JP2001120561A - Treatment tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment tool for an endoscope having a simple structure which can surely pick an in-vivo tissue and adjust the sampling quantity of the tissue. SOLUTION: The treatment tool 10 for the endoscope comprises a cup 44 for removing the tissue having a pair of openable/closable half members 44a provided on a tip of an insertion part 14, and a suction tube 40 which is provided on the tip part of the insertion part 14 to fix the tissue by the suction force, the suction tube 40 is protruded from the cup 44, and disposed in the cup 44 in a retractable manner.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment tool, and more particularly to an endoscope which is used in combination with an endoscope and is suitable for cutting or collecting tissue in a body cavity of a patient or the like. The present invention relates to a treatment instrument.

[0002]

2. Description of the Related Art Examples of such an endoscope treatment instrument used for medical applications are disclosed in Japanese Patent Application No. 10-34784 and Japanese Unexamined Patent Application Publication No.
0-216148 and JP-A-11-9610.

[0003] Japanese Patent Application No. 10-34784 has an inner tube and an outer tube, a tissue excision means and a tip unit for aspirating a living tissue are provided at a distal end of the inner tube, and a suction is provided at a proximal end of the inner tube. There is disclosed an endoscope treatment tool which is provided with a means and is capable of cutting tissue sucked at a distal end portion of the inner tube by relative movement between the inner tube and the outer tube.

Further, Japanese Patent Application Laid-Open No. Hei 10-216148 discloses a forceps device in which forceps means and a snare means are arranged in an insertion shaft having a hollow structure.

[0005]

Problems to be Solved by the Invention Japanese Patent Application No. 10-34784 mentioned above.
The treatment tool for endoscope described in the item, since the resection means and the tip unit for sucking the tissue move simultaneously in the axial direction of the insertion portion,
It is difficult to adjust the amount of tissue resection. Also, since the tip unit is in a position hidden from the tip of the cutting means,
The target tissue is difficult for the operator to see, and the resection means hits the tissue before the distal end unit, so that it is difficult to reliably aspirate the target tissue.

In the forceps device described in Japanese Patent Application Laid-Open No. 10-216148, the tissue holding means is formed by a link-type metal holding mechanism, so that the insulating structure required when used together with the snare is used. To do so, an extremely complicated structure had to be adopted. In addition, in the case of a tissue that easily expands and contracts, it is disadvantageous in that the gripping means is slippery.

[0007] The present invention has been made in view of the above,
An object of the present invention is to provide a treatment tool for an endoscope which can reliably collect tissue in a body, can adjust the amount of tissue to be collected, and has a simple structure.

[0008]

According to the present invention, there is provided an endoscopic treatment instrument which solves the above-mentioned problems. The openable and closable tissue cutting means provided at the distal end of the insertion portion, and the tissue fixing means provided at the distal end of the insertion portion. Wherein the tissue fixing means is disposed in the tissue excision means so as to be able to advance and retreat.

[0009]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS <First Embodiment> A first embodiment of the present invention will be described with reference to FIGS. The treatment tool for an endoscope according to the first embodiment is suitable for use in combination with a flexible endoscope when removing a bladder tumor or the like, for example. The endoscope treatment tool 10 according to the present embodiment includes an operation unit 12 and an insertion unit 14. The operation section 12 has a ring 16 at one end on the hand side, an operation section main body 18 connected to the insertion section 14 at one end on the other end side, and a first slidable first operation section main body 18. A slider 20, a plug 22 disposed on the first slider 20 and connected to a power supply (not shown), and a slit 24 formed in the operation portion main body 18 along the axial direction and connected to the plug 22 And an operating rod 26. Also, the insertion portion 14
Is connected to the operating section main body 18 via a base 28, and the base 28 is connected to the second slider 30, the syringe mounting port 32, the syringe mounting port 32, and the second
And a slit 34 on which the slider 30 slides.

The insertion section 14 includes an operation wire 38 and a suction tube 40 slidably accommodated in an insertion section sheath 36 formed by covering the periphery of a coil 36a with an insulating coating 36b. The tube 40 forms a tissue fixing means for suction-fixing a living tissue by a suction force of a syringe, as described later. The distal end cover 42 is provided at the distal end of the insertion portion sheath 36 formed in the flexible structure as described above.
Is fixed, and a cup 44 forming a tissue resection means which can be freely opened and closed is attached to the inner surface side of the distal end cover 42.

The cup 44 forming the tissue resection means
Is provided with a pair of half pieces 44a having a similar structure to each other. Each half member 44a has a tip 4 formed in a hemispherical shape.
6, an intermediate portion 48 formed of an elastic plate-like arm,
And a rear end portion 50 formed in a semi-cylindrical shape, and the entirety thereof is formed from a suitable metal material such as stainless steel through an appropriate process such as stamping. When no external force is applied to each half member 44a of the cup 44, the intermediate portion 48 is deformed outward in an arc shape by the elastic force of the plate-like arm (FIGS. 2 and 3).

One end 4 of these half members 44a
6, a locking portion 52 is provided on a part of the outer surface, and the other half member 44a has a hole 54 through which the operation wire 38 is inserted.
Is provided. Also, on the operation unit side of the cup 44,
A disk-shaped spacer 56 made of a suitable insulating material such as PTFE or ceramic is fixed. The spacer 56 has a large-diameter opening 58 through which the suction tube 40 is inserted.
Is formed substantially at the center, and a small-diameter opening 60 through which the operation wire 38 is inserted is formed near the outer periphery.

The operation wire 38 is formed in a loop shape so as to surround the distal end portion on the cup 44 side, and the opening portion 60 of the spacer 56 and the half-piece member 44a are inserted from the insertion portion sheath 36.
Through the hole 54 in this order, and protrudes to the outer surface of the half piece member 44a. Further, the distal end portion 38a of the operation wire 38 passes through the locking portion 52 provided on the outer surface of the other half piece 44a of the cup 44 and the hole 54 of the half piece 44a that has passed earlier in this order, and passes through the cup 44. It is fixed to an intermediate portion of the operation wire 38 at a position adjacent thereto. On the other hand, the operation unit 1 of the operation wire 38
2 is fixed to the operation rod 26,
The cup 44 and the plug 22 are electrically connected via the operation wire 38.

Since the operation wire 38 is attached to the cup 44 and the operation rod 26 in this manner, the operation unit 1
When it is pulled to the second side, the two halves 44a of the cup 44 close the tip 46 thereof. By the pulling force of the scanning wire 38, each half member 44 a of the cup 44, which is normally urged to open its distal end 46, is connected to the operating wire 3.
The loop-shaped portion of the tip portion 8 is drawn down from the hole 54 formed in the one half member 44a as a base point, whereby the hemispherical tip portions 46 of the half members 44a are moved in a direction approaching each other. The cup 44 is closed.

In the endoscope treatment tool 10, the suction tube 40 is inserted into the cup 44 provided at the distal end 14a of the insertion portion 14 by forming the distal end 14a of the insertion portion 14 as described above. It can be slidably arranged.

The suction tube 40 is provided with the spacer 56 described above.
Is connected to the second slider 30 and the syringe mounting port 32 of the operation unit 12 through a large-diameter opening 58 formed at a substantially central portion of the operation unit 12. As a result, the second slider 30 moves relative to the insertion portion sheath 36 through the slit 34, so that the state in which the distal end protrudes from the distal end of the cup 44 and the state in which the second slider 30 is retracted into the cup 44. Can be moved freely. The lumen of the suction tube 40 communicates with a syringe mounting port 32 provided in the mouthpiece 28.

Next, the treatment tool 1 for an endoscope according to the present embodiment.
The operation of 0 will be described with reference to FIG. When excising or collecting the living tissue S in the body, a flexible endoscope or the like is placed in advance near a required part. Then, the insertion portion 14 of the endoscope treatment instrument 10 is inserted into the body cavity through the channel of the endoscope, and the cup 4 is inserted from the body tissue surface H side.
4 is brought closer to the living tissue S which is the target part.

Next, the first slider 20 of the operation section 12 is operated to open the cup 44, and a syringe (not shown) is attached to the syringe mounting port 32 of the operation section 12 with the cup 44 opened. After that, the second slider 30 is operated to cause the distal end of the suction tube 40 to protrude from the cup 44 so as to come into contact with the target biological tissue S. Then, by operating the syringe of the operation unit 12, the living tissue S is sucked into the distal end portion of the suction tube 40, and fixed in this state.

Further, the suction tube 40 is pulled into the cup 44. At this time, while adjusting the amount of retraction by adjusting the amount of movement of the suction tube 40, the
Is closed, and the living tissue S is excised from the living body by the cutting edge formed on the opposite edge of each half member 44a. When removing this living tissue, a high-frequency power source is connected to the plug 22,
The cutting may be performed while energizing the cup 44.

The treatment tool 10 for an endoscope according to this embodiment
Can be cut while pulling the living tissue S into the cup 44, so that the half member 44
A living tissue larger than the distal end portion 46a can be cut off, and a large living tissue can be cut at a time. In addition, since the living tissue S is sucked into the suction tube 40 and the living tissue S is fixed by the suction force of the suction tube 40, the living tissue S is less likely to slip at the time of resection,
Accordingly, the living tissue S can be easily and reliably fixed with a simple structure. Furthermore, the amount of retraction into the suction tube 40 can be adjusted arbitrarily, so that the amount of resection can be adjusted freely.

Further, since a high-frequency current can be supplied to the cup 44, even if the amount of the living tissue to be cut is increased, the cut can be reliably performed while stopping the blood.

<Second Embodiment> A second embodiment of the present invention will be described with reference to FIGS. In the following embodiments, the same members as those in the above-described embodiments are denoted by the same reference numerals, and detailed description thereof will be omitted.

The treatment tool 110 for an endoscope according to the present embodiment.
In the embodiment, two O-rings 70 and 72 are provided in a sliding lumen of the suction tube 140 in the mouthpiece portion 128, and a peripheral wall portion of a portion of the suction tube 140 disposed between the two O-rings 70 and 72 is provided. The opening 74 is formed, and the syringe mounting portion 76 is provided in the mouth portion 128, whereby one continuous lumen is formed by the lumen of the suction tube 140 and the mouth of the mouth portion 128. This suction tube 140
The rear end is connected to the operating rod 26.

At the distal end of the insertion portion 14, a cup 144 is formed slidably with respect to the distal end cover 42. That is, the rear end portion 150 formed in a semi-cylindrical shape of each half member 144a is fixed to the front end portion or the outer peripheral portion of the spacer 156, and together with this spacer 156, each half member 144a slides in the axial direction with respect to the front end cover 42. It is free.

The suction member 7 connected to the distal end of the suction tube 140 is provided in the cup 144 thus formed.
The suction tube 140 and the suction member 78 are slidably provided with respect to the insertion portion sheath 36 or the coil 36a. The suction member 78 has a small diameter portion 78a on the side close to the suction tube 140, and the small diameter portion 78a is
After being slidably inserted into the central opening 158 of the sixth, it is connected to the suction tube 140.

In this embodiment, the distal end of the suction tube 140 is fixed to the outer periphery of the small diameter portion 78a of the suction member 78. The outer diameter is formed larger than the inner diameter of the opening 158 of the spacer 156. In addition, a step formed at a portion that transitions from the distal end of the suction member 78 to the small-diameter portion 78 a is formed to have a diameter larger than the inner diameter of the opening 158 of the spacer 156, and serves as an abutting portion 78 b against the spacer 156. Works. Therefore, the suction member 7
8 is not drawn into the coil 36a from the spacer 156. Other configurations are the same as those in the first embodiment.

The operation of the endoscope treatment tool 110 according to this embodiment is as follows. When the slider 20 in the operation unit 12 is moved toward the distal end, the distal end of the suction tube 140 or the suction member 78 is moved to the hemispherical distal end 14 of the cup 144.
6, the cup 144 moves axially toward the distal end with respect to the distal end cover 42. As a result, the intermediate portion 148 formed by the elastic plate-like arm is released from the restraint, and the hemispherical tip portion 146 is opened outward. Furthermore,
When the slider 20 is moved to the distal end side, the suction member 78 slides the small diameter portion 78a with respect to the spacer 156,
The suction member 78 is moved relative to the cup 144 so that the tip of the suction member 78 protrudes from the tip of the cup 144. To ensure the movement of the suction member with respect to the cup, a suitable stopper mechanism may be provided on the inner peripheral surface of the distal end cover 42 and the outer peripheral surface of the cup 144.

With the tip of the suction member 78 protruding from the tip of the cup 144, the syringe is operated to
The living tissue is suction-fixed in the distal end of 8. Next, the slider 20 is moved to the proximal side or the proximal side, and the living tissue is drawn into the cup 144. Further, when the slider 20 is moved to the proximal end side, the abutting portion 78b of the suction member 78 abuts on the distal end surface of the spacer 156, and the cup 144 is drawn into the distal end cover 42 together with the spacer 156, and the distal end portion of each half member 144a. Close 146.

Endoscope treatment tool 11 in this embodiment
0, the suction member 78 and the cup 144 cooperate with each other, so that the suction member 7 can be operated only by operating one slider 20.
8 and the cup 144 can be operated, and the operability is improved.

<Third Embodiment> Next, a third embodiment of the present invention will be described with reference to FIGS. The treatment tool 210 for an endoscope according to the present embodiment is substantially the same as that according to the second embodiment, except that the cup 144 according to the second embodiment is used.
Is formed in a state where the half-piece member 144a forming the above is further divided into half. That is, as shown in FIGS. 8 and 9, in the present embodiment, the cup 244 is
When 4a is closed, a semicircular cross-sectional shape is formed.
In addition, a bent portion 240a that bends toward the cutting edge 245 of the cup 244 is formed at the distal end of the suction member 240 as tissue fixing means. For other points,
This is the same as the above-described second embodiment.

The treatment tool for an endoscope according to the third embodiment operates in the same manner as the treatment tool for an endoscope according to the second embodiment described with reference to FIGS.

The treatment tool 210 for an endoscope according to the third embodiment.
According to this, since the movement of the suction member 240 can be observed, the cup 244 can be reliably and easily approached to the portion T to be resected, and the living tissue S can be more reliably drawn into the cup 244 and resected. Further, in order to make it easier to observe, the respective distal ends of the half pieces 244 a forming the cup 244 may be bent with respect to the axis of the insertion section 14.

According to the above description, at least the features listed below as supplementary notes are obtained.

<Supplementary Notes> An endoscopic treatment instrument comprising a tissue resection means capable of opening and closing the distal end of an insertion portion and a tissue fixing means at the distal end of the insertion portion, wherein the tissue fixing means is disposed in the tissue resection means so as to be able to advance and retreat. Endoscope treatment tool.

2. 2. The treatment tool for an endoscope according to claim 1, wherein the distal end of the tissue fixing means is protrudable from the distal end of the resection means.

3. In the above item 2, the tissue fixing means has a means for connecting to the suction means, a lumen, and a tip opening,
An endoscope treatment tool, wherein a conduit is formed from a suction means to a distal end opening.

4. 4. The treatment tool for an endoscope according to any one of the above items 1 to 3, wherein the tissue fixing means and the tissue resection means can be operated independently of each other.

5. 5. The treatment tool for an endoscope according to any one of the above items 1 to 4, wherein the tissue excision means comprises a pair of members that can be freely opened and closed.

6. 6. The treatment tool for an endoscope according to any one of the above items 1 to 5, wherein the resection means is energizable.

7. 7. The treatment instrument for an endoscope according to the above item 6, wherein the tissue fixing means and the excision means are electrically insulated from each other.

[0041]

As is clear from the above, according to the endoscopic treatment tool of the present invention, the tissue in the body can be reliably collected, and the amount of tissue to be collected is required even though the structure is extremely simple. Can be adjusted accordingly.

[Brief description of the drawings]

FIG. 1 is an explanatory view schematically showing the entire structure of a treatment tool for an endoscope according to a first embodiment of the present invention.

FIG. 2 is an enlarged view showing details of a distal end portion of the endoscope treatment tool in FIG. 1;

3A and 3B show an internal structure of a distal end portion shown in FIG. 2, wherein FIG. 3A is an exploded view, and FIG. 3B is a cross-sectional view taken along line BB of FIG.

4A and 4B show a state in which a living tissue is cut by the endoscope treatment tool according to the first embodiment, and FIG. 4A is an explanatory diagram when a suction tube is projected and brought into contact with the living tissue, and FIG. FIG. 3 is an explanatory view of a state in which a suction tube is drawn in and cut off by a cup.

FIG. 5 is an explanatory view schematically showing an entire endoscope treatment tool according to a second embodiment.

FIG. 6 is a sectional view showing the internal structure of the mouthpiece of the endoscope treatment tool shown in FIG. 5;

7A and 7B show the operation of the cup of the endoscope treatment tool according to the second embodiment, wherein FIG. 7A is a cross-sectional view in a closed state, and FIG. 7B is a cross-sectional view in an open state.

FIG. 8 is a schematic perspective view of a distal end portion of a treatment tool for an endoscope according to a third embodiment.

9A and 9B show the operation of the distal end portion of the treatment tool for an endoscope shown in FIG. 8, wherein FIG. 9A is an end view in a state where a cup is closed, and FIG.

[Explanation of symbols]

10, 110, 210 ... endoscope treatment tool, 12 ... operation part, 14 ... insertion part, 16 ... ring, 18 ... operation part main body,
20, 30: slider, 22: plug, 24: slit, 26: operating rod, 28, 128: base part, 32: syringe mounting port, 34: slit, 36: insertion part sheath, 36a: coil, 36b: insulating coating , 38 operation wire, 40, 140, 240 suction tube, 42 tip cover, 44, 144, 144 cup, 44a, 1
44a, 244a: half member, 46, 146: tip portion,
48,148 ... intermediate part, 50,150 ... rear end part, 52 ...
Locking portion, 54 ... hole, 56, 156 ... spacer, 58, 6
0, 158: opening, 70, 72: O-ring, 74: opening, 76: syringe mounting part, 78: suction member, S: living tissue.

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Takuo Sasaki 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Tsuruo Hatori 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Masatoshi Tomura 2-43-2 Hatagaya, Shibuya-ku, Tokyo In-house Olympus Optical Industries Co., Ltd. (72) Yasushi Ogoshi 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Inside Olympus Optical Industry Co., Ltd. (72) Akira Shiga, Inventor 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industry Co., Ltd. (72) Hideto Yoshimine 2-chome, Hatagaya, Shibuya-ku, Tokyo 43-2 F-term in Olympus Optical Co., Ltd. (reference) 4C060 EE28 FF23 GG23 4C061 AA00 BB00 CC00 DD00 GG15

Claims (1)

[Claims] 1. An endoscope treatment tool comprising: a tissue resection means provided at the distal end of an insertion portion, which can be freely opened and closed; and a tissue fixing means provided at a distal end of the insertion portion, wherein the tissue fixing means is provided in the tissue resection means. A treatment tool for an endoscope, wherein the treatment tool is arranged so as to be able to advance and retreat.