JP2007289593A - Endotherapy accessory - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endotherapy accessory capable of smoothly rotating a distal end endotherapy accessory piece around a shaft by the operation at the distal end of a flexible sheath put through an endotherapy accessory guide pipe from the hand side even in a state that the endotherapy accessory guide pipe of an endoscope is bent at a small curvature radius at a large angle in a curved part by performing a rotation operation at the hand side. <P>SOLUTION: As an operation wire 12, a flexible wire having larger rotation followability than that of a flexible sheath 11 is used, and the flexible sheath 11 and the operation wire 12 are integrally rotated around the shaft on a proximal end side, and on a distal end side, each rotates independently around the shaft. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an endoscope treatment tool.

  In general, an endoscope treatment tool used by being inserted into and removed from an endoscope treatment tool guide tube is used for operating a distal treatment piece disposed at a distal end portion of a flexible sheath from the proximal side on the hand side. The operation wire is loosely inserted into the flexible sheath, and in order to perform an appropriate treatment according to the state of the affected part, the operating direction (for example, opening and closing direction) of the distal end operating part is from the hand side. It is desirable to be able to change arbitrarily.

  However, in the case of a conventional endoscope forceps or the like in which the flexible sheath and the operation wire are configured to rotate integrally at each of the proximal end portion and the distal end portion, the flexible sheath and the operation wire are bent at a large angle with a small curvature radius. In the portion located in the curved portion near the distal end of the endoscope insertion portion, the resistance to the relative rotational movement around the axis between the flexible sheath and the treatment instrument guide tube is large, so the flexible sheath on the hand side The rotational force applied to is greatly absorbed in the curved portion, and the rotational operation is not smoothly transmitted to the tip side. However, even if it is configured to be able to rotate only the operation wire having a diameter of less than 1 mm and having a length of about 1.5 to 2 m over the entire length, even if it is rotated from the hand side, it is flexible with the operation wire. Due to the frictional resistance over the entire length between the sheath and the sheath, the operating wire cannot be smoothly rotated at the tip portion.

Therefore, conventionally, the flexible sheath and the operation wire rotate integrally around the axis of the operation wire on the proximal end side, and each independently rotate around the axis of the operation wire on the distal end side. (Patent Document 1), or a sheath (Patent Document 2) in which a flexible sheath is coated around a flexible shaft.
Japanese Patent Laid-Open No. 10-192286 JP 2004-154682 A

  In the invention described in Patent Literatures 1 and 2, when the entire operation portion on the proximal side is rotated, the inner circumference of the treatment instrument guide tube is located in a portion located within the bending portion of the endoscope that can be bent at a large angle with a small radius of curvature. The rotation of the member that touches the surface (flexible sheath in Patent Document 1 and coated tube in Patent Document 2) is stopped by frictional resistance with the treatment instrument guide tube, but at the same time, a thin operation wire passed through the inside Most of the rotation of the flexible sheath (in the case of Patent Document 2) stops there, and the distal treatment piece cannot be rotated smoothly. If the rotation operation is further continued on that side from that state, a very irregular movement that causes the entire flexible sheath to suddenly rotate greatly at the moment when the force applied by the rotation operation overcomes the frictional resistance. Resulting in.

  The present invention has been made to solve such a problem, and by rotating on the hand side, the treatment instrument guide tube of the endoscope was bent at a large angle with a small curvature radius in the bending portion. An object of the present invention is to provide an endoscopic treatment instrument that can smoothly rotate a distal treatment piece around an axis at the distal end of a flexible sheath passed through the treatment instrument guide tube even in a state. .

  An operation wire for an endoscope, which is used by being inserted into and removed from a treatment instrument guide tube of an endoscope, and for operating a distal treatment piece arranged at a distal end portion of a flexible sheath from the proximal end side In an endoscope treatment instrument having a configuration in which a flexible sheath is inserted loosely into a flexible sheath, a flexible wire having a greater rotational followability than the flexible sheath is used as the operation wire. Are configured to rotate integrally around the axis on the base end side, and independently rotate around the axis on the distal end side.

  The distal end body that supports the distal treatment piece may be connected to the distal end of the flexible sheath so as to be rotatable about the axis and not movable in the axial direction. Alternatively, the flexible sheath may be formed by covering a flexible tightly wound coil with a flexible electrically insulating tube.

  According to the endoscope treatment tool of the present invention, a flexible wire having a greater rotational followability than the flexible sheath is used as the operation wire, and the flexible sheath and the operation wire are axially arranged on the proximal end side. It is designed to rotate around the axis and rotate independently around the axis on the tip side, so that the flexible sheath and the operation wire can be rotated around the axis on the hand side. Thus, even when the treatment instrument guide tube of the endoscope is bent at a large angle with a small radius of curvature in the bending portion, the distal treatment is performed at the distal end of the flexible sheath that is passed through the treatment instrument guide tube. The piece can be smoothly rotated around the axis.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 2 shows a use state in which the flexible sheath 11 of the endoscope treatment tool 10 is passed through the treatment tool guide tube 55 of the endoscope 50.
The endoscope 50 is formed in the vicinity of the distal end of the flexible insertion portion 51, and the bending portion 52 is large with a small curvature radius by remote operation from the endoscope operation portion 53 connected to the proximal end of the insertion portion 51. The entrance opening of the treatment instrument guide tube 55 that is configured to be bent at an arbitrary angle and is inserted through the entire length of the insertion portion 51 is disposed in the endoscope operation portion 53, and the outlet opening is formed in the insertion portion 51. Located at the cutting edge.

  A flexible sheath 11 that covers a portion that can be inserted into and removed from the treatment instrument guide tube 55 of the treatment instrument for endoscope 10 is made of, for example, a flexible metal made by tightly winding a spring-like stainless wire with a constant diameter. It is formed of a tightly wound coil. However, the flexible sheath 11 may be formed of a fluororesin tube, a PEEK (polyether ether ketone) resin tube, or the like. In the flexible sheath 11, for example, an operation wire 12 made of a metal stranded wire formed by twisting stainless thin wires is loosely passed over the entire length.

  The operation unit 20 connected to the proximal side proximal end of the flexible sheath 11 is fixed to the operation unit main body 21 to which the proximal end of the flexible sheath 11 is fixedly connected, and the proximal end of the operation wire 12 is fixed. And a slide operation member 22 connected to each other. The slide operation member 22 is slidable in the axial direction of the operation wire 12 with respect to the operation portion main body 21, but attached so as not to rotate around the axis. It has been. Therefore, when the entire operation portion 20 is rotated around the axis of the flexible sheath 11, the proximal end portion of the flexible sheath 11 and the proximal end portion of the operation wire 12 rotate integrally around the axis. At the most distal portion of the flexible sheath 11, a distal treatment piece 13 that is operated by a remote operation from the operation unit 20 via the operation wire 12 is supported by the distal body 15 and disposed. For example, in this embodiment, when the slide operation member 22 is slid as indicated by the arrow A in the operation unit 20, the distal treatment piece 13 is opened and closed as indicated by the arrow B at the distal end of the flexible sheath 11. To work.

  FIG. 1 shows a distal end portion of an endoscope treatment tool 10, and a distal treatment piece 13 of this embodiment is a pair of forceps pieces that open and close forward about a support shaft 14. The tip main body 15 to which is attached is connected to the tip of the flexible sheath 11 via the connecting cylinder 16 so as to be rotatable around the axis. Reference numeral 17 denotes a link mechanism disposed in the slit 15a of the distal end body 15 in a state of being connected to the distal end of the operation wire 12 via a wire connecting rod 17a in order to open and close the pair of distal treatment pieces 13. The explanation is omitted. With this configuration, when the operation wire 12 is slid from the operation unit 20 side, the link mechanism 17 is activated and the distal treatment piece 13 opens and closes around the support shaft 14. A two-dot chain line indicates a state in which the distal treatment piece 13 is closed.

  The connecting tube 16 that connects the flexible sheath 11 and the distal end body 15 is formed in a cylindrical shape having a slightly smaller inner diameter of the front end portion 16a, and the rear end portion is fixed to the outer surface of the flexible sheath 11 by welding or the like. The tip portion 16a having a small inner diameter is rotatable around the axis between two flange portions 15b, 15c formed in the rear half portion of the tip body 15 with an axial gap therebetween. It is inserted loosely so as not to move in the axial direction. Therefore, the distal end portion of the flexible sheath 11 and the distal end portion of the operation wire 12 can rotate relatively freely. The tip body 15 may be appropriately divided into a plurality of parts for the convenience of manufacture.

  In the endoscope treatment tool 10 configured as described above, a flexible wire having a characteristic of greater rotational followability than the flexible sheath 11 is used as the operation wire 12. The rotational followability of the flexible sheath 11 and the operation wire 12 in the present application means that the operation unit 20 side is about the axis when the endoscope treatment tool 10 is passed through the treatment tool guide tube 55 of the endoscope 50. The degree to which the tip side rotates around the axis following the rotational motion when it is rotated. The smaller the rotation followability, the less the rotation angle on the tip side when there is frictional resistance etc. Becomes larger.

  As described above, in this embodiment, a stranded wire is used as the operation wire 12 and a metal close-wound coil is used as the flexible sheath 11. Since the magnitude of the rotational follow-up is relative, when the flexible sheath 11 is very softly formed of thin strands and the rotational follow-up is small, the operation wire 12 is a single core wire. A so-called 1 × 7-stranded stranded wire or the like in which seven wires are twisted around the periphery can be used. If the strand diameter of the flexible sheath 11 is somewhat thick, the operation wire 12 can be rotated and followed. It is preferable to use a so-called torque wire or the like having extremely high properties. As such a torque wire, a well-known one described in JP-A-2005-14040 may be used, and the description thereof is omitted.

  With such a configuration, as shown in FIG. 2, when the bending portion 52 of the endoscope 50 is bent at a large angle with a small curvature radius, the endoscope is passed through the treatment instrument guide tube 55. When the treatment instrument 10 is rotated around the axis of the flexible sheath 11 on the operation section 20 side, the flexible sheath 11 is caused by frictional resistance between the bending section 52 and the inner peripheral surface of the treatment instrument guide tube 55 or the like. The rotational motion is attenuated between the portion in the bending portion 52 and the operation portion 20, and the tip portion hardly rotates. However, the operation wire 12 having greater rotational followability than the flexible sheath 11 rotates around the axis in the flexible sheath 11 even in the portion located in the bending portion 52, and the rotational motion is transmitted to the tip portion. As a result, the distal treatment piece 13 rotates smoothly around the axis together with the distal body 15 and an appropriate treatment can be performed by adjusting the opening / closing direction of the distal treatment piece 13 according to the state of the affected part.

  Such an operation is realized by the flexible sheath 11 and the operation wire 12 rotating together on the operation unit 20 side, and only the operation wire 12 is rotated around the axis on the operation unit 20 side. Even if it does, rotation of the operation wire 12 will attenuate | damp on the way greatly by the frictional resistance etc. over the full length between the inner peripheral surfaces of the flexible sheath 11. FIG. By rotating the flexible sheath 11 and the operation wire 12 together on the operation unit 20 side as in the present invention, in the range from the operation unit 20 to the portion in the bending portion 52, The frictional resistance that the operation wire 12 receives from the peripheral surface is very small, and the operation wire 12 rotates only on the front side from the vicinity of the portion in the bending portion 52. Can be rotated.

  FIG. 3 shows an endoscope treatment tool according to a second embodiment of the present invention, in which an outer peripheral surface of a flexible sheath 11 is covered with an electrically insulating insulating tube 18 over its entire length. The distal end portion of the insulating tube 18 is fixed and fixed to a circumferential groove 16 b formed on the outer peripheral surface near the rear end portion of the distal end body 15. Other configurations are the same as those of the embodiment shown in FIG. In the case of a treatment instrument that applies a high-frequency current to the distal treatment piece 13 through the operation wire 12 in order to obtain a hemostatic effect or the like, it is possible to obtain the same effect as that of the first embodiment by configuring in this way. it can.

  FIG. 4 shows an endoscopic treatment instrument according to a third embodiment of the present invention, and an outer tube 19 made of, for example, a fluororesin tube or the like is provided around the entire length of the outer surface of the flexible sheath 11. It is loosely fitted so as to be rotatable (and slightly slidable in the axial direction). Further, as the distal treatment piece 13 ′, for example, a clip placed in the body is rotatable about the axis and slidable in the axial direction with respect to the distal end portion of the flexible sheath 11, and the distal end of the operation wire 12 with a known configuration. It is connected to. The other configuration is the same as that of the first embodiment shown in FIG. 2, and the flexible sheath 11 and the operation wire 12 rotate integrally around the axis on the operation unit 20 side, and mutually on the distal end side. Rotate freely. The present invention can be applied to various endoscopic treatment tools in which an endoscopic snare, a basket, a gripping tool, or the like is disposed as the distal treatment piece 13.

The side sectional view of the tip part of the treatment tool for endoscopes of the 1st embodiment of the present invention. The side view of the use condition by which the treatment tool for endoscopes of the 1st Embodiment of this invention was passed through the treatment tool guide tube of the endoscope. Side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of the 2nd Embodiment of this invention. The side view of the use condition by which the treatment tool for endoscopes of the 3rd Embodiment of this invention was passed through the treatment tool guide tube of the endoscope.

Explanation of symbols

DESCRIPTION OF SYMBOLS 11 ... Flexible sheath 12 ... Operation wire 13 ... End treatment piece 15 ... End body 16 ... Connection pipe | tube 18 ... Insulation tube 19 ... Outer tube 50 ... Endoscope 52 ... Bending part 55 ... Treatment instrument guide tube

Claims (4)

An operation wire for an endoscope, which is used by being inserted into and removed from a treatment instrument guide tube of an endoscope, and for operating a distal treatment piece arranged at a distal end portion of a flexible sheath from the proximal end side In the endoscopic treatment tool configured to be loosely inserted into the flexible sheath,
As the operation wire, a flexible wire having greater rotation followability than the flexible sheath is used, and the flexible sheath and the operation wire rotate integrally around the axis on the proximal end side, An endoscopic treatment tool, wherein each of the distal end side is configured to independently rotate around an axis.   2. The endoscope treatment tool according to claim 1, wherein a distal end main body that supports the distal treatment piece is connected to a distal end of the flexible sheath so as to be rotatable about an axis and not movable in the axial direction. Endoscopic treatment tool.   The endoscopic treatment instrument according to claim 1 or 2, wherein the flexible sheath is formed of a soft tightly wound coil.   The endoscope treatment tool according to claim 1 or 2, wherein the flexible sheath is formed by covering a flexible tightly wound coil with a flexible electrically insulating tube.

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