JP2000342600A - Snare for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable the foolproof excision of even a lesion of a small- protuberance by fixing the base part of a puncture needle having a forwardly pointed front end to the base part of a snare wire and constituting the snare in such a manner that the front end of the puncture needle can be protruded from the front end of a sheath by advancing and retreating the puncture needle as well by the advance and retreat of the snare wire. SOLUTION: When using the snare for an endoscope, an operator pricks the puncture needle 4 into the root part of a polyp of a small protuberance. Since the snare wire 3 eventually exists in the state of enclosing the polyp 100, the polyp is protruded and the front end of the sheath 1 is bitten to the root of the polyp by pressing the front end of the sheath 1 to the polyp 100 in this state. A manipulation wire 2 is thereafter pulled and manipulated toward the operator side, by which the polyp 100 is tied into the snare wire 3. In succession, high-frequency current is passed to the snare wire 3, by which the root part of the polyp is cut by the effect of Joule heat and the polyp is excised.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a snare for an endoscope used to cut a polyp through a treatment tool insertion channel of the endoscope.

[0002]

2. Description of the Related Art In general, an endoscope snare has an operation wire inserted and disposed in a sheath so as to be able to advance and retreat in the axial direction, and a snare wire made of an elastic wire is connected to the tip of the operation wire. When the snare wire moves in and out of the sheath, the snare wire goes into and out of the distal end of the sheath, and the snare wire expands in a loop shape by its own elasticity outside the sheath and contracts by being drawn into the sheath.

[0003] However, with such a simple structure, it is not possible to bind and resect a small lesion with a small elevation or a small lesion without a projection. Therefore, conventionally, an injection needle is provided in a sheath of an endoscope snare having the structure described above so as to be able to advance and retreat in the axial direction independently of the snare wire. A so-called artificial polyp was made, and then the artificial polyp was excised with a snare wire (JP-A-5-2120).
No. 45, JP-A-9-173348 and the like).

[0004]

However, in such a conventional endoscope snare, since the injection needle and the snare wire operate independently of each other, the injection needle is retracted after the liquid is injected under the mucous membrane. Next, during the operation until the snare wire swells, the target position is displaced by the movement of the mucous membrane by the peristaltic movement or the operation movement, etc., and the operation of tightening the artificial polyp with the snare wire must be performed again from zero. In many cases, the operation was complicated.

Accordingly, an object of the present invention is to provide a snare for an endoscope which can easily bind and resect a small lesion or a small non-elevated lesion with a snare wire.

[0006]

In order to achieve the above object, an endoscope snare according to the present invention comprises a sheath in which an advancing / retreating member which is advanced / retracted in an axial direction by an operation from a hand side is inserted and arranged in a sheath. A snare wire made of an elastic wire is connected to the distal end of the advance / retreat member, and the snare wire moves in and out of the distal end of the sheath by moving the advance / retreat member back and forth in the axial direction. In a snare for an endoscope which is made to contract by being drawn into a sheath, a base of a puncture needle having a tip pointed forward is fixed to a base of the snare wire, and puncture is performed together with the advance and retreat of the snare wire. The needle is advanced and retracted so that the tip of the puncture needle can be projected from the tip of the sheath.

If the snare wire is formed of a conductive metal and a high-frequency current can be supplied to the snare wire from the proximal side of the sheath, a polyp or the like can be cut by Joule heat generated by the high-frequency current.

Further, if the advancing / retreating member is an operation wire, the structure is simple and the operation is easy. If the anti-slip irregularities are formed on the distal end surface of the sheath, the distal end surface of the sheath slides on the mucosal surface. Disappears.

Further, the puncture needle is an injection needle, and the advance / retreat member is a liquid sending pipe connected to the injection needle. The liquid can be sent from the proximal side of the sheath to the injection needle via the liquid sending pipe. By doing so, the lesion can be raised by injecting the liquid under the mucous membrane.

[0010] If the puncture needle is formed of a conductive metal so that a high-frequency current can be supplied to the puncture needle from the proximal side of the sheath, the puncture needle can be used to perform hemostatic treatment.

[0011]

Embodiments of the present invention will be described with reference to the drawings. 1 and 2 show a distal end portion of an endoscope snare according to a first embodiment of the present invention.
For example, it is a flexible sheath made of, for example, an electrically insulating tetrafluoroethylene resin tube, and is inserted into and removed from a treatment tool insertion channel of an endoscope (not shown).

An operating wire 2 made of a flexible conductive metal is inserted into the sheath 1 so as to be able to advance and retreat in the axial direction over the entire length thereof, and an operating portion (not shown) connected to the proximal end of the sheath 1. ) Is operated arbitrarily.

A snare wire 3 made of a conductive elastic wire is connected to a distal end portion of the operation wire 2 via a connection pipe 5. Specifically, the base of the snare wire 3 and the tip of the operation wire 2 are inserted into the connection pipe 5 from the front and back, and are integrally fixed by silver brazing or the like.

The snare wire 3 is made of, for example, a stranded wire or a single wire of a stainless steel wire, and forms a loop extending several centimeters as shown in FIG. 1 when no external force is applied. , It can be elastically deformed and contracted by applying an external force.

The base of the puncture needle 4 formed of, for example, a stainless steel wire having a pointed tip toward the front is inserted into the front half of the connection pipe 5 together with the base of the snare wire 3 and integrally fixed. ing.

Accordingly, when the operating wire 2 is advanced or retracted from the operating portion, the snare wire 3 moves in and out of the distal end of the sheath 1, and the snare wire 3 is formed outside the sheath 1 by its own elasticity as shown in FIG. And retracted into the sheath 1 to contract as shown in FIG.

The puncture needle 4 advances and retreats along with the snare wire 3 advances and retreats, and the tip of the puncture needle 4 protrudes and retracts from the tip of the sheath 1. Since the puncture needle 4 is formed shorter than the snare wire 3, the needle tip is always inside the snare wire 3. In addition, a high-frequency current can be supplied to the snare wire 3 and the puncture needle 4 via the operation wire 2 from the proximal end side of the sheath 1.

FIG. 3 shows an example of a procedure for using the endoscope snare of the above embodiment. As shown in FIG. 3, the puncture needle 4 is pierced into the root portion of the small raised polyp 100. Then, the snare wire 3 is positioned so as to surround the polyp 100.

Next, as shown in (1), when the distal end of the sheath 1 is pressed against the polyp 100,
Rises, and the tip of the sheath 1 digs into the root of the polyp 100 and stabilizes.

After confirming that the distal end of the sheath 1 does not slip with respect to the polyp 100, by pulling the operation wire 2 toward the hand side, as shown in FIG.
The polyp 100 is tightened in the snare wire 3.

Therefore, when a high-frequency current is applied to the snare wire 3 in this state, the root of the polyp 100 is cut by Joule heat. Instead of using the high-frequency current, the snare wire 3 may be further tightened to mechanically cut the polyp 100.

As shown in FIG. 4, when the distal end surface of the sheath 1 is formed into, for example, a saw-toothed uneven surface, the sheath 1 becomes less slippery when pressed against the mucous membrane surface, thereby facilitating use. The irregularities may have other shapes.

FIG. 5 shows a state in which a polyp 100 is excised with a snare for an endoscope according to a second embodiment of the present invention. The only difference from the first embodiment is that a conductive material is used.

When the puncture needle 4 is punctured to the extent that the tip touches the blood vessel 101 at the center of the polyp 100, and a high-frequency current is applied, the blood vessel 101 is coagulated with protein. The polyp 100 can be cut mechanically without bleeding.

FIG. 6 shows the entire configuration of an endoscope snare according to a third embodiment of the present invention. FIG. 7 is a plan cross-sectional view of the distal end portion. The puncture needle 4 is formed in an injection needle shape by a pipe material, and a liquid feed tube 8 made of, for example, a tetrafluoroethylene resin tube is used instead of the operation wire 2. The conductive wire 9 passed through the inside of the liquid feeding tube 8 is connected to the snare wire 3. The sheath 1 and the snare wire 3 are the same as in the first embodiment.

The proximal end of the liquid supply tube 8 extends from the proximal end of the sheath 1 as described later, and supplies liquid to the puncture needle 4 from the proximal side through the liquid supply tube 8 to supply a needle like a syringe. Can be sent from the front.

An operation unit 10 connected to the proximal end of the sheath 1
A first finger hook 12 is formed at the proximal end of the operation unit main body 11, and a second finger 14 is provided on a slider 14 slidable along a slit 13 formed in the longitudinal direction of the operation unit main body 11.
Is formed.

FIG. 8 shows an engaging portion (a section taken along the line VIII-VIII) of the slider 14 with the operation section main body 11, and a liquid feed pipe that is directly connected to the liquid feed tube 8 inserted into the sheath 1. 8A is passed through the center position of the slot 13 (that is, the axis position of the operation section main body 11).

The base end of the liquid feed pipe 8A has a large outer diameter and is fitted into an insulator block 15 made of an electric insulating material. The insulator block 15 is held by the slider 14 in the slit 13 and has a syringe barrel receiving base 16 projecting from the liquid feed pipe 8A.

As shown in FIG. 9, the retaining plate 17 for preventing the liquid sending pipe 8A from coming off is shown in a section IX-IX in FIG.
A large hole through which the large diameter portion at the end of the liquid sending pipe 8A passes and a small hole which cannot pass through are formed with a continuous locking hole 17a.

Therefore, if the push button 18 attached to the outer end of the liquid feed pipe 8A is pressed, the large diameter portion at the end of the liquid feed pipe 8A passes through the locking hole 17a, and if not, the liquid feed pipe 8A Is caught by the locking hole 17a, and is fixed to the slider 14 via the insulator block 15.

The conductor block 19 into which the connection terminal 20 is screwed is made of a conductive metal, and is electrically connected to the conductive wire 9 via the liquid feed pipe 8A or directly. Therefore, by connecting the high-frequency power cord to the connection terminal 20, a high-frequency current can be supplied to the snare wire 3 via the conductive wire 9.

FIG. 10 schematically shows an example of a procedure for using the endoscope snare of the third embodiment described above. First, as shown in FIG. The puncture needle 4 is punctured.

Then, the snare wire 3 is connected to the polyp 100
When the physiological saline or the like is injected from the puncture needle 4 below the mucous membrane at the root of the polyp 100, the polyp 100 protrudes greatly as shown in FIG.

Then, as shown in FIG. 7, if the liquid feeding tube 8 is pulled toward the user, the puncture needle 4 is attached to the sheath 1.
And into the polyp 100 by the snare wire 3
Is tied up.

Accordingly, when a high-frequency current is applied to the snare wire 3 in this state, the root of the polyp 100 is cut by Joule heat. Instead of using the high-frequency current, the snare wire 3 may be further tightened to mechanically cut the polyp 100.

[0037]

According to the present invention, since the puncture needle advances and retreats as the snare wire advances and retreats, the snare wire is punctured with a puncture needle with a small lesion or a small non-elevated lesion. , It is possible to easily bind and resect a lesion that has been raised using a puncture needle with a snare wire.

[Brief description of the drawings]

FIG. 1 is a plan sectional view of a tip portion of a snare for an endoscope according to a first embodiment of the present invention in a state where a snare wire is projected.

FIG. 2 is a plan sectional view of a distal end portion of the snare for an endoscope according to the first embodiment of the present invention in a state in which a snare wire is drawn.

FIG. 3 is a schematic view illustrating a usage state of the endoscope snare according to the first embodiment of the present invention.

FIG. 4 is a perspective view of the endoscope snare according to the first embodiment of the present invention in a case where the distal end surface of the sheath has an uneven surface.

FIG. 5 is a plan sectional view of a use state of an endoscope snare according to a second embodiment of the present invention.

FIG. 6 is a plan view of an endoscope snare according to a third embodiment of the present invention.

FIG. 7 is a plan sectional view of a distal end portion of an endoscope snare according to a third embodiment of the present invention.

8 is a sectional view taken along line VIII-VIII in FIG.

9 is a sectional view taken along line IX-IX in FIG.

FIG. 10 is a schematic view illustrating a usage state of an endoscope snare according to a third embodiment of the present invention.

[Explanation of symbols]

 Reference Signs List 1 sheath 2 operation wire 3 snare wire 4 puncture needle 8 liquid sending tube 100 polyp

Claims (6)

[Claims] An advancing / retreating member, which is operated in an axial direction by an operation from a hand side, is inserted into a flexible sheath, and a snare wire made of an elastic wire is connected to a tip of the advancing / retreating member. By moving the member back and forth in the axial direction, the snare wire goes in and out of the distal end of the sheath, and the snare wire expands in a loop outside of the sheath due to its own elasticity and contracts by being pulled into the sheath. In a snare for an endoscope, a base of a puncture needle having a tip pointed forward is fixed to a base of the snare wire, and the puncture needle advances and retreats as the snare wire advances and retreats. An endoscope snare characterized in that a distal end of the snare can be made to protrude from a distal end of the sheath. 2. A snare for an endoscope according to claim 1, wherein said snare wire is formed of a conductive metal, and a high-frequency current can be supplied to said snare wire from a hand side of said sheath. 3. The reciprocating member is an operating wire.
Or the snare for an endoscope according to 2. 4. A snare for an endoscope according to claim 1, wherein irregularities for preventing slippage are formed on the distal end surface of said sheath. 5. The puncture needle is an injection needle, and the advance / retreat member is a liquid feed tube connected to the injection needle, and is connected to the injection needle from the proximal side of the sheath via the liquid feed tube. 3. The endoscope snare according to claim 1, wherein the liquid can be sent. 6. The puncture needle is made of a conductive metal, and a high-frequency current can be supplied to the puncture needle from the proximal side of the sheath.
The snare for an endoscope according to the above.