JP2014057746A - Medical instrument - Google Patents

Medical instrument Download PDF

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JP2014057746A
JP2014057746A JP2012205021A JP2012205021A JP2014057746A JP 2014057746 A JP2014057746 A JP 2014057746A JP 2012205021 A JP2012205021 A JP 2012205021A JP 2012205021 A JP2012205021 A JP 2012205021A JP 2014057746 A JP2014057746 A JP 2014057746A
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inner cylinder
treatment instrument
cylinder
instrument
outer cylinder
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JP6071361B2 (en
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Takuya Miyazaki
卓也 宮崎
Tsukasa Akiba
司 秋葉
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Ophthalmology & Optometry (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)

Abstract

PROBLEM TO BE SOLVED: To provide a medical instrument which allows an operator to confirm the projecting state of an outer cylinder and an inner cylinder at hand of the operator.SOLUTION: A medical instrument 1 includes: an outer needle 2; an inner cylinder 3 inserted into the outer needle 2; and a treatment implement 4 inserted into the inner cylinder 3. The outer needle 2 is movable between a first position Pwhere the tip is projected from the forward end of the inner cylinder 3 and a second position Pwhere the tip is retreated from the forward end of the inner cylinder 3. The base end part of the inner cylinder 3 is provided with a projection member 8 projected in the radial direction and a turning member 15 for the outer cylinder, which is supported on the projection member 8 so as to be freely turnable and can come close to and separate from the outer peripheral surface of the outer needle 2. The base end part of the outer needle 2 is provided with an engaging member 5 which can be engaged with the turning member 15 for the outer cylinder. The turning member 15 for the outer cylinder includes: a first engagement part 19 for holding the outer needle 2 in the first position Pby engagement with the engaging member 5; and a second engagement part 20 for holding the outer needle 2 in the second position Pby engagement with the engaging member 5.

Description

本発明は、医療器具に関する。   The present invention relates to a medical device.

従来、内視鏡下外科手術に用いられ、中空の針と、該針に挿通され該針の先端から出没される鉗子、スネア等の処置具とを備える医療器具が知られている（例えば特許文献１参照）。前記医療器具によれば、まず、前記針によって臓器に穿刺することができ、次に、前記処置具が鉗子である場合には、該鉗子によって目的の組織を把持することができる。しかし、前記医療器具において、前記外針は常に露出しているので、術中に臓器を損傷する虞がある。   2. Description of the Related Art Conventionally, a medical instrument that is used for endoscopic surgery and includes a hollow needle and a treatment tool such as a forceps or a snare inserted through the needle and retracted from the tip of the needle is known (for example, a patent). Reference 1). According to the medical instrument, first, an organ can be punctured with the needle, and then, when the treatment instrument is a forceps, a target tissue can be grasped with the forceps. However, in the medical instrument, since the outer needle is always exposed, there is a risk of damaging an organ during the operation.

前記問題を解消するために、前記針に代えて、針状の外筒と、該外筒に挿通される内筒とからなる二重構造の針を用い、該外筒の先端から該内筒を突出させることにより該外筒の先端を保護することが考えられる（例えば特許文献２参照）。前記保護とは、前記針状の外筒の先端に長手方向から接触できないようにすることにより、ものを穿刺しにくい状態にすることを意味する。   In order to solve the problem, instead of the needle, a double-structure needle comprising a needle-like outer cylinder and an inner cylinder inserted through the outer cylinder is used, and the inner cylinder is moved from the tip of the outer cylinder. It is conceivable to protect the tip of the outer cylinder by projecting (see, for example, Patent Document 2). The protection means that it is difficult to puncture the needle-like outer cylinder by preventing it from coming into contact with the tip from the longitudinal direction.

特開２００９−５２９９８３号公報JP 2009-529983 A 特開平１１−１２８３４６号公報JP-A-11-128346

しかしながら、前記外筒及び前記内筒を備える医療器具は、内視鏡下外科手術で用いられることから、該外筒及び該内筒の突出状態を施術者の手元で確認することができないという不都合がある。   However, since the medical instrument including the outer cylinder and the inner cylinder is used in an endoscopic surgical operation, the protruding state of the outer cylinder and the inner cylinder cannot be confirmed by a practitioner. There is.

本発明は、かかる不都合を解消して、外筒及び内筒の突出状態を施術者の手元で確認することができる医療器具を提供することを目的とする。   An object of this invention is to provide the medical device which eliminates this inconvenience and can confirm the protrusion state of an outer cylinder and an inner cylinder with a practitioner's hand.

かかる目的を達成するために、本発明は、外筒と、該外筒に挿通される内筒と、該内筒に挿通される処置具とを備える医療器具において、該外筒は、先端が該内筒の先端から突出する第１の位置と、該先端が該内筒の先端よりも後退する第２の位置との間を移動可能であり、該内筒の基端部に、径方向に突出する突出部材と、該突出部材に回動自在に支持され該外筒の外周面に対して接近及び離反可能な外筒用回動部材とを備え、該外筒の基端部に、該外筒用回動部材に係合可能な係合部材を備え、該外筒用回動部材は、該係合部材が係合することにより該外筒を第１の位置に保持する第１の係合部と、該係合部材が係合することにより該外筒を第２の位置に保持する第２の係合部とを備えることを特徴とする。   In order to achieve this object, the present invention provides a medical instrument comprising an outer cylinder, an inner cylinder inserted through the outer cylinder, and a treatment instrument inserted through the inner cylinder. It is movable between a first position protruding from the tip of the inner cylinder and a second position where the tip is retracted from the tip of the inner cylinder. A projecting member projecting on the outer cylinder, and an outer cylinder pivoting member supported rotatably on the projecting member and capable of approaching and separating from the outer peripheral surface of the outer cylinder, and at the base end of the outer cylinder, An engaging member that can be engaged with the outer cylinder rotating member is provided, and the outer cylinder rotating member holds the outer cylinder in a first position by the engagement of the engaging member. And a second engagement portion that holds the outer cylinder in the second position when the engagement member is engaged.

本発明の医療器具では、前記外筒用回動部材を回動させて前記係合部材を前記第１の係合部に係合させることにより、前記外筒を前記第１の位置に保持し、該外筒の先端を前記内筒の先端から突出させることができる。また、前記外筒用回動部材を回動させて前記係合部材を前記第２の係合部に係合させることにより、前記外筒を前記第２の位置に保持し、該外筒の先端を前記内筒の先端よりも後退させ、該外筒の先端を該内筒によって保護することができる。   In the medical instrument of the present invention, the outer cylinder is held in the first position by rotating the outer cylinder rotating member and engaging the engaging member with the first engaging portion. The tip of the outer cylinder can protrude from the tip of the inner cylinder. Further, by rotating the outer cylinder rotating member to engage the engaging member with the second engaging portion, the outer cylinder is held at the second position, and the outer cylinder The tip can be retracted from the tip of the inner cylinder, and the tip of the outer cylinder can be protected by the inner cylinder.

したがって、本発明の医療器具によれば、前記外筒及び前記内筒の突出状態を、前記係合部材の保持位置によって、施術者の手元で確認することができる。   Therefore, according to the medical instrument of this invention, the protrusion state of the said outer cylinder and the said inner cylinder can be confirmed by the operator's hand by the holding position of the said engagement member.

また、本発明の医療器具では、前記外筒用回動部材を回動するだけで前記係合部材の係合及びその解除を行うことができるので、前記外筒の進退に伴う操作を簡単に行うことができる。   In the medical instrument of the present invention, the engagement member can be engaged and released simply by rotating the outer cylinder rotation member, so that the operation associated with the advancement and retraction of the outer cylinder can be easily performed. It can be carried out.

ところで、前記医療器具において、前記処置具を使用するとき以外のときは、該処置具が前記内筒の先端から突出することを防ぐことが求められる。   By the way, in the medical instrument, when the treatment instrument is not used, it is required to prevent the treatment instrument from protruding from the tip of the inner cylinder.

そこで、本発明の医療器具において、前記処置具は、基端が前記内筒の基端から突出している状態で、先端が該内筒の先端よりも後退する第３の位置と、先端が該内筒の先端から突出する第４の位置との間を移動可能であり、前記突出部材に回動自在に支持され該処置具の外周面に対して接近及び離反可能な処置具用回動部材を備え、該処置具用回動部材は、該処置具に係合し該処置具を第３の位置に保持する第３の係合部を備えることが好ましい。   Therefore, in the medical instrument of the present invention, the treatment instrument has a third position where the distal end is retracted from the distal end of the inner cylinder in a state where the proximal end projects from the proximal end of the inner cylinder, and the distal end is A rotating member for a treatment instrument that is movable between a fourth position protruding from the distal end of the inner cylinder and that is rotatably supported by the protruding member and can be moved toward and away from the outer peripheral surface of the treatment instrument. Preferably, the rotation member for a treatment instrument includes a third engagement portion that engages with the treatment instrument and holds the treatment instrument in a third position.

前記処置具用回動部材を備える医療器具では、前記処置具は、第３の位置に位置するとき、先端が前記内筒の先端よりも後退され、該先端を該内筒によって保護することができる。このとき、前記処置具は使用することができない状態である。一方、前記処置具は、第４の位置に位置するとき、先端が前記内筒の先端から突出される。このとき、前記処置具は使用することができる状態である。   In the medical instrument provided with the rotation member for the treatment instrument, when the treatment instrument is located at the third position, the distal end is retracted from the distal end of the inner cylinder, and the distal end is protected by the inner cylinder. it can. At this time, the treatment instrument cannot be used. On the other hand, when the treatment instrument is located at the fourth position, the distal end protrudes from the distal end of the inner cylinder. At this time, the treatment instrument is ready for use.

そして、前記処置具用回動部材を備える医療器具では、前記処置具を使用しないときに前記第３の係合部を前記処置具に係合させることにより、該処置具を前記第３の位置に固定することができ、この結果、前記処置具が前記内筒の先端から突出することを防ぐことができる。   Then, in the medical instrument including the treatment instrument rotating member, the treatment instrument is moved to the third position by engaging the third engagement portion with the treatment instrument when the treatment instrument is not used. As a result, the treatment instrument can be prevented from protruding from the tip of the inner cylinder.

また、前記処置具用回動部材を回動するだけで前記第３の係合部の係合及びその解除を行うことができるので、前記処置具の突出防止に伴う操作を簡単に行うことができる。   Further, since the third engagement portion can be engaged and released simply by rotating the treatment instrument rotation member, the operation for preventing the treatment instrument from protruding can be easily performed. it can.

また、本発明の医療器具では、前記内筒の基端部に、軸方向に間隔を存して径方向に突出する一対のフランジ部を備え、前記突出部材は、該一対のフランジ部を挟むように鎹状に形成されているとともに、該一対のフランジ部間に亘る部分が該フランジ部の直径よりも肉薄に形成されていることが好ましい。   In the medical instrument of the present invention, the proximal end portion of the inner cylinder includes a pair of flange portions protruding in the radial direction with an interval in the axial direction, and the protruding member sandwiches the pair of flange portions. Thus, it is preferable that a portion extending between the pair of flange portions is formed thinner than the diameter of the flange portion.

本発明の医療器具を、施術者が前記一対のフランジ部間の部分に手指を掛けて操作するとき、前記楔状の前記突出部材の前記一対のフランジ部間に亘る部分が該フランジ部の直径よりも肉薄に形成されているので、フランジ部による操作の妨げになることを防ぐことができる。   When the practitioner operates the medical instrument of the present invention with his / her fingers on the portion between the pair of flange portions, the portion of the wedge-shaped projecting member extending between the pair of flange portions is larger than the diameter of the flange portion. Since it is also formed thin, it can be prevented that the operation by the flange portion is hindered.

さらに、前記鎹状の突出部材を備える医療器具は、突出部材が、先端側に前記内筒の外周面を保持するように着脱自在の内筒保持部を備えるとともに、基端側に前記処置具の外周面を摺動可能に保持するように着脱自在の処置具保持部を備えることが好ましい。   Furthermore, the medical instrument including the hook-shaped projecting member includes a removable inner cylinder holding portion so that the projecting member retains the outer peripheral surface of the inner cylinder on the distal end side, and the treatment instrument on the proximal end side. It is preferable to provide a detachable treatment tool holding portion so as to slidably hold the outer peripheral surface of the rim.

前記内筒保持部及び該処置具保持部を有する突出部材を備える医療器具によれば、該突出部材を既存のフランジ部を有する医療器具に取り付けることが可能であり、該医療器具を設計変更することなく本発明を実現することができる。また、前記内筒保持部により前記内筒の外周面を保持するとともに、前記処置具保持部によって前記処置具の外周面を保持するので、施術者が前記医療器具を安定に保持した状態で該医療器具を操作することができる。   According to the medical instrument provided with the protruding member having the inner cylinder holding part and the treatment instrument holding part, the protruding member can be attached to the existing medical instrument having the flange part, and the design of the medical instrument is changed. The present invention can be realized without any problem. In addition, since the outer peripheral surface of the inner cylinder is held by the inner cylinder holding portion and the outer peripheral surface of the treatment instrument is held by the treatment instrument holding portion, the practitioner holds the medical instrument in a stable state. Medical instruments can be operated.

また、本発明の医療器具では、一端が前記内筒の基端部に取り付けられるとともに他端が前記処置具の基端部に取り付けられ、該処置具の該内筒からの抜脱を防止するためのベルト部材を備え、該ベルト部材は、前記第３の位置に保持された処置具に取り付け可能な第３の位置用係止部と、前記第４の位置に保持された処置具に取り付け可能な第４の位置用係止部とを備えることが好ましい。   In the medical instrument of the present invention, one end is attached to the proximal end portion of the inner cylinder and the other end is attached to the proximal end portion of the treatment instrument to prevent the treatment instrument from being detached from the inner cylinder. And a belt member attached to the treatment instrument held in the fourth position and a third position locking portion attachable to the treatment instrument held in the third position. It is preferable to include a possible fourth position locking portion.

前記ベルト部材を備える医療器具によれば、前記第３の位置に保持された処置具に前記ベルト部材の前記第３の位置用係止部を取り付けることにより、該処置具が該第３の位置から外れて前記内筒から抜脱することを防ぐことができる。また、前記第４の位置に保持された処置具に前記ベルト部材の前記第４の位置用係止部を取り付けることにより、該処置具が該第４の位置から外れて前記内筒から抜脱することを防ぐことができるとともに、該処置具の先端を該内筒から突出させた状態に維持することができる。   According to the medical instrument including the belt member, the treatment instrument is moved to the third position by attaching the third position locking portion of the belt member to the treatment instrument held at the third position. It is possible to prevent it from being removed from the inner cylinder. In addition, by attaching the fourth position locking portion of the belt member to the treatment tool held at the fourth position, the treatment tool is detached from the fourth position and removed from the inner cylinder. This can be prevented, and the distal end of the treatment instrument can be kept protruding from the inner cylinder.

本発明の実施形態の医療器具を示す説明図。Explanatory drawing which shows the medical device of embodiment of this invention. 図１のＩＩ−ＩＩ線断面図。II-II sectional view taken on the line of FIG. 本発明の実施形態の医療器具の使用状態を示す説明図。Explanatory drawing which shows the use condition of the medical device of embodiment of this invention.

次に、添付の図面を参照しながら本発明の実施の形態についてさらに詳しく説明する。   Next, embodiments of the present invention will be described in more detail with reference to the accompanying drawings.

図１及び図２に示す本実施形態の医療器具１は、内視鏡下外科手術に用いられ、外筒としての外針２と、外針２に挿通される内筒３と、内筒３に挿通される処置具４を備える。   A medical instrument 1 according to this embodiment shown in FIGS. 1 and 2 is used for an endoscopic surgical operation, and includes an outer needle 2 as an outer cylinder, an inner cylinder 3 inserted through the outer needle 2, and an inner cylinder 3 The treatment tool 4 inserted in is provided.

外針２は、内筒３の基端側を露出した状態で内筒３に対して進退自在に外装されている。外針２は、先端が内筒３の先端から突出する第１の位置Ｐ１（図３（ａ）参照）と、先端が内筒３の先端よりも後退する第２の位置Ｐ２（図３（ｃ）参照）との間を移動可能である。外針２の基端部には、径方向に突出する係合部材５が設けられている。 The outer needle 2 is packaged so as to be movable forward and backward with respect to the inner cylinder 3 with the proximal end side of the inner cylinder 3 exposed. The outer needle 2 has a first position P 1 (see FIG. 3A) where the tip protrudes from the tip of the inner cylinder 3 and a second position P 2 (see FIG. 3A) where the tip retracts from the tip of the inner cylinder 3. 3 (see (c)). An engagement member 5 protruding in the radial direction is provided at the proximal end portion of the outer needle 2.

内筒３の基端部には、両端に径方向に突出する一対のフランジ部６ａ，６ｂを有する筒状体７と、径方向に突出して形成されるとともに一対のフランジ部６ａ，６ｂを挟むように楔状に形成された突出部材８とが形成されている。突出部材８は、筒状体７に対向する部分が該フランジ部６ａ，６ｂの直径よりも肉薄に形成されている。   A cylindrical body 7 having a pair of flange portions 6a and 6b projecting radially at both ends and a pair of flange portions 6a and 6b are sandwiched between the tubular body 7 having a pair of flange portions 6a and 6b projecting radially at both ends. Thus, the protruding member 8 formed in a wedge shape is formed. The protruding member 8 is formed such that the portion facing the cylindrical body 7 is thinner than the diameter of the flange portions 6a and 6b.

処置具４は、シャフト９と、シャフト９の先端に設けられた一対の顎部材からなるジョー１０（図２参照）とからなる。シャフト９の基端には、処置具４全体を進退させるとともにジョー１０を開閉するハンドル１１が連結されている。医療器具１、特に処置具４は、通常、ハンドル１１の孔部に施術者の第１指が掛けられるとともに、一対のフランジ部６ａ，６ｂ間の部分に第２指及び第３指が掛けられた状態で操作される。また、処置具４には、内筒３からの抜脱を防止するためのベルト部材１２が設けられている。   The treatment instrument 4 includes a shaft 9 and a jaw 10 (see FIG. 2) including a pair of jaw members provided at the tip of the shaft 9. A handle 11 for moving the entire treatment instrument 4 forward and backward and opening and closing the jaw 10 is connected to the proximal end of the shaft 9. In the medical instrument 1, particularly the treatment instrument 4, the practitioner's first finger is usually hung on the hole of the handle 11, and the second and third fingers are hung on the portion between the pair of flange portions 6 a and 6 b. It is operated in the state. Further, the treatment instrument 4 is provided with a belt member 12 for preventing the treatment tool 4 from being detached from the inner cylinder 3.

処置具４は、ハンドル１１を進退させることにより、シャフト９の基端が内筒３の基端から突出している状態で、ジョー１０が内筒３の先端よりも後退する第３の位置Ｐ３（図２参照）と、ジョー１０が内筒３の先端から突出するとともに一対の顎部材が開いた状態となる第４の位置Ｐ４（図３（ｄ）参照）の間を移動可能である。 The treatment instrument 4 advances and retracts the handle 11 to move the jaw 10 backward from the distal end of the inner cylinder 3 in a state where the proximal end of the shaft 9 projects from the proximal end of the inner cylinder 3. (See FIG. 2) and the fourth position P 4 (see FIG. 3 (d)) where the jaw 10 protrudes from the tip of the inner cylinder 3 and the pair of jaw members are open. .

処置具４は、本実施形態では鉗子を用いるが、鉗子に代えて、スネア、圧排子等を用いてもよい。   The treatment tool 4 uses forceps in the present embodiment, but may use a snare, an extruding element or the like instead of the forceps.

突出部材８は、先端側に内筒３の外周面を保持するように着脱自在のスリット状の内筒保持部１３を備えるとともに、基端側に処置具４の外周面を摺動可能に保持するように着脱自在のスリット状の処置具保持部１４を備える。   The projecting member 8 includes a detachable slit-shaped inner cylinder holding portion 13 so as to hold the outer peripheral surface of the inner cylinder 3 on the distal end side, and slidably holds the outer peripheral surface of the treatment instrument 4 on the proximal end side. A detachable slit-shaped treatment instrument holding portion 14 is provided.

突出部材８の先端側には、ピン１５ａで突出部材８に回動自在に支持され外針２の外周面に対して接近及び離反可能な外針用回動部材１５が設けられている。また、突出部材８の基端側には、ピン１６ａで突出部材８に回動自在に支持されシャフト９の外周面に対して接近及び離反可能な処置具用回動部材１６が設けられている。   On the distal end side of the protruding member 8, there is provided an outer needle rotating member 15 that is rotatably supported by the protruding member 8 by a pin 15 a and can be moved toward and away from the outer peripheral surface of the outer needle 2. Further, on the proximal end side of the protruding member 8, there is provided a treatment instrument rotating member 16 that is rotatably supported by the protruding member 8 by a pin 16 a and that can approach and leave the outer peripheral surface of the shaft 9. .

外針用回動部材１５は、外針２の外周面に嵌着可能なスリット状の第１の爪部１７と第２の爪部１８とを備えるとともに、爪部１７，１８の基端側に回動時に把持するための把持部１５ｂを備えている。第１の爪部１７と第２の爪部１８との間隙には、少なくとも第１の爪部１７が外針２の外周面に嵌着しているとき、係合部材５が係合することにより外針２を第１の位置Ｐ１に保持する第１の係合部１９が設けられている。また、第２の爪部１８の基端側には、第１の爪部１７及び第２の爪部１８が外針２の外周面に嵌着しているとき、第２の爪部１８と内筒保持部１３との間隙に係合部材５が係合することにより外針２を第２の位置Ｐ２に保持する第２の係合部２０が設けられている。 The outer needle rotating member 15 includes a slit-like first claw portion 17 and a second claw portion 18 that can be fitted to the outer peripheral surface of the outer needle 2, and the proximal end sides of the claw portions 17, 18. Is provided with a gripping portion 15b for gripping when rotating. The engagement member 5 is engaged in the gap between the first claw portion 17 and the second claw portion 18 when at least the first claw portion 17 is fitted to the outer peripheral surface of the outer needle 2. the first engagement portion 19 for holding the outer needle 2 to the first position P 1 is provided with. When the first claw portion 17 and the second claw portion 18 are fitted to the outer peripheral surface of the outer needle 2 on the proximal end side of the second claw portion 18, the second engagement portion 20 for holding the outer needle 2 in the second position P 2 is provided by the engagement member 5 in the gap between the inner tube holding part 13 is engaged.

処置具用回動部材１６は、シャフト９の外周面に嵌着してハンドル１１の先端面に係合し、ジョー１０を第３の位置Ｐ３に保持するスリット状の第３の爪部２１を備えるとともに、第３の爪部２１の基端側に回動時に把持するための把持部１６ｂを備えている。 Treatment instrument pivot member 16 engages the front end surface of the handle 11 fitted on the outer circumferential surface of the shaft 9, the third claw portion 21 a slit-shaped to hold the jaws 10 in a third position P 3 And a gripping portion 16b for gripping at the time of rotation on the proximal end side of the third claw portion 21.

ベルト部材１２は、一端が基端側のフランジ６ｂと処置具保持部１４との間に取り付けられるとともに、他端がハンドル１１の先端に設けられた突起部２２に取り付け可能となっている。ベルト部材１２の一端と処置具保持部１４との間には弾性部材２３（図２参照）が設けられている。   One end of the belt member 12 is attached between the proximal-side flange 6 b and the treatment instrument holding portion 14, and the other end can be attached to a protrusion 22 provided at the distal end of the handle 11. An elastic member 23 (see FIG. 2) is provided between one end of the belt member 12 and the treatment instrument holding portion 14.

ベルト部材１２は、処置具４が第３の位置Ｐ３に保持されているときに突起部２２に取り付け可能な第３の位置用係止部２４と、処置具４が第４の位置Ｐ４に保持されているときに突起部２２に取り付け可能な第４の位置用係止部２５（図２参照）とを備えている。 Belt member 12 has a third position for engagement portion 24 of the attachable to the protruding portion 22 when the treatment instrument 4 is held at the third position P 3, the treatment instrument 4 is the fourth position P 4 And a fourth position locking portion 25 (see FIG. 2) that can be attached to the protrusion 22 when being held by the.

次に、図３を参照して、本実施形態の医療器具１の使用方法について説明する。   Next, with reference to FIG. 3, the usage method of the medical device 1 of this embodiment is demonstrated.

まず、施術者は、片手の第１指をハンドル１１の孔部に掛けるとともに第２指及び第３指を掛けることにより、医療器具１を把持する。このとき、突出部材８の筒状体７に対向する部分が該フランジ部６ａ，６ｂの直径よりも肉薄に形成されているので、フランジ部６ａ，６ｂによる操作の妨げになることを防ぐことができる。特に、突出部材８の筒状体７に対向する部分を、筒状体７フランジ部６ａ，６ｂを連結する部分の直径と同等又は該部分の直径よりも肉薄に形成することにより、操作性をさらに向上することができる。   First, the practitioner holds the medical instrument 1 by placing the first finger of one hand on the hole of the handle 11 and the second and third fingers. At this time, the portion of the protruding member 8 that faces the cylindrical body 7 is formed thinner than the diameter of the flange portions 6a and 6b, so that it is possible to prevent the operation by the flange portions 6a and 6b from being hindered. it can. In particular, the portion of the projecting member 8 that faces the cylindrical body 7 is formed to have the same operability as the diameter of the portion connecting the cylindrical body 7 flange portions 6a and 6b or thinner than the diameter of the portion. This can be further improved.

次に、図３（ａ）に示すように、係合部材５を、外針の外周面に嵌着された第１の爪部１７と第２の爪部１８との間に設けられた第１の係合部１９に係合させるとともに、シャフト９の外周面に嵌着された第３の爪部２１をハンドル１１の先端面に係合する。これにより、外針２が、第１の位置Ｐ１、すなわち内筒３の先端から突出する位置に固定されるとともに、ジョー１０が、第３の位置Ｐ３、すなわち内筒３の先端よりも後退された位置に固定される。 Next, as shown in FIG. 3A, the engaging member 5 is provided between the first claw portion 17 and the second claw portion 18 that are fitted to the outer peripheral surface of the outer needle. The third claw portion 21 fitted to the outer peripheral surface of the shaft 9 is engaged with the distal end surface of the handle 11 while being engaged with the first engaging portion 19. As a result, the outer needle 2 is fixed to the first position P 1 , that is, the position protruding from the tip of the inner cylinder 3, and the jaw 10 is moved from the third position P 3 , that is, the tip of the inner cylinder 3. Fixed in the retracted position.

このとき、ベルト部材１２の第３の位置用係止部２４を突起部２２に取り付けることにより、処置具４が第３の位置Ｐ３から外れて内筒３から抜脱することを防ぐことができる。 At this time, by attaching the third position locking portion 24 of the belt member 12 to the protrusion 22, it is possible to prevent the treatment instrument 4 from being detached from the inner cylinder 3 by being detached from the third position P 3. it can.

次に、外針２を図示しない内視鏡用オーバーチューブに挿通し、該内視鏡用オーバーチューブの先端から突出させ、該外針２により臓器に穿刺する。このとき、外針２は、係合部材５が第１の係合部１９に係合されることにより固定されているので、確実に穿刺を行うことができる。   Next, the outer needle 2 is inserted into an endoscope overtube (not shown), protruded from the tip of the endoscope overtube, and the organ is punctured by the outer needle 2. At this time, the outer needle 2 can be reliably punctured because the engaging member 5 is fixed by being engaged with the first engaging portion 19.

次に、ジョー１０で目的の組織を把持するために、まず、図３（ｂ）に示すように、外針用回動部材１５を回動して外針２の外周面から離反させることにより、係合部材５と第１の係合部１９との係合を解除する。   Next, in order to grasp the target tissue with the jaw 10, first, as shown in FIG. 3B, the outer needle rotating member 15 is rotated and separated from the outer peripheral surface of the outer needle 2. Then, the engagement between the engagement member 5 and the first engagement portion 19 is released.

次に、係合部材５が第２の爪部１８と内筒保持部１３の間に位置するように、係合部材５を後退させる。このとき、係合部材５を後退させる代わりに、係合部材５の位置を保持したまま、係合部材５が第２の爪部１８と内筒保持部１３の間に位置するまで医療器具１全体を前進させてもよい。   Next, the engaging member 5 is moved backward so that the engaging member 5 is positioned between the second claw portion 18 and the inner cylinder holding portion 13. At this time, instead of retracting the engaging member 5, the medical instrument 1 is held until the engaging member 5 is positioned between the second claw portion 18 and the inner cylinder holding portion 13 while maintaining the position of the engaging member 5. The whole may be advanced.

次に、図３（ｃ）に示すように、把持部１５ｂを把持し外針用回動部材１５を回動して外針２外周面に接近することにより、係合部材５を、外針２の外周面に嵌着された第２の爪部１８と内筒保持部１３との間に設けられた第２の係合部２０に係合させる。これにより、外針２が、第２の位置Ｐ２、すなわち内筒３の先端よりも後退する位置に固定され、外針２の先端を内筒３によって保護することができる。 Next, as shown in FIG. 3C, the engaging member 5 is moved to the outer needle by gripping the gripping portion 15 b and rotating the outer needle rotating member 15 to approach the outer peripheral surface of the outer needle 2. 2 is engaged with a second engaging portion 20 provided between the second claw portion 18 fitted to the outer peripheral surface of the second outer peripheral surface and the inner cylinder holding portion 13. Thereby, the outer needle 2 is fixed to the second position P 2 , that is, a position retracted from the tip of the inner cylinder 3, and the tip of the outer needle 2 can be protected by the inner cylinder 3.

次に、把持部１６ｂを把持し処置具用回動部材１６を回動してシャフト９の外周面から離反させることにより、第３の爪部２１とハンドル１１の先端面との係合を解除する。   Next, the engagement between the third claw portion 21 and the distal end surface of the handle 11 is released by gripping the grip portion 16b and rotating the treatment instrument rotating member 16 away from the outer peripheral surface of the shaft 9. To do.

次に、施術者の第１指でハンドル１１を前方へ押すことにより、ハンドル１１を処置具保持部１４に当接するまで前進させる。このとき、処置具保持部１４と基端側フランジ部６ｂとの間に弾性部材２３が設けられているので、ハンドル１１を前方へ押したとき、ハンドル１１による処置具保持部１４への押圧を緩和することができる。   Next, by pushing the handle 11 forward with the practitioner's first finger, the handle 11 is advanced until it comes into contact with the treatment instrument holding portion 14. At this time, since the elastic member 23 is provided between the treatment instrument holding portion 14 and the proximal flange portion 6b, when the handle 11 is pushed forward, the handle 11 is pressed against the treatment instrument holding portion 14. Can be relaxed.

そして、ハンドル１１の前進に連動してシャフト９が前進することにより、図３（ｄ）に示すように、ジョー１０が第４の位置Ｐ４、すなわち内筒３の先端から突出する位置に達するとともに、ジョー１０の一対の顎部材が開く。 Then, when the shaft 9 moves forward in conjunction with the advance of the handle 11, the jaw 10 reaches the fourth position P 4 , that is, the position protruding from the tip of the inner cylinder 3 as shown in FIG. At the same time, the pair of jaw members of the jaw 10 opens.

次に、ジョー１０を目的の組織に位置させた後、施術者の第１指でハンドル１１を後方へ押すことにより、ハンドル１１を後退させる。これにより、前記一対の顎部材が閉じてジョー１０により目的の組織を把持することができる。   Next, after the jaw 10 is positioned on the target tissue, the handle 11 is moved backward by pushing the handle 11 backward with the first finger of the practitioner. Accordingly, the pair of jaw members are closed, and the target tissue can be grasped by the jaw 10.

このとき、ベルト部材１２の第３の位置用係止部２４に代えて第４の位置用係止部２５を突起部２２に取り付けることにより、前記一対の顎部材が閉じた状態を維持することができ、ジョー１０に把持された組織を安定して保持し続けることができる。また、処置具４が内筒３から抜脱することを防ぐことができる。   At this time, instead of the third position locking portion 24 of the belt member 12, the fourth position locking portion 25 is attached to the protruding portion 22, thereby maintaining the closed state of the pair of jaw members. And the tissue held by the jaw 10 can be held stably. In addition, the treatment tool 4 can be prevented from being detached from the inner cylinder 3.

以上説明したように、本実施形態の医療器具１は、外針２及び内筒３の突出状態を、係合部材５の保持位置によって、施術者の手元で確認することができる。   As described above, the medical instrument 1 of the present embodiment can confirm the protruding state of the outer needle 2 and the inner cylinder 3 with the operator's hand by the holding position of the engaging member 5.

また、本実施形態の医療器具１では、外針用回動部材１５を回動するだけで係合部材５の係合及びその解除を行うことができるので、外針２の進退に伴う操作を簡単に行うことができる。   Further, in the medical instrument 1 of the present embodiment, the engagement member 5 can be engaged and released simply by rotating the outer needle rotation member 15, so that the operation associated with the advancement / retraction of the outer needle 2 is performed. It can be done easily.

また、本実施形態の医療器具１では、処置具４を使用しないとき、第３の爪部２１をハンドル１１の先端面に係合させてハンドル１１及びジョー１０を固定することにより、ジョー１０が内筒３の先端から突出することを防ぐことができる。また、処置具用回動部材１６を回動するだけで第３の爪部２１の係合及びその解除を行うことができるので、ジョー１０の突出防止に伴う操作を簡単に行うことができる。   Further, in the medical instrument 1 of the present embodiment, when the treatment tool 4 is not used, the jaw 10 is fixed by fixing the handle 11 and the jaw 10 by engaging the third claw portion 21 with the distal end surface of the handle 11. Protruding from the tip of the inner cylinder 3 can be prevented. Further, since the third claw portion 21 can be engaged and released simply by rotating the treatment instrument rotation member 16, an operation for preventing the jaw 10 from protruding can be easily performed.

本実施形態では、外筒としての外針２と該外筒に挿通される内筒３とを備える医療器具１について説明しているが、外針２に代えて針状でない外筒を用いてもよい。また、針状でない内筒３に代えて、針状のものを用いてもよく、この場合には、針状でない外筒が内筒３の先端から突出する第１の位置に位置するとき、該外筒によって針状の内筒３の先端を保護することができる。   In this embodiment, although the medical instrument 1 provided with the outer needle 2 as an outer cylinder and the inner cylinder 3 penetrated by this outer cylinder is demonstrated, it replaces with the outer needle 2 and uses the outer cylinder which is not a needle shape. Also good. Further, instead of the inner cylinder 3 that is not needle-shaped, a needle-shaped one may be used. In this case, when the outer cylinder that is not needle-shaped is located at the first position protruding from the tip of the inner cylinder 3, The tip of the needle-shaped inner cylinder 3 can be protected by the outer cylinder.

また、本実施形態の医療器具１は、内筒保持部１３及び処置具保持部１４がスリット状であることにより突出部材８全体が内筒３及び処置具４に対して着脱自在に構成されているので、該突出部材８を既存のフランジ部を有する医療器具に取り付けることが可能であり、既存の医療器具を設計変更することなく本実施形態を実現することができる。   Further, in the medical instrument 1 of the present embodiment, the entire protruding member 8 is configured to be detachable from the inner cylinder 3 and the treatment instrument 4 because the inner cylinder holding part 13 and the treatment instrument holding part 14 are slit-shaped. Therefore, the protruding member 8 can be attached to a medical device having an existing flange portion, and this embodiment can be realized without changing the design of the existing medical device.

また、本実施形態の医療器具１では、外針用回動部材１５が外針２の外周面に嵌着可能な第１の爪部１７と第２の爪部１８とを備えるとしているが、第１の爪部１７及び第２の爪部１８は、外針２の外周面に接近したときに爪部１７，１８の間隙に係合部材５を係合させて保持することができる構成であれば、外針２の外周面に嵌着可能でなくてもよい。   In the medical instrument 1 of the present embodiment, the outer needle rotating member 15 includes the first claw portion 17 and the second claw portion 18 that can be fitted to the outer peripheral surface of the outer needle 2. The first claw portion 17 and the second claw portion 18 are configured to be able to engage and hold the engaging member 5 in the gap between the claw portions 17 and 18 when approaching the outer peripheral surface of the outer needle 2. If present, it may not be possible to fit the outer peripheral surface of the outer needle 2.

また、本実施形態の医療器具１において、外針２及び内筒３の突出状態をさらに明確にするために、外針用回動部材１５の第１の係合部１９の近傍及び第２の係合部２０の近傍に、外針２が突出状態であること又は内筒３が突出状態であることを示す目印等を設けてもよい。   Further, in the medical instrument 1 of the present embodiment, in order to further clarify the protruding state of the outer needle 2 and the inner cylinder 3, the vicinity of the first engaging portion 19 of the outer needle rotating member 15 and the second A mark or the like indicating that the outer needle 2 is in a protruding state or the inner cylinder 3 is in a protruding state may be provided in the vicinity of the engaging portion 20.

１…医療器具、 ２…外筒、 ３…内筒、 ４…処置具、 ５…係合部材、 ６ａ，６ｂ…一対のフランジ部、 ８…突出部材、 １２…ベルト部材、 １３…内筒保持部、 １４…処置具保持部、 １５…外筒用回動部材、 １６…処置具用回動部材、 １９…第１の係合部、 ２０…第２の係合部、 ２１…第３の係合部、 ２４…第３の位置用係止部、 ２５…第４の位置用係止部、 Ｐ１…第１の位置、 Ｐ２…第２の位置、 Ｐ３…第３の位置、 Ｐ４…第４の位置。 DESCRIPTION OF SYMBOLS 1 ... Medical instrument, 2 ... Outer cylinder, 3 ... Inner cylinder, 4 ... Treatment tool, 5 ... Engagement member, 6a, 6b ... A pair of flange part, 8 ... Projection member, 12 ... Belt member, 13 ... Inner cylinder holding | maintenance , 14 ... treatment instrument holding part, 15 ... rotating member for outer cylinder, 16 ... rotating member for treatment instrument, 19 ... first engaging part, 20 ... second engaging part, 21 ... third Engagement part, 24 ... third position locking part, 25 ... fourth position locking part, P 1 ... first position, P 2 ... second position, P 3 ... third position, P 4 ... Fourth position.

Claims (5)

外筒と、該外筒に挿通される内筒と、該内筒に挿通される処置具とを備える医療器具において、
該外筒は、先端が該内筒の先端から突出する第１の位置と、該先端が該内筒の先端よりも後退する第２の位置との間を移動可能であり、
該内筒の基端部に、径方向に突出する突出部材と、該突出部材に回動自在に支持され該外筒の外周面に対して接近及び離反可能な外筒用回動部材とを備え、
該外筒の基端部に、該外筒用回動部材に係合可能な係合部材を備え、
該外筒用回動部材は、該係合部材が係合することにより該外筒を第１の位置に保持する第１の係合部と、該係合部材が係合することにより該外筒を第２の位置に保持する第２の係合部とを備えることを特徴とする医療器具。 In a medical instrument comprising an outer cylinder, an inner cylinder inserted through the outer cylinder, and a treatment instrument inserted through the inner cylinder,
The outer cylinder is movable between a first position where the tip projects from the tip of the inner cylinder and a second position where the tip recedes from the tip of the inner cylinder,
A projecting member projecting in the radial direction at a base end portion of the inner cylinder, and a rotating member for an outer cylinder that is rotatably supported by the projecting member and can approach and leave the outer peripheral surface of the outer cylinder. Prepared,
At the base end of the outer cylinder, an engagement member that can be engaged with the rotating member for the outer cylinder is provided,
The outer cylinder turning member includes a first engagement portion that holds the outer cylinder in a first position by the engagement of the engagement member, and the engagement member engages the outer cylinder. A medical instrument comprising: a second engaging portion that holds the tube in a second position. 請求項１記載の医療器具において、
前記処置具は、基端が前記内筒の基端から突出している状態で、先端が該内筒の先端よりも後退する第３の位置と、先端が該内筒の先端から突出する第４の位置との間を移動可能であり、
前記突出部材に回動自在に支持され該処置具の外周面に対して接近及び離反可能な処置具用回動部材を備え、
該処置具用回動部材は、該処置具に係合し該処置具を第３の位置に保持する第３の係合部を備えることを特徴とする医療器具。 The medical device according to claim 1, wherein
The treatment instrument has a third position where the distal end is retracted from the distal end of the inner cylinder in a state where the proximal end projects from the proximal end of the inner cylinder, and a fourth position where the distal end projects from the distal end of the inner cylinder. Can be moved between
A treatment instrument rotating member supported rotatably on the projecting member and capable of approaching and moving away from the outer peripheral surface of the treatment instrument;
The medical instrument rotation member includes a third engagement portion that engages with the treatment instrument and holds the treatment instrument in a third position. 請求項２記載の医療器具において、
前記内筒の基端部に、軸方向に間隔を存して径方向に突出する一対のフランジ部を備え、
前記突出部材は、該一対のフランジ部を挟むように鎹状に形成されているとともに、該一対のフランジ部間に亘る部分が該フランジ部の直径よりも肉薄に形成されていることを特徴とする医療器具。 The medical device according to claim 2,
A proximal end portion of the inner cylinder is provided with a pair of flange portions projecting in the radial direction with an interval in the axial direction,
The protruding member is formed in a bowl shape so as to sandwich the pair of flange portions, and a portion extending between the pair of flange portions is formed thinner than a diameter of the flange portion. Medical equipment to do. 請求項３記載の医療器具において、
前記鎹状の突出部材は、先端側に前記内筒の外周面を保持するように着脱自在の内筒保持部を備えるとともに、基端側に前記処置具の外周面を摺動可能に保持するように着脱自在の処置具保持部を備えることを特徴とする医療器具。 The medical device according to claim 3,
The hook-shaped projecting member includes a removable inner cylinder holding portion so as to hold the outer peripheral surface of the inner cylinder on the distal end side, and slidably holds the outer peripheral surface of the treatment instrument on the proximal end side. A medical instrument comprising a detachable treatment tool holding portion as described above. 請求項２乃至請求項４のいずれか１項記載の医療器具において、
一端が前記内筒の基端部に取り付けられるとともに他端が前記処置具の基端部に取り付けられ、該処置具の該内筒からの抜脱を防止するためのベルト部材を備え、
該ベルト部材は、前記第３の位置に保持された処置具に取り付け可能な第３の位置用係止部と、前記第４の位置に保持された処置具に取り付け可能な第４の位置用係止部とを備えることを特徴とする医療器具。 The medical device according to any one of claims 2 to 4,
One end is attached to the base end of the inner cylinder and the other end is attached to the base end of the treatment instrument, and includes a belt member for preventing the treatment instrument from being detached from the inner cylinder,
The belt member has a third position locking portion attachable to the treatment instrument held in the third position, and a fourth position attachable to the treatment instrument held in the fourth position. A medical instrument comprising a locking portion.
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JP2016146961A (en) * 2015-02-12 2016-08-18 株式会社トップ Assist device for surgical treatment instrument
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