JP2012200414A - Treatment instrument for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment instrument enabling a smooth and rapid endoscopic treatment by correctly aligning a treatment function member with a desired direction by a simple operation for moving forward and backward a forward/backward movement member in an axial direction.SOLUTION: The treatment instrument for endoscope includes a rotation control means 55 for converting the forward/backward movement of the forward/backward moving member 17 inserted into a sheath 11 into the unidirectional rotation movement of the treatment function member 15. The rotation control means 55 has a first engaging member 57 formed on the inner circumferential side of the sheath, and a second engaging member 59 formed on the forward/backward movement side of the sheath. When the forward/backward moving member 17 moves in a first direction, the first and second engaging members relatively slide in the S1 direction and the circumferential direction of the sheath 11 to cause the forward/backward moving member 17 to generate a rotational force, thereby changing the rotation position of the treatment function member 15. When the forward/backward moving member 17 moves in a S2 direction, the first and second engaging members relatively slide in the S2 direction, thereby maintaining the changed rotation position of the treatment function member 15.

Description

  The present invention relates to an endoscope treatment tool.

  In general, a treatment functional member is disposed at the distal end of a flexible sheath in an endoscope treatment tool, and a treatment operation is possible by remote operation from the proximal end side of the sheath. For example, when a living tissue is sandwiched for biopsy tissue collection, hemostasis, or the like, a pair of gripping pieces is used as a treatment function member. When sandwiching the living tissue by opening and closing the pair of gripping pieces, by rotating the operation wire on the hand operation unit side, the gripping piece is rotated around the sheath axis to determine from which direction the living tissue is sandwiched. There is an endoscope treatment tool that can be changed (see, for example, Patent Documents 1 and 2).

Japanese Patent No. 4414662 Japanese Patent No. 4542559

  However, the operation wire has a long shape inserted through the sheath, and there is discontinuity in the rotational torque transmission characteristics of the operation wire. Further, when the sheath is bent halfway, the rotational force applied to the operation wire is absorbed by the bent portion. For this reason, in the configuration of Patent Document 1, even if the operation wire is rotated on the hand operation unit side, the pair of grip pieces do not have a proportional rotational behavior corresponding to the rotation operation amount. For example, the gripping piece may not rotate until a rotation operation is accumulated to some extent, and a rotation jump may occur in which the gripping piece rotates at once when there is a further rotation operation.

  Moreover, in the structure of patent document 2, it is a mechanism which provides a rotation suppression part between a treatment function member and a sheath, and performs a rotation behavior every 90 degree | times. In this case, it can be rotated at a relatively large angle, but the rotation angle cannot be finely changed. Thus, it is a fact that it is difficult to rotate the treatment function member with high controllability by rotating the operation wire.

  Therefore, the present invention provides an endoscopic treatment tool that can accurately adjust a treatment function member to a desired direction by a simple operation of moving the advance / retreat member in the axial direction, and thereby endoscopic treatment. The purpose is to be able to perform smoothly and quickly.

The present invention has the following configuration.
An elongated sheath having flexibility;
A treatment function member rotatably supported around the axis of the sheath at the distal end of the sheath;
An elongate advancing / retreating member, which is inserted into the sheath so as to freely advance and retract, and has one end fixed to the treatment function member;
When the advance / retreat movement member is moved in the first direction along the sheath axis, the advance / retreat movement member generates a rotational force in one direction to change the position of the treatment function member, and the advance / retreat movement member Treatment function member control means for maintaining the changed position of the treatment function member when moved in a second direction opposite to the first direction;
With
The treatment function member control means includes a first engagement member provided on the inner peripheral side of the sheath, and a second engagement provided on the advance / retreat movement member side so as to be able to contact the first engagement member. Consisting of a joint material,
The change of the position of the treatment function member when the advance / retreat member is moved in the first direction is relative to the first engagement member and the second engagement member. Direction and sliding in the circumferential direction of the sheath,
Maintenance of the changed position of the treatment function member when the advance / retreat member is moved in the second direction is relative to the first engagement member and the second engagement member. An endoscopic treatment tool made by sliding in a second direction.

  The endoscope treatment tool of the present invention can accurately align the treatment function member in a desired direction by a simple operation of moving the advance / retreat member in the axial direction. Thereby, endoscopic treatment can be performed smoothly and quickly.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for describing embodiment of this invention, and is a schematic perspective view which shows the whole treatment tool for endoscopes in a partial cross section. It is sectional drawing which shows the structure of a hand operation part vicinity. It is a figure which shows the structure of the front-end | tip of grasping forceps, and is a partial cross section block diagram which showed a part of grasping part and the sheath front-end | tip in the cross sectional view. It is explanatory drawing which expanded and showed the structure of the rotation control mechanism. (A) is a top view of a projection part, (B) is a side view, (C) is a front view. It is AA sectional drawing of FIG. It is explanatory drawing which shows operation | movement of a rotation control mechanism in steps. It is explanatory drawing which showed the projection part and the brush hair typically. It is the block diagram which showed typically the bristle provided in the fixing ring in multistage shape. It is explanatory drawing which shows the other structural example of a rotation control mechanism. It is explanatory drawing which shows the other structural example of a rotation control mechanism. It is explanatory drawing which shows the other structural example of a rotation control mechanism. It is sectional drawing of the same position as FIG. 6 with respect to the rotation control mechanism of FIG. It is explanatory drawing which showed the projection part and the brush hair typically. It is explanatory drawing which shows the other structural example of a rotation control mechanism. It is sectional drawing of the same position as FIG. 6 with respect to the rotation control mechanism of FIG. It is explanatory drawing which showed the projection part and the protrusion piece typically. It is an enlarged view of the front-end | tip part of a protrusion piece. It is an enlarged view of the front-end | tip part of a protrusion piece. (A) is a biological tissue collection cup, (B) is a clip, (C) is a high-frequency snare, and (D) is a schematic configuration diagram of an injection needle.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a diagram for explaining an embodiment of the present invention, and is a schematic perspective view showing the entire endoscope treatment tool in a partial cross section, and FIG. 2 is a cross sectional view showing a configuration in the vicinity of a hand operation section.

  As shown in FIG. 1, the endoscope treatment instrument 100 is inserted into a forceps channel of an electronic endoscope, and is connected to a flexible long sheath 11 and a proximal end portion of the sheath 11. It is comprised from the hand operation part 13 and the grasping forceps 15 as a treatment function member provided in the front-end | tip part of the sheath 11. As shown in FIG. The sheath 11 has a configuration in which, for example, a cylindrical net body formed by braiding stainless fine wires is bonded to an outer skin layer made of a flexible material such as ethylene tetrafluoride. An operation wire 17 that is an advancing / retreating member is inserted into the sheath 11 over the sheath axis direction.

  The hand operation unit 13 includes an operation unit main body 19 and a slider 21 as a moving operation unit supported slidably on the operation unit main body 19. As shown in FIG. 2, a connecting member 23 in which a male screw is formed is provided on the outer peripheral surface of the proximal end portion of the sheath 11. The connecting member 23 is screwed into a female screw (not shown) formed on the inner peripheral surface of the distal end portion of the operation portion main body 19 to connect the sheath 11 and the operation portion main body 19.

  The operation portion main body 19 is provided with an annular finger hook portion 25 and a slit portion 27 in which a slit parallel to the axial direction of the sheath 11 is formed. The slider 21 is engaged with the slit portion 27 and slides in the axial direction of the sheath 11 along the slit portion 27. When performing the procedure, the thumb is hung on the finger rest 25 and the index finger and the middle finger of the same hand are hung on the slider 21.

  As shown in FIG. 2, the slider 21 is formed with an insertion hole 29 through which the proximal end of the operation wire 17 is inserted, and an accommodation portion 31 formed by expanding the diameter from the insertion hole 29. A fixing disk 33 is fixed to the proximal end of the operation wire 17. The fixing disk 33 is rotatable in the housing portion 31 and abuts against the inner wall of the housing portion 31 to restrict the axial movement of the operation wire 17. For this reason, the operation wire 17 is driven by the slide movement of the slider 21, and is moved forward and backward in a movement that is sent out toward the sheath tip in the sheath 11 and a movement that is pulled back from the sheath tip.

  FIG. 3 is a diagram showing the configuration of the distal end of the grasping forceps 15, and is a partial cross-sectional configuration diagram showing a part of the grasping forceps 15 and the sheath distal end in a sectional view. The gripping forceps 15 includes a pair of gripping pieces 35A and 35B and a support column 39 having a support hole 37 that pivotally supports the gripping pieces 35A and 35B.

  The support 39 has a pin 41 attached to the support hole 37 and supports the gripping pieces 35A and 35B so that the pin 41 can be opened and closed. The support column 39 has an annular groove 43 on the base end side opposite to the support hole 37 side.

  The cover member 45 is formed with a flange 47 at one end of a cylindrical shape, and the other end is inserted and fixed to the distal end of the sheath 11. The inner peripheral surface of the cover member 45 is the same as the inner peripheral surface of the sheath 11, and the sheath inner peripheral surface in this specification includes the inner peripheral surface of the cover member 45.

  The support column 39 is supported by the sheath 11 so as to be rotatable about the sheath axis by engaging the groove portion 43 of the support column 39 with the flange portion 47 of the cover member 45.

  The operation wire 17 is branched from the branch portion 49 into two branch wires 51A and 51B on the tip side. The branch wires 51A and 51B are fixed to connection holes 56A and 56B provided on the rear end sides of the gripping pieces 35A and 35B, respectively.

  A rotation control mechanism 55 is provided at the distal end of the sheath 11. The rotation control mechanism 55 rotates the treatment function member including the pair of gripping pieces 35A and 35B and the support post 39 that supports them by converting the advance / retreat operation of the operation wire 17 into a rotation operation.

FIG. 4 is an explanatory view showing the structure of the rotation control mechanism 55 in an enlarged manner.
The rotation control mechanism 55 includes a projection 57 as a first engagement member provided on the inner peripheral side of the sheath 11 and a second engagement member provided on the operation wire 17 side so as to be able to contact the projection 57. And bristles 59 which are protruding pieces.

  When the operation wire 17 moves along the sheath axis in the direction S1 (first direction) to be fed to the distal end portion of the sheath 11, the protrusion 57 and the brush hair 59 are relatively in the direction of S1 and the circumferential direction of the sheath 11. To cause the operating wire 17 to generate a rotational force. The rotational force generated on the operation wire 17 slides the groove 43 of the support post 39 and the flange 47 of the cover member 45 shown in FIG. 3 to rotate the gripping pieces 35A and 35B.

  Further, when the operation wire 17 moves in the direction S2 (second direction) to be pulled back from the distal end portion of the sheath 11 opposite to S1, the protrusion 57 and the brush hair 59 slide relatively in the S2 direction. . At this time, no rotational force is applied to the operation wire 17, and the rotational positions of the gripping pieces 35A and 35B are maintained as they are.

  As described above, the rotation control mechanism 55 functions as a one-way rotation mechanism that rotates only in one direction (R direction) by movement in the S1 direction in the forward / backward movement of the operation wire 17.

  More specifically, the rotation control mechanism 55 radiates from the outer periphery of the plurality of protrusions 57 protruding from the inner peripheral side of the sheath 11 and the operation wire 17 facing the protrusion 57 toward the inner periphery of the sheath 11. The brush bristles 59 that are a large number of protruding pieces and a guide surface 61 formed on the protrusion 57 are provided.

  5A is a plan view, FIG. 5B is a side view, FIG. 6C is a front view, and FIG. 6 is an AA cross-sectional view of FIG. Projecting in the same shape from a plurality of locations on the surface toward the sheath axis. Each protrusion 57 is formed at a position on the same circumference of the inner peripheral surface of the cover member 45. In the illustrated example, the protrusions 57 are provided at a total of eight positions at equal intervals in the circumferential direction, but the present invention is not limited thereto.

  As shown in FIGS. 5A and 5B, the shape of the protrusion 57 has a top surface 63 in which the protrusion height gradually increases in the S2 direction. The top surface 63 is a smooth continuous surface that extends from the base end portion 63a to the topmost portion 63b along the S2 direction. Further, a guide surface 61 that is a side surface connected from the top surface 63 via the side 65 is formed on one side surface of the protrusion 57, and gradually protrudes in the circumferential direction C of the inner periphery of the sheath 11 toward the S1 direction. It is a smooth continuous surface slope.

  That is, the protrusion 57 has an asymmetric shape having one side surface 67 parallel to the S1 direction and the other side surface which is the guide surface 61 in the plan view of the protrusion 57 shown in FIG. . The guide surface 61 functions as an inclined surface that attracts the brush hair 59. Each of the plurality of protrusions 57 is a guide surface 61 inclined in the same direction with respect to the sheath axis.

  Further, the maximum width H of the guide surface 61, which is the height of the topmost portion 63b of the protrusion 57, is set to a width H at which the tip of the bristles 59 can sufficiently abut.

Returning to FIG. 4 again, the protruding piece will be described.
The bristle 59, which is a protruding piece, is fixed to the fixing ring 69 at the base side, and the tip side is formed in such a length that the tip abuts against the inner peripheral surface of the sheath 11 and the inner peripheral surface of the cover member 45 and the tip is bent. Yes. The bristles 59 are planted at a uniform density over the entire circumference of the fixing ring 69 and extend in an oblique direction in which the diameter gradually increases along the S1 direction.

  The brush bristles 59 are made of a straight elastic body, and have an elastic region that does not undergo plastic deformation even at least when contacting the protrusion 57. As a material for the brush bristles 59, materials such as hard nylon (registered trademark: polyamide-based synthetic resin) fiber bundles, vinyl chloride, polystyrene, stainless steel and the like can be suitably used.

Next, the operation of the rotation control mechanism 55 will be described with reference to FIG.
First, when the slider 21 shown in FIG. 1 is moved in the S2 direction and attracted to the finger hooking portion 25, the operation wire 17 is pulled toward the proximal end side of the sheath 11. Then, the branch wires 51A and 51B at the tip of the operation wire 17 shown in FIG. 3 are pulled and moved in the S2 direction. As a result, as shown in St1 of FIG. 7, the pair of gripping pieces 35A and 35B are closed.

  Thereafter, when the slider 21 is moved in the S1 direction and separated from the finger hooking portion 25, the operation wire 17 moves to the distal end side of the sheath 11. When the operation wire 17 moves to the distal end side of the sheath 11, the fixing ring 69 fixed to the operation wire 17 and having the bristles 59 implanted therein moves in the S1 direction together with the operation wire 17 (St2).

  At this time, the plurality of protrusions 57 and the bristle 59 slide, so that the rotational force applied to the operation wire 17 by the rotation control mechanism 55 is generated according to the movement of the operation wire 17.

  FIG. 8 schematically shows the protrusion 57 and the bristles 59. As shown in the drawing, when the brush hair 59 is further pressed in the S1 direction by the movement of the operation wire 17 in a state where the tip of the brush hair 59 is in contact with the guide surface 61 of the protrusion 57, the tip of the brush hair 59 is Then, it slides on the guide surface 61 and gradually moves in the C direction in the order of contact positions P1, P2, P3, P4, and P5. In this configuration, since the protrusion 57 is integrated with the sheath 11, the rotational force generated by sliding becomes a driving force for the rotation of the operation wire 17, and the operation wire 17 is an axis of the operation wire 17 (sheath). Rotate around the same axis.

  As shown in St2 of FIG. 7, when the operation wire 17 rotates around the sheath axis, the pair of gripping pieces 35A and 35B rotate by an angle θ from the direction in which the gripping forceps opening / closing direction is St1. That is, when the slider 21 moves in the S1 direction, a rotational force is applied to the operation wire 17 by the rotation control mechanism 55 to rotate the pair of gripping pieces 35A and 35B by an angle θ. Thereby, the direction of the grasping forceps opening / closing direction changes.

  Next, when the slider 21 moves in the S2 direction, the operation wire 17 moves in the S2 direction, and the protrusion 57 and the brush hair 59 of the rotation control mechanism 55 slide. However, in this case, the side surface of the brush bristle 59 is in sliding contact with the projecting part 57 and gets over the projecting part 57, and the tip of the brush bristle 59 does not hit the projecting part 57.

  That is, as shown in FIG. 5, the top surface 63 of the protruding portion 57 is continuously raised from the base end portion 63a having the same protruding height as the inner peripheral surface of the sheath 11 toward the topmost portion 63b. The bristles 59 slide smoothly along the top surface 63. And the front-end | tip of the bristle 59 falls out from the top part 63b, and a sliding with the projection part 57 is complete | finished.

  Therefore, the protrusion 57 and the brush hair 59 do not generate a movement in the C direction, that is, a rotational force to the operation wire 17. Therefore, the direction of the gripping forceps opening / closing direction of the pair of gripping pieces 35A and 35B maintains the same state (St3). As described above, the pair of gripping pieces 35A and 35B expands by the movement of the operation wire 17 in the S2 direction, but does not affect the direction of the gripping forceps opening / closing direction.

  When the slider 21 moves again in the S1 direction, the operation wire 17 moves in the S1 direction, and a rotational force is applied to the operation wire 17 by the rotation control mechanism 55, so that the pair of gripping pieces 35A and 35B are further moved by an angle θ. Rotate (St4). Thereby, the direction of the grasping forceps opening / closing direction changes. When the slider 21 is moved in the S2 direction, the direction of the grasping forceps opening / closing direction is maintained in the same state as in St3.

  As described above, when the movement of the slider 21 in the S1 and S2 directions is repeated, the pair of gripping pieces 35A and 35B rotate each time the operation wire 17 is moved in the S1 direction. This rotation operation is performed in a predetermined angle θ and only in one direction around the sheath axis.

  Therefore, the user of the endoscope treatment tool 100 moves the slider 21 of the hand operating unit 13 in the S1 direction when changing the current direction of the grasping forceps opening / closing direction to a direction suitable for the procedure. Then, the direction of the grasping forceps opening / closing direction is changed by the angle θ in the specified rotation direction by one pushing operation of the slider 21. To further increase the rotation angle, the slider 21 is reciprocated in the S1 and S2 directions a plurality of times.

  As described above, since the direction in which the gripping forceps open / close direction is rotated is determined by which direction the slider 21 is rotated once by the pushing operation of the slider 21, the user can sense the amount of rotation adjustment in the direction of the gripping forceps opening / closing direction. Can be easily grasped and can be adjusted to a desired direction quickly and accurately. Further, since the direction of the grasping forceps opening / closing direction is rotated by the pushing operation of the slider 21, it is not confused with the pulling back operation of the slider 21 in which the user closes the grasping forceps.

  The brush bristles 59 extend from the fixing ring 69 in an oblique direction that gradually increases in diameter along the S1 direction. As a result, when the operation wire 17 moves in the S1 direction to generate a rotational force on the operation wire 17, the tips of the bristles 59 are curved and aligned in the S1 direction along the inner peripheral surface of the sheath 11. .

  The tip of the bristle 59 comes into contact with the guide surface 61 of the protrusion 57 in a state where the axis of the bristle tip is aligned in the S1 direction. In other words, since the bristle 59 comes into contact with the projection direction of the projecting portion 57 from the vertical direction, the rotational contribution force that the bristle 59 gives to the guide surface 61 can be increased. Therefore, the movement operation in the S1 direction can be efficiently converted into the rotation operation in the R direction (see FIG. 4).

  Further, the tip of the bristle 59 is inclined with respect to the sheath axis and is pressed against the inner peripheral surface of the sheath 11 or the cover member 45. For this reason, the rotation at the time of stopping the rotation operation is restricted by the frictional force pressed against the inner peripheral surface of the sheath. As a result, the orientation of the grasping forceps opening / closing direction does not change unintentionally, and rotation adjustment can be easily performed.

  Further, in this configuration, since the direction of the grasping forceps opening / closing direction is rotated via the brush bristles 59 that are flexible elastic bodies, the rotation operation can be performed flexibly. That is, if the pair of gripping pieces 35A and 35B is strongly pressed against the surface of the living body or the like is difficult to rotate, the gripping pieces 35A and 35B are not forcibly rotated. That is, even if the operation wire 17 is moved in the S1 direction, the brush hair 59 that comes into contact with the guide surface 61 is not bent, and the operation wire 17 does not generate a rotational force. For this reason, it is possible to prevent an excessive force from being applied to the surface of the living body from the pair of gripping pieces 35A and 35B, and the user can move the slider 21 with peace of mind.

  Furthermore, if the rigidity of the brush bristles 59 is designed in accordance with the level of whether or not the rotational force can be transmitted, the transmission of the rotational force to the operation wire 17 can be cut off when there is a predetermined rotational resistance. .

  Further, as shown in FIG. 9, the bristle 59 implanted in the fixing ring 69 is provided in multiple stages at different axial positions of the fixing ring 69, thereby extending the flocking range L where the rotational force can be generated. be able to. According to this, the direction of the grasping forceps opening / closing direction can be largely changed by one movement of the slider 21.

  The bristle 59 can be variously planted in a manner other than being planted in a multi-stage shape, such as a configuration in which the brush hair 59 is uniformly planted in a predetermined range along the axis of the operation wire 17 instead of a spiral shape or a step shape. Can be adopted.

<Second configuration example>
Next, a second configuration example of the endoscope treatment tool will be described.
FIG. 10 shows another configuration example of the rotation control mechanism. The rotation control mechanism 55A of this configuration is different from the rotation control mechanism 55 shown in FIG. 4 in that the bristle 59A as a protruding piece extends in a direction perpendicular to the sheath axis. It has a configuration.

  As described above, the brush bristles 59A of the rotation control mechanism 55A extending in the direction perpendicular to the sheath axis have the tip of the bristles 59A abutted against the guide surface 61 of the protrusion 57 by the movement of the operation wire 17 in the S1 direction. In contact therewith, the operating wire 17 generates a rotational force in the R direction. Thereby, the direction of the grasping forceps opening / closing direction rotates around the sheath axis. In this case, it is preferable to increase the rigidity of the bristle 59A because the followability of the bristle 59A with respect to the guide surface 61 of the protrusion 57 is further improved.

  Further, when the operation wire 17 moves in the S2 direction, the side surface of the bristle 59A slides along the top surface 63 (see FIG. 5) of the protrusion 57 and gets over the protrusion 57. For this reason, no rotational force is generated in the operation wire 17, and the gripping forceps opening / closing direction does not rotate.

  According to the above configuration, the rotational force can be obtained even with a simple configuration in which the bristles 59A extend in the direction perpendicular to the sheath axis. Moreover, the rotational force received from the guide surface 61 of the projection part 57 is transmitted to the operation wire 17 at a short distance, and the transmission loss of the rotational force can be reduced.

<Third configuration example>
Next, a third configuration example of the endoscope treatment tool will be described.
FIG. 11 shows another configuration example of the rotation control mechanism. In the rotation control mechanism 55B of this configuration, the protrusion 57B is formed of an elongated protrusion having a major axis and a minor axis, and the major axis K is formed to be inclined at a predetermined angle φ with respect to the sheath axis. 4 is different from the rotation control mechanism 55 shown in FIG.

  The entire protrusion 57B has a uniform protrusion height, and a pair of side surfaces along the long axis K are formed in parallel. Of the pair of side surfaces, the side facing the proximal end side of the sheath 11 becomes the guide surface 61, and the tip end of the brush hair 59 contacts. The other side surface 73 is also formed symmetrically with the guide surface 61.

  As described above, the brush bristle 59 of the rotation control mechanism 55B makes the tip of the bristle 59 abut on the guide surface 61 of the protrusion 57B by the movement of the operation wire 17 in the S1 direction, and the operation wire 17 is rotated in the R direction. Is generated. Thereby, the direction of the grasping forceps opening / closing direction rotates around the sheath axis.

  Further, when the operation wire 17 moves in the S2 direction, the side surface of the brush bristle 59 slides on the side surface 73 of the projecting portion 57B and gets over the projecting portion 57B. For this reason, no rotational force is generated in the operation wire 17, and the gripping forceps opening / closing direction does not rotate.

  According to the above configuration, even if the shape of the protrusion portion 57B is a simple elongated shape that is easy to manufacture, the guide surface 61 of the protrusion portion 57 and the brush bristles 59 abut against each other and slide against each other, so that the operation wire 17 rotates. Can generate power.

<Fourth configuration example>
Next, a fourth configuration example of the endoscope treatment tool will be described.
FIG. 12 shows another configuration example of the rotation control mechanism, and FIG. 13 shows a cross-sectional view of the rotation control mechanism of FIG.
In the rotation control mechanism 55C of this configuration, the protrusion 57C has a simple cylindrical boss shape. Further, the tip of the bristle 59B, which is a protruding piece, is curved toward the tip of the rotation direction R of the operation wire 17 over the entire circumference. These points are different from the rotation control mechanism 55 shown in FIG.

  The plurality of projecting portions 57C are formed so as to protrude from the inner peripheral surface of the cover member 45, and the side surface (guide surface) 61 of the projecting portion 57C and the brush bristles 59B slide with each other. Each protrusion 57C is formed at a position on the same circumference of the inner peripheral surface of the cover member 45, and simultaneously contacts the brush bristles 59B by the movement of the operation wire 17 in the sheath axis direction.

  As shown in FIG. 13, the bristles 59B are curved so that the straight portion 75 from the outer peripheral surface of the fixing ring 69 to the radius r and the tip side of the bristles 59B from the radius r toward the front side in the rotational direction. And a large number of them are planted radially.

  FIG. 14 schematically shows the protrusion 57C and the brush hair 59B. When the bristle portion 59B is pressed against the guide surface 61 formed on the side surface of the protruding portion 57C and the brush bristle 59B is further pressed in the S1 direction, the curved portion 77 of the bristle 59B is guided. It slides on the surface 61 and gradually moves in the C direction in the order of contact positions P1, P2, P3, and P4. The rotational force generated thereby becomes a driving force for the rotation of the operation wire 17, and the operation wire 17 rotates around the axis of the operation wire 17 (same as the sheath axis).

  According to the above configuration, the bristle 59B can move more smoothly due to the synergistic action of the curved shape of the curved portion 77 and the shape of the guide surface 61 of the protruding portion 57C, and the operation wire 17 in the S1 direction can be moved. Resistance accompanying movement is reduced. For this reason, it is possible to reduce resistance when the user operates the slider 21.

  Further, by forming the curved portion 77 on the brush bristle 59B, the shape of the protruding portion 57C can be further simplified. That is, it is not necessary to incline the guide surface 61 of the protruding portion 57C from the S1 direction so as to invite the brush hair 59B. For example, even if the shape of the protruding portion 57C is a quadrangular shape having a side surface perpendicular to the S1 direction, the bending force 77 of the bristle 59B can be slidably contacted along the curve, thereby generating a rotational force on the operation wire 17. .

<Fifth configuration example>
Next, a fifth configuration example of the endoscope treatment tool will be described.
FIG. 15 shows another configuration example of the rotation control mechanism, and FIG. 16 shows a cross-sectional view at the same position as FIG. 6 with respect to the rotation control mechanism of FIG.
The rotation control mechanism 55D of this configuration is different from the configuration shown in FIG. 4 in that the protrusion 57C has a simple cylindrical boss shape and a plurality of protruding pieces 60 are radially extended from the fixing ring 69. The rest of the configuration is the same.

  The plurality of projecting portions 57 </ b> C are formed to protrude from the inner peripheral surface of the cover member 45, and the side surface 61 (guide surface) of the projecting portion 57 </ b> C is in sliding contact with the tip end portion 79 of the projecting piece 60. Each protrusion 57C is formed at a position on the same circumference of the inner peripheral surface of the cover member 45, and simultaneously comes into sliding contact with the tip 79 of the protruding piece 60.

  The protruding piece 60 extends radially outward from the operation wire 17, and an inclined surface that is inclined with respect to the sheath axial direction is formed at the distal end portion 79 on the extending side. The projecting piece 60 is made of a highly rigid material such as a metal plate or hard resin, and the base end portion is fixed to the fixing ring 69. Further, when the fixing ring 69 is formed of a metal plate, the protruding piece 60 can be integrally formed by punching from the metal plate of the fixing ring 69.

  FIG. 17 schematically shows the protrusion 57 </ b> C and the protruding piece 60. When the operation wire 17 moves in the S1 direction in a state in which the tip 79 having the inclined surface is in contact with the guide surface 61 formed on the side surface of the protrusion 57C, the projecting piece 60 further extends in the S1 direction on the guide surface 61. Pressed. Then, the leading end 79 of the protruding piece 60 slides on the contact position P of the guide surface 61 and gradually moves in the C direction. The rotational force generated thereby becomes a driving force for the rotation of the operation wire 17, and the operation wire 17 rotates around the axis of the operation wire 17 (same as the sheath axis).

  According to the above configuration, the projecting piece 60 is connected to the fixing ring 69 with high rigidity, and when the guide surface 61 of the projecting portion 57C and the distal end portion 79 of the projecting piece 60 slide, the operation wire 17 is highly efficient. Can transmit rotational force.

  Note that the distal end portion 79 of the protruding piece 60 is inclined toward the inner peripheral side of the sheath 11 at a predetermined angle δ with respect to the inner peripheral surface 85 of the cover member 45 as shown in an enlarged view of the distal end portion in FIG. . By providing this inclination, one side of the tip portion 79 of the projecting piece 60 can ride on the top surface 83 of the projecting portion 57C.

  That is, at the tip 79 of the projecting piece 60, the outer peripheral surface 81 of the tip 79 is the apex of the protrusion 57C on both sides facing the adjacent projecting piece 60 on the rotation destination side in the R direction of the operation wire. The protrusion height from the inner peripheral surface of the sheath is higher than the surface 83. A gap 87 exceeding the projection height of the projection 57C is formed on the rotation destination side between the outer circumferential surface 81 of the protruding piece 60 and the inner circumferential surface 85 (the bottom surface excluding the projection 57C) of the cover member 45. Has been.

  By forming the gap 87, when the protruding piece 60 rotates in the R direction, the protruding piece 60 does not hit the side surface of the protrusion 57C, and the rotation in the R direction becomes smooth.

  Further, as shown in FIG. 19, the protrusion 57 </ b> D may have a shape in which the protrusion height gradually increases along the rotation direction R. In this case, the rotation of the protruding piece 60 in the R direction is smoothed without inclining the tip 79 of the protruding piece 60 at the predetermined angle δ (see FIG. 18) toward the inside of the sheath 11.

  In addition to the grasping forceps shown in FIG. 3, each configuration of the endoscope treatment tool described above includes, for example, a biological tissue collection cup 110 shown in FIG. 20A and an indwelling clip shown in FIG. The present invention can be applied to other treatment function members such as a high-frequency snare 130 shown in 120, (C), and an injection needle 140 shown in (D).

  The biological tissue collection cup 110 shown in FIG. 20A has a pair of cups 91A and 91B in which saw-tooth teeth are formed at the edges and the inside is hollowed out, and the operation wire 17 is advanced and retracted similarly to the grasping forceps. And a link mechanism 64 that converts the opening / closing operation of the cups 91A and 91B. A living tissue can be collected with these cups 91A and 91B.

  A clip 120 shown in FIG. 20B includes a clip main body 95 having a connecting portion and an arm portion, a ring 97 that accommodates the connecting portion of the clip main body 95, and a connecting portion of the clip main body 95 drawn from the ring 97. It has a connection mechanism 99 that closes the clip and separates when a predetermined tensile force is applied. The operation wire 17 pulls the connection mechanism 99 and grips the living tissue with the clip body 95. Then, the clip body 95 and the ring 97 after gripping the living tissue are separated from the connection mechanism 99 and left in the body cavity.

  A high-frequency snare 130 shown in FIG. 20C has a snare wire 151 that protrudes from the distal end of the sheath 11 and expands in a loop shape when the operation wire 17 moves back and forth. The high-frequency snare 130 can cut out a lesioned portion by passing the snare wire 151 around the lesioned portion and causing a high-frequency current to flow through the snare wire 151.

  An injection needle 140 shown in FIG. 20D includes a needle part 153 having a sharp tip, and a tube 155 in which the needle part 153 is press-fitted and fixed, and advances and retracts in the sheath 11 by an advancement and retraction operation of an operation wire (not shown). Have. The injection needle 140 punctures the living tissue and injects physiological saline supplied from the tube 155 into the living tissue to raise the living tissue.

  In any endoscopic treatment tool, the direction of pinching by the cups 91A and 91B and the clip main body 95, the direction of hanging the snare wire 151, and the direction of the puncture needle portion 153 are appropriately determined during endoscopic treatment. There is a request to change. According to the rotation control mechanisms 55, 55A, 55B, 55C, and 55D in the endoscope treatment tool 100 of the present embodiment, the various treatment function members described above around the sheath axis by moving the operation wire 17 forward and backward. Can be rotated, and endoscopic treatment can be performed smoothly. And the rotation angle of the treatment function member is changed only at the time of pushing operation toward the distal end side of the sheath 11 of the slider 21.

  In this way, the treatment function member rotates in only one direction and is a one-way rotation mechanism that does not reverse. Further, the mechanism rotates only when the slider 21 is pushed out. Therefore, the user of the endoscope treatment tool can quickly and accurately adjust the treatment function member to a desired direction (rotation angle) without being aware of the rotation skip of the operation wire.

  In the above embodiment, the protruding portion is provided on the sheath side (cover member side) and the protruding piece is provided on the operation wire side. On the contrary, the protruding piece is provided on the sheath 11 side and protruded on the operation wire side. You may comprise and provide a part. Moreover, you may comprise with the groove | channel into which the front-end | tip of a protrusion piece enters instead of a projection part.

  In addition, the rotation control mechanism may be a drive mechanism that detects the movement of the advance / retreat movement member in the first direction and the movement distance and electrically rotates the treatment function member by a dielectric force or the like accordingly.

  As described above, the present invention is not limited to the above-described embodiments, and those skilled in the art can make changes and applications based on combinations of the configurations of the embodiments, descriptions in the specification, and well-known techniques. This is also the scope of the present invention, and is included in the scope for which protection is sought.

As described above, the following items are disclosed in this specification.
(1) An endoscopic treatment tool inserted into a forceps channel of an endoscope,
An elongated sheath having flexibility;
A treatment function member rotatably supported around the axis of the sheath at the distal end of the sheath;
An elongate advancing / retreating member, which is inserted into the sheath so as to freely advance and retract, and has one end fixed to the treatment function member;
When the advance / retreat movement member is moved in the first direction along the sheath axis, the advance / retreat movement member generates a rotational force in one direction to change the position of the treatment function member, and the advance / retreat movement member Treatment function member control means for maintaining the changed position of the treatment function member when moved in a second direction opposite to the first direction;
With
The treatment function member control means includes a first engagement member provided on the inner peripheral side of the sheath, and a second engagement provided on the advance / retreat movement member side so as to be able to contact the first engagement member. Consisting of a joint material,
The change of the position of the treatment function member when the advance / retreat member is moved in the first direction is relative to the first engagement member and the second engagement member. Direction and sliding in the circumferential direction of the sheath,
Maintenance of the changed position of the treatment function member when the advance / retreat member is moved in the second direction is relative to the first engagement member and the second engagement member. An endoscopic treatment tool made by sliding in a second direction.
According to this endoscope treatment tool, the first and second engaging members slide by moving the advance / retreat moving member in the first direction, so that the treatment function member is moved at a predetermined angle. The rotation position can be changed. That is, since the treatment function member rotates by a predetermined angle in a predetermined constant direction by one movement of the advance / retreat movement member, the adjustment of the rotation position of the treatment function member can be easily and accurately adjusted.

(2) The endoscope treatment tool according to (1),
The first engaging member is a plurality of protrusions protruding toward the sheath axis on the inner peripheral side of the sheath;
A plurality of projecting pieces in which the second engaging member extends radially from the outer peripheral position of the advance / retreat moving member facing the projecting portion to the inner periphery of the sheath with a length contacting the projecting portion. And
An endoscopic treatment tool in which the plurality of protrusions each have a guide surface inclined in the same direction with respect to the sheath axis.
According to the endoscope treatment tool, when the advance / retreat moving member moves in the first direction in a state where the guide surface of the protrusion is in contact with the protruding piece, the guide surface and the protruding piece slide to advance and retract. A rotational force can be generated in the moving member.

(3) The endoscope treatment tool according to (2),
An endoscope treatment tool in which the plurality of protrusions are formed at positions on the same circumference of the inner circumference of the sheath.
According to this endoscopic treatment tool, since the protrusions are formed on the same circumference of the inner periphery of the sheath, the protruding pieces abut against all of the plurality of protrusions at a time, The rotating force to be increased can be increased.

(4) The endoscopic treatment tool according to (2) or (3),
An endoscope treatment tool, wherein the protrusion has a top surface in which the protrusion height gradually increases along the second direction.
According to this endoscope treatment tool, when the advancing / retreating movement member is moved in the second direction, the projecting piece slides along the top surface of the projecting portion and gets over the projecting portion, and the distal end of the projecting piece projects. It does not hit the part.

(5) The endoscopic treatment tool according to (2) or (3),
An endoscopic treatment tool, wherein the protrusion is composed of an elongated protrusion having a major axis and a minor axis, and the major axis is inclined with respect to the sheath axis.
According to this endoscope treatment tool, even if the shape of the protrusion is a simple elongated shape that is easy to manufacture, the guide surface of the protrusion and the protruding piece come into contact with each other and slide on each other, so that A rotational force can be generated.

(6) The treatment instrument for endoscope according to any one of (2) to (5),
An endoscopic treatment tool in which the protruding piece includes a large number of brush hairs extending from the advance / retreat moving member over the entire circumference.
According to this endoscope treatment tool, transmission of rotational force to the advancing / retreating member can be interrupted when there is a predetermined rotational resistance, so that an excessive force is applied to the surface of the living body. Can be prevented.

(7) The endoscope treatment tool according to (6),
An endoscopic treatment tool in which the brush bristles extend from the perpendicular direction of the sheath axis toward the first direction.
According to this endoscope treatment tool, the bristle comes into contact with the projection direction of the projection portion from the vertical direction. For this reason, the rotation contribution force which a bristle gives to a projection part becomes large, and the conversion efficiency to the rotation operation of an advancing / retreating movement member can be improved.

(8) The endoscope treatment tool according to (6),
An endoscope treatment tool in which the brush bristles extend in a direction perpendicular to the sheath axis.
According to this endoscope treatment tool, the rotational force received from the protrusion is transmitted to the advancing / retreating member at a short distance, and the transmission loss of the rotational force is reduced.

(9) The endoscope treatment tool according to (6),
The treatment tool for endoscopes, wherein the brush hair has a curved portion that is curved toward the front side in the rotation direction of the rotation operation on the outer peripheral side.
According to this endoscopic treatment tool, the curved shape of the bending portion can smoothly move along the protrusion, and the resistance accompanying the movement of the advance / retreat moving member is reduced. For this reason, the feeling of resistance when the user operates can be reduced.

(10) The treatment instrument for endoscope according to any one of (2) to (5),
An endoscopic treatment tool in which the plurality of projecting pieces extend radially from the advance / retreat moving member, and an inclined surface that is inclined with respect to the sheath axial direction is formed at the extended distal end portion.
According to this endoscope treatment tool, since the protruding piece is connected to the advance / retreat moving member with high rigidity, when the protrusion and the tip of the protruding piece are in sliding contact with each other, a high rotational force is applied to the advance / retreat moving member. Can communicate with efficiency.

(11) The endoscope treatment tool according to (10),
Endoscopic treatment in which a clearance larger than the protrusion height of the protrusion is defined between the distal end of the protrusion and the sheath inner peripheral surface on the rotation direction front side of the protrusion of the protrusion. Ingredients.
According to this endoscope treatment tool, when the protruding piece rotates, the protruding piece does not hit the side surface of the protruding portion, and a smooth rotating operation can be obtained.

(12) The endoscope treatment tool according to (10),
A treatment instrument for an endoscope, wherein the protrusion has a top surface in which a protrusion height gradually increases from an inner peripheral surface of the sheath toward a rotation direction front side of the rotation operation.
According to this endoscope treatment tool, the protrusion piece can be smoothly rotated without inclining the distal end portion of the protrusion piece toward the inside of the sheath.

(13) The endoscope treatment tool according to any one of (2) to (12),
An endoscopic treatment tool in which the protruding piece is pressed against the inner peripheral surface of the sheath.
According to this endoscope treatment tool, the rotation of the protruding piece when the rotation operation is stopped is regulated by the frictional force pressed against the inner peripheral surface of the sheath. Thereby, the rotation position of the treatment function member does not change unintentionally, and the rotation position can be easily changed.

(14) The treatment instrument for endoscope according to any one of (1) to (13),
Endoscopic treatment wherein the first direction is a direction in which the advance / retreat member is sent out toward the distal end portion of the sheath, and the second direction is a direction in which the advance / retreat member is pulled back from the distal end portion of the sheath. Ingredients.
According to this endoscope treatment tool, the movement direction of the advancing / retreating movement member for performing the rotation operation of the treatment function member is generally made different from the operation in the pull-back direction for causing the treatment function member to function. Does not confuse the operation.

(15) The endoscope treatment tool according to any one of (1) to (14),
A treatment instrument for an endoscope, comprising a movement operation unit for moving the advance / retreat member forward and backward on a proximal end side opposite to a distal end portion of the sheath.
According to this endoscope treatment tool, by moving the moving operation unit forward and backward, the forward / backward moving member can be easily moved, and usability is improved.

(16) The treatment instrument for endoscope according to any one of (1) to (15),
A treatment instrument for an endoscope, wherein the treatment function member is any one of grasping forceps, a biological tissue collection cup, a clip, an injection needle, and a high-frequency snare.
According to this endoscope treatment tool, the rotational position of various treatment function members with respect to the sheath axis can be quickly and accurately adjusted to a desired position.

<Appendix>
The following items are also disclosed in this specification.
An elongated sheath having flexibility;
A treatment function member rotatably supported around the axis of the sheath at the distal end of the sheath;
An elongate advancing / retreating member, which is inserted into the sheath so as to freely advance and retract, and has one end fixed to the treatment function member;
When the advance / retreat movement member is moved in the first direction along the sheath axis, the advance / retreat movement member generates a rotational force in one direction to change the position of the treatment function member, and the advance / retreat movement member Treatment function member control means for maintaining the changed position of the treatment function member when moved in a second direction opposite to the first direction;
An endoscopic treatment tool comprising:

DESCRIPTION OF SYMBOLS 11 Sheath 13 Hand operation part 15 Gripping forceps 17 Operation wire (advance / retreat member)
19 Operation unit body 21 Slider 35A, 35B Holding piece 45 Cover member 55, 55A, 55B, 55C, 55D Rotation control mechanism (rotation control means)
57, 57A, 57B, 57C, 57D Protrusion 59, 59A, 59B Brush hair (protruding piece)
60 Protruding piece 61 Guide surface 63 Top surface 63a Base end portion 63b Topmost portion 69 Fixing ring 87 Gap 91A, 91B Cup 95 Clip body 97 Ring 100 Endoscopic treatment tool 110 Biopsy sampling cup 120 Clip 130 High frequency snare 140 Injection Needle 151 Snare wire 153 Needle portion 155 Tube R Rotation direction C Circumferential direction θ Rotation angle φ Inclination angle δ Inclination angle

Claims (16)

An elongated sheath having flexibility;
A treatment function member rotatably supported around the axis of the sheath at the distal end of the sheath;
An elongate advancing / retreating member, which is inserted into the sheath so as to freely advance and retract, and has one end fixed to the treatment function member;
When the advance / retreat movement member is moved in the first direction along the sheath axis, the advance / retreat movement member generates a rotational force in one direction to change the position of the treatment function member, and the advance / retreat movement member Treatment function member control means for maintaining the changed position of the treatment function member when moved in a second direction opposite to the first direction;
With
The treatment function member control means includes a first engagement member provided on the inner peripheral side of the sheath, and a second engagement provided on the advance / retreat movement member side so as to be able to contact the first engagement member. Consisting of a joint material,
The change of the position of the treatment function member when the advance / retreat member is moved in the first direction is relative to the first engagement member and the second engagement member. Direction and sliding in the circumferential direction of the sheath,
Maintenance of the changed position of the treatment function member when the advance / retreat member is moved in the second direction is relative to the first engagement member and the second engagement member. An endoscopic treatment tool made by sliding in a second direction. The endoscope treatment tool according to claim 1,
The first engaging member is a plurality of protrusions protruding toward the sheath axis on the inner peripheral side of the sheath;
A plurality of projecting pieces in which the second engaging member extends radially from the outer peripheral position of the advance / retreat moving member facing the projecting portion to the inner periphery of the sheath with a length contacting the projecting portion. And
An endoscopic treatment tool in which the plurality of protrusions each have a guide surface inclined in the same direction with respect to the sheath axis. An endoscope treatment tool according to claim 2,
An endoscope treatment tool in which the plurality of protrusions are formed at positions on the same circumference of the inner circumference of the sheath. An endoscopic treatment tool according to claim 2 or claim 3,
An endoscope treatment tool, wherein the protrusion has a top surface in which the protrusion height gradually increases along the second direction. An endoscopic treatment tool according to claim 2 or claim 3,
An endoscopic treatment tool, wherein the protrusion is composed of an elongated protrusion having a major axis and a minor axis, and the major axis is inclined with respect to the sheath axis. An endoscope treatment tool according to any one of claims 2 to 5,
An endoscopic treatment tool in which the protruding piece includes a large number of brush hairs extending from the advance / retreat moving member over the entire circumference. An endoscope treatment tool according to claim 6,
An endoscopic treatment tool in which the brush bristles extend from the perpendicular direction of the sheath axis toward the first direction. An endoscope treatment tool according to claim 6,
An endoscope treatment tool in which the brush bristles extend in a direction perpendicular to the sheath axis. An endoscope treatment tool according to claim 6,
The treatment tool for endoscopes, wherein the brush hair has a curved portion that is curved toward the front side in the rotation direction of the rotation operation on the outer peripheral side. An endoscope treatment tool according to any one of claims 2 to 5,
An endoscopic treatment tool in which the plurality of projecting pieces extend radially from the advance / retreat moving member, and an inclined surface that is inclined with respect to the sheath axial direction is formed at the extended distal end portion. The endoscope treatment tool according to claim 10,
Endoscopic treatment in which a clearance larger than the protrusion height of the protrusion is defined between the distal end of the protrusion and the sheath inner peripheral surface on the rotation direction front side of the protrusion of the protrusion. Ingredients. The endoscope treatment tool according to claim 10,
A treatment instrument for an endoscope, wherein the protrusion has a top surface in which a protrusion height gradually increases from an inner peripheral surface of the sheath toward a rotation direction front side of the rotation operation. An endoscope treatment tool according to any one of claims 2 to 12,
An endoscopic treatment tool in which the protruding piece is pressed against the inner peripheral surface of the sheath. It is a treatment tool for endoscopes as described in any one of Claims 1-13,
Endoscopic treatment wherein the first direction is a direction in which the advance / retreat member is sent out toward the distal end portion of the sheath, and the second direction is a direction in which the advance / retreat member is pulled back from the distal end portion of the sheath. Ingredients. The treatment tool for endoscope according to any one of claims 1 to 14,
A treatment instrument for an endoscope, comprising a movement operation unit for moving the advance / retreat member forward and backward on a proximal end side opposite to a distal end portion of the sheath. An endoscope treatment tool according to any one of claims 1 to 15,
A treatment instrument for an endoscope, wherein the treatment function member is any one of grasping forceps, a biological tissue collection cup, a clip, an injection needle, and a high-frequency snare.

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