JP2007260314A - Treatment implement for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To improve the efficiency and speed of treatment and to reduce burdens on an examinee and an operator by reducing the exchange frequency of a treatment implement to the treatment implement insertion channel of an endoscope or eliminating the need of exchange when performing treatment using the plurality of treatment implements. <P>SOLUTION: A treatment unit 1 comprises a flexible sheath 2 to be inserted to the treatment implement insertion channel C of an endoscope insertion part S and an operation part 3 composed of a main body shaft 4 and a slider 5. A marking means 10, a local injection means 11 and a high frequency knife 12 are mounted inside the flexible sheath 12, the electrode 10a of the marking means 10 and the electrode 12a of the high frequency knife 12 are connected by a conductive wire 13, and the conductive wire 13 is wound around a pulley 18 provided on the slit 4a of the main body shaft 4 and connected to a connection terminal 21 provided on the slider 5. When the slider 5 is moved back and forth along the main body shaft 4, the electrode 10a or the electrode 12a is selectively led out from the distal end of the flexible sheath 2. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an endoscope treatment tool that is guided into a body cavity using a treatment tool insertion channel of an endoscope as a guide means and used for performing appropriate treatment.

  For example, if a lesion, such as a tumor, is found on the mucosal part of the inner wall of a body cavity such as the esophagus, stomach, duodenum, and large intestine by endoscopy, a procedure is performed to remove the lesioned mucosa using a high-frequency treatment instrument. Is called. In this case, in order to ensure the safety of the treatment, the treatment is performed under observation with an endoscope. The treatment tool used for this purpose is inserted into the treatment tool insertion channel of the endoscope and placed at the site to be treated. Led. Here, in the inner wall of the body cavity, a submucosal layer exists below the mucosal layer, and the muscle layer is covered with the submucosal layer. Therefore, in the treatment of incising and removing the lesion mucosa using a high-frequency treatment tool, it is necessary to prevent the lesion from being left behind, and to prevent any damage to the muscle layer.

  A treatment instrument used for incision of a lesioned mucosa is configured by mounting a high-frequency knife made of an electrode member having a rod-shaped part in a flexible sheath, and an operating means is provided at the proximal end of the flexible sheath. The high-frequency knife can be controlled so as to appear and disappear from the distal end of the flexible sheath by remote operation by the operation means. And by energizing the high frequency knife protruded from the flexible sheath, the mucosa can be cauterized and incised.

  As the structure of the electrode member constituting the high-frequency knife, a needle-like knife in which a rod-shaped electrode member extends straightly, a large-diameter electrode portion is connected to the tip of the rod-shaped electrode member, or the tip is roughly L-shaped. A hook knife or the like in which a hook portion is formed by bending is used. The needle knife is operated so as to pierce the mucous membrane, and the electrode member is operated so as to move horizontally or swing, thereby incising the mucous membrane or the like. On the other hand, the hook knife is incised by hooking a tissue such as a mucous membrane with a hook part at the tip and pulling it to the insertion part side of the endoscope.

  Under the observation of the endoscope, the hook knife makes the hook part hook on the mucous membrane or the like, and then operates the hook knife so as to draw it into the treatment instrument insertion channel while passing a high-frequency current, thereby incising the mucous membrane. Therefore, while operating the hook knife, the tip of the hook knife can always be operated under the observation of the endoscope, so that it is operated so as not to contact the muscle layer when energized. be able to. This type of high-frequency treatment instrument using a hook knife is disclosed in Patent Document 1, for example. In the high-frequency treatment instrument of Patent Document 1, an electrical insulating member is attached to the distal end of a flexible sheath, a through hole is provided in the electrical insulating member, and a rod-shaped portion of an electrode member constituting a hook knife is formed in the through hole. The hook portion at the tip can be brought into contact with and separated from the outer surface of the tip of the electrical insulating member. When energized, the electrode member is projected from the flexible sheath by a predetermined length.

During treatment for incising the lesion using this electrode member, bleeding may occur, which may make it impossible to confirm the lesion. Therefore, by forming an opening different from the through-hole through which the electrode member is inserted into the electrical insulating member, or by forming the through-hole into a cross shape or a triangle shape, the rod-shaped portion of the electrode member cannot enter, that is, with the electrode member. The liquid outflow part which is not obstruct | occluded is formed. Connect a syringe to the base end of the flexible sheath, fill the syringe with physiological saline, and operate the syringe to eject the physiological saline from the liquid outflow part toward the bleeding part and wash it. To be able to.
JP 2004-313537 A

  By the way, in order to perform the above-described treatment for incising the lesion mucosa more safely, and to remove only the lesion mucosa and suppress damage to a healthy tissue to a minimum, first, the site to be incised in the mucosa layer Next, it is desirable that sodium hyaluronate or physiological saline is locally injected into the submucosa layer of the lesion mucosa to bulge the lesion area, and then the mucosa is incised using a high-frequency treatment instrument. Here, the marking method is generally performed by cauterization using high frequency. Therefore, although marking and incision are performed using a high-frequency treatment instrument, the shape of the electrode at the tip differs between marking and incision. That is, an electrode having a large diameter and a spherical tip is preferable as a treatment tool for marking, and a high-frequency treatment tool for incision is preferably a knife-like electrode having a thin tip and a wide width. In view of the above, at least three types of treatment tools such as a local injection means, a marking high-frequency treatment tool, and a high-frequency treatment tool for incision are required for performing a treatment for incising a lesion mucosa. .

  Therefore, when the treatment is executed, the treatment tool used according to the procedure of the treatment must be replaced and inserted into the treatment tool insertion channel of the endoscope. As described above, since the operation for exchanging the treatment tool is complicated and time-consuming, the entire treatment takes a long time, which gives a large burden to the subject and makes the operator tired. There is a point.

  The present invention has been made in view of the above points, and an object of the present invention is to provide a treatment tool to a treatment instrument insertion channel of an endoscope when performing a treatment using a plurality of treatment instruments. By reducing the frequency of replacement or eliminating the need for replacement, it is intended to improve the efficiency and speed of the procedure and reduce the burden on the subject and the operator.

  In order to achieve the aforementioned object, the present invention provides a flexible sheath inserted into a treatment instrument insertion channel of an endoscope, at least two treatment means inserted into the flexible sheath, The main body shaft and a slider that reciprocates in the axial direction of the main body shaft are connected to the base end portion of the flexible sheath, and the treatment is performed from the distal end opening of the flexible sheath in conjunction with the operation of the slider. It is characterized by having a configuration including an operation unit that performs an operation of alternately moving two treatment means out of the means.

  Here, the treatment means inserted through the flexible sheath includes high-frequency treatment means, forceps, tissue collection means, injection solution injection means, and the like, and is at least two kinds of treatment means. For example, when performing incision of a lesioned mucosa, two types of high-frequency treatment means and local injection means are used. The two types of high-frequency treatment means differ in the electrode portion at the tip, but there is no particular difference in the conductive wire for connecting the electrode to the high-frequency power source. Therefore, when mounting two types of high-frequency treatment means, electrodes having different shapes are connected to both ends of the conductive wire, and the conductive wire connecting these electrodes is connected to a high-frequency power source. These two types of electrodes are alternately led out from the tip of the flexible sheath, but in order to perform this interlocking operation by operating the slider, a pulley is attached to the operation part and both ends are connected to a high-frequency power source. The conductive wire is wound and provided. A connection terminal of a high frequency power source provided on the slider is connected to a conductive wire led out from one of the pulleys. If comprised in this way, when a slider is arrange | positioned in a predetermined position (origin position), both electrodes will be located in a flexible sheath. When the slider is displaced in one direction with respect to the operation member from this position, one electrode is led out from the distal end of the flexible sheath, and the other electrode is drawn into the flexible sheath. When the slider is slid in the opposite direction, the other electrode is led out from the flexible sheath, and one electrode is drawn into the flexible sheath.

  Furthermore, in the flexible sheath, in addition to the two treatment means described above, a water injection means as a third treatment instrument, for example, a local injection means with a needle tip attached to the tip of the flexible tube is provided, This water injection means can be made to protrude from the flexible sheath independently of these two treatment means. Therefore, in the state where the above-mentioned two electrodes are drawn into the flexible sheath and located at the origin, the water injection means is operated to push out the flexible sheath to pump sodium hyaluronate, physiological saline, etc. By doing so, it is possible to bulge the lesioned mucosa by local injection to the inner wall of the body cavity.

  The flexible sheath must form a passage having a larger diameter than each of the treatment means because a plurality of treatment means are inserted. If the flexible sheath passage is opened at the tip as it is, a large gap may be generated between the inner diameter of the flexible sheath and the outer diameter of the treatment means, and the direction control of the treatment means may not be performed accurately. . In particular, in the case of an electrode that performs high-frequency treatment, control of the direction of lead-out from the flexible sheath may be extremely important. Therefore, the distal end of the flexible sheath has a lead-out passage through which the treatment means having a smaller diameter than the passage and the largest diameter can be inserted, and a treatment means lead-out member made of a hard member that is an electrically insulating member is mounted. can do. The inner side of the flexible sheath in the treatment instrument outlet member is configured to expand the outlet passage in a tapered shape. Moreover, it is also possible to adopt a configuration in which the plurality of treatment means are inserted through mutually independent paths instead of making the flexible sheath path a single path over the entire length. That is, the flexible sheath can be configured as a multi-lumen tube in which a plurality of passages are provided in one tube.

  By adopting the above configuration, when performing treatment using a plurality of treatment tools, the frequency of replacement of the treatment tool to the treatment tool insertion channel of the endoscope is reduced, or without requiring replacement, The target treatment can be performed, the efficiency and speed of the treatment can be improved, and the burden on the subject and the operator can be reduced.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows a cross-sectional configuration of a treatment unit including a high-frequency treatment tool used for incising a lesion mucosa as an example of an endoscope treatment tool of the present invention.

  First, as is apparent from FIG. 1, the treatment unit 1 includes a long flexible sheath 2 and an operation unit 3 connected to a proximal end portion of the flexible sheath 2. The operation unit 3 includes a main body shaft 4 connected to the flexible sheath 2 and a slider 5 that is fitted to the main body shaft 4 and is slidable in the axial direction of the main body shaft 4.

  The flexible sheath portion 2 is inserted into the treatment instrument insertion channel C of the endoscope insertion portion S (see FIGS. 6 to 8), and the distal end portion of the flexible sheath 2 is an endoscope. A predetermined length can be derived from the opening at the tip of the mirror insertion portion S. The flexible sheath portion 2 has a flexible guide tube 6, and three types of treatment means described later are inserted into the guide tube 6. The distal end portion of the guide tube 6 is a plastic material having heat resistance, and a treatment means lead-out member 7 made of a hard member is inserted and fixed by means such as adhesion. The treatment means lead-out member 7 is formed with a lead-out passage 8 having a slightly larger hole diameter than the maximum diameter treatment means attached to the treatment unit 1. The lead-out passage 8 is a calling portion 8a that expands in a tapered shape on the inner side of the guide tube 6.

  The treatment unit 1 is equipped with three types of treatment means. That is, the marking means 10, the local injection means 11, and the high frequency knife 12 for incision are them. The marking means 10 has an electrode 10a formed at the tip, and a conductive wire is fixedly provided on the electrode 10a, and the conductive wire is detachably connected to the high-frequency power supply device. The local injection means 11 is provided by connecting a needle tip portion 11b to the tip of the flexible tube 11a, and a liquid supply path is formed inside the flexible tube 11a. A passage leading to the liquid supply path is formed in the portion 11b, and the tip thereof is open. Further, the high-frequency knife 12 has an electrode 12a formed at the tip, and a conductive wire is fixedly provided on the electrode 12a.

  The electrode 10a of the marking means 10 and the electrode 12a of the high-frequency knife 12 have the same shape except for the shape. That is, the electrode 10a of the marking means 10 should cauterize only the surface layer portion of the inner wall of the body cavity, and this cauterization range must be extended to some extent. On the other hand, since the high frequency knife 12 is incised, it needs to be sharp to some extent. Therefore, the thickness should be thin, and the cut width at the time of incision should be as small as possible. And although a conductive wire is connected to these electrodes 10a and 12a, this conductive wire may be the same. Therefore, as shown in FIG. 2, the electrode 10 a constituting the marking means 10 and the electrode 12 a constituting the high-frequency knife 12 are configured to use a common conductive wire 13, and electrodes 10 a are connected to both ends of the conductive wire 13. The electrodes 12a are connected to each other.

  As described above, the three types of treatment means including the marking means 10, the local injection means 11, and the high-frequency knife 12 are connected to the main body shaft 4 constituting the operation unit 3 from the proximal end of the guide tube 6 constituting the flexible sheath 2. It has come to be guided. A branch member 14 is attached to the guide tube 6, and an extension portion from the electrode 10 a and an extension portion from the electrode 12 a of the conductive wire 13 from the inside of the guide tube 6 are positioned at upper and lower positions. The direction adjusting pipes 15 and 16 whose derivation directions are controlled so as to be related to the direction adjusting pipe 17 through which the flexible tube 11a of the local injection means 11 is inserted and directed in a desired direction are connected to each other. It has been. The main body shaft 4 is provided with a slit 4a. The slit 4a is formed at an intermediate position in the axial direction of the main body shaft 4 and has a length that does not reach both ends. The direction adjusting pipes 15 to 17 in the branching member 14 are introduced into the distal end portion in the slit 4a.

  A pulley 18 is attached to the base end side portion of the slit 4a, and the conductive wire 13 extended from the direction adjusting pipes 15 and 16 is wound around the pulley 18 to change its direction. Here, the pulley 18 can be fixed to the main body shaft 4 in a non-rotatable manner. However, in the illustrated case, the pulley 18 is attached to the rotary shaft 19 and is rotatable. On the other hand, the flexible tube 11 a of the local injection means 11 extended from the direction adjusting pipe 17 is led into a holder cylinder 20 provided continuously with the main body shaft 4. Further, a connection terminal 21 is provided in a connected position at an intermediate position of the conductive wire 13, for example, a portion on the connection side from the portion wound around the pulley 18 to the electrode 10 a. The connection terminal 12 is fixed to a surrounding wall portion 22 provided on the slider 5, and a connector from a high frequency power supply device (not shown) is detachably connected to the surrounding wall portion 22. On the other hand, an adapter 23 is connected to the flexible tube 11 a of the local injection means 11, and this adapter 23 is inserted so as to be movable in the axial direction of the holder cylinder 20. The adapter 23 has a luer lock receiving portion 23a, and liquid pressure feeding means such as a syringe 24 is detachably fixed to the luer lock receiving portion 23a. A bulging liquid for bulging an inner wall of a body cavity, such as sodium or physiological saline, can be supplied to the needle tip portion 11b.

  The treatment unit 1 manually operates the operation portion 3 to selectively move the electrode 10a of the marking means 10, the electrode 12a of the high-frequency knife 12 and the needle tip portion 11b of the local injection means 11 from the distal end of the flexible sheath 2. Can be derived. For this purpose, the slider 5 is fitted to the main body shaft 4 and can be reciprocated in the axial direction of the main body shaft 4. Finger insertion rings 25 and 26 are provided on opposite sides of the slider 5, and a finger insertion ring 27 is also provided on the base end portion of the main body shaft 4. Accordingly, the index finger and the middle finger are inserted into the finger insertion rings 25 and 26, the thumb is inserted into the finger insertion ring 27, and the aforementioned treatment means is selectively led out from the distal end of the flexible sheath 2. .

  The above three types of treatment means are all located inside the flexible sheath 2 in the state shown in FIG. This is the origin position, and at this time, no treatment is performed. FIG. 3 shows a marking operation state in which the marking means 10 is led out from the flexible sheath 2 to perform the marking operation.

  This marking operation state is a state in which the slider 5 is slid and displaced toward the distal end side of the body shaft 4 from the non-treatment state, which is the origin position in FIG. 1, as indicated by an arrow in FIG. By this operation, among the conductive wires 13 located in the slit 4a, the connection side of the electrode 10a is drawn out, and the connection side of the electrode 12a is drawn into the pulley 18 side. As a result, the electrode 10 a of the marking means 10 moves toward the distal end side of the flexible sheath 2. The distal end portion of the guide tube 6 constituting the flexible sheath 2 is provided with a treatment means lead-out member 7, and the treatment means lead-out member 7 is provided with a lead-out passage 8 having a calling portion 8a. Is guided to the lead-out passage 8 and is led out from the front end opening of the lead-out passage 8 by a predetermined length. At this time, since the conductive wire 13 is wound around the pulley 18 and is in an inverted state, the electrode 12a constituting the high-frequency knife 12 is drawn to the inner back of the guide tube 6. Accordingly, when a counter electrode (not shown) is brought into contact with the subject, the electrode 10a is brought into contact with the inner wall of the body cavity, and a high-frequency current is passed from the connection terminal 21 to the conductive wire 13, the electrode 10a is directed toward the inner wall of the body cavity. High-frequency current flows. On the other hand, since the electrode 12a is located inside the guide tube 6, no high-frequency current flows.

  FIG. 4 shows the operation state of the local injection means. When the adapter 23 is pushed into the holder cylinder 20 by a predetermined amount from the origin position in FIG. 1, that is, when it is moved in the direction of the arrow shown in FIG. 4, the needle tip portion 11 b constituting the local injection means 11 is treated with the treatment means lead-out member 7. A predetermined amount is derived from the leading end of the deriving passage 8. This allows local injection with the bulging liquid.

  Further, FIG. 5 shows a high-frequency knife operating state. In this high-frequency knife operating state, the slider 5 is slid and displaced from the origin position in FIG. 1 in the direction opposite to the above-described marking. That is, as indicated by the arrow in FIG. 5, the slider 5 is slid and displaced toward the base end side of the main body shaft 4. As a result, the electrode 12 a of the high-frequency knife 12 is led out by a predetermined length from the distal end opening of the lead-out passage 8 of the treatment instrument lead-out member 7. At this time, the electrode 10 a of the marking means 10 is drawn into the inner portion of the guide tube 6.

  The treatment unit 1 is inserted into the treatment instrument insertion channel C of the endoscope insertion portion S and treatment is performed according to a predetermined procedure. As described above, the treatment unit 1 is operated by hand operation by the electrodes 10a, By selectively deriving either the needle tip 11b of the local injection means 11 or the electrode 12a of the high-frequency knife 12, three types of treatment are performed while the treatment unit 1 is inserted into the treatment instrument insertion channel C. be able to.

  The treatment unit 1 having the above configuration is inserted into a body cavity via a treatment instrument insertion channel C provided in the endoscope insertion portion S, as shown in FIGS. 6 to 8, for example, the esophagus, stomach, When inserted into a body cavity such as the duodenum or the large intestine and a lesioned mucosa is present on the inner wall of the body cavity, it is used to perform a treatment for peeling and removing the lesioned mucosa. That is, when the endoscopic insertion portion S is inserted into the body cavity and the lesion mucosa is found by observation by the endoscopic observation means, the treatment unit 1 is inserted into the treatment instrument insertion channel C, and this The distal end portion of the treatment unit 1 is led out from the treatment instrument insertion channel C. Since a high-frequency treatment instrument is used, a counter electrode is brought into contact with the subject when performing treatment.

  First, as shown in FIG. 6, marking is performed on the mucous membrane where the lesioned part to be excised exists so as to surround the lesioned mucosal region. Then, the distal end of the endoscope insertion portion S is opposed to the outer edge of the lesion mucosa region at a predetermined distance, and the electrode 10a of the marking means 10 is energized, thereby marking the inner wall of the body cavity by cauterization. Apply. The area to be marked is a range in which the lesion can be completely removed and the healthy mucous membrane part is not damaged as much as possible. The cautery part is assumed to be remarkable enough to be observed by the endoscope observation means, and cautery is performed only on the surface layer part. For this purpose, the electrode 10a of the marking means 10 having a spherical tip is used.

  Therefore, the slider 5 in the operation unit 3 of the treatment unit 1 is displaced to the marking operation state shown in FIG. As a result, only the electrode 10 a is led out from the distal end of the flexible sheath 2. Then, this electrode 10a is brought into contact with the outer edge portion of the lesioned mucosa region, and the electrode 10a is energized to perform cauterization. Then, the position of the endoscope insertion portion S is changed, and a plurality of places are cauterized to mark the mucosal site to be incised. Here, the high-frequency current flows between the electrode 10a that is in contact with the inner wall of the body cavity of the subject and the inner wall of the counter electrode that is in contact with the subject, and the other electrode 12a also passes through the conductive wire 13. The electrode 12a is located inside the guide tube 6 and is electrically insulated from the inner wall of the body cavity, so that a high-frequency current flows through the electrode 12a. There is nothing.

  Next, local injection of the bulging liquid is performed inside the lesioned mucosa region. At this time, it is not necessary to remove the treatment unit 1 inserted through the treatment instrument insertion channel C from the treatment instrument insertion channel C. By operating the slider 5, the electrode 10 a of the marking 10 is pulled back into the flexible sheath 2. Of course, at this time, the other electrode 12 a is not led out from the flexible sheath 2. That is, it returns to the origin position in FIG. Then, the distal end of the endoscope insertion portion S is moved to a predetermined position in the marked part, and then the adapter 23 is operated to be pushed into the holder tube 20. As a result, the needle-like portion 11b of the local injection means 11 protrudes a predetermined length from the distal end of the flexible sheath 2 via the outlet passage 8 of the treatment means outlet member 7 provided in the guide tube 6 as shown in FIG. It becomes a state. The needle-like portion 11b at the tip of the local injection means 11 is sharp, but the treatment means lead-out member 7 is a hard member, and the lead-out passage 8 is provided with a calling portion 8a that expands in a tapered shape. Therefore, the lead-out operation of the needle-like portion 11b of the local injection means 11 can be performed smoothly. Thereby, as shown in FIG. 7, the needle-like part 11b is penetrated to the submucosa LM through the mucosa layer LU. However, the acicular portion 11b is prevented from reaching the muscle layer LB.

  A syringe 24 is attached to the adapter 23 provided in the holder cylinder 20 in advance, and the bulging liquid is supplied from the syringe 24 toward the needle-like portion 11b penetrating the mucosal layer LU and positioned in the submucosa LM. . As a result, the submucosa LM bulges and rises. The reason why the submucosal layer LM is thus bulged is to separate the mucosal layer LU from the muscle layer LB and perform a smooth and safe treatment.

  After the submucosal layer LM is sufficiently bulged, the adapter 23 is displaced in the holder tube 20 in a direction to draw a predetermined amount. Thereby, the treatment unit 1 returns to the origin position. Therefore, the slider 5 is operated to be displaced to the high frequency knife operating state of FIG. That is, by moving the slider 5 to the base end side of the body shaft 5, the connecting side of the conductive wire 13 to the electrode 12a is sent out, and the connecting side to the electrode 10a is pulled in. As a result, the electrode 12a of the high-frequency knife 12 is pulled. It is derived from the tip of the flexible sheath 2.

  Then, by supplying a high-frequency current from the high-frequency power supply device through the connection terminal 21, as shown in FIG. 8, the electrode 12a of the high-frequency knife 12 penetrates the mucosal layer LU and is guided to the submucosa LM. Incision of the lesioned mucosa area is started. Then, an incision is made along the marked cauterized part by moving the endoscope insertion part S or bending the angle part. At this time, the electrode 10 a constituting the marking means 10 is drawn into the inner depth of the guide tube 6.

  As described above, the treatment unit 1 is marked in the state where it is attached to the endoscope insertion portion S, and the incision of the lesioned mucous membrane is also performed. The two electrodes 10 a and 12 a are not led out from the flexible sheath 2. Therefore, a safe treatment is possible when any treatment is performed.

  Here, as a matter of course, when marking is performed by the marking means 10, the muscle layer LB must not be damaged by the electrode 12 a when the mucosal layer LU is incised by the high-frequency knife 12. Therefore, it is preferable to restrict the protruding length of the electrode 12a from the flexible sheath 2 to be larger than the thickness dimension of the mucosa layer LU and shorter than the total thickness dimension of the mucosa layer LU and the submucosa LM. As described above, since the submucosal layer LM is bulged by local injection, the mucosal layer LU can be reliably incised unless otherwise specified, and any damage is caused to the muscular layer LB. The incision of the mucosal layer LU is performed without. Although the entire lesioned mucosal area can be incised at a time, if the lesioned mucosal area is large, it is desirable to repeat the operation of incising and exfoliating a part several times.

  Even if the entire circumference of the lesioned mucosa region is incised, the mucosal layer LU cannot be removed by itself. That is, since the mucosal layer LU and the muscle layer LB are connected by the fibrous submucosa LM, it is necessary to separate the fiber from the muscle layer LB by cutting the fibers. This mucosal peeling can also be performed by operating the high-frequency knife 12 by the treatment unit 1. That is, the electrode 12a of the high-frequency knife 12 is made to enter the exposed portion of the submucosa LM generated by the incision, and the flexible sheath 2 is horizontally moved or swinged to cut the submucosa LM. To make it work. This operation can be easily performed by an operation such as bending the distal end portion of the endoscope insertion portion S. As a result, mucosal detachment is performed quickly and efficiently.

  When performing mucosal detachment, it is necessary to replenish the swelling liquid. The lesion mucosa region has already been bulged by local injection, but the bulging liquid supplied during the incision may flow out or be absorbed into the body, causing the bulging portion to contract. Therefore, in order to maintain the submucosa LM in the bulging state, the mucous membrane is peeled off while supplying the bulging liquid. The operation is performed by operating the slider 5 to pull the electrode 12a into the flexible sheath 2 and operating the adapter 23 to cause the needle tip portion 11b of the local injection means 11 to be led out from the lead-out passage 8. By operating the mounted syringe 24, the swelling liquid is injected into the submucosa LM. As a result, the bulging liquid can be supplied more efficiently and can be directly injected toward the submucosa LM. As a result, the submucosa LM to be peeled can be maintained in a bulging state.

  The above operation can be performed with the treatment unit 1 inserted through the treatment instrument insertion channel C of the endoscope insertion portion S. The slider 5 can be moved back and forth or the adapter 23 can be slid with respect to the holder tube 20. The treatment means is exchanged by the operation of making it happen. The operation of inserting / removing the treatment tool into / from the treatment tool insertion channel C does not contribute to the process of incision of the mucous membrane of the lesion itself, and is only a complicated operation. By not requiring it, rapid treatment is possible, and the burden on the operator and the subject is significantly reduced.

  In the embodiment described above, the flexible sheath 2 constituting the treatment unit 1 selectively leads out any treatment means to the distal end of the guide tube 6 in which a common passage is provided for each treatment means. Although the treatment means derivation member 7 provided with the derivation passage 8 is provided, the three passages 31, 32, and 33 may be provided as in the flexible sheath 30 as shown in FIG. . The passage 10 includes the electrode 10a and the conductive wire 13 connected thereto, the passage 32 includes the electrode 12a and the conductive wire 13 connected thereto, and the passage 33 includes the flexible member 11 constituting the local injection means 11. The tube 11a is inserted.

It is sectional drawing of the treatment unit as a treatment tool for endoscopes which shows one embodiment of the present invention. It is structure explanatory drawing of the treatment means with which a treatment unit is mounted | worn. It is sectional drawing similar to FIG. 1 made into the marking operation state. It is sectional drawing similar to FIG. 1 made into the local injection means operation state. It is sectional drawing similar to FIG. 1 made into the high frequency knife operation state. It is action explanatory drawing which shows the state which is marking the lesioned-mucosa part. It is effect | action explanatory drawing which shows the state which is performing local injection. It is effect | action explanatory drawing which shows the state which has cut | disconnected the lesion mucosa part. It is sectional drawing which shows the modification of a flexible sheath.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Treatment unit 2,30 Flexible sheath 3 Operation part 4 Main body axis | shaft 5 Slider 6 Guide tube 7 Treatment means derivation member 8 Derivation passage 10 Marking means 10a Electrode 11 Local injection means 11a Flexible tube 11b Needle tip part 12 High frequency knife 12a Electrode 13 Conductive wire 18 Pulley 20 Holder cylinder 21 Connection terminal 23 Adapter 24 Syringe

Claims (5)

A flexible sheath inserted into the treatment instrument insertion channel of the endoscope;
At least two treatment means inserted through the flexible sheath;
The flexible sheath is connected to the base end of the flexible sheath, and includes a main body shaft and a slider that reciprocates in the axial direction of the main body shaft. An endoscopic treatment tool comprising: an operation unit that performs an operation for causing two of the treatment means to alternately appear and disappear. The two treatment means are high-frequency treatment tools having electrodes of different shapes, and both the electrodes are connected to both ends of a conductive wire, and a pulley around which the conductive wire is wound is provided in the operation portion. The endoscope according to claim 1, wherein a connection terminal to a high-frequency power source is connected to a conductive wire led out from one side of the pulley, and the connection terminal is connected to the slider. Treatment tool. In the flexible sheath, water injection means is inserted as a third treatment tool in addition to the two treatment means, and the water injection means is provided from the flexible sheath independently of the two treatment means. The endoscopic treatment tool according to claim 1 or 2, wherein the endoscope is configured to project and retract. One passage is formed in the flexible sheath, and a lead-out passage which is smaller in diameter than the insertion passage and through which the largest diameter treatment means can be inserted is formed at the distal end of the passage. The endoscopic treatment tool according to any one of claims 1 to 3, wherein a treatment means lead-out member made of a rigid member is mounted on the electrically insulating member. The endoscopic treatment tool according to any one of claims 1 to 3, wherein the flexible sheath is configured by a multi-lumen tube in which a plurality of passages are provided in one tube.

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