JP2005204995A - Treatment instrument and device for endoscope and endoscope treatment instrument system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a treatment instrument and device for an endoscope and an endoscope treatment instrument system reducing troubles by facilitating an inserting operation of a treatment instrument when alternately using a plurality of treatment instruments, even if the instrument repeatedly approaches to a target tissue from the same position and direction. <P>SOLUTION: This treatment instruments for the endoscope is so constituted that a high frequency knife is provided with a treatment instrument insertion part 10 having flexibility and insertable into a channel, a proximal end side of the treatment instrument insertion part 10 is disposed with a rigid linear part 11 insertable into the channel, and the proximal end side of the linear part 11 is connected with a regulation part 12 regulating the insertion of the treatment instrument insertion part 10 into the channel as a bent part formed by bending the linear part 11 in an approximately perpendicular direction. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an endoscope treatment tool, an endoscope treatment apparatus, and an endoscope treatment tool system.

When different types of treatment tools are used with an endoscope, in particular, two treatment tools (for example, refer to Patent Documents 1 and 2) such as endoscopic mucosal resection are alternately exchanged for one channel. When using, since the long treatment tool which has flexibility was inserted and removed for every use purpose, there existed a problem that handling was troublesome. In order to alleviate the troublesomeness of this insertion / removal operation, there has been proposed one in which a treatment instrument is inserted into an endoscope having two channels (see, for example, Patent Document 3). In addition, a treatment tool capable of performing a plurality of treatments with one treatment tool has been proposed (see, for example, Patent Document 4).
JP-A-8-299355 (FIG. 1) JP 2001-58006 A (FIG. 1) Japanese Utility Model Publication No. 2-126603 (FIG. 1) Japanese Patent Laid-Open No. 2000-210295 (FIG. 1)

However, in the conventional technique described in Patent Document 3, since the tip positions of the two channels are different from each other, the treatment tool inserted into each channel has a different protruding position at the tip of the endoscope. It is not suitable for procedures that require repeated approaches to the tissue from the same position and orientation.
The present invention has been made in view of the above circumstances, and facilitates the insertion / extraction operation of a treatment instrument when alternately using a plurality of treatment instruments, even in a treatment in which a target tissue is repeatedly approached from the same position and direction. An object of the present invention is to provide an endoscope treatment tool, an endoscope treatment apparatus, and an endoscope treatment tool system that can reduce annoyance.

The present invention employs the following means in order to solve the above problems.
An endoscope treatment tool according to the present invention has a treatment tool insertion portion that is flexible and can be inserted into a channel of an endoscope, and the endoscope has a treatment tool insertion portion on a proximal end side of the treatment tool insertion portion. A rigid straight portion that can be inserted into the channel is disposed, and a restriction portion that restricts insertion of the treatment instrument insertion portion into the channel is connected to a proximal end side of the straight portion. To do.

  Since this endoscope treatment instrument has a rigid straight portion on the proximal end side of the treatment instrument insertion portion, the rigid straight portion is compared with the case of a conventional treatment instrument having only flexibility. By gripping and performing the insertion operation, the linear portion serves as a guide when inserted into the channel, and the insertion operation into the channel can be performed more easily than in the past. In addition, since the restricting portion is provided on the base end side of the linear portion, it is possible to prevent the treatment instrument from being inserted more than necessary into the channel during insertion.

Further, the endoscope treatment tool according to the present invention is the endoscope treatment tool, wherein the linear portion is provided with an index serving as a guide for an insertion length into the channel. And
Since this endoscopic treatment instrument has the above-described configuration, by providing the index position at a predetermined position determined in advance from the positional relationship between the distal end of the treatment instrument insertion portion and the channel, By confirming the index position, the distal end of the treatment instrument insertion portion, the channel, and the relative position can be grasped, which can be used as a guide for the insertion length of the treatment instrument insertion portion.

Further, the endoscope treatment tool according to the present invention is the endoscope treatment tool, and extends from a base end of the linear portion or the restriction portion and has a treatment tool operation portion at the base end. It is characterized by having.
The endoscope treatment tool according to the present invention is the endoscope treatment tool, wherein the restriction portion is a bent portion in which a part of the linear portion is bent.
Since the endoscope treatment instrument has the above-described configuration, insertion of the treatment instrument insertion portion into the channel can be restricted, and the treatment instrument operation portion is guided in the direction in which the treatment instrument operator is present. Can be easier.

An endoscopic treatment apparatus according to the present invention can be engaged with a pair of endoscopic treatment instruments according to the present invention and the linear portion, and the treatment instrument insertion portions are disposed in opposite directions in the channel. And an advancing / retreating device capable of moving at the same time.
In this endoscopic treatment apparatus, one treatment instrument insertion portion that has been treated is removed from within a channel by operating the advance / retreat apparatus during a treatment that uses a pair of endoscopic treatment instruments alternately. Simultaneously with the movement in the direction of extraction, the other treatment instrument insertion portion can be moved in the direction of insertion into the channel. Therefore, it is possible to easily perform the treatment corresponding to each treatment instrument for an endoscope, instead of replacing the treatment instrument insertion portion by gripping the restricting portion and performing the direct insertion / removal operation on the forceps opening for each treatment.

  Further, the endoscope treatment apparatus according to the present invention is the endoscope treatment apparatus, wherein the advance / retreat apparatus is formed so as to be supported by an operation part included in the endoscope, and the linear parts are parallel to each other. A main body that can be supported by the main body, a pair of rotating members that are sandwiched between the pair of linear portions in the main body and are arranged in parallel with the linear portions and pivotally supported by the main body, and the pair An endless member wound around the rotating member and having a concavo-convex portion formed on the surface thereof, and an engaging portion disposed in the linear portion so as to be engageable with the concavo-convex portion.

  Since this endoscope treatment apparatus has the above-described configuration, the endless member can be rotated in the same direction by rotating the rotating member. At this time, since the moving direction of the endless member on one linear portion side and the endless member on the other straight portion side is opposite to each other, the respective engaging portions engaged with the concavo-convex portions of the endless member are opposite to each other. By moving in the direction, one linear portion and the other linear portion can be moved in different directions. Therefore, when one treatment instrument insertion portion is moved in the insertion direction in the channel, the other treatment instrument insertion portion can be simultaneously moved in the direction of removal from the channel.

The endoscope treatment apparatus according to the present invention is the endoscope treatment apparatus, wherein the advance / retreat apparatus has a rotation shaft between a pair of the linear portions, and the straight line extends from the rotation shaft. And a swivel portion including a pair of gripping portions that extend toward the portion and are swingably fixed to the straight portions.
Since this endoscope treatment apparatus has the above-described configuration, when the swivel unit is rotated around the rotation axis, the one gripping unit and the other gripping unit can be moved in opposite directions. . Therefore, when the turning unit is rotated in a state in which each linear part is gripped by each gripping part, one linear part and the other linear part can be simultaneously advanced and retracted in opposite directions.

The endoscope treatment apparatus according to the present invention is the endoscope treatment apparatus, wherein the pair of endoscope treatment tools have different functions.
According to this endoscope treatment apparatus, when performing different treatments, the corresponding next treatment can be performed without completely removing the treatment instrument insertion portion from the endoscope channel and replacing it with a new treatment instrument. It can be carried out.

  An endoscope treatment instrument system according to the present invention includes an endoscope treatment instrument according to the present invention, or an endoscope treatment apparatus according to the present invention, and a channel through which the endoscope treatment instrument can be inserted. A plurality of endoscopic treatment tools can be inserted at the same time on the base end side of the channel, and any one of the endoscopic treatment tools is placed on the distal end side from the middle of the channel. It is possible to insert.

Since this endoscopic treatment instrument system has the above-described configuration, when performing treatment using a plurality of treatment instruments alternately for a target tissue, a plurality of treatment instrument insertion portions are provided on the proximal end side of the channel. Can be inserted.
At this time, when performing the next treatment with a different treatment instrument, the first treatment instrument insertion portion selected previously is returned to the proximal end partway, while the other treatment instrument insertion portion is inserted into the distal end instead. It is possible to project, and it is possible to perform treatment by switching to another treatment instrument without completely removing one treatment instrument insertion portion from the channel.
In addition, the target organization can be approached from the same position and direction.

The endoscope treatment instrument system according to the present invention is the endoscope treatment instrument system, wherein the proximal end side of the channel includes a plurality of tubular members into which any one of the treatment instrument insertion portions can be inserted. It is preferable.
Since this endoscope treatment instrument system has the above-described configuration, when a treatment is performed by alternately using a plurality of treatment instruments for one target tissue, each endoscope member is disposed in each tubular member on the channel proximal end side. The above-described operation can be performed by inserting one treatment instrument insertion portion.

The endoscope treatment tool system according to the present invention is the endoscope treatment tool system, wherein the proximal end side of the channel has a diameter or shape capable of simultaneously including a plurality of treatment tool insertion portions. It is preferable to provide a member.
Since this endoscopic treatment instrument system has the above-described configuration, when a plurality of treatment instruments are alternately used for a target tissue in one place, a plurality of treatment instrument insertion portions are combined into a channel. The above-mentioned operation can be performed by inserting it in the base end side.

The endoscope treatment tool system according to the present invention is the endoscope treatment tool system, wherein the channel is detachable from an outer peripheral surface of an insertion portion provided in the endoscope. And
Since this endoscope treatment instrument system has the above-described configuration, a plurality of treatment instruments are used for one target tissue even in a normal endoscope having only one channel. When the treatment is performed alternately, the endoscope treatment tool according to the present invention can be used, and the insertion / extraction operation into the channel can be easily performed.

Further, the endoscope treatment tool system according to the present invention is the endoscope treatment tool system, wherein an index serving as a guide for the insertion length into the channel is provided in the operation portion of the endoscope. It is characterized by that.
Since this endoscope treatment instrument system has the above-described configuration, the treatment instrument position that passes the index by providing a predetermined index that is determined in advance from the positional relationship between the distal end of the treatment instrument insertion portion and the channel. Therefore, the relative position between the distal end of the treatment instrument insertion portion and the channel can be grasped, and the insertion length of the treatment instrument insertion portion can be used as a guide.

  According to the present invention, even when a procedure is repeated for the target tissue from the same position and direction, it is possible to facilitate the insertion / extraction operation of the treatment tool when a plurality of treatment tools are used alternately, thereby reducing annoyance. Therefore, the operator can easily and reliably perform the channel insertion / extraction operation of the treatment instrument insertion portion without depending on the operator of the treatment instrument.

A first embodiment according to the present invention will be described with reference to FIGS.
The endoscope treatment tool system 1 according to the present embodiment is a system that is used when resecting a lesioned part by repeatedly performing a bulge treatment and an incision treatment of a target tissue, and is a diagram used when incising the target tissue. A high-frequency knife (endoscopic treatment tool) 2 as shown in FIG. 1, an endoscope injection needle (endoscopic treatment tool) 3 as shown in FIG. An endoscope 8 as shown in FIG. 3 having a channel 7 through which these endoscope treatment tools can be inserted is provided.

As shown in FIG. 1, the high-frequency knife 2 has a treatment instrument insertion portion 10 that is flexible and can be inserted into the channel 7, and can be inserted into the channel 7 on the proximal end side of the treatment instrument insertion portion 10. A restriction that restricts insertion of the treatment instrument insertion portion 10 into the channel 7 as a bent portion in which the straight portion 11 is bent at a base end side of the straight portion 11 in a substantially right angle direction. The part 12 is connected.
The straight line portion 11 is provided with an index 13 that serves as a guide for the insertion length into the channel 7.
Further, an extending portion 16 that extends from the proximal end of the restricting portion 12 and has a treatment instrument operating portion 15 at the proximal end is provided.

  As shown in FIGS. 4A and 4B, the treatment instrument insertion portion 10 includes a flexible tube 17 and an operation wire 18, and the flexible tube 17 covers the tightly wound coil 20 and the outer periphery thereof. The insulating tube 21 is made of a tetrafluoroethylene tube. A cylindrical stopper member 22 is connected to the tip of the closely wound coil 20. The outer periphery of the stopper member 22 is covered with the closely wound coil 20 by the tip portion of the insulating tube 21.

On the inner surface of the hole 23 of the stopper member 22, a tapered portion 25 having a narrowed tip end side, and a small diameter portion 26 and a large diameter portion 27 positioned on the front and rear sides of the tapered portion 25 are formed. The stopper member 22 guides the electrode knife 28, which will be described later, through the inner surface of the hole 23 so as to protrude into and out of the distal end side of the flexible tube 17.
The operation wire 18 is inserted into the flexible tube 17, the straight portion 11, the restriction portion 12, and the extension portion 16 so as to freely advance and retreat, and a base end is connected to an operation slider 30 provided in the treatment instrument operation portion 15. The operation slider 30 can be moved forward and backward by pushing and pulling it back and forth. The operation slider 30 is provided with a connection port 31 for electrically connecting a cord (not shown) leading to a high frequency generator (not shown).

The electrode knife 28 is connected to the distal end of the operation wire 18 and is formed of a relatively thin linear wire formed of a conductive material. The base end of the electrode knife 28 has a taper portion 25 of the stopper member 22. A stopper receiving portion 32 that can come into contact with the inner surface is provided. The high frequency knife 2 is connected to the tip of the operation wire 18 through the stopper receiving portion 32. If the operation wire 18 is pushed and pulled by moving the operation slider 30 back and forth, the electrode knife 28 can be exposed by projecting and retracting from the opening of the distal end of the flexible tube 17 to the outside.
An electrically insulating insulating tip 33 having a diameter larger than the outer diameter of the treatment instrument insertion portion 10 is provided at the tip of the electrode knife 28. The insulating chip 33 is formed of a heat resistant electric insulator such as ceramics.

Like the high-frequency knife 2, the endoscope injection needle 3 has a treatment instrument insertion portion 35 that is flexible and can be inserted into the channel 7, as shown in FIG. A rigid straight portion 36 that can be inserted into the channel 7 is disposed on the end side, and the straight portion 36 is bent on the proximal end side of the straight portion 36 in a substantially right angle direction. A restricting portion 37 for restricting insertion into the channel 7 is connected.
The straight line portion 36 is provided with an index 38 that serves as a guide for the insertion length into the channel 7.
Further, an extending portion 41 that extends from the restricting portion 37 and has a treatment instrument operating portion 40 at the proximal end is provided.

As shown in FIG. 5, the treatment instrument insertion portion 35 can advance and retreat within the outer tube 42 made of a resin such as a fluorine tube or a polyamide tube, and the outer tube 42, the straight portion 36, the regulating portion 37, and the extending portion 41. The inner tube 43 is provided.
The distal end of the outer tube 42 is formed in a bowl shape in which a locking contact portion 45 composed of an edge projecting inward in the radial direction is integrated with the outer tube 42 by thermoforming. Since the locking contact portion 45 is configured in a bowl shape, the distal end opening 42A of the outer tube 42 formed at the center of the locking contact portion 45 has a diameter smaller than the inner diameter of the outer tube 42. Is formed.

Connected to the distal end of the inner tube 43 is a needle body 46 which is hollow and has a sharp blade shape with the distal end cut obliquely at an angle of approximately 30 degrees.
The outer diameter of the needle body 46 is sized so as to be able to be inserted through the distal end opening 42A. The outer diameter of the needle body 46 is smaller than the inner diameter of the outer tube 1 and larger than the diameter of the distal end opening 42A, and the inner tube. A stepped cylindrical locking member 47 having an inner diameter substantially equal to the inner diameter of 43 and having a small-diameter portion 47B in which the distal end portion of the inner tube 43 is tightly fitted and fixed by an adhesive is a so-called caulking (2- 4 is fixed by tightening from a plurality of directions.
The adhesive is applied so as to cover a part of the outer peripheral surface of the needle body 46 beyond the base end surface of the locking member 47. At the same time as the adhesive bonding between the inner tube 43 and the locking member 47, the adhesive is locked to the needle body 46. Watertightness with the member 47 is also ensured.

  The treatment instrument operation unit 40 is fixedly attached to the base end of the extension part 41, and the base 51 is attached to the base end of the inner tube 43 and engages with the syringe 50 at the proximal end. And a base unit 52 made of ABS. The operation portion main body 48 and the base unit 52 can freely move back and forth. When the base unit 52 is pulled toward the hand side with respect to the operation portion main body 48, the needle body 46 is accommodated in the outer tube 42. Further, when the base unit 52 is pushed into the operation section main body 48, the needle body 46 is protruded from the distal end opening 42 </ b> A of the outer tube 42.

The endoscope 8 includes a flexible insertion portion 53 and an operation portion 55 that is connected to a proximal end of the insertion portion 53 and operates the insertion portion 53, and the channel 7 includes the insertion portion 53 and the operation portion 55. It is arranged to communicate with the inside.
As shown in FIGS. 6 to 8, the channel 7 has a first tubular member 56 through which the high-frequency knife 2 can be inserted so that the base end side can simultaneously insert the high-frequency knife 2 and the endoscope injection needle 3. And a second tubular member 57 through which the endoscope injection needle 3 can be inserted, and both are integrated on the distal end side from the middle of the channel 7 and either the high-frequency knife 2 or the endoscope injection needle 3 It is set as the front-end | tip part 7A which has a diameter which can insert one.
A first forceps port 58 is connected to the proximal end of the first tubular member 56, and a second forceps port 60 is connected to the proximal end of the second tubular member 57.

Next, usage methods, actions, and effects of the endoscope treatment instrument system 1, the high-frequency knife 2, and the endoscope injection needle 3 according to the present embodiment will be described below with reference to FIGS. .
First, the operator 61 inserts the insertion portion 53 of the endoscope 8 into the body cavity of the patient, and brings the tip close to the vicinity of the target tissue.
Next, as shown in FIG. 9, the treatment instrument insertion portion 10 of the high-frequency knife 2 is inserted into the first forceps port 58 and inserted into the first tubular member 56 of the channel 7, and the endoscope injection needle The third treatment instrument insertion portion 35 is inserted into the second forceps port 60 and inserted into the second tubular member 57 of the channel 7. A cord (not shown) that leads to a high-frequency generator (not shown) is electrically connected to the connection port 31 of the operation slider 30.
At this time, as shown in FIG. 10, the treatment instrument operation units 15 and 40 are each held by the treatment instrument operator 62.

When performing the bulging treatment, the operator 61 grasps the restricting portion 37 of the endoscope injection needle 3, and the position of the index 38 is hidden in the second forceps port 60 as shown in FIG. The treatment instrument insertion portion 35 is pushed into the distal end portion 7A of the channel 7 from the second tubular member 57 to the position. At this time, the distal end of the outer tube 42 protrudes from the distal end of the channel 7 by a predetermined distance. At that time, the distal end of the treatment instrument insertion portion 10 of the high-frequency knife 2 is in a state of being arranged in the first tubular member 56.
After the distal end of the outer tube 42 protrudes outward from the channel 7, the base unit 52 is pushed into the operation unit main body 48, and the inner tube 43 is moved toward the distal end side with respect to the outer tube 42 to remove the needle body 46. It protrudes from the tip of the tube 42 and is fixed. And in this protruding state, it pushes in with the control part 37, punctures the target body with the needle body 46, sends a medicine etc. with the syringe 50, inject | pours in a structure | tissue, and makes it bulge.
After the swelling, the needle body 46 is accommodated again in the outer tube 42 and the outer tube 42 is immersed in the channel 7.

Next, an incision procedure is performed. At this time, the distal end of the treatment instrument insertion portion 35 of the endoscope injection needle 3 is drawn from the distal end portion 7A of the channel 7 into the second tubular member 57, and instead the grasping portion 12 of the high-frequency knife 2 is grasped. The treatment instrument insertion portion 10 is pushed from the first tubular member 56 into the distal end portion 7A of the channel 7 until the position of the index 13 is hidden in the first forceps port 58. At this time, the tip of the flexible tube 17 protrudes from the tip of the channel 7 by a predetermined distance.
Then, the operation wire 18 is advanced with respect to the flexible tube 17 so that the electrode knife 28 and the insulating tip 33 protrude from the tip of the flexible tube 17 as shown in FIG. A high frequency is supplied from the high frequency generator to the electrode knife 28 with the insulating chip 33 applied to the target tissue, and an incision is made while moving around the target tissue.
After the incision, the electrode knife 28 is immersed in the flexible tube 17, and the high-frequency knife 2 is pulled out into the first tubular member 56.

When the target tissue contracts during the incision procedure, it is necessary to bulge. Therefore, as shown in FIG. 12, the high-frequency knife 2 and the endoscope injection needle 3 are operated again as described above to provide an endoscope. The bulge treatment with the injection needle 3 is performed.
Thus, the lesioned part is excised by repeating the bulging treatment and the incision treatment.
At this time, since only one of the treatment instrument insertion portions 10 and 35 can be inserted into the distal end side of the channel 7, the restriction portions 12 and 37 are gripped during the treatment to the operation portion 55. By moving up and down, one of the treatment tools is selected and the corresponding treatment is performed.

According to the endoscope treatment instrument system 1, the high-frequency knife 2, and the endoscope injection needle 3, the rigid straight portions 11 and 36 are provided on the proximal end sides of the treatment instrument insertion portions 10 and 35. Compared to the case of a conventional treatment instrument having only flexibility, the operator 61 can hold the rigid straight portions 11 and 36 and perform an insertion operation into the channel 7. At this time, the straight portions 11 and 36 serve as a guide during insertion, and the insertion operation into the channel 7 can be performed more easily than in the past.
Further, since the restricting portions 12 and 37 are provided on the base end sides of the straight portions 11 and 36, respectively, even if the indicators 13 and 38 are inserted into the channel beyond the positions at the time of insertion, the restricting portion 12 is When the forceps port 58 or the restricting portion 37 of the contact with the second forceps port 60 prevents the treatment instrument insertion portions 10 and 35 from being inserted into the channel 7 more than necessary and protruding from the tip of the channel 7. Can do.

In addition, the positions of the indexes 13 and 38 with respect to the endoscope 8 can be confirmed by providing the positions of the indexes 13 and 38 at predetermined positions determined in advance from the positional relationship between the distal ends of the treatment instrument insertion portions 10 and 35 and the channel 7. Thus, the relative positions of the distal ends of the treatment instrument insertion portions 10 and 35 and the channel 7 can be grasped, and the insertion length of the treatment instrument insertion portions 10 and 35 can be used as a guideline. Interference can be prevented.
Further, since the insertion of the treatment instrument insertion portions 10 and 35 into the channel 7 can be restricted by the restriction portions 12 and 37 and is bent, the treatment instrument operation portions 15 and 40 are connected to the treatment instrument operator 62. It can be easily guided in the direction.

Further, when a treatment is performed using a plurality of treatment tools alternately on the target tissue, the treatment tool insertion portion 10 is previously placed in each of the first tubular member 56 and the second tubular member 57 on the proximal end side of the channel 7. 35 can be inserted.
At this time, when the next treatment is performed, for example, the treatment instrument insertion portion 35 of the previously selected endoscope injection needle 3 is moved proximally from the distal end portion 7A of the channel 7 to the second tubular member 57. On the other hand, the treatment instrument insertion portion 10 of the high-frequency knife 2 can be inserted into the distal end portion 7A and protruded from the first tubular member 56 instead, and the treatment instrument insertion portion 35 of the endoscope injection needle 3 is channeled. The treatment can be performed by switching to the high-frequency knife 2 without completely removing it from the inside.

Next, a second embodiment will be described with reference to FIGS.
In addition, the same code | symbol is attached | subjected to the component similar to 1st Embodiment mentioned above, and description is abbreviate | omitted.
The difference between the second embodiment and the first embodiment is that an endoscope treatment tool system 65 according to the second embodiment has a high-frequency knife 66 and an endoscope injection as shown in FIG. An endoscopic treatment apparatus 70 having a needle 67 and an advance / retreat apparatus 68 that can be engaged with the straight portions 11 and 36 and can simultaneously move the treatment instrument insertion sections 10 and 35 in the channel 7 in opposite directions. It is a point that it has.

The advancing / retreating device 68 is formed so as to be supported by the operation portion 72 of the endoscope 71 and a main body 73 capable of supporting the straight portions 11 and 36 in parallel to each other, and a pair of straight lines within the main body 73 as shown in FIG. A pair of gears (rotating members) 75 and 76 that are sandwiched between the portions 11 and 36 and arranged in parallel with the straight portions 11 and 36 and pivotally supported by the main body 73, and a pair of gears 75, An endless belt (endless member) 78 wound around 76 and having a concavo-convex portion 77 formed on the surface thereof, and a first engaging portion (disposed in the linear portion 11 of the high-frequency knife 66 so as to be engageable with the concavo-convex portion 77 ( Engagement portion) 80 and a second engagement portion (engagement portion) 81 disposed on the linear portion 36 of the endoscope injection needle 67 so as to be engageable with the concavo-convex portion 77.
The gear 75 is connected to a dial 82 that can rotate the gear 75 around the rotation center axis.
When attaching the main body 73 to the endoscope 71, a pair of attachment portions 83 and 85 are disposed at both ends of the one end 73a on the endoscope 71 side. The pair of attachment portions 83 and 85 are provided so as to protrude outward from the one end 73a along the treatment instrument insertion portions 10 and 35, and a jaw portion 86 protruding to the opposite side is formed at the tip. A groove 87 that can be engaged with the jaw 86 is formed in the vicinity of the first forceps port 58 and the second forceps port 60 of the operation unit 55.

Next, a method of using the endoscope treatment tool system 65 and the endoscope treatment apparatus 70 according to the present embodiment, and actions and effects will be described.
First, similarly to the first embodiment, the operator 61 inserts the insertion portion 53 of the endoscope 71 into the body cavity of the patient, and brings the tip close to the vicinity of the target tissue.
Next, the treatment instrument insertion portion 10 of the high-frequency knife 66 is inserted into the first forceps port 58 and inserted into the first tubular member 56 of the channel 7, and the treatment instrument insertion portion 35 of the endoscope injection needle 67 is inserted. Is inserted into the second forceps port 60 and inserted into the second tubular member 57 of the channel 7, and as shown in FIG. The mirror treatment device 70 is attached to the endoscope 71.

When performing the bulging treatment, the dial 82 is rotated counterclockwise in FIG.
At this time, the gear 75 rotates counterclockwise in FIG. 14, and accordingly, the endless belt 78 engaged with the gear 75 rotates in the same direction to transmit the rotational force to the gear 76. Rotate in the direction.
At this time, the first engaging portion 80 moves upward in FIG. 14, and accordingly, the straight portion 11 of the high-frequency knife 66 moves upward, so that the treatment instrument insertion portion 10 is in the first tubular shape in the channel 7. Retreat within member 56. At the same time, the second engaging portion 81 engaged with the endless belt 78 moves downward, and along with this, the linear portion 36 moves downward to insert the treatment tool of the endoscope injection needle 67. The portion 35 moves downward, and moves from the second tubular member 57 to the distal end portion 7A.
Thus, by rotating the dial 82 to a position where the index 38 of the endoscope injection needle 67 overlaps the main body 73, the distal end of the outer tube 42 of the endoscope injection needle 67 is moved from the distal end of the channel 7 to a predetermined direction. Make it protrude by a distance.
Thereafter, the procedure with the endoscope injection needle 67 is performed in the same manner as in the first embodiment.

When performing an incision treatment, the dial 82 is rotated clockwise in FIG.
At this time, the gear 75 rotates clockwise in FIG. 14, and the endless belt 78 engaged with the gear 75 rotates in the same direction to transmit the rotational force to the gear 76. The gear 76 also rotates in the same direction. Rotate to.
At this time, the second engaging portion 81 engaged with the endless belt 78 moves upward, and along with this, the linear portion 36 moves upward, and the treatment instrument insertion portion of the endoscope injection needle 67 is moved. 35 moves upward and is pulled into the second tubular member 57 from the distal end portion 7A. At the same time, the first engaging portion 80 engaged with the concavo-convex portion 77 moves downward in FIG. 15, and accordingly, the linear portion 11 moves downward, and the treatment instrument insertion portion of the high-frequency knife 66 is moved. 10 moves forward in the channel 7.
Thus, by rotating the dial 82 until the index 13 of the high-frequency knife 66 overlaps the main body 73, the tip of the flexible tube 17 of the high-frequency knife 66 is projected outward from the tip of the channel 7 by a predetermined distance.
Thereafter, the procedure using the high-frequency knife 66 is performed as in the first embodiment.

  According to the endoscope treatment instrument system 65 and the endoscope treatment apparatus 70, for example, the treatment instrument insertion portion 10 of the high-frequency knife 66 that has been treated is removed from the channel 7 by operating the advance / retreat apparatus 68. At the same time, the treatment instrument insertion portion 35 of the endoscope injection needle 67 can be inserted into the channel 7. Therefore, at each treatment, the high-frequency knife 66 and the endoscope injection can be performed more easily and quickly than when the treatment instrument insertion sections 10 and 35 are exchanged by holding the regulating sections 12 and 37 and performing direct insertion / removal operations. A treatment corresponding to each needle 67 can be performed.

Further, when the treatment instrument insertion portion 10 of the high-frequency knife 66 is moved in the insertion direction in the channel 7 by operating the dial 82 of the endoscope treatment apparatus 70, the treatment instrument insertion of the endoscope injection needle 67 is simultaneously performed. The part 35 can be moved in the direction of being removed from the channel 7.
As described above, even when different treatments are performed continuously, the treatment instrument insertion portion 10 of the high-frequency knife 66 is completely removed from the channel 7 of the endoscope 71 and replaced with a new endoscope injection needle 67. Even if it does not do, the following next applicable treatment can be performed.

Next, a third embodiment will be described with reference to FIGS.
In addition, the same code | symbol is attached | subjected to the component similar to other embodiment mentioned above, and description is abbreviate | omitted.
The difference between the third embodiment and the second embodiment is that the advance / retreat apparatus 68 of the endoscope treatment apparatus 70 according to the second embodiment rotates the pair of gears 75 and 76 by operating the dial 82. In contrast to the configuration, the advancing / retreating device 91 of the endoscope treatment apparatus 90 according to the present embodiment has a rotating shaft 92 between a pair of straight portions 11 and 36 as shown in FIGS. And having a swivel portion 96 that includes a pair of gripping portions 93 and 95 that extend from the pivot shaft 92 toward the straight portions 11 and 36 and are fixed to the straight portions 11 and 36 so as to be swingable. It is.
The swivel part 96 is formed in a plate shape, and is pivotally connected to the turning shaft 92 at the center part.
The rotation shaft 92 is disposed in the operation unit 99 of the endoscope 98 provided in the endoscope treatment instrument system 97.

Next, a method of using the endoscope treatment apparatus 90 and the endoscope treatment tool system 97 according to the present embodiment, and actions and effects will be described below.
First, as in the second embodiment, the operator 62 inserts the insertion portion 53 of the endoscope 98 into the body cavity of the patient, and places the treatment instrument insertion portion 10 of the high-frequency knife 2 into the first forceps port 58. Further, the treatment instrument insertion portion 35 of the endoscope injection needle 3 is inserted into the second forceps port 60, the linear portion 11 of the high-frequency knife 2 is engaged with the grip portion 93, and the endoscope injection needle. The three straight portions 36 are engaged with the grip portion 95.

When the bulging treatment is performed, as shown in FIG. 18A, the swivel unit 96 is rotated counterclockwise.
At this time, the linear portion 11 of the high-frequency knife 2 engaged with the grasping portion 93 moves upward in FIG. 18A, and the treatment instrument insertion portion 35 moves backward in the first tubular member 56 in the channel 7. . At the same time, the grip portion 95 moves downward, and accordingly, the linear portion 36 of the endoscope injection needle 3 moves downward, the treatment instrument insertion portion 10 moves downward, and the second It moves further from the tubular member 57 to the distal end portion 7A.
Thus, by rotating the swivel unit 96 until the index 38 of the endoscope injection needle 3 overlaps the second forceps port 60, the distal end of the outer tube 42 of the endoscope injection needle 3 is removed from the distal end of the channel 7. Project outward by a predetermined distance.
After that, the procedure with the endoscope injection needle 3 is performed as in the first embodiment.

When performing an incision treatment, as shown in FIG. 18B, the turning unit 96 is rotated clockwise.
At this time, the grip portion 95 moves upward, and accordingly, the linear portion 36 and the treatment instrument insertion portion 35 of the endoscope injection needle 3 move upward, and the second tubular member 57 is moved from the distal end portion 7A. Drawn into. At the same time, the straight line portion 11 of the high-frequency knife 2 engaged with the grip portion 93 moves downward in FIG. 18B, and the treatment instrument insertion portion 10 moves forward in the channel 7.
In this way, the tip of the flexible tube 17 of the high-frequency knife 2 protrudes outward from the tip of the channel 7 by a predetermined distance by rotating the swivel unit 96 until the index 13 of the high-frequency knife overlaps the first forceps port 58. Let
Thereafter, the procedure using the high-frequency knife 2 is performed as in the first embodiment.

  According to the endoscope treatment instrument system 97 and the endoscope treatment apparatus 90, when the turning unit 96 is rotated around the rotation shaft 92, the holding unit 93 and the holding unit 95 are moved in directions opposite to each other. Can do. Therefore, when the swivel unit 96 is rotated while the gripping portions 93 and 95 are gripping the linear portion 11 of the high-frequency knife 2 and the linear portion 36 of the endoscope injection needle 3, respectively, they are simultaneously advanced and retracted in opposite directions. It is possible to insert and remove the treatment instrument insertion portions 10 and 35 from the channel 7 at the same time.

Next, a fourth embodiment will be described with reference to FIG.
In addition, the same code | symbol is attached | subjected to the component similar to other embodiment mentioned above, and description is abbreviate | omitted.
The difference between the fourth embodiment and the other embodiments described above is that the channel 102 of the endoscope 101 provided in the endoscope treatment tool system 100 according to this embodiment is detachably arranged on the outer peripheral surface of the insertion portion 103. It is the point that it was established.
In the endoscope 101, a forceps channel 104 different from the channel 102 is disposed in the insertion portion 103, and the channel 102 has a first tubular member 56 on the proximal end side as in the other embodiments. And a second tubular member 57, which are integrated at the distal end side from the middle of the channel 102, and have a diameter capable of inserting any one of the treatment instruments.
In this case, for example, a needle knife as shown in FIG. 1 of Japanese Patent Laid-Open No. Sho 62-87144 is inserted into the forceps channel 104, and the target tissue is first perforated with the needle knife, and then the above-mentioned. Perform bulge / incision procedure.
In the case of incision treatment or the like, if there is bleeding from the tissue at the time of incision of the target tissue, for example, a high-frequency coagulator as shown in FIG. 4 of JP-A-62-87144 is inserted into the forceps channel 104. Inserted into the tube, heat is generated by supplying a high frequency, and hemostasis is performed by coagulation.

  According to this endoscope treatment instrument system 100, even with a normal endoscope 101 having only one forceps channel 104 built therein, treatment is performed alternately using a plurality of treatment instruments for one target tissue. When performing, insertion / extraction operation to / from the channel 102 such as the high frequency knife 2 or the endoscope injection needle 3 can be easily performed.

The technical scope of the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.
For example, in the above embodiment, the proximal ends of the channels 7 and 102 are bifurcated into the first tubular member 56 and the second tubular member 57 with respect to the distal end portions 7A and 102A. As shown in FIG. 22, the proximal end side of the channel 105 includes one tubular member 106 having a diameter or a shape that can simultaneously include a plurality of treatment instrument insertion portions, and both are integrated from the middle of the channel 105 to the distal end side. In addition, the distal end portion 105A having a diameter that allows any one of the treatment tools to be inserted may be used.
In this case, when a plurality of treatment tools are alternately used for one target tissue, a plurality of treatment tool insertion portions are collectively inserted into the tubular member 106 of the channel 105, so that Similar operations can be performed.

In the above embodiment, the indexes 13 and 38 are arranged on the straight portions 11 and 36, respectively, but as shown in FIG. 23, the operation unit 108 of the endoscope 107 is provided with an index 110. It does not matter. A plurality of the indicators 110 are attached at predetermined intervals along the axial direction of the operation unit 108.
In this case, the relative positions of the distal ends of the treatment instrument insertion portions 10 and 35 and the channel 7 can be grasped from the positions of the restriction portions 12 and 37 passing through the index 110, and the insertion length of the treatment instrument insertion portions 10 and 35 is obtained. Can be used as a guide.

Furthermore, in the fourth embodiment, treatment tools such as needle knives and high-frequency coagulators conventionally used may be inserted into the channel 7 or the channel 102 and used.
Further, the needle knife may be a needle knife (endoscopic treatment tool) 111 as shown in FIG. 24 according to the present invention, and the high frequency coagulator as shown in FIG. 25 according to the present invention ( Endoscope treatment tool) 112 may be used.

In this case, the needle knife 111 has the same configuration as the high frequency knife 2 as shown in FIGS.
As shown in FIG. 25, the high-frequency coagulator 112 has the same configuration as the other treatment instruments described above, and as shown in FIG. 27, the treatment instrument insertion portion 113 includes a flexible tube 115 and a power supply wire 117. I have. The flexible tube 115 is composed of a tightly wound coil 20 and an insulating tube 21 made of a tetrafluoroethylene tube covering the outer periphery of the coiled coil 20. A cylindrical tip member 118 is connected to the tip of the flexible tube 115. The power supply wire 117 is arranged to penetrate through the flexible tube 115, the straight portion 11, the restricting portion 12, and the extending portion 16.
A screw hole 120 that opens to the tip side is formed in the center of the tip side portion of the tip member 118, and a tip chip 121 made of conductive ceramics is screwed into the screw hole 120.

A connecting portion 122 for electrically connecting a cord (not shown) that leads to a high-frequency generator (not shown) is provided at the proximal ends of the extending portion 41 and the power supply wire 117.
In use, a cord (not shown) is connected to the connecting portion 122 and electrically connected to a high-frequency generator (not shown), while the treatment instrument insertion portion 10 protrudes from the distal end of the channel 7 and the distal tip 121 is applied to the bleeding portion, Supply and solidify.
According to the needle knife 111 and the high-frequency coagulator 112, the same operation and effect can be obtained by the same usage method as the other endoscopic treatment tools described above.

It is a side view showing the high frequency knife concerning a 1st embodiment of the present invention. 1 is a side view showing an endoscope injection needle according to a first embodiment of the present invention. FIG. 1 is a side view showing an endoscope according to a first embodiment of the present invention. It is sectional drawing which shows the principal part of the high frequency knife which concerns on the 1st Embodiment of this invention. It is sectional drawing which shows the principal part of the injection needle for endoscopes which concerns on the 1st Embodiment of this invention. It is a perspective view showing a channel of an endoscope concerning a 1st embodiment of the present invention. It is AA sectional drawing of FIG. It is BB sectional drawing of FIG. It is a perspective view which shows the principal part of the endoscope treatment tool system which concerns on the 1st Embodiment of this invention. It is explanatory drawing which shows the state at the time of use of the endoscope treatment tool system which concerns on the 1st Embodiment of this invention. It is explanatory drawing which shows the state at the time of use of the endoscope treatment tool system which concerns on the 1st Embodiment of this invention. It is explanatory drawing which shows the state at the time of use of the endoscope treatment tool system which concerns on the 1st Embodiment of this invention. It is a perspective view which shows the treatment apparatus for endoscopes which concerns on the 2nd Embodiment of this invention. It is sectional drawing which shows the inside of the treatment apparatus for endoscopes which concerns on the 2nd Embodiment of this invention. It is explanatory drawing which shows the state at the time of use of the endoscope treatment tool system which concerns on the 2nd Embodiment of this invention. It is a perspective view which shows the treatment apparatus for endoscopes which concerns on the 3rd Embodiment of this invention. It is a side view which shows the endoscope treatment tool system which concerns on the 3rd Embodiment of this invention. It is explanatory drawing which shows the time of use of the endoscope treatment tool system which concerns on the 3rd Embodiment of this invention. It is a side view which shows the endoscope treatment tool system which concerns on the 4th Embodiment of this invention. It is a perspective view which shows the channel of the endoscope which concerns on other embodiment of this invention. It is CC sectional drawing of FIG. It is DD sectional drawing of FIG. It is a side view which shows the endoscope treatment tool system which concerns on other embodiment of this invention. It is a side view which shows the acicular knife which concerns on other embodiment of this invention. It is a side view which shows the high frequency coagulator which concerns on other embodiment of this invention. It is sectional drawing which shows the principal part of the needle-shaped knife which concerns on other embodiment of this invention. It is sectional drawing which shows the principal part of the high frequency coagulator which concerns on other embodiment of this invention.

Explanation of symbols

1, 65, 97, 100 Endoscopic treatment instrument system 2, 66 High frequency knife (endoscopic treatment instrument)
3, 67 Endoscopic injection needle (endoscopic treatment tool)
7, 102, 105 Channel 8, 71, 98, 101, 107 Endoscope 10, 35 Treatment instrument insertion part 11, 36 Straight part 12, 37 Restriction part 13, 38, 110 Index 16, 41 Extension part 56 First Tubular member (tubular member)
57 Second tubular member (tubular member)
68, 91 Advance / Retreat device 70, 90 Endoscope treatment device 75, 76 Gear (rotating member)
78 Endless belt (endless member)
80 1st engaging part (engaging part)
81 2nd engaging part (engaging part)
92 Rotating shafts 93 and 95 Grip part 96 Rotating part 106 Tubular member 111 Needle knife (endoscopic treatment tool)
112 High-frequency coagulator (endoscopic instrument)

Claims (13)

Having a treatment instrument insertion portion that is flexible and can be inserted into the channel of the endoscope;
A rigid straight portion that can be inserted into the channel is disposed on the proximal end side of the treatment instrument insertion portion,
A treatment instrument for an endoscope, wherein a restriction part for restricting insertion of the treatment tool insertion part into the channel is connected to a proximal end side of the linear part.   The treatment instrument for an endoscope according to claim 1, wherein the straight line portion is provided with an index serving as a guide for an insertion length into the channel.   The endoscopic treatment tool according to claim 1, further comprising an extension portion that extends from a base end of the linear portion or the restriction portion and has a treatment tool operation portion at the base end.   The treatment instrument for an endoscope according to claim 3, wherein the restricting portion is a bent portion in which a part of the straight line portion is bent. A pair of endoscopic treatment tools according to any one of claims 1 to 4;
An endoscopic treatment device comprising: an advancement / retraction device that is engageable with the linear portion and capable of simultaneously moving the treatment instrument insertion portion in opposite directions in the channel. The advance / retreat apparatus is formed so as to be supported by an operation part of the endoscope, and a main body capable of supporting the linear parts in parallel to each other;
A pair of rotating members disposed between the pair of linear portions in the main body and arranged in parallel with the linear portions and pivotally supported by the main body;
An endless member wound around the pair of rotating members and having an uneven portion formed on the surface;
The endoscopic treatment device according to claim 5, further comprising an engaging portion disposed in the linear portion so as to be engageable with the uneven portion.   The advancing / retreating device has a pivot shaft between a pair of linear portions, and includes a pair of gripping portions that extend from the pivot shaft toward the linear portion and are fixed to each linear portion so as to be swingable. The endoscopic treatment device according to claim 5, further comprising a section.   The endoscope treatment apparatus according to any one of claims 5 to 7, wherein the pair of endoscope treatment tools have different functions. The endoscopic treatment tool according to any one of claims 1 to 4, or the endoscopic treatment device according to any one of claims 5 to 8,
An endoscope having a channel through which the endoscope treatment tool can be inserted;
The proximal end side of the channel is capable of simultaneously inserting a plurality of the treatment instruments for endoscope, and the distal end side is capable of inserting any one of the treatment instruments for endoscope from the middle of the channel. An endoscopic treatment instrument system that is characterized.   The endoscopic treatment instrument system according to claim 9, wherein a proximal end side of the channel includes a plurality of tubular members into which any one of the treatment instrument insertion portions can be inserted.   The endoscopic treatment instrument system according to claim 9, wherein the proximal end side of the channel includes one tubular member having a diameter or a shape capable of simultaneously including a plurality of the treatment instrument insertion portions.   The endoscope treatment tool system according to any one of claims 9 to 11, wherein the channel is detachably attached to an outer peripheral surface of an insertion portion provided in the endoscope.   The endoscope treatment tool system according to any one of claims 9 to 12, wherein an index serving as a guide for an insertion length into the channel is provided in the operation unit of the endoscope. .

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