JP2007260248A - Treatment implement for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To improve the operability of a control cable inserted to the inside without specially increasing the diameter of a flexible sheath. <P>SOLUTION: A biopsy forceps apparatus 1 is composed by connecting the operation part 3 to the proximal end of the flexible sheath 2 for which a treatment means 5 is mounted on the distal end, and an operation wire 9 for opening and closing the pawl member 5a of the treatment means 5 is inserted into the flexible sheath 2 and connected to the slider 7 of the operation part 3. For the flexible sheath 2, a structure is a 2-layer flexible tube body 11 wherein a helical tube 12 for which a metal belt piece is helically wound is an inner layer and an adhesion coil 13 for which a metal wire is adhered and wound is an outer layer, and a flexible tube 14 composed of a synthetic resin is equipped outside the flexible tube body 11 as a jacket layer. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an endoscope treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and performs a desired treatment in a body cavity.

  An endoscope used for medical purposes has a treatment instrument insertion channel. The treatment instrument insertion channel is opened as a treatment instrument outlet at the distal end portion of the insertion section into the body cavity, and the proximal end side is connected to a treatment instrument introduction section mounted on the main body operation section. The insertion portion is generally composed of a flexible portion that can be bent along the insertion path for most of the length from the connecting portion to the main body operation portion, and the flexible portion is bent by remote operation from the main body operation portion. An angle portion is provided, and a hard end portion is connected to the angle portion. The treatment instrument outlet is open at the distal end hard portion, and illumination means and observation means are mounted on substantially the same surface as the treatment instrument outlet.

  Since the treatment instrument for endoscope is inserted into the treatment instrument insertion channel of the endoscope configured as described above, the outer diameter size thereof must be smaller than the inner diameter of the treatment instrument insertion channel. Naturally, at least the distance between the treatment instrument outlet and the treatment instrument introduction part, that is, a length that allows the predetermined length to be derived from the treatment instrument outlet by inserting the distal end of the treatment instrument from the treatment instrument introduction part. Must have. Moreover, since the insertion part is comprised with the soft member, this treatment tool shall have flexibility in a bending direction. For this purpose, the endoscope treatment tool is provided with a treatment means at the distal end of the flexible sheath, and the proximal end portion of the flexible sheath is provided with an operation portion for operating the treatment means by remote operation. .

  As typical treatment means, there are forceps, and there are various kinds such as high-frequency treatment means such as a high-frequency knife and a high-frequency snare. By inserting a control cable into the flexible sheath and pushing and pulling this control cable, or rotating it, the operation of the treatment means, for example, opening and closing operation of forceps, push-pull operation of the high frequency snare, etc. Will be done.

  Patent Document 1 discloses a forceps device as a treatment tool for an endoscope. This forceps device is constituted by a double contact coil wound in opposite directions as a flexible sheath, and a link for opening and closing a pair of forceps cups by providing an attachment at the tip of the flexible sheath A mechanism is mounted, and the link mechanism is opened and closed by pushing and pulling an operation wire inserted through the flexible sheath. An operation portion is connected to the proximal end portion of the flexible sheath, the operation wire is extended to the operation portion, and the operation wire is pushed and pulled by remote operation.

Here, in Patent Document 1, a body tissue is collected with a forceps cup, and a part of the body tissue cannot be cut simply by closing the forceps cup from an open state. By doing so, it is configured so that the tissue can be torn off. This is the reason why the flexible sheath is composed of double contact coils. That is, when the proximal end portion of the flexible sheath is rotated around the axis, when the inner contact coil spreads, the outer contact coil contracts, so this rotation is surely performed at the tip. And a strong rotational force can be applied to the forceps cup.
Japanese Patent No. 3634655

  As described above, the double contact coil wound in the opposite direction has flexibility and excellent rotation transmission. For example, an external force acts in the crushing direction or the shearing direction. When a load is applied, the internal operation wire passage may not be able to maintain its shape. Here, an angle portion is provided in the vicinity of the distal end of the insertion portion of the endoscope, and this angle portion may be bent with a small radius of curvature within a short length range. When the treatment tool is operated in this state, the operation wire inserted into the flexible sheath is pressed by the contact coil, and the sliding resistance when pushing and pulling the operation wire is increased. In the case where the operation wire becomes worse and severe, the operation of the operation wire may become impossible. If the inner diameter of the inner contact coil is made sufficiently large so that there is a wide gap between it and the operation wire inserted inside, the operation wire can be pressed against the inner surface of the flexible sheath. It will be possible to operate smoothly. However, if the contact coil is thickened, there is a possibility that the operation of inserting the flexible sheath into the treatment instrument insertion channel may be hindered.

  The present invention has been made in view of the above points. The object of the present invention is to improve the operability of the control cable inserted through the flexible sheath without particularly increasing the diameter of the flexible sheath. There is.

  In order to achieve the above-mentioned object, the present invention is inserted into a treatment instrument insertion channel of an endoscope, and a treatment means is provided at the distal end of the flexible sheath, and the treatment means is remotely connected within the flexible sheath. An endoscopic treatment instrument provided with a control cable to be operated being inserted and operating means connected to a proximal end portion of the control cable, wherein the flexible sheath is wound around a metal strip in a spiral shape. A spiral tube provided as an inner layer, and is composed of a double flexible tube with an outer layer made of a tightly wound spiral coil of metal wire wound around the outer periphery of the spiral tube, The control cable for operating the treatment means is inserted into the flexible tube.

  In the endoscope treatment tool according to the present invention, a control cable is connected to a treatment means provided at the distal end of a flexible sheath, and the treatment means is operated by operating the control cable. For example, in the case of forceps, a pair of claws or cups opens and closes. Further, in the case of a high-frequency snare, the snare wire is caused to appear and disappear from the flexible sheath in order to expand and contract the snare wire. Therefore, the control cable is used to push and pull the treatment means, or may transmit rotation to the treatment means. When the treatment means is pushed and pulled, a control cable is constituted by an operation wire. Further, when the treatment means is rotationally driven, it is desirable to use a contact coil. This close contact coil is composed of a separate member from the close contact coil constituting the flexible sheath.

  The spiral tube is for securing the insertion path of the control cable, and ensures the shape retention of the insertion path. The spiral tube is composed of a metal strip having elasticity, and the spiral tube is coarsely wound, that is, wound at regular intervals. The degree of flexibility in the bending direction of the helical tube can be adjusted by the width of the metal strip constituting the helical tube and the pitch interval given when it is spirally wound. Considering the shape retention of the inner diameter of the spiral tube, it is desirable that the metal strip has a larger width dimension. However, if a metal strip having a very wide width is used, the flexibility in the bending direction is lowered. Therefore, the width dimension of the metal strip and the pitch interval at the time of winding are adjusted according to the actual use purpose.

  The flexible sheath is inserted into the treatment instrument insertion channel of the endoscope and has flexibility in the bending direction. In order to adjust the direction of the treatment means provided at the distal end of the flexible sheath, the proximal end portion of the flexible sheath is rotated while the distal end portion of the flexible sheath is inserted into the treatment instrument insertion channel. It is desirable to rotate. At this time, the rotation of the flexible sheath must be accurately transmitted to the tip. If the rotation of the flexible sheath is limited to the direction in which the close contact coil is wound, this rotation is reliably transmitted to the distal end when the proximal end portion is rotated. In addition, a flexible tube made of a synthetic resin can be provided on the outer periphery of the contact coil, and the flexible tube can be substantially non-stretchable. As a result, the outer diameter of the contact coil is regulated, and this rotational force is reliably transmitted to the tip portion not only in the direction in which the coil is tightened but also in the direction of rewinding. Further, by covering the flexible tube, the flexible sheath can be held so as not to expand and contract in the axial direction. As a result, it is possible to prevent a situation in which the flexible sheath expands and contracts when it is taken out from the treatment instrument insertion channel, and a pollutant such as a body fluid adhering to the outer surface diffuses around. Further, when the treatment means is a device that allows high-frequency current to flow, the flexible tube also functions as an insulating coating.

  The winding direction of the spiral tube as the inner layer may be opposite to the winding direction of the contact coil as the outer layer, or may be wound in the same direction. Here, since the spiral tube is wound with a pitch interval, when the proximal end portion of the spiral tube is rotated around the axis, the pitch interval changes, and the rotational force may not reach the tip. is there. As described above, since the close contact coil as the outer layer is in a close contact state, when the close contact coil is rotated in the winding direction, the rotational force is transmitted to the tip, so what is the winding direction of the spiral tube? Irrespective of this, the rotational force can be transmitted effectively. The winding direction of the spiral tube and the close coil is the same, and the pitch angle of the close coil is reduced, that is, close to the direction perpendicular to the axis, and when the spiral angle of the spiral tube is increased, it is rotated in the rewinding direction. Since there is a difference in the amount of diameter expansion between the contact coil and the spiral tube, the diameter expansion of the spiral tube is restricted, and a force acts in the direction of transmitting rotation. In particular, if the outer diameter of the helical tube is set to be larger than the inner diameter of the close contact coil and the double tube is configured as a double tube, the rotational force can be further increased by incorporating the spiral tube so as to be pressed against the close contact coil. Can be transmitted reliably and effectively

  In this way, by configuring the flexible sheath with the double flexible tube body of the spiral tube and the close-contact coil, even if this flexible sheath is bent to some extent, the control cable inserted inside Thus, the gap between the control cable and the flexible sheath can be minimized, and the diameter of the treatment instrument can be reduced.

    Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows an overall configuration of a biopsy forceps device as an endoscope treatment tool. In addition to the biopsy forceps, it can also be configured as a treatment instrument having various treatment means such as a grasping forceps, a high-frequency snare, a high-frequency knife, and a needle holder.

  As is clear from FIG. 1, the biopsy forceps device 1 has an operation portion 3 connected to a proximal end portion of a flexible sheath 2, and a holding cylinder 4 is attached to a distal end portion of the flexible sheath 2. The treatment means 5 is attached to the holding cylinder 4. The treatment means 5 is composed of a pair of claw members 5a and 5a, and a needle member 5b is provided between the claw members 5a and 5a. The claw members 5a, 5a constituting the treatment means 5 can be opened and closed, and can be displaced between a closed state shown in FIG. 2 and an open state shown in FIG.

  The opening / closing operation of the claw members 5a, 5a constituting the treatment means 5 is performed by remote operation from the operation unit 3. For this purpose, the operation unit 3 includes a main body shaft 6 and a slider 7 slidably fitted to the main body shaft 6. A slit 8 having a predetermined width is formed in the sliding direction of the slider 7 on the main body shaft 6 over a predetermined length in the axial direction, and an operation wire 9 is provided in the slit 8. The operation wire 9 is connected to the slider 7, and the operation wire 9 is pushed and pulled by moving the slider 7 in the axial direction of the main body shaft 6 with fingers. And the front-end | tip of the operation wire 9 branches in two, and each branch wire 9a, 9a is connected with the lever parts 10 and 10 provided in a row by claw member 5a, 5a, respectively.

  FIG. 4 shows the configuration of the flexible sheath 2. As is clear from this figure, the flexible sheath 2 has a double flexible tube 11 as a structural member. The double flexible tube 11 includes a spiral tube 12 in which metal strips having spring properties are wound spirally at an interval as an inner layer, and a metal wire as an outer layer wound tightly without gaps. It is comprised from the contact | adhered coil 13 rotated. Then, a flexible tube 14 made of a synthetic resin is packaged on the adhesion coil 13 as an outer skin layer. As a result, the flexible tube 11 has flexibility in the bending direction, and the internal shape of the insertion passage is maintained by the spiral tube 12. An operation wire 9 is inserted through an insertion passage formed inside the flexible tube 11.

  Here, as shown in FIG. 5, in the free state, the spiral tube 12 has an outer diameter D <b> 1 that is larger than the inner diameter of the contact coil 13, as indicated by the section F, and the section R. As shown in Fig. 5, when the contact coil 13 is wound around the outer periphery of the spiral tube 12, the inner diameter D2 of the contact coil 13 is reduced. Accordingly, when the flexible tube 11 is configured, the spiral tube 12 is assembled in a state in which an urging force is applied in the expanding direction. As a result, the interlayer between the spiral tube 12 and the contact coil 13 is brought into a close contact state, and the two layers of the flexible tube body 11 are integrated.

  The biopsy forceps device 1 is configured as described above, and the biopsy forceps device 1 has the flexible sheath 2 attached to the endoscope 20 as shown in FIG. become. The endoscope 20 is provided by connecting a main body operation portion 21 with an insertion portion 22 into a body cavity, and the insertion portion 22 is mostly a flexible portion 22a from the connection side to the main body operation portion 21. The flexible portion 22a is provided with an angle portion 22b, and the angle portion 22b is provided with a hard tip portion 22c. And although illustration is abbreviate | omitted, the front-end | tip hard part 22c is equipped with the endoscope observation means which consists of an illumination part and an observation part. The angle portion 22b can be bent up and down and left and right so that the distal end hard portion 22c provided with the endoscope observation means is directed in a desired direction. This bending operation is performed by operating the angle knob 23 provided in the main body operation unit 21 with fingers.

  The endoscope 20 is provided with a treatment instrument introduction section 24 in the main body operation section 21, and a treatment instrument insertion channel 25 extending from the treatment instrument introduction section 24 to the entire length of the insertion section 22. The tool insertion channel 25 is open to the distal end hard portion 22c of the insertion portion 22 together with the endoscope observation means. Therefore, in the biopsy forceps device 1, the flexible sheath 2 is inserted into the treatment instrument introduction portion 24 and is led out by a desired length from the distal end hard portion 22c of the insertion portion 22 to collect tissue cells or the like. Treatment is performed. When the tissue cells are collected by the treatment means 5, the claw members 5a and 5a are opened and closed. This operation is performed by sliding the slider 7 of the operation unit 3 along the main body axis 6.

  As described above, the claw members 5a and 5a constituting the treatment means 5 are opened and closed by the operation of the operation unit 3. The treatment means 5 operates smoothly and reliably, and the claw members 5a and 5a can be opened and closed with a light load. It must be possible to operate. For this reason, the change of the cross-sectional shape of the insertion path of the operation wire 9 formed in the flexible tube 11 is suppressed to the minimum, and the sliding resistance during the push-pull operation of the operation wire 9 is suppressed to the minimum. . For example, as shown in FIG. 6, the angle portion 22b of the insertion portion 22 of the endoscope 20 may be bent so as to have a small radius of curvature. In such a curved state, a compressive force or a shearing force acts on the flexible tubular body 11 inserted into the treatment instrument insertion channel 25. However, the helical tube 12 constituting the flexible tubular body 11 has a higher shape retention than a synthetic resin tube, a close contact coil, or the like, and the insertion passage formed therein has a shape. Curve while keeping. In particular, when the helical tube 12 is assembled in a reduced diameter state and the outer periphery thereof is regulated by the contact coil 13, the original cylindrical shape is maintained even if a compression force acts on the helical tube 12. . Therefore, even if the diameter difference between the inner diameter of the spiral tube 12 and the outer diameter of the operation wire 9 is reduced and the flexible sheath 2 is made thinner, the operation of the treatment means 5 performed by remote operation from the operation unit 3 is performed. Thus, the claw members 5a and 5a can be opened and closed smoothly with a light load.

  By the way, when performing treatment such as collection of tissue cells, it is necessary to adjust the treatment means 5 so as to be in an optimum direction with respect to the body tissue to be collected. That is, the treatment means 5 is composed of a pair of claw members 5a, 5a, and the opening / closing direction of the claw members 5a, 5a is the optimum direction with respect to the body cavity inner wall. If this direction is not appropriate, it is necessary to rotate the flexible sheath 2 so that the direction of the treatment means 5 can be adjusted. Further, after closing the claw members 5a and 5a and holding tissue cells therebetween, the flexible sheath 2 is operated to be pulled into the treatment instrument insertion channel 25. At this time, the claw members 5a and 5a are formed. If the treatment means 5 is twisted, tissue cells can be torn off smoothly. Therefore, also at this time, a rotational force must be applied to the treatment means 5.

  As described above, in order to apply a rotational force to the treatment means 5, a portion of the operation portion 3 or the flexible sheath 2 that is located outside from the treatment instrument introduction portion 24 is rotated, and the flexible sheath 2 is moved. This is performed by rotating around the axis in the treatment instrument insertion channel 25. Thus, in order to improve the operability of the biopsy forceps device 1, the rotation of the flexible sheath 2 within the treatment instrument insertion channel 25 is smoothly and reliably transmitted, and the flexible sheath 2 It is necessary to ensure that the site of the treatment means 5 follows the rotational force on the proximal end side of the 2. The flexible sheath 2 is composed of a double flexible tube 11 composed of a spiral tube 12 and a close coil 13, and the close coil 13 is wound in a close spiral shape. Accordingly, when the flexible sheath 2 is rotated in the direction in which the tight coil 13 is wound and tightened, no further tightening can be performed, so that the rotational force is smoothly and reliably transmitted to the tip.

  On the other hand, when the flexible sheath 2 is rotated in the direction in which the contact coil 13 is rewound, if there is no restriction on the contact coil 13, the contact coil 13 is rewound, and the rotational force reaches the tip. Not transmitted. And since the spiral tube 12 located inside the tight coil 13 is wound with a pitch interval, the spiral tube 12 is rotated only in the pitch interval, and the rotational force is changed regardless of which direction the spiral tube 12 is rotated. Is not transmitted to the tip. Therefore, in order to accurately transmit the rotational force also in this direction, the flexible tube 14 is formed with no or almost no stretchability. Then, as described with reference to FIG. 5, when the close contact coil 13 is wound around the outer periphery of the spiral tube 12, the spiral tube 12 is always pressed against the close contact coil 13 by reducing the diameter of the spiral tube 12. To do. As a result, the contact coil 13 is not unwound, and the twisting force is partially retained and the rotational force does not reach the tip.

  By the way, as shown in FIG. 7, the spiral tube 12 constituting the flexible tube 11 and the contact coil 13 are wound in the same direction, and the spiral tube 12 is wound around the axis A of the flexible tube 11. The rotation angle θ1 can be made smaller than the winding angle θ2 of the contact coil 13. In particular, when the winding angle θ2 of the close contact coil 13 is an angle close to a right angle with respect to the axis A, when the close contact coil 13 is rotated in the rewinding direction, the close contact coil 13 hardly expands in diameter. On the other hand, since the winding angle θ1 of the spiral tube 12 is small, when the spiral tube 12 is rotated in the rewinding direction, it tries to expand the diameter, but the contact coil 13 increases the diameter. Of being regulated. As a result, the rotational force is transmitted toward the tip.

  As described above, when the flexible sheath 2 is rotated in the direction in which the contact coil 13 or the spiral tube 12 is rewound, the rotational force is controlled by restricting the diameter expansion of the contact coil 13 or the spiral tube 12. The rotation force is effectively transmitted to the tip, not lost due to the diameter expansion. As a result, operations such as adjusting the direction of the treatment means 5 and adjusting the direction of the treatment means 5 by twisting the treatment means 5 and tearing the tissue can be performed smoothly.

1 is an overall configuration diagram of a biopsy forceps device showing an embodiment of the present invention. It is the external view which showed the structure of the treatment means of the biopsy forceps apparatus of FIG. 1, and made this treatment means closed. It is an external view shown in the state which opened the treatment means of FIG. It is a structure explanatory view of a flexible sheath. It is composition explanatory drawing which shows the state which winds a close_contact | adherence coil around the helical tube which comprises a flexible sheath. It is an external view which shows the state which penetrated the biopsy forceps apparatus of FIG. 1 through the endoscope. It is composition explanatory drawing at the time of making the winding direction of a helical tube and a close_contact | adherence coil the same.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Biopsy forceps apparatus 2 Flexible sheath 3 Operation part 5 Treatment means 5a Claw member 6 Main body shaft 7 Slider 9 Operation wire 11 Flexible tube 12 Spiral tube 13 Adhesion coil 14 Flexible tube

Claims (4)

A treatment means is inserted through the treatment instrument insertion channel of the endoscope, a treatment means is provided at the distal end of the flexible sheath, and a control cable for remotely operating the treatment means is inserted into the flexible sheath. In an endoscopic treatment tool provided with an operating means connected to the end,
The flexible sheath has a spiral tube provided by spirally winding a metal strip as an inner layer, is attached to the outer periphery of the spiral tube, and tightly wound with a metal wire wound closely Consists of a double flexible tube with the coil as the outer layer,
A treatment instrument for an endoscope, characterized in that the control cable for operating the treatment means is inserted into the flexible tube. The endoscopic treatment instrument according to claim 1, wherein the control cable is pushed and pulled in an axial direction inside the spiral tube or operated so as to rotate around an axis. When the outer diameter of the helical tube is set to be larger than the inner diameter of the free state of the contact coil, and the double flexible tube is configured, the spiral tube is assembled so as to be pressed against the contact coil. The endoscope treatment tool according to claim 1 or 2, wherein the treatment tool is configured. 4. The structure according to claim 1, wherein a flexible tube made of a synthetic resin is attached to the close contact coil constituting the flexible sheath of the flexible tube body. The treatment instrument for endoscope as described.

Images