wire is projected from the distal end of the catheter into the bile duct.

FIG. 7 is a vertical cross-sectional view showing a state in which only the catheter is removed from the treatment tool insertion channel of the endoscope while the guide wire is left inside the bile duct.

FIG. 8 is a vertical cross-sectional view showing a state in which an incision device is inserted into a treatment tool insertion channel of an endoscope along a guide wire and is projected into a bile duct.

FIG. 9 shows a second embodiment of the present invention (A)
Longitudinal sectional view of the distal end of the insertion portion of the incision device, (B) is L ₁ -L ₁ line cross-sectional view of (A).

FIG. 10 shows a third embodiment of the present invention,
(A) is a longitudinal cross-sectional view showing the distal end portion of the insertion portion of the incision device,
(B) is a sectional view taken along line L ₁ -L ₁ of (A), and (C) is (B).
L ₂ -L ₂ cross-sectional view taken along a line.

FIG. 11 shows a fourth embodiment of the present invention,
(A) is a longitudinal cross-sectional view showing the distal end portion of the insertion portion of the incision device,
(B) is L ₁ -L ₁ line cross-sectional view of (A).

FIG. 12 is a vertical cross-sectional view of a main part showing a conventional example.

[Explanation of symbols]

15 ... Electrically insulating sheath, 15a ... Sheath body, 16 ...
Conductive wire, 19a, 19b ... Wire outlet, 20 ...
Knife part, 17 ... Outer lumen (X-ray opaque member), 17
a: wire lumen (lumen), 17b ... multipurpose lumen (lumen), 17c ... thinned lumen (lumen), 21 ... X
Radiopaque pipe (X-ray opaque member), 61 ... X-ray opaque tip (X-ray opaque member), 71 ... X-ray opaque rod (X-ray opaque member), 81 ... X-ray opaque portion ( X-ray opaque member).

Claims (1)

[Claims] 1. A plurality of lumens extending in the axial direction are formed in a sheath body of an electrically insulating sheath, and a conductive wire is inserted through one lumen, and a conductive wire insertion lumen or the like is formed. Insertion of a guide wire through one lumen,
And / or a multipurpose lumen into which a liquid is injected is formed, and the conductive wire is led out to the outside of the sheath body from a wire lead-out port formed in the outer peripheral surface near the tip of the sheath body. In a high-frequency incision device for an endoscope in which a knife portion for high-frequency incision is formed by an exposed portion of the conductive wire on an outer side of the sheath main body, the multipurpose lumen is formed in an inner cavity of the sheath main body. A radiofrequency incision device for an endoscope, wherein an X-ray opaque member is provided in at least one lumen other than the lumen.